Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial.

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

Pass or Fail: A New Test for Password Legitimacy

While other programs check for bad passwords after the fact, it is important to have good passwords at all times, not just after the latest Crack run. To this end we have modified Larry Wall's Perl password program and added, among other features, the ability to check a sorted list of all the "bad passwords" that Crack will generate, given all the dictionaries that we could get our hands on (107 MB of unique words, so far). The combination of improvements has turned publicly available code into a powerful tool that can aid sites in the maintenance of local security. 1 The Problem Our motivation for developing a new test for passwords was based on the following assumptions: ffl There is some cracker out there on The Net who has our password file and nothing better to do. ffl Every so often we find out that someone is trying to break into our systems. ffl Having weak passwords on a system is an invitation for trouble, especially when connected to the Internet. ffl Stock passwd as i..

Pass or Fail: A New Test for Password Legitimacy

While other programs check for bad passwords after the fact, it is important to have good passwords at all times, not just after the latest Crack run. To this end we have modified Larry Wall's Perl password program and added, among other features, the ability to check a sorted list of all the "bad passwords" that Crack will generate, given all the dictionaries that we could get our hands on (107 MB of unique words, so far). The combination of improvements has turned publicly available code into a powerful tool that can aid sites in the maintenance of local security. 1 The Problem Our motivation for developing a new test for passwords was based on the following assumptions: ffl There is some cracker out there on The Net who has our password file and nothing better to do. ffl Every so often we find out that someone is trying to break into our systems. ffl Having weak passwords on a system is an invitation for trouble, especially when connected to the Internet. ffl Stock passwd as i..

Argonne's Computing and Communications Infrastructure Futures Laboratory Designing the Future

science. In order to meet this goal, the lab is organized aroun

Building and measuring a high performance network architecture

Once a year, the SC conferences present a unique opportunity to create and build one of the most complex and highest performance networks in the world. At SC2000, large-scale and complex local and wide area networking connections were demonstrated, including large-scale distributed applications running on different architectures. This project was designed to use the unique opportunity presented at SC2000 to create a testbed network environment and then use that network to demonstrate and evaluate high performance computational and communication applications. This testbed was designed to incorporate many interoperable systems and services and was designed for measurement from the very beginning. The end results were key insights into how to use novel, high performance networking technologies and to accumulate measurements that will give insights into the networks of the future

Gut bacteria dysbiosis and necrotising enterocolitis in very low birthweight infants: a prospective case-control study.

BACKGROUND: Gut bacteria might predispose to or protect from necrotising enterocolitis, a severe illness linked to prematurity. In this observational prospective study we aimed to assess whether one or more bacterial taxa in the gut differ between infants who subsequently develop necrotising enterocolitis (cases) and those who do not (controls). METHODS: We enrolled very low birthweight (1500 g and lower) infants in the primary cohort (St Louis Children\u27s Hospital) between July 7, 2009, and Sept 16, 2013, and in the secondary cohorts (Kosair Children\u27s Hospital and Children\u27s Hospital at Oklahoma University) between Sept 12, 2011 and May 25, 2013. We prospectively collected and then froze stool samples for all infants. Cases were defined as infants whose clinical courses were consistent with necrotising enterocolitis and whose radiographs fulfilled criteria for Bell\u27s stage 2 or 3 necrotising enterocolitis. Control infants (one to four per case; not fixed ratios) with similar gestational ages, birthweight, and birth dates were selected from the population after cases were identified. Using primers specific for bacterial 16S rRNA genes, we amplified and then pyrosequenced faecal DNA from stool samples. With use of Dirichlet multinomial analysis and mixed models to account for repeated measures, we identified host factors, including development of necrotising enterocolitis, associated with gut bacterial populations. FINDINGS: We studied 2492 stool samples from 122 infants in the primary cohort, of whom 28 developed necrotising enterocolitis; 94 infants were used as controls. The microbial community structure in case stools differed significantly from those in control stools. These differences emerged only after the first month of age. In mixed models, the time-by-necrotising-enterocolitis interaction was positively associated with Gammaproteobacteria (p=0·0010) and negatively associated with strictly anaerobic bacteria, especially Negativicutes (p=0·0019). We studied 1094 stool samples from 44 infants in the secondary cohorts. 18 infants developed necrotising enterocolitis (cases) and 26 were controls. After combining data from all cohorts (166 infants, 3586 stools, 46 cases of necrotising enterocolitis), there were increased proportions of Gammaproteobacteria (p=0·0011) and lower proportions of both Negativicutes (p=0·0013) and the combined Clostridia-Negativicutes class (p=0·0051) in infants who went on to develop necrotising enterocolitis compared with controls. These associations were strongest in both the primary cohort and the overall cohort for infants born at less than 27 weeks\u27 gestation. INTERPRETATION: A relative abundance of Gammaproteobacteria (ie, Gram-negative facultative bacilli) and relative paucity of strict anaerobic bacteria (especially Negativicutes) precede necrotising enterocolitis in very low birthweight infants. These data offer candidate targets for interventions to prevent necrotising enterocolitis, at least among infants born at less than 27 weeks\u27 gestation. FUNDING: National Institutes of Health (NIH), Foundation for the NIH, the Children\u27s Discovery Institute. Lancet 2016 May 7; 387(10031):1928-3