Do Ask, Do Tell: High Levels of Acceptability by Patients of Routine Collection of Sexual Orientation and Gender Identity Data in Four Diverse American Community Health Centers

Background: The Institute of Medicine and The Joint Commission have recommended asking sexual orientation and gender identity (SOGI) questions in clinical settings and including such data in Electronic Health Records (EHRs). This is increasingly viewed as a critical step toward systematically documenting and addressing health disparities affecting lesbian, gay, bisexual, and transgender (LGBT) people. The U.S. government is currently considering whether to include SOGI data collection in the Stage 3 guidelines for the incentive program promoting meaningful use of EHR. However, some have questioned whether acceptable standard measures to collect SOGI data in clinical settings exist. Methods: In order to better understand how a diverse group of patients would respond if SOGI questions were asked in primary care settings, 301 randomly selected patients receiving primary care at four health centers across the U.S. were asked SOGI questions and then asked follow-up questions. This sample was mainly heterosexual, racially diverse, and geographically and regionally broad. Results: There was a strong consensus among patients surveyed about the importance of asking SOGI questions. Most of the LGBT respondents thought that the questions presented on the survey allowed them to accurately document their SOGI. Most respondents—heterosexual and LGBT—answered the questions, and said that they would answer such questions in the future. While there were some age-related differences, respondents of all ages overwhelmingly expressed support for asking SOGI questions and understood the importance of providers' knowing their patients' SOGI. Conclusions: Given current deliberations within national health care regulatory bodies and the government's increased attention to LGBT health disparities, the finding that patients can and will answer SOGI questions has important implications for public policy. This study provides evidence that integrating SOGI data collection into the meaningful use requirements is both acceptable to diverse samples of patients, including heterosexuals, and feasible

Measuring the Changing Cost of Cybercrime

In 2012 we presented the first systematic study of the costs of cybercrime. In this paper, we report what has changed in the seven years since. The period has seen major platform evolution, with the mobile phone replacing the PC and laptop as the consumer terminal of choice, with Android replacing Windows, and with many services moving to the cloud. The use of social networks has become extremely widespread. The executive summary is that about half of all property crime, by volume and by value, is now online. We hypothesised in 2012 that this might be so; it is now established by multiple victimisation studies. Many cybercrime patterns appear to be fairly stable, but there are some interesting changes. Payment fraud, for example, has more than doubled in value but has fallen slightly as a proportion of payment value; the payment system has simply become bigger, and slightly more efficient. Several new cybercrimes are significant enough to mention, including business email compromise and crimes involving cryptocurrencies. The move to the cloud means that system misconfiguration may now be responsible for as many breaches as phishing. Some companies have suffered large losses as a side-effect of denial-of-service worms released by state actors, such as NotPetya; we have to take a view on whether they count as cybercrime. The infrastructure supporting cybercrime, such as botnets, continues to evolve, and specific crimes such as premium-rate phone scams have evolved some interesting variants. The overall picture is the same as in 2012: traditional offences that are now technically ‘computer crimes’ such as tax and welfare fraud cost the typical citizen in the low hundreds of Euros/dollars a year; payment frauds and similar offences, where the modus operandi has been completely changed by computers, cost in the tens; while the new computer crimes cost in the tens of cents. Defending against the platforms used to support the latter two types of crime cost citizens in the tens of dollars. Our conclusions remain broadly the same as in 2012: it would be economically rational to spend less in anticipation of cybercrime (on antivirus, firewalls, etc.) and more on response. We are particularly bad at prosecuting criminals who operate infrastructure that other wrongdoers exploit. Given the growing realisation among policymakers that crime hasn’t been falling over the past decade, merely moving online, we might reasonably hope for better funded and coordinated law-enforcement action

Numerical simulation of plasticity in double lap metallic bolted joints

This article aims to compare three plasticity models, namely Bai-Wierzbicki (BW), von Mises and Drucker Prager, to predict the failure modes in double-lap metallic bolted joints under shear loading. The double-lap bolted joint finite element model has been validated against literature data, which demonstrated the application of BW ductile fracture model to bolt joint failure prediction. Taguchi Design is used to investigate the effects of geometrical parameters, preload and stress triaxiality on the failure modes. Force–displacement response amongst the three models differs up to 20% when failing in shear and a different prediction of the failure mode (shear out vs. net section) under the same loading and geometry conditions is observed

Egress-related osmiophilic bodies

© 2014 John Wiley & Sons Ltd. Summary: Gametogenesis is the earliest event after uptake of malaria parasites by the mosquito vector, with a decisive impact on colonization of the mosquito midgut. This process is triggered by a drop in temperature and contact with mosquito molecules. In a few minutes, male and female gametocytes escape from the host erythrocyte by rupturing the parasitophorous vacuole and the erythrocyte membranes. Electron-dense, oval-shaped organelles, the osmiophilic bodies (OB), have been implicated in the egress of female gametocytes. By comparative electron microscopy and electron tomography analyses combined with immunolocalization experiments, we here define the morphological features distinctive of male secretory organelles, hereafter named MOB (male osmiophilic bodies). These organelles appear as club-shaped, electron-dense vesicles, smaller than female OB. We found that a drop in temperature triggers MOB clustering, independently of exposure to other stimuli. MDV1/PEG3, a protein associated with OB in Plasmodium berghei females, localizes to both non-clustered and clustered MOB, suggesting that clustering precedes vesicle discharge. A P.berghei mutant lacking the OB-resident female-specific protein Pbg377 displays a dramatic reduction in size of the OB, accompanied by a delay in female gamete egress efficiency, while female gamete fertility is not affected. Immunolocalization experiments indicated that MDV1/PEG3 is still recruited to OB-remnant structures

Comparative analysis of various hyperelastic models and element types for finite element analysis

This study aims to evaluate the precision of nine distinct hyperelastic models using experimental data sourced from the existing literature. These models rely on parameters obtained through curve-fitting functions. The complexity in finite element models of elastomers arises due to their nonlinear, incompressible behaviour. To achieve accurate representations, it is imperative to employ sophisticated hyperelastic models and appropriate element types and formulations. Prior published work has primarily focused on the comparison between the fitting models and the experimental data. Instead, in this study, the results obtained from finite element analysis are compared against the original data to assess the impact of element formulation, strain range, and mesh type on the ability to accurately predict the response of elastomers over a wide range of strain values. This comparison confirms that the element formulation and strain range can significantly influence result accuracy, yielding different responses in various strain ranges also because of the limitation with the curve fitting tools

On a numerical methodology to assess the fatigue life of connecting rods

Although simulation-based fatigue analysis is a standard tool adopted in every sector including automotive industry, the design of engine components in automotive and motorsport applications mostly relies on simplified design approaches supported by time-consuming testing programs. This manuscript proposes a new methodology based on individual engine speed damage estimation and engine speed time history combined with Palmgren-Miner linear damage rule to predict the fatigue state of the connecting rod. The track data, engine multibody simulation (AVL ExciteTM) and engine combustion simulation (AVL BoostTM) are used to generate the initial variable trace that is processed to obtain the block programs. Stress amplitude estimated with finite element analysis (Abaqus) are used to estimate the damage from S-N curve and the cumulative damage is estimated with Palmgren-Miner cumulative damage model. The method proposed is demonstrated using a connecting rod case study and the duty cycle from the race on Sebring international raceway. This work shows the suitability of the approach and the benefit in terms of accuracy in the prediction of the fatigue life

Measuring the changing cost of cybercrime

In 2012 we presented the rst systematic study of the costs of cybercrime. In this paper, we report what has changed in the seven years since. The period has seen major platform evolution, with the mobile phone replacing the PC and laptop as the consumer terminal of choice, with Android replacing Windows, and with many services moving to the cloud. The use of social networks has become extremely widespread. The executive summary is that about half of all property crime, by volume and by value, is now online. We hypothesised in 2012 that this might be so; it is now established by multiple victimisation studies. Many cybercrime patterns appear to be fairly stable, but there are some interesting changes. Payment fraud, for example, has more than doubled in value but has fallen slightly as a proportion of payment value; the payment system has simply become bigger, and slightly more ecient. Several new cybercrimes are signicant enough to mention, including business email compromise and crimes involving cryptocurrencies. The move to the cloud means that system misconguration may now be responsible for as many breaches as phishing. Some companies have suered large losses as a side-eect of denial-of-service worms released by state actors, such as NotPetya; we have to take a view on whether they count as cybercrime. The infrastructure supporting cybercrime, such as botnets, continues to evolve, and specic crimes such as premium-rate phone scams have evolved some interesting variants. The overall picture is the same as in 2012: traditional oences that are now technically `computer crimes' such as tax and welfare fraud cost the typical citizen in the low hundreds of Euros/ dollars a year; payment frauds and similar oences, where the modus operandi has been completely changed by computers, cost in the tens; while the new computer crimes cost in the tens of cents. Defending against the platforms used to support the latter two types of crime cost citizens in the tens of dollars. Our conclusions remain broadly the same as in 2012: it would be economically rational to spend less in anticipation of cybercrime (on antivirus, rewalls, etc.) and more on response. We are particularly bad at prosecuting criminals who operate infrastructure that other wrongdoers exploit. Given the growing realisation among policymakers that crime hasn't been falling over the past decade, merely moving online, we might reasonably hope for better funded and coordinated law-enforcement action