The effectiveness of an acceptance and commitment therapy self-help intervention for chronic pain

Objective: To evaluate the effectiveness of an Acceptance Commitment Therapy based self-help book for people with chronic pain. Method: This was a randomized 2 group study design. Over a 6-week period, 6 participants read the self-help book and completed exercises from it with weekly telephone support whereas 8 others formed a wait-list control group. Subsequently, 5 of the wait-list participants completed the intervention. Participants completed preintervention and postintervention questionnaires for acceptance, values illness, quality of life, satisfaction with life, depression, anxiety, and pain. Initial outcome data were collected for 8 control participants and 6 intervention participants. Including the wait-list controls, a total of 11 participants completed preintervention and postintervention measures. Whilst completing the self-help intervention, each week participants' rated the content of the book according to reading level and usefulness, and their comprehension of the content was also assessed. Results: Compared with controls, participants who completed the book showed improved quality of life and decreased anxiety. When data from all the treatment participants were pooled, those who completed the intervention showed statistically significant improvements (with large effect sizes) for acceptance, quality of life, satisfaction with life, and values illness. Medium effect sizes were found for improvements in pain ratings. Conclusions: These findings support the hypothesis that using the self-help book, with minimal therapist contact adds value to the lives of people who experience chronic pain

Culture, space, and metapopulation: a simulation-based study for evaluating signals of blending and branching

This paper explores the robustness of phylogenetic methods for detecting variations in branching and blending signals in the archaeological record. Both processes can generate a spatial structure whereby cultural similarity between different sites decays with increasing spatial distance. By generating a series of artificial records through the controlled and parameterised environment of an agent-based simulation, we: a) illustrate the weakness and the strength of different analytical techniques (empirical distogram, Mantel test, Retention Index, and d-score); b) determine whether they are capable of assessing how spatial isolation determines cultural diversity; and c) establish whether they can detect variations in the nature of horizontal transmission over time. Results suggest that variables other than the spatial range of interaction (e.g. the frequency of fission events, population dynamics, and rates of cultural innovation) have different effects on the output of some phylogenetic analyses

British Neolithic Axehead Distributions and Their Implications

Neolithic stone axeheads from Britain provide an unusually rich, well-provenanced set of evidence with which to consider patterns of prehistoric production and exchange. It is no surprise then that these objects have often been subject to spatial analysis in terms of the relationship between particular stone source areas and the distribution of axeheads made from those stones. At stake in such analysis are important interpretative issues to do with how we view the role of material value, supply, exchange, and demand in prehistoric societies. This paper returns to some of these well-established debates in the light of accumulating British Neolithic evidence and via the greater analytical power and flexibility afforded by recent computational methods. Our analyses make a case that spatial distributions of prehistoric axeheads cannot be explained merely as the result of uneven resource availability in the landscape, but instead reflect the active favouring of particular sources over known alternatives. Above and beyond these patterns, we also demonstrate that more populated parts of Early Neolithic Britain were an increased pull factor affecting the longer-range distribution of these objects

Development of a core outcome set for effectiveness studies of breech birth at term (Breech-COS)-an international multi-stakeholder Delphi study: study protocol.

BACKGROUND: Women pregnant with a breech-presenting foetus at term are at increased risk of adverse pregnancy outcomes. The most common intervention used to improve neonatal outcomes is planned delivery by caesarean section. But this is not always possible, and some women prefer to plan a vaginal birth. A number of providers have proposed alternative interventions, such as delivery protocols or specialist teams, but heterogeneity in reported outcomes and their measurements prevents meaningful comparisons. The aim of this paper is to present a protocol for a study to develop a Breech Core Outcome Set (Breech-COS) for studies evaluating the effectiveness of interventions to improve outcomes associated with term breech birth. METHODS: The development of a Breech-COS includes three phases. First, a systematic literature review will be conducted to identify outcomes previously used in effectiveness studies of breech birth at term. A focus group discussion will be conducted with the study's pre-established Patient and Public Involvement (PPI) group, to enable service user perspectives on the results of the literature review to influence the design of the Delphi survey instrument. Second, an international Delphi survey will be conducted to prioritise outcomes for inclusion in the Breech-COS from the point of view of key stakeholders, including perinatal care providers and families who have experienced a term breech pregnancy. Finally, a consensus meeting will be held with stakeholders to ratify the Breech-COS and disseminate findings for application in future effectiveness studies. DISCUSSION: The expectation is that the Breech-COS will always be collected in all clinical trials, audits of practice and other forms of observation research that concern breech birth at term, along with other outcomes of interest. This will facilitate comparing, contrasting and combining studies with the ultimate goal of improved maternal and neonatal outcomes. TRIAL REGISTRATION: Core Outcome Measures in Effectiveness Trials (COMET) #1749

Isolation-by-distance, homophily, and “core” vs. “package” cultural evolution models in Neolithic Europe

Recently there has been growing interest in characterising population structure in cultural data in the context of ongoing debates about the potential of cultural group selection as an evolutionary process. Here we use archaeological data for this purpose, which brings in a temporal as well as spatial dimension. We analyse two distinct material cultures (pottery and personal ornaments) from Neolithic Europe, in order to: a) determine whether archaeologically defined “cultures” exhibit marked discontinuities in space and time, supporting the existence of a population structure, or merely isolation-by-distance; and b) investigate the extent to which cultures can be conceived as structuring “cores” or as multiple and historically independent “packages”. Our results support the existence of a robust population structure comparable to previous studies on human culture, and shows how the two material cultures exhibit profound differences in their spatial and temporal structuring, signalling different evolutionary trajectories

Cycles in Stone Mining and Copper Circulation in Europe 5500–2000 BC: A View from Space

The authors of this article consider the relationship in European prehistory between the procurement of high-quality stones (for axeheads, daggers, and other tools) on the one hand, and the early mining, crafting, and deposition of copper on the other. The data consist of radiocarbon dates for the exploitation of stone quarries, flint mines, and copper mines, and of information regarding the frequency through time of jade axeheads and copper artefacts. By adopting a broad perspective, spanning much of central-western Europe from 5500 to 2000 bc, they identify a general pattern in which the circulation of the first copper artefacts was associated with a decline in specialized stone quarrying. The latter re-emerged in certain regions when copper use decreased, before declining more permanently in the Bell Beaker phase, once copper became more generally available. Regional variations reflect the degrees of connectivity among overlapping copper exchange networks. The patterns revealed are in keeping with previous understandings, refine them through quantification and demonstrate their cyclical nature, with additional reference to likely local demographic trajectories

Pills and prayers: a comparative qualitative study of community conceptualisations of pre-eclampsia and pluralistic care in Ethiopia, Haiti and Zimbabwe.

BACKGROUND: Pre-eclampsia is a leading cause of preventable maternal and perinatal deaths globally. While health inequities remain stark, removing financial or structural barriers to care does not necessarily improve uptake of life-saving treatment. Building on existing literature elaborating the sociocultural contexts that shape behaviours around pregnancy and childbirth can identify nuanced influences relating to pre-eclampsia care. METHODS: We conducted a cross-cultural comparative study exploring lived experiences and understanding of pre-eclampsia in Ethiopia, Haiti and Zimbabwe. Our primary objective was to examine what local understandings of pre-eclampsia might be shared between these three under-resourced settings despite their considerable sociocultural differences. Between August 2018 and January 2020, we conducted 89 in-depth interviews with individuals and 17 focus group discussions (n = 106). We purposively sampled perinatal women, survivors of pre-eclampsia, families of deceased women, partners, older male and female decision-makers, traditional birth attendants, religious and traditional healers, community health workers and facility-based health professionals. Template analysis was conducted to facilitate cross-country comparison drawing on Social Learning Theory and the Health Belief Model. RESULTS: Survivors of pre-eclampsia spoke of their uncertainty regarding symptoms and diagnosis. A lack of shared language challenged coherence in interpretations of illness related to pre-eclampsia. Across settings, raised blood pressure in pregnancy was often attributed to psychosocial distress and dietary factors, and eclampsia linked to spiritual manifestations. Pluralistic care was driven by attribution of causes, social norms and expectations relating to alternative care and trust in biomedicine across all three settings. Divergence across the contexts centred around nuances in religious or traditional practices relating to maternal health and pregnancy. CONCLUSIONS: Engaging faith and traditional caregivers and the wider community offers opportunities to move towards coherent conceptualisations of pre-eclampsia, and hence greater access to potentially life-saving care