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Predicted Probability of Bystander-Initiated Cardiopulmonary Resuscitation (CPR). Final Adjusted Model for Provision of Bystander-Initiated CPR. Predicted Probability of Bystander-Initiated CPR According to the Median Income and Racial Composition of the Neighborhood.

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October 25, 2012 N Engl J Med 2012; 367:1607-1615 DOI: 10.1056/NEJMoa1110700

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The first chemotherapy in Britain is owed to Leonard Colebrook (1882-1967). He was the Medical Research Council bacteriologist at the Queen Charlotte's infectious diseases unit and had fought long for the use of rubber gloves and proper face masks (with cellophane between the gauge layers) in the labour wards. In January 1936 he introduced prontosil (a sulphonamide) to Queen Charlotte's Hospital with startlingly good results. 6 This led to the use of many other antibiotics as they appeared in the following 40 years and puerperal sepsis was removed as a major cause of maternal mortality in Britain.

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Bleeding is still a major cause of death in many parts of the world; it is one, however, that responds to treatment. Antepartum haemorrhage may be due to placenta praevia or to separation or abruption of the normally sited placenta. Postpartum haemorrhage can follow trauma at delivery, or more usually, because the uterus does not contract down after delivery.

Placenta praevia

In placenta praevia, the low implanted placenta starts to peel off as the lower segment of the uterus is pulled up in late pregnancy. This is accompanied by maternal bleeding, which can be profuse.

Edward Rigsby (1747-1821) of Norwich had described this in the late 18th century and suggested the use of membrane rupture. James Young Simpson later described this bleeding from the placental site as placenta praevia, ‘... a condition which aroused more anxiety in the attendant and was more dangerous to the mother than any other complication of childbirth’.

In the earlier 19th century, if the cervix was closed, the vagina was packed firmly with cloth. Very cold and then very hot douches were sometimes used to staunch the haemorrhage. If the cervix was dilated, Braxton Hicks (1823-1897), an obstetrician of Guy's Hospital, had described in 1860 a combined bipolar version of the baby and then passing a finger through the low lying placenta, bringing down a leg. This was tied with a tape to a weight over the end of the bed and thus the half-breech was plugged down into the pelvis to reduce or even stop the bleeding. Once the lower segment had been compressed with the half-breech, it was important not to make a rapid delivery of the baby, but to allow the haemorrhage to settle. Labour would follow soon anyway. It was considered at this procedure that there was no need to remove the operator's coat, but that just rolling up the sleeve would suffice. No attempt to clean the hand or arm was made but it was a very successful way of preventing bleeding and it led to a noted reduction of maternal mortality.

Later Lawson Tait (1845-1899) of Birmingham advanced the idea of performing caesarean section for placenta praevia that bled. This was widely taken up. Unfortunately, since many of these women suffered their bleeding early in the third trimester of pregnancy, this often meant the child was born very premature and, in those days, died. It was Charles Macafee (1898-1978) in Belfast who in 1945 advocated admitting the women who had bled to hospital and keeping them there till about 38 weeks of pregnancy when caesarean section was performed. Excessive bleeding was treated with liberal blood transfusion until 38 weeks. The baby stood a better chance after a delivery at this later stage.

Abruption of the placenta

Edward Rigby had differentiated the unavoidable antepartum haemorrhage of placenta praevia from the accidental bleeding due to separation of a normally sited placenta. He called this ‘accidental haemorrhage’ and the name stuck—as, unfortunately, it was misleading. The American term of abruption of the placenta came to Britain much later. The normally positioned placenta was separated from its bed accompanied by much pain and shock. There was little external bleeding which Rigby described as ‘cadaver blood’ for it did not clot due to the haematological upset accompanying this condition. The treatment was to rupture the membranes and await a speedy delivery thereafter. This remained the mainstay of treatment until caesarean section became a practical measure in the 20th century. It was only comparatively recently that it was realized that the massive shock was best managed by large replacements of blood, with up to six units being required.

Postpartum haemorrhage

Whilst some of the excessive bleeding after delivery might be due to damage to the cervix or uterus, most follows the poor contraction of that organ. Sometimes this is associated with the non-delivery of the placenta, in whole or part. Management in the 19th century depended upon knowledge of the physiology of the third stage of labour, which was often misapplied. Sometimes placental delivery was hastened by uncontrolled traction on the cord or by violent pressure on the uterus (Credé manoeuvre).

Treatment of excessive postpartum bleeding was attempted with vaginal packing, or with cold and later, more effectively, with hot vaginal douches, but the first effective treatment was with ergot, which caused uterine muscles to contract. This has been known of since the 16th century, but it was Oliver Prescott of Massachusetts who, in 1813, described its use for uterine haemorrhage. Extracts of ergot were given by mouth as ‘labour tea’; later ergot was used as an injection after the fetal head was born. Barry Hart of Edinburgh advocated its use preventively, not waiting for the haemorrhage before injection.

The sorting out of the three alkaloids in crude ergot and the isolation of ergometrine is owed to Chassar Moir (1900-1977), who was working in F J Browne's unit at University College Hospital. He did extensive research recording intra-uterine pressures after delivery, inserting a balloon into the uterus and recording the pressures via a rubber tube led out of the window of the labour ward, along a ledge and into the next room as the recording instruments were so bulky. Unfortunately, the pigeons of University Street attacked this bright red tube, releasing the mercury and so invalidating the pressure readings. A hole had to be drilled in the wall between the two rooms to continue the experiments. The ultimate value of prophylactic ergometrine in all deliveries was shown by the intramuscular route and by the intravenous route by John Martin and Jack Dumalin. The latter compared the postpartum blood loss in a thousand primiparous women with normal deliveries who had intravenous ergometrine at the crowning of the fetal head, with women who had not. Oxytocin came much later in the 1950s, first synthesized in Cornell and its use for reduction of postpartum haemorrhage is increasing.

The battle for reduction of blood loss as a cause of maternal death has been mostly won in the Western world. Unfortunately, these drugs and the skills associated with their use are still not available to everybody in the Developing world.

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It was hard to designate a cause of maternal death to a disease until it had been discovered. Probably it was John Lever (1811-1859), a lecturer in obstetrics at Guy's Hospital, who first recognized the link between protinuria and fits. 16 Blood pressure measurements did not start until the early days of the next century. Lever wondered if the disease was a manifestation of Bright's disease of the kidney and so this type of maternal death was often classified under renal causes. Its aetiology has been debated widely but its treatment was by sedation with drugs currently available, leading to the technique devised by Stroganoff (1857-1938) in 1898 of controlling fitting by the use of sub-cutaneous morphia and chloroform. 17 Magnesium sulphate was first used in America in the 1920s 18 and soon spread there to both treat and prevent fitting, but was not picked up in Britain until some 60 years after its widespread use in the USA.

Search The Netherlands and beyond
is fields of blooming colour
is illuminated canal life
is windmills under vast skies

Welcome to The Netherlands

Tradition and innovation intertwine here: artistic masterpieces, windmills, tulips and candlelit coexist with groundbreaking architecture, cutting-edge design and phenomenal nightlife.

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Art Architecture

The legacies of Dutch Masters such as Rembrandt, Vermeer, Van Gogh, Frans Hals, Hieronymus Bosch, Piet Mondrian and MC Escher hang on the walls of the Netherlands' world-renowned museums, along with contemporary Dutch works.The Dutch influence on construction spans more than a millennia, from Romanesque and Gothic medieval magnum opuses to Dutch Renaissance creations, revolutionary, Golden Age gabled houses and engineering endeavours including canals, neoclassicism, Berlage and the Amsterdam School, Functionalism, modernism, structuralism, neorationalism, postmodernism and neomodernism, with trailblazing structures making their mark on the cityscapes.


Geography plays a key role in the Netherlands' iconic landscapes. More than half the pancake-flat country is below sea level, and 20% has been reclaimed from the sea, making rows of polders (areas of drained land) omnipresent. Uninterrupted North Sea winds have powered windmills since the 13th century, pumping water over the dykes, and milling flour and more. Some two-thirds of the surface is devoted to agriculture, including fields of tulips.


The flat, fabulously scenic landscapes make cycling in the Netherlands a pleasure (headwinds not withstanding). Cycling is an integral part of life and locals live on their (bicycle): more than a quarter of all journeys countrywide are by bike, rising to more than a third in big cities.Experiencing the wind-in-your-hair freedom of cycling is a breeze. Bike-rental outlets are ubiquitous, and the country is criss-crossed with some 32,000km of cycling paths, including the Dutch 'motorways' of cycling, the long-distance LF routes. Grab some wheels and start exploring.

Café Culture

When the Dutch say they mean a pub, and there are thousands of them. In a country that values socialising and conversation more than drinking, are places for contemplation and camaraderie. Many have outdoor terraces, which are glorious in summer and sometimes covered and heated in winter. Most serve food, from bar snacks to fabulous meals. The most atmospheric is a (brown café), named for the nicotine stains of centuries past – the ultimate place to experience the Dutch state of (conviviality, cosiness).

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Ready to go? Get to the heart of The Netherlands with one of Lonely Planet's in-depth, award-winning guidebooks.

Zaanse Schans Windmills, Volendam, and Marken from Amsterdam

Next, you'll travel to the world-famous fishing villages of Volendam and Marken, on the coast of the former Zuiderzee (now called Ijselmeer). The old wooden houses here are built on stilts and locals still wear their colorful traditional dresses. Then, take a 20-minute boat trip from Volendam to Marken, with approximately 45 minutes at each stop (summer only). The cruise is optional but is included in the cost of the tour. During the day you'll also stop at one of the few farms where cheese is still made in the traditional way. 7-Hour tour departing at 12pmThis option was created based on customer feedback to offer an alternative itinerary and longer tour duration. The afternoon tour at 12pm is 7hours in duration. It visits the windmill village of "Zaanse Schans" and the towns of Marken and Volendam. However, this tour gives you more time at all 3 locations.

Amsterdam Evening Canal Cruise with 4-Course Dinner and Drinks

Step aboard your sightseeing cruise boat near Amsterdam Central Station, and then help yourself to a drink from the bar. Take a seat at your table – either out on deck or inside the lower saloon – and gaze out at the sights of Amsterdam as your waiting staff serves your first course. Unlike many other Amsterdam dinner cruises, all food is prepared and cooked on board – ensuring that your meal is of the freshest quality! Savor a full four courses as you cruise, passing the sights of Amsterdam.The route taken is dependent on water levels on the day, but typical attractions that may be seen include the Anne Frank House, Hermitage Museum, Amstel River and Magere Brug (Skinny Bridge). Listen out for details about famous sights from the onboard waiting staff, and hear fun facts and trivia about the city.After 2.5 hours cruising around the canals, return to the start point and hop back onto dry land.For a sample menu, please refer to the section below. Please submit your menu choice (meat, fish or vegetarian) in the Special Requests field at time of booking! Customers will automatically get the meat menu if no choice has been made.

Amsterdam Red Light District Walking Tour

The tour takes you to the area that's synonymous with Amsterdam, De Wallen (Red Light District), passing monuments and entering narrow old streets such as the well-known Zeedijk street. In the past it was one of the most dangerous streets in Amsterdam, where sailors could be found searching for local amusement. Nowadays, instead of the shady bars of yester year you'll find lively and welcoming Dutch pubs and restaurants.The walk includes the entrance to the Museum of Prostitution where you can take a look behind the scenes and listen to the secrets of the women themselves.Your safety is guaranteed during this excursion into Amsterdam's darker side, as a reliable and trustworthy guide will be accompanying you.

Amsterdam Dutch Wine and Cheese Candlelight Cruise

Head to central Amsterdam at night to board the boat and begin your romantic cruise of the city's historic canals, a UNESCO World Heritage Site. No matter where you sit aboard the glass-enclosed vessel, you'll enjoy great views of the canals and the waterfront.Sit back, relax and soak up the sultry atmosphere created by candlelight as you glide along Amsterdam's canals. Winding your way through the Canal Belt of the Amstel river, pass under bridges adorned in festive lights, see charming waterfront houses and buzzing cafes, and watch reflections of light shimmer across the water. During your cruise, you and your loved one will enjoy a glass of wine and cheese tasting. You'll be served a variety of fine wines and a selection of typical Dutch cheeses, as well as nuts, pickled cucumbers and other snacks. Spend two hours soaking up the romantic ambience of the illuminated canals. Savor the last of this special moment before making your way back to central Amsterdam to conclude your candlelight cruise.

Van Gogh Museum, Rijksmuseum Skip the Line Tour, Canal Cruise

Your full-day tour starts in Amsterdam’s Museum District in the morning. Your guide will first take you to the Rijksmuseum, a Dutch national museum dedicated to the arts and history of the Netherlands. Enjoy skip-the-line entry and head straight inside for a small-group tour. This recently renovated museum has a magnificent collection of artwork, crafts and historical pieces dating back from the year 1200 to today. Admire and learn about masterpieces such as Vermeer’s Milkmaid and Rembrandt’s Night Watch. The entire collection of the Rijksmuseum is an incredible one million items, with 8,000 on display in 80 galleries.After the tour, you have free time to browse the museum shop. This is where you will also enjoy a light lunch at the Rijksmuseum. Next it's time to admire Amsterdam's outdoor beauty with a 75 minute boat tour along the city's picturesque canals. Relax as you cruise along the elaborate ring of UNESCO World Heritage-listed canals, passing charming bridges, canal houses, classic Dutch gables, churches, towers and other wonderful waterfront highlights.Following the canal cruise, your guide will take you to the Van Gogh Museum.The Van Gogh Museum is home to the world's largest collection of paintings by Van Gogh, with more than 200 paintings as well as many letters and drawings. You can also see the work of those who inspired Van Gogh throughout various displays of art by other 19th-century painters. Your art historian guide will teach you about select paintings and about Van Gogh’s life, plus answer any questions you have. After your Van Gogh Museum tour, your guide will take you to Coster Diamonds -- one of the oldest still-operating diamond polishing factories -- where you will receive an entrance ticket to the Diamond Museum. The guided portion of your tour ends here, and you're free to continue exploring independently.

I amsterdam Card - City Pass for Amsterdam

Amsterdam has so much to offer, including world-renowned museums, delicious food and delightful canals. The I amsterdam city card makes it easy to get the most out of your stay in this vibrant city while saving lots of money. With your pass, gain free admission to illustrious Amsterdam museums including the Rijksmuseum, the Van Gogh Museum (with time slot booking option), Rembrandthuis Museum and Hermitage Amsterdam. Save 25% off popular Amsterdam attractions such as Madame Tussauds and Icebar XtraCold, and receive discount offers for restaurants and shows. You'll also get a free city map to help you navigate the streets and canals of Amsterdam and unlimited use of public transport (airport train not included). Enjoy the sights from a free canal cruise, also included with your city pass. Your I amsterdam card contains 2 separate chips which can be activated separately, so you can choose when you will make the best use of the 2 components: museums and public transport.

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