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Objectives: Dysphagia is a presenting symptom of both pharyngeal and oesophageal cancers. The referral pathway choice is determined by whether it is thought to be oropharyngeal or oesophageal, and this is in turn influenced by whether dysphagia is perceived to be above or below the suprasternal notch. We studied the concordance between the presence of pharynx‐localised dysphagia (PLD) and the location of the underlying disease processes. Design: A subset analysis of the Dysphagia Hotline Cohort, collected between 2004 and 2015, of patients with PLD and a structural diagnosis. Main outcome measures: Information about patient demography and presenting symptoms were recorded. The incisor‐to‐pathology distance, and the nature of the pathology, were recorded. Logistic regression analysis was used to identify independent predictors of malignancy. Results: The study included 177 patients. There were 92 males, and mean age at presentation was 74 years. The commonest benign pathologies were cricopharyngeal dysfunction with or without pharyngeal pouch (n = 67), peptic stricture (n = 44) and Schatzki's ring (n = 11). There were 49 cases of cancer, including one hypopharyngeal cancer, one cervical oesophageal cancer, 28 cancers of the upper/mid‐thoracic oesophagus, 15 cancers of the lower thoracic oesophagus and 4 cardio‐oesophageal cancers. In 105 (59%) patients, PLD was caused by oesophageal disease. Independent predictors of malignancy were weight‐change (loss >2.7 kg), a short history (<12 weeks) and presence of odynophagia. Nineteen (39%) of oesophageal cancers that presented with dysphagia that was localised only to the pharynx would have been beyond the reach of rigid oesophagoscopy. Conclusions: Pharynx‐localised dysphagia is more likely to be a referred symptom of structural oesophageal disease, including cancer, than a primary symptom of structural pharyngeal disease. Absence of additional alarm symptoms such as a short history, weight‐loss, and odynophagia, do not adequately exclude the possibility of oesophageal cancer. When the differential diagnosis of PLD includes malignancy, cancer should be presumed to be arising from the oesophagus or the cardio‐oesophageal region until proven otherwise. This requires direct visualisation of the mucosal surfaces of the oesophagus and the cardio‐oesophageal region, using either transoral or transnasal flexible endoscopy, irrespective of whether the initial assessment occurs within head and neck or upper gastrointestinal suspected cancer pathways. [ABSTRACT FROM AUTHOR]

The objective of this study was to measure the long-term odor emissions and corresponding concentrations and emissions of 20 odorous volatile organic compounds (VOCs). This study was an add-on study to the National Air Emission Monitoring Study (NAEMS). Odor and odorous gas measurements at four NAEMS sites, including dairy barns in Wisconsin (WI5B) and Indiana (IN5B), a swine finisher barn in Indiana (IN3B), and swine gestation and farrowing barns in Iowa (IA4B), were conducted from November 2007 to May 2009. The odorous gas samples were collected every two weeks using sorbent tubes (samples were collected twice each season of the year, with the exception of spring 2009 when samples were collected three times) and analyzed by gas chromatography-mass spectrometry-olfactometry (GC-MSO). In this article, we summarize the measured gas concentrations and emissions of the 20 target VOCs from each of the four sites. The average total odorous VOC concentrations for the entire sampling period were 276, 96.9, 1413 and 394 µg dsm-3 for WI5B, IN5B, IN3B, and IA4B, respectively. For the swine sites, the highest seasonal average total odorous VOC concentrations for each barn were observed during spring (1890 µg dsm-3 for IN3B and 458 µg dsm-3 for IA4B). For the dairy sites, the highest seasonal average total odorous VOC concentrations were observed in winter at WI5B (446 µg dsm-3) and in summer at IN5B (129 µg dsm-3). The average total emission rates for the 20 odorous VOCs were 290 mg h-1 AU-1 (WI5B), 36.0 mg h-1 AU-1 (IN5B), 743 mg h-1 AU-1 (IN3B), 33.9 mg h-1 AU-1 (IA4B swine gestation barns), and 91.7 mg h-1 AU-1 (IA4B swine farrowing room). The average seasonal total odorous VOC emission rates were highest during summer at WI5B (805 mg h-1 AU-1), IN5B (121 mg h-1 AU-1), and IN3B (1250 mg h-1 AU-1) and during spring at IA4B (95.8 mg h-1 AU-1). The emissions of specific VOCs varied between seasons, sites, and species. To date, this is the most comprehensive VOC measurement survey of odorous compound emission rates from commercial livestock buildings. [ABSTRACT FROM AUTHOR]

Simultaneous chemical and sensory analyses using gas chromatography-mass spectrometry-olfactometry (GC-MS-O) for air samples collected at barn exhaust fans were used for quantification and ranking of the odor impacts of target odorous gases. Fifteen target odorous VOCs (odorants) were selected. Air samples were collected at dairy barns in Wisconsin and Indiana and at swine barns in Iowa and Indiana over a one-year period. The livestock facilities with these barns participated in the National Air Emissions Monitoring Study (NAEMS). Gas concentrations, odor character and intensity, hedonic tone, and odor peak area of the target odorants in air samples were measured simultaneously with GCMS- O. The four individual odorants emitted from both dairy and swine sites with the largest odor impacts (measured as odor activity value, OAV) were 4-methyl phenol, butanoic acid, 3-methyl butanoic acid, and indole. The total odor (limited to target VOCs and referred to as the measured concentrations, odor intensities, and OAVs) emitted from the swine sites was generally greater than that from the dairy sites. The Weber-Fechner law was used to correlate measured odor intensities with chemical concentrations. Odorants with higher mean OAV followed the Weber-Fechner law much better than odorants with lower mean OAV. The correlations between odor intensities and chemical concentrations were much better for the swine sites (typically p < 0.05 and R² = 0.16 to 0.51) than for the dairy sites (typically p > 0.05 and R² < 0.15). Linking specific gases to odor could assist in the development and evaluation of odor mitigation technologies for solving livestock odor nuisance problems. [ABSTRACT FROM AUTHOR]

There is a growing concern with air and odor emissions from agricultural facilities. A supplementary research project was conducted to complement the U.S. National Air Emissions Monitoring Study (NAEMS). The overall goal of the project was to establish odor and chemical emission factors for animal feeding operations. The study was conducted over a 17-month period at two freestall dairies, one swine sow farm, and one swine finisher facility. Samples from a representative exhaust airstream at each barn were collected in 10 L Tedlar bags and analyzed by trained human panelists using dynamic triangular forced-choice olfactometry. Samples were simultaneously analyzed for 20 odorous compounds (acetic acid, propanoic acid, butyric acid, isobutyric acid, valeric acid, isovaleric acid, hexanoic acid, heptanoic acid, guaiacol, phenol, 4-methylphenol, 4-ethylphenol, 2-aminoacetophenone, indole, skatole, dimethyl disulfide, diethyl disulfide, dimethyl trisulfide, hydrogen sulfide, and ammonia). In this article, which is part 6 of a six-part series summarizing results of the project, we investigate the correlations between odor concentrations and odor activity value (OAV), defined as the concentration of a single compound divided by the odor threshold for that compound. The specific objectives were to determine which compounds contributed most to the overall odor emanating from swine and dairy buildings, and develop equations for predicting odor concentration based on compound OAVs. Single-compound odor thresholds (SCOT) were statistically summarized and analyzed and OAVs were calculated for all compounds. Odor concentrations were regressed against OAV values using multivariate regression techniques. Both swine sites had four common compounds with the highest OAVs (ranked high to low: hydrogen sulfide, 4-methylphenol, butyric acid, isovaleric acid). The dairy sites" had these same four compounds in common in the top five, and in addition diethyl disulfide was ranked second at one dairy site, while ammonia was ranked third at the other dairy site. Summed OAVs were not a good predictor of odor concentration (R² = 0.16 to 0.52), underestimating actual odor concentrations by 2 to 3 times. Based on the OAV and regression analyses, we conclude that hydrogen sulfide, 4-methylphenol, isovaleric acid, ammonia, and diethyl disulfide are the most likely contributors to swine odor while hydrogen sulfide, 4-methyl phenol, butyric acid, and isovaleric acid are the most likely contributors to dairy odors. [ABSTRACT FROM AUTHOR]

Livestock facilities have historically generated public concerns due to their emissions of odorous air and various chemical pollutants. Odor emission factors and identification of principal odorous chemicals are needed to better understand the problem. Applications of odor emission factors include inputs to odor setback models, while chemical emission factors may be compared with regulation thresholds as a means of demonstrating potential health impacts. A companion study of the National Air Emissions Monitoring Study (NAEMS) included measurements necessary for establishing odor and chemical emission factors for confined animal feeding operations. This additional investigation was conducted by the University of Minnesota, Iowa State University, West Texas A&M Agri-Life Center, and Purdue University. The objectives were to (1) determine odor emission rates across swine and dairy facilities and seasons using common protocols and standardized olfactometry methods, (2) develop a chemical library of the most significant odorants, and (3) correlate the chemical library with the olfactometry results. This document describes the sampling and quality assurance methods used in the measurement and evaluation of odor and chemical samples collected at two freestall dairy farms, one sow (gestation/farrowing) facility, and one finishing pig site. Odor samples were collected in Tedlar bags and chemical samples were collected in sorbent tubes at barn inlet and exhaust locations using the NAEMS multiple-location gas sampling systems. Quality assurance protocols included interlaboratory comparison tests, which were evaluated to identify variations between olfactometry labs. While differences were observed, the variations among the labs and samples appeared random and the collected odor data were considered reliable at a 0.5% level of statistical significance. Overall, the study took advantage of groundbreaking opportunities to collect and associate simultaneous odor and chemical information from swine and dairy buildings while maintaining accordance with standard methods and comparability across laboratories. [ABSTRACT FROM AUTHOR]

Abstract Background Colorectal cancer (CRC) is a heterogeneous and biologically poorly understood disease. To tailor CRC treatment, it is essential to first model this heterogeneity by defining subtypes of patients with homogeneous biological and clinical characteristics and second match these subtypes to cell lines for which extensive pharmacological data is available, thus linking targeted therapies to patients most likely to respond to treatment. Methods We applied a new unsupervised, iterative approach to stratify CRC tumor samples into subtypes based on genome-wide mRNA expression data. By applying this stratification to several CRC cell line panels and integrating pharmacological response data, we generated hypotheses regarding the targeted treatment of different subtypes. Results In agreement with earlier studies, the two dominant CRC subtypes are highly correlated with a gene expression signature of epithelial-mesenchymal-transition (EMT). Notably, further dividing these two subtypes using iNMF (iterative Non-negative Matrix Factorization) revealed five subtypes that exhibit activation of specific signaling pathways, and show significant differences in clinical and molecular characteristics. Importantly, we were able to validate the stratification on independent, published datasets comprising over 1600 samples. Application of this stratification to four CRC cell line panels comprising 74 different cell lines, showed that the tumor subtypes are well represented in available CRC cell line panels. Pharmacological response data for targeted inhibitors of SRC, WNT, GSK3b, aurora kinase, PI3 kinase, and mTOR, showed significant differences in sensitivity across cell lines assigned to different subtypes. Importantly, some of these differences in sensitivity were in concordance with high expression of the targets or activation of the corresponding pathways in primary tumor samples of the same subtype. Conclusions The stratification presented here is robust, captures important features of CRC, and offers valuable insight into functional differences between CRC subtypes. By matching the identified subtypes to cell line panels that have been pharmacologically characterized, it opens up new possibilities for the development and application of targeted therapies for defined CRC patient sub-populations.

Abstract Background The continued increase in hospital admissions is a significant and complex issue facing health services. There is little research exploring patient perspectives or examining individual admissions among patients with frequent admissions for chronic ambulatory care sensitive (ACS) conditions. This paper aims to describe characteristics of older, rural patients frequently admitted with ACS conditions and identify factors associated with their admissions from the patient perspective. Methods Patients aged 65+ resident in North Coast NSW with three or more admissions for selected ACS chronic conditions within a 12 month period, were invited to participate in a postal survey and follow up telephone call. Survey and telephone data were linked to admission and health service program data. Descriptive statistics were generated for survey respondents; logistic regression models developed to compare characteristics of patients with 3 or with 4+ admissions; and comparisons made between survey respondents and non-respondents. Results Survey respondents (n=102) had a mean age of 77.1 years (range 66–95 years), and a mean of 4.1 admissions within 12 months; 49% had at least three chronic conditions; the majority had low socioeconomic status; one in five (22%) reported some difficulty affording their medication; and 35% lived alone. The majority reported psychological distress with 31% having moderate or severe psychological distress. While all had a GP, only 38% reported having a written GP care plan. 22% of those who needed regular help with daily tasks did not have a close friend or relative who regularly cared for them. Factors independently associated with more frequent (n=4+) relative to less frequent (n=3) admissions included having congestive heart failure (p=0.003), higher social isolation scores (p=0.040) and higher Charlson Comorbidity Index scores (p=0.049). Most respondents (61%) felt there was nothing that could have avoided their most recent admission, although some potential avoidability of admission was described around medication and health behaviours. Respondents were younger and less sick than non-respondents. Conclusions This study provides a detailed description of older patients with multiple chronic conditions and a history of frequent admission in rural Australia. Our results suggest that programs targeting medication use, health behaviours and social isolation may help reduce multiple hospital admissions for chronic disease.

Abstract Background Frequent and potentially avoidable hospital admission amongst older patients with ambulatory care sensitive (ACS) chronic conditions is a major topic for research internationally, driven by the imperative to understand and therefore reduce hospital admissions. Research to date has mostly focused on analysis of routine data using ACS as a proxy for 'potentially avoidable'. There has been less research on the antecedents of frequent and/or avoidable admission from the perspectives of patients or those offering community based care and support for these patients. This study aimed to explore community based service providers' perspectives on the factors contributing to admission among older patients with chronic disease and a history of frequent and potentially avoidable admission. Methods 15 semi-structured interviews with community based providers of health care and other services, and an emergency department physician were conducted. Summary documents were produced and thematic analysis undertaken. Results A range of complex barriers which limit or inhibit access to services were reported. We classified these as external and internal barriers. Important external barriers included: complexity of provision of services, patients' limited awareness of different services and their inexperience in accessing services, patients needing a higher level or longer length of service than they currently have access to, or an actual lack of available services, patient poverty, rurality, and transport. Important internal barriers included: fear (of change for example), a 'stoic' attitude to life, and for some, the difficulty of accepting their changed health status. Conclusions The factors underlying frequent and/or potentially avoidable admission are numerous and complex. Identifying strategies to improve services or interventions for this group requires understanding patient, carer and service providers' perspectives. Improving accessibility of services is also complex, and includes consideration of patients' social, emotional and psychological ability and willingness to use services as well as those services being available and easily accessed.

Introduction: The routine collection of long-term patient health outcomes after serious traumatic injury at the health service level is uncommon. In 2019, we implemented the longitudinal Trauma Service Follow Up (TSFU) program at a level I trauma centre. Delivered by the trauma service clinicians involved in inpatient care, it assesses quality of life and disability. This study reports the 6- and 12-month outcomes of the first two years of operation of the TSFU program., Methods: This is a prospective cohort study of seriously injured adult trauma patients admitted to a level I trauma centre with 6- and 12-months post-discharge outcome assessments. Outcomes were quality of life and function/disability as measured using the EQ-5D-5L and WHODAS 2.0 validated instruments. Changes from 6 to 12 months were assessed using generalised estimating equations methods. Logistic regression models were used to identify factors associated with ongoing problems at each time point., Results: Five-hundred and eight seriously injured patients were eligible for the TSFU program with follow-up rates over 80 % at both 6- and 12-month timepoints. At six months, ongoing problems with pain (69.9 %), anxiety and depression (49 %) and carrying out usual activities (57.5 %) were highly prevalent; at 12 months problems with pain (61.4 %) and anxiety and depression (43.8 %) persisted. Lower extremity and/or pelvic surgery was associated with ongoing pain, odds ratio (OR) = 3.77 (95 % CI 1.54-9.21, p=0.01), anxiety and depression (OR 1.95, 95 % CI 1.09-3.48, p=0.02) and problems carrying out their usual activities (OR 3.19, 95 % CI 0.75-13.5, p=0.11) at six months. These patterns mostly persisted at 12 months. Similar associations between surgical intervention and high levels of disability were evident at both time points., Conclusion: Persistent impairments in physical and emotional health continues to affect many people following serious traumatic injury. The collection of longitudinal health outcomes by trauma clinicians enables identification of factors that contribute to disability and a reduction in quality of life. This in turn can drive quality improvement initiatives within the hospital trauma system. Longitudinal follow-up programs may provide a platform to provide ongoing specialist trauma-informed care after hospital discharge., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: A case-management model of care is frequently used in acute-care settings for patients with major traumatic injuries; however, its application to trauma follow-up care after hospital discharge remains unclear., Aim: To describe the services provided by the Trauma Connect Clinic (TCC): a NP- led case management model, in trauma follow-up care., Methods: An exploratory descriptive study design was used. Data collected included patient and injury characteristics, clinic activities, attendance rates, referral patterns and complications., Results: Three-hundred and twenty-four TCC appointments were scheduled for 194 patients ( n = 302) with an attendance rate of 93% ( n = 302). Ongoing health issues included pain ( n  = 22, 37%), thrombotic events ( n  = 8, 13%) and infection ( n  = 7, 12%). Clinic activity included 77 referrals to the wider MDT ( n = 77), radiology reviews ( n = 225) and 39 prescribing events, consisting mainly of analgesia., Conclusion: A case management model can successfully deliver trauma follow-up care and efficiently use limited resources. Key elements involve careful assessment and management of patients' physical and emotional needs. Evaluation of longer-term outcomes of this model of care in trauma settings is required.

Objective: Bilateral selective reinnervation of the larynx aims to restore both vocal cord tone and abductor movements in patients with bilateral vocal cord palsy., Methods: Four females and one male treated by bilateral selective reinnervation of the larynx were included in the present study. In all cases, both posterior cricoarytenoid muscles were reinnervated using the C3 right phrenic nerve root through the great auricular nerve graft, while adductor muscle tone was bilaterally restored using the thyrohyoid branches of the hypoglossal nerve through transverse cervical nerve grafts., Results: After a minimum follow-up of 48 months, all patients were successfully tracheostomy free and had recovered normal swallowing. At laryngoscopy, the first patient recovered a left unilateral partial abductor movement, the second had complete bilateral abductor movements, the third did not show improvements of abductor movements, but symptomatology was improved, the fourth recovered partial bilateral abductor movements and the fifth case did not show improvements and needed posterior cordotomy., Conclusions: Bilateral selective laryngeal reinnervation, although a complex surgical procedure, offers a more physiologic recovery in the treatment of bilateral vocal fold paralysis. Selection criteria still needs to be precisely defined to avoid unexpected failures., (Copyright © 2023 Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Rome, Italy.)

Introduction: In Australia, people living in rural areas, compared to major cities are at greater risk of poor health. There is much evidence of preventable disparities in trauma outcomes, however research quantifying geographic variations in injuries, pathways to specialised care and patient outcomes is scarce., Aims: (i) To analyse the Australia New Zealand Trauma Registry (ATR) data and report patterns of serious injuries according to rurality of the injury location ii) to examine the relationship between rurality and hospital mortality and iii) to compare ATR death rates with all deaths from similar causes, Australia-wide., Method: A retrospective cohort study of patients in the ATR from 1 st July 2015 to 30 th June 2019 was conducted. Descriptive analyses of trauma variables according to rurality was performed. Logistic regression quantified the moderating effect of rurality on trauma variables and hospital mortality. Australian death data on similar injuries were sourced to quantify the additional mortality attributable to severe injury occurring outside Major Trauma Centres (MTCs)., Results: Compared to major cities, rural patients were younger, more likely to have spinal cord injuries, and sustain traffic-related injuries that are 'off road'. Injuries occurring outside people's homes are more likely. Mortality risk was greater for patients sustaining severe traumatic brain injury (TBI) spinal cord injury (SCI) and head trauma in addition to intentional injuries. Compared to the ATR data, Australian population-wide trauma mortality rates showed diverging trends according to rurality. The ATR only captures 14.1% of all injury deaths occurring in major cities and, respectively, 6.3% and 3.2% of deaths in regional and remote areas., Conclusion: Compared to major cities, injuries occurring in rural areas of Australia often involve different mechanisms and result in different types of severe injuries. Patients with neurotrauma and intentional injuries who survived to receive definitive care at a MTC were at higher risk of hospital death. To inform prevention strategies and reduce morbidity and mortality associated with rural trauma, improvements to data systems are required that involve data linkage and include information about patient care from pre-hospital providers, regional hospitals and major trauma centres., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier Ltd.)

Sleep and fatigue were investigated in aviation search and rescue, firefighting, emergency medical services and offshore transfer operations in 210 participants, for 21 days each, across 17 datasets in seven countries. Sleep data were collected using wrist-worn actigraphs and sleep diaries. Sustained attention was assessed using a 5-min Psychomotor Vigilance Task (PVT). Duty information was provided from corporate IT systems. Despite the number of 24 h operations, most work occurred during daytime hours, and most sleep occurred at night. There were seasonal changes in work and sleep patterns, with naps used to augment total sleep time. The proportion of sleep occurring during duty varied from zero to 30%. Differences in PVT response times were trivial to small. Legislation that defines flight, duty time and minimum rest limits assume that sleep is not obtained during duty periods, apart from some napping under Fatigue Risk Management Systems (FRMS). However, especially in cases where the aviation service requires waiting for tasks (e.g. search and rescue, emergency medical response), this assumption may not always hold. FRMS should accommodate different modes of working that safely facilitate sleep during duty time where appropriate., (© 2022. The Author(s).)

Objective: Understanding the longitudinal patient experience outcomes following major trauma can promote successful recovery. A novel, hospital-led telephone follow-up program was implemented by a multi-disciplinary clinical trauma service team at a Level I trauma center. This process evaluation examined what factors promoted or impeded the program's implementation., Methods: A prospective convergent mixed-methods process evaluation design was used. Quantitative data included patient and injury demographics and program feasibility data such number of telephone calls attempted/completed and call duration. Qualitative data consisted of semi-structured interviews with program participants (staff, patients, and caregivers) who had participated in the program. Descriptive statistics and thematic analysis were applied to quantitative and qualitative data, respectively. Data were collected concurrently and merged in the results to understand and describe the implementation and sustainability of the program.274 major trauma patients (ISS ≥ 12) were eligible for follow-up. A response rate of over 75% was achieved, with nurses responsible for most of the calls. Limited time and competing clinical demands were identified as barriers to the timely completion of the calls., Results: Participants valued the preexisting trauma service/patient relationship, and this facilitated program implementation. Clinicians were motivated to evaluate their patient's recovery, whilst patients felt 'cared for' and 'not forgotten' post-hospital discharge. Teamwork and leadership were highly valued by the clinical staff throughout the implementation period as ongoing source of motivation and support.Staff spontaneously developed the program to incorporate clinical follow-up processes by providing guidance, advice, and referrals to patients who indicated ongoing issues such as pain or emotional problems., Conclusion: Telephone follow-up within a clinical trauma service team is feasible, accepted by staff and valued by patients and families. Despite time constraints, the successful implementation of this program is reliant on existing clinical/patient relationships, staff teamwork and leadership support.

Aims: This study investigated the association of resilience on caregiver burden and quality of life in informal caregivers of patients with severe traumatic musculoskeletal injuries., Methods: A prospective cohort study of eligible caregivers and acutely injured trauma patients was conducted during 2018 in South East Queensland, with follow-up 3 months after patient discharge. Resilience was examined using the 10-item Connor Davidson Resilience Scale. The primary outcomes, caregiver burden and quality of life were measured respectively, using the Caregiver Strain Index and the Short Form Version 12 Health Survey., Results: Baseline measures were completed with fifty-three (77%) patient/carer dyads. Thirty-eight (28%) were available for follow up at 3 months. Significant reductions from baseline were found at follow up, for levels of resilience, mental health, physical exercise and community support. In multiple regression models, caregiver resilience at follow-up independently predicted lower caregiver burden ( β  = -0.74, p  = 0.008) and higher levels of patient physical health and function ( β  = -0.69, p  = 0.003)., Conclusions: Upon commencing informal care, caregivers' resilience, mental health and support systems are adversely affected. Higher levels of caregiver resilience appear to be protective against caregiver burden and declines in patient physical function. Early evaluation of caregivers' resilience, their physical and mental health and socio-ecological networks could improve carer and patient health outcomes.Implications for rehabilitationAfter 3 months of providing informal care to severely injured musculoskeletal trauma patients, there are apparent declines in their mental health, resilience, community support and physical activity levels. However, those with higher levels of resilience compared to lower levels could be protected against caregiver burden. Higher caregiver resilience could also prevent declines in patients' physical function.The rehabilitation of severe trauma patients should additionally include routine assessment and management of informal caregivers with the aim to prevent caregiver burden.Early clinical assessment of caregiver resilience using a valid resilience measurement tool could identify caregivers at risk of caregiver burden and flag vulnerable caregivers for ongoing support in the community.Early assessment of caregivers' physical and mental health and health related behaviours could flag the need for health promotion interventions aimed at supporting caregivers' physical and mental health.

Purpose: To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe., Methods: Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion., Results: Twenty-four sections on HNC-specific OD topics., Conclusion: This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.

Ambient fine particulate matter <2.5 µm (PM 2.5 ) air pollution increases premature mortality globally. Some PM 2.5 is natural, but anthropogenic PM 2.5 is comparatively avoidable. We determined the impact of long-term exposures to the anthropogenic PM component on mortality in Australia. PM 2.5 -attributable deaths were calculated for all Australian Statistical Area 2 (SA2; n = 2310) regions. All-cause death rates from Australian mortality and population databases were combined with annual anthropogenic PM 2.5 exposures for the years 2006-2016. Relative risk estimates were derived from the literature. Population-weighted average PM 2.5 concentrations were estimated in each SA2 using a satellite and land use regression model for Australia. PM 2.5 -attributable mortality was calculated using a health-impact assessment methodology with life tables and all-cause death rates. The changes in life expectancy (LE) from birth, years of life lost (YLL), and economic cost of lost life years were calculated using the 2019 value of a statistical life. Nationally, long-term population-weighted average total and anthropogenic PM 2.5 concentrations were 6.5 µg/m 3 (min 1.2-max 14.2) and 3.2 µg/m 3 (min 0-max 9.5), respectively. Annually, anthropogenic PM 2.5 -pollution is associated with 2616 (95% confidence intervals 1712, 3455) deaths, corresponding to a 0.2-year (95% CI 0.14, 0.28) reduction in LE for children aged 0-4 years, 38,962 (95%CI 25,391, 51,669) YLL and an average annual economic burden of $6.2 billion (95%CI $4.0 billion, $8.1 billion). We conclude that the anthropogenic PM 2.5 -related costs of mortality in Australia are higher than community standards should allow, and reductions in emissions are recommended to achieve avoidable mortality.