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Background/Aims Acute coronary syndromes include unstable angina and myocardial infarction, of which occlusive myocardial infarction is a high-risk subset that is often missed because of a lack of ST elevation. Pre-hospital electrocardiograms may be able to identify myocardial infarction early and reduce mortality. However, it is unclear whether pre-hospital electrocardiograms can accurately detect occlusive myocardial infarction and how this affects outcomes. This study will analyse the outcomes of patients with occlusive myocardial infarction who had a pre-hospital electrocardiogram. Method Electrocardiograms transmitted to the coronary care unit triage service were identified, along with data regarding patient demographics, referrals and mortality. Data were analysed for correlations between demographic and clinical factors and type of myocardial infarction. Results A total of 838 electrocardiograms were identified; 69 (8.2%) showed myocardial infarction and eight (1.0%) showed occlusive myocardial infarction, of which 50% had ST elevation. Patients with occlusive myocardial infarction were more likely to be triaged to the coronary care unit than patients with non-occlusive myocardial infarction (P=0.04). However, 38 (55.1%) of the patients with myocardial infarction and four (50.0%) of the patients with occlusive myocardial infarction were not directed to a coronary care unit or the catheterisation laboratory. Patients with occlusive myocardial infarction had higher index episode mortality rates (P=0.03) and 30-day mortality rates (PConclusions Despite pre-hospital electrocardiogram transmission and adherence to the guidelines, triage of myocardial infarction and occlusive myocardial infarction is imperfect. Refinement of risk scores and adaptation of new technology is required to help identify patients with occlusive myocardial infarction so they can be prioritised for immediate reperfusion therapy.

BACKGROUND: Heart transplantation is an effective treatment offering the best recovery in both quality and quantity of life in those affected by refractory, severe heart failure. However, transplantation is limited by donor organ availability. The reintroduction of heart donation after the circulatory determination of death (DCD) in 2014 offered an uplift in transplant activity by 30%. Thoraco-abdominal normothermic regional perfusion (taNRP) enables in-situ reperfusion of the DCD heart. The objective of this paper is to assess the clinical outcomes of DCD donor hearts recovered and transplanted from donors undergoing taNRP. METHOD: This was a multicentre retrospective observational study. Outcomes included functional warm ischaemic time, use of mechanical support immediately following transplantation, perioperative and long-term actuarial survival and incidence of acute rejection requiring treatment. 157 taNRP DCD heart transplants, performed between February 2, 2015, and July 29, 2022, have been included from 15 major transplant centres worldwide including the UK, Spain, the USA and Belgium. 673 donations after the neurological determination of death (DBD) heart transplantations from the same centres were used as a comparison group for survival. FINDINGS: taNRP resulted in a 23% increase in heart transplantation activity. Survival was similar in the taNRP group when compared to DBD. 30-day survival was 96.8% ([92.5%-98.6%] 95% CI, n = 156), 1-year survival was 93.2% ([87.7%-96.3%] 95% CI, n = 72) and 5-year survival was 84.3% ([69.6%-92.2%] 95% CI, n = 13). INTERPRETATION: Our study suggests that taNRP provides a significant boost to heart transplantation activity. The survival rates of taNRP are comparable to those obtained for DBD transplantation in this study. The similar survival may in part be related to a short warm ischaemic time or through a possible selection bias of younger donors, this being an uncontrolled observational study. Therefore, our study suggests that taNRP offers an effective method of organ preservation and procurement. This early success of the technique warrants further investigation and use. FUNDING: None of the authors have a financial relationship with a commercial entity that has an interest in the subject.

The stdy of prehistory is subject to the same bias and prejudice as any other scientific discipline. When the rewards are likely to be few and the effort required great, researchers will avoid problem areas in favour of more lucrative fields. One such neglected area of research has been the archaeology of the coastal plains and forests of southeastern Australia, where poor visibility and the diffuse nature of the archaaeological record militate against the investment of valuable research time. In the Sydney region, the archaeological data accumulated relate almost exclusively to rock shelter deposits. While such sites do have the potential to provide a great deal of valuable information, they reflect only a fraction of the activities carried out by the prehistoric population. In order to counteract the bias evident in the archaeological investigations, I undertook a systematic archaeological survey of the western Cumberland Plain. In the early chapters of this thesis, I examine the environmental setting and the resources which were available to Aboriginal people at the time of European settlement in 1788. After evaluating the ethnographic accouns, a clear picture emerges of two major economic systems operating; one based on coastal resources and one reliant on a wider range of locally abundant foods. Associate with this dichotomy were linguistic, technological and social differences suggestive of dense Aboriginal populations exploiting relatively narrow territories. Archaeological surveys were undertaken, a representative rockshelter site and two open sites were excavated, and, in conjunction with the surface collection of artefacts, it was possible to identify patterns in the archaeological record suggesting that the technological changes evident in the stone tools were a reflection of a changing resource base. In the final chapters, te factors which have influenced the location of sites and the distribution of artefact types are examined, and a model proposed which accounts for the observed data. The model suggests that macropodids formed a major component of the diet for several thousand years following the introdution of a microlithic industry, but that over the last 2,000 years increasing Aboriginal population has necessitated a diversification into a wider range of resources.

Evaluation influence is a reconceptualization of evaluation use that reflects the broad and diffuse impacts an evaluation can have on social programs and policies. This way of thinking about impact provides an opportunity to investigate how and why evaluations influence social programs and policy. Twenty participants (practitioners and managers) from two child protection programs evaluated in the previous 24 months were interviewed about the influence of these evaluations, which was complemented with the collection of internal documents about changes to the programs. A qualitative case study analysis of evaluation influence was conducted using the interviews and documents to investigate the influence of two evaluations at different stages in the dissemination process. The participants identified that the evaluations appeared to have significant high-level policy level influence; however, limited examples of influence on practices in the programs were identified. There was some suggestion that the evaluations had increased practitioner interest in working with and participating in program evaluations. The findings suggest the importance of developmental evaluation approaches and practitioner engagement in evaluation to improve the influence and adoption of new knowledge from the evaluation of social programs. Refereed/Peer-reviewed