Small-scale societies exhibit fundamental variation in the role of intentions in moral judgment

Intent and mitigating circumstances play a central role in moral and legal assessments in large-scale industrialized societies. Although these features of moral assessment are widely assumed to be universal, to date, they have only been studied in a narrow range of societies. We show that there is substantial cross-cultural variation among eight traditional small-scale societies (ranging from hunter-gatherer to pastoralist to horticulturalist) and two Western societies (one urban, one rural) in the extent to which intent and mitigating circumstances influence moral judgments. Although participants in all societies took such factors into account to some degree, they did so to very different extents, varying in both the types of considerations taken into account and the types of violations to which such considerations were applied. The particular patterns of assessment characteristic of large-scale industrialized societies may thus reflect relatively recently culturally evolved norms rather than inherent features of human moral judgment

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Prospective evaluation of electronic cigarettes, smoking behaviors, and cardiopulmonary disease: addressing biases with novel analytic methods

There is growing evidence that electronic cigarettes (e-cigarettes) might be associated with youth initiation of combustible cigarette smoking, and yet for adults, e-cigarettes hold potential as a cessation aid for combustible cigarette smoking. There is also growing concern over the health risks of e-cigarettes for individuals of all ages. This dissertation examines the prospective association between e-cigarette use and youth cigarette smoking initiation, adult cigarette smoking abstinence, and cardiopulmonary disease using four waves of the Population Assessment of Tobacco and Health study (2014-2018). This work enhances prior literature by incorporating novel analytic methods to account for previously unaddressed challenges in e-cigarette research, including time-dependent confounders that simultaneously act as causal intermediates, misclassification of self-reported e-cigarette use, and measurement of cumulative e-cigarette exposure. Study 1 examines the association between time-varying e-cigarette initiation and cigarette smoking initiation in a cohort of cigarette and e-cigarette naïve youth at baseline, and employs marginal structural models (MSMs) to account for time-dependent confounding. MSMs allowed for the modeling of e-cigarette use as a time-varying exposure while appropriately adjusting for time-dependent confounders that otherwise produce overestimates of the association between vaping and cigarette smoking. Youth who initiated e-cigarettes over follow-up were three-times more likely than youth who did not initiate e-cigarettes to subsequently initiate combustible cigarette smoking. The association with smoking initiation appeared stronger for more frequent e-cigarette use. Study 2 uses MSMs to examine the independent and joint association between e-cigarette use frequency at two time-points and combustible cigarette smoking abstinence. MSMs allowed for estimation of the simultaneous effect of e-cigarette use at multiple time points, as well as the direct effect of short-term e-cigarette use on smoking abstinence 24-months later. Consistent daily e-cigarette use was associated with four-times the likelihood of sustained 12-month cigarette smoking abstinence compared to no e-cigarette use over follow-up. Participants who reported consistent non-daily e-cigarette use were 70% less likely to achieve cigarette smoking abstinence than non-users. Study 3 develops a novel measure of cumulative e-cigarette exposure (“vape-years”) using a volume-based approach to measuring e-cigarette dose. The study assesses the association between vape-years and incident cardiovascular disease, lung disease, and disease precursors (hypertension, wheezing/whistling in the chest, dry cough). The highest levels of cumulative e-cigarette exposure were associated with increased risk of incident cardiovascular disease and lung disease among participants with lower combustible smoking pack-years of exposure, though residual confounding by combustible smoking is likely. There was little association between cumulative e-cigarette exposure and disease precursors. This dissertation demonstrates analytic techniques that can be used to address methodological challenges when evaluating longitudinal e-cigarette exposures. Findings provide evidence that e-cigarette use predisposes youth to initiate combustible cigarettes, and e-cigarettes can both help and hinder combustible smoking cessation depending on frequency of use. The association between cumulative e-cigarette exposure and cardiopulmonary disease risk remains unclear. Findings can inform e-cigarette regulations aimed at preventing youth vaping, reducing harm for adult tobacco users, and communicating health effects of vaping.2022-08-04T00:00:00

Crash proximity and equivalent property damage calculation techniques: An investigation using a novel horizontal curve dataset

Despite the numerous breakthroughs in crash analytics, there remains a lack of consensus among safety practitioners as to the optimal method for locating high crash locations. Two critical components in the traffic safety analysis process not agreed upon are 1) how the crash distance to a target location is included in the analysis and 2) how crashes are weighted based on crash-related characteristics. For example, the commonly used buffering technique to determine which crashes are associated with a specific target road segment does not associate crashes that are closer to a target road segment with any additional weight, even though it is likely to be more greatly associated with the characteristics of the target location. Additionally, the commonly used equivalent property damage only (EPDO) crash weight method has been found to weigh fatal crashes significantly more than serious injury crashes, even if the difference between the two outcomes was a single factor. This study proposes more robust crash weighting techniques for use in high-risk location identification using an application of a novel horizontal curve dataset. Specifically, a heteroscedastic censored regression approach was used to investigate the impact of different crash proximity weighting techniques and crash severity weighting methods on model outcomes. The results demonstrate that the use of a linear distance weighting factor used in conjunction with the buffering technique as well as a less precise EPDO weighting factor method results in more robust safety analysis outcomes. The improved results have the potential to improve hot spot identification and resource allocation at both the federal and regional levels by employing models that more accurately link specific crash segments with contributing crash characteristics.36 month embargo; available online: 28 December 2021This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Developing a Geospatial Safety Analysis Tool: A Systematic Approach to Identify Safety-Critical Horizontal Curve Segments and Hazardous Contributing Factors

Transportation agencies make substantial efforts to implement safety improvement countermeasures to mitigate safety hazards. However, region-specific safety considerations, rather than accepting more general, widespread methods, and the most ideal investment decisions to improve safety, are often unclear. This is of increased concern for horizontal curve segments, because they are locations of elevated safety risk. Yet, there exists a gap in literature on the development and use of a geospatial tool to investigate horizontal curve safety. To fill this gap, a methodological approach to create a region-specific geospatial horizontal curve safety tool was developed in this research. The tool was created using two regions as application areas to ensure the methodological approach was reproducible and transferable. Geolocated crash data, roadway infrastructure data, and curve data were spatially integrated using a GIS. Bayesian hierarchical models were estimated with crash severity data to gain region-specific safety results. A GIS tool was then derived from the applied model coefficients. The tool was applied to prioritize the most safety-critical horizontal curves and to select optimal countermeasures, especially in cases with specific infrastructure investment identification needs. The results of this research benefit regional agencies in their aim to efficiently distribute investments and identify the most appropriate countermeasures to improve roadway safety in their region.Transportation agencies make substantial efforts to implement safety improvement countermeasures to mitigate safety hazards. However, region-specific safety considerations, rather than accepting more general, widespread methods, and the most ideal investment decisions to improve safety, are often unclear. This is of increased concern for horizontal curve segments, because they are locations of elevated safety risk. Yet, there exists a gap in literature on the development and use of a geospatial tool to investigate horizontal curve safety. To fill this gap, a methodological approach to create a region-specific geospatial horizontal curve safety tool was developed in this research. The tool was created using two regions as application areas to ensure the methodological approach was reproducible and transferable. Geolocated crash data, roadway infrastructure data, and curve data were spatially integrated using a GIS. Bayesian hierarchical models were estimated with crash severity data to gain region-specific safety results. A GIS tool was then derived from the applied model coefficients. The tool was applied to prioritize the most safety-critical horizontal curves and to select optimal countermeasures, especially in cases with specific infrastructure investment identification needs. The results of this research benefit regional agencies in their aim to efficiently distribute investments and identify the most appropriate countermeasures to improve roadway safety in their region.Immediate accessThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Data from: Optimal frequency of rabies vaccination campaigns in Sub-Saharan Africa

Rabies causes more than 24 000 human deaths annually in Sub-Saharan Africa. The World Health Organization recommends annual canine vaccination campaigns with at least 70% coverage to control the disease. While previous studies have considered optimal coverage of animal rabies vaccination, variation in the frequency of vaccination campaigns has not been explored. To evaluate the cost-effectiveness of rabies canine vaccination campaigns at varying coverage and frequency, we parametrized a rabies virus transmission model to two districts of northwest Tanzania, Ngorongoro (pastoral) and Serengeti (agro-pastoral). We found that optimal vaccination strategies were every 2 years, at 80% coverage in Ngorongoro and annually at 70% coverage in Serengeti. We further found that the optimality of these strategies was sensitive to the rate of rabies reintroduction from outside the district. Specifically, if a geographically coordinated campaign could reduce reintroduction, vaccination campaigns every 2 years could effectively manage rabies in both districts. Thus, coordinated campaigns may provide monetary savings in addition to public health benefits. Our results indicate that frequency and coverage of canine vaccination campaigns should be evaluated simultaneously and tailored to local canine ecology as well as to the risk of disease reintroduction from surrounding regions

Co‐ideation and co‐design in co‐creation research: Reflections from the ‘Co‐Creating Safe Spaces’ project

Abstract Introduction Numerous frameworks for defining and supporting co‐created research exist. The practicalities of designing and conducting co‐created research are clearly important, yet the utility of these frameworks and their operationalisation within local contexts and involving a diversity of stakeholders and interests are currently not well‐researched. Methods Using an instrumental case study approach, we examined the utility of a published systematic framework designed to improve clarity about co‐creation as a concept and approach. The framework is explored based on the first two processes that correspond to our own work to date: co‐ideation and co‐design. Results Our study showed that diverse stakeholders bring challenges regarding research priorities, methods, language and the distribution of power within co‐creation processes. Co‐creation activities were incremental, adaptable, responsive and made best use of established relationships, structures and collective leadership to meet the competing demands of funders and human research ethics committees, while ensuring the meaningful participation of multiple stakeholders. Conclusion The findings highlight the iterative, fluid and deeply relational nature of co‐created research. Rather than seeking to categorise these processes, we argue that the social relations of research production that provide the structures within which all co‐created knowledge is generated are more important drivers of effective knowledge mobilisation and implementation. Thus, close attention to these social relations is needed in co‐created research. Patient or Public Contribution People with lived experience of emotional distress and/or suicidal crisis, including academic researchers, service and peer workers, carers and advocates were involved in the co‐ideation and co‐design of this research. All authors identify as people with lived experience, from both academic and nonresearch backgrounds

Ngorongoro_Base_Case

Model code for Ngorongoro in base case

Serengeti_Base_Case

Model code for Serengeti in base case

Uncertainty_Analysis_Reintroduction

Model code for uncertainty analysis varying reintroduction in Ngorongoro and Serenget