'Across the pond'—a response to the NICE guidelines for management of multi-morbidity in older people

No abstract available

Enabling the Internet White Pages Service -- the Directory Guardian

The Internet White Pages Service (IWPS) has been slow to materialise for many reasons. One of them is the security concerns that organisations have, over allowing the public to gain access to either their Intranet or their directory database. The Directory Guardian is a firewall application proxy for X.500 and LDAP protocols that is designed to alleviate these fears. Sitting in the firewall system, it filters directory protocol messages passing into and out of the Intranet, allowing security administrators to carefully control the amount of directory information that is released to the outside world. This paper describes the design of our Guardian system, and shows how relatively easy it is to configure its filtering capabilities. Finally the paper describes the working demonstration of the Guardian that was built for the 1997 World Electronic Messaging Association directory challenge. This linked the WEMA directory to the NameFLOWParadise Internet directory, and demonstrated some of the powerful filtering capabilities of the Guardian

Hydrogen in Type Ic Supernovae?

By definition, a Type Ic supernova (SN Ic) does not have conspicuous lines of hydrogen or helium in its optical spectrum. SNe Ic usually are modelled in terms of the gravitational collapse of bare carbon-oxygen cores. We consider the possibility that the spectra of ordinary (SN 1994I-like) SNe Ic have been misinterpreted, and that SNe Ic eject hydrogen. An absorption feature usually attributed to a blend of Si II 6355 and C II 6580 may be produced by H-alpha. If SN 1994I-like SNe Ic eject hydrogen, the possibility that hypernova (SN 1998bw-like) SNe Ic, some of which are associated with gamma-ray bursts, also eject hydrogen should be considered. The implications of hydrogen for SN Ic progenitors and explosion models are briefly discussed.Comment: Accepted by PASP. Several significant changes including one additional figur

Secondary resurfacing of the patella in total knee arthroplasty

Anterior knee pain following primary total knee arthroplasty is common and can be difficult to treat satisfactorily. We reviewed 28 consecutive patients (29 knees) who underwent secondary resurfacing of the patella for persistent anterior knee pain and report on the results. Mean follow-up was 28 months (range12-61) with no cases lost to follow-up. Oxford knee scores, range of motion, the patient's assessment of outcome and overall satisfaction were recorded. Seventeen out of 19 (59%) felt their knee was better following patellar resurfacing, 10 out of 29 (34%) felt it was the same and two out of 29 (7%) felt it was worse. There was a significant improvement in Oxford knee scores (p < 0.001) and significant increase in patient satisfaction (p < 0.001) following secondary resurfacing. While secondary resurfacing of the patella does not provide the solution for every case of anterior knee pain following total knee joint replacement, in greater than 50% of cases it can be effective at relieving symptoms and in this series carries a low risk of worsening symptoms or complications

Providing secure remote access to legacy applications

While the widespread adoption of Internet and Intranet technology has been one of the exciting developments of recent years, many hospitals are finding that their data and legacy applications do not naturally fit into the new methods of dissemination. Existing applications often rely on isolation or trusted networks for their access control or security, whereas untrusted wide area networks pay little attention to the authenticity, integrity or confidentiality of the data they transport. Many hospitals do not have the resources to develop new ''network-ready'' versions of existing centralised applications. In this paper, we examine the issues that must be considered when providing network access to an existing health care application, and we describe how we have implemented the proposed solution in one healthcare application namely the diabetic register at Hope Hospital. We describe the architecture that allows remote access to the legacy application, providing it with encrypted communications and strongly authenticated access control but without requiring any modifications to the underlying application. As well as comparing alternative ways of implementing such a system, we also consider issues relating to usability and manageability, such as password management

Merging and Extending the PGP and PEM Trust Models - the ICE-TEL Trust Model

The ICE-TEL project is a pan-European project that is building an Internet X.509 based certification infrastructure throughout Europe, plus several secure applications that will use it. This paper describes the trust model that is being implemented by the project. A trust model specifies the means by which a user may build trust in the assertion that a remote user is really who he purports to be (authentication) and that he does in fact have a right to access the service or information that he is requesting (authorization). The ICE-TEL trust model is based on a merging of and extensions to the existing Pretty Good Privacy (PGP) web of trust and Privacy Enhanced Mail (PEM) hierarchy of trust models, and is called a web of hierarchies trust model. The web of hierarchies model has significant advantages over both of the previous models, and these are highlighted here. The paper further describes the way that the trust model is enforced through some of the new extensions in the X.509 V3 certificates, and gives examples of its use in different scenarios

Are you a researcher as well as a medical illustrator?

When we list the areas of practice for medical illustrators we always include research, but how involved in research are we? The aim of this activity is to encourage your professional development not just as a medical illustrator but your involvement with research whether that is undertaking your own research, undertaking evidence based practice (1) , working as part of a research team, advising researchers on the value of medical illustration or supporting a student undertaking a research project for their degree or post-graduate qualification

Initial Experiences of Building Secure Access to Patient Confidential Data via the Internet

A project to enable health care professionals (GPs, practice nurses and diabetes nurse specialists) to access, via the Internet, confidential patient data held on a secondary care (hospital) diabetes information system, has been implemented. We describe the application that we chose to distribute (a diabetes register); the security mechanisms we used to protect the data (a public key infrastructure with strong encryption and digitally signed messages, plus a firewall); the reasons for the implementation decisions we made; the validation testing that we performed and the preliminary results of the pilot implementation