PROJECT SUMMARY Brief resolved unexplained events (BRUE) are frightening episodes characterized by appearance of life-threatening choking, cyanosis, and limpness in infants. These common events are resource-intensive and current management inadequately addresses persistent symptoms. Infants with BRUE commonly have oropharyngeal dysphagia with aspiration, which is a modifiable risk factor for persistent symptoms, but there are no studies determining the mechanism behind this swallow dysfunction and if swallow interventions reduce morbidity. Systematic investigation of the contribution of oropharyngeal dysphagia to disease burden in this population is urgently needed, as this approach has vast potential to optimize clinical outcomes, improve quality of life and reduce healthcare utilization. Daniel Duncan, MD MPH is an Instructor at Harvard Medical School (HMS) and a subspecialist within the Aerodigestive Center at Boston Children’s Hospital (BCH). He has gained substantial clinical research experience during his medical training and has demonstrated commitment to an academic career in patient oriented research. His career goal is to direct a clinical research program focused on identifying evidenced-based, state of the art interventions for oropharyngeal dysphagia and aerodigestive disorders that transform clinical care for this vulnerable pediatric population. This Career Development Award will provide additional mentored training and research opportunities in high resolution impedance-manometry and decision analysis for Dr. Duncan to advance his quantitative research skills while addressing the current knowledge gap related to mechanisms of swallow dysfunction in BRUE. The proposed innovative studies will systematically determine mechanisms by which thickened feeds modulate swallow function and confirm these findings in a larger cohort, which will allow for derivation of an improved algorithm for BRUE care. He will study effects of alterations in liquid viscosity on upper esophageal motility using pharyngeal impedance-manometry, follow a prospective cohort to determine predictors of response to thickening, and use decision analysis to identify patients that could receive empiric thickening. The mentorship and scientific training afforded by this career development award will be critical for Dr. Duncan’s academic development. His primary mentor, Dr. Rosen, is an aerodigestive expert. His co-mentors, Drs. Jadcherla and Omari, are experts in neonatal swallow dysfunction and impedance-manometry; all are outstanding clinical researchers with deep commitment to mentorship. He will be supported by his Scholarship Advisory Committee consisting of Drs. Snapper, Nurko, Landrigan, and Stamoulis, who lend content-area expertise. His formal training includes advanced coursework in decision analysis at Harvard School of Public Health, personal instruction on esophageal motility and decision analysis, and professional development courses. His training and r...