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The COVID-19 pandemic was a significant threat to perinatal mental health. This study examined differences in clinically significant depression, anxiety, and co-morbid symptoms among pregnant and postpartum women across several countries and compared prevalence of perinatal depression and anxiety before and during the pandemic in each participating country.Participants were 3326 pregnant and 3939 postpartum women (up to six months postpartum) living in Brazil, Chile, Cyprus, Greece, Israel, Portugal, Spain, Turkey, and the United Kingdom. An online survey was completed between June 7th and October 31st 2020, and included the Edinburgh Postnatal Depression Scale (EPDS) and the Generalized Anxiety Disorder Screener (GAD-7). The pre-pandemic studies were identified through literature review.Prevalence of clinically significant depression (EPDS≥13), anxiety (GAD-7 ≥ 10), and co-morbid (EPDS≥13 and GAD-7 ≥ 10) symptoms was 26.7 %, 20 % and 15.2 %, in pregnant women, and 32.7 %, 26.6 % and 20.3 %, in postpartum women, respectively. Significant between-country differences were found in all mental health indicators in both perinatal periods. Higher levels of symptoms were observed during (versus before) the pandemic, especially among postpartum women.Participants were mostly highly educated and cohabiting with a partner. The online nature of the survey may have limited the participation of women from vulnerable socio-economically backgrounds.Our findings expand previous literature on the negative impact of the COVID-19 pandemic on perinatal mental health, by highlighting that this may be influenced by country of residence. Mental health care policies and interventions should consider the unique needs of perinatal women in different parts of the world.

Objectives This pilot study aimed to explore the perceived benefits of a new children’s sensory garden in a healthcare centre in south-eastern Melbourne that provides specialised care, support and guidance to parents. Methods A mixed-method research design was employed in this study comprising a combination of quantitative (surveys) and qualitative (interviews) data collection methods. A total of 19 staff and 36 parents completed surveys relating to their experiences in the new garden. Results The staff members and parents surveyed were found to use the new children’s garden on a regular basis and suggested that the new garden provided them with an opportunity to escape and feel calmer and had positively impacted on their interactions with their child. Interviews were also undertaken with four staff members who indicated that they believe the new garden is affording them perceived personal wellbeing benefits and that the activities in the new garden led to better perceived outcomes for families. Conclusion The perceived benefits reported provide support for the development of sensory gardens at other similar healthcare facilities.

Breastfeeding promotes children's health and is associated with positive effects to maternal physical and mental health. Uncertainties regarding SARS-CoV-2 transmission led to worries experienced by women and health professionals which impacted breastfeeding plans. We aimed to investigate the impact of self-reported and country-specific factors on breastfeeding rates during the COVID-19 pandemic.

Climate change and environmental degradation caused by human activities are having an irrefutable impact on human health, particularly mental health. People working in the environment sector are confronted with these impacts daily. This exploratory study was conducted as a response to concern in the sector about rising levels of worry and distress, and a need for organizational knowledge about effective workplace mental health strategies. Using evidenced-based frameworks for workplace mental health and wellbeing, the study focused on the relationship between climate change, environmental degradation and mental health issues for this sector. This Australian-based exploratory qualitative study was guided by participatory research approaches. Maximum variation and criterion sampling strategies were applied to engage environmental sector senior managers ( n = 8) in individual/paired interviews, followed by online focus group sessions with frontline employees ( n = 9). Qualitative thematic analysis techniques were used in an iterative process, combining inductive and deductive strategies. Data was triangulated and interpretation was finalized with reference to literature and a workplace mental health promotion framework. Interview data provided new perspectives on the interconnectivity between risk and protective factors for mental health. Workers were motivated by commitment and values to continue their work despite experiencing increasing levels of trauma, ecological grief, and stress due to overwork and ecological and climate change crises. The findings highlight the need for integrated health promotion approaches that acknowledge the complex interactions between risk and supportive factors that influence mental health in this sector.

Background Twenty percent of women in the UK develop perinatal mental health (PMH) problems, which have widespread effects on maternal and child health. Community pharmacists are ideally placed to identify PMH problems and refer to other trained healthcare professionals. Objective This study explored community pharmacists’ attitudes, current counselling practices, and barriers to providing mental health advice to perinatal women. Methods A qualitative focus group study was performed virtually with community pharmacists (n = 11), working in urban settings across London. A topic guide was used to cover current counselling practice, barriers to and confidence in counselling women, and thoughts on potential pharmacist-led perinatal mental health services. The focus groups were recorded, transcribed, and analysed using thematic analysis. Results Three themes were identified: Doing Mental Health Care; Willing, but Unable; and Introspection and reflection, which were related through a central organising concept of ‘Perinatal mental health care as a new frontier for community pharmacy’. It was found that while community pharmacists provide mental health advice to perinatal women and their partners, they lacked confidence, which was related to a lack of knowledge and inadequate training opportunities. Organisational barriers were identified including a lack of a formal referral pathway to existing mental health services and other trained healthcare professionals. Perceptions of opportunities and recommendations for service improvement and change were also garnered. Conclusion This study demonstrates community pharmacists have a potential role within community mental healthcare in identification of PMH problems and providing appropriate advice and support. Upskilling community pharmacists in mental health should be considered to increase knowledge and confidence while formal referral pathways to other trained healthcare professionals and existing services should be established and made available to pharmacists.

Erica Ai Li,1 Claire A Wilson,2 Jacob Davidson,2 Aaron Kwong,1 Amrit Kirpalani,3 Peter Zhan Tao Wang2,4 1Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; 2Division of Pediatric Surgery, London Health Sciences Centre, London, Ontario, Canada; 3Division of Pediatric Nephrology, London Health Sciences Centre, London, Ontario, Canada; 4Division of Urology, London Health Sciences Center, London, Ontario, CanadaCorrespondence: Erica Ai Li, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, Ontario, N6A 5C1, Canada, Email ali2024@meds.uwo.caBackground: There is limited work exploring competency-based medical education (CBME) in undergraduate medical education. We aimed to assess medical students’ and faculty’s perception of CBME in the undergraduate medicine setting after its implementation at our institution through a Content, Input, Process, Product (CIPP) program evaluation model.Methods: We explored the rationale for the transition to a CBME curriculum (Content), the changes to the curriculum and the teams involved in the transition (Input), medical students’ and faculty’s perception of the current CBME curriculum (Process), and benefits and challenges of implementing undergraduate CBME (Product). A cross-sectional online survey was delivered over 8-weeks in October 2021 to medical students and faculty as part of the Process and Product evaluation.Results: Medical students displayed greater optimism towards CBME, compared to faculty, in terms of its role in medical education (p< 0.05). Faculty were less certain about how CBME was currently implemented (p< 0.05), as well as how feedback to students should be delivered (p< 0.05). Students and faculty agreed on perceived benefits to CBME implementation. Faculty time commitment to teaching and logistical concerns were reported as perceived challenges.Conclusion: Education leaders must prioritize faculty engagement and continued professional development of faculty to facilitate the transition. This program evaluation identified strategies to aid the transition to CBME in the undergraduate setting.Keywords: competency-based medical education, competency by design, undergraduate, medical student, faculty

This study presents on the initial development and validation of the Resilience Scale for Older Adults (RSOA). This new measure is based on a theoretical model of resilience grounded in qualitative research conducted with older adults. The scale consists of four resilience protective factors with 11 underlying facets. The Intrapersonal factor consists of Perseverance and Determination, Self-Efficacy and Independence, Purpose and Meaning, and Positive Perspective. The Interpersonal factor consists of Sense of Community, Family Support, and Friend/Neighbour Support. The Spiritual factor consists of Faith and Prayer, and the Experiential factor consists of Previous Adversity and Proactivity. The findings of three independent studies using older adult samples support the four-factor, 11-facet structure of the RSOA. Results also provide promising initial reliability and validity information, and analysis of gender invariance suggests that the factor structure is comparable across men and women. Implications for the applicability of the RSOA in research and clinical settings are discussed.

Social prescriptions are one term commonly used to describe non-pharmaceutical approaches to healthcare and are gaining popularity in the community, with evidence highlighting psychological benefits of reduced anxiety, depression and improved mood and physiological benefits of reduced risk of cardiovascular disease and reduced hypertension. The relationship between human health benefits and planetary health benefits is also noted. There are, however, numerous barriers, such as duration and frequencies to participate in activities, access, suitability, volition and a range of unpredictable variables (such as inclement weather, shifting interests and relocating home amongst others) impeding a comprehensive approach to their use on a wider scale. From a multidisciplinary perspective, this commentary incorporates a salutogenic and nature-based approach to health, we also provide a range of recommendations that can be undertaken at the patient level to assist in shifting the acknowledged systemic barriers currently occurring. These include using simple language to explain the purpose of health empowerment scripts, ensuing personal commitment to a minimum timeframe, enabling ease of access, co-designing a script program, providing ongoing motivational support and incorporating mindfulness to counter unexpected disruptions.

The Warden procedure is one of the most common techniques for surgical correction of partial anomalous pulmonary venous return (PAPVR), involving transection and reanastomosis of the superior vena cava (SVC) to the right atrial appendage and baffling of the anomalous pulmonary veins through the atrial septal defect. While the procedure is typically well-tolerated in pediatric patients, adult patients requiring surgical correction of PAPVR are uncommon. The authors report a case of a 33-year-old woman who developed SVC syndrome as a delayed complication of the Warden procedure. Keywords: Cardiac, Congenital, Complications © RSNA, 2022

In this study, we aimed to inform implementation of an animal-assisted intervention (AAI) in an Australian university setting by exploring previously implemented university AAIs. Universities internationally have attempted to address growing concerns around student and staff stress and anxiety by adopting AAIs. However, despite stress and anxiety being common among Australian students and staff, studies are yet to investigate the implementation of an AAI as a strategy to promote health and well-being in this context. Twelve academics who had previously implemented AAIs were recruited via purposeful intensity sampling, with data collected via semistructured interviews. Our findings highlight several facilitators to successful implementation of an AAI, along with strategies used to overcome barriers. Understanding how to amplify strengths and minimize challenges will support Australian universities to implement successful AAIs on campus and, in turn, assist in promoting improved student and staff well-being.

The aim of this study was to explore staff perceptions of the impact of the COVID-19 pandemic on mental health service delivery and outcomes for women who were pregnant or in the first year after birth (‘perinatal’ women). Secondary analysis was undertaken of an online mixed-methods survey open to all mental health care staff in the UK involving 363 staff working with women in the perinatal period. Staff perceived the mental health of perinatal women to be particularly vulnerable to the impact of stressors associated with the pandemic such as social isolation (rated by 79.3% as relevant or extremely relevant; 288/363) and domestic violence and abuse (53.3%; 192/360). As a result of changes to mental health and other health and social care services, staff reported feeling less able to assess women, particularly their relationship with their baby (43.3%; 90/208), and to mobilise safeguarding procedures (29.4%; 62/211). While 42% of staff reported that some women engaged poorly with virtual appointments, they also found flexible remote consulting to be beneficial for some women and helped time management due to reductions in travel time. Delivery of perinatal care needs to be tailored to women’s needs; virtual appointments are perceived not to be appropriate for assessments but may be helpful for some women in subsequent interactions. Safeguarding and other risk assessment procedures must remain robust in spite of modifications made to service delivery during pandemics.

Over the past several decades, transformational leadership theory and research have made considerable contributions in addressing factors relevant for leader effectiveness. Trait emotional intelligence (TEI), dark personality traits, and HEXACO personality factors correlate significantly with transformational leadership. However, due to overlap among measures, there remains a need for incremental analysis. This study investigates how TEI and Dark Tetrad traits predict transformational leadership beyond HEXACO personality factors. Participants (195 women, 104 men) between the ages of 17 and 36 years (Mage = 18.44, SD = 1.45) completed self-report measures of transformational leadership, HEXACO personality factors, TEI, and Dark Tetrad traits. Regression analyses revealed that HEXACO personality factors provide significant predictive value for transformational leadership. TEI, narcissism, Machiavellianism, and psychopathy also accounted for additional variance in transformational leadership scores beyond HEXACO personality factors. This study supports the use of TEI and dark personality traits in addition to HEXACO personality factors when appraising transformational leadership potential. These findings have implications for screening and selection of applicants for leadership positions across a variety of contexts (business, military, education, athletic coaching, etc.).

There is growing evidence for a role of maternal diabetes in the pathogenesis of neurodevelopmental disorders. However, the specific association between gestational diabetes (GDM), as opposed to pre-gestational diabetes, has been poorly isolated. Thus the aim was to systematically review and meta-analyse literature pertaining to prevalence and risk for two neurodevelopmental disorders: autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), when exposed to GDM. PubMed, Cochrane Library, EMBASE, PsycINFO and CINAHL were systematically searched for eligible literature, with forward and backward citation tracking. Screening for eligibility, risk of bias assessment and data extraction were performed by two independent reviewers. 18 studies measuring ASD and 15 measuring ADHD met inclusion criteria. On meta-analysis there was an increased risk of ASD (OR 1.42; 95% CI 1.22, 1.65) but not ADHD (OR 1.01; 95% CI 0.79, 1.28). We discuss potential mechanisms for these differing risks. Greater understanding of risk factors, including GDM, for these neurodevelopmental disorders and potential mechanisms may help inform strategies aimed at prevention of exposure to these adversities during pregnancy.

Issue addressed Health promotion has adopted the planetary health perspective to address the threats posed by climate change, environmental degradation and environmental deprivation. Nature is a setting for health promotion that can produce co-benefits for human health and the protection of the environment. This paper presents the findings of a New South Wales (NSW) study of peoples' motivations for, and co-benefits of, environmental volunteering. Methods This paper combines the findings of a literature review and qualitative data from a larger mixed-methods study of environmental volunteering (eg administration and co-ordination, bush regeneration, advocacy, tour guiding) in NSW. A review of international literature from 2005 yielded 100 documents for analysis. Maximum variation and stratified purposeful sampling strategies were applied to engage 12 environmental volunteers and 30 employees of environmental organisations in a series of focus groups (n = 2) and interviews (n = 22). Qualitative thematic analysis techniques were applied and data triangulated. Results Motivations for environmental volunteering include the following: personal, for example, new skills or knowledge, environmental, for example, improve the environment and social/community, for example, forming connections. Environmental volunteering offers a range of benefits for individuals, environmental organisations and the natural environment. These include enhanced mental and social health, and connection to place and learning about the environment. Conclusions Environmental volunteering has the potential to address key determinants of health - social inclusion, employment and education. From a planetary health perspective, there are multiple co-benefits of human-environmental interaction arising from environmental volunteering. Environmental volunteering is a planetary health strategy that could be incorporated into community-based health promotion. SO WHAT?: Health promotion has a mandate to act on ecological determinants of health. Environmental volunteering is an untapped resource for community-based health promotion and for achieving planetary health goals.

ObjectivesTo compare, in a population of women with gestational diabetes mellitus (GDM), the time to diagnosis of Type 2 diabetes in those with and without common mental disorder (CMD) (depression and/or anxiety) during pregnancy.Design and settingprospective study of the Born in Bradford cohort in Bradford, UK.Participants909 women diagnosed with GDM between 2007 and 2010, with linkage to their primary care records until 2017. The exposed population were women with an indicator of CMD during pregnancy in primary care records. The unexposed were those without an indicator.Outcome measuresTime to diagnosis of type 2 diabetes as indicated by a diagnosis in primary care records.Analysistime to event analysis using Cox regression was employed. Multiple imputation by chained equations was implemented to handle missing data. Models were adjusted for maternal age, ethnicity, education, preconception CMD and tobacco smoking during pregnancy.Results165 women (18%) were diagnosed with type 2 diabetes over a follow-up period of around 10 years. There was no evidence of an effect of antenatal CMD on the development of type 2 diabetes following GDM (adjusted HR 0.95; 95% CI 0.57 to 1.57).ConclusionsWomen with CMD were not at an increased risk of type 2 diabetes following GDM. This is reassuring for women with these co-morbidities but requires replication in other study populations.

ISSUE ADDRESSED Internationally, universities have recognised the benefits of Pet Support Programs (PSPs). However, existing literature has predominately focused on quantitatively measuring health outcomes associated with a PSP amongst student populations. This research aimed to explore the feasibility of a PSP within an Australian university, as there is a need to explore practical considerations involved in implementation. METHODS This research used a qualitative descriptive approach. Participants were recruited via purposive snowball sampling. The sample included 17 participants across eight administrative divisions within an Australian university. Semi-structured individual interviews were used to collect data. Data were analysed using thematic analysis. RESULTS Three main themes emerged from the data: Organisational Change, Program Management and Perceived Outcomes. Findings suggest several considerations from both an organisational and program level that need to be addressed prior to implementation, including the university's policies, the location and animal welfare. The main perceived outcomes were stress relief and social support. Ways to minimise risks to those who may have an aversion towards animals were also discussed. CONCLUSIONS Participants believed implementing a PSP would be feasible in the university setting, provided all aforementioned considerations were adequately addressed. Considerations identified have the potential to act as a barrier or a facilitator depending on how they are managed. SO WHAT?: Where feasible and later implemented, a PSP could provide Australian university students and staff with an alternative means of improving mental health, providing stress relief and contributing towards the Health Promoting University framework.

Emerging adulthood represents a time of substantial change and unpredictability. Personal resiliency is defined as an ability to adapt and thrive in the face of challenging circumstances. This study evaluated the cross-cultural validity of a new Spanish translation of the Resiliency Scale for Young Adults (RSYA) using samples of 393 young adults (66.2% women) from Spain (ages 18–30 years, Mage = 25.88, SDage = 2.87) and 365 young adults (71.23% women) from Canada (ages 18–30 years, Mage = 18.56, SDage = 1.26). Results showed that scores on the Spanish RSYA demonstrated high internal consistency reliability, convergent validity, a sound three-factor structure, and partial scalar invariance. Overall, the RSYA translation is a promising theory-based measurement tool designed for use in Spanish young adult samples.

Intimate partner violence (IPV) is a major international public health concern that poses significant mental and physical health risks for affected individuals. To improve prevention efforts, it is imperative that researchers and government bodies understand risk factors for IPV. One such risk factor concerns the extent to which violence is intergenerational, such that exposure to violence predisposes individuals to engage in violence toward intimate partners. The purpose of this research is to assess childhood exposure to violence as a risk factor for perpetration of IPV in adulthood, and to evaluate the Dark Tetrad personality traits as mediators in this relationship. We recruited 153 men and 246 women (age range = 18–73, Mage = 33.50, SDage = 10.26) through Amazon’s Mechanical Turk to complete a series of questionnaires and an open-ended IPV perpetration assessment. Results showed no relationship between IPV perpetration and childhood IPV exposure, indicating that mediation analyses were not possible. Possible explanations are discussed. Follow-up exploratory analyses demonstrated that gender moderated the relationships between childhood IPV exposure and levels of Factor 1 psychopathy and Machiavellianism. Specifically, men who were exposed to IPV in childhood were more likely to develop higher levels of Factor 1 psychopathy and Machiavellianism, whereas women were not. Overall, our findings highlight the importance of providing researchers and clinicians with a greater understanding of environmental events preceding maladaptive trait development. It is also important for researchers and clinicians to consider gender differences in pathways between exposure to IPV and subsequent development of dark personality traits. Theoretical and practical implications are discussed.

The study of resilience in an older adult population is expanding rapidly. However, most theoretical models of resilience have been developed with children or young to middle-aged adults. The objective of the present study was to review systematically the qualitative literature examining resilience in older adults, and to develop a comprehensive model of resilience in older adulthood. A qualitative meta-synthesis was conducted to review the qualitative literature examining resilience from older adults’ perspectives. An exhaustive search of the literature revealed 1,752 articles. From these articles, 34 studies meeting inclusion criteria were selected for analysis. Across the 34 studies analysed, eight themes were revealed as important for achieving resilience later in life: perseverance and determination, self-efficacy and independence, purpose and meaning, positive perspective, social support, faith and prayer, previous experience and being proactive. These themes can be organised into a four-factor model: (a) Intrapersonal Protective Factors; (b) Interpersonal Protective Factors; (c) Spiritual Protective Factors; and (d) Experiential Protective Factors. This study presents a new model of resilience in older adulthood that is grounded in qualitative literature and is relevant and appropriate for an older adult population. This research may be useful for clinicians, support workers and researchers working with older individuals through improving our understanding of what contributes to resilience later in life.

Introduction Temporomandibular disorders (TMD) are a common source of facial pain, resulting from an interaction of biopsychosocial factors. However, social risk factors related to TMD have been researched very little, particularly in patients attending a tertiary care service.Aims To review sociodemographic trends among patients referred to a UK tertiary TMD clinic for specialist management. To provide an insight into the sociodemographic risk factors associated with TMD in patients referred for specialist input and to discuss the surrounding literature.Methods Retrospective review of notes of patients referred to a UK tertiary TMD clinic. Trends in areas of deprivation from which patients came from were quantified into deciles using the English Multiple Indices of Deprivation.Results The mean age of patients was 41.1 years, with women being overrepresented compared to men. Most patients were referred by their general dental practitioner, although a variety of secondary care specialties also referred to this service. A disproportionate number of patients came from the highest decile of deprivation, a trend seen throughout the entire sample and in patients seen by dental professionals specifically. There was no apparent association between this and longer symptom duration.Conclusion Women and those from areas with the highest levels of deprivation were overrepresented in this tertiary clinic setting. Dentists should maintain an awareness of the risk factors for TMD development as well as those which may complicate its management in cases requiring specialist input.

This study examined (1) the availability and content of national CPGs for treatment of peripartum depression, including comorbid anxiety, with antidepressants and other psychotropics across Europe and (2) antidepressant and other psychotropic utilization data as an indicator of prescribers’ compliance to the guidelines. We conducted a search using Medline and the Guidelines International Network database, combined with direct e-mail contact with national Riseup-PPD COST ACTION members and researchers within psychiatry. Of the 48 European countries examined, we screened 41 records and included 14 of them for full-text evaluation. After exclusion of ineligible and duplicate records, we included 12 CPGs. Multiple CPGs recommend antidepressant initiation or continuation based on maternal disease severity, non-response to first-line non-pharmacological interventions, and after risk-benefit assessment. Advice on treatment of comorbid anxiety is largely missing or unspecific. Antidepressant dispensing data suggest general prescribers’ compliance with the preferred substances of the CPG, although country-specific differences were noted. To conclude, there is an urgent need for harmonized, up-to-date CPGs for pharmacological management of peripartum depression and comorbid anxiety in Europe. The recommendations need to be informed by the latest available evidence so that healthcare providers and women can make informed, evidence-based decisions about treatment choices.

Summary With levels of stress and anxiety rising among the university community, universities worldwide are implementing animal-assisted interventions (AAIs) on campus. However, to date, little is known about how to implement these initiatives. Questions also remain as to the impact of evaluated AAIs on health and wellbeing. Therefore, this study sought to review the implementation and effectiveness of previous AAIs in university settings. Electronic databases ProQuest Central, Gale and 16 databases within EBSCOHost were searched with key words, such as AAI, and university or college students for relevant articles. Inclusion criteria included primary research studies that measured a health, wellbeing or behavioural outcome. A total of 47 articles met inclusion criteria, including 24 RCTs. There was limited reporting on the implementation of AAIs in the higher education setting. A total of 11 different mental health and behavioural outcomes have been summarized, with stress, anxiety and mood providing favourable results. An AAI on campus may provide a form of stress and anxiety relief for the university community. Other mental health and behavioural outcomes require further research to determine their effectiveness. These findings highlight that an AAI on campus could potentially provide a form of stress and anxiety relief, and could be a strategy for addressing rising levels of psychological stress and mental health issues among university students and staff in Australia and internationally.

Typically substitution of alcohols involves a two-step activation/displacement pathway thus leading to the generation of additional waste. The current chapter considers an alternative reaction manifold with the displacement taking place directly through activation of the alcohol by either a Lewis or Brønsted acid. With particular focus on the literature since 2011, an initial overview of carbenium ion reactivity is provided followed by a survey of displacement reactions grouped by the nature of the nucleophile. Finally, advances in both diastereoselective and enantioselective variants of the reaction are discussed.

Animal Assisted Interventions (AAIs) have become increasingly popular in the university setting; however, there is limited research exploring their potential on an Australian university campus and participants’ views prior to implementation. Therefore, this study aimed to explore university staff members’ and students’ interest in participating in an AAI and their perspectives on intervention characteristics. This was a mixed methods study, using an online survey and semi-structured interviews. The survey had 344 responses, and 45 interviews were conducted. A large majority of participants (86%) were interested in participating in an AAI. In the survey, participants indicated their preferred intervention characteristics for the location of the intervention, frequency of participating, and ways of hearing about the intervention. Participants also expressed concerns regarding therapy animal welfare. In interviews, participants discussed various considerations which may impact the intervention (such as the accessibility of the location, the impact of workload on participating, the effectiveness of promotion strategies, and factors that may assist therapy animal welfare, such as the therapy animals’ handlers). Gaining an insight into the university community’s views prior to implementation may ensure the intervention is feasible to implement and can be beneficial to both humans and therapy animals.

This article reflects on the way objects can become part of the creative writing process in unfamiliar cultural contexts. I draw from my example of writing haiku in response to everyday objects found in Barcelona public space, but more than an analysis of form this article aims to address ways in which the thing-power of objects can train a poet to see more clearly in unfamiliar environments. Drawing from the research of political theorist Jane Bennett (2010) and her investigation of thing-power, as well as poets such as Francis Ponge and Elizabeth Bishop, the paper pushes past viewing objects simply as tools for human subjects and questions what happens when one explores the thingliness of objects themselves. By paying attention to local spaces through the prism of objects moving within those spaces, the paper explores ways in which creative practice can reflect on unfamiliar cultural contexts. Through my research I tested in what ways critical reflection through objects might encourage the writer to see things as they are rather than as they appear, question the influence of past experience, and enhance a receptivity to unfamiliar things.

Studies indicate that learning surgical skills on low-fidelity models is equally beneficial to learning on high-fidelity models in terms of skills retention and transfer. However, it is unclear how low-fidelity simulation training impacts retention and transfer in novice learners, particularly on complex surgical tasks that incorporate multiple challenging skills. This study explores the capacity of complete novices to learn and transfer complex surgical skills from a low-fidelity model to a high-fidelity simulation after a delay.Task-naïve medical and nonmedical undergraduate students (n = 62) participated in a three-phase prospective double-arm randomized (2:1) experimental study. Participants completed two skills training sessions (end-to-side anastomosis) on a low-fidelity bench model. After a 4-week delay, participants completed the task again either using the low-fidelity model or a high-fidelity model (cadaver) and were assessed using a validated checklist.There was a significant time × fidelity group interaction (P = 0.004). Simple effects analysis indicated the high-fidelity group (MThese findings suggest that for novice populations, relying on low-fidelity simulation training as a source of teaching complex skills may not provide a reliable transfer to high-fidelity models and in turn clinical settings.