Background: Rapidly resolving acute subdural hematomas (RRASDHs) have been described in case reports and case series but are still poorly understood. We hypothesized that a cohort analysis would confirm previously reported predictors of RRASDH including coagulopathy, additional intracranial hemorrhage, and low-density band on imaging. We also hypothesized that rapid resolution would be associated with improved trauma outcomes. Methods: We reviewed all nonoperative acute subdural hematomas (ASDHs) treated at our center from 2011 to 2015. Inclusion criteria were ASDH on computed tomography (CT), admission Glasgow coma score > 7, and repeat CT to evaluate ASDH change. RRASDH was defined as reduced hematoma thickness by 50% within 72 h. Clinical data, CT findings, and trauma end points were analyzed for the RRASDH and nonresolving groups. Results: There were 154 ASDH patients included, with 29 cases of RRASDH. The RRASDH group had a lower rate of comorbidities than the nonresolving group (58.6% versus 78.4%, P = 0.03) and a lower rate of prehospital anticoagulation (7.7% versus 37.1%, P = 0.004). Previously reported predictors of RRASDH did not differ between the groups, nor did any clinical outcome measures. When compared with patients who experienced rapid growth (> 50% increased width in 72 h), the RRASDH group had lowermortality (3.4% versus 23.5%, P = 0.04). Conclusions: To our knowledge, this is the largest review of RRASDHs. We identified two previously unrecognized factors that may predict resolution; however, previously reported predictors were not associated with resolution. We also found no relationship between RRASDHs and improved standard trauma outcomes, calling into question the clinical significance of RRASDH. (C) 2017 Elsevier Inc. All rights reserved.

Background. Intracranial pressure (ICP) is currently measured with invasive monitoring. Sonographic optic nerve sheath diameter (ONSD) may provide a noninvasive estimate of ICP. Our hypothesis was that bedside ONSD accurately estimates ICP in acutely injured patients. The specific aims were (1) to determine the accuracy of ONSD in estimating elevated ICP, (2) to correlate ONSD and ICP in unilateral and bilateral head injuries, and (3) to determine the effect of ICP monitor placement on ONSD measurements.Materials and Methods. A blinded prospective study of adult trauma patients requiring ICP monitoring was performed at a University-based urban trauma center. The ONSD was measured by ultrasound pre- and post-placement of an ICP monitor (Camino Bolt or Ventriculostomy).Results. One-hundred fourteen measurements were obtained in 10 trauma patients requiring ICP monitoring. Pre- and post-ONSD were compared with side of injury in the presence of an ICP monitor. ROC analysis demonstrated ONSD poorly estimates elevated ICP (AUC = 0.36). Overall sensitivity, specificity, PPV, NPV, and accuracy for estimating ICP with ONSD were 36%, 38%, 40%, 16%, and 37%. Poor correlation of ONSD to ICP was observed with unilateral (R-2 = 0.45, P < 0.01) and bilateral (R-2 = 0.21, P = 0.01) injuries. ICP monitor placement did not affect ONSD measurements on the right (P = 0.5), left (P = 0.4), or right and left sides combined (P = 0.3).Conclusions. Sonographic ONSD as a surrogate for elevated ICP in lieu of invasive monitoring is not reliable due to poor accuracy and correlation. (C) 2011 Elsevier Inc. All rights reserved.

Kwan, Rita O. MD, MPH; Ereso, Alexander Q. MD; Cureton, Elizabeth MD; Dozier, Kristopher MD; Castro-Moure, Frederico MD, PhD; Patel, Atul MD; Sadjadi, Javid MD; Victorino, Gregory P. MD, FACS Author Information

Objective To study the safety and antiretroviral effectiveness of concomitant use of rifampicin and efavirenz for antiretroviral-naïve patients in India who are coinfected with tuberculosis (TB) and HIV-1. Design and Methods The study was an observational longitudinal cohort investigation. HIV-1–infected patients with CD4 cell counts of ≤200/μL who attended the Infectious Disease Clinic of Sterling Hospital (Ahmedabad, India) from June 2001 to December 2002 were recruited for the study. Patients were divided in 2 groups: group A, patients with active TB (n = 126); and group B, patients without TB (n = 129). Group A patients were given efavirenz with 2 nucleoside reverse transcriptase inhibitors along with rifampicin-containing anti-TB treatment. Group B patients were treated for presenting opportunistic infections and started therapy with efavirenz plus 2 nucleoside reverse transcriptase inhibitors. The nucleoside reverse transcriptase inhibitors were either zidovudine and lamivudine (n = 30) or stavudine and lamivudine (n = 225). Patients self-funded their investigations and medications (antiretroviral, anti-TB, and other opportunistic infection–related agents). Indian generic medications were used. Results Efavirenz-based highly active antiretroviral therapy with rifampicin for HIV/TB-coinfected patients resulted in an immunologic response that was comparable with that of the group not receiving rifampicin. Median CD4 cell counts at baseline, 3 months, 6 months, and 9 months in group A were 84/μL (range, 5–200/μL), 225/μL (range, 26–528/μL), 251/μL (range, 65–775/μL), and 275/μL (range, 61–611/μL), respectively, and in group B, these values were 118/μL (range, 2–200/μL), 244/μL (range, 38–881/μL), 294/μL (range, 23–1322/μL), and 295/μL (range, 26–991/μL), respectively. The overall increase in CD4 cell count was greater in group A than in group B at 9 months (190 vs. 176/μL, respectively). Patients in both groups tolerated the therapy well; the adverse effects profile was comparable except that group A patients had a higher incidence of hepatitis than group B patients (13.49% vs. 0, respectively; P < 0.0001). Conclusion Clinical and immunologic benefits are comparable for patients receiving efavirenz-based antiretroviral therapy with or without rifampicin.

SEMATECH has sponsored a "Test Method Evaluation" study to understand the trade-offs among the most common test methodologies used in the industry. This paper presents the results of the failure analysis portion of that project. The testing, reliability stressing, characterization, fault diagnosis and physical analysis results are presented for 25 devices including "IDDq-only" failures and "delay test-only" failures.

Combined WBRT and radiosurgery for the treatment of patients with two to four brain metastases significantly improves control of brain disease. Whole-brain radiation therapy alone does not provide lasting and effective care when treating most patients. Surgical resection remains important for patients with large symptomatic tumors and in whom limited extracranial disease has been demonstrated.

A newly developed parameterization of the third-order isentropic finite strain equation of states (EOS) is used in conjunction with experimental data and theoretical results on MgSiO3 perovskite. New geotherms for the lower mantle are derived by comparison with preliminary reference earth model (PREM). The geotherms are adiabatic up to 1500 km depth and super-adiabatic thereafter. A description of the critical steps in obtaining the new parameterization is also given.

Purpose: Multiple brain metastases are a common health problem, frequently diagnosed in patients with cancer. The prognosis, even after treatment with whole brain radiation therapy (WBRT), is poor with average expected survivals less than 6 months. Retrospective series of stereotactic radiosurgery have shown local control and survival benefits in case series of patients with solitary brain metastases. We hypothesized that radiosurgery plus WBRT would provide improved local brain tumor control over WBRT alone in patients with two to four brain metastases.Methods: Patients with two to four brain metastases (all less than or equal to 25 mm diameter and known primary tumor type) were randomized to initial brain tumor management with WBRT alone (30 Gy in 12 fractions) or WBRT plus radiosurgery. Extent of extracranial cancer, tumor diameters on MRI scan, and functional status were recorded before and after initial care.Results: The study was stopped at an interim evaluation at 60% accrual. Twenty-seven patients were randomized (14 to WBRT alone and 13 to WBRT plus radiosurgery). The groups were well matched to age, sex, tumor type, number of tumors, and extent of extracranial disease. The rate of local failure at 1 year was 100% after WBRT alone but only 8% in patients who had boost radiosurgery. The median time to local failure was 6 months after WBRT alone (95% confidence interval [CI], 3.5-8.5) in comparison to 36 months (95% CI, 15.6-57) after WBRT plus radiosurgery (p = 0.0005). The median time to any brain failure was improved in the radiosurgery group (p = 0.002). Tumor control did not depend on histology (p = 0.85), number of initial brain metastases (p = 0.25), or extent of extracranial disease (p = 0.26). Patients who received WBRT alone lived a median of 7.5 months, while those who received WBRT plus radiosurgery lived 11 months (p = 0.22). Survival did not depend on histology or number of tumors, but was related to extent of extracranial disease (p = 0.02). There was no neurologic or systemic morbidity related to stereotactic radiosurgery.Conclusions: Combined WBRT and radiosurgery for patients with two to four brain metastases significantly improves control of brain disease. WBRT alone does not provide lasting and effective care for most patients. (C) 1999 Elsevier Science Inc.

SEMATECH has sponsored a "Test Method Evaluation"study to understand the trade-offs among the most commontest methodologies used in the industry [1,2]. This paper presentsthe results of the failure analysis portion of thatproject. The testing, reliability stressing, characterization,fault diagnosis and physical analysis results are presentedfor 25 devices including "IDDq-only" failures and "delaytest-only" failures.

Gliomas that aggregate in otherwise unremarkable families may have a heritable genetic basis. To determine the spectrum of genetic alterations in glioma-susceptible families, we examined tumor DNA from familial cases for regions of chromosomal gain or loss using comparative genomic hybridization (CGH). We compared chromosomal alterations within and among glioma families to those found in sporadic gliomas. A specific chromosomal abnormality common to the tumors of multiple unrelated probands with glioma or a specific chromosomal abnormality common to multiple affected persons in a single glioma-prone family would support the hypothesis of an inherited predisposition to glioma and at the same time identify specific regions of the genome harboring putative glioma susceptibility genes. Tumor DNA from 11 patients from seven families with two or more individuals with glioma was analyzed, including three members of a remarkable family having 10 affected individuals. We found no chromosomal abnormality common to all tumors of all probands nor did we find family-specific abnormalities in two of three glioma-prone kindreds. There were frequent copy number aberrations (CNAs) on chromosomes 7, 10, 19, and the sex chromosomes; other CNAs included +3q(13.3-29), −4q, +5q, −9q34, +12, −13q(21 → 33), −15, −16p, +17qter, −18, −21, and −22. Amplifications occurred at ++7p(11.1 → 12), ++7q(21.2 → 33), ++12q(13.2 → 14), and ++12p(11 → 12). Although there were several novel CNAs [−16p, and ++12p(11-p12)], none could readily explain the inheritance of these tumors.

The structural and ground-state electronic properties of the layered orthorhombic molybdenum trioxide (α-MoO 3 ) have been investigated using a periodic boundary condition ab initio Hartree–Fock method. The effect of electron correlation is estimated with a posteriori density functional corrections to the total energy. The structure has been optimised using the correlation corrected Hartree–Fock energy (except for the interlayer separation where the correlation correction has not been applied), treating each degree of freedom independently. The bonding in the solid is examined in detail: the nature of the Mo–O interaction changes considerably with the equilibrium bond distance, and varies from strongly covalent for the shortest bond to a predominantly ionic interaction for the longest bonds in the MoO 6 octahedron. The degree of covalence in the bonding is characterised using electron density maps and the Mulliken population analysis; the net charge shows a value as low as -0.44|e| for the oxygen involved in the shortest Mo–O bond. The energy as a function of the interlayer spacing has a minimum, both at the correlated and the Hartree–Fock level, indicating that a weak attractive Coulombic force is active between adjacent layers.

We have used a combination of molecular dynamics and lattice dynamics simulation techniques to calculate the thermoelastic properties of MgSiO3 perovskite over a wide range in P-T space. Our calculated values for the parameters which are of use in equation of state modelling are: Θ (K) = 1039, K0 (GPa) = 250, K′0 = 4.0, V0 (cm3 mol−1 K−1) = 24.44, γ0 = 1.97 and δT0 = 7.0. There is excellent agreement between our predicted values and the X-ray diffraction diamond anvil cell (XRD-DAC) experiments of Mao et al. (1991, J. Geophys. Res., 96: 8069–8079) but disagreement on the values of δT0 and γ when compared with the high pressure multi-anvil experiments of Wang et al. (1994, Phys. Earth Planet. Inter., 83: 13–41) and the fitted values of Anderson et al. (1995a, Phys. Earth Planet. Inter., 89: 35–49). In addition, the second Grüneisen parameter, q, was found to decrease with pressure, where q drops from 3.0 (0 GPa) to 1.7 at 100 GPa.

The structural and electronic properties of bulk cubic and tetragonal tungsten trioxide are investigated using a periodic boundary condition ab initio Hartree-Fock method; a posteriori density functional corrections are used to estimate the effect of electron correlation on the energy. The farces involved in the bonding between metal and oxygen are examined to shed light on the crystal chemistry of the compound. While the cubic phase is highly ionic, the symmetry distortion leading to the tetragonal phase causes an increase in covalence between tungsten and its nearest oxygen. The observed instability of cubic WO3 is explained by its higher energy (0.80 eV per formula unit) with respect to the tetragonal phase. We attribute this energy,oy difference to the increased covalence observed in the latter phase. The calculated structural parameters for tetragonal WO3 agree with available experimental data. A layered structure emerges from our calculations for tetragonal WO3; when the effect of applying pressure is examined, only the interlayer spacing is appreciably modified. This softer degree of freedom results in a lower value of the bulk modulus when compared to that of the cubic phase. In the range of experimentally obtainable pressures, the order of stability of the two phases cannot be reversed, and the cubic structure remains unstable with respect to the tetragonal structure.

Abstract Ab initio calculations using the local density approximation and pseudopotentials were made on forsterite from 0 to 700 kbar. Our calculations are generally consistent with almost all the experimental cell-parameter and bond-length data. In contrast to some experimental data, however, we find no evidence for abrupt changes in compressional mechanism at any pressure.

The lattice dynamics (LD) and molecular dynamics (MD) methods have been used to calculate the structure, bulk modulus, and volume thermal expansivity of MgSiO3 perovskite, in order to investigate the reliability of the two simulation techniques over a wide range of temperature and pressure conditions. At an intermediate temperature of 500 K and zero pressure, the LD and MD values are in exellent agreement for both the structure and bulk modulUS of MgSiO3 perovskite. At high temperatures and zero pressure, however, the LD method, which is based on the quasi-harmonic approximation, increasingly overestimates the molar volume of MgSiO3 perovskite because of the neglect of higher-order anharmonic terms. At the high temperatures and high pressures prevailing in the lower mantle, the errors in the LD values for both the molar volume and bulk modulus, relative to the MD values, are generally small or negligible. However, since anharmonicity decreases substantially with pressure but increases rapidly with temperature, the error in the LD simulated volume thermal expansivity is serious, especially in the lower pressure region.

We use an atomistic model to simulate the structure, lattice dynamics and thermodynamics of silicate minerals. Our approach uses the Born model of a solid, in which the interaction between atoms is described by an interatomic pair potential. We have extended the study of thermodynamics to its very limit by looking at the subtle reaction of oxygen isotope exchange. We have modelled equilibria involving the important metamorphic minerals; albite, diopside, forsterite, pyrope, quartz and wollastonite. The predicted structural and thermodynamic data for these silicates are in very good agreement with the observed values. In addition, we predict not only the correct direction for the phase equilibria for oxygen isotope exchange, but also fractionation factors for the reaction to within a factor of two of the available experimental data. Hence, the potentials used in our approach have shown excellent transferability and have performed very well against the most stringent of tests.