"Comprehensive Healthcare for America": Using the Insights of Behavioral Economics to Transform the U. S. Healthcare System.

"Comprehensive Healthcare for America" is a largely single-payer reform proposal that, by applying the insights of behavioral economics, may be able to rally patients and clinicians sufficiently to overcome the opposition of politicians and vested interests to providing all Americans with less complicated and less costly access to needed healthcare.

Effects of a farm-specific fecal microbial transplant (FMT) product on clinical outcomes and fecal microbiome composition in preweaned dairy calves.

Gastrointestinal disease (GI) is the most common illness in pre-weaned dairy calves. Therefore, effective strategies to manipulate the microbiome of dairy calves under commercial dairy operations are of great importance to improve animal health and reduce antimicrobial usage. The objective of this study was to develop a farm-specific FMT product and to investigate its effects on clinical outcomes and fecal microbial composition of dairy calves. The FMT product was derived from feces from healthy donors (5-24 days of age) raised in the same calf ranch facility as the FMT recipients. Healthy and diarrheic calves were randomly enrolled to a control (n = 115) or FMT (n = 112) treatment group (~36 g of processed fecal matter once daily for 3 days). Fecal samples were collected at enrollment and again 9 days later after the first FMT dose. Although the FMT product was rich in organisms typically known for their beneficial probiotic properties, the FMT therapy did not prevent or ameliorate GI disease in dairy calves. In fact, calves that received FMT were less likely to recover from GI disease, and more likely to die due to GI disease complications. Fecal microbial community analysis revealed an increase in the alpha-diversity in FMT calves; however, no major differences across treatment groups were observed in the beta-diversity analysis. Calves that received FMT had higher relative abundance of an uncultured organism of the genus Lactobacillus and Lactobacillus reuteri on day 10. Moreover, FMT calves had lower relative abundance of Clostridium nexile and Bacteroides vulgatus on day 10. Our results indicate the need to have an established protocol when developing FMT products, based on rigorous inclusion and exclusion criteria for the selection of FMT donors free of potential pathogens, no history of disease or antibiotic treatment.

Fecal microbiome profiles of neonatal dairy calves with varying severities of gastrointestinal disease.

Gastrointestinal disease (GI) is the most common illness in pre-weaned dairy calves. Studies have associated the fecal microbiome composition with health status, but it remains unclear how the microbiome changes across different levels of GI disease and breeds. Our objective was to associate the clinical symptoms of GI disease with the fecal microbiome. Fecal samples were collected from calves (n = 167) of different breeds (Holstein, Jersey, Jersey-cross and beef-cross) from 4-21 d of age. Daily clinical evaluations assessed health status. Calves with loose or watery feces were diagnosed with diarrhea and classified as bright-sick (BS) or depressed-sick (DS) according to behavior. Calves with normal or semiformed feces and no clinical illness were classified as healthy (H). One hundred and three fecal samples were obtained from consistently healthy calves and 64 samples were from calves with diarrhea (n = 39 BS; n = 25 DS). The V3-V4 region of 16S rRNA gene was sequenced and analyzed. Differences were identified by a linear-mixed effects model with a negative binomial error. DS and Jersey calves had a higher relative abundance of Streptococcus gallolyticus relative to H Holstein calves. In addition, DS calves had a lower relative abundance of Bifidobacterium longum and an enrichment of Escherichia coli. Species of the genus Lactobacillus, such as an unclassified Lactobacillus, Lactobacillus reuteri, and Lactobacillus salivarius were enriched in calves with GI disease. Moreover, we created a model to predict GI disease based on the fecal microbiome composition. The presence of Eggerthella lenta, Bifidobacterium longum, and Collinsella aerofaciens were associated with a healthy clinical outcome. Although lactobacilli are often associated with beneficial probiotic properties, the presence of E. coli and Lactobacillus species had the highest coefficients positively associated with GI disease prediction. Our results indicate that there are differences in the fecal microbiome of calves associated with GI disease severity and breed specificities.

Parenteral Antimicrobial Treatment Diminishes Fecal Bifidobacterium Quantity but Has No Impact on Health in Neonatal Dairy Calves: Data From a Field Trial.

There is evidence that neonatal calves are over treated with antimicrobials that may disrupt colonization of their gastrointestinal tract (GIT) microbiota. The study objectives were to assess the decision-making process of antimicrobial use on a commercial dairy and impacts of parenteral antibiotics on dairy calves' GIT Bifidobacterium and calf health. Unhealthy pre-weaned dairy calves were enrolled based on farm personnel identification with age-matched healthy calves. Half the calves in each group were treated with a 3-day course of IM ampicillin and half were given supportive therapy as needed. Health scores (appetite, fecal consistency, attitude, and temperature) were recorded twice daily throughout the study. Because of inconsistency in employee health decisions, the 121 enrolled calves were reassessed using objective clinical observations plus fecal dry matter and placed into 1 of 3 health categories: healthy, uncomplicated diarrhea (bright attitude and good appetite but with diarrhea), and sick. Accounting for treatment group allocation, this resulted in six post-enrollment health and treatment categories. Calves were followed daily for 14 days post-enrollment and fecal samples collected at 6 time points and Bifidobacterium was quantified from these samples using quantitative PCR. The objective criteria for disease definition reclassified many "unhealthy" calves as uncomplicated diarrhea. Including all calves, on average, the quantity of Bifidobacterium decreased from the day of enrollment (median 8 days of age) across time to 14 days post-enrollment. Calves given an antibiotic the day of enrollment had a greater decrease in Bifidobacterium 4 and 9 days later relative to enrollment Bifidobacterium compared to untreated calves. At enrollment, sick calves and those categorized as uncomplicated diarrhea were more likely to have low Bifidobacterium counts and less likely to be categorized as healthy following antimicrobial treatment. Our results indicate that relying on farm personnel to identify morbidity may lead to some clinical misclassification. There was no indication that antimicrobials affected subsequent health outcomes, but antimicrobials did impact Bifidobacterium dynamics. These results highlight the importance and difficulty in assigning appropriate illness classification on farms and point to a need to develop better point of care diagnostics that improve calf husbandry and stewardship of antimicrobials.

Dairy veterinarians' perceptions and experts' opinions regarding implementation of antimicrobial stewardship on dairy farms in the western United States.

OBJECTIVE: To explore veterinarians' perceptions and veterinary experts' opinions regarding antimicrobial stewardship (AMS) on dairy farms in the western United States. SAMPLE: 20 dairy veterinarians and 9 AMS experts. PROCEDURES: 3 focus group discussions involving 20 dairy veterinarians from California, Idaho, and Washington and an expert opinion study involving 9 North American AMS experts were conducted. During focus group discussions, participants were asked open-ended questions regarding implementation of AMS programs on dairy farms. Discussions were recorded and transcribed for thematic analysis. An asynchronous nominal group process was used for the expert opinion study. Participants were asked to complete a series of 3 online surveys consisting of open-ended questions. Expert opinion data underwent thematic analysis and were compared with results obtained from focus group discussions. RESULTS: Veterinarian-perceived barriers to implementation of AMS on dairy farms included variable relationships with clients and farm employees, ensuring AMS provided value to the farm, and uncertainty about regulations for monitoring on-farm antimicrobial use (AMU). Veterinarians were willing to accept additional responsibility for AMU provided that protocols were adopted to ensure them more complete control of on-farm AMU and they were compensated. The AMS experts indicated that effective implementation of AMS on dairy farms requires producer buy-in and tools to facilitate treatment protocol development and monitoring. CONCLUSIONS AND CLINICAL RELEVANCE: Additional veterinary oversight of AMU on dairy farms will require engagement by both veterinarians and producers and practical value-added methods for AMS. Continuing education programs should address treatment protocol development, AMU monitoring strategies, and employee training.

Prevalence of methicillin-resistant Staphylococcus pseudintermedius on hand-contact and animal-contact surfaces in companion animal community hospitals.

Methicillin-resistant Staphylococcus pseudintermedius (MRSP) is an important companion animal pathogen, but few published studies have evaluated its epidemiology in primary care settings. This study determined MRSP prevalence on hand- and animal-contact surfaces in 11 small animal primary care hospitals in Washington and Idaho, USA. Overall, MRSP was isolated from at least 1 sample from 7 of 11 hospitals (64%) and from 36 of 374 total samples (10%) with no difference in prevalence between hand- and animal-contact surfaces (P = 0.51). Strain typing by pulsed-field gel electrophoresis indicated high within-hospital similarity of MRSP strains, but minimal similarity between strains from different hospitals. Indistinguishable MRSP strains were present on handand animal-contact surfaces within individual hospitals. A questionnaire was administered to a representative from each hospital. Respondents reported that animal-contact surfaces were cleaned and disinfected more frequently than hand-contact surfaces (P < 0.001). Improving hand hygiene and disinfection of hand-contact surfaces may decrease exposure of veterinary patients to MSRP.

Prévalence de Staphylococcus pseudintermedius résistant à la méthicilline sur des surfaces en contact avec les mains et des surfaces en contact avec les animaux dans des hôpitaux de première ligne pour animaux de compagnie. Staphylococcus pseudintermedius résistant à la méthicilline (MRSP) est un agent pathogène important chez les animaux de compagnie, mais peu d'études publiées ont évalué son épidémiologie dans les sites de soins de première ligne. Dans la présente étude on détermina la prévalence de MRSP sur les surfaces de contact avec les mains et les surfaces de contact avec les animaux dans 11 hôpitaux de première ligne pour animaux de compagnie dans les états de Washington et de l'Idaho, USA. De manière globale, le MRSP fut isolé à partir d'au moins un échantillon dans 7 des 11 hôpitaux (64 %) et de 36 des 374 échantillons (10 %) sans noter de différence dans la prévalence entre les contacts main-surface ou animal-surface (P = 0,51). Le typage des souches par électrophorèse en champs pulsés indiqua une similarité intra-hôpital élevée des souches de MRSP, mais une similarité minimale entre les souches provenant d'hôpitaux différents. Des souches indistinguables de MRSP étaient présentes sur les surfaces de contact avec les mains et les animaux dans un même hôpital. Un questionnaire fut soumis à un représentant de chaque hôpital. Les répondants rapportèrent que les surfaces de contact avec l'animal étaient nettoyées et désinfectées plus fréquemment que les surfaces de contact avec les mains (P < 0,001). Une amélioration de l'hygiène des mains et de la désinfection des surfaces en contacts avec les mains pourraient diminuer l'exposition de patients vétérinaires au MSRP.(Traduit par Dr Serge Messier).

Assessment of veterinarians' engagement with backyard poultry and small-scale livestock operations in four western states.

OBJECTIVE: To assess veterinarian engagement with owners of poultry and livestock in urban and peri-urban areas (UPAs) of 4 western states, to evaluate the knowledge and experience of veterinarians in UPAs for treating domestic poultry and livestock, and to identify barriers to the provision of veterinary services to backyard poultry and small-scale livestock operations. SAMPLE: 880 veterinarians in UPAs. PROCEDURES: 2,400 members of the veterinary medical associations of California, Colorado, Oregon, and Washington who worked in metropolitan areas with a population > 5,000 people were randomly selected and invited to participate in a needs assessment survey. Response data were analyzed with univariable logistic regression and multiple correspondence analysis. RESULTS: 880 (37%) invitees completed or partially completed the survey. Most respondents self-reported working in UPAs (686/825 [83%]) and companion animal only (n = 551) or predominant (211) practices. Although most (656/863 [76%]) respondents perceived an increase in backyard poultry and livestock in their practice areas, few were actively treating such animals primarily because of a lack of facilities, interest, or experience. Most respondents believed veterinarians have an important role in ensuring public health and preventing zoonotic disease. CONCLUSIONS AND CLINICAL RELEVANCE: Backyard poultry and livestock are increasing in popularity in UPAs of 4 western states, and veterinarians are needed to provide services to such animals. Further research and continuing education are necessary to encourage practitioners in UPAs to engage with owners of backyard poultry and livestock to ensure the health and welfare of those animals and guard public health. (J Am Vet Med Assoc 2020;257:196-209).

Novel single-use duodenoscope compared with 3 models of reusable duodenoscopes for ERCP: a randomized bench-model comparison.

BACKGROUND AND AIMS: Multidrug-resistant infectious outbreaks associated with duodenoscope reuse have been documented internationally. A single-use endoscope could eliminate exogenous patient-to-patient infection associated with ERCP. METHODS: We conducted a comparative bench simulation study of a new single-use and 3 models of reusable duodenoscopes on a synthetic anatomic bench model. Four ERCP tasks were performed: guidewire locking (single-use and 1 reusable duodenoscope only), plastic stent placement and removal, metal stent placement and removal, and basket sweeping. The study schedule included block randomization by 4 duodenoscopes, 4 tasks, and 2 anatomic model ERCP stations. Ability to complete tasks, task completion times, and subjective ratings of overall performance, navigation/pushability, tip control, and image quality on a scale of 1 (worst) to 10 (best) were compared among duodenoscopes. RESULTS: All 4 ERCP tasks (total 14 subtasks) were completed by 6 expert endoscopists using all 4 duodenoscopes, with similar task completion times (median, 1.5-8.0 minutes per task) and overall performance ratings by task (median, 8.0-10.0). Navigation/pushability ratings were lower for the single-use duodenoscope than for the 3 reusable duodenoscopes (median, 8.0, 10.0, 9.0, and 9.0, respectively; P < .01). Tip control ratings were similar among all the duodenoscopes (median, 9.0-10.0; P = .77). Image quality ratings were lower for 1 reusable duodenoscope compared with the single-use and other 2 reusable duodenoscopes (median, 8.0, 9.0, 9.0, and 9.0, respectively; P < .01). CONCLUSIONS: A new single-use duodenoscope was used to simulate 4 ERCP tasks in an anatomic model, with performance ratings and completion times comparable with 3 models of reusable duodenoscopes.

Small-scale and backyard livestock owners needs assessment in the western United States.

The number of small-scale and backyard livestock and poultry owners in urban and peri-urban areas has increased greatly over the last 10 years in the U.S. However, these animal owners may live in areas without access to livestock and/or poultry veterinary care. The purpose of this study was to identify potential veterinary service needs of these animal owners in the western US, assess their use of management and husbandry practices with regards to disease prevention, and assess their attitudes about animal health and food safety. A semi-structured survey was made available to small-scale and backyard livestock and poultry owners in Washington State, California, Colorado and Oregon. The survey instrument included questions about types of animals reared, uses of the animals, veterinary services and information-seeking behaviors of owners, attitudes on animal health and food safety, and management practices. Four hundred thirty-five individuals completed at least some portion of the survey. Most described themselves as living in rural areas (76%). Most (86%) owned chickens, 53% owned small ruminants, and 31% owned cattle. Many individuals owned more than one species and most had fewer than 20 animals of a given species. About 74% of respondents utilized their animals' products for their own consumption but 48% sold animal products (primarily through internet sales (35%) or farmers' markets (25%)). Overwhelmingly, respondents gained information about animal health (82%) and animal treatment procedures (71%) from the internet. Respondents reported their veterinarian's practice type as companion animal (26%) or a mixed animal or food animal predominant (66%). Overall, respondents were very satisfied with the level of care (82%), but 43% had not sought animal health care in last 12 months. However, the veterinarian's primary practice type and owner's satisfaction with veterinary care were associated with their location (state), species owned, and urban or peri-urban setting. Livestock species type (cattle, small ruminants and swine), and use (personal or commercial) were associated with implementation of different biosecurity practices. The results of this survey highlight some of the needs of these animal owners for veterinary care and information which are location- and species-specific. Veterinary care for these small-scale and backyard animals is vital to the health and welfare of the animals as well as for identification of zoonoses and assurance of the food safety of animal products.

Rapid Communication: Genome-wide association analyses identify loci associated with colostrum production in Jersey cattle1.

Consumption of an adequate volume of high-quality colostrum soon after birth is critical for a calf's health. Few studies have focused on the genetics associated with colostrum production, even though several dairy herds in the United States have reported incidents of low to no colostrum production during the fall and winter seasons. The objectives of this study were to identify loci associated with quantity and quality of colostrum production in a herd of Jersey cattle (n = 345) and to identify potential positional candidate genes and/or transcription factor binding site motifs located near associated loci. Cattle that freshened between the months of October and December of 2016 at a single dairy were enrolled in the study and produced on average 3.03 kg of colostrum at their first milking. This study included 112 cattle genotyped with the GeneSeek GGP50k BeadChip and another 233 cattle previously genotyped with various other arrays. The 233 cattle genotyped at lower densities were imputed to the GGP50k BeadChip density using BEAGLE 4.1.1, and 2 genome-wide association analyses (GWAA) were conducted using an additive efficient mixed-model association expedited method with a genomic relationship matrix (EMMAX-GRM). The first GWAA investigated loci associated with colostrum quantity and identified 7 loci: 6 that were moderately associated (5 × 10-07 > P < 1 × 10-05) and 1 that was strongly associated (P < 5 × 10-07). The second GWAA investigated colostrum quality and identified 1 moderately (5 × 10-07 > P < 1 × 10-05) associated locus. Five loci harbored positional candidate genes which had functional relevance to colostrum production, and 1 locus located on BTA10 contained a transcription factor binding site motif for TFAP2A which has previously been linked to mammary gland development. Pseudoheritability estimates were moderate for colostrum quality (0.19 ± 0.06) and high for colostrum quantity (0.76 ± 0.11), suggesting that genomic selection for these traits would be possible. Diminished colostrum quantity or quality can have a significant impact on herd health and herd economics. The identification of loci, positional candidate genes, and transcription factor binding site motifs associated with colostrum production could be used in genomic selection to allow producers to select for cattle with good colostrum production, improving calf health, and reducing economic losses to the herd.

Characterization of the Temporal Trends in the Rate of Cattle Carcass Condemnations in the US and Dynamic Modeling of the Condemnation Reasons in California With a Seasonal Component.

Based on the 2016 National Cattlemen's Beef Association statistics, the cattle inventory in the US reached 93.5 million head, from which 30.5 million were commercial slaughter in 2016. California ranked fourth among all the US states that raise cattle and calves, with 5.15 million head and approximately 1.18 million slaughtered animals per year. Approximately 0.5% of cattle carcasses in the US are condemned each year, which has an important economic impact on cattle producers.In this study, we first described and compared the temporal trends of cattle carcass condemnations in all the US states from Jan-2005 to Dec-2014. Then, we focused on the condemnation reasons with a seasonal component in California and used dynamic harmonic regression (DHR) models both to model (from Jan-2005 to Dec-2011) and predict (from Jan-2012 to Dec-2014) the carcass condemnations rate in different time horizons (3 to 12 months).Data consisted of daily reports of 35 condemnation reasons per cattle type reported in 684 federally inspected slaughterhouses in the US from Jan-2005 to Dec-2014 and the monthly slaughtered animals per cattle type per states. Almost 1.5 million carcasses were condemned in the US during the 10 year study period (Jan 2005-Dec 2014), and around 40% were associated with three condemnation reasons: malignant lymphoma, septicemia and pneumonia. In California, emaciation, eosinophilic myositis and malignant lymphoma were the only condemnation reasons presenting seasonality and, therefore, the only ones selected to be modeled using DHRs. The DHR models for Jan-2005 to Dec-2011 were able to correctly model the dynamics of the emaciation, malignant lymphoma and eosinophilic myositis condemnation rates with coefficient of determination ( Rt2 ) of 0.98, 0.87 and 0.78, respectively. The DHR models for Jan-2012 to Dec-2014 were able to predict the rate of condemned carcasses 3 month ahead of time with mean relative prediction error of 33, 11, and 38%, respectively. The systematic analysis of carcass condemnations and slaughter data in a more real-time fashion could be used to identify changes in carcass condemnation trends and more timely support the implementation of prevention and mitigation strategies that reduce the number of carcass condemnations in the US.

Improving Dairy Organizational Communication from the Veterinarian's Perspective: Results of a Continuing Veterinary Medical Education Pilot Program.

The increasing size and complexity of US dairy farms could make it more difficult for a veterinary practitioner to effectively communicate protocol recommendations for prevention or treatment on the farm. A continuing education workshop was set up based on the results of research on dairy organizational communication on dairy farms, which resulted in a tool to assess dairy communication structure and flow. The workshop specifically focused on communication structure and whom to talk to when implementing health care changes in calf rearing. In addition, modern methods of veterinary-client communication knowledge and skills were provided. Primary outcomes of the workshops were to obtain feedback from participants about research findings and the communication model, to improve awareness about the complexity of communication structures on dairy farms, and to change participants' knowledge and skills associated with on-farm communication by providing communication theory and skills and an approach to evaluate and improve dairy organizational communication. Of the 37 participants completing the pre-program assessment, most recognized a need for themselves or their practice to improve communication with clients and farm employees. After the program, most participants were confident in their new communication skills and would consider using them. They highlighted specific new ideas they could apply in practice, such as conducting a "communication audit." The results from the assessment of this communication workshop, focused on dairy veterinarians, highlighted the need for communication training in this sector of the profession and practitioners' desire to engage in this type of training.

Recent Emergence of Escherichia coli with Cephalosporin Resistance Conferred by blaCTX-M on Washington State Dairy Farms.

Enterobacteriaceae-associated blaCTX-M genes have become globally widespread within the past 30 years. Among isolates from Washington State cattle, Escherichia coli strains carrying blaCTX-M (CTX-M E. coli strains) were absent from a set of 2008 isolates but present in a set of isolates from 2011. On 30 Washington State dairy farms sampled in 2012, CTX-M E. coli prevalence was significantly higher on eastern than on northwestern Washington farms, on farms with more than 3,000 adult cows, and on farms that recently received new animals. The addition of fresh bedding to calf hutches at least weekly and use of residual fly sprays were associated with lower prevalence of CTX-M E. coli. In Washington State, the occurrence of human pathogens carrying blaCTX-M genes preceded the emergence of blaCTX-M-associated E. coli in cattle, indicating that these resistance determinants and/or their bacterial hosts may have emerged in human populations prior to their dissemination to cattle populations.

Associations among serum pro- and anti-inflammatory cytokines, metabolic mediators, body condition, and uterine disease in postpartum dairy cows.

BACKGROUND: Adipose tissue is an active endocrine organ which secretes a wide range of hormones and protein factors, collectively termed adipokines. Adipokines affect appetite and satiety, glucose and lipid metabolism, inflammation and immune functions. The objectives were to evaluate serum concentrations of adipokines (adiponectin, leptin, tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta and IL-6) in lactating dairy cows with postpartum uterine inflammatory conditions (metritis, clinical endometritis or subclinical endometritis) and in cows experiencing loss of body condition, and to assess the relationship of adipokines and body condition loss in the establishment of persistent uterine inflammatory conditions. METHODS: Lactating multiparous Holstein cows (N = 40), with body condition scores (BCS) from 2 to 4 (eight cows for each 0.5 score increment) were enrolled. Body condition was monitored for all cows weekly for 7 weeks post calving; cows with uterine inflammatory conditions were also re-evaluated 2 weeks later. Blood samples were collected from 1 week prior to calving to 7 weeks after calving for determination of serum concentrations of adipokines, insulin and insulin like growth factor (IGF)-1. RESULTS: Cows with metritis or clinical endometritis had higher serum concentrations of adiponectin, leptin, TNF-alpha, IL-1beta and IL-6 compared to normal cows (P < 0.05). Furthermore, serum leptin, TNF-alpha, IL-1beta and IL-6 were higher in cows with subclinical endometritis compared to normal cows (P < 0.05), and insulin and IGF-1 concentrations were lower in cows with metritis or clinical endometritis. Cows with low BCS (2 and 2.5) had significantly higher adiponectin, TNF-alpha, IL-1beta and IL-6 than those with high BCS (3 to 4). Cows with persistent uterine inflammatory conditions had higher adiponectin, leptin TNF-alpha, IL-1beta and IL-6 and insulin compared to normal and spontaneously recovered cows, except for IGF-1 (P < 0.05). CONCLUSIONS: Serum concentrations of adipokines, insulin, and IGF-1 had significant associations with BCS categories (low vs. high) and postpartum uterine inflammatory conditions. Perhaps loss of body condition mediated increases in anti- and pro-inflammatory cytokines, whereas increased pro- and anti-inflammatory cytokines concentrations mediated body condition loss and thereby prolonged persistence of uterine inflammation in dairy cows.

Pet poultry training for veterinary practitioners.

Keeping backyard poultry in urban areas is a burgeoning trend in the United States. As such, we believe urban pet poultry owners are increasingly likely to seek veterinary services from urban companion-animal practitioners. Traditionally, poultry species have been classified as production animals. Most small-animal practitioners have limited experience or knowledge of these species and hesitate to accept these animals at their practices. We developed a one-day course to train veterinarians in pet poultry (as opposed to commercial poultry) medicine. The course covers poultry examination, diseases, and treatments and provides an introduction to poultry breeds and behavior and the basics of nutrition and husbandry. We believe this type of continuing education program is important for veterinarians because they are often on the front line of human public health issues. In addition, courses of this type increase the number of veterinarians trained to spot serious avian diseases, including foreign diseases and diseases with zoonotic potential. Most important, veterinarians with this training develop the knowledge to contribute to the health and well-being of pet poultry along with their clients' other companion animals.

Outbreak of malignant catarrhal fever among cattle associated with a state livestock exhibition.

CASE DESCRIPTION: Severe disease and death were identified in cattle exhibited at a state fair that were naturally infected with ovine herpesvirus type 2 (OvHV-2). CLINICAL FINDINGS: Most affected cattle had anorexia, signs of depression, diarrhea, fever, and respiratory distress ultimately leading to death. Mean duration of clinical signs prior to death was 6 days (range, 1 to 26 days). Mean number of days between apparent exposure and death was 71 days (range, 46 to 139 days). TREATMENT AND OUTCOMES: 19 of 132 cattle cohoused in 1 barn died of malignant catarrhal fever (MCF). The diagnosis of sheep-associated MCF was confirmed on the basis of results of an OvHV-2-specific PCR assay performed on tissue samples obtained from affected cattle. The disease was associated but not significantly with distance from the center of the barn and was not associated with distance from the center of the sheep pens. CLINICAL RELEVANCE: Outbreaks of MCF in cattle are unusual, particularly in association with livestock exhibitions. Because the clinical signs may be similar to those of some transboundary diseases, cases of MCF should be reported and investigated. Findings for this outbreak provided evidence to suggest that fair boards and veterinarians should reexamine biosecurity recommendations for livestock exhibitions.

Comparison of published recommendations regarding biosecurity practices for various production animal species and classes.

OBJECTIVE: To compare published recommendations regarding biosecurity practices for various production animal species and classes. DESIGN: Literature review. POPULATION: Educational materials available on the World Wide Web that provided biosecurity recommendations for dairy cattle, beef cattle, small ruminant, swine, and poultry producers. PROCEDURES: Web sites for national producer organizations, university cooperative extension services, and state departments of agriculture were searched to identify educational materials with biosecurity recommendations. RESULTS: A single national organization was selected as representing each animal agriculture commodity group. A total of 53 university Web sites were visited, and 65 publications prepared by university cooperative extension services were identified and evaluated. Web sites for all 50 state departments of agriculture were searched, and 29 were found to have at least 1 publication related to biosecurity practices, for a total of 46 publications. Evaluation of the biosecurity recommendations revealed wide variations by source and within and among commodity groups. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that educational materials for producers contained wide variations in recommended biosecurity practices. It is possible that some producers choose not to implement biosecurity recommendations because of confusion as to the specific recommendations they should follow.

Effects of a veterinary student leadership program on measures of stress and academic performance.

Assuming leadership roles in veterinary student governance or club activities could be considered an added stressor for students because of the impact on time available for personal and academic activities. The study reported here evaluated the effects of participation in a leadership program and leadership activity across two classes of veterinary students on measures of stress, using the Derogatis Stress Profile (DSP), and on veterinary school academic performance, measured as annual grade-point average (GPA) over a three-year period. Program participants and their classmates completed the DSP three times across the first three years of veterinary school. On average, participating students reported self-declared stress levels that were higher and measured DSP stress levels that were lower than those of the general population. Students were more likely to assume elected or appointed leadership roles while in their first three years of the veterinary degree program if they participated in the optional leadership program and demonstrated lower stress in several dimensions. Some increased stress, as measured in some of the DSP stress dimensions, had a small but statistically significant influence on professional school GPA. The study determined that the most important predictors of students' cumulative GPA across the three-year period were the GPA from the last 45 credits of pre-veterinary coursework and their quantitative GRE scores. The results of the study indicate that neither participation in the leadership program nor taking on leadership roles within veterinary school appeared to influence veterinary school academic performance or to increase stress.