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For suspected acute myocardial infarction (AMI) and unstable angina patients, prehospital aspirin (ASA) administration has been the standard of care by Emergency Medical Services (EMS) field providers. Recently, Emergency Medical Dispatchers (EMDs), using Medical Priority Dispatch System (MPDS), provide telephone instructions to qualifying suspected AMI patients to take ASA, prior to EMS field provider arrival. No formal studies exist that measure time saved from earlier Dispatcher-Directed Aspirin Administration (DDAA).
Objectives:
The primary objectives of the study were: (1) to determine the amount of time saved, if any, using DDAA; and (2) to describe the frequency of DDAA and Field Provider-Directed Aspirin Administration (FPAA).
Methods:
The retrospective study analyzed EMD and EMS data collected during a six-month period at three dispatch services and three EMS agencies in the United States. The frequency and mean (plus 95% confidence interval [CI]) time of DDAA and FPAA were calculated. Reasons why patients who qualified to take ASA per dispatch protocol but did not take it were also assessed.
Results:
A total of 108,459 EMS cases were analyzed; EMD/EMS delivered ASA to 4.0% (n = 4,113) of these patients. The most frequent primary impressions were: cardiac chest pain (angina), cardiovascular (CV)-chest pain (presumed cardiac), ST-segment elevation myocardial infarction (STEMI), and CV-chest pain – acute coronary syndrome (ACS; 50.0%). Overall, DDAA saved 13 minutes mean time (95% CI, 11.4-14.6; P < .001) (median: 12.3 minutes) from the case creation time.
Conclusions:
It was found that DDAA provides measurable time savings in ASA delivery to patients. Further studies will need to assess if the reduction of ASA delivery time by EMDs has the potential to improve overall care and survival for patients. The study identified beneficial new knowledge for possible future enhancements to medical dispatch protocols and for EMS providers.
With the eastward expansion of the Western Zhou c. 1050 BC, the Jiaodong Peninsula on the north-east coast of modern-day China became part of a large polity. Excavations at Qianzhongzitou, located on this peninsula, are revealing how political control over local populations took place. Here, the authors focus on a sequence of Zhou-period, non-residential platforms, the construction of which signifies new forms of ritual spaces. These types of spaces, also found elsewhere in the region, arguably aided in the state assimilation of local deities, illustrating the critical role that ritual played in political unification of early Chinese states and dynasties.
We prove large and moderate deviations for the output of Gaussian fully connected neural networks. The main achievements concern deep neural networks (i.e. when the model has more than one hidden layer) and hold for bounded and continuous pre-activation functions. However, for deep neural networks fed by a single input, we have results even if the pre-activation is ReLU. When the network is shallow (i.e. there is exactly one hidden layer), the large and moderate principles hold for quite general pre-activation functions.
Phonotactic patterns are commonly constrained by morphology. In English, for example, non-homorganic nasal–stop sequences are disallowed within morphemes but may occur across morpheme boundaries. This article demonstrates that similar effects of morphology on phonotactics can be found with non-concatenative morphology, even though they involve morphological domains that are more difficult to identify on the surface. Specifically, vowel alternation in a class of Egyptian Arabic verbs is affected by gradient phonotactic restrictions on consonant–vowel co-occurrence. However, such restrictions are only active in the imperfective form (e.g., [-rgaʕ] ‘return.ipfv’), not the perfective (e.g., [rigiʕ] ‘return.pfv’). Using a lexicon study and a wug test, I show that this pattern is in fact bounded by morphological domains and is reliably generalised by speakers when deriving novel forms. I compare accounts of this effect that differ on whether they require abstract morphosyntactic representations and non-concatenative morphemes and discuss their implications.
Comparativists (about mass) eliminate absolute masses from the fundamental ontological picture by virtue of a principle of economy, the “Comparative Razor”, which requires that only mass-relations, that are invariant under (metrical) symmetries be considered fundamental. I show how this weapon backfires. If mass-relations are endowed with a standard (multiplicative) concatenation structure, power-transformations become (metrical) symmetries, leaving comparativists prima facie unable to distinguish a possible world and its duplicate where mass-relations are uniformly squared. Then, I considered possible exit strategies, which unfortunately either rely on hidden absolutist assumptions, or leave comparativists and absolutists on equal footing.
We investigate the shape of a tin sheet formed from a droplet struck by a nanosecond laser pulse. Specifically, we examine the dynamics of the process as a function of laser beam properties, focusing on the outstanding puzzle of curvature inversion: tin sheets produced in experiments and state-of-the-art extreme ultraviolet (EUV) nanolithography light sources curve in a direction opposite to previous theoretical predictions. We resolve this discrepancy by combining direct numerical simulations with experimental data, demonstrating that curvature inversion can be explained by an instantaneous pressure impulse with low kurtosis. Specifically, we parametrise a dimensionless pressure width, $ W$, using a raised cosine function and successfully reproduce the experimentally observed curvature over a wide range of laser-to-droplet diameter ratios, $ 0.3 \lt d/D_0 \lt 0.8$. The simulation process described in this work has applications in the EUV nanolithography industry, where a laser pulse deforms a droplet into a sheet, which is subsequently ionised by a second pulse to produce EUV-emitting plasma.