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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.
Introduced mammalian predators are responsible for the decline and extinction of many native species, with rats (genus Rattus) being among the most widespread and damaging invaders worldwide. In a naturally fragmented landscape, we demonstrate the multi-year effectiveness of snap traps in the removal of Rattus rattus and Rattus exulans from lava-surrounded forest fragments ranging in size from <0.1 to >10 ha. Relative to other studies, we observed low levels of fragment recolonization. Larger rats were the first to be trapped, with the average size of trapped rats decreasing over time. Rat removal led to distinct shifts in the foraging height and location of mongooses and mice, emphasizing the need to focus control efforts on multiple invasive species at once. Furthermore, because of a specially designed trap casing, we observed low non-target capture rates, suggesting that on Hawai‘i and similar islands lacking native rodents the risk of killing non-target species in snap traps may be lower than the application of rodenticides, which have the potential to contaminate food webs. These efforts demonstrate that targeted snap-trapping is an effective removal method for invasive rats in fragmented habitats and that, where used, monitoring of recolonization should be included as part of a comprehensive biodiversity management strategy.
Here we present stringent low-frequency (185 MHz) limits on coherent radio emission associated with a short-duration gamma-ray burst (SGRB). Our observations of the short gamma-ray burst (GRB) 180805A were taken with the upgraded Murchison Widefield Array (MWA) rapid-response system, which triggered within 20s of receiving the transient alert from the Swift Burst Alert Telescope, corresponding to 83.7 s post-burst. The SGRB was observed for a total of 30 min, resulting in a
persistent flux density upper limit of 40.2 mJy beam–1. Transient searches were conducted at the Swift position of this GRB on 0.5 s, 5 s, 30 s and 2 min timescales, resulting in
limits of 570–1 830, 270–630, 200–420, and 100–200 mJy beam–1, respectively. We also performed a dedispersion search for prompt signals at the position of the SGRB with a temporal and spectral resolution of 0.5 s and 1.28 MHz, respectively, resulting in a
fluence upper-limit range from 570 Jy ms at DM
pc cm–3 (
) to 1 750 Jy ms at DM
pc cm–3 (
, corresponding to the known redshift range of SGRBs. We compare the fluence prompt emission limit and the persistent upper limit to SGRB coherent emission models assuming the merger resulted in a stable magnetar remnant. Our observations were not sensitive enough to detect prompt emission associated with the alignment of magnetic fields of a binary neutron star just prior to the merger, from the interaction between the relativistic jet and the interstellar medium (ISM) or persistent pulsar-like emission from the spin-down of the magnetar. However, in the case of a more powerful SGRB (a gamma-ray fluence an order of magnitude higher than GRB 180805A and/or a brighter X-ray counterpart), our MWA observations may be sensitive enough to detect coherent radio emission from the jet-ISM interaction and/or the magnetar remnant. Finally, we demonstrate that of all current low- frequency radio telescopes, only the MWA has the sensitivity and response times capable of probing prompt emission models associated with the initial SGRB merger event.
Investigate an outbreak of coronavirus disease 2019 (COVID-19) among operating room staff utilizing contact tracing, mass testing for severe acute respiratory coronavirus virus 2 (SARS-CoV-2), and environmental sampling.
Operating room staff with positive SARS-CoV-2 molecular testing.
Epidemiologic and environmental investigations were conducted including contact tracing, environmental surveys, and sampling and review of the operating room schedule for staff-to-staff, staff-to-patient, and patient-to-staff SARS-CoV-2 transmission.
In total, 24 healthcare personnel (HCP) tested positive for SARS-CoV-2, including nurses (29%), surgical technologists (25%), and surgical residents (16%). Moreover, 19 HCP (79%) reported having used a communal area, most commonly break rooms (75%). Overall, 20 HCP (83%) reported symptomatic disease. In total, 72 environmental samples were collected from communal areas for SARS-CoV-2 genomic testing; none was positive. Furthermore, 236 surgical cases were reviewed for transmission: 213 (90%) had negative preoperative SARS-CoV-2 testing, 21 (9%) had a positive test on or before the date of surgery, and 2 (<1%) did not have a preoperative test performed. In addition, 40 patients underwent postoperative testing (mean, 13 days to postoperative testing), and 2 returned positive results. Neither of these 2 cases was linked to our outbreak.
Complacency in infection control practices among staff during peak community transmission of SARS-CoV-2 is believed to have driven staff-to-staff transmission. Prompt identification of the outbreak led to rapid interventions, ultimately allowing for uninterrupted surgical service.
Among 353 healthcare personnel in a longitudinal cohort in 4 hospitals in Atlanta, Georgia (May–June 2020), 23 (6.5%) had severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antibodies. Spending >50% of a typical shift at the bedside (OR, 3.4; 95% CI, 1.2–10.5) and black race (OR, 8.4; 95% CI, 2.7–27.4) were associated with SARS-CoV-2 seropositivity.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
Potential effectiveness of harvest weed seed control (HWSC) systems depends upon seed shatter of the target weed species at crop maturity, enabling its collection and processing at crop harvest. However, seed retention likely is influenced by agroecological and environmental factors. In 2016 and 2017, we assessed seed-shatter phenology in 13 economically important broadleaf weed species in soybean [Glycine max (L.) Merr.] from crop physiological maturity to 4 wk after physiological maturity at multiple sites spread across 14 states in the southern, northern, and mid-Atlantic United States. Greater proportions of seeds were retained by weeds in southern latitudes and shatter rate increased at northern latitudes. Amaranthus spp. seed shatter was low (0% to 2%), whereas shatter varied widely in common ragweed (Ambrosia artemisiifolia L.) (2% to 90%) over the weeks following soybean physiological maturity. Overall, the broadleaf species studied shattered less than 10% of their seeds by soybean harvest. Our results suggest that some of the broadleaf species with greater seed retention rates in the weeks following soybean physiological maturity may be good candidates for HWSC.
Seed shatter is an important weediness trait on which the efficacy of harvest weed seed control (HWSC) depends. The level of seed shatter in a species is likely influenced by agroecological and environmental factors. In 2016 and 2017, we assessed seed shatter of eight economically important grass weed species in soybean [Glycine max (L.) Merr.] from crop physiological maturity to 4 wk after maturity at multiple sites spread across 11 states in the southern, northern, and mid-Atlantic United States. From soybean maturity to 4 wk after maturity, cumulative percent seed shatter was lowest in the southern U.S. regions and increased moving north through the states. At soybean maturity, the percent of seed shatter ranged from 1% to 70%. That range had shifted to 5% to 100% (mean: 42%) by 25 d after soybean maturity. There were considerable differences in seed-shatter onset and rate of progression between sites and years in some species that could impact their susceptibility to HWSC. Our results suggest that many summer annual grass species are likely not ideal candidates for HWSC, although HWSC could substantially reduce their seed output during certain years.
Establishment of alfalfa by interseeding it with corn planted for silage can enhance crop productivity but weed management is a challenge to adoption of the practice. Although a simple and effective approach to weed management would be to apply a glyphosate-based herbicide, concerns about herbicide resistance and limitations in available alfalfa varieties exist. Field experiments were conducted to compare the efficacy and selectivity of PRE, POST, and PRE followed by POST herbicide programs to a glyphosate-only strategy when interseeding alfalfa with corn. Experiment 1 compared PRE applications of acetochlor, mesotrione, S-metalochlor, metribuzin, and flumetsulam. Results indicate that acetochlor and metribuzin, and S-metalochlor used at a rate of 1.1 kg ai ha−1 were the most effective and selective PRE herbicides 4 wk after treatment (WAT), but each resulted in greater overall weed cover than glyphosate by 8 WAT. Experiment 2 evaluated applications of bentazon, bromoxynil, 2,4-DB, and mesotrione at early and late POST times. Several herbicides used POST exhibited similar effectiveness and selectivity as glyphosate, including early applications of bromoxynil (0.14 kg ai ha−1) and 2,4-DB (0.84 or 1.68 kg ai ha−1), as well as late applications of bromoxynil (0.42 kg ai ha−1), 2,4-DB (0.84 kg ai ha−1), and mesotrione (0.05 or 0.11 kg ai ha−1). A third experiment compared applications of acetochlor PRE, bromoxynil POST, and a combination of acetochlor PRE with bromoxynil POST. All treatments were effective and safe for use in this interseeded system, although interseeded alfalfa provided 65% to 70% weed suppression in corn planted for silage without any herbicide. Herbicide treatments had no observable impacts on corn and alfalfa yields, so weed management was likely of limited economic importance. However, weed competitiveness can vary based on several different factors including weed species, density, and site-specific factors, and so further investigations under different environments and conditions are needed.
Emergency Medical Services (EMS) systems have developed protocols for prehospital activation of the cardiac catheterization laboratory for patients with suspected ST-elevation myocardial infarction (STEMI) to decrease first-medical-contact-to-balloon time (FMC2B). The rate of “false positive” prehospital activations is high. In order to decrease this rate and expedite care for patients with true STEMI, the American Heart Association (AHA; Dallas, Texas USA) developed the Mission Lifeline PreAct STEMI algorithm, which was implemented in Los Angeles County (LAC; California USA) in 2015. The hypothesis of this study was that implementation of the PreAct algorithm would increase the positive predictive value (PPV) of prehospital activation.
This is an observational pre-/post-study of the effect of the implementation of the PreAct algorithm for patients with suspected STEMI transported to one of five STEMI Receiving Centers (SRCs) within the LAC Regional System. The primary outcome was the PPV of cardiac catheterization laboratory activation for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The secondary outcome was FMC2B.
A total of 1,877 patients were analyzed for the primary outcome in the pre-intervention period and 405 patients in the post-intervention period. There was an overall decrease in cardiac catheterization laboratory activations, from 67% in the pre-intervention period to 49% in the post-intervention period (95% CI for the difference, -14% to -22%). The overall rate of cardiac catheterization declined in post-intervention period as compared the pre-intervention period, from 34% to 30% (95% CI, for the difference -7.6% to 0.4%), but actually increased for subjects who had activation (48% versus 58%; 95% CI, 4.6%-15.0%). Implementation of the PreAct algorithm was associated with an increase in the PPV of activation for PCI or CABG from 37.9% to 48.6%. The overall odds ratio (OR) associated with the intervention was 1.4 (95% CI, 1.1-1.8). The effect of the intervention was to decrease variability between medical centers. There was no associated change in average FMC2B.
The implementation of the PreAct algorithm in the LAC EMS system was associated with an overall increase in the PPV of cardiac catheterization laboratory activation.
Addition of fats to the diets of ruminants has long been known to result in a reduction in enteric methane emissions. Tannins have also been used to reduce methane emissions but with mixed success. However, the effect of feeding fat in combination with tannin is unknown. Eight ruminally cannulated Holstein-Friesian cows were fed four diets in a double Latin-square, full crossover sequence. The treatments were 800 ml/day of water (CON), 800 g/day of cottonseed oil, 400 g/day of tannin, and 800 g/day of cottonseed oil and 400 g/day of tannin in combination (fat- and tannin-supplemented diet). Methane emissions were measured using open-circuit respiration chambers. Intake of basal diets was not different between treatments. Cows fed cottonseed oil had greater milk yield (34.9 kg/day) than those fed CON (32.3 kg/day), but the reduced concentration of milk fat meant there was no difference in energy-corrected milk between treatments. Methane yield was reduced when either cottonseed oil (14%) or tannin (11%) was added directly to the rumen, and their effect was additive when given in combination (20% reduction). The mechanism of the anti-methanogenic effect remains unclear but both fat and tannin appear to cause a reduction in fermentation in general rather than cause a change in the type of fermentation.
Methadone, a long-acting opioid agonist commonly used in the treatment of opiate dependence, has been reported to cause QTc interval prolongation, increasing the risk of a fatal cardiac arrhythmia – Torsades-de-Pointes (TdP). This effect seems to be attributable to methadone's inhibitory effect on the cardiac “hERG”-K+ ion channel and is dose-dependent. There is a lack of consensus regarding when to perform an ECG for patients on methadone.
Identifying other TdPPRFs in a cohort of patients receiving ≥ 85 mg (high dose) methadone daily to inform local clinical safety guidelines.
Our outpatient caseload was filtered to select opiate-dependent patients receiving more than 85 mg methadone daily. Primary care summaries and laboratory results databases were analysed for the presence of other TdPPRFs: female sex a documented history of ECG abnormalities, electrolyte imbalance, liver or renal failure, and concomitant use of other QT prolonging medication or stimulants.
Fourteen opiate-dependent patients (10.29% of patients on methadone) were maintained on ≥ 85 mg methadone daily. Gender distribution was F:M = 1:1.8; 64% misused illicit stimulants; 57% were prescribed other QTc prolonging medication and 29% had a documented history of liver/renal failure or electrolyte imbalance. Only 14% had previous ECGs documented in primary care summaries. Of patients on high dose methadone, 85.7% had at least one TdPPRFs present and 64.3% had at least two.
These results demonstrate an increased rate of TdPPRFs in this patient group and highlight the importance of ECG monitoring which ideally should be offered to patients receiving even lower doses of methadone.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
We present a machine learning methodology to separate quasars from galaxies and stars using data from S-PLUS in the Stripe-82 region. In terms of quasar classification, we achieved 95.49% for precision and 95.26% for recall using a Random Forest algorithm. For photometric redshift estimation, we obtained a precision of 6% using k-Nearest Neighbour.
We have analyzed Chandra/High Energy Transmission Grating spectra of the X-ray emission line gas in the Seyfert galaxy NGC 4151. The zeroth-order spectral images show extended H- and He-like O and Ne, up to a distance r ˜ 200 pc from the nucleus. Using the 1st-order spectra, we measure an average line velocity ˜230 km s–1, suggesting significant outflow of X-ray gas. We generated Cloudy photoionization models to fit the 1st-order spectra; the fit required three distinct emission-line components. To estimate the total mass of ionized gas (M) and the mass outflow rates, we applied the model parameters to fit the zeroth-order emission-line profiles of Ne IX and Ne X. We determined an M ≍ 5.4 × 105Mʘ. Assuming the same kinematic profile as that for the [O III] gas, derived from our analysis of Hubble Space Telescope/Space Telescope Imaging Spectrograph spectra, the peak X-ray mass outflow rate is approximately 1.8 Mʘ yr–1, at r ˜ 150 pc. The total mass and mass outflow rates are similar to those determined using [O III], implying that the X-ray gas is a major outflow component. However, unlike the optical outflows, the X-ray emitting mass outflow rate does not drop off at r > 100pc, which suggests that it may have a greater impact on the host galaxy.
We used Space Telescope Imaging Spectrograph (STIS) long slit medium-resolution G430M and G750M spectra to analyze the extended [O III] λ5007 emission in a sample of twelve QSO2s from Reyes et al. (2008). The purpose of the study was to determine the properties of the mass outflows and their role in AGN feedback. We measured fluxes and velocities as functions of deprojected radial distances. Using photoionization models and ionizing luminosities derived from [O III], we were able to estimate the densities for the emission-line gas. From these results, we derived masses, mass outflow rates, kinetic energies and kinetic luminosity rates as a function of radial distance for each of the targets. Masses are several times 103 - 107 solar masses, which are comparable to values determined from a recent photoionization study of Mrk 34 (Revalski). Additionally, we are studying the possible role of X-ray winds in these QSO2s.
Observations at high redshift reveal that a population of massive, quiescent galaxies (called red nuggets) already existed 10 Gyr ago. These objects undergo a significant size evolution over time, likely due to minor mergers. In this work we present an analysis of local massive compact galaxies to assess if their properties are consistent with what is expected for unevolved red nuggets (relic galaxies). Using integral field spectroscopy (IFS) data from the MaNGA survey from the Sloan Digital Sky Survey (SDSS), we characterized the kinematics and properties of stellar populations of massive compact galaxies, and find that these objects exhibit, on average, a higher rotational support than a control sample of average sized early-type galaxies. This is in agreement with a scenario in which these objects have a quiet accretion history, rendering them candidates for relic galaxies.