A prospective randomized trial of long term azithromycin (AZM) versus placebo in cystic fibrosis (CF): Impact on clinical, laboratory and quality of life (QOL) outcomes

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Studies on the nutrition and metabolism of turbot (Scophthalmus maximus L) with reference to fish farming

This thesis provides the first detailed study of maximal oxygen consumption of turbot on a fish farm over a range of fish sizes and temperatures. Also provided is a study of the diets used in turbot farming and the development of a diet that contains no fresh fish. A detailed study of previous research on flatfish nutrition, identified fresh fish, sprat in particular, as the optimum diet for turbot farming. A series of experiments was undertaken that confirmed this and also identified one possible explanation for the optimum performance of sprat, as a function of high non-protein energy ratios in sprat. This factor was exploited in the production of a diet containing no fresh fish and which produced superior results to diets containing fresh fish; the optimum level of lipid in the diet was determined as 18%. The study of oxygen consumption was on fully-fed fish so that maximum demand could be quantified. Continuous monitoring of tank water oxygen levels enabled the calculation of the Specific Dynamic Action (SDA) effect in turbot and the relation of it to dietary energy. Variation of SDA with the dietary energy profile was identified as a contributing factor to differential fish growth on various diets. Finally, the implications of this work to fish farming were considered. Economic appraisal and comparison of the diets routinely used in turbot farming identified that the diet developed as a result of this work, ie the diet containing no fresh fish protein, was more cost effective on the basis of the production of one tonne of turbot. The study of oxygen consumption enables water supply to be calculated for any fish size between 1g and 1000g between the temperatures of 7® C and 16® C. The quantification of SDA enables correct adjustment of oxygen flows according to the feeding status of the fish.

Inhaled human insulin (Exubera®):clinical profile and patient considerations

Inhaled human insulin (Exubera®) is a rapid-acting regular human insulin administered by oral inhalation before meals. It provides a non-invasive alternative to multiple subcutaneous injections for the treatment of hyperglycemia in adult patients with type 1 and type 2 diabetes. Compared with subcutaneous rapid-acting insulin analogs, Exubera provides equivalent HbA1c control. As a monotherapy or in combination with oral agents, Exubera also provides greater glycemic control than oral agents alone, at least in patients with high levels of HbA1c. Exubera demonstrates improved patient satisfaction compared with subcutaneous insulin or oral agents alone. When offered as a treatment option together with standard treatments in uncontrolled patients naive to insulin, Exubera increases acceptance of insulin therapy three-fold compared with patients offered standard regimens only. Exubera is well tolerated in comparison to subcutaneous insulin, with a similar incidence of mild to moderate hypoglycemia. Although cough is a common adverse effect early in therapy, this leads to treatment discontinuations in less than 1% of patients. Despite an increased incidence of insulin antibodies compared with subcutaneous administration, and a consistent but minor impact on pulmonary function, long-term safety data of up to 4 years continue to support the safety profile of Exubera.

The translation of cell-based therapies:clinical landscape and manufacturing challenges

Cell-based therapies have the potential to make a large contribution toward currently unmet patient need and thus effective manufacture of these products is essential. Many challenges must be overcome before this can become a reality and a better definition of the manufacturing requirements for cell-based products must be obtained. The aim of this study is to inform industry and academia of current cell-based therapy clinical development and to identify gaps in their manufacturing requirements. A total of 1342 active cell-based therapy clinical trials have been identified and characterized based on cell type, target indication and trial phase. Multiple technologies have been assessed for the manufacture of these cell types in order to facilitate product translation and future process development.