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Transgender and gender diverse people often experience voice-gender incongruence, which is inversely correlated with health and quality of life. Such incongruence could be reduced with voice and communication training, but expert-administered training is often inaccessible while self-guided training is difficult and potentially risky. Training could alternatively be provided through software (eg, smartphone apps), but such software is at an early stage. This qualitatively driven mixed-methods study thus includes surveys and interviews with 21 transfeminine, transmasculine and nonbinary people to identify general views of voice and communication training software as well as most desirable features of such software. Participants were positive about the general idea and described ways to effectively implement four critical features: feedback, accountability, automated goal setting, and training characteristics other than pitch. They also discussed optional or undesirable features. These findings may inform development of voice and communication training software, thus improving health and quality of life for gender minorities., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: Individuals with aphasia commonly experience reading and writing difficulties, negatively impacting everyday communication and life participation. Using mixed methods, this study aimed to understand literacy experiences described by individuals with aphasia and explore how their perspectives are related to test performance and other demographic factors., Method: Twenty-one stroke survivors with aphasia completed reading and writing testing and shared their perspectives through a close-ended survey and an open-ended interview about literacy abilities and experiences. Quantitative methods were used to compare pre- and poststroke self-ratings and explore associations between self-ratings and demographic factors. Qualitative methods were used to identify themes in the interviews. The data sets were merged to derive mixed-methods results for a more in-depth view of participants' perspectives., Results: Significant decreases in perceived literacy abilities were found; however, there were no differences in literacy importance or enjoyment pre- to poststroke. Reading and writing test scores were correlated with self-rated abilities but not with importance, enjoyment, or frequency of reading and writing. The thematic analysis process identified four main themes: Feelings about literacy , Literacy challenges , Literacy supports , and Literacy goals ., Conclusions: The data indicate that individuals with aphasia highly value reading and writing and are heavily invested, despite recognized challenges, in using and improving these skills. Therefore, assessments and treatments addressing literacy in aphasia are critical, and individuals with aphasia should be invited to share their literacy experiences and goals, allowing for more person-centered clinical resources to be collaboratively constructed., Supplemental Material: https://doi.org/10.23641/asha.25893049.

Hands-on laboratory experience that allows for manipulation of realistic and relevant materials in course curricula has been shown to improve students' learning, understanding, and critical thinking skills. The purpose of this study was to gain insight into the experiences of students who engaged in laboratory coursework using a virtual dissection (VD) table as part of an undergraduate course in anatomy and physiology of speech and hearing. Undergraduate students enrolled in an anatomy and physiology of speech and hearing course at a single university for the fall 2021 semester consented to participate. Nine students, divided into two focus groups, were encouraged to describe their experiences and perspectives about the VD table and corresponding laboratory assignments. Following verbatim transcription of the data, the authors conducted a thematic analysis. Five themes emerged from the body of data: (1) using the VD table , (2) completing the VD lab assignments , (3) preparation for laboratory sessions , (4) suggested modifications , and (5) enriched learning. Students believed using the VD table aided in a better understanding of course material than traditional methods. Moreover, they surmised that this method of learning, particularly for speech-language pathologists, may be superior to learning through models and cadavers., Competing Interests: None declared., (Thieme. All rights reserved.)

Epstein-Barr virus (EBV) reactivation is commonly observed in lung transplant recipients (LTRs). However, cellular immune responses to EBV in adult LTRs have not been well described. We aimed to study CD4/CD8 ratio, EBV-specific T cells polyfunctional responses and phenotypic changes in natural killer (NK) cells in adult LTRs presenting with EBV-associated diseases. The CD4/CD8 ratio was significantly decreased in LTRs with EBV DNAemia compared with LTRs without EBV DNAemia and healthy controls (HCs). Stimulation with EBV lytic antigen BZLF1 peptide pools induced significant individual and polyfunctional responses from CD8 + CD69 + T cells. Frequencies of CD8 + CD69 + T cells expressing CD107a were significantly higher in LTRs without EBV DNAemia than in LTRs with DNAemia. Frequencies of CD8 + CD69 + T cells concurrently expressing CD107a, IFN-γ, and TNF-α were significantly greater in LTRs with and without EBV DNAemia than in HCs. Finally, BZLF1 induced significantly higher frequencies of CD8 + CD69 + T cells expressing CD107a and IFN-γ in LTRs without EBV DNAemia when compared with EBNA3B. Frequency of more differentiated CD56 dim CD16 pos NK cells was significantly decreased in LTRs with EBV DNAemia and PTLD compared with HCs. In conclusion, we noted the presence of significant changes in circulating cellular immune responses to EBV in adult LTRs., (© 2023 Wiley Periodicals LLC.)

Epstein-Barr virus (EBV)-driven posttransplant lymphoproliferative disorder (PTLD) is a serious complication following lung transplant. The extent to which the presence of EBV in PTLD tissue is associated with survival is uncertain. Moreover, whether the heterogeneity in expression of EBV latency programs is related to the timing of PTLD onset remains unexplored. We retrospectively performed a comprehensive histological evaluation of EBV markers at the tissue level in 34 adult lung transplant recipients with early- and late-onset PTLD. Early-onset PTLD, occurring within the first 12 months posttransplant, had higher odds to express EBV markers. The presence of EBV in PTLD was not associated with a difference in survival relative to EBV-negative tumors. However, we found evidence of heterogeneous expression of EBV latency programs, including type III, IIb, IIa, and 0/I. Our study suggests that the heterogeneous expression of EBV latency programs may represent a mechanism for immune evasion in patients with PLTD after lung transplants. The recognition of multiple EBV latency programs can be used in personalized medicine in patients who are nonresponsive to traditional types of chemotherapy and can be potentially evaluated in other types of solid organ transplants., (© 2021 Wiley Periodicals LLC.)

Background: People living with Parkinson disease (PD) have multiple health care needs that intensify over time, because the disease is both chronic and degenerative. Past research indicates that issues with mobility, financial constraints, and lack of support networks impede access to health care for people with PD. These challenges are elevated for individuals who live in rural communities due to the lack of local health care professionals and specialists and support resources, and the need to travel to see providers/specialists. The research objective was to have PD community stakeholders identify health care barriers and resources as well as possibilities for improved health care in a rural state., Methods: Focus groups were conducted in the context of a community-based participatory research (CBPR) approach. Focus group data collection helped create comfort and parity in the discussion, while a CBPR approach allows for authenticity of the findings because members of the community in question are involved as researchers. The responses were recorded and transcribed verbatim. Coding and organizing of themes was completed manually and using NVIVO 10 software., Results: Qualitative analysis revealed three main themes, PD issues, access issues, and stigma. These themes described disease-related stigma and concerns about disease progression and treatment, as well as challenges in accessing information, providers, and support by the PD stakeholders. The study results provided insight into the needs of people living with PD in rural communities., Conclusions: Rural PD stakeholders proposed the use of technology (e.g., telehealth) to provide support to improve health care for people with PD.

Purpose This exploratory study examined speech-language pathologists' (SLPs) clinical experience and work environment characteristics impacting comfort with providing intervention to children with traumatic brain injury (TBI). Method This study included 162 SLPs who responded to a national survey about their comfort providing intervention to children with TBI, clinical experience (i.e., years of experience treating children with TBI, TBI preprofessional training and professional development, and licensure/credentialing), and work environment (i.e., work setting, caseload size, geographic location). Results Findings from latent class analysis revealed 3 distinct groups of SLPs based on their comfort with providing services to children with TBI: those with low comfort, moderate comfort, and high comfort. Further analyses revealed statistically significant differences across the 3 groups in the areas of years of experience treating children with TBI, professional development, work setting, TBI caseload size, and geographic location. Conclusions Our findings reveal that most SLPs feel comfortable providing intervention to children with TBI; however, differences in characteristics across groups suggest that specific steps can be taken to ensure increased comfort for all SLPs working with this population. Practicing SLPs may increase their level of comfort through professional development and hands-on, mentored experience with TBI. Efforts such as these may influence the quality of service provision and expand the population of SLPs who feel comfortable treating children with TBI. Future research is needed to further examine how comfort and SLP characteristics directly impact the quality of speech and language intervention and long-term outcomes of children with TBI.

Objective: The researchers explored the return-to-work experiences of five adults with severe traumatic brain injuries (TBIs) and those associated with them by performing a qualitative, multiple case study investigation involving in-depth, semi-structured interviews. Selection of this qualitative methodology allowed for personal, individualized accounts of adults with TBI returning to work. Specifically, this methodology promoted accurate representation of the idiosyncratic nature of each participant's experiences., Methods: The researchers asked individuals to participate based on the diversity of their vocational experiences following TBI., Results: Four of the five participants had returned to their pre-injury jobs. Two were subsequently fired and, at the time of research participation, were unemployed. One participant never returned to paid employment; however, he had held two volunteer positions for several years post-injury. Salient content from interview transcripts allowed for the identification of five to eight themes pertinent to each case., Conclusions: Interpretation of the themes led to three main conjectures about return-to-work experiences following TBI: (a) job satisfaction may relate more to involvement in productive activities than monetary compensation; (b) adults with TBI can be successful in holding and maintaining positions with high cognitive demands; and, ((c) individualized job modifications and strategies are likely necessary for adults with TBI to succeed vocationally.)

Background: A large multistate outbreak of equine herpesvirus myeloencephalopathy (EHM) occurred in May 2011 among horses that participated in a competitive event., Objective: To identify EHM risk factors among horses with a common exposure venue., Animals: A total of 123 horses: 19 horses with EHM, 14 equine herpesvirus-1 cases with no reported neurologic signs, and 90 control horses., Methods: EHM case survey data were compared with data from EHV-1 cases with no neurologic signs and healthy controls using univariable and multivariable methods., Results: Significant factors associated with higher risk for EHM compared with EHV-1 cases with no neurologic signs were (1) greater number of biosecurity risks at the event, (2) female sex, (3) increasing number of classes competed in at the event, and (4) an interaction between sex and number of classes competed in. In the EHM versus controls comparison, in addition to sex and biosecurity risks, factors associated with higher EHM risk included EHV-1 vaccination in the 5 weeks before the event and increasing number of events attended in April 2011; zinc dietary supplementation was associated with decreased risk. An interaction between sex and the number of events attended in April 2011 also was significant., Conclusions and Clinical Importance: Findings from this study suggest that dietary zinc supplementation may be associated with decreased risk of EHM. Several factors were associated with increased risk of EHM. Additional investigations of factors associated with risk of EHM are warranted to evaluate the importance of these factors in this complex disease of horses., (Copyright © 2013 by the American College of Veterinary Internal Medicine.)

Concern about Salmonella contamination of food is compounded by fear that antimicrobials traditionally used to combat the infection will become useless due to rising antibiotic resistance. Livestock, in particular swine, often are blamed for illnesses caused by Salmonella and for increasing antibiotic resistance due to use of antibiotics in pigs. As part of the National Animal Health Monitoring System Swine 2000 and 2006 studies, swine fecal samples were cultured for Salmonella. These samples were collected from 123 operations in 17 states in 2000 and from 135 operations in 17 states in 2006. At each operation, 50 and 60 fecal samples were collected from late finisher pig pens in 2000 and 2006, respectively. Salmonella isolates were characterized to determine serogroup and serotype and were tested for susceptibility to a panel of 17 and 15 antimicrobial drugs in 2000 and 2006, respectively. A total of 5,470 and 7,788 samples were cultured for Salmonella in 2000 and 2006, respectively. Overall, 6.2% of the samples and 34.2% of the farms were positive for Salmonella in 2000. In 2006, 7.2% of the samples and 52.6% of the farms were positive. Salmonella Derby, Salmonella Typhimurium var. 5- (formerly Salmonella Typhimurium var. Copenhagen), and Salmonella Agona were the three serotypes most often recovered in both study years. The most common antimicrobial resistance pattern for Salmonella Derby in the two study years was resistance to streptomycin, sulfisoxazole, and tetracycline. Most isolates were resistant to tetracycline, sulfisoxazole, and streptomycin in both study years. The proportion of Salmonella isolates that were susceptible to all antimicrobials (pansusceptible) was 38.1% in 2000 and 20.4% in 2006. The proportion of Salmonella isolates that were resistant to three or more antimicrobials (multidrug resistant) was similar in 2000 and in 2006 (52.8 and 57.7%, respectively).

When considering the development of antimicrobial resistance in food animals, comparing gross use estimates of different antimicrobials is of little value due to differences in potencies, duration of activity, relative effect on target and commensal bacteria, and mechanisms of resistance. However, it may be valuable to understand quantities of different antimicrobials used in different ages of swine and for what applications. Therefore, the objective of this project was to construct an estimate of antimicrobial use through the feed in swine production in the United States. Estimates were based on data from the National Animal Health Monitoring System (NAHMS) Swine 2006 Study and from a 2009 survey of swine-exclusive practitioners. Inputs consisted of number of pigs in a production phase, feed intake per day, dose of the antimicrobial in the feed, and duration of administration. Calculations were performed for a total of 102 combinations of antimicrobials (n=17), production phases (n=2), and reasons for use (n=3). Calculations were first conducted on farm-level data, and then extrapolated to the U.S. swine population. Among the nursery phase estimates, chlortetracycline had the largest estimate of use, followed by oxytetracycline and tilmicosin. In the grower/finisher phase, chlortetracycline also had the largest use estimate, followed by tylosin and oxytetracycline. As an annual industry estimate for all phases, chlortetracycline had the highest estimated use at 533,973 kg. The second and third highest estimates were tylosin and oxytetracycline with estimated annual uses of 165,803 kg and 154,956 kg, respectively. The estimates presented here were constructed to accurately reflect available data related to production practices, and to provide an example of a scientific approach to estimating use of compounds in production animals.

A high yielding, batch mode synthesis of diaryl ethers and sulfides by an S(N)Ar fluoride-mediated process in scCO(2) has been developed; the use of a polymer-supported imidazolium fluoride reagent in batch mode led to the development of a fixed-bed continuous flow process, with high conversions.

Yersinia enterocolitica is considered an important food-borne pathogen impacting the pork production and processing industry in the United States. Since this bacterium is a commensal of swine, the primary goal of this study was to determine the prevalence of pathogenic Y. enterocolitica in pigs in the United States using feces as the sample source. A total of 2,793 fecal samples were tested for its presence in swine. Fecal samples were collected from late finisher pigs from 77 production sites in the 15 eastern and midwestern pork-producing states over a period of 27 weeks (6 September 2000 to 20 March 2001). The prevalence of ail-positive Y. enterocolitica was determined in samples using both a fluorogenic 5' nuclease PCR assay and a culture method. The mean prevalence was 13.10% (366 of 2,793 fecal samples tested) when both PCR- and culture-positive results were combined. Forty-one of 77 premises (53.25%) contained at least one fecal sample positive for the ail sequence. The PCR assay indicated a contamination rate of 12.35% (345/2,793) compared to 4.08% (114/2,793) by the culture method. Of the 345 PCR-positive samples, 252 were culture negative, while of the 114 culture-positive samples, 21 were PCR negative. Among 77 premises, the PCR assay revealed a significantly (P < 0.05) higher percentage (46.75%, n = 36 sites) of samples positive for the pathogen (ail sequence) than the culture method (22.08%, n = 17 sites). Thus, higher sensitivity, with respect to number of samples and sites identified as positive for the PCR method compared with the culture method for detecting pathogenic Y. enterocolitica, was demonstrated in this study. The results support the hypothesis that swine are a reservoir for Y. enterocolitica strains potentially pathogenic for humans.

Objective: To estimate the annual cost of infections attributable to porcine reproductive and respiratory syndrome (PRRS) virus to US swine producers., Design: Economic analysis., Sample Population: Data on the health and productivity of PRRS-affected and PRRS-unaffected breeding herds and growing-pig populations were collected from a convenience sample of swine farms in the midwestern United States., Procedure: Health and productivity variables of PRRS-affected and PRRS-unaffected swine farms were analyzed to estimate the impact of PRRS on specific farms. National estimates of PRRS incidence were then used to determine the annual economic impact of PRRS on US swine producers., Results: PRRS affected breeding herds and growing-pig populations as measured by a decrease in reproductive health, an increase in deaths, and reductions in the rate and efficiency of growth. Total annual economic impact of these effects on US swine producers was estimated at dollar 66.75 million in breeding herds and dollar 493.57 million in growing-pig populations., Conclusions and Clinical Relevance: PRRS imposes a substantial financial burden on US swine producers and causes approximately dollar 560.32 million in losses each year. By comparison, prior to eradication, annual losses attributable to classical swine fever (hog cholera) and pseudorabies were estimated at dollar 364.09 million and dollar 36.27 million, respectively (adjusted on the basis of year 2004 dollars). Current PRRS control strategies are not predictably successful; thus, PRRS-associated losses will continue into the future. Research to improve our understanding of ecologic and epidemiologic characteristics of the PRRS virus and technologic advances (vaccines and diagnostic tests) to prevent clinical effects are warranted.

A study was conducted to determine the prevalence of Shiga toxin-producing Escherichia coli (STEC) in swine feces in the United States as part of the National Animal Health Monitoring System's Swine 2000 study. Fecal samples collected from swine operations from 13 of the top 17 swine-producing states were tested for the presence of STEC. After enrichment of swine fecal samples in tryptic soy broth, the samples were tested for the presence of stx1 and stx2 by use of the TaqMan E. coli STX1 and STX2 PCR assays. Enrichments of samples positive for stx1 and/or stx2 were plated, and colony hybridization was performed using digoxigenin-labeled probes complementary to the stx1 and stx2 genes. Positive colonies were picked and confirmed by PCR for the presence of the stx1, stx2, or stx2e genes, and the isolates were serotyped. Out of 687 fecal samples tested using the TaqMan assays, 70% (484 of 687) were positive for Shiga toxin genes, and 54% (370 of 687), 64% (436 of 687), and 38% (261 of 687) were positive for stx1, stx2, and both toxin genes, respectively. Out of 219 isolates that were characterized, 29 (13%) produced stx1, 14 (6%) produced stx2, and 176 (80%) produced stx2e. Twenty-three fecal samples contained at least two STEC strains that had different serotypes but that had the same toxin genes or included a strain that possessed stx1 in addition to a strain that possessed stx2 or stx2e. The STEC isolates belonged to various serogroups, including O2, O5, O7, O8, O9, OX10, O11, O15, OX18, O20, O57, O65, O68, O69, O78, O91, O96, O100, O101, O120, O121, O152, O159, O160, O163, and O untypeable. It is noteworthy that no isolates of serogroup O157 were recovered. Results of this study indicate that swine in the United States harbor STEC that can potentially cause human illness.

Objective: To determine types and doses of injectable medications given to periparturient sows and reasons for administering those medications, and to compare medication practices among farms of different sizes., Design: Survey., Sample Population: 301 farms; 231,016 periparturient sows., Procedure: A survey was used to obtain information regarding medications given to sows during the farrowing period. State and federal veterinary medical officers completed surveys during their final interview with producers who had participated in the National Animal Health Monitoring System's (NAHMS) Swine 95 study. Data were summarized and treatment regimens compared among farms of different sizes., Results: More than a third of the sows received medications during the farrowing period. The most common reasons for administering medications were routine preventive treatment and treatment of dystocia, uterine discharge, and poor appetite. The most commonly used medications for treatment of sick sows were oxytocin, procaine penicillin G, and B vitamins. A high percentage of medications were either not indicated for the specific condition or used at greater or less than the approved dose. In general, treatment rates and medications used did not differ among farms of different sizes., Conclusions and Clinical Relevance: Better treatment protocols are needed to provide more appropriate treatment of sick sows.

In the 1995 National Swine Study of the United States National Animal Health Monitoring System, producers identified respiratory problems as the leading cause of death in pigs during the grower/finisher phase of production. Over a six-month period, 61.7 +/- 4.1% (mean +/- SEM) of operations reported at least one death attributed to respiratory problems among finisher pigs (based on 388 operations representing operations with > or = 300 finisher pigs in 16 states). Mean mortality attributed to respiratory problems was 0.9 +/- 0.1% of finisher pigs per operation. Stepwise logistic regression (using SAS) was used to identify factors associated with operations attributing at least one death to respiratory problems, and to identify factors associated with reporting > or = 2% mortality attributed to respiratory problems. Final models were run with SUDAAN to account for the sampling strategy. Attributing at least one death to respiratory problems was associated with having > or = 3000 pigs enter the grower/finisher unit over a six-month period; diagnosis of Haemophilus (or Actinobacillus) in the past 12 months; and keeping pigs in the grower/finisher unit > 120 days (as compared to < 100 days). Not having a farrowing facility, mean weaning age < 28 days, and < 50% of finisher pigs on solid concrete only were associated with reporting > or = 2% mortality attributed to respiratory problems.

The United States Department of Agriculture's National Animal Health Monitoring System 1995 National Swine Study was designed to estimate management, health and productivity parameters on pig operations in the United States. Sixteen major swine-producing states that accounted for nearly 91% of June 1, 1995 swine inventory and nearly three-fourths of United States swine producers were included in the study. In the initial phase of the study, National Agricultural Statistics Service enumerators collected information from 1477 producers involved in all phases of swine production (farrowing, nursery, and grower/finisher). Of these, 405 operations with > or = 300 finisher pigs (with at least one finisher pig > or = 54 kg) participated in the subsequent component of the study, which involved on-farm visits by state and federal veterinary medical officers and animal health technicians, and which concentrated on the grower/finisher phase of production. Of those eligible to take part in the second phase of the study, participation was higher among independent producers (48.3%) than among contract producers (15.3%). Participation was also higher among operations that used advanced record-keeping systems (such as record cards for individual breeding hogs or a computer-based record-keeping system). Thus, study results could have been influenced by response biases. As a biosecurity measure, 40.5 +/- 2.1% of operations restricted entry to employees only. For operations that permitted non-employees to enter the premises, relatively few enforced other biosecurity measures on visitors (0.4 +/- 0.1% required feed-delivery personnel and livestock handlers to shower before entering the premises; 3.3+/- 0.9% required a footbath; and 7.0 +/- 1.5% required feed-delivery personnel and livestock handlers not to have visited another operation with pigs on that day). The most common method of waste storage (used by 49.9 +/- 3.8% of operations with > or = 300 finisher pigs) was below-floor slurry or deep pit.

Over a 6-month period, the mean mortality risk (based on 393 operations participating in the United States National Animal Health Monitoring System 1995 National Swine Study, and representing operations with > or = 300 market hogs in 16 states), was 2.3 +/- 0.2% in the grower/finisher production phase (where figures after the +/- represent the standard error of the estimate). Mortality > or = 4% was experienced by 13.5 +/- 2.9% of grower/finisher operations, while 63.6 +/- 5.3% had < or = 2% mortality. To identify factors associated with > or = 4% mortality, stepwise logistic regression [Statistical Analysis Systems, 1989. SAS/STAT User's Guide, Version 6, 4th edn, Vol. 2. SAS Institute, Cary, NC, 794 pp.] was performed twice: once using operations with all mortality rates, and again excluding operations with between 2% and 4% mortality. Final models were run with SUDAAN [Shah, B.V., Barnwell, B.G., Bieler, G.S., 1996. SUDAAN User's Manual, Version 6.40, 2nd edn. Research Triangle Institute, Research Triangle Park, NC, 492 pp.] to take the sample design into account. In addition, SAS and SUDAAN logistic regression models were developed to analyze factors associated with > 2.3% mortality among grower/finisher pigs. Mean weaning age < or = 28 days entered all models as being associated with increased mortality in the grower/finisher unit. Not obtaining all grower/finisher pigs from farrowing units belonging to the operation was associated with > or = 4% mortality among grower/finisher swine. Not typically giving grower/finisher pigs antibiotics or other agents as disease-preventives or growth-promotants in the feed or water, and ranking producer organizations as very or extremely important sources of antibiotic information were associated with < or = 2.3% mortality in the grower/finisher phase.

Data from the United States National Swine Survey collected by the National Animal Health Monitoring System were used to describe the use of feed additives in swine feeds. Data were collected from 710 farms. The concentration of feed additives expressed in grams per ton of complete feed was described by stage of production, and the use of feed additives above the labeled treatment levels (i.e. off-label) was identified. Of the 3328 feeds, about 79% contained feed additives used in the labeled manner. For all classes of pigs, the prevalence of labeled feed additive use was greater than 75%. Penicillin was used according to its label most often, followed by apramycin, bacitracin, tetracyclines, lincomycin, and tylosin. Carbadox had the highest prevalence of off-label use. Of the 699 feeds that included feed additives in an off-label manner, about 57% included additives at greater than the recommended concentrations or were fed to an incorrect class of pig. About 56% of the feeds had off-label combinations of additives. Small farms were more likely to use rations with no feed additives than intermediate or large farms (P < 0.001). Of those farms using feed additives, the odds of a small farm using all feed additives in the labeled manner was 7.7 times that of an intermediate or large farm (P < 0.0001). After controlling for herd size, producers who used a veterinary consultant were 2.1 times more likely to use feeds with feed additives (P < 0.0001).