Optimal glycaemic control, pre-eclampsia and gestational hypertension in women with type 1 diabetes in the Diabetes and Pre-Eclampsia Intervention Trial

OBJECTIVE
To assess the relationship between glycemic control, pre-eclampsia, and gestational hypertension in women with type 1 diabetes.

RESEARCH DESIGN AND METHODS
Pregnancy outcome (pre-eclampsia or gestational hypertension) was assessed prospectively in 749 women from the randomized controlled Diabetes and Pre-eclampsia Intervention Trial (DAPIT). HbA1c (A1C) values were available up to 6 months before pregnancy (n = 542), at the first antenatal visit (median 9 weeks) (n = 721), at 26 weeks’ gestation (n = 592), and at 34 weeks’ gestation (n = 519) and were categorized as optimal (<6.1%: referent), good (6.1–6.9%), moderate (7.0–7.9%), and poor (=8.0%) glycemic control, respectively.

RESULTS
Pre-eclampsia and gestational hypertension developed in 17 and 11% of pregnancies, respectively. Women who developed pre-eclampsia had significantly higher A1C values before and during pregnancy compared with women who did not develop pre-eclampsia (P < 0.05, respectively). In early pregnancy, A1C =8.0% was associated with a significantly increased risk of pre-eclampsia (odds ratio 3.68 [95% CI 1.17–11.6]) compared with optimal control. At 26 weeks’ gestation, A1C values =6.1% (good: 2.09 [1.03–4.21]; moderate: 3.20 [1.47–7.00]; and poor: 3.81 [1.30–11.1]) and at 34 weeks’ gestation A1C values =7.0% (moderate: 3.27 [1.31–8.20] and poor: 8.01 [2.04–31.5]) significantly increased the risk of pre-eclampsia compared with optimal control. The adjusted odds ratios for pre-eclampsia for each 1% decrement in A1C before pregnancy, at the first antenatal visit, at 26 weeks’ gestation, and at 34 weeks’ gestation were 0.88 (0.75–1.03), 0.75 (0.64–0.88), 0.57 (0.42–0.78), and 0.47 (0.31–0.70), respectively. Glycemic control was not significantly associated with gestational hypertension.

CONCLUSIONS
Women who developed pre-eclampsia had significantly higher A1C values before and during pregnancy. These data suggest that optimal glycemic control both early and throughout pregnancy may reduce the risk of pre-eclampsia in women with type 1 diabetes.

Religious Geographies in Ireland: Pre-Famine, Post-Famine, Pre-Partition

This paper examines changes in religious geographies for Ireland from 1834 to 1911. It shows that in a period of dramatic social and economic change religious geographies remained remarkably stable. In this it challenges the accepted historiography. It makes use of new data in new ways with the full exploitation of the 1834 Enumeration of Religion and, in so doing, is able to examine the impact of the Great Irish Famine on geographies of religion. These data are visualised both using traditional choropleth maps and, more innovatively in this subject area, cartograms.

A method to reconstruct patient-specific proximal femur surface models from planar pre-operative radiographs

Three-dimensional reconstruction from volumetric medical images (e.g. CT, MRI) is a well-established technology used in patient-specific modelling. However, there are many cases where only 2D (planar) images may be available, e.g. if radiation dose must be limited or if retrospective data is being used from periods when 3D data was not available. This study aims to address such cases by proposing an automated method to create 3D surface models from planar radiographs. The method consists of (i) contour extraction from the radiograph using an Active Contour (Snake) algorithm, (ii) selection of a closest matching 3D model from a library of generic models, and (iii) warping the selected generic model to improve correlation with the extracted contour.

This method proved to be fully automated, rapid and robust on a given set of radiographs. Measured mean surface distance error values were low when comparing models reconstructed from matching pairs of CT scans and planar X-rays (2.57–3.74 mm) and within ranges of similar studies. Benefits of the method are that it requires a single radiographic image to perform the surface reconstruction task and it is fully automated. Mechanical simulations of loaded bone with different levels of reconstruction accuracy showed that an error in predicted strain fields grows proportionally to the error level in geometric precision. In conclusion, models generated by the proposed technique are deemed acceptable to perform realistic patient-specific simulations when 3D data sources are unavailable.

High contrast plasma mirror: spatial filtering and second harmonic generation at 10(19)Wcm(-2)

Recently, the use of plasma optics to improve temporal pulse contrast has had a remarkable impact on the field of high- power laser-solid density interaction physics. Opening an avenue to previously unachievable plasma density gradients in the high intensity focus, this advance has enabled researchers to investigate new regimes of harmonic generation and ion acceleration. Until now, however, plasma optics for fundamental laser reflection have been used in the sub-relativistic intensity regime (10(15) - 10(16)Wcm(-2)) showing high reflectivity (similar to 70%) and good focusability. Therefore, the question remains as to whether plasma optics can be used for such applications in the relativistic intensity regime (> 10(18)Wcm(-2)). Previous studies of plasma mirrors (PMs) indicate that, for 40 fs laser pulses, the reflectivity fluctuates by an order of magnitude and that focusability of the beam is lost as the intensity is increased above 5 x 10(16)Wcm(-2). However, these experiments were performed using laser pulses with a contrast ratio of similar to 10(7) to generate the reflecting surface. Here, we present results for PM operation using high contrast laser pulses resulting in a new regime of operation - the high contrast plasma mirror (HCPM). In this regime, pulses with contrast ratio > 10(10) are used to form the PM surface at > 10(19)Wcm(-2), displaying excellent spatial filtering, reflected near- field beam profile of the fundamental beam and reflectivities of 60 +/- 5%. Efficient second harmonic generation is also observed with exceptional beam quality suggesting that this may be a route to achieving the highest focusable harmonic intensities. Plasma optics therefore offer the opportunity to manipulate ultra-intense laser beams both spatially and temporally. They also allow for ultrafast frequency up-shifting without detrimental effects due to group velocity dispersion (GVD) or reduced focusability which frequently occur when nonlinear crystals are used for frequency conversion.

Pre- to Post-discharge Behavior in Saline Solution

The development of a plasma discharge at low voltage (200-600 V) in saline solution is characterized using fast and standard CCD camera imaging. Vapor formation, plasma formation, and vapor collapse and subsequent pressure wave propagation are observed. If, with increasing voltage, the total energy deposited is kept approximately constant, the sequence and nature of events are similar but develop faster and more reproducibly at the higher voltages. This is attributed to the slower temporal evolution of the vapor layer at lower voltages which means a greater sensitivity to hydrodynamic instabilities at the vapor-liquid interface.