The role of angiogenic and antiangiogenic factors in the second trimester in the prediction of preeclampsia in pregnant women with type 1 diabetes

OBJECTIVE To assess the association between circulating angiogenic and antiangiogenic factors in the second trimester and risk of preeclampsia in women with type 1 diabetes.

RESEARCH DESIGN AND METHODS Maternal plasma concentrations of placental growth factor (PlGF), soluble fms-like tyrosine kinase 1 (sFlt-1), and soluble endoglin (sEng) were available at 26 weeks of gestation in 540 women with type 1 diabetes enrolled in the Diabetes and Preeclampsia Intervention Trial.

RESULTS Preeclampsia developed in 17% of pregnancies (n = 94). At 26 weeks of gestation, women in whom preeclampsia developed later had significantly lower PlGF (median [interquartile range]: 231 pg/mL [120–423] vs. 365 pg/mL [237–582]; P < 0.001), higher sFlt-1 (1,522 pg/mL [1,108–3,393] vs. 1,193 pg/mL [844–1,630] P < 0.001), and higher sEng (6.2 ng/mL [4.9–7.9] vs. 5.1 ng/mL[(4.3–6.2]; P < 0.001) compared with women who did not have preeclampsia. In addition, the ratio of PlGF to sEng was significantly lower (40 [17–71] vs. 71 [44–114]; P < 0.001) and the ratio of sFlt-1 to PlGF was significantly higher (6.3 [3.4–15.7] vs. 3.1 [1.8–5.8]; P < 0.001) in women who later developed preeclampsia. The addition of the ratio of PlGF to sEng or the ratio of sFlt-1 to PlGF to a logistic model containing established risk factors (area under the curve [AUC], 0.813) significantly improved the predictive value (AUC, 0.850 and 0.846, respectively; P < 0.01) and significantly improved reclassification according to the integrated discrimination improvement index (IDI) (IDI scores 0.086 and 0.065, respectively; P < 0.001).

CONCLUSIONS These data suggest that angiogenic and antiangiogenic factors measured during the second trimester are predictive of preeclampsia in women with type 1 diabetes. The addition of the ratio of PlGF to sEng or the ratio of sFlt-1 to PlGF to established clinical risk factors significantly improves the prediction of preeclampsia in women with type 1 diabetes.

Preeclampsia is characterized by the development of hypertension and new-onset proteinuria during the second half of pregnancy (1,2), leading to increased maternal morbidity and mortality (3). Women with type 1 diabetes are at increased risk for development of preeclampsia during pregnancy, with rates being two-times to four-times higher than that of the background maternity population (4,5). Small advances have come from preventive measures, such as low-dose aspirin in women at high risk (6); however, delivery remains the only effective intervention, and preeclampsia is responsible for up to 15% of preterm births and a consequent increase in infant mortality and morbidity (7).

Although the etiology of preeclampsia remains unclear, abnormal placental vascular remodeling and placental ischemia, together with maternal endothelial dysfunction, hemodynamic changes, and renal pathology, contribute to its pathogenesis (8). In addition, over the past decade accumulating evidence has suggested that an imbalance between angiogenic factors, such as placental growth factor (PlGF), and antiangiogenic factors, such as soluble fms-like tyrosine kinase 1 (sFlt-1) and soluble endoglin (sEng), plays a key role in the pathogenesis of preeclampsia (8,9). In women at low risk (10–13) and women at high risk (14,15), concentrations of angiogenic and antiangiogenic factors are significantly different between women who later develop preeclampsia (lower PlGF, higher sFlt-1, and higher sEng levels) compared with women who do not.

Few studies have specifically focused on circulating angiogenic factors and risk of preeclampsia in women with diabetes, and the results have been conflicting. In a small study, higher sFlt-1 and lower PlGF were reported at the time of delivery in women with diabetes who developed preeclampsia (16). In a longitudinal prospective cohort of pregnant women with diabetes, Yu et al. (17) reported increased sFlt-1 and reduced PlGF in the early third trimester as potential predictors of preeclampsia in women with type 1 diabetes, but they did not show any difference in sEng levels in women with preeclampsia compared with women without preeclampsia. By contrast, Powers et al. (18) reported only increased sEng in the second trimester in women with pregestational diabetes who developed preeclampsia.

The aim of this study, which was significantly larger than the previous studies highlighted, was to assess the association between circulating angiogenic (PlGF) and antiangiogenic (sFlt-1 and sEng) factors and the risk of preeclampsia in women with type 1 diabetes. A further aim was to evaluate the added predictive ability and clinical usefulness of angiogenic factors and established risk factors for preeclampsia risk prediction in women with type 1 diabetes.

Intra-operative decision making by ophthalmic surgeons

Research on surgical decision making and risk management usually focuses on peri-operative care, despite the magnitude and frequency of intra-operative risks. The aim of this study was to examine ophthalmic surgeons' intra-operative decisions and risk management strategies in order to explore differences in cognitive processes.

Advancing impact prediction and hypothesis testing in invasion ecology using a comparative functional response approach

Invasion ecology urgently requires predictive methodologies that can forecast the ecological impacts of existing, emerging and potential invasive species. We argue that many ecologically damaging invaders are characterised by their more efficient use of resources. Consequently, comparison of the classical ‘functional response’ (relationship between resource use and availability) between invasive and trophically analogous native species may allow prediction of invader ecological impact. We review the utility of species trait comparisons and the history and context of the use of functional responses in invasion ecology, then present our framework for the use of comparative functional responses. We show that functional response analyses, by describing the resource use of species over a range of resource availabilities, avoids many pitfalls of ‘snapshot’ assessments of resource use. Our framework demonstrates how comparisons of invader and native functional responses, within and between Type II and III functional responses, allow testing of the likely population-level outcomes of invasions for affected species. Furthermore, we describe how recent studies support the predictive capacity of this method; for example, the invasive ‘bloody red shrimp’ Hemimysis anomala shows higher Type II functional responses than native mysids and this corroborates, and could have predicted, actual invader impacts in the field. The comparative functional response method can also be used to examine differences in the impact of two or more invaders, two or more populations of the same invader, and the abiotic (e.g. temperature) and biotic (e.g. parasitism) context-dependencies of invader impacts. Our framework may also address the previous lack of rigour in testing major hypotheses in invasion ecology, such as the ‘enemy release’ and ‘biotic resistance’ hypotheses, as our approach explicitly considers demographic consequences for impacted resources, such as native and invasive prey species. We also identify potential challenges in the application of comparative functional responses in invasion ecology. These include incorporation of numerical responses, multiple predator effects and trait-mediated indirect interactions, replacement versus non-replacement study designs and the inclusion of functional responses in risk assessment frameworks. In future, the generation of sufficient case studies for a meta-analysis could test the overall hypothesis that comparative functional responses can indeed predict invasive species impacts.

Genetic Markers Enhance Coronary Risk Prediction in Men: The MORGAM Prospective Cohorts

Background: More accurate coronary heart disease (CHD) prediction, specifically in middle-aged men, is needed to reduce the burden of disease more effectively. We hypothesised that a multilocus genetic risk score could refine CHD prediction beyond classic risk scores and obtain more precise risk estimates using a prospective cohort design.

Methods: Using data from nine prospective European cohorts, including 26,221 men, we selected in a case-cohort setting 4,818 healthy men at baseline, and used Cox proportional hazards models to examine associations between CHD and risk scores based on genetic variants representing 13 genomic regions. Over follow-up (range: 5-18 years), 1,736 incident CHD events occurred. Genetic risk scores were validated in men with at least 10 years of follow-up (632 cases, 1361 non-cases). Genetic risk score 1 (GRS1) combined 11 SNPs and two haplotypes, with effect estimates from previous genome-wide association studies. GRS2 combined 11 SNPs plus 4 SNPs from the haplotypes with coefficients estimated from these prospective cohorts using 10-fold cross-validation. Scores were added to a model adjusted for classic risk factors comprising the Framingham risk score and 10-year risks were derived.

Results: Both scores improved net reclassification (NRI) over the Framingham score (7.5%, p = 0.017 for GRS1, 6.5%, p = 0.044 for GRS2) but GRS2 also improved discrimination (c-index improvement 1.11%, p = 0.048). Subgroup analysis on men aged 50-59 (436 cases, 603 non-cases) improved net reclassification for GRS1 (13.8%) and GRS2 (12.5%). Net reclassification improvement remained significant for both scores when family history of CHD was added to the baseline model for this male subgroup improving prediction of early onset CHD events.

Conclusions: Genetic risk scores add precision to risk estimates for CHD and improve prediction beyond classic risk factors, particularly for middle aged men.

Scalable black-box prediction models for multi-dimensional adaptation on NUMA multi-cores

This paper presents a scalable, statistical ‘black-box’ model for predicting the performance of parallel programs on multi-core non-uniform memory access (NUMA) systems. We derive a model with low overhead, by reducing data collection and model training time. The model can accurately predict the behaviour of parallel applications in response to changes in their concurrency, thread layout on NUMA nodes, and core voltage and frequency. We present a framework that applies the model to achieve significant energy and energy-delay-square (ED2) savings (9% and 25%, respectively) along with performance improvement (10% mean) on an actual 16-core NUMA system running realistic application workloads. Our prediction model proves substantially more accurate than previous efforts.

Earthmoving trucks condition level prediction using neural networks

Purpose: The purpose of this paper is to present an artificial neural network (ANN) model that predicts earthmoving trucks condition level using simple predictors; the model’s performance is compared to the respective predictive accuracy of the statistical method of discriminant analysis (DA).

Design/methodology/approach: An ANN-based predictive model is developed. The condition level predictors selected are the capacity, age, kilometers travelled and maintenance level. The relevant data set was provided by two Greek construction companies and includes the characteristics of 126 earthmoving trucks.

Findings: Data processing identifies a particularly strong connection of kilometers travelled and maintenance level with the earthmoving trucks condition level. Moreover, the validation process reveals that the predictive efficiency of the proposed ANN model is very high. Similar findings emerge from the application of DA to the same data set using the same predictors.

Originality/value: Earthmoving trucks’ sound condition level prediction reduces downtime and its adverse impact on earthmoving duration and cost, while also enhancing the maintenance and replacement policies effectiveness. This research proves that a sound condition level prediction for earthmoving trucks is achievable through the utilization of easy to collect data and provides a comparative evaluation of the results of two widely applied predictive methods.

The prediction of process-induced deformation in a thermoplastic composite in support of manufacturing simulation

Digital manufacturing techniques can simulate complex assembly sequences using computer-aided design-based, as-designed' part forms, and their utility has been proven across several manufacturing sectors including the ship building, automotive and aerospace industries. However, the reality of working with actual parts and composite components, in particular, is that geometric variability arising from part forming or processing conditions can cause problems during assembly as the as-manufactured' form differs from the geometry used for any simulated build validation. In this work, a simulation strategy is presented for the study of the process-induced deformation behaviour of a 90 degrees, V-shaped angle. Test samples were thermoformed using pre-consolidated carbon fibre-reinforced polyphenylene sulphide, and the processing conditions were re-created in a virtual environment using the finite element method to determine finished component angles. A procedure was then developed for transferring predicted part forms from the finite element outputs to a digital manufacturing platform for the purpose of virtual assembly validation using more realistic part geometry. Ultimately, the outcomes from this work can be used to inform process condition choices, material configuration and tool design, so that the dimensional gap between as-designed' and as-manufactured' part forms can be reduced in the virtual environment.

Prediction of failure and fracture mechanisms of polymeric composites using finite element analysis. Part 1:Particulate filled composites

Micro-mechanical analysis of polymeric composites provides a powerful means for the quantitative assessment of their bulk behavior. In this paper we describe a robust finite element model (FEM) for the micro-structural modeling of the behavior of particulate filled polymer composites under external loads. The developed model is applied to simulate stress distribution in polymer composites containing particulate fillers. Quantitative information about the magnitude and location of maximum stress concentrations obtained from these simulations is used to predict the dominant failure and crack growth mechanisms in these composites. The model predictions are compared with the available experimental data and also with the values found using other methods reported in the literature. These comparisons show the range of the validity of the developed model and its predictive potential.

Wear analysis and prediction of the life of a riveting die used in the automotive industry

Knowledge on the life span of the riveting dies used in the automotive industry is sparse. It is often the case that only when faulty products are produced are workers aware that their tool needs to be changed. This is of course costly both in terms of time and money. Responding to this challenge, this paper proposes a methodology which integrates wear and stress analysis to quantify the life of a riveting die. Experiments are carried out to measure the applied load required to split a rivet. The obtained results (i.e. force curves) are used to validate the wear mechanisms of the die observed using scanning electron microscopy. Sliding, impact, and adhesive wears are observed on the riveting die after a certain number of riveting cycles. The stress distribution on the die during riveting is simulated using a finite element (FE) approach. In order to confirm the accuracy of the FE model, the experimental force results are compared with the ones produced from FE simulation. The maximum and minimum von Mises' stresses generated from the FE model are input into a Goodman diagram and an S-N curve to compute the life of the riveting die. It is found that the riveting die is predicted to run for 4 980 000 cycles before failure.