First observation of edge localized modes mitigation with resonant and nonresonant magnetic perturbations in ASDEX Upgrade.

First experiments with nonaxisymmetric magnetic perturbations, toroidal mode number n=2, produced by newly installed in-vessel saddle coils in the ASDEX Upgrade tokamak show significant reduction of plasma energy loss and peak divertor power load associated with type-I edge localized modes (ELMs) in high-confinement mode plasmas. ELM mitigation is observed above an edge density threshold and is obtained both with magnetic perturbations that are resonant and not resonant with the edge safety factor profile. Compared with unperturbed type-I ELMy reference plasmas, plasmas with mitigated ELMs show similar confinement, similar plasma density, and lower tungsten impurity concentration.

Note: Internal diamagnetic flux measurements on ASDEX Upgrade.

Internal diamagnetic flux measurements, with measurement loops and compensation magnetic probes inside the vacuum vessel, are now available on the ASDEX Upgrade tokamak. The measured diamagnetic flux is compared to that predicted by simulations and calculated from equilibrium reconstruction. The diamagnetic flux measured at 2 positions separated toroidally by 180° in the vacuum vessel is compared.

Carotid endarterectomy: creating the pathway to 1-day stay.

Use of a collaborative team approach to design a care pathway and standing orders for carotid endarterectomy patients achieved the project's goals. Variation, LOS, and resource consumption were decreased while quality of care and patients' satisfaction levels were maintained. Education of patients, patients' families, and staff members increased. Coordination between caregivers increased. The consistent concurrent database provided a feedback loop for continued change and for setting the target. Essential to the success was sponsorship from key leadership via the hospital's steering committee. The diverse membership of key associates on the CQI team helped to create an excellent revised carotid endarterectomy process and ensured full implementation. This membership of the CQI team was essential to comprehensive education and implementation. The step-by-step implementation kept the project moving forward. Creating a care pathway and changing practice require collaboration between nurses, doctors, and administrators. Creativity and systematic, thorough steps are what move a practice change from idea to inception.

Patient care conference: a coordinated, collaborative effort.

The flow chart, guidelines, and document describe the mechanism for patient care conferences. Because the need, process, and documentation of patient care conferences have been clarified, care conferences are now more consistent, efficient, and effective. Documentation streamlined the process of setting up care conferences by recording the following information: who was notified, who would attend, specific issues to be discussed, conference scheduling summary of plans and decisions made. Task force satisfaction was high because of a short timeline, clear problem definition, clear goals, team sponsorship, and a good end product. Use of continuous quality improvement techniques added to the success of this project, because there was a methodology for starting with a variable, unclear process and ending with a creative, efficient process. All members of the healthcare team and patients and families were satisfied, because the patient care conference was available to discuss specific issues and reach consensus on decisions about the patient's treatment plan at critical points during the patient's hospital course.

Application of AXUV diode detectors at ASDEX Upgrade.

In the ASDEX Upgrade tokamak, a radiation measurement for a wide spectral range, based on semiconductor detectors, with 256 lines of sight and a time resolution of 5 µs was recently installed. In combination with the foil based bolometry, it is now possible to estimate the absolutely calibrated radiated power of the plasma on fast timescales. This work introduces this diagnostic based on AXUV (Absolute eXtended UltraViolet) n-on-p diodes made by International Radiation Detectors, Inc. The measurement and the degradation of the diodes in a tokamak environment is shown. Even though the AXUV diodes are developed to have a constant sensitivity for all photon energies (1 eV-8 keV), degradation leads to a photon energy dependence of the sensitivity. The foil bolometry, which is restricted to a time resolution of less than 1 kHz, offers a basis for a time dependent calibration of the diodes. The measurements of the quasi-calibrated diodes are compared with the foil bolometry and found to be accurate on the kHz time scale. Therefore, it is assumed, that the corrected values are also valid for the highest time resolution (200 kHz). With this improved diagnostic setup, the radiation induced by edge localized modes is analyzed on fast timescales.

Anomalous dispersion measurement by interference fringe shift.

The shift of interference fringes near an absorption line is measured. In an advanced evaluation procedure values of Nfl from isolated lines as well as from line groups can be determined over a large dynamic range. Criteria are presented for estimating the sensitivity of the method and for calculating and adjusting the optimum fringe system. In comparison to the conventional hook technique the overall accuracy is improved, a rms error can be given for every single measurement, and an overestimation of small hook distances by an observer is excluded. However, this is at the expense of more measurements and computation. Comparison is made with other dispersion methods. variations are demonstrated.

Preceptorship and skill validation programs.

Nursing in the PACU is an art as well as a science. Development of competent nurses requires a systematic yet creative process. Competency is a measure of professionalism and a guarantee to customers. Ensuring competence requires administratively supported and well-organized mechanisms: preceptorship and skill validation. The preceptor program must be able to teach role delineation, socialization, clinical skills, and policy and procedure to orientees while supporting preceptors and providing feedback. Good preceptors are a valuable resource and deserve renumeration. Ongoing evaluation of the preceptor program monitors cost-effectiveness and expected outcomes. The PACU environment includes patients with a wide spectrum of ages and diagnoses. Application of new and changing technology makes skill validation imperative. An appropriate skill validation plan assesses nurses' performance and targets procedures that are high technology, high risk, or infrequently performed. Quality patient care and nurse retention are two potential outcomes dependent on good preceptor programs and skill validation.

Patient outcomes: the link between nursing diagnoses and interventions.

The North American Nursing Diagnosis Association classification is approved for nursing diagnoses, the Nursing Intervention Classification system provides a common nursing intervention language but to date there is no complete classification for patient outcomes. An outcome classification system can be used for making effective decisions. Recognizing the need for standardized outcomes, clinical nurse specialists developed a classification of patient outcomes. These outcomes, written to fit the Nursing Intervention Classification taxonomy, incorporate Orem's Self-Care Deficit Theory.

Assessment of verapamil in the treatment of angina pectoris.

A brief review is given of the pharmacological data of verapamil, which chemically shows a certain similarity to papaverine. The effect of the drug (80 mg) 3 times daily, on angina pectoris, as compared with placebo, was evaluated in a double-blind cross-over therapeutic trial with 4-wk periods in 47 patients. The incidence of attacks and the nitroglycerine consumption decreased in the second fortnight of the verapamil period by approximately 25% compared with the placebo period. An ergometer test showed a prolongation of the exerice time of 20%. The mean blood pressure and the heart rate fell under verapamil treatment if the patients had values which were relatively high in the placebo period. The increase in heart rate during exercise from two different resting levels showed a tendency to become more pronounced under treatment with verapamil than under placebo. The length of the P-Q intervals were not affected by verapamil. The mechanism of action in angina pectoris is discussed, but it is concluded that it is still not possible to explain it. Twelve Danish medical departments took part in the trial.