Nonprofits and Change: Building Competencies for the Future

Nonprofit organizations are connected integrally to the communities in which they exist. They are important providers of health care and social services, libraries and the arts, and education for children and adults. They form the local associations we join as volunteers. Today, many of these same nonprofits face the need to change in order to survive into the 21st century. This article describes the imperative to change currently faced by nonprofit organizations and presents eight core competencies for surviving the future. It is intended for nonprofit leaders, practitioners, and board members alike

The rapid increase in telemedicine visits during COVID-19

Prior to the COVID-19 pandemic, facilitated telemedicine encounters were available at outreach locations; however, our tertiary children’s hospital had not invested widely in direct to patient telemedicine. Our daily pediatric subspecialty visits dropped from an average of 2066 visits a day prior to COVID-19 in our community to 1000 patients a day during the study period. Over the four-week period from April 15 to May 12, 2020, patient and family experience ratings of percentage of positive responses (9 or 10) on the provider rating 0-10 scale between telemedicine and in-person visits were compared for our pediatric subspecialty clinics using a Pearson’s Chi Squared test, p-value \u3c0.05 determined significance. Several process measures were compared using the same method. Total visits conducted via telemedicine and survey response rates were calculated with frequencies and percentages. Of the 14,428 subspecialty visits attended, 10,135 (70.2%) were telemedicine. Developmental and Behavioral Medicine saw the highest proportion of patients (99.5%) via telemedicine while Cystic Fibrosis, Dentistry, and Neurosurgery saw no telemedicine patients. Telemedicine visits yielded a 6.5% higher survey response rate than in-person visits. Overall rating of 9 or 10 for telemedicine visits was 87.9%, compared to 83.9% for in-person visits (p-value = 0.07). All process measures scored higher in telemedicine visits. This may reflect telemedicine visits’ ability to improve the efficiency of care delivery: removing the need to travel, park, navigate the building, register for the visit, obtain vital signs and wait for the provider. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this len

Redox-Active Nanomaterials For Nanomedicine Applications

Nanomedicine utilizes the remarkable properties of nanomaterials for the diagnosis, treatment, and prevention of disease. Many of these nanomaterials have been shown to have robust antioxidative properties, potentially functioning as strong scavengers of reactive oxygen species. Conversely, several nanomaterials have also been shown to promote the generation of reactive oxygen species, which may precipitate the onset of oxidative stress, a state that is thought to contribute to the development of a variety of adverse conditions. As such, the impacts of nanomaterials on biological entities are often associated with and influenced by their specific redox properties. In this review, we overview several classes of nanomaterials that have been or projected to be used across a wide range of biomedical applications, with discussion focusing on their unique redox properties. Nanomaterials examined include iron, cerium, and titanium metal oxide nanoparticles, gold, silver, and selenium nanoparticles, and various nanoscale carbon allotropes such as graphene, carbon nanotubes, fullerenes, and their derivatives/variations. Principal topics of discussion include the chemical mechanisms by which the nanomaterials directly interact with biological entities and the biological cascades that are thus indirectly impacted. Selected case studies highlighting the redox properties of nanomaterials and how they affect biological responses are used to exemplify the biologically-relevant redox mechanisms for each of the described nanomaterials

A New Planet Around an M Dwarf: Revealing a Correlation Between Exoplanets and Stellar Mass

We report precise Doppler measurements of GJ317 (M3.5V) that reveal the presence of a planet with a minimum mass Msini = 1.2 Mjup in an eccentric, 692.9 day orbit. GJ317 is only the third M dwarf with a Doppler-detected Jovian planet. The residuals to a single-Keplerian fit show evidence of a possible second orbital companion. The inclusion of an additional Jupiter-mass planet (P = 2700 days, Msini = 0.83 Mjup) improves the quality of fit significantly, reducing the rms from 12.5 m/s to 6.32 m/s. A false-alarm test yields a 1.1% probability that the curvature in the residuals of the single-planet fit is due to random fluctuations, lending additional credibility to the two-planet model. However, our data only marginally constrain a two-planet fit and further monitoring is necessary to fully characterize the properties of the second planet. To study the effect of stellar mass on Jovian planet occurrence we combine our samples of M stars, Solar-mass dwarfs and intermediate-mass subgiants. We find a positive correlation between stellar mass and the occurrence rate of Jovian planets within 2.5 AU; the former A-type stars in our sample are nearly 5 times more likely than the M dwarfs to harbor a giant planet. Our analysis shows that the correlation between Jovian planet occurrence and stellar mass remains even after accounting for the effects of stellar metallicity.Comment: ApJ accepted, 27 pages, 6 figures, 3 table

Five Planets Orbiting 55 Cancri

We report 18 years of Doppler shift measurements of a nearby star, 55 Cancri, that exhibit strong evidence for five orbiting planets. The four previously reported planets are strongly confirmed here. A fifth planet is presented, with an apparent orbital period of 260 days, placing it 0.78 AU from the star in the large empty zone between two other planets. The velocity wobble amplitude of 4.9 \ms implies a minimum planet mass \msini = 45.7 \mearthe. The orbital eccentricity is consistent with a circular orbit, but modest eccentricity solutions give similar \chisq fits. All five planets reside in low eccentricity orbits, four having eccentricities under 0.1. The outermost planet orbits 5.8 AU from the star and has a minimum mass, \msini = 3.8 \mjupe, making it more massive than the inner four planets combined. Its orbital distance is the largest for an exoplanet with a well defined orbit. The innermost planet has a semi-major axis of only 0.038 AU and has a minimum mass, \msinie, of only 10.8 \mearthe, one of the lowest mass exoplanets known. The five known planets within 6 AU define a {\em minimum mass protoplanetary nebula} to compare with the classical minimum mass solar nebula. Numerical N-body simulations show this system of five planets to be dynamically stable and show that the planets with periods of 14.65 and 44.3 d are not in a mean-motion resonance. Millimagnitude photometry during 11 years reveals no brightness variations at any of the radial velocity periods, providing support for their interpretation as planetary.Comment: accepted to Ap

Progression of foot deformity in charcot neuropathic osteoarthropathy

BACKGROUND: Charcot neuropathic osteoarthropathy associated foot deformity can result in joint instability, ulceration, and even amputation. The purpose of the present study was to follow patients with and without active Charcot osteoarthropathy for as long as two years to examine the magnitude and timing of foot alignment changes. METHODS: We studied fifteen subjects with Charcot osteoarthropathy and nineteen subjects with diabetes mellitus and peripheral neuropathy without Charcot osteoarthropathy for one year; eight of the subjects with osteoarthropathy and five of the subjects with diabetes and peripheral neuropathy were followed for two years. Bilateral weight-bearing radiographs of the foot were made at baseline for all subjects, with repeat radiographs being made at six months for the osteoarthropathy group and at one and two years for both groups. Radiographic measurements included the Meary angle, cuboid height, calcaneal pitch, and hindfoot-forefoot angle. RESULTS: The Meary angle, cuboid height, and calcaneal pitch worsened in feet with Charcot osteoarthropathy over one year as compared with the contralateral, uninvolved feet and feet in patients with diabetes and peripheral neuropathy. Cuboid height continued to worsen over the two-year follow-up in the feet with Charcot osteoarthropathy. These feet also had a greater change in the hindfoot-forefoot angle at one year as compared with the feet in patients with diabetes and peripheral neuropathy and at two years as compared with the contralateral, uninvolved feet. CONCLUSIONS: In patients with Charcot neuropathic osteoarthropathy, radiographic alignment measurements demonstrate the presence of foot deformity at the time of the initial clinical presentation and evidence of progressive changes over the first and second years. The six-month data suggest worsening of medial column alignment prior to lateral column worsening. This radiographic evidence of worsening foot alignment over time supports the need for aggressive intervention (conservative bracing or surgical fixation) to attempt to prevent limb-threatening complications. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence

Nicotinamide mononucleotide supplementation reverses vascular dysfunction and oxidative stress with aging in mice

We tested the hypothesis that supplementation of nicotinamide mononucleotide (NMN), a key NAD (+) intermediate, increases arterial SIRT1 activity and reverses age‐associated arterial dysfunction and oxidative stress. Old control mice (OC) had impaired carotid artery endothelium‐dependent dilation (EDD) (60 ± 5% vs. 84 ± 2%), a measure of endothelial function, and nitric oxide (NO)‐mediated EDD (37 ± 4% vs. 66 ± 6%), compared with young mice (YC). This age‐associated impairment in EDD was restored in OC by the superoxide ([Formula: see text]) scavenger TEMPOL (82 ± 7%). OC also had increased aortic pulse wave velocity (aPWV, 464 ± 31 cm s(−1) vs. 337 ± 3 cm s(−1)) and elastic modulus (EM, 6407 ± 876 kPa vs. 3119 ± 471 kPa), measures of large elastic artery stiffness, compared with YC. OC had greater aortic [Formula: see text] production (2.0 ± 0.1 vs. 1.0 ± 0.1 AU), nitrotyrosine abundance (a marker of oxidative stress), and collagen‐I, and reduced elastin and vascular SIRT1 activity, measured by the acetylation status of the p65 subunit of NFκB, compared with YC. Supplementation with NMN in old mice restored EDD (86 ± 2%) and NO‐mediated EDD (61 ± 5%), reduced aPWV (359 ± 14 cm s(−1)) and EM (3694 ± 315 kPa), normalized [Formula: see text] production (0.9 ± 0.1 AU), decreased nitrotyrosine, reversed collagen‐I, increased elastin, and restored vascular SIRT1 activity. Acute NMN incubation in isolated aortas increased NAD (+) threefold and manganese superoxide dismutase (MnSOD) by 50%. NMN supplementation may represent a novel therapy to restore SIRT1 activity and reverse age‐related arterial dysfunction by decreasing oxidative stress

Neuropathic midfoot deformity: Associations with ankle and subtalar joint motion

BACKGROUND: Neuropathic deformities impair foot and ankle joint mobility, often leading to abnormal stresses and impact forces. The purpose of our study was to determine differences in radiographic measures of hind foot alignment and ankle joint and subtalar joint motion in participants with and without neuropathic midfoot deformities and to determine the relationships between radiographic measures of hind foot alignment to ankle and subtalar joint motion in participants with and without neuropathic midfoot deformities. METHODS: Sixty participants were studied in three groups. Forty participants had diabetes mellitus (DM) and peripheral neuropathy (PN) with 20 participants having neuropathic midfoot deformity due to Charcot neuroarthropathy (CN), while 20 participants did not have deformity. Participants with diabetes and neuropathy with and without deformity were compared to 20 young control participants without DM, PN or deformity. Talar declination and calcaneal inclination angles were assessed on lateral view weight bearing radiograph. Ankle dorsiflexion, plantar flexion and subtalar inversion and eversion were assessed by goniometry. RESULTS: Talar declination angle averaged 34±9, 26±4 and 23±3 degrees in participants with deformity, without deformity and young control participants, respectively (p< 0.010). Calcaneal inclination angle averaged 11±10, 18±9 and 21±4 degrees, respectively (p< 0.010). Ankle plantar flexion motion averaged 23±11, 38±10 and 47±7 degrees (p<0.010). The association between talar declination and calcaneal inclination angles with ankle plantar flexion range of motion is strongest in participants with neuropathic midfoot deformity. Participants with talonavicular and calcaneocuboid dislocations result in the most severe restrictions in ankle joint plantar flexion and subtalar joint inversion motions. CONCLUSIONS: An increasing talar declination angle and decreasing calcaneal inclination angle is associated with decreases in ankle joint plantar flexion motion in individuals with neuropathic midfoot deformity due to CN that may contribute to excessive stresses and ultimately plantar ulceration of the midfoot