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de Mongeot LB, Galofaro E, Ramadan F, D'Antonio E, Missiroli F, Lotti N, Casadio M, Masia L. Combining FES and Exoskeletons in a Hybrid Haptic System for Enhancing VR Experience. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4812-4820. [PMID: 37971913 DOI: 10.1109/tnsre.2023.3334190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Robotic technology and functional electrical stimulation (FES) have emerged as highly effective rehabilitative techniques for individuals with neuromuscular diseases, showcasting their ability to restore motor functions. Within the proposed study, we developed and tested a new hybrid controller combining an upper-limb exoskeleton with FES to enhance haptic feedback when performing task-oriented and bimanual movement, like pick-and-place, in a virtual environment. We investigated the performance of the proposed approach on eight unimpaired participants providing haptic feedback either only by the exoskeleton or by the hybrid system. The hybrid control presents two different modalities, assistive and resistive, to modulate the perception of the load. FES intensity is calibrated to the subjects' biomechanical properties and it is adjusted in real-time according to the real-time motion of the upper limbs. Experimental results highlighted the ability of the hybrid control to improve kinematic performance: in both hybrid modalities subjects reduced the target matching error(values between 0.048±0.007 m and 0.06±0.006 m) without affecting the normal motion smoothness (SPARC values in the hybrid conditions range from -2.58±0.12 to -3.30±0.13). Moreover, the resistive approach resulted in greater metabolic consumption (1.04±0.03 W/kg), indicating a more realistic experience of lifting a virtual object through FES that increased the perceived weight. The innovation in our hybrid control relies on the modulation of muscular activation during manipulation tasks, which could be a promising approach in the clinical treatment of neuromuscular diseases.
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Abd El-Ghany I, Ramadan F. EFFECT OF BUFFALO AND COW SKIM MILK FLOURIDIZATION ON: 2. SOME CHARACTERISTICS OF CASEIN MICELLES, PROTEOLYTIC DIGESTIBILITY AND MICROBIOLOGICAL PROPERTIES. Egyptian Journal of Agricultural Sciences 2008; 59:197-208. [DOI: 10.21608/ejarc.2008.216922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Azzam, M, Abd EI-Ghany I, Ramadan F. THE USE OF PECT-KAO® SUSPENSION AND QUESTRA1 POWDER AS CLARIFIERS OF THE COMMERCIAL LlQUI RENNET EXTRACT. Journal of Food and Dairy Sciences 2003; 28:6237-6245. [DOI: 10.21608/jfds.2003.245082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Abstract
OBJECTIVES To develop a prognostic model to predict outcome of older patients with severe pneumonia requiring mechanical ventilation. DESIGN A nonconcurrent prospective study. SETTING A 24-bed intensive care unit (ICU) within two university-affiliated tertiary care hospitals. PARTICIPANTS All patients age 75 and older with severe pneumonia between June 1996 and September 1999 were included. Demographic data including activities of daily living (ADL) index score before admission, and clinical and laboratory data were collected in the first 24 hours of admission to the ICU. One hundred four patients (mean age +/- standard deviation (SD) 82.3 +/- 5.5 years) met the inclusion criteria. MEASUREMENTS A classification tree was developed using binary recursive partitioning to predict hospital discharge. The model was compared with a logistic regression model using variables selected by the tree analysis and with the Acute Physiologic and Chronic Health Evaluation (APACHE) II. RESULTS Outcome predictors for the classification tree were use of vasopressors, presence of multilobar pneumonia on chest radiograph, ratio of blood urea nitrogen to creatinine, Glasgow Coma Scale, urine output, and ADL score before admission. The tree achieved a sensitivity of 83.8% (95% confidence interval (CI) 69.2-92.4) and a specificity of 93.3% (95% CI 83-98.1). The predictive accuracy as assessed by the area under the curve (c-index +/- standard error) was significantly higher with the classification tree (0.932 +/- 0.03) than with logistic regression and APACHE II, (0.801 +/- 0.028 and 0.711 +/- 0.049, respectively (P < .05). CONCLUSIONS The classification tree model demonstrated a superior predictive accuracy to that of logistic regression and APACHE II. If validated prospectively, the classification tree can be used as a tool to assess the outcome of older patients with severe pneumonia requiring mechanical ventilation on admission to the ICU. In addition, the classification tree can be used to assist healthcare workers in providing a concise summary of local outcome experience and prognostic information to patients and their surrogates.
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Affiliation(s)
- A A El-Solh
- Division of Pulmonary and Critical Care Medicine, University at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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Naughton BJ, Mylotte JM, Ramadan F, Karuza J, Priore RL. Antibiotic use, hospital admissions, and mortality before and after implementing guidelines for nursing home-acquired pneumonia. J Am Geriatr Soc 2001; 49:1020-4. [PMID: 11555061 DOI: 10.1046/j.1532-5415.2001.49203.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To compare two strategies for implementing guidelines for nursing home-acquired pneumonia (NHAP) and to measure outcomes associated with treatment in accordance with the guidelines. DESIGN Randomized controlled trial. SETTING Ten skilled nursing facilities (SNFs) from a single metropolitan area. PARTICIPANTS Patients with an episode of pneumonia acquired more than 3 days after admission to SNF (N = 350): 226 preintervention episodes of pneumonia and 116 postintervention episodes. INTERVENTIONS Multi-faceted education intervention including small-group consensus process limited to physicians and a similar intervention that included physicians and nurses within randomly selected SNFs. MEASUREMENTS Antibiotic use at diagnosis compared with the guidelines, hospital admission, severity of pneumonia, and 30-day mortality. RESULTS Data were complete for 344 episodes of NHAP. For the preintervention group (n = 226), 62.2% (79/127) of the episodes were treated with parenteral antibiotics (PA) when PA were recommended by the guidelines and 57.6% (57/99) of episodes were treated with oral antibiotics (OA) when OA were indicated by the guidelines. Postintervention, treatment with PA and OA according to the guidelines was not significantly different between the two groups of randomized SNFs. A multivariate analysis comparing PA use pre- and postintervention for all SNFs, adjusted for variation in the frequency and severity of pneumonia, found significantly more of the postintervention episodes were treated with PA in accordance with the guidelines (P < .02). A preintervention significant difference in 30-day mortality observed between episodes with indications for PA (37.8% (48/127)) and episodes with indications for OA (6.1% (6/99)) (P < .001) was not present postintervention (11.5% (6/52); (23.8% (15/64); P = .06). There was no significant difference in 30-day mortality preintervention and postintervention for episodes with guideline indications for OA (P = .35) or for PA (P = .05) (P = .16 for multivariate analysis). The difference in PA use was not associated with significant differences in hospital admissions for episodes on NHAP. CONCLUSION The increase in the use of PA provides evidence that care within SNFs can be significantly changed using standard quality improvement techniques. Use of the guidelines did not significantly affect mortality. The addition of a practical severity of NHAP model or a change in reimbursement structure may enhance the guidelines' impact on hospitalization for NHAP. The financial benefits available with use of the guidelines will be limited unless the guidelines contribute to a reduction in rates of hospitalization.
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Affiliation(s)
- B J Naughton
- Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, USA
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Abstract
The etiology of severe pneumonia requiring mechanical ventilation in the very elderly has been imprecise because of lack of comprehensive studies and low yield of diagnostic approach. Overall, 104 patients 75 yr of age and older with severe pneumonia were studied prospectively at two university-affiliated hospitals. Microbial investigation included blood culture, serology, pleural fluid, and bronchoalveolar secretions. Streptococcus pneumoniae (14%), gram-negative enteric bacilli (14%), Legionella sp. (9%), Hemophilus influenzae (7%), and Staphylococcus aureus (7%) were the predominant pathogens in community-acquired pneumonia (CAP). Staphylococcus aureus (29%), gram-negative enteric bacilli (15%), Streptococcus pneumoniae (9%), and Pseudomonas aeruginosa (4%) accounted for most isolates of nursing home-acquired pneumonia (NHAP). The case fatality rate was 55% (53% for CAP and 57% for NHAP; p > 0.5). Activity of Daily Living (ADL) Index, pulmonary, endocrine and central nervous system (CNS) comorbidities were associated with distinct microbial etiology. By multivariate analysis, hospital mortality was associated independently with 24-h urine output (odds ratio [OR], 5.6; 95% confidence interval [CI], 2.5 to 7.9; p < 0.001), septic shock (OR, 4.3; 95% CI, 1.9 to 8.9; p = 0.0059), radiographic multilobar involvement (OR, 3.7; 95% CI, 1.8 to 15.6; p = 0.02), and inadequate antimicrobial therapy (OR, 2.6; 95% CI, 1.4 to 23.9; p = 0.034). Further studies should focus on identifying effective antimicrobial regimens in randomized trials.
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Affiliation(s)
- A A El-Solh
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Erie County Medical Center and Kaleida Health Care System, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York 14215, USA.
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Abstract
Anti-allergen antibodies were searched for by an Enzyme Immunoassay in the sera obtained from 60 patients with a clinical diagnosis of asthma. Allergic rhinitis was also present in 28 patients. The diagnosis of asthma was based on clinical criteria that include history and clinical evidence of airflow obstruction. Ten potential allergens (Bermuda grass, Olive tree, Parietaria, Alternaria, Cat hair dander, Dog hair dander, Mite DPT, Mugwort, Birch tree and Timothy grass) common to the Mediterranean area, were utilized. Twenty-five of 60 specimens were seropositive. Mite DPT was the allergen identified in 16 of the 25 seropositive specimens. Six of the 25 seropositive specimens reacted with more than one allergen. This may be due to the existence of similar antigenic determinant groups in the allergens used. There was no correlation between the occurrence of rhinitis in addition to asthma on one hand and the identified allergen on the other. Sixteen of the 25 seropositive patients were female. This observation is believed to be related to their occupation. Dog hair dander was identified as the allergen in 1 of the 25 seropositive patients. The low figure obtained was expected because keeping house pets is not a common practice in Lebanon. The 35 seronegative patients may belong to the intrinsic asthma group or the causative allergen in each case was not one of the 10 allergens used in this study. These results indicate that the house dust mite appears to be the most common allergen in the Lebanese asthmatic group studied.
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Affiliation(s)
- F Ramadan
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Lebanon
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Abstract
PURPOSE Many issues surrounding the management and outcome of carotid artery injuries remain controversial. The purpose of this study was to review a large contemporary experience with such injuries in the setting of designated trauma centers. METHODS A statewide computerized trauma registry was used to identify all patients with injuries to the common or internal carotid arteries from October 1987 to June 1993. The records of 82 such patients were retrieved and analyzed. RESULTS Overall mortality and stroke rates were 17% and 28%, respectively. Patients presenting with coma or shock had a particularly bad prognosis (50% and 41% mortality, respectively). Internal carotid injuries resulted in mortality and stroke rates of 21% and 41%, respectively, compared with 11% each for common carotid injuries. Patients with blunt injuries had a much higher stroke rate (56% vs 15%) but had lower mortality (7% vs 22%) than did patients with penetrating injuries. Airway compromise and associated injuries did not affect prognosis. Operative repair and percutaneous balloon occlusion had the best survival and functional outcomes. CONCLUSIONS Operative repair offers the best chances for recovery in all categories of patients regardless of injury mechanism. Ligation is useful only as a last-resort lifesaving effort. Shock and neurologic impairment are poor prognostic factors but should not negate repair.
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Affiliation(s)
- F Ramadan
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill 27599-7210
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Smith DL, Cairns BA, Ramadan F, Dalston JS, Fakhry SM, Rutledge R, Meyer AA, Peterson HD. Effect of inhalation injury, burn size, and age on mortality: a study of 1447 consecutive burn patients. J Trauma 1994; 37:655-9. [PMID: 7932899 DOI: 10.1097/00005373-199410000-00021] [Citation(s) in RCA: 229] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The relative impact of inhalation injury, burn size, and age on overall outcome following burn injury was examined in 1447 consecutive burn patients over a five and a half year period. The overall mortality for all patients was 9.5% (138 of 1447). The presence of inhalation injury, increasing burn size, and advancing age were all associated with an increased mortality (p < 0.01). The incidence of inhalation injury was 19.6% (284 of 1447) and correlated with increasing percent total body surface area (%TBSA) burn (r = 0.41, p < 0.01) and advancing age (r = 0.15, p < 0.01). The overall mortality for patients with inhalation injury was 31% (88 of 284) compared with 4.3% (50 of 1163) for those without inhalation injury. Using multivariate analysis inhalation injury was found to be an important variable in determining outcome, but the most important factor in predicting mortality was %TBSA burn (accuracy = 92.8%) or a combination of %TBSA burn and patient age (accuracy = 93.0%). Adding inhalation injury only slightly improved the ability to predict mortality (accuracy = 93.3%). The presence of inhalation injury is significantly associated with mortality after thermal injury but adds little to the prediction of mortality using %TBSA and age alone.
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Affiliation(s)
- D L Smith
- Department of Surgery, University of North Carolina, Chapel Hill 27707-7210
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Ramadan F. New trends in asthma. J Med Liban 1993; 41:27-31. [PMID: 7914544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Asthma, better termed hyperactive airway disease, is characterized by increased responsiveness of the tracheo-bronchial tree to exogenous and endogenous stimuli. The hallmark of this illness is widespread inflammation and narrowing of the tracheo-bronchial tree. This is manifested clinically by paroxysms of dyspnea, wheezing and cough which generally occur together. Treatment involves addressing the bronchospastic as well as the inflammatory components of asthma.
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Affiliation(s)
- F Ramadan
- American University of Beirut Medical Center
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Abstract
True primary venous aneurysms are rare. This is the first report of such an aneurysm involving the lesser saphenous vein. Though most often a medical curiosity, such lesions can result in serious morbidity and even mortality. Because of their rarity they are often misdiagnosed. Salient features pertaining to classification, diagnosis, and treatment are reviewed.
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Affiliation(s)
- F Ramadan
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill 27599-7210
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Upchurch GR, Banes AJ, Wagner WH, Ramadan F, Link GW, Henderson RH, Johnson G. Differences in secretion of prostacyclin by venous and arterial endothelial cells grown in vitro in a static versus a mechanically active environment. J Vasc Surg 1989; 10:292-8. [PMID: 2674482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The objective of this study was to compare the effect of cyclic tension on prostacyclin secretion by venous and arterial endothelial cells. Early passage endothelial cells from bovine aortas and venae cavae were subjected to cyclic deformation (up to 17% elongation and 60 cycles/min). On posttreatment days 3 and 5 a radioimmunoassay was used to assess supernatant fluids from the endothelial cells for prostacyclin activity. The results indicate that in vitro (1) under static or control conditions, venous endothelial cells secrete significantly more prostacyclin (an increase of 1.5- and 4.8-fold on days 3 and 5, respectively) than do arterial endothelial cells isolated from the same animal and (2) prostacyclin secretion by mechanically deformed venous and arterial endothelial cells was significantly less than static control cultures on days 3 and 5. However, prostaglandin I2 secretion remained at higher levels in cyclically deformed venous endothelial cells than in cyclically deformed arterial endothelial cells. These data suggest that endothelial cells from the vena cava have a greater capacity for prostacyclin secretion than have their aortic counterparts. If these observations are maintained in vivo, greater prostacyclin secretion by venous endothelial cells could represent a homeostatic mechanism aimed at reducing thrombus formation in low-velocity areas of the vasculature.
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Affiliation(s)
- G R Upchurch
- Department of Surgery, University of North Carolina Chapel Hill
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Morrison NJ, Abboud RT, Ramadan F, Miller RR, Gibson NN, Evans KG, Nelems B, Müller NL. Comparison of single breath carbon monoxide diffusing capacity and pressure-volume curves in detecting emphysema. Am Rev Respir Dis 1989; 139:1179-87. [PMID: 2712446 DOI: 10.1164/ajrccm/139.5.1179] [Citation(s) in RCA: 97] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
To evaluate the sensitivity of diffusing capacity (DLCO) and pressure-volume (P-V) curves in the detection of emphysema, these tests were compared with pathologic assessment of emphysema in patients undergoing lung resection for a localized tumor, and with the overall extent of emphysema as assessed by computed tomography (CT). The resected lung specimens were fixed in the inflated state and cut at 1-cm intervals in the horizontal plane. The pathologic extent of emphysema was quantitated by comparison with a standard reference panel of emphysema grading. The overall extent of emphysema on CT was assessed by a visual scoring system in a total of 55 patients, 19 undergoing lung resection and 36 not undergoing lung resection. Analysis of 37 patients by pathology scores revealed 18 with no or trivial emphysema (emphysema grades less than or equal to 5; mean grade, 2.2 +/- SD 2.6) and 19 with emphysema (grades greater than or equal to 10; mean grade, 33.2 +/- SD 24.2). Diffusing capacity, the ratio of DLCO to alveolar volume (DLCO/VA), maximal lung elastic recoil (PLmax), and lung elastic recoil at 90% of total lung capacity (PL90) were significantly different between the two groups, whereas K (the exponential constant describing the shape of the P-V curve) was not. The pathology grade of emphysema showed a significant correlation with (DLCO) (r = -0.53) and DLCO/VA (r = -0.55), which was greater than the correlation with PLmax (r = -0.42) and PL90 (r = -0.43).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- N J Morrison
- Department of Pathology, University of British Columbia, Vancouver General Hospital, Canada
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Rakic M, Elhosseiny A, Ramadan F, Iyer R, Howard RG, Gross L. Adult-type osteopetrosis presenting as carpal tunnel syndrome. Arthritis Rheum 1986; 29:926-8. [PMID: 3741505 DOI: 10.1002/art.1780290718] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We describe a patient with adult-type osteopetrosis presenting as carpal tunnel syndrome. Radiographs demonstrated sclerosis of the carpal bones, bone biopsy revealed wide bone spicules containing areas of cartilage, and electrophysiologic studies confirmed the diagnosis of median nerve entrapment in the carpal tunnel. Any condition which alters the size or shape of the carpal canal or its contents may result in median nerve compression.
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