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Background: Preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) ranges for several shoulder arthroplasty indications are not well understood. Purpose: We sought to compare preoperative ESR and CRP values for a variety of shoulder arthroplasty indications and evaluate risk factors for elevated preoperative ESR and CRP values. Methods: We conducted a retrospective cohort study of shoulder arthroplasty cases performed at a single academic medical institution from 2013 to 2018. Preoperative ESR and CRP values for 235 shoulder arthroplasties with various indications were recorded. Independent risk factors for elevated values (CRP > 10.0 mg/L and ESR > 30.0 mm/h) were determined via multiple variable logistic regression. Results: Patients undergoing shoulder arthroplasty for osteoarthritis had an ESR (mean ± SD) of 22.6 ± 17.8, with 29.8% of patients elevated, and a CRP of 6.5 ± 6.4, with 25.5% of patients elevated. Arthroplasty for acute fracture and prosthetic joint infection (PJI) had higher preoperative ESR and CRP values. Multivariate analysis identified several predictors of elevated ESR, including infection, acute fracture, diabetes, and female sex. It also identified predictors of elevated CRP, including infection, acute fracture, and younger age. Conclusions: Preoperative ESR and CRP values may be elevated in 25% to 30% of patients undergoing primary shoulder arthroplasty. Arthroplasty for both acute fracture and PJI, along with several other patient factors, was associated with elevated preoperative ESR and CRP. Thus, routine collection of ESR and CRP preoperatively may not be of benefit, as elevated values are common. Further study is warranted.

Shoulder injuries account for a large portion of all recorded injuries in professional baseball. Much is known about other shoulder pathologies in the overhead athlete, but the incidence and impact of acromioclavicular (AC) joint injuries in this population are unknown. We examined the epidemiology of AC joint injuries in Major League Baseball (MLB) and Minor League Baseball (MiLB) players and determined the impact on time missed.The MLB Health and Injury Tracking System was used to compile records of all MLB and MiLB players from 2011 to 2017 with documented AC joint injuries. These injuries were classified as acute (sprain or separation) or chronic (AC joint arthritis or distal clavicular osteolysis), and associated data extracted included laterality, date of injury, player position, activity, mechanism of injury, length of return to play, and need for surgical intervention.A total of 312 AC joint injuries (183 in MiLB players and 129 in MLB players; range, 39-60 per year) were recorded: 201 acute (64.4%) and 111 chronic (35.6%). A total of 81% of acute and 59% of chronic injuries resulted in time missed, with a mean length of return to play of 21 days for both. Of the injuries in outfielders, 79.6% were acute (P.0001), as were 66.3% of injuries in infielders (P = .004). Pitchers and catchers had more equal proportions of acute and chronic AC injuries (P.05 for all). Acute AC injuries occurred most often while fielding (n = 100, 84.7%), running (n = 25, 80.6%), and hitting (n = 19, 61.3%), whereas chronic injuries tended to be more common while pitching (n = 26, 68.4%). Of contact injuries, 82.5% were acute (P.0001), whereas 59.0% of noncontact injuries were chronic (P = .047). MLB players showed consistently higher regular-season rates of both acute and chronic AC injuries than MiLB players (P.0001 for each).Acute AC joint injuries are contact injuries occurring most commonly among infielders and outfielders while fielding that result in 3 weeks missed before return to play, whereas chronic AC joint injuries occur more commonly in pitchers and catchers from noncontact repetitive overhead activity. Knowledge of these data can better guide expectation management in this elite population to better elucidate the prevalence of 2 common injury patterns in the AC joint.

PURPOSE OF REVIEW: Periprosthetic infection is a relatively rare but potentially devastating complication after shoulder arthroplasty. The purpose of this article is to review the incidence, diagnosis, prevention, and management of periprosthetic infections after reverse shoulder arthroplasty, with a focus on literature published within the last 5 years. RECENT FINDINGS: The 2018 International Consensus Meeting on Musculoskeletal Infection provides us with a framework for the diagnosis and management of periprosthetic infections after shoulder arthroplasty. Reverse shoulder arthroplasty has a higher reported rate of infection compared with anatomic total shoulder arthroplasty. Our current diagnostic tests do not appear to be as sensitive when compared with the hip and knee literature. Similar success has been reported with single and two-stage revision protocols, although prospective comparative data are lacking. The significance of unexpected positive cultures during revision arthroplasty remains unclear. SUMMARY: We report current diagnostic and therapeutic options for periprosthetic infection after reverse shoulder arthroplasty. Much of the current literature does not distinguish between anatomic and reverse shoulder arthroplasty. Further high-level studies are warranted to refine these definitions and guide management.

Background: Orthopaedic trauma etiologies are a common cause for amputation. Targeted muscle reinnervation (TMR) is a technique aimed at reducing or preventing pain and improving function. The purpose of this study was to examine postoperative phantom limb pain and residual limb pain following TMR in orthopaedic trauma amputees. In addition, postoperative rates of opioid and neuromodulator medication use were evaluated. Methods: Twenty-five patients (60% male) prospectively enrolled in a single-institution study and underwent TMR at the time of major limb amputation (48% nonmilitary trauma, 32% infection secondary to previous nonmilitary trauma, and 20% other, also secondary to trauma). Phantom limb pain and residual limb pain scores, pain temporality, prosthetic use, and unemployment status were assessed at the time of follow-up. The use of opioid and neuromodulator medications both preoperatively and postoperatively was also examined. Results: At a mean follow-up of 14.1 months, phantom limb pain and residual limb pain scores were low, with 92% of the patients reporting no pain or brief intermittent pain only. Pain scores were higher overall for male patients compared with female patients (p < 0.05) except for 1 subscore, and higher in patients who underwent amputation for infection (odds ratio, 9.75; p = 0.01). Sixteen percent of the patients reported opioid medication use at the time of the latest documented follow-up. Fifty percent of the patients who were taking opioids preoperatively discontinued use postoperatively, while 100% of the patients who were not taking opioids preoperatively discontinued postoperative use. None of the patients who were taking neuromodulator medication preoperatively discontinued use postoperatively (0 of 5). The median time to neuromodulator medication discontinuation was 14.6 months, with female patients taking longer than male patients (23 compared with 7 months; p = 0.02). At the time of the latest follow-up, the rate of reported prosthetic use was 85% for lower-extremity and 40% for upper-extremity amputees, with a rate of unemployment due to disability of 36%. Conclusions: The use of TMR in orthopaedic trauma amputees was associated with low overall pain scores at 2-year follow-up, decreased overall opioid and neuromodulator medication use, and an overall high rate of daily prosthetic use. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Objectives: Shoulder injuries account for a large portion of all recorded injures in professional baseball. Much is known about other shoulder pathologies in the overhead athlete, but the incidence and impact of acromioclavicular (AC) joint injuries in this population is unknown. The purpose of this study was to examine the incidence, rates, and characteristics of AC joint injuries in professional baseball, and determine the impact on time missed. Methods: The Major League Baseball Health and Injury Tracking System (HITS) was used to compile records of all major and minor league player from 2011-2017 with documented AC joint injuries. These injuries were classified as acute (sprain or separation) or chronic (AC joint arthritis or distal clavicular osteolysis), and associated data included laterality, date of injury, player position, activity, mechanism of injury, length of return to play (RTP), and need for surgical intervention. Results: A total of 312 AC joint injuries (183 MiLB, 129 MLB; range 39-60 per year) were recorded (acute n=201, 64.4%; chronic n=111, 35.6%). A total of 81% of acute injuries resulted in time missed with an average RTP of 22.8 days whereas 59% of chronic injuries resulted in days missed with an average RTP of 32.2 days (pConclusion: Acute AC joint injuries are contact injuries occurring most commonly among infielders and outfielders that result in more than 3 weeks missed before return to play whereas chronic AC joint injuries occur more commonly in pitchers and catchers from repetitive overhead activity. Knowledge of these data can better guide expectation management in this elite population to better elucidate the prevalence of two common injury patterns in the acromioclavicular joint.

Background: Recent evidence has specified indications for performing superior labral anterior posterior (SLAP) repair and biceps tenodesis (BT) for the treatment of bicipital-labral lesions in the shoulder. Trends in performance of these procedures are expected to reflect the growing body of research regarding this topic. Purpose: To report practice trends for the surgical treatment of SLAP lesions utilizing the American Board of Orthopaedic Surgery (ABOS) database, particularly in older patients. Study Design: Cohort study; Level of evidence, 3. Methods: The ABOS database was retrospectively queried between 2012 and 2017 by Current Procedural Terminology (CPT) codes for SLAP repair (29807), open BT (23430), and arthroscopic BT (29828). The patient population was excluded if any concomitant open shoulder procedure was performed. Trends over time were evaluated with respect to case volume, patient age, surgeon subspecialty, and whether a concomitant arthroscopic rotator cuff repair (RCR) was performed (CPT 29827). Results: A total of 9908 cases met inclusion/exclusion criteria: 4632 performed with RCR and 5276 performed without. The mean age of patients without RCR was 40.8 ± 13.8 years, while for those receiving RCR it was 55.0 ± 9.9 years ( P < .001). In patients without RCR, there was a significant decline in rate of SLAP repairs performed over this period ( P < .001). A significantly greater proportion of patients receiving open and arthroscopic BT were older than 35 years of age, compared with those receiving SLAP repair ( P < .001). Within the RCR cohort, there was also a significant decline in concomitant SLAP repairs performed ( P < .001) over the study period. With respect to BT, open BT was performed more frequently in the cohort without RCR (74.5%) than in the cohort with RCR (52.1%) ( P < .001). Similarly, arthroscopic BT was performed more commonly in the cohort with RCR (47.9%) than in the cohort without RCR (25.5%) ( P < .001). Conclusion: The ABOS database revealed significantly reduced rates of SLAP repairs performed in recent times. Trends with age remained consistent over time, in that SLAP repairs were predominantly performed in younger patients. Open BT was performed more frequently overall, but with an increased proportion of arthroscopic BT occurring with RCR. Arthroscopic BT was performed much more frequently with RCR than without.

Oxygen consumption is a key metric of metabolism in aerobic organisms. Current respirometric methods led to seminal discoveries despite limitations such as high sample demand, exchange with atmospheric O(2), and cumulative titration protocols leading to limited choice of useable tissue, complex data interpretation, and restricted experimental design. We developed a sensitive and customizable method of measuring O(2) consumption rates by a variety of biological samples in microliter volumes without interference from the aerobic environment. We demonstrate that O(2) permeability of the photopolymer, VeroClear, is comparable to that of polyetheretherketone (0.125 vs. 0.143 barrer, respectively) providing an efficient barrier to oxygen ingress. Optical transparency of VeroClear, combined with high resolution 3D printing, allows for optode-based oxygen detection in enclosed samples. These properties yield a microrespirometer with over 100× dynamic range for O(2) consumption rates. Importantly, the enclosed respirometer configuration and very low oxygen permeability of materials makes it suitable, with resin pre-conditioning, for quantitative assessment of O(2) consumption rates at any desired [O(2)], including hyperbaric, physiological or hypoxic conditions as necessary for each cell type. We characterized two configurations to study soluble enzymes, isolated mitochondria, cells in suspension, and adherent cells cultured on-chip. Improved sensitivity allows for routine quantitative detection of respiration by as few as several hundred cells. Specific activity of cell suspensions in the microrespirometer was in close agreement with that obtained by high-resolution polarographic respirometry. Adherent cell protocols allowed for physiologically relevant assessment of respiration in retinal pigment epithelial cells, ARPE-19, which displayed lower metabolic rates compared with those in suspension. By exchanging medium composition, we demonstrate that cells can be transiently inhibited by cyanide and that 99.6% of basal O(2) uptake is recovered upon its removal. This approach is amenable to new experimental designs and precision measurements on limited sample quantities across basic research and applied fields.

Background: Patients who have undergone shoulder instability surgery are often allowed to return to sports, work, and high-level activity based largely on a time-based criterion of 6 months postoperatively. However, some believe that advancing activity after surgery should be dependent on the return of strength and range of motion (ROM). Hypothesis: There will be a significant loss of strength or ROM at 6 months after arthroscopic Bankart repair with remplissage compared with Bankart repair alone. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 38 patients in a prospective multicenter study underwent arthroscopic Bankart repair with remplissage (33 males, 5 females; mean age, 27.0 ± 10.2 years; 82% with ≥2 dislocation events in the past year). Strength and ROM were assessed preoperatively and at 6 months after surgery. Results were compared with 104 matched patients who had undergone Bankart repair without remplissage, although all had radiographic evidence of a Hill-Sachs defect. Results: At 6 months, there were no patients in the remplissage group with anterior apprehension on physical examination. However, 26% had a ≥20° external rotation (ER) deficit with the elbow at the side, 42% had a ≥20° ER deficit with the elbow at 90° of abduction, and 5% had persistent weakness. Compared with matched patients who underwent only arthroscopic Bankart repair, the remplissage group had greater humeral bone loss and had a greater likelihood of a ≥20° ER deficit with the elbow at 90° of abduction ( P = .004). Risk factors for a ≥20° ER deficit with the elbow at 90° of abduction were preoperative stiffness in the same plane ( P = .02), while risk factors for a ≥20° ER deficit with the elbow at the side were increased number of inferior quadrant glenoid anchors ( P = .003), increased patient age ( P = .02), and preoperative side-to-side deficits in ER ( P = .04). The only risk factor for postoperative ER weakness was preoperative ER weakness ( P = .04), with no association with remplissage ( P = .26). Conclusion: Arthroscopic Bankart repair with remplissage did not result in significant strength deficits but increased the risk of ER stiffness in abduction compared with Bankart repair without remplissage at short-term follow-up.

Wang Shi, a business mogul who created his empire of wealth from scratch, relished in his fame and basked in the glory of his affluent business. Nothing lasts forever! After mastering the turbulent business of real estate development in his country and therefore enjoying a rising and robust stock price, China Vanke Co. Ltd ("Vanke") founder and Chairman of the Board of Directors, Wang Shi was suddenly presented with a scathing notice from the Hong Kong Stock Exchange: rival Baoneng Group ("Baoneng") filed the regulatory documentation indicating that it had nicodemously acquired 5% of his company and was looking to buy more. Vanke case became brutal and sparked national controversy over corporate governance and the role of Chinese government in capital markets., Latex version 3.9, double pages, 10 pages, 5 figures

Objectives: Optimal surgical indications for massive, irreparable rotator cuff tears (RCT) without arthritis remain unclear. The purpose of this study was to compare the clinical outcomes of superior capsular reconstruction (SCR), partial rotator cuff repair (PR), and reverse total shoulder arthroplasty (rTSA) at greater than 2 years follow-up and identify any characteristics or risk factors which may correlate with outcomes. Methods: A retrospective analysis of prospectively collected data from a single tertiary academic medical center of consecutive patients undergoing surgical treatment for massive irreparable RCT without arthritis using SCR, PR (using interval slide and/or margin convergence), or rTSA from 01/01/2006 to 01/01/2018 was performed. Patients were required to be at least 18 years of age, have intraoperative confirmation of a massive, irreparable, RCT without arthritis, failed attempts at prior non-operative management, and a minimum of two years of clinical post-operative data. Patient demographics and pre-operative clinical findings (strength and range of motion (ROM), external rotation (ER) lag, pseudoparalysis, subscapularis function) were collected. Post-operative data included complications, patient satisfaction, strength and ROM, and patient reported outcomes (ASES, VAS, SANE). Multivariate analysis was also performed to identify risk factors. Results: 32 patients met inclusion criteria for SCR, 24 for PR, and 42 for rTSA (mean follow-up years: SCR 3.2; PR 4.0; rTSA 3.5; p=0.02). The rTSA patients were older (66.2 years; SCR - 57.3; PR - 59.0; p=0.0001) and more likely to be female (61.9%; SCR - 12.5%; PR - 25.0%; p0.18 for all). Comparing pre-operative to post-operative outcomes within respective groups (Table 3), all groups saw significant post-operative improvement in strength in all planes and all patient reported outcomes (p0.12 for all). When comparing between the three groups (Table 4), rTSA had significantly worse post-operative ROM in all planes when compared to SCR and PR (p0.16 for all) or patient reported outcomes (ASES p=0.14; VAS p=0.86; SANE p=0.61). Patients were satisfied or somewhat satisfied in 81.2% of SCR cases, 87.5% of PR, and 95.3% of rTSA (p=0.33). Regarding surgical complications, 3 of 32 (9.4%) SCR patients required conversion to rTSA, while 3 of 24 (12.5%) PR patients required reoperation (2 revision repairs, one conversion to rTSA). There were 4 surgical complications among 42 rTSA patients (9.5%) (2 acromial stress fractures - 1 operative, 1 non-operative; 1 dislocation requiring open reduction). There were 4 non-surgical complications in the SCR group (2 falls resulting in 1 distal radius fracture and 1 HAGL lesion; 1 persistent pain; 1 persistent stiffness) and 1 stroke in the rTSA group. One SCR patient and 3 rTSA patients were deceased within the follow-up time period. Multivariate analysis demonstrated no independent predictors of revision surgery, and the only independent predictors of patient satisfaction to be improved pre-op active ER ROM (0.03) and strength (p=0.048). However, older age (0.03), improved pre-op internal rotation (IR) strength (0.03), and having SCR (p=0.048) or PR (p=0.045) rather than rTSA were independent predictors of an improved post-op ASES score. Male gender was found to be an independent predictor of improved post-operative forward elevation ROM (p=0.03) (Table 7), while undergoing rTSA was an independent predictor of worse post-operative IR and ER ROM (p0.05 for all). Conclusions: SCR, PR, and rTSA for massive, irreparable RCT without arthritis all significantly improved post-op strength and outcome scores with >80% patient satisfaction, but with rTSA having worse post-op ROM. For all patients, increased pre-op ER ROM and strength correlated with improved patient satisfaction, while increased AH distance correlated with improved post-op strength. No further risk factors were identified, and further study is needed to continue to delineate indications for each operation.

Purpose The purpose of this paper is to examine the relationship between CEO leadership behavior and the culture of the organization within the context of Indian organizations. Design/methodology/approach Two five-scale questionnaires were completed by senior executives (n=485) who have interaction with their CEO. The first instrument captured the executives’ perspective of their CEO’s leadership behavior along six dimensions (People Centric, Global Ambitions, Opportunity Sensing, Visionary, Exemplary, and Dependable). The second instrument captured the executives’ perspective of their organization’s culture along six dimensions (Results Focused, Talent Development, Employee Empowerment, Equity and Fairness, Open Communication, and Decentralization). These data were analyzed using factor analysis, correlation analysis, and least-squares regression. Findings A correlation analysis indicates that a significant relationship exists between several aspects of CEO leadership behavior and characteristics of the organizational culture. Regression analysis indicated that the overall CEO leadership behavior prominently explains (R2=0.397) the organization’s culture. Notably, two CEO dimensions, People Centricity and Global Ambition, were found to have an exceptionally high degree of association with the culture of the organization. Research limitations/implications There is consistency between findings from western academic leader-culture research and the same in the Indian work setting. Practical implications Findings of this study can serve as a guidepost for the selection of leaders in an organization. Originality/value There is a scarcity of leader-organization research involving national culture features; the Indian context is fundamental to this study and is called for by the growing presence of India-born leadership in western organizations.

Objectives: The Latarjet procedure is the becoming increasingly popular for the treatment of young athletes with recurrent instability. Earlier return to play protocols have been trialed with the thought that one is primarily waiting on bone healing. However, the impact of post-operative range of motion (ROM) and strength must be considered as well. Return to play has traditionally been accepted at 6 months post-operatively, but it is unknown what percentage of athletes achieve full strength and range of motion at that point. The purpose of this study was to 1) To evaluate rates of return of full strength and range of motion at 6 months after Latarjet, and 2) determine whether rates of results vary by percent bone loss, subscapularis split versus tenotomy, or athlete status (contact or overhead). Methods: Ten participating sites throughout the United States enrolled patients in a multicenter prospective cohort study. Sixty-five athletes met inclusion criteria (mean age 24.5 SD 8.2; 59 male, 6 female) and underwent Latarjet procedure for anterior instability (19/65 (29%) primary operation, 46/65 (71%) had a prior failed anterior stabilization). All participated in either contact sports (83%) and/or overhead sports (37%). Regarding anterior glenoid bone loss, 10% had Results: 45% of patients failed to meet one or more return to play criteria: 9% failed for persistent weakness and 39% for ≥ 20 degree side to side loss of motion. All patients with loss of motion had ≥ 20 degree external rotation (ER) deficits either with elbow at side (88%) or at 90 degrees abduction (44%). There was no difference in achieving RTP criteria at 6 months between subscapularis split versus tenotomy either for strength (p=0.89) or range of motion (p=0.53). Contact athletes had a 53% RTP rate while overhead athletes had a 67% passage rate (p=0.17). Pre-operative weakness was not significantly predictive of post-operative weakness (p=0.13), and pre-operative external rotation was not predictive of post-operative ER deficits (p=0.16). Percent bone loss was not predictive of side-to side post-operative ROM deficits or weakness (p>0.20 all planes of motion). No other predictors for failure to meet RTP criteria at 6 months were identified. Conclusion: A large percentage of athletes do not have full return of strength and range of motion at 6 months following Latarjet procedure. Further consideration may be warranted prior to releasing these athletes to contact sports.

Background: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy of the upper extremity. We sought to assess the subjective improvement in preoperative symptoms related to CTS, particularly those affecting sleep, and describe opioid consumption postoperatively. Methods: All patients undergoing primary carpal tunnel release (CTR) for electromyographically proven CTS were studied prospectively. All procedures were performed by hand surgery fellowship–trained adult orthopedic and plastic surgeons in the outpatient setting. Patients underwent either endoscopic or open CTR from June 2017 to December 2017. Outcomes assessed were pre- and postoperative Quick Disabilities of Arm, Shoulder and Hand (QuickDASH), visual analog scale (VAS), and Pittsburgh Sleep Quality Index (PSQI) scores as well as postoperative pain control. Results: Sixty-one patients were enrolled. At 2 weeks, all showed significant ( P < .05) improvement in QuickDASH scores. At 6 weeks, 40 patients were available for follow-up. When compared with preoperative scores, QuickDASH (51 vs 24.5; P < .05), VAS (6.7 vs 2.9; P < .05), and PSQI (10.4 vs 6.4; P < .05) scores continued to improve when compared with preoperative scores. At 2-week follow-up, 39 patients responded to the question, “How soon after your carpal tunnel surgery did you notice an improvement in your sleep?” Seventeen patients (43.6%) reported they had improvement in sleep within 24 hours, 12 patients (30.8%) reported improvement between 2 and 3 days postoperatively, 8 patients (20.5%) reported improvement between 4 and 5 days postoperatively, and 2 patients (5.1%) reported improvement between 6 and 7 days postoperatively. Conclusions: The present study demonstrates rapid and sustained improvement in sleep quality and function following CTR.

The effectiveness of carbohydrase enzymes has been inconsistent in corn-based swine diets; however, the increased substrate of nonstarch polysaccharides in drought-affected corn may provide an economic model for enzyme inclusion, but this has not been evaluated. A total of 360 barrows (PIC 1050 × 337, initially 5.85 kg BW) were used to determine the effects of drought-affected corn inclusion with or without supplementation of commercial carbohydrases on growth performance and nutrient digestibility of nursery pigs. Initially, 34 corn samples were collected to find representatives of normal and drought-affected corn. The lot selected to represent the normal corn had a test weight of 719.4 kg/m3, 15.0% moisture, and 4.2% xylan. The lot selected to represent drought-affected corn had a test weight of 698.8 kg/m3, 14.3% moisture, and 4.7% xylan. After a 10-d acclimation period postweaning, nursery pigs were randomly allotted to 1 of 8 dietary treatments in a completely randomized design. Treatments were arranged in a 2 × 4 factorial with main effects of corn (normal vs. drought affected) and enzyme inclusion (none vs. 100 mg/kg Enzyme A vs. 250 mg/kg Enzyme B vs. 100 mg/kg Enzyme A + 250 mg/kg Enzyme B). Both enzymes were included blends of β-glucanase, cellulose, and xylanase (Enzyme A) or hemicellulase and pectinases (Enzyme B). Pigs were fed treatment diets from d 10 to 35 postweaning in 2 phases. Feed and fecal samples were collected on d 30 postweaning to determine apparent total tract digestibility of nutrients. The nutrient concentrations of normal and drought-affected corn were similar, which resulted in few treatment or main effects differences of corn type or enzyme inclusion. No interactions were observed (P > 0.10) between corn source and enzyme inclusion. Overall (d 10 to 35), treatments had no effect on ADG or ADFI, but enzyme A inclusion tended to improve (P < 0.10; 0.74 vs. 0.69) G:F, which was primarily driven by the improved feed efficiency (0.76 vs. 0.72; P < 0.05) of pigs fed Enzyme A in Phase 2 (d 10 to 25 postweaning) and was likely a result of improved xylan utilization. In conclusion, drought stress did not alter the nonstarch polysaccharide concentration of corn beyond xylan concentration, so it was not surprising that enzyme inclusion showed little benefit to nursery pig growth performance. However, improved feed efficiency of pigs fed diets containing Enzyme A from d 10 to 25 postweaning warrants further investigation

From birth to adulthood, the gut microbiota matures from a simple community dominated by a few major bacterial groups into a highly diverse ecosystem that provides both benefits and challenges to the host. Currently there is great interest in identifying environmental and host factors that shape the development of our gut microbiota. Breast milk is a rich source of maternal antibodies, which provide the first source of adaptive immunity in the newborn's intestinal tract. In this addendum, we summarize our recent data demonstrating that maternal antibodies in breast milk promote long-term intestinal homeostasis in suckling mice by regulating the gut microbiota and host gene expression. We also discuss important unanswered questions, future directions for research in this field, and implications for human health and disease.

Antibodies of the secretory IgA (SIgA) class comprise the first line of antigen-specific immune defense, preventing access of commensal and pathogenic microorganisms and their secreted products into the body proper. In addition to preventing infection, SIgA shapes the composition of the gut microbiome. SIgA is transported across intestinal epithelial cells into gut secretions by the polymeric immunoglobulin receptor (pIgR). The epithelial surface is protected by a thick network of mucus, which is composed of a dense, sterile inner layer and a loose outer layer that is colonized by commensal bacteria. Immunofluorescence microscopy of mouse and human colon tissues demonstrated that the SIgA co-localizes with gut bacteria in the outer mucus layer. Using mice genetically deficient for pIgR and/or mucin-2 (Muc2, the major glycoprotein of intestinal mucus), we found that Muc2 but not SIgA was necessary for excluding gut bacteria from the inner mucus layer in the colon. Our findings support a model whereby SIgA is anchored in the outer layer of colonic mucus through combined interactions with mucin proteins and gut bacteria, thus providing immune protection against pathogens while maintaining a mutually beneficial relationship with commensals.

Maintenance of intestinal homeostasis requires a healthy relationship between the commensal gut microbiota and the host immune system. Breast milk supplies the first source of antigen-specific immune protection in the gastrointestinal tract of suckling mammals, in the form of secretory IgA (SIgA). SIgA is transported across glandular and mucosal epithelial cells into external secretions by the polymeric Ig receptor (pIgR). Here, a breeding scheme with polymeric Ig receptor-sufficient and -deficient mice was used to study the effects of breast milk-derived SIgA on development of the gut microbiota and host intestinal immunity. Early exposure to maternal SIgA prevented the translocation of aerobic bacteria from the neonatal gut into draining lymph nodes, including the opportunistic pathogen Ochrobactrum anthropi. By the age of weaning, mice that received maternal SIgA in breast milk had a significantly different gut microbiota from mice that did not receive SIgA, and these differences were magnified when the mice reached adulthood. Early exposure to SIgA in breast milk resulted in a pattern of intestinal epithelial cell gene expression in adult mice that differed from that of mice that were not exposed to passive SIgA, including genes associated with intestinal inflammatory diseases in humans. Maternal SIgA was also found to ameliorate colonic damage caused by the epithelial-disrupting agent dextran sulfate sodium. These findings reveal unique mechanisms through which SIgA in breast milk may promote lifelong intestinal homeostasis, and provide additional evidence for the benefits of breastfeeding.

Background: The pathogenesis of inflammatory bowel disease (IBD) is complex and the need to identify molecular biomarkers is critical. Epithelial cells play a central role in maintaining intestinal homeostasis. We previously identified five ‘‘signature’’ biomarkers in colonic epithelial cells (CEC) that are predictive of disease phenotype in Crohn’s disease. Here we investigate the ability of CEC biomarkers to define the mechanism and severity of intestinal inflammation. Methods: We analyzed the expression of RelA, A20, pIgR, tumor necrosis factor (TNF), and macrophage inflammatory protein (MIP)-2 in CEC of mice with dextran sodium sulfate (DSS) acute colitis or T-cell-mediated chronic colitis. Factor analysis was used to combine the five biomarkers into two multifactorial principal components (PCs). PC scores for individual mice were correlated with disease severity. Results: For both colitis models, PC1 was strongly weighted toward RelA, A20, and pIgR, and PC2 was strongly weighted toward TNF and MIP-2, while the contributions of other biomarkers varied depending on the etiology of inflammation. Disease severity was correlated with elevated PC2 scores in DSS colitis and reduced PC1 scores in T-cell transfer colitis. Downregulation of pIgR was a common feature observed in both colitis models and was associated with altered cellular localization of pIgR and failure to transport IgA. Conclusions: A multifactorial analysis of epithelial gene expression may be more informative than examining single gene responses in IBD. These results provide insight into the homeostatic and proinflammatory functions of CEC in IBD pathogenesis and suggest that biomarker analysis could be useful for evaluating therapeutic options for IBD patients.

This case illustrates how Mainland China based Tencent Holdings Ltd., through focusing on its core competencies, has rapidly evolved into a technology powerhouse in the global Instant Messaging market. In just over a decade, the company has influenced and changed the communication methods and life-style of hundreds of millions of Chinese in China and around the world. Staying true to its core competencies, such as intense attention to innovation, efficiency, and customer responsiveness, the company successfully expanded its marketplace footprint from a locally-sighted, straight-forward telecommunications service provider into a complex, internet value-added service provider with a global reach. This case includes an introduction to the instant messaging industry, followed by a profile of the company. Also, an extensive analysis of Tencents core competencies is presented, along with a summary of the companys path towards internationalization.

The polymeric immunoglobulin receptor (pIgR) transports IgA antibodies across intestinal epithelial cells (IECs). Expression of pIgR is upregulated by proinflammatory signaling pathways via activation of nuclear factor-κB (NF-κB). Here, we examined the contributions of the RelA-dependent classical and RelB-dependent alternative pathways of NF-κB to pIgR regulation in the HT-29 human IEC line following stimulation with tumor necrosis factor (TNF), lipopolysaccharide (LPS; Toll-like receptor 4 (TLR4) ligand), and polyinosinic: polycytidylic acid (pIC; TLR3 ligand). Whereas induction of proinflammatory genes such as interleukin-8 (IL-8) required only RelA, pIgR expression was regulated by complex mechanisms that involved both RelA and RelB. Upregulation of pIgR expression by ligation of the lymphotoxin-β receptor suggested a direct role for the alternative NF-κB pathway. Inhibition of mitogen-activated protein kinases reduced the induction of IL-8, but enhanced the induction of pIgR by TNF and TLR signaling. Regulation of pIgR through unique signaling pathways could allow IECs to sustain high levels of IgA transport while limiting the proinflammatory responses.

Rit knockout mice and D-Ric null Drosophila were used to identify the Rit/RIC subfamily of Ras-related GTPases as regulators of an evolutionarily conserved, p38-dependent signaling cascade that functions as a survival mechanism for cells in response to reactive oxygen species exposure., Ras-related small GTP-binding proteins control a wide range of cellular processes by regulating a variety of effector pathways, including prominent roles in the control of mitogen-activated protein kinase (MAPK) cascades. Although the regulatory role(s) for many Ras family GTPases are well established, the physiological function for the Rit/Rin subfamily has been lacking. Here, using both knockout mice and Drosophila models, we demonstrate an evolutionarily conserved role for Rit subfamily GTPases (mammalian Rit and Rin, and the Drosophila RIC homologue) in governing survival in response to oxidative stress. Primary embryonic fibroblasts derived from Rit knockout mice display increased apoptosis and selective disruption of MAPK signaling following reactive oxygen species (ROS) exposure but not in response to endoplasmic reticulum stress or DNA damage. These deficits include a reduction in ROS-mediated stimulation of a p38-MK2-HSP27 signaling cascade that controls Akt activation, directing Bad phosphorylation to promote cell survival. Furthermore, D-RIC null flies display increased susceptibility to environmental stresses and reduced stress-dependent p38 signaling, extending the Rit-p38 survival pathway to Drosophila. Together, our studies establish the Rit GTPases as critical regulators of an evolutionarily conserved, p38 MAPK–dependent signaling cascade that functions as an important survival mechanism for cells in response to oxidative stress.

This project analyzes the intersection between two highly specialized fields, sustainable building practices and the environmental controls crucial to art conservation maintained in art museum buildings. Art museums often cite these highly specialized light and atmospheric controls as an impediment to sustainable building. My goal is to bring these fields more closely together so that art museums can build sustainable facilities that cause less harm to the environment while simultaneously meeting art conservation needs.

Multiply injured patients (MIPs) in hemorrhagic shock develop oxygen debt which causes organ dysfunction and can lead to death. We developed a noninvasive patient-specific index, Shock Volume (SV), to quantify the magnitude of hypoperfusion. SV integrates the magnitude and duration that incremental shock index values are elevated above known thresholds of hypoperfusion using serial individual vital sign data. SV can be monitored in real time to assess ongoing hypoperfusion. The goal of this study was to determine how SV corresponded to transfusion requirements and organ dysfunction in a retrospective cohort of 74 MIPs. We measured SV in 6-h increments for 48 h after injury in multiply injured adults (18-65; Injury Severity Score ≥18). Patients who had accumulated 40 units of SV within 6 h of injury and 100 units of SV within 12 h of injury were at high risk for requiring massive transfusion or multiple critical administration transfusions. SV measurements were equally sensitive and specific as compared with base deficit values in predicting transfusions. SV measurements at 6 h after injury stratified patients at risk for multiple organ failure determined by Denver scores. In addition, SV values corresponded to the magnitude of organ failure determined by Sequential Organ Failure Assessment scores. SV is a patient-specific index that can be quantified in real time in critically injured patients. It is a surrogate for cumulative hypoperfusion and it predicts high-volume transfusions and organ dysfunction.

The Enron email corpus is appealing to researchers because it represents a rich temporal record of internal communication within a large, real-world organization facing a severe and survival-threatening crisis. We describe how we enhanced the original corpus database and present findings from our investigation undertaken with a social network analytic perspective. We explore the dynamics of the structure and properties of the organizational communication network, as well as the characteristics and patterns of communicative behavior of the employees from different organizational levels. We found that during the crisis period, communication among employees became more diverse with respect to established contacts and formal roles. Also during the crisis period, previously disconnected employees began to engage in mutual communication, so that interpersonal communication was intensified and spread through the network, bypassing formal chains of communication. The findings of this study provide valuable insight into a real-world organizational crisis, which may be further used for validating or developing theories and dynamic models of organizational crises; thereby leading to a better understanding of the underlying causes of, and response to, organization failure.

Numerous organizational mergers fail because the post-merger integration process fails: this research responds by investigating the concealed relationship of the known, premerger organizational characteristics, on the unknown, post-merger consequences. Various structural and behavioral characteristics of the merging organizations are studied to measure their association with two decisive outcomes: the integration of the distinctive cultures and the combined organization s performance. Considered are varied antecedent organizational characteristics, which are believed to have an unknown effect on the organizational communication and learning process, and therefore have impact also to some unknown degree on post-merger outcomes. This study employs computational organization theory (COT) techniques, such as agent-based modeling and computer simulation, to experimentally manipulate these organizational characteristics in a series of controlled experiments all conducted within a virtual laboratory.

We apply treemap technology in the analysis of large, social network datasets principally for examining network subgroups. A treemap is graphically-based information and exploration tool which is used in diverse fields such as computer science, finance, and human-gene research; from our experience, we find treemaps also useful in the social network analysis setting. A treemap represents hierarchical and categorical data in a mosaic form containing embedded, rectangular shapes, where the size of each shape is germane. Treemap displays are especially helpful when examining data in an interactive mode (as opposed to a static or printed form). We have found that treemaps are a powerful tool for exploring large social-networks, particularly during the exploratory data analysis phase. Their use quickly leads to a thorough perspective of the holistic characteristics of the network and to easier identification of significant subgroups; both of these perspectives may otherwise remain hidden using traditional visualization techniques. In this report, we introduce treemap technology, first broadly, then, specifically how it can be applied to social network analysis. We also show how we have actually applied treemaps to an interactive study of a large, real-world dataset. As a result of our experiences, we encourage other social network analysts to consider applying treemaps in their work.

The authors present precise and explicit definitions and descriptions of pertinent terms and constructs related to a specific type of network topology -- the cellular network. First, they clarify the construct of a cell and establish the concept of a cell-core and cell-periphery. Next, they present details of the broader, cellular network. Then they introduce the notion of a k-cell subgraph construct. Throughout the report, the authors introduce several supplementary terms related to these concepts. The terminology and formalization they present can be effectively utilized when conversing about real-world social networks, but may be essential as guidelines when constructing cellular social-networks for virtual experiments. Increasingly, the network form referred to as "cellular" is appearing in empirical social network studies and is being applied in virtual experiments of social networks. The presence of a cellular network is particularly prominent in research pertaining to covert and terrorist organizations, although the form can be found in other less saturnine groups. While the structure of a cellular network is often rather intuitive, to avoid confusion, researchers, analysts, and, especially, experimenters have a need for formal definitions and a precise description of the topology. In this paper, the authors provide a formalism of cellular networks that is primarily intended for use in generating networks in virtual experiments. They also have introduced terminology that is pertinent to communicating about cellular networks. The terminology includes cell subgroup, cell-core subgroup, cell-periphery subgroup, and cellular network. Finally, they introduce the k-cell subgraph, which provides for high-level examination of a complex cellular network.

"This paper reports on a simulation study of social networks that investigated how network topology relates to the robustness of measures of system-level node centrality. This association is important to understand as data collected for social network analysis is often somewhat erroneous and may -- to an unknown degree -- misrepresent the actual true network. Consequently the values for measures of centrality calculated from the collected network data may also vary somewhat from those of the true network, possibly leading to incorrect suppositions. To explore the robustness, i.e., sensitivity, of network centrality measures in this circumstance, we conduct Monte Carlo experiments whereby we generate an initial network, perturb its copy with a specific type of error, then compare the centrality measures from two instances. We consider the initial network to represent a true network, while the perturbed represents the observed network. We apply a six-factor full-factorial block design for the overall methodology. We vary several control variables (network topology, size and density, as well as error type, form and level) to generate 10,000 samples each from both the set of all possible networks and possible errors within the parameter space. Results show that the topology of the true network can dramatically affect the robustness profile of the centrality measures. We found that across all permutations that cellular networks had a nearly identical profile to that of uniform-random networks, while the core-periphery networks had a considerably different profile. The centrality measures for the core-periphery networks are highly sensitive to small levels of error, relative to uniform and cellular topologies. Except in the case of adding edges, as the error increases, the robustness level for the 3 topologies deteriorate and ultimately converges."

This technical report describes the data collection and analysis methodologies used in a social network study of computer science faculty that was recently conducted at a top U.S. university. The study involved the construction of a social meta-network that combines multiple dimensions of the faculty's knowledge, task assignments, and collaborative networks. The process of collecting the source data, then messaging the data for analysis was completely automated through the use of custom computer software. This allowed for an entirely unobtrusive data collection process and simplified and repeatable analytic tasks. In this report, the authors introduce the metamatrix framework and discuss its utility as a tool for complex network analysis, describe the data collection methodology, explain the metamatrix construction process, and, finally, present some closing remarks. The report does not discuss the specific findings of the underlying research, which are regarded as confidential.

Objective: To describe the perceptions of diverse professionals involved in computerized physician order entry (POE) at sites where POE has been successfully implemented and to identify differences between teaching and nonteaching hospitals. Design: A multidisciplinary team used observation, focus groups, and interviews with clinical, administrative, and information technology staff to gather data at three sites. Field notes and transcripts were coded using an inductive approach to identify patterns and themes in the data. Measurements: Patterns and themes concerning perceptions of POE were identified. Results: Four high-level themes were identified: (1) organizational issues such as collaboration, pride, culture, power, politics, and control; (2) clinical and professional issues involving adaptation to local practices, preferences, and policies; (3) technical/implementation issues, including usability, time, training and support; and (4) issues related to the organization of information and knowledge, such as system rigidity and integration. Relevant differences between teaching and nonteaching hospitals include extent of collaboration, staff longevity, and organizational missions. Conclusion: An organizational culture characterized by collaboration and trust and an ongoing process that includes active clinician engagement in adaptation of the technology were important elements in successful implementation of physician order entry at the institutions that we studied.

A method of welding two thermoplastic workpieces (W) together along a predetermined weld line during a weld cycle utilizing a high frequency vibration sonic or ultrasonic welding apparatus. This welding apparatus includes an electroacoustic transducer (18) which transmits such vibrations to a horn (19) which is dimensioned to be resonant with the horn being brought into forced engagement with at least one of the workpieces to be welded. The method comprising the steps of bringing the workpieces into bearing relation against one another along the weld line. Then the electroacoustic transducer is energized so as to resonate the horn with a desired motional amplitude. Forceful contact is established between the horn and one of the workpieces. Then, the forceful contact between the horn and the one workpiece is maintained throughout the weld cycle. The motional amplitude of the horn is varied in accordance with a desired motional amplitude profile.

An experimental and theoretical study is presented which characterizes the flow of xerographic developer powders out of small hoppers. A small hopper in this reference is defined as one having a maximum height of 12 in. Two walls of the hopper converge at the gate and the remaining two walls are parallel to each other. The flow is studied as a function of the gate opening, hopper angle, particle size, the total height of the particulate material in the hopper, and the angle of repose. Experimental results are presented for particle diameters between 100 ? and 600 ?. A theory is presented to predict flow rates. The predicted functional dependence agrees very well with the observations. The predicted flow rates are about 3.75 times higher than the observed ones. It is suggested that this is due to a resistive force originating in particle interactions. Inclusion of this correction factor in the theory results in very good agreement between theoretical predictions and experimental observations.

THE first report of specific, high affinity and low capacity binding of radioiodinated ovine prolactin to homogenate particles from lactating mouse mammary glands, liver and several other organs of rats and mice1 was followed by a radioreceptor assay for prolactin using purified mammary fractions2. Other reports of prolactin binding have been with reference to a variety of crude or partially purified membrane fractions3–7 or tissue slices8–10. These can be assumed to describe various degrees of submaximal binding response because of proteolysis, denaturation or structural factors that restrict free access of the hormone to capable binding sites. We now report specific, high affinity, low capacity binding of radioiodinated prolactin to cultured rat anterior pituitary cells, from two sources—those derived from oestradiol-induced anterior pituitary tumours, and normal anterior pituitary glands. Both cells lines were shown by radioimmunoassay to secrete prolactin. In addition to the possible significance of these findings with respect to pituitary control mechanisms they indicate the recommendation of the development of radioreceptor assays based on cultured cell lines as a source for specific binding sites. The technology seems to be available to develop a standardised assay of great convenience and versatility, which models better the conditions for hormone action in vivo; the regulatory hormone ‘sees’ only the outside of an intact cell in a favourable environment for specific interaction.