We describe a case of a delayed presentation of a traumatic soft tissue mallet injury to the distal phalanx of the hallux in a teenager. Reports of this rare injury are sparse and there is no consensus in their treatment. This injury was treated with open repair of the tendon using a Mitek suture anchor, and stabilization with a 1.2-mm K-wire and extension splinting for 8 weeks. Following this treatment, she regained full power and a range of movement compared with the contralateral side, and achieved full function. We advocate surgical reconstruction of these injuries with suture anchors and stabilization of the interphalangeal joint.
Although children with painful sickle cell crises (PSCC) frequently present to the Emergency Department (ED), pain in sickle cell disease is often under-recognised, under-treated and treatment may be delayed. We aimed to evaluate pain assessment and management in children presenting to the ED with PSCC.
Methods
A 12-month prospective descriptive study of acute pain management of PSCC at an urban tertiary paediatric ED. Pain was assessed by the triage nurse or physician using a validated age appropriate pain scale (Faces, Legs, Activity, Cry, Consolability (FLACC) Scale; Manchester Pain Ruler).
Results
There were 96 presentations in 66 patients with PSCC (Table 1). Nineteen (19.7%) patients recieved no pre-hospital analgesia.
Conclusion
PSCC pain is under-treated, under-monitored and adequate treatment of pain is delayed in our ED. Patients with severe pain appear at highest risk for treatment guideline violation. This is predominantly related to lack of opiate administration. An educational intervention, with/without the inclusion of an easily administered, fast-onset and short-acting opiate e.g. intranasal fentanyl, may decrease the time from ED arrival to effective pain relief.
The authors have used low energy electron-excited nanoscale depth-resolved cathodoluminescence spectroscopy (DRCLS) to probe the bulk and interface defect states of ultrathin Mo∕HfO2∕Si with eight different process sequences. After atomic layer deposition of 4nm HfO2 on Si and an O2 post-treatment, they deposited 10nm Mo using either plasma vapor or electron beam deposition, with or without a subsequent 1000°C N2 anneal and with or without a forming gas anneal. DRCLS revealed pronounced gap state emissions within the ultrathin films and their interfaces with Mo and Si. There are multiple deep level emissions below the ∼5.9eV near band edge, including peak emissions at 3.4, 3.5, and 3.9–4.3eV that can be associated with HfO2 oxygen vacancies in different charge states predicted theoretically. In addition, states at 2–2.6eV that resemble known SiO2-related nonbonding oxygen hole centers and E′ (positively charged O vacancy) native defects increase with depth within the 4nm HfO2 film, suggesting the formation of a Hf silicate at the HfO2∕Si interface. No metal-specific interface states at the HfO2∕Mo interface are evident. Furthermore, different process steps produce large changes in these states and for at least one sequence, a dramatic decrease in both types of defects. The differences between process sequences can be understood in terms of known reactions at HfO2–Si interfaces.
The authors have used low energy electron-excited nanoscale-depth-resolved spectroscopy to probe the bulk and interface defect states of ultrathin Mo∕HfO2∕Si with conventional process sequences. Multiple deep level emissions are evident below the 5.9eV HfO2 near band edge, including three associated with HfO2 oxygen vacancies in different charge states predicted theoretically. Defects resembling SiO2-related nonbonding oxygen hole centers and positively charged O vacancies increase with depth within the 4nm HfO2 film suggesting Hf silicate formation at the HfO2∕Si interface. These states vary dramatically between process sequences and can be understood in terms of known reactions at HfO2–Si interfaces.
We present patient outcomes following surgical excision of primary wrist ganglia over a 5 year period. Patients (48 of 59; 81%) responded to a questionnaire by post or telephone, with a mean time to follow-up of 44 (range 21-77) months. There was a statistically significant reduction in all reported symptoms, including pain, paraesthesia, weakness, stiffness, and cosmesis. The recurrence rate was 8%. In total, 98% of patients were satisfied or very satisfied with treatment. Surgical excision of primary wrist ganglia may have advantages over aspiration and reassurance alone, particularly in reducing recurrence and hastening resolution of symptoms.
A B S T R A C T Statutory recognition of Chinese medicine (CM) practitioners and their use of acupuncture in the treatment of injured workers does not exist in most workers compensation (WC) systems throughout Australia, even though they are an accepted part of that system. Consequently, there is little data available on the use of acupuncture and the engagement of the CM profession in this system. This paper reports on the first survey study designed to provide information on the CM profession’s engagement with the WC systems and their perceptions of these systems. Results: Five hundred completed surveys were returned, which represented a response rate of 25%. Results indicate that over 50% of the CM practitioners across Australia were engaging with the various WC systems and despite this engagement were also reporting varying levels of confusion and difficulties with the WC system frameworks. There was a noted relationship between the demographic information collected (as part of the survey) and a practitioner’s perception of the WC systems. Overall, practitioners’ experiences of the WC system were overwhelmingly negative, irrespective of their state or territory of residence; yet, 67% of respondents reported they would like to increase their WC patient load in the future. Conclusions: Despite the CM workforce engagement with the various state and territory based WC systems, there remains a lack of statutory gazetting of CM practitioners as treatment providers and this may account for some of the noted confusion and negativity reported in the survey results. While there was some variance in individual practitioner’s perceptions of the system, a common finding was an overall lack of knowledge about this system. This raises several issues that range from the timely provision of treatment services by CM practitioners, reporting processes to insurance companies, the subsequent assessment structures of those insurers and the assessment of the appropriateness of the acupuncture treatment provided. These issues need to be addressed in practical terms with the development of policy and protocols to assist CM practitioners and also made a priority given the consistent growth in treatment frequency reported in the decade from 1994 to 2004, and which is only projected to increase given the surveys participants’ wishes to engage further with the WC systems.
Depth-resolved cathodoluminescence spectroscopy (DRCLS) is a powerful technique for probing the nature of defects in oxides, both electronically and spatially on a nanometer scales. The information derived from this technique provides a tool to guide the growth and processing of state-of-the-art semiconductors and dielectrics for micro and opto-electronics. DRCLS is particularly effective in probing electronic and chemical structure within ultrathin films, beyond the capabilities of conventional techniques. This talk highlights the capabilities of DRCLS with recent results from conventional oxides such as ZnO, to complex oxides such as the perovskite titanates, and the high-K dielectric HfO 2 . These studies establish the physical nature of native point defects in these materials as well as their spatial distribution on a nanometer scale.
The Fliker, the new version of the foot-propelled scooter, has emerged as an increasingly popular recreational activity for children. This increase in popularity has led to a number of attendances to our tertiary paediatric emergency department (ED) with Fliker-associated injuries. The aim of this study was to examine the incidence and type of such injuries. This was a prospective descriptive study of all children (aged 0–16 years) attending the ED during a summer with Fliker-related injuries. Patients were identified through the ED Symphony Information System. Clinical notes of identified patients were investigated for the mechanism, location and type of injury. The clinical outcome of identified patients was also determined. Eighty patients, 39 boys (48.8%) and 41 girls (51.2%), were identified in the study period. The mean age of the patients was 7.9 years (range from 2 to 13 years). Upper limb injuries were most common, found in 33 (41.2%) children. There were 12 head injuries. The rest sustained lower limb injuries, soft tissue lacerations and dental injuries. The Fliker is one of a number of fad recreational activities to have emerged in recent times. Similar to some of its predecessors (e.g. Heelys, rollerblades), it is associated with a spectrum of injuries in children.
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