published literature definition

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Literature Reviews

• What is a literature review?
• Steps in the Literature Review Process
• Define your research question
• Determine inclusion and exclusion criteria
• Choose databases and search
• Review Results
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What is a Literature Review?

A literature or narrative review is a comprehensive review and analysis of the published literature on a specific topic or research question. The literature that is reviewed contains: books, articles, academic articles, conference proceedings, association papers, and dissertations. It contains the most pertinent studies and points to important past and current research and practices. It provides background and context, and shows how your research will contribute to the field. 

A literature review should: 

• Provide a comprehensive and updated review of the literature;
• Explain why this review has taken place;
• Articulate a position or hypothesis;
• Acknowledge and account for conflicting and corroborating points of view

From  S age Research Methods

Purpose of a Literature Review

A literature review can be written as an introduction to a study to:

• Demonstrate how a study fills a gap in research
• Compare a study with other research that's been done

Or it can be a separate work (a research article on its own) which:

• Organizes or describes a topic
• Describes variables within a particular issue/problem

Limitations of a Literature Review

Some of the limitations of a literature review are:

• It's a snapshot in time. Unlike other reviews, this one has beginning, a middle and an end. There may be future developments that could make your work less relevant.
• It may be too focused. Some niche studies may miss the bigger picture.
• It can be difficult to be comprehensive. There is no way to make sure all the literature on a topic was considered.
• It is easy to be biased if you stick to top tier journals. There may be other places where people are publishing exemplary research. Look to open access publications and conferences to reflect a more inclusive collection. Also, make sure to include opposing views (and not just supporting evidence).

Source: Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal, vol. 26, no. 2, June 2009, pp. 91–108. Wiley Online Library, doi:10.1111/j.1471-1842.2009.00848.x.

Meryl Brodsky : Communication and Information Studies

Hannah Chapman Tripp : Biology, Neuroscience

Carolyn Cunningham : Human Development & Family Sciences, Psychology, Sociology

Larayne Dallas : Engineering

Janelle Hedstrom : Special Education, Curriculum & Instruction, Ed Leadership & Policy ​

Susan Macicak : Linguistics

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For help in other subject areas, please see the guide to library specialists by subject .

Periodically, UT Libraries runs a workshop covering the basics and library support for literature reviews. While we try to offer these once per academic year, we find providing the recording to be helpful to community members who have missed the session. Following is the most recent recording of the workshop, Conducting a Literature Review. To view the recording, a UT login is required.

• October 26, 2022 recording
• Last Updated: Oct 26, 2022 2:49 PM
• URL: https://guides.lib.utexas.edu/literaturereviews

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The Oxford Dictionary of Literary Terms (3 ed.)  

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“This dictionary’s virtues and its plain-spokenness make it ... as apt to the bedside table as to the desk: Dr Baldick is a Brewer for specialized tastes” - Times Literary Supplement

The best-selling Oxford Dictionary of Literary Terms (formerly the Concise dictionary) provides clear, concise, and often witty definitions of the most troublesome literary terms from abjection to zeugma. Now available in a new, fully updated and expanded edition, it offers readers increased coverage of new terms from modern critical and theoretical movements, such as feminism, and schools of American poetry, Spanish verse forms, life writing, and crime fiction.

It includes extensive coverage of traditional drama, versification, rhetoric, and literary history, as well as updated and extended advice on recommended further reading and a pronunciation guide to more than 200 terms. New to this fully revised edition are recommended entry-level web links. Boasting over 1,200 entries, it is an essential reference tool for students of literature in any language.

Bibliographic Information

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Chris Baldick is Professor of English at Goldsmiths’ College, University of London. He has written widely on nineteenth-century literature and is the editor of The Oxford Book of Gothic Tales .

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Literature Definition

• disquisition

Other Word Forms of Literature

Origin of literature.

Middle English book learning from Old French litterature from Latin litterātūra from litterātus lettered literate

From American Heritage Dictionary of the English Language, 5th Edition

From Latin literatura or litteratura .

From Wiktionary

Literature Sentence Examples

Waller edited the Cambridge History of English Literature (1907, &c.).

In literature Argentina is still under the spell of Bohemianism and dilettanteism.

His love for literature was a passion.

In a state of deep depression, she stopped by the social services office on the way home and picked up some literature and a form.

In a word, literature is my Utopia.

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1.1: What is Literature?

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• Heather Ringo & Athena Kashyap
• City College of San Francisco via ASCCC Open Educational Resources Initiative

Defining Literature

In order for us to study literature with any kind of depth, first we must decide what constitutes literature. While works like William Shakespeare’s Romeo and Juliet and Harper Lee’s To Kill a Mockingbird are almost universally accepted as literature, other works are hotly debated, or included or excluded based on the context. For example, while most consider Toni Morrison’s Beloved literature, others debate whether more recent publications such as David Mitchell’s Cloud Atlas or Rupi Kaur’s Instagram poetry constitute literature. And what about the stories told through tweets, like Jennifer Egan’s “Black Box” ? What about video games, like Skyrim , or memes, like Grumpy Cat?

Students often throw their hands up in the air over such distinctions, arguing literature is subjective. Isn't it up to individual opinion? Anything can be literature, such students argue. At first glance, it could seem such distinctions are, at best, arbitrary. At worst, such definitions function as a means of enforcing cultural erasure.

However, consider a story about Kim Kardashian’s plastic surgery in People Magazine . Can this be considered on the same level of literary achievement as Hamlet ? Most would concede there is a difference in quality between these two texts. A blurb about Kim Kardashian’s latest plastic surgery, most would agree, does not constitute literature. So how can we differentiate between such works?

Literature vs. literature

As illustrated in the somewhat silly example above, one way we can define what constitutes literature is by identifying what is definitely not literature. For our intents and purposes of defining most terms in this textbook, we will use the Oxford English Dictionary ’s definitions. Many professors who teach Literature use the concept of Big L Literature vs. little l literature (Rollison).

While the definition of little l literature is fairly easy to understand and apply, the definition of Big L Literature remains amorphous. What makes a work “artistic”? How do we define “superior” or “lasting”?

Let’s break down some of the defining qualities of literature in a bit more detail, starting with the word “artistic.”

Exercise 1.1.1

Consider the following works of art. Which of these images do you feel is higher quality or more “artistic”? Which is lower-quality or less artistic? Why? Justify your position by analyzing the elements of each artwork.

While there may be some debate, most students usually respond that Friedrich's painting is more artistic. This is due to several composition differences between the two works:

• Artist’s skill: it certainly appears as if the first image was produced by an artist with superior skill
• Fame: for anyone who knows art history, the first image is famous while the other is not
• Lasting quality: the first image has survived the test of time, remaining popular over two hundred years!
• Meaning: the first image likely conjures deeper feelings, themes, or ideas, such as isolation and the primacy of nature. This is why this image has become the face of Romanticism.

But what about the images demonstrate the artists’ superior skills? While the second image appears to be produced with a simple doodle, and quickly composed, the first indicates more complexity, attention-to-detail, and craft. Freidrich leverages different colors, textures, shapes, and symbols to evoke a feeling in the viewer. Skilled artists will use different techniques, like the way they move the paintbrush, the pressure they exert or the direction of the brush. They will use textured paintbrushes for a specific effect, such as the difference between the light fluffy clouds and dark mountain rocks. They will use different color pallets to project, as accurately as possible, the feelings they are trying to evoke. In short, while anyone can paint, true artists leverage many different skills, techniques, and materials to render what is in their imagination into a real-life product.

So how does this relate to our attempts to define literature?

Literature is art, but with words.

While the artist uses different colors, paintbrushes, mediums, canvases, and techniques, the writer uses different genres and literary techniques called literary devices . Just like different types of paint, paintbrushes, and artistic tools, there are literally hundreds of literary devices, but some of the most common are metaphor, simile, personification, and imagery. Genre is the type or style of literature. Each genre has its own conventions. Literary genres include creative nonfiction, fiction, drama, and poetry . Works that are literary tend to masterfully use genre conventions and literary devices to create a world in the mind of the reader. Works that are less literary tend to be for practical and/or entertainment purposes, and the writer dedicates less focused energy towards artfully employing literary devices.

However, just because a work is not as literary as another does not mean it cannot be enjoyed. Just like a stick figure or cartoon character might be perfectly fine if intended for a particular audience or purpose, readers can still enjoy People Magazine even though it is not of the same literary quality as Hamlet .

So, to use an example from earlier:

While some literature falls into clear designations of literature or not literature, most works are open to debate. Given the sometimes difficult task of determining whether a work falls into one camp or the other, it may be more helpful to think of Literature less as a dichotomy than a spectrum, with popular magazines on one end and works like Hamlet and Beloved on the other, and most written works falling somewhere between the two extremes.

The Literary Spectrum

This spectrum can be a helpful way to think about literature because it provides a more open-ended way to discuss writing as art than simply labeling works as literary or not. After viewing the above chart, why do you think popular magazines and a Calculus textbook are considered "less literary"? In terms of popular magazines, they do not fit the definition of literature as "lasting" in the sense that they usually fade from relevancy quickly after publication. Additionally, the authors of such magazines are striving for quick entertainment rather than leaving a meaningful impression on the reader. They tend not to use literary devices, such as metaphor, in a masterful way. On the other end, Shakespeare's Hamlet definitely fits the definition of "lasting," in that it has survived hundreds of years. It is full of literary devices used for rhetorical effect and, one would argue, it touches upon deep themes such as death, the afterlife, murder, vengeance, and love, rather than trifling issues such as a starlet's most recent plastic surgery.

Certainly, works of literature are up for debate: that is the quintessential question literary scholars might ask. What makes certain literary works survive the test of time? What makes a story, poem, or drama "good"? While literary scholars are less interested in proving a certain work is "good" or not -- and more focused on analyzing the ways to illuminate a given work -- it can be helpful for you to consider what kinds of literature you like and why you like it. What about the way it was written causes you to feel the way you do about it?

Who Decides What is Literature?

Now that we have at least somewhat clarified the definition of literature, who decides what works are or are not literature? Historically speaking, kings, queens, publishers, literary critics, professors, colleges, and readers (like you!) have decided which works survive and which works do not.

Aristotle was one of the first writers to attempt to decide what works fall into the category of literature, and what works do not. While Aristotle was most famous for his contributions to science and philosophy, he is also considered one of the first literary critics. A literary critic is a person who studies and analyzes literature. A literary critic produces scholarship called literary criticism . An example of this would be Aristotle’s Poetics , in which he identifies the defining qualities of a “good” Tragedy. Aristotle’s analysis of Tragedy was so influential that it is still used today, over two thousand years later!

When a work is officially decided to constitute literature, it enters something called the Canon. Not to be confused with the large metal tube that shoots bombs popular in the 16th through the 19th centuries (cannon), the Literary Canon is a collection of works that are considered by the powers that be to constitute literature. A work that falls into this designation is called canonical. So, to use an example from Aristotle’s Poetics , Aristotle defined Sophocles’ Oedipus Trilogy as the pinnacle of the Tragic Genre. From there, in part due to Aristotle's influence, Greek society valued Oedipus so much that they kept discussing, reading, referencing, and teaching it. Thus, it became a kind of shining example of the Tragic Canon, one which has lasted thousands of years and continues to be read and lauded to this day. Other tragedies, fairly or not, are often judged on their quality in comparison to Sophocles' works. Wild to think that someone who died thousands of years ago still influences what we consider literature today!

Memes and Video Games: Today's Literature?

All this talk of thousands-of-years-old texts might seem out of touch. A lot of people think "old and boring" and literature are synonymous. Students are often surprised to hear that comic books and video games can arguably be considered literature, too. There are plenty of arguments to be made that comic books, such as Maus by Art Spiegalman (1991) or Fun Home by Alison Bechdel (2006) are literature. Cutting edge literary scholars argue video games like Kentucky Route Zero by Cardboard Computer (2015) can be considered literary. There is also literature that is published in tweets, like Jennifer Egan's "Black Box" (2012). Some might even consider memes literature!

Generative question: do you think memes can be literary?

A meme is an image or video containing cultural values or ideas, often represented through allusion (implied reference to another work, without naming that work or its author). Memes can spread rapidly spreads through social media. Why? Because the best ones are #relatable; that is, they speak to a common human experience.

Usually memes take the form of text superimposed on an image. For example, the meme above conveys the dramatic reaction students sometimes give when I assign an essay. This is done primarily through a literary device called hyperbole , or exaggeration for rhetorical effect. It conveys its message comically through certain conventions that come along with the meme genre, such as the syntactic structure "me, a [insert noun]" and asterisks, which convey action. Just like in the Shakespearean drama, the colon indicates what each character (me and the students, in this case) is saying or doing. My chihuahua's face looks silly and very dramatic. Through this use of image, text, format, and convention, the meaning I intended to convey was that I was making fun of my students for being over-dramatic about what to me seems like a fairly simple assignment. While some might dismiss memes as shallow, when you start to unravel the layers of meaning, they can actually be very complex and even, dare I say, literary!

Think about a recent meme you have seen, or your favorite meme of all time. Imagine explaining this meme to someone who has no idea what it means. What is the message or idea behind the meme? What cultural reference points does it use to convey its message? In what ways might this meme be considered literature? How might this compare to a short poem, like a haiku?

Not Literature

Let's say you come to the conclusion that a meme, a gossip magazine, or the Twilight Series is not literary. Does that mean you have to feel guilty and give up reading it forever? Or that it is not "good"?

Just because a work is not literary does not mean it is "bad," that it does not have value, or that one cannot enjoy it. Indeed, there are plenty of examples of written works that are on the less literary side of the spectrum but are still fun and enriching to read. Joe Dirt i s not on the same artistic level of cinema as Schindler's List , but my husband still loves watching it. Nothing Taylor Swift has produced is as deep as Tupac Shakur's "Changes" (1992) or Mitski's "Last Words of a Shooting Star" (2014), but listening to Taylor Swift is my guilty pleasure. This is all to say that whether a text is literary or not is not as important as the methods of analyzing texts. In fact, texts which were excluded from literature are often argued into the literary canon through such analysis. Part of what makes analyzing literature so fun is that it means the definition of literature is always up for debate! This is especially important given the history of the canon.

The Problem with the Canon

In an ideal world, literature would be celebrated purely based on its artistic merit. Well-written works would last, poorly-written works would wither from public memory. However, that is not always the case. Works often achieve public prominence or survive based on qualities unrelated to skill or aesthetics, such as an author's fame, wealth, connections, or acceptance by the dominant culture. William Wordsworth, for example, was named Poet Laureate of England and has been taught as one of the "Big Six" major Romantic-era authors ever since. Indeed, he is accepted as part of the Romanticism literary canon. One would be hard-pressed to find a Literature anthology that does not feature William Wordsworth . However, how many people have read or heard of Dorothy Wordsworth , William Wordsworth's sister, who arguably depicted Romantic themes with equal skill and beauty? Or James Hogg, a Scottish contemporary of Wordsworth who was a lower-class shepherd? Similarly, while most readers have encountered F. Scott Fitzgerald or Edgar Allen Poe in their high school literature classes, how many have read Frederick Douglass in these same classes? In short, all artistic skill (arguably) considered equal, why do some authors predominantly feature in the Canon while others do not?

Let’s perform an experimental activity.

• Find a piece of paper or a whiteboard. On this piece of paper or whiteboard, write down as many works of literature that you feel constitute “Big L Literature.” Perhaps they are works you read in high school, works which have been made into films, or works you have been taught or told are literary masterworks. Don’t turn the page until you have written them down. Try to think of at least 10, but a larger sample size is better. Once you are finished, continue to the next paragraph.
• Alright, now look at your list. If you know the author of the literary texts you named, write their name next to the work. If you do not know the author, Google the information and write it down. Continue doing this until you have named the author of each work. Once you are finished, read on to the next paragraph.
• Now, as uncomfortable as it seems, label the gender/race/age/presumed sexual orientation of the authors you listed. After you have categorized them to the best of your ability, consider the following questions:
• What percentage of the authors are male?
• What percentage of the authors are white?
• What percentage of the authors are old/dead?
• What patterns do you notice? Why do you think this is?

I have replicated this experiment dozens of times in the classroom, and, in most classes, the vast majority of what students have been taught are “Literary Masterworks” are written by (pardon my colloquialism) dead white males. Although, as time progresses, it seems there is increasing but not proportionate representation on average. For example, while women make up about half of the population, over 80% of the most popular novels were written by men ("Battle"). While there are many possible reasons for this discrepancy in representation (which could be the focus of an entire textbook), what does this mean for scholars of literature? For students? For instructors? For society?

As a cultural relic, similar to art, many scholars suggest literature is a reflection of the society which produces it. This includes positive aspects of society (championing values such as love, justice, and good triumphing over evil), but it can also reflect negative aspects of society (such as discrimination, racism, sexism, homophobia, historical lack of opportunity for marginalized authors).

For example, enslaved Africans were often prevented from learning to read and write as a form of control. When Phillis Wheatley published her book of poetry, Poems on Various Subjects, Religious and Moral (1773) she had to defend the fact that she wrote it, due to popularly held racist views that slaves were incapable of writing poetry. Later, Frederick Douglass wrote about how his enslavers banned him from reading and writing, as they realized "education and slavery were incompatible with each other" (Douglass). He later championed his learning to read and write as the means which conveyed him to freedom. However, even when trying to publish The Narrative of the Life of Frederick Douglass ( 1845) his publishers were forced to prove that it was, in fact, an enslaved person who wrote the story and not a white man who wrote it for him. Slave owners actively attempted to keep this book from circulation as it threatened the institution of slavery upon which they depended. Indeed, to this day, Douglass' book continues to be banned in some prisons for its potential to incite revolution (Darby, Gilroy).

How could Black writers enter the canon en masse if they were not allowed to read or write? Or if they were forced to spend all of their waking hours working? And if those who had the means to read and write had to jump through absurd hoops just to have their works published? And if even those texts which were published were banned?

Similarly, throughout much of Western history, women have been discouraged from pursuing reading and writing, as it distracted from society's expectations for women to focus on motherly and household duties. Until the 1700s, women were not allowed to go to college. Even then, very few went: only the extremely wealthy. It was not until the 19th century that women attended college in representative numbers. Virginia Woolf wrote in A Room of One's Own that if there are fewer works of literature written by women, it is only because society, historically, has not given women the time, education, funding, or space to do so. In this extended essay, she describes an imaginary sister of William Shakespeare who could have been just as great of a writer had she the same opportunities as her brother.

I told you in the course of this paper that Shakespeare had a sister; but do not look for her in Sir Sidney Lee's life of the poet. She died young—alas, she never wrote a word. She lies buried where the omnibuses now stop, opposite the Elephant and Castle. Now my belief is that this poet who never wrote a word and was buried at the cross-roads still lives. She lives in you and in me, and in many other women who are not here tonight, for they are washing up the dishes and putting the children to bed. But she lives; for great poets do not die; they are continuing presences; they need only the opportunity to walk among us in the flesh. This opportunity, as I think, it is now coming within your power to give her.

Woolf argues that in our time those who have been excluded from literature can now join the canon by adding their voices. The inequity of representation in literature -- which has arguably improved, but in many ways persists today -- can be remedied if more people from a wide array of backgrounds and walks of life are empowered to study and create Literature. That is one reason why the current study of literature is so exciting. As a student and budding literary scholar, you have the power to influence culture through your reading and analysis of literature! For one author and scholar's perspective on this topic, please watch this the following TED Talk by Chimamanda Ngozi Adichie to see the ways in which such misrepresentations are harmful, and why it is important to veer away from the historically parochial Canon into what Chinua Achebe calls "a balance of stories" (qtd. Bacon).

• Original video available on TED Talk website
• Transcript of video

What "single stories" do you know? What are the "single stories" people have told about you? What story would you tell if you could? What kinds of stories do you want to read? Throughout this class, you will get the opportunity to encounter many different voices and stories from all over the world. While we faced hurdles of copyright permissions, the authors of this textbook attempted to embody the values espoused in this TED Talk & Chinua Achebe's conception of the "balance of stories." As you read the textbook, consider the stories which were omitted, why they were omitted, and what works of Literature you would include in this class if you could.

Works Cited

Bacon, Katie. "An African Voice." The Atlantic , 2000.

"Battle of the Authors: Are The Most Popular Rated Fiction Books Written by Men or Women?" Wordery , 1 Mar. 2019.

Darby, Luke. "Illinois Prison Bans Frederick Douglass's Memoir and Other "Racial" Books." GQ , 20 August 2019.

Douglass, Frederick. The Narrative of the Life of Frederick Douglass. 1845.

Friedrich, Caspar David. "Wanderer Above the Sea of Fog." Hamburger Kunsthalle Museum , 1818.

Gilroy, Paul. "Banned Books of Guantánamo: 'An American Slave' by Frederick Douglass." Vice , 14 Nov. 2014.

"literature, n.; 3b & 5" OED Online , Oxford University Press, September 2019, www.oed.com/view/Entry/109080. Accessed 6 September 2019.

Rollison, David. "Big L vs Little L Literature." Survey of World Literature I. College of Marin, 2008. Lecture.

Wheatley, Phillis. Poems on Various Subjects, Religious and Moral . 1773.

Woolf, Virginia. A Room of One's Own. 1929.

Definition of 'literature'

Video: pronunciation of literature

literature in American English

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to issue (printed or otherwise reproduced textual or graphic material, computer software, etc.) for sale or distribution to the public .

to issue publicly the work of: Random House publishes Faulkner.

to submit (content) online, as to a message board or blog: I published a comment on her blog post with examples from my own life. They publish a new webcomic once a month.

to announce formally or officially; proclaim; promulgate.

to make publicly or generally known.

Law . to communicate (a defamatory statement) to some person or persons other than the person defamed.

to issue newspapers, books, computer software, etc.; engage in publishing : The new house will start to publish next month.

to have one's work published: She has decided to publish with another house.

Origin of publish

Synonym study for publish, other words for publish, opposites for publish, other words from publish.

• pub·lish·a·ble, adjective
• mis·pub·lished, adjective
• non·pub·lish·a·ble, adjective
• un·pub·lish·a·ble, adjective
• un·pub·lished, adjective
• well-published, adjective

Dictionary.com Unabridged Based on the Random House Unabridged Dictionary, © Random House, Inc. 2023

How to use publish in a sentence

A report published last November by the Centers for Disease Control and Prevention points to those long-term consequences.

He and his colleagues published their findings June 8 in the Proceedings of the National Academy of Sciences.

On the blog, you can publish news, information materials, as well as infographics, video reviews – everything that can attract attention and encourage visitors to make a deal.

Every now and then SEO specialists and marketers publish reviews of our platform.

Mario Peshev is the CEO of DevriX, a global WordPress agency serving industries from publishing to automotive and airline.

Her latest book, Heretic: The Case for a Muslim Reformation, will be published in April by HarperCollins.

That is why The Daily Beast stands with Charlie Hebdo and published their controversial covers in the wake of the attack.

The trials produced positive results, published in The New England Journal of Medicine in November.

This article was adapted from one originally published by IranWire.

In life, José Saramago refused to see his once-rejected book Skylight published.

Some were even re-arrested for the same nefarious purpose, and the daily papers published their names on each occasion.

He was rector of the university of Ilfeldt 40 years, and published several learned works.

In his condemned cell he composed a beautiful poem of 14 verses (“My last Thought”), which was found by his wife and published.

William Penn, published in England his frame of government for the colony of Pennsylvania.

Upon seeing the said ritual, I ordered it to be published, and it was done on the day of Sts.

British Dictionary definitions for publish

/ ( ˈpʌblɪʃ ) /

to produce and issue (printed or electronic matter) for distribution and sale

(intr) to have one's written work issued for publication

(tr) to announce formally or in public

(tr) to communicate (defamatory matter) to someone other than the person defamed : to publish a libel

Derived forms of publish

• publishable , adjective
• publishing , noun

Collins English Dictionary - Complete & Unabridged 2012 Digital Edition © William Collins Sons & Co. Ltd. 1979, 1986 © HarperCollins Publishers 1998, 2000, 2003, 2005, 2006, 2007, 2009, 2012

Scholarly Literature Types

Types of scholarly literature, non-formally published substantive literature.

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• Qualitative vs Quantitative Research
• Anatomy of a Scholarly Article

You will encounter many types of articles and it is important to distinguish between these different categories of scholarly literature. Keep in mind the following definitions.

Peer-reviewed (or refereed):  Refers to articles that have undergone a rigorous review process, often including revisions to the original manuscript, by peers in their discipline, before publication in a scholarly journal. This can include empirical studies, review articles, meta-analyses among others.

Empirical study (or primary article): An empirical study is one that aims to gain new knowledge on a topic through direct or indirect observation and research. These include quantitative or qualitative data and analysis. In science, an empirical article will often include the following sections: Introduction, Methods, Results, and Discussion.

Review article:  In the scientific literature, this is a type of article that provides a synthesis of existing research on a particular topic. These are useful when you want to get an idea of a body of research that you are not yet familiar with. It differs from a systematic review in that it does not aim to capture ALL of the research on a particular topic.

Systematic review:  This is a methodical and thorough literature review focused on a particular research question. It's aim is to identify and synthesize all of the scholarly research on a particular topic in an unbiased, reproducible way to provide evidence for practice and policy-making. It may involve a meta-analysis (see below). 

Meta-analysis:  This is a type of research study that combines or contrasts data from different independent studies in a new analysis in order to strengthen the understanding of a particular topic. There are many methods, some complex, applied to performing this type of analysis.

What is Grey Literature?

Grey literature is literature produced by individuals or organizations outside of commercial and/or academic publishers. This type of non-formally published substantive information (often not formally peer-reviewed; especially important in all kinds of sciences) can include information such:

• theses and dissertations
• technical reports 
• working papers 
• government reports
• evaluation and think tank reports and resources
• conference proceedings, papers and posters
• publications from NGOs, INGOs, think tanks and policy institutes
• unpublished clinical trials
• and much more

The sources you select will be informed by your research question and field of study, but should likely include, at a minimum, theses and dissertations.

Why Search the Gray Literature?

Most of gray literature is considered less prestigious, reliable, and "official" than publication in a peer-reviewed journal. But they are still fully legitimate avenues of publication. Often they are used to publicize early findings, before a study is entirely complete. Or, in the case of theses, they are published as a condition of receiving an advanced degree. Government technical reports are issued either by agencies that do scientific research themselves or else by a lab that has received government funding. Increasingly, such labs may be required to publish technical reports as a condition of receiving such funding. Gray literature may be cited like any other paper although with the caveat mentioned before that it is considered less "official" and reliable than peer-reviewed scientific papers.

When doing evidence synthesis, it's important because the intent is to synthesize  all available evidence  that is applicable to your research question. There is a strong bias in scientific publishing toward publishing studies that show some sort of significant effect. Meanwhile, many studies and trials that show no effect end up going unpublished. But knowing that an intervention had no effect is just as important as knowing that it did have an effect when it comes to making decisions for practice and policy-making. While not peer-reviewed, gray literature represents a valuable body of information that is critical to consider when synthesizing and evaluating all available evidence.

The guide is based on the Cornell University Library Tutorial: Scholarly Literature Types.

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Home » What is Literature – Definition, Types, Examples

What is Literature – Definition, Types, Examples

Table of Contents

Definition:

Literature refers to written works of imaginative, artistic, or intellectual value, typically characterized by the use of language to convey ideas, emotions, and experiences. It encompasses various forms of written expression, such as novels, poems, plays, essays, short stories, and other literary works.

History of Literature

The history of literature spans thousands of years and includes works from many different cultures and languages. Here is a brief overview of some of the major periods and movements in the history of literature:

Ancient Literature (3000 BCE – 500 CE)

• Ancient Mesopotamian Literature (3000 BCE – 2000 BCE): This period includes the earliest known writings, such as the Epic of Gilgamesh, a Sumerian epic poem that explores themes of friendship, mortality, and the search for immortality.
• Ancient Greek Literature (800 BCE – 200 BCE): This era produced works by legendary writers such as Homer, known for the Iliad and the Odyssey, and playwrights like Sophocles, Aeschylus, and Euripides, who wrote tragic plays exploring human nature and the conflicts between gods and mortals.
• Ancient Roman Literature (200 BCE – 500 CE): Roman literature included works by poets like Virgil (known for the Aeneid) and historians like Livy and Tacitus, who chronicled the rise and fall of the Roman Empire.

Medieval Literature (500 CE – 1500 CE)

• Early Medieval Literature (500 CE – 1000 CE): During this period, literature was mainly religious and included works such as Beowulf, an Old English epic poem, and The Divine Comedy by Dante Alighieri, an Italian epic poem that describes the journey through Hell, Purgatory, and Heaven.
• High Medieval Literature (1000 CE – 1300 CE): This era saw the emergence of troubadour poetry in Provence, France, which celebrated courtly love, as well as the works of Geoffrey Chaucer, such as The Canterbury Tales, which combined diverse stories and social commentary.
• Late Medieval Literature (1300 CE – 1500 CE): Notable works from this period include Dante’s Divine Comedy, Petrarch’s sonnets, and the works of Christine de Pizan, an early feminist writer.

Renaissance Literature (14th – 17th centuries)

• Italian Renaissance Literature (14th – 16th centuries): This period witnessed the flourishing of humanism and produced works by authors such as Francesco Petrarch and Giovanni Boccaccio, who emphasized the individual, the secular, and the revival of classical themes and styles.
• English Renaissance Literature (16th – 17th centuries): This era saw the works of William Shakespeare, including his plays such as Hamlet and Macbeth, which explored complex human emotions and the human condition. Other notable writers include Christopher Marlowe and Edmund Spenser.

Enlightenment Literature (17th – 18th centuries)

• This period marked a shift towards reason, rationality, and the questioning of established beliefs and systems. Influential writers during this time included René Descartes, John Locke, Voltaire, Jean-Jacques Rousseau, and Denis Diderot.

Romanticism (late 18th – mid-19th centuries)

• Romantic literature emphasized individual emotion, imagination, and nature. Key figures include William Wordsworth, Samuel Taylor Coleridge, Lord Byron, Percy Bysshe Shelley, and John Keats.

Victorian Literature (19th century)

• This era was characterized by the reign of Queen Victoria and featured writers such as Charles Dickens, Jane Austen, Charlotte and Emily Brontë, and Oscar Wilde.

Modernist Literature (late 19th – early 20th centuries)

• Modernist literature emerged as a response to the social, political, and technological changes of the time. It is characterized by experimentation with narrative structure, language, and perspective. Notable modernist writers include T.S. Eliot, Virginia Woolf, James Joyce, and Marcel Proust.

Postmodern Literature (mid-20th century – present)

• Postmodern literature challenges traditional notions of narrative and reality. It often incorporates elements of metafiction, intertextuality, and fragmented narratives. Prominent postmodern authors include Jorge Luis Borges, Italo Calvino, Salman Rushdie, and Margaret Atwood.

Contemporary Literature (late 20th century – present)

• Contemporary literature encompasses a wide range of diverse voices and styles. It explores various themes and addresses contemporary issues, reflecting the cultural, social, and political contexts of the present time. Notable contemporary authors include Toni Morrison, J.K. Rowling, Haruki Murakami, Chimamanda Ngozi Adichie, and Zadie Smith.

Types of Literature

Types of Literature are as follows:

Short story

Graphic novel, electronic literature.

Poetry is a form of literature that uses language to convey emotions or ideas in a concise and often rhythmic manner. Poetry has been around for centuries, with many different cultures creating their own unique styles. While some people may view poetry as difficult to understand, there is often great beauty in its simplicity. Whether you are looking to read poems for enjoyment or to better analyze literary works, understanding the basics of poetry can be very helpful.

Examples of Poetry in Literature

There are countless examples of poetry in literature, ranging from ancient works to contemporary masterpieces. Here are just a few examples:

• “ The Love Song of J. Alfred Prufrock ” by T.S. Eliot (1915): This modernist poem explores themes of alienation, identity, and the human condition.
• “ Do not go gentle into that good night ” by Dylan Thomas (1951): This villanelle is a powerful meditation on death and the struggle for survival.
• “ The Waste Land” by T.S. Eliot (1922) : This epic poem is a complex and multi-layered exploration of the modern world and its spiritual emptiness.
• “ The Raven” by Edgar Allan Poe (1845) : This famous poem is a haunting and macabre exploration of grief, loss, and the supernatural.
• “ Sonnet 18″ by William Shakespeare (1609) : This classic sonnet is a beautiful and romantic tribute to the beauty of the beloved.
• “ Ode to a Nightingale” by John Keats (1819) : This ode is a sublime exploration of the power of beauty and the transcendent experience of art.
• “ The Road Not Taken” by Robert Frost (1916) : This famous poem is a contemplative meditation on choices, regrets, and the uncertainties of life.

These are just a few examples of the many works of poetry that exist in literature. Poetry can explore a wide range of themes and emotions, using language and imagery to create powerful and moving works of art.

Prose is a type of written language that typically contains dialogue and narration. In literature, prose is the most common form of writing. Prose can be found in novels, short stories, plays, and essays.

Examples of Prose in Literature

“ The Essays” by Michel de Montaigne (1580) – This collection of prose is a seminal work of the French Renaissance and is credited with popularizing the use of personal reflections in prose literature. Montaigne’s writing style in these works is informal and conversational, and covers a vast range of topics including morality, philosophy, religion, and politics. The prose is notable for its intimacy and personal nature, as Montaigne often uses his own experiences and thoughts to illustrate his ideas.

A novel is a fictional book that is typically longer than 300 pages. It tells a story, usually in chronological order, and has characters and settings that are developed over the course of the story. Novels are often divided into chapters, which help to break up the story and make it easier to read.

Novels are one of the most popular genres of literature, and there are many different types of novels that you can read. Whether you’re looking for a romance novel, a mystery novel, or a historical fiction novel, there’s sure to be a book out there that you’ll love.

Examples of Novels in Literature

• “Don Quixote” by Miguel de Cervantes (1605) – This novel is considered one of the greatest works of Spanish literature and is a satirical take on chivalric romance. It follows the adventures of a delusional knight, Don Quixote, and his loyal squire, Sancho Panza.
• “Robinson Crusoe” by Daniel Defoe (1719) – This novel is considered one of the earliest examples of the English novel and is a tale of survival and self-reliance. It follows the story of a man named Robinson Crusoe, who is stranded on a deserted island for 28 years.
• “Pride and Prejudice” by Jane Austen (1813) – This novel is considered one of the greatest works of English literature and is a romantic comedy of manners. It follows the story of Elizabeth Bennet and her complicated relationship with Mr. Darcy, a wealthy landowner.
• “To Kill a Mockingbird” by Harper Lee (1960) – This novel is a classic of American literature and deals with issues of race, class, and justice in the American South during the 1930s. It follows the story of a young girl named Scout and her experiences with racism and prejudice.
• “The Great Gatsby” by F. Scott Fitzgerald (1925) – This novel is considered a masterpiece of American literature and is a social commentary on the decadence and excess of the Roaring Twenties. It follows the story of Jay Gatsby, a wealthy and mysterious man, and his obsession with a woman named Daisy Buchanan.

A novella is a work of fiction that is shorter than a novel but longer than a short story. The word “novella” comes from the Italian word for “new”, which is fitting because this type of story is often seen as being between the old and the new. In terms of length, a novella typically has about 20,000 to 40,000 words.

While novels are usually about one main plot with several subplots, novellas are usually focused on one central conflict. This conflict is usually resolved by the end of the story. However, because novellas are longer than short stories, there is more room to develop characters and explore themes in depth.

Examples of Novella in Literature

• “Heart of Darkness” by Joseph Conrad (1899) – This novella is a powerful and haunting portrayal of European imperialism in Africa. It follows the journey of a steamboat captain named Marlow, who is sent to find a man named Kurtz deep in the Congo.
• “The Old Man and the Sea” by Ernest Hemingway (1952) – This novella is a Pulitzer Prize-winning story of an aging Cuban fisherman named Santiago and his epic struggle to catch a giant marlin. It is a testament to the resilience and determination of the human spirit.
• “The Metamorphosis” by Franz Kafka (1915) – This novella is a surreal and disturbing tale of a man named Gregor Samsa, who wakes up one morning to find himself transformed into a giant insect. It explores themes of isolation, identity, and the human condition.
• “Of Mice and Men” by John Steinbeck (1937) – This novella is a tragic story of two migrant workers, George and Lennie, who dream of owning their own farm but are thwarted by their own limitations and the harsh realities of the Great Depression. It is a powerful commentary on the American Dream and the plight of the working class.
• “Animal Farm” by George Orwell (1945) – This novella is a satirical allegory of the Russian Revolution and the rise of Stalinism. It follows the story of a group of farm animals who overthrow their human owner and create their own society, only to be corrupted by their own leaders. It is a cautionary tale about the dangers of totalitarianism and propaganda.

A short story is a work of fiction that typically can be read in one sitting and focuses on a self-contained incident or series of linked incidents.

The short story is one of the oldest forms of literature and has been found in oral cultures as well as in written form. In terms of length, it is much shorter than the novel, typically ranging from 1,000 to 20,000 words.

The short story has often been described as a “perfect form” because it allows for greater compression and variety than either the novel or poem. It also allows writers to experiment with different styles and genres.

Examples of Short Story in Literature

• “The Tell-Tale Heart” by Edgar Allan Poe (1843) – This classic horror story is a chilling portrayal of a murderer who is haunted by the sound of his victim’s heartbeat. It is a masterful example of Poe’s psychological and suspenseful writing style.
• “The Lottery” by Shirley Jackson (1948) – This controversial short story is a commentary on the dark side of human nature and the dangers of blind adherence to tradition. It follows the annual tradition of a small town that holds a lottery, with a surprising and shocking ending.
• “The Gift of the Magi” by O. Henry (1905) – This heartwarming story is a classic example of a holiday tale of selflessness and sacrifice. It follows the story of a young couple who each give up their most prized possession to buy a gift for the other.
• “A Clean, Well-Lighted Place” by Ernest Hemingway (1933) – This minimalist story is a reflection on the existential angst and loneliness of modern life. It takes place in a cafe late at night and explores the relationships between the patrons and the waiter.
• “The Yellow Wallpaper” by Charlotte Perkins Gilman (1892) – This feminist short story is a powerful critique of the medical establishment and the treatment of women’s mental health. It follows the story of a woman who is confined to her bedroom and becomes obsessed with the yellow wallpaper on the walls.

A graphic novel is a book that tells a story through the use of illustrations and text. Graphic novels can be based on true stories, or they can be fictional. They are usually longer than traditional books, and they often have more complex plots.

Graphic novels first gained popularity in the 1970s, when publishers began releasing collections of comics that had been previously published in magazines. Since then, the genre has grown to include original works, as well as adaptations ofexisting stories.

Graphic novels are now widely respected as a form of literature, and they have been adapted into many different mediums, including movies, television shows, and stage plays.

Examples of Graphic Novels in Literature

• “ Watchmen” by Alan Moore and Dave Gibbons (1986-1987) – This graphic novel is considered one of the greatest works of the medium and is a deconstruction of the superhero genre. It follows a group of retired superheroes who come out of retirement to investigate the murder of one of their own.
• “ Maus” by Art Spiegelman (1980-1991) – This Pulitzer Prize-winning graphic novel is a harrowing and poignant account of a Jewish survivor of the Holocaust and his strained relationship with his son. The characters are depicted as animals, with the Jews as mice and the Nazis as cats.
• “ Persepolis” by Marjane Satrapi (2000-2003) – This autobiographical graphic novel is a coming-of-age story set against the backdrop of the Iranian Revolution. It follows the author’s experiences growing up in Iran and then moving to Europe as a teenager.
• “Sandman” by Neil Gaiman (1989-1996) – This epic fantasy series is a masterful exploration of mythology, literature, and human nature. It follows the story of Morpheus, the Lord of Dreams, as he navigates through the world of dreams and interacts with characters from across time and space.
• “Batman: The Dark Knight Returns” by Frank Miller (1986) – This influential graphic novel is a gritty and realistic portrayal of an aging Batman who comes out of retirement to fight crime in a dystopian future. It is credited with revolutionizing the Batman character and inspiring a new era of darker and more mature superhero stories.

Electronic literature, also known as e-literature, is a genre of writing that uses electronic media to create works of art. This type of literature often includes elements of interactivity, hypertextuality, and multimedia.

E-literature has its roots in early computer games and interactive fiction. These early works were created using simple text-based programming languages like BASIC and HTML. Today, e-literature has evolved into a complex form of art that incorporates multimedia elements such as audio and video.

Examples of Electronic Literature in Literature

• “ Afternoon: A Story” by Michael Joyce (1987) – This hypertext fiction is considered one of the earliest examples of electronic literature. It is a nonlinear narrative that can be read in multiple paths and contains multimedia elements like images and sound.
• “ Patchwork Girl” by Shelley Jackson (1995) – This hypertext novel is a retelling of Mary Shelley’s “Frankenstein” that uses digital media to explore the themes of identity, gender, and creation. It contains animated graphics, video, and sound.
• “ The Dreamlife of Letters” by Brian Kim Stefans (2000) – This work of interactive poetry uses computer algorithms to generate new poems based on the user’s input. It combines traditional poetic forms with digital technologies to create a unique reading experience.
• “ Flight Paths” by Kate Pullinger and Chris Joseph (2007) – This work of electronic literature is a collaborative multimedia project that explores the lives of immigrants and refugees. It combines text, video, and audio to create an immersive and interactive experience.
• “Inanimate Alice” by Kate Pullinger and Chris Joseph (2005-2016) – This interactive digital novel follows the story of a young girl named Alice as she grows up in a world of technology and media. It uses a combination of text, video, animation, and sound to create a unique and engaging narrative.

Non-fiction

Non-fiction in literature is defined as prose writings that are based on real events, people, or places. Non-fiction is often divided into categories such as biography, history, and essay.

Examples of Non-fiction in Literature

• “ The Origin of Species” by Charles Darwin (1859) – This landmark book is one of the most influential works in the history of science. It lays out Darwin’s theory of evolution by natural selection and provides evidence for the descent of all living things from a common ancestor.
• “The Autobiography of Malcolm X” by Malcolm X and Alex Haley (1965) – This autobiography is a candid and powerful account of Malcolm X’s life as an African American civil rights leader. It explores his journey from a troubled youth to a powerful orator and activist, and provides insights into the social and political climate of the time.
• “ The Feminine Mystique” by Betty Friedan (1963) – This groundbreaking book is a seminal work of feminist literature. It critiques the idea of the “happy housewife” and argues that women’s social roles and expectations are limiting and oppressive.
• “The New Jim Crow” by Michelle Alexander (2010) – This book is a powerful critique of the criminal justice system and its impact on communities of color. It argues that the system perpetuates racial inequality and provides a call to action for reform.

Drama is a genre of literature that tells a story through the use of dialogue and action. It often has a strong plot and characters who undergo change or development over the course of the story. Drama can be divided into several subgenres, such as tragedy, comedy, and farce.

Examples of Drama in Literature

• “ Hamlet” by William Shakespeare (1603) – This tragedy is considered one of the greatest plays ever written. It tells the story of Prince Hamlet of Denmark and his quest for revenge against his uncle, who murdered his father and married his mother.
• “ A Doll’s House” by Henrik Ibsen (1879) – This play is a landmark work of modern drama. It explores themes of gender roles, marriage, and personal identity through the story of a married woman who decides to leave her husband and children in order to discover herself.
• “ Death of a Salesman” by Arthur Miller (1949) – This play is a powerful critique of the American Dream and the pressures of modern society. It tells the story of a salesman named Willy Loman and his family, as they struggle to come to terms with the realities of their lives.
• “ Fences” by August Wilson (1985) – This play is part of Wilson’s “Pittsburgh Cycle,” a series of ten plays that explore the African American experience in the 20th century. It tells the story of a former Negro League baseball player named Troy Maxson and his relationship with his family.

Also see Literature Review

Examples of Literature

Examples of Literature are as follows:

• “The Silent Patient” by Alex Michaelides
• “Normal People” by Sally Rooney
• “Where the Crawdads Sing” by Delia Owens
• “The Water Dancer” by Ta-Nehisi Coates
• “Harry Potter and the Cursed Child” by J.K. Rowling, Jack Thorne, and John Tiffany
• “The Ferryman” by Jez Butterworth
• “The Inheritance” by Matthew Lopez
• “Sweat” by Lynn Nottage
• “The Hill We Climb” by Amanda Gorman (inaugural poem at the 2021 U.S. presidential inauguration)
• “The Tradition” by Jericho Brown
• “Homie” by Danez Smith
• “The Carrying” by Ada Limón
• “Call Me by Your Name” (2017) directed by Luca Guadagnino (based on the novel by André Aciman)
• “The Great Gatsby” (2013) directed by Baz Luhrmann (based on the novel by F. Scott Fitzgerald)
• “The Lord of the Rings” trilogy (2001-2003) directed by Peter Jackson (based on the novels by J.R.R. Tolkien)
• “The Handmaiden” (2016) directed by Park Chan-wook (based on the novel “Fingersmith” by Sarah Waters)
• “Lemonade” (2016) by Beyoncé (visual album with accompanying poetry and prose)
• “To Pimp a Butterfly” (2015) by Kendrick Lamar (rap album with dense lyrical storytelling)
• “I See You” (2017) by The xx (album inspired by themes of love and connection)
• “Carrie & Lowell” (2015) by Sufjan Stevens (folk album exploring personal and familial themes)
• Blogs and online articles that discuss literary analysis, book reviews, and creative writing
• Online literary magazines and journals publishing contemporary works of fiction, poetry, and essays
• E-books and audiobooks available on platforms like Kindle, Audible, and Scribd
• Social media platforms where writers share their works and engage with readers, such as Twitter and Instagram

Purpose of Literature

The purpose of literature is multifaceted and can vary depending on the author, genre, and intended audience. However, some common purposes of literature include:

Entertainment

Literature can provide enjoyment and pleasure to readers through engaging stories, complex characters, and beautiful language.

Literature can teach readers about different cultures, time periods, and perspectives, expanding their knowledge and understanding of the world.

Reflection and introspection

Literature can encourage readers to reflect on their own experiences and beliefs, prompting self-discovery and personal growth.

Social commentary

Literature can serve as a medium for social criticism, addressing issues such as inequality, injustice, and oppression.

Historical and cultural preservation

Literature can document and preserve the history, traditions, and values of different cultures and societies, providing insight into the past.

Aesthetic appreciation:

literature can be appreciated for its beauty and artistic value, inspiring readers with its language, imagery, and symbolism.

The Significance of Literature

Literature holds immense significance in various aspects of human life and society. It serves as a powerful tool for communication, expression, and exploration of ideas. Here are some of the key significances of literature:

Communication and Expression

Literature allows individuals to communicate their thoughts, emotions, and experiences across time and space. Through various literary forms such as novels, poems, plays, and essays, writers can convey their ideas and perspectives to readers, fostering understanding and empathy.

Cultural Reflection

Literature often reflects the values, beliefs, and experiences of a particular culture or society. It provides insights into different historical periods, social structures, and cultural practices, offering a glimpse into the diversity and richness of human experiences.

Knowledge and Education

Literature is a valuable source of knowledge, as it presents ideas, concepts, and information in an engaging and accessible manner. It introduces readers to different subjects, such as history, science, philosophy, psychology, and more, allowing them to expand their understanding and broaden their intellectual horizons.

Emotional and Intellectual Development

Literature has the power to evoke emotions and provoke critical thinking. By immersing oneself in literary works, readers can develop a deeper understanding of complex emotions, empathy for diverse perspectives, and the ability to think critically and analytically.

Preservation of Cultural Heritage

Literature acts as a repository of a society’s cultural heritage. It preserves the history, traditions, myths, and folklore of a particular community, ensuring that future generations can connect with their roots and learn from the experiences of the past.

Social Commentary and Critique

Literature often serves as a platform for social commentary and critique. Writers use their works to shed light on social issues, challenge societal norms, and promote positive change. By addressing controversial topics and presenting alternative viewpoints, literature can spark discussions and inspire activism.

Entertainment and Escapism

Literature offers a means of entertainment and escapism from the realities of everyday life. Engaging narratives, compelling characters, and vivid descriptions transport readers to different worlds, allowing them to experience joy, excitement, and adventure through the pages of a book.

Imagination and Creativity

Literature fuels the human imagination and nurtures creativity. It encourages readers to think beyond the boundaries of their own experiences, envision new possibilities, and explore alternative realities. Literature inspires writers to craft unique stories and ideas, contributing to the expansion of artistic expression.

Personal Growth and Self-Reflection

Reading literature can have a profound impact on personal growth and self-reflection. It provides opportunities for introspection, introspection, and self-discovery, as readers identify with characters, grapple with moral dilemmas, and contemplate the deeper meaning of life and existence.

The Enduring Impact of Literature

Literature has an enduring impact that transcends time and continues to influence individuals and societies long after it is written. Here are some ways in which literature leaves a lasting impression:

Cultural Legacy:

Literary works become part of a society’s cultural legacy. They shape and reflect the values, beliefs, and traditions of a particular era or community. Classic works of literature, such as Shakespeare’s plays or the novels of Jane Austen, continue to be studied, performed, and celebrated, preserving their impact across generations.

Influence on Other Art Forms:

Literature has a profound influence on other art forms, such as film, theater, music, and visual arts. Many famous literary works have been adapted into films or stage productions, reaching new audiences and extending their influence beyond the written word. Artists and musicians often draw inspiration from literary themes, characters, and narratives, further amplifying their impact.

Shaping Worldviews:

Literature has the power to shape and challenge worldviews. Through stories, ideas, and perspectives presented in literary works, readers are exposed to different cultures, experiences, and ideologies. This exposure fosters empathy, broadens perspectives, and encourages critical thinking, ultimately influencing how individuals perceive and understand the world around them.

Inspirational Source:

Literature serves as an inspirational source for individuals in various fields. Writers, artists, scientists, and thinkers often draw inspiration from the works of literary giants who have explored the depths of human emotions, grappled with existential questions, or challenged societal norms. Literature provides a wellspring of ideas and creativity that continues to fuel innovation and intellectual discourse.

Social and Political Change:

Literature has played a significant role in driving social and political change throughout history. Many literary works have addressed pressing social issues, advocated for human rights, and challenged oppressive systems. By shedding light on societal injustices and encouraging readers to question the status quo, literature has been instrumental in inspiring activism and fostering social progress.

Universal Themes and Human Experience:

Literature explores universal themes and the complexities of the human experience. Whether it’s love, loss, identity, or the pursuit of meaning, these themes resonate with readers across time and cultures. Literary works offer insights into the depths of human emotions, dilemmas, and aspirations, creating a shared understanding and connecting individuals across generations.

Intellectual and Personal Development:

Reading literature stimulates intellectual growth and personal development. It encourages critical thinking, analytical skills, and the ability to empathize with diverse perspectives. Literary works challenge readers to reflect on their own lives, values, and beliefs, promoting self-discovery and personal growth.

Enduring Literary Characters:

Iconic literary characters have a lasting impact on popular culture and the collective imagination. Characters like Sherlock Holmes, Hamlet, or Elizabeth Bennet have become archetypes, influencing the portrayal of similar characters in other works and becoming a part of our cultural lexicon.

Preservation of History and Memory:

Literature plays a crucial role in preserving historical events, experiences, and cultural memories. Historical novels, memoirs, and eyewitness accounts provide valuable insights into past eras, allowing future generations to learn from and connect with the past.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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Meaning of published in English

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• Her publishers knew they were taking a gamble when they agreed to publish such an unusual novel .
• Newspapers publish these outrageous stories because they know what their public wants .
• She agreed not to publish the names of the people involved .
• Last week the commission published its long-awaited report on the problem of teenage pregnancies .
• Photographs were published of her in a compromising position with her bodyguard .
• 3-D printing
• indentation
• print on demand
• print something out
• typographical
• unpublished

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Examples of published.

In English, many past and present participles of verbs can be used as adjectives. Some of these examples may show the adjective use.

Word of the Day

in store for someone

planned or likely to happen

I feel it in my bones: phrases connected with believing or disbelieving

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• factoid - An unsubstantiated statement, account, or report published as if it were factual, coined by the novelist Norman Mailer from fact + -oid (as in android, humanoid), in reference to his fictionalized biography of Marilyn Monroe.
• divulgate - If something is divulgate, it is published.
• libel , slander - Libel—from Latin libellus, "little book"—must be published, while spoken defamatory remarks are slander; libel first meant "document, written statement."
• backlist - Older books kept in print by a publisher.
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Synonyms of published

• as in posted
• as in printed
• as in announced
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Thesaurus Definition of published

 (Entry 1 of 2)

Synonyms & Similar Words

• promulgated
• unclassified
• spotlighted
• well - known
• nonclassified

Antonyms & Near Antonyms

• confidential
• undisclosed
• unannounced
• clandestine
• unadvertised
• conspiratorial
• surreptitious
• underhanded

Thesaurus Definition of published  (Entry 2 of 2)

• republished
• came out with
• co - published
• contributed
• copublished
• distributed
• manufactured
• broadcasted
• disseminated
• annunciated
• beat the drum (for or about)
• called (off or out)
• communicated
• billboarded
• handed down
• hushed (up)

Thesaurus Entries Near published

Cite this entry.

“Published.” Merriam-Webster.com Thesaurus , Merriam-Webster, https://www.merriam-webster.com/thesaurus/published. Accessed 27 Nov. 2023.

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• Introduction
• Conclusions
• Article Information

a Uninfected included acute cohort (n = 1092) and postacute cohort (n = 999) participants. Uninfected participants had no known history of SARS-CoV-2 infection. Acute uninfected participants were enrolled within 30 days of a SARS-CoV-2 negative test result, while postacute uninfected participants were enrolled more than 30 days after a SARS-CoV-2 negative test result.

b Participants who completed visit without reaching end of visit window were included in this count.

A, Optimal score cutoff for classifying a participant as PASC positive using cross-validation (eMethods in Supplement 3 ). The decision rule based on symptoms is intended to identify participants with PASC. PASC status for participants not meeting the score threshold requires consideration of additional data inputs.

B, Symptom frequencies among PASC-positive participants for symptoms that contribute to the PASC score. Many other symptoms have high frequency in PASC-positive participants (eTable 8 in Supplement 3 ).

C, Distribution of Patient-Reported Outcomes Measurement Information System (PROMIS) Global 10 responses among participants with a zero PASC score and among participants within nonzero PASC score quintiles. The PROMIS Global 10 provides an assessment of quality of life along 10 dimensions, each rated on a 5-point scale. The shading corresponds to frequency within each column on a scale from 0% to 100%.

a Additional severity criteria required (eTables 1 and 2 in Supplement 3 ).

A, Dendrogram illustrating how PASC-positive participants with similar symptom profiles cluster. Each branch in the dendrogram represents a participant, and each cluster represents a subgroup of participants.

B. Heatmap of symptom frequencies within PASC unspecified and within each PASC-positive subgroup. The shading corresponds to frequency within each column on a scale from 0% to 100%.

a Although unsupervised learning uses 12 symptoms selected by least absolute shrinkage and selection operator (LASSO) (Figure 2), many other symptoms occur in combination with these 12.

Trial Protocol

Statistical Analysis Plan

eReferences

eTable 1. Symptoms Considered in Analysis

eTable 2. Additional Severity Criteria Applied to Symptoms for Analysis

eTable 3. PROMIS Global-10 Questions Used

eTable 4. Vaccination Category Definitions

eTable 5. RECOVER-Adult Additional Demographic and Clinical Characteristics by Infection Status

eTable 6. RECOVER-Adult Demographic Characteristics by Sub-cohort

eTable 7. Symptoms That Correlate With Symptoms Contributing to PASC Score

eTable 8. Symptom Frequencies Among PASC-Positive Participants

eTable 9. PASC Frequencies by Time Since Index Date, Infected Participants

eTable 10. PASC Onset and Resolution Over Time

eTable 11. PASC Subgroup Distributions

eFigure 1. Symptom Frequency, Full Analysis Cohort

eFigure 2. New Onset Symptom Frequency, Full Analysis Cohort

eFigure 3. Symptom Frequency, Full Cohort, Without Severity Scores

eFigure 4. Distribution of Time From Index to Analysis Visit Date

eFigure 5. Symptom Frequency, Acute, Omicron

eFigure 6. Symptom Frequency, Post-Acute, Pre-Omicron

eFigure 7. Symptom Frequency, Post-Acute, Omicron

eFigure 8. Symptom Frequency, Acute, Fully Vaccinated, Omicron

Nonauthor Collaborators. RECOVER Consortium

Data Sharing Statement

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Thaweethai T , Jolley SE , Karlson EW, et al. Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection. JAMA. 2023;329(22):1934–1946. doi:10.1001/jama.2023.8823

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Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection

• 1 Massachusetts General Hospital, Boston
• 2 Harvard Medical School, Boston, Massachusetts
• 3 University of Colorado Anschutz Medical Campus, Aurora
• 4 Brigham and Women’s Hospital, Boston, Massachusetts
• 5 University of Alabama at Birmingham
• 6 Case Western Reserve University, Cleveland, Ohio
• 7 Patient-Led Research Collaborative, Calabasas, California
• 8 Icahn School of Medicine at Mount Sinai, New York, New York
• 9 The University of Arizona College of Medicine, Tucson
• 10 Stanford University School of Medicine, Stanford, California
• 11 Emory University School of Medicine, Atlanta, Georgia
• 12 Mass General Brigham, Boston, Massachusetts
• 13 New York University Grossman School of Medicine, New York
• Editorial Disentangling the Postacute Sequelae of SARS-CoV-2 Robert Gross, MD, MSCE; Vincent Lo Re III, MD, MSCE JAMA
• Medical News & Perspectives How Primary Care Physicians Can Recognize and Treat Long COVID Esther Wei-Yun Landhuis, PhD JAMA
• Comment & Response Postacute Sequelae of SARS-CoV-2 Infection—Reply Tanayott Thaweethai, PhD; Andrea S. Foulkes, ScD JAMA
• Comment & Response Postacute Sequelae of SARS-CoV-2 Infection Ayush Batra, MD; Avindra Nath, MD; Igor J. Koralnik, MD JAMA
• Original Investigation Documentation of Diagnostic Codes for Long COVID in the National Veterans Affairs Health Care System George N. Ioannou, BMBCh, MS; Aaron Baraff, MS; Alexandra Fox, MSIS; Troy Shahoumian, PhD; Alex Hickok, MS; Ann M. O’Hare, MD; Amy S. B. Bohnert, PhD; Edward J. Boyko, MD, MPH; Matthew L. Maciejewski, PhD; C. Barrett Bowling, MD, MSPH; Elizabeth Viglianti, MD; Theodore J. Iwashyna, MD, PhD; Denise M. Hynes, MPH, PhD, RN JAMA Network Open
• Original Investigation Prevalence and Correlates of Long COVID Symptoms Among US Adults Roy H. Perlis, MD, MSc; Mauricio Santillana, PhD; Katherine Ognyanova, PhD; Alauna Safarpour, PhD; Kristin Lunz Trujillo, PhD; Matthew D. Simonson, PhD; Jon Green, PhD; Alexi Quintana, BA; James Druckman, PhD; Matthew A. Baum, PhD; David Lazer, PhD JAMA Network Open
• Original Investigation Complexity and Challenges of the Clinical Diagnosis and Management of Long COVID Ann M. O’Hare, MA, MD; Elizabeth K. Vig, MD, MPH; Theodore J. Iwashyna, MD, PhD; Alexandra Fox, PhD; Janelle S. Taylor, PhD; Elizabeth M. Viglianti, MD; Catherine R. Butler, MD, MA; Kelly C. Vranas, MD, MCR; Mark Helfand, MD, MPH; Anaïs Tuepker, PhD, MPH; Shannon M. Nugent, PhD; Kara A. Winchell, MA; Ryan J. Laundry, BS; C. Barrett Bowling, MD, MSPH; Denise M. Hynes, RN, PhD; Matthew L. Maciejewski, PhD; Amy S. B. Bohnert, PhD; Emily R. Locke, MPH; Edward J. Boyko, MD, MPH; George N. Ioannou, BMBCh, MS; VA COVID Observational Research Collaboratory (CORC) JAMA Network Open

Question   What symptoms are differentially present in SARS-CoV-2–infected individuals 6 months or more after infection compared with uninfected individuals, and what symptom-based criteria can be used to identify postacute sequelae of SARS-CoV-2 infection (PASC) cases?

Findings   In this analysis of data from 9764 participants in the RECOVER adult cohort, a prospective longitudinal cohort study, 37 symptoms across multiple pathophysiological domains were identified as present more often in SARS-CoV-2–infected participants at 6 months or more after infection compared with uninfected participants. A preliminary rule for identifying PASC was derived based on a composite symptom score.

Meaning   A framework for identifying PASC cases based on symptoms is a first step to defining PASC as a new condition. These findings require iterative refinement that further incorporates clinical features to arrive at actionable definitions of PASC.

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.

More than 658 million people worldwide have been infected with SARS-CoV-2. 1 Postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID and defined as ongoing, relapsing, or new symptoms or conditions present 30 or more days after infection, is a major clinical and public health concern. 2 - 6 Short- and long-term effects of PASC have substantial impacts on health-related quality of life, earnings, and health care costs. 7 , 8 Most existing PASC studies have focused on individual symptom frequency and have generated widely divergent estimates of prevalence due to their retrospective design and lack of an uninfected comparison group. Moreover, defining PASC precisely is difficult because it is heterogeneous, composed of conditions with variable and potentially overlapping etiologies (eg, organ injury, viral persistence, immune dysregulation, autoimmunity, and gut dysbiosis). 9 , 10

It is of significant public health and scientific importance to better research the underlying mechanisms of PASC and potential preventive and therapeutic interventions. This effort requires data collection on SARS-CoV-2–infected and –uninfected individuals in a large prospective cohort study designed specifically to characterize PASC. Additionally, simultaneous consideration of multiple symptoms that persist over time and application of appropriate analytical techniques are essential. Further consideration of changes in PASC frequency and its manifestations over the course of the COVID-19 pandemic, due to variable SARS-CoV-2 strains, new treatment and prevention strategies, and repeat infections, is important.

This study is part of the National Institutes of Health’s Researching COVID to Enhance Recovery (RECOVER) Initiative, which seeks to understand, treat, and prevent PASC ( https://recovercovid.org/ ). In this first analysis of data from the RECOVER adult cohort, criteria for identifying PASC based on self-reported symptoms are delineated and several distinctive PASC subphenotypes with varying impacts on well-being and physical health are described. This study was enriched with self-referred participants to promote inclusive participation. Estimates were expected to be more accurate in the subcohort of participants enrolled within 30 days of acute infection, for whom selection bias based on PASC would be minimal.

Unlike electronic health records and most existing cohort studies, data from this study captured PASC-specific self-reported symptoms based on standardized questionnaires developed with input from patient representatives. This report is an adequately powered, prospective study of PASC based on participant-reported symptoms that included both infected and uninfected individuals over the course of the pandemic. Notably, unlike prior reports, the paradigm presented here does not rely on predefined clinical symptoms; instead, a definition of PASC as a new condition specific to SARS-CoV-2 infection is proposed.

Institutional review boards at NYU Grossman School of Medicine, serving as a single institutional review board, and other participating institutions reviewed and approved the protocol. All participants provided written informed consent to participate in research.

The RECOVER adult cohort study included SARS-CoV-2–infected and –uninfected participants (the trial protocol is in Supplement 1 and the statistical analysis plan in Supplement 2 ). All infected participants met World Health Organization suspected, probable, or confirmed criteria. 11 Index for infected participants was defined as date of first positive SARS-CoV-2 test result or COVID-19 symptom onset. Uninfected participants had no known history of SARS-CoV-2 infection and index was defined as a past negative SARS-CoV-2 test result date. Participants belonged to either the acute cohort (enrolled ≤30 days since index) or the postacute cohort (enrolled >30 days to 3 years after index). Participants were recruited from 85 sites across the United States and completed office visits and remote surveys developed with early engagement of patients, support group stakeholders, and multidisciplinary clinical experts. 12

Adult participants enrolled prior to April 10, 2023 (N = 13 754) were considered ( Figure 1 ). Enrollment is ongoing, and not all enrolled participants have reached eligibility for inclusion. The analysis cohort included participants with a study visit completed 6 months or more after the index date ( Table 1 ). Uninfected participants with a reported on-study infection and participants who had no symptom survey data were excluded. A subgroup of participants also belonged to the RECOVER pregnancy cohort. Race and ethnicity were captured via participant self-report using fixed categories to better understand racial and ethnic differences in sequelae due to SARS-CoV-2 infection (eMethods in Supplement 3 ).

The analysis used the first study visit at 6 months or more after the index date. The exposure was SARS-CoV-2 infection prior to study enrollment. Uninfected participants with antibody results at enrollment indicating prior infection were reclassified as infected and assigned an index date 90 days prior. The primary outcome was the presence of each of 44 symptoms (eTable 1 in Supplement 3 ). Using these symptoms, a PASC definition was developed. The primary analysis used symptom presence for inclusivity; sensitivity analysis considered new-onset symptoms. Results were reported for 3 additional age- and sex-dependent symptoms (eTable 1 in Supplement 3 ).

Results were reported overall and within 3 subcohorts: acute Omicron (n = 2231 infected, n = 388 uninfected; index date on or after December 1, 2021); postacute pre-Omicron (n = 3732 infected, n = 290 uninfected; index date before December 1, 2021); and postacute Omicron (n = 2666 infected, n = 438 uninfected; index date on or after December 1, 2021). Acute cohort participants with a pre-Omicron index date (17 infected, 2 uninfected) were included in overall analyses.

Balancing weights were used to account for differences in the age, sex, and race and ethnicity distributions between infected and uninfected participants (eMethods in Supplement 3 ). Symptom frequency was defined as the proportion reporting a symptom and exceeding corresponding moderate to severe symptom severity threshold (eTables 1 and 2 in Supplement 3 ). Symptoms with frequency of 2.5% or greater were considered. Symptom frequencies by infection status were reported and adjusted odds ratios (aORs) were calculated using weighted logistic regression. In sensitivity analysis, new-onset symptom frequency was defined as the proportion of participants with the symptom at study visit among those without the symptom in the year prior to the index date. Symptom frequencies characterized the study cohort and were not unbiased estimators of population-level prevalence due to the cohort sampling strategies. Symptom frequency estimates within the acute Omicron subcohort were expected to be more aligned with the corresponding population frequencies.

A rule for identifying PASC was derived. Symptoms differentiating infected and uninfected participants were identified using least absolute shrinkage and selection operator (LASSO) with balancing weights. 13 Each symptom was assigned a score based on the estimated coefficients and participants were assigned a total score by summing the symptom scores for each reported symptom. Using 10-fold cross-validation, an optimal score threshold for PASC was selected (eMethods in Supplement 3 ). Participants meeting the PASC score threshold were classified as PASC positive; others were classified as PASC unspecified. The proportions were reported.

Participants classified as PASC positive were clustered into subgroups using unsupervised learning (K-means consensus clustering 14 followed by hierarchical clustering 15 ) including symptoms identified with LASSO. Symptoms highly correlated with those identified by LASSO were reported. The distribution of PASC score and Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health 10 general quality of life (Q2), general physical health (Q3), and ability to carry out everyday physical activities (Q6) (eTable 3 in Supplement 3 ) were reported.

Rates of PASC were assessed by infection status, sex, age, and vaccination status at the index date (eTable 4 in Supplement 3 ), reinfection (between index and analysis visit), and visit month. The proportion of participants meeting criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS, defined based on RECOVER survey; eMethods in Supplement 3 ) who were PASC positive at the same visit was reported. Sensitivity analyses removed the symptom severity thresholds and separately added well-being and physical health requirements for PASC (Q2 or Q3: fair or poor; Q6: moderate or worse). Inverse probability weighting was applied to account for loss to follow-up in the acute Omicron subcohort (eMethods in Supplement 3 ).

A total of 9764 participants (8646 infected; 1118 uninfected) met study criteria ( Figure 1 , 71% female [6932/9712]; 16% Hispanic/Latino [1592/9664]; 15% non-Hispanic Black [1417/9664]; 58% fully vaccinated at the index date [5585/9633]; median age, 47 years [IQR, 35-60]). After application of balancing weights, the distributions of age, sex, and race and ethnicity were the same in infected and uninfected participants ( Table 1 ). In the weighted cohort, uninfected participants were more likely to be fully vaccinated (77% vs 55%). Comorbidity frequencies were similar between infected and uninfected participants (eTable 5 in Supplement 3 ). Uninfected participants were more likely to be self-referrals or recruited via community outreach (eTable 5 in Supplement 3 ). A total of 1260 of 6932 female participants (18%) were in the pregnancy cohort.

In the full cohort, 37 symptoms had frequency of 2.5% or greater and aORs were 1.5 or greater (infected vs uninfected participants) for all 37 (eFigure 1 in Supplement 3 ). Symptoms (using severity thresholds) with more than 15% absolute difference in frequencies (infected vs uninfected) included postexertional malaise (PEM) (28% vs 7%; aOR, 5.2 [95% CI, 3.9-6.8]), fatigue (38% vs 17%; aOR, 2.9 [95% CI, 2.4-3.4]), dizziness (23% vs 7%; aOR, 3.4 [95% CI, 2.6-4.4]), brain fog (20% vs 4%; aOR, 4.5 [95% CI, 3.2-6.2]), and gastrointestinal (GI) symptoms (25% vs 10%; aOR, 2.7 [95% CI, 2.2-3.4]).

In infected participants, the frequencies of new-onset symptoms (with severity thresholds) were similar, including PEM (28%), fatigue (37%), dizziness (21%), brain fog (20%), and GI symptoms (20%) (eFigure 2 in Supplement 3 ). The corresponding observed symptom frequencies without severity thresholds were higher (eg, fatigue, 47%; brain fog, 40%) (eFigure 3 in Supplement 3 ).

The distributions of demographics and comorbidities were comparable across the acute Omicron, postacute pre-Omicron, and postacute Omicron subcohorts, though there was a higher proportion unvaccinated in the postacute pre-Omicron subcohort (eTable 6 in Supplement 3 ). Time from the index date to analysis visit ranged from 6 to 15 months in the acute Omicron and postacute Omicron subcohorts and 6 to 39 months in the postacute pre-Omicron subcohort (eFigure 4 in Supplement 3 ). Generally, symptom frequencies and the differences between infected and uninfected participants were lower in the acute Omicron subcohort, higher in the postacute Omicron subcohort, and highest in the postacute pre-Omicron subcohort (eFigures 5-7 in Supplement 3 ). Symptom frequencies in acute Omicron participants who were also fully vaccinated were the lowest (eFigure 8 in Supplement 3 ).

Using the full cohort, LASSO identified 12 symptoms with corresponding scores ranging from 1 to 8 ( Table 2 ). The optimal PASC score threshold used was 12 or greater ( Figure 2 A). The symptoms (ordered by decreasing frequencies among participants with a qualifying PASC score) were PEM, fatigue, brain fog, dizziness, GI symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Symptoms correlated with the selected symptoms included dry mouth, weakness, headaches, tremor, muscle and abdominal pain, fever/sweats/chills, and sleep disturbance (eTable 7 in Supplement 3 ).

The proportion with a qualifying PASC score in the full cohort (subject to selection bias) was 1990 of 8646 infected participants (23%) and 41 of 1118 of uninfected participants (3.7%) (overall: 2031/9764 [21%]). Among participants with PASC, the most common symptoms were PEM (87%), fatigue (85%), brain fog (64%), dizziness (62%), GI (59%), and palpitations (57%) ( Figure 2 B; eTable 8 in Supplement 3 ). Higher PASC scores were associated with worse PROMIS Global 10 scores ( Figure 2 C).

The proportion of infected participants with PASC in the acute Omicron subcohort was 10% (95% CI, 8.8%-11%; 224/2231). After adjustment for missing data, the estimated rate was 9.8% (95% CI, 8.6%-11%). It was greater in the postacute pre-Omicron (1320/3732 [35%; 95% CI, 34%-37%]) and postacute Omicron (442/2666 [17%; 95% CI, 15%-18%]) subcohorts ( Table 3 ). Symptom frequencies among PASC-infected participants were similar across subcohorts, with a few notable exceptions, including brain fog, GI symptoms, and palpitations (eTable 8 in Supplement 3 ). The proportion of PASC positivity was lower among fully vaccinated than unvaccinated participants (acute Omicron: 9.7% vs 17%; postacute pre-Omicron: 31% vs 37%; postacute Omicron: 16% vs 22%) ( Table 3 ). In the Omicron cohorts, the estimated proportion of PASC positivity was greater among reinfected participants compared with participants with 1 reported infection (acute Omicron: 20% vs 9.7%; postacute Omicron: 21% vs 16%) ( Table 3 ).

Among infected participants in the full cohort, the proportions of PASC positivity were 39% (299/757) among hospitalized participants and 22% (1636/7387) among not hospitalized participants during acute infection; 19% (442/2377) among males and 25% (1540/6221) among females; and 20% (885/4389) among those aged 18 to 45 years and 28% (904/3175) (28%) among those aged 46 to 65 years. In cross-sectional analysis, the proportion of PASC-positive participants was consistent over the visit month used in analysis (eTable 9 in Supplement 3 ). In subgroups with repeated visits at 6 and 9 months after the index date, PASC positivity varied over study visit, though 68% of PASC-positive participants remained positive at the subsequent visit (eTable 10 in Supplement 3 ). Among infected participants meeting criteria for ME/CFS, 98% met the criteria for PASC.

The proportions of PASC increased to 27% (2300/8646) among infected participants and 4.7% (52/1118) among uninfected participants when severity scores were not included in the PASC score determination. After applying additional PROMIS Global 10 criteria to qualify as PASC positive, 17% (1434/8646) were PASC positive among infected participants and 3.0% (34/1118) among uninfected participants.

Four PASC subgroups were identified ( Figure 3 A). Features of PASC subgroups included loss of or change in smell or taste (100%) in cluster 1 (n = 477); PEM (99%) and fatigue (84%) in cluster 2 (n = 405); brain fog (100%), PEM (99%), and fatigue (94%) in cluster 3 (n = 587); and fatigue (94%), PEM (94%), dizziness (94%), brain fog (94%), GI (88%), and palpitations (86%) in cluster 4 (n = 562) ( Figure 3 B). Twenty-six percent of the PASC-unspecified group also met PROMIS Global 10 criteria compared with 53% of participants in cluster 1, 69% in cluster 2, 77% in cluster 3, and 86% in cluster 4. Among infected participants, 456 of 1540 females (30%) and 102 of 442 males (23%) with PASC were in cluster 4. A total of 277 of 885 participants aged 18 to 45 years (31%), 254 of 904 participants aged 46 to 65 years (28%), and 29 of 198 participants aged older than 65 years (15%) with PASC were in cluster 4.

The proportion of PASC-positive infected participants in cluster 4 was higher within the postacute pre-Omicron (31%) than postacute Omicron (23%) and acute Omicron (23%) subcohorts (eTable 11A in Supplement 3 ). Overall, among PASC-positive infected participants, the proportion in cluster 4 among fully vaccinated compared with unvaccinated participants was 23% vs 32% (eTable 11B in Supplement 3 ). The distribution of clusters was similar for participants with a single reported infection compared with those with more than 1 infection, though the results varied by prevalent SARS-CoV-2 strain (eTable 11C in Supplement 3 ).

This study reported early results from a prospective, survey-based cohort of adult SARS-CoV-2–infected and –uninfected individuals with ascertainment of patient-reported symptoms. A data-driven scoring framework was developed to classify PASC as a condition specific to SARS-CoV-2 infection. Based on this PASC score, 10% of participants first infected on or after December 1, 2021, and enrolled within 30 days of infection were classified as PASC positive at 6 months after infection. Increasing levels of the PASC score were associated with progressively worse measures of well-being and functioning. Although only 12 symptoms contributed to the PASC score, other symptoms correlated with this subgroup are individually important, considering their potential adverse impact on health-related quality of life.

PASC positivity was more common and associated with more severe manifestation in participants infected in the pre-Omicron era. Though participants with earlier infection may have been more likely to enroll in the RECOVER adult cohort because of known PASC, multiple studies reported an association between PASC and early pandemic variants. 16 Among participants with a first infection during the Omicron era, PASC frequency was higher among those with recurrent infections, corroborating electronic health record–based studies. 4 , 17 - 23 Though studies on the effect of vaccination are conflicting, these findings of modest reduction in PASC frequency among fully vaccinated participants align with recent systematic reviews. 24 , 25

This study found that long-term symptoms associated with SARS-CoV-2 infection spanned multiple organ systems. The diversity of symptoms may be related to persistent viral reservoirs, autoimmunity, or direct differential organ injury. The symptoms identified are consistent with those reported in studies that assessed PASC manifestations (eMethods in Supplement 3 ). However, by simultaneously considering the contributions of multiple self-reported symptoms, a PASC-scoring algorithm that provides a framework for diagnosing PASC was developed.

Given the heterogeneity of PASC symptoms, determining whether PASC represents one unified condition or reflects a group of unique phenotypes is important. Recent evidence supports the presence of PASC phenotypes, although characterization of these phenotypes is inconsistent and largely dependent on available data. 2 , 6 , 22 , 23 Accurate phenotypic stratification has important implications for investigations into the pathophysiological processes underlying PASC and clinical trial design. PASC subgroups that demonstrate overlap with conditions previously described in clinical practice are detailed here, including olfactory dysfunction, cardiopulmonary sequelae, neurocognitive impairment, ME/CFS, and dysautonomia 26 - 30 and overlap with those reported by the National COVID Cohort Collaborative. 6 Biological samples from these participants may enable the development of biomarkers of PASC and reveal insights into the mechanistic underpinnings of PASC that inform choice of therapeutic interventions and case selection in upcoming clinical trials for PASC.

First, the proposed paradigm and accompanying decision rule require iterative refinement as additional data become available. The PASC score provides an operational definition of PASC and requires further refinement and validation. RECOVER recruitment is ongoing, and not all participants have reached the analysis stage. Evolution and refinement of the phenotypes are anticipated as additional data become available.

Second, selection bias was likely among postacute cohort participants that may have affected frequency estimates including distribution of subphenotypes because PASC severity may impact study participation. Differential attrition of symptomatic and asymptomatic participants at follow-up visits could also have biased frequency estimates though use of inverse probability weighting in the acute cohorts mitigated this bias.

Third, uninfected participants may have had prior asymptomatic SARS-CoV-2 infections not detected due to variations in antibody production and persistence, weakening the discriminant characteristics of this PASC score threshold.

Fourth, symptoms were self-reported and only some symptoms integrate severity scales. Participants could report other symptoms as free text; these were not included in this analysis.

Fifth, confounding may have impacted effect sizes, eg, vaccination status may have been higher in participants at higher risk of PASC, attenuating a vaccination effect. Additionally, PASC status can change over time, perhaps due to underlying mechanistic changes.

Sixth, more than 200 symptoms of PASC have been reported, each with the potential of being life-altering and debilitating, and the symptoms highlighted herein may not reflect the severity or impact of other symptoms.

This symptom-based PASC definition represents a first step for identifying PASC cases and serves as a launching point for further investigations. Definition of a classification rule for PASC requires an updated algorithm that incorporates symptoms as well as biological features. Future analyses must consider the relationships among age, sex, race and ethnicity, social determinants of health, vaccination status after index date, comorbidities, and pregnancy status during infection on the risk of PASC and the distribution of PASC subgroups.

Accepted for Publication: May 1, 2023.

Published Online: May 25, 2023. doi:10.1001/jama.2023.8823

Corresponding Author: Andrea S. Foulkes, ScD, Massachusetts General Hospital Biostatistics, 50 Staniford St, Ste 560, Boston, MA 02114 ( [email protected] ).

RECOVER Consortium Authors: George A. Alba, MD; Radica Alicic, MD; Natasha Altman, MD; Khamal Anglin, MD, MPH; Urania Argueta, BS; Hassan Ashktorab, PhD; Gaston Baslet, MD; Ingrid V. Bassett, MD, MPH; Lucinda Bateman, MD; Brahmchetna Bedi, PhD; Shamik Bhattacharyya, MD, MS; Marie-Abele Bind, PhD; Andra L. Blomkalns, MD, MBA; Hector Bonilla, MD; Patricia A. Bush, MS, EdD; Mario Castro, MD, MPH; James Chan, MA; Alexander W. Charney, MD, PhD; Peter Chen, MD; Lori B. Chibnik, PhD, MPH; Helen Y. Chu, MD, MPH; Rebecca G. Clifton, PhD; Maged M. Costantine, MD; Sushma K. Cribbs, MD, MSc; Sylvia I. Davila Nieves, MS; Steven G. Deeks, MD; Alexandria Duven, RN; Ivette F. Emery, PhD; Nathan Erdmann, MD, PhD; Kristine M. Erlandson, MD, MS; Kacey C. Ernst, PhD, MPH; Rachael Farah-Abraham, PhD; Cheryl E. Farner, MSN; Elen M. Feuerriegel, PhD; Judes Fleurimont, MPH; Vivian Fonseca, MD; Nicholas Franko, BS; Vivian Gainer, MS; Jennifer C. Gander, PhD; Edward M. Gardner, MD; Linda N. Geng, MD, PhD; Kelly S. Gibson, MD; Minjoung Go, MD, MPH; Jason D. Goldman, MD, MPH; Halle Grebe, BS; Frank L. Greenway, MD; Mounira Habli, MD; John Hafner, MD, MPH; Jenny E. Han, MD, MS; Keith A. Hanson, MD, PhD; James Heath, PhD; Carla Hernandez, RN; Rachel Hess, MD, MS; Sally L. Hodder, MD; Matthew K. Hoffman, MD, MPH; Susan E. Hoover, MD, PhD; Beatrice Huang, BA; Brenna L. Hughes, MD; Prasanna Jagannathan, MD; Janice John, MS, MHCDS; Michael R. Jordan, MD; Stuart D. Katz, MD, MS; Elizabeth S. Kaufman, MD; John D. Kelly, MD; Sara W. Kelly, PhD, MPH; Megan M. Kemp, BA; John P. Kirwan, PhD; Jonathan D. Klein, MD, MPH; Kenneth S. Knox, MD; Jerry A. Krishnan, MD, PhD; Andre Kumar, MD; Adeyinka O. Laiyemo, MD; Allison A. Lambert, MD; Margaret Lanca, PhD; Joyce K. Lee-Iannotti, MD; Brian P. Logarbo, MD, MS; Michele T. Longo, MD; Carlos A. Luciano, MD; Karen Lutrick, PhD; Jason H. Maley, MD, MS; Jai G. Marathe, MD, MBBS; Vincent Marconi, MD; Gailen D. Marshall, MD, PhD, MS; Christopher F. Martin, MBA; Yuri Matusov, MD; Alem Mehari, MD; Hector Mendez-Figueroa, MD; Robin Mermelstein, PhD; Torri D. Metz, MD, MS; Richard Morse, BA; Jarrod Mosier, MD; Christian Mouchati, MD; Janet Mullington, PhD; Shawn N. Murphy, MD, PhD; Robert B. Neuman, MD; Janko Z. Nikolich, MD, PhD; Ighovwerha Ofotokun, MD; Elizabeth Ojemakinde, MD, MPH; Anna Palatnik, MD; Kristy Palomares, MD, PhD; Tanyalak Parimon, MD; Samuel Parry, MD; Jan E. Patterson, MD; Thomas F. Patterson, MD; Rachel E. Patzer, PhD, MPH; Michael J. Peluso, MD; Priscilla Pemu, MD, MS; Christian M. Pettker, MD; Beth A. Plunkett, MD, MPH; Kristen Pogreba-Brown, PhD; Athena Poppas, MD; John G. Quigley, MD; Uma Reddy, MD; Rebecca Reece, MD; Harrison Reeder, PhD; W. B. Reeves, MD; Eric M. Reiman, MD; Franz Rischard, DO, MSc; Jonathan Rosand, MD, MS; Dwight J. Rouse, MD; Adam Ruff, BS; George Saade, MD; Grecio J. Sandoval, PhD; Shannon M. Schlater, MS; Fitzgerald Shepherd, MD; Zaki A. Sherif, PhD; Hyagriv Simhan, MD; Nora G. Singer, MD; Daniel W. Skupski, MD; Amber Sowles, RN, BSN; Jeffrey A. Sparks, MD, MMSc; Fatima I. Sukhera, MD; Barbara S. Taylor, MD; Larissa Teunis, MPA; Robert J. Thomas, MD; John M. Thorp, MD, MS; Paul Thuluvath, MD; Amberly Ticotsky, MPH, RN; Alan T. Tita, MD, PhD; Katherine R. Tuttle, MD; Alfredo E. Urdaneta, MD; Daisy Valdivieso, BS; Timothy M. VanWagoner, PhD; Andrew Vasey, MD; Monica Verduzco-Gutierrez, MD; Zachary S. Wallace, MD; Honorine D. Ward, MD; David E. Warren, PhD; Steven J. Weiner, MS; Shelley Welch, MS; Sidney W. Whiteheart, PhD; Zanthia Wiley, MD; Juan P. Wisnivesky, MD, DrPH; Lynn M. Yee, MD; Sokratis Zisis, MD.

Affiliations of RECOVER Consortium Authors: Massachusetts General Hospital, Boston (Alba, Bassett, Bind, Chan, Chibnik, Morse, Murphy, Reeder, Rosand, Wallace); Harvard Medical School, Boston, Massachusetts (Lanca, Mullington, Plunkett); University of Colorado Anschutz Medical Campus, Aurora (Altman, Erlandson, Feuerriegel); Brigham and Women’s Hospital, Boston, Massachusetts (Baslet, Bhattacharyya, Sparks); University of Alabama at Birmingham (Erdmann); Case Western Reserve University, Cleveland, Ohio (Zisis); Icahn School of Medicine at Mount Sinai, New York, New York (Charney, Wisnivesky); Stanford University School of Medicine, Stanford, California (Go, Kumar, Urdaneta); Emory University School of Medicine, Atlanta, Georgia (Bedi, Cribbs, Han, Ofotokun); New York University Grossman School of Medicine, New York (Katz); University of Washington, Seattle (Alicic, Franko, Kemp, Lambert, Tuttle); University of California, San Francisco (Anglin, Argueta, Deeks, Grebe, Huang, Peluso, Valdivieso); Howard University, Washington, DC (Ashktorab); Bateman Horne Center, Salt Lake City, Utah (Bateman); Stanford University, Stanford, California (Blomkalns, Bonilla, Geng, Jagannathan); Kaiser Foundation Health Plan of Georgia Inc, Atlanta (Bush, Neuman); University of Kansas Medical Center, Kansas City (Castro); Cedars-Sinai Medical Center, Los Angeles, California (Chen, Matusov); University of Washington School of Medicine, Seattle (Chu); George Washington University, Washington, DC (Clifton); The Ohio State University, Columbus (Costantine); Universidad de Puerto Rico Recinto de Ciencias Medicas, San Juan, Puerto Rico (Davila Nieves); Swedish Medical Center, Seattle, Washington (Duven, Goldman); MaineHealth, Portland (Emery); The University of Arizona, Tucson (Ernst, Lutrick, Nikolich, Pogreba-Brown); Emory University, Atlanta, Georgia (Farah-Abraham, Marconi, Martin, Patzer, Teunis, Wiley); The University of Texas Health Science Center at San Antonio (Farner, J. E. Patterson, T. F. Patterson, Taylor, Verduzco-Gutierrez); University of Illinois Chicago (Fleurimont, Mermelstein); Tulane University Health Sciences Center, New Orleans, Louisiana (Fonseca); Partners HealthCare Systems, Boston, Massachusetts (Gainer); Kaiser Permanente Georgia, Atlanta (Gander); Denver Health, Denver, Colorado (Gardner); MetroHealth Medical Center, Cleveland, Ohio (Gibson, Singer); Pennington Biomedical Research Center, Baton Rouge, Louisiana (Greenway, Kirwan); TriHealth, Cincinnati, Ohio (Habli); University of Illinois Chicago College of Medicine (Hafner); University of Illinois College of Medicine at Peoria (Hanson, S. W. Kelly); Institute for Systems Biology, Seattle, Washington (Heath); UH Cleveland Medical Center, Cleveland, Ohio (Hernandez); University of Utah Schools of the Health Sciences, Salt Lake City (Hess); West Virginia Clinical and Translational Science Institute, Morgantown (Hodder); Christiana Care Health Services Inc, Newark, Delaware (Hoffman); Sanford Health, Sioux Falls, South Dakota (Hoover); Duke University, Durham, North Carolina (Hughes); Cambridge Health Alliance, Cambridge, Massachusetts (John, Ticotsky); Tufts Medical Center, Boston, Massachusetts (Jordan, Ward); MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio (Kaufman); University of California, San Francisco (J. D. Kelly); University of Illinois Chicago (Klein, Quigley); The University of Arizona College of Medicine, Phoenix (Knox, Lee-Iannotti); University of Illinois Hospital and Health Sciences System, Chicago (Krishnan); Howard University College of Medicine, Washington, DC (Laiyemo, Mehari, Sherif); Tulane University, New Orleans, Louisiana (Logarbo); Tulane School of Medicine, New Orleans, Louisiana (Longo); Universidad de Puerto Rico, San Juan, Puerto Rico (Luciano); Beth Israel Deaconess Medical Center, Boston, Massachusetts (Maley, Thomas); Boston University, Boston, Massachusetts (Marathe); University of Mississippi, Oxford (Marshall); McGovern Medical School at The University of Texas Health Science Center at Houston (Mendez-Figueroa); University of Utah Health, Salt Lake City (Metz, Schlater, Sowles); University of Arizona, Tucson (Mosier); Case Western Reserve University School of Medicine, Cleveland, Ohio (Mouchati); Morehouse School of Medicine, Atlanta, Georgia (Ojemakinde, Pemu); Medical College of Wisconsin, Milwaukee (Palatnik); Saint Peter’s University Hospital, Brunswick, New Jersey (Palomares); Cedars-Sinai Health System, Los Angeles, California (Parimon); University of Pennsylvania, Philadelphia (Parry); Yale School of Medicine, New Haven, Connecticut (Pettker); NorthShore University HealthSystem, Evanston, Illinois (Plunkett); Warren Alpert Medical School, Brown University, Providence, Rhode Island (Poppas); Columbia University Irving Medical Center, New York, New York (Reddy); West Virginia University School of Medicine, Morgantown (Reece); Department of Medicine, The University of Texas Health Science Center at San Antonio (Reeves); Banner Alzheimer’s Institute, Phoenix, Arizona (Reiman); Banner University Medical Center Tucson, Arizona (Rischard); Brown University, Providence, Rhode Island (Rouse); The University of Kansas Medical Center, Kansas City (Ruff); Eastern Virginia Medical School, Norfolk (Saade); Milken Institute of Public Health, The George Washington University, Washington, DC (Sandoval); Boston University School of Medicine, Boston, Massachusetts (Shepherd); University of Pittsburgh, Pittsburgh, Pennsylvania (Simhan); Weill Cornell Medicine, New York, New York (Skupski); The University of Oklahoma, Norman (Sukhera); The University of North Carolina at Chapel Hill (Thorp); Mercy Medical Center, Baltimore, Maryland (Thuluvath); University of Alabama, Birmingham (Tita); University of Oklahoma Health Sciences Center, Oklahoma City (VanWagoner); University of Nebraska Medical Center, Omaha (Vasey, Warren); The George Washington University Biostatistics Center, Rockville, Maryland (Weiner); West Virginia University, Morgantown (Welch); University of Kentucky, Lexington (Whiteheart); Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Yee).

Author Contributions: Drs Thaweethai and Foulkes had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Thaweethai, Jolley, Karlson, Levy, McComsey, Parthasarathy, Singh, Shinnick, Altman, Bassett, Chan, Charney, Chibnik, Clifton, Deeks, Erdmann, Ernst, Fonseca, Gander, Gibson, Heath, Hodder, Hughes, Jagannathan, Jordan, Katz, J. Kelly, Kirwan, Knox, Krishnan, Kumar, Laiyemo, Lee-Iannotti, Maley, Marshall, Mehari, Mendez-Figueroa, Mermelstein, Metz, Mosier, Mullington, Murphy, Nikolich, Ofotokun, J. Patterson, Patzer, Peluso, Pemu, Pettker, Poppas, Reeves, Reiman, Sherif, Teunis, Thomas, Tita, Verduzco-Gutierrez, Wisnivesky, Yee, Zisis, Horwitz, Foulkes.

Acquisition, analysis, or interpretation of data: Thaweethai, Jolley, Karlson, Levitan, Levy, McComsey, McCorkell, Nadkarni, Parthasarathy, Singh, Walker, Selvaggi, Shinnick, Schulte, Atchley-Challenner, Alba, Alicic, Anglin, Ashktorab, Argueta, Baslet, Bassett, Bateman, Bedi, Bhattacharyya, Bind, Blomkalns, Bonilla, Bush, Castro, Chan, Charney, Chen, Chibnik, Chu, Clifton, Costantine, Cribbs, Davila Nieves, Deeks, Duven, Emery, Erdmann, Erlandson, Farah-Abraham, Farner, Feuerriegel, Fleurimont, Fonseca, Franko, Gainer, Gander, Gardner, Geng, Go, Goldman, Grebe, Greenway, Habli, Hafner, Han, Hanson, Heath, Hernandez, Hess, Hodder, Hoffman, Hoover, Huang, John, Katz, Kaufman, J. Kelly, S. Kelly, Kemp, Kirwan, Klein, Laiyemo, Lambert, Lanca, Lee-Iannotti, Logarbo, Longo, Luciano, Lutrick, Maley, Marathe, Marconi, Martin, Matusov, Metz, Morse, Mosier, Mouchati, Mullington, Murphy, Neuman, Ofotokun, Ojemakinde, Palatnik, Palomares, Parimon, Parry, T. Patterson, Patzer, Peluso, Pemu, Plunkett, Pogreba-Brown, Quigley, Reddy, Reece, Reeder, Rischard, Rosand, Rouse, Ruff, Saade, Sandoval, Schlater, Shepherd, Sherif, Simhan, Singer, Skupski, Sowles, Sparks, Sukhera, Taylor, Teunis, Thomas, Thorp, Thuluvath, Ticotsky, Tita, Tuttle, Urdaneta, Valdivieso, VanWagoner, Vasey, Verduzco-Gutierrez, Wallace, Ward, Warren, Weiner, Welch, Whiteheart, Wiley, Wisnivesky, Yee, Zisis, Horwitz, Foulkes.

Drafting of the manuscript: Thaweethai, Jolley, Karlson, McComsey, McCorkell, Parthasarathy, Singh, Walker, Selvaggi, Bedi, Farner, Fleurimont, Gander, Jordan, J. Kelly, Kirwan, Kumar, Taylor, Teunis, Zisis, Foulkes.

Critical revision of the manuscript for important intellectual content: Thaweethai, Jolley, Karlson, Levitan, Levy, McComsey, McCorkell, Nadkarni, Parthasarathy, Walker, Selvaggi, Shinnick, Schulte, Atchley-Challenner, Alba, Alicic, Altman, Anglin, Ashktorab, Argueta, Baslet, Bassett, Bateman, Bhattacharyya, Bind, Blomkalns, Bonilla, Bush, Castro, Chan, Charney, Chen, Chibnik, Chu, Clifton, Costantine, Cribbs, Davila Nieves, Deeks, Duven, Emery, Erdmann, Erlandson, Ernst, Farah-Abraham, Feuerriegel, Fonseca, Franko, Gainer, Gander, Gardner, Geng, Gibson, Go, Goldman, Grebe, Greenway, Habli, Hafner, Han, Hanson, Heath, Hernandez, Hess, Hodder, Hoffman, Hoover, Huang, Hughes, Jagannathan, John, Jordan, Katz, Kaufman, J. Kelly, S. Kelly, Kemp, Kirwan, Klein, Knox, Krishnan, Laiyemo, Lambert, Lanca, Lee-Iannotti, Logarbo, Longo, Luciano, Lutrick, Maley, Marathe, Marconi, Marshall, Martin, Matusov, Mehari, Mendez-Figueroa, Mermelstein, Metz, Morse, Mosier, Mouchati, Mullington, Murphy, Neuman, Nikolich, Ofotokun, Ojemakinde, Palatnik, Palomares, Parimon, Parry, J. Patterson, T. Patterson, Patzer, Peluso, Pemu, Pettker, Plunkett, Pogreba-Brown, Poppas, Quigley, Reddy, Reece, Reeder, Reeves, Reiman, Rischard, Rosand, Rouse, Ruff, Saade, Sandoval, Schlater, Shepherd, Sherif, Simhan, Singer, Skupski, Sowles, Sparks, Sukhera, Thomas, Thorp, Thuluvath, Ticotsky, Tita, Tuttle, Urdaneta, Valdivieso, VanWagoner, Vasey, Verduzco-Gutierrez, Wallace, Ward, Warren, Weiner, Welch, Whiteheart, Wiley, Wisnivesky, Yee, Zisis, Horwitz, Foulkes.

Statistical analysis: Thaweethai, Selvaggi, Shinnick, Schulte, Bind, Chan, Chibnik, Reeder, Taylor, Foulkes.

Obtained funding: Thaweethai, Karlson, Levy, McComsey, Parthasarathy, Bassett, Charney, Chu, Cribbs, Deeks, Erlandson, Ernst, Heath, Hess, Katz, J. Kelly, Kirwan, Knox, Krishnan, Maley, Martin, Metz, Murphy, Nikolich, Parry, T. Patterson, Patzer, Peluso, Pemu, Quigley, Reeves, Reiman, Saade, Sherif, Simhan, Taylor, Teunis, Tita, Tuttle, Warren, Wisnivesky, Horwitz, Foulkes.

Administrative, technical, or material support: Levy, McComsey, Nadkarni, Singh, Anglin, Ashktorab, Argueta, Bassett, Bedi, Bhattacharyya, Bush, Chan, Charney, Clifton, Costantine, Cribbs, Davila Nieves, Emery, Farah-Abraham, Farner, Feuerriegel, Fleurimont, Franko, Gainer, Gander, Gardner, Geng, Go, Grebe, Habli, Hafner, Han, Hanson, Heath, Hernandez, Hess, Hodder, Hoffman, Huang, Jagannathan, John, Katz, J. Kelly, S. Kelly, Kirwan, Klein, Krishnan, Kumar, Laiyemo, Lambert, Lanca, Lee-Iannotti, Luciano, Lutrick, Maley, Marshall, Martin, Mehari, Mendez-Figueroa, Metz, Morse, Mosier, Mouchati, Mullington, Murphy, Neuman, Ojemakinde, Palomares, Parimon, J. Patterson, Patzer, Peluso, Pettker, Pogreba-Brown, Poppas, Reiman, Rouse, Saade, Schlater, Shepherd, Simhan, Sowles, Sparks, Sukhera, Taylor, Teunis, Thuluvath, Tita, Urdaneta, Valdivieso, Wallace, Ward, Weiner, Yee, Horwitz, Foulkes.

Supervision: Thaweethai, Jolley, Karlson, Levy, McComsey, Parthasarathy, Singh, Walker, Alba, Bassett, Bateman, Bedi, Blomkalns, Bonilla, Castro, Chan, Charney, Chen, Chu, Costantine, Emery, Erlandson, Farah-Abraham, Gander, Goldman, Greenway, Hafner, Han, Heath, Hernandez, Hodder, Hoffman, Huang, Jagannathan, Jordan, Katz, J. Kelly, Kirwan, Knox, Krishnan, Lee-Iannotti, Longo, Martin, Mendez-Figueroa, Metz, Mullington, Murphy, Neuman, Nikolich, Ofotokun, Patzer, Peluso, Plunkett, Poppas, Reiman, Rosand, Saade, Shepherd, Simhan, Skupski, Sukhera, Thorp, Thuluvath, Tita, Ward, Warren, Whiteheart, Yee, Horwitz, Foulkes.

Other - gave feedback based on study design: Singer.

Other - cohort recruitment and study supervision: Alba.

Other - was one of the original Boston Hub investigators involved in application for funding: Mullington.

Other - operationalization: Farah-Abraham.

Other - literature review: Atchley-Challenner.

Other - site PI team management: Marconi.

Other - data procurement: Kumar.

Conflict of Interest Disclosures: Dr Thaweethai reported receiving grants from the National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) and serving as co-investigator of the RECOVER Data Resource Core. Dr Jolley reported receiving grants from the NIH/NHLBI. Dr Karlson reported receiving grants from the NIH. Dr Levitan reported receiving grants from the NIH and Amgen. Dr Levy reported receiving grants from the NHLBI and personal fees or research support from Entrinsic Bioscience, Nocion Therapeutics, Gossamer Bio, AstraZeneca, Novartis, Sanofi, Amgen, Genentech, Pieris Pharmaceuticals, and SRA. Dr McComsey reported serving as a consultant for Gilead, Merck, Janssen, and GlaxoSmithKline and receiving research support from Pfizer, Genentech, and Roche. Ms McCorkell reported receiving personal fees from NIH RECOVER and research funding as a subcontractor from the NIH and the Patient-Centered Outcomes Research Institute (PCORI). Dr Parthasarathy reported receiving grants from the NIH, NHLBI, Sergey-Brin Foundation, and Regeneron and personal fees from Jazz Pharmaceuticals. Dr Singh reported receiving grants from Pfizer and serving as an advisor to Regeneron and Gilead. Dr Walker reported receiving grants from the NHLBI. Mr Shinnick reported receiving grants from the NIH/NHLBI. Dr Horwitz reported receiving grants from the NIH and serving on an ad hoc committee for the National Academy of Medicine. Dr Foulkes reported receiving grants from the NIH/NHLBI and personal fees from the Round Table Group and serving as principal investigator of the RECOVER Data Resource Core. Dr Alba reported receiving personal fees from Minerva Biotechnologies. Dr Alicic reported receiving grants from the NIH, the Centers for Disease Control and Prevention, and Travere Therapeutics and personal fees from Boehringer Ingelheim. Dr Ashktorab reported receiving grants from the NIH. Dr Bhattacharyya reported receiving grants from NIH RECOVER, Alexion Pharmaceuticals, UCB, and Massachusetts Consortium on Pathogen Readiness and personal fees from American Academy of Neurology and UpToDate. Dr Castro reported receiving grants from the NIH, American Lung Association, PCORI, AstraZeneca, Gala Therapeutics, Genentech, GlaxoSmithKline, Novartis, Pulmatrix, Sanofi, Shionogi, and Theravance Biopharma; personal fees from Allakos, Amgen, OM Pharma, Pfizer, Pioneering Medicines, AstraZeneca, GlaxoSmithKline, Genentech, Teva Pharmaceutical Industries, Sanofi, Merck, Novartis, Arrowhead Pharmaceuticals, and Regeneron; stock options from Aer Therapeutics; and royalties from Elsevier. Dr Chu reported receiving grants from the NIH and personal fees from Merck, Vir Biotechnology, AbbVie, Ellume, Pfizer, and the Bill and Melinda Gates Foundation; serving on advisory boards for Merck and AbbVie; conducting CME teaching with Medscape, Vindico, and Clinical Care Options; and receiving research funding from Gates Ventures and support and reagents from Ellume and Cepheid. Dr Clifton reported receiving grants from the NIH. Dr Costantine reported receiving grants from the NIH, Baxter International, and Siemens Healthcare and personal fees from Quidel, Progenity, and Siemens Healthcare. Dr Davila Nieves reported receiving grants from the NIH. Dr Deeks reported receiving grants from the NIH. Dr Emery reported receiving grants from the NIH. Dr Erdmann reported receiving grants from the NIH and personal fees from Perspectum and having a patent for Plantform. Dr Erlandson reported receiving grant funding and advisory fee payments from Gilead Sciences (paid to the University of Colorado) and advisory fee payments from Merck and ViiV (paid to the University of Colorado) in the last 3 years. Ms Gainer reported receiving grants from NIH RECOVER. Dr Geng reported receiving grants from Pfizer and personal fees from UnitedHealthcare. Dr Gibson reported receiving grants from the NIH. Dr Go reported receiving grants from the NIH. Dr Goldman reported receiving grants from Gilead Sciences and Merck; personal fees from Gilead Sciences and Eli Lilly; contracted research from Gilead Sciences, Eli Lilly, and Regeneron Pharmaceuticals; and nonfinancial support from Adaptive Biotechnologies, Labcorp, and Monogram Biosciences. Dr Greenway reported receiving grants from the NIH. Dr Heath reported receiving grants from Merck and Gilead Sciences, personal fees from Regeneron Pharmaceuticals, and being a board member for IsoPlexis. Dr Hess reported receiving grants from the NIH and being a member of a data and safety monitoring board for Astellas Pharmaceuticals. Dr Hodder reported receiving grants from the NHLBI. Dr Hoffman reported receiving grants from the NHLBI. Dr Hughes reported receiving honorarium from UpToDate and personal fees from AMAG Pharmaceuticals. Ms John reported receiving grants from the NIH. Dr Katz reported receiving grants from the NIH. Dr Klein reported receiving grants from NIH RECOVER and consulting fees from Gilead Sciences. Dr Knox reported receiving grants from the NIH. Dr Krishnan reported receiving grants from the NIH/NHLBI; personal fees from GlaxoSmithKline, AstraZeneca, CereVu Medical, BData, Propeller, ResMed, American Board of Internal Medicine, American Academy of Allergy, Asthma, and Immunology; and research funding from the NIH, PCORI, American Lung Association, COPD Foundation, and the Sergey Brin Family Foundation. Dr Laiyemo reported receiving grants from the NIH. Dr Lambert reported receiving grants from the NIH and the PCORI and serving as a site principal investigator for trials funded by Vertex and Aceragan. Dr Luciano reported receiving grants from the NIH and speaker fees from Sanofi-Genzyme. Dr Marathe reported receiving grants from NIH RECOVER and funding from Boston Medical Center. Dr Marconi reported receiving grants from the Centers for Disease Control and Prevention, Veteran Affairs, and the NIH; grants, personal fees, nonfinancial support, and other from Eli Lilly and Gilead; grants and personal fees from ViiV; and nonfinancial support from Bayer. Dr Marshall reported receiving grants from the NIH. Mr Martin reported receiving grants from the NIH. Dr Metz reported receiving grants from the NIH and Pfizer and personal fees from Pfizer. Mr Morse reported receiving grants from the NIH/NHLBI. Dr Mullington reported receiving grants from the NIH and Open Medicine Foundation and speaker and book chapter contribution for Idorsia Pharmaceuticals. Dr Murphy reported receiving grants from the NIH/NHLBI. Dr Nikolich reported receiving grants from the NIH/NHLBI. Dr Ojemakinde reported receiving grants from the NIH. Dr Parry reported receiving grants from NIH RECOVER paid to Penn and funding from the Sergey Brin Family Foundation. Dr Peluso reported receiving personal fees from Gilead Sciences and AstraZeneca. Dr Pogreba-Brown reported receiving grants from NIH RECOVER. Dr Poppas reported owning stock in GE and serving as an UpToDate contributor and co-editor of Hurst and Fuster’s The Heart. Dr Quigley reported receiving grants from the NIH, Pfizer, AbbVie, and Teva Pharmaceutical Industries and personal fees from Alexion Pharmaceuticals, Servier Laboratories, Agios Pharmaceuticals, and Rigel Pharmaceuticals. Dr Reiman reported receiving grants from the NIH. Dr Rischard reported receiving grants from the NIH/NHLBI, Bayer, Janssen, Merck, Aerovate Therapeutics, and Respira Therapeutics and consulting relationships with Acceleron Pharma and United Therapeutics. Dr Rosand reported receiving grants from the NIH and the American Heart Association and personal fees from the National Football League and Takeda Pharmaceutical Co. Dr Shepherd reported receiving grants from NIH RECOVER. Dr Simhan reported receiving grants from the NIH. Dr Singer reported receiving grants from Case Western Reserve University and MetroHealth. Dr Sparks reported receiving grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the R. Bruce and Joan M. Mickey Research Scholar Fund, the Llura Gund Award for Rheumatoid Arthritis Research and Care, Brigham and Women’s Hospital, and Bristol Myers Squibb and personal fees from Bristol Myers Squibb, AbbVie, Amgen, Boehringer Ingelheim, Gilead Sciences, Inova Diagnostics, Janssen, Optum, and Pfizer. Dr Thomas reported receiving personal fees from Guidepoint Global and GLG Councils and having a patent for ECG-spectrogram with royalties paid from MyCardio LLC through Beth Israel Deaconess Medical Center. Dr Thuluvath reported receiving grants from Mercy Medical Center. Dr Tita reported receiving grants from Pfizer. Dr VanWagoner reported receiving grants from the NIH. Dr Vasey reported receiving grants from NIH RECOVER. Dr Wallace reported receiving grants from Bristol Myers Squibb, Sanofi, and Horizon Therapeutics and personal fees from Sanofi, Novartis, Shionogi, Visterra, Horizon Therapeutics, PPD Inc, Zenas BioPharma, and Medpace. Dr Warren reported receiving grants from the NIH. Mr Weiner reported receiving grants from the NIH. Ms Welch reported receiving grants from the NIH. Dr Wisnivesky reported receiving personal fees from PPD Inc, Banook, Sanofi, Atea Pharmaceuticals, and Prospero and grants from Regeneron Pharmaceuticals, Axella, Sanofi, and Arnold. Dr Yee reported receiving grants from the NIH. No other disclosures were reported.

Funding/Support: This research was funded by the NIH (OTA OT2HL161841, OT2HL161847, and OT2HL156812) as part of the Researching COVID to Enhance Recovery (RECOVER) research program. Additional support for Drs Foulkes, Thaweethai, and Schulte was provided by R01 HL162373.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Group Information: The RECOVER Consortium nonauthor collaborators are listed in Supplement 4 .

Disclaimer: This content is solely the responsibility of the authors and does not necessarily represent the official views of the RECOVER Initiative, the NIH, or other funders.

Data Sharing Statement: See Supplement 5 .

Additional Information: This study is part of the RECOVER initiative, which seeks to understand, treat, and prevent the postacute sequelae of SARS-CoV-2 infection. For more information on RECOVER, visit https://recovercovid.org/ . We thank all the participants enrolled in the RECOVER Initiative, the National Community Engagement Group (NCEG), and all patient, caregiver and community representatives.

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