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Unlike the traditional factors of production--land, labor, and capital--knowledge is a resource that can't be forced out of people. But creating and sharing knowledge is essential to fostering innovation, the key challenge of the knowledge-based economy. To create a climate in which employees volunteer their creativity and expertise, managers need to look beyond the traditional tools at their disposal. They need to build trust. The authors have studied the links between trust, idea sharing, and corporate performance for more than a decade. They have explored the question of why managers of local subsidiaries so often fail to share information with executives at headquarters. They have studied the dynamics of idea sharing in product development teams, joint ventures, supplier partnerships, and corporate transformations. They offer an explanation for why people resist change even when it would benefit them directly. In every case, the decisive factor was what the authors call fair process--fairness in the way a company makes and executes decisions. The elements of fair process are simple: Engage people's input in decisions that directly affect them. Explain why decisions are made the way they are. Make clear what will be expected of employees after the changes are made. Fair process may sound like a soft issue, but it is crucial to building trust and unlocking ideas. Without it, people are apt to withhold their full cooperation and their creativity. The results are costly: ideas that never see daylight and initiatives that are never seized.

Locked-in syndrome due to midbrain infarct is very rare. This report describes a patient with locked-in syndrome whose magnetic resonance images showed bilateral infarcts in the cerebral peduncle. Cerebral angiography disclosed bilateral irregular thrombotic narrowing of the vertebral and proximal basilar arteries with rostral basilar artery occlusion, a previously unreported findings.

Why are some companies able to sustain high growth in revenues and profits--and others are not? To answer that question, the authors, both of INSEAD, spent five years studying more than 30 companies around the world. They found that the difference between the high-growth companies and their less successful competitors was in each group's assumptions about strategy. Managers of the less successful companies followed conventional strategic logic. Managers of the high-growth companies followed what the authors call the logic of value innovation. Conventional strategic logic and value innovation differ along the basic dimensions of strategy. Many companies take their industry's conditions as given; value innovators don't. Many companies let competitors set the parameters of their strategic thinking; value innovators do not use rivals as benchmarks. Rather than focus on the differences among customers, value innovators look for what customers value in common. Rather than view opportunities through the lens of existing assets and capabilities, value innovators ask, What if we start anew? The authors tell the story of the French hotelier Accor, which discarded the notion of what a hotel is supposed to look like in order to offer what most customers want: a good night's sleep at a low price. And Virgin Atlantic challenged industry conventions by eliminating first-class service and channeling savings into innovations for business-class passengers. Those companies didn't set out to build advantages over the competition, but they ended up achieving the greatest competitive advantages.

Patellofemoral contact pressures resulting from fixed rotational deformities of the femur were studied in human cadaver knees. The increase in the degree of fixed rotational deformities of the femur results in a nonlinear increase in patellofemoral contact pressures on the contralateral facets of the patella (i.e., external rotational deformity resulted in a contact pressure increase on the medial facet, and internal rotational deformity resulted in a contact pressure increase on the lateral facet of the patella). With the initial isometric tension of 200 N in the quadriceps tendon for 30 degrees, 60 degrees, 90 degrees, and 120 degrees knee flexion, the peak contact pressure showed no significant differences between the medial and lateral facets of the patella in its anatomic position. At 20 degrees of rotational deformity of the femur, only a slight increase was noted for the tension in the quadriceps tendon and the patellofemoral contact pressures on the contralateral facets of the patella. However, at 30 degrees rotational deformity of the femur, both the external and internal rotational deformity of the femur showed a significant increase in the tension of the quadriceps tendon and the patellofemoral contact pressures on contralateral facets of the patella. The greatest increase in patellofemoral contact pressures was observed at 30 degrees and 60 degrees knee flexion for both the external and internal rotational deformity of the femur. The external rotational deformity of the femur for all knee flexion angles showed significantly higher peak patellofemoral contact pressure increases on the medial facet of the patella as compared with the lateral patellofemoral contact pressure increase resulting from internal rotational deformity of the femur.

Bone ingrowth in the porous canine implants does occur; the early clinical results are indeed encouraging and justify further investigation. The quality of ingrowth as measured by depth and extent in the dog was stress-related. Remodelling was superior in the more compliant or elastic acetabular components without an interposed metal shell. No human specimens have been retrieved thus far, but we are encouraged because the results in the canine model with acrylic-fixed implants were comparable to the results we subsequently observed in human THARIES implantation. Those were initially excellent, but with time radiolucencies increased and loosening occurred. The quality of the canine biologic ingrowth suggests optimism for secure and durable fixation. Our patients have continued to improve through the follow-up period. There has not been a single case in which a qualitative increase in pain occurred over the cemented versions after operation. The technical problems of the surgical procedure have been overcome, but it must be performed precisely to achieve the initial inherent stability to assist in biologic ingrowth. The operative procedures in this series have been performed by or under the direct supervision of the senior author. As our competence has grown, we have applied the procedure to younger patients and those who have bone stock deficiency. One of the major advantages of the biologic ingrowth systems is the facility to graft cysts and defects. For humans, the current chamfered cylinder is an extremely bonestock-conservative procedure when combined with reaming of the femoral head to the neck size. Although space is limited in resurfacing, we have been able to achieve a minimum 4-mm bearing thickness of polyethylene. We believe that the compliant mesh chamfered cylinder system provides excellent stability. However, the hemispheric component, although technically more difficult to seat and fix, has definite applications in bonestock deficiency and with further refinement will be useful in primary replacements as well. Nevertheless, because of the uncertain future of any type of implant, especially new, we have encouraged the patients to follow a careful postoperative management program and refrain from heavy activity during the first year. Many are active and some are now participating in athletics, although this is certain to shorten the life of these implants just as was observed in acrylic-fixed devices. The biologic problems of interface corrosion, migration, and metal ion transfer indicate that these implants must be followed for longer periods. Therefore it seems unwise to extend this technology to a wide clinical use at this time.

An edited summary of an Interdepartmental Conference arranged by the Department of Medicine, UCLA School of Medicine, Los Angeles. William M. Pardridge, MD, Associate Professor of Medicine, is Director of Conferences.

Long-term experimental data support the hypothesis that biologic bone ingrowth into porous surfaces in a hip-resurfacing model is a viable alternative to stem-type porous implants. Ingrowth of bone was demonstrated in long-term canine arthroplasty. The components were well fixed and stable at the time of sacrifice, although ingrowth occurred to varying degrees. The ingrowth and quality of remodeling was influenced by stress. Dislocations were overcome by a change in surgical technique. Loosening and neck fractures were associated with insufficient stability at operation or to component impingement (prevented by modifications of design). The formation of metal debris-filled cysts is a concern and appeared to be associated with the poor quality of porous sintering and possibly abrasion. The effects of increased surface area of the porous components such as increased corrosion products on biologic compatibility are still not well defined and require further research and longer follow-up examination.