Graduate medical education tool kit for the Supplemental Offer and Acceptance Program: Navigating the National Resident Matching Program supplemental offer assistance program.

More residency training programs are involved in the National Resident Matching Program (NRMP) Supplemental Offer and Acceptance Program (SOAP) than in the past, which is unanticipated by many. Without an action plan in place, the SOAP process can be chaotic and could result in offers to incompletely vetted residency applicants and unfilled residency slots. Faced with this challenge, it is important that programs have a unified, clear process and action plan for the SOAP. Our instution has created a SOAP tool kit that documents our strategies, scripts, and timelines in preparation of SOAP. The success of our approach has been gauged by the positive response from the key stakeholders who found this easy to use without significant advanced training. Faculty and staff noted significant efficiencies and improvements in the process when using the SOAP tool kit. Applicants indicated that the process was more organized than other residency programs they interacted with during the SOAP week. We anticipate that the use of the documents in the SOAP tool kit will help other training programs improve their performance during the SOAP process.

Students' Surgical Experiences in a Distributed Model of Clinical Education: A Mixed-Methods Sequential Case Study.

OBJECTIVE: Equal opportunity to learn has received much attention in higher education. Ensuring students' comparable educational experiences in the surgical clerkship can be challenging, especially when considering multiple sites in multiple regional medical campuses (RMCs). This study examined whether students were provided with comparable learning opportunities across different campuses/sites and what factors impacted students' educational experiences during the surgical clerkship. DESIGN: A mixed-methods explanatory sequential approach was used to elicit students' experiences. The study involved the separate data collection and analysis by first using a survey questionnaire, followed by focus groups. The quantitative phase provided a general understanding of students' experiences, and the qualitative data and analysis refined and further explained statistical results by exploring students' perceptions in much more depth. The responses to the Likert-scale survey items were analyzed using the Kruskal-Wallis test and the qualitative responses were analyzed through a standard qualitative thematic inductive coding approach. SETTING: The distributed clinical medical education program of College of Medicine, Central Michigan University, adopted a wide range of rural and urban communities across Michigan. Its surgical clerkship was located across 3 regional medical campuses, utilizing a total of 6 clinical sites. PARTICIPANTS: A total of 92 students responded to the survey questionnaire at the end of their surgery rotation. Using the purposeful sampling, 2 focus groups with 7 participants were conducted. RESULTS: The survey results demonstrated some statistically significant educational experiences in different sites during the surgery clerkship within this context. Those site differences were related to roles and expectations, supervision, feedback, and team collaboration. Whether students had comparable surgery learning experiences across the RMCs was associated with multiple factors. Those factors that included Site Features (organizational culture and volume and specialties), Health Professionals (un/engaged surgeons and team dynamics), and Personal Traits (self-directed learning), combined together, contributed to students' achieved roles and responsibilities. CONCLUSIONS: The research found students' differing educational experiences in the general surgery clerkship from students' perspectives using a case study design. More studies conducted with other medical schools are needed to fully understand the common conceptualization of comparable educational opportunities in the surgical clerkship. Further research is also necessary to investigate perceptions of clerkship directors, faculty, and other health professionals.

Broadening substrate specificity of a chain-extending ketosynthase through a single active-site mutation.

An in vitro model system based on a ketosynthase domain of the erythromycin polyketide synthase was used to probe the apparent substrate tolerance of ketosynthase domains of the mycolactone polyketide synthase. A specific residue change was identified that led to an emphatic increase in turnover of a range of substrates.

The drive to life on wet and icy worlds.

This paper presents a reformulation of the submarine alkaline hydrothermal theory for the emergence of life in response to recent experimental findings. The theory views life, like other self-organizing systems in the Universe, as an inevitable outcome of particular disequilibria. In this case, the disequilibria were two: (1) in redox potential, between hydrogen plus methane with the circuit-completing electron acceptors such as nitrite, nitrate, ferric iron, and carbon dioxide, and (2) in pH gradient between an acidulous external ocean and an alkaline hydrothermal fluid. Both CO2 and CH4 were equally the ultimate sources of organic carbon, and the metal sulfides and oxyhydroxides acted as protoenzymatic catalysts. The realization, now 50 years old, that membrane-spanning gradients, rather than organic intermediates, play a vital role in life's operations calls into question the idea of "prebiotic chemistry." It informs our own suggestion that experimentation should look to the kind of nanoengines that must have been the precursors to molecular motors-such as pyrophosphate synthetase and the like driven by these gradients-that make life work. It is these putative free energy or disequilibria converters, presumably constructed from minerals comprising the earliest inorganic membranes, that, as obstacles to vectorial ionic flows, present themselves as the candidates for future experiments. Key Words: Methanotrophy-Origin of life. Astrobiology 14, 308-343. The fixation of inorganic carbon into organic material (autotrophy) is a prerequisite for life and sets the starting point of biological evolution. (Fuchs, 2011 ) Further significant progress with the tightly membrane-bound H(+)-PPase family should lead to an increased insight into basic requirements for the biological transport of protons through membranes and its coupling to phosphorylation. (Baltscheffsky et al., 1999 ).

Sound velocities and thermodynamic properties of water to 700 MPa and -10 to 100 degrees C.

Sound velocities in liquid water were measured by the method of impulsive stimulated scattering in a sapphire-windowed high-pressure cell from -10 to 100 degrees C and pressures as high as 700 MPa. Velocity measurements are compared with previous experimental efforts relative to the International Association for the Properties of Water and Steam (IAPWS-95) formulation for the equations of state. At 0 and -10 degrees C, sound velocities are in agreement with the one previously published study at sub-zero temperatures to 350 MPa. At ambient and elevated temperatures, differences between the present measurements and IAPWS-95 velocities approach 0.5% near 700 MPa. Inversion of velocity data for density yields results within IAPWS-95 uncertainties, except at the highest temperatures, where elevated sound velocity at high pressure corresponds to as much as -0.2% disagreement with IAPWS-95.

Measurement frequency influences the rating of perceived exertion during sub-maximal treadmill running.

To examine the influence of the frequency of measurement on the rating of perceived exertion (RPE) during sub-maximal exercise. On two occasions participants performed 35 min sub-maximal treadmill exercise at the same running speed. In both runs RPE was measured after 5 min. Thereafter, RPE was measured at either 10-min intervals (RPE10 min), or 60-s intervals (RPE60 s) with the order of conditions controlled using a counter-balanced, cross-over design. The heart rate, VO(2) and RER were measured throughout each experimental trial. Significant differences in RPE between RPE60 s and RPE10 min were evident at 15, 25 and 35 min of exercise. No differences were evident between conditions in heart rate, VO(2) or RER. Differences in RPE between RPE60 s and RPE10 min indicate that the perception of exertion may be influenced by the act of measurement. The elevated RPE in RPE60 s may have been induced by an increased associative attentional focus.

The simulator for icy world interiors: a 700 MPa pressure system for impulsive stimulated scattering and other optical measurements, with thermal control from -20 to 100 degrees C.

The simulator for icy world interiors (SIWI) was developed for sound velocity measurements in simulated extraterrestrial ocean materials by the method of impulsive stimulated scattering (ISS). The design and operation of SIWI are described. Optical measurements at low temperature in corrosive solution were enabled by enclosing sample fluid in a stoppered spectrophotometric cuvette. To maintain minimum optical density it was necessary to limit contact of the dioctyl sebacate hydraulic fluid with nitrile o-rings, which caused discoloring enhanced absorption of the 532 nm ISS probe pulses. Dilution of hydraulic fluid with kerosene in the amount of 5% by volume prevented clouding at high pressures and at low temperatures. Pure kerosene was found to attenuate the ISS signal, and so was deemed unsatisfactory at low temperatures where the lower thermal expansion of water leads to weaker density contrasts between heated and unheated regions in the sample fluid. When 50 cS silicone oil was used as a hydraulic medium, clouding was observed at pressures above 400 MPa when temperatures were raised above approximately 50 degrees C and lowered to less than approximately 10 degrees C. To our knowledge, such clouding has not been reported previously for dioctyl sebacate, nor for silicone at such low pressures.

Hydrothermal systems in small ocean planets.

We examine means for driving hydrothermal activity in extraterrestrial oceans on planets and satellites of less than one Earth mass, with implications for sustaining a low level of biological activity over geological timescales. Assuming ocean planets have olivine-dominated lithospheres, a model for cooling-induced thermal cracking shows how variation in planet size and internal thermal energy may drive variation in the dominant type of hydrothermal system-for example, high or low temperature system or chemically driven system. As radiogenic heating diminishes over time, progressive exposure of new rock continues to the current epoch. Where fluid-rock interactions propagate slowly into a deep brittle layer, thermal energy from serpentinization may be the primary cause of hydrothermal activity in small ocean planets. We show that the time-varying hydrostatic head of a tidally forced ice shell may drive hydrothermal fluid flow through the seafloor, which can generate moderate but potentially important heat through viscous interaction with the matrix of porous seafloor rock. Considering all presently known potential ocean planets-Mars, a number of icy satellites, Pluto, and other trans-neptunian objects-and applying Earth-like material properties and cooling rates, we find depths of circulation are more than an order of magnitude greater than in Earth. In Europa and Enceladus, tidal flexing may drive hydrothermal circulation and, in Europa, may generate heat on the same order as present-day radiogenic heat flux at Earth's surface. In all objects, progressive serpentinization generates heat on a globally averaged basis at a fraction of a percent of present-day radiogenic heating and hydrogen is produced at rates between 10(9) and 10(10) molecules cm(2) s(1).