Nurses\u27 Alumnae Association Bulletin - Volume 17 Number 1

Alumnae Notes Committee Reports Digest of Alumnae Association Meetings Greetings from Miss Childs Greetings from the Educational Director Greetings from the President Graduation Awards - 1951 Jefferson\u27s New Hospital Addition Marriages Necrology Neurosurgery Department New Arrivals New Drugs Notes on the Cause of Leukemia Nursing Staff Saul Among the Prophets Staff Activities, 1951-1952 Students\u27 Corner The Hospital Pharmacy The Student Nurse Association of Pennsylvania White Haven and Barton Memorial Division

Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

BACKGROUND: Establishment of the range of reference values and associated variations of two-dimensional speckle-tracking echocardiography (2DSTE)-derived left ventricular (LV) strain is a prerequisite for its routine clinical adoption in pediatrics. The aims of this study were to perform a meta-analysis of normal ranges of LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) measurements derived by 2DSTE in children and to identify confounding factors that may contribute to variance in reported measures. METHODS: A systematic review was launched in MEDLINE, Embase, Scopus, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library. Search hedges were created to cover the concepts of pediatrics, STE, and left-heart ventricle. Two investigators independently identified and included studies if they reported 2DSTE-derived LV GLS, GCS, or GRS. The weighted mean was estimated by using random effects models with 95% CIs, heterogeneity was assessed using the Cochran Q statistic and the inconsistency index (I(2)), and publication bias was evaluated using the Egger test. Effects of demographic (age), clinical, and vendor variables were assessed in a metaregression. RESULTS: The search identified 2,325 children from 43 data sets. The reported normal mean values of GLS among the studies varied from -16.7% to -23.6% (mean, -20.2%; 95% CI, -19.5% to -20.8%), GCS varied from -12.9% to -31.4% (mean, -22.3%; 95% CI, -19.9% to -24.6%), and GRS varied from 33.9% to 54.5% (mean, 45.2%; 95% CI, 38.3% to 51.7%). Twenty-six studies reported longitudinal strain only from the apical four-chamber view, with a mean of -20.4% (95% CI, -19.8% to -21.7%). Twenty-three studies reported circumferential strain (mean, -20.3%; 95% CI, -19.4% to -21.2%) and radial strain (mean, 46.7%; 95% CI, 42.3% to 51.1%) from the short-axis view at the midventricular level. A significant apex-to-base segmental longitudinal strain gradient (P 94% and P < .001 for each strain measure), which was not explained by age, gender, body surface area, blood pressure, heart rate, frame rate, frame rate/heart rate ratio, tissue-tracking methodology, location of reported strain value along the strain curve, ultrasound equipment, or software. The metaregression showed that these effects were not significant determinants of variations among normal ranges of strain values. There was no evidence of publication bias (P = .40). CONCLUSIONS: This study defines reference values of 2DSTE-derived LV strain in children on the basis of a meta-analysis. In healthy children, mean LV GLS was -20.2% (95% CI, -19.5% to -20.8%), mean GCS was -22.3% (95% CI, -19.9% to -24.6%), and mean GRS was 45.2% (95% CI, 38.3% to 51.7%). LV segmental longitudinal strain has a stable apex-to-base gradient that is preserved throughout maturation. Although variations among different reference ranges in this meta-analysis were not dependent on differences in demographic, clinical, or vendor parameters, age- and vendor-specific referenced ranges were established as well

Mapping Exoplanets

The varied surfaces and atmospheres of planets make them interesting places to live, explore, and study from afar. Unfortunately, the great distance to exoplanets makes it impossible to resolve their disk with current or near-term technology. It is still possible, however, to deduce spatial inhomogeneities in exoplanets provided that different regions are visible at different times---this can be due to rotation, orbital motion, and occultations by a star, planet, or moon. Astronomers have so far constructed maps of thermal emission and albedo for short period giant planets. These maps constrain atmospheric dynamics and cloud patterns in exotic atmospheres. In the future, exo-cartography could yield surface maps of terrestrial planets, hinting at the geophysical and geochemical processes that shape them.Comment: Updated chapter for Handbook of Exoplanets, eds. Deeg & Belmonte. 17 pages, including 6 figures and 4 pages of reference

Greenhushing: the deliberate under communicating of sustainability practices by tourism businesses

Greenhushing selectively communicates fewer pro-sustainability actions by businesses than are practiced; based on a perception of customers’ rights to consumerism. We first studied the gap between the communication of sustainability practices in the audits and websites of 31 small rural tourism businesses in the Peak District National Park (UK). The analysis showed that businesses only communicate 30% of all the sustainability actions practiced. Their websites emphasised customer benefits, using explicit, affective, experiential and active language that legitimises the customers’ hedonistic use of the landscape, while downplaying complex issues and normalising sustainability to reduce customer guilt. Just one website mentioned climate change. We found that greenhushing results from a low moral intensity, masking potentially negative consequences of perceived lower competence, whilst protecting business from more cynical consumers who may interpret their statements as hypocritical. Subsequent textual analysis and interviews were used to understand how communication constitutes these organisations. We propose that greenhushing reshapes and constitutes tourism businesses through their communications. Moreover, greenhushing is a form of public moralisation that adopts communication practices similar to greenwashing, reflecting the social norms expected from a business; however, in this case, located in a moral muteness, rather than moral hypocrisy, that businesses accept but resent

Atlas of Minnesota Resources and Settlement.

Minnesota State Planning Agency and the Center for Urban and Regional Affairs

The Minimal Complexity of Adapting Agents Increases with Fitness

What is the relationship between the complexity and the fitness of evolved organisms, whether natural or artificial? It has been asserted, primarily based on empirical data, that the complexity of plants and animals increases as their fitness within a particular environment increases via evolution by natural selection. We simulate the evolution of the brains of simple organisms living in a planar maze that they have to traverse as rapidly as possible. Their connectome evolves over 10,000s of generations. We evaluate their circuit complexity, using four information-theoretical measures, including one that emphasizes the extent to which any network is an irreducible entity. We find that their minimal complexity increases with their fitness

KRAS-mutation incidence and prognostic value are metastatic site-specific in lung adenocarcinoma: poor prognosis in patients with KRAS-mutation and bone metastasis

Current guidelines lack comprehensive information on the metastatic site-specific role of KRAS mutation in lung adenocarcinoma (LADC). We investigated the effect of KRAS mutation on overall survival (OS) in this setting. In our retrospective study, 500 consecutive Caucasian metastatic LADC patients with known KRAS mutational status were analyzed after excluding 32 patients with EGFR mutations. KRAS mutation incidence was 28.6%. The most frequent metastatic sites were lung (45.6%), bone (26.2%), adrenal gland (17.4%), brain (16.8%), pleura (15.6%) and liver (11%). Patients with intrapulmonary metastasis had significantly increased KRAS mutation frequency compared to those with extrapulmonary metastases (35% vs 26.5%, p=0.0125). In contrast, pleural dissemination and liver involvement were associated with significantly decreased KRAS mutation incidence (vs all other metastatic sites; 17% (p<0.001) and 16% (p=0.02) vs 33%, respectively). Strikingly, we found a significant prognostic effect of KRAS status only in the bone metastatic subcohort (KRAS-wild-type vs KRAS-mutant; median OS 9.7v 3.7 months; HR, 0.49; 95% CI, 0.31 to 0.79; p =0.003). Our study suggests that KRAS mutation frequency in LADC patients shows a metastatic site dependent variation and, moreover, that the presence of KRAS mutation is associated with significantly worse outcome in bone metastatic cases.(VLID)469049

Earth as a Transiting Exoplanet: A Validation of Transmission Spectroscopy and Atmospheric Retrieval Methodologies for Terrestrial Exoplanets

The James Webb Space Telescope (JWST) will enable the search for and characterization of terrestrial exoplanet atmospheres in the habitable zone via transmission spectroscopy. However, relatively little work has been done to use solar system data, where ground truth is known, to validate spectroscopic retrieval codes intended for exoplanet studies, particularly in the limit of high resolution and high signal-to-noise (S/N). In this work, we perform such a validation by analyzing a high S/N empirical transmission spectrum of Earth using a new terrestrial exoplanet atmospheric retrieval model with heritage in Solar System remote sensing and gaseous exoplanet retrievals. We fit the Earth's 2-14 um transmission spectrum in low resolution (R=250 at 5 um) and high resolution (R=100,000 at 5 um) under a variety of assumptions about the 1D vertical atmospheric structure. In the limit of noiseless transmission spectra, we find excellent agreement between model and data (deviations < 10%) that enable the robust detection of H2O, CO2, O3, CH4, N2, N2O, NO2, HNO3, CFC-11, and CFC-12 thereby providing compelling support for the detection of habitability, biosignature, and technosignature gases in the atmosphere of the planet using an exoplanet-analog transmission spectrum. Our retrievals at high spectral resolution show a marked sensitivity to the thermal structure of the atmosphere, trace gas abundances, density-dependent effects, such as collision-induced absorption and refraction, and even hint at 3D spatial effects. However, we used synthetic observations of TRAPPIST-1e to verify that the use of simple 1D vertically homogeneous atmospheric models will likely suffice for JWST observations of terrestrial exoplanets transiting M dwarfs.Comment: 37 pages, 14 figures, 9 tables. Accepted for publication in PS

X-ray lenses fabricated by deep x-ray lithography

Refractive x-ray lenses have been fabricated using deep x-ray lithography. Lenses were produced directly in 1- to 6-mm-thick sheets of polymethylmethacrylate (PMMA) with as many as 100 cylindrical lenses along the optical axis. The fabrication process consists of exposing the PMMA sheets to high-energy synchrotron radiation through a mask of 50-micron-thick gold on silicon and subsequent development in ketone. The lenses are suitable for use in synchrotron radiation from a bending magnet at the Advanced Photon Source in the energy range of 8-16 keV. Results of measurements of focus quality, flux density gain, and scatter are presented and discussed with regard to the quality of lens material and fabrication method. Means for improving the performance of the lenses is discussed