A postal survey of 500 general practitioners (GPs) in south-west England was undertaken to evaluate the levels of undergraduate and postgraduate otolaryngology training and/or experience received by GPs in that area. Most GPs had received two weeks of undergraduate training in ENT, which had involved no formal assessment. Three-quarters of GPs considered this inadequate. A quarter of GPs had completed a hospital post in ENT prior to entering general practice, most of which lasted three months. Sixty-one per cent of GPs had received some formal postgraduate training in ENT, in the form of courses, lectures or hospital training sessions. Almost half of the GPs considered this inadequate. Seventy-five per cent of GPs stated they would like further training in ENT. Subjective estimates of referral rates to hospital ENT specialist clinics varied considerably. This study illustrates the variability and level of dissatisfaction regarding ENT training amongst GPs at both undergraduate and postgraduate levels.

This finding raises significant questions about the Department of Health policy in question. The authors suggest that an alternative policy should be considered, with scrubs worn for in-patient situations and formal attire during out-patient encounters.

In April 2012, Rogers and Cliff (R&C) demonstrated a theoretical financial brokerage model for cloud computing that is profitable for the broker, offers reduced costs for cloud users, and generates more predictable demand flow for cloud providers. Relatively cheap, long-term reserved instances (RIs) are bulk-purchased by the broker, and then re-packaged and re-sold as monthly options contracts at a price lower than a user can purchase "on-demand" from the provider. Thus, the broker risks exposure on purchase for margin on sales. R&C's result has generated significant interest in the cloud computing community and is currently the fifth most accessed research paper of all time in the Journal of Cloud Computing: Advances, Systems and Applications. Here, we perform an independent replication of R&C's brokerage model using CReST, a discrete event simulation platform for cloud computing developed at the University of Bristol. We identify two implementation problems in R&C's original work: firstly, the broker buys fewer RIs than the model suggests; and secondly, the broker is undercharged for RIs used. We correct R&C's results accordingly: while broker's profits are not as high as R&C suggest, the model still supports the theoretical possibility of a profitable brokerage. However, aggressive competition between cloud providers has reduced the cost of cloud services to users and led to the introduction of new secondary markets where users can buy and sell RIs between themselves. This has squeezed the opportunity for an intermediary brokerage. By recalibrating R&C's model to fit current market conditions, we conclude that the commercial viability of R&C's brokerage model has been eradicated. The window of opportunity has now closed.

Objective Mastoidectomy is considered an aerosol-generating procedure. This study examined the effect of wearing personal protective equipment on the view achieved using the operating microscope. Methods ENT surgeons assessed the area of a calibrated target visible through an operating microscope whilst wearing a range of personal protective equipment, with prescription glasses when required. The distance between the surgeon's eye and the microscope was measured in each personal protective equipment condition. Results Eleven surgeons participated. The distance from the eye to the microscope inversely correlated with the diameter and area visible (p < 0.001). The median area visible while wearing the filtering facepiece code 3 mask and full-face visor was 4 per cent (range, 4–16 per cent). Conclusion The full-face visor is incompatible with the operating microscope. Solutions offering adequate eye protection for aerosol-generating procedures that require the microscope, including mastoidectomy, are urgently needed. Low-profile safety goggles should have a working distance of less than 20 mm and be compatible with prescription lenses.

Bone conduction implant systems utilize osseointegrated fixtures to transmit sound through the bones of the skull. They allow patients with hearing loss to receive acoustic signals directly to the inner ear, bypassing the outer and middle ear. The new Cochlear™ Baha(®) Attract System (Cochlear Bone Anchored Solutions AB, Mölnlycke, Sweden) has been designed as a non-skin penetration hearing implant. The system uses magnetic coupling to hold the external sound processor in place and transmit acoustic energy. An implantable magnet is anchored to the skull via a single osseointegrated fixture, maximizing the efficiency of energy sound transfer. The interposed soft tissue is protected by a SoftWear pad that evenly distributes pressure in order to minimize the risk of pressure necrosis. This article summarizes the design features and early clinical results of the Baha 4 Attract System and provides context as to its place in the broader hearing aid market.

We have concluded that cut and push is a safe method of removal for Freka 15-Fr PEG tubes in ambulant patients without significant gastrointestinal history.

All abnormalities on post-operative imaging were minor and did not alter patient management. The future role of post-operative imaging is discussed.

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