Rationale and study design for lifestyle intervention in preparation for pregnancy (LIPP): A randomized controlled trial

INTRODUCTION

Maternal obesity increases neonatal risk for obesity and metabolic syndrome later in life. Prior attempts to break this intergenerational obesity cycle by limiting excessive gestational weight gain have failed to reduce neonatal adiposity. Alternatively, pre-conception lifestyle interventions may improve the in utero metabolic milieu during early pregnancy leading to improved fetal outcomes. This randomized controlled trial (RCT) is evaluating whether a lifestyle intervention to reduce weight and improve maternal metabolism in preparation for pregnancy (LIPP) attenuates neonatal adiposity, compared to standard medical advice.

MATERIAL AND METHODS

Overweight/class 1 obese women after a previous pregnancy, ~12 weeks postpartum, preparing for a subsequent pregnancy, will be block randomized (1:1) to either LIPP or standard of care in a parallel design. Randomization is stratified by lactation status and overweight vs. class 1 obesity. The LIPP program consists of intensive short-term weight loss followed by weight maintenance until conception using supervised exercise and a low glycemic Mediterranean diet.

PRIMARY OUTCOMES

Group differences in neonatal adiposity at birth assessed by PEA POD and placental mitochondrial lipid metabolism.

SECONDARY OUTCOMES

Group differences in maternal pregravid and gestational body composition, insulin sensitivity, β-cell function, fasting metabolic and inflammatory biomarkers, and overall quality of life. Exploratory outcomes include umbilical cord blood insulin resistance, lipid profile and inflammation.

DISCUSSION

This RCT will determine the efficacy of maternal weight loss prior to pregnancy on reducing neonatal adiposity. Findings may change standard obstetrical care by providing Level 1 evidence on lifestyle interventions improving neonatal outcomes for women planning for pregnancy.

CLINICAL TRIAL REGISTRATION

NCT03146156.

Drinking water quality in the glacial aquifer system, northern USA

Groundwater supplies 50% of drinking water worldwide, but compromised water quality from anthropogenic and geogenic contaminants can limit usage of groundwater as a drinking water source. Groundwater quality in the glacial aquifer system, USA (GLAC), is presented in the context of a hydrogeologic framework that divides the study area into 17 hydrogeologic terranes. Results are reported at aquifer-system scale and regional (terrane) scale. This paper presents a quantitative assessment of groundwater quality in the GLAC using data from numerous sources for samples collected 2005-2013, compared to health-based and aesthetic (non-health) benchmarks, and evaluated with areal and population metrics. Concentrations above a benchmark are considered high. Trace elements are widespread across the study area, with an estimated 5.7 million people relying on groundwater with high concentrations of one or more trace elements; manganese and arsenic are most often at high concentration. Nitrate is found at high concentration in 4.0% of the study area, serving about 740 thousand people. Organic compounds including pesticides and volatile organic compounds are high in 2.0% of the assessed study area, with about 870 thousand people relying on groundwater with high concentrations of an organic compound. High arsenic and manganese concentrations occur primarily in the terranes with thick, stratigraphically complex, fine-grained glacial sediment, coincident with groundwater under reducing conditions (indicated by iron concentrations >100 μg/L); high nitrate is uncommon in those same terranes. When nitrate is high in thick, fine-grained, complex terranes, though, it is much more commonly associated with groundwater under more oxidizing conditions. Common geogenic trace elements occur at high concentration due to characteristic geologic and geochemical conditions. Conversely, anthropogenic nitrate and organic compounds are introduced at or near the land surface. High concentrations of nitrate or organic compounds are generally limited to areas in proximity where people live and use the chemicals.

Isolation and extreme sex-specific expression of cytochrome P450 genes in the bark beetle, Ips paraconfusus, following feeding on the phloem of host ponderosa pine, Pinus ponderosa

We have identified cDNAs and characterized the expression of 13 novel cytochrome P450 genes of potential importance in host colonization and reproduction by the California fivespined ips, Ips paraconfusus. Twelve are of the Cyp4 family and one is of the Cyp9 family. Following feeding on host Pinus ponderosa phloem, bark beetle transcript levels of several of the Cyp4 genes increased or decreased in males only or in both sexes. In one instance (IparaCyp4A5) transcript accumulated significantly in females, but declined significantly in males. The Cyp9 gene (Cyp9T1) transcript levels in males were > 85 000 x higher at 8 h and > 25 000 x higher at 24 h after feeding compared with nonfed controls. Transcript levels in females were approximately 150 x higher at 24 h compared with nonfed controls. Cyp4G27 transcript was present constitutively regardless of sex or feeding and served as a better housekeeping gene than beta-actin or 18S rRNA for the real-time TaqMan polymerase chain reaction analysis. The expression patterns of Cyp4AY1, Cyp4BG1, and, especially, Cyp9T1 in males suggest roles for these genes in male-specific aggregation pheromone production. The differential transcript accumulation patterns of these bark beetle P450s provide insight into ecological interactions of I. paraconfusus with its host pines.

Discrimination functions: can they be used to classify singing voices?

Researchers long have searched for invariant acoustic features that can be used to identify singing voice categories or even individual singers. Few researchers have examined how listeners perceive singing voice categories or individual voices. Timbre, the most studied perceptual dimension of the singing voice, is generally believed to vary systematically between singing voice categories but is often assumed to be invariant with an individual singer. To test this assumption, 2 mezzo-sopranos and 2 sopranos were recorded singing the vowel /a/ on the pitches A3, C4, G4, B4, F5, and A5. Trials of three stimuli were constructed. Two of the three stimuli in each trial were produced by the same singer at two different pitches (X1 and X2), while the third stimulus was produced by a different singer (Y). Three X1X2 conditions were created: (1) G4, B4; (2) C4, F5; and (3) A3, A5. For each singer and each condition, Y was varied across the three remaining singers and across all six pitches. Experienced and inexperienced listeners were asked to identify which stimulus was produced by the "odd" person. The ability to correctly choose the odd person varied greatly depending on pitch factors, suggesting that the traditional concept of an invariant timbre associated with a singer is inaccurate and that vocal timbre must be conceptualized in terms of transformations in perceived quality that occur across an individual singer's range and/or registers.

Simultaneous effects on vowel duration in American English: a covariance structure modeling approach

The powerful techniques of covariance structure modeling (CSM) long have been used to study complex behavioral phenomenon in the social and behavioral sciences. This study employed these same techniques to examine simultaneous effects on vowel duration in American English. Additionally, this study investigated whether a single population model of vowel duration fits observed data better than a dual population model where separate parameters are generated for syllables that carry large information loads and for syllables that specify linguistic relationships. For the single population model, intrinsic duration, phrase final position, lexical stress, post-vocalic consonant voicing, and position in word all were significant predictors of vowel duration. However, the dual population model, in which separate model parameters were generated for (1) monosyllabic content words and lexically stressed syllables and (2) monosyllabic function words and lexically unstressed syllables, fit the data better than the single population model. Intrinsic duration and phrase final position affected duration similarly for both the populations. On the other hand, the effects of post-vocalic consonant voicing and position in word, while significant predictors of vowel duration in content words and stressed syllables, were not significant predictors of vowel duration in function words or unstressed syllables. These results are not unexpected, based on previous research, and suggest that covariance structure analysis can be used as a complementary technique in linguistic and phonetic research.

Do earthworms help to sustain the slug predator Pterostichus melanarius (Coleoptera: carabidae) within crops? Investigations using monoclonal antibodies

Earthworms provide a major potential source of alternative food for polyphagous predators, such as carabid beetles, that are natural enemies of slugs, aphids and other agricultural pests. Non-pest prey may foster larger numbers of natural enemies, which then help to control pests, or alternatively may help to divert the predators away from pest control. An earthworm-specific monoclonal antibody was developed to study carabid-earthworm interactions in the field and assess the role of earthworms as alternative prey. The antibody could identify as little at 7 ng of earthworm protein in an ELISA, and could detect earthworm remains in the foregut of the carabid beetle Pterostichus melanarius for 64 h after consumption. Thirty-six per cent of field-collected beetles contained earthworm remains. Quantities of earthworm proteins in the beetle foreguts were negatively related to total foregut biomass, suggesting that earthworm consumption increased as total prey availability declined. There was also a negative relationship between foregut biomass and beetle numbers, but both quantities and concentrations of earthworm proteins in beetle foreguts were positively related to beetle numbers. This suggests that as beetle activity-density increased, total prey availability declined, or, as prey availability declined, beetles spent more time searching. In these circumstances, beetles fed to a greater extent on earthworms, an acceptable but nonpreferred food item. Earthworms may, therefore, provide an ideal alternative prey for P. melanarius, helping to sustain it when pest numbers are low but allowing it to perform a 'lying-in-wait' strategy, ready to switch back to feeding on pests when they become available.

Endometrial sampling techniques in the diagnosis of abnormal uterine bleeding

There have been many advances in sampling of the endometrium. Ideas and technologies have evolved, increasing our ability to gather adequate specimens that provide reliable information about uterine cavity pathologies. No technique surpasses the sensitivity and specificity of hysteroscopy with directed biopsy. Owing to its superior diagnostic potential, hysteroscopy, even when performed in the office with narrow scopes (not significantly larger in diameter than the Pipelle catheter), leads to precise diagnosis and appropriate management of intrauterine pathologic conditions. For physicians who are untrained or lacking the equipment to perform diagnostic hysteroscopy with directed biopsy, simple in-office endometrial sampling techniques with no visual control provide a means to obtain reasonably reliable samples with negligible patient discomfort.

Global endometrial ablation technologies

The value of extirpative surgery for excessive uterine bleeding is questionable. A number of technologies have been developed that destroy the endometrial lining while preserving the uterus. This article compares and contrasts multiple modalities of global endometrial ablation technology.

Amplified detection, using a monoclonal antibody, of an aphid-specific epitope exposed during digestion in the gut of a predator

Monoclonal antibodies are invaluable tools for identifying and quantifying prey remains in the fore-guts of predators. However, they must be target-specific, detect an epitope that is well replicated within the prey (to enhance assay sensitivity) and, critically, recognise a site that can resist digestion. A monoclonal antibody is reported that proved to be aphid-specific and capable of detecting, and accurately identifying, as little as 16.5 ng of aphid protein within a heterologous mixture of invertebrate material. The antibody was selected by screening hybridoma lines for antibodies that bound with semi-digested aphid proteins. The antibody detected an epitope that was found, against expectation, to significantly increase in concentration with time (by approx. 50% over 6 h) in the gut of the carabid predator Pterostichus melanarius. The resultant extended antigen detection period and half-life, and the high specificity of this antibody, showed it to be an enhanced tool for studying interactions between aphids and their predators in the field. It was concluded that the antibody was initially generated to a surface epitope on a high molecular weight native protein (> 200 kD). This epitope, however, was then either replicated on internal sites progressively revealed by digestion, or new epitopes became available as the conformation of the protein changed during digestion.