Some Common Forms Of Neuropathy

Today's post from dressamed.com (see link below) tries to explain what the characteristics of a few sorts of neuropathy are. One of the first things we hear when we try to research neuropathy is, that there are over 100 types and over 100 causes. It generally stops there but most of us want a little more information than just the bare facts, This article looks at probably the 7 most common forms of neuropathy and gives a short description of each. In the confusion after hearing a diagnosis of neuropathy, most people are left bewildered as to exactly what's wrong with them and why. This article helps set a few things straight and hopefully helps many nerve damage patients better understand why they're suffering so much. The authors admit themselves that it's a limited choice but it's better than no choice at all.

The Different Types of Neuropathy 
Posted on May 11, 2016 Posted in Staff Pick by Staff Pick

Neuropathy, also known as peripheral neuropathy, is a disease often associated with diabetes, although there are actually more than 100 known types of neuropathy – each with its own characteristic symptoms, pattern of development, and prognosis. Although there are several “tell-tale” symptoms that seem to afflict all neuropathy sufferers, each version of the disease is different and comes with its own set of problems.

Below are several of the main types of neuropathy, although this is not an exhaustive listing by any means.

DIABETIC NEUROPATHY — Over 30% of all neuropathies can be linked to diabetes, and diabetes is the most common cause of neuropathy in the western world. Both Type 1 and Type 2 diabetes can lead to diabetic neuropathy – high blood sugar levels damage the nerves and neuropathy is one of the outcomes.

IMMUNE MEDIATED/CIDP — manifestations of neuropathy such as CIDP (Chronic Inflammatory Demyelinating Polyneuropathy) is caused by an abnormal immune system response. In this condition, nerves swell and become irritated due to an immune reaction, eventually damaging the nerves outside the brain or spinal cord with peripheral neuropathy symptoms thus following.

HEREDITARY NEUROPATHY — Diseases like Charcot-Marie-Tooth have been discovered to be inherited and lead to hereditary neuropathy. This condition deals with the role of different proteins in the role of physiology in peripheral nerve conduction.
 
AUTONOMIC NEUROPATHY — actually a group of symptoms more than a disease itself, autonomic neuropathy concerns damage to the nerves of the body that control every-day functions in the body that are autonomic in nature, such as blood pressure, heart rate, bowel and bladder emptying, even digestion. When the nerves that control or affect these functions are disrupted, these autonomic functions cease to perform normally and can cause many complications.

COMPRESSIVE NEUROPATHY — Known to laymen as a “pinched nerve,” compressive neuropathy often comes about by an accidental injury to the body. Herniated discs, sciatica, arthritis in the spine and spinal stenosis are just some of the ways a nerve can become compressed and cause pain and discomfort to an afflicted sufferer. 

DRUG-INDUCED/TOXIC NEUROPATHY –– toxic polyneuropathies come about in the human body when nerves are damaged or destroyed by chemicals introduced that have cumulative or highly-toxic effects. These tend to be occupational, chance exposures or intentional, even homicidal ingestions.

There are other forms of neuropathy, including those from infectious diseases such as shingles, as well as from nutritional deficiencies. The best bet for understanding any form of neuropathy that a person may be experiencing is to visit their doctor or a trained neurologist for a consultation.

About The Author

Brian M McLauren is an expert author in Neuropathy. To gain a better understanding of the many neuropathy causes, or if you are experiencing any neuropathy symptoms, please consult your physician.

https://www.dressamed.com/root/the-different-types-of-neuropathy/

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Electro Stimulation to Treat Neuropathic Pain

Following on from the post of February 13th, todays' article from hepatitiscresearchandnewsupdates.blogspot.com (see link below) again talks about electro-stimulation of the spinal cord as a means of reducing neuropathic pain. It looks like there will be more articles of this sort in the coming months - it seems to be potentially a hot topic but it's difficult to know how far away a standard, universal and trustworthy treatment may be. The trials seem to be encouraging but neuropathy patients may prefer the believe it when they see it approach. In the meantime, it's worth researching all you can and talking either to your HIV-specialist or neurologist about the possiblities for you.

Spinal Cord Stimulation Effective for HIV Neuropathy
Kate Johnson Monday, February 6, 2012

February 6, 2012 (Miami Beach, Florida) — Constant spinal cord stimulation delivered through a permanently implanted device can offer pain relief to patients with HIV-related polyneuropathy that is refractory to conservative treatment, according to Kenneth Candido, MD, and colleagues. Results were presented in a poster here at the 6th World Congress of the World Institute of Pain.

"We believe that it is not only a new indication, but it offers relief for individuals who were previously left to the devices of primary care physicians who really only have at their disposal the ability to prescribe narcotic analgesics," Dr. Candido, who is chair and professor in the Department of Anesthesiology at Advocate Illinois Masonic Medical Center in Chicago, told Medscape Medical News in an interview during the meeting.

Spinal cord stimulation is a well-established technique currently indicated for the management of failed back surgery syndrome, complex regional pain syndrome, inoperable peripheral vascular disease, and refractory angina pectoris, Dr. Candido and colleagues report.

To date, the team has used the technique in 6 patients with debilitating pain from HIV-related polyneuropathy. The first case is described in the poster.

The patient, a 50-year-old man with a 20-year history of HIV, was receiving highly active antiretroviral therapy (HAART). He had an 8-year history of "excruciating" pain.

"He had ongoing severe peripheral neuropathic pain and burning allodynia in both feet, primarily the plantar surfaces. He had not responded to conservative management, which had included high doses of opioid analgesics, anti-inflammatory medications, antiepileptic drugs, and other adjuvants such as peripheral nerve block therapies and epidural injections," said Dr. Candido.

The syndrome of HIV-related pain tends to have a distal "stocking" distribution in the lower extremities, similar to diabetic peripheral neuropathic pain, he explained. "It has been almost exclusively related to pain below the knees. It tends to be bilateral, and we suspect that the mechanism is similar to diabetic peripheral neuropathic pain, in that there is microvascular disruption either due to the virus attacking the vasculature or, alternatively, due to the HAART therapy, which may have a predisposition for the small blood vessels."

After the patient underwent a trial of temporary spinal cord stimulation, in which 2 eight-electrode leads were advanced into the dorsal epidural space and fluoroscopically guided to T9–T10, with good results, a permanent implant was placed.

"He has now had almost 2 years of reduction in his pain, from a constant level of about 8 out of 10 down to about 1 or 2 out of 10, and we've been able to wean him off his opiate analgesics," said Dr. Candido.

On the basis of this initial experience, 5 other HIV patients have received permanent implants, with similar success.

"The beauty of neuromodulation is that we can tailor therapy to the patient's individual symptoms. While I would say that we've used a lumbar approach and lower thoracic stimulators in all patients, clearly not every individual is exactly alike, so we choose our criteria very carefully and we select the actual placement of the stimulators based on the concordant response that we identify during the trial process. We've individualized it, but by and large every individual has responded favorably to T8 through T10 placement of these electrodes."

Dr. Candido explained that as HIV patients live longer because of HAART, the medical community must find pain relief options that are superior to opiate analgesics, which have the potential for extensive adverse effects, including nausea, vomiting, pruritis, constipation, urinary retention, and respiratory depression.

His group has also permanently implanted continuous intrathecal drug delivery systems in 4 HIV patients who did not want spinal cord stimulators.

"Dorsal column stimulation and/or intrathecal delivery of opioids and adjuvants proves to be the primary modality that we believe should be used as a first-line therapy once individuals are identified with this peripheral neuropathic pain process," he said.

Despite the immunocompromised state of HIV patients, he said no adverse events have been reported.

"We know that individuals who have compromised immune status are always predisposed to...infectious processes.... Infections are found in 1% to 2% of individuals who have a dorsal column stimulator, but...in almost two-and-a-half years, we have not identified any superficial or deep infections associated with the permanent implantation process."

Before proceeding, his group studied the orthopedic literature looking at infection rates among HIV patients with hip and knee replacements. "We haven't seen an increase in the incidence of infection in those individuals, so we extrapolated the orthopedic data to our own neurological/surgical population and found that it was logical and intuitive that we should also not have a high level of systemic infection or even localized infection if we took all the appropriate precautions."

Dr. Candido has disclosed no relevant financial relationships.

6th World Congress of the World Institute of Pain: Abstract 171. Presented February 5, 2012.

http://hepatitiscresearchandnewsupdates.blogspot.com/2012/02/spinal-cord-stimulation-effective-for.html

Is Virtual Reality Hypnotherapy A Treatment Option For Neuropathic Pain

Today's post from tandfonline.com (see link below) is a fascinating subject and of possible value for neuropathy patients looking for potential future options regarding their own treatment. It concerns a case study of a patient who has already undergone multiple standard neuropathy treatments without success and contacted one of the authors with a view to trying Virtual Reality Hypnotherapy. Her fascinating story and experiences are shown below and open up the possibility of sophisticated hypnosis being a very useful and possibly standard tool in the treatment of nerve pain in the future. As always, it's assumed cost will be a determining factor.

Virtual Reality Hypnosis In The Treatment Of Chronic Neuropathic Pain: A Case Report 
Brent J. Oneal, David R. Patterson, Maryam Soltani, Aubriana Teeley, and Mark P. Jensen1,2 Volume 56, Issue 4, 2008

The publisher's final edited version of this article is available at Int J Clin Exp Hypn

See other articles in PMC that cite the published article.

Abstract

This case report evaluates virtual reality hypnosis (VRH) in treating chronic neuropathic pain in a patient with a 5-year history of failed treatments. The patient participated in a 6-month trial of VRH, and her pain ratings of intensity and unpleasantness dropped on average 36% and 33%, respectively, over the course of 33 sessions. In addition, she reported both no pain and a reduction of pain for an average of 3.86 and 12.21 hours, respectively, after treatment sessions throughout the course of the VRH treatment. These reductions and the duration of treatment effects following VRH treatment were superior to those following a trial of standard hypnosis (non-VR) treatment. However, the pain reductions with VRH did not persist over long periods of time. The findings support the potential of VRH treatment for helping individuals with refractory chronic pain conditions.

Hypnotic analgesia has become an increasingly important aspect in the treatment of clinical and experimental pain (Lang et al., 2000; Montgomery, DuHamel; Redd, 2000) and has been used on virtually every type of pain (Patterson; Jensen, 2003). Patterson and Jensen reviewed 29 randomized, controlled studies of hypnotic analgesia and concluded that (a) the evidence supporting the efficacy of hypnotic analgesia is strong, and (b) hypnotizability is usually related to outcome in studies that measure this variable. With respect to the importance of hypnotizability, one potential strategy for increasing the impact of hypnosis is to make hypnotic induction less effortful. We hypothesized that by providing visual stimuli for a patient during hypnosis treatment and giving the patient an illusion of “sinking into a virtual world,” the induction would require less concentration and mental effort from the patient and therefore might be more effective than standard hypnosis. As Patterson, Tininenko, Schmidt, and Sharar (2004) posited, using computer-generated stimuli to capture and to guide the patient's attention may not only make the induction less effortful but also more widely available, given that such a treatment would not require the presence of a clinician trained in hypnosis.

Although there have been few attempts to apply computer-generated hypnosis to clinical situations, results from a recent study on procedural pain revealed that hypnosis delivered through immersive virtual reality (VR) was very effective in reducing patients' reported pain and anxiety and may have reduced the need for opioid analgesics (Patterson, Wiechman, Jensen, Sharar, 2006). Immersive VR hypnosis (VRH) isolates patients from the outside world. With VR, patients have the illusion of going inside the three-dimensional computer-generated environment. Because VR is designed to be a highly attention-grabbing experience, it reduces the amount of attention available to process pain and instead maximizes the person's ability to narrowly focus on a hypnotic induction thereby facilitating dissociation of pain. The goal of creating VRH was to develop a three-dimensional, immersive virtual reality technology that could guide the patient through the same steps that are used when hypnosis is induced through an interpersonal process.

While there is a recent interest in using VR as a medium for hypnosis, this application is relatively new and has primarily been applied to acute procedural pain. The purpose of this case study was to expand the use of VRH to the treatment of a patient with chronic neuropathic pain, and, to our knowledge, it is the first research of its kind. In addition, in the present study, we were able to compare the results of the current trial of VRH to the results of a previous trial of standard hypnosis (non-VR) treatment that was conducted with the patient a few years earlier by one of the investigators. We hypothesized that this patient would have a significant reduction in pain and achieve a greater and longer lasting reduction in pain with VRH than standard (non-VR) hypnosis.

Case History

The patient was a 36-year-old female with a 5-year history of C4 tetraplegia and upper extremity neuropathic pain. She had no psychiatric history and was otherwise healthy. Approximately 5 years prior to the initiation of VRH treatment, she was injured as the passenger in a motor vehicle crash and spent close to 4 months in a major regional trauma center. Since that time, she has participated in both inpatient and outpatient rehabilitation and has worked closely with medical staff through a major regional multidisciplinary pain clinic. She described her pain as a constant burning sensation along the lateral aspects of her shoulders, medial arms, and proximal/anterior forearms, which was worse in her left arm. She was unable to wear clothes with sleeves as those garments increased her pain. She was also unable to be outdoors when there was any wind or precipitation due to her pain. In addition, her pain was very sensitive to temperature, and if the temperature was more than a few degrees above or below 73° F, her pain intensified. Finally, she also reported significant sleep difficulties secondary to her pain.

She has tried many treatments for pain management over the years, including multiple medications, physical therapy, massage therapy, acupuncture, Tibetan sound therapy, meditation, and electrical stimulation. Also, as noted above, she participated in a clinical trial of standard (non-VR) self-hypnosis training (Jensen et al., 2005, 2008). She reported that all of those treatments had been relatively unhelpful in the reduction of her pain.

Regarding past medications, this patient has tried over 15 medications to help her with pain management, including oxycodone, methadone, oxcarbazepine (Trileptal), venlafaxine (Effexor), diazepam (Valium), lorazepam (Ativan), pregabalin, mexiletine, and triazolam. She used to meet with her physician through the multidisciplinary pain clinic once every 3 weeks for pain management. However, for the year prior to the time that this study began, she had been meeting with that professional about once every 2 months.

During this study, the patient was taking the following medications: Diazepam 5 mg SID for sleep and pain; oxcarbazepine 300 mg SID for pain; trazodone 100–150 mg SID for sleep; mexiletine 150 mg BID for pain; venlafaxine 150 mg in am/75 mg in pm for pain; and tolterodine (Detrol LA) 4 mg SID for treatment of an overactive bladder.

Procedure

The patient became known to us after she contacted one of the authors with an interest in virtual reality distraction after hearing about this in the media. She was told that virtual reality distraction is not well suited for chronic pain but also that we could provide virtual reality hypnosis to see if this might be of benefit for her. The first two authors met with the patient to explain the study and VRH treatment. She consented to participate. The measures and data collection procedures for this study were very similar to those used in a previous trial of standard hypnosis (Jensen et al., 2005). Baseline and follow-up data was obtained from the patient by telephone interview. In order to determine the longer-term effects of having participated in VRH, the patient was asked to take a hiatus from treatment for a 1-month period. During that time one of the authors contacted her on a weekly basis by telephone to assess her comfort with the treatment hiatus and she was told that at any time during the break, if her pain became too intense, she was welcome to return to VRH sooner than the 1-month timeframe. Session logs were completed with the patient before and after each VRH session. The treatment outcome measures analyzed for this case report included average pain intensity and pain unpleasantness, as well as amount of time (in hours) the patient experienced a reduction or absence of pain between treatment sessions. The patient was also administered the Stanford Hypnotic Clinical Scale (SHCS; Morgan; Hilgard, 1978–1979) in order to assess level of hypnotizability.

The patient participated in a total of 33 VRH treatment sessions over the course of 6-months. All sessions occurred in a private office at a regional trauma medical center in Seattle, Washington. All sessions involved the patient receiving an audio recording of a hypnotic induction, suggestions for pain relief, and then alerting while drifting through a three-dimensional computer-generated virtual world called SnowWorld (See Patterson, Tininenko, Schmidt, Sharar, 2004; Patterson et al., 2006 for details of SnowWorld). Between sessions, the patient was encouraged to practice self-hypnosis regularly by using the compact disc that was given to her with the audio of the VRH protocol. In other words, she could listen to the audio version of the hypnosis at home, but did not have the visual stimuli available during the at-home practice sessions. She was also asked to complete daily diaries of her pain, unpleasantness, and frequency of home practice throughout the 6-months of treatment. She e-mailed the diaries to the first author of this article.

The VRH program began by having the patient hovering at the top of the snow canyon while an audiotape of the hypnotist's voice prepared the patient for what she would experience during the virtual hypnosis. After approximately 6 minutes of instruction, she began a 6-minute descent in the “snowy” 3-D canyon and she experienced herself as floating by numbers (1 through 10, in order) and was instructed to deepen her relaxation as she passed by each number. At number 10, she was told that she was in her most relaxed state and had descended deep into the canyon. At that point, she experienced herself hovering above the lake and was given about 18 minutes of audio posthypnotic suggestions. That was followed by approximately 10 minutes of alerting as she ascended back up the “snowy” 3-D canyon and floated by numbers (10 through 1, in order).

The Nature of Hypnotic Suggestions

Although the exact transcript of the hypnotic suggestions is too long to report, we will provide examples of the content. First, there was an introduction to the lake. The lake was described to the patient, and she was encouraged to become increasingly absorbed in the scene and to let her body relax. Then the program addressed her mind and how it could be a tremendous resource to help her feel safe and comfortable. The next section discussed how pain affects her life. An example of this dialogue is, “Part of you knows what it takes to feel more comfortable, to allow you to heal faster. It is there, it's just that it only comes to you, to your awareness, during certain times of your life, and what you realize is that this part of your mind is going to become present in your life during this time of healing, or during the time when you are undergoing pain.” The following segment dealt with asking the patient to imagine a time before the trauma. She was then instructed to recall images from a time in the past when she had positive experiences and to remember how comfortable she felt then.

After she was asked to recall positive images and experiences from her past, she was directed to move forward in time and to continue to see positive images of herself functioning well. She was told that images from the past and from the future should start to have a strong connection. Then the patient was given suggestions for sleeping better through the night, and it was also suggested that any exercises she engages in would become easier. It was recommended that she change the experience of her pain to a sense of coolness or numbness, or even forget about it altogether. She was also guided that as her pain improved she would find the ability to continue doing things that make her feel better, such as increasing her movement and participating more in life. The lake segment concluded by giving the patient a chance to engage in any other experiences or images that she might like to have, or to give herself positive suggestions of her own. She was then provided a period of silence for her to do that. The final suggestion focused on the fact that her comfort would be far greater when she took off the VR helmet than it was before she started the session.

Outcome Measures

The outcome measures analyzed for this study included pre- to posttreatment through 1-month follow-up of average pain intensity and pain unpleasantness. These outcome measures were the two that demonstrated significant effects in the original hypnosis only (non-VR) study that this patient previously participated in (Jensen et al., 2005). Both outcome domains were assessed at each outcome assessment point by contacting the patient four times within a 7-day window, and asking her to rate her usual pain intensity and pain unpleasantness over the past 24 hours on 0 (no pain; not bad at all) to 10 (the most intense pain sensation imaginable; the most intense bad feeling possible for me) Numerical Rating Scales. The four ratings for each outcome domain were then combined into composite measures of average pain intensity and pain unpleasantness.

In addition, the patient rated pain intensity and unpleasantness before and after each VRH session, using the same 0 to 10 Numerical Rating Scales described. These ratings were averaged into separate composite scores. That is, the pre- and postsession pain intensity and pain unpleasantness ratings were averaged for both the first 10 sessions and also all 33 sessions of VRH. Developing the composite scores from the first 10 sessions of VRH allowed for a direct comparison between VRH and the standard (non-VR) hypnosis trial, which included 10 sessions of treatment. The final outcome measure was the amount of time (in hours) that the patient experienced a reduction or absence of pain between treatment sessions. In the same manner as described above, these ratings were averaged into separate composite scores (VRH-33 sessions, VRH-first 10 sessions, standard hypnosis-10 sessions).

Outcome Data

Relative to the pretreatment baseline, the patient's ratings of average pain intensity and pain unpleasantness were not significantly different from her posttreatment or 1-month follow-up ratings. This outcome was similar for both the current VRH study as well as the hypnosis (non-VR) study that was conducted in 2004–2005. See Table 1 for the patient's average pain intensity and pain unpleasantness ratings pre/posttreatment as well as at 1-month follow-up for both the VRH and hypnosis (non-VR) treatments. In other words, VRH did not create lasting changes in the patient's pain perception.



Table 1


Means and SDs of Average Intensity of Pain and Pain Unpleasantness at Pretreatment, Posttreatment, and 1-Month Fallow-Up for VRH and Hypnosis Treatments

However, when investigating pain levels immediately after treatment, the patient's average pain intensity levels and pain unpleasantness ratings from pre- to posttreatment session, there was a 36% reduction in her average pain intensity and a 33% reduction in her average pain unpleasantness from pre- to post-VRH (see Table 2). As explained above, in order to directly compare the VRH and hypnosis (non-VR) ratings, the first 10 sessions of the VRH treatment were compared to the 10 sessions of hypnosis (non-VR) treatment that this patient had previously completed. See Table 2 for a depiction of the VRH 10-session and the hypnosis (non-VR) 10-session ratings. This patient reported an average of 25% pain intensity reduction and 20% pain unpleasantness reduction over the course of the first 10 sessions of VRH, compared to an average of 7% pain intensity reduction and 15% pain unpleasantness reduction over the course of the 10-session hypnosis (non-VR) treatment.



Table 2

Means and SDs of Presession to Postsession Intensity of Pain and Unpleasantness of Pain for 33-Sessions of Virtual Reality Hypnosis (VRH33), 10-Sessions of Virtual Reality Hypnosis (VRH10), and 10-Sessions of Hypnosis (Hyp10)

With respect to the duration of pain decrease between treatment sessions, this patient reported an average of 12.21 hours of pain reduction and 3.86 hours of being pain free over the course of the 33 sessions of VRH treatment. For the first 10 sessions of the VRH treatment she reported an average of 8.5 hours of pain reduction and 4.3 hours of being pain free, compared to an average of 1 hour of pain reduction and 0 hours of being pain free over the course of the 10-session hypnosis (non-VR) treatment (See Table 3).




Table 3

Means and SDs of the Duration (in Hours) of No Pain and Reduced Pain Throughout the Course of 33-Sessions of Virtual Reality Hypnosis (VRH33), 10-Sessions of Virtual Reality Hypnosis (VRH10), and 10-Sessions of Hypnosis (Hyp10)

Finally, on the Stanford Hypnotic Clinical Scale (Morgan; Hilgard, 1978–1979), the patient received a score of 2, placing her in the low to low-moderate range of hypnotizability.

Discussion
 
This report represents our first attempt to apply immersive virtual reality hypnosis to treat chronic neuropathic pain in a woman with a spinal cord injury who had not responded to any form of prior treatment. The patient's subjective ratings of pain intensity and pain unpleasantness showed an immediate reduction that averaged 36% and 33%, respectively, from pre- to post-VRH treatment. In addition, the amount of time that this patient experienced no pain or a reduction of pain over the course of the 33 VRH-treatment sessions averaged 3.86 and 12.21 hours, respectively. Furthermore, when compared to hypnosis alone (non-VR), this patient experienced a greater reduction in pain intensity and pain unpleasantness as well as longer lasting freedom from pain throughout the course of treatment with VRH.

The fact that this patient's pretreatment ratings of pain intensity and pain unpleasantness were not significantly different from her posttreatment and 1-month follow-up ratings of pain intensity and pain unpleasantness suggests that VRH treatment was helpful for her on a time-limited basis, that is, on average, 12.1 hours. The relatively short-lived effect of VRH in this patient's case is consistent with recent research suggesting that although hypnosis may not “cure” a person's chronic pain, it can be an important part of a person's plan to manage chronic pain on a daily basis (Jensen et al., 2008). In other words, hypnosis can provide many patients with a means of coping with pain, much like they might use medications (that also provide only short-term relief), but without the negative side-effects of those medications. In fact, research suggests that hypnosis can provide many beneficial “side effects” (e.g., improved well-being, improved sense of control over pain, improved sleep, etc.) that can contribute to a patient's quality of life over and above its effects on pain (Jensen et al., 2006).

Thus, even though some patients (about between 20%–30%, cf. Jensen et al., 2008) with chronic pain can experience substantial and long-term reductions in average daily pain following hypnosis treatment, many more patients than this report some relief of pain via hypnosis, view it as helpful and continue to use it up to 12 months following treatment. Therefore, although the patient in this case report was not “cured” of her pain, which would have been surprising given the refractory nature of it, she did achieve meaningful benefits through the use of VRH that lasted for many hours. Furthermore, while overall pain measurements did not change substantially, observation of means suggests that the directions of changes were in the direction anticipated. Specifically, overall ratings went down during the treatment period rather than baseline and then increased again during the month with no treatment.

The findings that this patient, who has suffered from severe and chronic neuropathic pain for over 5 years and has tried a myriad of other interventions, including over 15 medication trials, achieved a significant and lasting reduction in her pain throughout the course of VRH treatment is extremely promising. It was interesting that the patient went through the efforts to come to the hospital for months; given her spinal cord injury this was logistically difficult for her. It was also noteworthy that she reported that she benefited more from the induction when it was paired to the visual stimuli, rather than presented simply through audiotape. She also chose to resume treatment after a 1-month no-treatment period requested by the investigators. During one of the final VRH sessions before the treatment hiatus, this patient indicated that over time she was learning how to control her pain better, largely due to the experience that she has received through virtual reality hypnosis.

It was also noteworthy that the patient scored low on a scale measuring hypnotizability. Although the Stanford Hypnotic Clinical Scale is a screening measure, it has been reported to have good correlations with the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C; Bryant, Guthrie, Moulds, Nixon, and; Felmingham, 2003). The fact that the patient had a good response to the virtual reality hypnosis with a relatively low hypnotizability score is encouraging to us. Our hope is that this technology will be most useful to patients that do not have a high level of hypnotizability. Specifically, it may be that providing attention-grabbing stimuli that matches the suggestions may help patients become more absorbed in the process when this does not come naturally.

We maintain that this patient's chronic neuropathic pain is a challenging clinical problem with no easy solution. This report is provided after 6-months of treatment, with an empirical hiatus of no treatment. Our hope is that with repeated treatment, the pain relief experienced by the patient will last for greater, and hopefully more extensive, periods of time.

There are several limitations to this case report. As with a study of this design, we are not controlling for historical factors that might have influenced the patient's pain perception; randomized controlled studies are necessary to control such extraneous variables. One of the biggest threats to validity is not knowing if the patient reported pain reductions simply to please the investigators. However, we should note that she was willing to report no reductions in pain over several periods during the study. Further, although historical confounds are always a consideration, it is difficult to argue that the drops in pain that occurred over almost all of the 33 treatments were attributable to anything other than the intervention. The activity required to travel to the hospital was more likely to exacerbate than to reduce pain in itself. Finally, this technology used in the intervention was novel and has not yet been refined for use. In spite of these drawbacks, however, we view the pain reductions that occurred with VRH, especially in light of previous poor response to other treatments, as promising and indicate that additional investigation of virtual reality hypnosis for chronic pain is warranted.

Footnotes

1This article was supported by grants from the National Institutes of Health (R01 GM42725-09A1 and R01AR054115-01A1) as well as with gifts or grants from the Paul Allen Foundation, Scan Design by Inger and Jens Bruun Foundation, Gustavus and Louise Pffiefer Research Foundation, and other private donors. The software expertise necessary to design the immersive virtual reality delivery system was provided by Hunter Hoffman, Ph.D., at the University of Washington Human Interface Technology Lab as well as Ari Hollander at Imprintit.com.

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http://www.tandfonline.com/doi/abs/10.1080/00207140802255534?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#.U5_rnbFqQUM

Prurigo Of Pregnancy

Puppp Rash Pregnancy

Prurigo nodularis is a skin disease affecting mainly the extremities and neck. The two words prurigo -itching and nodularis-nodules itself suggests the meaning of .What is Prurigo Nodularis? Pictures, Causes, Symptoms, Diagnosis, Histopathology and Treatment. It is a skin disease, which has a characteristic nodules that are .Prurigo nodularis is a skin ailment, occurring on the forearms, lower extremity and neck. It manifests as a tiny, red itchy bumps, having crusts and scales and.We need to recognize that when women in their 20s and 30s complain of vulvar pruritus, it is not always vulvovaginal candidiasis," Dr..A new and positive cure for Blotched Face, Barber's Itch, Scall-Head, Black-heads or Grubs, Salt Rheum, Papules, Erythema, Nettle Rash, Lichen, Prurigo or Itching .Prurigo [proo-rigo] any of several itchy skin eruptions in which the characteristic lesion is dome-shaped with a small transient vesicle on top, followed by .Breast eczema also known as "Nipple eczema" may affect the, areolae, or surrounding skin, with eczema of the being of the moist type with oozing and .Prurigo of Pregnancy Epidemiology Clinical Features Prurigo of pregnancy affects approximately one in 300 to one in 450 pregnancies..As a result, prurigo nodularis can negatively affect a person's quality of life-interfering with daily activities, social interactions, and sleep..Prurigo Nodularis PN is often called several other names. Read these and more information about Prurigo Nodularis PN ..

Puppp Rash Pregnancy

Prurigo Pregnancy

Prurigo [proo-rigo] any of several itchy skin eruptions in which the characteristic lesion is dome-shaped with a small transient vesicle on top, followed by .A new and positive cure for Blotched Face, Barber's Itch, Scall-Head, Black-heads or Grubs, Salt Rheum, Papules, Erythema, Nettle Rash, Lichen, Prurigo or Itching .As a result, prurigo nodularis can negatively affect a person's quality of life-interfering with daily activities, social interactions, and sleep.. Prurigo of Pregnancy Epidemiology Clinical Features Prurigo of pregnancy affects approximately one in 300 to one in 450 pregnancies..Prurigo nodularis is a skin disease affecting mainly the extremities and neck. The two words prurigo -itching and nodularis-nodules itself suggests the meaning of .What is Prurigo Nodularis? Pictures, Causes, Symptoms, Diagnosis, Histopathology and Treatment. It is a skin disease, which has a characteristic nodules that are .Prurigo Nodularis PN is often called several other names. Read these and more information about Prurigo Nodularis PN ..Prurigo nodularis is a skin ailment, occurring on the forearms, lower extremity and neck. It manifests as a tiny, red itchy bumps, having crusts and scales and.We need to recognize that when women in their 20s and 30s complain of vulvar pruritus, it is not always vulvovaginal candidiasis," Dr..Breast eczema also known as "Nipple eczema" may affect the, areolae, or surrounding skin, with eczema of the being of the moist type with oozing and .

BAD EFFECTS OF CRY

BAD EFFECTS OF CRY

PSYCHIATRIC COMPLAINTS – BAD EFFECTS OF CRY 

In general, cry is treated as an expression of sorrows and grievances.

Eyes alone should be never blamed for crying, since those innocents are squeezed between brain and heart with one’s feelings and needs. Depending upon the cause, intensity and environment, expression of cry commonly differs. The tolerance or breaking point of cry also differs from person to person. Some cry even for trivial, some other won’t cry even for a major loss. Some persons control their tears and cry in their heart with inner feelings and some other would cry as they had ruptured out. The effects of cry too differ from person to person. For some, cry may act as a drain for sorrows and stress, to have clear thoughts and for some other, cry can create more and more clumsy thoughts to give an extreme emotional upset to derail the life train.

Anything excess often bring problems, cry is no way exception. Even though, by the time of birth good cry brings good respiration, intensified and aggressive cry may arrest respiration and can complicate one’s life with respiratory distress syndrome, syncope, panic and with brain damage too. Cry syncope not only occurs in infants, but can also happen in adults too (with extreme emotional upset or after violent cry). Getting fainting after hearing shocking news (i.e. even before starting to cry) is nothing but a series of cry syncope. Women and children are more susceptible to these bad effects and in fact sometimes, gains good claims too with this advantageous (?) cry.

In case of infants, cry is the only way to communicate concerning their need. No one can predict when they would start crying and what for. Parents or caretaker need to provide immediate attention to the violently crying baby to pacify and satisfy them at the earliest or otherwise complications may crop up by anytime. Some kids could not stop crying once they have started it. They may cry until they get tired or get into the sleep. In case of violent cry (in adult or child), commonly adrenaline hormone will be loaded into the blood to cause constriction of blood vessels or arteries to elevate the blood pressure for combating stress. Elevated pressure / constriction of blood vessels caused by adrenaline load can turn hazardous by anytime. So infants or kids should never be left alone. The common bad effects of nagging cry are

• Mental trauma with emotional upset
  
• Anxiety, tension, panic, etc
• Loss of self esteem (when not attended properly)
• Restless sleep / sleeplessness
• Arrest of breath / choking / respiratory distress
• Syncope with blueness of the body
• Seizures
• Cold like symptoms
• Cough and vomiting
• Wheezing
• Buildup of habit like adamant character / cruelty / anger (when cry is often uncared or suppressed)

TIPS AND TRICKS TO AVOID / TACKLE AGGRESSIVE CRYING – Prevention is always better than cure, so never allow a trigger or otherwise one may find difficult to get them stop crying. Proper parental care is very much essential to keep infants / kids in enthusiastic and cheering mood. The parents should comprehend that the crying infants / kids need to be cared, served, distracted and educated in due course to accept the granted offers / offerings. To pacify or to keep calm and comfort babies, following things need to be followed.

• Feed baby at regular time and avoid over feeding
• Care for nature of diets
• Provide them with comfort clothing and bedding
• Give attention to them and play with them
• Care for every complaint then and there consulting a doctor
• Never self medicate them and go for investigations as early as possible in case of any complaints.
• Observe regular bowel emptying and bladder emptying
• Serve their needs with out denying – if it could not be offered, distract them with better offers or otherwise make them to understand.
• Avoid unnecessary travels which make them sleep deprived
• Avoid talking loudly, scolding, beating, pinching, punishing by any means since they often worsen the condition.
• Never tease them to cry or make them angry

TREATMENT FOR VIOLENT CRY – Cry as such cannot be treated with

medicines, since it is not at all a disease. Any how, its bad effects like choking / respiratory distress / causing cold like symptoms / wheezing / headache can be well controlled / prevented with homeopathic medicines / treatment (analysing one’s psychology – in child or adult). On screening out crying children all the way (mentally and physically), ruling out the complication or emergency, homeopathy can provide good solution with its sweet medicines and constitutional approach. With proper treatment, complications can be significantly minimised. The breath taking violent cry can be avoided in future by enhancing tolerance, i.e., after treatment, even though if the child happened to cry violently, there won’t be any choking or fainting or wheezing or any other sufferings. Crying tendency / adamancy can also be altered / lowered with treatment, habit development & distraction / mind modulation in case of growing children.

In the deal of child, children’s friendly homeopathy is matchless. It treats everyone as a different individual and treats them according to their symptom presentations, constitution make up (mental and physical) and feelings. I.e., some babies cries all thro the night and sleep fine in the day, some other babies cries all thro the day and sleep fine all the night and some other cries often through out day and night. Some children may cry in night (in sleep) with brooding for the happenings in the day. Likewise, effects of cry, its intenstiy and needed care also differ from person to person. Some needs consolation, some other need to be left undisturbed. Some babies just wish to be cared in calm environments and some others want to be held, massaged and stroked in midst of music. Some other infant wants to be held constantly. Commemorating child’s nature, homeopathy stands high with its classical individualisation and treatment to rectify everything with remedy. Homeopathy is very safe and free from all sorts of harmful effects since it is given in very minute doses. One more advantage with homeopathic approach is children need not be forced to take medicines (as they love it for its sweet taste) which saves lot of weeping and inconvenience.

Homeopathic medicines commonly indicated for adamant crying character and cry syncope are Aconitum, Bacillinum, Belladonna, Calc carb, Chamomilla, Cina, Cypripedium, Graphites, Hepar sulph, Hyoscyamus, Ignatia, Merc sol, Pulsatilla, Silicea, Sulphur, syphilinum, Thuja, Tuberculinum, etc. These Medicines should be taken under the advice and diagnosis of a qualified Homeopath.

for new hope

Dr. S. Chidambaranathan, BHMS, MD (Homeo)

Laxmi Homeo Clinic

24 E. New Mahalipatti Road

Madurai, TN 625 001

India

Tel:  +91-452-233-8833 | +91-984-319-1011 (Mob)

Fax: +91-452-233-0196

E-mail:  drcheena@yahoo.com

www.drcheena.com  / www.drcheena.in

(Disclaimer - The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)

YOGA FOR RELIEVING OSTEOARTHRITIS PAIN

An orthopaedic surgeonhas said that yoga is an effective natural remedy for osteoarthritis, which can not only reduce the pain and stiffness, but also slow the progression of the disease.

imon Moyes, consultant orthopaedic surgeon at The Wellington Hospital in London’s St John’s Wood, said that small and easy lifestyle changes in your everyday routine can be effective in protecting your knee joints and slowing the progression of osteoarthritis .

He said that the most important of these are keeping your body mass index down to normal levels, having a healthy diet, exercising regularly and keeping supple – these will all reduce the risk of injury and limit the chances of developing arthritis.

Moyes, who specialises in arthroscopic surgery for knee, shoulder, foot and ankle problems, said that yoga also helps improve flexibility and functioning of joints and therefore reduces the risk of injury, especially if the patient takes part in contact sports.

He added that they are seeing more and more ‘high level’ athletes such as professional footballers engaging in yoga to reduce their injury rates and risks.

Pregnancy 11 Weeks

Baby At 31 Weeks Pregnant

Printables, coloring pages, recipes, crafts, and more from your child's favorite Nickelodeon and Nick Jr. shows..TODAY Parents is the premiere destination for parenting news, advice community. Find the latest parenting trends and tips for your kids and family on TODAY.com..

2nd Pregnancy 11 Weeks Pregnant

11 Weeks Pregnant And Showing

TODAY Parents is the premiere destination for parenting news, advice community. Find the latest parenting trends and tips for your kids and family on TODAY.com..Printables, coloring pages, recipes, crafts, and more from your child's favorite Nickelodeon and Nick Jr. shows..

HIGHEST RESOLUTION EVER WITH X RAY MICROSCOPY

A record-setting X-ray microscopy experiment may have ushered in a new era for nanoscale imaging. Working at the U.S. Department of Energy (DOE)'s Lawrence Berkeley National Laboratory (Berkeley Lab), a collaboration of researchers used low energy or "soft" X-rays to image structures only five nanometers in size. This resolution, obtained at Berkeley Lab's Advanced Light Source (ALS), a DOE Office of Science User Facility, is the highest ever achieved with X-ray microscopy.

Using ptychography, a coherent diffractive imaging technique based on high-performance scanning transmission X-ray microscopy (STXM), the collaboration was able to map the chemical composition of lithium iron phosphate nanocrystals after partial dilithiation. The results yielded important new insights into a material of high interest for electrochemical energy storage.

"We have developed diffractive imaging methods capable of achieving a spatial resolution that cannot be matched by conventional imaging schemes," says David Shapiro, a physicist with the ALS. "We are now entering a stage in which our X-ray microscopes are no longer limited by our optics and we can image at nearly the wavelength of our X-ray light."

Shapiro is the lead and corresponding author of a paper reporting this research in Nature Photonics. The paper is titled "Chemical composition mapping with nanometer resolution by soft X-ray microscopy."  

In ptychography (pronounced tie-cog-raphee), acombination of multiple coherent diffraction measurements is used to obtain 2D or 3D maps of micron-sized objects with high resolution and sensitivity. Because of the sensitivity of soft x-rays to electronic states, ptychography can be used to image chemical phase transformations and the mechanical consequences of those transformations that a material undergoes.

"Until this work, however, the spatial resolution of ptychographic microscopes did not surpass that of the best conventional systems using X-ray zone plate lenses," says Howard Padmore, leader of the Experimental Systems Group at the ALS and a co-author of the Nature Photonics paper. "The problem stemmed from the fact that ptychography was primarily developed on hard X-ray sources using simple pinhole optics for illumination. This resulted in a low scattering cross-section and low coherent intensity at the sample, which meant that exposure times had to be extremely long, and that mechanical and illumination stabilities were not good enough for high resolution."

Key to the success of Shapiro, and his collaborators were the use of soft X-rays which have wavelengths ranging between 1 to 10 nanometers, and a special algorithm that eliminated the effect of all incoherent background signals. Ptychography measurements were recorded with the STXM instruments at ALS beamline 11.0.2, which uses an undulator x-ray source, and ALS beamline 5.3.2.1, which uses a bending magnet source. A coherent soft X-ray beam would be focused onto a sample and scanned in 40 nanometer increments. Diffraction data would then be recorded on an X-ray CCD (charge-coupled device) that allowed reconstruction of the sample to very high spatial resolution

"Throughout the ptychography scans, we maintained the sample and focusing optic in relative alignment using an interferometric feedback system with a precision comparable to the wavelength of the X-ray illumination," Shapiro says.

Lithium iron phosphate is widely studied for its use as a cathode material in rechargeable lithium-ion batteries. In using their ptychography technique to map the chemical composition of lithium iron phosphate crystals, Shapiro and his collaborators found a strong correlation between structural defects and chemical phase propagation.

"Surface cracking in these crystals was expected," Shapiro says, "but there is no other means of visualizing the correlation of those cracks with chemical composition at these scales. The ability to visualize the coupling of the kinetics of a phase transformation with the mechanical consequences is critical to designing materials with ultimate durability."

Shapiro and his colleagues have already begun applying their ptychography technique to the study of catalytic and magnetic films, magnetotactic bacteria, polymer blends and green cements.

In this soft X-ray ptychography set-up, a 60 nm width outer-zone-plate focuses a coherent soft X-ray beam onto the sample, which is scanned in 40 nm increments to ensure overlap of the probed areas.

For the chemical mapping of lithium iron phosphate they used the STXM instrument at ALS beamline 5.3.2.1 which required up to 800 milliseconds of exposure to the X-ray beam for each scan. Next year, they anticipate using a new ALS beamline called COSMIC (COherent Scattering and MICroscopy), which will feature a high brightness undulator x-ray source coupled to new high-frame-rate CCD sensors that will cut beam exposure times to only a few milliseconds and provide spatial resolution at the wavelength of the radiation.

"If visible light microscopes could only achieve a resolution that was 50 times the wavelength of visible light, we would not be able to see most single celled organisms," Shapiro says. "Where would the life sciences be with such a limitation? We are now approaching the point where we will have X-ray microscopes of comparable quality to today's visible light instruments for the study of nanomaterials."

Co-authoring the Nature Photonics paper in addition to Shapiro and Padmore were Young-Sang Yu, Tolek Tyliszczak, Jordi Cabana, Rich Celestre, Weilun Chao, David Kilcoyne, Stefano Marchesini, Tony Warwick and Lee Yang of Berkeley Lab; Konstantin Kaznatcheev of Brookhaven National Laboratory; Shirley Meng of the University of San Diego; and Filipe Maia of Uppsala University in Sweden.

This research was primarily supported by the DOE Office of Science.

IMPLANT WIRELESS DEVICES TRIGGER AND MAY BLOCK PAIN SIGNALS

Building on wireless technology that has the potential to interfere with pain, scientists have developed flexible, implantable devices that can activate -- and, in theory, block -- pain signals in the body and spinal cord before those signals reach the brain

The researchers, at Washington University School of Medicine in St. Louis and the University of Illinois at Urbana-Champaign, said the implants one day may be used in different parts of the body to fight pain that doesn't respond to other therapies.

"Our eventual goal is to use this technology to treat pain in very specific locations by providing a kind of 'switch' to turn off the pain signals long before they reach the brain," said co-senior investigator Robert W. Gereau IV, PhD, the Dr. Seymour and Rose T. Brown Professor of Anesthesiology and director of the Washington University Pain Center.

The study is published online Nov. 9 in the journal Nature Biotechnology.

Because the devices are soft and stretchable, they can be implanted into parts of the body that move, Gereau explained. The devices previously developed by the scientists had to be anchored to bone.

"But when we're studying neurons in the spinal cord or in other areas outside of the central nervous system, we need stretchable implants that don't require anchoring," he said.

The new devices are held in place with sutures. Like the previous models, they contain microLED lights that can activate specific nerve cells. Gereau said he hopes to use the implants to blunt pain signals in patients who have pain that cannot be managed with standard therapi Building on wireless technology that has the potential to interfere with pain, scientists have developed flexible, implantable devices that can activate -- and, in theory, block -- pain signals in the body and spinal cord before those signals reach the braines.

The researchers experimented with mice that were genetically engineered to have light-sensitive proteins on some of their nerve cells. To demonstrate that the implants could influence the pain pathway in nerve cells, the researchers activated a pain response with light. When the mice walked through a specific area in a maze, the implanted devices lit up and caused the mice to feel discomfort. Upon leaving that part of the maze, the devices turned off, and the discomfort dissipated. As a result, the animals quickly learned to avoid that part of the maze.

The experiment would have been very difficult with older optogenetic devices, which are tethered to a power source and can inhibit the movement of the mice.

Because the new, smaller, devices are flexible and can be held in place with sutures, they also may have potential uses in or around the bladder, stomach, intestines, heart or other organs, according to co-principal investigator John A. Rogers, PhD, professor of materials science and engineering at the University of Illinois.

"They provide unique, biocompatible platforms for wireless delivery of light to virtually any targeted organ in the body," he said.

Rogers and Gereau designed the implants with an eye toward manufacturing processes that would allow for mass production so the devices could be available to other researchers. Gereau, Rogers and Michael R. Bruchas, PhD, associate professor of anesthesiology at Washington University, have launched a company called NeuroLux to aid in that goal.

WORLD POPULATION TO KEEP GROWING THIS CENTURY HIT 11 BILLION BY 2100

Using modern statistical tools, a new study led by the University of Washington and the United Nations finds that world population is likely to keep growing throughout the 21st century. The number of people on Earth is likely to reach 11 billion by 2100, the study concludes, about 2 billion higher than widely cited previous estimates

The paper published online Sept. 18 in the journalScience includes the most up-to-date numbers for future world population, and describes a new method for creating such estimates.

"The consensus over the past 20 years or so was that world population, which is currently around 7 billion, would go up to 9 billion and level off or probably decline," said corresponding author Adrian Raftery, a UW professor of statistics and of sociology. "We found there's a 70 percent probability the world population will not stabilize this century. Population, which had sort of fallen off the world's agenda, remains a very important issue."

The paper explains the most recent United Nations population data released in July. This is the first U.N. population report to use modern statistics, known as Bayesian statistics, that combines all available information to generate better predictions.

Most of the anticipated growth is in Africa, where population is projected to quadruple from around 1 billion today to 4 billion by the end of the century. The main reason is that birth rates in sub-Saharan Africa have not been going down as fast as had been expected. There is an 80 percent chance that the population in Africa at the end of the century will be between 3.5 billion and 5.1 billion people.

Other regions of the world are projected to see less change. Asia, now 4.4 billion, is projected to peak at around 5 billion people in 2050 and then begin to decline. Populations in North America, Europe, and Latin America and the Caribbean are projected to stay below 1 billion each.

The figures largely support U.N. projections from 2013 but add a new dimension, said first author Patrick Gerland, a demographer at the U.N.

"Earlier projections were strictly based on scenarios, so there was no uncertainty," Gerland said. "This work provides a more statistically driven assessment that allows us to quantify the predictions, and offer a confidence interval that could be useful in planning."

World population projections are based mostly on two things: future life expectancy and fertility rates. Earlier techniques relied largely on expert opinion for how those trends were expected to change.

The newer forecast instead uses statistical methods to combine government data and expert forecasts for such things as mortality rates, fertility rates and international migration.

Also, earlier reports represented uncertainty by using scenarios in which women would have 0.5 children more or less than the experts' forecast. That method, Raftery said, generates too great a range.

"In a given year and country the fertility rate might be half a child higher, but the probability that it would be half a child higher in all countries in all years in the future is very low," Raftery said.

The new method uses statistical models to narrow the range, finding an 80 percent probability that the population in 2100 will be between 9.6 billion and 12.3 billion.

"This paper brings together the research from the past seven years, and also brings in recent data," Raftery said. "We can answer questions about future population growth using standard principles of statistical inference, which has never really been done before."

Rising population could exacerbate world problems such as climate change, infectious disease and poverty, he said. Studies show that the two things that decrease fertility rates are more access to contraceptives and education of girls and women, Raftery said. Africa, he said, could benefit greatly by acting now to lower its fertility rate.

The research was supported by the U.S. National Institute of Child Health and Human Development and Science Foundation Ireland. Other co-authors are Hana Ševčiková and Nevena Lalic at the UW; Nan Li, Danan Gu, Thomas Spoorenberg, Guiomar Bay and John Wilmoth at the U.N.; Leontine Alkema, a former UW graduate student now at the National University of Singapore; Bailey Fosdick, a former UW graduate student now at Colorado State University; Jennifer Chunn, a former UW graduate student now at Singapore's James Cook University; and Gerhard Heilig and Thomas Buettner, consultants who formerly worked at the U.N.