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

Kinetic Model for Triglyceride Hydrolysis Using Lipase: Review

Triglyceride hydrolysis using lipase has been proposed as a novel method to produce raw materials in food andcosmetic industries such as diacylglycerol, monoacylglycerol, glycerol and fatty acid. In order to design a reactor forutilizing this reaction on industrial scale, constructing a kinetic model is important. Since the substrates are oil andwater, the hydrolysis takes place at oil-water interface. Furthermore, the triglyceride has three ester bonds, so that thehydrolysis stepwise proceeds. Thus, the reaction mechanism is very complicated. The difference between theinterfacial and bulk concentrations of the enzyme, substrates and products, and the interfacial enzymatic reactionmechanism should be considered in the model

Search for the Θ+\Theta^{+} pentaquark via the π−p→K−X\pi^-p\to K^-X reaction at 1.92 GeV/cc

The $\Theta^+$ pentaquark baryon was searched for via the $\pi^-p\to K^-X$ reaction in a missing-mass resolution of 1.4 MeV/$c^2$(FWHM) at J-PARC. $\pi^-$ meson beams were incident on the liquid hydrogen target with the beam momentum of 1.92 GeV/$c$. No peak structure corresponding to the $\Theta^+$ mass was observed. The upper limit of the production cross section averaged over the scattering angle of 2$^{\circ}$ to 15$^{\circ}$ in the laboratory frame was obtained to be 0.26 $\mu$b/sr in the mass region of 1.51$-$1.55 GeV/$c^2$.The upper limit of the $\Theta^+$ decay width using the effective Lagrangian approach was obtained to be 0.72 MeV/$c^2$ and 3.1 MeV/$c^2$ for $J^P_{\Theta}=1/2^+$ and $J^P_{\Theta}=1/2^-$, respectively.Comment: 5 pages, 3 figures, 1 tabl

KINETIC MODEL FOR TRIGLYCERIDE HYDROLYSIS USING LIPASE: REVIEW

Triglyceride hydrolysis using lipase has been proposed as a novel method to produce raw materials in food andcosmetic industries such as diacylglycerol, monoacylglycerol, glycerol and fatty acid. In order to design a reactor forutilizing this reaction on industrial scale, constructing a kinetic model is important. Since the substrates are oil andwater, the hydrolysis takes place at oil-water interface. Furthermore, the triglyceride has three ester bonds, so that thehydrolysis stepwise proceeds. Thus, the reaction mechanism is very complicated. The difference between theinterfacial and bulk concentrations of the enzyme, substrates and products, and the interfacial enzymatic reactionmechanism should be considered in the model.Keywords: Lipase, kinetic model, enzymatic reaction mechanism, hydrolysis, triglycerid

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

SummaryBackground The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation

KINETIC MODEL FOR TRIGLYCERIDE HYDROLYSIS USING LIPASE: REVIEW

Abstract Triglyceride hydrolysis using lipase has been proposed as a novel method to produce raw materials in food and cosmetic industries such as diacylglycerol, monoacylglycerol, glycerol and fatty acid. In order to design a reactor for utilizing this reaction on industrial scale, constructing a kinetic model is important. Since the substrates are oil and water, the hydrolysis takes place at oil-water interface. Furthermore, the triglyceride has three ester bonds, so that the hydrolysis stepwise proceeds. Thus, the reaction mechanism is very complicated. The difference between the interfacial and bulk concentrations of the enzyme, substrates and products, and the interfacial enzymatic reaction mechanism should be considered in the model

Gemcitabine-based versus fluoropyrimidine-based chemotherapy with or without platinum in unresectable biliary tract cancer: a retrospective study

<p>Abstract</p> <p>Background</p> <p>There is no standard palliative chemotherapy regimen in biliary tract cancers (BTC). Fluoropyrimidine or gemcitabine, with or without platinum, are most frequently used. We conducted this study to clarify the efficacy of palliative chemotherapy in BTC.</p> <p>Methods</p> <p>Patients with unresectable BTC treated with palliative chemotherapy between Oct 2001 and Aug 2006 at Seoul National University Hospital were reviewed retrospectively. Histologically confirmed cases of intrahepatic cholangiocarcinoma, gallbladder cancer, extrahepatic bile duct cancer, and ampulla of Vater carcinoma were enrolled. We analyzed the efficacy of regimens: gemcitabine (G) <it>versus </it>fluoropyrimidine (F) and with or without platinum (P).</p> <p>Results</p> <p>A total of 243 patients were enrolled. 159 patients (65%) were male and the median age of the patients was 60 years (range 26–81). Intrahepatic cholangiocarcinoma, gallbladder cancer, extrahepatic bile duct cancer, and ampulla of Vater carcinoma were 92, 72, 58, and 21 cases, respectively. The median progression free survival (PFS) was 4.3 months (95% CI, 3.7–4.9) and median overall survival (OS) was 8.7 months (95% CI, 7.4–10.0). Ninety-nine patients received G-based chemotherapy (94 GP, 5 G alone), and 144 patients received F-based chemotherapy (83 FP, 61 F alone). The response rate (RR), disease control rate (DCR), PFS and OS of G-based chemotherapy <it>versus </it>F-based chemotherapy were 16.7% <it>vs</it>. 19.5% (P = 0.591), 52.8% <it>vs</it>. 58.9% (P = 0.372), 4.0 months <it>vs</it>. 4.3 months (P = 0.816), and 7.8 months <it>vs</it>. 9.1 months (P = 0.848), respectively. Sixty-six patients received F or G without P, and 177 patients received F or G with P. The RR, DCR, PFS and OS of chemotherapy without P <it>versus </it>chemotherapy including P were 12.7% <it>vs</it>. 20.6% (P = 0.169), 46.0% <it>vs</it>. 60.6% (P = 0.049), 3.3 months <it>vs</it>. 4.4 months (P = 0.887), and 10.6 months <it>vs</it>. 8.1 months (P = 0.257), respectively.</p> <p>Conclusion</p> <p>In unresectable BTC, F-based and G-based chemotherapy showed similar efficacy in terms of RR, DCR, PFS and OS. The benefit of adding P to F or G was not significant except for DCR. Further prospective studies which define the efficacy of various chemotherapeutic regimens in BTC are warranted.</p