This commentary focuses on how some Indigenous communities in the United States (U.S.) and Canada are addressing the opioid epidemic within the context of the COVID-19 pandemic, from the perspective of the co-authors as researchers, clinicians, and pharmacists working within or among Indigenous communities in three eastern Canadian provinces and two western U.S. states. The pandemic has likely exacerbated opioid use problems among Indigenous communities, especially for individuals with acute distress or comorbid mental illness, or who are in need of withdrawal management or residential services. In response to the pandemic, we discuss first how greater prescription flexibility has facilitated and even increased access to medications for opioid use disorder. Second, we describe how Indigenous-serving clinics have expanded telemedicine services, albeit not without some challenges. Third, we note challenges with restricted participation in traditional Indigenous healing practices that can be helpful for addiction recovery. Fourth, we mention providers' worries about the pandemic's impact on their patients' mental health and safety. We argue that certain treatment transformations may be helpful even after the pandemic is over, through enhancing access to community-grounded treatment, decreasing stigma, and promoting patient self-efficacy.

This comprehensive review examined the continuing education (CE) training offered to psychologists by the Ordre des Psychologues du Québec (OPQ [College of Psychologists of Québec]). The aim was to determine the extent to which the CE workshops advertised by the OPQ promote evidence-based practices. All 26 psychotherapies that advertised for training in the OPQ official journal, Psychologie Québec, were systematically evaluated to determine the quantity and quality of available evidence in support of their effects. The results indicate that nearly half of the psychotherapies promoted in OPQ-approved workshops are not yet supported with research. These findings suggest that psychologists in Québec may be receiving suboptimal training, which may in turn have a negative impact on psychotherapy service users. Recommendations for the regulatory bodies, the trainers developing and providing these CE workshops, and the psychologists enrolling in these workshops are discussed. Public Significance StatementThe continuing education (CE) of psychologists is vital in ensuring that the public is receiving high-quality psychotherapy services. As such, the quality of the CE training offered to psychologists by their professional order should be examined. This review represents the first examination of this nature and provides recommendations based on the findings.

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Objective —We sought to evaluate continuous ultrasound contrast infusion Optison® as an adjunct to color duplex ultrasound (CDU) in endoleak detection. Methods —Endoleak surveillance, including CDU, Optison®, and computed tomography (CTA), was performed during 18 examinations. One (3 ml) vial of Optison® was diluted in a 57-ml syringe of normal saline (total 60 ml) and administered by infusion pump at 4 ml/hr. Transverse and sagittal views were performed of the aortic aneurysm sac, endograft, and arteries outside the aneurysm sac. Primary endpoints were endograft patency, the presence or absence of endoleak, and limb dysfunction. Results —There were no adverse events related to the contrast agent. Contrast appearance through the endograft occurred after an average of 1 min using a mean of 46.8 ml of contrast infusion per patient. There were 10 enodleaks clearly identified by CDU and Optison®, i.e., 2 type I, 4 type II, and 2 type III endoleaks with an additional study suspicious for endoleak. Using CDU and CTA, we found 9 studies without endoleaks whereas with Optison®, we found 8 studies normal. Comparatively, when using CTA, we identified only 2 definitive endoleaks. Of the 9 endoleaks identified by using CDU and Optison®, 2 of the endoleaks were type I and not observed on conventional CTA and were later confirmed by arteriogram. One study was deemed negative by CDU and Optison® whereas CTA results were suspicious. Body habitus was prohibitive for definitive CDU findings in one patient. Conclusions —Using continuous ultrasound contrast infusion as an adjunct to CDU allowed for longer imaging time and more extensive evaluation of the endograft, the aneurysm sac, and the perianeurysmal arteries in these patients. Our early results demonstrate that the use of ultrasound contrast for endoleak detection is reliable and may be considered a primary surveillance modality after endovascular aortic aneurysm repair.

Purpose -This paper aims to explore how varsity football athletes and coaches negotiate meanings when faced with the unmet expectations of a new head coach brought into lead a turnaround process. It also aims to pay particular attention to the role of history in this meaning making process.Design/methodology/approach -This paper draws on semi-structured interviews with players and coaches at two points in time. To preserve the richness of their experiences and illuminate the historical aspects of change, it focuses on the stories of three players and one supporting coach.Findings -Numerous symbols of change emerge that have multiple and contradictory meanings. The meanings around success and failure are renegotiated over time as individuals struggle with the unmet expectations of change. Moreover, individuals are unable to shed the failures of the past and move forward.Practical implications -Change is a complex and messy process of managing multiple meanings. Understanding change entails more than a snapshot picture of an organization. New leaders have no control over the past, yet they need to be aware of how individuals experienced the past in order to increase the likelihood of success in the present.Originality/value -Success and failure are experienced as an ongoing process as athletes and coaches experience, reflect on and interact with others. In illuminating the role of history in how change is experienced in the present, the paper demonstrates that the past can serve as both an immobilizing force, as well as a comparative point enabling individuals to rationalize their emotions. IntroductionEstimates from the 1980s, 1990s, and through into the 2000s indicate that up to 70-75 percent of all change programs fail (Higgs and Rowland, 2005;Miller, 2002) but give little attention to how we determine the extent to which organizational change is successful. We argue here that the evaluations of the "success" and "failure" of organizational change are subjective in nature and that we need to look to the meanings constructed by individuals over time and through interaction with others to understand better the experience of organizational change. Experiences of organizational change are complex and multifaceted (Podlog, 2002) and when change does not result in the outcomes expected the sense making processes of individuals involved in the change are likely to become even more problematic. In this research we set out to understand how individuals make sense of organizational change when it does not result in expected outcomes. We look to a sports organization, that is, a varsity football [1] team, to explore how athletes and coaches negotiate meanings when faced with the unmet expectations of a new head coach brought into lead a turnaround process. In doing this, we pay particular attention to the role of history in this meaning making process. We contend that an appreciation of the organization's past performance, leadership, and change efforts will help new leaders understand how individuals make sense...