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Mental distress in medical learners and its consequent harmful effects on personal and professional functioning, a well-documented concern, draws attention to the need for solutions. The authors review the development of a comprehensive mental health service within a large and complex academic medical education system, created with special attention to offering equitable, accessible, and responsive care to all trainees. From the inception of the service in January 2017, the authors placed particular emphasis on eliminating obstacles to learners' willingness and ability to access care, including concerns related to cost, session limits, privacy, and flexibility with modality of service delivery. Development of outreach initiatives included psychoeducational programming, consultation services, and cultivation of liaison relationships with faculty and staff. Significant utilization of clinical services occurred in the first year of the program and increased further over the course of 4 academic years (2017-2021); with a 2.2 times increase in trainees served and a 2.4 times increase in visits annually. In the 2020-2021 academic year, 821 medical learners received services (for a total 5,656 visits); 30% of all medical students and 25% of house staff and fellows sought treatment in that year. In 2021, 38% of graduating medical school students and 27% of graduating residents and fellows had used mental health services at some point in their training. Extensive use of services combined with very high patient satisfaction ratings by medical learners within this system demonstrate the perceived value of these services and willingness to pursue mental health care when offered a resource that is cognizant of, and responsive to, their unique needs. The authors reflect on potential factors promoting utilization of services-institutional financial support, outreach efforts, and design of services to increase accessibility and reduce barriers to seeking treatment-and propose future areas for investigation.

Background: There is still controversy regarding the appropriate operative procedure of distal radius fractures. We reviewed a method of fracture stabilization, which combines the advantages of open fixation and closed reduction. The method is less complex than regular K-wire osteosynthesis. The follow-up treatment is similar to plate osteosynthesis. Methods: Without using any drill-device long K-wires are placed percutaneously in the distal radius. The result of the particular wire-placement is an isoelastic tension in the opposite direction of the common redislocations. This enables an early functional treatment. We reviewed 45 patients and determined the Castaing-Score and the loss of correction. Results: 88.9% showed excellent or good results. The average loss of correction of 2.84° is recognizable lower than within regular K-wire osteosynthesis. Complications are rare and comparable to other closed-reduction procedures. Conclusions: The study confirms the theoretical advantages of the described method and we recommend this technique.

In Australia the utilisation of clay in the construction of landfill liners has recently come under criticism either due to the difficulty in reproducing the laboratory results on site, or because of the potential for cracking of the compacted liner after construction. Realising that clay is weak in tension and given the possibility of certain areas of the liner being subjected to flexure, a testing program was undertaken to determine the effects of placement (compaction), moisture content and internal reinforcement on the potential failure of clay liners. In particular, this paper discusses the load carrying capacity and deformation sustained by compacted clay beams in flexure, and the improvement gained through the introduction of an economical reinforcement in the form of galvanised steel wire netting. Results obtained by flexural bending tests are discussed in detail, and the extent of improvement provided by galvanised wire netting is evaluated.

Two new CT techniques, dynamic multiscan and dynamic sequence, are introduced using examples from initial heart, liver, pancreas and kidney examinations. Dynamic multiscan provides reconstructed CT images at 0.1 sec intervals, permitting improved assessment of the perfusion phase in liver processes and aortocor-onary bypass studies. Dynamic sequence allows the examination of a single anatomical region by using rapid scan sequences with table feed. A single bolus administration of contrast medium is sufficient to display the enhancement of a mass in numerous tomographic planes, as demonstrated in the pancreas and kidney. Both methods raise hopes for improved early diagnosis of smaller masses in parenchymal organs. The decisive advantage of the new technology is the high economy made possible by the tremendous saving in contrast medium dosage.