The clinic-in-a-clinic design moves disease management from individual practice into a property of the health systems and places importance on the collaboration of patient, provider and delivery system in reducing the consequences of chronic illness. Use of the 'plan, do, study, act' cycle model offers a method for changing the process of care delivery in a structured, sequential approach.

While Johne's disease (JD) is less common in beef than in dairy herds, consolidation is increasing transmission risk. Estimates of Mycobacterium avium spp. paratuberculosis (MAP) prevalence and test performance in cow-calf herds are needed to inform control programs. Objectives of this study included describing the prevalence of MAP in Canadian cow-calf herds and comparing the relative performance of a serum ELISA, pooled fecal PCR and individual fecal PCR using Bayesian latent class models, and to investigate factors associated with positive MAP tests. Blood and fecal samples (n = 3,171) were collected from 159 Canadian cow-calf herds. All samples were analyzed using serum ELISA and fecal PCR (pools of five samples) and a subset of 913 fecal samples were also tested with individual PCR. Based on latent class analysis, MAP prevalence was higher in eastern compared to western Canada for both animals {East, 3% [95% Credible Interval (CrI) 1–7%]; West, 1% [95% CrI 0.2–2%]} and herds [East, 15% (95% CrI 2–35%); West, 10% (95% CrI 1–26%), based on one or more positive results]. Sensitivity (Se) and specificity (Sp) for animal level individual PCR were 96% (95% CrI 80–100%) and 98% (95% CrI 96–100%), respectively followed by pooled PCR [Se = 54% (95% CrI 36–72%), Sp > 99.9% (95% CrI 99.8–100%)] and ELISA [Se = 36% (95% CrI 22–52%), Sp = 98% (95% CrI 96–99%)]. Based on 20 samples per herd, the herd level Se of ELISA was 79% (95% CrI 47–100%) (at least one positive sample) compared to 43% (95% CrI 14–94%) for pooled PCR. Herd-level Sp was 99% (95% CrI 96–100%) for pooled PCR and 90% (95% CrI 83–100%) for ELISA. Cows from herds with dairy cattle on farm and cows with symptoms of JD in the past 3 years were more likely to be MAP positive. Herds that had animals with JD symptoms in the previous 3 years and those with more breeding females were most likely to test positive for MAP. While serum ELISA can be effective for herd screening, PCR performed better for animal testing. Pooled PCR testing could be a less costly option; however, determining the most cost-effective approach will require further economic analysis.

This 28-day study in rats evaluated the safety of melatonin delivered continuously subcutaneously by an ALZET Osmotic Pump. ALZET Osmotic Pumps 2ML4 continuously delivered 60 μ1/day of vehicle (polyethylene glycol 400), 0.03%, 0.3%, or 3% melatonin subcutaneously for 28 days to Sprague-Dawley rats (19/sex/group). The dose of melatonin delivered based on weekly group mean body weights (n = 10) was approximately 0.050,0.50, and 4.8 mg/kg day for the male groups and 0.074, 0.75, and 7.3 mg/kg day for the female groups. An additional group (19/sex) underwent surgery, but no osmotic pumps were implanted (sham control). No deaths or changes in clinical observations occurred that were attributed to melatonin. No drug effect occurred in body weights, hematology, clinical chemistry, urinalyses, or gross pathology. A dose-related trend of increasing serum melatonin concentrations occurred in males and females. In males, there was a trend toward decreasing serum prolactin concentrations with time at all levels of melatonin treatment. No difference in serum follicle-stimulating hormone (FSH) concentrations occurred between treated groups. Most of the samples were at the limit of detection for the serum luteinizing hormone (LH) assay (0.157 ng/ml). A dose-related increase occurred in urine 6-sulphatoxymelatonin (the primary metabolite) concentrations in melatonin-treated male and female groups. No treatment-related organ weight or histopathology changes were present in rats infused with 0.03% or 0.3% melatonin. Two of 10 males administered 3.0% melatonin had decreased testes weights and testicular degenerative changes composed of reduced or absent spermatogenesis, spermatidic giant cells, and edema. The cause of the observed testicular degenerative changes in the high-dose group and possible reversibility should be investigated in follow-up studies of longer duration.

Johne's disease is an insidious infectious disease of ruminants caused by Mycobacterium avium subspecies paratuberculosis (MAP). Johne's disease can have important implications for animal welfare and risks causing economic losses in affected herds due to reduced productivity, premature culling and replacement, and veterinary costs. Despite the limited accuracy of diagnostic tools, testing and culling is the primary option for controlling Johne's disease in beef herds. However, evidence to inform specific test and cull strategies is lacking. In this study, a stochastic, continuous-time agent-based model was developed to investigate Johne's disease and potential control options in a typical western Canadian cow-calf herd. The objective of this study was to compare different testing and culling scenarios that included varying the testing method and frequency as well as the number and risk profile of animals targeted for testing using the model. The relative effectiveness of each testing scenario was determined by the simulated prevalence of cattle shedding MAP after a 10-year testing period. A second objective was to compare the direct testing costs of each scenario to identify least-cost options that are the most effective at reducing within-herd disease prevalence. Whole herd testing with individual PCR at frequencies of 6 or 12 months were the most effective options for reducing disease prevalence. Scenarios that were also effective at reducing prevalence but with the lowest total testing costs included testing the whole herd with individual PCR every 24 months and testing the whole herd with pooled PCR every 12 months. The most effective method with the lowest annual testing cost per unit of prevalence reduction was individual PCR on the whole herd every 24 months. Individual PCR testing only cows that had not already been tested 4 times also ranked well when considering both final estimated prevalence at 10 years and cost per unit of gain. A more in-depth economic analysis is needed to compare the cost of testing to the cost of disease, taking into account costs of culling, replacements and impacts on calf crops, and to determine if testing is an economically attractive option for commercial cow-calf operations.