Dans le cadre de cette thèse, nous proposons une prothèse de mémoire « intelligente », appelée CAPTAIN MEMO, destinée aux malades d’Alzheimer, pour pallier leurs problèmes mnésiques. Cette prothèse est basée sur l’ontologie temporelle, floue et multilingue appelée MemoFuzzyOnto.Cette prothèse offre des interfaces accessibles à cette classe particulière d’utilisateurs. Nous proposons, pour mettre en œuvre ces interfaces, une méthodologie de conception appelée InterfaceToAlz pour concevoir des interfaces accessibles aux malades d’Alzheimer, et qui offre un guide de 146 bonnes pratiques ergonomiques. De plus, nous proposons un outil de visualisation d’ontologies appelé Memo Graph qui génère un graphe dont la visualisation et la manipulation sont accessibles aux malades d’Alzheimer. Cette proposition est motivée par le fait que CAPTAIN MEMO a besoin de générer et d’éditer le graphe de la famille et de l’entourage du patient, à partir de l’ontologie MemoFuzzyOnto qui structure sa base de connaissances. Memo Graph est fondé sur notre guide de bonnes pratiques ergonomiques et notre approche, appelée Incremental Key-Instances Extraction and Visualisation, qui permet une extraction et une visualisation incrémentale du résumé des assertions ABox de l’ontologie. Il supporte également la visualisation des données ouvertes liées (Linked Data) et le passage à l’échelle. Par ailleurs, nous proposons, dans le cadre de cette thèse, une typologie de l’imperfection des données saisies (principalement due à la discordance mnésique provoquée par la maladie), et une méthodologie pour permettre à CAPTAIN MEMO d’être tolérante à la saisie des données fausses. Nous proposons un modèle d’évaluation de la crédibilité et une approche, nommée Data Believability Estimation for Applications to Alzheimer Patients, permettant d’estimer qualitativement et quantitativement la crédibilité de chaque donnée saisie. Enfin, pour que CAPTAIN MEMO soit tolérante à la saisie des intervalles temporels imprécis nous proposons deux approches : l’une basée sur un environnement précis et l’autre basée sur un environnement flou. Dans chacune des deux approches, nous étendons l’approche 4D-fluents pour représenter les intervalles temporels imprécis et les relations temporelles qualitatives, puis nous étendons l’algèbre d’Allen pour prendre en compte les intervalles imprécis dans le cadre de notre ontologie MemoFuzzyOnto. Nos contributions sont implémentées et évaluées. Nous avons évalué l’accessibilité de ses interfaces utilisateurs, le service de CAPTAIN MEMO qui a pour but de stimuler la mémoire du patient, notre approche pour l’estimation quantitative de la crédibilité des données saisies ainsi que la visualisation du graphe générée à l’aide de Memo Graph. Nous avons également évalué la performance de Memo Graph et son utilisabilité par des experts du domaine. / In the context of this thesis, we propose a “smart” memory prosthesis, called CAPTAIN MEMO, to help Alzheimer’s disease patients to palliate mnesic problems. It is based on a temporal, fuzzy and multilingual ontology named MemoFuzzyOnto. It provides accessible user interfaces to this demographic. To design these interfaces, we propose a methodology named InterfaceToAlz which serves as an information base for guiding and evaluating the design of user interfaces for Alzheimer’s disease patients. It identifies 146 design guidelines.Besides, we propose an ontology visualization tool called Memo Graph which offers an accessible and understandable visualization to Alzheimer’s disease patients. In fact, in the context of CAPTAIN MEMO, there is a need to generate the patient entourage/family tree from its personal data structured according to MemoFuzzyOnto. Memo Graph is based on our design guidelines and our approach, named Incremental Key-Instances Extraction and Visualisation, to extract and visualize descriptive instance summarizations from a given ontology and generate “summary instance graphs” from the most important data. It supports Linked Data visualization and scaling.Furthermore, we propose a typology of the imperfection of the data entered (mainly due to the memory discordance caused by this disease), and a methodology to allow false data entry. We propose a believability model and an approach called Data Believability Estimation for Applications to Alzheimer Patients to estimate qualitatively and quantitatively the believability of each data entered. Finally, CAPTAIN MEMO allows imprecise time intervals entry. We propose two approaches: a crisp-based approach and a fuzzy-based approach. The first one uses only crisp standards and tools and is modeled in OWL 2. The second approach is based on fuzzy sets theory and fuzzy tools and is modeled in Fuzzy-OWL 2. For the two approaches, we extend the 4D-fluents model to represent imprecise time intervals and qualitative interval relations. Then, we extend the Allen’s interval algebra to compare imprecise time interval in the context of MemoFuzzyOnto. Our contributions are implemented and evaluated. We evaluated the service of CAPTAIN MEMO which has the aim to stimulate the patient’s memory, the accessibility of its user interfaces, the efficiency of our approach to estimate quantitatively the believability of each data entered and the visualization generated with Memo Graph. We also evaluated Memo Graph with domain expert users.

No description available.

La prothèse totale de la hanche (PTH) avec cupule acétabulaire monobloc et articulation de grand diamètre (LDH) offre une amplitude articulaire supraphysiologique et une stabilité accrue. Reposant sur une fixation primaire par press-fit, l’implantation de ces prothèses sur des cotyles atypiques peut représenter un défi technique. L’objectif principal de ce mémoire est d’évaluer la stabilité de la fixation primaire et secondaire de ces implants lorsqu’utilisés dans un cotyle atypique en première intention ou en révision prothétique. Comme objectif secondaire, nous évaluerons les résultats fonctionnels rapportés par le patient (PROMs) à l’aide de scores validés. Deux séries de cas consécutifs de PTHs LDH monoblocs sur cotyles atypiques ont été évaluées : 125 PTHs primaires et 47 révisions de PTH (rPTH). La mesure d’efficacité primaire était la révision acétabulaire pour toutes causes aseptiques. Les PROMs ont été évalués au dernier suivi avec les scores de Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Forgotten Joint Score (FJS) et Patient’s Joint Perception (PJP). Une évaluation radiologique à la recherche de signes de descellement aseptique a été complétée au dernier suivi. En PTH primaire, après un suivi moyen de 9,2 ans (2,2-15,8), aucun descellement aseptique de la cupule n’a été identifié. Il y a eu 13 (10,4%) révisions sans lien avec la fixation acétabulaire. En rPTH, après un suivi moyen de 4,5 ans (2,0-13,7), il y a eu 5 (10,6%) ré-révision de la cupule incluant 2 pertes de fixation primaire. Le taux de luxation fut de 0% en PTH primaire et de 8,5% (4/47) en rPTH. Les résultats fonctionnels moyens en PTH primaire et rPTH étaient un WOMAC de 9,2 et 19,5 ainsi qu’un FJS de 80,9 et 57,3, respectivement. Quant au PJP en PTH primaire et en rPTH, respectivement, 49,4% et 8,8% des patients percevaient leurs hanches comme naturelle, 19,1% et 23,5% comme une articulation artificielle sans restriction tandis que 31,5% et 67,7% rapportaient un certain degré de restriction. Lorsqu’utilisés par des opérateurs expérimentés sur cotyles présentant un défi de fixation primaire, les cupules monoblocs LDH sont des options intéressantes offrant un faible taux de révision et de complication ainsi que d’excellents résultats cliniques à moyen terme. / Total hip arthroplasty (THA) with monobloc acetabular cup with large diameter bearing (LDH) offers supraphysiologic range of motion and increased stability. Relying on primary press-fit fixation, implantation of these prostheses on atypical acetabula can represent a technical challenge. The main objective of this thesis is to evaluate the stability of primary and secondary fixation of these implants on atypical acetabula in first intention or prosthetic revision. As a secondary objective, we will assess the mid-term clinical results using validated patient-reported outcome measures (PROMs). Two consecutive case series of monobloc LDH THA with atypical acetabula were evaluated: 125 THAs and 47 revisions THA (rTHA). The primary efficacy measure was acetabular revision for all aseptic causes. PROMs were assessed at last follow-up with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Forgotten Joint Score (FJS) and Patient’s Joint Perception question (PJP). A radiological evaluation assessing for signs of aseptic loosening was completed at last follow-up. In primary THA, after a mean follow-up of 9,2 years (2,2-15,8), no aseptic loosening of the acetabular cup was identified. There were 13 (10,4%) revisions unrelated to acetabular fixation. In rTHA, after a mean follow-up of 4,5 years (2,0-13,7), there were 5 (10,6%) cup re-revisions: 2 loss of primary fixation and 3 recurrent instabilities. The dislocation rate in primary THA was 0% and 8,5% (4/47) in rTHA. The average functional scores in primary THA and rTHA were a WOMAC of 9,2 and 19,5 and a FJS of 80,9 and 57,3, respectively. As for PJP in primary THA and rTHA, respectively, 49,4% and 8,8% of patients perceived their hip as natural, 19,1% and 23,5% as an unrestricted artificial joint while 31,5% and 67,7% reported some degree of restriction. When used by experienced operators on acetabula presenting a technical challenge for primary fixation, LDH monoblocs cups are attractive options offering low revision and complication rates and excellent mid-term clinical results.

本論文の目的は、外科手術を必要としない、非侵襲人工内耳の開発である。スナネズミを対象とした基礎研究からヒトを対象とした応用研究まで包括的に行うことで、赤外光レーザー刺激を用いて音声知覚を再現する刺激手法の確立を目指した。スナネズミを対象とした実験によりレーザー刺激が生み出す音の「聞こえ」を明らかにし、ヒトを対象とした実験で、レーザー人工内耳で言語知覚を生み出す刺激アルゴリズムを提案した。 / This study aimed to develop a laser auditory prosthesis that can produce intelligible speech perception by stimulating auditory nerves from the outer ear. I investigated laser-evoked auditory perception using Mongolian gerbil. Subsequently, I synthesized a CMS based on animal research using Mongolian gerbils as a simulated sound of the laser auditory prosthesis to propose a speech encoding scheme using laser stimulation. The results showed that all human participants could comprehend the CMS contents by replicating the original sound's formant frequency transition and amplitude envelopes, suggesting that laser auditory prostheses with the CMS could restore speech perception. / 博士(工学) / Doctor of Philosophy in Engineering / 同志社大学 / Doshisha University

Microprocessor-controlled knees (MPK’s) allow amputees to walk with increasing ease and safety as technology progresses. As an amputee is fitted with a new MPK, the knee’s internal parameters are tuned to the user’s preferred settings in a controlled environment. These parameters determine various gait control settings, such as flexion target angle or swing extension resistance. Though these parameters may work well during the initial fitting, the MPK experiences various internal & external environmental changes throughout its life-cycle, such as product wear, changes in the amputee’s muscle strength, temperature changes, etc. This work investigates the feasibility of using a reinforcement learning (RL) control to adapt the MPK’s swing resistance to consistently induce the amputee’s preferred swing performance in realtime. Three gait features were identified as swing performance indicators for the RL algorithm. Results show that the RL control is able to learn and improve its tuning performance in terms of Mean Absolute Error over two 40-45 minute training sessions with a human-in-the-loop. Additionally, results show promise in using transfer learning to reduce strenuous RL training times. / Mikroprocessorkontrollerade knän (MPK) gör att amputerade kan utföra fysiska aktiviteter med ökad lätthet och säkerhet allt eftersom tekniken fortskrider. När en ny MPK monteras på en amputerad person, anpassas knäts interna parametrar till användarens i ett kontrollerad miljö. Dessa parametrar styr olika gångkontrollinställningar, såsom flexionsmålvinkel eller svängförlängningsmotstånd. Även om parametrarna kan fungera bra under den initiala anpassningen, upplever den MPK olika interna och yttre miljöförändringar under sin hela livscykel, till exempel produktslitage, förändringar i den amputerades muskelstyrka, temperaturförändringar, etc. Detta arbete undersöker möjligheten av, med hjälp av en förstärkningsinlärningskontroll (RL), att anpassa MPK svängmotstånd för att konsekvent inducera den amputerades föredragna svängprestanda i realtid. Tre gångegenskaper identifierades som svingprestandaindikatorer för RL-algoritmen. Resultaten visar att RL-kontrollen kan lära sig och förbättra sin inställningsprestanda i termer av Mean Absolute Error under två 40-45 minuters träningspass med en människa-i-loopen. Dessutom är resultaten lovande när det gäller att använda överföringsinlärning för att minska ansträngande RL-träningstider.

[ES] Mucha gente en el mundo se ve afectada por la pérdida de una extremidad (las predicciones estiman que en 2050 habrá más de 3 millones de personas afectadas únicamente en los Estados Unidos de América). A pesar de la continua mejora en las técnicas de amputación y la prostética, vivir sin una extremidad sigue limitando las actividades de los afectados en su vida diaria, provocando una disminución en su calidad de vida. En este trabajo nos centramos en los casos de amputaciones de extremidades superiores, entendiendo por ello la pérdida de cualquier parte del brazo o antebrazo. Esta tesis trata sobre el control mioeléctrico (potenciales eléctricos superficiales generados por la contracción de los músculos) de prótesis de extremidades superiores. Los estudios en este campo han crecido exponencialmente en las últimas décadas intentando reducir el hueco entre la parte investigadora más dinámica y propensa a los cambios e innovación (por ejemplo, usando técnicas como la inteligencia artificial) y la industria prostética, con una gran inercia y poco propensa a introducir cambios en sus controladores y dispositivos. El principal objetivo de esta tesis es desarrollar un nuevo controlador implementable basado en filtros adaptativos que supere los principales problemas del estado del arte. Desde el punto de vista teórico, podríamos considerar dos contribuciones principales. Primero, proponemos un nuevo sistema para modelar la relación entre los patrones de la señales mioélectricas y los movimientos deseados; este nuevo modelo tiene en cuenta a la hora de estimar la posición actual el valor de los estados pasados generando una nueva sinergia entre máquina y ser humano. En segundo lugar, introducimos un nuevo paradigma de entrenamiento más eficiente y personalizado autónomamente, el cual puede aplicarse no sólo a nuestro nuevo controlador, sino a otros regresores disponibles en la literatura. Como consecuencia de este nuevo protocolo, la estructura humano-máquina difiere con respecto del actual estado del arte en dos características: el proceso de aprendizaje del controlador y la estrategia para la generación de las señales de entrada. Como consecuencia directa de todo esto, el diseño de la fase experimental resulta mucho más complejo que con los controladores tradicionales. La dependencia de la posición actual de la prótesis con respecto a estados pasados fuerza a la realización de todos los experimentos de validación del nuevo controlador en tiempo real, algo costoso en recursos tanto humanos como de tiempo. Por lo tanto, una gran parte de esta tesis está dedicada al trabajo de campo necesario para validar el nuevo modelo y estrategia de entrenamiento. Como el objetivo final es proveer un nuevo controlador implementable, la última parte de la tesis está destinada a testear los métodos propuestos en casos reales, tanto en entornos simulados para validar su robustez ante rutinas diarias, como su uso en dispositivos prostéticos comerciales. Como conclusión, este trabajo propone un nuevo paradigma de control mioélectrico para prótesis que puede ser implementado en una prótesis real. Una vez se ha demostrado la viabilidad del sistema, la tesis propone futuras líneas de investigación, mostrando algunos resultados iniciales. / [CA] Molta gent en el món es veu afectada per la pèrdua d'una extremitat (les prediccions estimen que en 2050 hi haurà més de 3 milions de persones afectades únicament als Estats Units d'Amèrica). Malgrat la contínua millora en les tècniques d'amputació i la prostètica, viure sense una extremitat continua limitant les activitats dels afectats en la seua vida diària, provocant una disminució en la seua qualitat de vida. En aquest treball ens centrem en els casos d'amputacions d'extremitats superiors, entenent per això la pèrdua de qualsevol part del braç o avantbraç. Aquesta tesi tracta sobre el control mioelèctric (potencials elèctrics superficials generats per la contracció dels músculs) de pròtesis d'extremitats superiors. Els estudis en aquest camp han crescut exponencialment en les últimes dècades intentant reduir el buit entre la part investigadora més dinàmica i propensa als canvis i innovació (per exemple, usant tècniques com la intel·ligència artificial) i la indústria prostètica, amb una gran inèrcia i poc propensa a introduir canvis en els seus controladors i dispositius. Aquesta tesi contribueix a la investigació des de diversos punts de vista. El principal objectiu és desenvolupar un nou controlador basat en filtres adaptatius que supere els principals problemes de l'estat de l'art. Des del punt de vista teòric, podríem considerar dues contribucions principals. Primer, proposem un nou sistema per a modelar la relació entre els patrons de la senyals mioelèctrics i els moviments desitjats; aquest nou model té en compte a l'hora d'estimar la posició actual el valor dels estats passats generant una nova sinergia entre màquina i ésser humà. En segon lloc, introduïm un nou paradigma d'entrenament més eficient i personalitzat autònomament, el qual pot aplicar-se no sols al nostre nou controlador, sinó a uns altres regresors disponibles en la literatura. Com a conseqüència d'aquest nou protocol, l'estructura humà-màquina difereix respecte a l'actual estat de l'art en dues característiques: el procés d'aprenentatge del controlador i l'estratègia per a la generació dels senyals d'entrada. Com a conseqüència directa de tot això, el disseny de la fase experimental resulta molt més complex que amb els controladors tradicionals. La dependència de la posició actual de la pròtesi respecte a estats passats força a la realització de tots els experiments de validació del nou controlador en temps real, una cosa costosa en recursos tant humans com de temps. Per tant, una gran part d'aquesta tesi està dedicada al treball de camp necessari per a validar el nou model i estratègia d'entrenament. Com l'objectiu final és proveir un nou controlador implementable, l'última part de la tesi està destinada a testar els mètodes proposats en casos reals, tant en entorns simulats per a validar la seua robustesa davant rutines diàries, com el seu ús en dispositius prostètics comercials. Com a conclusió, aquest treball proposa un nou paradigma de control mioelèctric per a pròtesi que pot ser implementat en una pròtesi real. Una vegada s'ha demostrat la viabilitat del sistema, la tesi proposa futures línies d'investigació, mostrant alguns resultats inicials. / [EN] Many people in the world suffer from the loss of a limb (predictions estimate more than 3 million people by 2050 only in the USA). In spite of the continuous improvement in the amputation rehabilitation and prosthetic restoration, living without a limb keeps limiting the daily life activities leading to a lower quality of life. In this work, we focus in the upper limb amputation case, i.e., the removal of any part of the arm or forearm. This thesis is about upper limb prosthesis control using electromyographic signals (the superficial electric potentials generated during muscle contractions). Studies in this field have grown exponentially in the past decades trying to reduce the gap between a fast growing prosthetic research field, with the introduction of machine learning, and a slower prosthetic industry and limited manufacturing innovation. This thesis contributes to the field from different perspectives. The main goal is to provide and implementable new controller based on adaptive filtering that overcomes the most common state of the art concerns. From the theoretical point of view, there are two main contributions. First, we propose a new system to model the relationship between electromyographic signals and the desired prosthesis movements; this new model takes into account previous states for the estimation of the current position generating a new human-machine synergy. Second, we introduce a new and more efficient autonomously personalized training paradigm, which can benefit not only to our new proposed controller but also other state of the art regressors. As a consequence of this new protocol, the human-machine structure differs with respect to current state of the art in two features: the controller learning process and the input signal generation strategy. As a direct aftereffect of all of this, the experimental phase design results more complex than with traditional controllers. The current state dependency on past states forces the experimentation to be in real time, a very high demanding task in human and time resources. Therefore, a major part of this thesis is the associated fieldwork needed to validate the new model and training strategy. Since the final goal is to provide an implementable new controller, the last part of the thesis is devoted to test the proposed methods in real cases, not only analyzing the robustness and reliability of the controller in real life situations but in real prosthetic devices. As a conclusion, this work provides a new paradigm for the myoelectric prosthetic control that can be implemented in a real device. Once the thesis has proven the system's viability, future work should continue with the development of a physical device where all these ideas are deployed and used by final patients in a daily basis. / The work of Carles Igual Bañó to carry out this research and elaborate this dissertation has been supported by the Ministerio de Educación, Cultura y Deporte under the FPU Grant FPU15/02870. One visiting research fellowships (EST18/00544) was also funded by the Ministerio de Educación, Cultura y Deporte of Spain. / Igual Bañó, C. (2021). Co-adaptive myoelectric control for upper limb prostheses [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/168192

<p dir="ltr">Over 150,000 people undergo lower-extremity amputations yearly in the United States. In recent years, multiple efforts have been made to improve the human-robot interaction between amputees and active lower limb prostheses. Using lightweight wearable technologies has been a viable solution to implement algorithms that can estimate gait kinematics and prosthesis users’ intent. Examples of wearable technologies include inertial measurement units, strain gauges, and electromyography sensors. Kinematic and force data is inputted into an Error-State Kalman filter to estimate the inversion-eversion, external-internal, and dorsiflexion-plantarflexion ankle angle. The filter tracked the ankle angle with an accuracy of 0.7724°, 0.8826°, and 1.3520°, respectively. The gait phase was estimated using a linear regression model based on a shank kinematics ground truth pattern with an average normalized accuracy of 97.79 %. A numerical simulation of a gait emulator in the form of a 3-Revolute-Prismatic-Revolute (3-RPR) manipulator. The gait emulator can test lower limb prostheses independent of human subjects, eliminating many hurdles associated with human subject testing. The manipulator was simulated with two control strategies: a traditional PID and a hybrid PID + Active Force Control controller (AFC). The hybrid PID+AFC provided higher accuracy in tracking the desired end-effector trajectory due to improved disturbance rejection. A low-cost surface electromyography (sEMG) platform was developed to robustly acquire sEMG signals, with an overall component cost of 35.06 US$. The sEMG platform integrates directly into a Micro:bit microcontroller through an expansion board. During testing with human subjects, sEMG Micro:bit platform had a reported average signal-to-noise ratio of 24.7 dB.</p>

Introdução: A atresia congênita de orelha constitui uma deformidade presente ao nascimento, de prevalência unilateral, decorrente da alteração no desenvolvimento das estruturas das orelhas externa e média. Geralmente, provoca perda auditiva condutiva, e pode ser acompanhada por componente sensorioneural. Dentre as formas de tratamento disponíveis, encontra-se o implante de orelha média Vibrant Soundbridge (VSB), que tem se mostrado eficaz no tratamento deste tipo de alteração. A literatura mostra melhora nos limiares tonais e nos resultados dos testes de percepção auditiva da fala, realizados com o uso do processador de fala após a cirurgia. Considerando que os indivíduos com este tipo de malformação podem passar por um período de privação sensorial auditiva anterior à reabilitação, torna-se interessante avaliar o estágio maturacional das estruturas auditivas corticais e o processamento das informações auditivas em nível central, bem como, verificar o benefício da indicação do VSB unilateral em situação de escuta difícil. Não foram encontrados estudos que abordam este aspecto e o emprego dos potenciais evocados auditivos corticais (PEAC) e do P300 em usuários de VSB. Objetivo: Analisar o impacto da perda auditiva condutiva e mista nos PEAC e P300 em usuários de VSB unilateral, com atresia de orelha bilateral, e verificar as habilidades auditivas, em situação de escuta difícil, considerando a indicação do VSB unilateral. Casuística e método: Vinte indivíduos, divididos em dois grupos, pareados em idade, sexo e grau de escolaridade. G1: dez indivíduos com perda auditiva condutiva ou mista bilateral, usuários de VSB unilateral, atendidos na Instituição de realização da pesquisa. Todos fizeram uso de aparelhos auditivos convencionais antes do VSB. G2: Dez indivíduos normo-ouvintes. Realização de audiometria em campo livre com o uso do VSB (apenas o G1), avaliação das habilidades auditivas pelo Hearing in Noise Test, pesquisa dos componentes P1, N1, P2, N2 e P300, em campo calibrado. Resultados: A média dos limiares tonais nas frequências de 500 a 3000 Hz, de 20 a 36 dB NA, mostrou que o VSB possibilitou o acesso aos sons da fala. Não foi observada diferença estatisticamente significante entre os valores de latência dos PEAC e P300 entre os grupos. Foi observada diferença estatisticamente significante entre o limiar de reconhecimento de sentenças e a relação sinal/ruído entre os grupos, sendo os melhores resultados apresentados pelo G2. Conclusão: Indivíduos com atresia de orelha e perda auditiva condutiva ou mista bilateral, quando adequadamente reabilitados, podem atingir a maturação das vias auditivas centrais e o processamento da informação auditiva em nível cortical. As habilidades de reconhecimento auditivo, sem e com ruído competitivo, mostraram-se defasadas quanto à normalidade, apontando para a indicação do VSB bilateral / Introduction: Congenital aural atresia is a congenital deformity. It is unilaterally prevalent due to alterations in the development of the external and middle ear structures. Congenital aural atresia causes conductive hearing loss and can be accompanied by sensorineural component. Among the available forms of treatment is the middle ear implant, Vibrant Soundbridge (VSB), which has been shown to be effective in treating this type of alteration. The literature shows improvement in tonal thresholds and in the results of tests of auditory perception of speech that were performed using the speech processor after surgery. Individuals with this type of malformation often experience a period of auditory sensory deprivation prior to rehabilitation. Hence, it is important to evaluate the maturation stage of the cortical auditory structures, the processing of auditory information at the central level, and to verify the benefit of unilateral VSB in difficult listening situations. There are no previous data on this aspect and with the use of cortical auditory evoked potentials (CAEP) and event-related potential (P300) in users of VSB. Aim: To analyze the impact of conductive and mixed hearing loss on CAEP and P300 in unilateral VSB users with bilateral ear atresia. To verify the auditory abilities in a difficult listening situation considering the indication for unilateral VSB. Materials and methods: Twenty individuals were divided into two groups matched for age, sex, and educational level. G1 comprised ten individuals with bilateral conductive or mixed hearing loss and users of unilateral VSB, who visited the research institution. All subjects used conventional hearing aids prior to VSB. G2 comprised ten normal hearing individuals. Audiometry in the free field was performed with the use of VSB (G1 only) and evaluation of hearing skills by the Hearing in Noise Test was conducted; components P1, N1, P2, N2, and P300 in a calibrated field were recorded. Results: Evaluation of the mean tonal thresholds in the frequencies between 500 and 3000 Hz, from 20 to 36 dB HL, demonstrated that VSB allowed access to speech sounds. There was no statistically significant difference in the CAEP and P300 latency values between the two groups. A statistically significant difference was observed in the sentence recognition threshold and the signal-to-noise ratio between the groups, with best results presented by G2. Conclusion: Individuals with congenital aural atresia and bilateral conductive or mixed hearing loss may reach maturation of the central auditory pathway and achieve adequate processing of auditory information at the cortical level, when rehabilitated. The auditory recognition skills, with and without competitive noise, were shown to be out of phase with normality, indicating the need for a bilateral VSB

Noventa e seis pacientes com diabetes melito do tipo 2 foram randomizados para receberem ou não abciximab durante o implante eletivo de stent coronário, com o objetivo de determinar se esse inibidor da glicoproteína IIb/IIIa reduz a hiperplasia intimal intra-stent, avaliada pelo ultra-som intracoronário, aos seis meses de evolução. A análise volumétrica mostrou que o abciximab não reduz o volume de obstrução intra-stent nestes pacientes [41,3% (DP21,0%) versus 40,5% (DP18,3%), p=0,853]. / Ninety-six type 2 diabetics were randomly assigned to receive abciximab or no abciximab at the time of elective stent implantation to determine whether this IIb/IIIa glycoprotein inhibitor would reduce in-stent intimal hyperplasia, measured by intravascular ultrasound, at 6-month follow-up. Volumetric analysis showed that abciximab was not associated with a reduction of in-stent volume obstruction in diabetic patients [41.3% (DP21.0%) versus 40.5% (DP18.3%), p=0.853).

With his suicide in 1961, Ernest Hemingway seemingly cemented into place his legacy as the classic image of the able-bodied, masculine man; he was, to many, the anti-disability writer, the author who lived for ability, lost ability, and took his life once he realized no chance of regaining his ability existed. Such a narrative, however, ignores the truly complicated and dynamic shape his understanding of the body took. Through an analysis of The Old Man and the Sea, I examine the form this ideology of ability took at the end of his life when, like the novella’s protagonist, Santiago, his failing health forced him to focus on the realities of the inevitable failure of his own body. Through the application of research such as David T. Mitchell and Sharon L. Snyder’s theory of narrative prosthesis, Tobin Siebers’ work on the ideology of ability, and Andrew Farah’s research on Hemingway’s declining physical condition, I demonstrate the ways The Old Man and the Sea legitimizes the disabled body, avoiding, in the process, several common narrative tropes such as the overcoming narrative or the kill-or-cure dichotomy and creating a space in which the inevitable decay of the human body must be seriously and honestly addressed. Through this research, a new more nuanced picture of Hemingway emerges, one that recognizes the complicated and dynamic nature his view of the able-bodied individual took.