Early detection of ST-segment elevation myocardial infarction (STEMI) on the prehospital electrocardiogram (ECG) improves patient outcomes. Current software algorithms optimize sensitivity but have a high false-positive rate. The authors propose an algorithm to improve the specificity of STEMI diagnosis in the prehospital setting. A dataset of prehospital ECGs with verified outcomes was used to validate an algorithm to identify true and false-positive software interpretations of STEMI. Four criteria implicated in prior research to differentiate STEMI true positives were applied: heart rate <130, QRS <100, verification of ST-segment elevation, and absence of artifact. The test characteristics were calculated and regression analysis was used to examine the association between the number of criteria included and test characteristics. There were 44,611 cases available. Of these, 1,193 were identified as STEMI by the software interpretation. Applying all four criteria had the highest positive likelihood ratio of 353 (95% CI, 201-595) and specificity of 99.96% (95% CI, 99.93-99.98), but the lowest sensitivity (14%; 95% CI, 11-17) and worst negative likelihood ratio (0.86; 95% CI, 0.84-0.89). There was a strong correlation between increased positive likelihood ratio (r2 = 0.90) and specificity (r2 = 0.85) with increasing number of criteria. Prehospital ECGs with a high probability of true STEMI can be accurately identified using these four criteria: heart rate <130, QRS <100, verification of ST-segment elevation, and absence of artifact. Applying these criteria to prehospital ECGs with software interpretations of STEMI could decrease false-positive field activations, while also reducing the need to rely on transmission for physician over-read. This can have significant clinical and quality implications for Emergency Medical Services (EMS) systems.

AbstractThis study explores the pig-raising practices of Chinese migrants in Los Angeles Chinatown during the Chinese Exclusion Era. Chinese butcher shops sold pork meat, and previous research indicates that they likely sold the more profitable parts outside of Chinatown for additional income while consuming cheaper cuts themselves. Using dental calculus analysis and archival research, this study further explores how Chinatown residents relied on pork to thrive in an anti-Chinese environment. Dental calculus results suggest that Chinese migrants raised their own pigs with food waste and by-products from rice fields; this pork was then sold to meat markets or consumed within the community. The analysis of immigration records indicates that Chinese butcher shops provided employment opportunities as well as housing, banking, and immigration support for Chinese migrants. Pig raising, therefore, not only supplied a source of meat for Chinese migrants but also supported a range of social and financial services for a marginalized group that faced everyday discrimination from dominant society. Overall, this study traces the labor and networks that small businesses in the late nineteenth and early twentieth centuries needed to source and distribute pork, and it highlights how a Chinese diasporic community developed a pork production system to resist racism.

Wildfires, intensified by climate change and perhaps human activity, may have doomed Southern California's big mammals 13,000 years ago.

The Brazilian Legal Amazon region is divided into at least 155 ethnic groups and has the largest concentration of Indigenous people globally. It represents one of the most extraordinary levels of human, cultural, and artistic diversity, but its material culture is one of the least well-studied. This is especially true in technical art history and conservation science, largely due to (1) the limited international awareness of the richness of materials and techniques used by these Indigenous people and (2) the limitations of knowledge access for many scientists to literature usually published in Portuguese within social sciences and humanities. One result is that these arts are marginalized within technical art history, conservation, and conservation science. To address this knowledge gap, the authors explore 70 materials—among them pigments, dyes, binding media, and varnishes—used for paint production and coloring processes, including syntheses. The authors facilitate research possibilities within technical art history, conservation, and conservation science by presenting data from historical texts from the 18th and 19th centuries and more recent scientific literature. The work aims to build a more global, inclusive, and decentralized vision of art history and to create a more pluralistic narrative of Indigenous art history from South America.

ABSTRACT Fossil bird eggs from the Pleistocene of the Americas are rare. Previous records include Uruguay, Bermuda, California (USA) and Mexico, including reports of complete fossil eggs from extinct puffin (Fratercula dowi) from California, Tinamou (Tinamidae indet.) from Uruguay, Brown Pelican (Pelecanus occidentalis) from Bermuda and Sandhill Crane (Grus canadensis) from México. The fossil record of flamingos in Mexico is restricted to palaeolakes in Central Mexico, which is very interesting because the current distribution of flamingos in North America is restricted to some areas of the Southeastern United States and Yucatan Peninsula, which are far from palaeontological sites. We report a fossil flamingo egg found during the construction of a new International Airport ‘Felipe Angeles’, Santa Lucía, State of México. This egg is the first Pleistocene fossil egg record for the family Phoenicopteridae, the first fossil egg record of this family in the Americas and the second record of a phoenicopterid fossil egg in the world. We re-identified the fossil eggs described by Martin del Campo in the 1940s, suggesting that they are also flamingo eggs. Using biogeographical and climate niche data for family Phoenicopteridae in North America, we infer the presence of a salinity and shallow palaeolake during the Late Pleistocene, with climatic condition being warmest and wetter than at present.

Advances in technology have equipped paleobiologists with new analytical tools to assess the fossil record. The functional traits of vertebrates have been used to infer paleoenvironmental conditions. In Quaternary deposits, birds are the second-most-studied group after mammals. They are considered a poor paleoambiental proxy because their high vagility and phenotypic plasticity allow them to respond more effectively to climate change. Investigating multiple groups is important, but it is not often attempted. Biogeographical and climatic niche information concerning small mammals, reptiles, and birds have been used to infer the paleoclimatic conditions present during the Late Pleistocene at San Josecito Cave (~28,000 14C years BP), Mexico. Warmer and dryer conditions are inferred with respect to the present. The use of all of the groups of small vertebrates is recommended because they represent an assemblage of species that have gone through a series of environmental filters in the past. Individually, different vertebrate groups provide different paleoclimatic information. Birds are a good proxy for inferring paleoprecipitation but not paleotemperature. Together, reptiles and small mammals are a good proxy for inferring paleoprecipitation and paleotemperature, but reptiles alone are a bad proxy, and mammals alone are a good proxy for inferring paleotemperature and precipitation. The current paleoclimatic results coupled with those of a previous vegetation structure analysis indicate the presence of non-analog paleoenvironmental conditions during the Late Pleistocene in the San Josecito Cave area. This situation would explain the presence of a disharmonious fauna and the extinction of several taxa when these conditions later disappeared and do not reappear again.

Use of extracorporeal membrane oxygenation (ECMO) in cardiopulmonary resuscitation, termed eCPR, offers the prospect of improving survival with good neurological function after cardiac arrest. After death, ECMO can also be used for enhanced preservation of abdominal and thoracic organs, designated normothermic regional perfusion (NRP), before organ recovery for transplantation. To optimize resuscitation and transplantation outcomes, healthcare networks in Portugal and Italy have developed cardiac arrest protocols that integrate use of eCPR with NRP. Similar dissemination of eCPR and its integration with NRP in the USA raise novel ethical issues due to a non-nationalized health system and an opt-in framework for organ donation, as well as other legal and cultural factors. Nonetheless, eCPR investigations are ongoing, and both eCPR and NRP are selectively employed in clinical practice. This paper delineates the most pressing relevant ethical considerations and proposes recommendations for implementation of protocols that aim to promote public trust and reduce conflicts of interest. Transparent policies should rely on protocols that separate lifesaving from organ preservation considerations; robust, centralized eCPR data to inform equitable and evidence-based allocations; uniform practices concerning clinical decision-making and resource utilization; and partnership with community stakeholders, allowing patients to make decisions about emergency care that align with their values. Proactively addressing these ethical and logistical challenges could enable eCPR dissemination and integration with NRP protocols in the USA, with the potential to maximize lives saved through both improved resuscitation with good neurological outcomes and increased organ donation opportunities when resuscitation is unsuccessful or not in accordance with individuals’ wishes.

AbstractThe oldest macaw specimen in Pre‐Hispanic Mexico and the southwestern United States was recovered in Cueva de Avendaños, Chihuahua, Mexico, at the base of the Sierra Madre Occidental. It dates to the Late Archaic/Early Agricultural period (1929–2057 cal BP). The head is the only preserved element of the macaw and it was mummified through natural causes. Research on this specimen examines its sex identification and its geographical range, questioning whether this specimen belongs to a local population living in the vicinity of the cave. A species distribution model over the last 2000 years was elaborated to ascertain the presence of military macaw in the study area. Our results show that the macaw was non‐local, sustaining the idea that the practice of early animal husbandry existed in the early stages of the Pre‐Hispanic world, and also suggest that a significant and rapid climate changes characterized the Holocene, affecting the military macaw's distributional range.

The philosophical ties between Northeastern Asia and the Northern Rockies as represented in a selection of fine art — including Daoist nature deities and immortals, Confucian scholar brushes and inkstones, and Buddhist guardian kings and compassionate bodhisattvas — have never been explicated. This catalog lays the groundwork for a serious discussion of trans-Pacific acculturation: first by explaining the fundamentals of Daoism, Confucianism, and Buddhism in reference to rare works of art produced in China, Korea, and Japan between the Tang Dynasty and the Qing Dynasty, and second, by assessing the prevalence of these philosophies as indicated by photographs of temples, shrines, deities, and rituals recreated in Idaho, Montana, Wyoming, and Colorado between the Civil War and World War I. Drawing from the collections of the Los Angeles County Museum of Art and the Daryl S. Paulson Collection in Bozeman, Montana, Asian art curator Stephen Little offers three brief essays that distinguish the philosophies of Daoism, Confucianism, and Buddhism according to their founding values, each followed by several object case studies that illustrate, elaborate, and develop those ideals. Mining the photographs of the state historical societies of Boise, Helena, Cheyenne, and Denver, Euro-American art professor T. Lawrence Larkin offers a long essay that compares religious values and artistic forms on both sides of the Pacific illustrated by objects that highlight migrant and settler culture in the Inner West. Profusely illustrated with new color and rarely seen black-and-white images, and containing useful maps, chronologies, and an index, Northeastern Asia and the Northern Rockies is an invaluable reference for the general reader and an important resource for the regional scholar.

Quantifying the niche of contemporary and fossil organisms is key to identifying the primary factors driving species and community dynamics through time, in particular teasing apart abiotic and biotic drivers of change. However, niche quantification can be difficult due to short time spans (for contemporary systems), time averaging (for fossil systems), and incomplete information on different aspects of ecology and environment (for both contemporary and fossil systems). Here, we use stable isotope analyses coupled with specimen-level radiocarbon dating from the Rancho La Brea Tar Pits in Los Angeles, California to examine niche dynamics over the last >55,000 years. We sampled over 100 specimens of small and mid-sized mammals, mostly sciurids (squirrels) and leporids (rabbits), from Rancho La Brea to quantify their isotopic niche, track niche changes through time, and identify probable cause(s) of those changes. Individual specimens were radiocarbon dated and niches were quantified from stable carbon (δ13C) and nitrogen (δ15N) isotope analysis of fossil collagen to track individual isotopic niches at precise points in time. Overall, sciurids and leporids exhibit different isotopic signals, suggesting niche variation among taxa. Comparison of animals during the Pleistocene versus the Holocene reveals overall greater δ13C values and greater δ13C and δ15N isotopic niche breadth among Holocene individuals, suggesting that small mammal resource use changed from the last glacial to current interglacial period. Evaluating the isotopic data continuously through time against a high-resolution regional paleoclimate record shows that climate contributed to small mammal niche variation over the last 55,000 years in the Los Angeles Basin. These findings reveal the complexity of long-term abiotic and biotic forcings on organismal niches and emphasize the importance of scale and data resolution when quantifying and interpreting (paleo)ecological patterns and processes.