JP Baker

Presented and described in detail is a clinical technique called subjective global assessment (SGA), which assesses nutritional status based on features of the history and physical examination. Illustrative cases are presented. To clarify further the nature of the SGA, the method was applied before gastrointestinal surgery to 202 hospitalized patients. The primary aim of the study was to determine the extent to which our clinician's SGA ratings were influenced by the individual clinical variables on which the clinicians were taught to base their assessments. Virtually all of these variables were significantly related to SGA class. Multivariate analysis showed that ratings were most affected by loss of subcutaneous tissue, muscle wasting, and weight loss. A high degree of interobserver agreement was found (kappa = 0.78, 95% confidence interval 0.624 to 0.944, p less than 0.001). We conclude that SGA can easily be taught to a variety of clinicians (residents, nurses), and that this technique is reproducible.

In February 2006, the US Supreme Court heard cases that may affect whether intermittent streams are jurisdictional waters under the Clean Water Act. In June 2006, however, the cases were remanded to the circuit court, leaving the status of intermittent streams uncertain once again. The presence of commercial species, such as coho salmon (Oncorhynchus kisutch), can be an important consideration when determining jurisdiction. These salmon spawn in the upper portions of Oregon coastal stream networks, where intermittent streams are common. In our study of a coastal Oregon watershed, we found that intermittent streams were an important source of coho salmon smolts. Residual pools in intermittent streams provided a means by which juvenile coho could survive during dry periods; smolts that overwintered in intermittent streams were larger than those from perennial streams. Movement of juvenile coho into intermittent tributaries from the mainstem was another way in which the fish exploited the habitat and illustrates the importance of maintaining accessibility for entire stream networks. Loss of intermittent stream habitat would have a negative effect on coho salmon populations in coastal drainages, including downstream navigable waters.