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Roy Haeusler and John Versace

driving such a car would behave and we also wanted to get expert opinions from a cross section of experienced automotive engineers, all in an effort to determine whether drivers could be expected to appreciate and gain safety from such superimposed control. Fig. 11. Beam pattern (Chrysler simulated radar brake study). The simulator used for our investigations consisted of an actual car that was provided with an overriding brake control which was operated just as might be expected of the finally engineered version. This simulator car was driven in city

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William L. Kissick

. In effect, this method translates demands for services, as measured by probable expenditures, into manpower requirements. Professional judgment, the third method, utilizes expert opinion as to medical needs as a basis for calculating manpower requirements. This method formed the basis for the projections of the Surgeon General's Consultant Group on Nursing, that 850,000 nurses would be needed by 1970. Calculations were based on the opinion that adequate services were provided when 50% of inpatient nursing care was provided by registered nurses, 30% by LPN's, and

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Lawrence C. Dempsey and Byron C. Pevehouse

Chemical composition of suspected lymphatic fluid Chemical Composition Lymphatic Fluid Serum protein fraction *  pre-albumin 1%  albumin 65%  alpha-1 7%  alpha-2 10%  beta 14%  gamma 5% electrolytes  Na (mEq/l) 125 130  K (mEq/l) 3.0 4.7  Cl (mEq/l) 98 109 HCO 3 19 * Total protein was 800 mg%. The lymphatic fistula drained 1200 to 1700 ml/day for 35 days, despite expert opinion that it would close

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Marco L. Rossi, John S. Bevan, Margaret M. Esiri, John T. Hughes and Christopher B. T. Adams

prolactin concentrations of less than 3000 mU/liter (90 ng/ml) require early surgery for diagnosis and should be treated by surgical decompression. 3 Acknowledgments We thank Prof. L. J. Rubinstein and Drs. D. B. Brownell, T. Moss, and S. Rutherfoord for expert opinion on the histology. We also thank Ms. M. Reading, Ms. H. Kidd, and Mr. R. Cross for technical assistance and Ms. P. Deacon and Dr. D. Ferguson for the photography. References 1. Allan PM , Garson JA , Harper El , et al : Biological characterization and clinical

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Patrick W. McCormick, Robert F. Spetzler, Julian E. Bailes, Joseph M. Zabramski and James L. Frey

that, according to expert opinion, ICA occlusion was a contraindication to ICA surgery. 21 In fact, after reviewing 1000 carotid endarterectomies, the responders categorized the 60 procedures (6%) performed for complete carotid artery occlusion as inappropriate. To help clarify this issue, we have reviewed our experience with ICA thromboendarterectomy using strict patient selection criteria, a uniformly applied surgical algorithm, standardized microsurgical technique, and aggressive intraoperative neuronal ischemic protection. Clinical Material and Methods

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Gary M. Nesbit, Wayne M. Clark, Oisin R. O'Neill and Stanley L. Barnwell

emergency thromboendarterectomy yields variable results and controversial opinions on the benefits of surgery in patients with profound neurological deficits. However, expert opinion 19, 32 considers ICA occlusion with severe acute neurological deficit a contraindication to surgery unless it occurs in a hospital where reestablishment of flow can be achieved in less than 1 to 2 hours. In the most optimistic study of carotid endarterectomy in patients with profound neurological deficits, Meyer, et al. , 20 reported good outcome in 38.3%, fair outcome in 29.4%, poor

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Association. In this methodology, the strength of the study designs used in supportive research is reflected in the level of the recommendations given. To achieve “guideline” status, a recommendation would have to be based on a comparative studies such as a nonrandomized cohort study or a case control study. What this case series represents is no more than a practice option and therefore has no more validity than expert opinion. For these reasons, we caution any neurosurgical colleague that the data presented in this report do not document the safety of allowing return to

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Michael G. Fehlings and Charles H. Tator

-defined comparison groups), and Class III (case series, retrospective reviews, and expert opinion). TABLE 1 Effect of decompressive surgery in animal models of SCI * Authors & Year Animal Model of Injury Duration of Compression Results Tarlov, 1954 & 1957, dog extradural balloon mins to days DC improves NR  Tarlov & Klinger, 1954 Brodkey, et al., 1972 cat static weight model mins early removal of weight restores axonal  conduction Croft, et al., 1972 cat static weight model

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Ahmed Alkhani and Andres M. Lozano

study design, content, and outcomes. Prospective and retrospective studies, clinical series, and case reports in all languages were included. Studies were classified according to the AAN criteria for classification of evidence: 70 Class I, evidence provided by one or more well-designed, randomized controlled trials, including overviews (metanalyses) of such trials; Class II, evidence provided by one or more well-designed, observational clinical studies with concurrent controls (for example, case-control and cohort studies); and Class III, evidence provided by expert

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G. Evren Keles, Kathleen R. Lamborn and Mitchel S. Berger

III evidence, which is provided by expert opinions, nonrandomized historical controls, or case reports. 2, 12 A recent review by the Guidelines and Outlines Committee of the American Association of Neurological Surgeons, 18 based on data published from 1966 to 1994 on low-grade gliomas, showed that the only available standard for adults with suspected or known supratentorial nonoptic-pathway low-grade gliomas is to obtain a tissue diagnosis before active treatment commences. Several key issues, including the need for biopsy before observation and the effects of