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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.

Natural disturbances are key processes in the vast majority of ecosystems and a range of ecological theories have been developed in an attempt to predict biotic responses to them. However, empirical support for these theories has been inconsistent and considerable additional work remains to be done to better understand the response of biodiversity to natural disturbance. We tested predictions from the intermediate disturbance hypothesis and the habitat accommodation model of succession for reptile responses to fire history and a single major fire event. We focused our work on a broad range of vegetation types spanning sedgeland to temperate rainforest located within a national park in south-eastern Australia. We found no significant relationships between reptile species richness and the number of fires over the past 35 years, the time since the last fire, or the severity of a major fire in 2003. Thus, we found no strong evidence to support the intermediate disturbance hypothesis. A correspondence analysis of reptile assemblages revealed a gradient in species responses to fire history. However, we found limited evidence for an ordered succession of reptiles. Nor could the responses of individual species be readily predicted from life history attributes. Thus, our findings were generally not consistent with predictions from the habitat accommodation model of succession. A possible explanation for the absence of a predictable sequence of recovery following disturbance might be the rapidity of post-fire recovery of many components of native vegetation cover that were found to be important for reptiles (e.g. the extent of grass cover). This would have limited the time for early successional conditions to prevail and limited opportunities for species associated with such conditions. We found that most reptile species responses were much more strongly linked to vegetation type than fire variables, emphasizing a need to understand relationships with vegetation before being able to understand possible fire effects (if and where they exist). We found the disturbance concepts we examined were limited in their ability to accurately predict reptile responses to past fire history or the impacts of a single major fire in 2003. Practical management might be best guided not by disturbance theory, but by carefully setting objectives to meet conservation goals for particular individual species of reptiles.

Introduction: Novel ecosystems occur when new combinations of species appear within a particular biome due to human activity, environmental change, or impacts of introduced species. Background: Managing the trajectory of ecosystems toward desired outcomes requires an understanding of the means by which they developed. To facilitate this understanding, we present evidence for the development of a novel ecosystem from a natural experiment focusing on 52 woodland remnants surrounded by maturing stands of exotic radiata pine. Results: Bird community composition changed through time resulting in a unique blend of tall closed forest and open-woodland birds that previously did not occur in the study area, nor in the region's tall closed forest or open-woodland biomes. Conclusion: Novel ecosystems will become increasingly common due to climate change, raising complex management and ethical dilemmas for policy makers and resource managers.

Biodiversity conservation on agricultural land is a major issue worldwide. We estimated separate and joint effects of remnant native woodland vegetation and recent tree plantings on birds on farms (approximately 500-1000 ha)