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The U.S. has merely 4% of the world population, but contains 25% of the world’s COVID-19 cases. Since the COVID-19 outbreak in the U.S., Massachusetts has been leading other states in the total number of COVID-19 cases. Racial residential segregation is a fundamental cause of racial disparities in health. Moreover, disparities of access to health care have a large impact on COVID-19 cases. Thus, this study estimates racial segregation and disparities in testing site access and employs economic, demographic, and transportation variables at the city/town level in Massachusetts. Spatial regression models are applied to evaluate the relationships between COVID-19 incidence rate and related variables. This is the first study to apply spatial analysis methods across neighborhoods in the U.S. to examine the COVID-19 incidence rate. The findings are: (1) Residential segregations of Hispanic and Non-Hispanic Black/African Americans have a significantly positive association with COVID-19 incidence rate, indicating the higher susceptibility of COVID-19 infections among minority groups. (2) Non-Hispanic Black/African Americans have the shortest drive time to testing sites, followed by Hispanic, Non-Hispanic Asians, and Non-Hispanic Whites. The drive time to testing sites is significantly negatively associated with the COVID-19 incidence rate, implying the importance of the accessibility of testing sites by all populations. (3) Poverty rate and road density are significant explanatory variables. Importantly, overcrowding represented by more than one person per room is a significant variable found to be positively associated with COVID-19 incidence rate, suggesting the effectiveness of social distancing for reducing infection. (4) Different from the findings of previous studies, the elderly population rate is not statistically significantly correlated with the incidence rate because the elderly population in Massachusetts is less distributed in the hotspot regions of COVID-19 infections. The findings in this study provide useful insights for policymakers to propose new strategies to contain the COVID-19 transmissions in Massachusetts.

Background Studies on the impact of the novel SARS-CoV-2 virus (COVID) for healthcare workers (HCWs) rarely include the full spectrum of hospital workers, including less visible patient support roles. In the early days of the pandemic, COVID testing was preferentially available to HCWs. The objective of this study was to understand how individual experiences for all HCWs during the pandemic were associated with perceptions of access to, and receipt of COVID testing . Methods All hospital employees ( n  = 6736) in a single academic medical center in Boston, Massachusetts were invited to participate in a cross-sectional survey regarding perceived access to, and receipt of COVID testing during the first wave of the pandemic (March – August 2020). Responses were linked to human resources data. Log binomial univariate and multivariable models were used to estimate associations between individual and employment variables and COVID testing. Results A total of 2543 employees responded to the survey (38 %). The mean age was 40 years (± 14). Respondents were female (76 %), white (55 %), worked as nurses (27 %), administrators (22 %) and patient support roles (22 %); 56 % of respondents wanted COVID testing. Age (RR 0.91, CI 0.88–0.93), full time status (RR 0.85, CI 0.79–0.92), employment tenure (RR 0.96, CI 0.94–0.98), changes in quality of life (RR 0.94, CI 0.91–0.96), changes in job duties (RR 1.19, CI 1.03–1.37), and worry about enough paid sick leave (RR 1.21, CI 1.12–1.30) were associated with interest in testing. Administrators (RR 0.64, CI 0.58–0.72) and patient support staff (RR 0.85, CI 0.78–0.92) were less likely than nurses to want testing. Age (RR 1.04, CI 1.01–1.07), material hardships (RR 0.87, CI 0.79–0.96), and employer sponsored insurance (RR 1.10, CI 1.00-1.22) were associated with receiving a COVID test. Among all employees, only administrative/facilities staff were less likely to receive COVID testing (RR 0.69, CI 0.59–0.79). Conclusions This study adds to our understanding of how hospital employees view availability of COVID testing. Hazard pay or other supports for hospital workers may increase COVID testing rates. These findings may be applicable to perceived barriers towards vaccination receipt.

Background Alaska has one of the highest rates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in the United States. Alaska Native people, women and youth (ages 15–29) are disproportionately affected. Alaska Native health organisations have jurisdictions over large geographic areas, containing small isolated communities where a perceived lack of confidentiality and privacy is an identified barrier to accessing Sexually Transmitted Disease (STD) testing. The Alaska Native Tribal Health Consortium (ANTHC) has partnered with the “ I Want the Kit” programme (IWTK) at Johns Hopkins University (JHU) to provide a discrete and reliable STD testing alternative. Methods Alaska residents 14 years of age and older can request a no-cost STD testing kit online or by phone, which is mailed via U.S. Postal Service. After collection, the kit is returned in a prepaid envelope to JHU where it is tested for Chlamydia, gonorrhoea and Trichomonas . JHU reports all testing results to ANTHC, where a nurse notifies all participants of their results and refers positive cases for treatment. IWTK Alaska focuses its advertising efforts in rural Alaskan areas where the disease burden can be high and the barriers to accessing confidential healthcare are greatest. Results In 2012, JHU received a total of 439 home testing kit requests from Alaska of which 161 (37%) were returned. Alaska Native and/or American Indian participants comprised 30% and Whites 53% of kits tested; other minority groups made up the remaining 17% of kits tested. The ages of individuals who returned kits ranged from 16 to 63 years, with a median age of 28 years. Among the 161 kits tested, 14 (8.6%) tested positive for Chlamydia, two of these also tested positive for gonorrhoea, and four kits were positive for Trichomonas. Conclusion This web-based STD testing option increases access to STD testing by alleviating privacy and confidentiality concerns.

The number of disorders for which genetic testing is available has increased nearly 500% in the past 15 years. Access to genetic tests and services often hinges on physicians’ ability to identify patients at risk for genetic disease and provide appropriate testing and counseling or refer to genetic specialists. Recent research demonstrates the need for referrals to genetic specialists by showing that many physicians lack skills required to perform appropriate genetic services, such as making proper risk assessments, providing genetic counseling, ordering genetic testing and interpreting results. However, little research exists on physicians’ awareness and utilization of genetic services. In this study, an electronic survey evaluating practicing physicians’ awareness of, utilization of and perceived barriers to genetic services in Texas, and interest in learning more about genetics and genetic services was distributed via state physician organizations. Of the 157 participants, approximately half reported they were moderately or very aware of genetic testing and services in their area. Very few reported awareness of telemedicine services. Over two-thirds reported never or rarely referring to genetic counselors or other genetic specialists, despite 75% reporting they had noticed an increased impact of genetics on their field and 61% reporting they had discussed genetics more in their day-to-day practice in the last 5–10 years. Only 20% reported genetics was very integral to their specialty. Over three-fourths of all participants indicated interest in learning more about genetics, genetic testing, and genetic services. Among the most frequently chosen barriers to genetic counselors were awareness-related barriers such as not knowing how to refer to a genetic counselor. Responses to many items varied significantly by medical specialty. The results identify a need to increase awareness of genetic services and referral logistics. Specific findings can help direct outreach efforts to educate clinicians, such as developing clinically meaningful, specialty-specific educational objectives.

The importance of automated and reproducible security testing of web applications is growing, driven by increasing security requirements, short software development cycles, and constraints with respect to time and budget. Existing automated security testing tools are already well suited to detect some types of vulnerabilities, e.g., SQL injection or cross-site scripting vulnerabilities. However, other vulnerability types are much harder to uncover in an automated way. One important representative of this type are access control vulnerabilities, which are highly relevant in practice as they can grant unauthorized users access to security-critical data or functions in web applications. In this paper, a practical solution to automatically detect HTTP GET request-based access control vulnerabilities in web applications is presented. The solution is based on previously proposed ideas, which are extended with novel approaches to enable completely automated access control testing with minimal configuration effort, which in turn enables frequent and reproducible testing. An evaluation with seven web applications based on different technologies demonstrates the general applicability of the solution and that it can automatically uncover most access control vulnerabilities while keeping the number of false positives low.

Background Recent systems for Human Immunodeficiency Virus 1 (HIV-1) viral load (VL) monitoring allow one-by-one analysis and fast turn-around-time for results. VL measurement on two rapid recently commercialized systems, GeneXpert (Cepheid) and Veris (Beckman Coulter) was compared to classical methods. Methods Plasma specimen from HIV-1 (group M) positive patients ( n  = 129) initially quantified with Abbott RealTime HIV-1 and Generic HIV-VL Biocentric assays were retrospectively tested with GeneXpert and Veris. Results Valid results on all techniques were obtained for 116/129 specimens composed of 89 Abbott quantifiable VL (38 B, 51 non-B subtypes) [range: 2.09–7.20 log cp/mL] and 27 plasma (9 B, 18 non-B) with Abbott-VL below the limit of quantification (LLQ). All techniques showed good correlation and agreement with a lowest Spearman correlation coefficient of 0.86. Compared to Abbott, the mean bias was 0.35 (95% CI: 0.25–0.45), 0.44 (0.36–0.53) and − 0.04 (− 0.13–0.05) for Biocentric, Beckman and Cepheid, respectively. A difference over 0.5 log cp/mL between VL-quantification of the same sample was observed for 19, 9 and 6 samples with Biocentric, Beckman and Cepheid, respectively. No influence of HIV-1 subtypes on VL was identified. Among 29 samples below LLQ on Abbott, only one was detected and quantified with the Veris assay (38 cp/mL), none with Cepheid. Conclusion Both random access systems from Cepheid and Beckman appear well designed for quantifying plasma HIV-1 VL, are easy to handle, fast and fully automated. The slight observed differences suggest to follow the current guidelines recommending the use of the same technique over time for patient viral load monitoring.

Background. Inherited BRCA gene mutations convey a high risk for breast and ovarian cancer, but current guidelines limit BRCA mutation testing to women with early-onset cancer and relatives of mutation-positive cases. Benefits and risks of providing this information directly to consumers are unknown. Methods. To assess and quantify emotional and behavioral reactions of consumers to their 23andMe Personal Genome Service(®) report of three BRCA mutations that are common in Ashkenazi Jews, we invited all 136 BRCA1 and BRCA2 mutation-positive individuals in the 23andMe customer database who had chosen to view their BRCA reports to participate in this IRB-approved study. We also invited 160 mutation-negative customers who were matched for age, sex and ancestry. Semi-structured phone interviews were completed for 32 mutation carriers, 16 women and 16 men, and 31 non-carriers. Questions addressed personal and family history of cancer, decision and timing of viewing the BRCA report, recollection of the result, emotional responses, perception of personal cancer risk, information sharing, and actions taken or planned. Results. Eleven women and 14 men had received the unexpected result that they are carriers of a BRCA1 185delAG or 5382insC, or BRCA2 6174delT mutation. None of them reported extreme anxiety and four experienced moderate anxiety that was transitory. Remarkably, five women and six men described their response as neutral. Most carrier women sought medical advice and four underwent risk-reducing procedures after confirmatory mutation testing. Male carriers realized that their test results implied genetic risk for female relatives, and several of them felt considerably burdened by this fact. Sharing mutation information with family members led to screening of at least 30 relatives and identification of 13 additional carriers. Non-carriers did not report inappropriate actions, such as foregoing cancer screening. All but one of the 32 mutation-positive participants appreciated learning their BRCA mutation status. Conclusions. Direct access to BRCA mutation tests, considered a model for high-risk actionable genetic tests of proven clinical utility, provided clear benefits to participants. The unexpected information demonstrated a cascade effect as relatives of newly identified carriers also sought testing and more mutation carriers were identified. Given the absence of evidence for serious emotional distress or inappropriate actions in this subset of mutation-positive customers who agreed to be interviewed for this study, broader screening of Ashkenazi Jewish women for these three BRCA mutations should be considered.

We report the case of a woman who pursued direct access genetic testing and then presented with concerns regarding a positive test result for Long-QT syndrome. Although the result ultimately proved to be a false positive, this case illustrates that costs associated with follow-up of direct access genetic testing results can be non-trivial for both the patient and for health care systems. Here we raise policy questions regarding the appropriate distribution of these costs. We also discuss the possibility that, when confronted by a direct access genetic test result that reports high risk for one or more actionable diseases, a family physician might feel compelled to act out of a desire to avoid liability, even when information regarding the accuracy and validity of the testing were not easily accessible. This case outlines lessons that can easily be translated into clinical practice, not only by genetic counselors, but also by family physicians, medical specialists and members of the public.

IN DETAIL BackTrack is a penetration testing and security auditing platform with advanced tools to identify, detect, and exploit any vulnerabilities uncovered in the target network environment. Applying appropriate testing methodology with defined business objectives and a scheduled test plan will result in robust penetration testing of your network. BackTrack 4: Assuring Security by Penetration Testing is a fully focused, structured book providing guidance on developing practical penetration testing skills by demonstrating the cutting-edge hacker tools and techniques in a coherent step-by-step strategy. It offers all the essential lab preparation and testing procedures to reflect real-world attack scenarios from your business perspective in today's digital age. The authors' experience and expertise enables them to reveal the industry's best approach for logical and systematic penetration testing. The first and so far only book on BackTrack OS starts with lab preparation and testing procedures, explaining the basic installation and configuration set up, discussing types of penetration testing (black-box and white-box), uncovering open security testing methodologies, and proposing the BackTrack specific testing process. The authors discuss a number of security assessment tools necessary to conduct penetration testing in their respective categories (target scoping, information gathering, discovery, enumeration, vulnerability mapping, social engineering, exploitation, privilege escalation, maintaining access, and reporting), following the formal testing methodology. Each of these tools is illustrated with real-world examples to highlight their practical usage and proven configuration techniques. The authors also provide extra weaponry treasures and cite key resources that may be crucial to any professional penetration tester. This book serves as a single professional, practical, and expert guide to developing hardcore penetration testing skills from scratch. You will be trained to make the best use of BackTrack OS either in a commercial environment or an experimental test bed. A tactical example-driven guide for mastering the penetration testing skills with BackTrack to identify, detect, and exploit vulnerabilities at your digital doorstep. APPROACH Written as an interactive tutorial, this book covers the core of BackTrack with real-world examples and step-by-step instructions to provide professional guidelines and recommendations to you. The book is designed in a simple and intuitive manner, which allows you to explore the whole BackTrack testing process or study parts of it individually. WHO THIS BOOK IS FOR If you are an IT security professional or network administrator who has a basic knowledge of Unix/Linux operating systems including awareness of information security factors, and you want to use BackTrack for penetration testing, then this book is for you.

BackTrack is a penetration testing and security auditing platform with advanced tools to identify, detect, and exploit any vulnerabilities uncovered in the target network environment. Applying appropriate testing methodology with defined business objectives and a scheduled test plan will result in robust penetration testing of your network. BackTrack 4: Assuring Security by Penetration Testing is a fully focused, structured book providing guidance on developing practical penetration testing skills by demonstrating the cutting-edge hacker tools and techniques in a coherent step-by-step strategy. It offers all the essential lab preparation and testing procedures to reflect real-world attack scenarios from your business perspective in today's digital age. The authors' experience and expertise enables them to reveal the industry's best approach for logical and systematic penetration testing. The first and so far only book on BackTrack OS starts with lab preparation and testing procedures, explaining the basic installation and configuration set up, discussing types of penetration testing (black-box and white-box), uncovering open security testing methodologies, and proposing the BackTrack specific testing process. The authors discuss a number of security assessment tools necessary to conduct penetration testing in their respective categories (target scoping, information gathering, discovery, enumeration, vulnerability mapping, social engineering, exploitation, privilege escalation, maintaining access, and reporting), following the formal testing methodology. Each of these tools is illustrated with real-world examples to highlight their practical usage and proven configuration techniques. The authors also provide extra weaponry treasures and cite key resources that may be crucial to any professional penetration tester. This book serves as a single professional, practical, and expert guide to developing hardcore penetration testing skills from scratch. You will be trained to make the best use of BackTrack OS either in a commercial environment or an experimental test bed.