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Paradigm Change of Pegmatite Formation – Where Does the Water Come From?

DOI: 10.31038/GEMS.2025752

Abstract

We show in this contribution, mainly on the example of diamond and boron extracted from grey cast iron and natural samples from the Variscan mineralizations of the German and Czech Erzgebirge, that both disciplines, metalurgy and mineralogy, can together find a way to explain a surprising observation in nature. Of course, the interpretation of the natural observation of diamond and boron, found in the Earth’s crust, is in the hands of the geologist. Nevertheless, a deeper understanding of thermodynamics guides any material scientist in explaining the existence of unexpected phases.

Keywords

Supercritical fluid, Grey cast iron, Diamond, First natural boron, Pegmatite formation

Introduction

Water has a fundamental meaning for the pegmatite formation. Niggli (1920) [1] has already explicitly discussed that. Yuan et al. (2021a and 2021b) [2,3] discuss a paradigm change, however, not based on the origin of water. Some authors ignore the extraordinary meaning of water [4]. Generally, it is accepted that the water for the pegmatites comes from the hosting granite. We will now show that this, at least for a lot of pegmatites, does not apply. Thomas (2023a) [5] and references in that) has shown in a row of contributions that supercritical fluid (SCF) or supercritical melts (SCM) have left their traces, especially in pegmatites and related mineralizations. A row of authors experimentally and theoretically studied the properties of such media. At this place we call Ni et al. (2017) [6], Ni (2023) [7], and Sun et al. (2023) [8]. Regarding the redox behavior, there is little information, mainly in the form of experimental speculations. Over the transition from the supercritical to the critical and under critical states, there is not much information. By doing exceptional work in a very different field (producing grey cast iron), new information and ideas could be obtained. The first surprising observation was the remarkable amount of diamond. A rough estimation gives a diamond volume of about 0.06%. That is more content than in kimberlite, the mother rock of diamonds. During the study of grey cast iron [9], we found, within the matrix, a lot of diamonds (spherical crystals from < 0.3 µm, over 1.5- 2.0 µm, and aggregates ≥ 10 to 20 µm) – see Figure 1. In Figure 2, a typical Raman spectrum of such a cast iron-diamond is shown. Besides diamonds, we found after dissolution of the matrix many small (1-2 µm) spherical boron crystals (see Figure 3) that demonstrate at strong reducing conditions. In nature, particularly in the Earth’s crust, such conditions are scarce. Therefore, Boron is not a mineral – it is missing in the mineral systems. However, borates are widespread minerals.

Figure 1: Diamonds (D) and silicon carbide (SiC) crystals after dissolving of grey cast iron in hydrochloric acid (25%) placed on a microscope slide.

In this contribution, we will now show that such strongly reducing conditions are not rare at the Variscan tin mineralizations of the Erzgebirge/Germany. The first hints are the omnipresent graphite crystals in many minerals (beryl, cassiterite, quartz, topaz, Zinnwaldite), which were overlooked in the past. Another essential hint was the wrongly interpreted occurrence of hydrogen in the fluid phase of melt inclusions in pegmatite quartz from Ehrenfriedersdorf [10]. With Raman spectroscopy, we determined XCO2 = 0.160 ± 0.040; XCH4 = 0.260 ± 0.080, and XH2 = 0.580 ± 0.050. Another proof came from a new fluid inclusion type in so-called hydrothermal-grown beryl, grown from supercritical fluid [5]. The vapor phase is entirely composed of methane.

As we see in Figure 2, there is a shift of the main Raman line from 1333.5 cm-1 to 1319.4 cm-1. Because no 13C-rich carbon is used, the shift is the result of the insertion of Si-Si [11]. Free silicon carbide (SiC) is a scarce component of the grey cast iron and of controversial origin; however, it is a minor component in the boron. Orthorhombic iron carbide (Fe3C) has two broad bands at 1342 and 1580 cm-1 [12]. Orthorhombic (Pnma) cohenite (Fe3C), as a natural analog, is tin- white and opaque metallic, and has only Raman bands in the low frequency range (RRUFF database, see Lafuente (2016) [13].

Figure 2: Raman spectrum of diamond spheres (Figure 1) dissolved (using hydrochloric acid) out of the grey cast iron.

In addition to diamond, many small spherical crystals of α-rhombohedral boron are present. Besides the spherical boron crystals, they are also flat, rectangular plates. These plates are completely colorless, and the spherical crystals are too.

Figure 3a: Crystals, most of them spherical, of α-rhombohedral boron dissolved out of ductile cast iron and placed on a microscope slide. The spheres in the background are also boron, sometimes diamonds, and borcarbides.

That diagram (Figure 3b) shows clearly that boron oxide would most probably not exist in a molten metal that contains C and Si, and certainly not in Mg-treated ductile iron. If nitrogen is dissolved in such a melt, boron nitride would appear only in the absence of Ti and Zr. As Mg-treatment removes nitrogen from a ductile iron melt, boron nitride would most likely not occur. Boron carbide is well known as a tool to improve the strength and hardness of certain steel qualities, and its existence is slightly preferred in comparison to iron carbide [14]. But Iron carbide is effectively avoided by reasonable Si levels above 1,5%. The sample discussed had a Si-content of 2,7% and was free of iron carbide. Thus, silicon avoids the appearance of Fe3(C, B)-carbides as well as Fe2B phases; consequently, the small amount of boron included ends up as separate boron- and boron carbide microphases within the matrix.

Figure 3b: A view on the free energy of various well-known metallurgy, oxides, nitrides, and carbides.

Table 1 shows the results of the α-boron extracted from grey cast iron. The colorless spheres of boron have a diameter of 2 µm (Table 1 and Figure 4).

Figure 4: Raman spectrum of α-rhombohedral boron (from Figure 3), contaminated by β-rhombohedral boron and boron carbide, shown by the strong and broad Raman band (A1g + Eg) at 1093.7 cm-1, typical for the β-rhombohedral boron [15] and the main peak of boron carbide around 1100 cm-1 [16].

Table 1: Measured important Raman lines of α-boron extracted from ductile cast iron (Thomas et al., 2025) [9] using the Raman line 532 nm, (the modes are according to Werheit et al., 2010) [15].

α-Boron

[cm-1] Mode n

Werheit et al. (2010) [cm-1]

First order

553.6

  3 552
  575.2 ± 1.50 Eg 14

589

 

591

Eg 1 589
  771.5 Eg 1

778

 

795.4 ± 1.99

A1g 11 795
  938.6 A1g 1

934

 

1096.2 ± 5.35

  15 1094

Second order

1403.2   5

1409

 

1583.6

  3 1582
  1708.1   3

1710

E. Weintraub [17] first prepared pure elementary boron in 1909- 1911 after a lot of misunderstanding. According to Oganov (2010) [18], most of the discoveries related to pure boron were done in two “waves” – 1957–1965 and 2001–2009. Boron has been found in star dust and meteorites, but does not exist in the high-oxygen environment of the Earth. That is the state today. We will show that α- and β-Boron, together with boron carbides, can be found not only in meteorites but also in Earth’s material, which has significant importance and is the first observation ever. The rare appearance in different samples documents the strong reducing conditions of the supercritical fluid or melt (Figure 5).

Figure 5: Schematic phase diagram of boron from Organov et al. (2009, 2010) [18-19]. The γ-B28 and α-Ga types are special high-pressure phases, which are not crucial in our viewing and are not important here. α, β, and δ stand for α-, β-, δ-boron; and L for liquid or molten boron.

Besides diamond and boron, there are a couple of minerals that demonstrate a connection between the Earth’s mantle and crust via supercritical fluid and/or melts. Because we find such minerals first and foremost in pegmatites and related mineralisations, we will summarize here the data.

Natural Occurrence of Boron in Pegmatites and Related Mineralization

Up to now, boron in nature is not present. Only a lot of boron complexes and straightforward compounds are well known (e.g., boric acid, tourmaline). To form boron, strong reducing conditions are necessary. Astonishing is the occurrence of boron as smooth spherical inclusions in some minerals (cassiterite, quartz, topaz, Zinnwaldite) of the Variscan Erzgebirge, similar to the boron in the ductile cast iron. Such spherical crystals occur in different minerals in Ehrenfriedersdorf, Sadisdorf, Zinnwald, here also in the mineral Zinnwaldite. Of course, the boron is mainly a mixture of boron, boron carbide, and other minor phases, making the identification very difficult. Also, the reverse case is possible: traces of boron in diamond from Zinnwald. In Figure 6, such an ellipsoid-shaped boron crystal in cassiterite (found in 2023) from Ehrenfriedersdorf (Sn-58) from Magdalena vein, second gangway (Mining Academy Freiberg, No. 11814) is shown.

Figure 6: Spheroid of Boron in cassiterite from Ehrenfriedersdorf (Sample: Sn-58).

The Raman spectrum is depicted in Figure 7. The main line at 478 cm-1 corresponds to A1g + Eg of β-rhombohedral boron; also, the bands at 630 (A1g) and 773 cm-1 . The median strong band at 1106 cm-1 is, according to Werheit et al. (2010) [15], from β-rhombohedral boron with about 0.11 at% carbon. The 1082 cm-1 Raman band, according to Roma et al. (2022) [16], is attributed to the boron carbide. The classification by the mixture of different B-phases according to Roma alone is not possible, especially since traces of boron carbides and β-Si3N4 can be present [20].

Figure 7: Raman spectrum of the boron crystal shown in Figure 6. The strong line 478 cm-1 is from the β-rhombohedral boron [15].

Besides the spherical shape, there are also black whisker-like crystals in α-quartz from Zinnwald present (Figure 8). If the crystals are thin enough, the needles are transparent with a yellow shade. Often we observe beside boron diamonds. The largest diamond crystal, beside a large boron crystal, has a diameter of 20 µm. In the α-quartz crystal, there are zones with hundreds of diamond and boron whiskers (Figures 8 and 9).

Figure 8: α-rhombohedral boron crystal needle in α-quartz from Zinnwald beside a diamond whisker (DW). The black part in Figure 8 is a graphite aggregate, containing boron, indicated by a strong line at 781.4 cm-1 (in Werheit et al., 2010 [15] the 778 cm-1 line).

The α-quartz crystal from Zinnwald contains a lot of whisker or needle-like α-boron crystals, which include constant small amounts of β-Boron. Particularly, the ends of those boron needles show a strong Raman band at 456 cm-1 (A1g + Eg) characteristically for β-rhombohedral Boron [15]. In Table 2 are the measured Raman bands of natural α- and β-Boron summarized. Because the small needles are in quartz, the Raman measurements in the low-frequency range are difficult due to the strong quartz band (at 464 cm-1). The tetragonal metastable d- and e-Boron was not found up to now (Table 2).

Figure 9: Raman spectrum of the boron needle in Figure 8. The bands at 694, 800, (1088), 1160, 2238 cm-1 are, according to Werheit et al. (2010) [15], typical for α-rhombohedral boron.

Table 2: Measured important Raman lines of α- and β-boron (532 nm laser), modes according to Werheit et al. (2010) [15].

α-Boron

[cm-1] Mode n

Werheit et al. (2010) [15] [cm-1]

First order

693.9 ± 0.81

A1g 11 694
  747.0 ± 0.24   5

750

 

774.8 ± 6.68

Eg 5 778
  799.8 ± 1.05 A1g 10

795

 

870.9 ± 2.63

Eg 10 873
  1159.4 ± 0.90   11

1160

Second order

1244.9 ± 5.20

  7 1238
  1579.6 ± 2.20   10

1582

β-Boron        
First order

219.0

  1 219
  282.0   1

282

 

305.0 ± 1.65

  5 309
  459.9 ± 2.62 A1g + Eg 6

456

 

480.6

  1 480
  689.0 ± 3.20   5

685

Those remarks on boron should be enough to show the strong reducing conditions during the interaction of supercritical fluids with the Variscan mineralization. If we use the pressure-temperature diagram for SiO2 polymorphs from Frondel (1962) [21] and use the results from Zinnwald quartz [22], the coexistence of α-quartz with coesite results in a more or less exact temperature value of 1300°C and a pressure of nearly 3,4 GPa. Such values are realistic for supercritical fluid if they meet the crustal granitic rocks. However, these values are too low according to the experimentally determined equilibrium curve for diamond-graphite [23] (Figure 10).

Figure 10: A mesh of diamond and boron whiskers in pegmatite quartz from Zinnwald. The black dot in the middle of the left side is also a diamond containing remnants of α- and β-boron [22].

Poofs for the Deep Origin of Water as a Supercritical Fluid or Melt

In this chapter, we will summarize proofs found by the first author in recent years showing the influence of supercritical fluids or melts as carriers of high-pressure and high-temperature minerals. Or, in reverse, the high-pressure and high-temperature minerals, mostly spherical, in Variscan pegmatites, granite, and other mineralizations, demonstrate clearly that the input of supercritical fluids or melts has a significant influence on these mineralizations. That story is obvious. However, the formation of diamond and boron whiskers in quartz and moissanite whiskers in beryl crystals raises some questions: What is the mechanism of the formation of such whisker-like crystals far away from the experimentally determined equilibrium conditions? Is the formation of such exceptional crystals the result of catalytic action? Which catalyst is working? Table 3 shows some mineral phases in minerals of deposits in the Variscan Erzgebirge/Germany. These are generally minerals formed at high pressures and high temperatures, and not at the place of mineralization. The whiskers of diamond, moissanite, and boron are obviously crystallized at the place of mineralization in the crustal region.

Table 3: Mineral phases in pegmatites determined with Raman spectroscopy that demonstrate the foreign (deep) origin (selection from more cases).

Mineral

Mineral host Deposit

References

Diamond, Lonsdalite Quartz, Topas, Fluorite,Cassiterite, Zinnwaldite Ehrenfridersdorf, Greifensteingranite, Annaberg granite, Sadisdorf, Zinnwald granite and pegmatite Thomas (2025) – [20] and references in this.

Thomas and Trinkler, 2024 [24], Thomas et al., 2023a [5]

Boron Quartz Zinnwald This work
Moissanite Beryl Ehrenfriedersdorf Thomas et al., 2023c [25]
Coesite Quartz, Topaz, Prismantine Ehrenfriedersdorf, Greifenstein granite, Waldheim Thomas (2025) [22], Thomas et al., 2022a [26]
Orthorhombic cassiterite Cassiterite Ehrenfriedersdorf, Krupka, Schlaggenwald Thomas (2023b) [27]
Cristobalite-X-I Topaz Greifenstein granite Thomas et al., 2023 [28]

In this contribution, we have restricted ourselves to examples from the Variscan mineralisations in the German and Czech Erzgebirge. However, we know that in a lot of other pegmatites and granites, diamonds and similar HP and HT minerals are present: Königshain granite and his miarolithic pegmatites, as well as quartz veins in the Lusatian Mts, Bornhom pegmatites [29], Volyn pegmatites [26], pegmatites from the Reinbolt Hills/East Antarctica [25], and many others.

Discussion

Schröcke (1954) [30] has already demonstrated this with his excellent generalized sections of II. gangway of the Prinzler West cross-cut in the Sauberg mine near Ehrenfriedersdorf, where the granite’s water alone cannot form the amount of pegmatite bodies and streaks. We need an extra source of water to bring together minerals (beryl-II, α- and β-boron, boron carbide, diamond, coesite, cristobalite X-I, graphite, silicon carbide, stishovite) as well as CH4, H2 and D2 [5,10,31]. That means at least that the supercritical fluids and melts will feed a large amount of water coming from the mantle regions. The supercritical fluids/melt have a large amount of energy, which can, at the transition to the under critical stage, make the necessary room for pegmatites and vein mineralizations. That means at least a lot of observations in the past are of secondary meaning. At that place, the extreme element enrichment according to Lorentzian- like curves as proof of the meaning of supercritical fluids is foregone, because we have discussed this point enough [32]. Because elemental boron in an oxidized surrounding and high temperatures is not stable, it must form more stable compounds, like boric acid and many other B-bearing minerals. Another critical point is that a large part of boron comes directly from the mantle region.

Appendix: Microscopy, Raman Spectroscopy, and Extraction of Diamond and Boron from the Grey Cast Iron Sample No. 2

Besides a polarization microscope for transmission and reflection (JenaLab Pol), we performed all microscopic and Raman spectroscopic studies with a petrographic polarization microscope (BX 43) with a rotating stage coupled with the EnSpectr Raman spectrometer R532 (Enhanced Spectrometry, Inc., Mountain View, CA, USA) in reflection and transmission. The Raman spectra were recorded in the spectral range of 0–4000 cm-1 using an up-to-50 mW single-mode 532 nm laser, an entrance aperture of 20 µm, a holographic grating of 1800 g/mm, and a spectral resolution of 4 cm-1. Generally, we used an objective lens with a magnification of 100x: the Olympus long-distance LMPLFLN100x objective (Olympus, Tokyo, Japan). The laser power on the sample is adjustable down to 0.02 mW. The Raman band positions were calibrated before and after each series of measurements using the Si band of a semiconductor-grade silicon single-crystal. The run-to- run repeatability of the line position (based on 20 measurements each) is ± 0.3 cm-1 for Si (520.4 ± 0.3 cm-1) and 0.4 cm-1 for diamond (1332.7 cm-1 ± 0.4 cm-1 over the range of 80–2000 cm-1). The FWHM = 4.26 ± 0.42 cm-1. FWHM is the Full-Width at Half Maximum. We also used a water-clear natural diamond crystal (Mining Academy Freiberg: 2453/37 from Brazil) as a diamond reference (for more information, see Thomas et al., 2023) [28]. The zero-point position for the Raman spectroscopic measurements is checked before each measurement campaign. For the identification of mineral phase, we used Hurai et al. (2015), the RRUFF database by Lafuente et al. (2015) [13], and Liu et al. (2024) [12].

Extraction of Diamond and Boron from Grey Cast Iron

To the extraction of diamond and boron from the grey cast iron No. 2 [9], we have, from this sample (15.20 g), in two steps, 1.90 g and 1.60 g dissolved in hydrochloric acid (25%). The first solution was rejected for the removal of the diamond used for the preparation. The second fraction was cleaned with distilled water and concentrated in a trough washer of a petri dish. With a micropipette, a droplet with diamond and boron is placed on a microscope slide to dry. By skillfully placing many sub-micrometer-sized grains of diamond and boron, it was possible to determine the Raman spectra from such small things [33].

Acknowledgment

Many colleagues have provided relevant advice and documentation for the success of this work over the years.

References

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The Mental Healing Function of Artistic Engagement: From the Neuroaesthetic Perspective

DOI: 10.31038/PSYJ.2025734

Abstract

Neuroaesthetics provides a new perspective for exploring the healing process of artistic engagement, including artistic creation and aesthetic appreciation. The engagement in the arts, through regulating the activity pattern of specific brain networks, in addition to achieving immediate emotional release and positive emotional reinforcement, can also promote deep self-integration and construction of meaning. Through neuroplasticity, it can induce long-term improvement in psychological resilience, and thus reveals its multidimensional and multilayered therapeutic essence at the neural level.

Keywords

Artistic engagement, Mental healing function, Neuroaesthetic

In the face of the mental health challenges in contemporary society, artistic engagement is increasingly valued for its potential healing function. However, the underlying neurobiological mechanisms and the transcendent therapeutic logic of this seemingly intuitive experiential phenomenon have yet to be systematically explored. Neuroaesthetics, an emerging interdisciplinary field, is dedicated to investigating the neural underpinnings of aesthetic perception and creation, as well as their emotional and cognitive effects. This field provides a new perspective for exploring the mental healing process of engagement in the arts. It explores the dynamic interaction of key brain networks during engagement in the arts and further systematically argues for its healing process that promotes mental health.

The Neural Mechanism of Artistic Creative Process

Artistic creation is a kind of specialized creation. The Geneplore Model suggests that the general creative process includes two stages whose are Generative process and Exploration process. In the generative process, individuals generate useful components related to creativity and combine them together to form pre-creative structures, and in the exploration process, individuals interpret pre-creative structures, select and verify the generated artistic ideas. The brain network dynamic model illuminates that the neural basis of the creative idea generation and exploration process involves the dynamics of the brain’s default network and executive control network interaction. Here we review recent work on the neural substrates of artistic creativity. A lot of studies demonstrate that the generation of artistic creative ideas involves the separate function of the prefrontal cortex, while the exploration of artistic creative ideas is related to the cooperation of the executive network and the default network. In the generative process, the separate function of the prefrontal cortex is extensive inactivation of the dorsolateral prefrontal cortex (DLPFC), which is responsible for executive control, and activation of the medial prefrontal cortex (MPFC), which is responsible for generating new artistic creative ideas. Activation of the default network contributes to the generation of artistic creative ideas, and the inactivation of the executive control brain region reduces its inhibitory effect on the generation of artistic creative ideas. In the exploration process, the executive network and the default network are cooperated to generate and maintain the internal creative thinking, evaluate and select the generated artistic creative ideas. However, the activation of caudate nucleus, the deactivation of the default mode network and the activation of the limbic network during the artistic creative process indicate that beyond the dual-process highlighted by the Geneplore model there is a higher level of artistic creative integration stage. At this stage, the artist has a peak creative and holistic experience and enters a flow state.

The Neural Process of Aesthetic Pleasure

The aesthetic objects arouse aesthetic pleasure that is specific and intense. The Pleasure-Interest Aesthetic model (PIA) suggests that aesthetic processing is a dual-process including the automatic process for sensory pleasure and the control process for aesthetic interest pleasure. Here we review recent work on the neural substrates of aesthetic pleasure. A large body of studies demonstrates that the orbitofrontal cortex is automatically activated by the objects of aesthetic appreciation. The orbitofrontal cortex which is responsible for automatic emotion regulation and reward processing of pleasure is generally activated in aesthetic activities and it is the neural basis of the automatic processing for sensory pleasure. Different modes of functional connectivity with the striatum support different aspects of aesthetic processing: the release of endogenous dopamine in the caudate nucleus is concentrated in the early aesthetic stage, and then gradually decreases during the in-depth process of aesthetic experience, while the release of endogenous dopamine in the nucleus accumbens gradually increases during the in-depth phase. This is evidence for the PIA model. However, additional brain circuitry is engaged such that the default mode network (DMN) is activated and the lateral prefrontal cortex is deactivated when the aesthetic flow experience occurs, indicating that beyond the dual-process highlighted by the PIA model there is a higher level of aesthetic flow pleasure. The automatic processing for sensory pleasure and the control processing for aesthetic interest pleasure are different from the aesthetic flow pleasure. Aesthetic flow pleasure is not the satisfaction of the needs of the senses, but the high-level pleasure which is liberated from the spirit; it is the experience of the soul gaining strength and courage and it is related to a clear self-consciousness. Therefore, aesthetic flow pleasure is independent of the automatic processing for sensory pleasure and the control processing for aesthetic interest pleasure. The extended PIA model shows that aesthetic pleasure includes three levels of sensory pleasure, aesthetic interest pleasure, and aesthetic flow pleasure. They are generated respectively in three stages of aesthetic appreciation: automatic processing, controlled processing, and integration and sublimation.

The Mental Healing Function of Artistic Engagement

The therapeutic effects of artistic engagement are mainly reflected in the regulation of brain’s ”inhibitory gate” and reinforcement of positive experience. In the process of creation, deactivating the prefrontal executive control center (particularly the DLPFC) during the generative phase can effectively alleviate the excessive rational scrutiny and cognitive inhibition in daily thinking. This neural “release” state provides participants with a safe container to express their inarticulate inner emotion, unstructured thoughts, and even traumatic memories. When these contents are materialized in the form of lines, colors, sounds, movements, or words, they become an intense emotional catharsis. Concurrently, the activation of the medial prefrontal cortex (MPFC) during the creative process, as a core node of the default mode network (DMN), facilitates associations and emotional processing related to the self. On the aesthetic process, automatic processing of sensory pleasure during creation (activation of OFC) and controlled processing of interest pleasure during appreciation provide immediate positive emotional reinforcement and cognitive motivation. This positive reinforcement mechanism can activate brain’s reward pathway and further effectively improve participants’ emotion, suppress negative emotion, and sustainly stimulate their intrinsic motivation to participate in the arts.

Moreover, the deep healing power of participation in the arts comes from the fact that viewing and creating arts works significantly activates the DMN and the integrative functions it supports. In the exploratory stage of the creative process, the DMN is working together with the executive network to evaluate and clarify pre-structural ideas that are emerging from the unconscious. This is a process of conscious integration and making meaning of unconscious content. More importantly, when one is in the integrative stage of the creative process, the significant activation of the DMN and deactivation of certain parts of the executive network reflects that the artist is in a state of flow, which is a strong blockage of external stressors and internal distractions that serve as a powerful psychological buffer to the task. This also reflects, from a neurological perspective, a highly integrated dynamic balance among three large-scale brain networks (the DMN, responsible for internal self-reference and integration, the salience network, responsible for capturing information that is relevant to the self, and the executive network working efficiently under certain goals).At the peak of the aesthetic flow pleasure, a similar pattern is also seen—with the DMN’s dominant activation. Its core lies in the deep integration of inner experiences—the integration of emotions and meanings aroused by the aesthetic object into one’s own life story, system of values, and conception of existence. So, participation in the arts (particularly in the state of flow) induces a DMN-dominant state that achieves profoundly psychologically healing and growing experiences that go beyond the pleasure, by reaching the core of the self in three ways: promoting the deep integration of inner experiences, providing a pressure buffer by inducing self-forgetfulness, and enhancing self-identity and a conception of life’s meaning.

Conclusion

Neuroaesthetics provides a new perspective for exploring the mental healing process of engagement in the arts, including artistic creation and aesthetic appreciation. From the Neuroscience evidences, art participation is in essence a “neuroplastic intervention”. Its long-term therapeutic value lies in that it can gradually reshape brain networks by repeatedly inducing certain patterns of neural activities, and help with building resilience to psychological trauma, improving stress coping abilities, and hence promoting mental health and development in the long run. Future studies are urgently needed to explore how these neural mechanisms translate into clinical efficacy for different clinical populations such as post-traumatic stress disorder, depression and anxiety disorder, and how different art forms differ in or are common to their specific neural activations and inducible plasticity.

Psychological Consultation: A Meeting of Subjects that Takes Place in a Social Context

DOI: 10.31038/PSYJ.2025733

Abstract

We propose here a conceptualisation of the first step in each patient’s clinical journey. To do this, it is necessary to start by focusing on two concepts, the subject, and the care, and then to place consultation within this perimeter by giving it a specific place. This paper wishes to deal with consultation as a clinical process having a general scope: to co-construct a form of care that is useful for the person requesting it and possible for both systems – an ‘orientation’ objective -, and to provide a sample of a possible care experience – an ‘experiential or transformative’ objective.

Keywords

Psychological consultation, Psychotherapy, Psychodiagnosis, Subject, Relationship, Child, Adolescent, Family, Network

Setting Up the Meeting

When the psychotherapist receives a request for care, the theoretical thinking and technical tools he possesses are immersed in his wider humanity and sociality. The encounter with people who express a request for care is therefore not, except in part, an encounter of words and thoughts. First of all, we think of it as a meeting of subjects [1,2] that takes place in a social context [3]. Therefore, how can we set about organising and preparing this meeting? And getting ourselves ready for it… Setting up the first meeting is usually the responsibility of the psychologist/psychotherapist and the Association he/she is a member of, with legal norms and cultural perspectives that delimit, as mentioned, the options but always leave room for his/her – the clinician’s – and their – the Association’s – interpretation. On the other hand, anyone presenting a request for care does so to an interlocutor, a person and/or Association, whom he/she has an affective representation of, and expectations, albeit unsubstantiated, beforehand. We would therefore not be indulging in an ‘industrial’, manualistic vision of care, but its representation as a ‘scientific craft practice’ [4], where singularities are not obstacles but where seriality and repetitiveness are certainly very contained not only as a respectful tribute to the singularities of the protagonists as well as the need to favour the complexification of the request for care as the expression of the complexity of the subjects present, as we shall see better. For the time being, we will limit ourselves to considering that there is someone presenting a request for care and someone who responds, although there are forms of consultation in which this configuration of roles is reversed, and there are contexts of care in which it is not the clinical system that sets the premises of the meeting but the patient or other actors. In order to facilitate understanding, however, it is appropriate to start with the most common form, since we believe that the general model of thinking we propose does not change in the other possible forms. If, therefore, the person presenting the request for care does so not only with words but by presenting himself, and the person who accepts this demand does the same, it is from this point that we should start to ask ourselves how to consider the meeting, and even before that, how to set it up, how to prepare both concretely and symbolically for this meeting. If we were only interested in words, it would be sufficient to set up and proceed with efficient phone calls, but we would be missing the best part of the meeting with the other: the bodies and their reciprocal interaction in the space that is intertwined with words and the para-verbal characters that accompany and qualify them. Anyone working with children knows this particularly well, but it is to be hoped that anyone caring for the older groups should recall this and take it into account. Let us therefore imagine that, because of the possibility that the psychotherapist has of configuring the space and time of the meeting, he can arrange to favour the matching of concrete human subjects, including himself and/or others representing the caregivers. We find it useful, as we have pointed out, to distinguish ab initio between two systems, two ‘relational configurations’ that meet: the clinical one and the one that expresses a request for care. Consultation starts from these two ‘systems’, each of which can be formed by several people or, of course, by just one person in each system. Thus, it may be that the phone call, the e-mail, the knock at the door, finds someone who answers and is not the psychotherapist – who would proceed with the second or third step, the actual clinical meeting – but a secretary, a nurse, a colleague… or it may be the psychotherapist himself. It is important, however, to recall that the consultation begins right there, at this first contact, and that it is already an initial response, an initial form of signification, an initial rebound that the request for care expresses at the moment of its formulation. It refers to ‘reception’, and that is no small matter among humans. It cannot be taken for granted, especially when one brings one’s self, pervaded with fragility, to a meeting with a stranger who receives us in places that are familiar to him. Places and people that are, instead, unfamiliar to the patients. Depending on the organisations, the timing, the number of requests, etc., this first meeting can take on various forms. This is where the consultation starts, at the first meeting of the two systems. Usually the request for care is not formulated in presence, it is generally expressed in a phone call or through a device that ensures distance and a dual dialectic. This forms part of the current constraints of technology, and not only. The caller, however, does not necessarily express the request for himself, or only for himself. He often does so ‘on behalf of’, or ‘with’ someone. We would therefore consider it reductive to delve too deeply into that dual moment at a distance since it could artificially dualise a possible and potentially rich multiplicity. With children and adolescents, this is actually the norm, but it could also be the case later on in the developmental trajectory, if we are the first to give space to this possibility. Our wish and expedient approach is therefore to invite those who feel the need, to express their request for care in presence as soon as possible, together with anyone who feels involved in that request. ‘Anyone who needs to may come’ is the succinct expression that may be expressed at the conclusion of the call. This clinical perspective can of course be integrated, and it is possible to do so in many ways, with existing legal norms that are, as always, expressive of a culture in which clinician and patient coexist. This move may seem risky and, above all, uncertain. Who will come on Monday at 4pm? Maria? Will she be with her son? Or will she come with her husband? And the grandmother who is at home caring for the little one during the day? We believe we should avoid asking questions on the phone about who it is relevant to invite, given the unreliability of the results, due banally to the clinician’s lack of knowledge of his interlocutor, and so we might as well take seriously the fact that up to that moment, and even afterwards, the person who has turned to us with their request knows better than we do what questions to put forward, and who can best interpret them. To do otherwise, if we were to choose, would result in arbitrary randomness on the part of the respondent, however experienced and attentive he may be. One then gradually allocates those present at the session, and requests other presences. To accept a request means initiating a process that can start in many ways, the important thing is that it should start in the most useful of ways. Since the consultation is not a photograph, but a film, and we have indicated above when it begins and we will say when it ends, knowing that it involves a meeting, or a series of meetings, at a place and with times that will be negotiated between the two systems. Different actors may be involved in different interviews, or even within the same interview. We can ask a child’s parents to leave the room for a moment so that we can talk to the child alone, or we can ask the dad who arrived late to come in and participate in the meeting, or to wait a moment in the waiting room. But this will be done in compliance with the situation that emerges based on the evolving relationships. The psychotherapist/clinical system will, however, need prior notification concerning the setting up of the place where the meeting will take place, as well as the proposed space-time of the meeting: a decision will be taken as to whether the psychologist will be alone in welcoming the guests or not, and a proposal will be made as to whom to invite, from the clinical system, to take part in the meeting and when, with whom, and for what purpose. This starting option should, of course, be communicated to the person who makes the phone call, and it is an important element in setting up the meeting we are discussing.

What is the Purpose of Consultation?

At this point we should ask ourselves an important question. What is the purpose of the consultation in the light of the theoretical thinking we started out with? The consultation has two objectives: to co-construct a form of care that is useful for the person requesting it and possible for both systems – an ‘orientation’ objective – and to provide a sample of a possible care experience – an ‘experiential or transformative’ objective. Sometimes a sample tasting may be sufficient, but more often it stimulates the appetite. This is also the case with consultation. It is rare, but it does happen, that a few meetings will expend the need for care, and there are situations where – either because of the significance of the meetings in relation to the quality of the needs, or because of the difficulty of moving forward together – no follow-up is required, or perhaps not with that professional or with that clinical system, or at that time. In most cases, however, the care needs remain intertwined with those provided by the caregivers, introducing a pathway that develops over time. It is our belief that the guiding purpose of the consultation is to jointly identify the best possible way to continue the care process. This is where the consultation ends, and the next therapeutic pathway is initiated, with the same or other actors. We have often used the prefix ‘co’ or ‘con’ – already present, and not by chance, in the word ‘consultation’ – and we believe it is useful to spend a few words on the importance of this prefix. If we have respect and consideration for the subject, we evidently cannot treat him or her as an object, as a thing that is learned, and ‘about’ which one can voice an opinion in terms of therapeutic indications. The clinician does not know the patient or the configuration of persons who present themselves to him, and will not know them fully even at the end of the longest and most accurate psychotherapeutic journey. He will have a representation of them that will be enriched and complexified over time, but this cannot justify decisions ‘about’ him or ‘about’ them. If we have respect and consideration for the subject, it is evident that we cannot treat them as an object, as something that we learn about. Does this mean that he should refrain from proposing, or shy away from proposals that come from the patient’s system? Not at all. It would be disrespectful both to the clinician and his system and to the knowledge that resides in it, and to the patient himself. And there lies the meaning of co-construction. A negotiation process that respectfully brings into play the options and idiosyncrasies of which the two systems are bearers as living systems. The forms the subjects use to place themselves in the consultation relationship constitute their way of being together, and allow us to observe and experience how they are configured in the relationship between the two systems in that specific space and time. At the becoming of the consultation interaction, all participants will experience a partly new relationship to which they will inevitably and appropriately bring their experience of life, be it short or long, and that will also be the case for us clinicians, of course. There is a widespread belief that the initial clinical meetings serve to assess the other, i.e. there is a way of thinking about consultation, which in this case takes on different names – assessment, evaluation, etc. – and which sees it as focusing on the object, the patient – the individual or the family. We cannot disregard the value of this approach, in which attention is given to the person who presents the request for care, but we believe that it needs to be integrated with three other aspects: the plurality of subjects at times constituting the system that presents a request for care – a family for example -, the part of signification that the clinical system performs, and the specificity and singularity of the meeting of those two systems in that context. We shall spend a few words on the latter aspects. In the following paragraphs, we will say something about the former. We should not underestimate that the first meeting is such also for us, and therefore the references we have built up over time in our personal and professional lives are challenged each time by the singularity of the person we meet and of course this cannot be scotomised but, on the contrary, it is the object of specific attention because it is the starting point of our experience of the other, of that other, which will then evolve over time. Furthermore, our interlocutor(s) will engage with us within the meaning they give to that request for care and, therefore, to the system towards which they have addressed this request. It is true, therefore, that in this, too, they will express their way of being, but we must be careful to place this information within that specific relationship and not treat the care context as a neutral, observational place because neutrality is simply not there. If that person or that family were encountered in a research context or in a hospital or at home, they would show partly different aspects in relation to what that meeting means. From another perspective, and using a more traditional language, we can draw attention to the relational aspects of the meeting, and to the central role of the transference/countertransference dynamic, conceived as a deep-rooted weaving of the process between the care system and the patient’s system with all the dual and supra-dual weavings often present, as mentioned earlier, a dynamic that is also present from the outset in the weaving of the consultative meetings.

Subjects and Systems that Meet

We need to present a further theoretical explanation here by adding something to what has already been mentioned: the request for care, we think, is a ‘request for confirmation’, which also implicitly contains an ‘expectation of disconfirmation’. Let us try to explain this better. Our position in the world will always be the result of how we have arrived where we are, applied at all times to an experience that will always be new and old to some extent. By definition, it will therefore always be an opportunity for confirmation and disconfirmation of what we are because we are constituted precisely by the self-definition of what we have learned to be. Our identity. If a subject feels that he is well, he will not formulate a request for psychological help, but also in his other relationships at that or other times in his life, he will tend to read his present experience in the light of what he has learnt from his history, and if he feels that this ‘works’, if he does not perceive unbridgeable discrepancies, what he will experience – and there will always be discrepancies, as we have pointed out – will be stimuli that he will know how to take into account in order to broaden his experiential complexity and his identity. Meetings with small or large disconfirmations will constitute a continuous urge to revise one’s idea of oneself and the world. As far as the initial part of this binomial is concerned, this will constitute what one of the authors has called elsewhere ‘self-learning’ [5,6]. If he formulates a request for care, he will be the bearer of experiences of discontinuity that he is unable to integrate into his identity, i.e. into his ‘definition of self’. This is typically the symptom. It seems to us that this is also the case in the medical sphere, and there is nothing strange about this because we are talking as a unit about a subject whose biological part functions according to general principles that also apply to the ‘mental’ part, to use this now obsolete dualistic distinction. What he brings to the scene of the care is, therefore, this wound, this failure, this expectation of confirmation/disconfirmation, which, however, contains information which is very useful for us. Obviously, each subject who presents himself at the scene of care, if and how we allow him to do so, if and how we favour or hinder him in this, will be the bearer of this perspective and what happens in the consultation is the transfer of this perspective into the meeting with the clinical system. If we take an individual, a person, he will bring, he will tend to implement on the clinical scene his way of being and this is exactly the object of psychological diagnosis, as we will see shortly. In the case of children or adolescents, for instance, we are often faced with parents who bring their ‘broken child’ to the consultation: a child or adolescent who needs to be fixed, and in that case, the purpose of the consultation also becomes the ‘signification’ of that experience of rupture within the family functioning. The child’s or adolescent’s discomfort may be a symptom of an uneasiness that goes far beyond the subject himself and may be the expression of the child’s identification with unconscious, painful, traumatised and never processed aspects of the parents. In a way, it is as if parents sometimes ask us to be healed through their children. The weaving of these dynamics highlights the differences present in the ways of being within a family or a couple who present a request for care, and the therapeutic paths that will be the outcome of the consultation can therefore be very varied. These weavings have so far been balanced and that balance is now brought to the consultation meeting where it will receive a stimulus. This is our responsibility. However, it is worth emphasising that the therapist and the clinical system as a whole are affected by this quality of demand. Even the professionals who make up the clinical system are in fact subjects with a personal history which, as we pointed out in the first part of this paper, has been enriched and integrated with knowledge and training experiences; it survives and urges to find in therapy as in life occasions for confirmation, even with that patient, even with that family, even with that couple. Thus, what the encounter with those patients produces in the clinician and in his or her system, will become very interesting not because it is introduced to him/her by the patient, but because it is a personal experiential reflection of what that patient/family/couple produces in him/her as a clinician. It, therefore, becomes very enriching to be able to pause on these lived stimuli right from the consultation because right from the consultation, the density of the internal world of the relational configuration that shares that space-time with us will ask us for complementarity and, therefore, confirmation/disconfirmation. Being present to this feeling means a lot and will help us form a relationship that is also possible for us and implement useful therapeutic options.

Psychodiagnosis: An Ugly Word?

Forming an idea of what we experience is one of the ways that humans put into practice to find order in the chaos of uncertainty. They do this all the time and they also do it in their clinical activity when they are caring professionals. Psychological diagnosis is simply the organisation of this attitude. It is guided by knowledge, by theories, and produced by means of techniques that are sometimes very refined and specific. In many cases they are aimed at placing that specific subject within a population range with regard to certain parameters (e.g. learning or anxiety). Although we understand the social usefulness of this form of diagnosis, it is not to be placed at the centre of the idea of consultation that we propose, since what interests us is to accompany the subject to a contact with his or her specific way of being at that moment, and therefore we are interested in singularity and not its relationship with the general population. This singularity, however, also requires thinking, since it is also on the basis of the thinking – a thinking that feeds on and integrates emotions and actions – that we will construct that subject and we will be able to compare him with himself. The ‘diagnostic’ tools we will be most interested in, or if you like, the use we will preferentially make of diagnostic tools – in a broad sense, from interviews to tests, to the use of play materials, etc. – will thus be oriented by their ‘heuristic’ function, that is, by the capacity they have to facilitate self-expression and an approach to the self on our part and on the part of the subject in the room with us. Diagnosis is, therefore, the progressive focus of a subject’s way of being within a caring relationship and the premise and object of the future caring relationship itself. This ‘way of being’, in its most stable form over time, is expressed by psychologists with the word ‘personality’ and thus personality styles are to be understood as macro-categories that contain the specific forms of that singular subject in the becoming of the relational experience.

More or Less Stable Subjective Configurations

If we widen the field to include the familiar or the proximal world of our subject in care (the couple’s relationship or the one with one’s best friend or mother for example), we will see that in these relationships a complementarity of subjective configurations takes place. The other, we speculate, sufficiently confirms our way of being. It can never be completely so, it would not be a relationship between living beings, but if it were too little we would feel much more threatened than confirmed, or perhaps simply indifferent, and, we believe, we would hardly maintain that relationship. Those who grow up within subjectively important relationships (children, adolescents…) will pursue a continuous learning operation to actively place what they gradually become within that family context and then school, friendship, etc. contexts. Thus, what a family brings to the scene of care is precisely this balance of forms of different ways of being to which each person brings his or her own experience of being there, and what each person will tend to do is implement his or her own affective culture that, if they are with us, presents some discontinuity that he or she feels is not easily integrated. It therefore becomes important and useful to give the subject(s) seeking care a further opportunity among those that life has offered them to get in touch with and relocate the experience by recomposing the fractures, reconnecting the discontinuities, reuniting the internal alterities in a form which is different to what was historically acquired. Here we should add another theoretical piece which once again concerns the theory of the subject and, to some extent, the ethics of care. Our function as therapists is not to restore a functioning closer to the norm (statistical or social), nor to facilitate an adjustment to the demands of the context (social, school, family), but to provide an opportunity for a better self-presence of the subject(s) in our care. We could say that whatever configuration of personality, whatever form the subject has taken on to be in the world deserves respect because it is his, it is what he has succeeded in doing best, and if he is there we can, if he wishes, help him to come to terms with a different outlook that puts him better in touch with what he experiences in his life that, at this moment, constitutes a discontinuity that he cannot manage, digest, integrate. It is this discontinuity – what we read in the experience we live – that today in part seems to be failing and we are unable to evolve because we are anchored to our historical identity; this creates problems for us and leads us to consultation. And it is the consultation that is the start, the taster, the moving towards a better quality of presence to oneself that can be pursued later in therapy and in life. It goes without saying that this non-regulatory view also applies to family configurations, couple configurations, etc., otherwise we would be bringing into care a social orthopaedics and not an application for freedom. Thus today provides a new and unique opportunity, and we, as a clinical system, are part of this opportunity with the function of observer/returner of what the subject or supra-subjective configuration brings into play with us as representative of what is/are in his/her/their world. It is easy to understand, on the basis of what has been reported so far, that what the subjects, whether individuals or within a relational configuration, bring to the scene of the psychological consultation is quite unpredictable before the meeting, and will be further articulated as the meetings proceed, but it will provide us, and provide them, with material to perceive and propose experiences and thoughts about the way of being of the subjects who are there with us, and about the complementarities and discontinuities between them. What happens when we place ourselves in this form of listening, is that each of the actors in the field will be inclined towards the care they are getting a taster of. Therapists included. Another principle that has inspired us and which we propose is that no one who asks for care should be excluded. It is a matter of identifying, together, how to respond to that request, not of choosing who is in need and who is not. Again, that would be presumptuous and disrespectful. The outcome of the consultation is just that. It is to jointly identify the forms that are possible and useful for the different actors on the scene, to start along their own paths of self-presence. Including the clinical system, which is not omnipotently endowed with all skills, but which may have the opportunity to offer suggestions concerning others which are available in the wider system of which it is a part. The awareness that we are part of a welfare system which is itself part of a social system, and a culture, will guide us towards building in advance and maintaining collaborative relationships even outside the clinical system to which we belong, and which, for the aims of the specific situation – that patient, that family – we coordinate. If we go back to the psychological diagnosis, what we propose is thinking that the sectorial and specific diagnostic focuses – the psychological ones relating to functions such as learning or anxiety, but also the medical ones relating to aspects of corporeity such as illness or disability – should be placed within a representation of the ‘relational subject’, who constitutes the central focus of the consultation and who, in many cases, is present in the psychological consultation itself together with other mutually significant subjects, who bring and propose in the here and now of the encounter with that clinical system their forms of existing, thus providing us with material that is as rich and valuable to understand as it is delicate to treat.

Criteria for the Proposal of a Therapeutic Set-up: Feasibility

But what further criteria can we turn to, to think about the subsequent care arrangements to be proposed to our patients? The question is important and loaded. It is a question that guides us, often in implicit forms, in our proposal and that should deserve a better explanation, one that we shall try to present here. The work with children and adolescents and their families, perhaps more than anything else, helps us to consider one variable as central, that is to say, ‘feasibility’. We could say, on the one hand, that the subject is the bearer of a feasibility to profitably take care of himself or, on the other, that this possibility is absent or untraceable at that moment of his life and in his relationship with us. The subject’s autonomy is evidently a key issue: when the other is so relevant in the patient’s daily life, as is usually the case, for instance, with children versus parents, it clearly appears that the space of psychological feasibility that the child can exert is reduced, and this recommends a co-participation in the therapeutic process – in various possible forms – of those persons that are so decisive. Of course, this relevance also relates to the very possibility of participating in a therapeutic process which, if not shared by the reference persons, might not be feasible or even presentable, even as a request for treatment – unless expressed in symptomatic forms, naturally. This criterion, which is evident in childhood and adolescence, is actually present also later on if we think of the feasibility of introducing a third party with therapeutic functions, within a couple or a family, in whatever form this takes place, and of the phantasmatic relevance of this third party in the relational dynamics. It is therefore not a matter of a concrete but a psychological dependence that welds and stabilises the existing by turning the third party into a threat, rather than an opportunity. In the consultation, therefore, it will be necessary to explore the possibilities of developing the therapeutic pathway in one direction rather than another, to reach an outcome that is possible for the clinical system and its interlocutors, and that may not coincide with the arrangement wished for by the clinicians themselves but possible instead, at the moment, for the patients or for some of them.

The Consultative Process and Consultation as a Permanent Posture

We are now in a better position to understand the consultative process that follows the telephone call, and the start of the in-presence process because the reciprocal positioning of the actors in the field, belonging to the two systems, will lead them to actions that, as far as the clinical system is concerned, will be inspired by the needs we have described, which are to explore experiences that favour forms of approach, of contact with the self. If, therefore, the position we suggest ab initio is one of open acceptance to whoever wishes to be present on the scene of psychological care, and however they wish to do so, as the meetings proceed, but even during the first meeting, the clinician and his or her system can propose and indicate actions of various kinds, thus becoming more active, so to say, on the basis of what they will gradually understand-feel is happening. Consultation is thus configured as a space-time of an exploratory nature that introduces entirely provisional relational arrangements – a listening space for an adolescent, a meeting with the parental couple and/or with each of them, perhaps even with the school class coordinator – providing us and the persons in our care with relational experiences and restitutive glances within that arrangement, but also providing glimpses of possible future more stable configurations. We are, of course, describing highly complex situations, but the possibility of accommodating an individual subject who brings with him a need for care, is well present in the consultation, and where the forms of the therapeutic pathway that are negotiated in the consultation concern aspects of the setting, such as the frequency of the meetings, the timetable, the fee, and little else, issues that are nonetheless present even in the most complex consultations, of course. In adulthood, these kinds of requests for treatment are very frequent and naturally may not require any extension to include other actors in the field, beyond the therapeutic couple, and at times moments of intervision or supervision involving the therapist. However, we should point out that consultation, in addition to being the name we give to the initial phase of the care encounter – as it has thus far been presented – is also a perspective, a posture, which can and, in our opinion, should accompany the clinical system, even in the course of subsequent care, since the needs that the subject or systems in care will bring over time may evolve, and evolutions even of the forms of treatment may be recommended. Having agreed on a specific care and setting following the consultation, it is then possible to deal with the need to introduce changes based on a shared contractuality and its meaning for all participants involved in the process, and thus to assess what to do while keeping in mind the meaning and value of what was previously agreed upon. Nothing is therefore unchanging or permanent, but everything, in psychotherapy, is to be produced in the light of a shared history. Not so in consultation where, instead, the choice of actors, times, forms are characterised by reversibility and explicit experimentation.

The Team as Network

While it is important to safeguard the privacy of the dual relationship, both in the consultation and in the subsequent individual psychotherapeutic treatment, I believe it is useful to consider the importance of a group of colleagues – I use the expression in a broad sense here – with whom one can share both the treatment pathway – I am thinking here of supervision, interviews, team discussions – and any needs for circumscribed counselling or the broadening or redirection of the therapeutic pathway. The individual adult patient also feels and sees if the therapist is inside a system, and how he feels there. He often sees it also from the configuration of the place, from the website, from the snatches of sentences he overhears in the corridors spoken by the colleagues, and once again the microsocial dimension appears, not as an extraneous presence in the dual and private care pathway. This certainly does not mean supporting the indiscriminate sharing of thoughts about patients within the team. Privacy is important for the patient, just as it is for the therapist. The team can therefore be a relatively mute and deaf presence, but can become a speaking presence if needed. This obviously requires prior attention paid to the care systems, which we will not dwell on but which cannot be improvised. Instead, it needs to be planned and maintained over time as an integral part of the clinical system and an indispensable element of its quality.

References

  1. Minolli M (2015) Essere e divenire, la sofferenza dell’individualismo. FrancoAngeli, Milano Trad. eng: New Frontiers of Relational Thinking in Psychoanalysis: A Meta-Theory of Being and Becoming, Routledge, NY, 2021.
  2. Morin E (1983) Il metodo: ordine, disordine, organizzazione. Feltrinelli, Milano, 1994.
  3. Vanni F (2015) La consultazione psicologica con l’adolescente. FrancoAngeli, Milano
  4. Lingiardi V (2018) Diagnosi e destino. Einaudi, Torino.
  5. Vanni F (2023) Presence and Self-learning: an evolutionary hypothesis. In: F. Irtelli, ed., Happiness – Biopsychosocial and Anthropological Perspectives. Intech Open Editore, 2023.
  6. Mc Williams N (2011) Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process, second edition, Guilford Press, NY.

Mindfulness Education Across Age Groups: A Taiwanese Instructor’s Reflections

DOI: 10.31038/PSYJ.2025732

Abstract

This study investigates the experiences of a Taiwanese mindfulness educator in implementing structured mindfulness programs for children, adolescents, and adults with visual impairments. The first author, serving as both teacher and researcher, facilitated 12-week sessions for 22 children, 10-week sessions for 20 adolescents, and 8-week sessions for 16 adults. Following each session, the teacher recorded reflective notes documenting participants’ engagement, questions, feedback, and observable responses. These reflections also included critical evaluations of teaching strategies. The collected records formed the primary dataset for a thematic analysis conducted collaboratively by two researchers. Three central themes emerged: (1) children demonstrated enthusiastic and active participation in mindfulness learning; (2) adolescents exhibited mixed levels of engagement, with some showing commitment and others struggling; and (3) visually impaired adults displayed a range of capacities and challenges in comprehending and practicing mindfulness. The study emphasizes the importance of developmentally responsive and learner-centered instructional design, highlighting intrinsic motivation as a key factor for successful practice in mindfulness. Educators are encouraged to motivate learners and to tailor curricula that align with learners’ psychological and developmental profiles to support meaningful engagement and long-term commitment.

Keywords

Mindfulness, Mindfulness education, Child, Adolescence, Adult

Introduction

Mindfulness, originally rooted in Eastern philosophy and meditative traditions, has evolved significantly through integration with neuroscience and psychology. Since the 1990s, mindfulness- based interventions have gained traction across educational and therapeutic contexts, supported by empirical evidence demonstrating their physical and psychological benefits [1,2]. As interest in mindfulness continues to grow, educators face increasing demands to adapt their teaching approaches for learners across diverse age groups, backgrounds, and motivational profiles. This study examines the instructional experiences of a Taiwanese mindfulness educator working with children, adolescents, and visually impaired adults. The first author, a supervisor in mindfulness-based therapy and education, draws upon over a decade of teaching experience and maintains extensive records of classroom observations and reflective teaching journals. These records inform ongoing pedagogical refinement and curriculum design. The second author, also formally trained in mindfulness, integrates mindfulness principles into their teaching practice and collaborated in the thematic analysis. The aim of this study is to explore the challenges and insights gleaned from the first author’s teaching experiences across developmental stages, with particular attention to learner engagement, instructional strategies, and the role of intrinsic motivation in sustaining mindfulness practice.

Mindfulness

Kabat-Zinn [3] defines mindfulness as “paying attention in a particular way: on purpose, in the present moment, and non- judgmentally.” This practice emphasizes sustained awareness of the present moment through non-reactive observation of bodily sensations, thoughts, and emotions. Core mindfulness techniques include sitting meditation, mindful breathing, body scanning, mindful walking, stretching, and mindful eating. These exercises foster openness, kindness, curiosity, and acceptance, cultivating emotional resilience and balanced decision-making [4]. Mindfulness- based approaches also encourage individuals to enhance appreciation and gratitude in their interactions with others and their surroundings [5]. As such, mindfulness programs are increasingly used to promote well-being and self-regulation. Learner motivation is pivotal to successful mindfulness education. Educators must employ strategies that enhance engagement and encourage consistent practice [6]. When learners understand the rationale for mindfulness training and clarify personal goals, they are more likely to cultivate sustained interest. Shapiro [7] identifies three core motivations for mindfulness engagement: self-regulation, self-liberation, and self-exploration. Clarity of intention can lead to deeper commitment and integration of mindfulness into everyday life.

Literature on Mindfulness-Based Programs in Taiwan

Mindfulness-based programs have seen substantial growth in Taiwan, with their principles and practices applied across diverse populations and institutional contexts. These include children [8], adolescents [9], university students [10,11], adults [12,13], older adults [14], patients [15], and clients receiving psychological services [16,17]. Empirical studies consistently highlight the psychological and cognitive benefits of mindfulness. For instance, Chen and Yu [18] conducted a comprehensive review indicating that mindfulness practice within educational settings effectively supports students’ stress reduction, cognitive functioning, emotional intelligence, and interpersonal skills. Similarly, Chao [19] emphasized the role of mindfulness in improving emotional regulation, reducing habitual reactivity, alleviating anxiety and pain, and promoting psychophysiological balance. Expanding on this evidence, Chen et al. [20] found that short-term mindfulness interventions in Taiwan led to significant improvements in attention, bodily awareness, emotion regulation, self-compassion, and overall quality of life. At the neurobiological level, mindfulness practices have been shown to dampen emotional reactivity and enhance connectivity in brain regions associated with regulation and stability [21].

Programs tailored for children prioritize the cultivation of foundational emotional and physical well-being. These curricula are typically brief and developmentally appropriate, grounding present- moment awareness in everyday experience [22]. Huang noted that children frequently engage with mindfulness in spontaneous and intuitive ways, yielding insightful shifts in self- and social awareness. The adolescent years, characterized by intense physical and psychological transitions, often involve curiosity, confusion, and emotional vulnerability [23]. Adolescents may demonstrate resistance toward authority and a heightened focus on self-concept [24]. In this context, mindfulness serves as a stabilizing tool. McGeechan et al. [25] implemented mindfulness programs with adolescents facing emotional and academic challenges, reporting improvements in concentration, stress management, and family dynamics. Other studies underscore the practice’s positive influence on adolescent well- being, emotional regulation, and self-esteem [26,27].

In higher education, mindfulness is increasingly embedded within course curricula. For example, Chiang documented that university students participating in a mindfulness-integrated psychology course reported enhanced self-awareness, present-moment focus, and emotional acceptance. Among middle-aged and older adult populations, mindfulness training has facilitated improvements in emotional management, interpersonal relationships, and appreciation of daily life. Nevertheless, these groups also encountered challenges in practice. Yu and Chen found that effective program design for older adults necessitated adjustments in class duration, group size, and pacing to accommodate physical and cognitive needs.

Mindfulness Education for Children, Adolescents, and Adults

The first author of this study is a university professor and licensed clinical psychologist, certified as a mindfulness supervisor. With extensive experience in promoting mindfulness education across Taiwan, they have worked in diverse educational and community settings—including elementary schools, universities, community groups, nonprofit organizations, social welfare agencies, community colleges, and correctional institutions. The second author is also a university professor and practicing counseling psychologist, specializing in the professional development of undergraduate and graduate counseling students, with an emphasis on mindfulness- based approaches. Drawing upon years of practical experience, the first author primarily utilizes standardized curricula rooted in Mindfulness-Based Cognitive Therapy (MBCT). The second author integrates mindfulness principles into academic instruction, particularly within courses focused on counseling theories, applied practices, and school guidance. Between 2020 and 2022, the first author implemented three distinct mindfulness programs tailored to the developmental needs of different age groups: the Paws b curriculum for children (2020), the Dot b curriculum for adolescents (2021), and the MBCT curriculum for adults (2022). The Paws b and Dot b programs, developed by a UK-based consortium of educators, mindfulness practitioners, and researchers, are widely recognized for their age-appropriate design and evidence-based methodology. The MBCT curriculum, originally formulated by Segal, Williams, and Teasdale [28], is broadly employed in clinical and educational contexts. While each program was adapted for its respective audience, all shared core objectives: fostering participants’ attentional control, present- moment awareness, emotional regulation, self-management, and interpersonal competence. These goals reflect a commitment to the holistic development of learners through structured, developmentally sensitive mindfulness instruction.

Method

Participants and Program Implementation

The mindfulness programs were implemented across three distinct groups in northern Taiwan. The first author conducted a mindfulness program during homeroom periods with 22 third- and fourth-grade students (ages 9–10). A homeroom teacher supported classroom management throughout the sessions. The program consisted of 12 weekly sessions, each lasting 30 minutes, delivered over 12 consecutive weeks. Another mindfulness program was offered to 20 high school students (approximately age 17) as part of an elective curriculum. The program comprised 10 weekly sessions of 90 minutes each, spanning a 10-week period. Finally, the first author facilitated a mindfulness program at a community institution serving visually impaired adults. Sixteen participants, aged 20 to 60, received one introductory session followed by eight weekly sessions of 120 minutes, totaling nine weeks.

Researchers

The first author is a university professor and licensed clinical psychologist with over a decade of experience in mindfulness-based therapy and education. As a certified mindfulness supervisor, she has facilitated numerous workshops and programs across Taiwan, working with children, adolescents, and adults in both school and community settings. The second author, also a university professor and counseling psychologist, completed four months of formal mindfulness training and regularly integrates mindfulness principles into her academic instruction and personal practice. Both researchers are committed to advancing mindfulness-based education and recognize its potential to foster physical, emotional, and social well-being.

Data Collection

Before the programs commenced, participants were informed of the structure, procedures, and purpose of the study. They were notified that an anonymous satisfaction survey and feedback form would be distributed prior to the final session. Participation in these instruments was voluntary. Additionally, the instructor explained that she would document classroom observations after each session, focusing on instructional strategies and learner responses. All observational data were anonymized, and informed consent was obtained from each participant prior to the first session.

Following every session, the instructor composed detailed observational notes and reflective journal entries, recording participants’ engagement, feedback, and learning progression. She also critically evaluated her own pedagogical approaches. These anonymized reflections constituted the primary dataset for analysis. Supplementary data included survey responses and written feedback forms. Ethical protocols—such as informed consent, confidentiality, and data protection—were strictly followed.

Data Analysis and Validation

Qualitative data were analyzed using Braun and Clarke’s [29] reflexive thematic analysis. The process involved six stages: (1) familiarization with the data, (2) generation of initial codes, (3) theme construction, (4) theme revision, (5) theme definition and naming, and (6) report writing. The researchers engaged in repeated readings of the data, annotating emergent ideas, emotional tones, and thematic patterns. Semantic and latent content were coded and grouped into preliminary themes and subthemes. These were organized into an initial thematic map and refined through iterative review, with irrelevant codes eliminated or reassigned. Final themes were defined with attention to internal consistency and inter-theme relationships. To ensure methodological rigor, the analysis adhered to qualitative research criteria including credibility, coherence, persuasiveness, reflexivity, practical relevance, and verifiability. The reporting prioritized clarity and logical structure, avoiding redundancy while maintaining fidelity to participants’ perspectives.

Results

Three major themes emerged from the data analysis: (1) children demonstrated enthusiastic and active participation in mindfulness learning; (2) adolescents exhibited mixed levels of engagement, with some showing commitment and others struggling; and (3) visually impaired adults displayed a range of capacities and challenges in comprehending and practicing mindfulness. Overall, the participants’ openness and receptivity varied across developmental stages.

Enthusiastic and Active Participation Among Children

Elementary school participants showed high levels of enthusiasm, focus, and engagement with mindfulness practices. Activities were perceived as novel and enjoyable, prompting the student participants to experiment with new behaviors and cultivate present-moment awareness. The instructor’s guidance, combined with the supportive presence of the homeroom teacher, contributed to a safe and relaxed learning atmosphere conducive to participation.

Children expressed positive emotional responses and identified concrete benefits from mindfulness practices. Sample reflections included:

  • “When I’m upset, I do mindful breathing, and then I calm down and can go back to doing my ”
  • “The activities are I feel great during the practice, and I’m learning to concentrate.”
  • “I look forward to the mindfulness teacher coming more My grades are getting better, and I feel happier.”
  • “Mindfulness is interesting and always feels I want to keep practicing it regularly.”

The instructor observed that a conducive learning environment for children includes ample physical space and active homeroom teacher involvement to facilitate attentiveness and emotional safety.

Mixed Engagement Among Adolescents

High school participants responded to the mindfulness curriculum with varying levels of interest and engagement. Approximately one- quarter to one-third of the students demonstrated a clear willingness to participate. These students understood core mindfulness concepts, actively contributed to classroom discussions, and offered thoughtful reflections on how practices influenced their daily lives. For example:

  • “Mindful breathing helps me calm down before I give a speech or take an ”
  • “[The mindfulness practice reminds me to] pause when I argue with my family ”

In contrast, the majority of students appeared disengaged and exhibited signs of impatience throughout the session. Many reported difficulties with sustained attention and present-moment awareness. Their feedback commonly reflected experiences such as boredom, distraction, and mental fatigue. Typical responses included remarks such as: “The activity felt dull,” “It was boring,” “I was easily distracted,” “I couldn’t focus on the task,” “My mind kept drifting,” “I felt sleepy,” and “I wasn’t sure what I was supposed to be doing.” These reactions suggested low motivation and limited understanding of mindfulness principles and practices. The instructor noted that many students exhibited difficulty in recognizing or articulating their internal experiences, indicating a developmental need for clearer instruction and contextual relevance.

Diverse Comprehension and Engagement Among Visually Impaired Adults

The adult group, comprised of visually impaired individuals recruited through a social welfare institution, presented a heterogeneous profile in terms of psychological vulnerability and openness to mindfulness training. Approximately half of the participants approached the practice with openness and gradually developed awareness of mood fluctuations and concentration challenges. They practiced techniques such as mindful breathing, walking, and eating, which they found effective for stress reduction and emotional regulation. However, the remaining participants faced notable challenges in understanding key concepts. Many expressed boredom or perceived practices—such as body scans or stretching— as irrelevant to their lived experiences. Entrenched cognitive and emotional patterns, including persistent negative thoughts about their impairment and life circumstances, contributed to disengagement. Mental fragmentation and emotional turbulence further hindered their ability to focus and cultivate present-moment awareness. Some participants misunderstood mindfulness as a method for suppressing thoughts or achieving relaxation alone. They struggled with accepting and observing their internal experiences, making it difficult to apply mindfulness principles in meaningful ways.

Discussion

The participants who demonstrated a willingness to engage with mindfulness practices experienced mindfulness as a novel and enriching approach to self-awareness, emotional regulation, and present-moment attention. The findings of this study reinforce the notion that mindfulness training may reduce reactivity to negative emotional stimuli, foster emotional regulation, and improve psychological well-being and emotional stability. These results align with prior evidence suggesting that mindfulness can help individuals recognize and regulate emotions, relieve anxiety and physical discomfort, and improve psychophysiological balance. Echoing Chiang’s findings, the integration of mindfulness into educational settings appears to enhance learners’ mindfulness-related awareness and application. Moreover, these results are consistent with Chen et al., who reported that short-term mindfulness interventions improved attention, bodily awareness, and emotion regulation while reducing psychological symptoms. This study also supports Yu and Chen’s assertion that classroom environments and instructional pacing must be appropriately adjusted to accommodate the physical and psychological needs of participants. Children in this study demonstrated sincerity, openness, curiosity, and eagerness to engage with novel experiences—qualities that foster mindfulness learning through authentic awareness. These dispositions supported active engagement and self-application of mindfulness practices. As Huang noted, children often make spontaneous discoveries about themselves and their surroundings through mindfulness, expressed through candid and unfiltered reflections. The present study underscores that childhood may be a particularly sensitive and promising period for introducing mindfulness education, given children’s intrinsic motivation, adaptability, and receptiveness to experiential learning.

By contrast, adolescent participants revealed more complex responses. While approximately one-third reported benefits such as emotional regulation and stress relief, the majority appeared disengaged or resistant. This ambivalence likely reflects the developmental transitions of adolescence, characterized by psychological turbulence, identity formation, and emotional volatility. Consistent with Lawlor and Zenner et al., mindfulness has the potential to support adolescents’ self-regulation and stress coping; however, resistance among participants suggests that traditional formats may not fully align with adolescents’ developmental needs or motivational styles. Adolescents’ reluctance may be rooted in a tendency toward defiance or egocentrism. To increase engagement, mindfulness educators must consider strategies that are both developmentally appropriate and contextually relevant—such as curricula grounded in adolescent experiences and interests. Additionally, the active presence of homeroom teachers may enhance classroom management and contribute to a supportive learning atmosphere conducive to focused practice.

The adult participants with visual impairments presented significant diversity in both motivation and comprehension. Their enrollment, which was not entirely voluntary, may have influenced initial levels of engagement. While half of the participants gradually cultivated self-awareness and benefitted from mindfulness exercises (e.g., breathing, walking, eating), the other half struggled to grasp core concepts and exhibited skepticism or disinterest. For some, entrenched cognitive and emotional patterns related to disability and adversity limited their capacity to connect with mindfulness instruction. Misunderstandings—such as equating mindfulness solely with relaxation or thought suppression—further impeded their practice. These findings underscore the crucial role of learner motivation, particularly in vulnerable populations. As Lin emphasized, motivation is a pivotal determinant of learning success. Educators must therefore proactively foster motivation by helping learners understand the purpose and benefits of mindfulness, and by designing accessible and psychologically attuned curricula. For visually impaired adults, long- term, structured mindfulness education tailored to their unique needs may be essential to achieving meaningful engagement and outcomes [30-32].

Implications and Conclusions

This study underscores the importance of aligning mindfulness education with the developmental characteristics of children, adolescents, and adults. Educators should tailor program duration, instructional pacing, and content complexity to meet the cognitive and emotional capacities of each group. For example, children benefit from shorter sessions and activity-based approaches that support attentional focus and engagement. Adolescent programs should emphasize the relevance of mindfulness to everyday life and progressively integrate more advanced techniques to sustain interest and deepen reflection. Across all age groups, the learning environment should be psychologically safe, physically comfortable, and responsive to learners’ developmental needs.

Furthermore, efforts should be directed toward localizing Western-developed mindfulness curricula to better reflect the cultural and contextual realities of Taiwanese learners. Adapting core principles to suit local educational, psychological, and social frameworks will increase the accessibility and resonance of mindfulness instruction. For learners exhibiting low motivation or cognitive challenges, instructors must simplify abstract concepts into concrete, meaningful experiences that facilitate gradual engagement and practice. Ongoing refinement of curriculum design and pedagogical strategies is critical to ensure the effectiveness and inclusivity of mindfulness education. By continuously evaluating and improving instructional methods, educators can better address diverse learner profiles and foster the emotional and cognitive well-being of participants across developmental stages.

Author Note

The authors have no relevant financial or non-financial interests to disclose. Yi-Hsing Claire Chiu is a licensed clinical psychologist, and an assistant professor, Hsuan Chuang University, Taiwan. Yii-nii Lin is a licensed counseling psychologist and a professor, National Tsing Hua University, Taiwan.

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On the Structure of Continental Boundaries

DOI: 10.31038/GEMS.2025744

Abstract

We show the loss of land ice mass is determined not by global warming but by seismic activity and thus neither supports nor rebuts global warming theories.

Keywords

Loss of land ice mass

Recent article claims that land ice loss has been reversed and so might be global warming. Figures 1, 3 show that the distribution of land ice loss in Greenland and Antarctica mimics the distribution of coastal seismic activity, strongly suggesting that the primary factor aecting land ice loss is not temperature but the coastal seismic activity. As Figure ?? shows, the Arctic sinkholes of the past 30 years appeared almost antipodal to the centers of Antarctic ice loss. Specially, the largest loss of ice mass in Antarctica occurs in and close to Amundsen Sea sector, almost antipodal to Taymyr, Kara Sea, and Novaya Zemlya.

Figure 1: Map A shows GRACE and GRACE-FO observations of Greenland land ice mass change in 2002 2023, according to NASA. MapB shows magnitude ⩾4.0 earth quakes in 60.3°N-84°N, 70°W-10°W in 1997/1/1 2025/6/1. Map A is shown in the projection employed by NASA, while map B is shown in the projection employed by USGS. For the ease of comparison, each map shows the towns of Savissivik, Aasiatt, Nanortalik, Kulusuk, mount Gunnbjorn, points 77°N, 24°W, 82°N, 64°W, 79°N, 66°W, all marked with asterisks, as well as Scorse by Sound. Coastal earthquakes are marked with different colors, while quakes removed from the coast are shown in gray. The regions of large ice loss around Savissivik and Aasiatt and the region between the two towns with somewhat lesser ice loss correspond to earthquakes marked purple. The region of large ice loss around Nanotalik corresponds to earthquakes marked green. The region of large ice loss around Kulusuk, Gannbjorn corresponds to earthquakes marked blue. The region of medium ice loss between points 77°N, 24°W, 82°N, 64°W corresponds to earthquakes marked orange. The region between Scorse by Sound and 77°N, 24°W shows no ice loss, nor does it show any earthquakes. The region between points 82°N, 64°W and 79°N, 66°W shows only small ice loss, and only one earthquake. Map C is a copy of map be showing two largest landslides; the 2017/6/17 landslide was just next to two purple quakes, while the 2023/9/16 one was close to the two quakes marked brown.

Figure 2: MapA shows GRACE and GRACE-FO observations of land ice mass change in Antarctica, according to NASA. Map B shows magnitude⩾4.0 earth-quakes south of 62°S in 1997/1/12025/6/1. Map A is presented in the projection selected by NASA, while map B is presented in the projection selected by USGS. Images C and D are parts of map A placed under the corresponding portions of map B. The largest rate of ice loss is on the Amundsen Sea sector. The second largest rate of ice loss is on the Antarctica Peninsula and Alexander Island 71°S, 70°W, The third largest rate of ice loss in Antarctica is in Queen Mary Land and Wilkes Land. The fourth largest rate of ice loss in Antarctica is CapeAndreyev.MapEshowsmagnitude⩾4.0 earthquakes south of 62°S in 2015/1/12025/6/1. It shows no earthquakes in Queen Mary Land and Wilkes Land, the region has experienced most ice gain in 2021-2023. Map F shows all magnitude ⩾5.3 earthquakes in 19002024 south of 64°S; it reveals that the centers of coastal seismic activity practically coincide with the centers of ice loss.

Figure 3: Map A shows the 2017/6/17 landslide in Nuugaat-siaq, 71.535°N 53.2125°Wand the 2023/9/16 landslide in Dickson Fjord, 72.833°N, 26.95°W from Figure 1-C, marked by diamonds; recently-formed sinkholes in the Gyda, Yamal peninsulas, as well as one in Taymyr peninsula at ≈75.5°N, 108°E, marked by asterisks ⋆; an unusual melting in Auyuittuq NationalPark 67.883°N, 65.017°W in the summer of 2008, marked by a four-point star; the northernmost volcano Beerenberg; and the most powerful earthquake north of 64°N. Map B shows the southernmost volcano Erebus; three most powerful earthquakes south of 60°S; and the regions of ice loss from Figure 3.Map C shows the antipode of Antarctica contour superimposed on the contours of the Arctic.

The two volcanoes are almost antipodal to each other, as are the 1933/11/20 and 1998/3/28 earthquakes. The Amundsen Sea sector of ice loss is almost antipodal to the recently-formed sinkholes Gyda and Yamal peninsulas; as well as the Novaya Zemlya and Severnaya Zemlya archipelagos, which, according to the University of Edinburgh, experienced the largest loss of ice in the Russian Arctic in 20102018. Antarctica Peninsula and Alexander Island 71S, 70W, which showed the second largest rate of ice loss, are almost antipodal to the recently-formed sinkhole in Taymyr. Queen Mary Land and Wilkes Land, which showed the third largest rate of ice loss, is almost antipodal to the 2017/6/17 landslide and Auyuittuq National Park. The fourth largest rate of ice loss in Antarctica is almost antipodal to the 2023/9/16 landslide and the giant oods around 71.08N,26.83W in the Scores by Sound70.5N,25W (Figure 4).

Figure 4: Map A shows magnitude ⩾3.9 earthquakes in 66°N−80°N, 34°E−180°Ein 2003/6/12025/6/1 along with sink-holes discovered after2015/5/1. Map B zooms in on the Taymyr peninsula. Map C shows all nuclear explosions in the region in 1973-1990, there have been no nuclear explosions in the region since. Map C is just a part of Figure3-C. The sink holes in Yamal are within the triangle formed by the 3 earthquakes around it, but the sinkhole in Gyda are not.

However, the sinkholes in Gyda are just north of nuclear explosions shown. The Taymyr sinkhole, it seems to be a harbinger of the earthquakes to hit Taymyr shortly. Prior to 2003/6/1, only two quakes of that magnitude are known to have hit Taymyr, one on 1986/5/19, the other one on 1990/6/9 (Figure 5).

Figure 5: On 2025/5/28, a huge portion of a glacier in the Swiss Alps had broken from the mountainside and crashed onto the village of Blatten at 46.417°N, 7.817°E, shown by an asterisk, approximately 16 km from the epicenter of the 1946/1/25 magnitude 6.2 quake at 46.499°N, 7.644°E, shown by a disk. Although the earthquake struck in 1946, smaller quakes in the region have not stopped until now; e.g. 2016/10/24 46.421°N 7.576°E magnitude 4.4, 2024/6/4 47.085°N 8.796°E magnitude 4.2, etc., not to mention numerous magnitude ⩽4.0 quakes.

WL-QML, almost antipodal to Ban Island and Greenland, not too far from the earthquakes in Figure ??-A. The Taymyr-Kara Sea-Novaya Zemlya region has been also marked by recently formed sinkholes. Figure 3 suggests that the much-larger-than-average loss of ice mass and the appearance of sinkholes are due to subglacial/subperma frost thermal activity most likely caused by seismicity. Figures ??, 1 con rm that the regions of ice loss mimic seismic activity in Antarctica as well as Greenland; the events in Greenland and Ba n Island marked in Figure 3A occurred near the regions of increased seismicity in Figure 1. NASA does not provide any information about ice mass loss along the arctic boundary of Russia, however, Figure 4 suggests that the recently-formed sinkholes are also related to seismic activity. That ice loss, in one form or another, may be caused by quakes, contemporaneous or precedent, is supported by Figure 5 and the 1958/7/10 UTC time (1958/7/9 local time) massive landslide caused by a magnitude 7.8 quake.

Seroprevalence of Brucellosis Among Small Ruminants Around the World: A Systematic Review and Meta-analysis Protocol

DOI: 10.31038/IJVB.2025922

Abstract

Background: Brucellosis remains a significant zoonotic disease affecting livestock globally, especially small ruminants (goats and sheep). The global burden of brucellosis in these animals is underestimated in many regions.

Objective: To estimate the global pooled seroprevalence of brucellosis in small ruminants through a systematic review and meta-analysis.

Methods: Following PRISMA-P guidelines, we will search databases such as PubMed, Scopus, Web of Science, and regional databases from 2000 to 2025. We will include cross-sectional studies reporting seroprevalence in goats or sheep. Random-effects meta-analysis will be used to compute pooled prevalence estimates. Risk of bias will be assessed using a validated critical appraisal tool.

Expected Outcome: This study will provide updated global estimates of brucellosis prevalence in small ruminants and identify geographical and methodological heterogeneity.

Introduction

Brucellosis is a bacterial disease mostly of animals caused by gram negative, facultative intracellular coccobacilli belonging to the genus Brucella [1,2]. Though both animals and man are susceptible to the various species of Brucella, B. melitensis has been reported to be the most pathogenic of all the species to man [3]. The disease affects several species of domestic, wild and marine animals [4]. It is mostly characterized by inflammation of the genital organs and foetal membranes. Abortion, sterility, formation of localized lesions in joints and the lymphatic system are also important features of the disease [5,6].

Brucellosis is recognized as one of the neglected tropical zoonotic diseases with a global public health significance [7]. Although the disease been controlled/eradicated in many industrialized nations, it remains prevalent in parts of Asia [8], South America [9] and Africa [10-12]. Small ruminant production plays an important role in the economic improvement of “poor farmers” and contributes to poverty alleviation [13].

Numerous individual seroprevalence studies have been conducted across diverse geographic settings; however, no recent comprehensive synthesis of global data exists for small ruminants. A systematic review and meta-analysis are essential to evaluate the true burden of the disease, inform policy, and prioritize surveillance and control interventions globally.

Objectives

General Objective

To estimate the pooled global seroprevalence of brucellosis in small ruminants (sheep and goats) from published studies.

Specific Objectives

  1. To assess the seroprevalence distribution by region, diagnostic method, species (sheep vs goats), and time period.
  2. To identify risk factors reported in included studies.
  3. To Identify geographic regions with higher prevalence.
  4. To Explore methodological differences affecting prevalence estimates (test used, sample size, study setting).
  5. To identify gaps in research and propose recommendations for control strategies.

Research Questions and Eligibility Criteria

Research Question (PICO Framework)

  1. Population: Small ruminants (sheep and goats)
  2. Intervention/Exposure: Natural exposure to Brucella spp.
  3. Comparison: Not applicable
  4. Outcome: Seroprevalence of brucellosis

Eligibility Criteria

Inclusion Criteria

  1. Observational studies (cross-sectional, cohort) reporting seroprevalence of brucellosis in sheep/goats.
  2. Peer-reviewed articles published in English or French between 2000 and 2025.
  3. Diagnostic methods: Rose Bengal Test, ELISA, Complement Fixation Test, etc.
  4. Studies reporting seroprevalence of brucellosis in small ruminants.
  5. Cross-sectional or cohort study designs

Exclusion Criteria

  1. Experimental studies, reviews, conference abstracts without full text.
  2. Studies without clearly stated sample size or prevalence.
  3. Studies on animals other than small ruminants or on humans
  4. Case reports, reviews, or editorials.
  5. Studies without seroprevalence data.
  6. Duplicate datasets.

Methods

Protocol and Registration

This protocol follows the PRISMA-P guidelines and will be registered in PROSPERO (International Prospective Register of Systematic Reviews).

Information sources and Search Strategy

Data will be retrieved from electronics and strong Databases: PubMed, Scopus, Web of Science, CAB Abstracts, AJOL, Science Direct, and Google Scholar.

These keywords will be used for searching: “Brucellosis”, “seroprevalence”, “goats”, “sheep”, “small ruminants”, “systematic review”, “meta-analysis”.

MeSH terms and Boolean operators:

(“brucellosis” OR “Brucella melitensis”) AND

(“seroprevalence” OR “prevalence”) AND (“small ruminants” OR “sheep” OR “goats”) AND

(“world” OR “global” OR “Africa” OR “Asia” OR “Europe” OR “America”)

Grey literature from FAO, OIE, WHO reports will be considered. Search strategies will be adapted for each database.

Data Management and Selection Process

All citations will be imported into Mendeley/Zotero.

  1. Two reviewers will independently screen titles and abstracts. Full texts of eligible studies will be assessed. Duplicate records will be removed. Discrepancies will be resolved by a third reviewer.
  2. Selection process illustrated using a PRISMA flow diagram.

Data Extraction

A standardized data collection form will be used to extract:

Author(s), year, country; Animal species (sheep/goat); Sample size; Number of positives; Diagnostic method; Study design; Reported risk factors; Seroprevalence (%) or prevalence (%); Study setting (farm/abattoir/market).

Quality Assessment (Risk of Bias)

Quality will be assessed using a modified Joanna Briggs Institute (JBI) checklist for prevalence studies:

  1. Sampling method, Sample size, Diagnostic test validity, Clear inclusion/exclusion criteria, Confounding factors addressed
  2. A score >70% will be considered high quality. Each study will be evaluated by two reviewers independently.

Data Synthesis and Meta-Analysis

  1. Meta-analysis will be conducted using R (meta and metafor packages).
  2. Pooled seroprevalence calculated using a random-effects model (DerSimonian and Laird method).
  3. Subgroup analyses by continent, species, diagnostic method, countries, and by year intervals (2000–2010, 2011–2020, 2021–2024)
  4. Heterogeneity assessed using I² statistic and Cochran’s Q test.
  5. Publication bias assessed via funnel plot and Egger’s test.

Ethical Considerations and Dissemination

As this study is based on published data, no ethical approval is required. Results will be published in a peer-reviewed journal and presented at relevant international conferences and shared with global health and livestock development agencies.

Timeline

Activity

Duration

Protocol registration (PROSPERO)

2 weeks

Literature search

3 weeks

Screening and selection

2 weeks

Data extraction and quality appraisal

3 weeks

Data analysis and interpretation

3 weeks

Manuscript writing and submission

3 weeks

Limitations

  1. Potential publication bias.
  2. Language restriction to English and French.
  3. Variability in diagnostic methods and study quality.

Expected Outcomes

  1. A pooled global estimate of brucellosis seroprevalence in small ruminants.
  2. Regional and species-specific insights to inform One Health interventions (identification of high-risk regions)
  3. Identification of research gaps for future studies.
  4. Evidence-based insights for Brucella control programs

References

  1. Young EJ (2000) Brucella species. In: Doughlas and Bennett’s Principles and Practice of Infectious Diseases. Mandell GL, Bennett JE, Dolin R (eds) Elsevier Churchill Livingstone, Philadelphia, USA.
  2. Alton GG, Forsyth JRL (2004) Brucella, General Concepts. Medical Microbiology, Fourth edition
  3. OIE (2009) Bovine Brucellosis: Terrestrial Manual. Office International des Epizooties.
  4. Agada CA, Ogugua AJ, Anzaku EJ (2018) Occurrence of brucellosis in small ruminants slaughtered at Lafia Central Abattoir, Nassarawa State, Nigeria. Sokoto J Vet Sci [crossref]
  5. Franco MP, Mulder M, Gilman RH, Smits HL (2007) Human brucellosis. Lancet Infect Dis [crossref]
  6. CDC (2005) Brucellosis. Centers for Disease Control and Prevention.
  7. OIE (2018) Bovine Brucellosis. In: Terrestrial Manual, Chapter 2.4.3. Office International des Epizooties
  8. Sofian M, Aghakhani A, Velayati AA, Banifazl M, Eslamifar A, Ramezani A (2008) Risk factors for human brucellosis in Iran: a case-control study. Int J Infect Dis [crossref]
  9. Dias RA, Gonçalves VSP, Figueiredo VCF (2009) Epidemiological situation of bovine brucellosis in the State of São Paulo, Brazil. Arq Bras Med Vet Zootec
  10. Bronsvoort BM, Koterwas B, Land F, Handel IG, Tucker J, Morgan KL, Tanya VN, Abdoel TH, Smits HL (2009) Comparison of a flow assay for brucellosis antibodies with the reference cELISA test in West African Bos indicus. PLoS One [crossref]
  11. Ogugua AJ, Akinseye OV, Ayoola MC, Stack J, Cadmus SIB (2015) Risk factors associated with brucellosis among slaughtered cattle: Epidemiological insight from two metropolitan abattoirs in Southwestern Nigeria. Asian Pac J Trop Dis [crossref]
  12. Mubanga M, Mfune RL, Kothowa J, Mohamud AS, Chanda C, Mcgiven J, Bumbangi FN, Hang’ombe BM, Godfroid J, Simuunza M, Muma JB (2021) Brucella seroprevalence and associated risk factors in occupationally exposed humans in selected districts of Southern Province, Zambia. Front Public Health [crossref]
  13. Yakubu A, Salako AE, Imumorin IG (2011) Comparative multivariate analysis of biometric traits of West African dwarf and red Sokoto goats. Trop Anim Health Prod [crossref]

Toponym Disputes in Indigenous North America

DOI: 10.31038/GEMS.2025751

 

Toponyms is a general scholarly study of place names as they have been established and disputed over time by different cultural groups and nation states. Culturally based place names can reference small geosites, long ceremonial landscapes based on established trails, and massive geoscapes that are functionally integrated by geology, climate, and human use. Many of these geosites have been celebrated by nations in recent times as national parks and world heritage sites. Multivocality is a term used by the USA federal government to reflect multiple names for places by cultural groups. Sunset Crater in Arizona after ethnographic studies [1] involving multiple Native groups who are now recognizes in a trail sign containing authentic traditional toponyms reflecting ancient connections with this volcano (Figure 1). Surrounding the park are volcanic lands (Figure 2). The park continues to be referred to by its colonial name Sunset Crater and the surrounding lands are called the Flagstaff Volcanic Landscape.

A geosite is best understood in terms of its surrounding topography (geoscape). A new trail sigh provides a map of eight Native toponyms (Figure 2). Only one mountain toponym is allocated to each tribe or pueblo although all peaks in this area have their own Native names and stories. Note the Native toponyms map is imbedded in a larger colonial toponym interpretation where the peaks are named after one Spanish and three English colonial explorers, and the area is called by the Spanish colonial name, the San Franciso Mountains. Figure 2B illustrates the complexity of modern toponym renaming and the resulting multivocality.

Figure 1: The multivocality of cultural place names on a trail sign at Sunset Crater National Monument in Arizona (soured Van Vlack 2025) [2].

As they increasingly become more formally defined and celebrated, debates over place names and their meanings have increased, which, now have been more specifically defined by Toponymic Guidelines of the United Nation which have been negotiated by a series of formal committees (United Nations Group of Experts on Geographical Names2018) [3]. The content of Toponymic Guidelines has been developed since 1979 and includes information about official, national and minority languages, names authorities, source material for toponyms, glossaries, abbreviations used on official maps, differentiating text from toponyms on national maps, and administrative regions. At the Ninth Conference (United Nations 2007) [4], it was acknowledged that the format should not be too restrictive; also considered important were having guidelines in more than one language and cooperating with neighboring countries. A toponymic landscape involves the functional interconnections of geosites and geotrails to form a geoscape. The naming of new places during colonial expansion is well documented. For example, in Australia, studies analyze the effects of British settler colonialism on the toponymic landscape of lands traditionally cared for by Indigenous Australian peoples [5]. So, in the Australian research and analysis as of contemporary national efforts to rectify these past colonial changes. Detailed toponymic research has focused on lands where Germans were the first settler colonialists to alienate land in portions of southern Australia, thus dispossessing the Nunga as traditional owners. The encroaching German settlers created a toponymic landscape that reflected their culture and history and the geological characterizes of the new lands where they settled. The German toponymic landscape of settled places was derived from religious sources, from a person’s name, and from the name of their home communities in German.

Figure 2: A Park Trail Sign Identify Nearby Native Toponyms of Volcanic Mountains (Source Van Vlack 2025) [2].

The Cases

This brief, case-based review essay reflects findings from five of our ethnographic studies that have involved Native Americans. Each case illustrated contemporary Toponyms issues involving Native people and Colonial Settlers in North America and disputes over the names of places. Each of these case studies represent but a small segment of a much broader international issue that was largely crated by worldwide human events in the Pre-colonial, Colonial, Post-colonial, and Neocolonial periods which have occurred over the past 500 years. All these cases of Toponym disputes have occurred or are occurring between the Native and Colonial peoples. The cases involve Geosites, Geotrails, and Geoscapes. Findings from all cases are available publicly.

Geosite- Mato Tepe or Devils Tower, Wyoming

Mateo Tepe (Figure 3) is a Native name for a shared sacred geosite composed earth and fire materials. Debate of toponyms is whether it should be the stairs to Heaven as the 23 Native tribes maintain or the steps to Hell as the Devils Tower implies (Stoffie et al 2024). This place name debate immediately when it was mapped by exploring expedition of the USA colonial state and continues to today. Mateo Tepe has been placed on the list of the most important geosites in the World and was nominated as both a geology place and a cultural place [6]. Using both Toponyms, this geosite was awarded a position on the official lists of significant International Commission on Geoheritage Sites.

Figure 3: Mateo Tepe Stairs to Heaven or Steps to Hell?

Devils Tower was declared as the first National Monument because of its geological value, but it is now recognized for its value for Native Americans.

Geotrail – Old Spanish Trail: Native Communities, USA Southwest

The Old Spanish Trail (OST) has been designated as a National Historic Trail by the NSP. An ethnographic study [7] involving Native tribes who traditionally lived along the trail study was funded and thus were impacted by the thousands of animals and people who traveled in large caravans along it from New Mexico to California. All participating tribes disputed the US applied name for the trail which they maintained was a series of traditional Native trails linked for the caravans. The Taos Pueblo was so incensed by the name that they refused to participate in the study even though the events along the OST were key in their history.

Geoscape – Bears Ears, Utah

Presently 32 tribes have expressed cultural connections to Bears Ears (Figure 4) as a geosite and its surrounding geoscape. Each tribe has a name for this place in their own language and their own stories about why it is important. The Hopi refer to it as Hoon’Naqvut, the Navajo call it Shash Jaa,’ the Utes named it Kwiyagatu Nukavachi, and for Zuni it is Ansh An Lashokdiwe. During an ethnographic study that involved nine culturally affiliated tribes, tribal representatives shared their deep time but different kinds of cultural attachments to this geosite and geoscape [2].

Figure 4: Bears Ears is a culturally significant geoscape in southeast Utah.

Geoscape – Iliamna Lake (Nanvarpak, Nila Vena) Native and Local Place Names Alaska)

This is an extended ethnographic and linguistic study of a Native toponyms associated with large lake (Figure 5) (a geosite) and the numerous geosites that constitute its massive integrated surrounding geoscape [8-10]. The research illustrates how difficult it is to both explain and share toponymic information across linguistic and cultural differences. The researcher devoted years to accomplishing this goal which had epistemological, cultural protocols, and privacy challenges.

Figure 5: Iliamna Lake, Biggest Lake in Alaska.

Geoscape – El Malpais National Monument, New Mexico

El Malpais National Monument is an ancient area consisting of two unique geoscapes– lava flows occurring on top of each other forming layers of volcanic fields (Figure 6) and underground lava tunnels (Figure 7). It occurs at the foot of a massive sacred mountain with the colonial name Mount Taylor. The mountain and lava field are active ceremonial areas and considered living due to the rebirth of the Earth.

Figure 6: Volcanic Fields of El Malpais National Monument.

Today the lava flows are managed as a park by the US NPS using the area’s original colonial toponym. El Malpais is a Spanish term for a bad place or bad lands but the many tribes and pueblos who participated in the NPS funded ethnographic study of this lava flow park define it using their own linguistic terms and traditional uses patterns that its cultural importance and spiritual value [11].

Figure 7: One of Many Lava Tunnels in the Monument.

Toponyms Discussion

Many geosite toponym disputes are between Native people whose lands are involved in encroachment of members of the conquering colonial society. Native people today, however, often experience conflict with each other regarding appropriate place terms. This is a situation debate that derives from the western views of property and ownership of places. A finding from our ethnographic studies is that places are culturally layered with different meaning specific to the peoples who have interrelated with each other and the geosite for long periods. For Native people of the Southwest US this is now documented to be about 40,000 years. Deep time and multicultural connections make for complex understandings of places, as our studies have shown. This complexity becomes a key issue when Native people participate as tribal representatives at land management meetings where their desire to apply or preference traditional toponyms face resistant from supporters of colonial toponym meanings.

References

  1. Stoffie, Richard, and Kathleen Van Vlack (2022) Talking with a Volcano: Native American Perspectives on the Eruption of Sunset Crater, Arizona. Land 11.
  2. Van Vlack Kathleen, H Lim, J Yaquinto, J Gazing Wolf, B Eguino-Uribe, et (2025) Monticello BLM Ethnographic Partnership: An Ethnographic Overview and Assessment of the Cedar Mesa and Bears Ears Region. Heritage Lands Collective: Cortez, CO.
  3. United Nations Group of Experts on Geographic Names (2018) Toponymic Guidelines for Map and Other Editors for International Use.
  4. United Nations (2007) Ninth United Nations Conference on the Standardization of Geographical New York. United Nations.
  5. Spennemann DHR (2025) A Disappearing Cultural Landscape: The Heritage of German-Style Land Use and Pug-And-Pine Architecture in Land. 14.
  6. Stoffie R, K Van Vlack V, Semeniuk, M Brocx (2025) Devils Tower, Mateo The Second 100 IUGS Geological Heritage Site. The Second 100 IUGS Geological Heritage Site.
  7. Stoffie R, K Van Vlack R, Toupal S, O’Meara, R Arnold (2008) American Indians and the Old Spanish Tucson, AZ: Bureau of Applied Research in Anthropology, University of Arizona.
  8. Kugo Y (2020) Artic Data: Iliamna Lake (Nanvarpak, Nila Vena) Native and Local Place Names (2016-2019).
  9. Kugo Y (2021) Documenting Yup’ik Place Names with Yoko Kugo. Artic Data Center Blog.
  10. Kugo Y( ed) (2024) Nanvarpagmiut Qanemciit-llu/ Iliamna Lake People and Their Stories: Place Names and Sense of Fairbanks, AK: Alaska Native Language Center, University of Alaska.
  11. Larsson Simon (2025) The Connectedness of People and Geological Features in the El Malpais Lava Flows of New Mexico, USA. Land 14.

Use of Preoperative Low Dose Etomidate Infusion in Severe Ectopic ACTH-Dependent Cushing Syndrome Due to Thymic Carcinoid: A Case Report

DOI: 10.31038/EDMJ.2025941

Abstract

A 51-year-old man with hypertension and diabetes presented with proximal muscle weakness and severe hypokalemia. Hormonal evaluation confirmed ACTH-dependent Cushing’s syndrome, with extremely elevated cortisol levels (>1100 ng/ml), consistent with a severe form of the condition. Imaging and biopsy identified an ectopic ACTH-secreting thymic neuroendocrine tumor (atypical carcinoid) with chromogranin A positivity. Initial medical therapy with fluconazole failed to reduce cortisol levels. To mitigate perioperative risk from hypercortisolemia, a low-dose overnight etomidate infusion was initiated, successfully lowering cortisol levels below 300 ng/dl. Surgical excision of the tumor was then performed. Histology confirmed atypical carcinoid with a Ki-67 index of 7.5%, and evidence of capsular and vascular invasion. Postoperatively, cortisol and ACTH levels dropped significantly, and the patient was started on physiological hydrocortisone replacement. He experienced no complications from cortisol excess and is currently being monitored for disease re-staging. The case underscores etomidate’s value in preoperative cortisol control in severe ectopic Cushing’s syndrome.

Keywords

Ectopic Cushing’s syndrome, Atypical thymic carcinoid, Etomidate, Severe Cushing’s syndrome

Background

Ectopic Cushing’s syndrome is a rare condition that contributes to 10-20% of Adrenocorticotropic Hormone (ACTH)-dependent Cushing’s syndrome cases. Severe Cushing’s syndrome, which is defined when serum cortisol levels are above 1100 ng/ml, is rare in ectopic Cushing’s syndrome and carries higher perioperative and postoperative morbidity and mortality. Distinguishing ectopic Cushing’s syndrome from other causes of Cushing’s syndrome is imperative, as removing the tumor can cure the condition. Normalizing cortisol levels prior to surgical removal is crucial to reduce peri- and postoperative morbidity and mortality.

We present a case of severe ACTH-dependent Cushing’s syndrome due to an ectopic ACTH-secreting atypical thymic carcinoid tumor, which we successfully treated with etomidate pre-operatively, leading to good postoperative outcomes. In environments where intensive care facilities are scarce, high-dependency units (HDUs) may offer a safe and effective alternative for administering low-dose etomidate infusion to manage hypercortisolemia. In this particular case, serum cortisol levels were successfully reduced to approximately 300 nmol/L without inducing cardio-respiratory compromise.

Pre-operative etomidate prior to definitive surgical treatment of thymic carcinoid tumors helps to minimize complications.

Introduction

Hypercortisolism and the range of symptoms associated with it are collectively referred to as Cushing’s syndrome. Exogenous Cushing’s syndrome is the most common type, while endogenous Cushing’s syndrome occurs secondary to excess cortisol, which may be due to ACTH-dependent and ACTH-independent mechanisms. ACTH-dependent causes account for 70–80% of cases, while 20–30% of cases are ACTH-independent. ACTH-dependent Cushing’s syndrome can occur due to pituitary tumors or tumors at ectopic sites, and ACTH-independent Cushing’s syndrome is usually caused by adrenal lesions [1,2].

Ectopic Cushing’s syndrome is a rare condition contributing 5-20% of all Cushing’s syndrome cases and 10-20% of all ACTH-dependent Cushing’s syndrome cases. The commonest sites for ectopic ACTH secretion are the lung, mediastinum, gastro-entero-pancreatic neuroendocrine tumors, or pheochromocytomas, respectively [3].

Severe Cushing’s syndrome is defined by random serum cortisol levels more than 40 μg/dL (1100 nmol/L) at any time or a 24-hour urinary free cortisol more than fourfold the upper limit of normal and/or severe hypokalemia (<3.0 mmol/L). Severe hypercortisolism is associated with a higher risk of infection, septicemia, thromboembolism, and postoperative morbidity compared to mild and moderate Cushing’s syndrome. Thus, reducing hypercortisolism at the time of intervention may benefit these patients. Depending on the lesion site, we can categorize the available treatment options into medical, surgical, and radiotherapy-related treatments. It’s pivotal to differentiate ectopic Cushing’s syndrome from other causes because identification of the ectopic site and surgical removal may completely cure the disease [4].

We present a case report on a 51-year-old Sri Lankan male who was diagnosed with severe ACTH-dependent Cushing’s syndrome secondary to ectopic ACTH-secreting atypical thymic carcinoid tumor. He was successfully treated using low-dose etomidate with minimal postoperative complications. This case report highlights the benefits of preoperative low-dose etomidate treatment, leading to a successful postoperative outcome in managing severe hypercortisolism. Also, in environments where intensive care facilities are scarce, high-dependency units (HDUs) may offer a safe and effective alternative for administering low-dose etomidate infusion to manage hypercortisolemia. In this particular case, serum cortisol levels were successfully reduced to approximately 300 nmol/L without inducing cardio-respiratory compromise.

Case Presentation

A 51-year-old male who is a known patient with well-controlled diabetes mellitus and hypertension presented with the complaint of episodic diarrhea over a 2-week duration and difficulty in standing from a squatting position, suggesting proximal muscle weakness. He also had sinister lower back pain that was persistent throughout the day with the same intensity, with no recent history of trauma. He noted facial flushing and mild facial puffiness along with exertional shortness of breath and excessive tiredness with routine tasks.

He had severe constitutional symptoms, including weight loss of nearly 10 kg over the last 2 months with loss of appetite. The patient denied any recent onset of pigmentation, palpitations, episodic flushing, or wheezing episodes in the recent past. The patient complained of visual and auditory hallucinations with depressive symptoms, episodically over the last two months. There were no visual disturbances, history of dyspeptic symptoms, renal stone disease, or any family history of similar disease to suggest multiple endocrine neoplasia (MEN) syndrome.

On examination, the patient had a BMI of 19.53 kg/m² with an initial blood pressure of 180/100 mmHg. He had flushing involving the face and upper chest with thin skin and subtle nail hyperpigmentation. Overt clinical signs of Cushing’s syndrome, including buffalo hump, purple abdominal striae, or hirsutism, were not seen. The patient exhibited proximal muscle weakness with a power of 3/5 in both the upper and lower limbs, in contrast to distal muscle power, which was 4/5. His mental status examination revealed visual and auditory hallucinations with a moderate degree of depression. Throughout the hospital stay, it was noted that he had poor blood pressure control with evidence of resistant hypertension and poor glycemic control (Table 1).

Table 1: Investigations

White cell count 14.98 × 109
Hemoglobin 11.7 g/dL
Platelet count 238 × 103
Serum sodium 141 mmol/L (136-145)
Serum potassium 2.1 mmol/L (3.5-5.1)
Erythrocyte sedimentation rate 45 mm/1st hour
Aspartate transferase 58 U/L (11-34)
Alanine transaminase 145 U/L (<45)
Total Bilirubin 1.9 mg/dl
Direct Bilirubin 1.0 mg/dl
Alkaline phosphatase 350 mu/L
Gamma-glutamyl transferase 284 mu/L
Albumin 2.1 g/dL
Globulin 2.7 g/dL
9am cortisol (initial) 1220 nmol/l (118.6-618)
9am cortisol (Post fluconazole for 1 week) 1100 nmol/L
Overnight dexamethasone suppression test (ODST) 880.33 nmol/L (≤50)
Low dose dexamethasone suppression test (LDDST) 260.3 nmol/L (≤50)
Cortisol day curve 9am 674.95 nmol/L
11am 1038.61 nmol/L
3pm 760.38 nmol/L
5pm 797.55 nmol/L
Adrenocorticotrophic Hormone (ACTH) level 172 pg/ml (4.7-48.8)—— 81 pg/ml (Post operatively)
Albumin corrected Calcium 8.9 mg/dL (8.6 to 10.3 mg/dL)
Serum Prolactin 203.24 mIU/L (73-412)
Abdominal ultrasound (USS) Normal USS abdomen with no evidence of organomegaly or adrenal lesions.
Contrast-Enhanced Computed Tomography (CECT) chest- abdomen- pelvis Lobulated soft tissue density lesion in the anterior mediastinum measuring 3.3 cm × 4.8 cm × 5 cm.

Lesion shows avid contrast enhancement with internal non-enhancing areas.

No calcifications.

It compresses the left subclavian vein posteriorly, and in-between fat planes are obliterated.

Fat planes between the lesion and SVC are also obliterated.

Enlarged lymph nodes are seen in the right lower paratracheal and upper paratracheal regions.

 

USS guided FNAC of the mediastinal lesion Cellular smears reveal epithelial clusters and single cells with acinar arrangement and sheets.

Nuclei are prominent with fine speckled chromatin with a few enlarged nuclei and eosinophilic cytoplasm.

No admixed lymphocytes or keratin pearls.

Ki67 30%

Suggestive of neuroendocrine carcinoma of the thymus.

Serum Chromogranin A <39 ng/L (Normal- < than 39 ng/l)
Serum 5- HIAA levels 2.1 mg/24 hrs (2-9)
Histology of the thymic gland biopsy specimen (Figure 4) Atypical Carcinoid tumor with lympho-vascular invasion and infiltration of inferior margins and capsule invasion.

All mediastinal and pre-tracheal nodes were positive for tumor invasion. (PT1a pN2 IV B)

Post operative 9am cortisol 358 nmol/L
Post operative ACTH 81 pg/ml
DOTATE-PET imaging Not done due to unavailability
Post-operative short synacthen test Basal 121.50 nmol/L

30 min 233.50 nmol/L

60 min 315.60

After confirming ectopic ACTH-dependent severe Cushing’s syndrome with elevated serum cortisol levels above 1100 ng/dl and non-suppressed ODST and LDDST, we started the patient on oral fluconazole 150 mg twice daily as a steroid synthesis inhibitor. Given the presence of severe hypokalemia, ectopic ACTH syndrome was suspected. As a result, we proceeded directly with a CECT of the chest, abdomen, and pelvis to search for an ectopic tumor, which revealed a thymic lesion in the anterior mediastinum. Severe hypokalemia with serum potassium levels of 2.1 mg/dl was treated with oral and intravenous supplementation of potassium. Even though there was no liver metastasis, the presence of facial flushing and the history of diarrhea prompted us to exclude the possibility of carcinoid syndrome in this patient. USS guided FNAC of the mediastinal lesion confirmed the tumor as a neuroendocrine carcinoid tumor of the thymus, without evidence of carcinoid syndrome, as indicated by non-measurable levels of 5-HIAA and serum Chromogranin A.

Treatment

Thus, the cardiothoracic surgical team’s opinion was taken to embark on surgery. Given the risk of mobilization of the carcinoid tumor to prevent carcinoid crisis, the patient was started on subcutaneous octreotide 50 mg every 6 hours two weeks prior to surgery.

Protocol for Low Dose Etomidate

The patient was started on a low-dose etomidate infusion of 0.05 mg/kg/hr on the day before surgery in an intensive care setup to closely monitor respiratory compromise and hemodynamic instability (Figures 1 and 2).

Figure 1: Serum cortisol levels following low dose etomidate infusion.

Patient’s serum cortisol levels were measured 2 hourly, aiming at a target cortisol level of <300 ng/dl. The etomidate infusion rate was slowly titrated to obtain a cortisol drop of around 100 nmol/l/hr.

Once cortisol levels reached <300 nmol/L, low-dose etomidate infusion was stopped. Within 16 hours of low-dose etomidate infusion, the expected range of cortisol was achieved (Figures 1 and 2).

Figure 2: Blood pressure and oxygen saturation alteration with time.

The patient was operated on through median sternotomy, and an anterior mediastinal mass was removed. The tumor was measured 5 cm x 6 cm x 3 cm and weighed 140 g (Figure 3). Histology of the anterior mediastinal mass was suggestive of atypical carcinoid tumor of the thymic gland with lymphovascular invasion and infiltration of inferior margins and capsule invasion (Figure 4).

Figure 3: Macroscopic appearance of the tumor during surgery.

Outcome and Follow Up

The patient had postoperative symptomatic and biochemical improvement (Table 1). The post-operative cortisol level was 78 nmol/L and ACTH level was 81pg/ml showing partial cure of disease. Despite the partial cure patient did not develop any complications of cortisol excess during the post-operative period including infections or venous thromboembolism. Patient was started on physiological doses of hydrocortisone until the recovery of hypothalamo-pituitary -adrenal axis. (HPA axis). He is awaiting re-imaging for re-staging of the thymic tumor in 6 months with assessment for HPA axis recovery (Figure 3 and 4).

Figure 4: Thymic gland histology : hematoxylin and eosin (x400 magnification).

Discussion

Ectopic ACTH-secreting tumors account for 5 to 10% of cases of ACTH-dependent Cushing’s syndrome, which is commonly caused by thymic, bronchial, gastrointestinal, and pancreatic neuroendocrine tumors. Ectopic ACTH-secreting tumors can be challenging to identify, with up to 19% of cases lacking clear tumor localization. Hypokalemia is an important clue pointing toward ectopic ACTH-secreting tumors. It occurs in 80% of ectopic ACTH-secreting tumors, which is due to the mineralocorticoid action of excess steroids and the decreased 11-hydroxysteroid dehydrogenase type 2 [7].

Carcinoid tumors, which were renamed by the World Health Organization as neuroendocrine tumors in 2000, are derived from enterochromaffin cells. These tumors release biologically active amines and peptides, including serotonin, histamine, and prostaglandins. Carcinoid syndrome is a group of symptoms brought on by the release of biologically active substances. It happens in about 10% of neuroendocrine tumors. Most of these clinical features are due to serotonin, which is an end product of tryptophan metabolism. But the thymic neuroendocrine tumor, which was observed in our patient, is a foregut tumor that lacks the enzyme aromatic L-amino acid decarboxylase, which metabolizes 5-hydroxytryptophan to serotonin [27]. Therefore, they theoretically do not produce serotonin or cause carcinoid syndrome, which was true in view of our patient.

Neuroendocrine tumors of the thymus are rare, accounting for approximately 0.4% of all neuroendocrine tumors [20]. 80% of these tumors are malignant [21]. These tumors are larger in size (median 7.9 cm) compared to thymic carcinoma and are usually present before the advanced stage [22]. According to the 2015 tumor classification by the World Health Organization, NETTs were included in the thymic cancer group. These were classified into well-differentiated neuroendocrine carcinomas (typical and atypical carcinoids) and poorly differentiated ones (small-cell and large-cell neuroendocrine carcinomas) [23]. Atypical carcinoid, which was the diagnosis in our patient, accounts for about 40–50% of NETTs, and middle-aged adults (48–55 years) were commonly affected [24].

Approximately 50% of NETTs were associated with endocrinopathies, including Cushing’s syndrome (ectopic ACTH production) and acromegaly (growth hormone releasing hormone hypersecretion). Multiple endocrine neoplasia-1 was seen in approximately 20% of NETTs [25].

Surgical resection of the tumor removes the source of ectopic ACTH secretion, which is the treatment of choice for ectopic ACTH-secreting tumors. In NETTs, the resectability rate ranged from 28% to 100% in a published single-center case series, but this may depend on the surgical experience in that center [26]. Hypercortisolemia can increase peri- and postoperative complications and mortality in these patients. So, it is important to normalize cortisol levels as early as possible and preoperatively to minimize the adverse effects associated with hypercortisolism, such as increased risk of infection, thromboembolism, etc., which are the main factors that contribute to Cushing’s syndrome mortality [12].

There are several medical options that can be used to control Cushing’s syndrome, including ketoconazole, mitotane, metyrapone, etomidate, and the newer medication osilodrostat. Etomidate, an induction anesthetic, in its lower doses reduced serum cortisol levels by inhibiting 11β-hydroxylase action. 11β-hydroxylase catalyzes cortisol conversion from deoxycortisol, whereas at its higher concentrations, it inhibits the conversion of cholesterol to pregnenolone [13].

The mean rate of drop of cortisol in literature is 104.3 nmol/L/hr; that is when etomidate is used as a first-line medication to reduce hypercortisolism. It has been observed to have a lesser mean percentage of drop when it becomes the second or third line treatment modality, 62% and 41%, respectively [14]. Our patient had a mean rate of drop of cortisol of ~134.3 nmol/L/hr, where we used etomidate as second-line therapy. Also, according to literature, when etomidate was used as the first-line medication, the time to reach the expected baseline was around 15 hours, and if cortisol is used as a second-line or third-line, it has been observed to take more time to achieve its effect. (80 hours and 48 hours, respectively) [14]. In our patient, even though we used etomidate as a second-line medication, we were able to achieve the expected baseline value within 16 hours of initiating the infusion.

It has been shown that during the treatment for hypercortisolemia with etomidate, ACTH-independent Cushing’s syndrome had a higher incidence of adrenal insufficiency than ACTH-dependent Cushing’s syndrome. The mechanism responsible would be the increased production of cortisol under the influence of ACTH. Therefore, ACTH-dependent Cushing’s syndrome might need higher doses of etomidate in the management [15]. Our patient needed the dose to achieve the expected cortisol level, which was 0.05 mg/kg/hr. This might infer higher benefit and safety of etomidate in cases of ACTH-dependent Cushing’s syndrome, rather than in ACTH-independent cases.

The use of etomidate for acute management of severe hypercortisolemia was first described in 2012, and the current protocol for continuous infusion of low-dose etomidate for Cushing’s syndrome was validated in 2019 by Carroll et al. [16]. They describe giving a 5 mg bolus dose followed by an infusion of etomidate with a dose of 0.02 mg/kg/hr and up titration aiming for a maximum dose of 0.3 mg/kg/hr with 6-hourly up-titration of the etomidate dose if necessary. This method was proven to be minimally associated with cardio-respiratory compromise. In our patient we did not give the bolus dose, rather continued the low dose continuous infusion of etomidate with up-titration until the expected rate of decline was achieved.

Studies have experimented on the use of etomidate in ICU setups vs. ward setups [17,18]. Agnieszka et al. had carried out very low dose infusions of 0.1-0.2 mg/kg/hr with a bolus dose of 2.5 mg at the outset for prolonged periods of time without any hemodynamic compromise, thus suggesting the safety of etomidate infusion, whereas in Constantinescu et al., the study did not reveal any difference in the outcomes when etomidate was used in the ICU setup vs. the inward setup. For our patient, we were able to arrange an ICU bed for close monitoring of parameters. In our patient, we used a 0.05 mg/kg/hr infusion safely without any fluctuations in hemodynamic status. However, in a resource-poor setup, for the acute management of severe hypercortisolemia, unavailability of an intensive care unit should not be a limiting factor, given the extensive availability of the drug due to its use for anesthetic purposes and its cost-effectiveness.

It is also possible to use the “block and replace” strategy with intravenous hydrocortisone to reach a serum cortisol goal of 500–800 nmol/L, but only for a short time [19]. But in our patient, we did not adhere to the block-and-replace strategy and only used etomidate at 0.05 mg/kg per hour. We maintained serum cortisol around 300 nmol/L. We did not observe any cardiorespiratory complications or drastic electrolyte alterations in our patient. Due to the difficulty in allocating an ICU bed upon our observation, we propose to start etomidate in the ward in the high dependency unit under careful monitoring. Etomidate, its complications, and cost analysis are areas that need future research.

Learning Points

  • Ectopic ACTH-secreting atypical thymic carcinoid tumors are a rare cause of severe Cushing’s Syndrome.
  • Administering an initial dose of 0.05 mg/kg/hour of the anesthetic agent etomidate in an HDU setting, even without Intensive care facilities to lower serum cortisol levels is safe while maintaining the serum cortisol around 300nmol/L without leading to any cardio-respiratory compromise.
  • Pre-operative etomidate prior to definitive surgical treatment of thymic carcinoid tumors helps to minimize complications.

Funding

None

Competing Interests

Authors declare that they have no competing interests.

Contribution

Dr. W.M.D.A.S. Wanninayake, Dr. H.S.Senanayake, Dr. U.C.Hettiarachchi, Dr. Manilka Sumanathilake were involved in managing the patient. Dr.W.M.D.A.S. Wanninayake and Dr. Tilan Aponso did the literature review and writing of the initial manuscript was done by Dr.W.M.D.A.S. Wanninayake. Dr. Manilka Sumanathilake finalized the manuscript and gave expert opinion. All the authors read and approved the final manuscript.

Acknowledgements

None

Ethical Declaration

Not applicable

Consent for Publication

Informed written consent for publication of details was taken from the patient. Consent form can be made available to the editor on request.

Availability of Data and Materials

The data is available from the corresponding author on reasonable request.

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Unexpected Carbon Phases in Grey Cast Iron–Diamond, Calcite, and Methane

DOI: 10.31038/GEMS.2025743

Abstract

During the study of graphite in grey cast iron, we found unexpectedly small diamond crystals similar to those shown by Gong et al. (2024). Using Raman spectroscopy, we have characterized the graphite nodules as well as the diamond crystals, which can obtain dimensions up to 25 x 9 µm. We have also found diamond films. Our finding shows that diamond can grow at high temperatures and low pressure (> 10 kPa), possibly by an unknown catalyst. This study is a bridge between the diamond synthesized at about 5-6 GPa and 900-1400°C and the diamond formed at about 700°C and 0.1 GPa in the Earth’s crust.

Keywords

Diamond, Graphite, Cast iron, Raman spectroscopy, Forbidden Raman lines in graphite

Introduction

The first author has found diamond and related minerals, like SiC (moissanite), and complex boron carbides as small (10-20 µm), very smooth spheres in minerals of crustal origin and has interpreted these as little presents brought into the crust by supercritical fluids or melts from the Earth’s mantle. Such testimonies to the past are not uncommon in the German and Czech Variscan Erzgebirge and also in the Lusatian Mountains. Further examination of the rock bearing such evidence brought an enormous surprise: the formation of such minerals on the spot, means in crustal regions. Such unambiguous proofs include whiskers of diamond, moissanite, and boron carbides in quartz, topaz, cristobalite, and others [1,2]. Also unnoticed were small diamond crystals in synthetic fluorite produced at room pressure and high temperature using the Stockbarger method [1].

Carbon liquifies iron and makes it much easier to cast than steel (Figure 1). After solidification, carbon ends up in castings either as graphite (grey cast iron) or as iron carbide (chilled cast iron). If graphite appears, solidification takes place according to the stable Fe-C binary phase system; if iron carbide appears, solidification happens according to the metastable Fe-Fe3C system. Usually, cast iron contains both carbon phases; thus, foundrymen are used to thermodynamic metastable phases, and the enormous range of material properties which cast iron could offer is caused by the knowledge of foundrymen how to modify the solidification of their castings to get the right shape and balance of stable and metastable carbon phases. Ductile Iron (GJS) is available with tensile strength starting from 350 N/mm² in conjunction with elongations up to 25 % – free of Fe3C – to „as cast“ 700 N/mm² tensile strength and a limited elongation at that level containing a lot of Fe3C formed at about 723°C. Grey Cast Iron is available with tensile strength between 150 and 300 N/mm², has nearly no elongation, and includes, in most cases, Fe3C formed at about 723°C. Besides Carbon, Silicon is always present as an alloying element at a level of typically 2 %. This range of properties could be modified and enlarged by additional alloying elements as well as specific heat treatments and makes cast iron applicable for such different products as pillars for forging, rolls for paper production, pipes for freshwater supply, callipers and brake discs for vehicles up to little keys with a weight range from some 100 metric tons down to some few grams.

Figure 1: Draft of the combined stable and metastable iron-carbon binary phase system [3].

Although grey cast iron is a relatively well-known material used industrially for much more than 200 years, the question of how carbon precipitates and carbon phases grow in detail is still under investigation. Thus, collecting more information about the crystallinity of carbon in grey cast iron by using Raman spectroscopy was the key target of the research (report will be published soon). During this study, we found for ourselves surprising nanodiamonds and diamonds. Here we will briefly describe our observations.

Sample Material

Several samples of various kinds of cast iron are studied. But just in one of them, all these unexpected carbonaceous phases have been detected rather close together. Figure 2 shows the microstructure of this specific ductile iron, which is quite typical for a rapid solidified thin-walled casting in conjunction with a bismuth-cerium inoculation. Both rapid cooling and the bismuth-cerium inoculation increase the number of nodules and cause a sound casting free of Fe3C where a high elongation above 20 % in conjunction with a tensile strength of roughly 420 N/mm² could be expected.

Figure 2: Micrograph of the sample referring to phases shown in Figure 1. It is an etched GJS 400. Foundrymen would consider all black particles as nodules of graphite. The white area between them is ferrite, and the grey lines within ferrite are the borders between eutectic cells. Thus, all material within a grey line belongs to one austenite crystal, which became ferrite below the eutectoid transformation point.

This casting and thus the sample have been produced while using a standard FeSiMg below 10 % magnesium, containing a reasonable amount of Ca, but no rare earths (REE). The treatment was done using the sandwich method. High-purity pig iron, low-Mn steel scrap, and electrode graphite were used as raw materials. The melting has been performed in an induction furnace. As a preconditioner, a FeSiBa- alloy with approx. 2 % Ba and less than 50 % Si has been added together with FeSiMg. After Mg-treatment, approximately 0,15 % of a FeSiBiCe-inoculant (containing besides 74 % of silicon roughly 1 % Bi, 1 % Ca, and 2 % Ce) is added in stream, and finally a mould inoculation with approx. 0,1 % of a FeSiAl4 optimizes successfully the microstructure. The final composition of the melt was 3.55 % C, 2.72 % Si, 0.05 % Cu, 0.003 % Sn, 0.20 % Mn, 0.15% Ni, 0.035 % Mg, 0.010 % S, 0.0017 % Ce, 0.0013 % Bi, 0.001 % Ca. The main target was to identify the crystallinity of the graphite phase, and Figure 3 shows one Raman spectrum of the centre of one of such nodules. For our studies, we used a rectangular parallelepiped, about 14 x 14 x 9 mm. The large area is diamond-polished. To distinguish between the diamonds used for this polishing procedure, we show a Raman spectrum of such diamonds in Figure 4, which has been detected in samples as well [4].

Figure 3: Raman spectrum of a graphite nodule of the sample (see Figure 2). The meaning of the band at 75.2 cm-1 is unclear, and its general appearance must be a task for the future.

Figure 4: Raman spectrum of diamond used for sample polishing. Typical is the strong intensity and very small FWHM (about 4 cm-1; see further below). The graphite band (G-band) is absent.

Microscopy and Raman Spectroscopy

Besides a polarization microscope for transmission and reflection (JenaLab Pol), we performed all microscopic and Raman spectroscopic studies with a petrographic polarization microscope (BX 43) with a rotating stage coupled with the EnSpectr Raman spectrometer R532 (Enhanced Spectrometry, Inc., Mountain View, CA, USA) in reflection and transmission. The Raman spectra were recorded in the spectral range of 0–4000 cm-1 using an up-to-50 mW single-mode 532 nm laser, an entrance aperture of 20 µm, a holographic grating of 1800 g/mm, and a spectral resolution of 4 cm-1. Generally, we used an objective lens with a magnification of 100x: the Olympus long-distance LMPLFLN100x objective (Olympus, Tokyo, Japan). The laser power on the sample is adjustable down to 0.02 mW. The Raman band positions were calibrated before and after each series of measurements using the Si band of a semiconductor-grade silicon single-crystal. The run-to-run repeatability of the line position (based on 20 measurements each) is ± 0.3 cm-1 for Si (520.4 ± 0.3 cm-1) and 0.4 cm−1 for diamond (1332.7 cm-1 ± 0.4 cm-1 over the range of 80–2000 cm-1). The FWHM = 4.26 ± 0.42 cm-1. FWHM is the Full-Width at Half Maximum. We also used a water-clear natural diamond crystal (Mining Academy Freiberg: 2453/37 from Brazil) as a diamond reference (for more information, see Thomas et al., 2023) [5]. The zero-point position for the Raman spectroscopic measurements is checked before each measurement campaign. For the identification of mineral phase, we used Hurai et al. (2015) [6], the RRUFF database by Lafuente et al. (2015) [7], and Liu et al. (2024) [8]. Figure 5 shows the Raman spectrum of the diamond reference and the zero point of the used Raman spectrometer.

Figure 5: Raman spectrum of the reference diamond No. 2453/37 from the Mining Academy Freiberg. From 20 measurements, the mean is (1332.7 ± 0.4) cm-1 and the FWHM is 4.26 ± 0.42 cm-1.

Results

During the study of graphite nodules in ductile iron, we also found inclusions of calcite, and besides them, a small diamond crystal (26 x 9 µm). Others are even smaller and spherical. Figure 6 shows details of such as calcite and diamond-bearing area (Figures 6, 7a and 7b). Also important is the very strong Raman band of methane (CH4). Figure 7b shows the Raman spectrum of methane dissolved in the calcite of Figure 6. Other calcite crystals show the Raman band of saturated hexane (C6H14) (2931.8 cm-1) – see Hurai et al. (2015) [6]. The Raman spectrum of diamond (D) in Figure 6 is shown in Figure 9. Characteristically, there are the double peaks of diamond and graphite. Figure 8a shows the Raman spectrum of a graphite nodule. Typical is the presence of the forbidden Raman band at 866 cm-1 (Figure 8b). According to Estandia et al. (2014), the irreducible representation of the graphite modes is ΓGr = 2A2u + 2B2g + 2E1u + 2E2g. There are two infrared (IR) modes: E1u at 1587 cm-1 and A2u at 870 cm-1, and two Raman modes: E2g at 1580 cm-1 and E2g at 42 cm-1. For the Madagascar graphite, the E2u lies between 65.6 and 75.8 cm-1. The often observed Raman line at 1350 cm-1 (D-mode) stands for disordered graphite. The A2u mode at about 870 cm-1 is an infrared (IR) band and is Raman forbidden. In our case, this forbidden band is present at about 865 cm-1 and may be the result of intercalated sulfur, which changes the symmetry of graphite [10,11]. However, the concentration of sulfur is with 0.01% so low that this interpretation is very doubtful. A better candidate would be Si or REEs. According to Gong et al. (2024) [12], Si is critical for the diamond growth at low pressure and high temperature (Figures 8b and 9). In the same sample, there are also larger diamond “aggregates” as can be seen in Figure 10. This aggregate is composed of two diamond grains and a diamond film in between. The Raman spectra of the studied sample are not uniform. There are also those without or only a tiny or weak graphite Raman band. Single diamond bands without graphite are scarce. The Raman spectrum in Figure 11 shows the ideal graphite G-band at 1580.0 cm-1. The carbon D-mode at 1350 cm-1 is characteristic of disordered graphite (see e.g., Enstandia et al. 2014) [9] and is here not present. The strong Raman band at 1320.7 cm-1 is representative of the first-order line of diamond. The shift of about 12 cm-1 (1320.7 cm-1) from the 1333 cm-1 standard position of diamond can be attributed, according to Zaitsev (2001) [13], to highly doped diamonds (e.g., aluminium). Another possibility is, according to the same author, stacking faults oriented in (111) planes of lonsdaleite (hexagonal diamond polytypes). A further explanation for these observations is that the Raman values of the diamond main line are low. However, there are two further possibilities: (i) isotope shift in the direction of higher 13C contents, and (ii) the position of the Raman line decreases strongly with the increase of the temperature [13], which means the temperature state is frozen during cooling. The first case (i) is not valid because 13C-rich carbon was not used. The Raman value of 1325 cm-1 for diamond speaks for freezing the diamond in the sample at about 730°C (see Figure 1 and Zaitsev 2001) (Figure 11 and Table 1) [13].

Figure 6: Surface of cast iron with calcite (Cal), diamond (D), and graphite (Gr). The calcite crystal is about 48 x 44 µm in size, and the graphite spheres are ≤ 20 µm in diameter. This diamond here is exceptionally huge. Most diamonds are more petite, similar to nanodiamonds. Calcite could be identified with the typical Raman lines at 152.4, 276.3, 710.7, and 1084.6 cm-1 (see Figure 7a). Figure 7b represents the typical Raman band of methane (CH4).

Figure 7a: Raman spectrum of calcite. Noteworthy are also the typical Raman bands of carbon at 1364 and 1600 cm-1. The color of calcite is black due to the distributed carbon particles. CaO could not be proved.

Figure 7b: Raman spectrum of methane (CH4) in calcite, shown in Figure 6. Hydrogen is always present in cast iron.

Figure 8a: Raman spectrum of a graphite nodule in ductile iron. The presence of the D-band in graphite (G-band) shows that the graphite is not defect-free. Note the very weak Raman band at 865 cm-1. The Raman band at about 75 cm-1 was cut off because they should lie at about 42 cm-1 (Estandia et al., 2014) – [9]. The significant difference is unclear.

Figure 8b: Raman-forbidden A2u mode of a graphite nodule in cast iron, sample 2 – counting time about 8 times the time used for the spectrum in Figure 8a.

 

Figure 9: Raman spectrum of the diamond in Figure 6. The intense 1569.0 cm-1 band is, according to Zaitsev (2001) – [13], a feature of the Raman spectra of low-quality diamond films.

Figure 10: Larger diamond aggregate and a film in the sample shown in Figure 2.

Figure 11: Raman spectrum of diamond with a very sharp graphite band. The origin of the band at 2692 cm-1 is the 2D band (second order) of graphite.

Table 1: Results of the Raman measurements on the main lines of 12 diamond-graphite crystals in cast iron (Sample 2) 12 different diamond crystals. The exact number is for 2a after etching.

Sample

Diamond

FWHM

Graphite

FWHM

2

1324.6 ± 11.8 cm-1

66.9 ± 13.8 cm-1

1572.3 ± 9.5 cm-1

42.0 ± 21.1 cm-1

2a

1317.8 ± 10.0 cm-1

77.7 ± 15.8 cm-1

1580.2 ± 7.1 cm-1

62.1 ± 22.7 cm-1

Remark to sample 2a: These diamond grains are on all sides of the sample parallelepiped exposed after strongly etching sample 2 with HCl (25%) for 24 hours and strong cleaning with distilled H2O to prevent measurement on diamonds used for preparation.

Interpretation

Thomas (2025a and b) [13,14] has shown that diamond can be brought via supercritical fluids or melts from the mantle into the crustal regions as small spherical crystals. The introduction of diamond in this way poses no problems. A larger problem is the growth of such minerals, such as diamond and moissanite (SiC) whiskers, in minerals formed at the crustal places (at about 700°C and 0.1 GPa). Traditionally, for the development of diamonds, we need temperatures of 900-1400°C and 5-6 GPa. Gong et al. (2024) [12] have now demonstrated that diamond can grow on a graphite crucible at one atmospheric pressure and 1175°C without any diamond seeds with a mixture of methane and hydrogen, and a mixture of Ga, Ni, Fe, and Si as metallic melt. The Fe/Si ratio within cast iron is similar to that reported by Gong et al. (2024) [12]. After these authors, Si played a critical role in the growth of diamond. We have now shown that diamonds can also grow in standard cast iron. The found macroscopic diamond crystals are up to 20 µm large. There are also many nanodiamonds present. A careful investigation is necessary to quantify the amount of diamond in the cast iron. There are also a lot of questions to solve: What is the critical component for the formation of diamond? Does calcite, together with hydrogen as a supplier of methane, have a key meaning (see Matjuschkin et al. (2020).

Practical Conclusions

Ductile cast iron is made from a melt, for which at least 10 key elements need to be considered, as well as some more, and all of them influence the precipitation of the crystalline phases. Metastable compounds, especially Fe3C, are known and used to modify the mechanical properties of cast iron. Oxides and sulphides are considered to play an essential role during graphite nucleation and avoid eutectic growth of Fe3C. Thus, a wide range of nanoparticles found within cast iron is standard and well documented over decades (e.g., Stefanescu 2020, Sommerfeld & Tonn 2008, Zykova et al. 2018) [15-17]. Cast iron solidifies at temperatures around 1140°C, and although graphite expansion causes some pressure within the casting during solidification as well as during further cooling phases, the sum of pressures measured outside at the casting surface, according to Nandori & Dul (1982) [18,19], is not impressive. Therefore, considering the formation conditions needed to generate such phases as diamond and calcite just out of their elements, it is surprising that they exist under the circumstances of cast iron production. On the other side, if their amount is marginal – and it seems so, as it took until now to detect them – they will not have any practical influence on cast iron production. Whether the “cast iron synthesis” of nanoparticles, as e.g., those three-dimensional carbon structures, might have any value for other applications is doubtful, but at least foundrymen might feel now that the value of their castings is higher than what they get traditionally paid for.

Acknowledgment

Thanks to DI Dieter Nemetz, managing owner of Johann Nemetz & Co. GmbH and chairman of PROGUSS Austria, for supporting this research as well as others with ongoing interest.

References

  1. Thomas R (2025a) The change from the supercritical fluid-melt system into the under-critical stage: The Zinnwald example. Geol Earth Mar Sci 7: 1-9.
  2. Thomas R, Trinkler M (2024) Monocrystalline lonsdaleite in REE-rich fluorite from Sadisdorf and Zinnwald/E-Erzgebirge, Germany. Geol Earth Mar Sci 6: 1-5.
  3. Bauer W (2013) Gusseisen mit Lamellengraphit, Leoben, ÖGI-Eigenverlag.I-V and 95 PG.
  4. Keller DS, Ague JJ (2022) Possibilities for misidentification of natural diamond and coesite in metamorphic Neues Jb. Mineral Abh 197: 253-261.
  5. Thomas R, Davidson P, Rericha A, Recknagel U (2023) Ultrahigh-pressure mineral inclusions in a crustal granite: Evidence for a novel transcrustal transport mechanism. Geosciences 13: 1-13.
  6. Hurai V, Huraiová M, Slobodník M, Thomas R (2015) Geofluids – Developments in Microthermometry, Spectroscopy, Thermodynamics, and Stable Isotopes. Elsevier.
  7. Lafuente B, Downs RT, Yang H, Stone N (2015) The power of database: the RRUFF project. In: Armbruster T, Danisi, R.M. (eds). Highlights in mineralogical W. De Gruyter, Berlin. Pg: 1-30.
  8. Liu Q, Miao H, Liu W, Bu L, Yao J, et (2024) Selective transformation of cementite: Graphitization or spheroidization. Materials Today. 18 pages, under review.
  9. Estandia B, Rodriguez L, Alvarez, JA, Ferreño D, Hernández D, et al. (2014) Raman spectroscopy of flake graphite as a tool to detect stress-strain states in cast Advanced Sustainable Foundry. 71st World Foundry Congress in Bilbao. 6 pages.
  10. Yang H-P, Wen H-H, Zhao Z-W, Li S-L (2001) Possible superconductivity at 37 K in graphite-sulphur Chin Phys Lett 18: 1648-1650.
  11. Thomas R, Rericha A, Pohl WL, Davidson P (2018) Genetic significance of the 867 cm-1 out-of-plane Raman mode in graphite associated with V-bearing green Mineralogy and Petrology 112: 613-645.
  12. Gong Y, Luo D, Choe M, Seong WK, Bakharev P, et (2024) Growth of diamond inliquid metal at 1 atm pressure. Nature 629: 348-354.
  13. Zaitsev AM (2001) Optical Properties of A Data Handbook. Springer, I-XI, and 1-502 pages.
  14. Thomas R (2025b) Strong Isotope Fractionation Between 13C and 12Cin the Supercritical Fluids Related to the Variscan Mineralizations in Erzgebirge, Slavkovský Les (Kaiserwald), and Lusatian Mountains, Germany, and the Czech Republic, and Some Remarks on the Low-Pressure Formation of Geol Earth Mar Sci 7: 1-6.
  15. Stefanescu DM, Alonso G, Suarez R (2020)Recent Developments in Understanding Nucleation and Crystallization of Spheroidal Graphite in Iron-Carbon-Silicon Metals 10 Bericht-Nr. 221.
  16. Sommerfeld A, Tonn B (2008) Nucleation of graphite in cast iron melts depending on manganese, sulphur, and oxygen. International Journal of Cast Metals Research 21: 23-26.
  17. Zykova A, Lychagin, D, Chumaevsky, A, Popova N, Kurzina (2018) Influence of Ultrafine Particles on Structure, Mechanical Properties, and Strengthening of Ductile Cast Iron. Metals.
  18. Nandori G, Dul J (1982) Beurteilung von Gußeisenschmelzen durch Messung der Makrovolumenänderungen und der Ausdehnungskräfte während der Erstarrung. Giesserei-Rundschau 29: 9-16.
  19. Matjuschkin V, Woodland Ab, Frost DJ, Yaxley M (2020) Reduced methanebearing fluids as a source for diamond. Scientific Peports. 10: 6961, 8 pages.

Review: Knowledge and Prevalence of Cervical Cancer Screening Among Women Receiving Prenatal Care in Accra, Ghana

DOI: 10.31038/IGOJ.2025812

Study Overview

This cross-sectional study examined cervical cancer screening (CCS) knowledge and prevalence among 393 women receiving prenatal care at three health facilities in the Okaikwei North Municipal Assembly, Greater Accra Region, Ghana. Utilizing a two-stage cluster sampling method, the research targeted women over 18 years attending Achimota Hospital (36.6%), Lapaz Community Hospital (32.1%), and NK-Salem Medical Centre (31.3%). The study addressed a critical gap in understanding CCS awareness among pregnant women, a high-risk population with frequent healthcare contact opportunities. The research employed a quantitative methodology with data collection through REDCap electronic surveys administered in English and Asante Twi. Knowledge of CCS was assessed using 12 questions scored from 0-12, with participants categorized into low (0-4), moderate (5-8), and high (9-12) knowledge levels using percentile-based classification. Analysis of covariance (ANCOVA) was used to compare CCS knowledge scores across facilities while controlling for demographic variables including age, marital status, education, employment, and income.

Key Findings

The study revealed alarmingly low levels of both CCS knowledge and screening prevalence. Only 19.8% of participants demonstrated high CCS knowledge, with the majority (98.5%) scoring below adequate levels. The overall mean CCS knowledge score was 3.0 ± 2.57 out of 12 possible points. While 75.6% had heard of CC and 68.4% were aware of CCS, substantial knowledge gaps existed when probed further, thus 46.5% did not understand what CCS entailed, 71.7% were unaware of screening intervals, 62.0% did not know the recommended screening age, and only 33.9% correctly identified Pap smear as the primary screening test. The prevalence of CCS was remarkably low at 7.4%, with 90% of participants never having been screened. This finding aligns with Ghana’s national CCS rates of 2-3% and reflects broader challenges in sub-Saharan Africa where over 85% of global cervical cancer cases occur. Participants correctly identified key risk factors including multiple sexual partners (23.3%), STI infections (18.0%), and early sexual onset (13.1%).

Significance and Inter-facility Variations

A significant finding was the substantial variation in CCS knowledge across health facilities. ANCOVA results revealed statistically significant differences (F (2,384)=75.03, p<0.001, ηp²=0.281), with facility type accounting for 28.1% of variance in knowledge scores beyond demographic factors. Pairwise comparisons showed that women at Achimota Hospital (M=4.33) and NK-Salem Medical Centre (M=4.74) had significantly higher knowledge scores compared to Lapaz Community Hospital (M=1.25). These differences raise facility-specific factors such as patient education programs, healthcare provider engagement, or access to health information materials may influence knowledge levels.

Among demographic covariates, income (ηp²=0.187) and marital status (ηp²=0.144) had the strongest influence on CCS knowledge, followed by age and education. This indicates that financial stability and spousal support may positively affect CCS awareness, while younger, less-educated, and lower-income women face greater knowledge barriers.

Limitations and Methodological Considerations

The study acknowledges several limitations that affect generalizability. The single-district focus in Greater Accra may not represent all Ghanaian women receiving prenatal care, particularly those in rural areas or different socioeconomic contexts. The two-stage cluster sampling method, while enhancing representativeness within the district, may introduce selection bias if certain clusters are more likely to be selected. Additionally, reliance on self-reported data introduces potential recall and social desirability biases.

The cross-sectional design prevents assessment of knowledge changes over time, and the focus on prenatal care attendees may not reflect the general population’s CCS knowledge. The study’s strength lies in its robust sample size (92.9% response rate), rigorous statistical analysis controlling for demographic confounders, and focus on a high-risk population with regular healthcare contact opportunities.

Implications and Future Directions

The findings reveal critical gaps in CCS knowledge and uptake that require urgent intervention. The significant inter-facility differences suggest that targeted, facility-specific interventions may be more effective than uniform approaches. The research recommends integrating structured cervical cancer education into routine prenatal care through health talks, standardized materials in local languages, and most importantly pre- and post-natal counseling sessions.

Practical interventions should include mobile screening clinics, community health worker outreach, and culturally appropriate educational materials. Catering for groups that are characterized by no formal education and unstable financial stability, the employment of existing social networks such as market associations, church groups, neighborhood committees could benefit from CCS education and mobile screenings. The study emphasizes leveraging social media and local dialects for awareness campaigns, as participants identified social media as their primary information source (31.0%). Future research should conduct multi-site studies across different geographical areas/regions to examine disparities among the geographical areas to understand the specific barriers that exist to screening uptake.

Conclusion

This study provides compelling evidence of the urgent need to strengthen cervical cancer prevention efforts in Ghana’s prenatal care settings. The combination of low CCS knowledge levels (19.8% high knowledge) and minimal screening prevalence (7.4%) among pregnant women represents a missed opportunity for early detection and prevention. The significant facility-based variations in CCS knowledge calls for targeted interventions considering the local contexts and demographic factors. Implementing these interventions could substantially improve outcomes. As prenatal care provides a structured platform for health education, integrating comprehensive CCS awareness programs could dramatically enhance early detection rates and reduce cervical cancer mortality in Ghana. The research contributes essential insights for developing evidence-based interventions that address both knowledge gaps and systemic barriers to screening access.