Monkeypox in Patient Immunized with ACAM2000 Smallpox Vaccine During 2022 Outbreak.

We report a case of monkeypox in the United States in a patient who had been vaccinated with ACAM2000 smallpox vaccine 8 years earlier. Despite his vaccination status, he still contracted disease. He showed prodromal symptoms preceding development of painless penile lesions that later coalesced.

Inequities in Employment by Race, Ethnicity, and Sector During COVID-19.

OBJECTIVE: To determine whether people of Color experienced disparate levels of employment loss in frontline versus non-frontline occupations during the onset of the COVID-19 pandemic. METHODS: The Bureau of Labor Statistics Current Population Survey data was analyzed in a cross-sectional study. Percent change in number employed was tabulated quarterly for groups by race and ethnicity (Black or African American, Asian American, or Hispanic or Latinx compared to White or non-Hispanic or Latinx) and frontline occupation status between January 1 and June 30, 2020. Two-tailed two-sample tests of proportions were used to compare groups statistically. RESULTS: More dramatic declines in number employed occurred in the Black or African American, Asian American, and Hispanic or Latinx groups. When stratified by sector, greater declines were noted in the Hispanic or Latinx and Asian American frontline, and Black or African American non-frontline groups when compared to the referent groups. CONCLUSIONS: Structural racism has further affected people of Color through differential employment loss during the onset of the pandemic, both overall and by sector. However, the effect of sector varies dramatically across racial and ethnic groups. POLICY IMPLICATIONS: Because employment is an important social determinant of health and a potential risk factor for contracting COVID-19, these trends may provide important context for the prioritization of PPE and immunizations, as well as the provision of stable health insurance and income support for vulnerable workers.

PTSD and Trauma as Mitigating Factors in Sentencing in Capital Cases.

Posttraumatic stress disorder (PTSD) is commonly used as a mitigating sentencing factor, although how successfully it is used varies. In cases involving the death penalty, use of a PTSD diagnosis as a sentencing mitigating factor has been considered in the postconviction appeals process. This article analyzes a decade of American federal appellate case law regarding postconviction claims of ineffective assistance of counsel by capital defendants in regard to investigating and litigating trauma and PTSD. We found a high tolerance by the courts for deficient investigating, ruling against the petitioner in 20 of 23 (87%) of identified cases. The article discusses how these situations might be avoided and explores the critical role of forensic psychiatrists and mitigation specialists in investigating and presenting trauma to the court.

Primary Aortic Angiosarcoma: A Review of Two Cases Highlighting Unique Imaging and Clinical Characteristics.

Angiosarcomas are rare vascular connective tissue tumors originating from the tunica intima, media, or adventitia and may arise in large vessels. Here two cases of primary angiosarcoma of the aorta are described that highlight initial manifestations and unique complications from diffuse arterial tumor emboli, which led to delayed cancer diagnosis. In patients with aortic lesions, imaging characteristics must be thoughtfully reconciled with clinical scenarios, particularly in patients with no additional evidence of atherosclerosis or vasculitis. Keywords: Oncology, Neoplasms-Primary, MR-Angiography, Aorta © RSNA, 2021.

Preclinical Assessment Performance as a Predictor of USMLE Step 1 Scores or Passing Status.

PURPOSE: To determine the association between student performance on preclinical pass/fail assessments in an allopathic medical school curriculum and Step 1 scores or passing status. MATERIALS AND METHODS: This observational retrospective study involved preclinical assessments, including National Board of Medical Examiners Customized Assessment Services (NBME CAS) exams, faculty developed exams, and the United States Medical Licensing Examination (USMLE) Step 1 from 582 medical students in four cohorts (2018-2021). Analyses included descriptive statistics, Pearson's correlation coefficient (ρ) and logistic regression, presented as odds ratios (ORs) and associated p values. RESULTS: Mean scores on Component 4 end-of-block NBME CAS examinations positively correlated with Step 1 scores (ρ = 0.83, p < .001), as did mean scores on both Component 1 weekly faculty-created assessments and Component 3 end-of-block faculty-created assessments (ρ = 0.70, p < .001; ρ = 0.73, p < .001). Passing all Component 3 end-of-block faculty-created assessments in all blocks was associated with passing Step 1 (OR = 8.66, p < .001). Independently, passing all Component 4 NBME CAS exams or passing all Component 1 weekly faculty-derived assessments in all blocks did not correlate with passing Step 1 (OR = 2.40, p = .12.; OR = 0.29, p = .30). Passing all assessment types in all blocks was among the strongest correlators with passing Step 1 (OR = 9.026, p < .001). CONCLUSIONS: Scores on faculty-derived and NBME CAS end-of-block assessments were positively correlated with Step 1 scores. Passing status on institution-derived end-of-block assessments was associated with passing Step 1, whereas passing status on weekly institution-derived assessments or end-of-block NBME CAS assessments was not associated with passing Step 1. End-of-block pass/fail NBME CAS and faculty-derived preclinical examinations may help prepare students for Step 1 and predict their outcomes. Weekly faculty-created assessments should primarily be used to continuously reinforce educational material.

E-cigarette and dual product use as an emerging health threat to the US military.

INTRODUCTION: Cigarette and e-cigarette use are threats to the health and readiness of the US military. The study objective was to determine the prevalence and factors associated with e-cigarette, cigarette, and dual use among active duty service members (SMs). METHODS: We used data from the 2015 Health Related Behaviors Survey-a crosssectional survey weighted to represent the US military (n=16699). Weighted prevalence and odds ratios assessed associations between risk factors and e-cigarette/cigarette use via weighted multinomial logistic models. RESULTS: The prevalence of cigarette use in the US military declined from 24% in 2011 to 13.8% in 2015. However, e-cigarette use (12.4%) and dual product use (4.7%) increased during this period. Additionally, prevalence of e-cigarette use was higher in the military compared to the general population (12.4% vs 3.5%), particularly among those aged 17-24 years (22.8% vs 5.2%); cigarette use was also higher in the military in this age group (19.3% vs 13.0%). After adjustment, SMs who were enlisted, lacked a Bachelor's degree, and/or had probable alcohol use disorder had significantly greater odds of cigarette, e-cigarette, and dual use. While SMs aged 17-24 years had the highest prevalence of all types of product use, only being aged ≥45 years was significantly associated with decreased odds of product use in adjusted models. CONCLUSIONS: Military efforts to control cigarette use among SMs seem to have been successful, as demonstrated by the dramatic declines in its use and the lower prevalence seen in the military compared to the general population. However, the concurrent increases in e-cigarette use are concerning, particularly among the youngest members of the military. The US military must continue to monitor emerging trends in e-cigarette, cigarette, and dual use and rapidly take steps to address them as threats to health and readiness.

The Content Quality of YouTube Videos for Professional Medical Education: A Systematic Review.

PURPOSE: To evaluate the content quality of YouTube videos intended for professional medical education based on quality rating tool (QRT) scores and determine if video characteristics, engagement metrics, or author type are associated with quality. METHOD: The authors searched 7 databases for English-language studies about the quality of YouTube videos intended for professional medical education from each database's inception through April 2019. To be included, studies had to be published in 2005 (when YouTube was created) or later. Studies were classified according to the type of QRT used: externally validated, internally validated, or limited global. Study information and video characteristics and engagement metrics were extracted. Videos were classified by video author type. RESULTS: Thirty-one studies were included in this review. Three studies used externally validated QRTs, 20 used internally validated QRTs, and 13 used limited global QRTs. Studies using externally validated QRTs had average scores/total possible scores of 1.3/4, 26/80, and 1.7/5. Among the 18 studies using internally validated QRTs, from which an average percentage of total possible QRT score could be computed or extracted, the average score was 44% (range: 9%-71%). Videos with academic-physician authors had higher internally validated QRT mean scores (46%) than those with nonacademic-physician or other authors (26%; P < .05). CONCLUSIONS: The authors found a wide variation in QRT scores of videos, with many low QRT scores. While videos authored by academic-physicians were of higher quality on average, their quality still varied significantly. Video characteristics and engagement metrics were found to be unreliable surrogate measures of video quality. A lack of unifying grading criteria for video content quality, poor search algorithm optimization, and insufficient peer review or controls on submitted videos likely contributed to the overall poor quality of YouTube videos that could be used for professional medical education.