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Open in new tab Download slide Open in new tab Download slide OBJECTIVES Many adults with repaired tetralogy of Fallot will require a pulmonary valve replacement (PVR), but there is no consensus on the best timing. In this study, we aim to evaluate the impact of age at PVR on outcomes. METHODS This is a national multicentre retrospective study including all patients >15 years of age with repaired tetralogy of Fallot who underwent their first PVR between 2000 and 2013. The optimal age cut-off was identified using Cox regression and classification and regression tree analysis. RESULTS A total of 707 patients were included, median age 26 (15–72) years. The mortality rate at 10 years after PVR was 4.2%, and the second PVR rate of 6.8%. Age at PVR of 35 years was identified as the optimal cut-off in relation to late mortality. Patients above 35 years of age had a 5.6 fold risk of death at 10 years compared with those with PVR under 35 years (10.4% vs 1.3%, P  < 0.001), more concomitant tricuspid valve repair/replacement (15.1% vs 5.7%, P  < 0.001) and surgical arrhythmia treatment (18.4% vs 5.9%, P  < 0.001). In those under 50 years, there was an 8.7 fold risk of late death compared with the general population, higher for those with PVR after 35 than those with PVR below 35 years (hazard ratio 9.9 vs 7.4). CONCLUSIONS Patients above 35 years of age with repaired tetralogy of Fallot have significantly worse mortality after PVR, compared with younger patients and a higher burden of mortality relative to the general population. This suggests that there are still cases where the timing of initial PVR is not optimal, warranting a re-evaluation of criteria for intervention. [ABSTRACT FROM AUTHOR]

• A novel method for classifying food waste into edible & inedible parts is presented. • This method fills a major gap in global efforts to monitor changes in food waste. • Gap found between what people perceive as edible and what they state that they eat. • For many food parts, divergence in population regarding what is considered edible. • The method is suitable for replication studies in different countries and over time. Food that is either wasted or lost, rather than being eaten, accounts for around a third of global food production and is linked to several environmental, economic and social issues. The reliable quantification of this wasted food is essential to monitor progress towards the United Nations' Sustainable Development Goal 12.3, which covers food loss and waste. Currently quantification of food waste is made difficult by many differing definitions, some of which require categorisation of food items into those parts considered edible and those considered inedible. Edibility is difficult to define as it is affected by cultural and social influences. This study presents a novel, easily-replicable, questionnaire-based methodology to categorise 'borderline' food items thrown away from households, e.g. parsnip skin, apple cores. The methodology captures self-reported information on what people eat (self-reported consumption) and their perceptions of edibility. Our results for the United Kingdom indicate that, for a given food 'part', there is divergence between individuals' responses to the survey questions: e.g. many people would 'never' eat carrot skins, whilst many others would 'always' eat them. Furthermore, there is a systematic difference between people's self-reported consumption and their perceptions of edibility. We suggest that both need to be considered to create a balanced categorisation of edible and inedible parts; we propose a method for incorporating both elements. Within this method, a threshold needs to be applied and the resultant classification, especially of those items close to this threshold, will inevitably be contentious. Despite this, the categorisation of what is considered edible using this methodology reflects the views of the majority of the population, facilitating the quantification of food waste. In addition, we envisage this methodology can be used to compare geographical differences and track changes over time with regard to edibility. [ABSTRACT FROM AUTHOR]

Assisting with tracheal intubation is an aspect of clinical practice that requires knowledge and skill if the procedure is to be carried out in a timely and safe manner. Maintaining this knowledge and skill requires good quality education and regular opportunities to practise. These two factors appear to be inconsistent in critical care units. This article details an audit performed on a large tertiary referral centre critical care unit. It was undertaken in two phases: the first was a self-assessment of knowledge and the second was a practical assessment of the audit subjects in a simulated setting. Results indicated that formal training was inconsistent, as was the opportunity to assist with tracheal intubation. These factors may have contributed to the varying levels of skill seen in the practical assessment phase. The authors recommend devising a standardised training programme to address these issues, which could be distributed nationally. High standards need to be instilled early in critical care nurses’ careers, with regular updates to maintain knowledge and skills. [ABSTRACT FROM AUTHOR]

This study reviewed the current situation of carbon capture and storage (CCS) development in the UK, mainly within the last 10 years in general. It looked at the positive ways to implement the CCS technologies, including the geological advantages, potential sector growth, financial incentives and the support in the policies. Current projects were brought forward together with university and industry research. Some concerns and limitations of applying CCS technologies were discussed. Finally, the conclusion was made that the UK is in a good position to implement CCS technologies and would become a global leader in CCS development, providing that the first four trials were successful. [ABSTRACT FROM PUBLISHER]

Food waste going to landfill is a significant environmental issue with 33% of all food we buy simply being thrown away. Not only is this extremely wasteful but rotting food produces gases that are harmful to the environment and contributes to global warming. The UK government is committed to reducing the amount of household waste directly being disposed of at landfills by 10.1 million tonnes tonnes over 20 years from 2000 (Waste Composition Analysis: Guidance for Local Authorities, Defra, 2004). As part of this the Waste Reduction Action Programme was set up to fund and facilitate innovative solutions to reduce waste to landfill. Part of that process was to assess bids by solution providers with regards the effectiveness of the technologies that they were offering. This was found to be a non-trivial task, with multiple input parameters and large variations in data. Establishing which parameters have the greatest effect on food waste estimation was therefore essential in any decision-making process. However, the large number of unknowns, assumptions and parameters makes this understanding both difficult and time consuming. A branch of mathematics known as uncertainty analysis can be used to analyse these types of situations quickly and effectively and is easily adapted to understanding of food waste estimation. This paper outlines the techniques used to develop an internet-based decision-making tool and demonstrates the methodology used with simple case studies. [ABSTRACT FROM AUTHOR]

Objectives: To report the numbers of consultant congenital cardiac surgeons and cardiologists who have joined and left UK practice over the last 10 years and explore the reasons for leaving., Methods: Retrospective observational questionnaire study completed between 11 June 2019 and 1 July 2020 by UK level 1 congenital cardiac centres of 10-year consultant staff movement and reasons suggested for leaving UK practice., Results: At survey completion there were 218 (202 whole time equivalent (WTE)) consultant cardiologists and surgeons working within level 1 centres made up of 39 (38 WTE) surgeons, 137 (128.5 WTE) paediatric cardiologists, 42 (35.5 WTE) adult congenital heart disease (ACHD) cardiologists. 161 (74%) consultants joined in the last 10 years of whom 103 (64%) were UK trained. There were 91 leavers giving a staff turnover rate 42% (surgeons 56%, paediatric cardiologists 42%, ACHD cardiologists 29%). Of those, leaving 43% moved to work abroad (surgeons 55%, paediatric cardiologists 40%, ACHD cardiologists 67%). Among the 65 reported reasons for leaving 16 were financial, 9 for work life balance, 6 to working conditions within the National Health Service (NHS) and 12 related to the profession in the UK including six specifically highlighting the national review process., Conclusions: There has been a high turnover rate of consultant staff within UK congenital cardiac services over the last 10 years with almost half of those leaving moving to work overseas. Financial reasons and pressures relating to working in the NHS or the specialty in the UK were commonly reported themes for leaving. This has major implications for future planning and staff retention within this specialised service., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Treatment of infants with tetralogy of Fallot (ToF) has evolved in the last two decades with increasing use of primary surgical repair (PrR) and transcatheter right ventricular outflow tract palliation (RVOTd), and fewer systemic-to-pulmonary shunts (SPS). We aim to report contemporary results using these treatment options in a comparative study., Methods: This a retrospective study using data from the UK National Congenital Heart Disease Audit. All infants (n=1662, median age 181 days) with ToF and no other complex defects undergoing repair or palliation between 2000 and 2013 were considered. Matching algorithms were used to minimise confounding due to lower age and weight in those palliated., Results: Patients underwent PrR (n=1244), SPS (n=311) or RVOTd (n=107). Mortality at 12 years was higher when repair or palliation was performed before the age of 60 days rather than after, most significantly for primary repair (18.7% vs 2.2%, P<0.001), less so for RVOTd (10.8% vs 0%, P=0.06) or SPS (12.4% vs 8.3%, P=0.2). In the matched groups of patients, RVOTd was associated with more right ventricular outflow tract (RVOT) reinterventions (HR=2.3, P=0.05 vs PrR, HR=7.2, P=0.001 vs SPS) and fewer pulmonary valve replacements (PVR) (HR=0.3 vs PrR, P=0.05) at 12 years, with lower mortality after complete repair (HR=0.2 versus PrR, P=0.09)., Conclusions: We found that RVOTd was associated with more RVOT reinterventions, fewer PVR and fewer deaths when compared with PrR in comparable, young infants, especially so in those under 60 days at the time of the first procedure., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Although ventricular fibromas are rare, they are the second most common type of cardiac tumor in children. While histologically benign, they have a propensity to cause malignant arrhythmias, with cardiac arrest often being the first presentation., Objective: The purpose of this study was to evaluate the arrhythmia risk and management strategies for pediatric ventricular fibromas., Methods: Fifteen centers in the British Paediatric Arrhythmia Group network were contacted to partake in the study to contribute cases. A detailed database search was performed at 2 hospitals for cases of ventricular fibromas., Results: A total of 19 patients were included in the study. Arrhythmias were common, with 5 patients presenting with cardiac arrest and 5 others having documented ventricular tachycardia. Nine patients have undergone surgical resection at various hospitals, and all these patients have survived with good long-term outcomes. One patient who did not have any treatment died, presumably of a ventricular arrhythmia; another died of metastatic disease. There were no recurrences of arrhythmia after surgery, and the need for a defibrillator was alleviated in all cases., Conclusion: Ventricular fibromas have a high propensity to cause malignant arrhythmias, and if they are not managed appropriately, mortality is high. The outcomes of surgical resection are good, regardless of size, and this represents the best therapeutic option, with most patients being symptom free in the longer term., (Copyright © 2018 Heart Rhythm Society. All rights reserved.)