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Superwetting Materials with Different Dimensions are Used in the Study of Oil-Water Separation

DOI: 10.31038/AFS.2024613

Introduction

With global warming, the shortage of water resources is aggravated, and a large amount of oily wastewater produced by the petroleum industry poses a threat to the ecological environment. The traditional oil-water separation methods have some problems, such as low efficiency, long cycle, complicated operation and secondary pollution. The appearance of ultra-wetting materials has brought new hope for solving these problems. This paper focuses on the application of ultra-wetting materials in the field of oil and water separation, introduces the limitations of traditional separation methods, expounds the research progress of ultra-wetting materials, wetting theory, and discusses various types of ultra-wetting materials in detail, and finally summarizes the shortcomings of existing materials and looks forward to the future.

Superwetting Oil-Water Separation Material

Super Hydrophobic – Super Oil Wet Material

Summarizing this type of material, compared with the previous two, its three-dimensional structure is equivalent to a random stacking of multi-level two-dimensional materials, which significantly enhances separation efficiency. Additionally, small oil droplets undergo demulsification, coalescence, and separation within the internal space, thereby achieving emulsion separation and efficient “dewatering”. However, for most non-metallic substrates, further research is needed to explore and improve their mechanical stability, reusability, and durability.

Super Hydrophilic – Underwater Super Oil Phobic Material

In summary, in the realm of superhydrophilic–underwater superoleophobic three-dimensional materials, there still exist a series of application issues such as structural instability, poor overall wear resistance, and susceptibility to contamination in complex environments. These issues serve as inspirations for targeted solutions in subsequent development efforts. Additionally, practical applications of the material are often limited by factors such as synthetic preparation methods. Nevertheless, overall, these “oil-removing” type three- dimensional wetting materials exhibit higher emulsion separation performance compared with two-dimensional materials.

Superhydrophobic – Superoleophobic Materials

According to the previous discussion, three-dimensional materials can utilize porous nickel foam substrates, directly forming micro-nano rough structures on the three-dimensional framework. Compared with two-dimensional materials where particles adhere to the surface and are combined with binders, this approach offers superior performance and a more efficient preparation process. For non-metallic substrate materials, the three-dimensional structure provides sufficient space to accommodate inorganic hybrid polymers, forming a unique porous structure and significantly enhancing their mechanical strength.

“Special” Ultra-Wetting Materials

Compared with two-dimensional materials, three-dimensional “special” superwetting materials exhibit enhanced water absorption capabilities. Additionally, the selection of these materials increasingly considers the application of green, biodegradable materials. To address common oil–water separation clogging issues, porous superamphiphilic materials offer a fundamental solution, with aerogel materials selectively capturing the water phase to improve separation performance.

Smart Switchable Superwetting Material

Two-dimensional switchable superwetting materials focus on reusability and recyclability while conserving energy. They achieve on-demand emulsion separation under external stimuli, effectively addressing the single-use issue of one dimensional materials. Additionally, the in situ growth method overcomes the stability problems common in most superwetting materials.

Summary and Outlook

In the future, green and biodegradable base materials have enormous development potential and prospects. The green recycling of materials for renewable use is a key direction for future research. However, current recycled materials still exhibit some apparent disadvantages: cumbersome and complex recycling processes, high energy input, poor durability, and a short lifespan during use. The future aims to combine repairability, self-cleaning, high corrosion resistance, and material recycling to form a completely new industrial chain and breakthrough direction in technology development.

Does Water Immersion Have a Role in Cord BDNF Levels and Neurological Development of the Baby: A Case Control Study

DOI: 10.31038/IGOJ.2024713

Abstract

Background: Brain-derived neurotrophic factor (BDNF) levels in maternal serum and umbilical cord blood serum samples from women who underwent water immersion during labor and those who gave birth without water immersion were compared.

Objectives: This study aimed to investigate the impact of water immersion on maternal and neonatal serum BDNF levels. A total of 57 pregnant women were included in the study, 32 in the non-water immersion group and 25 in the water immersion group. Serum BDNF levels were measured by ELISA an Enzyme-Linked ImmunoSorbent Assay (ELISA). For comparisons between groups, the independent samples t-test, Mann-Whitney U-test, and Spearman rho correlation test were used.

Results: No differences were observed in age, gravidity, parity, maternal BMI, infant weight, and infant sex (p=0.97, p=0.61, p=0.71, p=0.24, p=0.14, and p=0.88, respectively). There was no difference in maternal serum BDNF levels between the two groups were compared (p=0.152). Cord blood BDNF levels were found to be significantly different in the water immersion group compared to the conventional vaginal delivery group (p=0.03).

Conclusions: The high BDNF levels in the water immersion group suggest that this method may contribute to the neurological development of infants. We believe that water immersion can have a positive effect on the psychology of mothers and their babies.

Keywords

Hydrotherapy, Brain-derived neurotrophic factor, Immersion in water, Neurological development

Introduction

Hydrotherapy and water immersion are long-standing therapeutic techniques used in medicine. Thus, the popularity of this method has increased. Water immersion has become widely used worldwide as a non-pharmacological method for reducing the stress of labor pain [1-3].

Although water birth and hydrotherapy (water immersion or immersion in water) are thought to be similar techniques, they are different. While hydrotherapy is a non-pharmacological method to cope with labor pain, water birth is the use of hydrotherapy in the second stage of labor, and as the delivery takes place in water, it can be accepted as a birth method.

Studies have underscored the drawbacks of water birth, including the risks of maternal and neonatal infections as well as potential respiratory issues for newborns [3]. Water birth performed by skilled obstetric care providers in a hospital setting is a reasonable option for low-risk women and their newborns. In a recent study, the water immersion group demonstrated lower rates of neonatal intensive care, special care nursery admission, and perineal laceration than the control group. Furthermore, this review provides additional information on immersion water [4-6].

The benefits of water immersion for pregnant women are apparent. Owing to the buoyancy of water, hydrotherapy enables pregnant women to move their legs more easily. It has been proposed that water immersion during labor enhances maternal satisfaction and a sense of control [1].

Women who sense control during childbirth tend to have enhanced emotional well-being postnatally [1]. It is also known that immersion in water significantly reduces the anxiety of pregnant women [2]. Some professional associations, such as the Royal College of Obstetricians and Gynecologists and the American College of Nurse-Midwives, support uncomplicated healthy pregnant women having water births [7].

BDNF is a protein belonging to the neurotrophin subfamily that has various effects on the central nervous system. Neurotrophins is a crucial intracellular factor that contributes to the maintenance of neuronal function. BDNF forms neurotrophins, which are very important in protecting the nervous system and neuronal structure. BDNF plays a role in the differentiation of cells into neurons in the neural root during development by preventing neuronal death in cases such as trauma or ischemia in adult brain cells. It contributes significantly to the continuation of their vitality. In addition, BDNF has a significant impact on brain development in the prenatal and postnatal periods [8-10].

BDNF has been studied in mammals, mostly during the prenatal period and neurogenesis phase [8]. This stage is important because although neurogenesis is completed a few days before birth, most neurons in the hippocampus occur after birth [11].

We aimed to investigate the relaxing and pain-reducing effects of water immersion on maternal and infant cord serum BDNF levels.

Methods

Study Design

This prospective case-control observational study was carried out at the Zekai Tahir Burak Women’s Health Education and Research Hospital with the approval of the ethics committee (ethical approval statement: 58/2018) and in accordance with the Helsinki criteria. The women were divided into two groups: the control group consisted of 32 pregnant women who did not receive water immersion during labor and gave birth vaginally, and the case group consisted of 30 women who received water immersion during labor and gave birth vaginally.

Setting

We selected our study patients among full-term pregnant women between 37-40 weeks, hospitalized in the obstetrics clinic for delivery. Our study was conducted over a period of 6 months.

Immersion water was present in the special pools in the delivery room. Attention was paid to the cleaning of the pool. The bathtub was cleaned after each use as part of the precautions taken to prevent infection before immersion. First, the organic waste was removed and prewashed with running water. After preliminary cleaning with detergent and water, drainage pipes were cleaned and treated with chlorine tablets. The cleaning was completed after waiting for a certain period. Materials used in bathtubs, such as thermometers and hand dopplers, are also disinfected by surface disinfectants. After disinfection, cultures were collected from the bathtub surface, pool bottom, drain, and water flow areas. If the culture result is negative, the pregnant woman can be placed in a bathtub. All operations were performed by trained personnel.

Participants

A total of 62 pregnant women between the ages of 18 and 40 years, with pregnancies between 37 and 40 weeks, and who were in active labor during the examination, were included in our study. All pregnant women were in vertex presentation at the examination and had antenatal follow-ups in the maternity polyclinics of the same hospital. The amniotic membrane was observed to be intact during the examination. The exclusion criteria were as follows: pregnant women with a history of cesarean section, chronic disease, malpresentation, ruptured amniotic membrane, high-risk pregnancy, and medical and obstetric risks. Pregnant women with macrosomia fetuses and refugees on ultrasound who also had signs of active infection and fetal distress with bleeding were excluded from the study (Figure 1).

Figure 1: Inclusion and exclusion criterias.

The control group comprised of 32 patients with normal birth pain. No non-pharmacological or pharmacological pain relief methods were applied in this group. Labor was not induced.

Pregnant women in the case group (n=30) with cervical dilatation of 3 cm and 70% were taken to a pool, which had a temperature of 37–37.5⁰C and was wide enough for the woman to move freely. Fetal heart monitoring was performed at regular intervals using Doppler or non-stress tests (NST). The second stage of labor was carried out in a controlled manner outside the water. In both groups, as soon as the baby was born, it was placed on the mother’s womb, the cord was cut, and the delivery of the placenta and membranes was completed.

Venous blood samples were obtained from the mothers after birth. After the cord was clamped, blood samples were collected.

Measurements

Serum samples were separated by centrifugation at 5000 revolutions/min (2236 × g) for 10 min within 15–20 min of blood sampling. They were frozen immediately and stored at -80⁰C until the final analysis.

Serum BDNF levels were measured using an ELISA. The BDNF concentration was determined using the Elab Science Human BDNF ELISA kit (Elabscience Biotechnology Inc., Wuhan, China), which had a sensitivity of 18,75 pg/mL. The sandwich principle was used for the ELISA kit. The micro-ELISA plate provided in this kit was precoated with an antibody specific for human BDNF. Assays were performed according to the manufacturer’s instructions as follows: standards and samples were added to the micro-ELISA plate wells and combined with the specific antibody. Then, a biotinylated detection antibody specific for human BDNF and an avidin-horseradish peroxidase (HRP) conjugate were added to each microplate well and incubated. The free components were then washed away. The substrate solution was then added to each well. The enzyme-substrate reaction was terminated by the addition of a stop solution. The optical density (OD) was measured spectrophotometrically at a wavelength of 450 ± 2 nm. The OD value is proportional to the concentration of human BDNF. Maternal serum and infant cord blood BDNF levels (pg/ml) were recorded.

Bias

The case and control groups were selected from patients with the same characteristics. In contrast, only hydrotherapy was administered in the patient group. Five of the 30 patients in the case group were excluded from the study because their blood samples were damaged during transport. The number of cases had decreased to 25.

Statistical Analyses

Study Size

The mean standard deviation of BDNF in women giving birth in water was predicted to be 1200 ± 290 pg/ml. Thus, the effect size was calculated to be 0.741. With an alpha of 0.05 and power of 0.80, the sample size was determined to be 60 people in total, with at least 30 people in each group.

Variables

After birth, the weight and sex of the infants were recorded. In this study, age, gravidity, parity, BMI, baby weight, baby sex, and BDNF levels were compared between the two groups.

Statistical Methods

Whether the variables with numerical results in the study were normally distributed was examined using the Shapiro–Wilk test and graphs (histogram, boxplot, etc.). Normally distributed variables, such as age, infant weight, and BMI, were compared between the two groups using an independent sample t-test. While performing the independent samples t-test, Levene’s test was used for the equality of variances. The distribution of other numerical variables that did not show a normal distribution was compared between the two independent groups using the Mann-Whitney U test, which is a nonparametric test. Descriptive statistics are given as the mean standard deviation for numerical variables compared with parametric tests and median (min-max) for nonparametric tests. Sex, which is a categorical variable, was compared between the groups using the Pearson Chi-Square test. Yates’ correction was not used, and descriptive statistics for this variable are given as numbers and percentages. The relationships between numerical variables were analyzed using Spearman’s rho correlation coefficients. Statistical significance was set at p < 0.05. Analyses were performed using SPSS IBM Statistics 23.0 Program.

Of the 62 pregnant women included in the study, 32 were in the control group and all were considered suitable until the end of the study. As the serum samples of 30 pregnant women in the case group were collected during transportation, 25 were evaluated.

Results

Descriptive Data

When the demographic data of the two groups were examined, no differences were observed in age, gravidity, parity, maternal BMI, infant weight, and infant sex (p=0.97, p=0.61, p=0.71, p=0.24, p=0.14, p=0.88, respectively) (Table 1).

Table 1: Comparison of demographic characteristics, clinical features and BDNF levels of umbilical cord, and maternal serum between the control and case groups.

Variables

The control group (labor without immersion-no hydrotherapy) The case group (labor immersion in water-hydrotherapy)

P-value t/df/z/x²

Frequency

32

25  

Age (years) Mean ± SD

26 ± 5.5 26 ± 5.8

0.979

t: -0.027

df: 55

Gravida Mean ± SD (Median (Min-Max)

2.03 ± 0.7

2(1-4)

2.16 ± 0.8

2(1-4)

0.613

z: -0.505

Parity Mean ± SD (Median (Min-Max)

0.94 ± 0.6

1(0-2)

1 ± 0.6

1(0-2)

0.711

z: -0.370

BMI kg/m2 Mean ± SD

28.76 ± 4.7

27.49 ± 2.9 0.249

t: 1.166

df: 55

Baby weight kg Mean ± SD

3.304 ± 447 3.460 ± 329

0.149

t: -1.063

df: 55

Baby gender male/female n (%)

Male: 16 (50%)

Female: 16 (50%)

Male: 13 (52%)

Female: 12 (48%)

0.881

x²: 0.022

df: 1

Maternal serum BDNF levels pg/ml Mean ± SD

(Median (Min-Max)

110.07 ± 79.89

85.49(39.16-359.68)

130.83 ± 79.44

113.79(13.90-332.57)

0.152

z: -1.431

Umbilical cord serum BDNF levels pg/ml Mean ± SD

(Median (Min-Max)

160.47 ± 82.31

137.81(66.72-415.49)

226.48 ± 128.44

168.20(84.99-48.204)

0.033* z: -2.127

P-value <0.05 is considered as statistically significant.
BMI: Body mass index; BDNF: Brain derived neurotrophic factor; SD: Standard deviation.Min-Max: Minimal and maximal value.
An independent samples t-test (with t and df) was used to compare age, baby weight, and BMI. While performing the Independent samples t test, Levene’s test was used for equality of variances.
The Mann-Whitney U test (with p and z values) was used to compare gravida, parity, and BDNF.
The Pearson Chi-Square test (with value (x²) and df) was used to compare the gender distribution of babie. Yates’s correction was not us.

Outcome Data

When the maternal serum BDNF levels were analyzed, no statistically significant difference was observed between the two groups (p=0.152). However, cord blood BDNF levels were significantly different between the case group compared with the control group (p=0.03).

Neither maternal serum nor cord serum BDNF values differed according to sex (p=0.861 and p=0.718, respectively). A statistically weak but significant correlation was found between infant weight and maternal serum BDNF level (p=0.004; r=0.371). There was also no relationship between baby weight and cord BDNF level (p=0.642; r=0.063) (Table 2).

Table 2: Maternal and umbilical cord serum BDNF levels acccording to baby gender.

Variables

Female n=28 Male n=29 P-value

Maternal serum BDNF levels pg/ml Mean ± SD

(Median (Min-Max)

126.77 ± 92.05

87.03(39.16-359.68)

111.85 ± 66.38

96.95(13.90-312.64

0.861

z: -0.176

Umbilical cord serum BDNF levels pg/ml Mean ± SD

(Median (Min-Max)

189.94 ± 117.05

191.84 ± 104.02

0.718

z: -0.361

BDNF: Brain Derived Neurotrophic Factor; SD: Standard deviation; Min-Max: Minimal and maximal value.
The Mann-Whitney U test (with p and z values) was used to compare BDNF.

Discussion

Immersion in the waterbirth method provides many benefits in the form of maternal satisfaction, pain control, and easy movement in water. In this method, pain is reduced by hydrotherapy by taking pregnant women into the pool during labor, but birth takes place outside the pool. On the other hand, during a water birth, the pregnant woman is taken into the water during labor, and the birth takes place in the water. Both methods have been found to be beneficial for the emotional comfort of postpartum mothers [1]. However, studies on the neonatal benefits of these methods are limited. There are selected studies on immersion in water and the absence of fetal side effects during birth [4,12].

This study was designed to investigate the potential benefits of water immersion. The advantages of water immersion during labor or birth encompass reduced pain, expanded functional diameter of the true pelvis, improved quality of contractions, heightened release of endorphins, diminished reliance on opiates, increased mobility for the mother, and enhanced positioning during various stages of labor [13]. We aimed to investigate whether hydrotherapy has an increasing effect on maternal and infant cord BDNF values, and whether hydrotherapy has a positive neurohormonal effect. We compared BDNF, a neurotrophic factor in the serum of maternal and infant cord blood, in hydrotherapy and conventional vaginal delivery and found that maternal serum BDNF levels were not different. Although there was no statistical difference between maternal serum BDNFs levels, the mean values in the hydrotherapy group were significantly higher. This may be because of the small sample size. Despite this, cord serum BDNF levels were significantly higher in the hydrotherapy group.

Neurotrophins are important regulators of neural cell survival, development, function and plasticity. Mammals have four neurotrophins that are derived from the same ancestral gene [26]. Neurotrophins support neuron survival and prevent neuron apoptosis [14].

Neurotrophins play an important role in axon growth during development, higher neuronal function, morphologic differentiation, and neurotransmitter expression [15]. Thus, neurotrophins can play an important role in the development of the brain before and after birth. However, data on the presence and effects of neurotrophins in preterm infants are insufficient. BDNF and NT-3 are highly expressed in the cortical and hippocampal structures and have been linked to the survival and function of multiple neuronal populations [16].

BDNF was found to be related to hypoxic-ischemic encephalopathy, mental retardation, and autism in newborns. The importance of BDNF and NT3 in neurodevelopment in the intrauterine period has been emphasized. There is evidence that prenatal or maternal traumatic stress has a significant impact on neurodevelopment. In general, the earlier and more severe the trauma, the more impaired the neurodevelopment [17]. The better the mother’s comfort during delivery, the easier the mother’s adaptation to the mother’s puerperium, and the lower the rate of postpartum depression. Therefore, we believe that immersion in water may be beneficial to neurological development.

BDNF is important in neuronal plasticity [18]. BDNF has mostly been studied in mammals during the prenatal and neurogenesis stages, but relatively less in the postnatal period [8]. This phase is important because, although neurogenesis is completed several days before birth, most neurons in the hippocampus appear after birth [11]. In addition, since BDNF is very important in mammalian adults, our research goal was to investigate whether BDNF changes depending on the mode of delivery.

In the water immersion group, high BDNF levels in the cord blood, but not in the mother’s blood, may contribute positively to the neurological development of the newborn. Moreover, Kodomori et al. showed in their animal study that maternal BDNF contributes to the neurological development of the fetus through uteroplacental passage. In our study, high BDNF levels were detected in the cord blood of rats in the water immersion group. In the perinatal period, the blood-brain barrier is immature because circulating BDNF may reflect the level of BDNF in the central nervous system, and circulating cortical BDNF levels are correlated, as has been reported. Again, in previous studies, conditions such as surgery, stress, birth, and hypotension that cause stress in the central nervous system have been found to cause changes in BDNF release. Accordingly, since hydrotherapy is a less painful and emotional form of delivery, higher BDNF values were obtained in our study group [18-20].

We also investigated the relationship between infant weight and BDNF levels and found only a weak link between maternal serum BDNF levels and infant weight. All the infants included in this study were term. In a recent animal experimental study [21], the relationship between infant sex and BDNF was investigated, and it was shown that BDNF content increased in the brains of both male and female rat pups 0 h after hypoxia and 4 h in serum; however, only males had increased brain BDNF levels 4 h after hypoxia. When we investigated the relationship between baby sex and BDNF levels, we did not find any difference in BDNF levels between the sexes. This may be due to the small number of patients. As this subject has been extensively researched and the importance of BDNF and other neurohormones is increasing, more long-term studies are needed.

Recent studies have investigated the use of serum BDNF levels in Alzheimer’s disease and as a biomarker of schizophrenia and depression. We aimed to examine serum BDNF levels because we believe that hydrotherapy has positive effects on maternal psychology and protects against the development of postpartum depression. As hydrotherapy has positive effects on maternal psychology and postpartum depression, we examined serum values [21-23].

Neurotrophic factors play crucial roles in neuroprotection. Neurotrophins promote survival and reduce apoptosis in many populations of neurons [14].

Limitations of the Study

The small number of participants in our study and the fact that we did not follow mothers and babies in the long term may be a limitation of our study.

Conclusions

In light of these studies, the neuroprotective effects of neurotrophins, especially BDNF, including anti-apoptotic axonal development of neurons, neurodevelopmental effects that have healing effects in some neurodegenerative diseases, and their positive effects in diseases such as autism and mental retardation, have increased the importance of BDNF in recent years. The relationship between BDNF, other delivery modes, and hydrotherapy has not been previously studied. Although we have shown in our study that hydrotherapy delivery may have a positive effect on BDNF levels, we believe that immersion in water contributes to the development of neurons in newborns by increasing BDNF levels. We hope that our study will encourage future research on this very important subject and will shed light on future studies on this very important subject.

Declarations

  1. Conflict of interest: Not applicable
  2. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
  3. Ethical approval: Ethical approval was received from the Zekai Tahir Burak Women’s Health Education and Research Hospital with the approval of the ethics committee (ethical approval statement: 58/2018).
  4. Consent to Participate: All participants provided written informed consent prior to their participation in the study in accordance with the tenets of the Declaration of Helsinki.
  5. Authors’ Contributions:
    Conceptualization: Rahime Bedir Findik
    Investigation: Rahime Bedir Findik, Ozlem Uzunlar, Esin Merve Erol Koc
    Methodology: Rahime Bedir Findik, Ozlem Uzunlar
    Resources: Rahime Bedik Findik, Ozlem Uzunlar, Esin Merve Erol Koc
    Validation: Rahime Bedir Findik, Ozlem Uzunlar
    Supervision: Yaprak Ustun
    Writing – original draft: Rahime Bedir Findik, Ozlem Uzunlar
    Writing – review & editing: Rahime Bedir Findik, Ozlem Uzunlar
    Formal analysis: Jale Karakaya, Gulsen Yilmaz, Fatma Meric Yilmaz Mert
    All authors have read and agreed to the submitted version of the manuscript.
    1. Data availability: Data are however available from the authors upon reasonable request and with permission from [third party name].

    Abbreviations

    BDNF: Brain-Derived Neurotrophic Factor; ELISA: Enzyme- Linked ImmunoSorbent Assay; OD: The Optical Density

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Evaluation of In Vitro Cell Viability and Cytokine Production by Mesenchymal Stem Cells Exposed to the Homeopathic Medicine Matricaria chamomilla D3

DOI: 10.31038/IJVB.2024823

Abstract

Chamomilla has long been recognized in traditional medicine for its established uses in herbal medicine and homeopathy. It is commonly recommended for treating respiratory, hepatic, gastrointestinal, and mental disorders. Additionally, it exhibits sedative, antiseptic, antiemetic, and anti-inflammatory properties and is frequently used to address issues related to teething in young patients. Despite its widespread use, scientific validation is essential to enhance the credibility of this medicine. In vitro studies offer a valuable approach for assessing the impact of homeopathic medicines on cellular functions, including cytotoxicity and cytokine secretion. Cell viability is typically evaluated through assays such as MTT, which measures cellular metabolic activity and provides insight into the proportion of viable cells following exposure to specific compounds. In the case of mesenchymal stem cells (MSCs) exposed to Matricaria chamomilla D3, the goal is to determine whether the homeopathic remedy affects cell survival or induces cytotoxicity. MSCs are known for secreting various cytokines that regulate inflammatory responses and promote tissue regeneration. Exposure to Matricaria chamomilla D3 may influence cytokine secretion, potentially altering the inflammatory response. This study evaluated the in vitro toxicity of injectable Chamomilla D3 in human mesenchymal stem cells, along with its potential anti-inflammatory effects, as evidenced by the reduction in the pro-inflammatory cytokine IL-8. The findings suggest that homeopathic Chamomilla D3 exhibits in vitro anti-inflammatory activity.

Keywords

Homeopathy, Vegetal, Complementary medicine

Introduction

Matricaria chamomilla, also known as chamomile, is a globally distributed plant [2]. It has a rich history in herbal medicine and homeopathy, with indications for treating various diseases [1]. Matricaria chamomilla is a versatile plant with multiple uses in folk medicine. It treats respiratory, hepatic, gastrointestinal, and mental alterations like stress and anxiety. It is also used as a sedative, antiseptic, and antiemetic, among others reported.

The phytochemistry, biological, and pharmacological properties of Matricaria chamomilla extracts are extensively characterized and systematically documented within herbal medicine. Its phytochemical composition encompasses over 120 bioactive compounds, including essential oils, terpenoids, and phenolic substances such as phenolic acids, flavonoids, and coumarins. These compounds impart a range of well-documented activities, including antioxidant, antibacterial, antifungal, antiparasitic, insecticidal, antidiabetic, anticancer, anti-inflammatory, antidepressant, antipyretic, anti-allergic, and analgesic effects [3].

According to the Homeopathic Medical Material, Matricaria chamomilla is indicated for various clinical manifestations such as irritability and hypersensitivity. Additionally, it may be relevant for treating otitis and diarrhea, especially in children, and for conditions associated with teething and gastrointestinal disturbances [4]. described effects such as anti-inflammatory and antispasmodic activities, among others, that support alleviating clinical symptoms. These effects may significantly improve the previously mentioned signs and symptoms [5].

The present study aimed to evaluate the anti-inflammatory activity of Matricaria chamomilla prepared according to the homeopathic pharmacopeia, specifically at a D3 potency and a concentration of 8 µL/mL. This evaluation focused on releasing the inflammatory cytokine Interleukin 8 (IL-8) and assessed the viability of healthy mesenchymal stem cells exposed to the medicine Matricaria chamomilla.

Materials and Methods

MTT Assay

The injectable homeopathic medicinal product Chamomilla D3 was tested on human mesenchymal stem cells (MSC) by the MTT test at a concentration of 8 µL/mL. Cell culture was performed in 75 cm2 flasks until reaching 80% confluence. Human mesenchymal stem cells in culture were trypsinized and distributed in a 96-well plate. After this process, the cells were incubated for 24 hours at 37°C in a 5% CO₂ environment. The test substance was prepared at 8 µL/mL and distributed into the designated wells. After 24-hour incubation, the culture medium was withdrawn and discarded. A volume of 50 μL of medium supplemented with 20% FBS was added, followed by 50 μL of medium containing the diluted test substance. The cells were incubated for an additional 48 hours in a CO₂ incubator, maintained at 5% CO₂ and a temperature of 37°C. After this period, the treatment medium was discarded, and 100 µL of the MTT solution was added to each well. The plate was covered with aluminum foil and incubated for 4 hours in an oven. Subsequently, MTT was removed, and 100 µL of DMSO was added to each well. The optical density was measured at 570 nm ± 10 nm using a plate reader. After this assay, the cytokine levels released upon exposure to the medicine were measured.

Cytokine Dosing

After reaching cellular confluence, cultured human mesenchymal stem cells were subjected to trypsinization and plated in 96-well plates. After 24 hours of incubation at 37°C with 5% CO₂, the culture medium was removed, and the wells were washed with PBS. Subsequently, 200 μg/mL of LPS (lipopolysaccharides from *Escherichia coli* O55: B5 – Sigma Aldrich), diluted in an antibiotic-free medium, was added in wells of positive control group and treatment group. Negative control group did not receive LPS, only culture medium. A subsequent incubation was performed for an additional 24 hours. Following the induction period of cellular inflammation with LPS, the medium was removed from the plate, and the wells were washed with PBS. The medicine was added at a final concentration of 8 μL/mL in treatment group. In negative and positive control groups, culture medium was added. The plate was then incubated for 24 hours under the previously described conditions.

After the treatment period, the supernatant was removed, and serum-free culture medium was added for 24 hours. The supernatant was collected for IL-8 analysis. IL-8 levels were measured using flow cytometry with the FACS VIA BD™ cytometer.

Results and Discussion

The present study assessed the cytotoxicity of the injectable homeopathic medicine Chamomilla D3 in human mesenchymal stem cells. The analysis revealed that, at the tested concentration, the material exhibited no cytotoxic potential (Table 1 and Figure 1).

Table 1: Cell viability obtained from the control and treated groups (Chamomilla 8 μl/mL) after MTT testing.

Cell viability(%)

Control

Chamomilla 8µl/mL
94

93

101

93
102

95

Figure 1: Cell viability (%) of the control and treated groups (Chamomilla 8 μl/mL): ns = no statistical difference.

Following the initial analysis, the release of the inflammation marker IL-8 by MSCs was evaluated both in response to LPS exposure and after treatment with the medicine. It was observed that LPS induced the release of IL-8, demonstrating its effectiveness in stimulating inflammation within the cell culture environment (see Figure 2). Additionally, cells previously “inflamed” by LPS were subsequently “treated” with the homeopathic medicine Chamomilla D3. The results demonstrated a significant reduction in the inflammation marker IL-8 following treatment. A similar pattern was observed in the control group, which consisted of cells maintained in a culture medium without LPS induction or Chamomilla D3 treatment (see Figure 2).

Figure 2: The results of the cytokine dosage test are presented in pg/mL for the following groups: the control group without LPS addition, the control group with LPS addition, and the treated group with Chamomilla at 8 μl/mL.

Homeopathy is frequently investigated due to its low likelihood of toxicity and minimal risk of causing side effects. According to Millstine [6], homeopathy can benefit the treatment of specific clinical conditions by potentially providing symptom relief.

Homeopathic Chamomilla is known for its anti-inflammatory effects, which can aid in treating various conditions [10]. Studies have demonstrated that the compounds in Chamomilla, such as flavonoids and terpenoids, possess properties that aid in reducing inflammation and alleviating related symptoms. As noted by Amsterdam [7], Chamomilla is also recognized for its calming and relaxing effects, which can contribute to alleviating stress and anxiety – factors often associated with inflammatory processes in the body.

Furthermore, regarding the anti-inflammatory properties of homeopathic Chamomilla, this article supports and validates the study by Scabello and Gardin [8], which examines injectable dynamized medicines available in Brazil. The authors noted that Chamomilla harmonizes the excessive action of the soul organization over the vital force, particularly within the digestive and menstrual spheres, and addresses general inflammation, per the principles of Anthroposophical Medicine.

In the homeopathic form, Chamomilla was identified as one of the ten most frequently used medicines for treating migraines, as highlighted and reviewed by Santos. Migraines are types of headaches that impair the patient’s quality of life.

Another property attributed to a medicine based on Matricaria chamomilla is its relaxation and analgesic effects. These effects were demonstrated in the study by Jyothis [9], which experimentally evaluated its impact on the central nervous system. As a result, a significant reduction in locomotor activity was observed, indicating muscle relaxation, analgesic effects, and anticonvulsant activity. Pinto [12] also reported relaxation effects in animals subjected to stress and depression.

The antibacterial and fungicidal actions of Matricaria chamomilla were emphasized in the study by, which explored its various aspects and properties. The study noted that its compounds impart sedative attributes, support digestion, and exhibit antimicrobial effects against bacteria and fungi [13].

Conclusion

The present study demonstrated the low in vitro toxicity of injectable Chamomilla D3 in human mesenchymal stem cells. Additionally, it suggested a potential anti-inflammatory action, as evidenced by a reduction in the levels of the pro-inflammatory cytokine IL-8. However, further studies are needed to confirm the homeopathic indications of its compounds in their homeopathic form and establish Chamomilla‘s in vivo anti-inflammatory activity.

References

  1. Reis LS, Pardo PE, Oba E, Kronka Sdo N, Frazatti-Gallina NM (2006) Matricaria chamomilla CH12 decreases handling stress in Nelore calves. J Vet Sci. [crossref]
  2. El Mihyaoui A, Esteves da Silva JCG, Charfi S, Candela Castillo ME, Lamarti A, Arnao MB (2022) Chamomile (Matricaria chamomilla L.): A Review of Ethnomedicinal Use, Phytochemistry and Pharmacological Uses. Life (Basel) [crossref]
  3. Santos ARF, da C, Cruz JH, de A, Guênes GMT, Oliveira Filho A Ade, Alves M ASG (2020) Matricaria chamomilla L: pharmacological properties. Archives Of Health Investigation, 8(12)
  4. Lathoud JA (2017) Studies of Homeopathic Materia Medica. Ed. Organon. 3rd edition. Sao Paulo.
  5. Fernanda Michel Tavares CANTO(a) Oswaldo de Castro COSTA NETO(a) Jéssica Muniz LOUREIRO(a) Guido Artemio MARAÑÓN-VÁSQUEZ(a) Daniele Masterson Tavares Pereira FERREIRA(b) Lucianne Cople MAIA(a) Matheus Melo PITHON(c) (2022) Efficacy of treatments used to relieve signs and symptoms associated with teething: a systematic review. Oral Res. [crossref]
  6. Millstine D (2023, December) Homeopathy. MSD Manual.
  7. Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J (2009) A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol. [crossref]
  8. Scabello RT, Gardin NE (2015) Potentized injectable medicines available in Brazil: indications based on homotoxicology and possibilities of use according to anthroposophic medicine. Arte Med Ampl
  9. JYOTHIS, AB Ram. A Study on Analgesic activity of Matricaria chamomilla.
  10. Srivastava JK, Shankar E, Gupta S (2010) Chamomile: A herbal medicine of the past with bright future. Mol Med Report. [crossref]
  11. Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J (2009) A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol.
  12. Pinto SAG, Bohland E, de Paula Coelho C, de Azevedo Morgulis MSF, Bonamin LV (2008) An animal model for the study of Chamomilla in stress and depression: pilot study. Homeopathy [crossref]
  13. Singh O, Khanam Z, Misra N, Srivastava MK (2011) Chamomile (Matricaria chamomilla L.): an overview. Pharmacognosy Reviews.

Existential Communication – Old Wine in New Skins?

DOI: 10.31038/PSYJ.2024644

Abstract

Background: The term existential communication did not emerge but recently in medical terminology. It refers to doctor-patient-communication comprising issues of mortality, fragility of human being, and associated rational and emotional coping.

Objective and methods: A literature search the term existential communication was carried out in PubMed. Moreover, from the results and the author`s long background of facilitating “breaking-bad-news” workshops for oncologists, features of an existential communication are demonstrated.

Results: A PubMed search resulted in only 8 papers from the last decade explicitly using the term existential communication. Hundreds of papers used existential in various other attributions – from existential aspects to existential yearnings. The term existential was rooted in various directions of predominantly German existential philosophy, which after National-Socialism resonated in the USA and catalyzed pioneering strategies of psycho- oncological support. Some training programs for existential communication have been established and share the principles of breaking-bad-news communication.

Conclusion: Existential communication describes more precisely than end-of-life (EOL) discussion a long-standing and teachable medical task which must not be neglected without compromising high quality patient care, in particular in oncology and palliative medicine. Existential communication is prerequisite to avoid burdening patients with very advanced cancers with futile tumor-specific treatments and detrimental adverse-effects. Existential communication is important for patients but may foster a deeper professional satisfaction of health care professionals (HCP).

Keywords

Medical communication, Cancer, Psycho-oncology palliative care, Spirituality end-of-life discussion

Im existentiellen Bereich sind Wahrheit und Kommunikation dasselbe.

In the existential realm truth and communication are identical (translation HK) Hannah Arendt, 1957 [1]

Introduction

Originally the term existential communication has been a central concept of the existential philosophy of Karl Jaspers (1883-1969) [2], a renowned German philosopher and psychiatrist. Nearly a century ago, he coined existential communication for a uniquely dyadic and non-hierarchical communication which enables both interlocutors to evolve their distinctive personhood, their existence. The term opposed the Daseins-communication (communication of being) of daily life inclusive clinical practice. Thus, Jaspers` philosophical construct of existential communication was not established for clinical practice and consequently did not enter medical terminology. Hence, in 1969 Swiss- American psychiatrist Elisabeth Kübler-Ross could finish her landmark book On death And Dying [3] without using the term existential, even if her end-of-life conversations with patients doubtlessly meet today´s understanding of existential communication. Neither can be found the term existential in Cicely Saunders paramount book of palliative medicine of 1978 [4]. However, this book outlined her concept of total pain, which soon should shape the understanding of palliative care of the World Health Organization (WHO) [5] and of international and national palliative care societies [6]. Since then, state-of-the-art care of patients with life-threatening disease embraces a spiritual dimension. Almost simultaneously with the term spiritual the term existential emerged in the Anglo-American medical literature, though. Unlike existential communication the single term existential had entered psychiatric literature of German language already in the first half of the 20th century. The German philosopher Martin Heidegger (1889- 1976) had influenced the psychiatric and respective psychotherapeutic Daseins-Analysis of Ludwig Binswanger [7] and Medard Boss [8], both Swiss psychiatrists and psycho-analysts. Moreover, Viktor Frankl, an Austrian psychiatrist of Vienna, who had established his scientific reputation with innovative concepts of care for suicidal individuals and patients with depression, i.e. patients facing an existential crisis, had outlined his Existence-analysis and Logotherapy since the mid- thirties [9]. But during the Nazi-Era humanistic psychiatric patient care influenced by psychoanalysis and existential philosophy was eradicated in Nazi-dominated Europe and many of the most eminent representatives of German oncology and psychiatry – for being Jews – were forced to emigrate or into murderous concentration camps. In regard to their Nazi-collaboration German medical organizations put under taboo and discouraged any deeper reflection of existential philosophical issues like responsibility, guilt, and shame after the defeat of the Nazi-regime for more than one generation. However, US-American psychiatrists explicitly referring to the above mentioned European philosophers and clinicians soon should introduce the term existential into a now Anglo-American medical literature. Viktor Frankl, who had survived four concentration camps, took an important role for this transatlantic loop of the term existential. He refined his meaning-centered Logotherapy and Existence-analysis reflecting his years of existential threat and the murdering of his family in concentration camps. Initially his concept did not resonate much in the scientific community of post war Austria and Germany, but he gained recognition as a visiting professor at Harvard and other US- universities and with the English translation [10] of his post war book, which has been sold in millions of copies. In a 1991 survey Man’s Search for Meaning was rated one of the ten most influential books in the US. Independently, Stanford psychiatrist Irvin Yalom developed his very influential Existential Psychotherapy [11] leaning on Viennese psycho- analytic concepts and European pre-war existential philosophy. Yalom´s resources-centered therapeutic approach has been modified for psycho- oncological support for patients with cancer: at Stanford psychiatrist David Spiegel established his Supportive-Expressive Psychotherapy [12,13], while William Breitbart – a child of Holocaust survivors, and explicitly referring to Viktor Frankl – developed his Meaning-Centered Psychotherapy [14] at New York´s Sloan-Kettering Cancer Center. Spiritual, existential and finally existential communication had entered literature of oncology and palliative medicine, even if the conceptual understanding of different authors diverge [15].

Methods and Materials

A literature search was conducted in Pubmed (accessed June 21,2024) using the search term existential communication which resulted in 834 references. These comprised both papers using the combined term or just the single term existential or communication. Thus, many references dealt with the vast fund of medical communication which was considered helpful for outlining principles of existential communication. Moreover, the author returned to his extensive experience from facilitating workshops for clinicians on “breaking-bad-news” [16] where modules of communication on death and dying and associated emotions regularly were appreciated most by the participants.

Results

The term existential communication emerged in medical literature only a decade ago and of the 834 references only 6 papers had existential communication in their titles, with 5 of them affiliated with the Denish University of Odense [17-22]. In addition, 2 papers used the term (or modified as existential conversation [23]) in their abstracts or texts [24]. Hundreds of papers employed existential attributively to describe illness experiences, suffering, crisis, loss, shock, aspects of relationships and core values, feelings of guilt, isolation, and yearning (Table 1).

Table 1: Attributive use of existential in medical literature.

existential anxiety

e. conflicts

e. guilt

e. outcome

e. struggle

e. aspects

e. constructs

e. impact

e. pain

e. suffering

e. beliefs

e. crisis

e. uncertainty

e. perspective

e. support

e. burden

e. decision making

e. insight

e. intervention

e. problems

e. survivorship

e. terror

e. care

e. determinator

e. isolation

e. quality

e. thoughts

e. challenges

e. dimension

e. issues

e. questions

e. threat

e. circumstances

e. distress

e. loneliness

e. reactions

e. values

e. communication

e. encounter

e. loss

e. relation

e. vulnerability

e. concern

e. experience

e. meaning

e. rupture

e. well-being

e. condition

e. fear

e. needs

e. shock

e. yearnings

The term existential is embedded into two concurrent concepts. The European Association of Palliative Care (EAPC) und papers adopting its definition use spiritual as a meta-concept which includes existential [6]. Irvin Yalom`s Existential Psychotherapy considers existential as overarching concept, though, which comprises spiritual and religious issues [11]. In the same manner Scandinavian study groups understand existential as a meta-concept, which includes spiritual issues [20]. They are backed by a sample survey of the Denish population, which showed that “the existential” serves well as an overarching construct potentially including secular, spiritual and religious domains of meaning [25]. Moreover, general practitioners of the secular Denish society felt more at ease with the term existential in comparison to spiritual. However, the structural differences of both meta-concepts do not interfere much in actual communication with severely ill patients, and both meta- concepts sometimes may be found in parallel use by the same authors, or existential, spiritual and religious aspects are pragmatically put side by side on a same level [20,26].

Elise Tarbi`s study group at Boston`s Dana-Farber Cancer Institute defines existential communication “as any discussion concerned with confronting mortality and the fragility of existence; in particular, relating to major themes of (1) time as a pressing boundary; (2) maintaining a coherent self; and (3) connecting with others” [24]. This definition is compatible with the one used by the Denish study group at Odense University: “a metaconcept that includes communication about broad existential aspects and potentially, but not mandatorily, communication about spiritual and religious aspects [20].

Why Existential Communication?

In oncological and palliative care existential communication means communication in and about an existential crisis. Coping with a crisis situation depends on communication. Thus, existential communication features both a diagnostic and a therapeutical dimension [27]. The concept of total pain [4] already underscores the importance of giving attention to existential suffering for adequate symptom control [24,28] and quality of life. Otherwise patients might run the risk of being labeled as “difficult” by medical care providers. Breitbart pointed out that he teaches his trainees that “whenever they encounter an angry patient with advanced cancer think existential guilt […]Anger and anxiety have the same etymological roots, and in fact angry typically comes from fear. The fear of loss; loss of love, hope, life. [..]. Clinically I see Existential Guilt manifest as either depression, shame, anger, or intense death anxiety” [29].

Patients with advanced cancer usually want to talk about existential issues with their doctors. But doctors often fail to recognize these wishes or feel time pressured or incompetent for a sensitive wording or consider these issues too private to address. Moreover, physicians with their training in the biomedical approach often focus on obtaining objective measures and fixing a problem. Confronted with problems that cannot be measured objectively and with no direct solutions at hand this approach is bound to reach deadlock [26]. On the other hand, HCPs who engage in communication about existential issues report higher professional meaning and satisfaction and personal depth. Early communication on death and dying with patients with advanced oncological diseases entails less futile and costly oncological treatments and detrimental adverse effects in the weeks before death. These patients have a better quality of life, spend fewer days in a hospital, are less frequently admitted to intensive care units and have a higher chance to die outside a hospital [30]. As the percentage of patients receiving futile oncological treatment in the last weeks of their life did not diminish in the last decade eminent US- American cancer centers pleaded for a better training of oncologists to communicate with patients on existential issues [31].

Principles and Practice of Existential Communication

Existential issues like finitude, mortality and meaning of life cannot be solved but require an individual positioning, acceptance and maybe a possible reevaluation. Patients with life-threatening illness may have a lot of physical and psychosocial problems, but in contrast, they share their existential condition with their HCPs – even if the latter sense less urgency for grappling with their existential issues. Thus, doctors and nurses, wo feel confident in providing medical expertise or advice, generally feel far more challenged when a patient addresses existential suffering. It is beneficial for HCP-teams to reflect personal values and existential beliefs. As a matter of fact, doctors who have been confronted with existential threats in their biography tend to be more attentive to their patients` existential concerns [2]. Spiegel`s concept of “detoxifying dying” in group therapy constructively confronts one´s own mortality when faced with death or imminent loss and can be helpful for HCP-teams [12]. Communication is not an end in itself. Medical communication should be beneficial in coping with severe illness: patients should experience: (1) a sense of resonance – having been seen, heard and understood; (2) a “solidarity of mortals” – an empathetic relationship respecting the remaining autonomy and dignity; (3) hope – an expectation that in severe illness and even with facing death positive experiences may be possible [27]. For Suchman “the feeling of being understood by another person is intrinsically therapeutic: it bridges the isolation of illness and restores the sense of connectedness that patients need to feel whole.” [32] Quite often physicians neglect the crucial elements of establishing a therapeutic relationship: respectful greeting, eye contact, attention and showing interest and empathy. Connection will fail, if doctors just have eye contact with the display of their digital tools for timesaving and simultaneous documentation of patient information. Empathy is not identical with professional friendliness.

As soon as a patient gets informed about a life-threatening disease existential issues intermingle with questions about therapeutic options and treatment schedules: “How much time will I have left? “Why me?” “I am trapped in a black pit”, “I can´t be a burden for my family”, or “oh gosh, that´s the end!” During the last three decades very useful protocols for “breaking bad news” communication have been evaluated, even if lack of adherence to them still is a problem in clinical reality [33,34]. Existential topics are rarely expressed explicitly in palliative care conversations [21]. They often sprinkle patient-caregiver contacts for physical or psycho-social symptom assessment, medical or nursing procedures, or are woven within practical conversations during medical rounds. Statements like “It´s enough!”, “please give me something to die” deal with death, others with issues of justice and guilt: “Why do I have to suffer like this?” Issues of existential loss – loss of self-esteem and identity – emerge in sighs like “I am just a burden”, “This isn´t me anymore!” Again, as in “breaking-bad-news” communications, it is of paramount importance for HCPs not only to grasp the literal content of those statements but also to identify and to primarily address their implicit and dominant emotional contents: uncertainty, fear, despair, anger, shame, feelings of worthlessness. That is how emotional resonance is achieved [16,32,35]. A clinical snippet may demonstrate this approach:

Patient: “This is no life any more.”

Physician responding to the literal message:

Oh no, we do everything to help you, you can rely on our palliative care expertise.Physician responding to the emotional message:

“You are really despaired.” Pause, and when the patient confirms non-verbally (nod, eye contact):

Please tell me what is haunting you most?

The response to the literal message implicitly devaluates the present illness experience while dodging the emotional issue as a “empathetic terminator” [32]. To minimize a risk of rebuff patients weave existential cues within conversations during medical care or nursing procedures. They sound the openness of HPCs for existential communications [22]. This may be underlined by another clinical snippet:

A 67-year-old woman presenting with ascites was diagnosed with advanced ovarian cancer. She is scheduled for a diagnostic laparotomy. When the experienced anesthesiologist sees her the day before surgery to explain his procedure he is puzzled by the welcome statement of that friendly lady: “I wonder about my future?” The senior doctor hesitates, then answers: “In my opinion, people don´t reflect enough about death.” The patient is startled. She just answers to the technical questions relevant for adequate anesthesia. She is too upset to sleep during the night before surgery.

The patient´s statement “I wonder about my future” doubtlessly is a distinct existential cue. The doctor perceives the emotional message of fear of death. He could address this emotion by labeling it: “Are you afraid to die soon?” However, the doctor flinched from dealing with the emotional issue und took refuge to a rational comment, schoolmasterly dodging the patient´s existential distress. Every existential crisis is charged with unpleasant emotions. Therefore, physicians may be tempted to side-step these emotions by moving quickly to the field of professional action competence with comments, giving advice, or hurriedly suggesting solutions. But it is crucial to take up the patients´ emotional cues first in order to advance to an existential communication. Moreover, HCPs should keep in mind that strong emotions hamper cognitive information processing. Nevertheless, before engaging in an existential communication HCPs should clarify, whether there are any interfering uncontrolled physical symptoms such as pain, thirst, or an urge to urinate. The above snippet demonstrates: Existential clues often hit the HCPs by surprise. They have to decide whether momentarily engaging in an existential communication is a feasible or wise option. Anyway the HCP should signify having registered the cue, maybe – concerning the above snippet by commenting: “That´s an important issue for you, but it makes sense to wait for the results of tomorrow`s operation.Or the consultant may request the patient´s consent to inform his responsible physician about a desire for a deeper communication, or may ask permission to pass a more specific religious topic to a chaplain.

Tarbi found that conversations with more discussion of prognosis also contained more discussion of existential topics [24]. But without showing a lack of courteous manners doctors often focused on strictly medical facts, failing to notice or ignoring the patient´s existential illness experience and strife for meaning and validation. “Courteous but not curious” is Agledahl`s [36] summary of analysis of doctor- patient encounters in a Norwegian teaching hospital. Whether patients open up to share their existential thoughts heavily depends on non-verbal and sensory elements of an encounter: whether a HCP is perceived both physically and relationally present. “The bodily sensation of presence and sensing seems to precede the verbal dimension of spiritual care and communication […] The patients use a sort of decoding in which they try to sense and decipher whether they will be accommodated, if they initiate a conversation about spiritual matters” [37]. Reciprocally HCPs have to decode the patients` non- verbal cues and keep in mind the most important principles of medical communication: (1) active listening – learning the illness experience; (2) asking questions – showing interest, and encouraging a narrative and its clarification; (3) perception – what and how does the patient communicate verbally and non-verbally. It is important to recognize that a patient is the single expert of his illness experience which he might share by answering to questions like:

“What burdens you most?”

“If you ponder on your illness, how much time do you think you have got to live?”

“When thoughts of death and dying come to your mind, do they cause fear or anxiety?”

“When you think about the rest of your life, what matters most for you?”

“Do you have a specific event or goal you would like to live?”

“When you think back, what did help you most in coping with your disease?”

“When you reflect on your life, what makes you really proud?”

I encourage this kind of “empathetic curiosity” which had been lacking in Agledahl`s study of patient-doctor encounters [36]. Addressing tabooed or anxiety-ridden issues reduces anxiety. Moreover, a simultaneous validation of coping efforts will diminish a patient´s sense of helplessness, hopelessness, and isolation and restore a sense of agency in spite of an advanced disease. Meanwhile, useful concepts of existential communication have been established [18,20,22]. In addition, established guidelines for “breaking bad news” in medicine and reviewed programs of communication skills training in oncology [34] comprise the principles of existential communication.

Conclusion

The recent term existential communication with its secular roots and associations excellently describes a long standing medical task which is crucial for state-of-the art patient care, especially in oncology and palliative medicine. In contrast to the common term end-of-life discussion existential communication semantically does not focus on the end of life but also on the life before. Existential communication also deals with maybe lifelong individual values and resources which impact treatment decisions. But on disease progression of advanced cancer oncologists often “skip over discussions of prognosis and jump to offering a new line of therapy” [31]. They struggle with “taking away hope” [38]. feel uncomfortable with existential issues, and biasedly believe that additional treatment will benefit the patient. That is why existential communications are to be actively scheduled in patient care and are particularly crucial when disease-modifying treatment is stopped. Existential issues of remaining life time and anxiety or confusion surrounding dying regularly emerge at this phase of an illness trajectory. At the same time therapeutic responsibility often changes which may structurally augment the patient´s suffering of having to leave behind loved ones. A patient`s complicit encouragement of his oncologist to offer additional treatment sometimes is motivated by the patient´s fear that otherwise his medical life-line will be cut. Therefore, an early integration of palliative care specialists into the oncological care team is important. Moreover, patients may feel very relieved when oncologists empathetically explain, that with stopping a futile treatment survival will not be shorter but quality of life will be better because adverse effects will cease.

Acknowledgment

The author thanks Matthias Demandt, MD,. for constructive comments on early versions of the manuscript

Competing Interest

The author declares that he has no competing interests.

Funding Information

The author did not receive external funding.

The author did not receive external assistance with data collection, analysis, and manuscript preparation

Ethical Declaration

This study did not involve human participants or animal subjects.

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Tobacco Pandemic: Challenges and Responses

DOI: 10.31038/CST.2024943

Abstract

Smoking is the leading cause of preventable death worldwide. Its toxicity affects every organ. It is a risk factor or aggravating cause of many diseases: cancer, chronic obstructive pulmonary disease, cardiovascular disease, diabetes, HIV infection and tuberculosis, and is a major source of environmental pollution. The socio-economic costs of smoking, already exorbitant, are likely to become unsustainable by 2050 for all countries, particularly low- and middle-income countries. Twenty years after the adoption and implementation of the WHO Framework Convention on Tobacco Control (FCTC), this article aims to take stock of the situation regarding tobacco use and tobacco control. All countries and international health agencies must be involved in the fight against the tobacco pandemic. It is more important than ever to strengthen tobacco control policies, particularly by helping people to stop smoking, to curb the pandemic and its devastating consequences.

Keywords

Smoking, Smoking-related diseases, Tobacco control, Smoking cessation, Public-health

Introduction

Currently more than 20% of the world’s population were smokers. Smoking remains a global health issue despite the gradual reduction in its prevalence. It is responsible for more than 8 million deaths a year worldwide [1]. The toxicity of tobacco products affects every organ in the body, and it is a direct cause, adjuvant and aggravating factor in many diseases: cancer, cardiovascular disease, chronic obstructive pulmonary disease (COPD), diabetes, HIV infection, tuberculosis, environmental health risks, all of which affect all countries, particularly low- and middle-income countries [2]. The prevalence and mortality of these diseases are set to rise sharply by 2050, entailing very high socio- economic costs. Twenty years after the adoption and implementation of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), this article takes stock of the impact of this pandemic and the state of tobacco control, highlighting the necessity to intensify efforts to combat smoking.

Smoking: A Preventable Killer

Smoking is a chronic disease causing many illnesses. It is the leading preventable cause of death. Smoking cessation is associated with an improvement in life expectancy and quality of life, the greater the earlier the cessation, but even after the age of 60 it is associated with an increase in life expectancy [3].

Cancer

In 2022, there will be 20 million new cases and 9.7 million deaths from cancer. It is estimated that there will be more than 35 million new cases of cancer in 2050, an increase of 77% compared with 2022, particularly in low- and middle-income countries, where cancer mortality will double [4].

Smoking is associated with an increased risk of most cancers.The harmful effects of smoking are exacerbated by other factors (alcohol abuse, malnutrition, viral infections, air pollution) [3,4]. Smoking is the main cause of lung cancer (12.4% of all new cancer cases and 18.7% of all cancer deaths). The prevalence of this cancer is increasing in all countries and its incidence could rise by 47% between 2020 and 2040 [4].

The risk of cancer decreases with the length of time smokers have quit [3]. In Korea, a retrospective cohort study of 3 million smokers aged 30 years and older showed that the risk of cancer decreased after 10 years of smoking cessation (HR=0.83 ; 95% CI: 0.80-0.86) compared with continued smoking. The reduction in the risk of lung cancer is more pronounced for quitting before the age of 50 (HR=0.43; 95% CI: 0.35-0.53) compared with quitting at the age of 50 or older (HR=0.61 ; 95% CI: 0.56-0.66). Smoking cessation also reduces the risk of perioperative complications from excisional surgery and the risk of recurrence after cure, it increases life expectancy and quality of life in patients treated for cancer [5].

Cardiovascular Disease

Nearly two million deaths per year are attributable to smoking- related cardiovascular diseases, and the socioeconomic costs of these diseases will rise sharply by 2050 [6].

In high-income countries, tobacco-related cardiovascular mortality is tending to decrease among men, but is increasing among women. In France, for example, the incidence of myocardial infarction before the age of 65 increased by 50% in women (16% in men) between 2005 and 2014. For the same level of smoking, women have a 25% higher risk of coronary heart disease than men [7]. Almost 75% of deaths from cardiovascular disease occur in developing countries, where people have less access to primary health care, screening and early treatment of these diseases.

Mortality from coronary heart disease is reduced by 35% after 2 to 4 years of smoking cessation and by 50% after 10 years. Smoking cessation helps prevent coronary heart disease in young people, where smoking is the main cause. Quitting also reduces the risk of death or reintervention after coronary artery bypass graft surgery or angioplasty, stroke, abdominal aortic aneurysm and obliterative arteritis of the lower limbs [3,7].

Chronic Obstructive Pulmonary Disease

COPD is the fourth leading cause of death worldwide (4.7% of annual mortality), affecting 10.3% of the world’s population, and its prevalence is expected to increase by more than 20% by 2050 [6]. The socioeconomic costs of smoking are increasing, particularly in low- and middle-income countries [8].

Tobacco smoke is the main risk factor for COPD, and women are more susceptible than men [9]. Smoking accelerates the decline in lung function, which is a source of disability. It increases the frequency of exacerbations, leading to death and hospitalisation, and the development of cardiovascular, metabolic and cancer-related comorbidities [9].

Stopping smoking is associated with a reduction in patient-reported symptoms of chronic bronchitis within one to two months. It slows the decline in lung function (FEV1) in COPD patients and reduces the risk of respiratory infections, exacerbations, hospitalisations, death and smoking-related co-morbidities [3,9].

Diabetes

In 2021, 10.5% of adults aged 19-75 worldwide had diabetes mellitus; 90% of them lived in an emerging country. Diabetes will cause 6.7 million deaths. By 2045, 12.2% of adults will have diabetes, and the explosion in the number of cases, in which smoking is a key factor, will place a socioeconomic burden on all countries [10]. The prevalence of smoking is 20.8% in patients with type 2 diabetes and 10-30% in those with type 1 diabetes [11].

Smoking increases insulin resistance, the risk of prediabetes and diabetes in the general population, and gestational diabetes. Diabetic smokers have a 48% excess risk of premature death from all causes and a 36% excess risk of cardiovascular mortality. Smoking increases the risk of macroangiopathy and microangiopathy, hospitalisation for infections, cancer and depression [10,11].

In people with diabetes, smoking cessation reduces the risk of premature mortality, cardiovascular disease and progression of microangiopathy lesions. It also reduces the risk of cancer, hospitalisation for infections and maternal-foetal complications in gestational diabetes. Finally, it facilitates glycaemic control and reduces symptoms of anxiety and depression [11].

HIV Infection

Worldwide, 39 million people are living with HIV ; 630,000 die and 1.3 million are newly infected each year [12]. Antiretroviral therapy (ART) has significantly reduced AIDS-related mortality, but the proportion of deaths from non-AIDS-related causes has increased, mainly due to smoking, which is twice as common as in the general population [13].

HIV-infected smokers have lower CD4 cell counts, higher HIV viral loads and lower self-reported quality of life than HIV-positive non-smokers. Their risk of dying from cardiovascular disease, cancer or bacterial pneumonia is twice as high and with equivalent ART, smokers have a life expectancy 12 years less than non-smokers. [14].

Smoking cessation among people living with HIV is associated with a reduction in all-cause and smoking-related mortality compared with compared with continuous smokers. Stopping smoking reduces the risk of cardiovascular disease, bacterial pneumonia, COPD and cancer, especially lung cancer [13]. WHO recommends that smoking cessation interventions be integrated into HIV care [12].

Tuberculosis

In 2023, tuberculosis (TB) was no longer among the top ten causes of death worldwide, but it still caused 1.3 million deaths. Nearly 8 million new cases of TB were diagnosed: 410,000 people developed a multidrug resistant or resistant to rifampicin TB [15].

More than 80% of TB case and 90% of TB deaths occur in developing countries. The main drivers of the TB epidemic are the spread of HIV and drug-resistant TB, but smoking is responsible for 17.6% of TB case and 15.2% of deaths in high-burden countries [16]. Smoking, whether active or passive, triples the risk of tuberculosis infection and disease, particularly severe and infectious lung disease, forms resistant to anti-tuberculosis drugs, mortality and disease recurrence, and treatment failure [16].

Smoking cessation among smokers with TB is associated with better treatment adherence, higher cure rates, lower mortality and fewer relapses [16]. WHO recommends that TB and tobacco control should be tackled simultaneously to end the TB epidemic, which is one of the United Nations Sustainable Development Goals [17].

Environmental Health Risks

The WHO estimates that 12.6 million deaths worldwide (23% of all deaths) are attributable to the environment; 75% of pollution-related deaths occur in developing countries. Every year, tobacco production, processing and transport emit 84 million tonnes of CO2, contributing to global warming [18].

Air pollution and passive smoking are responsible for 35% of all cases of bronchopulmonary disease worldwide [18] Cigarette smoking produces toxic substances in mainstream smoke (inhaled by the smoker), second-hand smoke (burning of the glowing end of the cigarette), third-hand smoke (deposition of tobacco residue on surfaces) and cigarette butts [19].

The toxic gases and particles produced (polycyclic aromatic hydrocarbons (PAHs), nitrosamines, aldehydes, ketones, alcohols, phenols, PM2.5 and PM10 microparticles) cause lung cancer, COPD, respiratory infections and allergies, as well as cardiovascular, metabolic (type 2 diabetes, thyroid dysfunction), intestinal and mental diseases [20]. These facts are a justification for tobacco control and smoking cessation.

Tobacco Control and Smoking Cessation

Financial Implications of Smoking

A report from the World Health Organization (WHO) estimates that the annual economic cost of smoking worldwide, including health expenditure, lost productivity, is approximately $1.4 trillion (1.8% of the annual global gross domestic product) and in the USA, the economic cost of smoking is nearly $300 billion a year. [20]. Of this amount, 40% affects developing countries. In France, despite a decline in smoking prevalence, the social cost of smoking is estimated at €156 billion annually, representing an annual cost of €2,300 per inhabitant, regardless of smoking status [21]. In Belgium, this cost reaches €20 billion per year and €2,000 per inhabitant per year [22].

Globally, at least 70% of tobacco consumption occurs in low- and middle-income countries. In addition to the morbidity and mortality associated with tobacco use, the cultivation, processing, and disposal of tobacco products pose environmental risks, including atmospheric pollution, global warming, and changes to ecosystems. These challenges impede the economic development of these countries.

Modalities of Tobacco Control

All forms of tobacco use are detrimental to health and well- being. Only a comprehensive, global approach to tobacco control, encompassing regulation of production, marketing and smoking cessation, can effectively safeguard individuals and the environment from the adverse effects of tobacco use.

The WHO Framework Convention on Tobacco Control (FCTC) – A Legal Framework for Tobacco Control

Adopted in 2003 and implemented in 2005, it has been ratified by 183 countries, representing 90% of the world’s population [21]. Its objectives are “to protect present and future generations from the health, social, environmental and economic consequences of tobacco use and exposure to tobacco smoke by providing a framework for the implementation of tobacco control measures by Parties at the national, regional and international levels, with a view to achieving sustained and substantial reductions in the prevalence of tobacco use and exposure to tobacco smoke”.

It has led to the implementation of tobacco control measures: (1) demand reduction (increasing tobacco price and restricting its availability, banning all forms of tobacco advertising, informing and warning the public, providing cessation services); (2) supply reduction (combating illicit trade, banning sales to minors, unit sales, vending machines); (3) evaluation, scientific and technical cooperation on tobacco control.

These measures have already led to a reduction in the prevalence of smoking worldwide, but the devastating effects will only be felt in the long term.

Strengthening Tobacco Control

Tobacco control needs to be continuously strengthened to meet new challenges [1]. For example, banning the sale of all new tobacco products (nicotine pearls and pouchs, disposable vaping products and non-tobacco flavors, the use of menthol) and restricting the places where tobacco is consumed (health units, urban and outdoor areas) will make it possible to reduce the trade and consumption of tobacco. Plain packaging must become the rule, the sale of tobacco products must be strictly regulated and fighting illicit trafficking must be stepped up. Finally, the policy of increasing tobacco prices must be pursued relentlessly. Taken together, these measures will denormalize the image of smokers and smoking [18,21].

The Protection of Young People is a Priority

Smoking often starts in adolescence, and young people are a prime target for the tobacco industry. Their brains are more vulnerable to the effects of psychoactive substances such as nicotine. The prevalence of smoking peaks between the ages of 25 and 35, and tobacco addiction makes it difficult to quit [1].

The promotion of a tobacco-free lifestyle from an early age is based on: (1) the strict application of tobacco control measures (regular and consistent increases in tobacco prices, bans on the sale of tobacco to minors and on new tobacco products: nicotine pearls and pouchs, disposable vaping devices, smoke-free schools, universities and transport); (2) parental information and smoke-free homes; (3) educational initiatives in schools aimed at strengthening young people’s psychosocial skills and critical thinking are effective [24]. All these measures contribute denormalizing tobacco use, preventing smoking and, more generally, addictive behaviour [24,25].

Various actors are involved in preventing smoking (tobacco, cancer, respiratory associations, etc.). In 2024, the theme of World No Tobacco Day was ‘Protecting children from tobacco industry interference’, which raised awareness of the tobacco industry’s harmful influence on young people [26]. Many countries are working towards a ‘tobacco-free adult generation’ in the next decade [22].

Helping People to Stop Smoking

Strategies to Help People Quit

The provision of smoking cessation services is explicitly included in the FCTC (Art. 14) [23]. Smoking cessation is the only way to reduce the morbidity and mortality associated with tobacco use.

Smoking cessation is part of the treatment of diseases related to tobacco use. Health professionals must be involved in this intervention, using evidence-based non-medication strategies (counselling to quit, cognitive behavioral therapy) [26] and medication strategies (nicotine replacement therapy, bupropion, varenicline) [28].

Medications to help people stop smoking are not widely available in low- and middle-income countries because of their high cost and the lack of trained prescribers. Only a public health framework that takes into account the specific characteristics of these countries and based on the denormalization of smoking, the training of health professionals in smoking cessation and the provision of smoking cessation medications by international health authorities, will enable them to implement effective tobacco control [29].

Strategies for Harm Reduction?

There is no threshold of consumption below which smoking is safe [30]. However, can strategies be proposed to reduce risks and harms associated with smoking?

Tobacco companies offer products that deliver nicotine without burning tobacco (heated tobacco, snus, nicotine pearls and pouchs), promising an alternative to traditional cigarettes. These products may reduce the harmful effects associated with smoke inhalation (lung cancer, COPD), but they maintain nicotine dependence, they are not free of toxicity and therefore not credible proposals [31].

The electronic cigarette (e-cig.) vaporizes a nicotine-containing liquid that is much less toxic than tobacco smoke, making it a potential tool for reducing the risks of smoking when used exclusively, although there are uncertainties about the safety of long-term use. Recent studies [28,32] show that e-cig. can help people to quit smoking; further studies are needed to determine whether this benefit applies to smokers in developing countries [33]. The increasing use of e-cigarettes by young people, especially disposable (puff) and high-nicotine devices (JUUL), could lead to nicotine addiction and subsequent cigarette smoking [34], which has led many countries [35] and the WHO to propose measures to prevent e-cig. use by young people [36].

Conclusion

Twenty years after the implementation of the FCTC, every country in the world is affected by the tobacco pandemic, the leading cause of preventable death. Tobacco control in all its forms remains a major public health challenge because of its health, socioeconomic and environmental consequences. More than ever, health professionals need to be involved in smoking prevention initiatives and in helping people to quit.

Contribution to the Article

All authors contributed to the writing and correction of this article.

Conflict of Interest

The authors declare that they have no conflict of interest.

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13C-rich Diamond in a Pegmatite from Rønne, Bornholm Island: Proofs for the Interaction Between Mantle and Crust

DOI: 10.31038/GEMS.2024671

Abstract

In this contribution, we show for the first time 13C-rich diamonds in a pegmatite of the 1,400 Ma old Rønne granite. The position of the first-order diamond line depends on the laser excitation energy in the case of deep (55µm) diamond crystals. The best values can be obtained at energies lower than 1mW. The value of 1309 cm-1 corresponds to 55% 13C-diamond, a pressure of ~7 GPa, and a depth of ~210 km. Diamond crystals about 20 µm under the sample surface show no such dependence. Diamonds in a pegmatite sample are unusual and are an essential hint for the involvement of supercritical fluids in the pegmatite formation.

Keywords

13C-rich diamond, Raman spectroscopy, Pegmatite, Supercritical fluid, Bornholm island

Introduction

During the work on deuterium and 13CO2-rich fluid inclusion in pegmatite quartz from the Rønne pegmatite from Bornholm Island, Denmark [1], we found as a surprise 13C-rich diamond inclusion. The G-band of graphite is completely missing. Diamonds in a more crustal rock are entirely out of place. In a couple of papers, the author and the co-authors [1-5] and references in there) have shown that supercritical fluid comes fast from the Earth’s mantle into the crustal region together with its load (diamond and other high-pressure minerals). In the crust region, the supercritical fluid changes into critical and under-critical fluid. In this state, chemical and physical processes that are nearly unknown happen.

Sample Material and Early Results

The about 1,400 Ma old granite from the Klippelokke quarry, 3 km ENE of Rønne (Bornholm Island, Denmark), contains an uncomplicated quartz-feldspar pegmatite veins (subhorizontal or vertical) with a conspicuous graphic texture and only minor amounts of mica. The potassium felspar is flesh-red (called “red admirals”), and the quartz glyphs are smoky-colored [3]. The quartz contains mainly fluid inclusions of secondary origin. However, a small number of quartz grains contain a very high number of carbonate-CO2 inclusions. Some inclusions also contain significant amounts of zabuyelite [Li2CO3] [3]. In such quartz grains, secondary fluid inclusions are rare. Figure 1 shows a typical 13C-rich diamond-calcite aggregate, which is 55 µm deep under the surface, demonstrating that such diamonds are not contaminations from the preparation [6]. The up to now found largest area with some graphite and 13C-rich diamond is 660 x 600 µm2 (like Figure 2). That means that in the Rønne pegmatite sample, diamond is not a rare phase. In quartz grains often related to graphite, there are also smooth spherical inclusions of different minerals (for example, coesite remnants and 13C-rich graphite). Generally, we used for our studies cleaned and, on both sides polished thick sections with a thickness of 500 µm.

Figure 1: Detail of the pegmatite quartz from Bornholm Island. The dashed line shows the inclusion of a 13C-rich diamond in quartz. The inclusion is not easy to see in the quartz material (only in polarized light). D – diamond, Cal – calcite. The diamonds are about 55 µm deep. Note the semicircular patterns of tiny diamonds right above.

Figure 2: Large area with many 13C-rich graphite (Gr) and 13C-rich diamond (D) crystals. The quartz in-between is characterized by very strong Raman bands (as high as the main quartz band at 464 cm-1 in the region (80 – 300 cm-1). The diamond-bearing area is about 20 µm deep.

Methodology

For our studies here, we used only microscopic and Raman spectroscopic technics.

Raman Spectroscopy

We have performed all microscopic and Raman spectroscopic studies with a petrographic polarization microscope with a rotating stage coupled with the EnSpectr Raman spectrometer R532. The Raman spectra were recorded in the spectral range of 0–4000 cm-1 using an up to 50 mW single-mode 532 nm laser, an entrance aperture of 20 µm, a holographic grating of 1800 g/mm, and a spectral resolution ranging from 4–6 cm-1. Generally, we used an objective lens with a magnification of 100x – the Olympus long-distance LMPLFLN100x objective. The laser power on the sample is adjustable down to 0.02 mW. The Raman band positions were calibrated before and after each series of measurements using the Si band of a semiconductor- grade silicon single-crystal. The run-to-run repeatability of the line position (based on 20 measurements each) is ± 0.3 cm-1 for Si (520.4 ± 0.3 cm-1) and 0.5 cm-1 for diamond (1332.7 ± 0.4 cm-1 over the range of 80–2000 cm-1). The FWHM = 4.26 ± 0.42 cm-1. FWHM is the Full- Width at Half Maximum. We used a water-clear natural gem-type diamond crystal (Mining Academy Freiberg: 2453/37 from Brasil) as a diamond reference (for more information, see Thomas et al. 2022 [4]. Other references are small diamond grains in pegmatite quartz left by the preparation [6]: Mean from 10 grains (Lorentz-fitting): 1332.7 ± 0.39 cm-1 and FWHM = 4.26 ± 0.42 cm-1.

Results

Raman measurements on four different diamond crystals in pegmatite quartz from Bornholm Island (Table 1) gave for the first- order Raman line a mean of 1313.52 ± 3.06 cm-1 (53 measurements; crystals: I-IV) and FWHM = 64.47 ± 3.61 cm-1. Opposite to gem diamond crystals, the FWHM value is enormous. This results from the long way from the mantle region at high temperatures and an extended stay at about 700°C in the intrusion level. The group with the lowest value for the first-order diamond line is 1309 ± 0.93 cm-1. They result in long-time measurements at low laser energy (≤1 mW), however, at long time (2000 s).

Table 1: Results of the measured data on the 13C-rich diamond from the Bornholm pegmatite. Crystals I-IV: 55 µm deep under the surface; crystal V: 20 µm deep.

Crystal

Laser energy (mW) Mean (cm-1) ±1s FWHM (cm-1) ±1s

n

I

50.0 mW 1318.24 62.16 2
I 29.1 mW 1315.33 1.78 65.82 10.59

20

I

22.1 mW 1311.64 69.40 1
I 4.33 mW 1309.30 61.45

1

I

0.92 mW 1308.60 60.28 2
I 0.15 mW 1309.00 0.93 56.65 4.00

6

II

0.92 mW 1311.11 0.40 69.09 4
III* 29.1 mW 1315.80 0.89 63.32 2.40

10

IV

9.1 mW 1313.16 0.18 68.70 3.20 6
IV 0.92 mW 1309.00 63.00

1

V**

9.1 mW 1304.40 2.78 85.78 5.98

10

*Crystal III is a small, maybe different 13C-rich diamond -see Figure 1. **Crystal V is from the large area near the surface (20 µm deep) – see Figure 2.

Refrain from crystal III in Table 1; there is a passable correlation between the used laser energy (mW) for the 532 nm excitation) and the position of the first-order Raman line (P) of the studied 13C-rich diamond:

P = 1308.56 cm-1 + 0.1976 * (mW). (r2 = 0.928)              (1)

The scatter is the result of minor variations of the laser focus on the diamond sample, about 55 µm deep, from the sample surface. Such variations with the laser energy are not observed for diamonds in Figure 2.

Figures 3 and 4 show exemplarily typical Raman spectra of 13C-rich diamonds taken at different laser powers on the sample (taken with 29.1 and 0,91 mW on the sample, respectively).

The lowest value for the first-order diamond line is 1303.4 cm-1, obtained from the largest diamond-graphite area (660 x 600 µm2; see above). The large FWHM values for all measured diamond grains are the result of stress in an extraneous surrounding (upper crust), by a large dislocation density and 13C/12C disorder [6].

Figure 3: Raman spectrum of the first-order Raman line (29.1 mW on the sample) of 13C-rich diamond from pegmatite quartz from Bornholm Island (exposition 50 s). The line at 1158.9 is from the quartz of the matrix.

Figure 4: Raman spectrum of the first-order Raman line (0.91 mW on the sample) of 13C-rich diamond from pegmatite quartz from Bornholm Island (exposition 2000 s).

Interpretation

We have found in pegmatite quartz from Bornholm Island (Rønne granite) diamonds rich in 13C. Because there is a relatively good correlation between the used excitation energy and the 13C content in the diamond, we can accept that the data for the low energy represents the best Raman values for the 13C-rich diamond (1308.9 ± 0.16 cm-1, n = 9) because at high excitation and the dark color heating and Raman shift to higher values is inevitable. According to Schiferl (1997) [7] and Akaishi et al. (2000) [8], the results correspond to a hydrostatic pressure of about 7 GPa (~210 km depth), and according to Anthony and Banholzer (1992) [9] to 55% 13C in the studied diamond (see also Thomas et al. 2021) [10]. 13C-rich graphite has a D band at 1338 cm-1 and a G band at 1555 cm-1 [11]. The D band for the 12C implanted graphite is 1358 cm-1, and the G band is at 1581 cm-1. From the graphite with the typical very weak D and very strong G bands, the values are given in Table 2.

Table 2: Data for the Raman G band of graphite (Gr) – laser wavelength 532 nm.

Gr-Crystal

Laser energy (mW) Mean (cm-1) ± 1s FWHM (cm-1) ± 1s

n

13C-rich Gr

29.1 mW

1562.56 10.82 76.02 6.02

10

12C-rich Gr*

29.1 mW

1581.5 13.50

1

Gutierrez et al. (2014)
12C Gr

1581

13C Gr

1555

*See Thomas et al. (2021) – [10].

Opposite the Variscan diamonds and lonsdaleite in the Lusatian Mts, the Erzgebirge, and Thuringia, which consistently show a graphite G band, the Rønne diamond shows in the case of 13C-rich diamond with no graphite band [12,13]. However, the pegmatite samples from Rønne contain very graphite-rich parties, too. The graphite is also 13C-rich and is sometimes coupled with the rare 1332.3 ± 2.7 cm-1 nano diamond. An important conclusion follows that the presence of 13C-rich diamond is a further important hint that supercritical fluids often cause the formation of pegmatites by supercritical water with their load, which takes part in their formation.

Acknowledgment

The short paper is dedicated to my parents, Gerhard (1915-1994) and Anni (1920-1993) Thomas, who have prematurely promoted my strong interest in chemistry and Earth sciences.

References

  1. Thomas R (2024) NaHCO3-NaDCO3 and 13CO2-rich fluid inclusion in pegmatite quartz from Bornholm Island/Denmark. Geol Earth Mar Sci In preparation.
  2. Thomas R, Rericha A (2024) Meaning of supercritical fluids in pegmatite Formation and critical-element redistribution. Geol Earth Mar Sci 6: 1-5.
  3. Thomas R, Davidson P, Schmidt C (2011) Extreme alkali bicarbonate- and carbonate- rich fluid inclusions in granite pegmatite from the Precambrian Rønne granite, Bornholm Island, Denmark. Contrib Mineral Petrol 161: 315-329.
  4. Thomas R, Davidson P, Rericha A, Recknagel U (2022) Water-rich coesite in prismatine-granulite from Waldheim/Saxony. Veröffentlichungen Naturkunde Museum Chemnitz 45: 67-80.
  5. Thomas R, Davidson P, Rericha A, Recknagel U (2023) Ultra-high pressure mineral inclusions in the crustal rocks: Evidence for a novel trans-crustal transport Geoscience 12: 1-12.
  6. Keller DS, Ague JJ (2022) Possibilities for misidentification of natural diamond and coesite in metamorphic Neues Jb – Mineral Abh 197: 1276-1293.
  7. Schiferl D, Malcolm N, Zaug JM, Sharma SK, Cooney TF, et (1997) The diamond 13C/12C isotope Raman pressure sensor system for high-temperature/pressure diamond-anvil cells with reactive samples. J. Appl Phys 82: 3256-3265.
  8. Akaishi M, Kumar MDS, Kanda H, Yamaoka (2000) Formation process of diamond from supercritical H2O-CO2 fluid under high pressure and high temperature Diamond and Related Materials 9: 1945-1950.
  9. Anthony TR, Banholzer WF (1992) Properties of diamond with varying isotope Diamond and Related Materials 1: 717-726.
  10. Thomas R, Rericha A, Davidson P, Beurlen H (2021) An unusual paragenesis of diamond, graphite, and calcite: A Raman spectroscopic Estudos Geologicos 31: 3-15.
  11. Gutierrez G, Le Normand F, Aweke F, Muller D, Speisser C, et (2014) Mechanism of thin layers graphite formation by 13C implantation and annealing. Appl Sci 4: 180- 194.
  12. Thomas R, Trinkler M (2024) Monocrystalline lonsdaleite in REE-rich fluorite from Sadisdorf and Zinnwald/E-Erzgebirge, Geol Earth Mar Sci 6: 1-5.
  13. Thomas R, Recknagel U (2024) Lonsdaleite, diamond, and graphite in a lamprophyre: Minette from East-Thuringia/Germany. Geol Earph Mar Sci 6: 1-4.

NaHCO3-NaDCO3 and 13CO2-Rich Fluid Inclusion in Pegmatite Quartz from Bornholm Island/Denmark

DOI: 10.31038/GEMS.2024663

Abstract

In this short contribution, we present Raman data for the main lines of the synthetic system NaHCO3-NaDCO3. Furthermore, we show that some CO2– rich fluid inclusions in pegmatite quartz in the 1,400 Ma old Rønne granite from Bornholm Island contain D-rich nahcolite. Moreover, we also found 13C-rich CO2 in some fluid inclusions, as well as coronene [C24H12], a highly condensed six-ring polycyclic aromatic hydrocarbon. The occurrence of 13C-rich diamonds in a granite-pegmatite system forces the acceptance of supercritical fluids coming fast from the old mantle region. Maybe supercritical fluids are generally responsible for pegmatite formation.

Keywords

Raman spectroscopy, NaHCO3-NaDCO3-rich CO2 inclusions, 13CO2-rich inclusions, 13C-rich diamond, Pegmatites, Bornholm Island

During the study of nahcolite-rich [NaHCO3] inclusions in pegmatite quartz from Bornholm [1], we found carbonates that could not identified with Raman spectroscopy because of missing reference spectra. Other with Raman determined carbonates and bicarbonates are calcite, zabuyelite [Li2CO3], rare amounts of natrite [Na2CO3], gregoryite [K2CO3], kalicinite [KHCO3], and dawsonite [NaAl(CO3) (OH)2]. Also, graphite is present. A list of carbonate species is in Table 1, given in Thomas et al. 2011 [1]. Because most inclusions are composed of solid carbonates in CO2 only and there are a small couple of silicate melt inclusions, we can assume that the trapping temperature must be about 700°C or higher. After our studies [2,3] about supercritical fluids coming from mantle deeps, unusual mineral phases are possible. We think here on deuterium-bearing carbonates. No Raman spectra are available for deuterium-bearing nahcolite; therefore, we have synthesized such phases in the NaHCO3 – NaDCO3 system. Furthermore, we observed exceptional 13CO2-rich fluid inclusions, which can traced back to the reaction of the supercritical fluid with 13C-rich diamond present in the pegmatite quartz from Bornholm Island.

Sample Material

The about 1,400 Ma old granite from the Klippelokke quarry, 3 km ENE of Rønne (Bornholm Island, Denmark), contain uncomplicated quartz-feldspar pegmatite veins (subhorizontal or vertical) with a conspicuous graphic texture and only minor amounts of mica. The potassium felspar is flesh-red (called “red admirals”), and the quartz glyphs are smoky-colored (see Thomas et al. 2011) [1]. The quartz contains mainly fluid inclusions of secondary origin. However, a small number of quartz grains contain a very high number of carbonate- CO2 inclusions. Some inclusions also contain significant amounts of zabuyelite [Li2CO3] (see Thomas et al. 2011) [1]. In such grains, secondary fluid inclusions are rare. Figure 1 show typical nahcolite- bearing CO2 inclusions.

Figure 1: Typical nahcolite+D and CO2-bearing inclusion in pegmatite quartz from Bornholm Island.

Because there are no Raman spectra of deuterium-bearing nahcolite present as a reference in the literature, we have prepared such crystals by reaction of analytical poor NaHCO3 and D2O (heavy water).

The simple reaction is NaHCO3 + D2O → NaDCO3 +HDO (D2O in excess).                (1)

By the further reaction of NaDCO3 with the produced HDO, we obtain, according to the following equation, the stable compound Na2HD(CO3)2:

2 NaDCO3 + HDO → Na2HD(CO3)2 + D2O ­                  (2)

The pure NaDCO3 compound is rare after the reactions (1) because the DHO concentration increases steadily. The pure NaDCO3 phase forms during fractionated crystallization under the microscope as tiny crystals (Figures 2 and 3). X-ray studies about the last compound must follow.

Figure 2: NaDCO3 crystals grown from a concentrated NaDCO3 solution under the microscope (in transmitted light).

Figure 3: NaDCO3 crystals on silicon grown from a concentrated NaDCO3 solution under the microscope (in reflected light). The arrows show the pure NaDCO3 crystals.

Methodology

For our preliminary studies, we used only microscopic and Raman spectroscopic technics.

Raman Spectroscopy

We have performed all microscopic and Raman spectroscopic studies with a petrographic polarization microscope with a rotating stage coupled with the EnSpectr Raman spectrometer R532. The Raman spectra were recorded in the spectral range of 0–4000 cm-1 using an up to 50 mW single-mode 532 nm laser, an entrance aperture of 20 µm, a holographic grating of 1800 g/mm, and a spectral resolution ranging from 4–6 cm-1. Generally, we used an objective lens with a magnification of 100x – the Olympus long-distance LMPLFLN100x objective. The laser power on the sample is adjustable down to 0.02 mW. The Raman band positions were calibrated before and after each series of measurements using the Si band of a semiconductor-grade silicon single-crystal. The run-to-run repeatability of the line position (based on 20 measurements each) is ± 0.3 cm-1 for Si (520.4 ± 0.3 cm-1) and 0.5 cm-1 for diamond (1332.7 ± 0.4 cm-1 over the range of 80–2000 cm-1). The FWHM = 4.26 ± 0.42 cm-1. FWHM is the Full- Width at Half Maximum. We used a water-clear natural diamond crystal (Mining Academy Freiberg: 2453/37 from Brasil) as a diamond reference (for more information, see Thomas et al. 2022 [3].

class=”pdfsubheading”>Calibration Curve for the Determination of NaDCO3

For the construction of a provisional calibration curve between NaHCO3 and NaDCO3, we solved a small amount of analytical pure NaHCO3 in D2O 99.9% from PelementSamples, Belchertown, MA/ USA. We converted it into a significant excess of pure heavy water [D2O] into NaDCO3 according to reaction (1). We gave a droplet of this solution on a microscope glass slide with a hollow or semiconductor- grade silicon wafer (Figure 3 and Figure 4).

Figure 4: Raman spectrum of NaDCO3 on a Si wafer (520 cm-1 reference).

As described above, we produced NaDCO3-rich phases by reaction of NaHCO3 and heavy water (D2O) according to the equation (1) and (2). Richardson and Hood (1937) [4] wrote that the concentration of NaDCO3 is directly proportional to the amount of D2O. That means pure NaDCO3 crystals are rare (Figure 5).

Figure 5: Raman spectra of NaHCO3 (a) and very NaDCO3-rich nahcolite (b) with D = 0.99.

The obtained Raman data are presented in Figure 6. For the first experiment, we used glass test tubes. The solution is strongly alkaline (pH ~ 11) and reacts readily with glass, forming K2CO3, KHCO3, and other compounds. The formation of K2CO3 could proved by Raman spectroscopy (see also Conrad 2020) [5]. Therefore, for most experiments, we used later plastic vessels. In Table 1 are the results of the Raman determination listed.

Figure 6: Calibration curve for the determination of the deuterium in mol fractions determined from the Raman shift.

Table 1: Results of the Raman measurements on pure NaHCO3 and NaDCO3 and mixed Na(HD)CO3.

Compound

Origin Mean (cm-1) FWHM (cm-1)

n

NaHCO3

RRUFF R070237

1045.3 4.82

1

NaHCO3

This work

1045.1 ± 0.9 5.41 ± 0.13

12

On Si
NaHCO3 This work

1044.1 ± 0.3

7.14 ± 0.23

6

Na(H0.18D0.82)CO3 This work

1064.4 ± 1.8

13.71 ± 4.39

12

NaDCO3 This work

1069.1 ± 0.2

5.91 ± 0.33

13

On glass
Na(H0.02D0.98CO3 This work

1068.3 ± 0.4

6.10 ± 1.17

10

NaDCO3 This work

1069.3 ± 0.6

5.45 ± 1.18

11

Table 2: Results of the Raman measurements on pure NaHCO3 and mixed Na(H, D)CO3 in CO2 inclusion in pegmatite quartz from Bornholm Island.

Compound

Origin Mean (cm-1) FWHM (cm-1)

n

NaHCO3 RRUFF R070237

1045.3

4.82

1

NaHCO3 This work

1045.2 ± 0.4

5.58 ± 0.89

15

Na(H0.32D0.68CO3 This work

1061.3 ± 2.5

19.87 ± 6.58

21

Table 3: lists the main Raman lines of synthetic NaHCO3, NaDCO3, and mixed phases in inclusions in pegmatite quartz from Bornholm Island.

NaHCO3
(synthetic)

Rel. Intensity NaDCO3
(synthetic)
Rel. Intensity NaDCO3-rich Bornholm

Rel. Intensity

88.7

s 75.1 s 70.0 m
110.5 vs 110.2 s 99.0

vs

141.4

s 150.3 m 153.8 s
164.6

m

203.8

w
224.5 w 225.6

w

684.7

w 672.4 vw 695.2 vw
701.3

vw

1045.1

vs 1069.2 vs 1065.1 s
1266.7 m

1434.5

vw 1428.3

vw

Relative intensities: vs: Very Strong, s: Strong, m: Medium, w: Weak, vw: Very Weak. The mean for Bornholm is 1061.3 ± 2.5 cm-1 (21 different inclusions) and corresponds to D = 0.68 ± 0.11 and for 1065.1 cm-1 D = 0.84, the highest value.

From our observation under the microscope, we see for the reaction NaHCO3 + D2O an order of:

NaHCO3 → NaHnD1-nCO3 → NaDCO3 according to the equations (1) and (2).

Results

NaDCO3-rich CO2 Inclusion

In a small number of quartz grains in the Bornholm pegmatite, we found a high concentration of NaHCO3-rich CO2 inclusions. The amount of nahcolite [NaHCO3] in these inclusions is a high variable. Figures 7 and 8 show that variability, from about 0 to more than 40% (in rare cases up to 100%).

Figure 7: Complex NaHCO3-Na(H, D)CO3 inclusion in pegmatite quartz from Bornholm Island. V – CO2-rich vapor phase.

Figure 8: NaHCO3-rich CO2 inclusion in pegmatite quartz. a) The NaHCO3 inclusion is composed of pure nahcolite. b) a deuterium-rich nahcolite inclusion in quartz. The volume of this solid phase is about 40%.

13CO2-rich Vapor Phase in the NaHCO3-NaDCO3-Rich Fluid Inclusions

Some NaHCO3-NaDCO3-rich CO2 inclusions contain also 13CO2– rich phases. According to Vitkin et al. 2021 [6], there is a significant difference between the Raman position of pure 12CO2 and 13CO2, with 1388 cm-1 and 1370 cm-1 (Raman mode ν1), respectively. From measurements at nine different inclusions, we obtained a mean of 1381.6 ± 1.44 cm-1 and a FWHM = 14.8 ± 4.7 cm-1 corresponding to 35.56 ± 8% 13CO2. A natural reference with secondary CO2 inclusion in quartz, taken at the same conditions, gave almost pure 12CO2: 1387.94 ± 0.28 cm-1 (n = 11 different inclusions). Using a mean value comparison at a 0.999 statistical certainty results in a significant difference. A different method is used by Remingi et al. 2023 [7]. The 13CO2-rich fluid phase is the result of the interaction between supercritical fluid and 13C-rich diamond. Figure 9 shows an example of 13C rich diamond beside calcite in pegmatite quartz from Bornholm Island.

Figure 9: 13C-rich diamond in a near spherical calcite inclusion in pegmatite quartz from Bornholm Island. The figure shows the diamond grain (D) in calcite. In the calcite is a CO2-rich fluid inclusion (Fl).

From 10 different measuring points on the diamond (see Figure 10), a mean of 1316.11 ± 2.5 cm-1 and an FWHM = 60.54 ± 7.16 cm-1, and according to Thomas et al. (2021) [6], this value corresponds to about 40% 13C, which is relatively high. In the 13CO2-rich inclusions, we have often observed coronene [C24H12] (~1351 cm-1, FWHM = 9.9). Coronene is a highly condensed six-ring polycyclic aromatic hydrocarbon. For the formation, high temperatures are necessary.

Figure 10: Raman spectrum of 13C-rich diamond in pegmatite quartz from Bornholm Island.

Discussion

The enrichment of D2O can be explained by enrichment of D2O by diffusion because the light water (H2O) diffuses faster than the heavy water D2O (Thomas and Davidson 2019) [8-11] in the supercritical fluid. The presence of 13C-rich diamond (Figure 10) shows clearly that a supercritical fluid has transported diamonds via supercritical fluid from mantle depths to the intrusion level of pegmatites. These findings force the idea that supercritical fluids are responsible for the formation of some pegmatites, as the author and coauthors have shown in many papers.

Acknowledgment

We dedicate this paper to Adolf Rericha from Falkensee/Germany for his insistent interest in supercritical fluids.

References

  1. Thomas R, Davidson P, Schmidt C (2011) Extreme alkali bicarbonate- and carbonate- rich fluid inclusions in granite pegmatite from the Precambrian Rønne granite, Bornholm Island, Denmark. Contrib Mineral Petrol 161: 315-329.
  2. Thomas R, Rericha A (2024) Meaning of supercritical fluids in pegmatite Formation and critical-element redistribution. Geol Earth Mar Sci 6: 1-5.
  3. Thomas R, Davidson P, Rericha A, Recknagel U (2022) Water-rich coesite in prismatine-granulite from Waldheim/Saxony. Veröffentlichungen Naturkund Museum Chemnitz 45: 67-80.
  4. Richardson JS, Hood GR (1933) An experiment with heavy water. The Journal of Physical Chemistry 37: 82-84.
  5. Conrad J (2020) Deuterium isotope effects on acid ionization and metal oxide – hydrolysis under hydrothermal conditions. Thesis, Guelph, Ontario, Canada. Pg: 505.
  6. Thomas R, Rericha A, Davidson P, Beurlen H (2021) An unusual paragenesis of diamond, graphite, and calcite: A Raman spectroscopic study. Estudos Geologicos 31: 3-15
  7. Remigi S, Frezzotti ML, Rizzo AL, Esposito R, Bodnar RJ, et al. (2023) Spatially resolved CO2 carbon stable isotope analyses at the microscale using Raman Scientific Reports 13: 1-11.
  8. Thomas R, Davidson P (2019) Shaw meteorite: water-poor and water-rich melt inclusions in olivine and Mineralogy and Petrology 113: 1-5.
  9. Thomas R, Davidson P, Rericha A, Recknagel U (2023) Ultra-high pressure mineral inclusions in the crustal rocks: Evidence for a novel trans-crustal transport Geoscience 12: 1-12.
  10. Thomas R, Davidson P, Rericha A, Recknagel U (2023) Supercritical fluids conserved as fluid and melt inclusions in quartz from the Sherba-Gold Mine, Barberton, South Aspects in Mining & Mineral Sciences 10: 1193-1196.
  11. Vitkin V, Polishchuk A, Chubchenko I, Popov E, Grigorenko K, et al. (2020) Raman laser spectrometer: Application to 12C/13C isotope identification in CH4 and CO2 greenhouse gases. Applied Sciences 10: 1-11.

China Moves against Taiwan: Using AI Simulation and Mind Genomics Thinking to Explore an International Conflict

DOI: 10.31038/ALE.2024122

Abstract

This paper is part of a series of papers using generative AI to simulate issues of current importance in the world of nations and their interactions. Through AI and the Mind Genomics platform, BimiLeap.com, one can explore different facets of a situation. The study here on the potential move of China on Taiwan explores the topic from five viewpoints, each simulated by AI, and the entire processing taking less than 24 hours, and at low cost. Phase 1 deals with reconstructing the recent past through simulated interviews with government officials. Phase 2 deals with the mind-sets of the Chinese people regarding Taiwan. Phase 3 projects the future history of the conflict by positioning the simulation in 2030 and simulating one’s recall of events six years before when the conflict between China and Taiwan took place. Phase 4 simulates a congressional hearing to explore the conflict. Phase 5 presents five simulations of what one must do to avoid the problem. The five phases provide an easy-to-understand briefing document, designed to capture the “human face” of the conflict, and involve the reader in critical thinking about issues and solutions.

Keywords

China-Taiwan conflict, Generative AI, Geopolitical issues, International conflict, Mind Genomics

Introduction

The relationship between China and Taiwan has been a contentious issue for decades, with China viewing Taiwan as a rogue province and Taiwan viewing itself as a sovereign state. The conflict has roots in the Chinese Civil War, where the defeated Nationalist Party retreated to Taiwan, establishing a separate government. Despite growing trade and cultural exchanges, political tensions have not fully dissolved. In 2024, tensions are at extreme levels, with China’s President Xi Jinping making increasingly threatening statements about Taiwan’s autonomy. The Chinese people view this as a rightful step to ensure China’s global standing. On the other hand, Taiwan’s President Tsai Ing-wen faces immense pressure from both citizens and international allies. The U.S. and other international allies have played a central role in maintaining peace in the region, but the stakes have never been higher. Intensifying espionage and propaganda efforts have driven public sentiment further to extremes, with Chinese media portraying Taiwan as dangerously rebellious and Taiwanese media portraying China as an oppressive neighbor. The future hinges on how long Taiwan can hold out and what the international community is willing to do in its defense [1-3].

Phase 1 — Reconstructing the Past Through Simulated Interviews

Simulating history through imaginary interviews offers profound insights beyond mere facts, allowing for a deeper understanding of the intentions, motivations, tensions, and decisions that might have been obscured in official records or documents. This mode of exploration fosters empathy, deeper understanding of complexities, and a recognition that history is more than a collection of dates and events; it is a narrative shaped by the thoughts, emotions, and actions of individuals and institutions. By placing oneself in the shoes of both the interviewer and the interviewee, one can ask pointed questions that reflect contemporary concerns and imagine the answers through the lens of the individuals involved, reconstructing not just their public- facing personas but their personal doubts, ambitions, and limitations. This exercise in empathy allows for a deeper understanding of the uncertainty and messiness of decisions that might seem inevitable or preventable with the benefit of hindsight [4-6].

Simulated interviews also help to test assumptions, uncovering underlying ideologies, competing narratives, and significant ideological blind spots that governed behavior and choices. They also model a different type of dialogue, allowing for a better understanding of the role of personality and individual agency in history. This approach instills analytical rigor and creative empathy, skills crucial for any student of history. Table 1 shows the instructions to the AI to synthesize the interviews with ten government officials.

Table 1: Simulated interviews about the China-Taiwan situation with 10 government officials.

Phase 2 — Mind-Sets of China Regarding Taiwan

Mind Genomics is an emerging science which identifies different “mind-sets” based on cognitive patterns, preferences, and biases. It suggests that people respond to the same issue in different but predictable ways, not because they are irrational or misinformed. This concept can be applied to geopolitical issues like the China-Taiwan conflict, helping to deconstruct varying viewpoints in China regarding Taiwan’s status and potential actions. Within China, multiple mind- sets exist regarding Taiwan, including nationalistic, historical, economic, and strategic perspectives. Understanding these different mind-sets can help decision-makers craft targeted policies to appeal to specific segments of the population, preventing oversimplification of the complex issue of the China-Taiwan conflict.

Table 2 shows the three mind-sets synthesized by AI. China’s mind- sets regarding Taiwan are influenced by its historical conception of sovereignty and territorial integrity, as well as its long-standing belief in a unified China dating back to imperial dynasties. The Chinese government views Taiwan as an integral yet temporarily estranged part of the modern Chinese nation-state, with the Taiwan question seen as a symptom of a larger historical trajectory. The Chinese leadership is aware of the political repercussions of losing Taiwan, and any deviation could weaken the Chinese Communist Party’s (CCP) grip on the narrative. Taiwan’s strategic role in global geopolitical dynamics, particularly its dominance in advanced semiconductor production, further influences Beijing’s approach. China’s approach to Taiwan is long-term, with strategic patience informed by the Confucian principle that “time will solve all problems.” However, the international context is not overlooked, with Taiwan’s close ties to the United States, alliances with Japan, and its pivotal role in the Indo- Pacific strategy. The prevailing mind-set of the Taiwanese people, who overwhelmingly prefer maintaining the current status quo, conflicts with Beijing’s strategy of eventual reunification. Understanding China’s mind-set can help navigate its decision-making processes and understand its complex emotions and motivations [7-9].

Table 2: Mind-sets of China Regarding Taiwan.

Phase 3 — Looking Forward by Looking Backwards: The Experts Recall What Happened Six Years Ago

Edward Bellamy’s novel “Looking Backward” offers a unique approach to understanding the future by imagining it as if it has already occurred. By placing the reader in the year 2000, looking back at the societal transformations that fixed the problems of 1887, Bellamy provides a structured way of imagining possible trajectories and assessing the decisions that lead to certain outcomes. This technique can be applied to the fraught situation between China and Taiwan, as it allows for better analysis and prevention of repeating mistakes.

Bellamy’s method enhances our ability to learn by structuring our critical analysis, allowing us to mentally walk backward and identify key events or errors that determined the future. The immediacy of the China-Taiwan conflict is complicated by militaristic, economic, and geopolitical uncertainties, but by mentally projecting Taiwan as having already been annexed or successfully defended its sovereignty, the outcome can only be understood and studied.

Storytelling is another aspect of “looking backward,” making complex international relations more graspable for everyone involved in the process. By offering a blueprint in the form of an already- imagined outcome, Bellamy effectively shifts the reader toward structured speculation.

Looking backward frames today’s decisions with the weight of historical responsibility while maintaining the speculative flexibility the future demands. By using Bellamy’s method creatively, we may better navigate the tense and dangerous waters of contemporary geopolitics [10-13].

Table 3 presents us the results of ten interviews with individuals who were simulated to be conversant with the issues, and who had opinions about what could have been done better. The approach follows Edward Bellamy’s approach of telling the story of a moderately recent past to foretell the future in a way which is palatable and interesting.

Table 3: Ten interviews about the Chinese move on Taiwan which occurred five years before.

Phase 4 — Questions and Answers at the Congressional Hearing

Simulating a congressional hearing with unnamed professionals recounting their memories of an event like a Chinese move on Taiwan can be an educational and thought-provoking exercise. It allows readers to explore complex foreign-policy issues within a structured context, encouraging critical thinking, engagement with hypothetical expertise, and scenario analysis. This method focuses on roles and expertise rather than individuals, allowing readers to consider the processes and systems that underpin decisions. Table 4 presents the simulated congressional hearing.

Table 4: Simulated questions and answers at a congressional hearing about the Chinese move on Taiwan.

Simulating a congressional hearing can also deepen understanding of contemporary geopolitics and history by placing students in hypothetical situations where they need to apply historical knowledge, critical analysis, and strategic thinking. It also trains students and participants to ask better questions, identifying gaps in knowledge and anticipating the need for further information.

The interdisciplinary nature of the simulation allows readers to understand how disciplines interact in policy decisions, highlighting the union of various domains of expertise in resolving international conflicts. While some may enjoy the freedom of working within fictive or simulated environments, others may find the exercise challenging due to the added responsibility of dealing with a complex situation that has not “actually” happened but could happen in the future.

Ultimately, employing simulations in history and policy classes can nurture analytical skills, leadership potential, and decision-making acumen. A hearing simulation on an event like a Chinese move on Taiwan helps attendees and readers practice working with complex, nuanced issues, serving as an effective preparatory exercise for those who may enter fields in government, law, international relations, or academia where nuanced and critical decisions will be valued [14-16].

Phase 5 — Five “Faces of Prevention”

In times of uncertainty, questions play a crucial role in national security, foreign policy, and crisis management. The unpredictability of information and insights can create tension when different answers create more ambiguity. Consultations from experts from the cabinet and Pentagon bring varied experiences, fields of study, and specializations to the table. Receiving different answers does not necessarily signify the system is failing or confused, but it highlights the reality of complexity and the necessity of pulling from diverse perspectives [17-19].

Repetition of questions can signal attention to the critical nature of the issue, revealing nuances in arguments, gaps in logic, or overlooked information. Inconsistency in responses may give a broader, more comprehensive understanding of the nuances faced, prompting deeper thinking. Table 5 shows four different answers to the same question: What steps should be taken to prevent similar acts of aggression in the future?

Table 5: Five answers to the same question: What steps should be taken to prevent similar acts of aggression in the future?

Discussion and Conclusion

China’s intentions and potential military actions towards Taiwan are a major concern for national security and policymakers worldwide. AI-enabled simulations have been used to study and predict China’s strategies, including triggers, diplomatic channels, military postures, and deterrence scenarios. These simulations provide quicker, more adaptable analyses of complex geopolitical scenarios, allowing policymakers to run multiple “what-if” scenarios that take into account economic pressures, diplomatic relationships, and military movements. However, concerns about overemphasis on AI-based simulations exist, as they may not fully grasp cultural, historical, and deeply embedded political factors. To ensure AI does not dominate the decision-making process, traditional simulation techniques, field experience, and diplomatic insight should be used alongside AI- based simulations. Simulation exercises can help decision-makers better prepare for potential real-world conflicts without endangering national security or international stability.

Acknowledgments

The authors delightedly acknowledge the ongoing help of Vanessa Marie B. Arcenas and Isabelle Porat in the preparation of this manuscript and its companions.

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Anticipating and Countering Foreign Malign Influence Such as Disinformation and Propaganda: The Contribution of AI Coupled with Mind Genomics Thinking

DOI: 10.31038/ALE.2024121

Abstract

This paper presents a new approach to understand FMI (foreign malign influences) such as disinformation and propaganda. The paper shows how to combine AI with the emerging science of Mind Genomics to put a “human face” on FMI, and through simulation suggest how to counter FMI efforts. The simulations comprise five phases. Phase 1 simulates a series of interviews from people about FMI and their suggestions about how to counter the effects of FMI. Phase 2 simulates questions and answers about FMI, as well as what to expect six months out, and FMI counterattacks. Phase 3 uses Mind Genomics thinking to suggest three mind-sets of people exposed to FMI. Phase 4 simulates being privy to a strategy meeting of the enemy. Phase 5 presents a simulation of a briefing document about FMI, based upon the synthesis of dozens of AI-generated questions and answers. The entire approach presented in the paper can be done in less than 24 hours, using the Mind Genomics platform, BimiLeap.com, with the embedded AI (ChatGPT 3.5) doing several levels of analysis, and with the output rewritten and summarized by AI (QuillBot). The result is a scalable, affordable system, which creates a database which can become part of the standard defense effort.

Keywords

AI simulations, Disinformation, Mind genomics, Foreign malign influences

Introduction: The Age of Information Meets the Agents of Malfeasance

Information warfare is a powerful tool for adversarial governments and non-state actors—with propaganda, fake news, and social media manipulation being key strategies to undermine democracies, particularly the United States. Foreign actors like Russia and China exploit socio-political divides to spread fake news, amplifying racial tensions and cultural clashes. The U.S. government is increasingly concerned about disinformation and propaganda efforts from foreign adversaries, with agencies like the Department of Homeland Security (DHS) and Federal Bureau of Investigation (FBI) warning about evolving tactics. The private sector, particularly social media companies, has a key role in countering propaganda but has been criticized for being insufficient. To combat these threats, the U.S. government, social media companies, and civil society organizations need to collaborate effectively, using innovative techniques to detect and counter malign influences without infringing on civil liberties [1-4].

The war on disinformation continues apace. Sustained efforts are evermore vital to preserve the integrity of democratic systems. Malign influences do their evil work through their deliberate use of deceptive or manipulative tactics. The actors may be state or non-state actors, who spread false information, distort public perception, or undermine trust in democratic institutions. Traditional media plays one of two roles, or sometimes both roles. Traditional media either amplifies misinformation by reporting unverified stories or counteracts it by adhering to journalistic standards of fact-checking and verification. The outcome is a tightrope, balancing act, one part being freedom of expression, the other being the structural harm from the willy-nilly acceptance of potentially injurious information. Balancing freedom of expression with the need to protect citizens from harmful deceit can be difficult [5-7].

Strategies currently in use include increased investment in fact- checking initiatives, creating algorithms to detect fake accounts and bots, public awareness campaigns about media literacy, and stricter regulations about political ad funding, respectively. Nonetheless, it is inevitable that challenges remain in detecting and removing disinformation, clearly in part due to the avalanche effect, the sheer volume of content and evolving tactics. Fact-checking can help reduce the spread of false stories, but it is often limited by reach, speed, and the willingness of individuals to believe corrections. Artificial intelligence may identify patterns in disinformation campaigns, flagging suspicious accounts or content, but may struggle to distinguish among opinion, satire, and deliberately harmful misinformation [2,8].

Misinformation can erode trust in traditional media by making it difficult for the public to discern what is true and what is propaganda. Broad laws targeting online speech often raise concerns about censorship and the infringement of free speech. Media literacy programs give people the tools to critically evaluate sources and identify fake news, but they require widespread implementation and can be hindered by existing biases [9-11].

This paper moves the investigation of malign influences such as fake news into the direction of the analysis of the everyday. The paper attempts to put a human face on malign influences by using AI to simulate interactions with people, with questions that people might ask, and with ways that people deal with information sent out by “actors” inimical to the United States. The paper presents AI “exercises” using the Mind Genomics platform, BimiLeap.com.

Phase 1: Putting a Human Face on the Topic Through Snippets of Stories with Recommendations

The psychological principle of presenting a “human face” to issues like foreign malign influences (FMI) resonates with people as they are naturally driven by stories. Simulating interviews with individuals recounting personal struggles with misinformation injects warmth, vulnerability, and relatability, making it easier to feel empathy [12-14]. Building trust and emotional connection is essential in addressing the erosion of trust in media, government, and social institutions. To this end, Table 1 presents 22 short, simulated interviews with ordinary people, as well as the recommendation that they make.

Table 1: AI simulated snippets of interviews and recommendations about FMI (foreign malign influences).

Phase 2: Simulating Advice

AI can be used to generate specific questions and detailed, actionable answers to counter foreign malign influences (FMI). This approach allows for quick identification of common points of intrusion or manipulation by foreign actors, providing an organized strategy to address key vulnerabilities. AI-driven directives prioritize immediate actions, enabling individuals or institutions to respond swiftly to rapid information warfare. AI’s ability to flesh out complex situations while accounting for multiple variables allows it to present tangible alternatives and outcomes with ease through simulation, providing a “what if ” perspective. This actionable level of detail bridges the gap between theory and practice, making recommendations feel natural and embedded in the broader scenario being played out in real-time simulation. The iterative nature of AI allows for constant feedback and improvement, making it better suited to the evolving circumstances of FMIs. AI’s role also provides clarity and simplicity, making it suitable to create directives for targeted messaging campaigns, media outlets, and the general public [15-17].

Table 2 shows questions and answers based on a simple AI “understanding” of the topic, along with additional analyses such as predictions of what might happen six months out, and FMI’s counterstrategy. Information presented in this manner may produce more compelling reading, and a greater likelihood that the issues of FMI end up recognized and then thwarted.

Table 2: Questions, answers, strategies and counterstrategies for FMI efforts.

Phase 3: Mind-sets of People in the United States Exposed to FMI

Mind-sets are stable ways individuals react to stimuli or situations which are shaped by cognitive processes, personal experiences, emotional predispositions, and sociocultural factors [18-21]. AI- generated mind-sets can be crucial for understanding how different people process misleading material, such as the topic of this paper, Foreign Malign Influence (FMI). Machine learning algorithms use clustering methods, unsupervised learning, and statistical analysis to generate or simulate these mind-sets. By feeding AI real-world data, AI can identify distinct groups of people who respond to information in specific ways. This enables predictions on how these groups will behave when confronted with different types of foreign malign influence, making interventions more effective. Table 3 shows the simulation of three mind-sets of individuals responding to FMI information.

Table 3: AI simulation of three mind-sets, created on the basis of how they respond to misinformation presented by the FMI.

Exploring mind-sets in the context of FMI provides insights into social resilience and helps design better defense mechanisms against misinformation. Educational platforms can teach people how to recognize manipulation techniques based on their underlying mind-set. Furthermore, governments, social media companies, and other stakeholders can measure the effectiveness of counter- disinformation campaigns by targeting specific mind-sets and adjusting their message based on real-time feedback or simulation predictions from AI.

Phase 4: Predicting the Future by Looking Backwards

The “Looking Backwards” strategy is an innovative method for predicting trends and outcomes, inspired by Edward Bellamy’s “Looking Backwards” process. By mentally placing ourselves in 2030 and reviewing the events of 2024, we can distance ourselves from innate biases, misinformation, anxieties, and uncertainties of the present moment. This mental distance allows for clearer, more holistic insights into the trajectory of ongoing issues, such as foreign malign influences attempting to flood the U.S. with disinformation. Table 4 shows the AI simulation of looking backward from 2030.

Table 4: Predicting the future by looking backward at 2024 from 2030 to see what was done.

By looking back at 2024 from 2030, we can better assess the societal, political, and psychological ramifications of foreign influence operations, especially disinformation campaigns. By identifying the steps taken today that resulted in negative or positive outcomes by 2030, we might adjust our efforts now, fortifying our democratic resilience against foreign ideologies seeking to undermine our stability. This approach also holds potential when shared with the public, as it can help improve resilience and empower the democratic system to remain agile [22-26].

Phase 5: Creating a Briefing Document — Instructing the AI Both to Ask 60 Questions and Then to Summarize Them

In this step AI was instructed to create 60 questions, and provide substantive, detailed answers to each. The questions focused on various aspects regarding the impact of foreign disinformation on public opinion, civic engagement, and stability. These responses were then condensed into a more digestible briefing using summarizing tools like QuillBot [27-29]. This process allows for the inclusion of ideas and hypotheses that might not be immediately apparent to human analysts due to cognitive biases or blind spots [30,31] (Table 5).

Table 5: A simulated “set of five questions briefing document” about FMI, based upon the AI-generated set of 60 questions and answers, followed by an AI summarization of the results.

In the short term, AI-generated answers are objective and free from emotional bias, allowing analysts to base their next moves on data-driven insights. In the long term, AI technologies can be used for long-term planning and resilience strategies, allowing for rapid adjustment to evolving situations and trend recognition. This AI- driven approach also contributes to international cooperation against FMI, fostering a united front against foreign disinformation.

Discussion and Conclusions

The paper shows how the team developed a system using artificial intelligence, Mind Genomics, and real-time simulation capabilities to identify, counteract, and neutralize foreign malign influences (FMI). The system aims to understand the psychological and tactical mechanisms driving disinformation campaigns, and in turn generate strategic responses to reduce their efficacy.

AI simulations mimic real-world strategic meetings, interpersonal interviews, and situational dynamics, revealing the “human face” of the enemy and transforming large volumes of data into actionable intelligence. Mind Genomics thinking creates mind-sets, allowing for the identification of different tactics employed by adversaries. This allows mapping of a psychological landscape, understanding which messages take root and which defensive strategies resonate best with different audience segments. Real-time insights are crucial for adjusting countermeasures in sync with the adversary’s shifting methods.

The system has potential to influence public perception and bolster civic resilience by simulating the actions of enemy actors and the reactions of different segments of society. It could enable preemptive action, enabling policymakers and national security analysts to deploy specific public information campaigns or strategic maneuvers based on projections. The system’s broader geopolitical implications extend beyond national borders, creating a cooperative defense mechanism against foreign powers which exploit misinformation to sow international discord.

Acknowledgments

The authors gratefully acknowledge the ongoing help of Vanessa Marie B. Arcenas and Isabelle Porat in the creation of this and companion papers.

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The Psychology of Deterrence: Using AI with Mind Genomics to Broadcast the Seriousness of the Response to Nations Promising to Use Nuclear Weapons

DOI: 10.31038/ALE.2024114

Abstract

The paper introduces the use of AI coupled with Mind Genomics technology (BimiLeap.com) to understand the topic of how countries think about the U.S.’ position on nuclear deterrence. The entire exercise is done using AI (ChatGPT 3.5), with the BimiLeap.com platform. The five sections cover a broad range of aspects for the topic, and are set up to be rapid, cost effective, easy to do, and in some respects, virtually automatic. The results presented in this paper required approximately six hours to generate, including the initial and secondary AI analyses. The range of aspects goes from simulated “listening to enemy strategy meetings” to key emerging ideas, and onto AI-suggested innovations, expected responses by different audiences, and finally suggested questions and both optimistic and pessimistic answers. The paper is presented as an approach, with the topics easy to change, and the scalability straightforward to demonstrate.

Keywords

AI-generated simulations, Mind Genomics, Nuclear deterrence, Strategic signaling

Introduction

The U.S.’ nuclear arsenal is a crucial part of its strategic defense, but its lack of open threat to nations has led to aggressive postures. To revise defense signals without compromising global stability or reputation, U.S. policymakers must evolve strategic signaling, including bolstering military presence, conducting high-profile exercises, and issuing diplomatic statements. Monitoring hostile nations’ rhetoric and consistent communication of “red lines” is crucial for effective nuclear deterrence. AI simulation and Mind Genomics thinking offer a powerful tool to understand high-level strategic discussions in the minds of nation-states. AI simulation platforms can analyze geopolitical data and simulate decision- making processes based on historical patterns, key events, and diplomatic or military postures. Mind Genomics, the study of how individuals or groups structure their thinking and interpret the world, can codify the thought processes of leaders and policymakers. By merging these technologies, the U.S. can simulate different nations’ responses to various U.S. actions, such as bolstering military presence, conducting strategic exercises, or issuing diplomatic statements [1,2]. This approach can break down a nation’s strategic rationale into cognitive and cultural predispositions, enabling more accurate forecasts of a nation’s response to U.S. policy changes [3,4]. It can also function as a form of strategic empathy, enabling the U.S. to craft tailored policies.

Phase 1: Simulating Private Strategy Discussions Among Opponents of the USA

AI-driven simulations of enemy conversations can provide valuable insights into American policy and strategy development (Table 1). By role-playing the enemy’s perspective, AI can anticipate potential threats and understand weaknesses in American policies [2]. This predictive insight can mitigate risks and enhance national defense mechanisms [5]. AI simulations can also expose blind spots within current strategic thinking, revealing perspectives that American strategists may not see naturally. This effort can fuel defensive preparedness and negotiation tactics [6]. AI simulations can compress time and offer predictive outcomes based on potential decisions, allowing agencies to respond in real-time to threats while staying ahead of competitors [7,8]. However, there are risks and limitations to AI-assisted simulations. One issue is over-reliance on technology and algorithms instead of human judgment and intuition. AI algorithms may not have human motivations, emotions, or spontaneity, leading to irrational or emotional decisions. Additionally, AI simulations may not reflect real discussions due to human factors. Despite these limitations, AI-assisted simulations can enhance understanding, decision-making speed, and avoid blind spots.

Table 1: AI simulation of an overheard “enemy” discussion about American nuclear policy.

Phase 2: Key Ideas Emerging

The key ideas in the topic questions revolve around the concept of U.S. nuclear deterrence and strategic signaling — focusing on how the United States can communicate its readiness to use military force, including nuclear weapons, to deter adversaries without explicitly threatening them [9-12]. These key ideas emphasize the delicate balance the United States must maintain in its nuclear deterrence strategy, combining visible military strength with subtle diplomatic moves to ensure that its adversaries perceive its willingness to defend its interests while avoiding global instability. Table 2 shows 12 key ideas emerging from the simulation present in Table 1 and a subsequent AI- based analysis by the Mind Genomics platform, BimiLeap.com.

Table 2: Key ideas emerging from the AI simulation of an enemy strategy meeting, and then a second and further AI analysis. The analyses were done by the Mind Genomics platform, BimiLeap.com.

Phase 3: Innovations in Products and Services

The themes associated with U.S. nuclear deterrence and strategic signaling offer several conceptual frameworks for developing new products, services, or experiences [13-15]. Table 3 presents products and services suggested by AI, based upon the material presented in Tables 1 and 2. The AI further evaluated the information in both Tables, and generated the suggestions in Table 3.

Table 3: Innovation in products and services, suggested by AI, and based upon the information shown in Tables 1 and 2.

Phase 4: The Different Players (Positive Versus Negative Audiences)

Several distinct audiences would have a strong interest in the topic questions, each bringing a unique perspective based on their professional, academic, or geopolitical involvements [16-18]. These audiences are shown in Table 4 and comprise both those who are “interested” and those who are not interested, viz., possibly “hostile.” Once again, the analysis was done after the fact, in a second pass through the data to provide more insight by AI.

Table 4: Positive and negative audiences.

Phase 5: AI-Generated Questions and Answers for Further Thought

The AI was presented with the situation presented in Table 2. The AI was instructed to create questions, and then give both an optimistic answer and a pessimistic answer to the same question. Table 5 shows the results. The benefit here is that the AI can generate a great number of questions in a short time and provide answers [4,19-21].

Table 5: AI generated questions and two answers for each question; optimistic versus pessimistic, respectively.

Discussion and Conclusions

AI combined with Mind Genomics works as a safe testing ground where various communication scenarios — words, actions, or threats— can be “played forward” to understand precisely how they may backfire, escalate tensions, or bring about desired mediations. Such tools would also enable the U.S. to make faster, informed decisions in unprecedented crises, whether arising from smaller rogue nations or larger superpowers. By anticipating hostile rhetoric, understanding a nation’s internal political conditions, and knowing exactly where the “red lines” fall, AI simulations can precisely calculate the tipping point at which a country might enter an irreversible aggressive stance. Thus, this system works like a blueprint for creating not only stronger deterrence policies but also more effective diplomatic resolutions. Finally, the long-term potential of these simulations lies in their ability to integrate into international consensus-building. For deterrence to be effective, it must not only be unilateral but shared among allies. This enhanced AI and Mind Genomics model could be a framework that multiple democratic governments employ to analyze the decisions of shared adversaries. In doing so, the U.S. would gain not only tactical advantages but help contribute to a shared platform of predictive thinking, ensuring stability and global peace.

Based upon the AI exercise reported here, the key ideas related to U.S. nuclear deterrence and strategic signaling can be grouped into six distinct themes:

Perception and Willingness

Perceptions of U.S. Willingness to Use Nuclear Weapons. Some adversaries doubt the U.S.’ willingness to use nuclear weapons, leading to questions about the effectiveness of its deterrent posture.

Actions and Military Readiness

Actions to Signal Deterrence. The U.S. can engage in military actions such as exercises, missile testing, and tough diplomatic messaging to show its readiness and resolve. These actions not only test U.S. readiness, but they are also key components in strategic signaling to deter adversaries.

Diplomatic Efforts and Communication

Importance of Diplomatic Language. Strategic use of diplomatic language can underscore U.S. seriousness without escalating tensions. Diplomatic support of public signaling is pivotal, both with adversaries and allies, ensuring that messages are clearly communicated through multiple channels. Establishing and clearly communicating red lines helps avoid ambiguity and ensures adversaries are clear about the consequences of crossing thresholds.

Adversary Reactions and Feedback

Adversaries’ denouncements, such as accusing the U.S. of “escalation,” might paradoxically indicate that U.S. signaling is effective and being acknowledged. Visible shifts in rhetoric or behavior toward calls for diplomacy from adversaries can be viewed as signs of effective deterrence.

Geopolitical Assessment and Strategy Adjustment

Strategic signaling must be informed by constant assessments of adversarial military activities and propaganda to ensure proper messaging and deterrent force are applied. Signs of successful deterrence include adversaries scaling down aggressive maneuvers and showing a willingness to negotiate.

Failures, Escalation, and Risk Management

If adversaries respond to U.S. signaling with increased military presence or aggression, it points to a failure in deterrence, necessitating strategic recalibration. The U.S. must strike a balance between projecting sufficient strength to deter adversaries without causing unintended escalation or regional destabilization.

Acknowledgments

The authors gratefully acknowledge the ongoing help of Vanessa Marie B. Arcenas and Isabelle Porat in the preparation of this and companion manuscripts.

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