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Malnutrition or its risk affects up to 70% of cancer patients. Compared to adequately nourished oncology patients, those with malnutrition experience more complications and have poorer prognoses, thus higher needs for healthcare. We compared utilization of emergency department (ED) services and costs for Medicare-covered cancer patients with or without a malnutrition diagnosis.We used the Centers for Medicare and Medicaid Services (CMS) Standard Analytic File to identify fee-for-service beneficiaries who had a cancer diagnosis, and had one or more outpatient claims in 2018. We totaled individual claims and costs for ED visits per beneficiary, then calculated mean per-person claims and costs for malnourished vs non-malnourished patients.Using data from over 2.8 million claims of patients with cancer diagnoses, the prevalence of diagnosed malnutrition was 2.5%. The most common cancer types were genitourinary, hematologic/blood, and breast. Cancer patients with a malnutrition diagnosis, compared to those without, had a significantly higher annual total number of outpatient claims (21.4 vs. 11.5, P.0001), including a 2.5-fold higher rate of ED visits (1.43 vs. 0.56, p.0001). As result, such patients incurred more than 2-fold higher mean ED claim costs than did their adequately nourished counterparts ($10,724 vs. $4,935, P.0001).Our results suggest that malnutrition in cancer patients imposes a high outpatient burden on resource utilization and costs of care in terms of ED use. We propose that nutritional interventions can be used to improve health outcomes for people with cancer and to improve economic outcomes for patients and providers.

Patient reported outcome measures (PROMs) can evaluate the quality of health in patients with established renal failure. There is limited experience of their use within national renal registries.To describe the Scottish Renal Registry's (SRR) experience of collecting PROMS in the haemodialysis population and correlate PROMS to demographic and clinical parameters.Retrospective observational cross-sectional study.Haemodialysis patients in Scotland were invited to complete the KDQOL™-36 questionnaire on the day of the annual SRR census in 2015 and 2016. Questionnaires were linked to census demographic and clinical variables.In 2016, 738 questionnaires were linked to census data (39% of prevalent haemodialysis population). Response rates differed with age (≥ 65 years 42%, 65 years 36%) [χ2P = 0.006]; duration of renal replacement therapy (1 year 46%, ≥1 5 years 38%, ≥ 5 years 33%) [χ2P = 0.002] and social class (Scottish Index of Multiple Deprivation (SIMD) Class 1 32%, Class 2 41%, Class 3 40%, Class 4 48%, Class 5 40%) [χ2P 0.001]. There were significant differences in PROMs with age, SIMD quintile and primary renal diagnosis. Achieving a urea reduction ratio of 65% and dialysing through arteriovenous access were associated with significantly higher PROMs. PROMs were not affected by haemoglobin or phosphate concentration.Routine collection of PROMs is feasible and can identify potentially under-recognized and treatable determinants to quality of life. The association between attaining recommended standards of care and improved PROMs is striking. Individual and population-wide strategies are required to improve PROMs.

This practice paper describes how leadership education faculty and students at Virginia Tech have facilitated change through the use of appreciative inquiry (Ai) at the departmental level, program level, and project level. Appreciative inquiry has been found to be a useful tool for leadership educators, as its foundation in social constructionist philosophy aligns with contemporary leadership and learning theories. This paper outlines (a) the philosophy of Ai as it applies to organizational development (b) illustrates Ai practices associated with a fivestage model, and (c) highlights three examples that can be used as models for leading change in a variety of organizational situations. The authors suggest that leadership educators are uniquely positioned to serve academic communities as

The loop configuration, structure and growth are studied in a series of megathiridoid dorsal valves ranging in length from 0·7 to 6 mm. The structure of the posterior and anterior sectors of the descending lamellae and their relationships with the socket ridges, dorsal septa and dorsal valve floor, are studied, illustrated and described. Detailed studies show that internal structures display great variability. In the megathiridoids the lamellae of more typical terebratulide loops are replaced by partially developed loops in early developmental stages, resulting in a mix of free sections of loop together with sections where the lophophore rests directly on the epithelium of the valve floor. Comments on the ecology of the megathiridoid species are included and relate their unusually wide gapes, which position their lophophores fully accessible to the open sea, with their strong lophophore attachments and loss of typical free loops. The new genus Joania (type species Terebratula cordata Risso, 1826) is erected for those Argyrotheca which, although having a typical megathiridoid brachidium, differ in their adult crural development, their narrow hinge line, their prominent cardinal process, their characteristic dorsal median septum and their tuberculate radial ridges terminating anteriorly in tubercles.

The Devonian cemented brachiopod Schuchertellopsis durbutensis has proved difficult to classify and its possible taxonomic relationships are unknown. Morphologically Schuchertellopsis resembles more closely members of the Orthotetidina than the Davidsoniidina. Examination of the shell structure, a key diagnostic feature of the Orthotetidina, shows that Schuchertellopsis has the cross laminar secondary shell typical of all orthotetidines. However, the presence of both pseudopunctate and incipient an extropunctate fabric within the ventral valve is unique amongst orthotetidine brachiopods and is thought to represent a phase of shell fabric experimentation. Schuchertellopsis probably fits most comfortably within the Schuchertellidae, and is the earliest representative of that family.

A previously unknown Namurian goniatite and brachiopod fauna is described from Southeast Asia. The goniatites provide new insights into their global distribution and the age of the fauna. Two new brachiopod genera, Eileenella Racheboeuf and Plicambocoelia Boucot and Brunton, and five new species are described. The brachiopod fauna is unlike any known previously from Asia.

A new neoretziid brachiopod genus, Coveenia, from the Lower Carboniferous of western Europe is erected; the type species is Coveenia ulothrix (de Koninck, 1843), and C. buchiana (de Koninck, 1843, sensu 1887) and C. tilsleia sp. nov. are included, diagnosed and described. Neotypes are selected and illustrated for C. ulothrixC. buchiana.

The upper Lower Carboniferous, Serpukhovian (=Chesterian) productide brachiopod genusGondolina, from China, is made the type for the new subfamily Gondolininae in the Aulostegidae. Sectioned specimens reveal an unusual posterior dorsal flap of shell partially covering the ventral interarea.

In the Lower Devonian the first productellids evolved from their chonetidine ancestors as the Productellinae. This subfamily was the stem group from which all the later Productidina evolved, yet three of its five subfamilies persisted to the end of the Permian. The main characters used in the new classification, here presented, for the Productellidae are described and reviewed, and the main changes seen during its evolution are discussed. Within this new classification five new genera are described: in the Overtoniinae are Barunkhuraya Lazarev from the latest Famennian, Onavia Lazarev from the Tournaisian, both from Mongolia, and Echinariella Lazarev (type species Krotovia jisuensiformis Sarycheva) from the late Permian of Transcaucasia; in the Marginiferinae there is Breileenia Brunton from the Visean of western Europe and in the Plicatiferinae is Maemia Lazarev from the mid and Upper Carboniferous on the coast of the Barents Sea. New species described in these genera are Barunkhuraya indrengynensis Lazarev, Onavia barunkhurensis Lazarev, Breileenia radiata Brunton, Maemia chaykensis Lazarev, and M. nana Lazarev.

SUMMARY The genus Nebenothyris Minato, 1963 closely resembles the common spiriferoid genus Phricodothyris, but differs in having median ridges in both valves. It has seldom been mentioned in British faunas, but has been recognized in brachiopod collections from the Craven Reef Belt, North Yorkshire. We review the occurrence of Nebenothyris and recognize a new species, N. rhachis, from B2b ‘reefal’ limestones of late Asbian age in northern England and Ireland.

Revision of Productus lorieri d' Orbigny , 1850 questions the locality of the type specimen and refutes its assignment to the genus Strophalosia . The Carboniferous age, instead of Devonian, is established and the species lorieri is questionably assigned to the genus Retaria within the retariine productids.

A new classification of the Brachiopoda is proposed to take into account recent advances in our understanding of the anatomy, shell morphology, ontogeny and phylogeny of the phylum. The use of phylogenetic analysis to help rationalize this new information did not obviate the dilemma facing all previous classifications of how best to reconcile fossil and living data. Over 95% of all recognized genera are founded on extinct species, with the greatest diversity occurring in Cambro-Ordovician times when all but two of the 26 major groups constituting the phylum first appeared. Only five of these groups survive to the present day, albeit as well dispersed representatives of the early diversity. To com pare phylogenies extrapolated from these data, phylogenetic analyses of Recent and Cambro-Ordovician groups were conducted independently by using 55 biological characters for the former group and 69 morphological (and inferred anatomical) features for the latter; only 12 characters were common to both exercises. The cladogram derived for seven Recent suprafamilial taxa, withPhoronisand cyclostome and ctenostome bryozoans as outgroups, is virtually the same as that being obtained by studies of the brachiopod genome. It is also largely compatible with the cladogram for 33 Cambro-Ordovician suprafamilial taxa withPhoronisas outgroup. This cladogram has, in turn, been subjected to stratocladistic tests and has been shown to be consistent with the stratigraphic records of the taxa analysed. A reconciliation of the genealogies derived from the Recent and Cambro-Ordovician data, represented by 14 taxa and clades (with Phoronis as outgroup), was effected by using the 19 synapomorphies characterizing these groups. The resultant cladogram shows living organophosphatic-shelled lingulids (and discinids) as a sister group to a clade of all other living brachiopods. This clade, however, includes the extinct organophosphatic-shelled paterinids and the organocalcitic-shelled craniids. The inclusion of the craniids, in particular, is a cladistic compromise that is inconsistent with genetic and some anatomical and morphological evidence. It was therefore decided to accommodate these inconsistencies by dividing the Brachiopoda into three subphyla, each typified by Recent species with early Palaeozoic ancestors and defined by easily identifiable synapomorphies. The inarticulated Linguliformea, consisting of two classes (Lingulata and Paterinata), is characterized by an organophosphatic shell with a stratiform secondary layer and by planktotrophic larvae. Its modern representatives are the lingulids and discinids. The inarticulated Craniiformea is primarily distinguished by an organocarbonate shell with a laminar secondary layer and the absence of a pedicle throughout ontogeny. The craniids are the sole Recent descendants. The mainly articulated Rhynchonelliformea is the largest subphylum as it embraces five Classes (Chileata, Obolellata, Kutorginata, Strophomenata and Rhynchonellata). Its synapomorphies include an organocarbonate shell with a fibrous secondary layer, the presence of a pedicle without a coelomic core and the development of a recognizable diductor muscle system controlling the opening of the valves about a hinge axis defined by interareas. All Recent brachiopod species articulating with cyrtomatodont teeth and sockets are rhynchonelliforms.

The living terebratellid brachiopod Bouchardia rosea (Mawe), from the southeast Atlantic Ocean, has an unusual internal morphology; both valves are so heavily thickened posteriorly as almost to fill the space, leaving room only for the pedicle, its posterior adjuster muscles and the diductor muscles. These structures are here described in functional terms for the first time and, with the help of partial dissection of the soft tissues, the true nature of the musculature is revealed. Despite its unusual aspects, cardinalial structures of the dorsal valve can be interpreted in terms of those more commonly found in terebratellids. Copyright © 1996 The Royal Swedish Academy of Sciences. Published by Elsevier Science Ltd.

The literature on fossil and Recent brachiopods is replete with terms for a vast array of morphological features, many of which are effectively synonyms or represent minor variants or unusual growths of other well known structures. It is possible to relate most features to many fewer, and well defined, terms. One of the most difficult areas of brachiopod internal morphology is the cardinalia, positioned posteromedianly in dorsal valves. Our varied studies of these features enable us to define all the main structures and recommend a series of terms covering their description.

SUMMARY A rare constituent of late Visean flank subfacies of Cracoean buildups in northern England is an attached productoid brachiopod described here as Tenaspinus smarti gen. et sp. nov.; it is classified within our provisionally diagnosed Leioproductinae within the Productidae.

Reinvestigation of Semenewia concentrica ( De Koninck , 1847), previously considered to be a chonetoidean, reveals that it belongs amongst the strophalosioid productida. Futhermore Semenewia turns out to be a synonym of some specimens of Palmerhytis Brunton & Mundy , 1986, so the remaining specimens of the latter are renamed Parmephrix nov. gen., with the new type species P. eileeni nov. sp.

SUMMARY As an aid to the identification of brachiopods from the Asbian (Lower Carboniferous) reef environments in the northern British Isles, 125 species known from Treak Cliff, Derbyshire, are listed and characterised. Their presence at other localities is recorded. A brief survey of literature related to Treak Cliff is provided.

Alvarez, F. & Brunton, C. H. C. 1990 04 15: The shell-structure, growth and functional morphology of some Lower Devonian athyrids from northwest Spain. Lethaia, Vol. 23, pp. 117–131. Oslo. ISSN 0024–1164. In the Emsian (Lower Devonian) of northwest Spain three congeneric species of athyrids have been recognized principally by their, as yet, unique shell microstructures. The shell remains thin throughout ontogeny, with hardly any internal thickening, while the external lamellac are long and two to four times as thick as the valves. being composed of many layers of secondary fibres. A growth model for these shells is presented, including the recognition and differentiation of true valve growth as compared to growth of lamellae. Functional morphology is discussed and a new explanation presented for the function of the visceral foramen. The possible growth and disposition of the lophophore are described and, taken together with morphological and environmental factors, an anterior inhalant water circulation system is proposed. *Brachiopods, Athyrididae, Devonian, shell-structure, growth. functional morphology.

Carbon sequestration in plantation forests provides the main means by which New Zealand will meet its international climate change obligations in the first commitment period of the Kyoto Protocol (2008–2012). However, without active policy, forests are unlikely to contribute as much in subsequent commitment periods. This research paper provides the background for examining policy measures for encouraging carbon sequestration in plantation forests in New Zealand. Part I focuses on providing factual information and positive analysis of: key domestic and international regulations; information on New Zealand forests, the forestry industry and forest profitability; discussion of land-use decision making, including the central question of what influences conversion of farmland to forestry; and forest carbon ecology. Part II moves on to normative analysis of policy design. It discusses how including considerations of the value of carbon sequestration and storage changes optimal land-use behaviour, and outlines key issues that need to be addressed when developing a policy to encourage sequestration and storage in a pragmatic way. Finally, the paper identifies a number of key areas where we need more information before we can make well- informed choices about policy design. Future work will endeavour to identify and evaluate policies that would effectively encourage sequestration.

First, to investigate the effect on Canterbury rest home residents of national policy making influenza vaccination free for those aged 65 years and over. Second, to assess rest home staff influenza vaccination coverage.A comparison of influenza vaccination coverage in Canterbury rest home residents during 1996 and 1997 was conducted. Subgroups of rest homes were formed in 1997 to minimise the bias introduced through conducting a coverage survey in 1996. Staff vaccination coverage was also assessed in 1997.Influenza vaccination coverage of Canterbury rest home residents was 74% in 1996 and 76% in 1997. Staff vaccination coverage was 21% in 1997. Significantly more staff were vaccinated in rest homes that offered free influenza vaccination to their staff.The free influenza vaccination policy had no measurable impact on Canterbury rest home residents' vaccination coverage. This may be due to a ceiling effect of previously high coverage. Coverage was low amongst rest home staff. Providing the vaccination free of charge might improve staff coverage.

To measure the cumulative incidence of hepatitis C virus seroconversion over a two year period in a group of seronegative injecting drug users.The study involved follow-up, in 1996, of a cohort (n=85) of injecting drug users identified as hepatitis C virus seronegative in 1994. Participants were interviewed about risk factors for hepatitis C. A blood sample was also taken for anti-hepatitis C virus antibody and hepatitis C virus RNA testing.Forty-four participants were interviewed and 39 gave blood for testing. Most (80%) were aged 29 years or under and two thirds (n=26) were male. Around half reported borrowing (49%) or lending (57%) needles and syringes since 1994 and both of these behaviours were associated with seroconversion. The majority (88%) also reported sharing other injecting equipment. Nine were anti-hepatitis C virus positive giving a seroconversion rate over two years of 23% (13 per 100 person years). Four out of the nine seropositive specimens tested were also hepatitis C virus RNA positive.This study demonstrates a high rate of recent hepatitis C virus seroconversion amongst a group of New Zealand injecting drug users. Transmission of hepatitis C virus appears to be unabated by current control measures. These findings confirm the need to develop more effective policy and practices to prevent further spread, not just of hepatitis C, but of other blood-borne viruses in injecting drug user populations.