CPR 'hands-only' guidelines may not be best for rural areas

Public release date: 1-May-2013
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Contact: Leslie Shepherd
shepherdl@smh.ca
416-864-6094
St. Michael's Hospital

Rural communities might need different CPR recommendations than urban settings

TORONTO, May 1,2013Hands-only CPR (CPR without mouth-to-mouth resuscitation), may not be the best method for rural or remote areas or for anyone who has to wait more than a few minutes for an ambulance, a new study suggests.

New guidelines released by the American Heart Association in 2010 permit the use of simpler hand-only or compression-only CPR in some cases instead of conventional CPR. If ambulances come quickly, experts believe that instructing people to just "push hard, push fast" saves more lives.

But a literature review by Dr. Aaron Orkin found little evidence to support those guidelines outside of urban settings or in communities with no 911 services. His findings were published in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.

Of the 10 studies on saving lives with hands-only CPR he reviewed, only one included rural populations and people who had to wait longer than 15 minutes for an ambulance. Some of those studies showed that people who waited longer for ambulances to arrive had a better chance of surviving if mouth-to-mouth breathing was performed as well as chest compressions.

"Urban studies can't always be applied outside big cities," said Dr. Orkin, a physician and graduate student affiliated with the University of Toronto, the Northern Ontario School of Medicine and Rescu, a St. Michael's Hospital research team dedicated to improving out-of-hospital resuscitation.

"Rural communities might need different CPR recommendations to urban settings," he said.

Dr. Orkin said he study suggests that "push hard, push fast" might be better refined to "push hard, push fast, if you're downtown."

One in five Canadians and nearly half of the world's population live in rural areas. Even in the most developed and densely populated cities, people can wait longer than 10 or 15 minutes for ambulance services

"If someone is unresponsive, doing any kind of CPR is clearly better than doing nothing," said Dr. Orkin. "But shouldn't CPR guidelines serve everybody, not just people who live a few minutes from an ambulance dispatch station or hospital?

###

About St. Michael's Hospital

St. Michael's Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital's recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Center, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About the Northern Ontario School of Medicine

The Northern Ontario School of Medicine is committed to the education of high quality physicians and health professionals, and to international recognition as a leader in distributed, learning-centred, community-engaged education and research.

For more information or to interview Dr. Orkin, please contact:

Leslie Shepherd
Manager, Media Strategy
St. Michael's Hospital
Phone: 647-300-1753
http://www.stmichaelshospital.com
Follow us on Twitter: http://www.twitter.com/stmikeshospital

Or

Kimberley Larkin
Communications Officer, East
Northern Ontario School of Medicine
Phone: 705-662-7243
kimberley.larkin@nosm.ca

---

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?

AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Public release date: 1-May-2013
[ | E-mail | Share ]

Contact: Leslie Shepherd
shepherdl@smh.ca
416-864-6094
St. Michael's Hospital

Rural communities might need different CPR recommendations than urban settings

TORONTO, May 1,2013Hands-only CPR (CPR without mouth-to-mouth resuscitation), may not be the best method for rural or remote areas or for anyone who has to wait more than a few minutes for an ambulance, a new study suggests.

New guidelines released by the American Heart Association in 2010 permit the use of simpler hand-only or compression-only CPR in some cases instead of conventional CPR. If ambulances come quickly, experts believe that instructing people to just "push hard, push fast" saves more lives.

But a literature review by Dr. Aaron Orkin found little evidence to support those guidelines outside of urban settings or in communities with no 911 services. His findings were published in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.

Of the 10 studies on saving lives with hands-only CPR he reviewed, only one included rural populations and people who had to wait longer than 15 minutes for an ambulance. Some of those studies showed that people who waited longer for ambulances to arrive had a better chance of surviving if mouth-to-mouth breathing was performed as well as chest compressions.

"Urban studies can't always be applied outside big cities," said Dr. Orkin, a physician and graduate student affiliated with the University of Toronto, the Northern Ontario School of Medicine and Rescu, a St. Michael's Hospital research team dedicated to improving out-of-hospital resuscitation.

"Rural communities might need different CPR recommendations to urban settings," he said.

Dr. Orkin said he study suggests that "push hard, push fast" might be better refined to "push hard, push fast, if you're downtown."

One in five Canadians and nearly half of the world's population live in rural areas. Even in the most developed and densely populated cities, people can wait longer than 10 or 15 minutes for ambulance services

"If someone is unresponsive, doing any kind of CPR is clearly better than doing nothing," said Dr. Orkin. "But shouldn't CPR guidelines serve everybody, not just people who live a few minutes from an ambulance dispatch station or hospital?

###

About St. Michael's Hospital

St. Michael's Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital's recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Center, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About the Northern Ontario School of Medicine

The Northern Ontario School of Medicine is committed to the education of high quality physicians and health professionals, and to international recognition as a leader in distributed, learning-centred, community-engaged education and research.

For more information or to interview Dr. Orkin, please contact:

Leslie Shepherd
Manager, Media Strategy
St. Michael's Hospital
Phone: 647-300-1753
http://www.stmichaelshospital.com
Follow us on Twitter: http://www.twitter.com/stmikeshospital

Or

Kimberley Larkin
Communications Officer, East
Northern Ontario School of Medicine
Phone: 705-662-7243
kimberley.larkin@nosm.ca

---

[ | E-mail | Share ]

?

AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Source: http://www.eurekalert.org/pub_releases/2013-05/smh-cg050113.php

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King Me

Dutch King Willem-Alexander is saluted by guests during the religious crowning ceremony at Nieuwe Kerk

Photo by Robin Utrecht / Pool / Reuters

Queen Beatrix of the Netherlands abdicated on Tuesday, making way for her son Willem-Alexander to become the first Dutch king in more than a century. European monarchs are largely powerless. Why do so many countries keep them around?

Because breaking up is hard to do. When asked whether they want to keep their monarchies, large majorities of Europeans answer ?yes.? Around 80 percent of Dutch subjects want the royal family to stick around, and about the same proportion of U.K. citizens favor Queen Elizabeth II. But there?s a quirk in the polling data: Fewer than 1 in 4 Britons think the monarchy will actually last another century. This suggests that Europeans envision a future without kings and queens but don?t personally want to undertake the national convulsion that might accompany the change. Although monarchs these days are more likely to be voted out rather than guillotined or shot, overthrowing a monarch is an act of revolution, and Europeans have long since lost their taste for sudden political change. Countries historically only overthrow monarchies after a major crisis makes the system untenable. Kaiser Wilhelm, for example, was blamed for Germany?s defeat in World War I. Italy?s House of Savoy was overthrown for tolerating Mussolini, after a contentious national referendum.

Powerless monarchs bewilder many Americans, but, in fact, the arguments for and against them are fairly evenly balanced. Royal families are apolitical symbols of national unity and, in ideal circumstances, sources of pride. Queen Wilhelmina of the Netherlands, for example, became a national hero when she fled the Nazis and encouraged resistance from abroad. Monarchs sometimes intervene when the government veers off track. Spanish King Juan Carlos notably turned back fascism after the death of Franco. During the 1975 Australian constitutional crisis, Queen Elizabeth?s representative righted the teetering government by ousting the scandal-ridden prime minister. Many Europeans also have genuine affection for their monarchs. (The Explainer once heard an English mother lecturing her child during the changing of the guard at Buckingham Palace about why he should love the Queen.) On a more mundane level, monarchs can be lucrative. The British royal family brings tourists to England in droves.

The financial costs of monarchy are fairly modest. The British royal family, for example, costs the average taxpayer less than $1 per year and probably brings in far more than that in tourism dollars. (The Dutch monarchy takes home somewhat larger paychecks.) The more significant costs of monarchy are harder to measure. Critics argue that an aging white person is a lousy national symbol for an increasingly diverse Europe. Moreover, some political scientists theorize that a monarch undermines the feeling of ownership a citizen should have for his government. Then there?s the obvious problem of having an unaccountable hereditary leader sitting atop a democracy, even if the job entails very little power.

Without a completely convincing argument for or against their positions, the surviving European monarchs have proven surprisingly adept politically. They have surrendered power and land in exchange for their jobs. They have adapted their images to suit the times. The Dutch royal family are, along with their Danish and Scandinavian counterparts, the so-called ?bicycle monarchs,? who eschew the pomp of a royal cavalcade for a simple bicycle, giving them the appearance of being an ordinary family. Willem-Alexander has neutralized the charge that he symbolizes the Netherlands of the past by marrying an Argentine woman, and the couple is regularly photographed visiting schools full of immigrant children. The British royal family works for a variety of charitable causes, in part to give their subjects a good reason to keep them.

Got a question about today?s news? Ask the Explainer

Explainer thanks Charles Ingrao of Purdue University, author of The Habsburg Monarchy, 1618-1815; Alison Frank Johnson of Harvard University, Paul Monod of Middlebury College, author of Solomon's Secret Arts: The Occult in the Age of Enlightenment; Axel Korner of University College London; and Rachel Weil of Cornell University, author of the forthcoming book A Plague of Informers: Conspiracy and Political Trust in William III's England.

Source: http://feeds.slate.com/click.phdo?i=d1fc70bd26307a673a4866f310d2a586

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Lawyer: Former ricin suspect's home is unlivable

OXFORD, Miss. (AP) ? Attorneys for a Mississippi man who was briefly charged with sending ricin-laced letters to the president and others are encouraged after speaking with the FBI and the U.S. Attorney's office about repairing or replacing the man's house after an intensive search left it uninhabitable.

Christi McCoy, an attorney for Kevin Curtis, a 45-year-old Elvis impersonator, said Monday that she and another attorney had spoken with authorities about the process to go through to get their client's property repaired or replaced.

She said she was encouraged by their response to a letter she sent U.S. Attorney Felicia Adams demanding that Curtis be provided temporary housing and that the government repair his Corinth, Miss., home and possessions. She also wants the government to pay his legal bills.

"We feel like the letter was well-received and we'll be working with the FBI to get all his property returned and get his property repaired," she said Monday night.

McCoy contended that Curtis couldn't return home after investigators searched it but failed to find evidence of the deadly poison ricin.

"To be specific, Mr. Curtis' home is uninhabitable. I have seen a lot of post search residences but this one is quite disturbing. The agents removed art from the walls, broke the frames and tore the artwork. Mr. Curtis offered his keys but agents chose to break the lock. Mr. Curtis' garbage was scheduled to be picked up Thursday, the day after he was snatched from his life. A week later, the garbage remains in his home, along with millions of insects it attracted," the letter says.

Curtis was once charged in the mailing of poisoned letters to President Barack Obama, U.S. Sen. Roger Wicker and a Mississippi judge, but the charges were later dropped. The investigation shifted last week to another man who had a falling out with Curtis, and that suspect appeared in court Monday on a charge of making ricin.

Though attorneys for Curtis say their client was framed, McCoy believes whoever sent the letters had a primary goal of targeting the public officials. Curtis has said that he feuded with the man now charged in the case, 41-year-old James Everett Dutschke.

"I think Kevin was just an afterthought or a scapegoat," McCoy said.

Some of the language in the letters was similar to posts on Curtis' Facebook page and they were signed, "I am KC and I approve this message." Curtis often used a similar online signoff.

Had damaging Curtis been the point of the scheme, McCoy said she believes that whoever set up her client could have done a better job of implicating him, such as planting evidence at his home.

McCoy said in an interview Monday that she still believes the FBI acted on the best information available at the time, but it's time to make her client whole. The letter said Curtis' life was "ruined."

Curtis was arrested April 17. The charges were dropped six days later and Curtis was released from jail.

A message left seeking comment about McCoy's letter at the federal prosecutor's office in Oxford, Miss., wasn't immediately returned.

After Curtis was released, the focus turned to Dutschke. In court Monday, a judge ordered that Dutschke be held without bond until a preliminary and detention hearing Thursday. More details are likely to emerge at that hearing, when prosecutors have to show they have enough evidence to hold him.

Dutschke made a brief appearance wearing an orange jumpsuit with his hands shackled. He said little during his hearing other than answering affirmatively to the judge's questions about whether he understood the charges against him.

Dutschke (pronounced DUHS'-kee) has denied involvement in the mailing of the letters, saying he's a patriot with no grudges against anyone. He has previously run for political office and was known to frequent political rallies in northern Mississippi.

An attorney from the public defender's office appointed to represent Dutschke declined to comment after Monday's hearing. Another attorney of Dutschke's, Lori Nail Basham, said she will continue to represent him in other matters but not in the federal case.

Dutschke's house, business and vehicles in Tupelo, Miss., were searched last week, often by crews in hazardous materials suits, and he had been under surveillance.

He faces up to life in prison if convicted. A news release from federal authorities said Dutschke was charged with "knowingly developing, producing, stockpiling, transferring, acquiring, retaining and possessing a biological agent, toxin and delivery system, for use as a weapon, to wit: ricin."

He already had legal problems. Earlier this month, he pleaded not guilty in state court to two child molestation charges involving three girls younger than 16, at least one of whom was a student at his martial arts studio. He also was appealing a conviction on a different charge of indecent exposure. He told The Associated Press last week that his lawyer told him not to comment on those cases.

Earlier in the week, as investigators searched his primary residence in Tupelo, Dutschke told the AP, "I don't know how much more of this I can take."

"I'm a patriotic American. I don't have any grudges against anybody. ... I did not send the letters," Dutschke said.

Dutschke and Curtis were acquainted. Curtis said they had talked about possibly publishing a book on a conspiracy that Curtis says he uncovered about the black-market sale of body parts. But he said they later had a feud.

Curtis's attorney Hal Neilson said the legal team gave authorities a list of people who may have had a reason to hurt Curtis and Dutschke's came up.

The Mississippi judge who received one of the letters, Sadie Holland, is part of a family that has had political skirmishes with Dutschke. Her son, Steve Holland, a Democratic state representative, said his mother encountered Dutschke at a rally in the town of Verona in 2007, when Dutschke ran as a Republican against Steve Holland.

Holland said his mother confronted Dutschke after he made a derogatory speech about the Holland family. She demanded that he apologize, which Holland says he did.

Dutschke's MySpace page has several pictures with him and Wicker, though he's never worked for Wicker's campaign. Republicans in north Mississippi say Dutschke used to frequently show up at GOP events and mingle with people, usually finding a way to get a snapshot of himself with the headliner.

"He would always hand his camera to somebody to get his picture made," longtime Republican Mike Armour of Tupelo said by phone Monday.

A woman described by a neighbor as Dutschke's wife arrived at their home Monday afternoon but covered her face and did not respond to a reporter as she walked from a green minivan into the house.

Rory Key lives just down the street from Dutschke's house. He said Dutschke came to his house while the FBI was searching the suspect's home asking for a drink and a snack.

He said the suspect was more upset than nervous. Key said he doesn't believe Dutscke committed the crime. He also said he didn't know him that well because Dustchke kept to himself.

___

Associated Press writer Emily Wagster Pettus in Jackson, Miss., contributed to this report.

___

Follow Mohr at http://twitter.com/holbrookmohr .

Source: http://news.yahoo.com/lawyer-former-ricin-suspects-home-unlivable-205130828.html

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Luxembourg seeks to overcome tax haven stigma

BRUSSELS (Reuters) - Luxembourg is willing to discuss international moves to stop big companies using cross-border tactics to reduce tax, its finance minister said, part of a bid to show its growing transparency after moving to end bank secrecy.

As European countries try to increase revenues to rein in heavy debts, the impetus to challenge tax havens as well as end company schemes structured to cut tax bills is growing.

Luxembourg said this month it would lift bank secrecy rules for EU citizens with savings there.

On Tuesday, Finance Minister Luc Frieden also responded to criticism of schemes used to reduce corporate tax, saying the fight against tax evasion was top of the agenda and Luxembourg was willing to contribute to discussions about so-called tax-base erosion, or the avoidance tactics companies use.

"Whereas current tax structures are fully in line with international standards the move from double taxation to double non-taxation is, of course, of serious concern," he said.

Companies used to risk paying tax twice on cross-border deals, but more recently, groups such as Amazon, Apple, Microsoft and Google have been able to capitalise on varying international rules to reduce taxes on profits. The groups say they abide by tax regulations in all the markets in which they operate.

Amazon minimises tax by channelling most of its European profits through a tax-exempt entity in Luxembourg.

The European Commission welcomed Frieden's comments.

"The statements we've seen from Luxembourg to go even further in transparency and information exchange are very welcome," said a spokeswoman for Algirdas Semeta, the EU commissioner in charge of tax policy.

Tax evasion and fraud are on the agenda for a summit meeting of EU leaders on May 22.

(Reporting By John O'Donnell; Editing by Helen Massy-Beresford)

Source: http://news.yahoo.com/luxembourg-seeks-overcome-tax-haven-stigma-144537709.html

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'Jeffersons,' 'Sanford and Son' director dies at 84

TV

Reuters

12 hours ago

AP file

Jack Shea with Steven Spielberg

Jack Shea, who directed episodes of TV's "The Jeffersons," "Silver Spoons" and "Sanford and Son," died Sunday at his Tarzana home.

Shea, who had been suffering from Alzheimer's, was 84.

In addition to the sitcoms, Shea directed 10 editions of Bob Hope Christmas specials and earned two Emmy nominations. But he'll be remembered just as much for his work with the Directors Guild of America, according to the guild president, Taylor Hackford.

"He occupied a truly unique position in the history of the modern DGA," he said Monday. "As the West Coast president of the Radio & Television Directors Guild in 1960, he was at the table sitting across from Frank Capra when the two guilds representing television and theatrical directors merged to form the modern Directors Guild of America."

CBS via Getty Images

Sherman Hemsley, Isabel Sanford and Zara Cully in a 1976 scene from "The Jeffersons."

Following the merger, he was elected to the DGA's national board, where he served for more than 35 years before serving as DGA president from 1997-2002. He also chaired the DGA Foundation. In 1992, Shea was honored with the Robert B. Aldrich Award for extraordinary service to the DGA.

Hackford called Shea a pleasure to work with.

"He always had a ready smile and keen interest in everyone he encountered," he said. "Jack enjoyed life and shared it with everyone around him; as a leader, his gentle manner and the kindest of hearts will be the things we miss the most."

Shea is survived by his wife of 59 years, TV screenwriter Patt Shea, a three-time Humanitas Award winner who worked on "All in the Family" and "Cagney & Lacey." He also leaves his children Shawn, Bill, Michael and John Francis III, and grandchildren Amanda, Michael, Dylan, Hudson Patrick, Katie and Jackson.

Copyright 2013 Thomson Reuters.

Source: http://www.today.com/entertainment/jeffersons-sanford-son-director-dies-84-6C9676196

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Monday in politics: Obama expected to nominate Charlotte mayor to run Transportation, and more

BERLIN, April 29 (Reuters) - Barcelona will try every trick in the book to overturn a 4-0 first-leg deficit against Bayern Munich in their Champions League semi-final return leg on Wednesday, honorary Bayern president Franz Beckenbauer warned on Monday. Bayern crushed the Spaniards last week in a surprisingly one-sided encounter but Beckenbauer, former player, coach and president of Germany's most successful club, warned that Barcelona were not ready to surrender. "Barca will try everything to throw Bayern off balance," he told Bild newspaper. ...

Source: http://news.yahoo.com/blogs/ticket/monday-politics-obama-expected-nominate-charlotte-mayor-run-095107327.html

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