RESUMEN
Letters of recommendation (LORs) play an important role in applicant selection for graduate medical education programs. LORs may be of increasing importance in the evaluation of applicants given the recent change of the USMLE Step 1 to pass/fail scoring and the relative lack of other objective measures by which to differentiate and stratify applicants. Narrative letters of recommendation (NLORs), although widely used, have certain limitations, namely variability in interpretation, introduction of gender/race bias, and performance inflation. Standardized letters of recommendation (SLOR) have been proposed as a potential corrective to these limitations. We conducted a series of semi-structured interviews and focus groups to gather perspectives from letter writers and readers to inform methods for improving information elicited by SLORs from which we collected and analyzed data using the constant comparative method and a process of iterative coding. We applied our findings to the development of a novel SLOR for use in surgical residency program applications and were subsequently invited to help revise existing SLORs for a surgical post-graduate training program.
RESUMEN
Opportunities for environmental contamination by the insecticide etofenprox are increasing as its uses expand from primarily indoor residential to rice cultivation and mosquito control. To provide toxicity data for sensitive saltwater species, effects of etofenprox were assessed using three life stages of the estuarine grass shrimp, Palaemonetes pugio. Adults, larvae, and embryos were tested in aqueous exposures, while adults and larval shrimp were also tested in the presence of sediment. In addition, sublethal cellular stress biomarkers, glutathione and lipid peroxidation, were examined. Larval shrimp was the most sensitive life stage, with 96-h median lethal concentration (LC(50)) of 0.89 microg/l, compared with 1.26 microg/l for adults and 100 microg/l for embryos. Presence of sediment significantly decreased toxicity of etofenprox to both adult and larval shrimp. Etofenprox exposure (100 micog/l) increased time to hatch in embryos. Lipid peroxidation levels were reduced in adult and larval shrimp after 96 h exposure to etofenprox, while no effect on glutathione was detected. The results of this study provide new information on the toxicity of etofenprox to estuarine invertebrates. These data may prove beneficial to the regulation of this pesticide and management of its uses in coastal areas.