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The coronavirus (COVID-19) pandemic disrupted all surgical specialties significantly and exerted additional pressures on the overburdened United Kingdom (UK) National Health Service. Healthcare professionals in the UK have had to adapt their practice. In particular, surgeons have faced organisational and technical challenges treating patients who carried higher risks, were more urgent and could not wait for prehabilitation or optimisation before their intervention. Furthermore, there were implications for blood transfusion with uncertain patterns of demand, reductions in donations and loss of crucial staff because of sickness and public health restrictions. Previous guidelines have attempted to address the control of bleeding and its consequences after cardiothoracic surgery, but there have been no targeted recommendations in light of the recent COVID-19 challenges. In this context, and with a focus on the perioperative period, an expert multidisciplinary Task Force reviewed the impact of bleeding in cardiothoracic surgery, explored different aspects of patient blood management with a focus on the use of haemostats as adjuncts to conventional surgical techniques and proposed best practice recommendations in the UK., (© 2023. The Author(s).)

Empirical evidence has shown that individuals from minority ethnic communities have been at an increased risk of COVID-19 infections and adverse clinical outcomes including hospitalization, intensive care unit admission, and mortality. The COVID-19 vaccine has been heralded as key in ending the global pandemic. However, evidence suggests that although minority ethnic communities have been disproportionately affected by COVID-19, vaccine delivery to these communities has been poor. A barrier to the vaccine uptake has been health information. Health information is an important variable in the health decision-making process. Lack of or wrong health information has serious implications. Health information leads to better understanding of personal health and appropriate utilization of health services and consequently improves an individual's health outcomes. This study sought to explore the health information seeking practices among participants from a Black ethnic minority community in the UK. This study interviewed six Black Africans from the UK. The study explored and highlighted the thoughts, perceptions, and experiences of the participants while health information seeking. This study found challenges in health information access, assumptions about health information and feelings of being dismissed, and an information void. Participants acknowledge that there is a lot that could be done to improve their health information experiences. Targeted health information and measures such as cultural sensitivity and competency could be important in improving health information seeking, not just for Black Africans but all ethnic minorities in the UK., (© 2023. W. Montague Cobb-NMA Health Institute.)

Background: Nurses, midwives and paramedics are the largest collective group of clinical staff in the National Health Service and have some of the highest prevalence of psychological ill-health. Existing literature tends to be profession-specific and focused on individual interventions that place responsibility for good psychological health with nurses, midwives and paramedics themselves., Aim: To improve understanding of how, why and in what contexts nurses, midwives and paramedics experience work-related psychological ill-health; and determine which high-quality interventions can be implemented to minimise psychological ill-health in these professions., Methods: Realist synthesis methodology consistent with realist and meta-narrative evidence syntheses: evolving standards' reporting guidelines., Data Sources: First round database searching in Medical Literature Analysis and Retrieval System Online Database ALL (via Ovid), cumulative index to nursing and allied health literature database (via EBSCO) and health management information consortium database (via Ovid), was undertaken between February and March 2021, followed by supplementary searching strategies (e.g. hand searching, expert solicitation of key papers). Reverse chronology screening was applied, aimed at retaining 30 relevant papers in each profession. Round two database searches (December 2021) targeted COVID-19-specific literature and literature reviews. No date limits were applied., Results: We built on seven key reports and included 75 papers in the first round (26 nursing, 26 midwifery, 23 paramedic) plus 44 expert solicitation papers, 29 literature reviews and 49 COVID-19 focused articles in the second round. Through the realist synthesis we surfaced 14 key tensions in the literature and identified five key findings, supported by 26 context mechanism and outcome configurations. The key findings identified the following: (1) interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors; (2) it is difficult to promote staff psychological wellness where there is a blame culture; (3) the needs of the system often override staff well-being at work ('serve and sacrifice'); (4) there are unintended personal costs of upholding and implementing values at work; and (5) it is challenging to design, identify and implement interventions to work optimally for diverse staff groups with diverse and interacting stressors., Conclusions: Our realist synthesis strongly suggests the need to improve the systemic working conditions and the working lives of nurses, midwives and paramedics to improve their psychological well-being. Individual, one-off psychological interventions are unlikely to succeed alone. Psychological ill-health is highly prevalent in these staff groups (and can be chronic and cumulative as well as acute) and should be anticipated and prepared for, indeed normalised and expected. Healthcare organisations need to (1) rebalance the working environment to enable healthcare professionals to recover and thrive; (2) invest in multi-level system approaches to promote staff psychological well-being; and use an organisational diagnostic framework, such as the NHS England and NHS Improvement Health and Wellbeing framework, to self-assess and implement a systems approach to staff well-being., Future Work: Future research should implement, refine and evaluate systemic interventional strategies. Interventions and evaluations should be co-designed with front-line staff and staff experts by experience, and tailored where possible to local, organisational and workforce needs., Limitations: The literature was not equivalent in size and quality across the three professions and we did not carry out citation searches using hand searching and stakeholder/expert suggestions to augment our sample., Study Registration: This study is registered as PROSPERO CRD42020172420. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172420., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129528) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 9. See the NIHR Funding and Awards website for further award information.

Rationale, Aims and Objectives: Critical incident debriefing is an occupational health tool for supporting healthcare workers following critical incidents. Demand for debriefing has increased following the Covid-19 pandemic. There is now a need for more trained debrief facilitators to meet demand, but there is a dearth of literature regarding how best to train facilitators. This study addressed this by exploring participant experiences of an online critical incident debrief training programme., Methods: We conducted semi-structured interviews with 14 individuals who received a 5-day training programme based on the Critical Incident Stress Management model. Participants were recruited from a range of professional disciplines including psychology, nursing and human resources within one British healthcare system. Data were analysed using thematic analysis., Results: The analysis produced three themes. Managing trainee experiences and expectations suggested that disciplinary heterogeneity in training groups supported inter-participant knowledge exchange. However, this variation also meant that training materials did not meet the learning needs of all participants. Modality of training suggested that while online learning was acceptable for some, others experienced screen fatigue and found it hard to build rapport with other participants. Systematic and organisational obstacles to training access and delivery suggested that lack of managerial support and organisational mental health stigma may be barriers to accessing training., Conclusion: A 5-day online CISM-based training programme was acceptable to participants. Organisations implementing critical incident debrief training may benefit from (1) offering both in-person and online training options, and (2) tailoring course materials according to the disciplinary make-up of groups., (© 2024 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)

Background: Speech and language therapists (SLTs) and care home activities staff play key roles in managing and supporting the communication needs of older residents in care homes. However, the current practice and perspectives of these two professions in the United Kingdom has not been examined., Aims: To investigate the practice patterns and views of SLTs and activities staff working in UK care homes for older adults in relation to residents' communication needs., Methods and Procedures: Two online surveys, with 63 questions (SLT survey) and 46 questions (activities staff survey) in total, were created using the online platform Qualtrics. Participants were asked to consider their routine practice before COVID-19. Results were analysed using descriptive statistics and qualitative content analysis., Outcomes and Results: A total of 116 valid responses were received from SLTs and 29 valid responses from activities staff. A high level of communication needs in care homes was reported by both participant groups, as was insufficient time and resources and lack of managerial encouragement in this area. SLTs reported that the majority of referrals to their service from care homes was for swallowing needs (70%). Cognitive communication difficulty was the most commonly reported communication need by SLTs (65%). Most SLTs (73%-87%) provided some level of communication intervention and considered management of residents' communication needs to be both part of the SLT role and a good investment of their time. Lack of confidence setting goals and providing direct intervention for communication needs was reported, with 25% feeling stressed at the thought of this. The main themes from free text responses about SLT service improvement were increased staff training, funding (of resources and specialist posts) and changes to service provision (referral criteria and accessibility/awareness of SLT service). Hearing impairment was the communication need most commonly reported by activities staff (43%). Participants demonstrated relatively high awareness of communication difficulty in residents and reported high levels of knowledge and confidence identifying and supporting residents' communication. Most (79%-89%) considered identifying and supporting the communication needs of residents to be part of their role and expressed interest in receiving further training in communication support. The reported activities staff data set may be positively biased., Conclusions and Implications: SLTs and activities staff were highly motivated to support the communication needs of care home residents. Increased training, time and resources dedicated to managing the communication needs of residents emerged as opportunities for service improvement across both data sets., What This Paper Adds: What is already known on the subject There is a high level of communication need amongst older care home residents. Social interaction and relationships are important factors contributing to quality of life in this population and rely on successful communication. Speech and language therapists (SLTs) and activities staff play key roles in managing and supporting the communication needs of this client group, but the current practice and perspectives of these professions in the United Kingdom has not been examined. What this study adds A high level of communication need in care home residents was identified by both SLT and activities staff and both participant groups were motivated to address, identify and manage this need. However, insufficient time and resources, as well as a perceived lack of encouragement from managers to provide communication support/intervention, were reported by both groups. SLT practice was constrained by referral criteria and care pathways, which differed between services. Suggestions for SLT service improvement are reported. Clinical implications of this study Targeted, ongoing staff training is required in care homes to improve the communication environment and develop care home staff capacity to support residents' communication needs. There is also a call for service level improvements to increase the range of SLT practice in care homes, including a greater focus on communication needs and more specialist (e.g., dementia) SLT roles., (© 2024 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

This paper investigates the author's classroom practice of implementing an interpretive perspective on intercultural language teaching and learning in two online intercultural workshops on the topic of face masks designed and delivered during the COVID-19 pandemic. It reflexively examines two critical incidents in classroom practice in terms of what these incidents reveal about the challenges faced by pre-service teachers in operationalizing an interpretive stance towards intercultural language teaching and learning in practice. Based on the epistemology of reflective practice, this self-study seeks to produce knowledge-of-practice by framing the author's practical knowledge as language teacher in relation to theories of intercultural language teaching. Classroom discourse analysis of teaching and learning sequencies provides an emic lens on the enactment of an interpretive perspective on intercultural language teaching at the micro level in terms of two basic aspects of pedagogical practice: 1) Embedding interpretation in learning design and 2) Mediating learners' interpretations in classroom interaction. The findings reveal that this author's attempts to personalise intercultural language learning and elicit meaningful reflections from students were constrained by the limited semiotic richness of the material presented and the difficulty of going beyond a superficial interactional format to provide effective scaffolding and successfully realize a dialogic stance towards knowledge building. The paper considers the implications of these challenges for pre-service teacher education and offers suggestions for supporting teachers hoping to teach interculturally.

This paper focuses on the epistemic inequality of international students as a "new" inequality that is under-represented in the current debates about decolonisation (albeit shaped by colonial discourses depicting international students as in deficit and incapable of meeting the standards of (colonial) universities). In this theoretical context, the paper reflects on a multi-modal digital methodology used in a research project that aimed to understand how international students deploy their epistemological resources to learn the curriculum. The paper describes selected artefacts submitted by the students around which their epistemic frames were expressed, suggesting where these may be concealed by epistemological situatedness of the lecturers. Based on the analysis of these artefacts, the paper develops and interrogates an epistemology for support towards interrogating the role of our own epistemological binaries in adversely affecting students' epistemic frames in the curriculum. As such, it contributes to a gap in the literature around decolonial pedagogy, and its role in tackling educational inequalities.

The COVID-19 lockdown in the UK during the spring of 2020 led to the closure of schools and school premises to most students, including complementary school pupils; yet while the lockdown in autumn 2020 allowed state schools to remain open, Polish complementary schools found themselves in an ambiguous position. This paper explores the experiences of eight Polish complementary school heads, focusing on their response to lockdown and the measures they took to provide online learning through the year. The paper also examines how changing lockdown policies impacted the running of their schools. Key findings suggest a creative approach was taken to learning, and that students were eager to respond. Meanwhile, there was increasing cooperation between different schools and support from external organisations. However, the challenges of online learning were also highlighted. Additionally, heads expressed concern about student retention and recruitment, and the potential long-term effects on their school. There was also discussion about the position of complementary schools within the broader education system. The paper argues that these findings highlight questions of inequality between the complementary and mainstream sectors, which has been exacerbated by the pandemic.

This paper explores the role that conflicting rhythms of academic life and crisis have on the ability of academics to meet their commitments, such as providing support to students. Drawing from our experience in UK higher education, we argue that contemporary academic life can be seen as a constant process of being taken over by different crises. These crises tend to follow a rhythm of brief periods as emergencies subsequently operationalised into forms of ongoing, unresolved crisis. In turn, these crisis rhythms intersect with contrasting rhythms of different actors in university life, specifically that of academics, the institution itself, and students. Drawing from Lefebvre's vocabulary of rhythmanalysis, we argue that the arrhythmia between these different groups in the university is a key part in the failure of higher education to do more than proliferate crisis. Illustrated by our experiences in student-support focused roles during the height of COVID-19 lockdowns, we explore how this particular crisis imposed itself as emergency but was then absorbed into the group of ongoing crises which impact on academic life. The paper concludes with suggestions of alternative approaches to university workload for staff and students alike, which might render university life more eurhythmic and equitable.

This paper applies a posthumanist lens, informed by the work of Hollett and Ehret and of Ingold, to consider children's playful affective entanglements with the human and the more-than-human during fluctuating periods of social distancing in the COVID-19 pandemic. Through this refracting theoretical lens, I (re)examine a selection of play and leisure experiences of an emergent subject -- the pandemic child -- during the national U.K. lockdowns of 2020 and 2021. Via a national online, qualitative survey, children and families were invited to share examples of their play and leisure experiences during the pandemic to the Play Observatory, a U.K. research project that ran from 2020 to 2022. These survey contributions provide portals through which to (re)consider children's connection, participation and emergent becomings, attuning analytical attention towards children's affective place-event entanglements during pandemic times. A posthumanist (re)telling of children's Play Observatory contributions demonstrates how children were imbricated in constantly emergent affects, meanings, becomings and potentialities, that waxed and waned, intensified and dissipated, transcending the physical locus of lockdown. This paper contributes to the field by unsettling discourses of rupture, loss and deficit that have tended to dominate public and policy discussions of children's experience of lockdowns. It contributes to ongoing, collective attempts to interrupt policy responses to the pandemic that centre individualising practices of curriculum 'catch-up' and fail to invite into the debate consideration of the potential richness of experiences and events encountered by the pandemic child outside of the strictures of normal schooling and curriculum.

The rise in technology-rich learning environments is reflective of a global trend in higher education (HE), recently accelerated because of necessary digital teaching and assessment practices embraced during the COVID-19 pandemic. This qualitative study facilitated through focus groups and an interview explores the teaching and learning experiences of tertiary level students in the COVID-19 era. Data from 24 students based within a UK Higher Education Institution highlights how an expanded digital environment can optimise conditions for some students to independently practise and apply what they are learning at their own pace. Digitally enhanced opportunities to interact with teaching staff and learning resources also increased the options for these students to experience themselves as competent members of the HE community. This was particularly relevant for first-year students new to the processes and practices of tertiary education. In contrast, third year students with more experience of HE appeared less reliant on the provision of online learning resources. Participants also identified some potential problems associated with the enhanced flexibility of online teaching and learning resources in relation to students' ability to be self-regulated. This paper rationalises the need for educators and educational and learning developers who teach and undertake scholarship in teaching and learning to consider the sociocultural context of the student and their learning environment when designing teaching activities and curricula. The data presented here highlight the need for a clearly defined framework to underpin the integration of digital technologies with on-campus activities.

Background: The COVID-19 pandemic has caused numerous casualties, overloaded hospitals, reduced the wellbeing of many and had a substantial negative economic impact globally. As the population of the United Kingdom was preparing for recovery, the uncertainty relating to the discovery of the new Omicron variant on November 24 2021 threatened those plans. There was thus an important need for sensemaking, which could be provided, partly, through diffusion of information in the press, which we here examine., Method: We used topic modeling, to extract 50 topics from close to 1,500 UK press articles published during a period of approximately one month from the appearance of Omicron. We performed ANOVAs in order to compare topics between full weeks, starting on week 48 of 2021., Results: The three topics documenting the new variant (Omicron origins, Virus mutations, News of a new variant) as well as mentions of vaccination excluding booster, Scotlands First minister statement (Communications) travel bans and mask wearing (Restrictions) and the impact of market and investing (Domains and events) decreased through time (all ps < .01). Some topics featured lower representation at week two or three with higher values before and after: Government's Scientific Advisory Group for Emergencies recommendations (Communications), Situation in the US, Situation in Europe (Other countries and regions), all ps < .01. Several topics referring to symptoms and cases-e.g., rises of infections, hospitalisations, the pandemic the holidays, mild symptoms and care; restrictions and measures-e.g., financial help, Christmas and Plan B, restrictions and New Year; and domains of consequences and events-e.g., such as politics, NHS and patients, retail sales and airlines, featured increasing representation, (all ps < .01). Other topics featured less regular or non-significant patterns., Conclusion: Changes in sensemaking in the press closely matched the changes in the official discourse relating to Omicron and reflects the trajectory of the infection and its local consequences., (© 2023. BioMed Central Ltd., part of Springer Nature.)

This paper displays a Systemic Functional Linguistic and Critical Discourse Analysis of Boris Johnson's first public speech on COVID-19. COVID-19 is a very dangerous infectious disease caused by the last discovered virus of the Coronavirus strain. This virus began in Wuhan's Chinese city in December 2019. COVID-19 has spread from Wuhan to the rest of the world. It has now turned into a pandemic affecting the whole world. Halliday's (2004) model of systemic functional linguistics (meta-functions), relying on interpersonal and ideational meta-functions, and Van Dijk's ideology and discourse (2000) model depending on the argumentation categories, are the adopted models of analysis. The paper's main objectives are to analyze the speech of Prime Minister Boris critically to uncover the used ideologies to advise, persuade and control the people's beliefs and actions. In addition, this paper aims to identify the interpersonal and ideational meta-functions in the selected speeches of the chosen figure stating their frequencies, then finding out how these features uncover the ideological strategies used to affect all people; Finding the argumentation categories that are used by the prime minister to support the ideas and actions presented. The paper presents a theoretical background of discourse, Critical discourse analysis, dominant, and ideology. Explains the adopted models; Analyzes the speech critically.

Background: Acute inpatient mental health services report high levels of safety incidents. The application of patient safety theory has been sparse, particularly concerning interventions that proactively seek patient perspectives., Objective(s): Develop and evaluate a theoretically based, digital monitoring tool to collect real-time information from patients on acute adult mental health wards about their perceptions of ward safety., Design: Theory-informed mixed-methods study. A prototype digital monitoring tool was developed from a co-design approach, implemented in hospital settings, and subjected to qualitative and quantitative evaluation., Setting and Methods: Phase 1: scoping review of the literature on patient involvement in safety interventions in acute mental health care; evidence scan of digital technology in mental health contexts; qualitative interviews with mental health patients and staff about perspectives on ward safety. This, alongside stakeholder engagement with advisory groups, service users and health professionals, informed the development processes. Most data collection was virtual. Phase 1 resulted in the technical development of a theoretically based digital monitoring tool that collected patient feedback for proactive safety monitoring. Phase 2: implementation of the tool in six adult acute mental health wards across two UK NHS trusts; evaluation via focused ethnography and qualitative interviews. Statistical analysis of WardSonar data and routine ward data involving construction of an hour-by-hour data set per ward, permitting detailed analysis of the use of the WardSonar tool., Participants: A total of 8 patients and 13 mental health professionals participated in Phase 1 interviews; 33 staff and 34 patients participated in Phase 2 interviews., Interventions: Patients could use a web application (the WardSonar tool) to record real-time perceptions of ward safety. Staff could access aggregated, anonymous data to inform timely interventions., Results: Coronavirus disease 2019 restrictions greatly impacted the study. Stakeholder engagement permeated the project. Phase 1 delivered a theory-based, collaboratively designed digital tool for proactive patient safety monitoring. Phase 2 showed that the tool was user friendly and broadly acceptable to patients and staff. The aggregated safety data were infrequently used by staff. Feasibility depended on engaged staff and embedding use of the tool in ward routines. There is strong evidence that an incident leads to increased probability of further incidents within the next 4 hours. This puts a measure on the extent to which social/behavioural contagion persists. There is weak evidence to suggest that an incident leads to a greater use of the WardSonar tool in the following hour, but none to suggest that ward atmosphere predicts future incidents. Therefore, how often patients use the tool seems to send a stronger signal about potential incidents than patients' real-time reports about ward atmosphere ., Limitations: Implementation was limited to two NHS trusts. Coronavirus disease 2019 impacted design processes including stakeholder engagement; implementation; and evaluation of the monitoring tool in routine clinical practice. Higher uptake could enhance validity of the results., Conclusions: WardSonar has the potential to provide a valuable route for patients to communicate safety concerns. The WardSonar monitoring tool has a strong patient perspective and uses proactive real-time safety monitoring rather than traditional retrospective data review., Future Work: The WardSonar tool can be refined and tested further in a post Coronavirus disease 2019 context., Study Registration: This study is registered as ISRCTN14470430., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128070) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information.

Background: The COVID-19 pandemic resulted in rapid changes to head and neck cancer (HNC) services. Multidisciplinary team (MDT) face-to-face appointments were converted to telehealth appointments (telephone and video-call) to reduce the risk of COVID-19 transmission. The literature exploring HNC patient experience of these appointment types is limited., Aims: To explore patient experience of telehealth appointments at one UK centre during the COVID-19 pandemic, as well as the variables that may influence patient preference for virtual or face-to-face appointments., Methods & Procedures: A survey-based study design was used, with closed questions and open text options to capture the views of the participants. Quantitative data were analysed using descriptive statistics. Open text data was used to add depth to the findings., Outcomes & Results: A total of 23 participant surveys were returned. Six categories were identified: Usability; Information receiving & giving; Satisfaction; Emotions and comfort; Rapport; and Travel time and cost. Overall, participants gave positive responses to each category and indicated that telehealth appointments met their needs. Areas for clinical consideration are highlighted. Variables such as age, travel distance from hospital site, fear of COVID-19 and information technology (IT) access did not appear to influence patient preference for appointment type., Conclusions & Implications: Going forward, telehealth may be considered for use in combination with face-to-face appointments in the HNC pathway. Areas for further development include a 'telehealth screening tool' that may help to identify those patients most appropriate for these appointment types, or who require support to access them., What This Paper Adds: What is already known on this subject The COVID-19 pandemic resulted in major disruption to HNC centres across the world. Services adapted to meet the needs of patients with many implementing telehealth into pathways. Studies exploring telehealth in speech and language therapy (SLT) services with the HNC population indicate positive results. It is clear telehealth has a role in modern healthcare and should not be viewed as a temporary solution to the pandemic. It is, however, recognized that embedding telehealth into pathways is not straightforward and requires ongoing review and evaluation, which includes patient and clinician perceptions. What this study adds to the existing knowledge The service evaluation gives insight into HNC patient experience of telehealth appointments for MDT clinics (led by SLT, dietician and clinical nurse specialist) during the COVID-19 pandemic. Overall, patients report a positive experience of telehealth in the HNC pathway and are willing to accept this platform into their healthcare. Areas for clinical consideration are highlighted. What are the actual and clinical implications of this work? This findings of this service evaluation can be used to support the co-design of HNC pathways which embed telehealth as an option for patients. Areas that were important to the participants are highlighted; this includes the timing of telehealth appointments in the pathway, the need to meet the MDT face to face and the positive benefit of cost savings. The authors suggest a telehealth appointment screening tool as an area for future development., (© 2023 Royal College of Speech and Language Therapists.)

Background: Network meta-analyses (NMAs) are statistical techniques used to synthesize data from multiple studies and compare the effectiveness of different interventions for a particular disease or condition. They have gained popularity in recent years as a tool for evidence-based decision making in healthcare. Whether publications in NMAs have an increasing trend is still unclear. This study aimed to investigate the trends in the number of NMA articles over the past 10 years when compared to non-NMA articles., Methods: The study utilized data from the Web of Science database, specifically searching for articles containing the term "meta-analysis" published between 2013 and 2022. The analysis examined the annual number of articles, as well as the countries, institutions, departments, and authors associated with the articles and the journals in which they were published. Ten different visualization techniques, including line charts, choropleth maps, chord diagrams, circle packing charts, forest plots, temporal heatmaps, impact beam plots, pyramid plots, 4-quadrant radar plots, and scatter plots, were employed to support the hypothesis that the number of NMA-related articles has increased (or declined) over the past decade when compared to non-NMA articles., Results: Our findings indicate that there was no difference in mean citations or publication trends between NMA and non-NMA; the United States, McMaster University (Canada), medical schools, Dan Jackson from the United Kingdom, and the Journal of Medicine (Baltimore) were among the leading entities; NMA ranked highest on the coword analysis, followed by heterogeneity, quality, and protocol, with weighted centrality degrees of 32.51, 30.84, 29.43, and 24.26, respectively; and the number of NMA-related articles had increased prior to 2020 but experienced a decline in the past 3 years, potentially due to being overshadowed by the intense academic focus on COVID-19., Conclusion: It is evident that the number of NMA articles increased rapidly between 2013 and 2019 before leveling off in the years following. For researchers, policymakers, and healthcare professionals who are interested in evidence-based decision making, the visualizations used in this study may be useful., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

BACKGROUND: The emergence of COVID-19 resulted in a substantial loss of education because of global school closures. Face masks are a potential measure to restrain the COVID-19 spread; therefore, this paper evaluated the effectiveness of face masks in reducing COVID-19 incidence in school settings. METHODS: A systematic review was conducted by searching the literature in the Cochrane COVID-19 Study Register and the World Health Organization COVID-19 global literature. Data were summarized in tabular forms, and the findings were presented as narrative synthesis. RESULTS: A total of 15,709 records were retrieved. The screening and selection led to the inclusion of 12 observational and 2 quasi-experimental studies. Nine studies were conducted in different states, counties, or districts of the United States, and the remaining 5 were reported from Germany, Finland, Spain, and the United Kingdom. The results of 10 out of 14 studies favored mask use in reducing school COVID-19 incidence. Three studies found no link between mask use and COVID-19 incidences, whereas 1 quasi-experimental study noted a higher COVID-19 incidence with mask use in students aged 6-11 years than no use of mask among preschool children aged 3-5 years. CONCLUSION: Mask mandates may lessen the incidence of respiratory infectious diseases in school settings during a pandemic; more well-designed studies are warranted to clarify further the evidence regarding mask use in school settings.

Background: Governments have relied on their citizens to adhere to a variety of transmission-reducing behaviours (TRBs) to suppress the Covid-19 pandemic. Understanding the psychological and sociodemographic predictors of adherence to TRBs will be heavily influenced by the particular theories used by researchers. This review aims to identify the theories and theoretical constructs used to understand adherence to TRBs during the pandemic within the UK social and legislative context., Methods: A systematic review identified studies to understand TRBs of adults in the UK during the pandemic. Identified theoretical constructs were coded to the Theoretical Domains Framework. Data are presented as a narrative summary., Results: Thirty-five studies (n = 211,209) investigated 123 TRBs, applied 13 theoretical frameworks and reported 50 sociodemographic characteristics and 129 psychological constructs. Most studies used social cognition theories to understand TRBs and employed cross-sectional designs. Risk of sampling bias was high. Relationships between constructs and TRBs varied, but in general, beliefs about the disease (e.g. severity and risk perception) and about TRBs (e.g. behavioural norms) influenced behavioural intentions and self-reported adherence. More studies than not found that older people and females were more adherent., Conclusions: Behavioural scientists in the UK generated a significant and varied body of work to understand TRBs during the pandemic. However, more use of theories that do not rely on deliberative processes to effect behaviour change and study designs better able to support causal inferences should be used in future to inform public health policy and practice., Prospero Registration: CRD42021282699., (© 2023. The Author(s).)

This paper focuses on the introduction of a new model of digital teaching and resource provision for the University of Law (ULaw) Library Service, during the COVID-19 pandemic. It details the processes and steps we took to achieve the three core aims of: a new mode of online skills delivery, the creation of self-directed, independent learners in the various student cohorts at the university and the creation of a flexible self-assessment platform to provide an incremental learning journey for both students and staff. This paper also highlights some of the challenges and difficulties we faced, arising from a project of this size and nature.

In this academic comic (or acadomic) I reflect on impacts to the creative process when reconceptualizing and recontextualizing a comics-based research (CBR) project as an acadomic for an edited book during the Covid-19 pandemic. The lockdowns intensified computer-mediated-communication (CMC) and I am compelled by two years of virtually exclusive engagement with digital technologies to explore the impact unrestrained online activities have on my creative comics practice, on my conceptions of research, and on my experiences as a teacher. Analysis of this process and its impacts is realized through a mixed research methodology that explores the impacts of conceptualizing and making an earlier acadomic, which in turn documents a comics-based research project between university students and a national charity as they successfully collaborate on the creation of a graphic novel. I probe the boundaries of academic writing by visualizing and performing Baudrillard's theoretical violence to critique digital intensification through metaphor, semiotics, and comics. The work for this article was undertaken during the rolling pandemic lockdowns in the UK and around the world from 2020 to 2022. Academic theory and the medium of comics problematize the digital simulacrum as I action a utopian pedagogy that supports balance between traditional and digital techniques. [ABSTRACT FROM AUTHOR]

This paper analyzes interviews with 27 K-12 distance/online learning experts conducted during the early COVID-19 pandemic, as schools rapidly transitioned to emergency remote instruction. Short video interviews gathered insights from veteran online teachers, school leaders, officials, and scholars on effective remote practices and supporting home learning. Five key themes emerged from qualitative analysis of the transcripts: leveraging synchronous learning for engagement, community, and social-emotional needs; building personal connections among teachers, students, and parents; using technology simply and purposefully; individualizing learning experiences; and distinguishing emergency remote teaching from well-designed online learning. Findings highlighted the value of synchronous interaction, simplicity in technology use, personalized instruction, and managing expectations around crisis teaching limitations compared to systematic online programs. This study offers practitioner perspectives on quality K-12 online education amid emergency circumstances.

This paper reports findings from a research study at The Open University, UK into the quality of distance learners' online exam experience and the differences in experience between online (pandemic) and in-person (pre-pandemic) modes of examination. Our research responds to the ongoing need for greater insight into the exam experience and is?uniquely positioned in two ways. First, we made use of a robust reference dataset collected before the COVID-19 pandemic and compared this with a second survey administered a year after the pandemic started; second, we asked students about their experience preparing and revising for the exam as well as the exam itself. Exam revision represents an important transitional period for learners. Our results show that, overall, the shift to online remote exams did not impact the quality of distance learners' experience of revising for exams or taking the exam itself. We found no significant change in the revision experience across six of eight measures, including the learning benefits of learning while revising, enjoyment, and support. However, students reported feeling less anxious when revising for online exams. The quality of the exam experience itself was largely unaffected by the move from in-person to online remote exams. No significant differences were found for seven of the nine measures of exam experience. However, we found satisfaction with the exam environment was significantly higher for online exams and that learners felt the online exam was harder than they expected. Age and gender differences are also explored.

The epistemological beliefs of students are an important area for higher education research. This paper firstly reports on a research review concerning the impact of epistemological beliefs on academic outcomes. This review indicates that students' epistemological beliefs are an influence on their engagement with learning and academic success, and that educators should consider them in developing learning experiences. This issue became particularly pertinent in the context of a global pandemic that necessitated an international trend in moving to online distance education, where student disengagement is more likely to occur. However, research into distance education students' epistemological beliefs emerged as an under-researched field. Consequently, an empirical questionnaire study was conducted with data collected from 550 distance education students. A principal component analysis indicated that particular epistemological beliefs were significantly associated with students' enjoyment of studying online. Their beliefs regarding the role of fun in online learning materials and activities are discussed, and the usefulness of considering fun and epistemological beliefs as factors within distance learning in higher education is highlighted. [Note: The page range (213-232) shown on the PDF is incorrect. The correct page range is 213-231.]

Abstract: Military service and ex-service personnel commonly experience difficulties with anger. The COVID-19 pandemic had several negative consequences upon social, economic, and health factors that influence anger. This study aimed to explore 1) levels of anger in an ex-serving military cohort during the COVID-19 pandemic; 2) self-reported changes in anger compared with prepandemic levels; and 3) identify sociodemographic characteristics, military characteristics, COVID-19 experiences, and COVID-19 stressors associated with anger. UK ex-service personnel ( n = 1499) completed the Dimensions of Anger Reactions 5-item measure within an existing cohort study. Overall, 14.4% reported significant difficulties with anger, and 24.8% reported their anger worsened during the pandemic. Anger was associated with factors such as financial difficulties, extra/new caring responsibilities, and COVID-19 bereavement. Endorsing more COVID-19 stressors was associated with higher odds of anger difficulties. This study highlights the impact of the pandemic on ex-service personnel, including a strain on family/social relationships and financial hardship, which affected anger., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To understand whether reproductive decision-making among United Kingdom (UK) respondents had changed in light of the COVID-19 pandemic and, if so, why COVID-19 had led them to change their intentions., Methods: We conducted a cross-sectional online survey in January 2021. We asked survey participants if their fertility intentions had changed and to rate how aspects of their life had changed during COVID-19. We also included an open-ended question and asked participants to explain in their own words how COVID-19 had influenced their reproductive decision-making. We used descriptive and regression analyses to explore the quantitative data and thematically analyzed written responses., Results: Nine percent (n = 70) of our 789 UK respondents reported a change in fertility intention after the start of the pandemic. Changes in both pro-natal and anti-natal directions made the overall change in intentions small: there was a 2% increase across the sample in not intending a child between the two time points. Only increased financial insecurity was predictive of changing intentions. Responses to the open-ended question (n = 103) listed health concerns, indirect costs of the pandemic, and changing work-life priorities as reasons for changing their intentions., Conclusion: While studies conducted at the beginning of the pandemic found that fertility intentions became more anti-natal, we found little overall change in fertility intentions in January 2021. Our findings of small pro-natal and anti-natal changes in fertility intentions align with emerging UK birth rate data for 2021, which show minimal change in the total fertility rate in response to the pandemic., (© 2023 The Authors. Perspectives on Sexual and Reproductive Health published by Wiley Periodicals LLC on behalf of University of Ottawa.)

This paper extends earlier on socioeconomic inequality in mental health, measured by the General Health Questionnaire, to include the second national lockdown up to March 2021., (© 2022 John Wiley & Sons Ltd.)

Teacher education has gathered interest globally and nationally among teachers, educators, researchers and policy makers. Madalinska-Michalak, O 'Doherty and Assuno Flores (2018) observe that regional/ national, social, economic, political and historical factors impact upon teacher education and 'it is also impacted by global problems and tendencies' (pp. 567). This paper builds on these debates and examines the effects of global discourses of teacher education in the national contexts of developed and developing countries, for example, Guyana, Japan, South Africa, United States of America (USA) and the United Kingdom (UK). This includes consideration of teacher education and training before and during the current global COVID-19 pandemic (UNESCO, 2020). The paper concludes that teacher education continues to be under scrutiny due to global and national expectations, the demand of and how they are positioned in preparing teachers for the 21st century. Notwithstanding, as globalisation becomes more integrated in societies globally teacher education curricula not only has to retain its emphasis on standards, but equally its agility to ensure that the needs of all learners are met.

Jonathan Shay argued that social, relational, and institutional contexts were central to understanding moral injury and conceptualised moral injury as a normative response to the betrayal of an individual's understanding of what is right by a more senior/authoritative "other". Using the conceptual lens of moral injury, this paper investigates academic staff experiences of HE during the COVID-19 pandemic and explores the rapid transition back to face-to-face teaching that took place in autumn 2020. To collect data, we used an online survey that opened in January 2021 and ran until the end of March 2021. A total of 663 complete questionnaires were received across the survey period. The questionnaire was comprised of ten topic-related questions, each of which included follow-up sub-questions and also invited participants to write in additional information. The majority of participants felt that during the course of the COVID-19 pandemic, they had acted in ways that put their own health and wellbeing at risk. Of those who had acted in ways that put their health and wellbeing at risk, they believed that their senior management were the most responsible for them acting in such ways, followed by the UK government. Qualitative data showed a systemic absence of leadership in the sector during the time, a sense of betrayal of staff and students by senior management and the government, and feelings of compulsion to act in ways which put lives at risk. On the basis of these results, we argue that there could be synergies between the situation facing healthcare staff and academics during the pandemic. Many of the experiences of HE academic staff during the pandemic reported to us in this research are resonant with the concepts of betrayal and moral injury and resulted in affective responses which we understand here in relation to feelings of guilt, shame, and anger, leading ultimately to poor mental health and wellbeing. This paper discusses implications for the HE sector going forward.

Single-parent families represent a significant proportion of all UK families, but literature suggests that they face challenges in accessing, participating in, and completing Higher Education (HE). This article draws on data obtained from three months of mixed-methods research in 2021 with single-parent students to explore the meanings of being a single parent studying at university in the UK in the context of the COVID-19 pandemic. In doing so it considers the personal demands that the pandemic placed on single-parent students, and the avenues of support available for single-parent students in the context of the UK HE system. These issues are then analysed within a theoretical framework to argue that single-parent students occupied a simultaneous position of agency and mastery in the context of HE. The article concludes with three key recommendations for change: (1) Universities should collect data on student parents and use this data to enable tailored support via student support services; (2) Universities should work with Student Unions to ensure parent-friendly freshers activities and ongoing social/support groups for student parents; and (3) Universities should make concrete changes to campus space, including the introduction of accessible, flexible, discounted childcare on campus, parent and baby rooms, and baby-changing facilities. These three changes would significantly improve the experiences of single-parent students studying at university in the UK. [This paper was presented at Aberystwyth University School of Education Research Seminar in November, 2021.]

Purpose: The paper offers commissioners and practitioners insights into how a gender and culturally sensitive COVID-19 vaccination clinic was set up in a local area that was experiencing lower uptake rates. Design/methodology/approach: This paper seeks to examine and share a city-wide approach to improve vaccine uptake in a large metropolitan city in the UK. Findings: In mitigating inequalities and ensuring underserved populations have access to the COVID-19 vaccine, there is a need to work with communities to develop vaccine clinics that provide a local, convenient and trusted offer that meets the needs of residents. Originality/value: Developing a local COVID vaccine offer that meets cultural needs focusing on an area of low uptake in a large metropolitan city.

Purpose: This paper examines how the COVID-19 pandemic has accelerated digital developments in apprenticeship and work-based learning in higher education (HE), focusing on practices that have ongoing value. Design/methodology/approach: A literature review was carried out on the theme of HE work-based and work-integrated learning during the pandemic, followed by minimally-structured interviews with UK university staff responsible for apprenticeship and other work-based programmes. Findings: The pandemic has accelerated adoption of online and digital methods to support work-based and apprenticeship learning. There has been progress from emergency measures to more pedagogically consistent ones. A blended approach is becoming common, with the learning and logistical benefits from digital methods ensuring their continuing use. Progress is uneven and there is still a need for improved digital pedagogy and better integration of theoretical and practical learning. Practical implications: More attention is needed to digital pedagogy and to effective use of online methods to support work-based learning with corresponding implications for staff development. There are institutional implications in terms of ensuring that systems and structures support what is, particularly for work-based learners, likely to be a permanent move towards digital, blended and online learning. Originality/value: There has been limited research on the impact of the pandemic on work-based learning, with most of the literature focusing on placements and projects. This paper presents findings at a point when universities are considering how technologically-supported methods will be employed on a more permanent basis.

COVID-19 immediately and radically necessitated changes in the way we worked as social researchers; not only in terms of fieldwork, but also in terms of collaboration. In this paper, we outline the rationale, processes, and potential of a collective of 14 research teams both inside and outside of academia working together across the UK to synthesise findings on the experiences of over 4,000 families parents and carers living on a low-income during the pandemic. Drawing on an approach based on meta-ethnography, our collective body of work comprises novel evidence and insights generated with a major cohort of families living on a low-income, through which we examine the impacts of the pandemic, and implications for social policy. This paper focuses on the practical, ethical, and methodological learnings and reflections on the processes of research synthesis in the pandemic context, and beyond. We set out the underpinning principles that guided our collaborative efforts before we explore the possibilities and challenges of working together to produce coherent, timely, and relevant findings that were shared with policy makers and those in power. Finally, we emphasise the significant potential of working collaboratively, and stress the importance of continuing to do so in a post-pandemic context.

This paper utilises a Teaching and Learning Regime (TLR) approach to analyse the student experience (SE) in the COVID-19 setting. Using mixed-methods methodology, the research uses interviews and survey responses from current students at a UK university to identify the multi-dimensional and immersive relationship with their institution. TLR moments were used to thematically analyse the findings. They illustrated a nuanced and often divided SE that, in a COVID-19 environment, bring in extensive external influences from home-life, mental health levels and socio-economic standing. The analysis reveals COVID-19 mixed responses to online learning and the relationship between students and staff members, and the perceived value of online learning. It highlights the importance of spaces and buildings in the SE, and the significant impact friendships and flatmates have had on sustaining university routines and activities. It will also show the intense powerlessness and sadness that has impacted this cohort of students, and how this has manifested through distrust of higher management structures and health implications. The paper highlights ways in which the TLR approach can be used to identify enhancements to the SE in COVID-19 times. These include understanding the value students place on materiality and personal connections, and in maintaining accessibility and flexible learning that have had a positive impact on their studies.

Purpose: This paper aims to stimulate the nascent research agenda on the environmental sustainability of the ongoing mushrooming of international student mobility (ISM). The higher education (HE) system in the UK and elsewhere is increasingly predicated upon the hosting of international students. Whilst this drive towards internationalisation undoubtably has multiple benefits, little attention thus far has been paid to its potentially very considerable environmental impact. The drive for internationalisation within HE thus potentially sits at odds with ambitions and strategies to promote sustainability within the sector and beyond. Design/methodology/approach: In-depth interviews with 21 students and representatives of 14 university international offices offer insights into how the environment features in the decisions that young people and HE institutions make with regards to partaking in and promoting education-related mobility. Findings: The results find that students take environmental considerations into account when undertaking education-related mobility, but these aspirations are often secondary to logistical issues concerning the financial cost and longer travel times associated with greener travel options. At the institutional scale, vociferously championed university sustainability agendas have yet to be reconciled with the financial imperative to recruit evermore international students. Originality/value: This paper identifies a thus far neglected contradiction within HE whereby the sustainability agenda that it so rightly espouses is potentially undermined by the drive towards internationalisation. The paper uses the anthropause concept to consider the future environmental sustainability of ISM.

Opportunity areas are primarily selected to improve the social mobility of citizens using education. This paper explores teachers' perspectives on school transitions, particularly emphasizing the role of school transition intervention activities in supporting students' resilience, behavior, academic understanding, and positive parental involvement. Informed by Multiple and Multi-dimensional Transitions (MMT) theory, the paper focuses on the outcomes of school transition intervention activities applied to new Year 7 students in a UK opportunity area. Data was collected through document review, teacher survey, and semi-structured interviews. As a result, 14 interventions were identified, such as a summer school program, peer mentoring, and interschool visits, aiming to make primary to secondary school transition smoother. However, the findings suggested that many schools did not employ some of the school transition intervention projects. Moreover, the data indicated that the COVID-19 pandemic negatively affected the implementation of many of the school transition projects. The paper contributes to understanding the impact of school transition projects on students' confidence, wellbeing, and academic achievement.

Social and economic barriers that students face during their studies can impact severely on their attainment and can be due to many factors. This study investigated how different socio-economic factors, with a focus on digital poverty and workspace availability may have affected students' attainment (during October 2021-March 2022) at university post-COVID-19. Quantitative data collected during the first teaching block of the 2021-2022 academic year using specific questions in a paper-based questionnaire indicated that a good proportion of life science students did not have access to a home internet source (35%) or proper workspace facilities (34%) and had the requirement to work alongside their degree in order to fund their studies. In contrast to the lack of internet students experienced, many of the surveyed students did have access to a personal computer within their household. Possible reasons for some of the findings, and the implications of the findings, are discussed here.

Widening participation has been a vehicle to facilitate access and support towards the successful completion of university studies for underrepresented groups who are less likely to pursue higher education. Yet, despite its widely accepted importance and adoption across countries such as Australia and the United Kingdom, studies to date remain largely fragmented -- often employed through the lens of a single institution, or a particular priority group. Amidst this backdrop, universities and other higher education providers are increasingly probed as to their role in supporting social capital mobility, of which widening participation plays a vital component in delivering wider societal imperatives. In addition, the COVID-19 effect has worsened university participation and completion rates, as the global pandemic has placed vulnerable students (often those involved in widening participation initiatives) in more precocious conditions than ever before. Nevertheless, the purpose of this paper is to conduct a systematic literature review comprising 102 journal articles that derive 15 meta-themes to provide a timely introspection of widening participation, show key trends over time, and chart future areas of investigation for scholars and practitioners in this space.

Research involving young people is a challenging process that requires managing relationships with diverse individuals and groups, including the young participants and their various gatekeepers. While it is normally assumed that the researcher is in overall control of their research, by using a Foucauldian conception of 'power as effects' that operate in the form of relations and through discourse as the articulation of norms, this paper discusses how, in practice, the researcher can lose control over their research and so be forced into making substantial compromises concerning the nature and extent of the data they can collect. I do this by reflecting on my experience of conducting research involving UK secondary school students using online data collection methods during the COVID-19 pandemic. I identify several factors that generated power effects which influenced the conduct of the research, including: an ethics review that relied on a simplistic discourse concerning young participants' (in)competence; my own self-regulation of my conduct in respect of 'ethical' research; my 'positionality' in the field; and a researcher's general dependence on participants and gatekeepers to complete their research. I conclude by reflecting on how these factors may impact upon the conditions for viable social research involving young people.

The transition to school is a critical period for children and families. Successful transition predicts later school achievement and socio-emotional outcomes with sustained long-term benefits. Educational disruptions caused by the COVID-19 pandemic meant that support for the transition of children from nursery to school was limited. The study aimed to investigate the impact of the pandemic on early years transitions in the U.K., with a focus on children with Special Educational Needs and Disabilities. Using a sequential mixed-methods research design, data was gathered from a survey before children started school, and semi-structured interviews after starting school. Results revealed that support for the transition of young children from nursery to school was inevitably affected. Key challenges and facilitating factors in planning for transition are reported as well as the impact of the pandemic on children, families and early years practitioners. The paper concludes with recommendations for policy and practice.

University student mental health and wellbeing is a concern, exacerbated by the COVID-19 pandemic. Loneliness and social isolation are drivers of student mental health problems, amenable to intervention. "Connecting People" was developed and piloted in health and social care services to support people to enhance their social connections. This paper reports results of a pre-post, single-group evaluation of training provided to 105 people supporting students in a UK university, and the feasibility of using a "Connecting People" adaptation to reduce student social isolation. Trainee confidence in supporting socially isolated students increased after training and remained high six months post-training. Positive feedback included students making new friends, and helping trainees to break down tackling loneliness and social isolation into manageable steps. Further evaluation is required to test effectiveness, but the model appears feasible to use at minimal cost, and may offer a suitable model to alleviate student social isolation.

In response to the spread of COVID-19 in early 2020, schools across the UK moved to virtual teaching arrangements for the majority of their learners. Some localized school closures occurred in England in February 2020, with a national lockdown following in March 2020. Although relaxed in June 2020, concerns about rising cases of the virus led to a second period of enforced school closure across the UK in January 2021. With no sign of the pandemic abating, we wanted to gain insights into teachers' experiences at this unique time. We used a solicited diary method with teachers over a 4-month period to reflect on workload and wellbeing issues related to their changing teaching practices. The diaries were supplemented by a series of teacher interviews. In this paper, we carry out a critical reflection of diary use. We observe how diaries provide a structure for eliciting ideas in an ordered way, and which then become a resource for a teacher's professional reflection. This process also appears to strengthen some of the social connections that were compromised during the social distancing periods of the pandemic, and which has benefits for teachers' wellbeing.

Objective: This review summarizes evidence pertaining to the impact of the COVID-19 pandemic on the psychological health of children and adolescents with autism spectrum disorder (ASD). Materials and Methods: An electronic search was conducted using four major databases--PubMed, ScienceDirect, Web of Science, and Google Scholar. Using an umbrella methodology, the reference lists of relevant papers were reviewed, and citation searches were conducted. The study included articles written in English between January 2020 and March 2021 that focused on the psychological health of autistic children and adolescents. Results: All eight studies included in the final review were cross-sectional. Three of the eight studies were conducted in Italy, two in Turkey, and one study each in Portugal, Spain, and the United Kingdom, with a total of 1,407 participants. All studies used a mixture of standardized and non-standardized questionnaires to collect data. The total number of patients were 1407 at a mean age of 9.53 (SD = 2.96) years. Seven studies report gender; male 74.7% (657/880) and female 25.3% (223/880). The finding showed that behavioral issues in children and adolescents with ASD have significantly increased; 521 (51.9 percent) of the 1004 individuals with ASD presented with behavioral changes, including conduct problems, emotional problems, aggression, and hyperactivity. Some studies also found increased anxiety and difficulties managing emotions. Only one study reported clinical stabilization in children with ASD during COVID-19. Finally, 82.7% of families and caregivers of children with ASD (544 out of 658) faced challenges during COVID-19. Conclusion: Although the studies in this review suggest a general worsening of ASD children's clinical status, it remains difficult to draw definitive conclusions at this moment, with newer COVID-19 variants on the rise worldwide. During this difficult pandemic period, caregivers, families, and healthcare professionals are recommended to pay more attention to the ASD patients' health and care needs.

This paper reports on a study of Chinese parents' involvement in their children's heritage language (HL) development during the COVID-19 lockdowns in the UK. Involving seven transnational families, we examined the roles parents played during the online learning sessions and the factors shaping their involvement. Employing a netnographic approach, this study incorporates online classroom observations, semi-structured and focus group interviews with parents, and analysis of their Instagram posts. The study underscores the critical role of parental involvement (PI) in enhancing children's HL education, offering insights into distinct parental roles, including as emotional supporters, co-educators, teaching assistants, and technical supporters. The study introduces a three-dimensional PI model within the framework of family language policy (FLP), enhancing our understanding of FLP by concretely manifesting what, how and why parents get involved in their children's HL development. This study contributes to the discourse on PI and FLP, shedding light on the evolving roles of parents and the complexity of their involvement during the unique circumstances of the pandemic.