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Michel JJ, Schwartz SR, Dawson DE, Denneny JC, Erinoff E, Dhepyasuwan N, Rosenfeld RM. Quality Improvement in Otolaryngology-Head and Neck Surgery: Developing Registry-Enabled Quality Measures From Guidelines for Cerumen Impaction and Allergic Rhinitis Through a Transparent and Systematic Process. Otolaryngol Head Neck Surg 2021; 166:13-22. [PMID: 34000906 DOI: 10.1177/01945998211011987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND SIGNIFICANCE Quality measurement can drive improvement in clinical care and allow for easy reporting of quality care by clinicians, but creating quality measures is a time-consuming and costly process. ECRI (formerly Emergency Care Research Institute) has pioneered a process to support systematic translation of clinical practice guidelines into electronic quality measures using a transparent and reproducible pathway. This process could be used to augment or support the development of electronic quality measures of the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) and others as the Centers for Medicare and Medicaid Services transitions from the Merit-Based Incentive Payment System (MIPS) to the MIPS Value Pathways for quality reporting. METHODS We used a transparent and reproducible process to create electronic quality measures based on recommendations from 2 AAO-HNSF clinical practice guidelines (cerumen impaction and allergic rhinitis). Steps of this process include source material review, electronic content extraction, logic development, implementation barrier analysis, content encoding and structuring, and measure formalization. Proposed measures then go through the standard publication process for AAO-HNSF measures. RESULTS The 2 guidelines contained 29 recommendation statements, of which 7 were translated into electronic quality measures and published. Intermediate products of the guideline conversion process facilitated development and were retained to support review, updating, and transparency. Of the 7 initially published quality measures, 6 were approved as 2018 MIPS measures, and 2 continued to demonstrate a gap in care after a year of data collection. CONCLUSION Developing high-quality, registry-enabled measures from guidelines via a rigorous reproducible process is feasible. The streamlined process was effective in producing quality measures for publication in a timely fashion. Efforts to better identify gaps in care and more quickly recognize recommendations that would not translate well into quality measures could further streamline this process.
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Affiliation(s)
| | | | | | - James C Denneny
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
| | | | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
| | - Richard M Rosenfeld
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
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2
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Piepmeier JR, Focardi P, Horgan KA, Knuble J, Ehsan N, Lucey J, Brambora C, Brown PR, Hoffman PJ, French RT, Mikhaylov RL, Kwack EY, Slimko EM, Dawson DE, Hudson D, Peng J, Mohammed PN, De Amici G, Freedman AP, Medeiros J, Sacks F, Estep R, Spencer MW, Chen CW, Wheeler KB, Edelstein WN, O'Neill PE, Njoku EG. SMAP L-Band Microwave Radiometer: Instrument Design and First Year on Orbit. IEEE Trans Geosci Remote Sens 2017; 55:1954-1966. [PMID: 32661449 PMCID: PMC7357195 DOI: 10.1109/tgrs.2016.2631978] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The Soil Moisture Active-Passive (SMAP) L-band microwave radiometer is a conical scanning instrument designed to measure soil moisture with 4% volumetric accuracy at 40-km spatial resolution. SMAP is NASA's first Earth Systematic Mission developed in response to its first Earth science decadal survey. Here, the design is reviewed and the results of its first year on orbit are presented. Unique features of the radiometer include a large 6-m rotating reflector, fully polarimetric radiometer receiver with internal calibration, and radio-frequency interference detection and filtering hardware. The radiometer electronics are thermally controlled to achieve good radiometric stability. Analyses of on-orbit results indicate that the electrical and thermal characteristics of the electronics and internal calibration sources are very stable and promote excellent gain stability. Radiometer NEDT < 1 K for 17-ms samples. The gain spectrum exhibits low noise at frequencies >1 MHz and 1/f noise rising at longer time scales fully captured by the internal calibration scheme. Results from sky observations and global swath imagery of all four Stokes antenna temperatures indicate that the instrument is operating as expected.
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Affiliation(s)
| | - Paolo Focardi
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - Kevin A Horgan
- NASA Goddard Space Flight Center, Greenbelt, MD 20771 USA
| | - Joseph Knuble
- NASA Goddard Space Flight Center, Greenbelt, MD 20771 USA
| | - Negar Ehsan
- NASA Goddard Space Flight Center, Greenbelt, MD 20771 USA
| | - Jared Lucey
- NASA Goddard Space Flight Center, Greenbelt, MD 20771 USA
| | | | - Paula R Brown
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - Pamela J Hoffman
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - Richard T French
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - Rebecca L Mikhaylov
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - Eug-Yun Kwack
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - Eric M Slimko
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - Douglas E Dawson
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - Derek Hudson
- NASA Goddard Space Flight Center, Greenbelt, MD 20771 USA
| | - Jinzheng Peng
- NASA Goddard Space Flight Center, Greenbelt, MD 20771 USA
| | | | | | - Adam P Freedman
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - James Medeiros
- NASA Goddard Space Flight Center, Greenbelt, MD 20771 USA
| | - Fred Sacks
- NASA Goddard Space Flight Center, Greenbelt, MD 20771 USA
| | - Robert Estep
- NASA Goddard Space Flight Center, Greenbelt, MD 20771 USA
| | - Michael W Spencer
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - Curtis W Chen
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - Kevin B Wheeler
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - Wendy N Edelstein
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | | | - Eni G Njoku
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
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Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, Dawson DE, Dykewicz MS, Hackell JM, Han JK, Ishman SL, Krouse HJ, Malekzadeh S, Mims JWW, Omole FS, Reddy WD, Wallace DV, Walsh SA, Warren BE, Wilson MN, Nnacheta LC. Clinical practice guideline: allergic rhinitis executive summary. Otolaryngol Head Neck Surg 2015; 152:197-206. [PMID: 25645524 DOI: 10.1177/0194599814562166] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Allergic Rhinitis. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 14 recommendations developed address the evaluation of patients with allergic rhinitis, including performing and interpretation of diagnostic testing and assessment and documentation of chronic conditions and comorbidities. It will then focus on the recommendations to guide the evaluation and treatment of patients with allergic rhinitis, to determine the most appropriate interventions to improve symptoms and quality of life for patients with allergic rhinitis.
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Affiliation(s)
- Michael D Seidman
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford West Bloomfield Hospital, West Bloomfield, Michigan, USA
| | - Richard K Gurgel
- Department of Surgery Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Sandra Y Lin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Fuad M Baroody
- Department of Otolaryngology, University of Chicago Medical Center, Chicago, Illinois, USA
| | | | | | - Mark S Dykewicz
- Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | | | - Joseph K Han
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Stacey L Ishman
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | | | | | - William D Reddy
- Acupuncture and Oriental Medicine (AAAOM), Annandale, Virginia, USA
| | - Dana V Wallace
- Florida Atlantic University, Boca Raton, Florida, and Nova Southeastern University, Davie, Florida, USA
| | - Sandra A Walsh
- Consumers United for Evidence-based Healthcare, Fredericton, New Brunswick, Canada
| | - Barbara E Warren
- Consumers United for Evidence-based Healthcare, Fredericton, New Brunswick, Canada
| | - Meghan N Wilson
- Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Lorraine C Nnacheta
- Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, Dawson DE, Dykewicz MS, Hackell JM, Han JK, Ishman SL, Krouse HJ, Malekzadeh S, Mims JWW, Omole FS, Reddy WD, Wallace DV, Walsh SA, Warren BE, Wilson MN, Nnacheta LC. Clinical practice guideline: Allergic rhinitis. Otolaryngol Head Neck Surg 2015; 152:S1-43. [PMID: 25644617 DOI: 10.1177/0194599814561600] [Citation(s) in RCA: 372] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Allergic rhinitis (AR) is one of the most common diseases affecting adults. It is the most common chronic disease in children in the United States today and the fifth most common chronic disease in the United States overall. AR is estimated to affect nearly 1 in every 6 Americans and generates $2 to $5 billion in direct health expenditures annually. It can impair quality of life and, through loss of work and school attendance, is responsible for as much as $2 to $4 billion in lost productivity annually. Not surprisingly, myriad diagnostic tests and treatments are used in managing this disorder, yet there is considerable variation in their use. This clinical practice guideline was undertaken to optimize the care of patients with AR by addressing quality improvement opportunities through an evaluation of the available evidence and an assessment of the harm-benefit balance of various diagnostic and management options. PURPOSE The primary purpose of this guideline is to address quality improvement opportunities for all clinicians, in any setting, who are likely to manage patients with AR as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The guideline is intended to be applicable for both pediatric and adult patients with AR. Children under the age of 2 years were excluded from the clinical practice guideline because rhinitis in this population may be different than in older patients and is not informed by the same evidence base. The guideline is intended to focus on a limited number of quality improvement opportunities deemed most important by the working group and is not intended to be a comprehensive reference for diagnosing and managing AR. The recommendations outlined in the guideline are not intended to represent the standard of care for patient management, nor are the recommendations intended to limit treatment or care provided to individual patients. ACTION STATEMENTS The development group made a strong recommendation that clinicians recommend intranasal steroids for patients with a clinical diagnosis of AR whose symptoms affect their quality of life. The development group also made a strong recommendation that clinicians recommend oral second-generation/less sedating antihistamines for patients with AR and primary complaints of sneezing and itching. The panel made the following recommendations: (1) Clinicians should make the clinical diagnosis of AR when patients present with a history and physical examination consistent with an allergic cause and 1 or more of the following symptoms: nasal congestion, runny nose, itchy nose, or sneezing. Findings of AR consistent with an allergic cause include, but are not limited to, clear rhinorrhea, nasal congestion, pale discoloration of the nasal mucosa, and red and watery eyes. (2) Clinicians should perform and interpret, or refer to a clinician who can perform and interpret, specific IgE (skin or blood) allergy testing for patients with a clinical diagnosis of AR who do not respond to empiric treatment, or when the diagnosis is uncertain, or when knowledge of the specific causative allergen is needed to target therapy. (3) Clinicians should assess patients with a clinical diagnosis of AR for, and document in the medical record, the presence of associated conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media. (4) Clinicians should offer, or refer to a clinician who can offer, immunotherapy (sublingual or subcutaneous) for patients with AR who have inadequate response to symptoms with pharmacologic therapy with or without environmental controls. The panel recommended against (1) clinicians routinely performing sinonasal imaging in patients presenting with symptoms consistent with a diagnosis of AR and (2) clinicians offering oral leukotriene receptor antagonists as primary therapy for patients with AR. The panel group made the following options: (1) Clinicians may advise avoidance of known allergens or may advise environmental controls (ie, removal of pets; the use of air filtration systems, bed covers, and acaricides [chemical agents formulated to kill dust mites]) in patients with AR who have identified allergens that correlate with clinical symptoms. (2) Clinicians may offer intranasal antihistamines for patients with seasonal, perennial, or episodic AR. (3) Clinicians may offer combination pharmacologic therapy in patients with AR who have inadequate response to pharmacologic monotherapy. (4) Clinicians may offer, or refer to a surgeon who can offer, inferior turbinate reduction in patients with AR with nasal airway obstruction and enlarged inferior turbinates who have failed medical management. (5) Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with AR who are interested in nonpharmacologic therapy. The development group provided no recommendation regarding the use of herbal therapy for patients with AR.
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Affiliation(s)
- Michael D Seidman
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford West Bloomfield Hospital West Bloomfield, Michigan, USA
| | - Richard K Gurgel
- Department of Surgery Otolaryngology-Head and Neck Surgery University of Utah, Salt Lake City, Utah, USA
| | - Sandra Y Lin
- Johns Hopkins School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland, USA
| | | | - Fuad M Baroody
- University of Chicago Medical Center, Department of Otolaryngology, Chicago, Illinois, USA
| | | | | | - Mark S Dykewicz
- Department of Internal Medicine, St Louis University School of Medicine, St Louis, Missouri, USA
| | | | - Joseph K Han
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Stacey L Ishman
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | | | | | - William D Reddy
- Acupuncture and Oriental Medicine (AAAOM), Annandale, Virginia, USA
| | - Dana V Wallace
- Florida Atlantic University, Boca Raton, Florida and Nova Southeastern University, Davie, Florida, USA
| | - Sandra A Walsh
- Consumers United for Evidence-based Healthcare, Fredericton, New Brunswick, Canada
| | - Barbara E Warren
- Consumers United for Evidence-based Healthcare, Fredericton, New Brunswick, Canada
| | - Meghan N Wilson
- Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Lorraine C Nnacheta
- Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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5
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Haydon RC, Dawson DE, McMains KC, Brodner DC, Veling MC. Evidence-based Allergy Clinical Update 2008. Otolaryngol Head Neck Surg 2008. [DOI: 10.1016/j.otohns.2008.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Physicians facing malpractice litigation are in uncharted territory. The language, concepts, rules, and strategies of the legal system are foreign to science-based physicians. Understanding the statistics of rhinology malpractice litigation may aid the physician to cope with the assault of a claim. METHODS Information from the 2006 Physician Insurers Association of America (PIAA) and the 2006 PIAA Risk Management Report (RMR)-Otorhinolaryngology were searched for claims data referable to the nose, nasal chamber, and paranasal sinuses. The PIAA data sharing report (DSR) is the largest single resource of malpractice claims data containing both settlement and trial judgment information. RESULTS The nose, nasal cavity, and paranasal sinuses represent nearly two-thirds of the total indemnity paid for improper performance from otolaryngology head and neck surgery (Oto-HNS) medical malpractice claims between 1985 and 2005 based on claims information. Improper performance accounts for 50.3% of total monies paid ($107.6 million of $213.6 million) to resolve Oto-HNS claims in this period. Of nearly 2400 operative claims closed in the period of 1985-2005, 34.1% involved procedures on the nose and sinuses. In the past 6 years, $103.5 million indemnity has been added to the otolaryngology total. CONCLUSION The area of endoscopic sinus surgery has substantially contributed to Oto-HNS claims in the PIAA DSR. Despite malpractice being a cost of medical practice, every claim is perceived as an assault on the surgeon's competence. Ensuring informed consent and complete documentation may assist the provider in defending their care.
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7
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Dawson CJ, Nielsen R, Dawson DE. Best practice forum: standard high level disinfection protocol development. ORL Head Neck Nurs 2003; 21:18-21. [PMID: 12747039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Gluteraldehyde-based high-level disinfection (HLD) poses significant safety risks for staff and patients as well as institutional cost concerns. A value analysis team reviewed HLD practices, available products, and environmental requirements in view of the literature and standards developed by the Occupational Safety and Health Administration (OSHA). Institutional areas were identified and standardized unit-specific educational and competency programs were established. The overall use of gluteraldehyde-based HLD was decreased in this institution based on the findings and policy and procedure modification.
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Affiliation(s)
- Cindy J Dawson
- Otolaryngology-Head and Neck Surgery Clinic, Oral Surgery Clinic, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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8
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Synnott HJ, McGee EJ, Rafferty B, Dawson DE. Long-term trends of radiocesium activity concentrations in vegetation in Irish semi-natural ecosystems. Health Phys 2000; 79:154-161. [PMID: 10910385 DOI: 10.1097/00004032-200008000-00008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
137Cs activity concentrations were determined in vegetation from four Irish blanket bog ecosystems during the summer months of 1989-1997. The dominant and abundant vegetation species were sampled at each site and the data were used to estimate long-term trends of 137Cs activity concentrations. A general decline in the 137Cs activity concentrations in vegetation was observed from all sites sampled. The fastest and most consistent long-term rates of 137Cs decline were observed in the bryophyte and lichen vegetation group with 137Cs effective half-life (T ef) values of 2.2 to 10.7 y. The ericoid group with the exception of one case also showed a significant long-term decline in 137Cs activity concentrations with T ef values of 3.5 to 12.4 y as did the rush species Juncus squarrosus (T ef range 9.3 to 12.8 y). The sedge and grass groups showed the slowest and the least consistent rates of 137Cs decline, with T ef values of 2.9 to 59.8 y. Preliminary evaluation of 137Cs activity concentrations in sheep from some of the studied sites suggests that the decline found in vegetation is reflected in sheep.
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Affiliation(s)
- H J Synnott
- The Radiological Protection Institute of Ireland, Dublin.
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9
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Rafferty B, Dawson DE, Colgan PA. Seasonal variations in the transfer of 137Cs and 40K to pasture grass and its ingestion by grazing animals. Sci Total Environ 1994; 145:125-134. [PMID: 8016626 DOI: 10.1016/0048-9697(94)90303-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Samples of grass and sheep faeces were taken monthly over a 12-month period from three pasture sites. Biomass, 137Cs and 40K were measured. The activity concentration of these two radionuclides in grass was influenced by season and soil type. The seasonal patterns of 137Cs and 40K transfer to grass were inversely related, but evidence is presented which suggests that soil contamination of grass samples contributed to the 137Cs and 40K activity concentrations of the grass and augmented the difference between their patterns of transfer. This was influenced by season, climate and farm management. A parallel seasonality was identified in the 137Cs activity concentration of the faeces of sheep grazing these pastures. This was not observed for 40K in sheep faeces.
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Affiliation(s)
- B Rafferty
- Radiological Protection Institute of Ireland, Dublin
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10
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Rafferty B, Dawson DE, Colgan PA. Assessment of the role of soil adhesion in the transfer of 137Cs and 40K to pasture grass. Sci Total Environ 1994; 145:135-141. [PMID: 8016627 DOI: 10.1016/0048-9697(94)90304-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
137Cs and 40K were analyzed in pasture grass and soils throughout a 12-month period. The titanium content of the samples was determined as a marker of soil contamination of the grass samples. The 137Cs activity concentration in the grass was closely correlated with titanium and both increase in the winter months suggesting that increased soil contamination of grass is responsible for the increased 137Cs activity concentration observed at this time. The method greatly overestimates the contribution made by soil to the 137Cs activity concentrations of the grass samples and the results are highly variable. Some problems associated with the method are discussed and it is proposed that this method is unreliable.
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Affiliation(s)
- B Rafferty
- Radiological Protection Institute of Ireland, Dublin
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11
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Dawson DE, Gapany M, Burgess RC, Boesen PV, Headley DB. Tumor necrosis factor and chemotherapeutic agents. Potentiation of cytotoxicity with interferon gamma. Arch Otolaryngol Head Neck Surg 1992; 118:1168-71. [PMID: 1418895 DOI: 10.1001/archotol.1992.01880110036009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This study examined combinations of the recombinant human cytokines, tumor necrosis factor alpha and interferon gamma, with doxorubicin and dactinomycin as well as other drugs on six squamous cell carcinoma cell lines of head and neck origin using the 3(4,5-dimethylthiazol-2-yl)2,5-diphenyl-tetrazolium bromide proliferation assay. Interferon gamma significantly enhanced the cytotoxicity of tumor necrosis factor alpha with dactinomycin on all six cell lines investigated, while in four of six cell lines the cytotoxicity of tumor necrosis factor alpha with doxorubicin was significantly augmented by interferon gamma. Additional experiments showed no effect with either cytokine in combination with cisplatin, fluorouracil, methotrexate, or etoposide. These data demonstrate that human recombinant cytokines in concert with certain drugs improve in vitro cytotoxicity and may have a potential for improving in vivo therapy.
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Affiliation(s)
- D E Dawson
- Otologic Medical Services of Iowa City, University of Iowa Hospitals and Clinics
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12
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Abstract
This study investigated the relationship between altitude and 137Cs fallout in soils and plants. The soils and plants, Calluna vulgaris, Erica cinerea and Molinia caerulea, were sampled across a transect of two valleys in north-western Ireland. The results provided evidence that greater 137Cs deposition to soils occurred at higher altitudes, and the data supported the findings of a previous investigation in the same area. A valley effect, whereby greater concentrations of 137Cs accumulated in plants on the lower altitudes of the valley floors, was shown to be significant. Deposition values for total 137Cs in soils were not correlated with plant concentrations, although a relationship between concentrations in C. vulgaris and M. caerulea was found to be statistically significant. No relationship was observed between the 137Cs from weapons fallout with that of Chernobyl origin in the 0-10 cm depth soils, although a significant correlation emerged between the same two components measured in C. vulgaris. The results suggest that existing definitions of concentration ratios and transfer factors are, for many reasons, inappropriate for studies of soil to plant transfer of 137Cs in peatland ecosystems.
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Affiliation(s)
- E J McGee
- Nuclear Energy Board, Dublin, Ireland
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13
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Headley DB, Gapany M, Dawson DE, Kruse GD, Robinson RA, McCabe BF. The effect of hyperbaric oxygen on growth of human squamous cell carcinoma xenografts. Arch Otolaryngol Head Neck Surg 1991; 117:1269-72. [PMID: 1747231 DOI: 10.1001/archotol.1991.01870230085013] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Hyperbaric oxygen is an important adjunct to the treatment of patients with head and neck cancer with existing or recurrent wound healing problems. Anecdotal clinical observations and a recent study of chemically induced oral cancer in hamsters have raised concern that hyperbaric oxygen therapy may accelerate tumor growth in such patients. This study evaluated the effect of hyperbaric oxygen therapy on the growth of human squamous cell carcinoma xenografts in a proved animal model. Fresh tumor specimens from three patients with head and neck squamous cell carcinoma of varying degrees of differentiation were first subcutaneously transplanted into a nude mouse host. Growing xenografts were then transplanted into one of three mouse groups. Half of the mice in each group were given hyperbaric oxygen therapy. The transplant volume as an index of tumor growth was measured in controls and mice given hyperbaric oxygen therapy six times during the 3-week course. Xenograft growth was almost linear in all mice. No statistical difference in overall group mean growth rates was observed in mice given hyperbaric oxygen or control mice regardless of the degree of tumor differentiation. Xenograft tissue from all mice was microscopically examined for tumor mitotic indices and degree of differentiation. This study suggests that hyperbaric oxygen therapy has no effect on established tumor xenograft growth.
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Affiliation(s)
- D B Headley
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City 52242
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14
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Bailet JW, Abemayor E, Andrews JC, Rowland JP, Fu YS, Dawson DE. Malignant nerve sheath tumors of the head and neck: a combined experience from two university hospitals. Laryngoscope 1991; 101:1044-9. [PMID: 1921630 DOI: 10.1288/00005537-199110000-00003] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Malignant schwannoma is an aggressive neoplasm whose cell of origin and histologic characteristics remain controversial. Despite advances in diagnostic techniques, the natural history of this tumor remains uncertain. The charts of all patients with malignant schwannoma who were treated at the UCLA Center for the Health Sciences and the University of Iowa Hospital and Clinics were retrospectively reviewed. Sixteen patients received surgery and radiotherapy in combination or as sole therapy. Irrespective of treatment modality, prognosis was poor with an overall survival of 15%. Recent advances in imaging and histologic techniques that assist in establishing the diagnosis and delineating tumor location are discussed. In addition, the literature pertaining to malignant schwannoma of the head and neck is reviewed.
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Affiliation(s)
- J W Bailet
- UCLA Medical Center, Division of Head and Neck Surgery
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15
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Abstract
Inverted papillomas of the oral cavity are rare lesions. Although in the seven oral cases previously reported the lesions were benign, approximately 10% to 15% of inverted papillomas of the nasal cavity and paranasal sinuses develop or are associated with squamous cell carcinoma. This report presents a case of squamous cell carcinoma arising in an inverted papilloma of the buccal mucosa. Histologically, this lesion demonstrated the morphologic features of inverted papilloma in the superficial portion, and squamous carcinoma in deeper sections. This case suggests that although rare, inverted papillomas of the oral cavity should be considered potentially malignant or capable of harboring a malignancy.
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Affiliation(s)
- P V Boesen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City
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16
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Affiliation(s)
- R C Burgess
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City
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17
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Affiliation(s)
- D E Dawson
- Otologic Medical Services, Iowa City, IA
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Gapany M, Dawson DE, Schriever C, Burgess R, Gipple JR, Riggs CE. Tumor necrosis factor and cytotoxic agents. Effect on squamous carcinoma lines. Arch Otolaryngol Head Neck Surg 1990; 116:436-9. [PMID: 2317326 DOI: 10.1001/archotol.1990.01870040058014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The cytotoxicity of dactinomycin (actinomycin D), doxorubicin hydrochloride (Adriamycin), cisplatin, fluorouracil, and methotrexate alone and in combination with recombinant human tumor necrosis factor (rHuTNF) on human squamous cell carcinoma lines was studied by an MTT proliferation assay. The rHuTNF alone caused no inhibition after 24 to 72 hours. All lines investigated showed a dose-dependent response to dactinomycin and doxorubicin. Potentiation of dactinomycin and doxorubicin cytotoxicity occurred with four of six cell lines following incubation of rHuTNF and the drug. No synergistic effect on cytotoxicity was seen with rHuTNF and any chemotherapeutic agent on two cell lines. The addition of rHuTNF did not augment the cytotoxic effect seen with cisplatin, methotrexate, or fluorouracil on any cell line. These results show that rHuTNF can enhance the cytotoxic effect of certain chemotherapeutic agents on squamous cell lines in vitro.
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Affiliation(s)
- M Gapany
- Department of Otolaryngology Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242
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Abstract
The plasma of 15 normal volunteers, four patients with benign head and neck disease, and 12 patients with biopsy proven head and neck malignancies were evaluated using water-suppressed nuclear magnetic resonance (NMR) spectroscopy. While the mean full width at half height (HHLW) of the NMR spectra showed a significant difference between groups (P less than .05), the predictive value of a positive test was only 57% the sensitivity was only 33%, and individual values in all groups demonstrated considerable overlap. The mean HHLW of the control group was 38.5 Hz +/- 3.5 compared with 35.2 Hz +/- 4.7 for the cancer group and 35.0 Hz +/- 10 for the benign disease group. This method was not able to distinguish patients with malignancy from those with benign disease or controls. Its use as a specific screening method for head and neck malignancy cannot be recommended.
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Affiliation(s)
- D E Dawson
- Department of Otolaryngology Head and Neck Surgery, University of Iowa, Iowa City
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Dawson DE, Everts EC, Vetto RM, Burger DR. Assessment of immunocompetent cells in patients with head and neck squamous cell carcinoma. Ann Otol Rhinol Laryngol 1985; 94:342-5. [PMID: 3875306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Patients with squamous cell carcinoma of the head and neck have impaired T cell function and poor tumor-specific responsiveness. Disproportionate levels of circulating immunocompetent cells could be one reason for this diminished immunity. In this study, a panel of monoclonal antibodies and flow cytofluorometry were used to define the relative proportions of selected immune cell populations. We detected a deficiency of the interleukin-2-producing subset of T helper-inducer cells (TH 5.2+) in these patients. Our data showed no significant differences in circulating levels of total T cells, T cell subsets, B cells, monocytes, or natural killer cells when compared to age, alcohol- and tobacco-use matched controls.
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