Does clinical mastitis in the first 100 days of lactation 1 predict increased mastitis occurrence and shorter herd life in dairy cows?

The objectives of this study were to estimate the direct effects of clinical mastitis (CM) occurring in early productive life (defined as the first 100 d of the first lactation) of Holstein dairy cows on the future rate of CM occurrence and on the length of total productive lifetime. Information on CM cases and other data occurring in 55,144 lactations in 24,831 cows in 5 New York State Holstein herds was collected from January 2004 until February 2014. For the first objective, a generalized linear mixed model with a Poisson distribution was used to study the effects of CM cases occurring in the first 100 d of a cow's first lactation, as well as farm indicator and number of days in the cow's lifetime, on the future lifetime rate of CM. Only cows that had completed their productive life [i.e., all had been culled (or sold) or had died; n = 14,440 cows] were included in this analysis. For the second objective, a Cox proportional hazards model was used to study the effects of CM cases occurring in the first 100 d of a cow's first lactation on the length of total productive lifetime. The model was stratified by farm. All 24,831 cows were included in this analysis with right censoring. Cows experienced between 0 and 4 CM cases in the first 100 d of lactation 1. Over their lifetime, cows experienced between 0 and 25 CM cases. During the study period, 10% of all cows died and nearly half of all cows were culled. The average length of productive life, including censored observations, was 2.0 yr after first calving. Compared with cows having no CM cases in the first 100 d of lactation 1, cows with 1 CM case in that time period had a 1.5 times higher rate of total number of CM cases over their lifetime. Cows with 2 (or 3 or more) CM cases in the first 100 d of lactation 1 had a 1.7 times (or 2.6 times) higher rate of total number of CM cases over their lifetime. For each additional CM case occurring in the first 100 d of lactation 1, the hazard rate of culling increased by 34%. Given economic conditions for preferentially culling mastitic cows, the study findings may help farmers make optimal decisions with regard to culling of such cows

Effects of pathogen-specific clinical mastitis occurrence in the first 100 days of lactation 1 on future mastitis occurrence in Holstein dairy cows: An observational study

The objective of this observational study was to estimate effects of clinical mastitis (CM) cases caused by different pathogens (Streptococcus spp., Staphylococcus aureus, Staphylococcus spp., Escherichia coli, Klebsiella spp., and CM cases with no growth) occurring in the first 100 d in lactation 1, of a dairy cow on the future rate of occurrence of different types of CM during a cow's full lifetime. The outcomes were occurrence of Streptococcus spp., Staphylococcus aureus, Staphylococcus spp., Escherichia coli, Klebsiella spp., and CM cases with no growth, after the first 100 d of lactation 1, until a cow's removal through death or sale in that or a subsequent lactation. Data, including information on CM cases, milk production, and event dates (including death or sale dates), were collected from 14,440 cows in 5 New York State Holstein herds from January 2004 until February 2014. Generalized linear mixed models with a Poisson distribution and log link function were fit for each pathogen. The individual cow was the unit of analysis. Escherichia coli was a predictor of future occurrence of E. coli, Klebsiella spp., and CM cases with no growth. Early-occurring Klebsiella spp. was a predictor of future cases of Klebsiella spp. Cases with no growth were predictors of future occurrence of Staphylococcus spp., E. coli, Klebsiella spp., and cases with no growth. Thus, E. coli and cases with no growth occurring early in lactation 1 appear to be consistent risk factors for future cases of CM, whether cases with the same pathogen or a different pathogen. In this study, farm effects on later pathogen occurrence differed somewhat, so treatment protocol and culling strategy may play a role in the findings. Nevertheless, the findings may help farmers in managing young cows with CM in early productive life, especially those with E. coli or cases with no growth, in that they may be more susceptible to future CM cases in their later productive life, thus meriting closer attention

Association of pathogen-specific clinical mastitis in the first 100 days of first lactation with productive lifetime : An observational study comparing competing risks models for death and sale with the Cox model

The objective of this observational study was to study the association between clinical mastitis (CM) (Streptococcus spp., Staphylococcus aureus, Staphylococcus spp., Escherichia coli, Klebsiella spp., cases with other treated or other not treated organisms, CM without growth) occurring in a dairy cow's first 100 days (d) of her first lactation and her total productive lifetime, ending in death or sale (for slaughter). Data were collected from 24,831 cows in 5 New York Holstein herds from 2004 to 2014. Two analytical approaches were compared. First, removals (death, sale) were treated as competing events in separate survival analyses, in proportional subdistribution hazards models. In one, death was coded as the event of interest and sale as the competing event; in another, sale was the event of interest and death the competing event. Second, traditional survival analysis (Cox proportional hazards) was conducted. In all models, the time variable was number of days from date of first calving until event (death or sale) date; if the cow was alive at study end, she was censored. Models were stratified by herd. Ten percent of cows died; 48.4 % were sold. In the competing risks analysis, E. coli and CM without growth were associated with death; the former with an increased hazard rate of death, the latter with a lower one. Streptococcus spp., Staph. aureus, Klebsiella spp., cases with other treated or untreated organisms, and CM without growth were associated with higher hazard rates of sale. The Cox proportional hazards model's hazard rates were higher than those in the competing risks model in which death was the event of interest, and resembled those in the model in which sale was the event of interest. Four additional Cox models, omitting dead or sold cows, or censoring each, were also fitted; hazard ratios were similar to the above models. Proportional subdistribution hazards models were appropriate due to competing risks (death, sale); they produce less-biased estimates. A study limitation is that while proportional subdistribution hazards models were appropriate, they have the illogical feature of keeping subjects at risk for the event of interest even after experiencing the competing event. This is, however, necessary in estimating cumulative incidence functions. Another limitation concerns pathogen variability among study farms, implying that CM decisions are farm-specific. Misclassification of ‘dead’ vs. ‘sold’ cows was also possible. Nevertheless, the findings may help in optimizing management of cows contracting specific types of CM early in productive lifetime

Does clinical mastitis in the first 100 days of lactation 1 predict increased mastitis occurrence and shorter herd life in dairy cows?

The objectives of this study were to estimate the direct effects of clinical mastitis (CM) occurring in early productive life (defined as the first 100 d of the first lactation) of Holstein dairy cows on the future rate of CM occurrence and on the length of total productive lifetime. Information on CM cases and other data occurring in 55,144 lactations in 24,831 cows in 5 New York State Holstein herds was collected from January 2004 until February 2014. For the first objective, a generalized linear mixed model with a Poisson distribution was used to study the effects of CM cases occurring in the first 100 d of a cow's first lactation, as well as farm indicator and number of days in the cow's lifetime, on the future lifetime rate of CM. Only cows that had completed their productive life [i.e., all had been culled (or sold) or had died; n = 14,440 cows] were included in this analysis. For the second objective, a Cox proportional hazards model was used to study the effects of CM cases occurring in the first 100 d of a cow's first lactation on the length of total productive lifetime. The model was stratified by farm. All 24,831 cows were included in this analysis with right censoring. Cows experienced between 0 and 4 CM cases in the first 100 d of lactation 1. Over their lifetime, cows experienced between 0 and 25 CM cases. During the study period, 10% of all cows died and nearly half of all cows were culled. The average length of productive life, including censored observations, was 2.0 yr after first calving. Compared with cows having no CM cases in the first 100 d of lactation 1, cows with 1 CM case in that time period had a 1.5 times higher rate of total number of CM cases over their lifetime. Cows with 2 (or 3 or more) CM cases in the first 100 d of lactation 1 had a 1.7 times (or 2.6 times) higher rate of total number of CM cases over their lifetime. For each additional CM case occurring in the first 100 d of lactation 1, the hazard rate of culling increased by 34%. Given economic conditions for preferentially culling mastitic cows, the study findings may help farmers make optimal decisions with regard to culling of such cows

The value of pathogen information in treating clinical mastitis

The objective of this study was to determine the economic value of obtaining timely and more accurate clinical mastitis (CM) test results for optimal treatment of cows. Typically CM is first identified when the farmer observes recognisable outward signs. Further information of whether the pathogen causing CM is Gram-positive, Gram-negative or other (including no growth) can be determined by using on-farm culture methods. The most detailed level of information for mastitis diagnostics is obtainable by sending milk samples for culture to an external laboratory. Knowing the exact pathogen permits the treatment method to be specifically targeted to the causation pathogen, resulting in less discarded milk. The disadvantages are the additional waiting time to receive test results, which delays treating cows, and the cost of the culture test. Net returns per year (NR) for various levels of information were estimated using a dynamic programming model. The Value of Information (VOI) was then calculated as the difference in NR using a specific level of information as compared to more detailed information on the CM causative agent. The highest VOI was observed where the farmer assumed the pathogen causing CM was the one with the highest incidence in the herd and no pathogen specific CM information was obtained. The VOI of pathogen specific information, compared with non-optimal treatment of Staphylococcus aureus where recurrence and spread occurred due to lack of treatment efficacy, was $20.43 when the same incorrect treatment was applied to recurrent cases, and$30.52 when recurrent cases were assumed to be the next highest incidence pathogen and treated accordingly. This indicates that negative consequences associated with choosing the wrong CM treatment can make additional information cost-effective if pathogen identification is assessed at the generic information level and if the pathogen can spread to other cows if not treated appropriately

The value of pathogen information in treating clinical mastitis

The objective of this study was to determine the economic value of obtaining timely and more accurate clinical mastitis (CM) test results for optimal treatment of cows. Typically CM is first identified when the farmer observes recognisable outward signs. Further information of whether the pathogen causing CM is Gram-positive, Gram-negative or other (including no growth) can be determined by using on-farm culture methods. The most detailed level of information for mastitis diagnostics is obtainable by sending milk samples for culture to an external laboratory. Knowing the exact pathogen permits the treatment method to be specifically targeted to the causation pathogen, resulting in less discarded milk. The disadvantages are the additional waiting time to receive test results, which delays treating cows, and the cost of the culture test. Net returns per year (NR) for various levels of information were estimated using a dynamic programming model. The Value of Information (VOI) was then calculated as the difference in NR using a specific level of information as compared to more detailed information on the CM causative agent. The highest VOI was observed where the farmer assumed the pathogen causing CM was the one with the highest incidence in the herd and no pathogen specific CM information was obtained. The VOI of pathogen specific information, compared with non-optimal treatment of Staphylococcus aureus where recurrence and spread occurred due to lack of treatment efficacy, was $20.43 when the same incorrect treatment was applied to recurrent cases, and$30.52 when recurrent cases were assumed to be the next highest incidence pathogen and treated accordingly. This indicates that negative consequences associated with choosing the wrong CM treatment can make additional information cost-effective if pathogen identification is assessed at the generic information level and if the pathogen can spread to other cows if not treated appropriately.</p

Diagnosis and Management of Pemphigus: recommendations by an International Panel of Experts.

BACKGROUND Several European countries recently developed international diagnostic and management guidelines for pemphigus, which have been instrumental in the standardization of pemphigus management, OBJECTIVE: We now present results from a subsequent Delphi consensus to broaden the generalizability of recommendations. METHODS A preliminary survey, based on the European Dermatology Forum (EDF) and the European Academy of Dermatology and Venereology (EADV) guidelines, was sent to a panel of international experts to determine the level of consensus. The results were discussed at the International Bullous Diseases Consensus Group in March 2016 during the annual American Academy of Dermatology (AAD) conference. A second survey was sent following the meeting to more experts to achieve greater international consensus. RESULTS The 39 experts participated in the first round of the Delphi-survey while 54 from 21 countries completed the second round. The number of statements in the survey was reduced from 175 topics in Delphi I to 24 topics in Delphi II based on Delphi results and meeting discussion. LIMITATIONS Each recommendation represents the majority opinion and therefore may not reflect all possible treatment options available. CONCLUSIONS We present here the recommendations resulting from this Delphi process. This international consensus includes intravenous CD20 inhibitors as a first line therapy option for moderate to severe pemphigus