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Objectives/Hypothesis To examine changes in health-related quality of life among oropharyngeal cancer patients by stages and across treatment types among advanced cancer patients. Study Design Individual prospective cohort study. Methods All newly diagnosed patients with oropharyngeal cancer treated with curative intent were routinely assessed. The European Organization for Research and Treatment of Cancer (EORTC) both the Main Module quality-of-life questionnaire (QLQ-C30) and the Head and Neck Cancer (HNC) Module (QLQ-H&N35) were administered at diagnosis and 3, 6, and 12 months thereafter. Complete case analysis was used following assessment of missing data. The proportion of patients with clinically significant deterioration (changes of ≥10 points) from baseline were calculated for each follow-up time point and compared by stage (I/II vs. III/IV) and then treatment type (chemotherapy and radiotherapy [CRT] vs. surgery and postoperative radiotherapy [S&PORT]). Results Deterioration in most domains was most frequent for stage III/IV patients at 3 months (both modules), whereas stage I/II patients experienced this at 6 months (QLQ-C30) and 12 months (H&N35). Among stage III/IV patients, this happened at all time points for S&PORT patients (QLQ-C30) versus 12 months for CRT patients (H&N35). The number of patients reporting deterioration was lower for most domains at 12 months compared to earlier periods, although dry mouth remained a problem for most patients (60%-85% across treatment/stage groups). Conclusions Our preliminary findings suggest that general and disease-specific deterioration is of most concern for stage I/II patients at 6 and 12 months and at 3 months for advanced cancer patients. For stage III/IV patients receiving S&PORT, general deterioration remains a problem after diagnosis, whereas for CRT patients, disease-specific deterioration is of most concern at 12 months. Level of Evidence 4. Laryngoscope, 124:151-158, 2014

In response to the water-related risks posed by climate change, the U.S. Army Corps of Engineers, (USACE) has embarked on a comprehensive approach that is flexible enough to incorporate new knowledge and changing conditions. Adequately incorporating potential sea level change (SLC) into the planning and engineering process will improve the resilience of project systems and will maximize sustainability over time. The USACE goal is to develop practical, nationally consistent, legally justifiable, and cost-effective measures, both structural and nonstructural, to reduce vulnerabilities and improve the resilience of our water resources infrastructure. Analytical perspectives will be developed to determine the appropriate investments in maintenance, operations improvements, reallocation, major rehabilitation, and new construction. A tiered analysis is recommended for the assessment of SLC impacts on Corp projects. Inherent in this approach is the understanding that decision points exist after each analysis tier that allow engineers to reassess the required data and analysis. The three primary tiers are as follows: (1) establishing a strategic decision context, (2) determining project area exposure and vulnerability, and (3) developing and evaluating alternatives for addressing SLC at the project site. What is being assessed at the strategic decision level is whether there is potential for significant or catastrophic consequences to human lives, property, critical infrastructure, and ecosystems. The second tier of the screening process determines project area exposure and vulnerability by looking at three categories: project area characterization, capacity/resilience, and loading/processes. The third tier addresses project alternative development and evaluation under SLC. The Corps' most recent update to sea level change guidance was in 2011 in the form of an Engineering Circular, EC 1165-2-212, Incorporating Sea-Level Change Considerations in Civil Works Programs.

Recent models of care recommend that provision of psychosocial support be provided across disciplines throughout cancer treatment. While nurses are well positioned to provide this support as they have the most access to patients and patients perceive support from nurses as acceptable, little is known as to how much they perceive provision of psychosocial support as part of their role as cancer nurses. This study aimed to explore factors influencing nurses' attitudes towards providing psychosocial care and unmet training needs.