OAHN Poultry Expert Network Quarterly Producer Report – Q1 2023
Ontario Animal Health Network (OAHN)
Poultry Expert Network
Quarterly Veterinarian Report
Deadstock management and Protecting Your Flock
Al Dam – Poultry Specialist, OMAFRA
There is a lot of concern with H5N1 Highly Pathogenic Avian Influenza (HPAI) in Ontario this spring. This “bird flu” variant showed up in North America last year and has been devastating to our wild bird populations and to domestic poultry flocks. One of the critical ways that you can protect your farm and your flocks from catching this nationally reportable disease is to properly manage your deadstock.
In Ontario, you can legally dispose of your dead animals either on-farm or off-farm.
- The requirements for on-farm disposal of dead farm animals are specified in Ontario Regulation 106/09 under the Nutrient Management Act, 2002 (NMA). . These options include: burial, composting, incineration, disposal vessels, anaerobic digestors.
- Off-farm disposal of dead farm animals is addressed in Ontario Regulation 105/09. The regulation stipulates who may collect or receive deadstock for disposal, licensing requirements and sets out the methods of disposal. Off farm disposal could include: rendering, feeding to carnivores, delivery to landfill or a central site composting, etc. This all has to be done through a licensed deadstock operator. Contact information for licenced deadstock operators in Ontario or an interactive map of licensed deadstock operators in Ontario provides information on companies located in your region providing this service.
Regardless of your deadstock management strategy, dealing with the carcasses appropriately has a huge impact to the biosecurity of your operation. Proper deadstock management means you prevent any scavenging of the carcasses on your farm.
In the past year, numerous scavengers have tested positive for HPAI. The scavengers represent a vector for moving this disease, both from wildlife to our domestic flocks and vice-versa but also between farms.
Avian scavengers like turkey vultures, hawks, crows, ravens and gulls all have tested positive for HPAI. Numerous mammal scavengers have also tested positive like foxes, coyotes, racoons, and skunks. We know this since wild birds and mammals have been submitted to the Canadian Wildlife Health Cooperative (CWHC can be contacted at 1-866-673-4781) for testing. CWHC has been receiving both dead animals or live animals exhibiting neurological symptoms.
Recent news stories have highlighted that scavengers infected with HPAI are not limited to wild animals. One domestic dog in Ontario and several domestic cats in the United States have contracted HPAI and died shortly after scavenging on infected bird carcasses. This has One Health implications as pet owners in close contact with their sick pets could represent a potential disease transmission pathway to humans.
Improperly managing your deadstock means you could be inviting HPAI onto your farm from scavengers OR if you are unfortunate enough to have contracted HPAI in your flock, you could be spreading it to other farms, wildlife, or domestic pets if you allow scavenging of carcasses.
Biosecurity is a fortress of protection around your flock and improper deadstock management means you have a large hole in your defenses that can allow diseases in.
If you have questions about deadstock management, contact the Agricultural Information Contact Centre with OMAFRA at 1-877-424-1300
Poultry Veterinarian Survey Highlights – Q1 2023
Broilers
Early systemic bacterial infection (<14 d old)
AHL: The number of cases were increased from last quarter. All cases had at least E. coli isolated either in pure culture or in combination with primarily 1 other bacteria (S. aureus, E. cecorum, C. perfringens, and P. aeruginosa). In 1 case E. coli was isolated with 3 other bacteria (E. cecorum, Clostridium novyi, and C. perfringens).
Practitioners: A similar number of practitioners indicated stable or increased cases this quarter. Escherichia coli, Enterococcus cecorum, Staphylococcus, and Pseudomonas were identified by practitioners.
Other causes of early mortality (>14 d old)
AHL: No other causes of early mortality were diagnosed this quarter.
Practitioners: Generally stable cases this quarter with one veterinarian reporting an increase in cases.
Late systemic bacterial infection (>14 d old) – LSBI
AHL: The number of cases were increased from previous quarters. E. coli and E. cecorum were each isolated either in pure culture or in combination. In 1 case these 2 bacteria were also isolated with 2 species of Bacteroides (B. fragilis and B. ovatus).
Practitioners: Practitioners reported increased numbers of infections comparable with last quarter with E. coli listed as the main bacteria identified. Also, E. cecorum was identified as a bacterial agent responsible for LSBI. Practitioners reported that 2-33% of E. coli isolates have been resistant to Trimethoprim sulfa (TMS).
Lameness – viral
AHL: The confirmed reovirus pathology cases were slightly decreased but the viral isolations were stable compared to the previous quarter. There were an increased variety of reovirus strains identified this quarter: PA 6-03200-2012, ON_classic_10-076656, ON_variant_F_12-087411, ON_variant_H_18-008168, PA genotype 6-03200-2012, and SK_R38-AHL 13-030320. Reovirus suspicious cases (identified on histopathology) are increased compared to previous quarters.
Practitioners: Cases were reported as stable with Reovirus variant H the common serotype identified.
Lameness – bacterial
AHL: Cases were increased compared to last quarter. These cases were primarily diagnosed on histology. However, there was 1 case of E. coli and 2 cases of E. coli plus E. cecorum tenosynovitis identified.
Practitioners: Reported as stable to slightly increased for this quarter with cases attributed to E. coli, E. cecorum and S. aureus.
Infectious bursal disease
AHL: The number of pathology cases as well as virus isolations were increased compared to previous quarters. On sequencing there were predominantly field strains identified with the most common being USA PA105-2014 field strain. Other strains identified included USA Del-E field strain, Ont 05-SA08-03-25355 field strain, and USA GA-1 field strain. One case of BC 15-062782 field strain was identified.
Practitioners: Reported as stable to increased cases this quarter.
Infectious bronchitis (IBV)
AHL: The number of pathology cases as well as virus isolations were increased compared to previous quarters. Vaccine strains were primarily identified on sequencing as well as 2 DMV strains (IBV_DMV_ON_21-017385 and IBV_DMV_ON_15-077145).
Practitioners: Increase in IBV detection was reported by the majority of the responders for this quarter. Equal number of responders reported stable to increased cases.
Lameness – developmental
AHL: Cases of tibial dyschondroplasia were slightly increased from the previous quarter. Practitioners: Stable cases this quarter with cases identified as tibial dyschondroplasia.
Lameness – nutritional
AHL: After the spike in cases of Riboflavin deficiency last quarter, the number of nutritional causes if lameness returned to levels like those prior to last quarter.
Practitioners: Most responders reported stable condition with one veterinarian that noticed decreased incidences of nutritional lameness. Rickets was the most common cause of this condition.
Ascites
AHL: No cases of ascites were diagnosed this quarter.
Practitioners: Reported as stable to increased condition
Coccidiosis and necrotic enteritis
AHL: Cases of coccidiosis and necrotic enteritis were stable compared to last quarter. The majority of coccidiosis cases were identified in the small intestine. Three cases had C. perfringens confirmed on bacterial culture.
Practitioners: Cases of coccidiosis were reported as stable to slightly increased this quarter, whereas necrotic enteritis was mainly stable with equal number of responders reporting decreased and increased cases.
Inclusion body hepatitis (IBH)
AHL: Histologic cases have been stable for the last 3 quarters, but viral isolations were variable. On Fowl Adenovirus PCR, the most common species was FAdVE but in some cases all 3 species were identified as positive (FAdVE, FAdVD, FAdVAC). As in previous quarters, on sequencing the primary strain identified was FAdV08b (i.e., FAdV08b_AHL_16-049095_ON and FAdV08b_AHL_18-057921_ON). Viral isolation also identified FAdV11_USA_1047.
Practitioners: Equal number of practitioners reported stable and increased cases this quarter.
Infectious bursal disease
AHL: The number of pathology cases as well as virus isolations were increased compared to previous quarters. On sequencing there were predominantly field strains identified with the most common being USA PA105-2014 field strain. Other strains identified included USA Del-E field strain, Ont 05-SA08-03-25355 field strain, and USA GA-1 field strain. One case of BC 15-062782 field strain was identified.
Practitioners: Reported as stable to increased cases this quarter.
Infectious bronchitis (IBV)
AHL: The number of pathology cases as well as virus isolations were increased compared to previous quarters. Vaccine strains were primarily identified on sequencing as well as 2 DMV strains (IBV_DMV_ON_21-017385 and IBV_DMV_ON_15-077145).
Practitioners: Increase in IBV detection was reported by the majority of the responders for this quarter. Equal number of responders reported stable to increased cases.
Spiking mortality
AHL: One case was diagnosed this quarter (i.e., hypoglycemia and histologic lesions).
Practitioners: Reported as stable for this quarter.
Salmonella
Practitioners: Salmonella isolations were reported as stable to slightly increased this quarter.
Histomoniasis (blackhead)
AHL: No cases diagnosed this quarter.
Practitioners: Reported as stable.
Runting and Stunting Syndrome (RSS)
AHL: Confirmed cases of RSS (diagnosed on histology) were increased this quarter, particularly in birds <14 days of age.
Practitioners: RSS caused by astrovirus were reported as stable to decreased.
Other diagnostic findings
AHL: Other diagnoses made at the AHL included granulomatous bacterial pneumonia and airsacculitis, swollen head (conjunctivitis/blepharitis/myositis, airsacculitis, pneumonia, E. coli sinusitis), liver hemorrhage, undefined peripheral nerve lesions, and thymic atrophy.
Practitioners: No specific findings this quarter except increase in respiratory conditions with the examined flocks.
Condemnation issues
AHL: Diagnoses included ascites/heart failure, liver hemorrhage, and septicemia (E. coli or E. coli/E. cecorum/S. aureus).
Practitioners: Issues were reported as increased by veterinarians this quarter. Cellulitis, airsaculitis and liver conditions were the most common causes of condemnations.
Slaughter provincial plants: Processing volume average 1.78M per month. The top condemnation conditions were reported as air sacculitis, cellulitis and ascites. Dead-on arrival (DOA) was 24.5 birds/10,000.
Slaughter federal plants: Processing volume average 20 M per month. Sub-cutaneous lesions and liver conditions were reported as the main conditions for condemnation. DOA was 14.9 birds/10,000.
Broiler-Breeders
Fowl cholera
AHL: Occasionally isolated from lameness cases from vaccinated flocks.
Practitioners: Reported stable to slightly decreased this quarter.
Early bacterial infection (<14 d old)
AHL: The number of cases were slightly decreased from the previous quarter. Cases had either E. coli isolated in pure culture or in combination with E. cecorum.
Practitioners: Reported a shift from stable to increased cases that continued its pattern from the previous quarter. The main bacteria isolated was E. coli.
Other causes of early mortality (<14 d old)
AHL: There were 2 cases of dehydration identified in this age group.
Practitioners: Reported as stable to slightly increased this quarter. Birds seem to be healthy for the first 2 weeks but then random increased conditions with mild to severe forms noted lately.
Prelay morbidity/mortality (<20 weeks)
AHL: The case numbers were increased from Q3 and Q4 of 2022 but had similar numbers to Q1 and Q2 2022. Cases of septicemia had E. coli isolated either in pure culture or in combination with E. cecorum or E. cecorum/S. aureus. Other diagnoses included mycotic pneumonia (A. flavus), bacterial pneumonia (E. coli, E. cecorum, S. aureus, P. aeruginosa, C. perfringens), coccidiosis, and emaciation.
Lameness – bacterial
AHL: The case numbers were stable compared to the previous quarter. Cases consisted of primarily pure culture of S. aureus (approximately half with lesions of osteomyelitis). Other cases consisted of E. coli either in pure culture or combined with 1 other bacterium including S. aureus, E. cecorum or G. anatis. Two cases of bacterial vertebral osteomyelitis had isolation of E. cecorum alone or in combination with E. coli.
Practitioners: Stable to slightly increased. Staphylococcus aureus was the most predominant bacteria that caused lameness. Also, E.coli and E. cecorum were mentioned as being identified with this condition.
Lameness – viral, developmental and nutritional
AHL: One case of valgus deformity, 1 case of tendon rupture, and 2 cases of reovirus (1 suspicious on histology, 1 PCR positive plus compatible histologic lesions).
Practitioners: All reported as stable by responders.
In-lay bacterial septicemia
AHL: Cases continue to slightly decrease from the previous 2 quarters (numbers were similar to Q1 2022). There were cases of E. coli or S. aureus in pure culture. Bacterial combinations were also identified including E. coli and G. anatis. Also, E. coli and E. cecorum together as well as in combination with S. aureus, C. perfringens, or G. anatis. One case had isolation of 4 bacteria: E. coli, E. cecorum, S. aureus, and G. anatis.
Practitioners: Septicemia was reported as stable to slightly decreased and generally seen as mixed infection
IBV- decreased production/ abnormal eggs
AHL: Two cases diagnosed this quarter. One case of cystic oviducts based on post-mortem examination and 1 having IBV_DMV_ON_15-077145 isolated.
Practitioners: Stable to decrease this quarter.
IBV – sudden spike in mortality
AHL: There was an increase in both pathology cases and virus isolations this quarter compared to the previous year. Strains identified included IBV_USA_Mass_AHL21-008165-001 vaccine, IBV_Mass-H120 vaccine, IBV_Mass-MA5 vaccine, USA Conn Vaccine, CU82792, IBV_DMV_ON_21-017385, and IBV_DMV_ON_15-077145.
Practitioners: Stable to decreased cases this quarter.
Disease related hatchability issues
Practitioners: Reported as stable for this quarter.
Mycoplasmosis
AHL: No cases diagnosed this quarter.
Practitioners: Stable to slightly decreased condition reported this quarter.
Necrotic enteritis
AHL: No cases diagnosed this quarter.
Practitioners: The number of necrotic enteritis cases were reported as stable to slightly decreased this quarter.
Coccidiosis
AHL: Decreased cases from the previous quarter but the same as Q3 2022. Identified coccidia in the small intestines or the small intestines and ceca (1 case with E. maxima).
Practitioners: Generally stable number of cases reported.
Fowl pox and ILT
AHL: No cases diagnosed this quarter.
Practitioners: Reported stable for this quarter.
Salmonellosis (clinical)/Salmonella isolation
Practitioners: Stable this quarter. Practitioners reported a variety of Salmonella isolates including S. Livingstone, S. Kiambu, S. Mbandaka, S. I rough-O: r:1,5, S. I rough-O: k:1,5, S. Infantis, S. Thompson, S. Anatum and S. Senftenberg.
Aggression and cannibalism
AHL: No cases diagnosed this quarter.
Practitioners: Cases were reported as stable with one case of feather licking and mild vent pecking among males only in productive breeder flock.
Multi-drug resistant E. coli (resistant to >3 drugs)
Practitioners: Reported as stable.
Histomoniasis (blackhead)
AHL: Case numbers were decreased compared to last quarter, but cases are still being diagnosed.
Practitioners: Stable cases reported by responders.
White Chick Syndrome
AHL: One case diagnosed this quarter.
Other
AHL: Other diagnoses this quarter included ascites/heart failure, bone fracture, liver hemorrhage, and salpingitis (E. coli, G. anatis, C. perfringens).
Practitioners: Three responders mentioned other cases, but no specific information provided with the comments.
Layers
Less responders were noted completing the survey for this quarter.
Overall, veterinarians reported good and solid health status for this quarter.
Osteoporosis
Practitioners: Stable condition.
Bacterial peritonitis/salpingitis
Practitioners: Stable cases with E. coli identified as the most common bacteria but also Enterococcus cecorum and Gallibacterium anatis were isolated in the layer flocks.
Early systemic bacterial infection (<14 old) – ESBI
AHL: No cases diagnosed this quarter.
Practitioners: Reported generally stable with one responder that noted an increase in cases for this quarter.
Other causes of early mortality (>14 d old)
AHL: One case of synovitis (E. coli, E. cecorum, S. aureus), 1 case of spinal abscesses, and 1 case of visceral/articular gout.
Practitioners: The same as with ESBI, other causes of early mortalities were stable with no identification of other causes of early mortality.
Prelay mortality (<20 weeks)
AHL. One case of septicemia had multiple bacteria isolated (E. coli, E. cecorum, S. aureus). Other diagnoses included E. coli pneumonia, airsaculitis (1 isolated E. coli), and dehydration/urate nephrosis.
Focal duodenal necrosis (FDN)
AHL: Three cases diagnosed this quarter (diagnosis made on histopathology).
Practitioners: Responders were reporting mainly stable but also increased cases for this quarter. Demand for larger egg size has increased the investigation into FDN.
IBV – production drop/abnormal eggs and respiratory issues
AHL: Cases identified on viral testing (no pathology cases) this quarter. On sequencing the strains identified were IBV_DMV_ON_21-017385 and IBV_Mass-MA5 vaccine.
Practitioners: Stable cases reported by respondents.
Salmonellosis (clinical) / Salmonella isolation
Practitioners: Reported as stable.
There were 317 Salmonella isolations for the past 12 months, and 63 isolations for this quarter in chickens. The most common isolates were S. Heidelberg, S. Typhimurium, and S. Enteritidis.
Ontario Hatchery and Supply Flock Policy (OHSFP) – Isolates of Salmonella in chicken with the following subtypes: S. Enteritidis, S. I:8, 20: -: z6, S. Infantis, S. Kiambu and S. Kentucky.
ILT and Mycoplasma
AHL: No cases identified this quarter.
Practitioners: Stable for both conditions
Coccidiosis and necrotic enteritis
AHL: One case of coccidiosis diagnosed.
Practitioners: Reported stable for both conditions.
Aggression, cannibalism and hysteria
Practitioners: All reported as stable this quarter
Multi-drug resistant E. coli (resistant to >3 drugs)
Practitioners: Stable.
Histomoniasis (blackhead)
AHL: No cases diagnosed this quarter.
Practitioners: Stable.
Other
AHL: Diagnoses included bacterial endocarditis, vaginal prolapse, salpingitis (E. coli, G. anatis), dehydration, and encephalitis (vaccine strain of APMV-1). Also, bacterial lameness cases isolated either S. aureus or Enterococcus fecalis.
Practitioners: Reported stable to slightly increased cases. The most common encountered conditions were related to Enterococcus cecorum spinal abscesses and hock or stifle infections.
Turkeys
This quarter was quite challenging for turkey flocks with increased cases of the majority of conditions seen in the field. Conditions noted to be of concern included early and late bacterial infections, ORT, erysipelas, colibacillosis, septicemia (E. cecorum with or without E. coli), Salmonella, reovirus tenosynovitis, round heart, aggression, gangrenous dermatitis, aortic rupture (reovirus related?), crop mycosis (secondary to antibiotic treatment) and HPAI.
Fowl cholera and Erysipelas
AHL:No cases diagnosed this quarter.
Practitioners: both conditions were reported stable
Early systemic bacterial infection (<14 day old) – ESBI
AHL: Stable compared to last quarter. Two cases of septicemia had Streptococcus gallolyticus isolated either in pure culture or combined with S. aureus and E. coli.
Practitioners: Stable to increased cases. The most common bacteria involved with ESBI were E. coli and S. aureus.
Other causes of early mortality (<14 d old)
AHL: No other causes of early mortality identified this quarter.
Practitioners: Reported stable with slightly increased cases for this quarter. One case of viral hepatitis related to reovirus infection was reported.
Late systemic bacterial infection (>14 d old) – LSBI
AHL: Stable compared to last quarter. One diagnosis of E. coli septicemia and 1 diagnosis based on histopathology.
Practitioners: Increased to slightly stable cases reported. E. coli was the main bacteria identified by multiple practitioners to be responsible for late systemic bacterial infection.
ORT
Practitioners: Equal numbers of respondents were reporting stable to increased cases.
Mycotic respiratory disease
AHL: No cases diagnosed this quarter.
Practitioners: Stable to slightly decreased.
Other respiratory diseases
AHL: One case of E. coli pneumonia identified and on histopathology there was a case of fibrinosuppurative bronchopneumonia.
Practitioners: Stable to slightly decreased cases
Coccidiosis, Mycoplasma, Salmonellosis, Histomoniasis and Multi-drug resistant E. coli (resistant to >3 drugs)
AHL: Cases stable compared to last quarter. Two case of coccidiosis (1 small intestine, 1 small intestine and ceca).
Practitioners: All stable conditions reported by respondents
Necrotic enteritis and enteritis
AHL: Cases stable compared to last quarter. Two cases of necrotic enteritis with underlying coccidiosis. C. perfringens was isolated.
Practitioners: Stable.
Mycoplasma (species)
Practitioners: Stable to decreased cases.
Reovirus tenosynovitis
AHL: The number of cases were increased from last quarter. Three cases were diagnosed on histopathology. One other case had PA 13-22342 identified on sequencing.
Practitioners: Equal numbers of respondents were reporting stable to increased cases this quarter.
Round heart
Practitioners: Stable condition with equal number of respondents reporting increased and decreased cases.
Salmonellosis (clinical)/Salmonella isolation
Practitioners: Reported stable and S. Brandenburg listed by practitioners.
Salmonella isolations in turkey were 427 for the past 12 months and 80 isolations for this quarter.
Ontario Hatchery and Supply Flock Policy (OHSFP) Salmonella isolated in turkey with the following subtypes: S. Cero, S. Brandenburg, S.I: ROUGH-O: z10: e,n,x, S. Uganda and S. Hadar.
Aggression and cannibalism
Practitioners: Generally stable to slightly increased.
AHL and practitioners reported no cases detected for this quarter.
Other
AHL: Other diagnoses included dilated cardiomyopathy, fungal/bacterial dermatitis, necrotizing typhlitis, HE inclusion bodies (in an unvaccinated flock).
Practitioners: Toe trimming practices were identified as the start point of the secondary septic-gangrenous dermatitis caused by Clostridium sepsis, aortic ruptures, and crop mycosis
Provincial slaughter plants: Processing volume average of 16,060/month. The top 3 conditions of condemnation were abscesses, airsaculitis and cellulitis. DOA ratio was 9.7 birds/10,000.
Federal slaughter plants: Processing volume average of 675,000 per month. The top conditions of condemnation were subcutaneous lesions and respiratory. DOA ratio was 6.6 birds/10,000.
Rural/Backyard/Non-Quota Flocks
AHL:
Chickens: Diagnoses at AHL included Ascaridia, Marek’s disease, peritonitis/salpingitis,
stomatitis/esophagitis/tracheitis, chronic heart disease, and osteosarcoma.
Duck: Diagnoses included septicemia (E. coli, Streptococcus parauberis) and airsacculitis/pneumonia.
Goose: One case of septicemia (E. rhusiopathiae, E. coli, E. cecorum).
Practitioners:
Chicken:
Ectoparasitism (lice, mites, and scaly leg mites) and endoparasitism were rated as common or very common. Marek’s disease had variable ratings including one in each category (rare, common, very common). Vent trauma rarely identified. Pneumonia or airsacculitis were listed as common. Other diseases diagnosed were GI impaction, trauma, pododermatitis, septicemia, fatty liver, peritonitis, toxin, and mycoplasma. ILT, urates, histomoniasis, and erysipelas were reported by 2 practitioners but were uncommon. There was one report of rare neoplasia. Everything was relatively stable, other than ecto and endo parasites which may be increased from last quarter.
Turkeys:
Mycoplasma, bacterial septicemia, parasitism, toxin, pododermatitis and neoplasia were identified as stable. The only increased category was parasitism. One respondent reported arthritis in an older turkey.
Waterfowl:
Mycotic pneumonia, bacterial septicemia, parasitism, other intestinal conditions (no comments on this yet), botulism, peritonitis, pododermatitis, toxin and neoplasia were reported as stable since last quarter. One practitioner reported unusual head bobbing with an unknown diagnosis.
Gamebirds/ pigeons:
Practitioner reported canker and trauma as main conditions seen this quarter. During export testing a pigeon was identified as APMV-1 positive, velogenic strain.
Poultry research from Ontario and beyond
- Poultry | Free Full-Text | The Effect of Housing Environment on Egg Production, USDA Egg Size, and USDA Grade Distribution of Commercial White Egg Layers (mdpi.com)
- Poultry | Free Full-Text | Effects of Perching on Poultry Welfare and Production: A Review (mdpi.com)
- Salmonella enterica serovars in absence of ttrA and pduA genes enhance the cell immune response during chick infections | Scientific Reports (nature.com)
Events and News
Poultry Industry Council events: https://www.poultryindustrycouncil.ca/events
Poultry Health Research Network information, events, and lectures can be accessed on the PHRN website: https://phrn.net/ or on the PHRN YouTube channel: https://www.youtube.com/user/PoultryHRN
Thank You!
We thank the following poultry veterinarians who completed the veterinary survey:
Dr. Elizabeth Black, Dr. Joanne Dias, Dr. Fernando Salgado-Bierman, Dr. Shahbaz Haq, Dr. Elana Huong, Dr. Anastasia Novy, Dr. Mike Petrik, Dr. Erin Preiss, Dr. Joanne Rafuse, Dr. Stephanie Rheaburgen, Dr. Ben Schlegel, Dr. Chanelle Taylor, Dr. Brenna Tuer, Dr. Alex Weisz, and Dr. Jessalyn Walkey.
