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Summary The aim of the study was to examine the efficacy and safety of temazepam on nocturnal oxygenation and next‐day performance at altitude. A double‐blind, randomized, cross‐over trial was performed in Thirty‐three healthy volunteers. Volunteers took 10 mg of temazepam and placebo in random order on two successive nights soon after arrival at 5000 m, following a 17‐day trek from 410 m. Overnight SaO2 and body movements, and next‐day reaction time, maintenance of wakefulness and cognition were assessed. Compared with placebo, temazepam resulted in a reduction in periodic breathing from a median (range) of 16 (0–81.3)% of the night to 9.4 (0–79.6)% (P = 0.016, Wilcoxon's signed‐rank test), associated with a small but significant decrease in mean nocturnal SaO2 from 78 (65–84)% to 76 (64–83)% (P = 0.013). There was no change in sleep latency (P = 0.40) or restlessness (P = 0.30). Temazepam had no adverse effect on next‐day reaction time [241 (201–380) ms postplacebo and 242 (204–386) ms post‐temazepam], maintenance of wakefulness (seven trekkers failed to maintain 40 min of wakefulness postplacebo, and four post‐temazepam), cognition or acute mountain sickness. At high altitude temazepam reduces periodic breathing during sleep without an adverse effect on next‐day reaction time, maintenance of wakefulness or cognition. The 2% reduction in mean SaO2 post‐temazepam is likely to be predominantly because of acclimatization, as by chance more trekkers took temazepam on the first night (19 versus 14). We conclude that at high altitude temazepam is effective in reducing periodic breathing, and is safe to use, without any adverse effect upon next‐day performance.

PurposeFew companies have had the success that Toyota Motor Corporation has experienced over the past 70 years. Many give credit for Toyota's success to the company's famous Toyota Production System. Companies outside of Toyota have tried to implement versions of Toyota's system as Lean production; however, few companies have experienced the success of Toyota, and none have experienced Toyota's sustained success. In 2001, Toyota released a publication entitled The Toyota Way 2001 as a set of globalized standards of the culture that drives the success of the Toyota Production System.Design/methodology/approachThis research examines the effect of the Toyota Way on the implementation of Lean production outside of Toyota. A survey was developed and a study was performed on a sample of 349 participants with Lean experience. Structural equation modeling was used to test the relationship between the Toyota Way culture, Lean production, and achieving the desired Lean production system results.FindingsThe results of this research discovered that the existence of the Toyota Way culture has a significant and positive mediating effect on a Lean production system achieving the desired Lean results.Originality/valueThis research created a validated survey instrument that can be used to evaluate and understand the status of a Lean implementation initiative based upon employee perception. The results of this study support assertions made by Lean practitioners and previous research stating that culture affects the level of success of Lean production system implementation. While this may not seem like breaking news, prior to this study no statistically validated research supporting such an assertion could be found. Furthermore, this research defines culture very specifically as the Toyota Way culture as outlined in The Toyota Way 2001.

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Compression socks have become a popular recovery aid for distance running athletes. Although some physiological markers have been shown to be influenced by wearing these garments, scant evidence exists on their effects on functional recovery. This research aims to shed light onto whether the wearing of compression socks for 48 hours after marathon running can improve functional recovery, as measured by a timed treadmill test to exhaustion 14 days following marathon running. Athletes (n = 33, age, 38.5 ± 7.2 years) participating in the 2012 Melbourne, 2013 Canberra, or 2013 Gold Coast marathons were recruited and randomized into the compression sock or placebo group. A graded treadmill test to exhaustion was performed 2 weeks before and 2 weeks after each marathon. Time to exhaustion, average and maximum heart rates were recorded. Participants were asked to wear their socks for 48 hours immediately after completion of the marathon. The change in treadmill times (seconds) was recorded for each participant. Thirty-three participants completed the treadmill protocols. In the compression group, average treadmill run to exhaustion time 2 weeks after the marathon increased by 2.6% (52 ± 103 seconds). In the placebo group, run to exhaustion time decreased by 3.4% (-62 ± 130 seconds), P = 0.009. This shows a significant beneficial effect of compression socks on recovery compared with placebo. The wearing of below-knee compression socks for 48 hours after marathon running has been shown to improve functional recovery as measured by a graduated treadmill test to exhaustion 2 weeks after the event.

Exercise-associated hyponatremia was found to occur in 4.5% of the study group and was associated with weight gain during a prolonged bike ride. Postride [Na+] varied inversely with weight change and with fluid intake. Three of 4 hyponatremic riders had significant elevations of [NT-proBNP]. These results support the hypothesis that overconsumption of hypotonic fluids in this setting is the most important cause of EAH.

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