The Impact of Sleep on Mental Toughness: Evidence From Observational and N-of-1 Manipulation Studies in Athletes

This is the author accepted manuscript. The final version is available from American Psychological Association via the DOI in this recordhe purpose of this study was to explore the direction and magnitude of the relationship between sleep and mental toughness and examine the effect of time in bed extension and restriction on mental toughness. Study 1 was an observational study examining the relationship between sleep quality and duration (hours) and mental toughness in 181 participants. Winsorized correlations revealed both longer sleep duration (ρω = .176 [.033, .316], p = .016) and higher quality (ρω = .412 [.270, .541], p ≤ .001) were associated with increased mental toughness. Follow-up regression analyses revealed sleep quality (b = 0.177, [0.117, 0,238], p ≤ .001), but not sleep duration (b = 0.450, [0.3254, 1.22], p = .256), predicted mental toughness score. In Study 2, we utilized a longitudinal N-of-1 influenced methodology with 6 participants to further examine whether manipulated time in bed (i.e., sleep duration) influenced mental toughness. Participants recorded sleep quality, duration, and mental toughness over 5 weekdays during 2 separate 2-week periods of baseline (normal sleeping pattern) followed by manipulated time in bed (counterbalanced 9 hr or 5 hr). Visual analyses (including determination of nonoverlapping data points between baseline and intervention weeks) revealed reduced time in bed negatively impacted the mental toughness of 4 of the participants. Social validation interviews were conducted to further explore participants' perceptions of the sleep manipulation. A cumulative effect of reduced sleep on mental toughness was noted by specific individuals. In addition, participants identified potential buoys of mental toughness in the absence of sleep

An exploratory case study of mental toughness variability and potential influencers over 30 Days

This is the final version. Available from the publisher via the DOI in this record.The purpose of this study was to explore whether mental toughness varies across a 30-day training block and whether such variability is associated with specific antecedents. This exploratory case study research investigated mental toughness variability using the Mental Toughness Index (MTI) with thirteen elite master runners across a series of self-selected training sessions, followed by interviews and follow-up questionnaires, to identify primary influencers of variability. There were significant differences in the MTI scores between baseline (before the training period), and the minimum and the maximum reported score over five self-selected training sessions (p's < 0.004). The proceeding follow-up interviews and questionnaires then provided insights into factors influencing this intra-individual variability. These higher-level themes included foundational wellbeing, specific preparation, and actions utilized in the moment. This study is the first to demonstrate within-person MTI variability across specific training sessions and provides initial insights for both athletes and practitioners into potential influencers of mental toughness

Internal and External Barriers to Effective Supply Chain Management Implementation in Malaysian Manufacturing Companies: A Priority List Based on Varying Demographic Perspectives

Successful implementation of supply-chain management in a developing country such as Malaysia is considered a major challenge due to lack of awareness and unclear missions and goals. Focusing on this idea, this article compares the ranking of various demographic groups in relation to the internal and external barriers experienced by Malaysian manufacturing companies. The identified lists of internal and external barriers are prioritised using the Analytic Hierarchy Process (AHP). Ten respondents with wide ranging experience in SCM provided the necessary information in the prioritisation exercise. The ranking of the respondents from different races, age groups, education levels, employment types, work experience and designations suggests significant variations between these groups in the ranking of the internal and external barriers. The findings of this research provide important information to company managers who desire to implement SCM in a multi-cultural setting such as Malaysia. The onus is on these managers to be cautious in developing a strategic plan for its effective implementation and also in designing programs to overcome SCM obstacles

Bmi1+ Progenitor Cell Dynamics in Murine Cornea During Homeostasis and Wound Healing

The outermost layer of the eye, the cornea, is renewed continuously throughout life. Stem cells of the corneal epithelium reside in the limbus at the corneal periphery and ensure homeostasis of the central epithelium. However, in young mice, homeostasis relies on cells located in the basal layer of the central corneal epithelium. Here, we first studied corneal growth during the transition from newborn to adult and assessed Keratin 19 (Krt19) expression as a hallmark of corneal maturation. Next, we set out to identify a novel marker of murine corneal epithelial progenitor cells before, during and after maturation, and we found that Bmi1 is expressed in the basal epithelium of the central cornea and limbus. Furthermore, we demonstrated that Bmi1+ cells participated in tissue replenishment in the central cornea. These Bmi1+ cells did not maintain homeostasis of the cornea for more than 3 months, reflecting their status as progenitor rather than stem cells. Finally, after injury, Bmi1+ cells fueled homeostatic maintenance, whereas wound closure occurred via epithelial reorganization. Stem Cells 2018

The impact of chromosomal translocation locus and fusion oncogene coding sequence in synovial sarcomagenesis.

Synovial sarcomas are aggressive soft-tissue malignancies that express chromosomal translocation-generated fusion genes, SS18-SSX1 or SS18-SSX2 in most cases. Here, we report a mouse sarcoma model expressing SS18-SSX1, complementing our prior model expressing SS18-SSX2. Exome sequencing identified no recurrent secondary mutations in tumors of either genotype. Most of the few mutations identified in single tumors were present in genes that were minimally or not expressed in any of the tumors. Chromosome 6, either entirely or around the fusion gene expression locus, demonstrated a copy number gain in a majority of tumors of both genotypes. Thus, by fusion oncogene coding sequence alone, SS18-SSX1 and SS18-SSX2 can each drive comparable synovial sarcomagenesis, independent from other genetic drivers. SS18-SSX1 and SS18-SSX2 tumor transcriptomes demonstrated very few consistent differences overall. In direct tumorigenesis comparisons, SS18-SSX2 was slightly more sarcomagenic than SS18-SSX1, but equivalent in its generation of biphasic histologic features. Meta-analysis of human synovial sarcoma patient series identified two tumor-gentoype-phenotype correlations that were not modeled by the mice, namely a scarcity of male hosts and biphasic histologic features among SS18-SSX2 tumors. Re-analysis of human SS18-SSX1 and SS18-SSX2 tumor transcriptomes demonstrated very few consistent differences, but highlighted increased native SSX2 expression in SS18-SSX1 tumors. This suggests that the translocated locus may drive genotype-phenotype differences more than the coding sequence of the fusion gene created. Two possible roles for native SSX2 in synovial sarcomagenesis are explored. Thus, even specific partial failures of mouse genetic modeling can be instructive to human tumor biology

A 3000-mile tour of mental toughness: An autoethnographic exploration of mental toughness intra-individual variability in endurance sport

This is the author accepted manuscript. The final version is available from Routledge via the DOI in this recordMental toughness has garnered considerable attention over the past two decades because of the perception that this psychological construct influences an athlete’s ability to strive, thrive, and survive in sport. However, few researchers have explored the lived experiences of mental toughness within endurance sport. Analysis of lived experiences could help reveal how an athlete demonstrates (or does not demonstrate) mental toughness in real-world settings and provide insights for researchers, coaches and athletes in the future. The current autoethnographic approach offers an alternative perspective to supplement the existing mental toughness literature, and provides the most appropriate format to analyze the within-person mental toughness element at the core of this research study. The study recounts and analyses the personal experience of mental toughness across a trilogy of cycling, triathlon, and running endurance events by a single athlete over a 5-month period. The main findings focus on the variability of perceived mental toughness at different stages of competition and training and identify potential factors driving the notable fluctuation in levels of mental toughness. Factors identified as increasing this within-person mental toughness included anger, love, competition, encouragement and the recognition of a last chance to achieve meaningful goals. These findings are expected to support future research into within-person mental toughness and the practical application across a broader spectrum of settings

Defining emergency department episodes by severity and intensity: A 15-year study of Medicare beneficiaries

Background. Episodes of Emergency Department (ED) service use among older adults previously have not been constructed, or evaluated as multi-dimensional phenomena. In this study, we constructed episodes of ED service use among a cohort of older adults over a 15-year observation period, measured the episodes by severity and intensity, and compared these measures in predicting subsequent hospitalization. Methods. We conducted a secondary analysis of the prospective cohort study entitled the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). Baseline (1993) data on 5,511 self-respondents 70 years old were linked to their Medicare claims for 1991-2005. Claims then were organized into episodes of ED care according to Medicare guidelines. The severity of ED episodes was measured with a modified-NYU algorithm using ICD9-CM diagnoses, and the intensity of the episodes was measured using CPT codes. Measures were evaluated against subsequent hospitalization to estimate comparative predictive validity. Results. Over 15 years, three-fourths (4,171) of the 5,511 AHEAD participants had at least 1 ED episode, with a mean of 4.5 episodes. Cross-classification indicated the modified-NYU severity measure and the CPT-based intensity measure captured different aspects of ED episodes (kappa = 0.18). While both measures were significant independent predictors of hospital admission from ED episodes, the CPT measure had substantially higher predictive validity than the modified-NYU measure (AORs 5.70 vs. 3.31; p < .001). Conclusions. We demonstrated an innovative approach for how claims data can be used to construct episodes of ED care among a sample of older adults. We also determined that the modified-NYU measure of severity and the CPT measure of intensity tap different aspects of ED episodes, and that both measures were predictive of subsequent hospitalization. © 2010 Kaskie et al; licensee BioMed Central Ltd

Rifampicin and clarithromycin (extended release) versus rifampicin and streptomycin for limited Buruli ulcer lesions: a randomised, open-label, non-inferiority phase 3 trial.

BACKGROUND: Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans infection that damages the skin and subcutis. It is most prevalent in western and central Africa and Australia. Standard antimicrobial treatment with oral rifampicin 10 mg/kg plus intramuscular streptomycin 15 mg/kg once daily for 8 weeks (RS8) is highly effective, but streptomycin injections are painful and potentially harmful. We aimed to compare the efficacy and tolerability of fully oral rifampicin 10 mg/kg plus clarithromycin 15 mg/kg extended release once daily for 8 weeks (RC8) with that of RS8 for treatment of early Buruli ulcer lesions. METHODS: We did an open-label, non-inferiority, randomised (1:1 with blocks of six), multicentre, phase 3 clinical trial comparing fully oral RC8 with RS8 in patients with early, limited Buruli ulcer lesions. There were four trial sites in hospitals in Ghana (Agogo, Tepa, Nkawie, Dunkwa) and one in Benin (Pobè). Participants were included if they were aged 5 years or older and had typical Buruli ulcer with no more than one lesion (caterories I and II) no larger than 10 cm in diameter. The trial was open label, and neither the investigators who took measurements of the lesions nor the attending doctors were masked to treatment assignment. The primary clinical endpoint was lesion healing (ie, full epithelialisation or stable scar) without recurrence at 52 weeks after start of antimicrobial therapy. The primary endpoint and safety were assessed in the intention-to-treat population. A sample size of 332 participants was calculated to detect inferiority of RC8 by a margin of 12%. This study was registered with ClinicalTrials.gov, NCT01659437. FINDINGS: Between Jan 1, 2013, and Dec 31, 2017, participants were recruited to the trial. We stopped recruitment after 310 participants. Median age of participants was 14 years (IQR 10-29) and 153 (52%) were female. 297 patients had PCR-confirmed Buruli ulcer; 151 (51%) were assigned to RS8 treatment, and 146 (49%) received oral RC8 treatment. In the RS8 group, lesions healed in 144 (95%, 95% CI 91 to 98) of 151 patients, whereas lesions healed in 140 (96%, 91 to 99) of 146 patients in the RC8 group. The difference in proportion, -0·5% (-5·2 to 4·2), was not significantly greater than zero (p=0·59), showing that RC8 treatment is non-inferior to RS8 treatment for lesion healing at 52 weeks. Treatment-related adverse events were recorded in 20 (13%) patients receiving RS8 and in nine (7%) patients receiving RC8. Most adverse events were grade 1-2, but one (1%) patient receiving RS8 developed serious ototoxicity and ended treatment after 6 weeks. No patients needed surgical resection. Four patients (two in each study group) had skin grafts. INTERPRETATION: Fully oral RC8 regimen was non-inferior to RS8 for treatment of early, limited Buruli ulcer and was associated with fewer adverse events. Therefore, we propose that fully oral RC8 should be the preferred therapy for early, limited lesions of Buruli ulcer. FUNDING: WHO with additional support from MAP International, American Leprosy Missions, Fondation Raoul Follereau France, Buruli ulcer Groningen Foundation, Sanofi-Pasteur, and BuruliVac

Yours ever (well, maybe): Studies and signposts in letter writing

Electronic mail and other digital communications technologies seemingly threaten to end the era of handwritten and typed letters, now affectionately seen as part of snail mail. In this essay, I analyze a group of popular and scholarly studies about letter writing-including examples of pundits critiquing the use of e-mail, etiquette manuals advising why the handwritten letter still possesses value, historians and literary scholars studying the role of letters in the past and what it tells us about our present attitudes about digital communications technologies, and futurists predicting how we will function as personal archivists maintaining every document including e-mail. These are useful guideposts for archivists, providing both a sense of the present and the past in the role, value and nature of letters and their successors. They also provide insights into how such documents should be studied, expanding our gaze beyond the particular letters, to the tools used to create them and the traditions dictating their form and function. We also can discern a role for archivists, both for contributing to the literature about documents and in using these studies and commentaries, suggesting not a new disciplinary realm but opportunities for new interdisciplinary work. Examining a documentary form makes us more sensitive to both the innovations and traditions as it shifts from the analog to the digital; we can learn not to be caught up in hysteria or nostalgia about one form over another and archivists can learn about what they might expect in their labors to document society and its institutions. At one time, paper was part of an innovative technology, with roles very similar to the Internet and e-mail today. It may be that the shifts are far less revolutionary than is often assumed. Reading such works also suggests, finally, that archivists ought to rethink how they view their own knowledge and how it is constructed and used. © 2010 Springer Science+Business Media B.V