the United States Appalachian region harbors a higher cancer burden than the rest of the nation, with disparate incidence of head and neck squamous cell carcinomas (HnScc), including oral cavity and pharynx (oc/p) cancers. Whether elevated HnScc incidence generates survival disparities within Appalachia is unknown. To address this, HNSCC survival data for 259,737 tumors from the North American Association for Central Cancer Registries 2007-2013 cohort were evaluated, with ageadjusted relative survival (RS) calculated based on staging, race, sex, and Appalachian residence. tobacco use, a primary HnScc risk factor, was evaluated through the Behavioral Risk factor Surveillance System from Appalachian states. Decreased oc/p RS was found in stage iV Appalachian white males within a subset of states. The survival disparity was confined to human papillomavirus (HPV)-associated oropharyngeal cancers, specifically the oropharynx subsite. This correlated with significantly higher smoking and male smokeless tobacco use in most Appalachian disparity states. Lower survival of Appalachian males with advanced-stage HpV-associated oropharyngeal cancers suggests pervasive tobacco consumption likely generates more aggressive tumors at HpV-associated oropharynx subsites than national averages. comprehensive tobacco and HpV status should therefore be evaluated prior to considering treatment de-intensification regimens for HPV-associated oropharyngeal cancers in populations with high tobacco consumption. HNSCC involves the epithelium of the oral cavity, pharynx and larynx. OC/P cancers are a major HNSCC subset, with nearly 11,000 deaths predicted in the US in 2020 1. Risk factors include tobacco and alcohol use, and highrisk human papillomavirus (HPV) infection 2,3. OC/P cancers are subdivided into HPV-associated oropharynx (HPV-associated) and non-HPV-associated oral cavity, hypopharynx, and nasopharynx (non-HPV-associated) cancers 4. These designations are supported by studies indicating that non-HPV-associated cancers are primarily tobacco/alcohol induced, whereas HPV-associated cancers are predominantly caused by HPV infection 5. Furthermore, HPV-negative or non-HPV-associated cancers consistently have poorer outcomes than HPV-positive or HPV-associated cancers, segregating these cancers as distinct diseases with differential clinical management 6,7. While national incidence of non-HPV-associated cancers is decreasing due to tobacco cessation, HPV-associated cancers are increasing due to rising infection rates 8. Regarding race, blacks with HNSCC present with more advanced disease, are older and have worse survival than whites, denoting a racial disparity 9-11. Increased screening for HPV coupled with subsite analysis indicates that blacks with HNSCC have less HPV-positive cancer than whites, explaining differences in survival 12,13. Consistent with this, HPV-associated cancers continue to increase in white males and in rural areas 4,14,15. The Appalachian region encompasses 205,000 square miles across 420 counties in 13 contiguo...

Early exposure to ON surgeries may aid in residents' decision to pursue a fellowship in ON. The presence of fellows appears to facilitate residents' ON experience.

Objective: To define the changing incidence, risk, and therapy of acute myocardial infarction (A311). Data sources: Review of contemporary AMI data from the University of Alberta Hospitals, six other sites of the Clinical Quality Improvement Network (CQIN), and other Canadian and international centers. Data synthesis: Ischemic heart disease is age-related and the Canadian population is rapidly aging. At the University of Alberta Hospitals, the incidence of Q wave AMI (per 100,000 population) in 1985 was 113 and has remained unchanged (NS) since that time (129 in 1994). In contrast, the combined incidence of non.Q-wave AMI and unstable angina has increased markedly, from 74 in 1985 to 226 in 1994 (p < 0.05). The use of proven efficacious therapies for AMI has greatly increased in recent years, with thrombolytic drugs being given to approximately 35;percnt; of all patients by 1993; and beta-blockers and aspirin to 75;percnt; and 98;percnt; of patients, respectively. However, females and patients older than 70 years' despite their greater risk, received significantly less efficacious medication than males and younger AMI patients. The use of calcium antagonists decreased from a peak utilization rate of 60;percnt; for all AMI patients in 1989 to less than 10;percnt; by 1993. In-hospital AMI mortality risk has also decreased in the last several years, particularly among higher risk older patients (35;percnt;, 1987 vs. 19;percnt;,1993). In a population of 3896 consecutive AMI patients, recruited largely in 1992 and 1993 from seven CQIN sites, logistic regression analyses revealed aspirin was associated with the greatest relative risk reduction (61%); beta-blocker and thrombolytic therapy were related to risk reductions of 55;percnt; and 16;percnt;, respectively. Incremental age was the most important factor associated with increased relative risk in AMI, overall and in both sexes; sex was not an independent risk predictor. Qualitatively very similar AMI incidence, risk, and treatment data have also been recently observed in other centers in Canada, the United States, and elsewhere. Conclusions: Although widespread primary or secondary prevention is possibly contributory, the recent static incidence of Q-wave AMI and the marked increase in unstable angina and non-Q-wave AMI are more likely due to enhanced health awareness and diagnosis-seeking behavior in the population at risk. The decline in AMI mortality, at least for high-risk acute care patients, is compatible with a clinically relevant secondary prevention effect. There are still, however, windows of opportunity to further improve AMI outcomes by increasing the utilization of proven efficacious therapy, especially among women and older patients. Another particularly attractive epidemiologic benefit in the immediate future would accrue from the further development and effective use of efficacious therapies directed against unstable angina and n-Q-wave AMI.

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