A comparative assessment of culture and serology in the diagnosis of brucellosis in dairy cattle.

To investigate the usefulness of culture for the confirmation of brucellosis in cattle, a comparison of culture and serology was undertaken on 248 animals in four dairy herds where the disease was active. Paired supramammary (SM), retropharyngeal (RP), and internal iliac (IL) lymph nodes were cultured, and five serological tests were deployed: the microserum agglutination test (MSAT), complement fixation test (CFT), the indirect (iELISA) and competitive ELISA, and the fluorescence polarisation assay (FPA). Brucella abortus was isolated from 86.8% of animals on combined culture of all three lymph nodes. Individually, the highest isolation rate was from the RP (90.5% of culture positives). Of culture positive animals, 13.7% and 6.2% were positive from the RP and SM alone, respectively. Approximately half of the positive cultures yielded <10 colonies/culture plate. Although 80.9% of animals were positive in at least one serological test, only 45.2% were positive in all five. For culture-positive animals, the MSAT was the most sensitive test (71.8%). Of the culture-negative animals 67.7% were positive in at least one test, while 12.9% were positive in all five. Titres were higher in animals culture-positive from the SM, and there was a direct correlation between higher titres and higher colony counts in SM cultures. Only 8.9% of animals were both culture-negative and seropositive (in at least one test), while 16.5% were culture-positive and seronegative in all five tests. The results highlight and validate the sensitivity of bacteriological culture in confirming a diagnosis of bovine brucellosis. While the MSAT and FPA were the most sensitive serological tests, a significant percentage of infected animals were undetectable using these standard serological assays.

Public-private partnerships: working at the local level to increase the quality and number of medical homes for Medicaid children.

We have described a process in which one state's public health leaders provided a large degree of flexibility at the community level to improve pediatric health care access for children in need. This "room-to-wiggle" allowed program providers to tailor their programs to the specific needs of their communities while remaining faithful to the statewide goals. Among the most promising outcomes of the coordinated efforts to forge public-private partnerships is the continuation of the relationships that developed in the process and the further collaborations they have spawned.

Low efficacy radiography of children.

Radiographic procedures performed at a 100-bed pediatric hospital were reviewed jointly by a radiologist and the primary physician staff. The reviewers judged several procedures to be performed unnecessarily, with undue patient risk or cost. Low efficacy examinations were divided into two categories: (1) low-yield examinations with significant gonadal radiation as well as significant cost, and (2) low-yield examinations with low gonadal radiation but significant cost. A joint policy recommendation was then delivered to the house staff concerning appropriate indications for the performance of these low-yield procedures. This active review process is submitted as a model for other medical facilities that seek to reduce risk and cost to the pediatric patient.