Community based trial of home blood pressure monitoring with nurse-led telephone support in patients with stroke or transient ischaemic attack recently discharged from hospital.

BACKGROUND: High blood pressure in patients with stroke increases the risk of recurrence but management in the community is often inadequate. Home blood pressure monitoring may increase patients' involvement in their care, increase compliance, and reduce the need for patients to attend their General Practitioner if blood pressure is adequately controlled. However the value of home monitoring to improve blood pressure control is unclear. In particular its use has not been evaluated in stroke patients in whom neurological and cognitive ability may present unique challenges. DESIGN: Community based randomised trial with follow up after 12 months. PARTICIPANTS: 360 patients admitted to three South London Stroke units with stroke or transient ischaemic attack within the past 9 months will be recruited from the wards or outpatients and randomly allocated into two groups. All patients will be visited by the specialist nurse at home at baseline when she will measure their blood pressure and administer a questionnaire. These procedures will be repeated at 12 months follow up by another researcher blind as to whether the patient is in intervention or control group. INTERVENTION: INTERVENTION patients will be given a validated home blood pressure monitor and support from the specialist nurse. Control patients will continue with usual care (blood pressure monitoring by their practice). Main outcome measures in both groups after 12 months: 1. Change in systolic blood pressure.2. Cost effectiveness: Incremental cost of the intervention to the National Health Service and incremental cost per quality adjusted life year gained

Double-active-layer index-guided InGaAsP-InP laser diode

A buried crescent InGaAsP-InP laser with two active layers was fabricated to study the temperature behavior of the double-carrier-confinement structure. An anomalously high characteristic temperature T0 was measured, and optical switching behavior was observed. A mode analysis and numerical calculation using a rate equation approach explained qualitatively very well the experimental results. It was revealed that both the Auger recombination in this special double-active-layer configuration and the temperature-dependent leakage current, which leads to uniform carrier distribution in both active regions, are essential to increase T0

Does Choice Mean Freedom And Well-Being?

Americans live in a political, social, and historical context that values personal freedom and choice above all else, an emphasis that has been amplified by contemporary psychology. However, this article reviews research that shows that in non-Western cultures and among working-class Westerners, freedom and choice do not have the meaning or importance they do for the university-educated people who have been the subjects of almost all research on this topic. We cannot assume that choice, as understood by educated, affluent Westerners, is a universal aspiration. The meaning and significance of choice are cultural constructions. Moreover, even when choice can foster freedom, empowerment, and independence, it is not an unalloyed good. Too much choice can produce a paralyzing uncertainty, depression, and selfishness. In the United States, the path to well-being may require that we strike a balance between the positive and negative consequences of proliferating choice in every domain of life

Regularization independent of the noise level: an analysis of quasi-optimality

The quasi-optimality criterion chooses the regularization parameter in inverse problems without taking into account the noise level. This rule works remarkably well in practice, although Bakushinskii has shown that there are always counterexamples with very poor performance. We propose an average case analysis of quasi-optimality for spectral cut-off estimators and we prove that the quasi-optimality criterion determines estimators which are rate-optimal {\em on average}. Its practical performance is illustrated with a calibration problem from mathematical finance.Comment: 18 pages, 3 figure

Vacuum Polarization and the Electric Charge of the Positron

We show that higher-order vacuum polarization would contribute a measureable net charge to atoms, if the charges of electrons and positrons do not balance precisely. We obtain the limit $|Q_e+Q_{\bar e}| < 10^{-18} e$ for the sum of the charges of electron and positron. This also constitutes a new bound on certain violations of PCT invariance.Comment: 9 pages, 1 figure attached as PostScript file, DUKE-TH-92-38. Revised versio

Testing spontaneous localization theories with matter-wave interferometry

We propose to test the theory of continuous spontaneous localization (CSL) in an all-optical time-domain Talbot-Lau interferometer for clusters with masses exceeding 1000000 amu. By assessing the relevant environmental decoherence mechanisms, as well as the growing size of the particles relative to the grating fringes, we argue that it will be feasible to test the quantum superposition principle in a mass range excluded by recent estimates of the CSL effect.Comment: 4 pages, 3 figures; corresponds to published versio

Fractional derivatives of random walks: Time series with long-time memory

We review statistical properties of models generated by the application of a (positive and negative order) fractional derivative operator to a standard random walk and show that the resulting stochastic walks display slowly-decaying autocorrelation functions. The relation between these correlated walks and the well-known fractionally integrated autoregressive (FIGARCH) models, commonly used in econometric studies, is discussed. The application of correlated random walks to simulate empirical financial times series is considered and compared with the predictions from FIGARCH and the simpler FIARCH processes. A comparison with empirical data is performed.Comment: 10 pages, 14 figure

Inhibition and stimulation of the human breast cancer resistance protein as in vitro predictor of drug–drug interactions of drugs of abuse

Transporter-mediated drug–drug interactions (DDI) may induce adverse clinical events. As drugs of abuse (DOA) are marketed without preclinical safety studies, only very limited information about interplay with membrane transporters are available. Therefore, 13 DOA of various classes were tested for their in vitro affinity to the human breast cancer resistance protein (hBCRP), an important efflux transporter. As adenosine 5′-triphosphate (ATP) hydrolysis is crucial for hBCRP activity, adenosine 5′-diphosphate (ADP) formation was measured and used as in vitro marker for hBCRP ATPase activity. ADP quantification was performed by hydrophilic interaction liquid chromatography coupled to high-resolution tandem mass spectrometry and its amount in test compound incubations was compared to that in reference incubations using the hBCRP substrate sulfasalazine or the hBCRP inhibitor orthovanadate. If DOA caused stimulation or inhibition, further investigations such as Michaelis–Menten kinetic modeling or IC50 value determination were conducted. Among the tested DOA, seven compounds showed statistically significant hBCRP ATPase stimulation. The entactogen 3,4-BDB and the plant alkaloid mitragynine were identified as strongest stimulators. Their affinity to the hBCRP ATPase was lower than that of sulfasalazine but comparable to that of rosuvastatin, another hBCRP model substrate. Five DOA showed statistically significant hBCRP ATPase inhibition. Determination of IC50 values identified the synthetic cannabinoid receptor agonists JWH-200 and WIN 55,212-2 as the strongest inhibitors comparable to orthovanadate. The present study clearly demonstrated that tested DOA show in part high affinities to the hBCRP within the range of model substrates or inhibitors. Thus, there is a risk of hBCRP-mediated DDI, which needs to be considered in clinical settings