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This article documents the transition from the Late Classic to Postclassic periods at Río Amarillo, a hinterland outpost of the Copan polity, and at an associated residential group, Site 5, in the Río Amarillo East Pocket of the Copan Valley. Late Classic period evidence indicates that the site of Río Amarillo operated as an administrative center for the Copan polity with the likely objective of increased agricultural production for the burgeoning population in the Copan Pocket. In the Terminal Classic period, Río Amarillo shared the fate of Copan, with evidence indicating it was burned and sacked. However, unlike the Copan Pocket, many residential groups remained occupied during the Early Postclassic. Here we focus on Site 5. An unbroken occupation from the Late Classic through to the end of the Early Postclassic period, as this site provides a window into an existence without the requirements of tribute given to their western neighbor. We hypothesize that the smaller settlement size and higher amount of rainfall in this valley pocket, as well as a richer and more diversified environment, were important factors in the survival of some of its population.
Emergency Medical Services (EMS) systems have developed protocols for prehospital activation of the cardiac catheterization laboratory for patients with suspected ST-elevation myocardial infarction (STEMI) to decrease first-medical-contact-to-balloon time (FMC2B). The rate of “false positive” prehospital activations is high. In order to decrease this rate and expedite care for patients with true STEMI, the American Heart Association (AHA; Dallas, Texas USA) developed the Mission Lifeline PreAct STEMI algorithm, which was implemented in Los Angeles County (LAC; California USA) in 2015. The hypothesis of this study was that implementation of the PreAct algorithm would increase the positive predictive value (PPV) of prehospital activation.
This is an observational pre-/post-study of the effect of the implementation of the PreAct algorithm for patients with suspected STEMI transported to one of five STEMI Receiving Centers (SRCs) within the LAC Regional System. The primary outcome was the PPV of cardiac catheterization laboratory activation for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The secondary outcome was FMC2B.
A total of 1,877 patients were analyzed for the primary outcome in the pre-intervention period and 405 patients in the post-intervention period. There was an overall decrease in cardiac catheterization laboratory activations, from 67% in the pre-intervention period to 49% in the post-intervention period (95% CI for the difference, -14% to -22%). The overall rate of cardiac catheterization declined in post-intervention period as compared the pre-intervention period, from 34% to 30% (95% CI, for the difference -7.6% to 0.4%), but actually increased for subjects who had activation (48% versus 58%; 95% CI, 4.6%-15.0%). Implementation of the PreAct algorithm was associated with an increase in the PPV of activation for PCI or CABG from 37.9% to 48.6%. The overall odds ratio (OR) associated with the intervention was 1.4 (95% CI, 1.1-1.8). The effect of the intervention was to decrease variability between medical centers. There was no associated change in average FMC2B.
The implementation of the PreAct algorithm in the LAC EMS system was associated with an overall increase in the PPV of cardiac catheterization laboratory activation.
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