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ABSTRACT Objectives: to describe the validity process of the TBApp mobile application for self-care management for people with tuberculosis linked to Primary Health Care. Methods: methodological research developed with ten expert judges, carried out virtually. The application was assessed in relation to content and technology quality in seven domains (objectivity; structure and appearance; relevance; functionality; reliability; usability; and efficiency), using an instrument with a Likert scale. Results: TBApp was considered valid, relevant, functional, reliable and effective by expert judges. The objectives, structure and presentation and relevance domains presented an overall Content Validity Index of 0.93, and the functionality, reliability, usability and efficiency domains presented characteristics and sub-characteristics values greater than 0.80. Conclusions: TBApp is a creative and innovative tool that can be used by people with TB and disseminated in the scientific community.

Abstract We derive price limits as decision aids for identifying favorable and unfavorable contracts from the perspective of a selling firm in face of uncertain outcomes. The analysis is based on the concept of almost stochastic dominance to incorporate incomplete information about the decision-maker’s preferences. The main challenges to use this concept in practice are to define and limit the required preference information and to demonstrate the performance of the resulting price limits. We propose price limits that are suitable for a wide range of applications, in particular services. While their information requirements vary, all price limits refer to the same type of aggregate information about marginal utilities and risk aversion. In the scenario with the lowest requirements, the preference information shrinks to a single number which is easy to approximate and to communicate. A comprehensive numerical study featuring fixed-price contracts shows that the incomplete preference information may lead to substantial improvements of the price limits over the situation of no preference information. We also discuss determinants and caveats of these improvements. For instance, the improvements increase with decreases of the decision-maker’s risk sensitivity and may differ substantially in magnitude between the lower and the upper price limit.

Abstract Background Sclerosing angiomatoid nodular transformation is a benign disorder of splenic tissue and is often mistaken as a potentially malignant entity in the diagnostic process. To the best of our knowledge, this is the first report of sclerosing angiomatoid nodular transformation mimicking metastasis of melanoma in the literature. Case presentation A 43-year-old white man presented with a newly found splenic mass 4 years ago to our Department of Gastroenterology. He was diagnosed as having a superficial spreading malignant melanoma localized at his left instep 7 years ago and was successfully treated with radical local resection. Several diagnostic procedures were conducted. Ultrasound showed a hypoechoic lesion in the inferior pole of his spleen with a diameter of 2 cm, blurred boundaries, and inhomogeneous interior pattern. Contrast-enhanced ultrasound was inconclusive and showed only discrete contrast enhancement of the lesion with accentuated nodule-like enrichment of the boundaries in the arterial phase. Computed tomography and magnetic resonance imaging scans showed two splenic lesions which were highly suspicious of metastasis. Magnetic resonance imaging of his head was inconspicuous. Bone scintigraphy showed no abnormal results. Fine-needle aspiration indicated metastasis of the above-mentioned malignant melanoma. We conducted a laparoscopic splenectomy. His intraoperative and postoperative course were uneventful. In contrast to the result of the fine-needle aspiration, the presence of metastasis of melanoma could not be confirmed. Histological analysis revealed nodule-like arrangement of fibroblasts with low cell density and a predominance of dilated capillaries, indicating sclerosing angiomatoid nodular transformation of the spleen. Conclusions There are no preoperative diagnostic imaging procedures which can definitely differentiate sclerosing angiomatoid nodular transformation from malignancies in cases of morphological and immunophenotypic variations of the specimen. Morphological and immunophenotypic variations of the specimen represent a diagnostic challenge and can mimic malignoma. As reported in our case, the specimen obtained by ultrasound-guided fine-needle aspiration led to the diagnosis of metastasis of melanoma. Splenectomy is often conducted due to a splenic mass suspicious of malignoma as described in our case or with unknown valency in different diagnostic imaging procedures.

Road traffic is one of the main causes of poor air quality in European cities. The air pollution burden due to road traffic in a street canyon consists of shares from local traffic and contributions of vehicles driving elsewhere in the city as well as elsewhere on a larger scale. Are electric vehicles a solution for air quality problems in cities? Do they reduce noise levels in street canyons significantly? The aim of this sensitivity study is to investigate the regional and local effects of electric vehicles on noise and air quality taking possible effects of additional electricity production into account. Focus of the present study lies for air quality on the regional scale in North Rhine-Westphalia and the overall effect in some selected street canyons, to be more precise the annual average PM10 and NO2 concentrations. A sensitivity study using the chemistry transport model EURAD and a screening model for street canyons was carried out. The influence on noise levels was analysed based on measurements of vehicles at different speeds. It turns out that road traffic has a significant impact on the regional air pollution levels. Furthermore it is shown that the reduction potential is bigger for NO2 than for PM10. With regard to EC limit value compliance a major share of electric vehicles could be a solution for the NO2 problems in moderately polluted street canyons. One of our findings is that if the additional electricity need causes additional emissions these counteract the possible reduction, especially for PM10. The noise reduction potential of electric vehicles is only significant for vehicles moving at low speeds.

Two commonly used models to assess air pollution concentration for investigating health effects of air pollution in epidemiological studies are Land Use Regression (LUR) models and Dispersion and Chemistry Transport Models (DCTM). Both modeling approaches have been applied in the Ruhr area, Germany, a location where multiple cohort studies are being conducted. Application of these different modelling approaches leads to differences in exposure estimation and interpretation due to the specific characteristics of each model. We aimed to compare both model approaches by means of their respective aims, modeling characteristics, validation, temporal and spatial resolution, and agreement of residential exposure estimation, referring to the air pollutants PM2.5, PM10, and NO2. Residential exposure referred to air pollution exposure at residences of participants of the Heinz Nixdorf Recall Study, located in the Ruhr area. The point-specific ESCAPE (European Study of Cohorts on Air Pollution Effects)-LUR aims to temporally estimate stable long-term exposure to local, mostly traffic-related air pollution with respect to very small-scale spatial variations (≤100 m). In contrast, the EURAD (European Air Pollution Dispersion)-CTM aims to estimate a time-varying average air pollutant concentration in a small area (i.e., 1 km2), taking into account a range of major sources, e.g., traffic, industry, meteorological conditions, and transport. Overall agreement between EURAD-CTM and ESCAPE-LUR was weak to moderate on a residential basis. Restricting EURAD-CTM to sources of local traffic only, respective agreement was good. The possibility of combining the strengths of both applications will be the next step to enhance exposure assessment.

Diabetes mellitus is the most common cause of treated end-stage renal disease (ESRD), and diabetic hemodialysis patients have a high mortality rate. To identify differences in risk of septicemia among diabetic and nondiabetic hemodialysis patients, we examined the incidence, risk factors, and mortality for septicemia in a large sample of the US hemodialysis population. We performed a longitudinal cohort study of the incidence and risk factors for hospitalized cases of septicemia in diabetic and nondiabetic hemodialysis patients using baseline data from the US Renal Data System case-mix severity study with 7-year follow-up from hospitalization and death records. Independent risk factors for septicemia were assessed using Poisson regression. Independent effect of septicemia on mortality was assessed using Cox proportional hazards analysis. Over 7 years, 11.1% of nondiabetic patients and 12.5% of diabetic patients experienced at least one episode of septicemia. Older age and low serum albumin were independent risk factors for septicemia in all patients. In diabetics, white race, peripheral vascular disease, and hemodialyzer reuse, particularly in type 1, were independent risk factors. In nondiabetics, coronary artery disease, cerebrovascular disease, and temporary and permanent catheters were associated with an increased risk. In both groups, patients who experienced an episode of septicemia had twice the risk of death from any cause and an eightfold risk of death from septicemia. Septicemia occurs equally frequently and carries a marked increased risk of death in both nondiabetic and diabetic hemodialysis patients. Improving nutritional status and minimizing the use of catheters might help ameliorate the risk of septicemia. In diabetics, aggressive treatment of peripheral vascular disease might help reduce the risk of septicemia. Further research to elucidate potential mechanisms for variations in risk for septicemia according to race and hemodialyzer reuse practices are warranted in diabetic patients.

Background: Black persons historically undergo fewer invasive cardiovascular procedures than white persons., Objective: To determine whether acquisition of Medicare health insurance and comprehensive care for severe illness reduce ethnic disparity in use of cardiovascular procedures., Design: 7-year longitudinal analyses in a cohort from the United States Renal Data System., Setting: Health care institutions in the United States., Patients: Nationwide random sample of 4987 adult black and white patients with incident end-stage renal disease (ESRD) from 303 dialysis facilities in 1986 to 1987., Measurements: Medical history and service use records, physical examination, and laboratory data. Main outcome measures were receipt of a coronary catheterization or revascularization procedure before (baseline) and after (follow-up) development of ESRD and acquisition of Medicare, adjusted for clinical and socioeconomic variables., Results: At baseline, 9.9% of white patients and 2.8% of black patients had had a cardiac procedure; the odds were almost three times greater in white than in black patients (adjusted odds ratio, 2.92 [95% CI, 2.04 to 4.18]). During follow-up, white patients were only 1.4 times more likely than black patients to have a procedure (adjusted relative risk, 1.41 [CI, 1.13 to 1.77]); rates were 7.8% for white persons and 8.5% for black persons. In patients with Medicare coverage before development of ESRD, the initial three-fold difference in procedure use was eliminated over follow-up (odds ratio, 1.05 [CI, 0.56 to 1.60]). For procedures after hospital admission for myocardial infarction or coronary disease, no difference between ethnic groups was seen during follow-up (relative risk, 1.12 [CI, 0.68 to 1.85])., Conclusions: Differences between ethnic groups in use of cardiovascular procedures narrowed markedly once a serious illness (ESRD) developed and adequate insurance coverage was ensured; the disparity was eliminated in patients with previous Medicare insurance or a stronger indication for a procedure. These findings suggest that almost equal access to care is attainable by combining insurance with delivery of comprehensive, clinically appropriate care.

Objective: To investigate the possible immunoregulatory role of interleukin-11 (IL-11) in rheumatoid arthritis (RA)., Methods: IL-11 protein was assayed in RA tissue, and the effect of exogenous IL-11 on neutralization of endogenous IL-11 was investigated with respect to tumor necrosis factor alpha (TNFalpha), matrix metalloproteinase (MMP), and tissue inhibitor of metalloproteinases (TIMP) production., Results: IL-11 was found in RA synovial membranes, synovial fluids, and blood sera. Blockade of endogenous IL-11 resulted in a 2-fold increase in TNFalpha levels, which increased to 22-fold if endogenous IL-10 was also blocked. Addition of exogenous IL-11 inhibited spontaneous TNFalpha production in RA synovium only in the presence of soluble IL-11 receptor. However, exogenous IL-11 directly inhibited spontaneous MMP-1 and MMP-3 production, and up-regulated TIMP-1 in RA synovial tissue., Conclusion: IL-11 has important endogenous immunoregulatory effects in RA synovium, which suggests that exogenous IL-11 may have therapeutic activity in RA.

A simple technique is described for calculating the maximum scintillation factor in a statistical model of optical beam propagation within the atmosphere. This enables laser safety analyses to be performed within a semideterministic framework.

Male Sprague-Dawley rats were rendered uremic by surgical removal of 70% of functioning renal mass. This produced a rapid threefold rise in serum creatinine to 0.87 +/- 0.067 (SEM) mg/dl at 2 weeks postoperatively which declined subsequently to a value of 0.64 +/- 0.06 (SEM) and remained stable thereafter for an additional 4 weeks in animals maintained on a diet with normal phosphate content. Increase of dietary phosphate content to 2.2% at 2 weeks after surgery produced a significant and progressive increase in serum creatinine to values fourfold higher than the mean values in comparable partially nephrectomized control animals maintained on a diet with normal phosphate content (P less than 0.001). This deterioration in renal function was associated with extensive nephrocalcinosis, tubular dilatation, cellular necrosis, and marked interstitial inflammation. 3-phosphocitric acid, a compound which has been shown to prevent calcium phosphate crystal growth as well as to prevent in vivo nephrocalcinosis, was very effective in preventing this phosphate-induced deterioration of renal function and in preventing any significant increase in renal calcium content in animals fed a high phosphate diet. This compound was also effective in preventing the renal histologic changes associated with phosphate-induced uremia.

Previous recommendations to employ occurrence, nonoccurrence, and overall estimates of interobserver reliability for interval data are reviewed. A rationale for comparing obtained reliability to reliability that would result from a random-chance model is explained. Formulae and graphic functions are presented to allow for the determination of chance agreement for each of the three indices, given any obtained per cent of intervals in which a response is recorded to occur. All indices are interpretable throughout the range of possible obtained values for the per cent of intervals in which a response is recorded. The level of chance agreement simply changes with changing values. Statistical procedures that could be used to determine whether obtained reliability is significantly superior to chance reliability are reviewed. These procedures are rejected because they yield significance levels that are partly a function of sample sizes and because there are no general rules to govern acceptable significance levels depending on the sizes of samples employed.

Within the mean-field approximation, an analysis of the two-photon equation of state predicts double optical bistability and tristability. When spatial dependence is included, a precise description of multistability for the Kerr regime and for higher intensities is given.

Stark terms associated with nonresonant transitions are shown to have important consequences when they are incorporated into the theory of dispersive optical bistability for a ring cavity. The perturbing effects of the nonresonant transitions should be detectable in an experiment.

This study evaluated the effectiveness of an incentive procedure designed to increase the punctuality of six workers who were chronically late to work in a manufacturing company. The six workers in the experiment received a 2.00 pesos ($0.16 U.S.) bonus for every day that they arrived on time. A reversal design was used. The contingent bonuses increased the workers' rates of punctuality compared to their baseline rates. A control group of six workers observed during the same 77-week period showed a trend toward decreasing punctuality. These results suggest that the use of small daily bonuses is a practical procedure for modifying chronic tardiness among industrial workers.