Organizational Capital: A New Approach to Lending in Nonprofit Affordable Housing

In spite of a diminishing supply of public resources, many nonprofit housing developers are expanding their roles and their portfolios to address an increasing need for decent affordable housing. But as nonprofit housing organizations mature, the traditional project-by-project funding system fails to support their broader development goals. This paper stresses the urgent need for equity, or "organizational capital," to help nonprofit housing organizations build their capacity and their impact. Unlike conventional financing, organizational capital is underwritten against a borrower's balance sheet, or its organizational ability to repay. Whereas project-based loans are tied to one particular project, organizational loans can be a source of liquidity whenever an organization needs it: on the front end of a deal, for general business operations or during periods of organizational expansion. Despite its many advantages, there is an extremely limited supply of organizational capital in nonprofit affordable housing. This research outlines the practical challenges to organizational investing and uncovers the underlying barriers that have prevented a nonprofit organizational capital market from emerging. These findings lead us to explore nonprofit housing organizations in a "closed system" of standardized reporting and rational decision-making. The study concludes that while a new nonprofit reporting system would greatly encourage organizational investing in housing, the private markets alone will not bring organizational lending to scale. The final sections of the paper discuss the public policy implications of a closed nonprofit capital system and highlight some innovative approaches taken by lenders to overcome the obstacles of organizational investing and advance a new model of lending in nonprofit affordable housing

Das Druckgeschwür als krankheitsmodifizierender Faktor nach akuter Rückenmarksverletzung

Fragestellung: Es wurde der Frage nachgegangen, ob in der Akut- oder Rehabilitationsphase erworbene Druckgeschwüre (DG) nach einer akuten traumatischen Rückenmarksverletzung (spinal cord injury / SCI) die langzeitige neurologische oder funktionelle Rehabilitation beeinflussen. Methode: In einer longitudinalen Kohortenstudie innerhalb der prospektiven multizentrischen National Spinal Cord Injury Database (Birmingham, AL, USA) wurden 3.654 Patienten erfasst, welche zwischen 1996 und 2006 in einem der 20 angeschlossenen Studienzentren behandelt, und bis 2016 nachverfolgt, worden waren. Einschlusskriterien der Studie waren eine traumatische zervikale Rückenmarksverletzung des Schweregrads ASIA Impairment Scale (AIS) A, B oder C. Bis zum Ende der Rehabilitationsphase neu aufgetretene DG wurden hinsichtlich ihrer Assoziation mit der neurologischen und funktionellen Erholung analysiert. Veränderungen des ASIA Motor Score (ASIAmotor) beziehungsweise des motorischen Functional Independence Measure (FIMmotor) innerhalb eines Jahres wurden anhand von linearen gemischten Modellen analysiert. Des Weiteren wurde die mit DG assoziierte 10-Jahres-Sterblichkeit mittels Cox-Regression untersucht. Ergebnis: 1.282 Patienten erfüllten die Einschlusskriterien, von welchen 45,7% bis Ende der Rehabilitation mindestens ein DG entwickelten. Im adjustierten linearen gemischten Modell konnte gezeigt werden, dass ein in der Erstbehandlung nach SCI erworbenes DG sehr deutlich mit einer reduzierten Verbesserung des ASIAmotor ein Jahr nach SCI assoziiert ist (-8,6 Punkte; 95% KI: -11,8 bis -5,5; p < 0,001). Die Analyse der funktionellen Verbesserung, gemessen am FIMmotor-Score ergab, dass der Faktor DG ebenfalls sehr deutlich mit einem verminderten Funktionsgewinn ein Jahr nach SCI assoziiert ist (-8,0 Punkte; 95% KI: -10,7 bis -5,2; p < 0,001). Die adjustierte Cox-Regression identifiziert das DG als bedeutenden mit höherer Sterblichkeit assoziierten Faktor über einen Zeitraum von zehn Jahren nach SCI (Risikoquotient HR 1,42; 95% KI: 1,11 bis 1,83; p = 0,006). Schlussfolgerung: In der Frühphase einer traumatischen Rückenmarksverletzung erworbene Druckgeschwüre sind ein vermeidbarer, krankheitsmodifizierender Faktor, welcher präventiv und therapeutisch gezielt berücksichtigt werden sollte, um das Ergebnis der langfristigen neurologischen und funktionellen Rehabilitation zu verbessern und die Mortalität zu reduzieren.Objective: This study investigates whether pressure ulcers (PU) acquired during acute and rehabilitative care affect the clinical long-term outcome after traumatic spinal cord injury (SCI). Methods: A longitudinal cohort study within the prospective multi-center National Spinal Cord Injury Database (Birmingham, AL, USA) enrolled n = 3,654 patients who had been treated at one of 20 affiliated study centers between 1996 and 2006 and followed up until 2016. Inclusion criteria for the study were traumatic cervical spinal cord injury of severity ASIA Impairment Scale (AIS) A, B or C. PU acquired during acute surgical care or inpatient rehabilitation were analyzed for their effects on neurologic and functional recovery. Changes within one year in ASIA Motor Score (ASIAmotor) and motor items of the Functional Independence Measure (FIMmotor) respectively, were analyzed using linear mixed models. Furthermore, 10-year PU related mortality was examined using Cox regressions. Results: 1,282 patients were included in the study, of whom 45.7% developed at least one PU by the end of rehabilitation. The adjusted linear mixed model demonstrated that PU acquired during initial treatment after SCI was associated with reduced improvement in the ASIAmotor one year after SCI (-8.6 points; 95% CI: -11.8 to -5.5; p < 0.001). Analysis of functional improvement, as measured by the FIMmotor score, revealed that PU was also associated with reduced functional gain one year after SCI (-8.0 points; 95% CI: -10.7 to -5.2; p < 0.001). Adjusted Cox regressions identified PU as a significant risk factor associated with higher mortality over a 10-year period after SCI (hazard ratio 1.42; 95% CI: 1.11 to 1.83; p = 0.006). Conclusion: Pressure ulcers acquired in the early phase of traumatic spinal cord injury are a preventable, disease-modifying factor that should be specifically targeted preventively and therapeutically to improve long-term neurologic and functional rehabilitation outcomes and reduce mortality

Writing-to-Learn in introductory Materials Science and Engineering

We present a study on the impact of Writing-to-Learn (WTL) assignments on student learning in introductory materials science/engineering. WTL promotes deeper thinking by asking students to address “real-world” situations via writing. The inclusion of peer review and revision processes in the WTL assignments allows students to give and receive feedback and critically assess their work. Through analysis of writing products and using pre/post assessments, we examine student gains in conceptual understanding and critical reasoning. Gain distributions across topics suggest that highly-effective assignments require students to map between qualitative and quantitative representations of phenomena and to connect their microscopic and macroscopic understandings.http://deepblue.lib.umich.edu/bitstream/2027.42/169562/1/L_Marks_Honors_Capstone.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/169562/2/APS-2021-13mar2021-marks.pptxhttp://deepblue.lib.umich.edu/bitstream/2027.42/169562/3/L_Marks_Honors_Capstone_Supplemental.pd

Cross-Sectional Area of the Rotator Cuff Muscles in MRI - Is there Evidence for a Biomechanical Balanced Shoulder?

OBJECTIVE To provide in-vivo evidence for the common biomechanical concept of transverse and craniocaudal force couples in the shoulder that are yielded by both the rotator cuff muscles (RCM) and the deltoid and to quantitatively evaluate and correlate the cross-sectional areas (CSA) of the corresponding RCM as a surrogate marker for muscle strength using MRI. MATERIALS AND METHODS Fifty patients (mean age, 36 years; age range, 18-57 years; 41 male, 9 female) without rotator cuff tears were included in this retrospective study. Data were assessed by two readers. The CSA (mm2) of all rotator cuff muscles was measured on parasagittal T1-weighted FSE sequence at two different positions (at the established "y-position" and at a more medial slice in the presumably maximal CSA for each muscle, i.e., the "set position"). The CSA of the deltoid was measured on axial intermediate-weighted FSE sequences at three positions. CSA measurements were obtained using 1.5 Tesla MR-arthrographic shoulder. Pearson's correlation for the corresponding CSA of the force couple as well as was the intraclass correlation coefficient for the inter- and intra-reader agreement was calculated. RESULTS The mean CSA was 770 mm2 (±167) and 841 mm2 (±191) for the supraspinatus (in the y- and set-positions, respectively) and 984 mm2 (±241) and 1568 mm2 (±338) for the infraspinatus. The mean CSA was 446 mm2 (±129) and 438 mm2 (±128) for the teres minor (in the y- and set-positions, respectively) and 1953 mm2 (±553) and 2343 mm2 (±587) for the subscapularis. The three measurements of the deltoid revealed a CSA of 3063 mm2 (±839) for the upper edge, 3829 mm2 (±836) for the lower edge and 4069 mm2 (±937) for the middle of the glenoid. At the set position Pearson's correlation of the transverse force couple (subscapularis/infraspinatus) showed a moderate positive correlation of r = 0.583 (p<0.0001) and a strong correlation when the CSA of the teres minor was added to the infraspinatus CSA (r = 0.665, p = 0.0008) and a strong positive correlation of the craniocaudal force couple (supraspinatus/deltoid) that ranged from r = 0.565-0.698 (p<0.0001). Inter-reader agreement (ranged from 0.841 to 0.997, p = 0.0007) and intra-reader agreement were excellent (ranged from 0.863 to 0.999, p = 0.0006). CONCLUSION The significant correlation of the CSA of the RCM that form the transverse (subscapularis/infraspinatus-teres minor) and craniocaudal (supraspinatus/deltoid) force couple measured by MR-arthrography supports the biomechanical concept of a dynamically balanced shoulder in patients with an intact rotator cuff

A Portrait of MWrite as a Research Program: A Review of Research on Writing-to-Learn in STEM through the MWrite Program

The writing-to-learn (WTL) literature is varied in how assignments are structured and implemented in the classroom, making it difficult for instructors to identify how to incorporate writing effectively. Drawing on the WTL literature, the MWrite program was established to work with STEM faculty to design, implement, and assess evidence- based WTL assignments. Herein we present a review of the WTL research generated through the MWrite program, situating our findings in a four-dimensional framework of engagement to identify how the MWrite WTL assignment design and implementation has supported students’ learning. Our analysis indicates that the multi-faceted design of MWrite WTL assignments supports students’ development of conceptual knowledge and disciplinary thinking. The assignments’ rhetorical features (i.e., context, audience, and genre) guide how students write about content, and peer review and revision stages encourage a collaborative, knowledge building process between students and their peers

Correction for fast pseudo-diffusive fluid motion contaminations in diffusion tensor imaging

In this prospective study, we quantified the fast pseudo-diffusion contamination by blood perfusion or cerebrospinal fluid (CSF) intravoxel incoherent movements on the measurement of the diffusion tensor metrics in healthy brain tissue. Diffusion-weighted imaging (TR/TE = 4100 ms/90 ms; b-values: 0, 5, 10, 20, 35, 55, 80, 110, 150, 200, 300, 500, 750, 1000, 1300 s/mm2, 20 diffusion-encoding directions) was performed on a cohort of five healthy volunteers at 3 Tesla. The projections of the diffusion tensor along each diffusion-encoding direction were computed using a two b-value approach (2b), by fitting the signal to a monoexponential curve (mono), and by correcting for fast pseudo-diffusion compartments using the biexponential intravoxel incoherent motion model (IVIM) (bi). Fractional Anisotropy (FA) and Mean Diffusivity (MD) of the diffusion tensor were quantified in regions of interest drawn over white matter areas, gray matter areas, and the ventricles. A significant dependence of the MD from the evaluation method was found in all selected regions. A lower MD was computed when accounting for the fast-diffusion compartments. A larger dependence was found in the nucleus caudatus (bi: median 0.86 10-3 mm2/s, Δ2b: -11.2%, Δmono: -14.4%; p = 0.007), in the anterior horn (bi: median 2.04 10-3 mm2/s, Δ2b: -9.4%, Δmono: -11.5%, p = 0.007) and in the posterior horn of the lateral ventricles (bi: median 2.47 10-3 mm2/s, Δ2b: -5.5%, Δmono: -11.7%; p = 0.007). Also for the FA, the signal modeling affected the computation of the anisotropy metrics. The deviation depended on the evaluated region with significant differences mainly in the nucleus caudatus (bi: median 0.15, Δ2b: +39.3%, Δmono: +14.7%; p = 0.022) and putamen (bi: median 0.19, Δ2b: +3.1%, Δmono: +17.3%; p = 0.015). Fast pseudo-diffusive regimes locally affect diffusion tensor imaging (DTI) metrics in the brain. Here, we propose the use of an IVIM-based method for correction of signal contaminations through CSF or perfusion

Quantitative magnetic resonance imaging of meniscal pathology ex vivo

OBJECTIVE To determine the ability of conventional spin echo (SE) T2 and ultrashort echo time (UTE) T2* relaxation times to characterize pathology in cadaveric meniscus samples. MATERIALS AND METHODS From 10 human donors, 54 triangular (radially cut) meniscus samples were harvested. Meniscal pathology was classified as normal (n = 17), intrasubstance degenerated (n = 33), or torn (n = 4) using a modified arthroscopic grading system. Using a 3-T MR system, SE T2 and UTE T2* values of the menisci were determined, followed by histopathology. Effect of meniscal pathology on relaxation times and histology scores were determined, along with correlation between relaxation times and histology scores. RESULTS Mean ± standard deviation UTE T2* values for normal, degenerated, and torn menisci were 3.6 ± 1.3 ms, 7.4 ± 2.5 ms, and 9.8 ± 5.7 ms, respectively, being significantly higher in degenerated (p  0.14). In terms of histology, we found significant group-wise differences (each p < 0.05) in fiber organization and inner-tip surface integrity sub-scores, as well as the total score. Finally, we found a significant weak correlation between UTE T2* and histology total score (p = 0.007, R$_{s}$$^{2}$ = 0.19), unlike the correlation between SE T2 and histology (p = 0.09, R$_{s}$$^{2}$ = 0.05). CONCLUSION UTE T2* values were found to distinguish normal from both degenerated and torn menisci and correlated significantly with histopathology