United States Medical Research Articles

Precarious employment and mental health in the United States: Results from the Medical Expenditure Panel Survey (MEPS), 2008–2021

ObjectivesTo measure associations between employment precarity and mental health among United States (US) workers. MethodsThis study used data from the US Medical Expenditure Panel Survey for 2008–2021. Multivariable generalized estimating equations were used to measure associations between employment precarity (operationalized as a multi-dimensional exposure) and self-rated mental health after adjusting for relevant confounders. Marginal effects analysis was used to assess potential dose-response relationships between precarity and mental health. ResultsOur sample (n = 57,529) was representative of >106 million US workers employed throughout 2008–2021. Compared to those with low levels of employment precarity, those with medium and high levels of precarity had an increased odds of reporting poor/fair mental health (aOR = 1.21; 95% CI = 1.11, 1.32 and 1.51; 95% CI = 1.36, 1.68, respectively). Marginal effects analysis indicated that increasing levels of precarity were associated with an increased probability of reporting poor/fair mental health. ConclusionsIncreasing levels of employment precarity were associated with poor/fair self-rated mental health, findings potentially indicative of a dose-response relationship between the two. These nationally representative findings suggest employment precarity is an important social determinant of mental health. Future research could investigate how best to mitigate the negative effects of precarity on workers' lives and well-being, particularly regarding mental health.

The Prevalence of Sexual Misconduct in US Medical Education: Examining the Intersecting Vulnerabilities of Gender and Sexual Orientation.

This study explores the prevalence, characteristics, and correlates of sexual harassment and nonconsensual sexual contact among medical students in the United States (US). The study aims to understand the association between gender, sexual orientation, and these incidents within the context of undergraduate medical education in the US. Employing a cross-sectional approach, this study collected primary data from 23,124 medical students across various US allopathic and osteopathic medical schools. After the data were cleaned, 245 (1% of the targeted population) respondents were included in the final analysis.The focus was on the prevalence and characteristics of sexual harassment and nonconsensual sexual contact and the association of gender and sexual orientation with these experiences. The findings revealed that 12.2% (n = 30) of the respondents experienced nonconsensual sexual contact, with other medical students being the most common perpetrators. A significant association was found between gender, sexual orientation, and the occurrence of unwanted sexual contact, indicating a disproportionate impact on non-heterosexual individuals and females. The study underscores the prevalence of sexual harassment and nonconsensual sexual contact within the US undergraduate medical education, highlighting disparities based on gender and sexual orientation. These results call for the implementation of policies and programs to address sexual misconduct in medical schools. The study elucidates the need for an understanding of the impact of sexual misconducton students attending both allopathic (MD) and osteopathic (DO) medical programs.

Opioid Overdose Recognition: A Survey of Perceived Preparedness and Desire for Curricular Integration Among Current US Medical Students.

Opioid overdose deaths remain a major health issue in the United States (US). As future physicians, medical students must receive comprehensive training to recognize and manage opioid overdoses. This study aimed to highlight training gaps at the medical student level and understand students' attitudes toward patients with opioid use disorder (OUD). We assessed baseline knowledge of and attitudes toward the management of opioid overdoses and naloxone administration among medical students in the US. Two validated survey tools (Opioid Overdose Knowledge Scale and Opioid Overdose Attitude Scale) were administered to medical students training at accredited institutions along with supplemental questions measuring knowledge and attitudes towards opioid overdose management, naloxone administration, and prior training. The final sample had N = 73 participants from US medical schools with a mean age of 25.3 (range of 22-37): 72.6% of respondents were female. Although most respondents reported personal/professional experience with OUD before medical school, they expressed interest in additional training. Knowledge surrounding opioid overdoses increased insignificantly over the 4 years of medical school. However, there was a significant increase in both perceived competence in overdose recognition/management and in concerns about intervening from the first to fourth year of medical school. Female respondents had significantly lower perceived competence and readiness to intervene sub-scores than male counterparts; however, there was no significant difference in overall attitude and knowledge scores when stratified by sex. Incorporating opioid overdose prevention training (OOPT) into early medical education was favorable among respondents, who expressed an overwhelming interest in learning and supporting patients with OUD. Given the ongoing opioid crisis, medical students are ideally placed to identify and manage opioid overdoses. Medical students are ready to receive this training, thus strengthening the argument for OOPT integration into early medical student curricula.

Pathologists Shortage in United States of America (USA) - How Academic Centers and Private Laboratories Can Play an Effective Role in Recruiting Qualified Future Pathology Residents from Pool of United States (US) and International Medical Graduates (IMGs)

Abstract Introduction/Objective Pathology training (PT) in the US requires 4 years of AP/CP training. Only 2% of any medical school class (US or IMGs) enter Pathology. However, among practicing pathologists, an estimated 20 to 30% are IMGs that are working in academia/private settings. Even with artificial intelligence (AI) and digital pathology (DP), the need for pathologists will continue to rise, especially those who will acquire AI and DP skills. Methods/Case Report Our facility is a private reference laboratory. About 60 to 70% of graduates after residency join private practices. We initiated an education model to offer internship opportunities mainly for IMGs who have difficulty in gaining access to US academic centers due to numerous obstacles. Our initiative also offered electives for US medical students (US-MS) exploring pathology as a career. Between 2016 and 2022, 72 IMGs (12 countries) and 18 MS (5 states) rotated with us in a structured rotation lasting 4 weeks. Results (if a Case Study enter NA) Most of our IMGs were not able to find access to academic centers for internship. From the pool of IMGs who rotated with us, 51/72 (70%) matched into PT. In addition, we were able to positively influence 16/18 (88%) US-MS to adopt pathology as a career. Conclusion 1) We successfully created an educational model in a non-academic setting to mentor and prepare access to academic centers through PT as aspiring pathologists, 2) IMGs in our program excel in their respective countries; they were interviewed before being accepted into our program and committed to pathology with higher chance of matching, 3) US-MS that rotated through our program have higher rate of adopting pathology as a career when compared to traditional academic pathology rotations, and 4) more academic centers should consider allowing internships to IMGs and initiate private collaborations as an integral part of supporting the future of our profession.

Impact of the Affordable Care Act on participation in the Supplemental Nutrition Assistance Program among low-income older Medicare beneficiaries

BackgroundThe Affordable Care Act (ACA) provisions, especially Medicaid expansion, are believed to have “spillover effects,” such as boosting participation in the Supplemental Nutrition Assistance Program (SNAP) among eligible individuals in the United States (US). However, little empirical evidence exists about the impact of the ACA, with its focus on the dual eligible population, on SNAP participation. The current study investigates whether the ACA, under an explicit policy aim of enhancing the interface between Medicare and Medicaid, has improved participation in the SNAP among low-income older Medicare beneficiaries.MethodsWe extracted 2009 through 2018 data from the US Medical Expenditure Panel Survey (MEPS) for low-income (≤ %138 Federal Poverty Level [FPL]) older Medicare beneficiaries (n = 50,466; aged ≥ 65), and low-income (≤ %138 FPL) younger adults (aged 20 to < 65 years, n = 190,443). MEPS respondents of > %138 FPL incomes, younger Medicare and Medicaid beneficiaries, and older adults without Medicare were excluded from this study. Using a quasi-experimental comparative interrupted time-series design, we examined (1) whether ACA’s support for the Medicare-Medicaid dual-eligible program, through facilitating the online Medicaid application process, was associated with an increase in SNAP uptake among low-income older Medicare beneficiaries, and (2) in the instance of an association, to assess the magnitude of SNAP uptake that can be explicitly attributed to the policy’s implementation. The outcome, SNAP participation, was measured annually from 2009 through 2018. The year 2014 was set as the intervention point when the Medicare-Medicaid Coordination Office started facilitating Medicaid applications online for eligible Medicare beneficiaries.ResultsOverall, the change in the probability of SNAP enrollment from the pre- to post-intervention period was 17.4 percentage points higher among low-income older Medicare enrollees, compared to similarly low-income, SNAP-eligible, younger adults (β = 0.174, P < .001). This boost in SNAP uptake was significant and more apparent among older White (β = 0.137, P = .049), Asians (β = 0.408, P = .047), and all non-Hispanic adults (β = 0.030, P < .001).ConclusionsThe ACA had a positive, measurable effect on SNAP participation among older Medicare beneficiaries. Policymakers should consider additional approaches that link enrollment to multiple programs to increase SNAP participation. Further, there may be a need for additional, targeted efforts to address structural barriers to uptake among African Americans and Hispanics.

1836. Frequency and Antimicrobial Susceptibility of Gram-negative Bacteria Isolated from Patients with Bloodstream Infections in United States (US) Medical Centers (2020-2021)

Abstract Background Antimicrobial resistance among Gram-negative bacteria (GNB) is a major problem in US hospitals. The development of various β-lactamase inhibitor combinations (BLICs) markedly increased the armamentarium to treat infections caused by GNB in recent years. We evaluated the frequency and antimicrobial susceptibility of GNB causing bloodstream infection (BSI). Methods 5,796 organisms were consecutively collected (1/patient) from patients with BSI in 31 US medical centers in 2020-2021. The collection included 2,893 (49.9%) GNB, which were susceptibility tested against ceftazidime-avibactam (CAZ-AVI), ceftolozane-tazobactam (C-T), meropenem-vaborbactam (MEM-VAB), imipenem-relebactam (IMI-REL), and many comparators by CLSI broth microdilution method. Enterobacterales (ENT) isolates with an ESBL phenotype were screened for β-lactamase genes by whole genome sequencing. Results The most common GNBs were E. coli (41.9%), K. pneumoniae (16.1%), P. aeruginosa (10.2%), and E. cloacae (6.8%). Ceftriaxone susceptibility rates were 80.1%, 82.9%, and 74.0% for E. coli, K. pneumoniae, and E. cloacae, respectively. CAZ-AVI and MEM-VAB showed almost complete activity (≥ 99.7%) against ENT, whereas IMI-REL exhibited limited activity against P. mirabilis and indole-positive Proteeae isolates and C-T showed limited activity against E. cloacae, ESBL-phenotype, and multidrug-resistant (MDR) isolates (Table). CAZ-AVI, MEM-VAB, and IMI-REL were active against 84.2%, 57.9%, and 52.6% of carbapenem-resistant ENT (CRE) isolates, respectively. PSA susceptibility to PIP-TAZ, MEM, and CAZ were 86.1%, 88.5%, and 88.5%, respectively. CAZ-AVI (97.6% susceptible [S]), C-T (97.6%S), IMI-REL (99.0%S), and tobramycin (TOB; 98.3%S) were the most active agents against PSA and retained good activity against piperacillin-tazobactam (PIP-TAZ) nonsusceptible (NS), MEM-NS, and multidrug-resistant (MDR) isolates. Conclusion CAZ-AVI and MEM-VAB were the most active agents against ENT and CAZ-AVI; C-T and IMI-REL were the most active BLICs against PSA. The new BLICs represent valuable treatment options for infections caused by MDR GBNs. CAZ-AVI exhibited a more balanced spectrum against ENT and PSA when compared to other BLICs. Disclosures Helio S. Sader, MD, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|Melinta: Grant/Research Support|Nabriva Therapeutics: Grant/Research Support|Pfizer: Grant/Research Support Rodrigo E. Mendes, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|GSK: Grant/Research Support|Melinta: Grant/Research Support|Nabriva Therapeutics: Grant/Research Support|Office for Assistant Secretary of Defense for Health Affairs: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support|Spero Therapeutics: Grant/Research Support Cecilia G. Carvalhaes, MD, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support Michael D. Huband, BS, AbbVie: Grant/Research Support|Melinta: Grant/Research Support Dee Shortridge, PhD, AbbVie: Grant/Research Support|JMI Laboratory: Employee|Melinta: Grant/Research Support|Menarini: Grant/Research Support|Shionogi: Grant/Research Support Mariana Castanheira, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|GSK: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support.

United States Medical School Academic Faculty Workforce Diversity, Institutional Characteristics, and Geographical Distributions From 2014-2018.

PurposeAcademic healthcare workforce diversity is important in addressing health disparities. Our goal was to evaluate trends and associations in faculty diversity of United States (US) medical schools over a five-year period.MethodsWe analyzed the Association of American Medical Colleges (AAMC) Faculty Roster data of 151 US medical schools from 2014-2018. Outcome faculty variables were female gender, underrepresented in medicine (UiM), age, and professorial representation. Predictor variables included geographical distributions, and institutional characteristics. Statistical analysis included Jonckheere-Terpstra test, ANOVA, and regression analysis.ResultsFemale faculty increased from 37.6% to 40.4% (p<0.001), senior faculty (age >60 years) from 22.6% to 25.9% (p=0.001) while UiM faculty stayed relatively flat from 9.74% to 10.08% (p=0.773). UiM [adjusted odds ratio (aOR) = 0.39, p=0.015], and female faculty (aOR=0.3, p=0.001) had independently significantly decreased associations with professorial representation, while senior faculty had increased associations (aOR=3.82, p<0.001). Significant independent differences occurred in female, UiM, and professorial faculty distributions within US regions; Hispanic faculty were highest in Southwest (6.57%) and lowest in Midwest region (1.59%), while African-American faculty were highest in Southeast (8.15%) but lowest in the West (3.12%). UiM faculty had significantly independent decreased associations with MD/PhD degree (aOR=0.30, p=0.004) and higher US ranking institutions (aOR=0.45, p=0.009).ConclusionsFrom 2014 to 2018, female faculty increased modestly while the UiM faculty trend remained flat. Female and UiM faculty were less represented at the professor level. UiM faculty were less represented in higher-ranking institutions. Geographic location is associated with faculty diversity.

A Ten-Year Analysis of Recent National Institutes of Health Funding for Anesthesiology Research in United States Medical Schools

The characteristics of recent National Institutes of Health (NIH) grant funding to anesthesiology researchers in United States (US) medical schools have not been systematically quantified. NIH funding to cardiac anesthesiologists has also not been estimated. The author conducted an internet-based analysis of NIH awards to anesthesiology researchers from 2011-2020 to identify the types, duration of funding, and amount of grants, and the terminal degree(s), faculty rank, gender, board certification status, and type of appointment of the grant recipients including those with an interest in cardiac anesthesiology. Observational study. Internet analysis. NIH grants recipients. None. NIH grant recipients affiliated with anesthesiology departments were identified from the Blue Ridge Institute for Medical Research website. The number of grants, years of support, and total amount of funding were quantified for research project grants (R series), mentored career development awards (K series), and other grants (U and P series) using NIH Research Portfolio Online Reporting Tools. The terminal degree(s), faculty rank, gender, and type of appointment of grant recipients were identified using department web pages. American Board of Anesthesiology (ABA) certification, National Board of Echocardiography Advanced Perioperative Transesophageal Echocardiography (TEE) certification, and previous or current Foundation for Anesthesia Education and Research (FAER) awards to NIH grant recipients were obtained from each organization's website. A total of 532 researchers received 1250 grants with 3844 cumulative years of funding amounting to $1,676,482,440. R series grants accounted for three-quarters of all funding. PhDs were awarded more than one-half of NIH grants. MDs had lower median numbers of projects, R01 grants, and total R series grants than their colleagues with PhD or MD PhD degrees, but MDs received more K awards. One hundred ninety-eight MD and MD PhD NIH grant recipients were ABA diplomates. These physician-scientists received 26.0% and 53.1% of R and K series grants, respectively. Thirty physician-scientists also held TEE certification; these individuals with an interest in cardiac anesthesiology were awarded 4.8% of all NIH grants. Full Professors were awarded more than three-quarters of R grants and amassed more than $1.3 billion in funding, whereas assistant and associate professors received the majority of K series grants. Male investigators received greater median R grants but fewer median K awards than female researchers. One hundred-fifteen previous or current holders of FAER grants were identified; these individuals earned a total of 240 NIH awards totaling $357.7 million. PhDs, Professors, and male researchers receive the majority of R01 and other R series grants to anesthesiology departments at US medical schools. Physician-scientists, including those interested in cardiac anesthesiology, are awarded a minority of R series grants. FAER continues to provide an important stimulus for subsequent NIH funding of physician-scientists in anesthesiology.

Healthcare Worker Mental Health After the Initial Peak of the COVID-19 Pandemic: a US Medical Center Cross-Sectional Survey.

BACKGROUNDThere is a paucity of data on the mental health impact of the Coronavirus disease 2019 (COVID-19) pandemic on United States (US) healthcare workers (HCWs) after the first surge in the spring of 2020.OBJECTIVETo determine the impact of the pandemic on HCWs, and the relationship between HCW mental health and demographics, occupational factors, and COVID-19 concerns.DESIGNCross-sectional survey in an urban medical center (September–November 2020) in Baltimore, MD, in the United States.PARTICIPANTSA total of 605 HCWs (physicians, nurse practitioners, nurses, physician assistants, patient care technicians, respiratory therapists, social workers, mental health therapists, and case managers).MAIN MEASURESMeasures of mental health (Patient Health Questionnaire-2, Generalized Anxiety Disorder-7, PROMIS Sleep Disturbance 4a, Impact of Event Scale-Revised, Maslach Burnout Inventory-2 item, Connor-Davidson Resilience Scale-2 item), demographics, occupational factors, and COVID-19 related concerns.KEY RESULTSFifty-two percent of 1198 HCWs responded to the survey and 14.2% reported depression, 43.1% mild or higher anxiety, 31.6% sleep disturbance, 22.3% posttraumatic stress symptoms, 21.6% depersonalization, 46.0% emotional exhaustion, and 23.1% lower resilience. Relative to HCWs providing in-person care to COVID-19 infected patients none of their working days, those doing so all or most days were more likely to experience worse depression (adjusted odds ratio, 3.9; 95% CI, 1.3–11.7), anxiety (aOR, 3.0; 95% CI, 1.4–6.3), possible PTSD symptoms (aOR, 2.6; 95% CI, 1.1–5.8), and higher burnout (aOR, 2.6; 95% CI, 1.1–6.0). Worse mental health in several domains was associated with higher health fear (aORs ranged from 2.2 to 5.0), job stressors (aORs ranged from 1.9 to 4.0), perceived social stigma/avoidance (aORs ranged from 1.8 to 2.9), and workplace safety concerns (aORs ranged from 1.8 to 2.8).CONCLUSIONSUS HCWs experienced significant mental health symptoms eight months into the pandemic. More time spent providing in-person care to COVID-19-infected patients and greater COVID-19-related concerns were consistently associated with worse mental health.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07251-0.

1236. Update on the In Vitro Activity of Ceftaroline against Staphylococcus aureus from United States (US) Medical Centers Stratified by Infection Type (2018-2020)

1236. Update on the In Vitro Activity of Ceftaroline against Staphylococcus aureus from United States (US) Medical Centers Stratified by Infection Type (2018-2020)

217. Antimicrobial Activity of Dalbavancin against Gram-Positive Bacteria Isolated from Patients Hospitalized with Bacteremia in United States and European Medical Centers: Results from the International Dalbavancin Evaluation of Activity (IDEA) Program (2018-202)

217. Antimicrobial Activity of Dalbavancin against Gram-Positive Bacteria Isolated from Patients Hospitalized with Bacteremia in United States and European Medical Centers: Results from the International Dalbavancin Evaluation of Activity (IDEA) Program (2018-202)

Gender Distribution of Deans Among US Medical Schools: Towards Equity in Academic Medicine

Less than half of medical school professorships and decanal ranks are held by women. Our study investigates the gender-based geographical distribution and differences in lifetime peer-reviewed publications, H-index, and grant funding by the National Institutes of Health (NIH) of all allopathic medical school deans in the United States (US). A cross-sectional cohort study utilizing data from US allopathic medical school websites, PubMed, and the NIH Research Portfolio Online Reporting Tools regarding lifetime peer-reviewed publications and quantity/monetary sum of NIH grants received by medical school deans. Descriptive statistics, independent sample T-tests, and ANOVA were performed with statistical significance defined as P < 0.05. Women occupied 33/157 (21.0%) dean positions overall. Compared to women, men possess higher mean number of lifetime peer-reviewed publications (112.0vs. 55.2, P=0.001) and H-index (43.2vs. 25.7, P=0.001); however, there are no differences in the mean number of NIH grants (27.5vs. 19.1, P=0.323) nor mean total NIH funding received ($18,931,336vs. $14,289,529, P=0.524). While significant differences in mean H-index between all US regions were found (P=0.002), no significant differences exist between major US regions regarding the mean lifetime publication count (P=0.223), NIH grants received (P=0.200), nor total NIH funding (P=0.824) received. A significant discrepancy in the gender distribution, lifetime peer-reviewed publications, and H-index of allopathic medical school deans exists across the US, highlighting the need for adequate support for women in academic medicine. Greater implementation of mentorship, increased institutional support, and diversity training can improve the representation of women in medical school decanal positions.

Content and Functionality of United States Medical School Websites

IntroductionMost medical school applicants use the internet as a source of information when applying for medical school. Previous analyses have evaluated residency and fellowship websites; however, an in-depth analysis of medical school websites is lacking.MethodsWe evaluated 192 United States (US) medical school websites for presence or absence of 39 items relevant to medical school applicants. Items fell into seven general categories: curriculum, research, demographics of incoming class, admissions information, faculty, financial aid, and social.ResultsOf the 192 websites evaluated (152 allopathic and 40 osteopathic schools), websites contained a mean of 23 items (59%) with a standard deviation of 4.2 items.ConclusionOur study examining US medical school websites revealed a lack of online information for medical school applicants. As medical school interviews transition to being online during the COVID-19 pandemic, the importance of the medical school website to applicants becomes increasingly crucial. The information contained in our study could be used to improve the functionality and quality of information on medical school websites, which could help both applicants and the medical schools themselves.

#9: Frequency and Antimicrobial Susceptibility of Gram-Negative Organisms Causing Bloodstream Infections in Pediatric Patients from United States (US) Medical Centers (2014–2018)

Abstract Background Ceftazidime–avibactam is US FDA approved for the treatment of pneumonia and complicated intra-abdominal and urinary tract infections in adults, and it is in late-stage clinical development for the treatment of pediatric patients. Methods Organisms were consecutively collected from pediatric patients (≤17 years old) with bloodstream infections in 33 US medical centers in 2014–2018. Enterobacterales, P. aeruginosa, and H. influenzae isolates (n = 976) were susceptibility (S) tested against ceftazidime–avibactam and comparators by reference broth microdilution methods; 42.9% of isolates tested were from patients &amp;lt;1 year old, and 70.7% from patients ≤5 years old. Isolates with an ESBL–phenotype were screened for β-lactamase genes. Results Overall, 40.1% of organisms were Gram-negative bacteria (GNB), 57.0% Gram-positives, and 2.8% Candida spp. The five most common GNB were E. coli (32.4% of GNB), K. pneumoniae (17.3%), E. cloacae (9.8%), P. aeruginosa (9.2%), and S. marcescens (5.5%; Table). Enterobacterales, P. aeruginosa, and H. influenzae isolates combined represented 89% of GNB and all isolates (100.0%) were susceptible to ceftazidime–avibactam. Among Enterobacterales (n = 845; MIC50/90, 0.12/0.25 mg/L), the highest ceftazidime–avibactam MIC value was only 4 mg/L and 99.2% of isolates were inhibited at ≤1 mg/L. Enterobacterales susceptibility to ceftriaxone, piperacillin–tazobactam, ceftolozane–tazobactam, and meropenem were 88.2%, 93.1%, 97.5%, and 99.5%, respectively. Forty-four Enterobacterales isolates (5.2%) produced an ESBL, including CTX-M-type (n = 35 [79.5% of ESBL producers], 21 being CTX-M-15), SHV-type (12; 27.3%), and OXA-1/30 (9; 20.5%). Twelve isolates (27.3%) produced &amp;gt;1 ESBL. No carbapenemase gene was detected. Among ESBL producers, highest ceftazidime–avibactam MIC was 2 mg/L, and susceptibility rates for ceftolozane–tazobactam and meropenem were 92.9% and 100.0%, respectively. Ceftazidime–avibactam exhibited complete activity against P. aeruginosa (MIC50/90, 2/4 mg/L; 100.0% susceptible). P. aeruginosa susceptibility rates for meropenem, piperacillin–tazobactam, and ceftolozane–tazobactam were 82.5%, 85.6%, and 100.0%, respectively; and 10.3% of isolates exhibited multidrug-resistance phenotype (not susceptible to ≥3 classes). Ceftazidime–avibactam was highly active against H. influenzae (n = 34; MIC50/90, ≤0.015/0.03 mg/L; highest MIC, 0.06 m/L). Conclusions Ceftazidime–avibactam exhibited potent activity against a large collection of GNB isolated from pediatric patients with bacteremia and showed complete coverage (100.0% susceptibility) against P. aeruginosa, Enterobacterales, and H. influenzae.

Online Hide and Seek: Allopathic US Medical Schools’ Radiology Education Virtual Presence

Rationale and ObjectivesTo highlight radiology's merits and boost appeal to medical students in the digital era, it is increasingly important for radiology departments to be readily accessible to medical students. We report the results of a multivariate analysis of the virtual presence of radiology medical student education of 152 allopathic United States (US) medical schools, the first report of its kind to the authors’ knowledge. We detail eight elements to include when optimizing a radiology medical student education website. MethodsIn August 2020, the Department of Radiology websites at 152 allopathic US medical schools were assessed for the presence of a medical student radiology education website and accessibility of collated information about preclinical and clinical course offerings, radiology interest groups, and outreach initiatives in the form of student radiology mentorship, shadowing, and research opportunities. Results65.1% (99/152) of allopathic US medical schools’ radiology departments have a dedicated medical student radiology education website, one of which was excluded from further review due to password protected content. 58.2% (57/98) of departmental websites include information about preclinical radiology coursework and 90.8% (89/98) of departments provide information about clinical courses. Details about interest groups were found on 26.5% (26/98) of departmental websites. Information about mentorship and shadowing was identified on less than half of departmental websites. 51% (50/98) of Department of Radiology websites provide information about research opportunities for students. ConclusionsThis study demonstrates that the majority of allopathic US medical schools’ radiology departments lack full information of relevance to medical students. To engage today's and tomorrow's medical learners digitally, there is opportunity and need to improve the online availability of information about preclinical and clinical radiology courses, student interest groups, shadowing opportunities, student mentorship, and student research. We detail eight elements to include when optimizing a radiology medical student education website. In most instances, this can be accomplished by revising an existing radiology department website in a manner that engages, educates, and recruits medical students. As a specialty, radiology must expand our digital footprint to reach tomorrow's colleagues and leaders.

More Is More: Drivers of the Increase in Emergency Medicine Residency Applications.

IntroductionThe average number of applications per allopathic applicant to emergency medicine (EM) residency programs in the United States (US) has increased significantly since 2014. This increase in applications has caused a significant burden on both programs and applicants. Our goal in this study was to investigate the drivers of this application increase so as to inform strategies to mitigate the surge.MethodsAn expert panel designed an anonymous, web-based survey, which was distributed to US allopathic senior applicants in the 2017–2018 EM match cycle via the Council of Residency Directors in Emergency Medicine and the Emergency Medicine Residents Association listservs for completion between the rank list certification deadline and release of match results. The survey collected descriptive statistics and factors affecting application decisions.ResultsA total of 532 of 1748 (30.4%) US allopathic seniors responded to the survey. Of these respondents, 47.3% felt they had applied to too many programs, 11.8% felt they had applied to too few, and 57.7% felt that their perception of their own competitiveness increased their number of applications. Application behavior of peers going into EM was identified as the largest external factor driving an increase in applications (61.1%), followed by US Medical Licensing Exam scores (46.9%) – the latter was most pronounced in applicants who self-perceived as “less competitive.” The most significant limiter of application numbers was the cost of using the Electronic Residency Application Service (34.3%).ConclusionA substantial group of EM applicants identified that they were over-applying to residencies. The largest driver of this process was individual applicant response to the behavior of their peers who were also going into EM. Understanding these motivations may help inform solutions to overapplication.

A 15-Year Analysis of International Medical Graduates Matching Into Diagnostic Radiology Residency Programs in the United States

To analyze the trends in international medical graduates (IMGs) matching into diagnostic radiology residency programs in the United States (US). The National Resident Match Program data was accessed for years 2005-2020 and diagnostic radiology residency-specific data was extracted for US MD, osteopathic (DO), and IMG applicants. IMGs were categorized into US-citizen IMGs and non-US citizen IMGs per the National Residency Match Program. Variables collected for each year included the number of positions, number of applicants in each group, positions filled/unfilled, and fill rate of each group. Additional data for some years included USMLE Step 1 score, United States Medical Licensing Examination (USMLE) Step 2 clinical knowledge (CK) score, number of research experiences, number of abstracts/publications, and additional degrees obtained. Trends were analyzed using simple linear regression model and p value <0.05 was considered significant. The number of diagnostic radiology residency programs increased from 203 (2006) to 212 (2020). The total number of diagnostic radiology residency positions increased from 1011 (2006) to 1113 (2020), with the peak of 1145 in 2014. The overall "match rate," that is, proportion of positions filled to positions available, increased from 96.4% (2006) to 97.3% (2020), with a brief decline to 86.7% in 2015. Among the filled positions, the proportion filled by US medical school graduates significantly declined from 89.7% (2006) to 69.2% (2020) (p < 0.001), and the proportion of positions filled by osteopathic seniors and graduates significantly increased from 2.2% (2006) to 15.1% (2020; p < 0.001). The proportion of US IMGs increased from 3.2% (2006) to 5.4% (2020), while the proportion of non-US IMGs increased from 4.4% (2006) to 9.4% (2020), with overall IMG match rate increased significantly from 7.6% to 14.9% (p = 0.009). The mean Step 1 scores of US IMGs and non-US IMGs were 238 and 237.3, and the mean Step 2 CK scores were 241.67 and 241, respectively. Cumulatively over the study period, a total of 736 US IMGs and 1051 non-US IMGs have matched into diagnostic radiology residency. There is an increasing proportion of IMGs, especially the non-US citizen IMGs, matching into US radiology residency programs in the last decade. Diagnostic radiology remains a competitive specialty evidenced by average USMLE scores higher than national average and research experiences of matched candidates.

An Evaluation of Self-Reported Publications in Orthopaedic Sports Medicine Fellowship Applications.

Background:Orthopaedic sports medicine fellowship positions are increasing in popularity, as evidenced by the increasing number of applicants to these programs. As positions have become more competitive, greater emphasis has been placed on an applicant’s research experience. However, there has been a lack of research evaluating the accuracy of self-reported publications from fellowship applications.Purpose:To evaluate the accuracy of self-reported research publications and the outcomes of studies submitted for publication by applicants to an Accreditation Council for Graduate Medical Education (ACGME)–accredited sports medicine fellowship in the United States (US).Study Design:Cross-sectional study.Methods:Demographic and research publication data were retrospectively collected from 435 applications to an ACGME-accredited orthopaedic sports medicine fellowship program at a single high-volume academic institution from 2013 to 2017. All self-reported manuscript publications and studies in progress were analyzed with a minimum 2-year follow-up. “Submitted” publications were reviewed by searching the originally submitted journal and all publicly available sources. Publications were verified on PubMed, MEDLINE, and other open access journals. Journal impact factors were collected through use of InCites Journal Citation Reports.Results:Only 5.7% (85/1504) of papers reported as “completed” were inaccurately self-reported, with 44 (51.8%) remaining unverified and 41 (48.2%) reporting discordant authorship, in which the published study listed a different author order than reported on the application. Further, 28.3% (197/696) of papers self-reported as “submitted” remained unpublished, 21.8% (152/696) were published in a different journal than originally reported, and 7.6% (53/696) were published with a different authorship order than reported. Among 95 applicants whose papers were published in different journals than originally reported, the mean impact factor of the final accepting journal was significantly lower than that of the journal of original submission (0.97 ± 0.13 vs 3.91 ± 0.79, respectively; 95% CI of the difference, 1.34-4.54; P < .01). Univariate analysis showed no significant relationships between variables of interest (age, sex, US Medical Licensing Examination Step 1 score, American Orthopaedic Association membership, medical school ranking, and advanced degree) and the presence of an inaccuracy.Conclusion:There is a low rate of inaccurate self-reporting of “completed” publications on applications for orthopaedic sports medicine fellowships. The majority of papers listed as “submitted” on these applications were not published in the journals to which they were originally submitted.

Silicone prosthesis: A viable treatment option for rehabilitation of residual ocular defects

Rehabilitation of a residual ocular defect is a challenge for prosthodontists as it needs utilization of favorable anatomical factors and modification of unfavorable conditions so as to meet the triad of form, esthetics, and comfort. During the World War II, the United States Naval Dental and Medical School introduced the use of methyl methacrylate for the fabrication of ocular prosthesis. Since then, it has been widely used in the form of stock eye shell and modified stock shell and for custom-made ocular prosthesis. Medical-grade room-temperature vulcanizing silicone and its various advancements over the years have revolutionized the science of maxillofacial rehabilitation. The use of this material for ocular prosthesis has been underexplored. It exhibits numerous advantages over the age-old poly methyl methacrylate such as absence of monomer, flexibility, and improved esthetics in terms of intrinsic coloration, making it more biocompatible and comfortable for the patient. This case report aims to highlight the fabrication of custom-made ocular prosthesis using medical-grade silicone with emphasis on the use of multi-specialty approach for the selection of the iris and the use of photographic grid for iris placement. Medical-grade silicone has been used successfully for the fabrication of eye prosthesis in animals achieving desirable biological, mechanical, and esthetic goals of the rehabilitation process.

Coalition military personnel with stabilised facial fractures are less likely to require tracheostomy: a comparison of treatment in US and UK Medical Treatment Facilities during the Iraq and Afghanistan conflicts

Introduction: The United States (US) and United Kingdom (UK) deployed Medical Treatment Facilities (MTF) in support of the military campaigns in Iraq and Afghanistan. The approach to treatment of patients with facial injuries differed between nations, reflecting management protocols and the capabilities of deployed surgeons.