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Beyond the Wall: A Comprehensive Meta-Analysis of Metacognitive Strategies, Executive Function, and Psychological Resilience in Ultrarunning Performance
Full text linkThe discipline of ultrarunning, encompassing all footraces exceeding the standard marathon distance of 42.195 kilometers, represents a singular intersection of physiological extremity and cognitive endurance. As participation rates in events ranging from 50 kilometers to multi-day endeavors have surged by over 345 percent in the last decade, the scientific community has increasingly turned its attention to the psychological determinants of performance in this domain.1 While physiological metrics such as maximal oxygen uptake and lactate threshold provide the requisite biological platform for endurance, a growing body of peer-reviewed literature suggests that cognitive control mechanisms, specifically metacognition, serve as the ultimate arbiter of success in events where metabolic and muscular fatigue are guaranteed. This meta-analysis synthesizes data from disparate studies to construct a unified framework of the "ultra mindset." It scrutinizes the transition from classical associative and dissociative attentional models to complex metacognitive self-regulation, examines the distinct psychological profiles of elite versus non-elite practitioners, and evaluates the degradation of executive function under conditions of sleep deprivation and extreme fatigue. The analysis reveals that elite performance is characterized not by an insensitivity to pain, but by a nuanced, metacognitive engagement with internal sensory data, characterized by low emotional reactivity and high self-regulatory efficacy. Furthermore, this report identifies significant gaps in methodological approaches, specifically the reliance on retrospective recall, and proposes new directions for real-time cognitive monitoring in endurance sports
Prevalence and risk factors of diarrhea among young children in Kenya’s drylands: A longitudinal study
Full text linkDiarrhea is the third leading cause of malnutrition and mortality among children under five globally. Environmental and socioeconomic conditions in the drylands of sub-Saharan Africa may increase the risk of diarrhea, yet few studies have examined the factors in these settings. We therefore aimed to estimate the prevalence of diarrhea and identify potential risk factors among young children in Kenya drylands. Data are from a longitudinal population-based study conducted in Turkana County, Kenya. Surveys were implemented across six waves (May 2021 to September 2023) among 1211 households with children under 36 months at baseline. Caregivers reported on household conditions and episodes of diarrhea in the prior two weeks. Prevalence trends were examined by survey zone, livelihood zone, and child age and sex. Multivariable logistic regressions with generalized estimating equations were used to access distal, intermediate, proximal, and immediate risk factors and reported adjusted odds ratio (AOR) together with the associated 95% confidence interval (CI). Diarrhea prevalence declined significantly over time, from 32.1% at baseline to 8.7% at end of the study. Factors associated with higher odds of diarrhea included caregiver alcohol consumption [AOR = 1.28, 95% CI: 1.02–1.60], child malnutrition (wasting: AOR = 1.20, 95% CI: 1.04–1.39; stunting: AOR = 1.40 95% CI: 1.19–1.65; underweight: AOR = 1.29, 95% CI: 1.11–1.49), household shocks (biological: AOR = 1.37, 95% CI: 1.20–1.57; climatic: AOR = 1.18, 95% CI: 0.93–1.50; conflict: AOR = 1.60, 95% CI: 1.40–1.83), and moderate (AOR = 1.25, 95% CI: 1.04–1.50) or high-water insecurity (AOR = 1.46, 95% CI: 1.19–1.81) relative to no-to-marginal household water insecurity. Protective factors included greater child age (AOR = 0.97, 95% CI: 0.96–0.98), receipt of vitamin A supplementation (AOR = 0.77, 95% CI: 0.66–0.89), deworming (AOR = 0.88, 95% CI: 0.75–1.02), and caregiver handwashing after toilet use (AOR = 0.83, 95% CI: 0.70–0.98). These findings highlight the multifactorial drivers of childhood diarrhea in drylands and underscore the need for integrated interventions that improve water security, strengthen nutrition, support hygiene practices, and enhance resilience to household shocks
Adapting the EAT-Lancet diet for West Africa: protein quality and micronutrient inadequacies improved through nutrient dense foods
Full text linkThe EAT-Lancet planetary health diet was designed as a universal nutritionally adequate diet with minimal environmental impact. We aim to assess and propose revisions to increase its nutrient adequacy in the context of West Africa based on the local food supply. We created a model EAT-Lancet diet using nutrient composition data from the FAO's Food Composition Tables for Western Africa (WAFCT). Median energy and nutrient profiles of EAT-Lancet diet food groups were calculated using WAFCT foods (n = 596). Protein content was adjusted using the Protein Digestibility Corrected Amino Acid Score (PDCAAS). We multiplied the recommended EAT-Lancet diet intake for each food subgroup by these medians to determine daily nutrient intake. Nutrient adequacy was determined based on alignment with the FAO Codex nutrient reference values for adults. The Nutrient Rich Food (NRF) index, based on priority micronutrients, defined nutrient density. Isocaloric revisions were made to the EAT-Lancet diet to enhance its nutrient adequacy using WAFCT foods. Total energy of the modeled diet was 2,516 kcal/day. Total protein was 87 g/day while PDCAAS corrected protein was 62 g/day. Micronutrient shortfalls were observed for zinc, calcium, and vitamin A but not for iron, folate, and vitamin B12. Increasing intake of nutrient-rich liver, small dried fish, and pulses, while reducing whole grains and tree nuts, achieved micronutrient adequacy. When analyzed using foods available in West Africa, the EAT-Lancet diet may provide adequate protein but not vitamin A, zinc, and calcium. Future iterations of the diet should consider including categories for micronutrient dense foods to ensure adequacy
Advancing Ultrasound Superharmonic Imaging Towards Clinical Translation
Full text linkThe microvasculature holds important information for improved early detection of disease. Early detection greatly improves survival outcomes, such as in breast cancer where survival rates increase significantly when tumors are detected in the early stages of development. Superharmonic imaging is a contrast-enhanced ultrasound imaging technique specifically designed to image microvasculature. Using dual-frequency band transducers, it exploits the nonlinear echoes of microbubbles at superharmonic frequencies to achieve significantly higher vascular sensitivity than other medical imaging modalities. Additionally, it retains the hallmark advantages of ultrasound in safety, accessibility, and temporal resolution. However, its clinical translation has been hindered by poorly optimized hardware and limited image processing. This dissertation directly addresses these limitations towards advancing superharmonic imaging to clinical use. First, dual-frequency transducer parameters are evaluated in vitro and in vivo to increase imaging depth and improve imaging sensitivity. The deepest application of superharmonic imaging (up to 55 mm) while maintaining high sensitivity (with contrast signal enhancement 30 dB) is demonstrated. Second, the advantage of superharmonic imaging for ultrasound localization microscopy (ULM) to image at resolutions beyond the diffraction limit is investigated in a rodent kidney. Direct comparison with traditional ULM processing based on Singular Value Decomposition shows improved detection of low-velocity vessels using superharmonic ULM. Last, deep learning analysis using convolutional neural networks is applied to streamline tumor detection in superharmonic volumes at high accuracies (up to 92.8%). Gradient-based class-activation visualization also reveal qualitative and quantitative correlation between network attention and vascular morphology metrics, offering potentially interpretable models for clinical decision support in oncology. Together, these innovations in dual-frequency transducer design, ULM processing, and deep-learning-based image analysis elevate superharmonic imaging towards clinical translation as a high-resolution, high-sensitivity, and computationally efficient method for microvascular imaging.Doctor of Philosoph
The Genitourinary Pathology Society and International Society of Urological Pathology Joint Expert Consultation Recommendations on intraductal carcinoma of the prostate
Full text linkConflicting practice recommendations regarding the grading of intraductal carcinoma of the prostate (IDCP) from two leading uropathology societies, the Genitourinary Pathology Society (GUPS) and the International Society of Urological Pathology (ISUP), are confusing for both pathologists and treating clinicians. The objectives of this consultation were to clarify unresolved issues regarding IDCP and atypical intraductal proliferation (AIP) terminology, diagnostic criteria, grading, and management implications, as well as to develop uniform reporting guidelines for IDCP and AIP, endorsed by both societies. A 32‐member expert panel, composed of five core members, 25 expert urological pathologists, and two expert urologists, employed a modified Delphi process consisting of multiple rounds of consultation and voting. These were supplemented by discussions at the 2025 United States and Canadian Academy of Pathologists Annual Meeting to achieve expert consensus (defined as at least 67% agreement). Consensus was reached on several key issues. IDCP was regarded most commonly as reflecting the retrograde spread of invasive prostate cancer (PCa). IDCP diagnosis should be based on the Guo and Epstein criteria, supported by basal cell immunohistochemistry in cases that are difficult to distinguish from invasive PCa. The term AIP should be used only in equivocal proliferations where IDCP is favoured but the criteria are not fully met, and these should be reported as ‘AIP, suspicious for IDCP’. In the presence of invasive PCa, IDCP should generally be incorporated into Gleason grading irrespective of Grade Group (GG). However, a significant minority (30%) favoured excluding IDCP from the Gleason score if the invasive component was solely Gleason pattern (GP) 3. Pure IDCP (not associated with invasive PCa) and AIP, suspicious for IDCP, should not be graded. IDCP should not be incorporated in the grading of invasive PCa when it is spatially distinct from invasive PCa. A second opinion from a senior or dedicated GU pathologist and discussion within a multidisciplinary management setting should be considered, in the rare settings of pure IDCP or GP3 + IDCP (formerly GG1 + IDCP scenario). This joint GUPS–ISUP consultation provides unified recommendations for the diagnosis, terminology, grading, and reporting of IDCP and AIP, and will pave the way for the development of future IDCP/AIP WHO guidelines. Their adoption should reduce interobserver variation, facilitate consistent communication with clinicians, and improve patient management.The GUPS–ISUP joint expert consultation on IDCP provides unified recommendations for the diagnosis, terminology, grading, and reporting of IDCP and atypical intraductal proliferation. Their adoption should reduce interobserver variation, facilitate consistent communication with clinicians, and improve patient management
Expanding Access via Transit Through Street Network Investments
Full text linkEvaluating changes to transit service using accessibility metrics is increasingly common. However, these metrics are almost always used to evaluate changes to the transit service itself. Almost every transit user is also a pedestrian at some point when accessing or egressing from a stop. In this article, I apply an automated algorithm to identify locations in the pedestrian network where adding an additional link would improve transit accessibility. I then evaluate these locations in terms of their impact on accessibility to jobs via transit, combining both the pedestrian network and the transit service to evaluate the real-world impact of these changes.
Improving accessibility via transit through street network improvements is an attractive proposition, because unlike service improvements street network improvements have minimal ongoing costs. Furthermore, many pedestrian network improvements (e.g. crosswalks or sidewalks) are relatively low cost compared to capital investment in transit service
A protocol for using rapid qualitative techniques to incorporate multi-level stakeholder feedback in a pragmatic clinical trial of mindfulness for chronic low back pain
Full text linkIntroduction Engaging community members and context experts is increasingly recognized as key to developing research that is responsive to community needs. Here, we describe a protocol for incorporating stakeholder feedback using rapid qualitative techniques into OPTIMUM (Optimizing Pain Treatment In Medical settings Using Mindfulness), a pragmatic clinical trial comparing a telemedicine-delivered mindfulness-based stress reduction intervention to usual care to address chronic low back pain. The aim of this stakeholder feedback supplement to the OPTIMUM parent trial is to consider many viewpoints regarding recruitment, retention, facilitation, delivery, sustainability, and dissemination of this program which are critical to understand before it can be successfully implemented. Methods Our team developed a multi-faceted approach to collecting feedback from representatives of three levels of influence: individuals, communities, and policy. We plan to conduct focus groups with study participants from both the intervention (MBSR) and usual care groups. We plan to conduct one-time semi-structured interviews with a diverse set of people with varied roles and perspectives (e.g., clinic personnel, health care system leadership, mindfulness instructors, patient pain advocacy groups, policy advocates). We will assemble a Community Advisory Board (CAB) to convene regularly throughout the project. Transcripts from interviews, focus groups, and meeting notes will be analyzed using rapid qualitative methods to facilitate timely incorporation of feedback into the trial. In-depth thematic content analysis will be conducted subsequently. Discussion Partnering with communities who are historically underrepresented in clinical research under the guidance of principles such as equity, inclusion, trust, and accountability can improve health outcomes that are most relevant and beneficial to the target community, accelerate uptake, and promote sustainability
The Association Between Urbanization and Frailty Status in China
Full text linkBackground: A frailty index (FI) can identify individuals with frailty in a population of interest. Previous literature suggests a need for frailty assessment methods for older adults in China and that urbanization may impact frailty status. We used a FI to examine the association between frailty and urbanization as living in a less urbanized area may put older adults at a higher risk frailty and poor healthcare outcomes. Methods: We included adults aged 55 years and older (n = 7695) from the China Health and Nutrition Survey (2018). The FI was based on health outcomes correlating with a deficit score divided by number of health items: robust (<0.08), pre-frail (0.08–0.24), and frail (≥0.25). We used multinomial logistic regression models to examine associations between urbanization tertile (low, medium, and high) and frailty, using our novel FI. We also conducted sub-analyses examining how urbanization level modifies the relationship between frailty status and region of residence, and education and income levels. Results: Living in an area of low versus high urbanization was associated with higher odds of frail versus robust (1.5; 1.2–2.0), and pre-frail versus robust (1.6; 1.4–2.0) status in the fully adjusted model. Generally, higher odds of worse frailty status (e.g., pre-frail or frail) was associated with lower tertiles of urbanization for region, income, and education when compared to the highest urbanization tertile. Conclusions: A FI can help identify specific characteristics that may benefit from individualized interventions to counteract frailty. Living in less urbanized areas was associated with higher odds of pre-frailty and frailty. Inclusion of urbanization level, geographic residence, and social determinants of health in FI development can help identify older adults most at risk of frailty and contribute to individual and policy-level frailty prevention interventions
Wave VI Neurodegeneration
Full text linkThis document summarizes the rationale, equipment, protocol, assay, internal quality control, data cleaning, external quality control, and procedures for the measurement and classification of neurodegeneration at the Wave VI home exam. Whenever possible, data collection and methods in Wave VI mirrored those of Wave V to ensure comparability of data between waves, although important inter-Wave differences between Waves V-VI exist and are grey-highlighted herein. This document is one in a set of Wave VI user guides.
The effects of biological sex on fatigue during and recovery from resistance exercise
Full text linkBackground Guidelines for resistance training prescription do not often consider sex as it relates to exercise prescription, despite its potential influence on responses to and adaptations following resistance training. If there are sex differences in the rate at which males and females fatigue during a resistance training session, or the rate at which they recover from resistance training between sessions, optimal resistance training volume may differ between the sexes. The purpose of this study was to investigate sex differences in fatigability and recovery from dynamic resistance exercise. Methods Male and female subjects with at least one year of bench press experience (N = 21 males and 21 females) performed a fatigue protocol consisting of barbell bench press with 75% 1RM loads for sets of five repetitions, with 90 seconds between sets, until the point of concentric failure. Recovery was monitored for the subsequent 72 hours using subjective ratings of soreness for the pectoral muscles, triceps, and anterior deltoids, and estimated 1RM strength derived from load-velocity profiles.ResultsThe female subjects completed more reps during the fatigue protocol (females: 58.3 ± 27.3; males: 29.6 ± 10.6; p = 0.0001), but post-training soreness and recovery of estimated 1RM strength did not significantly differ between sexes (p > 0.05). Conclusion Our results suggest that females fatigue slower than males during multiple sets of bench press yet appear to recover from training at the same rate in spite of completing a higher relative workload. Furthermore, the difference in performance during the fatigue protocol appears to be attributable to the female subjects recovering more quickly during the rest intervals, rather than fatiguing more slowly while performing each set