Development of a protocol for videoconferencing-based exposure and response prevention treatment of obsessive-compulsive disorder during the COVID-19 pandemic

BACKGROUND The existing literature indicates that psychotherapeutic treatment,especially exposure and response prevention(ERP)is efficacious in treating obsessivecompulsive disorder(OCD).The coronavirus disease 2019 pandemic adversely impacted many patients with OCD and disrupted their usual treatment.Moreover,the pandemic forced a global switch to telemental health(TMH)services to maintain the standards and continuity of care.Consequently,clinicians are increasingly using TMH-based psychotherapeutic treatments to treat OCD.However,several challenges have made it difficult for them to implement these treatments in the changed circumstances imposed by the pandemic.AIM To describe the formulation,implementation,feasibility,and usefulness of videoconferencing-based ERP(VC-ERP)treatment for OCD during the coronavirus disease 2019 pandemic.METHODS This prospective,observational study was conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo(July 2020-June 2021).All patients with OCD were assessed using the home-based TMH services of the department.The VC-ERP protocol for OCD was the outcome of weekly Zoom meetings with a group of clinicians involved in administering the treatment.After a systematic evaluation of the available treatment options,an initial protocol for delivering VC-ERP was developed.Guidelines for clinicians and educational materials for patients and their families were prepared.The protocol was implemented among patients with OCD attending the TMH services,and their progress was monitored.The weekly meetings were used to upgrade the protocol to meet the needs of all stakeholders.Feasibility and efficacy outcomes were examined.RESULTS All patients were diagnosed with OCD as a primary or a comorbid condition according to the International Classification of Diseases,10th version criteria.Out of 115 patients who attended the services during the study period,37 were excluded from the final analysis.Of the remaining 78 patients,VC-ERP was initiated in 43 patients.Six patients dropped out,and three were hospitalized for inpatient ERP.Eleven patients have completed the full VC-ERP treatment.One patient completed the psychoeducation part of the protocol.VC-ERP is ongoing in 22 patients.The protocol for VC-ERP treatment was developed and upgraded online.A large proportion of the eligible patients(n=34/43;79%)actively engaged in the VC-ERP treatment.Drop-out rates were low(n=6/43;14%).Satisfaction with the treatment was adequate among patients,caregivers,and clinicians.Apart from hospitalization in 3 patients,there were no other adverse events.Hybrid care and stepped care approaches could be incorporated into the VC-ERP protocol.Therefore,the feasibility of VC-ERP treatment in terms of operational viability,service utilization,service engagement,need for additional in-person services,frequency of adverse events,and user satisfaction was adequate.The VC-ERP treatment was found to be efficacious in the 11 patients who had completed the full treatment.Significant reductions in symptoms and maintenance of treatment gains on follow-up were observed.CONCLUSION This study provided preliminary evidence for the feasibility and usefulness of VC-ERP in the treatment of OCD.The results suggest that VC-ERP can be a useful option in resource-constrained settings.

Emergency management capacity assessment for urban rail transit-an example of Beijing Metro Line 13

In order to improve the emergency management capability of urban rail transit system and reduce accidents during metro operation,an emergency management capability evaluation method combining analytic hierarchy process(AHP)and technique for order preference by similarity to ideal solution(TOPSIS)is proposed.Based on the Prevention Preparation Response Recovery(PPRR)model,factors influencing the emergency management capability of the urban rail transit system are summarized from the perspective of‘human,machine,environment and management’.Then,an emergency management capability evaluation index system containing of 20 secondary indicators is constructed in four stages:emergency prevention,emergency preparation,emergency response and emergency recovery.The weights of indicators are calculated using the AHP method,and the closeness of each indicator to the optimal solution is analysed with the TOPSIS method.Finally,take the Beijing Metro Line 13 as an example to investigate the level of emergency management capability of urban rail transit.The results show that the emergency management capability of Beijing’s urban rail transit system is‘well’,among which hazard prevention measures(0.31)and emergency response team(0.34)have a greater weight on the emergency management capability of rail transit.The model can more accurately assess the emergency management capability of urban rail transit and provide a basis for emergency management.

Evolution of drought and flood events on the Qinghai-Tibet Plateau and key issues for response

The Qinghai-Tibet Plateau is a climate-sensitive region.The characteristics of drought and flood events in this region are significantly different as compared to other areas in the country,which could potentially induce a series of water security,ecological and environmental problems.It is urgent that innovative theories and methods for estimation of drought and flood disasters as well as their adaptive regulations are required.Based on extensive literature review,this paper identifies new situations of the evolution of drought and flood events on the Qinghai-Tibet Plateau,and analyzes the research progress in terms of monitoring and simulation,forecasting and early warning,risk prevention and emergency response.The study found that there were problems such as insufficient integration of multi-source data,low accuracy of forecasting and early warning,unclear driving mechanisms of drought and flood disaster chains,and lack of targeted risk prevention and regulation measures.On this basis,future research priorities are proposed,and the possible research and development paths are elaborated,including the evolution law of drought and flood on the Qinghai-Tibet Plateau,the coincidence characteristics of drought and flood from the perspective of a water resources system,prediction and early warning of drought and flood coupled with numerical simulation and knowledge mining,identification of risk blocking points of drought and flood disaster chain and the adaptive regulations.Hopefully,the paper will provide technical support for preventing flood and drought disasters,water resources protection,ecological restoration and climate change adaptation on the Qinghai-Tibet Plateau.