19 resultados para Surgical implants

em CentAUR: Central Archive University of Reading - UK


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Objectives: To assess the potential source of variation that surgeon may add to patient outcome in a clinical trial of surgical procedures. Methods: Two large (n = 1380) parallel multicentre randomized surgical trials were undertaken to compare laparoscopically assisted hysterectomy with conventional methods of abdominal and vaginal hysterectomy; involving 43 surgeons. The primary end point of the trial was the occurrence of at least one major complication. Patients were nested within surgeons giving the data set a hierarchical structure. A total of 10% of patients had at least one major complication, that is, a sparse binary outcome variable. A linear mixed logistic regression model (with logit link function) was used to model the probability of a major complication, with surgeon fitted as a random effect. Models were fitted using the method of maximum likelihood in SAS((R)). Results: There were many convergence problems. These were resolved using a variety of approaches including; treating all effects as fixed for the initial model building; modelling the variance of a parameter on a logarithmic scale and centring of continuous covariates. The initial model building process indicated no significant 'type of operation' across surgeon interaction effect in either trial, the 'type of operation' term was highly significant in the abdominal trial, and the 'surgeon' term was not significant in either trial. Conclusions: The analysis did not find a surgeon effect but it is difficult to conclude that there was not a difference between surgeons. The statistical test may have lacked sufficient power, the variance estimates were small with large standard errors, indicating that the precision of the variance estimates may be questionable.

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Is the human body a suitable place for a microchip? Such discussion is no longer hypothetical - in fact in reality it has not been so for some years. Restorative devices such as pacemakers and cochlear implants have become well established, yet these sophisticated devices form notably intimate links between technology and the body. More recent developments in engineering technologies have meant that the integration of silicon with biology is now reaching new levels - with devices which interact directly with the brain. As medical technologies continue to advance, their potential benefits for human enhancement will become increasingly attractive, and so we need to seriously consider where this may take us. In this paper, an attempt is made to demonstrate that, in the medical context, the foundations of more advanced implantable enhancement technologies are already notably progressed, and that they are becoming more science fact than is widely considered. A number of wider moral, ethical and legal issues stem from enhancement applications and it is difficult to foresee the social consequences, the fundamental changes on our very conception of self and the impact on our identity of adoption long term. As a result, it is necessary to acknowledge the possibilities and is timely to have debate to address the wider implications these possibilities may bring.

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It is now possible to directly link the human nervous system to a computer and thence onto the Internet. From an electronic and mental viewpoint this means that the Internet becomes an extension of the human nervous system (and vice versa). Such a connection on a regular or mass basis will have far reaching effects for society. In this article the authors discuss their own practical implant self-experimentation, especially insofar as it relates to extending the human nervous system. Trials involving an intercontinental link up are described. As well as technical aspects of the work, social, moral and ethical issues, as perceived by the authors, are weighed against potential technical gains. The authors also look at technical limitations inherent in the co-evolution of Internet implanted individuals as well as the future distribution of intelligence between human and machine.

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The possible relationship between nutritional status and clinical outcome following orthopaedic hip surgery was investigated. The nutritional status of 60 elderly female patients admitted for elective total hip replacement (THR) and emergency fractured neck of femur surgery (FNF) was measured over time. Specific measures of clinical outcome, including well-being and functional status, were monitored during hospital stay and at 4, 8 and 26 weeks following discharge. Patients were allocated to a high nutritional risk group where any three of the following were less than the 5th percentile value: serum albumin, haemoglobin, triceps skinfold thickness, mid-upper arm muscle circumference and body weight. Using this definition, malnutrition was present in 4% of THR patients and 41% of FNF patients. It was found that the high risk patients had significantly longer convalescence periods, (median stay27.5 days compared with 0 days, P < 0.0009), and a greater proportion were dependent upon walking frames at 6 months (46% compared with 11%, P < 0.01). Fifty percent of the high risk patients had been living independently prior to admission, in contrast only 29% had returned to their homes at 6 months after discharge. The results indicate an apparent link between clinical outcome and nutritional status based upon the allocation procedure employed, which has the potential for ensuring cost-effective nutritional intervention.

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This paper explores a novel tactile human-machine interface based on the controlled stimulation of mechanoreceptors by a subdermal magnetic implant manipulated through an external electromagnet. The selection of a suitable implant magnet and implant site is discussed and an external interface for manipulating the implant is described. The paper also reports on the basic properties of such an interface, including magnetic field strength sensitivity and frequency sensitivity obtained through experimentation on two participants. Finally, the paper presents two practical application scenarios for the interface.

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In his forum paper, Prof. Kevin Warwick considers four different examples of how the use of implant technology is opening up the possibility of upgrading human abilities, particularly in terms of mental cognition. The main thrust is an overview of Prof. Warwick's own research, which led to him receiving a neural implant linking his nervous system bi-directionally with the internet. With this implant in place, neural signals were transmitted to various technological devices to directly control them, in some cases via the internet, and feedback to the brain was obtained from such stimuli as the fingertips of a robot hand, ultrasonic (extra-) sensory input and neural signals directly from another human's nervous system. A view is taken as to the prospects for the future, both in the short-term as a therapeutic device and in the long-term as a form of enhancement, including the realistic potential, in the near future, for thought communication – thereby opening up tremendous commercial potential. The therapy/enhancement dichotomy is considered here, as well as military and medical issues. Clearly though, an individual whose brain is part human/part machine can have abilities that far surpass those who remain with a human brain alone. Will such an individual exhibit different moral and ethical values to those of a human? If so, what effects might this have on society?

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Power delivery for biomedical implants is a major consideration in their design for both measurement and stimulation. When performed by a wireless technique, transmission efficiency is critically important not only because of the costs associated with any losses but also because of the nature of those losses, for example, excessive heat can be uncomfortable for the individual involved. In this study, a method and means of wireless power transmission suitable for biomedical implants are both discussed and experimentally evaluated. The procedure initiated is comparable in size and simplicity to those methods already employed; however, some of Tesla’s fundamental ideas have been incorporated in order to obtain a significant improvement in efficiency. This study contains a theoretical basis for the approach taken; however, the emphasis here is on practical experimental analysis

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Human ICT implants, such as RFID implants, cochlear implants, cardiac pacemakers, Deep Brain Stimulation, bionic limbs connected to the nervous system, and networked cognitive prostheses, are becoming increasingly complex. With ever-growing data processing functionalities in these implants, privacy and security become vital concerns. Electronic attacks on human ICT implants can cause significant harm, both to implant subjects and to their environment. This paper explores the vulnerabilities which human implants pose to crime victimisation in light of recent technological developments, and analyses how the law can deal with emerging challenges of what may well become the next generation of cybercrime: attacks targeted at technology implanted in the human body. After a state-of-the-art description of relevant types of human implants and a discussion how these implants challenge existing perceptions of the human body, we describe how various modes of attacks, such as sniffing, hacking, data interference, and denial of service, can be committed against implants. Subsequently, we analyse how these attacks can be assessed under current substantive and procedural criminal law, drawing on examples from UK and Dutch law. The possibilities and limitations of cybercrime provisions (eg, unlawful access, system interference) and bodily integrity provisions (eg, battery, assault, causing bodily harm) to deal with human-implant attacks are analysed. Based on this assessment, the paper concludes that attacks on human implants are not only a new generation in the evolution of cybercrime, but also raise fundamental questions on how criminal law conceives of attacks. Traditional distinctions between physical and non-physical modes of attack, between human bodies and things, between exterior and interior of the body need to be re-interpreted in light of developments in human implants. As the human body and technology become increasingly intertwined, cybercrime legislation and body-integrity crime legislation will also become intertwined, posing a new puzzle that legislators and practitioners will sooner or later have to solve.