Uncovering the Importance of Peer-to-Peer Communication during the COVID-19 Pandemic: Rotating Chromatography Experiments to Overcome Limited Student Capacity

Even though scientific communication and collaboration play critical roles in academic success, they often come in second to teaching laboratory fundamentals. COVID-19 associated capacity constraints forced our program to reexamine the traditional laboratory instruction paradigm by limiting physical attendance, as well as laboratory duration. Instead, we opted to turn these restrictions into opportunities to study peer-to-peer communication as a means to enhance in-person experimentation. Here, a two-week high performance liquid and gas chromatography (HPLC and GC) module uses centralized student communication between peer groups to not only maintain but increase quality laboratory experiences. Students rotate between two chromatography experiments to ensure each person gains exposure to foundational separations techniques. The module's first week focuses on method development, while the second week highlights method validation. Since HPLC and GC can accommodate similar experimental objectives, students receive comparable method development and validation experiences no matter which specific instrument they are assigned to that week. By integrating communication into the experimental process and adding peer accountability to the laboratory's design, the authors observed an increase in laboratory report words and figures when compared to the prior years' reports. Student questionnaires also indicated structured rotation and group communication increased student interest and investment in obtaining and reporting quality data. © 2023 Authors. All rights reserved.

GATA2 deficiency presenting as fever and rash

Case Report: Our patient is an 8-year-old Caucasian female with a history of choanal atresia, first degree heart block, recurrent urinary tract infections, and recent COVID-19 infection, who initially presented with an episode of syncope and vomiting. By history, she had two weeks of daily fever and an intermittent nonspecific rash. She was diagnosed with a UTI 5 days prior to presentation but had not defervesced despite treatment. Shewas initially found to be in shock with tachycardia and poor perfusion and was treated with fluid resuscitation, antipyretics, and empiric antibiotics. Labs were significant for leukopenia, elevated inflammatory markers, lactic acidosis, coagulopathy, and mildly elevated troponin. Chest x-ray showed abnormal but non-specific widespread infiltrates. She was initially treated with IVIG and pulse steroids for a working diagnosis of MIS-C, however she did not improve and a more extensive infectious, oncologic, and rheumatologic work-up was performed. Her workup revealed a disseminated Mycobacterium abscessus infection. Bone marrow biopsy revealed myelodysplasia with monosomy 7. Her buccal swab testing revealed a heterozygous germline mutation in the GATA2 gene, a variant that is predicted to cause loss of normal protein function. She is presently on multidrug regimen for her mycobacterial infection. Her myelodysplasia evolved into an acute leukemia, and she is undergoing chemotherapy for that at this time. Discussion(s): GATA2 deficiency, first identified in 2011, is a rare immune disorder resulting in a wide variety of clinical presentations. It is caused by a germline mutation of the GATA2 gene that disrupts blood cell differentiation, resulting in decreased or absent monocytes, B cells, NK cells, and dendritic cells1. This case presented multiple challenges due to the broad range of differential diagnoses. This patient was ultimately diagnosed with myelodysplastic syndrome associated with monosomy 7 and GATA2 deficiency, confirmed by FISH testing. Due to the presentation and lab derangements this patient had, there was a delay in targeted treatment while managing her cytopenias and presumed pulmonary infection. GATA2 deficiency carries a high risk of progression from myelodysplastic syndrome to acute myelogenous leukemia. The best long-term treatment for GATA2 deficiency is hematopoietic stem cell transplant, which is the ultimate goal for our patient. Copyright © 2023 Southern Society for Clinical Investigation.

GIDDY UP! LESSONS LEARNED FROM INTRODUCING AN ONLINE, NATURE-BASED INTERVENTION TO ASSISTED LIVING

The processes involved with developing, funding, and conducting intervention studies in long-term care present a unique set of challenges for researchers. In this presentation, we explore the experiences of researchers evaluating an online nature-based intervention in assisted living. The first challenge lies in creating or finding a novel intervention specific to the setting and population. In this case, the researchers found and tailored an existing online, interactive program that focused on ranch life in rural Montana – Days at Dunrovin. In partnership with the developer of Days at Dunrovin, a group intervention was developed specifically for long-term care settings. The second challenge is finding a facility that has the desire, environment, and staffing to support the intervention. In this case, the researchers were able to partner with an assisted living facility that had an owner who was interested in research, an environment that matched the experimental design of the study, and a staff that was eager to find new ways for residents to engage with the world, particularly during the COVID-19 pandemic. The final challenge involves selecting a funding mechanism that best fits the needs of the study. In this case, the researchers targeted a private foundation that provided ample funding along with the latitude and flexibility that allowed the study to evolve and pivot as necessary. This presentation concludes with recommendations for both budding and seasoned researchers who seek to introduce creative interventions into long-term care settings.

Development of an mHealth app integrating pain-cognitive behavioral therapy and opioid support for patients with advanced cancer (STAMP+CBT)

Background: Pain affects 40-90% of patients with advanced cancer. Supplementing pharmacologic therapy with behavioral skills may improve pain outcomes. We sought to evaluate patients' perspectives of a pain-cognitive behavioral therapy (CBT) mobile health intervention for cancer pain. Method(s): We recruited patients from the Dana-Faber Cancer Institute outpatient palliative care clinic to review the pain-CBT mHealth intervention. Eligible patients were >21 years old, had an incurable solid malignancy, chronic pain related to cancer, and were using opioids for cancer. We excluded hospitalized patients and those with pain from a recent surgery, dementia/delirium, or an opioid use disorder. In individual, qualitative interviews patients reviewed pain-CBT content modified for advanced cancer and mHealth delivery, and provided feedback on the relevance of the content in the context of their own pain. Result(s): Patients (n = 14) reviewed pain-CBT app content and wireframes. Most rated the content and user interface as highly usable, informative, aesthetically pleasing, convenient, and relevant to their experiences. Suggested improvement included revising technical content to increase clarity/ reduce literacy, shortening length of texts, and including additional tracking for daily opioid use. Six subthemes regarding patients' current pain management approaches were identified. Individuals endorsed using physical coping skills including engaging in physical activity and at times struggling to recognize physical limits. Many endorsed utilizing psychological coping such as accepting their pain, reframing thoughts about pain, and using distraction or relaxation to cope. Social support was relevant to coping for almost all patients, and many described COVID-19 distancing guidelines as disruptive. Patients endorsed complex relationships with opioids including guilt related to use or difficulty understanding prescription instructions. Most patients emphasized the relationship between sleep, stress, and pain as central to their pain management, and that they wished their clinicians reviewed the relationship between pain and stress earlier. Conclusion(s): MHealth delivery was viewed as an attractive method to both integrate and deliver behavioral pain management skills with opioid support to alleviate cancer pain. A future pilot study will evaluate the app's feasibility and acceptability in patients with advanced cancer.

HIV PARTNER NOTIFICATION IN NEWLY DIAGNOSED PATIENTS IN THE CLINIC AGAINST BRITISH ASSOCIATION OF SEXUAL HEALTH AND HIV (BASHH) PARTNER NOTIFICATION (PN) STANDARDS

Introduction Effective HIV interventions have significantly reduced HIV transmission. However with each new case, effective HIV partner notification(HIV-PN) is pivotal in identifying new HIV transmission networks and is a crucial contribution towards ending new HIV infections in England by 2030. We aimed to review our local PN standards against the BASHH guidelines. Method Using GUMCAD coding and heath adviser/HIV team databases we collected data from all new HIV diagnoses in 2021. Results Overall, there were 24 individuals newly diagnosed with HIV in our clinic in 2021. There were 3(13%) who were experiencing sero-conversion at the time of diagnosis. 22 (92%) were cis-male, 17/24(71%) were MSM, the median age was 44 years (IQR=29-51) and 19(79%) described themselves as being of white ethnicity. We found that 1.88 (BASHH standard=0.88) contacts were reported by the index and 1.13 (BASHH standard=0.8) were tested per index case. The proportion of contactable partners tested according to the patient was 83%(BASHH=85%) and those verified by the clinician was 51%(BASHH=65%). 75%(BASHH=97%) of cases had a documented PN plan and 97%(BASHH=100) had a PEPSE assessment. From the notes review, the reasons why HIV PN was not achieved related to being diagnosed in other services and an absence of health adviser input. During Covid-19 inpatient diagnoses were unable to have HIV-PN initiated on 'red' wards. Discussion Overall we are meeting most of the BASHH standards for HIV PN. Further work is needed as an MDT to ensure this gap in PN follow up is addressed.

The COVID-19 Pandemic and Early Childhood Education in Ethiopia, Liberia, and Pakistan: Perspectives of Pre-primary School Teachers

School closures due to the COVID-19 pandemic have affected teachers and changed their role significantly. This chapter explores the extent to which early childhood education (ECE) teachers were engaged in children’s early learning during school closure through communication with their parents and families in three countries: Ethiopia, Liberia, and Pakistan. Using mobile phone surveys and key informant interviews, we investigate the support pre-primary teachers received during school closures and how they were able to support children’s home-based learning and prepare for school reopening. In all three countries, many teachers were in contact with children and families during school closures, yet the percentage varies by country, from 33% in Ethiopia to 64% in Liberia and 100% in Pakistan. Teachers in Ethiopia and Pakistan reported that children from disadvantaged backgrounds were missing out on essential support, but about 70% of ECE teachers sought to accommodate their learning needs or support psychosocial well-being. We discuss policy implications to support ECE teachers and children in the current and future crises in order to improve responsiveness and resilience in ECE systems. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Enabling Creative Small Business Innovation in a Crisis: An Abstract

The COVID-19 pandemic has impacted many businesses but has especially impacted small businesses (Dua et al. 2020, Eggers 2020). In the early months of the pandemic, many small business owners did not have the financial ability to sustain their services due to lacking funds during the shut-down (Bartik et al. 2020). This has significant long-term effects on the global economy as small-to-medium size businesses comprise 90% of all global businesses and 55% of GDP (Salesforce 2019). The demise of small businesses could have incomprehensible long term impacts on the global economy. As a result, it is not surprising that many scholars are calling for more research to understand how businesses can continue their services during the global pandemic (e.g., Batat 2020;Heinonen and Strandvik 2020;Sajtos et al. 2020). Although past research has investigated crisis management from a marketing perspective, little research has explored how small businesses are able to continue services in a crisis of this extent. Past research recognizes that business model innovation can offer new profitable opportunities and/or provide a shield against dynamic environmental changes (McDonald et al. 2019;Teece 2018), but less work has explored how small businesses can attain business innovation models in the challenge of a significant crisis, such as the COVID-19 pandemic. As such, we explore the following research question: What can enable small businesses’ business model innovation during a crisis? To investigate this research question, we take an inductive, qualitative approach. Using qualitative interviews with 10 industry-diverse small business owners and 5 small business resource providers, the data reveals there are multiple paths to pursuing their interests in sustaining business. Specifically, we identify that through a cocreative process, small businesses rely on technology and intermediary organizations to foster new forms of pursuing business, specifically engaging in business model innovation (BMI). This research answers calls for research inquiring how businesses, and specifically small businesses, are able to help others cope with the crisis and support the economy (Pantano et al. 2020). © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Telemedicine for Genetic Counseling in Huntington's Disease during the COVID-19 Pandemic

Objective: To evaluate the feasibility of using telemedicine for predictive genetic testing in Huntington's disease (HD). Background: While a specific protocol for genetic testing in HD exists, evidence regarding its applicability via telemedicine is lacking. The implementation of social distancing guidelines during the COVID-19 pandemic led us to utilize telehealth visits in our clinic for predictive testing. Methods: From May 2020 to Sep 2021, eligible patients seen at the UTHealth Houston, HDSA Center of Excellence multidisciplinary clinic were offered predictive genetic testing via telemedicine. The 2016 HDSA recommendations for predictive testing were adapted and implemented via telemedicine. Visits were conducted by a team consisting of a movement disorder specialist, genetic counselor, psychiatrist, neuropsychologist, and social worker utilizing institute-approved telemedicine platforms. Patient satisfaction and telehealth quality were assessed with Telehealth Usability Questionnaire (TUQ), which included the components of usefulness, ease of use, interface quality, interaction quality, reliability, and satisfaction [1]. Results: 50 individuals expressed interest in predictive testing via telemedicine. Of these, 11 did not continue after initial inquiry and three had already prior testing [Fig. 1]. Of the remaining 36 individuals (mean age: 37.17 ± 13.23 years), 21 completed the consent and sample collection with an in-person visit. For 15 elected to use telemedicine consent was obtained via telemedicine, and sample collection was coordinated remotely. 21 individuals had results disclosure via telemedicine, 13 of whom used telemedicine for both visits. Seven out of 21 completed the TUQ and rated the visit usability as 92.5% usefulness, 75.5% ease of use, 78.6% interface quality, 86.7% interaction quality, 64.1% reliability, and 89.3% satisfaction and future use. Conclusion: Delivering the predictive testing protocol via telemedicine depends on various patient and clinician-related factors including ease of use, comfort with the type of visit and technology used. In our experience, a majority of patients who underwent telemedicine for genetic counseling and result disclosure were satisfied and would use this service in the future. Despite the convenience and patient satisfaction, it is imperative that caution is applied prior to determining patient readiness and result disclosure given the sensitive nature of HD gene testing.

Contact tracing and the challenges of health equity in vulnerable Latino and native American communities

Communities of color are experiencing significantly higher rates of COVID-19 infection and significantly higher mortality rates when compared to white Americans. It is critical that contact tracing efforts are executed in ways that are appropriate to those communities experiencing a greater burden of COVID-19. In some cases these efforts should take into account the distrust some communities have in health care systems and providers. Other issues relevant to contact tracing include language, cultural competency, health literacy, stigma, and privacy concerns, particularly in multigenerational households. Furthermore, contact tracers may identify individuals who lack access to care and/or health insurance, or the supportive services needed to isolate if they test positive, and some individuals will be residents without documentation. Recruiting and building a new cadre of contact tracers should meet the immediate goal of addressing the pandemic, but attention could also be paid to building a public health infrastructure in communities that supports health equity. The National Academies of Sciences, Engineering, and Medicine's Roundtable on the Promotion of Health Equity hosted a public webinar titled, Doing It Right: Contact Tracing and Health Equity, on July 30, 2020, which focused on the role of contact tracing for vulnerable groups, in this case, Native Americans and Latino communities, during the COVID-19 pandemic. This publication provides a summary of the discussions from the workshop. © 2021 by the National Academy of Sciences. All rights reserved.

SERVICE EVALUATION OF ACUTE NEUROLOGY REFERRALS IN THE REGIONAL NEUROSCIENCE CENTRE

Background Neurological disorders account for 20% of acute medical admissions and 7% of GP consulta-tions. We evaluated our acute neurology service with the catchment area of 3 million people. Moreover, we investigated the impact on the service during the COVID19 pandemic. Methods We identified 6618 urgent phone calls logged between March 2017 and June 2020. We performed a detailed analysis of 800 referrals: 400 in 10 weeks before and 400 in 11 weeks during the first national lockdown. Results Referrals were made by teaching hospitals (43%), district general hospitals (35%) and GPs (22%). The reasons for referrals were similar between hospitals and GPs: epilepsy (33% vs 30%), headache (15% vs 20%), sensory symptoms (10% vs 7%) and weakness (10% vs 8%). The outcomes of these referrals were telephone advice only (64%), neurology ward admission (9%), rapid assessment and other outpatient clinics (8% and 25% respectively). There was a threefold decrease in the number of phone calls during the initial four weeks of national lockdown. However, the patient demographics and the range of diagnoses remained overall unchanged. Conclusions This provides important descriptive data on demographics and outcomes for acute neurology referrals, which can be used to guide service provision and training.

Agriculture in a more uncertain global trade environment

The global trade environment is more uncertain now than it has been for decades. In the short term, bilateral trade “wars” and the COVID-19 pandemic have added to longer-term uncertainties such as sporadic national policy responses to climate change, to the digital revolution, to up-scaled assertiveness and economic coercion by rapidly growing China, and to antiglobalization groups. The underlying concerns could be reduced through greater multilateral cooperation, but that has been in short supply in recent years, not least because of eroding support for globalization. This article re-examines the case for greater unilateral openness to agricultural trade in the wake of uneven economic growth and structural transformation as food systems respond to this increased uncertainty and to growing pressures for agriculture to become more sustainable and for food to be safer and more nutritious. The article concludes by pointing to better policy options than trade measures for achieving most national objectives—options that can simultaneously benefit the rest of the world in terms of easing natural resource and environmental stresses while supporting economic growth and reducing national and global poverty, food and nutrition insecurity, and inequalities in income, wealth, and health. © 2022 The Authors. Agricultural Economics published by Wiley Periodicals LLC on behalf of International Association of Agricultural Economists.

BILATERAL PLEURAL EFFUSIONS WITHOUT SIGNIFICANT ASCITES IN AN OVARIAN HYPERSTIMULATION PATIENT RECOVERED FROM COVID-19: A CASE REPORT

OBJECTIVE: To describe a patient who developed severe ovarian hyperstimulation syndrome (OHSS) with uncharacteristic features after recent COVID-19 infection. MATERIALS AND METHODS: A patient with prior mild COVID-19 developed an atypical case of OHSS with significant bilateral pleural effusions requiring bilateral thoracentesis and only minimal abdominal ascites. Isolated pleural effusions without significant ascites in not frequently found in patients with OHSS, with only one case with an effusion requiring a thoracentesis in 771 patients in a 1995 Canadian study. COVID-19 is known to cause inflammatory responses in the lung, however, pleural effusions are a rare symptom and usually only in those with severe disease. Long-standing damage from COVID-19, or ''post-COVID conditions'' is still under active investigation but can occur in patients even with mild disease. RESULTS: A 25yo G0 (BMI 27, AMH 9) without significant past medical or surgical history underwent IVF due to male factor infertility and polycystic ovarian syndrome (PCOS). She was diagnosed with COVID-19 5 weeks prior to stimulation and reported a mild course not requiring hospitalization. She underwent a long agonist protocol with a peak E2 of 6700 on day of HCG trigger (5000u) and had 42 oocytes retrieved. On POD #3, she presented with abdominal pain with distension and shortness of breath. A therapeutic paracentesis was performed with 500 ml drained and minimal improvement of symptoms. Due to significant response, she had a freeze all embryo cycle. On POD #5, she had worsening shortness of breath and underwent a CT pulmonary embolism (PE) protocol which did not demonstrate a PE but did show significant bilateral pleural effusions without abdominal ascites. She then underwent a bilateral thoracentesis with 800 ml drained from left lung and 1000 ml drained from right lung. She had significant improvement and returned to baseline after two days. CONCLUSIONS: OHSS is an uncommon side effect of gonadotropin stimulation, but this patient had multiple risk factors including age, PCOS diagnosis, AMH level, peak E2 level and number of oocytes retrieved. Ascites typically appears before pleural effusions. We postulate that the recent COVID-19 infection may have increased fluid accumulation preferentially to the lungs rather than the abdomen. IMPACT STATEMENT: With the ever increasing knowledge of post- COVID conditions, one must consider its potential long-term sequalae. Unexpected or atypical presentations may be due to COVID-19. The physiologic changes that occur with fertility treatment may be exacerbated by recent, even mild, COVID-19 illness.

PATIENT SATISFACTION WITH TELEMEDICINE VISITS FOR REPRODUCTIVE ENDOCRINOLOGY PATIENTS IN THE ERAOF COVID-19

OBJECTIVE: Due to the COVID-19 pandemic, video-based telemedicine visits have become the standard in many clinical practices. Many reproductive endocrinology consultations do not require a physical exam, allowing for integration of telemedicine. The purpose of this study is to evaluate patient satisfaction with telemedicine visits in the Reproductive Endocrinology and Infertility (REI) office. MATERIALS AND METHODS: This is a prospective cross-sectional study that includes any person undergoing a new patient visit at Washington University's Reproductive Endocrinology clinic from March 1st-April 20th 2021. After the visit, patients were contacted via telephone to obtain consent to participate in an online one-time research survey. A link was sent to their email with the survey through RedCap secure web application. The survey is 25 questions which includes the telehealth usability questionnaire (TUQ) survey, a previously published tool to evaluate usability and quality of telehealth interaction, along with questions specific to the REI clinic and the participation of learners during visits. Baseline patient demographics including age, race/ethnicity, BMI, distance from clinic, and recommended treatment were collected. RESULTS: 117 participants were contacted, 78% (n=91) agreed to participate in the study, and 45% (n=41) completed the survey. There were no significant differences in age, BMI, distance from clinic or length of infertility with response to survey. 92.5% responders would use telemedicine services again and were satisfied with the telehealth system. Telehealth improved access to healthcare for 82.5% and travel time for 95%. The mean distance from clinic was 76 miles, and there was no significance difference in satisfaction with telemedicine services (p=0.46) or perceived access to healthcare services (p= 0.43) between those living closer or further than 76 miles. Those living further also had no preference for telemedicine visits over in person visits (p=0.134). CONCLUSIONS: In the era of COVID-19, healthcare implementation has dramatically changed with a drastic increase in telemedicine services. Based on our survey, majority of patients were satisfied with telemedicine visits and believed it saved travel time while improving access to REI care. Despite no differences in patient preference for in person versus telemedicine depending on their distance from clinic, this finding is reassuring because patients are satisfied with telemedicine for reasons other than distance from clinic. IMPACT STATEMENT: Patient satisfaction surveys demonstrate the feasibility of using telemedicine services for new-patient visits to provide quality care to patients who perceive telemedicine similar to in-person visits. Given the wide acceptance of telemedicine, reimbursement by insurance companies should continue when the pandemic is over.

Agricultural development, structural transformation, and East Asian trade

Trends in regional trade in agricultural products are reviewed. The chapter includes discussion of the theory of the modern drivers of the evolution of agricultural comparative advantage as economies grow. It asks: to what extent are the actual trade patterns in East Asia consistent with that theory? The actual trade patterns are somewhat inconsistent with the theory, which is because trade-related policies have restricted agricultural trade of East Asian economies in various ways. In particular, several countries have restricted their exports of key farm products while their incomes were low, which implies the imposition of a tax on agriculture. Other countries have gradually raised barriers to agricultural imports as the international competitiveness of their farmers declined in the course of economic growth and industrialisation. A ‘tradition’ of gradually moving away from taxing and toward protecting farmers relative to producers in non-farm sectors is identified. But this process should not be taken as given. Some richer countries are reducing their agricultural protection, following the agricultural reforms of West European countries. Also there are new and cheaper means of achieving the policy objectives of agricultural policies, even in the region’s poorer countries, which allow countries to move away from less-efficient price- and trade-distorting policy instruments to more efficient ones for redistributing the benefits of economic growth and integration. While switching to these new measures is not a trivial task, doing so would help integrate regional trade in these products and provide better options for responding to supply shocks such as the COVID-19 epidemic and local events associated with climate change. © The Editors and Contributors Severally 2021.

Safety and Feasibility of Same-Day Discharge After TAVR, TEER, TMVR, Watchman Device Implantations

Background: Standard of care for elective structural heart disease (SHD) procedures have included at least one overnight stay in the hospital. Same day discharge (SDD) after PCI has been well studied with no difference in cardiovascular outcomes, repeat hospitalizations, or overall complications with SDD following PCI. With the ongoing COVID pandemic, there are several patients and family members who prefer to go home same day to avoid exposure. SDD after structural heart procedures such as valve repair/replacements, Watchman device implantations is not well studied. There are no recommendations on how to do this in a safe and effective way. After rigorous planning, we designed a protocol to assess the safety and feasibility of SDD after structural interventions in selected patients. Methods: A total of 114 patients undergoing elective SHD interventions between July 2020 till November 2021 who opted to go home on the same day in view of the ongoing pandemic were included in the study. These patients had good social support, met our centers safety protocol, TVT registry requirements, lab, and ambulation criteria. We assessed the demographics, safety, and outcomes. Results: Of the 114 patients, 37 underwent transfemoral TAVR, 2 BAV, 8 TEER, 2 transcatheter mitral valve in valve, 48 Watchman and 17 ASD/PFO closure. The mean age was 72.2 years (32 - 89y). The mean creatinine was 1.23 ( 0.6 - 2.6). General anesthesia was used in 96, conscious sedation in 17 and local anesthesia only in one. The mean contrast usage was 64 ml of visipaque (0 - 129 ml). The mean procedure time was 32 min(14 -121min). All patients were ambulated at least twice. The first within 2 hours of procedure and 2nd before discharge. There was no electrical block noted during anytime in the procedural or periprocedural period. The mean length of stay was 8.1 hours(4 - 16.8h). All patients received a cell number to call in case of any concerns and for easy access. All patients received a call in the evening on the same day and on the next day morning. There were no readmissions, bleeding episodes, acute kidney injury or deaths till last follow up. Conclusions: 1. Selective, same-day discharge after TF TAVR, Transcatheter Mitral valve in valve replacements, TEER, Watchman and ASD/PFO closures is safe and feasible and may be considered in patients who opt for it and have a good social fabric. 2. Patients did not enter the Hospital floor/ICU 3. SDD improves patient satisfaction and increases hospital bed availability, importantly in the ongoing pandemic. 4. SDD has enormous potential to reduce overall health care costs.

Post COVID Syndrome Cohort Characterization

Background. Post COVID Syndrome (PCS) is significant morbidity following COVID-19. This study aims to identify biomarkers that predict PCS in a Gulf Coast cohort known for poor health outcomes. Methods. Since March 2020 the study Collection of Serum and Secretions for SARS CoV-2 Countermeasure Development (aka ClinSeqSer) has been enrolling subjects with confirmed acute COVID-19, with initial visit at 1 month and follow up every three months from symptom onset. At follow-up, subjects complete symptom questionnaire, physical examination, nasopharyngeal swab/saliva collection, blood draw. Subjects with >= one symptom new since COVID are PCS, remainder are Non-PCS experienced at initial one month visit and six months or longer. Univariate and bivariate analysis was carried out to study significant associations of currently available dataset (N=60). Included if "new since covid". For 60 subjects consented post-covid with completed questionnaire, results were analyzed. Most common symptoms reported were fatigue/ tiredness or exhaustion (52%), muscle aches (38%), difficulty concentrating (33%) and headache (32%) as the most common symptoms during one month prior to their initial follow-up visit. The persistent symptoms experienced for six months or longer were fatigue/tiredness or exhaustion (25%), forgetfulness (22%), muscle aches (18%), and sleep difficulties (18%). Results. Cohort is 36 (60%) female, 24 (40%) male, age group of 49 (82%) 18-64 years, 11 (18%) 65+ years, 33 (55%) African American, 27 (45%) Caucasian. Median follow-up time after symptom onset: 290 days. Study cohort reported fatigue (52%), myalgias (38%), difficulty concentrating (33%), headache (32%) as most common symptoms during first month from initial symptom onset. Persistent symptoms ( >=6 months) are fatigue (25%), forgetfulness (22%), myalgias (18%), sleep difficulties (18%). Bivariate analysis shows that gender (female, P=0.04), past stroke/transient ischemic attack (P=0.04), deep venous thrombosis (P=0.02), abnormal kidney function (P=0.01) associate with PCS. Convalescent antibodies (ReSARS N IgG, S-RBD IgG) were measured and percentage inhibition of ACE2 spike interaction was recorded. Plasma inflammatory protein levels were measured using multiplex ELISA and Proximity Extension Assay technology during follow-up visit. Increased antibody ReSARS N IgG (2.91, 0.74-10.93;P=0.02) response and higher convalescent IL-10 (P=0.04) was associated with PCS. Percent inhibition of ACE2: spike interaction was not associated (P=0.79) with PCS. Nasal swab/saliva SARS-COV-2 sequencing has not identified a specific SARS-CoV-2 virus mutation predictive of PCS. Table 1. Demographic and Clinical Characteristics The bivariate analysis results showed that the gender (female, P=0.0354), history of stroke or transient ischemic attack (P=0.0382), chest pain from narrow heart vessels (P=0.0479), deep venous thrombosis (P=0.0241) and abnormal kidney function (P=0.0142) were associated with Post-COVID syndrome. Table 2. Antibodies and ACE2 spike inhibition. The convalescent antibodies, ReSARS N IgG and S-RBD IgG were measured in U/mL and percentage inhibition of ACE2 spike interaction was recorded during follow-up visit for PCS vs Non-PCS subjects. The increased antibody ReSARS N IgG (2.91, 0.74-10.93;P=0.0159) response was associated with Post-COVID syndrome. Percent inhibition of ACE2: spike interaction was not associated (P=0.7932) with PCS. Plasma inflammatory protein levels were measured using multiplex ELISA (MSD) and Proximity Extension Assay technology (Olink) recorded during follow-up visit for PCS vs Non-PCS subjects, revealing IL-10 (P=0.0379) was associated with development of PCS. Conclusion. This study identifies initial clinical and biomarker predictors of PCS in a cohort that is 55% African American. ReSARS N IgG measured in post-covid patients is significantly associated with post-COVID syndrome(P=0.0159). X axis: number of months from symptom onset to blood draw. Y axis: N IgG U/mL. Spike amino acid mutations detected in SARS-CoV-2 from acute-phase espiratory isolates. Nasal swab/saliva samples were collected from subjects with acute COVID-19 at time of enrollment into ClinSeqSer, stored at -80°C followed by RNA isolation and SARS-CoV-2 qRT-PCR. Samples with Ct value of ≤30 were then sequenced using NextSeq (Illumina). All sequences are deposited on GISAID and under BioProject (ID PRJNA681020). X axis: subject ID, with ID number increasing chronologically. Y axis: amino acid position of each mutation moving from N- to C-terminus.