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The transition to managed care raises concerns about the resulting quality of care. The report card, a publicly released, standardized report on quality, has received widespread acceptance as a method to evaluate physician performance. Current report cards provide insufficient information to allow purchasers of health care to assess accurately the performance of professionals who provide breast care. To overcome these limitations, we propose an expanded report card on breast cancer care. Mammographers and general surgeons would assess an independent series of at least 100 consecutive cases of newly diagnosed breast cancer. Mammographers would determine the percentage of invasive cancers < 15 mm detected on screening mammograms in asymptomatic women aged 50 to 74 years. Surgeons would determine the percentage of combined stages 0 and 1 breast cancers detected and the percentage of patients receiving breast-conserving surgical therapy. Performance targets are set at 60% for invasive cancers < 15 mm detected on screening mammography, 60% for combined stage 0 and 1 breast cancers, and 50% for patients receiving breast-conserving therapy. [ABSTRACT FROM AUTHOR]

Multiplexed analysis in medical diagnostics is widely accepted as a more thorough and complete method compared to single-analyte detection. While analytical methods like polymerase chain reaction and enzyme-linked immunosorbent assay (ELISA) exist for multiplexed detection of biomarkers, they remain time-consuming and expensive. Lateral flow assays (LFAs) are an attractive option for point-of-care testing, and examples of multiplexed LFAs exist. However, these devices are limited by spatial resolution of test lines, large sample volume requirements, cross-reactivity, and poor sensitivity. Recent work has developed capillary-flow microfluidic ELISA platforms as a more sensitive alternative to LFAs; however, multiplexed detection on these types of devices has yet to be demonstrated. In the aftermath of the initial SARS-CoV-2 pandemic, the need for rapid, sensitive point-of-care devices has become ever clearer. Moving forward, devices that can distinguish between diseases with similar presenting symptoms would be the ideal home diagnostic. Here, the first example of a multiplexed capillary-flow immunoassay device for the simultaneous detection of multiple biomarkers is reported. From a single sample addition step, the reagents and washing steps required for two simultaneous ELISAs are delivered to spatially separated test strips. Visual results can be obtained in <15 min, and images captured with a smartphone can be analyzed for quantitative data. This device was used to distinguish between and quantify H1N1 hemagglutinin (HA) and SARS-CoV-2 nucleocapsid protein (N-protein). Using this device, analytical detection limits of 840 and 133 pg/mL were obtained for hemagglutinin and nucleocapsid protein, respectively. The presence of one target in the device did not increase the signal on the other test line, indicating no cross-reactivity between the assays. Additionally, simultaneous detection of both N-protein and HA was performed as well as simultaneous detection of N-protein and human C-reactive protein (CRP). Elevated levels of CRP in a patient infected with SARS-CoV-2 have been shown to correlate with more severe outcomes and a greater risk of death as well. To further expand on the simultaneous detection of two biomarkers, CRP and N-protein were detected simultaneously, and the presence of SARS-CoV-2 N-protein did not interfere with the detection of CRP when both targets were present in the sample.

Introduction: Prolonged exposure therapy is an effective treatment for posttraumatic stress disorder that is underutilized in health systems, including the military health system. Organizational barriers to prolonged exposure implementation have been hypothesized but not systematically examined. This multisite project sought to identify barriers to increasing the use of prolonged exposure across eight military treatment facilities and describe potential solutions to addressing these barriers., Materials and Methods: As part of a larger project to increase the use of prolonged exposure therapy in the military health system, we conducted a needs assessment at eight military treatment facilities. The needs assessment included analysis of clinic administrative data and a series of stakeholder interviews with behavioral health clinic providers, leadership, and support staff. Key barriers were matched with potential solutions using a rubric developed for this project. Identified facilitators, barriers, and potential solutions were summarized in a collaboratively developed implementation plan for increasing prolonged exposure therapy tailored to each site., Results: There was a greater than anticipated consistency in the barriers reported by the sites, despite variation in the size and type of facility. The identified barriers were grouped into four categories: time-related barriers, provider-related barriers, barriers related to patient education and matching patients to providers, and scheduling-related barriers. Potential solutions to each barrier are described., Conclusions: The findings highlight the numerous organizational-level barriers to implementing evidence-based psychotherapy in the military health system and offer potential solutions that may be helpful in addressing the barriers., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Over the last few years, the SARS-CoV-2 pandemic has made the need for rapid, affordable diagnostics more compelling than ever. While traditional laboratory diagnostics like PCR and well-plate ELISA are sensitive and specific, they can be costly and take hours to complete. Diagnostic tests that can be used at the point-of-care or at home, like lateral flow assays (LFAs) are a simple, rapid alternative, but many commercially available LFAs have been criticized for their lack of sensitivity compared to laboratory methods like well-plate ELISAs. The Capillary-Driven Immunoassay (CaDI) device described in this work uses microfluidic channels and capillary action to passively automate the steps of a traditional well-plate ELISA for visual read out. This work builds on prior capillary-flow devices by further simplifying operation and use of colorimetric detection. Upon adding sample, an enzyme-conjugated secondary antibody, wash steps, and substrate are sequentially delivered to test and control lines on a nitrocellulose strip generating a colorimetric response. The end user can visually detect SARS-CoV-2 antigen in 15-20 min by naked eye, or results can be quantified using a smartphone and software such as ImageJ. An analytical detection limit of 83 PFU/mL for SARS-CoV-2 was determined for virus in buffer, and 222 PFU/mL for virus spiked into nasal swabs using image analysis, similar to the LODs determined by traditional well-plate ELISA. Additionally, a visual detection limit of 100 PFU/mL was determined in contrived nasal swab samples by polling 20 untrained end-users. While the CaDI device was used for detecting clinically relevant levels of SARS-CoV-2 in this study, the CaDI device can be easily adapted to other immunoassay applications by changing the reagents and antibodies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Overfishing has severe social, economic, and environmental ramifications. Eliminating global overfishing is one of the United Nations' Sustainable Development Goals (SDGs). The SDGs require effective policy and progress monitoring. However, current indicators are issue-specific and cannot be utilized to measure fisheries efficacy holistically. This study develops a comprehensive index that takes into account the inputs, outputs, and ecological implications of fisheries. These components are then merged to form a single composite fishing index that evaluates both total fishing pressure on the ecosystem and historical patterns. The global fishing intensity grew by a factor of eleven between 1950 and 2017, and geographical differences emerged. The fishing intensity of developed countries peaked in 1997 and has since fallen due to management, but developing countries' fishing intensity has increased continuously over the whole research period, with quasi-linear growth after 1980. Africa has experienced the most rapid expansion in fishing activity and now has the highest fishing intensity. This index takes a more comprehensive and objective look at fisheries. Its worldwide spatial-temporal comparison enables the identification of similar temporal trends across countries or regions, as well as areas of uneven development and hotspot sites for targeted policy action., (© 2023. The Author(s).)

A common goal among fisheries science professionals, stakeholders, and rights holders is to ensure the persistence and resilience of vibrant fish populations and sustainable, equitable fisheries in diverse aquatic ecosystems, from small headwater streams to offshore pelagic waters. Achieving this goal requires a complex intersection of science and management, and a recognition of the interconnections among people, place, and fish that govern these tightly coupled socioecological and sociotechnical systems. The World Fisheries Congress (WFC) convenes every four years and provides a unique global forum to debate and discuss threats, issues, and opportunities facing fish populations and fisheries. The 2021 WFC meeting, hosted remotely in Adelaide, Australia, marked the 30th year since the first meeting was held in Athens, Greece, and provided an opportunity to reflect on progress made in the past 30 years and provide guidance for the future. We assembled a diverse team of individuals involved with the Adelaide WFC and reflected on the major challenges that faced fish and fisheries over the past 30 years, discussed progress toward overcoming those challenges, and then used themes that emerged during the Congress to identify issues and opportunities to improve sustainability in the world's fisheries for the next 30 years. Key future needs and opportunities identified include: rethinking fisheries management systems and modelling approaches, modernizing and integrating assessment and information systems, being responsive and flexible in addressing persistent and emerging threats to fish and fisheries, mainstreaming the human dimension of fisheries, rethinking governance, policy and compliance, and achieving equity and inclusion in fisheries. We also identified a number of cross-cutting themes including better understanding the role of fish as nutrition in a hungry world, adapting to climate change, embracing transdisciplinarity, respecting Indigenous knowledge systems, thinking ahead with foresight science, and working together across scales. By reflecting on the past and thinking about the future, we aim to provide guidance for achieving our mutual goal of sustaining vibrant fish populations and sustainable fisheries that benefit all. We hope that this prospective thinking can serve as a guide to (i) assess progress towards achieving this lofty goal and (ii) refine our path with input from new and emerging voices and approaches in fisheries science, management, and stewardship., (© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objective: Using embedded performance validity (PVT) comparisons, Erdodi et al. suggested that Grooved Pegboard (GPB) T-score cutoffs for either hand ( ≤ 29) or both hands ( ≤ 31) could be used as additional embedded PVTs. The current study evaluated the relationship between these proposed cutoff scores and established PVTs (Medical Symptom Validity Test [MSVT]; Non-Verbal Medical Symptom Validity Test [NV-MSVT], and Reliable Digit Span [RDS])., Method: Participants (N = 178) were predominately Caucasian (84%) males (79%) with a mean age and education of 41 (SD = 11.7) and 15.8 years (SD = 2.3), respectively. Participants were stratified as "passing" or "failing" the GPBviaErdodi's proposed criteria. "Failures" on the MSVT, NV-MSVT, and RDS were based on conventional recommendations., Results: Moderate correlations between GPB classification and a condition of interest (COI; i.e. at least two failures on reference PVTs) were observed for dominant (χ 2 (1, n = 178) = 34.72, ϕ = .44, p < .001), non-dominant (χ 2 (1, n = 178) = 16.46, ϕ = .30, p = .001), and both hand conditions (χ 2 (1, n = 178) = 32.48, ϕ = .43, p < .001). Sensitivity, specificity, and predictive power were generally higher than Erdodi et al.'s initial findings., Conclusion: These findingsprovide supportfor the clinical utility of the GPB as an additional embedded PVT. More specifically, dominant and both hand cutoffs were found to be more robust measures ofnon-genuine performance in those without motor deficits. While promising, sensitivity continues to be low; therefore, it is ill-advised to use the GPB as a sole measure of -performance validity.

The United States, the EU and Canada established a trilateral working group on the ecosystem approach to ocean health and stressors under the Atlantic Ocean Research Alliance. Recognizing the Atlantic Ocean as a shared resource and responsibility, the working group sought to advance understanding of the Atlantic Ocean and its dynamic systems to improve ocean health, enhance ocean stewardship and promote the sustainable use and management of its resources. This included consideration of multiple ocean-use sectors such as fishing, shipping, tourism and offshore energy. The working group met for 4 years and worked through eight steps that covered the development of common language as a basis for collaboration, challenges of stakeholder engagement, review of the governance mandates, exploring the links between sectors and ecosystems effects, identifying gaps in knowledge and uptake of science, identification of tools for ecosystem-based management, customary best practice for tool development and communication of key research priorities. The key findings were that ecosystem-based management enables new benefits and opportunities, and that we need to make the business case. Further findings were that adequate mandates and effective tools exist for ecosystem-based management, and that ecosystem-based management urgently requires integration of human dimensions, so we must diversify the conversation. In addition, it was found that stakeholders do not see their stake in ecosystem-based management, so greater engagement with stakeholders and targeting of ocean literacy is required and a sustainable future requires a sustained investment in ecosystem-based management, so long-term commitment is key., (© 2022 Fisheries Society of the British Isles.)

Microfluidic paper-based analytical devices (μPADs) have garnered significant interest as a promising analytical platform in the past decade. Compared with traditional microfluidics, μPADs present unique advantages, such as easy fabrication using established patterning methods, economical cost, ability to drive and manipulate flow without equipment, and capability of storing reagents for various applications. This Review aims to provide a comprehensive review of the field, highlighting fabrication methods available to date with their respective advantages and drawbacks, device designs and modifications to accommodate different assay needs, detection strategies, and the growing applications of μPADs. Finally, we discuss how the field needs to continue moving forward to realize its full potential.

Living marine resources (LMRs) contribute considerably to marine economies. Oceans continue to respond to the effects of global change, with environmental factors anticipated to impact future seafood production and its associated economic performance. Here we document novel relationships between primary productivity and LMR-based economics for US regional marine ecosystems and 64 international large marine ecosystems (LMEs). Intermediate relationships between production, total biomass, fisheries landings, revenue, and LMR-based employment are also elucidated. We found that all these factors were dependent on the amount of basal production in a given system. In addition, factors including human population, exploitation history, and governance interventions significantly influenced these relationships. As system productivity plays a foundational role in determining fisheries-based economics throughout global LMEs, greater accounting for these relationships has significant implications for global seafood sustainability and food security. Quantifying the direct link between primary production and fisheries economic performance serves to better inform ecosystem overfishing thresholds and their economic consequences. Further recognition and understanding of these relationships is key to ensuring that these connections are accounted for more effectively in sustainable management practices.

Background: The ExteNET trial demonstrated improved invasive disease-free survival (iDFS) with neratinib, an irreversible pan-HER tyrosine kinase inhibitor, versus placebo in patients with human epidermal growth factor receptor 2-positive (HER2 + )/hormone receptor-positive (HR + ) early-stage breast cancer (eBC)., Patients and Methods: ExteNET was a multicenter, randomized, double-blind, phase III trial of 2840 patients with HER2 + eBC after neoadjuvant/adjuvant trastuzumab-based therapy. Patients were stratified by HR status and randomly assigned 1-year oral neratinib 240 mg/day or placebo. The primary endpoint was iDFS. Descriptive analyses were performed in patients with HR + eBC who initiated treatment ≤ 1 year (HR + /≤ 1-year) and > 1 year (HR + /> 1-year) post-trastuzumab., Results: HR + /≤ 1-year and HR + /> 1-year populations comprised 1334 (neratinib, n = 670; placebo, n = 664) and 297 (neratinib, n = 146; placebo, n = 151) patients, respectively. Absolute iDFS benefits at 5 years were 5.1% in HR + /≤ 1-year (hazard ratio, 0.58; 95% confidence interval [CI], 0.41-0.82) and 1.3% in HR + />1-year (hazard ratio, 0.74; 95% CI, 0.29-1.84). In HR + /≤ 1-year, neratinib was associated with a numerical improvement in overall survival (OS) at 8 years (absolute benefit, 2.1%; hazard ratio, 0.79; 95% CI, 0.55-1.13). Of 354 patients in the HR + /≤ 1-year group who received neoadjuvant therapy, 295 had residual disease, and results showed absolute benefits of 7.4% at 5-year iDFS (hazard ratio, 0.60; 95% CI, 0.33-1.07) and 9.1% at 8-year OS (hazard ratio, 0.47; 95% CI, 0.23-0.92). There were fewer central nervous system events with neratinib. Adverse events were similar to those previously reported., Conclusion: Neratinib significantly improved iDFS in the HER2 + /HR + /≤ 1-year population, and a similar trend was observed in patients with residual disease following neoadjuvant treatment. Numerical improvements in central nervous system events and OS were consistent with iDFS benefits and suggest long-term benefit for neratinib in this population., (Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.)

Projections of climate change impacts on marine ecosystems have revealed long-term declines in global marine animal biomass and unevenly distributed impacts on fisheries. Here we apply an enhanced suite of global marine ecosystem models from the Fisheries and Marine Ecosystem Model Intercomparison Project (Fish-MIP), forced by new-generation Earth system model outputs from Phase 6 of the Coupled Model Intercomparison Project (CMIP6), to provide insights into how projected climate change will affect future ocean ecosystems. Compared with the previous generation CMIP5-forced Fish-MIP ensemble, the new ensemble ecosystem simulations show a greater decline in mean global ocean animal biomass under both strong-mitigation and high-emissions scenarios due to elevated warming, despite greater uncertainty in net primary production in the high-emissions scenario. Regional shifts in the direction of biomass changes highlight the continued and urgent need to reduce uncertainty in the projected responses of marine ecosystems to climate change to help support adaptation planning., Competing Interests: Competing interestsThe authors declare no competing interests., (© The Author(s) 2021.)

There is long-standing ecological and socioeconomic interest in what controls the diversity and productivity of ecosystems. That focus has intensified with shifting environmental conditions associated with accelerating climate change. The U.S. Northeast Shelf (NES) is a well-studied continental shelf marine ecosystem that is among the more rapidly warming marine systems worldwide. Furthermore, many constituent species have experienced significant distributional shifts. However, the system response of the NES to climate change goes beyond simple shifts in species distribution. The fish and macroinvertebrate communities of the NES have increased in species diversity and overall productivity in recent decades, despite no significant decline in fishing pressure. Species distribution models constructed using random forest classification and regression trees were fit for the dominant species in the system. Over time, the areal distribution of occupancy habitat has increased for approximately 80% of the modeled taxa, suggesting most species have significantly increased their range and niche space. These niche spaces were analyzed to determine the area of niche overlap between species pairs. For the vast majority of species pairs, interaction has increased over time suggesting greater niche overlap and the increased probability for more intense species interactions, such as between competitors or predators and prey. Furthermore, the species taxonomic composition and size structure indicate a potential tropicalization of the fish community. The system and community changes are consistent with the view that the NES may be transitioning from a cold temperate or boreal ecoregion to one more consistent with the composition of a warm temperate or Carolinian system., (Published by Elsevier B.V.)

Implementing the Ecosystem Approach in marine ecosystems is moving from preliminary steps-dedicated to defining the optimal features for indicators and developing efficient indicator frameworks-towards an operational phase where multisector marine management decisions are executed using this information. Within this operational context, emergent ecosystem properties are becoming quite promising as they have been demonstrated to be globally widespread and repeatable, and to be quite effective in detecting significant state variations of complex systems. Biomass accumulation across TLs (CumB-TL) combines two important emergent properties of an ecosystem (energy flow, in terms of transfer efficiency, and storage, expressed as biomass), both amenable to detecting rapid ecosystem change. However, for further application, it is crucial to understand which types of drivers an indicator is sensitive to and how robust it is in relation to modifications of the external conditions and/or the system state. Here we address some outstanding questions of these CumB-TL curves related to their sensitivity to various drivers by carrying out a global scale assessment (using data from 62 LMEs) over six decades (1950-2010). We confirm the consistency of the S-pattern across all the LMEs, independent from latitude, ecosystem, environmental conditions, and stress level. The dynamics of the curve shape showed a tendency to stretch (i.e. decrease of steepness), in the presence of external disturbance and conversely to increase in steepness and shift towards higher TL in the case of recovery from stressed conditions. Our results suggest the presence of three main types of ecosystem dynamics, those showing an almost continuous increase in ecological state over time, those showing a continuous decrease in ecological state over time, and finally those showing a mixed behaviour flipping between recovering and degrading phases. These robust patterns suggest that the CumB-TL curve approach has some useful properties for use in further advancing the implementation of the Ecosystem Approach, allowing us to detect the state of a given marine ecosystem based on the dynamics of its curve shape, by using readily available time series data. The value of being able to identify conditions that might require management actions is quite high and, in many respects, represents the main objective in the context of an Ecosystem Approach, with large applications for detecting and responding to global changes in marine ecosystems., (© 2019 John Wiley & Sons Ltd.)

Acceptance and commitment therapy (ACT), a form of cognitive behavioral therapy, predominately focuses on addressing one's relationship with thoughts and emotions rather than attempting to alter them. The use of ACT has demonstrated efficacy in interactions with patients suffering from a variety of mental health concerns. While there are no specific criteria for the use of ACT, one compelling argument that exists in support of its use is that ACT may be more efficacious than other control-based protocols in treating experiential avoidance. Further, there is some evidence available to suggest that ACT is more effective than other active treatments for depression. Here, the six core processes of ACT therapy are discussed and the application of ACT techniques in clinical practice is explored., Competing Interests: FUNDING:No funding was provided. DISCLOSURES:The authors have no conflicts of interest relevant to the content of this article., (Copyright © 2019. Matrix Medical Communications. All rights reserved.)

The well-documented value of marine fisheries is threatened by overfishing. Management typically focuses on target populations but lacks effective tools to document or restrain overexploitation of marine ecosystems. Here, we present three indices and accompanying thresholds to detect and delineate ecosystem overfishing (EOF): the Fogarty, Friedland, and Ryther indices. These are based on widely available and readily interpreted catch and satellite data that link fisheries landings to primary production using known limits of trophic transfer efficiency. We propose theoretically and empirically based thresholds for each of those indices; with these criteria, several ecosystems are fished sustainably, but nearly 40 to 50% of tropical and temperate ecosystems exceed even extreme thresholds. Applying these criteria to global fisheries data results in strong evidence for two specific instances of EOF, increases in both pressure on tropical fish and a climate-mediated polar shift. Here, we show that these two patterns represent evidence for global EOF.

Background: ExteNET showed that 1 year of neratinib, an irreversible pan-HER tyrosine kinase inhibitor, significantly improves 2-year invasive disease-free survival after trastuzumab-based adjuvant therapy in women with HER2-positive breast cancer. We report updated efficacy outcomes from a protocol-defined 5-year follow-up sensitivity analysis and long-term toxicity findings., Methods: In this ongoing randomised, double-blind, placebo-controlled, phase 3 trial, eligible women aged 18 years or older (≥20 years in Japan) with stage 1-3c (modified to stage 2-3c in February, 2010) operable breast cancer, who had completed neoadjuvant and adjuvant chemotherapy plus trastuzumab with no evidence of disease recurrence or metastatic disease at study entry. Patients who were eligible patients were randomly assigned (1:1) via permuted blocks stratified according to hormone receptor status (hormone receptor-positive vs hormone receptor-negative), nodal status (0 vs 1-3 vs or ≥4 positive nodes), and trastuzumab adjuvant regimen (given sequentially vs concurrently with chemotherapy), then implemented centrally via an interactive voice and web-response system, to receive 1 year of oral neratinib 240 mg/day or matching placebo. Treatment was given continuously for 1 year, unless disease recurrence or new breast cancer, intolerable adverse events, or consent withdrawal occurred. Patients, investigators, and trial funder were masked to treatment allocation. The predefined endpoint of the 5-year analysis was invasive disease-free survival, analysed by intention to treat. ExteNET is registered with ClinicalTrials.gov, number NCT00878709, and is closed to new participants., Findings: Between July 9, 2009, and Oct 24, 2011, 2840 eligible women with early HER2-positive breast cancer were recruited from community-based and academic institutions in 40 countries and randomly assigned to receive neratinib (n=1420) or placebo (n=1420). After a median follow-up of 5·2 years (IQR 2·1-5·3), patients in the neratinib group had significantly fewer invasive disease-free survival events than those in the placebo group (116 vs 163 events; stratified hazard ratio 0·73, 95% CI 0·57-0·92, p=0·0083). The 5-year invasive disease-free survival was 90·2% (95% CI 88·3-91·8) in the neratinib group and 87·7% (85·7-89·4) in the placebo group. Without diarrhoea prophylaxis, the most common grade 3-4 adverse events in the neratinib group, compared with the placebo group, were diarrhoea (561 [40%] grade 3 and one [<1%] grade 4 with neratinib vs 23 [2%] grade 3 with placebo), vomiting (grade 3: 47 [3%] vs five [<1%]), and nausea (grade 3: 26 [2%] vs two [<1%]). Treatment-emergent serious adverse events occurred in 103 (7%) women in the neratinib group and 85 (6%) women in the placebo group. No evidence of increased risk of long-term toxicity or long-term adverse consequences of neratinib-associated diarrhoea were identified with neratinib compared with placebo., Interpretation: At the 5-year follow-up, 1 year of extended adjuvant therapy with neratinib, administered after chemotherapy and trastuzumab, significantly reduced the proportion of clinically relevant breast cancer relapses-ie, those that might lead to death, such as distant and locoregional relapses outside the preserved breast-without increasing the risk of long-term toxicity. An analysis of overall survival is planned after 248 events., Funding: Wyeth, Pfizer, and Puma Biotechnology., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

This work's goal was to research new candidate antigens for cutaneous leishmaniosis (CL). In order to reach the goal, we used random peptide phage display libraries screened using antibodies from Leishmania braziliensis patients. After selection, three peptides (P1, P2, and P3) were synthesized using Fmoc chemistry. The peptides individually or a mixture of them (MIX) was subsequently emulsified in complete and incomplete Freund's adjuvant and injected subcutaneously in golden hamsters. Sera from the hamsters administered with P1 presented antibodies that recognized proteins between 76 and 150 kDa from L. braziliensis . Sera from hamsters which had peptides P2 and P3, as well as the MIX, administered presented antibodies that recognized proteins between 52 and 76 kDa of L. braziliensis . The research on the similarity of the peptides' sequences in protein databases showed that they match a 63 kDa glycoprotein. The three peptides and the MIX were recognized by the sera from CL patients by immunoassay approach (ELISA). The peptides' MIX showed the best performance (79% sensitivity) followed by the P1 (72% sensitivity), and the AS presented 91% sensitivity. These results show a new route for discovering molecules for diagnosis or for immunoprotection against leishmaniosis., Competing Interests: The authors declare that they have no competing interests regarding the publication of this paper.

This Rehabilitation Measures Database summary provides a review of the characteristics of the BLT for individuals with right temporal lobe epilepsy. A full review of the BLT as well as reviews of over 300 other instruments can be found at www.rehabmeasures.org. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

The food habits of Melanogrammus aeglefinus were explored and contrasted across multiple north-eastern and north-western Atlantic Ocean ecosystems, using databases that span multiple decades. The results show that among all ecosystems, echinoderms are a consistent part of M. aeglefinus diet, but patterns emerge regarding where and when M. aeglefinus primarily eat fishes v. echinoderms. Melanogrammus aeglefinus does not regularly exhibit the increase in piscivory with ontogeny that other gadoids often show, and in several ecosystems there is a lower occurrence of piscivory. There is an apparent inverse relationship between the consumption of fishes and echinoderms in M. aeglefinus over time, where certain years show high levels of one prey item and low levels of the other. This apparent binary choice can be viewed as part of a gradient of prey options, contingent upon a suite of factors external to M. aeglefinus dynamics. The energetic consequences of this prey choice are discussed, noting that in some instances it may not be a choice at all., (© 2016 The Fisheries Society of the British Isles.)

Need to Assess the Skill of Ecosystem Models: Accelerated changes to global ecosystems call for holistic and integrated analyses of past, present and future states under various pressures to adequately understand current and projected future system states. Ecosystem models can inform management of human activities in a complex and changing environment, but are these models reliable? Ensuring that models are reliable for addressing management questions requires evaluating their skill in representing real-world processes and dynamics. Skill has been evaluated for just a limited set of some biophysical models. A range of skill assessment methods have been reviewed but skill assessment of full marine ecosystem models has not yet been attempted., Northeast Us Atlantis Marine Ecosystem Model: We assessed the skill of the Northeast U.S. (NEUS) Atlantis marine ecosystem model by comparing 10-year model forecasts with observed data. Model forecast performance was compared to that obtained from a 40-year hindcast. Multiple metrics (average absolute error, root mean squared error, modeling efficiency, and Spearman rank correlation), and a suite of time-series (species biomass, fisheries landings, and ecosystem indicators) were used to adequately measure model skill. Overall, the NEUS model performed above average and thus better than expected for the key species that had been the focus of the model tuning. Model forecast skill was comparable to the hindcast skill, showing that model performance does not degenerate in a 10-year forecast mode, an important characteristic for an end-to-end ecosystem model to be useful for strategic management purposes., Skill Assessment Is Both Possible and Advisable: We identify best-practice approaches for end-to-end ecosystem model skill assessment that would improve both operational use of other ecosystem models and future model development. We show that it is possible to not only assess the skill of a complicated marine ecosystem model, but that it is necessary do so to instill confidence in model results and encourage their use for strategic management. Our methods are applicable to any type of predictive model, and should be considered for use in fields outside ecology (e.g. economics, climate change, and risk assessment).

Whether there are common and emergent patterns from marine ecosystems remains an important question because marine ecosystems provide billions of dollars of ecosystem services to the global community, but face many perturbations with significant consequences. Here, we develop cumulative trophic patterns for marine ecosystems, featuring sigmoidal cumulative biomass (cumB)-trophic level (TL) and 'hockey-stick' production (cumP)-cumB curves. The patterns have a trophodynamic theoretical basis and capitalize on emergent, fundamental, and invariant features of marine ecosystems. These patterns have strong global support, being observed in over 120 marine ecosystems. Parameters from these curves elucidate the direction and magnitude of marine ecosystem perturbation or recovery; if biomass and productivity can be monitored effectively over time, such relations may prove to be broadly useful. Curve parameters are proposed as possible ecosystem thresholds, perhaps to better manage the marine ecosystems of the world., (Published by Elsevier Ltd.)

The objectives of this work were to quantify the spatial and temporal distribution of the occurrence of anadromous fishes (alewife Alosa pseudoharengus, blueback herring Alosa aestivalis and American shad Alosa sapidissima) in the stomachs of demersal fishes in coastal waters of the north-west Atlantic Ocean. Results show that anadromous fishes were detectable and quantifiable in the diets of common marine piscivores for every season sampled. Even though anadromous fishes were not the most abundant prey, they accounted for c. 5-10% of the diet by mass for several marine piscivores. Statistical comparisons of these data with fish diet data from a broad-scale survey of the north-west Atlantic Ocean indicate that the frequency of this trophic interaction was significantly higher within spatially and temporally focused sampling areas of this study than in the broad-scale survey. Odds ratios of anadromous predation were as much as 460 times higher in the targeted sampling as compared with the broad-scale sampling. Analyses indicate that anadromous prey consumption was more concentrated in the near-coastal waters compared with consumption of a similar, but more widely distributed species, the Atlantic herring Clupea harengus. In the context of ecosystem-based fisheries management, the results suggest that even low-frequency feeding events may be locally important, and should be incorporated into ecosystem models., (© 2015 The Fisheries Society of the British Isles.)

The ability to understand and ultimately predict ecosystem response to multiple pressures is paramount to successfully implement ecosystem-based management. Thresholds shifts and nonlinear patterns in ecosystem responses can be used to determine reference points that identify levels of a pressure that may drastically alter ecosystem status, which can inform management action. However, quantifying ecosystem reference points has proven elusive due in large part to the multi-dimensional nature of both ecosystem pressures and ecosystem responses. We used ecological indicators, synthetic measures of ecosystem status and functioning, to enumerate important ecosystem attributes and to reduce the complexity of the Northeast Shelf Large Marine Ecosystem (NES LME). Random forests were used to quantify the importance of four environmental and four anthropogenic pressure variables to the value of ecological indicators, and to quantify shifts in aggregate ecological indicator response along pressure gradients. Anthropogenic pressure variables were critical defining features and were able to predict an average of 8-13% (up to 25-66% for individual ecological indicators) of the variation in ecological indicator values, whereas environmental pressures were able to predict an average of 1-5 % (up to 9-26% for individual ecological indicators) of ecological indicator variation. Each pressure variable predicted a different suite of ecological indicator's variation and the shapes of ecological indicator responses along pressure gradients were generally nonlinear. Threshold shifts in ecosystem response to exploitation, the most important pressure variable, occurred when commercial landings were 20 and 60% of total surveyed biomass. Although present, threshold shifts in ecosystem response to environmental pressures were much less important, which suggests that anthropogenic pressures have significantly altered the ecosystem structure and functioning of the NES LME. Gradient response curves provide ecologically informed transformations of pressure variables to explain patterns of ecosystem structure and functioning. By concurrently identifying thresholds for a suite of ecological indicator responses to multiple pressures, we demonstrate that ecosystem reference points can be evaluated and used to support ecosystem-based management.

The economic and ecological impacts of fish consumption by marine mammals, the associated interactions with commercial fish stocks, and the forage demands of these marine mammal populations are largely unknown. Consumption estimates are often either data deficient or not fully evaluated in a rigorous, quantitative manner. Although consumption estimates exist for the Northeast United States (NEUS) Large Marine Ecosystem, there is considerable uncertainty in those estimates. We examined consumption estimates for 12 marine mammal species inhabiting the regional ecosystem. We used sensitivity analyses to examine metabolically driven daily individual consumption rates, resulting in a suite of feasible parameter-pair ranges for each of three taxonomic groups: mysticetes, odontocetes, and pinnipeds. We expanded daily individual consumption to annual consumption based on abundance estimates of marine mammals found on the NEUS continental shelf coupled with estimates of annual residence time for each species. To examine consumptive removals for specific prey, diet compositions were summarized into major prey categories, and predatory removals by marine mammal species as well as for total marine mammal consumption were estimated for each prey taxa. Bounds on consumption estimates for each marine mammal species were determined using Monte Carlo resampling simulations. Our results suggest that consumption for these 12 marine mammal species combined may be similar in magnitude to commercial fishery landings for small pelagic and groundfish prey groups. Consumption by marine mammals warrants consideration both as a source of mortality in assessments of prey-stocks, and to determine marine mammal forage demands in ecosystem assessment models. The approach that we present represents a rigorous, quantitative method to scope the bounds of the biomass that marine mammals are expected to consume, and is appropriate for use in other ecosystems where the interaction between marine mammals and commercial fisheries is thought to be prominent.