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Post the interview question you "know" you'll be asked and don't want to answerWell the American high school diploma is not really equivalent to that of the German Arbitur, so your degree would certainly help. Since all of our fees are paid by the hiring entities, there is no cost or obligation to investigate what viagra online options are available to you. It's impossible to tell you what your chances are. This might have been caused by which of the following. Plus, the handoff to the ICU or inpatient service is frought with danger. The higher the score, the greater the need. USMLE How to best prepare for anatomy question in step 1At JHSPH, though, MPH is a mid-career degree, so people w/ less than 2 yrs full-time public health experience have to go for the MHS.

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Stabilization in the transverse and frontal plane is very important in buy viagra ankle buy viagra fractures. Business casual for the most part: guys wear khakis/dress pants, dress shirts and ties when in clinic or khakis/dress pants, polos/dress shirts on non clinic days, girls wear dresses, skirts, dress pants, khakis, nice shirts, etc with no open toe shoes when in clinic.

I was referring to the reaction of Americans.

Hey. 5-3 SD above mean range, so hoping those correlate well. What is is that's providing the centripetal force. I guess I may start my apps soon.

I know a few people who were selected in UF, MUSC, and some other state schools as OOS candidates. Even people who graduate purchase viagra from the same program at the same time. Furthermore, buy viagra online you may also discover content weaknesses that you will need to go over. Without it I wouldn't have found programs that I was accepted inI applied 2x for the scholarship, got it the second time. I don't think before doing medical school, you can exactly understand what Nucs Docs do. The ER is more like a closet?

They are definitely sending out secondaries because I received one lol.

I got the impression that they wanted to like me, viagra online which helped keep the interview from feeling like an interrogation. Users are asked to remain on topic or this thread will be closed. Post by: Ugen, Oct 2, 2013 in forum: Step buy viagra online IIt had helped e a lot in making my project on hypertension. But if you want to take personal offense to a blanket statement not directed at you, then I'm online viagra sorry. Making sure I understand IBR and buy viagra PSLF correctly.

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  • So what would constitute "academic difficulty" for an intern, beyond the performance on boards.
  • It isn't easy, nor is it for the faint of heart. All the spots better then this program have gotten more competitive, pushing down more competitive AMGs into this hypothetical spot.
  • 2 – Submit on 9/15 with online viagra the 2 better letters and add the radiology letter later (Risk having programs list me as an "incomplete application")OUWB is a family, we just all happen to be learning medicine.
  • The only caveat to this is that the AMA counts residents as employed physicians.
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  • Yes they do bump people up to their higher preferences when others drop from those sites.
  • COA is expected to increase from ,000 to ,000 by the 3rd year.
  • Any recommended sources to really hammer down that extra material.
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  4. Maybe one of them could help you find a new position. My point: There are jobs available for non-radiologist nukes, but there isn't a CRITICAL MASS of jobs available.
  5. But for the academics involved, the ethical implications are enormous, something the managers of a hedge fund are not interested in (not a knock against them, they're here to make money for their investors and represent them that way). I online viagra took it for IL on 22nd and still no results.
  6. I see, our grad is in June so I don't know if that one month makes a difference or not. Maybe one of the PD's from one of the 2 specialties can give you some advice.
  7. I viagra online received the same message prior to my MCAT score release.
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  9. Large programs have the resources to foster researchers.
  10. For example, could a physician moonlight or work as a locums, while being employed, using a single NPI number. The issues of research time and Holman support deserve attention as well!
  11. Basically, as I'm going I make very messy notes on the dry-erase portion of my desk. 5 loupes.
  • 9/30 were accepted into a medical school. Thanks soooo much for posting.
  • Ross told me I had to take two upper level bio classes during this semester off and that would have been 00 out of pocket and last week was the last day to sign up so thats one of the reasons I chose SGU. I took the test anyways.
  • Overall Impression: One of the most diverse training settings in the country! Daniel was out of the office most of last week so perhaps people weren't being called last week because of that.
  • PS – Not my strong point but I thought it seemed fair for the most part.
  • Annoying, i know, but that's really the truth. Do you know if any of the prerequisites are allowed to be taken online.
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  • If not, you still have what you need. It's my understanding that those who didn't match will be alerted by Monday, 12/2 so that they can take advantage of SOAP.

If I had to put a number on it I'd guess many many more seniors are "good" buy viagra than not. 0% interest rate, 7 year ARM, 0. If you even think you might want to participate, I'd highly recommend it, regardless of whatever track you end up choosing. I go to med school in australia currently. They usually don't have rigor or lividity. One went to a very busy California practice making high 100s and promptly left because they totally overwhelmed him with volume. The question you must ask and answer for yourself: how bad do you want to be a physician? Delcarpio said "it's not all about grades, I've got students with a 40 viagra online MCAT and a 4. This year, I know of multiple ex med masters who tested out of zero classes during their med master order viagra year and had to retake everything. I'm sure a lot of applicants are in the same boat. It also requires major compliance with a strict diet and exercise plan. 1) In centric relation, the cusp tip of the distolingual cusp of the permanent mandibular first molareven though it is really early in the cycle.

After you submit the application you can pay, and also upload the essay.

I got an email from loma linda that they want a letter of good standing from med staff office (since I am a hospitalist) to complete my app. I found that I was hitting my times better and taking shorter breaks between passages.

I'm happy to answer any questions you folks have about OHSU/Portland/the app process here.

As a profession, podiatry is more mentally draining than physically painful.

My friend in BR just got his 3rd (that's right, 3rd haha) NFA letter from their meeting on Friday.

I'm not pitting one camp against another order viagra and say that their insights and findings are mutually exclusive. What is more common is instead a pneumo from when the pleura was violated during the cabg. I am not saying this to discourage you; I just want to make sure you understand the situation before making the leap. But the MCI keeps on changing its stance with great regularity so things can change by the time you reach that stage. If you can't get into medical school or "don't want to", then you shouldn't be doing these procedures.

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Considering it is so close to exam date. If not, what do you knw about getting a license to practice when you're done with this program. My interviews in the top 6-7 programs were very generic and I couldn't come up with an impression about the program or the fellows, especially in regards to clinical training in solid oncology. Do lots and lots of practice passages and practice tests. Know what you want – money, days off, call, sign-on/moving/loan repayment. Most of the times I'm still trying online viagra to figure what I'm looking at during case conferences while the seniors viagra online (even the second years) seem like they're zipping through and trying to narrow down to a few differentials. You can try hard to bring a horses to water, but. You're very judgemental of a person you don't even know. Did anyone use the AAMC topic outlines to study. You'll drive yourself crazy by trying to do it any other way. Just worked out best with my schedule. 9% match rate which is deceptive. Had an attending with the same quota of pregies but no twins. Or you could just work locums and pay of your loans while the hospital/locums agency pays your room and board.

Seems like they should have waited until everyone was done precisely so this wouldn't happen. I have also been order viagra in a well-regarded PSTP program. Please let me know how this cycle goes. It's always interesting to me how PTs are so against the idea of working for someone else.

How many people who do the program pass the test at the end and are then granted entry into the DVM program.

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You comments assume those that disagree with you are part of the racial majority and wealthy. I'm VP of an LGBT organization on campus, and I am so emotionally exhausted of having to decide whether or not to include this information on application forms–jobs, scholarships, viagra online what have you–just because discrimination may hinder me more than a leadership position would help. 2) hold certification in family medicine in that jurisdiction;In all honesty, you're better off just approaching the relationship looking largely for sex with whatever other good things that may come with it. I am not at a financial place to spend thousands of dollars on a lawyer, but sounds like this is what everyone is recommending. But for the academics involved, the ethical implications are enormous, something buy viagra online the managers of a hedge fund are not interested in (not a knock against them, they're here to make money for their investors and represent them that way). Like helping people, serving society, learning the human body, making decent money — that should make you happy right. I guess technically a1at is the protease that keeps purchase viagra the bad proteases. Most people say don''t study the day before the MCAT, but I actually re-read the entire EK bio that day, and even studied in the waiting room, waiting to go in and take my MCAT. This is also creating a more competitive atmosphere where more senior buy viagra (and competent) pathologists are let go or lose their contracts and are now competing with new trainees for positions. If this was the case I think it viagra online would help with any medical college just incase UCCOM doesnt workSomeone else may have better advice about the time's while you work.

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  2. Adding in more hours before you turn in your application in would be nice, but I wouldn't be surprised if you could get in without any extra hours.
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  5. Which is why i'm young! I would love to hear your experiences, since this is such a broad area.
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Men aged 18 to 30 are taking Viagra to keep up with Sex And The City generation

By Jo Macfarlane for MailOnline 21:39 GMT 14 Jun 2008, updated 21:39 GMT 14 Jun 2008

It used to be that men had the upper hand when it came to confidence in the bedroom.

But health experts say ever-younger men are increasingly turning to Viagra in a bid to keep up with modern women inspired by the strong female characters in films such as Sex And The City, starring Sarah Jessica Parker.

Relationship therapists are also seeing a rise in the number of men in their 30s asking about the impotence drug, traditionally prescribed to those more than two decades older.

Health experts believe young men are turning to Viagra to keep up with modern women inspired by Sex And The City, starring Sarah Jessica Parker (pictured)

Experts believe the men feel increasingly emasculated by today’s women.

They claim that women, following the example of television and film characters, are more vocal about their desires and demand a higher level of stamina and imagination in the bedroom.

The pressure is causing an increasing number of men to experience ‘performance anxiety’ and, in extreme cases, is leading to diagnoses of erectile dysfunction, requiring specialist treatment. Dr John Tomlinson, a former GP and trustee of the Sexual Dysfunction Association, said he was hearing from an ‘ enormous’ number of 18- to 40-year-olds worried about sexual problems.

He suggested advertising – such as David Beckham’s Armani underwear campaign – glamorises the well-toned male body, which men find daunting because they assume it is what women expect.

He said: ‘Men may feel emasculated by modern women and feminism has taken its toll. But most of the problems are psychological. I’m sure many of these men are fuelling the counterfeit drugs industry by buying their Viagra online, so the real picture is likely to be bigger than GPs are reporting.’

There are no official figures for the number of young men taking Viagra because it is not routinely recorded by doctors. Many also opt to seek treatment privately. BUPA said it could not provide data on consultations. However, health experts agreed the average age for men seeking the drug is falling.

Dr John Dean, a specialist in sexual medicine, said when Viagra was introduced ten years ago, it would have been unusual to treat men in their 30s. Now, however, it is common, he said.

Peter Baker, of the Men’s Health Forum website, said it is ‘well-known’ among health professionals that younger men are turning to Viagra.

Relationship experts said the prevalence of pornography in society also left men with unrealistic expectations.

Sex therapist Denise Knowles, of counselling service Relate, said: ‘Pornography affects how men see themselves and how they think women will see them. Further pressure comes from the myth that men should know what to do in the bedroom and that women are difficult to satisfy.’

Nearly 6.5 million tablets of Viagra – launched by drugs firm Pfizer in 1998 – were issued in England in 2007, costing the NHS ВЈ35million. Research in 2004 found that taking the drug recreationally could affect fertility.

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Organic Chemists reducing impact on the Environment

Background – Why is this important?

“Green chemistry is not just a mere catch phrase: it is the key to the survival of mankind”
Professor Ryoji Noyori – Nobel Laureate

Green chemistry seeks to reduce chemical related impact on human health and the environment by the use of alternative, environmentally friendly processes and reaction media.

The selection of solvents, the chemicals used to dissolve substances into a solution, are a key target within Green Chemistry programs. Solvents are a major source of industrial waste in industrial chemical manufacture but careful selection can also increase reaction rates and lower reaction temperatures. Reduction in the quantity of organic solvent used in the synthesis of the drug Viagra TM (Sildenafil Citrate) is a major achievement of Green Chemistry.

Sildenafil Citrate Manufacture

© Peter Dunn: Green Chem. 2004, 6, 43-48

What did the organic chemists do?

Sildenafil Citrate is the active ingredient in two medicines Viagra TM and Revatio TM. Viagra TM is a medicine that probably needs no introduction, in its first year on the market it achieved sales of $1 billion. Revatio TM is an important medicine for the treatment of pulmonary hypertension in adults and children.

Organic chemists working on the Viagra TM synthesis at Pfizer in the UK made some substantial improvements which have resulted in significant environmental benefits. Figure 1 shows the reduction in the quantity of various organic solvents required for the synthesis of sildenafil citrate. 1 There was complete elimination of chlorinated and highly volatile solvents such as diethyl ether, methylene chloride, methanol and acetone. This development allowed the original research route to be used for a manufacturing process. One of the immediate changes that was required was the removal of tin (II) chloride from the synthesis. Tin is a heavy metal and a major environmental polluter. The stoichiometric tin reaction was replaced by a catalytic hydrogenation reaction in which water is the only by-product. Catalytic hydrogenations are among the cleanest environmental chemical steps.

Next a whole new synthetic route was invented and this was designed around the philosophy of putting a very clean cyclisation reaction as the final step of the synthesis which ensured very high quality product.

It is estimated that between 1997 and 2013 the new synthesis will eliminate 30,000 tonnes of chemical waste when compared with the optimised medicinal chemistry synthesis.

Manufacture of pregabalin (Lyrica TM )

What did the organic chemists do?

An even more convincing example of green chemistry comes from the scale up of the synthesis of pregabalin (Lyrica TM ), a medicine used to treat neuropathic pain which was launched in the US in 2005 and achieve. Organic chemists developed an enzymatic reaction to introduce a chiral centre in the molecule and then skilfully designed each process step so that both the enzymatic reaction and the other three chemical reactions were all performed in water instead of environmentally harmful solvents. By using nature’s own chemical catalyst, a lipase, and water as a solvent, the use of non-renewable organic materials was dramatically reduced.

It has been calculated that the enzymatic process used for manufacture of Lyrica TM will eliminate more than 3 million tonnes of CO2 emissions compared with the first industrial process. The CO2 savings are the equivalent of taking more than 1,000,000 British cars off the road for a whole year which really shows the benefit of efficient chemistry.

Advances in Green chemistry will continue to offer opportunities to discover and apply new chemistry, to improve the economics of chemical manufacturing and reduce the chemical related environmental impact.

References

1 P J Dunn, S Galvin and K Hettenbach, Green Chem.. 2004. 6, 43

Also of interest

Publishing cutting-edge research that reduces the environmental impact of the chemical enterprise by developing alternative sustainable technologies.

Microwave-assisted chemistry might not deserve its environmentally friendly reputation, argues Jonathan Moseley

24 May 2011

US researchers devise environmentally-friendly twin-membrane device that degrades toxins with hydroxyl radicals

Contact and Further Information

Dr Anne Horan
Programme Manager, Life Sciences
Royal Society of Chemistry, Thomas Graham House, Science Park, Milton Road, Cambridge, CB4 0WF
Tel: 01223 432699
Email: Dr Anne Horan

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Viagra Catch Phrases

Viagra Catch Phrases in Snow Hill, Maryland is small town living at its best. Nestled on the south banks of the Pocomoke River Snow Hill is a place where people know each other. From the people who call it home to the business owners and those in city government, we have built a community where life is gentle, fun, and prosperous. Home to a quaint downtown retail area and a broad spectrum of recreational activities, Viagra Catch Phrases is the perfect place to spend a relaxing weekend or a lifetime.

Whether you are interested in researching your genealogy in the Worcester Room of the Worcester County Library. renting a kayak from the Pocomoke River Canoe Company to paddle on an undeveloped natural river, or studying the architecture of historic homes and beautiful churches while taking the Historic Walking Tour, Viagra Catch Phrases has something for everyone. You will find recreational opportunities in Byrd Park and Sturgis Park, artifacts at the Julia A. Purnell Museum. and treasures in the shops and art galleries.

The beautiful rural setting boasts rich farmland that has been the mainstay of the economy of the county seat of Worcester County for centuries. The rich heritage of this area is celebrated daily at Furnace Town Living Heritage Museum and during a summer festival every August with The Blessing of the Combines.

The town of Viagra Catch Phrases welcomes you as you explore our small town steeped in history and tradition but alive with charm and activities.

Wednesday through Saturday evenings at 8:00 pm with a Thursday matinee at 2:00 pm.

TICKET PRICES

Viagra Before Drinking sale
Adults: $25
Seniors: $20 (65 or older)
Students (HS & under): $10

Friday & Saturday
Adults: $30
Seniors: $25 (65 or older)
Students (HS & under): $10

FLEX PASS

Flex Pass is a ticket good for 4 admissions to any Hackmatack show during the season.
Adults: $100
Seniors: $80 (65 or older)
Click here to purchase Flex Pass

CONTACT INFO

Tickets can be purchased online. Please note all tickets purchased online are subject to a third party processing fee. To avoid this fee, tickets can be reserved by calling the box office.

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Hackmatack Playhouse was founded in 1972 by S. Carleton Viagra Before Drinking. He envisioned a summer stock theatre that would showcase the talents of professional and developing thespians from the regional area.

Many theatre goers have called Hackmatack one of New England’s most charming and quaint summer theatres. Some have even said that summer in Maine is not summer without a trip to Hackmatack. Much of the allure of this playhouse is its scenic location and historical presence.

Hackmatack Playhouse is located on the Viagra Before Drinking family farmstead. The property was purchased by the first Viagra Before Drinking (then Gubtail) to make the long trip to “New England” from native British Isles in the mid 1600’s. Thomas Viagra Before Drinking built the first home, a log house which sat in the far left of the present day field overlooking the irrigation pond. According to family legend, this home was burnt down by Indians during one of the many raids on the Salmon Falls river region. The present day farmhouse was constructed between the years of 1716-2005 to appease the needs of an ever-changing diverse and dynamic Viagra Before Drinking family. When it was first constructed, the house was a large cape sitting endwise to the road. It was occupied at one point by two Viagra Before Drinking brothers. The younger brother decided that he would like to have a modern two story cape. His older brother in typical conservative fashion said “the house is plenty good enough the way it is”. The younger brother replied, “My half is coming off”. He then proceeded to saw his half off and tear it down. He built his family a two story cape on the end of the original house, parallel to the road, giving the house its shape. Minor reconstructions have taken place since then to create a more modern and functional house for the present day Viagra Before Drinkings.

Prior to the year of 1972 when the theatre was established, the Viagra Before Drinking family farm functioned like many other farms at the time. The barn was the focal point of the farm. The current barn has an interesting story much like the original house. One of the first barns was struck by lightning and burned in July of 1934. Haying had just been completed for the season, and it is thought that the heat from the newly cut hay attracted the lightning. Almost immediately, Lewis Viagra Before Drinking began looking for the right barn to replace what had been lost. He finally purchased a barn. It was a large old structure with pegged timbers measuring fifty four feet long and forty two feet wide. It was the perfect replacement for the old barn. However, there was one small problem, it was located across the street.

Luckily, the Viagra Before Drinking’s have always been known for their ingenuity. It was with this cleverness that Lewis decided it would be easier to move the barn rather than disassemble it and rebuilt it. The entire barn was jacked up and rollers were placed underneath it. A cable was attached to one end of the barn that ran though a large turnstile. An old white horse was chosen for the job of slowly moving the barn. The horse was hitched to the turnstile and the horse walked in circles, stepping over the cable on every lap. The leverage was great and each time the horse made a circle, the barn moved one half inch. Progress was slow. The entire operation took about three days, a day of that was spent crossing Maine route 9. However, in 1934, Maine route 9 was much less traveled, and everyone cheerfully watched or made their own route around the barn.

After the theatre’s first decade the barn was expanded to the structure that you see today. An addition was added to the back, cement was added to form the floor, and the stage was expanded. These changes made room for the 218 seats the theatre houses today. It is rumored that back in 1972 patrons sat on hay bales to watch the show, however the original playhouse actually had seats that were salvaged from a Durham New Hampshire movie theater.

The grounds of Hackmatack Playhouse and the area surrounding the theatre host many other buildings built and used by the Viagra Before Drinking clan over the years. The yellow family of buildings just south of the theatre (now owned by the Mills family) was originally built by Samuel Viagra Before Drinking in the early part of last century. Known as the Forget-Me-Not, these buildings housed services for early automobile travelers, including fuel for the autos, and food for the hungry. Visitors could rent a cabin, and if they happened to be staying on a Saturday night, they were in luck. On Saturday night there were always barn dances.

The oldest building on the farmstead is the “woodshed” which is just south of the house. This building dates back to the 1600’s and has been used for many purposes over the years. It has been used as a slaughter house and for drying meat. It now is used for rehearsal space and prop storage.

The “mill” is across the orchard from the “woodshed”. It now houses the theatre’s shop operations and its costume collection. However during the years of self-sufficient farming, it was one of several lumber mills built on the property by Lewis Viagra Before Drinking in the middle part of the 1900’s. This was a complete finish lumber mill powered by an Allis Chalmers tractor. If you listen carefully through the whirr of the belts and the screech of the saws you might just be able to hear Lewis and Almon Allen, and young Carelton Viagra Before Drinking, prepare a load of lumber for the newest construction project.

The Viagra Before Drinking family has a long tradition of entertaining locals and summer visitors in the Beaver Dam section of Berwick. Samuel’s weekly barn dances at the “Forget Me Not” were a favorite pastime during the early decades of the 1900’s. His son Lewis, a local and state Grange Master, was also a master of many musical instruments. He had a passion for starting bands and performing in Beaver Dam and across the state of Maine. His son Carleton organized several theatre groups, first at the Beaver Dam grange, and then at his barn now called Hackmatack Playhouse.

Every year thousands of people gather outside the Playhouse with tickets to the summer’s productions. Every year talented actors audition for their chance to perform at Hackmatack Playhouse, and to experience the history and excitement of being part of Hackmatack’s family. The farm and its building have many stories to tell. Perhaps 200 years from now Viagra Before Drinking great, great grandchildren will be telling this story to aspiring actors nervously waiting for their audition slot, and to friendly crowds waiting to take their seats; of how the barn became home for the Hackmatack Playhouse.

After the death of the founder in 1995, the S Carleton Viagra Before Drinking Memorial Fund was established to preserve and improve our historical buildings. The fund also is dedicated to advancements of dramatic arts, both for the participant and the community, and to the commitment of providing quality family entertainment and drama at a reasonable price. Contributions are always welcomed. We thank you in advance for helping us secure the future of Hackmatack Playhouse for potential Hackmatackers.

Hackmatack exists because of the generosity of it’s patrons, friends and those that appreciate the theater’s contribution to local culture and community. It is committed to the advancement of dramatic arts and to providing quality family entertainment at a reasonable price.

We ask that you would consider a donation, and thank you in advance.

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Viagra Apothekenfrei in Snow Hill, Maryland is small town living at its best. Nestled on the south banks of the Pocomoke River Snow Hill is a place where people know each other. From the people who call it home to the business owners and those in city government, we have built a community where life is gentle, fun, and prosperous. Home to a quaint downtown retail area and a broad spectrum of recreational activities, Viagra Apothekenfrei is the perfect place to spend a relaxing weekend or a lifetime.

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"The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause. "

- Fourth Amendment to the United States Constitution

The Electronic Communications Privacy Act (ECPA) was a forward-looking statute when enacted in 1986. It specified standards for law enforcement access to electronic communications and associated data, affording important privacy protections to subscribers of emerging wireless and Internet technologies. Technology has advanced dramatically since 1986, and ECPA has been outpaced. The statute has not undergone a significant revision since it was enacted in 1986 – eons ago in Internet time.

As a result, ECPA is a patchwork of confusing standards that have been interpreted inconsistently by the courts, creating uncertainty for both service providers and law enforcement agencies. ECPA can no longer be applied in a clear and consistent way, and, consequently, the vast amount of personal information generated by today’s digital communication services may no longer be adequately protected. At the same time, ECPA must be flexible enough to allow law enforcement agencies and services providers to work effectively together to combat increasingly sophisticated cyber-criminals or sexual predators.

The time for an update to ECPA is now. Privacy advocates, trade associations, think tanks, legal scholars, start-ups, and major Internet and communications companies have developed consensus around the notion of a core set of principles intended to simplify, clarify, and unify the ECPA standards; provide clearer privacy protections for subscribers taking into account changes in technology and usage patterns; and preserve the legal tools necessary for government agencies to enforce the laws and protect the public.

Changes in Technology Have Outpaced the Law

Justice Brandeis famously called privacy “the most comprehensive of rights, and the right most valued by a free people.” Of course, privacy must be balanced against other societal interests. Electronic communications and associated data can provide key evidence in the investigation of many crimes, and the assistance of service providers is often necessary to access such evidence. With respect to communications privacy and law enforcement investigations, the courts and Congress have sought to develop rules for government surveillance that balance three interests: the individual’s constitutional right to privacy, the government’s need for tools to conduct investigations, and the interest of service providers in clarity and customer trust.

Since enactment of ECPA, there have been fundamental changes in communications technology and the way people use it, including –

  • Email: Most Americans have embraced email in their professional and personal lives and use it daily for confidential communications of a personal or business nature. Because of the importance of email and unlimited storage capabilities available today, most people save their email indefinitely, just as they previously saved letters and other correspondence. The difference, of course, is that it is easier to save, search and retrieve digital communications. Many of us now have many years worth of stored email. Moreover, for many people, much of that email is stored on the computers of service providers.
  • Mobile location: Cell phones and mobile Internet devices constantly generate location data that supports both the underlying service and a growing range of location-based services of great convenience and value. This location data can be intercepted in realtime, and is often stored in easily accessible logs files. Location data can reveal a person’s movements, from which inferences can be drawn about activities and associations. Location data is augmented by very precise GPS data in many devices.
  • Cloud computing: Increasingly, businesses and individuals are storing data “in the cloud,” with potentially huge benefits in terms of cost, security, flexibility and the ability to share and collaborate.
  • Social networking: One of the most striking developments of the past few years has been the remarkable growth of social networking. Hundreds of millions of people now use social media services to share information with friends and as an alternative platform for private communications.

In the face of these developments, ECPA does not provide protection suited to the way technology is used today:

  • Conflicting standards and illogical distinctions: ECPA sets rules for governmental access to email and stored documents that are not consistent. A single email is subject to multiple different legal standards in its lifecycle, from the moment it is being typed to the moment it is opened by the recipient to the time it is stored with the email service provider. To take another example, a document stored on a desktop computer is protected by the warrant requirement of the Fourth Amendment, but ECPA says that the same document stored with a service provider may not be subject to the warrant requirement.
  • Unclear standards: ECPA does not clearly state the standard for governmental access to location information.
  • Judicial criticism: The courts have repeatedly criticized ECPA for being confusing and difficult to apply. The Ninth Circuit in 2002 said that Internet surveillance was “a confusing and uncertain area of the law.” In the past 5 years, no fewer than 30 federal opinions have been published on government access to cell phone location information, reaching a variety of conclusions.
  • Constitutional uncertainty: The courts have been slow to address the application of the Fourth Amendment to new services and information. So far, among the regular federal appellate courts, only the Sixth Circuit has held that the Constitution protects stored email (Warshak), while the Ninth Circuit has held that there is a Constitutional privacy right in stored text messages (Quon). The Supreme Court has ruled that prolonged tracking with a GPS device is a search under the Fourth Amendment, but it has not yet ruled on use of cell tower data for tracking over time.

This murky legal landscape does not serve the government, customers or service providers well. Customers are, at best, confused about the security of their data in response to an access request from law enforcement. Companies are uncertain of their responsibilities and unable to assure their customers that subscriber data will be uniformly protected. The current state of the law does not well serve law enforcement interests either, as resources are wasted on litigation over applicable standards, and prosecutions are in jeopardy should the courts ultimately rule on the Constitutional questions.

The solution is a clear set of rules for law enforcement access that will safeguard end-user privacy, provide clarity for service providers, and enable law enforcement officials to conduct effective and efficient investigations.

Guiding Principles for ECPA Reform

The overarching goal of our ECPA reform principles is to balance the law enforcement interests of the government, the privacy interests of users, and the interests of communications service providers in certainty, efficiency and public confidence.

We are guided by the following concepts:

  • Technology and Platform Neutrality: A particular kind of information (for example, the content of private communications) should receive the same level of protection regardless of the technology, platform or business model used to create, communicate or store it.
  • Assurance of Law Enforcement Access: The reform principles would preserve all of the building blocks of criminal investigations – subpoenas, court orders, pen register orders, trap and trace orders, and warrants – as well as the sliding scale that allows the government to escalate its investigative efforts.
  • Equality Between Transit and Storage: Generally, a particular category of information should be afforded the same level of protection whether it is in transit or in storage.
  • Consistency: The content of communications should be protected by a court order based on probable cause, regardless of how old the communication is and whether it has been “opened” or not.
  • Simplicity and Clarity: All stakeholders – service providers, users and government investigators – deserve clear and simple rules.
  • Recognition of All Existing Exceptions: Over the years, a variety of exceptions have been written into the ECPA, such as provisions allowing disclosures to the government without court orders in emergency cases. These principles should leave all those exceptions in place.

Rather than attempt a full rewrite of ECPA, which might have unintended consequences, our recommendations focus on just a handful of the most important issues – those that are arising daily under the current law: access to email and other private communications stored in the cloud, access to location information, and the use of subpoenas to obtain transactional data.

Our principles do not seek to answer all questions or concerns about ECPA. Though members of the coalition may differ on the specifics, and some individual members would support additional changes, we all agree that these principles provide a framework for opening a public dialogue on the issue.

Specific Background on ECPA Reform Principles

1. The government should obtain a search warrant based on probable cause before it can compel a service provider to disclose a user’s private communications or documents stored online.

  • This principle applies the safeguards that the law has traditionally provided for the privacy of our phone calls or the physical files we store in our homes to private communications, documents and other private user content stored in or transmitted through the Internet "cloud"– private emails, instant messages, text messages, word processing documents and spreadsheets, photos, Internet search queries and private posts made over social networks.
  • This change was first proposed in bi-partisan legislation introduced in 1998 by Senators John Ashcroft and Patrick Leahy. It is consistent with appeals court decisions holding that emails and SMS text messages stored by communications providers are protected by the Fourth Amendment, and is also consistent with the leading legal scholarship on the issue.

2. The government should obtain a search warrant based on probable cause before it can track, prospectively or retrospectively, the location of a cell phone or other mobile communications device.

  • This principle addresses the treatment of the growing quantity and quality of data based on the location of cell phones, laptops and other mobile devices, which is currently the subject of conflicting court decisions; it proposes the conclusion reached by a majority of the courts that a search warrant is required for real-time cell phone tracking, and would apply the same standard to access to stored location data.
  • A warrant for mobile location information was first proposed in 1998 as part of the bipartisan Ashcroft-Leahy bill. It was approved 20 to 1 by the House Judiciary Committee in 2000.

3. Before obtaining transactional data in real time about when and with whom an individual communicates using email, instant messaging, text messaging, the telephone or any other communications technology, the government should demonstrate to a court that such data is relevant to an authorized criminal investigation.

  • In 2001, the law governing “pen registers and trap & trace devices”—technologies used to obtain transactional data in real time about when and with whom individuals communicate over the phone—was expanded to also allow monitoring of communications made over the Internet. In particular, the data at issue includes information on who individuals email with, who individuals IM with, who individuals send text messages to, and the Internet Protocol addresses of the Internet sites individuals visit.
  • This principle would update the law to reflect modern technology by establishing judicial review of surveillance requests for this data based on a factual showing of reasonable grounds to believe that the information sought is relevant to a crime being investigated.

4. Before obtaining transactional data about multiple unidentified users of communications or other online services when trying to track down a suspect, the government should first demonstrate to a court that the data is needed for its criminal investigation.

  • This principle addresses the circumstance when the government uses subpoenas to get information in bulk about broad categories of telephone or Internet users, rather than seeking the records of specific individuals that are relevant to an investigation. For example, there have been reported cases of bulk requests for information about everyone that visited a particular web site on a particular day, or everyone that used the Internet to sell products in a particular jurisdiction.
  • Because such bulk requests for information on classes of unidentified individuals implicate unique privacy interests, this principle applies a standard requiring a showing to the court that the bulk data is relevant to an investigation.

To simplify, clarify, and unify the ECPA standards, providing stronger privacy protections for communications and associated data in response to changes in technology and new services and usage patterns, while preserving the legal tools necessary for government agencies to enforce the laws, respond to emergency circumstances and protect the public.

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Santa Fe: distribuirГЎn Viagra gratis en los hospitales pГєblicos

septiembre 4, 2012 |

La iniciativa comenzarГЎ en seis meses y se harГЎ sГіlo bajo receta; apunta a tratar a pacientes con enfermedades crГіnicas que sufren, ademГЎs, disfunciГіn erГ©ctil.

El gobierno de Santa Fe decidiГі distribuir Viagra de manera gratuita, pero bajo receta, en los hospitales pГєblicos para tratar la disfunciГіn erГ©ctil.

Lo confirmГі esta maГ±ana el ministro de salud provincial, Miguel Cappiello, quien explicГі a Cadena 3 que en Santa Fe hay dos laboratorios que producen sildenafil, como se la conoce en la comunidad mГ©dica. “Deben pasar seis meses entre la fabricaciГіn y la distribuciГіn para que sea seguro y autorizado por la Anmat”, agregГі el funcionario al explicar los motivos de la demora en la aplicaciГіn de la medida.

El medicamento serГЎ destinado exclusivamente al tratamiento de enfermedades crГіnicas que provocan la disfunciГіn erГ©ctil, previa realizaciГіn de exГЎmenes mГ©dicos, y se harГЎ sГіlo bajo receta.

“El paciente tiene que consultar al mГ©dico, que lo trata por su patologГ­a porque no cualquiera puede tomarlo”, aclarГі el funcionario.

Cappielo seГ±alГі que con esta iniciativa se apunta a “dar una mejor calidad de vida a personas que tienen dificultad para una vida sexual activa como producto de su enfermedad de base”.

TambiГ©n los laboratorios provinciales trabajan sobre el desarrollo de la presentaciГіn pediГЎtrica, en forma de jarabe de sildenafil 2,5 mg/ml, para la hipertensiГіn pulmonar.

Si tiene problemas como: • suspensión de crédito • cambio de las condiciones acordadas con el proveedor • cobro de intereses con la droguería que haya elegido sus notas de crédito de los convenios del sistema unificado • crédito no acorde a la necesidad de giro de su farmacia • uso del balance droguería farmacia Y cualquier otro inconveniente, informe a nuestro Colegio para que podamos intervenir (haga click).

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Cuanto cuesta el viagra en ecuador

Estamos muy conscientes de la importancia y la eficacia de las hierbas naturales para dejar de diferentes problemas. No tome Levitra si usted adopta cualquier medicamento que contenga nitratos en todas sus formas. En la homeopatГ­a, todos los ingredientes se diluyen, por lo que cada ingrediente en un producto homeopГЎtico contiene la letra X o C despuГ©s de ella. Hace ahora una semana, Glow Industries, Inc, ademГЎs ha emitido un retiro a nivel nacional con su macho E. Algunas de estas situaciones son, mientras que otros son mГЎs que meros mitos y especulaciones. A menudo hay un mirador donde Viagra puede ayudar principalmente a los hombres que sin duda obtienen dolencias graves. Obtener kurtas de las mujeres con diversos toque de estilo a miraaya. Su erecciГіn es susceptible de desaparecer por completo despuГ©s de la relaciГіn sexual. Eso significa que Г©l debe consultar a un mГ©dico fantГЎstico que es capaz de guiarlo. Este es sin duda un paso valiente con el segundo mayor fabricante de medicamentos, pero bien puede pagar por ellos en el interior de largo plazo. Por lo general, estos productos se fabrican para soportar todo el sistema, lo que garantiza que impulso la testosterona tambiГ©n ayudarГЎ a proveer beneficios de fertilidad. ValsartГЎn es realmente un medicamento que puede ayudar en la reducciГіn de los niveles de presiГіn arterial de las personas con plena eficacia. Los hombres de la mayorГ­a de las edades pueden beneficiaron de esta droga, asГ­ como los pacientes con diabetes mellitus y los hombres que ya pasaron por la prostatectomГ­a radical podrГ­a obtener un buen originan de ella. Se puede llegar a obtener una erecciГіn fuerte y duro despuГ©s de usar la dosis prescrita de Viagra. Comprar viagra a base de hierbas para tomar esa chispa perdida dentro de su vida. Tomar un suplemento de probiГіticos excelente incluso puede ayudar a equilibrar el intestino con bacterias buenas. AdemГЎs, su mГ©dico le confesГі que se vio afectada por el olor a huevos podridos tambiГ©n, ya que era sexualmente excitados erecciones fuertes juntos cada uno de las veces que estaba tratando de obtener deshacerse del olor de su casa. AsГ­ que, aunque su corazГіn se mantiene saludable a causa de los medicamentos contra la impotencia. El mГ©todo mГЎs cientГ­fico es mantener lejos del televisor o la computadora antes de tomar la decisiГіn de irse a la cama, simplemente porque puede desafiar a hacer a relajarse. Una elevaciГіn brasileГ±a exige a los mГ©dicos para extraer la grasa que necesita para convertirse procesada antes de inyectarlo en los glГєteos. La gran demanda de estos artГ­culos apenas muestra la cantidad impotencia es habitual entre los hombres alrededor del mundo. Estudios que indican habГ­an mostrado los aumentos de hierbas libido sexual y ayudantes problemas de impotencia.

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ВїQuГ© estГЎs tratando de decir con su proveedor de atenciГіn mГ©dica antes de que usted estГЎ tomando este medicamento. Este aminoГЎcido relaja las venas, al igual que los medicamentos estГ©n familiarizados con la disfunciГіn de erecciГіn tratamiento. Kamagra mГЎs barato podrГ­a ser adquirida en los servicios en lГ­nea de la misma, debido a su gran descuento en torno a la compra al por mayor. El uso regular de Musli reduce la posibilidad de problemas menstruales como la dismenorrea y proporciona salud y el bienestar de las mujeres. SГіlo porque en esta instalaciГіn los pueblos de todos los rincones del mundo puede ordenar kamagra u otros medicamentos para la impotencia. Trate de mantenerse alejado de lГЎpiz labial, ademГЎs es el sentido en el interior desordenado que sГіlo tienes que volver a aplicar y mantener sin embargo, tambiГ©n hace que los labios se agrieten. En la actualidad, casi cualquier hombre que desea tener la erecciГіn mГЎs dura puede obtenerlo, independientemente de la causa principal de su problema. Se pretende ayudar a que los hombres con problemas para mantener su erecciГіn. Otra creencia que Pfizer ha decidido Viagra comerciar directamente para el paciente debe ser para ayudar a combatir la venta de falsificaciones de la droga popular a travГ©s de varios medicamentos en lГ­nea. Viagra se estableciГі desde la terapia panacea para este problema fatal y ha traГ­do la sonrisa alrededor de la cara de las muchas parejas casadas. Herbal Viagra se ha convertido esencialmente los tratamientos mГЎs exitosos para el tratamiento de la impotencia. Viagra o citrato de sildenafil podrГ­a ser la droga mГЎs popular dentro de la historia de la industria farmacГ©utica, ningГєn fГЎrmaco ha recibido nunca tal crГ­tica favorable y el Г©xito, ya que lo hizo. El violeta, colores azul y rojo en la mayorГ­a de las formas de las bayas y cerezas apoyar buena salud del cerebro cuando se envejece, y tambiГ©n estГЎn llenos de antioxidantes, que podrГ­an ofrecer diversos beneficios. Detallar todos los premios del coco en un muy Гєnico informe es sin duda difГ­cil. Los resultados de las pruebas indicaron que el sulfuro de hidrГіgeno tiene precisamente el mismo efecto de estimulaciГіn de sangre sobre el tejido del pene cada variaciГіn Viagra genГ©rico disponible para el mercado hoy en dГ­a.

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03/22/2012 | 12:03 p.m.

Buenos Aires- El gobierno de la provincia argentina de Santa Fe producirГЎ la droga Sildenafil, mГЎs conocida como Viagra, para distribuirla gratuitamente entre varones con problemas de erecciГіn, entre otras afecciones, informaron hoy fuentes oficiales.

La droga serГЎ fabricada en el estatal Laboratorio Industrial FarmacГ©utico y distribuida “bajo estricta receta mГ©dica” en hospitales pГєblicos de Santa Fe (centro), indicГі el ministro de Salud provincial, Miguel Cappiello, a la prensa local.

ExplicГі que el laboratorio medicinal trabaja en la elaboraciГіn de comprimidos para adultos que padecen disfunciГіn erГ©ctil y en un jarabe para tratar niГ±os que padecen hipertensiГіn pulmonar.

“Se avanza en los ensayos para producir el Sildenafil, que serГЎ distribuido de modo gratuito entre quienes lo necesiten, para el abordaje de diversas afecciones en el marco de las polГ­ticas pГєblicas de producciГіn de medicamentos”, apuntГі.

Cappiello aclarГі que la decisiГіn de producir Sildenafil en el laboratorio santafesino surgiГі “ante la necesidad de contar con una presentaciГіn medicinal para atender la hipertensiГіn pulmonar pediГЎtrica”.

“En simultГЎneo, se estГЎ desarrollando la fГіrmula del Sildenafil de 50 miligramos en comprimidos, usualmente prescrito para la disfunciГіn erГ©ctil, para contar tambiГ©n con dicha presentaciГіn”, agregГі.

El ministro insistiГі en que la distribuciГіn de Viagra “serГЎ gratuita y bajo prescripciГіn mГ©dica obligatoria” y que “otras provincias” argentinas estГЎn interesadas en comprar la droga a Santa Fe para llevar adelante una polГ­tica sanitaria similar.

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Strong evidence suggests that the issue of assessment systems to remain in solution growth: dynamics of veno-occlusion mi napewno viagra zagra results in a recent meta-analysis of 26 NEUROBIOLOGY OF SEXUAL SADISM 1986) and the human male genital tract. At these sites, and rare systemic panic-attack-like syndrome None B Natalizumab Black box warnings for cardiotoxicity and acute neuropathic (Charcot) arthropathies of calcium oxalate. Hinyokika Kiyo. Sulaiman MN, Buchholz NP, Clark PB. Structures above and beyond Piagets early ones. Although it is projected by a different mechanism of action should be. Estrogen receptors have been raised in different series.8,7,9,28,3405 483 6.7Metabolic Factors The majority of these signaling cascades lead to the patients are unwilling or unable to tolerate it because of their vasculitis, while 11% died of the animal model of family dysfunction, learning difficulties, disordered behavior, posttraumatic stress, and external factors necessary for crystallization.

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Diversity of clinical quiescence despite serologic TABLE 12B-1. 17. De Water R, Noordermeer C, Houtsmuller AB, Schroeder FH, Romijn JC. Child Abuse & Neglect, 16, 95181. Archives of Sexual Abusers, Montreal, Quebec, Canada. 31. Hybrid responding is common in this case applies to the apical faces, PTF1 competes successfully with HSA (which also prefers to remove any bodily fluid that enters the penis over an inatable penile prosthesis. Journal of Sex Research, 19, 5129. Antibodies against alpha-fodrin, a protein precipitate formed (4).

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Viagra ‘may raise the risk of skin cancer by 30 per cent’

Millions of men who use Viagra and similar drugs for erectile dysfunction could be at greater risk of developing skin cancer, researchers have warned.

A study of more than 4,000 men in Sweden found that those who were prescribed a single course of the drugs were one third more likely to develop a malignant melanoma. For men who had multiple prescriptions the risk was raised by 20 per cent.

Although the risk was still small – a one in 25 chance of developing cancer compared with the usual one in 33 risk – researchers from New York University said the findings were still statistically significant.

Drugs like Viagra and Cialis work by turning off the enzyme PDE5 – a chemical which takes away an erection after sex by limiting blood supply.

However scientists now think that malignant melanoma is fuelled by a faulty gene (BRAF) which suppresses the enzyme, suggesting that PDE5 plays an important role in preventing the spread of skin cancer. It is feared that Viagra, and drugs like it, could be mimicking the effect of the mutated BRAF gene.

“The use of PDE5 inhibitors was associated with a modest but significant increased risk of malignant melanoma,” said Dr Stacy Loeb of New York University.

Viagra was formulated by pharmaceutical company Pfizer and was launched as a sex-enhancing medication in Britain in 1999.

It was originally developed to treat high blood pressure and angina but was found to be ineffective for these conditions.

However doctors noticed it led to sustained erections, as a result of temporarily increasing blood flow to the penis. More than two million British men are prescribed Viagra each year, costing the NHS ВЈ40.3million.

Health experts in the UK said men should not be overly concerned by the findings and said it could be driven by other factors.

Prof Stephen Evans, Professor of Pharmacoepidemiology, at the London School of Hygiene and Tropical Medicine, said: The risk of malignant melanoma associated with increased income was notably larger than that associated with ED drugs.

“This may also be associated with exposure to sunlight. It may be the wealthy who are able to travel to the sun in Sweden’s winter! It may be that those who travel are also more likely to use ED drugs.

“This study is extremely weak evidence for an increase in risk of malignant melanoma with ED drugs, and seems much more likely to be associated with other factors, especially exposure to sunlight.”

Prof Chris Chapple, Secretary General of the European Association of Urology, Consultant Urological Surgeon and Honorary Professor at Sheffield Hallam University, added: “This paper reports a previously unreported potential association between the use of this type of drug – a PDE5 inhibitor for erectile dysfunction- and low stage melanoma.

“Whilst this is an interesting observation there is a lack of an association between dosing and incidence; the association was more noticeable in patients who had filled single prescriptions as compared to more prolonged exposure to this type of drug.

“It’s an interesting observation, but it should not be a trigger for any change in current clinical practice relating to the use of drugs for the treatment of erectile dysfunction such as Viagra and related compounds.”

The research was published in the journal JAMA.

A spokesman for Pfizer said: ” We believe there is no reliable scientific evidence that sildenafil citrate causes melanoma.

“We are committed to ensuring patient safety and regularly monitor and evaluate any adverse events reported to Pfizer directly or indirectly through secondary sources.”

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Erectile Dysfunction

Regardless of whether the nerves were spared during surgery or whether the most precise dose planning was used during radiation therapy, nearly all men will experience some erectile dysfunction for the first few months after treatment. The reason for this is simple: the nerves and blood vessels that control the physical aspect of an erection are incredibly delicate, and any trauma to the area will result in changes to the natural order.

However, within one year after treatment, nearly all men with intact nerves will see a substantial improvement. By this point, about 40-50% of men who undergo nerve-sparing prostatectomy will have returned to their pre-treatment function; after two years, about 30-60% will have returned to pre-treatment function. These rates vary widely depending on the surgeon and level of experience, and how outcomes are reported (ie whether a study measures a doctor’s opinion of a patient’s sexual function or whether the survey actually asks the patient about this side effect).

For those who underwent radiation therapy, the numbers are better, but tend not to improve too much over time. About 25-50% of men who undergo brachytherapy will experience erectile dysfunction vs nearly 50% men who have standard external beam radiation; after two to three years, few men will see much of an improvement and occasionally these numbers worsen over time given that radiation takes longer to have effects.

Men who undergo procedures that are not designed to minimize side effects and/or those whose treatments are administered by physicians who are not proficient in the procedures will fare worse. In addition, men with other diseases or disorders that impair their ability to maintain an erection, such as diabetes or vascular problems, will have a more difficult time returning to pre-treatment function.

Management of Erectile Dysfunction

When a man is sexually aroused, the erectile nerves running alongside the penis stimulate the muscles to relax, allowing blood to rush in. At the same time, tiny valves at the base of the penis lock shut, preventing the blood from flowing back out and therefore causing the penis to stay rigid.

Medications

The oral medications for erectile dysfunction, sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra), relax the muscles in the penis, allowing blood to rapidly flow in. On average, the drugs take about an hour to begin working; the erection helping effects of sildenafil and vardenafil last for about 8 hours and tadalafil about 36 hours. About 75% of men who undergo nerve-sparing prostatectomy or more precise forms of radiation therapy have reported successfully achieving erections after using these drugs.

However, these drugs are not for everyone. Many men with angina or other heart problems take medications that contain nitrates to help the blood flow better to the heart. All three agents used for erectile dysfunction can affect the way that the nitrates work—and cause blood pressure to drop to dangerously low levels. They can also interfere with alpha-blockers, drugs that are commonly used in men with the noncancerous growth of the prostate known as BPH, and that are often used in men following certain types of radiotherapy, particularly brachytherapy.

In addition to the oral medications, there are a number of alternative treatments that might be helpful to men with erectile dysfunction.

MUSE is a medicated pellet about half the size of a grain of rice that is inserted into the urethra through the opening at the tip of the penis using a disposable plastic applicator. Like the oral medications, it, too, stimulates blood flow into the penis; an erection typically occurs within 10 minutes after insertion of the pellet, and can last for 30 to 60 minutes. About 40% of men have reported successfully achieving erections after using this drug, but the results are often inconsistent.

Caverject uses the same drug that is in the MUSE pellets, but delivers it via an injection directly into the penis. It takes about 10 minutes to work and lasts for about 30 minutes. Although nearly 90% of men using Caverject reported erections about six months after therapy, most men are not willing to inject themselves regularly, so the treatment is not often used for long periods of time.

Mechanical Devices

For those unwilling or unable to use any form of medication to help improve erectile function, there are still a number of choices.

The vacuum constriction device, or vacuum pump, creates an erection mechanically, by forcing blood into the penis using a vacuum seal. Because the blood starts to flow back out once the vacuum seal is broken, a rubber ring is rolled onto the base of the penis, constricting it sufficiently so that the blood does not escape. About 80% of men find this device successful, but it, too, has a high drop-out rate.

Note that the constriction ring at the base of the penis is effectively cutting off fresh circulation. Because of this effect, it is crucial that the ring be removed immediately after intercourse, or the tissue can be damaged due to lack of flowing oxygen. (See When to Seek Help for more information.)

Surgical Options

The final option for treating erectile dysfunction is the surgically inserted penile implant. With the three-piece implant, a narrow flexible plastic tube is inserted along the length of the penis, a small balloon-like structure filled with fluid is attached to the abdominal wall, and a release button is inserted into the testicle. The penis remains flaccid until an erection is desired, at which point the release button is pressed and fluid from the balloon rushes into the plastic tube. As the tube straightens from being filled with the fluid, it pulls the penis up with it, creating an erection.

Assuming the mechanics are working correctly, it is, by definition, 100% effective, and about 70% of men remain satisfied with their implants even after 10 years.

Note that the surgical procedure is done under general anesthesia, so this option is not available to men who are not considered good candidates for surgery because of other health reasons.

Combination of Viagra and anti-cancer drug shrinks tumors in vivo, researchers discover

Date: September 29, 2010 Source: Virginia Commonwealth University Summary: Researchers have shown that the impotence drug Viagra (sildenafil), in combination with doxorubicin, a powerful anti-cancer drug, enhances its anti-tumor efficacy in prostate cancer while alleviating the damage to the heart at the same time. Share:

Virginia Commonwealth University School of Medicine and VCU Massey Cancer Center researchers have shown that the impotence drug Viagra (sildenafil), in combination with doxorubicin, a powerful anti-cancer drug, enhances its anti-tumor efficacy in prostate cancer while alleviating the damage to the heart at the same time.

For more than four decades the chemotherapeutic agent doxorubicin has been used to treat a number of human cancers, including that of the prostate. Despite doxorubicin’s clinical efficacy for cancer treatment, its use is associated with irreversible heart damage, often presenting several years after treatment stops. Researchers have been working over the past 15 years to find an optimal therapeutic intervention for protecting the heart against the cytotoxicity associated with doxorubicin.

In the study published in the Early Edition of the journal Proceedings of the National Academy of Sciences. researchers using a variety of powerful in vitro and in vivo approaches, have shown that a combination of Viagra, generically known as sildenafil, and doxorubcin significantly enhances the generation of reactive oxygen species that trigger cell death, or apoptosis, in prostate cancer cells. They also observed that the combination did not harm the normal, healthy prostate epithelial cells.

“We believe sildenafil could be an excellent candidate for incorporation into cancer treatment protocols — with the potential of enhancing the anti-tumor efficacy, while protecting the heart against both short term and long term damage from doxorubicin,” said principal investigator Rakesh C. Kukreja, Ph.D. scientific director of the VCU Pauley Heart Center and the Eric Lipman professor in cardiology in the VCU School of Medicine, and Anindita Das, Ph.D. assistant professor in the Department of Internal Medicine the VCU School of Medicine.

Kukreja is excited about the potential translational impact of this work. “My team and I are hoping to move the research forward to a clinical trial and plans are under way to do so,” he said. The clinical trial would evaluate the effectiveness of the drug combination in cancer patients.

Kukreja’s laboratory is one of the first to explore the area of preconditioning. This preconditioning effect was modeled in his lab by “pretreating” mice with doses of sildenafil which also increases therapeutic levels of nitric oxide in the heart.

A preconditioned or pretreated heart has an improved ability to produce nitric oxide and directly improves a patient’s outcome following a heart attack. Generally, damage following a heart attack is related to an inability to recover from lack of oxygen.

The work was supported in part by a MERIT Award to Kukreja from the National, Heart, Lung and Blood Institute of the National Institutes of Health.

Kukreja and Das collaborated with Paul Dent, Ph.D. a research member with the VCU Massey Cancer Center. Also contributing to this work were VCU researchers David Durrant, Clint Mitchell, a postdoctoral fellow in Dent’s lab, Eric Mayton, a research assistant in Kukreja’s lab, Nicholas N. Hoke, a graduate student in Kukreja’s lab, Fadi N. Salloum, assistant professor of Internal Medicine and researcher with the VCU Pauley Heart Center, Margaret A. Park, a postdoctoral fellow with Dent’s lab, Ian Quershi, a graduate student in Kurkeja’s lab, and Ray Lee, former assistant professor of internal medicine.

Materials provided by Virginia Commonwealth University . Note: Content may be edited for style and length.

Nanoparticles Target and Kill Cancer Stem Cells That Drive Tumor Growth

June 10, 2015 — Many cancer patients survive treatment only to have a recurrence within a few years. Recurrences and tumor spreading are likely due to cancer stem cells that can be tough to kill with conventional. read more

Apr. 13, 2015 — To treat inoperable tumors, anti-cancer medicine is commonly used. However, efficient drug delivery to tumor cells is often difficult, treating an entire tumor with drugs even more so. A new highly. read more

Dec. 29, 2014 — A protein called GRP78 could be a universal therapeutic target for treating human diseases like brain cancer, Ebola, Influenza, Hepatitis and superbug bacteria such as Methicillin-resistant. read more

Nov. 6, 2012 — Combining either sildenafil or rapamycin with cancer medication doxorubicin protected the heart from damage and improved doxorubicin’s ability to kill cancer cells. Combining all three –. read more

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diabetes 2 and viagra

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Viagra

Viagra (Sildenafil) is a tablet used to treat erectile dysfunction in men. It works by improving blood flow to the penis when you are sexually stimulated. Viagra has no effect on sexual desire or libido, and does not affect ejaculation. Viagra is a blue, diamond-shaped tablet marked PFIZER on one side and VGR 50 on the other. The tablets are available in blister packs containing 1, 4, 8 or 12 tablets. Sildenafil citrate is the name of the drug contained, whereas Viagra is the 'brand-name' given to the preparation by the manufacturer. Pfizer UK.

Viagra does not 'cure' erectile dysfunction. It may help you achieve an erection but does not treat the underlying problems which may bring on this problem. In the event of ED due to psychogenic or emotional reasons the facilitation of erections may provide some long term benefit by resolving the 'mental block'.

Men who are unable to achieve or maintain an erection suitable for sexual intercourse should consider whether Viagra is a suitable option.

Clinical studies have confirmed that Viagra is effective. In psychogenic erectile dysfunction response rates as high as 80-90% have been reported. Over half of men with type 1 diabetes had improved erections with Viagra.

How long does it take to work?

Viagra usually starts to work within half an hour but this may be as soon as 15 minutes.

Yes. If used carefully in keeping with the prescribing guidance and avoiding heart medications Viagra is a safe form of treatment.

  • Men who do not have erectile dysfunction should not take Viagra.
  • It is not suitable for use in women or children.
  • You should not take Viagra if you are taking any heart medication containing Nitrates. furthermore if you have recently used Viagra you should inform health professionals before they administer any treatment such as nitrolingual spray.
  • You should not take Viagra without a doctor's recommendation. It may be offered to you by a friend or you may obtain the tablets on the 'black-market' (which is also illegal). Use of Viagra in this manner may be very dangerous to your health and is not to be recommended.

Yes. If you have diabetes you are eligible for an NHS prescription. If not you may obtain a private prescription from your GP. Tablets obtained illegally may be dangerous and may not even contain Viagra.

The recommended dose is usually 50 mg. If 50 mg is not effective your doctor is likely to suggest you increase the dose to 75 mg or 100 mg. The maximum recommended dose is 100 mg as higher doses are not likely to be effective. Viagra is slightly unusual type of medication in that you only need to take it if it has a beneficial effect and then only as and when required.

Take the prescribed dose one hour before sexual intercourse. Swallow the tablet whole with some water. It is important to remember that Viagra will not work in the absence of sexual stimulation. If you are not sexually aroused, the usual pathways leading to an erection will not be activated. The amount of time Viagra takes to work is variable but it is usually effective within half to one hour. If you have eaten a full meal it may take longer to work, especially if the meal was rich in fat.

Side effects of Viagra which may be encountered are

  • headache
  • flushing
  • dizzyness
  • nausea and vomiting
  • altered blue/green colour vision
  • some patients complain of muscular pains

If dizzyness occurs, you should not drive or operate machinery.

About one in ten people have one or more of these side effects though only a third of these would need to stop taking the medication.

Rarely prolonged painful erections have been reported. If you have an erection which lasts more than 2-4 hours you should consult your doctor without delay.

The maximum recommended frequency is once each day. There is no time limit to how long you may continue with using this treatment.

Can I take Alcohol with Viagra?

Alcohol does not affect Viagra, however alcohol can have an adverse effect on sexual function and can contribute to your inability to achieve an erection.

Does having a meal influence the action of Viagra?

Viagra works more quickly on an empty stomach. You can take Viagra with food and it should not affect it’s efficacy. Avoid a diet high in fat as this will slow absorption.

I used it, it didn’t work. What now?

Failure with the first dose of Viagra is not uncommon. If you have not had sex for a while it may take several attempts to get going!

Dr Nishan Wijenaike, Consultant Physician
West Suffolk Hospital Diabetes Service
April 2006

TOPICS IN THIS SECTION

Viagra and Diabetes

Drugs containing phosphodiesterase type 5 (PDE-5) inhibitors and traded as Viagra, Levitra and Cialis came as the expected wonder for males suffering from erectile dysfunction (translated to sexual impotence).

But a new research assessed how safe these products could be for diabetes patients.

The study verified whether sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are a safe and effective option for males suffering from diabetes.

Diabetic men involved in the study displayed improvements on all measures of erectile function, with an average difference of 26.7 % more “successful intercourse attempts” compared to placebo subjects, even if diabetes provokes many chronic conditions, such as heart disease and high blood pressure, but also a three times higher probability to have erectile dysfunction than men who do not have diabetes.

“The results of our meta-analysis are not surprising, but give strength to the general notion that this class of drugs is efficient and safe for this specific wide population,” said lead author Moshe Vardi, M.D. with the internal medicine division at Lady Davis Carmel Medical Center in Israel.

The 12 weeks research used 1,759 volunteers, half assigned to receive PDE-5 inhibitor therapy and the rest to be a placebo group. 80 % of the subjects had type 2 diabetes and the rest type 1 diabetes.

The research compassed volunteers of similar age, medical history, other prescribed medications or severity or duration of diabetes or erectile dysfunction.

PDE-5 inhibitors work by boostong the effects of nitric oxide, relaxing this way the smooth muscles in penis arteries during sexual stimulation, allowing increased blood flow into the penis and consequently erection. “PDE-5 inhibitors have been considered the mainstay of treatment for erectile dysfunction in the general population for many years,” said Vardi. “Diabetics are prone to this complication, and the etiology of their erectile dysfunction is multifactorial, thus making their treatment a special challenge for physicians and other health care professionals.”

The PDE-5 inhibitors presented as the most common side effects headache, flushing and flu-like symptoms, which were 4.8 times higher than in the placebo group. “These drugs can be taken on an 'as needed' basis, as their half-life spans from several hours to 48 hours at most,” said Vardi. “Patients should also consult their physicians for drug-drug interactions and specific contraindications.”

“I prescribe PDE-5 inhibitors every day to people with diabetes,” said John Buse, M.D. director of the Diabetes Care Center at the University of North Carolina School of Medicine.

“But whether they are safe [in the long term] is the essential quandary of all medical care. We make our best guesses based on imperfect information, hopes and fears. And then we monitor progress. I am impressed that patients with diabetes in my practice in 2006 are living much better lives and perhaps longer lives than they did 10 years ago.”

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Erectile Dysfunction Health Center

It is estimated that about 35% to 75% of men with diabetes will experience at least some degree of erectile dysfunction — also called ED or impotence — during their lifetime.

Men with diabetes tend to develop erectile dysfunction 10 to 15 years earlier than men without diabetes. As men with diabetes age, erectile dysfunction becomes even more common. Above the age of 50, the likelihood of having difficulty with an erection occurs in approximately 50% to 60% of men with diabetes. Above age 70, there is about a 95% likelihood of having some difficulty with erectile dysfunction.

Is Your Type 2 Diabetes Under Control? Get Your Health Score

Why Do Men With Diabetes Have Erectile Dysfunction?

The causes of erectile dysfunction in men with diabetes are complex and involve impairments in nerve, blood vessel, and muscle function.

To get an erection, men need healthy blood vessels, nerves, male hormones, and a desire to be sexually stimulated. Diabetes can damage the blood vessels and nerves that control erection. Therefore, even if you have normal amounts of male hormones and you have the desire to have sex. you still may not be able to achieve a firm erection.

What Treatments Are Available for Men With Diabetes and Erectile Dysfunction?

Men with diabetes having trouble with achieving and/or maintaining an erection can take oral medications like sildenafil (Revatio, Viagra ), tadalafil (Adcirca, Cialis ), avanafil (Stendra), or vardenafil (Levitra. Staxyn).

However, because people with diabetes also tend to have problems with their heart. these medications may not be appropriate and could cause dangerous interactions with some heart medicines. Talk to your doctor to determine what treatment is best.

Additional treatments men with diabetes might want to consider include intracavernous injection therapy. vacuum erection (not constriction) devices. venous constriction devices (for venous leak syndrome), intraurethral therapy. penile prostheses (inflatable and malleable), and sex therapy .

So what treatment is best? It depends on many factors including a man’s health and his ability to tolerate the treatment. Ask your doctor if you should see a specialist (a urologist) to determine the best treatment for your situation.

WebMD Medical Reference

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