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Search Results: 1 - 10 of 44906 matches for " Michael Baram "
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Prone Position: Does It Help with Acute Respiratory Distress Syndrome (ARDS) Requiring Extracorporeal Membrane Oxygenation (ECMO)?  [PDF]
Nava Azimzadeh, Michael Baram, Nicholas C. Cavarocchi, Hitoshi Hirose
Open Journal of Respiratory Diseases (OJRD) , 2017, DOI: 10.4236/ojrd.2017.71003
Abstract: Introduction: Lung protective ventilation therapy with low tidal volume-high PEEP is the standard treatment for the patients with acute respiratory distress syndrome (ARDS). Oscillators are occasionally used for salvage ventilation in cases where poor compliance restricts the use of traditional ventilation with ARDS. In addition to ventilator therapy, prone positioning has been used to improve oxygenation. We presented a challenging case of ARDS, which failed medical management extracorporeal membrane oxygenation (ECMO) support and oscillatory ventilation. Prone positioning was initiated which improved oxygenation, respiratory compliance and posterior atelectasis. Case presentation: A 41-year-old morbid obese female developed ARDS due to influenza pneumonia. The patient remained hypoxic despite optimum medical and ventilator management and required veno-venous extracorporeal membrane oxygenation (VV ECMO). CT scan of the chest showed ARDS with posterior consolidation. Despite ARDSnet ventilation support, antiviral therapy and ECMO support, there was no clinical improvement. High frequency oscillatory ventilation was initiated on ECMO day #13, which resulted in no respiratory improvement over the next 5 days. On ECMO day #18, the patient was placed on a Rotaprone? bed Therapy, utilizing a proning strategy of 16 hours a day. The clinical improvements observed were resolving of the consolidation on CXR, improvements in ventilatory parameters and decreased oxygen requirements. The patient was successfully weaned off ECMO on POD#25 (8 days post prone bed). Conclusions: Prone position improved oxygen saturation and pulmonary compliance in severe ARDS requiring ECMO and it might facilitate early weaning.
What Is the Best Surgical Approach for Bilateral Pulmonary Hydatid Cysts in Children?  [PDF]
Aram Baram
World Journal of Cardiovascular Surgery (WJCS) , 2015, DOI: 10.4236/wjcs.2015.53006
Abstract: Introduction: The most common site for hydatid cysts in children is the lungs while in adult hepatic cysts are predominant. Bilateral pulmonary involvement is relatively rare and its surgical management is poorly described in the current literature. Until now no definite consensus has been described in the literature for the ideal surgical approach in pediatric bilateral pulmonary hydatid cysts (BPHC). The aim of this prospective cohort study was to describe the problems encountered in treating pediatric BPHC by two different surgical techniques. Patients and Methods: Between June 2007 and June 2014, 60 children (group one = 31, group two = 29) with BPHC were operated on in our center. Group one included all children with BPHC operated by single session bilateral anterolateral mini-thoracotomy. Group two included all cases operated by two stage standard posterolateral thoracotomy at 21 days interval. Results: In group one (19 males and 12 females), the mean age was 8.9 years (3.5-17). In group two, there were 29 cases (18 males and 11 females), the mean age was 9.6 years (2-17). There was no significant statistical difference in terms of the presentations and age distribution. The duration of surgery in group one was significantly shorter and the duration of hospital stay was significantly shorter as well (group one 3.6 days versus 4.6 days in the second group). Pain scale was not more in the first group as it was believed to be. Conclusion: We believe that single session bilateral anterolateral thoracotomy is a better approach than either one stage successive thoracotomies, median sternotomy or clamshell thoracotomy as it involves less postoperative pain and does not precipitate a decrease in the respiratory capacity.
Calculation of the Density of States Using Discrete Variable Representation and Toeplitz Matrices
Eli Eisenberg,Asher Baram,Michael Baer
Physics , 1995, DOI: 10.1088/0305-4470/28/16/003
Abstract: A direct and exact method for calculating the density of states for systems with localized potentials is presented. The method is based on explicit inversion of the operator $E-H$. The operator is written in the discrete variable representation of the Hamiltonian, and the Toeplitz property of the asymptotic part of the obtained {\it infinite} matrix is used. Thus, the problem is reduced to the inversion of a {\it finite} matrix.
Tuning synaptic transmission in the hippocampus by stress: the CRH system
Yuncai Chen,Adrienne L. Andres,Michael Frotscher,Tallie Z. Baram
Frontiers in Cellular Neuroscience , 2012, DOI: 10.3389/fncel.2012.00013
Abstract: To enhance survival, an organism needs to remember—and learn from—threatening or stressful events. This fact necessitates the presence of mechanisms by which stress can influence synaptic transmission in brain regions, such as hippocampus, that subserve learning and memory. A major focus of this series of monographs is on the role and actions of adrenal-derived hormones, corticosteroids, and of brain-derived neurotransmitters, on synaptic function in the stressed hippocampus. Here we focus on the contribution of hippocampus-intrinsic, stress-activated CRH-CRH receptor signaling to the function and structure of hippocampal synapses. Corticotropin-releasing hormone (CRH) is expressed in interneurons of adult hippocampus, and is released from axon terminals during stress. The peptide exerts time- and dose-dependent effects on learning and memory via modulation of synaptic function and plasticity. Whereas physiological levels of CRH, acting over seconds to minutes, augment memory processes, exposure to presumed severe-stress levels of the peptide results in spine retraction and loss of synapses over more protracted time-frames. Loss of dendritic spines (and hence of synapses) takes place through actin cytoskeleton collapse downstream of CRHR1 receptors that reside within excitatory synapses on spine heads. Chronic exposure to stress levels of CRH may promote dying-back (atrophy) of spine-carrying dendrites. Thus, the acute effects of CRH may contribute to stress-induced adaptive mechanisms, whereas chronic or excessive exposure to the peptide may promote learning problems and premature cognitive decline.
Exact Minkowski Sums of Polygons With Holes
Alon Baram,Efi Fogel,Michael Hemmer,Dan Halperin,Sebastian Morr
Computer Science , 2015, DOI: 10.1007/978-3-662-48350-3_7
Abstract: We present an efficient algorithm that computes the Minkowski sum of two polygons, which may have holes. The new algorithm is based on the convolution approach. Its efficiency stems in part from a property for Minkowski sums of polygons with holes, which in fact holds in any dimension: Given two polygons with holes, for each input polygon we can fill up the holes that are relatively small compared to the other polygon. Specifically, we can always fill up all the holes of at least one polygon, transforming it into a simple polygon, and still obtain exactly the same Minkowski sum. Obliterating holes in the input summands speeds up the computation of Minkowski sums. We introduce a robust implementation of the new algorithm, which follows the Exact Geometric Computation paradigm and thus guarantees exact results. We also present an empirical comparison of the performance of Minkowski sum construction of various input examples, where we show that the implementation of the new algorithm exhibits better performance than several other implementations in many cases. In particular, we compared the implementation of the new algorithm, an implementation of the standard convolution algorithm, and an implementation of the decomposition approach using various convex decomposition methods, including two new methods that handle polygons with holes - one is based on vertical decomposition and the other is based on triangulation. The software has been developed as an extension of the "2D Minkowski Sums" package of CGAL (Computational Geometry Algorithms Library). Additional information and supplementary material is available at our project page http://acg.cs.tau.ac.il/projects/rc
End Organ Recovery and Survival with the QuadroxD Oxygenator in Adults on Extracorporeal Membran Oxygenation  [PDF]
Joshua K. Wong, Vei Shaun Siow, Hitoshi Hirose, Pawel Karbowski, Joseph Miessau, Michael Baram, Matthew DeCaro, Harrison T. Pitcher, Nicholas C. Cavarocchi
World Journal of Cardiovascular Surgery (WJCS) , 2012, DOI: 10.4236/wjcs.2012.24015
Abstract: Introduction: Extracorporeal Membrane Oxygenation (ECMO) is used in selected patient with cardiogenic and/or re- spiratory shock. We report our experience with standardized management protocols and the application of the Qua- droxD oxygenator with a centrifugal pump to maximize end-organ recovery and improve survival. Methods: This is an Internal Review Board (IRB) approved, single institution retrospective study of end-organ recovery and survival in pa- tients who required ECMO for cardiogenic and/or respiratory shock between July 2010 and June 2011. Results: Sixteen patients (median age: 46 years) were initiated on either Veno-Arterial (VA) or Veno-Venous (VV) ECMO. Cardiogenic shock, acute respiratory distress syndrome (ARDS) and a combined respiratory and cardiogenic compromise were the primary indications for ECMO in 8 (50%), 5 (31%) and 3 (19%) patients respectively. The median time on ECMO was 8 days (range: 4 - 26 days). Twelve patients (75%) were successfully weaned off ECMO, of which four (25%) were bridged to a ventricular assist device (VAD) and eight (50%) were weaned to recovery. All eight patients (100%) that were weaned to recovery and two patients (50%) that were bridged to a VAD were successfully discharged from the hospital, resulting in a discharge rate of 63%. There was an improvement in pre- vs. post-ECMO AST (449 IU/L vs. 63 IU/L, p < 0.05) in 5 patients (31%) with liver injury; serum lactate (9.1 mmol/L vs. 1.9 mmol/L, p < 0.05) in 8 patients (50%); and PaO2/FiO2 ratio (87 to 161, p = 0.01) in 10 patients (62%) with ARDS. Patients with evidence of pulmonary edema (n = 8. 50%) and ARDS (n = 8, 50%) on chest X-ray showed radiographic evidence of complete resolution. Renal function was preserved in 15 patients (94%). Conclusion: ECMO using the QuadroxD oxygenator and a centrifugal pump, coupled with standardized management protocols is beneficial in carefully selected patients. Improvement or main- tenance of end-organ function is associated with successful bridge to device therapy and/or increased survival.
Single-Port Bilateral Thoracscopic Dorsal Sympathectmy for Primary Hyperhidrosis: Long-Term Outcome  [PDF]
Aram Baram, Salam Al Bermani
World Journal of Cardiovascular Surgery (WJCS) , 2014, DOI: 10.4236/wjcs.2014.44010
Abstract: Background: Primary hyperhidrosis of the upper limbs is characterized by over activity of the eccrine sweat glands, primarily occurring on palmar, plantar and axillary regions. It is distressing and often socially disabling condition. Conservative treatment is usually not effective in controlling the disease mainly due to adverse effect of therapies. Endoscopic thoracic sympathectomy is considered as the treatment of choice, causing minimal morbidity and high success rates and patient satisfaction. Objective: The study aims to evaluate the long-term outcomes of single port bilateralthoracoscopic dorsal sympathectomyin treatment of primary hyperhidrosis of the palm and axilla. Methods: In this prospective study, performed primarily by a single surgeon, between August 1st 2010, and August 1st 2012, we performed 200 thoracoscopies on 100 patients with signs and symptoms of primary palmar and axillary hyperhidrosis in different age groups and in both genders, and all were studied and analyzed following treatment by single-port bilateral thoracoscopic dorsal sympathectomy in Sulaimani teaching hospital. Results: Total of 99 patients were satisfied with the outcome of post-surgery with a follow-up in the mean of 27 months and only one patient was reported no change in symptoms postoperatively. Complications reported in 6 patients inform of compensatory sweating (n = 2), Gestatory sweating (n = 1), Pneumothorax (n = 1), Intraoperative minor bleeding (n = 1) and only 1% failure rate was reported. No mortality was reported. Conclusions: Single port bilateral thoracoscopic thoracic sympathectomy is a very effective method in the management of primary hyperhidrosis. Single port provides less postoperative pain, safety, short operative time, and quick method for the treatment of primary hyperhidrosis in comparison to two or three ports approaches.
The Effect of Cyberwar Technologies on Force Buildup: The Israeli Case
Gil Baram
Military and Strategic Affairs , 2013,
Abstract: Israel's national interest focuses on maintaining its security against those seeking to harm it and undermine its very existence. This interest, along with Israel's geopolitical location, necessitates superiority in cyberspace as an integral part of its ability to defend itself against conventional and cyber attacks, and an integral part of its deterrent attack capability in the Middle East theater and beyond. The aim of this article is to present the role of cyber warfare technology in Israel’s security doctrine and to examine Israel’s preparations for dealing with the cyber threat by evaluating three necessary levels: (1) formulating a regular strategy for handling the threat posed by the development of cyber warfare technology; (2) allocating resources and budgets; and (3) effecting changes in the manner in which Israel builds its forces. An assessment of government publications will presumably demonstrate the importance of this topic for decision makers and the resources they allocate for dealing with it. The aim here is to portray the situation in Israel and attempt to point out the existing gaps in this eld.
Role of Serum Cytokine Levels in Acute Respiratory Distress Syndrome Patients on Extracorporeal Membrane Oxygenation Support  [PDF]
Ena Gupta, Kyle Carey, Lydia McDermott, Nicholas Cavarocchi, Hitoshi Hirose, Michael Baram
World Journal of Cardiovascular Surgery (WJCS) , 2020, DOI: 10.4236/wjcs.2020.101001
Abstract: Background: Even with the use of extracorporeal membrane oxygenation (ECMO) in acute respiratory distress syndrome (ARDS), mortality remains high. Also, prognostication of patients with ARDS and ECMO is difficult. Cytokines are thought to be markers of inflammation in both ARDS and in ECMO, however, understanding is limited. We aimed to study the association of three serum cytokine levels with mortality in these patients with ARDS on ECMO. Methods: We performed a retrospective chart review of ARDS patients on ECMO between 2011 and 2017. Patients with serum TNF-α, IL-6 and IL-2 measured while on ECMO were included, with measurements recorded weekly up to a maximum of 4 measurements. A multivariable regression analysis was performed and generalizing estimating equations were used to analyze longitudinal trend of cytokines with mortality. Results: There were 47 patients with ARDS on ECMO, of which 31 (68.9%) survived at 30 days and 2 were lost to follow up. Initial IL-2 levels were found to be significantly higher among those who were alive compared to those who died at 30 days (2720 ± 2432 pg/ml vs.
Diffusional Relaxation in Random Sequential Deposition
Eli Eisenberg,Asher Baram
Physics , 1996, DOI: 10.1088/0305-4470/30/9/003
Abstract: The effect of diffusional relaxation on the random sequential deposition process is studied in the limit of fast deposition. Expression for the coverage as a function of time are analytically derived for both the short-time and long-time regimes. These results are tested and compared with numerical simulations.
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