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"Hardy, Thomas"
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A novel fast-slow model of diabetes progression: Insights into mechanisms of response to the interventions in the Diabetes Prevention Program
Several models for the long-term development of T2DM already exist, focusing on the dynamics of the interaction between glycemia, insulinemia and β-cell mass. Current models consider representative (fasting or daily average) glycemia and insulinemia as characterizing the compensation state of the subject at some instant in slow time. This implies that only these representative levels can be followed through time and that the role of fast glycemic oscillations is neglected. An improved model (DPM15) for the long-term progression of T2DM is proposed, introducing separate peripheral and hepatic (liver and kidney) insulin actions. The DPM15 model no longer uses near-equilibrium approximation to separate fast and slow time scales, but rather describes, at each step in slow time, a complete day in the life of the virtual subject in fast time. The model can thus represent both fasting and postprandial glycemic levels and describe the effect of interventions acting on insulin-enhanced tissue glucose disposal or on insulin-inhibited hepatic glucose output, as well as on insulin secretion and β-cell replicating ability. The model can simulate long-term variations of commonly used clinical indices (HOMA-B, HOMA-IR, insulinogenic index) as well as of Oral Glucose Tolerance or Euglycemic Hyperinsulinemic Clamp test results. The model has been calibrated against observational data from the Diabetes Prevention Program study: it shows good adaptation to observations as a function of very plausible values of the parameters describing the effect of such interventions as Placebo, Intensive LifeStyle and Metformin administration.
Journal Article
The mayor of Casterbridge
While inebriated, Michael Henchard sells his wife and daughter to a sailor. When he realizes the horror of what he has done, he vows to change his life through hard work and fierce ambition, but his past and his guilt still haunt him.
Book
Drone Surveys Do Not Increase Colony-wide Flight Behaviour at Waterbird Nesting Sites, But Sensitivity Varies Among Species
The popularity of using unmanned aerial vehicles (UAVs) to survey colonial waterbirds has increased in the past decade, but disturbance associated with this bourgeoning technology requires further study. Disturbance was investigated by conducting aerial surveys with a consumer-grade quadcopter (DJI Phantom 3), while concurrently recording behavioural reactions on video. Surveys of mixed-species waterbird colonies (1-6 species per colony) were flown in horizontal transects at heights of 122, 91, 61, and 46 m, which is a typical range for collecting aerial imagery and producing high-resolution mosaicked orthophotos of nesting bird sites. An upper limit of 122 m was used due to local regulations prohibiting higher-altitude flights without federal authorization. Behavioural reactions were tallied every minute and a disturbance score was calculated for each sampling period. When compared to control periods, we found no evidence that colony-wide escape (i.e., flight) behaviour increased during drone flights, at any altitude flown. However, disturbance score increased significantly by 53% for surveys at 46 m. Some species were more sensitive to surveys than others. Laughing Gulls, in particular, exhibited a significant (125%) increase in escape behaviour for surveys at 91 m. Our results indicate when used in a capacity to gather high-resolution imagery for estimating breeding pairs, UAV surveys affected some species more than others, but severe reactions did not appear to increase for mixed-species colonies as a whole. Further study on safe operating thresholds is essential, especially at local and regional scales.
Journal Article
Tess of the D'Urbervilles : a pure woman
The story of a simple but beautiful country girl's seduction by another man, which causes her husband to leave her on their wedding night, and thereby precipitates a course of events that ends in murder.
Rare Book
Dysthyroid optic neuropathy: a case series at a tertiary ophthalmic referral centre
Background/Objectives
To determine risk factors and treatment outcomes in dysthyroid optic neuropathy (DON) at a single tertiary ophthalmic centre.
Methods
Retrospective audit of DON patients who have received intravenous methylprednisolone (IVMP) therapy at Royal Victorian Eye and Ear Hospital, Melbourne, Australia from July 2015 to October 2021.
Results
Study included 24 patients (58% female) with an average age of 59.8 ± 14.7 years at DON diagnosis. Majority (92%) had Graves’ hyperthyroidism and 77% had a smoking history. At diagnosis, average visual acuity (VA) of worse eye was LogMAR 0.46, and 48% had relative afferent pupillary defect. Proptosis (89%) and diplopia (73%) were most commonly present at diagnosis. 78% showed predominantly extra-ocular muscle enlargement, and apical crowding (52%) on radiology. 38% (
n
= 9/24) responded to IVMP alone, 58% (
n
= 14/24) progressed to surgical orbital decompression. The average total cumulative dose of IVMP during DON treatment was 6.8 ± 1.9 g. 29% required further treatment after IVMP and surgical decompression, 4 (17%) had additional radiotherapy, and three (13%) required immuno-modulatory therapy. Average final VA was LogMAR 0.207, with all patients having inactive TED at final follow-up (mean 1.7 years). In refractory DON cases, 71% retained VA ≥ 6/9 and 48% had DON reversal.
Conclusions
DON patients typically present in late 50s, with a smoking history and predominant extra-ocular muscle enlargement. High-dose IVMP fully resolved DON in only 38%. A considerable proportion required urgent orbital decompression. Most patients retained good vision at final follow-up.
Journal Article
Tess of the D'Urbervilles: a pure woman - Part 3
The story of a simple but beautiful country girl's seduction by another man, which causes her husband to leave her on their wedding night, and thereby precipitates a course of events that ends in murder.
Rare Book
Retrobulbar haemorrhage post sub-Tenons block: a case report
Background
Retrobulbar hemorrhage is a rare, sight-threatening complication from trauma, orbital surgery, and, rarely, regional orbital anesthetic injections. This may lead to orbital compartment syndrome with vascular and neural compromise and subsequent irreversible vision loss if not addressed promptly. Retrobulbar hemorrhage following sub-Tenon’s anesthetic is very rare, typically occurring in patients with an increased risk of bleeding from various causes.
Case presentation
A 75-year-old Asian male with no known bleeding diathesis developed an acute retrobulbar hemorrhage immediately following a routine sub-Tenon’s block performed for a planned encysted bleb needling. The patient experienced sudden onset of severe ocular pain with tense eyelids, loss of extraocular movements, and ocular hypertension. Emergency lateral canthotomy and cantholysis resulted in prompt resolution of orbital compartment syndrome.
Conclusion
This case highlights a rare occurrence of retrobulbar hemorrhage following a routine sub-Tenon’s block in a patient without predisposing risk factors. Prompt recognition and timely intervention were crucial in preserving the patient’s vision. The case underscores the importance of vigilance and awareness of retrobulbar hemorrhage as a potential complication of sub-Tenon’s block.
Journal Article
Tess of the D'Urbervilles: a pure woman - Part 2
The story of a simple but beautiful country girl's seduction by another man, which causes her husband to leave her on their wedding night, and thereby precipitates a course of events that ends in murder.
Rare Book
European banking M&As: The role of financial advisors
We investigate the puzzle of banks contracting the services of external advisors for deals they can self-manage and the role of financial advisors in mergers and acquisitions among European banking firms. We also study the determinants of the choice by bank acquirers and bank targets to either appoint external advisors or manage in-house, as well as between appointing either top or lower tier advisors. Top tier advisors are more likely to be employed in debt financed and cross-border deals. We also find that most European bank mergers are managed in-house, contrary to prior findings reporting mostly externally managed deals attributed to the certification effect. Targets fail to benefit from deals where they do not match acquirer’s decision to appoint external advisors. However, there is an overall propensity to match the counter party’s tier of advisor.
Journal Article