Initiating Innovation: The Case of Entrepreneurship Education in the United Arab Emirates

Experiential learning encouraging critical thinking and creative problem-solving is the essence of innovation. Knowing this, in 2015, the United Arab Emirates (UAE) launched the Innovation and Entrepreneurship Education Program in partnership with Stanford University faculty. The purpose of the project was to create customized curriculum for university students, support educators teaching the material, and inspire an entrepreneurial mindset that transitions the nation into an innovation-based society. Three cohorts of university educators participated in workshops, professional development activities, and a four-day visit at Stanford University to learn design thinking, the pedagogical platform of the custom curriculum. After a three-year pilot, remarkable results were realized among students, faculty, and within the entrepreneurial ecosystem of UAE. Analyzing the faculty and student interviews, reviewing an initiative impact report, and referencing related research, this case study: establishes the importance of teaching innovation and entrepreneurship, outlines the program's practical and operational elements, and documents how educators succeeded in integrating and customizing the curriculum (before and during the coronavirus pandemic).

Going Virtual During Covid with the NCI-Connect Cares (Coping, Advocacy, Resources, Education, Support) Group for Rare Brain and Spine Tumor (RBST) Patients and their Families

Background/Purpose: RBST patients have limited supportive care resources and feel secluded as few healthcare providers have expertise in these diseases. The NCI-CONNECT specialized clinic for adults with RBSTs created a multidisciplinary approach with a genetic counselor, knowledgeable healthcare team, and group sessions with a health and wellness counselor (CARES). The CARES sessions created an educational and supportive space for patients to share their unique experiences. We report the adaptation of the CARES group that evolved from in-person to virtual during COVID. Method(s): Patients with RBSTs and their families attended weekly (1 h) groups at their clinic appointments. The CARES group leaders (A.A, S.S) led wellness/coping presentations (15-20 min) and a guided discussion on the topic. In 2021, the COVID pandemic shifted the group to monthly virtual meetings, and educational content was shared via a closed-Facebook group and NCI-CONNECT website. Six groups included presenters within Neuro-Oncology, shortened prerecorded presentations (10 min) allowing for more engagement opportunities, and a coping activity concluded the meeting. Emailed survey feedback was requested (5 out of 13 completed). Result(s): On average, six patients attended each group. Topics included mindfulness, distress, relational challenges, body image, and an educational series on symptom management. All presentations can be found on the NCI-CONNECT website. Patients reported enjoyment in the ability to connect with others, with 80% preferring monthly virtual meetings. Open-ended comments noted that hearing other patients' stories created connections patients expressed they needed. Conclusions and Implications: The virtual CARES group created an accessible space for RBST patients to build relationships and gain support to manage the uncertainties of coping with a rare disease during a time of physical isolation. Patient responses capture the need to continue the group further. Future work will focus on expanding the group based on patient needs and building metrics to understand the overall group benefits in a virtual world.

The COVID-19 Pandemic Experience for Patients with Central Nervous System (CNS) Tumors: Differences in Patient- Reported Outcomes (PROs) and Practice Recommendations

Background/Purpose: The COVID-19 pandemic and associated mitigation procedures have significantly altered daily life in ways that may disproportionately affect patients with CNS tumors. This study aimed to explore differences in symptom burden and interference, mood disturbance, and health-related quality of life in the CNS tumor patient population during the COVID-19 pandemic, compared to a normative sample of pre-pandemic data. Method(s): Data from the Neuro-Oncology Branch (NOB) Natural History Study, including demographic and clinical data, as well as PROs including PROMIS Anxiety and Depression Short-Forms, EQ- 5D-3L, MDASI-Brain Tumor/Spine Tumor, and NeuroQOL-Cognition Function, were collected and compared across groups ('NOB normative sample' and 'COVID year' patients) using one-sample proportion tests. Result(s): 178 COVID year CNS tumor patients (55% male, 82% Caucasian, median age 45 years) were compared with 678 NOB normative sample patients with similar demographic and clinical characteristics. Symptom burden remained comparably high during the COVID year compared to the NOB normative sample with the most common moderate-severe symptoms being fatigue (31% vs. 35%), difficulty remembering (28% vs. 24%), drowsiness (22% vs. 25%), disturbed sleep (20% vs. 22%), and distress (20% for both). However, a significantly greater proportion of COVID year assessments endorsed moderate-severe depression on the PROMIS compared to the NOB normative sample (17% vs. 12%, p = 0.023, Cohen's h = 0.22) and moderate-severe depression/anxiety on the EQ-5D-3L was also more prevalent (53% vs. 43%, p = 0.009, Cohen's h = 0.28). There were no other significant differences in PROs between groups. Conclusions and Implications: These findings demonstrated that while objective symptom burden for CNS tumor patients was unchanged, there was an increase in depression reported during the COVID-19 pandemic. Future work should investigate potential pandemic-era interventions for screening, targeting, and improving both mood disturbance and other disease-specific symptoms to improve symptom burden and quality of life.

Disease threats to tigers and their prey

The contraction of the global tiger population over the last 100 years into small, often isolated subpopulations has made them increasingly vulnerable to the impact of disease. Despite this, the health of wild tigers continues to be insufficiently funded and explored. For example, canine distemper virus (CDV), has been associated with localized declines and increased risk of extinction, and yet has received little research attention in most tiger range countries. The emergence of new pathogenic threats has posed fresh challenges, including African swine fever virus (ASFV), which has the potential to devastate wild boar populations, and severe acute respiratory syndrome coronavirus (SARS-CoV2) with implications for tiger conservation that remain unknown. The objective of this review is to synthesize current research on the health of tigers and their prey that impacts the conservation of tigers in the wild. Published sources are interpreted based on three mechanisms through which disease can affect the viability of tiger populations: (1) by reducing the survival of adult tigers, (2) by reducing breeding productivity, and (3) by reducing the carrying capacity of tiger habitat through decreased prey abundance. Examples of CDV, SARS-CoV2, carnivore protoparvovirus 1 and ASFV are used to illustrate these processes and inform discussion of research and mitigation priorities. Copyright © 2023 Gilbert, Dvornicky-Raymond and Bodgener.

COVID-19-related consultation-liaison (CL) mental health services in general hospitals: A perspective from Europe and beyond.

OBJECTIVE: The COVID-19 pandemic posed new challenges for integrated health care worldwide. Our study aimed to describe newly implemented structures and procedures of psychosocial consultation and liaison (CL) services in Europe and beyond, and to highlight emerging needs for co-operation. METHODS: Cross-sectional online survey from June to October 2021, using a self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies, working groups, and heads of CL services. RESULTS: Of the participating 259 CL services from Europe, Iran, and parts of Canada, 222 reported COVID-19 related psychosocial care (COVID-psyCare) in their hospital. Among these, 86.5% indicated that specific COVID-psyCare co-operation structures had been established. 50.8% provided specific COVID-psyCare for patients, 38.2% for relatives, and 77.0% for staff. Over half of the time resources were invested for patients. About a quarter of the time was used for staff, and these interventions, typically associated with the liaison function of CL services, were reported as most useful. Concerning emerging needs, 58.1% of the CL services providing COVID-psyCare expressed wishes for mutual information exchange and support, and 64.0% suggested specific changes or improvements that they considered essential for the future. CONCLUSION: Over 80% of participating CL services established specific structures to provide COVID-psyCare for patients, their relatives, or staff. Mostly, resources were committed to patient care and specific interventions were largely implemented for staff support. Future development of COVID-psyCare warrants intensified intra- and inter-institutional exchange and co-operation.

Performance of Rapid Diagnostic Testing at Days 4-6 from Diagnosis: Implications for Discharge from Isolation on a University Campus

Background. Omicron rapidly replaced delta as the predominant strain causing COVID-19 related illness in the United States (US) in December 2021, the same month the US CDC reduced the recommended isolation period from 10 to 5 days for asymptomatic individuals or those with resolving symptoms. New evidence suggests some asymptomatic individuals with omicron remain culture positive beyond 5 days from diagnosis. We sought to evaluate the performance of a SARS-CoV-2 antigen rapid diagnostic test (RDT) in predicting persistent potential for transmission at the end of a five-day isolation period among young, fully vaccinated individuals in a university community setting. Methods. A subgroup of participants enrolled in a longitudinal COVID-19 cohort were asked to self-perform RDTs on days 4 to 6 from diagnostic test date in addition to a separate self-collected anterior nasal swab used for culture and RT-PCR, and a daily symptom screen (15 COVID-19 symptom questions on a 4-point scale). We calculated the daily and overall sensitivity and specificity of the RDTs in comparison to SARS-CoV-2 culture result. We also compared the N1 cycle threshold (CT) values and symptom score on each day of the study by RDT results. Results. Of 23 participants, the mean age was 20 years, all had completed their primary COVID-19 vaccine series, and 13 (65.0%) had received a booster vaccine (Table 1). Compared to culture, sensitivity and specificity of the RDTs were 100% and 62% respectively (Table 2). Compared to participants with negative RDTs, median CT values were lower in those with positive RDTs on each day of the study (Figure 1). Participants who had positive RDTs on all three days had higher symptom scores (Figure 2) than those without. Conclusion. RDTs have a high sensitivity in detecting culture positive SARS-CoV-2 on Days 4 to 6 from initial diagnostic test. However, the high false positive rate of 38% means that over a third of culture negative individuals will stay in isolation longer than necessary if RDTs are used in test to release from isolation protocols. Viral loads (CT values) and symptom scores were higher for participants with persistently positive RDT result. An approach that uses a combination of RDTs, CT values and symptom score may prove useful in guiding isolation duration.

Time from last COVID-19 vaccination's impact on rapidity of viral culture conversion following SARS-CoV-2 infection: a prospective cohort study

Background. Vaccination is a fundamental element of pandemic control;however, insufficient data exists on vaccine's impact on SARS-CoV-2 viral dynamics. We aimed to evaluate the relationship between time to negative viral culture conversion after diagnosis and time since most recent COVID-19 vaccination. Scatterplot illustrating relationship between time since completion of initial COVID-19 vaccine series and time to culture conversion among un-boosted participants. The vaccine type received has also been designated by plot labels. The black solid line shows the best fit for the Spearman correlation model;gray shading denotes 95% confidence interval around this estimate. Spearman correlation coefficient, R, and p-value were estimates for the model. Methods. CoViD Post-vax is longitudinal cohort study collecting baseline clinical questionnaires, and daily anterior nasal swabs and symptom screens on enrolled Boston University SARS-CoV-2 PCR-positive cases detected through a serial screening testing program or symptomatic testing. Data was collected from November 2021 to March 2022. Participants were excluded from analysis if they lacked at least one positive culture or did not culture convert during their study involvement. Scatter plots comparing time to culture conversion to time from initial vaccine series were created.We calculated spearman correlation coefficients to determine the relationship between time to culture conversion and time from last vaccination for all participants, those who completed the initial vaccine series (unboosted), and those who were boosted. Scatterplot illustrating relationship between time since receiving a booster COVID-19 vaccine dose and time to culture conversion among boosted participants. The vaccine type received has also been designated by plot labels. The black solid line shows the best fit for the Spearman correlation model;Gray shading denotes 95% confidence interval around this estimate. Spearman correlation coefficient, R, and p-value were estimates for the model. Results. Of 54 CoViD Post-Vax participants included in this analysis, the mean age was 21 years (SD=2) and culture conversion occurred after a median of 4 days (IQR=3-5.75). There was no association between time to culture conversion and time since last dose of a COVID-19 vaccination (R= -0.13, p= .34). When stratified by vaccination status, there was no association between time to culture conversion and time since initial COVID-19 vaccine series (R= -0.25, p= .21, n=26) or time since COVID-19 booster vaccination (R= -0.24, p= .22, n=28). Conclusion. Our results show no significant relationship between time to culture conversion and time since most recent dose of COVID-19 vaccination in an initially culture positive, young, University-based cohort. More work needs to be done to understand the impact of symptom severity, disease burden, SARS-CoV-2 variants, and COVID-19 vaccine status on duration of transmissible SARS-CoV-2 infection. (Figure Presented).

Lockdown: The construction of a new social representation among students and employees

Introduction: The lockdown caused by the COVID-19 pandemic was a brutal experience that had a lasting impact on people's daily lives. Objective: The construction of the social representation of this event was monitored over one year in two sampling phases (March 2020 and March 2021). Method: The evolution of social representation was carried out using the hierarchical verbal association method and a characterisation questionnaire. Results: The results obtained highlighted, on one hand, the emergence of a figurative core, which is transformed into a central core by the repetition and pressure of the lockdown episodes. On the other hand, the variability of the social representation of confinement according to social status, employees structure the social representation around isolation whereas students are focused on loneliness. Conclusion: The effects of lockdown are reflected in the social representation of confinement, showing an impact on mental health, particularly on students. © 2022 Société Française de Psychologie

Confinement : construction d’une nouvelle représentation sociale chez les étudiants et les salariés

Résumé Introduction Le confinement, dû à la pandémie de la COVID-19, a été une expérience brutale, qui a durablement impacté le quotidien des individus. Objectif Étudier la construction de la représentation sociale de cet événement a été suivie sur une année sur deux phases d’échantillonnage (mars 2020 puis avril 2021). Méthode Le suivi de l’évolution de la représentation sociale a été réalisé par la méthode d’association verbale hiérarchisée, et un questionnaire de caractérisation. Résultats Les résultats obtenus ont mis en évidence, d’une part, l’émergence d’un noyau figuratif qui se transforme en noyau central par la répétition et la pression des épisodes de confinement ;d’autre part, la variabilité de la représentation sociale du confinement en fonction du statut social, les salariés structurent la représentation sociale autour de l’isolement alors que les étudiants sont centrés sur la solitude. Conclusion Les effets du confinement se retrouvent dans la représentation sociale du confinement, montrant un impact sur la santé mentale et plus particulièrement celle des étudiants. Introduction The lockdown caused by the COVID-19 pandemic was a brutal experience that had a lasting impact on people's daily lives. Objective The construction of the social representation of this event was monitored over one year in two sampling phases (March 2020 and March 2021). Method The evolution of social representation was carried out using the hierarchical verbal association method and a characterisation questionnaire. Results The results obtained highlighted, on one hand, the emergence of a figurative core, which is transformed into a central core by the repetition and pressure of the lockdown episodes. On the other hand, the variability of the social representation of confinement according to social status, employees structure the social representation around isolation whereas students are focused on loneliness. Conclusion The effects of lockdown are reflected in the social representation of confinement, showing an impact on mental health, particularly on students.

Subjective well-being and households’ resilience strategies to COVID-19 pandemic in South Kivu, Eastern Democratic Republic of Congo (preprint)

The South-Kivu province, located in the eastern part of the Democratic Republic of Congo, has not been spared by the COVID-19 pandemic. By the end of March 2022, South Kivu had registered 1682 confirmed cases of COVID-19. Different response measures had been used to maintain the disease. The effects of the response measures had worsened the state of poverty and vulnerability among the population. This study aimed to assess the results of the COVID-19 pandemic on the subjective well-being of South-Kivu households and the impact of resilience strategies on the well-being of these households. The data were collected thrice in 474 households, from August 2020 to February 2021, and analyzed using the structural equations model. We found that 85% of households lost their purchasing capacity, 98% were afraid of being infected with COVID-19 and 54% complied with health measures. The results showed that the resilience strategies adopted by families had increased their subjective well-being. In general, during the third round, the health (84%), socioeconomic (97%) and psychological (97%) dimensions of resilience had a positive impact (68%) on the subjective well-being of South-Kivu households. This study suggests that, in addition to the adaptive resilience strategies developed by families, there is a need to develop proactive and early warning measures for unforeseen pandemics that could lead to health crises.

Remote work during the COVID-19 pandemic: How do digital technology use affects mental fatigue, psychological distress and well-being?

Introduction: In the wake of the COVID-19 pandemic, many organizations had made a major shift towards remote work, causing an increased use of digital technology. While remote working has several benefits, one of its downsides is to create information and communication technology (ICT) demands (e.g., feeling obligated to stay connected). While previous studies have revealed the harmful effects of ICT, very few have investigated the impact of ICT demands on three specific related psychosocial factors. In such a context, this study aims to shed light on the relationship between ICT demands, mental fatigue, psychological distress and well-being. 2. Material and Method. The study was conducted during the first wave of COVID-19 in 2020 in Canada. The data was collected from 320 workers who provided online consent and completed the survey on a voluntary basis. Ethical approval from the research ethics committee of Laval University was obtained. Hayes Process add-on for SPSS was used to test parallel mediation analyses. The study used validated measures to assess ICT demands, mental fatigue, psychological distress, and well-being. 3. Results and Conclusions. The results reveal that mental fatigue and psychological distress significantly mediate the negative relationship between ICT demands and well-being. In a context where many organizations are now considering adopting telecommuting on a permanent or hybrid basis, these findings suggest that special attention must be paid to sufficiently supported workers in their remote work to mitigate the adverse effects on psychological health.

Financial toxicity and distress during the COVID-19 pandemic in people living with primary brain tumors

Primary brain tumor (PBT) patients experience high symptom burden and functional limitations, which may be impacted by the economic strain and mood disturbance during the COVID-19 pandemic. We assessed financial toxicity and associated patient reported outcomes (PROs) after one year of lockdown in a cohort of PBT patients. Patient and disease characteristics and PROs including FACIT-COST, MDASI-Brain Tumor, PROMISAnxiety/ Depression short forms, and EQ-5D-3L were collected from 7/2020 to 5/2021 from participants in our Natural History Study. Descriptive statistics, Pearson correlations, and independent samples t-tests evaluated PRO relationships. The cohort included 112 PBT patients: 57% male, 87% white, mean age = 47 (range 25 - 80). Majority were married (65%), completed ≥ 4-year college degree (73%), earned annual family income ≥ $50,000 (68%) and living with a high-grade glioma (72%) complicated by recurrence (51%). Using FACIT-COST, 56% reported some financial hardship due to illness with a mean FACIT-COST of 28.3 (SD = 11.3, range: 0 - 44). Half of patients reported feeling moderately to extremely anxious or depressed. Non-Whites and Hispanics as well as those not currently working reported worse financial toxicity compared to White non- Hispanics and individuals currently working (21.4 vs 29.8 and 25.7 vs 30.4, respectively). Worse financial toxicity scores strongly correlated with worse overall symptom burden (r = -0.55) and interference (r = -0.42), worse anxiety (r = -0.39) and depression scores (r = -0.44), and worse overall HRQOL scores (r = -0.33)[all p< .01]. This is the first report of FACIT-COST in PBT patients to our knowledge and demonstrates that non-White individuals living with high grade glioma who are not currently working due to their tumor reported worse financial toxicity which was strongly correlated with higher symptom burden and interference with lower HRQOL. Future studies to assess financial toxicity longitudinally and post-pandemic using the FACIT-COST are needed.

An innovative virtual multi-institutional, multidisciplinary neuro-oncology tumor board: The Nih-Nob experience during the COVID-19 pandemic

BACKGROUND: The American Academy of Neurology Institute and Society for Neuro-Oncology recommend multidisciplinary tumor board (MTB) meetings as a quality metric in neuro-oncology. With the COVID-19 pandemic resulting in travel restrictions, we expanded our existing MTB by transitioning to a virtual format that maintained our commitment to providing consultation for primary CNS tumor cases. This transition permitted participation by neuro-oncology teams from over 30 Brain Tumor Trials Collaborative (BTTC)/National Cancer Institute-Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT) centers across the United States. Here, we describe results from opening our MTB remotely to these teams. METHODS: We retrospectively reviewed records from remote MTB meetings held between April 2020 and March 2021. To gauge the impact of our MTB on clinical management, we administered a brief survey querying BTTC members. RESULTS: Twenty-eight providers presented 41 cases during 24 virtual MTB meetings (range: 1-4 cases per meeting). Two cases (5%) were presented only for educational value. Approximately half (54%) of the cases discussed dealt with diagnosis/management of an NCI-CONNECT rare CNS tumor. During MTB discussions of the 39 cases seeking diagnosis/management recommendations, 32% received clinical trial recommendations, 10% were suggested to enroll in the NCI Neuro-Oncology Branch (NOB) Natural History Study (NCT02851706), 17% received a recommendation to obtain central neuropathology review, and 100% received recommendations for further disease management. Most BTTC survey respondents (83%) found these recommendations impactful in the management/treatment of their presented case or generally useful/ informative for their clinical practice. CONCLUSION: We describe the feasibility and utility of an innovative virtual multi-institutional MTB. These novel remote meetings allowed for discussion of complex neuro-oncology cases and recommendations from experts, particularly important for those with rare CNS tumors. Our study's findings during the COVID-19 pandemic of the value of providing remote access to MTBs should apply postpandemic.

Mood disturbance in patients with central nervous system (CNS) tumors during the COVID-19 pandemic

BACKGROUND: Primary CNS tumors are associated with uncertainty likely contributing to mood disturbance that is common throughout the disease trajectory. The intersection of the COVID-19 pandemic with a CNS tumor diagnosis may further impact the anxiety/depression experienced in this population. This study assessed key anxiety/depression symptoms in patients with CNS tumors prior to and during the COVID year. METHODS: Patient reported outcomes (PROs), including the PROMIS Anxiety and Depression Short Forms and EQ-5D-3L, were collected at the time of clinical or telehealth evaluation from the COVID year (March 2020-February 2021) and were compared to assessments through February 2020 (a NOB-normative sample), reflecting what we would typically see in our regular clinic evaluations. RESULTS: The COVID sample (N = 178) was primarily White (82%), male (55%), median age of 45 (range 18-79), and KPS 3 90 (50%). The majority had high grade (70%) brain (83%) tumors with 3 1 prior recurrence (60%) and 25% were on active treatment. Visits were primarily conducted via telehealth (64%) and 20% had progression at assessment. Compared to the NOB-normative sample, patients reported significantly higher depression scores (moderate-severe, 17% vs. 12%, p < 0.05), but not anxiety (18% vs. 16%). Eleven percent reported both moderate-severe anxiety and depressive symptoms (8% pre-COVID). Overall health assessed by the EQ-5D-3L was similar to the normative sample in all dimensions, apart from impact of moderate/extreme mood disturbance, which was more prevalent in the COVID year (53% vs. 43%, p < 0.05%). CONCLUSION: Patients with CNS tumors are at risk for significant symptoms of depression and anxiety;this risk was heightened during the COVID year. Further evaluation of clinical factors associated with risk are underway. These findings highlight the need for assessments and interventions that can be administered via telehealth to address the mental health needs of this vulnerable population.

Patient-reported symptom burden and interference: A comparison between COVID-19 pandemic year and normative data in patients with central nervous system (CNS) tumors

CNS tumor patients are highly symptomatic causing interference with activity and worse quality of life. Social distancing due to the COVID-19 pandemic increased demands on the patient, caregivers, clinicians, and the health care system. The NCI's Neuro-Oncology Branch Natural History Study (NHS) systematically collected patient-reported outcomes (PROs) provide insight into how these challenges influenced symptom burden and interference during the COVID year. METHODS: Patient and disease characteristic as well as patient-reported symptoms and interference (MDASI-BT/-SP) and general health status (EQ-5D-3L) from 3/2020-2/2021) were compared to NHS normative sample collected prior to 3/2020. RESULTS: The sample (n = 178) was primarily White (82%), male (55%), median age of 45 (range 18 - 79) and KPS 3 90 (51%). The majority had high-grade (70%) brain (83%) tumors (BT) with ≥ 1 prior recurrence (60%) and 25% were on active treatment. Clinical visits were primarily conducted via telehealth (64%) and 20% of all patients were diagnosed with progression at the time of assessment. Most commonly reported moderate-severe symptoms among BT patients were fatigue (30%), difficulty remembering (28%), feeling drowsy (22%). Among spinal cord tumor patients, fatigue (39%), pain (35%) and numbness/tingling in arms/legs/trunk (35%) were most frequently reported. These symptoms were reported in similar frequencies by the normative sample. Nearly half of the COVID year sample (48%) reported moderatesevere activity-related interference. Reported problems with mobility (38%), self-care (19%), pain/discomfort (40%), and usual activities (50%) were similar in both groups except for increased mood disturbance (53%) was reported during the COVID year. CONCLUSION: These findings support CNS tumor patients remained highly symptomatic with significant impact on health-related quality of life during the COVID year. Clinicians should develop timely individual care plans to help BT patients navigate their disease course. Evaluation of risk associated with more severe symptoms and functional limitations are ongoing.

How are OCD patients and their families coping with the COVID-19 pandemic? A qualitative study.

Patients with obsessive-compulsive disorder (OCD) are likely to be affected by the COVID-19 crisis since fear of contamination is highly prevalent in this illness and disease reminders are omnipresent during this crisis. The current study aimed to investigate the impact of the pandemic and the lockdown on the mental health, well-being and coping abilities of OCD patients and their families in order to increase our understanding of the underlying mechanisms of the disorder. Twenty-two patients and 13 family members were interviewed one-to-one about their experiences and challenges caused by the pandemic and home-confinement directives. Verbatim transcripts of the interviews were analyzed using inductive thematic analysis. Five overarching themes were identified: (1) changing point of reference: confusion and legitimization of OCD behavior, (2) coping strategies were challenged: too much or too little exposure to obsessional concerns, (3) distress but also relief in some areas, (4) developing a new equilibrium within the family, (5) changes in accessibility and nature of therapy: perils and merits of online treatment. These findings make clear the importance of the accessibility of mental health services during this pandemic through direct patient contacts or in a remote format. In therapy therapists should focus on challenging the changing point of reference, providing practical advice on coping, stimulating to engage in exposure and encouraging patients to seek social support. Furthermore, it is important to involve family members in therapy to support and coach them to be validating, supportive and encouraging, without accommodating to the OCD behaviour.

A world apart: Levels and determinants of excess mortality due to COVID-19 in care homes: The case of the Belgian region of Wallonia during the spring 2020 wave

BACKGROUND In Western countries, COVID-19 has been particularly deadly for care home residents. OBJECTIVE To understand the role of age and sex structures, health frailty, and contamination dynamics in COVID-19 mortality in populations living inside and outside care homes. METHODS We compared COVID-19 death data recorded in March-June 2020 in Wallonia (southern Belgium) for populations living inside and outside care homes, using annual death data (all-cause mortality in 2017) to assess the health condition of each population. RESULTS Sixty-four percent of COVID-19 deaths were residents in care homes, where the outbreak started after that in the external population, but at a faster pace. The death rate varied between 0 parts per thousand and 340 parts per thousand (mean 43 parts per thousand) per care home, increasing with the number of both residents and staff. All-cause and COVID-19 mortality rates increased exponentially with age but were much higher in care homes. The ratio of male (M) to female (F) death rates was 1.6 for all-cause mortality and 2.0 for COVID-19 mortality (both confirmed and suspected). The COVID-19 mortality reached 24% (M) and 18% (F) of the all-cause mortality rate in care homes, compared to 5% (M) and 4% (F) outside care homes. CONCLUSIONS The COVID-19 mortality rate was 130x higher inside than outside care homes, due to the near multiplicative effects of differences in the residents' age and sex structure (11x), health frailty (3.8x), and infection risk (probably 3.5x). CONTRIBUTION Care homes should be treated as a very specific population in epidemiological studies due to their extreme vulnerability to COVID-19.

Addressing the opioid crisis during the COVID-19 pandemic with a virtual, interactive and interprofessional opioid overdose workshop for healthcare professionals

Introduction: The opioid epidemic is a growing and significant public health concern in California's Fresno County. To prevent opioid misuse, overdoses, and deaths, health professionals must learn how to work collaboratively to rapidly identify overdose threats, reverse overdoses, link people to effective treatment and reduce harms associated with opioids. A traditional interprofessional in-person workshop was not feasible due to the COVID-19 pandemic;therefore, a virtual interprofessional workshop was developed and implemented. The faculty team who developed the workshop sought to discover if a virtual approach would promote learning and influence participants' attitudes toward opioid overdose. Research Question or Hypothesis: Does a virtual, synchronous, interprofessional workshop impact healthcare professionals' knowledge and attitudes toward opioid misuse? Study Design: A quantitative, quasi-experimental pre and post approach was used. The target population were healthcare professional providers and students. Methods: Participants attended a 4-hour online synchronous workshop focused on opioid overdose and Naloxone training. Firstresponder Naloxone kits were provided through California's Naloxone Distribution Project. Data were collected via an online survey platform using the Opioid Overdose Knowledge Scale (OOKS) using a pre/post method, and the Opioid Overdose Attitudes Scale (OOAS), using a retrospective pre/post method. Data were confirmed to be non-parametric, so Mann-Whitney U tests were performed to compare pre- and post-test OOKS overall score and risk, sign, action, and naloxone use subscales and OOAS overall score and competence, concerns, and readiness subscales (Bonferroni adjusted α=0.006). Results: A total of 80 providers, students, and faculty from a variety of specialties participated. All OOKS and OOAS scores, except the readiness subscale, were significantly improved following the workshop and Naloxone training (p<0.004). Conclusion: A 4-hour online synchronous workshop significantly improved knowledge of and attitudes toward opioid overdose among healthcare professional providers and students. These study findings will inform future curriculum development and enhancement of future virtual programs to efficiently train healthcare professionals about approaching an opioid overdose.