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Introduction The aim of this study was to determine the knowledge, attitudes, and practices of family physicians and pediatricians in regard to adolescent immunization.Methods The study was conducted from March to May 2017. A total of 665 physicians participated. Participants were asked 31 questions about their personal sociodemographic characteristics and their knowledge, attitudes, and practices around adolescent immunization.Results The study sample consisted of 348 family physicians (52.3% of the sample) and 317 pediatricians (47.7%). The results showed that 5.4% of family physicians and 10.4% of pediatricians thought that they had enough knowledge about adolescent immunization (p less then  .01). Overall, 15.8% of family physicians and 12.7% of pediatricians provided adolescents with information about vaccines ‘always/most of the time’. A variety of reasons for not providing information about adolescent vaccines was provided, including ‘inability to allocate time’ (50.2% of family physicians, 69.3% of pe time, forgetfulness, and lack of knowledge about vaccines. We conclude that educational programs should be used to improve knowledge of adolescent immunization among family physicians and pediatricians.Influenza is a viral respiratory disease that causes significant clinical and economic burden globally. Quadrivalent influenza vaccine (QIV) is frequently used to protect people who have a high-risk of developing influenza complications due to comorbidities. QIV offers protection against influenza A (A/H1N1 and H3N2) and B (B/Victoria, and B/Yamagata) strains. The European Medicines Agency has recently approved a cell-based QIV (QIVc) in people aged over 9 years old. QIVc has been shown to be more effective at preventing influenza than traditional egg-based QIV (QIVe). In this study, we use a health economic model adapted to Spain to assess the costs and outcomes associated with using QIVc instead of QIVe in people aged 9-64 at high-risk of complications. Observed vaccine coverage of 32% in the 9-17 age group, 17% in those aged 18-59, and 22% for ages 60-64 was used in the analysis. In total, 2.5 million people were vaccinated in the simulations. Using QIVc instead of QIVe was associated with 16,221fewer symptomatic cases, 4,522 fewer primary care visits, 1,015 fewer emergency room visits and 88 fewer hospitalizations. From a societal perspective, QIVc was more effective and less expensive compared to QIVe, leading to a cost-saving of €3.4 million. From a public payer perspective, the incremental cost-effectiveness ratio for QIVc vs QIVe was €12,852 per QALY gained. In conclusion, QIVc offers a cost-effective alternative to QIVe and should be considered as an alternative vaccine to QIVe for people aged 9-64 at high-risk of influenza complications in Spain.We performed whole-genome sequencing of two phytoplasmas associated with sugarcane grassy shoot (SCGS) and Bermuda grass white leaf diseases. These are the first draft genomes of SCGS phytoplasma (strain SCGS) and ‘Candidatus Phytoplasma cynodontis’ (strain LW01) and may help to delineate these phytoplasmas at a finer taxonomic level.Xanthomonas vasicola pv. vasculorum (Xvv) is an emerging bacterial plant pathogen that causes bacterial leaf streak on corn. First described in South Africa in 1949, reports of this pathogen have greatly increased in the past years in South America and in the U.S. The rapid spread of this disease in North and South America may be due to more favorable environmental conditions, susceptible hosts and/or genomic changes that favored the spread. To understand whether genetic mechanisms exist behind the recent spread of Xvv we used comparative genomics to identify gene acquisitions in Xvv genomes from the U.S. and Argentina. We sequenced 41 genomes of Xvv and the related sorghum-infecting X. vasicola pv. holcicola (Xvh), and performed comparative analyses against all available X. vasicola genomes. Time-measured phylogenetic analyses showed that Xvv strains from the U.S. and Argentina are closely related and arose from two introductions to North and South America. Gene content comparisons identified clusters of genes enriched in corn Xvv that showed evidence of horizontal transfer including one cluster corresponding to a prophage found in all Xvv strains from the U.S. and Argentina as well as in Xvh strains. In this work we explore the genomes of an emerging phytopathogen population as a first step towards identifying genetic changes associated to the emergence. The acquisitions identified may contain virulence determinants or other factors associated with the spread of Xvv in North and South America, and will be the subject of future work.Background Hepatitis A vaccine has been used in mass and routine public vaccination programs in China. Long-term follow-up studies are required to determine the duration of protection and the need for booster vaccinations.Methods A prospective, randomized, open-label clinical trial was performed to compare the geometric mean concentration (GMC) and seroprotection rates of anti-Hepatitis A virus (HAV) antibodies elicited by the inactivated vaccines Healive and Havrix. 400 healthy children were randomly assigned 31 ratio to receive two doses of Healive or Havrix at 0 and 6 months. Persistence of anti-HAV antibodies for 5 years post immunization has been reported The current study reports new data at 11 years post immunization for the purpose of showing antibody persistence. Sensitivity analyzes were performed to assess the results. In addition, predictions for long-term antibody persistence were performed using a statistical model. Two different serological assays were used that were shown to be 98.3% concordant for detecting anit-HAV antibody.Results GMCs were significantly higher following Healive compared to Havrix at 1, 6, 7, 66, 112 and 138 months post-vaccination. In addition, the GMCs obtained using sensitivity analysis were very similar to those obtained using the original models. Prediction analysis indicated that the duration of protection for both vaccines was at least 30 years after immunization, with a lower limit of the 95% confidence interval for GMC of greater than 20mIU/mL.Conclusions Healive is more immunogenic than Havrix in children at 11 years post full immunization. Prediction analysis indicated at least 30 years of antibody persistence for both vaccines.Introduction The past decade has witnessed numerous advances in colorectal surgery secondary to minimally invasive surgery, evidence-based enhanced recovery programs, and a growing emphasis on patient-centered outcomes. The purpose of this study is to benchmark outcomes and experiences of patients undergoing colorectal surgery at a tertiary Veterans Affairs Medical Center for a 10-year period. Materials and Methods Veterans who underwent nonemergent colorectal procedures between 2008 and 2018 were identified using targeted Current Procedural Terminology (CPT) codes and the Computerized Patient Record System. Patient outcomes were captured using the Veterans Affairs Surgical Quality Improvement Program and focused on length of stay and aggregate postoperative morbidity profiles. SAS® Version 9.4 (SAS Institute Inc., Cary, NC) was used for all data analysis with P  less then  .05 used to indicate significance. Results In total, 327 patients underwent colon/rectal resection at our medical center. Of whom 95% of patients were male and the average age was 66 years. The median length of stay after surgery was 8 days. Within the 30-day postoperative period, the composite morbidity score was 24.1% most notable being superficial surgical site infections (6.5%), wound dehiscence (4.6%), and pneumonia (3.1%). Over the course of the study period, the laparoscopic approach increased in utilization, with 22.2% of cases performed laparoscopically in 2008 that rose to 61.1% in 2018. Conclusion Cataloging this decade of practice provides a foundation for future changes in the field of colorectal surgery and in the treatment of veterans. Understanding historical outcomes should help identify areas for ongoing process improvement and guide targeted approaches to quality metrics.Parathyroid carcinoma is a rare malignancy, representing 0.005% of all cancers and 0.5%-1% of all parathyroid disorders. Parathyroid carcinoma occurs equally in males and females, as opposed to primary hyperparathyroidism, which has a female predominance. Patients with parathyroid carcinoma present with symptoms of hypercalcemia, similar to those with benign primary hyperparathyroidism. Parathyroid carcinoma should be suspected when calcium or parathyroid hormone levels are high. Because of the difficulty of discerning parathyroid carcinoma from adenoma preoperatively, the diagnosis of carcinoma is often made only after parathyroidectomy. The goals of surgery are resection with negative margins because surgery represents the only opportunity for cure. Adjuvant therapy with chemotherapy or external beam radiation has not been proven to affect disease-free or overall survival for these patients. Recurrence is common, with reoperation recommended for resectable recurrent disease. Palliation with calcimimetic pharmacotherapy can aid with management of symptomatic hypercalcemia in recurrent or persistent disease after parathyroidectomy. Ultimately, patients succumb to sequelae of hypercalcemia rather than tumor burden.OBJECTIVE The aim of this study is to measure drivers’ attention to preview and their velocity and acceleration tracking error to evaluate two- and three-dimensional displays for following a winding roadway. BACKGROUND Display perturbation techniques and Fourier analysis of steering movements can be used to infer drivers’ spatio-temporal distribution of attention to preview. Fourier analysis of tracking error time histories provides measures of position, velocity, and acceleration error. METHOD Participants tracked a winding roadway with 1 s of preview in low-fidelity driving simulations. Position and rate-aided vehicle dynamics were paired with top-down and windshield displays of the roadway. see more RESULTS For both vehicle dynamics, tracking was smoother with the windshield display. This display emphasizes nearer preview positions and has a closer correspondence to the control-theoretic optimal attentional distributions for these tasks than the top-down display. This correspondence is interpreted as a form of stimulus-response compatibility. The position error and attentional signal-to-noise ratios did not differ between the two displays with position control, but with more complex rate-aided control much higher position error and much lower attentional signal-to-noise ratios occurred with the top-down display. CONCLUSION Display-driven influences on the distribution of attention may facilitate tracking with preview when they are similar to optimal attentional distributions derived from control theory. APPLICATION Display perturbation techniques can be used to assess spatially distributed attention to evaluate displays and secondary tasks in the context of driving. This methodology can supplement eye movement measurements to determine what information is guiding drivers’ actions.Introduction Although there are studies about sepsis treatment in different age groups, data on immunoglobulin-M (IgM)-enriched intravenous immunoglobulin use in pediatric intensive care units (PICUs) are limited. The aim of this study was to evaluate the clinical features and prognoses of children receiving IgM-enriched intravenous immunoglobulin to treat sepsis, septic shock, and multi-organ failure.Method We extracted data from the medical records of 254 children who received IgM-enriched intravenous immunoglobulin infusion (104 children for 3 days, 150 children for 5 days) in addition to standard treatment between 2010 and 2017.Results When the 5-day vs. 3-day IgM-enriched immunoglobulin treatments were compared, the mortality rate was shown to be lower in patients who received the longer duration of treatment (p less then  .001). Better outcomes were observed among children with septic shock (p less then  .01).Conclusion Our clinical work with 5-days IgM-enriched intravenous immunoglobulin may reveal a survival benefit of this treatment for children with septic shock.