What are the experiences of supportive care in people affected by brain cancer and their informal caregivers: A qualitative systematic review.

PURPOSE: To critically synthesise qualitative research to understand experiences of supportive care in people affected by brain cancer and their informal caregivers. METHODS: A qualitative systematic review was conducted according to the Joanna Briggs methodology and has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines. Electronic databases were searched by an expert systematic review librarian for all qualitative studies irrespective of research design. All publications were double screened by two reviewers using a pre-determined exclusion and inclusion criteria. The review was managed using Covidence systematic review software. Methodological quality assessment and data extraction were performed. Qualitative findings accompanied by illustrative quotes from included studies were extracted and grouped into categories, which created the overall synthesised findings. RESULTS: A total of 33 studies were included which represented a total sample of 671 participants inclusive of 303 patients and 368 informal caregivers. There was a total of 220 individual findings included in this review, which were synthesised into two findings (1) caregivers and patients perceived supports which would have been helpful and (2) caregiver and patient experiences of unmet supportive care needs. CONCLUSION: This review highlighted the suffering and distress caused by brain cancer and associated treatments. Both patients and their informal caregivers experienced disconnect from themselves in renegotiating roles, and a profound sense of loneliness as the physical deterioration of the disease progressed. Both patients and informal caregivers reported similar unmet needs within the current service provision for brain cancer. However, what is apparent is that current cancer services are provided solely for patients, with little or no consideration to the support needs of both the patient and their informal caregiver. Service re-design is needed to improve care coordination with individualised informational support, implementation of holistic needs assessments for both the patients and their caregivers, better community support provision, improved opportunities for emotional care with early referral for palliative care services. IMPLICATIONS FOR CANCER SURVIVORS: It is recommended that members of the multidisciplinary brain cancer team reflect on these findings to target holistic needs assessments and develop shared self-management care plans for both the patient and the informal caregiver.

How COVID-19 Changed Self-Presentation on Instagram and its Relation to User Well-Being

Social media use increased during the COVID-19 pandemic with platforms providing an important forum for communication and self-expression. In this study, we explore shifts in online posting behaviors and self-presentation following the onset of lockdown. Content analysis of active Instagram accounts (n = 73) was conducted for the 3-month period before and immediately following the start of lockdown in the UK, and compared to psychological well-being, social media dependency and motives for online self-presentation during lockdown. Changes in the nature of images and captions used by profile owners were found following the start of lockdown, with more selfies and throwback photographs of past events being posted. Images in contexts depicting users as 'social', and positive or explanatory message captioning decreased during lockdown. Limited evidence was found to support the hypothesis that images posted were predictive of psychological well-being in lockdown. More followers and the degree to which online portrayals represented 'real-self' appeared more critical to well-being during lockdown.

New Mexico 4-H Online Horse Bowl Tournament

Under COVID-19 public health order constraints, Extension professionals used readily available technology (e.g., Google Forms, Zoom, Facebook Live, and QuizBowl Pro) to conduct a traditional 4-H quiz bowl contest entirely in a virtual setting as an innovative means of offering positive youth development in a structured environment when most New Mexicans were homebound and unable to travel. Participation in the virtual contest was substantially greater than similar in-person contests in the preceding five-year period, and youth reported an increase in equine knowledge as well as life skill development. © This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License

Theme 12 - Clinical Management and Support

Power wheelchair prescription, utilization, satisfaction, and cost for patients with amyotrophic lateral sclerosis: preliminary data for evidence-based guidelines. Stage at which riluzole treatment prolongs survival in patients with amyotrophic lateral sclerosis: a retrospective analysis of data from a dose-ranging study. Support needs and interventions for family caregivers of patients with amyotrophic lateral sclerosis (ALS): a narrative review with report of telemedicine experiences at the time of COVID-19 pandemic. [Extracted from the article]

Generation Of Macro-scale And Mature Lung Organoids Through Engineering Cell Microenvironment

Purpose/Objectives: <Most used lower respiratory tract models consist of cell monolayers which lack of tissue and organ level response and of in-vivo phenotype. Ex-vivo lung tissues have short viability and limited availability. Lung organoids, which recapitulates better the 3D cellular complex structures, architecture, and in-vivo function, fail to reach maturity even after 85 -185 days of culture. Therefore, these models have a limited use to study fetal lung diseases. Other lung models, consist of only one structure of the lower track, such as bronchial tubes or alveoli, but fail to recapitulate the whole organ structure. In this work, cell microenvironment was used to promote the self-organization of epithelial and mesenchymal cells into macro-structures, aiming to mimic the whole and adult lower respiratory tract model> Methodology: <Different parts of the microenvironment were considered to create a compliant matrix. Alginate-Gelatin hydrogels were used for 3D encapsulation of mesenchymal origin cells. This hydrogel provided a stiffness like the one on the lung. Base membrane zone proteins were used to induce the attachment and guidance of epithelial cells into 3D structures. The interactions between both cell types, further guided them into lung fate. The morphology of resulting organoids was analyzed using immunostaining and confocal microscopy, LSM710, with the purpose of evaluate polarization, protein markers, and different cell populations. Quantitative PCR was performed to evaluate and compare the expression of lung fate genes with traditional cell monocultures.> Results: <The engineered microenvironment and protocol development done in this work resulted in macro-scale structures, in which branching morphogenesis occurred at day 21. Different structures were identified in the organoid including bronchial tube, bronchioles, and alveoli. Polarization of the organoids was confirmed by visualization of E-cadherin, and ZO-1. Expression of Surfactant Protein B and C into the organoids confirmed the presence of alveolar type II cells, which are only present in the later development stage. Surfactant Protein B, Transmembrane protease, serine 2, TMPRSS-2, and Angiotensin-converting enzyme 2, ACE2 were found to be significantly higher expressed into the organoids in comparison with traditional epithelial cells monolayers.> Conclusion/Significance: <Growth factors are normally used to induce the fate of stem cells into lung organoids;however, these fail to reach maturity. Here, we developed a new methodology to induce the formation of the organoids based on the cell microenvironment. The resulting organoids require less time for development. The initial stage of adult cells can be modulated through culture conditions induce a 3D structure like the adult lung. As such, these organoids have the potential to be used for modeling adult diseases and to develop specific models from patient cells, which is one step forward to personalized medicine. SFTPB is one of the main proteins which facilitates the breathing process. Its high expression into our model may indicate that breathing occurs into our lung organoids. The higher expression of TMPRSS-2 and ACE2 into the organoids has a major significance in the field of virology since both proteins are the mainly entrance of SARS-CoV-2, and influenza H1N1.>.

The psychosocial impact of the Australian Rare Cancer Portal on patients with rare cancer

Background: Patients with a rare cancer (RC) diagnosis face unique challenges affecting psychological wellbeing. Vast geographical distances further compound challenges in accessing RC sub-specialist expertise, clinical trials, research and non-reimbursed therapies. The Australian Rare Cancer (ARC) Portal is a novel model of care delivery that has a positive psychological impact on these patients. Methods: The ARC Portal is a national free online referral platform implemented to overcome barriers to accessing excellent care. It is funded by Omico, with support from BioGrid Australia, Rare Cancers Australia (RCA), and The WEHI Stafford Fox Rare Cancer Program (SFRCP). We have recorded 924 referrals for a diverse range of RC in early (30%) and late stages (70%). Our 162 referring clinicians derive from every Australian state and from both regional and metropolitan centres. Over 50 content experts from Australia and internationally have provided case advice. Referring clinical impact surveys and patient feedback surveys were analysed to identify psychosocial impacts of the ARC Portal. Results: Our model of care keeps patients with their primary oncologists by equipping referrers with increased expertise drawing from, on average, two to five experts. The entirely online consent process overcomes geographical barriers to enrolment, and is of particular importance in the context of the ongoing COVID-19 restrictions removing in person interaction. Provision of expertise and treatment recommendations meets informational needs and increased the patient confidence patients in their treating clinicians. Report recommendations directly altered the treatment delivered to patients in 20/ 48 of surveyed referrer respondents. Early stage patients are eligible for referral to guide neoadjuvant and adjuvant therapy, and those in remission for anticipatory identification of next lines of therapy. We identify appropriate access to investigator-driven research efforts to overcome financial barriers to genomic sequencing e.g. via the MoST Program funded by OMICO and the WEHI-SFRCP enabling access to molecularly-guided therapy. A lack of reimbursed therapeutic options in RC poses financial stress on patients. The ARC Portal expands patients' treatment options via links with clinical trial networks, coordination with industry, and cross-referral to the charity, RCA, for fundraising assistance. We provide patients with the opportunity for involvement in research, which for many provides hope, either for themselves, or for others, as they can opt to provide access to biomarker and tumour specimens via the WEHI-SFRCP;the majority of patients (82.5%) have provided consent. Conclusions: The ARC Portal offers patients access to excellent rare cancer care resulting in positive impacts upon patients' psychological wellbeing. These initial observations require more formal assessment.

One Health and Pathogen Sharing: Filling the Gap in the International Health Regulations to Strengthen Global Pandemic Preparedness and Response

The c Owl)-19 pandemic and other major public health emergencies of international concern occurred in the last zo years remind us of the close interconnections between human, animal, and environmental health and the need for collaborative and multisectoral approaches to address complex health threats. These outbreaks also serve to highlight the importance of timely sharing of pathogens, which are used to characterise the causative agent of an outbreak, understand its spread, and develop diagnostics, antiviral treatments, and vaccines. Despite their relevance to preparedness and response, neither One Health nor pathogen sharing are grounded within the International Health Regulations (IHR). This paper analyses the existing institutional and normative gaps within the IHR, including examining how other regimes within the international legal landscape have sought to 'fill the gaps'. We explore possible solutions and make proposals to strengthen interinstitutional cooperation and coordination through mechanisms alternative to IHR reform or a global pandemic treaty.

The World Health Organization's Emergency Powers: Enhancing Its Legal and Institutional Accountability

This paper evaluates the powers both legal and non-legal which the World Health Organization has at its disposal in an emergency. We demonstrate that the Director General's emergency decision-making powers are of concern for the relationship between the organization and Member States. We further question to whom it owes accountability as an international institution, and how to enhance it. Existing literature shows how the legal responsibility of international organizations for wrongful acts constitutes one type of accountability. Internal and external institutional inquiries into the WHO's decision-making, though not deriving in legal responsibility, also represent distinct models of accountability. Against this backdrop, the article looks at past and ongoing events where the WHO Director-General's emergency decision making powers gave way to different modes of accountability, both within and beyond the organization. We provide concluding remarks focused on the need for enhanced accountability in the WHO's exercise of emergency decision-making powers.

Bayesian emulation and history matching of JUNE.

We analyze JUNE: a detailed model of COVID-19 transmission with high spatial and demographic resolution, developed as part of the RAMP initiative. JUNE requires substantial computational resources to evaluate, making model calibration and general uncertainty analysis extremely challenging. We describe and employ the uncertainty quantification approaches of Bayes linear emulation and history matching to mimic JUNE and to perform a global parameter search, hence identifying regions of parameter space that produce acceptable matches to observed data, and demonstrating the capability of such methods. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.

Virtual role-play: A useful tool for undergraduate obstetrics and gynaecology teaching during a pandemic

Background and Aims: The Obstetrics and Gynaecology undergraduate programme at our hospital transitioned to a blended learning programme in response to the COVID-19 pandemic. Students attended for clinical assignments at the hospital two days per week and availed of online learning from home three days per week. The challenge we faced was to create opportunities for students to practice history taking and consultation skills and to create opportunities for social interaction. Methods: In order to address these concerns, weekly virtual role-play tutorials based on two clinical cases were facilitated by the clinical tutor for ten students learning from home. The cases involved role-playing a patient (played by the tutor) doctor (played by a student) interaction to obtain a history, followed by feedback, discussing investigations, interpretation of results, further management, and another role-play to counsel a patient for the indicated gynaecological procedure. After one of these tutorials, given to two groups of ten students, student feedback was obtained using a ‘one-minute paper’. Students completed the questionnaire anonymously via a Google Form. Students were asked three questions;1) What was the most useful thing you learned? 2) What remains unclear to you? 3) Other comments/ideas for improvements? Results: The response rate was 95% (19 of 20 students). Students described the tutorials as “well-structured” and “really interactive”. The opportunity to role-play counselling a patient for a procedure was of particular value to students, with 73% of students specifying this as the most useful thing they learned. Student comments also suggest they appreciated the opportunity to receive feedback. Conclusions: Student feedback was valuable. Our findings suggest virtual role-play is a useful learning tool to support teaching in Obstetrics and Gynaecology during the COVID-19 pandemic and perhaps beyond.

Identifying the unmet supportive care needs of individuals affected by testicular cancer: a systematic review.

PURPOSE: To critically appraise studies to identify experiences of unmet supportive care needs of individuals affected by testicular cancer. METHODS: A registered priori systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. CINAHL, PsycINFO, and MEDLINE were searched for quantitative, qualitative, and mixed methods studies using a wide range of search terms. All articles were double screened according to a pre-determined eligibility criterion. Reference lists of the final included studies were checked for further eligible studies. The review process was managed using Covidence systematic review software. Data from the studies were extracted, methodological quality appraisal conducted, and a narrative synthesis conducted. RESULTS: Of the 72 papers identified, 36 studies were included. In descending order of frequency of need, psychological needs were identified in 26/36, physical needs 18/36, interpersonal/intimacy needs 19/36, health system/information needs 11/36, cognitive needs 9/36, social needs 7/36, and of equal frequencies counts of 4/36 for family, practical, and patient-clinician information needs. Only one study explored spiritual needs and no daily living needs were identified. CONCLUSIONS: The experience of needs varied in terms of frequency and distress which were commonly influenced by the age of the individual across the cancer care continuum persisting after 1-year post-treatment. IMPLICATIONS FOR CANCER SURVIVORS: When caring for individuals affected by testicular cancer, clinicians are encouraged to take a holistic lens to cancer care, particularly to explore issue or concerns that young men affected by testicular cancer might be embarrassed or reticent to discuss.

THE QUICK GUIDE TO STARTING, REVAMPING AND WORKING IN PRIVATE PSYCHIATRY PRACTICE

Background: Private practice is a challenge for everyone, and particularly now that COVID-19 and its changes to health care have moved in. Working through how to meet all requirements of running a high-quality practice, from privacy, informed consent, financial consent, storing of documents, release of notes, managing insurance and Medicare is complex. Many doctors start a business with no business background. This is a summary to help you get started. Objectives: To take away the 'Mel Quick guide' to running a solid, well-run, private practice. Methods: Provides a snapshot of •• practice management software •• privacy and information sharing guidelines •• Medicare billing, codes summary and invoicing •• running a calendar, cancellation list and being paid •• working with administration •• insurance, legal and business 'Must do's'. Conclusion: Hopefully you will walk away with a clear idea of the 'Must-do' list for a practice and a summary of how to get it running.

THE ALPHA COLLABORATION FOR RANDOMISED MEGA-STUDIES TO IMPROVE MORTALITY AND DISABILITY

Background: COVID-19 trials took <1 year to identify therapies reducing death in >30,000 patients but the Australian Placental Transfusion Study took >12 years to show that delaying cord clamping reduced death or major disability (cerebral palsy, severe visual loss, deafness, or cognitive delay) in 1,531 preterm infants. What can this teach us? Further, as composite outcomes of death or major disability can be inconclusive if each is unequally affected (as in the NeOProM Collaboration1) 2 important aims are (i) global co-operation (https://www.alphacollaboration.com/) to identify core Participant-Intervention-Comparator-Outcome questions for trials assessing mortality, a key outcome, and (ii) to answer those questions in much larger, faster trials. Such trials will also yield much more precise estimates of disability in survivors than was previously typical - a major benefit. Method: To inform these aims we compared enrolment in 2 COVID-19 trials and in 10 trials by IMPACT collaborators with samples >1,500 in high- or low-or-middle-income countries (HIC/LMIC). Results: The COVID-19 trials took 3-9 months, enrolling 13 - 219 per-site-per-year. Perinatal trials took 16-86 months, enrolling 5 - 1,700 per site per year. Trials in pregnant women or LMIC (n = 53,092) enrolled 5 times more than trials in newborns or restricted to HIC (n = 9,014). (Table) Conclusions: Greater international collaboration could resolve questions of shared relevance and priority more rapidly. Megatrials addressing mortality may benefit from highly streamlined processes for enrolment and minimal data collection, e.g., RECOVERY's one-page outcome form.

The futility of the pandemic treaty: caught between globalism and statism

This article critically examines proposals for a pandemic treaty. It highlights the misalignment between the treaty proposal and the actual problems of global health governance by showing that the treaty can't solve the multiple problems of global health cooperation. In November 2021, the World Health Assembly (WHA) is hosting a special session to discuss the proposed plans for a pandemic treaty. Despite the fact that there are scant details concerning the treaty, the proposal has gained considerable support in both the academic community, and at the international level. While we agree that in the wake of the numerous governance failures during COVID-19, we need to develop appropriate global solutions to be able to prevent, detect, respond to, and recover from future global health crises-and that such mechanisms should be rooted in global equity-we disagree, however, that this pandemic treaty, currently, is the most appropriate way in which to achieve this. Indeed, notions of global community, solidarity, fairness are far removed from the reality that we have seen unfolding in the actions of states responding to the pandemic. This is the crux of the tension with the proposed treaty: the balance between the ideal cosmopolitan worldview held by those in power in global health, and the practice of national security decision-making witnessed in the last 18 months. Indeed, we do not believe that a pandemic treaty will deliver what is being extolled by its proponents, and it will not solve the multiple problems of global cooperation in global health that supporters believe it will.

Ex Vivo and In Vivo CD46 Receptor Utilization by Species D Human Adenovirus Serotype 26 (HAdV26)

Human adenovirus serotype 26 (Ad26) is used as a gene-based vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and HIV-1. However, its primary receptor portfolio remains controversial, potentially including sialic acid, coxsackie and adenovirus receptor (CAR), integrins, and CD46. We and others have shown that Ad26 can use CD46, but these observations were questioned on the basis of the inability to cocrystallize Ad26 fiber with CD46. Recent work demonstrated that Ad26 binds CD46 with its hexon protein rather than its fiber. We examined the functional consequences of Ad26 for infection in vitro and in vivo. Ectopic expression of human CD46 on Chinese hamster ovary cells increased Ad26 infection significantly. Deletion of the complement control protein domain CCP1 or CCP2 or the serine-threonine-proline (STP) region of CD46 reduced infection. Comparing wild-type and sialic acid-deficient CHO cells, we show that the usage of CD46 is independent of its sialylation status. Ad26 transduction was increased in CD46 transgenic mice after intramuscular (i.m.) injection but not after intranasal (i.n.) administration. Ad26 transduction was 10-fold lower than Ad5 transduction after intratumoral (i.t.) injection of CD46expressing tumors. Ad26 transduction of liver was 1,000-fold lower than that ofAd5 after intravenous (i.v.) injection. These data demonstrate the use of CD46 by Ad26 in certain situations but also show that the receptor has little consequence by other routes of administration. Finally, i.v. injection of high doses of Ad26 into CD46 mice induced release of liver enzymes into the bloodstream and reduced white blood cell counts but did not induce thrombocytopenia. This suggests that Ad26 virions do not induce direct clotting side effects seen during coronavirus disease 2019 (COVID-19) vaccination with this serotype of adenovirus. IMPORTANCE The human species D Ad26 is being investigated as a low-seroprevalence vector for oncolytic virotherapy and gene-based vaccination against HIV-1 and SARS-CoV-2. However, there is debate in the literature about its tropism and receptor utilization, which directly influence its efficiency for certain applications. This work was aimed at determining which receptor(s) this virus uses for infection and its role in virus biology, vaccine efficacy, and, importantly, vaccine safety.

An Outbreak of Coronavirus Disease, 2019 (COVID-19) in a Skilled Nursing Facility - California, 2021: Description, Mitigation, Challenges, and Opportunities

Background. Skilled nursing facility (SNF) residents comprised 11% of all COVID-19 cases in the United States;however, they account for 43% of deaths with case fatality rates (CFR) of 26.0-33.7%. Methods. We report an outbreak of COVID-19, from June 15 to July 21, 2020 in a 159-bed SNF with a staff of 172 that resulted in an infection rate of 97% in residents and 23% in HCWs (Figure 1). A retroactive review outlined mitigation efforts, discussed challenges, identified risk factors among residents and health care workers (HCW) for acquisition of COVID-19, and reviewed opportunities for improvement (Figure 2). Results. Factors that contributed to the outbreak: delay in test results had an impact on cohorting;suboptimal adherence to the principles of infection prevention and control (IPC) and minimal adherence monitoring;strict criteria were used to screen for infection;the underappreciated transmissibility of COVID-19 from presymptomatic and asymptomatic persons;symptomatic HCWs who continued to work;the changing guidance on, the suboptimal use of, and an inadequate supply of personal protective equipment;poor indoor air quality due to ventilation challenges;and the important role of community/family/interfacility spread on the outbreak. Whole genome sequencing, performed in 52 samples, identified a common strain that was also found in clusters of 2 other facilities: 1 in the same geographic location, the other in a different geographic location but whose HCWs had the same zip codes as the facility (Figure 3). Certified nursing and restorative nursing assistants had the highest risk of infection with an odds ratio (OR) of 4.02 (confidence interval 1.29-12.55, p value: 0.02) when compared to registered and licensed vocational nurses. The residents' CFR was 24%. The OR for death was increased by 10.5 (10.20-11.00) for every decade of life as was morbid obesity (BMI > 35) with an OR of 8.50. BMI as a continuous variable increased risk of mortality for every additional unit, OR 1.07 (Tables 1, 2). Conclusion. While implementation of optimal IPC measures in the pre-COVID-19 vaccination era had no impact on the infections in residents who were likely already infected or exposed at the onset of the outbreak, these measures along with non-pharmacologic strategies were effective in halting the spread among HCWs.

Network on the Coordination and Harmonisation of European Occupational Cohorts (OMEGA-NET): Achievements after 4 years of networking, collaboration and training

Introduction OMEGA-NET (2017-2022) is a COST Action network, funded by EU, involving about 200 occupational health researchers in 40 countries, including non-European partners. The goal is to create a network to optimize the coordination and use of occupational, industrial, and population cohorts in Europe and beyond, to inform evidence-based interventions and policy. Material and Methods A range of networking tools are available for COST Actions, such as meetings, workshops, conferences, training schools, short-term scientific missions (STSMs) and dissemination activities. Results Despite COVID-19 restrictions, the network has made great achievements, including two online searchable inventories: the Inventory of Occupational Cohorts, with more than 140 cohorts registered, and the Inventory of Occupational Exposure Tools, with about 75 tools, of which half are Job-Exposure Matrices. Working groups have discussed and written papers on harmonisation and standardisation of occupational exposure and health outcome information. So far, 15 papers are published, some as editorials or position papers, others are accepted or in progress. A webinar series, available on YouTube, present work of OMEGA-NET. The Action also includes opportunities for networking, leadership and training for early career researchers in occupational epidemiology and exposure assessment, and visits to other research institutions (STSMs), as well as stakeholder engagement. Conclusions OMEGA-NET is the largest coordination activity on occupational health globally and will substantially enhance future European and international research.

"Listen to the Feedback of Students": First-Generation College Students Voice Inequalities in Schooling Brought on by the COVID-19 Pandemic

In March 2020, the higher-education community faced one of its largest disruptions to date with the COVID-19 pandemic forcing campuses to close their doors to thousands of students. The university-wide closures prompted a collaboration between researchers and college administrators to assess the impact of COVID-19 on First-Generation College Students (FGCS). The team surveyed 659 FGCS across five U.S. universities to assess the ways in which the pandemic exacerbated already existing inequalities students faced in their persistence to graduate from college. The team used the social cognitive career theory as a conceptual framework for analysis. Our findings revealed that when respondents compared their life before COVID-19 with their present state, FGCS were less likely to perceive they had enough money to return to college, felt overwhelmed and lonely by added stress, and were more likely to see an increase in family responsibilities.

COVID-19 and the workplace

The SARS-CoV-2 virus pandemics has raised several challenges at the workplace. Within the omega-net COVID-19 taskforce, we developed standardized COVID-19 questionnaires for occupational research, a multi-country COVID-19 Job Exposure Matrix, and research on COVID-19 as an occupational disease. The compiled questionnaire resource covers all key aspects of the COVID-19 pandemic, including: COVID-19 diagnosis & prevention, Health and demographic, Use of personal protective equipment, Health effects, Work-related effects, Financial effects, Work-based risk factors, Psychosocial risk factors, Lifestyle risk factors, and Personal evaluation of the impact of COVID-19. For each of the domains additional questions are available. A second questionnaire (in a short and along version) focusses on occupational risk factors for SARS-CoV-2 infection and COVID-19 disease. The questionnaires are available online at https://omeganetcohorts.eu/news/covid19-questionnaires-omeganet/. The JEM was developed by experts from three European countries (Denmark, the Netherlands, UK), who defined the relevant exposure and workplace characteristics with regard to the possible exposure to SARS-COV 2 infection. The C19-JEM contains four determinants of transmission risk (number of people, type of people, indirect contact and location), two mitigation measures (social distance and face covering), and two social factors (income insecurity and migrant workers). Finally, we developed and piloted a questionnaire on COVID-19 as occupational disease, which provide data on 1) COVID-19 as occupational disease or injury, 2) criteria for recognition and compensation regarding exposure, disease, role of use of PPE and of competing non-occupational exposure;and 3) what can be compensated. Results are available from 36 largely European countries. Through the development and implementation of tools we not only provide instruments, but also insights on the occupational risks and diseases in relation to SARS-COV 2.

Initiating advance care planning discussions during COVID-19: A mixed methods study of healthcare professionals' experiences

Background: Advance care planning (ACP) is a process of discussion to help people make and record choices about their future care and treatment. COVID-19 has increased the need for ACP, as life and death decisions are made with and for vulnerable people who are likely to die from the virus. There is sparse evidence about how ACP is being managed in nursing homes (NHs) and hospices during the pandemic. Aims: The study aimed to explore the views and experiences of frontline healthcare staff in NHs and hospices in England, to identify challenges, training and support needs in relation to ACP. Methods: We used a sequential mixed methods design in two phases. In Phase 1, in-depth telephone interviews were conducted with staff from hospices and NHs. Interview data were transcribed, analysed thematically using NVivo, and used to inform an online survey, which was distributed to NHs in all nine regions of England and 147 adult independent hospices in Phase 2. Numerical survey data were analysed using descriptive statistics, and free text data were analysed thematically. Results: In Phase 1, 10 interviews took place with hospice (n=6) and NH (n=4) staff. In Phase 2, 98 surveys were completed, the majority (69.4%) by hospice staff. Findings from both phases of the study showed differences between hospices and NHs in terms of infrastructure (culture, organisational processes, communication and sharing of information across the health and social care system);autonomy and agency of staff;educational preparation;the ACP process (initiating, documenting, sharing ACPs);and access to and use of technology. In all these areas, hospice staff reported better training, resources and support than NH staff, and higher levels of confidence in facilitating ACP discussions. Conclusion: Despite local initiatives to provide training around ACP at the start of the pandemic, there remains a need to develop national training and documentation to support ACP in all organisations.