Warmer autumns and winters could reduce honey bee overwintering survival with potential risks for pollination services.

Honey bees and other pollinators are critical for food production and nutritional security but face multiple survival challenges. The effect of climate change on honey bee colony losses is only recently being explored. While correlations between higher winter temperatures and greater colony losses have been noted, the impacts of warmer autumn and winter temperatures on colony population dynamics and age structure as an underlying cause of reduced colony survival have not been examined. Focusing on the Pacific Northwest US, our objectives were to (a) quantify the effect of warmer autumns and winters on honey bee foraging activity, the age structure of the overwintering cluster, and spring colony losses, and (b) evaluate indoor cold storage as a management strategy to mitigate the negative impacts of climate change. We perform simulations using the VARROAPOP population dynamics model driven by future climate projections to address these objectives. Results indicate that expanding geographic areas will have warmer autumns and winters extending honey bee flight times. Our simulations support the hypothesis that late-season flight alters the overwintering colony age structure, skews the population towards older bees, and leads to greater risks of colony failure in the spring. Management intervention by moving colonies to cold storage facilities for overwintering has the potential to reduce honey bee colony losses. However, critical gaps remain in how to optimize winter management strategies to improve the survival of overwintering colonies in different locations and conditions. It is imperative that we bridge the gaps to sustain honey bees and the beekeeping industry and ensure food and nutritional security.

Association of Discharge Location Following Pediatric Tracheostomy with Social Determinants of Health: A National Analysis.

OBJECTIVE: To evaluate the breakdown of discharge locations among pediatric tracheostomy patients and determine the impact of demographic variables and social determinants of health. STUDY DESIGN: Retrospective review of the 2016 and 2019 Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP KID). SETTING: A total of 4000 United States community hospitals, defined as short-term, non-Federal, general, and specialty hospitals. METHODS: ICD-10-PCS, ICD-10 CM codes, and HCUP data elements were selected for patients and variables of interest. Bivariate comparisons were performed using Rao-Scott Chi-square tests; significance levels in post hoc pairwise testing were adjusted using Bonferroni adjustment. Multinomial generalized logistic regression models were used to determine the average annual odds ratio (OR) of 3 dispositions at discharge relative to discharge home for self-care. RESULTS: Patients aged 11-17, patients from large metropolitan areas, and patients of "Other" race have an increased odds of discharge to a short- or long-term care facility (all P < .001). Weekend admissions, nonelective admissions, patients in Northeast hospitals, and patients at urban nonteaching hospitals are also more likely to be discharged to a short- or long-term care facility (all P < .001). Mean and median total costs of admission were $424,387 and $243,479, respectively, with a median total charge of $854,499. CONCLUSION: Among pediatric tracheostomy patients, demographic factors that affect discharge disposition include age, community type, and race, and significant hospital factors include day and type of admission, geographic region, and hospital type. Hospitalizations are associated with high overall costs and charges to the patient, which are increasing over time.

Phytochemicals, Probiotics, Recombinant Proteins: Enzymatic Remedies to Pesticide Poisonings in Bees.

The ongoing global decline of bees threatens biodiversity and food safety as both wild plants and crops rely on bee pollination to produce viable progeny or high-quality products in high yields. Pesticide exposure is a major driving force for the decline, yet pesticide use remains unreconciled with bee conservation since studies demonstrate that bees continue to be heavily exposed to and threatened by pesticides in crops and natural habitats. Pharmaceutical methods, including the administration of phytochemicals, probiotics (beneficial bacteria), and recombinant proteins (enzymes) with detoxification functions, show promise as potential solutions to mitigate pesticide poisonings. We discuss how these new methods can be appropriately developed and applied in agriculture from bee biology and ecotoxicology perspectives. As countless phytochemicals, probiotics, and recombinant proteins exist, this Perspective will provide suggestive guidance to accelerate the development of new techniques by directing research and resources toward promising candidates. Furthermore, we discuss practical limitations of the new methods mentioned above in realistic field applications and propose recommendations to overcome these limitations. This Perspective builds a framework to allow researchers to use new detoxification techniques more efficiently in order to mitigate the harmful impacts of pesticides on bees.

Comparison of indoor (refrigerated) versus outdoor winter storage of commercial honey bee, Apis mellifera (Hymenoptera: Apidae), colonies in the Western United States.

Honey bees (Apis mellifera L.) are critical to the pollination of many important crops in the United States, and one crop that demands large numbers of colonies early each year is almonds. To provide adequate numbers of colonies for almond pollination, many beekeepers move colonies of bees to high-density holding yards in California in late fall, where the bees can fly and forage, but little natural pollen and nectar is available. In recent years, high colony losses have occurred in some operations following this management strategy, and alternative approaches, including indoor storage of colonies, have become more commonly used. The current study evaluated colonies kept indoors (refrigerated and/or controlled atmosphere) for the winter compared with those kept outdoors in either Washington or California. Colonies were evaluated for strength (frames of bees), brood area, lipid composition of worker bees, colony weight and survival, parasitic mites (Varroa mites, tracheal mites), and pathogens (Nosema spp.). No differences were found in colony weight, survival, parasitic mite levels, or pathogen prevalence among the treatments. Colonies stored indoors and outdoors in WA had significantly more frames of bees and less brood present after the storage period than colonies stored outdoors in CA. Lipid composition of honey bees stored indoors was significantly higher than colonies stored outdoors in WA or CA. The implications of these findings for overall colony health and improved pollination activity are discussed.

Interdisciplinary assessment of tracheostomy care knowledge: An opportunity for quality improvement.

PURPOSE: A 2013 AAOHNS consensus statement called for reduced variation in tracheostomy care. Multidisciplinary approaches and standardized protocols have been shown to improve tracheostomy outcomes. This study aims to identify inconsistencies in knowledge in order to design standardized education targeting these areas to improve quality of care. MATERIALS AND METHODS: An online, multiple-choice tracheostomy care knowledge assessment was administered to nurses and respiratory therapists in ICUs, stepdown units, and regular nursing floors, as well as residents in otolaryngology, general surgery, and thoracic surgery. The survey was administered and data were recorded using the Select Survey online platform. RESULTS: 173 nurses, respiratory therapists, and residents participated in this study. Over 75 % of respondents identified correct answers to questions addressing basic tracheostomy care, such as suctioning and humidification. Significant variation was observed in identification and management of tracheostomy emergencies, and appropriate use of speaking valves. Only 47 % of all respondents identified all potential signs of tracheostomy tube displacement. Respiratory therapists with over 20 years of experience (p = 0.001), were more likely to answer correctly than those with less. Nurses were less likely than respiratory therapists to have received standardized tracheostomy education (p = 0.006) and were less likely than others to choose the appropriate scenario for speaking valve use (p = 0.042), highlighting the need for interdisciplinary education. CONCLUSIONS: An interdisciplinary assessment of tracheostomy care knowledge demonstrates variation, especially in identification and management of tracheostomy emergencies and appropriate use of speaking valves. Design of a standardized educational program targeting these areas is underway.

Refractory tympanostomy tube otorrhea: Outcomes with otowick placement.

OBJECTIVE: To evaluate rates of resolution of and antibiotic use in refractory otorrhea (otorrhea ≥2 weeks with no more than 2 days of otorrhea resolution during the episode) with otowick placement in comparison to medical therapy and tube removals with or without replacements. STUDY DESIGN: Retrospective cohort study of pediatric patients with a history of tympanostomy tube placement and refractory otorrhea between 2017 and 2022. SETTING: Cleveland Clinic Foundation (CCF) pediatric otolaryngology group. METHODS: Demographic data (sex, race, and age at tympanostomy tube placement) were collected. Outcome measures included number of oral and topical antibiotic treatments, duration of otorrhea episode, and resolution of otorrhea at 1 and 3 months follow-up. Wilcoxon rank sum and Kruskal-Wallis tests were used to compare number of antibiotics treatments. An ANOVA test and linear regression model using log-transformed data were used to compare duration of otorrhea. Fisher's exact test was used to compare rates of otorrhea recurrence. RESULTS: 70 patients met inclusion criteria: 37 male (52.9%), 33 female (47.1%), with an average age at tube placement of 29.66 months. There was a statistically significant decrease in total duration of otorrhea (in days) with otowicks (17.29 ± 13.13), compared to patients receiving medical therapy (27.09 ± 22.02) and tube removals and replacements (29.63 ± 19.95) (p = 0.025). There was no significant difference between the follow-up rates of resolution at 1 month (p = 1) and 3 months (p = 0.12). CONCLUSION: Otowick use is associated with shorter duration of otorrhea and can be considered as a first-line treatment for refractory otorrhea. Otowicks and medical therapy alone can reduce need for tube removals and the associated risk of anesthesia.

Strategies and techniques to mitigate the negative impacts of pesticide exposure to honey bees.

In order to support food, fiber, and fuel production around the world, billions of kilograms of pesticides are applied to crop fields every year to suppress pests, plant diseases and weeds. These fields are often home to the most important commercial pollinators, honey bees (Apis spp.), which improve yield and quality of many agricultural products. The pesticides applied to support crop health can be detrimental to honey bee health. The conflict of pesticide use and reliance on honey bees contributes to significant honey bee colony losses across the world. Recommendations for reducing impact on honey bees are generally suggested in literature, pesticide regulations, and by crop consultants, but without a considerable discussion of the realistic limitations of protecting honey bees. New techniques in farming and beekeeping can reduce pesticide exposure through reduction in bee exposure, reduced toxicity of pesticides, and remedies that can be in response to exposure. However, lack of assessment of those new techniques under a systematical, comprehensive framework may overestimate or underestimate these techniques' potential to protect honey bees from pesticide damage. In this review, we summarize the current and arising strategies and techniques with the goal to inspire the development and adoption of pesticide mitigation practices for both agriculture and apiculture.

Utility of the finance-electronic medical record digital dashboard in pediatric otolaryngology.

BACKGROUND: The time and cost of data collection via chart review of the electronic medical record (EMR) is a research barrier. This study describes the development of a digital dashboard conjoining EMR and finance data and its application in a pediatric otolaryngology practice. METHODS: The dashboard creates a common language crosswalk between surgeries via the EMR, financial data, and national Vizient database. First, all Otolaryngology procedures billed via ICD-10 or CPT codes were categorized into Procedure Groups, which constitute the common language that links all data sources. The joined dataset was inputted into a Tableau workbook supporting dynamic filtering and custom real-time analysis. RESULTS: The dashboard includes 84 Procedure Groups within Otolaryngology. Examples for pediatrics include Sistrunk procedure and supraglottoplasty. User-friendly dynamic filtering by Procedure Group, surgery date range, age, insurance, hospital, surgeon, and discharge status were developed. Outcomes include length of stay, telephone callbacks, postoperative hemorrhage, reoperations, return to Emergency Department, readmissions, and mortality. National comparisons can be analyzed via embedded Vizient data. The usability of the dashboard was tested by evaluating pediatric tonsillectomy outcomes, which revealed a significantly higher rate of postoperative hemorrhages and reoperations during the COVID-19 pandemic. CONCLUSION: The hybrid finance/EMR dashboard creates a crosswalk between data sources and shows utility for use in evaluating patient outcomes via real-time data analysis and dynamic filtering. This innovative dashboard expedites data extraction, promoting efficient implementation of quality improvement initiatives and surgical outcomes research.

Amplifying patient voices amid pandemic: Perspectives on tracheostomy care, communication, and connection.

OBJECTIVE: To investigate perspectives of patients, family members, caregivers (PFC), and healthcare professionals (HCP) on tracheostomy care during the COVID-19 pandemic. METHODS: The cross-sectional survey investigating barriers and facilitators to tracheostomy care was collaboratively developed by patients, family members, nurses, speech-language pathologists, respiratory care practitioners, physicians, and surgeons. The survey was distributed to the Global Tracheostomy Collaborative's learning community, and responses were analyzed. RESULTS: Survey respondents (n = 191) from 17 countries included individuals with a tracheostomy (85 [45 %]), families/caregivers (43 [22 %]), and diverse HCP (63 [33.0 %]). Overall, 94 % of respondents reported concern that patients with tracheostomy were at increased risk of critical illness from SARS-CoV-2 infection and COVID-19; 93 % reported fear or anxiety. With respect to prioritization of care, 38 % of PFC versus 16 % of HCP reported concern that patients with tracheostomies might not be valued or prioritized (p = 0.002). Respondents also differed in fear of contracting COVID-19 (69 % PFC vs. 49 % HCP group, p = 0.009); concern for hospitalization (55.5 % PFC vs. 27 % HCP, p < 0.001); access to medical personnel (34 % PFC vs. 14 % HCP, p = 0.005); and concern about canceled appointments (62 % PFC vs. 41 % HCP, p = 0.01). Respondents from both groups reported severe stress and fatigue, sleep deprivation, lack of breaks, and lack of support (70 % PFC vs. 65 % HCP, p = 0.54). Virtual telecare seldom met perceived needs. CONCLUSION: PFC with a tracheostomy perceived most risks more acutely than HCP in this global sample. Broad stakeholder engagement is necessary to achieve creative, patient-driven solutions to maintain connection, communication, and access for patients with a tracheostomy.

Elevated CO2 Increases Overwintering Mortality of Varroa destructor (Mesostigmata: Varroidae) in Honey Bee (Hymenoptera: Apidae) Colonies.

Indoor storage of honey bees (Apis mellifera L.) during winter months has been practiced for decades to protect colonies from the adverse effects of long, harsh winter months. Beekeepers have recently employed indoor storage to reduce labor, feeding costs, theft, and woodenware degradation. Despite the growing number of colonies stored indoors, national survey results still reveal high losses. Varroa mites (Varroa destructor Anderson and Trueman) are the most critical threat to colony winter survival and health of colonies because they contribute to the transmission of viruses and colony mortality. To investigate the effect of high CO2 on varroa mites during the indoor storage of honey bees, 8-frame single deep colonies were stored in two separate environmental chambers at 4°C each. One environmental chamber was set at 8.5% CO2 (high CO2), while the other was set at low CO2 (0.12%). Dead and falling mites were collected and counted from the bottom of individual colonies weekly during the experiment. There was a significant difference in mite mortality of colonies with high CO2 compared to colonies held at low CO2. These results indicated that high CO2 could increase mite mortality during the period of indoor storage, potentially improving honey bee health coming out of the winter months. Our research offers a critical addition to beekeepers' tools for managing varroa mite populations.

An institution-wide tracheostomy rounding team: Initial caregiver perceptions.

PURPOSE: To analyze and present the initial findings of provider perceptions regarding the impact of the implementation of a hospital-wide Tracheostomy Rounding Team (TRT) on the delivery of tracheostomy care at the Cleveland Clinic. MATERIALS AND METHODS: Based on prior literature, a novel multidisciplinary TRT was designed and implemented at the Cleveland Clinic in December of 2018. After the TRT began clinical care, a previously validated RedCap survey was administered anonymously to 358 caregivers to assess provider experience, comfort, and prior education regarding tracheostomy management. Survey results were collected, and descriptive statistics were applied. Answers were compared between providers who interacted with the TRT clinically and those who did not. RESULTS: 42.9% of providers who interacted with the TRT clinically reported that the TRT improved hands-on assistance with tracheostomy care, and 36.7% reported that the TRT improved the identification of safety concerns. Similarly, 34.7% reported that the TRT improved the overall quality of tracheostomy care at the Cleveland Clinic. Providers with active exposure to the TRT additionally reported statistically higher comfort with multiple topics surrounding tracheostomy care. CONCLUSIONS: The implementation of this team improved provider comfort in managing patients with tracheostomies both qualitatively and quantifiably. This intervention offered a perceived benefit to patient care at our institution. Further study of the impact of this team on quantitative patient outcomes is forthcoming.

Directed evolution of Metarhizium fungus improves its biocontrol efficacy against Varroa mites in honey bee colonies.

Entomopathogenic fungi show great promise as pesticides in terms of their relatively high target specificity, low non-target toxicity, and low residual effects in agricultural fields and the environment. However, they also frequently have characteristics that limit their use, especially concerning tolerances to temperature, ultraviolet radiation, or other abiotic factors. The devastating ectoparasite of honey bees, Varroa destructor, is susceptible to entomopathogenic fungi, but the relatively warm temperatures inside honey bee hives have prevented these fungi from becoming effective control measures. Using a combination of traditional selection and directed evolution techniques developed for this system, new strains of Metarhizium brunneum were created that survived, germinated, and grew better at bee hive temperatures (35 °C). Field tests with full-sized honey bee colonies confirmed that the new strain JH1078 is more virulent against Varroa mites and controls the pest comparable to current treatments. These results indicate that entomopathogenic fungi are evolutionarily labile and capable of playing a larger role in modern pest management practices.

Nitrogen vapor immersion: An accessible alternative for honey bee (Apis mellifera L.) semen cryopreservation.

Semen cryopreservation is a valuable conservation tool and is often used in livestock species to accelerate artificial selection of desirable traits. Recently, semen cryopreservation has been successfully introduced to honey bees, bolstering trait selection for breeders and aiding conservation efforts for threatened bee populations. Current cryopreservation methods use slow-programmable freezing to achieve long-term storage of honey bee germplasm. However, the equipment necessary for this method is costly and time consuming to use, making it less accessible to breeders and researchers. We tested two cost and time efficient alternatives to slow-programmable freezing, vitrification and vapor immersion using two freezing devices, the CryoLock and microdialysis tube. Semen was preserved in either 20, 40, or 60% dimethyl sulfoxide (Me2SO). The post-thaw sperm viability (% living sperm) and subjective motility (0-5 scale) of these techniques were compared to those of slow-programmable frozen semen and non-frozen controls. Semen frozen in microdialysis tubes produced higher motility and sperm viability than semen frozen with the CryoLock device. The same trend was observed between vapor immersion and vitrification, with vapor immersion proving superior. Vapor immersed semen dialyzed with 20% Me2SO produced statistically similar sperm motility (4 ± 0.41) and viability (73.51% ± 5.56%) to slow-programmable freezing (4.25 ± 0.25, 80.61% ± 4.20%) and the non-frozen control (4.5 ± 0.28, 93.39% ± 0.90%). Optimization of the dialysis process and freezing rate may further increase the post-thaw sperm quality. Nonetheless, these results show promise for an effective replacement to slow-programmable freezing that maintains high sperm quality while increasing accessibility.

Diagnosis and patterns of hearing loss in children with severe developmental delay.

INTRODUCTION & OBJECTIVE: Children with cognitive delay often experience challenges with obtaining hearing thresholds through behavioral audiometry (BA). This necessitates sedated Auditory Brainstem Response (sABR) testing. This study aimed to evaluate diagnostic and hearing patterns in children with Down Syndrome (DS), Autism Spectrum Disorder (ASD), Global Developmental delay (GDD), and Cerebral Palsy (CP) who were unable to complete reliable BA testing due to severe cognitive delay. METHODS: Retrospective chart review on a cohort of children aged 0.5-18 years with a diagnosis of DS, ASD, GDD, or CP who underwent sABR due to unsuccessful BA testing. This was performed at a tertiary care institution from 2014 to 2019. Testing patterns and audiometric data were collected. RESULTS: Across 15 DS, 39 ASD, 10 GDD, and 11 CP patients, the average time from first nondiagnostic BA to sABR ranged from 8.6 months (in GDD) to 21.8 months (in DS). The average number of BAs performed before sABR ranged from 1.6 (in ASD and GDD) to 2.7 (in DS). Hearing loss (HL) was diagnosed in 10%, 13%, 36% and 46% of patients with GDD, ASD, CP and DS respectively. Up to 75% of the HL was sensorineural (in CP patients). CONCLUSION: In children with significant cognitive delays, a high incidence of HL (especially SNHL) was identified, therefore high suspicion for HL should be held in these patients. Multiple unsuccessful BAs contribute to prolonged time to diagnosis and treatment, thus prompt sABR should be performed in patients whose severe cognitive delay inhibits reliable testing with BA.

Impacts of Different Winter Storage Conditions on the Physiology of Diutinus Honey Bees (Hymenoptera: Apidae).

Global decline in insect pollinators, especially bees, have resulted in extensive research into understanding the various causative factors and formulating mitigative strategies. For commercial beekeepers in the United States, overwintering honey bee colony losses are significant, requiring tactics to overwinter bees in conditions designed to minimize such losses. This is especially important as overwintered honey bees are responsible for colony expansion each spring, and overwintered bees must survive in sufficient numbers to nurse the spring brood and forage until the new 'replacement' workers become fully functional. In this study, we examined the physiology of overwintered (diutinus) bees following various overwintering storage conditions. Important physiological markers, i.e., head proteins and abdominal lipid contents were higher in honey bees that overwintered in controlled indoor storage facilities, compared with bees held outdoors through the winter months. Our findings provide new insights into the physiology of honey bees overwintered in indoor and outdoor environments and have implications for improved beekeeping management.

Office-Based Lower Airway Endoscopy: Feasibility and Safety.

OBJECTIVES: The primary aim of this study was to identify the ease and safety of office-based lower airway endoscopy (OLAE) in patients with and without comorbidities. In addition, we identified the most common indications for OLAE and the associated diagnosis. METHODS: A retrospective review on 567 patients and 706 in-office flexible fiberoptic procedures was performed. Using a previously established grading system, the ease of visualization of the subglottis, trachea, and carina was assessed, in addition to the overall ease of the exam. RESULTS: Four hundred and eighty-eight videos were available for review. Of those, 105 videos included an OLAE, accounting for 21.5% of all procedures. Laryngomalacia was the most common diagnosis in 35 of 105 (36%) OLAE. For all laryngomalacia cases, the overall ease was found to be on average 2.15 (standard error 0.12). Fisher exact testing showed a statistical significance in the ability to visualize the trachea between the types of Laryngomalacia (LM) (P = .035). Fisher exact testing was performed comparing LM types I, II, or III, and combined types of LM; no statistical difference was found between groups. In 4.76% of OLAE procedures, a subglottic pathology was diagnosed. Comorbidities were found in OLAE 26 of 105 patients. There were no complications identified. CONCLUSION: We found OLAE more challenging than previously reported. OLAE of combined types of laryngomalacia was subjectively more difficult, but this difference did not reach statistical significance. OLAE continues to be a safe alternative to operative laryngoscopy in pediatric patients and appears safe in those with comorbidities when precautions are taken. LEVEL OF EVIDENCE: 4. Laryngoscope, 131:E649-E652, 2021.

Zinc-Sponge Battery Electrodes that Suppress Dendrites.

We report two methods to create zinc-sponge electrodes that suppress dendrite formation and shape change for rechargeable zinc batteries. Both methods are characterized by creating a paste made of zinc particles, organic porogen, and viscosity-enhancing agent that is heated under an inert gas and then air. During heating under the inert gas, the zinc particles anneal together, and the porogen decomposes; under air, the zinc fuses and residual organic burns out, yielding an open-cell metal foam or sponge. We tune the mechanical and electrochemical properties of the zinc sponges by varying zinc-to-porogen mass ratio, heating time under inert gas and air, and size and shape of the zinc and porogen particles. An advantage of the reported methods is their ability to finely tune zinc-sponge architecture. The selected size and shape of the zinc and porogen particles influence the morphology of the pore structure. A limitation is that resulting sponges have disordered pore structures that result in low mechanical strength at low volume fractions of zinc (<30%). Applications for these zinc-sponge electrodes include batteries for grid-storage, personal electronics, electric vehicles, and electric aviation. Users can expect zinc-sponge electrodes to cycle up to 40% depth of discharge at technologically relevant rates and areal capacities without the formation of separator-piercing dendrites.

Benign postcricoid hypertrophy: Case report and review of the literature.

This is a case of a premature infant with stridor, supplemental oxygen requirement, and dysphagia refractory to anti-reflux and anti-inflammatory medications. Endoscopy revealed postcricoid fullness with MRI showing submucosal lobulations. Microscopic resection of an obstructive postcricoid mass resulted in immediate resolution of stridor and oxygen requirement with mild improvement in dysphagia. Pathology demonstrated submucosal fibrosis, edema, and vascularity with no evidence of malignancy, fibromatosis, or cystic/polypoid components. Review of the literature shows that lesions in postcricoid region include amyloidosis, lymphatic malformation, and normal-variant hypertrophy. Surgery should be considered for atypical postcricoid lesions with symptoms refractory to medical management.