Author Archives: author

Treatment of Genital Warts in Pregnant Women

DOI: 10.31038/AWHC.2024752

Abstract

There are various treatments available for managing genital warts in pregnant women, but this does not mean that there is a definitive treatment protocol. We conducted a review to gain a better understanding of the available treatments for genital warts during pregnancy. We used Google Scholar, PubMed, and Web of Science databases to search for articles on this topic. To date, the most effective treatment is still unknown. Many indicators, including patient satisfaction and physiological conditions, are effective in determining treatment. Cryotherapy, laser therapy, and Trichloracetic acid 80–90% solution are among the safe treatments with the least side effects. Given that the likelihood of genital warts recurring increases due to changes in the body’s immune system during pregnancy especially in younger pregnant women, more research is needed on this subject. We used the keywords pregnancy, genital warts, HPV, cryotherapy, laser therapy, electrocautery, surgery, topical treatments, and safe treatments in pregnancy in the article search process.

Keywords

Pregnancy, genital warts, HPV, Cryotherapy, Laser therapy, Topical treatments, Common and safe treatments

Introduction

Human papillomavirus (HPV) poses a significant public health challenge, particularly due to its role in various anogenital conditions, including condyloma acuminata. This virus consists of over 100 different types, which are categorized into low-risk and high-risk groups based on their potential to cause cancer. Low-risk types, especially HPV 6 and 11, are primarily responsible for benign lesions such as genital warts, while high-risk types, including HPV 16 and 18, are associated with cervical cancer and other anogenital malignancie.

The global prevalence of HPV infection is estimated to be between 9% and 13%, with a notably higher incidence observed among sexually active individuals aged 20 to 39 years. Genital warts, largely caused by HPV, are a considerable public health issue due to their widespread occurrence and related complications. The often asymptomatic nature of HPV infections can lead to underdiagnosis, particularly among partners of infected individuals. Research assessing the prevalence of HPV in spouses of men with genital warts revealed that many of these women were infected despite appearing healthy during clinical evaluations, highlighting the inadequacies of conventional diagnostic techniques [1-3].

Pregnancy creates a distinct environment for HPV infections, as physiological changes and a mildly immunocompromised state can affect the virus’s behaviour. Evidence suggests that the rate of HPV infections increases during pregnancy, particularly in the third trimester [2,4]. Effective treatment options for genital warts are crucial, especially for vulnerable populations such as pregnant women. Among the most commonly employed treatments are cryotherapy and trichloroacetic acid (TCA), each having distinct efficacy and safety profiles. A randomized controlled trial comparing these two treatment modalities indicated that while TCA had a higher cure rate, both treatments were effective and well-tolerated by patients. This emphasizes the necessity for tailored treatment strategies that take into account patient preferences and the specific clinical situation, especially when managing genital warts related to HPV infection [5].

Managing genital warts in pregnant women presents several challenges due to the potential risks associated with various treatment options. Traditional approaches, such as surgical excision, may pose risks to both the mother and the fetus. As a result, less invasive alternatives like cryotherapy have become preferred first-line treatments because of their safety and effectiveness [2,6]. Additionally, the possibility of vertical transmission of HPV during childbirth raises concerns about neonatal health outcomes, including the risk of juvenile laryngeal papillomatosis [2]. Given the complexities involved in treating HPV-related genital warts during pregnancy, it is essential to investigate optimal management strategies for this demographic. This study aims to assess the efficacy and safety of various treatment modalities for genital warts associated with HPV in pregnant women, with a focus on minimizing risks to both maternal and neonatal health. Through this research, we aspire to improve clinical practices and contribute to the broader understanding of managing HPV-related conditions in pregnant patients.

Methods

A review of the keywords of scientific journal articles on the management of genital warts in pregnant women showed that the important issue in the management of this disease in pregnancy is the presence of the least side effects of the selected treatment on the mother and fetus, and common but teratogenic treatments are completely excluded from the treatment strategies. We tried to extracted and summarize the studies related to the title in order to provide useful information to the readers. In writing this review, the scientific databases PubMed, Scopus, Google Scholar and Web of Science were used.

HPV in Pregnancy

Human papillomavirus (HPV) infection is among the most prevalent sexually transmitted infections in both young individuals and adults. It often presents without symptoms, can remain dormant for months, and may not be detectable through routine clinical examinations. Despite its asymptomatic nature, HPV infection can progress to cancer, contributing significantly to morbidity and mortality worldwide [3]. Although HPV infections are generally transient and self-limiting, they can persist in immunocompromised individuals, and pregnancy is considered a state of immunosuppression Pregnant women are at a higher risk of HPV infection due to their altered immunological and endocrinological status [7]. In a review study with 13,640 pregnant women, the rate of HPV infection was higher than that of age-matched non-pregnant women, especially in those under 25 years of age. HPV-16 was the most common observed type [2]. This prevalence is two times higher in pregnant women compared to non-pregnant women. Furthermore, there is a potential risk of vertical transmission of HPV from the mother to the fetus during pregnancy or delivery. HPV cervical infections are also detected more frequently during pregnancy (15.53%) than in the non-pregnant population (12.6%). A systematics review that analyzed 14 articles involving a total of 7008 women demonstrated the significant association was identified between HPV infection and preterm delivery A comparative study showed a higher rate of HPV infection in women with abnormal course of the first trimester of pregnancy Compared to women with a normal pregnancy period. Intrauterine HPV infections are also possible, as HPV DNA has been detected in the placenta, amniotic fluid, and fetal membranes. Transmission to the fetus can occur through ascending infection from the vagina and cervix or via hematogenous spread. Studies further indicate that HPV can infect trophoblastic cells, potentially impacting the intrauterine environment and influencing pregnancy outcomes [7-9].

The Prevalence of HPV Infection in Pregnant Women

Pregnancy-related hormonal changes, including mild immunosuppression and elevated steroid levels, may further promote HPV replication. These physiological changes often lead to the proliferation of condyloma acuminata, resulting in larger lesions [10-12]. While some studies suggest pregnancy as a risk factor for HPV infection, findings remain inconsistent [2,13-15].

A meta-analysis by Liu et al reported a higher prevalence of HPV in pregnant women (16.82%) compared to non-pregnant women (12.2%) [2]. More recently, Ardekani and collogues, found that nearly one-third of pregnant women globally test positive for HPV based on cervico-vaginal samples. HPV infection during pregnancy has been associated with significant maternal and fetal morbidity and mortality [16,17]. Studies link HPV to placental abnormalities and adverse outcomes, including spontaneous abortion, preterm birth, premature rupture of membranes, intrauterine growth restriction, fetal death, and low birth weight [11,18]. Regarding HPV prevalence across pregnancy trimesters, results have varied. While Ardekani et al, reported the highest prevalence in the second trimester [16]. Liu et al, found the lowest prevalence during this period [2]. Ambühl et al, observed a declining trend from the first to the third trimester [14]. Globally, HPV types 16 and 18 are the most prevalent across all sampling sites [16]. Due to their oncogenic potential, these types are linked to pregnancy complications and future cancer risks, emphasizing the need for further research and preventive measures [19,20].

Treatment Strategy in Pregnant Women

Pregnancy creates a situation in which genital warts may recur and grow more rapidly in pregnant women than in non-pregnant women. Growth is most rapid between weeks 12 and 14 of pregnancy, and the lesions are larger in size. The severity of these processes is greater in new warts that develop during pregnancy. Changes such as decreased cellular immunity and increased blood vessel number, which consequently leads to increased blood flow in the genital area, increase human papillomavirus activity. Among the features of warts that develop during pregnancy, could mention their fragility of their structure, which leads to itching and bleeding [21,22]. Warts that become exceptionally large can cause labor dystonia or heavy bleeding by blocking the birth canal, and in such cases, a cesarean section is recommended for patients. There is a risk of human papillomavirus transmission from mother to fetus during childbirth. Infants infected with the virus may develop lesions on the conjunctiva, mouth, and/or genitals. [22-24]. Prenatal transmission of HPV types 6 and 11 from mother to fetus can rarely cause juvenile laryngeal papillomatosis (JLP). These clinical observations make effective management of genital warts during pregnancy essential. Our goal in this review is to provide a summary of approved and unapproved treatments for genital warts during pregnancy.

Cryotherapy

Cryotherapy is a therapeutic process in which liquid nitrogen causes tissue freezing and ultimately necrosis. Cryotherapy is one of the main treatments for genital warts, which, in addition to causing tissue necrosis, can stimulate specific immune responses against the remaining lesion tissue, resulting in the immunomodulatory function of T lymphocytes [25,26]. One of the unique features of cryotherapy is that it is safe during pregnancy. In addition, it is a simple and inexpensive treatment that rarely causes scarring or pigmentation in patients’ skin [6]. The liquid nitrogen used in cryotherapy causes inflammation as it destroys the wart tissue, which subsides after a short period of time [27]. In cryotherapy, the base of the lesions and 1 to 2 millimeters of surrounding normal tissue are frozen. This treatment is continued every 2 weeks until the lesions are completely gone [27-29]. Although there have been reports of swelling, discharge, erythema, and pain in patients, all patients were able to complete the treatment. In the study by Bergman et al., cryotherapy resulted in two preterm deliveries in 28 pregnant women (7.1%) [30,31] and in the study by Matsunaga et al., in 51 pregnant women, it resulted in five preterm deliveries (9.8%). Cryotherapy is a suitable treatment modality in non-pregnant patients, and results in satisfactory results, but it should be used with caution in pregnant women. Despite the weak evidence of the side effects mentioned, cryotherapy is considered a safe treatment for genital warts during pregnancy [28,32].

Laser Therapy

The advantages of using laser therapy include high precision of operation, reduced bleeding through vessel sealing and reduced scar surface. In addition, this treatment method has the ability to cause necrosis in a specific area. This ability leads to reduced inflammation, edema and infection . In a study conducted by Kryger and Baggesen, 15 pregnant women underwent laser therapy for genital warts. Except for one pregnant woman who experienced “symptoms of preterm labor for a few days,” the rest responded to the treatment without any side effects [33,34]. The use of CO2 lasers and Nd-YAG lasers is known as effective treatment methods for removing genital warts. This treatment method reduces the risk of recurrence and complications during childbirth and prevents infection of the fetus [30,35,36]. Overall, various studies showed that the use of lasers for the removal of vascular lesions of the skin, pigmented lesions and treatment of genital warts is a safe and effective method [37].

Electrocautery and Surgery

Surgery is a mechanical procedure using a scalpel or scissors that allows for direct removal of the genital wart. The use of electrical energy during surgery is called electrosurgery, which is a more advanced method of lesion removal [28]. In a study conducted by Duus et al., it was shown that the clearance, recurrence, and postoperative side effects including pain, healing time, and scar formation of surgical treatments were similar to laser therapy [38]. One advantage of these methods is the possibility of removing all lesions in one session and creating the opportunity for pathological evaluation [30]. In addition, they are considered a suitable treatment option during pregnancy [39].

Photodynamic Therapy

Photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) method clears a very large volume of lesions and is well tolerated by the patient. This method is a unique treatment in pregnant women with genital warts with minimal adverse effects on the mother and fetus [40]. Other studies have shown that photodynamic therapy, in addition to helping to better clear the lesion, reduces the recurrence rate more than other treatment methods. However, further studies are recommended to ensure fewer side effects and the safety of this treatment in pregnant women [30].

5-Fluorouracil

In addition to inhibiting DNA synthesis, 5-fluorouracil can block thymidylate synthase, thereby inducing apoptosis [41]. It is available commercially as a 5% cream. Pain, burning, inflammation, and ulceration are known side effects of 5-fluorouracil therapy [42]. Studies have shown that 5-fluorouracil therapy should not be used during pregnancy [30,41].

Interferon

Interferon heals virus-infected cells by strengthening the immune system. Interferon can reduce the risk of relapse by treating virus-infected cells. In addition, it is also used to treat lesions that are visible to the naked eye [43,44]. Interferon is contraindicated during pregnancy [30]. Because interferon therapy is expensive, and because it is controversial in the treatment of genital warts, it is preferred for treatment-resistant cases [45]. In refractory non-pregnant patients, interferon may be used as an adjunct to other treatment strategies, such as surgical and ablative therapies. Overall, the evaluations suggest that interferon is contraindicated in pregnancy [41].

Podophyllotoxin

Topical podophyllotoxin, which is prescribed as one of the first-line medications for the treatment of genital warts, is contraindicated during pregnancy, All medications that use this compound in their structure are contraindicated during pregnancy due to its antimitotic properties, which are considered a toxic compound for the fetus [46-48]. No teratogenic effects have been observed following topical administration in animal studies, but the use of this drug during pregnancy is limited due to the limitations in extrapolating animal data to humans. The lack of teratogenic effects has also been demonstrated at doses up to 5 times the maximum recommended human dose [49-51]. Studies have shown that doses much higher than the maximum recommended human dose, approximately 19 times, administered intraperitoneally to pregnant rats resulted in fetal toxicity. However, topical application of podophyllotoxin has shown negligible systemic absorption. Avoiding topical treatments for genital warts with Topical podophyllotoxin is recommended during pregnancy [52-54].

Sinecathecins

Treatment of genital warts with syncatechin resulted in the occurrence of the side effects of urethral stricture, urinary tract irritation, genital herpes simplex, vulvitis, hypersensitivity, skin pruritus, pyelonephritis, application site reactions, phimosis, and inguinal lymphadenitis in 5% of patients, which led to discontinuation of further treatment. Sinecatechins is FDA Pregnancy Category C According to the FDA, Sinecatechins is a Category C drug and is contraindicated during pregnancy [55].

Retinoids

Retinoids are contraindicated in pregnant women and women attempting to conceive because of their teratogenic effects. Retinoid therapy during pregnancy has been associated with skeletal abnormalities that result from long-term chronic toxicity. In most cases, these symptoms correspond to the symptoms of diffuse idiopathic hyperostosis syndrome [56].

Imiquimod 5% Cream

Imiquimod was first approved by the U.S. Food and Drug Administration (FDA) in 1997 as a treatment option for genital warts. Randomized, double-blind, placebo-controlled trials have confirmed the effectiveness of imiquimod. It is a member of a class of immune response modifiers that is well tolerated. The U.S. Food and Drug Administration does not recommend the use of imiquimod during pregnancy and has classified it as a category B drug. It should only be used as a last resort when the benefits outweigh the risks [57-59].

Trichloracetic acid 80–90% Solution

The therapeutic effect of trichloroacetic acid on genital warts is by chemical coagulation of the proteins of the wart cells, which leads to corrosion of the skin and mucous membranes. These processes ultimately lead to tissue necrosis. Because trichloroacetic acid is not absorbed through the skin and mucous membranes, it is considered a safe treatment for pregnant women. However, the effectiveness of this compound in different populations requires further study [27,30]. Studies have shown the positive effect of administering trichloroacetic acid in combination with laser therapy in pregnant women. In another study, treatment with trichloroacetic acid resulted in complete clearance of the wart lesions in 97% of women, but premature rupture of membranes in one patient at 35 weeks of gestation and acute pyelonephritis in another pregnant patient were side effects of this type of treatment. However, it is not definitively determined whether these adverse effects were side effects of the drug [60]. Despite the widespread use of trichloroacetic acid in clinical practice, this drug should be prescribed with caution [47].

Topical and Intralesional Immunotherapy

The use of immunotherapy in the treatment of genital warts has been associated with good efficacy. The advantages of this method include high safety, low recurrence rate, and clearance of untreated long-term warts. Bayoumy et al., showed showed that the use of immunotherapy in 40 pregnant women resulted in improvement in 85% of patients. Among them, 47.5% showed complete clearance with minimal side effects. This treatment leads to increased serum interleukin-12 (IL-12) and the production of Th1 cytokines such as interleukin-4 (IL-4), interleukin-5 (IL-5), IL-8 through recruitment of antigen-presenting cells. It also helps to clear warts through a general response that includes the secretion of interferon (IFN)-gamma and TNF-alpha. This treatment method is considered safe for use in children and pregnant women [61-63].

Conclusion

Given that genital warts are among one of the common sexually transmitted diseases, and that pregnant mothers are at risk of contracting this disease, it seems appropriate to pay attention to these patients and choose the appropriate treatment for them. During pregnancy, the exacerbation of genital warts and the risk of transmitting the disease to the fetus must be considered. Another important point to keep in mind is the limitations of available treatments that can be chosen for mothers during pregnancy. Cryotherapy, TCA application, Topical and intralesional immunotherapy, as well as laser and surgical treatments, are among the treatments that can be usable and safe in during pregnancy.

References

  1. Chang, K.C, Yen-Chang MD; Ding Dah-Ching MD (2022) Condyloma acuminatum mimicking cervical cancer in a pregnant woman and treatment with cryotherapy: A case report. Medicine. 101(49). [crossref]
  2. Liu P, et al. (2014) The prevalence and risk of human papillomavirus infection in pregnant women. Epidemiology & Infection. 142(8). [crossref]
  3. Maleki M, et al. (2020) Prevalence of HPV Infection in Spouses of Men with Genital Warts. Archives of Pharmacy Practice. 11(1-2020)
  4. Robert F. Rando P, Steven Lindheim, MD, Lisa Hasty, MD, Thomas V. Sedlacek, MD, Mark Woodland, MD, Catherine Eder, BA (1989) Increased frequency of detection of human papillomavirus deoxyribonucleic acid in exfoliated cervical cells during pregnancy. American Journal of Obstetrics and Gynecology. 161(1). [crossref]
  5. Pegah Lotfabadi M, Farzaneh Maleki, MD, Ali Gholami, MSc, Mohammad Javad Yazdanpanah, MD (2015) Liquid nitrogen cryotherapy versus 70% trichloroacetic acid in the treatment of anogenital warts: A randomized controlled trial. Iranian Journal of Dermatology. 18(4).
  6. Yang, L.J, et al. (2016) Treatment of condyloma acuminata in pregnant women with cryotherapy combined with proanthocyanidins: Outcome and safety. Experimental and Therapeutic Medicine. 11(6). [crossref]
  7. Popescu, S.D, et al. (2022) Maternal HPV infection and the estimated risks for adverse pregnancy outcomes—a systematic review. Diagnostics 12(6). [crossref]
  8. Kovács D, et al. (2024) Association between human papillomavirus and preterm delivery: A systematic review and meta‐analysis. Acta obstetricia et gynecologica Scandinavica. 103(10). [crossref]
  9. Bober L, et al. (2019) Influence of human Papilloma Virus (hPV) infection on early pregnancy. Ginekologia polska. 90(2). [crossref]
  10. Robinson, D.P, S.L. Klein (2012) Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis. Hormones and Behavior. 62(3). [crossref]
  11. Schumacher A, S.-D. Costa, A.C. Zenclussen (2014) Endocrine factors modulating immune responses in pregnancy. Frontiers in Immunology. 5: 196. [crossref]
  12. Suzuki S, et al. (2016) Current status of condylomata acuminata in pregnant Japanese women. Japanese Journal of Infectious Diseases. 69(4). [crossref]
  13. Schmeink, C.E, et al. (2012) Human papillomavirus detection in pregnant women: a prospective matched cohort study. Journal of women’s health.21(12). [crossref]
  14. Ambühl, L.M.M, et al. (2016) Human papillomavirus infection as a possible cause of spontaneous abortion and spontaneous preterm delivery. Infectious diseases in obstetrics and gynecology. 2016(1). [crossref]
  15. Mittal R, A. Pater, M.M. Pater (1993) Multiple human papillomavirus type 16 glucocorticoid response elements functional for transformation, transient expression, and DNA-protein interactions. Journal of virology.67(9). [crossref]
  16. Ardekani A, et al. (2023) Worldwide prevalence of human papillomavirus among pregnant women: A systematic review and meta‐analysis. Reviews in medical virology. 33(1). [crossref]
  17. Wiik J, et al. (2021) Associations of treated and untreated human papillomavirus infection with preterm delivery and neonatal mortality: A Swedish population-based study. PLoS medicine. 18(5). [crossref]
  18. Niyibizi J, et al. (2020) Association between maternal human papillomavirus infection and adverse pregnancy outcomes: systematic review and meta-analysis. The Journal of infectious diseases. 221(12). [crossref]
  19. Faridi R, et al. (2011) Oncogenic potential of Human Papillomavirus (HPV) and its relation with cervical cancer. Virology Journal. 8: 1-8. [crossref]
  20. Boon, S.S, et al. (2019) Human papillomavirus type 18 oncoproteins exert their oncogenicity in esophageal and tongue squamous cell carcinoma cell lines distinctly. BMC cancer. 19: 1-12. [crossref]
  21. Osborne, N.G, M.D. Adelson (1990) Herpes simplex and human papillomavirus genital infections: controversy over obstetric management. Clinical obstetrics and gynecology. 33(4). [crossref]
  22. Workowski, K.A, et al. (2000) Sexually transmitted diseases treatment guidelines, 2015.
  23. Mant C, et al. (2000) Non-sexual transmission of cervical cancer-associated papillomaviruses: an update. Papillomavirus Report. 11(1). [crossref]
  24. Ferenczy A, (1989) HPV-associated lesions in pregnancy and their clinical implications. Clinical obstetrics and gynecology. 32(1). [crossref]
  25. Gilson R, et al. (2009) A multicentre, randomised, double-blind, placebo controlled study of cryotherapy versus cryotherapy and podophyllotoxin cream as treatment for external anogenital warts. Sexually transmitted infections. 85(7). [crossref]
  26. Mi X, et al. (2011) A randomized clinical comparative study of cryotherapy plus photodynamic therapy vs. cryotherapy in the treatment of multiple condylomata acuminata. Photodermatology, Photoimmunology & Photomedicine. 27(4). [crossref]
  27. Wiley D, et al. (2002) External genital warts: diagnosis, treatment, and prevention. Clinical Infectious Diseases. 35(Supplement_2). [crossref]
  28. J, A. Bergman, N.N. Bhatia, (1987) Genital condylomata acuminata in pregnancy: effectiveness, safety and pregnancy outcome following cryotherapy. BJOG: An International Journal of Obstetrics & Gynaecology. 94(2). [crossref]
  29. Bergman A, N. Bhatia, E. Broen (1984) Cryotherapy for treatment of genital condylomata during pregnancy. The Journal of Reproductive Medicine. 29(7). [crossref]
  30. Sugai S, K. Nishijima, T. Enomoto, (2021) Management of condyloma acuminata in pregnancy: a review. Sexually transmitted diseases. 48(6). [crossref]
  31. Bergman A,J. Matsunaga, N.N. Bhatia (1987) Cervical cryotherapy for condylomata acuminata during pregnancy. Obstetrics & Gynecology. 69(1). [crossref]
  32. Javame Ghazvini F, et al. (2024) Comparison of topical potassium hydroxide 5% solution with cryotherapy in the treatment of patients with genital warts: A randomized controlled clinical trial. International Journal of STD & AIDS. p. 09564624241300776. [crossref]
  33. Hankins, G.D, et al. (1989) Use of laser vaporization for management of extensive genital tract condyloma acuminata during pregnancy. Journal of Infectious Diseases. 159(5). [crossref]
  34. Kryger-Baggesen N, J.F. Larsen, P.H. Pedersen, (1984) CO2-laser treatment of condylomata acuminata. Acta obstetricia et gynecologica Scandinavica. 63(4). [crossref]
  35. ADELSON, M.D, et al. (1990) Laser vaporization of genital condylomata in pregnancy. Journal of gynecologic surgery. 6(4). [crossref]
  36. Ferenczy A, (1984) Treating genital condyloma during pregnancy with the carbon dioxide laser. American journal of obstetrics and gynecology. 148(1). [crossref]
  37. Allameh F, et al. (2021) A systematic review of elective laser therapy during pregnancy. Journal of Lasers in Medical Sciences. 12. [crossref]
  38. Duus B, et al. (1985) Refractory condylomata acuminata: a controlled clinical trial of carbon dioxide laser versus conventional surgical treatment. Genitourin Med. 61(1). [crossref]
  39. Kodner, C.M, S. Nasraty (2004) Management of genital warts. American family physician. 70(12): 2335-2342.
  40. Yang, Y.G, et al. Photodynamic therapy of condyloma acuminata in pregnant women. Chinese medical journal. 125(16). [crossref]
  41. Kilic A, U.M. Ural, (2019) Anogenital warts: an update on human papilloma virus, clinical manifestations and treatment strategies. Mucosa. 2(2): 30-40.
  42. Atista, C.S, et al. (2010) 5‐FU for genital warts in non‐immunocompromised individuals. Cochrane Database of Systematic Reviews, 2010(4). [crossref]
  43. Westfechtel L, et al. (2018) Adjuvant treatment of anogenital warts with systemic interferon: a systematic review and meta-analysis. Sexually Transmitted Infections. 94(1). [crossref]
  44. Yang J, et al. (2009) Interferon for the treatment of genital warts: a systematic review. BMC Infectious Diseases.9: 156. [crossref]
  45. Özkaya, D.B, G. Erfan, B. Çıtamak (2023) The Effectiveness of Genital Wart Treatments.
  46. Lacey C, et al. ( 2013) European guideline for the management of anogenital wart Journal of the European Academy of Dermatology and Venereology.27(3). [crossref]
  47. Workowski, K.A, S.M. Berman, (2011) Centers for Disease Control and Prevention sexually transmitted disease treatment guidelines. Clinical infectious diseases. 53(suppl_3): S59-S63.
  48. Patel V, R. Schwartz, W. Lambert (2017) Topical antiviral and antifungal medications in pregnancy: a review of safety profiles. Journal of the European Academy of Dermatology and Venereology.31(9). [crossref]
  49. Briggs, G.G, R.K. Freeman, S.J. Yaffe (2011) Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk.Lippincott Williams & Wilkins.
  50. Didcock K, C. Picard, J. Robson (1952) The action of podophyllotoxin on pregnancy. The Journal of physiology. 117(4)
  51. Bargman, H (1988) Is podophyllin a safe drug to use and can it be used during pregnancy? Archives of Dermatology. 124(11): 1718-1720. [crossref]
  52. Thiersch, J (1963) Effect of podophyllin (P) and podophyllotoxine (PT) on the rat litter in utero. Proceedings of the Society for Experimental Biology and Medicine, 113(1): 124-127.
  53. Von Krogh G, E. Longstaff (2001) Podophyllin office therapy against condyloma should be abandoned. Sexually transmitted infections. 77(6). [crossref]
  54. G, (1982) Podophyllotoxin in serum: Absorption subsequent to three-day repeated applications of a 0.5% ethanolic preparation on condylomata acuminata. Sexually Transmitted Diseases. 9(1). [crossref]
  55. Masters, K.P, (2009) Sinecatechins (Veregen) for external genital and perianal warts. American Family Physician. 80(12): 1447-1454.
  56. Zasada M, E. Budzisz (2019) Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 36(4). [crossref]
  57. Edwards L, et al. (1998) Self-administered topical 5% imiquimod cream for external anogenital warts. Archives of dermatology. 134(1). [crossref]
  58. O’mahony C, et al. (2001) New patient-applied therapy for anogenital warts is rated favourably by patients. International journal of STD & AIDS. 12(9). [crossref]
  59. Ciavattini A, et al. (2012) Topical Imiquimod 5% cream therapy for external anogenital warts in pregnant women: Report of four cases and review of the literature. The Journal of Maternal-Fetal & Neonatal Medicine.25(7). [crossref]
  60. chwartz, D.B, et al. (1988) Genital condylomas in pregnancy: use of trichloroacetic acid and laser therapy. American journal of obstetrics and gynecology. 158(6). [crossref]
  61. Othman, N.E, F.A. Safan (2023) Immunotherapy for the treatment of female anogenital wart with purified protein derivative and measles mumps rubella vaccine: a comparative clinical and immunological study. Journal of Pharmaceutical Negative Results, 2023: 640-649.
  62. Eassa, B.I, A.A. Abou‐Bakr, M.A. El‐Khalawany, (2011) Intradermal injection of PPD as a novel approach of immunotherapy in anogenital warts in pregnant women. Dermatologic therapy. 24(1). [crossref]
  63. Jain S, Y.S. Marfatia (2021) A comparative study of intralesional vitamin D3, measles mumps rubella vaccine, and tuberculin purified protein derivative in the treatment of recalcitrant warts: an approach to solve a therapeutic conundrum. The Journal of Clinical and Aesthetic Dermatology. 14(11). [crossref]

Determination of Awareness and Knowledge Levels of Men Between the Ages of 18-45 About HPV and HPV Vaccine

DOI: 10.31038/AWHC.2024751

Abstract

This study was designed to determine the awareness and knowledge levels of male patients about HPV and the HPV vaccine. This study was planned as a single-center, descriptive and cross-sectional study. This cross-sectional study included 255 patients who presented to the Family Medicine Polyclinic at Tekirdağ Namık Kemal University Hospital. Data were collected between 01.07.2023 and 01.12.2023 with a face-to-face survey form. The content of the survey form included questions about the participants, a survey assessing awareness and knowledge regarding HPV and the HPV vaccine, which we prepared by scanning the literature and whose content validity index was 0.98. The data obtained were evaluated in the 152 (59.6%) of the men stated that they did not have information about HPV, 250 (98.0%) stated that they had not received the HPV vaccine, 102 (40.0%) stated that they did not consider getting the HPV vaccine, and 144 (56,5%) stated they thought it was difficult to access the HPV vaccine. The median (min-max) score of the men in the study group from the survey was 24.0 (6.0-32.0) and the mean (SD) was 23.20. The findings of this study showed that more than half of the men had not heard of the HPV vaccine, almost all of the men had not received the HPV vaccine, and the majority thought it was difficult to access the vaccine. However, men’s general HPV knowledge was average and their knowledge of the current HPV vaccination program was low. In addition, men’s awareness and knowledge survey scores about HPV and the HPV vaccine were at an average level, and HPV knowledge affected men’s attitudes and behaviors. It may be recommended to take initiatives to increase men’s knowledge about general HPV and the HPV vaccine.

Keywords

Man, HPV, HPV vaccine, Knowledge level, Awareness

Introduction

Human Papilloma Virus (HPV) is a DNA virus belonging to the Papillomavirinae family. HPV infects the basal epithelial layer cells of human skin and mucosal surfaces. This virus is a non-enveloped, double-stranded circular DNA virus. The genome of HPV is approximately 8 kilobase pairs long. The replication cycle of HPV is a very slow process. There can be a long period between the onset of HPV infection and the appearance of symptoms, and this period can vary from person to person. It can take weeks or even months from the moment the infection begins to appear for symptoms to appear. HPV can be transmitted directly from cracks in the skin and mucosa, as well as during sexual intercourse. In addition, HPV can be transmitted indirectly from contaminated surfaces (fomites) of shared bathroom floors, towels, clothing or personal belongings, and from the mother to the newborn during birth through the infected birth canal [1-3]. HPV is a common sexually transmitted infection worldwide. There are many different types of HPV, and most types of the virus do not cause any symptoms or health problems in the infected person; however, a small percentage of infections caused by certain types of HPV can persist and cause clinically significant disease. HPV types are classified according to their epidemiological association with cancer. Low-risk HPV types can also cause genital warts and a rare condition called recurrent respiratory papillomatosis. High-risk HPV types are associated with a variety of cancers, including cervical, anal, penile, vaginal, vulvar, and head and neck. Different vaccines have been developed for HPV vaccination, and there are currently three vaccines: bivalent (HPV types 16 and 18), quadrivalent (HPV types 6, 11, 16, and 18), and nonavalent (HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58). Each HPV vaccine has been shown to be safe and effective against the HPV strains involved [3-6]. HPV vaccines are used as part of national vaccination programs in the United States, Australia, and many European countries. The fact that HPV vaccines are not included in national vaccination programs and are not covered by health insurance affects access to the vaccine and vaccination rates. Parental knowledge, mentality, and income levels affect whether HPV vaccines are widely used. Increasing resistance to vaccination can make it difficult for vaccines to be accepted and implemented in society [5-7]. HPV research generally focuses on understanding the development of cervical cancer and precancerous lesions, as well as how to prevent and control these conditions. This research focuses particularly on women’s health and the prevention of cervical cancer. The administration of HPV vaccines to women has been seen as an effective strategy for preventing cervical cancer. Recent studies have shown that HPV-related cancers pose a significant burden not only to women but also to men. In addition to HPV being linked to cervical cancer in women, HPV infections in areas such as the anus, oral cavity, and oropharynx pose a serious cancer risk in men [8-10]. HPV infections have now become preventable thanks to HPV vaccines. Countries can increase cancer prevention by expanding such vaccines through vaccination programs [1-4]. The aim of this study was to assess the knowledge and behaviors of men aged 18-45 about HPV and the HPV vaccine.

Material and Methods

This study is a cross-sectional descriptive survey. In order to evaluate the level of knowledge and behavior about HPV and HPV vaccine among male patients aged 18-45 who applied to Tekirdağ Namık Kemal University Hospital Family Medicine Outpatient Clinic between July 1, 2023 and December 1, 2023, the Adult Vaccination Knowledge Level Survey consisting of 16 questions was applied on a voluntary basis. Data from a total of 255 participants were analyzed. Before starting the study, approval was obtained from the Namık Kemal University Faculty of Medicine Ethics Committee (protocol no: 223.129.06.15).

Criteria for Including Participants in the Study

  • Being between the ages of 18-45
  • Having applied to Tekirdağ Namık Kemal University Hospital Family Medicine Polyclinic center
  • Being male
  • Having mental competence
  • Being a volunteer

Criteria for Exclusion of Volunteers from the Study

  • Being under the age of 18 and over the age of 45,
  • Not having mental competence
  • Being a woman

A questionnaire form prepared by the researcher based on literature review at the time of application, which questioned the sociodemographic data of the patients, their knowledge level and behaviors about HPV and HPV vaccine, was filled out by the volunteers.

Validity and Reliability of the Awareness and Knowledge Questionnaire on HPV and HPV Vaccine

A total of 16 items were created to measure awareness and knowledge levels on HPV and HPV vaccine in line with the literature. The suitability and comprehensibility of each scale item was assessed by 10 experts (1 internal medicine, 4 family physicians, 1 emergency, 1 public health, 1 infection, 1 dermatology and 1 gynecology and obstetrics). The experts were asked to evaluate the items in three groups as “important”, “useful but insufficient”, and “unnecessary”. The scope validity rates of the scale ranged from 0.8 to 1.0 and the scope validity index was 0.98.

The Adult Vaccination Knowledge Level Questionnaire, which was created to assess the knowledge level, consists of 16 questions. Factor analysis was used for structural validity. It was performed using Principal Component Analysis (PCA) with Varimax rotation. PCA generally tests the psychometric qualities of structured questionnaires and is a frequently used multivariate statistical technique and is used to determine the structure . The reliability levels expressed by the Cronbach alpha coefficient range were taken into account in the study. For the reliability analyses of the scale, it was calculated again according to the Cronbach alpha coefficient and item total correlation. In the factor analysis, Kaiser-Meyer-Olkin: 0.875, Barlett’s test result was p<0.001. Factor loadings below 0.30 varied between 0.302-0.812, and it was determined that the items collected in a single sub-domain explained 31.63% of the total variance. Cronbach alpha value was determined as 0.814. The item total correlation values ​​for the items in the questionnaire varied between 0.201-0.714. For confirmatory factor analysis, goodness of fit statistic (GFI), adjusted goodness of fit statistic (AGFI), CFI (Comparative fit index), Normed fit index (NFI), Incremental Fit Index (IFI), Relative Fit Index (RFI), Parsimony Fit Index (PNFI), Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR) indices were calculated. For the acceptability levels of fit indices, CFI, NFI, IFI and AGFI ≥0.90, RMSEA <0.08 and SRMR ≤0.10 were taken as criteria. As a result of confirmatory factor analysis, no incompatible values ​​were detected for each item for CFI (0.89), NFI (0.81), IFI (0.89), RFI (0.76) and SRMR (0.06). The values ​​were in appropriate ranges. When the fit indices of the model obtained with CFA were examined, it was seen that the X2/df (2.08) value was less than 3, but the CFI (0.89), RFI (0.76), GFI (0.90), AGFI (0.87) and SRMR (0.06) values were at an acceptable level. As a result of the confirmatory factor analysis, these fit indices showed that the model had a good fit [11-14].

The correct answer given to the awareness and knowledge survey items regarding HPV and HPV vaccine was calculated as “2”, the “I don’t know” answer as “1” and the wrong answer as “0”. It was accepted that the awareness and knowledge level increased as the score obtained from the survey increased.

Statistical Analysis

The obtained data were evaluated in the Statistical Package for Social Sciences (SPSS) 25.0 statistical package program. Descriptive statistics were given as mean, standard deviation, median for numerical variables, and number and percentage for categorical variables. In the evaluation of validity and reliability, Exploratory Factor Analysis was applied and factor loadings, item total correlation values, and Cronbach alpha values ​​were calculated for the items. Confirmatory factor analysis was performed using the R studio package program. The conformity of the data to normal distribution was assessed using the Kolmogorov-Smirnov test. Differences between two groups in terms of continuous variables that were not normally distributed were analyzed using the Mann Whitney U test, and differences between multiple groups were analyzed using the Kruskal Wallis test. The results were evaluated at a 95% confidence interval and p<0.05 values ​​were considered significant.

Results

The mean age of the participants was 29.04 ± 6.62 years. 156 (61.2%) of the participants were in the 21-30 age group and 174 (68.2%) were university graduates. 148 (58.0%) of the participants were single, 158 (62.0%) were employed, 73 (28.6) were healthcare workers, and 181 (71.0%) lived in the city center or a metropolitan city. 225 (88.2%) of the participants had no chronic disease and (98.8%) stated that they were heterosexual (Table 1). Of the men, 152 (59.6%) reported that they had not received any information about HPV, 250 (98.0%) had not received the HPV vaccine, 102 (40.0%) did not consider receiving the HPV vaccine, and 144 (56.5%) thought that it was difficult to obtain the HPV vaccine.

Table 1: Distribution of participants according to sociodemographic characteristics and some variables related to HPV.

 

n

%

n

255

100

Age group (year)    
18-20

11

4.3

21-25

82

32.2

25-30

74

29

31-35

51

20

36-40

16

6.3

41-45

21

8.2

Marital status    
Single

148

58

Married

102

40

Widow

5

2

Eğitim düzeyi    
Primary – secondary school

13

5.1

High school

23

9

College

174

68.2

Masters

45

17.7

Occupation    
Working

158

62

Not working

21

8.2

Student

76

29.8

Health worker

73

28.6

Place where lived during most of life
City center

181

71

District

58

22.7

Village

16

6.3

Income level
Income is less than expenses

84

32.9

Income is equal to expenses

102

40

Income is more than expenses

69

27.1

Has children

78

30.6

Smoking

96

37.6

Comorbidity

30

11.8

Sexual orientation
Heterosexual

252

98.8

Homosexual

3

1.2

Given information about HPV vaccine

103

40.4

HPV vaccination status    
Not vaccined

250

98

Gardasil 4/2 dose

3

1.2

Gardasil 9/2 dose

2

0.8

Considering to be vaccined for HPV    
Yes

55

21.6

No

102

40

Undecided

98

38.4

Considers hard to reach HPV vaccine

111

43.5

184 (72.2%) of the men in the study group thought that HPV was a very common disease in humans. The item with the highest number of correct answers among men (82.7%) was “Having more than one sexual partner increases the risk of HPV transmission.”, while the item with the lowest number of correct answers (8.6%) was “How many types of HPV vaccines are there?” (Table 2).

Table 2: Distribution of responses to the participants’ awareness and knowledge survey regarding HPV and HPV vaccine.

 

n

%

1. HPV is a virus that is quite common in humans.    
Yes (C)

184

72.2

No

71

27.8

2. How many types of HPV are there?    
2

2

0.7

4

10

3.9

9

17

6.7

More than 200 (C)

93

36.5

I don’t know

133

52.2

3. HPV can often be found in a person without any symptoms or signs.    
Yes (C)

153

60

No

19

7.5

I don’t know

83

32.5

4. HPV does not cause disease anywhere on the body except the genital areas.    
Yes

21

8.2

No (C)

145

56.9

I don’t know

89

34.9

5. HPV only causes disease in women.    
Yes

5

2

No (C)

178

69.8

I don’t know

72

28.2

6. HPV can cause mouth, pharynx, anus and penis cancer and genital warts in men.    
Yes (C)

172

67.5

No

5

2

I don’t know

78

30.5

7. HPV is transmitted only through genital contact.    
Yes

59

23.1

No (C)

119

46.7

I don’t know

77

30.2

8. Using a condom reduces the risk of HPV infection.
Yes (C)

193

75.7

No

13

5.1

I don’t know

49

19.2

9. Having more than one sexual partner increases the risk of contracting HPV.
Yes (C)

211

82.7

No

3

1.2

I don’t know

41

16.1

10. Are there any medications that can be used against HPV?
Yes (C)

125

49

No

36

14.1

I don’t know

94

36.9

11. How many types of HPV vaccines are there?
1

8

3.1

2

48

18.8

3 (C)

22

8.6

4

18

7.1

I don’t know

159

62.4

12. What is the best age for the first HPV vaccine?
9 (C)

83

32.5

11

22

8.7

13

28

11

18

114

44.7

45

8

3.1

13. How many doses of HPV vaccine given after the age of 18 provide immunity?
1

9

3.5

2

35

13.8

3 (C)

51

20

I don’t know

160

62.7

14. HPV vaccine has side effects that can cause health problems.
Yes

48

18.8

No (C)

61

23.9

I don’t know

146

57.3

15. HPV vaccine is only administered to women
Yes

10

3.9

No (C)

159

62.4

I don’t know

86

33.7

16. Do you think that HPV vaccination should be given to men?
Yes (C)

201

78.8

No

54

21.2

17. HPV vaccine can be administered to men between the ages of 18-45
Yes (C)

146

57.2

No

15

5.9

I don’t know

94

36.9

18. HPV vaccination in men can contribute to the elimination of HPV (having no patients in the community).
Yes (C)

146

57.3

No

12

4.7

I don’t know

97

38

(C): Correct answer.

In the factor analysis for the awareness and knowledge survey about HPV and HPV vaccine, Kaiser-Meyer-Olkin: 0.875, Barlett’s test result was p<0.001. Two items in the survey (Item 13: 0.021 and Item 14: 0.038) were removed from the survey because their factor loadings were below 0.30. The factor loadings ranged between 0.302 and 0.812, and it was determined that the items collected in a single sub-domain explained 31.63% of the total variance. Cronbach’s alpha value was determined as 0.814. The item-total correlation values ​​for the items in the survey ranged between 0.201 and 0.714 . In addition, according to the confirmatory factor analysis results of the awareness and knowledge scale regarding HPV and HPV vaccine, the x2/dF value was determined as 2.08, AGFI as 0.87, RMSEA as 0.07, SRMR as 0.06, and GFI as 0.90. The path diagram showing the model structure and standard regression coefficients is shown in Figure 1. The median (min-max) score of the men in the study group from the survey was 24.0 (6.0-32.0) and the mean (SD) was found to be 23.20. In the study group, those in the 26-30 age group were found to have higher knowledge and awareness scores than those in the 31-35 age group (p=0.032). Singles had higher scores than married individuals (p=0.014). In terms of educational status, those with primary school education had lower scores than those with university and master’s degrees, those with high school education had lower scores than those with university and master’s degrees, and those with university level education had lower scores than those with master’s degrees (p<0.001). Those who were health workers had higher scores than those who were not (p<0.001). Those whose income was equal to expenses had lower scores than those whose income was greater than expenses (p=0.012). Those who did not have children were found to have higher scores than those who did (p=0.002). Those who had information about HPV vaccination had higher scores than those who had not (p<0.001). Those who considered getting HPV vaccination were found to have higher levels of awareness and knowledge about HPV and HPV vaccination than those who did not consider it and were undecided (p<0.001). Those who thought it was difficult to access HPV vaccination were found to have higher scores than those who did not consider it (p<0.001) (Figure 1 and Tables 3-5).

Figure 1: Path diagram showing the model structure and standard regression coefficients.

Table 3: Factor loadings for the questionnaire, correlation between items and Cronbach alpha values when items are removed.

Items

Factor loading Correlation between items Cronbach alpha value when item is removed
Item 1 0.493 0.409

0.814

Item 2

0.504 0.420 0.811
Item 3 0.657 0.561

0.803

Item 4

0.615 0.523 0.805

Item 5

0.749 0.645

0.801

Item 6 0.812 0.714

0.797

Item 7

0.416 0.351 0.817
Item 8 0.483 0.361

0.815

Item 9

0.684 0.575 0.807
Item 10 0.302 0.201

0.827

Item 11

0.305 0.203 0.823
Item 12 0.373 0.316

0.823

Item 15

0.641 0.542 0.805
Item 16 0.594 0.500

0.806

Item 17

0.550 0.432 0.811
Item 18 0.473 0.476

0.808

Scale Cronbach alpha value: 0.821.

Table 4: Katılımcıların sosyodemografik özelliklerine göre anketten aldıkları puanın karşılaştırılması.

 

Median (min-max)

p

Age group (year)  

0.032*

18-20

26.0 (18.0-30.0)

 
21-25

25.0 (6.0-32.0)

 
26-30

26.0 (13.0-32.0)

 
31-35

21.0 (13.0-32.0)

 
36-40

23.5 (13.0-32.0)

 
41-45

20.0 (13.0-32.0)

 
Marital status  

0.014*

Single

25.0 (6.0-32.0)

 
Married

22.0 (13.0-32.0)

 
Widow

20.0 (15.0-28.0)

 
Eğitim düzeyi  

<0.001*

Primary – secondary school

16.0 (13.0-22.0)

 
High school

18.0 (13.0-32.0)

 
College

24.0 (6.0-32.0)

Masters

28.0 (13.0-32.0)

Occupation

0.075*

Working

23.0 (13.0-32.0)

Not working

22.0 (13.0-30.0)

 
Student

25.0 (6.0-31.0)

Health worker

<0.001**

No

22.0 (6.0-32.0)

 
Yes

27.0 (13.0-32.0)

Place where lived during most of life

0.407*

City center

24.0 (6.0-32.0)

District

23.0 (12.0-31.0)

 
Village

22.5 (13.0-30.0)

Income level

0.012*

Income is less than expenses

23.0 (6.0-32.0)

 
Income is equal to expenses

23.0 (12.0-32.0)

 
Income is more than expenses

26.0 (13.0-32.0)

Has children

0.002**

No

25.0 (6.0-32.0)

 
Yes

20.5 (13.0-32.0)

Smoking

0.149**

No

24.0 (6.0-32.0)

 
Yes

23.0 (13.0-32.0)

Comorbidity

0.837**

No

24.0 (6.0-32.0)

 
Present

22.5 (13.0-32.0)

Sexual orientation

0.699**

Heterosexual

24.0 (6.0-32.0)

 
Homosexual

19,0 (18,0-29,0)

*Kruskal-Wallis test, **Mann-Whitney U test

Table 5: Comparison of the participants’ scores on the survey according to factors that may be related to them.

 

Median (min-max)

p

Given information about HPV vaccine  

<0.001*

Yes

28.0 (6.0-32.0)

 
No

21.0 (12.0-32.0)

 
HPV vaccination status  

0.320*

Yes

26.0 (6.0-32.0)

 
No

24.0 (12.0-32.0)

 
HPV vaccination status according to vaccine type  

0.336**

Not vaccined

24.0 (12.0-32.0)

 
Gardasil 4/2 doz

25.0 (6.0-32.0)

 
Gardasil 9/2 doz

29.0 (26.0-32.0)

 
Considering to be vaccined for HPV  

<0.001**

Yes

28.0 (15.0-32.0)

 
No

23.0 (6.0-32.0)

 
Undecided

23.0 (12.0-32.0)

 
Considers hard to reach HPV vaccine  

<0.001*

Yes

27.0 (13.0-32.0)

 
No

22.0 (6.0-32.0)

 

Discussion

Among sexually transmitted diseases, HPV infection is considered the most common worldwide. Persistent HPV infection is associated with more than 5% of all cancers worldwide. One of the main problems with HPV as an oncovirus is the significant difference between the time of diagnosis and the early stages of chronic infection. Early detection of HPV infection and HPV-induced lesions is critical for cancer prevention [1,3,15]. Genital HPV infection is very common among males, with an estimated prevalence of 65.2% in asymptomatic males aged 18–70 [16]. In our survey, most participants correctly answered a similar question: “HPV is a highly prevalent virus in humans.” Regarding risks to daughters, single fathers were significantly more likely to believe that their daughters were at risk for both HPV and cervical cancer. Concerns specific to single fathers included explaining the sexual nature of HPV and taking their daughters to the gynecologist for vaccination. In this respect, the results obtained for single men in our study are similar [17].

In the awareness and knowledge scale regarding HPV and HPV vaccine in this study, it was determined that those with primary school education had lower scores than those with university and master’s degrees, those with high school education had lower scores than those with university and master’s degrees, and those with university education had lower scores than those with master’s degrees. It is known that risky sexual behaviors are directly related to low education levels. Insufficient education levels negatively affect the tendency to this problem. This situation makes it difficult to prevent and treat these diseases. Similar to our findings, a cross-sectional study of 22,974 men in Denmark found that higher education was strongly associated with having heard of HPV. One study reported that men with less than a high school education were approximately 40% more likely to develop HPV infection. A cohort study of men in the United States found that having a college degree or other higher education was significantly associated with a lower risk of new infection with any type of HPV. The effectiveness of medical education has been demonstrated in an experimental study that demonstrated a statistically significant difference between pretest and posttest scores after the implementation of the education. These results support our findings. This suggests that level of education is a factor associated with HPV infection and that educated individuals have easier access to information sources and can use information more effectively. Our study found that those who were healthcare workers had higher scores than those who were not. Aslan and Bakan found that in a descriptive study conducted among health education students, including men, students who had knowledge about sexually transmitted infections had significantly higher levels of HPV knowledge. Lack of knowledge is a significant barrier to the prevention, diagnosis, and treatment of HPV infections and related diseases. The reason for the high level of knowledge among those who were knowledgeable about HPV and HPV vaccines may be attributed to the education men received as students or employees in the health field. In our study, 98% of the participants reported that they had not received HPV vaccination. In a similar study, Loke et al. reported that the HPV vaccination rate among men in the United States and Canada was very low, with rates ranging from 1.1% to 31.7% . This systematic review and meta-analysis showed that compliance with HPV vaccination was low (11% in total) among young men of working age (18-30 years). In addition, in our study, those whose income was equal to their expenses had lower scores than those whose income was greater than their expenses (0: 0.012). When the HPV and HPV vaccine awareness and knowledge level score is low, the rate of HPV vaccination is also low. From this, it is inferred that the lower the socioeconomic level, the lower the rate of HPV vaccination. The results in another study were similar. In this study, the fact that the vaccine is not covered by many health insurance companies makes it difficult for men to access the vaccine [18-24].

In this study, those who considered getting HPV vaccine were found to have higher levels of awareness and knowledge about HPV and HPV vaccine compared to those who were not considering or were undecided (p<0.001). One study found that they were more willing to get vaccinated and had higher awareness about HPV infection and malignancy [25]. Another study found that students who were more willing to get vaccinated had higher HPV knowledge scores [26]. Our findings are supported by similar studies. This situation can be explained by the fact that knowledge about the risk of exposure to HPV, especially in men, increases vaccine acceptance. In fact, when the HPV and HPV vaccine awareness and knowledge score is low, the rate of HPV vaccine application may be low. When the HPV and HPV vaccine awareness and knowledge score is high, the rate of HPV vaccine application is also high [27]. Our results were comparable to a previous study that showed that knowledge and awareness about HPV and HPV vaccine predicted it. The median score (min-max) of the men in this study group from the survey was 24.0 (6.0-32.0) and the mean (SD) was determined as 23.20. In the study group, those in the 26-30 age group were found to have higher knowledge and awareness scores than those in the 31-35 age group. In addition, men who obtained information about the HPV vaccine had higher scores than those who did not. The reason for the high mean score may be that the study was conducted in a university hospital polyclinic and most of the participants who applied were students or workers in the health field. Contrary to our findings, a study reported that 930 Singaporean men had insufficient knowledge and awareness about HPV [28]. In a descriptive study conducted by Aslan and Bakan [22] on health education students, it was found that male students had lower mean scores on the HPV knowledge level. These different results may be due to the recent increase in information about HPV and the HPV vaccine. In this study, more than half of the participants stated that HPV does not only cause diseases in women (69.8%) and that it can also cause mouth, pharynx, anus and penis cancer and genital warts in men (67.5). In a study conducted in Syria, 8.7% stated that HPV can be transmitted to both women and men [29]. According to these studies, it is thought that introducing Human papillomavirus as a cause of cervical cancer in particular may lead to the wrong perception that it is a disease specific to women only. The reason for the different results in our study is thought to be that the majority of the participants in the study are healthcare workers working at a university hospital and that there have been intensive information activities on HPV recently. It is known that HPV is a virus with more than 200 types that can be transmitted directly to the genital area, mouth and throat through sexual contact. In this study, less than half of the participants (47%) answered the question ‘HPV is transmitted only through contact with the genital area.’ correctly. According to literature data, participants stated that HPV can be transmitted sexually with a percentage ranging from 7.4% to 74.1% [30]. As can be seen, the awareness rate regarding the sexual transmission of HPV is generally low, although it varies between countries. Conservative family structures, education levels, and socioeconomic conditions can restrict society’s attitudes toward sexuality and the freedom to conduct research and discuss sexuality. In our study, more than half of the participants had a bachelor’s degree or higher, and the study was conducted in a large city, suggesting that the participants may be more aware of sexuality.

As of 2018, more than 80 countries and regions have implemented HPV vaccination programs. Although international organizations have made significant efforts to expand HPV vaccination programs, HPV vaccination rates remain below 50% in many countries worldwide. In our study, almost all participants (98%) did not receive HPV vaccination. In terms of considering HPV vaccination, the majority (78.4%) said ‘no’ or ‘undecided’. In terms of accessing HPV vaccination, more than half of the participants (56.5%) thought it was difficult. A study from sixteen European countries reported that the rate of participants considering HPV vaccination ranged from 45.6% to 79.5%. Among the Scandinavian countries, Sweden and Iceland have the highest acceptance rates of HPV vaccination. In studies, 7.7% to 37% of participants believed that the HPV vaccine could lead to early sexual orientation, while 7.9% to 68.1% stated that they avoided vaccinating themselves or their children due to safety concerns [6-8,31]. One study revealed that 62.3% of participants had heard of the HPV vaccine and 50.7% agreed to have themselves or their children vaccinated [32]. One study determined that 39.6% of participants did not get vaccinated because they did not have sufficient information and 30.8% did not get vaccinated because they thought it was unnecessary . Concerns about the potential side effects of the vaccine are an effective factor in not reaching the desired level of vaccination rates [6-9]. Research findings also reveal the need for HPV education interventions aimed at men. The level of knowledge about the HPV vaccine can affect an individual’s intention to get vaccinated. In male-specific HPV training, when the incidence of oropharyngeal and penile cancer was emphasized, it was found that men wanted to be vaccinated [33]. In a study conducted in Turkey, it was revealed that 1.1% of the participants had received the HPV vaccine. The reason for this was 94.4% of the participants stated that they were not informed, 18.7% thought it was harmful, and 4% avoided the vaccine because they were afraid of possible side effects [34]. In our study, only five (2%) of the male participants had received the HPV vaccine. In studies conducted in Turkey, the rates of receiving the HPV vaccine ranged from 1.0% to 4.3% [35]. Lack of information about HPV and the HPV vaccine prevents the desired level of interest in the vaccine both in our country and worldwide. In our country, the HPV vaccine has not yet been included in the vaccination calendar of the Ministry of Health. Although the level of knowledge about the HPV vaccine varies by country, it is generally low. Governments should make the Human Papillomavirus vaccine freely available, make it an important part of their national agenda and actively fight against it. There is generally less awareness among men that the HPV vaccine can also protect against various HPV-related cancers in men. HPV-related cancers can be largely prevented through vaccination. Vaccination protects men from developing anogenital condylomas, other malignancies related to the infection, including the penis, anus and base of the tongue. If both sexes are vaccinated, the spread of the virus decreases. Thus, it can be more effective in successfully achieving herd immunity against the virus [5-9]. In our study, most participants answered a similar question correctly. ‘HPV vaccination in men can contribute to the elimination of HPV (no cases in the community)’. HPV vaccination also helps to control the spread of HPV and reduce the overall burden of the virus on health systems. In addition, HPV-related cancer treatments are often costly and require significant resources from health systems, so vaccination against HPV may also provide cost savings in the long term. Primary and school-based HPV vaccination programs at this stage allow for higher vaccination rates and contribute to sociodemographic equality. A good solution to increase vaccination worldwide is to provide catch-up vaccination, preferably in school health systems [7-10]. The biggest problem is the lack of knowledge about preventing HPV-related pathologies. More education on this issue will increase compliance with vaccination campaigns. People who are not recommended for vaccination by their primary care physicians are less likely to receive HPV vaccination than young people who are. Vaccination of men, as well as women, is being integrated into national school-based and primary care vaccination programs worldwide, but vaccination coverage is still patchy, information is insufficient, and misconceptions persist [8-13]. Our study had some limitations. Since the data were collected cross-sectionally at a single university clinic over a specific time period, the results may not be generalizable to the entire population.

When we look at the content of our study, it is seen that healthcare workers, participants with higher income than expenses and undergraduate/graduate degrees scored higher in terms of knowledge and awareness levels about HPV and HPV vaccine. Considering the general structure of the society, male compliance with HPV vaccine is not considered sufficient. This study investigates a population of men aged 18-45, where there is evidence that compliance with vaccines is extremely poor. In order to achieve a higher level of compliance, it is important to give importance to vaccination campaigns and dissemination of information about the benefits of the vaccine as well as the risks of HPV infection.

To date, vaccination is the only way to break the chain of infection, but HPV vaccination programs, especially gender-neutral programs, are still inadequate. This makes it difficult to achieve herd immunity, especially in men who are invited to get vaccinated years after their first vaccination. There is increasing evidence that gender-neutral vaccination alone can significantly control HPV-related diseases in both women and men and can maximize the prevention of cervical cancer, especially if vaccine coverage is not high among girls in a given region. Given the current situation, it is reasonable to assume that secondary prevention will continue to be the basis for cervical cancer prevention. Another global public health goal should also be to provide scientific evidence to determine the most appropriate timing of vaccination to maximize cancer recurrence and improve outcomes of recommended treatments. Finally, health communication should also play an important role. Indeed, standardizing both the quality and quantity of information can lead to increased adherence to various vaccine awareness campaigns, which must already overcome the biases and psychological factors that complicate promotion and prevention interventions. Of course, investing in promotion campaigns, as in the case of polio, will both improve the cost-benefit balance (making this balance even more favorable than that achieved by primary prevention alone) and equalize vaccination coverage between the two sexes.

References

  1. Zayats R, Murooka TT, McKinnon LR (2022) HPV and the Risk of HIV Acquisition in Women. Front Cell Infect Microbiol 12: 814948. [crossref]
  2. Muñoz-Bello JO, Carrillo-García A, Lizano M (2022) Epidemiology and Molecular Biology of HPV Variants in Cervical Cancer: The State of the Art in Mexico. Int J Mol Sci 23(15). [crossref]
  3. Lin G, Li J (2023) Circulating HPV DNA in HPV-associated cancers. Clin Chim Acta 542: 117269. [crossref]
  4. Võrno T, Lutsar K, Uusküla A, Padrik L, Raud T, et al. (2017) Cost-effectiveness of HPV vaccination in the context of high cervical cancer incidence and low screening coverage. Vaccine 35(46). [crossref]
  5. de Oliveira CM, Fregnani JHTG, Villa LL (2019) HPV Vaccine: Updates and Highlights. Acta Cytol 63(2). [crossref]
  6. Conageski C (2023) Human Papillomavirus Vaccines. Clin Obstet Gynecol 66(3). [crossref]
  7. Marshall S, Fleming A, Sahm LJ, Moore AC (2023) Identifying intervention strategies to improve HPV vaccine decision-making using behaviour change theory. Vaccine 41(7). [crossref]
  8. Garolla A, Graziani A, Grande G, Ortolani C, Ferlin A (2024) HPV-related diseases in male patients: an underestimated conundrum. J Endocrinol Invest 47(2). [crossref]
  9. Williamson AL (2023) Recent Developments in Human Papillomavirus (HPV) Vaccinology. Viruses 15(7)[crossref]
  10. Gamboa-Hoil SI (2023) Human papillomavirus in men. Rev Int Androl 21(1). [crossref]
  11. Erkorkmaz U, Ozdamar K, Sanisoglu Y (2013) Confirmatory Factor Analysis and Fit Indices: Review. Article in Turkiye Klinikleri Journal of Medical Sciences. Turkiye Klinikleri J Med Sci 33(1)
  12. Abdi H, Williams LJ (2010) Principal component analysis. Wiley Interdiscip Rev Comput Stat 2: 433–59.
  13. Kılıç S (2016) Cronbachs alpha reliability coefficient. Psychiatry and Behavioral Sciences 6(1)
  14. Cakmur H (2012) Measurement-Reliability-Validity in Research. TAF Preventive Medicine Bulletin 11(3)
  15. Yarbrough ML, Burnham CAD (2016) The ABCs of STIs: An Update on Sexually Transmitted Infections. Clin Chem 62(6). [crossref]
  16. Spencer JC, Brewer NT, Trogdon JG, Weinberger M, Coyne-Beasley T, Wheeler SB (2020) Cost- effectiveness of Interventions to Increase HPV Vaccine Uptake. Pediatrics 146(6). [crossref]
  17. Lelliott M, Sahker E, Poudyal H (2023) A Review of Parental Vaccine Hesitancy for Human Papillomavirus in Japan. J Clin Med 12(5). [crossref]
  18. Nielsen A, Munk C, Liaw KL, Kjær SK .(2009) Awareness of human papillomavirus in 23 000 Danish men from the general male population. European Journal of Cancer Prevention 18(3). [crossref]
  19. Han JJ, Beltran TH, Song JW, Klaric J, Choi YS (2017) Prevalence of Genital Human Papillomavirus Infection and Human Papillomavirus Vaccination Rates Among US Adult Men: National Health and Nutrition Examination Survey (NHANES) 2013-2014. JAMA Oncol 3(6). [crossref]
  20. Lu B, Wu Y, Nielson CM, Flores R, Abrahamsen M, et al. (2009) Factors Associated with Acquisition and Clearance of Human Papillomavirus Infection in a Cohort of US Men: A Prospective Study. J Infect Dis 199(3). [crossref]
  21. Ford ME, Cannady K, Nahhas GJ, Knight KD, Chavis C, et al. (2020) Assessing an intervention to increase knowledge related to cervical cancer and the HPV vaccine. Adv Cancer Res 146: 115–37. [crossref]
  22. Aslan G, Bakan AB (2021) Identification of the Knowledge Level of Students Receiving Health Education About the Human Papilloma Virus, Screening Tests, and Human Papilloma Virus Vaccination. J Community Health 46(2). [crossref]
  23. Loke AY, Kwan ML, Wong YT, Wong AKY (2017) The uptake of human papillomavirus vaccination and its associated factors among adolescents: A systematic review. J Prim Care Community Health 8(4). [crossref]
  24. Chow EPF, Tabrizi SN, Fairley CK, Wigan R, Machalek DA, et al. (2021) Prevalence of human papillomavirus in young men who have sex with men after the implementation of gender-neutral HPV vaccination: a repeated cross-sectional study. Lancet Infect Dis 21(10). [crossref]
  25. Baloch Z, Yasmeen N, Li Y, Zhang W, Lu H, et al. (2017) Knowledge and awareness of cervical cancer, human papillomavirus (HPV), and HPV vaccine among HPV-infected chinese women. Medical Science Monitor 23: 4269–77. [crossref]
  26. Varer Akpinar C, Alanya Tosun S (2023) Knowledge and perceptions regarding Human Papillomavirus (HPV) and willingness to receive HPV vaccination among university students in a north-eastern city in Turkey. BMC Womens Health 23(1). [crossref]
  27. Dönmez S, Öztürk R, Kısa S, Karaoz Weller B, Zeyneloğlu S (2019) Knowledge and perception of female nursing students about human papillomavirus (HPV), cervical cancer, and attitudes toward HPV vaccination. J Am Coll Health 67(5). [crossref]
  28. Pitts M, Smith A, Croy S, Lyons A, Ryall R, et al. (2009) Singaporean men’s knowledge of cervical cancer and human papillomavirus (HPV) and their attitudes towards HPV vaccination. Vaccine 27(22). [crossref]
  29. Alsaad MA, Shamsuddin K, Fadzil F (2012) Knowledge towards HPV infection and HPV vaccines among Syrian mothers. Asian Pac J Cancer Prev 13(3). [crossref]
  30. Koç Z (2015) University students’ knowledge and attitudes regarding cervical cancer, human papillomavirus, and human papillomavirus vaccines in Turkey. J Am Coll Health 63(1). [crossref]
  31. López N, Garcés-Sánchez M, Panizo MB, De La Cueva IS, Artés MT, et al. (2020) HPV knowledge and vaccine acceptance among European adolescents and their parents: a systematic literature review. Public Health Rev 41. [crossref]
  32. Ortiz RR, Smith A, Coyne-Beasley T (2019) A systematic literature review to examine the potential for social media to impact HPV vaccine uptake and awareness, knowledge, and attitudes about HPV and HPV vaccination. Hum Vaccin Immunother; 15(7-8). [crossref]
  33. Bonafide KE, Vanable PA (2015) Male human papillomavirus vaccine acceptance is enhanced by a brief intervention that emphasizes both male-specific vaccine benefits and altruistic motives. Sex Transm Dis 42(2). [crossref]
  34. Keten HS, Ucer H, Dalgaci AF, Isik O, Ercan Ö, Guvenc N (2021) Knowledge, Attitude, and Behavior of Teachers Regarding HPV (Human Papillomavirus) and Vaccination. J Cancer Educ 36(3). [crossref]
  35. Karasu AFG, Adanir I, Aydin S, Ilhan GK, Ofli T (2019) Nurses’ Knowledge and Opinions on HPV Vaccination: a Cross-Sectional Study from Istanbul. J Cancer Educ 34(1). [crossref]

Putting A Human Face on ‘Burnout’ in the World of Medicine: Using AI and Mind Genomics Thinking about Mind-Sets to Create a Sense of what is Going on, and What to Do

DOI: 10.31038/ALE.2024124

Abstract

This paper explores the emerging problem of burnout among medical professionals. The approach is a combination of simulations using artificial intelligence structured by Mind Genomics thinking about mind-sets. The paper begins with using the simulations to explore the way professionals talk when in a staff meeting at a local hospital when the hospital was independent versus when it was acquired by a private equity firm. The paper continues with the exploration of mind-sets about the way medical professionals burn out, showing five different patterns or types of people. The paper continues with the use of AI to suggest messaging for the five burnout mind-sets to encourage preventive actions, and then finishes with the use of AI as a co-development coach or even partner. Through the paper the stress is on simplicity, speed, iterations to gradually improve, and the opportunity for the democratization of solving problems and advancing medicine.

Introduction

The topic of burnout and the immediate stimulus for writing this paper comes from a web posting in the news section (Table 1). Service in the medical profession at all levels and in all functions seems to be hitting the ‘respected brick wall’, of frustration. Medical professional burnout is causing higher healthcare costs, higher turnover rates, and decreased patient care. This is detrimental to the healthcare system and patients. Non-medical professionals should address mental health and well-being, empathizing with healthcare workers experiencing burnout. They should advocate for better support systems and resources for medical professionals. Concern should also arise for non-medical professionals, as a healthcare system struggling to meet patient needs due to burnout could lead to dangerous situations and subpar care [1-4].

Table 1: The Story about burnout the world of burnouts in the world of medicine.

Phase 1 – Simulations of Interviews with People

Taking a simulation approach to understanding burnout in the medical profession (Table 2) allows for a more in-depth exploration of the personal thoughts and feelings of those experiencing it. By bringing together a variety of relevant individuals, such as doctors, nurses, and administrators, and simulating discussions using advanced AI like GPT 3.5, this method delves into the underlying issues driving burnout. It personalizes the experience by allowing participants to express their true feelings, creating a more intimate and detailed understanding of the challenges they face.

Table 2: Three simulations about the causes of burnout, two from medical professionals, one from employees who are not medical professionals.

The benefits of this approach include gaining insights that may not be uncovered through traditional methods like surveys or interviews. First, simulations allow the investigator to do more deeply into inner thoughts and motivations, leading to a deeper understanding of the root causes of burnout. Second, simulation of interviews allows for a more nuanced exploration of complex relationships and dynamics within the healthcare system, providing a holistic view of the issues at hand.

When people question the validity of using simulations and AI like GPT 3.5 for understanding burnout, it can be argued that this method allows for a unique glimpse into the minds of individuals in the medical profession. By focusing on personal experiences and emotions, rather than just facts and figures, simulations provide a rich tapestry of insights that can inform future interventions and solutions. The simulated interview offers a novel way to explore the complexities of burnout and relationships within the healthcare system, paving the way for more effective strategies to address these challenges [5-8].

Phase 2 – The Value of Mind-sets and How AI Uncovers These Mind-sets Through Simulation

Carol Dweck’s seminal work on mindsets developed the concept of fixed vs growth mindsets, emphasizing the value of trusting in one’s ability to learn and evolve. This concept has been used to many fields, including medicine. Mind Genomics, as well as Moskowitz and colleagues’ research, have expanded on the concept of mindsets in healthcare, utilizing experimental design to blend multiple messages about the medical experience and analyze how people respond to them [9-11].

Researchers were able to identify fundamentally diverse attitudes among individuals by employing well established approaches such as regression analysis, grouping, and permutation. These mindsets are not necessarily innate characteristics, but rather modes of thinking that can influence behavior and decision-making.

In Phase 2 we simulate mind-sets, first using mind-sets typically discussed in the popular press because it involves the world of the everyday. We then move to simulating mind-sets focusing strictly on patterns of burnout among medical processionals (Table 3).

Table 3: Simulation of burnout mind-sets.

Simulating Solutions to Problem by the Targeted Messages Appropriate for a Mind-set

One way to begin dealing with burnout is the ‘soft’ approach of messaging. The development of Mind Genomic starting almost 40 years ago in the mid 1980’s recognized that there were different mind-sets for items as simple as toothpaste. The continuing use of Mind Genomics, and the emerge of speed, the lowering of cost, and the ease of application ended with revealing that much could be gained by working with mind-sets to craft effective messages.

Table 4 shows how generative AI can be ‘fed’ a group of mind-sets, and emerge with appropriate messages that might be used. In conventional use, these messages might either be developed with empirical-based Mind Genomics using people, or at least checked and validated later before use. Right now, however, Table 4 shows a richness of messaging to jump start the solution and can probably outperform many suggestions emerging from brainstorming. The process can be looked at as a cost-effective AI-brainstorm.

Table 4: Five AI-suggested mind-sets of doctors based on burnout patterns, and AI-suggested appropriate messaging to them to reduce burnout.

Using AI as an Invention Machine, or at least as an Invention Colleague

Generative AI, along with Mind Genomics thinking, can transform the way we address burnout by proposing new ideas that provide general guidance and explain what the innovation achieves/ The strength of generative AI in conjunction with Mind Genomics thinking stems from its potential to handle complicated human nature concerns, such as burnout, which are currently baffling and difficult to address.

Using the Mind Genomics platform such as BimLeap.com, those in the medical world may run the AI numerous times in minutes and quickly modify components of their request to adapt the suggestions to their exact needs. This ability to swiftly produce and customize burnout solutions can be extremely beneficial when made publicly available, low-cost, and user-friendly.

Table 5 shows nine innovations from one run. The objective of showing the ideas in Table 5 is to demonstrate the ease with which AI can become an integral part, even perhaps a ‘member’ in the effort to solve human-experience problems, where the issue no long is ‘factual correctness’ but rather ‘it is useful?’.

Table 5: Nine suggested innovations suggested by AI and returned to the user automatically after the ‘study’ is closed and AI has had a chance to further analyze the information it provided. The material comes from the ‘Idea Book’, and Idea Coach, attached to the project.

Discussion and Conclusions

Generative AI coupled with Mind Genomics thinking has the potential to revolutionize the way we approach burnout by suggesting innovative solutions that give general direction and outline what the innovation accomplishes. By utilizing a Mind Genomics platform like Bimieap.com, users can run the AI multiple times in minutes and easily change aspects of their request to tailor the suggestions to their specific needs. This ability to quickly generate and customize solutions for burnout can be incredibly valuable when made widely available, inexpensive, and user-friendly.

The power of generative AI in conjunction with Mind Genomics thinking lies in its ability to tackle complex human nature issues, such as burnout, that are currently perplexing and challenging to address. With the AI’s capacity to generate a multitude of suggestions and ideas, users can explore a range of innovative solutions that may not have been considered before. This opens up new possibilities for individuals to find effective ways to combat burnout and improve their overall well-being.

The democratization of expertise through generative AI and Mind Genomics platforms like Bimieap.com means that everyone can become an expert when it comes to addressing personal challenges like burnout. By empowering individuals to take control of their own solutions and decisions, this technology promotes a sense of agency and ownership over one’s well-being. This shift towards self-directed problem-solving can lead to more effective and sustainable strategies for managing burnout.

As generative AI becomes more widely accessible and user-friendly, the potential for addressing a range of human nature issues beyond burnout increases exponentially. From stress management to mental health support, the applications of AI and Mind Genomics thinking are limitless. By encouraging widespread discussion and exploration of innovative solutions, this technology has the power to catalyze positive changes in how we approach and overcome challenges in our daily lives.

Overall, the combination of generative AI and Mind Genomics thinking represents a new frontier in problem-solving and innovation, offering individuals the tools and resources they need to address complex issues like burnout in a creative and effective manner. Through this technology, we can tap into our collective expertise and wisdom, empowering everyone to become a master of their own well-being. The future looks bright with these powerful tools at our disposal, ready to shape a more resilient and thriving society.

Acknowledgments

The authors thank Vanessa M Arcenas and Isabelle Porat of the Tactical Data Group for help in preparing this and companion manuscripts in this set.

References

  1. Bridgeman PJ, Bridgeman MB, Barone J (2018) Burnout syndrome among healthcare professionals. The Bulletin of the American Society of Hospital Pharmacists 75: 147-152. [crossref]
  2. Chou LP, Li CY, Hu SC (2014) Job stress and burnout in hospital employees: comparisons of different medical professions in a regional hospital in Taiwan. BMJ open 4: e004185. [crossref]
  3. Erschens R, Keifenheim KE, Herrmann-Werner A, Loda T, Schwille-Kiuntke J, et al. (2019) Professional burnout among medical students: systematic literature review and meta-analysis. Medical teacher 41: 172-183. [crossref]
  4. Schrijver I (2016) Pathology in the medical profession?: taking the pulse of physician wellness and burnout. Archives of pathology & laboratory medicine 140: 976-982. [crossref]
  5. Fuse Brown EC, Hall MA (2024) Private equity and the corporatization of health care. Stanford Law Review 76.
  6. Gerard RA (2024) Lead With Purpose: Reignite Passion and Engagement for Professionals in Crisis. Friesen Press.
  7. Howell TG, Mylod DE, Lee TH, Shanafelt T, Prissel P (2020) Physician Burnout, Resilience, and Patient Experience in a Community Practice: Correlations and the Central Role of Activation. J Patient Exp 7: 1491-1500. [crossref]
  8. Peterson MD (2024) Another View on Workforce Projections: A Bright Future, but the Details Can Be Cloudy. ASA Monitor 88: 29.
  9. Jahja E, Papajorgji P, Moskowitz H, Margioukla I, Nasto F, et al. (2024) Measuring the perceived wellbeing of hemodialysis patients: A Mind Genomics cartography. Plos one 19: e0302526. [crossref]
  10. Moskowitz Howard R, Stephen D Rappaport, Sunaina Saharan, Sharon Wingert, Tonya Anderson, et al. (2024) “Mind-Sets for Prescription Weight Loss Products That Are Advertised Directly to Consumers: Using Mind Genomics Thinking with AI for Synthesis and Exploration.” Acta Scientific Pharmaceutical Sciences (ISSN: 2581-5423)
  11. Moskowitz H, Rappaport SD, Wingert S, DiLorenzo A, Sunaina Saharan, et al. (2024) Learning from Ai Synthesis of Mind-Sets: Dealing with Patients Injured by Violence in The New York City Subway System. J Clin Nur Rep 3: 01-06.

Putting a Human Face on Legal Disputes: Eviction for Non-Payment of Rent Simulated by AI and Mind Genomics Thinking

DOI: 10.31038/ALE.2024123

Abstract

Using generative AI (Chat GPT3.5), the paper shows how a legal case such as eviction for non-payment of rent can be ‘brought to life’. The first simulation shows how AI can be used as a preparatory device for the Mind Genomics experiment, thus making the lawyer’s job easier when using Mind Genomics for a legal case. This first simulation focuses on AI-created questions and answers, and the ‘guesstimate’ by AI as to the likelihood that a jury will find ‘for the plaintiff’ vs ‘for the defendant’. The second simulation focuses on different reasons for the eviction, and AI-based analyses of legal aspects vs ethical aspects. This second stimulation demonstrates the ability of AI to consider the nuances of a case. In both simulations the focus is on types of issues that are best described by phrase ‘subjective, and open to interpretation.’

Introduction

As legal education evolves, law schools are placing greater emphasis on equipping students with the skills to critically analyze intricate legal cases. Traditional methods for teaching law methods frequently rely on rote memorization of statutes and procedures. However, a growing number of educators are now embracing experiential learning opportunities, allowing students to hone their analytical skills in practical contexts. In this new era of legal education, innovative technologies such as generative AI are increasingly being utilized to simulate legal cases, enabling students to navigate real-world scenarios effectively. When combined with the emerging science of Mind Genomics the new mix enables students, or indeed anyone, to gain a human perspective on the law, viz., put a human face on the facts through simulation. The simulation allows learning by asking ‘what-if’ questions, not about the case law itself, but about the softer, human aspects [1-5].

This paper shows two simulations of the same case, where a landlord seeks to evict tenants who have fallen behind on rent for two months due to job loss. The case itself is rich with legal versus emotional and moral complexities. In the classroom, students might end up relishing the back-and-forth analysis, as they engage in a spirited discussion, exploring the pertinent legal principles, the rights of both landlords and tenants, and possible solutions to the issue at hand. This exchange of ideas enables students to examine various viewpoints, sharpen their arguments, and gain a richer insight into the intricacies of legal decision-making.Can we make this back and forth into an AI application, using currently available LLM’s, large language models? As this paper shows, we can do so in ways which are staggeringly fast, inexpensive, scalable, and adaptable to many situations [6-8].

Simulation in the legal field breathes life into cases, offering a vivid experience which textbooks and lectures often fail to convey. Generative AI lets law students explore the intricate complexities and subtleties of real-world legal dilemmas through simulated cases. In this scenario, the AI offers clarity on landlord-tenant laws, the eviction process, and the delicate balance of interests between property owners and tenants.Students can delve into various viewpoints and possible results of the case through simulation. The legal rights and responsibilities of both landlords and tenants can be examined, alongside an evaluation of the ethical implications stemming from the decisions made by each party. This practical method sharpens critical thinking and fosters a richer comprehension of legal principles at work.

This paper explores the two simulations, based on the same ‘facts of the case’. Simulation 1 deals with what to present to a jury to get the jury to vote for the client. Simulation 2 moves more deeply into the role of the lawyer as an advocate for their client.

Simulation 1: Mr. Owner vs Mr. & Mrs. Tenant – Rent Dispute and the Search for Discovering Powerful Messages Resonating with the Jury

We begin with the facts in the case, shown in Table 1. The stimulation is set up to provide messages that can be tested by the emerging science of Mind Genomics, to identify those specific messages which will resonate with a jury [9-12].

Table 1: Facts of the case and instructions to AI (Simulation 1)

The actual Mind Genomics experiment with real people (not shown) follows a straightforward process. The steps are as follows:

  1. Select a topic
  2. Develop four different questions about that topic which give a human face to the topic
  3. For each question develop four different answers to the question, phrased as stand-alone phrases which paint a word picture
  4. Combine the 16 elements into small, easy-to-read vignettes comprising a minimum of two and a maximum of four elements. The composition of the 24 vignettes to be evaluated by a single respondent follows an underlying experimental design. Each question contributes only one element to the vignette. Across the set of 24 vignettes each of the 16 elements appears 5x and is absent 19x. Mathematically the structure of each respondent’s set of 24 vignettes is identical, but the permutation ensures that the vignettes are different across all respondents.
  5. Each respondent evaluates a permuted set of 24 vignettes, using a simple rating scale. The vignette is a stand-alone composition, easy to read. The respondent requires about 3-4 seconds to scan the combination of messages and assign a rating.
  6. The data are put into a simple data base to prepare them for statistical analysis. Ordinary least-squares, dummy variable regression analysis shows the driving power of each element, first for each respondent, and then for groups of respondents defined by methods such as cluster analysis.

Up to now the creation of raw material, questions especially, has emerged as a stumbling block. For whatever reason, people are intimidated. Over a 24-year period, 1998 to 2022, the same plaint was heard, always by the researcher using the tool. It was simply daunting, although children had fewer problems than did adults, and especially far fewer problems than did professionals. Professionals wanted perfection in the vignette, ending up enamored with overly polished, wordy paragraphs, hard to read, hard to test more than a few.

The introduction of AI in 2022 revolutionized this emerging science of Mind Genomics. As Table 1 showed it is straightforward to come up with the statement of the ‘facts of the case’. It is the creation of the questions and elements (answer) which are difficult.

Table 2 shows what emerged after one iteration requiring 10-15 seconds. These four answers are statements about the case, and the AI’s ‘guesstimate’ about the jury’s decision based on each answer. The key benefit to critical thinking is the ability of AI to jump-start the thought process. To ‘have fun’ one could iterate, with each iteration requiring the 15 seconds. An encyclopedia of questions and elements (answers) would emerge in about 10 minutes or shorter. The enterprising user could change the facts in the case as well and explore different ‘what if’ aspects, using the Idea Coach features.

Table 2: Simulation of four questions and four elements (answers to each question), prepared for a Mind Genomics experiment with actual people (Simulation 1).

The effort is finished, whether one iteration or 100 iterations, the results of each iteration are stored on an Excel spreadsheet, with one tab dedicated to each iteration. Thus, it is possible to run many iterations, acquire the data, but leave the subsequent analysis to an off-line effort, that effort taking about 5-6 hours. The results are returned to the user by email. The remainder of this simulation is generated after the study preparation is closed. AI then goes over its own questions and answers and provides a summarization and deeper analysis shown in Table 3, and beyond. Table 3 presents the first set of information,

  1. Key Ideas: AI can provide valuable insights into key ideas by analyzing large amounts of data and identifying patterns and trends. It can summarize complex concepts and present them in a clear and concise manner. This can help individuals better understand key concepts and make informed decisions.
  2. Themes: AI can also identify common themes across different sources of information, allowing for a deeper understanding of the subject matter. This can help in identifying trends and patterns that may not be apparent at first glance.
  3. Perspectives: AI can provide different perspectives on a topic by analyzing a wide range of sources and presenting diverse viewpoints. This can help individuals gain a more comprehensive understanding of the subject matter and consider different angles.
  4. What is missing: AI can also highlight what is missing in a particular discussion or research study by pointing out gaps in information or potential areas for further exploration. This can guide researchers in identifying areas that need further investigation.
  5. Alternative viewpoints: Additionally, AI can present alternative viewpoints on a topic by analyzing conflicting information and presenting different sides of the argument. This can help individuals consider different perspectives and make well-informed decisions.

Table 3: AI summarization of simulation 1 in terms of key ideas, themes, perspectives, what is missing and alternative viewpoints.

Table 4 compares interested audiences versus opposing audiences regarding the material presented in Table 3. AI can expand the topic by questions and answers tailored to specific interested audiences, allowing for a more personalized and engaging experience for learners. AI can create content that is relevant and meaningful content. increasing their motivation and interest in the material. Going a step further, AI can also identify prospective opposing audiences by presenting diverse perspectives and challenging viewpoints. By generating questions and answers that provoke critical thinking and debate, AI can stimulate discussions and encourage individuals to consider alternative viewpoints. This can lead to a more well-rounded understanding of the topic and foster a culture of open-mindedness and tolerance.

Table 4: AI synthesis of interested versus opposing audiences, based on material in Table 3.

The final analysis as of this writing (November 2024) is the suggestion of innovations. The initial suggestion of innovations produced a list of AI-generated innovations. During the summer of 2024, the Mind Genomics system was modified so that the post-creation of the study (not-yet-run with people) would offer a far more complete analysis of each innovation that was being created and offered to the user. These nine aspects appear below and are shown in Table 5 for each of the four innovations.

  1. Specific suggestion: AI can provide specific and targeted suggestions based on data analysis and patterns
  2. Explanation why the suggestion is relevant:
  3. Importance and uniqueness of the suggestion:
  4. Social Good resulting from the suggestion.
  5. Slogan which emblemizes the suggestion:
  6. Investment pitch:
  7. Potential investor pushback:
  8. Answer to the potential investor pushback:
  9. Compromise, go forward positioning:

Table 5: The four innovations suggested by AI and an AI ‘work-up’ of each innovation

Simulation 2 – Dealing with the Same Issue, but From the Point of View as the Lawyers Helping Both Sides as ‘Trusted Parties’

In this simulation we move backwards, away from the situation of a lawyer trying to anticipate what to say to the jury (Mind Genomics approach), to understanding the ‘facts in the case’ from the point of view of the client. Here the lawyer becomes a trusted friend. The process becomes more personal and empathic.

Table 6 shows the ‘facts of the case’ and the instructions to AI to generate the relevant questions and answers. Table 7 shows nine different questions and the structured answers to those questions.

Table 6: Facts of the case and instructions to AI (Simulation 2)

It is worth noting here that generative AI such as Chat GPT3.5 used here, can be instructed to simulate different people talking to each other, e.g., listening in as a ‘fly on the wall’ to the lawyer’s conference.

Table 7: Nine relevant questions generated by AI regarding the case, with answers simulated by AI with respect to from the legal standpoint and the moral standpoint.

Discussion and Conclusion

Simulations are crucial for students to understand the intricacies of legal decision-making, enabling active engagement with complex scenarios and practicing their knowledge in real-world contexts. These simulations enhance students’ understanding of the law and its real-world uses, as well as their critical thinking and problem-solving abilities. The future of law schools will likely employ diverse techniques and technologies, guiding students to think critically about complex issues. Mind Genomics, enhanced by AI, presents a groundbreaking solution for the legal system, offering students an engaging and interactive approach to grasp the intricacies of legal cases. This technology has the potential to reshape the legal landscape, fostering quicker case resolutions, enhancing transparency, and expanding access to justice for everyone. Mind Genomics and generative AI can craft realistic legal scenarios by examining the many factors which shape legal decision-making, including case law, evidence, and ethical considerations. These scenarios can provide students with practical experience to enhance their legal reasoning skills in a simulated environment.

Mind Genomics, powered by AI, has the potential to revolutionize the legal profession by improving decision-making, streamlining case resolutions, and ensuring justice is served efficiently and transparently. This technology would benefit students by providing interactive learning tools, real-world case studies, and hands-on experience, while professors would have access to cutting-edge research tools and real-time data. The implementation of Mind Genomics could transform the legal practice, leading to more efficient case resolutions, improved transparency, and greater access to justice for all individuals.

Reflection and debriefing sessions on simulated legal cases can help students improve their legal reasoning abilities, bridge the gap between theoretical legal knowledge and practical application in real-world scenarios, and develop a deeper understanding of human factors involved in legal decision-making. At the same, it might well be productive is during the application of AI to legal issues the user requests both legal and ethical/moral considerations as separable steps in the process.In conclusion, using technology-driven simulations in legal education can promote active learning, enhance critical thinking skills, and provide practical experience in legal decision-making, equipping students for successful careers in law.

Acknowledgments

Author Moskowitz wishes to acknowledge the help of the audience at his lecture at the law school in of the University of Kragujevac, November, 2024. Many of the points of view regarding ethics and morality and the law were challenged by the students and professors, leading to refinements in the authors’ thinking.

The authors would like to thank Vanessa M. Arcenas and Isabelle Porat for help in preparing this manuscript for publication.

References

  1. Curcio AA (2009) Assessing differently and using empirical studies to see if it makes a difference: Can law schools do it better. Quinnipiac L Rev 27: 899.
  2. Horwitz P (2012) What Ails the Law Schools. Mich L Rev 111: 955.
  3. Katz HN (2006) Evaluating the skills curriculum: Challenges and opportunities for law schools. Mercer L Rev 59: 909.
  4. Mertz E (2007) The language of law school: learning to” think like a lawyer”. Oxford University Press, USA.
  5. Shah M (2010) The legal education bubble: how law schools should respond to changes in the legal market. Geo J Legal Ethics, 23: 843.
  6. Alarie B, Niblett A, Yoon AH (2018) How artificial intelligence will affect the practice of law. University of Toronto Law Journal, 68: 106-124.
  7. Jinzhe Tan, Hannes Westermann, Karim Benyekhlef (2023)ChatGPT as an Artificial Lawyer? Canad Workshop on Artificial Intelligence for Access to Justice (AI4AJ 2023)
  8. Susskind R, Susskind RE (2023) Tomorrow’s lawyers: An introduction to your future. Oxford University Press.
  9. Moskowitz H, Kover A, Papajorgji P (2022) Applying mind genomics to social sciences. IGI Global.
  10. Moskowitz HR, Wren J,Papajorgji P (2020) Mind genomics and the law. Mauritius: LAP Lambert Academic Publishing.
  11. Papajorgji P (2023) Knowledge as a service: The case of Mind Genomics. EuroMediterranean, 19: 34-47.
  12. Porretta S, Gere A, Radványi D,Moskowitz H (2019) Mind Genomics (Conjoint Analysis): The new concept research in the analysis of consumer behaviour and choice. Trends in food science & technology, 84: 29-33.

Designing Eco-Serbia for High School Students: Using AI Simulation with Mind Genomics Thinking and Technology to Inspire Critical Thinking by a Gamifying a Topic

DOI: 10.31038/MGSPE.2024443

Abstract

AI (Chat GPT3.5) embedded in the Mind Genomics platform (Idea Coach feature of BimiLeap.com), was used to synthesize a teaching approach for critical thinking. The exercise, strictly based on interaction with AI, was guided by the request of students in the Gymnasium of Novi Sad, Serbia, to create a tool which would allow them to experience critical thinking in a gamified manner. The process and prompts are presented in this paper, with the path to create a new game, Eco-Serbia. The paper shows how to introduce the topic, the power of AI to simulate discussions about a topic, to create the specifics for the game, and then shows additional analyses. These additional analyses, done after the project has been ‘closed’ by the user. include showing how to discover key ideas, themes, perspectives, and types of responses by different audiences. The paper finishes with a detailed opportunity analysis of four innovations about eco-Serbi as suggested by the AI [1-4].

Introduction

Teaching gymnasium-level students critical thinking is vital; it empowers them to analyze information, evaluate arguments, and reach informed conclusions. Developing critical thinking skills enables students to sharpen their awareness of the world around them, prompting them to question assumptions, form their own opinions, and approach challenges with innovative solutions. The result is enhanced academic achievements while being equipped with the skills to navigate complex challenges in a diverse and interconnected world [5-9].

Integrating critical thinking into the high school gymnasium curriculum ignites student creativity, inspiring them to generate innovative ideas and solutions. Through the application of critical thinking skills across subjects such as science, literature, and history, students increase their understanding, interact meaningfully with the material, and enjoy a sense of curiosity and intellectual exploration. This method boosts academic success while igniting a lasting love for learning, inspiring students to engage in critical thinking across all areas of their lives.

Gamifying Strategy: Create a Game About the Topic, One Requiring and Rewarding Critical Thinking

Gamifying by using AI to create a game for eco-tourism in Serbia adds a level of excitement and engagement for the students. By turning the process into a game, it becomes more interactive and enjoyable, making the learning experience more fun and memorable. The outcome of making the AI effort focused on gamifying the project is more motivated students, enthusiastic about the task at hand. They will be more likely to invest their time and creativity into the project, leading to a higher quality final product [10-13].

When our Serbian gymnasium students in Novi Sad use AI and Mind Genomics-based thinking to create a game for eco-tourism in Serbia, we expect them to feel a sense of accomplishment and pride in their work. They will likely be more excited and engaged in the project, as they see it as a fun challenge rather than a tedious academic task. By gamifying the effort, they will be more likely to collaborate with their peers, think outside the box, and push themselves to create something unique and innovative [14-17].

By using AI to transform the creation of the eco-tourism game for Serbia into a gamification project, we hope to foster creativity, critical thinking, and a passion for innovation among our students. This approach will not only make the learning process more enjoyable and engaging but also equip them with valuable skills and experiences to apply in their future endeavors.

The remainder of this paper shows the approach, done virtually all with the aid of generative AI, specific Chat GPT3.5, using the Mind Genomics platform (www.BimiLeap.com). The AI is available through the Idea Coach feature. The set-up portions of the program are done by prompts easily created by the user. The detailed analysis after the program is closed, is done by a set of embedded prompts in the BimiLeap. Program and returns automatically for each iteration after the project is closed. The results done here required about 90 minutes. The deeper analysis was returned after the AI had finished its deeper analysis.

Phase 1 – ‘Listening in on the Conversations Among 10 Students When They Hear About the Project

Observing a conversation from the sidelines offers a glimpse into the thoughts, emotions, and viewpoints of individuals regarding a specific subject. The genuine voices of individuals discussing a topic offer an authenticity that written sources often lack. The subtleties of tone, body language, and emotions in spoken conversations enrich the understanding of the topic at hand.

Engaging in conversations about a topic fosters a deeper connection and understanding that reading from a textbook or article simply cannot achieve. Hearing firsthand accounts and personal anecdotes allows us to connect more deeply with the topic, revealing its significance in our own lives. Conversation’s human element weaves empathy and understanding into the fabric of discourse, essential for unraveling the complexities of any topic.

Additionally, being a ‘fly on the wall’ enables us to observe the intricate dynamics of group communication and the interplay of diverse perspectives and opinions. This opportunity allows us to broaden our perspectives and question our beliefs as we engage with the diverse viewpoints shared in the discussion. Engaging deeply in the conversation allows us to grasp a fuller and richer understanding of the subject matter.

In the realm of gamification, listening to discussions on a topic can offer essential insights for crafting captivating and interactive experiences. By grasping the subtleties of how individuals discuss and interact with a subject, game developers can craft gameplay that is more immersive and meaningful. Incorporating real-life dialogue and scenarios into games can make them more authentic, relatable, and ultimately more enjoyable for players. Table 1 shows the instructions for the AI to be a fly on the wal, and the results generated by AI.

Table 1: The fly on the wall’ strategy to simulate a conversation about Eco-Serbia.

Phase 2 – Using Detailed Instructions to AI to Create the Game

To craft a game, the AI must produce questions that are both stimulating and demanding, while also being enjoyable and captivating for the players. Incorporating elements of surprise, humor, or suspense into the questions can achieve this, along with varying the difficulty level or topic to engage a diverse group of players. The goal is to craft an engaging and lively game experience that captivates players and encourages them to return for more excitement. Using the AI’s cognitive skills and computational strength, game developers can craft tailored and immersive gaming experiences that resonate with the varied preferences and interests of players. The aim is to use AI’s potential to enrich the gaming experience, crafting more interactive and enjoyable games into which players can immerse themselves (Table 2).

Table 2: The AI-simulated created of the Eco-Serbia project, showing the instruction to the AI, and the steps returned to create the game.

Phase 3 – ‘Harvesting and Answering Questions Generated by AI at the End of Iteration 1, as well as Questions Asked in Iteration 2, and Finally Questions Emerging When AI Reviewed the Material After the Study was Closed

AI in platforms like Idea Coach on BimiLeap.com consistently prompts relevant questions and when instructed answers to those questions. These questions highlight important issues related to the topic. Inserting these questions into a BimiLeap iteration is simple, regardless of the topic’s origin or relevance. The user directs the AI, through the Idea Coach feature, to respond to the question using Chat GPT3.5 in a format relevant to the user. Table 3 shows 25 questions and answers generated by AI and answered by AI. These 25 questions and answers may overlap, but in the interests of showing what can be learned, all questions and answers are included.

Table 3: AI generated questions about the topic, and AI generated answers to those questions.

Phase 3: AI as Teacher of Critical Thinking by Reviewing the Original AI Output Automatically After the Study is Closed for Further Iteration

What are the Key Ideas?

The key ideas generated by AI in a topic provide a concise summary of the main concepts and themes within the subject matter (Table 4). Knowing the key ideas allows students to quickly grasp the most important information, enabling them to better understand and absorb the material. To find these key ideas, students can use tools such as text analysis software or utilize critical thinking skills to identify recurring themes and main points. Once the key ideas are determined, the next steps involve further exploring and analyzing them to deepen comprehension and stimulate critical thinking.

Table 4: Key Ideas

Finding key ideas and utilizing them to teach critical thinking is essential for developing students’ analytical skills and ability to extract meaningful information from complex topics. By focusing on key ideas, students learn to identify the most important elements of a subject and distinguish between relevant and irrelevant information. This process encourages critical thinking by prompting students to evaluate, question, and form their own opinions based on the key concepts presented.

What are the Themes and How do These Themes Manifest Themselves as Perspectives?

By exploring the themes highlighted by AI in the Mind Genomics analysis, individuals uncover a richer understanding of the patterns and foundational concepts embedded in the data. Examining the expression and interconnection of these themes allows researchers to glean valuable insights and pinpoint key takeaways from the study. A young researcher in Serbia can gain fresh insights and inspiration by exploring the list of themes, enriching their grasp of the subject matter. Through the examination of themes, students enhance their critical thinking abilities, recognizing patterns, forging connections, and deriving conclusions from the presented data. This approach prompts students to engage in analytical thinking, evaluate information with a critical eye, and present well-reasoned arguments to back their conclusions. The list of themes can act as a springboard for further research, igniting curiosity and encouraging students to explore the subject matter more deeply.

Students can enhance their critical thinking skills by examining the underlying assumptions and implications of each theme in the list. They can investigate the links between various themes and reflect on how these elements enhance the overall comprehension of the subject. Students can assess the relevance of each theme, gauge its impact on the research findings, and pinpoint any gaps or inconsistencies that may arise.

The themes identified through AI analysis provide a useful resource for enhancing critical thinking skills in education. Through a thoughtful exploration of themes, students can sharpen their analytical skills, foster logical thinking, and empower themselves to make well-informed decisions. This approach deepens understanding of the subject while inspiring students to tackle research and problem-solving with critical and analytical thinking (Table 5).

Table 5: Key themes recurring in the material generated by AI about the Eco-Serbia project, and the emerging perspectives.

Interested Audiences versus are Opposing Audiences

Understanding the interested and opposing audiences for the Eco-Serbia project, along with its gamification element, can significantly enhance our efforts in multiple ways. Identifying the audience interested in the topic enables us to customize our messaging and strategies, ensuring we engage and educate them effectively. This understanding enables us to craft focused campaigns and initiatives that connect with our audience, fostering increased participation and support for the project. Recognizing opposing audiences allows us to foresee challenges and objections, empowering us to tackle them head-on and refine our strategy to reduce resistance.

Additionally, grasping the perspectives of both supportive and opposing audiences can enhance critical thinking skills for participants and stakeholders alike. Through the examination of various viewpoints and the recognition of possible conflicts, individuals are prompted to engage in critical thinking regarding the project and its consequences. This cultivates a deeper insight into the relevant issues and promotes engaging conversation and discussion. Engaging with diverse viewpoints and opposing arguments allows participants to sharpen their analytical skills and make informed decisions regarding the project.

Integrating AI to analyze interested and opposing audiences in the Eco-Serbia project can significantly boost the effectiveness of its gamification elements. By grasping the preferences and viewpoints of various audience segments, we can customize the gamification elements to resonate more effectively with their interests and motivations. This focused method increases engagement and participation, paving the way for a more effective gamification strategy. By examining opposing viewpoints, we uncover potential challenges or concerns in the gamification process and tackle them proactively, creating a smoother and more enjoyable experience for all participants

Overall, it is important to address these potential oppositions by promoting the benefits of critical thinking, problem-solving, and environmental awareness, and by emphasizing the positive impact that the game can have on students’ education and understanding of the world around them (Table 6).

Table 6: Interested versus opposing audiences

Suggested Innovations – Analysis of Each from the Viewpoints and Business Opportunity, Respectively

The AI analysis prompts individuals to critically evaluate the project’s business dimensions. These dimensions include social aspects, uniqueness as well as business-case aspects. AI encourages individuals to foresee and tackle possible criticisms from investors, competitors, and other essential stakeholders, enabling researchers to craft a stronger and more convincing case for the gamification of the Eco-Serbia project. This thorough examination not only guides decision-making but also sharpens individuals’ capacity to strategically maneuver through intricate and layered challenges, ultimately boosting their critical thinking abilities along the way.

AI encourages individuals to question assumptions, challenge prevailing beliefs, explore alternative perspectives, and engage in strategic decision-making. The result is a culture of innovation, collaboration, and sustainability, crucial for tackling complex environmental challenges. Through critical analysis and reflection, individuals can cultivate stronger, more effective, and sustainable solutions for the Eco-Serbia project and beyond (Table 7).

Table 7: Deep AI analysis of four AI-suggested innovations.

Discussion and Conclusions

Making intellectual topics into games has greatly improved critical thinking by letting people interact with and think about knowledge in a fun and engaging way. Adding game features like challenges, puzzles, and competition encourages people to think critically and solve problems in order to win the game. This process helps people become better at analyzing things and pushes them to look at complicated issues from different points of view and think differently.

Gamification lets people use their critical thinking skills in the real world, making it easier to learn about and understand complicated topics through hands-on activities. People can improve their critical thinking skills in a safe and controlled setting by putting decision-making, strategy-building, and information processing into games. This makes them better at critical thought and gets them ready to use these skills in school, work, and personal life.

Using gamification as a tool helps people think more critically and interact with and learn more about intellectual topics in a more interesting and engaging way. This method turns learning into something fun and satisfying, which helps people understand and appreciate difficult topics more. By turning intellectual topics into games, people can connect with information in a fun and active way. This encourages exploration, analysis, and questioning, which leads to a deeper and more complete learning experience.

Adding game elements to educational topics could change the way people learn and improve their ability to think critically. Adding game features to intellectual and educational settings makes it easier for people to interact with and learn more about difficult topics in a fun and active way. This not only improves their critical thinking, but it also gives them the tools they need to deal with problems, face difficulties, and think deeply about different situations. By turning intellectual topics into games, people can start an interesting and exciting learning journey that can change them.

Acknowledgment

The authors gratefully acknowledge the ongoing help of Vanessa M Arcenas in the preparation of this manuscripts of the others in this grouping.

References

  1. Al-Menshawi A.H., Abu Al-Yazeed S (2020) Developing Skills of Systemic Thinking for Secondary Students. International Journal of Instructional Technology and Educational Studies, 1(2): 1-3.
  2. Gero A (2023) Systems thinking of secondary and post-secondary students majoring in engineering. Global Journal of Engineering Education, 25(3).
  3. Hernthaisong P, Sitti S, Sonsupap K (2015) Curriculum development for enhancing grade nine students systems thinking. Educational Research and Reviews, 10(12): 1722-1730.
  4. Rose J (2012) Application of systems thinking skills by 11th grade students in relation to age, gender, type of gymnasium, fluently spoken languages and international peer contact (Magister thesis) Wien: Universität Wien.
  5. Danry V.M (2023) AI enhanced reasoning: Augmenting human critical thinking with AI systems (Doctoral dissertation, Massachusetts Institute of Technology).
  6. Park C.S.Y, Kım H, Lee S (2021) Do less teaching, do more coaching: toward critical thinking for ethical applications of artificial intelligence. Journal of Learning and Teaching in Digital Age, 6(2): 97-100.
  7. Spector J.M, Ma S (2019) Inquiry and critical thinking skills for the next generation: from artificial intelligence back to human intelligence. Smart Learning Environments, 6(1): 1-11.
  8. Walter Y (2024) Embracing the future of Artificial Intelligence in the classroom: the relevance of AI literacy, prompt engineering, and critical thinking in modern education. International Journal of Educational Technology in Higher Education, 21(1), p.15.
  9. Yusuf A, Bello S, Pervin N, Tukur A.K (2024) Implementing a proposed framework for enhancing critical thinking skills in synthesizing AI-generated texts. Thinking Skills and Creativity, 53, p.101619.
  10. Joo T.M, Seng W.Y (2021) Validating the effectiveness of game-based learning approach in the form of video game for assessing computational thinking. Journal of ICT in Education, 8(4): 1-12.
  11. Lathifah A, Asrowi A, Efendi A (2023) Students’ Perspectives on Game-Based Learning and Computational Thinking. International Journal of Information and Education Technology, 13(3): 597-603.
  12. Shavab O.A.K, Yulifar L.E.L.I, Supriatna N.A.N.A, Mulyana A.G.U.S (2023) Development of gamification apps to enhance critical thinking and creative thinking. Eng. Sci. Technol, 18: 99-106.
  13. Zaibon Syamsul Bahrin, Emram Yunus. (2022) The effectiveness of game-based learning application integrated with computational thinking concept for improving student’s problem-solving skills. e-Infrastructure and e-Services for Developing Countries: 429-442.
  14. Bunt B, Gouws G (2020) Using an artificial life simulation to enhance reflective critical thinking among student teachers. Smart Learning Environments, 7(12).
  15. Katual D, Drevin L, Goede R (2023) GAME-BASED LEARNING TO IMPROVE CRITICAL THINKING AND KNOWLEDGE SHARING: LITERATURE REVIEW. Journal of the International Society for the Systems Sciences, 67.
  16. Muthmainnah, Ibna Seraj P.M, Oteir I (2022) Playing with AI to Investigate Human‐Computer Interaction Technology and Improving Critical Thinking Skills to Pursue 21st Century Age. Education Research International, 2022(1).
  17. Yang Y.T.C (2012) Building virtual cities, inspiring intelligent citizens: Digital games for developing students’ problem solving and learning motivation. Computers & Education, 59(2).

Simulating and Stimulating Critical Thinking Using Mind Genomics Turbocharged with AI: Homelessness in the America of Tomorrow, 2030

DOI: 10.31038/MGSPE.2024442

Abstract

This paper presents a new, AI-based computer approach to simulate as well as stimulate critical thinking and generate potential innovations in a topic chosen by the researcher. The presentation here speculates with the help of AI regarding the outlook for homelessness in th United States. The paper shows the different stages of critical thinking for this topic and provides examples of how to develop a critical thinking mind-set. The technology is resident in a publicly available website, www.BimiLeap.com.

Introduction

Homelessness is a widespread issue in the United States, with approximately 500,000 people experiencing homelessness on any given night. The causes of homelessness are complex and varied, including factors such as lack of affordable housing, poverty, mental illness, and substance abuse. Those experiencing homelessness often face numerous challenges, including lack of access to necessities such as food and shelter, as well as barriers to employment and healthcare [1-4]

Artificial intelligence (AI) has the potential to play a significant role in addressing homelessness in the future. AI can be used to analyze data and identify trends in homelessness, allowing policymakers to make more informed decisions about resource allocation and intervention strategies. AI can also be used to develop predictive models that can anticipate homelessness trends and help target interventions to those most at risk. Additionally, AI can be used to streamline processes and improve efficiency in the delivery of services to individuals experiencing homelessness [5-9]

This paper presents an attempt use generative AI (Chat GPT3.5) accessed and prompted by Idea Coach, a feature in the Mind Genomics platform, BimiLeap.com. the approach shows how to use AI to study homelessness as a problem, using simulations (fly on the wall technique), AI-generated questions and answers, and then critical thinking about the results suggested by AI. The paper finishes with using AI to generate 10 suggested innovations, and for each innovation the paper shows how AI can dissect the innovation into its components and business opportunities.

Phase 1 – The Fly on the Wall Strategy Simulated through AI

The phrase “fly on the wall” refers to being able to listen in on a talk without being seen. In this case, “fly on the wall” refers to both that action and knowing what someone is thinking and why they are saying something. Being a fly on the wall in a meeting gives one a unique view of conversations and exchanges that might not have been seen otherwise. Oen can learn more about people’s goals and motivations by listening in on their conversations and hearing their private thoughts. This can be especially helpful when talking about touchy or controversial issues, because it lets one hear other points of view without getting involved in the conversation directly (Table 1).

Table 1: ‘Fly on the wall’ strategy at local meeting in ‘Smallville, USA, a town with coping with homelessness.

Besides that, being a fly on the wall gives one some privacy and objectivity. One can listen to the discussion without taking part and form their own opinions based on what they hear. This can help one learn more about a complicated issue, like homelessness in oner neighborhood, by gathering information about it. Being a “fly on the wall” can also help one figure out political goals and hidden agendas that are not talked about publicly. One can find out about underlying tensions or alliances which may affect decision-making by listening in on private thoughts and responses. This is often very important for getting a sense of how a meeting or group really works. Being a “fly on the wall” also lets one get a better sense of how people talk to each other and who has power in a group. One can figure out alliances and hierarchies that aren’t clear at first glance by watching who asks what questions and how others answer. This can help one understand how choices are made and who has power in a certain situation [10-13] (Table 1).

Phase 2 – Jumpstarting Learning by Instructing the AI to Create Sets of 15 Questions and Answers

Working with AI to create questions and answers benefits critical thinking by promoting creativity, prompting exploration of different angles, improving problem-solving abilities, enhancing analytical skills, and fostering innovation. The Idea Coach feature of BimiLeap.com, the Mind genomics platform, can come up with 15 different questions detailed answers in less than 30 seconds. For a deep analysis in a very short time, the process can be done almost effortlessly, with an iteration completed every half minute, for a total of 300 questions and answers in 10 minutes. Across all 300 questions about a third to a half will be unique, and not repeats. The benefit for critical thinking is clear, if only that AI can, in a virtually automated fashion, produce thousands of questions and answers in an hour, sufficient for a rapid education in the topic [14-17] (Table 2).

Table 2: Questions and Answers from Iteration #21.

Critical Thinking – Letting AI Review Its Own Questions, and Identify Questions Which Were Missing

After the ‘study’ is closed, the AI reviews the material it created, shown in Tables 1 and 2. AI then identifies questions that may have been ‘missed’ being asked, and presents them. Table 3 shows the remaining 10 questions identified by AI in its ‘self-review’. These 10 questions were run separately, with the same instructions as given in Table 2. Table 3 shows the remaining 10 questions and their answers. The number is consistent with that used in Tables 1 and 2 [18-21].

Table 3: Questions discovered by AI not to have been asked previously by AI, with their AI-generated answers.

Critical Thinking – Key Ideas and Themes in the 15 Original Questions and Answers

Dividing the topic of homelessness into key ideas, identifying themes, can significantly enhance critical thinking skills, particularly when working on a do-it-yourself project. By delving into various perspectives, one can gain a deeper understanding of the complexities surrounding the issue of homelessness and develop a more well-rounded approach to addressing it. This process forces individuals to think critically about the root causes of homelessness, the societal factors at play, and the potential solutions that can be implemented. Table 4 shows the key ideas and the themes [22-24].

Table 4: AI-abstracted key ideas and themes.

Critical Thinking – Alternative Views and Systematizing Them Through Perspectives

People are pushed to question their own views and biases when they look at things from different points of view. This leads to a more open-minded and objective analysis of the issue at hand. By doing this, people not only improve their minds, but they also start to think about more options and answers. Finding perspectives in the topic of homelessness can also help people organize their thoughts and ideas in a way that makes sense. This makes it easier to see patterns and links between different points of view (Table 5).

Table 5: Alternative viewpoints regarding topics involved in homelessness, and formalized analysis of these differences through perspectives.

By looking at things from different points of view, people can see the problem of homelessness from more than one angle, which helps them understand and care about those who are homeless. People can think about different points of view and approaches, which can help them come up with more creative and useful answers. Overall, breaking up ideas into different points of view, formalizing the through perspectives and exploring themes forces people to think more deeply and critically [25-27].

Critical Thinking – Which Audiences are Likely to be Interested Versus Which Audiences are Likely to Oppose

Understanding the accepting and opposing audiences allows one to more deeply understand multiple perspectives before making decisions related to homelessness in Smallville township. By understanding the potential supporters and detractors of each proposed solution, one can anticipate challenges and resistance, and adjust the approach accordingly. This level of critical thinking helps identify potential pitfalls and ensures that the proposed solutions have a higher chance of successful implementation (Table 6).

Table 6: Responses of interested versus opposing audiences.

The understanding of responses by different audiences lets one consider the feasibility and impact of each solution in a more nuanced way. By recognizing the diverse viewpoints within the community, one ca approach problem-solving with a more holistic understanding of the situation. This process ultimately leads to more effective and sustainable solutions for addressing homelessness in the Smallville township (Table 6).

Critical Thinking – ‘Deep Dive’ Analysis of 10 AI-suggested Innovations

With AI’s ability to analyze vast amounts of data and identify patterns, it can suggest innovative solutions that may have been overlooked by human researchers. Additionally, AI can provide real-time feedback on the effectiveness of these inventions, allowing for quick adjustments and improvements. This can greatly accelerate the progress in tackling homelessness and provide more efficient and effective solutions for those in need.

However, it is important to critically analyze the potential drawbacks of relying too heavily on AI in addressing homelessness. Whereas AI can provide valuable insights and recommendations, it may lack the empathy and understanding that human intervention can offer. It is essential to strike a balance between using AI as a tool for innovation and ensuring that human intervention and support are still prioritized in addressing the complex and nuanced issue of homelessness.

A standard feature of the BimiLeap.com platform is that at the end of each iteration, and after having reviewed all the information generated in that iteration, the AI suggests innovations, and for each innovation does a ‘deep dive’. That ‘deep dive’ looks at the nature of the innovation, the explanation of the innovation, its importance, uniqueness, attractiveness and degree of expected social good. The ‘deep dive’ finishes with slogans, and then with the different facets of a ‘business pitch’. Table 7 shows the real depth of the analysis for the 10 innovations [28-33].

Table 7: ‘Deep dive’ analysis of 10 innovations generated during one iteration (#21).

Discussion and Conclusions

Critical thinking is essential for solving complex issues like homelessness, as it helps individuals weigh options based on facts and common sense. It helps avoid relying on assumptions or stereotypes, and allows individuals to see things from different perspectives. Critical thinking also helps individuals question the status quo and come up with new solutions, ensuring solutions are based on diverse experiences and perspectives. It also encourages a mindset of continuous learning and improvement, allowing for flexible and adaptable solutions. For instance, if one is unfamiliar with homelessness, critical thinking can help them understand the main causes, current laws, and available tools to help homeless individuals find stable housing. Overall, critical thinking is a useful skill for people who want to deal with tough social problems like homelessness. People can make real changes to help end homelessness in their community by keeping an open mind, asking deep questions, looking for solid proof, and coming up with creative solutions.

Within this framework, the strategy of simulating and stimulating critical thinking using the Mind Genomics platform provides a promising tool, perhaps a tutorial. In a matter of minutes up front, and with output later on, the user can try out one, two, even a dozen or more alternative scenarios and issues, with the analysis automatic, simple, rapid, easy to understand, and occasionally even profound.

Acknowledgments

The ‘research stimulations’ for this paper emerged from iteration 21 (Results 21_ using AI access through the Idea Coach feature of BimiLeap.com. The AI, Chat GPT3.5, provided all the AI-based material. Bimileap.com is openly available for public use at a modest platform fee. BimiLeap.com is the platform for the emerging science of Mind Genomics, the inspiration for the work shown here.

The authors wish to thank Vanessa M. Arcenas for her ongoing help in preparing this and other manuscripts in this series.

References

  1. Alpert JS (2021) Homeless in America. The American Journal of Medicine, 134(3): 295-296.
  2. Colburn, G. and Aldern CP (2022) Homelessness is a housing problem: How structural factors explain US patterns. Univ of California Press.
  3. Meyer BD, Wyse A, Grunwaldt A, Medalia, C. and Wu, D (2021) Learning about homelessness using linked survey and administrative data (No. w28861). National Bureau of Economic Research.
  4. Rukmana, D (2020) The causes of homelessness and the characteristics associated with high risk of homelessness: A review of intercity and intracity homelessness data. Housing Policy Debate, 30(2): 291-308.
  5. Kube AR, Das, S. and Fowler PJ (2023) Fair and efficient allocation of scarce resources based on predicted outcomes: implications for homeless service delivery. Journal of Artificial Intelligence Research, 76: 1219-1245.
  6. Alcalde-Llergo, José M, Carlos García-Martínez, Manuel Vaquero-Abellán, Pilar Aparicio-Martínez, and Enrique Yeguas-Bolívar. “Analysing the Needs of Homeless People Using Feature Selection and Mining Association Rules.” In 2022 IEEE International Conference on Metrology for Extended Reality, Artificial Intelligence and Neural Engineering (MetroXRAINE) 568-573. IEEE, 2022.
  7. Humphry, J (2022) Policing Homelessness: Smart Cities and Algorithmic Governance. In Homelessness and Mobile Communication: Precariously Connected (pp. 151-181). Singapore: Springer Nature Singapore.
  8. Kuo TS, Shen H, Geum J, Jones N, Hong JI, Zhu, H. and Holstein K (2023) Understanding Frontline Workers’ and Unhoused Individuals’ Perspectives on AI Used in Homeless Services. In Proceedings of the 2023 CHI Conference on Human Factors in Computing Systems (pp. 1-17)
  9. Thurman W, Semwal M, Moczygemba LR. and Hilbelink, M (2021) Smartphone technology to empower people experiencing homelessness: secondary analysis. Journal of Medical Internet Research, 23(9) pe27787.
  10. Bojić L, Cinelli M, Ćulibrk, D. and Delibašić, B (2024) CERN for AI: a theoretical framework for autonomous simulation-based artificial intelligence testing and alignment. European Journal of Futures Research, 12(1), p.15.
  11. Mensfelt A, Stathis, K. and Trencsenyi, V (2024) Logic-Enhanced Language Model Agents for Trustworthy Social Simulations. arXiv preprint arXiv: 2408.16081.
  12. Nirala KK, Singh NK. and Purani VS (2022) A survey on providing customer and public administration based services using AI: chatbot. Multimedia Tools and Applications, 81(16): 22215-22246.
  13. Shults FL. and Wildman WJ, 2020, May. Artificial social ethics: simulating culture, conflict, and cooperation. In 2020 Spring Simulation Conference (SpringSim) (pp. 1-2). IEEE.
  14. Baidoo-Anu, D. and Ansah LO (2023) Education in the era of generative artificial intelligence (AI): Understanding the potential benefits of ChatGPT in promoting teaching and learning. Journal of AI, 7(1): 52-62.
  15. Cooper, G (2023) Examining science education in ChatGPT: An exploratory study of generative artificial intelligence. Journal of Science Education and Technology, 32(3): 444-452.
  16. Kurdi G, Leo J, Parsia B, Sattler, U. and Al-Emari, S (2020) A systematic review of automatic question generation for educational purposes. International Journal of Artificial Intelligence in Education, 30: 121-204.
  17. Miao X, Brooker, R. and Monroe, S (2024) Where generative AI fits within and in addition to existing ai k12 education interactions: industry and research perspectives. Machine Learning in Educational Sciences: Approaches, Applications and Advances: 359-384.
  18. Alomari A, Idris N, Sabri AQ.M. and Alsmadi, I (2022) Deep reinforcement and transfer learning for abstractive text summarization: A review. Computer Speech & Language, 71, p.101276.
  19. Cortázar C, Nussba M, Harcha J, Alvares D, López F, Goñi, J. and Cabezas, V (2021) Promoting critical thinking in an online, project-based course. Computers in Human Behavior, 119, p.106705.
  20. Dergaa I, Chamari K, Zmijewski, P. and Saad HB (2023) From human writing to artificial intelligence generated text: examining the prospects and potential threats of ChatGPT in academic writing. Biology of sport, 40(2): 615-622.
  21. Sajja R, Sermet Y, Cikmaz M, Cwiertny, D. and Demir, I (2024) Artificial intelligence-enabled intelligent assistant for personalized and adaptive learning in higher education. Information, 15(10), p.596.
  22. Marouf A, Al-Dahdooh R, Ghali MJ.A, Mahdi AO, Abunasser BS. and Abu-Naser SS (2024) Enhancing Education with Artificial Intelligence: The Role of Intelligent Tutoring Systems.
  23. Onesi-Ozigagun O, Ololade YJ, Eyo-Udo NL. and Ogundipe DO (2024) Revolutionizing education through AI: a comprehensive review of enhancing learning experiences. International Journal of Applied Research in Social Sciences, 6(4): 589-607.
  24. Saaida MB (2023) AI-Driven transformations in higher education: Opportunities and challenges. International Journal of Educational Research and Studies, 5(1): 29-36.
  25. Bates T, Cobo C, Mariño, O. and Wheeler, S (2020) Can artificial intelligence transform higher education?. International Journal of Educational Technology in Higher Education, 17: 1-12.
  26. Dhawan, S. and Batra, G (2020) Artificial intelligence in higher education: Promises, perils, and perspective. Expanding Knowledge Horizon. OJAS, 11: 11-22.
  27. Escotet MÁ (2023) The optimistic future of Artificial Intelligence in higher education. Prospects: 1-10.
  28. Chen Y, Albert LJ. and Jensen, S (2022) Innovation farm: Teaching Artificial Intelligence through gamified social entrepreneurship in an introductory MIS course. Decision Sciences Journal of Innovative Education, 20(1): 43-56.
  29. Greene, J (2022) The homelessness research and action collaborative: case studies of the social innovation process at a university research center. Soial Enterprise Journal, 18(1): 163-181.
  30. Jian MJ.K.O (2023) Personalized learning through AI. Advances in Engineering Innovation, 5(1).
  31. Mollick, E. and Mollick, L (2024) Instructors as innovators: A future-focused approach to new AI learning opportunities, with prompts. arXiv preprint arXiv: 2407.05181.
  32. Rice E, Onasch-Vera L, DiGuiseppi GT, Wilder B, Petering R, Hill C, Yadav, A. and Tambe, M (2020) Preliminary results from a peer-led, social network intervention, augmented by artificial intelligence to prevent HIV among youth experiencing homelessness. arXiv preprint arXiv: 2007.07747.
  33. Tang, Ningjing, Jiayin Zhi, Tzu-Sheng Kuo, Calla Kainaroi, Jeremy J. Northup, Kenneth Holstein, Haiyi Zhu, Hoda Heidari, and Hong Shen. “AI Failure Cards: Understanding and Supporting Grassroots Efforts to Mitigate AI Failures in Homeless Services.” In The 2024 ACM Conference on Fairness, Accountability, and Transparency: 713-732. 2024.

Subsurface Geopressure Prediction: Perception and Pitfalls

DOI: 10.31038/GEMS.2024674

Abstract

In this short article, a review of the subsurface geopressure forecast’s characteristic in relation to geological building blocks is briefly presented. Geopressure is the driving mechanisms of generating and migrating of oil and gas to their traps. Geopressure is a double edge sword. Most of the large hydrocarbon pools are embedded in this pressure zone, and on the other hand it can be a serious hazard for drilling crews and properties. The lack of understanding the prediction process can resulted in unintended miscalculation and ambiguous interpretation. The science of predicting the sedimentary column pressure profile drift is widely diverse and mostly driven by algorithms rather than the exploration prospect’s geological settings.

Introduction

Pore pressure prediction (PPP) is a process synonym of estimating the subsurface pressure before and post drilling. However, predictions should apply only if the calculation takes place before drilling. On the other hand, any estimation or assessment of the pressure from drilling records and logs data should not be considered as forecasts. They are pressure calibration or simulation instead of prediction. Subsurface pressure compartments are the response of sedimentation process, that lead to compaction and burial. Sand and shale/clay dominate most of the deltaic and shallow marine environments. Compaction due to sediment load leads to fluids expulsion out of the rock matrix that leads to increase pressure. Terzaghi and Peck (1948) [1] illustrated this process with a mechanical device filled with water. Most of the geopressure scholars believe the clastic sedimentary column is divided to two sections: Normal and Abnormal pressure (geopressure) zones. Eaton (1975) [2] made a successful leap to build the base model of calculating subsurface pressure increasing with depth using petrophysical properties (sonic, resistivity and density). The assumption of two main subsurface zones were utilized in his assessment as well. Shaker (2015) [3,4] recognized a new concept in the presence of 4 pressure zones in offshore and 3 zones in onshore in the clastic sedimentary columns. Based on the new established subsurface compartmentalization, a geological based prediction model of the subsurface geopressure is attained. This was an eye opener for some of the unintended pitfalls of geopressure prediction methods.

The Basic Geological Framework

Sediments reach the depositional basin carried by water through the water shed feeder areas. Suspended detrital grains begin the slow consolidation and compaction throughout time and additional load. During the periods of high sea stand, capable competent seals form. The top seal represents the choking barrier for the subsurface fluids outflux. This is referred to as the top of geopressure (TOG). Studying many subsurface petrophysical properties behavior led to the updated conclusion of subdividing most of subsurface clastic into four main pressure compartments [3,4). This is because the change in porosity and consequently pore pressure directly impacts the rock sonic velocity, electric resistivity, and density. Figure 1 exhibits, in a nut-shell, the relationship between 15 million years of compartmentalized sedimentary sequence, velocity (sonic ∆t) profile drift due to compaction, pressure in psi, and the designated four zones (after shaker, 2019) [5]. The compaction drift of the data (sonic/resistivity etc.) in zone B [4,5] follows an exponential trend. The deeper extension of this trend is used to estimate the pore pressure (Figure 1).

Figure 1: Exhibits P-D conceptual cartoon plot represents a 15 million years four zones (A,B,C,D) of high sea stand shale beds interbedded with reservoir sand beds . Shale Velocity drift with depth reflects the pressure increase changes across the shale beds. CT is the compaction trend. Red arrows represent the Effective Stress [1,2]. The right display is in linear scale (exponential compaction trend), whereas the log display on the left is in logarithmic scale (linear compaction trend).

The following are some basic criteria for pressure prediction calculations:

  1. Predicting pore pressure (PP) is before drilling and calibrations/simulation are during and post drilling.
  2. Predicting PP is always in the section below the Top of Geopressure [1,2,5].
  3. Petrophysical data should be representing the clean shale/clay lithology only [1, 2 ].
  4. Normal hydrostatic pressure resides in the very shallow zone (A) only [3,4,5].
  5. The deeper extrapolation of zone B compaction trend is used only to calculate the Pore Pressure (PP) in zones C (top seal) and the compartmentalized geopressured zone D [2,5]. It is designated as CT instead of NCT by [5].
  6. Calibration of the predicting pressure’s model should not rely solely on the measured PP (MPP) in reservoir sands. Mud logs and drilling records should be collaborated in this process [5].

Pitfalls

Most of the pitfalls in calculation of subsurface pressure is driven by the lack of geological and geomechanical building blocks input in the prediction model. Since excess pressure generation and causes are the product of stressed water bearing formation, principal and minimum stresses vectors should be known in addition of the overburden gravity vector (Shaker,2024) [6]. Applying the old theorem that subsurface pressure profile is divided to two segments (Normal and Abnormal pressure zones) separated by the TOG can cause substantial miscalculations (Figure 2). This is because the misleading assumption of considering the compaction trend data set represents a normally pressured sequence (NCT). Compaction and expulsion of fluids by differential pressure is not normally hydrostatic pressure gradient [5]. Sequence stratigraphy also can be a guidance to geopressure compartmentalization and assessing sealing verses breaching reservoirs (Shaker, 2002) [7]. Calibrating and simulating the predicted pore pressure in the shale with the measured pp using the wireline tools in the reservoir can lead to substantial calculation errors. This due to the fact that most of the effective stress methods are designed for shale beds [1,2]. Figure 3 shows the prediction modeling blunder if the prediction model is enforced to follow the measured pressure value data. Utilizing pressure prediction software does not include the manipulation of extracting certain lithology or the flexibility of maneuvering the stresses vectors especially in salt basins and can be a main source of unintended pitfalls [6].

The symptoms of pitfalls are usually revealed on the interpreted pressure plots such as:

  1. Predicting pressure data trace (values) facing a porous/permeable lithology especially in reservoir sands/sandstones e.g. Bowers, 1995 [8], Ehsan M. et al. 2024 [9], and Merrell et al. 2014 [10].
  2. Extrapolating a Normal Compaction Trend (NCT) that covers the entire drilled lithological section four zones e.g. Berry et al. (2003) [11].
  3. Swaying and breaking the NCT to separate segments for the purpose of matching the predicted pp in the shale to the measured pp in the sand reservoirs e.g. Kuyken. and de Lange (1999) [12].
  4. Predicting pp in salt basins utilizing the Overburden as principal stress (S1), regardless the effect of salt – sediments differential stresses and salt buoyancy e.g. Shaker and Smith 2002 [13], Merrell et al. 2014 [10], and Zhang and Yin, 2017 [14].

In summary, geopressure prediction modeling is a product of multi-disciplinary geoscience and engineering fields of expertise. Therefore, collaboration between these different disciplines can improve and enhance forecasting and simulate a bonified subsurface pressure profile.

Figure 2: P-D plot showing correlation between Predicting seismic Velocity – Pressure model using the conventional NCT vs. CT/4 zones. The data using NCT shows ambiguous profile whereas prediction data using the CT/4 zone shows a bonified prediction with an agreement with the data extracted from nearby offset well.

 
 

Figure 3: Shows two P-D plots for the same deepwater well. On the left panel measured reservoir’s pp (RFT) only used as calibration tool for Predicting PP in shale (PPP shale). Note the mismatch between the circle and arrow zones. On the right panel is the right prediction method that using the shale only for prediction modeling.

Acknowledgement

Special Thanks to Kate Mariana of the research open world for facilitate publishing this short article.

References

  1. Terzaghi K, Peck RB (1948) Soil mechanics in engineering practice. John Wiley & Sons, Inc. N.Y., Pg: 566.
  2. Eaton BE (1975) The equation for geopressure prediction from well logs. Society of Petroleum Engineers of AIME paper #SPE 5544, 11.
  3. Shaker SS (2015a) A new approach to pore pressure predictions: Generation, expulsion, and retention trio—Case histories from the Gulf of Mexico. Gulf Coast Association of Geological Societies Transactions. 65: 323-s337.
  4. Shaker SS (2015b) Velocity for pore pressure modeling. Society of Exploration Geophysicist Annual Meeting, 1797-1801.
  5. Shaker SS (2019) Pore Pressure Prediction Before and During Drilling Applying the Four Zones Method, Offshore Technology Conference, OTC-29517-MS.
  6. Shaker SS (2024) Pore and fracture pressures prediction — A new geomechanic approach in deepwater salt overthrusts: Case histories from the Gulf of Mexico, Interpretation. 12: T501-T521,
  7. Shaker SS (2002) Predicted vs. Measured Pore Pressure: Pitfalls and Perceptions, Offshore Technology Conference, Houston Tx., OTC 14073.
  8. Bowers GL (1995) Pore pressure estimation from velocity data: accounting for overpressure mechanisms besides undercompaction. Society of Petroleum Engineers Paper SPE–27488, PA, Pg: 7.
  9. Ehsan M, Manzoor U, Chen R, Hussain M, Abdelrahman K, Radwan AE, Ullah J, Iftikhar MK, Arshad F, Pore pressure prediction based on conventional well logs and seismic data using an advanced machine learning approach, Journal of Rock Mechanics and Geotechnical Engineering, Pre – Print
  10. Merrell, M.P., Flemings, P.B., and Bowers, G.L.,2014, Subsalt pressure prediction in the Miocene Mad Dog field, Gulf of Mexico. AAPG Bulletin. 98: 315-340.
  11. Berry JR, McCormack N, Doyle E (2003) Overcoming pore-pressure challenges in deepwater exploration. OFFSHORE, Penn Well Corp., Reservoir Engineering.
  12. Kuyken CW, de Lange F (1999) Pore Pressure Prediction allows for tighter pressure gradient control, OFFSHORE, Penn Well Corp., Drilling Technology.
  13. Shaker SS, Smith M (2002) Pore Pressure Predictions in the Challenging Supra / Sub-Salt Exploration Plays in Deep Water, Gulf of Mexico. AAPG Search and Discovery Article #90007, presented at AAPG Annual Meeting.
  14. Zhang J, Yin S (2017) Fracture gradient prediction: an overview and an improved method. Springer, Pet Sci 14: 720-730.

Dysregulation of Cell-Mediated Immunity in Patients with Long ICU Stay Affected of Multiple Organ Dysfunction Syndrome and Multifocal Candidiasis

DOI: 10.31038/IDT.2024523

Abstract

Introduction: The endogenous immunosuppression in critically ill patients with Multiple Organ Dysfunction Syndrome, requiring long-term ICU, can play an important role in the prognosis of Multifocal Candidiasis.

Method: Prospective study with control group (33 healthy volunteers) and study group (43 critically ill patients non neutropenic admitted to ICU with invasive mechanical ventilation), about cellular immunity in vitro, using Lymphoblastic Transformation Tests (LTT) stimulated with phytohemagglutinin (PHA). Simultaneously, the study group is followed up on appearance of Invasive Candidiasis and in vivo immunity study, using skin tests during the first week of ICU stay.

Results: There are significant statistical differences between the control group and the study group in relation to LTT PHA results. These differences are also found in the study group in relation to mortality and when skin tests are negative. When analysing the subgroup of patients with ICU stay longer than 12 days, there are statistically significant differences in LTT PHA when comparing the test performed in the 1st week in ICU in survivor patients with Invasive Candidiasis and the control group, but there are no differences with the 2nd determination. There are statistically significant differences when comparing the results of LTT PHA among patients with Invasive Candidiasis according to mortality in the 2nd determination, but these differences were not identified in the 1st week of ICU.

Conclusions: Both in vivo cellular immunity studies, using skin tests, and in vitro studies with the LTT PHA, help to establish a prognosis in critically ill patients with Multiple Organ Dysfunction Syndrome requiring long-term ICU care and in which a Multifocal Candidiasis has been identified. Monitoring of T-cell dysregulation and endogenous immunosuppression can help to identify patients who may benefit from new immunomodulatory therapeutic strategies.

Keywords

Cell-immunity, Multifocal candidiasis, Multiple organ dysfunction syndrome, Non-neutropenic, ICU

Introduction

In order to make Multifocal Candidiasis equivalent to Invasive Candidiasis, and thus initiate an early antifungal treatment to prevent death attributable to Candida spp. in non-neutropenic critical ICU patients who are neither neutropenic nor affected by AIDS [1,2], we analysed the factors that could contribute to the transformation from colonization of Candida spp. [2] to Multifocal Candidiasis and subsequent disseminated candidiasis. It is universally accepted that Candida spp. infections are linked to the antibiotic era [3]. The prolonged use of broad-spectrum antibiotics leads to an intestinal microbiological imbalance, promoting an excessive growth of candida in the intestinal lumen and thus facilitating the translocation of these fungi into the interior of the organism [4]. As an example, in the observations that were made, it was very common that, after treating with antibiotics treatment with broad-spectrum antibiotics for a sepsis due to Pseudomonas spp., if the patient survived and remained in critical condition, it was very common to detect the appearance of an invasive candidiasis. However, in these ICU patients who remain in a critical condition for a prolonged period of time (more than 7 days), other factors related to ICU treatment and monitoring can be identified, which should be considered as facilitators of Multifocal Candidiasis [5]:

  • Gastrointestinal dysfunction: Malnutrition and/or absence of enteral nutrition due to intestinal paresis; breakdown of the intestinal physiological barrier; treatment with parenteral nutrition, gastric protectors and prolonged nasogastric tube
  • Prolonged vesical catheterization
  • Prolonged arterial or venous catheter
  • Mechanical ventilation more than 7 days
  • Hemofiltration techniques

In some cases, this list can also be added treatment with prolonged treatment or high doses of corticosteroids (30% in these patients) [6]. It is at this point where it is questioned whether there may be in these patients an immunodeficiency acquired in the ICU and that this may play a role as important as the prolonged antibiotic treatment.

Methods and Materials

Prospective Study with Control Group

Study Group (43 patients): Patients over 18 years old and middle ages of 61 ± 10,8 (37-86), admitted to ICU with invasive mechanical ventilation without history of neutropenia or AIDS, and need for mechanical ventilation for more than 48h. There was no informed consent from the patients because their level of consciousness on admission to the ICU does not allow it. Family members have been informed about participation in the study, its risks and that this participation will not modify any of the protocols required in patient care throughout their stay in the ICU. Only the patients with the consent of their relatives have been included. Mortality rate of this study population was 46%. In 12 cases the UCI stay was lesser than 12 days with 42% mortality rate, and in 31 cases UCI stay was more than 12 days with a 48% mortality rate. The diseases that were the reason for ICU admission, grouped as follows were:

  • Chronic Obstructive Pulmonary Disease with respiratory failure requiring invasive mechanical ventilation prior to ICU admission (15 cases)
  • Postoperatory complicated cardiac or abdominal surgery with more than 24 h. of mechanical ventilation (12 cases)
  • Patients with Tetanus disease with invasive mechanical ventilation (13 cases).

Control Group (33 healthy volunteers): Group formed by subjects who have been informed prior to the acceptance of being included in this study.

Immunity Cellular Evaluation

  1. In vivo immunity study using skin tests, only in the study group. The test is considered positive if they present, at least in one of the puncture sites, an induration greater than 5 mm in diameter against the selected antigens (Streptokinase- Streptodornase 1/4, Candidin 1/500, P.P.D. 1/1000, Toxoplasmin). The test is performed during the first week of ICU stay and is not repeated at any other time.
  2. In vitro immunity study using Lymphoblastic Transformation Tests (LTT), lymphocyte extraction is performed in both Technique: An adjustment of lymphocytes to 2×106 cells/ ml is performed. Three control cultures and three stimulated with phytohemagglutinin (PHA) are grown for 72 h. at 37°C, with aerobic culture and 5% CO2. After this time, the slide extension and May-Grünwald, Giemsa staining is performed. Once the staining is done, the percentage of blasts over the total population of lymphocytes is calculated. This test, in the study group, is performed during the first 6 days of stay in the ICU and then every 12-17 days until discharge from the ICU.

Diagnosis of Multifocal Candidiasis

From the inclusion of the patients in the study group, cultures to identify Candida spp. are carried out once a week, until the ICU is discharged, to identify Candida spp. in five foci:

  1. Blood cultures
  2. Respiratory secretions from tracheobronquial aspiration
  3. Urinary cultures from closed circuit bladder catheterization. Positive only with more than 5000 colonies/ml.
  4. Simultaneous presence of positive cultures in the pharyngeal swab and in the gastric aspirate obtained through the nasogastric tube
  5. Other foci. Positive cultures from drainages or wound exudates

Candida colonization is defined when this study demonstrates the presence of Candida spp. in only one of these foci and the blood culture is negative. Candida multifocality or Invasive Candidiasis is defined when positive cultures are identified simultaneously in two or more of these foci and/or positive blood cultures.

Variables and Statistical Analysis Methodology

The following variables were analysed: ICU stay, ICU outcome, presence or absence of Candida spp. multifocality, presence of positive skin tests and results of LTT stimulated with PHA. Data were analysed using the SPSS statistical program. Categorical variables were compared among groups with Chi-square or Fisher exact test as appropriate. Continuous variables were analysed with the Student’s t or Mann-Whitney U test when the distributions departed from normality and described as mean or median (standard deviation or variance). Statistical significance was established at p value < 0.05 on two-tailed testing. For statistical analysis, patients were grouped according to mortality (D: dead/S: survivors) or the presence of positive skin tests (P: positive/N: negative).

Results

No significant differences were detected between the number of days spent in the ICU and mortality (42% mortality in stays of less than 13 days vs. 48% in stays of more than 12 days, X2 = 0.16). Significant differences were detected between patients according to whether or not they had positive skin tests and mortality (mortality of 27.8% in patients with positive skin tests vs. 78.3% with negative skin tests, X2 = 10.45 (p = 0.001)) and between presence of multifocal candidiasis and mortality (30% mortality in patients with colonization vs. 73.9% in patients with multifocality, X2 = 8.29 (p = 0.004)). These differences are more significant if only the group with stays longer than 12 days is analysed (10% mortality in patients with colonization vs. 71.4% in patients with multifocalities, X2 = 10.24 (p = 0.001)). There were no significant differences between positive skin tests and the presence of Multifocal Candidiasis (50% of patients with colonization had negative skin tests vs. 60.9% of patients with multifocality, X2 = 0.48).

Related on the LTT PHA done:

  1. There are significant statistical differences between the control group and the study group, in relation to mortality (LTT PHA control group (group C) = 39.25% (6.79), LTT PHA study group survivors (group S) = 29.22% (11.67), LTT PHA study group dead (group D) = 22.89% (13.11). Statistical differences between group C and group S: t = 3.86 (65 d.f.), p = 4×10-4; between group C and group D: t = 6.29 (65 d.f.), p =6×10-8; between group S and group D: t = 2.45 (66 d.f.), p = 0.002). Statistically significant differences are not found when comparing the results of the LTT PHA of the first determination between group S and group D (LTT PHA group S = 27.29% (10.15), LTT PHA group D = 22.68% (12.33), t = 1.49 (34 d.f.), p = 0.131).
  2. There were significant statistical differences between the control group and the study groups, whether the skin tests were positive or negative (LTT PHA control group (group C) = 39, 25% (6.79), LTT PHA study group with positive skin tests (group P) = 30.03% (12.16), LTT PHA study group with negative skin tests (group N) = 21.52% (12.41). Statistical differences between group C and group P: t = 3.8 (66 d.f.), p = 0.001; between group C and group N: t = 6.98 (60 d.f.), p = 5×10-9; between group P and group N: t = 3.39 (62 d.f.), p = 0.002). There were significant statistical differences when comparing the results of LTT PHA of 2nd determination between group P and group N (LTT PHA group P = 30, 07% (10.73) and LTT PHA group N = 19,28% (10,59), t = 2,13 (18 d.f.), p = 0.025). Statistically significant differences are not found when comparing the results of the LTT PHA of the 1st determination between group P and group N (LTT PHA group P = 29.68% (8.27) and LTT PHA group N = 22.53% (13.05), t = 1.5 (34 d.f.), p = 0.129).
  3. When analysing the subgroup of patients with ICU stay of more than 12 days, there were significant statistical differences between the control group and the study group according to survivors with colonization (1st study LTT PHA: t = 3,8 (39 d.f.), p = 0,001; 2nd study LTT PHA: t = 3,461 (35 d.f.), p = 0.002) and dead with multifocality for Candida spp (1st study LTT PHA: t = 5,82 (41 d.f.), p = 1,3×10-6; 2nd study LTT PHA: t = 6,09 (43 d.f.), p = 4,5×10-7). There were only significant statistical differences between the control group and the study group according to survivors with multifocality for Candida spp in the 1st study LTT PHA (1st study LTT PHA: t = 3,957 (37 d.f.), p = 0,0005; 2nd study LTT PHA: t = 0,603 (35 d.f.), p = 0,329). There were only significant statistical differences between dead with multifocality for Candida spp. and survivors with multifocality for Candida spp. in the 2nd study LTT PHA (1st study LTT PHA: t = 0,751 (14 d.f.), p = 0,291; 2nd study LTT PHA: t = 3,764 (14 d.f.), p = 0.002) (Table 1). There were no deaths in patients with candida colonization of more than 12 days.

Table 1: LTT PHA results, 1st determination and 2nd determination, comparing control group with patients staying in the ICU for more than 12 days in the study group, collected according to mortality and presence or not of Multifocal Candidiasis.

Characteristics of the groups LTT PHA 1st determination

LTT PHA 2nd determination

Number of cases

Median Variance Number of tests Median

Variance

Control Group Healthy volunteers

33

39.25% 46 33 39.25% 46

Study Group with days of UCI stay > 12

Survivors and Candida spp colonization

8 27.69% 104.62 4 26.70%

30.99

Survivors and multifocal candidiasis

6

25.75% 111.35 4 37% 54.67

Dead and multifocal candidiasis

10 20.75% 166.17 12 20.78%

163.54

Discussion

Critical illness is defined by presence of altered organ function in acutely ill patients such that homeostasis cannot be maintained without medical intervention in ICU, such as mechanical ventilation, vasoactive support for hemodynamic, renal replacement therapy, and so on [7]. The Sequential Organ Failure Assessment (SOFA) score is a simple method of assessing and monitoring organ dysfunction in critically ill patients [8,9]. The prognostic value of skin tests in critically ill patients has been observed for years [10]. There is also evidence of the prognostic value of Multifocal Candidiasis in these non- neutropenic critically ill patients. The detection of Multifocal or Invasive Candidiasis [2] can be an indicator of acquired immunosuppression in ICU patients affected by a Multiple Organ Dysfunction Syndrome [10]. In the patients of the study, the need for mechanical ventilation for more than 24 h. together with continuous sedation, before identifying Multifocal Candidiasis, indicates that their SOFA score is higher than 5. This fact confirms that the selected patients are admitted to the ICU with a Multiple Organ Dysfunction Syndrome. The LTT PHA carried out in this study demonstrate that the cellular immunity of non- neutropenic patients requiring mechanical ventilation for more than 48 h. presented significantly lower values than in a control group of non-neutropenic subjects. These results confirm the existence of an immunological response known as endogenous immunosuppression [11] in non-neutropenic critically ill patients. At the same time, these statistically significant differences disappear in the 2nd determination of the LTT PHA in critically ill patients with an ICU stay of more than 12 days and who survive. Therefore, improvement of this T-cell dysregulation [12] will condition ICU outcome in patients who remain in critical condition for more than 12 days. This observation raises the possibility that quantitative and qualitative kinetic monitoring of T-lymphocytes in ICU patients may help to identify those who may benefit from new immunomodulatory therapeutic strategies [13]. A possibility of this monitoring can be found following the proposal of the REALIST score [14].

Conclusions

Both in vivo cellular immunity studies, using skin tests, and in vitro studies with the LTT PHA help to establish a prognosis in critically ill patients requiring long-term ICU care and in which a Multifocal Candidiasis has been identified. Monitoring of T-cell dysregulation and endogenous immunosuppression can help to identify patients who may benefit from new immunomodulatory therapeutic strategies.

Aknowledgements

Thank you to Torres Rodriguez JM. MD PhD, who served as scientific advisor.

References

  1. Ibañez-Nolla J, Nolla-Salas M, León MA, García F, Marrugat J, et al. (2004) Early diagnosis of candidiasis in non-neutropenic critically ill patients. J Infect 48: 181-192.
  2. Ibañez-Nolla J, Nolla-Salas M (2024) Multifocal Candidiasis can be considered a form of Invasive Candidiasis in critically non neutropenic patients. IJID 147: 107171.
  3. Monto Ho (1981) Non-bacterial infections in the Critical Care State of the Art (vol 2). Ed Shoemcker, UC y Thompson WL. Fullerton. California 1-12.
  4. Sprague JL, Kasper L, Hube B (2022) From intestinal colonization to systemic infections: Candida albicans translocation and Gut Microbes 14:2154548.
  5. Patterson L, McMullan R, Harrison DA (2019) Individual risk factors and critical care unit effects on Invasive Candida Infection occurring in critical care units in the UK: A multilevel Mycoses 62: 790-795.
  6. Surbatovic M, Vojvodic D, Khan W (2018) Immune response in critically ill patients. Mediators inflammation 2018: 9524315.
  7. Moreno R, Rhodes A, Piquilloud L, Hernandez G, Takala J, et al. (2023) The Sequential Organ Failure Assessment (SOFA) Score: has the time come for an Update? Critical Care 27: 15.
  8. Nolla M, León MA, Ibáñez J, Díaz RM, Merten A, et (1998) Sepsis-related organ failure assessment and withholding or withdrawing life support from critically ill patients. Critical Care 2: 61.
  9. George C, Robin M, Carlet J, Rapin R, Landais C, et al. (1978) Cellular immunity skin testing and sepsis in intensive care patients: relationship between results and Nouv Presse Med 7: 2541-2544.
  10. León Regidor MA, Ayuso Gatell A, Díaz Boladeras R, Robusté Morell J, Soria Guerrero G, et al. (1993) Candidiasis in an intensive care unit. Rev Clin Esp 193:49-54.
  11. Munford RS, Pugin J (2001) Normal responses to injury prevent systemic inflammation and can be Am J Respir Crit Care Med 163: 316- 321.
  12. Luperto M, Zafrani L (2022) T-cell dysregulation in inflammatory diseases in Intensive Care Medicine Experimental 10: 43.
  13. Rol ML, Venet F, Rimmele T, Moucadel V, Cortez P, et (2017) Rheanimation Low Immune Status Markers (REALISM) project: A protocol for broad characterisation and follow-up of injury-induced immunosuppression in intensive care unit (ICU) critically ill patients. BMJ Open 7: e015734.
  14. Tremblay JA, Peron F, Kreitmann L, Textoris J, Brengel-Pesce K, et al. (2022) A stratification strategy to predict secondary infection in critical illness-induced immune dysfunction: the REALIST Ann Intensive Care 12: 76.

Contribution to the Eruption Mechanism of Carbonatitic Diatremes and Volcanoes

DOI: 10.31038/GEMS.2024673

Abstract

The Eifel Volcanic Field (EVC) is one of the best-known intraplate volcanic fields on earth. Carbonatitic ejecta were already described at the beginning of the last century and were associated with volcanism. The investigation of carbonatitic tephra from the EVC, the Kaiserstuhl (KVC) and El Hierro (EHSR) with regard to shape, size, composition and geochemistry, together with thermodynamic and fluid mechanical considerations, allow a reconstruction of the eruption process that ultimately calls into question the sole interpretation of maar formation as a phraetomagmatic eruption.

Introduction

In their overview of the worldwide distribution of carbonatites, Woolley and Kjarsgaard (2008) [1] report 527 carbonatite localities, 46 of which are classified as extrusive. The ratio is unlikely to have changed significantly to date. While the intrusive carbonatites represent the frozen state of a relatively slow intruding melt that has cooled in the host rock, the extrusive carbonatites are the result of sudden events that, due to the physical nature of the carbonatite melts, leave behind mechanical but only minor chemical traces. The genesis of carbonatitic melts can be very different, depending on whether they occur alone or in combination with alkali silicate rocks. They can be formed primarily by partial melting in the mantle or also by fractional crystallization of melilitic-nephelinitic magmas or generally by segregation of silicate melts supersaturated with carbonate [2]. In all cases considered, the carbonatitic events are determined by the unique properties of the carbonatite melts themselves [2]. For example, carbonatites generally have a high solubility for rare earth elements, which makes them economically interesting. They have a strongly pressure-dependent density of 2000 kg /m3 at P = 0.1 GPa up to 2900 kg/m3 at P = 10 GPa, a very low viscosity and a high solubility of CO2 and H2O (Genge et al 1995). The high solubility of CO2 in carbonatitic melts is associated with the onset of incongruent melting of CaCO3 at temperatures > 1230°C and a pressure range of 0.1 – 0.7 GPa according to the reaction [3].

2CaCO3 (solid) = (CaCO3 +CaO)(liquid) + CO2                   Eq (1)

A further increase in pressure ultimately leads to congruent melting [3-4]. The incongruent melting behavior of CaCO3 explains the high saturation of carbonatite melts with CO2 . This saturation is associated with a drastic reduction in the melting temperature (solidification temperature). According to Huang and Wyllie (1976) [5], saturation of the carbonate melt with CO2 to 11.5 wt% at 2.7 GPa results in a melting point reduction from 1610°C to 1505°C. Investigations by Eggler (1974) [6] on the solubility of CO2 in diopside at 3 GPa show that mantle silicate melts dissolve approx. 5 wt% CO2 , which is associated with a melting point reduction of 120 degrees. Due to the incongruent melting behavior of the carbonate [Eq (1)], a high CO2 content of the melt combined with high fluidity and low density is inevitable. A high H2 O content also has the effect of lowering viscosity and melting point, which is particularly important in silicate melts. The low viscosity of carbonatitic melts leads to magma ascent velocities of 20 – 65 m/s (70-230 km/h) if the appropriate tectonic conditions are present [45]. However, this also means that extrusive carbonatitic events are unpredictable. Furthermore, rapid magma ascent leads to rapid depressurization, which results in spontaneous release of the CO2 dissolved in the melt and decomposition of the carbonate according to the relationship leads.

CaCO3 = CaO + CO 2               Eq (2)

This creates a gigantic CO2 fan at depths of 3 – 20 kilometers. This means that the probability of carbonatitic melt reaching the earth’s surface is very low. Such carbonatitic diatreme fillings are characterized by a quantitatively high proportion of accessory rock xenoliths, which can amount to 70% and more [7]. Silicate-magmatic tephra occurs when the eruptive reservoir is a carbonate-bearing silicate magma. Stoppa et al (2003) [8] have pointed out these processes. The type of eruption also means that only small traces of the carbonatite itself can be found. This may also be the reason why only a small number of extrusive carbonatites have been detected to date. A model is being developed from the known data of carbonatitic melts, which allows a better understanding of the phenomena associated with carbonatitic volcanism and a better interpretation of the material found in the field. For this purpose, data from sample material from three known volcanic fields are used: the Eifel (EVC = Eifel Volcanic Complex), the Kaiserstuhl KVC = Kaiserstuhl Volcanic Complex) and El Hierro (EHSR = El Hierro South Rift).

Geological Context of the Regions Belonging to the Sample Material

EVC, Eifel Volcanic Complex

One of the most famous intraplate volcanic districts in the world is located in the Eifel, as it contains the type locality of the Maar eruption type. The Eifel volcanic field has two quaternary volcanic fields that follow tectonic northwest-southeast AC fissures of the Variscan folded crust. The West Eifel consists of around 240 eruption centers, the East Eifel of around 100 [9]. Due to the economic use of the volcanic structures for the extraction of building materials, gravel and pumice, the two Eifel volcanic fields are excellently accessible for geological investigations. Multiphase volcanic activity began in both volcanic fields around 700 ka ago [10-11]. The last activities occurred in the Western Eifel around 11 ka ago with the eruption of the Ulmen Maar [12] and in the Eastern Eifel around 13 ka ago with the eruption of the Laacher See Volcano [13]. Two older foidite suites (melilitite, melilitite-nephelinite and ol-nephelinite/leucitite and leucite- phonolite) and a younger basanite-tephrite-phonolite suite [14-16] occur in both volcanic fields. In the West Eifel, the basanite suite first appears around 80 ka, in the East Eifel at around 215 ka [10-11]. These alkali-rich magmas originate from varying degrees of partial melting in the upper mantle (< 120 km), which were subjected to more or less strong differentiation by fractional crystallization on their way to the Earth’s surface. The foiditic magmas in particular are potential sources of carbonate-bearing to carbonatitic magmatic rocks, which have long been known from the Laacher See region [17-19]. They were first described from the West Eifel by Lloyd and Bailey (1969) – [20] and again investigated by Riley et al. (1996) [21] and Riley et al. (1999) [22]. To date, however, scientific interest in the Eifel carbonatites has remained rather low. A dissertation on the genesis of the Laacher See carbonatites was published by Liebsch (1997) – [23]. He interpreted the Laacher See carbonatites as precipitates from a phonolitic silicate melt supersaturated with carbonate in the last stage of differentiation and cooling. This work is little known as its results have not been published. Schmidt et al. (2010) [24] investigated the temporal development of intrusive carbonatites using uranium-thorium dating on the same sample material. Since 2019, an international working group led by the German Volcanological Society has turned its attention to the problem of Eifel carbonatites. The initial focus is on a geological survey combined with the discovery of further carbonatite deposits.

The carbonatite deposit of the Laacher See volcano is the youngest in the Eifel with an age of 13 ka years. The other known carbonatite deposits in the Eifel are located in the Rieden complex (Eastern Eifel) [25] and in the Western Eifel in the Rockeskyll and Essinger Maar area. They are generally linked to phonolitic magmatism and are characterized by the associated occurrence of sanidine megacrysts with masses of up to 60 kilograms. In terms of age, the West Eifel deposits can be dated to approx. 469 ka years ago and the East Eifel deposits to 410 ka years ago [10, 26]. If one takes the conspicuous association of sanidine megacrysts and carbonatites as an indicator, then there are still 3 carbonatite-rich areas. One area is the Kerpener- Maar in the West Eifel. This is a phonolitic maar, which is also known for its sanidine megacrysts [14]. The other two deposits are located in the Eastern Eifel. One is located on the southern edge of the Wehrer Kessel, a polyphase phonolitic eruption center where, according to Frechen (1976) [27], sanidine megacrysts were also found in the Wehr I tephra. The age of the deposits of the Wehr I eruption is given by Wörner et al. (1988) [28] as 480 ka years. The other occurrence is in the area of the Leilenkopf near Niederlützingen, where the oldest melilitic-nephelinitic deposits of the Leilenkopf volcano are also said to contain sanidine megacrysts [29]. The age of these sanidine ejecta was determined to be 405 ka years [30]. However, all 3 of these carbonatite-rich deposits are currently unexplored.

KVC, Kaiserstuhl Volcanic Complex

The Kaiserstuhl Volcanic Complex is the best-studied carbonatite complex in Europe [31-34]. Its age is given as 16-19 Ma [35], Braunger [36]. It consists mainly of tephritic to phonolitic rocks, associated with a small proportion of olivine nephelinites and melilites. The youngest formations are the carbonatites, whose age is given as 15 Ma [33]. The magmatic origin of the carbonatites from the Kaiserstuhl was first postulated by Högbom in 1895 [33]. The carbonatites of the KVC occur both as subvolcanic carbonatite bodies of sövitic character and as extrusive events in the form of dykes, veins and carbonatitic tephra. Carbonatitic tephras are of particular importance for the investigation of the eruption mechanism of carbonatitic volcanoes. A special feature of the Kaiserstuhl ejecta are the lapillite tuffs known from Henkenberg and Kirchberg, which are only known from a few other localities (Cape Verde, Silva et al. 1981 [37], Fort Portal Volcanic Field, Uganda, Barker and Nixon 1988) [38]. They are so distinctive that they form the locus typicus for this type of tuff. Since this paper is concerned with the interpretation of the eruption mechanisms of carbonatitic volcanoes, only those samples that can be expected to contribute to this topic were considered in the processing.

Region El Hierro, South Rift (EHSR)

El Hierro is one of the seven volcanic islands of the Canary Islands archipelago, which is located approximately 100 kilometers northwest of Africa in the Atlantic Ocean. The age of the archipelago is estimated at around 60 million years, with the island of El Hierro being the youngest link in this chain at around 1.2 million years old. All islands are considered volcanically active [39]. El Hierro can be divided into 3 rift systems [40]. The North-East Rift (Tinor Volcano, 1.2-0.88 Ma), the West Rift (El Golfo Volcano, 0.55-0.176 Ma) and the South Rift (0.158 Ma – today). The South Rift is the youngest formation and had its last eruption in 2011 as a submarine volcano off the southern tip of the island. The South Rift volcanism is characterized by highly differentiated lavas of tephritic character. Such lavas originating from tephritic magmas are certainly indicative of carbonate-enriched silicate rocks and their differentiates (carbonatites). The search for carbonatitic ejecta is therefore quite promising and opens up the possibility of verifying the thesis of the dissociation of CaCO3 with subsequent recombination according to equations 2 to 5 by applying the C14 determination method. Since C14 is only formed under the influence of high-energy particles in the atmosphere, volcanic CO2 is ad hoc free of C14 . If the detection of C14 in carbonatitic tephra is successful, then the proof for the sequence of reactions according to equations 2 to 5 is provided. As the isotope C14 is a relatively short- lived nuclide with a half-life of 5730 years, verification must take place in a young volcanic area with carbonatitic episodes. Through a systematic search, the author found suitable sample material for a C14 determination in the South Rift of El Hierro.

Gas Mechanical Processes in the Light of Volcanology

Depending on pressure, flow velocity, flow type, solid and liquid content, a gas flow through a tube produces effects that have long been used in technology and that can be studied excellently on extrusive carbonatites from the Eifel. Some of the gas-mechanical processes that we will deal with below are known as fluidized bed processes. In volcanology, publications dealing with this topic appear from time to time [41-44].

Basically, three processes can be distinguished in the fluidized bed process, depending on the prevailing conditions:

  1. Agglomeration, granulation, integration
  2. Abrasion, disintegration, fragmentation
  3. Transportation

The result of all three modes can be demonstrated on diatremes in the Eifel.

We want to understand a diatreme sensu stricto as a volcanic ascent channel, which is very narrow in relation to its length and can reach the Earth’s mantle under certain circumstances. It is tectonically pre-formed and is created by mechanical fragmentation as a result of rapidly rising highly fluid melts (70-230km/h; Genge et al 1995) [45]. In the case of carbonate-containing melts, these reach a pressure level during ascent at which the decomposition reaction of the calcium carbonate according to Eq. (1) and Eq. (2) begins explosively, which is accompanied by a fragmentation of the residual channel up to the earth’s surface. This leads to foreign xenolith contents of up to 70% and more in the eruption centers. The explosive initial phase can be followed by a quieter degassing phase, which can be described by a kind of boiling reaction in a relatively narrowly defined area of the ascent zone, whereby this area can be characterized by the diameter of the diatreme and the thickness of the boiling zone. The intensity of the eruption is determined by the amount of material extracted from the depth per unit of time. The onset of the reactions according to equations (1) and (2) is associated with the emission of large quantities of CaO in the volcanic ejecta. This fact has not yet been mentioned in the literature, although one has to ask how carbonatitic tuff was formed. Obviously, it is tacitly assumed that a carbonate liquid phase cemented the tephra particles. However, we have no known C, O and Sr isotope data to prove that the binding phase of the tephra is magmatic in nature (according to the usual criteria for magmatic isotopy, Taylor et al. 1967) [46]. As a way out of this dilemma, it is argued that the isotopy of the tephra has been altered by alteration processes (Demeny et al 1998) [47].

Accordingly, large quantities of CaO and CO2 are released into the atmosphere during the eruption. The overall isotopic picture of the CaCO3 is therefore split into a CaO isotope and a CO2 isotope. Both components are carried into the atmosphere, where they are influenced by the prevailing conditions such as humidity, temperature and air velocity. While the CO2 remains as a gas, the CaO sinks back to the earth’s surface as dust. The CaO can recombine with volcanic CO2 or CO2 from the air or react with the moisture in the air. The following reactions are possible:

CaO + CO2 = CaCO3                                   Eq (3)

CaO + H2 O = Ca(OH)2                              Eq (4)

Ca(OH)2 + CO2 = CaCO3 + H O2             Eq (5)

There is therefore ultimately a fallout of clasts (predominantly xenoliths from secondary rocks, but also xenocryst fragments from the primary carbonate melt) and a dust mixture of CaO, Ca(OH)2 and CaCO3 , with CaO as the main component. This dust forms the binding material for the carbonatitic tuff, whereby CaO and Ca(OH)2 are transformed into CaCO3 by the atmospherics according to Eqs. (4) and (5), a process that also takes place with quicklime. Ultimately, a tuff with a carbonate binder phase is formed. We will return to these facts below (Figure 1a-1c).

Figure 1a-c: Tuff with carbonate binder phase.

Above the evaporation zone, turbulence can occur within the ascent channel if the appropriate conditions for flow velocity and pressure are present, leading to the formation of a fluidized bed. This means that the diatreme is in agglomeration or granulation mode. Depending on the role played by the liquid phase involved, we obtain accretionary lapilli or droplet lapilli. Accretionary lapilli are formed when dust particles collect in a rotating gas flow and stick together due to a highly fluid medium (carbonatite melt). Droplet lapilli are formed when low-viscosity silicate melt (e.g. melilititic or melilite- nephelinitic) is atomized and the droplets agglomerate in the turbulent gas space. This causes the so-called “cauliflower surface” of these lapilli (Figure 2a-2b).

Figure 2:

The lapilli can occur with or without a nucleation center, with the droplet lapilli often forming around an inclusions or juxtaposed xenolith (Figure 2c-2d) with and without nucleation center (micrograph, edge length approx. 2.5 cm). If the flow conditions in the ascending channel change, the system can switch from agglomeration mode to abrasion mode. In this case, the rotating clasts transported in the conveyor chute are rounded in a similar way to a sandblasting fan. The rounded sanidine megacrysts from Rockeskyll and Hohenfels- Essingen, whose rounded surfaces have so far been interpreted as fusions, are well known (Eilhard 2018) [48]. There are also plenty of rounded accessory rock xenoliths and comagmatic clasts in the form of pyroxenites and amphibolites (Figure 3a-3b).

Figure 3:

The Problem of the Carbonatitic Binding Phase in Tephra

Ultimately, the problem of CO2 emission in carbonatitic volcanic eruptions can only be solved according to equation 2 by analyzing the binding phase of carbonatitic tephra. For this reason, we will deal with carbonatitic tephra from various volcanic regions in the following. These volcanic areas are the Eifel (EVC = Eifel Volcanic Complex), the Kaiserstuhl (KVC = Kaiserstuhl Volcanic Complex) and El Hierro (EHSR = El Hierro South Rift).

Sample Material from the EVC

The sample material comes from both the Eastern Eifel (EEVC) and the Western Eifel (WEVC).

In detail, the samples are as follows:

68.3 Tephra, EEVC, Thürer Wald

101.5 subvolcanic soevite, EEVC, Thürer Wald

101.6 Sövite, carbonatitic vein, EEVC, Thürer Wald

94.1 Tephra, WEVC, Essinger Maar

94.5 Tephra, WEVC, Essinger Maar

94.6 Tephra, WEVC, Essinger Maar

95.1 Tephra WEVC, Pulvermaar

Material 101.5 and 101.6 are subvolcanic carbonatites. Figures 4a and 4b provide a visual impression.

Figure 4:

The isotope signature can be used as a starting point (Table 1):

These data are typical for magmatic carbonatites. We will find comparable data in the subvolcanic soevites of the Kaiserstuhl.

Table 1: Isotope signature.

 

δ44Ca

δ13C δ18O 87Sr/86Sr Sr/μg g-1
101.5 -6,12 7,52 0,70442

14990

101.6

-5,79 7,53 0,70439

15060

Description of the Sample Material

Tephra Thürer Wald, Sample 68.3

The volcanic clastics are cemented by a zeolitic-carbonatitic binding phase. As a result of a syneruptive or posteruptive hydrothermal phase. The geochemical data of the carbonatitic phase are listed in the following table (Table 2).

Table 2: Geochemical data of the carbonatitic phase.

δ44Ca

δ13C δ18O 87Sr/86Sr Sr/μg g-1
68.3 -7,54 21,68 0,70442

3500

The oxygen signature indicates that the fluid phase was under the influence of vadose waters, with the magmatic signature of carbon and Sr preserved.

Tephra Essinger Maar, Sample 94.1/5/6 and Tephra Pulvermaar, Sample 95.1

They show the volcanic clastics embedded in a carbonatitic binding phase, whose isotopic signature is shown in the following table (Table 3 and Figure 5a-5c).

Table 3: Volcanic clastics embedded in a carbonatitic binding phase.

 

δ44Ca

δ13C δ18O 87Sr/86Sr Sr/μg g-1

94.1

-17,94 19,47 0,70594 800
94.5 0,53 -13,32 22,18 0,70645

410

94.6

0,59 -20,35 19,51 0,70613

1900

95.1

-12,64 25,60 0,70603

1900

Figure 5: The tephra of the Essinger Maar is shown in a-c.

The direct indication of the magmatic origin of the Eifel tephra is provided by the high Sr content. The Sr content of sedimentary limestones of the Eifel is max. 300 ppm. The C and O isotopy of the carbonate tephra binding phase can no longer represent the Taylor criteria for magmatic isotopy [46] due to its origin. The strontium content of the carbonate binding phase was determined at the tephra of the three localities EM, PM and TW using the ICP-OES method. The tephra of the Pulvermaar is not yet diagenetically consolidated due to its young age. The CaCO3 appears as an outer coating on the tephra particles, as demonstrated in the Figure 6.

Figure 6: Tephra from the Pulvermaar.

The figure shows the state of the tephra of the Pulvermaar on the left and the state after treatment with diluted acetic acid on the right. The CaCO3 coating has been removed in this case. However, this means that the tephra particles were embedded in the dusty fallout of CaO, Ca(OH)2 and CaCO3 and not in a liquid binding phase of CaCO3 melt.

Sample Material from KVC

The material was collected in 2023 and then processed. In detail, the samples are as follows:

Sample.                             Remarks.

69.1.                                  subvolcanic sövite, Badloch

97.2                                   Droplet lapilli, Kirchberg

105.1.                                Droplet lapilli, Henkenberg

105.4                                 Droplet lapilli, Henkenberg

105.5                                  white tephra, Henkenberg

105.6                                  hydrothermal limestone, Henkenberg

105.9                                  gray tephra, Henkenberg

105.10                                gray tephra, Henkenberg

Sample 69.1 is the reference value for the initial magma with the following isotope ratios (Table 4):

Table 4: The reference value for the initial magma with isotope ratios.

δ44Ca

δ13C δ18O 87Sr/86Sr Sr/μg g-1
0,60- -6,05 7,08 0,70357

0,70357

Description of the Sample Material

Droplet lapilli from Kirchberg, 97.2.

Figures 7a and 7b provide a visual impression of the sample material. The scale in mm is indicated at the bottom of the images. Figure 7b clearly shows the spherical shape of the droplets (droplet), which indicates that they were deposited in a solid state.

Figure 7a and b: Droplet lapilli from Kirchberg.

The isotope data are as follows (Table 5):

Table 5: Isotope data.

δ44Ca

δ13C δ18O 87Sr/86Sr Sr/μg g-1
0,48 -7,92 15,53 0,70354

4690

Figures 8a, b and c show the BSE image and the Ca and Sr element distribution mapping of a droplet. The Sr- mapping shows very nicely large Ca primary crystals floating in a matrix of fine crystalline CaCO3, which can be interpreted as residual solidification.

A pronounced carbonatitic binding phase similar to that of the Thürer Wald sample material is not present. This is also confirmed by comparing the δ13C values of the whole rock (wr) and the isolated droplet, which are almost identical (see Hubberten 1988 [49] Hay and O’Neil 1983 [50] and table 10.

Droplet Lapilli vom Henkenberg, 105.1 and 105.4.

A striking feature of Figure 9a is the occurrence of light (Dl) and dark (Dd) droplets in the center of the image, embedded in a strongly developed carbonate phase (M). Detailed examinations of the microstructural components (see pictures) reveal the following picture (Table 6).

Table 6: Detailed examinations of the microstructural components.

 

δ44Ca

δ13C δ18O 87Sr/86Sr Sr/μg g-1

Dd dark

0,66 -7,91 14,66 0,70376

3450

Dl light

–9,43 15,67 0,70376 3450

Matrix

0,80 -11,57 24,6

<NWG

Figure 9: a, b and c provide an optical impression of the sample material. Figure c shows a micrograph.

The absence of strontium and the high δ18O value of 24.6 ‰, as well as the occurrence of drusen spaces with calcite crystals in the matrix (9b) indicate a hydrothermal post-phase with vadose waters, which also explains the partial alteration of the magnetites and the associated brown coloration of part of the droplets.

Siliceous tephra from Henkenberg, 105.9 and 105. 10.

Figure 10 gives an optical impression of the tephra. 84% of the material consists of CaCO3 . In addition, fragments of silicate minerals such as olivine, pyroxene, Al-Ca-Fe-containing garnet and Mg-Al-Ti- containing iron spinel occur.

Figure 10: 84% of the material consist of CaCO3. In addition fragments of silicate minerals such as olivin, pyroxene, Al-Ca-fe containing garnets and Mg-Al-Ti containing spinel occur.

The isotope data are as follows (Table 7):

Table 7: Isotope data.

Sample

δ44Ca

δ13C δ18O 87Sr/86Sr Sr/μg g-1
105.9 0,42 -10,02 24,02 0,70477

281

105.10

0,80 -10,26 23,95 0,70485

239

Remarkable is the occurrence of calcite crystal fragments, with strontium contents of approx. 3000 μg g-1, which are interpreted as ejected primary crystal fragments from the carbonatitic magma (Figure 11a-b, 12a-b, and 13a-c).

Figure 11: a and b shows an 800 µm x 450 µm primary crystal fragment in thin section. Figure a parallel polarizers, figure b crossed polarizers. It can be clearly seen that the calcite matrix has recrystallized at the edge of the primary crystal fragment. The grain size of this edge is up to 100 µm in contrast to the matrix, which has a grain size of approx. 15 µm. The same proportions can also be seen on the primary crystal fragments of garnet and spinel in Fig. 12 a and b.

Figure 12:

Figure 13: a, b and c show the BSE image and the Ca and Sr mappings of the calcite xenolith.

Silicate-free tephra from Henkenberg, 105.5.

The material consists of 99% CaCO3 . Figure 15 gives a visual impression of the sample material (Figure 14).

Figure 14: Silicate-free tephra.

The isotope data are as follows (Table 8):

Table 8: Isotope data.

Sample

δ44Ca

δ13C δ18O 87Sr/86Sr Sr/μg g-1
105.5 1,03 -9,82 24,42 0,70656

68

The thin section shows a uniform growth structure with grain sizes of 20µm to 50µm. No foreign mineral phases are recognizable (Figure 15).

Figure 15: Thin section of sample 105.5.

The results of samples 105.5, 105.9 and 105.10 can be easily explained if one assumes that CaO and CO2 are erupted during a carbonatitic volcanic eruption and that the reactions take place according to equations 2 to 5.

During the eruption, CaO dust is blown into the atmosphere, which gradually sediments again. Coarser particles, such as mineral fragments and calcite clasts, are also deposited near the eruption site, as can be seen in material 105.9 and 105.10. The heavy SrO is also deposited near the eruption site. The material of sample 105.5 was transported further, making it xenolith-free, as the heavy crystal fragments sediment near the eruption site. Similarly, the strontium content decreases with distance from the eruption site. The material from Badloch has a strontium content of 9300 μg g-1, material 105.9/10 has a strontium content of 280 μg g-1 and material 105.5 of 68 μg g-1. The xenolith crystals of samples 105.9/10 act as nucleation centers for carbonate formation, as can be clearly seen.

Sample Material from EHSR

The find situation can be seen in Figures 16 and 17.

The discovery points are approx. 3 kilometers apart.

Figure 16: Finding point sample 108.1.

Figure 17: Finding point samples 108.2 and 108.3

Description of the Sample Material

The geochemical data is shown in the table (Table 9 and Figure 18a-c). These three tephras are not yet strongly diagenetically consolidated. As a result, surface waters can exert a strong altering influence. Nevertheless, the tephras show a clear magmatic signature, the C and O isotope values are shifted in the sense of Hay and O’Neil towards carbonates in equilibrium with meteoric water [50]. The 14C isotope analysis has shown that a considerable 14C content is present, which correlates with ages of 9000 and 4000 years. These ages represent maximum values, as the dilution effect of the natural air CO2 content by the volcanic CO2 means that the initial value of 14C is lower than is normally assumed. In any case, the detection of 14C in the tephra confirms the sequence of reactions according to equations 2 to 5.

Table 9: Geochemical data.

sample

δ44Ca

δ13C δ18O  87Sr/86Sr Sr/μg g-1 14C
108.1 0,79 -7,71 28,55 0,70390 980

0,5497

108.2

0,91 -8,931 28,12 0,70373 1100 n.d.
108.3 1,41 -8,832 29,24 0,70464 494

0,3262

Figure 18: a to c provide an impression of the sample material.

Results and Discussion

It can be seen that the δ18O value of the carbonatitic binder phase is generally greater than 20 ‰. Obviously, the δ18O value of the carbonatitic source materials (CaO and CO2) changes under the influence of atmospheric oxygen (δ18O = 23.5 ‰) in the eruption cloud to these high values of δ18O > 20‰ (Table 10).

Table 10: Summarizes the results of the tephra data.

Sample

Location age/Ma Sr/μg g-1 δ13C δ18O 87Sr/86Sr δ44Ca
68.3 TW 0,44 3500_ic -7,54 21,68 0,70442

n.d.

94.1

EM 0,47 800_ic -17,94 19,47 0,70594 n.d.
94.5 EM 0,47 410_ic -13,32 22,18 0,70645

0,53

94.6

EM 0,47 1900_ic -20,35 19,51 0,70613 0,59
95.1 PM 0,03 1900_ic -12,64 25,6 0,70603

n.d.

105.5

KS/HB 16,4 68_ic -9,822 24,42 0,70656 1,03
105.9 KS/HB 16,4 281_ic -10,02 24,02 0,70477

0,42

105.10

KS/HB 16,4 238_ic -10,26 23,95 0,70458 0,8
97.2 KS/K 16,4 4690_wr -7,92 15,53 0,70354

0,48

105.1/GLD

KS/HB 16,4 3450 -7,91 14,66 0,70376 0,66
105.1/GLH KS/HB 16,4 3450 -9,43 15,67

0,70376

 

105.1/M

KS/HB 16,4 <NWG -11,57 24,6   0,8
wr KS/K 16,4 n.d. -7,6 16,9  

Data from [49]

wr

KS/K 16,4 n.d. -7,8 15,7   Data from [49]
isolated lapilli KS/K 16,4 n.d. -7,1 15,6  

Data from [49]

isolated lapilli

KS/HB 16,4 n.d. -8,8 15   Data from [49]
M KS/HB 16,4 n.d. -10,4 24,6  

Data from [49]

M

KS/HB 16,4 n.d. -10,2 24,7   Data from [49]
M KS/HB 16,4 n.d. -10,2 24,6  

Data from [49]

GL

KS/HB 16,4 3500 -9,3 13,9 Data from [50] Data from [50]
GL KS/HB 16,4 3500 -9,2 14,3 Data from [50]

Data from [50]

GL

KS/HB 16,4 3500 -8,4 14,7 Data from [50] Data from [50]
M KS/HB 16,4 <NWG -17,7 20,6 Data from [50]

Data from [50]

M

KS/HB 16,4 <NWG -12,1 23 Data from [50] Data from [50]
108.1 El_H 0,003 980_ic -7,71 28,55 0,70390

0,79

108.2

EL_H 0,003 1100_ic -8,931 28,12 0,70373 0,91
108.3 El_H 0,003 494_wr -8,832 29,24 0,70464

1,41

Ic: isolated carbonate, wr: whole rock, n.d.: not detected.

The δ13C value does not change during the eruption as it lacks the exchange partner and the small amount of CO2 in the air also has a δ13 C value of -6.5‰. This means that the change in the δ C value of the tuffitic binding phase is due to later alteration. This can be seen very clearly in the tephra of El Hierro, which can be regarded as recent at around 3 ta and which still fulfills the Taylor criterion for carbon with values of δ13C of around -8‰, while the oxygen is already far from this with values of 28 ‰. This shows that the C isotope ratio will be changed by alteration processes after the eruption. However, the lapilli tephra from Kaiserstuhl also shows that the isotopic composition δ13C of massive carbonatite, as present in the lapilli, is much more stable than the δ18O isotopy. The values in the table also show that in cases where the δ13C isotope does not deviate or deviates only slightly from the Taylor criterion, the 87Sr/86Sr value has a magmatic signature. The formation of the droplet lapilli at Kirchberg and Henkenberg must have taken place under conditions that are extremely rarely realized in nature. This shows that only three such sites are currently known: Kaiserstuhl [51], Cape Verde Islands [37] and Fort Portal Volcanic Field, Uganda (Barker and Nixon 1988 [38]). The carbonate melt must have spattered. It then formed into a sphere due to the surface tension and suddenly solidified. Accordingly, the micrographs Figure 8c show calcite primary crystals precipitated from the melt and a fine-grained matrix as residual solidification.

Figure 8: a, b and c show the BSE image and the Ca and Sr element distribution mapping of a droplet. The Sr- mapping shows very nicely large Ca primary crystals floating in a matrix of fine crystalline CaCO3 , which can be interpreted as residual solidification.

The synthesis of physical data on the pressure- and temperature- dependent phase relationships in the CaCO3 system and the findings on the dissolution behaviour of CaCO3 and H2O in silicate melts and their influence on the density and fluidity of the melts under consideration, as well as the calculation of the associated ascent rates, allow conclusions to be drawn about the eruption behaviour in diatremes. Diatremes are bound to tectonically predetermined structures that allow the highly fluid melts to rise rapidly and thus leave them no time to cool. If the melts reach the pressure range that results in the decomposition of the CaCO3 or the release of the CO2, a gigantic fan is created that opens the vent to the Earth’s surface by fragmenting the overlying cover, which explains the high content of wall rock xenoliths in the diatreme. If one now takes into account the phenomena known from technology that are associated with the transport of particles in flowing gases (fluidisation), then the tephras of volcanic pipes that can be found in the terrain can be easily explained. Furthermore, the detection of the carbon isotope 14C in carbonatitic tephra confirms the dissociation and recombination of CaCO3 during the eruption. For the Eifel, this means that the formation of the maars exclusively by phreatomagmatic processes must be reconsidered. This concept was already criticised in the work of Rausch et al. (2015) [52], but was only included in the work of Schmincke et al (2022) [53], in which the formation of maars in the Eifel by sudden magma degassing is also considered possible.

Acknowledgement

We would like to thank A.Pack, Georg-August University of Göttingen for massive support at measuring the oxygen und carbon isotopy. We would also like to thank L. Viereck for valuable advice during the preparation of the manuscript.

References

  1. Woolley AR, Kjarsgaard BA (2008) Paragenetic types of carbonatite as indicated by the diversity and relative abundances of associated silicate rocks: evidence from a global The Canadian Mineralogist . 46 : 741-752.
  2. Jones AP, Genge M, Carmody L (2013) Carbonate Melts and Reviews in Mineralogy & Geochemistry. 75 : 289-322.
  3. Irving AJ, Wyllie PJ (1975) Subsolidus and melting relationships for calcite, magnesite and the join CaCO3-MgCO3 to 36 Geochim. Cosmochim. Acta 39 : 35-53.
  4. Shatskiy AF, Litasow KD, Palyanov YN (2015) Phase relations in carbonate systems at pressures and temperatures of lithospheric mantle: review of experimental data. Russian Geology and Geophysics. 56 : 113-142.
  5. Huang WL, Wyllie PJ (1976) Melting relationships in the systems CaO-CO2 and MgO-CO2 to 33 Geochim. Cosmochim. Acta. 40 : 129-132.
  6. Eggler DH (1974) Effect of CO2 on the melting of peridotite. Carnegie Inst. Yearb. 73 : 215-224.
  7. Zimanowski B (1985) Fragmentationsprozesse beim explosiven Vulkanismus in der Diss. Univ. Mainz, 251S. 64 Abb., 30 Tab., Mainz 1985.
  8. Stoppa F, Lloyd FE, Rosatelli G (2003) CO2 as the propellant of carbonatite-kamafugite cognate pairs and the eruption of diatreme tuffisite. Mineral. 72 : 205-222.
  9. Schmincke H-U (2007) The quaternary volcanic fields of the East and West Eifel (Germany). – In: Ritter R, Christensen U (Hrsg), Mantle Plumes – A Multidisciplinary Springer, Heidelberg. 241-322
  10. Bogaard van den P & Schmincke H-U (1990) Die Entwicklungsgeschichte des Mittelrheinraumes und die Eruptionsgeschichte des Osteifel-Vulkanfeldes. In: Schirmer W (Hrsg) Rheingeschichte zwischen Mosel und Maas. DEUQUA-Führer 1, Deutsche Quartärvereinigung, Hannover. 166-190.
  11. Mertz DF, Löhnertz W, Nomade S, Pereira A, Prelevic D, et al. (2015) Temporal- spatial evolution of low-SiO2 volcanism in the Pleistocene West Eifel volcanic field (west Germany) and relationship to upwelling Journal of Geodynamics 88 : 59-79.
  12. Zolitschka B, Negendank JFW, Lottermoser BG (1995) Sedimentological proof and dating of the early Holocene volcanic eruption of Ulmener Maar (Vulkaneifel, Germany). Rdsch. 84 : 213-219.
  13. Reinig F, Wacker L, Jöris O, Oppenheimer C, Guidobaldi G, et (2021) Precise date for the Laacher See eruption synchronizes the Younger Dryas. Nature. 595 : 66-69.
  14. Mertes H (1983) Aubau und Genese des Westeifeler Vulkanfeldes. Bochum. Geotech. Arb. 9 : 1-415.
  15. Mertes H, Schmincke H-U (1984) Age distribution of volcanoes in the West-Eifel. Jb. Geol. Paläont. Abh. 166 : 260-283.
  16. Mertes H, Schmincke H-U (1985) Petrology of potassic mafic magmas of the Westeifel volcanic Major and trace elements. Contrib. Mineral. Petrol. 89 : 330-345.
  17. A Brauns R (1925) Ein Carbonatit aus dem Laacher Seegebiet. Centralblatt für Mineralogie, Geologie und Paläontologie, A4, 97-101.
  18. Brauns R (1934) Ein neuartiges Skapolithgestein aus dem Laacher Seegebiet mit kurzer Uebersicht ueber die Laacher Auswürflinge und der Bedeutung der fluechtigen Bestandteile im Magma fuer deren Bildung und Centr. Miner. Abt.A. 3: 65-72.
  19. Schuster E (1920) Calcitführende Auswürflinge aus dem Laacher Seegebiet. Neues Jahrbuch für 4 : 295-318.
  20. Lloyd FE, Bailey DK (1969) Carbonatite in the tuffs oft he West Eifel,Germany. Mineral. Petrol. 23 : 136-139.
  21. Riley TR, Bailey DK, Lloyd FE (1996) Extrusive carbonatite from the quaternary Rockeskyll complex, West Eifel, The Canadian Mineralogist 34 : 389-401
  22. Riley TR, Bailey DK, Harmer RE, Liebsch H, Lloyd FE, et al. (1999) Isotopic and geochemical investigation of a carbonatite-syenite-phonolite diatreme, West Eifel (Germany). Mineralogical Magazine 63 : 615-631.
  23. Liebsch H (1996) Die Genese der Laacher See-Karbonatite. Thesis PHD, Göttingen 1996, ISBN 3-932325-06-0.
  24. Schmitt AK, Wetzel F, Cooper KM, Zou H, Worner G (2010) Magmatic Longevity of Laacher See Volcano (eifel, Germany) indicated by U-Th Dating of Intrusive Journal of Petrology, s1, 1053-1085.
  25. Viereck L (1984) Geologische und petrologische Entwicklung des pleistozänen Vulkankomplexes Rieden, Ost-Eifel. Bochumer Geologische und geotechnische Arbeiten, Herausgeber: Ruhr-Universität Bochum, 1984.
  26. Bogaard van den P (1995) Ar40/Ar39 ages of sanidine phenocrysts from Laacher See Tephra (12,900 yr BP) Chronostratigraphic and petrological Earth and Planetary Science Letters. 133 : 163-174.
  27. Frechen J (1976) Siebengebirge am Rhein – Laacher Vulkangebiet – Maargebiet der Westeifel – Vulkanisch – petrologische Exkursionen. Sammlung Geol. Führer, 4th Borntraeger, Berlin, Stuttgart, 1-195.
  28. Wörner G, Viereck L, Plaumann S, Pucher R, Bogaard vdP, Schmincke H-U (1988) The Quaternary Wehr Volcano: A multiphase evolved eruption center in the East Eifel volcanic field (FRG). Neues Jahrbuch Abh. 159 : 73-99.
  29. Meyer W (2013) Geologie der Eifel,4.Aufl., 435, ISBN 978-3-510-65279.
  30. Frechen J, Lippolt HJ (1965) Kalium-Argon-Daten zum Alter des Laacher Vulkanismus, der Rheinterassenund der Eiszeiten. Eiszeitalter und Gegewart.16 : 5-30.
  31. Keller J (1981) Carbonatitic Volcanism in the Kaiserstuhl Alkaline Complex: Evidence for Highly Fluid Carbonatitic Melts at the earth`s Surface. of Volcanology and Geoth. Reserarch. 9 : 423-431.
  32. Zartner S (2009) Der Kaiserstuhlkarbonatit. „Exkursion Oberrheingraben und Kaiserstuhl“ am 05.-06. Juni 2009, leitung Brügmann G, Mertz D.
  33. Braunger S, Marks MAW, Walter BF, Neubauer R, Reich R, et (2018)_The Petrology of the Kaiserstuhl VolcanicComplex, SW Germany: the Importance of metasomized and Oxidized Lithospheric Mantle for Carbonatite Generation. Journal of Petrology 59 : 1731-1762.
  34. Rapprich V, Walter BF, Kopackova-Strnadova V, Kluge T, Ceskova B, et (2023) Gravitational collapse of a volcano edifice as a trigger for explosive carbonatite eruption, The Geological Siciety of America.
  35. Ghobadi M, Brey GP, Gerdes A, Höfer H, Keller J (2021) Accessories in Kaiserstuhl carbonatites and related rocks as accurate and faithful recorders of whole rock age and isotopic International Journal of Earth Sciences.111 : 573-588.
  36. Högbom, AG (1895) Über das Nephelinsyenitgebiet auf der Insel Alnö. Fören. Stockholm Föhr. 17 : 101-115, 214-258.
  37. Silva LC, Le Bas MJ, Robertson AHF (1981) An oceanic carbonatite volcano on Santiago, Cape Verde Nature. 294 : 644-645.
  38. Barker DS, Nixon PH (1989) High-Ca, low-alkali carbonatite volcanism at Fort Portal, Contributions to Mineralogy and Petrology. 103 : 166-177.
  39. Carracedo JC, Troll VR (2016) The Geology of Canary Elsevier Inc.
  40. Abis C, Di Capua A, Marti J, Meletlidis S (2023) Geology of El Hierro Southern Rift.
  41. Woolsey TS, McCallum ME, Schumm SA (1975) Modelling of diatreme emplacement by Physics and Chemistry oft he Earth. 9 : 29-42.
  42. Gilbert JS, Lane SJ (1994) The origin of accretionary Bull. Volcanol. 56 : 398-411.
  43. Gernon TM, Gilbertson MA, Sparks RS, Field M (2007) Tapered Fluidized beds and the role of Fluidization in Mineral The 12th International Conference on Fluidization – New Horizons in Fluidization Engineering.
  44. Gernon TM, Brown RJ, Tait MA, Hincks TK (2012) The origin of pelletal lapilli in explosive kimberlite eruptions. Nature Communications 1-7.
  45. Genge MJ, Price GD, Jones AP (1995) Moleccular dynamics simulations of CaCO3 melts to mantle pressures and temperatures:implications for carbonatite magmas. Earth and Planetary Science Letters, 131 : 225-238.
  46. Taylot HP, Frechen J, Gegens ET (1967) Oxygen and carbon isotope studies of carbonatites from the Laacher See District, West Germany and the Alnö District, Geochimica et Cosmochimica Acta. 31 : 407-420.
  47. Demeny A, Ahiado A, Casillas R, Vennemann TW (1998) Crustal contamination and fluid/rock interaction in the carbonatites of Fuerteventura (Canary Islands, Spain): a C, O, H isotope study. Lithos 44 : 101-115.
  48. Eilhard N (2018) Genese der Sanidin-Megakristalle aus den Quartären Vulkanfeldern der Eifel, Deutschland. Dissertation Ruhruniversität Bochum 2018.
  49. Hubberten HW, Katz-Lehnert K, Keller J (1988) Carbon and Oxygen Isotope Investigations and Related Rocks from the Kaiserstuhl, Germany.
  50. Hay RL, O´Neil JR (1983) Carbonatite Tuffs in the Laetolil Beds of Tanzania and the Kaiserstuhl in Contrib. Mineral. Petrol. 82 : 403-406.
  51. Keller J (1965) Eine Tuffbreccie vom Henkenberg bei Niederrotweil und ihre Bedeutung für die Magmatologie des Kaiserstuhls.
  52. Rausch J, Grobety B, Volanthen P (2015) Eifel Maars: Quantitative shape characterisation of juvenile ash particles (Eifel Vlcanic Field, Germany). Journal of Volcanology and Geothermal Research. 291: 86-100.
  53. Schmincke H-U, Sumita M, Chakraborty S, Hansteen T (2022) The origin of maars at the type locality Eifel (Germany): H2O or CO2. (preprint).
  54. Jarosewich, E., MacIntyre, I.G., (1983) Carbonate reference samples for electron microprobe and scanning electron microscope analyses. Journal of Sedimentary Research. 53 : 677-678.
  55. Merlet C (1994) An accurate computer correction program for quantitative electron probe microanalysis. Microchimica Acta. 114-115, 363-376.
  56. Mollenhauer G, Grotheer H, Gentz T, Bonk E, Hrefter J (2021) Standart operation procedures and performance oft he MICDAS radiocarbon laboratory at Alfred Wegener Institute (AWI), Germany. Nuclear Instruments and Methods in Physics Research, Section B. 496 : 45-51.
  57. Wacker L, Christl M, Synal HA (2010) Bats: Anew tool for AMS data Nuclear Instruments and Methods in Physics Research, Section B. 268 : 976-979.

The Psychological and Social Impact of Immigration Policies: A Minority Stress Perspective

DOI: 10.31038/PSYJ.2024653

 
 

The incoming Trump administration has outlined plans to implement a series of immigration policies emphasizing stricter enforcement measures, prioritizing mass deportations, enhanced border security, and the rollback of humanitarian programs [1]. Key components are expected to include the reinstatement of the “Remain in Mexico” program, requiring asylum seekers to await their court proceedings outside the United States; rolling back Temporary Protected Status (TPS) for individuals from certain countries; targeting the Deferred Action for Childhood Arrivals (DACA) program; reducing pathways for family-based immigration; re-introducing the Social Security Administration (SSA) no-match letters program to identify employees who are unable to establish continued authorization to work in the U.S. [2]; and deploying the U.S. military to aid in deportation efforts [3]. While framed as mechanisms to enhance national security and uphold legal frameworks, these policies are likely to foster a hostile social environment that disproportionately affects immigrant populations in the country. When analyzed through the lens of social determinants of health and minority stress theories, the potentially far-reaching implications of these policies on mental health become evident.

Social Determinants of Health and Hostile Environments

Dynamic systems theory asserts that humans are susceptible to their social environments, and challenging conditions can profoundly affect physical and mental well-being. Aligning with this perspective, the World Health Organization recognizes that social and community contexts- where individuals are born, grow, live, work, and age – significantly shape health outcomes [4]. Hostile social environments shaped by stigma, prejudice, and racism can act as substantial sources of chronic stress, with detrimental effects on targeted individuals’ well-being [5].

The incoming administration’s proposed policies will likely intensify these challenges by fostering environments steeped in fear and uncertainty. The plan for mass deportations with the potential use of the military would exacerbate the sense of insecurity among irregular immigrants, increasing their anxiety and stress levels. Programs like “Remain in Mexico” could disrupt the social and community contexts central to health, forcing asylum seekers into precarious living conditions that lack access to stable housing, healthcare, and safety. These policies are likely to serve as structural mechanisms that amplify the chronic stressors already affecting marginalized populations.

Minority Stress and Stigma Consciousness

The chronic stress experienced by individuals belonging to marginalized social groups is referred to as minority stress. The sources of minority stress are categorized into external (distal) and internal (proximal) stressors. External stressors include observable experiences such as rejection, discrimination, and acts of violence (Meyer, 1995) -all of which are likely to escalate under the incoming administration’s stricter enforcement measures.

Internal stressors, on the other hand, involve internalized perceptions of stigma and societal prejudices, such as internalized racism or homophobia (Meyer, 1995). This process, also referred to as stigma consciousness [6], reflects an individual’s heightened awareness of sociocultural stereotypes and biases targeting their group. For immigrants in the U.S., stigma consciousness is further intensified by public narratives that dehumanize them and portray them as “threats” to social order and public security (E.g., Haitian immigrants eating pets).

Political leaders and public figures significantly shape societal perceptions and influence inter-group dynamics [7]. Provocative rhetoric that labels irregular immigrants as “illegal,” “criminal,” or even “pet-eaters” harms both communities. It creates immigraphobia, an irrational fear of incoming migrants and immigration, by fostering perceptions of threat to national identity, public safety, or resource availability amongst the American public, creating divisions and mistrust. Also, it simultaneously fuels stigma consciousness, fear, and anxiety within immigrant populations. Furthermore, the psychological strain of concealing one’s vulnerable identity, such as an immigrant with irregular status hiding their identity due to the fear of deportation, will add to the cumulative burden of minority stress (Meyer, 1995).

Research shows that stigma consciousness and vicarious experiences of racism – such as witnessing or hearing about discriminatory policies or deportations- foster pervasive fear and anxiety (Yip et al., 2022). Even in the absence of direct personal attacks, the anticipation of rejection, hostility, discrimination, or expulsion can place individuals in a chronic state of stress and hyper-vigilance, with long-lasting consequences for their mental health and well-being. The psychological harm resulting from prolonged personal, collective, and vicarious experiences of racism and discrimination can culminate in racial trauma [8] with symptoms of hyper-vigilance to threats, flashbacks, avoidance of others, heightened suspiciousness, and somatic symptoms such as headaches, heart palpitations (Comas-Díaz et al., 2019). Furthermore, research has consistently correlated perceived racial discrimination with increased severity of anxiety, depression, and psychological distress [9-13]. These findings underscore the profound and multifaceted potential impacts of planned exclusionary policies on the mental health of immigrants, highlighting the urgent need for systemic changes to mitigate these stressors.

Broader Impacts on Immigrant Communities

The ripple effects of the above-mentioned hostile migration policies may extend beyond individuals, disrupting the social fabric of immigrant communities. Deportations and fear-based environments can erode collective resilience, weaken informal support systems, and instill mistrust in institutions such as healthcare and education. This mistrust may discourage immigrants from accessing essential services, including mental health support, further compounding the psychological toll. Fear of exposure or legal repercussions can exacerbate this avoidance, leaving individuals without critical resources to mitigate the stressors they face.

Conclusion

The incoming Trump administration’s planned immigration policies are likely to contribute to a hostile sociopolitical environment, intensifying stigma consciousness and minority stress among immigrant populations. Based on research and theory, these policies are expected to exacerbate mental health disparities while undermining community cohesion and individual resilience. The resulting cycle of fear and exclusion could perpetuate systemic inequalities, highlighting the urgent need for more inclusive and equitable approaches to immigration and public health. By addressing the structural and systemic factors that contribute to chronic stress and trauma, policymakers can foster environments that promote mental health and well-being for all individuals, regardless of their immigration status.

References

  1. Alvarez P, Mattingly P (2024) Donald Trump’s plans on immigration are coming into focus | CNN Politics. CNN Politics.
  2. Benesch Attorneys at Law (2024) Sneak Peek into the Trump 2.0 Administration Immigration Landscape. JD Supra.
  3. Glebova D, Taer J (2024) Trump confirms plans to use military to deport migrants after declaring national emergency. New York Post.
  4. Cokley K, Krueger N, Cunningham SR, Burlew K, Hall S, et al. (2021) The COVID-19/racial injustice syndemic and mental health among Black Americans: The roles of general and race-related COVID worry, cultural mistrust, and perceived discrimination. Journal of Community Psychology. [crossref]
  5. Meyer IH (1995) Minority Stress and Mental Health in Gay Men. Journal of Health and Social Behavior, 36: 38-56. [crossref]
  6. Pinel EC (1999) Stigma consciousness: The psychological legacy of social stereotypes. Journal of Personality and Social Psychology, 76: 114-128. [crossref]
  7. Newman B, Merolla JL, Shah S, Lemi DC, Collingwood L. et al. (2021) The Trump Effect: An Experimental Investigation of the Emboldening Effect of Racially Inflammatory Elite Communication. British Journal of Political Science, 51: 1138–1159.
  8. Comas-Díaz L, Hall GN, Neville HA (2019) Racial trauma: Theory, research, and healing: Introduction to the special issue. The American Psychologist, 74: 1-5.
  9. Cheah CSL, Wang C, Ren H, Zong X, Cho HS, et al. (2020) COVID-19 Racism and Mental Health in Chinese American Families. Pediatrics, 146: e2020021816. [crossref]
  10. Ertorer SE (2024) Racism and Mental Health: Examining the Psychological Toll of Anti-Asian Racism during the COVID-19 Pandemic. Genealogy, 8: 3.
  11. Haft SL, Zhou Q (2021) An outbreak of xenophobia: Perceived discrimination and anxiety in Chinese American college students before and during the COVID-19 pandemic. International Journal of Psychology, 56: 522-531. [crossref]
  12. Huynh MP, Yellow Horse AJ, Mai NM, Mantuhac J, Saw A (2023) Discrimination and psychological distress among Asian Americans during COVID-19: Gender differences in the moderating role of social support. American Journal of Orthopsychiatry.[crossref]
  13. Wenger MR, Lantz B, Gallardo G (2022) The Role of Hate Crime Victimization, Fear of Victimization, and Vicarious Victimization in COVID-19-Related Depression. Criminal Justice and Behavior, 49: 1746-1762.