Biological Control of Three Major Cucumber and Pepper Pests: Whiteflies, Thrips, and Spider Mites, in High Plastic Tunnels Using Two Local Phytoseiid Mites.

To enhance food security, food safety, and environmental health, a bio-based integrated pest management (BIPM) strategy was evaluated at two coastal locations in Lebanon as an alternative to toxic pesticide sprays in commercial high-arched plastic tunnels common in many countries. The evaluation occurred during two cucumber and pepper cropping seasons: spring and fall. At each site, two commercial tunnels were used; farmers' conventional practices were applied in one tunnel, while the BIPM approach was followed in the second tunnel. In the farmers' practices, a total of 14 sprays of insecticide/acaricide mixtures were applied during the spring growing season, and 6 sprays were applied during the fall. In the BIPM tunnels, hotspot releases of local strains of Amblyseius swirskii and Phytoseiulus persimilis were applied. By the end of the spring season, the number of whitefly nymphs (WFNs)/leaf and thrips/leaf in the pesticide treatment were 4.8 and 0.06, respectively, compared to 0.1 and 0.33, respectively, in the BIPM treatment. Similarly, at the end of the fall season, the WFNs reached 19.7/leaf in the pesticide control as compared to 1.2/leaf in the BIPM treatment, proving the efficacy of A. swirskii. Farmers using conventional acaricides during both cropping seasons failed to control Tetranychus urticae, the two-spotted spider mite (TSSM). However, hotspot releases of P. persimilis were successful in controlling TSSM. By the end of June, the number of TSSMs reached 7.8/leaf in the BIPM treatment compared to 53/leaf in the pesticide treatment. Likewise, in December, TSSM numbers reached 9/leaf in the BIPM treatment compared to 40/leaf in the pesticide treatment. Preliminary observations of pepper showed that both predatory mites (A. swirskii and P. persimilis) gave similar or better efficacy against the three pests. The two local predatory phytoseiid mites seem to be effective in controlling these three major pests and to be adapted to local environmental conditions. A rate of increase of 0.86 was observed for P. persimilis and 0.22 for A. swirskii, in June, when maximum temperatures were close to 40 °C. This also shows a compatibility between the two predators. In conclusion, our BIPM approach was efficient under a Mediterranean climate in arched plastic tunnels with relatively poor aeration.

Evaluation of a guardian plant system to suppress Frankliniella occidentalis (Thysanoptera: Thripidae) in greenhouse ornamentals.

BACKGROUND: Western flower thrips (WFT), Franklinella occidentalis (Pergande), is an economically damaging pest of greenhouse ornamentals. A 'guardian plant system' (GPS) that targeted WFT was evaluated under controlled and commercial greenhouse conditions. This system used mycotized millet grains with the entomopathogenic fungus Beauveria bassiana (Balsamo-Crivelli) Vuillemin applied to soil of potted marigolds, Tagetes patula (L.), combined with the foliar-dwelling predatory mite Neoseiulus (=Amblyseius) cucumeris (Oudemans) in slow-release sachets under controlled greenhouse conditions, and with the addition of a pheromone lure under commercial settings. RESULTS: Significantly fewer WFT and less foliar damage on GPS was observed over the 10 and 12 weeks experimental periods compared to the untreated controls. Predatory mites were maintained up to 10 weeks with one release under controlled greenhouse conditions and 12 weeks with two releases in commercial greenhouses. In commercial greenhouses, greater numbers of WFT were found on marigolds than on crop plants within 1 m of the system. Fungal granules persisted for 12 weeks up to 2.5 × 105 CFU g-1 in the GPS soil. CONCLUSION: The use of biological control agents to suppress WFT within a GPS could be a useful IPM strategy for greenhouse production. The marigold GPS attracted WFT which were suppressed primarily through predation by foliar-dwelling predatory mites and to a lesser extent, infection from conidia produced by the granular fungal formulation in the soil. Further investigations into system deployment and fungal granular application rates and new fungal formulations are suggested to improve system efficacy. © 2023 Society of Chemical Industry.

Evaluation of the entomopathogenic fungus Metarhizium brunneum and the predatory mite Stratiolaelaps scimitus against Rhizoglyphus robini under laboratory conditions.

Rhizoglyphus robini Claparède (Acari: Acaridae) is a pest of bulbs, corms and tubers of several economically important crops. The biological control of R. robini has yet to be fully explored as an alternative to chemical pesticides. Entomopathogenic fungi in the genera Metarhizium (Hypocreales: Clavicipitaceae) are used for the biological control of several agricultural pests. The soil-dwelling predatory mite, Stratiolaelaps scimitus (Womersley) (Acari: Acaridae) is also frequently used alone or in combination with other biological control agents. There are few reports on the use of M. brunneum or S. scimutus against R. robini. The objectives of this research were to investigate the in vitro effect of different predatory mite ratios of S. scimitus on R. robini mortality and the combined use of a M. brunneum-based granule with S. scimitus as potential strategies to manage this pest. Mortality of R. robini in Petri dishes containing predators was significantly higher than without predators. When soil-filled containers containing R. robini were treated with both M. brunneum granules and S. scimitus, the lower densities of the bulb mite were obtained with the highest ratio of predator/prey mites. The number of bulb mites in the containers treated with only M. brunneum was significantly lower than the untreated control. These results demonstrate the potential for releasing of S. scimitus alone and in combination with M. brunneum granules to manage R. robini.

A Review of Commercial Metarhizium- and Beauveria-Based Biopesticides for the Biological Control of Ticks in the USA.

There is a need for the development of sustainable, nonchemical tick management strategies. Mycoacaricide and mycoinsecticide product development worldwide has focused primarily on fungi in the genera Beauveria (Hypocreales: Cordycipitaceae) and Metarhizium (Hypocreales: Clavicipitaceae). Microbial biopesticides containing entomopathogenic fungi have potential in tick management. However, despite considerable progress in the development of fungal biopesticides over the past 20 years, the establishment of commercial products available for use against ticks continues to be slow. We reviewed published scientific literature and compiled a comprehensive list of reports of the effectiveness of commercial biopesticides based on the fungal genera Metarhizium and Beauveria and registered for use in the USA against ixodid ticks under laboratory and field conditions. We also report on results when these biopesticides were used as a part of integrated tick management. Until efficacious fungus-based products become more available, tick management will rely primarily on synthetic chemical acaricides, with natural-product acaricides as the alternative.

First Report of the Bat Tick Carios kelleyi (Acari: Ixodida: Argasidae) From Vermont, United States.

The soft tick Carios kelleyi (Cooley and Kohls, 1941) is an ectoparasite of bats that can harbor bacteria known to cause disease in humans, such as Rickettsia spp., Bartonella spp., and relapsing fever Borrelia spp. Human-tick encounters may occur when bats occupy attics or similar dwellings with access points to human-inhabited areas. During May 2021, a partially engorged adult female C. kelleyi was collected from a Vermont home with an attic that was being used as a roost by big brown bats, Eptesicus fuscus (Chiroptera: Vespertilionidae). The source of the blood in the tick was the domestic dog, Canis lupus familiaris. Subsequently, eight C. kelleyi larvae were collected from a rescued E. fuscus adult. This is the first report of a soft tick species from Vermont and it is unknown how long C. kelleyi has been present in this state. Reports of C. kelleyi are on the rise across the northeastern United States but the implications for the health of humans, domestic animals, and bats in northern New England remain unclear. Bat management plans should consider the importance of bat exclusion in preventing tick encounters with members of the household and should include a tick monitoring component if bats are evicted.

Biological control of Western flower thrips, Frankliniella occidentalis using a self-sustaining granular fungal treatment.

Western flower thrips (WFT), Frankliniella occidentalis, is one of the most destructive pests of vegetables, fruits and ornamental crops worldwide, causing extensive damage by direct feeding of the crop and transmitting economically important viruses. Despite the successes of biocontrol agents to control WFT, more efficient and cost-effective ways must be found to encourage grower adoption of integrated pest management. A sustainable fungal treatment was developed to preserve fungal inoculum in potting soil and reduce thrips populations. Combining cooked, oven-dried millet with BotaniGard® (a commercial form of Beauveria bassiana strain GHA) to potting soil increased spore production and persistence of the fungus in the soil. In treated pots with millet, spore concentrations were 3-4 times greater after 30 days compared with spore yields at 10 days. The number of WFT adults was significantly lower in the marigold pots treated with GHA mix + millet than untreated controls, 12% and 10% in treated pots and 70% and 68% in untreated pots in sterile and non-sterile soil, respectively. Incorporation of millet in the potting mix enhanced the effect of the fungal treatments by providing a nutritive substrate on which the fungus could become established. This method is relatively inexpensive and easy for growers to use in greenhouses because granular formulations of B. bassiana are not commercially available.

Cardiopulmonary Testing before Pediatric Adenotonsillectomy for Severe and Very Severe Obstructive Sleep Apnea Syndrome.

OBJECTIVES/HYPOTHESIS: Adenotonsillectomy is first-line treatment for pediatric obstructive sleep apnea syndrome (OSAS) when not otherwise contraindicated. There is concern severe OSAS increases risk of comorbid cardiopulmonary abnormalities, such as ventricular hypertrophy or pulmonary hypertension, which preoperative testing could detect. Our objective is to determine if there is a severity of pediatric OSAS where previously undetected cardiopulmonary comorbidities are likely. STUDY DESIGN: Retrospective chart review. METHODS: We performed a retrospective review of 358 patients ≤21 years with severe OSAS who underwent adenotonsillectomy at a tertiary hospital June 1, 2016 to June 1, 2018. We extracted demographics, comorbidities, polysomnography, and preoperative tests. Wilcoxon rank-sum and logistic regression estimated associations of OSAS severity (based on obstructive apnea-hypopnea index [OAHI], hypoxia, hypercarbia) with preoperative echocardiograms and chest X-rays (CXRs). RESULTS: Mean age was 5.9 (±3.6) years and 52% were male. Mean OAHI and oxygen saturation nadir were 30.3 (±23.8) and 80.7% (±9.2), respectively. OAHI ≥60 was associated with having a preoperative echocardiogram (OR, 3.8; 95% CI, 1.7-8.5) or CXR (OR, 3.0; 95% CI, 1.4-6.8) compared to OAHI 10-59. There were no significant associations between OSAS severity and test abnormalities. The presence of previously diagnosed cardiopulmonary comorbidities was associated with abnormalities on echocardiogram (OR, 36; 95% CI, 4.1-320.1) and CXR (OR, 4.1; 95% CI, 1.2-14.4). CONCLUSIONS: Although pediatric patients with very severe OSAS (OAHI ≥60) underwent more pre-adenotonsillectomy cardiopulmonary tests, OSAS severity did not predict abnormal findings. Known cardiopulmonary comorbidities may be a better indication for cardiopulmonary testing than polysomnographic parameters, which could streamline pre-adenotonsillectomy evaluation and reduce cost. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2361-2368, 2021.

Validation of an Objective Assessment Tool for Tonsillectomy in Otolaryngology Resident Training.

OBJECTIVE: Create and validate an objective structured assessment of technical skills (OSATS) for otolaryngology residents learning how to perform a tonsillectomy. STUDY DESIGN: Multicenter prospective longitudinal validation study. METHODS: A multi-institutional study at six tertiary academic otolaryngology residency programs from July 2009 to May 2012. Using the modified Delphi technique, a panel of pediatric otolaryngologists created a tonsillectomy task-based checklist (TBC) for a tonsil OSATS using a 5-point Likert-type scale. Residents were assessed by pediatric otolaryngology staff at the time of surgery with the TBC and a global rating scale. Procedure time, patient age, number of previously performed tonsillectomies, and surgical technique were also collected. RESULTS: One hundred sixty-seven tonsil OSATS were completed for 38 residents, and competency was recorded for 99 (59.2%). Residents scored as competent had performed significantly more previous tonsillectomies than those deemed noncompetent, 44.4 ± 35.6 and 13.5 ± 11.6, respectively (P < .001). The mean overall score on the tonsil TBC was 4.0 ± 0.8 and 2.6 ± 1.0 for competent and noncompetent, respectively (P < .001). Higher number of tonsillectomies performed and mean tonsil TBC score significantly increased the likelihood of competency (P < .001). Each additional tonsillectomy performed increased the likelihood of achieving competency by 6.3% (P = .006, 95% confidence interval (CI): 1.330-1.110), and each 1.0 point increase in mean tonsil TBC score increased the likelihood of competency by a factor of 2.71 (P = .006, 95% CI:1.330-5.513). There is a 95% likelihood of competency at 48 tonsillectomies or a tonsil TBC score of 4.91. CONCLUSION: The tonsil OSATS is a valid and feasible instrument to assess resident competency with tonsillectomy and provides timely objective feedback. LEVEL OF EVIDENCE: 4. Laryngoscope, 131:E359-E366, 2021.

Evaluation of spray applications of Metarhizium anisopliae, Metarhizium brunneum and Beauveria bassiana against larval winter ticks, Dermacentor albipictus.

Dermacentor albipictus (Acari: Ixodidae), the winter tick, is a one-host tick that parasitizes large ungulates. They can dramatically affect moose, Alces alces (Artiodactyla: Cervidae), causing significant physiological and metabolic stress and mortality among heavily parasitized individuals. Entomopathogenic fungi in the genera Metarhizium (Hypocreales: Clavicipitaceae) and Beauveria (Hypocreales: Cordycipitaceae) are promising tick biological control agents. We examined the pathogenicity of experimental and commercially formulated isolates of M. anisopliae, M. brunneum and B. bassiana sprayed at concentrations of 106, 107 and 108 conidia/mL against the larval stage of D. albipictus and assessed the efficacy of spraying the commercial product Met52®EC, containing M. brunneum, strain F52, under laboratory conditions. Results showed larval D. albipictus mortality was significantly higher and occurred earlier when treated with M. anisopliae and M. brunneum isolates compared to B. bassiana at 106, 107 and 108 conidia/mL. Mortality was observed as early as 3 days in the M. anisopliae and M. brunneum treatments and after 6 days in the B. bassiana treatments. After 21 days, larval mortality ranged from 74-99% when ticks were treated with M. anisopliae and M. brunneum isolates at 106, 107 and 108 and conidia/mL. In contrast, mortality of ticks treated with B. bassiana ranged from 30 to 64%. When larvae were treated with the commercial product Met52, mortality was ~ 45% after 3 days and ~ 96% after 9 days. These results demonstrate the effectiveness of M. anisopliae and M. brunneum against D. albipictus.

Postoperative respiratory complications and disposition in patients with type 1 laryngeal clefts undergoing injection or repair - A single institution experience.

OBJECTIVE: Identify incidence and factors associated with respiratory complications after type 1 cleft repair. METHODS: Retrospective chart review of patients who underwent cleft repair over a 5-year period performed by a single surgeon. Primary endpoint was respiratory complications (oxygen desaturation <90%). Fisher's exact test was used to identify differences between repair types (endoscopic carbon dioxide laser-assisted repair and injection laryngoplasty). Logistic regression was used to identify predictors of respiratory events. RESULTS: Fifty-five patients were included. Thirty-four (62%) patients underwent endoscopic carbon dioxide laser-assisted repair and 21 (38%) underwent injection laryngoplasty. Average hospital stay for each group was 1.6 days (SD = 3.1) and 0.6 days (SD = 0.9), respectively. Desaturations occurred in three patients (9%) in the laser-assisted repair group and one patient (4%) in the injection group. All occurred within 3 h after surgery and resolved with supplemental oxygen, oral airway placement, and/or mask ventilation. Two affected patients had comorbid diagnosis of asthma (one had poor medication compliance), and one had a history of developmental delay and hypotonia. In the injection group, desaturations occurred in one patient with a history of tracheal stenosis and double aortic arch. No correlation existed between repair type and desaturation (p = 0.57). No variables were significant predictors of events. CONCLUSIONS: In this cohort, respiratory events after type 1 laryngeal cleft repair occurred early in the postoperative period, in children with cardiac and pulmonary comorbidities. This suggests postoperative admission may only be necessary for a select group of patients undergoing type 1 cleft repair. However, further research is needed to determine criteria for same-day discharge.

Structure and Functions of Pediatric Aerodigestive Programs: A Consensus Statement.

Aerodigestive programs provide coordinated interdisciplinary care to pediatric patients with complex congenital or acquired conditions affecting breathing, swallowing, and growth. Although there has been a proliferation of programs, as well as national meetings, interest groups and early research activity, there is, as of yet, no consensus definition of an aerodigestive patient, standardized structure, and functions of an aerodigestive program or a blueprint for research prioritization. The Delphi method was used by a multidisciplinary and multi-institutional panel of aerodigestive providers to obtain consensus on 4 broad content areas related to aerodigestive care: (1) definition of an aerodigestive patient, (2) essential construct and functions of an aerodigestive program, (3) identification of aerodigestive research priorities, and (4) evaluation and recognition of aerodigestive programs and future directions. After 3 iterations of survey, consensus was obtained by either a supermajority of 75% or stability in median ranking on 33 of 36 items. This included a standard definition of an aerodigestive patient, level of participation of specific pediatric disciplines in a program, essential components of the care cycle and functions of the program, feeding and swallowing assessment and therapy, procedural scope and volume, research priorities and outcome measures, certification, coding, and funding. We propose the first consensus definition of the aerodigestive care model with specific recommendations regarding associated personnel, infrastructure, research, and outcome measures. We hope that this may provide an initial framework to further standardize care, develop clinical guidelines, and improve outcomes for aerodigestive patients.

Financial and Health Impacts of Multidisciplinary Aerodigestive Care.

OBJECTIVES: (1) Analyze upstream and downstream activity before and after enrollment with the Multidisciplinary Pediatric Aerodigestive Care Team (MPACT). (2) Identify potential demand for MPACT services with ICD-9 data. STUDY DESIGN: Retrospective review of financial claims data. SETTING: Tertiary care children's center. SUBJECTS: Pediatric patients (0-18 years old) enrolled with MPACT (pediatric otolaryngology, gastroenterology, pulmonary, speech-language pathology). METHODS: Case mix data from fiscal years (FYs) 2010-2013 were analyzed for primary, secondary, and tertiary ICD-9 codes in 4 aerodigestive diagnostic categories (ADCs): dysphagia, chronic cough, gastroesophageal disease, and chronic pulmonary disease/asthma. Inclusion criteria included patients <18 years old, seen by MPACT, with FY2010-FY2013 case mix data and ≥2 ADCs. Unique outpatient and inpatient encounters and associated charges were evaluated to determine upstream and downstream activity trends. RESULTS: Of the 126 patients meeting inclusion criteria, 55 (44%) had ≥3 ADCs, and 11 (9%) had 4. These 126 patients received outpatient care during 3068 unique encounters. Outpatient total charges were $282,102 before and $744,542 after MPACT intervention. Eighty-six (68%) patients received inpatient care during 423 unique encounters. Inpatient charges were $4,257,137 before and $2,872,849 after MPACT enrollment. Overall, a net reduction of $921,848 in total charges, $7316 per MPACT patient, was noted. FY2010-FY2014 data identified an additional 1728 pediatric patients with ≥2 ADCs not enrolled in MPACT. CONCLUSION: A cohort of children with aerodigestive disease experienced a shift from inpatient to outpatient care with an overall 20% reduction in patient charges when the years before and after MPACT enrollment were compared. Available ICD-9 data suggest potential demand for MPACT services.

Virulence of BotaniGard(®) to Second Instar Brown Marmorated Stink Bug, Halyomorpha halys (Stål) (Heteroptera: Pentatomidae).

The brown marmorated stink bug, Halyomorpha halys (Stål) (BMSB) is an exotic invasive insect originating in East Asia, currently causing significant damage to fruits, vegetables and other crops throughout most of the Mid-Atlantic states of the U.S. It also is a nuisance pest, entering homes in the fall in search of suitable overwintering sites. Two formulations of BotaniGard(®) with a strain of Beauveria bassiana (GHA) as the active ingredient were tested against second instar BMSB. Both the wettable powder and the emulsifiable suspension formulations were efficacious at 1 × 107 conidia mL(-1), causing 67%-80% mortality 9 days post treatment and 95%-100% after 12 days. The wettable powder formulation was slightly more efficacious.

Airway obstruction after lingual frenulectomy in two infants with Pierre-Robin Sequence.

Pierre-Robin Sequence (PRS) is defined as the triad of micrognathia, glossoptosis, and cleft palate and affects approximately 1/8500 births. Airway obstruction is common in infants with PRS and results from glossoptosis leading to pharyngeal obstruction. Any procedure that increases the severity of glossoptosis, such as lingual frenulectomy, may increase the risk of obstruction or aggravate existing obstruction. This report discusses two cases of significant airway decompensation after lingual frenulectomy requiring surgical intervention in infants with PRS. We suggest that lingual frenulectomy be contraindicated in infants with PRS or suspected PRS due to the possible increased risk of airway obstruction.

Interdisciplinary pediatric aerodigestive care and reduction in health care costs and burden.

IMPORTANCE: Children with complex respiratory and gastrointestinal disorders frequently require care from multiple pediatric subspecialists. Interdisciplinary pediatric aerodigestive clinic centers have been established at several pediatric tertiary care centers in the United States. Their effectiveness is unknown. OBJECTIVE: To determine whether an interdisciplinary approach to pediatric aerodigestive disorders reduces health care costs and burden. DESIGN, SETTING, AND PARTICIPANTS: Retrospective medical record review for the first 125 unique pediatric patients (median age, 1.51 years) seen at the Pediatric Aerodigestive Center (PAC) for aerodigestive disorders between June 2010 and August 2013 for a total of 163 outpatient clinical encounters. The PAC is an academic pediatric tertiary care center where specialists in gastroenterology, otolaryngology, pulmonology, and speech-language pathology provide interdisciplinary evaluation during a single clinic encounter and combined operative management when indicated. INTERVENTIONS: Interdisciplinary evaluation and treatment of pediatric aerodigestive disorders. MAIN OUTCOMES AND MEASURES: Number of operative procedures and estimated hospital charges related to combining clinic encounters and operative procedures. RESULTS: During the initial visit, each of the 125 patients received a mean (SD) of 2.9 (0.8) of a potential 4 services. Estimating per-encounter visit costs for gas, parking, and facility fees, we found that the average cost savings per family per PAC visit was $182. Evaluation under anesthesia was recommended for 85 patients (68%), resulting in 267 operative procedures performed by participating services during 158 encounters with general anesthesia. Thus, 109 episodes of anesthesia were avoided (41% reduction), reducing the risks of anesthesia and related care costs ($1985 per avoided episode). CONCLUSIONS AND RELEVANCE: Coordination of interdisciplinary care in the PAC resulted in a reduction of hospital charges realized through reduction in clinic- and anesthesia-related visits. Reductions in episodes of anesthesia may also reduce neurocognitive risks associated with multiple anesthetic exposures. Other nontangible benefits associated with the coordination of care, such as caregiver satisfaction, warrant further study.

Production of antibacterial Bombyx mori cecropin A in mealworm-pathogenic Beauveria bassiana ERL1170.

Efforts are underway to produce antimicrobial peptides in yellow mealworms (Tenebrio molitor), which can be developed as more effective and safer animal feed additives. In this work, we expressed Bombyx mori (Bm) cecropin-A in mealworms by the infection of transformed entomopathogenic Beauveria bassiana ERL1170. The active domain of Bm cecropin A gene was tagged with a signal sequence of B. bassiana for extracellular secretion, and the fragment was inserted into ERL1170 by the restriction enzyme-mediated integration method. Transformant D-6 showed antibacterial activity against Bacillus subtilis and Listeria monocytogenes. Against T. molitor larvae, D-6 had similar mortality to wild-type, and D6-infected mealworm suspension showed strong antibacterial activity against the two bacteria, but not in the wild-type-infected mealworms, thereby increasing the value of mealworms as animal feed additives.

Hospitalizations in children with preexisting tracheostomy: a national perspective.

OBJECTIVES/HYPOTHESIS: To describe the reasons for hospitalization and characteristics of children with preexisting tracheostomy and to compare hospital utilization between children with and without tracheostomy. STUDY DESIGN: Retrospective cohort study. METHODS: Children with tracheostomy were selected in the Healthcare Cost and Utilization Project Kids' Inpatient Database 2009 using International Classification of Diseases, Ninth Revision, Clinical Modification codes. We compared hospital utilization with the children's clinical characteristics (e.g., chronic condition number and type). We also assessed hospitalizations for tracheostomy complications and ambulatory care sensitive conditions (ACSCs) that could be potentially influenced by high-quality outpatient and community care delivery. RESULTS: In 2009, there were 21,541 hospitalizations for children with tracheostomy totalling $1.4 billion (U.S.). On average, children with tracheostomy had five chronic conditions (standard deviation 1.4). Eighty-one percent (n = 17,448) had one or more complex chronic conditions (CCCs), and 67.1% (n = 14,379) had a gastrostomy. Among children with one or more CCCs, mean hospital charges were greater for hospitalizations of children with tracheostomy compared to without ($69,999 vs. $64,017, P = 0.008). Twenty-one percent (n = 4,421) of all hospitalizations of children with tracheostomy were due to an ACSC (14.5%, n = 3,122) or a tracheostomy complication (6.0%, n = 1,299). Bacterial pneumonia (9.6% of all hospitalizations, n = 2,059) was the most common ACSC. CONCLUSIONS: Children with tracheostomy are a vulnerable group of children with multiple CCCs who experience lengthy and costly hospitalizations. Many hospitalizations are due to an ambulatory care sensitive condition or a tracheostomy complication. Further investigation is needed to determine whether some of these hospitalizations may be avoidable with improved outpatient and community tracheostomy care. LEVEL OF EVIDENCE: 2b.

The association between laryngeal cleft and tracheoesophageal fistula: myth or reality?

OBJECTIVES/HYPOTHESIS: Laryngeal cleft (LC) associated with tracheoesophageal fistula (TEF) with or without esophageal atresia (EA) has rarely been described. The purpose of this study is to review our experience, clinical features, management, delay in diagnosis, and complications in children with these anomalies. STUDY DESIGN: Retrospective chart review at pediatric tertiary referral center. METHODS: Patients diagnosed with LC alone or LC and TEF over a 10-year period were included. Data including demographics, type of TEF and LC, comorbidities, symptoms, management, complications and swallowing outcomes were analyzed. RESULTS: There were 161 pediatric patients diagnosed with LC alone and 22 with LC and TEF. In patients with LC and TEF, aspiration was the most common presenting symptom (n = 11, 50%). Seventeen patients (77%, mean age 4 years 7 months) underwent endoscopic repair and five patients (23%) with type I clefts did not require surgery. Two patients required revision surgery. For patients with LC alone, the mean age at repair was 3.70 years (4 months-19.9 years) compared to 4.69 years (8 months-17.83 years) for patients with LC and TEF (P = 0.0187). The postoperative swallowing studies from 15 patients showed no aspiration. Mean follow-up was 4 years and 6 months. CONCLUSION: The diagnosis and management of LC in patients with TEF is often delayed. If a child presents with persistent aspiration after TEF repair, a complete airway endoscopy should be performed to evaluate for vocal fold mobility and cleft. Endoscopic repair is the recommended approach for those patients requiring surgical intervention. LEVEL OF EVIDENCE: 4.

Molecular markers for species identification of Hessian fly males caught on sticky pheromone traps.

Pheromone traps have been widely used to monitor insect population activity. However, sticky pheromone traps for the Hessian fly (Mayetiola destructor), one of the most destructive pests of wheat, have been used only in recent years. Hessian fly male adults are small and fragile, and preserving specimens during sorting of sticky pheromone traps is a challenge when intact specimens are often required to visually distinguish them from related insects such as fungus gnats. In this study, we have established a quick and reliable method based on polymerase chain reaction markers to correctly distinguish Hessian fly males from other closely related insects. Two Hessian fly-specific markers were established, one based on the trypsin gene MDP-10 and the other based on a gene encoding the salivary gland protein SSGP31-5. Both markers provided > 98% identification success of 110 Hessian fly samples prepared from single insects. The method should provide a useful tool to allow for identification of Hessian fly individuals on sticky pheromone traps or in other situations when Hessian fly eggs, larvae, pupae, and adults are difficult to distinguish from other insects.

A novel approach: Beauveria bassiana granules applied to nursery soil for management of rice water weevils in paddy fields.

BACKGROUND: Spraying of entomopathogenic fungi formulated as wettable powders and suspension concentrates based on oils or water has been used for the management of crop pests. However, the use of fungal granules to control paddy field pests has not been fully explored. Herein, several Beauveria bassiana isolates (ERL1170, ERL1578 and ERL836) were produced as granules using a millet-based solid culture. The granules were applied to the rice nursery 3 days before transplanting, and their control efficacy against rice water weevils was determined in paddy fields. RESULTS: The solid cultures produced ∼1 × 10(8) conidia g(-1) of millet grains 10 days after the inoculation. The granules were applied to the soil in the rice nursery 3 days before the rice seedlings were transplanted in the paddy fields. Rice in plots with granules of ERL1578 had 17.3% leaf damage (74% control efficacy) 14 days post-application, whereas rice plants in the untreated control had 66.5% damage. Rice plants treated in the nursery with ERL1170 and ERL836 had 52-54% damage. In the rice plots previously treated with ERL1578, the smallest numbers of larvae and adults were observed 38 days post-application. In laboratory conditions, ERL1578-treated larvae turned pink and were covered with mycelial mass. CONCLUSION: Applications of millet-based B. bassiana granules on rice nursery soil can be an effective and efficient biological control strategy for the management of rice water weevils. This method can be relatively inexpensive and requires less labor than practices involving the spraying of fungi directly on rice in paddy fields.