Sounding out the future of ultrasound education.

As in so many other fields, the internet has revolutionised medical education. It has done this by circumventing the traditional constraints of medical education, in particular the availability of local resources such as teachers and textbooks. This "education revolution" has been most successful in the areas of theoretical knowledge. This article explores the available resources, and the challenges that arise when attempting to teach point-of-care ultrasound via the internet, such as the visuomotor and visuospatial skills required to create a diagnostic image. This article also describes the progress to date in this field.

Point of care ultrasound strikes again.

The article by Vohra and colleagues, "Sonographic Signs of Snakebites", is reviewed and offers a novel use of ultrasound to assess the severity of soft tissue injury due to crotaline envenomation. The authors have shown the feasibility and potential utility of this modality. Further studies are needed to determine the true value of these sonographic findings and how to apply them to patient care.

Field ecology of toxic Pfiesteria complex species and a conservative analysis of their role in estuarine fish kills.

Within the past decade, toxic Pfiesteria outbreaks have been documented in poorly flushed, eutrophic areas of the largest and second largest estuaries on the U.S. mainland. Here we summarize a decadal field effort in fish kill assessment, encompassing kills related to Pfiesteria (49 major kills in North Carolina estuaries since 1991 and 4 in Maryland estuaries in 1997) and to other factors such as low oxygen stress (79 major fish kills in North Carolina estuaries). The laboratory and field data considered in developing our protocols are described, including toxic Pfiesteria behavior, environmental conditions conducive to toxic Pfiesteria activity, and impacts of toxic clonal Pfiesteria on fish health. We outline the steps of the standardized fish bioassay procedure that has been used since 1991 to diagnose whether actively toxic Pfiesteria was present during estuarine fish kills. Detailed data are given for a 1998 toxic Pfiesteria outbreak in the Neuse Estuary in North Carolina to illustrate of the full suite of diagnostic steps completed. We demonstrate that our conservative approach in implicating toxic Pfiesteria involvement in fish kills has biased in favor of causes other than Pfiesteria. Data are summarized from experiments that have shown stimulation of toxic Pfiesteria strains by nutrient (N, P) enrichment, supporting field observations of highest abundance of toxic strains in eutrophic estuaries. On the basis of a decade of research on toxic Pfiesteria, we present a conceptual model of the seasonal dynamics of toxic strains as affected by changing food resources and weather patterns. We also recommend protocols and research approaches that will strengthen the science of fish kill assessment related to Pfiesteria and/or other causative factors.

Stream water quality changes following timber harvest in a coastal plain swamp forest.

The Goshen Swamp, a fourth order blackwater creek in southeastern North Carolina, was clearcut of 130 acres of riparian and seasonally flooded forest in late May through September 1998. Downstream water quality had been monitored monthly for 2 1/2 years before the clearcut, during the clearcut, and for two years following the clearcut. The objective of this paper was to test the hypothesis that clearcutting in the Goshen Swamp watershed negatively impacted downstream water quality. To do so, data from the Goshen Swamp were compared with data collected from a neighboring control creek (Six Runs Creek) of similar size, land use, and hydrologic characteristics. Compared with the control creek, the post-clearcut Goshen Swamp displayed significantly higher suspended solids, total nitrogen, total phosphorus, total Kjeldahl nitrogen and fecal coliform bacteria, and significantly lower dissolved oxygen over a 15 month period. Longer-term deleterious effects included recurrent nuisance algal blooms that had not been present during the 2 1/2 years before the clearcut. Although a 10 m uncut buffer zone was left streamside, this was insufficient to prevent the above impacts to stream water quality.