Significant Breaches Research Articles

284 CT-Based Assessment of Prone Versus Lateral Pedicle Screw Placement Accuracy: A Retrospective Single-surgeon Study

INTRODUCTION: Lateral lumbar interbody fusion (LLIF) including the anterior-to-psoas oblique lumbar interbody fusion (OLIF) has conventionally relied on pedicle screw placement (PSP) for construct stabilization. Single-position surgery with lumbar interbody fusion (LIF) in the lateral decubitus position with concomitant PSP has been associated with increased operative efficiency. What remains unclear is the accuracy of PSP with robotic guidance when compared to the more familiar prone patient positioning. METHODS: We identified all consecutive patients treated with interbody fusion and PSP in the prone or lateral position by a single surgeon between January 2019 and October 2022. All pedicle screws placed were analyzed using CT imaging to determine appropriate positioning according to the Gertzbein-Robbins Classification Grading System. Multivariate logistic regression models were constructed to identify risk factors for the occurrence of a radiographically significant breach. RESULTS: 89 consecutive patients were included (n = 690 screws), of whom 46 were treated in the prone position (n = 477 screws) and 43 in the lateral decubitus position (n = 213 screws). There were fewer breaches in the prone (n = 13; 2.7%) versus lateral decubitus group (n = 15; 7.0%; p = 0.012). Nine (1.9%) radiographically significant breaches occurred in the prone group compared to 10 (4.7%) in the lateral decubitus group (p = 0.019), for a prone vs. lateral decubitus pedicle screw accuracy rate of 98.1% vs. 95.3%. There were no significant differences in BMI between prone vs. lateral decubitus cohorts (30.1 vs. 29.6) or breached patients vs. non-breached patients (31.2 vs. 29.5). In multivariate models, prone position was the only significant protective factor for screw accuracy; we did not identify any other significant risk factors for screw breach. CONCLUSIONS: The present data suggest pedicle screws placed with robotic assistance have higher placement accuracy in the prone position.

Improving Intrusion Detection using Satin Bowerbird Optimization with Deep Learning Model for IIoT Environment

Intrusion Detection in the Industrial Internet of Things (IIoT) concentrations on the security and safety of critical structures and industrial developments. IIoT extends IoT principles to industrial environments, but linked sensors and devices can be deployed for monitoring, automation, and control of manufacturing, energy, and other critical systems. Intrusion detection systems (IDS) in IoT drive to monitor network traffic, device behavior, and system anomalies for detecting and responding to security breaches. These IDS solutions exploit a range of systems comprising signature-based detection, anomaly detection, machine learning (ML), and behavioral analysis, for identifying suspicious actions like device tampering, unauthorized access, data exfiltration, and denial-of-service (DoS) attacks. This study presents an Improving Intrusion Detection using Satin Bowerbird Optimization with Deep Learning (IID-SBODL) model for IIoT Environment. The IID-SBODL technique initially preprocesses the input data for compatibility. Next, the IID-SBODL technique applies Echo State Network (ESN) model for effectual recognition and classification of the intrusions. Finally, the SBO algorithm optimizes the configuration of the ESN, boosting its capability for precise identification of anomalies and significant security breaches within IIoT networks. By widespread simulation evaluation, the experimental results pointed out that the IID-SBODL technique reaches maximum detection rate and improves the security of the IIoT environment. Through comprehensive experimentation on both UNSW-NB15 and UCI SECOM datasets, the model exhibited exceptional performance, achieving an average accuracy of 99.55% and 98.87%, precision of 98.90% and 98.93%, recall of 98.87% and 98.80%, and F-score of 98.88% and 98.87% for the respective datasets. The IID-SBODL model contributes to the development of robust intrusion detection mechanisms for safeguarding critical industrial processes in the era of interconnected and smart IIoT environments.

Strengthening the Constitutional Court’s Authority to Adjudicate on Disputes Regarding the Result of Regional Head Election In Indonesia: an Urgency to Clarify the Constitutional Framework

<em>Since the Constitutional Court is the guardian of democracy and the constitution, it is responsible for ensuring that elections in Indonesia are held in a democratic manner. The power rotation process must be carried out calmly and collectedly, without any significant breaches of people's fundamental rights or acts of violence. The instrument of authority is a necessary component for the Constitutional Court to achieve all of the goals stated in the text. The functioning of the Constitutional Court's authority to resolve disputes relating to the outcomes of Indonesia's regional head elections will be further examined in this research.</em> <em>Then, in order to determine the necessary treatments, a worldwide comparison of the increasing symptoms with those of other countries will be carried out. The research methodology used is doctrinal legal study using a comparative constitutional research strategy. The findings demonstrated the weakness of the Constitutional Court's authority to resolve disputes over the outcomes of regional head elections. It was observed that there were </em><em>three distinct interpretations of the norms that formed the basis for legitimacy, which resulted in progressive changes to this authority. The Republic of Indonesia's 1945 Constitution's ambiguous normative framework for regional head elections has led to ongoing interpretations</em> <em>It is really unique in light of the fact that the constitutions of 43 of 72 unitary nations in the world </em><em>fully regulate election procedures and the course of </em><em>dispute settlement in the event of a dispute. In fact, they specifically mention in one or more of the Constitutional Court's complete authority articles the nature of authority and the scope of elections. It is imperative to promptly establish the precedent with clear legal politics declaring that regional head elections are elections in order to guarantee that the Constitutional Court hears the majority of cases.</em>

Understanding the battleground of identity fraud

Identity fraud has rapidly expanded into one of the fastest-growing white-collar crimes in the US. Beyond its substantial economic toll, resulting in billions of dollars in losses to the economy, identity fraud inflicts significant financial losses and mental distress upon its victims. With increasing online activity and the growing frequency of significant data breaches, the complexity and scale of identity fraud continue to grow. However, most academic research in this space has been focused on identifying cognitive behaviors and interventions at the individual level. Addressing a complex, multifaceted social issue like identity fraud necessitates a more comprehensive understanding of its underlying drivers at a broader macro level. We employed statistical methodologies to examine and analyze the factors influencing identity fraud in the US across a wide spectrum of variables using data from 2005 to 2021. A total of 12 explanatory variables, including macroeconomic indicators, sociodemographic factors, and criminal behavior, were analyzed. We identified the statistically significant variables associated with identity fraud through multiple linear regression, ANOVA, and multicollinearity analysis. Our analysis supported the hypothesis that the national unemployment rate, online banking usage, and incidence of fraud-related offenses were statistically significant variables in explaining identity fraud. Although not statistically significant, the increasing occurrence of data breaches and cyber-attacks and their implications for data security and privacy may warrant further attention. The overarching objective of this study was to establish a macro-level framework to understand identity fraud better, thereby fostering subsequent research and intervention efforts at both the individual and societal levels.

Subject Review: Enhancing Cyber Security through Machine Learning Model in Cloud Computing Environment

Cloud computing (CC) has become more and more popular in environments that use distributed computing. Cloud-based processing and data storage is becoming a global trend. Perhaps might put up the effect that Software as a Service (SaaS) has on numerous commercial applications and daily lives as disruptive technology. Cloud computing (CC) is an extension of Internet-based computing, where devices can access shared software, resources, and data as required. Machine learning (ML) has become a popular tool in the areaof cybersecurity(CS)through the cloud computing environment in recent years. Examples of its applications include biometric-based user authentication and the detection of malware or intrusions. However, attacks on machine learning (ML) algorithms may occur in both the testing and training phases, which typically results in significant performance reductions and safety breaches. This article provides a comprehensive study on the use of machine learning (ML) algorithmsto enhance cybersecurity (CS), as well as a comparison of most of the machine learning (ML) techniques mentioned in the work. The article presents future work of previous works that help researchers find ways to improve cybersecurity.

‘Hacking the hackers’: reflections on state-implemented disruption as a ‘new model’ for cyber policing

ABSTRACT Following the most significant data breaches in Australia’s history, targeting Optus and Medibank, in November 2022 Australia’s Minster for Home Affairs and Cybersecurity Clare O’Neil announced ‘a new model of policing’ involving a collaboration between the Australian Federal Police and Australian Signals Directorate. This collaboration would result in a new taskforce focused on ‘hacking the hackers’ or disrupting criminal groups responsible for high-profile cyber-attacks against Australian entities. Since this announcement, significant discussion has ensued regarding the meaning of state-implemented ‘disruption’ and questions have been raised about the potential mandate and operations of the newly announced taskforce. This paper explores the concept of disruption as it applies to cyber-criminal groups. It then turns to considerations for policy and practice regarding the pursuit of disruption. The paper aims to advance existing understanding of disruption and encourage further research and policy debate into the policing of cybercrime as the Australian government commences work on the 2023–2030 Australian Cyber Security Strategy.

"Critical pedicle wall" breaches analysis in complex spinal deformity using O-arm navigation.

Free-hand and fluoroscopic-guided pedicle screw placement has been associated with higher rates of pedicle breaches (frequency range 15-40% especially in deformed pedicles). Neurological complications are more "critical" (i.e., frequent and significant) with medial and inferior pedicle-wall breaches due to the proximity of the neural elements. Here, we analyzed the effectiveness of O-arm navigation in minimizing "critical" pedicle wall breaches and their complications in 21 complex spinal deformity cases. Twenty-one complex spinal deformity cases were prospectively managed with O-arm-navigated posterior-instrumented fusions. Preoperative assessment included; evaluation of the type of scoliosis, the magnitude of the deformity, and the anatomy of the pedicles - (i.e., classified using Watanabe et al.). The O-arm was used to confirm and grade both the intraoperative and postoperative location of screws. Other variables analyzed included; duration of surgery, estimated blood loss, complications, and radiation exposure. In 21 patients, 259 (63.45%) of 384 pedicles were instrumented; we observed 22 of 259 pedicle screw breaches. Significant (>2 mm) breaches were observed in two medial and one inferior wall cases that required revision; the overall biomechanically significant screw breach rate was (3/259) 1.2% with an accuracy rate of 98.8%. Pedicle screw placement resulted in another 14 nonsignificant (<2 mm) breaches; ten were medial and four involved the inferior wall. As anterior, lateral, and "in-out-in" trajectory pedicle screws beaches were nonsignificant, they were not included in our analysis. O-arm navigation decreased the incidence of medial and inferior (i.e., >2 mm "critical") pedicle screw breaches applied in 21 patients with deformed pedicles due to scoliosis. Further, the O-arm minimized the operating time, decreased the estimated blood loss, and reduced the incidence of complications.

Retrospective single-surgeon study of prone versus lateral robotic pedicle screw placement: a CT-based assessment of accuracy.

Lateral lumbar interbody fusion including anterior-to-psoas oblique lumbar interbody fusion has conventionally relied on pedicle screw placement (PSP) for construct stabilization. Single-position surgery with lumbar interbody fusion in the lateral decubitus position with concomitant PSP has been associated with increased operative efficiency. What remains unclear is the accuracy of PSP with robotic guidance when compared with the more familiar prone patient positioning. The present study aimed to compare robot-assisted screw placement accuracy between patients with instrumentation placed in the prone and lateral positions. The authors identified all consecutive patients treated with interbody fusion and PSP in the prone or lateral position by a single surgeon between January 2019 and October 2022. All pedicle screws placed were analyzed using CT scans to determine appropriate positioning according to the Gertzbein-Robbins classification grading system (grade C or worse was considered as a radiographically significant breach). Multivariate logistic regression models were constructed to identify risk factors for the occurrence of a radiographically significant breach. Eighty-nine consecutive patients (690 screws) were included, of whom 46 (477 screws) were treated in the prone position and 43 (213 screws) in the lateral decubitus position. There were fewer breaches in the prone (n = 13, 2.7%) than the lateral decubitus (n = 15, 7.0%) group (p = 0.012). Nine (1.9%) radiographically significant breaches occurred in the prone group compared with 10 (4.7%) in the lateral decubitus group (p = 0.019), for a prone versus lateral decubitus PSP accuracy rate of 98.1% versus 95.3%. There were no significant differences in BMI between prone versus lateral decubitus cohorts (30.1 vs 29.6) or patients with screw breach versus those without (31.2 vs 29.5). In multivariate models, the prone position was the only significant protective factor for screw accuracy; no other significant risk factors for screw breach were identified. The present data suggest that pedicle screws placed with robotic assistance have higher placement accuracy in the prone position. Further studies will be needed to validate the accuracy of PSP in the lateral position as single-position surgery becomes more commonplace in the treatment of spinal disorders.

Vulnerability to Cyberattacks and Sociotechnical Solutions for Health Care Systems: Systematic Review.

Health care organizations worldwide are faced with an increasing number of cyberattacks and threats to their critical infrastructure. These cyberattacks cause significant data breaches in digital health information systems, which threaten patient safety and privacy. From a sociotechnical perspective, this paper explores why digital health care systems are vulnerable to cyberattacks and provides sociotechnical solutions through a systematic literature review (SLR). An SLR using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was conducted by searching 6 databases (PubMed, Web of Science, ScienceDirect, Scopus, Institute of Electrical and Electronics Engineers, and Springer) and a journal (Management Information Systems Quarterly) for articles published between 2012 and 2022 and indexed using the following keywords: "(cybersecurity OR cybercrime OR ransomware) AND (healthcare) OR (cybersecurity in healthcare)." Reports, review articles, and industry white papers that focused on cybersecurity and health care challenges and solutions were included. Only articles published in English were selected for the review. In total, 5 themes were identified: human error, lack of investment, complex network-connected end-point devices, old legacy systems, and technology advancement (digitalization). We also found that knowledge applications for solving vulnerabilities in health care systems between 2012 to 2022 were inconsistent. This SLR provides a clear understanding of why health care systems are vulnerable to cyberattacks and proposes interventions from a new sociotechnical perspective. These solutions can serve as a guide for health care organizations in their efforts to prevent breaches and address vulnerabilities. To bridge the gap, we recommend that health care organizations, in partnership with educational institutions, develop and implement a cybersecurity curriculum for health care and intelligence information sharing through collaborations; training; awareness campaigns; and knowledge application areas such as secure design processes, phase-out of legacy systems, and improved investment. Additional studies are needed to create a sociotechnical framework that will support cybersecurity in health care systems and connect technology, people, and processes in an integrated manner.

Factors influencing the implementation of a ventilation weaning protocol in an adult intensive care unit: a qualitative multidisciplinary evaluation.

Development of protocolized care in the intensive care unit (ICU) improves patient outcomes, but presents multiple challenges. A mechanical ventilation weaning protocol (WP) was adopted in our institution but was underused. This study aimed to determine the factors that influenced the implementation of this protocol locally. We performed a qualitative descriptive study using semidirected interviews in small profession-specific focus groups. The interviews were based on a standardized guide covering the major domains found in the Consolidated Framework for Implementation Research. A total of 32 participants across four key professions were recruited. The interviews were transcribed and codified sequentially, followed by categorization and analysis. Three broad factors emerged that negatively impacted the implementation of the WP. First, the goals of the WP differed between professional groups. This difference led to significant frustration and breaches in collaboration. Second, there was a lack of a continuous quality improvement process. Third, the WP was incompatible with the routine and procedures already in place at the time of implementation. Time-of-day of WP application and patient safety concerns were specifically identified issues. Implementation of a continuous improvement process with regular and specific follow-up may help identify potential challenges and thus help ensure a more consistent use of the WP.

Discovering the Potentials of Four Phage Endolysins to Combat Gram-Negative Infections.

Endolysin-based therapeutics are promising antibacterial agents and can successfully supplement the existing antibacterial drugs array. It is specifically important in the case of Gram-negative pathogens, e.g., ESKAPE group bacteria, which includes Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species, and are highly inclined to gain multiple antibiotic resistance. Despite numerous works devoted to the screening of new lytic enzymes and investigations of their biochemical properties, there are significant breaches in some aspects of their operating characteristics, including safety issues of endolysin use. Here, we provide a comprehensive study of the antimicrobial efficacy aspects of four Gram-negative bacteria-targeting endolysins LysAm24, LysAp22, LysECD7, and LysSi3, their in vitro and in vivo activity, and their biological safety. These endolysins possess a wide spectrum of action, are active against planktonic bacteria and bacterial biofilms, and are effective in wound and burn skin infection animal models. In terms of safety, these enzymes do not contribute to the development of short-term resistance, are not cytotoxic, and do not significantly affect the normal intestinal microflora in vivo. Our results provide a confident base for the development of effective and safe candidate dosage forms for the treatment of local and systemic infections caused by Gram-negative bacterial species.

Legal Governance of Brain Data Derived from Artificial Intelligence

Legal Governance of Brain Data Derived from Artificial Intelligence

828 Is Isolation Before Elective Surgery the Way Forward During The COVID-19 Pandemic?

IntroductionThe COVID-19 pandemic is here to last, and services must adapt to enable elective surgery to continue. Surgery involves high-risk aerosol generating procedures, potentially harmful to staff and patients. The current NICE guidance is for the patient to self-isolate for 72 hours prior to surgery. A question persists: Is 72-hour isolation the way forward in elective general surgery?MethodIn a DGH centre, using an anonymous questionnaire, we prospectively collected data on isolation for 36 elective general surgery patients during the 72h isolation period. The data was analysed to assess the concordance with isolation as well as patient's satisfaction with the process.Results75% of patients were concordant with 72 hours of isolation pre-operatively. This was an increase from 35% when compared to patients questioned during the 14 day isolation period. The main factors contributing to isolation breech were visitors to the house and the mode of transport used to attend hospital.ConclusionsThe protocol is now for a COVID swab 72 hours pre-operatively followed by isolation until the operation. Our results show that still significant breaches in isolation remain and patients welfare is adversely affected during that period. Further research and consideration is needed to optimise the COVID isolation protocol.

Covid-19 a Gateway to Enhance China’s Food Safety Culture

Despite scientific advances, the continuous improvements associated with food safety management systems and increasing aca- demic debate. There is a sobering reality in the twenty first century that 600 million people suffer from food contamination. China, through its ‘One Belt One Road’ Strategy is actively encouraging all enterprise sectors to export. However, the Chinese food sector has a tainted history of significant breaches in food safety compliance, which has significantly hindered its export market. The Covid-19 pandemic has once again turned global attending to China’s food safety management systems with increased concern. This paper utilises the implementation of the Enlighten Food Safety Culture model to assess food safety culture within the Inner Mongolian Food Sector and to provides a food safe culture road to recovery in terms of safe practices and in turn strengthen China’s food safety reputation..

Precision-Enhanced Differentially-Private Mining of High-Confidence Association Rules

Association rule mining discovers patterns in large data repositories, and benefits diverse application domains such as healthcare, marketing, etc. However, mining datasets that contain data about individuals may cause significant privacy breaches. Recent research addresses the privacy threats that arise when mining sensitive data, and several techniques allow data mining with differential privacy guarantees. However, existing methods only discover rules that have very large support, i.e., occur in a large fraction of the dataset transactions (typically, more than 50 percent). This is a serious limitation, as numerous high-quality rules do not reach such high frequencies (e.g., rules about rare diseases, or luxury merchandise). We propose a method that focuses on mining high-quality association rules with moderate and low frequencies. We employ a novel technique for rule extraction that combines the exponential mechanism of differential privacy with reservoir sampling. The proposed algorithm allows us to directly mine association rules, without the need to compute noisy supports for large numbers of itemsets. Our experimental evaluation shows that our technique is able to sample low- and moderate-support rules with good precision, clearly outperforming existing solutions.

World Heritage and Human Rights: Lessons from the Asia-Pacific and Global Arena ed. by Peter Bille Larsen

Reviewed by: World Heritage and Human Rights: Lessons from the Asia-Pacific and Global Arena ed. by Peter Bille Larsen Michael Herzfeld World Heritage and Human Rights: Lessons from the Asia-Pacific and Global Arena. Edited by Peter Bille Larsen. London and New York: Routledge, 2018. xxii + 325 pp., 26 figures, 2 tables. Paperback US $43, ISBN 978-1-13822-422-3; Hardback US $124, ISBN 978-1-13822-421-6; E-book $27, ISBN 978-1-31540-278-9. Heritage and rights, ethical domains that sometimes overlap like Venn circles, also often erupt into discord, pitting local cultural values against a universalism born of colonial domination and still embedded in the lofty presumptions of what UNESCO recognizes as “Outstanding Universal Value.” Regional (Asia-Pacific) coverage is necessarily uneven both because the record is itself highly variable and because authors are treading on political eggshells. That much is clear from the nine case studies and five legal reviews laid out in this cautiously optimistic volume. Amid multiple contradictions in legal writ and practice, several important common themes emerge. Consent, participation, and prosperity, along with a near-worldwide commitment to according dignity to all, loom large as rights, including the right to heritage, but also the right to ask, “Whose heritage?” Ownership itself is a conceptual quagmire for socialist societies or where land and material objects are not culturally viewed as individual property. Micro-histories of struggles for recognition challenge the triumphalism of national and international heritage regimes. Larsen argues that the UNESCO World Heritage program’s “original sin” (p. 7) is reflected in the absence of people from narratives of success; Alexander H. E. Morawa and Gabriel Zalazar call for “cross-referencing” (p. 198), allowing local groups and the international bureaucracy to learn from each other. As Larsen suggests (p. 16), “vague win-win language” can mask a variety of damaging concessions to economic [End Page 487] power and cultural insensitivity. The ethnographic methods he and Kristal Buckley advocate can only partially redress this imbalance, given the capacity of the powerful to camouflage their actions. Some significant breaches have nevertheless now broken the silence of complicity among states, corporations, religious authorities, and international organizations, as in the recognition (reported by Jonathan Liljeblad) of fragile, unofficial, Hindu-derived rituals performed by self-professed Buddhists in Sambor Prei Kuk, Cambodia (pp. 74–76); danger still lurks with the prospect of World Heritage listing, which threatens these highly localized religious practices with official reabsorption as “culture.” Human rights demand a shift of focus from the inaccessibly abstract and universalist to the fragile and specific. Law, while rhetorically abstract and generic, in practice is always case-specific. The language of “community” may nevertheless still mask internal inequality and intrusive exploitation. While the contrast drawn by Amran Hamzah (p. 115) between “Western” and “indigenous” understandings of good governance reproduces a dichotomy redolent of such official thinking, he is right to insist on the intellectual capabilities and knowledge of local actors. Binaries, by contrast, tend to support nationalist and regionalist generalizations. Thus, the Vietnamese instrumentalization of “Asian values,” as Larsen shows (p. 185), does not automatically entail respect for local values, although official acceptance of activists’ calls for remedial action is encouraging. Elsewhere, as Buckley, Ian Lilley, and Helena Kajlich demonstrate for Australia (against the complex legal background usefully detailed by Ben Boer and Stefan Gruber), it has not been easy to establish respect for indigenous negotiation methods and concepts of collective identity. Moreover, as Anne Laura Kraak demonstrates for Bagan, internal differentiation also requires attention; local factionalism and class hierarchy may filter policy impact. The case of Vigan (described by Sara Dürr, Malot Ingel, and Bettina Beer), for example, shows that anti-poverty policies work selectively, their trajectories overdetermined by the influence of unequally distributed wealth and power. Bipin Adhikari’s historical and legal survey of Nepal’s evolving heritage policies shows why, before democratization, one dominant area— the Kathmandu Valley, itself an area where “social complexity” today impacts heritage conservation efforts (Sudarshan Raj Tiwari, Pranita Shrestha, and Hans Christie Bjønness, p. 147)—received almost exclusive attention. Overly generic policies often spring from convenient assumptions, as when Southeast Asian officials treat swidden agriculturalist...

Gastos com Saúde e sua Relação com o Porte Populacional dos Municípios: Um Estudo em Pernambuco

Este artigo tem como objetivo analisar a aplicação dos recursos públicos na saúde e qual a sua relação com o porte populacional dos municípios do Estado de Pernambuco. Trata-se de uma pesquisa quantitativa, descritiva, analítica e retrospectiva, com a utilização de dados secundários referentes à série histórica de 2012 a 2017. Os dados foram coletados no Sistema de Informações sobre Orçamentos Públicos em Saúde e na ferramenta Cidades@ do Instituto Brasileiro de Geografia e Estatística. A análise estatística foi realizada utilizando o Programa Stata. Ao se verificarem as médias de gastos, observou-se que os anos de 2012 e 2016 foram os períodos que apresentaram os mais expressivos descumprimentos do percentual mínimo obrigatório de 15%. No que se refere à série histórica da média de aplicação dos recursos financeiros, verificou-se que em 2016 houve declínio de aplicação em todos os municípios. Constatou-se que os municípios de pequeno porte das mesorregiões da Zona da Mata, Agreste e Sertão apresentaram as maiores médias percentuais, o que demonstra a dependência entre estes e os demais entes federados, portanto faz-se necessário o aprimoramento da gestão dos recursos financeiros.

Feasibility of Endoscopic Inspection of Pedicle Wall Integrity in a Live Surgery Model.

Perforations of the pedicle wall during cannulation can occur with experienced surgeons. Direct endoscopic visualization has not been used to inspect pedicles previously due to bone bleeding obscuring the camera visualization. The hypothesis of this study was that endoscopic visualization of pedicle wall integrity was technically feasible and would enable identification of clinically significant pedicle breaches. A live porcine model was used. Eight lumbar pedicles were cannulated. Clinically significant breaches were created. An endoscope was introduced and was used to inspect the pedicles. All lumbar pedicles were endoscopically visible at a systolic pressure of 100 mm Hg. Clinically relevant anatomic structures and iatrogenic pathology, such as medial, lateral, and anterior breaches, were identified. There were no untoward events resulting from endoscopic inspection of the pedicle endosteal canal. Endoscopic inspection of lumbar pedicles was safe and effective. The findings on endoscopic inspection corresponded with the ball-tip probe palpation techniques. Additional techniques, such as selection between 2 tracts, was possible with the endoscopic technique.

Covering the Cover

Covering the Cover

Fire deaths – a review and an experimental investigation of post-mortem formation of carboxyhaemoglobin

The forensic investigation of deceased retrieved following a fire includes determining if death occurred before or during the event. A blood carboxyhaemoglobin level above 10% is considered indicative of respiration during a fire, implying that an individual was not deceased before the event. Previous spectroscopic studies have revealed that oxygen can passively diffuse through the skin and re-oxygenate haemoglobin. It was therefore questioned if carbon monoxide could also dermally diffuse and elevate post-mortem blood carboxyhaemoglobin levels, which could falsely insinuate that an individual had been alive and respired during a fire. Exposing both oxygenated and deoxygenated forms of haemoglobin to carbon monoxide converted them to carboxyhaemoglobin. This was measured using an ISP-REF Integrating sphere coupled to a USB spectrometer by fibre optic probe. Stillborn piglets were exposed to carbon monoxide to show that the gas can passively diffuse through the skin, resulting in formation of carboxyhaemoglobin in hypostasis, which was confirmed by observing a shift in the absorption spectrum. Piglets with significant cavity breaches, as could be found in cases with extensive stab/bullet wounds or heat defects, exposed to carbon monoxide demonstrated cavity carboxyhaemoglobin levels above 10% which could falsely suggest respiration of carbon monoxide had occurred.