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Healthy Boundaries Relationship Model

Abstract

Healthy Boundaries Relationship Model is a comprehensive discussion about the dynamics of maintaining respectful boundaries to protect your marriage. Emotional affairs and manipulating people who intrude on married couples or committed couples are problematic when proper boundaries are not maintained. Emotional affairs are not widely acknowledged compared to sexual affairs. Hidden in the guise of ‘friends only’ status can make them difficult to identify, yet, can easily ruin the best of any marriage or committed relationship. There are many influences and human flaws that can threaten your committed relationship through every day experiences. This article addresses couples with insight into the importance of exercising healthy boundaries to protect their relationship, along with identifying ploys from manipulative people, what an emotional affair looks like, and guidelines to help couples protect and/or restore their marriage.

Keywords

marriage, spouse, boundaries, manipulation, emotional affairs, third-party

Healthy Boundaries Relationship Model

Healthy Boundaries Relationship Model is a relationship model that outlines boundaries for a married couple or any couple in a committed loving relationship. As there are no guidelines that rule every couple, there are, however, compelling reasons for every couple to decide where boundaries lie for them in reference to opposite sex-friends, or any person posing as a romantic threat [1]. This dialogue theorizes the topic of affairs and healthy boundaries while simultaneously addressing couples in a committed relationship. It will maintain the terms ‘third- party friendship, third-party relationship, third-party person or intruder,’ as any type of third- party relationship that is outside of, or separate, or secret from the committed relationship which poses a romantic threat. For the sake of simplifying vocabulary, the terms ‘marriage and spouse’ refers to any type of committed loving relationship between two adult people.

What is a Boundary?

Boundaries come in all shapes and sizes. Psychological boundaries are invisible mental guidelines that determine what we do and do not do, and, what we will and will not accept in our lives. They are created when we realize where our limits are. Boundaries reflect our values, thoughts, and feelings that are important to us, and are held together by our actions. We create boundaries to protect the things we love [2].

We love our home; we lock the doors for safety to protect our possessions inside. We love ourselves; we create boundaries to protect ourselves from harm and hurt from others. We love our families; we create boundaries to protect them and the relationships we share with them. We love our partner. We love the love we feel inside our hearts from them. We love our relationship with them, and the sacred space that fills the intimacy in our bond with them. We create boundaries for our marriage to protect our partner and our relationship. Boundaries regarding third-party friendships are guidelines that the couple decides upon to protect their marriage.

When we have healthy boundaries in our relationship, we take into consideration how our partner feels. We show appreciation and respect for the differences in our opinions, but most especially show respect for each other’s feelings. In relationships with unhealthy boundaries we may be unknowledgeable, or assume our partner feels the same way we do in any various situations where we may inadvertently overstep proper boundaries causing misunderstandings, and perhaps great pain [3]. The Healthy Boundaries Relationship Model holds each other’s feelings in check with a responsibility to support the integrity of the relationship, support trust, and respect for each other. Each person is accountable for their behavior. To live by, ‘putting your relationship first before your need to be right or in competition with outside demands and influences’ [4] places boundaries at the top of the list as one tool to ensure a healthy relationship with your loved one, your spouse.

Why Have Boundaries?

The simple truth about taking measures to protect your marriage is based on the fact that we are all sentient human beings; meaning, we have the capacity for awareness, feelings, responding, and reacting to others [5]. This is not to suggest you are a promiscuous person by nature ready to fall into bed with anyone who comes along, or that you are a deliberate betrayer. But you are a human being with the capacity to feel, interact, respond with feelings, and have relationships. Being a sentient being is the foundation of human nature, and no one is immune to it. Avoiding situations that may provoke feelings of attraction, emotional or any type of unhealthy involvement, neediness, or desires for someone else that may threaten your marriage is living within the guidelines of healthy boundaries for you and your spouse. We protect the things that we love. Our ability to protect our marriage is related to the strength of the boundaries we maintain, emotional or physical [6]. Our boundaries are maintained by our actions [2].

Defining Boundaries: The first step in setting boundaries is through self-knowledge.

Learn what is important to you [3]. Boundaries set the tone for how much we allow others to influence us emotionally. Based on the thought that most people make decisions because of their emotions instead of logic, healthy boundaries deflect outside influences that may put our marriage at risk from unhealthy influences or a misunderstanding with your spouse.

A misunderstanding, for example, if you are spending large amounts of time with a third- party person, or interacting in ways that seem overly friendly, perhaps appearing flirtatious, your spouse may become very hurt and upset. You may have not thought anything about it, assuming it was harmless fun. By maintaining awareness of boundaries to place your marriage first, these types of situations can be avoided or managed appropriately. In other words, boundaries place responsibility upon you to conduct yourself appropriately with others, and how you allow others to interact with you.

Thirdly, boundaries define who you are as a couple. It provides the foundation of trust that each of you will conduct yourself properly with the outside world when you are not together. It is an announcement to the outside world that you are a couple, not a single person available to the wind of other people’s desires, influences, and interests.  Healthy boundaries puts your marriage first because it demonstrates respect for your spouse while reinforcing trust. It supports trust through the concept and exercise of healthy boundaries because healthy boundaries provide an umbrella of emotional safety. Do not underestimate the importance of boundaries in your marriage and in your life.

What are the Risks?

Statistics say that approximately 40% of all marriages will experience an affair [7]. There are many reasons why a person chooses to be unfaithful. The reason may be personal insecurities or character flaws which may not be reflective of the marriage at all, or of their partner [8]. Often, however, people fall into having an affair when they least expect from a seemingly harmless friendship. Feelings of neglect, conflict in your marriage, feeling an emotional void, frustrated, and angry may lead you to seek emotional comfort outside of the marriage. Stress and vulnerability may influence you to lower your guard without realizing it [7] or lose sight of your boundaries altogether. You are a sentient being. You have feelings and needs and wants just like anyone else. Naiveté and vulnerability can easily take control of you when you are not in control of yourself. Exercising healthy boundaries in your behavior is exercising self-control. No matter how stressful your marriage is, there is never a good reason for having an affair, as the aftermath is always heart-shattering. In every situation of unfaithfulness, however, having an affair is not a couple’s choice. It is always the choice of one member in the marriage who decided to step outside of the relationship [9].

Individual Boundaries

Some people may not be aware of the concept of boundaries. The risk of not having boundaries leaves a person wide open to following paths that they may have never intended to go. If you were raised in a home where boundaries were violated, never acknowledged or respected, you may not have an understanding of boundaries for yourself. Many people fear that enforcing boundaries, as in when you say ‘no’ is rude. Their need for approval takes priority over saying no. Thus, their fear of rejection outweighs their ability to set healthy boundaries [2].

Learning your own sense of boundaries as an individual ground’s you with personal strength to express who you are. Expressing your boundary is not an argument with anyone, it’s a statement about you, “This is who I am.” Personal boundaries are about respecting yourself, setting a stance for your individuality upholding standards that are right for you. It demonstrates you have control of your life [9]. It is not an argument. It is not a persuasive conversation with someone. It is an act of living your life authentically by upholding what you value. If you don’t uphold your boundaries for values that are important to you, more than likely no one else will either. Some people will try to manipulate you away from your values. But your boundaries will protect what you value, and prevent you from falling to the persuasion of others [2]. Healthy personal boundaries are just as important as relationship boundaries. Know your limits as an individual. Know what you will and will not tolerate, or participate in. Boundaries are guides for you to live authentically, and confidently with your true self. Although the concept of boundaries may seem rigid, it is not putting up walls around yourself from others. It is accepting and respecting yourself while respecting others. There is a gentle flexibility in exercising boundaries without building walls or losing the distinction of your individuality [6].

Third-Party Manipulators

While some people have no concept of boundaries, or simply do not have a defined set of boundaries, some people may know boundaries well enough to manipulate others. In fact, they may be inclined to manipulate your boundaries without your awareness. How so? In any multitude of ways: flattery, insincere emotional support, pretending to support your values when they themselves do not have values. They may share in a membership with you, clubs, or an organization. They may ask your advice when they already know the answer, asking favors of you [10] a friendly touch on the shoulder, and so forth are all examples of manipulative, coercing gestures.

There are many types of psychological manipulations that may seem like normal conversations and interactions. While it may seem normal and friendly, a third-party intruder may have maleficent intent to covertly intrude on your marriage with no concern about the effect it may have on you or your spouse. You are a sentient being. You have the capacity for feelings and responding like most normal people. A manipulative person knows this and uses it to their advantage. Understanding the manipulative mechanisms of third-party intruders is imperative for identifying them before you or your spouse are pulled in to the guise of their ploys. Knowing why people manipulate, and what manipulation looks like is valuable to prevent manipulation from occurring in the first place, can save from unpleasant situations, and perhaps lives.

For example, in 1978 the cult leader, Jim Jones psychologically manipulated over 900 people to commit suicide by drinking grape punch laced with cyanide. Before this suicidal measure of devotion, these vulnerable people were manipulated to turn on their families, and disconnected from them to follow his teachings and lifestyle. Once this was accomplished, he then manipulated his cult members into abusive acts, and to ultimately turn on each other if they did not follow the rules [11]. These people were extremely vulnerable and became victims of manipulation in the worst way.

Frailty of the Human Mind

There is a fundamental weakness in the human mind, a truth that applies to all. We are all at risk to the frailties of human nature, and subject to the persuasion of others [11]. Having vulnerabilities, and being vulnerable is part of the human experience. The Jim Jones story is an extreme example of manipulation. But manipulative tactics that influence us cannot be underscored in everyday life, including personal relationships. The psychodynamics of persuasion influences us in nearly every area of life every day [12]. Advertisement, music, art, literature, public speakers, corporate leaders for the organization we work for, conversations and interactions with friends, peers, family, and so forth all influence us throughout the day. A third-party person from our everyday life, who knows how to manipulate boundaries can influence any one of us without our awareness. We are sentient beings. We respond. We feel. We think the best of people by nature, without realizing others may not have the best of intentions for us.

What is Manipulation?

By definition, manipulation is the ability to influence another person by circumventing their sense of reason, with deliberate intent to induce a faulted thought or perception, a belief, a desire, or an emotion into someone [13]. The effect on the victim being manipulated results in a distortion in their normal decision-making process, which leads them to a thought, a feeling, a belief, a decision, or an action without knowledge of the manipulation being placed upon them. It is most generally viewed as an act that aims, “To achieve a desired goal using deception, coercion, and trickery, without regard for the interests or needs of those used in the process,” [14]. The style of manipulation can be covertly or aggressively. Covert measures are implemented in a manner that is secret, hidden, or not easily noticed. This form of manipulation is applied to win support from another individual, or group. This influence is focused on personal gain without concern of harm to others, achieved through acts of preying on another by using misleading messages, complaints, hidden intentions, and strategies. The personal gain for the third-party intruder is without empathy towards others affected by the manipulation [13] which means you or your spouse.

What is Their Motivation?

People with manipulative tendencies are often individuals with deep-rooted psychological insecurities. Their success in persuading others feeds their ego, leaving them with feelings of personal power. It is an ego-boosting method of building self-esteem that is, in reality, deeply missing. There are many types of personality disorders that classify maladaptive behaviors, manipulativeness, and apathy towards others.

To simplify, women, for example, who have affairs with married men, may find the experience thrilling from the perspective of the accomplishment to persuade him away from his marital commitment. A married man committed to his marriage, his love, his life with his spouse, his home and so forth has a lot to lose. The single woman who coerces him into a third- party relationship sees that through her persuasive efforts in her manipulation, he chose her, not his commitment to his marriage. Her accomplishment of luring him into the third-party relationship is an ego boost to nurture her low self-esteem. The accomplishment of winning his attention is the reward, as opposed to having a sincere healthy relationship.

Some people like toying with the energy of drama. One phone call or misplaced text message could destroy a marriage. Other women who desires a beautiful marriage sees love and happiness in the interactions of another couple. The single woman desires what that happy wife has, and pursues the husband. Fear of commitment, or simply looking for a father figure are other reasons for this type of behavior. Career women may not want the responsibility of a real relationship, but merely like the attention an affair offers [3]. There is a myriad of reasons why women do this.

Single men who have affairs with married women may lend itself to the fun of a carefree romantic relationship with no commitment on his part. A married woman with children, for example, is not available for a real relationship that involves dating, meeting each other’s friends and family. It creates a relationship for the single man, with no expectations and no responsibility. There is no need for dinner dates, remembering special anniversaries, or expenses. The focus is all about fun.

Underlying in both men and women from all walks of life, however, who intrude into committed relationships may represent a deep psychological aberrancy, as opposed to casual irresponsibility. The aim of a third-party intruder who violates the boundaries of a married couple through influence, persuasion, friendliness and so forth, is to win you or your partner’s attention. Their focus is to satisfy their personal needs and interests without consideration to either member of the marriage. There is no empathy on the part of the third-party intruder, they are manipulators.

Examples of Third-Party Manipulators

There are many examples of manipulation. Asking favors of you is an easy way to win someone’s attention. For example, the third-party person asks you to come to their house to help with a kitchen repair. Without telling your spouse you agree to help out. It seems easy enough, you’re in the neighborhood, it won’t take long, and the third-party person is just a friend or an acquaintance. While working on the repair the conversation becomes more friendly and casual. A separate personal friendship has been initiated. It seems harmless, after all, it was just a repair and conversation doesn’t hurt anything. Helping with a repair and talking is far from having an affair. It’s just being helpful to the third-party friend whom your spouse does not know you engaged upon. “No harm, no foul,” you say, you were just helping with their kitchen. This innocent thought is exactly what the third-party intruder was counting on.

Another example, the third-party person may initiate a boundary violation by confiding personal information with you while encouraging you to divulge personal information as well. What harm is that? You may think it’s of no harm. It’s just conversation and no one will hear about it anyway. The harm is, it is sharing personal information which should probably remain private anyway.

For example, during the event of that conversation, something personal comes to mind. You then view this dialogue as an opportunity to seek clarification of your thoughts, or validate your thoughts, or give you new thoughts, or help the third-party person with their thoughts. The intimacy of this situation creates a disclosure of privacy between you and the third-party. What’s wrong with this scenario is, it creates a ‘shared disclosure of privacy’ that is bonded between you two confiding private information with each other. Entrusting each other to keep that disclosure private is the bonding element between you and your new third-party friend.

Trust and bonding have now been developed with the third-party person without giving it a second thought. After all, you were only trying to help with their kitchen. Or you were just seeking answers to a thought that had been on your mind. The third-party person was friendly enough to help you and now you feel better. Feeling better gives light to the third-party intruder as a nice person whom you now feel very grateful to. Because they were so helpful to your private dilemma, you feel better. In fact, ‘you feel so much better and so grateful, you may be inclined to help them again’ is the third-party’s manipulation to further pursue boundaries with you, you may have never dreamed of.

Additionally, the third-party person with whom you helped repair their kitchen is now ever so grateful to you, ‘it would be wonderful to pay you back someday’ further sinks the hook of the third-party person’s manipulation to keep the rapport going and maintain a nice friendship with you. After all, you were so nice to help them with their kitchen. It all seems friendly and innocent is the guise of the third-party intruder manipulating every angle of the interactions. In all sincerity, you are a nice person, and now, without awareness, you are becoming a victim of their ploy.

Granted, there is nothing wrong with helping others. There is nothing wrong with appreciation when you are helped in return. When couples are specific about their boundaries for their relationship, such as no secrets, the expectations, the marriage, and third-party friendships can be very stable [3]. The scenarios above created a violation of healthy boundaries because your spouse did not know you went to the third-party person’s home, spending time alone with them to repair their kitchen. And because personal information was shared privately. Trust between you and your new third-party friend was held with an unspoken understanding that it would remain private, also created an unspoken bond between you two.

This third-party person with whom you feel good about, is in actuality, a manipulative third- party intruder, and you are not yet aware. The third-party relationship that was initiated outside the boundaries of your marriage has created triangulation. Three is always a crowd.

Another example, the third party-person may kick up a fun, flirty conversation with you at work, and asks to go to lunch with you. Perhaps they explain they have no one else to eat lunch with, and you feel sorry for them. Or they accidentally forgot their wallet and have no lunch money. Another example, the third-party person specifically volunteers to be on work projects, or committees with you to engage in that one on one connection they are seeking. The list can go on indefinitely of third-party intrusions that appear perfectly harmless.

The point is, if you do not have boundaries within your character, and/or the guidelines of your marriage you can easily fall prey to outside third-party influences before you know it [15] Why? Because you are a sentient human being interacting with another sentient human being. Feelings emerge, they are reciprocated politely or in true sincerity, and an experience ensues [5]. Covert manipulation by the third-party person may not be their deliberate intent, however, it cannot be ruled out. Having no boundaries is a perfect recipe for disaster in these precarious situations. By following healthy boundaries, and maintaining awareness, you avoid situations that may place you with possible temptation, and/or innocent, yet, painful misunderstandings with your spouse.

Emotional Affairs

In the discussion of having an affair, everyone has their definition of the term. Most people refer to the term’s affair, adultery, unfaithful, infidelity, cheating, and two-timing as sexual intimacy with another person outside of their marriage. But what about those personal outside third-party friendships that include emotional involvement without sex? It’s just a special friend with whom you confide in, share aspects of your personal life with, maybe regularly, maybe several times throughout the week, and you like their companionship. “No harm,” you say, “We’re not having sex. We’re just friends.”

When a third-party friendship is created that involves an overabundant level of interest, interacting, trust, a desiring, or a need for companionship with that third-party person that is ongoing, perhaps daily, and without any sexual intimacy. The question is, is this third-party relationship that could ‘potentially’ pose a threat to your marriage; is that a boundary violation? There is no sex. But does this third-party relationship fit in the category of unfaithful?

Yes! Because it is an emotionally based involvement with another person outside of your committed relationship, your marriage. Because the third-party person, your friend, with whom you like, trust, appreciate, and value as a friend could potentially become more than a friend, could also potentially place you at the pinnacle of sexual temptation, nevertheless. Following the path of heart, mind, thoughts, words, actions, feelings, accompanied by no sense of boundaries is the perfect formula for unfaithfulness. Faithfulness starts in your heart. Faithfulness in a marriage is, and was, initiated within the heart and mind of the beholders committed to the marriage. Betrayal may be viewed as, “Any act, or life choice that does not prioritize the commitment and put your partner before all others,” [16].

Emotional involvement with a third-party intruder separate’s marriage into an emotional triangle. It creates emotional betrayal that cuts into the heart of the marriage where love is sacred, and most importantly where your commitment was initially commenced [1]. Commitment starts in your heart. When you become emotionally involved with the third-party person, you have violated the very foundation of faithfulness where your bond with your spouse began. Additionally, when your emotions are pulled outside of your marriage towards the third- party friend, you have distanced yourself from your spouse emotionally, and from your marital commitment [1]. This gap violates the covenant of your union emotionally in your love for each other. Following the path that commitment starts with feelings in your heart, is then carried to your mind, your thoughts, words, and actions which then creates your beautiful relationship.

Unfaithfulness follows the same pattern. Most people do not awaken on any given morning and suddenly decides to have an affair with someone that afternoon. The development is a process that starts in the heart and mind way before he or she acts on it. Betrayal, stepping out of the marriage unfaithfully takes time and follows the same path of your original commitment to your spouse: heart, mind, thoughts, words, action. An affair has ensued.

Emotional involvement with a third-party person who poses a threat to your marriage is the foundation of betrayal initiating infidelity at the core of your commitment to your spouse. It is an affair. It is an emotional affair. It is a betrayal of trust, an insult to the integrity of love, marriage, and your commitment to your spouse. ‘Love, honor, cherish and forgo all others’ lays the ground rules for marriage in the commitment that is based on love for and with your partner. Nowhere does that include an additional partner on the side who also fills your heart with emotional joy, contentment, needs, reassurance, or satisfaction to fill your day. ‘I love you, Honey. But let me check in with my third-party friend to settle my day. I will then be happy to spend the rest of my evening with you,’ is relationship suicide.

By thinking of love as a verb, an action word that represents your feelings; your love is best shown to your spouse by your actions. Honoring your marriage with behaviors that protect your commitment, as in exercising healthy boundaries with third-party intruders is an act of love for your spouse and to your marriage. Emotional affairs are just as damaging as sexual affairs, and most often lead to sexual affairs anyway. Healthy boundaries avoid these sentient pitfalls of human nature, which lends the thought ‘it is best to avoid them altogether,’ instead of working through them later down the road. Not only does exercising healthy boundaries demonstrate love for your spouse and your relationship. It is also an act of respecting your own integrity. It conveys the message, ‘I am a faithful loyal person to my loved one. Do not approach me in any other manner, thank you. Now we can be friends,’ – meaning healthy friends with respectful boundaries that honor your marriage.

What Does an Emotional Affair Look Like?

Emotional affairs can be complicated because they are easy to deny when there is no sexual intimacy involved. They are easy to hide from your spouse, “We’re just friends.” Self- denial may be an easy trap to fall into; after all, there is no sex. He or she is just a friend. With all of this roundabout denial, how do you know if you or your partner is participating in an emotional affair?

Several aspects come into play that may require a discerning eye of observation, self- reflection, awareness of boundaries, and agreements made within your marriage about outside third-party friendships. Most third-party relationships begin with an innocent association with each other. Work, school, the gym, community volunteer groups, your child’s sporting events, walking the dog with a neighbor every day, or anything that entails a commonality for the interaction are perfect examples of situations where innocent friendships with a third-party intruder can develop. If your awareness of boundaries is lost, or you never had one in the first place, a personal relationship can easily evolve which may seem harmless [1]. It may remain harmless. But based on the fact that we are all sentient beings [5] leaves everyone at risk for feelings to evolve and grow [15]. Manipulative third-party intruders know this.

The damage occurs when you begin sharing personal information with the third-party person regarding your feelings, personal information about your life or your marriage that should remain private [1]. Sharing problems about your personal life, your family, or your marriage, for example, with the third-party intruder is an advertisement that you are open to receive consoling [17] and in need of a shoulder to lean on. In turn, listening to the third-party friend share their personal information with you seeking help from you, creates the role of the damsel in distress waiting to be rescued – BY YOU! It can be very tempting to help out, while it simultaneously pulls you into developing feelings for the third-party person. You feel sorry for them. You feel good about yourself to be helpful and to be needed. And, because you are not sexually intimate with the person, guilt and remorse for crossing any inappropriate lines are thrown out the window to denial.

Examples of the Emotional Affair:

There are many examples of third-party relationships that are inappropriate. Generally speaking, characteristics include an over-involvement, over and above normal communications, or unreasonable amounts of time with the third-party person that exceeds the call of duty of work, volunteering, school, or any situation may be leaning in the directions of an inappropriate third-party relationship. There is no professional, community, committee, or athletic necessity to discuss or engage in personal issues with the third-party person other than the task needed for the job, project, athletic team, or working out.

Do you find yourself, or do you see your spouse frequently communicating with the third-party person for extraneous reasons that have nothing to do with work or the committee? Consider the idea, then, that work, or the community committee project, or your child’s athletic team may now be an excuse to maintain that inappropriate third-party relationship.

Detailed Examples:

If the relationship with a third-party person is held separate from your spouse, including secrets, discrete and high frequency interacting and communicating with the third-party person, inappropriate text messages filled with flattery, personal pictures, romantic pictures, sentimental pictures, everyday pictures of your activities for the day, pictures of your family activities, sexual pictures, ongoing sharing of your personal life with the third- party person, sending pictures of the third-party person to the third-party person accompanied with comments such as, “Here’s your beautiful smile,” is flirtatious and inappropriate. Deleting or hiding text messages or emails, ongoing encouraging comments with personal moral boosting supportive type comments for the third-party friend, late-night communications such as, “Are you okay? Do you need anything tonight?” or “I’m thinking of you and you should be here with me,” are all inappropriate forms of communications with a third-party person. Verbal or physical gestures suggesting flirtatiousness are inappropriate. All of these forms of communication have nothing to do with work, volunteer projects, or your child’s athletic team. Neediness, missing the third-party person throughout the day and wanting to touch base to just say, “Hi,” is an inappropriate involvement with a third-party person. Going to their home alone and without your knowledge, followed with an excuse, “I was just trying to help with their kitchen, and Oh! – why her dad was there,” is inappropriate and may be grounds for question.

Going out of town alone with the third-party person without your knowledge or approval, followed with angry excuses of, “It was just business!” is inappropriate, hurtful and unacceptable. Communications with the third-party person that eliminates acknowledgment of your spouse, or eliminates acknowledgment of your love for your spouse, disregards or is demeaning of your spouse in any way shape or form is inappropriate. Defensive anger and excuses when confronted about the dynamics of your relationship with the third-party person, the inability to let go of the third-party person when your spouse asks you to, demonstrates emotional involvement with the third-party intruder and is inappropriate. This onslaught of examples provided here, and perhaps many more, most likely indicates an inappropriate third-party relationship. Namely, an emotional affair, if not a sexual one.

Because there is (presumingly) no sexual interaction, and there may be no sexual attraction, the underlying element of deep involvement with the third-party person, with whom your spouse cannot identify within him or herself their involvement. Their emotional involvement with the third-party person can compare to an addiction filled with denial of their behaviors that are unhealthy, destructive, co-dependent, destroys trust, and is damaging to their closest most valued relationship, your marriage. It is easy to see in others what people do not see in themselves [18]. Denial is a powerful front to hide behind yourself when, in fact, your spouse sees right through you.

Draw the Line: Third-party friendships that do not include you, or you are not including your spouse is clearly off-limits. Get-togethers, conversations, and interactions with the third- party person that are private, secret, or frequently one-on-one with the third-party person indicate that triangulation has been created in your marriage. You or your spouse may be aware of these interactions, but most likely you may not be aware of all of them. Partial disclosure of the third- party friendship is a half-truth, which means it is deceptive by the mere nature of hiding the other half. When the extent of the interaction and ongoing communication with the third-party intruder is well beyond the scope that a spouse would consider casual, or intermittent, and most definitely does not include them, the third-party relationship must change, have defining boundaries placed upon it, or removed altogether.

Why?

If your spouse is involved with someone that makes you uncomfortable for any reason and they are not sexually involved; they state to you there is no sexual attraction, why worry about it? The larger question is why do they have this third-party relationship? Why do they hang on to it when you have expressed your discomfort? Why would they need a third-party companion, a threat to your relationship when they have you?

Because they are emotionally invested! They did not utilize healthy boundaries in their behavior with their third-party relationship and now they are involved with the person emotionally. Their third-party friend has, most likely, become a very good friend, and perhaps now their best friend. They are attached to a need for the third-party person. They are having an emotional affair.

The term ‘emotional affair’ may come across as harsh when confronting your spouse who is in denial of their behavior, or never heard the term ‘emotional affair.’ To rephrase the situation as ‘you are overly involved’ might be easier to digest, but ultimately suggests the same thing. The damsel in distress and the knight in shining armor might best describe your complaint about your spouse’s involvement with the third-party relationship that is uncomfortable for you. Your spouse should be rescuing you, not someone else.

Any individual, your spouse or yourself, who is unable to say ‘no’ to others when no is appropriate is a person without personal boundaries and is a spouse who is not respecting healthy relationship boundaries either. Your spouse needs to say no to the damsel in distress because no is appropriate, and the damsel needs to move on. Not all emotional affairs turn into sexual affairs. But consider the thought that emotional involvement is the normal gateway for physical involvement and the rest is history.

Manipulative third-party people know this, and perhaps, has implemented tactics to encourage this with you, or your spouse. If you have lost sight of your marital boundaries and are involved in a third-party relationship, you are not only unfaithful to your spouse, you are most likely, also, a victim of manipulation from the third-party intruder who took advantage of a relationship with you that should have remained proper.

Painful Effects of an Emotional Affair

Considering that the third-party relationship has remained on the emotional level only, the difficulty dealing with these situations lies in the guise of ‘we’re just friends.’ It seems harmless to the spouse participating in the third-party relationship justified in the understanding there is no sexual relationship. The spouse participating in the third-party relationship may feel no sexual attraction either; nevertheless, engages in an overabundant level of interest, caring, concern for the third-party intruder, and need for their attention in return.

By nature, people are social beings with needs, interests, and activities which do not always involve the spouse. Additionally, it is fair to say that one person, your spouse, cannot fill your every need. Having outside friendships is normal, and healthy. When unhealthy circumstances evolve, however, demonstrating symptoms of an emotional affair, the spouse observing the situation is left with feelings of uncertainty, missing pieces, feeling excluded, and worried the marriage has changed. The third-party relationship, the emotional affair, is an emotional intrusion to the marriage. The heart is the foundation of love and commitment. It’s the starting point. It houses our emotions, our feelings of love and attraction, hate and disgust, and everything in between. In our committed relationship, our marriage, the heart is sacred space reserved for each other. A third- party intruder is overstepping territory that once was exclusive for you only or your spouse.

If a spouse is participating in an inappropriate third-party relationship, an emotional affair, that foundation of love, affection, and commitment in the marriage has been disrupted. That emotional space where trust, closeness, loving comfort that nurtures the marriage is no longer two people but is now shared with a third-party. Sections of that emotional sphere initially reserved for you, or your spouse is now sectioned off for someone else, and is left off-limits to the spouse left hurting [19]. Sharing that emotional space betrays the foundation of ‘love, honor, respect, and forgo all others.’ The spouse left hurting is left feeling betrayed, disrespected, threatened by the mere nature of a third-party’s presence in your heart. When the hurting spouse confronts the issue, the spouse participating in the emotional affair responds with defensiveness, ‘we’re just friends.’ Each spouse is left feeling insulted from each other [19].

The spouse left hurting did not receive reassurance that he or she was seeking. The spouse accused of the affair is taken aback by what may be deemed as a false accusation to their faithfulness, an insult to their integrity. It is pointing light on their character with question, are you faithful? Are you trustworthy? Are you honest? Are you a person of integrity? Are you lying? What do you two do together? What do you two talk about? Why am I not included? Why are you involved with this person? Are you in love with this person? Why is this friendship so important to you?’ And many more questions about their emotional world that has become closed off, now reserved for someone else. The spouse hurting is left feeling bewildered, confused, threatened, betrayed, and abandoned to defensiveness that warrants no room for comfort, cohesiveness, or emotional union in their love. Instead, the spouse left hurting is accused of being insecure, controlling, jealous, and insulting the integrity of the spouse who participates in the third-party relationship that he or she views as a harmless friend.

The discord creates a gap between the spouses, making the third-party friend appear more appealing as a friend, and now needed for emotional support. This gap in the marriage will fester if left unattended. The spouse hurting sulks in sadness, alone in their pain no longer comforted by their loved one has been hurt twice. Once with the uncertainty of the third-party’s place in your heart, and second by rejection from their loved one of their fears and worries. The spouse within the third-party relationship unable to see the inappropriateness of their involvement struggles with acknowledging the improper dynamics of their third-party relationship, the change in their marriage, their spouse, and defends their character which has now been shattered by the mere nature of question and/or accusations. Both members of the marriage end up hurt, not because hurt was intended. But because a third-party became an emotional interference in the union between two people.

A third-party person intruding into someone’s marriage is an emotional boundary violation. The emotional space in a loving marriage is between two people, not three. Not two and a half, indulging in brief contact with the third-party person for a quick emotional fix once in a while. A loving committed relationship between two people is two people only.

Why It is Unfair For All Three

The psychological imbalance in an emotional affair affects all three members, the spouse who is participating in the affair, the third-party person, and the spouse who is left hurting. Emotional affairs can evolve into a deep emotional bond with the third-party person that fills your thoughts with great appreciation for the friendship and sometimes love. Most often it includes sharing personal secrets, deep thoughts, innermost wishes, and concerns and worries. Sharing these issues with the third-party person creates a transference of intimacy that would normally be shared with your spouse. These friendships can develop innocently, or perhaps manipulatively from a deliberate intruder.

The Participating Spouse: When the hurting spouse is left out of fulfilling this intimate role within the marriage, the spouse participating in the emotional affair pulls the third-party person in to play the role of companion, confidant, and the emotionally supportive partner. The unfairness this plays on the spouse participating in this situation is, the effect causes a bifurcation of consciousness. Or, a splitting of your heart emotionally into two directions for two different people. Your spouse is the primary person you loved well enough to initially marry. Rather than dealing with improving your marriage, the arrangement of having a third-party relationship is much easier to have your cake and eat it too. In other words, two people can nourish your needs while you do very little to fulfill your own needs or the needs of your marriage. Unfortunately, however, this limits your capacity to experience deep love with your spouse. You are cheating yourself from a wholehearted loving experience by partially loving two different people.

Marriage takes a concerted effort to be a good marriage. By participating in two relationships that fill your emotional needs; you are, in reality, denying yourself the discipline and skills for maintaining a healthy relationship with one person. You are denying yourself development to be a quality partner for anyone; and, you are not working on improving your marriage. In effect, you are passively having your needs met by two different people. This lack of personal development of not dealing with the demands of a quality marriage in a healthy manner may be the result of sincere clinical denial, unable to see the dysfunction of the relationship triangle. Or, it may be plain old apathy, meaning emotional indolence.

The Third-Party: Provided that the emotional affair evolved out of innocent friendliness, the unfairness of the emotional affair for the third-party person is, they are essentially being used to fulfill your emotional emptiness. Provided that the third-party person is not having a sexual relationship with you, they may fanaticize of having an intimate relationship, perhaps a serious relationship with you when you have no intentions or desires of going down that road. This holds the third-party person stationary in their life from perusing a healthy relationship with someone else who could love them wholeheartedly, instead of part-time when you feel the need for them. Essentially, you are cheating the third-party person from a having real relationship.

On the other hand, a third-party intruder who deliberately initiated the emotional affair manipulatively may be left with boredom and frustration when the thrill of accomplishment wears off and they did not find the fulfillment they had initially fantasized about.

The Hurting Spouse: The spouse left hurting is left hurting for obvious reasons. Betrayal of trust, secrecy, dishonesty, feeling threatened of losing your love, and emotional betrayal that their spouse, you, could have feelings or love for someone else. When the participating spouse does not engage their (hurting) spouse as their emotionally intimate partner, the spouse left hurting is, unknowingly, disadvantaged to nurture the marriage or their spouse appropriately.

The hurting spouse is cheated from knowing their partner wholeheartedly because the spouse participating in the emotional affair is diverting his or her thoughts and feelings somewhere else, to a third-party person. This adds to the emotional gap between the spouses because the hurting spouse is without awareness of the true person they are married to, thus, is unable to interact with their loved one to fulfill their needs. The spouse left hurting, unfortunately, is interacting with a façade the participating spouse presents to them, because the participating spouse is hiding their true self, in addition to hiding their involvement with their third-party friend. The hurting spouse is also cheated from receiving wholehearted love from their loved one because their loved one is pouring energy into someone else, the third-party person.

The emotional pain from these experiences can be long-lasting and take time to work through. Re-establishing trust can be a slow process with experiences of ups and downs before reaching comfort with each other. Placing your spouse through the pain and challenges of an emotional affair by not exercising healthy boundaries in your behavior is an unfair lack of consideration that could have been avoided altogether. The situation neglects personal growth and development within the marriage. The overall effect of an emotional affair is that all three parties end up with an incomplete relationship.

Never too Late to Learn

Healthy boundaries protect yourself, and your marriage from unwanted influences, or painful misunderstandings, which may be sincere misunderstandings. Healthy relationships have healthy boundaries that prevent third-party intruders from overstepping boundaries that should be reserved for your marriage. Marriage is a responsibility. When we are in a loving committed relationship, we have a responsibility to hold that love in our hands with honor, respect, and appreciation. This is carried out by exercising respectful boundaries in your behavior to protect your marriage. Allowing someone to step into your emotional space is disrespectful, and deeply hurtful.

If you have never thought of healthy boundaries it is never too late to learn. Make yourself, and your marriage a work in progress for life. The willingness to grow, to make changes with yourself and your marriage not only helps you get the love you want but helps you keep the love you want [20].

Guidelines for the Healthy Boundaries Relationship Model

To set the ground rules for the Healthy Boundaries Relationship Model, the list of do’s and don’ts apply to the understanding of ourselves as sentient human beings. No one gets married with the commitment of ‘I will betray you.’ The commitment is to love, honor, cherish, and forgo all others. While there is nothing wrong with healthy third-party relationships, honoring your marriage should always come first. It starts by exercising respectful boundaries in your behavior.

The Model

First and foremost, start with having a conversation with your loved one about your relationship. Nothing underscores the importance of communication. Decide where you draw the line with third-party friends [7]. When developing your relationship consider creating a relationship notebook, so you can jot down your agreements. This is not a legal binding contract. It is a friendly note pad of your thoughts, feelings, and decisions you make together to keep you on track of ‘the marriage comes first policy,’ and to not forget what you talked about.

Cultivate friends that each of you enjoys socializing with together. Invite the third-party friend, and their partner to become friends with your spouse [21]. If your third-party friend is single, your friendship with that third-party person should change when you enter your committed relationship, your marriage. You are no longer a single person readily available for personal activities that may have once been a part of your casual friendship.

Your third-party friend should understand this without explanation. However, some people need direction.

If there is a third-party relationship that already makes you, or your spouse uncomfortable, nip it in the bud immediately. Do not deliver, or accept any excuses to rationalize or defend the third-party relationship [21]. Your marriage comes first over and above anyone else. Set defining guidelines on how to manage the third-party relationship. It may involve simply ignoring the third-party person. It may require a conversation, a letter, a meeting between the three of you to set healthy boundaries or eliminate the third-party relationship altogether. Whatever is initiated to change the dynamics of the third- party relationship, has to be carried out, and most definitely, maintained.

If your spouse is uncomfortable with your third-party relationship and setting boundaries is not an option, complete disengagement from the third-party relationship may be the only option. There is no one more valuable in your life than your loved one, your spouse. A friend, the third-party friend who is truly a friend ‘only’ should respect that, knowing that their friendship with you is just a friendship. Not a personal selfish need of theirs to have you, or your spouse at their disposal for their personal interests. If the third-party person knows that you or your spouse is uncomfortable, they should be respectful; back off, apologize, make corrections, or stay away altogether. The third-party friend should respect both of you as a couple because you are a couple, not a single.

The spouse in question also has a responsibility to reassure their partner that boundaries with the third-party person are being maintained. This may require personal conversations, or an open pass to see text messages, cell phone call logs, or emails. Everyone has their limit of sharing, and most especially passwords. So, consider this a boundary issue in your marriage as well. Instead of free reign to see texts and emails, perhaps the openness of the spouse to randomly show you when you ask may be a polite option to open that boundary between you two. Transparency is a fabulous passage for building and maintaining trust.

Do not cultivate private relationships with third-party people who may pose a threat to your marriage in anyway shape or form. Instead, cultivate relationships with other couples, or friendships that offer no means of threat of any type. Heterosexual married people can cultivate close friendships with others of the same sex; who can, and may become your best friend outside your marriage [21]. This rule holds true for any type of committed relationship between two people who love each other. Define this for yourselves in your lifestyle and your marriage.

With co-workers, civic committee members, volunteer members, other parents of your child’s class or group, your child’s teacher, your neighbor, or anyone who has the potential to cause havoc in your marriage or risk the potential of overstepping healthy boundaries, should be addressed in the confines of their appropriate role. If it’s a co-worker stick to business [22]. If it’s a committee member, stick to the committee agenda and so forth. Avoid developing personal or private relationships, but create open relationships that include your spouse and the third-party’s loved one as well.

Specifics: Specific guidelines are for you and your spouse to consider: Do not go out to lunch, dinners, or happy hour drinks alone with a third-party person co-worker. Go as a group [1]. Do not meet alone with third-party people if possible. Have your office door open, or an office with blinds open if possible [7]. Do not go out of town with a third-party person alone [1] and probably not as a group either. Let that person make their own way to their destination.  Consider taking your spouse with you when you go out of town for business or community projects that require travel. When you do travel out of town alone, make a point of calling your spouse every evening to check-in, or perhaps video chat. Offer reassurance of your love for them, and that you miss them. Rather there is an issue about boundaries or not, a little reassurance goes a long way to keep your marriage strong.

Be cognizant of a third-party intruder who demonstrates overly friendly gestures or flirting. Don’t feed into it. Ignore it, or tell the person you are uncomfortable. Do not deliver overly flattering comments that may come across as affectionate or flirtatious. Appropriate compliments have their natural place in all appropriate settings, so leave them there. Do not participate in conversations where you or the third-party opens the door for personal information. The privacy of your marriage is sacred space. Respect it and keep it private. Your problems with your spouse belong to you and your spouse, they are none of the third-party person’s business. Speak politely and kindly of the person you love to show the third- party person you are devoted to your spouse. Do not allow anyone to speak badly of your spouse with negative comments or name-calling. Always defend your spouse and inform the third-party person that insults and name-calling of any type are not acceptable in this manner. For the damsel in distress who needs your ear, encourage them to talk to the person they have the issue with, or get professional help [7]. You are not their therapist, and they are not yours either.

Do not keep secrets from your spouse at any time about your relationship, your feelings, or your interactions with a third-party friend. If you see that you are developing feelings for someone outside of your marriage talk to your spouse, or a therapist, but not the third-party person. Do not participate in personal private communications with the third-party person. This includes text messages, emails, private messages, any social media, Drop Box, video chats, or passing notes to each other at the office unless you are completely at ease to share it with your spouse. If your spouse becomes uncomfortable for reasons you did not anticipate, stop the communications. Take action to inform the third-party person that the private messages have to stop. Be honest with yourself about this and take care of it. If necessary, show your spouse that you took care of it and that there are no more communications. If communications cannot be discontinued for some reason, such as ex-spouses where children are involved, or other situations, see if copies of future correspondences can be openly shared with your spouse like a group text, or group email exchanges.

When out together and the third-party person is present with others, and/or a group event, avoid private dialogue with them that excludes your spouse. Include your spouse on the topic of the conversation that he or she may not understand if it is work-related for example. Or, avoid the third-party person altogether so you and your spouse can have a good time.

Reflect: Reflect inwardly. Are you feeling attracted to a third-party person? Do you think about them often, or compare them to your spouse? Would you be comfortable with your spouse doing any of the things you are doing with your third-party friend, that your spouse does not know about? Are you upholding your spouse’s requests? Or does the influence of your third- party relationship sway you from doing so? Do you and your third-party friend talk about your feelings for each other? Do you share your feelings and thoughts with your third-party friend more than your spouse? Do you isolate your third-party friendship away from your spouse? Do you feel sorry for the third party-person in such a way of taking on co-dependent behaviors to rescue them, to fix them, or fix their problems? Are you delivering excuses, defending your rationale for maintaining your third-party relationship when your spouse is uncomfortable, or highly upset about it? Is your third-party relationship coming between you and your spouse? Are you arguing about it? Has your committed relationship, your marriage broken up because of your involvement with a third-party friend?

If you answered yes to any of the above questions, you are in an inappropriate relationship with a third-party person. You are having an emotional affair, if not a sexual one. You are responsible for how you interact with others and how you allow them to interact with you. Be accountable for yourself as you would expect your spouse to do the same, and end the third-party relationship immediately. If your spouse is uncomfortable, do not dismiss their concerns. A wise person listens and respects the feelings of their loved one. Your marriage comes first, not the damsel in distress who can’t take care of him or herself emotionally, physically, financially, or in any manner. The same holds true if you are the one that is uncomfortable observing your spouse having a third- party friendship. Trust your intuitions! Confront your thoughts and your spouse honestly. Sooner is probably better than later.

Honesty: If you are in an affair of any type be honest with yourself. Be honest with your spouse. Honesty takes courage. As hard as it may be to face the embarrassment of confession and the fear of their reaction, it is much better to share the truth with your spouse than for them to find out otherwise. In many cases, the development of an outside friendship is not the insult to your spouse. It is the secrecy, the half-truths, and deception that betrays trust in your marital relationship that is most hurtful because it is a disregard for your spouse. And most especially, it ruins your character. It ruins the ‘good’ you with whom they knew and loved, which has now been lost to the pain of betrayal and the melting of trust that once embraced you both so lovingly.

Integrity starts with yourself. It belongs to you, so manage it in the best way possible. If you are afraid to be honest with your spouse about your feelings for your third-party friend, your emotional involvement, or sexual involvement, take comfort in the thought that your honesty may be a pivotal point in changing your marriage for the better. Your spouse will most likely be unhappy with the news, but they may ultimately respect you for finding the courage to be honest [23]. Honesty upholds the status of your integrity. Own it! Be honest with yourself and your spouse, because honesty may be your only option for staying in your marriage to make it work. Regardless of your spouse’s response, it goes without saying, change will occur.

You have been Confronted? If you have been confronted by your spouse about a third- party relationship that makes your spouse uncomfortable, fix it! Basic human nature needs to be social and have friends is not the insult. It’s the denial of your overabundant involvement. It’s the inability or refusal to make corrections with yourself to honor your spouse’s feelings that is insulting. To not make corrections with yourself and your third-party friendship is an insult not only to your spouse, but is insulting to your marriage, and yourself as well. Your marriage and your love for your spouse comes first over and above your excuses to rationalize your third-party friendship while denying your spouse’s requests and feelings. Take time to nurture your marriage. Address your concerns with your spouse constructively. Be respectful. Be trustworthy. Show trust with your actions that demonstrate faithfulness, protection of your marriage, and your love for each other. Address issues in your marriage that caused you to seek emotional solace outside of the marriage. Quality communication, sharing your thoughts and feelings, and personal interests may have been missing, and this is an opportunity to restore these things to your marriage. Your marriage comes first over and above anyone, and most especially to a third-party intruder.

Recommendations

There is much to learn about the frequency of emotional affairs and the dynamics that lead up to it. It is recommended that more research continue in the social-psychological sciences, and amongst marriage counselors to determine a set classification of symptoms and patterns of this heart-shattering relationship dynamic. The focus is to better help the spouse in distress who does not understand the behaviors, feelings, and the psycho-dynamics of their loved one who appears to be involved with a third-party person emotionally, yet, not sexually. For the spouse in question involved in a third-party relationship, who, perhaps, might be in denial; research and open discussions are avenues to guide that spouse to awareness of their actions and further self- reflection. More awareness of this topic through public forums, social media, and discussion panels will help educate the public to understand emotional affairs, third-party relationships, and preventative measures before they occur.

Conclusion

There are many philosophies, theories, and relationship models that emphasize techniques for putting your marriage first. Healthy Boundaries Relationship Model is only one perspective to do so. How you gauge your boundaries is a private decision between you and your spouse. This model merely provides guidance to help you define who you are, who you are as a couple, how to avoid manipulation, and how you hold your marriage together with happiness. In any situation, however, be your best. Be wise, discerning, and put your marriage first.

Insert

Do’s

Don’ts

  1. Communicate! Discuss with your partner boundary guidelines that work for both of you. Make a list, write it down.
  2. Cultivate mutual friends.
  3. A single third-party friend should become a mutual friend to each of you, and spend time with both of you only.
  4. If the third-party friend has a partner, invite everyone together as a group.
  5. Make necessary changes in any third- party relationship if your spouse is uncomfortable. Set agreeable boundaries that are respectful to both of you.
  6. Reassure and show your spouse that these boundaries are being maintained.
  7. Create your closest friendships with people that do not threaten your spouse, such as members of the same sex, or opposite sex, depending on your lifestyle.
  8. Keep conversations professionally appropriate to work related topics, committee, community, or volunteer projects only.
  9. Professional engagements, lunches, dinners, drinks should be in groups only.
  10. Travel alone for business, or groups, or with your spouse.
  11. Keep compliments and acknowledgments to others appropriate for the circumstance.
  12. Speak honorably of your spouse to everyone, especially someone who appears flirtatious or interested in you.
  13. For third-party intruders who come to you with their personal problems, inform them you are not a therapist. Encourage them to seek appropriate help elsewhere.
  14. Be honest and open with your spouse at all times. Transparency opens your relationship to love and closeness.
  15. At social gatherings include your spouse in conversations they may not understand. If necessary, avoid socializing with the third-party person at events.
  16. Reflect. Be honest with yourself. Ask yourself if you are overly involved with someone in such a way that it is causing conflict in your marriage.
  17. Listen carefully to your spouse. Be receptive of their needs and requests.
  18. Be honest with your spouse in every way.
  19. If an affair has occurred, talk it out. Apologize, find forgiveness if possible. The marriage doesn’t have to end, but change must occur. Try to work things through if possible.
  20. Put your marriage and your love for your loved one first.
  1. Do not ignore this issue with your spouse when it needs to be made clear.
  2. Do not separate your spouse from your friends, or hang out with previous single third-party friends as if you are still single.
  3. Do not allow third-party friends to encourage alone time with you. You’re not single anymore, you’re in a committed relationship.
  4. Do not exclude the third-party’s partner.
  5. Do not violate established boundaries that have been agreed upon.
  6. Do not hide information from your spouse, or disregard their feelings.
  7. Do not create best friend relationships with any third-party person that poses a threat to your marriage per your lifestyle.
  8. Do not engage in private, personal conversations with a third-party person that is unrelated to work, community, or social projects.
  9. Do not go out to lunch, dinner, drinks, or happy hours alone with a third-party person.
  10. Do not go out of town alone with a third- party person.
  11. Do not flirt or come across as overly flattering with others, and do not allow others to flirt with you.
  12. Do not complain about your spouse. Do not allow others to speak badly about your spouse either. Always hold their honor.
  13. Do not allow a third-party intruder to share their personal problems with you. Refrain from getting involved with their life drama and problems. And do not share personal information about your marriage with a third-party person.
  14. Do not engage in secrecy or hide a relationship from your spouse.
  15. Do not exclude your spouse from business conversations when socializing with groups that include the third-party person.
  16. Do not allow your feelings to develop for someone else. Do not hide this from your spouse if it has already occurred.
  17. Do not disregard your spouse’s feelings, worries, or insecurities.
  18. Do not deny the truth of your involvement with a third-party person that is causing problems in your marriage. Be honest with yourself and your spouse.
  19. Do not loose site of your marriage, and the depth of your loving relationship in spite of problems.
  20. Do not prioritize anyone over and above your spouse or your marriage.

References

  1. Cherry D (n.d.). Emotional affairs. Series about: Affairs and Adultery. Focus On The Family.
  2. Admin A (2014) Boundaries loving again after a pathological relationship. USA.
  3. Tartakovsky M (2018) Why healthy relationships always have boundaries & how to set boundaries in yours. Psych Central.
  4. Tatkin S (2011) Wired for love. Oakland, CA: New Harbinger Publications. USA Today. (1996, August). Many single women prefer married men. USA Today, 125.
  5. Ramsay K Life coaching certificate course (beginner to advanced). Udemy.
  6. Katherine A (1991). Boundaries where you end and where I begin. Center City, MN: Hazeldon.
  7. Caston M (2017) How to keep boundaries with the opposite sex.
  8. Cloud H, Townsend J (2000) Boundaries in dating. Orange, CA: Yates & Yates.
  9. Cloud H, Townsend J (1999) Boundaries in marriage. Orange, CA: Yates & Yates.
  10. Grant A (2014) Seven sneaky tactics that sway. Psychology Today 47: 43–44.
  11. Harrary K (1992) The truth about Jones town. Psychology Today 25: 62.
  12. Sarkissian H (2017) Situationism, manipulation, objective self-awareness. Ethical theory & Moral Practice. 20: 489–503.
  13. Noggle R (2017) Manipulations, salience, and nudges. Wiley Bioethics.
  14. Potter N (2006) What is manipulative behavior, anyway? Journal of Personality Disorders 20: 139–156.
  15. Daly J (2014) Keeping healthy boundaries. The Winnipeg Sun.
  16. Gottman J, Silver N (1999) Chapter 2 What does make marriage work. The seven principles for making marriage work (2ndedn). (p. 26). New York, NY: John Wiley & Sons, Inc.
  17. Mental Health (n.d.) Just answer mental health.
  18. Parr A (n.d.) Opposite sex friendships? Allen Parr Ministries.
  19. Lustbader W (2014) Emotional affairs: Why they hurt so much. Psychology Today.
  20. Hendrix H, Hunt H (1998) Getting the love you want. A guide for couples. New York, NY: Henry Holt and Company.
  21. Focus On The Family (n.d.). The Billy Graham rule: Should you be friends with someone of the opposite sex? Focus On The Family.
  22. Eckel S (2019) The power of boundaries. Psychology Today.
  23. Christy H (2017) The importance of being honest in marriage.

UK Specialists’ and GDPs’ Use of Systemic and Local Antimicrobial Administration in Periodontal Therapy: A Questionnaire Study

Abstract

Aim: The aim of the present study was to evaluate the use of antimicrobials, the prescription patterns and the reason(s) for prescribing antimicrobials when treating periodontal disease in selected UK General Dental Practitioner (GDP) and Periodontal Specialists. 

Materials & Methods: The questionnaire consisted of 21 questions and was sent to 488 Periodontal Specialists and 488 GDPs. Data management and analysis was performed using Microsoft Excel, SPSS® version 22.0 software and frequency distributions, cross tabulation tables and graphs were constructed from the data. Any association between variables was tested at the 5 % level of significance (P≤ 0.05).

Results: The questionnaires were completed by the Specialists (38.72%) (n=189) and 23.36% (n=114) of the GDPs.  The results indicated that the use of systemic and local antimicrobials followed the current guidelines. Specialists prescribed more systemic antimicrobials than the GDPs, although Specialists limited the use of local antimicrobials. The GDPs reported that decision making was difficult when to use local antimicrobials although recognised that using local antimicrobials were more effective than root surface debridement alone. Other reasons for using antimicrobials were based either on the patient request or patient satisfaction with the treatment. Lower frequency of antimicrobial use was reported in regeneration and implant procedures by both Specialists and GDPs although the Specialists were more inclined to use antibiotics/antimicrobials in these procedures.

Conclusions: The results of the study suggested that there was a need for dentists to follow current guidelines when prescribing antibiotics/antimicrobials in order to avoid unnecessary prescriptions, antibiotic resistance and adverse drug reactions.

Keywords

Adjunctive Use, Antibiotic Prescribing, Evidence-Based Guidelines for Prescribing, Management, Periodontal Diseases

Introduction

The effectiveness of adjunctive antimicrobial or antibiotic therapy in periodontal disease and implant placement has been strongly supported in the published literature [1-3]. However other studies both in the United Kingdom (UK) and in countries outside the UK have reported that antibiotics/antimicrobials may be inappropriately prescribed and used by dental practitioners [4-11].  Several investigators have also reported on the effect on non-clinical factors such as requests or demands from patients [8, 10]. From these studies it was evident that there is a need to not only to provide both General Dental Practitioners and Specialists with clear and concise guidelines on what and when to prescribe appropriate antimicrobials/antibiotics together with the correct dosage and duration of use but also the need to continually update their knowledge in attending continuing professional education courses and basing their prescribing habits on evidence-based clinical practice [7-8]. According to Gillam & Turner [12] the importance of current and updated recommendations and guidelines on the appropriate use of antibiotics/antimicrobials in general dental practice cannot be underestimated.  More recently several tool kits and guidance notes on dental prescribing have been made available such as the SCECP Scottish Drug Prescribing for Dentistry and the NHS England Public Health England Dental antimicrobial stewardship: toolkit. [13-14]

Materials and Methods

Aims and Objectives

The objective of present study was to evaluate the use of antimicrobials, the prescription pattern and the reason(s) for prescribing antimicrobials when treating periodontal disease in selected UK General Dental Practitioner (GDP) and Dentists who were on the Specialist list for Periodontics or who expressed an interest in Periodontics.

Questionnaire Design

The present study questionnaire was modified from Choudhury et al. [8] based on pre 1999 guidelines in order to implement the changes in the American Academy of periodontology (AAP) [15-16] classification and was assessed by the Queen Mary University of London (QMUL) Research Ethics Committee (QMREC1047) with the conclusion that no ethical concerns were present and the proposed study was considered to be of an “extremely low risk”. The questionnaire consisted of 20 questions which were mainly closed questions. Questions 1-4 requested the demographic data by identifying the age, gender, the years since graduation, and the type of practice. Question 5 requested information in relation to the amount of time allocated by the participants for root surface debridement for each quadrant and whether any local anaesthesia was used. Question 6 related to a question whether the participants prescribed local or systemic antimicrobials for periodontal conditions. Questions 7-11 attempted to determine the indications of use of the antimicrobial in periodontal diseases, and Questions 12-18 aimed to gain information about decision making in the choice of local/systemic antimicrobials in treating periodontal conditions, rationale for use or not using and whether the treatment was success/unsuccessful.  Questions 19-20 determined to obtain the information of attendance on courses on antimicrobials in periodontal therapy, as well as information on whether the respondent was a Member of a Specialist Society. The questionnaire consisted of four A4 pages. An introductory letter for participants was sent with each questionnaire together with a stamped address or prepaid envelope for those participants responding by the postal service (Royal Mail).

A pilot study using a cross-sectional self-administered questionnaire preceded the main survey in April 2013, during which time 100 questionnaires were given to dentists of different clinical disciplines. The participants were either staff members or postgraduate students working or studying in the Centre for Adult Oral Health at the Bart’s and The London School of Medicine and Dentistry, QMUL, London UK. The pilot study lasted for approximately 3 months (January to March 2013). The initial analysis of the pilot data enabled the investigators to check whether any clarification of the questions or improvement final layout of the questionnaire was required prior to distribution to practicing dentists on the GDC Specialist List or the General Dental Practice List. The selection of the practices for the present study was based on the available lists of Dentists from either the Specialist of Periodontics List or selected General Dental Practitioners (GDP) on the General Dental Council (GDC) Register respectively. The final version of the cross-sectional self-administered postal questionnaire survey was completed following very minor administrative revisions such as typographic errors prior to distribution. The practitioners on the Specialist list (388) were sent a questionnaire by Royal Mail. (A further 100 questionnaires were also distributed by EAP in April 2013 at a British Society of Periodontology (BSP) Conference in Manchester UK; and a randomized matched sample using addresses of General Dental Practitioners (GDP) on the GDC Register (488) were generated using a randomised number generator (RNG) (GraphPad Software Inc. 2002-2005). Due to time constraints a four-month period was allowed for to enable the participants to respond, no subsequent reminders were sent for those who did not response within this period. All completed questionnaires returned within the four-month period were included in the final analysis.

Statistical analysis

Data management and analysis was performed using both Microsoft Excel (Microsoft Office 2010) and SPSS® (version 22.0 software, IBM, Portsmouth UK) and Microsoft word 2010. Frequency distributions and cross tabulation tables were constructed and graphs for this data were plotted using Excel and Word software. For the description of median, standard deviations, minimum and maximum values for continuous data and frequencies and relative frequencies (proportions) for categorical data were also calculated. Statistical analysis performed on data from the returned questionnaires included both parametric and non-parametric tests and the significance level was set up at α = 0.05 (95%). Non-parametric tests were used if the data did not follow normal distribution. For categorical data, non-parametric tests were also used (Figure 1). Analysis performed included the following:

Steps of Data Analysis

JDMR 2020-303_David Gillam

Figure 1. Flow Diagram: Steps in Data Analysis.

  1. Calculation of mean values of age and years since graduation together with standard deviations
  2. Estimation of frequencies of answers for each question indicating categorical data
  3. A Chi-square test was performed in order to assess the association between two categorical variables, e.g. the relation of treatment chosen to the level of dentist’s interest
  4. Mann-Whitney tests were performed in order to assess the association between a continuous and a categorical variable, e.g. ease in decision making in using systemic or local antimicrobials and the General Practitioner/Specialist Periodontist status.

Data analysis from the present study was compared, where possible, to data from the original Choudhury et al. [8] study.

Results

Frequency distribution of the study participants

350 participants: 47 (13.4%) participants from the pilot study and from the main study 114 (32.6%) participants from General Dental Practice and 189 (54%) participants who were either on the Specialist List or who expressed an interest in Periodontology were included in the final analysis of the data. 

Characteristics of the pilot study participants

The pilot study population included dentists of different clinical disciplines who were either staff members or the postgraduate working or studying in the Centre for Adult Oral Health at the Bart’s and The London School of Medicine and Dentistry, QMUL, London United Kingdom, the sample population (n=47) was investigated. 100 questionnaires were handed out to the Dentists, and 57 questionnaires were returned (57%), of which 10 were incomplete or indicated as being not applicable to the individuals’ practice. In total 47 (47%) of the returned questionnaires were entered into the data set.

Demographic characteristics of the main study participants

The main study population included the Specialists (n=189) and GDPs (n=114) in the United Kingdom. A total sample population (n=303) was included in the main study.

Frequency distribution of the questionnaires of the main study population

In total 488 questionnaires sent out to the GDPs, and 119 questionnaires were returned (24.39%), of which 114 were usable (23.36%) and entered into the data base (Five participants reported that they had either, retired or that the questionnaire was not applicable to their practice).

The distribution of the questionnaire was in two parts: 1) 388 questionnaires were sent out to the Specialists in the Specialist list, and 109 were returned of which 98 were entered (11 questionnaires were either incomplete or not applicable to the individuals’ practice); 2) 100 questionnaires were handed out by EAP to the Specialists attending a British Society Meeting (BSP) in Manchester. Ninety-one (91) questionnaires were returned and completed. In total, 200 questionnaires (40.98%) were returned, and 189 (38.72%) were entered into the data set.

Age and years of graduation of the main study population

 The mean age of the 245 participants was 44.8 years (SD +/-11.96 years; age range 23-70 years, missing value 58). The mean years from graduation was 21.04 years (SD +/- 11.6 years; n=302, one missing value, range 1-48 years).

Gender distribution of the main study population of the GDPs and Specialists in the United Kingdom

The gender distribution of the main study population of the GDPs and Specialists were reported namely M:111/189 (58.73%); F:78/189 (41.27%) in the Specialist Group and M: 80/114 (70.18%); F 34/114 (29.82%) in the GDP Group.  The Specialist members therefore significantly comprised more females 41.27% (n=78) whereas the GDPs population comprised more males 70.18%% (n=80) (p=0.046).

Specialist membership in the main study population

85.56% (160, two missing value) were Specialist members whereas 14.91% (n=17) were GDPs. 85.09% (n=97) GDPs were not on a Specialist list. 14.44% (n=27) of participants who were Specialists reported that they did not have Specialist membership. Regarding the British Society Periodontology membership, 80% (148, four missing value) of specialist participants reported that they were members of the BSP and only 4.39% (n=5) of the GDPs were BSP members. Of those who were not members of the BSP 20% (n=37) were Specialists and 95.61% (n=109) were GDPs.

Lecture or course attended in systemic or local antimicrobial in periodontal therapy

A clear difference between the Specialist and GDP participants was observed when the participants were asked about their attendance on periodontal therapy lectures or courses in systemic and local antimicrobial therapy. There was a higher number of Specialist participants attending systemic [89.73% (n=166, six missing value)] or local antimicrobials in periodontal therapy, [76.50 % (n=140, six missing value)] compared to the GDP response [49.56 % (n=56, one missing value for systemic courses and 42.98 % (n=49, one missing value attending local delivery courses (p=0.0005 for both systemic and local delivery). One Specialist participant indicated that they gave a lecture on both systemic and local antimicrobial therapy in periodontal therapy.

Periodontal management

Duration allocated for root surface debridement (RSD) of an involved quadrant of 6-7 teeth of the main study population of the GDPs and Specialists in the United Kingdom

In relation to the allocation time for root surface debridement (RSD) duration of an involved quadrant of 6-7 teeth, GDPs tend to spend less time in RSD 51.33% (n=58) which was only up to 30 minutes. Whereas 27.03% (n=50) Specialist participants and 6.19% (n= 7) GDPs allocated up to 60 minutes for a quadrant. None of the GDPs reported spend more than 60 minutes for RSD whereas only 2.70% (n= 5) of Specialists reported that they spent more than 60 minutes (Table 1).

Table 1. Duration allocated for root surface debridement (RSD) of an involved quadrant of 6-7 teeth of the main study population of the GDPs (n=113) and Specialists (n=185) in the United Kingdom.

Item

Specialist society/list

N (%)

GDP

N (%)

P value

Up to 30 minutes

45/185 (24.32)

58/113 (51.33)

0.0005

Up to 60 minutes

50/185 (27.03)

7/113 (6.19)

>60 minutes

5/185 (2.70)

0/113 (0.00)

Frequency of participants routinely administer local anaesthetic (LA) for RSD procedure of the main study population of the GDPs and Specialists in the United Kingdom

When asked whether they would routinely administer a local anaesthetic (LA) for RSD procedures a higher number of Specialist participants 88.77% (n=166, two missing value) indicated that would tend to administer LA for RSD procedures compared to GDPs 62.39% (n=68, five missing value) (p=0.0005).

Frequency of the type of periodontal disease treated

All the Specialists 100% (n=188) and GDPs 100% (n=114) had observed patients with chronic periodontitis in their clinic.  A higher number of GDPs had observed gingivitis cases 99.10% (Table 2) (n=109) (p=0.061), apical periodontitis 84.90% (n=90) (p=0.099), and NUG 93.70% (n=104) (p=0.524) than the Specialist members however the difference was not significant. Whereas the Specialist members had treated aggressive periodontitis 94.14% (n=177) (p=0.0005), and unresponsive sites 90.10% (n=164) (p=0.0005) more than the GDPs.

Table 2. Frequency of the classification of periodontal disease treated of the main study population of the GDPs and Specialists in the United Kingdom (Please note the various descriptive terms to describe periodontal diseases has recently been reclassified).

Item

Specialist Society/List
N (%)

GDP
N (%)

P value

Gingivitis

168/177 (94.90)

109/110 (99.10)

0.061

Chronic periodontitis

188/188 (100)

114/114 (100)

ns

Aggressive periodontitis

177/188 (94.14)

78/106 (73.60)

0.0005

Apical periodontitis

139/181 (76.80)

90/106 (84.90)

0.099

Necrotising ulcerative gingivitis

171/184 (90.48)

104/111 (93.70)

0.524

Unresponsive sites

164/182 (90.10)

46/100 (46.00)

0.0005

Use of systemic and local delivery antimicrobials

Frequency of the use of systemic and local delivery antimicrobials: In general, more Specialist Society/List members reported that they had prescribed systemic antimicrobials as compared to the GDPs, whereas the local delivery antimicrobials were more frequently used by the GDPs compared to the Specialist Society/List members in treating the different types of periodontal diseases. Regarding the use of systemic antimicrobials, the Specialist Society/List members would more frequently use this type of antimicrobial therapy to treat aggressive periodontitis 76.90% (n=143, p=0.0005), and unresponsive sites, 33.16% (n=64) (p=0.008). Only one (0.57%) and (0.93%) of the Specialists and GDP used this antimicrobial therapy in gingivitis respectively (p=0.140). 

Regarding local antimicrobials, a small number of Specialist members 2.22 % (n=4) and GDP 4.80% (n=5) opted to use antimicrobial therapy in gingivitis respectively (p=0.005). There were no significant differences in the number of participants from both groups who opted to use local antimicrobials in chronic periodontitis, 17.43% (n=19) GDPs and Specialist members 9.44% (n=17) (p= 0.013, missing value 14).  There was no difference in the frequency of GDP 20.00% (n=17) who used local antimicrobials to treat sites and the Specialist members, 15.73 % (n=28). (p=0.0.395) (Table 3).

Table 3. Use of systemic and local delivery antimicrobials in periodontal therapy by GDPs and Specialists in the United Kingdom.

Item

Specialist Society/List

GDP

P value

Number

(%)

Number

(%)

Use of systemic antimicrobials

Often/routinely for gingivitis

1/174

0.57

1/107

0.93

0.140

Often/routinely for chronic periodontitis

11/184

5.98

5/112

4.46

0.404

Often/routinely for aggressive periodontitis

143/186

76.90

36/100

36.00

0.0005

Often/routinely for apical periodontitis

30/154

19.50

32/101

31.70

0.003

Often/routinely for necrotising ulcerative gingivitis

138/177

77.97

89/108

82.41

0.603

Often/routinely for unresponsive sites

64/177

33.16

18/79

22.78

0.008

Use of local antimicrobials

Often/routinely for gingivitis

4/180

2.22

5/104

4.80

0.005

Often/routinely for chronic periodontitis

17/181

9.39

19/109

17.43

0.013

Often/routinely for aggressive periodontitis

32/182

17.58

19/99

19.19

0.101

Often/routinely for apical periodontitis

4/173

2.31

8/95

8.42

0.0005

Often/routinely for necrotising ulcerative gingivitis

10/177

5.65

20/103

19.42

0.001

Often/routinely for unresponsive sites

28/178

15.73

17/85

20.00

0.395

Frequency and percentages of the Specialist Society/List vs. GDPs who prescribed antimicrobials in regenerative and implant procedure: The GDP group opted for prescribed antimicrobials in regenerative procedures 13.08% (n=14, nine missing value) or implant procedures 22.22% (n= 24, 9 missing value) less frequently as compared to the specialists (p=0.0005). Almost half of the Specialist members prescribed antimicrobials in regenerative procedures 45.60% (n=83, 12 missing value) or implant procedures 46.93% (n=84, 12 missing value).

Frequency of success perceived by the Specialist and GDP participants in the use of systemic and local delivery antimicrobials (often/routinely, very successful): Systemic antimicrobials as an adjunctive treatment was perceived to be a successful treatment by 78.33% (n=141, missing value 56) of the Specialist members compared to the GDP response [62.73% (n=69, 27), p=0.016]. In regard to local antimicrobials, the Specialists 25.55% (n=35, missing value 56) were less inclined to consider that antimicrobial therapy was successful as compared to the GDP response 32.58% (n=29, missing value 27) however this was not significantly different, p=0.172.

Ease in the decision-making process when using systemic antimicrobials in periodontal therapy: 97.88% (n=185) of the specialist members reported a median of 8 (0-10 scale) for the ease in making decision in systemic antimicrobial therapy whereas 98.25% (n=112) of the GDPs reported a median of 6 (p=0.0005, missing 6). Regarding the ease in the decision making process when using local antimicrobials, 92.60% (n=175) Specialist members reported a median of 8 (0-10 scale) whereas 94.73% (n=108) of the GDPs reported a median of 6 (p=0.0005, missing 28).

Stated reasons to use or not to use local antimicrobials: Of those using local antimicrobials, 65.85% (n=54) GDPs stated that a reason for use was the superiority of root surface debridement alone (p=0.0.50) whereas 27.63% (n=21) stated that the reason for use was more cost effective than any of the other options (p=0.333). The GDPs more frequently stated several reasons for this option namely 1) to avoid the need for surgery 56.41% (n=44) p=0.257, 2) patient requested the treatment 31.65% (n=25) p=0.011, and 3) patient satisfaction with treatment 53.25% (n=41) (p=0.0005).

In regard to the reason for not using local antimicrobials, the most commonly stated reasons were: 1) no need (Specialist members 74.13% (n= 106), GDP 66.67% (n=52), p=0.002, and 2) the lack of supporting research data (Specialist members 74.32%, GDP 55.70%, p=0.001. The lack of postgraduate training locally was also a reported discouragement for GDP 64.56% (n= 51) but was not for Specialist members 22.30% (n=31), p=0.0005 (Table 4).

Table 4. Stated reasons to use or not to use local antimicrobials in the main study population of the GDPs and Specialists in the United Kingdom.

Item

Specialist Society/List

GDP

 

P value

Number+

(%)

Number+

(%)

Stated reasons for using local antimicrobials

More effective than RSD alone

66/129

51.16

54/82

65.85

0.050

More cost effective than other options

27/129

20.93

21/76

27.63

0.193

Keen to try new treatment options

38/120

31.67

41/78

61.20

0.049

Avoids the need for surgery

57/127

44.88

44/78

56.41

0.257

Patient requests the treatment

16/124

12.90

25/79

31.65

0.011

Patient satisfaction with treatment

30/123

24.39

41/77

53.25

0.0005

Stated reasons for not using local antimicrobials

Cost

52/143

36.36

39/83

46.99

0.271

No need

106/143

74.13

52/78

66.67

0.002

Practicality of usage

47/140

33.57

43/76

56.58

0.011

Unsuccessful previous usage

60/138

43.48

40/75

53.33

0.404

Lack of supporting research data

113/152

74.32

44/79

55.70

0.001

Lack of postgraduate training locally

31/139

22.30

51/79

64.56

0.0005

Medico legal

10/136

7.35

12/71

16.90

0.103

Parameter of judgment of treatment success with antimicrobial therapy

The reduction in probing depth was judged to be the most frequent parameter for treatment success with antimicrobials by Specialist members 95.16% (n= 177) and the GDP 86.61% (n=97), p= 0.0005. This was followed by an improved attachment level by the Specialist members 88.65% (n=164) which was higher than GDPs 49.73% (n=92), p=0.0005. Both Specialist members 67.04% (n=120) and GDP 60.91% (n=67) had similar opinions regarding the radiographic support improvement, p=0.361. Microbial testing was the least parameter considered for treatment success in antimicrobial treatment (Specialist 10.34%, GDP 7.84%, p=0.282) (Table 5).

Table 5. Parameter for judgment of treatment success with antimicrobials in the main study population of the GDPs and Specialists in the United Kingdom.

Item

Specialist Society/List

GDP

P value

Number+

(%)

Number+

(%)

Patient satisfied with result

109/178

61.24

80/107

74.77

0.001

Reduction in bleeding

169/184

91.85

100/113

88.50

0.054

Reduction in probing depth

177/186

95.16

97/112

86.61

0.0005

Improved attachment level

164/185

88.65

92/185

49.73

0.0005

Reduced tooth mobility

129/181

71.27

94/113

83.19

0.012

Improved radiographic bone support

120/179

67.04

67/110

60.91

0.361

Microbial testing

18/174

10.34

8/102

7.84

0.282

Further steps to be taken when antimicrobial therapy was judged to be unsuccessful

The most common steps taken by the GDP when an antimicrobial was judged to be unsuccessful were 1) referral 94.29% (n=99), p=0.0005, 2) extraction 91.18% (n=93), p=0.001, and 3) re root debridement 90% (n=90), p=0.922.  There were no differences in the number of Specialist members 57.14% (n=92) and the GDP 62.63% (n=62) who opted for re root debridement together with a systemic antimicrobial if the antimicrobial was judged to be unsuccessful, p=0.200 (Table 6).

Table 6. Further steps when antimicrobial therapy was judged to be unsuccessful in the main study population of the GDPs and Specialists in the United Kingdom.

Item

Specialist Society/List

GDP

P value

Number

(%)

Number

(%)

Referral

57/170

33.53

99/111

89.20

0.0005

Re root debridement

154/172

89.53

90/106

84.91

0.338

Re root debridement + local delivery antimicrobial

70/162

43.21

56/98

57.14

0.019

Re root debridement + systemic antimicrobial

92/164

56.10

62/105

59.04

0.103

Periodontal surgery

165/182

90.66

56/106

52.83

0.0005

Maintenance

152/175

86.86

80/101

79.21

0.005

Extraction

153/176

86.93

93/108

86.11

0.0005

Associations between variables

In the main study result section, the data analysis of the survey consisted of four parts which explored the frequency distribution of the study participants, demographic characteristics, periodontal management and the use of systemic and local antimicrobial.

  1. The mean age of the sample was 44.8 years (range 23-70) and in relation to the years of graduation, the mean was 21.04 years (range 1-48). Regarding the gender, 36.63% of the population was male. The Specialist members significantly consisted of mainly females 41.27% (n=78) whereas males were dominant in the GDP group 70.18%% (n=80) (p=0.046).
  2. In terms of root surface debridement performed for a quadrant, the majority of the Specialist population opted to spend more time on the procedure as compared to the GDP population (p=0.0005). Specialists would also be more incline to routinely administer local anaesthetics for RSD (88.77%).
  3. The Specialist population treated more aggressive periodontitis patients than their GDP counterparts 94.14% (n=177) and unresponsive sites 90.10% (n=164) (p=0.0005).
  4. Regarding the use of systemic antimicrobials, the Specialist population would be more frequent to use systemic antimicrobial to treat aggressive periodontitis (76.90% (n=143), p=0.003), and for unresponsive sites (33.16% (n=64) p=0.008, missing value 55). Regarding local antimicrobials, a small number of Specialist members 2.22% (n=4) and GDP 4.80% (n=5) opted to prescribe this antimicrobial therapy for gingivitis respectively (p=0.005).
  5. There was a significant lower number of the GDP population who prescribed antimicrobials in regenerative procedures 13.8% (n=14) or implant procedures 22.22% (n= 24) (p=0.0005).
  6. Regarding the perception of successful treatment with antimicrobials, the GDP 32.58% (n=29) population opted to report that local antimicrobial therapy was often/routinely/very successful.
  7. The Specialist population noted that it was easier (median 8) to decide to use systemic and local delivery antimicrobials in periodontal therapy (97.88% and 92.60% respectively, p=0.0005).
  8. The most common reason for using local antimicrobial was because of its effectiveness; e.g., more effective than RSD alone as reported by the GDP population (65.85%), and this was significantly different when compared to the Specialist population (51.16%), p=0.050. The most common reason for not using the type of antimicrobial was due to lack of supporting research data which was reported by the Specialist population (74.32%, p=0.001)
  9. Reduction in probing depth was judged to be the most frequent parameter for treatment success with antimicrobials by the Specialist population (95.16%, p= 0.0005). Microbial testing was not considered to be a major variable for the treatment success in antimicrobial treatment, however no differences were noted between the groups (Specialist 10.34%, GDP 7.84%, p=0.282).
  10. The most common steps taken by the GDP population when antimicrobials were judged to be unsuccessful was referral to a Specialist 89.20%, p=0.0005, whereas the Specialist was more inclined to perform periodontal surgery 90.66%, p=0.0005.

Discussion

One of the main observations from the present study related to the BSP members’ demographic characteristics was the difference in the mean years from graduation namely 21.04 years (range 1-48 years). Regarding Specialist membership, a larger number of Specialists were members of a Specialist society (85.56%), and 80% were BSP members. In the present study (in comparison with the previous results from Choudhury et al. [[8]), a significantly proportion of BSP/Specialist members indicated that they had attended a course or lecture on systemic (89.73% vs. 88.3%) or local delivery antimicrobial delivery (76.50% vs. 90.9%) in the treatment of periodontal disease. These figures also contrasted dramatically with the responses of GDPs from the present study where the attendance was significantly different to that of the Specialist colleagues. This observation would appear to support the conclusions by Palmer et al. [7] who reported that there were significant differences in the knowledge of the use of antibiotics from those practitioners who attended a postgraduate course. The response rate to the present study compared reasonably to the response rate from previous questionnaires studies [17-18]. The response rate for the questionnaires in the Choudhury et al. [8] was 73% which was higher than the response rate in the present study. There were however, sufficient data to compare the results from the two studies, although it should be noted that the periodontal categories used in the studies were different as the studies used a different classification system of periodontal disease. In retrospect it may have been useful to construct a simple algorithm to compare the results. A note of caution however should be noted in regard to the recruitment of the BSP members as there may be a degree of unconscious bias due to number of questionnaires handed out at a BSP meeting in Manchester by EAP (e.g., 91% rate from 100 questionnaires).

The present study noted that the use of systemic antibiotics by the participants generally were in accord with both previous and current recommendations [2, 12, 16, 19-20].  The BSP members prescribed a more frequent use of antibiotics when treating more complex cases compared to GDPs. This practice may be due in part to the referral habits of the general practitioners who would refer the more advanced cases to Specialists (as recommended, e.g., BSP guidelines [based on the Basic Periodontal Examination]). One of the problems which may occur when referring patients with an advanced problem to a Specialist it may force the specialist to take a more aggressive treatment approach then if the patient had been referred at an earlier stage of the disease process [4].

No significant differences were noted between BSP members/Specialists and GDPs in the use of an antimicrobial in the treatment of chronic periodontitis, although a relatively small number of participants prescribed an antibiotic for the treatment of gingivitis. Both groups however prescribed both systemic and local antibiotics/antimicrobials for the treatment of aggressive periodontitis and necrotising ulcerative gingivitis. BSP members/Specialists would on account of their higher frequency of treating aggressive periodontitis, routinely prescribe antibiotics/antimicrobials whereas necrotising ulcerative gingivitis was mainly treated by the GDPs. When comparing the results from the present study to the previous findings of Choudhury et al. [8] it was evident that BSP members/Specialists prescribed antimicrobials more frequently to treat aggressive periodontitis (76.90% vs. 52.7%) however the treatment of the unresponsive sites was lower in the present study (33.16% vs. 49.6%.). However, this apparent different may be as a result of the changes in the American Academy of Periodontology (AAP) classification rather than an actual change in the treatment of the conditions [16, 21]. A further observation between the two studies was that in the present study, in comparison to Choudhury et al. [8], the BSP Members/Specialists reported the limited use of antibiotics and antimicrobials in general. In the present study the BSP members/Specialists were more inclined to prescribe an antimicrobial for regenerative (45.60%) or implant therapy procedures (46.93%), although the frequency of prescription was relatively low.  According to Heitz-Mayfield [2] this may be as a result of the limited data available on this practice which may subsequently lead to a degree of uncertainty by practitioners. This observation may also be true when considering guidelines and protocols for antibiotic prescribing regimens in dental implants procedures [11]. Regarding the use of a local antimicrobial, the results from the present study contrasted with the study by Choudhury et al. [8]. In general, a higher number of GDPs prescribed local antimicrobials as compared to the BSP members/Specialists although this was not statistically significant. This may be due to the perception by the GDPs that local antimicrobial therapy was more successful in resolving periodontal problems than BSP members. One observation that may be a concern was the observation that a relatively small number of GDPs (4.80%) prescribed an antimicrobial for the treatment of gingivitis. There are several reasons for this, for example a misunderstanding of what the question was asking or a random mistake when completing the questionnaire. However, this may by supported by several investigators who reported that there are numerous prescriptions which were not in accord with the normal recommendations [5, 10].

One of the problems that was apparent from the results from the present study was that of decision making in the prescription and use of antibiotics/antimicrobials for the treatment of periodontal disease. This may be due to a number of reasons, for example the lack of understanding or confidence in the evidence of the efficacy of a particular drug, in comparison to the Choudhury et al. [8] study where some of the antimicrobials were relatively new to the market GDPs were more willing to prescribe and use antimicrobials as a result of their ease of use. It was also apparent as indicated previously that the general perception of GDP’s was that the use of a local antimicrobial in treating periodontal disease would be successful. Furthermore, a higher number of GDPs choose to use a local antimicrobial as they considered it to be more effective than root surface debridement alone, and more cost effective than the other options in the questionnaire. Other reasons provided by the GDPs was that the use of a local antibiotic/antimicrobial would avoid the need for additional surgical procedure and that the patient often requested the treatment as well as indicating that patients were generally satisfied with the treatment. Regarding the reasons for not using a local antimicrobial, cost would appear to a barrier for the GDPs, however the lack of postgraduate training locally was also a major factor, which was similar to the previous study by Choudhury et al. [8] (64.56% vs. 47.6%). This was not surprising as it was evident from the significantly less numbers of GDPs who reported attending a lecture or course on local antimicrobial compared to BSP members/Specialists. The importance of updated one’s knowledge on this topic may therefore be a factor in the decision-making process as to whether to use or not use antibiotics/antimicrobials. There was however a strange anomaly in the responses from the GDPs in that they noted that one of the reasons for not prescribing an antibiotic as the lack of supporting research data in the literature. In comparison to GDPs, the BSP members/Specialists reported that they spent more than 30 minutes for debridement under local anaesthetic as compared to the GDPs. This would suggest that mechanical treatment performed by the specialist may be more effective than that of the GDPs who may spend less time due to the constraint of the NHS service provision.  A small percentage of the both specialist and GDPs in the present study reported that medico legal issues where a concern when considered whether to use/not use an antibiotic/antimicrobial. This would appear to be supported by the results of a questionnaire study by Lockhart et al. [22] who investigated the opinions and practices of infectious disease consultants regarding antimicrobial prophylaxis in dental procedures. 24% of the consultant population replied that the medico legal decision played a greater role than clinical data in the decision-making process.

When considering the success of an antimicrobial in the treatment of periodontal disease, both groups of participants indicated that the use of microbial testing was the least desirable variable to be taken into account when making a judgement, This observation was less than that reported in the Choudhury et al. [8] study (10.34% vs. 83.3%). When considering which of the clinical parameters were routinely used in their practice. BSP members/Specialists reported significantly higher numbers of these variables, for example in reduction in bleeding level, reduction in probing depth, improved attachment level, and improved in radiographic bone support. It is therefore evident from the results of the present study that while both GDPs and BSP/Specialist members followed the current recommendations when prescribing and using systemic and local antimicrobial in periodontal therapy there is still a requirement for practitioners to be aware of more recent and updated universally accepted protocols and guidelines on the appropriate prescription and use of antibiotics/antimicrobials.

Conclusion

The results of the present study would indicate that there were limitations in both, the awareness, knowledge and prescription by dentists in the use of antibiotics/antimicrobials in the treatment of periodontal disease. Furthermore, there does not appear to be consistency in prescribing in terms of antibiotics/antimicrobials, dose or duration in root surface debridement, regenerative and implant procedures. In conclusion there is therefore a need for dentists to follow current guidelines when prescribing antibiotics/antimicrobials in order to avoid unnecessary prescriptions, antibiotic resistance and adverse drug reactions.

References

  1. Preshaw PM (2004) Antibiotics in the treatment of periodontitis. Dent Update 31: 448–450, 453–4, 456. [crossref]
  2. Heitz-Mayfield LJ (2009) Systemic antibiotics in periodontal therapy. Aust Dent J 54: 96–101.
  3. Herrera D, Matesanz P, Bascones-Martínez A, Sanz M (2012) Local and systemic antimicrobial therapy in periodontics. J Evid Based Dent Pract 12: 50–60. [crossref]
  4. Preus HR, Albandar JM, Gjermo P (1992) Antibiotic prescribing practices among Norwegian dentists. Scand J Dent Res 100: 232–235. [crossref]
  5. Palmer NO, Martin MV Pealing R; Ireland RS (2000) An Analysis of Antibiotic Prescriptions From General Dental Practitioners In England. J Antimicrob Chemother 46: 1033–1035.
  6. Palmer NO, Martin MV, Pealing R, Ireland RS (2001) Paediatric antibiotic prescribing by general dental practitioners in England. Int J Paediatr Dent 11: 242–248. [crossref]
  7. Palmer NO, Martin MV Pealing R; Ireland RS, Roy K, Smith A; Bagg J (2001) Antibiotic Prescribing Knowledge of National Health Service General Dental Practitioners in England And Scotland. J Antimicrob Chemother 47: 233–237.
  8. Choudhury M, Needleman I, Gillam D; Moles DR (2001) Systemic and local antimicrobial use in periodontal therapy in England and Wales. J Clin Periodontol 28: 833–839.
  9. Mainjot A, D’Hoore W, Vanheusden A, Van Nieuwenhuysen JP (2009) Antibiotic prescribing in dental practice in Belgium. Int Endod J 42: 1112–1117. [crossref]
  10. Dar-Odeh NS, Abu-Hammad OA, Al-Omiri MK, Khraisat AS, Shehabi AA (2010) Antibiotic prescribing practices by dentists: a review. Ther Clin Risk Manag 6: 301–306. [crossref]
  11. Ireland RS, Palmer NO, Lindenmeyer A, Mills N (2012) An investigation of antibiotic prophylaxis in implant practice in the UK. Br Dent J 213: 14. [crossref]
  12. Gillam DG; Turner W (2014) Antibiotics In The Treatment of Periodontal Disease: A Guide For The General Dental Practitioner. Prim Dent J 3: 43–47.
  13. SDCEP Scottish Drug Prescribing for Dentistry Dental Clinical Guidance 3rd Edition Update June 2017. http://www.sdcep.org.uk/wp-content/uploads/2017/06/SDCEP-Drug-Prescribing-Ed-3-Update-June-2017.pdf
  14. Public Health England Dental antimicrobial stewardship: toolkit. Resources to help primary care practitioners promote the appropriate use of antibiotics in dental care. Published 9th November 2016; Updated 16th July 2019. https://www.gov.uk/guidance/dental-antimicrobial-stewardship-toolkit.
  15. Armitage GC (1999) Development of a classification system for periodontal diseases and conditions. Ann Periodontol 4: 1–6. [crossref]
  16. Armitage GC (2004) Periodontal diagnoses and classification of periodontal diseases. Periodontol 2000 34: 9-21. [crossref]
  17. Gillam DG, Seo HS, Bulman JS; Newman HN (1999) Perceptions of dentine hypersensitivity in a general practice population. J Oral Rehabil 26: 710–714.
  18. Gillam DG, Seo HS, Newman HN; Bulman JS (2001) Comparison of dentine hypersensitivity in selected occidental and oriental populations. J Oral Rehabil 28: 20–25.
  19. Palmer NA (2003) Revisiting the role of dentists in prescribing antibiotics. Dent Update 30: 570–574. [crossref]
  20. Dumitrescu AL (2011) Chapter 3 The Systematic Use of Antibiotics in Periodontal Therapy. In Antibiotics and Antiseptics in Periodontal Therapy. Ed Dumitrescu AL. Springer-Verlag Berlin Heidelberg 2011 Pg No: 79–169.
  21. Wiebe CB, Putnins EE (2000) The periodontal disease classification system of the American Academy of Periodontology–an update. J Can Dent Assoc 66: 594–597. [crossref]
  22. Lockhart PB, Brennan MT, Fox PC, Norton HJ, Jernigan DB, Strausbaugh LJ (2002) Decision-making on the use of antimicrobial prophylaxis for dental procedures: a survey of infectious disease consultants and review. Clin Infect Dis 34: 1621–1626.

An In Vitro Comparison of A Novel Self-Assembling Peptide Matrix Gel and Selected Desensitizing Toothpastes in Reducing Fluid Flow by Dentine Tubular Occlusion

Abstract

Objectives: The objective of this explorative in vitro study was to evaluate the ability of a novel self-assembling peptide matrix gel with calcium phosphate in effectively occluding dentine tubules compared to selected desensitizing toothpastes.

Methods: Mid-coronal dentine discs with a thickness of 1 mm were sectioned from caries-free human molars. The discs were etched with 6% citric acid for 2 minutes, halved and subjected to a 2-minute brushing with a novel gel (SAPM) and three selected desensitizing toothpastes ([SRP], [SRR] and [CSP]). The ability of the desensitizing gel and toothpastes to occlude the dentine tubules was assessed and compared before and after brushing using Scanning Electron Microscopy (SEM) on both etched and fractured dentine surfaces. The SEM observations were supplemented by hydraulic conductance measurements using a modified Pashley model before and after tooth brushing (n=5).

Results: The results demonstrated that there was a reduction in both the number and the diameter of the open dentine tubules, which was evident for all the treated dentine discs. The particles that occluded the open dentine tubules, however had different morphologies and distribution. The self-assembling peptide matrix gel (SAPM) demonstrated greater reduction in the number of open tubules compared to the other desensitizing toothpastes. Reductions in the hydraulic conductance measurements were observed for all tested materials (mean [SD, %]: SAPM 55.1 [12.5], SRP 64.9 [18.5], SRR 39.1 [17.1] and CSP 27.6 [6.8]). No statistically differences were observed between the SAPM and SRP, SRR toothpastes (paired t-Test; ≤0.05) although a significant difference was noted between the SAPM and the CSP toothpaste. There was an overall trend for reduction for the SAPM compared to the SRR toothpaste.

Conclusion: The results would suggest that a novel self-assembling peptide matrix gel (SAPM) was effective in blocking the dentine tubules and may therefore have the potential to be an effective desensitizing product for the treatment of Dentine Hypersensitivity.

Keywords

Self-assembling Peptide Matrix, Desensitizing Toothpastes, Tubular Occlusion, Hydraulic Conductance

Introduction

According to Hill & Gillam [1] Dentine Hypersensitivity (DH) is a clinical problem that may have impact on the Quality of Life of individuals who experience discomfort when eating and drinking hot and cold food during their day to day activities. The condition is postulated in the Hydrodynamic Theory [2] to be a result of minute fluid shifts within the dentine tubules following an external stimulus (e.g., cold, heat etc.). Currently toothpastes, gels and mouthwashes are designed to reduce or relieve pain arising from DH based on either their 1) tubular occluding components (e.g., silica, calcium carbonate, hydroxy- or nano-hydroxy apatite(s), oxalates or bioactive glass) or 2) nerve desensitization properties (e.g., potassium ions). Most of today’s commercial products have been reformulated from well-established technologies [3–5]. One of the few new developments representing a biomimetic approach to remineralization and thus being an alternative to the traditional desensitizing products for treating DH, is a self-assembling peptide matrix (SAPM) gel. The biomimetic self-assembling peptide P11–4 (SAP P11–4) has been shown to be effective as a non-invasive treatment for early stage dental caries [6–12]. In the treatment of early caries SAP P11–4 has been shown to diffuse into the subsurface micro-pores of enamel and form a 3D scaffold/matrix/hydrogel thereby mimicking the enamel matrix original function during tooth development, to support apatite crystallization, thus reversing tooth decay [6, 8]. According to previous reports SAP P11–4 (Ace-Gln-Gln-Arg-Phe-Glu-Trp-Glu-Phe-Glu-Gln-Gln-NH2) self-assembles into a matrix or hydrogel [13] under defined conditions. This matrix can support biomimetic mineralization and enamel regeneration [9]. The glutamic acid residues on the surface have been shown to act as nucleation sites for apatite formation and result in remineralisation of the lesion body [14].

The first product based on SAPM for treatment of Dentine Hypersensitivity (DH) has been marketed (Curodont D’Senz, Credentis ag, Switzerland). It has been recently shown to be effective in reducing DH in a randomised clinical study by Schlee et al. [15], demonstrating faster desensitization than a toothpaste including 5% Arginine and Calcium Carbonate. This product uses the same self-assembling peptide as included in the product for remineralization of carious lesions but was formulated as a gel with the self-assembling peptide in its assembled (i.e. matrix, SAPM) state. The SAPM is able to form a film on the dentine surface, without undergoing any chemical or physical transformation, solely by binding to the available Calcium ions on the tooth surface [14].

The in vitro measurement of fluid flow (hydraulic conductance [Lp]) in the dentine disk model has been used to assess the ability of desensitizing agents in treating Dentine Hypersensitivity (DH) [16]. According to Bränström [2] the mechanism underpinning the hydrodynamic theory is associated with rapid minute shifts in dentine fluid flow within the open dentine tubules, which acts as a capillary bore when a stimulus (e.g., cold) is applied to an exposed dentine surface. Fluid flow is dependent on the fourth power of the radius and therefore, any reduction in the diameter of the dentine tubule lumen should in theory reduce the fluid flow within the tubule, which in turn will decrease DH [16]. These investigators used a dentine section of approximately 1.0 mm in thickness to measure the hydraulic conductance of each desensitizing product applied on a dentine disc according to Greenhill & Pashley [16]. The aim of this explorative in vitro study was to investigate the ability of a commercially available SAPM containing gel in occluding dentinal tubules and thus reducing hydraulic conductance (fluid flow) through dentine.

Objectives

The main objective of this explorative in vitro study was to access the ability of a novel SAPM gel in reducing fluid flow (hydraulic conductance [Lp]) by tubular occlusion and to compare the effectiveness of the SAPM to three desensitizing technologies incorporated into toothpastes with established tubular occluding properties e.g., Colgate Sensitive ProRelief [CSP], Sensodyne Repair and Protect [SRP], and Sensodyne Rapid Relief [SRR].

Methods: In the present experiments a mid coronal dentine disc was used in a modified Pashley cell (Figure 1) [10, 17]. The fluid flow through the dentine discs was measured for the SAPM Gel and three selected desensitizing toothpastes (Table 1). The non-treated dentine discs were used as a control to the measurements obtained from the treated dentine discs.

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Figure 1: Dentine Disc Preparation (Based on Mordan et al., [17]).

Table 1. The desensitizing toothpastes investigated in the study.

Toothpaste Investigated

Company

Principal Ingredients

Self-Assembling Peptide Matrix Gel (Curodont D’Senz)(SAPM)

Credentis AG

P11–4

 

Colgate Sensitive ProRelief (CSP)

Colgate Palmolive

Pro-Argin(5% Arginine) Calcium Carbonate

Sensodyne Repair and Protect (SRP)

GSK Consumer Healthcare

Calcium phosphosilicate (Novamin) Bioactive Glass

Sensodyne Rapid Relief (SRR)

GSK Consumer Healthcare

Strontium Acetate*

*Current formulations include Stannous Fluoride instead of Strontium Acetate

Dentine Disc preparation: Caries free extracted mandibular and maxillary molars were used for the study. Teeth were obtained from the tooth bank at the Royal London Dental Hospital under agreed Ethics Committee approval (QMREC 2011/99). Teeth were stored in a 70/30 ethanol/water solution within the Department of Dental Physical Sciences under the Human Tissue Act (2004) regulations prior to the evaluation of the selected products.

The criteria for the teeth selection were as follows:

  1. Molar teeth.
  2. Large molar teeth, with a dentine area of at least 6 mm in diameter.
  3. Carious free.

The selected teeth were cleaned and stored in a 3% sodium hypochlorite solution (prepared from 14% sodium hypochlorite solution after dilution) for 24 hours to allow for disinfection. After the disinfection procedure, the teeth were stored in 70/30 ethanol/water prior to use. Each tooth was fixed in a sample holder using impression material compound (Kerr, Model: 813–00425) and placed perpendicular to the annular diamond coated blade of a precision slicer (Microslice II, Malvern Instruments, UK). The crown of the tooth was discarded, and the cutting continued below the dentine-enamel junction to produce discs consisting of mid coronal dentine (Figure 1). The diamond blade was adjusted to result in discs with a thickness of 1 mm. The prepared discs were then stored in 70/30 ethanol/water.

Polishing, Cleaning and Etching of Dentine Discs

Prior to the assembling of the dentine discs into the Pashley permeability holder (cell), they were polished, cleaned and etched. The polishing step was completed by wet polishing both sides of the dentine discs against a series of silicon carbide grinding paper (P800 – P4000 equivalent to 5 µm) using a polishing machine (Kent 4 Automatic Lapping & Polishing Unit, Kemet International Ltd., UK). The thickness of the polished dentine disc was measured using a digital Vernier calliper (AK962EV, Sealey). The polished dentine discs were cleaned (2x5min) in an Ultrasonic bath (Kerry Ultrasonic bath), the water was changed after the first five minutes. 

Dentine Tubule Occlusion Evaluation by Scanning Electron microscopy (SEM)

The dentine discs were etched (6% citric acid; 2 min) and rinsed thoroughly with de-ionised water. Each test surface was marked and then fractured into two halves using dental pliers, one half was used as a control, and the other half was subjected to two minutes brushing with 0.1 ml toothpaste by an electrical toothbrush with a sensitive brush head (Oral-B Trizone 5000, UK). Following brushing, the discs were rinsed by water and dried in air. All four test products described in Table 1 were evaluated and new brush heads were used for each of the test toothpastes.The control-half dentine disc and the test-half treated were again halved into quarter discs. A quarter from each half was prepared for SEM analysis. The specimens were gold coated and viewed under a field emission scanning electron microscope (FEI Inspect F, Oxford Instruments, Oxfordshire, UK) in the secondary scanning imaging mode at a voltage of 10 KV and a working distant of 10 mm. The deposit on the surface of the dentine and the distribution of the particles around and within the dentine tubules was investigated. SEM images were taken at the same region (close to the centre of the dentine disc) of the control and treated dentine disc with same magnification(s) (2000x, x 5000x, 10,000x and 20,000x) to evaluate the effectiveness of the ability of each toothpaste in occluding the dentine tubules. A cross section of a dentine disc was prepared by cutting one dentine disc in half using dental pliers [17]. The section designated the ‘test’ half was treated by applying the SAPM according to the Manufacturer’s instructions and viewed under the SEM.

Permeability Measurement (Hydraulic Conductance [Lp])

Following cleaning, the etched dentine disc was then placed in the Pashley specimen holder and prepared for the measurement of dentine permeability (hydraulic conductance). An air bubble (0.1 ml gas) was introduced into the system via a disposable plastic syringe, which then passed through the tubing and traversed the micro-capillary set up. The distance (in cm) that the air bubble travelled in the micro-capillary was recorded in one min intervals. Overall a continuous 10 min measurement was performed. The distance that the air bubble travelled was plotted against time, where a linear correlation was expected. The slope of the linear relationship was the fluid flow rate for the acid etched dentine disc. Following the application of the test products (see above) the toothpaste residual was rinsed with de-ionised water for five seconds and the fluid flow measurements were repeated in the same manner as described previously. The percentage reduction of the fluid flow was calculated using the following equation and presented in percentage (%).

JDMR 2020-302_David Gillam_F10

The selected desensitizing toothpastes investigated in the present study are listed in Table 1. 20 dentine discs were used for the permeability aspect of the study. Five discs were used in each of the four toothpaste groups.

Results

Figure 2–7 show the SEM images of the dentine discs 1) control (un-brushed sections) and 2) after brushing with the tested toothpastes at 3 different magnifications (2000x, 5000x and 20,000x) and a 3) cross-sectional view of the dentinal tubuli (Figure 2-3 only for SAPM). A magnification of 2000x gives an overall impression of the dentine tubules occlusion, where high magnification shows how the particles were distributed in and around the dentine tubules. The dentine disc treated with SAPM showed almost complete dentine tubule coverage by placing a hydrogel film over the dentine surface. The dentine disc surface was rather smooth with some big clusters presumably Dicalcium Phosphate particles from the formulation (Figure 2–4).

SEM images of dentine tubules treated SAPM before (left) and after treatment (right) can also be observed in Figure 4.

JDMR 2020-302_David Gillam_F2

Figures 2–3: Showing the hydrogel film of the SAPM gel covering the dentine surface: Figure 2 shows the top down view whilst Figure 3 shows the cross-section. The presence of large clusters was also observed which may be result of the deposition of dicalcium phosphate particles from the formulation.

JDMR 2020-302_David Gillam_F3

Figure 4: SEM images of dentine tubules treated with self-assembling peptide matrix (SAPM) before treatment (left) and after treatment (right).

CSP treated dentine discs showed levels of dentine tubule occlusion and a different morphology of the elongated particle, which has a tendency of forming clusters was observed (Figure 5). The dentine discs treated with SRP (Figure 6) provided levels of occlusion, however, a large area of open dentine tubules was observed. A small amount of fine particles (submicron level) was also observed on the dentine surface. Large clusters of particles also occluded some of the tubules. In contrast, the specimens treated with SRR formulation (Figure 7) provided better coverage compared with the SRP formulation (Figure 6). It was clear that there was precipitation of particles within the dentinal tubules as well as on the dentine surface.

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Figure 5: SEM images of dentine tubules treated with Colgate Sensitive ProRelief Toothpaste, before treatment (left) and after treatment (right).

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Figure 6: SEM images of dentine tubules treated with Sensodyne Repair and Protect Toothpaste, before treatment (left) and after treatment (right).

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Figure 7: SEM images of dentine tubules treated with Sensodyne Rapid Relief Toothpaste, before treatment (left) and after treatment (right).

Figure 8 demonstrated the variation of the fluid flow reduction (FFR) of the five discs used following the application of SAPM Gel (39.4%-65.7%). The mean FFR for the SAPM Gel was 55.1% which compared favourably to the other desensitizing products (Table 2). The percentage of fluid flow reduction by the SAPM Gel was statistically higher than for CSP, however no significantly differences were observed between the SAPM Gel and both SRP and SRR (paired t-test).

JDMR 2020-302_David Gillam_F7

JDMR 2020-302_David Gillam_F8

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Figure 8: Plot showing the fluid low changes of the dentine discs after 2 min brushing with the SAPM Gels (discs 1-5), where blue diamond represents etched control, and red square for after treatment (Fluid Flow Reduction [FFR] range: 39.4%-65.7%).

Table 2. Fluid Flow Reduction for the tested toothpastes (n=5).

Toothpaste

Mean FFR (%)

SD (%)

SAPM Gel

55.1a

12.5

CSP

27.6b

6.8

SRP

64.9ac

18.5

SRR

39.1ab

17.1

Discussion

According to Hill and Gillam [1] despite the vast array of commercial products designed either as professionally applied products or techniques (Dentist applied) or as over-the counter products (OTC) (Home use) there is no universally accepted product that can completely resolve DH. The desensitising technologies evaluated in the current in vitro study included a novel self-assembling peptide matrix (SAPM) gel and three selected desensitizing toothpastes with established tubular occluding properties namely 1) a technology consisting of arginine, a naturally occurring amino acid, and an insoluble calcium compound, in the form of calcium carbonate  (CSP), 2) a 45S5 bioactive glass formulation (SRP) and 3) a strontium acetate formulation (SRR). The use of SAP P11–4 as a non-invasive regenerative treatment for early stage dental caries has been documented [3–12]. Recent reports on favourable remineralisation after SAPM application have been published [18–19]. A randomised clinical trial investigating an SAPM Gel (as investigated in this report) demonstrated fast relief of DH compared to CSP [15]. An in vitro study by João-Souza et al. [20] also compared the desensitizing effects of selected toothpastes including a diluted SAPM formulation under erosive conditions. The other three test products of the present study (CSP, SRP, and SRR) have also been documented as effective desensitizing toothpastes based on both in vitro and in vivo evidence [3–4, 21–27].

The in vitro evaluation of desensitizing products was undertaken using the established methodology described by Greenhill & Pashley [16] and Mordan et al. [17], although one of the limitations using dentine discs from different teeth is the variability between and within the discs particularly when investigating hydraulic conductance (see variability with the fluid low within the five discs). This is due in part to the variation of the regional flow which may be affected by the proximity of the dentine disk to the pulp [27–29]. Other limitations of using this particular model relate to 1) the effect of the storage medium and the etching agents such as a sodium hypochlorite solution and citric acid which may impact and modify the dentine surface as well as the collagen; 2) the unknown age and history of the teeth and 3) the thickness, location and orientation of the dentinal tubules which may have an impact on any of the results from studies of this nature [30–34]. It should be noted, however that one of the original objectives of using the dentine disc was to identify the mode of action of the desensitizing agents as well as their potential as a therapeutic formulated product to treat DH [17].

All the treated discs in the present study resulted in a reduction in the number and the size of open dentine tubules on the surface of the dentine disc. This would suggest that there was a degree of effective tubular occlusion within all groups. The particles that occluded the open dentine tubules, however had different morphologies and distribution across the disc surface. The SAPM gel demonstrated the highest tubuli occlusion compared to the other groups, based on the SEM analysis. The SEMs of the treated discs suggested that the tubule occlusion originated by the placement of a hydrogel film of SAPM on the tooth surface. Yet, it is important to supplement the evidence from the SEM data by relating it to the hydraulic conductance measurements, as this new type of surface occlusion might result in a different degree of fluid flow inhibition as seen by insoluble particles from the conventional desensitisation groups. It is also important to recognise that the occlusion by the SAPM gel, does not involve any chemical or physical reaction, whereas all the other products rely on a precipitation reaction within the dentinal tubuli. For example, according to several investigators, arginine in the CSP formulation has been postulated to form a calcium arginine complex with calcium carbonate on the tooth surface and within the dentine tubules [1, 4]. The chemistry of this process however is poorly understood and has not been characterized in any detail [1]. The 45S5 bioactive glass composition in the SRP formulation was originally designed as a bone substitute and not as an additive in toothpastes for treating DH. It has been postulated that the glass particles dissolve in the mouth releasing Ca2+ and PO43- ions forming a hydroxycarbonated apatite (HCA) on the tooth surface and as such may not be acid resistant for permanent tubuli occlusion [1]. The main mode of action of strontium acetate (and strontium chloride) (SRR) for treatment of DH, has been suggested to be by tubular occlusion although the actual effect attributed to strontium in clinical studies has yet to be defined [35, 36]. Current formulations of SRR have replaced Strontium Acetate with Stannous Fluoride.

Most of the toothpastes evaluated in the present in vitro study exhibited very good tubule occlusion and fluid flow inhibition following tooth brushing, the exception being SRP that was less effective in occluding the dentinal tubules (Figs 4–8, Table 2). One possible reason for this observation was that in the mouth this toothpaste reacts with saliva to form hydroxyapatite and as such may perform more effectively in the clinical environment rather than in the in vitro setting, as has been shown in clinical trials [23, 25].The reductions in the dentine hydraulic conductance measurements were observed for all tested materials (mean [SD, %]: SAPM 55.1 [12.5], SRP 64.9 [18.5], SRR 39.1 [17.1] and CSP 27.6 [6.8]). No statistically differences were observed between the SAPM and SRP, SRR toothpastes (paired t-Test; ≤0.05) – possibly due to the small sample size in this explorative study – although a significant difference was noted between the SAPM and the CSP toothpastes. There was an overall trend for reduction for the SAPM compared to the SRR toothpaste.

Although the SAPM gel was effective in the present study compared to the other tested products there is currently only one report of a randomised clinical trial comparing its clinical efficacy to that of the CSP product [15]. An additional in vitro study has evaluated a SAPM containing product in a daily erosion toothpaste (with a much lower concentration of SAPM) [20], where the investigators reported that none of the desensitizing products showed any significant effects on tubular occlusion under the erosive conditions used. There are, however, significant differences in the methodology used in this study [20] compared to the current study. For example, the specimens were submitted to a 5-day erosion-abrasion cycling model and the fluid flow reductions were not shown as a time dependent graph, but rather as a value (with uncommonly large error bars). Furthermore, the toothpaste used in the João-Souza et al. study [20] included SAP P11–4 at a significantly lower level (1/30) than the product investigated in the current study. It would therefore be of interest to compare these two SAPM containing products in a future study to determine their individual effects on tubular occlusion and identify the optimal concentration and application frequency for SAPM.

Conclusion

The results from the current explorative in vitro study would suggest that a novel self-assembling peptide matrix gel was effective in occluding the dentine tubules and may therefore have the potential to be an effective desensitizing product for the treatment of dentine hypersensitivity.

Acknowledgement

The research was funded by Credentis AG, Switzerland

References

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  6. Kirkham J, Firth A, Vernals D, Boden N, Robinson C, Shore RC, et al. (2007) Self-assembling peptide scaffolds promote enamel remineralisation. J Dent Res 86: 426–430. [Crossref]
  7. Brunton PA, Davies RPW, Burke JL, Smith A, Aggeli A (2013) Treatment of early caries lesions using biomimetic self-assembling peptides – a clinical safety trial. Brit Dent J 215: 1–6. [Crossref]
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  10. Chen X, Gillam DG, Lysek DA, Hill RG (2014) In Vitro Evaluation of Dentine Remineralisation by a Self-Assembling Peptide Using Scanning Electron Microscopy. 61th ORCA Congress July 2–5, Greifswald, Germany, Abstract no. 40.
  11. Schlee M, Schad T, Koch JH, Cattin PC, Rathe F (2018) Clinical performance of self-assembling peptide P11–4 in the treatment of initial proximal carious lesions: A practice-based case series. J Invest Clin Dent.
  12. Bröseler F, Tietmann C, Bommer C, Drechsel T, Heinzel-Gutenbrunner M, Jepsen S (2019) Randomised clinical trial investigating self-assembling peptide P11–4 in the treatment of early caries. Clin Oral Investig 2019 Apr 29. [Epub ahead of print].
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  15.  Schlee M, Rathe F, Bommer C, Bröseler F, et al. (2018) Self-assembling peptide matrix for treatment of dentin hypersensitivity: A randomized controlled clinical trial. J Periodontol 89: 653–660. [Crossref]
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Brief Review of Enhanced External Counterpulsation (EECP)

Abstract

EECP (Enhanced External Counterpulsation) has been approved by the FDA (Food and Drug Administration) for management of refractory angina (class IIb). EECP uses 3 sets of pneumatic cuffs that sequentially contract during diastole, increasing aortic diastolic pressure, augmenting coronary blood flow and central venous return. EECP has been shown to improve angina symptoms, reduce nitroglycerin use, and improve exercise tolerance in patients with chronic stable angina. EECP has also been shown to be safe and beneficial in patients with symptomatic stable congestive heart failure. It’s been postulated that cardiac benefits of EECP are mediated though VEGF and Nitric oxide mediated vasodilatation and angiogenesis.  The Food and Drug Administration (FDA) has approved EECP therapy for heart failure patients.

Keywords

EECP (Enhanced External Counterpulsation), Angina Pectoris, Congestive Heart Failure, PCI (Percutaneous Coronary Intervention), Myocardial Infarction (MI), the International EECP Patient Registry (IEPR)

Introduction

Enhanced External Counterpulsation (EECP) is a noninvasive technology used in the United States to treat chronic severe angina that is refractory to medical management, especially in patients for whom intervention is contraindicated due to other metabolic conditions. (Class IIB) [1]. It was cleared by U.S. FDA in 1995 [2]. It is currently recommended as class IIB by the American Heart Association, as well as Chinese Medical Association, for refractory angina pectoris [3].

The evaluation of hemodynamic effects of counterpulsation was first studied in the mid-1960s. Water filled bags were wrapped around legs of patients with cardiogenic shock.  Soroff and colleagues first studied this technique in humans in 1965 [4].

One course of EECP involves 35 sessions designed as 1 hour sessions per day, 5 days per week

Methods & Materials

The technique involves sequential compression of 3 sets of pneumatic cuffs applied to the calves, thighs, and abdomen which are timed with early diastole of the heart based on EKG monitoring [5].  The patient is attached to finger plethysmograph and cardiac monitoring.  Inflation of the cuffs is timed with the R wave on EKG which corresponds with the diastole. This is followed by deflation just before systole. The main purpose is to enhance cardiac coronary perfusion during diastole by enhancing cardiac return and also enhancing backflow into coronaries during diastole. The deflation just before systole reduces the afterload by reducing systolic pressure and creating run-off, thus enhancing the cardiac output with reduced cardiac workload [3].

IMCI 20 - 301_Tak T-F1

Figure 1. Schematic of the sequential diastolic inflation and systolic deflations of leg cuffs during EECP therapy. 

The magnitude of clinical benefit of EECP is measured as a ratio of diastolic to systolic pressure during EECP called Effectiveness Ratio (ER).  It has been shown by Suresh, et al that the maximum benefit of EECP is obtained at an ER of 1.5–2. The goal of treatment for coronary disease is diastolic blood pressure /systolic blood pressure =Q>1.2 after counterpulsation [6]. However, Micheals, et al also reported that there is no additional benefit to higher ER with reduction of angina.  The clinical relevance of ER is confusing since it has also been shown that there is clinical benefit to patients with EECP in the absence of optimal ER.

IMCI 20 - 301_Tak T-F2

Figure 2. Finger plethysmogram showing the changes in vascular flow rate during EECP therapy; blue curve indicates blood flow without EECP; brown curve shows augmentation of blood flow as EECP cuff is inflated. [S: systole, D: diastole, T: transition (cuff inflation begins), EDP: end-diastolic pressure.]

Patients are screened at the time of referral for potential contraindications which include, but are not limited to, arrhythmias that interfere with machine triggering, bleeding diathesis, active thrombophlebitis, severe lower extremity peripheral vascular disease, presence of a documented aortic aneurysm requiring surgical repair, and pregnancy [1].

The 35-treatment sessions are typically completed once daily, Monday through Friday, for 7 weeks. However, extensions may be warranted for patients who display a late onset of improvement in symptoms. Patients are discouraged from missing scheduled sessions as lack of adherence to protocol may negatively affect the overall results.  Body weight, blood pressure, heart rhythm, and symptom assessment are recorded by the technician prior to each treatment session. The intended 60-minute treatment session is completed with as few interruptions as possible to produce the full benefit of the treatment. Although the treatment is generally well tolerated, blistering and bruising of the legs, leg pain, and back pain may occur in some patients [1].

Results

There have been multiple invasive studies that evaluated the hemodynamic effect of EECP on coronary flow. Michaels, et al evaluated the change in diastolic and systolic pressure in the coronaries, aorta, and intracardiac pressure while undergoing EECP with the help of left heart catheterization [7].  Central aortic pressure, intracoronary pressure, and intracoronary Doppler flow was measured while the patient was undergoing EECP in the Catheterization laboratory. The results unequivocally showed that there is a clear increase in coronary blood flow velocity and pressure during diastole with inflation of the cuff representing diastolic augmentation of the blood flow. Left ventricular afterload was reduced during systole with deflation, reducing the left ventricular work.

In a study by Sahebjami, et al, it was found that the frequencies of angina were linearly reduced in both diabetics and non diabetics after EECP therapy, but it was significant only in non-diabetic patients. Furthermore, the angina reduction only started occurring in the 5th week. It appears that diabetes is one of the obstacles for successful EECP therapies [8].

In an arteriogenesis network trial, it was shown that EECP improves fractional flow reserve and coronary collateral flow index. It has also been shown that EECP improves global left ventricular function in patients with coronary artery disease [9]. This was demonstrated by left heart catheterization at baseline and in 7 weeks after EECP therapy in patients with stable coronary artery disease with at least one stenosis amenable to PCI.  Invasive measurements of FFR and pressure derived collateral flow index were measured. The results were compared to a control group with no EECP. Results showed direct evidence for stimulation of coronary angiogenesis. This study indicates other modalities of benefit from EECP other than the acute hemodynamic changes.

EECP has also shown to benefit endothelial function by enhancing the release of nitric oxide and regulating endothelin-1 release, both of which play a role in maintaining vascular hemostasis. Masuda et al showed that there is a significant increase in plasma NO levels and reduction in neuro hormonal factors like human ANP and BNP after EECP treatment [10]. It also showed improved perfusion at rest and after dipyridamole in ischemic territories of myocardium on PET study after EECP, suggesting that development and recruitment of collateral vessels is one of the mechanisms of benefit [10].

EECP was shown to be effective in treating angina in patients with ischemic cardiomyopathy after CABG [11] although this is a small study with only 40 subjects. More studies are needed in this group of patients before it can be formally recommended.

Discussion

Further studies are needed to delineate the exact mechanism of both long term and short term benefit from EECP in chronic angina. Wu E et al conducted a qualitative study assessing the experiences of patients undergoing EECP therapy for refractory angina. The study showed that the patients were not that familiar with this treatment option prior to therapy [12]. This demonstrates the need for further education of patients and providers since it is a safe treatment modality with relatively limited side effects for refractory angina pectoris and severe congestive heart failure which also improves quality of life.

References

  1. Sharma U, Ramsey HK, Tak T (2013) the role of enhanced external counterpulsation therapy in clinical practice. Clin Med Res 11: 226–32.
  2. Wu E, Broström A, Mårtensson J (2019) Experiences of Undergoing Enhanced External Counterpulsation in Patients with Refractory Angina Pectoris: A Qualitative Study. J Cardiovasc Nurs 34: 147–158.
  3. Yang DY, Wu GF (2013) Vasculoprotective properties of enhanced external counterpulsation for coronary artery disease: beyond the hemodynamics. Int J Cardiol 166: 38–43.
  4. Soroff HS, Birtwell WC, Giron F, Collins JA, Deterling RA (1965) Support of the systemic circulation and left ventricular assist by synchronous pulsation of extramural pressure. Surg Forum 16: 148–50.
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  7. Michaels AD, Accad M, Ports TA, Grossman W (2002) Left ventricular systolic unloading and augmentation of intracoronary pressure and Doppler flow during enhanced external counterpulsation. Circulation 106: 1237–42.
  8. Sahebjami F, Madani FR, Komasi S, Heydarpour B, Saeidi M, et al (2019) Refractory angina frequencies during 7 weeks treatment by enhanced external counterpulsation in coronary artery disease patients with and without diabetes. Ann Card Anaesth 22: 278–282.
  9. Maryam Esmaeilzadeh, Arsalan Khaledifar, Majid Maleki, Anita Sadeghpour, Niloufar Samiei, et al (2009)  Evaluation of left ventricular systolic and diastolic regional function after enhanced external counterpulsation therapy using strain rate imaging. European Journal of Echocardiography 10: 120–126.
  10. D Masuda, R Nohara, T Hirai, K Kataoka, L.G Chen, et al (2001) Enhanced external counterpulsation improved myocardial perfusion and coronary flow reserve in patients with chronic stable angina. Evaluation by13N-ammonia positron emission tomography. European Heart Journal 22: 1451–1458.
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  12. Wu E, Broström A, Mårtensson J (2019) Experiences of Undergoing Enhanced External Counterpulsation in Patients With Refractory Angina Pectoris: A Qualitative Study. J Cardiovasc Nurs 34:147–158.

Cardiovascular Disease and the Evidence for Cystatin C as a Cardiovascular Risk Predictor in Native and Kidney Transplant Populations

Cardiovascular disease (CVD) in the form of coronary heart disease (CHD), stroke, or heart failure (HF) affects 9% of adults in the United States (U.S.) over the age of 20.1 When hypertension (HTN) is included in this grouping of CVD, its prevalence swells to 48% [1]. Meanwhile, peripheral arterial disease (PAD) has an estimated prevalence of 7.2% in American adults over the age of 40 [2]. Chronic kidney disease (CKD), defined as kidney injury or diminished glomerular filtration rate (GFR) lasting at least 3 months, is commonly associated with CVD and is an independent risk factor for CVD [3,4]. Furthermore, the risk of CVD in patients with CKD is significant, and patients with CKD are more likely to suffer from CVD than to progress to end stage renal disease (ESRD) [5]. There have been a number of pathophysiologic mechanisms posited with regards to the development of CVD in the setting of CKD. Abnormal vascular tone, hypertension, and endothelial injury can arise in CKD due to alterations in normal water and salt balance as well as activation of the renin, angiotensin, aldosterone system (RAAS) [6]. Runaway RAAS activity is also responsible for pathologic cardiac remodeling [6]. Hyperphosphatemia is a consequence of aberrant bone and mineral metabolism in CKD, and may cause direct vascular injury [7]. Hyperkalemia in the setting of CKD has been associated with cardiac conduction abnormalities [6]. The uremic milieu itself has been shown to contribute to CVD and anemia due to disruption of the erythropoietin (EPO) axis and functional iron deficiency have a correlative relationship to adverse cardiovascular outcomes [6,8]. In summary, there are numerous pathophysiologic mechanisms that may explain the increased CVD risk and events across various stages of CKD.

 It stands to reason then that estimated GFR (eGFR), as a measure of kidney function, would have some predictive value for cardiovascular outcomes. Indeed, a relationship has been described between declining eGFR and worsening risk for CVD. A few representative studies are highlighted here. Lees et al. found an association between decreasing eGFR and increased adjusted hazard ratios for adverse outcomes consisting of all-cause mortality, CVD, and ESRD [9]. Specifically, hazard ratios for adverse outcomes tended to be highest among patients with eGFR ranging from 15–30 mL/min/1.73m2, representing the group of patients with the lowest measured eGFR included in the study [9]. Guo et al. focused their investigation on the magnitude of eGFR decline over time and the effect of this change on risk for all-cause mortality and CVD events [10]. Their results had similar implications, as patients who experienced greater losses in GFR from one year to the next were at higher risk of mortality and CVD [10]. Therefore in addition to surveillance of renal function, it is imperative to define CV risk in CKD patients. In clinical practice, estimated GFR using creatinine (Cr) based eGFR equations has been the most commonly used approach to monitor renal function despite its limitations due to non-GFR determinants not accounted for in commonly used eGFR equations such as muscle mass and dietary protein intake for example [11,12]. Cystatin C (Cys C), another endogenous marker for estimating eGFR, is not influenced by body mass or dietary protein. It has been shown to have several non-GFR determinants including: elevated markers of inflammation, dyslipidemia, obesity, implying that inflammation and atherosclerosis may affect the accuracy of CysC-eGFR [12,13,14]. However the data has been overwhelmingly supportive of Cys C based eGFR as a better estimate of kidney function compared to Cr only eGFR in the native kidney population [15]. Furthermore, CysC and CysC eGFR have been shown to correlate with mortality and CVD [9,16,17]. Revisiting the study by Lees et al., though CVD risk was generally higher as Cr-eGFR and CysC-eGFR decreased CysC-eGFR was a more accurate predictor of mortality and cardiovascular events than Cr-eGFR [9]. Garcia-Carretero et al. found similar results with diminished CysC-eGFR being associated with higher hazard ratios of cardiovascular morbidity and mortality than Cr-eGFR [17].

In the kidney transplant (KTx) population, CVD remains the leading cause of death with a functioning graft [18]. Individuals in the KTx population remain subject to excess CVD risk due to recipient and donor characteristics which include: graft function, diabetes, history of dialysis prior to transplant, acute rejection events, and pre-transplant history of CVD [18,19]. Given significant differences between KTx patients and patients with native kidneys, it is appropriate to ask whether or not the evidence in support of Cys C as a preferred marker of eGFR and predictor of CVD risk holds true in the KTx patient population. With regards to the first question, Yang et al. found no significant difference between measured GFR and eGFR based on Cys C, while eGFR based on Cr significantly underestimated measured GFR [20]. However, Keddis et al. also compared the accuracy of Cr-eGFR and CysC-eGFR in a cohort of stable KTx recipients [21]. They found that CysC-eGFR measurements showed greater bias than Cr-eGFR, with greater inaccuracy and underestimation of GFR compared to Cr-eGFR [21]. In fact, Cys C was found to have more non-eGFR determinants than Cr in the KTx population [12]. In another study, Foster et al. examined the association of diminished CysC-eGFR and Cr-eGFR with mortality, cardiovascular events, and kidney failure [22]. They found that diminished CysC-eGFR was associated with significantly increased risk for cardiovascular events after adjustment for known CV risk factors. Diminished Cr-eGFR was also significantly associated with an increased risk for cardiovascular events. However, this relationship was not continuous and disappeared with multivariable adjustment [22]. Further studies are needed to validate the relationship of CysC-eGFR with CV events and mortality in the KTx population. In conclusion, there is strong evidence to support that Cys C and CysC-eGFR provide better CV risk stratification in the native and transplant kidney populations compared to Cr. Further studies are needed to guide the value of routine measurements and the clinical implications of identified CV risk using Cys C.

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  18. Stoumpos S, Jardine AG, Mark PB (2015) Cardiovascular morbidity and mortality after kidney transplantation. Transpl Int 28: 10–21. [Crossref]
  19. Kasiske BL, Chakkera HA, Roel J (2000) Explained and unexplained ischemic heart disease risk after renal transplantation. J Am Soc Nephrol 11: 1735–1743. [Crossref]
  20. Yang Y, Kim KY, Hwang I, Yim T, Do W, et al. (2017) Cystatin C-Based Equation for Predicting the Glomerular Filtration Rate in Kidney Transplant Recipients. Transplant Proc 49: 1018–1022. [Crossref]
  21. Keddis MT, Amer H, Voskoboev N, Kremers WK, Rule AD, et al. (2016) Creatinine-Based and Cystatin C-Based GFR Estimating Equations and Their Non-GFR Determinants in Kidney Transplant Recipients. Clin J Am Soc Nephrol 11: 1640–1649. [Crossref]
  22. Foster MC, Weiner DE, Bostom AG, Carpenter MA, Inker LA, et al. (2017) Filtration Markers, Cardiovascular Disease, Mortality, and Kidney Outcomes in Stable Kidney Transplant Recipients: The FAVORIT Trial. Am J Transplant 17: 2390–2399. [Crossref]

Global Photosynthesis is An Instrument in Large Natural Systems Studies

Abstract

The approximation of photosynthesis equation to describe global photosynthesis is considered. It is shown that the main features of global photosynthesis can be divided into features similar to traditional photosynthesis and features associated with its participation in the global carbon cycle. The global photosynthesis is used to describe interactions of geological and biosphere processes.

Key words

Carbon cycle, Ecological compensation point, Photosynthesis, Photosynthetic and heterotrophic Biomass, Lithospheric plates, Sedimentary organic matter,  Sulfate reduction

Photosynthesis is usually considered in respect to individual organism. Its formal description can be given as follows:

GEMS-2020-101_Ivlev AA_F3

where CO2 and H2O are photosynthetic substrates taken from the environment, (CH2O) is analog of biomass and O2 are photosynthetic products. They are produced in parallel during photosynthesis. In the most of cases CO2 is a rate limiting factor of the reaction. Hence, one can consider photosynthesis as the 1-st order chemical reaction whose kinetics is well examined. It stems from this approximation that changes of CO2 concentration and that of O2 concentration should be antiphase (substrate – product link), whereas biomass growth and O2 concentration (product – product link) should display proportional changes. In large systems, such as the biosphere or the global carbon cycle, which include a large number of individual organisms, photosynthesis should be considered as some generalized characteristic of an ensemble of organisms, which is defined as global. The photosynthesis equation for global photosynthesis should look otherwise as compared with equation (1), since the term “biomass” should be defined differently. At the time, the notable Russian geochemist [1], who investigated interaction of geological and biosphere processes, introduced the concept of “living matter”, defining it as the total biomass of all living organisms on the Earth. The term “living matter” as well as the “global photosynthesis” is a generalized characteristics. We used this term to describe global photosynthesis in the biosphere. As known, “living matter” consists of two parts: photosynthesized and heterotrophic biomass: 

GEMS-2020-101_Ivlev AA_F4

The “living matter” as a whole can be taken as a photosynthetic product consisting of the primary photosynthetic product, photosynthesized biomass, and the secondary photosynthetic product, heterotrophic biomass. When considering photosynthesis in the biosphere or in the other large system, it is evident the photosynthesis equation should look otherwise. In case of biosphere the equation should look like that:

GEMS-2020-101_Ivlev AA_F5

Indeed, equation (3) reflects the fact that CO2 and H2O are taken from the natural “atmosphere – hydrosphere” system, while resultant oxygen is released into the atmosphere. Equation (3) can be regarded as the equation of global photosynthesis, since the oxygen, which is released into the atmosphere, includes both the oxygen, produced by primary photosynthesizing organisms, as well as the oxygen, produced by those photosynthesizing organisms, whose biomass had become a source of carbon for the consumers of food chains [2]. Let’s see now, how the photosynthesis equation can be applied to the global carbon cycle. Given the above said and the key role of photosynthesis as well as that getting into the sediment, biomass turns into a sedimentary organic matter, the photosynthetic equation can be presented as follows:

GEMS-2020-101_Ivlev AA_F6

In equation (4) the biomass is presented by two parts. The first part is the biomass of currently living organisms. The corresponding portion of the oxygen released into the atmosphere. The second part of the biomass corresponds to the buried organic matter, which in the past was “living matter”. Oxygen, which corresponds to this part of the biomass converted into sedimentary organic matter, was released in the photosynthesis reaction, when corresponding organisms were alive. This oxygen has accumulated in the atmosphere. The validity of using the photosynthesis equation for the global carbon cycle is confirmed by two correlations of natural parameters. The first corresponds to the “substrate – product” relationship stemmed from photosynthesis equation. One can see the expected counter-phase correlation between time-averaged changes of CO2 and O2 concentrations in the atmosphere, obtained from model calculations in the Phanerozoic (Fig.1). The second correlation corresponds to the “product –product” relationship from photosynthesis equation (Fig.2)

GEMS-2020-101_Ivlev AA_F1

Figure 1. Changes in the atmospheric concentration of CO2 (solid line) and O2 (dashed line) during Phanerozoic eon. Abbreviation of the periods: S – Silurian, D – Devonian, C – Carboniferous, P- Permian (Palaeozoic era); Tr – Triassic, J – Jurassic, K – Cretaceous (Mesozoic era); Pg – Palaeogene and Ng – Neogene (Cenozoic era). Given that the reaction is of the first order, one can expect an antiphase link between CO2 and O2. The first two periods of Palaeozoic era (Cambrian and Ordovician) are not shown because there is some uncertainty around establishing the CO2 and O2 concentrations. CO2 estimates are from the Geocarb III model (Igamberdiev, Lea, 2006).

GEMS-2020-101_Ivlev AA_F2

Figure 2. The in-phase changes of oxygen content in the atmosphere and burial organic matter rates in the sedimentary rocks in Phanerozoic. The shaded zone for oxygen designates the zone of possible errors based on sensitivity analysis (Berner & Canfield, 1989).

One can see the expected syn-phase correlation between oxygen growth in the atmosphere and the increase in the mass of buried carbon (mol/million years) in the same time interval. Moreover, one can conclude that it is possible to neglect the biomass that corresponds to “living matter” as compared with buried organic matter. Following this approximation, the equation of photosynthesis for global carbon cycle can be simplified like that:  

GEMS-2020-101_Ivlev AA_F7

To use the term “global photosynthesis” in carbon cycle studies effectively, it is important to understand what properties of traditional photosynthesis could be applied to the global photosynthesis, according its definition [3]. The most important property is the presence of two reciprocally related processes – assimilation of CO2 and photorespiration. Besides, an increase in the concentration of CO2 in the environment strengthens the assimilation function, while an increase in the concentration of O2 in the atmosphere increases photorespiration. Therefore the CO2/O2 ratio is the important characteristic of the global carbon cycle. The growth of this ratio in the atmosphere causes sedimentary organic matter accumulation in the earth’s crust. In periods when the ratio drops, the organic matter content in the crust decreases. Like traditional photosynthesis, global photosynthesis is accompanied by isotopic fractionation. Notably CO2 assimilation and photorespiration are accompanied by the effects of the opposite sign. Increased CO2 assimilation (due to CO2

concentration growth) is accompanied with the enrichment of the biomass in light isotope 12С, while the strengthening of photorespiration (due to growth of O2 concentration) is accompanied by enrichment of the biomass with heavy isotope 13С. Unlike traditional photosynthesis, global photosynthesis does not have the capacity to ontogenetic changes. In addition to the features above mentioned, there are two important features of global photosynthesis, related to its participation in global carbon cycle. First is cyclicity, which is determined due to participation of global photosynthesis in orogenic cycles as their main element. Orogenic cycles, as known, are caused by the periodically recurring movement of lithospheric plates what leads to periodic injections of CO2 into the “atmosphere – hydrosphere” system. The combination of lithosphere plates’ motion with photosynthesis development provides climatic changes. The latter causes biotic turnover. Indeed, each orogenic cycle begins with low oxygen and high CO2 conditions and is completed with the inverse ratio of these parameters. Drastic climatic changes cause biotic turnover. The repetition of these cycles leads to natural selection, consolidation of useful properties and adaptability of organisms in different environment. It was manifested in the structural and chemical features of organic matter and oils observed in the course of evolution. Actually, each photosynthetic cycle begins with low oxygen and high CO2 conditions and completing with the inverse ratio of these parameters. It resulted in drastic climatic change causing mass extinction. The repetition of these cycles leads to natural selection, consolidation of useful properties and adaptability of organisms in different environment. The second important feature of global photosynthesis is spontaneous striving to a stationary state. It is a manifestation of the ability of each individual photosynthesizing organism to enhance the photorespiration in response to the increase of oxygen content in the environment. It goes on until the amount of the evolved carbon becomes equal to the amount of the assimilated carbon. This state is called ecological compensation point. It determines the boundaries of the physical survival of the organisms. It was also shown that a set of plants, placed in the closed camera, where photosynthesis occurs, in some time make the atmosphere in the camera stable [4], [5] conjectured that land plants are responsible for the equilibration of the atmosphere on the Earth. Developing this idea in respect to carbon cycle, we suggested the ecological compensation point concept. Taking into account that from the photosynthesis origin the oxygen content in the atmosphere steadily increased (Table 1) we believed that it went on up to the moment when biomass produced in photosynthesis became equal to the amount of organic matter oxidized to CO2 in the course of carbon turnover. We called this state the ecological compensation point. When the system achieved this state, all the processes in it became stationary and began to oscillate around some steady state level.

Table 1. Estimates of the average concentrations of O2 in the atmosphere during geological time, obtained by different models.

Eon / Era
Numerical age
Ma

Approximate
value

References

Precambrian/ Paleoproterozoic

2200 – 2000

~ 0,2 %

Holland 1998[7,8]; Bjerrum, Canfield, 2004 [9]

Precambrian/ Neoproterozoic

1700 – 570

2 – 3 %

Canfield, Teske, 1996 [10]

Phanerozoic/ Cambrian– Devonian

570 – 350

< 15 – 17 %

Berner, Canfield, 1989 [11]; Berner et al, 2000 [12]; Berner, 2003[13]

Phanerozoic/Carboniferous– Permian

350 – 230

25 – 30 %

Lenton, 2001[14]

Phanerozoic/ Mezozoic Triassic – Cretaceous

 230 – 145

20 %

Lenton, 2001 [14]; Bergman et al., 2004 [15]

Phanerozoic / Cenozoic / Neogene / Miocene

23

23 %

 

Berner [16], Kothavala, 2001 [17]

It was found this point was achieved in Miocene when new type of CO2 assimilation, called C4-type, has appeared [6]. Since this moments the regulation of the CO2/O2 ratio and the associated processes turned to be under the control and began to realize through the change in the ratio of C3/C4 type plants. The last feature of global photosynthesis has a very deep physical sense. Indeed, when the system became steady state it has become very unstable and dependent even on weak external impacts. Simultaneously many important vital parameters of the system, such as O2 and CO2 concentrations, surface temperatures, sea level, etc., which critical to humanity existence, has become unstable too. It makes people to follow closely variations of parameters to counter threats. From the stationary state of the global carbon cycle one can deduced that the amount of carbon produced in photosynthesis is approximately constant. Hence the amount of hydrocarbons produced by organic matter should be approximately constant too, as well as the amount of generated petroleum. Considering the steady state of oil reproduction and the ever increasing volume of its consumption, the expression that oil is a non-renewable resource acquires obvious sense.

Conclusion

  1. The term “global photosynthesis” is necessary to describe photosynthesis in large systems such as the biosphere or the global carbon cycle. On the basis of the equation of traditional photosynthesis, approximations were obtained that describe the “substrate – product” and “product – product” relationships in photosynthesis for the large systems, like biosphere and global carbon cycle.
  2. It is shown that to study the changes occurred during the evolution of the global carbon cycle, in particular, for the identification of orogenic cycles, it is possible to use such features of traditional photosynthesis as the dependence of photosynthesis products on environmental conditions, as features of carbon isotope fractionation and others features, excepting ontogenetic ones
  3. The features of global photosynthesis associated with participation in the global carbon cycle, such as cyclicality and spontaneous striving to a stationary state with oxygen growth in the environment, are of special interest. The first is responsible for natural selection and fixation of useful properties in the course of evolution, including the ability to adaptation, A spontaneous approach of the system to a stationary state, called ecological compensation point, means that eventually the system will reach it. This state is very unstable and is sensitive to weak external impacts. Therefore, such vital parameters of the system, as the oxygen and carbon dioxide content in the atmosphere, the associated surface temperature on the Earth, sea level and many others are unstable as well and should be monitored. That’s why the numerous environmental problems inevitably arise and humanity needs to solve them to survive.
  4. Following the logic of stationary state one can conclude that in position of ecological compensation point the reproduction of sedimentary organic matter becomes steady state as well. Given that oil generation makes up a certain portion of sedimentary organic matter and taking into account that oil consumption is steadily increases it become evident that it is high time to think what should replace the oil disappearing.

References

  1. Vernadsky VI (1926) Isotopes and “living” matter. Dokl.
  2. Ivlev AA (2019) The Global Carbon Cycle and the Evolution of photosynthesis. Cambridge Scholars Publishing.
  3. Ivlev AA (2019) Functions of Global Photosynthesis. AS Agriculture 3: 23–24.
  4. Jahren AH, Arens NC, Harbeson SA (2008) Prediction of atmospheric δ13CO2 using fossil plant tissues. Rev Geophys 46.
  5. Tolbert NE, Benker C, Beck E (1995) The oxygen and carbon dioxide compensation points of C3 plants: Possible role in regulating atmospheric oxygen. Proc Natl Acad Sci 92: 11230–11233. (Crossref)
  6. Cerling TE, Harris JM, MacFadden BJ, Leakey MJ, Quade J, et al. (1997) Global vegetation change through Miocene/Pliocene boundry. Nature 389: 153–158.
  7. Holland HD (1965) The history of ocean water and its effect on the chemistry of atmosphere. Proc Natl Acad Sci USA 53: 1173–1183. (Crossref)
  8. Igamberdiev AU, Lea PJ (2006) Land plants equilibrate O2 and CO2 concentrations in the atmosphere. Photosynthesis research 87: 177–194. (Crossref)
  9. Bjerrum CJ, Canifield DE (2004) New insight into the burial history of organic carbon on the early Earth. Geochim Geophys Geosyst 5.
  10. Canfield DE, Teske A (1996) Late Proterozoic rise in atmospheric oxygen inferred from phylogenetic and sulphur-isotope studies. Nature 382: 127–132. (Crossref)
  11. Berner RA, Canfield DE (1989) A new model for atmospheric oxygen over Phanerozoic time. Am J Sci 289: 333–361. (Crossref)
  12. Berner RA, Petsch ST, Lake JA, Beerling DJ, Popp BN et al. (2000) Isotope fractionation and atmospheric oxygen: implications for Phanerozoic O2 evolution. Science 287: 1630–1633.
  13. Berner R (2003) The long-term carbon cycle, fossil fuels and atmospheric composition. Nature 426: 323–326. (Crossref)
  14. Lenton TM (2001) The role of land plants, phosphorous weathering and fire in the rise and regulation of atmospheric oxygen. Global Change Biol 7: 613–629.
  15. Bergman MJ, Lenton TM, Watson (2004) AG COPSE: a new model of biogeochemical cycling over Phanerozoic time. Am J Sci 304: 397–437.
  16. Berner RA (1999) Atmospheric oxygen over Phanerozoic time. Proc Natl Acad Sci USA 96: 10955–10957. (Crossref)
  17. Berner RA, Kothavala Z (2001) GEOCARB III: a revised model of atmospheric CO2 over Phanerozoic time Am J Sci 301: 333–361.

Higher Maternal Death Rates Occur in Rural United States and Illinois

Introduction

Nationally and internationally, maternal mortality is an important indicator of the quality of a nation’s healthcare [1]. Recent statistics reported by the Centers for Disease Control and Prevention (CDC) indicates an increase in the pregnancy-related maternal mortality ratio (MMR) to 17.0 deaths per 100,000 live births from 2011–2013 [2], while  in Europe and maternal death rates are declining [3,4]. When analyzing the demographics of maternal deaths in the U.S., it appears pregnancies in rural environments are more at risk, with some maternal mortality rates in rural areas as high as 28.7 deaths per 100,000 live births [5]. A study by Kozhimannil and colleagues [6] demonstrated a rise in the maternal mortality and morbidity of both rural and urban areas, but rural mothers had a 9% greater chance of an adverse outcome compared to the urban mothers. The WHO has identified several factors that account for 75% of all maternal deaths: severe bleeding and infections after childbirth, pre-eclampsia and eclampsia, complications from delivery, and unsafe abortion [7]. The majority of these conditions could be prevented if recognized and treated by a skilled medical professional and if birth takes place in a sanitary place early enough (e.g. hospital), which can be difficult if the patient lives in an area with a shortage of skilled healthcare providers or a long distance from these professionals, as is often the case in rural settings. The purpose of this article is to examine the differences in maternal death rates between rural and urban Illinois stratified by urbanization level and race/ethnicity from 2007 to 2016.

Methods

Maternal death rates per 100,000 women ages 15 through 54 were obtained from the CDC Wonder website for years 2007 to 2016. This age range was chosen to include a larger sample size who are still capable of child-bearing and whose cause of death was within the pregnancy categories of ICD-10 (O00 to O99). This data was further stratified into six urbanization categories defined by the Office of Management and Budget and National Center for Health Statistics: large central metro, large fringe metro, medium metro, small metro, micropolitan, and non-core. A literature search using PRISMA guidelines was conducted using the term “maternal mortality” and keywords “community” and/or “neighborhood.” Studies were limited to those written in English. Maternal death rates per 100,000 women ages 15 through 54 for the various subgroups were calculated using the CDC Wonder website, and statistical comparison of rates was done using methods described by Dever [8].

Results

Maternal death rates were first analyzed by urbanization categories for all races for the U.S. compared to Illinois (Graph 1). The only statistically significant difference was found in the large fringe metro category with Illinois having a significantly lower maternal death rate than the U.S. Other than small metro, all other urbanization categories had lower maternal death rates than the U.S. When these urbanization categories were broken down into racial/ethnic subgroups, White mothers in both Illinois and the U.S. as a whole were found to have statistically significant higher maternal death rates in the micropolitan and non-core categories (rural) when compared to the large central metro category. The Illinois white non-core rate was at least twice that of the four most urban areas. Maternal deaths for African American mothers in Illinois were too low to calculate a valid rate for rural areas, but U.S. African American maternal deaths are on average about 2.5 times than that of the U.S. Whites.

AWHC 2020-302-Erin Hinkley_F1

Graph 1

A gradual increase in maternal death rates within both Hispanics and non-Hispanics was observed as urbanization decreased, as the area became more rural (Graph 2). When comparing the large central metro U.S. non-Hispanic mothers to those in non-core areas, the more rural mothers had a statistically significant higher maternal death rate. Regarding the causes of maternal death according to ICD-10 codes. Any obstetrical complication from 42 days to a year postpartum (O90.0) was the most common coded caused of death at 14% (Graph 3). Overall about 28% of maternal deaths, both indirectly and directly related to an obstetrical cause, occur greater than 42 days but less than a year postpartum.

AWHC 2020-302-Erin Hinkley_F2

Graph 2

AWHC 2020-302-Erin Hinkley_F3

Graph 3

Discussion

White mothers residing in rural areas have higher maternal death rates when compared to all other mothers. These maternal deaths negatively impact the health and future outcomes of the infants left motherless in addition to financially impacting the families due to medical costs. About one-third of maternal deaths occur 42 days postpartum; literature suggests these deaths may be due to life-threatening bleeding and infections, blood pressure elevations, complications from childbirth, and unsafe abortions [7]. Kozhimannil and colleagues [9] attribute the patterns seen in rural areas to the loss of obstetrical care in rural settings, requiring mothers to travel in order to safely deliver their babies. Future studies should focus on determining the specific clinical causes of maternal death in rural areas in order to develop interventions to reduce and prevent maternal death. The limitations within this study lie partially in the dataset from the CDC. The data assumes the causes of maternal death are correctly coded on the death certificate; incorrect coding would alter the death rate from its true value. Maternal mortality rates would have been a more precise measure as it uses the number of women who gave birth as the denominator rather than the number of women in that specific subgroup. Some data was limited due to low population numbers in different subgroups; maternal death rates for Hispanic mothers in Illinois could only be calculated in the large central metro area as the numbers were too low in the less urban categories. A future study should aim to investigate the causes of the very elevated Black maternal death rate in Illinois as well as the U.S. Other studies may investigate maternal death patterns according to age, education level, access to pre- and post-natal care, and the experience of the delivering provider in those areas. These findings may help stimulate improvements where shortfalls lie in order to provide the best care to mothers as possible.

In conclusion, this study shows substantially elevated maternal death rates for mothers residing in rural areas relative to urban areas and serves as basis to advocate for systematic changes in those areas whose mothers are at the highest risk.

References

  1. MacDorman MF, Declercq E, Cabral H, Morton C (2016) Recent increases in the U.S. maternal mortality rate: Disentangling trends from measurement issues. Obstet Gynecol 128: 447–455. [crossref]
  2. Creanga AA, Syverson C, Seed K, Callaghan WM (2017) Pregnancy-related mortality in the united states, 2011–2013. Obstet Gynecol 130: 366–373. [crossref]
  3. MacDorman MF, Declercq E, Thoma ME (2017) Trends in maternal mortality by sociodemographic characteristics and cause of death in 27 states and the District of Columbia. Obstet Gynecol 129: 811–818. [crossref]
  4. United nations millennium development goals. http://www.un.org.proxy.cc.uic.edu/millenniumgoals/. Accessed Mar 29, 2018.
  5. Meyer E, Hennink M, Rochat R, et al. (2016) Working towards safe motherhood: Delays and barriers to prenatal care for women in rural and peri-urban areas of georgia. Matern Child Health J 20: 1358–1365. [crossref]
  6. Kozhimannil KB, Interrante JD, Henning-Smith C, Admon LK (2019) Rural-urban differences in severe maternal morbidity and mortality in the US, 2007–15. Health Affairs 38: 2077–2085.
  7. WHO | maternal mortality. WHO Web site. http://www.who.int.proxy.cc.uic.edu/mediacentre/factsheets/fs348/en/. Accessed Mar 29, 2018.
  8. Dever GEA (1991) Community health analysis: Global awareness at the local level. 2nd ed. Gaithersburg, Md: Aspen Publishers.
  9. Kozhimannil KB, Hung P, Henning-Smith C, Casey MM, Prasad S (2018) Association between loss of hospital-based obstetric services and birth outcomes in rural counties in the united states. JAMA 319: 1239–1247.

Experimenting & learning to think critically and competently: Combining 2020 technology with student-driven research

Introduction

One might not think that the ubiquitous availability of cheap, easy, powerful computing power combined with storage and retrieval of information would produce in its wake better students, better minds, and the benefits of better education. The opposite is the case. As the increasing penetration of consumer electronics continues apace, it is becoming increasingly obvious that students have neither the patience to pay attention, nor the ability to think critically.  A good measure of that loss of student capability comes from the popular press, where blog after blog decries the loss of thinking and, in turn, the power of education. Not to be outdone, the academic press as signaled by Google Scholar ® provides us with a strong measure of this electronics-driven loss of thinking and withering of education. Table 1 shows the year by year data.

Table 1. Concern with the loss of critical thinking – a 10-year count (Source: Google Scholar®)

Year

Loss of critical thinking

Experiential Learning

2010

9,970

51,300

2011

11,800

53,700

2012

12,300

58,100

2013

13,800

61,400

2014

14,000

62,000

2015

15,800

57,500

2016

15,300

48,000

2017

17,200

47,200

2018

17,100

39,300

2019

9,800

30,100

How then can we make education more interesting?  This paper is not a review of attempts to make education more involving, more interesting, but rather presents a simple, worked approach to making learning more interesting, but really far deeper. It is obvious that children like to talk to each other about what they are doing, to present information about their discoveries, their developments, themselves. Children like experiences which resemble play, in which they are somewhat constrained, but not very much. And when a child discovers something new, something that is his or hers, the fun is all the greater because the discovery can be shared. The ingoing assumption is that if learning can be made fun, a game, with significant outputs of a practical nature, one might stimulate a love of learning which love seems to have disappeared.

Experiential learning and discovery of the new – A proposed approach based upon the emerging science of Mind Genomics

The emerging science of Mind Genomics can be considered as a hybrid of experimental psychology, consumer research, statistics, and mathematical modeling. The objective of Mind Genomics is the study of how people respond to the stimuli of the ordinary, the every day. We know from common experience that people go about their daily business almost without deeply thinking about things, in a way that Nobel Laureate Daniel Kahneman called System 1, or ‘thinking fast’ [1]. We also know that there are many different aspects to the same experience, such as shopping. People differ, consistently so, in when they shop, why they shop, how they get to the place where they will make a purchase, the pattern of shopping, what they shop for, and why.  The variation is dramatic, the topics not so interesting, the exploration of the topics left to mind-numbing tabulations, which list the facts, rather than penetrating below, into the reasons.

Mind Genomics was developed to understand the patterns of decision making, not so much in artificial laboratory situations to develop hypotheses for limited situations, but rather to understand the decision rules of daily life.  Instead of mind-numbing tables of statistics from which one gleans patterns, so-called ‘connecting the dots,’ Mind Genomics attempts to elicit these individual patterns of decision making in easy-to-do experiments.  The output, once explained, fascinates the user, converting that user into an involved explorer, looking for novella, insights, and discoveries that are new to the world, discoveries ‘belonging to the student’. The day to day worlds, the ordinary, quotidian aspects of our existence, become grist for the mill of discovery. The result is that discoveries about the ordinary, discoveries that when harnessed by teachers and appreciated by students, combine experiential learning, and learning how to think critically

As noted above, Mind Genomics derives historically from psychology, consumer research, statistics, and modeling. The objective of Mind Genomics is to uncover the specific criteria by which people assign judgments. The topics are unlimited.

The empirical portion of this paper will show how experiential learning and critical thinking may be at the fingertips, with the use of simple computer programs, specifically BimiLeap, freely accessible at www.BimiLeap.com.  In this paper we look at how a 14-year-old student can learn about laws and ethics, as well as the issues of daily life. The topic is taken from the way young students in a Yeshiva, a rabbinic school, can learn about the issues underlying property, specifically borrowing property and what happens when the property is somehow ‘lost.’

Experiential learning and discovery of the new

A proposed approach based upon the emerging science of Mind Genomics.  Mind Genomics is an emerging science combining experimental psychology, consumer research, experimental design, and statistical modeling. The objective is to explore decision making in the everyday world.

In terms of commercial and social practice, Mind Genomics has been applied in by author HRM to issues as varied as it applies to topics as different as decision making about what we choose to eat, legal cases, and communications in medicine to improve the outcomes during and after hospitalization, respectively. These practical applications along with the ongoing stream of studies suggest Mind Genomics as a simple-to-use but powerful knowledge-creation tool. With Mind Genomics, virtually anyone can become a researcher, explore the world, classify the strategies of decision making, and discover new-to-the-world mind-sets, groups of people who think about the topic in the same way, and who differ from other groups of people thinking about the topic in a different way.

The Mind-Genomics technology has been embedded in easy-to-use computer programs, making the typical Mind Genomics study fast, affordable, and structured. The same simplicity of research, studying what is, may thus find application to educate the non-researcher, the novice, the younger student. Rather than the researcher exploring a topic area with the point of view of a person interested in the specific topic, the notion emerged that the same tool can be used to each a novice how to think, using research as a the tool, and the information and accomplishment as the reward for using the tool.

The Yeshiva approach: Havrutas (groups) studying a topic in depth

This paper presents one of the early attempts to use Mind Genomics to teach legal reasoning to a teenager, helping the teenager to make a specific topic ‘come alive’ as well as imbue experiential learning and critical thinking into the process.  The paper will present the approach step by step, as a ‘vade mecum’ or ‘guide’ for the interested reader.

The objective of Mind Genomics is to understand the decision making in a situation.  The deliverable is a simple table, which one can adorn in different ways, but which at its heart shows questions and answers about a situation.

We take our approach from the way students in Jewish religious schools study the corpus of Jewish law, commentary and discussion.  The notion of using the Bible as a source for teaching modern concepts is not new [3]. created a course on economics, based upon biblical tests, as described in the following paragraph

The author describes a course designed to build the critical thinking skills of undergraduate economics students. The course introduces and uses game theory to study the Bible. Students gain experience using game theory to formalize events and, by drawing parallels between the Bible and common economic concepts, illustrate the pervasiveness of game-theoretic reasoning across topics within economics as well as various fields of study.

We take our source for the course in the way the Talmud is study. The Talmud comprises more than 2700 of pages of explication of basic Jew practice.  The origins of the Talmud are, according to Jewish sources, founded in the Oral Law, the law of Jewish practice based in the Old Testament, the Jewish Bible, but expanded considerably.  For the reader, the important thing to know is that the Talmud comprises two portions, the Mishna, a short, accessible compilation of Jewish Law and practice, finalized by Rabbi Judah the Prince around the second century CE, and then discussions of that compilations, attempting to find discrepancies to reconcile them, done by Rabbis and their students for about 300–400 years hundred years after the Mishna was finished. This section, discussion and reconciliation among sources, is embodied in difficult, occasionally tortuous material known as the Gemara, the word in Aramaic for‘completing.’

Talmud students who spend years learning the Talmud end up thinking critically [4]. The method is to pair off students with each other, havrutas, usually comprising two students, who read, decipher, debate, and struggle to understand the section together. The approach leads, when successful, to logical thinking, and ability to formulate problems ina way worthy of a lawyer.  In the words of [5].

when examined closely, havruta study is a complex interaction which includes steps, moves, norms and identifiable modes of interpretative discussion [5].

Havruta learning or paired study is a traditional mode of Jewish text study. The term itself captures two simultaneous learning activities in which the Havruta partners engage: the study of a text and learning with a partner. Confined in the past to traditional yeshivot and limited to the study of Talmud, Havruta learning has recently made its way into a variety of professional and lay learning contexts that reflect new social realities in the world of Jewish learning [6].

With this very short introduction, the notion emerged from a number of discussions with psychology researchers and with students of the Talmud that perhaps one might use technology inspired by Talmudic style thinking and discussion to teach students to think critically, whether these be Talmud students embedded in the Jewish tradition, or students who could take a topic of the Talmud in an ‘edited’ form, and work with that topic in the way a yeshivastudent might.

Adapting the approach, making it accessible, challenging, interactive, and fun

The situation for this study is simple, based upon a legal case well known to many students of the Talmud, but presented in secular terms. The case concerns an item, the nature of which is unstated but the implication is that the item is something portable.  The information available is:

  1. Who initiated the interaction?
  2. Why was the interaction initiated?
  3. Where was the interactioninitiated (viz., request made)?
  4. What happened to the item?

In order to make the system easy, but keep the tone serious, the design for the computer interface was created to be simple. 

Figure 1 shows the three key screen shots.

Mind Genomics-039_F1

Figure 1. The setup showing the three panels which force the student to think in an analytic yet creative and participatory fashion

The left panel shows the requirement that the student(s) select a name for the study. It may seem simple, but it will be the name of the study which drives much of the thinking.

The middle panel shows the requirement to create four questions dealing with the topic, with the questions ‘telling a story.’ It is here, at this second stage, beyond the name of the topic, where students encounter problems, and must ‘rewire’ their thinking. Students are taught to understand, to remember, to regurgitate. Students are not taught to ask a series of questions to elucidate a topic.  Eventually, the students will learn how to ask these questions, but it will be much later, when the student is introduced to research in the upper grades, and when the student becomes a professional, especially a lawyer.  We are creating the opportunity to bring that disciplined thinking to the junior high school or even to grade school.

The right panel shows the requirement to provide four answers to one of the questions. There is no hint, no guidance, about what the answers should be, but simply the question repeated to guide the student.  Typically, this third panel is easy to complete once the student has gone through the pain of thinking through the four questions. That is, the questions are hard to formulate; the answers are easy to come by after the hard thinking has been done.

Engaging the student in the creation of questions and answers

The key to the approach is the set of questions, and secondarily the set of answers. As noted above, the demand on the participant is to conceptualize the topic at the start, rather than being trained to deconstruct the topic when it is fully presented.  The approach thus is synthetic, requiring imagination on the part of the student. 

Table 2 presents the four questions and the four answers to each question.  The questions and the answers do not emerge simply from the mind of the student, at least not at first. There are the inevitable false steps, the recognition that that the questions do not make sense, do not tell a story, do not flow to create a sequence, etc.  These false steps are not problems, but rather part of the back and forth learning how to reason, how to tell a coherent story, and how to discard false leads.

Table 2. The four questions, and the four answers to each question

Question 1 – Who initiated?

A1

Initiated by:  Young neighbor (14 years old)

A2

Initiated by: Older neighbor (29 years old)

A3

Initiated by: School friend in high school

A4

Initiated by:  Uncle of person

Question 2 – What was the action

B1

Action: To borrow item for use in project

B2

Action: To use item as part of a charity event

B3

Action: To guard item while the owner went away

B4

Action: To try to sell the item at a garage sale

Question 3 – How or where was the request made?

C1

Request made: On telephone

C2

Request made: In a group meeting

C3

Request made: In a house of worship

C4

Request made: At a dinner party

Question 4 – What eventually happened?

D1

What eventually happened: Item lost

D2

What eventually happened: It destroyed in accident

D3

What eventually happened: Item stolen on bus

D4

What eventually happened: Item given away by error

The answers in Table 2 are simple phrases, with the introduction to the answer being a phrase to reinforce the story.  Various efforts at making the approach simply continue to reveal that for those who are beginning a topic, it is helpful to consider the answers as continuations of the questions. That specification, such as ‘initiated by’ will also make the respondent’s effort easier.

It is important to keep in mind that the process of topic/question/answer will become smoother with practice, the topics will become more interesting, the questions will move beyond simple recitation of the order of events, and the answers will become more like a literary sentence, and less like a menu item.

In the various experiences with this system, it is at this point, the four questions, that most people have difficulties. Indeed, even with practice, people find it hard to organize their thinking to bring a problem into sufficiently clear focus that they can make it into a story. When the researcher finally ‘understands the task’ the response is often a statement about ow they feel their ‘brains have been rewired.’ Never before did the researcher have to think in such a structured, analytic way, yet with no guidance about ‘what is right.’

One of the more frequent questions asked at this point is ‘Did I do this right?’  Most people are unaccustomed to structured thinking.  After creating the questions, and on the second or third effort, after the first experiment, the researcher begins to feel more comfortable, and is able to move around the order of questions, changing them to make more sense. This flexibility occurs only after the researcher feels comfortable with the process.

Creating ‘meaningful’ stimuli by means of an underlying experimental design

As students, we are typically taught the ‘scientific method,’ namely to isolate a variable, and understand it.  Our mind is attuned to dissecting a situation, focusing on one aspect.  We lose sight of the fact that the real world comprises mixtures, and that an understanding of the real world requires us to deal with the way mixtures behave.  An observation of our daily actions quickly reveals that virtually all of the situations in which we mind ourselves comprises many variables, acting simultaneously.  Indeed, much of the problem of learners is their experienced difficulties in organizing the multi-modal stimuli impinging on themand learning to focus and to prioritize.  It is to this skill we now turn as we look at the student experience.

The computer program combines alternative answers to these four questions, creating short vignettes, presents them to respondents, gets a rating of ‘must repay’ vs ‘does not need to repay’.’

The above-mentioned approach seems, at first glance, to be dry, almost overly academic. Yet, the Mind Genomics approach makes the ‘case’ into something that the students themselves can create, investigated, and report, with a PowerPoint® presentation of the study, something that will be part of their portfolio for life, and can be replicated on many different topics.

Each respondent evaluates a unique set of vignettes, created by a systematic permutation of the combinations. The mathematical rigor of the underlying experimental design is maintained, but the different combinations ensure that across all the respondents a wide number of potential combinations are evaluated.

The underlying experimental design and indeed all of the mathematics for the analysis are shielded from the respondent, who is forced to ‘think’ about the topic, and the meaning of the data, rather than getting lost in deep statistics. 

The composition of the vignettes is strictly determined by an underlying specification known as an experimental design [7]. Each vignette comprises either two, or three or four answers, at most one answer from a question, but sometimes no answer from a question.  The experimental design ensures that the 16 elements appear as statistically ‘independent of each other,’ so knowing that one answer appears in a vignette does not automatically tell us whether another answer will appear or not appear.

Figure 2 shows an example of a vignette created according to the underlying design.  The respondent does not know that the computer has systematically varied the combinations.The vignette is created by an underlying experimental design which prescribes the composition of each vignette.  Each respondent evaluates 24 different vignettes, or combinations of answers, and answers only. No questions leading to the answers are presented directly, although for this case the question is embodied at the beginning of the answer.

Mind Genomics-039_F2

Figure 2. Example of a vignette comprising three answers or elements, one answer from three of the four questions. Most vignettes comprise four answers, some comprise three answers, and a few comprise two answers.

An important challenge in Mind Genomics is to come up with a meaningful rating question. The rating question links the test stimuli, our vignettes, and the mind of the respondent.  Without a meaningful test question all we have are a set of combinations of messages.  The test question focuses the respondent’s mind on how to interpret the information in the vignette.

The test question is posed simply as either a unipolar scale (none vs a lot) or a bipolar scale (strong on one dimension vs strong on the opposite dimension, such as hate/love).  To the degree that the researcher can make the rating question meaningful, the researcher will have added to the power of the Mind Genomics exercise.

Our topic here concerns the loss of property occasioned by one person giving property to another person, after being asked to do so, or after being motivated to do so, that motivation coming from within.  A reasonable rating question is whether the person in whom the property is placed, for whatever reason, is required to ‘make good byreplacing the property’ or ‘not required to replace the property.’  Rather than requiring a yes/no answer, we allow the respondent to assign a graded value, using a Likert Scale:

1  =   The person who asked/borrow is not really to blame and doesn’t
          have to pay ….

5  =   The person who asked/borrowed should ‘make good.’

The phrasing of the question and the simple 5-point rating scale make the evaluation easy, and remove the stress from the respondent. By allowing the student a chance to assign a graded rating, the student can begin to understand gradations of guilt and innocence. Furthermore, the answers are not so clear cut, so straightforward that they prevent the student from thinking.  The requirement to take the facts of the case into account and rate the feeling of guilt vs innocence on a graded scale forces the student to think.  The very ‘ordinariness’ of the case encourages the student to become engaged, since the case is something that no doubt the student has either experienced personally, or at least has heard about at one or another time.

Obtaining additional information from the respondent

Quite often, those who teach do not pay much attention to WHO the respondent actually is, or even the different ways that people think. The academies where the Talmud was created did pay attention to the way people think, coming up with different opinion about the same topic. These different opinions were enshrined in discussions. The intellectual growth coming from thinking about the problem was maintained over the millennium and a half through the discussions of students about different points of a topic, and the study of those who commented on the law, and gave legal opinions about cases. The back and forth discussions about why the same ‘facts on the ground’ would lead to different opinions became a wonderful intellectual springboard for better thinking.  Few people, however, went beyond that to think, in a structured way about how ordinary people might think of the problem, people who were not trained as legal scholars, nor empaneled in a judicial panel.

Part of the effort of the Mind Genomics project is to show to the student the way different people think about the topic, and how there is not necessarily ‘one right answer.’  Thus, at the start of the experiment, before the evaluation of the 24 vignettes by the respondent, the respondent is asked three questions:

  1. Year of birth, to establish age
  2. Gender
  3. A third question, chosen by the researcher. Here is the third question for this study.

How do you feel about mistakes that are made in everyday life, by ‘accident’

1=I believe that the law is the law 2=I believe in being lenient 3=I want to know the facts of the case more

Running the study for educational purpose – Mechanics

During the past several decades, and as the Mind Genomics technology evolved and was refined, a key stumbling point, i.e., a ‘friction point’ in today’s language, continued to emerge. This was the deployment of the study in a way that could be quick, inexpensive, and thus have an effect within a short time. Two decades ago as the Internet was being developed, a great deal of the effort of a Mind Genomics study was expended getting the respondents to participate, typically by having them come into a central location, such as a shopping mall, and spending ten or 15 minutes.  The result was slow, and the pace was such that it would not serve the purposes of education. The process was slow, tedious, expensive, and not at all exciting to anyone but a serious researcher.

During the formative years of the technology, 2010–2015, efforts were put against making the system fast, with very fast feedback.  The upshot was that a study could be set up in 30 minutes or faster and deployed on the internet with simply a credit card to pay for the cost of respondents, usually about 3.00$ per respondent for what turned out to be a 4 minute study.  A field service, specializing in on-line ‘recruiting’ would provide the appropriate respondents, sending them to the link, and obtaining their completed, and motivated answers. The respondent motivation was there because they were part of the panel.

The mechanics were such that the entire study in the field would come back in less than one hour and one minute. The total analysis, including the preparation of the report in PowerPoint(r), ready for the student presentation, took less than one minute from the end of the field.  Figure 3 shows an example of the PowerPoint(r), expanded to the slide sort format, showing the systematic presentation of the results.

Mind Genomics-039_F3

Figure 3. Example of the PowerPoint® report for the study, shown inlide-sort format. The respondent receives the PowerPoint® report and the accompany Excel® data sheet one minute after the end of the data acquisition.The report is in color, and ‘editable.’

  1. The title page, showing the study name, the researcher, the date
  2. Information about the BimiLeap vision
  3. The raw material – elements, rating question
  4. How the data are analyzed, showing the transformation from a rating scale to a binary rating, as well as introducing the concept of ‘regression modeling’ …. This explanatory information is presented in a short, simplistic manner, yet sufficient to show the nature of mathematical (STEM) thinking
  5. Tables of data showing the results from the total panel, key subgroups
  6. Mind Sets – a short introduction to how people can think differently about the topic, and a short introduction to the calculations. Once again, the focus is on the findings, not on the method
  7. Results from dividing the respondents into two mind-sets and three mind-sets
  8. IDT – Index of Divergent Thought – showing how many elements have strong positive coefficients,   when the data are considered in terms of total panel, two mind-sets and three mind-sets, respectively. The IDT can be used to understand how well the researcher has ‘dived in’ to the topic, to uncover different ways of thinking about the topic. The IDT can be used to ‘gamify’ the research process, by providing an operationally defined, objective measure, of ‘winning ideas.’
  9. Introduction to ‘response time’ – how long it takes the respondent to ‘process’ the ideas
  10. Tables of data showing the results from the total panel, key subgroups, and mind-sets
  11. Screen shots of the respondent experience

The report is accompanied by an Excel book with the data, set up for further analysis, if the student wishes.

The results, embedded in a pre-formatted PowerPoint® presentation, and with supporting full data in Excel®, are immediately dispatched by email and can always be retrieved from the researcher’s account, when, for example, the data are ‘updated’ with the ratings assigned by new panel participants. This process compresses the entire time, from set-up to data reporting, so that the results can be discussed within 1–3 hours after the official start the entire process, viz., entering the questions and answers into the BimiLeap programming and getting the panel provider to provide respondents.

The vision behind the PowerPoint® report is that it provides a tangible record of the student’s effort, a measure of what the student has achieved in the growth to learning.  By creating different groups of students who work together, and working together for 90 minutes in the afternoon, once per week, the typical student can generate 20–30 or so PowerPoint® in a year, a collection the quality of whose contents, study by study, will demonstrably improve as each study is designed, and executed with real people, the respondents.

What the student receives and how the student learns

Table 3 presents the unadorned results, a table.  To interpret the table is straightforward, despite the fact that it has simply numbers.  The researcher who is doing the study need not know the mechanics of how the numbers are computed, at least not in the beginning, in order to enjoy the benefits of Mind Genomics, and in order to participate in experiential learning.

Table 3. Output from a Mind Genomics on a simple legal case. The data is from the total panel

 

Found responsible and must make good

Total

 

Base Size

30

 

Additive Constant (Estimated percent of the times the initiator must repay in the absence of any information)

60

 

Question A: Who initiated

 

A2

Initiated by: Older neighbor (29 years old)

0

A4

Initiated by:  Uncle of person

-8

A1

Initiated by:  Young neighbor (14 years old)

-10

A3

Initiated by: School friend in high school

-10

 

Question B: What was the action

 

B2

Action: To use item as part of a charity event

5

B4

Action: To try to sell the item at a garage sale

-5

B1

Action: To borrow item for use in project

-6

B3

Action: To guard item while the owner went away

-11

 

Question C: Where was the request made

 

C1

Request made: On telephone

4

C2

Request made: In a group meeting

3

C3

Request made: In a house of worship

2

C4

Request made: At a dinner party

-2

 

Question D: What happened

 

D2

What eventually happened: It was destroyed in accident

6

D3

What eventually happened: Item stolen on bus

-8

D1

What eventually happened: Item lost

-10

D4

What eventually happened: Item given away by error

-10

The question what is the initiator (Question A) required to do.  At the low end, the initiator does not have to ‘make good’ (innocent, i.e., not pay.)  At the top end, the initiator has ‘make’ good (guilty, i.e., pay.)

Base Size: The table shows us that there are 30 different people who participated in the study. This is the base size.

Additive Constant: This is the expected number of times out of 100 people that the verdict will be ‘guilty’, i.e., must repay. What is special is that the additive constant is a baseline, corresponding to the likelihood that a person will say ‘guilty’ even in the absence of information. Our additive constant is 60. It means that when someone requests from another to do something with the item, 3 out of 5 (60%) the onus is on the person who does the requesting to take responsibility and pay if something happens to the item.

Coefficient: Ability of Each Element to drive Guilty (must repay). Let’s look at the power of Question A: Who initiated.  The four answers or alternatives, which appeared in the vignette, are either 0 (nothing) or negative. The negative means that when we know who initiated, we are likely to forgive. We forgive most when the action is initiated by a young neighbor or, or school friend in high school. The value is -10. That value -10 means the likelihood of guilty (must make good) goes from 60 (no information about the initiator) to 50, when the one piece of information about the initiator is presented as part of the case (specifically,  initiated by: School friend in high school.)  Of course, when the initiator is an older neighbor (29 years old), the coefficient is no longer -10 as it was before, but now 0. We (and of the course the student) have just discovered that it makes a difference WHO the initiator is. 

The same thinking can be done for the other questions and answers. Some, like D2 (What eventually happened: It was destroyed in accident) increase the likelihood of being judged responsible, and forced to make good, i.e., to repay.

The process from the vantage point of the researcher (e.g., the student)

As presented above, the process is simple, although quite uninteresting, except perhaps to the subject matter expert interested in lawor in thinking processes. How can the student be engaged to participate?  Otherwise, what we have here is simply another ‘dry process’ with some interesting but unexciting results.

The three aspects of the process are involvement, ease, and fast/clear results.  Absent those, and the process will remain in the domain of the expert, to be used occasionally when relevant, and otherwise to be relegated to process. The excitement of thinking and learning will not be experienced.

Let us proceed with the process.  The process follows a series of steps designed to make the researcher think. The process is structured, not particular hard after the first few experienced, but sufficiently challenging at the start so that the researcher realizes the intellectual growth which is taking place at the time of the research set up.

Experimental Designs – mixtures of answers

The actual test stimuli comprise mixtures of answer, without the questions. One can go to Table 2, and randomly pick out one answer from each of the four questions, present these answers together, on separate lines, and instruct the respondent to read the vignette, the combination, and rate the combination as a single entity.  The task may seem ‘strange’ to those who are accustomed to reading properly constructed paragraphs in their native language, but to those who are selected from random individuals to be study participants, there is no problem whatsoever. People follow instructions.   The problem with evaluating a few unconnected combinations is that there are no explicit patterns waiting to be discovery, and a discovery in turn which can teach systematic and critical thinking.

As noted above several times, the Mind Genomics paradigms works with an explicitly developed experimental design, which makes it easy for the equipped research to discover the pattern. Table 4 shows an example of the experimental design for a single respondent. There is a total of 16 answers and 24 vignettes, or combinations. The number and arrangement of the vignettes are not accidental, nor haphazard, and certainly not random, although it is tempting to say that the combinations are randomly arranged. Nothing could be further from the truth. The design, i.e., the combinations are precisely defined ahead of time , so that each of the 16 elements or answers appears exactly five time, that any vignette of combination has at most four answers (without their questions), that some combinations comprises two, others comprise three answers, and that the answers are systematically varied.  Finally, each of the experimental design is mathematically identical to every other design, but the specific combinations are different.

Table 4. The experimental design for 7 of the 24 vignettes for a respondent, as well as the rating, the binary expansion of the rating, and the consideration time

Order

A1

A2

A3

A4

B1

B2

B3

B4

C1

C2

C3

C4

D1

D2

D3

D4

Rating

Top2

7

1

0

0

0

0

0

0

1

0

0

0

1

0

0

0

0

4

100

8

0

0

1

0

0

0

0

1

0

0

1

0

0

1

0

0

1

0

9

1

0

0

0

0

0

1

0

1

0

0

0

0

0

0

1

3

0

10

0

1

0

0

1

0

0

0

0

0

1

0

0

0

0

1

5

100

11

0

1

0

0

0

1

0

0

0

1

0

0

0

0

1

0

3

0

12

0

0

1

0

0

0

0

0

0

0

0

1

0

0

1

0

3

0

13

0

0

0

1

0

0

0

1

0

0

1

0

0

0

0

0

3

0

Different points of view for the same argument – Mind-Sets and exciting discoveries

Students who ask questions to engage discussion are generally appreciated by their teachers. The questions show involvement.  Sometimes the questions spark lively discussions, especially when they are offered in the spirit of ‘looking at the problem in different ways.’

A foundation stone of Mind Genomics is the recognition and elicitation of different points of view about the same topic. The ingoing rationale is that in matters of everyday life there are facts, but often radically different opinions. Sometimes more learning emerges from the discussion of the topic from these different viewpoints than could ever emerge from rote learning of the ‘facts.’

One of the computations of Mind Genomics is the discovery of different mind-sets, groups of people with these individuals in one group looking at the topic differently from individuals in another group. The computational machinery of Mind Genomics enables these mind-sets to be discovered rapidly and inserted into the PowerPoint® report as simply new groups to consider and to discuss.

Table 5 shows the additive constant and coefficients for total (already discussed), gender, age, and two mind-sets. The students who participate in the study, indeed those who may have come up with the elements, can now see how the simplest of facts can be interpreted in different ways.

Table 5. The pattern of coefficients for ‘make good’, generated by key demographic groups (total, gender, age) and newly uncovered mind-sets.

 

 

 

Gender

Age

Mind-Set

 

 

 

 

Rating 4–5 transformed to 100;

Ratings 1–3 transformed to 0

Focus on ‘make good’ (guilty)

Tot

Male

Female

A16–19

A20–23

MS1

MS2

 

Additive constant (percent of times a rating will be 4–5 in the absence of any elements (i.e., a baseline)

51

53

66

40

63

56

48

 

Elements driving ‘guilty’ – Mind-Set 1

(Focus on action)

 

 

 

 

 

 

 

B2

Action: To use item as part of a charity event

10

-15

10

17

1

20

-5

B1

Action: To borrow item for use in project

5

-13

5

11

-4

16

-15

C1

Request made: On telephone

-2

0

-6

1

-6

11

-18

B4

Action: To try to sell the item at a garage sale

0

-25

-11

14

-16

10

-17

C4

Request made: At a dinner party

-3

-12

-6

-5

-2

8

-18

 

Elements driving ‘guilty’ – Mind-Set 2

(Focus on what happened, and who, specifically, initiated)

 

 

 

 

 

 

 

D2

What eventually happened: It destroyed in accident

1

-6

-7

1

3

-6

14

D1

What eventually happened: Item lost

-4

-4

-9

-10

0

-14

14

D4

What eventually happened: Item given away by error

-5

-10

-10

-9

0

-17

13

A1

Initiated by:  Young neighbor (14 years old)

-1

-2

-6

-5

2

-12

10

A2

Initiated by: Older neighbor (29 years old)

0

-3

5

1

1

-10

9

A4

Initiated by:  Uncle of person

-4

-4

-7

0

-5

-14

8

 

Elements not driving guilty for any key group

 

 

 

 

 

 

 

D3

What eventually happened: Item stolen on bus

-5

-6

-10

-10

-2

-13

7

A3

Initiated by: School friend in high school

-5

0

-8

-3

-6

-14

6

C3

Request made: In a house of worship

-2

-9

-8

1

-4

1

-6

C2

Request made: In a group meeting

-1

6

-1

-6

4

4

-9

B3

Action: To guard item while the owner went away

-5

-4

-5

3

-13

4

-22

What should emerge from Table 5 is the charge to the students to ‘tell a story about the mind of each group,’ about whether the mind of the group seems to hold strong views or weak views about what makes a person guilty.  There is no right nor wrong answer, but simply the requirement that the student abstract from these data some narrative of how the group thinks.  The difference in coefficient is most dramatic for the two mind-sets, but what is the MEANING of the difference?  In that short question lies a great deal of opportunity for the students to think creatively, to see patterns, and indeed perhaps even to make new-to-the-world discoveries.  Furthermore, the excitement can be maintained by challenges to the students to create personas of the mind-sets, and to suggest and executed follow-up experiments with Mind Genomics to explore hypotheses about these mind-sets.

Learning to think even more deeply – Is justice blind, and how can the student prove or disprove it?

We finish off the data section by a new way of thinking, and two exercises can be done manually with available statistical programs, planned to be programmed into the next generation of the Mind Genomics report.  These are called ‘scenario analyses.’ The logic behind them is simple. The thinking emerging from them is far from simplistic, however. The struggle to understand the new patterns from this level of analysis helps to move the motivated student into a more profound way of thinking, in a subtle, easy, virtually painless way.

When people look at the ‘facts of the case’ they are often cautioned not to pay attention to the nature of the individuals, but simply the ‘facts on the ground,’ on what happened.  Such caution is easy to givebut may or may not be followed.   One of the opportunities afforded to the student of Mind Genomics is to understand clearly the interaction between WHO the person IS in the case, and the response.  For example, in our case we have four people who initiate the request, ranging from a young neighbor, an old neighbor, the uncle, school friend in high school.

We can learn a lot by sorting the data into five different strata, depending upon who does the requesting, and ten building the model. We don’t know what exactly happened to the item, but we do know who did the requesting.  We build the model based upon the five strata. Each stratum corresponds to one person who requested.  The independent variables are the three other aspects (action: where request was made; what happened.).

The original set up of the Mind Genomics process was to create four questions, and for each question develop four answers.  As described above, the underlying experimental design mixed and matched the combinations according to a plan. Each respondent, i.e., test participant, evaluated 24 different vignettes. Furthermore, unknown to the respondents, an underlying system created different sets of 24 vignettes, a unique set of combinations for each respondent.

It makes no difference to the respondent about the way the combinations are created. Whether the same 24 combinations are tested by 30 different people (the ordinary way), or whether the systemic variation produces 720 different combinations (24 different combinations x 30 different people), is irrelevant to the individual respondent. What happens, however, to the judgments when we look at five different groups of vignettes, varying, say, by WHO DOES THE INITIATION.  We have vignettes with no mention of who does the initiation, as well as vignettes specifying the initiation by the younger neighbor (14 years old), the older neighbor (29 years old), by a school friend in high school, and by the person uncle.

The question which emerges, one provoking a great of discussion, is whether justice is blind.  That is, the intended actions can be the same, the place where the request was made can be the same, and the outcome can be the same. Presumably, it does not matter WHO initiates the request. Justice should be blind. Is it?

We can sort the data into five strata, five groups, with each group comprising one of the five alternatives of ‘initiated by.’  There are five groups or strata because on group has NO mentionof ‘Initiated by:’ The next step is to estimate the coefficients, this time using only the remaining 12 elements. A1-A4 are absent from the regression because the regression is done on a stratum-by-stratum basis, where the element ‘Initiated by:’ is held constant.

After this effort the excitement increases when the students realize how strongly the initiator ‘drives’ the rating of ‘make good’ (i.e., rating of 4–5 converted to 100.)  Table 6 shows this analysis when the strata are based upon Question A (Who Initiated?). Table 7 shows the comparable analysis when the strata are based upon Question B (Action or Purpose).  In both cases there is plenty of space for discovery and for an ah ha experience, as the student uncovers truly new findings, itself motivating, and struggles to explain what she or he has revealed to the world.

Table 6. Coefficients for the models relating presence/absence of elements to the binary transformed rating ‘make good’ (i.e., guilty). The table shows the contribution of each of the elements to ‘make good’ when the ‘Initiated by’ was constant.

 

Rating 4–5 transformed to 100;

Ratings 1–3 transformed to 0

Focus on ‘make good’ (guilty)

No mention of Initiated

Initiated by: Older neighbor (29 years old)

Initiated by:  Young neighbor (14 years old)

Initiated by:  Uncle of person

Initiated by: School friend in high school

 

 

A0

A2

A1

A4

A3

 

Additive constant (percent of times a rating will be 4–5 when the ‘initiated by’ is the text at the head of each column

74

66

41

39

34

B2

Action: To try to sell the item at a garage sale

23

8

20

-10

7

B3

Action: To guard item while the owner went away

17

9

-11

-24

-11

B1

Action: To borrow item for use in project

4

8

19

-12

14

D1

What eventually happened: Item lost

-1

-9

7

0

4

B4

Action: To use item as part of a charity event

-4

9

-3

-3

-2

D3

What eventually happened: Item stolen on bus

-5

-10

-5

-3

-5

D4

What eventually happened: Item given away by error

-9

-16

-13

2

17

D2

What eventually happened: It destroyed in accident

-14

-6

6

3

7

C4

Request made: At a dinner party

-22

-17

-6

19

7

C3

Request made: In a house of worship

-28

-17

0

10

2

C2

Request made: In a group meeting

-33

-29

-1

26

8

C1

Request made: On telephone

-39

-16

19

28

-8

Table 7. Coefficients for the models relating presence/absence of elements to the binary transformed rating ‘make good’ (i.e., guilty). The table shows the contribution of each of the elements to ‘make good’ when the ‘Action’ or purpose was constant.

 

Rating 4–5 transformed to 100;

Ratings 1–3 transformed to 0

Focus on ‘make good’ (guilty)

Action: Not mentioned

Action: To borrow item for use in project

Action: To try to sell the item at a garage sale

Action: To guard item while the owner went away

Action: To use item as part of a charity event

 

 

B0

B1

B4

B3

B2

 

Additive constant (percent of times a rating will be 4–5 when the ‘initiated by’ is the text at the head of each column

-11

32

41

68

80

C2

Request made: In a group meeting

46

1

-16

10

-24

C4

Request made: At a dinner party

41

7

-7

-3

-12

C3

Request made: In a house of worship

38

16

-19

-5

-15

C1

Request made: On telephone

37

7

15

-14

-19

A4

Initiated by:  Uncle of person

24

0

19

-27

-22

A1

Initiated by:  Young neighbor (14 years old)

9

17

0

-29

1

D3

What eventually happened: Item stolen on bus

7

-4

-1

-15

-3

A3

Initiated by: School friend in high school

7

14

-2

-23

-15

D2

What eventually happened: It destroyed in accident

6

12

5

-7

1

D1

What eventually happened: Item lost

5

7

5

-19

7

A2

Initiated by: Older neighbor (29 years old)

5

11

12

-3

-17

D4

What eventually happened: Item given away by error

2

-2

6

-7

-6

IDT – Index of Divergent Thinking: Making the Mind Genomics into a game

As of this writing (early 2020), the world of students is awash with games, with fun, with a shortened attention span, and with the competition of different forms of entertainment. How do we convert Mind Genomics to entertainment or at least to that over-used neologism ‘edu-tainment?’

The notion of converting critical thinking to ‘games’ requires that there be criteria on which people can complete, and that these criteria be objective, rather than subjective.  That is, to make Mind Genomics into a ‘game’ with points means to create an easy-to-understand scoring system, and specifically a system within which everyone can compete.  Furthermore, in the spirit of critical thinking and experiential learning, the system should reward creative thought.

During the past three years author H Moskowitz has worked on criteria to ‘measure’ critical and creative thought within the framework of Mind Genomics. A key aspect of Mind Genomics is that it automatically estimates the degree of linkage between each of the 16 elements and the rating scale, after the rating is converted to a binary score, 0 or 100.  This linkage is the coefficient from the model relating the presence/absence of the elements to the binary transformed rating.  It will be the linkage, the coefficient, which provides the necessary data to create a gaming aspect to the Mind Genomics exercise.

Consider the tabulation of coefficients in Table 8. Table 8 presents the distribution of POSITIVE coefficients for six different groups which always appear in the Mind Genomics reports. The six groups are total panel, Mind Sets 1 and 2 from the two Mind-Set solutions, and then Mind Sets 1, 2 and 3 from the three Mind-Set solution.  We saw the total panel and the results from the two mind-sets, but not from the three mind-sets.

We tabulate the frequencies of coefficients between 0 and 5, 5 and 10, 10 and 15, 15 and 20, and finally higher than 20.  This tabulation generates a distribution of coefficients. We can either work with the absolute number of coefficients of a certain size (Computation 1) or weight the number of coefficients by the relative size of the subgroupsshowing the particular magnitude of coefficients (Computation 2.)

The summaries in Table 8 provide a quantitative, objective measure of ‘how good the elements are’ as they drive the response. When a student produces elements that score well across the different mind-sets, this is evidence of good thinking on the part of the study, thinking which is sufficiently powerful and expansive as to appeal to different-minded groups,

Table 8. Computation for the IDT, Index of Divergent Thought, a prospective gamifying metric to make Mind Genomics more interesting by being ‘gamified.’

Computation 1 – count the number of coefficients within the defined ‘range’, without accounting for the number of respondents showing the coefficient in their mind-set

Computation 1 does not account for the size of the mind-set

Group

Total

 

MS 1 of 2

MS 2 of 2

 

MS 1 of 3

MS 2 of 3

MS 3 of 3

 

Summary

Weight

1.0

 

0.6

0.4

 

0.4

0.3

0.3

 

 

Base

30

 

17

13

 

12

8

10

 

 

Regression Coefficient 0–9.99

6

 

3

4

 

3

1

1

 

18

Regression Coefficient 10–14.99

0

 

3

0

 

1

0

4

 

8

Regression Coefficient 15–19.99

0

 

0

3

 

3

1

0

 

7

Regression Coefficient 20+

0

 

2

2

 

1

4

3

 

12

Computation 2 – count the number of coefficients within the defined ‘range’, but weight each counted value by the proportion of all respondents (3xTotal) showing that coefficient.  Computation 2 accounts for the size of the mind-set. 

Group

Total

 

MS 1 of 2

MS 2 of 2

 

MS 1 of 3

MS 2 of 3

MS 3 0f 3

 

Summary

Weight (Base/Total)

0.33

 

0.19

0.14

 

0.13

0.09

0.11

 

 

Regression Coefficient 0–9.99

2.00

 

0.60

0.60

 

0.40

0.10

0.10

 

3.80

Regression Coefficient 10–14.99

0.00

 

0.60

0.00

 

0.10

0.00

0.40

 

1.10

Regression Coefficient 15–19.99

0.00

 

0.00

0.40

 

0.40

0.10

0.00

 

0.90

Regression Coefficient 20+

0.00

 

0.40

0.30

 

0.10

0.40

0.30

 

1.50

A one-year educational plan for Mind-Genomics to develop the student mind

  1. Goal: A one-year plan to create massive intellectual development among students through a once/week exercise using Mind Genomics through the BimiLeap program. The outcome… for each person, an individual portfolio of 20–30 studies showing topics investigated by the student … a portfolio to be shown proudly at interviews, and in school to be shared with fellow students, creating a virtuous circle of learning & knowledge
  2. The benefit to the education system: Create a school system which produces first rate creative thinking in younger students ages 7–13, high school students, and university students, each developing far beyond who they are today. Use the BiMiLeap program in the classroom or after school, once/week, to do a study in a topic area of intellectual interest, making it a social process which combines learning, true discovery, and competition,
  3. Process:  Four students work together. The younger students work with an older ‘docent.’ The docent records the material, prepares input for BimiLeap, ensures that the input is correctly submitted to the APP, and reviews the automated report with the students in the group after the data are obtained.  Each week, the composition of the group changes, allowing different students to collaborate.
  4. Mechanics:  The actual mechanics of the approach are presented in this paper. Mind Genomics studies concern a single topic area and collects data by obtaining reactions through an experiment, albeit an experiment which looks like a survey, but is not. Each group will get a topic from school, create the materials, run the study, get the PowerPoint® report, discuss, add insights to the PowerPoint,  present it in class to the other groups, incorporate the report into one’s personalized portfolio, and then repeat the process the following week with a reconstituted group.
  5. Specifics – Number of topics:  We believe that one good policy is to select a set of 10 topic areas, so each topic is treated 2–3 times a year by the students. Each time, the group addresses one of the topics afresh, encouraged to think critically about it and not just accept or replicate prior knowledge. They are freed to create new knowledge on the topic by re-using, updating, or adding new content.
  6. Specifics – The ‘sweet spot’ for users: The older students focus on different aspects of a single general topic, with each student creating 8–12 reports on research about the mind of people responding to different aspects of the topic …  Worthy of a PhD at the age of say 15, all while having fun, learning to think, collaborate, present.
  7. The BimiLeap program can be found at www.BimiLeap.com

References

  1. Kahneman D (2011) Thinking, Fast and Slow. Macmillan.
  2. Moskowitz HR, Gofman A, Beckley J, Ashman H (2006) Founding a new science: Mind genomics. Journal of sensory studies 2: 266–307.
  3. Mc Cannon BC (2007) Using game theory and the Bible to build critical thinking skills. The Journal of Economic Education 38: 160–164.
  4. Lehman M, Kanarek J (2011) Talmud: Making a case for Talmud pedagogy—the Talmud as an educational model. In International Handbook of Jewish Education, Springer, Dordrecht, 581–596.
  5. Kent O (2006) Interactive text study: A case of havruta learning. Journal of Jewish Education 72: 205–232.
  6. Holzer E, 7 Kent O, (2011) Havruta: What do we know and what can we hope to learn from studying in havruta? In International handbook of Jewish education, Springer, Dordrecht, 404–417.
  7. Box GE, Hunter WG, Hunter JS (1978) Statistics for Experimenters, New York, John Wiley

The Perceived Likelihood of Spousal Violence: A Mind Genomics Exploration

Abstract

We present a new way to understand how people perceive situations involving other people, situations that could be considered part of the everyday. The approach is Mind Genomics, which assesses the response of people to short, systematically varied vignettes about situations and other people. The responses to these vignettes are deconstructed into the part-worth contribution of the component elements that the vignette comprises, showing the ‘algebra of the mind.’ The deconstruction also is done on response time to the vignettes, showing the ability of the elements to engage attention when the respondent makes a judgment. When Mind Genomics is applied to descriptions of family life under stress, the data suggest that some elements are linked to predicted violence, others are not. Women appear to be more sensitive than men to the individual elements. Three different mind-sets emerged with different perceived ‘triggers’ to predicted family violence, with each mind-set encompassing both men and women: Mind-Set 1 – no specific warning; Mind-Set 2 – Sensitive to the economy; Mind-Set 3 – Family has problems. We present the PVI (personal viewpoint identifier) as a technique to assign new people to these mind-sets.

Introduction

Violence against the other sex, especially in marriage, is not new. Stories of murder and abuse fill the newspapers, the magazines, and the Internet news of today (late 2019.) Before today’s overwhelming plethora of news, violence by males against females, especially spouses and other family members, occupied a great deal of attention, from those in the news, but of course even more telling, from writers and poets. One cannot read the famous poem, My Last Duchess, by the 19th Century British poet, Robert Browning without a shudder when one realizes how easy it was to kill one’s spouse. And of course, the popular 1965 Rock n Roll song by Herman’s Hermits, hints at England’s royal lady-killer, King Henry VIII, transformed to a 1960’s idiom of a man with a broken heart.

What is popular in literature only reflects what is the common situation in everyday life. The literature in sociology and psychology is replete with studies about violence and anger. Violence against one’s spouse is dealt with in many publications, with the aspects dissected, studied, statistically analyzed and reports issued. Violence seems to be endemic to the relations, starting even in courtship [1]. The spousal violence continues, even into the 60’s [2]. Violence emerges when the woman ends up supporting the man [3]. Of course, alcoholism plays a role [4], but so does religion [5]. Violence comes from many quarters, but many studies have focused on gender and marriage [6, 7, 8].

The foregoing represents just a bit of the available material on violence in the home. These studies focus on both surveys and discussions with individuals. What is lacking is a sense of the richness of the family life through discussion, an absence promoted by the rigidity of the scientific method, but the absence filled by clinicians and social workers. The key issue is to make this topic come alive by merging the rigor of science with the immediacy of storytelling.

 Violence in the home is especially relevant because it is common and riveting to those involved. Although there seems to be very little academically oriented literature recounting the actual ‘story’ of the abuse, the Internet provides a repository of such personal studies in a number of websites, such as:

  1. https://www.getdomesticviolencehelp.com/domestic-violence-stories
  2. www.hiddenhurt.co.uk/domestic_violence_stories.html
  3. https://www.domesticshelters.org/articles/true-survivor-stories

It may be that websites are more conducive to people ‘telling their story’ in their own language. In contrast, the scientific community has made its information almost unobtainable, except to those schooled in the scholastic tradition, and able to cut through the jargon and statistics to understand what exactly is happening

Exploratory studies through Mind Genomics

This study explores the mind of ‘people’ by having them evaluate different vignettes about violence, vignettes that have been systematically varied, with the components of the vignette, the element, having a richness that is missing from surveys

A review of the scientific literature suggests that many of the studies involving human judgment are done in a manner which is slow, expensive, requiring teams of researchers, and extensive, rigorous statistical analysis. The statistical analysis is often of the type known as ‘inferential,’ with the objective to confirm or to falsify an ingoing hypothesis, with the hypothesis developed from theory.

Mind Genomics presents to the world of science a different approach, not grounded in theory and confirming or falsifying hypotheses [9]. Rather, Mind Genomics can be liked to an exploration of decisions, using cognitively meaningful stimuli, and dealing with issues of the every day. Mind Genomics can be likened to a new cartographical exercise of a land. Mind Genomics works by presenting vignettes to the respondents, with these vignettes comprising combinations of elements or messages to which a respondent can relate. The respondent reads the vignette and responds to the combination. The research approach is analogous to the MRI, which takes multiple pictures of tissue from different vantage points, and then combines these into a picture of the tissue.

The research in this study embodies the Mind Genomics paradigm, dealing with the very important issue of family violence. The objective is to understand a third-party’s estimate of either violence or peace at home occurring when a specific situation is presented, and then to assess the likelihood that each specific element is correlated either with violence or with a peaceful home, respectively, two opposite sides of the scale.

Mind Genomics combines the person with emotion and meaningful description of behavior, i.e., cognitively rich test stimuli. Mind Genomics obtains ratings from the response of people to vignettes about a situation, similar that presented in literature, storytelling, or song. The vignette paints a picture of a situation. The respondent is then asked to judge some aspect of the situation, such as projected violence or projected happiness, based upon what is read. Through this approach it now becomes possible to understand the mind of the person, either the one who is undergoing the experience, or the one who is hearing/reading about the experience. Both points of view differ dramatically from the almost lifeless array of statistics describing a situation. Mind Genomics combines the vividness of experience with numbers, probing the inner mind of the person exposed to the situation, first-hand or second-hand.

The Mind Genomics approach

The Mind Genomics approach is designed to be exploratory, affordable, iterative, and scalable. This set of objectives in the design means that there are certain simple aspects of the study:

  1. Exploratory. As suggested above, Mind Genomics does not work by confirming or disconfirming a hypothesis extant in the scientific literature. Rather, the exploration means taking new ideas from every-day experience and exploring them to find out the degree to which people respond positively or negatively to them.
  2. Affordable. Mind Genomics is set up to be a so-called DIY, Do it yourself system. The researcher needs access to an APP on the proper machine (Android or Kindle), the ideas (for the researcher), and a convenient source of respondents.
  3. Iterative. Mind Genomics is set up to return the data in easy-to-read formats (PowerPoint® for presentation, Excel® for data analysis. The data return in a matter of a few hours. A new study can be launched a few hours later, after the results from the first study are digested. Furthermore, the results are easy to understand, and set up to promote further exploration with the same tool. With the iterative approach the researcher can do as many as 4–6 studies in a 24-hour period, each study building upon the previous study.
  4. Scalable. Almost anyone can use Mind Genomics to explore problems. The system is scalable across people, but also across different aspects of a topic, by the same researcher. Within a matter of a week or two, the enterprising researcher can conduct 10–20 studies, exploring the different facets of a topic.

Raw materials

The origin of this study was the focus by author Peer on the causes of violence against women, the fact that so much is known, yet so little. When random people were asked by author Moskowitz about the topic ‘What do you think causes spousal violence,’ very few people could provide an answer quickly. There was no sense of a well-recognized phenomenon, violence, connected with the daily life of people, other than general statistical compilations, available in the literature.

The benefit of a Mind Genomics study is the degree to which it takes any topic and reduces that topic to a set of common aspects, experienced in the everyday. Thus, the elements shown in Table 1 represent the way a person might conceive of the nature of spousal violence. A Mind Genomics is not meant to be exhaustive, but rather introductory, approachable, and in some ways focuses on a very specific topic. When this notion of ‘cartography’ is recognized and accepted, the position of Mind Genomics advances to a useful, early-stage way of understanding a topic from the mind of people.

Table 1. The raw materials for the study, comprising four questions about the conditions of a family, and the four answers to each question.

 

Question A: What is the current situation of the person

A1

The local economy is stressed and in recession

A2

The local economy is growing

A3

The children are having problems

A4

The couple are having long term problems

 

Question B: What is the local situation

B1

Companies are firing employees

B2

Companies are hiring but people working long hours

B3

It’s in middle of winter … Christmas

B4

It’s summer time

 

Question C: What does the woman do

C1

The lady starts searching for a job to help out

C2

The lady is having problems with finances

C3

The husband is having job troubles

C4

The husband is sad and depressed

 

Question D: What happens afterward

D1

The family time is shorter together

D2

The family all eat at different times

D3

The wife wants to talk but the husband does not

D4

The husband wants to talk but the wife does not

The reader will see the approach in Table 1, showing the four questions (which tell a story), and the four answers to each question. As we read the answers or elements, we should keep in mind that the answers are concrete and simple. When exploring a topic, we can learn a great deal from four simple questions which tell a story, and from the pattern of responses to the 16 answers. The results in this study should reveal a variety of new-to-the-world patterns about domestic violence, based simply on the different ways that people respond to these unambiguous stimuli.

With the inputs shown in Table 1, Mind Genomics creates combinations of answers, so-called vignettes. An example of a vignette appears in Figure 1.

Mind Genomics-038_f1

Figure 1. Example of a vignette as presented to the respondent.

Each respondent evaluated 24 vignettes. The vignettes were constructed according to an experimental design, with the property that a vignette comprised at most one answer from each question, but often had no answers from either one or two of the questions. Thus, the vignettes comprised either two, three, or four answers, the so-called elements. Furthermore, each respondent evaluated a unique set of combinations. The underlying structure of the combinations was maintained, but the specific combinations differed from one respondent to another.

To the respondent, the combinations might seem to be random, but the reality is the exact opposite. The experimental design prescribes the combinations. The objective is to present combinations of elements or answers (without the questions), obtain ratings from the respondents who evaluate these combinations, and then deconstruct the ratings into the separate contribution from each element. In this way the respondent is unable to ‘game’ the system by providing politically correct answers. It is virtually impossible to detect the underlying pattern. As a result, the respondent simply relaxes, and gives responses which are more intuitive, and fundamentally less ‘edited.’ In the words of experimental psychologist Daniel Kahneman, the Mind Genomics approach calls into play ‘System 1’ thinking, the fast, almost automatic thinking that we use daily in our lives, when we don’t have to make rational calculations [10].

A sense of the underlying experimental design can be gotten from looking at the schematic in Table 2, which presents the structure of the first eight vignettes for Respondent #1. The respondent does not, of course, see the underlying structure, but rather the actual combinations, presented on the computer as in Figure 1, or restructured to fit on the screen of a smartphone.

Table 2. Structure of the first eight vignettes for Respondent #1, the conversion to binary for statistical analysis, and the deconstruction of the ratings and response time.

Vignette

Vig1

Vig2

Vig3

Vig4

Vig5

Vig6

Vig7

Vig8

Design

 

 

 

 

 

 

 

 

A

4

4

2

2

0

1

1

0

B

4

3

2

1

1

3

4

4

C

2

2

4

1

3

0

1

4

D

1

2

2

2

4

1

2

1

Binary

 

 

 

 

 

 

 

 

A1

0

0

0

0

0

1

1

0

A2

0

0

1

1

0

0

0

0

A3

0

0

0

0

0

0

0

0

A4

1

1

0

0

0

0

0

0

B1

0

0

0

1

1

0

0

0

B2

0

0

1

0

0

0

0

0

B3

0

1

0

0

0

1

0

0

B4

1

0

0

0

0

0

1

1

C1

0

0

0

1

0

0

1

0

C2

1

1

0

0

0

0

0

0

C3

0

0

0

0

1

0

0

0

C4

0

0

1

0

0

0

0

1

D1

1

0

0

0

0

1

0

1

D2

0

1

1

1

0

0

1

0

D3

0

0

0

0

0

0

0

0

D4

0

0

0

0

1

0

0

0

Rating

 

 

 

 

 

 

 

 

9-Point Rating

1

5

7

9

7

5

3

7

Binary – Violence

1

0

101

100

100

0

0

100

Binary – Happy

100

0

0

0

0

0

100

0

Response time

9.0

3.3

3.3

2.3

2.8

3.0

2.4

2.3

Executing the study

Each respondent receives the invitation to participate, and is instructed to read the vignette, and to rate it on the 9-point scale.

Here is a set of snapshots of families. Please read the full snapshot and tell us what will happen within the foreseeable future. Read the whole snapshot. Is it going to be peaceful or do you sense some family violence brewing?

What will happen in the foreseeable future with this family?

1=peace and love … 9=some violence

The respondent then read each of 24 unique vignettes. The respondent rated vignette on the above 9-point scale. The respondent was then instructed to fill out an open-ended question about violence (results not presented here.) The entire process took approximately 4–5 minutes.

Basic data transformation

The experimental design itself must be transformed to a binary no/yes, as shown in Table 2. Only with a binary scale (absent/present) is it feasible to understand the part-worth contribution of every element. In turn, the 9-point scale can be used as a dependent variable, but experience has shown that most people, researchers included, have a difficult time understanding what the scale points mean. Sometimes this difficulty in understand is addressed by labelling each of the nine scale points, a task which itself is fraught with difficulties. An easier way, taken from the world of consumer research, converts the nine-point scale to a binary scale, 0 or 100. Managers find it easy to understand the binary scale and know what to do with a ‘no’ or a ‘yes’ answer.

The conventional way to divide the scale creates three regions for the scale; 1–3, 4–6, and 7–9, respectively. Then the following conventions is invoked:

Ratings of 7–9 are assumed to represent ‘violence,’ and ratings 1–6 are assumed to reflect the lack of violence. For this new variable, ‘violence’, we convert ratings of 1–6 to 0, and ratings of 7–9 to 100. We then add a small random number (<10–5). The small random number ensures that that the regression analysis will ‘run’ on the binary-transformed data, even when the respondent confines all of the ratings either to the lower portion of the scale (1–6, transformed to 0), or confines all of the ratings to the upper portion of the scale (7–9 transformed to 100, 1–6 transformed to 0). The small random number provides just enough variability in the dependent to ensure that the OLS (ordinary least=squares) regression ‘does not crash,’

Analysis – What drives violence versus happiness – total panel?

The basic analysis in Mind Genomics is OLS (ordinary least-squares) regression, made possible by the ingoing structure of the vignettes for each individual respondent. Every respondent evaluated 24 carefully constructed vignettes, ensuring that at the individual level all 16 elements or answers to the questions, are statistically independent of each other. Most of the vignettes are different from each other, so that the combination of all the vignettes covers a great deal of the ‘design space.’

We combine all the data from the 50 respondents, creating a database of 1200 vignettes (50 × 24 = 1200). We run two OLS regressions. The first relates the presence/absence of all 16 variables to the binary value of ‘violence’, corresponding to the ratings 7–9 on the original 9-point scale, but now becoming the value 100 on the binary scale for violence. The second OLS regression relates the presence/absence of all 16 variables to the violence of ‘happiness’ corresponding to the ratings of 1–3 on the original 9-point scale.

Table 3 shows the coefficients for the two equations. The equation is expressed as (Binary Rating) = k0 + k1(A1) + k2(A2) + … k16(D4).

Table 3. Parameters of the model for the Total Panel relating the presence / absence of the 16 elements to predicted violence (Ratings of 7–9 converted to 100), and to predicted happiness (Ratings of 1–3 converted to 100).

 

 

Violence

Happiness

 

Additive constant

27

12

C4

The husband is sad and depressed

6

-3

B1

Companies are firing employees

5

4

A1

The local economy is stressed and in recession

4

-2

D3

The wife wants to talk but the husband does not

3

-4

B3

It’s in middle of winter .. Christmas

3

9

A4

The couple are having long term problems

1

0

C3

The husband is having job troubles

1

-3

A3

The children are having problems

1

1

D1

The family time is shorter together

-1

-2

D2

The family all eat at different times

-1

-2

D4

The husband wants to talk but the wife does not

-1

-2

B2

Companies are hiring but people working long hours

-1

5

C2

The lady is having problems with finances

-2

2

B4

It’s summer time

-4

10

A2

The local economy is growing

-5

6

C1

The lady starts searching for a job to help out

-11

4

The additive constant, k0, is the estimated value of the binary response in the absence of elements. All vignettes comprised a minimum of two and a maximum of four elements. Consequently, the additive constant is an estimated parameter. Nonetheless, the additive constant has value in because it gives a sense of baseline interest or baseline feeling, in the absence of elements.

As noted above, the experimental designs ensure that all 16 elements or answers are statistically independent of each other, allowing the absolute coefficients to be estimated. That is, the values of the coefficients are all relative to 0. A coefficient of 10 is twice as high as a coefficient of 5. Furthermore, the transformation of the scale to binary strengthens the mathematic property. The coefficient of 10 means that in the absence of elements, 10% of the responses will be suggest ‘violence’ (7–9). The coefficient of 5 means that in the absence of elements, 5% of the responses, half the number as before, will suggest ‘violence.’ The absolute value of the coefficient means that the coefficients can be compared from study to study, with different topics and different respondents. The ratio scale properties generated by the binary transformation means that one can relate ratio changes in the coefficients (or properly coefficient + additive constant) to external behaviors. The negative coefficient means that when the element is added to the vignette, the percent of response suggesting ‘violence’ will be removed. Thus, when the coefficient is -10, then adding the element to a vignette will decrease the percent suggesting ‘violence’ by 10%. The coefficients are additive and subtractive.

From thousands of such experiments, a set of rules of thumb have emerged about the value of the coefficients, based upon observations of the data, and knowledge about what happens in the external world. The table below provides these guidelines, which are qualitative in nature. There are no fixed values, but rather a shading of importance, so that the higher the positive number the more important the element.

  1. Coefficient of 15 or higher             Extremely important, major signal
  2. Coefficient 8–15                           Important to very important
  3. Coefficient of 0–8                         From irrelevant to almost important
  4. Coefficient 0 to -6                        From irrelevant to almost important
  5. Coefficient from -6 to lower           Important

We interpret the parameters of the model for violence (ratings of 7–9 converted to 100).

  1. The Additive constant is 27, meaning that there is a low likelihood of predicting violence in the absence of elements. We can compare this to say the purchase intent for pizza on the same type of 9-point scale, albeit with different anchors (definitely not buy … definitely buy). The additive constant for pizza is around 60.
  2. The elements for predicted violence are low. There is only one which even approaches potential meaningfulness, C4 (The husband is sad and depressed).
  3. We move now to the parameters of the model for happiness (ratings of 1–3 converted to 100.)
  4. The additive constant is 12, meaning that there is very little in the way of predicted happiness in the absence of elements.
  5. Two elements emerge as strong drivers of predicted happiness, both related to season:
    1. B4 (It’s summer time)
    2. B3 (It’s the middle of winter … Christmas)

Genders react differently when predicting violence, but similarly when predicting happiness

Respondents profiled themselves in term of gender. When we divide the data sets by gender and estimate the two models by gender (predicted violence versus predicted happiness), we find dramatic differences in the models for predicted violence, but similar models for predicted happiness (Table 4).

Table 4. Parameters of the model for males versus females relating the presence / absence of the 16 elements to predicted violence (Ratings of 7–9 converted to 100), and to predicted happiness (Ratings of 1–3 converted to 100).

 

 

Female

Male

Female

Male

 

 

Violence

Happiness

 

Additive constant

16

39

11

13

C4

The husband is sad and depressed

15

-4

-3

-2

B1

Companies are firing employees

13

-3

2

6

B3

It’s in middle of winter … Christmas

10

-5

8

11

A1

The local economy is stressed and in recession

4

4

-4

0

D3

The wife wants to talk but the husband does not

6

0

-3

-5

A3

The children are having problems

2

0

0

2

A4

The couple are having long term problems

3

-1

2

-2

C3

The husband is having job troubles

3

-2

0

-6

D4

The husband wants to talk but the wife does not

1

-2

-1

-2

D2

The family all eat at different times

0

-2

-4

-1

A2

The local economy is growing

-8

-3

9

2

D1

The family time is shorter together

4

-5

-3

-1

C2

The lady is having problems with finances

1

-6

2

2

B2

Companies are hiring but people working long hours

4

-7

2

9

B4

It’s summer time

1

-8

9

11

C1

The lady starts searching for a job to help out

-10

-12

3

4

Table 5. Parameters of the model for the three age groups relating the presence / absence of the 16 elements to predicted violence (Ratings of 7–9 converted to 100), and to predicted happiness (Ratings of 1–3 converted to 100).

 

 

Age50+

Age30–49

A19–29

Age50+

Age30–49

A19–29

 

Violence

Happiness

 

 

Additive constant

22

27

31

2

3

37

C4

The husband is sad and depressed

13

7

-5

0

-9

-6

B1

Companies are firing employees

11

5

-1

3

8

-4

A1

The local economy is stressed and in recession

1

8

3

-3

8

-12

D3

The wife wants to talk but the husband does not

4

2

8

2

-10

-9

B2

Companies are hiring but people working long hours

-3

-1

5

3

12

1

B3

It’s in middle of winter …Christmas

1

6

4

9

13

8

D1

The family time is shorter together

3

-7

3

4

-6

-6

D2

The family all eat at different times

2

0

-2

2

-6

-6

B4

It’s summer time

-5

-1

-2

8

19

3

A4

The couple are having long term problems

4

3

-6

-1

2

-1

A2

The local economy is growing

-7

-1

-6

8

6

3

A3

The children are having problems

1

6

-6

0

5

-2

D4

The husband wants to talk but the wife does not

2

3

-8

2

-3

-5

C3

The husband is having job troubles

6

6

-15

-2

-6

2

C2

The lady is having problems with finances

7

1

-18

3

2

1

C1

The lady starts searching for a job to help out

-7

-8

-23

7

-1

6

Predicted violence

  1. Additive constant – lower for females, higher for males (16 vs 39). The difference suggests that the prediction of violence by female respondent occurs for specific situations. In contrast, for males the additive constant is much higher, suggesting that they predict violence without needing to have specifics.
  2. Women predict that the violence will occur in different situations, the most surprising of which is the expectation of violence during Christmas time.

    The husband is sad and depressed

    Companies are firing employees

    It’s in middle of winter … Christmas

Predicted happiness

  1. Additive constant is very low, 11 for females, 13 for 13
  2. Surprisingly, women are divided on winter and Christmas, with females reacting to

    It’s in the middle of winter … Christmas

    The local economy is growing

    It’s summer time

  3. Males are happy as well, with both season and a growing economy

    It’s in the middle of winter … Christmas

    Companies are hiring but people are working long hours

    It’s summer time

Predicted Violence

  1. The additive constants, prediction of violence without other information, are low, with the additive constant lowest for age 50+ (value = 22), and the additive constant modestly higher for age 19 to 29 (value =31)
  2. There are age differences in what drives predicted violence.
  3. The oldest respondents, age 50+ predict that violence will occur with the husband sad and depressed, and the companies firing employees.
  4. The middle group age predict that violence will occur when the local economy is stressed and in recession
  5. The young respondents don’t predict violence will occur in these bad economic times but predict violence will occur when the wife wants to talk but the husband does not.
  6. We conclude from this pattern that the older respondents, age 50+, see violence as externally driven, whereas the young respondents, age 19–29 see violence as interaction driven.

Predicted happiness

  1. The additive constants, base expectations without elements, vary dramatically across ages. The older respondents (age 50+ and age 30 to 49) see no basic happiness. It’s all a matter of the specifics. The younger respondents, age 19 to 29, in contrast, feel that happiness is all around.
  2. The oldest respondents feel that happiness is a function of the time, whether Christmas or the summer.
  3. The middle group, age 30 to 39, show some answers which make sense (e.g., companies are honoring, summer time, winter time), but also some answers which don’t make sense (companies are firing employees’ the local economy is stressed and in recession). It could be that this age group feels that the hard times will bring the couple together, rather than eventuate in violence.
  4. The youngest group age 19 to 39 feel that happiness will emerge with the Christmas season, but not with the summer season.

Response time and engagement with the elements in the vignette

For more than a century, researchers have searched for ‘objective’ correlates of psychological processes. The notion that the information provided by people was not acceptable to many researchers, who believed, whether correctly or not, that only ‘objective’ physical measures could tell the truth about what a person perceives or thinks. The history of these approaches traces back to the original research on reaction time in the Leipzig laboratory of Wilhelm Wundt [11], and moves on to physiological measures of human reactions, whether GSR (galvanic skin response, electrical conductance of the skin), electromyography (muscle currents), then EEG (electroencephalographs and brain waves), culminating in such methods as fMRI [12, 13]. There are other more recently introduced methods, such as the implicit association test [14].

Response time, the earliest measure and perhaps the most frequently used measure, may shed additional light on the nature of the way people respond to the elements or answers embedded in the vignettes. Mind Genomics has the distinct benefit that the test stimuli, the elements, are themselves cognitively meaningful. It’s not a case of having to infer ‘what about the stimulus’ makes the respondent process it more quickly or more slowly. One can simply look at the response times to the different elements, using deconstruction method below, and ask whether there is something common about those elements taking longer to process, versus those elements processed more quickly.

The Mind Genomics computer program measured the response time to the different vignettes. It then eliminated all vignettes requiring more than 9 seconds to rate, under the assumption that in these Mind Genomics studies, rarely does a respondent stop to consider a vignette for longer than a few seconds. The Mind Genomics program also eliminates all vignettes tested in the first position, with the rationale that at the start of the experiment respondents don’t know what to do.

Figure 2 shows the distribution of response times, with the abscissa spaced logarithmically. The important thing is the relatively large number of vignettes requiring more than four seconds to process. In many comparable studies, albeit with mundane topics like food, we do not see such long response times. There may be a difference in the way people read serious vignettes, such as the vignettes here, versus ‘fun vignettes’ of other topics.

Mind Genomics-038_f2

Figure 2. Distribution of response times for the study on predicted family violence. The distribution has been trimmed to eliminate the responses from the vignette evaluated in the first position, and vignettes registering 9 seconds or longer to evaluate.

The analysis of response times follows the standard approach, involving OLS (ordinary least-squares) regression. The equation is written without the additive constant, based upon the ingoing assumption that in the absence of a vignette with elements, there is no response. All vignettes, however, except those tested first, are included in the OLS regression, with all vignettes of response times 9 or more seconds truncated to 9.

The equation is expressed as: Response Time = k1(A1) + k2(A2) … k16(D4)

The analysis was performed in the precisely the same way as the regression analyses for the ratings. That is, the relevant group was identified, and all the appropriate vignettes from everyone in the relevant group was put into a single data file, accessed by the OLS regression package.

The coefficients represent the number of tenths of seconds that can be ascribed to each element. The OLS regression deconstructs the response time, estimating the number of tenths of seconds for each element. In the analyses we will look at those response times for individual elements of 1.5 seconds or more. The cut-off of 1.5 seconds is arbitrary, allowing us to get a sense of those elements which strongly engaged the respondents. It is important to keep in mind that these socially relevant topics appear to be generating longer response times than the more typical business and marketing topics run in the same fashion, with the same type of respondents. It may be that respondents pay more attention to socially relevant topics.

The response times for the 16 elements as shown in Table 6 suggest a continuum with response times of 1.0–1.5 seconds. Keep in mind that all response times over 9 seconds or longer were eliminated as suggesting that the respondent might be doing other things. The data do not suggest a pattern. The most engaging elements, those with the longest response times, talk about the couple, about the economy, and about the woman having problems.

Table 6. Response times for the 16 elements, estimated from the data of the Total Panel.

 

Response time for the total panel

Total

A4

The couple are having long term problems

1.5

B2

Companies are hiring but people working long hours

1.5

C2

The lady is having problems with finances

1.5

D4

The husband wants to talk but the wife does not

1.5

A1

The local economy is stressed and in recession

1.3

B3

It’s in middle of winter … Christmas

1.3

D3

The wife wants to talk but the husband does not

1.3

A2

The local economy is growing

1.2

B1

Companies are firing employees

1.2

C1

The lady starts searching for a job to help out

1.2

D2

The family all eat at different times

1.2

C4

The husband is sad and depressed

1.1

D1

The family time is shorter together

1.1

A3

The children are having problems

1.0

B4

It’s summer time

1.0

C3

The husband is having job troubles

1.0

By gender

When we divide the respondents by gender, we see radical differences. The most important result is that men do not find the elements engaging, at least when we operationally define the term ‘engaging’ as a response time of 1.5 seconds (Table 7.)

Table 7. Response times for the 16 elements, estimated from the data broken out by gender.

 

Response time in seconds – by gender

Male

Female

D4

The husband wants to talk but the wife does not

1.0

2.0

A4

The couple are having long term problems

1.3

1.7

B2

Companies are hiring but people working long hours

1.3

1.7

C2

The lady is having problems with finances

1.4

1.6

A1

The local economy is stressed and in recession

1.0

1.6

D3

The wife wants to talk but the husband does not

0.9

1.6

B3

It’s in middle of winter … Christmas

1.1

1.5

B1

Companies are firing employees

0.9

1.5

D2

The family all eat at different times

1.1

1.4

C1

The lady starts searching for a job to help out

1.0

1.4

D1

The family time is shorter together

0.8

1.4

A2

The local economy is growing

1.2

1.2

C4

The husband is sad and depressed

1.2

1.1

B4

It’s summer time

0.9

1.1

C3

The husband is having job troubles

0.8

1.1

A3

The children are having problems

1.1

1.0

Table 7. Response times for the 16 elements, estimated from the data broken out by age group.

 

Response time in seconds – by age

Age 50+

Age 30–49

Age 19–29

B2

Companies are hiring but people working long hours

2.0

1.4

0.8

D4

The husband wants to talk but the wife does not

1.9

1.4

1.2

A4

The couple are having long term problems

1.9

1.4

0.7

D3

The wife wants to talk but the husband does not

1.9

1.2

0.7

C2

The lady is having problems with finances

1.8

2.1

0.7

B3

It’s in middle of winter … Christmas

1.6

1.2

0.9

C1

The lady starts searching for a job to help out

1.6

1.2

0.7

B1

Companies are firing employees

1.6

1.1

0.8

D1

The family time is shorter together

1.5

1.3

0.6

A1

The local economy is stressed and in recession

1.5

1.0

1.2

D2

The family all eat at different times

1.4

1.5

0.9

C4

The husband is sad and depressed

1.2

1.4

0.8

A3

The children are having problems

1.2

1.1

0.5

A2

The local economy is growing

1.1

1.5

1.0

C3

The husband is having job troubles

0.9

1.3

0.7

B4

It’s summer time

1.1

0.5

1.3

Males

The most engaging element is

The lady is having problems with finances.

The least engaging elements are

The wife wants to talk but the husband does not

Companies are firing employees

It’s summer time

The family time is shorter together

The husband is having job troubles

Females

There are many engaging elements. The fact that 8 of the 16 elements are engaging to women suggest that women are simply more attentive than men to the topic of violence versus happiness.

The husband wants to talk but the wife does not

The couple are having long term problems

Companies are hiring but people working long hours

The lady is having problems with finances

The local economy is stressed and in recession

The wife wants to talk but the husband does not

It’s in middle of winter … Christmas

Companies are firing employees

Age group

Respondents age 59+

The oldest respondents focus primarily about the issues between the members of the couple, but also react to the economy (companies are hiring but people working long hours). That element might be a signal for problems that emerge between the husband and wife.

Companies are hiring but people working long hours
The husband wants to talk but the wife does not
The couple are having long term problems
The wife wants to talk but the husband does not
The lady is having problems with finances
It’s in middle of winter … Christmas
Companies are firing employees
The lady starts searching for a job to help out

Respondents age 30–49

The most engaging element is the practical issue of finances. The elements are more practical.

The lady is having problems with finances
The family all eat at different times
The local economy is growing

Respondents age -29

None of the elements engaged them. They appear to be disinterested in the topic, or at least don’t pay much attention.

Mind Sets

One of the key tenets of Mind Genomics is that in any topic area involving judgment and decision-making, there are different groups, mind-sets, showing divergent patterns of what is important. The ideal situation, but one quite rare, is that these mind-sets are congruent with some easy-to-define and measure characteristic or set of characteristics of the respondent. Most of psychological and sociological research discovering groups with different points of view, e.g., voting for political parties, attempt to understand these differences within the framework of the standard ways to divide people. Thus, it is not unusual to see voting patterns broken out by age, gender, market, income, education, work, and so forth. Indeed, the world of analytics attempts to predict these mind-set-driven behaviors from some predictive model using easy to measure variables.

In the world of Mind Genomics, the discovery of these basic groups is straightforward, requiring simply one or several studies of the type performed here, and statistical methods to cluster together individuals with similar patterns of coefficients [15]. Individuals with similar patterns are assumed to belong to the same ‘mind genome’ for the topic. The creation of the mind genome is a simple statistical analysis, once the relevant experiment has been run. In this respect Mind Genomics holds the advantage of generating easy to interpret ‘mind genomes’ from simple experiments. The reason for the simplicity is that the experiment deals with the topic itself, and the test stimuli are all relevant. One need not array an analytic armory to discover the ‘mind genomes,’ which emerge readily from these focused experiments.

The procedure for uncovering mind genomes follows these eight steps.

  1. Array the vector of all 16 elements for a given respondent as a one line in a data base.
  2. Create all the data base, which in our case comprises 16 columns of data (one column per element), and 50 rows (one per respondent).
  3. The coefficients tell us the degree to which the respondent would rate that element a 7–9 if the vignette comprised only that element.
  4. Apply the method of clustering to divide the set of respondents into two groups, and then again into three groups.
  5. Build a model for each of the two groups, and then build a model for each of the three groups.
  6. Choose the more parsimonious solution, which is at the same time interpretable.
  7. Interpretable means that the strongest positive elements ‘tell a coherent story’.
  8. Parsimonious means that the fewer the number of clusters or mind-sets, the better, so long as the mind-sets tell a story which makes sense.

The results from the clustering suggest three mind-sets, as shown in Table 8. The clustering was done on the coefficients after the ratings were converted to the ‘predicted violence scale’ (ratings of 7–9 converted to 100, ratings of 1–6 converted to 0). The mind-sets are named according to the elements which generate the highest coefficients for the mind-set.

Table 8. Parameters of the model for the mind-sets relating the presence / absence of the 16 elements to predicted violence (Ratings of 7–9 converted to 100), and to predicted happiness (Ratings of 1–3 converted to 100.) The mind-sets were generated based upon the predicted violence scale.

 

 

Mind-Set: 1 No Specific Warning

Mind-Set: 2 Sensitive to the Economy

Mind-Set: 3 Family has Problems

 

Mind-Set: 1 No Specific Warning

Mind-Set: 2 Sensitive to the Economy

Mind-Set: 3 Family has Problems

 

 

Violence

 

Happiness

 

Additive constant

47

20

16

 

20

2

14

C4

The husband is sad and depressed

-4

4

16

 

-10

3

-2

C2

The lady is having problems with finances

-16

-6

13

 

3

5

-2

C3

The husband is having job troubles

-15

2

13

 

-6

5

-7

B1

Companies are firing employees

-14

21

7

 

7

0

3

B3

It’s in middle of winter … Christmas

-6

21

-7

 

18

-3

12

B2

Companies are hiring but people working long hours

-13

17

-8

 

9

2

5

A1

The local economy is stressed and in recession

-11

13

10

 

-5

5

-7

B4

It’s summer time

-11

11

-11

 

16

7

8

D2

The family all eat at different times

7

1

-9

 

-6

3

-5

D3

The wife wants to talk but the husband does not

6

7

-3

 

-7

0

-5

D4

The husband wants to talk but the wife does not

2

-6

1

 

-3

7

-7

D1

The family time is shorter together

1

0

-1

 

-5

3

-4

A3

The children are having problems

-9

4

7

 

-2

6

0

A2

The local economy is growing

-10

-2

-3

 

1

5

9

A4

The couple are having long term problems

-11

5

9

 

-10

7

2

C1

The lady starts searching for a job to help out

-21

-16

1

 

4

6

1

When we look at response times for the three mind-sets (Table 9) we see dramatic differences in the pattern of elements which ‘engage,’ i.e., operationally defined as generating a response time of 1.5 seconds or longer. The elements which drive the segmentation also appear to strongly engage only respondents in Mind-Set 3 (family has problems),

Table 9. Response times for the 16 elements, estimated from the separate models, one for each of the three mind-sets.

 

 

Mind-Set: 1
No Specific Warnin
g

Mind-Set: 2 Sensitive to the Economy

Mind-Set: 3 Family has Problems

B2

Companies are hiring but people working long hours

1.2

1.1

2.1

A4

The couple are having long term problems

1.0

1.6

1.8

C2

The lady is having problems with finances

1.4

1.4

1.7

D4

The husband wants to talk but the wife does not

1.3

1.5

1.6

B1

Companies are firing employees

1.0

1.2

1.5

B3

It’s in middle of winter … Christmas

1.2

1.2

1.5

D3

The wife wants to talk but the husband does not

1.0

1.7

1.1

D2

The family all eat at different times

1.2

1.7

0.9

A1

The local economy is stressed and in recession

1.0

1.6

1.4

A2

The local economy is growing

1.2

1.5

1.0

C4

The husband is sad and depressed

1.4

1.1

1.0

C3

The husband is having job troubles

1.4

0.8

0.6

D1

The family time is shorter together

1.0

1.1

1.4

C1

The lady starts searching for a job to help out

1.0

1.0

1.4

B4

It’s summer time

1.0

0.5

1.3

A3

The children are having problems

0.4

1.3

1.3

Mind-Set 3 (Family has problems)

Companies are hiring but people working long hours
The couple are having long term problems
The lady is having problems with finances
The husband wants to talk but the wife does not
Companies are firing employees
It’s in middle of winter are Christmas

Mind-Set 2 (Sensitive to the economy)

The wife wants to talk but the husband does not
The family all eat at different times
The couple are having long term problems
The local economy is stressed and in recession
The husband wants to talk but the wife does not
The local economy is growing

Mind-Set 1 (No specific warning)

No element engages

The nature of people – optimistic versus pessimistic

The original focus of this paper was the pattern of responses of people to vignettes describing a couple who are in a stressful situation. The pattern of responses of our 50 respondents can also show us whether the respondents themselves are typically optimistic, pessimistic, or neither. The analysis is straightforward. We have 24 samples of the respondent’s evaluations of vignettes, with all elements (answers) appearing an equal number of times, and the basic experimental design structure maintained.

In our preparation for modeling we created binary two scales, each 0/100. Each respondent generates an average on each binary scale. When we look at predicted violence, for example, an average of 100 means that 100% of the time, i.e., for all 24 vignettes, the respondent predicts violence will occur. In contrast, if the average if 50, then the respondent predicts that violence will occur on in half the vignettes.

With this way of plotting the data we can look at the respondents, either one at a time or for key subgroups, to determine where the respondent lies on the scatterplot, and what that implies about the respondent. Figure 3 shows the scatterplots for total panel, gender, age, and mind-set, respectively.

Mind Genomics-038_f3

Figure 3. Scatterplot of binary transformed ratings. Each point is the average binary rating for a respondent. The abscissa is the average for the respondent for ‘predicted violence’ (rating 7–9 converted to 100). The ordinate is the average for the respondent for ‘predicted happiness’ (rating of 1–3 converted to 100).

The key things to note are:

  1. The 45-degree line means that that the respondent is neither pessimistic nor optimistic but predicts violence and predicts happiness an equal number of times.
  2. The further out on the abscissa and the ordinate the respondent falls, the more the respondent is judgmental. There respondent either rates the vignette as describing a situation ending in violence, or describing a situation ending in happiness.
  3. The closer the respondent falls to 0,0 the less frequently the respondent is judgmental.
  4. Respondents falling to the right of the line and high on the abscissa (far right) tend to predict violence
  5. Respondents falling above the line, and high on the abscissa (far up) tend to predict happiness.
  6. Figure 3 immediately shows the greater negativity of females versus males, Age 50+ versus younger respondents, and Mind-Set 2 versus the other two mind-sets, respectively.

Finding the mind-sets in the population (Attila)

The conventional way to discover different groups in the population is through surveys. When one ‘knows’ the subgroup to which a person belongs, e.g., our mind-sets, it is only nature to believe that there are correlates of membership in the population. If only we could discover those correlates, goes the standard plaint. The ingoing assumption is that people who ‘think similarly’ (our mind-sets) should BE similar on the factors used to measure them. An example is age, another is gender, both of which, of course, are surrogates for various life situations and experiences.

Table 10 suggests that if we are to look to age and to gender as co-variates of segment membership, we are likely to be disappointed. Certainly, as our data suggest, these subgroups exhibit their own general patterns, different from each other, but not suggesting profound differences. In contrast, mind-set segmentation of the type performed with Mind-Genomics data divides people by how they respond, and thus think, in a particular situation.

Table 10. Distribution of the respondents by both the mind-sets (columns) and the more traditional divisions (gender, age, respectively).

 

Mind-Set: 1
No Specific Warning

Mind-Set: 2 Sensitive to the Economy

Mind-Set: 3 Family has Problems

Total

Total

15

17

18

50

Gender

 

 

 

 

Male

9

7

8

24

Female

6

10

10

26

Age

 

 

 

 

19–29

6

4

2

12

30–49

6

7

2

15

50+

3

6

13

22

No Answer

 

 

1

1

The specificity of the mind-set segments to the test stimuli means that we need a way to assign NEW people to one of the three mind-sets. The system must respect the fact that the mind-sets emerged from the elements specific to this topic and this study. Thus, we end up assigning new people to mind-sets based upon a system which is specific to the study. To this end, author Gere has created a PVI, personal viewpoint identifier which uses the pattern of coefficients from the averages for the three segments. The PVI is created by adding ‘noise’ to the basic summary data for the three mind-sets, and then using them to predict mind-set membership. The six strongest predictors in the ‘face of natural noise in data’ are selected as the cohort to be used to assign new people to one of the three mind-sets. Figure 4 shows the PVI for this study, and the three feedback pages which emerge, depending upon the mind-set to which the respondent is assigned. The feedback pages can be used for further scientific study, for clinical purposes, and even for digital and personal marketing. As of this writing (December 2019) the PVI is available this website:

Prediction of Violence: Violence: http://162.243.165.37:3838/TT20/

Prediction of Happiness: http://162.243.165.37:3838/TT21/

Mind Genomics-038_f4

Figure 4. The PVI (personal viewpoint identifier) for the spousal violence study, by which new people can be assigned to one of the three mind-sets uncovered in the research.

Discussion and Conclusions

This paper presents the emerging science of Mind Genomics as a way to bridge the gap between the impersonal, quantitative dimension of social science and the qualitative, story-telling, emotion-filled and narrative-rich material provided by qualitative methods, story-telling, and literature.

The scientific literature dealing with marital violence provides us with a sense of the many different contributors to the violence in the home, mainly between spouses and but directed to other members of the family. There is a body of sociological and psychological data looking for correlates of family violence. The range of these correlated variables is extensive, as can be sensed from the small sample the literature cited here.

The problem with studying violence and other factors of the ‘human condition’ is the virtual impossibility of doing experiments. The ethics of science and the moral responsibility of people to act ethically precludes doing experiments. We are left with observations and reports. Mind Genomics steps in with an attempt to go one step further, using the ordinary individual as an observer of a reported situation (the experiment), and reacting in terms of a prediction of the outcome (violence, nothing, happiness, respectively). In this respect we might consider Mind Genomics in these situations to be analogous to the behavioral economics tool of ‘predictive markets,’ or better ‘information markets’ which uses subjective perceptions embedded in a stock market-like game to drive deep insights into the reasons behind choice [16, 17, 18].

The future holds the promise of learning such as we obtained here, not only for violence in the home, but literally for the many dozens, if not hundreds of life situations that do not permit of an experiment, but may yield some of their secrets to Mind Genomics, which combines the rigor of quantitative science with the richness of cognitively meaningful stimuli actually descriptive of normally lived lives.

Acknowledgments

Attila Gere thanks the support of Premium Postdoctoral Research Program of the Hungarian Academy of Sciences.

The authors wish to thank Dr. Gillie Gabay for her help in formulating the problem and placing it into its academic perspective.

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  1. Makepeace JM (1981) Courtship violence among college students. Family relations 97–102.
  2. Poole C, Rietschlin J (2012) Intimate partner victimization among adults aged 60 and older: an analysis of the 1999 and 2004 General Social Survey. Journal of Elder Abuse & Neglect 24: 120–137. [Crossref]
  3. Macmillan R, Gartner R (1999) When she brings home the bacon: Labor-force participation and the risk of spousal violence against women. Journal of Marriage and the Family 947–958.
  4. Miller BA, Downs WR, Gondoli DM (1989) Spousal violence among alcoholic women as compared to a random household sample of women. Journal of Studies on Alcohol 50: 533–540. [Crossref]
  5. Brinkerhoff MB, Grandin E, Lupri E (1992) Religious involvement and spousal violence: The Canadian case. Journal for the Scientific Study of Religion 15–31.
  6. Dobash RP, Dobash RE, Wilson M, Daly M (1992) The myth of sexual symmetry in marital violence. Social problems 39: 71–91.
  7. Fyfe JJ, Klinger DA, Flavin JM (1997) Differential police treatment of male‐on‐female spousal violence. Criminology 35: 455–473.
  8. Stith SM, Farley SC (1993) A predictive model of male spousal violence. Journal of Family Violence 8: 183–201.
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  10. Kahneman D (2011) Thinking, Fast and Slow. New York: Farrar, Straus and Giroux.
  11. Blumenthal AL, Danziger K (2001) Wilhelm Wundt in History: The Making of a Scientific Psychology. Springer Science & Business Media.
  12. Nichols KA, Champness BG (1971) Eye gaze and the GSR. Journal of Experimental Social Psychology 7: 623–626.
  13. Stipp H (2015) The Evolution of neuromarketing research: From novelty to mainstream: How neuro research tools improve our knowledge about Advertising. Journal of Advertising Research 55: 120–122.
  14. Nosek BA, Greenwald AG, Banaji MR (2005) Understanding and using the Implicit Association Test: II. Method variables and construct validity. Personality and Social Psychology Bulletin 31: 166–180. [Crossref]
  15. De Hoon MJ, Imoto S, Nolan J, Miyano S (2004) Open source clustering software. Bioinformatics 20: 1453–1454.
  16. Abramowicz M (2004) Information markets, administration decision making, and predictive cost-benefit analysis. The university of Chicago Law Review 71: 933–1020.
  17. Box GEP, Hunter WP, Hunter JS (1978) Statistics for Experimenters, New York, John Wiley.
  18. Gofman A, Moskowitz H (2010) Isomorphic permuted experimental designs and their application in conjoint analysis. Journal of Sensory Studies 25: 127–145.

Estimating the Feelings of Prisoners Regarding Hope vs Despair: a Mind Genomics Cartography

Abstract

Prisoners are often thought to harbor thoughts about suicide, with sensationalized stories about the despair in prisons touching the hearts of listeners and readers. We explore the degree to which ordinary people, non-prisoners, feel that there is despair versus hope among prisoners. Through experimentally designed vignettes, we describe who the prisoner IS, what the prisoner FACES, what the OTHER PRISONERS are like, and what preparatory efforts are in place regarding RELEASE. Each respondent read a unique set of 24 vignettes, comprising different elements, and for each vignette rated the degree to which the prisoner would be likely to think of committing suicide versus be hopeful. The analysis reveals the specific contribution of each element in the vignette as a driver of projected suicide versus hopes, and the numbers of tenths of second required to ‘process’ the element before making the decision. The study suggests two mind-sets, one focusing on the prisoner, the other focusing on the surrounding, each as a driver of despair, as represented by the phrase ‘contemplates suicide’.

Introduction

The increasing cost of imprisonment, the increasing number of those imprisoned, and the alternative ways of imprisoning people, have created an entire industry of concern about what to do with the prisoner, how to rehabilitate the prisoner, and how to avoid post-release recidivism, or despair-driven suicide. Certainly, the prisoner, upon release, can be considered as a person with one or many ‘black marks,’ responses by others to his or his misdeeds and punishments. The prospect of a life after prison or a life in prison, one marked with rejection and condemnation by society often leads to severe psychological and social problems. One of these is the possibility of contemplating suicide and then successfully suiciding. The recent literature, both popular and academic, deals with the emotions involved in prison.

The experience of imprisonment is difficult, with detrimental effects on prisoners and their families [1]. The nature of life in prison is particularly noticeable among women whose socialization left them with a lack of voice in the public domain. Female prisoners often referred to their feeling of helpless during their prison experience [2].                                                                                                                                 

Accounts of prison life for males consistently describe a culture of mutual mistrust, fear, aggression and barely submerged violence [3]. Often too, prisoners adapt to this environment by putting on emotional ‘masks’ of masculine bravado hiding their vulnerabilities and deterring the aggression of their peers. Johnson [4] claimed that prisoners’ self-presentations of cool, hard manliness’ often reflect a ‘chronically defensive’ attitude rooted in feelings of moral self-doubt, social rejection and psychic vulnerability. This is a posture against the hurt that imprisonment threatens to expose [5]. Prisoners have a psychological need to re-establish their sense of masculine self-esteem and the need to develop personas to save them from exploitation [3]. De Viggiani [6] emphasized the ‘survival’ functions of prisoners whereas [7] emphasized their jostling for positions of power in their depriving environments.

Interviews with prisoners pointed to the protective functions of emotional self-control to hide fear or hurt which may be interpreted as signs of weakness exposing prisoners to ridicule and exploitation [3]. Prisoners expressed anger, fear, sadness and disgust through facial expressions [8]. Emotional control is an internal defense as means of coping. Many prisoners stressed the need to control their emotions in order not avoid ‘cracking’ especially due to events outside the prison over which they had almost no control [3]

Occasional displays of emotion were deemed acceptable if they were the outcome of bereavements or if they related to children (e.g. serious illnesses, custody issues). Yet to unload one’s emotions on a continuing basis was reported to be unwelcome. In the visiting room, prisoners showed warmth and tenderness that were taboo on the landings, closed to visitors. Visits offered the only opportunity to display authentic feelings and to show warmth. Some were visibly upset as their visitors left, or sat in silent contemplation, their stolidity contrasting with the animated tone of a few minutes earlier.

Although there are many studies about the statistics of prisoners and imprisonment, along with interview accounts with prisoners, there is relatively little in the literature about metric studies on the ‘mind’ of the prisoner from the point of view of those who are not prisoners, i.e., studies of one’s empathic feeling toward prisoners. This study examines the perception of the public regarding emotions of prisoners and the extent of empathy understanding, with empathy being the ability to ‘sense the feeling of the other. This paper introduces a new approach to thinking about a topic, namely the study of empathy of normal people towards people who find themselves in a particularly stressful situation. The worlds of literature and song, stories, novels, poems, ballads, are is filled with descriptions of how one person feels about another or a group of others. Science is not, however, at least with descriptions having depth and tonality. This study begins that new course of research effort.

Method

Mind Genomics is an emerging science of the ‘everyday,’ studying how people make decisions when confront by descriptions of ordinary experience, or at least experiences which could happen to people, experiences with which people are familiar [9, 10]. Mind Genomics moves away from the traditional scientific approach of isolating one variable at a time and studying that variables. Rather, the premise of Mind Genomics is that we are continually confronted by compound situations, comprising many aspects. We, ordinary people, seem to have no trouble coping with these compound situations, making a series of decisions, and moving forward. Often, we are not able to articulate the reason WHY we do what we do. Yet, our behavior is rapid, automatic, appearing considered rather than random.

In its world-view and execution, Mind Genomics differs from most conventional research, which pay a great attention to the test stimuli, and may test a very few stimuli, but offer a variety of conclusions and implications from one study. With Mind Genomics, we look at simple, broad brush strokes of different aspects of prison, and do fast, simple research. Our metaphor is to cover ground, to explore, much like a cartographer explores and maps out an area, without paying very close attention to the minutiae of the area being mapped. The goal is to understand the key points of the topic, what ideas drive strong responses, what ideas drive strong engagements. The responses are measured using rating scales, converted later to a binary scale. The engagements are measured by response time, deconstructed into the number of tenths of second a statement ‘holds the respondent’s attention’ while being processed.

The test stimuli comprise four questions dealing with the person who is in prison, what the person does basis, the nature of other people in the prison, and the preparations, if any, for re-entry. The four questions are used as prompts to drive the researcher to provide four answers to each question. Table 1 show the four questions and the four answers to each question.

Test stimuli created by experimental design

The typical way to understand what people feel about a topic is to ask them questions about the topic, either in discussion (interviews), or through a survey on pencil and paper. An emerging way to understand people is the belief that observing their recorded behavior, e.g., what the person buys or does, gives a sense of who the person is, and what the person believes. This latter approach, is called ‘Big Data.’ The reality is that each of the approaches provides some information about the person, but does not provide the specific information for the topic. Our topic is the empathy of normal people towards their ideas of prisoners, and specifically prisoner despair. There is no way that Big Data can provide this information. Rarely can we find a survey which focuses on this topic because the topic is so specific, and so different from the more mainstream, conventional topics in the world of sociological or psychological research,

Mind Genomics approaches the issue of empathy about prisoner despair by running a simple experiment. The respondent or subject is provided with test combination of the 16 answers, and instructed to rate the combination, the vignette, on an anchored 9-point scale, with the scale focusing on an assessment of estimated feelings. Figure 1 shows the test stimulus.

Mind Genomics-037_PSYJ_F1

Figure 1. Example of a 3-element vignette about a prisoner, and the instruction to the respondent to rate.

The underlying experimental design comprises a ‘recipe’ or systematic layout of 24 combinations, vignettes, each vignette comprising 2–4 elements or answers, selected from Table 1. Each respondent evaluated 24 different vignettes, comprising 2–4 elements per vignette, at most one element or answer from one question. The experimental design presents the combinations without concern as to whether the combination ‘makes sense’ [11]. The objective is to present the respondent with a set of test stimuli and force a judgment, that judgment being a rating of the entire vignette. The respondent cannot assign a ‘politically correct rating’ because there is no underlying pattern that the respondent can discern. The respondent may begin by trying to be politically correct and do the task ‘properly’ by paying attention, but soon gets frustrated, and reacts at an almost automatic, intuitive, ‘gut level’. This is the desired state for the respondent. The intuitive response means that the response will be relatively uncontaminated by what the respondent feels to be that which the research ‘wants’.

Table 1. The four questions, and the four answers to each question.

 

Question A: What kind of person is this?

A1

Young inner-city black woman

A2

White middle-age for theft

A3

21-year-old second conviction for drugs

A4

54-year old woman convicted for drugs

 

Question B: What does the person do on a daily basis?

B1

Boring stay, little to do

B2

Machine shop license plates

B3

4-hours of forced library

B4

Rehabilitation and reeducation

 

Question C: What other kind of people are in the prison?

C1

Lower and upper middle class (in the prison)

C2

Comradely (in the prison)

C3

Drug addicts (in the prison)

C4

Invisible status (in the prison)

 

Question D: What kind of links are there for a future after prison?

D1

Optional courses to prepare for jobs

D2

Out you go

D3

No support

D4

Re-enter prison

The experiment with 42 respondents generated a data set, comprising 1208 vignettes. Most of the vignettes differed from one another. This structure of testing different combinations by each respondent is known as a permutable experimental design [9, 12]. The structure allows the researcher to ‘cover the space’ of possible test combinations, an approach analogous to the MRI (taking different pictures of the tissue), rather than the way typical scientific research works (repeating the pictures many times to reduce the error of measurement).

Analysis

The ratings from the respondents were transformed to a binary scale, following the approach used by author HRM for 35 years, since the mid 1980’s, and based upon a combination of experience and common industry practice. Experience suggests that most users of scales do not know what the scales mean. Often the user of the data, the ultimate ‘client’ of the results, asks for an interpretation, such as ‘is a 6 a lot or a little better than a 5, or a little or a lot worse than a 7?’. These questions continue to reaffirm the fact that the user of the data does not really understand what to do with the data, other than to make conclusions about ‘better or worse’. A more productive approach, used for decades by market researchers bifurcates the scale, so that there is a top of the scale (e.g., 7–9), and a bottom of the scale (e.g., 1–6). In our case, we would interpret the top of the scale, the ratings of 7–9, as indicating that the prisoner is believed to be thinking of suicide. A rating of 1–6 indicates that the prison is not likely to commit suicide, or to think about committing suicide. We can also look at the scale from the opposite end, hopefulness with a rating of 1–3 indicating that the prisoner is believed to be hopeful,

The underlying experimental design enables us to combine the data from our 42 respondents into a database comprising the 1008 observation. Each observation comes from one respondent, one vignette. The experimental design ensures that the 16 predictor variables, the elements, are statistically independent of each other. The dependent is augmented by the addition of a very small random number, approximately 10–5.

Table 2 shows the results from the first OLS (ordinary least-squares) regression, focusing on the data from the transformation to the binary scale (1–6 = not thinking about suicide; 7–9 = thinking about suicide.) The regression procedure, colloquially known as curve fitting, deconstructs the 0/100 binary rating into the basic contribution of the 16 elements, the 16 coefficients, and an estimated basic level, the additive constant.

Table 2. Coefficients for ‘thinking about suicide’ (ratings 7–9 converted to binary). Data from the total panel.

 

Thinking about suicide (Scale points 7–9)

Coefficient

T Statistic

P Value

 

Additive constant

24.46

3.48

0

D3

No support

11.16

2.62

0.01

C3

Drug addicts

10.98

2.54

0.01

A3

21-year-old second conviction for drugs

7.08

1.65

0.1

B1

Boring stay, little to do

4.1

0.94

0.35

D2

Out you go

1.1

0.26

0.8

A2

White middle age for theft

-0.02

-0.01

1

A4

54-year-old woman convicted for drugs

-0.68

-0.16

0.88

C4

Invisible status (in the prison)

-1.17

-0.27

0.79

B4

Rehabilitation and reeducation

-2.34

-0.54

0.59

C2

Camaraderie (in the prison)

-3.4

-0.8

0.43

B3

4-hours of forced library

-3.81

-0.88

0.38

C1

Lower and upper middle class (in the prison)

-4.13

-0.96

0.34

D4

Re-enter prison

-4.22

-0.99

0.32

B2

Machine shop license plates

-5.25

-1.23

0.22

D1

Optional courses to prepare for jobs

-8.31

-1.94

0.05

A1

Young inner-city black woman

-8.52

-1.98

0.05

The interpretation of the results is straightforward:

  1. The additive constant is the estimated probability of a respondent saying that the person described in the vignette will attempt suicide (rating 7–9 on the scale). The additive constant is 24.46, which we interpret to mean that in the absence of elements, the expected proportion of responses 7–9 (thinking of suicide) is 24.46, about 25%.
  2. Table 2 shows the 16 elements sorted from highest (believed most likely to think of suicide), to lowest (believed least likely think of suicide).
  3. The coefficients have ratio-scale values, so that a value of 10 means believed twice as likely to thinking of suicide than a value of 5.
  4. The coefficients can be added to the additive constant to create a sum which provides the estimated probability of a prisoner thinking about suicide. Thus, one needs only the additive constant, and the elements, as well as their coefficients, to estimate the likelihood that one believes that thoughts of suicide will plague prisoner described by the vignette.
  5. The coefficients in Table 2 suggest that the two elements co-varying most strongly with likelihood of suicide are C3 (drug addicts, as fellow prisoners), and D3 (the recognition of no support). These two elements talk about two aspects, one who the fellow prisoners happen to be, and second the emotional support in the prison.
  6. The coefficients suggest that two descriptions are least likely to covary with the thought of suicide. One is the young inner-city black woman, the other is optional courses to prepare for jobs. These are radically different. The first suggests the appreciation who the prisoner happens to be. The second is the fact that someone is taking care of the prisoner, or at least thinking of the prison to prepare for a job.
  7. The T statistics tells us the ratio of the coefficient to the standard error of the coefficient. The higher the T statistic, the more likely it is that the coefficient or the additive constant comes from a distribution whose true value is not 0. The P value, in turn, is the probability that the T statistic comes from a distribution whose true value is 0.

Reversing the perspective – what drives the rating of ‘hopeful’ (1–3 on the 9-point scale)

Our respondents could assign rights on either side of the scale, 1 representing hopeful, 9 representing contemplating suicide at some point. What happens when we focus on the positive aspects, looking at the elements driving the ratings of 1–3. We now convert the ratings on the low end of the scale, 1–3, corresponding to hopeful, so that they become. In turn, the value 100. The remaining six scale points, 4–9, become 0, to denote not hopeful. We perform the same analysis on the data from the total panel, looking at the additive constant, and the coefficient for each element.

  1. The additive constant is 43.79, almost 44, meaning that in the absence of elements, almost half of the responses will be between 1 and 3, hopeful. We interpret this to mean that it is basic information (a person is in prison) which conveys some hope. Being in prison does not automatically drive one’s feeling that the imprisoned person will contemplate suicide. Being is prison does, however, drive a sense that the prisoner will be modestly hopeful.
  2. Estimated hopefulness is driven by reading about preparations for release, such as ‘optional courses to prepare for job’, and ‘4-hours of forced library’.
  3. Lack of hopefulness is driven by who a person is, and the situation in the prison. These are the elements with the lowest coefficients for hopefulness.

21-year-old second conviction for drugs
54-year-old woman convicted for drugs
drug addicts (in prison)
white middle age for theft
no support

Individuals – are they optimistic or pessimistic, based upon their coefficients

Can we classify an individual as optimistic (perceiving the situations in the vignette as ‘hopeful’) or pessimistic (contemplating suicide), both or neither? One way to answer this question computes the average coefficient across 16 elements for each individual, when we look at the equation for ratings of 7–9. Recall that the coefficient shows the believed likelihood that the prisoner being described is likely to commit suicide. Each respondent generates 16 coefficients. The average coefficient for a respondent tells us the proclivity of the respondent to see the described prisoner’s feelings as leading to thoughts of suicide. The second part of the answer is to compute the average for the same respondents for the 16 coefficients dealing with hopeful. The average coefficient for a respondent tells us the proclivity of the respondent to see the described prisoner vignette as leading to hopefulness.

We begin with the scattergram for the total panel, in Figure 2. Each filled point represents one respondent. The abscissa corresponds to the average of the respondent’s 16 coefficients on the top part of the scale, tendency to suicide, i.e., the coefficients of the individual-level regression model run for the respondents when the ratings of 1–6 were converted to 0, and the ratings of 7–9 were converted to 100. The ordinate corresponds to the average of the respondent’s 16 coefficients on the bottom of the scale, hopeful, when the ratings of 1–3 were converted to 100, and the ratings of 4–9 were converted to 0.

When the respondent cluster at 0, 0, we conclude that the respondent does not sense either prisoner despair or prisoner hopefulness in the vignettes. The averages for the latter two scales are both near 0, and thus the respondent falls at the bottom left. The further out to the right on the abscissa lies the respondent’s average, the more the respondent feels that the prisoner will contemplate suicide. The further up the ordinate lies respondent’s average more the respondent feels that the prisoner will feel hopeful. Figure 2 suggests more respondents feel that the prisoner will be hopeful, and fewer respondents will feel that the prisoner will contemplate suicide. Looking more closely at the distribution, we see about five respondents who feel primarily despair in the vignettes, and about five respondents who feel primarily hopefulness in the vignettes.

Mind Genomics-037_PSYJ_F2

Figure 2. Distribution of average coefficients for despair/suicide (Ratings 7–9 converted to binary) and average coefficients for happiness/hopefulness (Ratings 1–3 converted to binary). Each filled circle corresponds to a respondent.

As a side note, this format of presenting data suggests a new way to understand the basic mind-set of a person on two opposing dimensions of a feeling. The location of the points gives a sense of how different people think and empathize. Most of the respondents in the large area between 0, 0 and 0.3, 0.3. The location 0, 0 corresponds to a person who is neither pessimistic nor optimistic in the estimation of how the prisoner would feel. The location 0.5, 0.5 corresponds to the location where the person is absolutely decisive, rating the vignettes as either hopeful or despairing (contemplate suicide.) For the person located at 0.5, 0.5, there is no middle ground. For the person located at 0, 0 there is virtually only middle ground.

Subgroups – Gender, Age, Mind-Set – What is expected to drive the prisoner’s though to suicide?

One of the key benefits of the Mind Genomics approach is the use of different combinations of vignettes for each respondent, but at the same time ensure that each respondent evaluates the appropriate set of vignettes in order to create an experimental design. One can do the analysis on key subgroups, both self-defined (gender, age), and defined through analysis (mind-set). The small group of 42 respondents provides sufficient depth into the mind of the respondent to reveal the responses of subgroups, perhaps a bit noisily, but nonetheless powerfully.

Table 4 shows the set of key subgroups. For this study we divided the respondents by gender and by age, respectively, and then created mind-set segments as described in the following section.

Table 3. Coefficients for ‘hopeful’ (ratings 1–3 converted to binary). Data from the total panel.

 

 

Coeff

T Statistic

P Value

 

Additive constant

43.79

5.55

0.00

D1

Optional courses to prepare for job

13.24

2.76

0.01

B3

4-hours of forced library

8.52

1.76

0.08

C1

Lower and upper middle class (in the prison)

6.38

1.32

0.19

B4

Rehabilitation and reeducation

5.04

1.04

0.30

B1

Boring stay, little to do

1.38

0.28

0.78

B2

Machine shop license plates

1.15

0.24

0.81

A1

Young inner-city black woman

-1.44

-0.30

0.77

D2

Out you go

-2.10

-0.44

0.66

C4

Invisible status (in the prison)

-4.53

-0.94

0.35

C2

Camaraderie (in the prison)

-5.45

-1.14

0.26

D4

Re-enter prison

-8.72

-1.82

0.07

A3

21-year-old of second conviction for drugs

-11.23

-2.33

0.02

A4

54-year-old woman convicted for drugs

-11.86

-2.46

0.01

C3

Drug addicts

-11.89

-2.45

0.01

A2

White middle age for theft

-12.48

-2.59

0.01

D3

No support

-16.69

-3.49

0.00

Table 4. Strongest performing elements by key subgroup of the models relating the presence/absence of elements to the estimate of the prisoner’s contemplation of suicide.

 

Contemplate Suicide (Top 3 scale points, 7–9)

Total

Males

Females

Age<30

Age31+

Mind-Set 1
(want preparation
)

Mind-Set 2 (sensitive to surroundings)

 

Base size

42

19

23

14

26

19

23

 

Additive constant

24

25

22

22

27

26

24

D3

No support

11

5

18

10

12

32

-6

C3

Drug addicts

11

11

12

16

10

5

13

A3

21-year-old of second conviction for drugs

7

3

11

7

8

5

9

B1

Boring stay, little to do

4

14

-4

5

4

-5

12

D2

Out you go

1

5

0

-2

2

20

-15

  1. Additive constant – all subgroups are approximately the same, showing an additive constant of 22–27.
  2. Males feel that simply ‘being bored, having nothing to do’ is a cause for contemplating suicide. Females do not.
  3. There is no difference in projected potential of contemplating suicide by younger versus older respondent.
  4. We created two mind-sets by clustering the array of 16 coefficients, and extracting two different groups, which are maximally different from each other [13]. Clustering is a purely statistical technique. We extract the fewest number of clusters (parsimony) which tell coherent stories (interpretability).
  5. Mind-Set 1 feels that the prisoner will think of suicide if there is no emotional support in the prison, and if the prisoner is simply discharged, released, without any preparation. To Mind-Set 1, it is the sense of aloneness in the prisoner which is distressing. Mind-Set 1 can be called ‘want preparation’.
  6. Mind-Set 2 feels that the prisoner will contemplate suicide if there is a sense of nothing to do, and if the prisoner is either a serious drug addict (second conviction) or surround by drug addicts. Mind-Set 2 can be called sensitive to surroundings.

Subgroups – Gender, Age, Mind-Set – What is expected to drive the prisoner’s thoughts to happy

We can follow the same logic, this time looking at gender, age, and newly constructed mind-sets for the low part of the scale, ‘hopeful’.

  1. Males show a much higher imputed basic hopefulness for prisoners than do females (54 versus 36). Without any additional information, males believe that that the prisoner will be neither hopeful or not hopeful (additive constant 54), whereas females believe that it’s more likely that the prisoner will not be hopeful (additive constant 36).
  2. For males, hopeful is perceived as a matter of preparing for a job and being surrounded by prisoners who are middle class.
  3. For females, hopefulness is perceived when the message is about preparing for a job, library, rehabilitation, and surprisingly, with the prisoner has little to do. Males, in contrast feel when the prisoner in bored, and has little to do, the despair is higher, with a greater thought of suicide.
  4. Younger respondents (under 30) feel that hopefulness will come from job preparation and from the hours in the library.
  5. Older people feel the same way, and also feel that hopefulness will come from being surrounded by middle class prisoners.
  6. The previously created Mind Set 1 feels that hopefulness is a matter of the requirement of four forced hours in library, as well as being surround by middle-class prisoners.
  7. The previously created Mind-Set 2 feels that hopefulness will come with the preparatory course for jobs, and the requirement of library.

Subgroups – are they optimistic or pessimistic, based upon their coefficients

The previous analysis for the total panel presented a novel way to gauge whether the respondents are optimistic or pessimistic, by plotting the average coefficient from the two models, doing so for each respondent. The coefficient shows the average conditional probability that the respondent would assign the element a rating of 7–9 (top 3, contemplating suicide), versus that the same respondent would assign the element of 1–3 (bottom 3, happy). The two averages come from the coefficients of 16 elements.

When we plot each respondent on a two-dimensional graph, we can sense the respondent’s mind. To review:

  1. Each filled circle corresponds to one respondent.
  2. The location 0, 0 corresponds to a person who is ‘all middle ground,’ sensing neither despair leading to contemplation of suicide, nor sensing hopefulness. All the ratings for the vignettes lie between 4 and 6.
  3. The location 0.5, 0.5 corresponds to a person for whom there is ‘no middle ground’ but not basically optimistic nor basically pessimistic in the estimation of how a prisoner would feel.
  4. Plots to the right on the abscissa suggest a person who is more pessimistic, and sees despair leading to the contemplation of suicide.
  5. Plots upwards on the ordinate suggest a person who is more optimistic, and sees ‘hopefulness’
  6. Figure 3 shows the plots for key subgroups. Each panel (top, middle, bottom) compares two complementary subgroups. The statements below are purely from visual observation and impression, not from a statistical analysis.
  7. Females show more respondents closer to the 45-degree line, and further out than men on that line. Qualitatively, females seem to be more judgmental than men, but neither overly optimistic nor pessimistic.
  8. Younger respondents aged 30 and younger show more respondents lying close to the non-judgmental region of 0, 0. Older respondents age 31 and older show more respondents as lying further out towards 0.5, 0.5, with a tendency to be more optimistic, and feeling that the prisoner is more hopeful.
  9. Mind-Set 1 (want preparation) appears to be less judgmental, and if judgmental then optimistic in terms of rating what the prisoner would feel. Mind-Set 2 (sensitive to surroundings) is more judgmental, with fewer ratings in the 4–6 region of the scale. Mind-Set 2 appears to be slightly more pessimistic.

Mind Genomics-037_PSYJ_F3

Figure 3. Distribution of average coefficients for despair/suicide (Ratings 7–9 converted to binary) and average coefficients for happiness/hopefulness (Ratings 1–3 converted to binary). Each filled circle corresponds to a respondent. The three panels show the results for complementary subgroups.

Response time

The previous sections dealt with the analysis of the ratings, specifically what elements are perceived, in one’s opinion to correlate with thinking that would contemplate suicide, at least in the opinion of a non-prisoner respondent reading a vignette about the prisoner. The analysis deals with the conscious assignment of ratings to the test stimuli, even if the decisions tend to be automatic.

 Researchers have been interested in the past few years in possibly deeper mechanisms of decision-making, many of which they put in the grab-bag called neuromarketing, or more correctly non-conscious, physiological correlates of decision-making [14, 15, 16]. Summarize this new area of neuromarketing, or really physiological correlates of messaging. Genco [17] have popularized in a book ‘Neuromarketing for Dummies.’ We now proceed to the analysis of one of one of these measures, response time. The ingoing assumption is that longer response times signal that the respondent is somehow ‘engaged’ in reading and thinking about the particular element in the vignette.

Some of the vignettes constructed were responded to slowly, others were responded to quickly. After removing the first vignette evaluated by each respondent because the respondent was just ‘learning what to do in the experiment,’ and after removing all vignettes responded to after 9 seconds because it was likely the respondent was doing something else, we emerge with a distribution of response times as shown in Figure 4. The time scale, abscissa, is logarithmically spaced, emphasizing the many vignettes responded to faster than 2 seconds. The computer program picked up the response times in tenths of seconds.

Mind Genomics-037_PSYJ_F4

Figure 4. Distribution of the response times for the vignettes, after removal of the first vignette and after removal of all response times of 9 seconds or longer.

As stated above, we assume response time to be a correlate of engagement. We operationally define the term as ‘time spent attributed to the element when the vignette is being evaluated’. We cannot, of course, ask the respondent to tell us how engaging each element seems to be, although occasionally the novice researcher might ask that question. The reading and response occur so rapidly, so automatically, that the respondents are not aware of what holds their attention unless there is something so powerfully strong that it ‘stops’ the respondent.

The experimental design enables us to estimate the likely number of seconds in the response time that can be attributed to each element. It is important to note that this assignment is an estimate, only, based upon the application of OLS regression to the response times. Some interesting patterns emerge from Table 5.

Table 5. Strongest performing elements by key subgroup of the models relating the presence/absence of elements to the estimate of the prisoner’s hopefulness.

 

 

Total

Male

Female

LT30

GT31

Mind-Set 1
(want preparation)

Mind-Set 2 (sensitive to surroundings)

 

Base size

42

19

23

14

26

19

23

 

Additive constant

44

54

36

35

48

46

42

D1

Optional courses to prepare for jobs

13

8

17

14

13

7

18

B3

4-hours of forced library

9

6

11

9

8

9

8

C1

Lower and upper middle class

6

8

5

6

8

8

5

B4

Rehabilitation and reeducation

5

-1

10

-1

7

4

6

B1

Boring stay, little to do

1

-12

11

3

-1

5

-1

  1. The elements are presented in descending order of response time based upon the results from the total panel. These ratings are from 40 respondents, each evaluating at most 23 vignettes, but a number of vignettes have been removed because they were recorded as being unusually long.
  2. We have highlighted and bolded those response times of 1.4 seconds or longer, which can be assumed to be ‘engaging.’ The choice of 1.4 seconds is simply to represent a time that can be thought of as possibly conscious attention.
  3. The longest response time for any group is 1.7 seconds (female respondents with the element ‘lower and upper middle class’).
  4. The shortest response time for any group is virtually 0 time, ‘optional courses to prepare for jobs’ (0.2 seconds, for Mind-Set 2, who are sensitive to their surroundings, and would be expected not to care about courses for the future).
  5. Total panel: The longest response times, i.e., the most engaging, are descriptions of the person, requiring multiple words. The shortest times, i.e., the least engaging, are descriptions of occupation training in prison. It’s all about the people, who they are.

Table 6. Coefficients for response times, by total panel and key subgroups. Coefficients of 1.4 or higher are shown in shaded cells, with bold numbers.

 

Total

Male

Female

Age 30 or less

Age 31+

Mind-Set 1 (want preparation)

Mind Set 2 (sensitive to surroundings)

Lower and upper middle class (in the prison)

1.4

1.2

1.7

1.2

1.4

1.2

1.5

Young inner-city black woman

1.4

1.4

1.3

1.2

1.6

1.6

1.3

21-year-old-old, second conviction for drugs

1.4

1.6

1.1

1

1.6

1.6

1.3

54-year-old woman convicted for drugs

1.4

1.5

1.1

1

1.5

1.3

1.5

Invisible status (in the prison)

1.3

1.6

1.2

1.4

1.4

1.5

1.1

Drug addicts (in the prison)

1.3

1.3

1.4

1.2

1.5

1.7

0.9

White middle age for theft

1.2

1.8

0.7

0.4

1.7

1.4

1.2

Boring stay, little to do

1

0.8

1.2

0.6

1.2

1.1

1

Machine shop license plates

1

1.3

0.8

0.6

1.3

0.9

1.1

Re-enter

1

0.5

1.4

0.6

1.2

1.1

0.7

Camaraderie (in the prison)

0.9

1

0.9

0.4

1.3

0.7

1.2

4-hours of forced library

0.8

0.6

1.1

0.8

0.8

0.8

0.9

Rehabilitation and reeducation

0.7

0.4

1

0.3

1

0.7

0.8

Optional courses to prepare for jobs

0.6

0.3

0.8

0.7

0.6

1

0.2

No support

0.5

0.1

0.7

0.4

0.7

0.7

0.3

Out you go

0.3

0

0.5

0.5

0.2

0.6

-0.1

Assigning new individuals to one of the two mind-sets

Conventional research is grounded on the belief that there is an indivisible link between who the person IS and what the person THINKS. This belief motivates the use of large, representative samples of respondents, believing that it is important to measure the correct group of people in order to understand the way the mind works. Thus, good practice in business and political polling is often accompanied by large base sizes and a measure of ‘error,’ or underlying variability.

One of the premises of Mind Genomics is that in virtually any topic area where human judgment comes into play one can discover different points of view, different criteria for judgment. These are called Mind-Sets. Their reality emerges from the analysis of how individuals respond to the different elements or ‘answers’ in the particular study. That is, these mind-sets exist, but are really groups of individuals who behave similarly in a specific situation, as revealed by their patterns of responses, or perhaps as the next paragraph suggests, mind-sets are really combinations of ideas.

Underlying the research in Mind Genomics is the belief that some ideas ‘flow together.’ It is the combination of such ideas which flow together that comprises the focus of interest of Mind Genomics. Individuals, the respondents who participate, are ‘protoplasm’ which in some way embody these basic mind-sets, but the individuals are NOT the mind-sets. The mind-sets are primaries, like the colors red, yellow and blue. Each person comprises a set of mind-sets, with the methods of Mind Genomics both identifying the nature of the mind-sets from clustering, and establishing who in a study embodies each mind-set. Whether these mind-sets represent true primaries like color primaries, red, blue and yellow, is not important. What is important is that they show remarkably different, and interpretable patterns of responses, patterns which make sense, can be interpreted and labelled. These primaries may co-vary with external behaviors, and perhaps even with physiological patterns of responses. What is important is that they represent a new way of looking at individual differences.

With the foregoing accepted, the question is whether there is a natural affinity for the mind-sets established in an experiment to distribute in the way to which we have been accustomed. That is, for our study we have established two mind-sets, those who want preparation, and those who are sensitive to their surroundings, etc.

Table 7 shows that there is no clear relation between mind-set membership and either gender or age. This is typically the case. Mind-sets emerge quite clearly in Mind Genomics studies, but these mind-sets do not distribute in ways that are easy to discern, despite the radical differences in content between or among the mind-sets.

Table 7. Distribution of the two mind-sets by gender and age, respectively.

 

Want preparation

Sensitive to surroundings

Total

 

Male

9

10

19

Female

10

13

23

Total

19

23

42

 

 

Mind-Set

Mind-Set 2

Total

30 and under

8

6

14

31 and Older

10

16

26

No age given

NA

NA

2

Total

18

22

42

Given the clear similarity in the patterns of WHO are in the two mind-sets, at least in terms of gender and age, how then do we assign a new person to a mind-set? This is an important question, both for science, and for commerce. For science, we can begin to study the relation between membership in a mind-set for one topic, and both membership in other mind-sets for other topics, and/or external behaviors, and even biological/genetic covariates of membership in different mind-sets.

Our approach uses the average coefficients from each mind-set. We create 1,000 different variations of the average profile by adding ‘noise’ to the coefficients. We then identify the six questions which, in the presence of “noise” can be used to correctly assign the respondents to the correct mind-set. Figure 5 shows an example of the PVI (personal viewpoint identifier), presenting the six strongest questions which, in concert, help us assign a person to the correct mind-set. We also show the feedback page, which can go to the person being typed, or be used to drive the respondent to the right e-commerce website, or perhaps incorporated into the person’s profile for future use. As of this writing (Winter, 2019), the PVI is located at this location: http://162.243.165.37:3838/TT19/

Mind Genomics-037_PSYJ_F5

Figure 5. The PVI (personal viewpoint identifier) and the two feedback pages, one for each mind-set segment uncovered in the original study.

Discussion and Conclusions

The sociology and psychology literatures are replete with studies presenting statistics about the backgrounds of prisoners, their environment, and clinical analyses of personalities. There is no end to the fascination with other people, especially those who commit crime. What is lacking, however, is a sense of how the ‘other’ reacts to prisoners. We are aware of the prisoner, but what do we think of prisoners in terms of specifics? The answer may be found in novels, in news clippings, in common discussion, but not particularly in the scientific literature.

Mind Genomics provides a way of understanding how people perceive the ‘other,’ not so much in a clinical sense, but the ‘other’ when represented in a story, that story provided by the vignette. Mind Genomics opens new vistas, probing into the mind, and how the mind reacts to others, the ‘others’ presented in meaningful but manageable descriptions. Simple experiments, of the type presented here, generate the foundations of new knowledge that that hitherto could only be obtained in unstructured form by talking with people, or by reading personal accounts, news commentary, or literature.

Acknowledgements

Attila Gere thanks the support of Premium Postdoctoral Research Program of the Hungarian Academy of Sciences. The authors wish to thank Dr. Gillie Gabay for her help in formulating the problem and placing it into its academic perspective.

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