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The Latin term impotentia coeundi describes simple inability to insert the penis into the vagina; it is now mostly replaced by more precise terms, such as erectile dysfunction (ED). The study of ED within medicine is covered by andrology, a sub-field within urology. Research indicates that ED is common, and it is suggested that approximately 40% of males experience symptoms compatible with ED, at least occasionally. The condition is also on occasion called phallic impotence. Its antonym, or opposite condition, is priapism.
A meta-analysis of 36 744 men with ED in 12 prospective cohort studies found that the presence of ED significantly increased the risk of CVD, CAD, stroke and all-cause mortality, and the presence of ED was an independent risk factor for CVD. Ponholzer et al found that men with moderate to severe ED had a 65% increased relative risk for developing symptomatic CAD compared with men who did not have ED.26
Organic ED involves abnormalities the penile arteries, veins, or both and is the most common cause of ED, especially in older men. When the problem is arterial, it is usually caused by arteriosclerosis, or hardening of the arteries, although trauma to the arteries may be the cause. The controllable risk factors for arteriosclerosis--being overweight, lack of exercise, high cholesterol, high blood pressure, and cigarette smoking--can cause erectile failure often before progressing to affect the heart.
Impotence, also known as erectile dysfunction or ED, is a condition in which a man is unable to get or hold an erection long enough to have a satisfactory sex life. Impotence is a common problem, affecting up to half of Australian men between the ages of 40 and 70 years. The risk of developing erectile dysfunction increases as you get older.In the past, doctors considered impotence to be a mainly psychological problem, caused by performance anxiety or stress. Now, doctors know that many cases of impotence have a physical cause, which usually can be treated. Often, a combination of physical and psychological factors contributes to erectile dysfunction.Physical causes of impotencePhysical causes of impotence can include:problems with blood to flow into and out of the penis;damage to the nerves that send signals from the body’s central nervous system to the penis; and, more rarely,a deficiency in testosterone or other hormones.Some medicines can contribute to impotence, as can some types of surgery and radiotherapy treatments.Blocked blood vessels to the penisA very common cause of impotence is when blood flow into the penis is reduced. This can be due to atherosclerosis, also known as hardening of the arteries. In atherosclerosis, the arteries are clogged and narrowed, resulting in reduced blood flow.Risk factors for atherosclerosis include:high cholesterol;high blood pressure;obesity;sleep apnoea;diabetes; andsmoking.If your erection problems are caused by atherosclerosis, there is a chance that the arteries in other parts of your body (e.g. the coronary arteries that supply your heart) are also affected by atherosclerosis. In fact, erection problems may be the first sign that you are at risk of coronary heart disease.Because the arteries to the penis are narrower than those to the heart, you may develop symptoms of erectile dysfunction before you experience any symptoms of heart disease, such as angina. So seeing your doctor about erection problems may be important for your overall physical health.Impotence can also be caused by a blood clot that prevents enough blood from flowing into the penis to cause an erection.Venous leakageIn some men, blood can flow in to the penis easily, but the problem is that it leaks out again, so an erection cannot be sustained. This is called venous leakage. Doctors aren’t certain of the cause of venous leakage, but they can perform surgery to help repair it.Medicines that can cause impotenceMany medicines can cause erection problems as a side effect, including:diuretics (sometimes known as ‘water tablets’ - often used for high blood pressure);high blood pressure medications;cholesterol-lowering medicines (including statins);some types of antipsychotics;antidepressants;cancer treatments;some medicines used to treat heartburn and stomach ulcers;antihistamines;some pain medicines; andcertain epilepsy medications.If you experience impotence after starting a new medication, tell your doctor, who may be able to prescribe a different medicine for you. Don’t stop taking a medicine without first consulting your doctor. You should also tell your doctor about any over-the-counter medicines or complementary remedies you may be taking.The following table contains a list of specific medicines that may cause or contribute to erectile dysfunction. This list may not cover all types of medicines that can cause erectile dysfunction, so always ask your doctor if you are in doubt. Also, for some of these medicines ED is a very rare side effect. Most men taking these medicines do not experience erectile dysfunction.Medicines that may cause erectile dysfunctionType of medicineExamplesACE inhibitorscaptopril (Capoten), enalapril (Renitec), perindopril (Perindo), ramipril (Tritace), and othersAntidepressantsamitriptyline (Endep), clomipramine (Anafranil), desvenlafaxine (Pristiq), fluoxetine (Prozac), paroxetine (Aropax), sertraline (Zoloft), venlafaxine (Altven, Efexor), and othersAnti-epilepticsclonazepam (Rivotril), pregabalin (Lyrica)Antifungalsitraconazole (Sporanox)Anti-ulcer drugscimetidine (Magicul), nizatidine (Tazac), ranitidine (Zantac), and othersBeta-blockerspropranolol (Inderal), metoprolol (Betaloc, Lopresor), and othersOther blood pressure-lowering medicinesclonidine (Catapres), lercanidipine/enalapril (Zan-Extra), losartan (Cozaar), perindopril/amlodipine (Coveram), olmesartan/amlodipine (Sevikar), telmisartan/amlodipine (Twynsta), valsartan/hydrochlorothiazide (Co-Diovan)Calcium-channel blockersdiltiazem (Cardizem), felodipine (Plendil), nifedipine (Adalat)Cholesterol-lowering drugsatorvastatin (Lipitor), ezetimibe/simvastatin (Vytorin), fluvastatin (Lescol, Vastin), gemfibrozil (Ausgem), pravastatin (Pravachol), simvastatin (APO-simvastatin, Lipex, Zocor), and othersDiuretics ('water tablets')bumetanide (Burinex), chlorthalidone (Hygroton), spironolactone (Aldactone), and othersSchizophrenia drugsamisulpride (Solian, Sulprix), haloperidol (Haldol, Serenace), olanzapine (Lanzek, Ozin, Zypine, Zyprexa), paliperidone (Invega), risperidone (Rispa, Risperdal), ziprasidone (Zeldox)Combination cholesterol-lowering and anti-hypertensiveamlodipine/atorvastatin (Caduet, Cadatin)Pain medicinesfentanyl (Denpax, Durogesic), hydromorphone (Jurnista), morphine (Momex SR, MS Contin), oxycodone (OxyContin, OxyNorm, Targin), tramadolMiscellaneousoestrogens, antiandrogens, anticancer drugs and some chemotherapy treatments, baclofen (Clofen, Lioresal); cyproterone (Androcur, Cyprohexal, Cyprostat), degarelix (Firmagon), etoricoxib (Arcoxia), finasteride (Proscar and Propecia), flutamide (Flutamin), rotigotine (Neupro), triptorelin (Diphereline)*The names in brackets are just some examples of the trade names each specific medicine is marketed under in Australia. The medicine may also be known by other trade names.Diabetes and erectile dysfunctionMen who have diabetes have a higher risk of developing impotence than other men. Diabetes contributes to impotence because it can damage blood vessels and cause a type of nerve damage known as peripheral neuropathy.Hormones and impotenceLow levels of the male hormone, testosterone, are more commonly linked to a lowered sex drive, rather than impotence itself. Only a small percentage of cases of impotence are caused by hormone deficiency.Low testosterone levels may be the result of a condition called hypogonadism, in which the testicles don’t produce enough testosterone. More rarely, low testosterone can be caused by the pituitary (a small gland at the base of the brain) not secreting sufficient hormones to stimulate the testes to produce testosterone. The pituitary is also sometimes affected by small benign (non-cancerous) tumours that secrete prolactin, another hormone that can cause impotence.Mildly decreased levels of testosterone are often not due to specific testicular or pituitary problems, but rather stress or depression. In this situation, testosterone replacement is rarely of any benefit.Other hormone problems, including thyroid disease, can also cause impotence.Prostate cancer and erectile dysfunctionThe advanced stages of prostate cancer can affect the nerves and arteries that are vital for an erection.Radiation treatment for prostate cancer can harm the erectile tissues of the penis, and prostate cancer surgery can cause nerve or artery damage to the penis.Treatment for advanced prostate cancer often includes medicines that counteract testosterone, and commonly cause erectile dysfunction as well as loss of sexual interest.Peyronie’s diseasePeyronie’s disease is an uncommon condition that affects a man’s sex life because his penis curves abnormally and causes pain when he has an erection. He might also be unable to have a hard erection. The curvature of the penis is caused by a scar, called a plaque, that forms in the penis.Other physical causes of impotenceSeveral other factors and conditions can contribute to erectile dysfunction, including the following.Depression. Many men find that when they’re suffering from depression, they lose interest in sex and can’t get or keep an erection. Asking your doctor for treatments for depression may help alleviate your erection problems as well.Smoking contributes to vascular disease (disease of the blood vessels), so it can contribute to erectile dysfunction by affecting blood flow to the penis. Giving up smoking often has a beneficial effect on erectile function.Excessive alcohol use. Alcoholism can cause permanent nerve damage, resulting in impotence. This nerve damage is called peripheral neuropathy. Long-term alcohol use can impair the liver’s ability to function, resulting in a hormone imbalance in which a man has too much of the female sex hormone, oestrogen. On a day-to-day level, alcohol dulls the central nervous system, adversely affecting sexual response.Illicit drug use. Illicit drugs such as marijuana, cocaine, heroin, barbiturates, and amphetamines act on the central nervous system, impairing the body’s ability to respond sexually.Certain exercises. Nerve and artery damage can be caused by prolonged cycling, rodeo riding, or use of a rowing machine, resulting in the inability to get an erection. Often, minimising the use of hard bicycle seats and exercise machine seats, as well as correct positioning of the seat, will help restore sexual function.Surgery to organs near the nerve pathways of the penis, such as the bladder, rectum and prostate, can cause nerve or artery damage to the penis, resulting in the inability to have an erection.Injuries. Impotence can be caused by spinal cord injury; injury to your sex organs; or a pelvic fracture, which can cause damage to the nerves of the penis, or damage the blood vessels, resulting in reduced blood flow to the penis.Conditions affecting the nervous system. Multiple sclerosis (MS) and other degenerative diseases of the nervous system, such as Parkinson’s disease, can damage the nerves involved in erections.Psychological causes of impotenceMost cases of impotence have physical causes, but, in some men, psychological factors are the main contributors to impotence.Impotence that’s triggered by psychological factors is more common in men who are sexually inexperienced. Psychological erectile dysfunction may only occur when you’re with just one particular person. You’re also more likely to have morning erections, and be able to have an erection when you masturbate, than men whose impotence has a physical cause.Here are some psychological factors that can have an impact on your erections.Stress and anxietyWhen you’re stressed and focusing on other issues apart from sex, you might find that you don’t want to have sex as often and there might be a drop in your ability to perform when you do try. You might find that tackling the source of your stress can have benefits in the bedroom as well.Fear of failureAnxiety about your sexual prowess (commonly called performance anxiety) can, in itself, contribute to failure. By putting pressure on yourself, you become too anxious to get an adequate erection.Most men experience isolated episodes of erectile failure. Even when the transient physical cause has passed, anxiety that it may recur is sufficient to prevent erection. Anxiety, whether about something specifically sexual or part of a wider anxiety syndrome, is never helpful to good sexual function.Problems with your relationship and impotenceImpotence may be a manifestation of a poor relationship, or a problematic time in a relationship. Sexual boredom, tension or anger among partners, and lack of intimacy and communication are all possible triggers of erectile dysfunction. In these cases, seeing a counsellor may help.It’s worth remembering that impotence is a complex medical condition, which may have more than one cause. For example, if impotence is the result of a side effect of medicine or an underlying disease, the anxiety caused by lack of performance may perpetuate the erectile dysfunction even after the physical cause has been dealt with.Almost any chronic (ongoing) physical or mental health disorder, including those with no direct effect on penile nerves or blood supply, can have a powerful effect on sexuality, sexual self-image and erectile function.If you’re worried about your sexual response or the quality of your erections, don’t be afraid to talk to your doctor, who has access to treatments that can help. Last Reviewed: 16 December 2016
I would think the 25% is just an average. Some men never have a problem with erections. Some healthy men in their 60's never have a problem with their erections -- no Viagra needed at all, thank you. And, no, it is NOT completely associated with age. In fact, many men in their 40's and even younger, are already dealing with ED, especially if they smoke, are obese, don't exercise, or are addicted to porn, among other things. In fact, even men in their 20's and 30's can have these problems.
When lifestyle changes alone don’t work, drug therapy (Viagra®, Cialis®, Levitra®, etc.) is normally the next step. Most of these medications work similarly to enhance a natural chemical in your body that relaxes the muscles in your penis. The goal of this medication is to increase your response to sexual stimulation by increasing the blood flow in your penis allowing you to get an erection.22
Diabetes is an example of an endocrine disease that can cause a person to experience impotence. Diabetes affects the body’s ability to utilize the hormone insulin. One of the side effects associated with chronic diabetes is nerve damage. This affects penis sensations. Other complications associated with diabetes are impaired blood flow and hormone levels. Both of these factors can contribute to impotence.
PD is a chronic neurodegenerative disease characterized by “motor” and “non-motor” symptoms that lead to progressive disability. Erectile and SD are “non-motor” symptoms and can occur in 50–69% of males with PD (39-42). Ejaculatory and orgasmic function are also impaired. PD affects the dopaminergic pathways leading to erection and arousal. Dopaminergic therapy for PD can improve ED, and sometimes therapy may lead to hypersexuality (43,44). A comparison of married men with PD to age matched controls with non-neurologic chronic disease such as arthritis did not show any discrepancy in ED rates (45). This suggests that ED in certain groups with PD may occur from disease related factors common in chronic illness, in general.
Can apple cider vinegar treat erectile dysfunction? Apple cider vinegar is thought to have many health benefits, but can it help treat erectile dysfunction (ED)? ED can result from cardiovascular problems, diabetes, and other factors. Apple cider vinegar may help improve symptoms of conditions related to ED. Find out how it may help, and how to use it safely. Read now
VED involved placing the penis in a clear plastic tube where negative pressure created by the vacuum pump leads to penile engorgement and tumescence. Usually a constriction ring can be placed on the base of penis following penile engorgement. Some men complain of bruising, a “cold” penis and pain associated with the constriction ring; however, in some men with NED sensation may not be intact mitigating the side effects of VEDs. VEDs have reported effectiveness up to 90% in certain ED populations and it remains a non-invasive means to achieve and erection.
If it is determined that ED is a problem, the patient evaluation should include a detailed sexual and medical history and a physical exam. In particular, it is important to evaluate the ED within the context of ejaculatory problems. There is a strong interplay between premature ejaculation (PE) and ED, with about a third of ED patients reporting PE. The relationship between the PE and ED is bidirectional and successful treatment of one often requires treatment of the other.14
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Since endothelial dysfunction, CVD and ED are closely associated in epidemiological studies, the question for clinicians is whether to recommend the man presenting with ED undergo a cardiovascular (CV) evaluation. Clearly, based on numerous studies, ED can be considered at least a ‘marker’ for possible further vascular disease or CVD.15 In their report, Vlachopoulos and coworkers make the point that the man presenting with ED, the clinician, is offered an opportunity to attempt to improve the health of the man by addressing lifestyle modification, and consider further vascular evaluation owing to the clear relationship between endothelial dysfunction, ED and CVD.19
The FDA recommends that men follow general precautions before taking a medication for ED. Men who are taking medications that contain nitrates, such as nitroglycerin, should NOT use these medications. Taking nitrates with one of these medications can lower blood pressure too much. In addition, men who take tadalafil or vardenfil should use alpha blockers with care and only as instructed by their physician, as they could result in hypotension (abnormally low blood pressure). Experts recommend that men have a complete medical history and physical examination to determine the cause of ED. Men should tell their doctor about all the medications they are taking, including over-the-counter medications.
Acupuncture may help treat psychological ED, though studies are limited and inconclusive. You’ll likely need several appointments before you begin to notice any improvements. When choosing an acupuncturist, look for a certified practitioner who uses disposable needles and follows U.S. Food and Drug Administration guidelines for needle disposal and sterilization.
In some cases, nocturnal penile tumescence testing is performed to find out whether the man has erections while asleep. Healthy men usually have about four or five erections throughout the night. The man applies a device to the penis called a Rigiscan before going to bed at night, and the device can determine whether he has had erections. (If a man is able to have normal erections at night, this suggests a psychological cause for his impotence.)
Conditions that may be associated with ED include diabetes, [25, 26, 27] hypertension,  , and CAD, as well as neurologic disorders, endocrinopathies, benign prostatic hyperplasia,  , sleep apnea  , COPD,  and depression (see Table 1 below). [32, 33, 34, 35] In fact, almost any disease may affect erectile function by altering the nervous, vascular, or hormonal systems. Various diseases may produce changes in the smooth muscle tissue of the corpora cavernosa or influence the patient’s psychological mood and behavior.
Over a 2-year period, a third of the men randomized to a weight loss program demonstrated resolution of erectile dysfunction.10 A Mediterranean diet and nutritional counseling reported increased erectile quality.18 Little evidence supports that increased physical activity alone improves erectile quality; however, the strong association between physical activity and lower BMI is well described, and therefore recommended for men with erectile dysfunction and without a contraindication to physical activity.
Something else to consider is your porn use. If you are masturbating to very stimulating porn on a regular basis then it might be difficult to get as aroused in the bedroom with your partner. Watching video pornography is very stimulating and often men have difficulty creating that same level of arousal or stimulation with their partners. Consider masturbating without technology as visual images in your head are less stimulating then watching something live. Try this for two weeks and see if your erection quality improves.
The observation that TRT enhances the efficacy of PDE5 inhibitors in hypogonadal men taking these therapies with suboptimal response to the PDE5 inhibitors alone has been reported.33 In addition, investigators have demonstrated that TRT in hypogonadal men can improve erectile function even without the benefit of PDE5 inhibitors.33 In addition, guidelines for managing ED in hypogonadal men by the European Association of Urology recommend controlling the man to a eugonadal state prior to initiation of PDE5 inhibitor therapy.36 Testosterone measurement consists of a serum specimen which should be ideally obtained in the morning because of the normal diurnal variation of testosterone which is at its peak in the morning. Since TRT is relatively safe, and men can potentially see an improvement in erectile function, it seems prudent to consider this issue when presented with a patient suffering from ED.
Erectile dysfunction (ED), or impotence, is the inability to obtain or maintain an erection suitable for intimate activity. While most frequently seen in 50-65% of males aged 65 and older and nearly all men over the age of 70, erectile dysfunction affects up to 39% of 40-year-old men, too; more than 35 million men total in the United States. Left untreated, the physical frustrations of living with erectile dysfunction can quickly turn emotionally stressful as well, with men often reporting relationship and related issues. And that’s why NuMale Medical Center offers the most advanced and effective therapies to treat erectile dysfunction, so you and your partner can experience sex and intimacy both joyfully and confidently.
Besides PDE5 inhibitors and among second-line therapies are VCDs which are clear plastic chambers placed over the penis, tightened against the lower abdomen with a mechanism to create a vacuum inside the chamber. This directs blood into the penis. If an adequate erection occurs inside the chamber, the patient slips a small constriction band off the end of the VCD and onto the base of the penis. An erection beyond 30 min is not recommended. These devices can be a bit cumbersome, but are very safe.40
All devices that are currently approved by the FDA are considered safe for use in magnetic resonance imaging environments. However, 2 previously approved devices–the OmniPhase and the DuraPhase penile prostheses–are not considered safe in this environment. Other surgical procedures–including venous ligation to limit penile venous outflow and penile revascularization procedures–are rarely successful and are not recommended.19 These surgeries are only indicated when a patient demonstrates recent-onset ED and an occlusive lesion seen on angiogram or magnetic resonance angiography and should be performed only in centers of excellence for ED.
If you have symptoms of ED, it’s important to check with your doctor before trying any treatments on your own. This is because ED can be a sign of other health problems. For instance, heart disease or high cholesterol could cause ED symptoms. With a diagnosis, your doctor could recommend a number of steps that would likely improve both your heart health and your ED. These steps include lowering your cholesterol, reducing your weight, or taking medications to unclog your blood vessels.
Quitting smoking, exercising regularly, losing excess weight, curtailing excessive alcohol consumption, controlling hypertension, and optimizing blood glucose levels in patients with diabetes are not only important for maintaining good health but also may improve or even prevent progression of erectile dysfunction. It is unclear if such lifestyle changes can reverse erectile dysfunction. However, lifestyle improvements may prevent progression of the erectile dysfunction. Some studies suggest that men who have made lifestyle improvements experience increased rates of success with oral medications.
Impotence, also known as erectile dysfunction or ED, is a very common problem, affecting up to half of 40-70 year old men in Australia.Treatment techniques for impotence have varied through the years, from external steel mechanical attachments, to static electricity attached to the penis and testicles, to simple aphrodisiacs such as oysters. Until as recently as 1970, erectile failure was almost always seen as being due to psychological causes and was usually treated with psychotherapy.Since then, the medical causes contributing to impotence have been recognised and the treatment of impotence has been revolutionised, providing a range of options which are far more acceptable and very much more successful.Treatment options for impotenceTreatment choices for erectile dysfunction include:medicines;self-injection therapy;devices such as vacuum pumps;penile implant surgery;hormone therapy; andcounselling.If you have erectile dysfunction, the treatment your doctor recommends will depend on the severity of symptoms and the underlying cause of your impotence.Your doctor will want to check that any conditions that could be contributing to or causing erectile dysfunction are being treated.Your doctor may also suggest that you make some lifestyle adjustments, such as:increasing the amount of physical activity you get;losing weight if you are overweight;reducing the amount of alcohol you drink;quitting smoking; andnot taking illicit drugs.These lifestyle recommendations can help improve impotence related to several causes and improve your health in general.Medicines for erectile dysfunctionThe first tablet available for erectile dysfunction, sildenafil (brand name Viagra), has been largely responsible for helping to bring the topic of erectile dysfunction out into the open. Similar medications — tadalafil (Cialis) and vardenafil ( Levitra) — are also available. These medicines all work in a similar way, although there is some difference in how long their effect lasts. Sildenafil, tadalafil and vardenafil belong to a group of medicines called phosphodiesterase type 5 (PDE5) inhibitors because they block the PDE5 enzyme.How do oral medicines help treat erectile dysfunction?PDE5 inhibitors help in the process of getting and keeping an erection by working on chemicals in the body that are involved in erections. These medicines work by stopping PDE5 from breaking down an erection-producing chemical called cyclic guanosine monophosphate (cGMP). cGMP helps to relax the smooth muscle cells in the penis's erectile tissue, allowing more blood to flow into the penis to cause an erection. When PDE5 is temporarily blocked by these medicines, it can’t break down the erection producing cGMP, so an erection can be achieved and maintained. PDE5 inhibitors can be used in the treatment of erectile dysfunction that is due to physical or psychological causes.Medications such as Viagra, Cialis and Levitra will work only if you are sexually stimulated. They are not aphrodisiacs and won’t increase your sex drive.Side effects of PDE5 inhibitorsSide effects of these medicines can include headaches, flushes, blocked nose, indigestion and dizziness.In rare situations, sildenafil and vardenafil can cause a distortion of vision or change in colour vision.Tadalafil has been associated with back pain.Who can take medicines for impotence?PDE5 inhibitors cannot be taken by all men, so your doctor will need to evaluate your suitability before prescribing either of these medications.Men taking nitrates (often used to treat angina) should never take phosphodiesterase type 5 (PDE5) inhibitors. PDE5 inhibitors should also not be taken with some medicines used to treat high blood pressure.PDE5 inhibitors may also not be suitable for men with certain heart conditions or low blood pressure. Check with your doctor to find out if this type of medication may be suitable for you.Self-injection therapySelf-injection therapy delivers a medicine called alprostadil (brand name Caverject), also known as prostaglandin E-1, to the erectile tissue of the penis. Prostaglandin E-1 occurs naturally in the body and helps increase the blood flow to the penis to cause an erection. Unlike the PDE5 inhibitors, alprostadil will cause an erection whether the penis is stimulated or not.Self-injection therapy is usually recommended if PDE5 inhibitor medicines are not suitable or have not been effective in the treatment of erectile dysfunction.How to use self-injection therapyAlprostadil is injected into either of the 2 cigar-shaped chambers of the penis known as the corpora cavernosa, which run along the length of the penis, one on either side. Your doctor or urologist (specialist in problems with male reproductive organs and the urinary tract) will give you instructions on how to do this.Alprostadil should produce an erection in 5 to 20 minutes and, generally, the erection will last for 30 to 60 minutes.You should not use alprostadil more than once in a 24-hour period, and you should use it no more than 3 times a week.Don’t try to use more than the recommended dose of alprostadil, as your erection may last longer than is medically safe.Who can use self-injection therapy?You should ask your doctor if alprostadil is suitable for you. Your doctor will also be able to tell you how much alprostadil to use, depending on your condition and whether or not you are taking any other medications, and also how to use alprostadil properly.People with certain illnesses, such as leukaemia and sickle cell anaemia, or who have a penile implant or Peyronie’s disease, where the penis may be scarred and produces erections that are not straight, should not use alprostadil.Men for whom sexual activity is not advised should not use alprostadil.Side effects of injection therapyThe most common side effects of alprostadil include pain in the penis or bruising in the penis at the site of injection. Fibrosis (the development of fibrous tissue) can also develop following injections into the penis.The most serious side effect is priapism (a persistent erection), which is a medical emergency. Your doctor will inform you of what to do if you have an erection that persists for 2 hours or more. It is very important that you follow your doctor’s instructions and inform them that you have experienced this side effect.Vacuum erection devicesVacuum erection devices work by creating a vacuum, which increases blood flow to the penis, producing an erection.The penis is lubricated and placed inside a hollow plastic chamber. Air is pumped out of the chamber, either manually or by a battery powered pump. This creates a vacuum which pulls blood into the penis to cause an erection. This takes about 5 minutes.Once the penis is erect, the man fits a rubber ring around the base of his penis to keep the blood trapped inside the penis when the cylinder is removed. After intercourse, the ring can be removed to return the penis to a limp state.Vacuum erection devices avoid surgery and can be used as often as required. However, they may be difficult to use, and many men and their partners feel they take much of the pleasure and spontaneity away from sexual activities. Vacuum pumps are not suitable for men who have problems with blood clotting, or blood disorders such as leukaemia.Penile implant surgery for impotencePenile implant surgery is not a common procedure but in some cases it may be the most appropriate treatment for erectile dysfunction.The procedure involves placing an implant inside the penis, along its length, so that it can become erect. The implant may be a pair of semi-rigid rods or a pair of inflatable cylinders.The inflatable implants allow the penis to look and feel limp (flaccid) or erect, depending on how much the cylinders are inflated. The cylinders in an inflatable implant are hollow, and the man gets an erection by squeezing a pump located in his scrotum to fill the cylinders with salt water (saline) stored in a reservoir implanted in his lower abdomen. A release valve drains the saline out of the cylinders and back into the reservoir.With the semi-rigid, malleable rod type of implant, the rods run along the length of the penis and can be bent upwards to produce an erect penis, or downwards when an erect penis is not required.Like all surgery, there are some risks, such as infection or bleeding. If you have had surgery and have severe pain, fever, swelling or excessive bleeding, you should contact your doctor as soon as possible.Vascular surgery for erectile dysfunctionIn cases where a man’s anatomy prevents blood flow into or out of the penis, vascular surgery may be an option. This treatment option is rarely recommended, and is usually only successful in younger men.If there is a blockage that prevents blood from flowing into the penis, a doctor may recommend an operation that bypasses the blocked blood vessels, using a length of vein or manufactured tubing, to allow more blood to flow into the penis and help produce an erection.If the problem is that blood leaks back out of the penis, this can be corrected by tying off the major veins that drain the penis, a procedure known as venous ligation.Hormone treatments for impotenceIn a small number of men, blood tests may show abnormally low levels of testosterone, the male sex hormone. In such cases your doctor might prescribe a course of testosterone injections or a testosterone implant. The supplements can help boost sex drive as well as increasing the ability to have erections. Testosterone gel or patches, applied daily to the skin, are another option.Complementary medicines for erectile dysfunctionThere is a lack of scientific evidence supporting the effectiveness of complementary therapies for the treatment of impotence.Always check with your doctor before taking any herbal medicines or supplements for impotence. These formulations may contain ingredients that can interact with other medicines or cause dangerous side effects.Counselling for men with impotenceErectile dysfunction often has physical causes, but sometimes there is a psychological basis for erection problems. Often this is a form of performance anxiety. A man may have had an episode of erectile dysfunction due to some passing cause like fatigue, stress, relationship difficulty or intoxication. This may have led to embarrassment or a feeling of failure. Even if the physical cause does not remain, future attempts to have sex may trigger memories of this embarrassment and acute anxiety that it will happen again. This anxiety itself is capable of causing erectile dysfunction, and so a man may get trapped in a self-reinforcing cycle of anxiety and erectile dysfunction. In these instances, seeing a GP, counsellor or psychologist can be very helpful.Stress, anxiety, depression and low self-esteem, in fact, almost all significant emotional problems, can have a major effect on sexuality. So do many chronic physical illnesses, even if they don't directly affect genital function. Counsellors and psychologists can assist with these and a wide range of other sexual and relationship problems and can also help female partners suffering from sexual problems. They are particularly skilled in helping patients to overcome guilt or anxiety relating to sexual abuse, and in helping couples to sort out relationship difficulties. Simple problems can be dealt with in a few visits, but more complex problems may require several months or even years of therapy.Your doctor may be able to recommend a psychologist or counsellor who specialises in sexual and relationship problems. Last Reviewed: 12 December 2016
Testosterone replacement therapy may improve energy, mood, and bone density, increase muscle mass and weight, and heighten sexual interest in older men who may have deficient levels of testosterone. Testosterone supplementation is not recommended for men who have normal testosterone levels for their age group due to the risk of prostate enlargement and other side effects. Testosterone replacement therapy is available as a cream or gel, topical solution, skin patch, injectable form and pellet form placed under the skin.
Finally, there are NO-releasing polymers that are capable of delivering NO in a pharmacologically useful way. Such compounds include compounds that release NO upon being metabolised and compounds that release NO spontaneously in aqueous solution. Initial animal studies suggest that cavernosal injections of NO polymers can significantly improve erectile function.48
Several pathways have been described to explain how information travels from the hypothalamus to the sacral autonomic centers. One pathway travels from the dorsomedial hypothalamus through the dorsal and central gray matter, descends to the locus ceruleus, and projects ventrally in the mesencephalic reticular formation. Input from the brain is conveyed through the dorsal spinal columns to the thoracolumbar and sacral autonomic nuclei.
A meta-analysis of 36 744 men with ED in 12 prospective cohort studies found that the presence of ED significantly increased the risk of CVD, CAD, stroke and all-cause mortality, and the presence of ED was an independent risk factor for CVD. Ponholzer et al found that men with moderate to severe ED had a 65% increased relative risk for developing symptomatic CAD compared with men who did not have ED.26
The pathogenesis of organic ED is related to dysfunction of the endothelium. Endothelial cells can become injured through a variety of mechanisms, most of which cause oxidative stress on the tissues. Many of these causes of oxidative stress are related to lifestyle issues which lead to hypertension, diabetes and dyslipidaemia (figure 1). Endothelial cell dysfunction results in reduction of endothelium-dependent vasorelaxation as well as increased adhesion of leukocytes to the endothelium. Endothelial cell injury then leads to a variety of sequelae, including ED, other types of vasoconstriction, atherosclerosis and thrombus formation.18
As is true in so many medical conditions, lifestyle modifications, considered first-line therapy, can have a salutary effect in ED management, and men should be encouraged to make the necessary changes to the benefit of their sexual function and to their overall health as well. Despite the benefits of behaviour modification, men presenting with ED want the physician to help with measures that can have an immediate impact.
Erectile problems can happen to men of any age. There are many factors that contribute to ED including poor health, untreated medical problems, medications and pornography use. Many men struggle with understanding when they are experiencing situational sexual dysfunction verses when is your erectile issue an ongoing problem that requires medical help.
The recommended starting dose of vardenafil is 10 mg taken orally approximately one hour before sexual activity. A doctor may adjust the dose higher or lower depending on efficacy and side effects. The maximum recommended dose is 20 mg, and the maximum recommended dosing frequency is no more than once per day. Patients can take vardenafil with or without food. As with sildenafil, for vardenafil to be effective, sexual stimulation must occur.
The obvious risks are the same that accompany any surgery: infection, pain, bleeding, and scarring. If for some reason the prosthesis or parts become damaged or dislocated, surgical removal may be necessary. With a general success rate of about 90 percent, any of the devices will restore erections, but they will not affect sexual desire, ejaculation, or orgasm.
In a 2005 study, three months of twice-daily sets of kegel exercises combined with biofeedback and advice on lifestyle changes, such as quitting smoking, losing weight, and limiting alcohol, worked far better than just giving the participants advice. “Wearing tight pants will affect impotence along with some other medical conditions like diabetes and heart disease,” which can also affect a man’s degree of impotence, Dr. Jennifer Burns, specializing in family practice with an emphasis on gastrointestinal health at the BienEtre Center, told Medical Daily.
Cardiovascular diseases: The most common cause of cardiovascular diseases in the United States is atherosclerosis, the narrowing and hardening of arteries that reduces blood flow. Atherosclerosis (a type of vascular disease) typically affects arteries throughout the body; hypertension, high blood cholesterol levels, cigarette smoking, and diabetes mellitus aggravate atherosclerosis. Hardening of the arteries to the penis and pelvic organs, atherosclerosis, causes insufficient blood flow into the penis. There is a close correlation between the severity of atherosclerosis in the coronary arteries and erectile dysfunction. For example, men with more severe coronary artery atherosclerosis (hardening of the arteries in the heart) also tend to have more erectile dysfunction than men with mild or no coronary artery atherosclerosis. Some doctors suggest that men with new onset erectile dysfunction undergo evaluation for silent coronary artery diseases (advanced coronary artery atherosclerosis that has not yet caused angina or heart attacks).
All NOS subtypes produce NO, but each may play a different biologic role in various tissues. nNOS and eNOS are considered constitutive forms because they share biochemical features: They are calcium-dependent, they require calmodulin and reduced nicotinamide adenine dinucleotide phosphate for catalytic activity, and they are competitively inhibited by arginine derivatives. nNOS is involved in the regulation of neurotransmission, and eNOS is involved in the regulation of blood flow.
Begot, I., Peixoto, T. C. A., Gonzaga, L. R. A., Bolzan, D. W., Papa, V., Carvalho, A. C. C., ... & Guizilini, S. (2015, March 1). A Home-Based Walking Program Improves Erectile Dysfunction in Men With an Acute Myocardial Infarction. The American Journal of Cardiology, 115(5), 5741-575. Retrieved from http://www.ajconline.org/article/S0002-9149(14)02270-X/abstract
Supplements are popular and often cheaper than prescription drugs for ED. However, supplements have not been tested to see how well they work or if they are a safe treatment for ED. Patients should know that many over-the-counter drugs have been found on drug testing to have ‘bootlegged' PDE 5 Inhibitors as their main ingredient. The amounts of Viagra, Cialis, Levitra or Stendra that may be in these supplements is not under quality control and may differ from pill to pill. The FDA has issued consumer warnings and alerts.

domain: biology


text:
Toko Buku Bekas Online Aksiku menjual Buku Import Modern Garden Design.
Judul Modern Garden Design
Editorial Coordinator: Simone K. Schleiffer
Tebal: 575 halaman Full Colour, Art paper.
Harga Buku: Rp. 200.000,-HABIS
Berat Buku: 3660 gram
Penerbit: LOFT Publications
Terbit tahun: 2011 Cetakan ke 1
Kulit Muka: Hard Cover
Kondisi: Cukup Bagus (Buku Bekas/Kondisi fisik sesuai foto)
This book presents a selection of the green spaces around us from our own homes to the areas of plant life that give shape to our cities. Gardens, patios, balconies, Inner courtyards, parks, squares, avenues and vegetated buildings are just some of the examples included. In addition, the book also offers a number of tips for planning a garden, opening up the range of possibilities to any type of outdoor location.
the gardens featured provide an invaluable guide to help us appreciate the beautiful green sapces that surround us. Whether we live in the country or in the city, learning to value our immediate surroundings is the best guarantee for a sustainable future.
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domain: library


text:
Discussion Paper Assignment | Homework Help Websites
What are important interventions and programs for environmental health in Saudi Arabia? How are public health interventions planned and evaluated for environmental health? From Arab News (2014), Riyadh was ranked one of the most polluted cities globally according to the UN. How can air pollution in Riyadh be resolved by public health intervention?
please include in text citation and use the references below
MOH. (2016). Environmental and occupational health general department. Retrieved from: https://www.moh.gov.sa/endepts/EnvironmentalHealth/Pages/default.aspx
Milaat, W. A. (2014). Public health in the saudi health system: A search for new guardian. Saudi Journal of Medicine and Medical Sciences, 2(2), 77.
Kingdom of Saudi Arabia vision 2030 (2016). Saudi vision 2030. Retrieved from:
Skolnik, R. (2015). Global health 101. (3rd ed.). Burlington, USA: Jones & Bartlett Publishers
The Isosceles Group. (2014). Saudi Arabia environment, health & safety profile and checklist. Retrieved from: https://nimonik.com/case_studies/audit_previews/ksa_audit_preview_health_safety_environment.pdf
Arab News (2014). Riyadh ranked among most polluted cities globally. Retrieved from: http://www.arabnews.com/news/538861

domain: health


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GDPR for websites
The General Data Protection Regulation (GDPR) has significantly changed the way in which companies collect, process and store personal data. This applies in particular to Websiteswhich often include a large number of personal Record data.
In this blog post, we will go into detail about the steps companies should follow to GDPR compliance on their website.
From transparent Data protection declarations through to the integration of third-party tools - here are the key aspects that need to be considered.
1. transparent privacy statements:
A clear and understandable Data protection is not only a legal requirement, but also a signal of trust for visitors to the website. The company must clearly state which Data are collected, how they are used and with whom they are shared. This should also apply to third-party providers who are on the Website are integrated.
2. lawful data collection and processing:
Data collection must be lawful, transparent and accessible to the Purposefor which it is collected. Companies must ensure that they only collect the data that is absolutely necessary. Obtaining explicit Consent from the Users is crucial, especially when Third-party tools how analysis or marketing plug-ins collect data.
Cookies and similar technologies require clear Consent from the users. Companies must not only informwhich cookies are used, but also offer the possibility to delete them. accept or to reject. This applies both to First-party cookies as well as for third-party cookies that are integrated on the website.
4. security and privacy by design:
Data protection should be an integral part of the Website development be. Companies must ensure that the website is secure and that personal data is protected by Encryption and others Security measures are protected. This also includes third-party tools that are used on the website. It is important to check the security guidelines and data protection standards of these tools.
5. handling third-party integrations:
Third-party tools are often an integral part of websites and can collect personal data. Here are some examples of Third-party integrationswhich are often found on websites:
- Google Fonts: When Google Fonts are used on the website, data is transferred to Google. Companies should ensure that this is done in compliance with the GDPR.
- YouTube videos: When YouTube videos are embedded, cookies from YouTube may be placed on the page. Users should be informed about these cookies.
- Facebook Pixel: Companies that use the Facebook Pixel for advertising purposes must ensure that they obtain users' consent and provide transparent information about how the data will be used.
- Google Analytics: Google Analytics collects user data for website analysis. Companies must ensure that they activate the anonymization function of Google Analytics and inform users about this.
Risks and solutions
It is important to emphasize that The companywho do not have their website GDPR-compliant design, with sensitive Penalties have to reckon with. These penalties can be considerable and range from Fines up to legal Consequences.
For this reason, it is crucial that companies Data protection regulations continuously monitor and ensure that their Website and all associated third-party tools meet the highest Standards with regard to Data protection and Security correspond.
This is the only way they can ensure a positive user experience while meeting legal requirements.
GDPR compliance of websites requires a thorough review of all aspects of data collection and processing, including third-party integrations. Companies that ensure their website is in compliance with the GDPR guidelines are not only legally secure, but also gain the trust of their visitors.

domain: law


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Batsmen who have both good front foot and good back foot games, have much better chances of doing well all over the world.
And Shubman Gill fits the bill. He is obviously a top batting talent as everyone knows.
He comes across as a very international-type batsman with some old school qualities. Pluses ----
• Plays the ball under his eyes.
• Has a rather early back and across trigger movement.
• Gets a lot of time to play quick bowlers.
• Decisive foot work, both front and back.

domain: hobby


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By HockomockSports.com Staff
2019 Hockomock Softball Preview
2018 Record: 9-12
2018 Finish: Reached D1 South Preliminary Round
Coach: Mark Homer
After back-to-back playoff appearances, the expectations are high around the Attleboro program this spring. The Bombardiers return eight of nine starters from last year’s team and the lineup should be loaded with good hitters, as well as multiple players who can step into the circle and produce a good start. With the depth on the roster this season, Attleboro will be eyeing another postseason berth.
Senior McKenzie Bergdoll is one of the top power hitters in the league and will be back for another spring in the heart of the Attleboro lineup. She will be joined by classmates Jordyn Lako and Kayla Battisti as starters. Junior Makenzie Killough will be back at shortstop and also batting cleanup and providing protection for Bergdoll in the order. Sophomore Lora Woyton returns behind the plate, sophomore Autumn O’Connell will be in center and batting second and junior Ashley Macia will be out in left. Sophomore Brenna Morse will be taking over in rightfield. In the circle, Attleboro has plenty of depth with juniors Emily and Jenna Gittle and Bergdoll all able to step in. The Bombardiers will try to take advantage of their overall team speed and head coach Mark Homer said there are a few freshmen who may see playing time right away.
“The bar was set high from last season,” said Homer. “So the girls are onboard to perform well again this season with high hopes of competing in every game they play. They have set some goals to achieve one a\t a time. I am cautiously optimistic with our chances of winning more games this season than we have in the past. Knowing that there are no easy games on our schedule so we have to come to play every night.”
2018 Record: 8-13
2018 Finish: Reached D2 South Quarterfinal
Coach: Dave Bohane
Canton had quite the turnaround in 2018 under second-year head coach Jennifer Robillard, winning eight games, seven more than in 2017, and making a return to the state tournament. Robillard, last season’s HockomockSports.com Coach of the Year, has moved on to a position at Bentley and football coach Dave Bohane has taken over a team that has seen an influx of young talent and has momentum on its side heading into the spring.
Junior pitcher Caroline Hughes is one of the reasons for optimism in the program, as she is looking to build off a strong sophomore season in which she pitched almost every inning. Hughes was also one of the team’s top hitters and she will be at the heart of the lineup along with sophomore outfielder Liz Bickett, who batted .409 last season. Bickett is just one of several sophomores who the Bulldogs will be counting on, including infielders Olivia Lanci and Sarah Kelly, catchers Steph Trendell and Amanda Vrabel. Junior catcher Jackie Howard and seniors Haley Donovan and Ally Chin will provide leadership for this young group to try and get the Bulldogs right back into the state tournament mix.
“I am very excited to be coaching this team,” said Bohane, who has previously served the program as an assistant coach. “They are extremely hard working and devoted to the program. I think they will set the standard for our future players who come through the program. It’s a very tough league, but we will take it one game at a time and try to improve each game”.
2018 Record: 11-12
2018 Finish: Reached Div. 2 South Quarterfinal
Coach: Mark Maguire
Foxboro made a run in the Div. 2 tournament last season, winning a pair of games before being knocked out in the quarterfinals, and the Warriors will hope to build on that exciting finish to 2018 by making a run at the Davenport crown this spring. Even with the loss of catcher Hannah Davis, who was instrumental in the team’s playoff run, Foxboro has a strong returning core and some talented young players stepping in to give head coach Mark Maguire confidence ahead of the new season.
Senior Emma Rohan will be back in the circle for her fourth year as the Foxboro starter and she has the experience of pitching in a number of big games and against the top teams in the league. Senior Cam Willis will play first this season, but can also step in and pitch if needed along with junior Amelia Stowell. The pitchers will have a rookie to throw to, as freshman Allie Willis will be stepping in behind the plate. Sophomore Morgan Sylvestre returns at shortstop after a strong first season on varsity and will be one of the leaders of the infield. Senior Chelsea Gibbons is at third base and freshman Peyton Feldman takes over at second. Sophomore Nicole Theriault will be in centerfield but can play a number of positions, senior Riley Martignetti gives the team pop from the right side of the plate, and senior Jill Finn can play all three outfield positions.
“Preseason is going great as the girls are working very hard to be ready for the season,” said Maguire. “We have a group of girls who work hard. I think team defense should be good with our senior leadership, and the younger players who aggressively look to make plays in the field. I have high expectations for this team, as we look to compete for a Davenport title and gain a state tournament berth.”
2018 Record: 9-11
2018 Finish: Missed Playoffs
Coach: Kate Fallon
Franklin has consistently been right behind perennial league leaders Taunton and King Philip in the Kelley-Rex division standings but has narrowly missed out on the playoffs by a single win in each of the past two seasons. This year, the Panthers have eight seniors coming back with the goal of getting the team back into the postseason and use a typically tough schedule to prep for a tournament run.
Pitching will be a strength for the Panthers this year with seniors Jackie Cherry and Emily Valentino giving the team depth and different options in the circle. Throwing strikes will be the key for both and limiting opposition base runners. Behind the plate, Franklin has plenty of experience as well with seniors Ally Shea and Maggie Hobby both capable of stepping in and handling the pitchers as well as providing power at the plate. Senior Tara Hartnett will be back at shortstop and provides strong defense up the middle. Junior Anna Balkus will be in centerfield and will set the table for the offense as the lead-off hitter. Junior Maddy White will be at third base and joins Shea and senior Kylie-Jade Bouzan as the team’s primary run producers.
“We are excited to see the Panther players on the field again,” said Franklin coach Kate Fallon-Comeau. “Overall our tough league and non-league schedule will keep us focused for tournament and we will rely on our solid pitching and defense.”
2018 Record: 21-4
2018 Finish: Reached D1 South Final
Coach: Norm Beauchemin
Every season King Philip loses important players and every season the Warriors seem to be right back in the mix for the league title. This spring should be no different. KP will have several important players to replace in the lineup, but it expects to challenge for a 12th title in the past 13 seasons and also make another tournament run, following last year’s South final loss to Kelley-Rex rival Taunton.
Meghan Gorman is the player to watch for the Warriors this season, as the senior shortstop is one of the top defensive players in the state and also the spark plug at the top of the lineup. Senior Faith Turinese will move from the outfield into the circle and will split time with classmate Heather Nix as the top pitchers for the Warriors. Turinese also batted over .400 last year and will be an important bat in the middle of the order. Junior Destiny Goyco will step in behind the plate, after overcoming an injury from basketball season, and fellow junior Liliana Rolfe will take over at third. Grace Kelley will be at second base and Anna Bradley will be at first. The outfield will be filled with speed, including Kara McWhinnie in left, sophomore Paige Berdos in center, and either Ryan Stagg or junior Reaegan Simeone in right.
“One to nine, everyone hits the ball,” said KP coach Norm Beauchemin. “I’m looking forward to another solid season. The league overall is going to be very competitive, so it should be fun.”
2018 Record: 7-13
2018 Finish: Missed Playoffs
Coach: Lori Letendre
Mansfield is looking to bounce back from a tough 2018 season in which the Hornets struggled in the Hockomock (going 4-12 in league play) and missed the playoffs. This year, Mansfield hopes for a quick turnaround and return to the state tournament with an experienced roster that brings back 11 players, seven starters, and seven seniors from last season.
The battery of senior pitcher Sarah Cahill and senior catcher Caty DeMassi is back and should give the Hornets a good foundation on which to build on this season. Seniors Megan Letendre and Kara Bendanillo will hold down the left side of the infield and provide pop in the middle of the lineup, while Mady Bendanillo returns in centerfield to give Mansfield a dynamic defensive player and another strong bat. There is an influx of youth as well with two sophomores and a freshman jumping into varsity and having the chance to contribute right away.
“Our goal is to make it back to the tournament this year and with strong leadership from our captains and our seniors, I think we will have a good shot at it!” said Mansfield coach Lori Letendre.
2018 Record: 18-3
2018 Finish: Reached D1 South First Round
Coach: Steve DiVitto
The biggest question for Milford is how do the Hawks move on from a group of 10 seniors that won a combined 79 games, four league titles, and the 2017 state championship? Milford has been the team to beat in the Davenport division for six years and a relatively inexperienced group will have to face a season in which the target for every team in the league is squarely on their backs.
Junior Megan Hart is one of the primary options to replace Kelley Reichert in the circle to start the season, with freshman Olivia Morelli showing potential to step in and contribute innings right away. Senior Lucy Creedon can step in at first or in the outfield. Junior April Swain will jump into the outfield along with classmate Taylor Waldrup, while junior Amanda Wenckus can play either position on the left side of the infield and sophomore Carly Ferreira can play either corner infield spot. Sophomore Elise Fauerbach can play behind the plate or in the outfield, while her classmate Natalie Casilli will take an outfield spot. There are a lot of spots to fill this year, but head coach Steve DiVitto is talking about that as an opportunity for a new group of players to step into.
“We understand that lack of experience is something that we will need to combat with, however the bar will continue to be set high!” DiVitto said. “Each year a new page is turned over, and as always the focus is: what’s your legacy going to be? Keeping our awesome team chemistry will be an important part of this season. We’re excited for the challenges of playing in the best league in the state!”
2018 Record: 16-5
2018 Finish: Reached D1 South First Round
Coach: Bill Wallace
Two seasons ago, North Attleboro was a young team that made a surprise trip to the South semifinal, but this year the Rocketeers will have much higher expectations. North is now the experienced team in the Davenport division and has aspirations of unseating Milford and winning a first league title since 1990 and adding to the league’s recent history of strong tournament performances with another deep run.
Junior pitcher Bella Erti will be one of the league’s top pitchers again this season, after a 15-5 sophomore season in which she struck out 137 batters. She also hit .357. Junior Ashley Cangiano is also back for her third year as a starter and is one of the top catchers in the league. Abby Gallagher returns to the North outfield after hitting .500 last season as a sophomore and senior Olivia Capobianco will be back in centerfield and the middle of the North lineup. Freshman Mandi Hanewich and sophomores Emma Bailey and Belle Clarkin will compete for the third outfield spot after impressive preseasons. Senior Katie Daby is at first, while sophomore Emily Nardelli moves from shortstop to second base. Junior Alex Moulson takes over at short and her classmate Annabelle Hebard will be at third. Emily Bedard and Makenzie Nardelli add to North’s infield depth and Alivia Byrne will give Erti a rest in the circle and is another big bat in the lineup.
“We will need to be more multi-dimensional, as late in the year we couldn’t sustain our offensive start to the season,” said North coach Bill Wallace. “This group really wants to make their mark on the league and they know how much work that is going to take.”
2018 Record: 3-17
2018 Finish: Missed Playoffs
Coach: Lindsey Allison
Last season was a struggle for the Tigers, with only three wins and head coach Lindsey Allison is hoping that a group of younger players can add to the returning core and make a push to get Oliver Ames back into the state tournament. Allison is confident that the offense will get into the swing of things for the Tigers after scoring only 66 runs last season, second-lowest in the league.
Senior Kayla Georgeu will be back in the circle for OA and in the heart of the lineup. The Tigers will count on sophomore Emma Varella to provide some innings at pitcher, as well as playing in the infield. Senior first baseman Katie Mills is a big bat for the Tigers and junior Katie Abreu can step in at either shortstop or centerfield depending on the game to provide vocal leadership. Sophomore Grace Simone will be behind the plate this season.
“Every spot is open for the taking and there are many young players who are hungry to be on the field,” said Allison. “This group of players seem like a team – not just a group of individuals. They compete with one another for positions, but also support each other. They hold each other accountable and communicate. I am excited to see what hard work can accomplish this season.”
2018 Record: 0-20
2018 Finish: Missed Playoffs
Coach: Heather Poliferno
It was definitely a rough debut season for Sharon coach Heather Poliferno, but it was also a chance for a number of young players to get experience at the varsity level. This spring, there is renewed enthusiasm with a crop of underclassmen joining the experienced players to give Poliferno and the Eagles confidence for a much better spring.
Freshman Trinity Payne is the player to watch for the Eagles this season as she takes over as the starting pitcher and has already drawn the attention of coaches in the Davenport division. She will be used at a couple of different positions and gives the Eagles versatility in the lineup. Senior Alli Small will be back at shortstop this season, while classmate Jody Goldenberg is back at first, and senior Rebecca Clayman will be the leader of the outfield group. As the program is growing, Sharon is hoping for much different results this season.
“We are very excited for this season!” said Poliferno. “We have many returning players leading our varsity team, as well as the addition of a very talented freshman class. Though we have only had a handful of practices, one of our clear strengths is our desire to be the best on the field.”
2018 Record: 7-13
2018 Finish: Missed Playoffs
Coach: Deb Parker
Stoughton struggled to find a groove in 2018 and ended up missing the playoffs under first-year head coach Deb Parker, who had made the switch from Sharon before last season. This year, the Black Knights bring back starters in key positions and once again have the potential to make a run at a state tournament berth and even challenge for the Davenport title.
Seniors Nikki Coppola (second base) and Jordan Lyons (shortstop) give Stoughton a strong combination up the middle and senior Karly Estremera brings plenty of experience at third base. Sophomore pitcher Nicole Baker will take over full-time in the circle this season and Parker is impressed by the work that she put in during the off-season to get ready. Baker will be throwing to an experienced catcher, as senior Brianna Ferrandiz is back behind the plate for the Black Knights. Junior Lexi Baptista will lead the outfield crew in center and could also be one of Stoughton’s top hitters this season. Freshmen Melody Casna and Sydney Menz will give the Black Knights versatility by playing multiple positions.
“This team has come together so quickly, it is a real tribute to the leadership of our captains,” said Parker. “This team knows what they are playing for this year and we have high expectations going into the season. Softball in the Hockomock League is incredibly competitive but if we continue to work hard, we should have a great season.”
2018 Record: 26-2
2018 Finish: Won D1 State Championship
Coach: Dave Lewry
How do you follow up a state championship? For Taunton, it just may be to make a run at a repeat. The Tigers lost the second, third, and fourth hitters in the lineup (including league MVP and HockomockSports.com Player of the Year Kya Enos), who combined for 88 RBI, but there is a ton of talent coming back from last season, all of whom contributed at one point or another during Taunton’s run to the title.
It starts in the circle where sophomore Kelsey White will be the starter again this season after going 16-2 as a freshman and pitching every inning during the playoff run (not to mention batting .418). Her sister Alexa will also see time at pitcher, along with freshman Olyvia Mendonca, but will also play most of the season in centerfield. The infield will be a strength for the Tigers, with all four players back. Senior Jaime Brown (batted .469) is back for her fifth year at third base and is one of the top hitters in the league, sophomore Hanna Aldrich (.385 average with four homers and 30 RBI) is in her third year at shortstop and was this site’s Underclassman of the Year in 2018, sophomore McKenzie McAloon returns at second base for her third season, and junior Paige Silvia is back at first. Silvia and junior Riley Murphy are also in the running to replace Enos behind the plate, while junior Abbie McDonough takes over in left and eighth-grader Ava Venturelli could start the season in right.
“While we lost three outstanding players to graduation, I am excited about the potential of this year’s team,” said Taunton coach Dave Lewry. “We have a good nucleus of returning players looking to defend our D1 state championship.”

domain: news


text:
Locals is a start up located in Lund in Sweden. Locals.se offer home delivery as well as pre-ordering products from local shops. You can also browse around on their app and website to be inspired and discover the city's unique selection.
In this project seven Hyper Island students recreated the whole brand, including colors, typography, pictures, illustrations and tone of voice. Which all were presented in a Brand Strategy Book.
Keywords: Branding & Graphic Profile
My role: Ideas, design and illustrations

domain: design


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On his first role for ‘The Beachcombers’
As Kid on ‘Leo and Me’
Hanging with Todd Bridges on ‘High School U.S.A’
Being an idol to all young republicans on ‘Family Ties’
Being a Maine camp counselor in ‘Poison Ivy’ (WATCH THE RIFF ON THIS MOVIE AT THE END OF THIS POST!)
A time traveling rock star and a crazy scientist? Sounds like a silly movie… Or the best movie of all time. ‘Back to the Future’!
As a car surfing basketball playing winning in the end Werewolf in ‘Teen Wolf’
As a rock star in ‘The Light of Day’
Rocking ‘The Secret of My Succe$s’
As a coked out writer in ‘Bright Lights Big City’
A soldier in ‘Casualties of War’
As an actor shadowing a cop in ‘The Hard Way’
As Big City Doctor in ‘Doc Hollywood’
A prosector on ‘Tales from the Crypt’
As Chance in ‘Homeward Bound’
As a Child Talent booker on ‘Life With Mikey’
‘For Lover Or Money’ as a smooth talking hotel manager.
‘Where the Rivers Flow North’
as a bowler in ‘Greedy’
‘Don’t Drink the Water’ as a part of a USA Embassy.
‘Blue in The Face’
‘The American President’
Cameo in ‘Your Studio and You’ directed by Trey Parker.
Working with ghosts in the ‘Frighteners’
as Mike Flaherty in ‘Spin City’
‘Atlantis: The Lost Empire’
‘Interstate 60’ as Mr. Baker
As Gandhi’s Remaining Kidney in ‘Clone High’
As a Doctor on ‘Scrubs’
on ‘Boston Legal’
On ‘Rescue Me’
On ‘The Good Wife’
As Michael (what a stretch) on ‘Phineas and Ferb’
As himself on ‘Curb Your Enthusiam’
Joe and Dave tackle the made for TV movie “Poison Ivy’ starring the great Michael J Fox. Find out why Michael J Fox is a pimp even before he time traveled, Why no one likes Timmy, Why Jason Vorhees is stalking this camp and How awesome American Gladiators was.

domain: artistic


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One dies, two injured in Lagos-Abeokuta expressway accident
A fatal auto accident along Lagos-Abeokuta expressway claimed the life of one person and two others sustained serious injuries.
This report was confirmed by the Ogun Command of the Federal Road Safety Corps (FRSC) on Tuesday.
According to the Ogun FRSC Sector Commander, Clement Oladele, the accident occurred at about 12.45 a.m at the Toll-Gate, Sango-Ota, on the Lagos-Abeokuta expressway.
Oladele said a MAN Diesel Truck with registration number AAA-515 XM was heading to Lagos from Abeokuta when it lost control due to brake failure and rammed into a Mazda Space wagon bus marked GGE-250 BB.
He said five persons were involved in the accident; one died while two sustained injuries.
“The corpse of the victim had been deposited at the morgue of the Ifo General Hospital, while the survivors were taken to the General Hospital, Sango-Ota, for an intensive treatment,’’ he said.
The sector commander said that normalcy had been restored to ease the free-flow of traffic in the area.
Oladele, however, advised motorists to be cautious and refrain from acts that could lead to loss of lives and property on the roads.


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On Monday, March 2nd, Atlantic celebrated a Company milestone at the Pierre Hotel with our 30th Anniversary Gala. The Gala was hosted by Founding Ensemble member Felicity Huffman and honored longtime Atlantic supporters Charles Bendit and Paul Pariser, Co-CEOs of Taconic Investment Partners. Gaye Slater Gross and Deborah Magid served as Board Co-Chairs, Shai and Abigail Tambor as Patron Chairs, Atlantic Board member Wolf Hengst as Auction Chair and Bill Wrubel as Ensemble Chair. The evening featured cocktails, a live auction, a seated dinner and special musical performances by Atlantic friends and alumni like David Yazbek, Matthew Morrison, Mare Winningham, Ingrid Michaelson and members of the casts of Found and Spring Awakening. All proceeds will help fund our arts education programs, Mainstage and Stage 2 productions and new play development. And for the first time in our history, the Gala raised over a million dollars to support these endeavors! It was a wonderful and successful kick-off to our recently announced 30th Anniversary Season.
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2016 | Diciembre 15
The 2016 International TMT Dispute Resolution Survey, sponsored by Pinsent Masons LLP, is the seventh survey carried out by the School of International Arbitration since 2006. It is part of a major investigation into international dispute resolution practices and trends worldwide.
In relation to dispute resolution policies and preferences, the survey data showed that arbitration continues to be encouraged, although mediation was the dispute resolution mechanism of choice for in-house respondents. At an all-respondents level, arbitration is the preferred mechanism but litigation was the most used.
This year’s survey, the largest industry-sector empirical study ever conducted in international arbitration, sought to map out and investigate the prevalent interests and preferences of TMT players and their approach to dispute resolution. The results collected reveal a wealth of information from practice areas which were, until now, underexplored.


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Senate Banking, HUAF
Dodd (left) and Shelby voted for seven-year bill.
Besides its 15-year length, the House bill adds group life to the insurance lines covered by the federal program. The House bill also requires insurers to provide coverage for nuclear, biological, chemical and radiological (NBCR) terrorist acts. The Senate committee bill, approved 20-1, doesn’t include group life and only calls for a Government Accountability Office study of NBCR insurance.
Industry wants Congress to act soon to extend the backstop, which expires on Dec. 31. “We just want to get a workable bill passed in time before the end of the year,” says a source.
Kelly Knott, Associated General Contractors’ government affairs director for labor, safety and risk management, thinks the House and Senate will compromise on the extension’s length. “It wouldn’t surprise me to see something around 10 years,” she says. But the administration already has compromised by accepting a seven-year extension and may not go any further. Knott thinks a bigger battle will be over NBCR. She says House and Senate negotiators will have a harder time finding middle ground on that issue.
Treasury Secretary Henry M. Paulson Jr. told banking panel Chairman Christopher Dodd (D-Conn.) and the committee’s top Republican, Richard Shelby of Alabama, on Oct. 17 that the administration believes the backstop program “should be phased out in favor of a private market for terrorism insurance.” He said the administration wants the new bill to reflect three key elements: It “should be temporary and short-term,” it should not be expanded and it should have higher “retentions” by the private sector. Dodd and Shelby voted for the committee bill.
Paulson said the administration will not oppose the banking committee bill, but warned if it moves “further away from our key elements, the President’s senior advisers would recommend that he veto the bill.”
The program was created by the 2002 Terrorism Risk Insurance Act in response to the 9/11 terrorist attacks. The 2002 law authorized the program for three years. Congress extended it for two years in 2005.bill to extend federal terrorism-insurance backstop coverage for seven years has cleared a Senate committee and was further boosted when the Bush administration said it wouldn’t oppose it. That gives the bill, which the Senate Banking, Housing and Urban Affairs Committee approved on Oct. 17, a leg up on the 15-year extension the House passed in September. That House version drew a White House veto warning.

domain: politics


Equipped with the new Intel Haswell processor, the model of MacBook Air could be the best MacBook model yet. Unfortunately for Intel, its long partnership with Apple will be interrupted somewhat by Cupertino’s upcoming mobile chip.
The Haswell may have delivered impressive battery life for Apple’s new laptop, but we could eventually see future MacBook models running the A8 architecture. The chip may not be able compete with the raw power provided by Intel’s new Core i technology, but the A8 is still appropriate for use on future low-power MacBook model.
Given time, Apple will further develop its microprocessor solution, but it is unlikely that the company can produce something powerful enough to run the MacBook. Previously, we saw the partnerships between Apple and Motorola dissolved, as the company was able to produce reliable mobile chip series.


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As soon as the summer season rolls in, Chicagoans flock to rooftops and patios to soak up on the sun (and sangrias). While Chicago locals have their favorites—like Cindy’s and Cerise—give these 6 new rooftops a chance and they're sure to top your list of favorites.
160 E. Pearson
The Ritz-Carlton’s food and beverage program recently underwent a massive overhaul as part of the hotel group’s $100 million renovation project. Along with this came the Rooftop at Torali, a modern rooftop bar and lounge located at the 12th floor of the Water Tower Place. The menu features Italian-inspired bites, handcrafted cocktails (the Torali Frosé is a must!) and a rotating craft beer list, which guests can enjoy while admiring the beautiful views of the city.
The Rooftop at Torali comfortably accommodates up to 125 guests for private events.
324 W Chicago Ave
Taking over the space Parliament left behind is Bounce Sporting Lounge, a New York lounge that brought its sports-bar-by-day and dance-club-by-night concept to Chicago. The bar recently opened its rooftop patio for the summer, which features innovative bleacher seating facing the bar. Must-try drinks are the Story of OJ, which is vodka with kaffir lime, blood oranges and ginger, as well as Pretty in Pink, which mixes rosé, lemon, sugar, and vodka.
2101 N. California Ave
There’s no better combination than Tex-Mex and liquor and the Lonesome Rose on Logan Square knows this better than anyone. With a full food and drink menu of tacos, nachos, and frozen margaritas, as well as a cool millennial rose gold interior, this place is sure to be top of your Insta-worthy list. The bar also features a sidewalk patio and rooftop deck so you can bask in the sun (or take photos with perfect lighting!).
1112 N. State St
Located at the 18th floor of the Viceroy Chicago, Devereaux is a chic new addition from the Boka Group. Making its debut last September, the concept behind the bar is more opulent and grown-up (with 1960’s and 1970’s inspired decor) than sister bar J. Parker, but still keeps that element of fun with a boutique pool in the middle of the lounge.
2018 W. North Ave
A rooftop bar on the sixth floor of a building may not sound so impressive until you hear about the 180-degree view of the skyline it boasts of. Cabana Club, the Robey Chicago’s rooftop bar, has been dubbed “the casual bar of your dreams”. With no lines (unlike its sister bar Up & Up) and a guest-only outdoor swimming pool, Cabana Club’s resort vibe (replete with a Latin American-inspired food and drink menu) will have you relaxed in no time.
2018 W. North Ave
The group behind the Robey Hotel sure has a knack for conceptualizing the best rooftop bars. The Up Room (also known as Up & Up) on the 13th floor of the Robey Hotel is another rooftop to watch out for. It is smaller (only seats 35!) and feels more exclusive than its sister, Cabana Club, so there is always a wait. But once you get past that, prepare to be blown away by the stunning views of surrounding Wicker Park. There are also drinks like the Coyote, a blend of Ardbeg Scotch and grapefruit bitters, to get excited about. The Up Room does not serve food, but you're more than welcome to go to Cabana Club or Cafe Robey on the ground floor of the hotel if you're in need of a bite to prolong your rooftop drinking.
What are your favorite Chicago rooftops? Let me know in the comments!

domain: travel


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Six weeks ago, the CBC’s Katie Simpson reported that Canada’s former ambassador, David McNaughton, was “urging” the government to choose the acting ambassador, Kirsten Hillman. Hillman, a lawyer and trade expert by training and a long-time public servant, would be the first woman ever to hold the position.
A few days later, the Toronto Star’s Susan Delacourt framed the story differently. Hillman’s selection, she noted, “would fit well with what seems to be a depoliticization trend in Canada’s foreign affairs these past few weeks.” The last time a career public servant had served as Canada’s leading representative in Washington was 2005. Prior to that, it was 1989.
Both articles were products of sound reporting and analysis.
Canada has had 20 ambassadors to the United States since the position was created in 1943. That all 20 have been men is symptomatic of a still-strong old-boys club that continues to dominate political appointments processes across the country.
And in a minority Parliament, it makes sense to try to take the politics out of Canada’s most significant bilateral relationship.
Moreover, Hillman is impressive: smart, articulate, open, and fearless. She’s briefed my students a number of times and is on a short list of speakers who have left a lasting and overwhelmingly positive impression with me.
But the last line of Simpson’s piece hints at a different story: In his pitch, McNaughton was apparently planning “to point out that appointing a career diplomat to such an important role would send a positive signal to all of the foreign service.” (my italics)
That signal, for those unfamiliar with the politics of Canadian diplomacy, is that it will no longer be impossible to rise through the ranks of Global Affairs Canada (GAC) to a top position.
When the Trudeau government arrived in 2015, it announced that it would end its predecessor’s habit of parachuting partisan loyalists into major postings.
The Harper government’s approach had demoralized GAC officials. No matter how well they served their country, under the Conservatives, they would never rise to a position of serious influence. (Sure, they could become deputy minister of the department, but most diplomats join the foreign service to work abroad; they don’t aspire to a high-level bureaucratic position in Ottawa.)
At first, the Liberals seemed serious. When Ottawa announced 26 new foreign service appointments in July 2016, Maclean’s’ Shannon Proudfoot wrote: “The list is heavy on foreign service experience, short on overtly political appointments and pristinely gender balanced.”
Admittedly, the government has chosen its own (older, white, male) ambassadors to the United States and the United Nations. Those two files were top prime ministerial priorities and needed representatives who had already earned the personal trust of Mr. Trudeau.
But for the most part, the Liberals seemed to acknowledge that diplomacy was a learned skill. There was value in having experts representing Canadian interests abroad.
Less than a year later, two older, white, male former ministers, Stéphane Dion and John McCallum, were dispatched to Germany and China. Pretty soon, the Trudeau government faced the same criticisms that had been leveled at the Conservatives.
Today, to the best of my understanding, morale in the foreign service is hardly better than it was during the Harper years. Some might even call it worse, because of the disappointment caused by the Liberals’ broken promises.
Making Kirsten Hillman ambassador to the United States wouldn’t solve the morale problem overnight. But if her appointment came with explicit recognition that patronage diplomacy is hit-and-miss, while the best of Canada’s career diplomats rarely disappoint, it would be a move in the right direction.
And I can imagine few more deserving of being the face of such a move than Ambassador Hillman.
To learn more about the diplomatic process, take a look at the latest volume of the history of Canada’s Department of External Affairs by John Hilliker, Mary Halloran, and Greg Donaghy.
To be notified of the next blog post, follow me on Twitter @achapnick.
You can subscribe to my newsletter at https://buttondown.email/achapnick.


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By Chelsea Diana, Albany Business Review
A new, massive, digital sign measuring 65 feet wide by 4 1/2 feet tall greets commuters getting off the Northway Interstate 87. Pioneer Bank is emblazoned in green LED lights.
It is the latest addition as Pioneer finishes construction on its four-story, 60,000-square-foot headquarters near the corner of Wolf and Albany Shaker roads in Colonie, New York. The move is part of a three-year strategic plan to grow the bank, which was headquartered in Troy, and develop a regional brand.
"This will help us establish branding in a much more visible location," said CEO Tom Amell during an interview and tour of the new building, which is still under construction. "The design of the building and everything matches our new brand.”
The new headquarters stands at the corner of one of the busiest intersections in the Albany area with more than 60,000 cars passing by each day.