Plastic pollution on the world's coral reefs.

Coral reefs are losing the capacity to sustain their biological functions1. In addition to other well-known stressors, such as climatic change and overfishing1, plastic pollution is an emerging threat to coral reefs, spreading throughout reef food webs2, and increasing disease transmission and structural damage to reef organisms3. Although recognized as a global concern4, the distribution and quantity of plastics trapped in the world's coral reefs remains uncertain3. Here we survey 84 shallow and deep coral ecosystems at 25 locations across the Pacific, Atlantic and Indian ocean basins for anthropogenic macrodebris (pollution by human-generated objects larger than 5 centimetres, including plastics), performing 1,231 transects. Our results show anthropogenic debris in 77 out of the 84 reefs surveyed, including in some of Earth's most remote and near-pristine reefs, such as in uninhabited central Pacific atolls. Macroplastics represent 88% of the anthropogenic debris, and, like other debris types, peak in deeper reefs (mesophotic zones at 30-150 metres depth), with fishing activities as the main source of plastics in most areas. These findings contrast with the global pattern observed in other nearshore marine ecosystems, where macroplastic densities decrease with depth and are dominated by consumer items5. As the world moves towards a global treaty to tackle plastic pollution6, understanding its distribution and drivers provides key information to help to design the strategies needed to address this ubiquitous threat.

Terelabrus toretore sp. nov. (Perciformes: Labridae), a New Species of Striped Hogfish from Tahiti, with Range Extensions for Two Congeners.

A new labrid fish, Terelabrus toretore sp. nov., the fifth species within the genus, is herein described from two specimens collected at a depth of 140 m from a mesophotic coral ecosystem in Tahiti, French Polynesia. Terelabrus toretore sp. nov. is characterized by having 43-44 scaled rows in longitudinal series; 42 pored lateral-line scales; 5+10 gill rakers; 10 scale rows below the lateral line; 8 posterior branches on the main supratemporal sensory canal; a relatively long snout (snout length 9.6-9.7% SL), and a coloration consisting of a yellow caudal fin and a wide, red, mid-lateral stripe with no blotching, the space above which is white anteriorly, becoming predominantly yellow from beneath the dorsal fin to the caudal peduncle. In addition to describing this new species, we document the first record of Terelabrus rubrovittatus from the Republic of Marshall Islands, and the first record of Terelabrus zonalis from Australia, along with the first description of its coloration. We present a molecular phylogeny of the genus based upon mitochondrial cytochrome c oxidase subunit I (COI) DNA sequences.

Assembly rules of coral reef fish communities along the depth gradient.

Coral reefs are home to some of the most studied ecological assemblages on the planet. However, differences in large-scale assembly rules have never been studied using empirical quantitative data stratified along the depth gradient of reefs. Consequently, little is known about the small- and regional-scale effects of depth on coral reef assemblages. Using a large dataset of underwater surveys, we observed that the influence of classic biogeographic drivers on the species richness of coral reef fishes changes significantly with depth, shaping distinct assemblages governed by different rules in mesophotic coral ecosystems. We show that a general pattern of decreased taxonomic and functional richness of reef fish assemblages with depth results from convergent filtering of species composition and trophic strategies on deeper reefs across ocean basins and that at smaller scales deep-reef communities are less influenced by regional factors than shallower reefs.

Disturbance and distribution gradients influence resource availability and feeding behaviours in corallivore fishes following a warm-water anomaly.

Understanding interactions between spatial gradients in disturbances, species distributions and species' resilience mechanisms is critical to identifying processes that mediate environmental change. On coral reefs, a global expansion of coral bleaching is likely to drive spatiotemporal pulses in resource quality for obligate coral associates. Using technical diving and statistical modelling we evaluated how depth gradients in coral distribution, coral bleaching, and competitor density interact with the quality, preference and use of coral resources by corallivore fishes immediately following a warm-water anomaly. Bleaching responses varied among coral genera and depths but attenuated substantially between 3 and 47 m for key prey genera (Acropora and Pocillopora). While total coral cover declined with depth, the cover of pigmented corals increased slightly. The abundances of three focal obligate-corallivore butterflyfish species also decreased with depth and were not related to spatial patterns in coral bleaching. Overall, all species selectively foraged on pigmented corals. However, the most abundant species avoided feeding on bleached corals more successfully in deeper waters, where bleaching prevalence and conspecific densities were lower. These results suggest that, as coral bleaching increases, energy trade-offs related to distributions and resource acquisition will vary with depth for some coral-associated species.

Pseudanthiashangapiko, a new anthiadine serranid (Teleostei, Serranidae, Anthiadinae) from Rapa Nui (Easter Island).

Pseudanthiashangapiko sp. nov. (Teleostei, Serranidae, Anthiadinae) is herein described from three specimens collected from a depth of 83 m in a mesophotic coral ecosystem off Hanga Piko, Rapa Nui (Easter Island), Chile. Pseudanthiashangapiko sp. nov. can be distinguished from its congeners in live coloration and by the following combination of characters: dorsal-fin rays X, 17; anal-fin rays III, 8; pectoral-fin rays 16 (left side of one specimen 17); vertebrae 10+16; scales relatively large, two scales above lateral-line to base of fifth dorsal spine, and 16-17 circumpeduncular scales; gill rakers 11+23; and a slender body, with greatest body depth 3.6 (3.4-3.8) in SL. The most similar DNA barcodes (mitochondrial COI gene) are from Pseudanthiasventralis Randall, 1979 and Pseudanthiashawaiiensis Randall, 1979, with 16.8% and 17.0% uncorrected divergence, respectively. This fish is one of four new species that were documented from a pair of technical dives at a single location in Rapa Nui, emphasizing the high number of undescribed species likely still unknown in mesophotic coral ecosystems, especially in geographically remote locations. Pseudanthiashangapiko sp. nov. adds to the Rapa Nui ichthyofauna, which hosts the second-highest level of endemism in both shallow and deep-water fishes.

Two new species of Plectranthias (Teleostei, Serranidae, Anthiadinae) from mesophotic coral ecosystems in the tropical Central Pacific.

Two new species of Plectranthias perchlets are described, collected from mesophotic coral ecosystems in French Polynesia and the Republic of the Marshall Islands, in the tropical Central Pacific. Plectranthias polygonius sp. nov. was collected at a depth of 105 m in Tahiti, French Polynesia, and 120 m in Maloelap Atoll, Republic of the Marshall Islands. It was also observed in Moorea and Rangiroa (French Polynesia), and at Majuro and Erikub Atolls, Republic of the Marshall Islands. Plectranthias hinano sp. nov. was collected at a depth of 90-98 m in Tahiti, French Polynesia, and observed in Moorea. The barcode fragment of the cytochrome oxidase I gene of Plectranthias polygonius sp. nov. does not closely match any published sequence of Plectranthias, with approximately 15% uncorrected divergence from several species. Plectranthias polygonius sp. nov. can be distinguished from all of its congeners by coloration and morphology. The barcode fragment of the COI gene of Plectranthias hinano sp. nov. is closest to Plectranthias bennetti, with 5.4% uncorrected divergence. Plectranthias hinano sp. nov. is also distinguished from all of its congeners by morphology, and a coloration that includes two indistinct black spots along the base of the dorsal-fin, and transparent yellow dorsal and anal fin membranes. With this publication, the genus Plectranthias now comprises 58 valid species, with representatives from tropical to temperate waters of the Atlantic, Pacific, and Indian oceans. These two new discoveries add to the growing body of research highlighting the rich biodiversity of mesophotic ecosystems.

Mesophotic ecosystems at Fernando de Noronha Archipelago, Brazil (South-western Atlantic), reveal unique ichthyofauna and need for conservation

Abstract Although several studies on the ichthyofauna of the Fernando de Noronha Archipelago have been carried out, its mesophotic fish diversity has never been surveyed before. Here we used SCUBA and technical rebreather diving, baited remote underwater videos and remotely operated vehicle to record shallow (≤ 30 m depth) and mesophotic (31 to 150 m depth) fishes. Nineteen fish species belonging to 14 families are reported here as new records, representing an increase of 8.2% in marine fish richness for the region, which now has a total of 250 species and 77 families. These new records include four potential new species and highlight the importance of surveying mesophotic ecosystems, even in well studied sites. Our results also emphasize the need for protection and attention to the unique ichthyofauna found at mesophotic depths.(AU)

Resumo Apesar de muitos estudos sobre a ictiofauna do Arquipélago de Fernando de Noronha terem sido realizados, sua diversidade de peixes mesofóticos nunca foi estudada antes. Neste estudo utilizamos mergulho autônomo e mergulho técnico, vídeos subaquáticos remotos com isca e veículo operado remotamente para registrar peixes de ecossistemas rasos (≤ 30 m de profundidade) e mesofóticos (31 a 150 m de profundidade). Dezenove espécies de peixes pertencentes a 14 famílias são apresentadas aqui como novos registros, representando um aumento de 8,2% na riqueza de peixes marinhos da região, que agora possui um total de 250 espécies e 77 famílias. Esses novos registros incluem quatro prováveis novas espécies e reforçam a importância de estudos em ecossistemas mesofóticos. Nossos resultados também enfatizam a necessidade de proteção e atenção à essa ictiofauna única encontrada nesses ecossistemas profundos.(AU)

Plectranthiasahiahiata, a new species of perchlet from a mesophotic ecosystem at Rapa Nui (Easter Island) (Teleostei, Serranidae, Anthiadinae).

A new species of the perchlet genus Plectranthias is herein described from a single specimen found at Rapa Nui (Easter Island) in the South Pacific. Plectranthiasahiahiata sp. n. was collected at a depth of 83 m in a mesophotic coral ecosystem at Rapa Nui. The main difference between Plectranthiasahiahiata and other members of the genus is higher fin-ray counts (X, 18 dorsal; 18 pectoral) and its distinctive coloration. Compared to the three other known eastern South Pacific species, P.ahiahiata has more dorsal-fin rays, more pectoral-fin rays, fewer tubed lateral-line scales, fewer gill rakers, a longer head relative to SL, a very short first dorsal spine relative to SL, and a short third anal spine relative to SL. Plectranthiasahiahiata is distinguished from western Pacific species, by having more dorsal- and pectoral-fin rays. The closest relative based on genetic divergence (with 12.3% uncorrected divergence in the mitochondrial COI gene) is Plectranthiaswinniensis, a widely distributed species, suggesting important links between Rapa Nui and western Pacific islands. This new species adds to the high endemism of the Rapa Nui ichthyofauna, and is further evidence of the importance of mesophotic reefs as unique communities.

Outpatient continuing care after residential substance use disorder treatment in the US Veterans Health Administration: Facilitators and challenges.

BACKGROUND: In the U.S. Veterans Health Administration (VHA), residential treatment programs are an important part of the continuum of care for patients with substance use disorders (SUDs). Outpatient continuing care after residential treatment helps maintain early recovery and treatment gains. Knowing more about the drivers of variation in continuing care practices and performance across residential programs might inform quality improvement efforts. METHODS: Metrics of continuing care were operationalized and calculated for each of VHA's 63 SUD Residential Rehabilitation Treatment Programs (SUD RRTPs) and 34 Mental Health Residential Rehabilitation Treatment Programs (MH RRTPs) with a SUD track in fiscal year 2012. Management and frontline staff of these programs were then interviewed to learn what factors might contribute to high or low program performance on the metrics compared with national averages. RESULTS: Among SUD RRTPs, the mean rate of outpatient SUD/MH continuing care was 59% within 7 days and 80% within 30 days, and the mean rate of SUD continuing care was 63% within 30 days. Among MH RRTPs with a SUD track, these rates were 56%, 75%, and 36%, respectively. There was substantial variability in continuing care rates across the 97 programs: 21%-93% for SUD/MH care within 7 days, 36%-100% for SUD/MH care within 30 days, and 4%-91% for SUD care within 30 days. Interviews with representatives of 44 programs revealed key facilitators of continuing care: accountability of program staff, predischarge scheduling, predischarge introductions to continuing care providers, strong patient relationships, accessibility, and persistent emphasis. Key challenges included inadequate program staffing, lack of program staff accountability, and poor accessibility. CONCLUSIONS: Wide variation in continuing care rates across programs and identification of common facilitators at high-performing programs suggest substantial opportunity for improvement for programs with lower performance.

VA residential substance use disorder treatment program providers' perceptions of facilitators and barriers to performance on pre-admission processes.

BACKGROUND: In the U.S. Department of Veterans Affairs (VA), residential treatment programs are an important part of the continuum of care for patients with a substance use disorder (SUD). However, a limited number of program-specific measures to identify quality gaps in SUD residential programs exist. This study aimed to: (1) Develop metrics for two pre-admission processes: Wait Time and Engagement While Waiting, and (2) Interview program management and staff about program structures and processes that may contribute to performance on these metrics. The first aim sought to supplement the VA's existing facility-level performance metrics with SUD program-level metrics in order to identify high-value targets for quality improvement. The second aim recognized that not all key processes are reflected in the administrative data, and even when they are, new insight may be gained from viewing these data in the context of day-to-day clinical practice. METHODS: VA administrative data from fiscal year 2012 were used to calculate pre-admission metrics for 97 programs (63 SUD Residential Rehabilitation Treatment Programs (SUD RRTPs); 34 Mental Health Residential Rehabilitation Treatment Programs (MH RRTPs) with a SUD track). Interviews were then conducted with management and front-line staff to learn what factors may have contributed to high or low performance, relative to the national average for their program type. We hypothesized that speaking directly to residential program staff may reveal innovative practices, areas for improvement, and factors that may explain system-wide variability in performance. RESULTS: Average wait time for admission was 16 days (SUD RRTPs: 17 days; MH RRTPs with a SUD track: 11 days), with 60% of Veterans waiting longer than 7 days. For these Veterans, engagement while waiting occurred in an average of 54% of the waiting weeks (range 3-100% across programs). Fifty-nine interviews representing 44 programs revealed factors perceived to potentially impact performance in these domains. Efficient screening processes, effective patient flow, and available beds were perceived to facilitate shorter wait times, while lack of beds, poor staffing levels, and lengths of stay of existing patients were thought to lengthen wait times. Accessible outpatient services, strong patient outreach, and strong encouragement of pre-admission outpatient treatment emerged as facilitators of engagement while waiting; poor staffing levels, socioeconomic barriers, and low patient motivation were viewed as barriers. CONCLUSIONS: Metrics for pre-admission processes can be helpful for monitoring residential SUD treatment programs. Interviewing program management and staff about drivers of performance metrics can play a complementary role by identifying innovative and other strong practices, as well as high-value targets for quality improvement. Key facilitators of high-performing facilities may offer programs with lower performance useful strategies to improve specific pre-admission processes.

Predictive Validity of Outpatient Follow-up After Detoxification as a Quality Measure.

OBJECTIVES: Care coordination for substance use disorder (SUD) treatment is a persistent challenge. Timely outpatient follow-up after detoxification from alcohol and opiates is associated with improved outcomes, leading some care systems to attempt to measure and incentivize this practice. This study evaluated the predictive validity of a 7-day outpatient follow-up after detoxification quality measure used by the Veterans Health Administration (VHA). METHODS: A national sample of patients who received detoxification from alcohol or opiates (N = 25,354) was identified in VHA administrative data. Propensity score-weighted mixed-effects regressions modeled associations between receiving an outpatient follow-up visit within 7 days of completing detoxification and patient outcomes, controlling for facility-level performance and clustering of patients within facilities. RESULTS: Baseline differences between patients who did (39.6%) and did not (60.4%) receive the follow-up visit were reduced or eliminated with propensity score weighting. Meeting the quality measure was associated with significantly more outpatient treatment for SUD (b = 1.07 visits) and other mental health conditions (b = 0.58 visits), and higher inpatient utilization for SUD (b = 0.75 admissions) and other mental health conditions (b = 0.76 admissions). Notably, meeting the quality measure was associated with 53.3% lower odds of 2-year mortality (P < 0.001 for all). CONCLUSIONS: These findings support the predictive validity of 7-day follow-up after detoxification as a care coordination measure. Well-coordinated care may be associated with higher outpatient and inpatient utilization, and such engagement in care may be protective against mortality in people who receive detoxification from alcohol or opiates.

Predictive validity of a quality measure for intensive substance use disorder treatment.

BACKGROUND: Measures of substance use disorder (SUD) treatment quality are essential tools for performance improvement. The Veterans Health Administration (VHA) developed a measure of access to and engagement in intensive outpatient programs (IOPs) for SUD. However, predictive validity, or associations between this measure and treatment outcomes, has not been examined. METHODS: Data on veterans with SUD came from 3 samples: the Outcomes Monitoring Project (N = 5436), a national evaluation of VHA mental health services (N = 339,887), and patients receiving detoxification services (N = 23,572). Propensity score-weighted mixed-effects regressions modeled associations between receiving at least 1 week of IOP treatment and patient outcomes, controlling for facility-level performance and a random effect for facility. RESULTS: Propensity score weighting reduced or eliminated observable baseline differences between patient groups. Patients who accessed IOPs versus those who did not reported significantly reduced alcohol- and drug-related symptom severity, with significantly fewer past-month days drinking alcohol (b = 1.83, P < .001) and fewer past-month days intoxicated (b = 1.55, P < .001). Patients who received IOP after detoxification services had higher 6-month utilization of SUD outpatient visits (b = 2.09, P < .001), more subsequent detoxification episodes (b = 0.25, P < .001), and lower odds of 2-year mortality (odds ratio [OR] = 0.68, 95% confidence interval [CI]: 0.61-0.75; P < .001). CONCLUSIONS: Receiving at least 1 week of SUD treatment in an IOP was associated with higher follow-up utilization, improved health outcomes, and reduced mortality. These associations lend support to the predictive validity of VHA's IOP quality measure. Future research should focus on measure feasibility and validity outside of VHA, and whether predictive validity is maintained once this quality measure is tied to performance incentives.

Predictive validity of two process-of-care quality measures for residential substance use disorder treatment.

BACKGROUND: In order to monitor and ultimately improve the quality of addiction treatment, professional societies, health care systems, and addiction treatment programs must establish clinical practice standards and then operationalize these standards into reliable, valid, and feasible quality measures. Before being implemented, quality measures should undergo tests of validity, including predictive validity. Predictive validity refers to the association between process-of-care quality measures and subsequent patient outcomes. This study evaluated the predictive validity of two process quality measures of residential substance use disorder (SUD) treatment. METHODS: Washington Circle (WC) Continuity of Care quality measure is the proportion of patients having an outpatient SUD treatment encounter within 14 days after discharge from residential SUD treatment. The Early Discharge measure is the proportion of patients admitted to residential SUD treatment who discharged within 1 week of admission. The predictive validity of these process measures was evaluated in US Veterans Health Administration patients for whom utilization-based outcome and 2-year mortality data were available. Propensity score-weighted, mixed effects regression adjusted for pre-index imbalances between patients who did and did not meet the measures' criteria and clustering of patients within facilities. RESULTS: For the WC Continuity of Care measure, 76 % of 10,064 patients had a follow-up visit within 14 days of discharge. In propensity score-weighted models, patients who had a follow-up visit had a lower 2-year mortality rate [odds ratio (OR) = 0.77, p = 0.008], but no difference in subsequent detoxification episodes relative to patients without a follow-up visit. For the Early Discharge measure, 9.6 % of 10,176 discharged early and had significantly higher 2-year mortality (OR = 1.49, p < 0.001) and more subsequent detoxification episodes. CONCLUSIONS: These two measures of residential SUD treatment quality have strong associations with 2-year mortality and the Early Discharge measure is also associated with more subsequent detoxification episodes. These results provide initial support for the predictive validity of residential SUD treatment quality measures and represent the first time that any SUD quality measure has been shown to predict subsequent mortality.

Examining the Specification Validity of the HEDIS Quality Measures for Substance Use Disorders.

Accurate operationalization is a major challenge in developing quality measures for substance use disorder treatment. Specification validity is a term used to describe whether a quality measure is operationalized such that it captures the intended care processes and patients. This study assessed the specification validity of the 2009 Healthcare Effectiveness Data and Information Set (HEDIS®) substance use disorder initiation and engagement measures by examining whether encounters assumed to include relevant treatment have corroborating evidence in the clinical progress notes. The positive predictive values were excellent (>90%) for residential and outpatient records selected from addiction treatment programs but more modest for records generated in non-addiction settings, and were highly variable across facilities. Stakeholders using these measures to compare care quality should be mindful of the clinical composition of the data and determine if similar validation work has been conducted on the systems being evaluated.

Integrated Care Increases Treatment and Improves Outcomes of Patients With Chronic Hepatitis C Virus Infection and Psychiatric Illness or Substance Abuse.

BACKGROUND & AIMS: Patients with hepatitis C virus (HCV) infection with psychiatric disorders and/or substance abuse face significant barriers to antiviral treatment. New strategies are needed to improve treatment rates and outcomes. We investigated whether an integrated care (IC) protocol, which includes multidisciplinary care coordination and patient case management, could increase the proportion of patients with chronic HCV infection who receive antiviral treatment (a combination of interferon-based and direct-acting antiviral agents) and achieve a sustained virologic response (SVR). METHODS: We performed a prospective randomized trial at 3 medical centers in the United States. Participants (n = 363 patients attending HCV clinics) had been screened and tested positive for depression, post-traumatic stress disorder, and/or substance use; they were assigned randomly to groups that received IC or usual care (controls) from March 2009 through February 2011. A midlevel mental health practitioner was placed at each HCV clinic to provide IC with brief mental health interventions and case management, according to formal protocol. The primary end point was SVR. RESULTS: Of the study participants, 63% were non-white, 51% were homeless in the past 5 years, 64% had psychiatric illness, 65% were substance abusers within 1 year before enrollment, 57% were at risk for post-traumatic stress disorder, 71% had active depression, 80% were infected with HCV genotype 1, and 23% had advanced fibrosis. Over a mean follow-up period of 28 months, a greater proportion of patients in the IC group began receiving antiviral therapy (31.9% vs 18.8% for controls; P = .005) and achieved a SVR (15.9% vs 7.7% of controls; odds ratio, 2.26; 95% confidence interval, 1.15-4.44; P = .018). There were no differences in serious adverse events between groups. CONCLUSIONS: Integrated care increases the proportion of patients with HCV infection and psychiatric illness and/or substance abuse who begin antiviral therapy and achieve SVRs, without serious adverse events. ClinicalTrials.gov # NCT00722423.