Carlton J Covey1, Marvin H Sineath2, Joseph F Penta3, Jeffrey C Leggit4. 1. Uniformed Services University of the Health Sciences, Bethesda, MD, USA. Email: carlton.covey@usuhs.edu. 2. Nellis Family Medicine Residency, Nellis Air Force Base, NV, USA. 3. Naval Hospital Pensacola, FL, USA. 4. Uniformed Services University of the Health Sciences, Bethesda, MD, USA.