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Anushree Kucheria,1 Johan Bastianpillai,2 Shaharyar Khan,3 Vikas Acharya4 1Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Berkshire, UK; 2Northwick Park Hospital, London North west University Healthcare NHS Trust, London, UK; 3London North west University Healthcare NHS Trust, London, UK; 4Department of ENT Surgery, Northwick Park Hospital, London North west University Healthcare NHS Trust, London, UKCorrespondence: Anushree Kucheria Email anushreekuch@gmail.comIntroduction: General practitioners (GPs) encounter many adult and paediatric patients presenting with ear, nose and throat (ENT) complaints. There is a paucity of learning opportunities to develop knowledge and skills in ENT at undergraduate and postgraduate level. GP trainees starting an ENT rotation have very little prior experience, and therefore we recognise a need for an introduction through a focused induction programme. The aim of this study was to understand whether a GP trainee focussed induction programme can improve the confidence of these doctors in managing emergency hospital presentations in ENT.Methods: An ENT-focussed induction program was created: a didactic teaching program, shadowing period and supervised on-calls. Five GP trainees completed the induction programme. Questionnaires assessed the GP trainees’ confidence in managing common emergency presentations and performing common procedures before and after the induction program. For comparison, questionnaires were given to seven GP trainees who did not complete induction program before starting the rotation and 2 weeks subsequently.Results: With no induction in place, the mean increase in confidence was by 0.81. In comparison, the GP trainees who did complete the induction program had a mean increase in confidence by 1.2. The induction program had a dramatic increase in confidence in ENT-specific skills which would not have been experienced in other specialties such as flexible nasal endoscopy, post-tonsillectomy bleeding, neck sepsis, stridor and periorbital cellulitis.Limitations: A small cohort of participants in one hospital were included, thus affecting the reliability of the results.Conclusion: There was a greater level in confidence in managing ENT presentations of those who completed the induction program, and we recommend a similar structured programme for GP trainees who rotate in ENT. This may have wider implications in fostering interest in postgraduate degrees in ENT and improving the quality of primary care management of ENT complaints.Keywords: otolaryngology, ENT, general practitioner trainees, induction programs, confidence

James Arwyn-Jones,1,* Sanjana Bhalla,1,* Vikas Acharya,1 Issa Beegun,2 Zaid Awad,1 Neil Tolley1 1Otolaryngology Department, Imperial College Healthcare NHS Trust, The Bays, London W2 1NY, UK; 2Otolaryngology Department, Barts Health NHS Trust, Trust Headquarters, The Royal London Hospital, London, E1 2ES, UK*These authors contributed equally to this workCorrespondence: James Arwyn-JonesUndergraduate Education Office, Reynolds Building, Imperial College London, Charing Cross Campus, St Dunstan’s Road, London W6 8RP, UKTel +442033115811Email james.jones12@nhs.netObjective: We hypothesize that poor consideration of specialist surgery is due to a lack of exposure to information about careers and practice itself. Ear, Nose, and Throat (ENT) surgery is given little weight in medical school curricula, despite ENT problems being extremely common. Our objective is to assess whether a specialty showcase day was sufficient to boost informed consideration of this career.Design: We designed a half-day course involving an interactive careers workshop exploring ENT as a specialty choice, alongside simulation stations of commonly presenting ENT problems led by ENT doctors. We used pre- and post-course evaluation sheets to explore factors that encourage and discourage students from surgical careers and perceptions of ENT.Setting: A large proportion of UK medical schools do not offer ENT placements, and of those that do, nearly half are not compulsory. This leaves students unaware of ENT as a career option and unclear about what an ENT career comprises. Our half-day course took place in the simulation suite at St Mary’s Hospital, London.Participants: Medical students were mainly in their third year of study and had aspirations towards a variety of surgical and non-surgical careers, with a minority aspiring towards ENT before the course.Results: Our results demonstrate that all students found the session useful and had a much better understanding of ENT practice, with almost all students leaving more likely to consider a career in ENT.Conclusion: We would like to repeat this session in different student year groups and compare their perceptions with our results. We find our results a good case for including informative careers workshops as part of medical school teaching. We pose that interactive workshops exploring specialist surgical careers are a valid way to enable students in making informed career decisions – particularly in specialties that are under-represented at medical school.Keywords: undergraduate education, careers, specialist surgery, otorhinolaryngology, simulation

Saraswati Aryasomayajula,1 Amit Raithatha,1 Matthew Haywood,2 Ravi Jobanputra,2 Rujuta Roplekar,1 Vikas Acharya1 1Department of ENT Surgery, Luton and Dunstable University Hospital, Luton, UK; 2Department of ENT Surgery, Lister Hospital, Stevenage, UK Background: Ear, nose, and throat (ENT) surgery is a niche and unique specialty that has been recognized as being poorly taught throughout medical school and postgraduate training. Junior doctors who rotate into this specialty often find it hard and struggle to manage patients.Aims: The aim of this study was to devise a junior doctor-focused induction program with specific emphasis on shadowing and partnered working to improve confidence and competence.Methods: Feedback from previous trainees was used to identify valuable training opportunities within the 4-month rotation. Trainers identified clinical areas where supported learning could be delivered. Trainees were allocated to rotate between theater, ward, on-call shifts, and acute clinics. The degree of time spent in each area was analyzed in order to balance service provision vs learning needs. Furthermore, novel strategies were introduced in each session to maximize learning experiences. Junior doctors were aware of the opportunities that would be available to them at the start of the rotation. In order to assess whether the aims were met, a questionnaire survey was used to assess exposure to core ENT practical skills and junior doctors’ confidence levels in carrying them out unsupervised.Results: Junior doctors spent 40% of their time assessing new acute admissions. Twenty percent of time was spent in ENT clinic, but novel practical methods of induction were introduced such as 1 week of directly supervised shadowing, followed by a transition period with regular debrief. A three-stage model was used to offer training in practical procedures in the clinical setting. Over half of the trainees felt confident in undertaking 50% of the core ENT procedures unsupervised.Conclusion: Our study reveals that giving junior doctors a relevant, focused and appropriate induction helps orientate them, give them the opportunity to ask questions, and also find their grounding in order to begin working. Having dedicated time to shadow and be with a colleague to assess and treat patients initially, with ongoing telephone and in person support, ensured that their confidence and competence improved very quickly. It also improved workplace satisfaction and motivated doctors to undertake self-directed learning and improve and enhance their skills beyond the minimum. Keywords: medical education, improving confidence, junior doctor training, foundation training, transitions

Vikas Acharya,1 Matthew Haywood,1 Naomi Kokkinos,2 Anisha Raithatha,3 Sinthuja Francis,1 Rishi Sharma4 1Department of ENT Surgery, Luton and Dunstable Hospital, Luton, UK; 2Department of General Medicine, Luton and Dunstable Hospital, Luton, UK; 3Watford Rotation, East of England Deanery, Watford, UK; 4Department of ENT Surgery, Glasgow Royal Infirmary, Glasgow, UK Background: General practitioners (GPs) are key members of the health care profession who are required to have a considerable breadth of knowledge to manage and treat patients effectively in the community. Their skills and experience varies depending on the medical school they attended and their foundation training and specialist GP training schemes. Exposure to ear, nose, and throat (ENT)-specific pathology is often insufficient due to the lack of formal otolaryngology rotations, minimal relevant teaching opportunities, and inconsistencies in curricula, despite ENT-related pathology presentations being one of the commonest consultations in primary care. Methods: We undertook a learning needs assessment among Watford general practice vocational training scheme trainees to assess whether they lacked confidence in managing typical ENT pathology, as well as to ascertain whether they felt a formal and focused ENT teaching session would be beneficial to them. Results: The results suggested they were interested in such a session, and therefore we organized a formal program on the assessment and management of acute and common ENT pathologies with a postteaching questionnaire to evaluate participant confidence in these domains. The results showed an improvement in participant knowledge and confidence regarding the assessment and management of ENT pathologies following the teaching session intervention. In addition, most attendees were overall very satisfied with the session. Conclusion: This study highlights the need for teaching specifically tailored to the learning needs of general practice vocational training scheme trainees, particularly in niche specialties, in order to prepare them adequately for clinical practice in the community setting. Keywords: medical education, ENT surgery, GP training, training competence, primary care, GP education

The present research was done for the quantitative assessment of postharvest losses in guava. Factors responsible for the post-harvest losses in guava were identified and evaluated. The study was performed in Sawai Madhopur district of Rajasthan because the district has the highest guava production (27452 MT) among other districts of Rajasthan. The research was performed during the year of 2022. The data was taken from farmers through judgmental sampling. Modified average formula was employed to quantify the post-harvest losses in guava by taking consideration of all types of losses at 5 level (collection, sorting, grading, packaging and transportation). Friedman's test was employed to test the difference between factors responsible for the post-harvest losses in guava. The overall post-harvest losses in guava at farm level was 14.05 per cent at district level which was comparatively higher than NABCONS 2022 study on post-harvest losses. The post-harvest losses during collection & transportation to storage house (1.91%), sorting (7.50%), grading (1.73%), packaging (1.32%) and transportation (1.59%) operations at farm level majorly contributed to the post-harvest losses in guava. The highest loss (7.50%) was found during sorting operation among other operation at farm level. Friedman's test results reflected that inappropriate sorting & grading, heavy rainfall, insect infestation, disease infection and market infrastructure were the major contributing factors for the post-harvest losses in guava. [ABSTRACT FROM AUTHOR]

Pho NH Phan,1 Keyur Patel,2 Amar Bhavsar,3 Vikas Acharya4 1Warwick Medical School, University of Warwick, Coventry, 2Luton and Dunstable University Hospital, Luton, 3Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, 4Department of Neurosurgery, University Hospitals Coventry and Warwickshire, Coventry, UK Abstract: Junior doctors go through a challenging transition upon qualification; this repeats every time they start a rotation in a new department. Foundation level doctors (first 2 years postqualification) in neurosurgery are often new to the specialty and face various challenges that may result in significant workplace dissatisfaction. The neurosurgical environment is a clinically demanding area with a high volume of unwell patients and frequent emergencies – this poses various barriers to learning in the workplace for junior doctors. We identify a number of key barriers and review ideas that can be trialed in the department to overcome them. Through an evaluation of current suggestions in the literature, we propose that learning opportunities need to be made explicit to junior doctors in order to encourage them to participate as a member of the team. We consider ideas for adjustments to the induction program and the postgraduate medical curriculum to shift the focus from medical knowledge to improving confidence and clinical skills in newly qualified doctors. Despite being a powerful window for opportunistic learning, the daily ward round is unfortunately not maximized and needs to be more learner focused while maintaining efficiency and time consumption. Finally, we put forward the idea of an open forum where trainees can talk about their learning experiences, identify subjective barriers, and suggest solutions to senior doctors. This would be achieved through departmental faculty development. These interventions are presented within the context of the neurosurgical ward; however, they are transferable and can be adapted in other specialties and departments. Keywords: medical education, foundation program, junior doctors, induction program, neurosurgery, learning in the workplace

Vikas Acharya,1Amir Reyahi,2 Samuel M Amis,3 Sami Mansour2 1Department of Neurosurgery, University Hospitals Coventry and Warwickshire, Coventry, 2Luton and Dunstable University Hospital, Luton, 3Warwick Medical School, University of Warwick, Coventry, UK Abstract: Ward rounds are widely considered an underutilized resource with regard to medical education, and therefore, a project was undertaken to assess if the initiation of “trainee-centered ward rounds” would help improve the confidence, knowledge acquisition, and workplace satisfaction of junior doctors in the clinical environment. Data were collated from junior doctors, registrar grade doctors, and consultants working in the delivery suite at Luton and Dunstable University Hospital in Luton over a 4-week period in March–April 2013. A review of the relevant literature was also undertaken. This pilot study found that despite the reservations around time constraints held by both junior and senior clinicians alike, feedback following the intervention was largely positive. The junior doctors enjoyed having a defined role and responsibility during the ward round and felt they benefited from their senior colleagues’ feedback. Both seniors and junior colleagues agreed that discussing learning objectives prior to commencing the round was beneficial and made the round more learner-orientated; this enabled maximal learner-focused outcomes to be addressed and met. The juniors were generally encouraged to participate more during the round and the consultants endeavored to narrate their decision-making, both were measures that led to greater satisfaction of both parties. This was in keeping with the concept of “Legitimate peripheral participation” as described by Lave and Wenger. Overall, trainee-centered ward rounds did appear to be effective in overcoming some of the traditional barriers to teaching in the ward environment, although further work to formalize and quantify these findings, as well as using greater sample sizes from different hospital departments and the inclusion of a control group, is needed. Keywords: medical education, learner-focused ward rounds, trainee-centered ward round, workplace-based learning

Vikas Acharya,1 Sami Mansour,2 Samuel M Amis,3 Amir Reyahi3 1Department of Neurosurgery, University Hospitals Coventry and Warwickshire, 2Warwick Medical School, University of Warwick, Coventry, 3Luton and Dunstable University Hospital, Luton, UK Abstract: The transition period from foundation program doctor to specialty trainee can be difficult for junior doctors. This difficult period often acts as a major obstacle for learning in the workplace. Existing induction programs are commonly seen as inadequate at easing this transition, and therefore, a pilot study intervention was undertaken to assess if the initiation of “learner-centered induction programs” could help improve the confidence, knowledge acquisition, and satisfaction of junior doctors as they begin specialty training in neurosurgery. Ethnographic and anecdotal evidences were collated from junior doctors, specialty trainees, and consultants in order to investigate if further work on this subject would be beneficial. All participants were working in the Department of Neurosurgery at University Hospital Coventry and Warwickshire, Coventry, UK, over a 4-week period in March/April 2015. A review of the relevant literature was also undertaken. This report found that despite the reservations around the increased organizational demands of induction programs of this nature, as well as concerns around a single junior doctor covering the ward alone during the induction period, feedback following the intervention was largely positive. Junior doctors appreciated being taught about their roles and responsibilities from their predecessors as well as deciding among themselves what topics they wanted covering. As a result, the induction sessions tended to focus on clinical skills rather than theoretical knowledge, which most of the junior doctors believed they could cover adequately in their own time. The junior doctors felt that they benefited from learning/refreshing their relevant practical skills in a safe environment under senior supervision, prior to starting on the wards. Finally, as the induction program was of a greater duration than the traditional half day, they felt they had sufficient time to ask questions and address concerns while “on the job”. Overall, “learner-centered induction programs” did appear to show promise in this pilot study with regards to increasing the confidence of junior doctors starting a neurosurgical placement and helped ease the transition process from foundation doctor to specialty trainee in neurosurgery. We believe further work to formalize and quantify these findings using questionnaires and a larger sample group as well as across successive is indicated and may help junior doctor learning and transition processes in future practice. Keywords: induction programs, foundation training, transition processes, junior doctor transitions

This article discusses the perinatal outcomes of monochorionic diamniotic (MCDA) twin pregnancies complicated by selective fetal growth restriction (sFGR) in a tertiary fetal care center. The study, conducted from 2010 to 2023, retrospectively analyzed data from 416 MCDA twin pregnancies with sFGR. The primary outcomes examined were double survivors, single survivors, and double loss. The results showed that type 1 sFGR had the highest incidence of double live births, followed by type 3 sFGR, while type 2 had the highest double fetal loss rate. The study emphasizes the importance of umbilical artery Doppler assessment in predicting outcomes and guiding clinicians in making informed decisions. [Extracted from the article]

This article discusses a study conducted in a fetal care center in South India on fetuses with Fetal aberrant right subclavian artery (ARSA). The aim of the study was to determine the presence or absence of additional soft markers, structural and/or chromosomal anomalies, and postnatal outcomes in these fetuses. The study analyzed 559 fetuses and found that 16.8% had additional soft markers, 17.2% had associated anomalies, and 66% had no other anomalies/markers. The most common additional soft markers were EIF, nuchal edema, and hypoplastic nasal bone. The study concludes that ARSA is an important soft marker for chromosomal anomalies, and once other markers and anomalies are excluded, the prognosis for these babies appears to be excellent. [Extracted from the article]

The present study with bottle gourd in the zaid season in open field, assessed the infestation of fruit fly Bactrocera cucurbitae (Coquillet). The infestation was observed from third week of May, with the peak being in the first week of June. Five varieties and three genotypes were screened and none exhibiting resistance. The incidence assessed by fruit number and weight basis revealed that variety PSPL (28.07and 23.34) and Narendra rashmi (30.32 and 25.14) were least susceptible; Pusa Naveen (34.80 and 30.48), Pant louki -3 (35.85 and 32.03), Thar smridhi (33.66 and 27.68), DBG -5(36.74 and 33.53) and DBG-6 (37.87 and 34.90) were moderately susceptible; while, DBG -10 (39.06 and 36.18) was susceptible. [ABSTRACT FROM AUTHOR]

This article discusses a retrospective study conducted in a fetal care center in South India from 2012 to 2023. The study aimed to assess the detection of chromosomal anomalies by combining the quadruple marker test with the anomaly scan in the second trimester for soft markers and fetal defects. The results showed that combining these two tests improved the detection rate of chromosomal anomalies. The study suggests that invasive testing should be offered if there are fetal defects and/or markers, regardless of the risk category. [Extracted from the article]

This article discusses a retrospective study conducted in a tertiary fetal care center in South India, which aimed to assess the efficacy of selective fetal reduction by interstitial laser in monochorionic twin pregnancies complicated by selective fetal growth restriction (sFGR). The study found that performing interstitial laser to reduce the growth restricted baby in these pregnancies resulted in a significantly higher single survival rate compared to pregnancies without intervention. The authors recommend counseling parents about the increased risk of double and single loss when sFGR is complicated by additional findings of twin-twin transfusion syndrome (TTTS) and offering intervention to reduce the smaller twin. [Extracted from the article]

Purpose: Fracture is a frequent complication of resinous prostheses. The purpose of this study was to evaluate the effect of thickness on flexural strength of a resinous prosthesis containing a prosthetic tooth. Materials and Methods: Beam-shaped specimens 65-mm long, 12-mm wide, and 1, 2, 3, 4, or 6 mm in thickness were made from high-impact strength polymethyl methacrylate denture base material, each containing a resin-based molar prosthetic tooth at the center of the beam. A group of 3-mm-thick specimens without a prosthetic tooth (n = 7) were also made. Specimens were aged artificially, loaded in three-point flexure, examined fractographically, and analyzed. Results: The 1- and 2-mm-thick beams underwent considerable deformation at low loads. Maximum loads varied considerably from 0.6 kg (1-mm beams) to 38 kg (6-mm beams). The 3-, 4-, and 6-mm beam groups all underwent brittle fracture, with mean relative flexural strengths of approximately 73 MPa. Denture teeth reduced the relative flexural strength of resin beams by 0.7x. Fracture initiation sites were generally at tiny surface defects, but did not directly involve denture teeth. Denture resin fracture toughness was 3.2 MPa m1/2, and modulus of rupture was 104 MPa. Conclusion: Denture teeth substantially decreased the strength of resinous beams. Increased thickness markedly increased the load-bearing capacity of resinous beams containing denture teeth. Beams less than 2 mm in thickness with denture teeth were weakened substantially more than comparable beams of 2 mm or more in thickness. Surface finish was of critical importance. Fracture toughness was calculated fractographically, facilitating future forensic examination of clinically failed resinous prostheses. Int J Prosthodont 2012;25:53-59. [ABSTRACT FROM AUTHOR]

The maximum aphid population reduction as well as highest seed yield was obtained in the treatment of azadirachtin followed by NSKE whereas; it was minimum in dhatura extract. The highest benefit cost ratio (11.81) was obtained from tumba extract treated plots while it was minimum (1.16) in neem oil. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 73-year-old gentleman with chronic myelomonocytic leukaemia with bone marrow fibrosis, who was taking interferon and deferoxamine for iron chelation. It discusses that computed tomography scan of the head revealed right-sided pansinusitis, pre-septal cellulitis and paranasal soft tissue swelling.

In G1, 11/18 (61.1%) with known karyotype had aneuploidies (9 Trisomy 21, one Trisomy 18 and one 13) and in G2, 2/14 (14.2%) had Trisomy 21. 42 (97.7%) had balanced,1 (2.3%) had an unbalanced cAVSD in G1.43 (76.8%) and 13 (23.2%) fetuses in G2 had balanced and unbalanced cAVSD respectively. Commonest additional cardiac defect was obstructive outflow tract lesions and extracardiac defects involved brain, urinary tract, and limbs in both the groups. To assess the prevalence of chromosomal, cardiac and extracardiac abnormalities in fetuses with complete atrioventricular septal defect (cAVSD). [Extracted from the article]

Prevalence of cardiac defect in fetuses with NT between 95-99th centile was 8/110 (7.3%), between 3 and 3.9 mm was 19/256 (7.4%), between 4 and 4.9 mm was 9/50 (18%), between EP17.25: Table 1. To analyse the prevalence of cardiac defects according to the nuchal translucency (NT) thickness measured at the 11 SP +0 sp -13 SP +6 sp weeks' scan in euploid fetuses. [Extracted from the article]

Among 17 fetuses with DVA with other associated structural defects, 1 had a cardiac, 7 had extracardiac, 9 had both cardiac and extracardiac defects. To evaluate and prognosticate fetuses diagnosed to have ductus venosus agenesis (DVA). [Extracted from the article]

The incidence of ber fruit fly on cultivar Gola started in the third week of November and increased gradually and reached to its peak in the first week of February on number basis and in the second week of January on weight basis. A non significant negative correlation was observed between infestation of fruit fly with maximum, minimum temperature and temperature gradient. The morning relative humidity showed non-significant negative correlation with the incidence of fruit fly however, it was significant positive with evening relative humidity moreover the relative humidity gradient showed significant negative correlation with the incidence of fruit fly. Rainfall, sunshine hours and wind velocity showed non-significant positive correlation with the incidence of ber fruit fly. [ABSTRACT FROM AUTHOR]

All the fetuses were categorised into 5 groups according to NT > 95th centile and outcomes were summarised in the table. To assess the presence of fetal aneuploidies, structural defects, fetal loss and delivery of a normal live baby in fetuses with Nuchal Translucency (NT) above the 95th percentile at the 11 SP +0 sp -13 SP +6 sp week scan Methods This is a retrospective study from a single tertiary fetal care centre in South India from August 2009 to December 2019. [Extracted from the article]

To study the predictive value of different abdominal circumference (AC) cut-offs for low birthweight (LBW) < 5th centile for gestational age at delivery in structurally normal and euploid fetuses in a South Indian population. Conclusions Our study confirms that prediction by fetal AC < 3rd centile for LBW < 5th centile has the relatively highest detection rate of 56.3%. Fetal AC cut-offs of < 3rd, 5th and 10th centile were compared to predict LBW of < 5th centile for the gestational age at delivery as an isolated marker. [Extracted from the article]

Results 204 fetuses with CTEV, including 15 from 14 twin pregnancies were evaluated. To evaluate the antenatal association and postnatal prognosis of congenital talipes equinovarus deformity (CTEV). [Extracted from the article]

34 (40.5%) had a longitudinal bladder diameter (LBD) between 7-15 mm (G1) and 50 (59.5%) had an LBD of equal or more than 16 mm (G2). All fetuses with diagnosis of 1st trimester megacystis must be categorised according to the LBD and offered karyotyping. To study the incidence of associated anomalies and assess the possibility of spontaneous resolution according to the longitudinal bladder diameter (LBD) in fetuses with megacystis. [Extracted from the article]

To evaluate the association of genetic, extracardiac anomalies and postnatal outcome of fetuses with prenatal diagnosis of tetralogy of Fallot (ToF). With comprehensive post-natal cardiac care 75% of euploid, isolated ToF had favourable outcomes. [Extracted from the article]

Abstract No. 57 FEATURED ABSTRACT Prostate artery embolization: single-center experience of 576 patients with 5 years' follow-up. [Extracted from the article]

Combustion instability is a major issue facing lean, premixed combustion approaches in modern gas turbine applications. This paper specifically focuses on instabilities that excite transverse acoustic modes of the combustion chamber. Recent simulation and experimental studies have shown that much of the flame response during transverse instabilities is due to the longitudinal fluid motions induced by the fluctuating pressure field above a nozzle. In this study, we analyze the multi-dimensional acoustic field excited by transverse acoustic disturbances interacting with an annular side branch, emulating a fuel/air mixing nozzle. Key findings of this work show that the resultant velocity fields are critically dependent upon the structure of the transverse acoustic field and the nozzle impedance. Significantly, we also show that certain cases can be understood from relatively simple quasi one-dimensional considerations, but that other cases are intrinsically three-dimensional. [ABSTRACT FROM AUTHOR]