The phase equilibrium diagram has been determined for the liquidus surface of the portion of the system CaO-"FeO"-SiOz between fayalite, dicalcium silicate, wustite, and lime. Five ternary peritectic points have been located, but no true eutectics have been found. The primary fields of wustite and dicalcium silicate cover most of the area studied (ignoring free iron, which is actually the primary phase in all compositions investigated). The boundaries of smaller fields of olivine solid solution, a paralleltwinned modification of dicalcium silicate, tricalcium silicate, lime, and calciowustite solid' solutions also are delineated. X-ray data show that lime may contain up to 10% "FeO" in solid solution, whereas wiistite may contain as much as 28% CaO in solid solution. Equilibria involving tricalcium silicate explain earlier observations on open-hearth slags and furnacebottom refractories.

Context.-While trials have demonstrated that carotid endarterectomy is superior to best medical therapy, most recently among asymptomatic patients, uses and outcomes of the procedure in more representative settings have not been established. Objectives.-To profile the use and outcomes of carotid endarterectomy in a representative sample of Ohio's Medicare beneficiaries and to examine the relationships between provider-specific procedural volumes and patient outcomes. Design.-Retrospective cohort using Medicare Provider Analysis and Review files supplemented by detailed reviews of medical records on a random sample of patients. Setting.-Ohio hospitals performing carotid endarterectomy. Patients.-A random sample of 678 charts of the 4120 non-health maintenance organization Medicare beneficiaries who underwent carotid endarterectomy between July 1, 1993, and June 30, 1994. Main Outcome Measures.-Nonfatal stroke or death within 30 days of surgery. Results.-The reviewed patients were similar to all eligible patients in sociodemographic characteristics and 30-day mortality rates. Among the 678 patients, indications for surgery were asymptomatic carotid stenosis in 167 (24.6%), transient ischemic attack in 294 (43.4%), completed stroke in 62 (9.1%), and nonspecific symptoms in 155 (22.9%). Thirty-two patients (4.7%) died or suffered nonfatal strokes by 30 days postoperatively. In univariate analyses, rates varied by hospital volume (P=.004) but not surgeons' volume (P=.47), although power to detect this difference was limited. Patients at higher-and lower-volume hospitals had similar indications and distributions of comorbidities. In analyses controlling for indications, comorbid conditions, and surgeon's volume, being operated on in a higher-volume hospital conferred a 71% reduction in risk for 30-day stroke or death (odds ratio, 0.29; 95% confidence interval, 0.12-0.69; P=.006). Conclusions.-Almost half (47.5%) of the carotid endarterectomies among Ohio's Medicare population are performed on persons who are asymptomatic or who have nonspecific symptoms. These results highlight the importance of identifying patients and providers having the most favorable outcome profiles. The higher rate of adverse outcomes observed in lower-volume hospitals deserves further investigation, as it does not appear to be due to differences in patient selection.

Results: Individuals completing the 6-month program averaged a weight loss of 7.3% in men and 4.7% in women. Fasting lipids and blood glucose improved in both genders regardless of age. Outcomes including BMI and lipids improved in women regardless of menopausal status or hormone replacement therapy. There was a significant correlation between percentage weight loss and number of weekly counseling sessions attended and number of visits to the wellness center for exercise. Discussion: Participants who complete a structured community-based weight management program can achieve significant weight loss and improvement in cardiovascular risk factors regardless of age, gender, or menopausal status. Our analysis suggests that national treatment guidelines/recommendations for weight management can be effectively implemented in a community medical wellness center. The relatively high drop-out rate associated with this program suggests the need to identify strategies and techniques to enhance adherence and completion of programs.

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Symptoms of depression are often seen in patients with coronary heart disease. Symptoms appear more commonly in women and are negatively associated with measures of cardiovascular health. Using multiple logistic regression analyses, the authors evaluated the independent effects of depression (as measured by the Beck Depression Inventory [BDI-II]) and sex on cardiac rehabilitation (CR) completion. In addition, in those who completed CR, the authors evaluated whether depressive symptoms and sex affected clinical outcomes. Women as well as participants with enrollment BDI-II scores > or =14 had significantly higher rates of CR noncompletion. Patients with BDI-II scores> or =14 who completed CR achieved significant improvements in lipid profile, body mass index, and exercise capacity regardless of sex. Women and individuals with BDI-II scores > or =14 are at risk for CR noncompletion and should be encouraged to complete CR, because cardiovascular benefits comparable to those seen in men and individuals with low BDI-II scores were achieved when these patients completed the CR program.

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Participation in CR was associated with a marked improvement of cardiac risk factors and appears to independently decrease the level of CRP regardless of gender, age, or presence of metabolic syndrome.

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