Assessing doctors' competencies using multisource feedback: validating a Japanese version of the Sheffield Peer Review Assessment Tool (SPRAT).

OBJECTIVE: To assess the validity and reliability of the Sheffield Peer Review Assessment Tool (SPRAT) Japanese version for evaluating doctors' competencies using multisource feedback. METHODS: SPRAT, originally developed in the UK, was translated and validated in three phases: (1) an existing Japanese version of SPRAT was back-translated into English; (2) two expert panel meetings were held to develop and assure content validity in a Japanese setting; (3) the newly devised Japanese SPRAT instrument was tested by a multisource feedback survey, validity was tested using principal component factor analysis, and reliability was assessed using generalisability and decision studies based on generalisability theory. RESULTS: 86 doctors who had been practising for between 2 and 33 years participated as assessees and were evaluated with the SPRAT tool. First, the doctors identified 1019 potential assessors who were each sent SPRAT forms (response rate, 81%). The mean number of assessors per doctor was 9.7 (SD=2.5). The decision study showed that 95% CIs of ± 0.5 were achieved with only 5 assessors. 85 of the 86 doctors achieved scores that could be placed with 95% CI above the 4 expected standard. Doctors received lower scores from more senior assessors (p<0.001) and higher scores from those they had known longer (p<0.001). Scores also varied with the job role (p<0.05). CONCLUSIONS: Following translation and content validation, the Japanese instrument behaved similarly to the UK tool. Assessor selection remains a primary concern, as the assessment scores are affected by the seniority of the assessor, the length of the assessor-assessee working relationship, and the assessor's job role. Users of the SPRAT tool need to be aware of these limitations when administering the instrument

Groundwater management based on monitoring of land subsidence and groundwater levels in the Kanto Groundwater Basin, Central Japan

Over 40 million people live on and exploit the groundwater resources of the Kanto Plain. The Plain encompasses metropolitan Tokyo and much of Chiba Prefecture. Useable groundwater extends to the base of the Kanto Plain, some 2500 to 3000 m below sea level. Much of the Kanto Plain surface is at sea level. By the early 1970s, with increasing urbanization and industrial expansion, local overdraft of groundwater resources caused major ground subsidence and damage to commercial and residential structures as well as to local and regional infrastructure. Parts of the lowlands around Tokyo subsided to 4.0 m below sea level; particularly affected were the suburbs of Funabashi and Gyotoku in western Chiba. In the southern Kanto Plain, regulations, mainly by local government and later by regional agencies, led to installation of about 500 monitoring wells and almost 5000 bench marks by the 1990's. Many of them are still working with new monitoring system. Long-term monitoring is important. The monitoring systems are costly, but the resulting data provide continuous measurement of the "health" of the Kanto Groundwater Basin, and thus permit sustainable use of the groundwater resource

Management of preterm labor: Clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation

: This practice guideline follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation, bringing together groups and individuals throughout the world, with the goal of improving the management of preterm labor. In fact, this document provides further guidance for healthcare practitioners on the appropriate use of examinations with the aim to improve the accuracy in diagnosing preterm labor and allow timely and appropriate administration of tocolytics, antenatal corticosteroids and magnesium sulphate and avoid unnecessary or excessive interventions. Therefore, it is not intended to establish a legal standard of care. This document is based on consensus among perinatal experts throughout the world in the light of scientific literature and serves as a guideline for use in clinical practice

Integração da simulação termoenergética nas primeiras fases do processo projetual: o estudo de seis casos

Resumo O artigo tem o objetivo de demonstrar a viabilidade de integração de simulações termoenergéticas ao processo projetual desde as primeiras fases do projeto. Para tanto, apresenta uma sistematização dos procedimentos entre projetista e simulador para seis estudos de caso de edificações em clima quente. Destaca-se a necessidade de compreensão das características do edifício e da programação arquitetônica, incluindo informações, metas e necessidade, além de partido e intenções da solução, que motivaram a montagem de um checklist para melhorar o diálogo entre simulador e projetista. Os resultados também apontam as características da edificação que mais influenciam no consumo energético da edificação, e a interação entre o simulador e o projetista, de acordo com seu perfil, as liberdades e restrições implícitas, e a recorrência das soluções, que poderiam até mesmo dispensar as simulações. Além da confirmação de que é possível integrar simulações desde as primeiras fases, a contribuição principal do artigo é o mapeamento de processos entre projetista e simulador e sua intensidade para demonstrar as potencialidades e limitações das integrações, que podem ser úteis no desenvolvimento de interfaces de ferramentas e no treinamento de especialistas em simulação

Complete Genome Sequence and Comparative Analysis of the Fish Pathogen Lactococcus garvieae

Lactococcus garvieae causes fatal haemorrhagic septicaemia in fish such as yellowtail. The comparative analysis of genomes of a virulent strain Lg2 and a non-virulent strain ATCC 49156 of L. garvieae revealed that the two strains shared a high degree of sequence identity, but Lg2 had a 16.5-kb capsule gene cluster that is absent in ATCC 49156. The capsule gene cluster was composed of 15 genes, of which eight genes are highly conserved with those in exopolysaccharide biosynthesis gene cluster often found in Lactococcus lactis strains. Sequence analysis of the capsule gene cluster in the less virulent strain L. garvieae Lg2-S, Lg2-derived strain, showed that two conserved genes were disrupted by a single base pair deletion, respectively. These results strongly suggest that the capsule is crucial for virulence of Lg2. The capsule gene cluster of Lg2 may be a genomic island from several features such as the presence of insertion sequences flanked on both ends, different GC content from the chromosomal average, integration into the locus syntenic to other lactococcal genome sequences, and distribution in human gut microbiomes. The analysis also predicted other potential virulence factors such as haemolysin. The present study provides new insights into understanding of the virulence mechanisms of L. garvieae in fish