A Multicenter Retrospective Cohort Study to Characterize Patients Hospitalized With Multisystem Inflammatory Syndrome in Adults and Coronavirus Disease 2019 in the United States, 2020-2021.

BACKGROUND: The diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated multisystem inflammatory syndrome in adults (MIS-A) requires distinguishing it from acute coronavirus disease 2019 (COVID-19) and may affect clinical management. METHODS: In this retrospective cohort study, we applied the US Centers for Disease Control and Prevention case definition to identify adults hospitalized with MIS-A at 6 academic medical centers from 1 March 2020 to 31 December 2021. Patients MIS-A were matched by age group, sex, site, and admission date at a 1:2 ratio to patients hospitalized with acute symptomatic COVID-19. Conditional logistic regression was used to compare demographic characteristics, presenting symptoms, laboratory and imaging results, treatments administered, and outcomes between cohorts. RESULTS: Through medical record review of 10 223 patients hospitalized with SARS-CoV-2-associated illness, we identified 53 MIS-A cases. Compared with 106 matched patients with COVID-19, those with MIS-A were more likely to be non-Hispanic black and less likely to be non-Hispanic white. They more likely had laboratory-confirmed COVID-19 ≥14 days before hospitalization, more likely had positive in-hospital SARS-CoV-2 serologic testing, and more often presented with gastrointestinal symptoms and chest pain. They were less likely to have underlying medical conditions and to present with cough and dyspnea. On admission, patients with MIS-A had higher neutrophil-to-lymphocyte ratio and higher levels of C-reactive protein, ferritin, procalcitonin, and D-dimer than patients with COVID-19. They also had longer hospitalization and more likely required intensive care admission, invasive mechanical ventilation, and vasopressors. The mortality rate was 6% in both cohorts. CONCLUSIONS: Compared with patients with acute symptomatic COVID-19, adults with MIS-A more often manifest certain symptoms and laboratory findings early during hospitalization. These features may facilitate diagnosis and management.

The importance of infrastructure development to high-quality literacy instruction.

Although the education community has identified numerous effective interventions for improving the literacy of U.S. schoolchildren, little headway has been made in raising literacy capabilities. David K. Cohen and Monica P. Bhatt, of the University of Michigan, contend that a major obstacle is the organizational structure of the U.S. education system. Three features in particular--the lack of educational infrastructure, a decentralized governance system, and the organization of teaching as an occupation--stymie efforts to improve literacy instruction. The authors emphasize that the education system in the United States has always been a patchwork of local school systems that share no common curricula, student examinations, teacher education, or means of observing and improving instruction. Although localities have broad powers over education, few have built the capability to judge or support quality in educational programs. The quality criteria that have developed chiefly concern teachers, not teaching. The decentralization and weak governance of U.S. schooling also deprives teachers of opportunities to build the occupational knowledge and skill that can inform standards for the quality of work, in this case instruction. And, unlike practitioners in other professions teachers have little opportunity to try to strengthen teaching quality by setting standards for entry to the occupation. Cohen and Bhatt review six types of organizational reforms undertaken over the past several decades to improve literacy and other academic outcomes for U.S. students. After briefly describing accountability, comprehensive school reforms, knowledge diffusion, improvement of human capital, and market-based reforms, the authors turn to the Common Core State Standards, an effort initiated by state governors and school leaders to raise student achievement. The authors conclude that the fundamental question about the Common Core, as with the other reforms they discuss, is whether educators and policy makers can mobilize the capability to help states and localities invent, adapt, and implement reliable ways to improve instruction.