Manual Away (Volume 1: Beginnings)

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For the first time ever, the complete Away saga (Volume 1: Beginnings and Volume 2: Keepers of the Alliance) is now available in one book. Spanning over fifty.
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Fred C. Nicholson was the first Chief Judge for the Club. By the Club had devised a classification of categories for competition, divided into four categories, and 11 classes. In , Fred Nicholson retired and Mr. Donald A.

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Gallager became the new Chief Judge. By , membership rolls exceeded 2, The following year, newspaper accounts gave an estimated attendance of 5, and roughly automobiles were registered for show competition. The fall event had become a success by all measures. As early as , the increasing numbers of competing cars necessitated developing a more comprehensive classification system. In time for the show season, a new eighteen category classification system was put into place that remains the basis for our present evolving vehicle classification system today.

The new classifications included Classic cars, "less than 25 years old and pre". In , the participating cars literally overflowed the Devon Horse Show grounds. According to Jim Grundy, Jr. Bailey was one of the early organizers of the original gathering, which took place at Devon until an unusual episode separated the horseless carriages from the horse-drawn carriages that had prime claim to the park It was, after all, a horse show. The incident thereby led to the demanded relocation of the then-small event. At the Saturday October 16, meet, the entries exceeded cars.

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As if a harbinger of years to come, Hurricane Hazel had passed through Pennsylvania on Friday leaving mud aplenty in its wake. But, newly elected President Leslie R. He who tries to walk the proverbial chalk line, magnifying class in one hand and book of rules in the other, may make no mistakes but he may make no friends either for, finding no joy himself, he brings none to others. The demonstrated flexibility of the classification system, tuned to the times, has been essential to achieving this growth.

In the Model A's were pulled from Classes 18 and 20, and placed into their own class. In , Production car and truck classes were frozen, with a cutoff date. A cutoff date was established for Classic cars. These rules remained basically unchanged until , when a new rule was introduced, which allowed expansion by one year every other year. This rule continues in effect today. During ensuing years, separate classes were implemented to separate Ford V-8 cars, Chevrolet Corvettes, Ford Thunderbirds, Ford Mustangs, Chevrolets, and others. New categories were developed for "specifically named Prestige cars" and "Limited Production and Prototype vehicles".

Today, Drivers Participation vehicles dot the showfield, providing ample opportunity for car lovers to be a big part of AACA. Do you remember that those earliest events required participants to drive their cars from points at least 25 miles outside of Philadelphia? Well, AACA has always encouraged the use of our vehicles. The opportunity to tour with similar vehicles is a thrilling experience as members traverse the nations back roads and long forgotten byways.

In the early years, the Club's financial business was handled by the Provident Tradesmen's Bank of Philadelphia. In , at the invitation of the Hershey Estates, the financial operation of all Club business was moved to office space in the building occupied by the Hershey Museum. William E. In Mr. Bomgardner retired and was succeeded by Mr. William H. During the 's, Divisions were created to achieve placement of National Spring and Fall meets in all parts of the country. An annual Grand National Meet was established at which only Senior vehicles would compete, and held for the first time in , on the grounds of the International Salt Co.

Less than 10mL of fluid is required to perform these basic tests. The albumin concentration is used to confirm the presence of portal hypertension by calculating the serum-to-ascites albumin gradient, or SAAG. The SAAG is determined by subtracting the ascites albumin value from a serum albumin value obtained on the same day:. The SAAG has been proved in prospective studies to categorize ascites better than any previous criteria. The presence of a gradient higher than 1.

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Portal hypertension is usually caused by liver cirrhosis or, less commonly, outflow obstruction from right-sided heart failure or Budd-Chiari syndrome. A SAAG value lower than 1. Determination of the SAAG does not need to be repeated after the initial measurement. The cell count and differential are used to determine if the patient is likely to have SBP. Based on clinical judgment, additional testing can be performed on ascites fluid including total protein, lactate dehydrogenase LDH , glucose, amylase, triglyceride, bilirubin, cytology, or tuberculosis smear and culture.

These tests are generally only useful when there is suspicion of a condition other than sterile cirrhotic ascites. Tests that are not routinely helpful include determination of pH, lactate levels, and Gram staining. Results of Gram staining are of particular low yield unless a large concentration of bacteria, such as in the case of a free gut perforation, is suspected.

Successful treatment of cirrhotic ascites is defined as the minimization of intraperitoneal fluid without intravascular volume depletion. Despite a lack of data supporting decreased mortality, minimizing the amount of ascites fluid can decrease infection-related morbidity in the cirrhotic patient. Treatment of ascites can dramatically improve quality of life by decreasing abdominal discomfort or dyspnea, or both. General ascites management in all patients should include minimizing consumption of alcohol, nonsteroidal anti-inflammatory drugs NSAIDs , and dietary sodium.

The use of more-aggressive interventions largely depends on the severity of ascites and includes oral diuretics, therapeutic or large-volume paracentesis, transjugular intrahepatic portosystemic shunt TIPS , and orthotopic liver transplantation Figure 1.


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All patients with cirrhotic ascites should be encouraged to minimize consumption of alcohol. Even if alcohol is not the cause of their liver disease, cessation can lead to decreased fluid and improved response to medical therapies. Patients with ascites should also minimize use of all NSAIDs; these agents inhibit the synthesis of renal prostaglandin and can lead to renal vasoconstriction, decreased diuretic response, and acute renal failure. Because fluid passively follows sodium, a salt restriction without a fluid restriction is generally all that is required to decrease the amount of ascites.

In patients with minimal fluid, the restriction of alcohol, NSAIDs, and salt may be all that is needed to control ascites formation adequately. Patients with moderate fluid overload who do not respond to more conservative measures should be considered for pharmacologic therapy. A rapid reduction of ascites is often accomplished simply with the addition of low-dose oral diuretics in the outpatient setting.

First-line diuretic therapy for cirrhotic ascites is the combined use of spironolactone Aldactone and furosemide Lasix. Beginning dosages are mg of spironolactone and 40mg of furosemide by mouth daily. If weight loss and natriuresis are inadequate, both drugs can be simultaneously increased after 3 to 5 days to mg of spironolactone and 80 mg of furosemide. To maintain normal electrolyte balance, the use of the : 40mg ratio of spironolactone to furosemide is generally recommended. The response to diuretics should be carefully monitored on the basis of changes in body weight, laboratory tests, and clinical assessment.

Patients on diuretics should be weighed daily; the rate of weight loss should not exceed 0. Serum potassium, blood urea nitrogen BUN , and creatinine levels should be serially followed. In the event of marked hyponatremia, hyperkalemia or hypokalemia, renal insufficiency, dehydration, or encephalopathy, diuretics should be reduced or discontinued. Routine measurement of the urinary sodium level is not necessary, but it can be helpful to identify noncompliance with dietary sodium restriction. If not, they are noncompliant with their diet and should be referred to a dietician.

Because of the potentially severe complications associated with diuretic use, patients with ascites should be assessed by a health care provider at least once weekly until they are clinically stable. Large-volume ascites is defined as intraperitoneal fluid in an amount that significantly limits the activities of daily life. With additional fluid retention, the abdomen can become progressively distended and painful. This is commonly referred to as massive or tense ascites.


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    6. Therapeutic or large-volume paracentesis is a well-established therapy for large-volume ascites. However, the use of postprocedural colloid, usually albumin, continues to be a controversial issue. Studies have shown that patients who do not receive intravenous albumin after large-volume paracentesis develop significantly more changes in their serum electrolyte, creatinine, and renin levels.

    The clinical relevance of these findings, however, is not well established.

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    In fact, no study to date has been able to demonstrate decreased morbidity or mortality in patients given no plasma expanders compared with patients given albumin after paracentesis. In view of the high cost of albumin and its uncertain clinical role, more studies certainly need to be conducted. Until these studies are carried out, current practice guidelines state that it is reasonable, although not mandatory, to give albumin for paracenteses greater than 5 L.

    To prevent the reaccumulation of ascites fluid, patients with large-volume ascites should be counseled about limiting consumption of alcohol, NSAIDs, and sodium. They should also be placed on an aggressive diuretic regimen. Every winter, a season that lasts for 15 years, the Earthmen have neighbors, the humanoid hilfs: a nomadic people who only settle down for the cruel cold spell.

    The hilfs fear the Earthmen, who they think of as witches and call the farborns.


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