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Date

20240101

Document Version

1.0

Release Status

PRODUCTION


© 2024 International Council of Nurses and International Health Terminology Standards Development Organisation.  All rights reserved.  SNOMED CT® was originally created by the College of American Pathologists.

This document forms part of the ICNP SNOMED CT® Nursing Practice Refset Production package distributed by International Health Terminology Standards Development Organisation, trading as SNOMED International, on behalf of ICN and is subject to the SNOMED CT® Affiliate License, details of which may be found at https://www.snomed.org/snomed-ct/get-snomed

No part of this document may be reproduced or transmitted in any form or by any means, or stored in any kind of retrieval system, except by an Affiliate of SNOMED International in accordance with the SNOMED CT® Affiliate License. Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International.

Any copy of this document that is not obtained directly from SNOMED International [or a Member of SNOMED International] is not controlled by SNOMED International, and may have been modified and may be out of date. Any recipient of this document who has received it by other means is encouraged to obtain a copy directly from SNOMED International [or a Member of SNOMED International. Details of the Members of SNOMED International may be found at http://www.snomed.org/members/].

Access within SNOMED International member countries is provided by the Member National Release Centre in each country, via the relevant Member webpage.  Affiliates of SNOMED International in non-member countries can access the table through their MLDS (Member Licensing & Distribution Service) account.  

A human readable version of the refset is available from ICN along wih the equivalence table - both are available for download from the ICN website: http://www.icn.ch.

Users of the refset must comply with the licensing agreements of either ICN or SNOMED International, or both - according to the users' individual requirements. 



   

Page At A Glance

Introduction

The International Classification of Nursing Practice (ICNP) Reference Set is a product agreed as part of a collaboration agreement between the International Council of Nurses (ICN) and the International Health Terminology Standards Organisation (IHTSDO), trading as SNOMED International. ICNP content has been incorporated into SNOMED CT and is being released as a reference set by SNOMED International on behalf of ICN. This production release is based on ICNP 2019 plus additional content requested by ICN.

Background

ICN and SNOMED International have worked together since 2006 to advance terminology harmonisation and foster interoperability in health information systems. This work resulted in the release of an equivalence table between the International Classification for Nursing Practice (ICNP®) and SNOMED Clinical Terms (SNOMED CT®) for nursing diagnoses and an equivalence table between ICNP and SNOMED CT for nursing interventions which were released 6 monthly until 2018. It also resulted in the SNOMED CT Nursing Activities Reference Set and SNOMED CT Nursing Health Issues Reference Set which were released until October 2021. No further releases of these reference sets are planned. 

ICN initiated a review of its role in health informatics globally, enabling them to develop a strategy for supporting nursing globally. It is this review which lead to the new agreement between ICN and SNOMED International, with the following key components:

  • ICNP 2019 incorporated into SNOMED CT
  • SNOMED International to maintain and distribute ICNP as a SNOMED reference set on behalf of ICN
  • ICN to retain ownership of ICNP – SNOMED International to retain ownership of SNOMED CT
  • ICN to continue to lead on ICNP clinical development over time and its quality assurance through ICN governance processes
  • Free for use in SNOMED International member countries and licensed by ICN in non-member countries

ICN has established the ICNP Editorial Board through which decisions on the content of ICNP are made. The ICNP Editorial Board has put in place a mechanism for requesting changes and additions to ICNP reference set - for more information please contact icnp@icn.ch.

Motivation

The key drivers for this approach are:

  • To ensure that nursing remains connected to the wider health information landscape globally
  • To ensure that SNOMED CT continues to adequately reflect global nursing practice
  • To ensure that information collected using ICNP can link to SNOMED CT encoded records and be shared with other healthcare professionals to support the care of individuals
  • To capture nursing care in a standardised way thus avoiding local mapping which will lead to inconsistency
  • To facilitate the sharing of ICNP-based information in a standardised way to support delivery of patient care, usage for research purposes and participation in health policy making

The ICNP, and therefore this reference set, is a terminology that enables nurses to describe and report their practice in a systematic way. The resulting information is used to support care and effective decision-making, and to inform nursing education and health policy. 

As ICNP is intended for use by and for nurses, ICN has been able to focus attention on the development of ICNP specifically for nursing practice. This has resulted in a rich and comprehensive resource that nurses can use to describe and report in detail the things that they assess (diagnoses e.g. nausea) and the things that they do (interventions e.g. counselling). The potential benefits of a consistent approach to capturing nursing data are far-reaching. However, nurses do not practice in isolation, they practice alongside many other disciplines. One of the potential risks of a specific nursing-focus is that nursing will be somehow disconnected from a larger health information landscape, hence the integration of ICNP into SNOMED CT. 


Design

The decisions about additions and changes to SNOMED CT as a result of the incorporation of ICNP 2019 and additional content into SNOMED CT has been directed by the advice given by subject matter experts from both organisations and also members of ICNP Editorial Board at ICN. To ensure fit with international requirements and other sources of terminology, the SNOMED International Nursing Clinical Reference Group has also provided advise and expertise.

This work provided an opportunity for ICN to review and make decisions about the content of ICNP 2019 and additional content. 

Versions

The version of ICNP used in this reference set is the May 2019 release plus additional content requested by ICN.  

The version of SNOMED CT used is the January 2024 International Release.

Content

The 2024 International Classification of Nursing Practice (ICNP) Reference Set is comprised of 2120 active concepts from the SNOMED CT Clinical Finding, Procedure and Situation with Explicit Context hierarchies. Changes to the membership of the reference set for the 2024 release includes replacements for inactivated concepts as well as the addition of new concepts. The table below details the changes. 


ConceptStatusReplaced by Status of Replacement concept(s)
103693007 |Diagnostic procedure (procedure)|Concept inactivated - no longer an active reference set member386053000 |Evaluation procedure (procedure)|New refset member
1144845004 |Risk of suicide decreased (finding)|Concept inactivated - no longer an active reference set member394687007 |At low risk for suicide (finding)|New refset member
16386004 |Dry skin (finding)|Concept inactivated - no longer an active reference set member52475004 |Xeroderma (disorder)|New refset member
191816009 |Drug dependence (disorder)|Concept inactivated - no longer an active reference set member1254812006 |Substance dependence (disorder)|New refset member
249475006 |Thirst symptom (finding)|Concept inactivated - no longer an active reference set member289159000 |Thirst finding (finding)|New refset member
313332003 |Dressing patient (procedure)|Concept inactivated - no longer an active reference set member1230126004 |Performing dressing activity for full body of subject (procedure)|New refset member
399122003 |Swallowing problem (finding)|Concept inactivated - no longer an active reference set member288939007 |Difficulty swallowing (finding)|New refset member
402863005 |Venous stasis ulcer of leg (disorder)|Concept inactivated - no longer an active reference set member1237117000 |Venous ulcer of lower leg (disorder)|New refset member
409041001 |Reproductive risk (finding)|Concept inactivated - no longer an active reference set member
No replacement
409043003 |Infertility risk (finding)|Concept inactivated - no longer an active reference set member

1269478006 |At increased risk for male infertility (finding)|

1269477001 |At increased risk for female infertility (finding)|

New refset member


New refset member

409044009 |Contraception risk (finding)|Concept inactivated - no longer an active reference set member1279828000 |At increased risk for disorder due to contraceptive use (finding)|New refset member
409046006 |Perinatal risk (finding)|Concept inactivated - no longer an active reference set member1269553009 |At increased risk for perinatal disorder (finding)|New refset member
409048007 |Labor risk (finding)|Concept inactivated - no longer an active reference set member1269476005 |At increased risk for complication during labor and delivery (finding)|New refset member
409049004 |Delivery risk (finding)|Concept inactivated - no longer an active reference set member1269476005 |At increased risk for complication during labor and delivery (finding)|New refset member
409050004 |Postpartum risk (finding)|Concept inactivated - no longer an active reference set member1269562006 |At increased risk for postpartum disorder (finding)|New refset member
410304007 |Relaxation/breathing techniques education, guidance, and counseling (procedure)|Concept inactivated - no longer an active reference set member1284867003 |Education about relaxation technique (procedure)|New refset member
443999008 |Risk of exposure to communicable disease (situation)|Concept inactivated - no longer an active reference set member1296884009 |At increased risk of exposure to communicable disease (finding)|New refset member
52651000119105 |At risk of unplanned pregnancy (situation)|Concept inactivated - no longer an active reference set member1286875007 |At increased risk for unplanned pregnancy (finding)|New refset member
706892001 |At risk of intimate partner abuse (finding)|Concept inactivated - no longer an active reference set member22791000175108 |At increased risk of intimate partner violence (finding)|New refset member
710976005 |Maintaining ventilation (procedure)|Concept inactivated - no longer an active reference set member

40617009 |Artificial ventilation (regime/therapy)|

266700009 |Assisted breathing (regime/therapy)|

11140008 |Respiratory assist, manual (procedure)|

New refset member

New refset member

New refset member

710986006 |Monitoring drug withdrawal (regime/therapy)|Concept inactivated - no longer an active reference set member1254959003 |Monitoring substance withdrawal (regime/therapy)|New refset member
713103003 |Giving encouragement to be urinary continent (procedure)|Concept inactivated - no longer an active reference set member
No replacement
713105005 |Giving encouragement to be bowel continent (procedure)|Concept inactivated - no longer an active reference set member
No replacement
87502001 |At risk for imbalanced body temperature (finding)|Concept inactivated - no longer an active reference set member
No replacement
199312002 |Finding related to risk factor in pregnancy (finding)|Concept inactivated - no longer an active reference set member
No replacement
370773004 |Administration of prescribed medications and solutions (procedure)|Concept inactivated - no longer an active reference set member18629005 |Administration of drug or medicament (procedure)|Existing refset member
370774005 |Administration of prescribed medications based on arterial blood gas results (procedure)|Concept inactivated - no longer an active reference set member18629005 |Administration of drug or medicament (procedure)|Existing refset member
13197004 |Uses contraception (finding)|New refset member

282298003 |Able to balance (finding)|New refset member

871870009 |Able to demonstrate health literacy (finding)|New refset member

300199007 |Able to hear (finding)|New refset member

301570003 |Able to mobilize using mobility aids (finding)|New refset member

706954003 |Able to perform intermittent urethral self-catheterization (finding)|New refset member

705075002 |Able to see (finding)|New refset member

609328004 |Allergic disposition (finding)|New refset member

87486003 |Aphasia (finding)|New refset member

424167000 |At increased risk for unstable blood glucose level (finding)|New refset member

715238005 |At increased risk of electrolyte imbalance (finding)|New refset member

248279007 |Frailty (finding)|New refset member

74506000 |Bereavement due to life event (finding)|New refset member

131148009 |Bleeding (finding)|New refset member

48782003 |Delivery normal (finding)|New refset member

871869008 |Difficulty demonstrating health literacy (finding)|New refset member

102835006 |Difficulty passing urine (finding)|New refset member

3006004 |Disturbance of consciousness (finding)|New refset member

288784001 |Does communicate needs and wishes (finding)|New refset member

129882008 |Dysfunctional coping using self defense mechanisms (finding)|New refset member

300463007 |Efficient emptying of urinary bladder (finding)|New refset member

449892005 |Feeling safe (finding)|New refset member

271591004 |Fully conscious (finding)|New refset member

418363000 |Itching of skin (finding)|New refset member

278040002 |Loss of hair (finding)|New refset member

405273008 |Manic mood (finding)|New refset member

123640000 |Mucous membrane dryness (finding)|New refset member

169961004 |Normal birth (finding)|New refset member

45332005 |Normal capillary filling (finding)|New refset member

271720007 |Normal intracranial pressure (finding)|New refset member

162081000 |Not constipated (finding)|New refset member

301146007 |Peripheral pulse palpable (finding)|New refset member

228151002 |Personal care disability (finding)|New refset member

764816006 |Physically prepared to undergo surgery (finding)|New refset member

161047009 |Poor adaptation to disability (finding)|New refset member

301179007 |Poor venous access (finding)|New refset member

47295007 |Psychomotor agitation (finding)|New refset member

416751004 |Reduced drugs misuse (finding)|New refset member

286688002 |Splitting - mental defense mechanism (finding)|New refset member

226077000 |Therapeutic diet (finding)|New refset member

110483000 |Tobacco user (finding)|New refset member

418107008 |Unconscious (finding)|New refset member

95930005 |Victim of neglect (finding)|New refset member

271398006 |Weight steady (finding)|New refset member

87715008 |Xerostomia (finding)|New refset member

65971000052100 |Acute psychosis (disorder)|New refset member

432843002 |Acute rejection of cardiac transplant (disorder)|New refset member

17226007 |Adjustment disorder (disorder)|New refset member

781474001 |Allergic disorder (disorder)|New refset member

271737000 |Anemia (disorder)|New refset member

266154004 |Candidiasis of mouth and esophagus (disorder)|New refset member

698247007 |Cardiac arrhythmia (disorder)|New refset member

213151004 |Heart transplant failure and rejection (disorder)|New refset member

213152006 |Heart-lung transplant failure and rejection (disorder)|New refset member

8765009 |Hematemesis (disorder)|New refset member

128139000 |Inflammatory disorder (disorder)|New refset member

262890007 |Injury of urinary tract proper (disorder)|New refset member

2901004 |Melena (disorder)|New refset member

386033004 |Neuropathy (disorder)|New refset member

75478009 |Poisoning (disorder)|New refset member

33910007 |Postoperative infection (disorder)|New refset member

58126003 |Postoperative wound infection (disorder)|New refset member

69322001 |Psychotic disorder (disorder)|New refset member

46742003 |Skin ulcer (disorder)|New refset member

213148006 |Transplanted organ rejection (disorder)|New refset member

386502009 |Acid-base regulation: metabolic acidosis (procedure)|New refset member

431695009 |Administration of drug or medicament to skin via topical route (procedure)|New refset member

386351006 |Administration of drug or medicament via enteral tube (procedure)|New refset member

406172003 |Administration of drug or medicament via nasal route (procedure)|New refset member

386353009 |Administration of drug or medicament via ophthalmic route (procedure)|New refset member

386359008 |Administration of drug or medicament via oral route (procedure)|New refset member

225286008 |Alternating the patient's position (procedure)|New refset member

386516004 |Anticipatory guidance (procedure)|New refset member

14766002 |Aspiration (procedure)|New refset member

64374001 |Assessment and interpretation of higher cerebral function, aphasia testing (procedure)|New refset member

473207004 |Assessment of need for interpreter (procedure)|New refset member

443693006 |Assessment of self medication (procedure)|New refset member

1177155004 |Assessment of side effects of medication (procedure)|New refset member

428211000124100 |Assessment of substance use (procedure)|New refset member

20565007 |Bathing patient in shower (procedure)|New refset member

302787001 |Bilirubin measurement (procedure)|New refset member

30381006 |Bleeding precautions (procedure)|New refset member

170190000 |Child examination: fontanel (procedure)|New refset member

400921004 |Corneal light reflex test (procedure)|New refset member

243067002 |Counseling about coping strategies (procedure)|New refset member

736601004 |Demonstration of inhaler technique (procedure)|New refset member

167197004 |Digestive function tests (procedure)|New refset member

182882002 |Drug intake observed (procedure)|New refset member

171047005 |Drugs of addiction education (procedure)|New refset member

1263932002 |Education about sleep (procedure)|New refset member

439035007 |Education about sleep hygiene behavior (procedure)|New refset member

713607003 |Enhancement of self-efficacy (procedure)|New refset member

225991001 |Ensuring mobility aid available (procedure)|New refset member

1449002 |Epilation (procedure)|New refset member

1269479003 |Female perineal care management (procedure)|New refset member

276026009 |Fluid balance regulation (procedure)|New refset member

390906007 |Follow-up encounter (procedure)|New refset member

12894003 |Functional assessment (procedure)|New refset member

225285007 |Giving oral fluid (procedure)|New refset member

225885004 |Health assessment (procedure)|New refset member

110462006 |Health technology assessment procedure (procedure)|New refset member

84100007 |History taking (procedure)|New refset member

171410002 |Individual general health examination (procedure)|New refset member

310866003 |Informing patient (procedure)|New refset member

225103006 |Intermittent urethral catheterization (procedure)|New refset member

77248004 |Infection control procedure (procedure)|New refset member

1237094009 |Informing health care professional of presence of implantable cardiac device (procedure)|New refset member

371586004 |Learning assessment (procedure)|New refset member

1269480000 |Male perineal care management (procedure)|New refset member

737856008 |Management of vaginal blood loss (procedure)|New refset member

271347000 |Measurement of ketones in urine using dipstick (procedure)|New refset member

396073008 |Medication administration assessment (procedure)|New refset member

410265008 |Medication administration education, guidance, and counseling (procedure)|New refset member

385796006 |Medication prefill preparation (procedure)|New refset member

58707002 |Oral hygiene education (procedure)|New refset member

104847001 |Oxygen saturation measurement (procedure)|New refset member

71192002 |Peritoneal dialysis (procedure)|New refset member

398636004 |Physical activity assessment (procedure)|New refset member

431182000 |Placing subject in prone position (procedure)|New refset member

1230179009 |Positioning subject in lateral decubitus position (procedure)|New refset member

1230176002 |Positioning subject in supine position (procedure)|New refset member

275826003 |Preventing injury (procedure)|New refset member

1172583004 |Promotion of sleep hygiene (procedure)|New refset member

228620008 |Provision of communication aid (procedure)|New refset member

444894008 |Provision of stoma care equipment (procedure)|New refset member

445075008 |Request for language interpreter service (procedure)|New refset member

410305008 |Rest/sleep education, guidance, and counseling (procedure)|New refset member

444686003 |Restriction of oral fluid (procedure)|New refset member

182836005 |Review of medication (procedure)|New refset member

133916000 |Role clarification (procedure)|New refset member

430880004 |Self-confidence enhancement (procedure)|New refset member

1234812003 |Shaving of hair (procedure)|New refset member

226060000 |Stress management (procedure)|New refset member

225337009 |Suicide risk assessment (procedure)|New refset member

384762007 |Transportation procedure (procedure)|New refset member

386329003 |Treatment of hypothermia (procedure)|New refset member

169251004 |Ultrasonography of urinary bladder (procedure)|New refset member

252908007 |Urinary frequency volume chart (procedure)|New refset member

386494000 |Visitation facilitation (procedure)|New refset member

225074002 |Application of lubricant to lips (regime/therapy)|New refset member

225316001 |Bedrest (regime/therapy)|New refset member

385715006 |Cardiac care (regime/therapy)|New refset member

225356004 |Care of equipment and devices (regime/therapy)|New refset member

386262008 |Dysreflexia management (regime/therapy)|New refset member

386275008 |Electrolyte monitoring (regime/therapy)|New refset member

792805006 |Fasting (regime/therapy)|New refset member

113148007 |Fluid intake encouragement (regime/therapy)|New refset member

76168009 |Group psychotherapy (regime/therapy)|New refset member

410390008 |Growth/development surveillance (regime/therapy)|New refset member

386342003 |Kangaroo care (regime/therapy)|New refset member

225417009 |Intermittent observation (regime/therapy)|New refset member

386369002 |Newborn monitoring (regime/therapy)|New refset member

386279002 |Peripheral embolus care (regime/therapy)|New refset member

423687009 |Peripheral intravenous catheter care (regime/therapy)|New refset member

443425001 |Preparation for procedure (regime/therapy)|New refset member

386397008 |Providing presence (regime/therapy)|New refset member

423785008 |Provision of interpreter/translator services (regime/therapy)|New refset member

182809008 |Renal function monitoring (regime/therapy)|New refset member

243117007 |Sibling support (regime/therapy)|New refset member

386451005 |Substance use treatment: overdose (regime/therapy)|New refset member

61420007 |Tube feeding of patient (regime/therapy)|New refset member

386485006 |Unilateral neglect care (regime/therapy)|New refset member

388962008 |Weight maintenance regimen (regime/therapy)|New refset member

871480003 |No psychosis present (situation)|New refset member

860635002 |No anemia present (situation)|New refset member

401187007 |No itch (situation)|New refset member

314529007 |Medication review due (situation)|New refset member


Obtaining the reference set

This reference set covers content of ICNP 2019 and additional content requested by ICN and is published as a Production release in May 2024. It should be noted that SNOMED International is not providing an equivalence table as part of the 2024 release. For further information regarding a human readable version of the current equivalence table please contact icnp@icn.ch

Access within SNOMED international member countries is provided by the Member National Release Centre in each country, via the relevant Member page. Users of ICNP in non-member countries need to gain a licence from ICN in the first instance, unless they are also SNOMED CT Affiliates in which case they will be able to access the files using their MLDS accounts. Please contact info@snomed.org and icnp@icn.ch for more information if required. 

Feedback

Feedback should be sent jointly to info@snomed.org and icnp@icn.ch. Feedback should include any issues relating to implementation, suggestions for future content inclusion or general comments regarding the subset.

Technical Notes

RF2 package format

The RF2 package convention dictates that it contains all relevant files, regardless of whether or not there is content to be included in each particular release.  Therefore, the package contains a mixture of files which contain both header rows and content data, and also files that are intentionally left blank (including only a header record).  The reason that these files are not removed from the package is to draw a clear distinction between:

  1. ...files that have been deprecated (and therefore removed from the package completely), due to the content no longer being relevant to RF2 in this or future releases, and 
  2. ...files that just happen to contain no data in this particular release (and are therefore included in the package but left blank, with only a header record), but are still relevant to RF2, and could therefore potentially contain data in future releases.

This allows users to easily distinguish between files that have purposefully been removed or not, as otherwise if files in option 2 above were left out of the package it could be interpreted as an error, rather than an intentional lack of content in that release.

Metadata now incorporated into the Derivative Packages

After consultation in 2023, SNOMED International are in the process of migrating the Metadata components for Derivative product from the International Edition to the Derivative release packages themselves.

These Derivatives are solely single refsets/maps, and so don’t mean anything to end users without the supporting terms and other components from the International content.  The nature of these products is therefore such that we necessarily create Derivative packages that are inherently dependent on the relevant International Edition content.  Previously, therefore, we have always created the metadata components (refset/module concepts, descriptions, relationships, etc) in the International Edition release packages, with the Derivative products being dependent on the relevant International content. 

Whilst this dependency on the International content would continue, the transition would include the metadata components in the Derivative packages themselves, rather than in the International Edition packages – this will involve:

  • Inactivation (but not complete removal) of the current components in the International Edition
  • Activation of the Metadata components in each of the Derivative release packages

The consensus is that moving the Metadata components into the Derivative packages will bring benefits to both the Derivative maintainers, and also to the end users who will no longer need to pull this particular data down from the dependent International Edition in order to use the Derivative products.   It enables maintainers to move to a more efficient model of hosting the Derivative content in termServer branches, rather than importing Delta files from external tools.

Therefore in this ICNP Refset release, we are including the relevant metadata components in the following files in the Derivative release package:

  • sct2_Concept_ICNPSnapshot_INT_20240101.txt
  • sct2_Description_ICNPSnapshot-en_INT_20240101.txt
  • der2_cRefset_ICNPLanguageSnapshot-en_INT_20240101.txt
  • sct2_Relationship_ICNPSnapshot_INT_20240101.txt
  • sct2_sRefset_OWLExpressionICNPSnapshot_INT_20240101.txt

Notice of changes to the ICNP Release package

In line with the new implementation of Annotations, two new refsets have been added to the International Edition Release package, from December 2023 onwards:

  • der2_scsRefset_ComponentAnnotationStringValueSnapshot_INT_20231201.txt
  • der2_sscsRefset_MemberAnnotationStringValueSnapshot_INT_20231201.txt

The latest version of the ICNP release is based upon the January 2024 International Edition, and therefore these Annotations file types will also be included in the ICNP release package from the January 2024 ICNP release onwards, until further notice:

  • der2_scsRefset_ICNPComponentAnnotationStringValueFull_INT_20240101.txt
  • der2_scsRefset_ICNPComponentAnnotationStringValueSnapshot_INT_20240101.txt
  • der2_sscsRefset_ICNPMemberAnnotationStringValueFull_INT_20240101.txt
  • der2_sscsRefset_ICNPMemberAnnotationStringValueSnapshot_INT_20240101.txt

These refset files are empty for the January 2024 ICNP release, whilst content is being authored for future editing cycles. 


In addition to this, we have standardised the naming convention of the OWL Axiom files, in order to align them to the International standards:

  • Old:     sct2_sRefset_ICNPOWLExpressionSnapshot_INT.txt
  • New:   sct2_sRefset_OWLExpressionICNPSnapshot_INT.txt



Approvals


Final Version

Date

Approver

Comments

1.0

30 May 2024

Jane Millar

Approved

1.0

 

Cathy Richardson 

Approved 





Download .pdf here:





Draft Amendment History


Version

Date

Editor

Comments

0.1

 

Andrew AtkinsonInitial Version
0.2 

 

Cathy Richardson Revised minor edits
1.0

 

Andrew AtkinsonNew technical updates included


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