Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection
Tanayott Thaweethai
1, 2
,
Sarah E. Jolley
3
,
Elizabeth W. Karlson
4
,
Emily B. Levitan
5
,
Bruce Levy
2, 4
,
Grace A. McComsey
6
,
Lisa McCorkell
7
,
Girish N Nadkarni
8
,
Sairam Parthasarathy
9
,
Upinder Singh
10
,
Tiffany A Walker
11
,
Caitlin A Selvaggi
1
,
Daniel J Shinnick
1
,
Carolin C M Schulte
1
,
Rachel Atchley-Challenner
12
,
Leora I. Horwitz
13
,
Andrea S. Foulkes
1, 2
,
Judith A. Aberg
14
,
Natalie L Adolphi
14
,
Shreya Ahirwar
14
,
Shifa Ahmed
14
,
Neera Ahuja
14
,
Masanori Aikawa
14
,
Almary Akerlundh
14
,
Teresa T. Akintonwa
14
,
Aseel Al-Jadiri
14
,
Natalya Alekhina
14
,
Heather A Algren
14
,
Akram N. Alshawabkeh
14
,
Nariman Ammar
14
,
Adit Anand
14
,
Brett R. Anderson
14
,
Lisa Aponte-Soto
14
,
Judy L. Aschner
14
,
Mary M. Atha
14
,
Andrew M Atz
14
,
Robin L Aupperle
14
,
Mirna Ayache
14
,
Eduardo Azziz-Baumgartner
14
,
L. C. BAILEY
14
,
Fiona C. Baker
14
,
Venkataraman Balaraman
14
,
Jennifer A. Bandy
14
,
Dithi Banerjee
14
,
Deanna M. Barch
14
,
James M. Bardes
14
,
Jackson Barlocker
14
,
R G Barr
14
,
Arielle Baskin-Sommers
14
,
Sanjib Basu
14
,
Tracy A. Battaglia
14
,
Leah Baucom
14
,
Carmen J Beamon
14
,
Casey L. Beaty
14
,
Noam D Beckmann
14
,
Jasmine A Berry
14
,
Nahid Bhadelia
14
,
Daksh Bhargava
14
,
Sultana Bhuiyan
14
,
Jiang Bian
14
,
Christian Bime
14
,
James M. Bjork
14
,
Lora J Black
14
,
Catherine A. Blish
14
,
Jason P. Block
14
,
Amanda Bogie
14
,
Dawn Bolliger
14
,
William Bonaventura
14
,
Seuli Bose-Brill
14
,
Mary B Bower
14
,
Andrew D. Boyd
14
,
Jerusha Boyineni
14
,
Steven B. Bradfute
14
,
Carolyn T Bramante
14
,
M. D. Brannock
14
,
J. D. Bremner
14
,
Shari B. Brosnahan
14
,
Natalie C. Buchbinder
14
,
Elliott Bueler
14
,
Irina A. Buhimschi
14
,
Hulya Bukulmez
14
,
H. T. Bunnell
14
,
John B. Buse
14
,
Elizabeth A. Calhoun
14
,
Tingyi Cao
14
,
Michael D. Carrithers
14
,
Thomas W. Carton
14
,
Abigail Case
14
,
B.J. Casey
14
,
Faye Victoria C Casimero
14
,
Lauren Castro
14
,
Teresa Cato
14
,
Patricia Ceger
14
,
Connie L. Cerullo
14
,
Linda Chang
14
,
Arunee A Chang
14
,
Praneeth Chebrolu
14
,
Yong Chen
14
,
Li-Qing Chen
14
,
Benjamin K Chen
14
,
David Chestek
14
,
Robert F Chew
14
,
Deena J. Chisolm
14
,
Dominic C. Chow
14
,
Maryanne R Chrisant
14
,
Dimitri A. Christakis
14
,
Christopher G. Chute
14
,
Mine S. Cicek
14
,
Cheryl R. Clark
14
,
Duncan B. Clark
14
,
Geoffrey D. Clarke
14
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Katharine N. Clouser
14
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Thomas J. Connors
14
,
Judith A. Cook
14
,
Krista Coombs
14
,
Carlos Cordon-Cardo
14
,
Julie L. Costello
14
,
Lesley Cottrell
14
,
Kelly Cowan
14
,
Lindsay G Cowell
14
,
Savannah Cranford
14
,
Jamie Cronin
14
,
Mollie R Cummins
14
,
Hannah L. Curry
14
,
Viren D’Sa
14
,
Sean G. Dabney
14
,
Casey L Daniel
14
,
Mirella Dapretto
14
,
Dawood Darbar
14
,
Paul M. Darden
14
,
Raktima Dasgupta
14
,
Soham Dasgupta
14
,
Felicia Davis Blakley
14
,
Katherine Dea
14
,
Sara J. Deakyne Davies
14
,
Lauren A Decker
14
,
Ralph A DeFronzo
14
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Walter Dehority
14
,
Amelia N. Deitchman
14
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James del Alcazar
14
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Phoebe Del Boccio
14
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Carlos del Rio
14
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Marina del Rios
14
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Julie A Delisa
14
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Sean C Deoni
14
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Maya Z. Diaz
14
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John D. Dickinson
14
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Audrey Dionne
14
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Kathleen R Diviak
14
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Sarah E. Donohue
14
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Michael J Downey
14
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ALLEN J. DOZOR
14
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Benard P. Dreyer
14
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Kirsten B Dummer
14
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Matthew S. Durstenfeld
14
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Mark S. Dworkin
14
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Sherrie L. Edmonds
14
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Matthew D Elias
14
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Jamie Elifritz
14
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Evan Ellingworth
14
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Amy J. Elliott
14
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Angela M. Ellison
14
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Mike L. Enger
14
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Joaquin M Espinosa
14
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Shari Esquenazi-Karonika
14
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Michael D. Evans
14
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Danielle N Evans
14
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Julio C. Facelli
14
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Camila S. Fang
14
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E. Vincent S. Faustino
14
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Maria E. Fayad Lara
14
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Candace H Feldman
14
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Alexander G. Fiks
14
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Rebecca Fineman
14
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Aloke V Finn
14
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Melinda S. Fischer
14
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Megan L Fitzgerald
14
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Valerie J. Flaherman
14
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Thomas J. Flotte
14
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Daniel Forsha
14
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Meghan R Fortune
14
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John J. Foxe
14
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Nicole Franks
14
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Michael B. Freedman
14
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Catherine E. Freeland
14
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Naomi P. Friedman
14
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Greta Fry
14
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Margot Gage Witvliet
14
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Emily J. Gallagher
14
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Richard Gallagher
14
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Hugh Garavan
14
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Sunanda M Gaur
14
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Dylan G. Gee
14
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Maria Laura Gennaro
14
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Lynn B. Gerald
14
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Saikat B. Ghosh
14
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Joseph T. Giacino
14
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Andrew T. Girvin
14
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Stephanie L. Godfrey
14
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Mark P. Goldberg
14
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Steven N. Goodman
14
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Howard S. Gordon
14
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Ramkiran Gouripeddi
14
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Paige Graham
14
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Joey P Granger
14
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Kevin M Gray
14
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Tina Greimes
14
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Rachel S. Gross
14
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Nicholas Guthe
14
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Evan Gutter
14
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Stephanie Haasnoot
14
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Emily C. Hadley
14
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Melissa A. Haendel
14
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Stephanie Hafner
14
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Katia C Halabi
14
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Patrick C. Hanley
14
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Ashraf S. Harahsheh
14
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Michelle S. Harkins
14
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Kimberly L. Hartwig
14
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Keren Hasbani
14
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Sharon Hasek
14
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Kristine S. Hauser
14
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Andrew C Heath
14
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Camden L. Hebson
14
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Mary M. Heitzeg
14
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Monica Hendrickson
14
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Timothy J. Henrich
14
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Alfonso C. Hernandez-Romieu
14
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Christina M Hester
14
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Miranda Higginbotham
14
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Sophia Hill
14
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Kathryn Hirabayashi
14
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On Ho
14
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Laura Hobart-Porter
14
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M C Hoffman
14
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Maryann Holtcamp
14
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Travis K. Hong
14
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BENJAMIN D. HORNE
14
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Carol R. Horowitz
14
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DANIEL S. HSIA
14
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Harvey Hsu
14
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Priscilla Y. Hsue
14
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Matthew Huentelman
14
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Bryan E. Huerta
14
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Jared D. Huling
14
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Kathy Hummel
14
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William G. Iacono
14
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Alejandra L. Ibanez
14
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Carmel Ibeawuchi
14
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Katherine Irby
14
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Nahed Ismail
14
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Joanna Jacobus
14
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Vanessa L. Jacoby
14
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Leonard A. Jason
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Vidhi Javia
14
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Kyle J. Jennette
14
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Terry L. Jernigan
14
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Sihang Jiang
14
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Naimin Jing
14
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Jace D. Johnny
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Nadia Johnson
14
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Brandi Johnson
14
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Brandon Johnson
14
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Pei‐Ni Jone
14
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Suzanne E Judd
14
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Joy J Juskowich
14
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Edmond K Kabagambe
14
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David C. Kaelber
14
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Diane G Kanjilal
14
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Mayank M Kansal
14
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Tyler J. Kasmarcak
14
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Daniel Kaufman
14
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Rika Kawakami
14
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Dean L. Kellogg
14
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Denise A. Kent
14
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Deepshikha Kewlani
14
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Dhruv Khullar
14
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Keri S. Kim
14
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Arthur Y. Kim
14
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Patricia A Kinser
14
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Lawrence C. Kleinman
14
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Elizabeth B. Klerman
14
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Matthew J. Kluko
14
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Stacey Knight
14
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Misaki Kobayashi
14
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Karla J Kopp
14
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Michael Koropsak
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Jessica S. Kosut
14
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Ellen Kraig
14
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Amanda Krausert
14
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Ana C Krieger
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Hema Krishna
14
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Aparna Krishnamoorthy
14
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Sankaran S Krishnan
14
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James P. Lahs
14
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Angela R. Laird
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Victoria Laleau
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Michelle F Lamendola Essel
14
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Jeremy Landeo Gutierrez
14
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Sean M. Lang
14
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Christine L. Larson
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James P Lash
14
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Jessica Lasky-Su
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Gregory Laynor
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SIMON LEE
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Grace M. Lee
14
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F. E. Lee
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Matthew A. Lee
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Peter J. Leese
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R C Lefebvre
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Angelica J. Levreault
14
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Kennedy C. Lewis
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LI-Lu
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Janet Y. Lin
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Krista M. Lisdahl
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Matthew B. Litvack
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14
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Jennifer Lloyd
14
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Jennifer K Logue
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Johanna J. Loomba
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Vitaly Lorman
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14
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Katelyn R. Ludwig
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Jeri Mack
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Cheryl L. Maier
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Sergey Malchenko
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Gail L Mallett
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Gabrielle Maranga
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Megan W Martel
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Susanne P. Martin-Herz
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Maria Martinez-Lage
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Christine Maughan
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Cammeo Mauntel-Medici
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Heidi T. May
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Kenneth H. Mayer
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Dylan Mcdonald
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Julie A. McMurry
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Asuncion Mejias
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JONATHAN MELAMED
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Martha Menchaca
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Alan L. Mendelsohn
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Lucio Miele
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Mitchell G Miglis
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Lisa T. Newman
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Amber N Nguyen
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Lauren Nichols
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Sheila M. Nolan
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Richard M. Novak
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George T. O'Connor
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Carlos R. Oliveira
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Robert F. Padera
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Henry H Paik
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Nathan M. Pajor
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Huaqin (helen) Pan
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Deepti Pant
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Andrew Partridge
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Payal B. Patel
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Saaya Patel
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Khushboo Patel
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MARTIN P. PAULUS
14
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Ronald M Payne
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Ann Pearman
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Myriam Peralta-Carcelen
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Nicolas L. Perez
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Emily R. Pfaff
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De-Ann M. Pillers
14
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Chloe E Pitsch
14
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Neil H. Pliskin
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Michael A. Portman
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Radu Postelnicu
14
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Jennifer S Potter
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Bellur S. Prabhakar
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Priya Prahalad
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Bharati Prasad
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Barbara Predki
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Alexander J Preiss
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Heather M Prendergast
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Davin K. Quinn
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Yuri Quintana
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Dustin J Rabideau
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Jonathan M. Radosta
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Jeffrey Radwell
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Hengameh Raissy
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Ramaswamy Ramchandran
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Isabelle Randall
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Suchitra Rao
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Amy Rapkiewicz
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Sonja A. Rasmussen
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Hanieh Razzaghi
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Candida J. Rebello
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Paulina A. Rebolledo
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Neha V. Reddy
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Unma M. Reddy
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Cara Reedy
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Jalees Rehman
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R R Reichard
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Kayleigh M. Reid
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Jane E Reusch
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Kyung E. Rhee
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Mary B. Rice
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John-Ross R. Rizzo
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Nadia R. Roan
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Polly Robarts
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Timothy R Roberts
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Nitza Rochez
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Kathleen E. Rodgers
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Colin M. Rogerson
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Maria E. Romero
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Johana M Rosas
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Erika B. Rosenzweig
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Russell L. Rothman
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Nadine G. Rouphael
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Mark W. Russell
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Melissa Rutherfoord
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Arash A. Sabati
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Samer B. Sader
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Marzieh Salehi
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Amy L. Salisbury
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Barbara A. Sampson
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Yamuna Sanil
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ALICE I. SATO
14
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Sharon H. Saydah
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Michael S. Schechter
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Edward J. Schenck
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Katherine I. Schlepphorst
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Julia Schuchard
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Tina L. Schuh
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Jennifer A. Sculley
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Alan C Seifert
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Anisha K. Sekar
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Rangaraj Selvarangan
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Sudha Seshadri
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Howard D. Sesso
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Dimpy P. Shah
14
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Divya Shakti
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Nancy L. Shapiro
14
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Suchetha Sharma
14
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Kumar Sharma
14
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Shubhi Sharma
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Kavita Sharma
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Gwendolyn Shaw
14
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Eyal Shemesh
14
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Yishan Shen
14
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Elizabeth Shenkman
14
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Stephanie Shiau
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Michelle Siciliano
14
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Aylin Simsir
14
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Veronica E. Smith
14
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Jessica N. Snowden
14
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Isaac H. Solomon
14
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Leslie A Spikes
14
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Lindsay M Squeglia
14
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Shubhika Srivastava
14
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Mary L. St. Jean
14
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Kenneth A Stapleford
14
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Cheryl R. Stein
14
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Michelle D. Stevenson
14
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Sarah A. Stewart de Ramirez
14
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Lauren E. Stiles
14
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Aryeh Stock
14
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Melissa S. Stockwell
14
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James R Stone
14
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Jeran Stratford
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Til Stürmer
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Vignesh Subbian
14
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Jun Sun
14
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Mehul S. Suthar
14
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Ashley Sylvera
14
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David M. Systrom
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Jacqueline Szmuszkovicz
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Maria M Talavera Barber
14
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Kelan G Tantisira
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Nancy Tartt
14
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Tracy Terlinde
14
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Ronald J. Teufel
14
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Deepika Thacker
14
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Mansi Thakrar
14
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Stephen N. Thibodeau
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Gelise L. Thomas
14
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Moriah E. Thomason
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Jiayi Tong
14
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Jessica Traenkner
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Robin Tragus
14
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Jena S Tronieri
14
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Andrea B. Troxel
14
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Jennifer Truong
14
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Dongngan T Truong
14
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Joel Tsevat
14
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14
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Kristen Unterberger
14
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Paul J. Utz
14
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Viola Vaccarino
14
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Brittany B. Vallejos
14
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Terry L. Vanden Hoek
14
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14
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Jay K. Varma
14
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Suzanne D. Vernon
14
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Crystal M. Vidal
14
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Sara Vivensi
14
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Adam S. Vohra
14
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Laura K Wagner
14
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Fei Wang
14
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David Warburton
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Megan R. Warner
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Rebecca L. Watkins
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Sara E. Watson
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Ryan Webb
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Ryan M. Weeks
14
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Mark G Weiner
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Alan Werzberger
14
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Shelby C. West
14
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Jordan C. Weyer
14
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Jennifer L. Wheeler
14
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14
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14
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14
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Erika S. Wimberly
14
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Terra J. Winter
14
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Scott C. Woller
14
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Rachel Wong
14
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Jeremy P. Wood
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JOHN C. WOOD
14
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Marion J. J. Wood
14
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Qiong Wu
14
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Yinglin Xia
14
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Jie Xu
14
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Samuel Yang
14
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H S Yin
14
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Hsiang S Yin
14
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Yun Jae Yoo
14
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Chloe E. Young
14
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Natalie M. Young
14
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Chengxi Zang
14
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William T. Zempsky
14
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Bingyu Zhang
14
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Yongkang Zhang
14
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Dazheng Zhang
14
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Emily Zimmerman
14
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George A Alba
1
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Radica Alicic
15
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Natasha Altman
3
,
Khamal Anglin
16
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Urania Argueta
16
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Hassan Ashktorab
17
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Gaston Baslet
4
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Ingrid V. Bassett
1
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Lucinda Bateman
18
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Brahmchetna Bedi
11
,
Shamik Bhattacharyya
4
,
Marie-Abele Bind
1
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Andra L Blomkalns
19
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Hector Bonilla
19
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Patricia A Bush
20
,
Mario Castro
21
,
James Chan
1
,
Alexander W. Charney
8
,
Peter Chen
22
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Lori B. Chibnik
1
,
Helen Y. Chu
23
,
Rebecca G. Clifton
24
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Maged M. Costantine
25
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Sushma K. Cribbs
11
,
Sylvia I. Davila Nieves
26
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Steven G. Deeks
16
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Patient-Led Research Collaborative, Calabasas, California
|
14
for the RECOVER Consortium
18
Bateman Horne Center, Salt Lake City, Utah
|
20
Kaiser Foundation Health Plan of Georgia Inc, Atlanta
|
27
Swedish Medical Center, Seattle, Washington
|
28
MaineHealth, Portland
34
Partners HealthCare Systems, Boston, Massachusetts
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35
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36
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37
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38
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|
39
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|
42
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|
43
UH Cleveland Medical Center, Cleveland, Ohio
|
45
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|
46
Christiana Care Health Services Inc, Newark, Delaware
|
47
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|
49
Cambridge Health Alliance, Cambridge, Massachusetts
|
56
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|
65
Morehouse School of Medicine, Atlanta, Georgia
|
67
Saint Peter’s University Hospital, Brunswick, New Jersey
|
68
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|
71
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76
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77
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Publication type: Journal Article
Publication date: 2023-06-13
scimago Q1
wos Q1
SJR: 5.352
CiteScore: 30.8
Impact factor: 55.0
ISSN: 00029955, 00987484, 15383598
PubMed ID:
37278994
General Medicine
Abstract
Importance
SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals.
Objective
To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections.
Design, Setting, and Participants
Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling.
Exposure
SARS-CoV-2 infection.
Main Outcomes and Measures
PASC and 44 participant-reported symptoms (with severity thresholds).
Results
A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months.
Conclusions and Relevance
A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.
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656
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Thaweethai T. et al. Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection // JAMA - Journal of the American Medical Association. 2023. Vol. 329. No. 22. p. 1934.
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Thaweethai T. et al. Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection // JAMA - Journal of the American Medical Association. 2023. Vol. 329. No. 22. p. 1934.
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@article{2023_Thaweethai,
author = {Tanayott Thaweethai and Sarah E. Jolley and Elizabeth W. Karlson and Emily B. Levitan and Bruce Levy and Grace A. McComsey and Lisa McCorkell and Girish N Nadkarni and Sairam Parthasarathy and Upinder Singh and Tiffany A Walker and Caitlin A Selvaggi and Daniel J Shinnick and Carolin C M Schulte and Rachel Atchley-Challenner and Leora I. Horwitz and Andrea S. Foulkes and Judith A. Aberg and Natalie L Adolphi and Shreya Ahirwar and Shifa Ahmed and Neera Ahuja and Masanori Aikawa and Almary Akerlundh and Teresa T. Akintonwa and Aseel Al-Jadiri and Natalya Alekhina and Heather A Algren and Akram N. Alshawabkeh and Nariman Ammar and Adit Anand and Brett R. Anderson and Lisa Aponte-Soto and Judy L. Aschner and Mary M. Atha and Andrew M Atz and Robin L Aupperle and Mirna Ayache and Eduardo Azziz-Baumgartner and L. C. BAILEY and Fiona C. Baker and Venkataraman Balaraman and Jennifer A. Bandy and Dithi Banerjee and Deanna M. Barch and James M. Bardes and Jackson Barlocker and R G Barr and Arielle Baskin-Sommers and Sanjib Basu and others},
title = {Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection},
journal = {JAMA - Journal of the American Medical Association},
year = {2023},
volume = {329},
publisher = {American Medical Association (AMA)},
month = {jun},
url = {https://doi.org/10.1001/jama.2023.8823},
number = {22},
pages = {1934},
doi = {10.1001/jama.2023.8823}
}
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Thaweethai, Tanayott, et al. “Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection.” JAMA - Journal of the American Medical Association, vol. 329, no. 22, Jun. 2023, p. 1934. https://doi.org/10.1001/jama.2023.8823.