Alternative life-history strategy contributions to effective population size in a naturally spawning salmon population.

Alternative life-history tactics are predicted to affect within-population genetic processes but have received little attention. For example, the impact of precocious males on effective population size (N e) has not been quantified directly in Pacific salmon Oncorhynchus spp., even though they can make up a large percentage of the total male spawners. We investigated the contribution of precocial males ("jacks") to N e in a naturally spawning population of Coho Salmon O. kisutch from the Auke Creek watershed in Juneau, Alaska. Mature adults that returned from 2009 to 2019 (~8000 individuals) were genotyped at 259 single-nucleotide polymorphism (SNP) loci for parentage analysis. We used demographic and genetic methods to estimate the effective number of breeders per year (N b). Jack contribution to N b was assessed by comparing values of N b calculated with and without jacks and their offspring. Over a range of N b values (108-406), the average jack contribution to N b from 2009 to 2015 was 12.9% (SE = 3.8%). Jacks consistently made up over 20% of the total male spawners. The presence of jacks did not seem to influence N b/N. The linkage disequilibrium N e estimate was lower than the demographic estimate, possibly due to immigration effects on population genetic processes: based on external marks and parentage data, we estimated that immigrant spawners produced 4.5% of all returning offspring. Our results demonstrate that jacks can influence N b and N e and can make a substantial contribution to population dynamics and conservation of threatened stocks.

Resources and Support for Sexual Assault Survivors Receiving Services From the U.S. Air Force: What Survivors Say They Need for Recovery.

Sexual assault (SA) is a serious challenge faced by the U.S. military. Participants in this study included men and women who volunteered in response to a call for survivors of SA. Participants included active duty and reserve U.S. Air Force (USAF) members, spouses of service members, or civilian employees for the USAF (beneficiaries). The primary research question was, "if you could design the perfect response system to support survivors, what would be included in this system?" The research team conducted in-depth interviews with nine survivors. Next, 82 survivors completed a survey agreeing or disagreeing with strategies identified by interview participants to improve services for survivors and offered additional suggestions. Analysis revealed survivor recommendations to improve SA services.

Identifying and mitigating moral injury risks in military behavioral health providers.

The term "moral injury" was initially used to describe the multifaceted pain that service members feel after perpetrating, witnessing, or failing to prevent acts that conflict with their moral codes. More recently the term has been used to describe healthcare providers' pain stemming from their experiences serving on the frontlines of the healthcare system when: a medical error causes serious harm to patients, systems continuously impede their abilities to provide proper care, or providers assess that they have acted in ways that conflict with their professional ethics or oaths to "do no harm." This article explores moral injury risk at the intersection of military service and healthcare by examining challenges that military behavioral healthcare providers face. Leveraging moral injury definitions previously applied to service members (personal or witnessed transgressions) and in two healthcare contexts ("second victim" to adverse client outcomes and system-driven moral distress), as well as literature on ethical challenges in military behavioral health, this paper uncovers situations that may amplify military behavioral health providers' risks for moral injury. It concludes by offering policy and practice recommendations germane to military medicine aimed at alleviating pressures military behavioral healthcare providers face and mitigating moral injuries' potential ripple effects on provider wellness, retention and care quality.

Reproductive success of jack and full-size males in a wild coho salmon population.

Despite the wealth of research on Pacific salmon Oncorhynchus spp. life histories there is limited understanding of the lifetime reproductive success of males that spend less time at sea and mature at a smaller size (jacks) than full-size males. Over half of returning male spawners can be jacks in some populations, so it is crucial to understand their contribution to population productivity. We quantified adult-to-adult reproductive success (RS) of jacks and their relative reproductive success (RRS) compared to full-size males in a wild population of coho salmon in the Auke Creek watershed, Juneau, Alaska. We used genetic data from nearly all individuals (approx. 8000) returning to spawn over a decade (2009-2019) to conduct parentage analysis and calculate individual RS. The average adult-to-adult RS of jacks (mean = 0.7 and s.e. = 0.1) was less than that of full-size males (mean = 1.1 and s.e. = 0.1). Jack RRS was consistently below 1.0 but ranged widely (0.23 to 0.96). Despite their lower average success, jacks contributed substantially to the population by siring 23% of the total returning adult offspring (1033 of 4456) produced between 2009 and 2015. Our results imply that jacks can affect evolutionary and population dynamics, and are relevant to the conservation and management of Pacific salmon.

Theory of Planned Behavior and Active Duty Air Force Members' Mental Health Help-Seeking.

INTRODUCTION: Although military members often encounter significant atypical stressors while serving, many service members are still reluctant to seek mental health (MH) treatment. Help-seeking behavior for MH needs is a rising concern for active duty Air Force personnel. Conditions such as post-traumatic stress disorder, depression, anxiety, and substance abuse are just a few issues that military members deal with, but things like stigma, attitudes toward MH, and behavioral control might keep these individuals from seeking services. This study utilizes the theory of planned behavior (TPB) to identify better and understand barriers to the help-seeking behavior of active duty Air Force members. MATERIALS AND METHODS: The 2017 Air Force Community Feedback Tool was used for this study. This confidential survey was completed by a large sample of the military population (N = 10,705). The survey was used to examine relationships between the TPB-related variables and respondents with mood problems identifying a need for professional counseling, seeking MH services, and reporting that the services met their needs. Multiple linear and binary logistic regression models were utilized to analyze findings from this sample. RESULTS: This study highlights how attitudes, subjective norms, and perceived behavioral control impact help-seeking behavior for these individuals. Findings include the MH providers' good reputations, wait times for services, ease of access to care, and negative experiences with supervisor permission, all of which showed a statistically significant impact on help-seeking behavior. Dependent variables included "I need professional counseling," "I contacted a MH care provider in the past year to try to meet this need," and "How much the MH care provider helped you meet your needs." Each of these variables had statistically significant relationships with the connecting variables of the TPB. CONCLUSIONS: Findings from this study reveal how attitudes, subjective norms, and perceived behavioral control play an essential role in an active duty Air Force member's decision to seek help for MH concerns. This study suggests that active duty military members are less concerned about the belief that seeking MH care could harm their reputations and more aware of the potential negative reputations of MH clinics. Finally, actionable steps are outlined to better support help-seeking behavior, which might be recommended to better train and encourage military leaders to address the MH needs of themselves and the members of their units.

How the COVID-19 Pandemic Can and Must Expand Social Worker e-Interventions for Mental Health, Family Wellness, and Beyond.

Both media and academic reports have highlighted COVID-19's negative impacts on mental health and safety in the United States, yet care and service gaps persist. Evidence suggests that a default to in-person service delivery did not meet clients' needs before the pandemic, and that unmet needs have ballooned since COVID-19 spread throughout the United States due to a combination of increased stress, social isolation, and fewer available services during lockdowns. This article reviews literature on online interventions' utility and effectiveness in preventing and treating problems likely exacerbated under pandemic conditions, including mental health conditions, anger, couple dynamics, parenting, and alcohol misuse. The article also describes barriers to evidence-based e-interventions' wider and more consistent use, highlights some vulnerable populations' unique service needs, outlines service gaps that online programs might effectively mitigate, and offers a path by which social workers can lead an interdisciplinary charge in researching, developing, and implementing e-interventions during the current pandemic and beyond.

Enhancing behavioral sleep care with digital technology: study protocol for a hybrid type 3 implementation-effectiveness randomized trial.

BACKGROUND: Insomnia affects almost one in four military service members and veterans. The first-line recommended treatment for insomnia is cognitive-behavioral therapy for insomnia (CBTI). CBTI is typically delivered in-person or online over one-to-four sessions (brief versions) or five-to-eight sessions (standard versions) by a licensed doctoral or masters-level clinician with extensive training in behavioral sleep medicine. Despite its effectiveness, CBTI has limited scalability. Three main factors inhibit access to and delivery of CBTI including restricted availability of clinical expertise; rigid, resource-intensive treatment formats; and limited capacities for just-in-time monitoring and treatment personalization. Digital technologies offer a unique opportunity to overcome these challenges by providing scalable, personalized, resource-sensitive, adaptive, and cost-effective approaches for evidence-based insomnia treatment. METHODS: This is a hybrid type 3 implementation-effectiveness randomized trial using a scalable evidence-based digital health software platform, NOCTEM™'s Clinician-Operated Assistive Sleep Technology (COAST™). COAST includes a clinician portal and a patient app, and it utilizes algorithms that facilitate detection of sleep disordered patterns, support clinical decision-making, and personalize sleep interventions. The first aim is to compare three clinician- and system-centered implementation strategies on the reach, adoption, and sustainability of the COAST digital platform by offering (1) COAST only, (2) COAST plus external facilitation (EF: assistance and consultation to providers by NOCTEM's sleep experts), or (3) COAST plus EF and internal facilitation (EF/IF: assistance/consultation to providers by NOCTEM's sleep experts and local champions). The second aim is to quantify improvements in insomnia among patients who receive behavioral sleep care via the COAST platform. We hypothesize that reach, adoption, and sustainability and the magnitude of improvements in insomnia will be superior in the EF and EF/IF groups relative to the COAST-only group. DISCUSSION: Digital health technologies and machine learning-assisted clinical decision support tools have substantial potential for scaling access to insomnia treatment. This can augment the scalability and cost-effectiveness of CBTI without compromising patient outcomes. Engaging providers, stakeholders, patients, and decision-makers is key in identifying strategies to support the deployment of digital health technologies that can promote quality care and result in clinically meaningful sleep improvements, positive systemic change, and enhanced readiness and health among service members. TRIAL REGISTRATION: ClinicalTrials.gov NCT04366284 . Registered on 28 April 2020.

Serving on multiple fronts: A grounded theory model of complex decision-making in military mental health care.

RATIONALE: Military mental health providers must navigate multiple competing professional boundaries when delivering care in complex cases. Currently no clear policy exists to balance clinical professional obligations to do no harm with potentially-contradictory military policies. Thusly, military providers may face Catch-22 situations where they must choose to seemingly neglect either their duty to the military or their duty to clinical professional standards. OBJECTIVE: Recognizing such situations as emblematic of role strain (Goode, 1960), this study employed a grounded theory approach to examine military mental health providers' decision-making in the face of competing professional demands. METHOD: An evolving, semi-structured interview guide steered discussions with 20 active duty and civilian mental health providers across 16 Air Force/Department of Defense facilities. Using a symbolic interactionism framework, three rounds of coding enabled increasing levels of abstraction, ultimately revealing a grounded theory model of complex decision-making. RESULTS: The final model includes four antecedents - training, resources, consultation, and clinic climate. Those antecedents influence development of three different role views: clinical professional, agent of the client, and agent of the military. Role views impact decision-making and provider behaviors that may either enhance or detract from quality care. Decision-making and provider behaviors link to consequences at the patient, provider, clinic, and community levels. CONCLUSIONS: The model offers insights into military mental health providers' growth versus burnout, and engagement in quality-enhancing versus -detracting behaviors. It also illuminates strategies military leaders might leverage to normalize and relieve provider role strain as a means to improve individual and community trust, wellness, and helpseeking.

Impact of Surgeon Gender on Online Physician Reviews.

BACKGROUND: The increasing use of review websites by consumers has become a crucial first step in choosing a physician with more than half of Americans consulting review sites before physician selection. We sought to identify whether differences exist in the quality and content of online reviews for men versus women surgeons. METHODS: Using a deliberate sampling algorithm of the two most populated physician review websites, RateMDs.com and Yelp.com, we purposefully sampled reviews for the top 20 surgeons per tercile from the four most populated urban areas in the United States: New York, Houston, Los Angeles, and Chicago. A grounded theory qualitative assessment was performed of major and minor thematic elements including global rating, communication, technical skills, and comments on ancillary elements. RESULTS: Four-hundred and thirty-one online patient reviews of 238 surgeons were identified from RateMDs.com (51%) and Yelp.com (49%) with available information on gender for analysis. Seventy-six percent of reviews were of male surgeons. Reviewers were more likely to mention a global rating and technical skill for men compared with women surgeons. Most reviews were positive with no difference in global rating by gender (83.7% positive for men and 74.3% positive for women, P = 0.08). Women surgeons were more likely to have positive comments on social interactions as compared with men (94.7% versus 88.0%, P = 0.03); whereas men surgeons were more likely to have a positive rating on technical skill compared with women (88.2% versus 76.2%, P = 0.04). CONCLUSIONS: The content and quality of online surgeon reviews differ by gender. There is no difference in global rating between men and women. Women are rated higher for social interaction domains and men are rated higher on technical skill domains.

Do online parenting programs create change?: A meta-analysis.

With online education and programs becoming increasingly common, it is necessary to examine their effectiveness. In this study, we conduct a meta-analysis of online parenting programs. In this meta-analysis, we included 28 studies yielding 127 effect sizes examining 15 outcome variables. We found that online parenting programs had the strongest effects on increasing positive parenting and parents' encouragement. We also found significant effects of reducing negative parent-child interactions, child problem behaviors, negative discipline strategies, parenting conflicts, parent stress, child anxiety, parent anger, and parent depression. Results also revealed programs' significant effects on increasing parent confidence, positive child behavior and parenting satisfaction. Comparisons of programs that included clinical support (meaning programs through which participants had access to content experts, therapists, or content specialists in conjunction with the online program) versus programs that only contained online components, revealed no significant differences in 6 program outcomes between programs with and without clinical support. Comparisons of programs provided to targeted populations versus general populations revealed no significant differences in four program outcomes between populations. Results suggest that online parenting programs can provide benefits for parents who may not be able to access in-person resources. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Military service and crime: new evidence.

BACKGROUND: Evidence indicates that a substantial proportion of military personnel are involved in high-risk and antisocial behaviors that place them at jeopardy for criminal justice system involvement. However, prior research on military service and crime has disproportionately focused on veterans from the Vietnam War era (1955-1975), and has tended to focus on either current or former military members. METHODS: This study employed data from a population-based study (i.e., National Study on Drug Use and Health [NSDUH] between 2002 and 2014). It systematically examines the prevalence of self-reported antisocial behaviors, criminal justice system involvement, and substance abuse among the US civilian population and military service members, including reservists (n = 2206) and those who reported having been separated or retired from military service (n = 20,551). These factors are further examined across the developmental spectrum of adulthood (ages 18-34, 35-49, and 50-64). RESULTS: Results showed that military members were more prone to lifetime arrests and overall substance misuse. However, additional findings emerged suggesting that, while the military population overall seems to be positively associated with higher criminal activity than that found in the civilian population, these findings were based on a specific subgroup of the veteran population. This subgroup is comprised of individuals who likely did not fit in with the military culture and were discharged from the military early in their careers. CONCLUSION: Additional research on identifying this subgroup of military members is encouraged to better concentrate on prevention and treatment measures.

Mental Health Care Utilization: How Race, Ethnicity and Veteran Status are Associated with Seeking Help.

As veterans disproportionately experience higher rates of mental illness than civilians, conflicting results surround the impact of race/ethnicity on treatment utilization. This study utilized the CDC's Texas Behavioral Risk Factor Surveillance System data, a random-digit dialed telephone survey of non-institutionalized adults. A subset of Texas respondents (n = 8563) were asked questions related to mental health treatment, stigma, help-seeking attitudes and emotional support. While no differences were found in health care utilization between non-Hispanic white veterans and non-veterans, there were distinct patterns among racial/ethnic minority veterans and non-veterans. Black and Latino non-veterans reported significantly lower health care utilization compared to non-Hispanic white non-veterans. Among veterans, there were no differences in reported utilization rates comparing non-Hispanic whites and Latinos and also non-Hispanic whites and Blacks. Our study adds to the literature by examining health care utilization among a diverse group of veterans by focusing on Veterans Administration (VA) and non-VA services to veterans.