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Nonprofit organizations addressing societal challenges such as hunger, poverty, and racial inequities want to grow the impact of their promising solutions to these problems—scaling social impact. Yet, local, community-based nonprofits often struggle to identify a path to scale their impact. To address this problem, the authors partnered with 11 nonprofits engaged in social impact scaling. By integrating insights on scaling from these nonprofit research partners together with academic research on scaling across a range of disciplines, they outline a framework for scaling community-based nonprofits and the marketing practices that support it. This research advances a two-stage social impact scaling framework termed “T-shaped Scaling.” Within this framework, the vertical bar of the T refers to “scaling deep,” grounding solutions within a community, and the horizontal bar of the T represents “scaling wide,” adapting and transferring the scaled deep solutions to new communities. This framework advances both conceptual and practical understandings of social impact scaling. Finally, the authors explore the policy implications of social impact scaling and call on researchers in marketing to further investigate the scaling strategies and marketing practices that grow social impact.

BACKGROUND Tofactinib is a JAK inhibitor that targets mainly JAK 1 and JAK3 approved to treat Ulcerative Colitis (UC) in 2018. The JAK inhibitor Upadacitinib (upa) was recently approved to treat UC in March 2022 and has increased selectivity for JAK1. The relative efficacy and safety of these two JAK inhibitors is not presently clear. An important clinical question is whether patients who have not responded or lost response to tofacitinib will have a reasonable likelihood of response with upadacitinib. AIM To determine whether patients previously exposed to tofacitinib would benefit from treatment with upa. METHODS We identified adult patients at our center with active UC who had previously been treated with tofacitinib who were started on upa in the spring of 2022. Pre- and post- upa characteristics were recorded including demographic information, prior treatments, hemoglobin (hgb), albumin (alb), C-reactive protein (CRP), and partial Mayo score (pMS). Primary end points evaluated were clinical response (decrease in pMS >2), and clinical remission (pMS < 2). Secondary endpoints included serious adverse events, steroid use at time of follow up, and normalization of CRP, hgb and alb. IRB approval was obtained for the study. RESULTS A total of 3 patients were identified. All patients were given upa 45 mg daily for 8 weeks followed by 30 mg daily for maintenance. Median follow up time was 10 weeks (range 10-11 weeks). All three patients achieved the primary endpoints of clinical response and remission with pMS values of 0 at time of follow up. Patients 1 and 2 were concurrently started on a prednisone taper when initiating upa and were no longer on prednisone at time of follow up. Patients 1 and 2 had normalization of their CRP values, patient 3 only had a pre-upa CRP value available and that was 0. See table 1 for data on hgb and alb levels. Patient 1 had a pre-upa endoscopic mayo score of 3, while patients 2 and 3 had pre-upa endoscopic mayo scores of 2. No patient had post-upa endoscopic evaluation at time of follow up. No patient had any serious adverse events. CONCLUSIONS In this small case-series, use of upadacitinib in patients previously treated with tofacitinib was safe and effective in achieving clinical remission.

IntroductionIsolated tricuspid valve surgery (TVS) may be associated with high morbidity and mortality. The aim of this study was to investigate the association of preoperative imaging and haemodynamic data derived from echocardiography (ECHO), cardiac magnetic resonance (CMR) and right heart catheterisation (RHC) with postoperative outcomes following TVS.MethodsIn a retrospective cohort study, patients who underwent isolated TVS at our institution between 2012 and 2020 were screened and followed up to 1 year. We only included those who had all three tests before surgery: ECHO, CMR and RHC. Patients with congenital heart disease, infective endocarditis and those who underwent concomitant valve or pericardial surgery were excluded. The primary outcome was a composite of mortality and congestive heart failure at 1 year. Time-to-event analyses at 1 year and Cox proportional hazards regression analyses were performed.ResultsA total of 60 patients were included (mean age of 60±14 years, 63% women), of whom 67% underwent TV repair. The primary outcome occurred in 16 patients (27%) with a 1-year mortality of 7%. It was associated with ECHO-derived right ventricular (RV) free wall strain and RHC-derived RV systolic and diastolic as well as mean pulmonary pressures. On multivariable Cox regression analysis, only RV systolic and diastolic pressures were significantly associated with the primary outcome at 1 year (HRs=5.9 and 3.4, respectively, pConclusionBaseline invasive haemodynamic assessment could have a strong association with clinical outcomes and help risk-stratify patients undergoing isolated TVS.

Background Oscillometric, non-invasive blood pressure measurement (NIBP) is the first choice of blood pressure monitoring in the majority of low and moderate risk surgeries. In patients with morbid obesity, however, it is subject to several limitations. The aim was to compare arterial pressure monitoring by NIBP and a non-invasive finger-cuff technology (Nexfin®) with the gold-standard invasive arterial pressure (IAP). Methods In this secondary analysis of a prospective observational, single centre cohort study, systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP) were measured at 16 defined perioperative time points including posture changes, fluid bolus administration and pneumoperitoneum (PP) in patients undergoing laparoscopic bariatric surgery. Absolute arterial pressures by NIBP, Nexfin® and IAP were compared using correlation and Bland Altman analyses. Interchangeability was defined by a mean difference ≤ 5 mmHg (SD ≤8 mmHg). Percentage error (PE) was calculated as an additional statistical estimate. For hemodynamic trending, concordance rates were analysed according to the Critchley criterion. Results Sixty patients (mean body mass index of 49.2 kg/m2) were enrolled and data from 56 finally analysed. Pooled blood pressure values of all time points showed a significant positive correlation for both NIPB and Nexfin® versus IAP. Pooled PE for NIBP versus IAP was 37% (SAP), 35% (DAP) and 30% (MAP), for Nexfin versus IAP 23% (SAP), 26% (DAP) and 22% (MAP). Correlation of MAP was best and PE lowest before induction of anesthesia for NIBP versus IAP (r = 0.72; PE 24%) and after intraoperative fluid bolus administration for Nexfin® versus IAP (r = 0.88; PE: 17.2%). Concordance of MAP trending was 90% (SAP 85%, DAP 89%) for NIBP and 91% (SAP 90%, DAP 86%) for Nexfin®. MAP trending was best during intraoperative ATP positioning for NIBP (97%) and at induction of anesthesia for Nexfin® (97%). Conclusion As compared with IAP, interchangeability of absolute pressure values could neither be shown for NIBP nor Nexfin®, however, NIBP showed poorer overall correlation and precision. Overall trending ability was generally high with Nexfin® surpassing NIBP. Nexfin® may likely render individualized decision-making in the management of different hemodynamic stresses during laparoscopic bariatric surgery, particularly where NIBP cannot be reliably established. Trial registration The non-interventional, observational study was registered retrospectively at (NCT03184285) on June 12, 2017.

Emergencies and disasters often expose existing flaws in our systems As Warren Buffet said, “It’s only when the tide goes out that you discover who’s been swimming naked” (Emanuel 2020) We have been swimming in the buff The COVID-19 pandemic has exposed systemic vulnerabilities in food access for people experiencing hunger Simultaneously, it has revealed opportunities to strengthen food access Working with Hunger Task Force (HTF), an antihunger nonprofit that operates a food bank in Milwaukee and advocates for local, state, and federal policy to end hunger (Bublitz et al 2019), we outline three lessons from the COVID-19 pandemic and raise policy and research questions related to ensuring food access for all

In underserved communities throughout affluent countries, people lack access to affordable, nutritious food. To remedy this, Social Entrepreneurial Organizations (SEOs) are creating local, community-based food distribution infrastructure that provides sustainable access to healthy and affordable food. Our paper develops an integrative framework focused on identifying the key marketing practices that enhance the success of local, community-based SEOs securing affordable access to healthy foods. We adopt a relational engagement approach and bring an inductive case study method to our collaborative research partnerships with SEOs innovating community-based solutions to improve food access. Our research-based framework suggests opportunities for academic research on food access with conceptual and societal benefit. Finally, we call for more academic research to advance local, community-based social entrepreneurship focused on attaining healthy food access for all.

Background There is limited understanding of the characteristics and operational burden of persons under investigation (PUIs) and those testing positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) presenting to emergency departments (EDs). Methods We reviewed all adult ED visits to 5 Johns Hopkins Health System hospitals in the Maryland/District of Columbia (DC) region during the initial coronavirus disease 2019 (COVID‐19) surge, analyzing SARS‐CoV‐2 polymerase chain reaction test eligibility, results, demographics, acuity, clinical conditions, and dispositions. Results Of 27,335 visits, 11,402 (41.7%) were tested and 2484 (21.8%) were SARS‐CoV‐2 positive. Test‐positive rates among Hispanics, Asians, African Americans/Blacks, and Whites were 51.6%, 23.7%, 19.8%, and 12.7% respectively. African American/Blacks infection rates (25.5%–33.8%) were approximately double those of Whites (11.1%–21.1%) in the 3 southern Maryland/DC EDs. Conditions with high test‐positive rates were fever (41.9%), constitutional (36.4%), upper respiratory (36.9%), and lower respiratory (31.2%) symptoms. Test‐positive rates were similar in all age groups (19.9% to 25.8%), although rates of hospitalization increased successively with age. Almost half, 1103 (44.4%), of test‐positive patients required admission, of which 206 (18.7%) were to an ICU. Conclusion The initial surge of SARS‐CoV‐2 test‐positive patients experienced in a regional hospital system had ≈ 42% of patients meeting testing criteria and nearly one‐fifth of those testing positive. The operational burden on ED practice, including intense adherence to infection control precautions, cannot be understated. Disproportionately high rates of infection among underrepresented minorities underscores the vulnerability in this population. The high rate of infection among self‐identified Asians was unexpected.

This article explores the paradigm of Food Well-Being (FWB), “a positive psychological, physical, emotional, and social relationship with food,” for those who experience hunger. Building on the insights derived from two sources—research across a range of disciplines including marketing and the practices of the nonprofit Hunger Task Force to alleviate hunger and advance FWB—the authors explore the five domains of FWB: food availability, food socialization, food literacy, food marketing, and food policy as they relate to people who experience hunger. The authors establish a research contribution by extending the FWB paradigm to include people experiencing hunger and by applying this extended paradigm to illuminate the impact of hunger on people’s FWB. Finally, the authors propose research to guide researchers, policy makers, and nonprofits toward generating FWB for all.

Highlights • The coumadin ridge is a very unusual location for a cardiac PFE. • Although benign, large, mobile cardiac PFEs can pose a significant embolic risk. • Multimodality CV imaging can differentiate cardiac PFE from other cardiac tumors., Graphical abstract

There is growing pressure to measure and reduce unnecessary imaging in the emergency department.We study provider and hospital variation in utilization and diagnostic yield for advanced radiography in diagnosis of pulmonary embolism (PE) and to assess patient- and provider-level factors associated with diagnostic yield.Retrospective chart review of all adult patients presenting to four hospitals from January 2006 through December 2009 who had a computed tomography or ventilation/perfusion scan to evaluate for PE. Demographic data on the providers ordering the scans were collected. Diagnostic yield (positive scans/total scans ordered) was calculated at the hospital and provider level. The study was not designed to assess appropriateness of imaging.There was significant variation in utilization and diagnostic yield at the hospital level (chi-squared, p0.05). Diagnostic yield ranged from 4.2% to 8.2%; after adjusting for patient- and provider-level factors; the two hospitals with an emergency medicine residency training program had higher diagnostic yields (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.6-2.5 and OR 1.9, 95% CI 1.5-2.4). There was no significant variation in diagnostic yield among the 90 providers after adjusting for patient, hospital, and provider characteristics. Providers with10 years of experience had lower odds of diagnosing a PE than more experienced graduates (OR 0.8, 95% CI 0.6-0.9).Although we found significant variation in utilization of advanced radiography for PE and diagnostic yield at the hospital level, there was no significant variation at the provider level after adjusting for patient-, hospital-, and provider-level factors.

The aim of this study is to contribute to greater knowledge of the basis on which teachers award grades and how they view the national test. Five upper secondary school teachers of Swedish were asked in semi-structured interviews to say what significance they ascribe to the national test in general, what reasons they can see to explain why the course grade differs from the test grade, how they reasoned when they awarded a course grade that differed from the grade on the national test, and how they view a strengthened and clearer relationship between national tests and course grades in order to increase equivalence in Swedish schools. The material was then analysed with a method inspired by phenomenology. The study shows that there is no agreement in the outlook on the national test. One of the teachers does not think that the national test is more important than other tests, three think that it is more important, and one uses the national test chiefly to confirm previous results. There are three reasons why the course grade can differ from the national test grade: (1) the design of the test, (2) that the test result does not reflect the pupil’s knowledge and skills, and (3) that the teacher deliberately awards a wrong grade. The teachers was to see greater equivalence. Some think that a clearer and stronger relationship between national tests and course grades is not the right way to go, while others are in favour of the suggestion. Regardless of their opinion, however, most of the teachers wonder how it will be possible in practice to link the test grade to the course grade.

This article presents a dual-band/dual-polarized microstrip patch antenna.For a dual-band retrodirective array system, the dual-band/dual-polarized microstrip patch antenna operating at 11 and 12.2 GHz is designed and tested. The antenna consists of one rectangular microstrip patch and a square ring outside of the patch. Two different feeding locations are used for vertical and horizontal polarizations. The vertical polarization is used for a receiving mode and the horizontal polarization for a transmitting mode. The antenna shows a measured gain of 5.2 and 6.8 dBi at 10.9 and 12.2 GHz. The isolation between the two feeding ports is measured to be greater than 15 dB at each center frequency. © 2012 Wiley Periodicals, Inc. Microwave Opt Technol Lett 54:2781–2784, 2012; View this article online at wileyonlinelibrary.com. DOI 10.1002/mop.27217

Background The Surviving Sepsis Campaign (SSC) guidelines recommend that broad-spectrum antibiotics be administered to severely septic patients within 3 h of emergency department (ED) admission. Despite the well-established evidence regarding the benefit of timely antibiotics, adoption of the SSC recommendation into daily clinical practice has been slow and sporadic. Study Objective To study the impact of storing broad-spectrum antibiotics in an ED automated dispensing cabinet (ADC) on the timeliness of antibiotic administration in severely septic patients presenting to the ED. Methods Retrospective observational study of timeliness of antibiotic administration in severely septic patients presenting to a community ED before and after adding broad-spectrum antibiotics to the ED ADC. Data on 56 patients before and 54 patients after the intervention were analyzed. The primary outcome measure was mean order-to-antibiotic time. Secondary outcome measures included mean door-to-antibiotic time and percentage of patients receiving antibiotics within 3 h. Results The final analysis was on 110 patients. Order-to-antibiotic administration time was reduced by 29 min post-intervention (55 min vs. 26 min, 95% confidence interval [CI] 12.5–45.19). Mean door-to-antibiotic time was also reduced by 70 min (167 min vs. 97 min, 95% CI 37.53–102.29). The percentage of severely septic patients receiving antibiotics within 3 h of arrival to the ED increased from 65% pre-intervention to 93% post-intervention (95% CI 0.12–0.42). Conclusion Storing key antibiotics in an institution’s severe sepsis antibiogram in the ED ADC can significantly reduce order-to-antibiotic times and increase the percentage of patients receiving antibiotics within the recommended 3 h of ED arrival.

Here we investigate the role of rab5 and its cognate exchange factors rabex-5 and hRME-6 in the regulation of AP2 uncoating from endocytic clathrin-coated vesicles (CCVs). In vitro, we show that the rate of AP2 uncoating from CCVs is dependent on the level of functional rab5. In vivo, overexpression of dominant-negative rab5S34N, or small interfering RNA (siRNA)–mediated depletion of hRME-6, but not rabex-5, resulted in increased steady-state levels of AP2 associated with endocytic vesicles, which is consistent with reduced uncoating efficiency. hRME-6 guanine nucleotide exchange factor activity requires hRME-6 binding to α-adaptin ear, which displaces the ear-associated μ2 kinase AAK1. siRNA-mediated depletion of hRME-6 increases phospho-μ2 levels, and expression of a phosphomimetic μ2 mutant increases levels of endocytic vesicle-associated AP2. Depletion of hRME-6 or rab5S35N expression also increases the levels of phosphoinositide 4,5-bisphosphate (PtdIns(4,5)P2) associated with endocytic vesicles. These data are consistent with a model in which hRME-6 and rab5 regulate AP2 uncoating in vivo by coordinately regulating μ2 dephosphorylation and PtdIns(4,5)P2 levels in CCVs.

Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular (CV) mortality. The PRECISION trial evaluated the CV safety of celecoxib and nonselective NSAIDs. We assessed the contemporary impact of LVH on CV outcomes diagnosed by EKG in this randomized clinical trial. We

This paper presents a V-band dipole antenna designed on a planar substrate. The antenna is fed by a double-sided parallel microstrip (DSPM) transmission line connected to a grounded coplanar waveguide (GCPW). The center frequency of the antenna is set to 60 GHz. In the proposed antenna structure, input impedance can be matched by simply adjusting the width and length of the DSPM. The designed dipole antenna exhibits more than a 10 GHz bandwidth (55∼65 GHz) and high radiation efficiency of greater than 90%. The antenna also provides a low cross polarization level and supports uniform radiation within the entire operating bandwidth. In a full wave EM simulation, the antenna achieves a gain of approximately 6 dBi throughout the bandwidth.

A stacked-patch, broadband, dual-polarized, aperture-fed antenna is designed with a center frequency of 10 GHz and a bandwidth greater than 3 GHz. This antenna is then used in a four element array configuration which utilizes digital phase-shifters, controlled by LabVIEW, to steer the beam. The dual-polarized array can provide a ±45° scan angle over a 3 GHz bandwidth.

Protein biomarkers provide the key diagnostic information for the detection of disease, risk of disease progression, and a patient's likely response to drug therapy. Potential biomarkers exist in biofluids, such as serum, urine, and cerebrospinal fluid. Unfortunately, discovering and validating protein biomarkers are hindered by the presence of high-molecular-weight proteins, such as serum albumin and immunoglobulins, which comprise 90% of the proteins present in these samples. High-abundance, high-molecular-weight proteins mask the low-molecular-weight (LMW) proteins and peptides using conventional protein detection methods. Candidate biomarkers are believed to exist in very low concentrations and comprise less than 1% of serum proteins, and may be highly labile as well. Therefore, it is imperative to isolate and enrich LMW proteins from complex mixtures for biomarker discovery. This chapter describes a continuous -elution electrophoresis method, based on molecular weight sieving, to isolate specific molecular weight fractions for mass spectrometric, western blotting, or protein array analysis.

Protein biomarkers provide the key diagnostic information for the detection of disease, risk of disease progression, and a patient's likely response to drug therapy. Potential biomarkers exist in biofluids, such as serum, urine, and cerebrospinal fluid. Unfortunately, discovering and validating protein biomarkers are hindered by the presence of high-molecular-weight proteins, such as serum albumin and immunoglobulins, which comprise 90% of the proteins present in these samples. High-abundance, high-molecular-weight proteins mask the low-molecular-weight (LMW) proteins and peptides using conventional protein detection methods. Candidate biomarkers are believed to exist in very low concentrations and comprise less than 1% of serum proteins, and may be highly labile as well. Therefore, it is imperative to isolate and enrich LMW proteins from complex mixtures for biomarker discovery. This chapter describes a continuous -elution electrophoresis method, based on molecular weight sieving, to isolate specific molecular weight fractions for mass spectrometric, western blotting, or protein array analysis.

A method of modeling a diode for use in rectenna design is presented. The method uses measured S-parameters to define values of an equivalent circuit model which is comprised of both voltage-dependent and voltage-independent components which are systematically isolated from one another to allow their values to be determined independently. The model is designed to be used in the Agilent ADS simulation software.

A high gain, aperture coupled rectifying antwenna for 5.8 GHz operation is presented which has a measured gain of 9.3 dBi and an RF-to-DC conversion efficiency of 73%. Split ring resonators (SRRs) are utilized to suppress diode harmonics.

A gene encoding a putative peptidoglycan hydrolase, named acmB, which is a paralogue of the major autolysin acmA gene, was identified in the Lactococcus lactis genome sequence. The acmB gene is transcribed in L. lactis MG1363 and its expression is modulated during cellular growth. The encoded AcmB protein has a modular structure with three domains: an N-terminal domain, especially rich in Ser, Thr, Pro and Asn residues, resembling a cell-wall-associated domain; a central domain homologous to the Enterococcus hirae muramidase catalytic domain; and a C-terminal domain of unknown function. A recombinant AcmB derivative, devoid of its N-terminal domain, was expressed in Escherichia coli. It exhibited hydrolysing activity on the peptidoglycan of several Gram-positive bacteria, including L. lactis. Though showing sequence similarity with enterococcal muramidase, AcmB has N-acetylglucosaminidase specificity. The acmB gene was inactivated in order to evaluate the role of the enzyme. AcmB does not appear to be involved in cell separation but contributes to cellular autolysis.

A microstrip dumb-bell-shaped slot resonator (DSSR) is proposed for a miniaturised bandpass filter (BPF) design. An equivalent circuit model of the DSSR is also presented and validated through circuit and EM simulations. The proposed DSSR does not employ ground slots, so the fabrication process is simple. This ultimately results in an easy analysis and design which minimises fabrication errors. Using the DSSR, a miniaturised 7.35 GHz BPF is designed and tested. The filter dimensions are 0.37 g ×0.27× g , where λ g is the guided wavelength at the centre frequency of 7.35 GHz.

A piezoelectric transducer (PET)-controlled tunable hairpin bandpass filter (BPF) is introduced. A dielectric perturber is attached to a PET cantilever beam and suspended above the hairpin BPF. The PET actuator vertically lifts up or pulls down the attached dielectric perturber using a DC bias voltage. The dielectric perturber changes the effective permittivity, causing a variation in the BPF's effective capacitance. This changes the centre frequency and passband of the BPF. The hairpin BPF is designed at 5.8 GHz with a fractional bandwidth (FBW) of 0.414%. The fabricated BPF shows a measured insertion loss of less than 2.5 dB and a return loss of greater than 12 dB in the frequency tuning range.