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Objective: The Education in Palliative and End-of-life Care for Emergency Medicine Project (EPEC™-EM) is a comprehensive curriculum in palliative and end-of-life care for emergency providers. We assessed the adaptation of this course to an EM residency program using synchronous and asynchronous learning.Methods: Curriculum adaptation followed Kern’s standardized six-step curriculum design process. Post-graduate year (PGY) 1-4 residents were taught all EPEC™-EM cognitive domains, divided as seven synchronous and seven asynchronous modules. All synchronous modules featured large group didactic lectures and review of EPEC™-EM course materials. Asynchronous modules use only EPEC™-EM electronic course media for resident self-study. Targeted evaluation for EPEC™-EM knowledge objectives was conducted by a prospective case-control crossover study, with synchronous learning serving as the quasi-control, using validated exam tools. We compared de-identified test scores for effectiveness of learning method, using aggregate group performance means for each learning strategy.Results: Of 45 eligible residents 55% participated in a pre-test for local needs analysis, and 78% completed a post-test to measure teaching method effect. Post-test scores improved across all EPEC™-EM domains, with a mean improvement for synchronous modules of +28% (SD=9) and a mean improvement for asynchronous modules of +30% (SD=18). The aggregate mean difference between learning methods was 1.9% (95% CI -15.3, +19.0). Mean test scores of the residents who completed the post-test were: synchronous modules 77% (SD=12); asynchronous modules 83% (SD=13); all modules 80% (SD=12).Conclusion: EPEC™-EM adapted materials can improve resident knowledge of palliative medicine domains, as assessed through validated testing of course objectives. Synchronous and asynchronous learning methods appear to result in similar knowledge transfer, feasibly allowing some course content to be effectively delivered outside of large group lectures. [West J Emerg Med. 2010; 11(5):491-498.]

An approach is presented for determining the optimum flap angles and spanwise loading to suit a given flight condition. Multiple trailing-edge flaps along the span of an adaptive wing are set to either reduce drag in rectilinear flight conditions or to limit the wing bending moment at maneuvering conditions. For reducing drag, the flaps are adjusted to minimize induced drag, while simultaneously enabling the wing sections to operate within their respective low-drag ranges. For limiting wing bending moment, the flaps are used to relieve the loading near the wing tips. An important element of the approach is the decomposition of the flap angles into a distribution that can be used to control the spanwise loading for induced-drag control and a constant flap that can used for profile-drag control. The problem is linearized using the concept of basic and additional lift distributions, which enables the use of standard constrained-minimization formulations. The results for flap-angle distributions for different flight conditions are presented for a planar and a nonplanar wing. Postdesign analysis and aircraft-performance simulations are used to validate the optimum flap-angle distributions determined using the current approach.

BACKGROUND Cultivation of grapes is a major crop globally, particularly in support of the wine production industry which has significant economic impact in numerous countries. Sour rot is an economically important disease of grapes. It is caused by an interaction of yeast + acetic acid bacteria, and vectored by Drosophila spp. Substantial control of sour rot in wine grape vineyards has been achieved by control of Drosophila using insecticides such as zeta‐cypermethrin. An outbreak of sour rot and high populations of Drosophila melanogaster were observed in 2018 in a vineyard in New York (Finger Lakes region), USA. Flies from this population were found to be resistant to zeta‐cypermethrin (the active ingredient in Mustang Maxx®), but whether or not this was a widespread problem was not known. To determine if resistance was geographically limited, we surveyed populations of D. melanogaster collected from 11 vineyards across New York State and one in Missouri (USA). We also evaluated 19 alternative insecticides for their potential use for control of D. melanogaster, by determining their toxicity to a susceptible strain and by examining cross‐resistance using a field‐collected population. RESULTS: There were high levels of resistance to zeta‐cypermethrin, malathion, and acetamiprid found in all populations sampled. Resistance to zeta‐cypermethrin and malathion was stable over 33 months. Results from two vineyards also suggested that resistance to spinetoram was starting to evolve. The alternative insecticides we evaluated had LC50 values to the susceptible strain ranging from 0.65 to 15 000 ng·cm−2. CONCLUSION: Resistance to zeta‐cypermethrin, malathion, and acetamiprid is geographically widespread and the levels of resistance are similar between early season and late season collections. Cross‐resistance was detected against all the insecticides tested, with the lowest levels seen for broflanilide, fipronil, and flumethrin. These patterns of resistance/cross‐resistance/multiple resistance are discussed in terms of selection within and outside of vineyards. The implications of these results to insecticide resistance monitoring and management are discussed. [ABSTRACT FROM AUTHOR]

Purpose: We reviewed intervention studies that reported dementia caregiver outcomes published since 1996, including psychosocial interventions for caregivers and environmental and pharmacological interventions for care recipients. Our goal was to focus on issues of clinical significance in caregiver intervention research in order to move the field toward a greater emphasis on achieving reliable and clinically meaningful outcomes. Design and Methods: MEDLINE, PsycINFO, and Cumulative Index to Nursing & Allied Health databases from 1996 through 2001 were searched to identify articles and book chapters mapping to two medical subject headings: caregivers and either dementia or Alzheimer's disease. Articles were evaluated on two dimensions, outcomes in four domains thought to be important to the individual or society and the magnitude of reported effects for these outcomes in order to determine if they were large enough to be clinically meaningful. Results: Although many studies have reported small to moderate statistically significant effects on a broad range of outcomes, only a small proportion of these studies achieved clinically meaningful outcomes. Nevertheless, caregiving intervention studies have increasingly shown promise of affecting important public health outcomes in areas such as service utilization, including delayed institutionalization; psychiatric symptomatology, including the successful treatment of major and minor depression; and providing services that are highly valued by caregivers. Implications: Assessment of clinical significance in addition to statistical significance is needed in this research area. Specific recommendations on design, measurement, and conceptual issues are made to enhance the clinical significance of future research. Key Words: Alzheimer's disease, Randomized clinical trials, Intervention research

An introduction is presented in which the editor discusses various reports within the issue on topics including unaudited financial report of the periodical, conference of the Australian Rehabilitation and Assistive Technology Association (ARATA), and the National Allied Health Conference (NAHC).