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In respect to severe head injury, as has been intimated, the outcome is particularly discouraging Some aspects of prognosis have been mentioned earlier but the following general comments serve to frame the problem In the survey of the large European Brain Injury Consortium, comprising 10,005 adult patients, the injury proved fatal in 31 percent; 3 percent were left in a persistent vegetative state, and 16 percent remained severely disabled neurologically (Murray et al) Data from the extensively analyzed Traumatic Coma Data Bank are comparable (Marshall et al) The signs of focal brain disease, whether due to closed head injuries or to open and penetrating ones, tend always to ameliorate as the months pass A hemiplegia is often reduced to a minimal hemiparesis or to an ineptitude of voluntary motor function with exaggerated re exes

Exadata Storage Server Software makes intelligent decisions on what data to cache in the Exadata Smart Flash Cache When data is read as part of a SQL operation, the Exadata Storage Server Software checks to see if the data is likely to be accessed again and if the data is not part of a large scan The Exadata Smart Flash Cache does not cache the results of large I/O operations, since this would end up pushing a lot of data out of the cache as it added the scan results to it If the data does not fit this profile and the data is not a large object, the data block is placed into the Exadata Smart Flash Cache The Exadata Storage Server Software will also cache data from some modify operations Once the write to the log file is confirmed, allowing the write operation to complete, the block can be considered for addition to the Exadata Smart Flash Cache The Exadata Storage Server Software is smart enough to know to eliminate some types of writes from consideration, such as writes for backups, mirroring operations, Data Pump operations, ASM rebalances, and the like

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One of the most common causes of this referencing error is deleting an application rather than uninstalling it When you uninstall an application, its files are removed from the computer, its references are removed from the Registry and SYSTEMINI files, and its listing in the Programs menu is removed If you simply delete an application s files, these references remain in the system You should always remove applications using the manufacturer s uninstall utility or the Windows Uninstall utility, located in the Add/Remove Programs dialog box In Windows 2000 and XP, this is the Add or Remove Programs Icon

and an equivocal Babinski sign on that side, and an aphasia is gradually transformed into a stuttering or hesitant paraphasia or dysnomia that is not disabling except to a professional person, speaker, or writer Many of the signs of brainstem disease (cranial nerve dysfunction and ataxia) improve also, usually within the rst 6 months after injury (Jennett and Bond) and often to a surprising extent Most patients who had been in coma for many hours or days ie, those with severe brain injuries are left with memory impairment and other cognitive defects and with personality changes These may be the only lasting sequelae According to Jennett and Bond, these mental and personality changes are a greater handicap than focal neurologic ones as far as social adjustment is concerned In open head wounds and penetrating brain injuries, Grafman and coworkers found that the magnitude of tissue loss and location of the lesion were the main factors affecting the outcome The prognosis of head injury is in uenced by several other factors The age of the patient is the most important of these (Vollmer et al) Increasing age reduces the chances of survival and of good recovery Older patients often remain disabled, especially when compensation is involved Young and middle-aged ones do better, particularly if they are not entitled to compensation Russell has pointed out that the severity of the injury as measured by the duration of traumatic amnesia is a useful prognostic index Of patients with a period of amnesia lasting less than 1 h, 95 percent were back at work within 2 months; if the amnesia lasted longer than 24 h, only 80 percent had returned to work within 6 months However, about 60 percent of the patients in his large series still had symptoms at the end of 2 months, and 40 percent at the end of 18 months Of the most severely injured (those comatose for several days), many remained permanently disabled However, the degree of recovery was often better than one had expected; the motor impairment, aphasia, and dementia tended to lessen and sometimes cleared Improvement could continue over a period of 3 or more years Children seemed to recover more completely than adults.

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