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BACKGROUND: Studies evaluating titration of antihypertensive medication using self-monitoring give contradictory findings and the precise place of telemonitoring over self-monitoring alone is unclear. The TASMINH4 trial aimed to assess the efficacy of self-monitored blood pressure, with or without telemonitoring, for antihypertensive titration in primary care, compared with usual care.METHODS: This study was a parallel randomised controlled trial done in 142 general practices in the UK, and included hypertensive patients older than 35 years, with blood pressure higher than 140/90 mm Hg, who were willing to self-monitor their blood pressure. Patients were randomly assigned (1:1:1) to self-monitoring blood pressure (self-montoring group), to self-monitoring blood pressure with telemonitoring (telemonitoring group), or to usual care (clinic blood pressure; usual care group). Randomisation was by a secure web-based system. Neither participants nor investigators were masked to group assignment. The primary outcome was clinic measured systolic blood pressure at 12 months from randomisation. Primary analysis was of available cases. The trial is registered with ISRCTN, number ISRCTN 83571366.FINDINGS: 1182 participants were randomly assigned to the self-monitoring group (n=395), the telemonitoring group (n=393), or the usual care group (n=394), of whom 1003 (85%) were included in the primary analysis. After 12 months, systolic blood pressure was lower in both intervention groups compared with usual care (self-monitoring, 137·0 [SD 16·7] mm Hg and telemonitoring, 136·0 [16·1] mm Hg vs usual care, 140·4 [16·5]; adjusted mean differences vs usual care: self-monitoring alone, -3·5 mm Hg [95% CI -5·8 to -1·2]; telemonitoring, -4·7 mm Hg [-7·0 to -2·4]). No difference between the self-monitoring and telemonitoring groups was recorded (adjusted mean difference -1·2 mm Hg [95% CI -3·5 to 1·2]). Results were similar in sensitivity analyses including multiple imputation. Adverse events were similar between all three groups.INTERPRETATION: Self-monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings. With most general practitioners and many patients using self-monitoring, it could become the cornerstone of hypertension management in primary care.FUNDING: National Institute for Health Research via Programme Grant for Applied Health Research (RP-PG-1209-10051), Professorship to RJM (NIHR-RP-R2-12-015), Oxford Collaboration for Leadership in Applied Health Research and Care, and Omron Healthcare UK.

Neville Martin Bailey served as house surgeon at Withington Hospital and then as house obstetrician at Saint Mary’s Hospital Manchester. National service was still obligatory, so he joined the Royal Air Force and served in fighter command as senior medical officer at RAF Odiham from 1 January 1956 to 31 December 1958. During this time the station was testing new aircraft, often flying round the clock, and Neville had to be available on call for very long periods. He decided to use the time to study for an external degree in zoology at London University and travelled to the University of Reading on an occasional free Saturday, where the professor of zoology allowed him to use the laboratory and kept back specimens for his practical work. In 1958 he was awarded a BSc (Hons) from the University of London. At this time, he was invited to join the Royal Air Force on a permanent commission, but progression would inevitably have meant working in London, and he was a countryman who disliked city life. By this time, we had three children, and with a fourth due imminently, he decided to become a general practitioner—ideally in a country practice. But when a singlehanded retirement practice vacancy came up in Peterborough, he applied and was offered the appointment in mid-December 1958, but only on the condition that he could provide premises and a commitment to offer a service to the existing patients of the practice—24 hours a day, seven days a week, 365 days a year—from 1 January 1959. The RAF had provided a gratuity of £600, and Neville’s father lent us a deposit to enable us to buy a house. The house we bought in such a hurry soon proved to be in the wrong place and had no access to a …

We examine acute stroke patients' decisions and delays en route to the hospital after onset of symptoms.This was a qualitative study carried out in the West Midlands, United Kingdom. Semistructured interviews were conducted with 30 patients (6 accompanied by partners). Patients were asked about their previous experience of having had a stroke and their initial engagement with health services. "One sheet of paper" and thematic analyses were used.Three potential types of delay were identified from onset of symptoms to accessing stroke care in the hospital: primary delays caused by lack of recognition of symptoms or not dealing with symptoms immediately, secondary delays caused by initial contact with nonemergency services, and tertiary delays in which health service providers did not interpret the patients' presenting symptoms as suggestive of stroke. The main factors determining the speed of action by patients were the presence and influence of a bystander and the perceived seriousness of symptoms.Despite campaigns to increase public awareness of stroke symptoms, the behavior of both patients and health service providers apparently led to delays in the recognition of and response to stroke symptoms, potentially reducing access to optimum and timely acute specialist assessment and treatment for acute stroke.

The state-of-the-art in space solar cells utilizes epitaxially grown III-V multi-junction cells. Champion lattice matched triple-junction space cells now exceed the 30% efficiency barrier. The ultimate efficiency of such cells is restricted by the available bandgaps offered by the lattice-matching requirement and the necessity of having current-matching between the various junctions. It has been theoretically shown that efficiency improvements are possible if the spectral bandwidth of the GaAs or middle junction of a conventional lattice- matched triple junction cell (grown on Ge) could be extended to longer wavelengths. We have been investigating a method of providing this additional sub-gap absorption, and corresponding improvement of short-circuit current of this junction, through the use of self- organized InAs quantum dots. These quantum dots are incorporated using a Stranski- Krastanov organometallic vapor phase epitaxy growth mode in a sequentially stacked array of InAs quantum dots (QD) and GaAs cladding layers within the p-type / intrinsic / n-type (pin) GaAs cell structure. Spectral response results have demonstrated enhanced sub GaAs bandgap response and improvements in short-circuit current densities. We will discuss the potential that exists and the challenges associated with multi-junction device growth with the inclusion of quantum dot arrays. The unique challenges associated with the characterization of this type of device will also be presented. Finally, we will discuss the opportunities that these devices may hold for future space power systems.

Publisher Summary This chapter discusses the operation of solar cells in a space environment. The first 30 years of space solar cell development focused on silicon solar cells. The concept of a tandem cell was proposed in the early days to enhance the overall efficiency. An optimized three-cell stack followed with a theoretical optimum efficiency of 37%. However, it was 40 years later before a multijunction solar cell flew in space. Today, silicon cells still fly in space, but the cell of choice is a multijunction solar cell. While commercial satellites use silicon, dual, or triple junction GaInP/GaAs/Ge, there is a marked interest in military applications of thin-film cells. NASA also has planned missions in which a large specific power (kW/kg) and lower cost would be beneficial. The advantages of thin film solar cells are their large specific power when deposited on a flexible, lightweight substrate with a suitably lightweight support structure. This chapter discusses space missions and their environments. Concepts of air mass zero spectrum, trapped radiation environment, solar flares, neutral environment, the particulate environment, and thermal environment are explained in detail.

There are conflicting views of when children understand that the cardinality of a set is independent of the order in which the objects are counted. Some discrepancies between studies using similar tests may be due to children interpreting the experimenter as questioning the accuracy of their counting. Three studies are reported of children between 3 and 6 years old. In Experiments 1 and 2, more expected a count in a different order to yield the same number when they did not have to do any counting than when they had to count or monitor a puppet's counting. However, some also expected subtraction not to affect cardinality. In Experiment 3 substantially more children predicted correctly whether a recount would yield the same number than what the number would be. These variations may reflect the power of forms of questioning to orient the child toward principles or practice.

Electrochemical C-V (EC-V) profiling is the most often used and convenient method for accurate majority carrier concentration depth profiling of semiconductors. None of the previously developed electrolytes recommended for EC-V profiling of InP and GaAs based structures works with all the materials encountered. In our experience, the most common problems encountered when using these electrolytes are: (i) a poor electrolyte/semiconductor Mott-Schottky barrier, (ii) preferential dissolution at the defect areas, (iii) high chemical etch rates, (iv) formation of insoluble products on the surface, (v) large parasitic capacitance components, (vi) a rough bottom of the etch crater, (vii) rounding at the crater rim and (viii) electrolyte seeping under the edge of the sealing rim. Although, according to us, FAP is the best electrolyte for accurate profiling of InP structures, it does not work well with other III-V compounds. To overcome this, recently, we have developed a new electrolyte, which we call UNIEL (UNIversal ELectrolyte). However, as with the FAP electrolyte, the presence of HF makes the UNIEL incompatible with the electrochemical cell of Polaron EC-V profilers manufactured by BIG-RAD. By slightly modifying the electrochemical cell configuration we are able to use both the FAP and UNIEL electrolytes, without destroying the calomel electrode. Recently, we have, nevertheless, experimented with variations of the UNIEL with no HF content for EC-V profiling of structures based on InP and GaAs. Presently available results are presented here.

An etchant, namely (o-H/sub 3/PO/sub 4/)/sub u/: (HNO/sub 3/)/sub v/: (H/sub 2/O/sub 2/)/sub t/: (H/sub 2/O)/sub 1-(u+v+t/) has been developed for thinning, after contacting, the p/sup +/ emitter layer of p/sup +/n InP structures made by thermal diffusion. Varying u, v, and t, reproducible etch rates of 5 to 110 nm/min have been obtained. After thinning the 0.6 to 2.5 mu m thick p/sup +/ InP layer down to 60-250 nm, specular surfaces have been obtained at up to 80 nm/min etch rate. Due to its intrinsic qualities the residual P-rich oxide after thinning the emitter layer provides surface passivation of p/sup +/ InP surfaces and can also serve as a first-layer AR coating. >