Review of Speaking of Jack: A C. S. Lewis Discussion Guide

Review of: Will Vaus, Speaking of Jack: A C. S. Lewis Discussion Guide (Hamden, CT: 2011). 278 pages. $15.00. ISBN: 9781936294121

Early Life Energy Balance: The Development of Infant Energy Expenditure and Intake in the Context of Obesity

Purpose of Review: This review aims to provide a summary of the current knowledge on measurement tools and most recent evidence for prenatal and postnatal modulators of energy balance in young infants. Recent Findings: The prevention of pediatric obesity depends upon curating the perfect imbalance of energy intake to energy expenditure, taking into consideration the energy needs for healthy growth. We summarize the recent evidence for the programming of fetal and infant metabolism influenced by maternal preconception health, prenatal metabolic milieu, and physical activity behaviors. In the early postnatal environment, caregiver feeding behaviors shape the extent of energy imbalance through dictating quantity and modality of infant energy intake. Summary: There are biological and behavioral contributors to improper infant energy imbalance. Furthermore, caregiver and clinician education on overfeeding and clinical tools to prescribe and monitor infant overgrowth are absent. Ultimately, the lack of high-quality and modern research of infant energy expenditure underpins the lack of advancement in clinical guidelines and the needed prevention of pediatric obesity

A submillimetre survey of the kinematics of the Perseus molecular cloud - III. Clump kinematics

We explore the kinematics of continuum clumps in the Perseus molecular cloud, derived from C18O J=3-2 data. Two populations are examined, identified using the automated algorithms CLFIND and GAUSSCLUMPS on existing SCUBA data. The clumps have supersonic linewidths with distributions which suggest the C18O line probes a lower-density 'envelope' rather than a dense inner core. Similar linewidth distributions for protostellar and starless clumps implies protostars do not have a significant impact on their immediate environment. The proximity to an active young stellar cluster seems to affect the linewidths: those in NGC1333 are greater than elsewhere. In IC348 the proximity to the old IR cluster has little influence, with the linewidths being the smallest of all. A virial analysis suggests that the clumps are bound and close to equipartition. In particular, the starless clumps occupy the same parameter space as the protostars, suggesting they are true stellar precursors and will go on to form stars. We also search for ordered C18O velocity gradients across the face of each core, usually interpreted as rotation. We note a correlation between the directions of the identified gradients and outflows across protostars, indicating we may not have a purely rotational signature. The fitted gradients are larger than found in previous work, probably as a result of the higher resolution of our data and/or outflow contamination. These gradients, if interpreted solely in terms of rotation, suggest that rotation is not dynamically significant. Furthermore, derived specific angular momenta are smaller than observed in previous studies, centred around j~0.001 km/s pc, which indicates we have identified lower levels of rotation, or that the C18O J=3-2 line probes conditions significantly denser and/or colder than n~10^5 per cc and T~10 K.Comment: 20 pages, 20 figures, accepted for publication by MNRAS. Supplementary, on-line only material available from http://www.mrao.cam.ac.uk/~eic22/Papers/CR10b_suppmaterial.pd

Precision Nutrition for Management of Cardiovascular Disease Risk during Menopause

Background:Women can spend up to 40%of their lives in the postmenopausal state. As women begin to transition into menopause, known as perimenopause, changes in hormonal concentrations and body composition dramatically increase overall cardiometabolic risk. Dietary patterns and interventions can be utilized to prevent and treat cardiovascular disease (CVD) and some dietary patterns over others may be more beneficial due to their specific effects on the health aspects of menopause. In this narrative review, we summarize key cardiovascular alterations that occur during the menopause transition and explore current dietary recommendations to address CVD risk aswell as explore the newfrontier of precision nutrition and the implications for nutrition prescription during menopause. Summary: Popular dietary interventions for CVD such as the Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean diet (MED) have limited data in women following menopause. However, both diets improve CVD risk biomarkers of total cholesterol and low-density lipoprotein cholesterol as well as lower oxidative stress and inflammation and improve endothelial function. As the menopause transition increases the risk for developing metabolic syndrome, insulin insensitivity, and dyslipidemia, the DASH diet and MED may be impactful dietary strategies for mediating CVD risk in menopausal women. However, these are one-size-fits-all approaches that neglect individual characteristics such as genetic predisposition and environmental factors. Precision nutrition considers individual factors for nutrition prescription, spanning from evaluating food intake preferences and behaviors to deep phenotyping. Data from a large-scale investigation of the menopause transition suggests nutritional strategies that address postprandial glycemic responses, and the gut microbiome may attenuate some of the unfavorable effects of menopause on CVD risk factors. Key Messages: Considering menopause, women are a clinical population that would greatly benefit from precision nutrition. Future research should explore the use of machine learning and artificial intelligence in a precision nutrition framework to modify the DASH diet and MED to address adverse effects that occur during the menopause transition are vital for supporting women\u27s health as they age

Energetics of a World-Tour Female Road Cyclist During a Multistage Race (Tour de France Femmes)

Despite the increased popularity of female elite road cycling, research to inform the fueling requirements of these endurance athletes is lacking. In this case study, we report for the first time the energetics of a female world-tour cyclist competing in the 2023 Tour de France Femmes, an 8-day race of the Union Cycliste Internationale. The 29-year-old athlete presented with oligomenorrhea and low T3 before the race. Total daily energy expenditure assessed with the doubly labeled water technique was 7,572 kcal/day (∼4.3 physical activity levels), among the highest reported in the literature to date for a female. Crank-based mean maximal power was consistent with female world-tour cyclists (5 min, mean 342W, 4.8 W/kg; 20 min 289W, 4.1 W/kg). The average daily energy intake measured with the remote food photography method (Stage Days 1-7) was 5,246 kcal and carbohydrate intake was 13.7 g/kg (range 9.7-15.9 g/kg), and 84 g/hr during stages, and an average fat intake of 15% of daily energy intake. An estimated 2,326 kcal/day energy deficit was evidenced in a 2.2 kg decrease in body mass. Notwithstanding the high carbohydrate intake, the athlete was unable to match the energy requirements of the competition. Despite signs of energy deficiency preexisting (oligomenorrhea and low T3), and other further developing during the race (weight loss), performance was in line with that of other world-tour cyclists and a best personal performance was recorded for the last stage. This case study emphasizes the need for further research to inform energy requirements for female athletes\u27 optimal performance and health

Assessment of Eating Behaviors and Perceptions of Time-Restricted Eating During Pregnancy

Background: The maternal metabolic milieu is challenged during pregnancy and may result in unwarranted metabolic complications. A time-restricted eating (TRE) pattern may optimize the metabolic response to pregnancy by improving glucose metabolism and reducing circulating glucose concentrations, as it does in nonpregnant individuals. Objectives: The objectives of this study were to 1) assess eating timing in pregnant women; 2) understand the perceptions of adopting a TRE pattern; 3) determine the barriers and support mechanisms for incorporating a TRE pattern; and 4) identify those most willing to adopt a TRE pattern during pregnancy. Methods: This was a cross-sectional quantitative and quasi-qualitative online survey study for women who were pregnant at the time of study completion or had given birth in the prior 2 years. Group analyses were performed based off willingness to try a TRE pattern using chi-squared analyses, independent samples t-tests, or an analysis of variance. Three separate reviewers reviewed qualitative responses. Results: A total of 431 women (BMI, 27.5 ± 0.3 kg/m2) completed the study. Of the participating women, 23.7% reported willingness to try a TRE pattern during pregnancy. Top barriers to adopting a TRE pattern during pregnancy were concerns for 1) safety; 2) nausea; and 3) hunger. The highest ranked support mechanisms were: 1) the ability to choose the eating window; 2) more frequent prenatal visits to ensure the health of the baby; and 3) receiving feedback from a dietician/nutritionist. Women who did not identify as White/Caucasian expressed a higher willingness to try a TRE pattern during pregnancy (P = 0.01). Women who were nulliparous expressed a higher willingness to try a TRE pattern (P = 0.05). Discussion: TRE, an alternative dietary strategy shown to optimize metabolic control, may be effective to prevent and manage pregnancy-related metabolic impairments. To create an effective TRE intervention during pregnancy, the input of pregnant mothers is necessary to increase adherence and acceptability

Understanding Barriers and Facilitators to Physical Activity Engagement to Inform a Precision Prescription Approach during Pregnancy

Physical activity during pregnancy is an important health behavior. However, many pregnant individuals are provided with little-to-no guidance to adequately engage in physical activity. The purpose of this quantitative and quasi-qualitative study of currently or previously pregnant women was to examine physical activity behaviors in pregnancy and understand barriers and facilitators to achieving physical activity recommendations. Overall, 431 women (18+ years), White/Caucasian (84.5%), married (84.9%), and currently pregnant (66.6%), completed an online survey study. Most women (69.4%) reported engaging in cardio-based physical activity and willing to engage in physical activity to meet guidelines between 2 and 5 days per week (77.4 –88.8%). The most frequently reported barriers were feeling too tired (72.8%) or uncomfortable (71.8%) and childcare needs (57.8%). Being able to choose time of day (96.0%), accessing home workouts (92.9%), and having a personalized prescription (95.6%) were the most reported facilitators. Open comment feedback resulted in additional barriers, such as ensuring proper energy intake, while motivation and support from other pregnant individuals were fundamental facilitators. Individualized physical activity prescription is lacking in routine prenatal care. To support pregnant individuals to achieve physical activity recommendations, developing a prescription with suitable modalities, at-home options, and consideration for physical activity timing are required

Precision Interventions Targeting the Maternal Metabolic Milieu for Healthy Pregnancies in Obesity

Purpose of Review: Entering pregnancy with obesity increases the risk of adverse health outcomes for parent and child. As such, research interventions are largely focused on limiting excess gestational weight gain during pregnancy, especially in those with obesity. Yet, while many lifestyle interventions are successful in reducing GWG, few affect pregnancy outcomes. Here we review work targeting the metabolic milieu instead of focusing solely on weight. Recent Findings: Work done in non-pregnant populations suggests that specifically targeting glucose, triglyceride, and leptin levels or inflammatory makers improves the metabolic milieu and overall health. We posit that precision interventions that include strategies such as time restricted eating, following the 24 h movement guidelines, or reducing sedentary behavior during pregnancy can be successful approaches benefiting the maternal metabolic milieu and minimize the risk of adverse pregnancy outcomes. Summary: Personalized tools such as continuous glucose monitors or community-based approaches play an important role in pre-conception health and should be extrapolated to pregnancy interventions to directly benefit the metabolic milieu optimizing health outcomes for both parent and child

Dietary Considerations for Postmenopausal Women

Midlife women commonly experience changes in cardiometabolic, physical, and psychosocial health because of menopause. Importantly, these health changes can negatively affect the overall quality of life. Specifically, women experience changes in metabolism and weight gain (particularly abdominal fat), bothersome vasomotor symptoms (i.e., hot flashes and night sweats), sleep disturbances, mood swings, and reduced bone health. Women may also experience social isolation, loneliness, and changes in gastrointestinal health, which can further reduce their quality of life. In this chapter, we summarize these important health changes and discuss various dietary and lifestyle considerations that healthcare professionals can employ to help their patients throughout menopause and beyond

Prevalence of drug-drug interactions in oncology patients enrolled on National Clinical Trials Network oncology clinical trials

Abstract Background Drug-drug interactions (DDIs) in subjects enrolling in clinical trials can impact not only safety of the patient but also study drug outcomes and data validity. This makes it critical to adequately screen and manage DDIs. The study objective was to determine the prevalence of DDIs involving study medications in subjects enrolling in National Clinical Trials Network (NCTN) clinical trials at a single institution. DDIs were evaluated based on study protocol recommendations for concomitant medication use (i.e. exclude, avoid or use caution), screening via DDI tool, and pharmacist review. Methods Subjects enrolled in NCTN trials of commercially available agents between January 2013 and August 2017 were included if a complete medication list was available. Complete medication lists were collected from the date of enrollment or the next available date then screened utilizing protocol guidance and the DDI screening tool, Lexicomp® Drug Interactions (Wolters Kluwer, Hudson, OH). Interactions were reviewed for clinical relevance: defined as a DDI that would require a medication change to ensure study agent safety and efficacy at enrollment. Results One hundred and twenty-eight subjects enrolled in 35 clinical trials were included. Protocol guidance detected 15 unique DDI pairs that should be avoided or used with caution in 10.2% (13/128) of subjects. The majority of these subjects did not have a clinically relevant DDI (69.2%, 9/13) based on pharmacist review. Lexicomp® detected moderate to major DDIs in 24.2% (31/128) of subjects, with 9.4% (12/128) having a clinically relevant DDI. Conclusions This study confirms a high prevalence of DDIs present in subjects enrolling in oncology clinical trials. Further efforts should be made to improve methods to detect and manage DDIs in patients enrolling on clinical trials to ensure patient safety and trial data validity.https://deepblue.lib.umich.edu/bitstream/2027.42/146516/1/12885_2018_Article_5076.pd