Mental health is especially important as women transition into parenthood. The COVID-19 pandemic has necessitated the rapid reconfiguration of maternity services, including perinatal mental healthcare, as offered by Specialist Perinatal Mental Health Midwives, in NHS Trusts in the United Kingdom. This article represents work undertaken in rapid response to the COVID-19 pandemic and aims to document the findings from March 2020 up until May 2021 in literature published on perinatal mental health through the pandemic, as well as to engage in a knowledge mapping exercise across five NHS Trusts in London. In this research, we utilised a critical review methodology which purposefully selects and synthesises materials after extensive literature searching to provide a broad and informed narrative around an issue. For our knowledge mapping exercise, we utilised an inclusive stance to gather, pool, and synthesise data from five NHS Trusts regarding the provisions and reconfigurations of their perinatal mental health services, creating a comparable and translatable snapshot in time. Our rapid, critical review highlighted two themes: ‘Increased Perinatal Distress’ and ‘Inaccessible Services and Support’. Our knowledge mapping exercise produced four themes: ‘Retention of Existing Service Provision’; ‘Additional Services Provided’; ‘Reconfiguration of Service Provision’; ‘Additional Provision to Support Staff Wellbeing’. We conclude by offering best practice guidance in order to provide shared learning to aid the transition through para-pandemic circumstances to service delivery in a post-pandemic ‘new normal’.

Background: Rib fractures in adult horses are poorly documented.Objectives: To describe the presenting signs, diagnosis, treatment and outcome of horses diagnosed with rib fracture. Study design:Retrospective case series. Method:The clinical records and diagnostic images of all adult horses diagnosed with a rib fracture at three referral centres over a 15-year period were reviewed.Results: Seventy-three horses met the inclusion criteria. Horses presented due to either resistance to ridden work and poor performance (n = 41), lameness (n = 21) or trauma (n = 7). In four horses, the presenting complaint was not recorded. Clinical assessment and palpation localised the site of injury in 18/47 cases where recorded.Nuclear scintigraphic examination identified all fracture sites in which it was performed (59/59). In 10/24 horses, radiographic examination confirmed rib fracture.Ultrasonographic examination confirmed rib fracture in 58/59 horses (98%; 95% CI 92-100). Six horses underwent surgery due to ongoing clinical signs and non-healing fracture; all other horses were managed conservatively. Fifty-five horses were available for long-term follow up (>1 year), of which 28 (51%; 95% CI 38-64) returned to their previous level of exercise. Twelve horses did not return to their previous level of exercise due to lameness unrelated to the rib fracture and seven horses were subjected to euthanasia, of which three were as a result of the rib fracture. Eight horses did not return to their previous level of exercise for other reasons.Main limitations: Incomplete data set due to retrospective case series. Conclusions:Although uncommon, rib fractures should be considered in cases of reduced performance or resistance during ridden exercise. Palpation may be unrewarding. Scintigraphy and ultrasonography are useful in identifying the fracture site. Rib fractures in horses carry a fair prognosis and can be managed conservatively in most cases.

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Questionnaires were sent to speech-language pathologists who work in rural and urban school districts in the state of Washington in order to compare employment in these environments. Significant differences were found in program development, travel time, contact with peers, number of schools served, plans for changing job settings, years of experience, years of employment at their current positions, number of hours spent in continuing education, and type of continuing education activities attended. Similarities were found in place of residence, time spent in direct services, hours of inservice provided, contact with supervisors, number of students served, job satisfaction and preservice preparation. These results are discussed in relation to service delivery, retention, and job satisfaction.