title: Profumo affair

text: After the Denning Report, in defiance of general expectations that he would resign shortly, Macmillan announced his intention to stay on. On the eve of the Conservative Party's annual conference in October 1963 he fell ill; his condition was less serious than he imagined, and his life was not in danger but, convinced he had cancer, he resigned abruptly. Macmillan's successor as prime minister was Lord Home, who renounced his peerage and served as Sir Alec Douglas-Home. In the October 1964 general election the Conservative Party was narrowly defeated, and Wilson became prime minister. A later commentator opined that the Profumo affair had destroyed the old, aristocratic Conservative Party: "It wouldn't be too much to say that the Profumo scandal was the necessary prelude to the new Toryism, based on meritocracy, which would eventually emerge under Margaret Thatcher". "The Economist" suggested that the scandal had effected a fundamental and permanent change in relations between politicians and press. Davenport-Hines posits a longer-term consequence of the affair—the gradual ending of traditional notions of deference: "Authority, however disinterested, well-qualified and experienced, was [after June 1963] increasingly greeted with suspicion rather than trust".


title: Profumo affair

text: After expressing his "deep remorse" to the prime minister, to his constituents and to the Conservative Party, Profumo disappeared from public view. In April 1964 he began working as a volunteer at the Toynbee Hall settlement, a charitable organisation based in Spitalfields which supports the most deprived residents in the East End of London. Profumo continued his association with the settlement for the remainder of his life, at first in a menial capacity, then as administrator, fund-raiser, council member, chairman and finally president. Profumo's charitable work was recognised when he was appointed a Companion of the Order of the British Empire (CBE) in 1975. He was later described by Prime Minister Margaret Thatcher as a national hero, and was a guest at her 80th birthday celebrations in 2005. His marriage to Valerie Hobson lasted until her death on 13 November 1998, aged 81; Profumo died, aged 91, on 9 March 2006.


title: Profumo affair

text: In December 1963 Keeler pleaded guilty to committing perjury at Gordon's June trial, and she was sentenced to nine months' imprisonment, of which she served six months. After two brief marriages in 1965–66 to James Levermore and in 1971–72 to Anthony Platt that produced a child each, the eldest of whom was largely raised by Keeler's mother Julie, Keeler largely lived alone from the mid-1990s until her death. Most of the considerable amount of money that she made from newspaper stories was dissipated by legal fees; during the 1970s, she said, "I was not living, I was surviving". She published several inconsistent accounts of her life, in which Ward has been variously represented as a "gentleman", her truest love, a Soviet spy, and a traitor ranking alongside Kim Philby, Guy Burgess and Donald Maclean. Keeler also claimed that Profumo impregnated her and that she subsequently underwent a painful abortion. Her portrait, by Ward, was acquired by the National Portrait Gallery in 1984. Christine Keeler died on 4 December 2017, aged 75. Rice-Davies enjoyed a more successful post-scandal career, as nightclub owner, businesswoman, minor actress and novelist. She was married three times, in what she described as her "slow descent into respectability". Of adverse press publicity she observed: "Like royalty, I simply do not complain". Mandy Rice-Davies died on 18 December 2014, aged 70.


title: Profumo affair

text: Ward's role on behalf of MI5 was confirmed in 1982, when "The Sunday Times" located his former contact "Woods". Although Denning always asserted that Ward's trial and conviction were fair and proper, most commentators believe that it was deeply flawed—an "historical injustice" according to Davenport-Hines, who argues that the trial was an act of political revenge. One High Court judge said privately that he would have stopped the trial before it reached the jury. The human rights lawyer Geoffrey Robertson has campaigned for the case to be reopened on several grounds, including the premature scheduling of the trial, lack of evidence to support the main charges, and various misdirections by the trial judge in his summing up. Above all, the judge failed to advise the jury of the evidence revealed in the Gordon appeal that Keeler, the prosecution's chief witness against Ward, had committed perjury at the Gordon trial. The Criminal Cases Review Commission, which has the power to investigate suspected miscarriages of justice, reviewed his case starting in early 2014, but in 2017 decided not to refer it to the Court of Appeal after failing to find the original transcript of the judge's summing up.


title: Profumo affair

text: After his recall in January 1963, Ivanov disappeared for several decades. In 1992 his memoirs, "The Naked Spy", were serialised in "The Sunday Times". When this account was challenged by Profumo's lawyers, the publishers removed offending material. In August 2015 "The Independent" newspaper published a preview of a forthcoming history of Soviet intelligence activities, by Jonathan Haslam. This book suggests that the relationship between Ivanov and Profumo was closer than the latter admitted. It is alleged that Ivanov visited Profumo's home, and that such was the slackness of security arrangements that the Russian was able to photograph sensitive documents left lying about in the minister's study.


title: Profumo affair

text: Keeler describes a 1993 meeting with Ivanov in Moscow; she also records that he died the following year, aged 68. Astor was deeply upset at finding himself under police investigation, and by the social ostracism that followed the Ward trial. After his death in 1966, Cliveden was sold. It became first the property of Stanford University, and later a luxury hotel. Rachman, who had first come to public notice as a sometime-boyfriend of both Keeler and Rice-Davies, was revealed as an unscrupulous slum landlord; the word "Rachmanism" entered English dictionaries as the standard term for landlords who exploit or intimidate their tenants.


title: Profumo affair

text: There have been several dramatised versions of the Profumo affair. The 1989 film "Scandal" featured Ian McKellen as Profumo and John Hurt as Ward. It was favourably reviewed, but the revival of interest in the affair upset the Profumo family. The focus of Hugh Whitemore's play "A Letter of Resignation", first staged at the Comedy Theatre in October 1997, was Macmillan's reactions to Profumo's resignation letter, which he received while on holiday in Scotland. The ITV series "Endeavour" pilot episode makes reference to the affair and used elements of the affair as similar plot devices in the 2011 pilot episode. Andrew Lloyd Webber's musical "Stephen Ward" opened at London's Aldwych Theatre on 3 December 2013. Among generally favourable reviews, the "Daily Telegraph"s critic recommended the production as "sharp, funny – and, at times, genuinely touching". Robertson records that the script is "remarkably faithful to the facts". In his song, "We Didn't Start the Fire", Billy Joel refers to the scandal with the line "British politician sex". Scottish folk musician Al Stewart also refers to the scandal in his song "Post World War II Blues" on the album Past Present Future.


title: Hindus

text: Hindus (; ) are people who religiously adhere to Hinduism. Historically, the term has also been used as a geographical, cultural, and later religious identifier for people living in the Indian subcontinent.


title: Hindus

text: The term ""Hindu"" traces back to Old Persian which derived these names from the Sanskrit name "Sindhu" (सिन्धु ), referring to the river Indus. The Greek cognates of the same terms are ""Indus"" (for the river) and ""India"" (for the land of the river). The term ""Hindu"" also implied a geographic, ethnic or cultural identifier for people living in the Indian subcontinent around or beyond the Sindhu (Indus) River. By the 16th century CE, the term began to refer to residents of the subcontinent who were not Turkic or Muslims. Hindoo is an archaic spelling variant, whose use today is considered derogatory.


title: Hindus

text: The historical development of Hindu self-identity within the local Indian population, in a religious or cultural sense, is unclear. Competing theories state that Hindu identity developed in the British colonial era, or that it may have developed post-8th century CE after the Muslim invasions and medieval Hindu–Muslim wars. A sense of Hindu identity and the term "Hindu" appears in some texts dated between the 13th and 18th century in Sanskrit and Bengali. The 14th- and 18th-century Indian poets such as Vidyapati, Kabir and Eknath used the phrase "Hindu dharma" (Hinduism) and contrasted it with "Turaka dharma" (Islam). The Christian friar Sebastiao Manrique used the term 'Hindu' in a religious context in 1649. In the 18th century, European merchants and colonists began to refer to the followers of Indian religions collectively as "Hindus", in contrast to "Mohamedans" for groups such as Turks, Mughals and Arabs, who were adherents of Islam. By the mid-19th century, colonial orientalist texts further distinguished Hindus from Buddhists, Sikhs and Jains, but the colonial laws continued to consider all of them to be within the scope of the term "Hindu" until about mid-20th century. Scholars state that the custom of distinguishing between Hindus, Buddhists, Jains and Sikhs is a modern phenomenon.


title: Hindus

text: At more than 1.2 billion, Hindus are the world's third-largest religious group after Christians and Muslims. The vast majority of Hindus, approximately 966 million (94.3% of the global Hindu population), live in India, according to the 2011 Indian census. After India, the next nine countries with the largest Hindu populations are, in decreasing order: Nepal, Bangladesh, Indonesia, Pakistan, Sri Lanka, the United States, Malaysia, the United Arab Emirates and the United Kingdom. These together accounted for 99% of the world's Hindu population, and the remaining nations of the world combined had about 6 million Hindus .


title: Hindus

text: The word "Hindu" is an exonym. This word "Hindu" is derived from the Indo-Aryan and Sanskrit word "Sindhu", which means "a large body of water", covering "river, ocean". It was used as the name of the Indus River and also referred to its tributaries. The actual term " first occurs, states Gavin Flood, as "a Persian geographical term for the people who lived beyond the river Indus (Sanskrit: "Sindhu")", more specifically in the 6th-century BCE inscription of Darius I. The Punjab region, called Sapta Sindhu in the Vedas, is called "Hapta Hindu" in Zend Avesta. The 6th-century BCE inscription of Darius I mentions the province of "Hi[n]dush", referring to northwestern India. The people of India were referred to as "Hinduvān" (Hindus) and "hindavī" was used as the adjective for Indian in the 8th century text "Chachnama". The term 'Hindu' in these ancient records is an ethno-geographical term and did not refer to a religion. The Arabic equivalent "Al-Hind" likewise referred to the country of India.


title: Hindus

text: Among the earliest known records of 'Hindu' with connotations of religion may be in the 7th-century CE Chinese text "Records on the Western Regions" by the Buddhist scholar Xuanzang. Xuanzang uses the transliterated term "In-tu" whose "connotation overflows in the religious" according to Arvind Sharma. While Xuanzang suggested that the term refers to the country named after the moon, another Buddhist scholar I-tsing contradicted the conclusion saying that "In-tu" was not a common name for the country.


title: Hindus

text: Al-Biruni's 11th-century text "Tarikh Al-Hind", and the texts of the Delhi Sultanate period use the term 'Hindu', where it includes all non-Islamic people such as Buddhists, and retains the ambiguity of being "a region or a religion". The 'Hindu' community occurs as the amorphous 'Other' of the Muslim community in the court chronicles, according to the Indian historian Romila Thapar. The comparative religion scholar Wilfred Cantwell Smith notes that the term 'Hindu' retained its geographical reference initially: 'Indian', 'indigenous, local', virtually 'native'. Slowly, the Indian groups themselves started using the term, differentiating themselves and their "traditional ways" from those of the invaders.


title: Hindus

text: The text "Prithviraj Raso", by Chand Bardai, about the 1192 CE defeat of Prithviraj Chauhan at the hands of Muhammad Ghori, is full of references to "Hindus" and "Turks", and at one stage, says "both the religions have drawn their curved swords;" however, the date of this text is unclear and considered by most scholars to be more recent. In Islamic literature, 'Abd al-Malik Isami's Persian work, "Futuhu's-salatin", composed in the Deccan under Bahmani rule in 1350, uses the word " to mean Indian in the ethno-geographical sense and the word " to mean 'Hindu' in the sense of a follower of the Hindu religion". The poet Vidyapati's poem "Kirtilata" contrasts the cultures of Hindus and Turks (Muslims) in a city and concludes "The Hindus and the Turks live close together; Each makes fun of the other's religion ("dhamme")."


title: Hindus

text: One of the earliest uses of word 'Hindu' in a religious context, in a European language (Spanish), was the publication in 1649 by Sebastio Manrique. In the Indian historian DN Jha's essay "“Looking for a Hindu identity”", he writes: “No Indians described themselves as Hindus before the fourteenth century” and that “The British borrowed the word ‘Hindu’ from India, gave it a new meaning and significance, [and] reimported it into India as a reified phenomenon called Hinduism.” In the 18th century, the European merchants and colonists began to refer to the followers of Indian religions collectively as Hindus.


title: Hindus

text: Other prominent mentions of 'Hindu' include the epigraphical inscriptions from Andhra Pradesh kingdoms who battled military expansion of Muslim dynasties in the 14th century, where the word 'Hindu' partly implies a religious identity in contrast to 'Turks' or Islamic religious identity. The term "Hindu" was later used occasionally in some Sanskrit texts such as the later Rajataranginis of Kashmir (Hinduka, c. 1450) and some 16th- to 18th-century Bengali Gaudiya Vaishnava texts, including "Chaitanya Charitamrita" and "Chaitanya Bhagavata". These texts used it to contrast Hindus from Muslims who are called Yavanas (foreigners) or Mlecchas (barbarians), with the 16th-century "Chaitanya Charitamrita" text and the 17th-century "Bhakta Mala" text using the phrase "Hindu dharma".


title: Hindus

text: Scholar Arvind Sharma notes that the term "Hindus" was used in the 'Brahmanabad settlement' which Muhammad ibn Qasim made with non-Muslims after the Arab invasion of northwestern Sindh region of India, in 712 CE. The term 'Hindu' meant people who were non-Muslims, and it included Buddhists of the region. In the 11th-century text of Al Biruni, Hindus are referred to as "religious antagonists" to Islam, as those who believe in rebirth, presents them to hold a diversity of beliefs, and seems to oscillate between Hindus holding a centralist and pluralist religious views. In the texts of Delhi Sultanate era, states Sharma, the term Hindu remains ambiguous on whether it means people of a region or religion, giving the example of Ibn Battuta's explanation of the name "Hindu Kush" for a mountain range in Afghanistan. It was so called, wrote Ibn Battuta, because many Indian slaves died there of snow cold, as they were marched across that mountain range. The term "Hindu" there is ambivalent and could mean geographical region or religion.


title: Hindus

text: The term Hindu appears in the texts from the Mughal Empire era. It broadly refers to non-Muslims. Pashaura Singh states, "in Persian writings, Sikhs were regarded as Hindu in the sense of non-Muslim Indians". Jahangir, for example, called the Sikh Guru Arjan a Hindu:


title: Hindus

text: During the colonial era, the term Hindu had connotations of native religions of India, that is religions other than Christianity and Islam. In early colonial era Anglo-Hindu laws and British India court system, the term Hindu referred to people of all Indian religions as well as two non-Indian religions: Judaism and Zoroastrianism. In the 20th century, personal laws were formulated for Hindus, and the term 'Hindu' in these colonial 'Hindu laws' applied to Buddhists, Jains and Sikhs in addition to denominational Hindus.


title: Hindus

text: Beyond the stipulations of British colonial law, European orientalists and particularly the influential Asiatick Researches founded in the 18th century, later called The Asiatic Society, initially identified just two religions in India – Islam, and Hinduism. These orientalists included all Indian religions such as Buddhism as a subgroup of Hinduism in the 18th century. These texts called followers of Islam as "Mohamedans", and all others as "Hindus". The text, by the early 19th century, began dividing Hindus into separate groups, for chronology studies of the various beliefs. Among the earliest terms to emerge were "Seeks and their College" (later spelled Sikhs by Charles Wilkins), "Boudhism" (later spelled Buddhism), and in the 9th volume of Asiatick Researches report on religions in India, the term "Jainism" received notice.


title: Hindus

text: According to Pennington, the terms Hindu and Hinduism were thus constructed for colonial studies of India. The various sub-divisions and separation of subgroup terms were assumed to be result of "communal conflict", and Hindu was constructed by these orientalists to imply people who adhered to "ancient default oppressive religious substratum of India", states Pennington. Followers of other Indian religions so identified were later referred Buddhists, Sikhs or Jains and distinguished from Hindus, in an antagonistic two-dimensional manner, with Hindus and Hinduism stereotyped as irrational traditional and others as rational reform religions. However, these mid-19th-century reports offered no indication of doctrinal or ritual differences between Hindu and Buddhist, or other newly constructed religious identities. These colonial studies, states Pennigton, "puzzled endlessly about the Hindus and intensely scrutinized them, but did not interrogate and avoided reporting the practices and religion of Mughal and Arabs in South Asia", and often relied on Muslim scholars to characterise Hindus.


title: Hindus

text: In contemporary era, the term Hindus are individuals who identify with one or more aspects of Hinduism, whether they are practising or non-practicing or "Laissez-faire". The term does not include those who identify with other Indian religions such as Buddhism, Jainism, Sikhism or various animist tribal religions found in India such as Sarnaism. The term Hindu, in contemporary parlance, includes people who accept themselves as culturally or ethnically Hindu rather than with a fixed set of religious beliefs within Hinduism. One need not be religious in the minimal sense, states Julius Lipner, to be accepted as Hindu by Hindus, or to describe oneself as Hindu.


title: Hindus

text: Hindus subscribe to a diversity of ideas on spirituality and traditions, but have no ecclesiastical order, no unquestionable religious authorities, no governing body, nor a single founding prophet; Hindus can choose to be polytheistic, pantheistic, monotheistic, monistic, agnostic, atheistic or humanist. Because of the wide range of traditions and ideas covered by the term Hinduism, arriving at a comprehensive definition is difficult. The religion "defies our desire to define and categorize it". A Hindu may, by his or her choice, draw upon ideas of other Indian or non-Indian religious thought as a resource, follow or evolve his or her personal beliefs, and still identify as a Hindu.


title: Hindus

text: Although Hinduism contains a broad range of philosophies, Hindus share philosophical concepts, such as but not limiting to dharma, karma, kama, artha, moksha and samsara, even if each subscribes to a diversity of views. Hindus also have shared texts such as the Vedas with embedded Upanishads, and common ritual grammar (Sanskara (rite of passage)) such as rituals during a wedding or when a baby is born or cremation rituals. Some Hindus go on pilgrimage to shared sites they consider spiritually significant, practice one or more forms of bhakti or puja, celebrate mythology and epics, major festivals, love and respect for guru and family, and other cultural traditions. A Hindu could:


title: Hindus

text: In the Constitution of India, the word "Hindu" has been used in some places to denote persons professing any of these religions: Hinduism, Jainism, Buddhism or Sikhism. This however has been challenged by the Sikhs and by neo-Buddhists who were formerly Hindus. According to Sheen and Boyle, Jains have not objected to being covered by personal laws termed under 'Hindu', but Indian courts have acknowledged that Jainism is a distinct religion.


title: Hindus

text: The Republic of India is in the peculiar situation that the Supreme Court of India has repeatedly been called upon to define "Hinduism" because the Constitution of India, while it prohibits "discrimination of any citizen" on grounds of religion in article 15, article 30 foresees special rights for "All minorities, whether based on religion or language". As a consequence, religious groups have an interest in being recognised as distinct from the Hindu majority in order to qualify as a "religious minority". Thus, the Supreme Court was forced to consider the question whether Jainism is part of Hinduism in 2005 and 2006.


title: Hindus

text: Starting after the 10th century and particularly after the 12th century Islamic invasion, states Sheldon Pollock, the political response fused with the Indic religious culture and doctrines. Temples dedicated to deity Rama were built from north to south India, and textual records as well as hagiographic inscriptions began comparing the Hindu epic of Ramayana to regional kings and their response to Islamic attacks. The Yadava king of Devagiri named "Ramacandra", for example states Pollock, is described in a 13th-century record as, "How is this Rama to be described.. who freed Varanasi from the "mleccha" (barbarian, Turk Muslim) horde, and built there a golden temple of Sarngadhara". Pollock notes that the Yadava king "Ramacandra" is described as a devotee of deity Shiva (Shaivism), yet his political achievements and temple construction sponsorship in Varanasi, far from his kingdom's location in the Deccan region, is described in the historical records in Vaishnavism terms of Rama, a deity Vishnu avatar. Pollock presents many such examples and suggests an emerging Hindu political identity that was grounded in the Hindu religious text of Ramayana, one that has continued into the modern times, and suggests that this historic process began with the arrival of Islam in India.


title: Hindus

text: Brajadulal Chattopadhyaya has questioned the Pollock theory and presented textual and inscriptional evidence. According to Chattopadhyaya, the Hindu identity and religious response to Islamic invasion and wars developed in different kingdoms, such as wars between Islamic Sultanates and the Vijayanagara kingdom, and Islamic raids on the kingdoms in Tamil Nadu. These wars were described not just using the mythical story of Rama from Ramayana, states Chattopadhyaya, the medieval records used a wide range of religious symbolism and myths that are now considered as part of Hindu literature. This emergence of religious with political terminology began with the first Muslim invasion of Sindh in the 8th century CE, and intensified 13th century onwards. The 14th-century Sanskrit text, "Madhuravijayam", a memoir written by "Gangadevi", the wife of Vijayanagara prince, for example describes the consequences of war using religious terms,


title: Hindus

text: The historiographic writings in Telugu language from the 13th- and 14th-century Kakatiya dynasty period presents a similar "alien other (Turk)" and "self-identity (Hindu)" contrast. Chattopadhyaya, and other scholars, state that the military and political campaign during the medieval era wars in Deccan peninsula of India, and in the north India, were no longer a quest for sovereignty, they embodied a political and religious animosity against the "otherness of Islam", and this began the historical process of Hindu identity formation.


title: Hindus

text: Andrew Nicholson, in his review of scholarship on Hindu identity history, states that the vernacular literature of Bhakti movement sants from 15th to 17th century, such as Kabir, Anantadas, Eknath, Vidyapati, suggests that distinct religious identities, between Hindus and Turks (Muslims), had formed during these centuries. The poetry of this period contrasts Hindu and Islamic identities, states Nicholson, and the literature vilifies the Muslims coupled with a "distinct sense of a Hindu religious identity".


title: Hindus

text: Scholars state that Hindu, Buddhist and Jain identities are retrospectively-introduced modern constructions. Inscriptional evidence from the 8th century onwards, in regions such as South India, suggests that medieval era India, at both elite and folk religious practices level, likely had a "shared religious culture", and their collective identities were "multiple, layered and fuzzy". Even among Hinduism denominations such as Shaivism and Vaishnavism, the Hindu identities, states Leslie Orr, lacked "firm definitions and clear boundaries".


title: Hindus

text: Overlaps in Jain-Hindu identities have included Jains worshipping Hindu deities, intermarriages between Jains and Hindus, and medieval era Jain temples featuring Hindu religious icons and sculpture. Beyond India, on Java island of Indonesia, historical records attest to marriages between Hindus and Buddhists, medieval era temple architecture and sculptures that simultaneously incorporate Hindu and Buddhist themes, where Hinduism and Buddhism merged and functioned as "two separate paths within one overall system", according to Ann Kenney and other scholars. Similarly, there is an organic relation of Sikhs to Hindus, states Zaehner, both in religious thought and their communities, and virtually all Sikhs' ancestors were Hindus. Marriages between Sikhs and Hindus, particularly among "Khatris", were frequent. Some Hindu families brought up a son as a Sikh, and some Hindus view Sikhism as a tradition within Hinduism, even though the Sikh faith is a distinct religion.


title: Hindus

text: Julius Lipner states that the custom of distinguishing between Hindus, Buddhists, Jains, and Sikhs is a modern phenomena, but one that is a convenient abstraction. Distinguishing Indian traditions is a fairly recent practice, states Lipner, and is the result of "not only Western preconceptions about the nature of religion in general and of religion in India in particular, but also with the political awareness that has arisen in India" in its people and a result of Western influence during its colonial history.


title: Hindus

text: Scholars such as Fleming and Eck state that the post-Epic era literature from the 1st millennium CE amply demonstrate that there was a historic concept of the Indian subcontinent as a sacred geography, where the sacredness was a shared set of religious ideas. For example, the twelve "Jyotirlingas" of Shaivism and fifty-one "Shaktipithas" of Shaktism are described in the early medieval era Puranas as pilgrimage sites around a theme. This sacred geography and Shaiva temples with same iconography, shared themes, motifs and embedded legends are found across India, from the Himalayas to hills of South India, from Ellora Caves to Varanasi by about the middle of 1st millennium. Shakti temples, dated to a few centuries later, are verifiable across the subcontinent. Varanasi as a sacred pilgrimage site is documented in the "Varanasimahatmya" text embedded inside the "Skanda Purana", and the oldest versions of this text are dated to 6th to 8th-century CE.


title: Hindus

text: The idea of twelve sacred sites in Shiva Hindu tradition spread across the Indian subcontinent appears not only in the medieval era temples but also in copper plate inscriptions and temple seals discovered in different sites. According to Bhardwaj, non-Hindu texts such as the memoirs of Chinese Buddhist and Persian Muslim travellers attest to the existence and significance of the pilgrimage to sacred geography among Hindus by later 1st millennium CE.


title: Hindus

text: According to Fleming, those who question whether the term Hindu and Hinduism are a modern construction in a religious context present their arguments based on some texts that have survived into the modern era, either of Islamic courts or of literature published by Western missionaries or colonial-era Indologists aiming for a reasonable construction of history. However, the existence of non-textual evidence such as cave temples separated by thousands of kilometers, as well as lists of medieval era pilgrimage sites, is evidence of a shared sacred geography and existence of a community that was self-aware of shared religious premises and landscape. Further, it is a norm in evolving cultures that there is a gap between the "lived and historical realities" of a religious tradition and the emergence of related "textual authorities". The tradition and temples likely existed well before the medieval era Hindu manuscripts appeared that describe them and the sacred geography. This, states Fleming, is apparent given the sophistication of the architecture and the sacred sites along with the variance in the versions of the Puranic literature. According to Diana L. Eck and other Indologists such as André Wink, Muslim invaders were aware of Hindu sacred geography such as Mathura, Ujjain, and Varanasi by the 11th century. These sites became a target of their serial attacks in the centuries that followed.


title: Hindus

text: The Hindus have been persecuted during the medieval and modern era. The medieval persecution included waves of plunder, killing, destruction of temples and enslavement by Turk-Mongol Muslim armies from central Asia. This is documented in Islamic literature such as those relating to 8th century Muhammad bin-Qasim, 11th century Mahmud of Ghazni, the Persian traveler Al Biruni, the 14th century Islamic army invasion led by Timur, and various Sunni Islamic rulers of the Delhi Sultanate and Mughal Empire. There were occasional exceptions such as Akbar who stopped the persecution of Hindus, and occasional severe persecution such as under Aurangzeb, who destroyed temples, forcibly converted non-Muslims to Islam and banned the celebration of Hindu festivals such as Holi and Diwali.


title: Hindus

text: Other recorded persecution of Hindus include those under the reign of 18th century Tipu Sultan in south India, and during the colonial era. In the modern era, religious persecution of Hindus have been reported outside India in Pakistan and Bangladesh.


title: Hindus

text: Christophe Jaffrelot states that modern Hindu nationalism was born in Maharashtra, in the 1920s, as a reaction to the Islamic Khilafat Movement wherein Indian Muslims championed and took the cause of the Turkish Ottoman sultan as the Caliph of all Muslims, at the end of the World War I. Hindus viewed this development as one of divided loyalties of Indian Muslim population, of pan-Islamic hegemony, and questioned whether Indian Muslims were a part of an inclusive anti-colonial Indian nationalism. The Hindu nationalism ideology that emerged, states Jeffrelot, was codified by Savarkar while he was a political prisoner of the British colonial authorities.


title: Hindus

text: Chris Bayly traces the roots of Hindu nationalism to the Hindu identity and political independence achieved by the Maratha confederacy, that overthrew the Islamic Mughal empire in large parts of India, allowing Hindus the freedom to pursue any of their diverse religious beliefs and restored Hindu holy places such as Varanasi. A few scholars view Hindu mobilisation and consequent nationalism to have emerged in the 19th century as a response to British colonialism by Indian nationalists and neo-Hinduism gurus. Jaffrelot states that the efforts of Christian missionaries and Islamic proselytizers, during the British colonial era, each of whom tried to gain new converts to their own religion, by stereotyping and stigmatising Hindus to an identity of being inferior and superstitious, contributed to Hindus re-asserting their spiritual heritage and counter cross examining Islam and Christianity, forming organisations such as the "Hindu Sabhas" (Hindu associations), and ultimately a Hindu-identity driven nationalism in the 1920s.


title: Hindus

text: The colonial era Hindu revivalism and mobilisation, along with Hindu nationalism, states Peter van der Veer, was primarily a reaction to and competition with Muslim separatism and Muslim nationalism. The successes of each side fed the fears of the other, leading to the growth of Hindu nationalism and Muslim nationalism in the Indian subcontinent. In the 20th century, the sense of religious nationalism grew in India, states van der Veer, but only Muslim nationalism succeeded with the formation of the West and East Pakistan (later split into Pakistan and Bangladesh), as "an Islamic state" upon independence. Religious riots and social trauma followed as millions of Hindus, Jains, Buddhists and Sikhs moved out of the newly created Islamic states and resettled into the Hindu-majority post-British India. After the separation of India and Pakistan in 1947, the Hindu nationalism movement developed the concept of Hindutva in second half of the 20th century.


title: Hindus

text: The Hindu nationalism movement has sought to reform Indian laws, that critics say attempts to impose Hindu values on India's Islamic minority. Gerald Larson states, for example, that Hindu nationalists have sought a uniform civil code, where all citizens are subject to the same laws, everyone has equal civil rights, and individual rights do not depend on the individual's religion. In contrast, opponents of Hindu nationalists remark that eliminating religious law from India poses a threat to the cultural identity and religious rights of Muslims, and people of Islamic faith have a constitutional right to Islamic shariah-based personal laws. A specific law, contentious between Hindu nationalists and their opponents in India, relates to the legal age of marriage for girls. Hindu nationalists seek that the legal age for marriage be eighteen that is universally applied to all girls regardless of their religion and that marriages be registered with local government to verify the age of marriage. Muslim clerics consider this proposal as unacceptable because under the shariah-derived personal law, a Muslim girl can be married at any age after she reaches puberty.


title: Hindus

text: Hindu nationalism in India, states Katharine Adeney, is a controversial political subject, with no consensus about what it means or implies in terms of the form of government and religious rights of the minorities.


title: Hindus

text: There are 1.2-1.3 billion Hindus worldwide (15%–16% of world's population), with about 95% of them being concentrated in India alone. Along with Christians (31.5%), Muslims (23.2%) and Buddhists (7.1%), Hindus are one of the four major religious groups of the world.


title: Hindus

text: Most Hindus are found in Asian countries. The top twenty-five countries with the most Hindu residents and citizens (in decreasing order) are India, Nepal, Bangladesh, Indonesia, Pakistan, Sri Lanka, United States, Malaysia, Myanmar, United Kingdom, Mauritius, South Africa, United Arab Emirates, Canada, Australia, Saudi Arabia, Trinidad and Tobago, Singapore, Fiji, Qatar, Kuwait, Guyana, Bhutan, Oman and Yemen.


title: Hindus

text: The top fifteen countries with the highest percentage of Hindus (in decreasing order) are Nepal, India, Mauritius, Fiji, Guyana, Bhutan, Suriname, Trinidad and Tobago, Qatar, Sri Lanka, Kuwait, Bangladesh, Réunion, Malaysia, and Singapore.


title: Hindus

text: The fertility rate, that is children per woman, for Hindus is 2.4, which is less than the world average of 2.5. Pew Research projects that there will be 1.4 billion Hindus by 2050.


title: Hindus

text: In more ancient times, Hindu kingdoms arose and spread the religion and traditions across Southeast Asia, particularly Thailand, Nepal, Burma, Malaysia, Indonesia, Cambodia, Laos, Philippines, and what is now central Vietnam.


title: Hindus

text: Over 3 million Hindus are found in Bali Indonesia, a culture whose origins trace back to ideas brought by Hindu traders to Indonesian islands in the 1st millennium CE. Their sacred texts are also the Vedas and the Upanishads. The Puranas and the Itihasa (mainly "Ramayana" and the "Mahabharata") are enduring traditions among Indonesian Hindus, expressed in community dances and shadow puppet ("wayang") performances. As in India, Indonesian Hindus recognise four paths of spirituality, calling it "Catur Marga". Similarly, like Hindus in India, Balinese Hindus believe that there are four proper goals of human life, calling it "Catur Purusartha" – dharma (pursuit of moral and ethical living), artha (pursuit of wealth and creative activity), kama (pursuit of joy and love) and moksha (pursuit of self-knowledge and liberation).


title: Hindus

text: Hindu culture is a term used to describe the culture and identity of Hindus and Hinduism, including the historic Vedic people. Hindu culture can be intensively seen in the form of art, architecture, history, diet, clothing, astrology and other forms. The culture of India and Hinduism is deeply influenced and assimilated with each other. With the Indianisation of southeast Asia and Greater India, the culture has also influenced a long region and other religions people of that area. All Indian religions, including Jainism, Sikhism and Buddhism are deeply influenced and soft-powered by Hinduism.


title: Benzodiazepine withdrawal syndrome

text: Benzodiazepine withdrawal syndrome often abbreviated to benzo withdrawal or BZD withdrawal is the cluster of signs and symptoms that may emerge when a person who has been taking benzodiazepines, either medically or recreationally develops a physical dependence on them and reduces the dose or ceases their use.


title: Benzodiazepine withdrawal syndrome

text: Typically Benzodiazepine withdrawal is characterized by sleep disturbance, irritability, mast cell activation, increased tension and anxiety, panic attacks, hand tremor, shaking, sweating, difficulty with concentration, confusion and cognitive difficulty, memory problems, dry retching and nausea, weight loss, palpitations, headache, muscular pain and stiffness, a host of perceptual changes. More serious symptoms may also occur.


title: Benzodiazepine withdrawal syndrome

text: Awareness of the withdrawal reactions, individualized taper strategies according to withdrawal severity, the addition of alternative strategies such as reassurance and referral to benzodiazepine withdrawal support groups, all increase the success rate of withdrawal.


title: Benzodiazepine withdrawal syndrome

text: Withdrawal symptoms occur during dose reduction and may include insomnia, anxiety, distress, weight loss, dizziness, night sweats, shakes, muscle twitches, aphasia, panic attacks, depression, derealization, paranoia, indigestion, diarrhea and photophobia. As withdrawal progresses, patients often find their physical and mental health improves with improved mood and improved cognition.


title: Benzodiazepine withdrawal syndrome

text: The neuroadaptive processes involved in tolerance, dependence, and withdrawal mechanisms implicate both the GABAergic and the glutamatergic systems. Gamma-Aminobutyric acid (GABA) is the major inhibitory neurotransmitter of the central nervous system; roughly one-quarter to one-third of synapses use GABA. GABA mediates the influx of chloride ions through ligand-gated chloride channels called GABA receptors. When chloride enters the nerve cell, the cell membrane potential hyperpolarizes thereby inhibiting depolarization, or reduction in the firing rate of the post-synaptic nerve cell. Benzodiazepines potentiate the action of GABA, by binding a site between the α and γ subunits of the 5-subunit receptor thereby increasing the frequency of the GABA-gated chloride channel opening in the presence of GABA.


title: Benzodiazepine withdrawal syndrome

text: When potentiation is sustained by long-term use, neuroadaptations occur which result in decreased GABAergic response. What is certain is that surface GABA receptor protein levels are altered in response to benzodiazepine exposure, as is receptor turnover rate. The exact reason for the reduced responsiveness has not been elucidated but down-regulation of the number of receptors has only been observed at some receptor locations including in the pars reticulata of the substantia nigra; down-regulation of the number of receptors or internalization does not appear to be the main mechanism at other locations. Evidence exists for other hypotheses including changes in the receptor conformation, changes in turnover, recycling, or production rates, degree of phosphorylation and receptor gene expression, subunit composition, decreased coupling mechanisms between the GABA and benzodiazepine site, decrease in GABA production, and compensatory increased glutamatergic activity. A unified model hypothesis involves a combination of internalization of the receptor, followed by preferential degradation of certain receptor sub-units, which provides the nuclear activation for changes in receptor gene transcription.


title: Benzodiazepine withdrawal syndrome

text: It has been postulated that when benzodiazepines are cleared from the brain, these neuroadaptations are "unmasked", leading to unopposed excitability of the neuron. Glutamate is the most abundant excitatory neurotransmitter in the vertebrate nervous system. Increased glutamate excitatory activity during withdrawal may lead to sensitization or kindling of the CNS, possibly leading to worsening cognition and symptomatology and making each subsequent withdrawal period worse. Those who have a prior history of withdrawing from benzodiazepines are found to be less likely to succeed the next time around.


title: Benzodiazepine withdrawal syndrome

text: In severe cases, the withdrawal reaction or protracted withdrawal may exacerbate or resemble serious psychiatric and medical conditions, such as mania, schizophrenia, agitated depression, panic disorder, generalised anxiety disorder, and complex partial seizures and, especially at high doses, seizure disorders. Failure to recognize discontinuation symptoms can lead to false evidence for the need to take benzodiazepines, which in turn leads to withdrawal failure and reinstatement of benzodiazepines, often to higher doses. Pre-existing disorder or other causes typically do not improve, whereas symptoms of protracted withdrawal gradually improve over the ensuing months.


title: Benzodiazepine withdrawal syndrome

text: Symptoms may lack a psychological cause and can fluctuate in intensity with periods of good and bad days until eventual recovery.


title: Benzodiazepine withdrawal syndrome

text: According to the British National Formulary, it is better to withdraw too slowly rather than too quickly from benzodiazepines. The rate of dosage reduction is best carried out so as to minimize the symptoms' intensity and severity. Anecdotally, a slow rate of reduction may reduce the risk of developing a severe protracted syndrome.


title: Benzodiazepine withdrawal syndrome

text: Long half-life benzodiazepines like diazepam or chlordiazepoxide are preferred to minimize rebound effects and are available in low dose forms. Some people may not fully stabilize between dose reductions, even when the rate of reduction is slowed. Such people sometimes simply need to persist as they may not feel better until they have been fully withdrawn from them for a period of time.


title: Benzodiazepine withdrawal syndrome

text: Management of benzodiazepine dependence involves considering the person's age, comorbidity and the pharmacological pathways of benzodiazepines. Psychological interventions may provide a small but significant additional benefit over gradual dose reduction alone at post-cessation and at follow-up. The psychological interventions studied were relaxation training, cognitive-behavioral treatment of insomnia, and self-monitoring of consumption and symptoms, goal-setting, management of withdrawal and coping with anxiety.


title: Benzodiazepine withdrawal syndrome

text: With sufficient motivation and the proper approach, almost anyone can successfully withdraw from benzodiazepines. However, a prolonged and severe withdrawal syndrome can cause profound disability, which may lead to breakdown of relationships, loss of employment, financial difficulties, as well as more serious adverse effects such as hospitalization and suicide. As such, long-term users should not be forced to discontinue against their will.


title: Benzodiazepine withdrawal syndrome

text: Over-rapid withdrawal, lack of explanation, and failure to reassure individuals that they are experiencing temporary withdrawal symptoms led some people to experience increased panic and fears they are going mad, with some people developing a condition similar to post-traumatic stress disorder as a result. A slow withdrawal regimen, coupled with reassurance from family, friends, and peers improves the outcome. According to a 2015 Cochrane review, cognitive behavior therapy plus taper was effective in achieving discontinuation in the short-term but the effect was not certain after six months.


title: Benzodiazepine withdrawal syndrome

text: While some substitutive pharmacotherapies may have promise, current evidence is insufficient to support their use. Some studies found that the abrupt substitution of substitutive pharmacotherapy was actually less effective than gradual dose reduction alone, and only three studies found benefits of adding melatonin, paroxetine, trazodone, or valproate in conjunction with a gradual dose reduction.


title: Benzodiazepine withdrawal syndrome

text: Inpatient drug detox or rehabilitation facilities may be inappropriate for those who have become tolerant or dependent while taking the drug as prescribed, as opposed to recreational use. Such inpatient referrals may be traumatic for these individuals.


title: Benzodiazepine withdrawal syndrome

text: A 2006 meta-analysis found evidence for the efficacy of stepped care: minimal intervention (e.g. send an advisory letter, or meet a large number of patients to advise discontinuation), followed by systematic tapered discontinuation alone without augmentation if the first try was unsuccessful. Cognitive behavioral therapy improved discontinuation success rates for panic disorder, melatonin for insomnia, and flumazenil or sodium valproate for general long-term benzodiazepine use. A ten-year follow-up found that more than half of those who had successfully withdrawn from long-term use were still abstinent two years later and that if they were able to maintain this state at two years, they were likely to maintain this state at the ten-year follow-up. One study found that after one year of abstinence from long-term use of benzodiazepines, cognitive, neurological and intellectual impairments had returned to normal.


title: Benzodiazepine withdrawal syndrome

text: Those who had a prior psychiatric diagnosis had a similar success rate from a gradual taper at a two-year follow-up. Withdrawal from benzodiazepines did not lead to an increased use of antidepressants.


title: Benzodiazepine withdrawal syndrome

text: It can be too difficult to withdraw from short- or intermediate-acting benzodiazepines because of the intensity of the rebound symptoms felt between doses. Moreover, short-acting benzodiazepines appear to produce a more intense withdrawal syndrome. For this reason, discontinuation is sometimes carried out by first substituting an equivalent dose of a short-acting benzodiazepine with a longer-acting one like diazepam or chlordiazepoxide. Failure to use the correct equivalent amount can precipitate a severe withdrawal reaction. Benzodiazepines with a half-life of more than 24 hours include chlordiazepoxide, diazepam, clobazam, clonazepam, chlorazepinic acid, ketazolam, medazepam, nordazepam, and prazepam. Benzodiazepines with a half-life of less than 24 hours include alprazolam, bromazepam, brotizolam, flunitrazepam, loprazolam, lorazepam, lormetazepam, midazolam, nitrazepam, oxazepam, and temazepam. The resultant equivalent dose is then gradually reduced.


title: Benzodiazepine withdrawal syndrome

text: The consensus is to reduce dosage gradually over several weeks, e.g. 4 or more weeks for diazepam doses over 30 mg/day,


title: Benzodiazepine withdrawal syndrome

text: For example, the reduction rate used in the Heather Ashton protocol calls for eliminating 10% of the remaining dose every two to four weeks, depending on the severity and response to reductions with the final dose at 0.5 mg dose of diazepam or 2.5 mg dose of chlordiazepoxide.


title: Benzodiazepine withdrawal syndrome

text: A prolonged period of reduction for longer than six months should be avoided to prevent the withdrawal process from becoming a "morbid focus" for the person.


title: Benzodiazepine withdrawal syndrome

text: After the last dose has been taken, the acute phase of the withdrawal generally lasts for about two months although withdrawal symptoms, even from low-dose use, can persist for six to twelve months gradually improving over that period, however, clinically significant withdrawal symptoms may persist for years, although gradually declining.


title: Benzodiazepine withdrawal syndrome

text: A clinical trial of patients taking the benzodiazepine alprazolam for as short as eight weeks triggered protracted symptoms of memory deficits which were still present up to eight weeks after cessation of alprazolam.


title: Benzodiazepine withdrawal syndrome

text: Protracted withdrawal syndrome refers to symptoms persisting for months or even years. A significant minority of people withdrawing from benzodiazepines, perhaps 10% to 15%, experience a protracted withdrawal syndrome which can sometimes be severe. Symptoms may include tinnitus, psychosis, cognitive deficits, gastrointestinal complaints, insomnia, paraesthesia (tingling and numbness), pain (usually in limbs and extremities), muscle pain, weakness, tension, painful tremor, shaking attacks, jerks, dizziness and blepharospasm and may occur even without a pre-existing history of these symptoms. Tinnitus occurring during dose reduction or discontinuation of benzodiazepines is alleviated by recommencement of benzodiazepines. Dizziness is often reported as being the withdrawal symptom that lasts the longest.


title: Benzodiazepine withdrawal syndrome

text: A study testing neuropsychological factors found psychophysiological markers differing from normals, and concluded that protracted withdrawal syndrome was a genuine iatrogenic condition caused by the long-term use. The causes of persisting symptoms are a combination of pharmacological factors such as persisting drug induced receptor changes, psychological factors both caused by the drug and separate from the drug and possibly in some cases, particularly high dose users, structural brain damage or structural neuronal damage. Symptoms continue to improve over time, often to the point where people eventually resume their normal lives, even after years of incapacity.


title: Benzodiazepine withdrawal syndrome

text: A slow withdrawal rate significantly reduces the risk of a protracted or severe withdrawal state. Protracted withdrawal symptoms can be punctuated by periods of good days and bad days. When symptoms increase periodically during protracted withdrawal, physiological changes may be present, including dilated pupils as well as an increase in blood pressure and heart rate. The change in symptoms has been proposed to be due to changes in receptor sensitivity for GABA during the process of tolerance reversal. A meta-analysis found cognitive impairments in many areas due to benzodiazepine use show improvements after six months of withdrawal, but significant impairments in most areas may be permanent or may require more than six months to reverse.


title: Benzodiazepine withdrawal syndrome

text: Protracted symptoms continue to fade over a period of many months or several years. There is no known cure for protracted benzodiazepine withdrawal syndrome except time, however, the medication flumazenil was found to be more effective than placebo in reducing feelings of hostility and aggression in patients who had been free of benzodiazepines for 4–266 weeks. This may suggest a role for flumazenil in treating protracted benzodiazepine withdrawal symptoms.


title: Benzodiazepine withdrawal syndrome

text: The severity and length of the withdrawal syndrome is likely determined by various factors, including rate of tapering, length of use and dosage size, and possible genetic factors. Those who have a prior history of withdrawing from benzodiazepines may have a sensitized or kindled central nervous system leading to worsening cognition and symptomatology, and making each subsequent withdrawal period worse.


title: Benzodiazepine withdrawal syndrome

text: A neonatal withdrawal syndrome, sometimes severe, can occur when the mother had taken benzodiazepines, especially during the third trimester. Symptoms include hypotonia, apnoeic spells, cyanosis, impaired metabolic responses to cold stress, and seizures. The neonatal benzodiazepine withdrawal syndrome has been reported to persist from hours to months after birth.


title: Benzodiazepine withdrawal syndrome

text: A withdrawal syndrome is seen in about 20% of pediatric intensive care unit children after infusions with benzodiazepines or opioids. The likelihood of having the syndrome correlates with total infusion duration and dose, although duration is thought to be more important. Treatment for withdrawal usually involves weaning over a 3- to 21-day period if the infusion lasted for more than a week. Symptoms include tremors, agitation, sleeplessness, inconsolable crying, diarrhea and sweating. In total, over fifty withdrawal symptoms are listed in this review article. Environmental measures aimed at easing the symptoms of neonates with severe abstinence syndrome had little impact, but providing a quiet sleep environment helped in mild cases.


title: Benzodiazepine withdrawal syndrome

text: Discontinuing benzodiazepines or antidepressants abruptly due to concerns of teratogenic effects of the medications has a high risk of causing serious complications, so is not recommended. For example, abrupt withdrawal of benzodiazepines or antidepressants has a high risk of causing extreme withdrawal symptoms, including suicidal ideation and a severe rebound effect of the return of the underlying disorder if present. This can lead to hospitalisation and potentially, suicide. One study reported one-third of mothers who suddenly discontinued or very rapidly tapered their medications became acutely suicidal due to 'unbearable symptoms'. One woman had a medical abortion, as she felt she could no longer cope, and another woman used alcohol in a bid to combat the withdrawal symptoms from benzodiazepines. Spontaneous abortions may also result from abrupt withdrawal of psychotropic medications, including benzodiazepines. The study reported physicians generally are not aware of the severe consequences of abrupt withdrawal of psychotropic medications such as benzodiazepines or antidepressants.


title: Benzodiazepine withdrawal syndrome

text: A study of the elderly who were benzodiazepine dependent found withdrawal could be carried out with few complications and could lead to improvements in sleep and cognitive abilities. At 52 weeks after successful withdrawal, a 22% improvement in cognitive status was found, as well as improved social functioning. Those who remained on benzodiazepines experienced a 5% decline in cognitive abilities, which seemed to be faster than that seen in normal aging, suggesting the longer the intake of benzodiazepines, the worse the cognitive effects become. Some worsening of symptoms were seen in the first few months of benzodiazepine abstinence, but at a 24-week follow-up, elderly subjects were clearly improved compared to those who remained on benzodiazepines. Improvements in sleep were seen at the 24- and 52-week follow-ups. The authors concluded benzodiazepines were not effective in the long term for sleep problems except in suppressing withdrawal-related rebound insomnia. Improvements were seen between 24 and 52 weeks after withdrawal in many factors, including improved sleep and several cognitive and performance abilities. Some cognitive abilities, which are sensitive to benzodiazepines, as well as age, such as episodic memory, did not improve. The authors, however, cited a study in younger patients who at a 3.5-year follow-up showed no memory impairments and speculated that certain memory functions take longer to recover from chronic benzodiazepine use and further improvements in elderly people's cognitive function may occur beyond 52 weeks after withdrawal. The reason it took 24 weeks for improvements to be seen after cessation of benzodiazepine use was due to the time it takes the brain to adapt to the benzodiazepine-free environment.


title: Benzodiazepine withdrawal syndrome

text: At 24 weeks, significant improvements were found, including accuracy of information processing improved, but a decline was seen in those who remained on benzodiazepines. Further improvements were noted at the 52-week follow-up, indicating ongoing improvements with benzodiazepine abstinence. Younger people on benzodiazepines also experience cognitive deterioration in visual-spatial memory but are not as vulnerable as the elderly to the cognitive effects. Improved reaction times were noted at 52 weeks in elderly patients free from benzodiazepines. This is an important function in the elderly, especially if they drive a car due to the increased risk of road traffic accidents in benzodiazepine users. At the 24-week follow-up, 80% of people had successfully withdrawn from benzodiazepines. Part of the success was attributed to the placebo method used for part of the trial which broke the psychological dependence on benzodiazepines when the elderly patients realised they had completed their gradual reduction several weeks previously and had only been taking placebo tablets. This helped reassure them they could sleep without their pills.


title: Benzodiazepine withdrawal syndrome

text: The authors also warned of the similarities in pharmacology and mechanism of action of the newer nonbenzodiazepine Z drugs.


title: Benzodiazepine withdrawal syndrome

text: The elimination half-life of diazepam and chlordiazepoxide, as well as other long half-life benzodiazepines, is twice as long in the elderly compared to younger individuals. Many doctors do not adjust benzodiazepine dosage according to age in elderly patients.


title: Peripheral neuropathy

text: Peripheral neuropathy, often shortened to neuropathy, is a general term describing disease affecting the peripheral nerves, meaning nerves beyond the brain and spinal cord. Damage to peripheral nerves may impair sensation, movement, gland, or organ function depending on which nerves are affected; in other words, neuropathy affecting motor, sensory, or autonomic nerves result in different symptoms. More than one type of nerve may be affected simultaneously. Peripheral neuropathy may be acute (with sudden onset, rapid progress) or chronic (symptoms begin subtly and progress slowly), and may be reversible or permanent.


title: Peripheral neuropathy

text: Common causes include systemic diseases (such as diabetes or leprosy), hyperglycemia-induced glycation, vitamin deficiency, medication (e.g., chemotherapy, or commonly prescribed antibiotics including metronidazole and the fluoroquinolone class of antibiotics (such as ciprofloxacin, levofloxacin, moxifloxacin)), traumatic injury, ischemia, radiation therapy, excessive alcohol consumption, immune system disease, celiac disease, non-celiac gluten sensitivity, or viral infection. It can also be genetic (present from birth) or idiopathic (no known cause). In conventional medical usage, the word "neuropathy" (neuro-, "nervous system" and -pathy, "disease of") without modifier usually means "peripheral neuropathy".


title: Peripheral neuropathy

text: Neuropathy affecting just one nerve is called "mononeuropathy" and neuropathy involving nerves in roughly the same areas on both sides of the body is called "symmetrical polyneuropathy" or simply "polyneuropathy". When two or more (typically just a few, but sometimes many) separate nerves in disparate areas of the body are affected it is called "mononeuritis multiplex", "multifocal mononeuropathy", or "multiple mononeuropathy".


title: Peripheral neuropathy

text: Neuropathy may cause painful cramps, fasciculations (fine muscle twitching), muscle loss, bone degeneration, and changes in the skin, hair, and nails. Additionally, motor neuropathy may cause impaired balance and coordination or, most commonly, muscle weakness; sensory neuropathy may cause numbness to touch and vibration, reduced position sense causing poorer coordination and balance, reduced sensitivity to temperature change and pain, spontaneous tingling or burning pain, or allodynia (pain from normally nonpainful stimuli, such as light touch); and autonomic neuropathy may produce diverse symptoms, depending on the affected glands and organs, but common symptoms are poor bladder control, abnormal blood pressure or heart rate, and reduced ability to sweat normally.


title: Peripheral neuropathy

text: Peripheral neuropathy may be classified according to the number and distribution of nerves affected (mononeuropathy, mononeuritis multiplex, or polyneuropathy), the type of nerve fiber predominantly affected (motor, sensory, autonomic), or the process affecting the nerves; e.g., inflammation (neuritis), compression (compression neuropathy), chemotherapy (chemotherapy-induced peripheral neuropathy). The affected nerves are found in an EMG (electromyography) / NCS (nerve conduction study) test and the classification is applied upon completion of the exam.


title: Peripheral neuropathy

text: Mononeuropathy is a type of neuropathy that only affects a single nerve. Diagnostically, it is important to distinguish it from polyneuropathy because when a single nerve is affected, it is more likely to be due to localized trauma or infection.


title: Peripheral neuropathy

text: The most common cause of mononeuropathy is physical compression of the nerve, known as compression neuropathy. Carpal tunnel syndrome and axillary nerve palsy are examples. Direct injury to a nerve, interruption of its blood supply resulting in (ischemia), or inflammation also may cause mononeuropathy.


title: Peripheral neuropathy

text: ""Polyneuropathy"" is a pattern of nerve damage that is quite different from mononeuropathy, often more serious and affecting more areas of the body. The term "peripheral neuropathy" sometimes is used loosely to refer to polyneuropathy. In cases of polyneuropathy, many nerve cells in various parts of the body are affected, without regard to the nerve through which they pass; not all nerve cells are affected in any particular case. In distal axonopathy, one common pattern is that the cell bodies of neurons remain intact, but the axons are affected in proportion to their length; the longest axons are the most affected. Diabetic neuropathy is the most common cause of this pattern. In demyelinating polyneuropathies, the myelin sheath around axons is damaged, which affects the ability of the axons to conduct electrical impulses. The third and least common pattern affects the cell bodies of neurons directly. This usually picks out either the motor neurons (known as motor neuron disease) or the sensory neurons (known as "sensory neuronopathy" or "dorsal root ganglionopathy").


title: Peripheral neuropathy

text: The effect of this is to cause symptoms in more than one part of the body, often symmetrically on left and right sides. As for any neuropathy, the chief symptoms include motor symptoms such as weakness or clumsiness of movement; and sensory symptoms such as unusual or unpleasant sensations such as tingling or burning; reduced ability to feel sensations such as texture or temperature, and impaired balance when standing or walking. In many polyneuropathies, these symptoms occur first and most severely in the feet. Autonomic symptoms also may occur, such as dizziness on standing up, erectile dysfunction, and difficulty controlling urination.


title: Peripheral neuropathy

text: Polyneuropathies usually are caused by processes that affect the body as a whole. Diabetes and impaired glucose tolerance are the most common causes. Hyperglycemia-induced formation of advanced glycation end products (AGEs) is related to diabetic neuropathy. Other causes relate to the particular type of polyneuropathy, and there are many different causes of each type, including inflammatory diseases such as Lyme disease, vitamin deficiencies, blood disorders, and toxins (including alcohol and certain prescribed drugs).


title: Peripheral neuropathy

text: Most types of polyneuropathy progress fairly slowly, over months or years, but rapidly progressive polyneuropathy also occurs. It is important to recognize that at one time it was thought that many of the cases of small fiber peripheral neuropathy with typical symptoms of tingling, pain, and loss of sensation in the feet and hands were due to glucose intolerance before a diagnosis of diabetes or pre-diabetes. However, in August 2015, the Mayo Clinic published a scientific study in the Journal of the Neurological Sciences showing "no significant increase in...symptoms...in the prediabetes group", and stated that "A search for alternate neuropathy causes is needed in patients with prediabetes."


title: Peripheral neuropathy

text: The treatment of polyneuropathies is aimed firstly at eliminating or controlling the cause, secondly at maintaining muscle strength and physical function, and thirdly at controlling symptoms such as neuropathic pain.


title: Peripheral neuropathy

text: Mononeuritis multiplex, occasionally termed polyneuritis multiplex, is simultaneous or sequential involvement of individual noncontiguous nerve trunks, either partially or completely, evolving over days to years and typically presenting with acute or subacute loss of sensory and motor function of individual nerves. The pattern of involvement is asymmetric, however, as the disease progresses, deficit(s) becomes more confluent and symmetrical, making it difficult to differentiate from polyneuropathy. Therefore, attention to the pattern of early symptoms is important.


title: Peripheral neuropathy

text: Mononeuritis multiplex is sometimes associated with a deep, aching pain that is worse at night and frequently in the lower back, hip, or leg. In people with diabetes mellitus, mononeuritis multiplex typically is encountered as acute, unilateral, and severe thigh pain followed by anterior muscle weakness and loss of knee reflex.


title: Peripheral neuropathy

text: Autonomic neuropathy is a form of polyneuropathy that affects the non-voluntary, non-sensory nervous system (i.e., the autonomic nervous system), affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. These nerves are not under a person's conscious control and function automatically. Autonomic nerve fibers form large collections in the thorax, abdomen, and pelvis outside the spinal cord. They have connections with the spinal cord and ultimately the brain, however. Most commonly autonomic neuropathy is seen in persons with long-standing diabetes mellitus type 1 and 2. In most—but not all—cases, autonomic neuropathy occurs alongside other forms of neuropathy, such as sensory neuropathy.


title: Peripheral neuropathy

text: Autonomic neuropathy is one cause of malfunction of the autonomic nervous system, but not the only one; some conditions affecting the brain or spinal cord also may cause autonomic dysfunction, such as multiple system atrophy, and therefore, may cause similar symptoms to autonomic neuropathy.


title: Peripheral neuropathy

text: Neuritis is a general term for inflammation of a nerve or the general inflammation of the peripheral nervous system. Symptoms depend on the nerves involved, but may include pain, paresthesia (pins-and-needles), paresis (weakness), hypoesthesia (numbness), anesthesia, paralysis, wasting, and disappearance of the reflexes.


title: Peripheral neuropathy

text: Those with diseases or dysfunctions of their nerves may present with problems in any of the normal nerve functions. Symptoms vary depending on the types of nerve fiber involved. In terms of sensory function, symptoms commonly include loss of function ("negative") symptoms, including numbness, tremor, impairment of balance, and gait abnormality. Gain of function (positive) symptoms include tingling, pain, itching, crawling, and pins-and-needles. Motor symptoms include loss of function ("negative") symptoms of weakness, tiredness, muscle atrophy, and gait abnormalities; and gain of function ("positive") symptoms of cramps, and muscle twitch (fasciculations).


title: Peripheral neuropathy

text: In the most common form, length-dependent peripheral neuropathy, pain and parasthesia appears symmetrically and generally at the terminals of the longest nerves, which are in the lower legs and feet. Sensory symptoms generally develop before motor symptoms such as weakness. Length-dependent peripheral neuropathy symptoms make a slow ascent of the lower limbs, while symptoms may never appear in the upper limbs; if they do, it will be around the time that leg symptoms reach the knee. When the nerves of the autonomic nervous system are affected, symptoms may include constipation, dry mouth, difficulty urinating, and dizziness when standing.


title: Peripheral neuropathy

text: A user-friendly, disease-specific, quality-of-life scale can be used to monitor how someone is doing living with the burden of chronic, sensorimotor polyneuropathy. This scale, called the Chronic, Acquired Polyneuropathy - Patient-reported Index (CAP-PRI), contains only 15 items and is completed by the person affected by polyneuropathy. The total score and individual item scores can be followed over time, with item scoring used by the patient and care-provider to estimate clinical status of some of the more common life domains and symptoms impacted by polyneuropathy.


title: Peripheral neuropathy

text: Peripheral neuropathy may first be considered when an individual reports symptoms of numbness, tingling, and pain in feet. After ruling out a lesion in the central nervous system as a cause, diagnosis may be made on the basis of symptoms, laboratory and additional testing, clinical history, and a detailed examination.


title: Peripheral neuropathy

text: During physical examination, specifically a neurological examination, those with generalized peripheral neuropathies most commonly have distal sensory or motor and sensory loss, although those with a pathology (problem) of the nerves may be perfectly normal; may show proximal weakness, as in some inflammatory neuropathies, such as Guillain–Barré syndrome; or may show focal sensory disturbance or weakness, such as in mononeuropathies. Classically, ankle jerk reflex is absent in peripheral neuropathy.


title: Peripheral neuropathy

text: A physical examination will involve testing the deep ankle reflex as well as examining the feet for any ulceration. For large fiber neuropathy, an exam will usually show an abnormally decreased sensation to vibration, which is tested with a 128-Hz tuning fork, and decreased sensation of light touch when touched by a nylon monofilament.


title: Peripheral neuropathy

text: Diagnostic tests include electromyography (EMG) and nerve conduction studies (NCSs), which assess large myelinated nerve fibers. Testing for small-fiber peripheral neuropathies often relates to the autonomic nervous system function of small thinly- and unmyelinated fibers. These tests include a sweat test and a tilt table test. Diagnosis of small fiber involvement in peripheral neuropathy may also involve a skin biopsy in which a 3 mm-thick section of skin is removed from the calf by a punch biopsy, and is used to measure the skin intraepidermal nerve fiber density (IENFD), the density of nerves in the outer layer of the skin. Reduced density of the small nerves in the epidermis supports a diagnosis of small-fiber peripheral neuropathy.


title: Peripheral neuropathy

text: In EMG testing, demyelinating neuropathy characteristically shows a reduction in conduction velocity and prolongation of distal and F-wave latencies, whereas axonal neuropathy shows a reduction in amplitude.


title: Peripheral neuropathy

text: Laboratory tests include blood tests for vitamin B-12 levels, a complete blood count, measurement of thyroid stimulating hormone levels, a comprehensive metabolic panel screening for diabetes and pre-diabetes, and a serum immunofixation test, which tests for antibodies in the blood.


title: Peripheral neuropathy

text: The treatment of peripheral neuropathy varies based on the cause of the condition, and treating the underlying condition can aid in the management of neuropathy. When peripheral neuropathy results from diabetes mellitus or prediabetes, blood sugar management is key to treatment. In prediabetes in particular, strict blood sugar control can significantly alter the course of neuropathy. In peripheral neuropathy that stems from immune-mediated diseases, the underlying condition is treated with intravenous immunoglobulin or steroids. When peripheral neuropathy results from vitamin deficiencies or other disorders, those are treated as well.


title: Peripheral neuropathy

text: A range of medications that act on the central nervous system have been used to symptomatically treat neuropathic pain. Commonly used medications include tricyclic antidepressants (such as nortriptyline, amitriptyline. imapramine, and desipramine,) serotonin-norepinephrine reuptake inhibitor (SNRI) medications (duloxetine, venlafaxine, and milnacipran) and antiepileptic medications (gabapentin, pregabalin, oxcarbazepine zonisamide levetiracetam, lamotrigine, topiramate, clonazepam, phenytoin, lacosamide, sodium valproate and carbamazepine). Opioid and opiate medications (such as buprenorphine, morphine, methadone, fentanyl, hydromorphone, tramadol and oxycodone) are also often used to treat neuropathic pain.


title: Peripheral neuropathy

text: As is revealed in many of the Cochrane systematic reviews listed below, studies of these medications for the treatment of neuropathic pain are often methodologically flawed and the evidence is potentially subject to major bias. In general, the evidence does not support the usage of antiepileptic and antidepressant medications for the treatment of neuropathic pain. Better designed clinical trials and further review from non-biased third parties are necessary to gauge just how useful for patients these medications truly are. Reviews of these systematic reviews are also necessary to assess for their failings.


title: Peripheral neuropathy

text: It is also often the case that the aforementioned medications are prescribed for neuropathic pain conditions for which they had not been explicitly tested on or for which controlled research is severely lacking; or even for which evidence suggests that these medications are not effective. The NHS for example explicitly state that amitriptyline and gabapentin can be used for treating the pain of sciatica. This is despite both the lack of high quality evidence that demonstrates efficacy of these medications for that symptom, and also the prominence of generally moderate to high quality evidence that reveals that antiepileptics in specific, including gabapentin, demonstrate no efficacy in treating it.


title: Peripheral neuropathy

text: In general, according to Cochrane's systematic reviews, antidepressants have shown to either be ineffective for the treatment of neuropathic pain or the evidence available is inconclusive. Evidence also tends to be tainted by bias or issues with the methodology.


title: Peripheral neuropathy

text: Cochrane systematically reviewed the evidence for the antidepressants nortriptyline, desipramine, venlafaxine and milnacipran and in all these cases found scant evidence to support their use for the treatment of neuropathic pain. All reviews were done between 2014 and 2015.


title: Peripheral neuropathy

text: A 2015 Cochrane systematic review of amitriptyline found that there was no evidence supporting the use of amitriptyline that did not possess inherent bias. The authors believe amitriptyline may have an effect in some patients but that the effect is overestimated. A 2014 Cochrane systematic review of imipramine notes that the evidence suggesting benefit were "methodologically flawed and potentially subject to major bias."


title: Peripheral neuropathy

text: A 2017 Cochrane systematic review assessed the benefit of antidepressant medications for several types of chronic non-cancer pains (including neuropathic pain) in children and adolescents and the authors found the evidence inconclusive.


title: Peripheral neuropathy

text: A 2017 Cochrane systematic review found that daily dosages between (1800 - 3600) mg of gabapentin could provide good pain relief for pain associated with diabetic neuropathy only. This relief occurred for roughly (30 - 40)% of treated patients, while placebo had a (10 - 20)% response. Three of the seven authors of the review had conflicts of interest declared. In a 2019 Cochrane review of pregabalin the authors conclude that there is some evidence of efficacy in the treatment of pain deriving from post-herpetic neuralgia, diabetic neuropathy and post-traumatic neuropathic pain only. They also warned that many patients treated will have no benefit. Two of the five authors declared receiving payments from pharmaceutical companies.


title: Peripheral neuropathy

text: A 2017 Cochrane systematic review found that oxcarbazepine had little evidence to support its use for treating diabetic neuropathy, radicular pain and other neuropathies. The authors also call for better studies. In a 2015 Cochrane systematic review the authors found a lack of evidence showing any effectiveness of zonisamide for the treatment of pain deriving from any peripheral neuropathy. A 2014 Cochrane review found that studies of levetiracetam showed no indication for its effectiveness at treating pain from any neuropathy. The authors also found that the evidence was possibly biased and that some patients experienced adverse events.


title: Peripheral neuropathy

text: A 2013 Cochrane systematic review concluded that there was high quality evidence to suggest that lamotrigine is not effective for treating neuropathic pain, even at high dosages (200 - 400) mg. A 2013 Cochrane systematic review of topimirate found that the included data had a strong likelihood of major bias; despite this, it found no effectiveness for the drug in treating the pain associated with diabetic neuropathy. It had not been tested for any other type of neuropathy. Cochrane reviews from 2012 of clonazepam and phenytoin uncovered no evidence of sufficient quality to support their use in chronic neuropathic pain."


title: Peripheral neuropathy

text: A 2012 Cochrane systematic review of lacosamide found it very likely that the drug is ineffective for treating neuropathic pain. The authors caution against positive interpretations of the evidence. For sodium valproate the authors of a 2011 Cochrane review found that "three studies no more than hint that sodium valproate may reduce pain in diabetic neuropathy". They discuss how there is a probable overestimate of effect due to the inherent problems with the data and conclude that the evidence does not support its usage. In a 2014 systematic review of carbamazepine the authors believe the drug to be of benefit for some people. No trials were considered greater than level III evidence; none were longer than 4 weeks in length or were deemed as having good reporting quality.


title: Peripheral neuropathy

text: A 2017 Cochrane systematic review aiming to assess the benefit of antiepileptic medications for several types of chronic non-cancer pains (including neuropathic pain) in children and adolescents found the evidence inconclusive. Two of the ten authors of this study declared receiving payments from pharmaceutical companies.


title: Peripheral neuropathy

text: A Cochrane review of buprenorphine, fentanyl, hydromorphone and morphine, all dated between 2015 and 2017, and all for the treatment of neuropathic pain, found that there was insufficient evidence to comment on their efficacy. Conflicts of interest were declared by the authors in this review. A 2017 Cochrane review of methadone found very low quality evidence, three studies of limited quality, of its efficacy and safety. They could not formulate any conclusions about its relative efficacy and safety compared to a placebo.


title: Peripheral neuropathy

text: For tramadol, Cochrane found that there was only modest information about the benefits of its usage for neuropathic pain. Studies were small, had potential risks of bias and apparent benefits increased with risk of bias. Overall the evidence was of low or very low quality and the authors state that it "does not provide a reliable indication of the likely effect". For oxycodone the authors found very low quality evidence showing its usefulness in treating diabetic neuropathy and postherpetic neuralgia only. One of the four authors declared receiving payments from pharmaceutical companies.


title: Peripheral neuropathy

text: More generally, a 2013 review examining the overall efficacy of opioid therapy for the treatment of neuropathic pain found studies were often subject to bias and that their efficacy and safety was not deducible with the evidence available. A 2017 Cochrane review examining opioid therapy as a treatment for many non-cancer pain syndromes (including neuropathic pain) concluded, "There was no evidence from randomised controlled trials to support or refute the use of opioids to treat chronic non-cancer pain in children and adolescents."


title: Peripheral neuropathy

text: A 2016 Cochrane review of paracetamol for the treatment of neuropathic pain concluded that its benefit alone or in combination with codeine or dihydrocodeine is unknown.


title: Peripheral neuropathy

text: Few studies have examined whether nonsteroidal anti-inflammatory drugs are effective in treating peripheral neuropathy.


title: Peripheral neuropathy

text: There is some evidence that symptomatic relief from the pain of peripheral neuropathy may be obtained by application of topical capsaicin. Capsaicin is the factor that causes heat in chili peppers. However, the evidence suggesting that capsaicin applied to the skin reduces pain for peripheral neuropathy is of moderate to low quality and should be interpreted carefully before using this treatment option.


title: Peripheral neuropathy

text: Evidence supports the use of cannabinoids for some forms of neuropathic pain. A 2018 Cochrane review of cannabis-based medicines for the treatment of chronic neuropathic pain included 16 studies. All of these studies included THC as a pharmacological component of the test group. The authors rated the quality of evidence as very low to moderate. The primary outcome was quoted as, "Cannabis-based medicines may increase the number of people achieving 50% or greater pain relief compared with placebo" but "the evidence for improvement in Patient Global Impression of Change (PGIC) with cannabis to be of very low quality". The authors also conclude, "The potential benefits of cannabis-based medicine... might be outweighed by their potential harms."


title: Peripheral neuropathy

text: A 2014 Cochrane review of topical lidocaine for the treatment of various peripheral neuropathies found its usage supported by a few low quality studies. The authors state that there are no high quality randomised control trials demonstrating its efficacy or safety profile.


title: Peripheral neuropathy

text: A 2015 (updated in 2022) Cochrane review of topical clonidine for the treatment of diabetic neuropathy included two studies of 8 and 12 weeks in length; both of which compared topical clonidine to placebo and both of which were funded by the same drug manufacturer. The review found that topical clonidine may provide some benefit versus placebo. However, the authors state that the included trials are potentially subject to significant bias and that the evidence is of low to moderate quality.


title: Peripheral neuropathy

text: A 2007 Cochrane review of aldose reductase inhibitors for the treatment of the pain deriving from diabetic polyneuropathy found it no better than placebo.


title: Peripheral neuropathy

text: Transcutaneous electrical nerve stimulation (TENS) therapy is often used to treat various types of neuropathy. A 2010 review of three trials, for the treatment of diabetic neuropathy explicitly, involving a total of 78 patients found some improvement in pain scores after 4 and 6, but not 12 weeks of treatment and an overall improvement in neuropathic symptoms at 12 weeks. Another 2010 review of four trials, for the treatment of diabetic neuropathy, found significant improvement in pain and overall symptoms, with 38% of patients in one trial becoming asymptomatic. The treatment remains effective even after prolonged use, but symptoms return to baseline within a month of cessation of treatment.


title: Peripheral neuropathy

text: These older reviews can be balanced with a more recent 2017 review of TENS for neuropathic pain by Cochrane which concluded that, "This review is unable to state the effect of TENS versus sham TENS for pain relief due to the very low quality of the included evidence... The very low quality of evidence means we have very limited confidence in the effect estimate reported." A very low quality of evidence means, 'multiple sources of potential bias' with a 'small number and size of studies'.


title: Peripheral neuropathy

text: In people with diabetic peripheral neuropathy, two reviews make a case for nerve decompression surgery as an effective means of pain relief and support claims for protection from foot ulceration. There is less evidence for efficacy of surgery for non-diabetic peripheral neuropathy of the legs and feet. One uncontrolled study did before/after comparisons with a minimum of one-year follow-up and reported improvements for pain relief, impaired balance and numbness. "There was no difference in outcomes between patients with diabetic versus idiopathic neuropathy in response to nerve decompression." There are no placebo-controlled trials for idiopathic peripheral neuropathy in the published scientific literature.


title: Peripheral neuropathy

text: According to a review, strict gluten-free diet is an effective treatment when neuropathy is caused by gluten sensitivity, with or without the presence of digestive symptoms or intestinal injury.


title: Peripheral neuropathy

text: A 2015 review on the treatment of neuropathic pain with psychological therapy concluded that, "There is insufficient evidence of the efficacy and safety of psychological interventions for chronic neuropathic pain. The two available studies show no benefit of treatment over either waiting list or placebo control groups."


title: Peripheral neuropathy

text: A 2019 Cochrane review of the treatment of herbal medicinal products for people with neuropathic pain for at least three months concluded that, "There was insufficient evidence to determine whether nutmeg or St John's wort has any meaningful efficacy in neuropathic pain conditions.The quality of the current evidence raises serious uncertainties about the estimates of effect observed, therefore, we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect."


title: Peripheral neuropathy

text: A 2017 Cochrane review on the usage of acupuncture as a treatment for neuropathic pain concludes, "Due to the limited data available, there is insufficient evidence to support or refute the use of acupuncture for neuropathic pain in general, or for any specific neuropathic pain condition when compared with sham acupuncture or other active therapies." Also, "Most studies included a small sample size (fewer than 50 participants per treatment arm) and all studies were at high risk of bias for blinding of participants and personnel." Also, the authors state, "we did not identify any study comparing acupuncture with treatment as usual."


title: Peripheral neuropathy

text: Alpha lipoic acid (ALA) with benfotiamine is a proposed pathogenic treatment for painful diabetic neuropathy only. The results of two systematic reviews state that oral ALA produced no clinically significant benefit, intravenous ALA administered over the course of three weeks may improve symptoms and that long-term treatment has not been investigated.


title: Peripheral neuropathy

text: A 2008 literature review concluded that, "based on principles of evidence-based medicine and evaluations of methodology, there is only a 'possible' association of celiac disease and peripheral neuropathy due to lower levels of evidence and conflicting evidence. There is not yet convincing evidence of causality."


title: Peripheral neuropathy

text: A 2019 review concluded that "gluten neuropathy is a slowly progressive condition. About 25% of the patients will have evidence of enteropathy on biopsy (CD [celiac disease]) but the presence or absence of an enteropathy does not influence the positive effect of a strict gluten-free diet."


title: Peripheral neuropathy

text: Stem-cell therapy is also being looked at as a possible means to repair peripheral nerve damage, however efficacy has not yet been demonstrated.


title: Stripchat

text: Stripchat is an international adult website and social network featuring free live-streamed webcam performances, often including nudity and sexual activity, through traditional, virtual reality and mobile broadcasts.


title: Stripchat

text: The site averages over 400 million visitors a month, according to SimilarWeb. The site first launched in 2016, and has since won numerous awards including "Cam Site of the Year" and "Cam Company of the Year" at the XBIZ Europa Awards.


title: Stripchat

text: The company has attracted mainstream attention with controversial campaigns and offers, such as offering $15M to rename the New Orleans Superdome and providing jobs to crew members who walked off the set of "" following a rant by Tom Cruise.


title: Stripchat

text: Stripchat and other cam sites saw significant growth in 2020 due to the COVID-19 pandemic. During the lockdowns in March 2020, visits to the site surged 25% in countries like the United States and United Kingdom. Even after restrictions were lifted in most countries, traffic continued to rise, hitting a peak of nearly 120 million in August, up from about 60 million in January, a reverse of traditional traffic patterns. By November 2020 monthly visits to the site were more than double what they had been a year earlier. In the same period, the number of models appearing on the site increased by 300,000. In an interview with BBC News, a representative said that many traditional adult performers had moved to camming due to the lack of production on traditional porn sets, as had other types of sex workers and amateurs. Stripchat attempted to off-set increased competition from new performers coming onto the site by providing free tokens for new users.


title: Stripchat

text: Many of the new users to the site are the result of changing work patterns. According to data released by the company in June 2020, 75% of visitors to the site came between the hours of 10AM and 6PM.


title: Stripchat

text: In June 2020, following the extended shutdown of many businesses due to the COVID pandemic, Stripchat offered small businesses free advertising on the platform. The company asked small businesses to send in branded clothing for it to send to its most popular models. Multiple businesses applied and were accepted, including an art supply company, an erectile dysfunction device, a photography studio and a make-up artist. Models wore the clothing during their regular shows.


title: Stripchat

text: In addition to its adult content, Stripchat manages the Sexuality Resource Center, featuring videos of therapists answering questions about sex and relationship issues. The site began hosting live stream sessions with licensed therapists from the Sexual Health Alliance in July 2019 after a study of users showed that many felt anxiety about their cam viewing.


title: Stripchat

text: Stripchat has repeatedly sought business relationships with pro-athletes and sports organizations. In 2020, Stripchat offered the New Orleans Saints $15M in hopes of gaining naming rights for the Superdome. In March 2021, the company made a £20 million bid to replace Italian tire company Pirelli as the lead sponsor of the Inter Milan football organization, after Pirelli failed to renew a nearly three-decade-old deal.


title: Stripchat

text: In May 2021, UFC fighter Nick Diaz announced that he had partnered with the company to conduct self-defense webinars.


title: Sixteen Candles

text: Sixteen Candles is a 1984 American coming-of-age comedy film starring Molly Ringwald, Michael Schoeffling, and Anthony Michael Hall. Written and directed by John Hughes in his directorial debut, it was the first in a string of films Hughes would direct centering on teenage life. The film was a box office success, earning $23.6 million against a $6.5 million budget, and launched Ringwald to fame.


title: Sixteen Candles

text: In suburban Chicago, high school sophomore Samantha "Sam" Baker is hopeful her 16th birthday is the beginning of a great new year, but is shocked when her family forgets the occasion because her older, beautiful, self-absorbed sister Ginny is getting married the next day.


title: Sixteen Candles

text: At school, Sam fills out a friend's sex quiz where she reveals her crush on senior Jake Ryan. Meanwhile, Jake, having noticed Sam's looks at him, asks his friend Rock about her. Rock dismisses her as an immature child, but Jake says he is frustrated by his girlfriend Caroline's partying ways. On the bus ride home, Sam fends off repeated flirtations from geeky freshman Ted.


title: Sixteen Candles

text: At home, Sam's day gets worse when she discovers she must sleep on the sofa because her grandparents and a foreign exchange student named Long Duk Dong are all staying at the house for the wedding. She is further upset when her grandparents also do not remember her birthday and have Dong go with her to a dance at school that night.


title: Sixteen Candles

text: At the dance, Sam pines for Jake while Dong has attracted the powerful and strong jock, Marlene. Ted, in an effort to impress his friends Bryce and Wease, dances with Sam, who runs off in tears. In an effort to salvage his reputation with all the geeks, Ted bets Bryce and Wease a dozen floppy disks that he will get physical with Sam before the dance ends. As proof, Bryce and Wease demand Sam's underwear. Jake asks Ted about Sam, having seen them dancing.


title: Sixteen Candles

text: Ted apologizes to Sam, who opens up about her family forgetting her birthday and her crush on Jake. Ted tells her that Jake asked about her and Sam is shocked and asks what Ted thinks she should do. Despite his genuine interest in Sam, Ted encourages her to talk to Jake, and she agrees. Before she leaves, he gets her underwear to win his bet and he, Bryce, and Wease charge the other freshmen boys a dollar to see it. Meanwhile, Sam tries to approach Jake, but loses her nerve and runs off. Jake and Caroline leave the dance, leaving Sam thinking Jake does not like her.


title: Sixteen Candles

text: At Jake's house, Caroline and her friends have started a wild party. Jake, angry with Caroline, retreats to his bedroom and tries calling Sam, but instead is yelled at by her grandparents for waking them up, and tell him that Sam isn't interested. After the party, Jake is furious at the damage left behind. He finds Ted trapped under a glass coffee table after having knocked over the beer can pyramid the night before. Ted tells him Sam is interested in him and Jake confesses that he has lost interest in Caroline. He takes Sam's underwear from Ted and, in exchange, lets Ted take a drunken Caroline home in his father's Rolls Royce. To further impress the geeks, Ted stops at Bryce and Wease's house to get Wease to take a picture of him with Caroline in the expensive car, but the finished picture only reveals the top of Ted's head.


title: Sixteen Candles

text: Sam's father apologizes for forgetting her birthday, and tells her that if Jake does not see what a wonderful person she is, then he is not worth Sam's time. She lies on the couch thinking of Jake, not knowing that he is also thinking of her.


title: Sixteen Candles

text: The next morning, Sam's mother apologizes to her for forgetting her birthday, and everyone heads to the church for the wedding. Jake arrives at Sam's house, where a hungover Dong miscommunicates that Sam is at church getting married. Jake finds Caroline and Ted making out in the back of his dad's banged-up car, and they break up. Jake then surprises Sam at the church after the wedding and invites her back to his house.


title: Sixteen Candles

text: That night, Jake gives Sam her underwear, and a birthday cake with 16 candles on it. He tells her to make a wish and she tells him her wish already came true. They kiss as the film fades to black.


title: Sixteen Candles

text: John Hughes had asked his agent for headshots of young actresses, and among those he received were those of Robin Wright, Molly Ringwald and Ally Sheedy. Sheedy had auditioned for the role of Sam, but was dropped because Hughes thought Ringwald was more fitting for the role. He called her a year later to give her a role in "The Breakfast Club". Inspired by Ringwald's appearance, he put it up over his desk and wrote the film just over a weekend with her in mind for the lead role.