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To characterize the qualitative anatomy of posterior scapula structures encountered with the Judet approach and to perform a quantitative evaluation of these structures' anatomic locations, including their relationships to osseus landmarks to identify safe zones.Twelve fresh-frozen cadaveric shoulders (mean age, 55.2 years; range 41-64 years; 5 left, 7 right) were dissected. A coordinate measuring machine was used to collect the coordinates of anatomic landmarks, structures at risk during surgical approach to the posterior scapula, and the footprints of muscle attachments on the posterior scapula. These coordinates were analyzed for their relationships with clinically relevant anatomy.The suprascapular nerve was a mean of 20.3 mm (18.9-21.7 mm) medial to the glenoid 9-o'clock position. The posterior circumflex artery and vein were a mean of 100.0 mm (92.2-107.7 mm) lateral to along the lateral border of the scapula from the inferior angle of the scapula and a mean of 41 mm (34.2-47.9 mm) medial along the lateral scapular border from the 6-o'clock position on the glenoid rim. The long head of the triceps covers a mean of 132 mmA safe zone exists 19 mm medially from the glenoid 9-o'clock position to the suprascapular nerve and a minimum of 34.2 mm medially along the lateral scapular border from the glenoid 6 o'clock to the posterior circumflex scapular artery.The modified Judet approach is a minimally invasive surgery that reduces surgical trauma but necessitates precise knowledge of scapular neurovascular anatomy. Surgeons should be aware of these intervals to help avoid these structures when working near the posterior shoulder. This study may allow us to define neurovascular safe zones when this approach is used.

Man-made marine structures (MMS) are commonly used to describe any artificial structure in the marine environment, encompassing oil and gas infrastructure and pipelines, artificial reefs, jetties, piers and shipwrecks. MMS are increasingly proposed to address issues facing marine planners, including augmenting fish stocks through the creation of artificial reefs and the repurposing of redundant offshore oil and gas infrastructure (‘rigs to reefs’). Marine spatial planning is a highly contested process, characterised by multiple stakeholders with often divergent priorities due to competing objectives and values. Understanding stakeholder perspectives in relation to MMS is therefore critical in formulating appropriate policies. This review presents the first systematic and comprehensive integration of information from academic journals and ‘grey’ literature relating to social and economic values and perceptions of MMS. The review identifies that, despite advocacy for research on social and economic values of MMS, there are significant gaps in knowledge, in particular relating to comparative assessments of stakeholder values across different types of MMS. Priority areas for future research are highlighted.

How we define our problems determines the solutions; yet problem framing within coastal management is rarely critiqued. Consequently, opportunities for comprehensive policy response, vital in addressing the complex challenges impacting the coast, are missed. To address this gap, we develop and apply coastal sustainability paradigms to critique 48 institutional instruments contributing to coastal management in Australia. In doing so, we uncover similarities and differences in the framing of coastal sustainability within Australian coastal management. An anthropocentric framing dominates, particularly at the local scale, prioritising humans over the environment. However, differences exist between and within jurisdictions based on sector and recency of policy reform. We also find evidence of problem-solution coupling, with some States prioritising hazard management over coastal management, through legislative backing of select instruments and sectors. The findings provide those involved in the complex system of coastal governance with the information needed to consider how the chosen framing supports or impedes public engagement and cross-scale and cross-sector coordination.

Purpose: To investigate clinical outcomes, return to sport, and complication rate in patients with an isolated SLAP II-IV tear treated with biceps tenodesis (BT), SLAP-repair (SLAP-R), or both (SLAP-R+BT). Methods: A retrospective analysis of prospectively collected data was performed in patients who underwent surgery between February 2006 and February 2018 for isolated SLAP II-IV lesions with either BT, SLAP-R, or SLAP-R+BT and had minimum 2-year follow-up. Patients were excluded if they were older than 45 years of age, had anterior shoulder instability, rotator cuff tears, glenohumeral osteoarthritis, or concomitant fractures about the shoulder. Clinical outcomes were assessed by the use of the American Shoulder and Elbow Society Score, Single Assessment Numerical Evaluation Score, Quick Disabilities of the Arm, and Shoulder and Hand Score, the General Health Short Form-12 Physical Component, and patient satisfaction. Results: There were 38 shoulders in the isolated BT group with 1 (2.6%) shoulder requiring revision, 13 in the SLAP-R group with no patient requiring revision, and 21 in the SLAP-R+BT group with 2 (9.5%) shoulders requiring revision. Minimum 2-year follow-up was obtained in >85% of each group. Mean age at time of surgery was significantly different between the groups (36.5 years BT vs 27.7 years SLAP-R vs 36.5 years SLAP-R+BT; P = .003). While patient-reported outcomes improved significantly from pre- to postoperatively for the BT (P < .001) and SLAP-R+BT groups (P < .001), they did not significantly improve for the isolated SLAP-R group (P values ranging .635 to .123). The BT and SLAP-R+BT groups showed significant improvement in return to sport pre- to postoperatively whereas the SLAP-R group did not. The SLAP-R+BT group had the most patients reaching minimal clinical important difference, substantial clinical benefit, and patient acceptable symptom state American Shoulder and Elbow Society Score scores; however, this was not statistically significant. Conclusions: SLAP II-IV lesions treated with BT or both SLAP-R+BT demonstrated improved outcomes compared with isolated SLAP-R at minimum 2-year follow-up. Concomitant biceps tenodesis should be considered when performing repair of SLAP II-IV tears. Level of Evidence: III; Retrospective comparative study.

Purpose To perform a systematic review comparing clinical outcomes, radiographic outcomes, and complication rates after acute (surgery ≤6 weeks from injury) versus chronic (surgery >6 weeks from injury) acromioclavicular joint reconstructions for grade III injuries using modern suspensory fixation techniques. Methods We performed a systematic review of the literature examining acute versus chronic surgical treatment of Rockwood grade III acromioclavicular joint separations using the Cochrane registry, MEDLINE database, and Embase database over the past 10 years according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The inclusion criteria included techniques using suspensory fixation, a minimum study size of 3 patients, a minimum follow-up period of 6 months, human studies, and English-language studies. The methodology of each study was evaluated using the Methodological Index for Non-randomized Studies (MINORS) tool for nonrandomized studies and the revised Cochrane risk-of-bias (RoB 2) tool for randomized controlled trials. Results The systematic review search yielded 20 studies with a total of 253 patients. There were 2 prospective randomized controlled trials, but most of the included studies were retrospective. On comparison of acute surgery (≤6 weeks) and chronic surgery (>6 weeks), individual studies reported a range of Constant scores of 84.4 to 98.2 and 80.8 to 94.1, respectively. The ranges of radiographic coracoclavicular distances reported at final follow-up also favored acute reconstructions, which showed improved reduction (9.2-15.7 mm and 11.7-18.6 mm, respectively). The reported complication rates ranged from 7% to 67% for acute reconstructions and from 0% to 30% for chronic reconstructions. Conclusions The ranges in the Constant score may favor acute reconstructions, but because of the heterogeneity in the surgical techniques in the literature, no definitive recommendations can be made regarding optimal timing. Level of Evidence Level IV, systematic review of Level I through IV studies.

The coast is socially, economically, and environmentally vital to humanity, yet at risk due to population growth, development, and climate change. Coastal managers are required to make complex decisions regarding the trade-offs that may arise because of these threats, hence evidence-based policy is essential. Advances in biophysical data have improved understanding of coastal change, yet comparative social data is limited. Innovations are required to generate social values data that: (i) links with biophysical data; (ii) is consistent, representative, and long-term; and (iii) requires low resource investment. This paper reports on a pilot program that sought to address these needs by linking with an established citizen science program, CoastSnap, to collect information on community use and values in the Peron Naturaliste region, south-west Western Australia. The program successfully monitored community use and values uncovering the importance of nature-based activities and the mental/emotional health benefits of interacting with the coast. It highlights spatial differences in use and value that can support regional coastal planning. In the longer-term, the approach could enable decision-makers to monitor change in use and values resulting from, for example, infrastructure investments or physical coastal change. Limitations include little control over respondent sample and lack of knowledge regarding barriers to participation. Further research into the factors that motivate users and their preferences for interacting with the remote survey technologies, along with an expanded network of CoastSnap Social Survey sites, would facilitate regional, national, and global comparison of use and values. The approach provides a valuable addition to coastal managers’ data collection toolbox, generating social data that are temporal, integrates with biophysical data, and supports regional coastal planning, whilst increasing opportunities to interact with the public to enhance awareness, interest and support for coastal management.

Purpose To report clinical outcomes following arthroscopic suprascapular nerve (SSN) decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant pathology. Methods We retrospectively reviewed prospectively collected data of 19 patients who underwent SSN release at the suprascapular and/or spinoglenoid notch between April 2006 and August 2017 with ≥2 years of follow-up. Patients who underwent concomitant rotator cuff or labral repairs or had severe osteoarthritis were excluded. Pre- and postoperative strength and patient-reported outcomes were collected, including the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numerical Evaluation (SANE), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), 12-item Short Form (SF-12), and satisfaction. Complications and revisions were recorded. Results At a mean final follow-up of 4.8 years, pre- to postoperative ASES (64.9 ± 18.7 versus 83.5 ± 23.1; P = .018), QuickDASH (28.7 ± 17.2 versus 12.7 ± 17.1; P = .028), SANE (64.3 ± 16.4 versus 80.8 ± 22.3; P = .034), and SF-12 PCS (41.1 ± 10.8 versus 52.3 ± 5.8; P = .007) scores all significantly improved. Median strength for external rotation improved significantly (4 [range 2 to 5] versus 5 [range 3 to 5]; P = .014). There was no statistically significant improvement in median strength for abduction (4 [range 3 to 5] versus 5 [5]; P = .059). Median postoperative satisfaction was 9 (range 1 to 10), with 8 patients (50%) rating satisfaction ≥9. No complications were observed, and no patients went on to revision surgery. Conclusion Arthroscopic SSN decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in good functional outcomes with significant improvements from before to after surgery. Level of Evidence IV, therapeutic case series.

Background: Total shoulder arthroplasty (TSA) is an effective procedure for the treatment of glenohumeral osteoarthritis (GHOA) delivering reliable pain relief and improved shoulder function. Abnormal glenoid morphologies are common, and biconcave glenoids are enigmas that have been associated with poor clinical outcomes and implant survivorship. Purpose: To assess the clinical outcome scores of patients who underwent noncorrective, concentric reaming for TSA with biconcave glenoids (B2). We hypothesized that patients with B2 glenoids who underwent TSA with glenoid implantation using noncorrective, concentric reaming would have significant improvements in clinical outcome scores and high implant survivorship. Methods: All patients who underwent anatomic TSA for GHOA with B2 glenoids, performed by a single surgeon, between July 2006 and December 2015 with minimum 2-year follow-up were reviewed. Walch classification was obtained from preoperative imaging (magnetic resonance imaging or computed tomography). Clinical outcome scores were prospectively collected and included American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numerical Evaluation (SANE) score, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, 12-Item Short Form Health Survey physical component summary (PCS), and patient satisfaction. Clinical failures (revision TSA surgery or conversion to reverse TSA) and complications were reported. Paired t test and bivariate correlations level of significance was set at P = .05. Survivorship analysis with implant failure as an endpoint was done using Kaplan-Meier survival curves. Results: 51 TSA in 49 patients (9 females, 40 males) with primary GHOA with B2 glenoids were performed with a mean age of 64 (range 36-81 years) at the time of surgery. The mean retroversion was 19.1° (range 5.4°-38°), and posterior decentering was 42.0% (range 19.4%-78.5%). At final evaluation, 45/51 anatomic TSAs (88% follow-up) with a mean follow-up of 4.9 years (range 2.0-10.4 years) were assessed. All clinical outcome scores improved significantly pre- to postoperatively: ASES, 52.5 to 79.6 (P < .001); SANE, 52.4 to 74.7 (P < .001); QuickDASH, 39.2 to 19.1 (P = .001); and PCS, 40.9 to 48.9 (P = .001). Median postoperative satisfaction was 9 (range 1-10). There were 2 failures and 4 that required another surgery —subscapularis repair, lysis of adhesions, irrigation and débridement, and one to explore the status of the subscapularis for persistent pain. The implant survivorship rate was 95% at a mean follow-up of 4.9 years. Conclusion: Anatomic total shoulder replacement with minimally noncorrective, concentric reaming in patients with B2 glenoids had significant improvement in clinical outcome scores, high patient satisfaction, and high survivorship in this cohort.

Treatment of severe acromioclavicular joint injuries remains controversial and has evolved over the past 4-plus decades. Although several variations on reconstruction exist, an ideal technique will likely use a combination of coracoclavicular ligament reconstruction with suture backup stabilization, minimal drill holes to reduce the risk of fracture, arthroscopic-assisted guidance for anatomic graft and suture placement in and around the coracoid, and fluoroscopic-aided reduction to ensure an anatomic acromioclavicular joint. The objective of this Technical Note is to describe an arthroscopic-assisted coracoclavicular ligament reconstruction with allograft using fluoroscopically guided and cerclage-controlled anatomic reduction of the acromioclavicular joint.

MORC2 encodes an ATPase that plays a role in chromatin remodeling, DNA repair, and transcriptional regulation. Heterozygous variants in MORC2 have been reported in individuals with autosomal-dominant Charcot-Marie-Tooth disease type 2Z and spinal muscular atrophy, and the onset of symptoms ranges from infancy to the second decade of life. Here, we present a cohort of 20 individuals referred for exome sequencing who harbor pathogenic variants in the ATPase module of MORC2. Individuals presented with a similar phenotype consisting of developmental delay, intellectual disability, growth retardation, microcephaly, and variable craniofacial dysmorphism. Weakness, hyporeflexia, and electrophysiologic abnormalities suggestive of neuropathy were frequently observed but were not the predominant feature. Five of 18 individuals for whom brain imaging was available had lesions reminiscent of those observed in Leigh syndrome, and five of six individuals who had dilated eye exams had retinal pigmentary abnormalities. Functional assays revealed that these MORC2 variants result in hyperactivation of epigenetic silencing by the HUSH complex, supporting their pathogenicity. The described set of morphological, growth, developmental, and neurological findings and medical concerns expands the spectrum of genetic disorders resulting from pathogenic variants in MORC2.

Effective use of genetic and genomic data in cancer prevention and treatment depends on adequate communication with patients and the public. Although relevant empirical work has emerged, the scope and outcomes of this communication research have not been characterized. We conducted a comprehensive scoping review of recent published research (2010–2017) on communication of cancer-related genetic and genomic testing (CGT) information. Searches in six databases revealed 9,243 unique records; 513 papers were included. Most papers utilized an observational quantitative design; fewer utilized an experimental design. More attention has been paid to outcomes of CGT results disclosure than to decision making regarding CGT uptake or the process of results disclosure. Psychosocial outcomes were most common across studies. This literature has a strong focus on BRCA1/2, with few papers focused on Lynch syndrome or next-generation technologies. Women, Caucasians, older adults, and those of higher socioeconomic status were overrepresented. Research gaps identified include the need for studies on the process of CGT communication; examining behavioral, decision-making, and communication outcomes; and inclusion of diverse populations. Addressing these gaps can help improve the use of genomics in cancer control and reduce disparities in access to and use of CGT.

Widespread Lower Triassic microbial carbonates occur after the end-Permian mass extinction (EPME) and are commonly attributed to reduced metazoan competition after the EPME, or to paleoceanographic conditions that suppressed metazoan abundance and increased ocean carbonate saturation. Testing these hypotheses requires direct spatial (versus temporal) linkages between Lower Triassic microbial deposits and lithologic or geochemical proxy evidence for environmental perturbations. This study uses facies within and associated with an extensive Lower Triassic (Smithian) microbial carbonate mound complex, which developed across a > 400-km-wide middle-to-inner shelf in southern Utah, U.S.A., to assess potential controls on microbial carbonate development. Middle-shelf microbial mounds (1–2 m tall) are composed of stromatactis-rich peloidal boundstones that are laterally linked by microbial intermound beds. Inner-shelf microbial mounds ( Sparse, but persistent benthic fauna and bioturbation in all microbial facies and the lack of lithologic indicators of bottom-water anoxia indicate sufficient O2 levels to support animal life. The broad Utah shelf study area implies that shelf-edge, upwelling-derived, carbonate-saturated waters did not control microbial carbonate precipitation. Regional controls on microbial mound complex development include deposition during sea-level rise along a wide shallow shelf that maximized the areal extent of clear-water, low-energy subtidal environments and promoted growth of prolific photosynthesizing microbial communities. Probable global controls include the post-EPME reduction in skeletal metazoan competition, which permitted microbial mats to flourish, and elevated global-ocean carbonate saturation states and promoted extensive carbonate precipitation.