"Why I am no longer a skeptic"

Just so you know, I do my best to be factual and representative in my posts, so if you think something is wrong or misleading, it is likely that you just need to ask me for clarification.

Tim and I have been over this many times before, so discussion with him will not resolve his issues. 

Denture man - The emergency staff had initiated the reanimation process in the field (which includes CPR). The staff took over the reanimation process when the patient was brought to the room and the dentures were removed at that time.
http://netwerknde.nl/wp-content/uploads/...ureman.pdf

I was not pointing to the studies with respect to their hypotheses and conclusions. I referred to them because they included the data that we need - what levels of awareness may be present during CPR. I referred specifically to the figures in the papers showing 1) BIS scores in people who demonstrated some level of (anesthesia) awareness and 2) BIS scores obtained during CPR, to show that BIS scores obtained during CPR met or exceeded the scores associated with awareness.

Of course, we do not know what the situation was with the Denture man, and my point was only that this case would not satisfy what you had asked me about - evidence (in the scientific sense we had discussed) from an NDE/OBE - because do not have enough information to confirm that sense data would be impossible. I get that many proponents feel (quite vehemently) that we do have enough. But the question was about my perspective, which includes different knowledge and experience.

Pam Reynolds - I haven't seen any mention of a suppression ration from the surgeons' recollections or mention of EEG strips from the operation that were made available to provide this ratio. Pam Reynolds did not need to be conscious/awake (and I have stated many times that I agree that she would not be conscious under burst suppression) in order to register some words and include them in her NDE. Research into memory under anesthesia demonstrates that memories can be present without the subject becoming awake. In fact, this is fairly common (I can provide you with some references if you are interested in this).

No mention has been made of a record, recorded as Maria spoke to Kimberley Clark and prior to any investigation by Ms. Clark (and therefore blinded). Nor is there any mention of photographs which document the shoe or its location and visibility. This is the kind of information which might satisfy what you had asked me about (examples of scientific evidence pointing to impossible sense data), although we still have the problem that Maria had been in the hospital for several days prior to her NDE and we don't know what she may have been told or overhead (i.e. we don't have access to all the sense data available to her).

Part of why I said that the sighting of hidden targets would supply decent evidence was because of the situation above. Proponents will argue that sense data has been rendered impossible under conditions where we have inadequate information to determine this one way or the other. So all we end up with is one side accusing the other of credulity or unreasoning close-mindedness. The hiding of the targets can get us past that aspect. The problem which I think we all agree on, though, is that targets haven't been sighted and it doesn't seem likely they ever will - we're not sure that psi will work like that. 

Linda

For starters, I have NO intention of debating this with you as I have been down that road. I just want to clear up something that bothers me.

And I am not suggesting you are being intellectually dishonest, although I know others are.

You talk about the denture man's LOC (level of awareness for not med trained), and you specifically refer to BIS score. 

Is it your experience that this is typically a part a resuscitation process, treatment, and reporting?  

Which brings up the obvious question: what is your level of experience in emergency medicine?

I have been involved in perhaps 100 cardio/pulmonary resuscitations in the field and in ER settings over 20 years as an EMT. I am guessing that this is more than even most physicians: that is other than ones practicing cardiac or emergency medicine. 

I have never once seen the attending medical staff refer to the patient's BIS during this type of emergency procedure. I have also never been in a situation such as this when the patient wasn't obviously completely unconscious. But back to BIS. The medical team have never even mentioned it. Nor have we spoken of it during the standard debrief we often had with the staff. Nor have I ever seen it noted in a medical report describing the incident. Now maybe this is indicative of the backwards state of medicine being practiced in metro Boston in the 1980's-2000 but I'm thinking not.

Do I have this right? Are you suggesting that because this factor wasn't mentioned in the literature, you are suggesting that the reporting is lacking? Just want to make sure I understand your implication. 

Again I ask- how many of these situations have you personally participated in?

You talk about the denture man's LOC (level of awareness for not med trained), and you specifically refer to BIS score. 

Is it your experience that this is typically a part a resuscitation process, treatment, and reporting?

(Note for anyone unfamiliar with "LOC", C stands for "consciousness". Also not to be confused with LOC=loss of consciousness.)

No. I am only familiar with the use of BIS in resuscitation in the setting of clinical studies. There have been studies looking at whether it would be useful if broadly used in resuscitation (to monitor effectiveness of CPR), so that is why there is data available about its use.

Since the purpose of CPR is to maintain perfusion/oxygenation to vital organs, until circulation is restored, it's not any sort of stretch to suggest that there may cerebral perfusion and activity as a result of CPR, which is what the BIS studies are looking for.

Parnia used a different measure of cerebral perfusion in the AWARE study (cerebral oximetry), which also has been looked at as a way to monitor CPR effectiveness. 

Which brings up the obvious question: what is your level of experience in emergency medicine?

I have been involved in perhaps 100 cardio/pulmonary resuscitations in the field and in ER settings over 20 years as an EMT. I am guessing that this is more than even most physicians: that is other than ones practicing cardiac or emergency medicine.

I probably have a similar amount of experience in training and in practice (I spent the bulk of my practice in a university teaching hospital). 

I have never once seen the attending medical staff refer to the patient's BIS during this type of emergency procedure. I have also never been in a situation such as this when the patient wasn't obviously completely unconscious. But back to BIS. The medical team have never even mentioned it. Nor have we spoken of it during the standard debrief we often had with the staff. Nor have I ever seen it noted in a medical report describing the incident. Now maybe this is indicative of the backwards state of medicine being practiced in metro Boston in the 1980's-2000 but I'm thinking not.

Do I have this right? Are you suggesting that because this factor wasn't mentioned in the literature, you are suggesting that the reporting is lacking?

Not in the least. I'm saying that because BIS (and other) studies show us that CPR can be effective at maintaining perfusion to vital organs, including the brain, that it isn't a stretch to suggest that CPR may have been effective in the denture man case. At the least, it shouldn't be a slam dunk to assume that CPR wasn't effective, in the absence of data one way or the other. 

Linda

Just so you know, I do my best to be factual and representative in my posts, so if you think something is wrong or misleading, it is likely that you just need to ask me for clarification.

Tim and I have been over this many times before, so discussion with him will not resolve his issues. 

Denture man - The emergency staff had initiated the reanimation process in the field (which includes CPR). The staff took over the reanimation process when the patient was brought to the room and the dentures were removed at that time.
http://netwerknde.nl/wp-content/uploads/...ureman.pdf

I was not pointing to the studies with respect to their hypotheses and conclusions. I referred to them because they included the data that we need - what levels of awareness may be present during CPR. I referred specifically to the figures in the papers showing 1) BIS scores in people who demonstrated some level of (anesthesia) awareness and 2) BIS scores obtained during CPR, to show that BIS scores obtained during CPR met or exceeded the scores associated with awareness.

Of course, we do not know what the situation was with the Denture man, and my point was only that this case would not satisfy what you had asked me about - evidence (in the scientific sense we had discussed) from an NDE/OBE - because do not have enough information to confirm that sense data would be impossible. I get that many proponents feel (quite vehemently) that we do have enough. But the question was about my perspective, which includes different knowledge and experience.

Pam Reynolds - I haven't seen any mention of a suppression ration from the surgeons' recollections or mention of EEG strips from the operation that were made available to provide this ratio. Pam Reynolds did not need to be conscious/awake (and I have stated many times that I agree that she would not be conscious under burst suppression) in order to register some words and include them in her NDE. Research into memory under anesthesia demonstrates that memories can be present without the subject becoming awake. In fact, this is fairly common (I can provide you with some references if you are interested in this).

No mention has been made of a record, recorded as Maria spoke to Kimberley Clark and prior to any investigation by Ms. Clark (and therefore blinded). Nor is there any mention of photographs which document the shoe or its location and visibility. This is the kind of information which might satisfy what you had asked me about (examples of scientific evidence pointing to impossible sense data), although we still have the problem that Maria had been in the hospital for several days prior to her NDE and we don't know what she may have been told or overhead (i.e. we don't have access to all the sense data available to her).

Part of why I said that the sighting of hidden targets would supply decent evidence was because of the situation above. Proponents will argue that sense data has been rendered impossible under conditions where we have inadequate information to determine this one way or the other. So all we end up with is one side accusing the other of credulity or unreasoning close-mindedness. The hiding of the targets can get us past that aspect. The problem which I think we all agree on, though, is that targets haven't been sighted and it doesn't seem likely they ever will - we're not sure that psi will work like that. 

Linda

Linda said >"Tim and I have been over this many times before, so discussion with him will not resolve his issues. "

and > "Not in the least. I'm saying that because BIS (and other) studies show us that CPR can be effective at maintaining perfusion to vital organs, including the brain, that it isn't a stretch to suggest that CPR may have been effective in the denture man case. At the least, it shouldn't be a slam dunk to assume that CPR wasn't effective, in the absence of data one way or the other." 
...........................................................................................................................................................................

Disgraceful behaviour !! There is no issue other than your shenanigans , Linda.

From Smit's corroboration paper :

The patient, B., from Ooy near the city of Nijmegen, had indeed been
brought in on a cold night, more dead than alive, and had undergone
the whole procedure as reported in A.A.’s interview with T.G., who
was adamant in stating that B. had not shown any sign whatsoever of
being conscious at the time.

He was clinically dead, period: no heartbeat, no breathing, no blood pressure, and ‘‘cold as ice.’’ The
ambulance personnel had tried to carry out some reanimation while
driving to the hospital but without result.

More importantly, after B. entered the hospital, T.G. removed the dentures from
B.’s mouth and intubated him before starting up the entire
reanimation procedure. Therefore, as TG categorically stated, any
‘‘normal’’ observation by the patient of his dentures being removed from
his mouth was simply unthinkable !

In addition, the normal observation process could not have been the
basis of the patient’s detailed description of the crash cart as well as of
the entire resuscitation room. Once again, T.G. was adamant in that
regard, noting that patient B. had never before been in that hospital, let
alone in this resuscitation room, and that this particular crash cart was
absolutely unique, being a hand-made product of ramshackle quality
that had been stationed in that resuscitation room only and nowhere
else.

To guess the precise nature of that cart and its contents on the
basis of auditory impressions, or through briefly opened eyes characterized
by fixed, dilated, unresponsive pupils, was impossible by all
accounts. T.G. asserted that certainly it would have been impossible for
B. to know precisely where T.G. had placed the dentures.

You are simply repeating the same falsehoods that you were so fond of on Skeptiko.

(Note for anyone unfamiliar with "LOC", C stands for "consciousness". Also not to be confused with LOC=loss of consciousness.)

No. I am only familiar with the use of BIS in resuscitation in the setting of clinical studies. There have been studies looking at whether it would be useful if broadly used in resuscitation (to monitor effectiveness of CPR), so that is why there is data available about its use.

Since the purpose of CPR is to maintain perfusion/oxygenation to vital organs, until circulation is restored, it's not any sort of stretch to suggest that there may cerebral perfusion and activity as a result of CPR, which is what the BIS studies are looking for.

Parnia used a different measure of cerebral perfusion in the AWARE study (cerebral oximetry), which also has been looked at as a way to monitor CPR effectiveness. 


I probably have a similar amount of experience in training and in practice (I spent the bulk of my practice in a university teaching hospital). 


Not in the least. I'm saying that because BIS (and other) studies show us that CPR can be effective at maintaining perfusion to vital organs, including the brain, that it isn't a stretch to suggest that CPR may have been effective in the denture man case. At the least, it shouldn't be a slam dunk to assume that CPR wasn't effective, in the absence of data one way or the other. 

Linda

So you are not providing evidence of someone being lucid during CPR but saying it's possible...

You seem to be agreeing that this type of assessment is not used during emergency procedures such as CPR, but that doesn't seem to keep you from imagining that patients might have some awareness during these periods, based on what evidence I can only guess. 

Sorry to be harsh but I think you are full of it, and are making up a hypothetical so you have something to use as a point of argument.

That said: I have absolutely no interest in having a battle over this because I know it will be fruitless, and I have no interest in such a waste of my time beyond what I have already wasted.

But for those treading thread, please do yourself a favor and look at the two first sentences of this post and draw your own conclusions. You are spouting baseless jabberwocky.

So you are not providing evidence of someone being lucid during CPR but saying it's possible...  

I'm sorry, but where on earth is this coming from? Where did anybody say that any of these people were lucid?

You seem to be agreeing that this type of assessment is not used during emergency procedures such as CPR, but that doesn't seem to keep you from imagining that patients might have some awareness during these periods, based on what evidence I can only guess. 

I'm confused. Are you thinking that "awareness" = "lucidity"? If so, I apologize. That isn't at all what I was saying. 

Sorry to be harsh but I think you are full of it, and are making up a hypothetical so you have something to use as a point of argument.

I'm not trying to make up anything. I'm looking at what the research shows in order to see what we can and cannot rule out with respect to "impossible sense data". We don't have specific information about what sense data was available to any of these patients, so calling it "impossible" depends upon us looking at what we can rule out.

That said: I have absolutely no interest in having a battle over this because I know it will be fruitless, and I have no interest in such a waste of my time beyond what I have already wasted.

But for those treading thread, please do yourself a favor and look at the two first sentences of this post and draw your own conclusions. You are spouting baseless jabberwocky.

I think you must have misunderstood something. The studies I referenced showed the results of BIS in resuscitation. Why is it baseless jabberwocky to talk about those results, just because BIS wasn't commonly used in resuscitation in the institutions I worked in?

This is a waste of time - none of these cases have the power to change anyone's mind, and discussion inevitably devolves to hostility and insults as a result. And this is why I mentioned hidden targets. At least nobody would have to resort to name-calling to get scientists to take the results seriously. 

Linda

I'm sorry, but where on earth is this coming from? Where did anybody say that any of these people were lucid?


I'm confused. Are you thinking that "awareness" = "lucidity"? If so, I apologize. That isn't at all what I was saying. 


I'm not trying to make up anything. I'm looking at what the research shows in order to see what we can and cannot rule out with respect to "impossible sense data". We don't have specific information about what sense data was available to any of these patients, so calling it "impossible" depends upon us looking at what we can rule out.


I think you must have misunderstood something. The studies I referenced showed the results of BIS in resuscitation. Why is it baseless jabberwocky to talk about those results, just because BIS wasn't commonly used in resuscitation in the institutions I worked in?

This is a waste of time - none of these cases have the power to change anyone's mind, and discussion inevitably devolves to hostility and insults as a result. And this is why I mentioned hidden targets. At least nobody would have to resort to name-calling to get scientists to take the results seriously. 

Linda

Nope. Not sparring.

With reference to Linda's bogus claims about NDE/OBE by CPR :

In the vast majority of terminal cases, physicians medically define death based on when the heart no longer beats, said Dr. Sam Parnia, director of critical care and resuscitation research at NYU Langone School of Medicine in New York City.

"Technically speaking, that's how you get the time of death — it's all based on the moment when the heart stops,"
Once that happens, blood no longer circulates to the brain, which means brain function halts "almost instantaneously," Parnia said. "You lose all your brain stem reflexes — your gag reflex, your pupil reflex, all that is gone."

A trajectory of cell death :

The brain's cerebral cortex — the so-called "thinking part" of the brain — also slows down instantly, and flatlines, meaning that no brainwaves are visible on an electric monitor, within 2 to 20 seconds. This initiates a chain reaction of cellular processes that eventually result in the death of brain cells, but that can take hours after the heart has stopped, Parnia said.

Performing cardiopulmonary resuscitation (CPR) does send some blood to the brain — about 15 percent of what it requires to function normally, according to Parnia. This is enough to slow the brain cells' death trajectory, but it isn't enough to kick-start the brain into working again, which is why reflexes don't resume during CPR, he said.

With reference to Linda's bogus claims about NDE/OBE by CPR :

In the vast majority of terminal cases, physicians medically define death based on when the heart no longer beats, said Dr. Sam Parnia, director of critical care and resuscitation research at NYU Langone School of Medicine in New York City.

"Technically speaking, that's how you get the time of death — it's all based on the moment when the heart stops,"
Once that happens, blood no longer circulates to the brain, which means brain function halts "almost instantaneously," Parnia said. "You lose all your brain stem reflexes — your gag reflex, your pupil reflex, all that is gone."

A trajectory of cell death :

The brain's cerebral cortex — the so-called "thinking part" of the brain — also slows down instantly, and flatlines, meaning that no brainwaves are visible on an electric monitor, within 2 to 20 seconds. This initiates a chain reaction of cellular processes that eventually result in the death of brain cells, but that can take hours after the heart has stopped, Parnia said.

Performing cardiopulmonary resuscitation (CPR) does send some blood to the brain — about 15 percent of what it requires to function normally, according to Parnia. This is enough to slow the brain cells' death trajectory, but it isn't enough to kick-start the brain into working again, which is why reflexes don't resume during CPR, he said.

That's interesting, Tim. Can you post the source of those quotes? Does Parnia say "reflexes don't resume during CPR?" or is that your quote?

Not being argumentative, but I did a quick google search and studies do indicate that pupillary reaction can occur in both cardiac arrest and during CPR.

https://www.ncbi.nlm.nih.gov/pubmed/11373477

Abstract

OBJECTIVE: 
Traditionally, both pupil diameter and reaction to light have been examined to confirm the diagnosis of death. In the present study, we investigated quantitative changes in pupil diameter and light reaction for assessing the efficacy of cardiopulmonary resuscitation (CPR) and as a predictor of outcome.
DESIGN: 
Controlled experimental study.
SETTING: 
Animal research laboratory at a university-affiliated research institute.
SUBJECTS: 
Fifteen domestic male pigs weighing between 33 and 40 kg.
INTERVENTIONS: 
Ventricular fibrillation was induced with an alternating current delivered to the right ventricular endocardium. After 7 mins of untreated ventricular fibrillation, chest compression and mechanical ventilation were initiated and maintained for 6 mins. Restoration of spontaneous circulation then was attempted by electrical defibrillation.
MEASUREMENTS AND MAIN RESULTS: 
Spontaneous circulation was reestablished in 9 of 15 animals. Pupils were fully dilated, and pupillary reaction to light was absent in 7 of the 9 resuscitated animals during untreated cardiac arrest. Progressive decreases in pupil diameter were observed together with restoration of light reaction during CPR, in each animal that was successfully resuscitated. When the pupils remained dilated and unreactive after 6 mins of CPR, resuscitation efforts were uniformly unsuccessful. A highly significant linear correlation between coronary perfusion pressure generated during precordial compression and pupil diameter was documented. Both were predictive of outcome.
CONCLUSIONS: 
Dynamic changes of pupil diameter and reactions to light during cardiac arrest and resuscitation were correlated with coronary perfusion pressure, and both predicted the likelihood that spontaneous circulation and cerebral function would be restored.

Another study that indicates pupilary reflex during CPR, this time in humans.

http://www.sciencedirect.com/science/art...7212002638

Abstract
Background
The presence or absence of the pupillary light reflex following cardiopulmonary resuscitation has been shown to have prognostic value. We asked whether the light reflex could be objectively measured during cardiopulmonary resuscitation in humans and whether the quality of the reflex was associated with outcome.
Methods
Sixty-seven in-hospital code blue alerts were attended of which 30 met our inclusion criteria. Portable infrared pupillometry was used to measure the light reflex during each code. The reliability of the presence of the light reflex during each code as a predictor of survival and neurological outcome was analyzed statistically using the Barnard's Exact test.
Results
In 25 patients (83%) the pupillary light reflex was detectable throughout or during a part of the resuscitation. Continuous presence of the light reflex or absence for less than 5 min during resuscitation was associated with early survival of the code and a good neurological outcome. In contrast, no patients without a light reflex or with a gradually deteriorating light reflex survived the code and absence of a pupillary light reflex for more than 5 min was associated with an unfavorable outcome.
Conclusion
Portable infrared pupillary measurements can reliably demonstrate the presence and quality of the pupillary light reflex after cardiac arrest and during resuscitation. In our limited case series, the presence of the pupillary light reflexes obtained in serial measurements during resuscitation was associated with early survival and a favorable neurological status in the recovery period.

Keywords
Cardiopulmonary resuscitation
Pupillary light reflex
Outcome
Pupillometry

That's interesting, Tim. Can you post the source of those quotes? Does Parnia say "reflexes don't resume during CPR?" or is that your quote?

Not being argumentative, but I did a quick google search and studies do indicate that pupillary reaction can occur in both cardiac arrest and during CPR.

https://www.ncbi.nlm.nih.gov/pubmed/11373477

Abstract

OBJECTIVE: 
Traditionally, both pupil diameter and reaction to light have been examined to confirm the diagnosis of death. In the present study, we investigated quantitative changes in pupil diameter and light reaction for assessing the efficacy of cardiopulmonary resuscitation (CPR) and as a predictor of outcome.
DESIGN: 
Controlled experimental study.
SETTING: 
Animal research laboratory at a university-affiliated research institute.
SUBJECTS: 
Fifteen domestic male pigs weighing between 33 and 40 kg.
INTERVENTIONS: 
Ventricular fibrillation was induced with an alternating current delivered to the right ventricular endocardium. After 7 mins of untreated ventricular fibrillation, chest compression and mechanical ventilation were initiated and maintained for 6 mins. Restoration of spontaneous circulation then was attempted by electrical defibrillation.
MEASUREMENTS AND MAIN RESULTS: 
Spontaneous circulation was reestablished in 9 of 15 animals. Pupils were fully dilated, and pupillary reaction to light was absent in 7 of the 9 resuscitated animals during untreated cardiac arrest. Progressive decreases in pupil diameter were observed together with restoration of light reaction during CPR, in each animal that was successfully resuscitated. When the pupils remained dilated and unreactive after 6 mins of CPR, resuscitation efforts were uniformly unsuccessful. A highly significant linear correlation between coronary perfusion pressure generated during precordial compression and pupil diameter was documented. Both were predictive of outcome.
CONCLUSIONS: 
Dynamic changes of pupil diameter and reactions to light during cardiac arrest and resuscitation were correlated with coronary perfusion pressure, and both predicted the likelihood that spontaneous circulation and cerebral function would be restored.

Chuck said > "That's interesting, Tim. Can you post the source of those quotes? Does Parnia say "reflexes don't resume during CPR?" or is that your quote?"

I thought you'd placed me on ignore, Chuck...you did say so in the Carne Ross thread....if you remember  

The quote is from Live science but it's a fairly standard piece from Parnia. His is a recognised expert on resuscitation
so unfortunately for some members on here, his statements have to be given their due (over Linda) sorry about that (Arouet, Malf, Steve, Paul...)

This is a clip from one of his many papers.

Immediately following the cardiac arrest, the
mean arterial pressure (MAP) becomes immeasurable,
however, properly performed chest compressions
may raise the systolic values to 60–80 mmHg,
but the diastolic values and hence the mean arterial
pressure still remains inadequate

Concurrent EEG monitoring during a cardiac arrest has shown an
initial slowing of the EEG waves which then progress
to an isoelectric line within approximately 10–20 s
and remain flat during the cardiac arrest until the
resumption of cardiac out put (27, 30) In cases of
prolonged cardiac arrest, however EEG activity
may not return for many tens of minutes after cardiac
output has been returned.

Therefore during cardiac arrest impaired cerebral blood flow
leads to a lack of electrophysiological activity in
the cortex, which is made worse, as the time from
the initial period of ischaemia to adequate resuscitation
is increased. A reduction in cerebral blood
flow in humans is associated with a deterioration
in sustained attention (30)

Immediately after resuscitation there is a period
of multifocal no-reflow, a phenomenon observed
following recovery from cardiac arrest, in which,
despite the restoration of adequate blood pressure
multiple areas of the brain have been shown to develop
perfusion defects that range from a pin hole,
up to 95% of the brain (31) This is thought to occur
due to insufficient restoration of nutritive blood
flow due to a combination of increased blood viscosity
and perivascular oedema and is related to
the initial period of ischaemia. This is followed by
a period of transient global hyperaemia lasting
15–30 min

The papers you've presented are interesting, but nothing more.  I'm not an expert, I've never claimed to be which is why I don't make up my own facts as some of the sceptics on here do). What I do know is that pupillary reaction to light is on a spectrum (mm) and a reaction to light does NOT mean the person is conscious, only that the brain stem is intact/functioning (to some degree). In the onset of cardiac arrest it doesn't function. Denture man's pupils did not react to light for at least half an hour or more and he didn't regain consciousness, he was still in a coma. 

None of the patients in the Aware study on cardiac arrest patients showed any clinical signs of consciousness during
resuscitation

Although no patient demonstrated clinical signs of consciousness during CPR as assessed by the absence of eye opening response, motor response, verbal response whether spontaneously or in response to pain (chest compressions) with a resultant Glasgow Coma Scale Score of 3/15, nonetheless 39% (55/140) (category 2) responded positively to the question "Do you remember any-thing from the time during your unconsciousness". There were no significant differences with respect to age or gender between these two groups.

I suggest you contact Pim Van Lommel if you want further confirmation. He is another expert.