1,168,031 research outputs found

    The Ottawa ankle rules for the use of diagnostic X-ray in after hours medical centres in New Zealand

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    Aims: The aims of this study were to measure baseline use of Ottawa ankle rules (OAR), validate the OAR and, if appropriate, explore the impact of implementing the Rules on X-ray rates in a primary care, after hours medical centre setting. Methods: General practitioners (GPs) were surveyed to find their awareness of ankle injury guidelines. Data concerning diagnosis and X-ray utilisation were collected prospectively for patients presenting with ankle injuries to two after hours medical centres. The OAR were applied retrospectively, and the sensitivity and specificity of the OAR were compared with GPs’ clinical judgement in ordering X-rays. The outcome measures were X-ray utilisation and diagnosis of fracture. Results: Awareness of the OAR was low. The sensitivity of the OAR for diagnosis of fractures was 100% (95% CI: 75.3 – 100) and the specificity was 47% (95% CI: 40.5 – 54.5). The sensitivity of GPs’ clinical judgement was 100% (95% CI: 75.3 – 100) and the specificity was 37% (95% CI: 30.2 – 44.2). Implementing the OAR would reduce X-ray utilisation by 16% (95% CI: approx 10.8 – 21.3). Conclusions: The OAR are valid in a New Zealand primary care setting. Further implementation of the rules would result in some reduction of X-rays ordered for ankle injuries, but less than the reduction found in previous studies.Accident Compensation Corporation of New ZealandOtago Universit

    Important Lessons Derived from X.500 Case Studies

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    X.500 is a new and complex electronic directory technology, whose basic specification was first published as an international standard in 1988, with an enhanced revision in 1993. The technology is still unproven in many organisations. This paper presents case studies of 15 pioneering pilot and operational X.500 based directory services. The paper provides valuable insights into how organisations are coming to understand this new technology, are using X.500 for both traditional and novel directory based services, and consequently are deriving benefits from it. Important lessons that have been learnt by these X.500 pioneers are presented here, so that future organisations can benefit from their experiences. Factors critical to the success of implementing X.500 in an organisation are derived from the studies

    Forward pi^0 Production and Associated Transverse Energy Flow in Deep-Inelastic Scattering at HERA

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    Deep-inelastic positron-proton interactions at low values of Bjorken-x down to x \approx 4.10^-5 which give rise to high transverse momentum pi^0 mesons are studied with the H1 experiment at HERA. The inclusive cross section for pi^0 mesons produced at small angles with respect to the proton remnant (the forward region) is presented as a function of the transverse momentum and energy of the pi^0 and of the four-momentum transfer Q^2 and Bjorken-x. Measurements are also presented of the transverse energy flow in events containing a forward pi^0 meson. Hadronic final state calculations based on QCD models implementing different parton evolution schemes are confronted with the data.Comment: 27 pages, 8 figures and 3 table
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