Connecting thiamine availability to the microbial community composition in Chinook salmon spawning habitats of the Sacramento River basin.

Thiamine deficiency complex (TDC) is a major emerging threat to global populations of culturally and economically important populations of salmonids. Salmonid eggs and embryos can assimilate exogenous thiamine, and evidence suggests that microbial communities in benthic environments can produce substantial amounts of thiamine. We therefore hypothesize that natural dissolved pools of thiamine exist in the surface water and hyporheic zones of riverine habitats where salmonids with TDC migrate, spawn, and begin their lives. To examine the relationship between dissolved thiamine-related compounds (dTRCs) and their microbial source, we determined the concentrations of these metabolites and the compositions of microbial communities in surface and hyporheic waters of the Sacramento River, California and its tributaries. Here we determine that all dTRCs are present in femto-picomolar concentrations in a range of critically important salmon spawning habitats. We observed that thiamine concentrations in the Sacramento River system are orders of magnitude lower than those of marine waters, indicating substantial differences in thiamine cycling between these two environments. Our data suggest that the hyporheic zone is likely the source of thiamine to the overlying surface water. Temporal variations in dTRC concentrations were observed where the highest concentrations existed when Chinook salmon were actively spawning. Significant correlations were seen between the richness of microbial taxa and dTRC concentrations, particularly in the hyporheic zone, which would influence the conditions where embryonic salmon incubate. Together, these results indicate a connection between microbial communities in freshwater habitats and the availability of thiamine to spawning TDC-impacted California Central Valley Chinook salmon.IMPORTANCEPacific salmon are keystone species with considerable economic importance and immeasurable cultural significance to Pacific Northwest indigenous peoples. Thiamine deficiency complex has recently been diagnosed as an emerging threat to the health and stability of multiple populations of salmonids ranging from California to Alaska. Microbial biosynthesis is the major source of thiamine in marine and aquatic environments. Despite this importance, the concentrations of thiamine and the identities of the microbial communities that cycle it are largely unknown. Here we investigate microbial communities and their relationship to thiamine in Chinook salmon spawning habitats in California's Sacramento River system to gain an understanding of how thiamine availability impacts salmonids suffering from thiamine deficiency complex.

Complications of acute pancreatitis.

In 1925, Sir Berkeley Moynihan stated that "acute pancreatitis is the most terrible of all the calamities that occur in connection with the abdominal viscera." The case of M.H. clearly reflects the accuracy of that statement. It should be pointed out that through the exceptional, dedicated care provided by all members of the health care team, a young woman whose predicted mortality approached 100 percent was restored to her previous state of good health, and has since delivered a healthy baby girl by cesarean section. This illustrates that the nurse who possesses a sound understanding of the complications of acute pancreatitis and the pathophysiologic processes responsible, can integrate this knowledge into the management of the patient and improve the quality of care.

Self-in-relation theory and the role of the clinical nurse specialist. Part II: Application to advanced nursing roles in a professional practice model.

CONCEPTS AND ASSUMPTIONS of self-in-relation theory of women's development, as proposed by feminist scholars at the Stone Center in Wellesley, Massachusetts, are applied in this article. This theory was used as a framework to guide staff development and mentorship roles of advanced practice nurses. How the theory served to direct these roles and assisted in development of a professional practice model is discussed. Exemplars from the authors' practices and professional practice outcomes after 2 years of theory implementation are presented.

Improving stoma management in the low-vision patient.

Teaching the low-vision patient with an ostomy to manage a stoma independently provides a significant challenge for the WOC nurse. Although guide strips, lighted mirrors, and other handheld devices are available to patients with impaired eyesight, these products, when used alone, may be inadequate for the patient with an ostomy. In addition, there is a paucity of literature available to the WOC nurse describing specific interventions for the low-vision patient with an ostomy. Common visual problems encountered when managing people with an ostomy are reviewed. Specific interventions are discussed, including products designed to assist the low-vision patient with an ostomy with stoma care. A case study is provided that underscores the importance of consulting a low-vision specialist in the care of the patient with a new ostomy who has low vision as a result of albinism.

How reliable is the morphological diagnosis of penile ulcerations?

Material from 100 consecutive men who presented with penile ulcerations was tested for a variety of microorganisms. Fifty-one patients had microorganisms identified that were considered primary pathogens. The laboratory data were compared with the clinical diagnoses and the diagnostic accuracy and index of suspicion calculated. The diagnostic accuracy for lesions due to Treponema pallidum was 77.8%, Herpesvirus hominis 62.9% and Haemophilis ducreyi 33.3%, whereas the indexes of suspicion were 88.2%, 67.7% and 300% respecitively. These data show that the clinical diagnosis of genital ulcers is oftern inaccurate and that definitive diagnosis requires laboratory tests.