Revaluing work after COVID-19

The COVID-19 pandemic and its aftermath instigated a series of debates about economic value. From early discussions about "who counts as an essential worker" to post-pandemic arguments about what constitutes the "infrastructure" needed to rebuild the economy, the pandemic led to reexaminations of the kinds of investments and activities necessary for the continuity of our social system. This article examines these debates through the lens of the labor theory of value as expanded by feminists and ecologists. Drawing on my 2017 book, The Politics of Value, I discuss how the political-economic upheaval that the pandemic unleashed laid bare the essential nature of care and social reproductive work, low-wage labor, public sector provisioning, and ecosystem services. The stark dilemmas of holding body and soul together during the crisis created an opportunity to rethink the artificial lines between the market and the rest of life, highlighting the essential nature of activities formerly unrecognized or considered nonproductive. The article discusses how we might take advantage of this opening to create new vocabularies and measurement practices that take into "account" and fairly reward formerly invisible and unvalued forms of labor.

Stroke Telemedicine for Arizona Rural Residents, the Legacy Telestroke Study.

Background: Efficacy of telemedicine for stroke was first established by the Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) trials in California and Arizona. Following these randomized controlled trials, the Stroke Telemedicine for Arizona Rural Residents (STARR) network was the first telestroke network to be established in Arizona. It consisted of a 7 spoke 1 hub telestroke system, and it was designed to serve rural, remote, or neurologically underserved communities. Objective: The objective of STARR was to establish a multicenter state-wide telestroke research network to determine the feasibility of prospective collection, recording, and regularly analysis of telestroke patient consultations and care data for the purposes of establishing quality measures, improvement, and benchmarking against other national and international telestroke programs. Methods: The STARR trial was open to enrollment for 29 months from 2008 to 2011. Mayo Clinic Hospital, Phoenix, Arizona served as the hub primary stroke center and its vascular neurologists provided emergency telestroke consultations to seven participating rural, remote, or underserved spoke community hospitals in Arizona. Eligibility criteria for activation of a telestroke alert and study enrollment were established. Consecutive patients exhibiting symptoms and signs of acute stroke within a 12 h window were enrolled, assessed, and treated by telemedicine. The state government sponsor, Arizona Department of Health Services' research grant covered the cost of acquisition, maintenance, and service of the selected telemedicine equipment as well as the professional telestroke services provided. The study deployed multiple telemedicine video cart systems, picture archive and communications systems software, and call management solutions. The STARR protocol was reviewed and approved by Mayo Clinic IRB, which served as the central IRB of record for all the participating hospitals, and the trial was registered at ClinicalTrials.gov. Results: The telestroke hotline was activated 537 times, and ultimately 443 subjects met criteria and consented to participate. The STARR successfully established a multicenter state-wide telestroke research network. The STARR developed a feasible and pragmatic approach to the prospective collection, storage, and analysis of telestroke patient consultations and care data for the purposes of establishing quality measures and tracking improvement. STARR benchmarked well against other national and international telestroke programs. STARR helped set the foundation for multiple regional and state telestroke networks and ultimately evolved into a national telestroke network. Conclusions: Multiple small and rurally located community hospitals and health systems can successfully collaborate with a more centrally located larger hospital center through telemedicine technologies to develop a coordinated approach to the assessment, diagnosis, and emergency treatment of patients manifesting symptoms and signs of an acute stroke syndrome. This model may serve well the needs of patients presenting with other time-sensitive medical emergencies.Clinical Trial Registration number: NCT00829361.

Ecuador: The Return of Neoliberal Ghosts with Pandemic Woes

The Andean nation of Ecuador is an ethnically diverse, middle-income country, with significant oil reserves. Indigenous and social movements have played a central role in national politics for the last three decades. Ecuador entered the pink tide in 2007 with the election of new left radical populist, Rafael Correa, who served as president for a decade and led what he called a Citizens' Revolution. During Correa's ten years in power the country made significant progress in reducing poverty and inequality, as well as major infrastructure investments. However, civil liberties, including freedom of the press and the right to protest were infringed upon by the government. Economically, Correa pivoted away from neoliberalism, but failed to lessen Ecuador's dependence on extractive industries like oil and mineral mining, with all their concomitant environmental costs. Since Correa left power, Ecuadorian politics have swung to the right, first under President Lenin Moreno and then with the 2021 election of neoliberal banker-turned-politician, Guillermo Lasso. In recent years the country's economy has been pummeled by falling international oil prices, a devastating earthquake in 2016, and the coronavirus pandemic. Recent economic decline has reversed much of the progress made during the previous decade on poverty and inequality reduction. © 2023 selection and editorial matter, Harvey F. Kline and Christine J. Wade.

Hurricanes Laura and Sally: A Case Study of Evacuation Decision-Making in the Age of COVID-19

This study examines risk perceptions and evacuation planning for those residents affected by Hurricane Laura}the first major hurricane evacuation during the COVID-19 pandemic}and Hurricane Sally, prior to the wide-spread availability of vaccines. Research on hurricane evacuation behavior and risk perceptions during a pandemic is critical for quantifying the intersect of these compounding threats. Analyses captured how people perceive public shelters and whether evacuation choices changed in light of the pandemic. Many study participants considered themselves vulnerable to COVID-19 (39.4%), and two-thirds believed it would be “very serious” if they or their loved ones contracted COVID-19, but this had no impact on their actual evacuation decision-making. Approximately 75% of the sample stayed at home during Hurricanes Laura or Sally, and, of these, just over 80% indicated that COVID-19 was a somewhat important deciding factor. This reflects the partial role that COVID-19 played in balancing individual and household protective action decision-making during complex disasters, whereas 15.5% wanted to evacuate but waited until it was too late. For those who evacuated to a hotel, many found that staff and guests wore masks and socially distanced in common spaces. Of particular interest is that individuals have a continued negative perception of public shelters’ ability to safeguard against COVID-19 that was coupled with a significant decrease in the number of respondents that would potentially use shelters in 2020 as compared with before the COVID-19 pandemic. These results have informed and will inform future hazard mitigation planning during the current pandemic or future pandemics or infectious disease outbreaks. © 2022 American Meteorological Society.

Economic impacts of the COVID-19 crisis: evidence from credit and debt of older adults

This study documents the credit outcomes of older adults immediately before and after the onset of the COVID-19 pandemic in the United States. On average, older adults experienced larger reductions in total household debt relative to younger adults. However, there is significant heterogeneity, where older adults with higher incomes experienced the largest declines, and lower-income older adults experienced an increase in total debt. Overall, these data highlight important trends in the credit experiences of older adults that may affect their future financial security.

Virtual Interactive Surgical Skills Classroom: A Parallel-Designed, Non-Inferiority, Adjudicator-Blinded, Randomised Controlled Trial (VIRTUAL)

Introduction: Virtual classroom training (VCT) is a novel educational method that permits accessible, distanced interactive expert instruction. We aimed to evaluate the efficacy of VCT in comparison to face-to-face training (FFT) and non-interactive computer-based learning (CBL) for basic surgical skills training. Method: 72 participants recruited from five London medical schools underwent stratified block randomisation into three equal intervention groups based on subjective and objective suturing experience. VCT was delivered via the BARCO weConnect platform and FFT was provided by expert instructors. Optimal student-to-teacher ratio was used, 12:1 for VCT and 4:1 for FFT. The assessed task was interrupted suturing with hand-tied knots. The primary outcome was post-intervention Objective Structured Assessment of Technical Skills (OSATS) score, adjudicated by two blinded experts and adjusted for baseline proficiency. Results: VCT was non-inferior to FFT (adjusted difference 0.44, 95% CI: -0.54 to 1.75, delta 0.675), VCT was superior to CBL (adjusted difference 1.69, 95% CI 0.41 to 2.96) and FFT was superior to CBL (adjusted difference 1.25, 95% CI 0.20 to 2.29). FFT alone was associated with student travel expenses (mean £4.88, SD 3.70). Instructor hours used per student for VCT and FFT were 0.25 and 0.75, respectively. Conclusions: VCT has a similar educational benefit to FFT and is a suitable modality of high-quality surgical skills education. VCT provides greater accessibility and resource efficiency compared to FFT. VCT satisfies the requirement for social distancing during the COVID-19 pandemic and is better than non-interactive CBL. VCT has the potential to improve global availability and accessibility of surgical skills training.

Policy Solutions: Defying the gravitational pull of education politics

The biggest threat to an equitable and prosperous American society is not a particular educational policy, but the gravitational pull of politics, explains Jonathan Collins. Before educational policy can be developed and put into place, the politics that drive education must be acknowledged and addressed. Violence is erupting at school board meetings across the country over mask mandates, book bans, and critical race theory. Meanwhile, as has been the case throughout U.S. history, the political division and vitriol distract us from ensuring that our most vulnerable children are getting needed academic support. It is time, Collins says, for a politics of solutions that can defy the gravitational pull of politics that sidetrack leaders addressing the real problems students face.

ULTRASENSITIVE ELECTROCHEMICAL SENSOR PLATFORM FOR MULTIPLEXED DETECTION OF MULTIPLE ANTI-SARS-CoV-2 IgG

The COVID-19 pandemic has demonstrated the need for better understanding of the kinetics of anti-SARSCoV-2 antibody production and development of serological assays for multiple viral antigens. Electrochemical (EC) sensor platforms offer the potential to develop rapid, sensitive, point-of-care (POC) diagnostics for this type of application. Here, we describe multiplexed EC biosensors with novel antifouling properties that detect anti-SARSCoV-2 immunoglobulin G (IgG) against spike protein (S), spike receptor-binding domain (RBD), and nucleocapsid (NC) antigens. This POC assay was validated using 69 clinical blood samples and obtained 96% sensitivity and 100% specificity with area under the curve (AUC) of 0.98 for multiplexed detection of anti-SARS-CoV-2 IgG. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.

CRISPR-based electrochemical sensor for COVID-19 diagnostics

We report the development of an electrochemical sensor platform for ultrasensitive and rapid detection of SARS-CoV-2 viral RNA that integrates loop-mediated isothermal amplification (LAMP), CRISPR-based detection, and anti-fouling nanocomposite coating. By integrating LAMP amplification with CRISPR, we achieved ultrasensitive detection of SARS-CoV-2 RNA at levels as low as 5 copies µL-1. Data from this electrochemical diagnostic platform was comparable to traditional RT-PCR methodology in a fraction of the time, at low cost, and without requiring laboratory space. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.

Multisectoral Factors Associated with Global National Trends in Neonatal Mortality Rates: A Call for Targeted Public Health Intervention, Particularly in Countries Impacted Most by COVID-19

Background: The United Nations' 2030 Sustainable Development Goals (SDGs) target an end to preventable newborn deaths and a reduction in neonatal mortality rate (< 28 d, NMR) to 12/1,000 live births for all countries. Understanding concurrent trends in country-level, multisectoral factors associated with NMR trends may illuminate opportunities for intervention strategies. Our objective was to explore country-specific trends in NMR from 1990-2019 and identify those countries which contribute to the largest percentage of neonatal deaths in order to focus efforts on reducing NMRs in those specific countries. Unfortunately, due to the COVID-19 pandemic, the 2030 SDGs have been severely impacted. Methods: We created a comprehensive global database of NMR and associated variables that were selected based on literature review and categorized into Population Health, Health Systems, Maternal, Neonatal, and Social factors from 1990 to 2019. Data were compiled from publicly available sources including UNICEF, World Bank, WHO, and OECD. Data were collected and analyzed for 195 countries. NMR trends were analyzed from 1990 to 2019 with more targeted analysis of trends in the last 2 decades from 2000 to 2019. We then performed statistical analyses using the selected variables to compare variable means using t-tests, identify bivariate associations, and generate multivariable regression models. Results: In terms of total deaths, 20 countries contributed 75% of the total 2.5 million neonatal deaths. All of these 20 countries showed decreases in NMR since 1990 (Figure 1). However, only China and Egypt accomplished the UN goal of reducing NMR to 12/1,000 live births. We compared variables associated with NMR in our 20 target countries to the remaining countries and found significant differences between the means for most variables (Table 1). Bivariate regression analyses showed statistically significant associations between NMR trends and changes over time in median income, health care spending, literacy level, maternal mortality ratio, and low birthweight rate. Ultimately the variables maternal mortality ratio change and median income change were selected for multivariable analysis based on collinearity. The multivariate regression model generated using NMR, maternal mortality ratio change, median income change resulted in an r-squared value of 0.54, explaining 54% of the variance in NMR trends. Conclusion: Since 20 countries contribute 75% of the neonatal deaths worldwide, we propose that targeting these 20 countries would have the greatest impact on global neonatal deaths. Future research will focus on identification of country specific barriers and evaluating the countries with greatest NMR improvements to propose effective focused strategies for reducing NMRs in high burden countries. The disparate impact that COVID-19 has had on countries with the highest neonatal mortality burden should be a primary focus of continued public health invention efforts, and is a specific focus of our ongoing research.

Linerixibat dose-response analysis of C4 concentrations as a quantitative approach to predict gastrointestinal tolerability

Background and aims: Liver injury is common in patients with coronavirus disease-2019 (COVID-19) infection. Recently, few studies have reported the development of autoimmune hepatitis (AIH) following COVID-19 vaccination. However, there is a lack of studies reporting the outcomes of AIH following ChAdOx1 (vector-based) and BBV152 (inactivated virus) from India. Herewe aimed to describe the clinical profile of patients who developed AIH following COVID-19 vaccination. The causal association is attributed based on the temporal relationship in patients with no prior liver diseases. Method: Patients presenting with deranged liver functions following COVID-19 vaccination to hepatology clinic were included. Virus infections were ruled out in all patients either by serology or viral quantification methods. We aimed to assess the demographics, clinical profile, and outcome of patients with vaccine-induced AIH (V-AIH) in the absence of known liver disease. Results: A total of 31 patients presented with altered liver chemistries following vaccination. Seventeen patients were diagnosed with VAIH (age-39.8 ± 11.4 years;males-70.4%). None of the patient had history of alcohol overconsumption. Seventy six percent of patients had received ChAdOx1 and 23.53% had received BBV152 vaccine (Table). Seventy six percent of patients following first dose of vaccine and 23.5% following second dose of vaccinewere diagnosed as V-AIH. Mean duration for development of symptoms after first dosewas 25.7 days. Common symptom at presentation was jaundice in 82.3% of patients. Antinuclear antibodywas positive in 71% of patients and 17% patients were negative for all serological markers of autoimmune hepatitis but had elevated IgG levels. Fifty-nine percent of patients required immunosuppression of which 41% percet of patients received oral steroids, 17% patients received intravenous steroids for 3 days followed by oral steroid, 12% patients received azathioprine. One patient succumbed to pneumonia with multiorgan failure by day 30. At 3 months, it was observed that only 17% patients needed prolonged immunosuppression and had deranged liver functions until last follow-up. Mean duration of recovery amongst rest of 76.4% patients was 5.15 ± 3.1 weeks.

Hurricane Hazards, Evacuations, and Sheltering: Evacuation Decision-Making in the Prevaccine Era of the COVID-19 Pandemic in the PRVI Region

Although research relating to hurricane evacuation behavior and perceptions of risk has grown throughout the years, there is very little understanding of how these risks compound during a pandemic. Utilizing the U.S. territories of Puerto Rico and the U.S. Virgin Islands (PRVI) as a study region, this work examines risk perceptions and evacuation planning during the first hurricane season following the coronavirus disease 2019 (COVID-19) pandemic before vaccines were widely available. Analyses of how people view public shelters and whether evacuation choices will change in light of COVID-19 concerns were conducted, and results reflect major changes in anticipated evacuation behavior during the 2020 hurricane season. Key findings include that over one-half of the sample considered themselves vulnerable to COVID-19. When asked about their intended actions for the 2020 hurricane season, a significant number of individuals who would have previously evacuated to a shelter said that they would choose not to during the pandemic, reflecting that public shelter usage has the potential to decrease when the decision is coupled with COVID-19 threats. In addition, individuals were shown to have a negative perception of public shelter options. Approximately one-half of the respondents had little faith in shelters’ ability to protect them, and three-quarters of respondents found the risks of enduring a hurricane to be less than those posed by public shelters. These results will inform future hazard mitigation planning during a disease outbreak or pandemic. © 2022 American Meteorological Society.

An Analysis of Virtual Research Experiences for Undergraduates Programs in Light of the COVID-19 Pandemic

With the continued social distancing requirements of the novel COVID-19 pandemic, many in-person educational programs were halted in 2020, including specialty education and research experiences for undergraduates. However, some Research Experiences for Undergraduates (REUs) progressed in summer 2020 in a fully virtual format. The importance of understanding how these practical STEM skills translated in a virtual REU format, in addition to areas of improvement going forward, are critical to the development of effective online STEM learning through REUs. Two survey instruments were designed to capture data from both the REU mentors (including the PIs) and the students in the programs. Questions included information on the REU they participated in, their perceptions of the best and worst aspects, their overall satisfaction with the experience, and their likelihood to seek out virtual REUs in the future. Overall, both students and faculty involved in virtual REUs were glad to have had the experience and were satisfied with it. The benefits of flexibility, the ease of communication and scheduling, and the increased access to online resources were echoed as the strengths of the virtual format. However, many believe that an in-person REU had benefits that could not be replicated in a virtual environment, including community building and hands-on experiences. Several were bogged down by technical difficulties. With more effort made to include community building to a greater extent, as well as considerations and planning for technical demands, the future of widely accessible online REU experiences is a bright one.

Post-intensive care COVID survivorship clinic: a single centre experience

Introduction: Patients discharged from the intensive care unit (ICU) post coronavirus-19 (COVID-19) pneumonitis may experience longterm morbidity related to their critical illness, the treatment for this and the ICU environment. Methods: We performed a prospective cohort study in a post-ICU (PICS) follow-up clinic at Tallaght University Hospital in October 2020 for patients who had been admitted to the ICU in our institution with COVID-19 pneumonitis six months earlier. Our clinic was staffed by critical care physicians, a psychologist, a physiotherapist and a research nurse. Our aim was to characterise the cognitive, psychological and physical consequences of COVID-19 in patients admitted to the ICU and discharged alive. Results: A total of 22 patients attended the 6-month PICS follow-up clinic following admission to ICU with COVID-19 pneumonitis. The majority of these patients were male and obese. The most common comorbidities were hypertension, diabetes mellitus and ischaemic heart disease. The median ICU length of stay was 21 days (IQR 2-75 days) with a median hospital length of stay of 37 days (IQR 8-130 days). The mean ICU Mobility Scale (IMS) score at the PICS clinic was low at 9.8 (SD 0.4). Only 59% of patients were independent with regard to their activities of daily living (ADLs). 8/14 (57%) of patients had returned to work by 6 months post ICU discharge. Their mean Intensive Care Psychological Assessment Tool (IPAT) score was high at 6.7 (SD 4.6) with a high mean Post-Traumatic Stress Disorder (PTSD) score of 21.1 (SD 17.5). Conclusions: In this single centre prospective cohort study, we found that patients have a high burden of physical and psychological impairment at 6 months following ICU discharge post COVID-19 pneumonitis;in many cases requiring specialist referrals for long-term input. We advocate for increased resources for this much needed follow-up multidisciplinary intervention for an ever-growing population of patients.

Educational strategies used to improve the knowledge, skills, and attitudes of health care students and providers regarding implicit bias: An integrative review of the literature

Background: The thoughts, feelings, and attitudes health care professionals unconsciously have about patients can negatively impact patients’ health outcomes. Systematic reviews related to implicit bias in health care providers have uncovered negative implicit bias towards older adults, people of color, people with disabilities, psychiatric patients, patients who are obese, people of low socioeconomic status, and women. Implicit bias impacts the quality, safety, and competence of care delivered;interactions between patients and providers;and patient approval of treatment recommendations. Health care professions students and health care providers need to participate in evidence-based educational strategies to manage and diminish bias. Objective: To review the evidence regarding educational strategies used with health care professions students and providers to improve their knowledge of implicit bias, reduce bias, and improve attitudes about bias. Design: Integrative review. Methods: The literature review was completed in July 2020 with two updates performed in February 2021 and June 2021 using nine databases including Academic Search Complete™, Embase®, ERIC®, Ovid, PubMed®, Scopus®, and Web of Science™. Key terms used related to education, health care professions’ students, health care providers, implicit, bias, incivility, microaggression, and microassult. Publications dates from 2011 to 2021 were included. Covidence software was used for the initial screening and for full-text analysis. Results: Thirty-nine articles were analysed for this review. The most commonly used educational strategies to instruct about principles of implicit bias include discussion groups, simulation and case-based learning, pre-tests for awareness, use of expert facilitators, commitment to action/change, and debriefing. Common components of successful strategies include thoughtful program planning, careful selection of program facilitators (who are content experts), support of participants, and a system-level investment. Conclusions: Diverse educational strategies successfully addressed implicit bias across studies. Recommendations for future studies includes addressing limitations in sampling strategies and data collection to clarify relationships between educational strategies and participant outcomes. Educational opportunities are warranted that challenge health care professionals to explore their implicit bias towards others in an effort to provide care that considers diversity, equity, and inclusion and also limits personal implicit bias. © 2022

Nationwide Online Hand Hygiene Training Program/Competition for Azerbaijani Medical and Health Sciences Students

Introduction: Healthcare-associated infections (HAI) are the most frequent adverse event in healthcare. Hand Hygiene (HH) is a crucial intervention to prevent the transmission of HAIs that should be learned in the early years of education by health care workers. Since COVID 19 pandemic hit education systems worldwide and face-to-face (f2f) training stopped, there is a need for innovative and effective distance educational interventions. Objectives: This pre-test, post-test intact group experimental design educational intervention study aims to create a unique online HH training program/competition which motivates students to participate and learn with high satisfaction. Methods: HH training program/competition was developed with the involvement of all 8 health sciences faculties and 11 medical colleges' representatives in one f2f[jc1] and two online meetings. Pre/posttests, skills training guides and WHO guidelines-based ppt presentations were developed. Materials were made accessible at the "flipgrid" application. Students registered and attended 2 h long synchronous pre-test, demonstration sessions through Zoom and Facebook stream followed by a post-test. They then recorded and uploaded their correct handwashing practice. We used Google forms to collect students' feedback (0 very bad-10 very good). Results: The total target students number was 14.180. 812 and 1412 students completed pre and post-test respectively and 1.900 during the stream. All 212 students who uploaded videos were evaluated, ranked between 0 and 100, receiving written feedback. Post-test scores were high (x = 81.0 ± 2.3). There were significant differences between mean total scores (t = 26.5;p < 0.000) of the pre-post test. The mean score of the evaluated videos was found as (x = 72.0 ± 1.4). 842 students provided feedback;general satisfaction was very high (x = 9.57 ± 1.11). Conclusion: This study suggests that the organization of nationwide online HH training/competition for health students is feasible and associated with acceptable participation rates and learning levels, with high satisfaction. Technology,internet access and digital literacy levels remain under-researched in this study to explain nationwide 10% participation.

Prior sars-cov-2 infection is associated with subclinical changes in the cardiovascular morphology, function, energetics and exercise capacity

Background: COVID-19 has documented multisystem effects. Whether clinically significant cardiac involvement is related to severity of disease in a working age military population remains unknown, but has implications for occupational grading and ability to deploy. Aims: To determine in the military population 1) whether prior SARS-CoV-2 infection causes clinically significant cardiac disease and 2) whether changes are related to disease severity. Methods: 105 military personnel were recruited, 85 with prior SARS-CoV-2 infection (39±10 years, 87% male;50 mild (community), 35 severe (hospitalized) and 20 healthy volunteers (mean age 39 ±8.4 years, 90% male) underwent comprehensive cardiopulmonary investigations including;cardiopulmonary exercise test, exercise echocardiography, cardiac31MRI and P-MR spectroscopy (rest and dobutamine stress). Results: Prior SARS-CoV-2 infection was related to lower VO2max (110±18.2 vs 133±6.7% predicted, p<0.05), anaerobic threshold (45±10 vs 56±14% of peak VO2, p<0.05), VO2/HR (102±21 vs 128±24% predicted, p<0.05) and VE/VCO2 slope (28.3±5.0 vs 25.8±2.7, p<0.05) and an increase in average E/e' change from rest to exercise stress (+1.49±2.4 vs-0.16±3.6, p<0.05). Whilst resting myocardial energetics were similar, prior SARS-CoV-2 infection was associated with a fall in PCr/ATP during stress (by 8%, p=<0.01) which was not seen in healthy controls. When groups were ordered normal> mild> severe disease, RVEDVi, RV stroke volume, VO2peak, VO2pulse and VE/VCO slope were reduced (Jonckheere-Terpstra, all p<0.05). Conclusion: In a young military population, prior SARS-CoV-2 infection is associated with subclinical cardiovascular changes including;lower right ventricular volumes, reduced markers of exercise capacity and reduced myocardial energetics during stress.

Virtual: Virtual interactive surgical skills classroom-an ongoing randomized controlled trial

Introduction: High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction. They may optimise resources and increase accessibility, facilitating larger-scale training with a similar educational benefit. We aim to evaluate the efficacy of virtual BSS classroom training compared to both non-interactive video and face-to-face teaching. Method: 72 medical students will be randomly assigned to three equal intervention groups based on year group and surgical skill confidence. Interventions will be implemented following an instructional video. Group A will practice independently, Group B will receive face-to-face training, and Group C will attend a virtual classroom. Participants will be recorded placing three interrupted sutures with hand tied knots preand post-intervention, and Objective Structured Assessment of Technical Skills (OSATS) will be blind marked by two experts. Change in confidence, time to completion and a granular performance score will also be measured. Each intervention's feasibility and accessibility will be assessed. Results: Data collection will be completed in January 2021. Significant improvement in OSATS within groups will be indicative of intervention quality. Difference in improvement between groups will determine the relative performance of the interventions. Conclusions: To our knowledge, this will be the largest randomised control trial investigating virtual BSS classroom training. It will serve as a comprehensive appraisal of the virtual classroom's suitability as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and in the future.

A pilot study of oral bismuth subsalicylate for the treatment of symptoms of acute COVID-19 (saber-c)

Introduction: Readily available, non-toxic and economical therapies are needed for patients during this pandemic illness. An open-label clinical study to determine the tolerance and efficacy of oral BSS therapy (Pepto-Bismol chewable tablets) was performed in 10 patients with acute, active COVID-19. Concurrent COVID-19 standard of care treatment was continued in these patients. Methods: Entry into the study required a positive salivary COVID-19 test, and the ability to chew Pepto-Bismol tablets. Demographics, vitals, comorbidities, COVID-19 related symptoms and concomitant medications were recorded. Sixteen (16) Pepto Bismol tablets were given per day for three days. The presence/absence of salivary SARS CoV-2 virus by RT-LAMP assay was measured daily. Results: After three days two groups emerged, 5 remaining COVID-19 positive and 5 COVID-19 negative (-) patients. Both groups were not demographically different. Medical vitals were similar, but the COVID-19+ patients trended to have more starting comorbidities and concomitant medications. COVID-19 related morbidities were similar between the groups. All patients studied showed an overall decrease in COVID-19 symptoms. The difference between the two groups of patients that became COVID-19- and those that remained virus + was the preexisting use of SSRI/SNRI/SARI or second-generation histamine receptor 1 (H1R) medications. None of the COVID-19 - group were on these medications and appeared to respond to administration of bismuth subsalicylate by clearing the virus from the saliva within days. None of the 10 BSS treated patients required escalation of care to an ICU. Conclusion: Bismuth subsalicylate is an over-the-counter intestinal medication. Bismuth has been shown to decrease SARS-CoV-2 viral replication through its effects on the viral helicase. Preexisting medications can impact its efficacy. BSS has potential to be used as a low cost and safe therapy in addition to standard of care for the treatment of mild/moderate COVID-19 patients. A placebocontrolled study has been planned..

Case study of thrombosis and thrombocytopenia syndrome following administration of the AstraZeneca COVID-19 vaccine

Cerebral venous sinus thrombosis is a complication of the ChAdOx1 nCoV-19 vaccine that should elicit a high index of suspicion when patients present with persistent headache post vaccination.