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Most medical students apply for residency training upon completion of medical school. The choice of specialty is one of a student's first major career decisions, and the application process often results in considerable anxiety, as it is competitive, unpredictable, and requires a significant investment of time and money. This article, which addresses several important facets of the residency application using both experiential and evidence-based data, is organized chronologically into sections that describe a logical approach to applying for residency: choice of a specialty, the personal statement, the interview day, and developing a rank list. A list of relevant websites is also included. This paper is a resource that provides timely and tangible guidance to medical students applying for residency training.

Atrial fibrillation after cardiac surgery (AFACS) is a serious postoperative complication. There is significant research interest in this field but also relevant heterogeneity in reported AFACS definitions and approaches used for its identification. Few data exist on the extent of this variation in clinical studies. The authors reviewed the literature since 2001 and included manuscripts reporting outcomes of AFACS in adults. They excluded smaller studies and studies in which patients did not undergo a sternotomy. The documented protocol in each manuscript was analyzed according to six different categories to determine how AFACS was defined, which techniques were used to identify it, and the inclusion and/or exclusion criteria. They also noted when a category was not described in the documented protocol. The authors identified 302 studies, of which 92 were included. Sixty-two percent of studies were randomized controlled trials. There was significant heterogeneity in the manuscripts, including the exclusion of patients with preoperative AF, the definition and duration of AF needed to meet the primary endpoint, the type of screening approach (continuous, episodic, or opportunistic), the duration of monitoring during the study period in days, the diagnosis with predefined electrocardiogram criteria, and the requirement for independent confirmation by study investigators. Furthermore, the definitions of these criteria frequently were not described. Consistent reporting standards for AFACS research are needed to advance scientific progress in the field. The authors here propose pragmatic standards for trial design and reporting standards. These include adequate sample size estimation, a clear definition of the AFACS endpoints, and a protocol for AFACS detection. [ABSTRACT FROM AUTHOR]

Khapra beetle, Trogoderma granarium Everts, is one of the world's most important pests of stored grain. Common in Africa and Asia, it is a quarantine insect for much of the rest of the world where methyl bromide has traditionally been used for its control. However, this ozone-depleting fumigant is now heavily restricted, and alternate methods of control are required. In a two-step process, we examined the use of high-temperature exposure as one such method of control. First, different life stages were held at 45°C for different periods to calculate LT50 (lethal time to 50% mortality) values. In descending order, the most heat-tolerant life stages at 45°C were diapausing larvae (LT50 = 41 – 122 h) > nondiapausing larvae (LT50 = 47 h) > adults (LT50 = 33 h) > pupae (LT50 = 25 h) > eggs (LT50 = 10 h). Second, diapausing larvae (the most heat-tolerant stage) were held at 45, 50, 55, and 60°C for different periods to calculate LT50, LT95, LT99, and probit 9 (99.9968% mortality) values. Estimated LT99 values for diapausing larvae were 288 h at 45°C, 6 h at 50°C, 1.1 h at 55°C, and 1 h at 60°C. Based on these results, an exposure of 2 h at 60°C is recommended to control T. granarium with high temperatures. To meet requirements for control of quarantine pests, exposure of between 2 and 12 h at 50–60°C is recommended to cause probit 9 mortality, but additional experiments are needed to get a better estimate of probit 9. [ABSTRACT FROM AUTHOR]

Background and Objectives: Perineural dexamethasone and intravenous (IV) dexamethasone have been shown to prolong peripheral nerve block duration. The effects of perineural and IV dexamethasone have only been compared at doses of 4 mg or greater. This triple-blind, randomized trial examined the effect of 1 mg IV versus perineural dexamethasone on interscalene block (ISB) analgesia duration.Methods: Patients undergoing ambulatory shoulder arthroscopy received an ultrasound-guided ISB with 15 mL bupivacaine 0.5% and 1 mg preservative-free dexamethasone that was administered perineurally (PeriD) or IV (IVDex). All patients received IV ketorolac and were discharged on naproxen 500 mg 2 times a day plus oxycodone/acetaminophen as needed. Peripheral nerve block duration, pain, opioid consumption, and block satisfaction were assessed via telephone follow-ups.Results: There were 63 PeriD patients and 62 IVDex patients who completed the primary outcome follow-up. The median time until analgesia from the ISB completely wore off was 3.5 hours (95% confidence interval, 1.0-6.0 hours) longer in the PeriD versus IVDex groups; P = 0.007). Time until the pain relief from the ISB began to wear off was also longer in the PeriD versus IVDex group (5.5 hours [95% confidence interval, 2.1-9.0 hours]; P = 0.002). Other secondary outcomes, including opioid consumption, satisfaction, and pain scores, were not different between groups.Conclusions: In patients undergoing shoulder arthroscopy, low-dose perineural dexamethasone (1 mg) in combination with 15 mL of 0.5% bupivacaine prolonged the median time until pain relief from the ISB completely wore off compared with 1 mg IV dexamethasone. However, the degree of prolongation was smaller than the a priori-defined minimal clinically meaningful difference of 5 hours.Clinical Trial Registration: This study was registered at Clinicaltrials.gov, identifier NCT02506660. [ABSTRACT FROM AUTHOR]

Abstract: Khapra beetle, Trogoderma granarium Everts (Coleoptera: Dermestidae), is a pest of stored grain in Africa, Asia, and Europe. It is a quarantine insect for much of the rest of the world. Control of T. granarium can be achieved with methyl bromide, but this fumigant is an ozone‐depleting substance and is being phased out worldwide. Thus, there is an urgent need to find new methods of control, including the use of low temperatures. Here, we assess the effects of diapause and cold acclimation on the cold tolerance of T. granarium. The percentage of larvae in diapause increased with larval density, reaching 57.3% when reared at a density of 73 larvae g−1 diet. The cold tolerance of T. granarium was assessed by the supercooling points (SCPs) of various life stages. The SCP of non‐acclimated insects ranged from −26.2 ± 0.2 °C (mean ± SEM) for eggs to −14.4 ± 0.4 °C for larvae. The lowest SCP for larvae, −24.3 ± 0.3 °C, was obtained for diapausing‐acclimated larvae. Based on mean LT50 values, the most cold‐tolerant stage at −10 °C was the diapausing‐acclimated larvae (87 days) followed by non‐diapausing‐acclimated larvae (51 days), diapausing non‐acclimated larvae (19 days), adults (4 days), non‐diapausing non‐acclimated larvae (2 days), pupae (0.4 days), and eggs (0.2 days). The estimated times to obtain 99.9968% mortality (Probit 9) for diapausing‐acclimated larvae are 999, 442, 347, 84, and 15 days at 0, −5, −10, −15, and −20 °C, respectively. Probit 9 is an estimated value used by quarantine experts to estimate conditions that are required to kill all insects. In light of the long exposure time needed to control T. granarium even at −20 °C, cooling to below −27 °C (i.e., below the SCP of eggs) will quickly kill all life stages and may be the best way to control this insect with low temperatures. [ABSTRACT FROM AUTHOR]

Purpose: To compare the functional outcomes after arthroscopic treatment of femoroacetabular impingement (FAI) in adolescent patients and non-adolescent patients, and to report on the rate of cam recurrence within 2 years after femoral osteoplasty in a limited sample of the adolescent group.Methods: From 2010 to 2014, patients younger than 18 years with symptomatic FAI (alpha angle >50°) who underwent hip arthroscopy with minimum 2-year follow-up or reoperation were identified. A group of non-adolescent patients with identical inclusion criteria, except age of 18 years or older, was also identified for comparison. In addition, a separate group of adolescent patients with 2-year postoperative radiographs was reviewed for cam recurrence. Demographic data, operative data, and radiographic and clinical outcomes (modified Harris Hip Score [mHHS], Hip Outcome Score-Activities of Daily Living [HOS-ADL], Hip Outcome Score-Sport-Specific Subscale [HOS-SSS], and International Hip Outcome Tool 33 [iHOT-33] score) were collected.Results: We identified 34 adolescent patients (38 hips) with an average age of 16 years (range, 13-17 years). The mean clinical follow-up period was 36.1 ± 11.6 months (range, 24.1-71.7 months) and 29.6 ± 2.4 months (range, 27.9-31.3 months) without and with reoperation, respectively. A control group of 296 non-adolescent patients (306 hips), with a mean age of 31 years (range, 18-59 years), was identified as our non-adolescent group. The mean clinical follow-up period was 34.1 ± 11 months (range, 24.0-77.4 months) and 15.1 ± 9.1 months (range, 3.6-34.6 months) without and with reoperation, respectively. Significant improvement was noted in adolescents in the changes in outcome scores (mHHS, 22.2 [95% confidence interval (CI), 15.4-29.0]; HOS-ADL, 18.6 [95% CI, 11.9-25.2]; HOS-SSS, 33.5 [95% CI, 24.5-42.5]; and iHOT-33 score, 30.5 [95% CI, 21.8-39.2]; P < .001). Similar improvements were observed in non-adolescents (mHHS, 21.0 [95% CI, 19.0-23.0]; HOS-ADL, 16.6 [95% CI, 14.6-18.6]; HOS-SSS, 30.1 [95% CI, 26.6-33.6]; and iHOT-33 score, 34.9 [95% CI, 31.5-38.3]; P < .001). There was no evidence of a difference in follow-up survey scores between groups (P > .203). Revision surgery was required in 2 adolescent hips (5.3% [95% CI, 1.5%-17.3%]) and 19 non-adolescent hips (6.2% [95% CI, 4.0%-9.5%]). Minimum 2-year radiographs were available for review in 24 adolescent patients (30 hips). The alpha angle (mean ± standard deviation) was reduced from 55.4° ± 12.1° preoperatively to 38.7° ± 4.9° at 6 weeks postoperatively (mean difference, -16.4° [95% CI, -19.8° to -12.9°]; P < .001). At 2 years, the alpha angle remained at 39.2° ± 11.2°, which did not differ from 6-week measurements (mean difference, 0.5° [95% CI, -2.9° to 3.9°]; P = .784). There were no cases of cam recurrence (0% [95% CI, 0%-11.4%]).Conclusions: Significant improvement in clinical outcomes can be anticipated after arthroscopic treatment of FAI in adolescents. From a limited sample of our adolescent population, the risk of cam recurrence appears low; however, further follow-up is needed to ensure this does not represent a biased sample of the initial population.Level Of Evidence: Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]