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Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC.
The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.
The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.
To evaluate the association between novel pre- and post-operative biomarker levels and 30-day unplanned readmission or mortality after paediatric congenital heart surgery.
Children aged 18 years or younger undergoing congenital heart surgery (n = 162) at Johns Hopkins Hospital from 2010 to 2014 were enrolled in the prospective cohort. Collected novel pre- and post-operative biomarkers include soluble suppression of tumorgenicity 2, galectin-3, N-terminal prohormone of brain natriuretic peptide, and glial fibrillary acidic protein. A model based on clinical variables from the Society of Thoracic Surgery database was developed and evaluated against two augmented models.
Unplanned readmission or mortality within 30 days of cardiac surgery occurred among 21 (13%) children. The clinical model augmented with pre-operative biomarkers demonstrated a statistically significant improvement over the clinical model alone with a receiver-operating characteristics curve of 0.754 (95% confidence interval: 0.65–0.86) compared to 0.617 (95% confidence interval: 0.47–0.76; p-value: 0.012). The clinical model augmented with pre- and post-operative biomarkers demonstrated a significant improvement over the clinical model alone, with a receiver-operating characteristics curve of 0.802 (95% confidence interval: 0.72–0.89; p-value: 0.003).
Novel biomarkers add significant predictive value when assessing the likelihood of unplanned readmission or mortality after paediatric congenital heart surgery. Further exploration of the utility of these novel biomarkers during the pre- or post-operative period to identify early risk of mortality or readmission will aid in determining the clinical utility and application of these biomarkers into routine risk assessment.
Many important scientific and technical problems are best addressed using multiple, microscopy-based analytical techniques that combine the strengths of complementary methods. Here, we provide two examples from biomedical challenges: unravelling the attachment zone between dental implants and bone, and uncovering the mechanism of Alzheimer's disease. They combine synchrotron-based scanning transmission X-ray microscopy (STXM) with transmission electron microscopy ((S)TEM), electron tomography (ET), EELS tomography, and/or atom probe tomography (APT). STXM provides X-ray absorption based chemical sensitivity at mesoscale resolution (10–30 nm), which complements higher spatial resolution electron microscopy and APT.
Paediatric hospital-associated venous thromboembolism is a leading quality and safety concern at children’s hospitals.
The aim of this study was to determine risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation.
We conducted a retrospective, case–control study of children admitted to the cardiovascular intensive care unit at Johns Hopkins All Children’s Hospital (St. Petersburg, Florida, United States of America) from 2006 to 2013. Hospital-associated venous thromboembolism cases were identified based on ICD-9 discharge codes and validated using radiological record review. We randomly selected two contemporaneous cardiovascular intensive care unit controls without hospital-associated venous thromboembolism for each hospital-associated venous thromboembolism case, and limited the study population to patients who had undergone cardiothoracic surgery or therapeutic cardiac catheterisation. Odds ratios and 95% confidence intervals for associations between putative risk factors and hospital-associated venous thromboembolism were determined using univariate and multivariate logistic regression.
Among 2718 admissions to the cardiovascular intensive care unit during the study period, 65 met the criteria for hospital-associated venous thromboembolism (occurrence rate, 2%). Restriction to cases and controls having undergone the procedures of interest yielded a final study population of 57 hospital-associated venous thromboembolism cases and 76 controls. In a multiple logistic regression model, major infection (odds ratio=5.77, 95% confidence interval=1.06–31.4), age ⩽1 year (odds ratio=6.75, 95% confidence interval=1.13–160), and central venous catheterisation (odds ratio=7.36, 95% confidence interval=1.13–47.8) were found to be statistically significant independent risk factors for hospital-associated venous thromboembolism in these children. Patients with all three factors had a markedly increased post-test probability of having hospital-associated venous thromboembolism.
Major infection, infancy, and central venous catheterisation are independent risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or cardiac catheter-based intervention, which, in combination, define a high-risk group for hospital-associated venous thromboembolism.
Three collated geochemical surveys of surface water in the Clyde catchment have established the spatial variability in water composition, primarily under baseflow conditions. The waters are broadly pH-neutral to alkaline (maximum pH 8.7) in the lowlands, but mildly acidic in uplands on the catchment periphery. Electrical conductance is relatively high in lowland streams (maximum 8320μgL–1), with lower values in the uplands. Dissolved chromium (Cr; <0.05–971μgL–1) and lead (Pb; <0.05–19.4μgL–1) are of importance due to recognised pollution sources within the catchment. High aqueous Cr concentrations (>5μgL–1) are recorded in urban areas associated with the disposal of alkaline industrial chromite ore processing residue. Under such conditions, Cr probably occurs as Cr(VI). Numerous relatively high Pb values occur in the upland and urban areas. These are likely to be associated with a combination of soil reactions, diffuse pollution and contamination from Pb mineralisation/mining. Pb has a stronger correlation with water pH than with stream sediment Pb content, suggesting that pH has a greater control on Pb mobility than host-rock Pb. Exceedances of water-quality standards are <1% for both Cr and Pb across the catchment. Absolute exceedances are more extreme for Cr than for Pb, highlighting the scale of the Cr pollution problem for urban surface water within the catchment.
An assessment of topsoil (5–20cm) metal/metalloid (hereafter referred to as metal) concentrations across Glasgow and the Clyde Basin reveals that copper, molybdenum, nickel, lead, antimony and zinc show the greatest enrichment in urban versus rural topsoil (elevated 1.7–2.1 times; based on median values). This is a typical indicator suite of urban pollution also found in other cities. Similarly, arsenic, cadmium and lead are elevated 3.2–4.3 times the rural background concentrations in topsoil from the former Leadhills mining area. Moorlands show typical organic-soil geochemical signatures, with significantly lower (P<0.05) concentrations of geogenic elements such as chromium, copper, nickel, molybdenum and zinc, but higher levels of cadmium, lead and selenium than most other land uses due to atmospheric deposition/trapping of these substances in peat. In farmland, 14% of nickel and 7% of zinc in topsoil samples exceed agricultural maximum admissible concentrations, and may be sensitive to sewage-sludge application. Conversely, 5% of copper, 17% of selenium and 96% of pH in farmland topsoil samples are below recommended agricultural production thresholds. Significant proportions of topsoil samples exceed the most precautionary (residential/allotment) human-exposure soil guidelines for chromium (18% urban; 10% rural), lead (76% urban; 45% rural) and vanadium (87% urban; 56% rural). For chromium, this reflects volcanic bedrock and the history of chromite ore processing in the region. However, very few soil types are likely to exceed new chromiumVI-based guidelines. The number of topsoil samples exceeding the guidelines for lead and vanadium highlight the need for further investigations and evidence to improve human soil-exposure risk assessments to better inform land contamination policy and regeneration.
In the United States alone, ∼14,000 children are hospitalised annually with acute heart failure. The science and art of caring for these patients continues to evolve. The International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute was held on February 4 and 5, 2015. The 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute was funded through the Andrews/Daicoff Cardiovascular Program Endowment, a philanthropic collaboration between All Children’s Hospital and the Morsani College of Medicine at the University of South Florida (USF). Sponsored by All Children’s Hospital Andrews/Daicoff Cardiovascular Program, the International Pediatric Heart Failure Summit assembled leaders in clinical and scientific disciplines related to paediatric heart failure and created a multi-disciplinary “think-tank”. The purpose of this manuscript is to summarise the lessons from the 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute, to describe the “state of the art” of the treatment of paediatric cardiac failure, and to discuss future directions for research in the domain of paediatric cardiac failure.
The near infrared sky spectral brightness has been measured at the South Pole with the Near Infrared Sky Monitor (NISM) throughout the 2001 winter season. The sky is found to be typically more than an order of magnitude darker than at temperate latitude sites, consistent with previous South Pole observations. Reliable robotic operation of the NISM, a low power, autonomous instrument, has been demonstrated throughout the Antarctic winter. Data analysis yields a median winter value of the 2.4μm (Kdark) sky spectral brightness of ˜120μJy arcsec−2 and an average of 210 ± 80μJy arcsec−2. The 75%, 50%, and 25% quartile values are 270 ± 100, 155 ± 60, and 80 ± 30μJy arcsec−2, respectively.
The THz spectral region includes a number of important transitions which
allow us to trace the evolution of the interstellar medium. Because of the
opacity of the atmosphere in this spectral range, the best sites for
ground-based THz observations are on the Antarctic Plateau; of these sites,
Dome A is expected to be the best. THz survey science can be carried out
with small telescopes, easing logistical constraints. By deploying a
submillimetre-wave tipper/ telescope to Dome A, we have trialled several
technologies for such an instrument, and we are able to test whether the
site quality is sufficient for THz surveys.
The Gattini-DomeC project, part of the IRAIT site testing campaign and ongoing since January 2006, consists of two cameras for the measurement of optical sky brightness, large area cloud cover, and auroral detection above the DomeC site, home of the French-Italian Concordia station. The cameras are transit in nature and are virtually identical except for the nature of the lenses. The cameras have operated throughout the past two Antarctic winter seasons and here we present the results obtained from the 2006 winter-time dataset of the wide field “All-sky camera".
The Gattini cameras are two site testing instruments for the measurement of optical sky brightness, large area cloud cover and auroral detection of the night sky above the high altitude Dome C site in Antarctica. The cameras have been operating since installation in January 2006 and are currently at the end of the first Antarctic winter season. The cameras are transit in nature and are virtually identical, both adopting Apogee Alta CCD detectors. By taking frequent images of the night sky we obtain long term cloud cover statistics, measure the sky background intensity as a function of solar and lunar altitude and phase and directly measure the spatial extent of bright aurora if present and when they occur. The full data set will return in December 2006 however a limited amount of data has been transferred via the Iridium network enabling preliminary data reduction and system evaluation. An update of the project is presented together with preliminary results from data taken since commencement of the winter season.
Centrality is one of the most important and widely used conceptual tools for analyzing social networks. Nearly all empirical studies try to identify the most important actors within the network. In this chapter, we discuss three extensions of the basic concept of centrality. The first extension generalizes the concept from that of a property of a single actor to that of a group of actors within the network. This extension makes it possible to evaluate the relative centrality of different teams or departments within an organization, or to assess whether a particular ethnic minority in a society is more integrated than another. The second extension applies the concept of centrality to two-mode data in which the data consist of a correspondence between two kinds of nodes, such as individuals and the events in which they participate. In the past, researchers have dealt with such data by converting them to standard network data (with considerable loss of information); the objective of the extension discussed here is to apply the concept of centrality directly to the two-mode data. The third extension uses the centrality concept to examine the core-periphery structure of a network.
It is well-known that a wide variety of specific measures have been proposed in the literature dating back at least to the 1950s with the work of Katz (1953). Freeman (1979) imposed order on some of this work in a seminal paper that categorized centrality measures into three basic categories – degree, closeness, and betweenness – and presented canonical measures for each category.
Free radicals and reactive species produced in vivo can trigger cell damage and DNA modifications resulting in carcinogenesis. Dietary antioxidants trap these species limiting their damage. The present study evaluated the role of vitamins C and E in the prevention of potentially premalignant modifications to DNA in the human stomach by supplementing patients who, because of hypochlorhydria and possible depletion of gastric antioxidants, could be at increased risk of gastric cancer. Patients undergoing surveillance for Barrett's oesophagus (n 100), on long-term proton pump inhibitors were randomized into two groups: vitamin C (500 mg twice/d) and vitamin E (100 mg twice/d) for 12 weeks (the supplemented group) or placebo. Those attending for subsequent endoscopy had gastric juice, plasma and mucosal measurements of vitamin levels and markers of DNA damage. Seventy-two patients completed the study. Plasma ascorbic acid, total vitamin C and vitamin E were elevated in the supplemented group consistent with compliance. Gastric juice ascorbic acid and total vitamin C levels were raised significantly in the supplemented group (P=0·01) but supplementation had no effect on the mucosal level of this vitamin. However, gastric juice ascorbic acid and total vitamin C were within normal ranges in the unsupplemented group. Mucosal malondialdehyde, chemiluminescence and DNA damage levels in the comet assay were unaffected by vitamin supplementation. In conclusion, supplementation does not affect DNA damage in this group of patients. This is probably because long-term inhibition of the gastric proton pump alone does not affect gastric juice ascorbate and therefore does not increase the theoretical risk of gastric cancer because of antioxidant depletion.
Reactive oxygen species have been implicated in Helicobacter pylori-mediated gastric carcinogenesis, whereas diets high in antioxidant vitamins C and E are protective. We have examined the effect of vitamin C and E supplements in combination with H. pylori eradication on reactive oxygen species activity in H. pylori gastritis. H. pylori-positive patients were randomized into four groups: triple therapy alone (Bismuth chelate, tetracycline, and metronidazole for 2 weeks), vitamins alone (200 mg vitamin C and 50 mg vitamin E, both twice per day for 4 weeks), both treatments or neither. Plasma and mucosal ascorbic acid, malondialdehyde and reactive oxygen species were determined before and after treatment. Compared with normal controls (n 61), H. pylori-positive patients (n 117) had higher mucosal reactive oxygen species and malondialdehyde levels and lower plasma ascorbic acid. Plasma ascorbic acid doubled in both groups of patients receiving vitamins and mucosal levels also increased. Malondialdehyde and reactive oxygen species fell in patients in whom H. pylori was eradicated but vitamin supplements were not effective either alone or in combination with H. pylori eradication. Supplements of vitamins C and E do not significantly reduce mucosal reactive oxygen species damage in H. pylori gastritis.
An assessment of amniotic fluid volume has become an important component of antenatal testing for the at-risk pregnancy. The presence of normal amniotic fluid volume, either in association with a reactive nonstress test or as a component of the biophysical profile is considered to reflect current fetal well being and probable absence of chronic stress. The chronically stressed fetus is likely to have low amniotic fluid volume because of the shunting of blood preferentially to the brain, heart and adrenal glands at the expense of other body systems during the period of chronic stress. Decreased renal blood flow leads to decreased urinary output. Because the primary component of amniotic fluid in the third trimester of pregnancy is fetal urine, ongoing chronic stress can be recognised as oligohydramnios.
Precise amniotic fluid volume (AFV) measurement is accomplished either by use of a dye-dilution technique or by direct measurement of the fluid volume at the time of caesarean delivery. The need for laboratory support and the inherent invasiveness of dye-dilution procedures limits their application to study protocols. Direct measurement of AFV at caesarean delivery is reflective only of fluid volume at the time of delivery and cannot be used to serially evaluate fluid volume as a component of antenatal testing.