```xml
<?xml version="1.0" encoding="UTF-8" standalone="yes"?>
<ns3:query_definition xmlns:ns2="http://www.i2b2.org/xsd/cell/crc/psm/1.1/" xmlns:ns4="http://www.i2b2.org/xsd/cell/crc/psm/analysisdefinition/1.1/" xmlns:ns3="http://www.i2b2.org/xsd/cell/crc/psm/querydefinition/1.1/">
    <query_name>(t) zz V-codesCirculatory sysDigestive syste-Events of pregn@10:16:19</query_name>
    <query_timing>ANY</query_timing>
    <specificity_scale>0</specificity_scale>
    <panel>
        <panel_number>1</panel_number>
        <panel_timing>ANY</panel_timing>
        <panel_accuracy_scale>100</panel_accuracy_scale>
        <invert>0</invert>
        <total_item_occurrences>1</total_item_occurrences>
        <item>
            <hlevel>2</hlevel>
            <item_name>zz V-codes</item_name>
            <item_key>\\i2b2_DIAG\i2b2\Diagnoses\zz V-codes\</item_key>
            <item_icon>FA</item_icon>
            <tooltip>Diagnoses \ V-codes</tooltip>
            <class>ENC</class>
            <item_is_synonym>false</item_is_synonym>
        </item>
    </panel>
    <subquery_constraint>
        <first_query>
            <query_id>Event 1</query_id>
            <join_column>STARTDATE</join_column>
            <aggregate_operator>FIRST</aggregate_operator>
        </first_query>
        <operator>LESS</operator>
        <second_query>
            <query_id>Event 2</query_id>
            <join_column>STARTDATE</join_column>
            <aggregate_operator>FIRST</aggregate_operator>
        </second_query>
    </subquery_constraint>
    <subquery>
        <query_id>Event 1</query_id>
        <query_type>EVENT</query_type>
        <query_name>Event 1</query_name>
        <query_timing>SAMEINSTANCENUM</query_timing>
        <specificity_scale>0</specificity_scale>
        <panel>
            <panel_number>1</panel_number>
            <panel_timing>SAMEINSTANCENUM</panel_timing>
            <panel_accuracy_scale>100</panel_accuracy_scale>
            <invert>0</invert>
            <total_item_occurrences>1</total_item_occurrences>
            <item>
                <hlevel>2</hlevel>
                <item_name>Circulatory system</item_name>
                <item_key>\\i2b2_DIAG\i2b2\Diagnoses\Circulatory system (390-459)\</item_key>
                <item_icon>FA</item_icon>
                <tooltip>Diagnoses \ Circulatory system</tooltip>
                <class>ENC</class>
                <item_is_synonym>false</item_is_synonym>
            </item>
        </panel>
    </subquery>
    <subquery>
        <query_id>Event 2</query_id>
        <query_type>EVENT</query_type>
        <query_name>Event 2</query_name>
        <query_timing>SAMEINSTANCENUM</query_timing>
        <specificity_scale>0</specificity_scale>
        <panel>
            <panel_number>1</panel_number>
            <panel_timing>SAMEINSTANCENUM</panel_timing>
            <panel_accuracy_scale>100</panel_accuracy_scale>
            <invert>0</invert>
            <total_item_occurrences>1</total_item_occurrences>
            <item>
                <hlevel>2</hlevel>
                <item_name>Digestive system</item_name>
                <item_key>\\i2b2_DIAG\i2b2\Diagnoses\Digestive system (520-579)\</item_key>
                <item_icon>FA</item_icon>
                <tooltip>Diagnoses \ Digestive system</tooltip>
                <class>ENC</class>
                <item_is_synonym>false</item_is_synonym>
            </item>
        </panel>
        <panel>
            <panel_number>2</panel_number>
            <panel_timing>SAMEINSTANCENUM</panel_timing>
            <panel_accuracy_scale>100</panel_accuracy_scale>
            <invert>0</invert>
            <total_item_occurrences>1</total_item_occurrences>
            <item>
                <hlevel>2</hlevel>
                <item_name>Events of pregnancy</item_name>
                <item_key>\\i2b2_DIAG\i2b2\Diagnoses\Events of pregnancy (630-677)\</item_key>
                <item_icon>FA</item_icon>
                <tooltip>Diagnoses \ Events of pregnancy</tooltip>
                <class>ENC</class>
                <item_is_synonym>false</item_is_synonym>
            </item>
            <item>
                <hlevel>2</hlevel>
                <item_name>Genitourinary system</item_name>
                <item_key>\\i2b2_DIAG\i2b2\Diagnoses\Genitourinary system (580-629)\</item_key>
                <item_icon>FA</item_icon>
                <tooltip>Diagnoses \ Genitourinary system</tooltip>
                <class>ENC</class>
                <item_is_synonym>false</item_is_synonym>
            </item>
        </panel>
    </subquery>
</ns3:query_definition>

```

I want to find patients who have had an encounter with a diagnosis related to the circulatory system (codes 390-459) at any time, and at the same instance number, have a diagnosis related to the digestive system (codes 520-579) or events of pregnancy (codes 630-67) or genitourinary system (codes 580-629). The diagnoses should be from the same visit (SAMEINSTANCENUM), and the specificity scale is set to 0, meaning that all occurrences of the specified diagnoses will be included. The query is looking for the first occurrence of each diagnosis (FIRST aggregate operator) and the subquery constraint is set to LESS, meaning that the first query (circulatory system) should occur before the second query (digestive or genitourinary system or events of pregnancy). The accuracy scale for both subqueries is set to 10, indicating high confidence in the results. The query is named "zz V-codesCirculatory sysDigestive syste-Events of pre