For health information on the Internet to achieve its potential as a force for equity and patient well-being, actions are required to overcome the digital divide; assist the public in developing searching and appraisal skills; and ensure physicians have adequate communication skills.

BackgroundPublic use of the Internet for health information is increasing but its effect on health care is unclear. We studied physicians' experience of patients looking for health information on the Internet and their perceptions of the impact of this information on the physician-patient relationship, health care, and workload.MethodsCross-sectional survey of a nationally-representative sample of United States physicians (1050 respondents; response rate 53%).ResultsEighty-five percent of respondents had experienced a patient bringing Internet information to a visit. The quality of information was important: accurate, relevant information benefited, while inaccurate or irrelevant information harmed health care, health outcomes, and the physician-patient relationship. However, the physician's feeling that the patient was challenging his or her authority was the most consistent predictor of a perceived deterioration in the physician-patient relationship (OR = 14.9; 95% CI, 5.5-40.5), in the quality of health care (OR = 3.4; 95% CI, 1.1-10.9), or health outcomes (OR = 5.6; 95% CI, 1.7-18.7). Thirty-eight percent of physicians believed that the patient bringing in information made the visit less time efficient, particularly if the patient wanted something inappropriate (OR = 2.5; 95% CI, 1.5-4.4), or the physician felt challenged (OR = 3.6; 95% CI, 1.8-7.2).ConclusionsThe quality of information on the Internet is paramount: accurate relevant information is beneficial, while inaccurate information is harmful. Physicians appear to acquiesce to clinically-inappropriate requests generated by information from the Internet, either for fear of damaging the physician-patient relationship or because of the negative effect on time efficiency of not doing so. A minority of physicians feels challenged by patients bringing health information to the visit; reasons for this require further research.

No abstract

We report on vegetation changes and population dynamics during a 72—yr period within permanent plots in Sonoran Desert vegetation. A set of plots established in 1906 and supplemented in 1928 at Tumamoc Hill, near Tucson, Arizona, USA, have been mapped at irregular intervals through 1978. Data from the four 100—m2 and one 800—m2 plots censused most frequently (6—8 times since 1906 and 1928) are presented in detail; data from five less frequently censused plots are noted briefly. At each census all woody and succulent plants, including seedlings, were mapped by recording both stem coordinates and canopy outline. There have been no consistent, directional changes in vegetation composition in the Tumamoc Hill plots between 1906 and 1978, despite large fluctuations in absolute cover and density of most species. The relative cover of the dominants was generally similar within a given plot over the entire time sequence. Coverage of most species responded strongly to regimes of extremely wet or extremely dry years; the response of density to climatic extremes was somewhat less strong. Total cover, density,and species diversity have increased more or less continuously in many plots between 1906 and 1978. The species were divided into five groups based on several population dynamic traits. At one end of continuum are species with long maximum lifespan (often greater than the 72—yr study period), high early and long—term (50—yr) survivorship, large size at maturity, low density, erratic recruitment, and age structure skewed toward older plants. At the other end of the continuum are species with short maximum life—span, low early and long—term survivorship, small size at maturity, high density, some recruitment at most censuses, and age structures strongly skewed toward newest recruits. While some of these traits are necessarily related (e.g., long maximum life—span and high long—term survivorship), others are not (e.g., high early survivorship and erratic recruitment), and the relationships deserve further study.

Introduction ____________________________________ 1 Acknowledgments ____________________________________ 3 Changes in Colorado River streamflow regime ________ 3 Floods _________________________________ 3 Daily stage.__________________________ 6 Annual discharge_________________________ 7 Monthly discharge __________ _______________________? Changes in channel and alluvial deposits in the Colorado River below Glen Canyon Dam ______________________ 8 A history of photography on the Colorado River __________ 10 Vegetation _______________________________________12 Distribution of major plant species ___________________13 Bermuda grass ________________________________14