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Medtronic, Inc. (“Medtronic”) offers RemoteView, which permits a user (“Programmer User”) of the Medtronic CareLink® 2090 Programmer (“Programmer”) to allow the viewing of information presently displayed on the Programmer screen with one or more individuals in remote locations anywhere in the world (“Remote Viewer”), including remote health care professionals or Medtronic representatives.
Limited License Grant. You are hereby granted a nonexclusive, nontransferable, terminable, nonassignable, nonsublicensable, limited license to install and use a copy of the Licensed Software solely for authorized and legitimate purposes. You may not otherwise copy, use, modify, reverse engineer, decompile, disassemble, create derivative works based on, or integrate with other systems or programs the Licensed Software without the prior written consent of Medtronic. You shall have sole responsibility for any fees or charges, including service or data charges, incurred by you in connection with your use of the Licensed Software. You shall not remove any proprietary or other legend or restrictive notice contained or included in the Licensed Software or other documentation associated with such Licensed Software. You agree to maintain any and all copyright, trademark, and other notices on the Licensed Software and any associated documentation.
Licensed Software Functionality and Data Use, Collection, Viewing, and Transfer.
“Active Remote Viewer” as referred to herein shall mean a Remote Viewer that has installed the Licensed Software and has at the relevant point in time an active network connection to a Medtronic server via the Licensed Software.
By installing or using the Licensed Software or clicking any acceptance button in connection with this Agreement, you acknowledge, understand, agree to, and consent to all of the following, including when you are an Active Remoter User:
) Registration. To obtain access to the Licensed Software, you must register at the Medtronic RemoteView website and establish a user name and password. All information that you provide in connection with such registration must be complete, accurate, and truthful. The user name and password are personal to you and must not be shared with anyone else. You will also not attempt, directly or indirectly, to disable, bypass, or defeat any password protection associated with the Licensed Software. Medtronic reserves the right to deny or disable any user name or password or request for any user name or password.
) Your Personal Information. Medtronic will collect information in connection with your registration and installation and use of the Licensed Software, including your first and last name, your email address, a selected security question(s) and your corresponding answer(s), your address, and your telephone number. You agree that Medtronic may store this personal information about you on a Medtronic server, including a server located in the United States of America.
) Session Key. To view the information on the Programmer, the Remote Viewer must generate a Session Key that must be shared with and entered by the Programmer User. “Session Key” as used herein means a unique token active for a limited period of time generated by the Remote Viewer. You agree not to share this Session Key with anyone other than the Programmer User who has initiated the specific session.
) Logging of Session Activity. Each time you log in to the Licensed Software, Medtronic will collect information about your activity, including in an aggregated log or database, regarding you and your session, including your name, username, computer name, IP address, operating system details, and session details (including transferring and sharing activity, start and end times, view only or control activity, and any chat messages between or among any Active Remote Viewers. You agree that Medtronic may store any personal information about you on a Medtronic server, including a server located in the United States of America.
) Active Remote Users. When you are an Active Remote Viewer: (1) you will be able to view the name and/or user name of any other Active Remote Viewer who is logged into the same Medtronic server; and (2) any other Active Remote Viewer who is actively logged into the same Medtronic server will be able to view your name and/or user name. The Licensed Software also permits one Active Remote Viewer to share the information being viewed to any other Active Remote Viewer. You must not share any information from the Medtronic programmer, including with any other Active Remote Viewer, absent the express permission from the Programmer User that is allowing you to view the information.
) Availability. Medtronic has limitations on the number of users that can concurrently log in to the Licensed Software at any given time. Thus, installation of or accessing the Licensed Software does not guarantee that it will be available to you for use at any time.
Permissions. By installing and using the Licensed Software, you represent that you have permission to do so from any associated clinic, hospital, or medical practice and that your use of the Licensed Software complies with any policies or requirements of such associated clinic, hospital, or medical practice. You are also responsible for confirming that the Programmer User has obtained any necessary patient consent before allowing you to view any patient information via the Licensed Software.
Your Acknowledgements. You acknowledge that the Licensed Software is not the exclusive method of viewing information from the Programmer and that the Licensed Software is not the exclusive method by which to obtain a patient’s implanted cardiac device data, including any data on the Programmer. You also acknowledge that the Licensed Software is not intended to be used as a life-sustaining or interventional tool during medical emergencies. You further acknowledge that Medtronic is not, and shall not be deemed to be, a provider of patient health care services by virtue of its provision of access to the Programmer screen information via the Licensed Software. You also acknowledge that information from the Licensed Software is not an electronic medical record and use of the Licensed Software does not in any way relieve you from using your best medical judgment to determine a proper course of treatment for patients.
Security/Privacy of Patient Data. Your use of the Licensed Software and any Session Keys shall be solely for legitimate and lawful purposes and not for any malicious purpose. You are solely responsible for and will use your best efforts in maintaining the confidentiality and security of any copies of the Licensed Software as well as any user name, password credentials, and any Session Keys that can be used in accessing the Licensed Software, a Medtronic server, or any information from a Programmer. You are solely responsible for and will use your best efforts in keeping any patient information you may receive or view in connection with the Licensed Software confidential and secure, and you will not attempt to capture or copy any patient information you view in any electronic or hard copy format without the express permission of the Programmer User. You will be responsible for any obligations or liabilities associated with any lost, stolen, or otherwise compromised patient information.
Reporting Issues and Feedback. You agree that you will report any issues or questions, technical or otherwise, regarding the Licensed Software promptly and directly to Medtronic. If you submit any comments or ideas to Medtronic, in the absence of a separate agreement regarding such submissions, you grant to Medtronic an unrestricted, royalty-free, irrevocable license to use, reproduce, display, perform, modify, transmit, and distribute such ideas in any medium and agree that Medtronic is free to use them for any purpose. In addition, Medtronic has no obligation to provide continued maintenance and support to you in connection with the Licensed Software. Any maintenance and support services provided by Medtronic shall be at Medtronic’s sole discretion.
Limitations of Liability.
THE LICENSED SOFTWARE IS PROVIDED TO YOU “AS IS,” AND MEDTRONIC EXPRESSLY DISCLAIMS ANY AND ALL WARRANTIES WITH RESPECT TO THE LICENSED SOFTWARE AND YOUR USE THEREOF, INCLUDING WITHOUT LIMITATION ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE, AND NONINFRINGEMENT. MEDTRONIC DOES NOT WARRANT THAT THE USE OF THE LICENSED SOFTWARE WILL BE UNINTERRUPTED OR ERROR-FREE.
Legal Compliance. You shall at all times use the Licensed Software in compliance with all applicable laws. You shall ensure that your installation and use of the Licensed Software complies with all applicable export and import laws, regulations, orders, and policies of the United States of America and any other applicable jurisdiction. You represent and warrant that (i) you are not located in a country that is subject to a U.S. Government embargo, or that has been designated by the U.S. Government as a “terrorist supporting” country, and (ii) you are not listed on any U.S. Government list of prohibited or restricted parties.
Term, Termination, Modifications, and Support. This Agreement shall be in effect from the date when you first install or use the Licensed Software. Medtronic may modify, amend, or terminate this Agreement at any time, including by providing notices or an updated version of this Agreement on a Medtronic website. Medtronic may modify, disable, or terminate your use or Medtronic’s support of the Licensed Software at any time, including by providing notices on a Medtronic website. All obligations which are ongoing in nature shall survive termination or expiration of this Agreement. At any time upon Medtronic’s request (including via a notice on a Medtronic website), you agree to promptly delete and terminate use of any and all copies of the Licensed Software. In addition, upon Medtronic’s request, you agree to provide written verification that you have destroyed all copies of the Licensed Software together with the manner, date, and time of such destruction.
NayaMed International Sárl Customers: Whether the RemoteView feature shall be used in connection with NayaMed customers or devices shall be solely within the discretion of NayaMed International Sárl. If the Licensed Software is used connection with NayaMed customers or devices, this Agreement shall be directly between you and NayaMed with respect to those uses.
Ankylosis spondylitis (AS) is classified as a rheumatologic disorder of the spine. It is considered one of the so-called sero-negative arthropathies. This inflammation can eventually lead the joints to become fused, leading to stiffness and reduced range of motion (known as ankylosis). It also frequently affects the hips and other peripheral joints. Ankylosis comes from Latin words meaning "bent" or "crooked."
AS usually strikes a person between the teen years and the age of 40. The classic picture of AS is a man between the ages of 15 and 40 with intermittent, dull lower back pain, and stiffness slowly progressing over a period of months to years. Although AS was once considered to predominantly affect men, it is now known to affect women as well. There may also be differences in symptoms and outcomes in men and women with AS.1
The cause of AS is not known, but a genetic predisposition to the disorder does exist. People with AS often have stiffness in the morning that lasts a few minutes to several hours, sometimes coupled with fatigue. Prolonged inactivity can cause more pain and stiffness in the back, unlike other lower back disorders, which often improve with rest. With AS, there may be pain and stiffness in the shoulders, hips, or other joints as well. After a few years with the disorder, there may be pain in the middle or upper part of the back and gradual stiffening of the spine and eventually the neck. The classic deformity associated with AS is a rigid kyphosis, which causes a stiff, hunched forward posture.
Ankylosis spondylitis is often diagnosed after your doctor takes a thorough medical history, performs a physical examination, and orders appropriate x-rays and laboratory studies. There is a significant association of AS with a commonly performed blood test that detects the presence or absence of a particular marker in the blood called the human leukocyte antigen B27 (HLA-B27). A positive test, along with other clinical correlations, will help to establish the diagnosis of AS.
The goal of treatment for ankylosis spondylitis is to relieve your pain and stiffness, while preventing spinal deformities and other complications. Treatment will be most successful before AS causes irreversible damage to your joints. Non-steroidal anti-inflammatory agents (NSAIDS) may help relieve your inflammation, pain, and stiffness. If they aren’t helpful, your doctor may suggest tumor necrosis factor (TNF) blockers. These injections work differently from NSAIDS but also help to reduce inflammation, pain, and stiffness. Physical therapy can also help relieve pain while improving strength and flexibility.
Most people with facet arthropathy will complain of lower back pain that becomes worse when twisting, standing, or bending backward. Usually, the pain is confined to a particular point in the spine, and unlike the pain and numbness often caused by a slipped disc or sciatica, it doesn’t usually radiate into the buttocks or down the legs.
As the facet joints become arthritic, they often develop bone spurs—tiny outgrowths or projections of bone—that can decrease the amount of space available for the nerve roots as they exit the spinal canal. This can contribute to the development of spinal stenosis, another condition that may cause pain, numbness, and weakness in the buttocks and legs.
In fact, people who have facet arthropathy often have other conditions that may be contributing to their symptoms. Aside from spinal stenosis, it’s possible that arthritis in other parts of your spine or degenerative disc disease—a natural part of the aging process where our intervertebral discs lose flexibility, elasticity, and shock absorbing characteristics—could be contributing to your symptoms.
To find out if facet arthropathy is causing your back pain, your doctor may order the following tests: A CT scan (CAT scan) or MRI, which shows evidence of facet joint degeneration, even in most people who only have mild to moderate pain. A bone scan shows areas of active inflammation in the spine.
Another way to help confirm a diagnosis is to have your painful facet joints injected with a mixture of local anesthetic and an anti-inflammatory steroid. If the injection relieves your back pain, it’s likely that facet arthropathy is contributing to your symptoms.
There are several options for treating the pain and symptoms caused by facet arthropathy:
Osteoarthritis is the most common form of arthritis, affecting millions of people around the world. It’s sometimes known as “wear and tear” arthritis as it worsens with time and age. Osteoarthritis can affect any joint in your body, including the spine.
The symptoms of osteoarthritis usually come on slowly and become worse as time passes.
The signs and symptoms may include:
There are several factors that contribute to the likelihood of a person developing osteoarthritis.
These factors may include:
Your doctor will perform a complete medical exam and may also use x-rays to confirm the diagnosis and make sure you don’t have another type of arthritis. An MRI may also be necessary to get a more detailed look at the spine and the surrounding tissues if the x-ray does not clearly point to a diagnosis.
Osteoarthritis is usually first treated by a combination of non-surgical treatments including physical therapy, exercise, and medications. Surgery may be helpful to relieve pain when other treatment options are not effective, especially in the case of vertebral compression fractures.
Sacroiliac dysfunction is a common cause of back pain. In most instances, the discomfort that comes with it can be managed through conservative treatment; however, some cases may require back surgery.
The sacroiliac joint is located in the lower back between the spine and hip joint, and normally does not move much. Inflammatory arthritis (such as ankylosis spondylitis), degeneration of the sacroiliac joint, or misalignment of this joint can cause pain associated with sacroiliac dysfunction.
Sacroiliac joint pain is usually located in the buttock, just to the side of the midline. It is usually one-sided, but not always. The pain may radiate down the back of the thigh to the knee. Typically, it is difficult to find a comfortable position when lying in bed. Sacroiliac joint pain can become severe and disabling if not treated.
Some common causes of sacroiliac joint pain are muscle tightness, pregnancy, types of arthritis, and the wearing away of the cartilage between the bones. Although sacroiliac joint pain can be caused by trauma, it usually develops over a long period of time.2
Accurately diagnosing sacroiliac joint dysfunction can be difficult and must be done by clinical exam. Its symptoms can mimic those of other common conditions, such as herniated disc and radiculopathy (pain along the sciatic nerve that radiates down the leg). Unless your doctor specifically checks for sacroiliac dysfunction, your physical examination may turn out "normal" and you may be told that nothing is wrong with you.
During the exam, your doctor may try to determine if the sacroiliac joint is the cause of pain by moving the joint known as “provocative maneuvers.” If the movement recreates your pain, and no other cause of pain has been found (such as a herniated disc on an MRI scan), the sacroiliac joint may be the cause of the pain.
A sacroiliac joint injection is another diagnostic tool that may be used. In this test, your physician uses fluoroscopic guidance (live x-ray) and inserts a needle into the sacroiliac joint to inject lidocaine (a numbing solution). If the injection relieves your pain, it can be inferred that the sacroiliac joint is the source of the pain.
Sometimes sacroiliac dysfunction is associated with piriformis syndrome. The piriformis is a small muscle in the buttock that stabilizes the sacroiliac joint. When irritated, it causes pain in the buttock. The piriformis muscle happens to overlap the sciatic nerve and can also cause sciatic pain down the leg all the way to the foot. This is often mistaken for sciatica, which is caused by a pinched nerve root in the spine.
If diagnosed early, the majority of people with sacroiliac dysfunction and/or piriformis syndrome will improve with non-surgical treatment.
For those who do not respond to conservative measures, fusion of the sacroiliac joint may be the next step. Read more about sacroiliac joint fusion.
Information on this site should not be used as a substitute for talking with your doctor. Always talk with your doctor about diagnosis and treatment information.
Lee, et al. Women with Ankylosing Spondylitis: A Review. Arthritis & Rheumatism, Vol 59, 449-454, 2008
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