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Reproductive strategy can play a significant role in invasion success and spread. Asexual and sexual reproduction may confer different advantages and disadvantages to a founding population, resulting in varying impacts on genetic diversity and the ability to invade. We investigate the role of reproductive mode in two species of non-native hydromedusae ( Maeotias marginata and Moerisia sp.) in the San Francisco Estuary (SFE). Both species can reproduce asexually and sexually. We employed 7–8 microsatellite markers to determine overall genetic diversity and to investigate contributions of asexual and sexual reproduction to the populations. We found both species had high levels of genetic diversity (Average H E  = 0.63 and 0.58, Number individuals sampled = 111 and 277, for M. marginata and Moerisia sp. respectively) but also detected multiple individuals in clonal lineages. We identified the same clones across sampling locations and time, and the index of asexual reproduction (R) was 0.89 for M. marginata and 0.91 for Moerisia sp. Our results suggest both species maintain high population genetic diversity through sexual reproduction, in combination with asexual reproduction, which allows rapid propagation. In addition, we conducted genetic sequence analyses at the ribosomal ITS1 marker, using samples of Moerisia sp. from the SFE and M. lyonsi from Chesapeake Bay. We found 100 % sequence similarity showing that Moerisia sp. in the SFE and Chesapeake Bay are the same species. The two hydromedusae studied here possess the means to propagate rapidly and have high genetic diversity, both of which may allow them to successfully adapt to changing environments and expand their invasions.

Many contemporary mental health care programs rely on cross-agency models of service delivery. In these models, staff from different organizations provide care for the same clients, and this requires negotiation around role boundaries. In Australia, cross-agency programs have been developed to promote collaboration between government and not-for-profit community groups to meet the needs of those with serious mental health problems. Policy makers need to be aware of how staff in these roles conceptualize the boundaries and interconnection of their work with others to ensure that program goals are achieved. This study examined the division of labor that emerged between support workers (employed by the not-for-profit sector) and government health workers within a cross agency supported housing program for people with serious mental illness at risk of homelessness and self-neglect. Interviews were conducted with 40 government health workers and 37 staff from non-government agencies that shared clients in a supported housing program. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. While the division between clinical and non-clinical work was accepted and co-produced, tensions arose in defining the boundaries between them. These tensions resulted from poor communication on the part of both groups, perceived lack of clinical intervention by case managers, high caseloads of case managers, role ambiguity, and support workers feeling their input and feedback were not valued by government health workers. Divisions of labor in cross-agency programs need to be critically evaluated to assess whether they serve program goals. Tensions are inevitable when dividing the tasks involved in care of a single client between different organizations. Co-location of multidisciplinary teams that include health professionals, support workers and peer workers may lead to more effective recovery oriented care. The findings have implications for the future development of recovery oriented mental health services.

ObjectiveFutile treatment, which by definition cannot benefit a patient, is undesirable. This research investigated why doctors believe that treatment that they consider to be futile is sometimes provided at the end of a patient's life.DesignSemistructured in-depth interviews.SettingThree large tertiary public hospitals in Brisbane, Australia.Participants96 doctors from emergency, intensive care, palliative care, oncology, renal medicine, internal medicine, respiratory medicine, surgery, cardiology, geriatric medicine and medical administration departments. Participants were recruited using purposive maximum variation sampling.ResultsDoctors attributed the provision of futile treatment to a wide range of inter-related factors. One was the characteristics of treating doctors, including their orientation towards curative treatment, discomfort or inexperience with death and dying, concerns about legal risk and poor communication skills. Second, the attributes of the patient and family, including their requests or demands for further treatment, prognostic uncertainty and lack of information about patient wishes. Third, there were hospital factors including a high degree of specialisation, the availability of routine tests and interventions, and organisational barriers to diverting a patient from a curative to a palliative pathway. Doctors nominated family or patient request and doctors being locked into a curative role as the main reasons for futile care.ConclusionsDoctors believe that a range of factors contribute to the provision of futile treatment. A combination of strategies is necessary to reduce futile treatment, including better training for doctors who treat patients at the end of life, educating the community about the limits of medicine and the need to plan for death and dying, and structural reform at the hospital level.

Aim. To evaluate the effectiveness of a benchmarking initiative in facilitating quality improvement and reform in extended care mental health services.Method. Individual interviews and focus group discussions were conducted with 84 staff in 22 extended care mental health services that had previously participated in a State-wide benchmarking exercise in Queensland, Australia.Results. Staff reported positive outcomes from participation in the benchmarking exercise. Information derived from benchmarking provided a different perspective on the strengths and weaknesses of individual services and an opportunity to learn from peer services. Staff in 86% of the services identified issues that needed to be addressed and 64% of services had implemented one or more service improvement projects in response to shortcomings identified through the benchmarking exercise.Conclusions. The collection and reporting of performance data through a process of benchmarking was successful in facilitating service improvement in most of the participating facilities. Engaging services in all stages of the process was considered useful in converting benchmarking data into knowledge that was able to be applied at the local service level.

Challenging student behavior is a concern for teachers and administrators across the United States, and the situation in West Virginia is no different. In response to these behaviors, principals often use an exclusionary approach to discipline, including detentions, suspensions, and expulsions. While research indicates a functional approach to discipline is a highly effective strategy, teachers rarely utilize this approach, and little is known about if and when principals do. This qualitative study explored how principals define challenging behavior and make discipline decisions, identify which discipline practices they use, and determine if they apply the Circumstances View of Behavior (attributing a person's behavior to learning history and/or their environment) or a functional approach to discipline (considering why a behavior is happening) when making decision-related decisions. This was accomplished using discipline vignettes, semi-structured interviews, post-interview surveys, and document analysis within a Reflexive Thematic Analysis framework with a Multimethod Research design. This study synthesized a more comprehensive definition of challenging behavior for the participants and outlined traditional disciplinary practices along with an alternate approach expressed by one participant. The findings indicate that nearly all participants only partially subscribe to a Circumstances View of Challenging Behavior and a Functional View of Behavior and that partial subscription was not enough to shift their disciplinary decision-making away from progressive, exclusionary practices.

Socioeconomic disadvantage remains a major determinant of equitable access to, and progression within, medical education. This systematic review and meta-analysis examines both the impact and the magnitude of financial and economic disadvantage on student selection and progression in medical school. Studies were included if they reported associations between socioeconomic indicators (e.g., parental income, occupation, education, geographic deprivation, or premedical debt) and selection or progression outcomes, and were excluded if they lacked clearly defined economic predictors or sufficient data for binary effect sizes. Searches were conducted across PubMed, Scopus, ERIC, Embase, ProQuest, and EBSCO (2005-2025). Study selection employed an active machine-learning screening process. Extracted data included sample characteristics, socioeconomic measures, and outcome types, with risk of bias assessed using the Risk of Bias Instrument. Random-effects meta-analysis was conducted where appropriate. Thirty-two studies of medical programs were included, yielding 28 effect sizes for selection and 9 for progression. Household economic and educational disadvantage, identified through parental indices, was consistently associated with reduced odds of admission (odds ratio [OR], 0.6; 95% confidence interval [CI], 0.55-0.65) and poorer progression (OR, 0.56; 95% CI, 0.53-0.59). Geographic deprivation also exerted a negative effect, particularly on selection (OR, 0.69; 95% CI, 0.5-0.93). Socioeconomic disadvantage exerts a pervasive influence across the medical education continuum. Addressing these inequities requires sustained financial, academic, and psychosocial support both before and during their studies. Students' economic circumstances should therefore be considered in medical school selection policy and curriculum development to further enhance equity within medical schools and the profession.

Purpose - Support workers who provide in-home support to people with psychiatric disability are becoming a significant part of the mental health workforce. Research is needed to establish the optimum level and content of training they need to effectively carry out their role.Design methodology approach - This paper reports on this paper is to draw on the results of a survey of 104 support workers and interviews with 18 support workers and eight managers in Queensland, Australia, who provide in-home support for people with psychiatric disability. The authors describe the training undertaken by these workers and their perceptions of the adequacy of this training in relation to the challenges of their work.Findings - The majority of support workers felt they had adequate training, though many expressed the desire to know more about mental illness symptoms, medications and the concept of recovery. Support workers nominated motivating their clients and managing challenging behaviour as the most difficult aspect of the job. Future training offered to these workers needs to focus on increasing knowledge about mental illness and the concept of recovery, and supporting them in their work with clients who have low levels of motivation and or challenging behaviours. Access to professional supervision may also be of benefit.Originality value - This paper adds to knowledge about the training needs of support workers who provide in-home support to people with psychiatric disability. These findings will be useful for practitioners and decision makers who are considering the training needs of this group.

Purpose – The concept of recovery is well accepted internationally as a guiding vision for mental health services. The purpose of this paper is to highlight the challenges faced by in-home psychiatric support workers in implementing this vision in their work with clients with severe psychiatric disability. Design/methodology/approach – The findings reported here are based on interviews with 27 support workers and ten managers of organisations providing support services. These were collected as part of evaluations of two supported housing programmes carried out between 2010 and 2011. Findings – Challenges faced by support workers coalesced around two areas: first, balancing the need to provide care with the need to promote autonomy and second, developing an effective working relationship while working mainly within a clients’ home. Practical implications – These challenges for support workers highlight tensions within the recovery vision that are not easily resolved. To ensure high quality, recovery-oriented care services are provided, support workers need access to training courses that focus on challenging areas of this work and should be provided with regular professional supervision. Originality/value – Existing literature on support workers has generally focused on the nature of the role and support worker interactions with other health workers. In this paper, the authors highlight difficulties faced by support workers in implementing the vision of recovery in their work. The paper provides important information for policy makers and managers who are designing service delivery systems that aim to promote recovery.

Vaccinia virus (VACV), the prototypical poxvirus, was used to eradicate smallpox worldwide and, in recent years, has received considerable attention as a vector for the development of vaccines against infectious diseases and oncolytic virus therapy. Studies have demonstrated that VACV exhibits an extremely strong bias for binding to and infection of primary human antigen-presenting cells (APCs) including monocytes, macrophages, and dendritic cells. However, very few studies have evaluated VACV binding to and infection of primary human B cells, a main type of professional APC. In this study, we evaluated the susceptibility of primary human peripheral B cells at different developmental stages to VACV binding, infection, and replication. We found that VACV exhibited strong binding but little entry into ex vivo B cells. Phenotypic analysis of B cells revealed that plasmablasts were the only subset resistant to VACV binding. Infection studies showed that plasma and mature-naïve B cells were resistant to VACV infection, while memory B cells were preferentially infected. Additionally, VACV infection was increased in larger and proliferative B cells suggesting a bias of VACV infection towards specific stages of differentiation and proliferative ability. VACV infection in B cells was abortive, and cessation of VACV infection was determined to occur at the stage of late viral gene expression. Interestingly, B cell function, measured by cytokine production, was not affected within 24 hours post-infection. In contrast to ex vivo B cells, stimulated B cells were permissive to productive VACV infection. These results demonstrate the value of B cells as a tool to aid in deciphering the intricacies of poxvirus infection in humans. Understanding VACV infection in primary human B cells at various stages of differentiation and maturation is important for the development of a safer smallpox vaccine and better vectors for vaccines against cancers and other infectious diseases.

A mail survey was conducted with 49 suicide survivors from 13 different suicide support groups across Canada. Participants were asked about their experiences of grieving a suicide and if the suicide was part of a cluster. Quantitative and qualitative research methodology was used in the coding and analysis of the data. A theory diagram was devised to test four hypotheses. Results of the regression analyses contradicted one hypothesis: showing that an increase in coping mechanisms may heighten levels of grief for a suicide survivor. The number of possible suicide linkages was highly significant with 5 of the 49 participants answering positively when asked if the suicide they were grieving was part of a cluster. Suicide bereavement groups were consistently rated as beneficial or very beneficial by participants. Lastly, content analysis of the open-ended questions showed a common experience of stigma associated with a suicidal death for survivors.