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Objective: To evaluate the appropriateness of magnetic resonance imaging (MRI) of the knee requested by primary care physicians.Design: Retrospective observational study.Setting: Six primary care centres in the Elche Department of Health of the Valencian Community, Spain.Participants: Three hundred patients with knee pain who were prescribed MRI.Main Outcome Measures: Data were collected from the electronic clinical history, which allowed us to assess the appropriateness and inappropriateness of the MRI requests for the knee based on the American College of Radiology (ACR) criteria. A multivariate logistic regression model was used to identify factors associated with an inappropriate request.Results: About 45% (41-49%) of knee MRI prescriptions were assessed as inappropriate. The frequency was higher in female patients (odds ratio, OR = 1.96; P = 0.03). A history of knee trauma and urgent use of MRI were associated with a lower frequency of inappropriate requests (OR = 0.14, P < 0.001 and OR = 0.32, P = 0.03, respectively). In 82% of cases, the request for MRI was deemed inappropriate because it was used as the initial imaging test. The availability of a previous radiograph of the knee significantly reduced the rate of inappropriate requests (OR = 0.05, P < 0.001); only 47% of the patients had a previous radiograph.Conclusions: The percentage of inappropriate knee MRI prescriptions is high. Protocols should be put in place to improve the appropriateness of MRI requests by promoting understanding of the appropriate use of MRI among primary care physicians. [ABSTRACT FROM AUTHOR]

This work focuses on the transformation occurred with the shift from surface to drip irrigation, looking at three collective irrigation systems in Valencia (Spain). The extension of drip irrigation over areas previously irrigated by systems of gravity channels entails a process of change and transformation of institutions and organizations managing irrigation. We analyze the main management changes occurred and how farmers adapt to the new technology. In order to assess these changes, interviews were conducted with farmers and managers of Water User Associations. Drip irrigation implementation policies result in unforeseen consequences, paradoxes and challenges for collective drip irrigation management. In the three cases, drip irrigation and automation has contributed to the centralization of decision-making. Besides, farmers and managers have also developed irrigation and fertigation strategies to adapt to the new technology. When some of these new operating procedures are applied, farmers obtain results closer to their own goals, but not necessarily linked to the virtues frequently attributed to drip systems. [ABSTRACT FROM AUTHOR]