Antibiotic-Impregnated Versus Silver-Bearing External Ventricular Drainage Catheters: Preliminary Results in a Randomized Controlled Trial

Background: Evaluation of antibiotic-impregnated (AI) and ionized silver particle coated external ventricular drainage catheters (EVD) in patients with subarachnoid (SAH) or intracranial hemorrhage (ICH). Methods: Between February 2011 and June 2012, 40 patients with acute hydrocephalus due to SAH, ICH or intraventricular hemorrhage were enrolled in a prospective, randomized, mono-center pilot study. Primary endpoints were defined as: number of events of cerebrospinal fluid (CSF) infections. Secondary endpoints were defined as: neurosurgical complications following the placement of the EVD, number of revisions of EVD catheters, and cost effectiveness. Results: Sixty-one EVD placements in 40 patients, 32 antibiotic-coated (Bactiseal®), 29 silver-bearing catheters (VentriGuard®), have been performed. Confirmed or high suspicion of CSF infections occurred in 11 out of 61 events (confirmed infection: p=0.71, probable infection: p=0.90). Revisions of EVD were needed in 13 cases (22%) due to CSF infection, dysfunction, impaired healing, or malplacement (p=0.37). Conclusion: Regarding CSF infection rate and dysfunction, no statistical significant differences between the two EVD catheters Bactiseal® versus VentriGuard® were found. The silver-bearing catheter might offer a safe and cost-conscious alternative to the AI cathete

Integrating computer vision techniques into a touch pad system

A key strength of touchpads, such as iPads or Galaxy Tabs, is that they provide portable access to the Internet and many applications that entertain and help managing the lives of users. The integration of computer vision methods into touchpads results in even more powerful devices that enable natural human-computer interaction. This thesis proposes two techniques of incorporating computer vision methods -- one technique supports touch-based interaction for biomedical image analysis, the other camera-based interaction for music therapy and entertainment: I'mCell is an application for annotating objects in images, for example, cells in phase-contrast microscopy images. MusicTracks recognizes a user's facial expression, captured by the camera of the touchpad, and plays music according to the user's mood. The I'mCell and MusicTracks applications have been implemented for the iPad. Users who experimented with the applications report them to be convenient because they enable efficient (I'mCell) and enjoyable (MusicTracks) interactions and are easy-to-use and portable

Introducing a nationwide registry: the Swiss study on aneurysmal subarachnoid haemorrhage (Swiss SOS)

Background: Aneurysmal subarachnoid haemorrhage (aSAH) is a haemorrhagic form of stroke and occurs in a younger population compared with ischaemic stroke or intracerebral haemorrhage. It accounts for a large proportion of productive life-years lost to stroke. Its surgical and medical treatment represents a multidisciplinary effort. Due to the complexity of the disease, the management remains difficult to standardise and quality of care is accordingly difficult to assess. Objective: To create a registry to assess management parameters of patients treated for aSAH in Switzerland. Methods: A cohort study was initiated with the aim to record characteristics of patients admitted with aSAH, starting January 1st 2009. Ethical committee approval was obtained or is pending from the institutional review boards of all centres. In the study period, seven Swiss hospitals (five university [U], two non-university medical centres) harbouring a neurosurgery department, an intensive care unit and an interventional neuroradiology team so far agreed to participate in the registry (Aarau, Basel [U], Bern [U], Geneva [U], Lausanne [U], St. Gallen, Zürich [U]). Demographic and clinical parameters are entered into a common database. Discussion: This database will soon provide (1) a nationwide assessment of the current standard of care and (2) the outcomes for patients suffering from aSAH in Switzerland. Based on data from this registry, we can conduct cohort comparisons or design diagnostic or therapeutic studies on a national level. Moreover, a standardised registration system will allow healthcare providers to assess the quality of car

Factors Influencing Customers’ Switching Intentions in Commercial Banks of Tanzania.

The negative consequences of customer switching behaviour in the banking industry cannot be underestimated. Since there are limited studies addressing customers’ switching intentions and actual switching behaviour in the banking sector of Tanzania, this study intended to bridge the knowledge gap by addressing the influence of perceived control of bank charges, attitude toward service quality, subjective norms and convenience on customers’ switching intentions in commercial banks of Tanzania. The study followed a positivism research paradigm out of which a deductive research approach was adopted. In the same line, an explanatory research design was used. The study was conducted in Dar es Salaam with 400 respondents who were customers from NMB Bank Plc, TPB Bank Plc and NBC Bank Ltd. Multi-stage sampling was used to generate a sample for this study while a close-ended questionnaire was used to collect data. Multiple linear regression was employed to test the hypotheses. The findings of the study indicated that subjective norms insignificantly influence customers’ switching intentions in commercial banks. Further findings revealed that perceived control of bank charges, attitude toward service quality and convenience significantly influenced customers’ switching intentions in commercial banks. It was recommended that commercial banks should exercise care in fixing the level of bank charges for their services. Furthermore, commercial banks should invest in improving and maintaining service quality. In the end, commercial banks should ensure customer convenience aiming to promote customer comfort in the banking environment. Keywords: Bank Charges, Service Quality, Subjective Norms and Convenience

Flexible Screw Design for Bone Implant Application

Disruption of the scapholunate ligament can result in significant immediate and long-term disability. Of the available current acute and subacute treatment strategies for this disorder, the use of a solid screw to stabilize the scapholunate relationship has been proposed. However, subsequent carpal bone loss is an inherent risk to this technique. The goal of this study was to design a flexible orthopedic screw that can be placed between the scaphoid and lunate to restore more normal biomechanics without the risk of osteolysis. Several ideas were generated during the course of the study to create a moveable section in a bone screw implant. Designs that met the specifications and were promising from the manufacturing point of view were tested using finite element analysis. Some designs were prototyped and one of them was tested using a cadaver wrist. Every design concept revealed some positive and negative features in terms of manufacturing and functionality. It is promising in terms of fulfilling the design requirements, but prototyping the design was very difficult. In conclusion, it can be said that the invented flexible screw techniques are sufficient to hold the scaphoid and lunate together after the scapholunate ligament injury, to restore more normal wrist biomechanics

C-reactive protein elevation predicts in-hospital deterioration after aneurysmal subarachnoid hemorrhage: a retrospective observational study.

BACKGROUND There is increasing evidence that inflammation plays a role in the pathogenesis of aneurysmal subarachnoid hemorrhage (aSAH) and in the development of delayed cerebral ischemia (DCI). However, the assessment and interpretation of classically defined inflammatory parameters is difficult in aSAH patients. The objective of this study was to investigate the relationship between easily assessable findings (hyperventilation, fever, white blood cell count (WBC), and C-reactive protein (CRP)) and the occurrence of DCI and unfavorable neurological outcome at discharge in aSAH patients. METHODS Retrospective analysis of prospectively collected data from a single center cohort. We evaluated the potential of clinical signs of inflammation (hyperventilation, fever) and simple inflammatory laboratory parameters CRP and WBC to predict unfavorable outcomes at discharge and DCI in a multivariate analysis. A cutoff value for CRP was calculated by Youden's J statistic. Outcome was measured using the modified Rankin score at discharge, with an unfavorable outcome defined as modified Rankin scale (mRS) > 3. RESULTS We included 97 consecutive aSAH patients (63 females, 34 males, mean age 58 years) in the analysis. Twenty-one (22%) had major disability or died by the time of hospital discharge. Among inflammatory parameters, CRP over 100 mg/dl on day 2 was an independent predictor for worse neurological outcome at discharge. The average C-reactive protein level in the first 14 days was higher in patients with a worse neurological outcome (96.6, SD 48.3 vs 56.3 mg/dl, SD 28.6) in the first 14 days after aSAH. C-reactive protein on day 2 was an indicator of worse neurological outcome. No inflammatory parameter was an independent predictor of DCI. After multivariate adjustment, DCI, increased age, and more than 1 day of mechanical ventilation were significant predictors of worse neurological outcome. CONCLUSIONS Early elevated CRP levels were a significant predictor of worse neurological outcome at hospital discharge and may be a useful marker of later deterioration in aSAH

The Impact of Nonsteroidal Anti-inflammatory Drugs on Inflammatory Response After Aneurysmal Subarachnoid Hemorrhage

Background: The degree of inflammatory response with cytokine release is associated with poor outcomes after aneurysmal subarachnoid hemorrhage (SAH). Previously, we reported on an association between systemic IL-6 levels and clinical outcome in patients with aneurysmal SAH. The intention was to assess the impact of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen on the inflammatory response after SAH. Methods: Our method involved exploratory analysis of data and samples collected within a previous study. In 138 patients with SAH, systemic interleukin (IL-6) and c-reactive protein (CRP) were measured daily up to day 14 after SAH. The correlations among the cumulatively applied amount of NSAIDs, inflammatory parameters, and clinical outcome were calculated. Results: An inverse correlation between cumulatively applied NSAIDs and both IL-6 and CRP levels was found (r=−0.437, p<0.001 and r=−0.369, p<0.001 respectively). Multivariable linear regression analysis showed a cumulative amount of NSAIDs to be independently predictive for systemic IL-6 and CRP levels. The cumulative amount of NSAIDs reduced the odds for unfavorable outcome, defined as Glasgow outcome scale 1-3. Conclusions: The results indicate a potential beneficial effect of NSAIDs in patients with SAH in terms of ameliorating inflammatory response, which might have an impact on outcome

Therapeutic Hypothermia Reduces Middle Cerebral Artery Flow Velocity in Patients with Severe Aneurysmal Subarachnoid Hemorrhage

Background: Transcranial Doppler (TCD) is widely used to detect and follow up cerebral vasospasm after subarachnoid hemorrhage (SAH). Therapeutic hypothermia might influence blood flow velocities assessed by TCD. The aim of the study was to evaluate the effect of hypothermia on Doppler blood flow velocity after SAH. Methods: In 20 patients treated with hypothermia (33°) due to refractory intracranial hypertension or delayed cerebral ischemia (DCI), mean flow velocity of the middle cerebral artery (MFVMCA) was assessed by TCD. Thirteen patients were treated with combined hypothermia and barbiturate coma and seven with hypothermia alone. MFVMCA was obtained within 24h before and after induction of hypothermia as well as before and after rewarming. Results: Hypothermia was induced on average 5days after SAH (range 1-12) and maintained for 144h (range 29-270). After hypothermia induction, MFVMCA decreased from 113.7±49.0 to 93.8±44.7cm/s (p=0.001). The decrease was independent of SAH-related complications and barbiturate coma. MFVMCA further decreased by 28.2cm/s between early and late hypothermia (p<0.001). This second decrease was observed in patients with DCI (p<0.001), but not in patients with intracranial hypertension (p=0.715). Compared to late hypothermia, MFVMCA remained unchanged after rewarming (65.6±32.1 vs 70.3±36.8cm/s; p=0.219). However, patients treated with hypothermia alone showed an increase in MFVMCA after rewarming (p=0.016). Conclusion: Therapeutic hypothermia after SAH decreases Doppler blood flow velocity in both intracranial hypertension and DCI cases. The results can be the effect of hypothermia-related mechanisms or resolving cerebral vasospasm during prolonged hypothermia

Early Systemic Procalcitonin Levels in Patients with Aneurysmal Subarachnoid Hemorrhage

Background: Early (≤24h) systemic procalcitonin (PCT) levels are predictive for unfavorable neurological outcome in patients after out-of-hospital cardiac arrest (OHCA). Subarachnoid hemorrhage (SAH) due to aneurysm rupture might lead to a cerebral perfusion stop similar to OHCA. The current study analyzed the association of early PCT levels and outcome in patients after SAH. Methods: Data from 109 consecutive patients, admitted within 24h after SAH, were analyzed. PCT levels were measured within 24h after ictus. Clinical severity was determined using the World Federation of Neurological Societies (WFNS) scale and dichotomized into severe (grade 4-5) and non-severe (1-3). Neurological outcome after 3months was assessed by the Glasgow outcome scale and dichotomized into unfavorable (1-3) and favorable (4-5). The predictive value was assessed using receiver operating curve (ROC) analysis. Results: Systemic PCT levels were significantly higher in patients with severe SAH compared to those with non-severe SAH: 0.06±0.04 versus 0.11±0.11μg/l (median±interquartile range; p<0.01). Patients with unfavorable outcome had significantly higher PCT levels compared to those with favorable outcome 0.09±0.13 versus 0.07±0.15ng/ml (p<0.01). ROC analysis showed an area under the curve of 0.66 (p<0.01) for PCT, which was significantly lower than that of WFNS with 0.83 (p<0.01). Conclusions: Early PCT levels in patients with SAH might reflect the severity of the overall initial stress response. However, the predictive value is poor, especially compared to the reported predictive values in patients with OHCA. Early PCT levels might be of little use in predicting neurological outcome after SAH