The study is intended to examine the impact of crisis responsibility on the reputation of the Chinese public sector organization during the COVID-19 crisis. In addition to that, the study has also examined the mediating role of crisis response strategy in the relationship between crisis responsibility and the reputation of the Chinese public sector organization during the COVID-19 crisis. Lastly, the study has also examined the moderating role of internal crisis communication in the relationship between the crisis responsibility and crisis response strategy of the Chinese public sector organization during COVID-19. This study bases on a quantitative research approach along with a cross-sectional research design. The population of the study is the Chinese public sector organization companies. Data is collected from the employees working in Chinese public sector organizations. The current study used 500 sample sizes; 205 valid responses are received which were used in data analysis. The SEM-PLS is used for the data analysis. The result of the study indicates that all the direct hypotheses are accepted significantly, which indicates that the crisis responsibility and crisis response strategy are significant determinants of organizational reputation during the COVID-19. In a similar vein, the crisis responsibility has placed a significant impact on the crisis response strategy of Chinese organizations during COVID-19. The study is among the pioneer studies on crisis responsibility in the Chinese public sector organization during COVID-19. The study has employed an extended framework encircling the literature on crisis responsibility, crisis response strategy, internal crisis communication, and organizational reputation. Theoretically, the study has extended the situational crisis communication theory framework by incorporating internal crisis communication in the framework. The reputation management area has been gaining increased interest among scholars to examine criticism regarding reputation management as well as issues that affect the reputation of public organizations. The challenges and issues during COVID-19 associated with reputation management are public safety, situations which can have a direct impact on the life of citizens, for instance, public policies, and general elections which affect the public and are generally based on the public’s trust in the organization during COVID-19 .Since the emergence of coronavirus (COVID-19), there have been increasing levels of stress, uncertainty, and emotional disruption around the world. Even organizations and businesses are trying hard to overcome the challenges associated with the pandemic by providing resources to their stakeholders. However, businesses need effective communication to develop trust among the stakeholders through practicing empathy and transparency. Effective crisis response strategy facilitates organizations and businesses in developing hope and trust among the stakeholders and in adapting to the faced challenges during COVID-19. The world has never witnessed such a crisis in the past, therefore, keeping in view the current situation, the communicators and leaders are making efforts to formulate a plan for crisis communication, with an aim to connect communities, stakeholders, and the employees. In this regard, a course of action must be carefully chosen while developing such a plan, as it is required to be informative, effective, and appropriate for the given situation.The literature on crisis responsibility analyzed and limited research and studies were found concerning the favorable public sector reputation (in context to the benefits and its implications) in comparison to the private sector reputation. Although there is a lack of studies in this area, scholars and researchers have been showing conducting studies to examine the causes of the crisis in public sector organizations and their potential consequences. Reputation management awareness has been significantly improved since the public organization-related incidents have been increasing rapidly. As a result, COVID-19, scholars also realized that just like private sector firms, public organization management is also important since it affects the reputation and survival of the public organization .Since there is a lack of theory-based research available, therefore there is a need to extend explanatory theories focusing on the indicators and determinants of organizational reputation and crisis. Several scholars have attempted to present a theoretical framework for the organizational crisis, for instance, For instance, the attribution theory by Therefore, this study aims to use Prior studies  on crisi•To examine the impact of crisis responsibility on the reputation of the public sector organizations in China during COVID-19.•To examine the mediating role of crisis response strategy in the relationship between the crisis responsibility and reputation of the public sector organizations in China during COVID-19.•To examine the moderating role of internal crisis communication in the relationship between the crisis responsibility and crisis response strategy of the public sector organizations in China during COVID-19.Despite the extensive discussion and studies regarding organizational reputation, this concept is still controversial and debatable. Most of the research on this is confined to the private sector which resulted in the lack of studies on public sector organizations’ reputation, and it remained an underused resource . For insSeveral prior studies on public organizations have been examined and found that not enough studies have been conducted regarding the public organization’s reputation in context to reputational perspective. Most of the studies were mainly performed by focusing on the public organizational issues that have an indirect impact on the organization’s reputation. Thus, the reasoning behind this rationale is that public organization-related issues form the basis for their reputation among the public.For instance, some of the researchers also attempted to focus public perception on the public service quality, democratic ethos, public sector management , performAlthough, organizational reputation is a controversial concept because there has been a lack of consensus on the definition and approach of this concept, such as constructs, dimensions, and measurement issues , politicIt has now become a priority for public organizations to create and maintain a good reputation , howeverThe literature has been thoroughly examined to examine the crisis responsibility connection in public organizations, but little evidence has been found about this attribution. A general discussion on organizational crisis responsibility will be done in this section by analyzing and presenting examples of popular case studies. The Exxon Valdez oil disaster (EVOS) 1989 is a popular case of the largest spill that took place in coastal waters in the US. In the oil and gas industry, it is also recognized as an environmental tragedy that occurred due to human error . AlthougSimilarly, in the oil and gas industry, two big names also disappeared upon refusal for taking responsibility for the incident. At the beginning of 2001, the Enron scandal led the Enron Corporation toward bankruptcy. In addition, the well-known accounting and auditing firm not only faced a downfall but also lost Arthur Andersen. A simple fraud in accounting caused irregularities that greatly affected the reputation of Arthur Andersen .Delaying the crisis responsibility process increases the threat to the organization’s reputation as the delay will cause the media to assume that the organization is planning to cover up. Portraying an organization as responsible and at fault also damages the organization’s reputation . SimilarThe crisis response strategy refers to the approach that is followed by the organization during the crisis . Accordi1.Crisis response strategy is effective if it provides the organization members with the information that could help them in offsetting the damage caused by the crisis.2.Establishing a crisis response strategy using the available information about crisis management and causes and types of the crisis.3.An effective crisis response strategy should consider the reasons and causes of the crisis and must be conveyed to the concerned stakeholders in a timely manner.The crisis response strategy aims to mainly focus on the situation of the crisis and not on the reputation . In SCCTAccording to the SCCT model, crisis response strategy significantly influences crisis responsibility. There is still a dearth of studies concerning the significance of crisis response strategy in crisis responsibility and crisis management . The issIt is observed that most prior studies have emphasized mainly external communication, and the significance of internal communication has only been acknowledged until recently . AccordiAll such factors negatively influence organizational credibility which is a key factor in crisis management. Therefore, organizational members are required to investigate the crisis using their internal links and sources. Considering the situation, there might be the possibility that mass media gets access to the internal information and in that case, the management of the organization should be well aware of how to effectively, and accurately establish strong communication with the members of the organization to execute the planned process. Internal crisis communication refers to the effective and useful process of collaboration among internal stakeholders and managers at any stage i.e., prior, post, or during COVID-19 as well as in any type of organization, be it public, private, or NGOs.Governments around the world have been facing massive challenges resulting from COVID-19, ranging from income support to generating strong health services, to providing support to the companies who are struggling. Besides, a remarkable amount of collaboration and cooperation is also required among the nations on successfully obtaining vaccines and testing and detecting the virus. The ability of a state to handle such a crisis depends on how much cumulative investment it has made on its management and governing ability. Countries that overlook the need to make investments in dynamic capabilities face serious challenges and issues when such a COVID-19 crisis hits them .Before COVID-19, the main concerns of most governments were to deal with wicked issues and challenges faced by the modern world, such as demographic challenges, promoting the people’s well-being, and climate change . Such chThe outbreak of the novel coronavirus has accelerated and intensified the need to develop a challenge-based policy framework. The current pandemic situation provides policymakers and governments with the opportunity to critically analyze their policy foundations and observe areas that need realignment of policy and resources with the twenty-first century needs. The global pandemic also emphasized the significance of capabilities and capacity of the public sector, as it is expected to be capable to deal with emergencies and the required capabilities that are needed for resolving societal issues and challenges, such as, public health. Thus, the COVID-19 pandemic emphasized public sector both as a market fixer and the market shaper for the economy .According to the SCCT model, a crisis’s reputational threat should be considered for determining the appropriate crisis response strategy . Nekmat H1:Crisis Responsibility has a significant impact on the reputation of public sector organizations during COVID-19.According to the literature, organizational reputation is significantly and directly influenced by crisis responsibility . As crisThe crisis responsibility is attributed to the stakeholders considering the reasons and potential causes of the crisis which triggered the situation . InitialThe findings obtained in A thorough review of the literature suggests that the strategic actions of the organization i.e., to reject or accept the responsibility of the crisis play a significant role in restoring the damaged reputation resulting from the crisis threat . Given sH2:Crisis response strategy has a significant impact on the reputation of public sector organizations during COVID-19.H3:Crisis response strategy mediates the relationship between the crisis responsibility and the reputation of public sector organizations during COVID-19.H4:Internal crisis communication moderates the relationship between the crisis responsibility and Crisis response strategy of public sector organizations during COVID-19.The current study is survey-based, and a questionnaire survey is used. The relationship between crises responsibility, organizational reputation, crisis response strategy, and internal crisis communication matter is examined with the help of a questionnaire. Primary data is collected through survey questionnaires which were adapted from prior studies. Therefore, this study is based on a quantitative research approach along with a cross-sectional research design. The population of the study is the Chinese public sector organization during COVID-19. Data is collected from the employees working in the public sector organization of Hubei Province of China during COVID-19.The questionnaire is designed by using the scale items revealed in previous studies. Crises responsibility is measured by using six scale items, organizational reputation is measured by using 15 scale items, crisis response strategy is measured by using six scale items, and finally, five items are used to measure internal crisis communication matter. Therefore, all the measures are adapted from previous studies and designed a survey questionnaire which is based on two major sections. The first section is based on the respondent’s profile including age, education, marital status, income, and designation. Furthermore, the sample size is selected based on previous studies. Various studies in the concerned field used 300–500 sample sizes. Thus, the current study used 500 sample sizes. The total usable responses received were, which further processed for the analysis. Additionally, data statistics are given in 0.9 indicates that none of the values should be higher than 0.9. It is given in Data analysis of the current study is based on PLS-SEM. PLS-SEM is the most recommended data analysis technique which is recommended by several studies as the statistical analysis used in social sciences , 2017. Pt-value 1.96 as the minimum threshold level to accept the hypotheses. In the current study, all the hypotheses are supported because all the hypotheses have a t-value above 1.96. Direct in effect results are given The second step of PLS-SEM is PLS structural model which is used to examine the relationship between variables. In this step, PLS bootstrapping is used which is most recommended by previous studies . This stThe results of the study indicate that all the direct hypotheses are accepted significantly, which indicates that the crisis responsibility and crisis response strategy are significant determinants of organizational reputation during the COVID-19. In a similar vein, the crisis responsibility has placed a significant impact on the crisis response strategy of Chinese organizations during COVID-19 a low crisis responsibility is attributed to the organization in case of victim cluster. In an intentional or preventable crisis, strong crisis responsibility is attributed to the organization. Meanwhile, the effectiveness of the implemented strategies cannot merely be assessed using SCCT theory as this theory focuses only on the crisis type and response strategy and how they affect the organizational reputation. In context to organizational communication, several factors affect the organizational outcomes during a crisis. These factors also include factors internal to the organization, such as crisis responsibility, and leadership communication.The crisis response strategy significantly mediates the relationship between the Crises Responsibility—Organizational Reputation.Finally, this study examined the moderation effect of internal crisis communication matter between crisis responsibility and crisis response strategy. This effect is shown in Furthermore, the r-square value is reported in Based on the above-mentioned results, we assume that a responsible organization tends to accept the responsibility whenever any crisis appears and tries to take corrective measures for crisis management. Most of the time, the actions of the organization depend largely on who and what caused the crisis. In the crisis management process, the first step is always to frame the crisis by exploring the type of the crisis. The crisis responsibility during COVID-19 helps in identifying who should be attributed as responsible for the crisis. The crisis responsibility during COVID-19 is attributed based on the crisis framing, and its type, such as intentional, accidental, or victim clusters.The prior studies  reportedThe result of the study offers unique implications for managers and in particular employees of public sector organizations aimed COVID-19. By incorporating crisis response, crisis response strategy, and internal crisis communication, the study has extended the normal scope of crisis management during COVID-19 by offering new insights into SCCT in the public organization China. The extended model coupled with the new insights offered in studies will equip the managers with tools for managing crisis. The practical contributions of the study are multifold.The findings of the study have revealed that the conceptualization of internal crisis communication in unique settings of China is different from the western settings as the study has conceptualized the leader as a man of crisis with powerful oration skills and command of language and formal communication. The study not only considers the communication, but also has taken into account the CST.The study has worked on the public sector organizations in a given situation. The results of the study are limited in their application. The findings cannot be applied to any other sector or organizations experiencing a different crisis. Similarly, the respondents of China have been targeted in the study, which narrows down the scope. The results can differ for any other part of the economy. In other countries, the public sector organizations may have a difference in values, which can yield different results. Thus, the outcomes of this study cannot be applied to any other sector or organization. The organizations possessing similar values in any other sector or economy can take advantage of the findings of this study, as the public sector organizations in Asian countries have many resemblances with the public sector of China.The original contributions presented in this study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.All authors listed have made a substantial, direct, and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Specific classes of cyberspaces emphasize different types of digital transactions given the user’s context, thus making it essential to take into account what these environments can afford. In this way, we can portray the niches of technological use as ecologies of particular possibilities and compare how they differ between distinct spheres of human life. The present research is focused on describing the conceptual integration of a taxonomic crossover between Virtual Learning Environments and Educational Affordances of Technology, while also performing empirical testing and determining the psychometric properties in a scale regarding the aforementioned taxonomy. The study sample consisted of 320 students in the departments of foreign languages from three different universities in Sonora (northwestern region of Mexico). Students were given a questionnaire of 21 items organized into four subscales with a Likert-type response option to measure the notions concerning their usage of Virtual Learning Environments. Internal consistency procedures and confirmatory factor analysis by means of Cronbach’s alpha and Structural modeling support the derived factorial structure, which contains Cyber-Communications, Virtual Behavior Settings, Virtual Communities, and Availability and Access to Connectivity. This structure traces the environmental properties perceived by learners in a virtual environment. Results sustain the initial conceptual construction regarding the proposed taxonomy, conclude that the ‘Virtual Learning Environments Questionnaire’ demonstrates adequate psychometric properties, and validate it as a fitting measure to assess the perceived psychological experience of students in a digital educational setting. Categories and classifications are linked to everything humans do, ranging from the worlds where events happen to their complexities and the relationships between them. Categories as material or symbolic tools affect society in several ways: they are assigned, can become labels chosen for different events, and, in turn, can become statistical artifacts . WithoutNumerous concepts and constructs describing virtual learning environments, as well as their corresponding measures, have been proposed in the literature. Research on this topic has evolved to include several instruments designed to evaluate different learning environments by measuring variables such as the efficacy of learners and teachers that engage in them ; IntrinsThe conceptual integration as proposed in this study is focused on describing different components of the cyberspaces or virtual environments, given their potential in learning processes. These components reference the capacity of the Internet and the cyberspace to bring sources of information closer to electronically simulated “virtual” places that are physically distant . A virtuTherefore, we agree with the categorization of different components of cyberspace as conceived by Stokols (2018a), where distinct units of cyberspace emphasize different types of digital transactions. This categorization comprises Episodic Cyber Communications, that refer to conversations or exchanges in relatively short or designated time periods that are not as immersive as more extensive online interactions ; Virtual Behavior Settings, meaning sites that stay online during longer periods of time and develop a symbolic sense of “space” or “place.” These are frequently built around particular goals or activities ; and Virtual Communities, the most socially immersive kind of these cyberspaces, which makes reference to groups that involve recurring interactions between participants, who develop a shared identity and a virtual sense of camaraderie. Said cyberspaces often depict members of a community whose interactions and encounters are portrayed on an interface or screen .Educational Affordances of wearable technologies and Affordances of Information and Communication Technologies. In this article, we have retrieved mutual components to conceive a category that integrates the affordances of Accessibility, Diversity, Communication, Presence, and Distribution , and Educational platforms that are used in everyday learning practices, since the access and usage of these resources in education improves quality, enhances creative thought, is associated to productivity and efficiency of educational results, and facilitates both the teaching and learning process .The taxonomy comprised by the aforementioned variables may be illustrated in the following manner see .M = 19.4) in the departments of foreign languages from Universidad del Valle de Mexico, Instituto Tecnológico de Hermosillo, and Universidad de Sonora. This sample included 115 male students and 205 female students, all of them located in the city of Hermosillo, Sonora in Northwestern Mexico. All participants were invited and then volunteered to partake in the online study. Participants also completed several other questionnaires related to language learning variables as part of a broader online study regarding language learning environments.The study sample consisted of 320 students , was based on the Taxonomy for Virtual Learning Environments, and developed specifically for its use in this study. It contained 21 items with a closed-ended Likert five-point scale response option . The VLEQ comprised four main sections: (1) Episodic Cyber Communications, (2) Virtual Behavior Settings, (3) Virtual Communities, and (4) Availability and Access to Connectivity. Regarding the first three scales, each one of them aimed to assess the suitability of the environmental quality perceived from each of these types of digital spaces dedicated to learning. As for the fourth scale, it was designed to gather information about the students’ availability of equipment and services for connectivity.The VLEQ Questionnaire development procedure began in November 2020, based on a literature review and structuration of the taxonomic cross in this study. This was carried out with a review of major studies in the area, regarding virtual environments and the affordances of information technologies. Review evolved as ensued by peer feedback, followed by the technique proposed by The questionnaire was written in Spanish, and it was made available to students from March to April 2021. The recruitment process was tailored to ensure that the learners received the questionnaire via a link shared by their teachers, and then answered during their online classes. The VLEQ link provided also contained the informed consent clause which was signed by all participants.The classic strategy is one of the most prevalent practices in social research, which first consists in specifying the concepts or constructs and then measuring empirical cases of them. This strategy alludes to a basic type of indicator classification called a “three-level measurement model,” where we find the concept, the corresponding empirical occurrence of the concept, and the indicator of both the concept and the empirical occurrence . In thes2) statistic and its degrees of freedom. Moreover, other indexes used to estimate model fit include the Normed Fit Index (NFI), Non-normed Fit Index (NNFI), Comparative Fit Index (CFI), and Root-Mean-Square Error Approximation (RMSEA); all of which can be computed in EQS software.The main form of data analysis to be presented here is the results of the analysis from structural modeling procedures used to determine the taxonomy’s empirical validity and therefore the VLEQ’s reliability and construct validity. Specifically, we aimed to provide the first test of the factorial structure, presented here in two stages. The first step was to execute an Internal consistency analysis by means of Cronbach’s alpha reliability coefficient employing SPSS software. This coefficient was chosen in accordance with the needs of the study, given that it refers to the degree that the items of a measurement altogether reflect a simple latent variable . SecondlAll scales in this study were individually tested. Since, for the most part, tests are not always assumed to be homogeneous; but rather, it is sought that each of its scales, separately, measures a set of traits or characteristics different from those measured by the other scales included in the test . Table 12 = 668.04, df = 179, p = 0.000). However, we may also remark that all factorial loads are equal to or greater than 0.70, and adjunct or practical goodness of fit indexes  show that the model is well supported by the amount of observed data contained in our sample since fit index all values are equal to or greater than 0.90 and RMSEA ≤ 0.08  specializes in studying some of the perceived affordances in virtual learning environments solely based on the items derived from a taxonomic cross which included theoretical categories that had not been tested with empirical cases before. These indicators were subjected to empirical testing procedures in order to obtain and analyze the psychometric properties which determined the validity of the taxonomy portrayed in the questionnaire.Even in light of the results obtained, a significant limitation in this study relates to generalization, since we worked with data from only 320 second language learning students at university level, therefore the results cannot be claimed to universally be the case for all learners and educational degrees. Furthermore, this work only offers limited aspects regarding each category for virtual learning environments, future directions may point to the improvement of several features of the taxonomy. These may be explored by further development of the questionnaire, such as adding more examples to better describe the different kinds of cyberspaces or including more items in order to describe other affordances of information technologies.The obtained results justify further development of the method, several interesting aspects may be explored to a greater extent by adapting the instruments and methods of this study to the needs of other populations in different educational levels. Future works should include different kinds of students (including different areas and fields of knowledge), while also associating their virtual, physical, and social contexts in order to further detail the interconnection between these environments and its impact on variables related to learning processes.The original contributions presented in the study are included in the article/The studies involving human participants were reviewed and approved by the Committee of Ethics in Research (Comité de Ética en Investigación) of the University of Sonora. The patients/participants provided their written informed consent to participate in this study.MM-B contributed to the conceptualization and design of the study, acquired the data, ran formal analysis, and organized the databases. BF-S and GF-B contributed to supervising the study, methodological tasks, and data interpretation. CT-F made substantial contributions by editing and revising the manuscript critically for important intellectual content. MM-B and ON-C provided the writing of the original draft. All authors contributed to manuscript revision and read and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Academic research is one of the main avenues through which humans can fight the threat of infectious diseases. However, there have been concerns regarding whether the academic system has provided sufficient efforts to fight infectious diseases we potentially face. Answering these questions could contribute to evidence-based recommendations for setting research priorities and third-mission policies.With a focus on one of the most common categories of communicable diseases, infectious and parasitic diseases (IPDs), we searched Web of Science for articles and reviews relevant to IPDs published during the period 2000–2019 and retrieved WHO data on disease burden in corresponding years. The academic response patterns were explored by IPD subcategory and by human development level (an index established by the United Nations). We conduct the analysis in particular to gain insight into the dynamic relationship between disease burden and research effort on IPDs, scientific efforts contributed by countries with different development levels, and the variation trends in international joint efforts.The greatest burden of IPDs is clustered in the developing regions of Africa, but has received academic response from both developed and developing countries. Highly developed countries dominate the ranks of academic research in this area, yet there is also a clear increase in research efforts from the countries most affected, despite their low human development scale. In fact, the overall analysis reveals an improved capability for addressing local problems from African regions. In terms of international collaboration, highly developed countries such as the United States and United Kingdom have commonly collaborated with needy regions, whereas prolific but developing nations, like China, have not.From a global perspective, academia has positively responded to health needs caused by IPDs. Although the relevant research output contribution is primarily from the highly developed countries, concentrated and specialized efforts from the undeveloped regions to ease their local burden can be clearly observed. Our findings also indicate a tendency to focus more on local health needs for both developed and undeveloped regions. The insights revealed in this study should benefit a more informed and systemic plan of research priorities. Infectious diseases have for centuries been one of the leading causes of death and disability, and despite all human endeavours, they still present a growing challenge to health and social progress , 2. MostLong-standing infectious diseases are those that have existed for long periods in human history rather than emerging as outbreaks, epidemics or pandemics. They span many different conditions and presentations, from HIV to nematode infestations to hepatitis and leprosy. We examine 11 major subcategories of infectious and parasitic diseases in this study, collectively referring to them as IPDs. Although the burden of IPDs has decreased over the past few decades , the morThe extent to which researchers have responded to the health needs caused by infectious diseases reveals the connections between the so-called supply side of science and knowledge and the demand side in health fields . AcademiIndeed, assessing the research effort required to address complex global challenges has been drawing increasing attention from scholars in many fields—environmental and energy science , agriculAs metrics that reflect research effort, prior studies have considered academic research output , 30, funIt is well acknowledged that health research resources are unequally distributed. Evans et al.  found thThe other dimension through which we analyse response patterns is academic collaboration. This element of research is of great significance in that it presents how scholars from different countries with varying backgrounds jointly defend against diseases. Several studies have investigated the features of collaborative medical research between countries. For instance, Kozma and Calero-Medina  examinedIn short, this research gives rise to the following research questions:What is the dynamic relationship between research effort and the burden of IPDs?What roles do countries at various levels of human development play in contributing to scientific research related to IPDs?How have scholars from countries at various levels of human development jointly defended against IPDs?The rest of this paper proceeds as follows. The next section presents the data, methods and tools used in this analysis, including a primer on IPDs classifications and the sources of data used to explore IPDs research. The main results and our analysis are provided in the third section. The last section contains the conclusion and discussion of results, including the limitations and reflections on future work.Figure This study employs IPDs from the Global Health Estimates (GHE) cause categories established by WHO  accordinReliable and transparent health statistics are of great importance to anyone concerned with public health policy. To this end, a wide range of indicators have been developed to monitor and manage health initiatives. In line with similar prior studies , 21, 26,r for disease d, and d worldwide. r carries a relatively higher burden from disease d than the world average, while d than the world average. The value range of To calculate the trends relevant to DALYs for different time stages, the DALYs estimates were collected from WHO for all categories of diseases for 183 countries in the years 2000, 2005, 2010 and 2015  Core Collection using a search strategy developed by Confraria and Wang . The strr for disease d, and d published worldwide. r has exerted a higher research effort to address disease d than the world average, and d than the world average. A similar approach to the NSI of disease burden was also applied to normalize the We further searched for all disease-related articles and reviews in the same period in WoS with a view to comparing the proportion of research effort devoted to IPDs versus the total burden of disease. It should be noted that the retrieval of all disease-related publication data also refers to the search strategy developed by Confraria and Wang . Here, “For data visualization and analysis, we applied VOSviewerThe process of building the global collaboration network can be divided into three steps. In the first step, the country/region information is extracted from all publications and the number of collaborated publications for each country is calculated. Using the full counting approach, publications were assigned to a country according to the institutional address of each author . In otheIt should be noted that in addition to the calculation of each country’s number of publications, the number of publications for different human development groups (countries/regions with various HDI levels) is counted directly on the aggregate level instead of summing the number of publications for each country/region within the specific HDI level, to avoid duplicate counting of publications with collaboration by countries/regions within the same HDI level.The health dimension is assessed by life expectancy at birth, the education dimension is measured by mean of years of schooling for adults aged 25 years and more and expected years of schooling for children of school entering age. The standard of living dimension is measured by gross national income per capita. The HDI uses the logarithm of income, to reflect the diminishing importance of income with increasing GNI [gross national income]. The scores for the three HDI dimension indices are then aggregated into a composite index using geometric mean.A range of indicators or classifications have been developed to monitor and categorize a country’s development level, including the World Bank country classifications and the UNDP’s HDI. This study employs the HDI to classify countries into different development levels, since it serves as a more comprehensive measure of human development than purely economic measures . The criBased on the calculated HDI result, a country can fall into one of four categories—very high, high, medium and low. The HDI for each country is updated every year, with the exception of North Korea and Somalia, who do not have HDI indicators. Thus, we conducted our analysis on 181 countries, taking the HDI from the years 2000, 2005, 2010 and 2015 as our data. Table The research framework in Fig. Note that all DALYs in this subsection are based on unstandardized total DALYs, because differences between population sizes are not relevant to these global results.Figure Overall, the publications and burden for 11 subcategories have both maintained relatively stable shares within the category of IPDs. Diarrhoeal diseases, parasitic and vector diseases, HIV/AIDS and childhood-cluster diseases are the four conditions with relatively high burden throughout all four periods. However, the distribution of publications for 11 subcategories is different from that of burden, in which parasitic and vector diseases, hepatitis, HIV/AIDS and tuberculosis represent a high number of articles.Two diseases that are prominent on both the burden and effort sides are parasitic and vector diseases and HIV/AIDS. Parasitic and vector diseases accounted for the largest proportion of articles, at nearly 29% on average. A number of NTDs fall within this category, such as rabies, Chagas disease, leishmaniasis and schistosomiasis . These aHepatitis is the second most widely addressed condition in IPDs by academia. However, the burden caused by hepatitis seems to be inapparent globally. Hepatitis itself is an inflammation of the liver with five main strains, referred to as hepatitis A, B, C, D and E. However, it can progress to or be complicated by other diseases. In particular, types B and C are the most common causes of liver cirrhosis-, cancer- and viral hepatitis-related deaths in hundreds of millions of people , which hDiarrhoeal disease and childhood-cluster diseases are two subcategories with a remarkable burden but low level of research attention in IPDs. Diarrhoeal disease is the second leading cause of death in children under five years old and is mostly caused by contaminated food and water . As a diIn addition, leprosy, an age-old disease with a treatment scheme comprising multidrug therapy (MDT) , constitIn sum, this section examines the burden and publication volume in absolute terms for 11 IPDs. In the next part, a more extensive analysis will be provided in terms of the ratios of IPDs research/burden as a percentage of all disease-specific research/burden.relative degree of scientific response on IPDs in comparison with all diseases globally. We also investigate the correlation between IPDs research efforts and disease burden.Here, the ratios of IPDs research/burden as a fraction of all disease-specific research/burden are firstly calculated and compared to observe the x-axis) versus the share of publications (y-axis) for the general IPD and its 11 subcategories is demonstrated by scatter plots. Here, the upper left corner of the diagonal line indicates where the research effort exceeds the disease burden and vice versa.Figure In the last two decades, the share of the general IPD's publication is lower than that of the burden they impose. Despite the steady increase in the number of publications on IPDs Fig. , the shaIn terms of the 11 subcategories, the percentage of DALYs for most conditions is decreasing, with the exception of hepatitis. The percentage of DALYs of hepatitis remained consistent during 2000–2019, and even climbed marginally. Interestingly, despite the fact that its global burden appears to be insignificant, hepatitis is the disease with the second highest number of publications, trailing only parasitic and vector diseases, implying that diseases with stable burden have received greater attention as the overall burden of IPDs has decreased. Combined with the above discussion on hepatitis, the potential for complication by other diseases, the active involvement of Chinese academia in relevant research and its stable burden might be the reason for the significant scientific attention on hepatitis.On the research effort side, corresponding to the general decreasing trend in the share of IPDs publications, the proportion of publications declined throughout the 11 subcategories, except for tuberculosis. Among the 11 subcategories, tuberculosis represents the fourth most severe burden of infectious disease worldwide. Furthermore, among the top five high-burden infectious illnesses, the burden of tuberculosis is dropping at the slowest rate. At the national level, tuberculosis remains a serious health concern in certain populous nation, such as India and China, which have also made significant contributions to related research. In addition, the previously indicated link between tuberculosis and HIV/AIDS is another possible explanation for the growing volume of literature on the disease.Among the 11 subcategories, diarrhoeal diseases, childhood-cluster diseases and meningitis are diseases with a steady decline in both burden and share of publications. In particular, the burden of diarrhoeal diseases and childhood-cluster diseases was substantial in 2000, but has declined dramatically in subsequent years. While the proportion of publications remains lower than the percentage of DALYs for both diseases, the gap between the share of publications and the burden is closing. Encephalitis, hepatitis, parasitic and vector diseases, intestinal nematode infections and leprosy were the five diseases with greater publication share than burden. Except for parasitic and vector diseases, the burden of these diseases is fairly low. The various reasons for the large number of publications on hepatitis have already been discussed. The absolute number of publications for the remaining three diseases is equally low when compared to infections with a high burden. Parasitic and vector diseases is prominent on both the burden and effort sides. This category contains a variety of NTDs, which are not only responsible for considerable burden, but also have garnered increased attention from the global scientific community . FurtherFigure As expected, the countries with the highest disease burden are mainly concentrated in the less developed regions of Africa, with all top 40 countries with the greatest disease burden (DALYs standardized per 1000 population) situated on this continent. However, within these 40 countries, the particular conditions imposing the highest burden vary from country to country. Taking the top five as an example , HIV/AIDS tops the list in Malawi, Zimbabwe and Lesotho, while in Sierra Leone and the Central African Republic, HIV/AIDS is nudged into lower place by parasitic and vector diseases and also diarrhoeal diseases.The countries with the highest academic contributions are dispersed throughout the developed continents of the Americas, Europe, Asia and Oceania. Moreover, the top three countries with significant contributions are the traditional forces on academic publishing worldwide. Figure What is noteworthy is that parasitic and vector diseases is the most attended to category in the countries with high publication volumes, except for China. This type of IPDs carries one of the highest burdens for Sierra Leone and the Central African Republic, while research effort from China emphasizes diseases with a high potential local burden, as mentioned above, such as hepatitis. HIV/AIDS has received substantial attention from scholars in the United States and United Kingdom. Tuberculosis has also been a subject of interest for the top five publishing countries.The tendency of developed countries to give attention to global health needs was verified in a prior study on the funding priorities of public funding agencies in the United Kingdom and China . Their rNote that the following is a dynamic analysis over 20 years, during which the development level of many countries is constantly changing. Hence, we chose to divide countries according to their dynamic HDI levels to reflect the research response pattern of regions with four HDI levels globally against IPDs. Further observation and interpretation of “fixed-level” countries and others with a high impact on the results of global shares will also be provided in this section. Table Table always in the low HDI group  showed a clear and substantial increase (from 3.63 to 7.07%), which speaks to a persistent effort by scholars in the areas affected to do something to ease their high local burden.Consistent with the design of the HDI, countries in the lowest human development group carry the greatest disease burden. Likewise, the well-resourced infrastructure of countries in the very-high development group is responsible for contributing the most research to the literature. However, despite a steady increase in the number of publications produced by the very-high group across the four periods, the proportion of research effort they contribute is declining. In other words, the number of articles on IPDs produced by the other groups is also increasing and at a greater rate. In fact, the proportion of publications generated by those traditional highly developed countries  declined in a more significant manner from 72.31 to 48.29%  and publication volume will greatly affect the results of these two levels.In particular, India, a country with a large population, has the highest original DALYs across the whole study period on the aggregate IPDs level. Hence, the upgrade of India from the low to medium level in the third period inevitably leads to the increasing share of burden for medium groups, especially for several diseases with the highest burden in India . Moreover, China also has a high relative value of original DALYs in encephalitis and hepatitis . Indeed, although China’s burden of those two diseases is lower than India’s, the large volume of publications generated by Chinese scholars, together with China’s movement from the medium to high group in the last period, resulted in the growth in the share of publications of the high group. As for intestinal nematode infections, China ranked first in original DALYs from 2000 to 2019, which explains the high global share of the burden in the medium group during 2000–2004 and its substantial increase in the high group in 2015–2019. Correspondingly, the intensive effort from China on intestinal nematode infections, especially in the latest period, contributes to a marked rise in share of publications for the high group in 2015–2019. Unlike the above-mentioned diseases, the increased share of both burden and publications for HIV/AIDS in the high group in 2015–2019 is mainly due to the upgrade of South Africa from medium to high group in the same period. On average, South Africa ranked first and third in burden and publications, respectively, which also partly reflects its high research attention on local health needs.In spite of the highest share of burden and publications in the low and very-high groups, respectively, the tendency to give priority to local health needs can be observed not only from the steady increase in the always-low group’s share of publications, but also from the intensive research efforts on disease with high local burden from several major countries with mobility in HDI levels. This conclusion, however, does not consider the effort a country extends towards IPDs as a proportion of its entire disease-related research. Thus, one may reach a different conclusion when examining how a nation balances its research efforts between local and global needs. Such analysis needs to be based on a country-specific perspective, combined with the information of burden and research effort for all categories of diseases instead of only IPDs. This is somewhat beyond the scope of this paper, as we are focused on countries’ research efforts on IPDs, not the specific research priorities of each country. That said, this reasoning raises the point that our results cannot be taken at face value. Rather, they must be interpreted more carefully from a multidimensional and dialectical perspective. Indicators such as the percentage of a country’s publications devoted to IPDs relative of that of the world cannot accurately reflect the true dimensions of specific countries’ research concerns. A more fine-grained analysis is needed to address this problem.relative level of burden and efforts with respect to the world average without the impact of population size. Figures Following the global share of disease burden and research effort calculated based on original absolute numbers, this section adjusts the two factors to reflect The results for disease burden Fig.  are simiFigure What seems contrary to the above analysis is that the very-high group is making the least research contribution , the very-high group tends to focus more on noncommunicable diseases, such as neurological conditions and cardiovascular disease. These are diseases of high burden in developed countries .The tendency to focus more on local health needs was verified for both developed and undeveloped regions in the above analysis. Again, however, we must highlight that an integrated exploration of burden and research efforts on all types of disease for specific countries is needed to reflect detailed information on the balance between global and local needs. Nevertheless, what clearly emerges from this analysis is the complexity of setting research priorities and establishing a research agenda by referring to quantitative indices. Taking our results as an example, if one relies only on the results produced by the absolute calculations, then practical issues such as the actual research capacity of each country might be overlooked. Under such circumstances, analysing the quantitative outcomes from multidimensional perspectives and integrating them with qualitative analysis may help in developing more rational and effective policies.This section provides an analysis of the collaboration patterns in two respects: overall and with respect to the countries with a high disease burden.Among all the countries that have been involved in scientific publishing on IPDs, 65 have generated more than 1000 publications, and these we selected as the major subjects of study in this section. Figure Collaborations occur on all continents,In order to further explore the variation trends in collaboration patterns worldwide, the number of collaborative publications and collaboration strength are calculated for six collaboration pairs generated by four HDI groups in different time periods, as shown in Fig. From the perspective of time evolution, both the number of collaborative publications and the strength of the collaborations increased over the period, especially for the very-high and high group collaboration pair (the red sector). With the general increase in the number of IPDs publications, it is quite natural to observe the growing volume of collaborative publications. Furthermore, one possible explanation for such an increasing trend in the very-high and high group pair is the advancement of the countries’ development level. For instance, three productive countries  moved into the high group in various periods. Their primary collaborators are all from the very-high group, which increases the number of joint publications and the strength of collaboration between very-high and high groups. At the same time, the strength of collaboration between the low and medium groups has grown as a consequence of an increase in the number of joint publications by the two groups but a decline in the number of their individual publications. Specifically, China’s transition from medium to high group and India’s shift from low to medium group resulted in a decrease in publication volume in medium and low groups. However, the number of collaborative publications between the two groups continues to increase, reflecting the less developed regions’ intensive collaboration in responding to their local needs.As for the closer collaborative relations observed among different collaboration pairs, further observations are made from the perspective of number of HDI groups involved in one publication. The ratio of publications generated within the same HDI groupAs mentioned, high-burden countries are concentrated in Africa. However, among the 21 countries on the African continent with more than 1000 publications, only Malawi and Nigeria are in the top 10 list of countries with the greatest burden of IPDs, ranked third and sixth, respectively. To gain further insight into how countries with the highest IPDs burden conduct relevant research, the five countries with the highest burden  with stable burden have gained greater attention as the overall burden of IPDs has decreased, which to some degree reflects the sensitivity and responsiveness of research efforts with respect to disease burden. This is also demonstrated by the positive correlation between the level of research efforts and burden globally.In terms of the regional distribution, IPDs burden is mainly concentrated in the less developed regions in Africa, while related academic research is mainly from developed continents. Indeed, those highly developed countries account for nearly two thirds of all research outputs in terms of absolute number of publications. However, according to the SI, the underdeveloped area (low-level group) is not only the region with the largest IPDs burden, but also the region putting forth the most effort to research IPDs. Such a result again illustrates the alignment of disease burden and research effort from the perspective of geographical distribution. Furthermore, while the worldwide IPDs burden has decreased dramatically, the NSI value of IPDs burden in low-level countries is growing, highlighting the need for continued attention to disease burden in undeveloped regions. Simultaneously, there is a clear increase in research efforts from regions with the heaviest disease burden, despite their limited research capacity. In fact, apart from the constantly increasing number of publications produced by the least developed regions, the distribution of their research efforts on the 11 specific conditions also correlates with the distribution of burden in those regions, in which parasitic and vector diseases is the one with the highest burden and receives the most attention. In particular, Uganda stands out as a compelling example of diligence to its local health needs and achieving remarkable effects on alleviating their burden.In terms of academic collaboration, our analysis shows that both the number of collaborative publications and the collaboration strength has increased remarkably in the past two decades across the board. Collaborations are most intense between the very-high and low groups. In particular, the United States and United Kingdom play a prominent role in collaborating with high-burden countries. In fact, a cohesive collaboration within African countries can also be observed from this study. As for the dynamic trend, the strength of African countries’ collaboration with the very-high and medium groups is expanding, implying improvements in research and collaborative efforts of low-level groups with different regions. Given their own limited resources, low-level countries not only seek collaboration with highly developed countries to jointly handle their local health problems, but also unite areas with similar health needs. Moreover, among all the collaboration pairs, the high–low collaborations generate the fewest publications and are the weakest. Additionally, China, a high (medium)-level country, has a relatively weak collaboration with high-burden countries despite its place as the third highest research contributor. Such rapidly developing countries could also seek increased engagement and pursue a more active role in research on global needs.We also noted that there is no uniform standard or requirement for academic contribution for each country across the different development levels. The uneven distribution of research effort by the different nations once again raises the issue of whether research effort should be balanced between global and local needs or whether a local focus is optimal. Our analysis reveals a tendency for all countries of the world, no matter their development level, to concentrate on their own issues. This is a finding that is consistent with previous studies , 38 but This study has several limitations that need to be addressed. First, the only measure of research effort was publication counts from WoS. Drawing only from WoS might mean that the corpus did not include some relevant publications indexed in other scholarly databases. Moreover, while publication counts are an objective measure, they do not represent all types of research efforts. The same is true for the burden of disease. A wide range of indicators beyond DALYs have been developed to monitor and manage health initiatives , 76. TheSecond, it is controversial whether research effort and academic resources should be allocated relative to the health needs or more directly to the burden of disease . A rangeFor future research, multidimensional indices should be expanded to provide a more comprehensive understanding of the relationship between research efforts and societal demands in medical fields. Diverse societal factors relevant to health needs could be included to more comprehensively investigate the reasons behind the relationship between academic research and social needs. And, as always, the balance of research effort between global and local needs for different countries warrants further exploration.


Globally, the COVID-19 pandemic is triggering a public health emergency and crisis on a large scale, with far-reaching effects and severe damage to all aspects of politics, economy, cultural and social life, and health. Consecutive outbreaks over the past nearly 2 years of “living with COVID-19” have forced most schools to physically close, resulting in the largest educational disruption in human history. In turbulent times of the COVID-19 crisis, school leaders are facing numerous major challenges germane to school governance and leadership. The key objective of the study is to fully explore the prospective challenges principals are encountering in public schools in times of COVID-19. To fulfill the research purpose, a systematic literature review (SLR) was carried out to investigate the leadership challenges. As a result, a total of 24 challenges were explored through SLR approach. Frequency analysis approach was initially applied to figure out the most significant challenges. Accordingly, seven challenges were found statistically significant as showing frequency ≥ 50 each. Irrevocably, the study works as a contribution to K-12 school leadership by providing guidance for current and future leaders in crisis based on practical investigation, experiences, and recommendations. Policy makers can leverage these findings to make necessary adjustments to school policy to better prepare school leaders for crisis. Additionally, the findings of the current study are believed to have profound implications for future research. These findings expand our current understanding on school leadership in time of crisis that needs further investigation. Subsequent studies can quantitatively and/or qualitatively validate these leadership challenges findings regarding a particular school context. In December 2019, initial confirmed COVID-19 cases were detected in Wuhan, China . Since tAccordingly, hundreds of millions of cases have been recorded worldwide and the price to pay for this unequal battle is the lives of millions of innocent people . So far,The lockdown, social distancing, and travel restriction measures introduced by the governments and widely put in place in various forms to contain the coronavirus and mitigate the loss of human are also having a direct impact on people’s lives . The vulThe interruption of education triggered by repeated school closures following the successive outbreaks during the academic years of 2020 and 2021 is unprecedented in modern education. The implementation of lockdowns, social distancing, and travel restrictions on a global scale has hit local and international educational institutions at all levels of schooling, teachers, and students to varying degrees . These qThe COVID-19 pandemic has not spared the education of any country, both rich and poor . Most edSignificantly, school closures or resumptions overnight during COVID-19 outbreaks raise greater public concern over the safety of the school community, learning loss, the quality of instruction modalities, teaching and learning organization plans, compensation for learning loss, student progress and achievement, and safety return post-pandemic . The cloSchools in low- and lower-middle-income countries are still struggling to sustain student learning and deliver quality remote learning programs due to limitations of facilities, technological infrastructure, funding, additional resources, and a lack of experienced academics . AdditioThe COVID-19 crisis has exposed the leadership confusion in addressing the issue of “no one is left behind.” As the center of social activities and human interactions, when schools are physically shut down, millions of young students and youth miss out on the opportunities and social interactions essential for learning and developing life skills . It is eDevastatingly, the risk of not attending school during the disruptive times or in the aftermath of COVID-19 entails various dire consequences for children and youth, namely, being subjected to domestic violence, caught up in the labor market, and the risk of female children being abused and forced into early marriage . The lonIn the turbulent era of the COVID-19 pandemic causing sudden disruptions to global education, school leaders worldwide are facing numerous major challenges related to school governance and leadership. As schools quickly change their operations and organizational structure to respond to COVID-19, the emergence of pre-existing and new challenges is unavoidable and can become more complicated. As school leaders worldwide are navigating challenges triggered by the reign of COVID-19, various initial research has attempted to identify the critical challenges. With a purpose of systematically synthesizing existing literature related to this topic as well as adding more insights into the leadership knowledge, we primarily conducted a systematic literature review (SLR) to investigate the critical leadership challenges facing public school principals when they are navigating the impact of COVID-19. Accordingly, we also attempted to offer a thorough discussion on the identified challenges in order of frequency significance. The following key research question was formulated as “what are critical leadership challenges confronting public school principals as identified by a systematic literature review (SLR)?”The burgeoning COVID-19 crisis is redefining school leadership. Time is short to think twice, and school leaders need to make informed choices about the priority of their operational strategies and policies in the face of COVID-19. Accordingly, the first priorities are to keep track of all the students, ensure their physical and mental wellbeing, make sure students’ education is on track, and monitor student progress . “No chiIn these most uncertain times, school leaders struggle to maintain a balance between complying with local COVID-19 infection prevention and control protocols, soberly leading the school community through the pandemic safely, meeting local educational needs, and supporting the community materially and mentally . LeadersThe COVID-19 era has also tested the leadership capacity of school leaders in unprecedented ways, forcing them to make quick and critical decisions to protect the wellbeing of the academic community, maintain the continuity of the organization, and adjust the school education plan according to the direction of the governing body. This is a time when school leadership is further focused on addressing teacher and parent social and emotional concerns and engaged in more constructive dialogues with stakeholders. In turbulent times of pandemic, school leaders are forced to think fast, act fast, and fear less .It is no exaggeration to say that schools have become resilient fortresses against the onslaught of the pandemic. In the face of unpredictable developments of COVID-19, resilience, flexibility, adaptability, compassion, and trust are key for school leaders to being able to live with the pandemic . School Additionally, local communities are a noteworthy key resource for principals, due to their host of an asset of supplementary knowledge and additional capacity . ConstruCOVID-19 is not only a test of leadership resilience since the future can promise more volatility with greater impact, but also an opportunity to create better and more resilient education . Owing tA rigorous review of existing literature provides a universal list of challenges facing school leaders in the turbulent era of COVID-19, including continuity of learning and quality of virtual or blended education, digital divides, digital literacy and professional development, inequalities in access to education, equity gaps, school financing, cyber security for online education, safety of school reopening, and emotional and mental health.In times of school disruptions, blended online learning is hailed as practical for its feasibility of synchronous and asynchronous modes. The real challenge here is to get students motivated and engaged in blended strategies of learning to mitigate learning loss and sustain the quality of instruction, though online or in-person. The adoption of educational technology requires a sufficient level of digital literacy that many school stakeholders of materially impoverished groups are falling behind. As well, as school leaders, the principals must have the foresight for dynamic, efficient, and operative principles in tackling matters among the host community and school staff, it is only possible by adequate and continuous professional growth and advancement .Thanks to COVID-19, wide disparities in accessing Internet and digital devices expose themselves to the public eyes . During Furthermore, COVID-19 has deep cut into the inequalities in access to education of marginalized students , regardlSchool communities’ wellbeing and mental health have become even more urgent in times of school disruptions when COVID-19 is still raging . AccordiSimilarly, principals are struggling financially for the improvement of school functioning as schools are operating in various learning modalities. Before COVID-19, the average education spending of primary schooling of high-income countries was 43 times higher than that of low-income countries . In someThe world is adjusting to “new” life in the midst of a pandemic, and the same is true for education sector. Responding to the COVID-19 pandemic and its aftermath will be one of the biggest challenges for school leaders in this era. By being open and sharing insights with each other, school leaders are using data and latest tools to quickly adapt and navigate COVID-19 challenges. More than just a trend, this “new normal” will have lasting and powerful effects on the future of education and school leadership.To acquire the requisite objectives of the study, a Systematic Literature Review (SLR) was conducted. SLR is a significant investigation research approach to carry evidence-based research to gain a better insight into the research question or topic of interest . SLR allThis paper carried out SLR using PRISMA guidelines. All the steps of SLR were performed by subsequent step-by-step standards recommended by Keeping in mind the previous personal experience and considering the recommendations of Taylor and FrancisSage PublicationsSpringer LinkEmerald InsightWiley Online LibraryAcademiaGoogle ScholarA proper research string was used to retrieve the most related studies from these selected repositories. We made a string by using keywords and substitutes regarding our research question by keeping in mind the helpful ideas provided by The following criteria were used to include the selected literature at an early stage .The selected paper must have been published in a conference or quality journal.The study must be published in English medium.The selected article must contain an in-depth evaluation of the challenges encountered by the heads of the schools in COVID situation.The study should highlight the administrative factors significant for school principals.The following criteria were applied for the exclusion of studies .If there is no detailed description for highlighted challenges.Only one comprehensive study should be included in the case of two or more studies having similar findings.If the findings of selected studies do not construct empirical investigations.To measure the quality of selected papers, the guidelines used are recommended by The following checklist was developed to assess the quality of the selected literature:Whether the research method used in study follows the requirements of the research questions?Whether the selected literature describes any aspect of school leadership?Whether the selected literature describes the school administrative strategies and its application in education sector?Are the provided facts relevant to school leadership in education sector?Do the results of the studies relate to the validation of the research questions?Accordingly, the score “1” is administered to a study if it provides the satisfactory answer for the above listed research questions. A score “0.5” is given if the selected article provides answer to the questions of checklist to some extent and if a selected article fails to provide the answer to any checklist question, it is given a score of 0. The detailed list of selected primary studies along with showing their Quality Evaluation (QE) scores is placed at The selected primary studies were more refined by using the standards suggested by Primarily, a total of 138 articles were chosen from the mentioned-above digital libraries by using search strings, and by applying inclusion and exclusion criteria. Finally, a total of 41 primary studies were selected to address the research question of the study. According to Out of the 41 final selected papers, data were extricated. A 4-member team was deliberately formed for the purpose of data extraction. During the process, prospective statements, main themes, and identified administrative challenges encountered by the principals during COVID-19 were noted down and imported into Microsoft Excel sheet. Primarily, 36 administrative challenge statements were highlighted and recorded into another Microsoft Excel sheet. Moreover, after consulting to research experts and team members, 36 challenges were finally merged into 24 basic prospective challenges.p = 0.0013), which showed the signed agreement between the authors and the external reviewers. The code used to perform Kendall’s coefficient of concordance is placed at After the accomplishment of the data extraction procedure, an inter-rater reliability test was administered to perform the elimination of the inter-person biasness. By following the practice of Based on five QE questions, the QE scores for each primary study were analyzed. Accordingly, most of the primary studies achieved QE scores ≥75% after applying the QE criteria. Therefore, the achieved scores denoted that the selected primary studies are satisfactorily important to address the research question of this study. Moreover, given the selection of primary studies, a QE score of 40% as the threshold is used.Primary studies are chosen from the period of 2020 to 2021 . Thus, 3In The primary objective of the study was to identify critical leadership challenges during the COVID-19 pandemic. We employed Systematic Literature Review to place these challenges confronting school principals in order of frequency significance. The complete list of primary selected studies is provided at In order to address the research objective, the identified challenges along with the frequency and percentage are summarized in Ch3  was underlined by 73.17% of the selected primary studies as the highly reported challenge. In countries where COVID-19 is still sweeping and the health system is overwhelmed, it is really hard to say when the safest time is to welcome students back in this troubled context. It concerns many that without student vaccinations, increases in student transmission are likely within schools, possibly contributing to COVID-19 resurgences in the community . Any negSimilarly, Ch16  was reported by 68.29% of the selected primary studies as another daunting challenge. Though it is the 4.0 era, school closures and the shift to distance learning have made the digital divides even more pronounced . InevitaMoreover, Ch14  was indicated as a major challenge for smooth execution of school managerial activities during disruptive times. This pandemic has cut deep into the inequalities in access to education of marginalized students , regardlFurther Ch6 (Ensuring Distributive Leadership) with the percentage of 60.98 was identified as a remarkable challenge for school leadership. Distributed leadership practices are vital in this time of crises . DistribLikewise, Ch7  with the frequency of 58.54% was found as another major difficulty. Mental health-related problems have been accelerated during the COVID-19 outbreaks . The comThe interruption of going to school, constant online teaching, and the pressure to make ends meet, let alone themselves or family members being infected with COVID-19, or the loss of loved ones increasingly deteriorate the mental and psychological health of the teachers . BesidesAlso, Ch23  was observed as the commonly quoted challenge for the principals . Due to their greater reliance on technology and online interactions when working remotely, many schools are likely to fall prey to cybercriminals amid the pandemic . RecentlAdditionally, Ch5  was reported as another significant challenge in the list with a frequency of 53.66%. First and foremost, school leaders have prioritized efforts to ensure learning continuity for students and teachers. Pressures come from the need to introduce a full range of appropriate learning for students with different backgrounds so as not to interrupt their learning. Accordingly, schools are encouraged to utilize a variety of online learning modalities . AdditioWhile the universal awareness is that disruptive COVID-19 times are unprecedented, it is important that we consider some of the pressures school leaders are facing as they continue to go beyond the call of duty to support school-aged children and young people during a global health crisis. Whether there is a dearth of available research on the topic how school principals are responding to this pandemic situation, some emerging insights about school leadership during COVID-19 is available. A few intentions are offered for contemplation, in due course, about empirical propositions.There are many studies regarding leadership and its challenges; however, there was a lack of literature that included the effect of pandemics that would reflect the same situation that the world is facing during COVID-19. Focusing on crises, such as COVID-19, the current study is relevant as no previous research has discussed issues where the entire educational system worldwide is heavily affected with many interruptions. Therefore, this paper brought light to various leadership challenges, and their possibility and criticality.The findings of the study will not only contribute to the education sector to discuss the leadership problems of K-12 school principals in times of turbulence. The study may assist educational institutions in gaining a better understanding of the challenges for smooth running of management in disruptive times of COVID-19. Moreover, the study would provide fruitful results to raise management standards and to overcome the shortcomings of the education sector in this disruptive time. Ultimately, the results of the study will be of great benefit for the principals of public schools, researchers in school management, and leadership as well as education policy makers.However, one of the drawbacks of the present study regarding systematic literature review is that there is much possibility for missing any previous literature. Therefore, the same applied process would provide different results and findings due to the unavailability of all libraries and repositories.The educational process worldwide has been heavily interrupted due to the COVID-19 pandemic. Accordingly, most educational institutions shifted from in-class education toward E-learning and suffered from again-and-again closure and uncertainty of continuity of learning. There is a universal call for significant increase in leadership role, responsibility, and resilience in educational institutions.Educational institutions during COVID-19 face the unique challenges of smoothly maintaining the process of learning while ensuring that it is still beneficial. Therefore, educational leaders must understand what challenges are confronting them toward the smooth running of schools in this crucial time. The present study explored that the most-frequency-significance challenges influencing school activities during the COVID-19 pandemic were related to (1) self-care, wellbeing, and safe school opening; (2) learning continuity and quality of education; (3) ensuring distributive leadership; (4) emotional and mental health; (5) equity gaps; (6) digital divides; and (7) cyber security of online education. These finding should be seriously considered as the role of the principals is central in schools and it cannot be ignored.The study works as a contribution to K-12 school leadership by providing guidance for current and future leaders in crisis based on practical investigation, experiences, and recommendations. The findings of the current study are believed to have profound implications for future research. Critical challenges of leadership are substantial to be considered by school administration, policy makers, and future research. The identification of these leadership challenges helps fill the existing gaps in school leadership knowledge in the context of COVID-19. By addressing critical challenges facing school leaders in times of turbulence, school administration can revisit these results when navigating their own challenges. Policy makers can also leverage these findings to make necessary adjustments to school policy to better prepare current and would be school leaders for future crisis. These findings also upsurge the concern for further quantitative and/or qualitative investigation on school leadership challenges in disruptive times according to different contexts and the degree to which school leaders respond to a crisis. Besides, these leadership challenges are of significance for researchers to develop a crisis-response model for school leadership.The original contributions presented in the study are included in the article/supplementary Material, and further inquiries can be directed to the corresponding author.KP presented the main idea and wrote the first draft of the manuscript. PT and AA contributed to conduct the methodology. SA proofread the manuscript before submission. EN and TX helped in the revision of the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


There is a growing interest regarding the impact of the perioperative period and the application of anesthetic drugs on the recurrence of cancer metastases. Among them, the use of amide-type local anesthetics seems promising since in vitro studies and animal models have shown their potential to inhibit the Intercellular Adhesion Molecule 1 (ICAM-1) expression and Src activity, which are clearly implicated in the process of inflammation and cancer metastases. This review emphasizes the potential of amide-type local anesthetics in this context. Lidocaine is an old drug, which has been acknowledged to be exclusively indicated for the management of pain and cardiac arrhythmias through its ability to block the sodium channel; however, new research has demonstrated that this drug was able to block or interfere with other receptors and systems leading to new clinical development. One of them could be the potential to reduce cancer metastases.Cancer is still one of the major causes of morbidity and mortality worldwide . SurgicaRecently more and more evidence has shown that inflammation and metastases are closely connected . The preMetastases are the most crucial aspect of tumorigenesis because approximately 2/3 of cancer mortality is caused by metastases ,7. This Surgery is a known model to favor the development of cancer: There is a great inflammatory response, and the immune defenses are greatly impaired. Lin et al.  have extThe role of CTCs has been hypothesized to play a major role in the formation of metastases . RecentlThe CTCs are considered to be shed from different locations within tumors; however, this occurrence is accelerated during surgery. Sergeant et al.  have fouEach surgery or trauma will create new body homeostasis, called the surgical-induced stress response ,21. ThisIn humans, NK cells have been the most studied. NK cells were first described by Kiessling et al., 1975 , and it The interaction of different anesthetics on the NK cell activity has been tested. Among the volatiles, halothane has been shown in rats to reduce the cytotoxicity of NK cells . In the A dual effect of lidocaine has been observed. At a very high concentration in vitro, lidocaine has been shown to have a negative effect , whereasThe prerequisites for metastatic dissemination of solid tumors are migration, invasion, and adhesion of cancer cells. The movement mechanism of the cells is migration, while direct extension and penetration of cancer cells into tissues is invasion. In between, the process of adhesion also plays a critical aspect in the formation of metastases. It seems that this process is involved in the great majority of metastases. Amide-type LAs have been shown to interact positively with each of these steps. In a model of endotoxin-induced lung injury in rats, the application of ropivacaine IV was shown to significantly decrease ICAM-1 expression, as well as neutrophil adhesion and the concentration of albumin in bronchoalveolar lavage . PiegeleThere is some evidence in vitro and animal models that LAs in cancer patients undergoing surgery may have the potential to reduce CTCs extravasation during the perioperative period by preserving the endothelial barrier function, reducing the PMNs adhesion, and therefore having the potential to reduce the transmigration of CTCs.LAs may have the potential to reduce/inhibit the occurrence of metastases by targeting different receptors/mechanisms . PiegeleThe interest in lidocaine application in cancer patients has been the subject of many clinical studies in recent years.A retrospective analysis of medical records of a patient who had a mastectomy and axillary dissection for breast cancer was performed by Exadaktylos et al. . Two groIn a study including 2239 patients undergoing pancreatectomy for adenocarcinoma, Zhang et al.  found thAnother retrospective study was performed by Christopherson et al. . PatientPatients undergoing prostate cancer surgery receiving GA alone or GA with peridural anesthesia/analgesia were retrospectively compared. The results demonstrated that the epidural group had a better cancer recurrence-free of 57% compared to the control group.The same type of anesthesia  was used by de Oliveira et al.  to invesSimilar results were found in a retrospective analysis of patients receiving spinal anesthesia for excision of primary malignant melanoma of the lower extremity compared to the control group .However, more recent retrospective studies did not show any benefits of adding a neuraxial block in terms of recurrence-free interval or mortality ,71,72.A recent meta-analysis  confirmeTo summarize, it is well-known that the accuracy of medical records, the absence of randomization, blinding and standardization, and confounding factors are all serious bias, which can directly or indirectly influence the results and therefore do not allow for drawing valid conclusions.Karmakar et al.  undertooThe perioperative period should be considered a crucial time in surgical oncology because chemotherapy will be delayed for a few weeks, opening a window for the occurrence of metastases. The application during this period of amide-type LAs may add a new option in the armentarium for the prevention of metastases.In vitro and animal investigations have demonstrated the positive effect of lidocaine in the context of metastases on the biomolecular levels, including receptors and mechanisms.Lidocaine, via different mechanisms, could inhibit/reduce cancer growth in vitro and in animal models. This provides valuable potential for its further application in cancer therapy and opens new insight for new drug discovery.However, well-documented human studies in terms of dosage concentration and duration of time of application are needed to confirm the real benefit of this technique.


Technology can help to overcome human resource challenges in active trachoma grading and case finding for trachomatous trichiasis.Significant progress has been made to reduce the global burden of trachoma in recent years. Since 2002, the number of people at risk has reduced by 92%, from 1.5 billion to 124 million. The number of people estimated to require surgery to treat trachomatous trichiasis (TT), the late blinding stage of trachoma, has reduced by 76% in the same period: from 7.6 million to 1.8 million.When it comes to training people to grade active trachoma, or find people who need TT surgery (known as TT case finding), however, the global trachoma programme is becoming a victim of its own success. As the prevalence of trachoma declines, it is increasingly difficult to find individuals with active trachoma or TT who can serve as examples during the training of new field graders, or when re-certifying existing graders. This makes training more difficult, expensive and time consuming, and represents a significant challenge when integrating trachoma interventions into routine health services. Additionally, there are situations where the use of human case-finders or trained graders may not be ideal or sustainable, such as in conflict zones  or in remote or hard-to-reach areas.A recent reportMany opportunities and challenges were identified related to the use of photography to support training, supervision, and field grading in the future. These include the development of a library of appropriate images for training purposes, and establishing a consensus grading method for photographic images. Diverse options for photograph grading to replace field grading were explored, as was ensuring the feasibility of these new approaches. Different working groups organised by members of the trachoma community are now working to address these issues through the pursuit of various operational research projects.Researchers at the University of North Carolina at Chapel Hill and RTI International are carrying research into an image recognition algorithm and an associated smartphone app that identifies TT in eyelids using machine learning techniques. The user-friendly app allows users to enter participant information and take a photograph. After the photograph is taken, the algorithm determines whether the eye has TT. At present, this technology is showing positive results and is being pilot tested with Tropical Data support. In the coming months, the algorithm and app will be tested more broadly with a large group of TT case-finders in Senegal.To achieve the global elimination of trachoma as a public health problem, it will be critical to overcome human resource challenges, including grading for active trachoma and case-finding for TT. Technology offers a real opportunity to address the challenges of TT case finding and trachoma grading in a cost-effective way. However, there is currently a lack of standardisation and validated protocols outside of research projects for the use of photographs to train graders, for supervision purposes, and to serve as an adjunct to, or substitute for, field grading. Resolving these challenges will be critical if we are to scale up these new technologies and achieve vision for all.