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Background: Robot-guided spine surgery is based on a preoperatively planned trajectory that is reproduced in the operating room by the robotic device. This study presents our initial experience with thoracolumbar pedicle screw placement using Brainlab’s Cirq® surgeon-controlled robotic arm (BrainLab, Munich, Germany). Methods: All patients who underwent robotic-assisted implantation of pedicle screws in the thoracolumbar spine were included in the study. Our workflow, consisting of preoperative imagining, screw planning, intraoperative imaging with automatic registration, fusion of the preoperative and intraoperative imaging with a review of the preplanned screw trajectories, robotic-assisted insertion of K-wires, followed by a fluoroscopy-assisted insertion of pedicle screws and control iCT scan, is described. Results: A total of 12 patients (5 male and 7 females, mean age 67.4 years) underwent 13 surgeries using the Cirq® Robotic Alignment Module for thoracolumbar pedicle screw implantation. Spondylodiscitis, metastases, osteoporotic fracture, and spinal canal stenosis were detected. A total of 70 screws were implanted. The mean time per screw was 08:27 ± 06:54 min. The mean time per screw for the first 7 surgeries (first 36 screws) was 16:03 ± 09:32 min and for the latter 6 surgeries (34 screws) the mean time per screw was 04:35 ± 02:11 min (p < 0.05). Mean entry point deviation was 1.9 ± 1.23 mm, mean deviation from the tip of the screw was 2.61 ± 1.6 mm and mean angular deviation was 3.5° ± 2°. For screw-placement accuracy we used the CT-based Gertzbein and Robbins System (GRS). Of the total screws, 65 screws were GRS A screws (92.85%), one screw was a GRS B screw, and two further screws were grade C. Two screws were D screws (2.85%) and underwent intraoperative revision. There were no perioperative deficits. Conclusion: Brainlab’s Cirq® Robotic Alignment surgeon-controlled robotic arm is a safe and beneficial method for accurate thoracolumbar pedicle screw placement with high accuracy.

Value chain–based approaches offer tremendous scope for market-based improvements in production, productivity, rural economy diversification, and household incomes, but are often covered by literature that is too conceptual or heavily focused on analysis. This has created a gap in the information available to planners, practitioners, and value chain participants. Furthermore, few references are available on how these approaches can be applied specifically to developing agriculture in Africa. 'Building Competitiveness in Africa's Agriculture: A Guide to Value Chain Concepts and Applications' describes practical implementation approaches and illustrates them with scores of real African agribusiness case studies. Using these examples, the 'Guide' presents a range of concepts, analytical tools, and methodologies centered on the value chain that can be used to design, implement, and evaluate agricultural and agribusiness development initiatives. It stresses principles of market focus, collaboration, information sharing, and innovation. The 'Guide' begins by examining core concepts and issues related to value chains. A brief literature review then focuses on five topics of particular relevance to African agricultural value chains. These topics address challenges faced by value chain participants and practitioners that resonate through the many cases described in the book. The core of the book presents methodological tools and approaches that blend important value chain concepts with the topics and with sound business principles. The tools and case studies have been selected for their usefulness in supporting market-driven, private-sector initiatives to improve value chains. The 'Guide' offers 13 implementation approaches, presented within the implementation cycle of a value chain program, followed by descriptions of actual cases. Roughly 60 percent of the examples are from Africa, while the rest come from Europe, Latin America, and Asia. The 'Guide' offers useful guidance to businesspeople, policy makers, representatives of farmer or trade organizations, and others who are engaged in agro-enterprise and agribusiness development. These readers will learn how to use value chain approaches in ways that can contribute to sound operational decisions, improved market linkage, and better results for enterprise and industry development.

This paper investigates how the structure of political institutions influences the effectiveness of corporate political lobbying by shaping the “veto points” and “entry points” that lobbying firms encounter and require, respectively, when attempting to influence public policies; in so doing, this study deepens our understanding of the strategic implications of institutional environments. Using large-sample and cross-country firm-level data, we find that the influence of firms’ lobbying activities on public policies is weakened when there are tighter constraints generated as a result of greater political (partisan) competition and more subnational government tiers. We find that the negative association between the effectiveness of lobbying and political (partisan) competition is particularly pronounced in countries with lower electoral accountability and that the negative association between the effectiveness of lobbying and subnational government tiers is particularly pronounced in more centralized political systems.

Background: Global trade and travel are key factors affecting the initial introduction of vectors and VBDs (vector-borne diseases) in a country. Vectors know no borders; it is essential to establish systems for the surveillance of vectors and vector-borne diseases (VBDs). This study was conducted to investigate the strengths and weaknesses of a newly established entomological surveillance system for Aedes mosquitoes at points of entry (PoE) in West Azerbaijan Prov­ince. Methods: The Aedes surveillance system was implemented in West Azerbaijan Province from 2019 to 2023. Following national guidelines, Aedes eggs and larvae were surveyed at eight international PoEs using ovitraps and by collecting larvae from natural or artificial habitats. A specific checklist designed for this study was employed to evaluate the pro­gram. Results: Over 9008 ovitraps were deployed, while 552 had eggs, including species from the families Phasmatidae and Psychodidae, as well as species from the genus Culex and Aedes caspius. Additionally, 506 larvae were collected during the surveillance period. The program had several key strengths, including a well-structured reporting system, robust technical support, knowledgeable personnel, designated health staff spaces at PoE, standardized surveillance tools, initi­atives for environmental enhancement, the establishment of an entomology laboratory, cross-border collaborations, and public health education campaigns. Identified weaknesses comprised staff and entomologist shortages, the absence of a functional insectary, limited engagement of volunteer groups, and inadequate availability of insecticides and tools for emergency vector control.  Conclusions: The study outcomes shed light on the challenges and suggest operational and practical solutions to ad­dress the identified shortcomings.

Integrated landscape approaches are gaining momentum, but there is a lack of evidence on how to get started. Bringing multiple stakeholders together to negotiate trade-offs between conservation and development, as well as competing land uses, is an ambitious goal involving high transaction costs. There is a need to identify entry or leverage points for implementing landscape approaches and assess their potential. Although principles and criteria for landscape approaches are available, few studies provide concrete indicators to assess the viability of such entry points. This paper addresses this gap. Drawing on a systematic literature review and expert insights, we propose a set of indicators aligned with principles related to foundational conditions, stakeholder engagement, orientation toward landscape outcomes, negotiation processes, and learning, monitoring, and evaluation. These indicators can be used to assess the potential and limitations of landscape initiatives to evolve into full landscape approaches.

Transcutaneous neuromuscular electrical stimulation applied in clinical settings is currently characterized by a wide heterogeneity of stimulation protocols and modalities. Practitioners usually refer to anatomic charts (often provided with the user manuals of commercially available stimulators) for electrode positioning, which may lead to inconsistent outcomes, poor tolerance by the patients, and adverse reactions. Recent evidence has highlighted the crucial importance of stimulating over the muscle motor points to improve the effectiveness of neuromuscular electrical stimulation. Nevertheless, the correct electrophysiological definition of muscle motor point and its practical significance are not always fully comprehended by therapists and researchers in the field. The commentary describes a straightforward and quick electrophysiological procedure for muscle motor point identification. It consists in muscle surface mapping by using a stimulation pen-electrode and it is aimed at identifying the skin area above the muscle where the motor threshold is the lowest for a given electrical input, that is the skin area most responsive to electrical stimulation. After the motor point mapping procedure, a proper placement of the stimulation electrode(s) allows neuromuscular electrical stimulation to maximize the evoked tension, while minimizing the dose of the injected current and the level of discomfort. If routinely applied, we expect this procedure to improve both stimulation effectiveness and patient adherence to the treatment. The aims of this clinical commentary are to present an optimized procedure for the application of neuromuscular electrical stimulation and to highlight the clinical implications related to its use.

The use of ubiquitous devices is increasing worldwide due to signs of progress in sophisticated hardware technology with cutting-edge features. These features offer most users to store their personal information on the device. One of the most usable and off-the-shelf ubiquitous devices in our daily lives is the smartphone. To protect the stored information, the smartphone is enabled with entry-point authentication. Moreover, existing methods of entry-point authentication are not useful unless access control is vigilantly protected. To overcome these issues, the current trend in user authentication of the smartphone is implicit or continuous authentication. In the coming years, the smartphone is expected to enable with intelligent access control in support of continuous authentication. This article reviews available public datasets in continuous authentication of the smartphone. Then, we delve into unimodal and multimodal aspects of continuous authentication. We review the available literature on both aspects of continuous authentication that describe problems tackled, the methodology used, associated datasets, and approaches used for performance evaluation. At the end of each aspect, we highlight the lessons learned based on the literature. Furthermore, this article also reviews attacks on behavioral biometrics of the smartphone. Finally, this article confers open challenges and potential directions for future exploration that must be addressed. This article helps readers to understand the datasets, existing methods in this field, and fosters to implement new methods without pitfalls.

The transpedicular procedure has been widely used in spinal surgery. The determination of the best entry point is the key to perform a successful transpedicular procedure. Various techniques have been used to determine this point, but the results are variable. This study was carried out to determine the posterior endpoint of the lumbar pedicle central axis on the standard anterior–posterior (AP) fluoroscopic images. Computer-aided design technology was used to determine the pedicle central axis and the posterior endpoint of the pedicle central axis on the posterior aspect of the vertebra. The standard AP fluoroscopic image of the lumbar vertebral models by three-dimensional printing was achieved. The endpoint projection on the AP fluoroscopic image was determined in reference to the pedicle cortex projection by the measurements of the angle and distance on the established X–Y coordinate system of the radiologic image. The projection of posterior endpoint of the lumbar pedicle central axis were found to be superior to the X-axis of the established X–Y coordinate system and was located on the pedicle cortex projection on the standard AP fluoroscopic image of the vertebra. The projection point was distributed in different sectors in the coordinate system. It was located superior to the X-axis by 18° to 26° at L1, while they were located superior to the X-axis by 12° to 14° at L2 to L5. The projections of posterior endpoints of the lumbar pedicle central axis were located in different positions on the standard AP fluoroscopic image of the vertebra. The determination method of the projection point was helpful for selecting an entry point for a transpedicular procedure with a fluoroscopic technique.

Purpose The customer order decoupling point (CODP) concept addresses the issue of customer engagement in the manufacturing process. This has traditionally been applied to material flows, but has more recently been applied to engineering activities. This later subject becomes of particular importance to companies operating in “engineer-to-order” (ETO) supply chains, where each order is potentially unique. Existing conceptualisations of ETO are too generic for practical purposes, so there is a need to better understand order penetration in the context of engineering activities, especially design. Hence, the purpose of this paper is to address the question “how do customer penetration concepts apply to engineering design activities?” Design/methodology/approach A collaborative form of inquiry is adopted, whereby academics and practitioners co-operated to develop a conceptual framework. Within this overarching research design, a focus group of senior practitioners and multiple case studies principally from complex civil and structural engineering as well as scientific equipment projects are used to explore the framework. Findings The framework results in a classification of nine potential engineering subclasses, and insight is given into order penetration points, major uncertainties and enablers via the case studies. Focus group findings indicate that different managerial approaches are needed across subclasses. Practical implications The findings give insight for companies that engage directly with customers on a one-to-one basis, outlining the extent of customer penetration in engineering activities, associated operational strategies and choices regarding the co-creation of products with customers. Care should be taken in generalising beyond the sectors addressed in the study. Originality/value The paper refines the definition of the ETO concept, and gives a more complete understanding of customer penetration concepts. It provides a comprehensive reconceptualization of the ETO category, supported by exploratory empirical research.

The aim of the study was to investigate the uniformity of the muscle motor point location for lower limb muscles in healthy subjects. Fifty-three subjects of both genders (age range: 18–50 years) were recruited. The muscle motor points were identified for the following ten muscles of the lower limb (dominant side): vastus medialis, rectus femoris, and vastus lateralis of the quadriceps femoris, biceps femoris, semitendinosus, and semimembranosus of the hamstring muscles, tibialis anterior, peroneus longus, lateral and medial gastrocnemius. The muscle motor point was identified by scanning the skin surface with a stimulation pen electrode and corresponded to the location of the skin area above the muscle in which an electrical pulse evoked a muscle twitch with the least injected current. For each investigated muscle, 0.15 ms square pulses were delivered through the pen electrode at low current amplitude (<10 mA) and frequency (2 Hz). 16 motor points were identified in the 10 investigated muscles of almost all subjects: 3 motor points for the vastus lateralis, 2 motor points for rectus femoris, vastus medialis, biceps femoris, and tibialis anterior, 1 motor point for the remaining muscles. An important inter-individual variability was observed for the position of the following 4 out of 16 motor points: vastus lateralis (proximal), biceps femoris (short head), semimembranosus, and medial gastrocnemius. Possible implications for electrical stimulation procedures and electrode positioning different from those commonly applied for thigh and leg muscles are discussed.