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Total Shoulder Arthroplasty (TSA) anatomical, reverse or both is an increasingly popular procedure but the glenoid component is still a weak element, accounting for 30-50% of mechanical complications and contributing to the revision burden. Component mal-positioning is one of the main aetiological factors in glenoid failure and thus Patient-Specific Instrumentation (PSI) has been introduced in an effort to optimise implant placement. The aim of this systematic literature review and meta-analysis is to compare the success of PSI and Standard Instrumentation (STDI) methods in reproducing pre-operative surgical planning of glenoid component positioning. A search (restricted to English language) was conducted in November 2017 on MEDLINE, the Cochrane Library, EMBASE and ClinicalTrials.gov. Using the search terms \"Patient-Specific Instrumentation (PSI)\", \"custom guide\", \"shoulder\", \"glenoid\" and \"arthroplasty\", 42 studies were identified. The main exclusion criteria were: no CT-scan analysis results; studies done on plastic bone; and use of a reusable or generic guide. Eligible studies evaluated final deviations from the planning for version, inclination, entry point and rotation. Reviewers worked independently to extract data and assess the risk of bias on the same studies. The final analysis included 12 studies, comprising 227 participants (seven studies on 103 humans and five studies on 124 cadaveric specimens). Heterogeneity was moderate or high for all parameters. Deviations from the pre-operative planning for version (p<0.01), inclination (p<0.01) and entry point (p = 0.02) were significantly lower with the PSI than with the STDI, but not for rotation (p = 0.49). Accuracy (deviation from planning) with PSI was about 1.88° to 4.96°, depending on the parameter. The number of component outliers (>10° of deviation or 4mm) were significantly higher with STDI than with PSI (68.6% vs 15.3% (p = 0.01)). This review supports the idea that PSI enhances glenoid component positioning, especially a decrease in the number of outliers. However, the findings are not definitive and further validation is required. It should be noted that no randomised clinical studies are available to confirm long-term outcomes.

Shoulder arthroplasty procedures have increased significantly, with reverse shoulder arthroplasty (RSA) becoming more common. While RSA revision rates are reported as low, these figures may not accurately reflect implant success. Factors such as older patient demographics and surgeon reluctance to perform complex revisions may contribute to lower revision rates. This perception may encourage broader RSA use in younger patients, potentially increasing long-term revision burdens. This study examines whether revision thresholds differ between shoulder arthroplasty types to determine if low revision rates reported signify true implant success. All shoulder arthroplasties from the 1st April 2012 to the 31st March 2022 were requested from the National Joint Registry (NJR). Mean postoperative Oxford Shoulder Score (OSS) was calculated for RSA, total shoulder arthroplasty (TSA), and hemiarthroplasty (HA). Revision rates were analysed between implants for patients with a mean postoperative OSS of <29 (a pre-defined unsatisfactory score) and those with the lowest 25%, and lowest 10% of OSS scores. Chi-squared tests with Bonferroni correction assessed differences among implant groups. Among 21,918 NJR patients with postoperative OSS data, HA had the highest proportion of patients with 'unsatisfactory' function (38.12%), followed by RSA (26.99%) and TSA (15.35%). 4.87% of RSA patients with unsatisfactory function were revised, significantly less than TSA (10.58%) and HA (13.86%) (p < 0.001). In those with the lowest 25% of OSS scores, revision rates were 4.78% for RSA, 8.76% for TSA, and 15.02% for HA (p < 0.001). In the lowest 10%, revisions occurred in 6.53% of RSAs, 12.44% of TSAs, and 17.03% of HAs (p < 0.001). No significant difference was found between TSA and HA (p = 0.06). RSA has lower revision rates than HA and TSA; however, this may not reflect superior implant performance. Patients with poor RSA function are less likely to undergo revision, suggesting higher revision thresholds. As RSA use expands, its assumed low revision rate must be reassessed to prevent long-term burdens of poorly functioning implants. Further research is needed to determine whether surgical selection bias influences revision rates and to establish additional benchmarks or surrogates in joint registries for a more comprehensive assessment of implant performance.

Background Multiple non-arthroplasty surgical techniques are described for the management of large and massive irreparable rotator cuff tears. There is currently no consensus on the best management strategy. Our aim was to compare clinical outcomes following arthroscopic debridement, arthroscopic partial cuff repair, superior capsule reconstruction, balloon spacers or graft interposition for the management of large and massive irreparable rotator cuff tears. Methods A comprehensive search was performed of the following databases: Medline, Embase, CINAHL and Cochrane Database of Systematic Reviews. Data were extracted from relevant studies published since January 2000 according to the pre-specified inclusion criteria. The primary outcome was the post-operative improvement in shoulder scores. Meta-analysis of the primary outcome was performed. Secondary outcomes included retear rates and complications. Results Eighty-two studies were included reporting the outcomes of 2790 shoulders. Fifty-one studies were included in the meta-analysis of the primary outcome. The definition of an irreparable tear varied. All procedures resulted in improved shoulder scores at early follow-up. Shoulder scores declined after 2 years following balloon spacers, arthroscopic debridement and partial cuff repair. High retear rates were seen with partial cuff repairs (45%), graft interposition (21%) and superior capsule reconstruction (21%). Conclusions Large initial improvements in shoulder scores were demonstrated for all techniques despite high retear rates for reconstructive procedures. Shoulder scores may decline at mid- to long-term follow-up.

Quadrupole mass filters using non-sinusoidal driving potentials present exciting opportunities for new functionality. Predicting figures of merit like resolving power and transmission efficiency helps characterize these emerging devices. To this end, matrix methods of solving the Hill equation of ion motion are employed to calculate stability diagrams and pseudopotential well depth maps in the a,q plane for arbitrary waveforms. The theoretical resolving power and well depth of digital, trapezoidal and sinusoidal mass filters are compared. Simplified expressions for digital mass filter operation are presented. Graphical Abstract ᅟ

An efficient and cost-effective HR function is essential to the successful running of any organization. And yet for many businesses it is impossible or costly to have HR staff in every office. This is particularly true for companies who have many branches, such as banks and building societies. So what are they to do? Increasingly they are turning to shared services by creating a unit within the organization that typically undertakes personnel administration and basic operational support. This may be delivered to managers and employees through some combination of call centre, personal contact or intranet. Creating a shared services centre enables the HR function to redefine its relationship with its stakeholders. It can become more of a strategic player and make a more business-focused contribution. This book explains what shared services are and what they look like for the HR function. It describes why organizations opt for shared services and what activities are included. It sets out the relationship between shared services and the other HR activities, and between HR and line management. How To Get Best Value From HR outlines the process of introducing shared services, from identifying customer needs through designing the structure to implementation and monitoring. It also outlines the likely pitfalls and, importantly, offers possible solutions. In particular the book highlights the big design issues, including whether to outsource services, where a shared services centre should be located, how services should be delivered and organized, including through the option of e-HR. Crucially it features an extended case study of the Royal Bank of Scotland's experience of introducing HR shared services, providing a unique insight into the reality of this new way of working. Peter Reilly is Associate Director at the Institute for Employment Studies, leading its HR planning and resource work. Prior to joining the Institute he spent 16 years with Shell as an HR manager in the UK and overseas. He is the author of Flexibility at Work, also published by Gower. Tony Williams is the Head of HR Shared Services for the Royal Bank of Scotland Group and is responsible for implementing a fully integrated shared services model following the successful acquisition and integration of NatWest in 2000. Contents: What are HR shared services?; Why introduce HR shared services?; The big design decisions; How to introduce shared services: the process steps to take; The process of outsourcing; Implementation; Monitoring performance and evaluation; Case study: The Royal Bank of Scotland Group; Pitfalls and solutions; References; Index.

Ion traps and guides are integral parts of current commercial mass spectrometers. They are currently operated with sinusoidal waveform technology that has been developed over many years. Recently, digital waveform technology has begun to emerge and promises to supplant its older cousin because it presents new capabilities that result from the ability to instantaneously switch the frequency and duty cycle of the waveforms. This manuscript examines these capabilities and reveals their uses and effects on instrumentation. Graphical Abstract ᅟ

With advances in the precision of digital electronics, waveform generation technology has progressed to a state that enables the creation of m/z filters that are purely digitally driven. These advances present new methods of performing mass analyses that provide information from a chemical system that are inherently difficult to achieve by other means. One notable characteristic of digitally driven mass filters is the capacity to transmit ions at m/z ratios that vastly exceed the capabilities of traditional resonant systems. However, the capacity to probe ion m/z ratios that span multiple orders of magnitudes across multiple orders of magnitude presents a new set of issues requiring a solution. In the present work, when probing multiply charged protein species beyond m/z 2000 using a gentle atmospheric pressure interface, the presence of solvent adducts and poorly resolved multimers can severely degrade spectral fidelity. Increasing energy imparted into a target ion population is one approach minimizing these clusters; however, the use of digital waveform technology provides an alternative that maximizes ion transport efficiency and simultaneously minimizes solvent clustering. In addition to the frequency of the applied waveform, digital manipulation also provides control over the duty cycle of the target waveform. This work examines the conditions and approach leading to optimal digital waveform operation to minimize solvent clustering. Graphical Abstract ᅟ

ObjectivesThe aim of this study was to compare the cost-effectiveness of total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) and explore variation by age and gender.DesignCost-effectiveness analysis using a lifetime cohort Markov model.SettingNational population registry data.ParticipantsModel parameters were informed by propensity score-matched comparisons of TSA and HA in patients with osteoarthritis and an intact rotator cuff using data from the National Joint Registry.InterventionsTSA and HA.Primary outcome measuresQuality-adjusted life years (QALYs) and healthcare costs for age and gender subgroups. A probabilistic sensitivity analysis was performed.ResultsIn all subgroups, TSA was more cost-effective, with the probability of being cost-effective about 70% for TSA versus 30% for HA at any willingness-to-pay threshold above £1100 per QALY. TSA was dominant in young patients (≤60 years) with a mean cost saving of £463 in men and £658 in women, and a mean QALY gain of 2 in both men and women. In patients aged 61–75 years, there was a mean cost saving following HA of £395 in men and £181 in women, while QALYs remained superior following TSA with a 1.3 gain in men and 1.4 in women. In the older cohort (> 75 years), the cost difference was highest and the QALY difference was lowest; there was a cost-saving following HA of £905 in men and £966 in women. The mean QALY gain remained larger after TSA: 0.7 in men and 0.9 in women.ConclusionTSA was more cost-effective than HA in patients with osteoarthritis. QALYs were superior following TSA in all patient groups. Cost differences varied by age and TSA was dominant in young patients.

Abstract Background: Acyl-acyl carrier protein thioesterases (acyl-ACP TEs) catalyze the hydrolysis of the thioester bond that links the acyl chain to the sulfhydryl group of the phosphopantetheine prosthetic group of ACP. This reaction terminates acyl chain elongation of fatty acid biosynthesis, and in plant seeds it is the biochemical determinant of the fatty acid compositions of storage lipids. Results: To explore acyl-ACP TE diversity and to identify novel acyl ACP-TEs, 31 acyl-ACP TEs from wide-ranging phylogenetic sources were characterized to ascertain their in vivo activities and substrate specificities. These acyl-ACP TEs were chosen by two different approaches: 1) 24 TEs were selected from public databases on the basis of phylogenetic analysis and fatty acid profile knowledge of their source organisms; and 2) seven TEs were molecularly cloned from oil palm (Elaeis guineensis ), coconut (Cocos nucifera ) and Cuphea viscosissima , organisms that produce medium-chain and short-chain fatty acids in their seeds. The in vivo substrate specificities of the acyl-ACP TEs were determined in E. coli . Based on their specificities, these enzymes were clustered into three classes: 1) Class I acyl-ACP TEs act primarily on 14- and 16-carbon acyl-ACP substrates; 2) Class II acyl-ACP TEs have broad substrate specificities, with major activities toward 8- and 14-carbon acyl-ACP substrates; and 3) Class III acyl-ACP TEs act predominantly on 8-carbon acyl-ACPs. Several novel acyl-ACP TEs act on short-chain and unsaturated acyl-ACP or 3-ketoacyl-ACP substrates, indicating the diversity of enzymatic specificity in this enzyme family. Conclusion: These acyl-ACP TEs can potentially be used to diversify the fatty acid biosynthesis pathway to produce novel fatty acids.