Implementation of an Analgesia-Sedation Protocol Is Associated With Reduction in Midazolam Usage in the PICU
OBJECTIVES: Examine the association of a revised analgesia-sedation protocol with midazolam usage in the PICU. DESIGN: A single-center nonrandomized before-after study. SETTING: PICU at a quaternary pediatric hospital (Boston Children’s Hospital, Boston, MA). PATIENTS: Children admitted to the PICU who were mechanically ventilated for greater than 24 hours. The preimplementation cohort included 190 eligible patients admitted between July 29, 2017, and February 28, 2018, and the postimplementation cohort included 144 patients admitted between July 29, 2019, and February 28, 2020. INTERVENTIONS: Implementation of a revised analgesia-sedation protocol. MEASUREMENTS AND MAIN RESULTS: Our primary outcome, total dose of IV midazolam administered in mechanically ventilated patients up to day 14 of ventilation, decreased by 72% (95% CI [61–80%]; p
Optimal nutrition is crucial for honey bee colony growth and robust immune systems. Honey bee nutrition is complex and depends on the floral composition of the landscape. Foraging behavior of honey bees depends on both colony environment and external environment. There are significant gaps in knowledge regarding honey bee nutrition, and hence no optimal diet is available for honey bees, as there is for other livestock. In this review, we discuss (1) foraging behavior of honey bees, (2) nutritional needs, (3) nutritional supplements used by beekeepers, (4) probiotics, and (5) supplemental forage and efforts integrating flor...
Honey bees are faced with many diseases, some more serious than others. Observing irregularities during routine hive inspection may indicate potential problems. Not all disorders are equally important; some are more detrimental and need immediate attention, whereas others may only need time to clear up. It is important to be observant to be able to recognize these diseases and differentiate between them so the correct treatment may be done in a timely manner when needed to maintain the health of the colony. Colonies need to be healthy to survive and prosper.
Honeybee veterinary medicine is a developing field in Canada and the United States. Veterinarians interested in working with honeybees should develop a comprehensive knowledge base on disease dynamics as it applies to the individual, colony, apiary, and broader honeybee populations. There are currently several governmental, academic, and industry organizations that are carrying out epidemiological-based surveys. Although honeybees face unique challenges in regard to biosecurity, the basic principles still apply. Veterinarians can use their expertise in the area of biosecurity to make improvements to current protocols withi...
Honey bee (Apis mellifera) health and hive transport are regulated by local apiary programs composed of apiary inspectors. Inspectors monitor and ensure the health of honey bees through field visits to apiaries where they inspect, identify, diagnose, and provide recommendations for the treatment of honey bee health issues. Laws and regulations pertaining to beekeeping and honey bee health are present in most states, territories, and provinces. Veterinarians are encouraged to establish a relationship with their local apiary inspector to further support beekeepers and the management of healthy honey bee colonies.
Honey bee colonies can be afflicted by serious conditions beyond infectious etiologies. Noninfectious conditions, such as starvation, laying worker colonies, and environmental dysregulation, can be as devastating as any disease. Improper hive monitoring and care often are the underlying causes of noninfectious conditions and each condition may be prevented by instituting best management practices.
Infectious and parasitic diseases plague honey bees similarly to that of other food animal species. A complete understanding of each is necessary for a honey bee veterinarian to establish a strong veterinarian-client-patient relationship and make sound treatment recommendations. Control and management of these diseases is paramount to success of the colony and apiary operation. The following is not meant to be an end-all of information on each of the common honey bee diseases but more so a review and photo-documentation of each. A deeper understanding can be established through various other sources previously published an...
Raising Commercial Dairy Calves
Jeffrey R. Applegate Jr and Britteny Kyle
ROBERT A. SMITH, DVM, MS