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A recent examination of Philometra nematodes from mangrove red snapper Lutjanus argentimaculatus (Forsskal, 1775) from the Karachi coast, Kemari was done in the years 2021–2022. The present study reported three new species of genus Philometra (Costa, 1845) (Nematoda: Philometridae) Philometra kolachii, Philometra lutjani and Philometra kemarii. A total of 140 fish samples were examined, and 76 were infected. The intensity of infected fish was 54.28%. In Pakistan, literature on Philometrid nematodes is limited, therefore, this research would be helpful for the documentation and enhancement of nematods in Pakistan. Resumo Um exame recente dos nematóides Philometra do pargo vermelho de mangue Lutjanus argentimaculatus (Forsskal, 1775) da costa de Karachi, Kemari, foi feito nos anos 2021 e 2022. O presente estudo relatou três novas espécies do gênero Philometra (Costa, 1845) (Nematoda: Philometridae): Philometra kolachii, Philometra lutjani e Philometra kemarii. O total de 140 amostras de peixes foram examinadas e 76 estavam infectadas. A intensidade de peixes infectados foi de 54,28%. No Paquistão, a literatura sobre os nematóides Philometrid é limitada, portanto, esta pesquisa seria útil para a documentação e aprimoramento dos nematóides no Paquistão.

Environmental contamination with heavy metals is a threat to the organisms due to their toxicity, persistence and bioaccumulation in food chains. The study was aimed to assess cadmium (Cd) effect on calcium (Ca) level in bones of a freshwater fish Channa gachua. 42 fish individuals were kept into six (6) aquaria; labelled aq.0, 1, 2, 3,4 and 5 in the laboratory for treatment. Aq.0 was control group and aq.1, 2,3,4,5 were experimental with treatment solution of Cd 0, 0.1ppm, 0.5ppm, 1ppm, 2.5ppm and 5ppm respectively for three months. After exposure, bones tissue were examined for Cd accumulation and Ca concentration. Highest accumulation of Cd were recorded in aq.5 mean 46.86 ± 0.46 mgkg-1 .and lowest in the control group with mean 0.61 ± 0.06 mgkg-1. The order of Cd bioaccumulation in bones were aq.5 > aq.4 >aq.3 > aq.2 > aq.1 > aq.0. Highest concentration of Ca were noted in aq.0 (Control group) mean 7888.06 ± 4827.22 mgkg-1 and lowest were 1132.36 ± 203.73 mgkg-1 in aq.5 (at 5.0 ppm). Generally a pattern of decreasing Ca level were observed with each rise of Cd bioaccumulation aq.0 > aq.1 > aq.2 > aq.3 > aq.4 > aq.5. Current study indicated that Cd accumulation have substantial effect on Ca level in bones and hence on skeleton system. Strict rules must be implemented by government to control metals pollution and exploitations of biota. Resumo A contaminação ambiental com metais pesados é uma ameaça aos organismos devido à sua toxicidade, persistência e bioacumulação nas cadeias alimentares. O estudo teve como objetivo avaliar o efeito do Cd sobre o nível de Ca em ossos de peixes de água doce Channa gachua. Quarenta e dois indivíduos de peixes foram mantidos em seis aquários; marcado aq. 0, 1, 2, 3, 4 e 5 no laboratório para tratamento. Aq. 0 foi o grupo controle e aq. 1, 2, 3, 4, 5 foram experimentais com solução de tratamento de Cd 0, 0,1 ppm, 0,5 ppm, 1 ppm, 2,5 ppm e 5 ppm respectivamente por três meses. Após a exposição, o tecido ósseo foi examinado quanto ao acúmulo de Cd e concentração de Ca. O maior acúmulo de Cd foi registrado em aq. 5 com média de 46,86 ± 0,46 mgkg-1 e o menor no grupo controle com média de 0,61 ± 0,06 mgkg-1. A ordem de bioacumulação de Cd nos ossos foi aq. 5 > aq. 4 > aq. 3 > aq. 2 > aq. 1 > aq. 0. A concentração mais alta de Ca foi observada em aq. 0 (grupo controle) média de 7.888,06 ± 4.827,22 mgkg-1 e a mais baixa foi de 1.132,36 ± 203,73 mgkg-1 em aq. 5 (a 5,0 ppm). Geralmente um padrão de diminuição do nível de Ca foi observado com cada aumento da bioacumulação de Cd aq. 0 > aq. 1 > aq. 2 > aq. 3 > aq. 4 > aq. 5. O estudo atual indicou que o acúmulo de Cd tem efeito substancial no nível de Ca nos ossos e, portanto, no sistema esquelético. Regras estritas devem ser implementadas pelo governo para controlar a poluição por metais e a exploração da biota.

During the coronavirus disease 2019 pandemic, minimizing exposure risk for patients with cancer and health care personnel was of utmost importance. Here, we present steps taken to date to flatten the curve at the radiation oncology division of a tertiary cancer center with the goal of mitigating risk of exposure among patients and staff, and optimizing resource utilization. Response to the coronavirus disease 2019 pandemic in this large tertiary referral center included volume reduction, personal protective equipment recommendations, flexible clinic visit interaction types dictated by need and risk reduction, and numerous social distancing strategies. We hope these outlined considerations can assist the wider radiation oncology community as we collectively face this ongoing challenge.

Highlights • Prospective cohort of 121 cancer patients tested for SARS-CoV-2 over 35 days. • Of 7 positive cases, 6 were admitted with 4 warranting intensive care, and 2 died. • RT was delayed in one-third of patients while awaiting RT-PCR test results. • With a dual PPE policy, newly quarantined employees decreased 6-fold per day. • Each patient was an exposure risk to 5 employees, most commonly RTTs (38%), Background and purpose The COVID-19 pandemic warrants operational initiatives to minimize transmission, particularly among cancer patients who are thought to be at high-risk. Within our department, a multidisciplinary tracer team prospectively monitored all patients under investigation, tracking their test status, treatment delays, clinical outcomes, employee exposures and quarantines. Materials and methods Prospective cohort tested for SARS-COV-2 infection over 35 consecutive days of the early pandemic (03/19/2020-04/22/2020). Results A total of 121 Radiation Oncology patients underwent RT-PCR testing during this timeframe. Of the 7 (6%) confirmed-positive cases, 6 patients were admitted (including 4 warranting intensive care), 2 of whom died from acute respiratory distress syndrome. Radiotherapy was deferred or interrupted for 40 patients awaiting testing. As the median turnaround time for RT-PCR testing decreased from 1.5 (IQR: 1-4) to ≤1-day (P

Patients receiving radiation therapy (RT) for head and neck cancers often experience severe weight loss that can lead to difficulty in daily setup. The primary purpose of this study was to understand the impact of weight loss on patient’s setup in the era of image guided radiation therapy. One hundred and ninety-three consecutive patients were treated with radiation for head and neck malignancies. Weight loss was measured during weekly treatment visits, and percentage weight loss was calculated by dividing the total weight loss by the pre-treatment weight. Kilovoltage (KV) imaging was performed daily to ensure setup accuracy with shifts recorded on a daily basis in the anterior-posterior (AP), left-right (LR), and superior-inferior (SI) dimensions. Spearman correlation coefficients, Wilcoxon and Kruskal-Wallis tests were used in statistical analysis. A regression model based upon the beta distribution was used to fit multivariate models for percentage weight change. The average percentage weight loss for the cohort was 8 % (SD = 6 %). Weight loss was associated with the largest overall shift and the largest LR shift, but not shifts in other dimensions (ρ =

236 Background: The MD Anderson Cancer Network includes 29 distinct Radiation Oncology facilities spread across metropolitan Houston area locations, national partnerships, and international affiliates. Standard performance indicators (PIs) were developed to monitor the quality and safety of radiation treatment at these facilities spread across the globe. Methods: Stakeholders from Radiation Oncology nursing, dosimetry, physics, radiation therapy, and clinical operations identified PIs that measure safe, efficient, and effective radiation oncology care. PIs are collected monthly from each facility and are reported in a scorecard that includes performance goals. The appropriateness and effectiveness of the PIs are reviewed annually to determine if PIs need to be added, removed, or revised. Results: As the network expanded, scorecard use expanded from 11 facilities in 2013 to 29 facilities in 2019. Select PIs are summarized in the table. Scorecard composition has evolved over time. PIs such as completion of simulation orders and treatment planning directives were removed once consistently reaching 100% after improved monitoring, process improvements, and implementation of hard stops. The scorecard has been especially useful when onboarding new facilities, as evidenced by PIs increasingly meeting performance thresholds in the first year after joining the network. For example, one facility increased PI compliance from 61% to 100% the first year after joining the network. Conclusions: It is feasible to develop and implement a performance indicator scorecard across a large radiation oncology network. The scorecard permits timely assessment of quality indicators, provides oversight, and is effective in stabilizing operations at newly on-boarded radiation oncology practices. [Table: see text]

e18305 Background: The cost of a full cycle of radiation therapy at MD Anderson Cancer Center has not been determined using a bottom-up measurement approach. Due to the complexity and variation in clinical processes, typical costing strategies do not provide the level of detail necessary to evaluate the value equation, defined as outcomes over cost. To address this limitation, we designed and implemented a practice-wide Time-Driven Activity-Based Costing (TDABC) strategy to capture our total direct cost of care for all treatment modalities within each of 9 disease site-specific services. Methods: Process maps were created for each of the 9 disease site-specific services. Care delivery times were captured by treatment modality for each service as determined by multidisciplinary teams routinely performing each step of the process. The data were entered into a standardized tool, which calculated step costs based upon capacity cost rates for each human resource. The costing tool also calculated total direct labor costs for specific treatment plans based on modality, complexity, and fractionation. Results: The analysis took six months to complete and required the use of approximately 1,000 administrative hours, 250 physician hours, 250 clinical staff hours and 100 medical physics hours. Approximately 17 process maps were created for each of the 9 services with each process map receiving further analysis based upon radiation treatment modality. As a result of observed variation in costs between disease-site services, best practices were identified and 15 standardization opportunities were discovered. Additionally, the cost-benefit analysis between high profile modalities within each disease-site service, such as Proton Therapy and Intensity Modulated Radiation Therapy (IMRT) on the Head and Neck service, were easier to complete. Conclusions: Time-Driven Activity-Based Costing is a valid method for calculating direct costs in a large academic radiation oncology practice. Standardized clinical outcome data can be used to complete the value equation and ultimately provide insight for better clinical and administrative decision making.

Purpose: Demonstrate the effectiveness of in-house software in ensuring EMR workflow efficiency and safety. Methods: A web-based dashboard system (WBDS) was developed to monitor clinical workflow in real time using web technology (WAMP) through ODBC (Open Database Connectivity). Within Mosaiq (Elekta Inc), operational workflow is driven and indicated by Quality Check Lists (QCLs), which is triggered by automation software IQ Scripts (Elekta Inc); QCLs rely on user completion to propagate. The WBDS retrieves data directly from the Mosaig SQL database and tracks clinical events in real time. For example, the necessity of a physics initial chart check can be determined by screening all patients on treatment who have received their first fraction and who have not yet had their first chart check. Monitoring similar “real” events with our in-house software creates a safety net as its propagation does not rely on individual users input. Results: The WBDS monitors the following: patient care workflow (initial consult to end of treatment), daily treatment consistency (scheduling, technique, charges), physics chart checks (initial, EOT, weekly), new starts, missing treatments (>3 warning/>5 fractions, action required), and machine overrides. The WBDS can be launched from any web browser which allows the end user complete transparency and timely information. Since the creation of the dashboards, workflow interruptions due to accidental deletion or completion of QCLs were eliminated. Additionally, all physics chart checks were completed timely. Prompt notifications of treatment record inconsistency and machine overrides have decreased the amount of time between occurrence and execution of corrective action. Conclusion: Our clinical workflow relies primarily on QCLs and IQ Scripts; however, this functionality is not the panacea of safety and efficiency. The WBDS creates a more thorough system of checks to provide a safer and near error-less working environment.