2,497 publications from this institution
T he common phenomena of white-coat and masked hypertension have established the need for assessing blood pressure (BP) out of the office, particularly using 24-hour ambulatory monitoring (ABPM).In the last 2 decades, evidence on the usefulness of the alternative method for out-of-office BP assessment, namely home BP monitoring (HBPM), has accumulated, and guidelines on using this method have recently been published in the United States and Europe. 1,2As with ABPM, HBPM allows the detection of white-coat and masked hypertension and has additional advantages, such as wide availability, low cost, and excellent acceptability by hypertensive patients for repeated use. 1,2n this issue of Hypertension, Niiranen et al present the results of Finn-Home, an outcome study of HBPM in the general population in Finland. 3 Strengths of this study are the large data set (Ͼ14,000 subject-years, with 162 documented cardiovascular events) and the use of optimal methodology for office BP measurement (nurses using mercury sphygmomanometers) and HBPM (validated electronic device and guidelinesrecommended monitoring schedule with 7-day duplicate morning and evening measurements).This study contributes to the HBPM and outcome database that now comprises 8 large long-term prospective studies 3-10 including 17,688 subjects and almost 100,000 person-years of follow-up (Table ).There are important differences among these studies regarding the study population, the BP measurements, the definition of primary outcomes, and the methods of statistical adjustment.Studies have been performed in Europe and Japan. Office BP was measured using conventional mercury sphygmomanometers, apart from the Ohasama study, 4 which used electronic devices; and that of Okumiya et al, 5 which did not report
Recently, there has been considerable interest in providing "trusted computing platforms" using hardware~---~TCPA and Palladium being the most publicly visible examples. In this paper we discuss our experience with building such a platform using a traditional time-sharing operating system executing on XOM~---~a processor architecture that provides copy protection and tamper-resistance functions. In XOM, only the processor is trusted; main memory and the operating system are not trusted.Our operating system (XOMOS) manages hardware resources for applications that don't trust it. This requires a division of responsibilities between the operating system and hardware that is unlike previous systems. We describe techniques for providing traditional operating systems services in this context.Since an implementation of a XOM processor does not exist, we use SimOS to simulate the hardware. We modify IRIX 6.5, a commercially available operating system to create xomos. We are then able to analyze the performance and implementation overheads of running an untrusted operating system on trusted hardware.
Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Abstract In this issue of the Hastings Center Report, Jonathan Kimmelman and Alex London argue that in assessing the success of clinical translation, it is narrow‐minded to focus only on how many new drugs get licensed and how quickly they achieve licensure. Kimmelman and London show that clinical translation should be judged on its ability to generate as comprehensive an intervention ensemble as possible for the tested interventions. I would like to extend Kimmelman and London's position in two ways. First, I would argue that in the current environment, failures should be seen not just as acceptable, but probably as the most useful outcomes that translational research efforts can offer. Second, an intervention ensemble probably cannot be generated with information only about the drug or drugs produced by a single company. For most conditions and diseases, there are already a large number of other interventions whose use is supported or contradicted by various levels of evidence .
Most studies on global health inequality consider unequal health care and socio-economic conditions but neglect inequality in the production of health knowledge relevant to addressing disease burden. We demonstrate this inequality and identify likely causes. Using disability-adjusted life years (DALYs) for 111 prominent medical conditions, assessed globally and nationally by the World Health Organization, we linked DALYs with MEDLINE articles for each condition to assess the influence of DALY-based global disease burden, compared to the global market for treatment, on the production of relevant MEDLINE articles, systematic reviews, clinical trials and research using animal models vs. humans. We then explored how DALYs, wealth, and the production of research within countries correlate with this global pattern. We show that global DALYs for each condition had a small, significant negative relationship with the production of each type of MEDLINE articles for that condition. Local processes of health research appear to be behind this. Clinical trials and animal studies but not systematic reviews produced within countries were strongly guided by local DALYs. More and less developed countries had very different disease profiles and rich countries publish much more than poor countries. Accordingly, conditions common to developed countries garnered more clinical research than those common to less developed countries. Many of the health needs in less developed countries do not attract attention among developed country researchers who produce the vast majority of global health knowledge--including clinical trials--in response to their own local needs. This raises concern about the amount of knowledge relevant to poor populations deficient in their own research infrastructure. We recommend measures to address this critical dimension of global health inequality.
