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11 pages, 3 figures, 1 table, supplementary material https://doi.org/10.1126/sciadv.abm7452.-- Data and materials availability: All data needed to evaluate the conclusions in the paper are present in the paper, the Supplementary Materials, Dryad, and Zenodo, Phylogenetic relationships and the timing of evolutionary events are essential for understanding evolution on longer time scales. Cheilostome bryozoans are a group of ubiquitous, species-rich, marine colonial organisms with an excellent fossil record but lack phylogenetic relationships inferred from molecular data. We present genome-skimmed data for 395 cheilostomes and combine these with 315 published sequences to infer relationships and the timing of key events among c. 500 cheilostome species. We find that named cheilostome genera and species are phylogenetically coherent, rendering fossil or contemporary specimens readily delimited using only skeletal morphology. Our phylogeny shows that parental care in the form of brooding evolved several times independently but was never lost in cheilostomes. Our fossil calibration, robust to varied assumptions, indicates that the cheilostome lineage and parental care therein could have Paleozoic origins, much older than the first known fossil record of cheilostomes in the Late Jurassic, This project is funded by the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement no. 724324 to L.H.L.). Extra funding for specific sampling expeditions were provided by the National Science Centre of Poland (grant PANIC/2016/23/B/ST10/01936 to P.K.), the ASSEMBLE Plus (Horizon 2020), the Leverhulme Trust (Research Project Award RPG-2016-429 to A.W.), the Russian Science Foundation (grant 18-14-00086 to A.N.O.), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil [PQ-CNPq 308768/2018-3], Fundação de Amparo à Pesquisa do Estado de São Paulo, Brazil [FAPESP 19/17721-9] and the DISTANTCOM project (CTM2013-42667/ANT to C. Avila). B.F. was supported by Beatriu de Pinós (2019-BP-00183), funded by the AGAUR (Government of Catalonia) and by the Horizon 2020 programme under the Marie Skłodowska-Curie grant (no. 801370). The CAML-CEAMARC cruise of RV Aurora Australis (IPY project no. 53) were supported by the Australian Antarctic Division, the Japanese Science Foundation, the French Polar Institute IPEV, and the Muséum national d’Histoire naturelle, led by voyage leader, M. Riddle, With the institutional support of the ‘Severo Ochoa Centre of Excellence’ accreditation (CEX2019-000928-S)

As biological invasions continue to increase globally, eradication programs have been undertaken at significant cost, often without consideration of relevant ecological theory. Theoretical fisheries models have shown that harvest can actually increase the equilibrium size of a population, and uncontrolled studies and anecdotal reports have documented population increases in response to invasive species removal (akin to fisheries harvest). Both findings may be driven by high levels of juvenile survival associated with low adult abundance, often referred to as overcompensation. Here we show that in a coastal marine ecosystem, an eradication program resulted in stage-specific overcompensation and a 30-fold, single-year increase in the population of an introduced predator. Data collected concurrently from four adjacent regional bays without eradication efforts showed no similar population increase, indicating a local and not a regional increase. Specifically, the eradication program had inadvertently reduced the control of recruitment by adults via cannibalism, thereby facilitating the population explosion. Mesocosm experiments confirmed that adult cannibalism of recruits was size-dependent and could control recruitment. Genomic data show substantial isolation of this population and implicate internal population dynamics for the increase, rather than recruitment from other locations. More broadly, this controlled experimental demonstration of stage-specific overcompensation in an aquatic system provides an important cautionary message for eradication efforts of species with limited connectivity and similar life histories.

Understanding the mechanisms of spatial variation of biological invasions, across local-to-global scales, has been a major challenge. The importance of evolutionary history for invasion dynamics was noted by Darwin, and several studies have since considered how biodiversity of source and recipient regions can influence the probability of invasions. For over a century, the Panama Canal has connected water bodies and biotas with different evolutionary histories, and created a global shipping hot spot, providing unique opportunities to test mechanisms that affect invasion patterns. Here, we test for asymmetry in both the extent of invasions and predation effects, a possible mechanism of biotic resistance, between two tropical oceans at similar latitudes. We estimated nonnative species (NNS) richness for sessile marine invertebrates, using standardized field surveys and literature synthesis, to examine whether invasions are asymmetrical, with more NNS present in the less diverse Pacific compared to the Atlantic. We also experimentally tested whether predation differentially limits the abundance and distribution of these invertebrates between oceans. In standardized surveys, observed total NNS richness was higher in the Pacific (18 NNS, 30% of all Pacific species) than the Atlantic (11 NNS, 13% of all Atlantic species). Similarly, literature-based records also display this asymmetry between coasts. When considering only the reciprocal exchange of NNS between Atlantic and Pacific biotas, NNS exchange from Atlantic to Pacific was eightfold higher than the opposite direction, exceeding the asymmetry predicted by random exchange based simply on differences of overall diversity per region. Predation substantially reduced biomass and changed NNS composition in the Pacific, but no such effects were detected on the Atlantic coast. Specifically, some dominant NNS were particularly susceptible to predation in the Pacific, supporting the hypothesis that predation may reduce the abundance of certain NNS here. These results are consistent with predictions that high diversity in source regions, and species interactions in recipient regions, shape marine invasion patterns. Our comparisons and experiments across two tropical ocean basins, suggest that global invasion dynamics are likely driven by both ecological and evolutionary factors that shape susceptibility to and directionality of invasions across biogeographic scales.

Abnormal bone and mineral metabolism is a common complication of chronic kidney disease (CKD) and has been the subject of concern and controversy throughout the world [1–5]. Mounting evidence suggests that disorders of bone and mineral metabolism are associated with an increased risk for cardiovascular calcification, morbidity, and mortality [6, 7]. As kidney function declines, mineral homeostasis deteriorates leading to changes in the levels of various hormones such as parathyroid hormone (PTH), 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, other vitamin D metabolites, fibroblastic growth factor-23 (FGF23), and growth hormone. Eventually, serum and tissue concentrations of calcium and phosphorus become abnormal. The discovery of FGF23 has changed the understanding of abnormal phosphorus and vitamin D metabolism in CKD. FGF23 is a bone-derived hormone that increases phosphaturia and decreases the synthesis of 1,25-dihydroxyvitamin D (1,25(OH)2D). Increased secretion of 1,25(OH)2D and high dietary phosphorus intake are considered to be the main stimuli of FGF23 secretion [8]. FGF23 levels increase early (CKD stage 2 or 3) and steadily increase as CKD progresses. This hormone stimulates an appropriate physiologic adaptation to maintain normal phosphorus balance. It helps to augment urinary phosphate excretion, increase PTH levels, and lower 1,25(OH)2D production by decreasing phosphorus absorption from the GI tract. Over time this adaptation fails causing a progressive decline in 1,25(OH)2D levels with additional consequences such as secondary hyperparathyroidism (SHPT). High FGF23 levels have been independently linked with adverse outcomes in CKD, such as cardiovascular disease and mortality. Additionally, treatment with activated vitamin D compounds stimulates FGF23 which has reinforced the need to reconsider the risks and benefits of using activated vitamin D and to determine the optimal doses to treat CKD-mineral and bone disorder (CKD-MBD) [8].

More non-native species (NNS) are reported from harbors, estuaries and protected embayments than in wave-exposed, open-coast habitats. In California (USA), hundreds of NNS have become established in international ports, and dozens are known from smaller estuaries. In contrast, only 22 NNS are reported from the state’s 1350 km of open coast. As a result, the perception that open-coast habitats are not vulnerable to invasions has persisted. Management and monitoring focuses on ports and estuaries; the last major monitoring effort on the open coast occurred in 2004. Much of the species-rich Central California coast is now part of a network of marine protected areas (MPAs). We surveyed 12 wave-swept rocky intertidal and eight subtidal sites (from 37°53′40N 122°42′30W to 36°31′16N 121°56′22W) for NNS. At least one NNS was detected at half of the sites surveyed, but most were not widespread or abundant. One exception, a bryozoan in the Watersipora spp. complex, known primarily from ports and estuaries, was found at multiple sites, and was abundant at some. Another non-native, the alga Caulacanthus ustulatus, was abundant at a single site. MPAs were just as likely as sites outside of MPAs to have NNS. For subtidal sites, proximity to a harbor was correlated with the abundance of non-natives. Our findings suggest that our study area is still relatively uninvaded, but the success of Watersipora within some of these highly diverse rocky shore sites underscores the potential vulnerability of high-value open-coast systems to invasions.

The warm water marine bryozoan Amathia (= Zoobotryon) verticillata (delle Chiaje, 1822) is reported for the first time in the Galápagos Islands based upon collections in 2015. Elsewhere, this species is a major fouling organism that can have significant negative ecological and economic effects. Comprehensive studies will be necessary to determine the extent of the distribution of A. verticillata in the Galápagos and its effects on native species. The establishment of A. verticillata emphasizes the need for regular monitoring of those vectors that could bring additional non-native species to the Archipelago.

Serpulids are an important component of fouling communities. This paper provides an overview of the serpulid species found in North America, as part of a broader study of fouling invertebrates focused on NIS (non-indigenous species) in United States coastal ecosystems. Almost 4400 serpulid specimens were examined from selected fouling plates. Fouling plates were deployed in 26 bays and coastal lagoons along the continental coasts of the United States and Hawaiian islands, primarily in bays and lagoons with salinities averaging 20‰ or greater. Twenty-five serpulid species were identified, including four new records for the United States ( Ficopomatus uschakovi , Hydroides cf. brachyacantha , H. longispinosa and Protula longiseta ), three known NIS, two presumed NIS, three cryptogenic serpulids, and several range extensions. Crucigera websteri extends its northward range from Santa Barbara Island to Humboldt Bay, California; Ficopomatus enigmaticus , first recorded in North America from San Francisco, California in 1920, Rockport, Texas in 1952 and Barnegat Bay, New Jersey in 1980, is now recorded at additional localities on the east coast (Chesapeake Bay, Virginia, Charleston, South Carolina and Indian River, Florida) and the northern Gulf of Mexico (Galveston Bay, Texas); F. miamiensis extends its westward range from Louisiana to Texas; F. uschakovi , an Indo-Pacific and Western African species, was recorded formally for the first time from the northern Gulf of Mexico (Galveston Bay and Corpus Christi, Texas) and the east coast of Florida (Jacksonville). Hydroides cf. brachyacantha extends its northward range from Curaҫao to Pensacola Bay, Florida; H. dirampha from Veracruz, Mexico to Corpus Christi, Texas; H. floridana extends its westward range from Louisiana to Texas; H. gracilis extends its northward range from Pacific Grove to San Francisco, California; Salmacina huxleyi from Cape Hatteras, North Carolina to Rhode Island; and Spirobranchus minutus from Veracruz, Mexico to Pensacola Bay, Florida. The following additional species range extensions are provisional in that they represent only one record or were not found in the most recent surveys (e.g., Hydroides elegans - east coast): H. longispinosa from Marshall Islands to Oahu, Hawaii; Protula balboensis from Florida to Texas; P. longiseta from the Mexican Caribbean to the Indian River, Florida; H. elegans from San Francisco to Humboldt Bay, northern California and on the east coast from the Indian River, Florida, to Cape Cod, Massachusetts. Among surveyed bays, Biscayne Bay, Florida and Corpus Christi, Texas (northern Gulf of Mexico) had the greatest number of species (14 and 8, respectively); in contrast, almost all sites in Alaska, Washington, Oregon (northwest Pacific), Rhode Island, Virginia and South Carolina (Atlantic) had only one or two species each. Hydroides dianthus was, by far, the most abundant serpulid species on fouling plates in the northern Gulf of Mexico and the east coast, while Pseudochitinopoma occidentalis was the most abundant serpulid detected on the west coast. For each species recorded herein, we include the synonyms and some key references, a material studied section, a diagnosis, and updated distributional information. A checklist and identification key to the known shallow-water serpulids sensu stricto of the United States are included.

In recent years, several marine non-indigenous species (NIS) lists have been produced for many European countries but little is known about the diversity and distribution of fouling NIS in Portugal (mainland and islands). We conducted a six-year survey of a marina located on the south coast of Madeira island, Portugal to assess NIS diversity on the island, constituting the first NIS inventory for the archipelago. We found 16 NIS, of which 9 are new records. Both species richness and abundance changed during the course of colonization whether total, NIS, or native diversity were considered. The number of native species decreased with colonization while the number of NIS significantly increased. More importantly, we demonstrated that the number of NIS detections in the marina was correlated with increasing ship traffic over the years.

Global trade by merchant ships is a leading mechanism for the unintentional transfer of marine organisms, including non-indigenous species, to bays and estuaries worldwide. To reduce the likelihood of new invasions, ships are increasingly being required to manage their ballast water (BW) prior to discharge in coastal waters. In the United States, most overseas arrivals have been required to manage BW discharge since 2004, primarily through ballast water exchange (BWE), which flushes out ballast tanks in the open ocean (>200 miles from shore). Studies have found BWE to generally reduce the abundance of organisms, and the amount of water exchanged has been estimated at 96-100%. Despite its widespread use, the overall effect of this management strategy on net propagule supply through time has not been explored. Here, temporal changes in zooplankton concentrations and the volume of BW discharged in Chesapeake Bay, U.S. were evaluated, comparing pre-management era and post-management era time periods. Chesapeake Bay is a large port system that receives extensive BW discharge, especially from bulk cargo vessels (bulkers) that export coal overseas. For bulkers arriving from overseas, mean zooplankton concentrations of total and coastal indicator taxa in BW did not decline between pre- (1993-2000) and post management (2012-2013) eras, when controlling for season and sampling method. Moreover, bulkers discharged 21 million tonnes (82% of total for Chesapeake Bay) of overseas BW in 2013, representing a 374% increase in volume when compared to 2005. The combination of BW discharge volume and zooplankton concentration data indicates that (a) net propagule supply by bulkers has increased since BWE began in Chesapeake Bay; and (b) changes in vessel behaviour and trade have contributed strongly to this outcome. Specifically, the coal-driven increase in BW discharge volume from 2005-2013, concurrent with the onset of BWE regulations, worked to counteract intended results from BW management. A long-term analysis of bulker arrivals (1994-2013) reveals a 20-year minimum in arrival numbers in 2000, just when the implementation of BWE began. This study underscores the need to consider shifts in trade patterns, in order to advance and evaluate effective management strategies for biological invasions.

The colonial tunicate, Didemnum vexillum Kott, 2002, has a history of invading and overgrowing marine communities in temperate waters worldwide. The species can colonize and dominate remarkably large areas of benthic habitat, including coastal bays and outer coastal areas, causing concerns about potential long-term effects on community structure, critical habitats, and fisheries resources. We report here the confirmed occurrence of D. vexillum in Alaska, representing a dramatic 1000 km northward extension of this non-native species along the western coast of North America. The species was detected as part of a “bioblitz”, engaging citizen scientists to survey local biota and detect non-native marine species incursions. Following detection, the identity of D. vexillum was confirmed with robust genetic methods, and morphological characters were also consistent with previous species descriptions. Although invasions have been relatively rare in Alaskan waters to date, it is now clear that D. vexillum is established in at least one site (Whiting Harbor) near Sitka, Alaska. Given the explosive growth and spread of this species in other global regions, and its potential for significant impacts across diverse habitats in Alaska, current efforts are underway to evaluate its distribution and options to eradicate or control the species.

The calcium-sensing receptor (CaR) and the vitamin D receptor (VDR) play key roles in calcium homeostasis. The CaR regulates the release of parathyroid hormone (PTH) in response to changes in extracellular calcium, whereas the VDR mediates the effects of calcitriol, the active metabolite of vitamin D. The development of secondary hyperparathyroidism (HPT) is a common complication of chronic kidney disease. Secondary HPT is characterized by disturbances in mineral metabolism, elevated serum PTH, and parathyroid gland hyperplasia. Alterations in CaR and VDR expression and activation play central roles in the development of secondary HPT. The impact of any nutritional and pharmacologic intervention on these two receptors should be carefully considered, to optimize patient outcomes. The important roles of CaR and VDR in the pathogenesis of secondary HPT are demonstrated by the complex interactions between their respective signaling pathways.

The American Dietetic Association (ADA) Renal Dietitians Practice Group (RPG) and the National Kidney Foundation Council on Renal Nutrition (NKF CRN), under the guidance of the ADA Quality Management Committee and Scope of Dietetics Practice Framework Sub-Committee, have developed the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitians (Generalist, Specialty, and Advanced) in Nephrology Care (Supplementary Figures 1, 2, and 3 are available only online at www.jrnjournal.org). The SOP and SOPP documents are based upon the 2008 Revised Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitians (RDs)(1), which are part of ADA's Scope of Dietetics Practice Framework(2). The 2008 Revised SOP in Nutrition Care and SOPP, along with the Code of Ethics(3), guide the practice and performance of RDs in all settings.

Vector management is the primary method for reducing and preventing nonindigenous species (NIS) invasions and their ecological and economic consequences. This study was the first to examine the efficacy of in-water scrubbing using a submersible cleaning and maintenance platform (SCAMP) to prevent invertebrate species transfers from a heavily fouled obsolete vessel. Initially, prior to treatment, 37 species were recorded in a biofouling matrix that reached 30cm depth in some locations. The bryozoan Conopeum chesapeakensis, and bivalves Mytilopsis leucophaeata and Ischadium recurvum, were dominant sessile species that created structure, supporting mobile biota that included crabs and the associated parasitic barnacle Loxothylacus panopae. Scrubbing had the effect of significantly reducing organism extent and the number of species per sample, but a substantial and diverse (30 species) residual fouling community remained across the entire vessel. Further assessments of management options are needed to prevent potentially damaging NIS transfers. Additional measures taken within an integrated vector management (IVM) strategy may further improve invasion prevention measures.

Shipping has contributed strongly to biological invasions in coastal ecosystems, transferring species in ballast tanks and on exposed underwater surfaces (hulls). A long history exists that documents biota associated with ships' hulls, including some recent analyses of modern ships, but relatively little is known about the associated risks of invasion. In general, the likelihood of invasion is expected to increase with increasing propagule supply, which suggests that high-density transfers on hulls may pose a relatively high invasion risk. Obsolete vessels are expected to be at an extreme end of the spectrum for biofouling, since they sit at anchorage for long periods and are towed at relatively slow speeds when moved, but this remains largely unexplored. In this paper, we quantified the biofouling communities of two obsolete vessels, one stationary for one decade and the other for two decades, before and after their final transit from California to Texas. Pre-departure biofouling surveys across both vessels detected 22 species of macroinvertebrates. The biomass was dominated by the introduced bryozoan Conopeum chesapeakensis, which occurred in 98% of samples and created a three-dimensional structure (2-5 cm thick). Mobile species, inhabiting the vertical biofouling matrix, were more numerous than sessile ones. Interestingly, the non-native Asian clam Corbula amurensis, not previously associated with hull fouling assemblages, was recorded in 9% of samples. During the 43-day voyage, organisms encountered salinity variation that ranged between zero (Panama Canal) and at least 37 parts per thousand (Brownsville, Texas) and temperatures that varied between 9.9 °C and 31.6 °C. Upon arrival in Texas, we measured an expected decrease in biofouling extent across both vessels but also a surprising increase in species richness (57 species were recorded), with small compositional differences between ships that did not exist prior to departure. Several species were recorded alive upon arrival, including non-natives that are not known to be established in Texas waters. The physiological tolerance and associated risk of colonization have not yet been evaluated for these organisms, or for the broader species pool associated with a standing fleet (n > 200 ships) that may undergo similar movements. Nonetheless, a compelling case exists for vector management based on organism flux alone, to reduce the risk of coastwise and inter-oceanic invasions.

Nutritional assessment of patients with chronic kidney disease is a vital function of health care providers. Subjective Global Assessment (SGA) is a tool that uses 5 components of a medical history (weight change, dietary intake, gastrointestinal symptoms, functional capacity, disease and its relation to nutritional requirements) and 3 components of a brief physical examination (signs of fat and muscle wasting, nutrition-associated alternations in fluid balance) to assess nutritional status. SGA was originally used to predict outcomes in surgical patients; however, its use has gone beyond this function and population. In chronic kidney disease patients, SGA is incorporated into the complete nutritional assessment. Validation of SGA as a screening tool for surgical patients was done by Detsky et al in 1984. Since that time, SGA has been altered by different researchers and clinicians to better meet the needs of the patients they served. Validation of the altered SGA formats has not been thoroughly done. Further work in establishing validity and reliability of each version of SGA in different patient populations should be done to enable clinicians and researchers to properly use this nutritional assessment tool.

Nutritional assessment of patients with chronic kidney disease is a vital function of health care providers. Subjective Global Assessment (SGA) is a tool that uses 5 components of a medical history (weight change, dietary intake, gastrointestinal symptoms, functional capacity, disease and its relation to nutritional requirements) and 3 components of a brief physical examination (signs of fat and muscle wasting, nutrition-associated alternations in fluid balance) to assess nutritional status. SGA was originally used to predict outcomes in surgical patients; however, its use has gone beyond this function and population. In chronic kidney disease patients, SGA is incorporated into the complete nutritional assessment. Validation of SGA as a screening tool for surgical patients was done by Detsky et al in 1984. Since that time, SGA has been altered by different researchers and clinicians to better meet the needs of the patients they served. Validation of the altered SGA formats has not been thoroughly done. Further work in establishing validity and reliability of each version of SGA in different patient populations should be done to enable clinicians and researchers to properly use this nutritional assessment tool.

HE ABNORMALITIES of the skeleton in chronic kidney disease (CKD), collectively known as renal osteodystrophy, are an important cause of morbidity and decreased quality of life. In the management of patients with kidney disease, it is necessary to have a rational approach to the diagnosis and assessment of renal osteodystrophy in order to devise a treatment plan that hopefully will lead to an improved outcome. In the past, the term renal osteodystrophy was mainly equated only with abnormalities of bone turnover, but as described in the article by Cunningham and Sprague 1 in this same issue, renal osteodystrophy is a complex disorder of compromised bone strength in CKD patients. While osteoporosis is a term used to describe fragile bones prone to fracture in the general population and is most often assessed by dual x-ray absorptiometry (DEXA), renal osteodystrophy should be the principal term to describe fragile bones prone to fracture and other morbidities in CKD. Renal osteodystrophy is a function of bone turnover (assessed by bone biopsy), bone density (assessed by DEXA or quantitative CT [qCT]), and bone architecture, but the principal determinant of bone fragility in CKD is abnormal bone turnover. However, diagnosing and treating bone turnover abnormalities remains challenging. Our discussion group met to assess the current state of knowledge, understand the basis of our current therapy, and identify the information that needs to be gathered to improve the therapy of bone turnover and thereby improve the disorder of renal osteodystrophy. A number of important questions, listed in Table 1, were considered.

During a European Union Concerted Action study on species introductions, an intercalibration workshop on ship ballast water sampling techniques considered various phytoplankton and zooplankton sampling methods. For the first time, all the techniques presently in use worldwide were compared using a plankton tower as a model ballast tank spiked with the brine shrimp and oyster larvae while phytoplankton samples were taken simultaneously in the field (Helgoland Harbour, Germany). Three cone-shaped and 11 non-cone shaped plankton nets of different sizes and designs were employed. Net lengths varied from 50 to 300 cm, diameters 9.7- 50 cm, and mesh sizes 10- 100 m. Three pumps, a Ruttner sampler, and a bucket previously used in ballast water sampling studies were also compared. This first assessment indicates that for sampling ballast water a wide range of techniques may be needed. Each method showed different results in efficiency and it is unlikely that any of the methods will sample all taxa. Although several methods proved to be valid elements of a hypothetical `tool box' of effective ship sampling techniques. The Ruttner water sampler and the pump P30 provide suitable means for the quantitative phytoplankton sampling, whereas other pumps prevailed during the qualitative trial. Pump P15 and cone-shaped nets were the best methods used for quantitative zooplankton sampling. It is recommended that a further exercise involving a wider range of taxa be examined in a larger series of mesocosms in conjunction with promising treatment measures for managing ballast water.

The increasing prevalence of end-stage renal disease and planned expansion of the Medicare bundled payment system will place a greater financial burden on dialysis providers. Management of chronic kidney disease mineral and bone disorder (CKD-MBD) is dependent on interdisciplinary team (IDT) interventions such as dietary modification, medication, and adequate dialysis therapy. Optimizing adherence to diet and medications requires an educated and motivated IDT, patient, and patient support system. The financial constraints of bundling will increase the roles of social workers and dietitians in promoting therapy adherence. Innovative and relevant tactics provide opportunity to overcome monotonous routines, encourage adherence to diet and complex polypharmacy regimens, and achieve recommended biochemical targets as outlined in Kidney Disease Improving Global Outcomes Guideline for Chronic Kidney Disease (KDIGO) - CKD-MBD.

Compelling evidence indicates that the incidence of chronic kidney disease (CKD) is increasing because of an aging population and a higher prevalence of cardiovascular disease, diabetes, and hypertension. Nutrition management of patients with CKD requires early disease recognition, appropriate interpretation of the markers and stages of CKD, and collaboration with other health care practitioners. Better management of CKD can slow its progression, prevent metabolic complications, and reduce cardiovascular related outcomes. Caring for patients with CKD necessitates specialized knowledge and skills to meet the challenges associated with this growing epidemic. The Academy of Nutrition and Dietetics Renal Dietitians Practice Group and the National Kidney Foundation Council on Renal Nutrition, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, have updated the 2009 Standards of Practice in Nutrition Care and Standards of Professional Performance as a tool for registered dietitian nutritionists working in nephrology nutrition to assess their current skill levels and to identify areas for additional professional development in this practice area. The Standards of Practice apply to the care of patients/clients with kidney disease. The Standards of Professional Performance consist of six domains of professionalism, including: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate how nephrology nutrition principles can be applied to practice. The indicators describe three skill levels (ie, competent, proficient, and expert) for registered dietitian nutritionists working in nephrology nutrition.

Summary The advent of new technologies raises a question of the value of one-on-one personalized interaction in the reference environment. The first part of this paper briefly surveys leading library literature; the second part reports results of an informal survey of practitioners in the field, designed to elicit their views on the influence of theoretical models and new technologies on reference service. It is suggested that while there is no necessary conflict between integration of technology and existing structures in the reference environment, new technology does raise issues that need to be thoughtfully addressed.

The relationships between invasion pressure, post-transport inoculant survival, and regional susceptibility to invasion are poorly understood. In marine ecosystems, the movement and release of ballast water from ocean-going ships provides a model system by which to examine the interplay among these factors. One of the largest estuaries in North America, the Chesapeake Bay, receives tremendous amounts of foreign ballast water annually and thus should be at high invasion risk. To date, however, few introductions in Chesapeake Bay have been attributed to ballast release. To understand better the dynamics of this invasion process, we (1) characterized and quantified the biota arriving to Chesapeake Bay in foreign ballast water, (2) compared temperatures and salinities of ballast water and harbor water in upper Chesapeake Bay, and (3) tested experimentally survival of organisms collected from ballast water in temperatures and salinities characteristic of the region. From 1993 to 1994, we sampled planktonic and benthic organisms from 60 foreign vessels arriving to Chesapeake Bay. Our data show that the estuary is being inoculated by a diverse assemblage of aquatic organisms from around the world. Furthermore, the short transit time (≤15 d) for most vessels ensured that substantial numbers of larval and post-larval organisms were being deballasted alive. Most of the ballast water discharged into the upper Chesapeake Bay, however, was significantly higher in salinity (>20‰) than that of the receiving harbor. In laboratory tolerance experiments, ballast water organisms perished under such conditions. Thus, a mismatch in physical conditions between donor and receiver regions may explain the dearth of invasions in the upper Bay. It is likely that the lower Chesapeake Bay, which is more saline, remains at higher risk to ballast water invasion. Recognition of such intraregional differences should allow more focused predictions for monitoring and management.

The Dialysis Outcomes Quality Initiative is sponsored by the National Kidney Foundation with the objective of improving patient survival, reducing patient morbidity, increasing efficiency of care, and improving the quality of life for all dialysis patients. This initiative brought interdisciplinary teams together to evaluate contemporary renal practice in five clinical areas including hemodialysis adequacy, peritoneal adequacy, anemia, vascular access, and nutrition. The purpose of this report is to provide a general overview of the guidelines and their potential implications for renal dietitians. It also serves as a challenge for renal dietitians to get involved with development, evaluation, implementation, and continual revisions of the current or future practice guidelines.

Bryozoans are common fouling species present on ships and artificial substrates. A number of projects reporting the presence of bryozoans in Portugal have been carried out in recent years. As part of a field survey to examine and quantify the non-indigenous marine fouling species in several marinas in Portugal, we detected the bryozoan Celleporaria brunnea for the first time. The native range of C. brunnea seems to extend from British Columbia to the Galapagos, Ecuador. Our discovery indicates that this is the first record of C. brunnea across the East Atlantic and the first record of a species in this genus in the north-eastern Atlantic. The fouling nature of Celleporaria brunnea may have facilitated its spread to the western Pacific, the Mediterranean and now the eastern Atlantic from the Americas.

THE NUTRITIONAL STATUS of a renal patient can be assessed by a variety of methods, many of which rely on subjective reports, objective anthopometric measurements, or biochemical tests. Nutritional status also can be assessed using clinical criteria, such as medical history, dietary intake, and physical examination.’ Each patient requires ongoing assessment and evaluation to provide the data base from which appropriate intervention decisions can be made. Many forms have been developed individually and collectively to record and monitor data over time. The forms provided here (Figs 1 to 3) represent only a brief sampling of the wide variety available. 1991 A relatively new assessment tool, Subjective Global Assessment (SGA), has been shown to be highly predictive of outcome in renal patients2z3 SGA is simple to learn and implement. Much of what SGA includes is already being done by renal dietitians during their assessment of patients: (1) a review of the medical history, including

Call to request application; patient and physician must be enrolled; financial need is assessed on a case-bycase basis Call 800 number for specific information; two programs: Uninsured Patient Program (no insurance or Medicare and income

The use of a protocol to deliver and monitor the administration of intravenous calcitriol is described within the scope of practice by a renal dietitian. Advantages and disadvantages of protocol use as well as steps to develop protocols are focused within the context of an existing protocol.

Note: The following article was drafted in response to Council on Renal Nutrition (CRN) member concerns about the use of unqualified nutrition personnel in end-stage renal disease (ESRD) facilities. Its goal is to review the complexities of renal disease, specifically those that establish the professional expertise needed to provide quality nutrition care for the ESRD patient. CRN members at large, the CRN Executive Committee, and the CRN Quality Assurance Committee provided input, and the document was endorsed by the National Kidney Foundation in 1992. Views on the use of diet technicians and diet clerks in ESRD facilities were polarized. The authors feel that this paper reflects members' views that if a lesser qualified individual is used for provision of some nutrition services, they should not be used in place of a qualified dietitian (as described in the article), and their activities should be directed and supervised by a qualified dietitian.

Bone and mineral abnormalities begin early in the course of chronic kidney disease (CKD) and continue as kidney function diminishes. These abnormalities represent complex pathologic processes that can significantly impact morbidity, mortality, and quality of life for those individuals who have CKD. Additionally, the focus on bone and mineral abnormalities has changed as new assessment techniques and treatment options have evolved. Recognizing the magnitude of these bone and mineral abnormalities and the diversity in practice for treating them, the National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) developed and published evidence-based practice guidelines for CKD bone metabolism and disease in 2003. These guidelines address methods for identifying and classifying renal bone disease, recommend treatment options, and propose research initiatives. Early and continuous evaluation and treatment of bone and mineral abnormalities have the potential to improve outcomes of those with CKD.

ISTURBANCES in mineral and bone metabolism are common in patients with chronic kidney disease (CKD). A large body of evidence now clearly indicates that the derangements in mineral and bone metabolism in CKD are associated with increased morbidity and mortality. CKD patients can have bone pain, increased incidence of fractures, bone deformity, myopathy, muscle pain, and ruptures of tendons, and children with CKD suffer from retarded growth. The long-term effects of soft tissue calcifications have become an area of growing concern for CKD patients and those who treat them. Calcification of the lung leads to impaired pul

REcENT CHANGES in the Medicare policies for intradialytic parenteral nutrition (IDPN) became effective November 1 , 1993. Guidelines for coverage issued by the Durable Medical Equipment Regional Carriers (DMERC) reinforce many of the criteria already in place and suggest that adherence to those criteria will more rigid. Changes include minimum nutrient requirements and concrete proof of medical necessity. The Medicare Provider Reimbursement Manual (PRM) states

Address reprint requests to Linda McCann, RD, 1595 Riverfront Dr, Boise, 10 83703. © 1993 by the National Kidney Foundation, Inc. 1051-2276/93/ 0304-0006$03.00/ 0 see the patient before obtaining the results of the blood work for the current month. This questionnaire can be completed by the patient , the nurse, or the dietitian. Once the laboratory results are available, they can be interpreted in view of the information gathered on the questionnaire. Frequently, completing the questionnaire decreases the time needed to review the laboratory results and to problem solve with the patient by phone.

VITAMIN supplement recommendations for patients with renal disease have been somewhat controversial, with viewpoints ranging from the belief that no supplementation is needed in patients who are eating well to the belief that supplementation is always needed . Even those who propose that no supplementation is needed agree that supplementation with Recommended Dietary Allowance (RDA) levels of B-complex vitamins , folic acid, and vitamin C is not harmful in patients with renal disease. Since many renal patients do not eat well, supplementation seems appropriate. The products developed specifically to meet the needs of patients with renal disease are the supplements of choice. However, each patient has individual requirements that may not be met even with these specialized vitamin formulations . The renal dietitian has the responsibility to assess the individual needs of each patient. The assessment should include factors such as nutritional status, current nutrient intake, the disease state and comorbidities, drugnutrient interactions, nutrient-nutrient interactions, mode and parameters of renal replacement therapy, cultural practices , economics, and ease of compliance. Only after such an assessment can the appropriate vitamin therapy be recommended. Supplementation of specific vitamins , in addition to the renal vitamin, may be needed . In the past, patients who needed specific vitamins at levels greater than the RDA