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This study examined whether domain-general cognitive weaknesses in processing speed (PS) or executive functioning (EF) moderate the relation between word reading scores and anxiety such that lower word reading scores in combination with lower cognitive scores are associated with higher anxiety symptoms. The sample included 755 youth aged 8–16 who were recruited as part of the Colorado Learning Disabilities Research Center twins study. Lower scores on PS ( R2 = .007, p = .014), EF ( R2 = .009, p = .006), and word reading ( R2 = .006–.008, p = .010–.032) were associated with higher anxiety scores. In addition, the word reading × cognitive interactions were significant such that lower scores on PS ( R2 = .010, p = .005) or EF ( R2 = .013, p = .010) combined with lower word reading were associated with higher-than-expected anxiety symptoms. Results suggest that weaknesses in PS, EF, and word reading are modestly associated with higher anxiety symptoms, and these anxiety symptoms may be compounded in youth with both PS or EF weaknesses and word reading difficulties. These findings can guide assessment approaches for identifying youth with word reading challenges who may be at increased risk for anxiety.

Phase transitions are an intriguing yet poorly understood aspect of transition-metal-based materials; these phase transitions can result in changes to the refractive index, absorption coefficient, and other optical properties of the materials. Transition-metal-based materials exist in a variety of crystalline phases and also have metallic, semi-metallic, and semi-conducting characteristics. In this review, we demonstrate that alloyed W- and Mo-based dichalcogenides enable phase transitions in structures, with phase transition temperatures that are tunable across a wide range using various alloy models and modern DFT-based calculations. We also analyze the tuning the optical bandgap of the metal oxide nanoparticles through doping of the transition metal in a manner that is suitable for optical switching and thermal imaging. After the introduction and a brief illustration of the structures and their exceptional properties, we discuss synthetic methodologies and their application as part of important strategies toward the enhanced performance of transition-metal-based dichalcogenides and oxides. In the end, our conclusion highlights the prospects of 2D materials as phase transition materials due to their advantages in terms of scalability and adaptability.

(1) Background: Applications using touch screens are increasingly deployed in medical facilities, as well as in public areas. When touching the display with fingers, potentially pathogenic microorganisms such as methicillin-resistant Staphylococcus aureus (MRSA) can be transmitted. An automated process to decontaminate the device in between users would be highly useful. (2) Methods: Thin glass plates were superficially contaminated with the non-pathogenic Staphylococcus carnosus in a controlled manner. Subsequently, UVA radiation of 400 or 380 nm was laterally coupled into the glass plate, which acted as a light guide. Contact agar plates recorded the change in the staphylococci concentration over time. Additionally, the UVA radiation emitted by the glass plates was measured and the potential risk to humans assessed. (3) Results: Staphylococci concentration decreased as a result of UVA radiation for both wavelengths. At 400 nm, it took about 7.5 h and at 380 nm about 1 h until a reduction of 90% was reached. To meet higher disinfection requirements, disproportionately longer irradiation times were necessary. The potential UVA irradiation of humans in front of the glass pane was about 35 µW/cm2 or less and posed no risk to humans. (4) Conclusions: Side-coupled UVA radiation is in principle capable of safely automatically disinfecting microorganisms on touch screens. However, the required irradiation times are still in the hour range, so that a rapid disinfection within a minute or less is not yet possible with the presented setup. However, higher UVA intensities might reduce the current disinfection durations.

Nuisance alarm rate (NAR) is one of the key performance parameters in a phase-sensitive optical time domain reflectometry (φ-OTDR)-based fence intrusion detection system. Typically, the vibrations caused by ambient environmental conditions, such as heavy rain, strong wind, and passing vehicles, easily result in many nuisance alarms. Significant research efforts have been undertaken to suppress the NAR. In this paper, we propose to utilize short segments of the sensing fiber as reference sensors for significant reduction in the NAR in φ-OTDR for the first time, to the best of our knowledge. According to our field trial results, the proposed approach can reduce the NAR by more than 90%. The proposed approach is very simple, practical, and cost-effective, which can be easily integrated with the existing methods of reducing NAR and act as an additional level of decision-making algorithm for triggering alarms.

Educational narratives written by several cohorts of Latina/o/x students in a college-level ethnic studies course, first-year retention program showed how the current hegemonic educational paradigm—with its attendant neo-liberal, colonial, white supremacist and Eurocentric logics—abates the accumulation and employment of community cultural wealth. Specifically, thesesystemic obstacles impact linguistic, navigational, and resistant capital as Latina/o/x students recount how learning English, feeling othered by classmates and teachers, and internalizing assimilationist and deficit-based ideologies to avoid harassment or mistreatment factored into their educational experiences. Situating community cultural wealth amid the Americanization, deculturalization, or assimilationist projects that have shaped the schooling conditions for students of color better accounts how educational practices, curriculum and spaces can destabilize the range of community cultural wealth competences Yosso has classified. This project adds complexity and highlights the fluidity in the community cultural wealth model by recognizing competing forces at work: the cultivation of these assets via family/community home spaces, discourses and networks, as well as the attrition of these competencies in formal educational spaces. As such, this study contributes to the existing research about CCW by underscoring a dimensionality not yet fully addressed, and, by recognizing the epistemological significance of these skill sets.

Background and aims: Current research promotes complementary methods of coping with menstrual pain (MP). The objective of this study was to examine the effectiveness of the Kinesio Taping (KT) intervention on MP and determine whether KT has therapeutic impact or whether there is presence of placebo. Methods: In within-subject design, 30 female participants were divided into two groups: the first group received an application of KT spatial correction technique (E), then placebo KT (P), while in the other group the reverse order of interventions was used. Every phase included one menstrual cycle. The average age of participants was 23.5 years (18-39). VAS, Brief Pain Inventory Scale, and some SF-36 subscales were used in the assessment. Results: The worst MP without any intervention (6.17) did not significantly differ from P phase (6.07) but decreased significantly to 5.10 during E phase (F=18.38 ; p=0.000). There was also a significant difference between E and P phase in the average MP, in the worst experienced MP, the mildest one, and for current pain: in E phase all types of pain were less intense. Regarding quality of life, significantly better results were obtained during phase E for physical functioning, energy/fatigue, role limitations due to physical health, and due to pain. For emotional well-being and general health there weren’t significant differences between E and P phase. Conclusions: KT has beneficial effect in reducing MP and its consequences and it is significantly superior to placebo. The order of intervention showed no statistical significance, which also confirms the therapeutic effect of KT.

The clear indication for the transforaminal approach is simple or low migrated lumbar disc herniation (LDH). The incidence of migration of the disc fragment in LDH varies from 35% to 72%. The high up migrated disc herniation into MacNab’s hidden zone remains technical challenge. We provide a technical note of seldomly performed full endoscopic translaminar approach with its potential indications. A 52 years male patient presented with low back pain with left lower limb radiculopathy for 2 months. Visual analogue scale for back and leg was 2 and 8, respectively. MRI examination revealed high up migrated disc herniation with collapsed disc space at L4-5. Dynamic radiograph was not showing any instability. Based on the preoperative surgical planning working cannula was docked over left L4 lamina perpendicular to horizontal plane. With the help of 3.5 mm endoscopic burr translaminar keyhole was drilled in a concentric manner. The distance between lateral margin of pars and keyhole was intermediately inspected for preservation of adequate bone in pars interarticularis. Though the translaminar key hole subluxated tip of SAP, up-migrated disc fragment was removed. The VAS score of leg reduced significantly from 8 to 2 in immediate postoperative period. At the end of 6 months follow up period patients leg symptoms completely improved with minimal back pain. We measured the width of remaining pars postoperatively and found to be 5 mm. The full endoscopic translaminar approach is valid alternative approach for the high up migrated HNP.

Minimally invasive surgery has continued to grow as an alternative approach to traditional open methods of treating cervical and thoracic spine pathologies, with similar efficacy, shorter hospitalizations and decreased tissue destruction. This manuscript presents a review of the literature and summarizes complications seen in cervical and thoracic spine surgery, focusing on different types of minimally invasive procedures. Overall, our review suggests that minimally invasive approaches have less severe complications than open approaches, and indicates the need for prospective studies to examine this finding further.

Objective: Temporomandibular joint (TMJ) ankylosis is a disorder where the temporomandibular joint, which joins the lower jaw to the skull, fuses or becomes "ankylosed." This can result in pain, difficulty opening the mouth, and other symptoms as a result of an injury, infection, or other factors. TMJ ankylosis can be treated with surgery, medication, and physical therapy. Arthrocentesis, arthroscopy, and open-joint surgery are surgical options. This retrospective study sought to examine the temporomandibular joint (TMJ) ankylosis pattern and its underlying causes in patients who had received treatment at Multan's Nisthar Institute of Dentistry. Methods: From 2018 to 2022, Nishtar Institute of Dentistry, Multan treated patients with temporomandibular joint ankylosis for 4 years. All patients whose records were sufficiently complete were analyzed in this research. Demographic data, the cause and pattern of ankylosis, the interval between the injury and therapy, simultaneous facial lacerations, remnant dislocation, a previous pedicle method, mouth opening prior to and following ankylosis treatment, health issues, the follow-up period, and physical therapy prior to and following ankylosis treatment are all included in the information. Results: Out of 32 patients with 45 afflicted joints and a mean ± standard deviation age of 29.90 ± 17.08 years, 25 (78%) occurrences of temporomandibular joint ankylosis were attributed to trauma (mainly between 20 and 29 years old). Bilateral participation outweighed unilateral involvement 13 to 9 and males outnumbered women 23 to 9. Restricted mouth opening was the patient's primary complaint the majority of the time (n=24, or 75%). The temporomandibular joint was completely ankylosed in 24 individuals. Prior to surgery, the mean maximum mouth openness was 0.95 ± 0.45 cm; however, it dramatically elevated to 4.50 ± 0.50 cm (p-value 0.001) following surgery. Conclusions: This research found that the most frequent complication of temporomandibular joint ankylosis among the participants it looked at was trauma. The patient's limited mouth opening was their most frequent primary complaint. Additionally, this study's findings revealed that men are more likely than women to develop TMJ ankylosis and that these patients' TMJ functions can be significantly improved through the surgery. Keywords: temporomandibular, TMJ, temporomandibular joint

Objective: Uniportal full endoscopic thoracic endoscopic surgery can be performed through transforaminal and interlaminar approaches. The interlaminar approach is commonly described as thoracic endoscopic unilateral laminotomy for bilateral decompression (TE-ULBD), which is typically indicated for pathologies such as ossified ligamentum flavum and other posteriorly based compressive pathologies. TE-ULBD decompresses the central and lateral recesses of the thoracic spinal canal. Both the outside-in (over the top of ligamentum flavum) and inside-out (under the ligamentum flavum) approaches can decompress the thoracic spinal canal through the uniportal interlaminar endoscopic route.Methods: A retrospective clinical cohort evaluation of patients who underwent TE-ULBD was performed from January 2018 to December 2021 Results: A cohort of 50 cases of TE-ULBD with a mean age of 65 years old were evaluated. The complication rate was 5.4% and the reoperation rate was 2%. Statistically significant mean VAS improvements were found at 1 week, 6 months, and the final follow-up, with changes of 3.95 ± 1.49, 4.95 ± 1.7, and 5.2 ± 1.8 points, respectively. Likewise, the mean Oswestry Disability Index improvements at 1 week, 3 months, and the final follow-up were 33.8 ± 9.05, 40.12 ± 10.38, and 41.92 ± 11.26, respectively (p < 0.001). Significant improvements were found in the cross-sectional area of the spinal canal in the upper endplate, mid-disc, and lower endplate (57.62 ± 50.6, 89.86 ± 55.93, and 64.93 ± 60.91 mm2, respectively; p < 0.001). Conclusion: TE-ULBD using the outside-in technique could achieve good clinical outcomes and a low rate of complications in our cohort of patients.

This editorial article explores advances in the field of spinal surgery, focusing on minimally invasive spinal surgery (MISS) and its applications in treating cervical and thoracic spine conditions. MISS has gained popularity due to its reduced pain, minimal scarring, and shorter recovery times compared to traditional open surgery. Endoscopic surgery, the core of many MISS procedures, offers several advantages, such as reduced blood loss, minimal tissue damage, shorter hospital stays, and enhanced visualization. However, it is important to emphasize the need for sufficient experience in endoscopic surgery and the adoption of more delicate techniques when addressing cervical and thoracic spine disorders, as more serious complications can occur in these regions than in the lumbar spine. Various endoscopic techniques, including anterior cervical discectomy, posterior cervical foraminotomy, thoracic discectomy, and thoracic decompression, have been successfully employed to treat cervical and thoracic spine disorders. As the field of spinal surgery continues to advance, the use of endoscopic techniques in MISS is expected to become more widespread, benefiting patients and contributing to a more efficient and cost-effective healthcare system.

Objective: Destandau’s endospine technique was initially described for lumbar disc herniation and was later applied for lumbar spinal stenosis. Favorable outcomes have been reported with this technique for lumbar degenerative pathology. This article attempts to review the literature and define the scope of Destandau’s technique in cervical and thoracic pathologies.Methods: A literature search for the keywords “Destandau” and “endospine” was performed in the PubMed, Cochrane, Scopus, Embase, and MEDLINE databases. The review was conducted according to the Scale for the Assessment of Narrative Review Articles (SANRA) tool.Results: In total, 91 studies were found, out of which three studies employed Destandau’s endospine technique for cervical and thoracic pathologies. Three book chapters describing the Destandau technique in cervical pathology and intradural tumor excision were also included in the review. The technique has been successfully employed by various authors for an anterior or posterior cervical approach to disc herniation, cord decompression, and excision of intradural extra-medullary lesions of the spinal canal. No studies mentioned using the Destandau technique for thoracic disc herniation, traumatic fractures, or ossified ligamentum flavum decompression. Conclusion: Destandau’s endoscopic technique has been applied successfully in anterior and posterior cervical approaches for cervical disc herniation, myelopathy and intradural tumors, and its advantages include less pain, minimal muscle damage, shorter hospital stays, and the preservation of spinal stability/segment mobility. Further studies comparing various techniques would help choose the most patient-friendly technique for specific pathologies.

Objective: This study aimed to comprehensively assess the prevalence and distribution of degenerative cervical and thoracic diseases with compression of the spinal cord, such as disc herniation (TDH) or hypertrophied ligamentum flavum causing stenosis, by reviewing the literature. Methods: We searched PubMed/MEDLINE to identify articles on the prevalence of degenerative diseases with compression of the spinal cord in the cervical and thoracic spine. The levels of evidence were classified according to the NASS 2005 method. We selected articles containing information on the prevalence of degenerative cervical and thoracic diseases.Results: We identified 358 articles. Thirty-eight met our criteria, with evidence ranging from levels I to V. The prevalence of asymptomatic spinal cord compression lesions was found to be relatively high in elderly people with underlying conditions. Non-traumatic spinal cord injuries are caused by various degenerative diseases involving spinal cord compression, such as cervical myelopathy, ossification of the posterior longitudinal ligament, and ossification of the ligamentum flavum, and are observed in more than 50% of patients with lesions in Japan and the United States, more than 30% in Europe, and more than 20% in Australia. Regarding thoracic lesions, a prevalence of 5% to 10% has been reported for various spinal cord compression lesions such as herniated disc, ossification of the posterior longitudinal ligament, and ossification of the ligamentum flavum.Conclusion: Spinal cord compressive lesions appear not to be rare in the cervical and thoracic spine. The radiographic findings of various stenotic lesions must be well understood and correlated with clinical symptoms before treatment decisions.

Introduction: Maclura pomifera, is small deciduous tree which is commonly called as Osage orange. It typically grows about 8 to 15 meters tall. Maclura pomifera secrete white latex material which is sticky in nature on damaging. The common name of this plant is not related with citrus fruit family “orange” Maclura pomifera belongs to mulberry family called Moraceae. Method: The extract of Maclura pomifera leaves was prepared by using ethanol as a solvent. The major groups of phytochemicals were present it such as, alkaloids, tannins, saponins, flavonoids and steroids. Results: The different parts of plants contain, alkaloids, flavonoids, and polyphenolic and many other bio-compound. Due to these compounds, plants posse’s antidiabetic, anti-cardiovascular, and anticancer activities. The leaves of Maclura pomifera extract possessed higher cytotoxic potential with IC50 78.9 µg/ml. The cytotoxic potential of extract was checked through MTT assay against the hepatic cancer (HepG2) cells, Conclusion: These bio-compounds are present in the Maclura pomifera, due to this reason, this plant is used against several disorders such as diabetes, cardiovascular and cancer. Which give the valuable results. Keywords: Phytochemicals, Anticancer, Cardiovascular, Maclura pomifera, Bio-compounds, Cytotoxic potential

Advanced Raman spectroscopy (RS) systems have gained new interest in the field of medicine as an emerging tool for in vivo tissue discrimination. The coupling of RS with artificial intelligence (AI) algorithms has given a boost to RS to analyze spectral data in real time with high specificity and sensitivity. However, limitations are still encountered due to the large amount of clinical data which are required for the pre-training process of AI algorithms. In this study, human healthy and cancerous colon specimens were surgically resected from different sites of the ascending colon and analyzed by RS. Two transfer learning models, the one-dimensional convolutional neural network (1D-CNN) and the 1D–ResNet transfer learning (1D-ResNet) network, were developed and evaluated using a Raman open database for the pre-training process which consisted of spectra of pathogen bacteria. According to the results, both models achieved high accuracy of 88% for healthy/cancerous tissue discrimination by overcoming the limitation of the collection of a large number of spectra for the pre-training process. This gives a boost to RS as an adjuvant tool for real-time biopsy and surgery guidance.

Objective: The atlantoaxial complex exhibits unique morphological and biomechanical characteristics. Trauma, tumors, and inflammatory or congenital diseases may compromise the stability of this joint. The purpose of this study was to describe a minimally invasive surgical (MIS) technique for C1-C2 fixation through an anatomical corridor and to analyze the clinical, surgical, and fusion outcomes using this approach over a 15-year period.Methods: We present a MIS technique utilizing a natural anatomical corridor for C1-C2 screw fixation, which has been used at our institution since 2007. We analyzed the demographic characteristics and clinical results of the patients who underwent this procedure.Results: Forty-seven patients underwent C1-C2 MIS screw fixation during the study period, with 24 male patients and a median age of 66 years. The indication for surgery was atlantoaxial subluxation in 60% of cases and odontoid fracture in 23%. The median surgery duration was 130 minutes, with a median blood loss of 300 mL. There were no intraoperative complications, and only one patient presented with a superficial wound infection, which was successfully treated with antibiotics.Conclusion: The minimally invasive approach through a natural anatomical corridor to fuse the atlantoaxial joint using C1 lateral masses and C2 pedicle screws bilaterally has been demonstrated to be safe and effective. Preserving the occipital-cervical tension band provides additional biomechanical stability to the construct.

Objective: Cervical endoscopic unilateral laminotomy for bilateral decompression (CE-ULBD) is a promising novel surgical approach. However, to date, there is a paucity of data regarding safety, efficacy, and functional outcomes following CE-ULBD.Methods: The aim of this study was to investigate the outcomes of outpatient CE-ULBD combined with postoperative smartphone-based continuous physiological monitoring and virtual follow-up. Results: We included a total of 23 patients in our study group. The mean age was 69.1±2.5 years. A significant postoperative reduction of the visual analogue scale for neck pain (4.1±0.6 pre- vs. 2.3±0.5 post-surgery; P

Analizar el impacto de la COVID-19 en los modelos de negocio de las empresas de la ciudad de Cuenca permite reflexionar sobre el entendimiento de la vulnerabilidad o resiliencia de sus modelos de gestión. Aplicando una réplica del estudio Analyzing the impact of the coronavirus crisis on business models, de Ritter y Pedersen (2020a), con el enfoque del modelo de alineación de cuadrados en 14 casos de grupos corporativos familiares de la ciudad de Cuenca que participan en el estudio, se logró un análisis de los impactos de la pandemia de la COVID-19 en sus modelos de negocio. Al comparar los resultados con los del estudio en Dinamarca, se concluye con la importancia de reconocer los niveles de vulnerabilidad y resiliencia de los modelos de negocio ante una crisis, con lo que se ofrece una herramienta importante para tomar decisiones estratégicas de gestión para la nueva normalidad. Palabras clave: Impacto, estrategia, análisis, resiliencia, empresas, crisis, COVID-19. Abstractnalyzing the impact of the COVID-19 on business models of companies in the city of Cuenca provides reflections on the understanding of the vulnerability or resilience of their management models. Applying, a replica of the study “Analyzing the impact of the coronavirus crisis on business models” (Ritter & Pedersen, 2020a) using the square alignment model approach in 14 cases of family corporate groups in the city of Cuenca that participate in the study, an analysis of the impacts of the COVID-19 pandemic on their business models was achieved and when comparing the results with those of the study in Denmark, it is concluded with noting the importance of recognizing the levels of vulnerability and resilience of the business models in the face or a crisis thereby offering an important tool for making strategic management decisions for the new normal. Keywords: Impact, strategy, analysis, resilience, enterprise, crisis, COVID-19

El crecimiento tecnológico y la necesidad de acceder a información rápidamente ha provocado que la demanda por empresas que brinden un servicio de internet ágil y eficiente incremente, provocando incertidumbre en estas empresas por ser mejores que la competencia y retener al consumidor. El desarrollo metodológico se llevó a cabo por medio de una investigación descriptiva con enfoque cuantitativo. Se recolectó 402 datos en la Provincia del Azuay. Para el análisis de resultados se realizó regresiones lineales simples y compuestas que permitieron analizar la influencia sobre la intención de cambiarse de proveedor. Los hallazgos encontrados evidencian que la percepción de riesgo de la empresa incide de manera positiva en los consumidores al querer cambiarse de proveedor, mientras que la percepción de la calidad de marca no tiene significancia sobre su intención de compra; sin embargo, cuando éstas se evalúan en conjunto, su impacto sobre la intención de compra es positiva. Palabras clave: Calidad, empresa, Intención de compra, percepción, riesgo. AbstractTechnological growth and the need to access information quickly have caused the demand for companies that provide agile and efficient Internet service to increase, causing uncertainty in these companies for being better than the competition and retaining the consumer. The methodological development was carried out through a descriptive investigation with a quantitative approach. Four hundred two data were collected in the Province of Azuay. For the analysis of results, simple and compound linear regressions were carried out, which allowed us to analyze the influence on the intention to change providers. The findings show that the company’s risk perception positively affects consumers when they want to change suppliers, while the perception of brand quality has no significance on their purchase intention; however, when they are evaluated together, their impact on purchase intention is positive. Keywords: Quality, company, purchase intention, perception, risk.

Gran parte del crecimiento que ha tenido la industria camaronera en el Ecuador se debe a que Estados Unidos históricamente ha sido el principal comprador/importador de camarón ecuatoriano. Es por ello, que esta investigación tuvo como objetivo estimar la demanda de importación de camarón ecuatoriano de Estados Unidos entre 1990 y 2018. Las variables utilizadas fueron los precios del camarón ecuatoriano y tailandés, la renta de los consumidores americanos explicada a través del PIB de Estados Unidos y la presencia del virus de la mancha blanca en el camarón ecuatoriano como variable dummy. El método de estimación utilizado fue Mínimos Cuadrados Generalizados. Los resultados del modelo mostraron que las variables utilizadas explicaron esta demanda y que el precio del camarón ecuatoriano y la renta de los consumidores americanos, fueron las variables más significativas que deberían analizar los empresarios camaroneros del Ecuador, para ingresar a este mercado o incrementar sus exportaciones.Palabras clave: Camarón ecuatoriano, Demanda, Estados Unidos, importaciones, Mínimos Cuadrados Generalizados Abstract Great part of the shrimp industry growth in Ecuador is due to the fact that the United States has historically been the main buyer/importer of Ecuadorian shrimp. For this reason, this research aimed to estimate the US import demand for Ecuadorian shrimp between 1990 and 2018. The variables used were the prices of Ecuadorian and Thai shrimp, the American consumers’ income explained through the GDP of the United States and the presence of the white spot virus in Ecuadorian shrimp as a dummy variable. The estimation method used was Generalized Least Squares. The results of the model showed that the variables used explained this demand and that the price of Ecuadorian shrimp and the American consumers’ income were the most significant variables that Ecuadorian shrimp businessmen could analyze to enter this market or increase their exports.Keywords: Ecuadorian shrimp, Demand, The United States, imports, Generalized Least Squares

Information and communication technology (ICT) and digital media are less accessible for persons with intellectual disability (ID) but are important for citizenship. The aim was to conceptualize officials understanding of ICT usage among people with ID, and to analyze the possible influence of this understanding on the provision of services for people with ID. A qualitative study was conducted, using semi-structured interviews with municipal officials and politicians in the disability service area. Thematic analyses were conducted. ICT use is understood as an arena for democratization. Findings also illustrate the tension between integrity and protection as well as between legal and moral aspects of digital transformation in service provision. This understanding of digitalization is permeated by an individualized approach but conditioned by organizational issues. Disability services can be understood as undergoing digital transformation where regulative and normative elements in this area need to be harmonized to facilitate digitalization successfully.

Biportal spinal endoscopy has been successfully utilized for the surgical treatment of common spinal conditions, mainly in the lumbar spine. Surgeons recently have translated this technique to the cervical and thoracic spine. Little is known regarding the clinical effectiveness and safety profile of the biportal endoscopic technique in the cervical and thoracic spine. This is a narrative review of the applications of biportal spinal endoscopy in the cervical and thoracic spine, dis- cussing its current capabilities, limitations, and possible future applications.

Complex anatomy, difficult access, and low tolerance of cord manipulation in the cervical and thoracic spine are some of the most challenging aspects of spine surgery. Open cervical and thoracic spinal surgery incurs substantial morbidity, with significant postoperative pain, blood loss, and risk of infection in open cervical and thoracic wounds. With the evolution of endo- scopic surgical techniques and increasing familiarity with how to handle endoscopic equipment, the indications of endoscopic spine surgery have expanded to include cervical and thoracic spi- nal decompression in the surgical armamentarium for treating cervical and thoracic spinal pa- thologies to provide the maximal benefit zone of endoscopic spine surgery.

Objective: Various pathologies can occur at the craniovertebral junction (CVJ). Posterior decompression with occipitocervical fixation can improve many of these conditions, but anterior decompression is required in some cases. Anterior decompression of a CVJ lesion is very difficult to perform. The transoral approach has been considered the gold standard, but it has the disadvantage of a deep and limited operative field, and many complications are associated with this procedure. Three endoscopic approaches (transoral, transnasal, and transcervical) have been reported previously. Transcervical endoscopic odontoidectomy is a familiar approach for spinal surgeons and can be performed using a uniportal full-endoscopic spinal surgery system. Methods: As described in the present study, 12 patients underwent surgery, and their clinical records were reviewed retrospectively. Results: All patients had good recovery without complications.Conclusion: Fully endoscopic uniportal transcervical odontoidectomy has many advantages for ventral pathologies of the CVJ. In particular, it can avoid heat injury despite drilling very close to the brainstem in deep closed lesions.

Foraminal disc herniation at the C2–3 level is a very rare entity, for which a consensus treatment protocol has not been established. This case report explains that unilateral biportal endoscopic foraminotomy is a very effective, minimally invasive, and safe procedure for this condition. A 62-year-old woman presented to our clinic with complaints of a 6-week history of posterior axial neck pain and sudden onset of hypoesthesia over the right periauricular region, face and lip. Magnetic resonance imaging (MRI) revealed C2–3 right foraminal disc herniation, and posterior cervical foraminotomy was done using the unilateral biportal endoscopic technique. The patient reported complete relief of the axial neck pain soon after surgery and gradual improvement of the hypoesthesia. Postoperative MRI showed complete removal of the compressing disc fragment. In conclusion, this case shows that a minimally invasive biportal endoscopic procedure can be a better choice for decompression than many extensive and destructive procedures. This is the first case report in the literature describing the management of C2–3 foraminal disc herniation by posterior cervical unilateral biportal endoscopic foraminotomy.

Currently, little research exists on disabilities among Native American communities and no research exists on how Native Americans perceive disabilities, services currently available, and unmet needs. Understanding these key areas is essential to providing efficacious and culturally relevant care. To address this gap in the literature, we used Indigenous research methodology through sharing circles throughout the state of Utah to listen and amplify the voices of the Native communities. Participants shared how they conceptualize "disability," what they thought of current services, and how they thought the needs of Native persons with disabilities should be addressed. Four major themes emerged in the data: a culturally-based conceptualization of "disability," barriers to services, belonging, and needed actions. These themes highlight the cultural strengths among Native communities surrounding disabilities and bring attention to systematic change needed to better address the needs of Native Americans with disabilities.