Teaching, Learning, and Climate Change: Anticipated Impacts and Mitigation Strategies for Educators

The impacts of climate change present numerous risks to the present and future state of teaching and learning. Natural disasters such as hurricanes, heat waves, flooding, blizzards, wildfires, sea level rise, and droughts threaten our ability to produce the learning outcomes promised to our pupils. Taking action to adapt to imminent climate-related challenges and mitigating measures that provoke and prolong ecological challenges is critical to the survival of these cultural institutions. Paradoxically, centers of teaching and learning can be seen as both victims of climate change as well as an instrumental part of the solution. Providing an efficient and effective education to the world's youth is a catalyst for the innovations that future generations of skilled professionals will use to combat climate change. Educational settings are also crucial venues for raising social awareness about anthropogenic climate change to undermine the complacency and denialism that have stagnated the global response to this crisis thus far. This paper incorporates suggestions from climate scientists and learning scientists about how to change how we teach, where we teach, and what we teach to ensure teaching enterprises survive and thrive in the face of a changing climate.

Multizone Modelling of SARS-CoV-2 Airborne Transmission in Mechanically Ventilated Buildings

This study contributes to a better understanding of the airborne transmission risks in multizone, mechanically ventilated buildings and how to reduce infection risk. A novel modeling approach combining the Wells-Riley and the US National Institute of Standards and Technology (NIST) CONTAM models was applied to a multizone whole building to simulate exposure and assess the effectiveness of different mitigation measures. A case study for the US Department of Energy large office prototype building was conducted to illustrate the approach. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.

Appropriateness and Completion of Multitarget Stool DNA Testing in Primary and Subspecialty Care

Introduction: Colorectal cancer (CRC) is the third most prevalent cancer in the United States, with a 4% lifetime incidence. While more clinicians have begun ordering multitarget stool DNA (mt-sDNA) testing due to the COVID-19 pandemic, adherence to guidelines on mt-sDNA and rates of subsequent follow-up testing has not been well studied. We assessed the appropriateness of mt-sDNA orders and rate of high-quality colonoscopy completion following a positive result in a large academic medical center. Method(s): We identified patients ordered for mt-sDNA in primary care and gastroenterology clinics at our institution between April 2020 and July 2021. For each case, we reviewed the appropriateness of mtsDNA testing, documentation of shared decision making, result of testing, and subsequent follow-up. Appropriateness was defined in accordance to the most recent American College of Gastroenterology guidelines on mt-sDNA use for CRC screening. Result(s): Of the 797 patients in our study, 685 (86%) met all appropriateness criteria for mt-sDNA testing (Table). Shared decision making was documented in 488 (62%) cases, and the most common reason for ordering mt-SDNA was hesitancy for colonoscopy. 483 patients (61%) completed mt-sDNA testing, of which 74 cases (15%) were positive. Rates of positivity were higher in cases of inappropriate (28%) rather than appropriate (13.7%) orders (p = 0.01). Colonoscopy was ordered in 73 cases (99%) and completed by 59 patients (80%). Of the 56 patients who underwent colonoscopy at our institution, most had documentation of a high-quality colonoscopy, defined as adequate prep (84%), cecal intubation (93%), visualization of the appendiceal orifice and ileocecal valve (94%), and right colon retroflexion (83%). Sixteen patients (29%) were found with advanced adenomas and 19 (34%) had other adenomas or sessile polyps. Among the 409 patients with negative tests, a 3-year follow-up recommendation was documented for 369 patients (90%). Conclusion(s): Most clinicians at our institution identified appropriate patients for mt-sDNA testing and provided appropriate follow-up< and the majority of patients who underwent colonoscopy had documentation of a high-quality colonoscopy. In contrast, there were suboptimal rates of mt-sDNA completion and documentation of shared decision making. Further studies are needed to identify barriers to documentation of shared-decision making and to completion of high-quality colonoscopies in patients being screened with mt-sDNA.

Indoor Environmental Quality Performance Approaches: Trending IAQ to IEQ to COVID-19 Extended Abstract

The University of Colorado Boulder (CU Boulder) is in Boulder, Colorado USA at 5280 feet above sea level. The campus has approximately 12 million square feet of infrastructure spanning over 100 years of building infrastructure evolution. In response to the COVID-19 pandemic, the University employed a science-based approach with campus researchers including aerosol scientists and campus epidemiologist and industry standards to inform a layered risk management strategy for an oncampus learning experience during the pandemic. This strategy was applied campus wide and specifically informed higher risk activities such as singing, music, theater, dance, athletic activities, as well as lecture, labs, and maker spaces. Through contract tracing and testing the campus reported 52 positive cases, where infected students had spent time in at least one classroom. It was determined that the infected student(s) had not spread the virus to other students who had been in the classroom due to the control measures and strategy that was employed. The campus response and risk management approach are summarized in this paper, as well as, the science that informed the strategy, the infrastructure modifications applied, and lessons learned from the data that was collected such as trends for CO2, temperature, CO2 and particle measurements during high aerosol activities, HEPA air cleaner placement, and data collected through contact tracing. Lessons learned from the effort will also be described to help improve post pandemic operations, assist others to operate during a pandemic, and plan for future pandemic scenarios which are primarily aerosol driven

Longitudinal effects of pandemic stressors and dyadic coping on relationship satisfaction during the COVID-19 pandemic

Objective: This study examined changes in relationship satisfaction during the COVID-19 pandemic and the moderating roles of financial strain, perceived threat of COVID-19, and dyadic coping. Background: The systemic-transactional model of dyadic coping posits that relationship satisfaction varies as a function of the stressors partners face and their engagement in dyadic coping. Method: About 188 partnered adults completed questionnaires at three time points during the initial confinement period of the COVID-19 pandemic and at a 20-month follow-up. Results: Relationship satisfaction increased during the first confinement period and returned to its baseline level at the 20-month follow-up. Greater financial strain and perceived threat of COVID-19 were associated with poorer relationship satisfaction over time. Dyadic coping buffered the negative impact of financial strain on relationship satisfaction during the initial confinement period, but not 20 months later. Conclusions: Most individuals were resilient to the effect of pandemic stressors on relationship satisfaction. The buffering effect of dyadic coping was observed during the initial confinement period when access to support resources outside the family unit was curtailed. Implications: Intervention efforts to promote dyadic coping and financial well-being for couples may be especially helpful in the context of strict confinement measures. © 2023 The Authors. Family Relations published by Wiley Periodicals LLC on behalf of National Council on Family Relations.

Social Isolation Among Adults Living With Cystic Fibrosis in the United States: A Single-Center Experience

Adults with cystic fibrosis face challenges that may increase social isolation. The goal of this cross-sectional study was to describe social isolation in this population. Participants (N = 34) were recruited from an adult cystic fibrosis clinic. Demographic and clinical data, social isolation scores, coronavirus disease 2019 effects, and quality of life outcomes were collected and compared to describe social isolation. Significant social effects were not found in this group, but preliminary data reveal potential predictors of social isolation. This study provides insight into the predictors of social isolation among adults with cystic fibrosis and lays the groundwork for future studies. © 2023 Elsevier Inc.

Model Evaluation of Secondary Chemistry due to Disinfection of Indoor Air with Germicidal Ultraviolet Lamps

Air disinfection using germicidal ultraviolet light (GUV) has received increasing attention during the COVID-19 pandemic. GUV uses UVC lamps to inactivate microorganisms, but it also initiates photochemistry in air. However, GUV's indoor-air-quality impact has not been investigated in detail. Here, we model the chemistry initiated by GUV at 254 ("GUV254”) or 222 nm ("GUV222”) in a typical indoor setting for different ventilation levels. Our analysis shows that GUV254, usually installed in the upper room, can significantly photolyze O3, generating OH radicals that oxidize indoor volatile organic compounds (VOCs) into more oxidized VOCs. Secondary organic aerosol (SOA) is also formed as a VOC-oxidation product. GUV254-induced SOA formation is of the order of 0.1-1 μg/m3 for the cases studied here. GUV222 (described by some as harmless to humans and thus applicable for the whole room) with the same effective virus-removal rate makes a smaller indoor-air-quality impact at mid-to-high ventilation rates. This is mainly because of the lower UV irradiance needed and also less efficient OH-generating O3 photolysis than GUV254. GUV222 has a higher impact than GUV254 under poor ventilation due to a small but significant photochemical production of O3 at 222 nm, which does not occur with GUV254. © 2022 American Chemical Society.

THE ETHICS AND POLITICS OF CARE IN TIMES OF CRISES

This essay is based on The Global Ethics of Care round-table discussion which was organized by the Institute for Philosophy and Social Theory at the University of Belgrade in June 2021. The idea for organizing a discussion on this topic emerged as all societies were, and still are, facing a myriad of pressing moral and political issues that the outbreak of the COVID-19 pandemic in 2020 triggered or, perhaps more precisely, intensified in a dramatic and abrupt way. If it had not been obvious before, indeed, the (ongoing) COVID-19 pandemic highlighted the fact that human beings are needy and vulnerable creatures who depend on one another for physical and emotional care;speaking quite generally, moreover, it deepened various pre-existing inequalities both within and between sovereign states. What are the implications of recognizing human neediness, vulnerability, dependence and interdependence for the ways in which individuals act, the manner in which many societies are currently organized as well as existing domestic and international political practice? What do the values of freedom, equality and care require in times of crises on both the individual and the collective level? Can the ethics of care revitalize our moral commitment to equal human worth as well as to a decent life for all? In this essay, we explore and attempt to provide answers to these and other pertinent questions from the standpoint of the ethics and politics of care. © University of Belgrade - Institute for Philosophy and Social Theory.

The Impact of COVID-19 on nursing home residents? clinical, functional, and psychosocial outcomes

Background. Data on COVID-19 related nursing home infections and mortality accumulated at a rapid pace;yet little is known about the impact of nursing homes' response to COVID-19 on resident clinical, functional, and psychosocial outcomes. Methods. We examined aggregated Minimum Data Set (MDS) assessments to describe resident outcomes using an interrupted times series methodology for three timeframes: pre-COVID (1/2019 to 2/2020), pandemic (3/2020-12/2021), and vaccination (1/2021-6/2021). Data included 307,558 federally mandated resident MDS assessments from 60,846 resident in 489 nursing homes in a Mid-Western state. We calculated MDS based quality measures (QM) using definitions available from Centers for Medicare and Medicaid Services. Each QM-based outcome was fit to a logistic regression model using the method of generalized estimating equations. Results. None of the QMs displayed a statistically significant trend pre-COVID. The prevalence of excessive weight loss and ADL decline increased sharply during the pandemic and reversed that trend with vaccination. Pressure ulcers among high-risk residents followed a similar trend, although pandemic and vaccination-related regression parameters for thatQMwere only marginally significant (p = .08). Pain worsened during the pandemic and vaccination period approaching significance (p=.07). Antipsychotic medication use worsened in the pandemic (p< .001) and did not improve in the vaccination period. Other QMs including any fall, fall with major injury, and incontinence did not exhibit statistically significant change in trend. Prevalence Profiles Circles: Observed proportions, Dashed Line: Model expected value, Solid Lines: 95% confidence limits for expected values Conclusion. We noted significant changes in QMs for antipsychotic use, ADL loss, andweight loss, with the latter two improving in the vaccination period. Isolation, disease outbreaks, and staffing issues in facilities could have affected theseQMs. Data variability may have limited our ability to detect other changes. Antipsychotics may have increased with the need to reduce wandering and other behaviors common in the nursing home population;behaviors high risk for spreading COVID-19. Why antipsychotic use did not improve during the vaccination period is less clear. Data beyond June of 2021 may help clarify the pattern of antipsychotic use. (Figure Presented).

Statistical consulting in the healthcare professions: A model of student-led consulting services

Statistical consulting is a common and vital activity undertaken by those with advanced statistical training but may not be widely available to health professionals and trainees without access to dedicated statistical consulting cores. Here, we present a novel model of statistical consulting used by a student chapter of the American Statistical Association housed in a graduate health professions university. This student-led organization provides statistical consulting services for faculty, staff and students university-wide. Information on the methods of advertising consulting services, the role of a professional statistician faculty advisor, resources available to consultants and university community members and the ways in which consulting services were adapted to address the barriers introduced by the COVID-19 pandemic are addressed. Data from 108 consults performed over the past two and a half years with 88 different consultees are analysed and discussed. This article outlines an innovative model of student-led statistical consultation for healthcare professionals and trainees and aims to provide a template for future student-led organizations who similarly aim to perform university statistical consultations.

CORD COVID-19 Task Forces Report on the Pandemic Impacts on Undergraduate Medical Education

Learning Objective: We sought to describe the effects of COVID-19 on UME within EM. Background(s): The COVID-19 pandemic has affected multiple aspects of Undergraduate Medical Education (UME) beyond infection and illness. Many universities, medical schools, and hospitals instituted policy changes around educational gatherings and clinical participation. State-issued travel restrictions impacted both rotations and altered the Match process. Objective(s): We sought to describe the effects of COVID-19 on UME within EM. Method(s): CORD chartered a COVID-19 Task Force comprised of 18 selected educators to explore the pandemic's impact on EM. A Modified Delphi process was used to develop multiple survey instruments. This process included a literature search for validated questions and internal piloting with iterative changes. After IRB approval, the UME survey was distributed to members of CORD during the 2021 Academic Assembly. Using SPSS v26, a descriptive analysis was performed. Result(s): Sixty-three individuals responded to the UME survey, with 27 (42.9%) program directors (PDs), 19 (30.2%) assistant/associate PDs, 5 (7.9%) core faculty, 5 (7.9%) clerkship directors, 4 (6.3%) residents/fellows and 3 others (vice chair of education, educational researcher, unknown). Most respondents were white (84.1%) and approximately half identified as women (50.8%). Table 1 provides means and standard deviations for statements displayed from most to least important. Conclusion(s): The positive financial impact on medical students was described as the greatest benefit of the pandemic. Virtual technology was varied in its impact: positive for conferences and interviewing but negative as a surrogate for clinical rotations or the ability for students to evaluate residency program culture. The top challenge facing UME was the removal of students from clinical rotations. This may impact residency programs, requiring them to remediate those skills. A limitation of this geographically broad cohort was the number of respondents.

CORD COVID-19 Task Force Report on the Pandemic Impact on Undergraduate Medical Education

Learning Objectives: We sought to describe the effects of COVID-19 on UME within EM. Background(s): The COVID-19 pandemic has affected multiple aspects of Undergraduate Medical Education (UME) beyond infection and illness. Many universities, medical schools, and hospitals instituted policy changes around educational gatherings and clinical participation. State-issued travel restrictions impacted both rotations and altered the Match process. Objective(s): We sought to describe the effects of COVID-19 on UME within EM. Method(s): CORD chartered a COVID-19 Task Force comprised of 18 selected educators to explore the pandemic's impact on EM. A Modified Delphi process was used to develop multiple survey instruments. This process included a literature search for validated questions and internal piloting with iterative changes. After IRB approval, the UME survey was distributed to members of CORD during the 2021 Academic Assembly. Using SPSS v26, a descriptive analysis was performed. Result(s): Sixty-three individuals responded to the UME survey, with 27 (42.9%) program directors (PDs), 19 (30.2%) assistant/associate PDs, 5 (7.9%) core faculty, 5 (7.9%) clerkship directors, 4 (6.3%) residents/fellows and 3 others (vice chair of education, educational researcher, unknown). Most respondents were white (84.1%) and approximately half identified as women (50.8%). Table 1 provides means and standard deviations for statements displayed from most to least important. Conclusion(s): The positive financial impact on medical students was described as the greatest benefit of the pandemic. Virtual technology was varied in its impact: positive for conferences and interviewing but negative as a surrogate for clinical rotations or the ability for students to evaluate residency program culture. The top challenge facing UME was the removal of students from clinical rotations. This may impact residency programs, requiring them to remediate those skills. A limitation of this geographically broad cohort was the number of respondents.

Impact of the COVID-19 Pandemic on US Emergency Medicine Education: A Needs Assessment for Academic Emergency Medicine Faculty

Learning Objective: To characterize the challenges and benefits that the COVID-19 pandemic has provided to academic EM faculty. Background(s): The COVID-19 pandemic has presented unpredicted challenges to EM education. The speed of the pandemic and extraordinary clinical burden prevented a coordinated educational response at all levels, including that of faculty development. While COVID-19 research is prolific and ongoing, EM faculty educational impact is yet to be fully explored. Objective(s): To characterize the challenges and benefits that the COVID-19 pandemic has provided to academic EM faculty. Method(s): CORD chartered a COVID-19 Task Force of 18 selected educators to explore the pandemic's impact on EM. A Modified Delphi process was used to develop multiple survey instruments. This process included a literature search for validated questions and internal piloting with iterative changes. After IRB approval, the faculty survey was distributed to members of CORD during the 2021 Academic Assembly. Using SPSS v26, a descriptive analysis was performed. Result(s): Forty-one individuals responded to the survey concerning faculty. Eighteen (43.9%) respondents were program directors, 14 (34.1%) were assistant/associate program directors, four (9.8%) were core faculty, four (9.8%) were clerkship directors, and one individual (2.4%) was involved with faculty development and research. Most respondents were white (87.8%) and women (61%). Table 1 demonstrates the faculty responses for the benefits and challenges of COVID-19 to education. Table 2 notes the impact on the faculty themselves. Conclusion(s): While the educational response to the pandemic was felt by faculty to be positive in the utilization of virtual platforms, faculty felt less engaged and less connected. Personally, faculty reported benefitting from numerous sources of human support, including familial, professional, and public. Despite this support, faculty reported the pandemic left them stressed, distressed, and burned out. A limitation of this geographically broad cohort was the number of respondents.

The effects of Covid-19 pandemic on the post graduate plans of emergency medicine residents

Learning Objectives: Evaluate the economic impact of the COVID-19 pandemic on the post graduate plans of the 2020 and 2021 graduating emergency medicine residency classes to aid in the future career guidance by emergency medicine faculty. Background(s): The strict lockdown measures in response to the COVID-19 pandemic had significant effects in all aspects of the economy and the healthcare industry, including a reduction in emergency department visits by 42%, according to the CDC. This decrease in volume continued throughout 2020 and 2021, causing many physician practice groups to re-evaluate their costs. Objective(s): We hypothesize that the COVID-19 pandemic caused economic impacts on the class of 2020 and 2021 emergency medicine residents in a variety of ways both economically and with changes to post graduate plans to include fellowship. Method(s): We created a survey-based study of the graduating classes of emergency medicine residents of all 17 programs in Florida sent via email through the Florida CORD consortium. Inclusion criteria were that the survey respondent must be from the graduating class of 2020 or 2021. Data was collected through an anonymous online survey platform. Result(s): We received a total of 33 responses, stratifying the data based on the graduating class year. In our small sample, 49% of responders indicated that COVID-19 did impact their post-graduate plans in some way. 50% of responders from the class of 2020 noted some level of reduction in their number of post-graduate shifts, with a total of 33% of responders from both classes. We found a statistically significant difference (p=0.054) in expenses reduction for the class of 2021 graduates (43% of responders) compared to the class of 2020 (8%), with a total of 33% of responders of all classes indicating a reduction. There was no significant difference regarding impact on fellowship plans. Conclusion(s): There seemed to be some impact on employment opportunities and post-graduate career plans, though the degree of this impact is somewhat limited by small sample size. Similar studies need to be repeated to observe any potential generalizable trends to further aid residency program leadership in career guidance for residents.

A RARE CASE OF PLEURODYNIA AFTER THE COVID-19 VACCINE

SESSION TITLE: Rare Cases with Masquerading Pulmonary Symptoms SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: COVID vaccinations have been encouraged by many healthcare providers but many adverse effects have also been reported. The adverse effects of the vaccine can vary based on each individual. Common adverse effects of the vaccine included fatigue, fever, chills, sore throat, muscle pain, headache, rash at injection site. Pleurodynia, also known as Devil's Grip, is a viral myalgia which causes sharp chest pain or the sensation of a grip around one's chest. Pleurodynia treatment is mostly supportive like anti-inflammatories (NSAIDS), pain management, and antibiotics (if bacterial inflammation is suspected). CASE PRESENTATION: We present a case report of a 63-year-old female who presented with complaints of pleuritic chest pain worse with inspiration. She had a history of atrial fibrillation and HTN. Patient had received the Pfizer COVID booster vaccine a few days prior to onset of the pleuritic chest pain. She was obese and had a 40 pack year smoking history. She was on room air saturating 92% with no increased work of breathing. Lung sounds were diminished due to body habitus but clear. Chest x-ray showed low lung volumes with no evidence of acute pulmonary disease. Computed Tomography Angiography (CTA) chest showed no pulmonary embolism and small left partially loculated pleural effusion with peripheral airspace opacities abutting the pleura. Acute coronary syndrome was ruled out and other cardiac workup was negative. COVID PCR was negative. Patient was treated empirically for bacterial infection with ceftriaxone and azithromycin. She was given NSAIDS to decrease inflammation and pain. Patient's symptoms improved significantly with treatment. She was discharged on NSAIDS and advised to follow up outpatient with her primary care and pulmonology. DISCUSSION: Research studies have indicated that the COVID vaccines (like Pfizer) can cause exacerbation of inflammatory or autoimmune conditions. Multiple mechanisms may be responsible for myocarditis, pericarditis, and other inflammatory conditions post vaccines. One mechanism describes that lipid particles of SARS mRNA vaccines can induce inflammation by activating the NLR pyrin domain containing 3 inflammasome of mRNA which are recognized by toll like receptors and cytosolic inflammasome components leading to inflammation. Another mechanism explains that viral proteins can cause immune cross reactivity with self-antigens expressed in the myocardium leading to an inflammatory process. CONCLUSIONS: As per current literature review there are no case reports about pleurodynia post COVID vaccination but pericarditis and myocarditis have been described. Further research studies are indicated to assess the cause and pathophysiology of pleurodynia post COVID vaccine. Physicians should have a high index of clinical suspicion for pleurodynia when assessing a patient with pleuritic chest pain with a recent history of COVID vaccination. Reference #1: 1. Analysis of COVID 19 Vaccine Type and Adverse Effects Following Vaccination. Beatthy, A;Peyser, N;Butcher, X. AMA Netw Open. 2021;4(12):e2140364. doi:10.1001/jamanetworkopen.2021.40364 Reference #2: 1. Association of Group B Coxsackieviruses with Cases of Pericarditis Myocarditis, or Pleurodynia by Demonstration of Immunoglobulin M Antibody. Schmidt, N;Magoffin, R;& Lennette, E. Infection and Immunty Journal. 1973 Sep;8(3): 341–348. PMCID: PMC422854 Reference #3: 3. Autoimmune phenomena following SARS-CoV-2 vaccination. Ishay, Y;Kenig, A;Toren, T;Amer, R;et. al. International Journal of Immuno-pharmacology. 2021 Oct;99: 107970. DISCLOSURES: No relevant relationships by Olufunmilola Ajala No relevant relationships by Arij Azhar No relevant relationships by Louis Gerolemou No relevant relationships by Wael Kalaji No relevant relationships by Steven Miller No relevant relationships by Kunal Nangrani No relevant relationships by Gaurav Parhar No relevant relationships by iran Zaman

A RARE CASE OF ASYMPTOMATIC COVID-19 INFECTION MASQUERADING AS PHLEGMASIA CERULEA DOLENS

SESSION TITLE: Look again: Infections and Mimics SESSION TYPE: Case Reports PRESENTED ON: 10/18/2022 11:15 am - 12:15 pm INTRODUCTION: Phlegmasia Cerulea Dolens (PCD) is a rare and critical condition caused by venous thrombosis requiring emergent treatment to prevent limb ischemia. COVID 19 has been widely reported to cause venous thromboembolism and compromise of tissue perfusion. We report a case of PCD in a patient with asymptomatic COVID-19 infection. CASE PRESENTATION: A 60 year-old female with no known medical history, unvaccinated for COVID-19 presented with sudden onset left lower extremity pain and swelling associated with numbness. Physical examination was remarkable for left lower extremity swelling with bluish discoloration, poikilothermia, and paraesthesia. Computed tomography angiogram (CTA) chest, abdomen and pelvis revealed left lower extremity deep vein thrombosis with compromised blood flow with focal thrombosis of the IVC extending inferiorly to the great saphenous and popliteal vein, along with small bilateral segmental and subsegmental pulmonary emboli. Diffuse Ground glass opacities suspicious for COVID-19 pneumonia. COVID-19 PCR was positive. Anticoagulation with heparin drip was initiated, and the patient underwent successful left iliocaval to popliteal vein thrombectomy and venoplasty by interventional radiology with successful restoration of circulation to the affected extremity. She was eventually transitioned to apixaban. She experienced marked improvement in her symptoms post procedure. DISCUSSION: Patients with COVID 19 develop venous thromboembolisms at an alarming rate despite thromboprophylaxis. The mechanism is likely explained by the virchow's triad (venous stasis, hypercoagulable state, vessel wall injury) in the setting of increased pro-inflammatory markers. We report the first case at our institution of PCD in the setting of COVID-19.We noted that our patient had a similar presentation as those reported in literature, which include acute leg swelling associated with pain and cyanosis. Complications include venous outflow obstruction, which can result in compartment syndrome with arterial ischemia, eventually progressing to gangrene of the affected limb. PCD is a very rare but life-threatening complication caused by extensive clot burden associated with acute limb ischemia and increased mortality rates. This condition requires emergent initiation of intravenous anticoagulation and thrombectomy with or without tissue plasminogen activator (tPA). If this condition is not treated in a timely fashion, it can result in acute limb ischemia and gangrene requiring amputation. CONCLUSIONS: Physicians should recognize PCD in patients who have been exposed to COVID-19 as it is a life-threatening condition which requires emergent initiation of anticoagulation and treatment. Diagnosis is usually made with clinical examination and ultrasonography or CT imaging. Management options include open thrombectomy with leg fasciotomy or catheter directed thrombolysis or percutaneous transluminal angioplasty. Reference #1: Chun TT, Jimenez JC, Pantoja JL, Moriarty JM, Freeman S. Phlegmasia cerulea dolens associated with acute coronavirus disease 2019 pneumonia despite supratherapeutic warfarin anticoagulation. J Vasc Surg Cases Innov Tech. 2020;6(4):653-656. doi:10.1016/j.jvscit.2020.10.002 Reference #2: Gutierrez JR, Volteas P, Skripochnik E, Tassiopoulos AK, Bannazadeh M. A Case of Phlegmasia Cerulea Dolens in a Patient With COVID-19, Effectively Ttreated With Fasciotomy and Mechanical Thrombectomy. Ann Vasc Surg. 2022 Feb;79:122-126. doi: 10.1016/j.avsg.2021.07.034. Epub 2021 Oct 10. PMID: 34644637;PMCID: PMC8502248 Reference #3: : Morales MH, Leigh CL, Simon EL. COVID-19 infection with extensive thrombosis: A case of phlegmasia cerulea dolens. Am J Emerg Med. 2020;38(9):1978.e1-1978.e3. doi:10.1016/j.ajem.2020.05.022 DISCLOSURES: No relevant relationships by Arij Azhar No relevant relationships by Louis Gerolemou No relevant relationships by Wael Kalaji No relevant relationships by Steven Miller N relevant relationships by jasparit minhas No relevant relationships by houman mirtorabi No relevant relationships by Kunal Nangrani No relevant relationships by Gaurav Parhar No relevant relationships by Kiran Zaman

Comfort in Telemedicine Based on Diagnosis and Reason for Referral in Pediatric Gastroenterology

Background: Telemedicine can provide increased patient access to care, cost savings and high patient satisfaction. Payors have extended reimbursement for telemedicine and although few pediatric gastroenterologists had experience with telemedicine before the COVID-19 pandemic, many practices continue to offer this as a care modality model. Comfort in practicing telemedicine for specific conditions amongst NASPGHAN members is not known. This study evaluates comfort in practicing telemedicine for common indications for outpatient GI consultation referral and follow up visit diagnoses. Method(s): In June-August 2020, we surveyed members of NASPGHAN with an instrument that included two multi-select questions: 1) Which of the following reasons for referral would you feel comfortable completing with telemedicine? 2) Which of the following conditions would you feel comfortable using telemedicine for a routine follow up? Results: 136 participants answered the two survey items. Constipation (n=121, 89%), heartburn (n=109, 80%), and infant reflux (n=109, 80%) were the reasons for referral most frequently selected. Referral of jaundice (n=26, 19%), second opinion (n=45, 33%), and poor weight gain (n=51, 38%) received the least mentions. For follow up appointments, diagnoses of celiac disease (n=126, 93%), functional gastrointestinal disorders (n=126, 93%), eosinophilic esophagitis (n=120, 88%) were the three most frequent, while liver transplantation (n=24, 18%), intestinal failure (n=26, 19%), and short bowel syndrome without intestinal failure (n=34, 25%) were the diagnoses selected the least. 14 respondents selected comfort with all new patient reasons for referral and follow up visits. Conclusion(s): There is variability in provider comfort to utilize telemedicine for providing consultation or follow up care based on reason for referral or patient diagnosis. Provider comfort in providing care should be considered when offering telemedicine as a practice model moving forward. Reasons underlying provider dis/comfort should be explored using qualitative methods. (Figure Presented).