You may have expected the first ever portable motion picture camera to be housed in some form of stuffy box?but in fact it was shaped like a rifle, which lends a new accuracy to the idea of shooting some film.
Invented by scientist ?tienne-Jules Marey, the Fusil Photographique?that means photographic rifle if your French isn't so hot?was first revealed back in 1882. It was made to capture images of birds in flight, and it acquired 12 images in a second, each exposed for 1/720th of a second.
The length of the gun's barrel was adjusted to change focus, before it was?quite literally?aimed at animals to shoot 12 images. Interestingly, because this device was light enough to carry by hand, Marey was able to track his subject as it moved. In a way, then, the scientists accidentally invented the concept of panning. [The History of The Discovery of Cinematography via DIY Photography via Peta Pixel]
James E. Dutschke stands in the steet near his home in Tupelo, Miss., and waits for the FBI to arrive and search his home Tuesday April 23, 2013 in connection with the recent ricin letters sent to President Barack Obama and Sen. Roger Wicker. The Mississippi man charged with sending poisoned letters to President Barack Obama and others was released from jail Tuesday on bond, while FBI agents returned to Dutschke's house where they'd previously searched (AP Photo/Northeast Mississippi Daily Journal, Thomas Wells) MANADATORY CREDIT
James E. Dutschke stands in the steet near his home in Tupelo, Miss., and waits for the FBI to arrive and search his home Tuesday April 23, 2013 in connection with the recent ricin letters sent to President Barack Obama and Sen. Roger Wicker. The Mississippi man charged with sending poisoned letters to President Barack Obama and others was released from jail Tuesday on bond, while FBI agents returned to Dutschke's house where they'd previously searched (AP Photo/Northeast Mississippi Daily Journal, Thomas Wells) MANADATORY CREDIT
OXFORD, Miss. (AP) ? A Mississippi man charged with making a deadly poison sent to President Barack Obama and others was ordered held without bond until a hearing later this week when prosecutors are expected to describe what evidence they have against him
James Everett Dutschke made a brief appearance Monday in federal court wearing an orange jumpsuit with his hands shackled. Authorities spent several days last week searching Dutschke's home and former business but have said very little about the suspect beyond a news release announcing the charge of making and possessing ricin over the weekend.
Dutschke's arrest early Saturday capped a week in which investigators initially zeroed in on a rival of Dutschke's, then decided they had the wrong man. Dutschke (pronounced DUHS'-kee) has denied involvement in the mailing of the letters, saying he's a patriot with no grudges against anyone.
The 41-year-old suspect said little during his hearing other than answering affirmatively to the judge's questions about whether he understood the charges against him.
The judge ordered Dutschke to remain jailed until a preliminary and detention hearing scheduled for Thursday. More details are likely to emerge at that hearing, when prosecutors have to show they have enough evidence to hold him.
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 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.
The letters, which tests showed were tainted with ricin, were sent April 8 to Obama, U.S. Sen. Roger Wicker of Mississippi and Mississippi judge Sadie Holland.
The first suspect accused by the FBI was Paul Kevin Curtis, 45, an Elvis impersonator. He was arrested on April 17 at his Corinth, Miss., home, but the charges were dropped six days later and Curtis, who says he was framed, was released from jail.
The focus then turned to Dutschke, who has ties to the former suspect and the judge. 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.
Curtis' attorney, Christi McCoy, said Saturday: "We are relieved but also saddened. This crime is nothing short of diabolical. I have seen a lot of meanness in the past two decades, but this stops me in my tracks."
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.
Dutschke and Curtis were acquainted. Curtis said they had talked about possibly publishing a book on a conspiracy that Curtis insists he has uncovered to sell body parts on a black market. But he said they later had a feud.
Curtis' attorneys have said they believe their client was set up. An FBI agent testified that no evidence of ricin was found in searches of Curtis' home. Curtis attorney Hal Neilson said the defense gave authorities a list of people who may have had a reason to hurt Curtis and Dutschke's came up.
Judge Holland also is a common link between the two men, and both know Wicker. Dutschke's MySpace page has several pictures with him and Wicker at what appear to be campaign events.
Holland was the presiding judge in a 2004 case in which Curtis was accused of assaulting a Tupelo attorney a year earlier. Holland sentenced him to six months in the county jail. He served only part of the sentence, according to his brother.
Holland's family has had political skirmishes with Dutschke. Her son, Steve Holland, a Democratic state representative, said he thinks his mother's only encounter with Dutschke was 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 said Steve Holland exaggerated the incident, and that he has no problem with Sadie Holland. "Everybody loves Sadie, including me," he said.
As soon as Tamerlan and Dzhokhar Tsarnaev, the alleged perpetrators of the Boston Marathon bombings, were identified as Chechen immigrants, and then as refugees, questions were raised about where the system had gone wrong to admit them to the United States. But careful examination of the known facts reveals no flaws in the asylum system; it worked as it should have.
The tragedy in Boston could not have been foreseen in the case files of an 8-year-old asylum seeker and his 15-year-old brother. What can ? and has ? been questioned is whether authorities at all levels in the US do enough to integrate immigrant children into mainstream American life. (The same question could, of course, be asked about other disadvantaged children in the country?s underclass or those who suffer from undiagnosed or inadequately treated mental illness.)
OPINION: Boston bombings and a Muslim identity crisis
To immigrants in general, the US offers a bootstraps approach: a generous admissions policy compared to most other developed countries and very little help for those who take up the offer. A condition for legal immigration is that the immigrant is not likely to become a ?public charge.?
An exception is made for refugees and asylum seekers, in recognition of the fact that they were compelled to leave their home countries for fear of persecution. But even for them, assistance is very limited ? about seven months of cash assistance and help in connecting to a job, housing, and most of the public benefits available to US citizens.
The Tsarnaevs? family origins in Chechnya gave them a solid claim to a ?well-founded fear of being persecuted,? in the language of US and international refugee law. When the Tsarnaev family briefly moved to Chechnya from Kyrgyzstan after the break-up of the Soviet Union in 1991, things may have looked promising for the region.
But life in Chechnya became a nightmare after Russia invaded in 1994 to end Chechnya?s bid for independence. The subsequent turmoil tossed the family back to Kyrgyzstan, then to Dagestan, Mrs. Tsarnaev?s family homeland, and on to the US in 2002. Tamerlan would follow his parents and younger brother Dzhokhar to the US a year later.
Chechens as a group were always subject to discrimination throughout the Soviet Union, and from 1999 on, they were also tainted with the terrorist attacks that Chechen militants visited on Moscow and other Russian cities. Chechens, even those like the Tsarnaevs who had nothing to do with the insurgency, were subject not only to discrimination but attack, including by the police. By 2003, Chechens were by far the largest group of asylum seekers in Europe.
Tens of thousands of Chechens were granted asylum in the European Union, but many were pushed back to the borders of the EU, returned to countries that offered no effective protection, or even sent back to Russia. It was a logical move for a man like Aznor Tsarnaev, looking for a decent prospect for his family, to seek asylum in the US, especially since he had family already settled there. In 2003, the US had the second highest recognition rate for asylum seekers from Russia of any country, second only to Austria (which had given asylum status to 17,000 Chechens by 2005).
The Tsarnaev family showed no signs of anything more sinister than homesickness in most of their time in the US. The brothers? journey to disaffection, violence (in the case of the elder brother), and finally terrorism has yet to be fully traced. But to say that they should not have been given asylum in 2002 is to deny an honorable tradition of the United States as well as the facts of the Tsarnaevs? history.
They had every reason to claim ? and be granted ? asylum. If US authorities had made a blanket decision that children from Russia were potential terrorists, they would have turned away 6-year-old Sergey Brin, the computer genius who co-founded Google, along with 8-year-old Dzhokar Tsarnaev.
The laissez-faire immigration system of the US permits catastrophic failures as well as off-the-charts successes, though the reality for most newcomers to the United States lies well between those two extremes. One way to guard against failures is to pay more attention to the integration of children who come to the US, especially those who may be troubled by the legacies of war-torn areas, and to be alert to signs of disaffection.
A little help getting settled in the first few months after arrival does not constitute sufficient support for refugee families. A longer and deeper engagement both by government agencies and communities is needed to heed warning signs like a fall-off in school performance, a turning away from friends and activities, gang involvement or previously unheard-of aggressiveness.
OPINION: Motive in Boston bombings: Look to tribal code of honor
Such developments should prompt teachers, coaches, friends, and religious figures to ask questions and let kids know that someone notices them and cares what happens. If their families and ethnic communities feel themselves fully part of this country, they will be part of that effort as well.
Kathleen Newland directs the Migration Policy Institute?s refugee protection program. She serves on the boards of the International Rescue Committee, USA for UNHCR, Kids in Need of Defense (KIND), and the Stimson Center. She is a chair emerita of the Women's Commission for Refugee Women and Children.
U.S. suspects Syria used chemical weapons, wants proof
WASHINGTON (Reuters) - The White House said on Thursday the Syrian government of President Bashar al-Assad had probably used chemical weapons on a small scale in the country's civil war, but insisted that President Barack Obama needed definitive proof before he would take action. The disclosure created a quandary for Obama, who has set the use of chemical weapons as a "red line" that Assad must not cross. It triggered calls from some hawkish Washington lawmakers for a U.S. military response, which the president has resisted.
Boston bombing suspect moved to prison from hospital: officials
BOSTON (Reuters) - Boston Marathon bombing suspect Dzhokhar Tsarnaev has been moved to a prison at Fort Devens, Massachusetts, from the hospital where he had been held since his arrest a week ago, the U.S. Marshals Service said on Friday. The 19-year-old ethnic Chechen, who was badly wounded in an overnight shootout last week with police hours after authorities released pictures of him and his older brother, also a suspect, had previously been held at Beth Israel Deaconess Medical Center, where some of the victims were also being treated.
Anger on streets as Bangladesh building toll passes 300
DHAKA (Reuters) - Bangladesh textile workers vented their anger on Friday, burning cars and clashing with police, as the death toll passed 300 following the collapse of a building housing factories that made low-cost garments for Western brands. Miraculously rescuers were still pulling people alive from the rubble - 72 since daybreak following 41 found in the same room overnight - two days after the eight-storey building collapsed on the outskirts of the capital, Dhaka.
Fire kills dozens in Russian psychiatric hospital
RAMENSKY, Russia (Reuters) - Thirty-eight people were killed, most of them in their beds, in a fire that raged through a psychiatric hospital near Moscow on Friday, raising questions about the care of mentally ill patients in Russia. The fire, which broke out at around 2 a.m. (2200 GMT on Thursday), swept through a single-storey building at the hospital, a collection of wood and brick huts with bars on some windows that was home to people sectioned by Russian courts.
Syrian air strikes, shelling batter rebels in Damascus suburbs
BEIRUT (Reuters) - The Syrian army attacked two rebel-held suburbs of Damascus with fierce air strikes and shelling on Friday, pursuing an offensive against President Bashar al-Assad's foes, residents and a monitoring group said. Assad's forces, which have been trying to dislodge rebels from several outlying districts south and east of the capital, focused their assault on Jobar, just inside central Damascus.
Bomb blast kills four outside Sunni mosque in Iraq capital
BAGHDAD (Reuters) - A roadside bomb exploded outside a Sunni mosque in a southern district of the Iraqi capital Baghdad, killing four worshippers as they left following Friday prayers, police and medics said. The attack, which targeted the Kubaisi mosque, follows three days of the most widespread fighting in Iraq since U.S. troops withdrew in December 2011.
Italian government could be settled on Saturday: sources
ROME (Reuters) - Italian prime minister-designate Enrico Letta could announce a new government on Saturday and go before parliament to spell out its program early next week, political sources said on Friday. Letta, deputy leader of the center-left Democratic Party, has been in discussions to iron out remaining differences with Silvio Berlusconi's People of Freedom (PDL) party following an initial round of talks on Thursday.
South Korea to pull all workers from industrial zone in North
SEOUL (Reuters) - South Korea will pull out all remaining workers from a jointly run industrial zone in North Korea, it said on Friday, after Pyongyang rejected a call for formal talks to end a standoff that led to operations being suspended. The decision to remove about 170 people from the Kaesong factory park located just north of the armed border deepens a conflict between the two Koreas and puts at risk their last remaining channel of exchange that resulted from their breakthrough 2000 summit and a bid to improve ties.
Death toll in Nigeria shootout with Islamist militants reaches 25
KADUNA (Reuters) - Twenty-five people were killed in a clash between Nigerian security forces and suspected Islamist Boko Haram militants who robbed a bank and attacked a police station in northeastern Yobe state, police said on Friday. The military had earlier said seven people were killed in the shootout on Thursday.
Egypt's Pope says Islamist rulers neglect Copts
CAIRO (Reuters) - Egypt's Christians feel sidelined, ignored and neglected by Muslim Brotherhood-led authorities, who proffer assurances but have taken little or no action to protect them from violence, Coptic Pope Tawadros II said. In his first interview since emerging from seclusion after eight people were killed in sectarian violence between Muslims and Christians this month, the pope called official accounts of clashes at Cairo's Coptic cathedral on April 7 "a pack of lies".
Apr. 25, 2013 ? Liver fibrosis results from an excessive accumulation of tough, fibrous scar tissue and occurs in most types of chronic liver diseases. In industrialized countries, the main causes of liver injury leading to fibrosis include chronic hepatitis virus infection, excess alcohol consumption and, increasingly, nonalcoholic steatohepatitis (NASH).
Now, in a new study published in the journal Cell, scientists at the Salk Institute for Biological Studies have discovered that a synthetic form of vitamin D, calcipotriol (a drug already approved by the FDA for the treatment of psoriasis), deactivates the switch governing the fibrotic response in mouse liver cells, suggesting a potential new therapy for fibrotic diseases in humans.
"Because there are currently no effective drugs for liver fibrosis, we believe our findings would open a new door for treatment," says senior author Ronald M. Evans, a professor in Salk's Gene Expression Laboratory and lead researcher in the Institute's new Helmsley Center for Genomic Medicine.
The Salk study focused on a star-shaped "stellate" cell in the liver that serves as a beacon for damage. When called into action, stellate cells produce fibrotic proteins in an attempt to heal an injury. Under chronic stress, however, localized fibrosis expands, eventually leading to cirrhosis, increased risk of liver cancer, and the need for a liver transplant in advanced cases.
The Evans lab discovered a genetic switch through which vitamin D-related ligands such as calcitriol, a hormonally active form of the vitamin, can put the brakes on fibrosis. "Preclinical results suggest the 'vitamin D brake' is highly efficacious and led us to believe that the time is right to consider a trial in the context of chronic liver disease," says Evans, a Howard Hughes Medical Institute Investigator and holder of the March of Dimes Chair in Molecular and Developmental Biology.
Previous studies have shown a physiologic role for vitamin D in liver function, but "it was our discovery of high levels of vitamin D receptor (VDR) in the stellate cell that led us to consider it as a possible off switch for liver fibrosis," says lead author Ning Ding, a research associate in the Gene Expression Laboratory.
"Current therapeutic approaches, which treat the symptoms of liver disease, don't stop liver fibrosis from progressing," says Michael Downes, a senior staff scientist in the Gene Expression Laboratory and co-corresponding author on the paper. "In liver diseases where the underlying cause cannot be cured, progression to cirrhosis is currently inevitable in some people. What we have discovered is that by acting on the genome, VDR can simultaneously defend against multiple fibrotic activators. This is important because many different pro-fibrotic signaling pathways converge on the genome to affect their fibrotic response."
The Salk discovery that calcipotriol counters the fibrotic response in stellate cells illuminates a potentially safer, more effective strategy capable of neutralizing multiple convergent fibrotic triggers.
The Salk scientists say that clinical trials of the vitamin D analog for the treatment of liver fibrosis are being planned. The synthetic vitamin D analog is better than natural vitamin D, they say, for a couple of reasons. First, natural vitamin D, which is found in small amounts in a few foods and produced in the body by exposure to sunlight, degrades quickly, while synthetic versions of vitamin D are less susceptible to breakdown. Second, too much natural vitamin D can cause hypercalcemia, or elevated calcium in the blood, which can lead to nausea and vomiting, frequent urination, muscle weakness and joint aches and pain. The synthetic vitamin D analog, on the other hand, produces a strong response without adding calcium to the blood.
In addition, the researchers say this new model for treating liver fibrosis may also be helpful in treating other diseases with a fibrotic component, including those of the lung, kidney and pancreas.
Other researchers on the study were Ruth T. Yu, Mara H. Sherman, Mathias Leblanc, Mingxiao He, Annette R. Atkins and Grant D. Barish, from the Salk Institute; Nanthakumar Subramaniam, Caroline Wilson, Renuka Rao, Sally Coulter and Christopher Liddle, of the University of Sydney (Australia); and Sue L. Lau , Christopher Scott and Jenny E. Gunton, of the Garvan Insitute for Medical Research (Australia).
The work was supported by grants from the National Institutes of Health, the Howard Hughes Medical Institute, the National Health and Medical Research Council of Australia, the Genentech Foundation, the Leona M. and Harry B. Helmsley Charitable Trust, the Samuel Waxman Cancer Research Foundation, Stand Up to Cancer and Ipsen/Biomeasure.
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Stanford study examines cost-effectiveness of helicopter transport of trauma victimsPublic release date: 25-Apr-2013 [ | E-mail | Share ]
Contact: Sara Wykes swykes@stanfordmed.org 650-721-6263 Stanford University Medical Center
STANFORD, Calif. - Researchers at the Stanford University School of Medicine have for the first time determined how often emergency medical helicopters need to help save the lives of seriously injured people to be considered cost-effective compared with ground ambulances.
The researchers found that if an additional 1.6 percent of seriously injured patients survive after being transported by helicopter from the scene of injury to a level-1 or level-2 trauma center, then such transport should be considered cost-effective. In other words, if 90 percent of seriously injured trauma victims survive with the help of ground transport, 91.6 need to survive with the help of helicopter transport for it to be considered cost-effective.
The study, published online this month in the Annals of Emergency Medicine, does not address whether most helicopter transport actually meets the additional 1.6 percent survivorship threshold.
"What we aimed to do is reduce the uncertainty about the factors that drive the cost-effective use of this important critical care resource," said the study's lead author, M. Kit Delgado, MD, MS, an instructor in the Division of Emergency Medicine. "The goal is to continue to save the lives of those who need air transport, but spare flight personnel the additional risks of flying - and patients with minor injuries the additional cost - when helicopter transport is not likely to be cost-effective." (Helicopter medical services generally bill patients' insurance providers directly, but patients may have to pay some of the bill out of pocket, or, if they're uninsured, possibly all of it.)
The study comes at a time when finding ways to cut medical costs has become a national priority, and the overuse of helicopter transport has come under scrutiny. Previous studies have shown that, on average, over half of patients transported by helicopter have only minor, non-life threatening injuries. For these patients, transport by helicopter instead of ground ambulance is not likely to make a difference in outcomes, and the additional risk and cost of helicopter transport outweighs the benefit, Delgado said.
In 2010, there were an estimated 44,700 U.S. helicopter transports from injury scenes to level-1 and level-2 trauma centers, with an average cost of about $6,500 per transport. The total annual cost is around $290 million. (Level-1 and -2 trauma centers are hospitals equipped and staffed to provide the highest levels of surgical care to trauma patients; level-1 centers offer a broader array of readily available specialty care, and also are committed to research and teaching efforts.)
Yet emergency helicopter transport sits in a cost-efficiency conundrum: It is most needed in remote, rural areas where transport by ground can take far longer than by air. These areas also tend to have sparser populations and therefore fewer calls for aid, making it difficult to recoup the overhead costs of maintaining helicopter services, Delgado said.
In some areas of the country, however, helicopters are automatically launched based on the 911 call. "Once ground responders and the helicopter arrive, sometimes they may find patients who are awake, talking and have stable vital signs," Delgado said. "The challenge is getting helicopters to patients who need them in a rapid fashion so the flight team can intervene and make a difference, but also know based on certain criteria who isn't sick enough to require air transport."
Most health economists consider medical interventions that yield a year of healthy life - a measure known as a quality-adjusted life-year - at a cost of between $50,000 and $100,000 to be cost-effective in high-income countries, such as the United States, Delgado said. If society is willing to pay as much as $100,000 toward helicopter transport for each QALY gained by the seriously injured patients, then helicopter transport needs to reduce the mortality rate of these patients by a modest 1.6 percent compared with ground transport to meet this threshold, the study says. Or it needs to improve long-term disability outcomes, the study says.
"If future studies find helicopter transport leads to improved long-term quality of life and disability outcomes, then helicopter transport would be considered cost-effective, even if no additional lives were saved," Delgado said. "Only a handful of studies have examined outcomes other than death, without definitive results."
For severely injured patients, helicopter evacuation to a trauma center is preferable if it is faster than ground transport. However, helicopter transport is more expensive and poses rare, but often fatal, safety risks - specifically, the risk of crashing. Plus, it is often difficult for emergency responders to discern which patients would actually benefit from being flown in a helicopter rather than driven in an ambulance to a high-level trauma center. Until this study, the survival benefit needed to offset these potential drawbacks hasn't been clear.
"More accurately determining which patients have serious injuries and need to be flown is the most promising way to ensure you are getting a good value by using helicopter transport," Delgado said. "To do this, we should promote diligent use of the Centers for Disease Control's field triage guidelines among EMS responders. This would help ensure that injured victims who are transported by helicopter to a trauma center actually require trauma care. Secondly, we need to figure out whether the practice of autolaunching helicopters based on a 911 call makes sense. If the benefit of the faster response time outweighs the expenditure of resources on those patients who may not actually need helicopter transport, then autolaunching makes sense. If not, the practice should be reconsidered."
There is mixed evidence in the literature about the degree to which helicopter transport reduces mortality. It is therefore uncertain whether the routine use of helicopter transport is cost-effective for most patients in the United States when ground transport is also feasible. The study found that the cost-effectiveness also depends on regional variation in the costs of air and ground transport and the percentage of patients who are flown that have minor injuries.
"Of course, this study only applies to situations in which both ground and helicopter transport to a trauma center are feasible," Delgado added. "In situations where the only alternative is being taken by ground to a local nontrauma-center hospital or being flown to a trauma center, then clearly we want any patient with a suspicion of a serious injury flown to that trauma center."
###
The senior author of the study is Jeremy Goldhaber-Fiebert, PhD, assistant professor of health care research and policy. Other Stanford co-authors are Kristan Staudenmayer, MD, MS, assistant professor of surgery; N. Ewen Wang, MD, associate professor of emergency medicine; David Spain, MD, professor of surgery; and Douglas Owens, MD, MS, professor health research and policy.
The study was supported by the Agency for Healthcare Research and Quality, the National Institutes of Health (grants K23HD051595-02 and K01AG037593-01A1) and the Department of Veterans Affairs.
Information about Stanford's Division of Emergency Medicine, which also supported the work, is available at http://med.stanford.edu/emed.
The Stanford University School of Medicine consistently ranks among the nation's top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For information about all three, please visit http://stanfordmedicine.org/about/news.html.
Print media contact:
Sara Wykes 650-721-6263 (swykes@stanfordmed.org)
Broadcast media contact:
M.A. Malone 650-723-6912 (mamalone@stanford.edu)
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Stanford study examines cost-effectiveness of helicopter transport of trauma victimsPublic release date: 25-Apr-2013 [ | E-mail | Share ]
Contact: Sara Wykes swykes@stanfordmed.org 650-721-6263 Stanford University Medical Center
STANFORD, Calif. - Researchers at the Stanford University School of Medicine have for the first time determined how often emergency medical helicopters need to help save the lives of seriously injured people to be considered cost-effective compared with ground ambulances.
The researchers found that if an additional 1.6 percent of seriously injured patients survive after being transported by helicopter from the scene of injury to a level-1 or level-2 trauma center, then such transport should be considered cost-effective. In other words, if 90 percent of seriously injured trauma victims survive with the help of ground transport, 91.6 need to survive with the help of helicopter transport for it to be considered cost-effective.
The study, published online this month in the Annals of Emergency Medicine, does not address whether most helicopter transport actually meets the additional 1.6 percent survivorship threshold.
"What we aimed to do is reduce the uncertainty about the factors that drive the cost-effective use of this important critical care resource," said the study's lead author, M. Kit Delgado, MD, MS, an instructor in the Division of Emergency Medicine. "The goal is to continue to save the lives of those who need air transport, but spare flight personnel the additional risks of flying - and patients with minor injuries the additional cost - when helicopter transport is not likely to be cost-effective." (Helicopter medical services generally bill patients' insurance providers directly, but patients may have to pay some of the bill out of pocket, or, if they're uninsured, possibly all of it.)
The study comes at a time when finding ways to cut medical costs has become a national priority, and the overuse of helicopter transport has come under scrutiny. Previous studies have shown that, on average, over half of patients transported by helicopter have only minor, non-life threatening injuries. For these patients, transport by helicopter instead of ground ambulance is not likely to make a difference in outcomes, and the additional risk and cost of helicopter transport outweighs the benefit, Delgado said.
In 2010, there were an estimated 44,700 U.S. helicopter transports from injury scenes to level-1 and level-2 trauma centers, with an average cost of about $6,500 per transport. The total annual cost is around $290 million. (Level-1 and -2 trauma centers are hospitals equipped and staffed to provide the highest levels of surgical care to trauma patients; level-1 centers offer a broader array of readily available specialty care, and also are committed to research and teaching efforts.)
Yet emergency helicopter transport sits in a cost-efficiency conundrum: It is most needed in remote, rural areas where transport by ground can take far longer than by air. These areas also tend to have sparser populations and therefore fewer calls for aid, making it difficult to recoup the overhead costs of maintaining helicopter services, Delgado said.
In some areas of the country, however, helicopters are automatically launched based on the 911 call. "Once ground responders and the helicopter arrive, sometimes they may find patients who are awake, talking and have stable vital signs," Delgado said. "The challenge is getting helicopters to patients who need them in a rapid fashion so the flight team can intervene and make a difference, but also know based on certain criteria who isn't sick enough to require air transport."
Most health economists consider medical interventions that yield a year of healthy life - a measure known as a quality-adjusted life-year - at a cost of between $50,000 and $100,000 to be cost-effective in high-income countries, such as the United States, Delgado said. If society is willing to pay as much as $100,000 toward helicopter transport for each QALY gained by the seriously injured patients, then helicopter transport needs to reduce the mortality rate of these patients by a modest 1.6 percent compared with ground transport to meet this threshold, the study says. Or it needs to improve long-term disability outcomes, the study says.
"If future studies find helicopter transport leads to improved long-term quality of life and disability outcomes, then helicopter transport would be considered cost-effective, even if no additional lives were saved," Delgado said. "Only a handful of studies have examined outcomes other than death, without definitive results."
For severely injured patients, helicopter evacuation to a trauma center is preferable if it is faster than ground transport. However, helicopter transport is more expensive and poses rare, but often fatal, safety risks - specifically, the risk of crashing. Plus, it is often difficult for emergency responders to discern which patients would actually benefit from being flown in a helicopter rather than driven in an ambulance to a high-level trauma center. Until this study, the survival benefit needed to offset these potential drawbacks hasn't been clear.
"More accurately determining which patients have serious injuries and need to be flown is the most promising way to ensure you are getting a good value by using helicopter transport," Delgado said. "To do this, we should promote diligent use of the Centers for Disease Control's field triage guidelines among EMS responders. This would help ensure that injured victims who are transported by helicopter to a trauma center actually require trauma care. Secondly, we need to figure out whether the practice of autolaunching helicopters based on a 911 call makes sense. If the benefit of the faster response time outweighs the expenditure of resources on those patients who may not actually need helicopter transport, then autolaunching makes sense. If not, the practice should be reconsidered."
There is mixed evidence in the literature about the degree to which helicopter transport reduces mortality. It is therefore uncertain whether the routine use of helicopter transport is cost-effective for most patients in the United States when ground transport is also feasible. The study found that the cost-effectiveness also depends on regional variation in the costs of air and ground transport and the percentage of patients who are flown that have minor injuries.
"Of course, this study only applies to situations in which both ground and helicopter transport to a trauma center are feasible," Delgado added. "In situations where the only alternative is being taken by ground to a local nontrauma-center hospital or being flown to a trauma center, then clearly we want any patient with a suspicion of a serious injury flown to that trauma center."
###
The senior author of the study is Jeremy Goldhaber-Fiebert, PhD, assistant professor of health care research and policy. Other Stanford co-authors are Kristan Staudenmayer, MD, MS, assistant professor of surgery; N. Ewen Wang, MD, associate professor of emergency medicine; David Spain, MD, professor of surgery; and Douglas Owens, MD, MS, professor health research and policy.
The study was supported by the Agency for Healthcare Research and Quality, the National Institutes of Health (grants K23HD051595-02 and K01AG037593-01A1) and the Department of Veterans Affairs.
Information about Stanford's Division of Emergency Medicine, which also supported the work, is available at http://med.stanford.edu/emed.
The Stanford University School of Medicine consistently ranks among the nation's top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For information about all three, please visit http://stanfordmedicine.org/about/news.html.
Print media contact:
Sara Wykes 650-721-6263 (swykes@stanfordmed.org)
Broadcast media contact:
M.A. Malone 650-723-6912 (mamalone@stanford.edu)
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NEW YORK (AP) ? The longtime feud between late-night hosts Jay Leno and David Letterman is the stuff of legend and, apparently, so yesterday.
The two Jimmys: Jimmy Kimmel and Jimmy Fallon, agree there's no rivalry between them.
Both were among the honorees in New York Tuesday at a gala recognizing Time magazine's annual list of the 100 Most Influential People in the World.
"I feel good about it. We're very friendly. I know people expect us to dislike each other and say bad things about each other but that will never happen," said 45-year-old Kimmel.
He agreed that making nice is a good thing.
"It is nice. We're like (vocalist duo) Peaches & Herb. I'm Peaches," he laughed.
They'll face-off in the ratings next year when Fallon leaves NBC's "Late Night with Jimmy Fallon" and replaces Leno as host of "The Tonight Show."
Thirty-eight-year-old Fallon said, as of now, things won't change much when he switches to "The Tonight Show."
"We do a great show now. I think we're ready. I thank Jay Leno for being awesome and still being number one because without him I wouldn't have a job," he laughed. "It's just like they call you up from the minor league so I'm ready to go for the majors and I'm gonna swing for the fences."
In January, ABC's "Jimmy Kimmel Live!" moved to the 11:35 p.m. EST time slot, putting it in direct competition with "The Tonight Show" and "Late Show with David Letterman."
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Online:
http://www.latenightwithjimmyfallon.com/
http://beta.abc.go.com/shows/jimmy-kimmel-live
___
Alicia Rancilio covers entertainment for The Associated Press. Follow her online at http://www.twitter.com/aliciar
Hundreds of scientists, engineers and space-law experts are gathering this week to discuss the growing problem of space debris, and will propose ways to curb the accumulation of new junk in orbit.
The 6th European Conference on Space Debris is being held April 22-25 at the European Space Operations Center in Darmstadt, Germany. More than 300 representatives, ranging from researchers to policymakers, are expected to attend the four-day event, according to officials at the European Space Agency (ESA).
Conference attendees will discuss the buildup of potentially harmful debris in orbit, and address possible ways to remove defunct satellites and other pieces of errant space hardware.
More than 170 million pieces of space junk are currently orbiting Earth, including 29,000 objects that are larger than 4 inches (10 centimeters), according to ESA estimates. As they speed through space at 17,000 mph (27,000 km/h), these objects pose collision risks to both other satellites in orbit and the International Space Station.
"Any of these objects can harm an operational spacecraft," Heiner Klinkrad, head of ESA's Space Debris Office, said in a statement.
Roughly two-thirds of the known pieces of debris were created by explosions in orbit or collisions, ESA officials said.
In 2009, a U.S. Iridium communications satellite was struck by a defunct Russian Cosmos military satellite in what became a wake-up call for the industry. The crash destroyed the two spacecraft and left a huge cloud of debris.
Then, in 2007, China intentionally destroyed one of its aging weather satellites in a controversial anti-satellite test that littered Earth?s orbit with more than 2,500 scraps of space junk.
Since then, researchers and satellite operators have tried to tackle the issue of sustainability in space.
"Space-debris mitigation measures, if properly implemented by satellite designers and mission operators, can curtail the growth rate of the debris population," Klinkrad said. "Active debris removal, however, has been shown to be necessary to reverse the debris increase."
But finding any solution to the space-debris problem will require a collaborative approach.
"As this is a global task, active removal is a challenge that should be undertaken by joint efforts in cooperation with the world's space agencies and industry," Thomas Reiter, ESA's director of human spaceflight and operations, said in a statement.
Follow Denise Chow on Twitter @denisechow. Follow us?@Spacedotcom,?Facebook?or?Google+. Originally published on?SPACE.com.
Copyright 2013 SPACE.com, a TechMediaNetwork company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Sanitation workers consistently make it onto the list of the top 10 most dangerous occupations as tracked by The Bureau of Labor Statistics. It?s no wonder since they are often working in the dark, carrying heavy loads, working in traffic, handling hazardous materials, maneuvering large trucks in tight spaces and battling fatigue. Communication is a key factor in reinforcing safe behavior, yet reaching workers can be challenging when they spend most of their time on the road.
Increasingly, solid waste companies are installing electronic message boards at their facilities as a way to improve communication. The need for a mobile communications option is also becoming critical with the rapid growth of smart phone and tablet use. Most companies underestimate what?s involved in developing an effective program. There are three components to a successful deployment?
Click here to download the full article.
Jude Carter is Director of Marketing for The Marlin Company (Wallingford, CT). Her expertise includes all aspects of marketing, new business development, sales management and strategic planning. She joined The Marlin Company in 2005. As Director of Marketing, she is responsible for developing and executing the company?s integrated marketing strategy, which includes brand awareness, lead generation, direct marketing, events, PR, business development support and training. Jude can be reached at (800) 344-5901 or visit www.themarlincompany.com.
In an effort to curb distracted driving, the?Department of Transportation issued voluntary guidelines asking automakers to place restrictions on in-vehicle technology.
By Cricket Fuller,?Staff / April 23, 2013
A woman fiddles with her phone during rush-hour traffic in Copley Square in downtown Boston, in 2008.
Ann Hermes / The Christian Science Monitor
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Transportation officials want you to take your eyes off the road for no more than two seconds at a time, and they are asking automakers to help. ?
Click Here for your FREE 30 DAYS of The Christian Science Monitor Weekly Digital Edition
New voluntary guidelines released Tuesday by the US Department of Transportation and the National Highway Transportation Safety Administration (NHTSA) seek to curb distracted driving by limiting drivers? use of in-vehicle electronics while the vehicles are in motion. The guidelines ask automakers to place restrictions on in-car technologies, especially those connected to the Internet.
Proponents say the voluntary guidelines, which are to be phased in over the next three years, will help curb distracted driving. But critics argue that the guidelines unfairly target automakers.
What?s not in dispute is the growing impact of technology on driving. Federal data report that, in 2011, crashes involving a distracted driver?killed 3,331 people and injured another 387,000. For teenagers, the problem is worse: Car accidents are the No. 1 cause of death of teens (indeed, of all people ages 5 to 34), and a quarter of all teen-driving crashes are attributed to distracted driving. And, despite an increase in bans on cellphone use while driving, an NHTSA survey released earlier this month shows that this usage has remained steady during the past two years.
The new guidelines target only the electronic systems found in many newer cars. These systems mirror the capabilities of an Internet-enabled PC or tablet and often have large in-dash touch screens that coordinate navigation, phone calls, music, and text messaging. Many allow Web-browsing and social media activity, complete with text and multimedia displays. Some cars also allow drivers to sync their smartphone to the in-vehicle system.
The NHTSA says the guidelines include some changes to address automakers' concerns and to reflect the input of industry groups, researchers, and advocates. "These guidelines recognize that today's drivers appreciate technology," said Transportation Secretary Ray LaHood in a press release, "while providing automakers with a way to balance the innovation consumers want with the safety we all need."
Specifically the guidelines ask automakers to develop technology that would limit the time a driver must take his or her eyes off road to complete a specific task, such as adjusting or selecting music, to two seconds. And it would put a 12-second limit on more detailed tasks, such as initiating a phone call. A series of two-second actions could?thus not exceed a 12-second cumulative time period for the task as a whole ? unless the vehicle is stopped and in park.
This limitation would allow drivers to choose preset locations on maps or navigation devices, but would generally not allow enough time to input a new address while driving. The guidelines also ask automakers to develop technology that disallows any amount of manual text entry for communication or Internet browsing. The limitations would restrict all social media and Web-browsing activities unless the car is parked. And the system would not display text, images, or video while the car is in motion either. This restriction would not apply to maps and dynamic navigation systems.
Tweetbot for iPhone has been updated with a new media timeline view that features supported photos and videos. The image viewer has also been completely redesigned and Instagram previews have been fixed. Lastly, the Tweet/status detail view in Tweetbot now displays the number of Favs and Retweets.
I'm really liking this new media timeline. It's a great way to scroll through images and videos that have been shared to twitter, including Instagram photos. What do you think of the new media view?
Chaz Bono is shown at left at the Outfest opening night gala in Los Angeles on July 9, 2009, and on Saturday at the 24th Annual GLAAD Media Awards in Los Angeles.
By Kurt Schlosser, TODAY
Chaz Bono got motivated and went "Dancing With the Stars" a couple years ago, and now the reality star is taking on what he eats and showing great results -- he's lost 60 pounds.
Bono tweeted earlier this month that he hit the mark and tells People magazine in a new story that he's "still slowly losing" weight.
"I've just changed the way I eat," Bono told People. "Diets don't work. You just have to change what you eat, and I have." It was an assertion he also tweeted about on April 8, listing some of the food and exercise that's working for him.
In November, Bono detailed how he was setting out to lose weight with an appearance on "The Doctors." At 5 feet, 5 inches and 250 pounds, Bono, 44, said he had struggled with weight since his mid-20s. He was advised by experts on the show to lose 50 to 80 pounds.
Bono (formerly Chastity) documented his female-to-male gender transition in the 2011 film "Becoming Chaz."
KUWAIT (Reuters) - A prominent Kuwaiti opposition politician convicted of insulting the ruling emir was granted bail on Monday, his lawyer said, prompting celebrations by supporters who packed the court building and defusing tensions over his case.
Musallam al-Barrak, an outspoken former member of parliament, was sentenced to five years in jail last week for remarks made at a rally last year.
The sentencing had triggered a series of street protests that highlighted ongoing political tensions between opposition figures and the government, headed by a prime minister picked by the emir.
After the appeal court ruling on Monday, hundreds of Barrak's backers escorted him through the appeal court complex cheering, whistling and chanting: "The people want Musallam al-Barrak," and "God is great".
"It will ease tension", former opposition lawmaker Khaled al-Tahous said.
The five-year sentence was not overturned on Monday, defense lawyer Dokki al-Hasban told Reuters.
But the court ruled that Barrak should be granted bail, on a payment of 5,000 dinars ($17,600), and that his defense team would have a chance to argue his case next month.
Barrak was not taken into custody after his sentencing. Security forces had searched his guest house and a neighboring home last week but failed to find him, supporters said. It was not clear why police had not taken him into custody during subsequent speeches at the guest house.
Barrak was found guilty of insulting Sheikh Sabah al-Ahmed al-Sabah in a speech in October last year in which he appealed to the emir to avoid "autocratic rule".
Kuwait has avoided mass Arab Spring-style unrest but citizens held large street protests last year after the emir changed the electoral law, a move the opposition said was aimed at preventing them from winning a parliamentary majority.
The government has said the move brought Kuwait in line with voting systems elsewhere.
While Kuwait allows more freedom of speech than some other Gulf Arab states, the emir has the last say in state affairs and is deemed "immune and inviolable" in the constitution.
There has been a series of trials in Kuwait in recent months involving opposition activists accused of insulting the emir, mainly on social media.
(Reporting by Sylvia Westall and Mahmoud Harby; Editing by Yara Bayoumy and Andrew Torchia)
CLARKSVILLE, Mo. (AP) ? An all-too-familiar springtime ritual played out around the nation's heartland this weekend as volunteers, National Guardsmen and even prison inmates joined together in an effort to ward off fast-rising floodwaters.
Dangerously high waters dotted at least six Midwestern states following torrential rains this past week that dumped up to 7 inches in some locations. Record flooding was possible in some places as dozens of rivers overflowed their banks.
The water levels forced evacuations, closed roads, swamped hundreds of thousands of acres of farmland and shut down much of the upper Mississippi River to barge traffic. Even two Mississippi River bridges were closed. Several Mississippi River towns north of St. Louis were expected to see crests sometime Sunday, including Clarksville, Mo.
Volunteers in the tiny community have worked endlessly since Wednesday to build a makeshift sandbag levee that seemed to be holding as the crest? expected to be 11 feet above flood stage ? approached. Even prisoners from far-away Jefferson City were brought in to help.
After four 12-hour days of sandbagging, Trish Connelly, 57, was exhausted but optimistic the town would beat back the river. Her plan to open a new fine arts gallery downtown this weekend were on hold "until we know what the river is going to do," she said.
"This is frustrating for people," Connelly said. "This isn't as bad as 2008, but thank God it stopped raining."
Gov. Jay Nixon on Saturday toured the unprotected-by-choice town that was also flooded in 2008, 2001, 1998, 1995 and many times before that.
"The water is continuing to rise but it is our full hope and expectation that these walls will hold," Nixon said of the sandbag levees. Clarksville has a flood protection system in which a temporary levee ? aluminum slats filled with sand ? can be built if the river rises, but the Mississippi was too quick this time.
Mississippi River levels vary greatly but are typically highest in the spring, so minor flooding is not uncommon. But when river levels exceed flood stage by several feet, serious problems can occur.
Travel was at a standstill on most of the Mississippi between the Quad Cities and St. Louis. The Army Corps of Engineers closed several locks, halting barge traffic. Recreational traffic was halted, too, including the Mark Twain Riverboat that offers excursions at scenic Hannibal, Mo. Owner and pilot Steve Terry has moored the ship since Thursday, with no end in sight.
Even crossing the river was difficult. One of two bridges at Quincy, Ill., closed Friday, and the narrow two-lane bridge at the Missouri town of Louisiana was shut down Saturday. To get across, people in the Louisiana, Mo., area either had to drive 35 miles north to Hannibal, Mo., or 50-plus miles south to suburban St. Louis.
Penny Scranton's normal 13-minute commute from Rockport, Ill., to the BP convenience store in Louisiana turned into an hour and a half.
"There are others worse off," she shrugged.
Among those worse off was Louisiana resident Erica Campbell, whose rented home in a low-lying area of town was flooded for the second time in three years. She's had enough. Campbell, her husband and their eight kids are packing up.
"We're planning to move to the country ? as far away from water as I can get," Campbell, 35, said.
Smaller rivers across the Midwest were swelling, too. In Illinois, heavy equipment manufacturer Caterpillar will shut down its East Peoria, Ill., factory Sunday as the Illinois River approaches an expected 30-foot crest early next week.
Several Indiana towns were threatened by high water, forcing hundreds of evacuations. The Wabash River in Tippecanoe County reached more than 14 feet above flood stage on Saturday, the highest level since 1958. Indiana Gov. Mitch Pence took a helicopter tour Saturday of damage in Kokomo, Tipton and Elwood.
The mayor of Grand Rapids, Mich., declared a state of emergency Saturday, the same day high water forced the evacuation of the Courtyard Marriott Hotel and an apartment building.
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Salter reported from St. Louis. AP Photographer Jeff Roberson in Clarksville and Louisiana contributed to this report.
TEL AVIV, Israel (AP) ? U.S. Defense Secretary Chuck Hagel said Sunday the United States and Israel see "exactly the same" threat from Iran, but differ on when it may reach the point of requiring U.S. or Israeli military action.
Hagel used his first visit to Israel as Pentagon chief to highlight his view that Israel must decide for itself whether and when to pre-emptively attack its neighbor.
"Israel will make the decision that Israel must make to protect itself, to defend itself," Hagel told reporters before arriving here on Sunday to begin a weeklong tour of the Middle East.
Hagel acknowledged that while Israel and the U.S. share a commitment to ensuring that Iran does not acquire a nuclear weapon, there "may well be some differences" between the two allies on the question of when Iran's leaders might decide to go for a bomb.
He said there is "no daylight at all" between Israel and the U.S. on the central goal of preventing a nuclear-armed Iran.
But he added, "When you back down into the specifics of the timing of when and if Iran decides to pursue a nuclear weapon, there may well be some differences."
Israeli Prime Minister Benjamin Netanyahu tends to see more urgency, reflecting in part the fact that certain Iranian technological advances toward a nuclear weapon could put the program beyond the ability of the Israeli military to destroy it with airstrikes. U.S. forces have greater reach.
The first thing Hagel did upon arrival in Jerusalem was take a guided tour of the Yad Vashem Holocaust history museum, participate in a ceremony at the Hall of Remembrance and write an inscription in the guest book at a memorial for the 1.5 million Jewish children who perished in the Holocaust.
"There is no more poignant, more touching, more effective way to tell the story than this reality, as painful as it is, but it is a reality," he said after completing his visit. "It did happen, and we must prepare our future generations ... for a clear understanding that we must never allow this to happen again."
In an interview on an overnight flight from Washington, Hagel repeatedly emphasized Israel's right of self-defense and stressed that military force ? by implication, Israeli or American ? remains an option of last resort.
"In dealing with Iran, every option must be on the table," he said.
Hagel, 66, came under intense fire from Republican critics, prior to his February Senate confirmation hearing, for some of his past statements on Israel. His critics painted him as insufficiently supportive of the Jewish state.
In choosing to make Israel one of his first overseas stops, Hagel sought to put that controversy behind him ? with serious words and a touch of humor. The February confirmation hearing, which Republicans used to hammer him on Israel and other subjects, "was years ago," he deadpanned.
During his two-day visit to Israel, Hagel is expected to put the final touches on a U.S. arms deal that would provide Israel with missiles for its fighter aircraft, plus KC-135 refueling planes that could be used in a long-range strike on a country like Iran, as well as V-22 Osprey transport planes. He called the proposed sale a "very clear signal" to Iran.
"The bottom line is, Iran is a threat ? a real threat," he said, not only for its nuclear ambitions and its stated goal of destroying Israel but also for its alleged sponsoring of terrorism.
Hagel said U.S. and international economic sanctions are "hurting Iran significantly," but he said they do not guarantee that Iranian leaders will be persuaded to stop what the West sees as their ambition to become a nuclear power. Iran asserts that its nuclear program is designed entirely for non-military purposes.
Hagel suggested he holds hope that Iran's presidential election in June might change the trajectory of its nuclear drive.
He asserted that there is still time for diplomacy and international sanctions to resolve the Iran problem.
"These other tracks do have some time to continue to try to influence the outcome in Iran," he said.
In the interview en route to Tel Aviv, Hagel was asked whether the Obama administration has determined whether the Syrian government has used chemical weapons against opposition rebels. He said intelligences analysts are still assessing the evidence and have not reached a conclusion.
After his talks in Israel, Hagel is scheduled to visit Jordan, Saudi Arabia, Egypt and the United Arab Emirates. Each of those four is an important American ally in the Middle East, and each is worried by Syria's civil war.
Saudi Arabia and the UAE are part of a $10 billion proposed US arms sale that includes Israel. The UAE would get about 26 F-16 fighters and it and Saudi Arabia would get advanced air-launched missiles.
U.S. Secretary of State John Kerry is also in the region. He is working to mend the strained relationship between Turkey and Israel and on Sunday he announced the White House is doubling its non-lethal assistance to the Syrian opposition to $250 million.
BOSTON (AP) ? A defiant David Ortiz stood on the Fenway Park infield and told the crowd to "stay strong," bringing a rousing cheer from Bostonians weary from a week of bombings, stay-at-home orders and a manhunt that locked down the city for a day.
Playing at home for the first time since two explosions at the Boston Marathon finish line killed three people and wounded more than 180 others, the Red Sox honored the victims and the survivors with a pregame ceremony and an emotional video of scenes from Monday's race.
"This past week, I don't think there's one human being who wasn't affected by what was going on down here," Ortiz said after the Red Sox beat the Kansas City Royals. "I was emotional, very angry about the whole situation. ... Everybody was hurting. I know it's going to take some time to heal up, but the one thing everybody's got to remember is that everybody supports each other."
Starting with a video, alternating between celebratory and somber and accompanied by Jeff Buckley's "Hallelujah," the tributes continued with a first-pitch ceremony that honored a first responder, a victim of the blast, and a marathon institution: Dick and Rick Hoyt, who have participated in the race for more than 20 years.
Then Ortiz took the microphone and, in what he later said was an unplanned outburst, let loose with an expletive that drew a huge cheer from the 35,152 who managed to make it through the beefed-up security and into their seats on time.
"This is our (expletive) city, and nobody is going to dictate our freedom," he said. "Stay strong."
Neil Diamond, who flew into town on his own and asked if he could sing, gave a live performance in the eighth inning of "Sweet Caroline," the Fenway staple that has been adopted by opposing ballclubs to show their support for the city.
As Diamond, a New York native who wore a Red Sox cap, left the field, fans chanted "U.S.A.! U.S.A.!" In the bottom half of the inning, Daniel Nava hit a three-run homer to give the Red Sox the lead, and they held on to win 4-3.
"You give people hope," Ortiz said. "We wanted to let them know we're here for them."
Across town, the Bruins also returned to the ice after postponing their game against the Pittsburgh Penguins on Friday night, when a manhunt for the bombing suspects led to a "shelter-in-place" order that locked down the city. One suspect died and the other was captured, hiding in a dry-docked boat in a Watertown backyard.
"At least we could all breathe a little easier and sleep a little easier," coach Claude Julien said after the Bruins lost 3-2. "And now it's, hopefully, time to work ourselves into trying to get things back to normal again. But it will always leave a scar somewhere."
Penguins coach Dan Bylsma met with reporters before the game wearing a black T-shirt with words "Boston Strong" over his shirt and tie.
"I feel like we're playing with the Bruins today, not against them," Bylsma said before the game. "I know I share their pride yesterday in their city and their people and certainly their law enforcement yesterday. I'm certainly not a Bostonian, but I certainly share in that pride and hope to today with them as well."
The Bruins took the ice for their pregame warmup wearing baseball caps for the Boston and state police, along with one for the police in Watertown featuring the Bruins' "Spoked B" logo and the word "Strong" on the back.
Security was tight at both games, as it was when the Bruins made their emotional return after the bombing on Thursday night.
A SWAT team member with a German shepherd stood guard at the doorway to the tunnel leading to Royals dugout about 2? hours before game time. A man in military fatigues checked all of the players' lockers and the many cracks in the ceiling tiles with a flashlight.
Outside, fans milled around, waiting for the gates to open. Several of them were wearing Boston Marathon jackets dating back as long as a decade. Long lines of fans waited to be scanned by metal-detecting wands; many were still waiting to get in when the Red Sox and Royals lined up along the base-lines for the pregame ceremony.
With Boston Athletic Association volunteers in their yellow and blue jackets lined up in front of the Green Monster and police and public officials encircling the mound, ballpark organist Josh Kantor played The Star-Spangled Banner, with the crowd singing along. A giant U.S. flag was draped over the 37-foot-high Green Monster left-field wall, temporarily covering the "B Strong" logo newly painted in left-center field.
Pictures of the victims, including Massachusetts Institute of Technology police officer Sean Collier, were shown on the scoreboard, along with pictures from the marathon and the aftermath. Some of the biggest cheers were for the police who tracked down the suspects.
Gov. Deval Patrick and Boston Police Commissioner Ed Davis, along with other law enforcement officials and rank-and-file, circled the mound for the ceremonial first pitches from firefighter Matt Patterson, who rushed to the site of the bombings; from Steven Byrne, who was injured in the explosions, and from Dick Hoyt, accompanied by his son Rick, who has cerebral palsy.
Ortiz, who had been on the disabled list all season, took the microphone and showed fans the specially designed uniforms saying "Boston" on the front instead of the "Red Sox" they have worn for decades. Both teams wore patches with the "B Strong" logo.
The Red Sox said their uniforms would be autographed and auctioned off to raise money for the One Fund Boston, the charity established to help the victims. The Boston Celtics, who opened their playoff series against the Knicks with a loss in New York on Saturday, said they would donate $100,000 to the charity, with another $100,000 to come from fundraisers.
The team said fans would be given the option to donate their refund from the canceled April 16 game against Indiana to One Fund Boston.
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Public release date: 25-Apr-2013
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