This study aimed to evaluate Plectin-1 expression as a biomarker of malignant risk for intraductal papillary mucinous neoplasms (IPMNs). Plectin-1 immunohistochemistry (IHC) was performed retrospectively on surgical (n = 71) and cytological (n = 33) specimens from Mayo Clinic Jacksonville and UCLA Medical Center, including IPMNs with low-grade dysplasia, high-grade dysplasia (HGD), or an associated invasive adenocarcinoma. Plectin-1 expression was increased in invasive adenocarcinoma compared with adjacent in situ IPMN (P = 0.005), as well as the in situ HGD component of IPMNs with invasive cancer compared with HGD of IPMNs without invasive cancer (P = 0.02). Plectin IHC discriminated IPMNs with invasive adenocarcinoma from noninvasive IPMN (area under the curve [AUC] of 0.79, 75% sensitivity, and 85% specificity) but was insufficient for discriminating HGD IPMN from low-grade dysplasia IPMNs in surgical resections (AUC of 0.67, 56% sensitivity, and 64% specificity) or fine-needle aspiration specimens (AUC of 0.45). Although Plectin-1 IHC has insufficient accuracy to be used as a definitive biomarker for malignant risk in the evaluation of IPMN biopsy or cytological specimens, increased Plectin-1 expression observed in both invasive cancer and in situ HGD of malignant IPMNs suggests that it might be successfully leveraged as a cyst fluid biomarker or molecular imaging target.

Courses in strategy are an outgrowth of the business policy course first taught at Harvard Business School in 1912. This article examines how the teaching of a course concerned with the development and implementation of the goals and policies of a firm changed during three periods in the postwar period: first, with the introduction of the concept of corporate strategy; second, with the evolution of faculty interest in a concept of competitive strategy more closely grounded in industrial organization economics; and third, with the development of a new course in entrepreneurial management more closely linked to business policy's concerns with the general management challenges facing the leaders of modern firms. This history of the course is linked to changes in information technology, financial markets, and the managements of firms as well as related changes in the markets for students and faculty.

Monaural hearing imposes constraints under many listening conditions. The authors compared the effects of a semi-implantable bone conductor, the Entific bone anchored hearing aid, with conventional contralateral routing of offside signal amplification to assess rehabilitative benefit in adults with unilateral deafness. Prospective trials of subjects with unilateral deafness using benefit surveys, source identification testing, and hearing in noise testing. Tertiary referral center, outpatient surgical and audiologic services. Adults with unilateral deafness (pure tone average >90 dB, SD <20%) after acoustic neuroma excision (n = 7), meningitis (n = 1), sudden sensorineural hearing loss (n = 1), and sudden sensorineural hearing loss with chronic suppurative otitis media (n = 1). Entry criteria included normal hearing in the contralateral ear (pure tone average <25 dB, SD >80%). Subjects were fitted with contralateral routing of offside signal amplification devices for 1 month and tested with contralateral routing of offside signal before mastoid implantation of the deaf ear, fitting, and testing for bone anchored hearing aid. Subjects' assessment of experience with their devices and patterns of use, 2) source azimuth identification in noise test, and 3) speech discrimination in quiet and in noise under conditions of noise-front, noise-to-normal-ear, and noise-to-deaf-ear. There was consistent satisfaction with bone anchored hearing aid implantation and amplification, and poor acceptance of contralateral routing of offside signal amplification. Sound localization was poor at baseline and with both bone anchored hearing aid and contralateral routing of offside signal. Relative to baseline, contralateral routing of offside signal and bone anchored hearing aid produced significantly better speech recognition in noise under most conditions. The bone anchored hearing aid enabled significantly better speech recognition than contralateral routing of offside signal in quiet and in a composite of noise conditions. The advantages may relate to averting the interference of speech signals delivered to the better ear, as occurs with conventional contralateral routing of offside signal amplification. Preliminary data in subjects with normal monaural hearing indicate that vibromechanical stimulation with the bone anchored hearing aid overcomes some of the negative head shadow effects in unilateral deafness. The bone anchored hearing aid system, when placed on the side of a deaf ear, yields greater benefit in subjects with normal monaural hearing than does contralateral routing of offside signal amplification. It seems that this rehabilitative approach can expand the sound field of monaural listeners in further enhancing speech understanding. Observations suggest that further understanding of bone conduction as implemented in transcranial stimulation will guide further options for patients with monaural hearing. Longer follow-up will help to determine whether communicative skill improvements with the bone anchored hearing aid outweigh the disadvantages of implantation surgery, costs, and device maintenance.

Research suggests that while customer satisfaction and loyalty provide a foundation for high levels of customer lifetime value, they support a range of customer behaviors with widely varying values, characterized by mere loyalty (repeat purchase), commitment (willingness to refer others to a product or service), apostle‐like behavior (willingness to convince others to use a product or service), and ownership (willingness to recommend product or service improvements). As a result of these findings, it is of increasing importance that the small number of apostles and owners in a customer portfolio that can drive all of the profits should be identified and cultivated.

This paper examines the interaction and impact on performance of two organizational mechanisms supporting generation and retention of knowledge: experience accumulation and experimentation. It provides evidence that generation of knowledge through experimentation and retention of knowledge through experience were significantly correlated with performance, whereas other measures of R&D commitment and organization, including several suggested by prior studies, were not. It argues that experience and experimentation can function as at least partial substitutes for one another, possessing more of one, firms may need less of the other, and provides evidence that they were so in the semiconductor industry. The evolution of practice at one firm—Intel Corporation—is explored at greater length, providing a qualitative perspective on the process by which a shift towards greater experimentation occurred.

Implantation of an intraocular lens following vitreous loss at cataract surgery is a controversial decision. To address this issue, we retrospectively identified all cases performed at the University of Minnesota in the last three years that had either a posterior or an anterior chamber lens placed following anterior vitrectomy. Twenty patients had a posterior chamber lens implant; 14 had follow-up longer than six months. All these patients achieved 20/40 or better visual acuity, although one patient had a retinal detachment. Of the six patients with an anterior chamber lens implant, four achieved 20/40 or better acuity and two achieved 20/50 acuity with follow-up of six months; one patient had a retinal detachment. This review demonstrates that with a meticulous anterior vitrectomy, good visual results can be achieved, although the risk of retinal detachment is higher than in uncomplicated cases.

New England Electric was pondering whether to bid for the salvage rights to a grounded ship, the S.S. Kuniang. The ship could be repaired and used to haul coal for the utility's power stations, recently converted from oil. A bid was determined using a decision tree, a simulation, and net present value calculations.