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We provide an overview of the design and capabilities of the near-infrared spectrograph (NIRSpec) onboard the James Webb Space Telescope. NIRSpec is designed to be capable of carrying out low-resolution (\\(R\\!=30\\!-330\\)) prism spectroscopy over the wavelength range \\(0.6-5.3\\!~\\)m and higher resolution (\\(R\\!=500\\!-1340\\) or \\(R\\!=1320\\!-3600\\)) grating spectroscopy over \\(0.7-5.2\\!~\\)m, both in single-object mode employing any one of five fixed slits, or a 3.1\\(\\)3.2 arcsec\\(^2\\) integral field unit, or in multiobject mode employing a novel programmable micro-shutter device covering a 3.6\\(\\)3.4~arcmin\\(^2\\) field of view. The all-reflective optical chain of NIRSpec and the performance of its different components are described, and some of the trade-offs made in designing the instrument are touched upon. The faint-end spectrophotometric sensitivity expected of NIRSpec, as well as its dependency on the energetic particle environment that its two detector arrays are likely to be subjected to in orbit are also discussed.

Differences in female workers' finger temperatures, manual dexterity, ratings on thermal comfort, and local cooling exposure were studied in three factories in the Faroe Island fishing industry. Environmental temperatures in the factories varied from 5 to 19°C with vertical gradients of 7°C/m, and the mean temperatures of the flushing water varied from 2 to 15°C. Finger temperature varied from 12 to 24°C when measured 2 min after work was stopped, and about one-third of the women experienced thermal discomfort in the fingers during work. The fish temperature increased, on the average, less than 1°C during passage through the production room, notwithstanding the thermal differences among the factories. These findings should be used in attempts to reduce the cold exposure of the workers; but also improved control should be recommended for both environmental and water temperatures in the factories.

Antihypertensive drugs are often initiated and adjusted over a period of weeks to months. It is not clear whether the time and inconvenience of this approach is necessary. We studied whether or not drug adjustment over several days in the context of a physician–nurse team could produce a durable blood pressure benefit according to home blood pressure measurements. Sixty-eight patients (aged 65 ± 1 years, 47% men) were referred for management of hypertension. Indications for referral were new hypertension (13%), known/controlled hypertension (30%), or known/uncontrolled hypertension (57%). Patients had one to three brief nurse visits/day and were provided with an accurate semiautomated device for self-blood pressure (BP) measurement. Sixty patients provided follow-up data. Group 1 ( n = 16) required no change in their preexisting drug regimen during clinic visits, whereas group 2 ( n = 44) had drug therapy initiated or adjusted over 4 ± 1 days. Patients were evaluated at baseline, at dismissal from the clinic, and at latest follow-up (mailed-in report of 42 readings taken over 7 days at 1- to 3-month intervals). Mean follow-up was 11 ± 0.5 months. Mean BP at baseline, dismissal, and latest follow-up for group 1 were 132 ± 4/73 ± 2, 130 ± 6/70 ± 2, and 125 ± 3/73 ± 3 mm Hg ( P = not significant). Mean BP for group 2 at the same intervals were 150 ± 4/80 ± 2, 139 ± 3 ( P < .01 v baseline)/75 ± 2, 133 ± 2 ( P < .01 v baseline and < .05 v dismissal)/74 ± 1 ( P < .01 v baseline). The BP control rate (blood pressures less than 140/90 mm Hg) was 75% in group 2. Drug number/dose remained the same or lower in 87% and 91% of patients during follow-up in groups 1 and 2, respectively. These results suggest that a clinically significant lowering of blood pressure can often be achieved over several days and maintained for up to 1 year. Increased use of rapid drug titration, a physician–nurse team approach, and self-BP measurement at prescribed intervals have the potential to improve BP control rates and reduce the expense and inconvenience associated with the treatment of hypertension.

Facing surgery with an already stressed cardiovascular system, the hypertensive patient requires special attention. Avoiding exacerbations is discussed.

To assess whether a physician-nurse team model could improve long-term hypertension control rates by active intervention and modification of antihypertensive drug regimens based on home blood pressure (BP) measurements. This study consisted of patients referred to a hypertension specialty clinic between July 1999 and June 2002 for the evaluation and management of uncontrolled hypertension. Patients were evaluated initially by a physician. A treatment plan was designed and implemented subsequently by a hypertension nurse specialist. Each patient was given an automated digital home BP monitor and requested to provide 42 BP readings taken during 7 days at intervals of 1, 3, 6, 9, and 12 months after dismissal from the clinic. The mean of these weekly values was reviewed by the physician-nurse team, and the treatment regimen was adjusted to achieve a goal BP of less than 135/85 mm Hg. One hundred six consecutively referred patients were enrolled in the study (mean+/-SD age, 64+/-14 years; 58% female; baseline BP, 156+/-16/85+/-11 mm Hg). Ninety-four patients submitted BP data after 1 month, and 78 patients completed the entire 12-month study period. Overall, mean BP decreased to 138+/-17/78+/-8 mm Hg at 1 month and to 131+/-9/75+/-7 mm Hg at 12 months (P<.01 vs baseline). The percentage of patients who achieved BP control to less than 135/85 mm Hg increased from 0% at baseline to 63% at 12 months. Intensification of antihypertensive drug therapy was required, on average, in 24% of patients at each study interval. The mean number of drugs increased from 1.2 at baseline to 2.0 at 12 months (P<.01). The use of home BP measurement by a physician-nurse team has the potential to significantly improve long-term hypertension control rates in a geographically dispersed patient population. This model should reduce both cost and inconvenience associated with the treatment of hypertension.

The clinical value of renal vein renin sampling (RVRS) as a prognostic tool in the treatment of renovascular hypertension was evaluated. One hundred consecutive patients were included over a 4-year period of time. About half of the patients (49%) were treated interventionally by PTRA (21%), nephrectomy (20%), or vascular surgery (8%). Seven patients (15%) were cured and 15 (32%) had improved (reduction in antihypertensive medicine) after 6 months follow-up, whereas three patients (6%) were cured and 12 (26%) improved after 3-4 years follow-up. Thus, the number of patients cured or improved is comparable with the results from our department reported 20 years ago. However, in the present report, more than twice as many patients were enrolled, leading to double costs. Different indices of lateralisation of the renin generation were calculated for the use in cases of a shrunken kidney (functional share < or =15%). None of the indices clearly discriminated between the patients who did benefit from intervention, and those who did not. The only positive finding was that a peripheral renin concentration lower than 8 mlU/l predicted no effect of intervention, which might lead to the exclusion of 11% of the patients before entering the diagnostic programme. We conclude that the RVRS demands a very restrictive referral pattern if it should be of prognostic value for the blood pressure outcome after intervention. No indices of lateralised renin concentrations proved high predictive value. However, a peripheral renin concentration low in the normal range seems useful as an indicator of no benefit from intervention.

With the use of a climate chamber, the effects of a 3-h exposure to moderate heat stress (23 to 29°C) on the physiology, comfort, and performance of 20 subjects, 10 with slight (group I) and 10 with moderate (group II) ischemie heart disease (IHD), were studied. Twenty matched control subjects were similarly exposed. All of the subjects performed sedentary, mental work throughout the exposure. Humidity was 9 mm Hg; air velocity, 10 ± 3 cm per second; and thermal resistance of the clothing, 0.7 clo. Under identical conditions no significant differences in rectal, skin, and finger temperatures or weight loss existed between the three groups, but during heat stress the temperatures and weight loss were always significantly higher than under the control conditions, except for rectal temperatures during the first 2 h. There was no difference between the groups or the two sets of conditions in respiration rate and diastolic blood pressure, but the patients had a significantly lower systolic blood pressure in the third hour of heat stress than under the control conditions. Heart rate and the rate-pressureproduct during heat stress were significantly higher in the controls than in the patients. A few patients experienced a slight retrosternal oppression during heat stress, but only one had ECG changes, and none of these symptoms or signs were present under control conditions. Under both sets of temperature conditions the patients were uncomfortable during a longer period of time than the controls, and they were more sensitive to temperature changes, group II being more sensitive than group I. The comfort distribution curve was very narrow for group II. The performance tests were numerical addition, card punching, cue-utilization and creative association. In numerical addition no temperature effect could be shown on the speed of working, but for the patients in group II during heat stress the level of accuracy in the second hour was lower than under control conditions; the trend was the opposite for control subjects. No differences occurred in the first or third hour. In card punching the patients in group II worked significantly more slowly during heat stress than did the control subjects, who improved their performance in heat, as did the patients in group I. A similar effect was found on the accuracy with which this task was performed, the patients in group II making significantly more errors in the heat than patients in group I. Cue-utilization did not differ between groups or conditions. Patients performing the creative association test under heat stress supplied significantly fewer unique answers than did patients working under control conditions; no such effect of heat was observed for control subjects. We conclude that patients with IHD are more sensitive to moderate heat stress than healthy control subjects in terms of mental performance and comfort. There are some differences in cardiopulmonary function but no differences in thermoregulation.