Do diabetic veterans use the Internet? Self-reported usage, skills, and interest in using My HealtheVet Web portal.

OBJECTIVE: The Veterans Health Administration has developed My HealtheVet (MHV), a Web-based portal that links veterans to their care in the veteran affairs (VA) system. The objective of this study was to measure diabetic veterans' access to and use of the Internet, and their interest in using MHV to help manage their diabetes. MATERIALS AND METHODS: Cross-sectional mailed survey of 201 patients with type 2 diabetes and hemoglobin A(1c) > 8.0% receiving primary care at any of five primary care clinic sites affiliated with a VA tertiary care facility. Main measures included Internet usage, access, and attitudes; computer skills; interest in using the Internet; awareness of and attitudes toward MHV; demographics; and socioeconomic status. RESULTS: A majority of respondents reported having access to the Internet at home. Nearly half of all respondents had searched online for information about diabetes, including some who did not have home Internet access. More than a third obtained "some" or "a lot" of their health-related information online. Forty-one percent reported being "very interested" in using MHV to help track their home blood glucose readings, a third of whom did not have home Internet access. Factors associated with being "very interested" were as follows: having access to the Internet at home (p < 0.001), "a lot/some" trust in the Internet as a source of health information (p = 0.002), lower age (p = 0.03), and some college (p = 0.04). Neither race (p = 0.44) nor income (p = 0.25) was significantly associated with interest in MHV. CONCLUSIONS: This study found that a diverse sample of older VA patients with sub-optimally controlled diabetes had a level of familiarity with and access to the Internet comparable to an age-matched national sample. In addition, there was a high degree of interest in using the Internet to help manage their diabetes.

Floristical notes from Western Sierra de Gredos (Spanish Central System)

Se citan algunas plantas con interés corológico herborizadas en el macizo occidental de la Sierra de Gredos.

An Evaluation of the Impact of the Prospective Payment System on Antidepressant Use in Nursing Home Residents

Objectives: To determine the impact of the prospective payment system (PPS) for skilled nursing facilities on the pharmacologic treatment of depression.

Methods: We used a quasi-experimental study comparing the pharmacological treatment rates for depression in the pre-PPS period (1997) to the post-PPS period (2000) in 8149 residents with documented depression living in over 500 nursing facilities in Ohio. Logistic regression models adjusting for clustering effects of residents residing in homes using generalized estimating equations provided estimates of the PPS effect on use of any antidepressant and the use of selective serotonin reuptake inhibitors (SSRIs). We evaluated the extent to which the PPS effect was modified by organizational characteristics, including structural characteristics, resource characteristics, and staff resources available in the homes.

Results: Overall, there was no difference in the likelihood of any antidepressant [odds ratio (OR), 1.05; 95% confidence interval (CI), 0.93 to 1.18, resident-adjusted model] or an SSRI being used (OR, 0.98; 95% CI, 0.86 to 1.12, resident-adjusted model) after the introduction of PPS compared with 1997 when this reimbursement system was not in place (referent group). These trends did not appear to be modified substantially by organizational characteristics.

Conclusion: Although PPS did not appear to have influenced the treatment of depression in nursing homes, systems that provide checks and balances in relation to PPS are warranted.

Divergent Paths of Development: The Modern World-System and Democratization in South Africa and Zambia

This article examines whether a Modern World- Systems (MWS) perspective can provide an improved understanding of the processes of democratization in Africa (and other developing regions of the world) by conducting a comparative case study of South Africa and Zambia in the 1990s, examining the transitions to democracy and divergent processes of democratic consolidation in each country. Semiperipheral South Africa has, due to its more advantageous position in the world-system, been better equipped than peripheral Zambia to safeguard democracy against erosion and reversal. Th e central irony of the MWS is that the weakest states in the MWS can be pushed around by core powers and are more easily forced to democratize while at the same time they are least likely to possess the resources necessary for democratic consolidation. Semiperipheral states can maintain their independence vis-à-vis the core to a higher degree, but if the decision is made to undertake a democratic transition they are more likely to possess the resources necessary for successful consolidation. Th e MWS perspective allows for an improved understanding of the causal pathway of how position in the MWS translates into the ability to consolidate democracy than does approaches that emphasize domestic factors.

Performance analysis of a feasible air-cycle refrigeration system for road transport

The performance of an air-cycle refrigeration unit for road transport, which had been previously reported, was analysed in detail and compared with the original design model and an equivalent Thermo King SL200 vapour-cycle refrigeration unit. Poor heat exchanger performance was found to be the major contributor to low coefficient of performance values. Using state-of-the-art, but achievable performance levels for turbomachinery and heat exchangers, the performance of an optimised air-cycle refrigeration unit for the same application was predicted. The power requirement of the optimised air-cycle unit was 7% greater than the equivalent vapour-cycle unit at full-load operation. However, at part-load operation the air-cycle unit was estimated to absorb 35% less power than the vapour-cycle unit. The analysis demonstrated that the air-cycle system could potentially match the overall fuel consumption of the vapour-cycle transport refrigeration unit, while delivering the benefit of a completely refrigerant free system.

Design, construction and testing of an air-cycle refrigeration system for road transport

The environmental attractions of air-cycle refrigeration are considerable. Following a thermodynamic design analysis, an air-cycle demonstrator plant was constructed within the restricted physical envelope of an existing Thermo King SL200 trailer refrigeration unit. This unique plant operated satisfactorily, delivering sustainable cooling for refrigerated trailers using a completely natural and safe working fluid. The full load capacity of the air-cycle unit at -20 °C was 7,8 kW, 8% greater than the equivalent vapour-cycle unit, but the fuel consumption of the air-cycle plant was excessively high. However, at part load operation the disparity in fuel consumption dropped from approximately 200% to around 80%. The components used in the air-cycle demonstrator were not optimised and considerable potential exists for efficiency improvements, possibly to the point where the air-cycle system could rival the efficiency of the standard vapour-cycle system at part-load operation, which represents the biggest proportion of operating time for most units.