BACKGROUND Among patients with T0-2 N3 head and neck squamous cell carcinomas (HNSCC), those undergoing upfront neck dissection have better oncological outcomes. However, there is no consensual definition of disease resectability of N3 nodes, leading to major treatment attrition and interpretation biases between studies. We established a Delphi method-based consensus to define resectability and impact on decision-making for upfront neck dissection in N3 patients. METHODS The Delphi method was designed as recommended by the French Haute Autorite de Sante among head and neck surgeons from university hospitals and cancer centers, using a 24-item questionnaire. Strong and relative agreements were subsequently established, and recommendations were written. The resulting recommendations were assessed by 30 independent surgeons. RESULTS N3 nodes with intraparenchymal brain invasion, foramen invasion, skull base erosion, nodes requiring bilateral XIIth cranial nerve sacrifice, retropharyngeal N3 node or a node above the plan of soft palate are major contraindications to neck dissection. When neck dissection requires unilateral sacrifice of the IXth or Xth or XIIth cranial nerves or cervical nerve roots, upfront neck dissection may be performed, based on a case-by-case assessment of other patient and tumor estimates. CONCLUSION Consensual contraindications to neck dissection in patients with T0-2 N3 HNSCC were defined among French head and neck surgeons as concerns skull base invasion, retropharyngeal nodes and bilateral XIIth cranial nerve sacrifice. This consensus should allow more reliable comparisons between surgical and non-surgical strategies in N3 patients. BACKGROUND The scope of operations performed by surgery residents has progressively narrowed. This analysis was undertaken to determine the degree to which that narrowing has occurred in one particular operative domain – biliary surgery. STUDY DESIGN The total numbers of major cases and biliary cases by resident role were abstracted from annual ACGME national caselog reports from 1989-1990 through 2017-2018 as were the number of total operations performed by residents in each biliary case category. Trends were analyzed. RESULTS The total number of major cases and the total number of biliary cases performed throughout residency have significantly increased. For chief residents, the total number of major cases has declined but the total number of biliary cases has slightly increased. The increase in the total number of biliary cases performed is entirely due to laparoscopic cholecystectomy. All other types of biliary operations have significantly decreased in number and are now rarely performed. For 2018 graduates, laparoscopic cholecystectomy accounted for 11.2% of all major operations throughout residency and 11.7% of chief resident operations. CONCLUSIONS Resident operative experience in biliary surgery has significantly increased both in absolute numbers and as a proportion of overall operative experience but is increasingly limited to laparoscopic cholecystectomy. BACKGROUND Minimum case volume thresholds for complex cancer surgery have been proposed by the Leapfrog group. There has been no formal study of how these standards correlate with actual hospital mortality. STUDY DESIGN The National Cancer Database (NCDB) was used to identify patients undergoing surgery for esophageal, lung, pancreatic and rectal cancer between 2013-2015. Recommended annual hospital case volume was used to divide hospitals into those meeting minimum volume thresholds (MVT) and those below it. Hospitals in the highest quartile of adjusted hospital mortality were designated as poor performing hospitals (PPH). Sensitivity, specificity, negative (NPV) and positive predictive (PPV) values of current MVT to predict PPH were calculated. RESULTS The proportion of hospitals meeting MVT varied from 7% for esophagectomy to 27% for rectal operations. Proposed MVT had a sensitivity of 69-93%, specificity of 7-27%, and area under the curve (AUC) of 0.59-0.65 for identifying PPH. Although the NPV varied from 72-79%, the PPV was only 24-26%. selleck compound Optimal MVT to identify PPH were lower than those currently proposed- esophagus 4 vs. 20, lung 21 vs. 40, pancreas 7 vs. 20 and rectum 8 vs. 16. Even under these idealized volume cut offs, the best performing procedure specific model (esophagus) had an AUC of 0.68 CONCLUSIONS Although proposed MVT are reasonably good at identifying PPH, they misclassify 3 out of 4 hospitals below MVT as PPH and 1 out of 4 PPH as meeting MVT. Use of case volume cut-offs alone does not correlate well with actual hospital mortality. BACKGROUND Annually, over 400,000 adults served in U.S. trauma centers (≥ 20%) develop posttraumatic stress disorder and/or depression in the first year after injury. Yet, few trauma centers monitor and address mental health recovery, and there is limited evaluation and high structural variability across existing programs. More research is needed to guide efforts to establish such programs and to inform national standards and recommendations. STUDY DESIGN This paper describes patient engagement in a stepped-care service to address patients’ mental health needs. Trauma activation patients admitted to our Level I trauma center for at least 24 hours were approached prior to discharge. Patients were provided education in person at the bedside (Step 1), symptom monitoring via a 30-day text-messaging tool (Step 2), telephone screening ∼30 days post-injury (Step 3), and, when appropriate, mental health treatment referrals/treatment (Step 4). RESULTS We approached and educated 1,122 (56%) patients on the floor over a 33-month period. Of these, 1,096 (98%) enrolled in our program and agreed to 30-day follow-up mental health screening. We reached 676 patients for the 30-day screen, 243 (36%) of whom screened positive for PTSD and/or depression. Most of the 243 patients who graduated to step 4 accepted treatment referrals (68%) or were already receiving services from a provider (7%). Home-based telemental health was preferred by 66% of patients who accepted referrals. CONCLUSION This work demonstrates the feasibility of an evidence-based, technology-enhanced, stepped-care intervention to address the mental health needs of trauma center patients. Strategies to reach a higher percentage of patients in follow-up are needed. We recommend trauma centers test and adopt broad-based approaches to ensure optimal long-term patient outcomes.