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Abstract Importance Tracheotomy is one of the riskiest procedures for composite morbidity within pediatric otolaryngology. During the postoperative period, each time the tracheostomy tube is manipulated, there is opportunity for morbidity (e.g. a patient is vulnerable to accidental decannulation and airway loss). Objective To identify areas of improvement in caring for “fresh tracheostomy” patients by determining the number of times a tracheostomy tube is manipulated from placement until discharge. The hypothesis is that the more a tracheostomy is manipulated, the higher probability of morbidity. Methods A quality improvement initiative was conducted to map the care of patients who underwent tracheostomy placement over 12 months. Tracheostomy care and manipulation by all providers were reviewed. Complications, wound care, and respiratory treatments were also evaluated. Results Patients were hospitalized for an average of 39 days (7–140) following tracheostomy. The first tracheostomy tube change occurred on average 6 days (5–10) following placement. Tracheostomy tubes were manipulated an average of 6 (2.5–11.9) times a day to amount to 216 (51–1091) times between placement and discharge. Bedside nurses and respiratory therapists were responsible for 95% of these actions; physicians accounted for 4%. There were 6 tracheostomy related complications. Three were accidental decannulations resulting in cardiopulmonary arrest. One of these caused long term patient morbidity. Patients with more than 4 manipulations per day during the 2 weeks following tracheostomy tube placement, were more likely to have a tracheostomy related complication than those with less than 4 (OR: 12.5; 95% CI: 1.2–130.6; P = 0.0349). Interpretation While uncommon, complications related to tracheostomy can have serious long term effects and at best prolongs length of stay for patients. Reducing the number of tracheostomy manipulations may provide safer postoperative care ultimately reducing morbidity and potentially mortality; children on average have 6 tracheotomy manipulations/day with only 2% being by the physician.

The objectives of this study were to estimate the residual and half-life of [imazapic + imazapyr] and to infer on the impact of these residuals over time. The first experiment comprised the application of [imazapic + imazapyr] to Clearfield ® rice. On the following summer cropping season (365 days later), undeformed soil samples 0-5 cm depth were collected and seeds of six species or varieties were sown as bioindicators of residuals (experiment 2), being assessed plant height and dry mass 20 days after emergence start. The third experiment comprised the cultivation of the same species submitted to ten increasing herbicide doses (0-280 g ha -1 ) to establish standard response curves, also assessing plant height and dry mass 20 days after emergence start. About 2.1-5.8% of the applied imazapic remains in soil after one year, for the label doses. Imazapyr was considered to be at negligible doses as its half-life is short, and less than 0.0000001% of the applied dose is expected to be in soil 365 days later. The expected imazapic half-life in lowland areas of Southern Brazil is longer than for dryland, being estimated as between 63 and 77 days (95% confidence interval), contrasting to the 60 days half-life previously estimated for dryland soils.