New Oldowan locality Sare-Abururu (ca. 1.7 Ma) provides evidence of diverse hominin behaviors on the Homa Peninsula, Kenya.

The Homa Peninsula, in southwestern Kenya, continues to yield insights into Oldowan hominin landscape behaviors. The Late Pliocene locality of Nyayanga (∼3-2.6 Ma) preserves some of the oldest Oldowan tools. At the Early Pleistocene locality of Kanjera South (∼2 Ma) toolmakers procured a diversity of raw materials from over 10 km away and strategically reduced them in a grassland-dominated ecosystem. Here, we report findings from Sare-Abururu, a younger (∼1.7 Ma) Oldowan locality approximately 12 km southeast of Kanjera South and 18 km east of Nyayanga. Sare-Abururu has yielded 1754 artifacts in relatively undisturbed low-energy silts and sands. Stable isotopic analysis of pedogenic carbonates suggests that hominin activities were carried out in a grassland-dominated setting with similar vegetation structure as documented at Kanjera South. The composition of a nearby paleo-conglomerate indicates that high-quality stone raw materials were locally abundant. Toolmakers at Sare-Abururu produced angular fragments from quartz pebbles, representing a considerable contrast to the strategies used to reduce high quality raw materials at Kanjera South. Although lithic reduction at Sare-Abururu was technologically simple, toolmakers proficiently produced cutting edges, made few mistakes and exhibited a mastery of platform management, demonstrating that expedient technical strategies do not necessarily indicate a lack of skill or suitable raw materials. Lithic procurement and reduction patterns on the Homa Peninsula appear to reflect variation in local resource contexts rather than large-scale evolutionary changes in mobility, energy budget, or toolmaker cognition.

More than Three Decades of Bm86: What We Know and Where to Go.

Tick and tick-borne disease control have been a serious research focus for many decades. In a global climate of increasing acaricide resistance, host immunity against tick infestation has become a much-needed complementary strategy to common chemical control. From the earliest acquired resistance studies in small animal models to proof of concept in large production animals, it was the isolation, characterization, and final recombinant protein production of the midgut antigen Bm86 from the Australian cattle tick strain of Rhipicephalus (Boophilus) microplus (later reinstated as R. (B.) australis) that established tick subunit vaccines as a viable alternative in tick and tick-borne disease control. In the past 37 years, this antigen has spawned numerous tick subunit vaccines (either Bm86-based or novel), and though we are still describing its molecular structure and function, this antigen remains the gold standard for all tick vaccines. In this paper, advances in tick vaccine development over the past three decades are discussed alongside the development of biotechnology, where existing gaps and future directives in the field are highlighted.

Mental Effort in Elite and Nonelite Rowers.

Mental effort (intensity of attention) in elite sports has remained a debated topic and a challenging phenomenon to measure. Thus, a quasi-ecological laboratory study was conducted to investigate mental effort in elite rowers as compared with a group of nonelites. Findings suggest that eye-tracking measures-specifically, blink rates and pupil size-can serve as valid indicators of mental effort in physically demanding sport tasks. Furthermore, findings contradict the notion that elite athletes spend less cognitive effort than their lower-level peers. Specifically, elites displayed similar levels of self-reported effort and performance decrement with increasing mental load and significantly more mental effort overall as measured by pupil-size increase (relative to baseline) during rowing trials as compared with the nonelites in the sample. Future studies on eye tracking in sports may include investigations of mental effort in addition to selective attention during physically demanding tasks.

Cognitive load causes kinematic changes in both elite and non-elite rowers.

The current motor literature suggests that extraneous cognitive load may affect performance and kinematics in a primary motor task. A common response to increased cognitive demand, as observed in past studies, might be to reduce movement complexity and revert to previously learned movement patterns, in line with the progression-regression hypothesis. However, according to several accounts of automaticity, motor experts should be able to cope with dual task demands without detriment to their performance and kinematics. To test this, we conducted an experiment asking elite and non-elite rowers to use a rowing ergometer under conditions of varying task load. We employed single-task conditions with low cognitive load (i.e., rowing only) and dual-task conditions with high cognitive load (i.e., rowing and solving arithmetic problems). The results of the cognitive load manipulations were mostly in line with our hypotheses. Overall, participants reduced movement complexity, for example by reverting towards tighter coupling of kinematic events, in their dual-task performance as compared to single-task performance. The between-group kinematic differences were less clear. In contradiction to our hypotheses, we found no significant interaction between skill level and cognitive load, suggesting that the rowers' kinematics were affected by cognitive load irrespective of skill level. Overall, our findings contradict several past findings and automaticity theories, and suggest that attentional resources are required for optimal sports performance.

Interperformer coordination in piano-singing duo performances: phrase structure and empathy impact.

Musicians' body motion plays a fundamental role in ensemble playing, by supporting sound production, communication, and expressivity. This research investigates how Western classical musicians' head motion during ensemble performances relates to a piece's phrase structure and musicians' empathic perspective taking (EPT) profile. Twenty-four advanced piano and singing students took part in the study, and their EPT score was pre-assessed using the Interpersonal Reactivity Index. High and low EPT duos were formed, and musicians were paired with a co-performer from the same and the other EPT group. Musicians rehearsed Fauré's Automne and Schumann's Die Kartenlegerin, and performed the pieces one time before and three times after rehearsal. Motion capture data of the musicians' front head, audio, and MIDI recordings of the performances were collected and analysed. Similarity in musicians' head motion and tendency to lead/lag their co-performer were computed by extracting, respectively, power and phase difference of the cross-wavelet transforms of the velocity curves of each paired marker. Results demonstrate that the power of interperformer coordination corresponds to the piece's phrase levels and that singer's EPT can impact the leader-follower relationships between musicians, depending on piece and take number. In the Fauré piece, the higher the singer's EPT score, the higher the tendency for the singer to lead and pianist to follow in take 3, and the lower the tendency for the singer to lead and pianist to follow in take 2. These results contribute to a further understanding of the mechanisms underpinning social interactions, by revealing the complexity of the association between empathy and body motion in ensembles in promoting and diffusing leadership between musicians.

Recognition of brief sounds in rapid serial auditory presentation.

Two experiments were conducted to test the role of participant factors (i.e., musical sophistication, working memory capacity) and stimulus factors (i.e., sound duration, timbre) on auditory recognition using a rapid serial auditory presentation paradigm. Participants listened to a rapid stream of very brief sounds ranging from 30 to 150 milliseconds and were tested on their ability to distinguish the presence from the absence of a target sound selected from various sound sources placed amongst the distracters. Experiment 1a established that brief exposure to stimuli (60 to 150 milliseconds) does not necessarily correspond to impaired recognition. In Experiment 1b we found evidence that 30 milliseconds of exposure to the stimuli significantly impairs recognition of single auditory targets, but the recognition for voice and sine tone targets impaired the least, suggesting that the lower limit required for successful recognition could be lower than 30 milliseconds for voice and sine tone targets. Critically, the effect of sound duration on recognition completely disappeared when differences in musical sophistication were controlled for. Participants' working memory capacities did not seem to predict their recognition performances. Our behavioral results extend the studies oriented to understand the processing of brief timbres under temporal constraint by suggesting that the musical sophistication may play a larger role than previously thought. These results can also provide a working hypothesis for future research, namely, that underlying neural mechanisms for the processing of various sound sources may have different temporal constraints.

Expanded geographic distribution and dietary strategies of the earliest Oldowan hominins and Paranthropus.

The oldest Oldowan tool sites, from around 2.6 million years ago, have previously been confined to Ethiopia's Afar Triangle. We describe sites at Nyayanga, Kenya, dated to 3.032 to 2.581 million years ago and expand this distribution by over 1300 kilometers. Furthermore, we found two hippopotamid butchery sites associated with mosaic vegetation and a C4 grazer-dominated fauna. Tool flaking proficiency was comparable with that of younger Oldowan assemblages, but pounding activities were more common. Tool use-wear and bone damage indicate plant and animal tissue processing. Paranthropus sp. teeth, the first from southwestern Kenya, possessed carbon isotopic values indicative of a diet rich in C4 foods. We argue that the earliest Oldowan was more widespread than previously known, used to process diverse foods including megafauna, and associated with Paranthropus from its onset.

Human voices escape the auditory attentional blink: Evidence from detections and pupil responses.

Attentional selection of a second target in a rapid stream of stimuli embedding two targets tends to be briefly impaired when two targets are presented in close temporal proximity, an effect known as an attentional blink (AB). Two target sounds (T1 and T2) were embedded in a rapid serial auditory presentation of environmental sounds with a short (Lag 3) or long lag (Lag 9). Participants were to first identify T1 (bell or sine tone) and then to detect T2 (present or absent). Individual stimuli had durations of either 30 or 90 ms, and were presented in streams of 20 sounds. The T2 varied in category: human voice, cello, or dog sound. Previous research has introduced pupillometry as a useful marker of the intensity of cognitive processing and attentional allocation in the visual AB paradigm. Results suggest that the interplay of stimulus factors is critical for target detection accuracy and provides support for the hypothesis that the human voice is the least likely to show an auditory AB (in the 90 ms condition). For the other stimuli, accuracy for T2 was significantly worse at Lag 3 than at Lag 9 in the 90 ms condition, suggesting the presence of an auditory AB. When AB occurred (at Lag 3), we observed smaller pupil dilations, time-locked to the onset of T2, compared to Lag 9, reflecting lower attentional processing when 'blinking' during target detection. Taken together, these findings support the conclusion that human voices escape the AB and that the pupillary changes are consistent with the so-called T2 attentional deficit. In addition, we found some indication that salient stimuli like human voices could require a less intense allocation of attention, or noradrenergic potentiation, compared to other auditory stimuli.

Body motion of choral singers.

Recent investigations on music performances have shown the relevance of singers' body motion for pedagogical as well as performance purposes. However, little is known about how the perception of voice-matching or task complexity affects choristers' body motion during ensemble singing. This study focussed on the body motion of choral singers who perform in duo along with a pre-recorded tune presented over a loudspeaker. Specifically, we examined the effects of the perception of voice-matching, operationalized in terms of sound spectral envelope, and task complexity on choristers' body motion. Fifteen singers with advanced choral experience first manipulated the spectral components of a pre-recorded short tune composed for the study, by choosing the settings they felt most and least together with. Then, they performed the tune in unison (i.e., singing the same melody simultaneously) and in canon (i.e., singing the same melody but at a temporal delay) with the chosen filter settings. Motion data of the choristers' upper body and audio of the repeated performances were collected and analyzed. Results show that the settings perceived as least together relate to extreme differences between the spectral components of the sound. The singers' wrists and torso motion was more periodic, their upper body posture was more open, and their bodies were more distant from the music stand when singing in unison than in canon. These findings suggest that unison singing promotes an expressive-periodic motion of the upper body.

Judgment of togetherness in performances by musical duos.

Musicians experience varying degrees of togetherness with their co-performers when playing in ensembles. However, little is known about how togetherness is experienced by audiences and how interpersonal dynamics in body motion and sound support the judgment of togetherness. This research investigates audience sensitivity to audio and visual markers of interperformer coordination and expressivity in ensembles, in relation to modality of stimulus presentation and audience music background. A set of duo ensemble performances, comprising motion capture recordings of the musicians' upper bodies and instruments, were presented to participants with varying music background, including novices and semi-professional musicians. Participants were required to: (i) watch and listen, (ii) only watch, and (iii) only listen to the selected recordings, whilst providing dynamic ratings of how much togetherness between musicians they perceived. Results demonstrate that sound intensity and similarity in right arm motion (quantified using cross-wavelet transform analysis) were significant predictors of rated togetherness in novices, whilst sound synchronization and chest motion coordination predicted togetherness responses in semi-professional musicians. These results suggest the relevance of the quality of body motion coordination and of certain features of the audio outputs in the audience perception of togetherness. This research contributes to a better understanding of the perceptual mechanisms supporting socio-cognitive judgments of joint action activities.

Initiation of Buprenorphine/Naloxone on Rates of Discharge Against Medical Advice.

Objective: Evidence shows that patients with opioid use disorder (OUD) have an increased rate of discharge against medical advice (DAMA) as well as higher rates of hospital readmission. Therefore, the objective of this study was to determine if inpatient initiation of buprenorphine/naloxone in patients with OUD is associated with decreased rates of DAMA. Methods: This was a single center retrospective cohort study conducted at a level 1, academic medical center. The study included patients with OUD admitted to the Internal Medicine service from January through May of both 2018 and 2019 for an admitting diagnosis other than opioid withdrawal. The primary endpoint was rate of DAMA among OUD patients not initiated on opioid agonist therapy compared to those initiated on buprenorphine/naloxone. The secondary endpoint was the association between factors of the initiation process on rates of DAMA. Patients were excluded if they were discharged in less than 24 hours or received intermittent administration of buprenorphine/naloxone. Results: The rate of DAMA in OUD patients not initiated on buprenorphine/naloxone was 13.85% compared to 2.56% in those initiated on buprenorphine/naloxone (P = .048). Conclusion: In OUD patients initiated on buprenorphine/naloxone, the rate of DAMA was significantly lower than those who were not. This data supports the importance of optimizing the opportunity to initiate buprenorphine/naloxone in the acute care setting to minimize withdrawal symptoms therefore reducing the rate of DAMA. Ultimately increasing the ability to adequately treat the primary reason for admission and potentially decreasing readmission rates. Further studies are needed to evaluate this impact as this study is limited to a small sample size therefore lacking adequate power.

Association of in-hospital depression and anxiety symptoms following stroke with 3 months- depression, anxiety and functional outcome.

BACKGROUND: Post-stroke depression and anxiety are common and are associated with worse post-stroke outcomes. Even though checking for depression during stroke hospitalization has become a common practice, the prognostic value of a positive in-hospital depression screen following stroke remains unclear. METHODS: This is a retrospective cohort study of patients with stroke or TIA discharged home from a tertiary care center. We examined the association between premorbid history of depression and in-hospital anxiety/depressive symptoms, with anxiety/depressive symptoms and functional outcome at 3-months post-stroke. Logistic regression models were generated using two different main predictors: 1) pre-hospital history of depression (N = 117) and 2) in-hospital depression/anxiety measured by the EQ-5D-3L (N = 66). RESULTS: In the cohort of 117 patients, the mean age was 66 years, with median NIHSS 2;44% were women and 70% White. A history of pre-stroke depression was reported by 7% (8/117). Anxiety/depression on ED-5D-3L was reported by 29/66 (43%) in the hospital and by 22/66 (33%) at three months' post-stroke. In the first adjusted model, previous history of depression was associated with 3 months EQ-5D-3L anxiety/depression (OR = 10.2;95%CI:1.12-90.9, p = 0.038). In the second adjusted model, in-hospital anxiety/depression was associated with 3-month EQ-5D-3L anxiety/depression (OR = 3.9; 95% CI:1.16-13.1, p = 0.027). In-hospital anxiety/depression was associated with a higher mRS at 3 months but not after adjusting for covariates. CONCLUSION: A previous history of depression and in-hospital anxiety/depression symptoms are associated with anxiety/depression symptoms 3-months post-stroke but not with functional outcome. Screening stroke patients for both during hospitalization is warranted because of the association with later symptoms.

Effect of Computer-Assisted Cognitive Behavior Therapy vs Usual Care on Depression Among Adults in Primary Care: A Randomized Clinical Trial.

Importance: Depression is a common disorder that may go untreated or receive suboptimal care in primary care settings. Computer-assisted cognitive behavior therapy (CCBT) has been proposed as a method for improving access to effective psychotherapy, reducing cost, and increasing the convenience and efficiency of treatment for depression. Objectives: To evaluate whether clinician-supported CCBT is more effective than treatment as usual (TAU) in primary care patients with depression and to examine the feasibility and implementation of CCBT in a primary care population with substantial numbers of patients with low income, limited internet access, and low levels of educational attainment. Design, Setting, and Participants: This randomized clinical trial included adult primary care patients from clinical practices at the University of Louisville who scored 10 or greater on the Patient Health Questionnaire-9 (PHQ-9) and were randomly assigned to CCBT or TAU for 12 weeks of active treatment. Follow-up assessments were conducted 3 and 6 months after treatment completion. Enrollment occurred from June 24, 2016, to May 13, 2019. The last follow-up assessment was conducted on January 30, 2020. Interventions: CCBT included use of the 9-lesson computer program Good Days Ahead, along with as many as 12 weekly telephonic support sessions of approximately 20 minutes with a master's level therapist, in addition to TAU, which consisted of the standard clinical management procedures at the primary care sites. TAU was uncontrolled, but use of antidepressants and psychotherapy other than CCBT was recorded. Main Outcomes and Measures: The primary outcome measure (PHQ-9) and secondary outcome measures (Automatic Thoughts Questionnaire for negative cognitions, Generalized Anxiety Disorder-7, and the Satisfaction with Life Scale for quality of life) were administered at baseline, 12 weeks, and 3 and 6 months after treatment completion. Satisfaction with treatment was assessed with the Client Satisfaction Questionnaire-8. Results: The sample of 175 patients was predominately female (147 of 174 [84.5%]) and had a high proportion of individuals who identified as racial and ethnic minority groups (African American, 44 of 162 patients who reported [27.2%]; American Indian or Alaska Native, 2 [1.2%]; Hispanic, 4 [2.5%]; multiracial, 14 [8.6%]). An annual income of less than $30 000 was reported by 88 of 143 patients (61.5%). Overall, 95 patients (54.3%) were randomly assigned to CCBT and 80 (45.7%) to TAU. Dropout rates were 22.1% for CCBT (21 patients) and 30.0% for TAU (24 patients). An intent-to-treat analysis found that CCBT led to significantly greater improvement in PHQ-9 scores than TAU at posttreatment (mean difference, -2.5; 95% CI, -4.5 to -0.8; P = .005) and 3 month (mean difference, -2.3; 95% CI, -4.5 to -0.8; P = .006) and 6 month (mean difference, -3.2; 95% CI, -4.5 to -0.8; P = .007) follow-up points. Posttreatment response and remission rates were also significantly higher for CCBT (response, 58.4% [95% CI, 46.4-70.4%]; remission, 27.3% [95% CI, 16.4%-38.2%]) than TAU (response, 33.1% [95% CI, 20.7%-45.5%]; remission, 12.0% [95% CI, 3.3%- 20.7%]). Conclusions and Relevance: In this randomized clinical trial, CCBT was found to have significantly greater effects on depressive symptoms than TAU in primary care patients with depression. Because the study population included people with lower income and lack of internet access who typically have been underrepresented or not included in earlier investigations of CCBT, results suggest that this form of treatment can be acceptable and useful in diverse primary care settings. Additional studies with larger samples are needed to address implementation procedures that could enhance the effectiveness of CCBT and to examine potential factors associated with treatment outcome. Trial Registration: ClinicalTrials.gov Identifier: NCT02700009.

Musical and Bodily Predictors of Mental Effort in String Quartet Music: An Ecological Pupillometry Study of Performers and Listeners.

Music performance can be cognitively and physically demanding. These demands vary across the course of a performance as the content of the music changes. More demanding passages require performers to focus their attention more intensity, or expend greater "mental effort." To date, it remains unclear what effect different cognitive-motor demands have on performers' mental effort. It is likewise unclear how fluctuations in mental effort compare between performers and perceivers of the same music. We used pupillometry to examine the effects of different cognitive-motor demands on the mental effort used by performers and perceivers of classical string quartet music. We collected pupillometry, motion capture, and audio-video recordings of a string quartet as they performed a rehearsal and concert (for live audience) in our lab. We then collected pupillometry data from a remote sample of musically-trained listeners, who heard the audio recordings (without video) that we captured during the concert. We used a modelling approach to assess the effects of performers' bodily effort (head and arm motion; sound level; performers' ratings of technical difficulty), musical complexity (performers' ratings of harmonic complexity; a score-based measure of harmonic tension), and expressive difficulty (performers' ratings of expressive difficulty) on performers' and listeners' pupil diameters. Our results show stimulating effects of bodily effort and expressive difficulty on performers' pupil diameters, and stimulating effects of expressive difficulty on listeners' pupil diameters. We also observed negative effects of musical complexity on both performers and listeners, and negative effects of performers' bodily effort on listeners, which we suggest may reflect the complex relationships that these features share with other aspects of musical structure. Looking across the concert, we found that both of the quartet violinists (who exchanged places halfway through the concert) showed more dilated pupils during their turns as 1st violinist than when playing as 2nd violinist, suggesting that they experienced greater arousal when "leading" the quartet in the 1st violin role. This study shows how eye tracking and motion capture technologies can be used in combination in an ecological setting to investigate cognitive processing in music performance.

A Multi-Institutional Collaborative To Assess the Knowledge and Skills of Medicine-Pediatrics Residents in Health Care Transition.

Background Pediatric to adult health care transition (HCT) is an essential process in the care of youth with special health care needs (YSHCN). Many internal medicine-pediatrics (med-peds) residency programs have developed curricula to teach transition knowledge and skills for the care of YSHCN. Objective Using a national med-peds program director quality improvement collaborative to improve transition curriculum, we aim to identify curricular content areas of improvement by describing baseline trainee knowledge and skills taught through existing transition curricula in med-peds programs. Methods We analyzed data collected during the 2018-2019 national med-peds program director quality improvement collaborative to improve transition curriculum. Program directors assessed their programs, and trainees assessed themselves on five transition goals by completing a Likert-scale questionnaire. In addition, trainees received an objective assessment of their knowledge through a multiple-choice questionnaire (MCQ). Results All 19 programs in the collaborative, and 193 of 316 trainees from these programs, completed the questionnaires. Most programs were based at academic centers (68%) and provided transition training via didactics (63%) and/or subspecialty rotations (58%). More programs had high confidence (95%) than trainees (58%) in goal 1 (knowledge and skills of the issues around transition), whereas more trainees had high confidence (60%) than programs (47%) in goal 2 (understanding the developmental and psychosocial aspects of transition). Programs and trainees self-assessed lower in goals related to health insurance, educational and vocational needs, and application of health care system knowledge to the practice environment (goals 3, 4, and 5, respectively). Conclusions Using the assessments of the program directors and resident trainees, we identified subject areas for improvement of transition curricula, including health insurance and the application of health care system knowledge to the practice environment.

Bovid mortality patterns from Kanjera South, Homa Peninsula, Kenya and FLK-Zinj, Olduvai Gorge, Tanzania: Evidence for habitat mediated variability in Oldowan hominin hunting and scavenging behavior.

The archaeological record has documented Oldowan hominin occupation of habitats ranging from open grasslands to riparian forest by 2.0 Ma. Despite this we have a poor understanding of whether hominin foraging behavior varied in different environmental settings. We compared bovid mortality profiles from the two largest Oldowan zooarchaeological samples, one from a grassland (Excavation 1, Kanjera South, Kenya) and another from a woodland (FLK Zinj, Olduvai Gorge, Tanzania) with bovid mortality samples created by African carnivores in different habitats. Kanjera hominins frequently had early access, likely through hunting, to small (size 1 ≤ 23 kg and size 2 = 24-112 kg) juvenile bovids, creating a mortality pattern similar to that created by grassland dwelling carnivores. Kanjera hominins had more mixed access to large (size 3 = 113-340 kg), often juvenile, bovids and frequently scavenged heads. In contrast, previous work has shown that the few small bovids at FLK-Zinj were predominantly older individuals. Prime adults dominated the FLK-Zinj large bovid sample, leading to a mortality pattern similar to that created by carnivores occupying more closed habitats. Variation in bovid body size and mortality profiles between these archaeological assemblages may reflect the challenges of acquiring fauna in open versus closed habitats with a simple hunting toolkit. The heterogeneous woodland habitat of FLK-Zinj would have provided more opportunities to ambush prey, whereas on grasslands with more limited concealment opportunities Kanjera hominins focused their efforts on vulnerable juvenile prey, some likely acquired after short chases.

Eye gaze as a means of giving and seeking information during musical interaction.

During skilled music ensemble performance, a multi-layered network of interaction processes allows musicians to negotiate common interpretations of ambiguously-notated music in real-time. This study investigated the conditions that encourage visual interaction during duo performance. Duos recorded performances of a new piece before and after a period of rehearsal. Mobile eye tracking and motion capture were used in combination to map uni- and bidirectional eye gaze patterns. Musicians watched each other more during temporally-unstable passages than during regularly-timed passages. They also watched each other more after rehearsal than before. Duo musicians may seek visual interaction with each other primarily, but not exclusively, when coordination is threatened by temporal instability. Visual interaction increases as musicians become familiar with the piece, suggesting that they visually monitor each other once a shared interpretation of the piece is established. Visual monitoring of co-performers' movements and attention may facilitate feelings of engagement and high-level creative collaboration.

Computer-Assisted Cognitive-Behavior Therapy in Medical Care Settings.

PURPOSE OF REVIEW: We reviewed research on computer-assisted cognitive-behavior therapy (CCBT) performed in medical settings with the goals of assessing the effectiveness of this newer method of treatment delivery, evaluating the need for clinician support of therapeutic computer programs, and making suggestions for future research and clinical implementation. RECENT FINDINGS: The overall results of randomized, controlled trials suggest that CCBT can be an effective treatment for depression in primary care patients and health care anxiety. Also, it can be a useful component of treatment for somatic conditions including irritable bowel syndrome, diabetes, fibromyalgia, and chronic pain. The amount and type of clinician support needed for maximizing effectiveness remains unclear. CCBT offers promise for overcoming barriers to delivering effective psychotherapy in medical settings. We recommend that next steps for researchers include more definitive studies of the influence of clinician support, investigations focused on implementation in clinical practices, cost-benefit analyses, and use of technological advances.

Collaborative Musical Creativity: How Ensembles Coordinate Spontaneity.

Music performance is inherently social. Most music is performed in groups, and even soloists are subject to influence from a (real or imagined) audience. It is also inherently creative. Performers are called upon to interpret notated music, improvise new musical material, adapt to unexpected playing conditions, and accommodate technical errors. The focus of this paper is how creativity is distributed across members of a music ensemble as they perform these tasks. Some aspects of ensemble performance have been investigated extensively in recent years as part of the broader literature on joint action (e.g., the processes underlying sensorimotor synchronization). Much of this research has been done under highly controlled conditions, using tasks that generate reliable results, but capture only a small part of ensemble performance as it occurs naturalistically. Still missing from this literature is an explanation of how ensemble musicians perform in conditions that require creative interpretation, improvisation, and/or adaptation: how do they coordinate the production of something new? Current theories of creativity endorse the idea that dynamic interaction between individuals, their actions, and their social and material environments underlies creative performance. This framework is much in line with the embodied music cognition paradigm and the dynamical systems perspective on ensemble coordination. This review begins by situating the concept of collaborative musical creativity in the context of embodiment. Progress that has been made toward identifying the mechanisms that underlie collaborative creativity in music performance is then assessed. The focus is on the possible role of musical imagination in facilitating performer flexibility, and on the forms of communication that are likely to support the coordination of creative musical output. Next, emergence and group flow-constructs that seem to characterize ensemble performance at its peak-are considered, and some of the conditions that may encourage periods of emergence or flow are identified. Finally, it is argued that further research is needed to (1) demystify the constructs of emergence and group flow, clarifying their effects on performer experience and listener response, (2) determine how constrained musical imagination is by perceptual experience and understand people's capacity to depart from familiar frameworks and imagine new sounds and sound structures, and (3) assess the technological developments that are supposed to facilitate or enhance musical creativity, and determine what effect they have on the processes underlying creative collaboration.