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Effects of a Serotonin Receptor Peptide on Behavioral Pattern Separation in Sham- vs. Mild Traumatic Brain Injured Rats

DOI: 10.31038/EDMJ.2024821

Abstract

Aims: Behavioral pattern separation is a hippocampal-dependent component of episodic memory and a sensitive marker of early cognitive decline. Here we tested whether mild traumatic injury causes loss of pattern separation in the rat and for its prevention by a novel neuroprotective peptide fragment of the human serotonin 2A receptor (SN..8).

Methods: Lateral fluid percussion was used to induce mild traumatic brain injury in male Sprague- Dawley rats. Rats were trained to distinguish between a stable vs unstable swim platform separated by increasing distances (4.5 vs 3.0 vs 1.5 feet) in a modification to the classic Morris water maze. Peptide SN..8 vs scrambled version of same amino acids (2 mg/kg) was administered via intraperitoneal route (1-, 3- and 5-days) after lateral fluid percussion or sham injury. Rats received three weeks of training and two weeks of testing before injury and were tested again at 2 and 5-weeks after injury.

Results: There was a gradient of decreasing incorrect responses to the choice between (stable vs unstable platform) as the platform separation distance was increased from 1.5 to 3.0 to 4.5 feet consistent with behavioral pattern separation. Systemic administration of SN..8 peptide (vs scrambled) peptide was associated with statistically significant lower rate of incorrect responses (at both 4.5 feet and 3.0 feet platform separation) in traumatic brain- injured rats (but not in sham-injured rats) tested at 2-weeks post-injury. Five weeks after injury, the rats had largely recovered and exhibited a much lower overall rate of incorrect responses across both drug and injury subgroups.

Conclusions: Introduction of an unstable platform (choice phase of the Morris water maze) at varying distances from the stable platform resulted in behavior having the hallmark of pattern separation. Our data are the first to suggest that systemic administration of (2 mg/kg) SN..8 peptide immediately after mild traumatic brain injury (lateral fluid percussion) appeared to protect against loss of behavioral pattern separation in the rat.

Introduction

Accelerated cognitive decline frequently complicates traumatic brain injury (TBI) [1]. Pattern separation- the ability to encode similar spatial representations as distinct objects [2] is a hippocampal- dependent component of working memory [2]. Loss of pattern separation is an early marker of cognitive decline in humans [3]. The serotonin 2A receptor (5HT2A) is expressed on neurons, and neural progenitor cells in the dentate gyrus and hippocampus [4]. Agonists of the 5HT2A receptor in this brain region were reported to impair recall of spatial memory [5]. We designed a peptide identical to a sub-region of the human 5HT2AR (SN..8) involved in long-lasting receptor activation [6,7]. Systemic administration of SN..8, in a genetic strain of rats (Zucker) harboring neurotoxic 5-HT2A receptor activating IgG plasma autoantibodies [8] enhanced acquisition and recall of spatial memory in sham, but not in traumatic brain-injured lean Zucker rats [9]. Here we tested a different strain of rat, adult male Sprague-Dawley, for neuroprotection by SN..8 when administered immediately after mild traumatic brain injury (mTBI) in a pattern separation task which is hippocampal dependent and a highly sensitive marker of early cognitive decline.

Methods

Peptides

The linear synthetic peptide, corresponding to a fragment of the serotonin 2a receptor, SCLLADDN (SN..8) and a scrambled version LASNDCLD (LD.8) were both synthesized at Lifetein, Inc. (Hillsborough, NJ). Each peptide was provided as the hydrochloride salt and had purity > 95%. The lyophilized peptides were stored (in the presence of dessicant) at −40 degrees C prior to use. Before each experiment, peptide was reconstituted fresh in sterile saline at the indicated concentration.

Animals

All procedures were conducted in accordance with the NIH Guide for the Care and Use of Laboratory Animals and were approved by the Institutional Animal Care and Use Committee of the Veterans Affairs Medical Center (East Orange, New Jersey). Male SD rats n =38 (8-weeks-old) were obtained from Charles River Laboratories (Kingston, NY) and were individually housed with modest enrichment (wooden block). Rats were provided ad libitum access to food and water and maintained in a 12 h light/dark cycle with lights on at 0700. Training and testing were performed during the light phase of the light/ dark cycle. They underwent pattern separation pre-training training for 12 days over three weeks and testing for 6 days over two weeks. At approximately 17 weeks of age, rats underwent surgery (craniectomy) and injury (lateral fluid percussion) (See Timeline, Figure 1).

fig 1

Figure 1: Timeline of experimental procedures

Injections

Peptide (SN..8 or LD.8) was dissolved in sterile saline (2 mg/kg) and administered via intraperitoneal (IP) route 1-, 3- and 5-days after mild TBI vs sham injury.

Surgery/Injuries

Craniectomy and delivery of a pressure wave (lateral fluid percussion) procedures were carried out as previously reported [10]. The procedures are briefly summarized here. Day 1: Craniectomy-A 4 mm diameter craniectomy was performed under anesthesia with isoflurane, 3mm posterior and 3.5mm lateral to the bregma was made unilaterally in either the left or right parietal bone (figure). During the craniectomy, the skull was removed but the dura mater remains intact. A luer-lock connector was glued to the skull surrounding the craniectomy. A plastic cylinder about 2 mL was placed surrounding the craniectomy to protect the luer-lock connector. Dental cement was placed inside the plastic cylinder. A small Kim wipe was inserted inside the luer-lock to keep the dura moist and clean of debris. Lateral Fluid Percussion Injury– Twenty-four hours after the surgery, rats were anesthetized with isoflurane at 5 liters/min for (1min 30sec). The Kim wipe was removed from the luer-lock and filled with sterile saline. The luer-lock was then connected to the fluid percussion device and once rats reacted to a strong toe pinch, the fluid percussion injury was delivered to the exposed dura matter dorsal to the parietal lobe, via a voice-coil piston device. The pressure sensors located at the end of the pistol records PSI waves. Acute signs (Table 1) were recorded at the time of injury, including: startle, apnea (time in seconds from the time of injury to the time the rat returns to regular breathing) and righting reflex (RR= time in seconds from the time of injury until the time the rat fully supports its weight on all four paws). Sham animals underwent all procedures except they did not receive the fluid percussion injury.

Table 1: Acute signs of injury in rats randomized to either SN..8 or scrambled LD..8 peptide injections and mild TBI vs sham injury

tab 1

Behavioral Tests

Pattern Separation

A sixty-three- inch diameter metal pool with a stable and unstable platform visible above water line was used to complete the pattern separation task. The stable platform fully supports the weight of the rat and enables them to completely climb out of the water. The unstable platform appears identical to the stable platform; however, it does not support the rats’ weight and will not allow the rat to the climb out of the water.

Training

All animals underwent 3 weeks of training consisting of 4 consecutive training days per week of followed by 3 days of rest, e.g. week 1, training days 1-4; week 2 training days 5-8, week 3, training days 9-12 (Figure 1). This was followed by six days of baseline testing.

Training Day 1: Animal learns that to ‘escape’ from the pool, must be from stable platform. The maximum time for each trial is 60 seconds (60s); the rat must remain on the stable platform for 30 seconds (30s) to complete the trial. If after the 60s they can’t find the stable platform, they are guided to it and must stay on it for 30s before being removed. During trial 1, they are placed on the stable platform in the middle of the pool. In trial 2, they are placed in the middle between the platform and the edge of the pool approximately 12 inches from the platform. In trial 3, they are placed on the edge of the pool approximately 32 inches.

Training Day 2: Animal are run through a classic water maze protocol where the platform stays in the same location during all three trials. Stable platform is placed in quadrant 1 of the pool and rats undergo 3 trials with 1 hour time in between trials. The starting location of the rat changes in between trials. During trial 1, the starting location of the animals was between quadrant 1 and 2. In trial 2, the starting location was between quadrant 2 and 3. In trial 3, the starting location was between quadrant 3 and 4 (Figure 2).

fig 2

Figure 2: Training in the pattern separation task

Training Days 3-4: animal learns to search for stable platform within trials. Here, the location of the stable platform and the start position of the animal’s changes between trials. Within each trial, all animals are put in the water twice (sample phase and choice phase). During all three trials, the starting location of the animals to the platform is 4.5ft. During trial 1 the starting location of the animals was between quadrant 1 and 4. In the sample and choice phase, the stable platform is in quadrant 2. In trial 2, the starting location to the platform was between quadrant 3 and 4 and the location of the stable platform remained in quadrant 1 for both sample and choice phase. Trial 3 starting location to the platform was between quadrant 2 and 3 and the location of the stable platform remained at quadrant 4 for both the sample and choice phase.

Training Days 5-6: Introduction of unstable platform. Animal learns to search for stable platform within a trial and ignore unstable platform. The stable platform and the start point of the animals stayed the same between trials. During trial 1, animals run through easy pattern separation where the sample phase only consists of the stable platform and during the choice phase, we introduced the unstable platform. The unstable platform is placed in the water during the choice phase. For trial 2 and 3, the stable and the unstable platform are in the water at the same, at different location. The starting location of the animals during all three trials remain the same. Animal are run through “easy pattern separation” with the distance from the starting location to the platform to be 4.5ft.

Training Days 7-12: animal learns to search for stable platform within a trial and ignore unstable platform. Run animal through easy pattern separation task (at 4.5 ft from start location). Start location of animals, location of stable and unstable platform changes during each trial. After 12 days it was determined that approximately 25% of rats were correctly choosing the stable vs unstable platform, and in order to avoid ‘overtraining’ no further baseline training trials were performed.

Test Trials

Testing consists of sample phase and choice phase which begin 3 days after training and span 6 days over a two-week time period (three days per week). Results in the choice phase are indicative of pattern separation. The start location (pool quadrant) and the relative location of the unstable and stable platforms changes between individual testing trials (3 trials per day) and on each new testing day. Between the sample and choice phases, the rats are removed from the platform and given a 30- second break. There is an additional one- hour break between each successive trial.

Scoring/Data Collection

During testing, an incorrect response is when the rats touch and attempt to climb the unstable platform. The number of times each rat attempt to go to the unstable trial within each trial is recorded and percent incorrect is calculated as [incorrect responses/total responses].

Statistics

Student’s t-test was used for single comparisons. A P-value <0.05 was considered significant and values are expressed as means ± SEM. There was no correction for multiple comparisons.

Results

Acute Signs of Mild TBI (Lateral Fluid Percussion)

Mean apnea time and mean righting reflex time were significantly longer in rats subjected to mTBI vs sham-injury (Table 1). There was no statistically significant difference in mean apnea time or mean righting reflex time following lateral fluid percussion in rat subgroups randomized to treatment with SN..8 vs scrambled peptide injections on days 1, 3 and 5 after injury. The mean peak pressure (PSI, pounds per square inch) applied during the fluid percussion wave did not differ significantly between rats treated with SN..8 vs scrambled peptide following mTBI (Table 1).

Behavioral Pattern Separation (BPS)

Baseline

In baseline pre-injury testing, rats made fewer errors (14.2 vs 26.7 vs 35.8%) in behavioral pattern separation (Figure 3) at greater distance(s) between the (stable and unstable) platforms i.e. 4.5 vs 3.0 vs 1.5 feet. The observed gradient of increasing error rate as the spatial representations become less dissimilar is consistent with pattern separation. The difference in baseline error rate at platform separation distance of 4.5 vs 1.5 feet was statistically significant (N=39; P< 0.01). Because of the much higher baseline error rate at 1.5 foot platform separation distance, post-injury data was only analyzed and reported for the 3.0 and 4.5 foot platform separation distances.

fig 3

Figure 3: Baseline pattern separation declines by decreasing distance between platforms

Post-Injury

Rats treated with SN..8 vs scrambled peptide displayed significantly lower error rates (two weeks post-injury): (6.7 vs 25.9 %; N=19, P< 0.01) at both 4.5 feet and (20.0 vs 42.7% (N=19; P= 0.039); at 3.0 feet platform separation (Figure 4). There was no significant difference in BPS performance between SN..8 vs scrambled peptide- treated sham-injured rats two weeks’ post-injury (Figure 5). Across all drug and injury subgroups, the composite error rate was significantly lower at five- vs. two- weeks’ post-injury (7.75 +/- 4.4 vs 17.09 +/9%; P = 0.009) (Figure 6). This may be consistent (in part) with spontaneous recovery from injury after 5 weeks and increased experience with the task. In summary, systemic SN..8 (2 mg/kg) administered in three successive alternate daily doses (starting 1 day after mTBI) appeared to have a neuroprotective effect on early loss of behavioral pattern separation in adult male SD rats.

fig 4

Figure 4: Treatment with SN..8 vs scrambled peptide after mTBI is associated with significantly improved behavioral pattern separation at A) 4.5 feet and B) 3.0 feet platform distances.

fig 5

Figure 5: Treatment with SN..8 vs scrambled peptide sham injury is associated with no significant differences in behavioral pattern separation at A) 4.5 feet and B) 3.0 feet platform distance.

fig 6

Figure 6: Substantial improvement in pattern separation performance 5 weeks post-injury

Discussion

Behavioral pattern separation is thought to be a component of working memory which has an underlying neural circuitry that largely resides in the dentate gyrus and hippocampus [11]. Transient impairment in behavioral pattern separation reported here is consistent with a prior report that spatial memory was impaired (early 1-7 days) but recovered spontaneously 21 days following mild TBI (lateral fluid percussion) in Sprague-Dawley rats [10]. The mean peak pressure, apnea period, and righting reflex times experienced (by SD rats) in the present study were slightly lower than reported in the prior study [10], but apnea and righting reflex times are consistent with mild traumatic brain injury. Our findings suggest that introducing an unstable platform during the choice phase of the classic Morris water maze test is a useful method to model behavioral pattern separation in rats.

The mechanism of transient impairment of pattern separation following mTBI (lateral fluid percussion) in the SD rat is unknown. Cortical expression of both 5HT2A and a related catecholamine receptor, the alpha 1 adrenergic receptor was reported to increase (in rodents) following different forms of TBI [12, 13]. Much less is known about possible catecholamine receptor changes in the hippocampus following TBI. The hippocampus receives a dense projection of serotonergic fibers from the dorsal raphe [14]. The 5HT2AR was reported to mediate in part changes in synaptic input to hippocampal granule cells [15] which could result in impaired development of newly-born neurons derived from dentate gyrus neural progenitor cells. Reduced dentate gyrus neurogenesis is one of the mechanisms thought to underly impaired pattern separation [11]. Dentate gyrus neurogenesis plays an important role not only in pattern separation but also mood regulation, and in a prior study we found that human depression patients harbored plasma 5-HT2AR activating IgG autoantibodies [16] which impaired the survival and differentiation of rat DG neural progenitor cells [17,18] in vitro.

SN..8 is a small peptide having an amino acid sequence identical to that of a subregion of the second extracellular loop of the human 5HT2AR involved in mediating long-lasting receptor activation [6]. Although the SN..8 mechanism of action is not completely understood, it prevented neurotoxicity (in vitro) mediated by Ig isolated from plasma of patients with neurodegenerative disorders including Parkinson’ disease, dementia [18] and major depressive disorder [6]. Immunoglobulin G from a subset of patients with TBI displayed increased binding to the human 5HT2A receptor second extracellular loop peptide [6] (which includes SN..8). Baseline presence of 5HT2AR peptide binding in plasma human TBI IgG predicted accelerated (two-year) prospective decline in cognitive function in thirty-five older adult TBI patients [19].

Our underlying hypothesis is that long-lasting 5HT2AR agonist Ig may mediate in part cognitive decline following TBI. It is not clear to what extent Ig may have been a contributory factor in Sprague-Dawley rat since in our preliminary experiments (not shown here) the titer and potency of SD plasma Ig was significantly lower than what we had previously reported in the Zucker rat [8]. Still SN..8 may serve either as a ‘decoy receptor’ to prevent neurotoxicity from 5-HT2AR- targeting agonist Ig and/or stabilize an inactive conformation of the 5HT2AR. It is not known whether dysregulated serotonergic input to the hippocampus (following mTBI) might alter synaptic input to developing neurons in the dentate gyrus [15,20] which could result in reduced neurogenesis [20,21] which is a hallmark of reduced pattern separation [11].

In a prior study, systemic (IP) administration of SN..8 (vs. scrambled peptide) strengthened both recall and acquisition of spatial learning after sham injury (but not after mild traumatic brain injury) in Zucker lean rats. Genetic strain differences between Sprague- Dawley and Zucker rats might account in part for a neuroprotective effect (following mTBI) by SN..8 in SD but not in Zucker rats. It is also possible that pattern separation is a more sensitive method for detecting the earliest cognitive impairment changes following mTBI. More study using pattern separation in different genetic strains of rat can help clarify the differences.

Acknowledgments

Supported in part by a grant from the New Jersey Commission on Brain Injury Research NJCBIR PIL022 to MBZ; and a grant from the Department of Veterans Affairs, Office of Research and Development, Technology Transfer Program (Wash, DC) to MBZ.

References

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  3. Stark SM, Yassa MA, Stark CE (2010) Individual differences in spatial pattern separation performance associated with healthy aging in Learn Mem. May 21;17 (6): 284-8 [crossref]
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  5. Zhang G, Stackman RW Jr (2015) The role of serotonin 5-HT2A receptors in memory and cognition. Front Pharmacol 6: 225 [crossref]
  6. Zimering MB (2019) Autoantibodies in Type-2 Diabetes having Neurovascular Complications Bind to the Second Extracellular Loop of the 5-Hydroxytryptamine 2A Endocrinol Diabetes Metab J 3: 118. [crossref]
  7. Zimering MB (2021) A serotonin 2A receptor decoy peptide potently lowers blood pressure in male Zucker diabetic fatty rats. Endo Diab Metab J 5: 1-13. [crossref]
  8. Zimering MB, Grinberg M, Burton J, Pang K (2020) Circulating Agonist Autoantibody to 5-Hydroxytryptamine 2A Receptor in Lean and Diabetic Fatty Zucker Rat Endocrinol Diabetes Metab J 4: 413. [crossref]
  9. Grinberg M, Burton J, Pang KCH, Zimering MB (2023) Neuroprotective Effects of a Serotonin Receptor Peptide Following Sham Mild Traumatic Brain Injury in the Zucker Rat. Endocrinol Diabetes Metab J Volume 7 (3): 1-9. [crossref]
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  16. Zimering MB (2017) Diabetes Autoantibodies Mediate Neural- and Endothelial Cell- Inhibitory Effects Via 5-Hydroxytryptamine- 2 Receptor Coupled to Phospholipase C/Inositol Triphosphate/Ca2+ J Endocrinol Diab. 4 (4): 1-10 [crossref]
  17. Zimering MB, Behnke JA, Thakker-Varia S, Alder J (2015) Autoantibodies in Human Diabetic Depression Inhibit Adult Neural Progenitor Cells In vitro and Induce Depressive-Like Behavior in Rodents. J Endocrinol Diabetes. [crossref]
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  19. Zimering MB, Grinberg M, Myers CE, Bahn G (2022) Plasma Serotonin 2A Receptor Autoantibodies Predict Rapid, Substantial Decline in Neurocognitive Performance in Older Adult Veterans with Endocrinol Diabetes Metab J. 6 (1): 614 [crossref]
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Brain Health Best Practice Score: How Do Organizations Measure Up?

DOI: 10.31038/AWHC.2024723

 

Businesses and institutions rely on brain power to make important decisions, to solve critical challenges, and to think creatively and analytically. Employees also report that their work plays a major role in their brain health. However, most employees are reporting that work negatively impacts their brain, and the Organization for Economic Cooperation and Development’s (OECD) New Approaches to Economic Challenges initiative estimates that impaired brain health is costing the global economy as much as $8.5 trillion a year in lost productivity. This calls attention to the need for organizations to promote a healthy brain culture in their workforce, involving the implementation of programs and policies and creating an environment that supports brain health and function [1-4].

The HERO Health and Well-being Best Practices Scorecard in Collaboration with Mercer© (HERO Scorecard) is a free online survey that was designed as an educational and benchmarking tool to help employers identify and assess their use of practices that support more effective health and well-being initiatives. Version 5 of the HERO Scorecard was updated in 2021 to include recent emerging best practices in health and well-being initiatives in each of the six domains that the Scorecard measures (i.e., strategic planning, organizational and cultural support, programs, program integration, participation strategies, and measurement and evaluation). In late 2023, HERO convened a group of workforce brain health experts for an exhaustive review of the Scorecard to identify the workforce health and well-being practices that related to brain health. After extensive discussion, the final proposed practices were assigned tentative scores (out of a possible 100 points). Six independent subject matter experts then reviewed the proposed items and scores. Their feedback was combined and informed further revisions to the items included and final point allocations. A list of all practices included in the Brain Health Best Practice Score can be found in the HERO Scorecard user’s guide. In brief, the score is an indication of an organization’s adoption of practices related to policies, leadership support, programs, lifestyle behaviors, and the built environment. Table 1 provides a breakdown of the number of practices and points by section for the Brain Health Best Practice Score [5].

Table 1: Brain Health Best Practice Score Questions, Practices, and Points by Section

Scorecard section

Number of questions Number of practices

Points

Strategic planning

5

21 25.25

Organizational & Cultural Support

8 45

34.25

Programs

7

34 18.50

Program Integration

4 11

6.50

Participation Strategies

3

9 7.25

Measurement & Evaluation

1 7

8.25

TOTAL

28

127

100

Among the 388 organizations that completed the HERO Scorecard Version 5 through March 31, 2024, Brain Health Best Practice Scores were retroactively calculated. Organizations were categorized in many ways to examine variations in Brain Health Best Scores by size, industry type, percent of employees working remotely, geographic location, percent of workforce that is female, and age of employees.

  • Organizations were categorized by size into small (<500; n=118), midsize (500 to <5,000; n=161), and large (5,000+; n=104)
  • Industry type differences were assessed between financial (n=37), hospitals/healthcare clinics (n=36), technical/ professional services (n=68), government (n=52), education (n=58), manufacturing (n=34), and other (n=55), as well as for organizations that identified as high tech (n=90)
  • The percentage of employees working remotely was categorized as fully in-person (n=38), <25% remote (n=150), 25 to <50% remote (n=54), 50% to <75% remote (n=39), and 75% or more remote (n=70).
  • Geographic location was categorized as organizations with headquarters in Western (n=135), Midwestern (n=86), Northeastern (n=83), and Southern (n=81) regions.
  • Percent of workforce that is female was categorized as ≤40% of employees are female (n=141), 41 to 59% of employees are female (n=101), and ≥60% of employees are female (n=136).
  • Age of workforce was categorized as above the median age (>43 years; n=162) of responding organizations average age of employees and equal to and below the median age (≤43 years; n=211).

The mean Brain Health Best Practice Score for all respondents was 46.2 points. When comparing the Brain Health Best Practice Score by organization size (Table 2), large organizations received higher scores (mean = 58.8 points) than small organizations (mean = 33.2 points) or midsize organizations (mean = 46.9 points).

Table 2: A comparison of Brain Health Best Practice Score by Organization Size

n

Brain Health Score (X ± SD)

Small (<500 employees)

118

33.2 ± 18.4

Midsize (500 to <5,000 employees)

161

46.9 ± 19.3

Large (>5,000 employees)

104

58.8 ± 18.7

Large variations in Brain Health Best Practice Scores were observed among different industry types, with mean scores ranging from 40.8 for governmental organizations to 60.5 for financial service companies (Table 3).

Table 3: A comparison of Brain Health Best Practice Score by Industry

n

Brain Health Score (X ± SD)

Education

58

47.3 ± 22.5

Financial services

37

60.5 ± 20.6

Government

52

40.8 ± 16.3

Hospitals/Healthcare clinics

36

48.1 ± 22.6

Manufacturing

34

41.2 ± 20.0

Other services

55

41.5 ± 19.9

Tech/professional services

68

47.0 ± 20.3

Identified as High Tech

90

50.7 ± 21.0

Not identified as High Tech

294

44.6 ± 20.9

Brain Health Best Practice Scores differed among organizations with varying proportions of remote workforce. Overall, the organizations that reported being fully in-person scored the lowest of all groups with a score of 37.0. By contrast, organizations that reported 25-49% of their employees regularly work remotely reported the highest average score of 54.7. Table 4 displays the Brain Health Best Practice Score for all remote workforce categories.

Table 4: A Comparison of Brain Health Best Practice Score by Percent of Workforce that Regularly Working Remote.

n

Brain Health Score (X ± SD)

Fully in-person

38

37.0 ± 21.2

<25% remote

150

46.5 ± 20.6

25% to <50% remote

54

54.7 ± 21.5

50% to <75% remote

39

47.4 ± 20.2

75% + remote

70

42.9 ± 19.9

The comparison by U.S. geographic regions revealed minimal differences in the Brain Health Best Practice Score by region (Northeastern 47.2 ± 22.4, Midwest 46.1 ± 22.2, Southern 44.4 ± 21.0, West 47.0 ± 20.0). Similarly, there were minimal differences in the Brain Health Best Practice Score by the percent of female in the workforce. Organizations with ≤40% of employees that are female scored the lowest (43.3 ± 21.6), whereas organizations with similar percentages of male and female employees and those with ≥60% female employees scored slightly higher (41-59% female = 48.5 ± 19.3, ≥60% female = 47.4 ± 22.7). Finally, the average Brain Health Best Practice Score was found to be comparable between organizations that report an average employee age above 43 years (45.9 ± 22.1) and those with an average employee age ≤ 43 years (46.9 ± 21.0).

Overall, these findings highlight numerous opportunities for improvement in the implementation, promotion, and evaluation of workforce health and well-being initiatives to address brain health. Insights from neuroscience highlight the connection between physical health, mental health, and brain health.Organizations need to understand these connections in order to develop successful workforce health and well-being initiatives that positively impact the brain health of their workforce, ultimately leading to more healthy, happy, and productive employees. The HERO Scorecard’s Brain Health Best Practice Score can act as an educational tool to help organizations better understand how practices related to physical health, mental health, social connection, etc. are associated with brain health. Further, it can help inform an organization’s strategic plan by identifying areas of opportunity in which new programs, policies, and interventions can be implemented with the goal of improving workforce brain health. Organizations are encouraged to take the HERO Scorecard annually to measure progress and identify new areas of opportunity and focus [5,6].

References

  1. The Business Collaborative for Brain Health (2024) Available from https:// org/about
  2. Imboden M (2024) Maintaining Brain Health: An Imperative for Successful Aging and Business Performance 38(4)
  3. Robinson B (2023) Work Damages Your Brain Health, But 4 Strategies Can Improve It, Study Finds. Available from: https://www.forbes.com/sites/ bryanrobinson/2023/03/02/work-damages-your-brain-health-but-4-strategies-can- improve-it-study-finds/
  4. Organization for Economic Co-operation and Development (OECD)(2020) OECD Health Statistics. Available from: https://www.oecd-ilibrary.org/social-issues- migration-health/data/oecd-health-statistics_health-data-en
  5. HERO Scorecard. HERO (2024) Available from: https://hero-health.org/hero- scorecard/
  6. Kelly O Brien, MPA (2024) Unlocking Workplace Brain Health to Fuel Prosperity and Healthy Longevity 38(4).

The Cultural Elements in the Experience of Caregiving for Family Members with Alzheimer’s Disease

DOI: 10.31038/PSYJ.2024641

Abstract

With the increasing life expectancy, the world is facing population aging and related diseases. In this context, Alzheimer’s disease is one of the main neurodegenerative diseases that occur during the aging process. It compels family members of affected individuals to dedicate themselves to their care. Consequently, those who provide care are called family caregivers. They are engaged in a demanding caregiving relationship. The experience of caregiving is influenced by the cultural background of the caregivers.

This article aims to understand the cultural factors at play in the lived experience of caregiving among family caregivers. To achieve this, a clinical method, primarily case study, was employed, and data were collected through semi-structured interviews with caregivers in facilities dedicated to elderly care. Thematic content analysis revealed that Alzheimer’s disease is not universally perceived by all caregivers as a rupture. Some view their role as legitimate and rewarding (feeling useful, responsible, and competent). Cultural factors such as intergenerational solidarity and the desire not to contradict ancestors dominate their representation of the caregiving relationship.

Therefore, these cultural factors play an undeniable role in the caregiving relationship with close relatives who are experiencing illness. Taking these factors into account could be beneficial for the assistance provided to family caregivers.

Keywords

Alzheimer’s disease, Family caregiver, Lived experience, Caregiving relationship

Introduction

According to the World Health Organization (WHO) in 2022 [1], the proportion of people aged 60 and over in the global population will nearly double from 12% to 22% between 2015 and 2050. This rapid aging of the population necessitates significant efforts by all countries to prepare their social and health systems for this demographic shift. By 2050, the median age of the global population is expected to increase by 10 years, reaching 36 years.

As the world’s population ages, the incidence of Alzheimer’s disease and other types of dementia continues to rise. Alzheimer’s is a degenerative disease that causes brain lesions and is not a normal part of aging. Globally, approximately 46.8 million individuals are affected by dementia, with 58% residing in low-income countries. The frequency of new dementia cases is estimated at one every 3.2 seconds, totaling 9.9 million new cases annually. The WHO report from 2023 [2] projected a new dementia case every 4 seconds, equivalent to 10 million cases per year.

The impact of Alzheimer’s disease extends beyond individual patients, affecting families, caregivers, and communities. Understanding the cultural factors involved in caregiving for Alzheimer’s patients is crucial for providing effective support and improving the quality of life for both patients and their families.

In Africa, as in most southern countries, population aging poses numerous challenges, including the care of elderly individuals with reduced autonomy (Golaz, 2013). The current proportion of elderly individuals stands at 5.5% and is expected to more than triple by 2050 (Sajoux, Golaz, & Lefèvre, 2015), leading to increased demands for social protection and healthcare. Research indicates that elderly individuals in Africa face a significant burden of morbidity and disability, often due to chronic conditions that are frequently overlooked or untreated [3].

Within the context of large extended families in Africa, it becomes the duty of children to provide daily support and care for their parents, preserving the dignity and integrity of their ailing and dependent parents. African family dynamics consistently demonstrate this sense of duty toward parents, whether in North, West, South, or Central Africa.

In this context, caregiving for parents takes on an exclusive dimension, reversing traditional parent-child roles. In the eyes of children, parents are recognized for having provided unwavering attention, protection, and care, even during times of empowerment and strong family bonds.

Many informal caregivers actively engage in caring for sick individuals. In this study, we will use the term “caregiver” to define someone who primarily assists a dependent person within their immediate environment with daily activities [4]. Natural caregivers, family caregivers, or close caregivers encompass anyone who provides care or support.

Natural Caregivers: Understanding Their Role and Challenges

A natural caregiver, also known as a family caregiver or informal caregiver, refers to anyone who provides care and support to a family member, friend, or neighbor with physical or mental disabilities, chronic illness, or precarious health. These caregivers may be of any age and come from diverse backgrounds. Their profiles vary due to individual circumstances (such as age, gender, and cultural identity) and the specific needs of the person they assist (such as age and the nature of their disability).

According to the Quebec Institute of Statistics, 21.1% of the Quebec population aged 15 and older are natural caregivers. Their contributions are exceptional, but they may also require specific support and services. Many natural caregivers may not even realize they fall into this role, especially if the support they provide is occasional or if they have no direct family connection to the person they assist. However, the government adopts an inclusive definition of natural caregivers.

Definition of Natural Caregivers

A natural caregiver is defined by the Law Recognizing and Supporting Natural Caregivers as someone who provides support to one or more individuals in their close circle—regardless of age or life circumstances—who experience temporary or permanent physical, psychological, psychosocial, or other forms of disability. This support can be continuous or occasional, short-term or long-term, and is offered on a non-professional basis. It is provided freely, knowingly, and revocably with the goal of promoting the recovery of the person being cared for and maintaining or improving their quality of life at home or in other living environments. The support can take various forms, including transportation, assistance with personal care and household tasks, emotional support, and coordination of care and services. It may also have financial implications for the caregiver or impact their ability to care for their own physical and mental health or fulfill other social and family responsibilities.

Understanding the cognitive evaluation that natural caregivers make of their situation is crucial for adapting to the evolving circumstances and preventing feelings of burden. While natural caregivers share similar situations, their experiences can vary significantly. Adaptation skills and coping strategies play an essential role in managing the caregiving burden.

Indeed, natural caregivers constantly face what is known as “stressful situations,” defined as “a situation that an individual perceives as significantly impactful to their well-being and potentially exceeding their resources” [5].

Within this context, culture—understood as the collective characteristics of a specific group of people—becomes one of the factors influencing the caregiving experience among family caregivers of individuals with Alzheimer’s disease. According to Abou [6], culture encompasses the ways of thinking, acting, and feeling within a community, relating to nature, humanity, and the absolute. Group culture functions as a system that ensures coherence, facilitates organization, and symbolically regulates social life. It serves as a container where both implicit and explicit beliefs and convictions of the group reside. Culture thus acts as a knowledge system that organizes individuals within a given group around symbols, explicit and implicit concepts, and functions as a collective entity.

In line with this perspective, this article aims to explore the cultural elements at play in the caregiving experience among family caregivers.

Methodology of the Study

In line with the study’s objective, we employed the clinical method, which is fundamentally qualitative and relies on case study analysis. This choice is justified by its focus on the uniqueness of each case, allowing for in-depth understanding. Specifically, we prioritized studying the functioning and lived experience of family caregivers in their caregiving situation.

The case study approach aims to capture the singularity of each case. We conducted the study within Wellbeing associations in Yaoundé, APAC in Douala (Cameroon), and the Geronto-Geriatric Center in Melen-Libreville (Gabon). Participants were selected based on the following inclusion criteria: being a parent of the affected individual, being of legal age, serving as the primary caregiver for at least 6 months, not having a history of psychiatric illness, and obtaining a negative score on the Mini Zarit test.

After obtaining their consent, we emphasized confidentiality and anonymity. Subsequently, we proceeded with data collection.

In this study, we employed the clinical method, which is fundamentally qualitative and relies on case study analysis. This choice allows us to delve deeply into the psychological functioning of participants and comprehensively explore their experiences. Specifically, we focused on understanding the functioning and lived experience of family caregivers in their caregiving situation.

To collect data, we conducted semi-structured interviews. These interviews allowed participants to express themselves freely, providing valuable insights. We transcribed the spoken data to facilitate analysis. Our approach involved thematic content analysis, identifying essential themes or units of meaning. We selected key passages to empirically ground our analysis.

Results

Case Presentation

Case KM

KM is a 55-year-old widow, Catholic, and of Bamiléké ethnicity. She completed her education up to the first year of high school (1ère D). KM describes herself as an active woman in society, occupied by her profession as a “bayam-sellam.” This occupation involves purchasing staple food products in bulk from farms and selling them at retail prices in city markets. KM is the third of five siblings. For the past 10 months, she has been caring for her sick father. During the interview, she appeared relaxed and generously shared a wealth of information with us.

Case ED

ED is a 55-year-old woman from the Sanaga Maritime region, and she follows the Protestant faith. Despite her limited elementary education (CEPE – Certificate of Primary and Elementary Studies) obtained in Edéa, she expresses herself quite well in French. Her general knowledge surpasses her educational level, particularly regarding Alzheimer’s disease and societal matters. ED is a homemaker, married, and proud mother of five children.

Case LA

LA is a 35-year-old Cameroonian woman from the West region, specifically from the Bangangté tribe. She completed the equivalent of the third grade and works as a Community-Based Rehabilitation (CBR) agent. Her focus is on children and adolescents with disabilities.

Case P

P is a 30-year-old young military officer whom we met at the Geronto-Geriatric Hospital in Melen, Libreville, Gabon. He belongs to the Fang ethnic group, follows the Catholic faith, and holds a BEPC (Certificate of Basic Education). He is the second of three siblings, with the third sibling having passed away. As a single individual without children, he plays the primary caregiving role for his mother, who has been suffering from Alzheimer’s disease for several years.

In the relationship between KM and her parent, in addition to these moral values, we can see the influence of tradition that she upholds. She bases her motivation for fully playing her role as a caregiver on recognizing the bonds of kinship and a sense of moral obligation due to the care her parents provided in the past. She states, “I take care of my parent because I love them, and especially because they are my father.” Furthermore, she attributes to tradition a role akin to the superego, dictating the moral principles she follows. According to her, “If I were to abandon my parent during this illness, the ancestors and even God would be against me.” She adds, “According to tradition, a child should never abandon their parent.” For KM, caring for her parent is both a moral duty and a traditional obligation.

KM’s altruism means that she doesn’t concern herself with absent siblings in the caregiving relationship with their father. She is willing to give herself entirely for her brothers and sisters.

As for ED, her motivations in the caregiving relationship with her parent are evident in how promptly she mobilizes when her older brother expresses any concern about their mother’s health. She doesn’t hesitate to drop everything and rush to the village to assess the situation. She recounts, “When my mother fell ill, my older brother called me, saying that Mom wanted me, that she constantly mentioned my name, and that maybe she had something to tell me. So I went to the village… I asked her if I could take her with me to Douala, and she agreed. Then I sought my brother’s approval, and he gave his consent”. Beyond this dedication and constant concern, ED stands out with the certainty that she can take better care of her sick parent than anyone else: “But I want to stay by her side to make sure she gets better. I am convinced that no one can care for her like I can because I love my mother so much!”

In her altruistic spirit, ED acknowledges the sacrifices her mother made for her since childhood. This brings to mind authors such as Piaget, Wallon, Winnicott, and ethologists who emphasize the attachment bond between mother and child from early years, with lasting effects on the child’s personality. For ED, being close to her ailing mother evokes pleasant moments of affection, motivating her: “I have an opportunity to be close to her and repay what she has done for me since my childhood. I genuinely enjoy taking care of her because she’s my mother.”

According to her, it’s when parents are elderly that they become more valuable, contrary to modern notions of aging as a depleted, tired phase with nothing left to offer the younger generation: “Yes, even our village mothers become more endearing as they age because they have so much wisdom to share”.

In LA’s verbatim, we can discern her love not only for her grandmother but also for her own mother, who has always been caring toward her and her siblings. It’s as if through this assistance, she is also serving her own mother. Additionally, LA has experienced two divorces that affected her. Following the second divorce, she decides to live in the village and dedicate herself to caring for her grandmother. As the mother of her own mother, she believes her grandmother deserves her full devotion. It’s not only her duty to help but also a blessing to have a grandmother: “It’s normal; she’s my grandmother. I’m happy to take care of her, and I don’t complain even when it’s tough. It’s my duty as a granddaughter. Isn’t having a grandmother a blessing?”

In P’s case, we cannot overlook the positive influence of family harmony on lightening the burden of caring for their sick mother. Mr. P emphasizes that unlike families where discord prevails and individuals tend to shirk their responsibilities, in their family, a spirit of mutual aid ensures that no one feels “abandoned” in their caregiving duties. He highlights the importance of consultation in their relationship with their mother: “We consult on everything related to our mother’s health. Since her illness, we discuss her care more frequently”. It’s also worth noting that common sense prevails among the members of this family. While the older brother’s wife could have borne the responsibility of caring for their mother according to certain traditions, the brothers, especially our participant, come to her aid because she already has other significant family duties. This exemplifies practical wisdom within the family, contributing to lightening the burden. As our participant puts it, “The responsibility was too great to place solely on the wife, who already had a family to feed, care for, and children to educate. It was our duty as Mama T’s sons.”

He expresses gratitude for all the effort his mother put into raising them, especially their late sister. “Contrary to any hardship, I feel good because she has always been there for us, especially our late sister, whose passing deeply affected her. I’m content to take care of her”.

KM’s verbal expressions clearly reveal that cultural factors significantly influence her experience of caregiving for her father. She places great importance on the older generation, and her fear of ancestral retribution due to neglect is evident in her words: “According to tradition, a child should never abandon their sick father… If I even said he was wicked, may God forgive me…” Additionally, feelings of guilt and penance are present. KM believes that any wrongdoing toward parents is punished by God and ancestors. Out of fear of potential curses resulting from past misdeeds, she views caring for her parent as a form of penance.

Furthermore, KM emphasizes that her father deserves respect and honor in their culture: “He means everything to me. Besides, don’t you know that among the Bamiléké, parents are more cherished by children than anything else? If someone neglects their sick father, they don’t understand what they’re seeking, and they may even face curses!”.

According to KM, there is a belief that a curse awaits those who dare to neglect their sick or elderly parents. This starkly contrasts the treatment of older individuals in Western civilization versus African culture. While the former often involves retirement homes for the elderly, the latter keeps the elderly among their own, where they are cherished by their offspring. Like gathering around a fire, children find joy in surrounding their ailing father each evening, listening to stories, riddles, and advice. Even when ill, KM’s father remains a central figure around whom the children love to gather. This desire to be close to her sick father is particularly pronounced because other siblings envy KM. They believe she alone receives all the blessings from their father, while they must wait for holidays and vacations to share in them: “If any of them could leave their work to replace me, I’m sure they wouldn’t hesitate. During celebrations, the whole family gathers around Dad, and we celebrate together.”

Another testament to KM’s unwavering dedication to her father is her indignant response when asked about potential challenges in the caregiving relationship: “What problem could he cause me? I’ve been here since I understood he was ill. I’m proud to be his daughter, and I cannot neglect his illness!”.

ED’s family embodies the harmony characteristic of African families at large. This is evident in her older brother’s desire to have the sick mother sent to his home. Failing that, he sends one of his wives to assist our participant, ED, who insists on staying with the patient: “The family takes great care. My older brother even sent one of his wives to lend me a hand. He even asked me to send Mom to the village because there’s more family there. But I want to stay by her side to ensure she gets better.”

Despite knowing that tradition demands unwavering devotion from every child toward their parents, ED doesn’t need reminders. For her, it would be strange to act otherwise. Hence, she criticizes and feels indignant toward children who neglect their parents during illness: “We all know that even if tradition doesn’t explicitly require it, caring for parents is non-negotiable. If someone feels unable to do so, either they have a problem, or they’re not truly a child. I have no issues. Instead, I see it as an opportunity to be close to her and repay what she has done for me since my childhood. Taking care of her brings me genuine pleasure because she’s my mother”.

For LA, the notion of ancestral respect is sacred. She neglects her own needs in favor of those of her patient, and by extension, her own mother and other elders in the family. Even the patient’s numerous whims don’t cause her to lose her composure. She manages everything as best as she can. When necessary, she ensures she follows the patient during her wanderings to keep her in sight and avoid upsetting her. “Her biggest whims include eating everything and sometimes doing things her own way. But knowing it’s due to her illness, I endure and manage… It used to bother me a lot, but over time, I’ve grown accustomed to it. When she wants to leave, I let her and follow from a distance or send the children, as she can no longer cover long distances quickly.”

In P’s case, cultural factors influencing their experience primarily revolve around communal living. This manifests as harmony and cooperation among family members, where nobody shirks tasks but instead contributes willingly. Additionally, in this family, elders are revered, as Mr. P points out. This reverence for elders is a typical trait in African culture: “Elders are sacred beings among us”.

Discussion of Results

In Africa, old age is perceived not only as a time of rest but also as a sacred period for “reconnecting with the divine” (Tabboni, 2006, cited by Sadio-Ba Gning, 2015). Bourdieu previously noted that the entire relationship with the future is motivated by a desire to collaborate with God [7]. Consequently, old age is meant to involve contemplation and even asceticism for the elderly. Perceptions of old age, primarily shaped by implicit contracts, remind descendants of the intergenerational debt they must repay throughout their lives to their ancestors. In this context, participation in mosque or church discussions, visits to the sick, and pilgrimages to Islamic and Christian holy sites are highly valued. This assistance, which adheres to social norms, underscores the commitment children make to caregiving when their parents need assistance.

Old age represents a time of relinquishing personal plans, consolidated piety, strengthened moral authority, and the transfer of decision-making and economic power from the elderly to their descendants—the ones capable of maintaining family hierarchy and ensuring both material and moral survival.

Indeed, the care of elderly individuals in Africa follows a differentiation that favors male descendants with good socioeconomic status, often at the expense of women and younger siblings (Gning & Antoine, 2015). Descendants view old age as a “social retreat,” allowing parents to reap the fruits of their investments, sacrifices, and deprivations in peace and comfort. The elderly maintain precedence, arbitrate conflicts, and serve as guarantors of family cohesion (Golaz, 2007). Old age symbolizes a golden era, conferring respect, power, and social recognition. It becomes a means to revitalize the “social contract” of lineage.

In Africa, the need for assistance extends beyond professional care. Considering the trajectory of illness and care as developed by Corbin and Strauss [8], we recognize the significance of the family framework in dynamically rethinking the involvement of family members in providing necessary care for their loved ones. Communication, dialogue, and family solidarity play crucial roles in caregiving, whether rooted in blood ties, traditional values, or religious pillars. Each subject demonstrates that the family is the essential support system for bearing the burden of care.: Gning, S., & Antoine, P. (2015).

In Vieillir en Afrique (pp. 15-30). L’Harmattan. “Boquet and colleagues [9] drew attention to the cultural values of social groups and the social change that affects families, as the meaning attributed to assistance largely depends on it. It appears that intergenerational solidarity within the culture and the sense of gratification experienced in the caregiver-care recipient dyadic relationship are the cultural factors involved in the experience of caregiving among family caregivers of individuals with Alzheimer’s disease [10-21].

Conclusion

The objective of this article was to understand the cultural factors at play in the caregiving experience among family caregivers of individuals with Alzheimer’s disease. To achieve this, we used a clinical method, specifically case studies. Data were collected through semi-structured interviews with four caregivers from Wellbeing associations in Yaoundé, APAC in Douala (Cameroon), and the Geronto-Geriatric Center in Melen-Libreville (Gabon).”

Following a thematic content analysis, the obtained results reveal that Alzheimer’s disease is not necessarily perceived as a rupture by all caregivers. Some view their role as legitimate and rewarding (feeling useful, responsible, and competent). Cultural factors such as intergenerational solidarity and the desire not to upset ancestors dominate their representation of the relationship with their close relative. Consequently, these cultural factors play an undeniable role in providing assistance to close family members in situations of illness.

Taking these factors into account could be beneficial for the support offered to family caregivers. Beyond the daily care of individuals with Alzheimer’s disease, family caregivers also require psychological support to provide them with additional resources for coping with the situation. This, in turn, contributes to improving their quality of life.

References

  1. World Health Organization (2022). Aging and Health.
  2. World Health Organization (2023). Dementia.
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  4. Confederation of Family Organisations in the European Union (2007). European Charter for Family Carers. COFACE Families Europe.
  5. Coudin G. (2004). The reluctance of family caregivers to use gerontological services: A psychosocial approach. Psychology & NeuroPsychiatry of Aging 2: 285-296.
  6. Abou S. (1981). Cultural identity. Anthropos.
  7. Bourdieu P. (1982). Rites as acts of institution. Actes de la recherche en sciences sociales 43: 58-63.
  8. Corbin J M, Strauss A. (1988). Unending work and care: Managing chronic illness at home. Jossey-Bass
  9. Bocquet H, Berthier F, Pous J. (1996). Role and burden of caregivers for dependent elderly people: An epidemiological approach. Aging, Health, and Society 143-162.
  10. Cuijpers P. (2017). Four decades of outcome research on psychotherapies for adult depression: An overview of a series of meta-analyses. Canadian Psychology 58: 1-7.
  11. Darnaud T. (2003). Alzheimer’s disease and its victims… Cahiers critiques de thérapie familiale et de pratiques de réseau 133-147.
  12. Ducharme F. (2006). Family and care for the elderly: Challenges and strategies.
  13. Etters L, Goodall D, Harrison B E. (2008). Caregiver burden among dementia patient caregivers: A review of the literature. Journal of the American Association of Nurse Practitioners 20: 423-428.
  14. Aging in Rural Sereer Communities in Senegal: From Family Life to Social and Health Isolation of Very Elderly Individuals. In L. Nowik and B. Lecestre-Rollier (Eds.), Aging in Southern Countries (pp. 119-138). Karthala.
  15. Polygamy and Older Persons in Senegal. Mondes en développement 3: 31-50.
  16. Towards a New Definition of Intergenerational Relations in Gusii Rural Communities (Southwest Kenya). Intergenerational Relations in Africa: A Plural Approach 231-249.
  17. Dependency in Africa. Gerontology and Society 36145.2: 77-89.
  18. Gottlieb BH, Rooney J A. (2004). Coping effectiveness: determinants and relevance to the mental health and affect of family caregivers of persons with dementia. Aging & Mental Health 8: 364-373.
  19. Michon A, Deweer B, Pillon B, Agid Y, Dubois B. (1994). Relation of anosognosia to frontal lobe dysfunction in Alzheimer’s disease. J NeurolNeurosurgPsychiatry 57: 805–809.
  20. Assessment of Burden in Natural Caregivers: Properties of the French Version of the Brief Burden Interview. Revue québécoise de psychologie 25: 187-202.
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Grandparental Childcare and Maternal Labor Supply: A Short Commentary

DOI: 10.31038/IGOJ.2024711

 

China has experienced a widening of the gender gap in labor force participation, characterized by a decreasing percentage of female employees. This trend is potentially exacerbated by the relaxation of the one-child policy, as the primary responsibility for childcare falls on mothers, subsequently reducing women’s labor supply. The situation is further intensified by the restricted availability of formal childcare services, as having access to daycare services increases labor force participation (MLFP) by 24–29% in urban China. For children under the age of three, the work-family conflicts become evident for working mothers. Thus, grandparental childcare emerges as a practical solution [1-3].

According to recent study published in International Sociology [4], which uses data from the 2018 China Family Panel Studies (CFPS), the impact of grandparental childcare on mothers’ labor supply was analyzed. It was observed that grandparental childcare could significantly enhance mothers’ labor force participation rate and extend their weekly working hours. Regression analysis indicated a significant positive association between grandparental childcare and mothers’ labor force participation, notably amplifying labor participation and working hours for mothers with children aged 0 to 2 years. The study also confirmed that higher educational attainment and enrollment of children in formal childcare institutions significantly increased mothers’ labor force participation and working hours. Comparison between one-child and multi-child families revealed that grandparental childcare significantly bolstered labor force participation, particularly in one-child families. However, the augmentation in weekly working hours was marginally superior in multi-child families.

The research affirms that grandparental childcare promotes mothers’ labor force participation and working hours by lessening childcare obligations and facilitating a balance between work and family life. Moreover, the influence of grandparental childcare was more pronounced on the labor supply for mothers with children aged 0 to 2 years due to these children’s ineligibility for preschool and requirement of intensive care. This highlights the effective role of grandparental childcare in compensating for the limited services, easing women’s childcare responsibilities, and sustaining professional progression without significant interruptions.

The findings emphasize the necessity to establish a comprehensive childcare system that inclusively engages the government, family, and community to ease childcare burdens on women. Recommendations include the incorporation of flexible retirement plans and skill- enhancing training initiatives for grandparents in the childcare strategies. The findings also underscore the need to ensure women- friendly professional arrangements and extend accessible and affordable childcare resources, especially within the legal framework that permits up to three children in a home.

However, certain limitations exist in the study. One is the unavailability of women’s pre-childbirth labor supply data in CFPS, which could potentially lead to an underestimation of the correlation between grandparental childcare and maternal labor supply. The study also focused exclusively on labor force participation and working hours without considering the effects on work types and job specificity. A relatively small sample size of maternal grandparents providing childcare suggests a need for further research to differentiate between paternal and maternal grandparental support influences. Lastly, the current study does not explore the underlying causes of grandparental childcare preferences, which could be an area of further investigation to broaden the understanding in this domain.

In conclusion, the study underscores the significant role of grandparental childcare in bolstering maternal labor force participation in China, especially for mothers with infants and toddlers. It highlights the need for a comprehensive childcare system and flexible policies to balance women’s professional and familial roles. However, the study’s limitations suggest the need for more extensive research. Future work could explore the root causes of grandparental childcare preferences and the differential impacts of maternal and paternal grandparental support.

References

  1. Leng A, Kang F (2022) Impact of two-child policy on female employment and corporate performance: Empirical evidence from Chinese listed companies from 2010 to Humanities & Social Sciences Communications 9: 451.
  2. Wu X (2022) Fertility and maternal labor supply: Evidence from the new two-child policies in urban Journal of Comparative Economics 50: 584-598.
  3. Du F, Dong XY, Zhang Y (2019) Grandparent-provided childcare and labor force participation of mothers with preschool children in urban China. China Population and Development Studies, 2, 347-368.
  4. Bai H, Li M, Hong Y (2024) Grandparental childcare and maternal labor supply in Chinese families with young children: Evidence from the China Family Panel International Sociology 39(4).

Landscapes of Origin: Geoparks and Pilgrimage

DOI: 10.31038/GEMS.2024641

Abstract

This is an ethnological analysis of six unique geology reserves (or geoparks) each being the center of a larger geological landscape (or geoscape). Each park has been given special historical preservation status in the United States because of its cultural meanings to Native Americans and its special geological features. Ethnographic studies were funded to understand the special cultural connections between individual geological areas and cultural a more general ethnological perspective on such heritage places. The authors of this analysis participated in the ethnographic study of four of the six affiliated Native Americans. This analysis further compares these findings, drawing out four themes common across the case studies and thus producing geoparks.

Keywords

Landscapes of origin, Geoparks, Geoscapes, Pilgrimage, North American, Native American sacred areas

Background

The most current understanding of the UNESCO preference for using geology heritage terms like geoparks for research and management is discussed in a special issue of the journal Land entitled Geoparks, Geotrails, and Geotourism—Linking Geology, Geoheritage, and Geoeducation that was edited by Margaret Brocx and Vic Semeniuk [1]. They summarize the worldwide movement towards using these concepts to better understand heritage places that involve a number of geoparks and geotrails that have been established, e.g., UNESCO. Global Geoparks where the geology, geotours, and local economy are linked for the well-being of the local people and operate under the auspices of UNESCO, and National or State-oriented geoparks/geotrails where the geology is identified as significant and preserved in conservation estates and utilized for tours, education, and other commercial purposes. Well-designed and organized geoparks/geotrails provide valuable sites for geoeducation, including suitable localities for collecting minerals and fossils, and all types of geoparks/geotrails can function for geotourism. Geotours in geoparks/geotrails provide excellent opportunity for introducing the public and students to the wealth of information and history that the Earth has to offer and professional geologists to the diversity of Earth Science globally. This analysis contributes to our understanding of the UNESCO use of geoparks by demonstrating how Effigy Mounds National Monument (NM) and its surrounding ceremonial landscape fits into a broader discussion of multi-ethnic [Ethnicity is the social organization of cultural difference (Barth 1969). We use ethnic groups here to denote socially defined subdivisions of a common cultural heritage. Ethnic group membership tends to be organized by a number of boundary mechanisms, which may include shared religious practices, ancestry and descent, origin stories, geographies of and attachments to place, and language] ceremonial centers also known here as Landscapes of Origin and geoscapes. The purpose of this ethnological analysis is to show that, while Effigy Mounds has its own unique functions and connections, it parallels other ceremonial centers discussed in this analysis. The six case studies presented here were selected to demonstrate how some time-keeping elements using geological features, healing places, and renewal ceremonial locations are comparable with other heritage geoparks. In a book entitled Landscapes of Origin in the Americas: Creation Narratives Linking Ancient Places and Present Communities, Jessica Christie (2009) [2] assembled nine case studies of how Native American ethnic groups understand, use, and are attached to origin places. The cases are from North, Central, and South America. The organizing thesis of her book is that Creation is a complex concept which variously can mean where we came into previous worlds, where we came into the current world, or where we were culturally recreated as a result of some monumental event.

All Creation events discussed here, and thus their recounting through time, are tied totopographic places and, often, multiple geological features. Normally these places are topographically spectacular—the junctions of large rivers, a salt deposit in the caldera of a massive volcano, a mountain in a flat terrain, or the outcropping of a special mineral for making ceremonial pipes. Landscape of Origin naturally has a destination area, which is the focus of various kinds of ceremonies such as those associated with world balancing and conflict resolution activities, individual vision quests, and spiritual healing. At the center of the destination there often are a series of sequential use protocols which we have termed local ceremonial landscapes [4,5]. The journey to the destination center typically occurs along well established pilgrimage trails, which in turn have functionally special locations for ceremony (Grassy pubs). This ethnological analysis helps us to understand Effigy Mounds by placing it in a wider Native American heritage geoscape frame.

Landscapes of Origin

Tribal representatives describe Effigy Mounds [Effigy Mounds is used in this article instead of the acronym Effigy Mounds NM in order to talk about not only the monument lands but also the surrounding immediate landscape. The distinction upholds Native American uses shared during ethnographic interviews] as a large ceremonial center, which is located in an extensive, functionally integrated cultural landscape, called here a Landscape of Origin. The Effigy Mounds center and landscape have been used by many different Native American groups for thousands of years. Native American people have long maintained connections to Effigy Mounds through ceremonial activity and their origin and creation stories. Effigy Mounds also has been understood as an area free from inter-ethnic conflict; thus all culturally associated tribes have an inherent right to visit for ceremonial activities and conflict is not allowed in this sacred space. With these core understandings, it is important to place Effigy Mounds into a broader discussion of multi-ethnic ceremonial centers (Figure 1).

FIG 1

Figure 1: Map Placing the Five Multi-Ethnic Ceremonial Areas

This essay describes and compares six (6) Native American Landscapes of Origin including Effigy Mounts, in North America. The five other cases are (1) Pipestone National Monument (Pipestone), (2) Medicine Wheel/Medicine Mountain National Historic Landmark (Medicine Mountain), (3) the Zuni Salt Lake and Sanctuary (Zuni Salt Lake), (4) Chaco Culture National Historical Park (Chaco), and (5) Sugarloaf /Gold Strike Canyon (Sugarloaf Mountain) (Figure 2.1). The patterns or elements of these well-known Native American geoparks and geoscapes are used to situate Effigy Mounds as a ceremonial center.

Effigy Mounds

In the past, a number of Native American groups visited places located within the monument boundaries and the surrounding landscape for a variety of reasons, such as holding ceremony, burying their dead, and maintaining the mounds (Figure 2). While at this ceremonial center, interactions between the diverse groups were peaceful, due to the shared value of the mounds as a neutral zone for ceremonial use (Figure 2).

FIG 2

Figure 2: Landscape and Viewscape from the Marching Bear Group

Howey, whose work focused on mound groups in northern Michigan, suggests that mound groups may have served as ceremonial areas that build on pan-residential interaction and trade [6]. She argues that embedding these centers in the sacred allows members of communities from separate territories to meet and exchange goods where liturgical order ensures moral behavior, therefore public ritual restrains individual competition or hostility [6]. In short, the political functions of public ritual were just as important as the religious functions. These mounds were centered in shared ritual that brought communities from great distances. These relationships strengthened social bonds between territorially distinct groups and added group interdependencies through economic specialization. Building upon his research on mounds in South America, Dillehay [7] notes that once monuments are engaged in public ritual, they organize people’s responses and patterns of interaction. Similar cultural use patterns occurred along the Upper Mississippi River watershed. Tribal representatives maintained that these mounds served as a gathering place for the celebration of the solstice and other ceremonies, as well as the final resting place for spiritual leaders and other deceased community members from a number of tribes. Through time, Effigy Mounds continued to be a sacred place, or spiritual center, lending credence that it was seen as hallowed ground and a place of nonviolence.

Origin Stories

Effigy Mounds are a key component of many Native American tribes’ oral histories and creation stories. According to ethnographic interviews conducted during this study, Dakota, Ioway, and Winnebago have stories that connect them with the various mound groups within the monument. Tribal representatives noted that the zoomorphic effigies are closely linked to medicine and clan origins and migration. In particular, the Marching Bear Group found in the South Unit is associated with a period in history where the Ioway, Winnebago, and others were once part of one larger group of people. At one point the various clans within this larger society agreed to separate peacefully into multiple tribes. An Ioway representative noted that the formation of the Marching Bear Group is representative of that event (Figure 3). Each group broke away and headed their separate ways, one by one.

FIG 3

Figure 3: Aerial View of Marching Bear Group in the South Unit of Effigy Mounds (NPS)

Ho-Chunk oral histories tell of an origin story that tribal representatives believe corresponds to the Marching Bear Group: One night, the Great Spirit appeared to Bear in a dream, “My son,” he said, “it is time to leave your home and go to a new home I have made for you. No longer will you eat solely from the water. There will be other food that I have out there for you to eat.” So Bear called a council with all the other animals, including Wolf, Deer, Eagle, and Buffalo. It was decided that Deer would lead the way, so he and his people left first. Bear and his people left in the second group, followed by Wolf in the third group. Buffalo left the next morning. The final animal to leave was the mighty Eagle. Before he departed, he blessed the people who were left behind. Eagle then flew into the sunrise and disappeared over the mountains. The spirits of the early people watched them leave with tears in their eyes, but happiness in their hearts [8]. Oral history, such as the Ioway and Ho-Chunk stories, reaffirms contemporary Native American people’s connections to Effigy Mounds.

Pilgrimage and Ceremonial Activity

Human societies form complex connections and relationships with the environment that surrounds them. Their cultural understandings of the land are shared and transferred over generations through oral traditions and ceremony [9,10]. Many cultural groups, or ethnic groups, can hold different understandings of the same land [3]. For many Native American people, these engagements are grounded in their epistemologies and oral traditions [11-13]. Places are connected through songs, oral history, human relations, ceremony, and both physical and spiritual trails. These connections create synergistic relationships between people, places, and objects during ceremony. These types of connections and relationships are important for understanding the concept of pilgrimage. The act of pilgrimage involves religious specialists traveling to unique and powerful places and landscapes along special, well-established ceremonial pathways. As the religious specialists, or pilgrims, follow these trails, they perform ritual acts, which are critical to successfully completing the pilgrimage ceremony. The pilgrimage process allowed the pilgrims to gain knowledge and power at their destination places to use in ceremonies to restore balance and promote sustainability in their home communities.

The term pilgrimage is used here to describe the ceremonial journey cultural and religious leaders took when they visited the Effigy Mounds NM area. The UofA team chose this term because it was believed to be the best way to describe how the tribal leaders’ travel and visitation to their area would have hade social and spiritual importance. During pilgrimages, the travelers are left without their normal social structure, and a community or communitas (even if it is temporary) is formed [14]. Pilgrims use these new relationships to develop protocols for how to behave and perform rituals along the trail. These roles are based on the pilgrims’ ceremonial responsibilities and needs that are necessary for a successful pilgrimage. Ceremonial activity brings together people from different communities and cultural backgrounds [15-19].

Effigy Mounds served as a major ceremonial destination place for many Native American groups for thousands of years. Religious specialists followed specific trails, which included both terrestrial and water travel components. During their journeys, religious specialists likely visited places to pray and leave offerings along the routes in order to physically and spiritually prepare themselves to enter Effigy Mounds. Once they reached their destination place, religious specialists engaged in certain types of ceremonial activities. It is believed that certain types of activities occurred seasonally while others occurred annually at Effigy Mounds. According to some of the tribal representatives, ceremonies occurring at various locations within the monument were tied directly to time keeping. At least one mound group found on the high bluffs was constructed and placed in such ways that solar and lunar movements could be observed during the summer solstice. Time keeping is an important activity that exists in all human societies. Designated medicine men/religious specialists were trained for this task by tracking the movements of the planets, stars, moon, and the sun. Originally, physical time was marked at stable places on the landscape. Time often dictates and influences when specific human activities, such as ceremony, take place. Tracking solar and lunar movements plays an especially important role in agriculture; time keeping helps determine the best time for planting and harvesting produce [20]. Another major ceremonial component of Effigy Mounds was the annual activity of reconnecting with the ancestors and memorializing the deceased, as noted by tribal representatives. Annually, Native American people from connected communities visited Effigy Mounds for funeral ceremonies. Families worked together to bring in raw materials to repair and stabilize the mounds. Native American people brought the remains of important community members or religious leaders to be placed in the burial mounds at Sny Magill or on the high bluffs. Additionally, as part of the ritual activities, offerings would be brought and placed in and around the mounds.

Historical Accounts

Reuben Thwaites documented Prairie du Chien, which is located just across the Mississippi River (Figure 4), as a key trading center amongst numerous Native American tribes. [21] asserts that up to 6,000 Native Americans would visit annually. Blaine [22] makes a similar assessment about the region, referring to Prairie du Chien as an “older Indian trading rendezvous.” The proximity to the Wisconsin and Yellow River further affirms the magnitude of trade in this area, tying this landscape to the west via the Yellow River, and to the Great Lakes region via the Wisconsin River. Materials found within the burial mounds in and around Effigy Mounds also help frame the context of centralized trade in this area. Located within the mounds were traces of copper, mica, shells, and obsidian. It is speculated that each one of these materials was traded from areas to the north, south, east, and west.

FIG 4

Figure 4: View of Prairie du Chien from Effigy Mounds

Native American people came together in the Prairie du Chien area for other types of events aside from trade rendezvouses. Early Euro-Americans in the region noted accounts of Native American people coming together to take part in ceremonial games, such as lacrosse. According to the Ho-Chunk Nation’s timeline of their tribal history, over 300 people representing the Winnebago, the Fox, and the Sioux gathered to participate in a large lacrosse tournament near Prairie du Chien [23].

Landscapes of Origin Cases Elsewhere

Various ceremonial centers found in North America were utilized by multiple ethnic groups for a wide range of purposes. These locations had ritualistic and ceremonial components related to Native American epistemology and reinforced both intra- and inter- tribal bonds. Among these locations are: (1) Pipestone, (2) Medicine Mountain, (3) Zuni Salt Lake, (4) Chaco, and (5) Sugarloaf Mountain. The following section provides information on these locations and shows the parallels between them and Effigy Mounds.

Pipestone National Monument Case One

Pipestone National Monument (Pipestone) is located in Pipestone County, near the three-state border of Minnesota, South Dakota, and Iowa (Figure 5). Before the arrival of Europeans, various Native American groups lived in the vicinity of the present-day monument. They, along with other Native American groups who did not live in the immediate vicinity of the monument, visited the quarry in order to obtain catlinite to manufacture ceremonial pipe bowls and other objects. The stone gets its name from nineteenth-century artist, George Catlin, who described and painted it. The monument takes its name from this resource, and later the quarry and adjacent area became a national monument in 1937 [24].

FIG 5

Figure 5: Pipestone Landscape

Before Euro-American settlers introduced drastic changes to its natural landscape, the monument included some wetlands and tall grass prairies. This area was under natural fire and drought cycles that preserved its open grassland ecosystems. The monument lies on the outer, southwestern edge of the “Prairie Lake” subregion of the Northeastern Plains, which is characterized by inland lacustrine and riverine drainage systems that once fed both grasslands and wetlands [25]. The ancient heritage cultural landscape of the Pipestone quarries was the product of several Native American tribes who made use of the area, and specifically the pipestone, since A.D. 1400-1450 (Figure 6). These included the Poncas, Omahas, Ioways, Otoes, Sacs, Foxes, and Sioux, although the latter were in control of the Coteau des Prairies by the early 1700s. Sioux interest in the quarries and surrounding region are attested to through migration stories and documented annual pilgrimages to this ceremonial center to obtain pipestone. The Sioux also went there to perform rituals, hold ceremonies, gather plants, and hunt wildlife. Some camp and village sites were established periodically in the region, as were breastworks or enclosures presumed to be defensive structures [24].

FIG 6

Figure 6: Artist’s Rendition of Ceremonial Activity at Pipestone from the Monument Visitor Center

While ceremonial activities may have occurred elsewhere, it seems that the healing and ritual activities primarily involved the water, the waterfalls, and the view of the treeless prairie from the quartzite ridge. Overall, most activities involved one or more of four primary features in the traditional cultural landscape: the waterfalls, the Pipestone quarries, the Three Maidens, and Leaping Rock [5]. The sacred nature of the Pipestone local ceremonial landscape began with medicine plants and rites-of-passage rituals. Then, according to Sioux oral history, White Buffalo Women brought the pipe to the Sioux and the practice of quarrying pipestone began. Native American interpretations and attachments to the place persisted through time, although they became secondary to quarrying the pipestone [5]. The Cree also have oral histories about the sacred pipe and the creation of the catlinite quarry at Pipestone. Catlin [26] recorded one story of a Cree that had visited Pipestone: …in the time of a great freshet, which took place many centuries ago, and destroyed all the nations of the earth, all the tribes of the red men assembled on the Conteau du Prairie, to get out of the way of the waters. After they had all gathered here from all parts, the water continued to rise, until at length it covered them all in a mass, and their flesh was converted into red pipe stone. Therefore, it has always been considered neutral ground – it belonged to all tribes alike, and all were allowed to get it and smoke it together. Catlin documented several tribes’ origin stories of Pipestone. Each attributed the use of Pipestone to multiple groups, and each tribe emphasized Pipestone as a place of peace. For thousands of years, during which Native American people used this ceremonial center, it was primarily a male place where medicine men sought plants for healing, performed rites-of-passage, and pursued vision quests. One such rite involved a four-day submergence in the Pipestone Creek (Figure 7), after which boys became men and could be counted on to have the stamina necessary for hunting and fighting [5].

FIG 7

Figure 7: Winnewissa Falls along Pipestone Creek

Upon arriving at the ceremonial center, they would set up camp away from the quarries. Once greeted by thunder and lightning storms, the men would make ceremonial camps near the Three Maidens and begin to prepare themselves by cleansing in the creek and giving prayers and tobacco offerings at the Three Maidens, which is the gateway into the sacred areas of Pipestone. If thunder and lightning greeted them again, the place had heard their prayers and given them permission to enter the site. If thunder and lightning did not occur, the men may have returned to the ceremonial camp for more preparation or to the main camp to prepare for the return home [5]. Having entered the quarry sites, many of which paralleled the quartzite ridge for nearly a mile, the men who were not quarrying might continue with sweats and prayers until they were needed. Upon entering a quarry, each man would make a tobacco offering to indicate their purity and to protect them while they worked. When they were done, they took the offerings with them to show respect for the spirits of the sacred area [5].

Medicine Wheel/Medicine Mountain Case Two

Medicine  Wheel/Medicine  Mountain  National  Historical Landmark (Medicine Mountain) is a large ceremonial center in present day Wyoming (Figure 8). Many Native American groups such as the Arapaho, Bannock, Blackfeet, Cheyenne, Crow, Kootenai- Salish, Plains Cree, Shoshone, and Sioux have all come to this area for ritual activity over the course of at least 7,000 years. Medicine men/religious leaders visited the mountain for a range of ceremonial activities related to doctoring and vision questing. During recent ethnographic studies, tribal religious leaders and tribal elders have pointed out that even across the many different groups connected to Medicine Mountain, there is a common and shared understanding of the spiritual and ceremonial importance of this landscape [27,28].

FIG 8

Figure 8: Medicine Mountain Landscape

Medicine Mountain (Figure 9) is at the center of numerous ceremonial trails leading into the area from different directions. Once religious leaders approached the base of the mountain, they would ascend the eastern slope. The trails along the eastern side of the mountain have been interpreted by some Native Americans as being linked to the notion that Medicine Mountain is not just a mountain, but rather it is a spirit lodge in a very literal sense [27-29]. The mountain houses important spirits, and for those visiting the mountain, they must approach it in the same culturally appropriate manner as you would a spirit lodge (Sun Dance or ceremonial lodges). In order to do so, it must be approached from the east.

FIG 9

Figure 9: Medicine Mountain (NPS 2015)

The trails leading up the eastern flank of the mountain are marked with rock cairns surrounded by ritually deposited materials, or offerings. Numerous features are located along the trails up the mountain, such as stone-lined arrow effigies, rock cairns, prayer shrines, patches of medicinal plants, and places for short- and long- term occupancy. When reaching the top of the mountain, religious leaders had access to designated areas for vision questing along the rim [27-29]. The Bighorn Medicine Wheel on the ridge west of the Medicine Mountain summit is the principal ceremonial site (Figure 10). Native Americans have described it as “the altar” for Medicine Mountain. Healing ceremonies for sick individuals who have made the pilgrimage tothe mountain are performed in the northeastern part of the district [27-29].

FIG 10

Figure 10: Bighorn Medicine Wheel

The large medicine wheel at the top of the mountain is also a ceremonial destination place. The medicine wheel has been used for two distinct ceremonial purposes during two time periods. It is believed that Native Americans first used the medicine wheel as a time keeping instrument with a select and highly specialized group of religious leaders involved in time keeping ceremonies. It was likely their pilgrimages to Medicine Mountain occurred at different periods than those for vision quest. At a later point in time, the medicine wheel became an area associated with doctoring ceremonies. During healing ceremonies, balance would be restored to both the patient and the surrounding environment [27-29].

Zuni Salt Lake and Sanctuary Case Three

Located 42 miles south of the Pueblo of Zuni, the Zuni Salt Lake and Sanctuary (Zuni Salt Lake) (Figure 11) is a ceremonial center that is approximately ten miles in circumference. This landscape of origin is on the NRHP as a historic archaeology district rather than a TCP due to the number of inholding private properties. The lake is located in a circular depression and contains a large concentration of salt. The crater was formed by volcanic activity associated with the two cinder cones found at the south side of the lake [30]. People are often drawn to volcanic sites; volcanic activity plays a key role in the development of unique minerals and biotic communities. Volcanoes are seen as special places, especially to Pueblo communities, whose membership often refer to them as Earth Navels [31]. This ceremonial center features in the oral histories of Acoma, Hopi, Laguna, and Zuni. Each pueblo has individual origin stories that account for the lake and the Salt Woman who resides in it. Duff et al. [32] identifies the Salt Woman in each pueblo’s history, known as Ma’lokyyattsik’i to the Zuni, Öng.wùuti to the Hopi, and Mina Koya to Acoma and Laguna (Figure 11).

FIG 11

Figure 11: Zuni Salt Lake Landscape

Stories about Salt Woman have common themes among various Pueblo peoples. Salt Woman took a long journey to each of the tribes before she settled down at the salt lake, and her home can still be identified by the people in these respective locations. While living with the tribes she was not respected: some people wanted her to leave because of her appearance, and some even polluted her home. The Salt Woman eventually left the tribes and traveled east on the back of an eagle where she met Turquoise Man. From there she traveled south, leaving remnants of her travels behind, and eventually settled at the lake (Figure 12) [32].

FIG 12

Figure 12: Ariel View of Zuni Salt Lake (Duff et al. 2008)

Realizing their mistakes, the Pueblos reconnect with the Salt Woman at Zuni Salt Lake by collecting the sacred salt from the lake. Out of respect for Salt Woman, the Zuni Salt Lake area is a conflict-free area. Today, the sacred salt is acknowledged as spiritually important to the people and used for ceremony and healing. The lake is surrounded by prehistoric trails that connect associated Pueblos. Contemporary pilgrimages take these pueblos to Zuni Salt Lake via these trails for ceremony and ritual collecting of this highly valued salt (Figure 13) [32,33].

FIG 13

Figure 13: Aerial View of Zuni Salt Lake Taken from Google Earth

Oday, Zuni Salt Lake is protected by the Pueblo of Zuni. In order to access this sacred location, individuals would have to obtain permissions from governing Pueblo of Zuni officials. According to an elder from the Pueblo of Zuni, the idea of getting permission to visit the site is problematic because all culturally affiliated pueblos have rights to the sacred landscape, not just Zuni [32].

Chaco Culture Case Four

Chaco Culture National Historical Park (Chaco) (Figure 14) is located in the San Juan Basin of the Four Corners region of New Mexico in the Southwestern United States. Chaco is a large regional ceremonial center that builds on complex inter-tribal relationships [34-36]. Numerous Western Pueblo tribes are culturally affiliated with Chaco, including Acoma Pueblo, Hopi Tribe, Nambe Pueblo, Navajo Nation, Pojoaque Pueblo, Santa Ana Pueblo, Santa Clara Pueblo, Santo Domingo Pueblo, Tesuque Pueblo, Zia Pueblo, and Zuni Pueblo [36].

FIG 14

Figure 14: Chaco Landscape

Chaco was a regional pilgrimage center [37] and likely remained a destination of special importance and continued to be visited through pilgrimages after the fall of Chacoan culture [36,37] argue that “undertaking the pilgrimage [to Chaco] was a way to demonstrate one’s commitment to the religious system centered at Chaco and the identity and moral system tied to it.” Connections to distant communities are evident in exotic materials found within the canyon, such as macaw remains, which trace this linkage as far away as Mesoamerica. Much of the ceramics and lithic remains found within Chaco were identified as non-local, and great houses contained hundreds of rooms with sleeping platforms [37]. Estimates put the peak population of Chaco between 2,100 and 2,700. However, construction of structures and agricultural fields at Chaco could have supported much greater numbers [38]; this suggests Chaco served not as a larger pueblo for year-round living but as a ceremonial center for seasonal visitors. Lekson [39] also argues that Chaco served as the regional ceremonial center that was linked to Aztec Ruins and Casas Grandes (Paquimé) through the Chaco Meridian, a longitudinal line at approximately 108 degrees west that connects these three ceremonial centers.

Construction in Chaco suggests a ceremonial use of the great houses (Figure 15) within the area. According to Sofaer [40], “major buildings of the ancient Chacoan culture of New Mexico contain solar and lunar cosmology in three separate articulations: their orientations, internal geometry, and geographic interrelationships.” There are a series of great houses (Figure 15), large multi-level developments, often oriented with solar, lunar, and cardinal directions built within line of site with one another (NPS N.d. a) [41].

FIG 15

Figure 15: The Pueblo Bonito Great House as Seen from a Cliff

A unique system of signal fires connected the great houses of Chaco. Signaling stations played a major role in the organization of Chacoan communities. These stations, which were lit with fires and intensified with reflective materials such as mica or selenite, are located along the roads of Chaco, creating connections between the great houses [42]. Signal fires can have a wide range of purposes, such as for ritual and ceremony, warfare, hunting, scheduling, and even defense [43]. These signal fires are located in high areas with unobstructed views to the next, typically on a tall building or a hill. Selenite, a highly reflective material, was found at some of the signaling sites across Chaco [43]. These signaling stations were capable of quickly carrying information across the canyon to each great house, allowing ceremonies to be conducted simultaneously across the entire region.

Fajada Butte (Figure 16) is a large topographic feature that stands over 400 feet high. It was one of the primary ceremonial destination places for religious leaders who traveled from other Chacoan communities. These journeys would be part of major events that were marked by the Sun Dagger. Also, trips would be made to this area for continuous interactions with the sites and shrines, ceremonies, interactions with other religious specialists to share ideas, and for teaching inexperienced people about time keeping and the movements of the sun, moon, and stars. The Sun Dagger on Fajada Butte is in the southeastern gap of the primary canyon in Chaco, approximately one kilometer to the east of Chacra Mesa (Figure 17). The dagger is formed by three large sandstone slabs that collimate sunlight onto two spirals [44,45]. The slabs result from a natural rock fall, not human engineering. While impossible to date the rock fall and peckings, it can be inferred that ancestral Native Americans carved the spirals after observing the light patterns for numerous annual cycles, thus using naturally occurring patterns and human made alternations to engineer a calendar [36,44].

FIG 16

Figure 16: Fajada Butte

FIG 17

Figure 17: The Sun Dagger Over a Petroglyph at Fajada Butte

Along the predominant ledge just below the Sun Dagger, there are a series of rooms that extend around most of butte. These rooms have been exposed due to erosion processes. In nearly all of the rooms that were visited during the 1994 study, pieces of pottery were found. One of the rooms is circular shaped and visiting tribal representatives believed it to be a kiva. It has been estimated that 20 to 30 rooms were built at this level, and they are believed to be the rooms where time keeping specialists lived during ceremonial activities on the butte [36]. Rooms were used by more experienced specialists to teach newcomers about celestial movements. Near the roofs of these rooms are various calendars and peckings which have been identified as representing clans, origin beings, ancestral beings, and physical representations of time. In accordance with traditional and contemporary use patterns of Pueblo households, theroofs of these rooms were seen as appropriate places to study, teach, and record the movements of the stars, sun, and moon [36].

Sugarloaf Mountain/Goldstrike Canyon

Sugarloaf Mountain/Gold Strike Hot Springs (Sugarloaf Mountain) is the fifth Landscape of Origin to be described and used to compare with Effigy Mounds (Figure 18). Sugarloaf Mountain is a valuable point of comparison because it was the first Native American cultural property that existed in two U.S. states (Arizona and Nevada) to be placed on the NRHP as a Native American TCP. In addition, the Sugarloaf Mountain TCP includes a portion of the Colorado River where Indian people traditionally moved between the hot spring canyon in Nevada and the ceremonial mountain in Arizona (Figure 19). Because Sugarloaf Mountain has been placed on the NRHP, this description uses text from the formal document.

FIG 18

Figure 18: Sugarloaf Mountain Landscape

FIG 19

Figure 19: Sugarloaf Mountain and the Colorado River

This property (a technical term used in the TCP nomination process) was successfully evaluated as a part of a larger cultural landscape of origin that has significance to a number of Native American tribes in the region. Although the TCP evaluation focused primarily on the mountain and the hot spring canyon located just across the Colorado River to the west, its cultural significance is, in large part, determined by its place within this larger landscape of origin setting. The Southern Paiutes, Hualapais, and Mohaves have all traditionally used Sugarloaf Mountain as a place for practicing spiritual, scientific, educational, political, economic, and social activities. The long-term presence of Native Americans at Sugarloaf Mountain is evidenced by physical artifacts that include two noticeable demarcated ceremonial clearings, apetroglyph, a turquoise mine at the base of the mountain, a cave with grindstones for corn or paint, small healing rocks, and several lithic scatters [46]. In addition to archeological evidence, historical and contemporary documentation confirms the existence of strong connections between Sugarloaf Mountain and the Southern Paiutes, Hualapais, and Mohaves. These intimate and deeply forged connections to Sugarloaf Mountain are integral to the maintenance of cultural, spiritual, ecological, and historic continuity between the ancient people of southern Nevada and their contemporary descendants. Today, the preservation of sacred knowledge and traditional cultural practices through the education of young people hinges upon the recognition and protection of those sacred places of the Southern Paiutes, Hualapais, and Mohaves that have not been irrevocably altered. Sugarloaf Mountain is such a place [46]. Amongst the Mohaves, Sugarloaf Mountain is repeatedly mentioned as a place that is tied to the sacred mountain, Avikwame. In travel songs, bird songs, and celebratory songs, Sugarloaf Mountain is noted as the northern most boundary as well as a spiritual place of power, which islinked to the Origin Mountain, Avikwame. The Hualapais also experience enduring connections to Sugarloaf Mountain. Upon arriving to Sugarloaf Mountain, one Hualapai elder began to speak in the cry voice about that which came before. In the presence of the mountain, she re-experienced the memories of her ancestors whose presence at Sugarloaf remains strong. She relayed how elders, adults, youths, and babies were forced to leave their ancestral lands and march to La Paz. Many were shot, thrown into pits full of slain humans, and even buried alive. Hualapai women and children were frequently killed alongside Hualapai men. Those who were not shot often died of European diseases and starvation. Today the Hualapai meet each year to conduct a three-day ceremony to mourn and honor the people who died on the march to La Paz [46]. The Southern Paiutes also experience intimate connections with Sugarloaf Mountain. According to several elders, Sugarloaf Mountain is on the Salt Song Pathway to the afterlife. Although first recorded at the turn of the century, the Salt Songs have their origins in times before Euro-American histories. The Southern Paiutes continue to sing the Salt Songs today. As a result, the sacred places that are mentioned in these songs remain central to Southern Paiute identity and culture. This is confirmed in ethnographic interviews. The elders explained that “Sugarloaf is a sacred place to Southern Paiutes. It is the only place of its kind that is used as a path to communicate with spiritual beings in the area” [46]. In addition, “The doctor rocks, crystals, and offering places in this area were placed here by the Creator for Southern Paiutes and others” [46].

Since time immemorial, Southern Paiutes, Hualapais, and Mohaves have practiced cultural observances at Sugarloaf Mountain. On the top of Sugarloaf, individuals and shamans used the ceremonial clearings for spiritual purposes, astronomical observances, teaching, and both political and social gatherings. The base of Sugarloaf Mountain has frequently been used in connection with healing activities utilizing doctor rocks, plants, and whiptail lizards [46]. Today Sugarloaf Mountain is integral to the maintenance and perpetuation of the cultural traditions of the Southern Paiute, Hualapai, and Mohave. This sacred place serves as a location where cultural traditions and knowledge can be conveyed from generation to generation. As there are many factors that endanger the cultural traditions of these groups, it is essential to protect and preserve Sugarloaf Mountain so that it may continue to play its critical role in the transmission of knowledge from elders to youths. Many elders agree that Sugarloaf Mountain is “a good place to teach children and let them understand better what it’s all about” [46]. Sugarloaf Mountain has always been a ceremonial destination place where individuals, medicine men/ religious specialists, and healers have gone to develop and practice their knowledge. Amongst the Southern Paiutes, Sugarloaf Mountain has served as an area where people have gone to educate and prepare themselves for sacred ceremonies occurring at Gypsum Cave. Sugarloaf Mountain has also served as a community learning center. “The old people used to meet here with the Hualapais, Chemehuevi Paiutes, Moapa Paiutes and others for spiritualpurposes,” [46]. In addition, Sugarloaf Mountain has traditionally served as “a place away from main villages, where people came to talk about common interests,” [46]. Today the Southern Paiute, Hualapai, and Mohave express a unified desire to maintain these practices and thus ensure their knowledge and traditions will be kept alive and rejuvenated amongst younger generations [46]. The following are discussions of specific key cultural components of Sugarloaf Mountain as a TCP which is located within a larger Landscape of Origin. Figure 20 is a representation of the Sugarloaf landscape with the three pilgrimage trails marked in brown.

FIG 20

Figure 20: Diagram of Sugarloaf Mountain Pilgrimage Trails and Associated Features

A Landmark

Sugarloaf Mountain has been used as a landmark as well as a ceremonial center for the exchange of knowledge over thousands of years. This knowledge comes from elder teachers as well as the mountain itself, which the Southern Paiute, Hualapai, and Mohaves have been taught to attune themselves towards, and thus accrue knowledge from multiple rather than singular educational sources. As much of this knowledge is learned directly from the mountain itself, this place is integral to cultural traditions [46].

A Ceremonial Area

The ceremonial activities constitute one of the central functions of Sugarloaf Mountain. These activities involved both individual shamans and groups of people who regularly convened on Sugarloaf Mountain to worship, develop knowledge, and express knowledge through healing practices. These activities included astronomical observations, rituals, vision quests, and the collective augmentation of knowledge [46].

Vision Questing Area

Sugarloaf Mountain also served as a location for vision quests that sometimes involved both individuals and whole families. These vision quests occurred at Sugarloaf Mountain because it was a known center of power. Today this same power is acknowledged and understood by the Southern Paiute, Hualapai, and Mohave elders. The recognition of this power explains their need to teach their children at this location [46].

A Healing Area

Sugarloaf Mountain has always played an integral role in the healing traditions of the Southern Paiute, Hualapai, and Mohave. In both prehistoric and historic times successful healing required an in-depth knowledge of the healing resources provided at Sugarloaf Mountain, as well as a respectful relationship with this source of power. The power of Sugarloaf Mountain helped them to prepare themselves for receiving the songs necessary for healing, as well as the knowledge to utilize the water, doctor rocks, lizard tails, plants, and regions of healing in a manner conducive to physical and spiritual restoration [46].

An Area for Ceremony and Intertribal Gatherings

Sugarloaf Mountain has been repeatedly noted as a place of power. Those who gathered at Sugarloaf Mountain did so under varying circumstances. Frequently, the gathering focused on spiritual and educational purposes, which speaks to the focus on events that contributed to cultural continuity. It is suggested in interviews that Native Americans gathered at Sugarloaf Mountain under political pretenses including the Ghost Dance. Therefore, the ceremonial clearings had multiple functions [46].

A Component of a Cultural Landscape

Sugarloaf Mountain expresses its power through all of the elements of nature, which are understood to manifest in concert rather than as discrete entities. Sugarloaf Mountain exists as a place of power within a larger plane of interconnections. Tribal representatives noted that it is related to other significant places including Gypsum Cave and Avikwame. Sugarloaf Mountain has functions and uses that are simultaneously unique yet integrally related to places beyond itself. The cultural features/elements found at Sugarloaf Mountain are part of a larger cultural entity, preserving the larger traditions of multiple ethnic groups. The mountain and its natural/cultural elements are a significant part of a cognized landscape important to tribes in the region. From the top of Sugarloaf Mountain, the people who frequented this place had a viewscape that connected the mountain and its people to the four directions and the sacred places noted in both songs and oral histories [46].

A TCP with Continued Cultural Centrality

The Southern Paiutes, Hualapais, and Mohaves are invested in protecting and continuing their relationships with Sugarloaf Mountain because it is a ceremonial place in a landscape of origin and a significant source of knowledge and power. The designated boundaries of the TCP are shown in Figure 21. This power does not express itself in a unilinear fashion, wherein only humans benefit. Instead, the Southern Paiutes, Haulapais and Mohaves strive to create relationships that are mutually respectful, knowledge-based, and balanced [46].

FIG 21

Figure 21: Sugarloaf Mountain TCP Boundaries (Stoffle et al. 2000)

The Southern Paiute, Hualapai, and Mohave elders repeatedly voiced the need to bring their youth to Sugarloaf Mountain. This desire stems from the power of the place, as well as the educational process that has always played a primary function at this sacred landscape.

Discussion

These six case studies are comparable examples of geoparks in Landscapes of Origin. The purposes and uses of these places were different from place to place, however, there are distinct similarities. Numerous Native American tribes connected to these geoplaces have used these ceremonial centers for thousands of years. The connections that these groups have to these landscapes are complex and layered, and shift throughout time. Sacred connections to these areas are culturally significant to many different Native American people.

Landscapes of Origin – Creation

Common themes exist between these ceremonial centers and Effigy Mounds. One example is the connections made through origin stories. Places like Zuni Salt Lake, Chaco, and Pipestone are associated with multiple origin stories from surrounding Native American tribes. At Zuni Salt Lake, Salt Woman, the creator being that resides in the lake, features in the origin stories of Zuni, Acoma, Hopi, and Laguna. Furthermore, she continues to serve an important role in their cultures by providing salt to the associated Pueblos. Similarly, affiliated Pueblo groups have creation stories that tell of clan migrations through Chaco. At Pipestone, Sioux accounts attribute the creation of Pipestone to White Buffalo Woman, while Cree accounts associate the place with a great flood and the coming together of many different ethnic groups. Similarly, culturally affiliated tribes at Effigy Mounds have origin stories that link clan migrations to specific mound groups within the monument.

Landscapes of Origin – Ceremony

There are parallels between ritual activities conducted at Effigy Mounds and previously discussed ceremonial centers. For example, Effigy Mounds, Chaco, and Medicine Mountain have features used in time keeping ceremonies. Activities that occur at these three ceremonial centers are linked to solar and lunar observations made by religious leaders of the community. Tracking time was used for a range of activities including agriculture, pilgrimage, and balancing ceremonies. Chaco, a pilgrimage destination place, housed religious leaders from across the region to conduct large scale ceremony involving solar and lunar observations at Fajada Butte. Religious leaders were positioned throughout the canyon to conduct simultaneous ceremonies, which were coordinated through signal fires. Medicine Mountain also had a time keeping component; the medicine wheel itself was a calendar used to track the passage of time. Other ceremonies at Medicine Mountain involved healing and vision questing. At Effigy Mounds, a linear mound at the Marching Bear Group lines up perfectly with the sun during the summer solstice, similar to the structures across Chaco or the spokes of the Bighorn Medicine Wheel. Locations along the bluffs of Effigy Mounds and surrounding areas, such as Pikes’ Peak, contained evidence of fire use, which was used potentially to coordinate a region-wide simultaneous ceremony.

Landscapes of Origin – Pilgrimage

Pilgrimage is the third common theme among the landscapes of origin discussed in this article. Pilgrimages to these sacred landscapes involved patterned movements along predetermined routes and trail networks. The movement of people along these routes were part of the ceremonies themselves. Religious specialists traveled great distances to engage with these landscapes. Along the trails, the specialists (also referred to as pilgrims) visited shrines, leaving offerings and saying prayers. These acts provided the pilgrims with knowledge they needed to continue with their journeys. The six (6) case studies have well defined and understood trail systems that lead to the ceremonial destination places from the various home communities of the connected ethnic groups. For example, at Sugarloaf, Southern Paiute religious specialists traveled along trails from the west, Mohave people traveled from the south, and Hualapai traveled from the east to reach the mountain. The trails to Sugarloaf share similar features and places of prayer; along these trails a similar pecked figure is found, which is also found on the top of Sugarloaf Mountain. At Medicine Mountain, pilgrimage trails lead to the mountain from all directions, however these trails all come together at the base of the eastern slope of the mountain. All religious specialists seeking to engage the Medicine Wheel for ceremony must approach it from an easterly direction in a manner that parallels how one enters a medicine lodge. Effigy Mounds is a known destination place for many different ethnic groups, which would have used unique land and water trails to approach this scared landscape. River navigation likely played a key component in pilgrimage. Religious specialists would have canoed down the Mississippi, Wisconsin, and Yellow Rivers to reach their destination.

Landscapes of Origin – Conflict Free Zones

An important component of landscapes of origin in Native North America is the multi-ethnic use/neutral component to these places. Places, such as Pipestone and the Zuni Salt Lake, are well documented as playing an important role in the ritual, ceremony, and pilgrimage of multiple affiliated tribes and pueblos who have a shared use of the place and its resources. Pipestone and Zuni Salt Lake’s origin narratives indicate that the neutrality of the place is a part of respecting the creator being that resides in the landscape. Multiple narratives account for the multi-ethnic use of Pipestone, many of which were documented by Catlin [26] during his visit to Coteau des Prairie, though the territory was controlled by the Sioux during his travels. Similarly, Nicollet wrote about Pipestone being a place of peace that was visited at different times of the year by different tribes [47]. Zuni Salt Lake has an identified Sanctuary, 182,000 acres approximately ten miles around the lake, which was added to the NRHP. The area includes pilgrimage trails and religious shrines that play important roles in the ritual use of Zuni Salt Lake. This area is traditionally void of any violence out of respect for the Salt Woman [32]. The bluffs of Effigy Mounds were central to the ceremony conducted by multiple visiting Native Americans, but likely they were a part of a greater landscape that extended along the Mississippi River and across the river in Prairie du Chien, which was a documented trading hub and ceremonial center for visiting tribes. In order not to disrupt ceremonies at the mounds or the economic and cultural ties between these groups, this area would similarly be declared neutral grounds rooted in the creation narratives of the landscape. The common themes that have been highlighted throughout this analysis show that multi-ethnic ceremonial centers exist in Native North America, exist because of special geological features, and have ritual and cultural-historical components to them. Effigy Mounds fits into the definition of a multi-ethnic ceremonial center, because Native Americans have long-term spiritual connections to the mounds and the mounds serve as physical links to Creation stories. While the uses of Effigy Mounds are tribal and place specific, the broader pattern of this ceremonial center is found elsewhere. Like the five Zuni Salt Lake, Medicine Wheel, Chaco, and Sugarloaf Mountain, Effigy Mounds continues to hold cultural meaning and spiritual importance to contemporary tribal peoples.

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Cultural Meaning of Playas to Native Americans

DOI: 10.31038/GEMS.2024634

Abstract

The heritage cultural contexts of playas are poorly understood by United States federal and state agencies because there has been a persistent theory that these topographic features are marginal to Native American life. Despite this perspective, Native American peoples in formal public ethnographic interviews persistently state that these playas are old living areas going back to a time (end of the Pleistocene) when the lakes were full and surrounded by lush vegetation. Slowly the lakes receded but Indian people continued to live along their shores. Given the tens of thousands of years that Indian people have lived along the edges of these lakes, it is unsurprising that they should remember those past times and return to the playas today, seeking connection with their ancestors and the places that sustained them and permitted the formation of an ancient heritage way of life. The analysis is based on field ethnographic interviews with Paiute, Shoshone, and Goshute people.

Keywords

Pleistocene, Native American culture, Playas as Heritage, Persistent culture, Great basin ethnography, Ethnogeology

Playas as Native American Heritage Places

People from western cultures have regularly viewed desert playas of the western United States as sterile and of little utility except for gathering salt or minerals. In line with this unimportant valuation of desert playas by western observers, many call the region “The Great American Wasteland” [1]. The region’s culturally affiliated Native Americans, however, tend to view these playas as heritage areas extending back in deep time to the Pleistocene when they were filled with lakes, surrounded by wetlands, and drained by permanent streams. According to the University of Utah’s Shoshoni Dictionary[2] (Shoshoni Language Project 2024), the Goshute people refer to themselves as the Newe[nɨwɨ] or Newenee [nɨwɨnɨɨ] meaning the Person or the People. There have been times throughout their history where they have been referred to as Kutsipiuti (Gutsipiuti) or Kuttuhsippeh which translates to “People of the dry earth” or “People of the Desert” (literally: “dust, dry ashes People”) [1,3]. Goshute means people covered with dust, dusty people, or desert, terms which were reiterated generations later in Halmo et al. [4]. In the same study, contemporary Goshute people who are fluent in their language use the term in reference to the white alkali dust that lines the lowest portions of most valleys [4,5]. Our analysis explains why the playa dust symbolizes heritage connections with the land and past lives. Native American heritage perspectives regarding playas are required in national searches for places to drop bombs, make landing strips for large military aircraft, build industrial scale solar arrays, and mine rare earth minerals, including lithium. Native American cultural impacts regarding proposed federal land use are required by law and regulation and must be clearly articulated during environmental impact assessments. The spatial focus of this analysis is the Great Basin of the western U.S. It is largely defined by internal draining, endorheic lakes and rivers. Because of its unique topography, the Great Basin has been characterized by its state of being largely filled with water during the much wetter Pleistocene, as well as its dry salt, mineral, and sand flats in the latter Holocene. Playa is the term normally used to discuss these salty, white sand, mineral deposits (Figure 1).

FIG 1

Figure 1: The Great Basin

The temporal frame for this heritage analysis of playas is operationally defined as the late Pleistocene, which occurred between 128,000 BP and 11,700 BP, and the Holocene, from 11,700 BP to modern times. Scientific studies have placed Native Americans in the region at least by 37,000 BP with the geoarchaeology dates of 23,000- 21,000 BP at White Sands, New Mexico [6,7] and 38,900 to 36,250 BP at the Hartley locality, a mammoth kill site situated near the Rio Puerco, New Mexico [8]. These new geoscience dates indicate that Indigenous Peoples experienced this area as both a massive wetland filled with lakes, rivers, and swamps and later as an arid desert with intermittent streams, sand dunes, small artesian springs, and heritage playas.

Pleistocene in the Great Basin

The Late Pleistocene ecology of the Great Basin and western Colorado Plateau regions was rich in fauna and flora. Central to this supportive habitat were wet forested uplands, full grasslands, and long wetlands located along a complex network of streams feeding into medium and large lakes [9]. American Indian people lived here, hunting, gathering, making trails, building communities, and engaging the topographically interesting landscape with ceremonial activities. Large mammals, like mammoth, roamed these habitats from the lowest wetlands up to 8,990 feet where the Huntington Mammoth remains were found – a subalpine environment in the late Pleistocene [9]. While contemporary scholars often focus their studies on charismatic species like mammoth, dozens of medium sized mammals were found as well including camels, horses, ground sloths, skunks, bears, sabretooth cats, American lions, flat-headed peccaries, muskoxen, mountain goats, pronghorn antelope, and American cheetahs. Many smaller mammals were also present. Like their mammal cousins, avian species were abundant and ranging in different sizes from the largest being the Incredible Teratorn with a wingspan of 17 feet and the Merriam’s Teratorn with a wingspan of 12 feet (both related to the condors and vultures) to the smallest hummingbirds [9]. Other birds included flamingos, storks, shelducks, condors, vultures, hawks, eagles, caracaras, lapwings, thick-knees, jays, cowbirds, and blackbirds. The biodiversity of the land and air was matched by the fish species and with large numbers in the streams and lakes. There were at least 20 species of fish including whitefish, cisco, trout, chum, dace, shiner, sucker, and sculpin [9]. The fish species traveled widely across the Great Basin through a variety of interconnected lakes and streams. The massive late Pleistocene Lake Bonneville was a central portion of this hydrological network supporting fish species, and by implications of great biodiversity in flora and fauna (Figure 2).

FIG 2

Figure 2: Pleistocene Lakes in the western Great Basin [9]

Grayson concluded his analysis with an ecological assessment of the late Pleistocene natural conditions in the Great Basin region. “The large number of species of vultures, condors, and teratorns in the Late Pleistocene Great Basin raises a number of interesting ecological questions…the fact that there were so many species of these birds here suggests that the mammal fauna of the time was not only rich in species, but also rich in number of individual animals” [9]. Paleo- Indian populations were also well supported by this bounty of nature.

This Native American analysis of heritage playas is based on tribally approved public ethnographic findings derived from two major U.S. federal level environmental impact studies, generally referred to as either an Environmental Impact Study (EIS) or an Environmental Impact Assessment (EIA). Both EIAs were considered nationally important and referenced a Legislative EIS or a Programmatic EIS. The first study involves the US. Air Force and a Congressional review of a proposal to expand the Nevada Test and Training Range (NTTR) managed by the Nellis Air Force Base (Figure 3). The study involved three proposals for withdrawing lands from other federal agencies and adding them to the NTTR. Congressional review was required because the proposals involve multiple federal agencies and only the Congress has the authority to make these decisions [10]. The final report was called a Legislative EIS (LEIS).

FIG 3

Figure 3: Legislative EIS Proposed Withdrawn Study Areas [11]

The second study involved a Solar Programmatic EIS of nine proposed large-scale energy developments centered on large playas [12]. The playas are located on lands managed by the U.S. Bureau of Land Management (BLM) (Figure 4). These study areas were identified by a scientific team who suggested that establishing the social zones on playas was most effective. These areas were already managed by the federal government and the playas were largely devoted to natural and cultural resources [13]. The involved American Indian tribal governments and their appointed cultural representatives participated in the Solar PEIS to explain the meaning and cultural centrality of the plants, animals, spiritual trails, healing places, and places of historic encounters that exist in these playa lands.

FIG 4

Figure 4: Solar Map [12]

Both studies were funded by the involved federal agencies (U.S. Air Force and Bureau of Land Management) and conducted by a research team from the School of Anthropology at the University of Arizona, Tucson, AZ. These two large scale environmental impact assessments involved extensive and ancient playas occupied since the late Pleistocene by Native Americans. Formal government-to- government consultation with the participation of culturally affiliated Native American tribes was a foundation for each study. Each tribe selected representatives for field interviews and reviewed and approved the resulting ethnographic findings and recommendations.

Methods

The study areas of the LEIS and Solar PEIS were defined by the management agencies, but the University of Arizona ethnographers were asked to send invitation letters for study participation to culturally affiliated tribes. Those tribes interested in participating in the study were subsequently invited to participate. Each participating tribe had experience with the UofA ethnographic study team, so the parameters of the study were both clear and understood. The UofA methods have been published elsewhere (Stoffie 2007; 2000). The study methods were developed with participating tribal elders and tribal cultural departments.The following table cross-references participating tribes and the studies involved in this analysis. The reviewed and tribally approved research findings are available at Solar PEIS [12,13] and LEIS Websites [11] (Table 1).

Table 1: Cross-Referenced Chart of Tribes to Ethongraphies

TAB 1

In all studies, participating tribes selected culturally knowledgeable elders to visit the study area. Elders were provided Per diem, lodging, and transportation during the fieldwork. The timing and location of the site visits were influenced by the physical condition of elders. As a rule, up to 3 hours were available at each study site and all elders were provided with a confidential interview. The report text was written by the UofA study team and then sent to elders for review, corrections, and approval. Once the elder study team approved their text, it was sent to their tribal government who checked the text to be assured it did not contain confidential cultural knowledge. In all cases, the findings were available in final public report [12].

Playas as Heritage Places

The following are research studies where ethnographic interviews have been conducted with the permission of culturally affiliated tribal governments regarding their connections to a playa. The cases have been selected because they are both comparative and contrastive, thus providing a variety of cultural perspectives on the meaning of playas. We assert that the resulting database provides a solid foundation for an ethnographic statement on Native people and heritage playas.

Desert Lake Playa

Desert Lake Playa was observed and discussed by tribal representatives during field visits as part of the LEIS (Figure 5). It was said by tribal representatives that Desert Lake is a portal through which power flows and connects to other locations, people, and living ancestors of this sacred land [14]. These larger connections of the lake include the Southern Paiutes to the south and east and Shoshones to the west and north.

FIG 5

Figure 5: Location of Desert Lake Playa in LEIS Area 3c Proposed Withdrawal from the Desert National Wildlife Refuge.

A central pilgrimage trail documented by LEIS tribal representatives passes through a topographic constriction called Eagle Head and then connects with Desert Lake Playa (Figures 6 and 7). From the playa, the trail goes to other sacred features to the north and south [14]. Nuvagantu or Mount Charleston to the south, in the Spring Mountains the primary origin mountain range for Southern Paiute peoples, and Coyote’s Jar, or Pahranagat Valley to the north, a second origin location for Pahranagat and Moapa Paiutes, indicate a significance of the area tied to the oral histories of Native American people [16]. Visiting representatives identified the playa as the destination place, while others described the trail as a connection to their origin spots.

FIG 6

Figure 6: Satellite Picture of the Desert Lake Playa South along the Pilgrimage Trail from Eagle Head Gap [15].

FIG 7

Figure 7: Places along a pilgrimage trail that both goes to and passes through Desert Lake Playa.

A proposal to improve the Alamo Road, which crosses a portion of the Desert Lake Playa, created an EIA project study area of 322 acres of archaeology inventory and three backhoe trench excavations [17]. Seven archaeological sites were recorded, two of which were recommended as eligible for the National Register of Historic Places. This archaeology study documents that the area was occupied from the Middle Archaic to the Late Ceramic periods. Further carbon dating suggests occupation dates of 6970 BP and 2000 BP. The study is important to this analysis because it documents temporally old Native presence in the wetlands that formed around Desert Lake. Ethnographic interviews concluded that Desert Lake Playa is a Culturally Sensitive Area and a Scared Site and should be nominated to the National Register of Historic Places [14] as a Traditional Cultural Property (TCP) under Criterion D: history of yielding, or potential to yield, information important in prehistory or history. The ethnographic study concluded that for a very long time, the Desert Lake Playa developed a lush environment with a plentiful water source for the fauna and flora. As the playa gradually dried, Native American people continued to visit the playa feature, leaving offerings that remain today as archaeological investigations have determined. The connection between the Desert Lake Playa and a traditional pilgrimage trail to the north and south is a critical component of this history of Native American use, as are oral histories about spiritual beings that reside in playas even after the water has gone. Not only does the playa yield information about its cultural uses, but it also holds evidence of climate fluctuations that otherwise impacted the aboriginal communities throughout the broader landscape. The playa is considered a functional and thus still active portal to other dimensions.

Big Smoky Valley

A single study is useful because it produces ethnographic findings of a people, their culture, and their environment (for more on ethnography see- Agar [18]; Mead [19]). Multiple single comparative case studies become the basis for ethnological findings (for more on ethnology see- Benedict [20]; Lowie [21]). Shoshone tribal representatives were asked to evaluate the cultural importance of resources and places in the southern end of Big Smoky Valley, Nevada [22]. Big Smoky Valley is a north-trending basin within the Basin and Range physiographic province in south-central Nevada. The valley is roughly 567,700 acres and stretches 115 miles approximately 44 miles east of the California/Nevada border, 15 miles northwest of Tonopah, Nevada. The area has been perceived as aboriginal Shoshone lands since the Pleistocene.The environmental assessment of Big Smoky Valley was one of nine study areas considered for the large-scale solar farm to be placed on playa lakes formed during the late Pleistocene [12]. Each proposal focused on a large playa. Tribal consultations and findings were reviewed and approved by tribal government. During fieldwork, tribal representatives expressed deep knowledge of the now largely dry playas, which represented a time when large lakes and wetlands filled the valleys and were the central homes of Native American peoples. Cultural continuity back to the Pleistocene was expressed in each PEIS study.

Lake Tonopah

Central in the interpretation of Big Smoky Valley is a massive late Pleistocene Lake, wetland, river, and stream hydrological system dominated by what is called today ancient Lake Tonopah. This hydrological system supported both complex biodiversity and biocomplexity for tens of thousands of years—possibly since the Pleistocene as did a similar hydrological system centered on Fish Lake Valley and Columbus Marshes to the west [23] (Figure 8). According to their oral history, Indian people forever lived in this productive environment, and it became and continues to be centrally cultural in their lives.

FIG 8

Figure 8: The Big Smoky Valley Landscape and Pleistocene Lake Toiyabe

The watershed of ancient Lake Tonopah extends generally downhill from the north to the south along what is known today as Big Smoky Valley (Figure 8). This enclosed hydrological system is about 62 miles north to south and 21 miles east to west. Prominent mountains and ranges surround the major river, wetlands, and lakes in this watershed. Viewing this watershed anti-clockwise we find Lone Mountain in the southeast. San Antonio Mountains are in the East. Mount Jefferson and Wildcat Peak are high points in the Taquima Mountain Range, which defines the eastern edge of Big Smoky Valley. Round Mountain and Arc Dome are the southern and most visible portions of the Toiyabe Range, which is a portion of the Shoshone Mountains. Ironically the northern portion of Round Mountain is the headwater of the major north-flowing Reese River. The southeast side of Round Mountain contains Peavine Canyon, out of which flows the Peavine River. Royston Hills and Big Smoky Mountains define the watershed in the west as does the Monte Cristo Range in the southwest. Water flows off the slopes of all these mountains and hills, but Peavine River is the prominent hydrological feature today, as it flows down slope along the entire Big Smoky Valley to the current site of ancient Lake Tonopah. This hydrological system was a cultural and natural center in the lives of many Shoshone people for thousands of years.

While many individual resources and historic events were identified as significant in the Big Smoky Valley, this land was especially identified as the Origin place for the Shoshone people [22]. In ethnographic interviews, the Shoshone tribal representatives stipulated that because they have lived in these lands since the end of the Pleistocene and throughout the Holocene (or approximately 37,000 BP), they understand the dramatic shifts in climate and ecology that have occurred over these millennia.

Crescent Dune

Native American lifeways were dramatically influenced by natural shifts, but certain religious and ceremonial practices persisted unchanged. These traditional ecological understandings are carried from generation to generation through the recounting of origin stories occurring in mythic times and by strict cultural and natural resource conservation rules. At the time of the late Pleistocene, Big Smoky Valley was a wetland dominated by lakes, streams, and marshes. One Shoshone elder remembered that wetter, late Pleistocene landscape:

Just up the valley, from talking with elders and stuff, that’s where the Shoshone people started. That’s their Creation point. From there, they dispersed out into the north, south, east, and west. That’s where all the Shoshone came from, Smoky Valley, Monitor Valley. But then again, if we look at the stories, the people and the earth, they talk about a migration over water. We see that when the water skipper brought the coyote back with his little basket full of children that he made, they’re coming over water. Maybe these archaeologists have it wrong when they say that the people walked on the land. In out stories, they talk about coming over on a boat. I guess it would be a boat, if you look at the analogies. Again, we’re going back to the time when the animals talked, they conversed with each other, interacted with each other, and had ability to have children with each other. This is basically the Creation story, what I’m sharing with you. I listen to the Southern Paiute story and they talk about the Ocean Woman. You know, if you look at them, theirs is similar to ours, tied with the water. They’re the same as us. They didn’t come over walking, marching on the land like people think. They came over on the water. So we came over here in the time where this was all under water [22].

Although the climate has shifted, steams, seasonal playas and springs still dot the landscape and Shoshone use of the landscaped adapted to the drier conditions of the post-Pleistocene period. Streams originate in the mountains and at the base of the surrounding mountains and foothills, while springs provide water and luscious landscapes. Water occupies an important cultural role in the lives of Shoshone people. Natural water sources, called gwizho’naipe or life- producing water [24], play a large function in crucial rituals as well as day to day life. According to one elder:

Smoky Valley stands out. The whole valley is connected. The sand dunes and White Mountains stand out. I’m from the mountains so the mountains stand out. I was raised in the mountains so I’m a mountain person. 10,000 years ago, there was a big old lake right here where we’re sitting on [22].

In addition to the now seasonal and perennial lakes and streams, traditional Native American use of spiritual places persist. These include, for example, Crescent Dune, which is located in and around the playa with its own ecology today of pure sand and special plants. In Figure 9, Crescent Dune is viewed along with a large deposit of sand and Indian Ricegrass (Oryzopsis hymenoides), which is an ancient Native American food seen growing around Crescent Dune.

FIG 9

Figure 9: Crescent Dune in Big Smoky Valley

The dune rises above the valley bottom providing both a place of solitude and elevated viewscapes. Native traditional knowledge of sand dunes is extensive, and it is discussed in many of our ethnographic studies including the PEIS interviews of Big Dune on the Pleistocene Amargosa River in Nevada [25]. Dunes associated with Pleistocene lakes are understood as being a topographic feature placed at Creation for spiritual renewal and healing. According to a tribal representative, the Dunes Sing to Native people and convey information needed for ceremony. These dunes have eyes to watch over the land and a voice to share its messages in the songs that it sings and the stories it continues to tell our people ever since the beginning of time [25].

Escalante Desert

The Escalante Desert (Figure 10) is the southern portion of the extensive Pleistocene Lake Bonneville that continuously extended from Idaho to southern Utah [26]. The remains of Lake Bonneville are massive salt flats and the Great Salt Lake of northern Utah. Lake Bonneville filled its component lakes with sand, minerals, and salt which became the bottom of remnant playas like those in the Escalante Desert (Figure 11).

FIG 10

Figure 10: Escalante Desert with Wasatch Mountains to the east

FIG 11

Figure 11: Pleistocene Lake Bonneville with Southern End Filling What is Now Escalante Desert, Iron County Utah [22].

The Escalante Desert American Indian study area was traditionally occupied, used, aboriginally owned, and historically related to the Numic-speaking peoples of the Great Basin and western Colorado Plateau. This American Indian study area extends beyond the boundaries of the study area because of cultural resources in the surrounding landscape. The Paiute Indian Tribe of Utah (PITU) and the Confederated Tribes of the Goshute Reservation (CTGR) participated in the Solar PEIS field consultations to represent the cultural interests of Numic peoples. These Numic-speaking peoples have gone on record in past projects and stipulate again here that they are the American Indian people responsible today for the cultural resources (natural and manmade) in this study area. Their ancestors were placed here by the Creator, and they have subsequently lived in these lands while maintaining and protecting these places, plants, animals, water sources, and the cultural signs of their occupation. These Numic-speaking peoples further stipulate that because they have lived in these lands since the end of the Pleistocene and throughout the Holocene, they deeply understand the dramatic shifts in climate and ecology that have occurred over these millennia. Indian lifeways were dramatically influenced by these natural shifts, but certain religious and ceremonial practices continued unchanged. These traditional ecological understandings are carried from generation to generation through the recounting of origin stories occurring in Mythic Times and by strict cultural and natural resource conservation rules. PITU and CTGR have participated in this PEIS in order to explain the meaning and cultural centrality of the plants, animals, spiritual trails, healing places, and places of historic encounters that exist in these lands.

Escalante Desert (Figure 12) is named after the 1776 Spanish Fathers Escalante and Dominguez Expedition who became the first European to document the valley and the Native people living there (Figure 13). The expedition had followed well-traveled Native trails in an attempt to reach the Pacific Coast of North America. They failed, however, in this goal and turned back at the prominent hot spring in the valley. They returned via an alternative set of trails and would document the massive 1780 smallpox pandemic at Hopi on their journey to the northern New Spanish capital of Santa Fe. Because it was a government sponsored and formally approved expedition a gifted map maker was a part of the hundreds of participants.

FIG 12

Figure 12: The Escalante Desert, Utah is Generally Bounded by Enterprise in the South, Cedar City in the East, Lund in the North, and Modena in the West (Google Earth).

FIG 13

Figure 13: Escalante and Dominguez Expedition Map [22]

The Solar PEIS consulting tribes desired to be formally contacted on a government-to-government basis whenever projects or proposed land management actions occur on and/or near the following culturally special topographic places and features such as viewscapes, mesas from volcanic eruption, animals, and cultural plants for medicine and ceremony (Table 2). Points of contact with Euro Americans are remembered for their devastation due to diseases, armed conflicts, the arrival of grazing animals which ate Indian gardens and horticultural plants, and eventually settlement and physical removal from water and land.

Table 2: Table of Type and Names of Culturally Significant Topographic Features and Places

TAB 2

A few of these cultural places and features are indicated in this map (Figure 14) that identifies their spatial relationships with each other. Their temporal relationships are hundreds of thousands of years apart. Some of these are briefly discussed in this analysis to illustrate the heritage complexity of Escalante Desert.

FIG 14

Figure 14: Map of Special Cultural Features Considered in This Analysis [22]

Eagle Rock Ceremonial Complex

Eagle Rock is a translation of a Paiute name for an ancient healing rock. It is visually connected to the Escalante Deseret, which can be seen to the east from a landscape photo (Figure 15). The healing rock is spiritually connected though the Puha energy of the prominent mountain peak nearby, which is used for vision questing and restoring medicine songs. Next to Eagle Rock is Mountain Spring, which is used for bathing and water related plants. Nearby is Sulphur Spring, which is for purification before and after ceremony and healing.

FIG 15

Figure 15: Eagle Rock looking east to the Wasatch Mountains

According to an elder, Indian people came to this location from great distances to conduct important ceremonies. Eagle Rock, a famous doctor rock (Figure 16), was identified by tribal representatives as a key cultural feature in the Escalante Valley. Tribal representatives linked Eagle Rock to places such as Sulphur Springs, Mountain Spring Peak, and Mountain Spring and they thought these areas formed a large ceremonial complex. Tribal representatives described this as a traditional area used by Southern Paiute Puha’gants (shamans) and most likely Goshute shaman to tend to people who were ill and in need of rebalancing and healing. The Puha’gants would conduct complex healing ceremonies that could only be performed in a place of Puha, such as a doctor rock.

FIG 16

Figure 16: Eagle Rock Looking West with Mountain Spring in Background

According to an elder, rain and snow run-off from the mountains to the northwest also flow into the Escalante Valley. It is important from a Numic perspective to understand the hydrological system in this region. The flow of Puha follows the flow of water across a given landscape and connects places, people, and other elements. As water drains from the mountains in and around Eagle Rock and Mountain Spring Peak (each a place with high concentrations of Puha), the water and the Puha flow into the valley, connecting them with places like Table Butte, located to the southeast of the valley [22].

Thermo Hot Spring

These springs have been the center of activities in the immediate area since time immemorial. The hot springs are unique because they are located in the center of a valley instead of lying in a more typical location along the fault at the base of an uplifted mountain range. Thus, the Thermo Hot Springs (Figures 17 and 18) have a commanding view of the surrounding region—a 360-degree viewscape that is even further facilitated by the fact that the springs are perched above the surrounding ground by an estimated fifty feet. The views from this location include the Cricket Mountains to the north, the Mineral Mountains to the east, the Black Mountains to the south, and the San Francisco Mountains to the west. To the north is Sevier Lake and to the south is the southern expanse of the Escalante Valley. For millennia, Indian people have traveled to these special hot springs to engage in a variety of ceremonial activities. These activities include the curing of individuals using both the sulfuric muds and the mineralized hot waters. Other Indian people came to the hot spring to purify themselves before going to distant destinations where special activities such as vision quests or ceremonial balancing activities would occur. The hot springs were also visited by Puha‘gants (shamans) to acquire songs and Puha (power) needed to help their communities.

FIG 17

Figure 17: Grasses atop Thermo Hot Springs

FIG 18

Figure 18: Water from Hot Spring Mound

Water from the hot springs is used in healing ceremonies both at the springs and at other locations. Patients would come to hot springs at the instruction of or accompanied by a Puha’gant. Before entering a hot spring, Indian people would speak to the spirit of the spring, introducing themselves, and tell the spirit what type of healing was needed. Indian people have traditionally carried water from hot springs back to individuals who were unable to leave home due to age or illness [27]. Healing places occur at the locations where doctors take patients to conduct healing ceremonies or that doctors go to in order to gain insight into how to heal. Hot springs are recognized as strong sources of healing-Puha that derives from their form and characteristics, such as thermal heat or the location of the hot spring. A Puha’gant is required to facilitate the healing. Powerful minerals like paint and obsidian are used in the ceremony to assist in the healing. Hot springs are places of mixed power. Hot springs, like all water, were created for expressed and varying purposes. They can be embedded in powerful rivers, like the Pumpkin Springs in the lower Grand Canyon, canyons, like those in the Gold Strike Canyon [28], and small rivers, like those along the Virgin River near Hurricane, Utah [27]. Numic elders have stated that hot springs were also used by shamans for ritual purification prior to visiting sacred caves, valleys, or other spiritual locations, such as Parowan Gap. Such purification was necessary in order to prepare the mind and body for a safe and proper interaction with spiritual beings.

Parowan Gap

Parowan Gap (Figure 19) is a portal to the valley and the ceremonial places it contains. Before entering, prayers were made, and permission was requested. These ceremonies occurred because the valley is itself a living being with rights. This valley was a home to people. Like here and there, something attracted people to certain places where they could find medicine or food or things like that. That‘s what all these mountains and flats produced for those people. The times have changed things. Even if it‘s invisible, it changed. And the people start to change their ways without realizing or some of the times, they were forced to change. And the dances, like I said, ask for blessings for more wildlife and plants. They still have those dances [to keep the world in order]. Yeah they had round dances and certain times, like early in the morning, they’d have a sunrise ceremony. That’s when they thank the Mother Earth when the sun is coming up. They’d get a bucket of water and drink a little while they’re praying. They do that with an eagle feather usually. So a lot of Indian people are still very serious about doing those ceremonies, preserving our relationship with the earth [22].

FIG 19

Figure 19: Parowan Gap

Parowan Gap is one of the ceremonial places identified in the valley by Southern Paiute tribal representatives. People on pilgrimage (Puhahivats) would travel through Parowan Gap as part of the ceremonial process to and from areas out in the Escalante Valley. The gap between the volcanic ridge is a place where Puha collects, and it serves as a physical and spiritual transition zone between the Southern Paiute communities and the sacred areas out in the valley. The Parowan Gap trail follows the natural waterways and passes through the narrow and constricted opening in the Red Hills. Narrow spaces such as this contribute to the overall cultural meaning of physical and spiritual trails, especially to the Puhahivats moving along them to reach a pilgrimage destination place [29-31]. It is in these constrictions that Puha concentrates as a result of geological barriers.

A PITU Tribal Representative Explains How Parowan Gap Functioned for Puhahivats

Yeah, this is a gathering place, coming through, this is a main travel route. As a destination they used to stop here; this is where they used to have the houses, right through here and on top. They used to have different places where the medicine men would pray. It‘s a long climb up there. When I was here when I was growing up, I heard that some old fellas a long time ago found some gold up there inside one of the hills up there. Apparently, way in there someplace. They found the gold up there and they took it out and took it home, then came back to get some more and couldn‘t find it. It disappeared. Someone had put the gold there [as an offering]. Yeah, in a little sack or something [22]. Parowan Gap is associated with a Southern Paiute Creation story that explains the existence of a gap in the middle of the volcanic ridge and the presence of thousands of rock peckings and rock paintings (tumpituxwinap) (Figure 20). Places with tumpituxwinap are areas used by religious specialists during ceremonial activities, because these rock peckings and paintings are believed to be derived from supernatural authorship. According to the Southern Paiute Creation Story, the rocks were once people, and they became rocks for the benefit of humanity. The images on the rocks are related to this transformation and are part of the living universe. Southern Paiute people hold strong beliefs that the rocks are alive, have Puha, and spiritual value.

FIG 20

Figure 20: Rock Peckings in Parowan Gap

The peckings are used by religious specialists during ceremonial activities because these rock peckings and paintings are believed to be derived from supernatural authorship. According to the Southern Paiute Creation Story, the rocks were once people, and they became rocks for the benefit of humanity. The images on the rocks are related to this transformation and are part of the living universe. Southern Paiute people hold strong beliefs that the rocks are alive and have Puha and spiritual value.

Discussion

The previous ten ethnographic studies document that playas are culturally central heritage places for participating Native American tribes. The studies also document the cultural connections between the playas, their host valley, and the surrounding mountains that have provided water to the valley bottoms since the Pleistocene. Combining the playas, the valleys where they are located, and the surrounding mountain provide a heritage assessment framework for a holistic understanding of why and how Native Americans are culturally attached to this complex landscape. These study observations are consistent despite cultural and linguistic differences between the eighteen participating tribes.

These ethnographic studies specifically document that a holistic heritage assessment centered on a large playa will typically involve the following:

  1. A persistent Pleistocene Lake that is the center of this heritage landscape and the source of the salts and minerals that compose the playa.
  2. A residual wetland surrounding the Pleistocene Lake regardless of whether it is shrinking or expanding due to climate shifts.
  3. An overflow river that connects places along the playa valley which connects it with other similar valleys during wetter periods but continues to serve as a traditional path for both the normal movement of people and subsequent ceremonial movement. It does this because puha tends to flow along extant and ancient waterways.
  4. A large singing sand dune that often existed before the end of the Pleistocene because it was derived from and even older intervals of climate change and glacial shifts.
  5. An origin place or mythic time portal located at a self-voiced perturbance such as a volcanic outcrop or hot spring which was defined in the valley or along its edges at Creation for the use of Native peoples.
  6. An abundance of animals and plants that have occurred and are missing today like Mammoths and Saber Tooth Tigers but are remember and continue to be a spiritual presence.
  7. An abundance of animals and plants that have become increasingly spiritual such as the horned toad as the valley becomes dryer.

A tribal representative from Pahrump and Timbisha, during the Amargosa River PEIS study [25,32] provided an understanding of the cultural meanings associated with playas and their surrounding heritage landscapes. These are paraphrased below:

Geologic resources include a range of culturally significant features such as minerals used as paint sources, salts used in curing, quartz deposits used to make tools, volcanic basalt boulders used to hold the prayers of travelers, mountain tops used for vision questing, and fossil evidence of rivers used as devices for teaching about the past. All these geologic resources are alive according to the shared epistemology of our Numic-speaking peoples. The Creator made geologic resources alive by placing Puha in them when the Earth was formed. Today the geologic resources discussed here in Amargosa River Valley all have a place in the lives and history of Indian people.

Federal agencies are beginning to recognize the presence of Native people in these Pleistocene ecosystems. This is appropriate because the scientific dating of Native people in these areas extends now to about 40,000 BP thus placing people and megafauna and massive wet ecosystems together. White Sands National Monument is such a federal response, and it has illustrated this shift in perspective with paintings of Native people and the animals and ecosystems of the heritage past (Figure 21).

FIG 21

Figure 21: Human & Animals Trackway, Printed with permission of Karen Carr 2024 [32]

Native Americans involved in our ethnographic studies have asserted that the image above accurately represents their oral history of these ancient times. Of importance are the heritage implications of ancient places, animals, plants, springs, and now dry lakes and rivers being celebrated by land managers museums, geoarchaeologists, and of course, the ability of new generations of Native people to be connected with their lives in Time Immemorial.

References

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Safety Practice and Associated Factors among Waste Handlers at Selected Government Hospitals in Somali Region, Eastern Ethiopia: A Hospital Based Cross- Sectional Study

DOI: 10.31038/PSYJ.2024634

Abstract

Background: Healthcare waste is produced from various therapeutic procedures in hospitals, such as chemotherapy, dialysis, surgery, delivery, resection of gangrenous organs, autopsy, biopsy, and injections, and most of the wastes are toxic, harmful, carcinogenic, and infectious materials. Medical Waste handlers faced massive exposure to hazardous waste and occupational accidents as a result of manual handling of waste and working under unfavorable conditions. There are limited studies and updated information concerning these issues in the country.

Objective: To assess safety practice and associated factors among waste handlers at public hospitals in Somali Region, Ethiopia.

Method: An institutional-based cross-sectional study was carried out among 417 waste handlers in selected public hospitals from June 15 to July 15, 2021. Data were collected from respondents by using a simple random sampling technique. The collected data were entered into Epi-data 3.1 software and exported to SPSS 20 for analysis. Bi-variable analysis was done, and variables with p-values below 0.25 were identified as candidates for multi-variable analysis. Then multi-variable analysis was done, and an adjusted odd ration was computed and interpreted. A p-value less than 0.05 is the cut-off point for determining the significance of the association.

Result: The proportion of current safe practice among public hospital waste handlers was found to be 38.2% (95% CI: 33.2, 43.1). Good availability of safety materials (AOR=9.3; 95% CI: 5, 17.2), Good knowledge (AOR=7.2; 95% CI: 3.7, 14), a positive attitude (AOR: 5.4; 95% CI: 2.53, 11.47), and age group were significantly associated with safety practice.

Conclusion: The proportion of safe practices among hospital waste handlers was found to be low compared to national and international standards. Good knowledge, a positive attitude, a good supply of safety materials, and an age group are the determinants of safety practice. To provide good safety practice, adequate professional support and supervision should be in place to increase their knowledge about safety precautions, and similarly, providing enough safety materials is recommended to strengthen adherence to safety practice among hospital waste handlers.

Keywords

Safety Practice, Determinant Factors, Waste Handlers, Government hospitals, Somali Region, Ethiopia

Introduction

Workers and waste pickers handling solid waste throughout the world are exposed to occupational health and accident risks related to the content of the materials they are handling, emissions from those materials, and the equipment being used [1]. About 85% of wastes produced in health facilities are non-hazardous, and the remaining 15% of health care waste is characterized as hazardous and can pose a number of health risks [2,3]. Waste handlers are often at higher risk than health care professionals. Because healthcare professionals produce the waste and throw it in the garbage. However, waste handlers handle it extensively throughout, and mostly very little attention is given to their safety [4]. Medical waste handlers are working in a very poor and unsafe working environment, and mostly they are victims of occupational health hazards from poor safety practices [5]. The prevalence of needle stick injuries, sharp injuries, and blood and body fluid splashes among hospital waste handlers is higher because of the lack of personal protective equipment while on duty and inappropriate waste segregation practices [6]. The occupational safety of health care waste handlers cannot be overlooked because health care waste handlers are at constant risk of exposure to blood-borne pathogens .In Ethiopia, we have a set of Standard Precautions for health safety practices that have been demonstrated to be effective in reducing the occurrence of adverse healthcare events. Additionally, the set can help medical waste handlers and healthcare providers assess the degree to which safe practices have already been implemented in their settings and the degree to which the practices provide tangible evidence of the medical waste handler’s safety improvement and increased patient satisfaction and loyalty [7].

Worldwide, information on the spread of infections resulting from waste handling is limited. Studies from developed countries have shown that occupational exposure to waste may result from exposure to various work hazards [8]. There are studies showing different health complaints, such as respiratory problems [9,10], increased risk of hepatitis A and B [11,12] and skin diseases [13], for people working in waste handling. In addition, self-reported risks, including musculoskeletal, fatigue, gastrointestinal, and hearing complaints, were also identified [14]. Professional-related risk assessment reports showed that waste collectors had the third highest needle stick injury rate (18.4 per 1000 per year) and the second highest other sharps injury rate (7.1 per 1000 per year) compared with healthcare workers [15]. One study showed that each year, waste collectors reported 50–100 puncture wounds as a result of collecting medical waste from private medical practitioners and from the disposal of needles by drug addicts [16].Health care waste should be collected and transported in a safe way to avoid unnecessary exposure [17,18]. But about 58.8% and 41.2% of waste handlers were exposed to blood and body fluids due to carrying overfilled waste bags, which increase the risk of infection for different pathogens like HBV, HCV, and HIV/AIDS, and about 47% of medical waste handlers, had at least one accidental Sharp injury because of improperly discarded needles and sharp materials [19,20].Unavailability or shortage of personal protective devices aggravates the risk of acquiring infection while exposed to hazardous wastes (5). Waste handlers usually do not wear sufficient protective clothing during waste handling, which increases the potential risk of accidents .Inappropriate collection, storage, processing, transport, and handling of the health care waste exposes the staff of the facility, patients, and their attendants to the risk of serious health hazards. Many healthcare facilities in developing countries dispose of their waste in dustbins along with general waste; some even re-use sharps and syringes, thereby increasing the risk of transmission of infections [21].

Even though the impact of healthcare waste on healthcare workers is well described globally [22], less attention is given to waste collectors, and countrywide official statistical data do not address the health and working conditions of waste handlers [23].The study done in Eastern Ethiopia also showed that 30% of waste handlers were exposed to any sharp materials due to improper handling, poor waste segregation, and poor utilization of personal protective equipment (5). Waste handlers in Hawassa city in south Ethiopia have reported that they have experienced needle-stick injuries at least once in their lives at the different healthcare facilities, ranging from 25–100% [24,25].Studies in developing countries, including Ethiopia, indicate that there are limitations on safe waste handling practices among health care waste handlers due to different factors. However, there are few studies conducted regarding the prevalence of safety practices among hospital waste handlers in Ethiopia, and less attention is given to the prevalence of safety practices and factors exposing waste handlers to possible injuries and accidents. Hence, the intended study will determine the prevalence of safety practice and its associated factors among hospital medical waste handlers, which in turn will enable us to understand the overall situation of safety practice and minimize those factors that hinder the safety practice of hospital waste handlers.

Methods and Materials

Study Area and Period

The study was conducted in the Somali region, which is the second-largest and easternmost of the ten regions. The regional state borders the Ethiopian states of Afar and Oromia and the chartered city of Dire Dawa to the west, as well as Djibouti and Somalia to the south and north-east. Based on the 2007 census conducted by the central statistical agency of Ethiopia, the Somali region has a total population of 7,445, 2219, consisting of 3,472,490 men and 3,972,729 women. Urban inhabitants’ number 1,489,044 or 20% of the population and a further 5,956,175 or 80% were pastoralists and farmers. This region has an estimated density of 20.9 people per square kilometer in an area of 279,252 square kilometers. The region is divided into six councils and 93 districts for administrative purposes. The Somali Regional Health Bureau is responsible for the overall Health activity in the region.

There are Ten Primary Hospitals, Two General hospitals, and One Referral Hospital in the Somali region, namely, Dagahbour Primary Hospital, Qabri Dahare Primary Hospital, Warder Primary Hospital, Filtu Primary Hospital, Dollo Ado Primary Hospital, Raso Primary Hospital, Hargelle, Sitti/Biki Primary Hospital, Gashamo Primary Hospital, Fik Primary Hospital, Karamara General Hospital, Godey General Hospital, and Jig-jiga University. Sheik Hassen Yabare Referral Hospital, respectively, and the major common services given by those general hospitals and referral hospitals are maternal and child health services, prevention and control of major communicable diseases, non-communicable disease prevention and control, emergency services, laboratory services, and operational services. Generally, in the Somali region, there were approximately 710 medical waste handlers working in government hospitals. In selected hospitals, there were around 458 medical waste handlers. The study was conducted from June 15 to July 15, 2021, at public hospitals in the Somali Region and Eastern Ethiopia.

Study Design

Hospital based cross-sectional study was employed.

Source Population

Source populations were waste handlers working in Somali region public hospitals.

Study Population

All selected waste handlers working in the selected public hospitals during study period.

Inclusion Criteria

All waste handlers were enrolled in the selected government hospitals, present on duty during data collection period.

Exclusion Criteria

Waste handlers who were absent during the time of data collection and those with hearing impairments.

Sample Size Determination

Sample Size Calculation for the 1st Objective

The sample size for the first objective had been determined using the single population proportion formula by considering the prevalence of safe practice as 44.1% [26,27] from a previously conducted study on safety practice among waste handlers in Adisababa city administration public hospitals in central Ethiopia. Hence, assuming a 5% marginal error (d), a 95% confidence level (alpha=0.05), and the sample size for the first objective, it can be calculated as follows:

FOR

n=required sample size

Z=the standard normal deviation at 95%confidence interval=1.96

P=expected proportion (44.1%)

d=margin of error that can be tolerated 5% (0.05)

1-p=proportion of population that do not possess the character of interest.

Therefore n=(1.96) ^2 .0.441(1-0.559)=379

(0.05) ^2

=379 and by adding 10% non-response rate 417 was the sample size for the 1st objective.

Sample Size Calculation for the 2nd Objective

Sample size for specific objective 2 was calculated using the statcalc for sample size and power for cohort or cross-sectional studies of Epi Info version 7, considering the following assumptions (Table 1):

Therefore, from the calculated sample sizes for both objectives, the maximum sample size from the first objective, 417, was taken as the study sample since it covers the two objectives.

Table 1: Sample size determination for second specific objective using some important factors of safety practice

Factor

Cl Power (1-β) Ratio Proportion of outcome among exposed Proportion of outcome among un-exposed OR

Sample size(n)

Good Knowledge (27)

95%

80% 1 (Good) 53.3% (Poor) 24%  

3.57

 

100

Received Training (28)

95%

80% 1 (Trained) 73% (Not trained)53% 2.39

202

(Yes) Availability of colour coded bin (29)

95%

80% 1 (Yes)74.2% (No)31.1% 6.3

50

Sampling Technique

There are Ten Primary Hospitals, Two General hospitals, and One Referral Hospital in the Somali region; Three Primary Hospitals and One General Hospital were selected by lottery. Whereas the referral hospital was selected purposefully. Then the calculated sample size was proportionally allocated to each selected hospital based on the number of total medical waste handlers they had. To determine the total number of participants from each selected health facility, a computer-generated simple random sampling technique was used.

Sampling Procedure

Sampling procedure is shown in Figure 1.

fig 1

Figure 1: Schematic presentation of sampling procedure of waste handlers at selected government hospitals in Somali Region, Ethiopia 2021.

Data Collection Tool and Procedure

The data was collected by the interviewer through a structured questionnaire. A structured questionnaire was developed by the principal investigator after reviewing WHO, FMOH infection prevention guidelines, and different literature with modifications based on research objectives. Prior to the actual data collection, the questionnaire was adjusted and corrected based on the pre-test result, and the final questionnaire was translated into Somali and then back to English to ensure its consistency. Finally, one environmental health scientist and two public health professionals conducted face-to-face interviews to collect the data using the Somali version questionnaire.

Variables

Dependent Variable

Safety practice (Safe/Unsafe)

Independent Variables

Socio-Demographic and Economic Factor

  • sex
  • Age
  • Marital status
  • Educational Status
  • monthly income

Work Related Factors

  • working hours per day,
  • working departments/units,
  • Work experience

Waste handlers risk perceptions

  • Attitudes
  • Knowledge about safety practice

Organizational factors

  • Training,
  • Supportive supervision,
  • Availability of equipment’

Data Quality Control

To maintain the quality of the data, adequate training was given to data collectors and supervisors for three days on the techniques of data collection. The questionnaire was pre-tested by taking 5% of the study sample at one of the selected hospitals. The collected data was checked for completeness and consistency. Each questionnaire was coded and cleaned. Then the coded and cleaned data was entered into Epi-data version 3.1 software.

Operational Definition

Safety practice is the practice of using personal protective equipment’s such as (heavy duty glove, gown, boots and masks), hygiene, vaccination for HBV and appropriate waste segregation with separated bins to prevent oneself from disease causing microorganisms.

Waste handlers are cleaners that are involved in the handling of medical wastes.

Safe Practice

Respondents who scored more than mean of correct answer for seven practice questions with yes or no answer were classified as safe practiced [28].

Good Knowledge

Medical waste handlers who correctly responded4 and above out of the 7 knowledge-based questions were considered as having good knowledge [30].

Good Attitude

Attitude questions responses were indicated with the three-point Likert type scale of measurement as “         Disagree”, “neutral”, and Agree” and numerical values of 1,2 and 3 respectively were given. The mean score was determined after computing attitude assessing questions[26].

Good Supplies Availability

The presence of supplies like personal protective equipment’s (heavy duty glove, gown, masks and boots), three colour coded bins and hand washing facilities like soap and anti-septic hand rub.

Trained

Waste handlers who got any types of training concerning safe waste handling.

Data Processing and Analysis

The completeness of the data was checked manually and coded accordingly. The coded and cleaned data was entered into the computer using EpiData version 3.1 and exported to SPSS version 20. After completion of data entry, it was cleaned before analysis. A description of frequency, mean, proportion, and SD was done for the first objective. Binary logistic regression was employed to identify factors associated with safety practices. Initially, bivariate analysis was done, and variables with a p-value below 0.25 were identified as candidates for multivariate analysis. Then multi-variable analysis was done, and an adjusted odd ration was computed and interpreted. A p-value less than 0.05 is the cut-off point for determining the significance of the association. The results of the study were presented in text, tables, and graphs. Multi-collinearity was checked by the variance inflation factor (VIF), and the goodness of model fit was checked by the Hosmer-Lemeshow test.

Ethical Consideration

An ethical clearance letter was acquired from the ethical review board of the College of Medicine and Health Sciences, Jigjiga University, and a permission letter was secured from the regional health bureau and delivered to the public hospital administrations. Written informed consent was secured from each participant. The confidentiality of the information and the privacy of the study participants were maintained. The participation was voluntary, and they had the right to withdraw from the interview if it was not comfortable for them.

Dissemination and Utilization of Finding

The findings will be disseminated to Jigjiga University, the School of Graduate Studies, the School of Public Health, the Department of Epidemiology, the Somali Regional Health Bureau, and those selected hospitals through presentations and printed materials.

Results

Socio–demographic Characteristics and Work Related Factors of Respondents

From the total sample of 417 included in the study. 401 waste handlers were interviewed, with a response rate of 96.2%. The mean age of the study participants was 32.1 (SD 6.1) years, and all respondents were females (100%). About 118 (29.4%) of them were in the age group 31–35 years. Married hospital waste handlers were 220 (54.9%), while 251 (66.1%) were illiterate. The majority of them, 255 (63.6%), had greater than 5 years of working experience, and 235 (58.6%) of them had an income level of 2000 birr per month. Two hundred eighty-four (70.8%) waste handlers were working their job in regular time (8 hours only). As compared with the other departments, the highest numbers of participants (133, 33.2%) and 69, 17.2%) were from the emergency and surgical wards, respectively (Table 2).

Table 2: Socio demographic characteristics and work related factors of medical waste handlers in selected public hospitals in Somali region, Eastern Ethiopia, August, 2021(N=401).

Sn

Variables Category Frequency

Percentage (%)

1 Age ≤25yrs

56

14%

26-30yrs

107

26.7%

31-35yrs

118

29.4%

>35yrs

120

29.9%

2 Marital status Married

265

66.1%

Single

97

24.2%

Widowed

17

4.2%

Divorced

22

5.5%

3 Religion Muslim

296

73.8%

Orthodox

49

12.2%

Protestant

24

6%

Other

32

8%

4 Education level Illiterate

251

62.6%

Primary(1-8)

108

26.9%

Secondary(9-12)

28

7%

Diploma & above

14

3.5%

5 Service year ≤5yrs

146

36.4%

>5yrs

255

63.6%

6 Monthly Income ≤2000ETB

235

58.6%

>2000ETB

166

41.4%

7 Working hours per day ≤8hrs

284

70.8%

>8hrs

117

29.2%

8 Working departments Outpatient

50

12.5%

Emergency

133

33.2%

Laboratory

33

8.2%

Surgical

69

17.2%

Medical

33

8.2%

Pediatric

46

11.5%

Gyne & Obs

28

7%

Other

9

2.2%

Proportion of Safety Practice

The proportion of safe practice in this study was found to be153 (38.2%) with 95% CI: 33.2, 43.1) (Figure 2).

fig 2

Figure 2: The prevalence of safety practice among medical waste handlers at selected government hospitals in, Somali Region, Eastern Ethiopia, August 2021. Safety Practice of health care waste handlers.

About 108 (25.9%) of them wore at least four and above four types of personal protective equipment during the handling of health care waste. where 44 (11% of them) washed their hands at all the selected critical times of hand washing. Two hundred (49.9%) of the waste handlers were immunized for HBV. Among the medical waste handlers who participated in the study, 63.6% separated hazardous and non-hazardous waste during the collection and transportation of hospital waste to the disposal site. Nearly 90% of them used a separated, color-coded bin system during collection. But 265 (66.1%) were mixing waste stored at separate bins during transportation of hospital waste to the disposal site. Only 112 (27.9%) of them asked for decontamination of hazardous waste before disposal.

Among the respondents, 384 (95.8%) had ever had a needle stick injury. 127 (30.1%) of the respondents reported that they use antiseptic hand rub after handling medical waste, and 397 (99%) of the respondents reported that they hadn’t ever received post-exposure prophylaxis for HIV/AIDS. About 17 (4.2%) of the waste handlers had the intention to move medical waste using trolleys in the future.

Only 51 (12.7%) medical waste handlers of the study participants reported that they had been exposed to the blood or other body fluids of patients through contact; 383 (95.5%) of these waste handlers reported that they had ever faced a sharp injury in the last year. Finally, among all waste handlers asked, 153 (38.2%) of them were practicing safely, and the rest (248, 61.8%) were practicing unsafely (Table 3).

Table 3: The prevalence of safety practice among waste handlers in selected public hospitals of Somali region, eastern Ethiopia, August 2021.

Sn

Safety practice Category Frequency

Percentage (%)

1 Wore at least four and above four types of personal protective equipment’s

Yes

108

25.9%

No

293

73.1%

2 Hand washing at five critical time

Yes

44

11%

No

357

89%

3 Immunized for HBV

Yes

200

49.9%

No

201

50.1%

4 use colour coded bine system

Yes

360

89.8%

No

41

10.2%

5 separate hazardous and non-hazardous waste

Yes

255

63.6%

No

146

36.4%

6 Ask decontamination of waste before disposal

Yes

112

27.9%

No

289

72.1%

7 Mix waste stored in a separate bins during transportation

Yes

265

66.1%

No

136

33.9%

8 Ever had needle stick injury

Yes

17

4.2%

No

384

95.8%

9 Have you faced a sharp

Yes

18

4.5%

Injury in the last one year

No

383 95.5%
10 Have you ever exposed to blood or other body fluids of patients through contact

Yes

51

12.7%

No 350

87.3%

11 Ever got post exposure prophylaxis for HIV/ADIS

Yes

4 1%
No 397

99%

12 Move medical waste using trolley

Yes

17 4.2%
No 384

95.8%

13 Do you use antiseptic hand rub

Yes

127 30.1%
No 274

64.9%

Safety practice

Safe practice

153 38.2%
Unsafe practice 248

61.8%

Knowledge of the Respondents Regarding Safety Practice

Concerning knowledge of the study participants 244(60.9%) of the respondents were having knowledge about safety practice (Figure 3).

fig 3

Figure 3: Proportion of knowledge on safety practice of the study participants at selected public hospitals in Somali region, eastern Ethiopia, August 2021.

Knowledge of the Respondents Regarding Safety Practice

Out of 401 respondents, seven knowledge questions with a yes or no answer were asked to assess their knowledge about safety practices. 289 (72.1%) of the respondents knew they were at risk of hospital-associated infections. Nearly 70% of them knew that washing hands with plain soap and water inhibits resident flora, and 68.2% of them knew that gloves should be used not only in anticipation of blood or body fluid exposure. The majority of the respondents (274, or 68.3%) knew being vaccinated for the HBV vaccine was a means of preventing infection. Nearly 60% of them had knowledge of post-exposure prophylaxis. Nearly 61% of study participants had good knowledge (Table 4).

Table 4: Safety practice Knowledge related item responses of the study at selected public hospital waste handlers in Somali region, Ethiopia, August 2021.

Sn

Knowledge Category Frequency

Percentage (%)

1 Are hospital waste handlers are at risk of infections

Yes

289 72.1%
No 112

27.9%

2 Washing hand with plain soap and water inhibit resident flora

Yes

277 69.1%
No 124

30.9%

3 Gloves should be worn if blood or body fluid exposure is anticipated

Yes

276 68.2%
No 125

31.8%

4 Washing your hands with soap and alcohol decrease transmission of infectious disease

Yes

284 70.8%
No 117

29.2%

5 Immunized for HBV is a means of prevention from infections

Yes

274 68.3%
No 127

31.7%

6 Getting PEP with in 72hr of exposure is a means of treatment

Yes

240 59.9%
No 161

40.1%

7 Have you ever heard about safety practice

Yes

293 73.1%
No 108

26.9%

Knowledge about safety practice

Good

244 60.9%
Poor 157

39.1%

Attitude of Health Care Waste Handlers about Safety Practice

A total of 401 respondents were asked five attitude questions with Likert-type scale options ranging from “disagree to agree to assess their attitude about safety practices. The majority of them, 195 (48.6%), agreed that washing hands with soap or alcohol-based antiseptics decreased the risk of transmission of hospital-acquired infections. Nearly 56.1% of them disagreed that gloves provide complete protection against acquiring or transmitting hospital-acquired infections, and 252 (62.8%) disagreed that hand washing is unnecessary when gloves are worn. About 245 (61.1%) of the study participants disagreed that frequent hand washing damages the skin and causes cracking, dryness, irritation, and dermatitis. A total of 235 (58.6%) of the study participants disagreed that hospital waste handlers have a very low risk of acquiring infection from improperly disposed hospital waste. More than 50% (209) of the study participants had a positive attitude towards. Safety practices (Table 5).

Table 5: Attitude about safety practice of public hospital waste handlers in Somali region, Ethiopia, August 2021.

Sn

Attitude Category Frequency

Percentage (%)

1 Glove provides complete protection against acquiring /transmitting infections Disagree

225

56.1%

Neutral

46

11.5%

Agree

130

32.4%

2

Washing hands with soap or alcohol based antiseptic decrease the risk of transmission of hospital acquired infections

Disagree

161

40.2%

Neutral

45

11.2%

Agree

195

48.6%

3 Hand washing is unnecessary when gloves are worn Disagree

252

62.8%

Neutral

22

5.5%

Agree

127

31.7%

4

You have a very low risk of acquiring infection from improperly disposed hospital wastes

Disagree

235

58.6%

Neutral

106

26.4%

Agree

60

15%

5 Frequent hand washing damages skin and causes cracking, dryness, irritation and dermatitis Disagree

245

61.1%

Neutral

58

14.5%

Agree

98

24.4%

Attitude

Positive attitude

209

52.1%

Negative attitude

192

47.9%

Organizational Factors Affecting Safety Practice of Hospital Waste Handlers

Out of 401 waste handlers interviewed, 185 (46.2%) had gained any type of training about safety practices, 177 (44.1%) were supervised regularly by the organization, and 39 (9.7%) had both training and regular supportive supervision (Figure 4).

fig 4

Figure 4: Organizational factors affecting safety practice of hospital waste handlers in Somali region, Eastern, Ethiopia, August 2021.

Availability of Personal Protective Equipment’s among Waste Handlers

A total of 401 respondents were interviewed to check the availability of personal protective equipment in the health facility. From the interviewed respondents, almost 251 (95%) of them responded that gloves were available, while 376 (93.8%) of them responded that gowns were available. Almost 62.6% of them also responded that masks were available. Nearly 14.7% of them answered that caps were available, and 24 (6%) of them responded that goggles were available at the facilities. A few respondents (2.5%) responded that boots were available at the hospitals during the data collection period (Figure 5).

fig 5

Figure 5: Availability of personal protective equipment’s among waste handler in selected government hospitals in Somali region, Eastern, Ethiopia, August 2021.

Factors Associated with Safety Practice

Bivariate Analysis of Socio-demographic Factors Relating with Safety Practice

In this study, there is a significant association between respondent’s age and safety practices. Waste handlers whose age is between 31 and 35 years were 78% times (COR=0.22, 95% CI=0.13, 0.379; P=0.0001) less likely to be safe practiced compared to waste handlers whose age is included in other age categories. Also, health care waste handlers whose age is between 26 and 30 were 87% times (COR=0.13, 95% CI=0.72, 0.24; P=0.0001) less likely to be safe practiced compared to waste handlers whose age is included in other age categories.

The service year also showed a significant association with safety practices. Waste handlers who have worked less than or equal to 5 years were 34% (COR=0.66, 95% CI 0.44, 0.998; P=0.049) times less likely to be safe practiced compared to waste handlers who have worked greater than 5 years of working experience (Table 6).

Table 6: Sociodemographic and work related factors associated with safety practice using bivariate logistic regression at public hospitals in Somali Region, Eastern Ethiopia, August 2021.

Variable

Category Safety Practice COR (95% CI) P-value
Safe Unsafe
Age In Years ≤25yrs

4

52 0.033(0.11-0.098) 0.0001*

26-30yrs

25 82 0.131(0.72-0.237)

0.0001*

 31-35yrs

40

78 0.22(0.13-0.379) 0.0001*

>35yrs

84 36 1.00
Marital status Married

102

163 0.52 (0.22-1.25) 0.145

Single

32 65 0.41(0.16-1.1)

0.06

Widowed

7

10 0.58(0.16-2.1) 0.41

Divorced

12 10 1.00
Education Illiterate

84

167 1.84(0.5-6.79) 0.36

Primary(1-8)

54 54 3.67(0.97-13.88)

0.056

Secondary(9-12)

12

16 2.75(0.63-12.1) 0.18

Diploma & above

3 11 1.00
Monthly income ≤2000ETB

97

138 1.38(0.1-2.1) 0.126

>2000ETB

56 110 1.00
Service year ≤5yrs

55

114 0.66(0.44-0.998) 0.049*

>5yrs

98 134

1.00

Working hours ≤8hrs

103

163 1.1(0.69-1.62) 0.81

>8hrs

50 84 1.00
Working unit Outpatient

15

35 0.54(0.21-0.81) 0.398

Emergency

52 81 0.8(0.44-2.1)

0.75

Laboratory

7

26 0.34(0.17-0.86) 0.17

Surgical

28 41 0.85(0.65-3.1)

0.83

Medical

13

20 0.81(0.67-2.94) 0.79

Pediatric

21 25 1.1(0.5-2.93)

0.95

Gyne & Obs

13

15 1.1(0.43-5.64) 0.92

Others

4 5 1.00

Bivariate Analysis of Associated Variables Relating with Safety Practice

In this study, there was a statistically significant association between knowledge of waste handlers and safety practice. Waste handlers who had good knowledge were 4.3 times safer than those who had poor knowledge (COR=4.3, 95% CI 2.75, 6.75; P=0.0001).

Regarding attitude, there is also a significant association between attitude and safety practice. Respondents who had a positive attitude were 1.66 times (COR=1.66, 95% CI 1.1–2.6; P=0.024) more likely to be safe practitioners compared to respondents who had a negative attitude toward safety practices.

Whereas availability of materials is associated with safety practice, health care waste handlers who had availability of safety materials were 7.1 times (COR=7.1, 95% CI 4.4, 11.46; P=0.0001) more likely to be safe practitioners than those who had a shortage of safety materials (Table 7).

Table 7: Associated variables about safety practice of waste handlers using bivariate logistic regression at government hospitals in Somali Region, Eastern Ethiopia, August 2021.

Safety practice

COR (95% CI) P-value
Variable Categories Safe Unsafe
Knowledge Good 116 104 4.3(2.72-6.75) 0.0001*
Poor 37 144 1.00
Attitude Positive 113 156 1.67 (1.1,2.6) 0.024*
Negative 40 92 1.00
Training

 

Trained 83 111 1.46(0.976-2.19) 0.065
Not trained 70 137 1.00
Availability of materials

 

Good 125 96 7.1(4.4-11.46) 0.0001*
Poor 28 152 1.00

Multivariate Logistic Regression Analysis of Safety Practice among Hospital Waste Handlers in Somali Region, Ethiopia, August 2021

Bivariate logistic regression was done, and variables with p-values <0.25 were selected for the multiple logistic regression analysis, and multicollinearity was checked by looking at the VIF (variance inflation factor) in the linear regression model. In the bivariate analysis, it was found from socio-demographic variables: age group, had a statistically significant association with safety practice (p-value <0.05). From work-related variables, service year was significantly associated with safety practices. Also, the results revealed in the bivariate analysis of the variables, including knowledge, attitude, and availability of supplies, were significantly associated with safety practice.

In multivariate logistic regression, the confounding effect of one variable over the other variables was adjusted. Based on this, age category, knowledge of the participants, attitude, and availability of safety supplies were significantly associated with safety practice at a P-value of <0.05 (Table 8).

The odds of respondents with a positive attitude were 5.4 times more likely to be safe practiced compared to respondents who had a negative attitude toward safety practice (AOR: 5.4; 95% CI: 2.53, 11.47; P=0.05). The odds of waste handlers with good knowledge were 7.21 times safer than those who had poor knowledge (AOR=7.21, 95% CI 3.7–14; P=0.05). The odds of respondents who had availability of safety materials were 9.3 times higher than those who had a shortage of safety materials (AOR=9.3, 95% CI 5, 17.2); p=0.05. The odds of waste handlers with an age category between 31 and 35 years were 81.1% less likely to be safe practitioners than those whose age group was greater than 35 years (AOR=0.189, 95% CI: 0.094, 0.38; P=0.05). The results of the final multiple logistic regression models are found in the Table 8.

Table 8: Result of multiple logistic regression analysis on safety practice among hospital waste handlers in Somali region, Eastern Ethiopia, August, 2021.

Variable

Category Safety practice  COR (95% CI) AOR (95%CI)
Safe

Unsafe

Age in years ≤25yrs

4

52 0.03(0.11-0.098) 0.047(0.014-0.16)*

26-30yrs

25 82 0.13(0.72-0.237)

0.146(0.065-0.33)*

31-35yrs

40

78 0.22(0.13-0.379) 0.189(0.094-0.38)*

>35yrs

84 36 1.00

1.00

Service year ≤5years

55

114 0.66(0.44-0.998) 1.2(0.62-2.34)

>5years

98 134 1.00

1.00

Knowledge Good

116

104 4.3(2.72-6.75) 7.21(3.7-14)**

Poor

37 144 1.00

1.00

Availability of materials Good

125

96 7.1(4.4-11.46) 9.3(5-17.2)**

Poor

28 152 1.00

1.00

Attitude Positive

113

156 1.66 (1.1,2.6) 5.4(2.53-11.47)**

Negative

40 92 1.00

1.00

Discussion

The overall current prevalence of safety practice among hospital waste handlers in this study was 38.2% (95% CI: 33.2, 43.1). The finding was higher as compared with the study done in Shiraz, Iran [31]. This difference might be due to the difference in the study design, setting, and time of the study, as well as the implementation of different reforms by the federal ministry of health at hospitals like infection prevention and patient safety, which were promoting the safety practices of hospital waste handlers.

The prevalence of this study was lower than the prevalence of safety practice among medical waste handlers in Addis Ababa town and with research done in Gonder town among waste collectors, 44.1% (95% CI: 37.3-51) and 45% (95% CI: 40.3-49.4), respectively [26,32]. This difference might be due to the difference in the study setting and time, as well as the implementation of hospital infection prevention protocols. The number of participants with good safety practices reported in the finding was lower than the study done at KwaZulu-Natal (50%) [33]. This difference may be due to the study setting and time. Also, the finding was lower than the findings from Cameroon, in which 100% of the medical waste handlers used all the appropriate protective gear [34]. This difference might be due to the study setting, the difference in knowledge of hospital waste handlers, and the attention given to safety by the governing body. The finding was also lower than the finding from Debra Markos (80%) [35]. This difference may be due to the lower sample size they used.

In principle, all medical waste handlers should properly utilize personal protective equipment during the handling of medical wastes [5]. However, in this study, only 25.9% of medical waste handlers properly utilized personal protective equipment. The result was better than the study done in tertiary care health facilities at Shiraz Iran hospitals, the metropolitan city of Pakistan, and Adis Ababa government hospitals, in which 15%, 22.8%, and 25.2% of waste handlers utilized personal protective equipment properly[26,31,36]. This difference might be due to the implementation of different initiatives by the ministry of health like CASH, infection prevention, and patient safety, as well as an increase in knowledge of hospital-acquired infections among medical waste handlers.

In this study, attitude was shown to be an independent predictor of safety practice among medical waste handlers. The odds of safety practice among waste handlers with a positive attitude were 5.4 (AOR: 5.4; 95% CI: 2.53, 11.47; P=0.05) times higher than those who had a negative attitude. This was slightly higher with the study done in Adisababa [26] which showed that health care waste handlers with favorable attitudes had 4.78 (AOR=4.78, 95% CI 1.64, 13.9) higher safe practices compared to respondents with unfavorable conditions. The difference might be due to the setting in which the study was conducted, the lower sample size they used, and the difference in providing pre-service and in-service supervision to increase their intention for safe medical waste handling.

The odds of safety practice among waste handlers with good knowledge were 7.21 (AOR=7.21, 95% CI 3.7–14; p=0.05) times higher than those who had poor knowledge. This was slightly higher with the study done by DebreMarkos and Adisababa [32,36], which showed that waste handlers with good knowledge practiced safety more than those with poor knowledge. The findings of this study were inconsistent with those of a study done in South India [8]. The difference might be due to the difference in study settings, which were undertaken at a tertiary care hospital, and the sampling techniques they used, which were purposive sampling, which may introduce selection bias, and that the knowledge acquired may not necessarily be translated into practice.

The odds of safety practice among waste handlers with adequate supplies were 9.3 (AOR=9.3, 95% CI 5, 17.2); p=0.05 times higher than those with a lack of supplies. This finding was higher in studies conducted in DebreMarkos and Adisababa [26,37], in which those respondents with adequate supplies had good safety practices. This difference might be due to the attention given by the state health bureau and hospital administration to the fulfillment of the required supplies and inputs. In this study, the age group has shown a significant association with safety practices among medical waste handlers. The odds of waste handlers with an age group between 31 and 35 years were 81.1% (AOR=0.189, 95% CI: 0.094, 0.38; P=0.05) times less likely to be safe practitioners than those whose age group is greater than 35 years. The findings were lower with the study done in Bahardar [38], which showed that respondents in the age group 30-35 years had 4.1 (AOR=4.1, 95% CI: 1.27, 13.4) times more safe practices compared to their counterparts. The difference might be due to the lower sample proportion they used.

Limitation of the Study

The study was conducted only in government hospitals, which do not represent private hospitals. Moreover, since this study was a cross-sectional study, it may not allow for the establishment of a causal link between the factors associated with safety practices.

Conclusion

The result of this study showed that the level of safety practice was low compared to the national and international standards among hospital waste handlers in relation to waste handling and safety, which may increase the chance of getting infected with hospital-acquired infections and occupational infections. So reducing those problems through adequate professional support and supervision should be in place to increase their knowledge about safety precautions, and availing of safety supplies should be implemented to increase adherence to safety practices among hospital waste handlers. This study will also help hospital administrators take appropriate interventions, including providing important PPE, motivating the worker to utilize it properly, and planning to improve the safety practices of medical waste handlers working in public hospitals in the Somali Region.

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Mind-Sets of “Verbal Judo” – How Young Males Respond to Described Interactions between Perpetrators and Police Officers

DOI: 10.31038/ALE.2024111

Abstract

The study focuses on how young males, ages 16-30, in the Virginia area respond to different scenarios of a police officer interacting with a prospective lawbreaker. The scenarios were created by systematic combinations of messages (elements), developed from human experience and artificial intelligence. The deconstruction of the ratings into the part-worth contribution of each of 16 elements showed the degree to which each element would be “listened to” by the prospective lawbreaker, as well as the degree to which the same element would lessen the anger. Three mind-sets emerged. The first mind-set is the police officer who creates empathy, which de-escalates the situation. The second mind-set is the take-charge officer, who clearly senses a developing problem, talks authoritatively. The third mind-set pays attention to community-oriented and empathic policing. These mind-sets represent the way ordinary people, young males, think about the police and what the police do when they read about these different potential crimes and interactions between perpetrators and police. The approach allows us to identify the way young people think about the information that they read. The results show that not everybody is the same and that there may be different strategies about the role of police officers depending upon the nature of that to which a person pays attention.

Keywords

Lawbreaker, Mind-sets, Police officer, Verbal judo

Introduction

The origin of this study can be traced to ongoing work by the authors in the world of working with police officers to figure out how to deal with the public, how to deal with active lawbreakers, prospective lawbreakers, situations which may turn violent, and finally, just as important, how to recruit police officers in a world where certain kinds of social activities have been set up to hamper police officers. The study that was done here concerns what the police officer should say to an individual who looks like that individual will engage in violence. The study is based upon a series of discussions with various police departments, as well as the recognition that there are different mind-sets of criminals. A detailed look through the literature of crime suggests that criminals, those who do violence for example, are not doing it all for the same motive [1-5]. This statement may seem like a truism, and it is to some extent. However, the ramifications of this truism are especially important. We are not dealing here with academic issues which will result in the same outcomes. Rather, we are discussing real-world situations in which violence may take place, in which people may get hurt or even killed. We are looking at a problem which is systemic all over the world, namely the interaction, and perhaps even confrontation, between a police officer and a lawbreaker. Crimes are committed for different reasons. What’s not necessarily obvious is the nature of the motivation of the criminal, and perhaps just as well, the type of communication to which the criminal or at least the prospective lawbreaker might be receptive. Negotiators recognize these differences in the types of language and the types of wording that might be effective, but all too often, such knowledge resides in the mind of the person who has had experience, who has been trained “on the job” through personal interactions.

We would like to bring this effort into the public eye by doing research on what people think will be effective communications [6]. The objective here is not necessarily to have an encyclopedia of those discussions. We leave that to the professionals. Rather, our objective is to use new research techniques, such as Mind Genomics, to discover the types of mind-sets of prospective lawbreakers and their situations in which things happen. And, for both of them to figure out what type of language might be effective as perceived by a person who’s asked to judge the situation.

The science of criminology has long recognized the existence of mind-sets or types of individuals. It could be no other way. People are different in the reasons underlying their commission of crimes or misdemeanors. We all operate within different life circumstances. Can we make a tool that the negotiator in a crime or the police officer can use for specific circumstances, named at the time of use? The objective would be to use that tool as a way to learn, and to instruct. We do not expect the work to be presented here to be anything other than a start of using Mind Genomics as emergent science to understand the mind of what we might call negotiation [7-10]

The Foundation and Approach of Mind Genomics

The foundation of Mind Genomics is the belief that it is possible to study the reactions to the world of the everyday in a scientific manner. When we look at the specific details of the everyday, we may often find that people react to these details in different ways, but in a limited number of different ways. These different ways are called mind-sets. The objective of Mind Genomics is to understand the world by understanding how people differ from each other in their response to features of and messages about the daily world [11]. Rather than assuming that there are a limited grand number of mind-sets — let’s say three or ten or sixty even — we assume that the mind-set emerges from the pattern of reactions or the pattern of potential reactions to a granular, everyday situation. That is, people can be in one mind-set when they think about how they’re going to order and eat breakfast but be in totally different mind-sets when they realize how they’re going to commute to work. The goal of Mind Genomics, therefore, becomes one to understand these mind-sets at the granular level, doing so in a way which is efficient, inexpensive, educational, reliable, powerful [12-14]. One ultimate goal is to create a “database of everyday life.” This paper presents one application, the messaging or “verbal judo” between a police officer and a prospective lawbreaker.

Setting Up the Mind Genomics Study Through a Templated System

The templated approach developed for Mind Genomics ensures that any user can do a study, whether the user knows the elements to be tested or whether the user wants to be “coached” by AI in the form. of an LLM (large language model) to create these elements. Figure 1, Panel A shows what confronts the user at the start of the study. The user is requested to tell four or select four questions which “tell a story.” Panel A is already filled in but one could imagine Panel A with no questions whatsoever simply with four blanks, one blank per question.

The prospect of course is quite daunting as has been the experience of the authors over the past decades. It is for that reason that we embedded artificial intelligence using ChatGPT 3.5 [15]. ChatGPT 3.5 was programmed to receive a small squib shown in the box on the right (Figure 1, Panel B). The squib describes the issue. From that squib ChatGPT 3.5 creates 15 questions for each iteration [16,17]. The user can iterate again and again, each time creating 15 questions, until the user selects a total of four questions across the various iterations. The user can select the questions, edit them, provide other questions, doing so for many iterations. The Mind Genomics process will record each iteration, whether the elements were selected or not. The result is an education simply through creating questions in each iteration. Thus, the four selected questions could come from a variety of iterations and reflect the results of editing the suggested questions [16,17].

What ends up of course is that the user can drop the questions into the study as shown in Panel A, can edit it, put it into different words, or even use the user’s own ideas (Figure 1, Panel A). Table 1 shows the types of questions which emerge when the user uses Idea Coach ChatGPT for creating the questions.

Table 1: Output of AI for the squib. Topic: A policeman is responding to a situation. What should I ask?

TAB 1

The same approach requiring the user to generate four answers to each question finally selected once again generates a sense of discomfort. The level of discomfort seems to be less, perhaps because it is easier to answer questions than to pose them. Once again AI proves valuable here, reducing the panelist. The user only needs to select Idea Coach and AI is prompted to return with 15 answers to each question. The process can go on several times for each question, resulting in a book of questions and answers to those questions. Table 2 shows the final set of four questions and four answers to each question.

FIG 1

Figure 1: Panel A shows the user interface screen requesting four questions, with the questions filled in. Panel B shows the user interface box to write in the squib for the Idea Coach, using ChatGPT 3.5.

Table 2: The final set of four questions, and the four answers (elements) for each question

TAB 2

Orienting the Respondents and Providing a Rating Scale

The next step in the setup of the Mind Genomics study involves the creation of the orientation for the respondent and an easy-to-use rating scale. Traditionally, the rating scale has been unidimensional, from low to high, from 1 to 5. More recent efforts have used two-sided rating scales, allowing the respondent to provide two pieces of information in the same scale. It is a two-sided rating scale that we use in this study. The first side involves ratings of listening. The second one involves ratings of reducing anger. Table 3 presents the text of the rating scale. Respondents typically have little problem assigning ratings using this type of scale, even though it would seem that they are making two types of judgments. Figure 2, Panel A shows the screenshot for the respondent orientation provided by the researcher. Figure 2, Panel B shows the set up for the rating scale, allowing the user to select the question itself (top), the number of scale points, and the optional anchoring phrase for each scale point.

Table 3: The rating scale

TAB 3

FIG 2

Figure 2: Panel A shows the user interface to create the respondent orientation. Panel B shows the user interface to create the rating question.

Table 4 shows the three self-profiling questions selected by the user, in addition to two additional standard questions (age, gender). These self-profiling questions allow the user to obtain otherwise impossible-to-obtain information about the respondent. Figure 3 shows the actual pull-down menu as presented to the respondent at the start of the evaluation session.

Table 4: The three self-profiling questions selected by the user

TAB 4

FIG 3

Figure 3: The pull-down menu presenting the self-profiling questions

Once the consumer respondent logs in and completes the self-profiling classification (Figure 3), the respondent is presented with an orientation and immediately evaluates 24 vignettes, one vignette after another (see Figure 4). The vignettes are created by experimental design, a systematized layout. Each respondent evaluates a unique set of the 24 vignettes, the uniqueness guaranteed by a permutation scheme which maintains the mathematical properties of the combinations (statistical independence, equal frequency of appearance, etc.).

FIG 4

Figure 4: Example of a vignette as presented to the respondent, who reads and rates the vignette. The vignette automatically advances to the next vignette after the respondent assigns a rating.

A vignette has two, three, or four elements, at most one element from each question or one answer from each question. According to the experimental design, the combinations of the vignettes are incomplete. That is, the vignettes are not created by the obsessive requirement that each vignette have exactly one element (viz., answer) from each question. That requirement would, in fact, end up being counterproductive in a statistical sense because the 16 elements would not be statistically independent of each other, and only relative value of coefficients would emerge, not the more desirable absolute values.

The strategy of having each respondent evaluate a unique set of combinations was developed by Gofman and Moskowitz in the early 2000’s [18]. The objective was to ensure that Mind Genomics would explore many combinations and thus might be well used as a tool for exploration rather than a tool to confirm what was known. In traditional conjoint measurement, the typical user ends up testing known combinations, creating these limited numbers of combinations to test the hypothesis. It is important in traditional conjoint measurement to “know” the important elements ahead of time. In a complete about face, Mind Genomics was designed to explore the response to messages, elements, welcoming the absence of any ingoing knowledge about “what is important.” In Mind Genomics, the user may have absolutely no idea of what the important elements are, and therefore it makes far more sense to have each person test a unique set of combinations different from the combinations of everybody else. The consequence of that is that the Mind Genomics system is much like an MRI of the mind, looking at different areas, identifying things, and then putting everything together at the end of the experience with one grand computer analysis which shows exactly what every element contributes.

Transformation to Binary Scales and Creation of Equations Using OLS (Ordinary Least Squares) Regression

The analysis of Mind Genomics data follows a simple series of steps and like the setup is templated to make the approach easier for people to use. The rating scale has two dimensions. One dimension is listening, the second dimension is lessening anger. We want to capture both of these. The transformations create two new variables, each taking on the values of 0 or 100, as shown. Each rating thus generates these two binary variables. As a precautionary measure to ensure that every respondent generates some level of variation in these two binary variables, we add a vanishingly small random number (<10-5) to each newly created binary variable. By so doing we ensure that the subsequent analysis using OLS (ordinary least squares) regression will not “crash.”

R54 (Listen to Officer)       Ratings 5 and 4 transformed to 100, ratings 1,2, and 3 transformed to 0.

R52 (Lessen Anger)    Ratings 5 and 2 transformed to 100, ratings 1, 3 and 4 transformed to 0.

The effort put into creating the combinations now pays out. It is straightforward to apply OLS regression to the data, whether at the level of a single individual or at the level of a group. The equation shows how one deconstructs the rating, or more correctly the transformed binary variable, into the part-worth contribution of each of the 16 elements. The equation does not have an additive constant, meaning that the equation is forced through the origin. This simple expression contains within it all of the information about the driving strength of each of the 16 elements for Listen to Office or for Lessen Anger.

Binary Dependent Variable = k1A1 + k2A2… k16D4

Table 5 shows the coefficients from the ordinary least squares regression. The coefficients are sorted by the magnitude for R54 (Listen to Police Officer). The convention for this analysis will be that any coefficient of 21 or higher will be shaded to highlight as being an extremely important, highly significant coefficient. The value 21 emerges from statistical tests of significance. The second column shows the coefficient for R52 the binary dependent variable for Lessened Anger. In neither case is any element shown as highly significant with a coefficient of 21, although D3 is close: Policeman says I respect your right to voice your grievances.

Table 5: Coefficients for the Total Panel

TAB 5

The fact that there are no very strong elements for R54 (Listen to Police Officer) or for R52 (Lessen Anger) may emerge because people have different criteria, and therefore their ratings may cancel each other out. We can think of two streams meeting another stream in opposite directions. A stream flows quickly, but if two streams meet together and they’re going in opposite directions, often the result is a pool with a lot of disturbance, but the pool is not going fast in any direction. It just becomes a maelstrom. The same thing may occur with the coefficients from the total panel. We may have different groups of people with different ideas, and the question is whether in fact these people are canceling each other out. We will see that when we come to mind-sets, but first we have to work our way through the differences between people as they have defined themselves in the classification questions.

Self-Profiling

The respondents were required to answer three questions at the start of the study, shown in Table 3. Mind Genomics can generate a wall of numbers because of the different binary dependent variables (R54, R52), the 16 elements, and the several groups self-defined by the respondent. To make understanding and discovering patterns easier, we focus from this point forward on one key dependent variable, R54.

Table 6 shows the coefficients based upon Question 1, attitude towards police. The story in Table 6 is clear. Only one of the three subgroups generate consistently high coefficients, viz., those who say they trust police.

Table 6: Coefficients for elements based on self-profiling Question 1 (Attitude toward police).

TAB 6

Table 7 shows the coefficients for R54, this time based on how the respondent feels about violence in society. Once again, a story emerges, although not one quite as clear as before. Those who feel that violence is never justified end up saying they will listen to direct statements to them by the police. Those who feel that violence is occasionally warranted say that they will listen in a number of situations, but the common link is not clear. Finally, those who feel that violence is simply part of everyday life do not end up saying that they will listen to the police officer.

Table 7: Coefficients for elements based on self-profiling Question 2 (Violence in society).

TAB 7

Table 8 shows the coefficients for R54, this time for self-profiling question #3, “positive interactions with police.” Those respondents who say that they have had several positive interactions with the police are likely to listen, especially when spoken to respectfully.

Table 8: Coefficients for elements based on self-profiling Question 3 (Positive interactions with police).

TAB 8

Mind-Sets

The last analysis creates mind-sets. Mind-sets are defined as clusters of individuals who respond in the same way towards a specific topic. Individuals within a mind-set find certain patterns to be extraordinarily engaging and other patterns to be virtually irrelevant. Mind-sets emerge from statistical analyses of the patterns of coefficients for the individuals. Ideally for a topic such as listening to police officers, the statistical analysis should generate a limited number of clusters of patterns, the mind-sets, with these patterns telling easy to understand “stories.” The former is parsimony, the latter is interpretability.

The creation of mind-sets for these data involved the estimation of 108 individual-level equations, one equation for each respondent. It is just as easy for the computer to create 108 equations as to create one equation, since each respondent’s 24 vignettes were arranged ahead of time to ensure that the 16 elements appeared in a statistically independent fashion. As before, the key dependent variable is R54, Listen to the police officer. The final analysis to generate the mind-sets used k-means clustering [19]. The outcome is two, and then three clusters or mind-sets. The three-mind-set solution was easier to interpret. Table 9 shows the three-mind-set solution, sorted from high to low for each mind-set separately. Elements which generate coefficients of 21 or higher in two mind-sets appear in each mind-set in the proper order, to make interpretation easier. Table 9 shows many more strong performing elements, with these elements telling simpler stories. It is important to keep in mind that these mind-sets emerge without the help of human interpretation except at the very end. All of the analyses come from pure mathematical considerations.

The strong performance of elements in Table 9 should not surprise. The analogy given above for the total panel was of two or more streams, moving swiftly in opposite directions, clashing with each other and creating a pool of turbulent, but non-flowing flowing water. The mind-sets flow in different directions. We see weaker performance for the total panel (see Table 5, column for R54). Only when the different mind-sets emerge do we see how really strong the mind-sets are.

Table 9: The three-mind-set solution emerging from clustering the coefficient on the basis of values for R54 (Listen to the police officer).

TAB 9

Using AI to Understand the Mind-Sets More Deeply

Our final analysis comprises the deeper interpretation of our mind-sets through artificial intelligence. We know the strong performing elements for the key binary dependent variable R54. Table 9 shows these elements in shade. The LLM embedded in BimiLeap.com, the Mind Genomics platform, “summarizes” the patterns behind these strong performing elements. Table 10 presents these summaries exactly the way they emerged from the LLM. It is important to keep in mind that the user does not have to accept the summarization. For example, the mind-set names used in Table 9 are not those recommended by AI. Rather, the summarization shown in Table 10 is meant as an aid to learning and to critical thinking, essentially acting as a “coach” to suggest other aspects meriting the user’s attention.

Table 10: AI-generated “automated summaries” of strong-performing elements for each of the three mind-sets shown in Table 9.

TAB 10(1)

TAB 10(2)

TAB 10(3)

Discussion and Conclusions

The goal of this study was to demonstrate how a combination of artificial intelligence and Mind Genomics thinking can create different features of the interaction between a potential perpetrator of a violent act and the police. With the increasing power of artificial intelligence as manifested in large language models, it becomes straightforward to request these large language models to provide relevant questions and then for each question relevant answers. We demonstrated this through Idea Coach. Whether or not we created the correct questions and selected the correct answers becomes a minor issue when we realize that we can do an iteration in a minute or less. What would take months of thinking, now with the help of large language models, really takes minutes to do in terms of searching for new questions and in turn for new answers to those questions, the elements of our study.

The first half of the study was devoted to finding the test stimuli. The second half is devoted to finding the response of real people, in our case young males living in the Virginia area. The issue was whether these people would respond in a specific way to the various scenarios, to the different elements combined. The data from our 108 respondents suggest three different mind-sets. It’s important to know that this is our first foray. The first mind-set would be strong responses to listening when the place is familiar and when the police officer says to the effect that “I’m going to not do anything to you, just let’s talk.” The second mind-set stresses that the person says they will listen when there are clear actions that suggest a hostile nature. The police officer clearly senses a situation and the problem developing and talks authoritatively. It’s important to note that the police officer who talks authoritatively may also want to talk in a more peaceful manner to find common ground. The third mind-set is that the police officer really knows what’s going to happen and essentially threatens or orders the potential perpetrator not to do anything. As a closing comment, one should keep in mind that these mind-sets are not hard and fast divisions, but interpretable regions on a continuum. That itself is key learning, that sometimes there are strong differences, opposite or independent, orthogonal, and sometimes the mindsets fall along a continuum of power. It’s quite possible that in the case of police behavior in these situations we are dealing with positions on a continuum rather than radically different mind-sets. Only experimentation will tell us.

Acknowledgment

The authors would like to thank Vanessa Marie B. Arcenas for helping to produce this manuscript.

Abbreviations

Abbreviation Definition
AI Artificial Intelligence
ChatGPT Chat Generative Pre-trained Transformer
LLM Large Language Model
OLS regression Ordinary Least Squares regression

Competing Interests

The authors have no conflict of interest to disclose.

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Fertility Preservation Among Cancer Patients in Saudi Arabia: A Hot Topic

DOI: 10.31038/CST.2024923

Abstract

The future quality of life of cancer patients with respect to their fertility is impacted by cancer treatment for those who were diagnosed before or during their reproductive years. Fertility cryopreservation technologies give hope to cancer survivors for life following cancer treatments. However, a limited number of patients are taking advantage of the benefits provided by fertility preservation alternatives because of a lack of standardized guidelines, a lack of awareness, and the need for additional education and training.

Keywords

Knowledge, Attitudes, Practices, Fertility preservation, Cancer patients, Saudi Arabia

Introduction

Worldwide, the prevalence of cancer patients is increasing, with a long-term incidence projection showing that there will be a 1.8-fold increase by 2030, making it a life-threatening diagnosis [1]. Fortunately, recent advances in cancer treatment have resulted, for example, in female cancer survival rates increasing to 10% of all survivors under the age of 40 [2,3]. However, it is known that a number of cancer treatments harm the reproductive system, resulting in sterility or infertility. In order to improve the quality of life of cancer survivors of childbearing age, fertility preservation (FP), advice, and treatment are increasingly being offered [4]. The knowledge, attitudes, and practices (KAP) regarding FP, especially in cancer patients, are very advanced worldwide. In Saudi Arabia, FP in cancer patients is a topic that has gained increasing attention and importance. However, it is still a difficult problem, and for a variety of reasons, referral and consulting are not yet widely used.

The KAP among Oncologist

According to our previous studies in 2011, we identified several knowledge gaps among oncologists that could impact their attitude, which in turn was reflected in their poor practice. For example, the possibility of preserving female fertility was unknown to 45% of oncologists [5]. At that time, there was limited awareness about FP options, a lack of standardized guidelines, and a need for further education and training in this area, especially in the absence of legislation.

Twelve years after the above-mentioned study, the advice of senior religious scientists in 2018 allowed the freezing of tissue of the ovarian membrane, the entire ovary, and eggs for later use in reproduction in order to preserve the offspring. In a recent study conducted in 2023, we investigated whether oncologists’ knowledge, attitudes, and referral procedures regarding FP have improved. Their level of understanding has greatly increased, as we have discovered. Doctors were actually found to be significantly more knowledgeable about a wide range of female FP options, the most prevalent of which was egg cryopreservation (77%), than other options. It was still necessary to improve patient counseling and referrals to fertility services, though. Our results demonstrate Saudi Arabia’s deficiency in clinical practice standards for FP in cancer patients. [6].

The KAP among Health Practitioners

Understanding the knowledge, attitudes, and practices of health practitioners toward fertility preservation is crucial in ensuring that individuals receive accurate information and appropriate care regarding their reproductive options.

A recent study conducted in Saudi Arabia aimed to assess the attitude of health practitioners towards fertility preservation and showed that clinical practitioners’ knowledge is still inadequate. They concluded that there is a need to train health practitioners and establish practice guidelines and fertility preservation clinics for cancer patients [7].

The KAP among Medical Student

Medical students are the future doctors, and in order to successfully deal with the topic of FP, medical training should begin. To implement cancer education curricula related to fertility preservation, it is necessary to identify any gaps and other barriers that could be overcome through medical education to improve future clinical practices. Our recent study on the attitude and knowledge among Saudi medical students toward FP showed respectable awareness and attitudes toward FP. However, there are still some gaps; almost half of the respondents mentioned that cancer treatment should be started before FP, suggesting the need to improve education about FP in the medical curriculum [8].

The Knowledge among Cancer Patients

Cancer patients who may face fertility challenges in the future were recently surveyed. The study by Abusanad A. et al. in 2022 showed that 56.30% of the cancer patients surveyed had satisfactory knowledge about the consequences of cancer treatment for infertility and expressed a desire to have children through FP in the future. However, this desire has been hampered by limited oncofertility care and FP procedures. Unfortunately, such patients were occasionally referred to a specific fertility facility, where only 17% saw a fertility specialist and only 37.8% received fertility counseling [4].

Conclusions

To the best of our knowledge, there have not been studies addressing such an important topic in our region for a decade. To meet the patient’s needs and improve the quality of life of cancer survivors, the best way is to increase cancer awareness through cancer education and disseminate information about cancer prevention. This can be done in a number of ways: through educational events and continuing medical education programs for medical students, oncologists, and nurses caring for cancer patients whose fertility is affected by cancer treatment. Such educational programs will expand their knowledge and improve their practice. The public should be aware of the availability of fertility preservation services in government and private centers, as well as the cost, timing, and various procedures.

Acknowledgment

The authors are grateful to the Deanship of Scientific Research, King Saud University, Riyadh, Kingdom of Saudi Arabia, for funding through the Vice Deanship of Scientific Research Chairs.

Conflict of Interest

The author has no conflict of interest to declare.

References

  1. Arafa MA, Rabah DM, Farhat K (2020) Rising cancer rates in the Arab World: now is the time for action. East Mediterr Health J. 26(6): 1-5 [crossref].
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Thermal Properties of Natural and Hybrid Fiber Reinforced Composites

DOI: 10.31038/NAMS.2024731

Abstract

The thermal stability of natural fiber composites is a relevant aspect to be considered since the processing temperature plays a critical role in the manufacturing process of composites. At higher temperatures, the natural fiber components (cellulose, hemicellulose, and lignin) start to degrade and their major properties (mechanical and thermal) change. Different methods are used in the literature to determine the thermal properties of natural fiber composites as well as to help to understand and determine their suitability for a certain applications (e.g., Thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), and differential mechanical thermal analysis (DMA)). Weight loss percentage, the degradation temperature, glass transition temperature (Tg), and viscoelastic properties (storage modulus, loss modulus, and the damping factor) are the most common thermal properties determined by these methods. This paper provides an overview of the recent advances made regarding the thermal properties of natural and hybrid fiber composites in thermoset and thermoplastic polymeric matrices. First, the main factors that affect the thermal properties of natural and hybrid fiber composites (fiber and matrix type, the presence of fillers, fiber content and orientation, the treatment of the fibers, and manufacturing process) are briefly presented. Further, the methods used to determine the thermal properties of natural and hybrid composites are discussed. It is concluded that thermal analysis can provide useful information for the development of new materials and the optimization of the selection process of these materials for new applications. It is crucial to ensure that the natural fibers used in the composites can withstand the heat required during the fabrication process and retain their characteristics in service.

Keywords

Natural fiber reinforced composite material, Thermal analysis, Thermogravimetric analysis (TGA), Differential scanning calorimetry (DSC), Differential mechanical thermal analysis (DMA)

Introduction

The application of composites has continuously increased across many industries, in particular in the automotive and aerospace industries where lower weight and high resistance are key factors. The most commonly used fibers that attend these requirements are carbon and glass fibers [1-3]. However, nowadays, the industry is seeking new desirable characteristics of composite materials, such as renewability, eco-friendliness, and low cost. Consequently, there has been great interest in research and innovation in natural fiber composites owing to the advantages of these materials compared to their synthetic fiber counterparts (i.e., lower environmental impact and lower cost), supporting their potential across a wide range of applications in several industrial sectors [4-9]. The natural fiber-reinforced composites (NFRCs) are used mainly in non-structural car body parts, such as door panels, package trays, hat racks, instrument panels, internal engine covers, sun visors, boot liners, oil air filters, and even progressing to more structurally demanding parts, such as seat backs and exterior underfloor paneling [10,11]. Nowadays, most of the automotive makers, such as Audi, Volkswagen, Toyota, Daimler-Benz, Volvo, Ford, etc., use NFRCs to produce components. The continually growing demands for lightweight and fuel-efficient vehicles will further push the growth of NFRCs in the automotive market. There are other exciting market trends going forward in many different industries. For example, tri-dimensional hybrid natural fiber reinforcement preforms have been used recently by sports car manufacturers, such as Porsche and even McLaren in Formula 1 .Other applications of NFRCs include sport equipment, musical instruments, aerospace, construction industry [12-14], and ballistic armour [15,16].

Several types of natural fibers are currently used in industry, such as jute, sisal, oil palm, kenaf, and flax, which are well established in the global market with a well-defined production line. However, new promising natural fibers are being discovered and used on a smaller scale or are still being used only for research. This is the case of the buriti and curauáfibers, for example, that still need some improvements in their production line to be more commercially affordable and reach widespread use [17,18]. They are used as reinforcement fibers in thermoset or thermoplastic polymeric matrix in a variety of applications [19]. Depending upon the matrix type, NFRCs are categorized into completely biodegradable or partially biodegradable composites.The growing importance of natural fiber reinforced composites is reflected by the increasing number of publications (e.g., reviews, patents, book chapters, and books) during the recent years [20-25]. Therefore, it is important to study their thermal and mechanical behaviour in order to utilize their full potential. The thermal stability of natural fiber composites is a relevant aspect to be considered as the processing temperature plays a crucial role in the fabrication process of the composites. At higher temperatures, the natural fiber components (i.e., cellulose, hemicellulose, and lignin), start to degrade and the major properties (mechanical and thermal) of the composite change. Intense research efforts are continuously made and some of the shortcomings of NFRCs were addressed by recent advancements in fiber treatment and modification, exploration of new natural fibers, and hybridization. The fiber modification techniques provide improved fiber–matrix interfacial adhesion, improved fiber roughness, and wettability and depend on the particular fiber/matrix used and the composite application, while the hybridization methods provide flexibility in fiber selection for the material properties according to the end-use application requirements.

Even though there are many recent review articles concerning the use of natural fibers in the production of natural hybrid composites [26-34], one topic that was not covered in any significant detail relates to the thermal characterisation of NFRCs. This paper provides an overview of the recent advances in the thermal properties of natural and hybrid natural fiber composites in thermoset and thermoplastic polymeric matrices. First, the main factors that affect the thermal properties of natural and hybrid fiber composite materials (fiber and matrix type, the presence of additive fillers, fiber content and orientation, the treatment of the fibers, manufacturing process, and type of loading) are briefly presented. Further, the methods used to determine the thermal properties of natural and hybrid composites are discussed. Finally, some conclusions and critical challenges and future perspectives and research activities are summarized.

Influencing Factors

The main factors that affect the thermal properties of natural and hybrid fiber compo-site materials are: fiber and matrix type, the presence of additive fillers, fiber content and orientation, the treatment of the fibers, manufacturing process, and type of loading [35].

Methods Used to Determine the Thermal Properties of Natural and Hybrid Composites

The following methods are used

a) Thermogravimetric Analysis (TGA)

b) Differential Scanning Calorimetry (DSC)

c) Dynamic Mechanical Analysis (DMA)

Conclusions

Thermal analysis can provide useful information for the development of new materials and optimization of the selection process of these materials for new applications. The most common thermal properties studied in the literature are: the percentage of weight loss, the degradation temperature, Tg, and viscoelastic properties (storage modulus, loss modulus, and the damping factor). Different factors affect the thermal properties of natural fiber composites (i.e., fiber and matrix type, the presence of fillers, fiber content, and fiber orientation, the chemical treatment of the fibers, manufacturing process, and type of loading). It is crucial to ensure that the natural fibers used in the composites can withstand the heat required during the fabrication process and retain their characteristics after exposure to heat. Different approaches were used in the literature for the enhancement of thermal properties of natural fiber-based composite materials. For example, using natural fibers with low lignin content leads to a better thermal performance of composites. Another approach involves the removal of lignin through fiber treatment. Finally, the incorporation of synthetic fillers or synthetic fibers in natural fiber reinforced composites increase their thermal stability.

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