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The COVID-19 pandemic (e.g., especially the first and second COVID waves) had forced firms (organizations) to radically shift a considerable (if not all) proportion of their employees to serve in a work-from-home (WFH) mode. Industry statistics showcase that despite ushering in significant work-flexibility (and other) benefits, the WFH mode has also expanded an organization’s cyber-vulnerability space, and increased the number of cyber-breaches in IT and IT-OT systems (e.g., ICSs). This leads us to an important fundamental question: is the WFH paradigm detrimental to IT and IoT-driven ICS security in general? While vulnerability reasoning and empirical statistics might qualitatively support an affirmative answer to this question, a rigorous, practically motivated, and strategic cost-benefit analysis is yet to be conducted to establish in principle whether and to what degree WFH-induced cyber-security in an IT/ICS system is sub-optimal when compared to that in the non-WFH work mode. We propose a novel and rigorous strategic method to dynamically quantify the degree of sub-optimal cyber-security in an IT/ICS organization of employees, all of whom work in heterogeneous WFH “siloes”. We first derive as benchmark for a WFH setting - the centrally-planned socially optimal aggregate employee effort in cyber-security best practices at any given time instant. We then derive and compute (using Breton’s Nash equilibrium computation algorithm for stochastic dynamic games) for for the same setting - the distributed time-varying strategic Nash equilibrium amount of aggregate employee effort in cyber-security. The time-varying ratios of these centralized and distributed estimates quantify the free riding dynamics, i.e., a proxy concept for security sub-optimality, within an IT/ICS organization for the WFH setting. We finally compare the free-riding ratio between WFH and non-WFH work modes to gauge the (possible) extent of the increase (lower bound) in security sub-optimality when the organization operates in a WFH mode. We counter-intuitively observe through extensive real-world-trace-driven Monte Carlo simulations that the maximum of the time-dependent median increase in the related security sub-optimality ranges around 25% but decreases fast with time to near 0% (implying security sub-optimality in the WFH mode equals that in the non-WFH mode) if the impact of employee security effort is time-accumulative (sustainable) even for short time intervals.

No United States paradigm for the treatment of paediatric, adolescent and young adult vitiligo has been developed. To develop evidence and consensus-based expert opinion to promote therapeutic consistency for the diagnosis and treatment of vitiligo. An IRB-exempted process was developed to produce consensus recommendations based on literature review and SORT criteria. Research questions were reviewed on 9 May 2022 in a video-based conference. Forty-two recommendations were made on the diagnosis of vitiligo (5) and optimal topical therapeutics (37). Topical calcineurin inhibitors, topical corticosteroids and topical ruxolitinib 1·5% cream were all identified as potential first-line therapies in the management of paediatric and adolescent patients with specific guidance on age-based data, frequency of application, minimum length of the therapeutic trial and coordinated usage of ultraviolet light therapy. The literature on paediatric and adolescent vitiligo has a heterogeneous methodology and lack of patient-reported outcomes. Children with vitiligo may be effectively managed with a variety of topical agents as first- and second-line therapy. Evidence supports the utility of topical calcineurin inhibitors, topical corticosteroids and topical JAK inhibitors, with limitations based on factors such as location, body surface area and age.

Background and aims: Current guidelines for screening colonoscopies recommend a minimum adenoma detection rate (ADR) of 25%. There are no established benchmarks for surveillance colonoscopies and data surrounding the utility of other quality metrics in this setting is limited. We aimed to define the relationship between ADR and alternative quality measures in the setting of screening and surveillance colonoscopies and determine whether validated screening quality benchmarks can be extrapolated to surveillance procedures. Methods: A retrospective review was conducted of adults who underwent outpatient screening and surveillance colonoscopies at a tertiary health center. ADR, adenomas per colonoscopy (APC), adenomas per positive participant (APP), polyp detection rate (PDR), right-sided polyp detection rate (RSP), and withdrawal times (CWT) were analyzed for screening and surveillance colonoscopies. Normality tests were performed for each continuous variable. Kruskal-Wallis tests were performed to analyze categorical and continuous outcomes. Spearman rank correlations were performed to compare surrogate outcomes to ADR. Results: In total, 2646 procedures, 1884 screening and 762 surveillance, were analyzed. Surveillance ADR (CADR) was significantly higher than screening ADR (SADR) (65.6%+0.02 v. 47.0%+0.01%, pConclusion: Colonoscopy quality measures were significantly higher in surveillance procedures when compared to screening procedures despite similar CWT. Higher benchmarks must be established to ensure quality surveillance colonoscopies.

Introduction Racial disparities in COVID-19 morbidity and mortality have been well-documented. However, there may also be racial disparities in COVID-19 vaccination rates which, if present, would further exacerbate the existing disparities. No previously published articles have identified and quantified potential racial disparities in vaccination throughout the USA at any geography lower than the national level. Methods Using data compiled from state health departments, we calculated racial disparities in COVID-19 vaccination for the Black and Hispanic populations compared to the White population in each state. We explored the relationship between a state-level index of structural racism and the observed differences in the racial disparities in COVID-19 vaccination across states for both the Black and Hispanic populations by conducting linear regression analyses. Results Racial disparities in COVID-19 vaccination were present for both the Black and Hispanic populations in the overwhelming majority of states. There were vast differences between the states in the magnitude of the racial disparity in race-specific vaccination rates. These differences were largely explained by differences in the level of structural racism in each state. The relationship between structural racism and the racial disparities in vaccination was not entirely explained by racial differences in vaccine hesitancy or political affiliation. Conclusions There are marked racial disparities in COVID-19 vaccination throughout the USA, and structural racism is strongly associated with the magnitude of these disparities. Efforts to reduce these disparities must address not only individual behavior but must also confront the structural barriers that are inhibiting equitable vaccine distribution.

ImportanceFirearms are easily transported over state borders; hence permissive firearm laws in one state may have an interstate association with firearm-related deaths in nearby states.ObjectivesTo examine whether certain firearm laws have an interstate association with firearm-related deaths in nearby states.Design, Setting, and ParticipantsThis cross-sectional observational study used data on state firearm-related deaths in the 48 contiguous states of the US between January 1, 2000, and December 31, 2019. A spatial autoregressive model with fixed effects for state and year was used to evaluate within-state, interstate, and overall associations between firearm laws and firearm-related deaths. Analyses were performed during January 2022.ExposuresThe following 9 types of laws were evaluated: universal background checks for all firearms purchase, background checks for handgun sales at gun shows, license requirement to purchase all firearms, state dealer license requirement for handgun sales, requirement of retaining records of handgun sales, ban on purchasing a handgun on behalf of another, prohibition of firearm possession by persons who committed violent misdemeanors, required relinquishment of firearms for persons becoming prohibited from possessing them, and discretion in granting a concealed carry permit.Main Outcomes and MeasuresState-level total firearm-related death rates, suicide rates, and homicide rates.ResultsIn sum, the study period included 662 883 firearm-related deaths of all intents. License requirement for firearm purchase had a within-state association (effect size, −1.79 [95% CI, −2.73 to −0.84]), interstate association (effect size, −10.60 [95% CI, −17.63 to −3.56]), and overall association (effect size, −12.38 [95% CI, −19.93 to −4.83]) per 100 000 population decrease in total firearm-related deaths. This law also had within-state association (effect size, −1.26 [95% CI, −1.72 to −0.80]), interstate association (effect size, −9.01 [95% CI, −15.00 to −3.02]), and overall association (effect size, −10.27 [95% CI, −16.53 to −4.01]) per 100 000 population decrease in firearm-related homicide.Conclusions and RelevanceThe findings of this pooled cross-sectional analysis suggest that certain firearm laws in one state were associated with other states’ firearm-related deaths. Synergic legislative action in adjacent states, federal firearm legislation, and measures that reduce migration of firearms across state borders should be part of the overarching strategy to prevent firearm-related deaths.

Introduction Although disparities in COVID-19 mortality have been documented at the national and state levels, no previous study has quantified such disparities at the county level by explicitly measuring race-specific COVID-19 death rates. In this paper, we quantify the racial/ethnic disparities in COVID-19 mortality between the non-Hispanic Black and non-Hispanic White populations at the county level by estimating age-adjusted, race-specific death rates. Methods Using COVID-19 case data from the Centers for Disease Control and Prevention, we calculated crude and indirect age-adjusted COVID-19 mortality rates for the non-Hispanic White and non-Hispanic Black populations in each of 353 counties for the period February 2, 2020, through January 30, 2021. Using linear regression analysis, we examined the relationship between several county-level measures of structural racism and the observed differences in racial disparities in COVID-19 mortality across counties. Results Ninety-three percent of the counties in our study experienced higher death rates among the Black compared to the White population, with an average ratio of Black to White death rates of 1.9 and a 17.5-fold difference between the disparity in the lowest and highest counties. Three traditional measures of structural racism were significantly related to the magnitude of the Black-White racial disparity in COVID-19 mortality rates across counties. Conclusions There are large disparities in COVID-19 mortality rates between the Black and White populations at the county level, there are profound differences in the level of these disparities, and those differences are directly related to the level of structural racism in a given county.

We used data from the 2019 National Lawful Use of Guns Survey to segment the gun-owning population into different subcultural categories. Performing a latent class analysis, we introduce six types of indicators: (1) the types of firearm owned, (2) the reported primary reason for owning a firearm, (3) involvement in various gun-related activities, (4) Second Amendment activism, (5) the extent to which those in one’s social network own guns, and (6) measures of symbolic meanings attached to firearms. We introduce gender, race, U.S. region, and political affiliation as covariates. We find six classes of gun owners. The largest group (28 percent) is composed of family protectors who go to the shooting range and feel empowered by their guns. The second largest category (19 percent) is made up of incidental gun owners motivated by protection or family tradition. The third group (18 percent) consists of Second Amendment activists who engage in multiple gun-related activities and are resistant to social change. The fourth category (13 percent) contains target shooters. The fifth group (12 percent) is made up of hunters. The sixth category (11 percent), self-protectors, has a majority of women (51 percent). Our findings add to a very recent body of literature on variations in the meanings that guns have for people. In particular, we demonstrate that there are stark cultural differences between gun owners and that the body of existing research on this topic has mostly focused on the Second Amendment activists, who only represent about 18 percent of all gun owners.

Introduction Structural racism is strongly related to racial health disparities. However, surprisingly few studies have developed empirical tools to measure structural racism. In addition, the few measures that have been employed have only considered structural racism at the neighborhood level. To expand upon previous studies, this paper uses a novel measure to measure structural racism at the county level for the non-Hispanic Black population. Methods We used confirmatory factor analysis to create a model to measure the latent construct of structural racism for 1181 US counties. The model included five indicators across five dimensions: racial segregation, incarceration, educational attainment, employment, and economic status/wealth. Structural equation modeling and factor analysis were used to generate factor scores that weighted the indicators in order to produce the best model fit. The resulting factor scores represented the level of structural racism in each county. We demonstrated the utility of this measure by demonstrating its strong correlation with Black-White disparities in firearm homicide rates. Results Our calculations revealed striking geographic differences across counties in the magnitude of structural racism, with the highest values generally being observed in the Midwest and Northeast. Structural racism was significantly associated with higher Black firearm homicide rates, lower White homicide rates, and a higher Black-White racial disparity in firearm homicide. Conclusions These new measures can be utilized by researchers to relate structural racism to racial health disparities at the county level.

Cybersecurity is becoming an increasing hurdle for digital trade. The governance of cybersecurity in the global digital trade system is a bottom-up approach, where governments are implementing frag...

Introduction While the increased burden of COVID-19 among the Black population has been recognized, most attempts to quantify the extent of this racial disparity have not taken the age distribution of the population into account. In this paper, we determine the Black–White disparity in COVID-19 mortality rates across 35 states using direct age standardization. We then explore the relationship between structural racism and differences in the magnitude of this disparity across states. Methods Using data from the Centers for Disease Control and Prevention, we calculated both crude and age-adjusted COVID-19 mortality rates for the non-Hispanic White and non-Hispanic Black populations in each state. We explored the relationship between a state-level structural racism index and the observed differences in the racial disparities in COVID-19 mortality across states. We explored the potential mediating effects of disparities in exposure based on occupation, underlying medical conditions, and health care access. Results Relying upon crude death rate ratios resulted in a substantial underestimation of the true magnitude of the Black–White disparity in COVID-19 mortality rates. The structural racism index was a robust predictor of the observed racial disparities. Each standard deviation increase in the racism index was associated with an increase of 0.26 in the ratio of COVID-19 mortality rates among the Black compared to the White population. Conclusions Structural racism should be considered a root cause of the Black–White disparity in COVID-19 mortality. Dismantling the long-standing systems of racial oppression is critical to adequately address both the downstream and upstream causes of racial inequities in the disease burden of COVID-19.

Background No previous study has identified the specific brands of guns owned by gun owners. This study aimed to: (1) ascertain and describe patterns of brand- and model-specific gun ownership among US gun owners; and (2) investigate the relationship between gun owners’ brand and model preferences and their attitudes towards common firearm violence prevention policies. Methods Using a national, pre-recruited internet panel of US adults in 2019, we surveyed gun owners (N = 2086) to ascertain their opinions regarding firearm violence prevention policies and to assess the brands and models of guns that they owned. Results Brand-specific gun ownership was highly concentrated and was dominated by three pistol brands, two revolver brands, three rifle brands, and three shotgun brands. There was wide variation in policy attitudes among owners of different gun brands, but little variation across owners of different gun types (i.e., pistols, rifles, revolvers, shotguns). We were able to identify the specific gun models owned by 1218 (59.4%) of the gun owners. Based on the classification of these gun models into three types we categorized the gun ownership pattern of the sample as 33.4% recreational, 45.5% self-defense, and 21.1% tactical. There were marked differences in support for firearm-related policies among the three groups, with support generally highest among the Recreation group and lowest among the Tactical group. Conclusion We conclude that gun brands and models are strong predictors of a gun owner’s attitudes regarding firearm-related policies. This information could help public health practitioners develop segment-specific communications that will appeal to each group in order to more effectively engage gun owners in firearm violence prevention.

Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the United States population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.

We develop and analyze a multilevel model of fatal police shootings to better understand the interplay between individual-level and contextual-level factors in incidents of police use of deadly force. We use a three-level hierarchical logistic regression model to identify Census tract-, city-, and state-level predictors of fatal police shootings and a four-level model to identify predictors of fatal police shootings of black victims at the incident, Census tract, city, and state levels. We find that higher levels of concentrated disadvantage and interpersonal firearm violence in a Census tract are significant predictors of the likelihood of any fatal police shooting occurring in that tract. We also find that conditional upon a fatal police shooting having occurred in a Census tract, knowing that the victim was unarmed is a significant predictor of the likelihood that the victim was black. Three other predictors of a police shooting victim being black were a higher proportion of black residents in the Census tract, a greater presence of police officers in the city, and a higher level of black-white residential segregation in the state. We conclude that reducing excessive police use of deadly force requires consideration of not only the individual interactions between officers and citizens, but also the quantity of interactions and the characteristics of the place in which these interactions occur. Special consideration must be given to ameliorating the consequences of structural racism, including racial segregation, over-policing of predominantly black neighborhoods, concentrated disadvantage in segregated neighborhoods, and racial inequalities in income and wealth.

A model is constructed to describe the arbitrary deformation of a drop or vesicle that contains and is embedded in an electrolyte solution, where the deformation is caused by an applied electric field. The applied field produces an electrokinetic flow or induced charge electro-osmosis. The model is based on the coupled Poisson-Nernst-Planck and Stokes equations. These are reduced or simplified by forming the limit of strong electrolytes, for which ion densities are relatively large, together with the limit of thin Debye layers. Debye layers of opposite polarity form on either side of the drop interface or vesicle membrane, together forming an electrical double layer. Two formulations of the model are given. One utilizes an integral equation for the velocity field on the interface or membrane surface together with a pair of integral equations for the electrostatic potential on the outer faces of the double layer. The other utilizes a form of the stress-balance boundary condition that incorporates the double layer structure into relations between the dependent variables on the layer's outer faces. This constitutes an interfacial boundary condition that drives an otherwise unforced Stokes flow outside the double layer. For both formulations relations derived from the transport of ions in each Debye layer give additional boundary conditions for the potential and ion concentrations outside the double layer., Comment: 35 pages including 2 figures and references

Patient and caregiver perspectives are critical in understanding dermatologic disease impact, presentation, and management in children. The Pediatric Dermatology Research Alliance (PeDRA) Patient Advisory Committee (PtAC), a group of patient representatives and parents of children with cutaneous disease, pursued a multistep, iterative, consensus-building process to identify comprehensive, high-priority research needs.Building on discussions at the 2020 PeDRA Annual Conference, a research prioritization survey was developed and completed by PtAC members. Survey themes were aggregated and workshopped by the PtAC through a series of facilitated calls. Emerging priorities were refined in collaboration with additional PeDRA patient community members at the 2021 PeDRA Annual Conference. Subsequently, a final actionable list was agreed upon.Fourteen PtAC members (86.7% female) representing patients with alopecia areata, atopic dermatitis, vascular birthmarks, congenital melanocytic nevi, ectodermal dysplasias, epidermolysis bullosa, Gorlin syndrome, hidradenitis suppurativa, ichthyosis, pemphigus, psoriasis, Sturge-Weber syndrome, and pachyonychia congenita completed the survey. Following serial PtAC meetings, 60 research needs were identified from five domains: psychosocial challenges, health care navigation/disease management, causes/triggers, treatments to preserve or save life, and treatments to preserve or save quality of life.Many pediatric dermatology research priorities align across affected communities and may drive meaningful, patient-centric initiatives and investigations.

In the US, the COVID-19 pandemic intensified some conditions that may contribute to firearm violence, and a recent surge in firearm sales during the pandemic has been reported. However, patterns of change in firearm violence in the first year of the COVID-19 pandemic in the US remain unclear.To quantify the changes in interpersonal firearm violence associated with the pandemic across all 50 US states and the District of Columbia.This population-based cross-sectional study examined 50 US states and the District of Columbia from January 1, 2016, to February 28, 2021. The COVID-19 pandemic period was defined as between March 1, 2020, and February 28, 2021. Statistical analysis was performed from April to December 2021.A 2-stage interrupted time-series design was used to examine the excess burden of firearm-related incidents, nonfatal injuries, and deaths associated with the pandemic while accounting for long-term trends and seasonality. In the first stage, separate quasi-Poisson regression models were fit to the daily number of firearm events in each state. In the second stage, estimates were pooled using a multivariate meta-analysis.In the US (all 50 states and the District of Columbia) during the pandemic period of March 1, 2020, to February 28, 2021, there were 62 485 identified firearm-related incidents, 40 021 firearm-related nonfatal injuries, and 19 818 firearm-related deaths. The pandemic period was associated with 8138 (95% empirical confidence interval [eCI], 2769-12 948) excess incidents (increase of 15.0% [95% eCI, 4.6%-26.1%]), 10 222 (95% eCI, 8284-11 650) excess nonfatal injuries (increase of 34.3% [95% eCI, 26.1%-41.1%]), and 4381 (95% eCI, 2262-6264) excess deaths (increase of 28.4% [95% eCI, 12.9%-46.2%]). The increase in firearm-related violence was more pronounced from June to October 2020 and in Minnesota and New York State.In the US, the first year of the COVID-19 pandemic was associated with an excess burden of firearm-related incidents, nonfatal injuries, and deaths, with substantial temporal and spatial variations.