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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.
Insular species, particularly birds, experience high levels of speciation and endemism. Similarly, island birds experience extreme levels of extinction. Based on a 2012 taxonomic assessment, historically there were four reed-warbler species in the Mariana Islands, the Guam Reed-warbler Acrocephalus luscinia (Guam), the Nightingale Reed-warbler Acrocephalus hiwae (Saipan and Alamagan), the Aguijuan Reed-warbler A. nijoi (Aguiguan or Aguijuan), and the Pagan Reed-warbler A. yamashinae (Pagan). Between 2008 and 2010 we surveyed for three of these species on Alamagan, Aguiguan, and Pagan. Our results indicate that reed-warblers are extinct on Aguiguan, likely extinct on Pagan, and only the Nightingale Reed-warbler on Alamagan and Saipan remains. We estimated the global population at between 1,019 and 6,356 birds (95% CI; mean estimate 3,688), which has declined by more than 1,000 birds since the first quantitative surveys were conducted in 1982, i.e. a 24% decline in 28 years. Camp et al. (2009) describe the status of the Nightingale Reed-warbler on Saipan, which has also declined. We estimated the Alamagan population to be between 428 and 1,762 birds in 2010 (mean estimate 946). Thus, the Alamagan population is ~25 % of the global population, and it has declined slightly since 2000. This decline was not significant but is concerning, especially given a similar decline on Saipan. Restoration and protection of tall-stature native and secondary forest could benefit the Alamagan population, as would similar conservation on Saipan that includes wetland habitat. After suitable restoration of forest and wetland habitats on Aguiguan, Guam and Pagan, individuals from Alamagan and Saipan could serve as founder populations. Careful consideration of the extent and habitat preference of individuals translocated to Tinian, where an unknown reed-warbler species previously occurred, is warranted.
A feedforward pathological signaling loop generated by TNFα and IFN-γ synergy in the inflamed lung, driving CXCL-10 (IP-10) and CXCL-9 chemokine-mediated activated T-cell and monocyte/macrophage tissue recruitment, may define the inflammatory biology of lethal COVID-19 respiratory failure.
To assess TNFα-antagonist therapy, 18 hospitalized adults with hypoxic respiratory failure and COVID-19 pneumonia received single-dose infliximab-abda therapy 5 mg/kg intravenously between April and December 2020. The primary endpoint was time to increase in oxygen saturation to fraction of inspired oxygen ratio (SpO2/FiO2) by ≥50 compared to baseline and sustained for 48 h. Secondary endpoints included 28-day mortality, dynamic cytokine profiles, secondary infections, duration of supplemental oxygen support, and hospitalization.
Patients were predominantly in critical respiratory failure (15/18, 83%), male (14/18, 78%), above 60 years (median 63 years, range 31–80), race-ethnic minorities (13/18, 72%), lymphopenic (13/18, 72%), steroid-treated (17/18, 94%), with a median ferritin of 1953 ng/ml. Sixteen patients (89%) met the primary endpoint within a median of 4 days; 14/18 (78%) were discharged in a median of 8 days and were alive at 28-day follow-up. Three deaths were attributed to secondary lung infection. Mean plasma IP-10 levels declined sharply from 9183 to 483 pg/ml at Day 3 and 146 pg/ml at Day 14/discharge. Significant Day 3 declines in IFN-
, TNFα, IL-27, CRP, and ferritin occurred. IP-10 and CXCL-9 declines were strongly correlated among patients with lymphopenia reversal (Day 3, Pearson r: 0.98, P-value 0.0006).
Infliximab-abda may rapidly abrogate pathological inflammatory signaling to facilitate clinical recovery in severe and critical COVID-19.
Chapter 1 introduces the book’s main theme, namely the growing global contest over the future of coal. Three main aspects are identified – the changing world-historical status of coal as the fuel of development, the shifting significance of the coal commodity in economic growth, and its impact as a central driver of climate change and ecological exhaustion. Government-led development ideology remains closely bound up with the extraction of coal as a source of energy security, yet is increasingly exposed and contested. Increased populist rejection of climate policy in the name of fossil fuel reliance reflects the growing intensity of this contest. Pro-coal political forces gain most traction where they are most threatened, in high-income coal-producing countries such as in the US, Canada and Australia, as well as in the EU. In newly industrialising contexts with lower emissions targets, such as in India, coal is challenged by new low-cost renewable energy, and by immediate health imperatives.
To conduct a pilot study implementing combined genomic and epidemiologic surveillance for hospital-acquired multidrug-resistant organisms (MDROs) to predict transmission between patients and to estimate the local burden of MDRO transmission.
Pilot prospective multicenter surveillance study.
The study was conducted in 8 university hospitals (2,800 beds total) in Melbourne, Australia (population 4.8 million), including 4 acute-care, 1 specialist cancer care, and 3 subacute-care hospitals.
All clinical and screening isolates from hospital inpatients (April 24 to June 18, 2017) were collected for 6 MDROs: vanA VRE, MRSA, ESBL Escherichia coli (ESBL-Ec) and Klebsiella pneumoniae (ESBL-Kp), and carbapenem-resistant Pseudomonas aeruginosa (CRPa) and Acinetobacter baumannii (CRAb). Isolates were analyzed and reported as routine by hospital laboratories, underwent whole-genome sequencing at the central laboratory, and were analyzed using open-source bioinformatic tools. MDRO burden and transmission were assessed using combined genomic and epidemiologic data.
In total, 408 isolates were collected from 358 patients; 47.5% were screening isolates. ESBL-Ec was most common (52.5%), then MRSA (21.6%), vanA VRE (15.7%), and ESBL-Kp (7.6%). Most MDROs (88.3%) were isolated from patients with recent healthcare exposure.
Combining genomics and epidemiology identified that at least 27.1% of MDROs were likely acquired in a hospital; most of these transmission events would not have been detected without genomics. The highest proportion of transmission occurred with vanA VRE (88.4% of patients).
Genomic and epidemiologic data from multiple institutions can feasibly be combined prospectively, providing substantial insights into the burden and distribution of MDROs, including in-hospital transmission. This analysis enables infection control teams to target interventions more effectively.
Chapter 8 develops a series of comparative themes from the experience of coal and climate change in India, Australia and Germany. In each country, we find that coal’s legitimacy crisis has created sharp contradictions in wider society, as well as within state institutions, and that local contests over new mines are rapidly undermining the social value of coal. Coal’s value to ‘development’ reflects its cultural narration as a valuable commodity and source of energy and in concluding we chart the way these narratives are contested, and are changing. In particular the chapter shows how anti-coal groups have gained strategic traction in the context of growing contradictions in national climate and energy policy. In this we return to the book’s initial provocation, expressed in the coal conundrum of increased coal extraction coupled with climate instability, arguing the conundrum is on the way to being resolved, for a post-coal future.
Chapter 4 focusses on proposed brown coal mines for Lusatia, a region of Eastern Germany on the Polish border. The mines aimed to extend existing concessions, supplying coal for the nearby power generators. They were owned by the Swedish state-owned corporation Vattenfall, which sold them to a Czech conglomerate in 2016. The developmentalist argument for the mining is addressed first, especially in terms of its strategic value for German ‘energy security’. We examine the debates about coal’s economic necessity as a ‘transition fuel’ in Germany’s Energiewende, and its environmental or climate impacts. These themes are then developed in analysing the governance framework for the mine approval and opposition to it. The chapter shows how local opponents mobilise established conceptions of home or ‘heimat’ against the mining. These scripts, centred on local values of belonging in place, are integrated with concerns about impacts on livelihood and environment, and with concerns about climate change. The direct contradiction between Germany’s post-industrial ‘green economy’ and its determination to expand emissions-intensive brown coal is particularly powerful, not least as it destabilises technocratic authority.
Chapter 7 takes the historical analysis into the present day and charts a significant unravelling in the coal-industrial complex. Investor uncertainty about the future viability of energy installations has shifted into a dramatic (and long-awaited) process of capital flight from coal to renewables. Perhaps most revealing, the coal sector itself has begun hedging its losses by investing in renewables. The chapter discusses the reasons for this shift. The Paris Agreement’s 2050 deadline for ‘net-zero carbon’, which, at the time of writing in 2019, was well within the investor horizon for coal-fired power plants, has imposed a growing perception of risk associated with coal facilities. It has also precipitated an unexpected realignment of low-income economies to seek new industrial strategies linked to the renewables sectors, creating a new state-renewables nexus to rival coal.
The Introduction to the book defines coal as a key driver of climate change and outlines the urgent need for a global transition to renewable energy. It discusses the approach taken in the book, of comparing how new coal mines are contested, and justifies the focus on India, Australia and Germany. It outlines the book's research questions, its inter-disciplinary method and its chapter-by-chapter structure.
Chapter 2 investigates the proposal for a new thermal coal mine in Chhattisgarh, Central India. The proposed mine is located in an emerging coal-mining region that feeds power stations mainly for industry. The mine would destroy forested lands and displace a large number of villages populated by Indian indigenous Adivasi people. The proponent for the mine, Adani, is a major privately owned industrial conglomerate seeking the coal to fuel its industrial concerns. The national government strongly favours expanded coal extraction, and the mine forms part of its privatization effort, designed to stimulate the sector. Within civil society there is strong village-level opposition to the mine, with concerns centred on land and livelihood. Alliances of villages opposing the mine find allies at the regional level and are able to disrupt regional politics; they also are able to make legal claims at the national level, and link with national and international environmental NGOs. Arguments for sustainable energy gain momentum especially when there are viable renewable alternatives. The struggle is skewed by coercion, with anti-mine campaigners subjected to surveillance and arbitrary detention by Indian state security.
Chapter 6 investigates the contradiction between expanded coal use and the climate policy regimes that emerged after the adoption of the UN Framework Convention on Climate Change (UNFCCC) in 1992, and the subsequent Kyoto Protocol. During this period coal mines and coal-fired power remained ‘locked in’ as the key foundation for energy security, and for economic growth. Struggles over climate policy in support of renewable energy did secure some changes, especially in Germany, but overall there was a steep increase in aggregate emissions from the coal sector. During this period, ‘business as usual’ entrenched the primacy of coal: international agencies such as the IEA predicted that climate policy would fail and coal would remain dominant. Yet coal was now in direct collision with climate stability, and this was profoundly disruptive of coal’s hegemony.