Bovine mastitis is a dairy cattle disease with high economic impact. Subclinical mastitis (SCM) contributes to most of the financial losses. Colombia dairy sector accounts for 2.3% of the gross domestic product (GDP) and 24.3% of the livestock GDP. Milk production reaches 6,500 million liters/year from nearly 500,000 cattle farms and is mainly based on small-scale production systems. This study evaluates the financial impact of SCM and the potential for its control in three dairy farm strata in a region in Colombia. The objectives of the study were 1) to determine the perception of farmers about the SCM problem on their farms, 2) to assess prevalence and financial impact of SCM on farms and in the “Area five” sanitary region of the Bogota plateau, and 3) to assess costs and effectiveness of control methods of SCM. Information about disease management and decision-making process was obtained through a participatory epidemiology workshop and applying a semi-structured survey. A two-stage stratified cross sectional epidemiological study was conducted on dairy cattle from a region with approximately 400 farms and 12,000 cows, with a sample size of 55 farms. Prevalence of SCM was calculated by defining a cow as positive for the disease when any quarter had a somatic cell count (SCC) higher than 250 × 103 cells/ml. The prevalence of SCM in cows was 55.2%; significant differences were found between strata. Assessment of the financial impact of SCM in terms of milk losses was conducted using spreadsheet models. Milk production losses per farm ranged from 1.3% to 13.5%, and the economic impact in the region was estimated over USD $800.000 per year. The financial impact was greater in small- and medium-sized farms than large farms, and it was associated with the severity of SCC per quarter. Principal component analysis showed interactions, irrespective of the individual effect, and suggested three main groups of control interventions: application of basic milking hygiene practices, increase in the level of hygiene practices and veterinary advice, and SCM diagnosis and dry-cow treatment. Lack of information on management and production at farms promotes intuitive decision-making. Further research for the deeper understanding of intervention costs and effectiveness is suggested.

We studied the seroprevalence of antibodies against Trypanosoma cruzi in the human population along with domiciliary infestation by triatomine bugs in an area endemic for Chagas disease in the Chaco Province of Argentina. In addition, we carried out parasitologic surveys in patients, dogs, wild mammals, and vectors. The mean seroprevalence in humans was 27.81% (109 of 392) and 24.14% (63 of 261) in 1-15-year-old children. The minimum domiciliary infestation rate was 13.33%, with certain areas reaching 53.85%. The prevalence was 15.09% (16 of 106) in dogs and 35.71% (10 of 28) in opossums. Infection with T. cruzi was detected in 30.10% (59 of 196) of the Triatoma infestans tested. Compared with nationwide studies, our data suggest that 1) there are zones requiring immediate sanitary action, and 2) nationwide estimates are based on very heterogeneous epidemiologic situations. This heterogeneity emphasizes the importance of in-depth studies of restricted areas to provide additional information for a better understanding of the present status of Chagas disease in Argentina.

Trials in children with chronic kidney disease do not consistently report outcomes that are critically important to patients and caregivers. This can diminish the relevance and reliability of evidence for decision making, limiting the implementation of results into practice and policy. As part of the Standardized Outcomes in Nephrology-Children and Adolescents (SONG-Kids) initiative, we convened 2 consensus workshops in San Diego, California (7 patients, 24 caregivers, 43 health professionals) and Melbourne, Australia (7 patients, 23 caregivers, 49 health professionals). This report summarizes the discussions on the identification and implementation of the SONG-Kids core outcomes set. Four themes were identified; survival and life participation are common high priority goals, capturing the whole child and family, ensuring broad relevance across the patient journey, and requiring feasible and valid measures. Stakeholders supported the inclusion of mortality, infection, life participation, and kidney function as the core outcomes domains for children with chronic kidney disease.

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IMPORTANCE Robust laboratory use data are lacking to support the general assumption that teaching hospitals with trainees routinely order more laboratory tests for inpatients than do nonteaching hospitals.OBJECTIVE To quantify differences in the use of laboratory tests between teaching and nonteaching hospitals. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional study was performed using a statewide database to identify hospitalizations with a primary diagnosis of bacterial pneumonia or cellulitis from January 1, 2014, to June 30, 2015, at teaching and nonteaching hospitals with 100 or more hospitalizations of each condition. Patients included were adult inpatients with a primary diagnosis of bacterial pneumonia (n = 24 118) or cellulitis (n = 19 211); patients excluded were those with an intensive care unit stay, transfer from another hospital, or a length of stay that was 2 SDs or more of the condition's mean length of stay. MAIN OUTCOMES AND MEASURESMean laboratory tests per day stratified by illness severity, as well as factors associated with laboratory use rates.RESULTS A total of 43 329 hospitalized patients (20493 women and 22836 men) had a principal diagnosis of bacterial pneumonia or cellulitis across 11 major teaching hospitals, 12 minor teaching hospitals, and 73 nonteaching hospitals in Texas. Mean number of laboratory tests per day varied significantly by hospital type and was highest for major teaching hospitals for both conditions (bacterial pneumonia: major teaching hospitals, 13.21; 95% CI, 12.91-13.51; nonteaching hospitals, 8.92; 95% CI, 8.84-9.00; P < .001; cellulitis: major teaching hospitals, 10.43; 95% CI, 10.16-10.70; nonteaching hospitals, 7.29; 95% CI, 7.22-7.36; P < .001). This association held for all levels of illness severity for both conditions, except for patients with cellulitis with the highest illness severity level. In generalized mixed linear regression models, controlling for additional patient and encounter covariates, there was a significant difference in the marginal effect of hospital teaching status on mean number of laboratory tests per day between major teaching and nonteaching hospitals (difference in marginal mean laboratory tests per day for bacterial pneumonia, 3.58; 95% CI, 2.61-4.55; P < .001; for cellulitis, 2.61; 95% CI, 1.76-3.47; P < .001). CONCLUSIONS AND RELEVANCECompared with nonteaching hospitals, patients in Texas admitted to major teaching hospitals with bacterial pneumonia or cellulitis received significantly more laboratory tests after controlling for illness severity, length of stay, and patient demographics. These results support the need to examine how the culture of training environments may contribute to increased use of laboratory tests.