1% received telemedicine). Time-to-ECG was, on average, 0.39 times (95% confidence interval [CI] -0.26 to -0.52) faster for telemedicine cases. Among eligible patients, telemedicine was associated with higher odds of fibrinolysis administration (adjusted odds ratio 7.17, 95% CI 2.48-20.49). In a sensitivity analysis excluding patients with cardiac arrest, time-to-fibrinolysis administration did not differ when telemedicine was used. Discussion In telemedicine networks, telemedicine consultation during the ED visit was associated with improved timeliness of ECG evaluation and increased use of fibrinolytic reperfusion therapy for rural AMI patients. Future work should focus on the impact of telemedicine consultation on patient-centered outcomes.Purpose Changes in biophysiological markers related to perceived burnout and self-comfort were tested in this study. Method Forty-two student-athletes from middle and high school grades were evaluated for burnout, salivary cortisol levels, measures of arousal-related physiological markers (i.e., blood volume pulse; BVP), galvanic skin response (GSR), and respiratory rate, and self-comfort variables during the last two weeks of the season. Using self-comfort theory as its conceptual framework, we examined burnout through a conceptual model in which feeling of discomfort with the self was related to biophysiological markers affecting perceived burnout. The proposed model was tested by using a partial least squares structural equation modeling (PLS-SEM). Results The main findings indicate that increased self-discomfort is significantly (p less then .001) associated with increased salivary cortisol (β = - 0.189) along with a significant (p = .050) decrease in GSR (β = - 0.259). Increased salivary cortisol is significantly (p less then .001) associated with increased burnout (β = 0.242). Conclusion The findings partially support the model and encourage further effort to capture the burnout syndrome through the integration of biological and psychological markers.The objective of this research was to study a novel ozone-air flotation microalgae harvesting method and evaluate its effect on the recovery of biomass and biocomponents (lipids, carbohydrates, proteins). Best processing conditions were established using a response surface methodology (RSM). Microalgae separation and biocomponent recovery were evaluated according to changes in gas concentration (13, 18 and 25 mgO3/L), ozone dose (0.04, 0.09 and 0.16 mg O3/mg biomass) and airflow rate (0.5, 1.0 and 1.5 L/min). More than 95% of the biomass was recovered from wastewater at an ozone-air combination of 0.09 mgO3/mg biomass and 1.5 L air/min. Using ozone-air represented a reduction of 59% in the ozone dose compared to the flotation process solely using ozone (0.22 mgO3/mg biomass). In addition, there was an improved yield in the recovery of all microalgae biocomponents. A maximum yield of 0.18 mg lipids/mg biomass was achieved at 0.16 mg O3/mg biomass, 25 mg gas O3/L and 1.5 L air/min. In conclusion, combining the use of ozone-air for separation of microalgae reduces ozone requirement and enhances lipids and proteins post-extraction.The aim of this study was to investigate whether and how a picture book preventing child sexual abuse can improve children's self-protection skills. The study was conducted in China with Chinese children. In a 2 × 2 between-subjects design, character in the book (human versus animal) and message framing (gain versus loss) were manipulated. Compared to a baseline group who were not exposed to the prevention book, children in the experimental groups significantly enhanced their ability to recognize a potential abuse situation and refuse an inappropriate touch request. Results suggest that the prevention picture books are more effective when using a human character and a gain-framed message. The explanation for this was that human characters simulated children's perceived norm and gain-framed messages increased children's message recall, perceived self-efficacy and positive attitude toward the message, all of which in turn positively affected children's self-protection skills.When patients with significant comorbid risk factors undergo surgical procedures, they are at high risk for development of post-operative infectious complications, including surgical site infection (SSI). Obese patients characteristically fit within this risk category, and thus it is of paramount importance to establish evidence-based strategies to mitigate these infectious complications. The use of an antimicrobial prophylactic regimen is a well-established practice and is based on the principle of the "right drug, at the right time, in the right place." The subject of this article is to review the current evidence-based data on antimicrobial prophylaxis in obese patients undergoing bariatric surgical procedures.PURPOSE The relapse rate after primary retroperitoneal lymph node dissection (RPLND) for patients with pathologic stage (PS) IIA nonseminomatous germ cell tumors (NSGCTs) is 10%-20% but increases to ≥ 50% for PS IIB disease. We report our experience with 2 cycles of adjuvant etoposide plus cisplatin (EP×2) after therapeutic primary RPLND. PATIENTS AND METHODS All patients with PS II NSGCT seen at Memorial Sloan Kettering Cancer Center from March 1989 to April 2016 and who were planned to receive EP×2 were included. Each cycle consisted of cisplatin 20 mg/m2 and etoposide 100 mg/m2 on days 1 through 5 at 21-day intervals. Demographic characteristics, histopathologic features, therapeutic and survival outcomes were recorded.  https://www.selleckchem.com/products/MLN-2238.html  RESULTS Of 156 patients, 30 (19%) had pathologic N1, 122 (78%) had pathologic N2 (pN2), and 4 (3%) had pathologic N3 (pN3) disease. The median number of involved lymph nodes was 3 (range, 1-37 nodes), and the median size of the largest involved node was 2.0 cm (range, 0.4-7.0 cm); extranodal extension was present in 69 patients (45%). Embryonal carcinoma was the most frequent RPLND histology, present in 143 patients (92%). One hundred fifty patients (96%) received EP×2, five received EP×1 and one received EP×4. With a median follow-up of 9 years, 2 patients (1.3%; 1 patient each with pN2 and pN3 disease) experienced relapse; both patients remain continuously disease free at more than 5 and 22 years after salvage chemotherapy. Three patients died, all unrelated to NSGCT, yielding 10-year disease-specific, relapse-free, and overall survival rates of 100%, 98%, and 99%, respectively. CONCLUSION Adjuvant EP×2 for PS II NSGCT is highly effective, has acceptable toxicity, and incurs less drug cost than 2 cycles of bleomycin, etoposide, and cisplatin. Inclusion of bleomycin in this setting is not necessary.