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Counseling, education, and lifestyle modifications in CHF patients are the subject of this article, which presents the recommendations of the RAND Guideline Panel on congestive heart failure that counseling and education be used to improve patient outcomes and decrease unnecessary hospitalizations, that patients with mild to moderate heart failure should be restricted to three grams of sodium per day, that, initially, patients should be advised to drink no more than 30 ml per day of alcohol, and that exercise training is safe and can improve duration and symptoms.

Preamble......237 Medicine is experiencing an unprecedented focus on quantifying and improving health care quality. The American College of Cardiology (ACC) and the American Heart Association (AHA) have developed a multi-faceted strategy to facilitate the process of improving clinical care. The

Executive Summary andListing of Recommendations These guidelines are intended for physicians, nurses, and allied healthcare personnel who care for patients with suspected or established acute myocardial infarction (MI). These guidelines have been officially endorsed by the American Society of Echocardiography, the American College of Emergency Physicians, and the American Association of Critical-Care Nurses. This executive summary and listing of recommendations appears in the November 1, 1996, issue of Circulation. The guidelines in their entirety, including the ACC/AHA Class I, II, and III recommendations, are published in the November 1996 issue of the Journal of the American College of Cardiology. Beginning with these guidelines, the full text of ACC/AHA guidelines will be published in one journal and the executive summary and listing of recommendations in the other . Reprints of both the full text and the executive summary with its listing of recommendations are available from both organizations. Each year 900 000 people in the United States experience acute MI. Of these, roughly 225 000 die, including 125 000 who die “in the field” before obtaining medical care. Most of these deaths are arrhythmic in etiology. Because early reperfusion treatment of patients with acute MI improves left ventricular (LV) systolic function and survival, every effort must be made to minimize prehospital delay. Indeed, efforts are ongoing to promote rapid identification and treatment of patients with acute MI, including (1) patient education about the symptoms of acute MI and appropriate actions to take and (2) prompt initial care of the patient by the community emergency medical system. In treating the patient with chest pain, emergency medical system personnel must act with a sense of urgency. When the patient with suspected acute MI reaches the emergency department (ED), evaluation and initial management should take place promptly, because the benefit of reperfusion therapy is greatest if therapy …

Aluminium and polypropylene filters in series were used to eliminate scattered light below 10 nm from a grazing incidence monochrometer on the Doublet III tokamak. The 1s-2p O VII and O VIII resonance lines near 2 nm were observed with good signal-to-background. The background signal is caused by scattered light of longer wavelength of which metallic impurities is an important part. (AIP)

Executive Summary andListing of Recommendations These guidelines are intended for physicians, nurses, and allied healthcare personnel who care for patients with suspected or established acute myocardial infarction (MI). These guidelines have been officially endorsed by the American Society of Echocardiography, the American College of Emergency Physicians, and the American Association of Critical-Care Nurses. This executive summary and listing of recommendations appears in the November 1, 1996, issue of Circulation. The guidelines in their entirety, including the ACC/AHA Class I, II, and III recommendations, are published in the November 1996 issue of the Journal of the American College of Cardiology. Beginning with these guidelines, the full text of ACC/AHA guidelines will be published in one journal and the executive summary and listing of recommendations in the other . Reprints of both the full text and the executive summary with its listing of recommendations are available from both organizations. Each year 900 000 people in the United States experience acute MI. Of these, roughly 225 000 die, including 125 000 who die “in the field” before obtaining medical care. Most of these deaths are arrhythmic in etiology. Because early reperfusion treatment of patients with acute MI improves left ventricular (LV) systolic function and survival, every effort must be made to minimize prehospital delay. Indeed, efforts are ongoing to promote rapid identification and treatment of patients with acute MI, including (1) patient education about the symptoms of acute MI and appropriate actions to take and (2) prompt initial care of the patient by the community emergency medical system. In treating the patient with chest pain, emergency medical system personnel must act with a sense of urgency. When the patient with suspected acute MI reaches the emergency department (ED), evaluation and initial management should take place promptly, because the benefit of reperfusion therapy is greatest if therapy …

This article reviews the role of counseling, education, dietary modifications, and exercise for patients with heart failure due to left ventricular systolic dysfunction.We reviewed studies published in English between 1966 and 1993 and referenced in MEDLINE or EMBASE. We used the search terms heart failure, congestive; congestive heart failure; heart failure; cardiac failure; and dilated cardiomyopathy in conjunction with terms for the specific areas of interest. Where data were lacking, we relied on opinions of panel members and peer reviewers. STUDY SELECTION AND DATA SYNTHESIS: Studies were reviewed to determine whether patients had heart failure due to systolic dysfunction (left ventricular ejection fraction,0.35 to 0.40) and whether clinical outcomes were reported. Studies that reported only intermediate outcomes (eg, hemodynamics) were not reviewed.Counseling and education can improve patient outcomes and decrease unnecessary hospitalizations. Patients with mild to moderate heart failure should be restricted to 3 g/d of sodium initially. Those who are unresponsive to this dosage or who have more severe disease should be advised to consume 2 g/d or less. Patients should be strongly advised to drink no more than 30 mL/d of alcohol or, preferably, to abstain completely. Exercise training is safe and can improve exercise duration and symptoms. Adherence to the treatment plan should be stressed and monitored at each visit. Clinicians should inform patients of the seriousness of their disease and their prognosis, but they should emphasize that patients can continue to remain active and enjoy a reasonable quality of life.

Experimental results of divertor characteristics on impurity suppression, helium ash exhaust and remote radiative cooling are reviewed. In a throatless (open) divertor such as the single-null poloidal divertor in Doublet III, a dense and thick scrape-off layer provides strong particle shielding in high density divertor discharges, which results in a high neutral pressure and radiative cooling of the divertor even in an impurity-free condition. The feasibility of employing an open divertor in a reactor-grade device like INTOR is discussed. A preliminary result of divertor experiments with a 1.6 MW neutral-beam injection is presented.

OHTE reversed-field configurations with separatrix were produced, and high-beta confinement observed. Magnetic measurements identified m = 1 and m = 0 activity in both OHTE and RFP discharges, and B /B ∼ S − 1 2 . After careful adjustment of applied vertical field, both OHTE and RFP discharges were sustained well beyond the resistive decay or configuration time.

The Doublet III tokamak has been rebuilt as the DIII-D, to accommodate large cross-section (a = 0.67 m), highly elongated ( b a ≳ 2 ) plasmas with either a dee-shaped limiter configuration or a single null, poloidal divertor. The new vacuum vessel has been conditioned by a combination of 400°C baking, Taylor pulsed discharge cleaning (TDC), and rf-assisted glow cleaning (RGC). Tokamak operation began in February 1986 with the attainment of an 0.5 MA discharge on the first day plasmas were attempted. Rapid achievement of high current (I ≥ 2.0 MA) tokamak discharges in the DIII-D device underscores the importance of high temperature bakeout in shortening the initial cleanup period for a vessel with large amounts of graphitic armor.

Absorption oscillator strengths for rotational lines in Lyman transition vibrational bands of molecular hydrogen from equivalent widths measured photoelectrically

This report describes the experimental measurements and data analysis techniques used to evaluate the energy confinement in noncircular plasmas produced in Doublet III. Major aspects of the confinement measurements and analysis techniques are summarized. Machine parameters, diagnostic systems and discharge parameters relavent to the confinement measurements are given. Magnetic analysis techniques used to determine the plasma shape are reviewed. Scaling of the on-axis values of electron temperature, confinement time and Z/sub eff/ with plasma density is presented. Comparison with scaling results from other circular tokamaks is discussed. Numerical and analytic techniques developed for calculating the plasma energy confinement time and self-consistent profiles of density, temperature, current, and flux in non-circular geometries are described. These techniques are applied to the data and used to determine the central and global electron energy confinement time for a typical doublet plasma. Additional aspects of the confinement such as the radial dependence of the electron thermal conductivity and the estimated ion temperature are explored with the aid of a non-circular transport simulation code. The results of the confinement measurements are summarized and discussed. A brief summary of the theoretically expected effects of noncircularity on plasma confinement is included for reference as Appendix I.

Doublet IIA electron heating experiments utilize lower hybrid waves launched by slow wave structures with various n/sub parallel/ = ck/sub parallel//..omega.. (11, 14, 16) to achieve spatially localized heating by electron Landau damping. Radiofrequency power of 350 kW at 800 MHz and 200 kW at 915 MHz is available to heat circular discharges with ohmic input power of 100 kW. Significant increases in the electrical conductivity have been observed, but plasma response to the rf power is sensitive to the impurity level of the discharge. Power absorption mechanisms and energy balance will be discussed.

Sawtooth‐like oscillations in the line emission of impurity ions have been observed on Doublet IIA which agree in phase and frequency with fluctuations in the soft x‐ray signal caused by internal disruptions.

Optical determination of molecular hydrogen Lyman band oscillator strength from individual rotational lines