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ImportanceSelf-measured blood pressure (SMBP) with commercially available connected smartphone applications may help patients effectively use SMBP measurements.ObjectiveTo determine if enhanced SMBP paired with a connected smartphone application was superior to standard SMBP for blood pressure (BP) reduction or patient satisfaction.Design, Setting, and ParticipantsThis randomized clinical trial was conducted among 23 health systems participating in PCORnet, the National Patient-Centered Clinical Research Network, and included patients who reported having uncontrolled BP at their last clinic visit, a desire to lower their BP, and a smartphone. Enrollment and randomization occurred from August 3, 2019, to December 31, 2020, which was followed by 6 months of follow-up for each patient. Analysis commenced shortly thereafter.InterventionsEligible participants were randomly assigned to enhanced SMBP using a device that paired with a connected smartphone application (enhanced) or a standard device (standard). Participants received their device in the mail, along with web-based educational materials and phone-based support as needed. No clinician engagement was undertaken, and the study provided no special mechanisms for delivering measurements to clinicians for use in BP management.Main Outcomes and MeasuresReduction in systolic BP, defined as the difference between clinic BP at baseline and the most recent clinic BP extracted from electronic health records at 6 months.ResultsEnrolled participants (1051 enhanced [50.0%] vs 1050 standard [50.0%]; 1191 women [56.7%]) were mostly middle-aged or older (mean [SD] age, 58 [13] years), nearly a third were Black or Hispanic (645 [31%]), and most were relatively comfortable using technology (mean [SD], 4.1 [1.1] of 5). The mean (SD) change in systolic BP from baseline to 6 months was −10.8 (18) mm Hg vs −10.6 (18) mm Hg (enhanced vs standard: adjusted difference, −0.19 mm Hg; 95% CI, −1.83 to 1.44; P = .81). Secondary outcomes were mostly null, except for documented attainment of BP control to lower than 140/Conclusions and RelevanceThis randomized clinical trial found that enhanced SMBP paired with a smartphone application is not superior to standard SMBP for BP reduction or patient satisfaction.Trial RegistrationClinicalTrials.gov Identifier: NCT03796689

Purpose: To evaluate service access for women with epilepsy (WWE) during pregnancy; to determine seizure frequency and rates of adherence to anti-seizure medication (ASM).\ud \ud Methods: Between June 2019-June 2020, pregnant WWE within NHS Greater Glasgow and Clyde health-board were identified from the National Obstetric Register. A manual review of electronic patient records was undertaken to ensure diagnostic accuracy, as well as determine contact with epilepsy services and documented seizures. Medication dispensing records were obtained six months before and six months after midwifery booking and measures of ASM adherence calculated.\ud \ud Results: Between June 2019-June 2020, 4592 women were registered with a pregnancy. Eighty-five (1.9%) were identified as having active epilepsy (generalised- 40/85 (47.0%), focal- 35/85 (41.2%), unclassified- 10/85 (11.8%)). Preconceptually, 42/85 WWE (49.4%) had input from epilepsy services. Only 59/85 (69.4%) were reviewed during pregnancy (First trimester- 21/59 (35.6%), Second trimester- 25/59 (42.4%) and Third trimester- 13/59 (22.0%)). Seizure occurrence was documented in 37/85 WWE (43.5%) during the antenatal/postnatal period. 71/85 WWE (83.5%) were prescribed ASM. Poor adherence was noted in 50/85 (58.9%) and a documented seizure recorded in 26/50 (52.0%) of these women.\ud \ud Conclusion: Too many WWE do not receive input from epilepsy services during pregnancy, leaving some with poor ASM adherence and continued seizures. We aim to use “near-live” obstetric and dispensing data to facilitate early identification of WWE, promoting timely access to epilepsy specialists. This will also provide an opportunity to address concerns regarding ASM safety and allow medication dose changes to be considered.

The drawdown of CO2 via the temperature-dependent weathering of silicate minerals is thought to be one of the key processes acting to maintain Earth’s climate within narrow bounds over geologic time. However, the climatic responsiveness of weathering on multi-million-year timescales is, to our knowledge, yet to be demonstrated. If other factors dominate climate regulation on geologic timsecales, previously unexplored factors may be important in driving long-term carbon cycle changes. Here, we present the first continuous Cenozoic record of the concentration of calcium in seawater ([Ca2+sw]). Our record is based on the Na/Ca of exceptionally well-preserved foraminiferal calcite, a methodology which leverages the extremely long seawater Na+ residence time (>40 Myr) to interpret such changes predominantly in terms of [Ca2+sw] fluctuation. We show that a 12 mM decrease in [Ca2+sw] occurred over the last ~50 Ma, with a close correspondence to the timing of atmospheric CO2 changes, potentially implying a common driver. Using a carbon cycle box model, we demonstrate that, if the relationship between silicate weathering is shallower than commonly assumed, then this change in [Ca2+sw] can mechanistically explain the majority of the Cenozoic CO2 decrease, via the effect that Ca2+ has on CaCO3 burial rates. Given the recently identified major change in the global sea floor spreading rate, this finding shifts the key driver of long-term climate from the terrestrial to marine realm. Conversely, if there is a steep relationship between silicate weathering and climate, the climatic responsiveness of weathering is such that the system would rebalance before [Ca2+sw] can drive a major CO2 change. Our results therefore highlight the need to determine whether silicate weathering is responsive to climate change on geologic timescales before the long-term drivers of CO2 can be determined.

The influence of dimethyl sulfide (DMS) on climate is potentially large but highly uncertain. Some of this uncertainty results from the over-simplification of biological drivers of marine DMS production within predictive models. The available models rely on chlorophyll (chl) as the sole biological parameter and often fail to replicate observations, particularly during highly productive events with elevated seawater DMS concentrations. The major precursor for DMS is dimethylsulfoniopropionate (DMSP), an abundant compatible solute produced by many marine eukaryotes and prokaryotes. Despite its importance, knowledge of how, why and by what DMSP is produced is limited. For example, haptophytes and dinoflagellates typically produce 50-100 times more DMSP per unit chl than diatoms and prochlorophytes - yet the relevant enzymes have until recently been poorly characterised, limiting our understanding. Furthermore, although the DMSP synthesis genes and their transcripts are widespread in surface ocean bacterial communities, the contribution by this group of organisms to total DMSP production is so far unquantified.Here, we explore the diversity and expression of functional DMSP synthesis and lyase genes alongside DMS/P biogeochemical states and rates over a spring-summer time series (March – July 2021) at an established time series station in temperate shelf sea waters, to characterise the biological drivers of DMSP and DMS production.DMSP concentrations ranged from

Dimethylsulfoniopropionate (DMSP) is an abundant marine organosulfur compound[1] with roles in stress protection[2, 3], chemotaxis[4], nutrient and sulfur cycling[5] and, potentially, climate regulation[6, 7]. Marine algae and bacteria are considered significant DMSP producers, but many diverse representatives lack known DMSP synthesis genes/enzymes[8, 9]. Here, new DMSP biosynthesis enzymes were identified that considerably increase the number and diversity of potential DMSP-producing organisms, inferring new and significant global DMSP producers. A novel bifunctional DMSP biosynthesis enzyme, DsyGD, identified in the rhizobacterium Gynuella sunshinyii, produces DMSP at levels higher than any other bacterium from methylthiohydroxybutyrate (MTHB) via an N-terminal MTHB S-methyltransferase domain (termed DsyG) and a C-terminal dimethylsulfoniohydroxybutyrate (DMSHB) decarboxylase domain (termed DsyD, which is the first reported enzyme with this activity). DsyGD is also found in some filamentous cyanobacteria, not previously known to produce DMSP. Regulation of DMSP production and dsyGD transcription was consistent with their role in osmoprotection. Indeed, cloned dsyGD conferred osmotolerance to bacteria deficient in osmolyte production, something not previously demonstrated for any known DMSP synthesis gene, and which could be exploited for biotechnology e.g., engineering salt tolerance. DsyGD characterisation led to identification of phylogenetically distinct DsyG-like proteins, termed DSYE, with MTHB S-methyltransferase activity, in diverse and environmentally abundant Chlorophyta, Chlorachniophyta, Ochraphyta, Haptophyta and Bacillariophyta algae. These algae comprise a mix of low, high and previously unknown DMSP producers[10]. Algae containing DSYE, particularly bloom-forming Pelagophyceae species, which we showed to accumulate medium-high intracellular DMSP levels, were globally more abundant DMSP producers than Haptophyta, Dinophyta and Bacillariophyta with DSYB and/or TpMMT. This highlights the potential importance of Pelagophyceae and other DSYE containing algae in global DMSP production and sulfur cycling.

Dimethylsulfoxonium propionate (DMSOP) is a recently identified and abundant marine organosulfur compound with purported roles in oxidative stress protection, global carbon and sulfur cycling1. Diverse algae and bacteria synthesise DMSOP from dimethylsulfoniopropionate (DMSP), which potentially limits the production of climate-active gases e.g., dimethylsulfide (DMS) generated from microbial DMSP cleavage1. Here, DMSOP was found at mM levels in saltmarsh sediment, >10-fold higher than DMSP, and orders of magnitude higher than DMSOP levels previously reported in seawater1. Moreover, we showed bacteria could utilise DMSOP as an osmoprotectant. Some bacteria also cleave DMSOP liberating dimethyl sulfoxide (DMSO), an ubiquitous marine metabolite and acrylate1, but the enzymes responsible and their environmental importance were unknown. Here, we elucidated the DMSOP cleavage mechanism/s in diverse heterotrophic bacteria, e.g., SAR11 clade and Roseobacters, and fungi and phototrophic algae, e.g., Emiliania huxleyi, not previously known to have this activity. All these diverse organisms utilised their DMSP lyase ‘Ddd’ or ‘Alma1’ enzymes, that span five protein families, to cleave DMSOP with similar specific activities to DMSP. Bacteria with DMSP lyases that used DMSP as a carbon source likewise used DMSOP. Furthermore, ddd gene transcription in these bacteria was induced by DMSOP, including dddK in SAR11 strain HTCC1062. We determined the structure of DddK bound to DMSOP and concluded that the catalytic mechanisms of DMSOP cleavage by Ddd enzymes were like those for DMSP. Given the predicted teragram DMSOP production budget1, its newly found abundance in marine sediments, and the abundance of microbial DMSP lyase genes and transcripts in marine environments, DMSOP cleavage is likely a globally significant process influencing global carbon and sulfur fluxes and marine ecological interactions.

Background The HERO registry was established to support research on the impact of the COVID-19 pandemic on US healthcare workers. Objective Describe the COVID-19 pandemic experiences of and effects on individuals participating in the HERO registry. Design Cross-sectional, self-administered registry enrollment survey conducted from April 10 to July 31, 2020. Setting Participants worked in hospitals (74.4%), outpatient clinics (7.4%), and other settings (18.2%) located throughout the nation. Participants A total of 14,600 healthcare workers. Main Measures COVID-19 exposure, viral and antibody testing, diagnosis of COVID-19, job burnout, and physical and emotional distress. Key Results Mean age was 42.0 years, 76.4% were female, 78.9% were White, 33.2% were nurses, 18.4% were physicians, and 30.3% worked in settings at high risk for COVID-19 exposure (e.g., ICUs, EDs, COVID-19 units). Overall, 43.7% reported a COVID-19 exposure and 91.3% were exposed at work. Just 3.8% in both high- and low-risk settings experienced COVID-19 illness. In regression analyses controlling for demographics, professional role, and work setting, the risk of COVID-19 illness was higher for Black/African-Americans (aOR 2.32, 99% CI 1.45, 3.70, p < 0.01) and Hispanic/Latinos (aOR 2.19, 99% CI 1.55, 3.08, p < 0.01) compared with Whites. Overall, 41% responded that they were experiencing job burnout. Responding about the day before they completed the survey, 53% of participants reported feeling tired a lot of the day, 51% stress, 41% trouble sleeping, 38% worry, 21% sadness, 19% physical pain, and 15% anger. On average, healthcare workers reported experiencing 2.4 of these 7 distress feelings a lot of the day. Conclusions Healthcare workers are at high risk for COVID-19 exposure, but rates of COVID-19 illness were low. The greater risk of COVID-19 infection among race/ethnicity minorities reported in the general population is also seen in healthcare workers. The HERO registry will continue to monitor changes in healthcare worker well-being during the pandemic. Trial Registration ClinicalTrials.gov identifier NCT04342806 Supplementary Information The online version contains supplementary material available at 10.1007/s11606-020-06529-z.

BACKGROUND Optimizing STD reporting to state public health authorities is important to reduce incidence and manage outbreaks of STDs. Electronic lab reporting (ELR) is the standard through which local clinics report STDs to state public health authority. Electronic case reporting (eCR) is an alternative approach which automates transmission of case reports to public health jurisdictions using electronic health record (EHR) data. METHODS Working with three Community Health Centers (CHCs) in Oregon between February 3, 2020 and May 15, 2020, we piloted an automated electronic case reporting (eCR) approach for gonorrhea (GC) and chlamydia (CT) from these clinics to the Oregon Health Authority. We compared the eCR approach to the existing ELR approach to determine completeness of case reporting for GC/CT. RESULTS A total of 365 eCRs from 206 unique patients were generated. Among 154 instances where the case detection logic was satisfied for chlamydia, 37% (54 instances) were based on the presence of a diagnosis and 63% (97 instances) were based on laboratory data. Among 232 instances where logic was satisfied for gonorrhea, 44% (102 instances) reflected a diagnosis and 56% (130 instances) reflected laboratory results. Data completeness was uniformly equal or higher for eCRs vs. ELRs. CONCLUSIONS The eCR approach was successful in identifying chlamydia and gonorrhea cases and provided a more complete set of information to assist public health authorities when compared with ELRs. eCR has the potential to automate and relieve staff burden on an important reporting requirement for clinical providers.

Background The National Patient‐Centered Clinical Research Network Blood Pressure Control Laboratory Surveillance System was established to identify opportunities for blood pressure (BP) control improvement and to provide a mechanism for tracking improvement longitudinally. Methods and Results We conducted a serial cross‐sectional study with queries against standardized electronic health record data in the National Patient‐Centered Clinical Research Network (PCORnet) common data model returned by 25 participating US health systems. Queries produced BP control metrics for adults with well‐documented hypertension and a recent encounter at the health system for a series of 1‐year measurement periods for each quarter of available data from January 2017 to March 2020. Aggregate weighted results are presented overall and by race and ethnicity. The most recent measurement period includes data from 1 737 995 patients, and 11 956 509 patient‐years were included in the trend analysis. Overall, 15% were Black, 52% women, and 28% had diabetes. BP control ( Conclusions Major opportunities exist for improving BP control and reducing disparities, especially through consistent medication intensification when BP is uncontrolled. These data demonstrate substantial room for improvement and opportunities to close health equity gaps.

CaCoxZr1-xO3-δ (x = 0, 0.3, 0.5, 0.7 and 0.9) perovskites with and without Pd doping were synthesized for the first time and reported here to show outstanding redox property and oxygen storage capacity (OSC) compared to the ceria-based oxygen storage materials (OSMs). The studied perovskites retain their main phase of orthorhombic Lakargiite CaZrO3 structure, and were characterized by x-ray fluorescence (XRF), x-ray diffraction (XRD), temperature programmed reduction (TPR) and dynamic redox cycle measurements. Partial substitution of Co by Zr at B sites enhanced the perovskite structural crystallinity and stability, material reducibility and OSC properties, giving optimized OSM composition when x was around 0.5. Further kinetic studies showed a first order reaction mechanism with an activation energy (Ea) of 0.159 eV for CaCo0.5Zr0.5O3-δ. For Pd-containing samples, Pd was present in both forms of bulk Pd2+ and surface Pd0, and the amount of surface Pd0 increased with increasing Pd loading. Pd dopant also facilitated the Co reduction and improved the catalyst reducibility. Under simulated exhaust conditions at fuel lean-rich conditions (stoichiometric numbers of 1.16, 1.07 and 0.95), Pd-doped CaCo0.6-yZr0.4PdyO3 (y = 0.05 and 0.1) samples showed profound catalytic activity towards C3H6 and CO oxidation (T50s

Background: Uncontrolled blood pressure (BP) is a leading preventable cause of death that remains common in the US population despite the availability of effective medications. New technology and program innovation has high potential to improve BP but may be expensive and burdensome for patients, clinicians, health systems, and payers and may not produce desired results or reduce existing disparities in BP control. Methods and Results: The PCORnet Blood Pressure Control Laboratory is a platform designed to enable national surveillance and facilitate quality improvement and comparative effectiveness research. The platform uses PCORnet, the National Patient-Centered Clinical Research Network, for engagement of health systems and collection of electronic health record data, and the Eureka Research Platform for eConsent and collection of patient-reported outcomes and mHealth data from wearable devices and smartphones. Three demonstration projects are underway: BP track will conduct national surveillance of BP control and related clinical processes by measuring theory-derived pragmatic BP control metrics using electronic health record data, with a focus on tracking disparities over time; BP MAP will conduct a cluster-randomized trial comparing effectiveness of 2 versions of a BP control quality improvement program; BP Home will conduct an individual patient-level randomized trial comparing effectiveness of smartphone-linked versus standard home BP monitoring. Thus far, BP Track has collected electronic health record data from over 826 000 eligible patients with hypertension who completed ≈3.1 million ambulatory visits. Preliminary results demonstrate substantial room for improvement in BP control ( Conclusions: The PCORnet Blood Pressure Control Laboratory is designed to be a reusable platform for efficient surveillance and comparative effectiveness research; results from demonstration projects are forthcoming.

Wine is produced by one of two methods: inoculated fermentation, where a commercially produced, single Saccharomyces cerevisiae yeast strain is used; or the traditional spontaneous fermentation, where yeasts on grape and winery surfaces carry out the fermentative process. Spontaneous fermentations are characterized by a diverse succession of yeasts, ending with one or multiple strains of S. cerevisiae dominating the fermentation. In wineries using both fermentation methods, commercial strains may dominate spontaneous fermentations. In addition to S. cerevisiae, other vineyard-associated yeast and fungi affect grapevine crop health and impact wine quality, particularly in spontaneous fermentation. Grape fungal community composition – both S. cerevisiae strains and other fungal populations – varies regionally, and community differences may correlate with wine metabolite composition and sensory profile, suggesting a microbial role in shaping a wine’s terroir or regional character. Over two vintages, we characterize the S. cerevisiae and other fungal populations found in three closely situated vineyards and spontaneous fermentations of a British Columbian winery, elucidating the impact of the winery environment and commercial strain use on S. cerevisiae population structure in spontaneous fermentations. Winery fermentations were not dominated by commercial strains, but by a diverse number of strains with genotypes similar to commercial strains, suggesting a population of S. cerevisiae derived from commercial strains is resident in the winery. Commercial and commercial-related strains were identified at a lower frequency in the three study vineyards. There is low genetic differentiation and S. cerevisiae population structure in vineyards that may be driven by commercial strains. Genetically distinct S. cerevisiae populations unrelated to commercial strains were also identified. We lastly examined the fungal communities on the surface of grape berries, crushed grapes, and during fermentation. Spatiotemporal fungal community structure was evident among grape berry surface, crushed grape and fermentation samples from the three vineyards, with each vineyard retaining a community signature across vintages and throughout fermentation. This study, which is the first to profile Canadian vineyard-associated fungal populations, suggests that fungal populations may be a defining contributor to small-scale or ’micro’ terroir, having significant implications for ’single vineyard’ wine production.

Background Appropriate screening of individuals to detect latent tuberculosis infection (LTBI) is a critical step for achieving tuberculosis (TB) elimination in the US; >80% of TB cases are attributed to LTBI reactivation. TB infection testing and treatment must engage community health clinics where populations at risk seek care. However, there are significant data knowledge gaps in the current LTBI cascade of care (CoC) in this setting. We used an electronic health record (EHR) database from OCHIN, Inc., to characterize the LTBI CoC and identify potential future interventions. Methods We extracted a cohort of patients from 2012–2016 EHR data; we stratified by whether patients were at risk for TB based on meeting at least one of the following criteria: non-US born or non-English language preference, homelessness, encounter at correctional facility, history of close contact with a TB case, or being immunocompromised. Along each step of the LTBI CoC, we determined the proportions with a test for TB infection, with available test results, with a positive test, with an LTBI diagnosis, and with LTBI treatment prescribed. We used Χ 2 tests to compare the LTBI CoCs among patients at risk with those classified as not at risk. Results Of nearly 2.2 million patient records, 701,467 (32.0%) met criteria for being at risk for TB; 84,422 at risk (12.0%) were tested; 65,562 (77.7%) had available results, of whom 9,624 (14.7%) were positive. Among those with positive results, 6,958 (72.3%) had an LTBI diagnosis, of whom 1,732 (24.9%) were prescribed treatment. Among those classified as not at risk, fewer were tested (66,773 [4.5%], p< 0.001) and had positive results (2,500 [3.7%], p< 0.0001). Among those with positive results, 1,998 (80.0%) had an LTBI diagnosis, of whom 395 (19.8%) initiated treatment. Conclusion This study highlights gaps in the LTBI CoC, and where interventions are most needed. The largest gaps were in testing patients at risk, as 88% were not tested, and treatment, as 75% diagnosed with LTBI were not treated. Just under half (44%) of all TB tests appeared to be performed in persons with little risk for TB; this is a substantial amount of testing given very few begin treatment. Resources could be redirected to increase screening and treatment among populations at risk. Disclosures All Authors: No reported disclosures

Background Over 80% of tuberculosis (TB) cases in the United States are attributed to reactivation of latent TB infection (LTBI). Eliminating TB in the United States requires expanding identification and treatment of LTBI. Centralized electronic health records (EHRs) are an unexplored data source to identify persons with LTBI. We explored EHR data to evaluate TB and LTBI screening and diagnoses within OCHIN, Inc., a U.S. practice-based research network with a high proportion of Federally Qualified Health Centers. Methods From the EHRs of patients who had an encounter at an OCHIN member clinic between January 1, 2012 and December 31, 2016, we extracted demographic variables, TB risk factors, TB screening tests, International Classification of Diseases (ICD) 9 and 10 codes, and treatment regimens. Based on test results, ICD codes, and treatment regimens, we developed a novel algorithm to classify patient records into LTBI categories: definite, probable or possible. We used multivariable logistic regression, with a referent group of all cohort patients not classified as having LTBI or TB, to identify associations between TB risk factors and LTBI. Results Among 2,190,686 patients, 6.9% (n=151,195) had a TB screening test; among those, 8% tested positive. Non-U.S. –born or non-English–speaking persons comprised 24% of our cohort; 11% were tested for TB infection, and 14% had a positive test. Risk factors in the multivariable model significantly associated with being classified as having LTBI included preferring non-English language (adjusted odds ratio [aOR] 4.20, 95% confidence interval [CI] 4.09–4.32); non-Hispanic Asian (aOR 5.17, 95% CI 4.94–5.40), non-Hispanic black (aOR 3.02, 95% CI 2.91–3.13), or Native Hawaiian/other Pacific Islander (aOR 3.35, 95% CI 2.92–3.84) race; and HIV infection (aOR 3.09, 95% CI 2.84–3.35). Conclusion This study demonstrates the utility of EHR data for understanding TB screening practices and as an important data source that can be used to enhance public health surveillance of LTBI prevalence. Increasing screening among high-risk populations remains an important step toward eliminating TB in the United States. These results underscore the importance of offering TB screening in non-U.S.–born populations. Disclosures All Authors: No reported disclosures

Background: New technology and healthcare delivery approaches may help improve blood pressure (BP) control. Randomized controlled trials (RCTs) can demonstrate effectiveness of these emerging approaches, both overall and especially within underserved populations, but RCTs are expensive. Our objective is to establish a national platform to support BP control surveillance and efficient RCTs. Methods: The PCORnet BP Control Laboratory, designed and launched in partnership with the American Heart Association (AHA) and the American Medical Association (AMA), leverages electronic health record (EHR) systems throughout the US, the National Patient-Centered Outcomes Research Network (PCORnet), and the NIH-funded Eureka Research Platform, which enables direct-to-participant research including collection of patient-reported outcomes and mHealth data from wearable devices and smartphones. We will use these resources to 1) Conduct national surveillance through quarterly EHR data queries to calculate and track institution- and clinic-level BP control metrics across 23 PCORnet institutions, overall and within key subgroups, and support participation in the AHA/AMA’s Target:BP recognition program (BP Track); 2) Compare effectiveness of a Full Support versus Self-Guided version of the AMA’s Measure Accurately, Act Rapidly, and Partner with Patients (MAP) program at improving BP control in a cluster randomized trial of 24 safety net clinics (BP MAP); and 3) Compare effectiveness of Smartphone-linked versus standard home BP monitoring at reducing systolic BP in an individual-level, direct-to-participant RCT of 2000 patients with uncontrolled BP (BP Home). Results: Preliminary BP Track queries demonstrate an overall BP control rate of 56%, lower control in Black patients (51%), substantial heterogeneity in clinic-level metrics (e.g., 33% vs. 64% BP control), and low rates of medication intensification (9% prescribed a new medication class when BP was high). BP Track will launch PCORnet-wide queries in June; BP MAP in May; and BP Home in August 2019. Conclusions: Feasibility testing is underway to determine if the PCORnet BP Control Laboratory will be useful for investigators interested in conducting efficient RCTs of BP control interventions.

The Internet of Things (IoT) creates a theoretical bridge between end-users and the digital world. The IoT embodies a massive group of interconnected computing devices embedded with software, processors, and sensors capable of exchanging and transmitting data over a network infrastructure. IoT technology has become prevalent among central domains such as healthcare, commerce, and home. However, the IoT can often be thought of as a double-edged sword, in that it both assists with advancements in the respective fields and poses a potential risk. The rapid expansion of the IoT raises concern, in many cases, security tends to lag behind innovation in the global marketplace. Moreover, the United States government has not established stringent regulations that oversee IoT devices. Our research analyzes critical devices and the associated vulnerabilities and highlights the need for implementation of rigorous security controls. Furthermore, our research evaluates attack vectors for IoT devices that encompass three central domains, including healthcare, commerce, and home. A synopsis of our contributions include identification of vulnerabilities at the device-level; investigation of security threats created due to known vulnerabilities; application of appropriate security controls to closeout vulnerabilities and minimize the possibility of a threat occurring. Finally, specifically tailored case studies, designed to illustrate how our recommendations can be used to mitigate threats.

The advent of the twenty-first century has seen a myriad of amazing technological advancements. The Internet of Things (IoT) is a prime example of technological capabilities at its finest. The IoT is a series of interconnected devices capable of sending and receiving data over existing network infrastructure, but why does this matter? Technology is becoming a conventional commodity, while the uses are endless, technological advancement constitutes a very serious risk. Any device that is connected to the Internet poses a heightened security risk. These risks have the potential of compromising the device and its users. Therefore, the understanding of device-level security is critical to protect the users from various security threats. To provide a holistic view of IoT security, the investigated devices are broken down with respect to different domains (e.g., healthcare, commerce, and home). Specifically, this paper presents a survey of frequently used devices with a common vulnerability scoring system (CVSS) for each investigated IoT domain. This will be an attempt to identify the pivotal device vulnerabilities and determine which attack vectors are predominately exploited in IoT networks.

Nineteenth-century Moravian missionaries were assiduous recordkeepers. For those who lived in Native nations, their nearly daily accounting of life created a rich trove for historians. But for all ...