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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).)

Background: The COVID-19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high-risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future. Aims: To discuss the threats and opportunities from the COVID-19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership. Methods & Procedures: The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple-group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors. Main Contribution: The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID-19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non-instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding calls and high competition. Current research is affected by very limited access to participants and the ability to conduct face-to-face and instrumental assessments. However, research opportunities may result in greater collaboration, and changes in service delivery necessitate robust investigation and evaluation. A new national set of research priorities is likely to emerge. Conclusions & Implications: The immediate impact of the pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. It is unclear when any of these areas will resume operations and whether permanent changes to clinical practice, professional remits and research priorities will follow. However, significant opportunity exists in the post-COVID era to re-evaluate current practice, embrace opportunities and evaluate new ways of working.

Competing Interests: Competing interests: None declared.

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.

The COVID-19 pandemic had a disproportionate impact on ethnically minoritised and other marginalised communities, yet little is known about the impacts of long COVID-19 (LC) on this group. Living with LC takes its toll both physically, emotionally and financially and even more so when a diagnosis is hard to come by. By using qualitative interviews centring the view of undiagnosed and marginalised communities already classed as 'underserved' in the medical literature, we show the range of barriers and impacts faced by these groups in the UK, and the strategies of resilience they use. Whether trapped on a 'diagnostic odyssey' at the level of primary care, struggling to maintain employment and businesses, or managing family commitments, we argue many minoritised communities are caught in a liminal space of misrecognition, invalidation and ambiguity. We show how these impacts are generated by tensions and challenges in the process and categorisation of diagnosis, and how this effects the daily lives of many individuals already on the receiving end of health inequity. We also offer some examples and suggestions for best practices., (© 2024 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

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.)

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.

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.

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 reflects on the delivery of Professional Doctorate programmes from a sample of educational (EdD) and sustainable built environment (DSBE) practitioners at a Welsh University in the United Kingdom (UK). The paper explores the 'learner journey' of a sample of Professional Doctorate students as they navigate their studies during COVID-19 pandemic. A qualitative approach was adopted, and semi-structured questionnaires were used to collect data from students on the EdD and DSBE pathways. A thematic analysis was conducted, and the data presented explored how students have navigated their respective pathways and change projects across various modules, during their 'learning journey' and how successful they perceive that journey to be, in relation to a range of factors. The findings from this paper provide a unique insight into the experiences of Professional Doctorate students during a period of significant upheaval. Recommendations are provided for supervisors of Professional Doctorates, Higher Education Managers, as well as Policy Makers in supporting Professional Doctorate students during the studies. Best practice is highlighted with regard to practice-based approaches and demonstrates the differences across two academic disciplines. The use of agile digital and online learning in response to the COVID-19 pandemic further suggests an ongoing model for leadership in Higher Education.

This paper reflects on what we learnt about teaching geography during the COVID-19 pandemic. We interrogate how we, as geography educators working in different contexts, navigated the novel teaching spaces created during the pandemic using two key registers; courageous and compassionate pedagogies. Our premise is that understanding in more nuanced form the approaches we took to creating courageous and compassionate education during the pandemic may help geography educators to thrive when delivering future-facing education. Our approach was to write and share vignettes of our pandemic teaching upon which we (asynchronously) collectively reflected; creating emergent themes described in this paper. This approach to structured peer learning derives from our commitment to education as a collective endeavour. We argue that the disruption caused by the early pandemic required geography educators to focus attention explicitly on areas previously taken as given. Geography educators slowed down by: (1) recognising educator and student embodiment in a novel context; (2) prioritising listening, acknowledging and sharing with students; and (3) paying attention to and respecting difference amongst learners and colleagues. We propose that consciously adopting these approaches will support geography educators and their students in rapidly changing circumstances across educational, employment and climate contexts.

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.

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.)

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: People with intellectual disabilities commonly experience multiple barriers to 'going out'. Aims: This paper explores what barriers prevented people from going out, and if the extent and nature of going out changed over time for people with intellectual disabilities as the COVID-19 pandemic progressed. Methods: Data are drawn from a wider study that explored, at four time points, the experiences of people with intellectual disabilities through the COVID-19 pandemic in the United Kingdom. Findings: The number of people leaving the house for almost all reasons increased over time through the pandemic, except for some outdoor participation and exercise. However, there was a significant decrease in outdoor exercise at the final time point of the study. Reliance on other people and a lack of availability of support were identified as barriers. Conclusion: A combination of factors restricted the extent to which people were going out even after COVID-19 protections were lifted.

Familiarity with technology has become a requirement for independent living, however there is limited information on technology access and use for people with Down syndrome (DS). The aim of this study is to describe technology, gaming, and social-media use in people with DS. Parents/caregivers (N = 220) of individuals with DS aged 5-35 years (49% female) completed an online questionnaire. They felt that technology and social media use, and to a lesser extent gaming, played an important role in their son/daughter's life. However, many had concerns about their son/daughter's safety online, and identified challenges they faced with using technology, such as using a mouse and speech recognition. We also found substantial parental interest in learning more about technology-use in DS, particularly the impact of using social media. This paper summarises important details about technology-use in people with DS, providing foundational information for the design of effective technology-based activities and support.

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.

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.)

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.

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.

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 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.

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.)

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.

The COVID-19 pandemic has become a critical challenge for the higher education sector. Exploring the capacity of this sector to adapt in the state of uncertainty has become more significant than ever. In this paper, we critically reflect on our experience of teaching urban design research methods online during the early COVID-19 lockdown in the UK. This is an exploratory case study with a qualitative approach with an aim to inform resilient practices of teaching in the face of public health emergencies. Drawing on the experience of teaching the Research Methods and Techniques subject during lockdown, we discuss the rapid transition from face-to-face to online teaching and point to the challenges and opportunities in relation to the learning and teaching activities, assessment and feedback, and digital platforms. This paper concludes by outlining some key considerations to inform the development of more adaptive and resilient approaches to online teaching in the context of unprecedented global health crises such as the COVID-19 pandemic. We argue that it is critical to move beyond fixed pedagogical frameworks to harness the productive capacities of adaptive teaching.

Introduction: To meet the ambition of the UK becoming the global leader in health technology, the future workforce needs to have a developed digital literacy. The influence of the COVID-19 pandemic on the move to online learning has also increased the requirement for a reinvention of traditional teaching methodologies (Sá & Serpa, 2020). Methodology: A systematic review was conducted using a mix of Boolean search terms in twelve education and health journal databases to discover the extent of current international research of digital literacy in health programmes. Papers were selected for their specificity to digital literacy in health education pre-registration professional programmes. Results: The initial search included 5359 papers, 3925 after duplicates removed, 134 remained after title review which were then input into Covidence for full reading, finally 47 papers being included for thematic analysis. This thematic analysis identified a number of key themes within these papers: digital literacy of the educator, digital literate workforce, technical skills limit adoption, information literacy, a curriculum requirement in education, institutional infrastructure or personal access, preparedness for entering academia, concerns over the use of digital skills, personalised digital literacy experience, increased communication skills with digital literacies, competency frameworks, COVID-19 and social media in education. Conclusion: This research identifies areas of good practice and areas that need to be considered in higher education programmes and by academics to ensure the digital literacy of the future healthcare workforce.

This rapid systematic review aims to examine emerging evidence on the effects of COVID-19 on educational institutions and assess the prevalence of e-learning changes in the sector. This paper reviews literature on learning, teaching, and assessment approaches adopted since the COVID-19 outbreak, and assesses the impact on the sector, staff, and students, summarizing findings from peer-reviewed articles. It categorizes these into five key themes: (1) digital learning; (2) e-learning challenges; (3) digital transition to emergency virtual assessment (EVA); (4) psychological impact of COVID-19; and (5) creating collaborative cultures. This represents the first systematic review of COVID-19's impact on education, clarifying current themes being investigated. The author suggests that the term 'emergency virtual assessment' (EVA) is now added for future research discussion. Finally, the paper identifies research gaps, including researching the impact on lesser developed countries, the psychological impact of transition, and the important role of leadership and leadership styles during the transition and handling of the pandemic.