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WORKING TOGETHER FOR A HEALTHIER FUTURE
VOLUME 3 EDITION 2
Livestock
MATTERS
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Inside this issue:
Suckler cow fertility
We explain the key to profitability in suckler
farming and how good management and
recording can help maximise conception
rates on farm.
EXCELLENCE IN PRACTICE
XLVets - We Excel
The members of XLVets have worked hard to create what they see as a
model of how practices can work together, sharing the latest ideas and
passing on savings and joint expertise to clients.
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The group comprises of a number of the foremost farm practices in Ireland.
With many years of combined experience, it is able to give expert advice
on all areas of farm livestock, health and production.
XLVets member practices are dedicated to providing a
high quality, cost effective service to their clients, to
support long-term growth and future prosperity within
the Irish livestock industry.
www.xlvets.ie
Adare Veterinary Surgery
Donal Lynch Veterinary
Killenaule Vets
Riverview Veterinary Group
Adare, Co.Limerick
Telephone: 061 396390
Tullamore, Co.Offaly
Telephone: 057 9354505
Thurles, Co.Tipperary
Telephone: 052 9156065
Bandon, Co.Cork
Telephone: 023 8841503
All Creatures Veterinary Clinic
Glen Veterinary Clinics
Mulcair Veterinary Clinics
Sliabh Luachra Veterinary Centre
Roscommon Town, Co.Roscommon
Telephone: 0906 626898
Tipperary Town, Co.Tipperary
Telephone: 062 52992
Cappamore, Co.Limerick
Telephone: 061 381209
Rathmore, Co.Kerry
Telephone: 064 7758009
Avondale Veterinary Clinics
Glenbower Veterinary Group
O’Connor Julian Vets
Southview Veterinary Hospital
Arklow, Co.Wicklow
Telephone: 0402 33744
Killeagh, Co.Cork
Telephone: 024 95189
Cashel, Co.Tipperary
Telephone: 062 61196
Clonmel, Co.Tipperary
Telephone: 052 6121429
Clerkin Vets
Glenina Veterinary Clinic
Old Church Veterinary Hospital
The Veterinary Hospital
Cootehill, Co.Cavan
Telephone: 049 5552777
Galway, Co.Galway
Telephone: 091 752 014
Ballyshannon, Co.Donegal
Telephone: 071 9851559
Gorey, Co.Wexford
Telephone: 053 9421151
Comeragh Veterinary
Gortlandroe Veterinary Clinic
Ormonde Veterinary
Kilmacthomas, Co.Waterford
Telephone: 051 294143
Nenagh, Co.Tipperary
Telephone: 067 31016
Kilkenny, Co.Kilkenny
Telephone: 056 7763630
XLVets is committed to being
a part of a healthy future.
CONTENTS
VOLUME 3 EDITION 2
XLVets is a novel and exciting initiative
conceived from within the veterinary profession.
We are all independently owned, progressive
veterinary practices located throughout Ireland
committed to working together for the benefit
of our clients.
XLVets Ireland
Member Practices
Adare Veterinary Surgery
Station Road, Adare, Co.Limerick
All Creatures Veterinary Clinic
Lanesboro Street, Roscommon Town,
Co.Roscommon
Avondale Veterinary Clinics
Ferrybank, Arklow, Co.Wicklow
Clerkin Vets
90 Bridge Street, Cootehill, Co.Cavan
Comeragh Veterinary
Main Street, Kilmacthomas, Co.Waterford
Donal Lynch Veterinary
Killurin Cross, Killeagh, Tullamore Co.Offaly
Glen Veterinary Clinics
Blind Street, Tipperary Town, Co.Tipperary
CONTENTS
HERD HEALTH
03 Infectious respiratory disease in calves:
Tommy Heffernan, Avondale Veterinary
Clinics provides information on how to
identify the causes and clinical signs
of respiratory disease in calves and the
importance of timing when treating the
infected calves.
SUMMER FEATURE
Suckler cow fertility:
05
Karl Darcy, Glenina Veterinary Clinic explains the
key to profitability in suckler farming.
07 Johne’s disease:
Padraic Kilmartin, Glen Veterinary
Clinic focuses on the clinical problems
associated with Johne’s disease and
outlines basic principles of control.
09 Five ways that animals look at the
world differently to humans:
Willie Buckley, Riverview Veterinary
Clinic reflects on the book ‘Animals in
Translation’ from Temple Grandin’s
providing some interesting facts and
thoughts explaining how animals look
and think differently, to humans.
Glenbower Veterinary Group
Clashdermot East, Killeagh, Co.Cork
Glenina Veterinary Clinic
1 Glenina Heights, Galway, Co.Galway
Gortlandroe Veterinary Clinic
6 Church Street, Nenagh, Co.Tipperary
Killenaule Vets
Killenaule, Thurles, Co.Tipperary
Mulcair Veterinary Clinics
Dromsally, Cappamore, Co.Limerick
O’Connor Julian Vets
67 Main Street, Cashel, Co.Tipperary
Old Church Veterinary Hospital
The Mall, Ballyshannon, Co.Donegal
Ormonde Veterinary
14 Barrack Street, Kilkenny, Co.Kilkenny
Riverview Veterinary Group
Distillery Road, Bandon, Co.Cork
Sliabh Luachra Veterinary Centre
West End, Rathmore, Co.Kerry
Southview Veterinary Hospital
Irishtown, Clonmel, Co.Tipperary
Prac
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LVets:
Contact X05 and
061 3815xlvets.ie
office@
The Veterinary Hospital
Arklow Road, Gorey, Co.Wexford
XLVet Ireland Ltd Registered Office at:
Dromsally
Cappamore
County Limerick
Tel: 061 381505
© XLVet Ireland
No part of this publication may be reproduced
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contributors. No responsibility can be accepted
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Training is a vital part of the jigsaw that makes up modern
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for you needn’t be a puzzle.
XLVets FarmSkills courses are designed to
put the farmer first; finding out what you
know now and what you’d like to know to
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Courses are available across Ireland and are
open to everyone. Topics catered for include
cattle lameness, mastitis and cell count, calf
rearing and fertility management.
XLVets Skillnet is funded by member companies and the Training Networks Programme, an initiative of
Skillnets Ltd. funded from the National Training Fund through the Department of Education and Skills.
RESPIRATORY DISEASE
TO M M Y H E F F E R N A N M V B
It is important to remember when vaccinating young calves
that maternal antibodies are present. So this is why the
timing of vaccination programmes and the use of
intranasal vaccinations is so important.
Infectious respiratory
disease in calves
Veterinary Surgeon Tommy Heffernan
XLVets Practice
Avondale Veterinary
Clinics, Co.Wicklow
Belgian Blues can be even more susceptible to
pneumonia as they have smaller lungs due to
double muscling
1. Causes
2. Risk factors
The main causes of respiratory diseases
in calves are viruses and bacteria.
Another very important cause of
respiratory disease in calves is parasitic
however I will mainly deal with the
infectious causes in this article.
These can reduce calf immunity or
increase the infectious pressure,
meaning a respiratory infection can be
much worse under these conditions.
●
Poor colostrum management
The main viruses are:
●
Malnutrition
●
PI3
●
Poor weaning management
●
RSV
●
●
IBR
Contact/shared airspace with
older animals
●
Coronavirus
●
High humidity
●
BVD
●
High stocking density
●
Poor air quality
●
Wet bedding
The main bacterial causes are:
Healthy calf
3
LIVESTOCK MATTERS
●
Pasteurella multocida
●
Histophilus somni
●
Large groups/overcrowding
●
Mycoplasma bovis
●
Power washing in presence of calves
WORKING TOGETHER FOR A HEALTHIER FUTURE...
RESPIRATORY DISEASE
3. Recognition - what
are the clinical signs
to watch for?
1. Elevated respiratory rate (panting)
2. Fever
3. Nasal discharge
4. Depression and inappetance
It has been suggested that any animal
with a temperature of over 39.7 degrees
Celsius is deemed to be febrile.
6. Control vaccination
The main control is by reducing risk factors
and implementing vaccination strategies.
It is also important to remember when
vaccinating young calves that maternal
antibodies are present. So this is why
timing of vaccination programmes and
the use of intranasal vaccinations is so
important. All vaccination programmes
Vaccination timing essential to cover risk period
Disease
Resistance
Period of high
susceptibility
to pneumonia
If any of these symptoms are apparent,
then the key to a successful outcome is
BEGIN TREATMENT EARLY.
4. Making a diagnosis
This is important to isolate the viral
cause so you can implement an effective
control programme through vaccination.
Isolating mycoplasma could also be
important as treatment options can be
limited and some follow up herd
screening may also be important.
Samples should be taken early and
before treatment begins. Usually this is
done by nasal swabbing. Any calves
found dead should also have
postmortems undertaken to rule out
acute pneumonia as a cause.
should include the main viruses which
are IBR, RSV, PI3, BVD and there is also
a vaccination available against Pasteurella
pneumonia. A pneumonia vaccination
programme should be included as part of
your overall herd health plan. Also good
management plays an essential role in
reducing pneumonia outbreaks.
Passive
immunity
(Colostrum)
Active immunity
(Calf’s own
immune system)
0 1 2 3 4 5 6 7 8 9 10
Age of the calf (weeks)
5. Treatments
Antibiotics play a key role in the
treatments of pneumonia. There is no
general rule that one antibiotic is best for
treatment. There are many options which
your vet can advise you on. There are
some golden rules for using antibiotics
successfully when treating pneumonia.
These are that treatment is started early
generally within the first 48hrs of any of
the aforementioned clinical signs. Also
it is very important that antibiotics are
given for the correct duration. This means
that every case of calf pneumonia has
to be treated for at least three days.
Anti-inflammatories also play a key
role in treatment and can be given in
conjunction with antibiotic at the start
of treatment.
VOLUME 3 EDITION 2
LIVESTOCK MATTERS
4
Suckler cow fertility
SUCKLER COW FERTILITY
The key to profitability in suckler farming is to produce the maximum number of calves per cow. The
greatest loss of potential earnings arises in most Irish farms from a failure to get cows and heifers in
calf in the first place. Farmers should aim to produce one calf per cow per 365 day interval. In most
suckler herds a shorter calving and breeding season brings further advantages in terms of reduced
labour, production costs, simpler animal management, more calves and fewer and fewer calf health
problems. Good management and recording along with suitable veterinary intervention when needed
can help maximise conception rates.
Cows
Any cow that:
Cows kept for breeding must be fit, healthy
and have sound feet. For maximum fertility
correct body condition score (BCS) of cows
both at mating and calving is essential. The
ideal is a BCS of between 2-3 i.e. ‘fit not
fat’. Overly thin cows at calving will be
slower to cycle and conceive; overly fat
cows are more prone to calving difficulties
which in turn frequently lead on to
delayed conceptions.
Trace element deficiencies can have a
major impact on conception rates. Copper,
selenium, vitamin E and iodine should be
supplemented where necessary. Blood testing
along with silage/soil analysis can pinpoint
likely deficiencies. Supplementation with trace
element boluses, lick or feed additives should
start two months before calving, up to at least
early pregnancy.
Likely problem cows should be recognised
and managed on an individual basis. The
most obvious candidates to require special
care are those cows that had difficulty at or
around calving as a cow's womb has only a
few weeks to change from holding a full term
calf to being ready for conception.
had a dead calf/miscarriage
retained foetal membranes
had a difficult calving
had twins
should be considered a likely case of
endometritis and treated appropriately.
Bull
The bull is ‘half the herd’. Semen production
takes two months so ideally the bull should
be in good health and ready to operate two
months ahead of the breeding season. A
semen quality test should be considered at this
time. Even a sub-fertile (rather than completely
sterile) bull can wreck a well-planned
breeding schedule. Physical soundness is
vital, particularly of the reproductive organs
and of the feet and legs. A bull should be
watched at work to ensure he is serving
cows properly, particularly young bulls.
Early pregnancy diagnosis is the ultimate
guarantee that a bull is fertile.
Veterinary Surgeon Karl Darcy
XLVets Practice
5
Glenina Veterinary
Clinic, Co.Galway
LIVESTOCK MATTERS
WORKING TOGETHER FOR A HEALTHIER FUTURE...
SUCKLER COW FERTILITY
Disease control
A number of common diseases impact on suckler
cow conception rates. These include BVD
(Bovine Viral Diarrhoea), IBR (Infectious Bovine
Rhinotracheitis), leptospirosis, salmonella and
neosporosis. Where repeat services are higher
than expected, blood testing should be initiated.
Where a disease problem is diagnosed, a herd
health plan that encompasses a vaccination
programme, replacement policy and
quarantine procedures for new stock should be
drawn up in consultation with the farm vet.
K A R L DA R C Y M V B
The most obvious candidates to require special care are
those cows that had difficulty at or around calving as
a cow's womb has only a few weeks to change from
holding a full term calf to being ready for conception.
Existing vaccination programmes should be
tailored to fit around the critical and delicate
breeding stage. A shorter breeding season
will facilitate this.
Artificial insemination
and heat detection
Where AI is used either in part or in full good
heat detection is critical. Twenty minutes of alert
observation at least three times daily is a good
rule of thumb. Artificial heat detection aids such
as tail paint or scratch cards can be helpful.
Most accurate of all is an active vasectomised
bull with a chin ball.
Synchronisation
Synchronisation of heat in suckler cows
is useful for a variety of reasons:
●
It can help dramatically tighten the
calving period.
●
It can be used in cows that are not
coming into heat (more common in
suckler cows because of the maternal
bond).
●
It reduces time spent observing for heat.
●
It allows for fixed time AI, removing a
lot of guesswork.
●
Done correctly in suitable cows/heifers,
conception rates can be as high as
75 per cent.
Cows should be at least 40 days calved
and heifers at least 15 months old before
synchronisation is attempted. A number
of different protocols exist. All drugs used
are prescription only medicine (POM).
In general, a combination of a progesterone
releasing device with GnRH and
prostaglandin injections works well for cows
not yet seen in heat, while prostaglandin
injections alone can be used successfully
in heifers.
Pregnancy detection
Ideally pregnancy detection should occur
early on in pregnancy with a view both to
ensuring both bull and cow fertility and to
diagnose animals failing to conceive that
this may be rectified. Ultrasound scanning
can be performed from as early as four
VOLUME 3 EDITION 2
weeks. Early detection of a poor or
low conception rate allows for earlier
intervention and investigation and a
better chance of avoiding having to feed
a herd of empty cows!
LIVESTOCK MATTERS
6
JOHNE’S DISEASE
PA D R A I C K I L M A RT I N M V B
Johne’s disease
Diagnosis of cattle showing clinical signs
is not difficult but finding the subclinically
affected animals is more challenging.
Johne's disease is caused by Mycobacterium avium subspecies
paratuberculosis (MAP). It manifests clinically as chronic diarrhoea
without loss of appetite and results in progressive emaciation.
Once clinical signs occur animals rarely survive more than a year.
There is no cure for this disease.
Veterinary Surgeon Padraic Kilmartin
XLVets Practice
Glen Veterinary Clinic,
Co.Tipperary
Bottle jaw may be as a result of Johne's Disease
Infection is acquired as calves via the
faeco-oral route. MAP can survive in the
environment for up to one year and only
multiplies in a host animal. Not all animals
infected become clinical cases some are
affected subclinically but these animals
shed MAP intermittently in their faeces.
Risk factors for contracting clinical Johne's
disease include age and infectious dose.
The younger the calf at the time of exposure
and the greater the infectious load increases
the risk of developing clinical Johne's
7
LIVESTOCK MATTERS
disease. Clinical cases of Johne's disease
are rarely seen in animals less than two
years of age.
Johne's disease causes granulomatous
enteritis. Early in the disease process no
clinical signs are evident, these animals are
termed subclinically infected animals. As
the disease advances subclinical animals
progress to clinical cases, these animals
have intractable diarrhoea and an inability
to absorb plasma proteins causing weight
loss and eventual emaciation.
WORKING TOGETHER FOR A HEALTHIER FUTURE...
JOHNE’S DISEASE
Diagnosis
Diagnosis of cattle showing clinical signs
is not difficult but finding the subclinically
affected animals is more challenging.
There are two types of tests available.
Taking a faecal sample and culturing it
and/or looking for antibodies in the milk
and/or blood.
Type of Test
Advantages
Disadvantages
Faecal sampling
●
●
Accurate
●
●
Serology
●
Faster results
●
A. Milk (Dairy)
●
Easily performed
●
B. Blood (Dairy and
Beef)
Min 16 weeks to
culture MAP
Labour intensive
Expensive
Poor sensitivity.
(High % of infected
animals missed)
Repeat testing required
Control
Basic principles of control are:
1 New infections prevented
2 Infected animals identified and
removed from herd
3 Disinfection/Hygiene and Husbandry
A classification system in Holland was used
to reduce the level of Johne's on affected
farms. Due to the poor sensitivity of the
blood and milk sampling, repeat sampling
(every 3 months) is needed.
Animals were classified as low risk or
high risk.
Persistent scour may be as a result of Johne's Disease
Risk Level
Classification
Johne's
infection group
Definition
Low
Green
J0
Minimum two negative tests
Low
Green
J1
Negative but only one test performed
Low
Green
J2
Negative but one positive in more than three tests
High
Yellow
J3
Positive/Negative interchanging
High
Yellow
J4
Positive but all other tests negative
High
Red
J5
Two positive tests
●
Yellow and red animals should be calved in an isolation pen
away from green animals and calves should be removed
immediately after birth.
●
Calves should only be fed colostrum from green cows.
●
Colostrum should never be pooled.
●
●
Pens should be disinfected between calving to reduce the
level of exposure.
Red cows should be culled at the end of their lactation.
Poor condition may be as a result of Johne's Disease
VOLUME 3 EDITION 2
LIVESTOCK MATTERS
8
A N I M A L B E H AV I O U R
ARTICLE BY: WILLIE BUCKLEY MVB
River view Veterinar y Clinic, Co.Cork
Five ways that animals
look at the world
differently to humans
From Temple Grandin’s “Animals in Translation”
Temple Grandin is an associate professor at Colorado State University.
She lectures worldwide on both animal science and autism. She serves
as a role model for animal lovers and people with autism. She is best
known for being a passionate and effective animal advocate, and for
explaining how animals think, to humans. There are many interesting
thoughts in this book and here are just a few.
1. Ability to see colour
Veterinary Surgeon Willie Buckley
XLVets Practice
Riverview Veterinary
Clinic, Co.Cork
The ability to see colours varies
between animals.
Birds see four basic colours,
ultra-violet, blue, green and red.
People and some primates see
blue, green and red.
Most other mammals just see blue
and green.
‘Red rag to a bull’. Not Possible.
2. Sound
In nature any novel high pitched sound will
cause a cow to baulk. It activates the part of
the animal's brain that responds to distress.
Reflex makes it think that maybe its calf is in
distress or a herd mate in trouble.
An animal is more upset by a high pitched
sound that is intermittent and random. It can't
relax because nature has programmed the
animal to always look towards the direction of
a distressed sound and it is instinctively waiting
for the next sound so it can't relax. The animal
has to make a conscious decision about what
to do with the sound. If she is a predator, does
she need to chase something? If she is a prey
animal, should she run?
With our animals the less noise the better.
Air hissing in a parlour can mimic the high
pitched distress sound. Crush gates that rattle
too much or metal chains clanging, all cause
cows to move slower or unpredictably.
9
LIVESTOCK MATTERS
WORKING TOGETHER FOR A HEALTHIER FUTURE...
A N I M A L B E H AV I O U R
I see some farmers leave cows
out the side gate of the crush
when testing. The cows empty
easier and the next cows load
better because there is less noise.
3. Ability to see contrast
Most of our commercial animals were
prey in the wild before they were
domesticated; they depended on noticing
any unusual flick of a shrub, as it could
have made the difference between life
and death by predator.
Animals perceive more detail than
humans (who are predators) in order to
stay alive. Also animals' night vision is
much better than ours, so again they see
more intense contrasts of light and dark.
Cattle grids work because cattle perceive
the contrast between the bright at the top
and the dark at the bottom of the pit so
sharply, that they think it is a bottomless
pit and will not cross. In some countries
they just paint a series of very bright
lines on entrances to prevent cattle from
entering roads.
During the war the Allies recruited totally
colour blind people to interpret satellite
spy photos. They could see camouflage
netting draped over a tank much clearer
than people with normal sight. Contrast is
better seen without colour. Shadows are
much clearer in black and white. In fact
Temple Grandin always takes black and
white photographs, to try to see what the
animals see.
Strong changes in light are also very
distracting for cattle. Cows will baulk at a
shadow on the ground. Getting cattle to
go from either a brightly lit area to a dark
area or vice versa always causes trouble
to farmers.
We need to prevent strong
reflections or shadows along a
cow's path. Moving shadows or
reflections are even scarier to
a cow. We need to have more
consistent levels of brightness
when moving animals from
different areas. Changes of
texture from one floor to the
next also upset cows.
VOLUME 3 EDITION 2
4. Ability to deal with the new
Humans are blind to anything they are not
paying attention to. Humans have evolved
to see what they are expecting to see.
Cows are at the other end of the spectrum
and notice everything.
There have been studies done where people
have been interviewed by people holding a
banana rather than a microphone and most
people don't even see the banana. Humans
focus on the end-point or goal i.e. getting to
the other side of the field. If there is something
novel in our path, our more advanced brains
can process the new item out of our minds.
The human brain tries to recognise it,
compare it to other ‘like’ things that we have
seen in the past, analyses the threat it may
possess and it makes the decision that it
will not affect us achieving our goal. All this
happens without us consciously being aware
of these decisions.
If a cow was to see the same novel object
in its path its brain does things differently. If
something is novel or has changed in any
way, they notice and they need to think about
it before proceeding. The cow does not have
the processing ability of the human and they
will fear it more. It may be a new predator
and may not take the chance of passing the
object as they don't know what it will do.
Any object or image in a cow's visual
field will get her notice, but if they are
used to seeing it every day, it does not
cause fear. If it is the first time seeing it
i.e. it is a novelty, you can't be sure how
she will respond.
5. Pain and suffering
Prey animals hide their pain. In the wild,
an animal that shows pain is liable to
be finished off by a predator, so they
have to act as if nothing has happened.
A predator might howl like a big baby
when in pain. They don't need to worry
about being heard.
Prey animals in severe pain can still
function. An animal in a state of panic
cannot function at all. A prey animal has
to start running before the lion starts running
in order to survive. That means it has to be
hyper-alert all the time keeping an eye out
for danger.
All animals feel pain. But the fear of pain to
a cow is worse than actual pain. The single
worst thing you can do to a prey animal is
to make it feel afraid. If you gave a choice
to a human to choose between pain and
intense fear, most people would pick fear.
Humans have a lot more power to control
fear than animals do. Animals are more
punished by fear than pain and it is the
opposite for humans.
Animals also have a very long memory for
fear. Animals may never unlearn a bad fear.
Nature has made fear learning permanent.
Our brain remembers better where we were
on 9/11 than our leaving cert poems.
I believe when a lame animal shows pain, we need to also consider
the level of un-expressed pain. Maybe we should use a lot more
pain relief medication and not just antibiotics to help our cows
heal themselves.
There are many other aspects of
animal behaviour that Temple
Grandin has strong views on. It is
very hard to do a book like this
justice, in a short piece like this.
It is hard to think like a cow but
it would be a great help to us
and them if we did.
Temple Grandin's book ‘Animals
in Translation’ is available in
Easons and many other book
retailers nationwide.
LIVESTOCK MATTERS
10
NUMBER 11 ENTER
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competition...
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We have an XLVets fleece to give away to the
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competition closes.
To enter, simply answer the three questions below
GOOD LUCK...
and complete your details on the entry form. All the
answers can be found in the articles in this issue of the
magazine. Details of where to send your entry can be found below.
A winner will be chosen from all the correct entries received before the closing
date, Friday 23rd August 2013. The winner will be revealed in the next issue of
XLVets Ireland Livestock Matters.
one...
two...
My details
Name
three...
Address
List three viral causes of pneumonia in calves
What is the main clinical sign of Johne’s disease?
List three diseases that affect suckler cow fertility
Daytime Telephone Number
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Send your completed entry to: Farm Competition No.11
XLVets Ireland, Dromsally, Cappamore, Co.Limerick
Spring 2013 Livestock Matters
competition winner:
Mary B Tierney, Lanespark,
Killenaule, Thurles, Co. Tipperary.
(client of Killenaule Veterinary)
XLVets Ireland Our primary aims are 4 fold:
1. To be a primary source of on-farm advice and the
central co-ordinating consultant for other farm services
for our clients.
2. To be committed to the sharing of current best
practice advice to our clients through direct XLVets
newsletters and client training, associated with
our own high levels of Continuing Professional
Development (CPD).
3. To be highly competitive in the health and medicines
market with not just prescription only medicines but
also re-establishing the vet as a primary source for
other on-farm medicinal and consumable products
supported by impartial professional advice.
4. To improve our own efficiencies and reduce our costs
by economies of scale over a wide range of practice
needs and requirements.