The spread of data on the web has increased in the last twenty years. One of the reasons is the appearance of social media. The data on social sites describe many real-life events in our daily lives. In the period of the COVID-19 pandemic, a lot of people and media organizations were writing and documenting their health status and the latest news about the coronavirus on social media. Using these tweets (sentiments) about the coronavirus and analyzing them in a computational model can help decision makers in measuring public opinion and yielding remarkable findings. In this research article, we introduce a deep learning sentiment analysis model based on Universal Sentence Encoder. The dataset used in this research was collected from Twitter, and it was classified as positive, neutral, and negative. The sentence embedding model determines the meaning of word sequences instead of individual words. The model divides the dataset into training and testing and depends on the sentence similarity in detecting sentiment class. The obtained accuracy results reached 78.062%, and this result outperforms many traditional ML classifiers based on TF-IDF applied on the same dataset and another model based on the CNN classifier. As a result of its significant impact on people's day-to-day lives around the globe, the emergence of COVID-19 sparked a global wave of anxiety and fear. Governments have long employed lockdowns and social isolation against mental health of the populace. Keeping a track of mental health of individuals throughout a variety of events and topics will be essential for making appropriate decisions.The globe was in terrible condition as a result of the sudden spread of the coronavirus. The COVID-19 epidemic was claiming the lives of people across the planet. This sickness has had profound effects on people in both explicit and tacit ways.Twitter and other social media platforms are considered huge data repositories that may be used to collect data for studying human psychology and behavior so as to get a deeper understanding of psychology and health. Various social media channels have a significant impact on boosting public knowledge about the disease's importance and advocating preventive measures among community members . SentimeResearchers in the field of sentiment analysis highlighted concerns and obstacles of the social media platform in terms of trustworthiness and authenticity , 8. OtheIssues relating to the community individuals or parties from other fields or agencies are welcome to join the community in this section. Two parties were primarily targeted when scanning the issues related to sentiment analysis and infectious diseases and outbreaks, in addition to viruses, epidemics, and pandemics: (1) decision makers and (2) the scientific community. In particularly dangerous circumstances, such as disease outbreaks, decision makers face obstacles such as detecting people's attitudes on a subject and their views towards public health policy decision-making , 10, 11.Contrary to popular belief, it has been discovered that people were using social media to spread fake drugs or incorrect information . BecauseIn this research study, we provided a smart solution that can help in the case of the pandemic to analyze tweets (sentiments) written by people about what they feel with the symptoms of the disease, and using a computational model can assist decision makers in measuring public opinion and yielding remarkable findings. In this research study, a deep learning sentiment analysis model based on Universal Sentence Encoder is applied to a dataset collected from Twitter about coronavirus. The main contribution of this research is that the model is based on the semantic similarity of sentences not on their syntactic structure or word embeddings that constitute the tweet.Along with analyzing coronavirus-related searches using Google Trends, Basiri et al.  proposedZhu et al.  evaluateAs can be seen that the abovementioned works adopted different machine learning and deep learning algorithms based on word embedding, here we propose the semantic similarity model that applies sentence-based embedding using Universal Sentence Encoder for embedding and training tweets and then classifying the new ones.Textual input is encoded into high-dimensional vectors by Universal Sentence Encoder models, which can be used for a variety of NLP applications. It was first mentioned in the article . ModelinThe architecture of the suggested sentiment classification model for detecting the sentiment class using Universal Sentence Encoder is shown in this section. Data collection, document preprocessing, deep learning components, and semantic similarity based on Universal Sentence Encoder are all part of the platform. Each process generates an output that can be sent to the user or moved onto the next process in the sentiment classifier pipeline until it reaches the end. The semantic classification pipeline has five stages, as shown in LocationTweeting timeOriginal tweetSentiment classWe used data from Twitter in this study, as well as hand tagging that had been performed during the COVID-19 lockdown. The dataset contains 10000 tweets that have been cleansed and include themes such as COVID-19, coronavirus, and lockdown. The dataset contains names and usernames; however, they have been given codes to protect their privacy. The other columns are as follows:https://www.kaggle.com.The sentiment class domain is , with 0 denoting negative, 1 denoting neutral, and 2 denoting positive. The dataset is accessible for download and analysis at We used natural language processing (NLP), which is a type of machine learning that aids with tweet processing. Typically, NLP employs several text mining techniques, such as the removal of noise, which entails removing stop and buzz words. Immaterial substances, such as accent marks, mathematical properties, and new-line characters, were also removed to improve the semantic similarity model performance evaluations. By removing these pieces, the size of the test universe of possible capabilities is reduced, and the degree of execution is improved.To make sure that the classification model on the dataset cannot overfit, the dataset was divided into two parts: training and testing. Trained tweets aided in the identification of patterns in data, as well as the reduction of error rates, and the testing of the dataset was used to measure model performance. 87.5 percent of tweets were used for training reasons, while 12.5 percent were used for testing purposes. To improve accuracy, we ran our deep learning neural network on several epochs. Hyperparameter “number of epochs” determines how many times the learning algorithm will iteratively examine the entire training dataset. Once per epoch, the internal model parameters were updated based on data from each sample in the training dataset. We ran our experiment on the epochs from 1 to 100. The accuracy of epochs 10, 20, 30, 40, 50, and 60 is shown in We found that after 60 epochs, the improvement in the accuracy was very little, and the best result of accuracy achieved by the model was 78.0624%.More comparisons with different machine learning classifiers were applied to the same dataset against our semantic similarity proposed model shown in From Tables Another experiment was used to compare the result of the proposed model with a deep learning classifier based on the CNN, and the TF-IDF was the text representation method used. The basic architecture of the CNN is listed in It can be noticed that the best accuracy obtained by the CNN classifier appears only with the first 10 epochs, while the accuracy decreases by increasing the number of epochs, and this is unlike a visible increase in accuracy with every increase in the number of epochs with the proposed model. It can be noticed that the best accuracy resulting from the proposed semantic similarity classifier was 78.06% at epoch 60, while the best accuracy of the model based on CNN was 74.27% at epoch 3.In this research study, a new sentiment classification model was proposed. This model was based on the semantic similarity of tweets. Universal Sentence Encoder was used to encode the tweet's sentences into embedding vectors, and then, at the testing phase, it was used to classify new tweets based on cosine similarity. The classification accuracy reached 78.06% in the collected data, and this outperformed many ML classifiers. Also, the proposed model was compared against a CNN classifier model based on TF-IDF, and the results obtained proved that the proposed model outperformed the CNN classifier. In future work, we recommend increasing the number of tweets for training and testing, and this may enhance the obtained accuracy as the model learning rate increases with the increase in the number of training data.


Anxiety caused by the lack of social skills is the biggest problem faced by children with ASD. Playing can improve children’s social skills and relieve anxiety. This study aimed to explore the influence of urban built environments on ASD children’s play behavior. The participants in this study were 57 parents of children with ASD. An anonymous questionnaire was used to collect and analyze data. At the same time, retrospective semi-structured interviews with 31 parents of ASD children were performed to validate the data analysis results. The results showed that lower residential building density, higher residential greening and higher destination accessibility have positive effects on ASD children’s play behavior. Excellent transportation facilities and high NDVI vegetation coverage have positive effects on the play behavior of children with ASD. More recreational facilities and recreational playability have positive impacts on the play behavior of children with ASD. The population density and number of children in the destination, as well as public facilities, influence the play behavior of children with ASD. The research results can promote the integration of this group into urban life and further promote social equity. At the same time, with the social needs of autistic children as an intermediary, it is expected to further explore new directions for sustainable urban development. Finally, combined with the research results, parents of ASD children are given proposals for how to increase the likelihood of children’s play behavior by choosing appropriate urban built environments. According to the latest autism spectrum disorder statistics released by the US Centers for Disease Control and Prevention in 2020, the incidence of autistic spectrum disorder children (hereinafter referred to as ASD children) in the United States reached as high as 1:54, an increase of nearly 10% compared with the results of the 2018 statistics (1:59) . MontessIn past research, social impairments in ASD children were thought to be directly related to their personal deficits. However, a growing body of research has found that environmental factors influence their interactions with the social environment . TherefoThe urban built environment refers to manmade environments built to serve human activities, including large-scale urban environments, excluding the environment formed by nature. The earliest public transport-oriented development model proposed the 3D theory of urban built environment, where D refers to density, diversity and design . SubsequCities are designed for the general public. This study investigated the impact of the urban built environment on the play behavior of children with ASD. The research results can promote the integration of this group into urban life and further promote social equity. At the same time, with the social needs of autistic children as an intermediary, it is expected to further explore new directions for sustainable urban development. In the past 20 years, the research on the relationship between international children and youth activities and the built environment has focused on the impact of urban community buildings and planning environment on youth physical activity. Therefore, this study is expected to enrich the related theories on the built environment and ASD children’s play behavior, provide a new vision for building a child-friendly city and create a healthier and more inclusive urban environment for other socially disadvantaged groups. Two experimental methods were used in the study, anonymous questionnaires and retrospective semi-structured interview. The reason for using two data collection methods for the study is, on the one hand, to objectively quantify the play behavior of children with ASD. On the other hand, because of the particularity of ASD children, their play behavior is uncertain. Two data collection methods can maximize the accuracy and reliability of the research results.The sampling site of this study was the special education school in Jinjiang City, Fujian Province . The schMost children with ASD have language barriers, making it difficult for them to understand and respond to nonverbal behaviors . TherefoAccording to random interviews with parents of ASD children in the early stage, due to the particularity of the children themselves, they are generally accompanied by guardians, the main way of travel is walking, and most of the travel destinations are urban green spaces that can be reached on foot near the residence. In order to exclude subjective factors as much as possible, this study used WeChat mini program with positioning function instead of traditional questionnaire tools to collect urban built environment data. Parents were required to log on the WeChat mini-program and keep it running while going out. Then, after arriving at the destination, observe the play behavior of the ASD children and complete the questionnaire. At the same time, the mini program recorded coordinates every 5 s. In the server background, the coordinates of each questionnaire were imported into GIS (geographic information system) to generate travel routes. According to the 10 min walking distance of children in the existing literature, the radius of the travel path was determined to be 500 m. Taking this as a reference, the quantitative information on the path area was extracted and sorted, and the original data were obtained for subsequent analysis. The detailed steps are shown in (1)Solves the problem that the device needs to be charged regularly for battery life. In the previous study, the staff had to charge the equipment and export the data regularly every day.(2)Completely removes the interference to children of the device itself. The mini program is operated by parents, and they fill in questionnaires; the whole process does not have any on-device impact on children with autism.(3)Avoids unreasonable data. The mini program guides the user, accurately prompting how to operate in each step; if the operation is not followed, the next step cannot be entered.(4)The data export results are clearer. The completion of the questionnaire can be monitored in real time through the backend of the mini program, and the exported data items are clear and easy to understand.WeChat is currently the social software with the largest number of users in China, with a total of 1.26 billion users so far. The WeChat mini program is an application that can be used without downloading and installing. Compared with the previous use of GPS positioning equipment for children to obtain positioning information, the WeChat mini program has the following advantages:The urban built environment data involved in this study are: residential building density, residential greening, destination accessibility, transportation service facilities, NDVI vegetation coverage, population density, number of children in the destination, public facilities, number of recreational facilities and recreational playability. The data sources for the quantitative indicators of the urban built environment are as follows: The population density data come from the 2020 Jinjiang Census. The data on road network density, number of intersections, destination accessibility, and public transportation accessibility are from 2020 Quanzhou Road Network Data. The data on residential land, public management and public service land, commercial service land and transfer land are from the 2015–2035 Jinjiang City Land and Spatial Planning. POI data come from Gaode map POI data. The greening rate data come from the 2020 Quanzhou NDVI Index. Residential building density examines whether the vision of ASD children’s residential communities is sufficient. Residential greening examines the greening degree of ASD children’s residential communities. Destination accessibility examines how easy it is for ASD children to travel from home to their destination and whether it will be a burden on the body. Transportation service facilities examines the number of sidewalks on the travel route, the number of traffic lights, and the completeness of facilities such as separate facilities for people and vehicles. NDVI vegetation coverage examines the abundance of plant species and quantities on the travel path. Population density looks at the number of people in the destination. Number of children in the destination examines the number of children at the destination of the same age as the ASD children. Public facilities examines the number and availability of public facilities in the destination, such as public toilets. Number of recreational facilities and recreational playability examine whether children with ASD need to wait in line for their favorite facilities and whether the facilities need maintenance.The anonymous questionnaire consisted of two parts: sociodemographic background information on children with ASD and children’s play behavior.The sociodemographic background information on the children with ASD includes the local household registration, the gender of the child, the age of the child, the degree of autism, the number of children in the family, the education level of the guardian, the guardian’s employment and the monthly household income. Information on play behavior of children with ASD was derived from parental reports. One of the reasons why self-reporting is not used for children with ASD is that there may be language barriers that affect the accuracy of the reported results . On the The retrospective semi-structured interview is an in-depth exploratory research method that collects original data from interviewees after the event. During the interview process, the interviewer can appropriately guide the interviewee’s conversation toward the research topic and obtain as rich data as possible.The interviewees were selected from the parents who participated in this investigation at the special education school in Jinjiang City. Parents were invited to assist in this research by principals and teachers, and the interview was conducted by telephone. At the same time, the consent of the interviewee was obtained for recording, and the voice responses were converted into text for the record to prevent any omission of key points.(1)The urban built environment in the interview outlineThis part required parents to evaluate their satisfaction with the urban built environment, and the answers were strongly disagree, disagree, neutral, agree, strongly agree.(2)Play behavior of children with ASDTo validate the data analysis results in the previous subsection, this section asked parents to answer whether the urban built environment promoted, inhibited or had no effect on the play behavior of children with ASD. Considering the parent’s time to answer and comprehension, this part replaces the strongly disagree, disagree, neutral, agree, strongly agree in the questionnaire with facilitation, inhibition or no influence. The WeChat mini program was used to collect the questionnaire information, and at the end, the data from the fill-in person were extracted and sorted in the server background, and the original data were maintained for subsequent analysis.The data from the questionnaire were analyzed in stata16SE with stepwise regression. Stepwise regression analysis introduces variables into the model one by one. After each explanatory variable is introduced, it must be tested, and the selected explanatory variables are tested one by one. When the originally introduced explanatory variables become no longer appropriate due to the introduction of later explanatory variables, if significant, delete it. This is a method that ensures that only significant variables are included in the regression equation each time a new variable is introduced. Stepwise regression analysis is a multiple regression analysis method for studying the interdependent relationships between multiple variables, while stepwise regression analysis is often used to establish an optimal or suitable regression model, so as to study the dependencies between variables more deeply.The WeChat mini program was officially launched on 15 May 2021. It took nearly 7 months, and 57 valid questionnaires were collected.(1)The sociodemographic background characteristics of ASD childrenAmong the families of ASD children who participated in the survey, 51 children had a registered permanent residence in the city, accounting for 89% of the total. Among them, 47 children were boys, accounting for 82% of the total. There were 41 children aged 6–10, accounting for 72% of the total, 12 children aged 11–15, accounting for 21% of the total, and 4 children aged 0–5. There were no children aged 16–20. In terms of the degree of autism after hospital diagnosis, 36 children, or 63% of the total, were mild to moderate; 11 children were mild to asymptomatic and 10 children were severe. There were 2 children in 28 families, accounting for 49% of the total, 21 families were only-child families and 8 families had three children. There was no family with more than 3 children in this survey. In terms of education level, 22 families had guardians with college degrees, accounting for 38% of the total, 19 families had guardians with junior high school education, 9 guardians with high school education and 8 guardians with primary school education and below; only one family had a guardian with a master’s degree or above. Among them, 30 guardians were employed. In terms of income level, 21 families had a monthly income of RMB 4000 to 6000, accounting for 37% of the total; 12 families had a monthly income of RMB 6001 to RMB 9000; 10 families had a monthly income of below RMB 4000; 11 had a monthly income of more than RMB 12,000 and 3 had a monthly income of RMB 9000–12,000 . (2)The impact of sociodemographic backgroundPlay behavior is divided into five parts for description, and the five parts are assigned points and discussed together. The effect of sociodemographic background on the play behavior of children with ASD was investigated by variance analysis.p-value is 0.0680, indicating that at the significance level of 0.1, there is a significant difference in the play behavior of ASD children whether the guardian employment. The p-value is 0.064, indicating that at a significance level of 0.1, there is a significant difference in the avoidance behavior of ASD children depending on whether the guardian is employed. The p-value is 0.035, indicating that at the significance level of 0.05, there is a significant difference between the gender of the child in the concealment behavior of ASD children. The p-value is 0.087, indicating that at a significance level of 0.1, there is a significant difference in the age of the child in the concealment behavior of ASD children. The p-value is 0.074, indicating that at a significance level of 0.1, there is a significant difference between the monthly household income and the concealment behavior of ASD children. The results showed that only whether the primary guardian of the child was employed, the sex of the child, the age of the child, and the monthly household income had significant differences in the play behavior of children with ASD . The p-vThere were no significant differences in the level of autism, the number of children in the family, and the education level of the children’s primary guardians on the play behavior of children with ASD.(3)The impact of the urban built environmentThe questionnaire data were processed by stepwise regression analysis. The results showed that there was no significant relationship between the urban built environment and the observation behavior of children with ASD.The number of recreational facilities had a significant positive correlation with the play behavior of children with ASD.There was a significant positive correlation between NDVI vegetation coverage and public facilities on the avoidance behavior of children with ASD.The number of children in the destination and excellent transportation service facilities have significant positive correlations with the concealment behavior of children with ASD.The residential greening, public facilities and population density have significant negative correlations with the concealment behavior of children with ASD .A total of 31 parents of children with ASD participated in the retrospective semi-structured interview. The interview results are shown in With higher residential building density, children’s play behavior is promoted.With higher residential greening, children’s avoidance behavior and concealment behavior are inhibited.With higher destination accessibility, children’s play behavior is promoted while concealment behavior is inhibited.With excellent transportation service facilities, children’s observation behavior is promoted, and avoidance and concealed behavior are inhibited.With higher NDVI vegetation coverage, children’s play behavior is promoted, while the avoidance behavior is inhibited.With higher population density, children’s avoidance behavior and concealment behavior are promoted. The more children in the destination, the more children’s avoidance behavior and concealment behavior are promoted. With excellent public facilities, children’s avoidance behavior and concealment behavior are inhibited.A larger number of recreational facilities and better playability, children’s observation behavior is promoted, play behavior is promoted and avoidance behavior is inhibited.There are significant differences in the play behavior and avoidance behavior of ASD children whether the guardian is in office or not. Parents are their children’s best teachers, and the amount of time spent with them helps develop correct values and worldviews. A growing body of research shows that parental involvement or leadership in individualized therapy has a significant positive impact on the recovery of children with ASD. When a child with ASD behaves inappropriately, the guardian will promptly dissuade them and report that this is a wrong behavior. Intervention therapy promotes the generalization and maintenance effect of ASD children’s behavior through the repeated correction of stereotypical behavior. For some children with severe symptoms, the school will require guardians to accompany the children in class to stabilize their mood and behavior.Gender and age have significant differences in the concealment behavior of children with ASD. In general, there is little difference in behavior between boys and girls with autism before the age of 5, but with age, boys showed more frequent externalizing behavior problems, such as aggression and hyperactivity, while girls showed greater internalization difficulties, such as more frequent nonverbal communication and prosocial behavior. The gender bias in the field of autism research has also resulted in relatively few studies of girls with ASD in the relevant academic literature, so the behavioral phenotype and symptoms of girls with autism remain widely unknown .There is a significant difference between monthly household income and the concealment behavior of children with ASD. Parental income is an important predictor of household quality of life: children with ASD have improved quality of life with higher income. The cost of autism diagnosis and psychological counseling is high, and intervention therapy is also a considerable expense for the average family. Family income during childhood will cause individual differences in children’s subjective well-being, which will also affect children’s sense of experience and satisfaction with and cognition of things. In turn, cognition of things may cause children with ASD to be more sensitive than ordinary children and to display concealment behaviors in games .There were many differences between the data analysis results and the retrospective semi-structured interview results. Therefore, we combined the results of the two experiments to draw the following conclusions:The residential building density and residential greening have influence on the play behavior of children with ASD. Since the home is the place where they spend the most time, this means that both the physical and cultural environment of the residential area have long-term impacts on children with ASD. In addition to bringing visual oppression, higher building density also generates more occupants. Although there are some cases of insensitivity to crowd density, this can cause psychological stress for most children with ASD . A higheDestination accessibility has influence on the play behavior of children with ASD. Higher accessibility means reasonable distances and travel time without creating a physical burden and losing interest in games. Areas with high accessibility generally have urban built environments that attract people to walk, such as rich business varieties and excellent facilities. Children with ASD themselves have limited interests, and if the urban built environment remains unchanged during travel, it will easily give them a dull and boring psychological feeling. If this emotion is not relieved after reaching the destination, it will affect their play behavior . Transportation service facilities influence the play behavior of children with ASD. Reasonable sidewalk settings can not only effectively control the speed of vehicles and improve the safety perception of children with ASD on the environment but also regulate their stereotyped behavior and improve the safety travel. The people–vehicle isolation facility composed of green belts can visually weaken the edge of the road and play a soothing role for children with ASD. Less on-street parking can make the street look wider, and the expanded field of view can help ease anxiety .NDVI vegetation coverage has influence on the play behavior of children with ASD. Being in a green environment provides more opportunities for children to relax and unwind. Compared with ordinary children, children with ASD are more able to obtain this benefit from green plants. Green plants can increase activity in children with ASD, which in turn increases the possibility of play. Greenery can also provide a shelter when children with ASD are socially frustrated .The population density of the destination and the number of children at the destination have influence on the play behavior of children with ASD. Under normal circumstances, children with ASD will have anxiety in places with high population density, which may easily lead to the occurrence of avoidance and concealment behaviors. However, there is also a case where the influencing behavior is not related to the population density of the destination but to the number of children at the destination . This isPublic facilities have influence on the play behavior of children with ASD. For example, the setting of park benches was originally used for parents to rest, but different functional blocks are divided in space planning . The uncThe number and playability of recreational facilities have influence on the play behavior of children with ASD. The main purpose of children is to play, so the variety of recreational facilities and a certain number of recreational facilities of the same kind will have an important impact on the games of children with ASD. The number of recreational facilities determines the waiting time, and the playability of recreational facilities determines whether children with ASD are interested . HoweverThe results of data analysis showed that the social context made significant differences in the children’s play behavior. Although the subject of this study is the impact of the urban built environment on play behaviors in children with ASD, social context also plays a role that cannot be underestimated. For example, the level of household income may affect the location of the residence. Therefore, this part discusses the influence of family background on the play behavior of ASD children to supplement the research conclusions and enrich the conclusions.At present, the research on the urban built environment and ASD children’s play behavior is almost blank. It may be that there are so many uncertainties in children with ASD that research is difficult to conduct or that it is not easy to obtain research samples and most of the related studies are case studies. This study constructs the relationship between the play behavior of children with ASD and the urban built environment, explores the influencing factors of the urban built environment on the play behavior of children with ASD and achieves certain results.We found that there were significant differences in the play behavior and avoidance behavior of ASD children depending on whether the guardian was employed. Gender and age had significant differences in the concealment behavior of children with ASD. There was significant association between the monthly household income and the concealment behavior of children with ASD. In addition, lower residential building density, higher residential greening and higher destination accessibility had positive effects on ASD children’s play behavior. Excellent transportation service facilities and higher NDVI vegetation coverage have positive effects on the play behavior of children with ASD. More recreational facilities and recreational playability have positive impacts on the game behavior of children with ASD. The population density and number of children in the destination, as well as public facilities, may influence the play behavior of children with ASD.(1)When choosing a place to live, in addition to the building density of the residential area, the degree of greening should also be considered because low building density and high greening can not only promote the physical and mental health of children with ASD, but also help their play behavior.(2)In the choice of travel path, a road with more sidewalks, more traffic lights and higher vehicle speed limit should be selected as much as possible. At the same time, effective isolation facilities for people and vehicles are also very important. Parents should try to choose a road close to nature, which will play a positive role in promoting the play behavior of children with ASD after arriving at the destination.(3)In the choice of destination, green space with a larger number of recreational facilities should be preferred. The crowd at the destination is also important, and children-oriented parks should be considered first. Secondly, the sense of security is also an important reference for children with ASD. The monitoring functions of the park itself, such as patrolling personnel, lighting equipment and even monitoring from surrounding crowds are also important. Whether there are noise, odor and excellent public facilities will also have positive effects on the play behavior of children with ASD. The type and quantity of recreational facilities is also an important reference. There are more recreational facilities of the same type, which can reduce waiting time. The rich variety of recreational facilities can provide more choices. Some recreational facilities that require collaboration can promote the play behavior of children with ASD.Therefore, how to make ASD children benefit from games as much as possible in the limited time outside, such as relieving anxiety and improving social skills, has become an important issue for parents to consider. In view of this, based on the comprehensive consideration of sociodemographic background and the impact of urban built environment on ASD children’s play behavior, we make the following recommendations: However, due to the particularity of the research subjects, the sample size of the two experiments gradually decreased. This is partly due to conceptual issues that parents do not want their children to be used as research samples. On the other hand, some users have compatibility problems with WeChat mini programs, resulting in a small sample size. At the same time, due to the mobile phone network, the positioning information cannot be updated, resulting in missing samples.At this stage, it can only be concluded that the urban built environment has an impact on the play behavior of children with ASD. In future research, other methods and tools will be tried to further explore the impact mechanism. It is hoped that the results of this research can enrich the content of ASD children’s play behavior in related fields and provide a new perspective for planning and building a child-friendly city. At the same time, it also pays attention to social disadvantaged groups, using children with ASD as a medium, pays attention to social justice and explores the new direction of urban sustainable development.


The COVID-19 pandemic has impacted every aspect of our lives. The economic effects include the adverse consequences for economic growth, international trade, and foreign direct investment. This paper presents stylised facts about the fall and rebound of FDI inflows as a result of the pandemic. The effects of COVID-19 are considered from three angles: macroeconomic shocks to the economy, theories of foreign direct investment, and studies of the economic effects of disasters and crises. The change of heart away from globalisation and deindustrialisation may discourage FDI flows, which have already been undermined by other factors such as the digitisation of the economy and the emergence of Industry 4.0. The coronavirus disease 2019 (COVID-19) pandemic has impacted the world in ways that have not been experienced in generations, even though the pandemic is one of the recurring crises and disasters. It is unquestionably one of the most significant global events in recent history, affecting every aspect of daily life. In October 2020, a joint statement by four international organisations  described the economic and social disruption caused by the pandemic as “devastating” . The panCOVID-19 is not only a public health crisis, as it has also severely affected the global economy and financial markets. Among the consequences of the disease mitigation measures implemented by countries around the globe are significant reductions in incomes, higher unemployment rates, and disruptions in the transportation, service, and manufacturing industries. Financial markets worldwide have been affected by the pandemic. Initially, stock markets declined sharply in response to the pandemic, but recovered subsequently in a spectacular manner, buoyed by expansionary monetary policy and later on by the advent of vaccination . The reaOn the international scene, the pandemic has hit trade and capital flows. In particular, foreign direct investment (FDI) flows have fallen sharply and disproportionately to the decline in domestic economic activity and trade flows. This is the issue under consideration in this paper where we examine the facts and figures and make an attempt to provide some explanations for the sharp decline in FDI inflows in 2020. The explanations are based on the macroeconomic consequences of the pandemic, theories of FDI, and on the prevailing understanding of the economic effects of crises and disasters. We start with some background notes on the theory and empirics of FDI.Balance of Payments Manual defines FDI as “an investment that is made to acquire a lasting interest in an enterprise operating in an economy other than that of the investor, the investor’s purpose being to have an effective voice in the management of the enterprise”. The 1999 World Investment Report published by the United Nations Conference on Trade and Development [Foreign direct investment (FDI) is the process whereby the residents of one country (the source country) acquire ownership of foreign assets for the purpose of controlling the production, distribution, and other activities of a firm in another country (the host country). The International Monetary Fund’s elopment  defines Foreign direct investment FDI has assumed increasing importance over time, becoming a prime concern for policy-makers and a trendy debateable topic for economists. Iqbal et al.  suggest Chakrabarti  attributThe literature on FDI is huge and still growing. In what follows, a brief mention of some of the contributions to this literature is presented. A notable issue is corruption as a determinant of FDI inflows. This issue is examined by Hasan et al.  who arguThe objective of this paper is to examine the effect of the COVID-19 pandemic on FDI inflows. As at the middle of 2022, the pandemic is still going on and data availability is limited, which precludes the possibility of presenting a full-fledged and formal statistical analysis. As a result, this paper is based on descriptive analysis of the stylised facts with reference to economic theory.The starting point is to present the stylised facts pertaining to the behaviour of FDI inflows, which is done in the following section. The stylised facts are based on the data reported by the Organisation for Economic development and Co-operation and Development (OECD). Even though this paper is descriptive, dome forecasts will be presented for the rebound in FDI inflows based on four different scenarios. Once the stylised facts have been presented, the effects of COVID-19 are considered from three angles: macroeconomic shocks to the economy, theories of foreign direct investment, and studies of the economic effects of disasters and crises.Figure According to UNCTAD , FDI recIn Fig. The UNCTAD  suggestsAccording to UNCTAD , the 202Figure In Fig. The descriptive analysis presented in this paper shows that if the rebound in FDI inflows witnessed in the first half of 2020 had continued, this would have taken FDI inflows to a higher level than in 2018. However, it is unlikely that FDI inflows would have continued to grow at the same rate for the whole year, particularly with the uncertainty created by the emergence of the Omicron variant of the Coronavirus. This is why four scenarios are presented for the rebound of FDI inflows, such that the most optimistic scenario (scenario 1) is that growth in the second half would have continued at the same pace as that of the preceding half. In the other three scenarios, the second half growth would have been a fraction of growth in the first half.The analysis shows that FDI inflows do not exhibit any secular trend, but rather they move in cycles (this has been the case at least since 2005). Two troughs occurred in 2009 and 2020 as a result of the global financial crisis and the COVID crisis, respectively. The analysis indicates that the change in trend started well before the advent of the pandemic, but the pandemic augmented the bearish outlook for FDI inflows. The change in trend can be attributed to digitalisation and the emergence of Industry 4.0. Furthermore, the fragmentation of international trade and investment policy making, ha also appeared as a contributory factor.The analysis reveals that the outbreak of COVID-19 caused a slowdown of the capital expenditures of MNCs, forcing them to close some production locations or to operate at lower capacity. Apart from the primary effect of delayed capital expenditures, the pandemic exerted an indirect effect that worked through lower profits in foreign affiliates, leading to shrinking reinvested earnings.The analysis of the effect of the pandemic as postulated by the theories of FDI reveals that some theories are more relevant and provide better explanations than others. Some of the theories turn out to be totally irrelevant. The relevant theories, which can be used to explain the effect of the pandemic on FDI inflows, include the differential rates of return hypothesis, the portfolio diversification hypothesis, and the market size hypothesis. In relation to market size, the analysis does not reveal one-to-one correspondence between changes in GDP and changes in the ratio of FDI to GDP, but a positive relation can be seen clearly. The available data shows that in 2020, developed countries suffered a 4.8% decline in the size of their economies and lost a 0.8 percentage point of FDI relative to GDP.The results also confirm the relevance of the internal financing hypothesis. Based on available data, the capital expenditures of many MNCs slowed down while most of the top 100 MNCs reported lower profits, which translated into lower reinvested earnings. Significant cross-regional variation can be observed in earnings revision and the share of reinvested earnings in FDI.In a classic recession, aggregate demand falls short of aggregate supply (a situation of deficient demand), which prompts policy-makers to fill the gap in the supply–demand balance, typically via fiscal expansion. The COVID recession, however, is more complicated because it involves both supply and demand shocks. Hence, the macroeconomic effects of COVID-19 can be examined by distinguishing between the supply-side and demand-side effects of the pandemic. A supply shock is anything that reduces the economy’s capacity to produce goods and services at given prices. Lockdown measures preventing workers from going to work represent a supply shock, and so do absenteeism and interruption to international trade. A demand shock, on the other hand, reduces the ability or willingness of consumers to purchase goods and services at given prices. For example, a demand shock  occurs when people avoid restaurants for fear of being infected. The financial effects of COVID-19 include the effects on corporate debt, stock and commodity markets, and the financial sector in general. The effects can also be seen in terms of disruptions to the circular flow of income, which depicts flows of money, goods, and services between various sectors of the economy . With rNaturally, the effect of COVID-19 is uneven, as negative demand shocks are concentrated in the economies most severely hit by the pandemic. Effects caused by production stoppages and supply chain disruptions were felt particularly in economies that are closely integrated in the global supply chains centred around China, Korea, and Japan, as well as South-East Asian economies. One would expect the effect on FDI inflows to have a greater impact in those countries that have been forced to take the most drastic measures to contain the spread of the virus.The outbreak of COVID-19 caused a slowdown of the capital expenditures of MNCs and their foreign affiliates. Some production locations were closed or operated at lower capacity, implying that MNCs temporarily halted fresh investment in physical assets and forced them to delay expansion. The COVID-caused macroeconomic shocks were consequential for three kinds of FDI: market-seeking, efficiency-seeking, and resource-seeking.Nawo and Njangang  argue thThe differential rates of return hypothesis postulate that capital tends to flow from countries with low rates of return to countries with high rates of return in a process that eventually leads to the equality of ex ante real rates of return. This means that a country experiencing a lower rate of return caused by the pandemic  would attract less FDI inflows. The portfolio diversification hypothesis is similar to the differential rates of return hypothesis, except that it considers both return and risk. When the assumption of risk neutrality is relaxed, risk becomes another variable upon which the FDI decision is made. If risk is associated with the stringency of the restrictions imposed to combat the disease, one would expect a bigger decline in FDI in countries producing less favourable risk-return combinations. Nawo and Njangang  considerAnother relevant theory is the market size hypothesis, which states that the volume of FDI in a host country depends on its market size, which is measured by the sales of a multinational corporation (MNC) in that country or by its GDP . As soon as the size of the market of a particular country has grown to a level warranting the exploitation of economies of scale, the underlying country becomes a potential target for FDI inflows. The relationship between FDI and output can be derived from neoclassical models of domestic investment. The rationale for the hypothesis that firms invest more in response to growth in sales is based on neoclassical domestic investment theories. In Fig. The internal financing hypothesis is also relevant where internal financing refers to the utilisation of the profit generated by a subsidiary to finance the expansion of FDI by an MNC in the same country where the subsidiary operates. This hypothesis postulates that MNCs commit a modest amount of their resources to initial direct investment, while subsequent expansions are financed by re-investing the profits generated from operations in the host country. The hypothesis, therefore, implies the existence of a positive relation between internal cash flows and investment outlays, which is plausible because internal financing is cheaper than external financing.If we look at the facts and figures, we can see how relevant this hypothesis is. The UNCTAD  reported6Last, but not least, we have a hypothesis linking FDI inflows to political risk and country risk where the latter encompasses the former, as it takes into consideration political, economic, and other factors, such as natural disasters. What is under consideration here is the possibility of adverse economic or political decisions, including changes in the “rules of the game”, such as the possibility of raising the level of taxes or imposing restrictions on profit repatriation. Under COVID-19, there is a higher probability of changing the rules of the game in countries hardest hit by the pandemic .Literature is available on the effect of natural disasters on FDI. Few studies have been conducted on the specific issue of the COVID crisis (disaster) on FDI. Anuchitworawong and Thampanishvong  explore The effect of health-related disasters on FDI has been considered by several authors. Asiedu et al.  present The effect of the COVID pandemic on FDI flows has been examined by some economists. Hayakawa and Mukunoki  produce Kalotay and Sass  argue thIn past crises, FDI was typically found to be more stable and resilient than other financial flows (particularly portfolio investment) due to its link with productive capacities, and the inherent fixed and sunk costs. This is to be expected, since it is easier and quicker to liquidate a stock portfolio than to unwind a physical business or close down a factory. The UNCTAD  notes thA consensus view, on which crisis has had the biggest and the most lasting impact on FDI, does not exist. In general, the available evidence shows that the global financial crisis, by its financial nature, was the deepest and the longest crisis so far  seem to fall less than other forms of international flows as they represent an essential component of corporate restructuring and because of “fire sales”.The UNCTAD  makes fuThe literature produces mixed results on some issues. For example, Moon et al.  believe Every crisis has an effect on public policy or gives rise to suggestions of policy changes. For example, Thompson and Poon  emphasisThe pandemic is likely to force a rethinking of the benefits and costs of globalisation for at least two reasons. The first is that the collapse of supply chains may force companies to look for domestic suppliers to avoid interruption. The second pertains to the importance of the domestic production of medical goods, which has been recognised following the scramble for personal protection equipment and the price gouging events of the early stages of the pandemic. This is why Gray  believesLikewise, Darius  thinks tThe same goes for deindustrialisation, which some economists and observers believe to be a natural outcome of progress as an advanced economy tends to move away from manufacturing industry towards services. For example, an eminent economist, Jagdish Bhagwati, thinks that those who argue for boosting manufacturing output suffer from “manufacturing fetishism”, suggesting that the service industry is as good as manufacturing in generating jobs and boosting exports . This clAt this stage, it seems appropriate to ask what we have learned about the implications of the pandemic. Like any crisis, the pandemic represents both a challenge and an opportunity: a challenge because it has caused immense suffering, and an opportunity because it gives us a chance to reflect on what should be done to alleviate suffering when the next crisis hits. The pandemic has had a negative impact on FDI flows but it has also provided an opportunity to reflect on everything, including FDI.


Despite the fact that sex estimation methods from crania are very popular in forensic anthropology, few validation studies have verified their accuracy and reliability in different populations. Different from craniometrics, for which validation studies have remarkably increased lately, the methods based on cranial morphology still need to be thoroughly investigated, even if a large consensus exists on the effects of population variability on sexual cranial dimorphism. When dealing with forensic contexts, appropriately-validated methods should be applied for building accurate biological profiles. Since the possible sexual dimorphism variation of cranial morphological traits needs to be evaluated properly in various populations, in this study, we analyzed the accuracy of existing regression models for predicting sex from cranial morphological traits in an Italian contemporary/modern population. In addition, we propose new logistic regression models that are more accurate and specific for our sample. The results also update the reference standards for populations of this geographical area and provide an additional important warning on sexual dimorphism to anthropologists working in forensic contexts.Although not without subjectivity, the cranial trait scoring method is an easy visual method routinely used by forensic anthropologists in sex estimation. The revision presented by Walker in 2008 has introduced predictive models with good accuracies in the original populations. However, such models may lead to unsatisfactory performances when applied to populations that are different from the original. Therefore, this study aimed to test the sex predictive equations reported by Walker on a contemporary Italian population  in order to evaluate the reliability of the method and to identify potential sexual dimorphic differences between American and Italian individuals. In order to provide new reference data to be used by forensic experts dealing with human remains of modern/contemporary individuals from this geographical area, we designed logistic regression models specific to our population, whose accuracy was evaluated on a validation sample from the same population. In particular, we fitted logistic regression models for all possible combinations of the five cranial morphological traits . This approach provided a comprehensive set of population-specific equations that can be used in forensic contexts where crania might be retrieved with severe taphonomic damages, thus limiting the application of the method only to a few morphological features. The results proved once again that the effects of secular changes and biogeographic ancestry on sexual dimorphism of cranial morphological traits are remarkable, as highlighted by the low accuracy (from 56% to 78%) of the six Walker’s equations when applied to our female sample. Among our fitted models, the one including the glabella and mastoid process was the most accurate since these features are more sexually dimorphic in our population. Finally, our models proved to have high predictive performances in both training and validation samples, with accuracy percentages up to 91.7% for Italian females, which represents a significant success in minimizing the potential misclassifications in real forensic scenarios. One of the critical aspects concerning the application of sex diagnostic methods to human remains is the inter-population variation in sexual dimorphism . Indeed,Although the visual methods based on the morphological sex dimorphism of specific skeletal traits were among the first applied for assessing sex into the field of anthropology ,12,13,14Kruger et al.  tested tGiven the inter-population variation, the application of the equations proposed by Walker may lead to inaccurate results on the remains of geographical groups that are different from the tested, thus providing low rates of correct sex diagnosis. Hence, an examination to verify this aspect is necessary for other diverse osteological collections. While this critical aspect has already been investigated in some populations ,22,23,25Thus, the present study aims to: (i) test the repeatability of the assessment of morphological traits on crania of modern Italians from the CAL; (ii) test the accuracy of Walker’s equations on this population ; and (iii) create ad hoc discriminative equations for the Italian population through logistic regression analysis with the intent to identify which morphological traits provide the most accurate prediction for assessing the sex on the crania of individuals from this geographical area.A sample of 177 crania was selected from known individuals of CAL , housed The five points-scale scoring system described by Walker  and repoThe reproducibility  of each cranial morphological trait score was assessed using the whole study sample, whereas the repeatability  was evaluated using a subsample of 50 crania. In particular, the assessment of cranial morphological trait scores for repeatability was conducted over a period from 1 to 3 weeks. The intra- and interobserver agreements were evaluated using the percentages of agreement with a tolerance of 0, and its degree was measured by weighted Cohen’s kappa , which iWe reported absolute frequencies and proportions for age and each cranial morphological trait score according to sex. The differences in proportions according to sex were evaluated by means of a chi-squared test.The linear relationship between each pair of cranial morphological trait scores was assessed by Spearman’s correlation coefficient.The six discriminant equations proposed by Walker and developed on the American White/European sample  were appFinally, in order to predict sex for the set of cranial morphological traits of the Italian population, we performed logistic regression models specific to this population. Logistic regression allows for an analysis of the association between a binary outcome  and one or more covariates, which may be either categorical or continuous . In ordep < 0.01). The mean ± standard deviation of the age for females and males were 68.1 ± 20.1 and 60.3 ± 19.1 years, respectively. p-values in Overall, the females were significantly older than the males  than the accuracy proved in the original population. The percentages of a correct assessment for female crania were the lowest , and, precisely, the predictive equation that combines the orbital margin and the mental eminence was the one performing worst . On the –85% thanIntra- and inter-observer statistics proved the reliability of the scoring method, showing a good agreement between the analysts and the different trials . The highest agreement was observed for the glabella and the mastoid process in all tests , confirming the previous results from South African and American samples ,21. SuchConcerning the average scores for the five traits, our population showed significant differences between the scores assessed for males and females, proving a great sexual dimorphism, especially for the glabella and mastoid process, as is also deducible from our population-specific equation only including the two traits reported in Finally, we provided specific logistic regression equations for the Italian population. To be thorough, the equations for all possible combinations of cranial morphological traits were provided. However, the analyses revealed the best performing models with one or two cranial traits, showing no increasing accuracy with more combinations (more than two traits). In addition, the best performing models described included the traits associated with the highest agreement , thus suggesting that these models are the most reliable in sex diagnosis. In general, by applying our newly-developed regression equations to the testing sample, the accuracy can reach higher satisfactory percentages, a result that makes these new models more suitable to be used in forensic contexts. This study does not represent the first-ever analysis using the same logistic regression approach for predicting sex in this skeletal collection: a previous study has focused on sexual dimorphism of craniometric variables  and provThe present study has some limitations. In particular, the small number of young individuals, which included ages between 20 and 40 years and prevented the evaluation of the sexual dimorphism differences between different age classes. In fact, in the literature, age-related changes in the expression of cranial traits have been reported ,46, suggFinally, the use of non-metric traits for sex determination is a basic and fast method in forensic anthropology and bioarchaeology. However, it is an old-fashioned approach that mostly relies on the analyst’s opinion and experience and, as such, it is a questionable method because it is more characterized by subjectivity. We wish that the application of modern techniques  could be helpful for solving this task more objectively in the future.The increasing number of known/identified skeletal collections is encouraging validation studies of sex estimation methods on various and diverse populations, as well as the development of additional predictive models. This is beneficial for many anthropological methods that allow for the profiling of human remains in forensics.Since the sexual dimorphism of cranial morphological traits is population-specific, it is reasonable in forensic cases to employ the method proposed for the population from which the individual is supposed to come from. As in part suggested by the results of the present study and already reported in the literature, sexual dimorphism is affected by numerous factors, such as secular, ethnical, genetic, and environmental changes. Thus, when forensic anthropologists are dealing with real cases, they should always consider methods that are potentially validated on the proper population. The models here presented and built ad hoc for the Italian population allow for the prediction of the sex more accurately than the existing models and those based on craniometrics for the same population: they are weighted specifically for our sample, which might help avoid misclassifications in particular for female individuals.Lastly, given the intrinsic subjectivity of the old-fashioned approaches as the one here proposed, when non-metric traits are considered in forensic cases, it is important not only to apply population-specific models when possible, but it is also preferable for more than one anthropologist to rate/score the traits.


Nursing education in Iran is one of the disciplines of medical sciences and it needs a design tailored to the community needs in terms of theoretical and clinical approaches. This system is currently faced with various challenges. This study aims to explore the challenges of Iranian nursing education system to address community needs.A study was carried out through an exploratory descriptive qualitative design with content analysis method. In-depth semi-structured interviews were conducted with 21 participants from the nursing society, selected through purposive sampling. The interviews were continued until data saturation. Data analysis was performed simultaneous with data collection by using Graneheim & Lundman approach.Based on the interviews and simultaneous analyses, a total of 471 codes, 14 subcategories, six main categories, and two themes were extracted. The first theme, “system structure," consisted of three categories: "the need for ongoing revision of curriculum," "the need to recruit qualified students," and "the need for a proportionate educational environment." The second theme was “the education process” with three categories "the need for purposive educational design," "the need for purposive monitoring and feedback," and "the need for appropriate and early interaction with the community." The participants emphasized the continuous revision of the educational curriculum based on the current needs of the community and community-based nursing education.In general, the results showed that Iranian nursing education system is faced with many challenges in the educational system structure and processes. It is necessary to make appropriate plans to enhance the status of the educational system structure and develop educational designs to address community needs using a hospital/community-based approach. As a science that focuses on human healthcare, nursing is committed to promoting health standards and making efforts to address the care needs of patients and the community . The nurSocial accountability is defined as the accountability of individuals, groups, or institutions to the members of a society or an organization by accepting the consequences and results of their responsibilities . Social According to the social accountability approach, the nursing discipline should be responsible for the quality of care it provides to the community and be able to address people’s care needs by adopting proper policies and strategies . In contHowever, the Iranian nursing system is faced with challenges in terms of social accountability and accountable nursing such as the nursing shortage , the gapSocial accountability, in the Iranian nursing system, is considered as a new paradigm in health and cultural change and it is necessary to be studied and understood further in various disciplines including nursing . HoweverAmong various research approaches, qualitative research can play an effective role in explaining complicated, ambiguous, and unknown areas of phenomena, and lead to the clarification of the why and how of the phenomena of which we have little knowledge . TherefoThe study was based on an exploratory descriptive qualitative design using content analysis method  between The research environment included hospitals, nursing schools, centers, universities and faculties. Nursing programs in Iran include BSc, MSc, and PhD programs. In the master’s programs, students receive training on various disciplines including pediatrics, internal medicine and surgery, psychiatric nursing, community health, nursing management, rehabilitation nursing, military nursing, and ICU and NICU nursing. In the PhD program, the specialty is determined based on the dissertation topic. Currently, there are 80 state-run nursing schools and 84 nursing schools run by the Islamic Azad University  nationwide training students in nursing bachelor's degree program. Among these schools, 45  offer Master's programs in addition to Bachelor's degree programs, and 21  offer Bachelor's degree, Master's degree, and PhD degree programs. This study was conducted in 12 government colleges and institutions and one non-government institution in the north, center, west, north, southwest and south-central regions of Iran. The inclusion criteria were the age of nursing schools and presence of outstanding nursing professors. The selection was based on a snowball method.th interview. At the end of each interview, the participants were asked to introduce other potential participants for further interviews. Maximum variation in the participants’ selection was taken into account so that the participants were selected from different institutions with diverse work history, experiences, and gender.The research population consisted of nurses, policymakers, board certified nurses, nursing education and clinical managers, and the faculty members of nursing schools (All participants held at least a Bachelor's degree in nursing). The final research participants consisted of 21 individuals, 11 of them were male and 10 were female  who had completed a full course of qualitative research and voice recorded with the consent of the participants. In addition, memoirs were written and notes were taken to record body language, including the tone of voice, pronunciation of words, laughter, and pauses of the participants. The mean duration of the interviews in each session was 50 to 70 min depending on the subjects’ tolerance. Two of the participants, one nursing professor and one senior nursing manager, participated in two interviews and other participants took part in only one interview. During the interview, guide questions were also used to facilitate data collection. At first, the interviewer would ask general questions and greet the interviewees as a warm-up, then start the interview with the main question “What is your opinion regarding social accountability and nursing education?” Then the interviews would be conducted based on the guide questions.1. How do you see the current nursing education system in Iranian universities? Can you share your experience?2. How are community needs addressed in the nursing education system structure?3. What are the problems of the current nursing education system to address community needs?4. What is your opinion about the needs or the deficiencies of the nursing education system in addressing community needs?The guide questions:During the interview, based on the participants’ answers, more open-ended questions were asked to clarify the details of their answers. If the participants started to speak freely, the researcher would direct the interview to further clarify the phenomenon under study by asking the probing question at the appropriate time. Furthermore, the guide questions were reviewed and approved by six researchers, four with PhDs in Nursing and two with PhDs in Medical Education.In order to analyze the data, a qualitative approach was used based on Graneheim & Lundman qualitative content analysis method . The quaTo analyze each interview, after jotting down the interviews, the texts were reviewed several times (immersion in data) to achieve a general perception of the different aspects of the experiences and the perspectives. The sentences were then converted into units of meaning as parts of sentences or paragraphs, and the initial codes were obtained using the words close to the participants’ statements. Finally, the codes were categorized based on the differences and the similarities. Then they were classified based on similar meanings and the connections and the consistency among them. Thus, the categories were placed together based on meaningful conceptual patterns. By realizing the connections in the data, the themes emerged. At this stage, MAXQDA software version 18 was used for data management.Credibility, dependability, confirmability, and transformability were assessed to approve the trustworthiness of the findings .To confirm the acceptability of the data, methods such as long-term involvement with the study and data and integration in the study such as maximum variation in the participant’s selection in terms of workplace, work experience, and gender were used. In addition, the research colleagues (peer check) and study participants (member check) checked the codes and classes.To determine the reliability of the data, auditing method was used in this study. So that all research steps and details of the process, concepts, and results were clearly written. In addition, MAXQDA software V.18 was used to make sure that other researchers could follow and audit the data.To determine the verifiability, the researcher tried to abandon her presuppositions about the desired phenomenon and the results (bracketing). In addition, the researcher tried to explain the different stages of the research and all the activities in detail so that other people can do an external audit of the subject by reading these writings.To confirm the transferability in this study, the desired phenomenon was briefly examined and all the characteristics related to the cultural and contextual situations of the participants in the study were explained.A total of 21 interviews were conducted with 21 subjects. Based on the interviews and the simultaneous analyses, two themes, six main categories, 14 subcategories, and 471 codes were extracted. Table It was one of the main themes of the study, consisting of three categories and eight subcategories as follows:This category contains three subcategories and it is one of the most important concepts extracted, which can be the system structures for the education of nursing students tailored to the current community needs.This subcategory was formed based on the data derived from the participants’ statements, emphasizing the need to focus on the current needs of the community, emerging diseases, and hospital- and-community-based services. The following are the participants’ quotes on the matter:“Today, people need help for chronic and emerging diseases. However, due to COVID-19 pandemic, chronic diseases have been ignored to a great extent, and the topics about the levels of prevention have been disregarded” (P12).We studied lots of stuff in the program, but unfortunately the fact is that most of the materials cannot help us much in practice” (P1).“The nursing education curriculum is well-formulated. However, for developing practical courses in different settings, in addition to training and apprenticeship programs at hospitals, different areas of community-based services should also be considered” (P14).By analyzing the participants’ statements, it can be inferred that it is necessary to arrange the nursing education curriculum at different degrees, especially at undergraduate programs, using hospital/community-based perspectives, along with ongoing revisions. The following are some examples in this regard: ““A developed curriculum should target issues based on the current needs of the community. Hospital, community based, and practical training programs must be offered in the revisions and community health courses should be presented in a more practical manner” (P15).The majority of the participants believed that the nursing education curriculum at different levels, especially at the nursing undergraduate program, was formulated based on the hospital-based nursing services. The community-based framework only exists in community health courses, and in community health and geriatric nursing disciplines, at the master’s level. However, due to the country’s need for nursing experts’ working at hospitals, and even community nursing centers, it is necessary to include hospital-and-community-based materials proportionally while designing the curriculum. Participants said in this regard:“The nursing program, courses, and even training and apprenticeship programs are focused on the nurse's hospital activities. It was only during the community health nursing course that we received little training on the level one of prevention services,” (P2).Graduated nurses who enter hospitals all have a hospital-based perspective and hospital services are the centerpiece of all their activities and even their paradigm, with practically no tendency to provide community-based services” (P24).“The data obtained from the interviews showed that the number of qualified students and learners was one of the effective concepts in explaining the challenges of Iranian nursing education system. This category consisted of the following two subcategories:Considering the occupational opportunities for other disciplines and the large demand for nursing in the job market, most students in this discipline are not really interested in it and their only motive is the good job opportunity. The following are some examples in this regard:“Currently, the only criteria for admitting students in the program is the admission exam, and considering the good job opportunities for nurses, many students who choose this discipline only do this for the good job opportunity” (P16).Students are often not interested in nursing and do not have the motive to study or even learn nursing health care. This lack of interest is more common in male students compared to the female ones" (P18).“The participants emphasized that the students’ potential talents and abilities was an important factor in training nurses.Many freshman students are very intelligent and talented. But unfortunately, most of them focus their efforts on studying the materials needed to apply for non-nursing disciplines at higher levels, instead of focusing on learning and empowering themselves for clinical practice, and practically strive for higher degrees” (P11).“appropriate educational environment, consisting of the following three subcategories:Another category extracted in this study was In light of considering the significance of clinical education in the field of nursing, the participants believed that the presence of skilled professors and nurses was of great importance.There are a few good professors in the faculty and the rest are the graduated students with no clinical experience. They have not even worked one on-call night shift” (P21).“Many novice professors lack the skill and even the interest in teaching the students” (P3).“The participants believed that due to the large number of students in clinical wards from different disciplines, clinical education space in inpatient and outpatient wards is not proportionate to the number of students. The following are some statements in this regard:There were too many medical and nursing students from different faculties. Sometimes, during the training courses, there were even fewer patients than the students” (P16).“There are too many students in some clinical courses and we cannot teach the skills they need to all of them” (P13).“Unfortunately, our hospital wards are not educational. The nurses do not acknowledge students at all. In many wards, head nurses are not willing to see students in wards, and keep saying that, students only increase the workload and they have to monitor the students.” (P5).“It was found that attendance at community-based care centers was too low. Further planning and coordination is required to offer training and apprenticeship programs at community-based care centers. The following are some statements in this regard: Educational content in the field of community-based care is theoretical, and the students do not practically get acquainted with the concept of community-based care in a clinical manner during the program” (P7).“There is no proper planning within our treatment and educational system for the increased presence of nurses in the community. Therefore, in practice, in the educational programs for students, attending community-based care centers is limited to public clinics” (P12).“One of the important themes was nursing education challenges consisted of three categories and six subcategories:This category was also one of the important concepts in the study, which was mentioned both directly and indirectly by the participants and consisted of the following two subcategories:The participants believed that in the educational design of nursing education courses at different programs, theoretical education should be purposive and in line with community-and-hospital-based clinical education. The following are some examples in this regard:“Due to the large number of students in the classroom, in most cases, theoretical courses are limited to lectures” (P11).Theoretical lessons should be presented using real and objective cases in an understandable manner for students” (P20).““It is really important in clinical education to properly interact with patients, pay attention to them and accept them and focus on their problems and culture” (P15).One of the important topics in educating nursing students is to offer clinical courses as apprenticeship and training programs in a practical setting. All the participants stated that the clients and their needs should be considered in clinical training, and the student should realize that the most important issue in clinical practice is the clients’ needs and their preferences.This concept was one of the main categories consisting of the following two subcategories that can be effective in improving students’ clinical practice:“There is no proper and purposive clinical evaluation in many apprenticeship and training programs. Sometimes, the evaluation is done through a checklists or asking a few questions,” (P14).There was no certain plan in apprenticeship and training programs. The instructor only checked to see if we read patients’ medical records, administered their drugs, and checked the vital signs. There was no evaluation. The questions that were asked during the course were considered as evaluation and all the students received similar marks with slight differences” (P21).“According to the participants, it was revealed that theoretical and clinical evaluation approaches need to be redesigned and standardized based on modern evaluation approaches. In this regard, adopting modern methods of clinical evaluation is of great importance. The following are some examples in this regard:“Unfortunately, no regular and planned evaluation is done in apprenticeship and training programs and sometimes, evaluations are left incomplete. In most cases, no proper feedback is provided to the students” (P20).In the nursing education curriculum, appropriate logbooks and recommendations for evaluation are presented but, in most cases, the items listed in the logbook are not fully and seriously implemented, and there is no feedback, either,” (P13).“Another important subcategory was proportionate monitoring and feedback. The participants mentioned the need for the planning and implementation of standard and appropriate monitoring and evaluation through providing early feedback. They considered this topic as one of the necessities of the current nursing education program.This category was derived from the concept of focusing on the necessary clinical services and the early interaction with the community.The participants stated that the current hospital-and-community-based nursing care required by the community must be included in the theoretical and clinical education of students:“In general, the professors only mentioned the cases and the problems related to hospital wards. We did not see many of the cases, and community health nursing training in clinics was limited to vaccinations and injections, and visiting a few factories. We did not experience community-based care” (P18).“There is not enough time to deal with all the required cases during apprenticeship, and we have to cover most of the cases through videos and homework” (P17).If students enter hospitals and home care centers at the beginning of their education, they will spend more time doing clinical practice and interacting with people. In this way they can better understand people’s needs and prepare themselves to address these needs,” (P4).“According to the participants, the students should enter clinical fields at hospital and in the community as soon as possible, right after entering the nursing program. This helps them to better understand the community needs for nursing services and properly interact with the community. The following is an example in this regard:An exploratory descriptive qualitative design using content analysis method was carried out to explore the challenges of the Iranian nursing education system in order to address the community needs.In order to respond to the needs of the society, the Iranian nursing education system deals with two themes including system structure and educational process. In a similar study, an appropriate educational system structure including competent instructors and proper educational processes and design was considered as the foundation and the necessity of nursing education . AnotherThe results showed that the nursing curriculum should be regularly revised based on the community needs. One of the important categories was ignoring community needs in the nursing curriculum. The main requirements and needs in the nursing discipline are paying attention to community needs and providing services accordingly. Addressing community needs is one of the main priorities of nursing systems , 25. TheAnother important finding was the topic of qualified students. Being interested in nursing and having the potential abilities and talent is essential to enter this discipline. Some studies have stated that in order to succeed in this discipline, in addition to being interested and having potential abilities and talent, nurses should try to introduce their profession and its position to the public through enhancing their attitudes , 30, 31.A proportionate educational environment was another finding. The educational environment is one of the major requirements of the educational system, in terms of the presence of competent and committed faculty members, educational clinical wards proportionate to the number of the students, as well as community care centers. Moreover, it can be effective in making the education process accountable to the needs of the society. Universities should make plans to optimize the educational environment. Many studies have emphasized the importance of the educational environment, the evaluation of the situation, and the optimization of the learning environment in nursing education –34. The Given the continuous changes in the society’s needs in the health sector the Iranian nursing education system needs to be revised or even educationally redesigned to highlight the provision of theoretical and clinical education with an emphasis on the community needs and community-based care programs. Studies have shown that a community-based curriculum improves professional skills, communication skills, self-confidence, knowledge and awareness, critical thinking skills, and teamwork skills among nursing graduates . In anotThe results of the study also showed that monitoring and providing feedback in educational activities and the use of appropriate and standard educational evaluation methods in theoretical and clinical education were essential for nursing education and needed further improvement. Providing appropriate feedback to and purposive monitoring of students based on community-based curriculum can empower the students and make them feel responsible for the needs of the community . CurrentThe nursing education system needs to improve the interaction with the community. More focus is needed on clinical services and community-based care, and early interaction with the community should be a priority in the education system. Various studies have also emphasized community-based clinical education , 36 and One of the advantages of this study is adopting a qualitative approach in a real environment that provides a true representation of the process under study. Furthermore, conducting interviews with a wide variety of nursing professions, nursing professors, and students is noteworthy. Unfortunately, due to the COVID-19 pandemic, the participants were not willing to be interviewed for nearly a year. Therefore, the interviews were conducted after a decline in coronavirus cases and, at times, when the city of Kermanshah was in better conditions. Sampling and conducting the interviews took more than one year due to the community conditions. The study was prolonged inevitably, due to the closure of facilities and universities, as well as the participants’ reluctance to conduct interviews. In addition, considering the limitations of quantitative studies and the need to describe the challenges in the Iranian nursing education system in a real environment, a qualitative method was used in this study. Therefore, given the ongoing changes in the educational system and the needs of the health sector in the society, similar studies are needed in the future.The Iranian nursing education system is faced with many challenges in the field of educational system structure and educational process. In this regard, the need for revising the curriculum, more attention to the ever-changing community needs, and adopting standard and target-oriented educational approaches in the clinical and theoretical areas are all considered as the requirements of the Iranian nursing education system to cover the needs of society.


The rapid development and deployment of coronavirus disease 2019 (COVID-19) vaccines should be heralded as a feat of true scientific collaboration that saved millions of lives  and the The latest data highlight that vaccines only offer a 15% reduction against developing long COVID and a 34% reduction in the risk of mortality . This isEasing COVID-19 restrictions is a complex, multifactorial, and often controversial decision; public health authorities, scientific advisory groups, and health care professionals expressed concern about relaxing restrictions, stressing a need for caution in the continued response to the pandemic . The remIn the initial stages of the pandemic, patients reported a broad reoccurring symptom profile that occurs in the weeks and months post-acute infection with COVID-19. Colloquially referred to as COVID long haulers, post-COVID condition/syndrome or long COVID, it is characterised by chronic, persistent, episodic, and disabling symptoms that have broad economic and health and well-being impacts . In respPost COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, and cognitive dysfunction but also others and have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time.World Health Organisation, (2021)This is, to date, the most robust definition, as it encompasses the broad and changeable nature of the disease and the implications for patients, the authors also acknowledge that this is a temporary definition that will need to be revisited once more is known about the condition. As the knowledge base evolves, the definition must be refined to incorporate an increased understanding and must also be engrained with the patient’s voice and lived experience. There is a clear need for consistency in the development of a universal definition adoptable by governments and health care systems globally and used to support the service design and delivery of a growing global health challenge. While this might seem like a tall order, a consistent approach will ensure that long COVID patients have equitable access to the necessary treatments and support mechanisms needed to improve patient outcomes.The lived experience is defined as personal knowledge gained through direct, first-hand involvement in everyday events rather than through representations constructed by other people . AcknowlBeing part of research into Long COVID has been a game-changer on my long COVID journey. Knowing that I was able to actively engage in a process that could give so much hope to other patients, especially when I thought COVID had taken everything I had to give, was an awakening experience for me.Since the easing of restrictions in the UK and globally, the frequency and intensity of media coverage has reduced, with little or no mention of the sustained challenges faced by patients or health care providers. The restoration of economic and social activities is a driving force behind these decisions while the widespread impact of long COVID has been overlooked. In this context, public engagement initiatives must be prioritised to intensify the action needed to address the increasing burden of long COVID and to increase the public knowledge and awareness of the remaining threat to global health. The following passage is from an online patient survey of people with long COVID about “living with COVID-19”:I watch people behaving as though the virus has gone. They have no idea that my reality could become theirs. If this is ‘learning to live with Covid’ I would not wish it on anyone.Not only does long COVID drastically impact the global burden of disease, but it impacts health care services, which are historically underfunded and under-resourced. Furthermore, recent reports indicate that >200 000 UK frontline health care workers are off from work due to COVID-19-related issues, adding to existing pressures on capacity and service delivery . SimultaThe National Institute of Health Research and UK Research and Innovation demonstrated an agile response to the COVID-19 pandemic by allocating research funding to address the immediate burden of COVID-19. While this was important for an immediate response, the long-term and unanswered challenges of long COVID should be addressed with a sustained allocation of research funding. Currently, the National Institute of Health is the only health research authority to make a public sustainable commitment to provide $US1.15 billion in funding over four years for research into the long-term health consequences of SARS-CoV-2. Sustained research support is essential to addressing the needs of millions living with and those yet to develop long COVID. At present, a lack of mechanistic and clinical understanding has hampered the global response to long COVID and is in part contributing to the rise in confirmed long COVID diagnosis. In the absence of an appropriate understanding, it is difficult to design and develop support mechanisms that address the needs of patients and restorespre-COVID-19 quality of life. Accordingly, insight and knowledge from pre-existing chronic conditions, eg, postural tachycardia syndrome (PoTS), and myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) have been incorporated into support and management approaches . While sThere is a clear need to understand organ pathology and the mechanistic processes that are widely reported by long COVID patients and to support the development of pharmacological interventions. There is a promise that anti-viral medications may address viral persistence  thought MUST continue. Creating funding to enable research, planning environments to disseminate outcomes, and taking evidence seriously is the only way to avoid a new secondary COVID health crisis.Research into Long COVID The response to the long COVID conundrum, which feels reminiscent of the challenge that faced Alan Turing at Bletchley Park during World War 2, needs to be developed with true interdisciplinary collaboration ,28. MultWhile there is a clear need to understand and address the clinical burden of long COVID, research should also consider the broader impacts of long COVID and its adverse social and economic effect on children, families, and employment. The drive to restore pre-COVID-19 social and economic activity was part of the reason for removing all restrictions in the UK and globally. The long-term debilitating symptom profile that is widely reported will undoubtedly have a lasting impact on social and economic activities and must be considered in the long COVID global health crisis.The need to restore the functional status of long COVID patients is crucial for global and public health. Coupled with the removal of COVID-19 restrictions, sustained transmission, and future variants of concern, long COVID prevalence will increase affecting, hundreds of millions of people worldwide. Public recognition of disabilities associated with long COVID, alongside the urgent resources and collaborative research is required to develop treatments and support mechanisms that can better address the growing and future burden of long COVID.