Gods are watching and so what? Moralistic supernatural punishment across 15 cultures.

Psychological and cultural evolutionary accounts of human sociality propose that beliefs in punitive and monitoring gods that care about moral norms facilitate cooperation. While there is some evidence to suggest that belief in supernatural punishment and monitoring generally induce cooperative behaviour, the effect of a deity's explicitly postulated moral concerns on cooperation remains unclear. Here, we report a pre-registered set of analyses to assess whether perceiving a locally relevant deity as moralistic predicts cooperative play in two permutations of two economic games using data from up to 15 diverse field sites. Across games, results suggest that gods' moral concerns do not play a direct, cross-culturally reliable role in motivating cooperative behaviour. The study contributes substantially to the current literature by testing a central hypothesis in the evolutionary and cognitive science of religion with a large and culturally diverse dataset using behavioural and ethnographically rich methods.

Participatory action research for primate conservation: A critical analysis of a nonformal education program in Southern Mexico.

Historically, Mexico has had an important role in primate conservation research, however, studies have rarely included the human dimensions of primatology. Inclusion of these disciplines should be a priority, considering that human activities are responsible for the current socio-ecological crisis. Mexico is habitat for three primate species, and all are threatened. This urgency demands new approaches and broader perspectives. First, we propose three main research frameworks relevant for conducting PCEPs in Latin America: Participatory Action Research, Arts-based education in PCEPs and Knowledge Coproduction. Furthermore, we aimed to (1) describe a case study about primate conservation education in Southern Mexico based on participatory visual methods under the umbrella of Participatory Action Research (PAR), and (2) to conduct a self-reflective, critical, straightforward, and constructive analysis of the experience. We discuss the various challenges faced during the process (e.g., traditional teaching prevalence at schools, teachers that are not school-based, time and academic constraints). Additionally, we highlight some PAR aspects applicable for researchers and practitioners interested to go further than knowledge transmission (e.g., codesign, arts-based education, placed-based education, critical thinking, and capacity building). To collectively progress in primate conservation education in Mexico and other Latin American countries, projects could greatly benefit from context-specific, people-centered approaches, such as PAR. We encourage researchers to share more of their personal research experiences including both their successes and failures.

Best practices are never best: Evaluating primate conservation education programs (PCEPs) with a decolonial perspective.

Who do we aim to educate with primate conservation education programs (PCEPs)? In a commentary published in a recent AJP, Annette Lanjouw suggested that many efforts to "educate" habitat-country communities can be neocolonial in their approaches. Forest destruction and habitat loss are a result of global consumption and expansion. We therefore need to approach conservation education from many angles including local stakeholders, policy makers, government officials, and the humans living in industrialized nations who are major consumers of the items that shrink primate habitats. In this review, we investigate PCEPs to determine if the conservation education goals, education methods, and assessment processes are proceeding within a neocolonial context. We reviewed the last 20 years of primate conservation literature and looked for publications that were focused on education programs. We found that in 50 of 52 publications published between 2001 and 2021, the education programs take place in habitat-country local communities. We also reviewed primate field researcher and field site websites, and in most cases, education programs were also focused on educating local communities living near or in nonhuman primate habitats. Exceptions were student clubs, zoo programs, and a high school outreach program. Many PCEP providers presented a list of "lessons learned" and we compiled their wisdom in combination with our experience to provide a framework for moving forward. We conclude that as conservation primatologists, we must think beyond our field sites to create opportunities for educational outreach. We can reach global consumers by linking to zoos, television/motion picture, print media, social media, and working with schools on curricula. Primatologists can engage our undergraduates to establish clubs and create meaningful assignments that reach beyond the classroom. We encourage primatologists from the Global North to consider their positionality and the history of conservation exclusion in their attempts to conserve primates.

Safety and Acceptability of Three Ablation Treatments for High-Grade Cervical Precancer: Early Data From a Randomized Noninferiority Clinical Trial.

PURPOSE: This ongoing trial is comparing the efficacy and safety of three ablation treatments for cervical intraepithelial neoplasia grade 2 or higher. Here, we present early data regarding pain, side effects, and acceptability of CO2 gas-based cryotherapy (CO2), nongas cryotherapy, and thermal ablation (TA). Efficacy results are expected to become available in late 2023. MATERIALS AND METHODS: This noninferiority randomized trial is taking place in El Salvador, China, and Colombia. Patients are 1,152 eligible women with biopsy-confirmed cervical intraepithelial neoplasia grade 2 or higher who will receive one of three ablation treatments. Pain is measured before, during, and after treatment with a visual analog scale (1-10). Side effects and acceptability are assessed at 6 weeks. RESULTS: To date, 1,024 of 1,152 (89%) women were randomly assigned to treatment. The median pain level was higher during TA (4, IQR = 4) than CO2 (2, IQR = 4) or nongas cryotherapy (2, IQR = 4) (P < .01, range: 0-10). The most common post-treatment symptom was watery discharge, reported by 97.9% of women, and it lasted longer in the CO2 group than the other two treatments (in days, median [IQR]: CO2 = 20[20], nongas cryotherapy = 15[10], TA = 18[15], P < .01). Bleeding was reported more frequently in women treated with TA (27.6%) than CO2 (17.5) or nongas cryotherapy (18.7%) (P < .01). The majority of patients reported being very satisfied with the treatment they received at 6 weeks (91%) and again at 12 months post-treatment (97%). CONCLUSION: Despite differences in pain and side effects across ablation treatments, all were safe and highly acceptable to patients. In addition to efficacy, considerations such as cost and portability may be more significant in choosing a treatment method.

Grounding implementation science in health equity for cancer prevention and control.

BACKGROUND: The past decade of research has seen theoretical and methodological advances in both implementation science and health equity research, opening a window of opportunity for facilitating and accelerating cross-disciplinary exchanges across these fields that have largely operated in siloes. In 2019 and 2020, the National Cancer Institute's Consortium for Cancer Implementation Science convened an action group focused on 'health equity and context' to identify opportunities to advance implementation science. In this paper, we present a narrative review and synthesis of the relevant literature at the intersection of health equity and implementation science, highlight identified opportunities (i.e., public goods) by the action group for advancing implementation science in cancer prevention and control, and integrate the two by providing key recommendations for future directions. DISCUSSION: In the review and synthesis of the literature, we highlight recent advances in implementation science, relevant to promoting health equity (e.g., theories/models/frameworks, adaptations, implementation strategies, study designs, implementation determinants, and outcomes). We acknowledge the contributions from the broader field of health equity research and discuss opportunities for integration and synergy with implementation science, which include (1) articulating an explicit focus on health equity for conducting and reviewing implementation science; (2) promoting an explicit focus on health equity in the theories, models, and frameworks guiding implementation science; and (3) identifying methods for understanding and documenting influences on the context of implementation that incorporate a focus on equity. To advance the science of implementation with a focus on health equity, we reflect on the essential groundwork needed to promote bi-directional learning between the fields of implementation science and health equity research and recommend (1) building capacity among researchers and research institutions for health equity-focused and community-engaged implementation science; (2) incorporating health equity considerations across all key implementation focus areas (e.g., adaptations, implementation strategies, study design, determinants, and outcomes); and (3) continuing a focus on transdisciplinary opportunities in health equity research and implementation science. We believe that these recommendations can help advance implementation science by incorporating an explicit focus on health equity in the context of cancer prevention and control and beyond.

Cervical Cancer Prevention in El Salvador: Gains to Date and Challenges for the Future.

Cervical cancer is preventable through vaccination, early detection, and the treatment of pre-cancerous lesions. However, global inequalities mean that the disease remains a leading cause of cancer death around the world, with over 80% of new cases and 90% of deaths occurring in low- and middle-income countries (LMICs). In El Salvador, joint efforts between the Ministry of Health (MoH) and the non-profit organization Basic Health International (BHI) have been in place since 2008, with the goal of reducing the country's disease burden. While the World Health Organization's (WHO) call to action to eliminate cervical cancer provided worldwide momentum to implement new public health initiatives, the COVID-19 pandemic disrupted ongoing programs and jeopardized plans for the future. The purpose of this manuscript is to describe the progress that El Salvador has achieved in improving cervical cancer prevention, the impact of the pandemic on current strategies, and potential solutions that can help the country meet the WHO's strategic targets by 2030 to accelerate the elimination of cervical cancer.

Thermal Ablation Treatment for Cervical Precancer (Cervical Intraepithelial Neoplasia Grade 2 or Higher [CIN2+]).

Cervical cancer is a leading cause of mortality for women in low- and middle-income countries (LMICs). Invasive disease can be prevented through the treatment of high-grade cervical precancer lesions. Types of treatment for cervical precancer include excisional procedures that surgically remove the affected tissue and ablation treatments which utilize extreme temperatures to destroy precancerous cells. Excision is the first-line treatment in higher income countries, but requires specialized training and equipment that make it unsuitable for low-income settings. The most common treatment globally is cryotherapy, which utilizes cryogenic gas to freeze the area. However, the need for gas presents significant procurement and logistical challenges. The World Health Organization (WHO) has recently endorsed the use of thermal ablation, a method that utilizes heat to destroy precancerous tissue. This review describes three existing thermal ablation devices and protocols for their use, including step-by-step instruction guides to perform a successful treatment with each device and observations specific to each machine.

Processes driving seagrass soils composition along the western Mediterranean: The case of the southeast Iberian Peninsula.

Seagrasses are distributed all along the coast of the Mediterranean Sea being Posidonia oceanica and Cymodocea nodosa the most common species. They promote sedimentation, leading to the formation of well-structured soils. Over the last decade, a growing attention has been paid to their role as CO2 sinks in the form of organic carbon (Corg) and to their use as environmental archives. However, most of the knowledge about pedogenetic processes in these soils refer to the rhizosphere. This study aims to understand seagrass soils biogeochemistry in the rhizosphere and below, which in turn can help to understand their long term formation processes. Fifteen cores were strategically sampled along a 350 km stretch of the Southeast Iberian coast, and analyzed for elemental composition (XRF core-scanning), magnetic susceptibility, Corg content and gran size distribution. The cores were dated by 210Pb and 14C-AMS techniques to estimate soil accretion. Principal component analysis was used to explore the main geochemical processes linked to soil formation. The results showed that terrestrial runoff plays a key role in meadow soil composition. Furthermore, Corg accumulation did not follow any general depth trend in our soil records, suggesting that temporal variation in Corg inputs is an important factor in determining carbon depth distribution within the soil. We obtained evidence that the establishment of well-developed, stable C. nodosa meadows in the Mediterranean Sea may be promoted by adverse environmental conditions to P. oceanica settlement. Metal's behavior within the meadow deposit and their interaction with organic matter and carbonates is unclear. The results presented in this paper highlight the importance of the influence of land-based inputs in the characteristics of seagrass meadow deposits, highly determining their Corg content, as well as the need for further studies on metal behavior, to understand their full potential as environmental records.

Outcomes for Step-Wise Implementation of a Human Papillomavirus Testing-Based Cervical Screen-and-Treat Program in El Salvador.

PURPOSE: The Cervical Cancer Prevention in El Salvador (CAPE) project is a public-sector intervention introducing lower-cost human papillomavirus (HPV) testing in all four departments of the Paracentral region that screened a total of 28,015 women. After demonstrating success of an HPV screen-and-treat (S&T) algorithm over colposcopy management in the first two phases, the third phase scaled up the S&T strategy. We present results from phase III and evaluate S&T components across the entire project. METHODS: During phase III, 17,965 women age 30-59 years underwent HPV testing. HPV-positive women were asked to return and, if eligible, received gas-based cryotherapy. We compare loss to follow-up and time intervals between S&T steps across the three phases. RESULTS: There were no differences in HPV positivity across phases (phase I, 11.9%; phase II, 11.4%; phase III, 12.3%; P = .173). Although most HPV-positive women completed indicated follow-up procedures within 6 months in phases I (93.3%, 111 of 119) and II (92.3%, 429 of 465), this proportion declined to 74.9% (1,659 of 2,214; P < .001) in phase III. Mean days between testing and delivery of results to patients increased over program phases (phase I, 23.2 days; phase II, 46.7 days; phase III, 99.8 days; P < .001). CONCLUSION: A public-sector implementation of an HPV-based S&T algorithm was successfully scaled up in El Salvador, albeit with losses in efficiency. After CAPE, the Ministry of Health changed its screening guidelines and procured additional tests to expand the program.

Cervical Cancer Screening with Human Papillomavirus Self-Sampling Among Transgender Men in El Salvador.

Purpose: Sexual and gender minority persons in low-income countries have very limited access to routine health services. This study evaluated the feasibility of using a self-sampled human papillomavirus (HPV) test to increase access to screening for cervical cancer among transgender men in El Salvador. Methods: We partnered with a local advocacy organization for recruitment. A total of 24 transgender men (men assigned female at birth) ages 19-55 were enrolled and provided consent. Questionnaires assessed sociodemographics, health and sexual histories, and knowledge about HPV and cervical cancer. Screening was performed with a self-sampled HPV test. Participants with a positive test were offered colposcopy and cryotherapy treatment, if appropriate. Those with a negative test were advised to return in 5 years for rescreening. Results: Out of 24 consenting participants, 23 (95.83%) agreed to conduct HPV self-sampling, and 22/23 (95.65%) expressed willingness to self-sample in the future. Among self-sampled individuals, 3/23 (13%) tested positive and accepted colposcopy and biopsy. Analyses of biopsied tissue revealed one case of cervical intraepithelial neoplasia grade 1. Conclusion: HPV self-sampling and subsequent procedures were accepted by the majority of participants. This screening method may be a viable alternative to cytology among transgender men in El Salvador.

Evidence-based conservation education in Mexican communities: Connecting arts and science.

Several studies suggest that 63% of primate species are currently threatened due to deforestation, pet-trade, and bushmeat hunting. Successful primate conservation strategies require effective educational programs capable of enhancing critical system-thinking and responsible behavior towards these species. Arts-based conservation education can simultaneously foster cognitive and emotional processes. In this paper, we evaluate an arts-based educational program focused on the conservation of black howler monkeys (Alouatta pigra). Our goals were to determine (1) whether children's knowledge changed with our educational techniques, (2) if there was a particular educational technique that better improved the children's learning, and (3) the children's emotional feedback regarding the whole program. A total of 229 children from communities located in primate-habitat areas, both inside and outside protected areas, participated in the study. Different educational techniques were tested (storytelling, theater and shadow puppets), contrasted with a control group, and evaluated through an analysis of drawings. Our results showed that children's knowledge increase with each art-based technique, with storytelling being the most effective for children's learning. Specific drawings indicators also revealed the increase of children's knowledge and a decrease of misconceptions between pre and post evaluations. Finally, a satisfaction survey about the program showed a high positive feedback. The study highlights the value of designing multidisciplinary projects, where arts-based education program (grounded in scientific information) has shown to be a successful way to communicate animal knowledge and promote conservation.

The cost-effectiveness of human papillomavirus self-collection among cervical cancer screening non-attenders in El Salvador.

Cervical cancer screening with human papillomavirus (HPV) DNA testing has been incorporated into El Salvador's national guidelines. The feasibility of home-based HPV self-collection among women who do not attend screening at the clinic (i.e., non-attenders) has been demonstrated, but cost-effectiveness has not been evaluated. Using cost and compliance data from El Salvador, we informed a mathematical microsimulation model of HPV infection and cervical carcinogenesis to conduct a cost-effectiveness analysis from the societal perspective. We estimated the reduction in cervical cancer risk, lifetime cost per woman (2017 US$), life expectancy, and incremental cost-effectiveness ratio (ICER, 2017 US$ per year of life saved [YLS]) of a program with home-based self-collection of HPV (facilitated by health promoters) for the 18% of women reluctant to screen at the clinic. The model was calibrated to epidemiologic data from El Salvador. We evaluated health and economic outcomes of the self-collection intervention for women aged 30 to 59 years, alone and in concert with clinic-based HPV provider-collection. Home-based self-collection of HPV was projected to reduce population cervical cancer risk by 14% and cost $1210 per YLS compared to no screening. An integrated program reaching 99% coverage with both provider- and home-based self-collection of HPV reduced cancer risk by 74% (compared to no screening), and cost $1210 per YLS compared to provider-collection alone. Self-collection facilitated by health promoters is a cost-effective strategy for increasing screening uptake in El Salvador.

Evaluation of two alternative ablation treatments for cervical pre-cancer against standard gas-based cryotherapy: a randomized non-inferiority study.

INTRODUCTION: Gas-based cryotherapy is the conventional ablative treatment for cervical pre-cancer in low-income settings, but the use of gas poses significant challenges. We compared the depth of necrosis induced by gas-based cryotherapy with two gas-free alternatives: cryotherapy using CryoPen,and thermoablation. METHODS: We conducted a five-arm randomized non-inferiority trial: double-freeze carbon dioxide (CO2) cryotherapy (referent), single-freeze CO2 cryotherapy, double-freeze CryoPen, single-freeze CryoPen, and thermoablation. Subjects were 130 women scheduled for hysterectomy for indications other than cervical pathology, and thus with healthy cervical tissue available for histological evaluation of depth of necrosis post-surgery. The null hypothesis was rejected (ie, conclude non-inferiority) if the upper bound of the 90% confidence interval (90% CI) for the difference in mean depth of necrosis (referent minus each experimental method) was <1.14 mm. Patient pain during treatment was reported on a scale of 0 (no pain) to 10 (worst pain). RESULTS: A total of 133 patients were enrolled in the study. The slides from three women were deemed unreadable. One patient was excluded because her hysterectomy was postponed for reasons unrelated to the study, and two patients were excluded because treatment application did not follow the established protocol. For the remaining 127 women, mean depth of necrosis for double-freeze CO2 (referent) was 6.0±1.6 mm. Differences between this and other methods were: single-freeze CO2 = 0.4 mm (90% CI -0.4 to 1.2 mm), double-freeze CryoPen= 0.7 mm (90% CI 0.04 to 1.4 mm), single-freeze CryoPen= 0.5 mm (90% CI -0.2 to 1.2 mm), and thermoablation = 2.6 mm (90% CI 2.0 to 3.1 mm). Mean pain levels were 2.2±1.0 (double-freeze CO2 cryotherapy), 1.8±0.8 (single-freeze CO2 cryotherapy), 2.5±1.4 (double-freeze CryoPen), 2.6±1.4 (single-freeze CryoPen), and 4.1±2.3 (thermoablation). DISCUSSION: Compared with the referent, non-inferiority could not be concluded for other methods. Mean pain scores were low for all treatments. Depth of necrosis is a surrogate for treatment efficacy, but a randomized clinical trial is necessary to establish true cure rates.

Moralizing gods, impartiality and religious parochialism across 15 societies.

The emergence of large-scale cooperation during the Holocene remains a central problem in the evolutionary literature. One hypothesis points to culturally evolved beliefs in punishing, interventionist gods that facilitate the extension of cooperative behaviour toward geographically distant co-religionists. Furthermore, another hypothesis points to such mechanisms being constrained to the religious ingroup, possibly at the expense of religious outgroups. To test these hypotheses, we administered two behavioural experiments and a set of interviews to a sample of 2228 participants from 15 diverse populations. These populations included foragers, pastoralists, horticulturalists, and wage labourers, practicing Buddhism, Christianity, and Hinduism, but also forms of animism and ancestor worship. Using the Random Allocation Game (RAG) and the Dictator Game (DG) in which individuals allocated money between themselves, local and geographically distant co-religionists, and religious outgroups, we found that higher ratings of gods as monitoring and punishing predicted decreased local favouritism (RAGs) and increased resource-sharing with distant co-religionists (DGs). The effects of punishing and monitoring gods on outgroup allocations revealed between-site variability, suggesting that in the absence of intergroup hostility, moralizing gods may be implicated in cooperative behaviour toward outgroups. These results provide support for the hypothesis that beliefs in monitoring and punitive gods help expand the circle of sustainable social interaction, and open questions about the treatment of religious outgroups.

Through the eyes of children: Drawings as an evaluation tool for children's understanding about endangered Mexican primates.

This study seeks to understand children's perceptions and knowledge of endangered Mexican primates. The black howler monkey (Alouatta pigra) is a charismatic species endemic to Southern Mexico, Northern Belize, and Guatemala and is a symbol of the region that fosters a sense of local pride. Therefore, it can be considered a flagship species for the forests of Southern Mexico. We evaluated the perception and knowledge that 297 Mexican elementary school children (8-10 years old) have about black howler monkeys. Specifically, we analyzed and categorized drawings made by these children based on gender, geographic context (rural or urban), and residence within or outside of Protected Areas (PAs). Student drawings were categorized into three levels of knowledge (no familiarity, basic knowledge, and sophisticated knowledge). Common misconceptions and important landscape elements for black howler conservation were gathered from these visual representations. Children were largely unfamiliar with black howlers, despite sharing the same geographical location. Knowledge was affected by context and residence, with students living within PAs more aware of black howlers than students living outside of PAs. However, overall the children showed a deep understanding of the current forest conservation situation in Southern Mexico; meaning they could be presenting a shifting baseline syndrome. The study highlights the value of assessing children's drawings as a tool that can be used to help policy makers and educational practitioners in fine-tuning educational, environmental, and marketing programs. More importantly, it is a methodology that can be applied in future research for understanding children's perceptions and knowledge about endangered species and environmental change in deciding how to improve the effectiveness of conservation messaging.

The Faith of Sacrifice: Leadership Trade-Offs in an Afro-Brazilian Religion.

Despite secular trends in some countries, prestige-based authority in the form of religious leadership remains hugely influential in the everyday lives of millions of people around the world. Here, the costs and benefits of religious leadership are explored in an urban setting in northeastern Brazil. An economic game, within-group cooperation questionnaires, and social network analyses were carried out among adherents of an Afro-Brazilian religion. Results reveal that leaders display high levels of religious commitment and disproportionally provide cooperative services to group members. On the other hand, initiates cooperate less than leaders but do not differ in levels of received cooperation or social cohesion measures. This may indicate some level of exploitation or free-riding. Demographic and group variables also appear to play an important role in the degree of social cohesion a group achieves. These findings are discussed in the context of non-Western urban settings where religious leadership may represent both an alternative to social advancement and a crucial source of material aid, social support, and a strong sense of community.

Detecting affiliation in colaughter across 24 societies.

Laughter is a nonverbal vocal expression that often communicates positive affect and cooperative intent in humans. Temporally coincident laughter occurring within groups is a potentially rich cue of affiliation to overhearers. We examined listeners' judgments of affiliation based on brief, decontextualized instances of colaughter between either established friends or recently acquainted strangers. In a sample of 966 participants from 24 societies, people reliably distinguished friends from strangers with an accuracy of 53-67%. Acoustic analyses of the individual laughter segments revealed that, across cultures, listeners' judgments were consistently predicted by voicing dynamics, suggesting perceptual sensitivity to emotionally triggered spontaneous production. Colaughter affords rapid and accurate appraisals of affiliation that transcend cultural and linguistic boundaries, and may constitute a universal means of signaling cooperative relationships.

Coerced coordination, not cooperation.

Norenzayan et al. propose that Big God (BG) religions are large-group cooperative enterprises that promote internal harmony and higher fertility, resulting in "mutually beneficial exchanges" for those involved. We examine the possible distributions of costs and benefits within BG religions and propose that they are, instead, successful coordinating mechanisms that rely on intragroup competition and exploitation between the classes and sexes.