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Roberts R, Miller M, O'Callaghan M, Koczwara B. Bone health management of Australian breast cancer survivors receiving hormonal therapy. Intern Med J 2015; 45:1182-5. [DOI: 10.1111/imj.12897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/01/2015] [Indexed: 11/30/2022]
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Merker L, Murphy T, Roberts R, Brimioulle M, Clark R, Woodward M. Venous thromboembolism prophylaxis in children: The slow wheels of change. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Roberts R, Callander R, Duffy P, Jacobsen M, Knight R, Boobis A. Target organ profiles in toxicity studies supporting human dosing: Does severity progress with longer duration of exposure? Regul Toxicol Pharmacol 2015; 73:737-46. [PMID: 26517939 DOI: 10.1016/j.yrtph.2015.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/19/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Abstract
We have previously reported the profile of target organs (defined as organs showing histopathological changes) in rodent and non-rodent toxicity studies conducted prior to first-time-in-man (FTiM) for 77 AstraZeneca candidate drugs (CDs). Here, we test the assumption that toxicity is exacerbated by dosing duration by comparing the incidence and severity of target organ toxicities in these ≤ 6 week FTiM studies with those observed in subsequent subchronic/chronic (≥ 3 month) studies. Looking at the effect of dosing duration on severity (pathological score) and incidence (percentage of animals within the group) for the 39 CDs that met the criteria for inclusion (comparable doses between FTiM and subchronic/chronic studies), new toxicities appeared for 31 target organs but existing ones resolved for 29 target organs. Increased severity was more frequent for rodent (16 target organs) than for non-rodent (4 target organs). Most notable changes were a large increase in severity/incidence in liver and in non-rodent lung in contrast to a large decrease in severity and incidence for kidneys/ureter and for the non-rodent thymus. Overall this analysis shows that, even with continued exposure, target organ toxicities of CDs are as likely to show partial or complete recovery as they are to progress in severity.
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Manautou J, Boobis A, Rowlands C, Silva Lima B, Pearson J, Roberts R. Identifying and prioritising emerging issues in human & environmental sciences. Toxicol Lett 2015. [DOI: 10.1016/j.toxlet.2015.08.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Walsh J, Roberts R, Weber D, Faber-Heinemann G, Heinemann L. Insulin Pump and CGM Usage in the United States and Germany: Results of a Real-World Survey With 985 Subjects. J Diabetes Sci Technol 2015; 9:1103-10. [PMID: 26071425 PMCID: PMC4667344 DOI: 10.1177/1932296815588945] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This survey collected and evaluated user responses about routine tasks and preferences regarding insulin pumps and infusion sets (IIS) with comparison of intercountry differences between the United States (US) and Germany (GER), chosen for their large insulin pump populations. METHODS A total of 985 subjects (534 US, 451 GER; 60% female) with type 1 diabetes on pump therapy anonymously answered 20 pump-related questions. US subjects also answered 11 questions about continuous glucose monitoring (CGM) usage. RESULTS Length of use of insulin cartridges is shorter in US than in GER, mean (SD) 4.3 (5.0) versus 5.3 (3.2) days (P < .001), while the IIS is used longer: 3.3 (1.0) versus 2.7 (1.1) days (P < .001). Lower self-reported HbA1c levels were associated with longer use of insulin cartridges (7.3% for >3 days vs. 7.7% for <3 days; P < .01), and with use of an auto-insertion device (vs. manual IIS insertion) in the US (7.2% vs. 6.9%), but not in GER (7.7% vs. 7.9%). Only 47% of pump wearers stated that they were "very satisfied" with their pump (49% US vs. 45% GER, ns). However, 98% would recommend the pump to others (95% vs. 93%, ns). Analysis of CGM questions showed that 297 (60%) of 496 US responders currently wore one. Of these, 84% said they would recommend CGM to others. CGM wearers who stated they were "very satisfied" with their CGM had lower HbA1c than those who said they were "partly satisfied" (6.9% vs. 7.2%). CONCLUSIONS This survey shows interesting differences in real-world use of insulin pumps in 2 large markets, and suggests areas where insulin pumps and CGMs might be improved.
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Abstract
Patients with diabetes have to take numerous factors/data into their therapeutic decisions in daily life. Connecting the devices they are using by feeding the data generated into a database/app is supposed to help patients to optimize their glycemic control. As this is not established in practice, the different roadblocks have to be discussed to open the road. That large telecommunication companies are now entering this market might be a big help in pushing this forward. Smartphones offer an ideal platform for connectivity solutions.
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Punnen S, Zappala S, Palou J, Sjoberg D, Mathur V, Roberts R, Vincent V, Reeve M, O'Krongly D, Newmark J, Sant G, Steiner M, Morote J, Parekh D. 433 Among men with low-grade prostate cancer on prostate biopsy, the 4Kscore predicts the presence of more aggressive prostate cancer. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/s1569-9056(15)60426-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Roberts R, Speight L, Lee J, George L, Ketchell R, Lau D, Duckers J. Retinal screening of patients with cystic fibrosis-related diabetes in Wales — A real eye opener. J Cyst Fibros 2015; 14:282-4. [DOI: 10.1016/j.jcf.2014.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 05/08/2014] [Accepted: 07/24/2014] [Indexed: 10/24/2022]
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Richardson T, Elliott P, Roberts R. The impact of tuition fees amount on mental health over time in British students. J Public Health (Oxf) 2015; 37:412-8. [PMID: 25670684 DOI: 10.1093/pubmed/fdv003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Previous studies have shown a relationship between debt and mental health problems in students. This study aimed to examine the effect of differences in tuition fees amount on changes in mental health over time. METHODS A prospective cohort study followed 390 first-year British students who differed on their tuition fees level at 4 time points across their first 2 years at university. Participants completed measures of global mental health, depression, anxiety, stress, alcohol-related problems at up to four time points in their first two years at university. Mixed-factorial ANOVAs were used to assess the impact of tuition fees amount on changes in scores over time. RESULTS There was no difference based on fees at Time 1 for anxiety, stress, depression and global mental health. At Time 2, those charged £0-2.9k or £3-4k improved while those charged £8-9k stayed the same. However, this trend reversed by Times 3 and 4. CONCLUSIONS Undergraduates mental health is partially affected by the level of tuition fees; however, the recent increase in tuition fees does not appear to have had a lasting impact at present.
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Schwind KS, Freeman SA, Garcia M, Roberts R. Manic Monday to fabulous Friday: partnering to improve behavioral and mental health needs of students. NASN Sch Nurse 2015; 30:35-8. [PMID: 25626241 DOI: 10.1177/1942602x14558455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
School nurses across the United States continue to see an increase in the number of children and families with behavioral and mental health issues that affect many aspects of overall health and education. When referral to a mental health professional is indicated, there are often few available community mental health providers, long waits for appointments, or both. This article describes how school nurses can leverage school district and community resources and increase their capacity to meet the behavioral and mental health needs of children in the school setting.
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Dorstyn D, Roberts R, Kneebone I, Kennedy P, Lieu C. Systematic Review of Leisure Therapy and Its Effectiveness in Managing Functional Outcomes in Stroke Rehabilitation. Top Stroke Rehabil 2014; 21:40-51. [DOI: 10.1310/tsr2101-40] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Bowman G, Wright A, Crettenden A, Roberts R. Improving the wellbeing of young people with disabilities: An exploratory study of factors contributing to physical activity participation. J Sci Med Sport 2014. [DOI: 10.1016/j.jsams.2014.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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113
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Robinson S, Roberts R. What constitutes scientific justification for inclusion of recovery assessment in pre-clinical studies supporting first time in man (FTIM)? Regul Toxicol Pharmacol 2014; 70:572-3. [PMID: 25223564 DOI: 10.1016/j.yrtph.2014.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 09/06/2014] [Indexed: 11/17/2022]
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Deavall D, Roberts R, Knight R. The impact of preclinical data from non-rodent species in the risk assessment of anticancer small molecule drugs. Toxicol Lett 2014. [DOI: 10.1016/j.toxlet.2014.06.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kavanagh S, Mellor H, Pollard C, Robinson S, Platz S, Roberts R. Reducing attrition in drug development: Smart loading pre-clinical safety assessment. Toxicol Lett 2014. [DOI: 10.1016/j.toxlet.2014.06.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cove-Smith L, Woodhouse N, Hargreaves A, Price S, Marsden M, Betts C, Brocklehurst S, Backen A, Radford J, Roberts R, Schmitt M, Dive C, Tugwood J, Hockings P, Mellor H. An integrated characterisation of serological, pathological and functional events in doxorubicin-induced cardiotoxicity. Toxicol Lett 2014. [DOI: 10.1016/j.toxlet.2014.06.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jeromin A, Johnson GA, Bradley A, Redfern W, Roberts R. Assessment of neurotoxicity: The use of biomarkers as complementary measures. Toxicol Lett 2014. [DOI: 10.1016/j.toxlet.2014.06.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Horner S, Robinson S, Lees D, Callander R, Roberts R. Target organ profiles in toxicity studies supporting human dosing: an assessment of recovery and chronic dosing. Regul Toxicol Pharmacol 2014; 70:270-85. [PMID: 25020275 DOI: 10.1016/j.yrtph.2014.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/20/2014] [Accepted: 07/07/2014] [Indexed: 11/17/2022]
Abstract
We have previously reported the profile of toxic effects with respect to target organs (defined as organs showing histopathological changes) observed in rodent and non-rodent toxicity studies conducted prior to first time in man (FTIM) for 77 AstraZeneca candidate drugs (CDs) across a range of therapy areas. The main objectives of the current study were twofold; to determine which target organs observed in the FTIM studies recovered after a dose free recovery period and to determine which additional target organs were observed in subsequent chronic (⩾3month) studies required to support longer term clinical dosing. The analysis showed that ⩾86% of findings in studies supporting FTIM either fully or partially resolved at the end of the recovery period, with profiles of recovery that were similar whether the CD progressed into man or not and across different therapy areas. Compared to observations in FTIM studies, chronic studies identified toxicities in an additional 39% of target organs. Overall these data demonstrate that chronic studies in both rodents and non-rodents provide valuable information for the risk assessment for longer term dosing in humans. In addition, the high levels of recovery demonstrated in this analysis suggest that inclusion of recovery assessments on FTIM studies should be on a case-by-case basis driven by a positive indication of need. This is in line with ICH non-clinical guidance that states that reversibility of severe nonclinical toxicities of potential clinic relevance should be assessed 'when appropriate', but that the evaluation can be based on a study of reversibility or on a scientific assessment.
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Mauchline TH, Hayat R, Roberts R, Powers SJ, Hirsch PR. Assessment of core and accessory genetic variation in Rhizobium leguminosarum symbiovar trifolii strains from diverse locations and host plants using PCR-based methods. Lett Appl Microbiol 2014; 59:238-46. [PMID: 24739023 DOI: 10.1111/lam.12270] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/04/2014] [Accepted: 04/07/2014] [Indexed: 11/30/2022]
Abstract
UNLABELLED The nitrogen-fixing symbiosis between Rhizobium leguminosarum and host legumes is recognized as a key part of sustainable agriculture. A culture collection containing rhizobia isolated from legumes of economic importance in the UK and worldwide, maintained at Rothamsted Research for many years, provided material for this study. We aimed to develop and validate efficient molecular diagnostics to investigate whether the host plant or geographical location had a greater influence on the genetic diversity of rhizobial isolates, and the extent to which the core bacterial genome and the accessory symbiosis genes located on plasmids were affected. To achieve this, core housekeeping genes and those involved in symbiosis interactions were sequenced and compared with genome-sequenced strains in the public domain. Results showed that some Rh. leguminosarum symbiovar trifolii strains nodulating clovers and Rh. leguminosarum sv. viciae strains nodulating peas and vicias shared identical housekeeping genes, clover nodule isolates from the same location could have divergent symbiosis genes, and others isolated on different continents could be very similar. This illustrates the likely co-migration of rhizobia and their legume hosts when crops are planted in new areas and indicates that selective pressure may arise from both local conditions and crop host genotypes. SIGNIFICANCE AND IMPACT OF THE STUDY The nitrogen-fixing symbiosis between Rhizobium leguminosarum and host legumes has been recognized as a key part of sustainable agriculture for many years; this study provides new tools to study rhizobial biogeography which will be invaluable for extending the cultivation of legumes and indicating whether or not inoculation is necessary.
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Heinemann L, Walsh J, Roberts R. We Need More Research and Better Designs for Insulin Infusion Sets. J Diabetes Sci Technol 2014; 8:199-202. [PMID: 24876567 PMCID: PMC4455397 DOI: 10.1177/1932296814523882] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Moheet A, Kumar A, Eberly LE, Kim J, Roberts R, Seaquist ER. Hypoglycemia-associated autonomic failure in healthy humans: comparison of two vs three periods of hypoglycemia on hypoglycemia-induced counterregulatory and symptom response 5 days later. J Clin Endocrinol Metab 2014; 99:664-70. [PMID: 24423306 PMCID: PMC3913799 DOI: 10.1210/jc.2013-3493] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Hypoglycemia-associated autonomic failure (HAAF) limits the ability of patients with diabetes to achieve target glycemia. Animal models have provided insights into the pathogenesis of HAAF, but a robust human model of HAAF in which recurrent hypoglycemia impacts the counterregulatory responses to hypoglycemia days later is lacking. OBJECTIVE The aim of this study was to determine the impact of two or three episodes of moderate hypoglycemia on counterregulatory responses to subsequent hypoglycemia induced 5 days later. DESIGN AND SUBJECTS Six healthy subjects participated in each of the two study protocols. In both protocol 1 and 2, subjects underwent two 2-hour hypoglycemic clamp studies during the morning and afternoon of day 1. In protocol 2, subjects underwent an additional third hypoglycemic clamp during the morning of day 2. All subjects in both protocols underwent a final hypoglycemic clamp on the morning of day 5. RESULTS In protocol 1, there were no significant differences in the hypoglycemia-induced hormone response or in symptoms scores between the mornings of days 1 and 5. In protocol 2, hypoglycemia-induced epinephrine (P = .02) and cortisol (P = .04) secretions were significantly lower on day 5 compared with day 1, whereas glucagon (P = .08) and norepinephrine (P = .59) were not different. Also in protocol 2, neurogenic (P = .02) and neuroglycopenic (P = .04) symptoms during hypoglycemia were decreased on day 5 compared with day 1. CONCLUSION These results demonstrate that exposure of healthy humans to three 2-hour hypoglycemic episodes over 30 hours leads to significant blunting in counterregulatory and symptom response to subsequent hypoglycemia on day 5.
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Walsh J, Roberts R, Heinemann L. Confusion Regarding Duration of Insulin Action: A Potential Source for Major Insulin Dose Errors by Bolus Calculators. J Diabetes Sci Technol 2014; 8:170-178. [PMID: 24876553 PMCID: PMC4454113 DOI: 10.1177/1932296813514319] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
People with diabetes on insulin pumps often use a bolus calculator (BC) to obtain insulin dose recommendations. After the first bolus of the day, residual insulin activity, called bolus insulin on board (BOB), must be correctly accounted for to reduce the size of subsequent boluses and minimize the insulin stacking that would otherwise occur. Critical to achieving this calculation is having an appropriate duration of insulin action (DIA) setting in the BC. Unfortunately, the widespread use of inappropriately short DIAs may be causing unrecognized "stacking" of insulin that leads to unexplained hypoglycemic events. Currently, there is no widely accepted definition or value of the DIA for use in a BC. Various shortcomings regarding the selection of an appropriate DIA setting have led to considerable confusion among clinicians and insulin pump users about this important concept. Traditional pharmacological studies used to determine the pharmacodynamic (PD) properties of rapid-acting insulins create a misleading impression that insulin action times (IATs) in daily life vary from 3 to 5 hours and cause IATs to appear more variable than they actually are. These IAT time ranges are not appropriate for use as the DIA time value required to obtain an accurate bolus recommendation from a BC. We highlight the problems that arise when an inappropriately short DIA leads to excessive bolus recommendations, provide a research protocol to accurately measure DIA, and suggest appropriate DIA time recommendations for use in current clinical practice.
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Roberts R. Dr. Robert Roberts oversees special issue on genomic medicine for the Methodist DeBakey Cardiovascular Journal. Methodist Debakey Cardiovasc J 2014; 10:1. [PMID: 24932353 PMCID: PMC4051324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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