Worlds apart? Healthcare technologies for lifelong disease management.
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As a companion article to the Journal of Clinical Engineering's series on Bioengineering Education in the United States, this paper describes the biomedical engineering and biomedical engineering technology programs in Canada. The purpose of the article is not to evaluate each program, but to illustrate the breadth of bioengineering and related programs available today in this country. While biomedical engineering technology programs are offered at the college level, the Canadian philosophy toward biomedical engineering is slightly different from that found in the United States: in Canada, biomedical engineering is offered only at the graduate level to qualified applicants with a previous degree in engineering, science, medicine, or dentistry.
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The genetic engineering of protein-based polymers is a method that enables, in an easy way, the design of complex and highly functional macromolecules. As examples of this approach, different molecular designs are presented, with increasing degree of complexity, showing how the controlled increase in their complexity yields (multi)functional materials with more selected and sophisticated properties. The simplest designs show interesting properties already, but the adequate introduction of given chemical functions along the polymer chain provides an opportunity to expand the range of properties to enhanced smart behavior and self-assembly. Finally, examples are given where those molecular designs further incorporate selected bioactivities in order to develop materials for the most cutting edge applications in biomedicine and nano(bio)technology.
Many opinions and ideas about aging exist. Biological theories have taken hold of the popular and scientific imagination as potential answers to a "cure" for aging. However, it is not clear what exactly is being cured or whether aging could be classified as a disease. Some scientists are convinced that aging will be biologically alterable and that the human lifespan will be vastly extendable. Other investigators believe that aging is an elusive target that may only be "statistically" manipulatable through a better understanding of the operational principles of systems situated within complex environments. Not only is there confusion over definitions but also as to the safety of any potential intervention. Curing cell death, for example, may lead to cell cancer. The search for a cure for aging is not a clearly beneficial endeavour. This paper will first, describe contemporary ideas about aging processes and second, describe several current life extension technologies. Third, it analyses these theories and technologies, focusing on two representative and differing scientific points of view. The paper also considers the public health dilemma that arises from life extension research and examines two issues, risk/benefit ratio and informed consent, that are key to developing ethical guidelines for life extension technologies.
The introduction of stents to clinical practice in 1987 was the major breakthrough in the field of percutaneous coronary intervention (PCI). The use of stenting has drastically improved the outcomes of traditional PCI. First stents were approved for bailout and treatment of dissections, reducing dramatically the need for emergent coronary artery bypass grafting (CABG) as a result of vessel closure during PCI. Later stents were proven to reduce the restenosis rate of PCI from 30%-40% with balloon angioplasty to 15%-20% with stents, primarily by eliminating elastic recoil and vascular remodeling as shown by intravascular ultrasound (IVUS) studies. These outcomes have led to a wide acceptance of stenting as the strategy of choice for more than 80% of all PCI procedures performed. The current review focuses on the following topics: (1) strategies in drug selection to reduce neointimal proliferation, (2) stent designs and polymer selection as a platform for drug-eluting stents, (3) review of major preclinical and clinical experimental work performed in the field, and (4) a discussion of the potential and limitations of the technology.
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OBJECTIVE: To provide an introduction and a conceptual context for the articles presented in this special edition of the Journal of Head Trauma Rehabilitation on neuropsychological technologies. SUMMARY: Many clinical assessments in neuropsychology are metamorphosing from a psychometric search for a lesion to a functional image of the working brain. Behavioral probes increasingly employ technology to provide more ecologically valid stimuli to elicit diagnostically relevant responses. Intervention strategies include an expanding range of assistive devices and technologically based treatments. The advent of the microprocessor and discipline specific programming have allowed certain aspects of rehabilitation practice to incorporate these new assessment and intervention strategies. For example, the development of neuropsychological technologies has already lead to computer based prosthetics and orthotics, cognitive probes with millisecond accurate links to functional imaging, virtual reality managed ecological assessments, cognitive retraining, assistive devices, and online, and "real-time" database-driven evaluations. Emerging technologies offer the potential for personal, portable, everyday brain imaging and rehabilitation systems. Few psychologists, physiatrists, or allied health professionals are formally trained in technological development. What has emerged thus far is a collection of individual efforts that remain to be integrated into more comprehensive tools for the rehabilitation professions. The selective history of neuropsychological technologies presented here is meant to illustrate past difficulties in the emergence of this sub-specialty and point to new applications and technological integration that may prove fruitful. The convergence of neuroengineering, adaptive assessments, everyday neuroimaging, neuroinformatics, and educational neuroimaging, presage such future developments in neuropsychological technologies.
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The first part of this article discusses four forces underlying the emergence, adoption, and routinization of medical technology: key societal values, policies of the federal government, reimbursement policies, and economic incentives. It also addresses a set of impacts resulting from increased reliance on medical technology. The second part of the paper assesses three examples of childbirth technology: electronic fetal monitor, obstetric ultrasound, and cesarean birth. The tendency toward premature and excessive use of technology is especially strong in the area of childbirth and technology.
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