SummaryBackgroundStudies 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.MethodsThis 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.Findings1182 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.InterpretationSelf-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.FundingNational 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.

Aim The extent to which individuals from different breeding populations mix throughout the non‐breeding season (i.e. ‘migratory connectivity’) has important consequences for population dynamics and conservation. Given recent declines of long‐distance migrant birds, multipopulation tracking studies are crucial in order to assess the strength of migratory connectivity and to identify key sites en route. Here, we present the first large‐scale analysis of migration patterns and migratory connectivity in the globally near‐threatened European roller Coracias garrulus. Location Breeding area: Europe; passage area: Mediterranean, sub‐Saharan Africa, Arabian Peninsula; wintering area: southern Africa. Methods We synthesize new geolocator data with existing geolocator, satellite tag and ring recovery data from eight countries across Europe. We describe routes and stopover sites, analyse the spatial pattern of winter sites with respect to breeding origin and quantify the strength of connectivity between breeding and winter sites. Results We demonstrate the importance of the northern savanna zone as a stopover region and reveal the easterly spring loop (via Arabia) and leapfrog migration of rollers from eastern populations. Whilst there was some overlap between individuals from different populations over winter, their distribution was non‐random, with positive correlations between breeding and autumn/winter longitude as well as between pairwise distance matrices of breeding and winter sites. Connectivity was stronger for eastern populations than western ones. Main conclusions The moderate levels of connectivity detected here may increase the resilience of breeding populations to localized habitat loss on the winter quarters. We also highlight the passage regions crucial for the successful conservation of roller populations, including the Sahel/Sudan savanna for all populations, and the Horn of Africa/Arabian Peninsula for north‐eastern rollers.

In a high Arctic polar semidesert ecosystem (ambient N deposition c. 0.1 g N m À2 a À1 ), the effects of N enrichment on the diversity of soil microfungi and on N content and availability in organic and mineral soils were determined. Three N (total: 0, 0.5, 5 g N m À2 a À1 ) and two P (total 0, 1 g m À2 a À1 ) treatments were applied, since P may limit response to N in this ecosystem. Organic and mineral soils were sampled in June and August in the second year of treatment for microfungi, pH, moisture content, and total N and P. In the third year, soils were resampled for extractable and total N and P. The fungi isolated were typical of high pH soils in the High Arctic and Antarctic. The species richness and diversity of soil microfungi were very low, with ranges as follows: Shannon diversity, 0.56-1.5; richness, 2-6; evenness, 0.79-0.9. There was no significant effect of treatment on the frequency of occurrence of different taxa of soil microfungi. Time of sampling also had no significant impact on fungal assemblages, although different, more diverse communities were isolated from organic, rather than mineral, soils. Nitrate-N in organic soil decreased significantly when P was added alone, but not when P and N were added together. Addition of 0.5 g N m À2 a À1 , a rate deposition already occurring in Greenland and Iceland, appeared to exceed N demand even when P limitation was relieved. There was no apparent soil acidification as a result of the N treatments.

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