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Background Free Open-Access Medical education (FOAM) use among residents continues to rise. However, it often lacks quality assurance processes and residents receive little guidance on quality assessment. The Academic Life in Emergency Medicine Approved Instructional Resources tool (AAT) was created for FOAM appraisal by and for expert educators and has demonstrated validity in this context. It has yet to be evaluated in other populations. Objectives We assessed the AAT's usability in a diverse population of practicing emergency medicine (EM) physicians, residents, and medical students; solicited feedback; and developed a revised tool. Methods As part of the Medical Education Translational Resources: Impact and Quality (METRIQ) study, we recruited medical students, EM residents, and EM attendings to evaluate five FOAM posts with the AAT and provide quantitative and qualitative feedback via an online survey. Two independent analysts performed a qualitative thematic analysis with discrepancies resolved through discussion and negotiated consensus. This analysis informed development of an initial revised AAT, which was then further refined after pilot testing among the author group. The final tool was reassessed for reliability. Results Of 330 recruited international participants, 309 completed all ratings. The Best Evidence in Emergency Medicine (BEEM) score was the component most frequently reported as difficult to use. Several themes emerged from the qualitative analysis: for ease of use-understandable, logically structured, concise, and aligned with educational value. Limitations include deviation from questionnaire best practices, validity concerns, and challenges assessing evidence-based medicine. Themes supporting its use include evaluative utility and usability. The author group pilot tested the initial revised AAT, revealing a total score average measure intraclass correlation coefficient (ICC) of moderate reliability (ICC = 0.68, 95% confidence interval [CI] = 0 to 0.962). The final AAT's average measure ICC was 0.88 (95% CI = 0.77 to 0.95). Conclusions We developed the final revised AAT from usability feedback. The new score has significantly increased usability, but will need to be reassessed for reliability in a broad population.

In areas with dense landownership patterns, management of white-tailed deer (Odocoileus virginianus) depends upon collective decision making of landowners and hunters. To resolve conflicts associated with this commons dilemma, wildlife management associations (WMAs) have become a popular mechanism for coordinating wildlife management decisions in private land states, especially in Texas, USA. Social capital, represented by metrics such as trust, reciprocity, and community involvement, has been identified as an important determinant of the success of collaborative institutional arrangements. To determine the influence of social capital on the effectiveness of WMAs, we address 2 research questions: 1) do WMAs exhibit elements of social capital, and 2) what landowner characteristics affect elements of social capital within WMAs? We used a mail survey questionnaire to determine the effect of various factors on the activities and management practices in 4 WMAs in 2 regions in Texas: the Lower Post Oak Savannah (LPOS) and the Central Post Oak Savannah (CPOS). The LPOS landowners were members of larger associations, had generally acquired their land more recently, held more frequent meetings, and tended to have longer association membership than CPOS landowners, yet they exhibited lower social capital. The CPOS landowners owned significantly larger properties, and were predominantly absentee wealthy males that considered relaxation and hunting more important land uses than property ownership for a place to live. The smaller group size of the CPOS associations may be the most important factor in building and maintaining social capital. Intra-association trust, a primary measure of social capital, was positively influenced by the longevity of property ownership, the number of association meetings, the percentage of males in the association, and other factors. Conversely, negative influences on trust included absentee ownership and the proportion of woodland habitat present in each WMA. We suggest that deer are a common-pool resource whose populations are dependent upon collective action by stakeholders. Social capital building within landowner associations could facilitate the sustainable harvest of quality deer and possibly lead to cooperative management of other common-pool natural resources.

As nearly all of Texas’ rural lands are privately owned, landowner associations for the management of white-tailed deer and ground-water have become increasingly popular. Deer are a common-pool resource with transboundary characteristics, requiring landowner cooperation for effective management. Ground-water reserves are economically important to landowners, but are governed by the “rule of capture” whereby property rights are not defined. One ground-water association and four wildlife management associations (WMAs) were surveyed to characterize their member demographics, land use priorities, attitudes, and social capital. Members of the ground-water cooperative were part of a much larger, more heterogeneous, and more recently formed group than members of WMAs. They also placed greater importance on utilitarian aspects of their properties, as opposed to land stewardship for conservation as practiced by members of WMAs. If ground-water association members could be more locally organized with more frequent meetings, social capital and information sharing may be enhanced and lead to land stewardship practices for improved hydrologic functions and sustained ground-water supply. This, coupled with pumping rules assigned by the local ground-water district, could yield an effective strategy that is ecologically and hydrologicaly sound, and that allows rural provision of water supply to urban consumers.

Opportunities for wildlife undergraduates to engage in land conservation planning can bridge the gap between formal academic training and professional wildlife experiences. Land conservation plans are an important component in managing wildlife habitat. In 1995 state legislation offered Texas landowners the opportunity to remain under agricultural valuation (Texas House Bill 1358, Proposition 11, 1-d-1) by designating wildlife management activities as qualifying agricultural practices. To obtain a wildlife management tax valuation, a landowner must have an active, written wildlife management plan. Texas Parks and Wildlife Department (TPWD) biologists often provide technical guidance to landowners in this process. Allowing wildlife undergraduates to have an active role in this process offers a unique opportunity for them to gain practical “hands-on” experiences while improving their writing skills. Students enrolled in Wildlife Habitat Management and Conservation (WFSC 406) work in groups (3–4 students) to develop a management plan for 3 local landowners. In addition to writing an actual management plan, students gain experience in land surveying, vegetation sampling, GIS/GPS technology, and public speaking. Landowners receive 3 peer-reviewed management plans they can select from to implement on their property. Students assist TPWD biologists and Texas Cooperative Extension staff in providing technical guidance to local landowners. Wildlife education can be enhanced by integrating land conservation planning in the classroom via partnerships with natural resource agencies and landowners.

Cerebrovascular deposition of the amyloid beta-protein (A beta) is a common pathologic event in patients with Alzheimer's disease (AD) and certain related disorders including hereditary cerebral hemorrhage with amyloidosis Dutch-type (HCHWA-D). A beta deposition occurs primarily in the medial layer of the cerebral vessel wall in an assembled fibrillar state. These deposits are associated with several pathological responses including degeneration of the smooth muscle cells in the cerebral vessel wall. Severe cases of cerebrovascular A beta deposition are also accompanied by loss of vessel wall integrity and hemorrhagic stroke. Although the reasons for this pathological consequence are unclear, altered proteolytic mechanisms within the cerebral vessel wall may be involved. Recent studies from our laboratory have shown that cell-surface assembly of A beta into fibrillar structures causes cellular degeneration via an apoptotic pathway and creates an altered proteolytic microenvironment on the cell surface of human cerebrovascular smooth muscle cells (HCSM cells). For example, HCSM cell-surface A beta fibrils serve as a site for tight binding of cell-secreted amyloid beta-precursor protein (A beta PP). Since A beta PP is a potent inhibitor of key proteinases of coagulation cascade, its enhanced localization on the A beta fibrils would provide an strong anticoagulant environment. In addition, HCSM cell-surface A beta fibrils are potent stimulators of tissue plasminogen activator (tPA) creating a profibrinolytic milieu. Our findings indicate that A beta fibril assembly on the HCSM cell surface causes cellular degeneration and results in both a strong anticoagulant and fibrinolytic environment. Together, these altered proteolytic events could create a setting that is conducive to loss of vessel wall integrity and hemorrhagic stroke.