Respiratory therapies for Amyotrophic Lateral Sclerosis: A state of the art review.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative condition noteworthy for upper and lower motor neuron death. Involvement of respiratory motor neuron pools leads to progressive pathology. These impairments include decreases in neural activation and muscle coordination, progressive airway obstruction, weakened airway defenses, restrictive lung disease, increased risk of pulmonary infections, and weakness and atrophy of respiratory muscles. These neural, airway, pulmonary, and neuromuscular changes deteriorate integrated respiratory-related functions including sleep, cough, swallowing, and breathing. Ultimately, respiratory complications account for a large portion of morbidity and mortality in ALS. This state-of-the-art review highlights applications of respiratory therapies for ALS, including lung volume recruitment, mechanical insufflation-exsufflation, non-invasive ventilation, and respiratory strength training. Therapeutic acute intermittent hypoxia, an emerging therapeutic tool for inducing respiratory plasticity will also be introduced. A focus on emerging evidence and future work underscores the common goal to continue to improve survival for patients living with ALS.

Hospital length of stay for COVID-19 patients: Data-driven methods for forward planning.

BACKGROUND: Predicting hospital length of stay (LoS) for patients with COVID-19 infection is essential to ensure that adequate bed capacity can be provided without unnecessarily restricting care for patients with other conditions. Here, we demonstrate the utility of three complementary methods for predicting LoS using UK national- and hospital-level data. METHOD: On a national scale, relevant patients were identified from the COVID-19 Hospitalisation in England Surveillance System (CHESS) reports. An Accelerated Failure Time (AFT) survival model and a truncation corrected method (TC), both with underlying Weibull distributions, were fitted to the data to estimate LoS from hospital admission date to an outcome (death or discharge) and from hospital admission date to Intensive Care Unit (ICU) admission date. In a second approach we fit a multi-state (MS) survival model to data directly from the Manchester University NHS Foundation Trust (MFT). We develop a planning tool that uses LoS estimates from these models to predict bed occupancy. RESULTS: All methods produced similar overall estimates of LoS for overall hospital stay, given a patient is not admitted to ICU (8.4, 9.1 and 8.0 days for AFT, TC and MS, respectively). Estimates differ more significantly between the local and national level when considering ICU. National estimates for ICU LoS from AFT and TC were 12.4 and 13.4 days, whereas in local data the MS method produced estimates of 18.9 days. CONCLUSIONS: Given the complexity and partiality of different data sources and the rapidly evolving nature of the COVID-19 pandemic, it is most appropriate to use multiple analysis methods on multiple datasets. The AFT method accounts for censored cases, but does not allow for simultaneous consideration of different outcomes. The TC method does not include censored cases, instead correcting for truncation in the data, but does consider these different outcomes. The MS method can model complex pathways to different outcomes whilst accounting for censoring, but cannot handle non-random case missingness. Overall, we conclude that data-driven modelling approaches of LoS using these methods is useful in epidemic planning and management, and should be considered for widespread adoption throughout healthcare systems internationally where similar data resources exist.

Who Gains Mental Health Benefits from Work Autonomy? The Roles of Gender and Occupational Class.

In recent years, improving work autonomy as an important priority in the UK labour market has been shown to enhance employee mental health and well-being. However, previous theories and empirical studies have paid little attention to the intersectional inequalities in the mental health benefits of work autonomy, preventing us from gaining a comprehensive understanding of the mental consequences of work autonomy. By integrating literature from occupational psychology, gender and social class, this study develops theoretical hypotheses regarding whether and how the mental health benefits of work autonomy vary alongside the intersectional axes of gender and occupational class and tests these hypotheses using long-term panel data in the UK (2010-2021). Overall, we find that those from higher occupational class and male employees acquire significantly more mental health benefits from high work autonomy compared with those from lower occupational class and female employees. Moreover, further analyses show significant intersectional inequalities of gender and occupational class. While male employees from all occupational classes gain significant mental health benefits from work autonomy, only female employees from higher (but not lower) occupational classes benefit from work autonomy. These findings contribute to the literature in the sociology of work by demonstrating the intersectional inequalities in mental health consequences of work autonomy, especially for women in the lower occupational class, highlighting the need for a more gender- and occupation-sensitive design in future labour market policies.

The economic impact of the COVID-19 pandemic on ethnic minorities in Manchester: lessons from the early stage of the pandemic.

This review summarizes the economic impacts of the pandemic on ethnic minorities, focusing on the city of Manchester. It utilizes multiple reporting sources to explore various dimensions of the economic shock in the UK, linking this to studies of pre-COVID-19 economic and ethnic composition in Manchester and in the combined authority area of Greater Manchester. We then make inferences about the pandemic's short-term impact specific to the city region. Greater Manchester has seen some of the highest rates of COVID-19 and as a result faced particularly stringent "lockdown" regulations. Manchester is the sixth most deprived Local Authority in England, according to 2019 English Indices of Multiple Deprivation. As a consequence, many neighborhoods in the city were always going to be less resilient to the economic shock caused by the pandemic compared with other, less-deprived, areas. Particular challenges for Manchester include the high rates of poor health, low-paid work, low qualifications, poor housing conditions and overcrowding. Ethnic minority groups also faced disparities long before the onset of the pandemic. Within the UK, ethnic minorities were found to be most disadvantaged in terms of employment and housing-particularly in large urban areas containing traditional settlement areas for ethnic minorities. Further, all Black, Asian, and Minority ethnic (BAME) groups in Greater Manchester were less likely to be employed pre-pandemic compared with White people. For example, people of Pakistani and Bangladeshi ethnic backgrounds, especially women, have the lowest levels of employment in Greater Manchester. Finally, unprecedented cuts to public spending as a result of austerity have also disproportionately affected women of an ethnic minority background alongside disabled people, the young and those with no or low-level qualifications. This environment has created and sustained a multiplicative disadvantage for Manchester's ethnic minority residents through the course of the COVID-19 pandemic.

Exploring inspiratory occlusion metrics to assess respiratory drive in patients under acute intermittent hypoxia.

Patients living with Amyotrophic Lateral Sclerosis (ALS) experience respiratory weakness and, eventually, failure due to inspiratory motor neuron degeneration. Routine pulmonary function tests (e.g., maximum inspiratory pressure (MIP)) are used to assess disease progression and ventilatory compromise. However, these tests are poor discriminators between respiratory drive and voluntary respiratory function at rest. To better understand ALS disease progression, we can look into compensatory strategies and how patients consciously react to the occlusion and the effort produced to meet the ventilatory challenge of the occlusion. This ventilatory challenge, especially beyond the P0.1 (200 ms and 300 ms), provides information regarding the patient's ability to recruit additional respiratory muscles as a compensatory strategy. Utilizing a standard P0.1 protocol to assess respiratory drive, we extend the occlusion time analysis to 200 ms and 300 ms (Detected Occlusion Response (DOR)) in order to capture compensatory respiratory mechanics. Furthermore, we followed an Acute Intermittent Hypoxia (AIH) protocol known to increase phrenic nerve discharge to evaluate the compensatory strategies. Inspiratory pressure, the rate of change in pressure, and pressure generation normalized to MIP were measured at 100 ms, 200 ms, and 300 ms after an occlusion. Airway occlusions were performed three times during the experiment (i.e., baseline, 30 and 60 minutes post-AIH). Results indicated that while AIH did not elicit change in the P0.1 or MIP, the DOR increased for ALS patients. These results support the expected therapeutic role of AIH and indicate the potential of the DOR as a metric to detect compensatory changes.

Intra-Arterial, but Not Intrathecal, Baclofen and Codeine Attenuates Cough in the Cat.

Centrally-acting antitussive drugs are thought to act solely in the brainstem. However, the role of the spinal cord in the mechanism of action of these drugs is unknown. The purpose of this study was to determine if antitussive drugs act in the spinal cord to reduce the magnitude of tracheobronchial (TB) cough-related expiratory activity. Experiments were conducted in anesthetized, spontaneously breathing cats (n = 22). Electromyograms (EMG) were recorded from the parasternal (PS) and transversus abdominis (TA) or rectus abdominis muscles. Mechanical stimulation of the trachea or larynx was used to elicit TB cough. Baclofen (10 and 100 µg/kg, GABA-B receptor agonist) or codeine (30 µg/kg, opioid receptor agonist) was administered into the intrathecal (i.t.) space and also into brainstem circulation via the vertebral artery. Cumulative doses of i.t. baclofen or codeine had no effect on PS, abdominal muscle EMGs or cough number during the TB cough. Subsequent intra-arterial (i.a.) administration of baclofen or codeine significantly reduced magnitude of abdominal and PS muscles during TB cough. Furthermore, TB cough number was significantly suppressed by i.a. baclofen. The influence of these drugs on other behaviors that activate abdominal motor pathways was also assessed. The abdominal EMG response to noxious pinch of the tail was suppressed by i.t. baclofen, suggesting that the doses of baclofen that were employed were sufficient to affect spinal pathways. However, the abdominal EMG response to expiratory threshold loading was unaffected by i.t. administration of either baclofen or codeine. These results indicate that neither baclofen nor codeine suppress cough via a spinal action and support the concept that the antitussive effect of these drugs is restricted to the brainstem.

Length of Stay in ICU of Covid-19 patients in England, March - May 2020.

INTRODUCTION: Length of Stay (LoS) in Intensive Care Units (ICUs) is an important measure for planning beds capacity during the Covid-19 pandemic. However, as the pandemic progresses and we learn more about the disease, treatment and subsequent LoS in ICU may change. OBJECTIVES: To investigate the LoS in ICUs in England associated with Covid-19, correcting for censoring, and to evaluate the effect of known predictors of Covid-19 outcomes on ICU LoS. DATA SOURCES: We used retrospective data on Covid-19 patients, admitted to ICU between 6 March and 24 May, from the "Covid-19 Hospitalisation in England Surveillance System" (CHESS) database, collected daily from England's National Health Service, and collated by Public Health England. METHODS: We used Accelerated Failure Time survival models with Weibull and log-normal distributional assumptions to investigate the effect of predictors, which are known to be associated with poor Covid-19 outcomes, on the LoS in ICU. RESULTS: Patients admitted before 25 March had significantly longer LoS in ICU (mean = 18.4 days, median = 12), controlling for age, sex, whether the patient received Extracorporeal Membrane Oxygenation, and a co-morbid risk factors score, compared with the period after 7 April (mean = 15.4, median = 10). The periods of admission reflected the changes in the ICU admission policy in England. Patients aged 50-65 had the longest LoS, while higher co-morbid risk factors score led to shorter LoS. Sex and ethnicity were not associated with ICU LoS. CONCLUSIONS: The skew of the predicted LoS suggests that a mean LoS, as compared with median, might be better suited as a measure used to assess and plan ICU beds capacity. This is important for the ongoing second and any future waves of Covid-19 cases and potential pressure on the ICU resources. Also, changes in the ICU admission policy are likely to be confounded with improvements in clinical knowledge of Covid-19.

Hierarchical Modelling of COVID-19 Death Risk in India in the Early Phase of the Pandemic.

We improve upon the modelling of India's pandemic vulnerability. Our model is multidisciplinary and recognises the nested levels of the epidemic. We create a model of the risk of severe COVID-19 and death, instead of a model of transmission. Our model allows for socio-demographic-group differentials in risk, obesity and underweight people, morbidity status and other conditioning regional and lifestyle factors. We build a hierarchical multilevel model of severe COVID-19 cases, using three different data sources: the National Family Health Survey for 2015/16, Census data for 2011 and data for COVID-19 deaths obtained cumulatively until June 2020. We provide results for 11 states of India, enabling best-yet targeting of policy actions. COVID-19 deaths in north and central India were higher in areas with older and overweight populations, and were more common among people with pre-existing health conditions, or who smoke, or who live in urban areas. Policy experts may both want to 'follow World Health Organisation advice' and yet also use disaggregated and spatially specific data to improve wellbeing outcomes during the pandemic. The future uses of our innovative data-combining model are numerous.

Dans le contexte du développement international, on peut améliorer la modélisation de la vulnérabilité à une pandémie en combinant différentes disciplines, en combinant des données et en reconnaissant les nombreux niveaux imbriqués de l'épidémie. Des modèles de transmission ont été élaborés à l'échelle nationale ou pour plusieurs pays. A l'inverse, nous construisons un modèle permettant de prendre en compte les différents niveaux de risque selon les groupes sociaux, ainsi que le conditionnement des facteurs régionaux et des facteurs liés au mode de vie. La forme grave de la COVID-19 est notre résultat clé innovant. Nous utilisons trois sources de données simultanément: l'enquête nationale sur la santé des familles en Inde, le recensement de la population indienne de 2011 et les décès liés à l'épidémie de COVID-19. Nous fournissons des résultats pour 11 États en Inde, ce qui permet un meilleur ciblage des actions politiques. Les utilisations futures de ces modèles sont nombreuses. Dans le nord et le centre de l'Inde, les décès liés à la COVID-19 étaient plus nombreux dans les régions avec populations âgées et populations en surpoids. Ces décès étaient plus fréquents chez les personnes ayant déjà des problèmes de santé, ou chez celles qui fument ou qui vivent dans les zones urbaines. Les experts en politiques publiques pourront souhaiter à la fois « suivre les conseils de l'Organisation mondiale de la santé ¼ tout en utilisant des données désagrégées et spatiales pour améliorer les résultats en matière de bien-être pendant la pandémie.

Feasible Implementation Strategies for Improving Vocabulary Knowledge of High-Risk Preschoolers: Results From a Cluster-Randomized Trial.

Purpose Many children begin school with limited vocabularies, placing them at a high risk of academic difficulties. The goal of this study was to examine the effects of a vocabulary intervention program, Story Friends, designed to improve vocabulary knowledge of at-risk preschool children. Method Twenty-four early-childhood classrooms were enrolled in a cluster-randomized design to evaluate the effects of a revised Story Friends curriculum. In each classroom, three to four preschoolers were identified as having poor language abilities, for a total of 84 participants. In treatment classrooms, explicit vocabulary instruction was embedded in prerecorded storybooks and opportunities for review and practice of target vocabulary were integrated into classroom and home practice activities. In comparison classrooms, prerecorded storybooks included target vocabulary, but without explicit instruction, and classroom and home strategies focused on general language enrichment strategies without specifying vocabulary targets to teach. Intervention activities took place over 13 weeks, and 36 challenging, academically relevant vocabulary words were targeted. Results Children in the treatment classrooms learned significantly more words than children in the comparison classrooms, who learned few target words based on exposure. Large effect sizes (mean d = 1.83) were evident as the treatment group averaged 42% vocabulary knowledge versus 11% in the comparison group, despite a gradual decline in vocabulary learning by the treatment group over the school year. Conclusions Findings indicate that a carefully designed vocabulary intervention can produce substantial gains in children's vocabulary knowledge. The Story Friends program is feasible for delivery in early childhood classrooms and effective in teaching challenging vocabulary to high-risk preschoolers. Supplemental Material https://doi.org/10.23641/asha.13158185.

The Development Impacts of COVID-19 at Home and Abroad: Politics and Implications of Government Action.

What is COVID-19's impact on development? What lessons can be drawn from development studies regarding the effects of and recovery from COVID-19? The unprecedented scale and scope of government interventions carry implications at all levels: global, national, and local. In this introduction, our team of Editors underline the importance of systematic substantive study to further knowledge acquisition, and rigorous global-, national-, or context-specific evaluation to inform evidence-based policymaking. The 12 articles summarised here capture these values and sense of "high quality". In particular, despite early considerations in the first year of the pandemic, they illuminate the need for diverse responses beyond business-as-usual, attention to the multiplicity of impact of policies formulated, and progressive strategies to counteract the impacts of this disaster around the world. The path of future research is clear: studies need to consider and give voice to marginalised groups to counteract the short- and long-term impacts of the pandemic.

Quel est l'impact de la COVID-19 sur le développement international ? Quelles leçons pouvons-nous tirer des études de développement concernant les effets de la COVID-19, et du redressement après son passage ? L'ampleur et la portée sans precedent des interventions gouvernementales comportent des conséquences à tous niveaux: mondial, national, et local. Dans cette introduction, notre équipe éditoriale souligne l'importance des études à la fois systématiques et substantielles, afin d'élargir l'acquisition de connaissances; ainsi que des évaluations rigoureuses au niveau mondial, national, ou spécifiques au contexte, ayant pour but d'informer une politique des décisions basée sur l'évidence. Les 12 articles résumés ici présentent ces valeurs et ce sentiment de « haute qualité¼. En particulier, malgré des considérations précoces pendant la première année de cette pandémie, les articles soulèvent la nécessité de réponses diversifiées, bien au-delà des démarches jusqu' ici habituelles (en anglais, « business as usual¼), l'importance de prêter attention à la multiplicité d'impacts des politiques formulées, et le besoin de stratégies progressistes, pour faire face aux impacts de cette catastrophe partout dans le monde. Le chemin à prendre pour les recherches futures est clair: les études doivent considérer et donner une voix aux groupes marginalisés, pour faire face aux impacts à court et longue terme de la pandémie.

Well-Being During Recession in the UK.

This article explores the impact of the recent recession on the well-being of the UK working age population by comparing two measures of well-being. One is a measure of evaluative subjective well-being, a measure which previous research has shown to be stable in the UK throughout the economic crisis. The second is a different but complementary measure of positive psychological health. By comparing the trajectories of these two measures using the same sample and modelling techniques the analysis examines how different measures may lead to different interpretations. Six waves of longitudinal data from Understanding Society and the British Household Panel Survey (BHPS) are used. Latent curve models are used to analyse change over time. The results corroborate previous research showing that people's evaluative subjective well-being remained relatively stable, on average, throughout the economic crisis. In contrast, the positive psychological health measure was found to decline significantly during the recession period. The paper highlights that what we measure matters. Using single measures as summaries of well-being masks the complexity of the term, and given their appeal in the social policy arena, single measures of well-being can be seen as problematic in some scenarios.

Attention demands of language production in adults who stutter.

OBJECTIVE: We investigated whether language production is atypically resource-demanding in adults who stutter (AWS) versus typically-fluent adults (TFA). METHODS: Fifteen TFA and 15 AWS named pictures overlaid with printed Semantic, Phonological or Unrelated Distractor words while monitoring frequent low tones versus rare high tones. Tones were presented at a short or long Stimulus Onset Asynchrony (SOA) relative to picture onset. Group, Tone Type, Tone SOA and Distractor Type effects on P3 amplitudes were the main focus. P3 amplitude was also investigated separately in a simple tone oddball task. RESULTS: P3 morphology was similar between groups in the simple task. In the dual task, a P3 effect was detected in TFA in all three distractor conditions at each Tone SOA. In AWS, a P3 effect was attenuated or undetectable at the Short Tone SOA depending on Distractor Type. CONCLUSIONS: In TFA, attentional resources were available for P3-indexed processes in tone perception and categorization in all distractor conditions at both Tone SOAs. For AWS, availability of attentional resources for secondary task processing was reduced as competition in word retrieval was resolved. SIGNIFICANCE: Results suggest that language production can be atypically resource-demanding in AWS. Theoretical and clinical implications of the findings are discussed.

Surveying sexual orientation: asking difficult questions and providing useful answers.

Social survey data is essential to measuring equality, to assessing change over time and to the evaluation of the impact of new policies. In this article, we identified and evaluated the survey evidence for assessing equality in relation to sexual orientation in the UK. We reviewed the available survey data in relation to key policy areas such as criminal justice, employment and health. Our analysis suggests that there is only limited survey evidence on the circumstances of gays, lesbians and bisexuals in the UK. This poses major barriers for driving forward an agenda of social justice in relation to gay, lesbian and bisexual citizens. Robust research methodologies need to be developed and resourced in order to gain a representative picture of the socioeconomic circumstances of gay, lesbian and bisexual populations in the UK and to assess how they maybe changing over time.

The changing practice of eating: evidence from UK time diaries, 1975 and 2000.

This paper examines some central themes about change in consumption behaviour through an empirical investigation of the practice of eating. It analyses patterns of food consumption in the UK using time diary data from 1975 and 2000. The practice of eating is decomposed into four component activities which are used to explore systematically the inter-relationships between social processes - such as commodification and temporal fragmentation - and ways of providing and consuming food. It charts the expansion of eating out, the degree to which it substitutes for other eating activities, and the implications of its development for social relations and the temporal organization of daily life. Analysis reveals that food consumption continues to be differentiated along established lines of social division, although the content of those divisions has changed and varies across components of the practice. Increasing commodification of the food chain is documented, but without appearing to have a corrosive impact on household organization or social relationships. While tendencies indicative of temporal fragmentation are revealed, counter-tendencies exist which suggest that the practice of eating is resilient to many forms of external pressure. Finally, the application of a practice-based analytical approach permits critical evaluation of theories of social transformation.