Measuring the impact of COVID-19 on hospital care pathways

Care pathways in hospitals around the world reported significant disruption during the recent COVID-19 pandemic but measuring the actual impact is more problematic. Process mining can be useful for hospital management to measure the conformance of real-life care to what might be considered normal operations. In this study, we aim to demonstrate that process mining can be used to investigate process changes associated with complex disruptive events. We studied perturbations to accident and emergency (A &E) and maternity pathways in a UK public hospital during the COVID-19 pandemic. Co-incidentally the hospital had implemented a Command Centre approach for patient-flow management affording an opportunity to study both the planned improvement and the disruption due to the pandemic. Our study proposes and demonstrates a method for measuring and investigating the impact of such planned and unplanned disruptions affecting hospital care pathways. We found that during the pandemic, both A &E and maternity pathways had measurable reductions in the mean length of stay and a measurable drop in the percentage of pathways conforming to normative models. There were no distinctive patterns of monthly mean values of length of stay nor conformance throughout the phases of the installation of the hospital’s new Command Centre approach. Due to a deficit in the available A &E data, the findings for A &E pathways could not be interpreted

Parthenocissus renukae, a new species of Vitaceae from South India

A new species of Vitaceae from Kerala, India, Parthenocissus renukae Anto & Pradeep is described and illustrated. The species resembles P. semicordata Planch. and Cissus aristata Blume in certain morphological characters. It differs from P. semicordata in having simple leaves clothed with T-shaped hairs on its abaxial surface, shorter (upto 8cm) petioles, 8-branched tendrils, umbellate inflorescences and tomentose petals. It also differs from C. aristata in having pads at tendril tips, 8-branched tendrils and T-shaped hairs on the abaxial leaf surface. The species is known from the type locality, Mangad and Peruvanmala in Thrissur district of Kerala

Breast-conserving radiotherapy with simultaneous integrated boost; field-in-field three-dimensional conformal radiotherapy versus inverse intensity-modulated radiotherapy – A dosimetric comparison: Do we need intensity-modulated radiotherapy?

Background and Purpose: To examine the feasibility of improving breast-conserving radiotherapy with simultaneous integrated boost (SIB) and analyzing the efficiency of forward versus inverse intensity-modulated radiotherapy (IMRT) techniques in providing the same. Materials and Methods: Three-dimensional conformal radiotherapy (3DCRT) field-in-field (FIF) plans with simultaneous and sequential boost and IMRT SIB plans were generated for the datasets of 20 patients who had undergone breast-conserving surgery. The 3 plans were compared dosimetrically for efficiency in terms of planning target volume (PTV) coverage (PTV 95%), homogeneity and conformity, dose delivered to ipsilateral/contralateral lungs (I/L: V10, V20, C/L: Vmean, V5), heart and contralateral breast (Vmean, V30 for heart and Vmean, V1, V5 for C/L breast). Results: The FIF 3DCRT plan with SIB (PLAN B) was more homogeneous than the classical technique with sequential boost (PLAN A). There were less hot spots in terms of Dmax (63.7 ± 1.3) versus Dmax (68.9 ± 1), P < 0.001 and boost V107%, B (0.3 ± 0.7) versus A (3.5 ± 5.99), P = 0.001. The IMRT SIB (PLAN C) did not provide any significant dosimetric advantage over the 3DCRT SIB technique. IMRT SIB plan C was associated with increased dose to contralateral lung in-terms of V5 (10.35 +/- 18.23) vs. (1.13 +/- 4.24), P = 0.04 and Vmean (2.12 ± 2.18) versus Vmean (0.595 ± 0.89), P = 0.008. There was 3-fold greater exposure in terms of Monitor Unit (MU) (1024.9 ± 298.32 versus 281.05 ± 20.23, P < 0.001) and treatment delivery time. Conclusions: FIF 3DCRT SIB provides a dosimetrically acceptable and technically feasible alternative to the classical 3DCRT plan with sequential boost for breast-conserving radiotherapy. It reduces treatment time by 2 weeks. IMRT SIB does not appear to have any dosimetric advantage; it is associated with significantly higher doses to contralateral lung and heart and radiation exposure in terms of MU

Mycorrhizal synthesis between Pisolithus arhizus and adult clones of Arbutus unedo in vitro and in nursery

Arbutoid mycorrhizae were synthesized between adult selected clones of Arbutus unedo L. and Pisolithus arhizus. Two micropropagated clones were tested: AL1, in vitro and C1 (acclimatized plants) in nursery and later in a field trial. In vitro, rooted shoots were transferred to test tubes containing the substrate previously inoculated with mycelium cultured on agar. In the nursery, two inoculation treatments were tested (vegetative inocula or dry sporocarps) and compared to control plants. In the field trial, plants from nursery inoculation treatments were compared and an additional control treatment using seedlings was implemented. Plant height was evaluated 4 months later in the nursery and 20 months later in the field trial. Roots were examined by morphological and histological studies: a) in vitro plantlets one month after inoculation and nine months after acclimatization; and b) 20 months after the field trial was established. Arbutoid mycorrhizae were observed in vitro one month after inoculation, indicating compatibility between A. unedo and P. arhizus. These showed the presence of a mantle, Hartig net, and intracellular hyphal complexes confined to the epidermal root cells. Arbutoid mycorrhizae were also observed nine months after acclimatiza- Fund project: This work was supported by a PhD fellowship (SFRH/BD/37170/2007) from the Portuguese Foundation for Science and Technology (FCT) The online version is available at http://link.springer.com Filomena Gomes ( ) • Esteban San Martin Filomena Gomes. CERNAS, Dep. Recursos Florestais, Escola Superior Agrária Coimbra, Bencanta, 3040-316, Coimbra, Portugal, Tel: 351 239 802940, Fax: 351 239 802979, Email: [email protected] Helena Machado INIAV, Instituto Nacional de Investigação Agrária e Veterinária, IP., Av. República, Quinta do Marquês 2780-159 Oeiras, Portugal A. Portugal • Jorge M. Canhoto Centre of Functional Ecology, Department of Life Sciences, University of Coimbra, Ap. 3046, 3001-401 Coimbra, Portugal. Corresponding editor: Chai Ruihai tion in inoculated and control plants. In order to confirm the identity of mycorrhizae, molecular techniques were used, in previously inoculated in vitro plants, 12 months after acclimatization. Thelephora and Hebeloma mycorrhizae, two types of highly competitive and widespread mycorrhizae on nurseries were identified. In the nursery, dry sporocarp treatment improved plant height after four months. In a field trial (20 months later), plants growth did not show significant differences. By this time, mycorrhized roots with Cenococcum geophilum and other types were identified. These results and their implications on A. unedo breeding program are discussed.F. Gomes was supported by a PhD fellowship (SFRH/BD/37170/2007) from the Portuguese Foundation for Science and Technology (FCT)