Specialty care is associated with improved outcomes for adults with adult CHD and must be extended to the underserved. A retrospective cohort study was performed to describe the provision of care to adult CHD patients in America’s largest municipal public health system including patient demographics, diagnostic and therapeutic procedures, and adherence to guideline-recommended surveillance. We identified 229 adult CHD patients aged >18 years through electronic medical records. The most common diagnoses were atrial septal defect, ventricular septal defect, patent ductus arteriosus, and valvular pulmonary stenosis. In total, 65% had moderate or greater anatomic complexity. A large number of patients were uninsured (45%), non-white (96%), and non-English speaking (44%). One hundred forty-six patients (64%) presented with unrepaired primary defects. Fifty eight patients underwent primary repair during the study period; 48 of those repairs were surgical and 10 were transcatheter. Collaboration with an affiliated Comprehensive Care Center was utilised for 28% of patients. A high proportion of patients received adult CHD speciality visits (78%), echocardiograms (66%), and electrocardiograms (56%) at the guideline-recommended frequency throughout the study period. There was no significant difference in the rate of adherence to guideline-recommended surveillance based on insurance status, race/ethnicity, or primary language status. The proportion of patients who had guideline-recommended adult CHD visits, echocardiograms, and electrocardiograms was significantly lower for those with more advanced physiological stages. These results can inform the provision of adult CHD care in other public health system settings.

Telemetric techniques for the monitoring of physiological parameters during housing, handling and transport may help producers to reduce mortality and improve meat quality. In order to know the reliability of electrocardiogram parameters as stress indicators, piglets (12 to 23 kg) being different with respect to the halothane gene (homozygous halothane sensitive (nn) and non-sensitive (NN), heterozygotes (nN)), and thus different with respect to stress susceptibility, were monitored with an ambulatory ECG device during housing, handling and transport. Skeletal muscularity of all animals was measured with an ultrasound device.

Heterozygotes and homozygote halothane sensitive piglets had a higher muscularity, but only the homozygotes had a higher ST-elevation from the isoelectric line of the QRST-complex of the electrocardiogram when measured within housing conditions. This means a different propagation of the electric current related to the activation of the ventricle. Halothane gene carriers (Nn and nn piglets) had a statistically significant higher mean maximal heart rate during housing conditions. During handling heart rate rose by 14·8%, 0·61% and 42·9% respectively for NN, nN and nn piglets, with nn piglets having the highest values. During transport these measurements were respectively 6·88%, 3·66% and 9·7% higher for lines NN, nN and nn as compared with those in housing conditions. Heart arrhythmicity parameters were not different between housing and transport, but during handling up to a 23-fold increase could be observed.

Heart rate and arrhythmicity parameters may generate reliable information to monitor stress during housing, handling and transport of piglets through genotypes and skeletal muscularity.