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In seriously ill cardiac patients, several psychotherapy efficacy studies demonstrate little to no reduction in depression or improvement in quality of life, and little is known about how to improve psychotherapies to best address the range of patient needs. An interpersonal and behavioral activation psychotherapy was a key component of the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) multisite randomized clinical trial. Although depressive symptoms did improve in the CASA trial, questions remain about how best to tailor psychotherapies to the needs of seriously ill patient populations. The study objective was to describe psychosocial needs emerging during a clinical trial of a palliative care and interpersonal and behavioral activation psychotherapy intervention that were not specifically addressed by the psychotherapy.
During the CASA trial, patient needs were prospectively tracked by the psychotherapist in each visit note using an a priori code list. Preplanned analysis of study data using directed content analysis was conducted analyzing the a priori code list, which were collapsed by team consensus into larger themes. The frequency of each code and theme were calculated into a percentage of visits.
A total of 150 patients received one or more visits from the therapist and were included in the analysis. Participants screened positive for depressive disorder (47%), had poor heart failure-specific health status (mean Kansas City Cardiomyopathy Questionnaire score = 48.6; SD = 17.4), and multiple comorbidities (median 4.3). Common needs that emerged during the therapy included difficulty coping with fatigue (48%), pain (28%), and satisfaction issues with medical care (43%). The following broader themes emerged: social support (77% of sessions), unmet symptom needs (67%), healthcare navigation (48%), housing, legal, safety, and transportation (32%), and end of life (12%).
Significance of results
Coping with chronic symptoms and case management needs commonly emerged during psychotherapy visits. Future psychotherapy interventions in seriously ill populations should consider the importance of coping with chronic symptoms and case management.
Fruit producers in the Eastern United States face a wide range of weather-related risks that have the capacity to largely impact yields and profitability. This research examines the economic implications associated with responding to these risks for sweet cherry production in three different systems: high tunnels, revenue insurance, and weather insurance. The analysis considers a distribution of revenue flows and costs using detailed price, yield, and weather data between 1984 and 2013. Our results show that the high tunnel system generates the largest net return if significant price premiums exist for earlier and larger fruit.
As a label for a distinct category of life, “living fossil” is controversial. The term has multiple definitions, and it is unclear whether the label can be genuinely used to delimit biodiversity. Even taking a purely phylogenetic perspective in which a proxy for the living fossil is evolutionary distinctness (ED), an inconsistency arises: Does it refer to “dead-end” lineages doomed to extinction or “panchronic” lineages that survive through multiple epochs? Recent tree-growth model studies indicate that speciation rates must have been unequally distributed among species in the past to produce the shape of the tree of life. Although an uneven distribution of speciation rates may create the possibility for a distinct group of living fossil lineages, such a grouping could only be considered genuine if extinction rates also show a consistent pattern, be it indicative of dead-end or panchronic lineages. To determine whether extinction rates also show an unequal distribution, we developed a tree-growth model in which the probability of speciation and extinction is a function of a tip’s ED. We simulated thousands of trees in which the ED function for a tip is randomly and independently determined for speciation and extinction rates. We find that simulations in which the most evolutionarily distinct tips have lower rates of speciation and extinction produce phylogenetic trees closest in shape to empirical trees. This implies that a distinct set of lineages with reduced rates of diversification, indicative of a panchronic definition, is required to create the shape of the tree of life.
Species abundance data are of vital importance in paleontology, but fossil accumulations invariably represent a biased subset of original source communities. Efforts to quantify taphonomic biases are typically prevented by a lack of independent data on the ecological composition of prehistoric faunas. However, analysis of the continental Holocene record can provide a rare opportunity for independent calibration of fossil abundance patterns. We analyzed a comprehensive data set available for the Holocene avifauna of Sweden to investigate the relationship between species abundance in the recent fossil and zooarchaeological records and in prehistoric source communities, and to characterize the importance of different ecological factors in determining terrestrial vertebrate fossil abundances. The number of assemblages in which species occurred was compared with modern-day species abundance, annual residence, body mass, and ecological realm. Modern-day abundance is only one of several significant predictors of fossil abundance; the strongest predictor is body mass, and Holocene species abundance can be interpreted as a measure of species abundance in source communities for a given size class only. Our study represents one of the only direct attempts to quantify species abundance biases between fossil faunas and source communities, and has general applicability for a wide range of terrestrial vertebrate faunas.
Secretory immunoglobulin A (IgA) plays a critical role in gut mucosal immune defense. Initially provided by breastmilk, IgA production by the infant gut is gradually stimulated by developing gut microbiota. This study reports associations between infant fecal IgA concentrations 4 months after birth, breastfeeding status and other pre/postnatal exposures in 47 infants in the Canadian Healthy Infant Longitudinal Development cohort. Breastfed infants and first-born infants had higher median fecal IgA concentrations (23.11 v. 9.34 µg/g protein, P<0.01 and 22.19 v. 8.23 µg/g protein, P=0.04). IgA levels increased successively with exclusivity of breastfeeding (β-coefficient, 0.37, P<0.05). This statistical association was independent of maternal parity and household pets. In the absence of breastfeeding, female sex and pet exposure elevated fecal IgA to levels found in breastfed infants. In addition to breastfeeding, infant fecal IgA associations with pre/postnatal exposures may affect gut immunity and risk of allergic disease.
The Critically Endangered Chinese giant salamander Andrias davidianus, the world's largest amphibian, is severely threatened by unsustainable exploitation of wild individuals. However, field data with which to assess the salamander's status, population trends, or exploitation across its geographical range are limited, and recent field surveys using standard ecological field techniques have typically failed to detect wild individuals. We conducted community-based fieldwork in three national nature reserves (Fanjingshan, Leigongshan and Mayanghe) in Guizhou Province, China, to assess whether local ecological knowledge constitutes a useful tool for salamander conservation. We collected a sample of dated salamander sighting records and associated data from these reserves for comparative assessment of the relative status of salamander populations across the region. Although Fanjingshan and Leigongshan are still priority sites for salamander conservation, few recent sightings were recorded in either reserve, and respondents considered that salamanders had declined locally at both reserves. The species may already be functionally extinct at Mayanghe. Although respondent data on threats to salamanders in Guizhou are more difficult to interpret, overharvesting was the most commonly suggested explanation for salamander declines, and it is likely that the growing salamander farming industry is the primary driver of salamander extraction from Guizhou's reserves. Questionnaire-based surveys can collect novel quantitative data that provide unique insights into the local status of salamander populations, and we advocate wide-scale incorporation of this research approach into future salamander field programmes.
The Chinese giant salamander Andrias davidianus is endemic to China and is Critically Endangered, largely because of overexploitation for food. This species is an expensive delicacy in China, and a rapidly growing industry to farm the species has developed throughout much of the country, centred on the Qinling Mountain region of Shaanxi Province. During a 2010 workshop on Chinese giant salamander conservation, which involved a range of stakeholders from across China, it became clear that the conservation community knew little about the salamander farming industry and whether it posed actual or potential threats or opportunities for conservation of the Chinese giant salamander. We therefore conducted a series of investigations to understand the industry better. Our results indicate that although farming of Chinese giant salamanders has the potential to be a positive development for conservation by supplying market demand with farmed animals, it is currently more likely to threaten than support conservation of the species, with continued overexploitation and the potential added impacts of infectious disease and genetic pollution arising from farming practices such as movement of animals across the country and the release of untreated farm wastewater and farmed salamanders to the wild.
Background: Depression is a common and treatable illness in late-life. However, many do not seek treatment and may suffer from the stigma of the illness, which may vary across cultures. The aim of this study was to compare attitudes about depression in primary care practices in South Korea, Russia, and the USA.
Methods: A cross-sectional study was undertaken using a self-administered questionnaire and PHQ-9 diagnostic survey with 1,094 patients aged 60–93 years who attended a primary care clinic in Korea, Russia, or the USA.
Results: The mean age of participants was 71 years, with 61% being female. US patients were older and had higher education levels. Russian participants were more likely to be widowed and had lower self-rated health. The majority of participants agreed that depression is a kind of disease (Korea 77%, Russia 61%, USA 79%). Only 6% of US patients believed depression means a person is weak, compared to 78% (Korea) and 61% (Russia). Fewer US patients endorsed depression as a normal part of aging (29% vs. Korea at 42% and Russia at 54%). Among participants in the USA, age correlated negatively with endorsement of a medical model of depression (p = <0.001).
Conclusions: Though there was wide variation between countries in attitudes about depression, the majority of each endorsed items reflected a medical model of depression. Korean and Russian participants endorsed the view of depression as a personal weakness more than participants in the USA. Demographic correlates of negative attitudes about depression were moderate to weak.
Attenborough's long-beaked echidna Zaglossus attenboroughi is known from a single specimen collected in the Cyclops Mountains of northern Papua in 1961, and has previously been considered to be extremely rare if not already extinct. New fieldwork to investigate the continued survival of Z. attenboroughi was conducted on the north and south slopes of the Cyclops Mountains in May 2007 using community interviews, sign surveys and visual encounter surveys. Many villagers recognized photographs of long-beaked echidnas, were able to describe key biological characteristics of echidnas, and reported several recent sightings below 300 m elevation, referring to the animal as payangko. Although no echidnas were observed during fieldwork, diagnostic echidna feeding signs (imprints of nose pokes) were detected from < 300 m to 1,250 m and possibly up to 1,700 m elevation. These extensive reports and observations confirm that long-beaked echidnas are still present in the Cyclops Mountains, and descriptions provided by local informants strongly suggest that the reports refer to Z. attenboroughi. However, the species remains threatened by human impacts, primarily subsistence hunting and habitat loss. Efforts are now being made to learn more about the relationship of Attenborough's long-beaked echidna to all other Zaglossus species, and a project is being initiated with local communities to monitor sightings and increase awareness of this rare and evolutionarily distinct mammal.
The Hispaniolan solenodon Solenodon paradoxus, one of only two surviving native Hispaniolan land mammals, has declined drastically in Haiti and has only been recorded from the Duchity region of the Massif de la Hotte in recent decades. Previous studies have been pessimistic about the probability of even short-term survival of this relict population, predicting its likely extinction by the start of the 21st century because of a range of anthropogenic threats. However, new surveys (sign surveys and interviews with villagers and subsistence farmers) and the discovery of three dead solenodons confirm the continued survival of the species in the Duchity region, apparently across a greater geographic area than previously recognized. This may reflect a cull on dogs around the Duchity region. Given the lack of any targeted mammal conservation research in Haiti for almost 2 decades, immediate further investigation is required into solenodon distribution, habitat utilization, density, and interaction with introduced predators across the region. The solenodons of the Massif de la Hotte may represent a distinct taxon, making the establishment of an effective research and conservation programme for this population an urgent priority.
The role of crop insurance and new risk management tools for agriculture is evolving at an almost dizzying pace. One needs only to examine recent postings on the Risk Management Agency's website to see how expansive this is. Moreover, throughout the world we are witness to a host of new programs available in both developed and developing countries that are largely based on the U.S. experience. It is necessary that academics first recognize the scope of issues facing production and market risks in agriculture and then respond with new and creative ways to address the problems. To these needs, the Crop Insurance and Risk Management Workshop—the provenance of the papers in this volume—was designed to bring academics with research and extension responsibilities together with industry to explore this ever-changing landscape and discuss research and outreach of mutual interest.
The fundamental assumption of compensation for visual delays states that, since delays are dealt with, there must be compensatory mechanisms. These mechanisms are taken to be internal models. Alternatives for delay compensation exist, suggesting that this assumption may not be fundamental, and nor should the existence of internal models be assumed. Delays may even be employed in their own compensation.
This paper introduces a web-based computer program designed to evaluate weather risk management and weather insurance in the United States. The paper outlines the economics of weather risk in terms of agricultural production and household well-being; defines weather risk in terms of intensity, duration, and frequency; and illustrates the computer program use by comparing heat and precipitation risks at Ardmore, Oklahoma, and Ithaca, New York.
Agnostid trilobites are relatively abundant and taxonomically diverse in outer shelf facies of the Yangtze Platform and Jiangnan Transitional Belt regions of the South China Plate. Nine Arenig and Llanvirn species, representing at least five genera or subgenera in the Agnostidae, Diplagnostidae and Metagnostidae, are treated in a taxonomic review of the South Chinese Agnostida, based on new material from the Dawan and Kuniutan formations of W Hubei and the Zitai and Jiuxi formations of N Hunan. The new genus Han is established to incorporate the globally youngest known diplagnostid species. The new species Han solo, Geragnostus (Geragnostus) balanolobus and G. (G.) waldorfstatleri are established. G. carinatus is recognised as being based on inaccurately interpreted material, and is only tentatively retained within Geragnostus. Three further taxa represented by poorly preserved material are left in open nomenclature. The geographic distributions of different agnostid species across the South China Plate, and the endemicity to the palaeoplate displayed by all Arenig–Llanvirn South Chinese species, suggest that these agnostids at least were either benthic or epibenthic.
Psychoanalysis, once the dominant theoretical paradigm in cinema studies, has not fared well since the mid-1980s. New theoretical paradigms have arisen, creating a pluralism in the field. More importantly, psychoanalytical film theory has been subjected to a trenchant critique by analytical philosophers as well as film theorists informed by contemporary scientific and philosophical theories of mind. Some have criticized its basic premises and methodology. Noël Carroll (1988), for example, has pointed to numerous flaws in its founding analogies between cinematic phenomena and the irrational phenomena (putatively) explained by psychoanalysis. David Bordwell (1989) has shown how psychoanalytical film theorists of the past failed to adhere to even the most basic empirical and logical protocols of theory-building and instead simply integrated psychoanalytic concepts into traditional humanistic interpretive practices. Others, such as Murray Smith (1995) and Jeff Smith (1996), have pointed to the considerable failings of psychoanalytical theories of specific cinematic phenomena, such as identification and film music. The silence of psychoanalytical film theorists in the face of this critique – the fact that they have not attempted to systematically refute it or to reconstruct their theories in a dialectical response to it – is, I think, ample testimony to its power.
Although devastating for psychoanalytical film theories of the past, nothing about this critique rules out the possibility that there might be more successful psychoanalytical film theories in the future, for this critique is aimed at the failure to date of film theorists to build rigorous, plausible psychoanalytical theories, not the scientific or philosophical legitimacy of psychoanalysis itself.