Code Level Research Articles

Peculiarities of determining the circle of recipients of one-time financial assistance in case of death of a serviceman, person liable for military service or reservist under martial law

It has been proved that today the legislator has created a clear mechanism for the procedure for payment of a one-time financial assistance in the event of death of a serviceman, person liable for military service or a reservist (including a police officer), which indicates that they understand the importance of taking measures to ensure national security and defence in the context of a full-scale invasion of Ukraine by russian federation. It has been stressed that the issue of determining the list of persons who should be considered family members entitled to this social payment remains controversial.
 A scientific analysis of the content of the Law of Ukraine “On Amendments to the Law of Ukraine “On Social and Legal Protection of Servicemen and Members of Their Families” regarding the Appointment and Payment of a One-time Financial Allowance” dated 29 July 2022 No. 2489-IX has been carried out. It has been considered the Draft Law on the Institute of Registered Partnerships No. 9103 dated 13 March 2023, aimed at establishing a new concept of “registered partners” in family law, and the current Resolution of the Cabinet of Ministers of Ukraine “On Amendments to Clause 2 of the Resolution of the Cabinet of Ministers of Ukraine dated 28 February 2022 No. 168” dated 27 September 2022, No. 1066, which introduced new grounds for non-payment of a one-time financial assistance for the deceased, in terms of their compliance with the current legislation, relevance and validity of their adoption in the current conditions. The author's proposals for amendments to the Criminal Code of Ukraine related to high treason, collaboration, and aiding and abetting the aggressor state have been presented.
 The attention has been drawn to the emergence of new social phenomena which require appropriate regulation by the State, in particular, this concerns the possible emergence of new grounds for family formation in the future. The legal framework that regulates the concepts of “family”, “family members” and defines a specific list of family members is quite extensive and needs to be improved both in terms of its very design and in terms of clarifying the legal definition of the concepts of “family” and “family member” in the law. The necessity of addressing this issue at the level of the Family Code of Ukraine by enshrining the relevant definitions in it has been emphasised.

Co-Creating News Oases in Media Deserts

The Media Deserts Project is a research effort to map and model the changing media landscape in the United States. Media deserts are defined as geographies lacking fresh, daily news and information. Using circulation data of US print newspapers, emerging hyperlocal online news sites in digital networks, and broadband access data from the Federal Communication Commission, the Media Deserts Project maps these changes using geographic information systems down to the zip code level, making visible local communication systems and gaps. To develop community-centered news and information solutions, this research team used community-based research practices, where students engaged with residents, local business leaders, health, education, and other administrators to examine the communication needs of three specific communities in Southeast Ohio. We centered our efforts on building relationships with community members and designing localized media tools. We learned key insights that we believe may travel well into other projects using community-based engagement, participatory design, and co-creation practices.

Representasi Toxic Masculinity Pada Film “Seperti Dendam, Rindu Harus Dibayar Tuntas”: Analisis Semiotika Model Jhon Fiske

This article aims to describe the representation of toxic masculinity in the film "Seperti Dendam, Rindu Harus Dibayar Tuntas" through the main male character and film scenes. The film analysis of "Seperti Dendam, Rindu Harus Dibayar Tuntas" employs the semiotic data analysis technique using John Fiske's model. There are three levels of coding in this model: the level of reality, the level of representation, and the level of ideology. The research findings indicate that the representation of toxic masculinity portrayed by the main character at the level of reality is evident in the category of costumes, as seen in Ajo Kawir's simple attire. The level of representation code depicting toxic masculinity is displayed through cinematography techniques such as medium shots, close-ups, two shots, and over-the-shoulder shots. The ideology level observed is the high individualism of Ajo Kawir, who exhibits a sense of superiority, acts in his self-interest, and is stubborn. The toxic masculinity of the main character is influenced by past traumas and the patriarchal society depicted through John Fiske's semiotic model. The level of reality of social codes is conveyed through costumes, speech styles, and expressions. The level of representation of social codes is presented through camera work and lighting. The level of ideology of social codes is depicted through actions, dialogues, and character traits.

Association of Racial Residential Segregation With Long-Term Outcomes and Readmissions After Out-of-Hospital Cardiac Arrest Among Medicare Beneficiaries.

Background The national impact of racial residential segregation on out-of-hospital cardiac arrest outcomes after initial resuscitation remains poorly understood. We sought to characterize the association between measures of racial and economic residential segregation at the ZIP code level and long-term survival and readmissions after out-of-hospital cardiac arrest among Medicare beneficiaries. Methods and Results In this retrospective cohort study, using Medicare claims data, our primary predictor was the index of concentration at the extremes, a measure of racial and economic segregation. The primary outcomes were death up to 3 years and readmissions. We estimated hazard ratios (HRs) across all 3 types of index of concentration at the extremes measures for each outcome while adjusting for beneficiary demographics, treating hospital characteristics, and index hospital procedures. In fully adjusted models for long-term survival, we found a decreased hazard of death and risk of readmission for beneficiaries residing in the more segregated White communities and higher-income ZIP codes compared with the more segregated Black communities and lower-income ZIP codes across all 3 indices of concentration at the extremes measures (race: HR, 0.87 [95% CI, 0.81-0.93]; income: HR, 0.75 [95% CI, 0.69-0.78]; and race+income: HR, 0.77 [95% CI, 0.72-0.82]). Conclusions We found a decreased hazard of death and risk for readmission for those residing in the more segregated White communities and higher-income ZIP codes compared with the more segregated Black communities and lower-income ZIP codes when using validated measures of racial and economic segregation. Although causal pathways and mechanisms remain unclear, disparities in outcomes after out-of-hospital cardiac arrest are associated with the structural components of race and wealth and persist up to 3 years after discharge.

Pretransplantation coronavirus disease 2019 vaccination requirements: A matched case-control study of factors associated with waitlist inactivation

Numerous United States transplant centers require solid organ transplantation candidates to be vaccinated against the coronavirus disease of 2019 to be active on the United Network for Organ Sharing waiting list. This study examined characteristics of adult patients on one center's kidney transplantation waiting list whose status was inactivated due to a lack of coronavirus disease 2019 vaccination by July 1, 2022, and who did not subsequently provide proof of vaccination by August 31, 2022 (cases). Patients in the control group were retrospectively matched to patients in the case group in a 4-to-1 fashion according to age, sex, and “active” status on the waiting list. Multivariable logistic regression was performed, with race/ethnicity, primary language, health insurance, education, and Vaccine Equity Metric (VEM, a measure of health equity at the zip code level) quartile as covariates. Results revealed that patients from zip codes in the lowest VEM quartile (odds ratio [OR] 1.89; P = .02) and those insured by governmental payors (Medicare: OR, 2.00; P < .01 and Medicaid: OR, 2.89; P < .01) had higher odds of being inactivated than those from zip codes that make up the highest VEM quartile and those insured by commercial payors, respectively. These findings serve as a cautionary tale regarding universal pretransplantation vaccination requirements, which may raise equity concerns that should be considered upon policy implementation.

CONSUMER LAW IN THE SYSTEM OF MODERN RUSSIAN LAW AND LEGISLATION

The article is devoted to determining the place of consumer law in the system of Russian law and in the system of Russian legislation. Having formed in Russian civil law initially as a functional institution of civil law protection of consumer rights, it later, together with the norms of branches of public law, forms an intersectoral institute of Russian law, and under the influence of codified civil legislation, especially due to the reform of the Civil Code of the Russian Federation, as well as the improvement of legislation on consumer protection and the practice of its application, occupies the place of a functional sub-branch in the structure of modern civil law. For more than thirty years, consumer law has also been formed as a complex branch of legislation, including normative acts containing norms of various branches of Russian law. Consumer law (consumer protection legislation) is characterized by a number of features (it includes numerous regulations of various hierarchical levels and combines legal regulation contained in codified civil legislation and special acts on consumer protection). This, on the one hand, seems to be a very progressive phenomenon, since the civil law regulation of contractual relations with the participation of consumers is elevated to the level of the Civil Code of the Russian Federation, and, on the other hand, this is done in part two of the Civil Code of the Russian Federation, as well as in certain federal laws, is often inconsistent or insufficiently successful.

LncRNA-associated competing endogenous RNA network analysis uncovered key lncRNAs involved in temozolomide resistance and tumor recurrence of glioblastoma.

Temozolomide (TMZ) is a common alkylating chemotherapeutic agent used to treat brain tumors such as glioblastoma multiforme (GBM) and anaplastic astrocytoma. GBM patients develop resistance to this drug, which has an unclear and complicated molecular mechanism. The competing endogenous RNAs (ceRNAs) play critical roles in tumorigenesis, drug resistance, and tumor recurrence in cancers. This study aims to predict ceRNAs, their possible involvement, and underlying molecular mechanisms in TMZ resistance. Therefore, we analyzed coding and non-coding RNA expression levels in TMZ-resistant GBM samples compared to sensitive GBM samples and performed pathway analysis of mRNAs differentially expressed (DE) in TMZ-resistant samples. We next applied a mathematical model on 950 DE long non-coding RNAs (lncRNAs), 116 microRNAs (miRNAs), and 7977 mRNAs and obtained 10 lncRNA-associated ceRNAs that may be regulating potential target genes involved in cancer-related pathways by sponging 25 miRNAs in TMZ-resistant GBM. Among these, two lncRNAs named ARFRP1 and RUSC2 regulate five target genes (IRS1, FOXG1, GNG2, RUNX2, and CACNA1E) involved in AMPK, AKT, mTOR, and TGF-β signaling pathways that activate or inhibit autophagy causing TMZ resistance. The novel lncRNA-associated ceRNA network predicted in GBM offers a fresh viewpoint on TMZ resistance, which might contribute to treating this malignancy.

Individual Socioeconomic Factors Have a Greater Impact on End-of-Life Care Outcomes Than Regional Factors.

Background: End-of-life (EoL) care provided to Americans in urban and rural settings is distinct in terms of both available and delivered services. However, much less is known about which geographic, demographic, and health indicators are associated with disparities in EoL care and how individual versus regional characteristics influence quality of care (QoC). Objective: This study aimed to assess how regionality, rurality, and individual socioeconomic factors are associated with QoC in the last month of life (LML). Design: Nationally representative cross-sectional study using the proxy-completed LML questionnaire as part of the National Health and Aging Trends Study (NHATS). The data were linked at the zip code level to geographic and economic indicators. Settings/Subjects: A total of 2778 NHATS enrollees who died from 2012 to 2020. Measurements: Measurements included population density, socioeconomic indicators, health factors, and health outcomes. The primary independent variable was proxy-reported QoC during the LML (excellent vs. not excellent). Results: In our sample, 52.1% (n = 1447) reported not excellent care and 47.9% (n = 1331) reported excellent care. These populations varied in their demographic and socioeconomic characteristics. After accounting for survey weighting and design, decedents in the top (odds ratio [OR]: 1.58; 95% confidence interval [CI]: 1.08-2.32) income quartile had significantly greater odds of receiving excellent care than decedents in the bottom quartile. Decedents in zip codes with top quartile health outcome metrics had significantly greater odds of receiving excellent care (OR: 1.64; 95% CI: 1.17-2.29) than decedents in zip codes with bottom quartile health outcomes. County rurality index and county health factors were not correlated with QoC in the LML. Conclusions: High QoC at the EoL may be more associated with individual socioeconomic factors than regional indicators, including degrees of rurality. Clinicians should strive to recognize the interplay of individual characteristics and regional indicators to provide more personalized care.

On transforming model‐based tests into code: A systematic literature review

SummaryModel‐based test design is increasingly being applied in practice and studied in research. Model‐based testing (MBT) exploits abstract models of the software behaviour to generate abstract tests, which are then transformed into concrete tests ready to run on the code. Given that abstract tests are designed to cover models but are run on code (after transformation), the effectiveness of MBT is dependent on whether model coverage also ensures coverage of key functional code. In this article, we investigate how MBT approaches generate tests from model specifications and how the coverage of tests designed strictly based on the model translates to code coverage. We used snowballing to conduct a systematic literature review. We started with three primary studies, which we refer to as the initial seeds. At the end of our search iterations, we analysed 30 studies that helped answer our research questions. More specifically, this article characterizes how test sets generated at the model level are mapped and applied to the source code level, discusses how tests are generated from the model specifications, analyses how the test coverage of models relates to the test coverage of the code when the same test set is executed and identifies the technologies and software development tasks that are on focus in the selected studies. Finally, we identify common characteristics and limitations that impact the research and practice of MBT: (i) some studies did not fully describe how tools transform abstract tests into concrete tests, (ii) some studies overlooked the computational cost of model‐based approaches and (iii) some studies found evidence that bears out a robust correlation between decision coverage at the model level and branch coverage at the code level. We also noted that most primary studies omitted essential details about the experiments.

Variation in tiered network health plan penetration and local provider market characteristics.

To understand variation in enrollment in tiered network health plans (TNPs) and the local provider market characteristics associated with TNP penetration. We used 2013-2017 Massachusetts three-digit ZIP code level employer-sponsored health insurance enrollment data, data on physician horizontal and vertical affiliations from the Massachusetts Provider Database, state hospital reports in 2013, 2015, and 2017, and the 2013-2017 Massachusetts All-Payer Claims database. Linear regressions were used to estimate associations between TNP and local provider market characteristics. We constructed measures of TNP penetration and local provider market characteristics and linked these data using three-digit ZIP code. TNP penetration was at least 10% in all employer market sectors and highest among jumbo sized employers. All state employee health plan enrollees were in a tiered network health plan. Among enrollees not in the state employee health plan, TNP penetration varied from 6.0% to 19.6% across three-digit ZIP codes in Massachusetts. TNP penetration was higher in areas with less horizontal and vertical physician market concentration. Market competition, rather than the absolute quantity of physicians in an area, is associated with TNP penetration.

On the local modeling of count data: multiscale geographically weighted Poisson regression

A recent addition to the suite of techniques for local statistical modeling is the implementation of the multiscale geographically weighted regression (MGWR), a multiscale extension to geographically weighted regression (GWR). Using a back-fitting algorithm, MGWR relaxes the restrictive assumption in GWR that all processes being modeled operate at the same spatial scale and allows the estimation of a unique indicator of scale, the bandwidth, for each process. However, the current MGWR framework is limited to use with continuous data making it unsuitable for modeling data that do not typically exhibit a Gaussian distribution. This study expands the application of the MGWR framework to scenarios involving discrete response outcomes (count data following a Poisson’s distribution). Use of this new MGWR Poisson regression (MGWPR) model is demonstrated with a simulated data set and then with COVID-19 case counts within New York City at the zip code level. The results from the simulated data underscore the superiority of the MGWPR model in effectively capturing spatial processes that influence count data patterns, particularly those operating across diverse spatial scales. For empirical data, the results reveal significant spatial variations in relationships between socio-ecological factors and COVID-19 cases – variations often missed by traditional ‘global’ models.

Drinking water quality and social vulnerability linkages at the system level in the United States

Growing recognition of water quality concerns, particularly in socially vulnerable communities in the United States, has prompted recent policies and investments to improve drinking water system performance. Current environmental justice tools limit measurement of drinking water quality issues to proximity to point-source contamination, such as superfund sites and social vulnerability to county level or zip code level data. We examined relationships between health-based (HB) drinking water quality violations and social vulnerability using a new database of community water system (CWS) service areas and a modified Social Vulnerability Index, which we specifically designed for drinking water quality. CWSs with HB violations disproportionately impact socially vulnerable communities, with ∼70% of such systems characterized by high social vulnerability. Increased risks of drinking water quality violations in high socially vulnerable communities are attributed in part to violations related to pervasive, naturally occurring contaminants (e.g. arsenic) requiring treatment and difficulties for small systems to implement and maintain treatment systems. Notably, recurrence of any HB violation is also related to social vulnerability (R = 0.73). The relative importance of different social parameters, including socioeconomic status, race and language, and demographics and housing characteristics, varies with the type of violation. Further understanding linkages between drinking water quality violations and social vulnerability is essential for optimizing the deployment of, and motivating the next tranche of newly available drinking water infrastructure funding that is heavily prioritized toward disadvantaged communities.

Long-term exposure to summer specific humidity and cardiovascular disease hospitalizations in the US Medicare population

IntroductionMost climate-health studies focus on temperature; however, less is known about health effects of exposure to atmospheric moisture. Humid air limits sweat evaporation from the body and can in turn exert strain on the cardiovascular system. We evaluated associations of long-term exposure to summer specific humidity with cardiovascular disease (CVD), coronary heart disease (CHD) and cerebrovascular disease (CBV) hospitalization. MethodsWe built an open cohort consisting of ∼63 million fee-for-service Medicare beneficiaries, aged ≥65, living in the contiguous US (2000–2016). We assessed zip code level summer average specific humidity and specific humidity variability, based on daily estimates from the Gridded Surface Meteorological dataset (∼4km spatial resolution). To estimate associations of summer specific humidity with first CVD, CHD, and CBV hospitalization, we used Cox-equivalent Poisson models adjusted for individual and area-level socioeconomic status indicators, temperature, and winter specific humidity. ResultsHigher summer average specific humidity was associated with an increased risk of CVD, CHD, and CBV hospitalization. We found hazard ratios (HRs) of 1.07 (95%CI: 1.07, 1.08) for CVD hospitalization, 1.08 (95%CI: 1.08, 1.09) for CHD hospitalization, and 1.07 (95%CI: 1.07, 1.08) for CBV hospitalization per IQR increase (4.0 g of water vapor/kg of dry air) in summer average specific humidity. Associations of summer average specific humidity were strongest for beneficiaries eligible for Medicaid and for beneficiaries with an unknown or other race. Higher summer specific humidity variability was also associated with increased risk of CVD, CHD, and CBV hospitalization. Associations were not affected by adjustment for temperature and regions of the US, as well as exclusion of potentially prevalent cases. ConclusionLong-term exposure to higher summer average specific humidity and specific humidity variability were positively associated with CVD hospitalization. As global warming could increase humidity levels, our findings are important to assess potential health impacts of climate change.

Environmental exposures and pulmonary function among adult residents of rural Appalachian Kentucky.

Estimated residential exposures of adults to roadway density and several metrics of resource extraction, including coal mining and oil and gas drilling, were hypothesized to contribute to the prevalence of respiratory disease in rural Appalachia. Determine how small-area geographic variation in residential environmental exposures impacts measures of pulmonary function among adults in a community-based study. We examined associations between residential environmental respiratory exposures and pulmonary function among 827 adult participants of the "The Mountain Air Project", a community-based, cross-sectional study in Southeastern Kentucky during 2016-2018. Exposures characterized the density of roadways, oil/gas wells, or current/past surface and underground coal mining at the level of 14-digit hydrologic unit code (HUC), or valley "hollow" where participants resided. Each participant completed an in-person interview to obtain extensive background data on risk factors, health history, and occupational and environmental exposures, as well as a spirometry test administered by experienced study staff at their place of residence. Multivariable linear regression was used to model the adjusted association between each environmental exposure and percent predicted forced expiratory volume in one second (FEV1PP) and forced vital capacity (FVCPP). Adjusted regression models indicate persons living in HUCs with the highest level of roadway density experienced a reduction in both FEV1PP (-4.3: 95% CI: -7.44 -1.15;) and FVCPP (-3.8: 95% CI: -6.38, -1.21) versus persons in HUCs with the lowest roadway density. No associations were detected between the metrics associated with mining and oil and gas operations and individual pulmonary function. Our work demonstrates the potential adverse impact of roadway-related exposures on the respiratory health of rural Appalachia residents. We employed a novel method of small-areaexposure classification based on the hydrologic unit code (HUC), representing potentialexposure levels per hollow occurring in proximity to the residence, and controlled for individual-level risk factors for reducedrespiratory health. We highlightan overlooked yet ubiquitous source of residentialexposure from motor vehiclesthat may contribute to the regionally high prevalence of respiratory disease in rural Appalachia.

Representasi Perilaku Nekat Generasi Z Dalam Film Mencuri Raden Saleh:

Generation Z has many desires and goals that they want to achieve. However, to achieve these goals, Generation Z tends to choose instant methods and does not think long about the risks that will occur. Such reckless behavior from Generation Z has become a picture of reality in today's society. Reckless behavior is shown through the actions taken by generation Z in achieving their goals, which often lead to criminal acts. This research aims to find out how the representation of generation Z's reckless behavior in the film Stealing Raden Saleh. Mencuri Raden Saleh depicts the reality of generation Z's reckless behavior that has resulted in criminality in society. By using John Fiske's semiotic analysis method which divides into three levels of coding (Level of Reality, Level of Representation, and Level of Ideology), it was found that Stealing Raden Saleh represents the reckless behavior of generation Z through criminal acts committed by the six main characters such as forgery, hacking, fighting, and theft. Researchers also found that the reckless behavior of generation Z in the film was also influenced by family background factors and socio-economic conditions.

Environmental exposures and blood pressure in adolescents and adults in the T1D exchange clinic registry

AimsTo examine the associations between environmental determinants of health and blood pressure and whether age, sex, or race moderated the associations among 18,754 adolescents and adults from the type 1 diabetes (T1D) Exchange Clinic Registry. MethodsWe used multivariable linear regression. Environmental determinants included exposure to ambient fine particulate matter (PM2.5, obtained from an integrated model), nitrogen dioxide (NO2), noise and light pollution, and the normalized difference vegetation index (NDVI, a marker of green space) at the ZIP code level of residence. ResultsHigher exposure to PM2.5 and NO2, and lower NDVI, was associated with higher systolic and diastolic blood pressure, and higher light pollution exposure were similarly associated with higher diastolic blood pressure. These associations between environmental exposures and blood pressure remained significant after accounting for other covariates (age, sex, race/ethnicity, BMI, and T1D duration). With aging, the negative association between NDVI and blood pressure weakened. ConclusionsThese findings emphasize the significance of minimizing exposure to environmental pollutants, including PM2.5 and NO2, as well as ensuring access to areas with higher NDVI, to promote cardiovascular health in individuals with T1D.

Racial/Ethnic Residential Segregation, Neighborhood Health Care Provision, and Choice of Pediatric Health Care Provider Across the USA.

Much research has been conducted that demonstrates a link between racial/ethnic residential segregation and health care outcomes. We suggest that minority segregated neighborhoods may have diminished access to organizations and that this differential access may contribute to differences in health care outcomes across communities. We analyze this specifically using the case of pediatric health care provider choice. To examine this association, we estimate a series of multinomial logistic regression models using restricted data with ZIP code level geoidentifiers from the 2011-2012 National Survey of Children's Health (NSCH). We find that racial/ethnic residential segregation is related to a greater reliance on non-ideal forms of health care, such asclinics, and hospital outpatient departments, instead of pediatric physician's offices. This association is at least partially attenuated by the distribution of health care facilities in the local area, physician's offices, and health care practitioners in particular. Additionally, families express greater dissatisfaction with these other forms of care compared to physician's offices, demonstrating that the lack of adequate health care provision is meaningful for health care outcomes. This study expands the literature by examining how the siting of health organizations has consequences for individuals residing within these areas.

A comprehensive assessment on sludge conditioning by pyrite acid eluent-activated peroxymonosulfate based on dewaterability, heavy metals risk and ore recovery

Wastewater activated sludge (WAS) has poor dewaterability and contains heavy metals (HMs), limiting its land application. Therefore, in this study, a novel pyrite acid eluent-activated peroxymonosulfate (Fe2+pyrite/PMS) conditioning approach that can completely recover the residual pyrite and greatly reduce acid use was developed to improve WAS dewaterability, and the HMs chemical speciation and risks of conditioned WAS were assessed. Our results showed that under the optimized operational parameters, the capillary suction time (CST) and water content (Wc) of WAS decreased by 46.03% and 7.75%, respectively. Furthermore, during Fe2+pyrite/PMS conditioning processing, sulfate radical (SO4−) destroyed the extracellular polymeric substances (EPS) matrix, causing bound water release and the decrease of proteins/polysaccharides in outer layered EPS, even the decomposition of some protein-N in tightly bound EPS (TB-EPS) into inorganic-N. In addition, although the total concentration of HMs in the conditioned WAS matrix increased, the Ni concentration decreased in the solid fraction. Further, the risk assessment code (RAC) levels did not increase, and the eco-toxicity of Cr became weakened after Fe2+pyrite/PMS conditioning. However, after acid extraction, the pyrite residue had worsened recycle performance because the passivation layer contained S0/Sn2− on its surface, and no additional elements were detected in the pyrite residue, which had almost no effect on its further usage.

The Racial and Socioeconomic Characteristics of Men Using Mail-in Semen Testing Kits in the United States

To describe the racial and socioeconomic characteristics of men using mail-in semen testing kits for their fertility care in the United States over 3 years. A cross-sectional analysis was conducted of men who used mail-in semen analyses from a single direct-to-consumer (DTC) fertility platform between 2020 and 2022. Age, race/ethnicity, place of residence, and education level of men using mail-in semen analysis kits was collected from user questionnaires. Zip code level socioeconomic status was estimated using the Area Deprivation Index (ADI). These characteristics were compared to the overall population of the United States. 4,342 men used mail-in semen analyses from a single DTC fertility company between 2020 and 2022 and completed the questionnaire. The median age of this cohort was 36 (IQR: 32,40) years. The group consisted of predominantly white men (72%), with 7.9% Asian and only 5.1% Black, 3.2% Hispanic, 0.4% Indian American, 0.1% pacific islander, 5.8% mixed race, and 2.8% other groups. 45.8% of the group had completed college, 22% had a master's degree, and 9% had a doctoral degree. The mean ADI was 83.47 (SD 21.44) compared to the average ADI of 100 for the general US population (p<0.005). DTC mail-in semen analyses have the potential to improve access to affordable fertility care. Racial and ethnic minorities and lower socioeconomic classes are underrepresented for men seeking DTC fertility testing as they are for men presenting for in-office fertility care. Additional studies are needed to determine the factors responsible for these discrepancies.

Are all underimmunized measles clusters equally critical?

This research develops a novel system science approach to examine the potential risk of outbreaks caused by geographical clustering of underimmunized individuals for an infectious disease like measles. We use an activity-based population network model and school immunization records to identify underimmunized clusters of zip codes in the Commonwealth of Virginia. Although Virginia has high vaccine coverage for measles at the state level, finer-scale investigation at the zip code level finds three statistically significant underimmunized clusters. This research examines why some underimmunized geographical clusters are more critical in causing outbreaks and how their criticality changes with a possible drop in overall vaccination coverage. Results show that different clusters can cause vastly different outbreaks in a region, depending on their size, location, immunization rate and network characteristics. Among the three underimmunized clusters, we find one to be critical and the other two to be benign in terms of an outbreak risk. However, when the vaccine coverage among children drops by just 5% (or 0.8% overall in the population), one of the benign clusters becomes highly critical. This work also examines the demographic and network properties of these clusters to identify factors that are responsible for affecting the criticality of the clusters. Although this work focuses on measles, the methodology is generic and can be applied to study other infectious diseases.