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Great to see the the new print release of 'Fellow Traveller' Magazine in China featuring a lovely article on my 'Words In Sight' series.
Dong Gang Photo Festival /
Sunny Art Prize /
Happy to have 'Unforgiven' shortlisted for this years Sunny Art Prize, the exhibition opens in London for the month of August at The Sunny Art Gallery, Grays Road London
Dodha Magazine /
DongGang International Photo Festival /
I'm currently preparing the artworks for this years DongGang Photo festival taking place in Seoul Korea from the 14th of July to the 1st of October, the images will be displayed outdoors throughout the city.
Kuala Lumpur Photo Awards & Festival /
Great to hear 'Eyes Shut' and 'The Hearts Shadow' have been selected to be exhibited during the photo festival in Kuala Lumpur in the WhiteBox Gallery, opening from the 9th-9th of September
La Galleria Pall Mall, London /
Great opening night at La Galleria Pall Mall, I was excited to see 'Night Owl' exhibited as a light box which looks very striking, if you're in the are pop by the gallery in the Royal Opera Arcade, London SW1Y 4UY. The show runs till June 10th
CONTEXT Art Fair New York /
Last few days of the art fair, I've a selection of pictures with Galerie Bruno Massa, Stand C309
Fathom Gallery Exhibition Los Angeles /
If you're in LA head to Fathom Gallery on 29th April - 27th of May for the 'Present But Not Involved' exhibition is association with Fabrik to see a selection of street photography, I am happy that 'Night Owl' will be exhibited.
Ashurst Art Prize /
I'm very excited to have my photograph 'Trying Hard To Breathe' shortlisted for the prestigious Ashurst art prize, I'm looking forward to the exhibition in May.
Feature Shoot Photography Awards USA /
I am very happy that my 'Windows Into Havana' series was selected by Susan Spiritus Gallery as the winner of this years Feature Shoot Photography Awards. I am now represented by her gallery for artwork sales in California, more updates to come!
Travel Photography Society Awards /
Delighted to have the photograph 'Night Owl' shortlisted for the Travel Photography Society Editor's Choice Award, it is due to be Exhibited in White Box Gallery and the Mandarin Oriental Hotel in Kuala Lumpur during May.
Head On Festival Australia | Portrait Prize /
I'm excited that my photograph 'The Hearts Shadow' has been shortlisted for the Portrait Prize at this years Head On Festival which is due to open in May, If you're in Sydney this May check it out.
Sony World Photography Awards, National Portrait Prize /
I'm delighted to announce my photograph 'The Road Less Travelled' won 2nd Place for the Sony Portrait Award Ireland
The Other Art Fair London /
If you are in London join me at The Other Art Fair from the 31st March - 2nd of April at Victoria House at Stand 90, where I'll be exhibiting new work for sale during the exciting fair presented by Saatchi Art. For free tickets follow and link and enter the code - GillianHylandComp http://bit.ly/2nRSmc0
International Photographer Of The Year Award /
Very happy to receive the 1st place gold award for my series 'Havana Life' featuring pictures of children shot in Cuba last year, to see the full selection of images follow the link : http://bit.ly/2kVpqxf
Art Narratives /
Next Few Days Art Narratives instagram will be posting some pictures from my 'Windows Into Havana" series
Art Below /
'Delusion" poster in Regents Park Tube London as part of Art Below
ArtRooms opens tonight at Melia White House Hotel London, and runs until midday on the 23rd of January, see link below for tickets. I'm exhibiting a selection of work in room 135.
National Geographic /
Happy to see the image 'Lost In Blue' was awarded and featured on the daily dozen for National Geographic
Tagsmart Artist Feature /
Thank you to the Tagsmart team for the article, I'm happy to announce that now all my artwork comes with limited edition certificates and is fully authenticated through their platfrom


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Reduce Maintenance Costs for Operational Efficiency
|Potential Value Gains – Maintenance Management
|Preventative maintenance cost reduction of 30% less than reactive maintenance
|Significantly reduce maintenance spend
Preventative Maintenance & Asset Maintenance Management
Maintaining equipment pro-actively such as testing, measuring and replacing parts are specifically performed to prevent faults from happening, to keep equipment in a working order and to extend the life of equipment. Unplanned maintenance as a consequence of failed equipment is very costly and can greatly impact on production downtime planning and scheduling. Corrective maintenance occurs after a piece of equipment has failed, and is neither prevented nor predicted. Unplanned maintenance costs results in lost production, higher part costs, and lost time for fixing the problem; costing significantly more than planned maintenance. Preventative maintenance can be planned, reducing the costs as shut down can be planned to coincide with production downtime. A Maintenance Management System (MMS) will manage day to day operating costs and eliminate extra capital expenditure. Productivity can be improved by minimising unscheduled equipment downtime, and getting maximum value out of your assets. Having real-time visibility of equipment faults/breakdowns, their frequencies, and root causes, will bring a fresh perspective to better manage maintenance activities, PM, resources, spare parts, and cost. The operations-related approach to managing maintenance activities delivers improved KPIs (Mean Time To Repair (MTTR), downtime, Preventative Maintenance (PM) intervals, Mean Time Between Failures (MTBF), labour, and parts). Preventative and reactive maintenance needs to be controlled and managed effectively so to keep equipment producing consistently high product quality. PM can help reduce costs, equipment failure, and production downtime, whilst increasing the longevity of equipment. Technologies that determine and record equipment failure are key to reducing unplanned downtime whilst increasing operational efficiency.
High Maintenance Costs
High maintenance costs can be experienced as a result of a number of things, such as; unplanned downtime, equipment faults, breakdowns and lost production from quality, time or speed. Determining how much, where and why the costs are occurring and establishing the root causes of high maintenance costs is the first step to managing and reducing these costs.
Spare Parts
Spare parts can be used in unplanned or planned maintenance activities, but costs can often spiral out of control. Even if equipment is operational, it may not be running at maximum speed, it may break down too regularly creating inconsistent product quality – which generates too much waste, uses more energy and disrupts planning and scheduling. Having real-time visibility into maintenance management operations will enable better management of spare parts for improved production schedules and product quality.
For further information about maintenance management systems please call us on 01274 599955 or email us here

subset: commoncrawl


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Neurontin Dosage For Hot Flashes
Hot flashes for neurontin dosage physical
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Durrie, MD, moderator Dr Durrie Iвd like to work with the panel a little bit. Most of these technologies are addressing issues related to unique delivery systems and selectivity of these systems for affected organs or diseases.


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Bacon Cheddar Jalepeno Pinwheels collage
Layered Lemon Jello Cups - jello cups are so fun, plus these are gorgeous!
Little Big Company | The Blog: A "Beauty Spa: Themed Party by Styled By Belle
Day After Wedding Brunch | DIY Donut Hole "Croquembouche" | Snippet & Ink | Bloglovin'
rainbow fruit plate
This would be cute for the bridal party the morning of the wedding.
More party ideas-chocolate dipped pretzel rods - any color to match party theme. Ribbon around container to match.
Candy Corn Jell-O Shots Recipe
MIni Cheese Balls on a Stick! Fun finger food from Flavour and Savour
As I was making the final food list for our Christmas party, I decided that I didn't have a decent way to serve the chips and guacamole. I do have this lovely bowl that I made in a pottery class several years ago, but it's on the small side. Good for veggies and dip, but …


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Viagra medication comes in several different strengths; click on the strength you need to view prices from pharmacies competing to earn your business.
Viagra 25 mg
Viagra 50 mg
Viagra 100 mg
Viagra General Information
Viagra equals the most recognizable brand name drug available for the treatment of male erectile dysfunction (ED). Male ED can be characterized by the incapability to reach and/or sustain an erection. Erectile dysfunction may be induced by a number of different medical and psychological conditions; however, it is treatable. Cardiovascular diseases, such as cerebrovascular accident (CVA), heart attack, or diabetes can be attributed to ED.
How Viagra works
The active component in Viagra is the drug sildenafil citrate. Viagra (sildenafil) is manufactured in a pill-form taken orally. Viagra represents an enzyme known as a phosphodiesterase inhibitor It works by transporting blood flow into the penis to support and extend an erection. Viagra can be used as needed, so one is not likely to miss a dosage. If a dose of Viagra gets skipped, it can be taken as soon as recalled. If it is close to time for the next pill, then skip over the overlooked pill and take the medication at the next allotted time. Do not take additional medicine to compensate for the missed tablet. Viagra is effectively administered by taking a prescribed dose 45-60 minute before sexual activity. Since Viagra prompts the flow of blood to the penis, it aids stimulation of harder erections for lengthened periods and therefore, bettering a man's sexual response time. Contingent on when and how the dose works for an individual, an interim of 30 minutes to 4 hours should be anticipated. Sexual arousal is still needed to acquire an erection, but less than would be normally involved.
How to take Viagra and When
Men who take a nitrate-based drug, including nitroglycerin pills (Nitro-Bid, Nitrostat), nitroglycerin ointment (Nitro-Bid, Nitrol), nitroglycerin patches (Nitro-Dur, Transderm-Nitro), and isosorbide pills (Dilatrate-SR, Isordil, Sorbitrate) should not combine Viagra with their drug therapy. Conjointly, these medicinal drugs might cause a severe drop in blood pressure. Men should avoid using Viagra if they have heart problems severe enough to hinder sexual activity. Persons with a medical history of stroke, heart attack, or life-threatening heart irregularities within less than a year should consult their doctor to discuss safeguards and alternatives.
Side Effects
If while taking Viagra cardiac symptoms develop (for instance, dizziness, nausea, and chest pain) during sex, discontinue usage, and seek medical attention as soon as possible. Use Viagra with cautiously if conditions present that could result in longer erections, including sickle-cell disease, leukemia, or disease of the bone marrow). Additionally, men should use Viagra cautiously if the presence of a genital problem or deformity such as Peyronie' s disease manifests. Persons with bleeding disorders, stomach ulcers, or genetic eye conditions known as retinitis pigmentosa, should use Viagra with caution. The contraindications under these circumstances have not yet been substantiated. When taken responsibly, there are rarely any considerable side effects with the use of Viagra.
Other severe symptoms were dizziness, passing out, warmth or inflammation of the face, neck, or chest, swelling of the hands, ankles, or feet. Some individuals experienced difficulties with concentration and memory, partial or complete loss of hearing or ringing in the ears. Chest pain, irregular heartbeat or chest tightness with pain extending through the shoulder or arm, hot flashes, cold sweats, or general malaise has also been encountered. Some manifestations can be induced by an underlying medical consideration. In many cases, the side effects associated with Viagra are often temporary, resolving when the effects of the medication taper. Prior to using Viagra as an accompaniment to nitrates, like nitroglycerin, it would be advisable to consult a physician.
Other Brand Names, Dosages & Visual Description
Under the brand names Revatio and Viagra, sildenafil are obtainable with a prescription:
- Revatio comes in a white, round, film-coated 20-mg tablet.
- Viagra can be prescribed in 25, 50, and 100 mg. Viagra is a blue, rounded-diamond shaped pill.
- Viagra Jelly (Sildenafil Citrate) 25 mg, clear jelly solution. Those who uses protease inhibitors (such as for the treatment of HIV), the recommendation is not to surpass a maximum individual dosage of 25 mg of Viagra Jelly in a 48-hour period of time.
- Viagra Soft Tabs (Sildenafil Citrate) 50 and 100 mg. The soft gels are blue, square-like with rounded edges and taken orally 10-20 minutes before sexual activity. The manufacturer encourages a maximum of 1 dose per day (1 dose every 2 days for those individuals taking ritonavir). Viagra can be taken with or without food just swallow the tablet with juice or water.
This list consists of some other popular brand or generic formulations available in the marketplace:
- Cialis (tadalafil), a mustard colored, teardrop-shaped oral tablet available in 5, 10, 20 mg.
- Cialis Jelly (Tadalafil Jelly) 20 mg.
- Levitra (vardenafil) 20-mg tablet.
Safety Information:
Worldwide, Viagra helps millions of men. Importantly, Viagra users should adhere to the strict guideposts furnished by their personal doctors before use.
About Viagra
What Viagra is used for
VIAGRA (sildenafil citrate) is a treatment for erectile dysfunction in male adults. This is when a man cannot achieve or maintain a hard, erected penis for satisfactory sexual activity.
It is important to note that VIAGRA works only with sexual stimulation. VIAGRA alone does not increase your sex drive.
What Viagra does
VIAGRA belongs to a class of medicine called phosphodiesterase type 5 (PDE5) inhibitors. Following sexual stimulation, VIAGRA works by helping to relax the blood vessels in your penis by allowing blood to flow into your penis. This results in improved erectile function.
When Viagra should not be used
If you are taking any medicines containing nitrates in any form (oral, sublingual [under the tongue], skin patch, or by inhalation [spray]). Although VIAGRA is used occasionally, nitrates must never be used. Nitrates are found in many prescription medicines that are used in the treatment of angina pectoris (chest pain due to heart disease), such as nitroglycerin, isosorbide mononitrate, or isosorbide dinitrate. If you do not understand what nitrates are, or are unsure about whether a medication you are taking is a "nitrate", ask your doctor or pharmacist.
If you take VIAGRA with nitrate-containing medicines or any other nitrates (e.g., amyl nitrite "poppers"), your blood pressure could suddenly drop to a life-threatening level. You could get dizzy, faint, or even have a heart attack or stroke.
If you have ever had an allergic reaction to sildenafil citrate or the nonmedicinal ingredients in VIAGRA.
VIAGRA is not to be used in men for whom sexual activity is inadvisable.
What the medicinal ingredient is
Sildenafil citrate.
What the important nonmedicinal ingredients for Viagra are
Microcrystalline cellulose, anhydrous dibasic calcium phosphate, croscarmellose sodium, magnesium stearate, hypromellose, titanium dioxide, lactose, triacetin, and FD&C Blue #2 aluminum lake.
What dosage forms Viagra comes in
VIAGRA is available as blue, rounded, diamond-shaped tablets marked 'PFIZER' on one side, and 'VGR 25, 50, or 100' on the other. Each tablet contains either 25 mg, 50 mg or 100 mg sildenafil citrate.
Warnings and Precautions
This medicine has been prescribed for you personally and you should not pass it on to others. It may harm them, even if their symptoms are the same as yours.
BEFORE you use VIAGRA talk to your doctor or pharmacist if you:
have heart problems (irregular heart beats, angina, chest pain, or had a heart attack). If you have heart problems, ask your doctor if your heart is healthy enough to handle the extra strain of having sex. If you have chest pain, dizziness or nausea during sex, stop exerting yourself. You should not use nitrates but you should seek immediate medical assistance.
are 65 years of age or over
have had a stroke
have low blood pressure or uncontrolled high blood pressure
have liver or kidney problems
have sickle cell anemia (abnormality of the red blood cells), multiple myeloma (cancer of the bone marrow) or leukaemia (cancer of the white blood cells)
are allergic to sildenafil or any of the other ingredients of VIAGRA tablets
have a deformed penis or Peyronie's disease
have ever had an erection that lasted more than 4 hours
have stomach ulcers or other bleeding problems
have a rare inherited eye disease called retinitis pigmentosa
Ever had temporary, decrease, or permanent loss of vision, including a condition called Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION). The specific type of vision decrease or loss, called non-arteritic anterior ischemic optic neuropathy (NAION), seems to occur rarely when blood flow to the optic nerve is reduced or blocked. Vision decrease or loss may be partial or complete, in one or very occasionally both eyes. While in some cases the condition may improve over time, it can also be irreversible.
VIAGRA is not recommended for use in children under 18 years of age and in women.
VIAGRA does not protect against sexually transmitted diseases (STD), including Human Immunodeficiency Virus (HIV).
Alcohol consumption may decrease the ability to get an erection.
Patients should know how to react to the drug before operating a motor vehicle or any machinery.
If you are taking VIAGRA and experience temporary, decrease, or permanent loss of vision, stop taking VIAGRA and call your doctor.
In case of chest pain occurring during or after sexual activity you should not use nitrates but you should seek immediate medical assistance.
Sudden decrease or loss of hearing has been reported in a few number of postmarketing and clinical trial cases with the use of PDE5 inhibitors, including VIAGRA. It has not been established whether these are related directly to the use of these medications or to other factors. If you experience these symptoms, stop taking VIAGRA and call your doctor.
Interactions with Viagra
You should tell your doctor or pharmacist about any other medications that you are taking. VIAGRA may interfere with some drugs. Only take VIAGRA with other drugs if recommended by your doctor.
Drugs that may interact with VIAGRA include:
any drugs that contain nitrates in any form (oral, sublingual [under the tongue], skin patch or by inhalation [spray]). Nitrates are found in many prescriptions that are used to treat angina pectoris (chest pain due to heart disease). You should not take VIAGRA if you are taking these drugs.
alpha-blockers (drugs used to treat prostate problems or high blood pressure)
ketoconazole or itraconazole (drugs used to treat fungal infections)
erythromycin (a drug used to treat bacterial infections)
ritonavir, saquinavir or other drugs for the treatment of HIV
cimetidine (a drug generally used to treat duodenal or gastric problems)
Grapefruit juice may increase the levels of VIAGRA in your blood.
Proper Use of Viagra
Usual dose
Your doctor can determine the dose that works best for you. Always take VIAGRA as prescribed by your doctor. You should speak with your doctor or pharmacist if you are unsure. A dose above 100 mg per day is not recommended.
Swallow the tablet whole, with some water.
You should not take more than one dose of VIAGRA per day.
If you have serious liver or kidney problems or you are 65 years of age or over, your doctor may start you at the lowest dose (25 mg) of VIAGRA.
How to optimize your use of VIAGRA
You should take VIAGRA approximately 30 to 60 minutes before sexual activity. You can engage in sexual activity within 30 minutes of taking the tablet and for up to 4 hours. The amount of time it takes to have an effect varies slightly from person to person. Remember, sexual stimulation is required for VIAGRA to work.
You should avoid excessive drinking of alcohol, since alcohol can temporarily impair the ability to get an erection.
VIAGRA can be taken with or without food. However, you may find that it takes longer for VIAGRA to work if you take it with a high-fat meal.
VIAGRA may not work the first time or every time. If VIAGRA did not work for you on one occasion, try again on another day. You will learn how well VIAGRA works for you through your personal experience. The first few times may be charged with emotion or anxiety. If after a few separate attempts, you do not get the results you expect, talk to your doctor.
You should not take more than one dose of VIAGRA per day.
If you have taken more Viagra than you should, contact your doctor or a poison control centre immediately.
Side Effects for Viagra and What to Do About Them
As with most drugs, VIAGRA can cause some side effects. These effects are usually mild to moderate in nature and do not last for a long time.
The most common side effects are headache and facial flushing. Less commonly reported side effects are indigestion, dizziness, stuffy nose, effects on vision (including colour tinge, increased brightness of light and blurred vision), seizure, seizure recurrence, sudden decrease or loss of hearing and transient global amnesia (temporary memory loss).
In extremely rare instances, a man may have an erection that lasts many hours. You should call a doctor immediately if you ever have an erection that lasts more than 4 hours.
Reports of sudden loss of vision have occurred rarely with the use of oral erectile dysfunction medications (PDE5 inhibitors). It has not been established whether these are related directly to the use of these medications or to other factors. There may be an increased risk to patients who have already experienced a condition called Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION). You should stop taking VIAGRA and consult your doctor if you experience a decrease in, or loss of, vision in one or both eyes.
If you notice any side effects not mentioned above, or any of the above-mentioned side effects persist or become bothersome, please contact your doctor or pharmacist.
|Serious Side Effects, How Often They Happen and What to Do About Them
|Talk with your doctor or pharmacist
|Stop taking drug and call your doctor or pharmacist
|Only if severe
|In all cases
|facial flushing
|stuffy nose
|effects on visiona
|allergic reactionb
|prolonged erection
This is not a complete list of side effects. For any unexpected effects while taking VIAGRA, contact your doctor or pharmacist.
Viagra Facts
VIAGRA was originally developed to treat the chest pain associated with angina.
Boehringer Ingelheim is conducting four different clinical trials involving 5,000 women and a "VIAGRA-like" drug.
Nearly 17 million prescriptions were written in 2005 for VIAGRA and "act-alike" drugs.
Researchers are investigating VIAGRA as a possible treatment for pulmonary hypertension in children.
Drug Interactions
CYP3A4 Inducers
It can be expected that concomitant administration of CYP3A4 inducers, such as rifampin, will decrease plasma levels of sildenafil.
Effects of Other Drugs on VIAGRA
Pharmacokinetic data from patients in clinical trials showed no effect on sildenafil pharmacokinetics of CYP2C9 inhibitors (such as tolbutamide, warfarin), CYP2D6 inhibitors (such as selective serotonin reuptake inhibitors, tricyclic antidepressants), thiazide and related diuretics, angiotensin converting enzyme (ACE) inhibitors, and calcium channel blockers. The AUC of the active metabolite, N desmethyl sildenafil, was increased 62% by loop and potassium sparing diuretics and 102% by nonspecific beta blockers. These effects on the metabolite are not expected to be of clinical consequence.
In normal healthy male volunteers, there was no evidence of an effect of azithromycin (500 mg daily for 3 days) on the AUC, Cmax, Tmax, elimination rate constant, or subsequent half-life of sildenafil or its principle circulating metabolite.
In three specific drug-drug interaction studies, the alpha-blocker doxazosin (4 mg and 8 mg) and sildenafil (25 mg, 50 mg, or 100 mg) were administered simultaneously to patients with benign prostatic hyperplasia (BPH) stabilized on doxazosin therapy. In these study populations, mean additional reductions of supine blood pressure of 7/7 mmHg, 9/5 mmHg, and 8/4 mmHg, and mean additional reductions of standing blood pressure of 6/6 mmHg, 11/4 mmHg, and 4/5 mmHg, for 25 mg, 50 mg, or 100 mg respectively, were observed. When sildenafil and doxazosin were administered simultaneously to patients stabilized on doxazosin therapy, there were infrequent reports of patients who experienced symptomatic postural hypotension. These reports included dizziness and lightheadedness, but not syncope. Concomitant administration of sildenafil to patients taking alpha-blocker therapy may lead to symptomatic hypotension in a few susceptible individuals (see Warnings and Precautions).
Some alpha-blockers and antidepressants have reported priapism or prolonged/painful erections in their labels.
CYP2C9 Substrate
No significant interactions were shown with tolbutamide (single 250 mg dose) or warfarin (single 40 mg dose), both of which are metabolized by CYP2C9, when co-administered with 50 mg sildenafil.
CYP3A4 Inhibitors
The concomitant use of potent cytochrome P-450 3A4 inhibitors (e.g. erythromycin, saquinavir, ritonavir, ketoconazole, itraconazole) as well as the non-specific CYP inhibitor, cimetidine, is associated with increased plasma levels of sildenafil (see Dosage and Administration).
When a single 100 mg dose of VIAGRA was administered with erythromycin, a specific CYP3A4 inhibitor, at steady state (500 mg b.i.d. for 5 days), there was a 182% increase in sildenafil systemic exposure (AUC).
When the dose of sildenafil for subjects receiving potent CYP3A4 inhibitors was administered as recommended, the maximum free plasma sildenafil concentration did not exceed 200 nM for any individual and was consistently well tolerated.
Cimetidine (800 mg), a cytochrome P450 inhibitor and a non-specific CYP3A4 inhibitor, caused a 56% increase in plasma sildenafil concentrations when co-administered with VIAGRA (50 mg) to healthy volunteers.
Population pharmacokinetic analysis of clinical trial data indicated a reduction in sildenafil clearance when co-administered with CYP3A4 inhibitors (such as ketoconazole, erythromycin, cimetidine). However, there was no increased incidence of adverse events in these patients.
Effect of VIAGRA on Other Drugs
In vitro studies
Sildenafil metabolism is principally mediated by the cytochrome P-450 (CYP) isoforms 3A4 (major route) and 2C9 (minor route) (see Action and Clinical Pharmacology). Therefore, inhibitors of these isoenzymes may reduce sildenafil clearance and inducers of these isoenzymes may increase sildenafil clearance.
Sildenafil is a weak inhibitor of the cytochrome P-450 isoforms 1A2, 2C9, 2C19, 2D6, 2E1 and 3A4 (IC50>150 μM). Given sildenafil peak plasma concentrations of approximately 1 μM after recommended doses, it is unlikely that VIAGRA will alter the clearance of the substrates of these isoenzymes.
Bleeding Time
VIAGRA (50 mg) did not potentiate the increase in bleeding time, measured using a standard simplate method, caused by acetylsalicylic acid (150 mg).
Drug-Food Interactions
Grapefruit juice being a weak inhibitor of CYP3A4 gut wall metabolism may give rise to modest increases in plasma levels of sildenafil.
VIAGRA (sildenafil citrate) can be taken with or without food. However, when VIAGRA is taken with a high-fat meal, the rate of absorption is reduced with a mean delay in Tmax of 60 minutes and a mean reduction in Cmax of 29%. AUC is decreased by 11%. The patient may find that it takes longer to work if taken with a high-fat meal (see Action and Clinical Pharmacology).
HIV Protease Inhibitor
In addition, coadministration of the HIV protease inhibitor saquinavir, also CYP3A4 inhibitor, at steady state (1200 mg t.i.d) with sildenafil (100 mg single dose) resulted in a 140% increase in sildenafil Cmax and a 210% increase in sildenafil AUC. Sildenafil had no effect on saquinavir pharmacokinetics. Stronger CYP3A4 inhibitors such as ketoconazole, itraconazole would be expected to have still greater effects (see Dosage and Administration).
Coadministration with the HIV protease inhibitor ritonavir, which is a highly potent P-450 inhibitor, at steady state (500 mg b.i.d) with sildenafil (100 mg single dose) resulted in a 300% (4-fold) increase in sildenafil Cmax and a 1000% (11-fold) increase in sildenafil plasma AUC. At 24 hours the plasma levels of sildenafil were still approximately 200 ng/mL, compared to approximately 5 ng/mL when sildenafil was dosed alone. This is consistent with the marked effects of ritonavir on a broad range of P-450 substrates. Sildenafil had no effect on ritonavir pharmacokinetics (see Dosage and Administration).
Drug-Drug Interactions
When VIAGRA (100 mg) was co-administered with amlodipine, 5 mg or 10 mg, in hypertensive patients, the mean additional reduction of supine blood pressure was 8 mm Hg systolic and 7 mm Hg diastolic (see Action and Clinical Pharmacology).
Patients on multiple antihypertensive medications were included in the pivotal clinical trials for VIAGRA (sildenafil citrate). Analysis of the safety database was carried out after pooling of the following classes of antihypertensive medication: diuretics, beta-blockers, ACE inhibitors, angiotensin II antagonists, antihypertensive medicinal products (vasodilator and centrally-acting), adrenergic neurone blockers, calcium channel blockers and alpha-adrenoceptor blockers. The analysis showed no differences in the adverse effect profile of patients taking VIAGRA with and without antihypertensive medication.
A large controlled study was performed in men with erectile dysfunction and arterial hypertension who were taking combinations of diuretics, beta blockers, ACE inhibitors and calcium channel blockers. The incidence rate of all adverse events, including those possibly related to hypotensive episodes, was consistent with observations in other patient populations. Also, there was no evidence of an increased incidence rate of any adverse event in the subgroups taking 2 antihypertensive agents and 3 or more antihypertensive agents. There was no indication of additional safety risk of sildenafil use in this subject population.
In vivo studies
Sildenafil (50 mg) did not potentiate the hypotensive effect of alcohol in healthy volunteers with mean maximum blood alcohol levels of 0.08%.
In normal healthy male volunteers, co-administration of single doses of antacid (magnesium hydroxide/aluminium hydroxide) with sildenafil did not affect the AUC, Cmax, elimination rate constant, or subsequent half-life of sildenafil. The Tmax was reduced by 0.42 hours.
Use with Other Concomitant Therapies
Information for the Patient
Special Handling Instructions
Not applicable.
Dosage and Administration
Dosing Considerations
The following factors are associated with increased plasma levels (AUC) of sildenafil:
age 65 years or over (40%)
hepatic impairment (e.g. cirrhosis: 84%)
severe renal impairment (e.g. creatinine clearance <30 mL/min: 100%)
concomitant use of potent cytochrome P-450 3A4 inhibitors (e.g. erythromycin: 182%; saquinavir: 210%; ritonavir: 1000%). It can also be expected that more potent cytochrome P-450 3A4 inhibitors such as ketoconazole and intraconazole would result in increased levels of sildenafil.
(See Recommended Dose and Dosage Adjustment, Action and Clinical Pharmacology, Warnings and Precautions).
VIAGRA (sildenafil citrate) has been shown to potentiate the hypotensive effects of nitrates in healthy volunteers and in patients, and is therefore contraindicated in patients who are taking any type of nitrate drug therapy, or who utilize short-acting nitrate-containing medications, due to the risk of developing potentially life-threatening hypotension. The use of organic nitrates, either regularly and/or intermittently, in any form (e.g. oral, sublingual, transdermal, by inhalation) is absolutely contraindicated (see Action and Clinical Pharmacology, Contraindications).
Recommended Dose and Dosage Adjustment
For most patients, the recommended dose of VIAGRA is 50 mg taken as needed. The maximum recommended dose is 100 mg. Dosage may be decreased to 25 mg if necessary.
Since higher plasma levels may increase both efficacy and the incidence of adverse events, a starting dose of 25 mg should be considered in patients, age 65 years or over, on concomitant CYPA4 inhibitors, with severe renal impairment, with hepatic impairment and on ritonavir (see Dosing Considerations above, Action and Clinical Pharmacology, Warnings and Precautions).
The concomitant use of the potent cytochrome P-450 3A4 inhibitor, ritonavir is associated with a 1000% (11-fold) increase in plasma levels (AUC) of sildenafil. Given the extent of the interaction with patients receiving concomitant therapy with ritonavir, it is recommended not to exceed a maximum single dose of 25 mg of sildenafil in a 48-hour period (see Warnings and Precautions).
To be taken as needed approximately 30-60 minutes before sexual activity. However, VIAGRA may be taken anywhere from 0.5 hour to 4 hours before sexual activity. The maximum recommended dosing frequency is once per day.
Adverse Reactions
skin carcinoma, skin disorder, skin hypertrophy, skin ulcer, contact dermatitis, exfoliative dermatitis, pruritus, urticaria, photosensitivity reaction, nail disorder, acne, herpes simplex, furunculosis.
Post-Market Adverse Drug Reactions
Reports of adverse events temporally associated with VIAGRA during post-marketing surveillance that are not listed above and for which the causal relationship is unknown, include the following:
anemia and leukopenia.
Special Senses
diplopia, temporary vision loss/decreased vision, blurred vision, Non Arteritic Anterior Ischemic Optic Neuropathy (NAION) , retinal vein occlusion, visual field defect, eye pain, ocular redness or bloodshot appearance, ocular burning, ocular swelling/pressure, increased intraocular pressure, retinal vascular disease of bleeding, vitreous detachment/traction and paramacular edema.
Cases of sudden decrease or loss of hearing have been reported post-marketing in temporal association with the use of PDE5 inhibitors, including VIAGRA. In some of the cases, medical conditions and other factors were reported that may have also played a role in the otologic adverse events. In many cases, medical follow-up information was limited. It is not possible to determine whether these events are related directly to the use of VIAGRA, to the patient's underlying risk factors for hearing loss, a combination of these factors, or to other factors (see Warnings and Precautions, Adverse Reactions and Information for the Patient).
liver function tests abnormal, ALT increased.
asthma, dyspnea, laryngitis, pharyngitis, sinusitis, bronchitis, respiratory disorder, carcinoma of lung, sputum increased, cough increased.
At doses above the recommended dose range, adverse events were similar to those detailed above but generally were reported more frequently.
Pre-Marketing Experience
VIAGRA (sildenafil citrate) was administered to over 3700 patients (aged 19-87 years) during clinical trials worldwide. Over 550 patients were treated for longer than one year.
In placebo-controlled clinical studies, the discontinuation rate due to adverse events for VIAGRA (2.5%) was not significantly different from placebo (2.3%). The adverse events were generally transient and mild to moderate in nature.
myalgia, bone disorder, arthrosis, arthritis, tendon rupture, tenosynovitis, bone pain, joint disorder, synovitis.
face edema, peripheral edema, chills, allergic reaction, asthenia, pain, infection, shock, hernia, accidental fall, abdominal pain, chest pain, accidental injury, intentional overdose.
In an analysis of double blind placebo controlled clinical trials encompassing over 700 person-years of observation on placebo and over 1300 person-years on sildenafil, there were no differences in the incidence rate of myocardial infarction (MI) or in the rate of cardiovascular mortality for patients receiving sildenafil compared to those receiving placebo. The rates of MI were 1.1 per 100 person-years for men receiving sildenafil and for those receiving placebo. The rates of cardiovascular mortality were 0.3 per 100 person-years for men receiving sildenafil and those receiving placebo.
Less Common Clinical Trial Adverse Drug Reactions (<2%)
The following events occurred in <2% of patients in controlled clinical trials where a causal relationship is uncertain:
Vascular Disorders
cerebrovascular disorder, cerebral thrombosis.
prolonged erection, priapism (see Warnings and Precautions) and hematuria.
Central & Peripheral Nervous System
seizure, seizure recurrence, transient global amnesia.
Adverse Drug Reaction Overview
sweating, dry mouth.
edema, thirst, gout, hyperuricemia, hypoglycemic reaction, unstable diabetes, hyperglycemia, hyperlipidemia, hypernatremia.
Epistaxis; serious cardiovascular events—including myocardial infarction, sudden cardiac death, ventricular arrhythmia, cerebrovascular hemorrhage, and transient ischemic attack—have been reported. Most of these patients had pre-existing cardiovascular risk factors. Many of these events were reported to occur during or shortly after sexual activity, and a few were reported to occur shortly after the use of VIAGRA without sexual activity. Others were reported to have occurred hours to days after the use of VIAGRA with sexual activity. It is not possible to determine whether these events are related directly to VIAGRA, to sexual activity, to the patient's underlying cardiovascular disease, to combination of these factors, or to other factors (see Warnings and Precautions).
Indications and Clinical Use
VIAGRA (sildenafil citrate) is indicated for:
the treatment of erectile dysfunction, which is the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance.
Treatment of Priapism
Patients should be instructed to report any erections persisting for more than 4 hours to a physician. The treatment of priapism/prolonged erection should be according to established medical practice. Physicians may refer to two suggested protocols for detumescence presented below.
Detumescence Protocols
Aspirate 40 to 60 mL blood from either left or right corpora using vacutainer and holder for drawing blood. Patient will often detumesce while aspirating. Apply ice for 20 minutes post aspiration if erection remains.
If procedure 1) is unsuccessful, then try procedure 2).
Put patient in supine position. Dilute 10 mg phenylephrine into 20 mL distilled water for injection (0.05%). With an insulin syringe, inject 0.1 to 0.2 mL (50-100 µg) into the corpora every 2 to 5 minutes, until the detumescence occurs. The occasional patient may experience transient bradycardia and hypertension when given phenylephrine injections, therefore monitor patient's blood pressure and pulse every 10 minutes. Patients at risk include those with cardiac arrhythmias and diabetes. Refer to the prescribing information for phenylephrine before use. Do not give phenylephrine to patients on MAO inhibitors. When phenylephrine is used within the first 12 hours of erection, the majority of patients will respond.
If procedure 2) is unsuccessful, then try procedure 3).
If the above measures fail to detumesce the patient, a urologist should be consulted as soon as possible, especially if the erection has been present for many hours. If priapism is not treated immediateIy, penile tissue damage and/or permanent loss of potency may result.
Dosage Forms, Composition and Packaging
50 mg
Each blue, round, diamond-shaped tablet marked "PFIZER" on one side and "VGR 50" on the other side, contains: sildenafil citrate equivalent to 50 mg of sildenafil. Nonmedicinal ingredients: anhydrous dibasic calcium phosphate, croscarmellose sodium, FD&C Blue #2 aluminum lake, hypromellose, lactose, magnesium stearate, microcrystalline cellulose, titanium dioxide and triacetin. Blister packs of 4 and 8.
100 mg
Each blue, round, diamond-shaped tablet marked "PFIZER" on one side and "VGR 100" on the other side, contains: sildenafil citrate equivalent to 100 mg of sildenafil. Nonmedicinal ingredients: anhydrous dibasic calcium phosphate, croscarmellose sodium, FD&C Blue #2 aluminum lake, hypromellose, lactose, magnesium stearate, microcrystalline cellulose, titanium dioxide and triacetin. Blister packs of 4 and 8.
25 mg
Each blue, round, diamond-shaped tablet marked "PFIZER" on one side and "VGR 25" on the other side, contains: sildenafil citrate equivalent to 25 mg of sildenafil. Nonmedicinal ingredients: anhydrous dibasic calcium phosphate, croscarmellose sodium, FD&C Blue #2 aluminum lake, hypromellose, lactose, magnesium stearate, microcrystalline cellulose, titanium dioxide and triacetin. Blister packs of 4.
Warnings and Precautions
In volunteers with mild (CLcr=50-80 mL/min) and moderate (CLcr=30-49 mL/min) renal impairment, the pharmacokinetics of a single oral dose of VIAGRA (50 mg) was not altered. In volunteers with severe (CLcr <30 mL/min) renal impairment, sildenafil clearance was reduced, resulting in increases in AUC (100%) and Cmax (88%) compared to age-matched volunteers with no renal impairment.
A starting dose of 25 mg should be considered in patients with severe renal impairment (see Action and Clinical Pharmacology, Dosage and Administration).
In volunteers with hepatic cirrhosis (Child-Pugh A and B), sildenafil clearance was reduced, resulting in increases in AUC (84%) and Cmax (47%) compared to age-matched volunteers with no hepatic impairment.
A starting dose of 25 mg should be considered in patients with hepatic impairment (see Action and Clinical Pharmacology, Dosage and Administration).
Geriatrics (>65 years of age)
Healthy elderly volunteers had a reduced clearance of sildenafil, with free plasma concentrations approximately 40% greater than those seen in younger volunteers (18 to 45 years). Since higher plasma levels may increase both the pharmacological action and incidence of some adverse events, a starting dose of 25 mg should be considered (see Action and Clinical Pharmacology, Dosage and Administration).
Special Populations
In clinical trials, sildenafil has been shown to have systemic vasodilatory properties that result in transient decreases in blood pressure. This is of little or no consequence in most patients. However, prior to prescribing sildenafil, physicians should carefully consider whether their patients with certain underlying conditions could be adversely affected by such vasodilatory effects, especially in combination with sexual activity. Patients with increased susceptibility to vasodilators include those with left ventricular outflow obstruction (e.g., aortic stenosis, hypertrophic obstructive cardiomyopathy), or those with the rare syndrome of multiple system atrophy manifesting as severely impaired autonomic control of blood pressure.
In humans, VIAGRA (sildenafil citrate) has no effect on bleeding time when taken alone or with acetylsalicylic acid. In vitro studies with human platelets indicate that sildenafil potentiates the antiaggregatory effect of sodium nitroprusside (a nitric oxide donor). The combination of heparin and VIAGRA had an additive effect on bleeding time in the anesthetized rabbit, but this interaction has not been studied in humans (see Action and Clinical Pharmacology).
There is no safety information on the administration of VIAGRA to patients with bleeding disorders or active peptic ulceration. Therefore, VIAGRA should be administered with caution to these patients.
Sudden decrease or loss of hearing has been reported in a few number of postmarketing and clinical trial cases with the use of PDE5 inhibitors, including VIAGRA. These events, which may be accompanied by tinnitus and dizziness, have been reported in temporal association to the intake of PDE5 inhibitors, including VIAGRA. In some of the cases, medical conditions and other factors were reported that may have also played a role in the otologic adverse events. In many cases, medical follow-up information was limited. It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors (see Adverse Reactions, Post-Market Adverse Drug Reactions and Information for the Patient). Physicians should advise patients to stop taking VIAGRA and seek prompt medical attention in case of sudden decrease or loss of hearing.
The evaluation of erectile dysfunction should include a determination of potential underlying causes and the identification of appropriate treatment following a complete medical assessment.
Postmarketing reports of sudden loss of vision have occurred rarely, in temporal association with the use of PDE5 inhibitors. It is not clear whether these are related directly to the use of PDE5 inhibitors or to other factors. There may be an increased risk to patients who have already experienced Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION).
There are no controlled clinical data on the safety or efficacy of VIAGRA in patients with retinitis pigmentosa (a minority of these patients have genetic disorders of retinal phosphodiesterases). If prescribed, this should be done with caution (see Action and Clinical Pharmacology).
A small percentage of patients experience visual effects (e.g. impairment of colour discrimination, increased perception to light, blurred vision, eye pain, ocular redness) after taking VIAGRA. If this happens, then the patient should not operate a motor vehicle or any heavy machinery until the adverse effects disappear (see Action and Clinical Pharmacology).
VIAGRA is not indicated for use in children.
Sexual Function/Reproduction
Although priapism had not been reported during clinical trials, prolonged erection greater than 4 hours and priapism (painful erections greater than 6 hours in duration) have been reported infrequently during the post-marketing surveillance of VIAGRA. In the event of an erection that persists longer than 4 hours, the patient should seek immediate medical assistance. If priapism is not treated immediately, penile tissue damage and permanent loss of potency could result (see Adverse Reactions).
Agents for the treatment of erectile dysfunction should be used with caution in patients with anatomical deformation of the penis (such as angulation, cavernosal fibrosis or Peyronie's disease) or in patients who have conditions which may predispose them to priapism (such as sickle cell anemia, multiple myeloma or leukemia).
The safety and efficacy of combinations of VIAGRA with other agents for the treatment of erectile dysfunction have not been studied. Therefore, the use of such combinations is not recommended.
Pregnant Women
VIAGRA is not indicated for use in women.
Information to Be Provided to the Patient
Physicians should discuss with patients the increased risk of Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) in individuals who have already experienced NAION in one eye, including whether such individuals could be adversely affected by use of vasodilators, such as PDE5 inhibitors. Patients should stop taking VIAGRA and consult their physician if they experience a decrease in, or loss of, vision in one or both eyes.
Nursing Women
VIAGRA is not indicated for use in women.
As with all treatments for erectile dysfunction, there is a potential cardiac risk of sexual activity in patients with pre-existing cardiovascular disease, including hypertension (BP>140/90). Therefore, treatments for erectile dysfunction, including VIAGRA (sildenafil citrate), should not be generally administered in men for whom sexual activity is inadvisable because of their underlying cardiovascular status.
There are no controlled clinical data on the safety or efficacy of VIAGRA in the following groups, if prescribed, this should be done with caution.
Patients who have suffered a myocardial infarction, stroke, or life-threatening arrhythmia within the last 6 months
Patients with resting hypotension (BP <90/50 at rest) or hypertension (BP >170/110 at rest)
Patients with cardiac failure or coronary artery disease causing unstable angina
(See Action and Clinical Pharmacology).
Caution is advised when sildenafil is administered to patients taking an alpha-blocker, as the coadministration may lead to symptomatic hypotension in a few susceptible individuals (see Drug Interactions). In order to minimize the potential for developing postural hypotension, patients should be hemodynamically stable on alpha-blocker therapy prior to initiating sildenafil treatment. Initiation of sildenafil at lower doses should be considered. In addition, physicians should advise patients what to do in the event of postural hypotensive symptoms.
Storage and Stability
Store at controlled room temperature between 15 and 30°C.
Action and Clinical Pharmacology
Hepatic Insufficiency
In volunteers with hepatic cirrhosis (Child-Pugh A and B), sildenafil clearance was reduced, resulting in increases in AUC (85%) and Cmax (47%) compared to age-matched volunteers with no hepatic impairment. The pharmacokinetics of sildenafil in patients with severe hepatic impairment (Child-Pugh class C) have not been studied.
Since sildenafil clearance is reduced in geriatric patients (65 years or older), patients with renal impairment or patients with hepatic impairment, a starting dose of 25 mg should be considered. Based on efficacy and toleration, the dose may be increased to 50 mg or 100 mg (see Warnings and Precautions, Dosage and Administration).
Healthy elderly subjects (65 years or older) had a reduced clearance of sildenafil, resulting in approximately 90% higher plasma concentrations of sildenafil and the active N-desmethyl metabolite compared to those seen in healthy younger volunteers (18-45 years). Due to age-differences in plasma protein binding, the corresponding increase in free sildenafil plasma concentration was approximately 40%.
The mean steady state volume of distribution (Vss) for sildenafil is 105 litres, indicating distribution into the tissues. Sildenafil and its major circulating N desmethyl metabolite are both approximately 96% bound to plasma proteins. Protein binding is independent of total drug concentrations.
Based upon measurements of sildenafil in the semen of healthy volunteers, less than 0.001% of the ingested dose may appear in the semen of patients 90 minutes after drug intake.
Special Populations and Conditions
Sildenafil is rapidly absorbed. Maximum observed plasma concentrations are reached within 30 to 120 minutes (median 60 minutes) of oral dosing in the fasted state. The mean absolute bioavailability is 41% (range 25%-63%). The oral pharmacokinetics of VIAGRA is proportional over the recommended dose range studied (25 mg to 100 mg).
Sildenafil inhibits the human PDE5 enzyme in vitro by 50% at a concentration of 3.5 nM. In man, the mean maximum free plasma concentration of sildenafil following a single oral dose of 100 mg is approximately 18 ng/mL, or 38 nM.
When VIAGRA was administered with a high-fat meal, the rate of absorption was significantly decreased, with a 29% reduction in Cmax and a 60-minute delay in Tmax. The patient may find that it takes longer to work if taken with a high-fat meal. However, although it was statistically significant (AUC decreased by 11%), the decrease in the extent of absorption was not clinically relevant. The relative bioavailability fed/fasted was 89% (90% CI; 84-94%) (see Drug Interactions).
Mechanism of Action
VIAGRA (sildenafil citrate) is a cGMP-specific phosphodiesterase type 5 (PDE5) inhibitor, used for the treatment of male erectile dysfunction.
The physiological mechanism responsible for erection of the penis involves the release of nitric oxide (NO) in the corpus cavernosum in response to sexual stimulation. Nitric oxide then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation in the corpus cavernosum and allowing inflow of blood.
Sildenafil has no direct relaxant effect on isolated human corpus cavernosum, but enhances the effect of NO by inhibiting PDE5, which is responsible for the biodegradation of cGMP in the corpus cavernosum. When sexual stimulation causes local release of NO, inhibition of PDE5 by sildenafil produces increased levels of cGMP in the corpus cavernosum, resulting in smooth muscle relaxation and increased inflow of blood to the corpus cavernosum. Sildenafil, at recommended doses, has no effect in the absence of sexual stimulation.
Studies in vitro have shown that sildenafil has between 10 and 10,000-fold greater selectivity for PDE5 than for other phosphodiesterase isoforms namely PDEs 1, 2, 3, 4, and 6 and greater than 700-fold effect on PDE7-PDE11. In particular, sildenafil has greater than 4,000-fold selectivity for PDE5 over PDE3, the cAMP-specific phosphodiesterase isoform involved in the control of cardiac contractility. Sildenafil is about 10-fold as potent for PDE5 compared to PDE6, an isoenzyme found in the retina; this lower selectivity is thought to be the basis for colour vision abnormalities observed with higher doses or plasma levels of sildenafil (see Warnings and Precautions).
PDE5 is also found in lower concentrations in platelets, vascular and visceral smooth muscles, and skeletal muscle. The sildenafil-induced inhibition of PDE5 in these tissues appears to be the basis for the enhanced platelet antiaggregatory activity of nitric oxide observed in vitro, and inhibition of platelet thrombus formation in vivo, and peripheral arterial-venous dilation in vivo (see Warnings and Precautions).
The total body clearance of sildenafil is 41 L/h with a resultant terminal phase half-life of 3-5 hours. After either oral or intravenous administration, sildenafil is excreted as metabolites predominantly in the feces (approximately 80% of administered dose) and to a lesser extent in the urine (approximately 13% of the administered dose).
Renal Insufficiency
In volunteers with mild (CLcr=50-80 mL/min) and moderate (CLcr=30-49 mL/min) renal impairment, the pharmacokinetics of a single oral dose of VIAGRA (50 mg) were not altered. In volunteers with severe (CLcr <30 mL/min) renal impairment, sildenafil clearance was reduced, resulting in increases in AUC (100%) and Cmax (88%) compared to age-matched volunteers with no renal impairment.
In addition, N-desmethyl metabolite AUC and Cmax values were significantly increased by 200% and 79% respectively in subjects with severe renal impairment compared to subjects with normal renal function.
Effects of VIAGRA on Blood Pressure (BP)
Single oral doses of sildenafil (100 mg) administered to healthy volunteers produced decreases in supine blood pressure (mean maximum decrease of 8.3/5.3 mm Hg). The decrease in blood pressure was most notable approximately 1-2 hours after dosing. The effects are not related to dose or plasma levels. Larger effects were recorded among patients receiving concomitant nitrates (see Contraindications).
Sildenafil is cleared predominantly by the CYP3A4 (major route) and CYP2C9 (minor route) hepatic microsomal isoenzymes. The major circulating metabolite results from N-demethylation of sildenafil at the N-methyl piperazine moiety. This metabolite has a PDE selectivity profile similar to sildenafil and an in vitro potency against PDE5 approximately 50% that of the parent drug. Plasma concentrations of this metabolite are approximately 40% of those seen for sildenafil. The N-desmethyl metabolite is further metabolised, with a terminal half-life of approximately 4 hours.
Effects of VIAGRA on Cardiac Parameters
Single oral doses of VIAGRA up to 100 mg in healthy volunteers produced no clinically relevant effects on ECG.
Effects of VIAGRA on Erectile Response
VIAGRA was studied in clinical trials of various designs. In fixed-dose clinical trials, 62%, 74%, and 82% of patients on 25 mg, 50 mg and 100 mg of VIAGRA, respectively, reported an improvement in their erections, compared to 25% on placebo (p <0.0001).
In eight double-blind, placebo-controlled, cross-over studies using RigiScan (a device used to objectively measure penile rigidity and duration of erections), erections during sexual stimulation improved significantly on VIAGRA compared to placebo. These studies included patients with organic etiologies (such as spinal cord injury and diabetes mellitus), and patients without an established organic cause. Most studies assessed the efficacy of VIAGRA approximately 60 minutes post-dose.
All eight studies investigating the effects of sildenafil on penile plethysmography (RigiScan) after visual sexual stimulation (VSS) under laboratory conditions, consistently showed that doses of up to 100 mg resulted in statistically significant improvements in duration of erections of 60% rigidity (considered hard enough for penetrative sexual intercourse), compared with placebo. In patients who respond, the median time to onset of erections (60% rigidity) in response to VSS, was 25 minutes after an oral dose of 50 mg sildenafil. The mean total duration of erections 60% rigidity at the base of the penis was 3, 24 and 32 minutes for subjects receiving placebo, 25 mg and 50 mg doses, respectively, when exposed to VSS for 2 hours.
VIAGRA increases couples' ability to have sexual intercourse.
VIAGRA (sildenafil citrate) has been shown to potentiate the hypotensive effects of nitrates in healthy volunteers and in patients, and is therefore contraindicated in patients who are taking any type of nitrate drug therapy, or who utilize short-acting nitrate-containing medications, due to the risk of developing potentially life-threatening hypotension. The use of organic nitrates, either regularly and/or intermittently, in any form (e.g. oral, sublingual, transdermal, by inhalation) is absolutely contraindicated (see Action and Clinical Pharmacology, Dosage and Administration).
After patients have taken VIAGRA, it is unknown when nitrates, if necessary, can be safely administered. Plasma levels of sildenafil at 24 hours post-dose are much lower (2 ng/mL) than at peak concentration (440 ng/mL). In the following patients: age >65, hepatic impairment (e.g. cirrhosis), severe renal impairment (e.g. CLcr <30 mL/min), and concomitant use of potent cytochrome P-450 3A4 inhibitors (erythromycin), plasma levels of sildenafil at 24 hours post-dose have been found to be 3 to 8 times higher than those seen in healthy volunteers. Although plasma levels of sildenafil at 24 hours post-dose are much lower than at peak concentration, it is unknown whether nitrates can be safely coadministered at this time point.
Treatments for erectile dysfunction should not be generally used in men for whom sexual activity is inadvisable (see also Warnings and Precautions).
VIAGRA is contraindicated in patients with a known hypersensitivity to any component of the tablet.
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text:
|Leonard Nimoy
|Biographical Information
|March 26th, 1931
Boston, Massachusetts, United States
|February 27th, 2015
Los Angeles, California, United States
|Star Trek as Mr. Spock
Oliver! as Fagin
Camelot as King Arthur
The King and I as King Mongkut of Siam
Fiddler on the Roof as Tevye
My Fair Lady as Professor Henry Higgins
The Simpsons as Himself
|Leonard Nimoy Presents Mr. Spock's Music From Outer Space
The Two Sides of Leonard Nimoy
The Way I Feel
The Touch of Leonard Nimoy
The New World of Leonard Nimoy
|Vocal Type
Leonard Nimoy was an American actor.
Born in Boston, Massachussetts, Nimoy began acting in community theatre from the age of eight and, encouraged by his grandfather, studied to become an actor, appearing in bit parts and putting on shows to entertain his fellow soldiers whilst in the United States Army Reserve. He was a popular stage actor during the Fifties and Sixties, playing the male lead in Tennesee Williams' Cat on a Hot Tin Roof and A Streetcar Named Desire.
Appearing primarily on American television in such high profile shows as Dragnet, Bonanza! and The Untouchables, often as heavies, until in 1966 he was cast in his most famous role; as Mr. Spock in the original Star Trek series, which he would reprise for the films (two of which he directed), several video games and the reboot series, the only member of the original cast to do so. He was initially frustrated to be solely linked with the character, titling his biography I Am Not Spock, before later accepting this status and writing a follow up entitled I Am Spock.
Nimoy later appeared in a major role in the Mission Impossible series, as well as having several stage successes and becoming a popular voice actor due to his gravelly, authoritative tones. He remained a prolific and active performer and writer right up until his death; aged 83, in 2015.
While he only once sang briefly for roles on screen (as Spock in the original series of Star Trek and playing himself in The Simpsons), Nimoy had an extensive discography with Dot Records, recording both cover versions and original works, several of which he wrote himself. He was featured on the original Golden Throats compilation.
His first albums were designed to cash in on his success as Mr. Spock, the first being entitled Leonard Nimoy Presents Mr. Spock's Music From Outer Space, whilst the second; The Two Sides of Leonard Nimoy, jokingly reflected on the two sides of the character, the human and vulcan.
With the third album The Way I Feel, Nimoy dropped the Spock persona and performed as himself. The following year, he released The Touch of Leonard Nimoy, a poetic folk album with numerous pieces of his own writing. His final album, The New World of Leonard Nimoy, was released in 1970.
Nimoy followed his albums up with several major musical theatre roles; as Fagin in Oliver! in 1974, King Arthur in Camelot in 1973 and the following year as Tevye in Fiddler on the Roof and the King in The King and I.
After a year's respite from musicals, Nimoy portrayed Henry Higgins in My Fair Lady, which would be his final on stage musical.
Star Trek (1968)Edit
- Maiden Wine (solo)
The Simpsons (1997)Edit
- Good Morning Starshine (contains solo lines)
Oliver! (1972)Edit
- Pick a Pocket or Two (contains solo lines)
- I'd Do Anything (contains solo lines)
- Be Back Soon (contains solo lines)
- It's a Fine Life (reprise)(contains solo lines)
- Reviewing the Situation (solo)
- Reviewing the Situation (reprise)(solo)
Camelot (1973)Edit
- I Wonder What the King is Dong Tonight? (solo)
- Camelot (solo)
- Camelot (reprise)(solo)
- How to Handle a Woman (solo)
- The Jousts (contains solo lines)
- What Do the Simple Folk Do? (duet)
- Camelot (second reprise)(solo)
The King and I (1974)Edit
- A Puzzlement (solo)
- Finale Act One (contains solo lines)
- Song of the King (duet)
- Shall We Dance? (duet)
- I Whistle a Happy Tune (reprise) (duet)
- Finale Ultimo (contains solo lines)
Fiddler on the Roof (1974)Edit
- Tradition
- If I Were a Rich Man (solo)
- Sabbath Prayer
- To Life (contains solo lines)
- Tevye's Monologue (solo)
- Tevye's Dream (contains solo lines)
- Sunrise, Sunset (contains solo lines)
- Tevye's Rebuttal (solo)
- Do You Love Me? (duet)
- Chavaleh (little bird) (solo)
- Anatevka (contains solo lines)
My Fair Lady (1976)Edit
- Why Can't the English? (solo)
- I'm an Ordinary Man (solo)
- The Rain in Spain (contains solo lines)
- You Did It (contains solo lines)
- A Hymn to Him (duet)
- Without You (duet)
- I've Grown Accustomed to Her Face (solo)
Leonard Nimoy Presents Mr. Spock's Music From Outer Space (1967)Edit
- Alien (solo)
- Where Is Love? (solo)
- Music to Watch Space Girls By (solo)
- Beyond Antares (solo)
- Twinkle, Twinkle, Little Earth (solo)
- Lost in the Stars (solo)
- You Are Not Alone (solo)
- A Visit to a Sad Planet (solo)
The Two Sides of Leonard Nimoy (1968)Edit
- Highly Illogical (solo)
- The Difference Between Us (solo)
- Once I Smiled (solo)
- Spock Thoughts (solo)
- By Myself (solo)
- Follow Your Star (solo)
- Amphibious Assault (solo)
- The Ballad of Bilbo Baggins (solo)
- Cotton Candy (solo)
- Gentle on My Mind (solo)
- Miranda (solo)
- If I Was a Carpenter (solo)
- Love of the Common People (solo)
The Way I Feel (1968)Edit
- I'd Love Making Love to You (solo)
- Please Don't Try to Change My Mind (solo)
- Sunny (solo)
- Both Sides Now (solo)
- If I Had a Hammer (solo)
- Here We Go 'Round Again (solo)
- Billy Don't Play the Banjo Anymore (solo)
- It's Getting Better (solo)
- Love Is Sweeter (solo)
- The Hitch-Hiker (solo)
The Touch of Leonard Nimoy (1969)Edit
- I Search for Tomorrow (solo)
- Maiden Wine (solo)
- Now's the Time (solo)
- Cycles (solo)
- I Think it's Gonna Rain Today (solo)
- I Just Can't Help Believin' (solo)
- Nature Boy (solo)
- Contact (solo)
- The Man I Would Like To Be (solo)
- A Trip to Nowhere
- Piece of Hope (solo)
The New World of Leonard Nimoy (1970)Edit
- Time To Get It Together (solo)
- Ruby, Don't Take Your Love To Town (solo)
- The Mayor of Ma's Cafe (solo)
- I Walk the Line (solo)
- I Finally Saw the Two of You Today (solo)
- Mary's Near (solo)
- Abraham, Martin & John (solo)
- Proud Mary (solo)
- Let it Be Me (solo)
- Everybody's Talkin' (solo)
- The Sun Will Rise (solo)
- Put a Little Love in Your Heart (solo)


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The Adam D. Nevells Memorial Fund is in its eight year and as of the 2017 distributions has provided over $27,000 total through individual scholarships & grants to the areas Adam held most dearly: Academics, Music, Athletics, Boy Scouts, and his Church (OHS Athletic and Band Boosters, Boy Scout Troop 125, & Martin Luther Chapel to support a variety of community youth programs).
As the years continue to pass the challenges continue to grow in getting Adam's Memorial fund to a sufficient level to support long term the planed annual awards. The annual Wrestling Tournament and this Annual Golf Outing remain the two largest contributors to making Adam's Memorial Fund self-sustaining. The Fund is currently at a little more than 60% of the way to the minimum goal set.
The Adam D. Nevells Memorial fund continues to grow through the ongoing donations from the community he loved and who he touched and impacted so profoundly. Thank you for your contributions and support of Adam's Fund. This continued support will ensure that Adam's spirit will live on in the lives his memorial fund touches and helps the dreams and ambitions the fatal car accident stole from Adam come to fruition through the individuals and groups Adam's Fund supports.
In addition to supporting the Annual Golf Outing, contributions can be made payable to the Capital Region Community Foundation with the notation "Adam D. Nevells Memorial Fund" on the memo line or in accompanying note and online at:
Adam D. Nevells Memorial Fund


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Dwayne Michael Carter, Jr. (born September 27, 1982), better known by his stage name Lil Wayne, is an American rapper. At the age of nine, Lil Wayne joined Cash Money Records as the youngest member of the label, and half of the duo, The B.G.'z, with B.G.. In 1997, Lil Wayne joined the group Hot Boys, which also included rappers Juvenile, B.G., and Young Turk. Hot Boys debuted with Get It How U Live! that year. Lil Wayne gained most of his success with the group's major selling album Guerrilla Warfare, released in 1999. Also in 1999, Lil Wayne released his Platinum debut album Tha Block Is Hot, selling over one million copies in the U.S.
Although his next two albums Lights Out (2000) and 500 Degreez (2002) were not as successful (only reaching Gold status), Lil Wayne reached higher popularity in 2004 with Tha Carter, which included the single "Go D.J." Wayne also appeared on the Destiny's Child top ten single "Soldier" that year. In 2005, the sequel to Tha Carter, Tha Carter II, was released. In 2006 and 2007, Lil Wayne released several mixtapes and appeared on several popular rap and R&B singles. His most successful album, Tha Carter III, was released in 2008 and sold over 1 million copies in the U.S. its first week of release. It included the number-one single "Lollipop" featuring Static Major. It also includes the singles "A Milli" and "Got Money" featuring T-Pain and won the Grammy Award for Best Rap Album.
Pierre David Guetta (7 November 1967), known professionally as David Guetta (French pronunciation: [daˌvid ɡɛˈta]), is a French house music producer and DJ. Originally a DJ at nightclubs during the 1980s and 1990s, he co-founded Gum Productions and released his first album, Just a Little More Love, in 2002. Later, he released Guetta Blaster (2004) and Pop Life (2007). His 2009 album One Love included the hit singles "When Love Takes Over" (featuring Kelly Rowland), "Gettin' Over You" (featuring Chris Willis, Fergie & LMFAO) and "Sexy Bitch" (featuring Akon), the last becoming a top five hit in the United States and all three reaching #1 in the United Kingdom, as well as another internationally known single called "Memories" featuring Kid Cudi which became a top five hit in many countries. Guetta has sold over three million albums and 15 million singles worldwide. He is currently one of the most sought-after music producers. As at 2012 David Guetta is the world's most popular DJ, claiming the #1 poll position of the DJ Mag 100 popularity poll.
Tramar Dillard (born December 16, 1979) better known by his stage name Flo Rida (pronounced /floʊ ˈraɪdə/), is an American rapper. He released his debut album, Mail on Sunday, in March 2008. His debut single "Low", featuring T-Pain, was a No. 1 hit for ten weeks in United States in early 2008. Two other singles resulted from Mail on Sunday: "Elevator" and "In the Ayer". In 2009, his second album R.O.O.T.S. was released; its most successful single "Right Round" was at the top of the Hot 100 for six weeks. Since then, he has released his third studio album titled Only One Flo (Part 1), which will see a sequel titled Wild Ones.
Miley Ray Cyrus (born Destiny Hope Cyrus; November 23, 1992) is an American actress and pop singer-songwriter. She achieved wide fame for her role as Miley Stewart/Hannah Montana on the Disney Channel sitcom Hannah Montana.
Cyrus recorded music for the soundtracks, Hannah Montana (2006) and Hannah Montana 2/Meet Miley Cyrus (2007), released by Walt Disney Records. With the success of the Hannah Montana franchise she established herself as a teen idol. In 2007, Cyrus signed to Hollywood Records to pursue a solo career. She embarked upon the Best of Both Worlds Tour the same year, in which she performed as both herself and in character as Hannah Montana. The tour was eventually turned into a high-grossing concert film titled Hannah Montana & Miley Cyrus: Best of Both Worlds Concert (2008). In July 2008, Cyrus released her first solo album, Breakout (2008), which was commercially successful.
She began her foray into film by providing the voice of "Penny" in the animated film Bolt (2008). Cyrus earned a nomination for the Golden Globe Award for Best Original Song for her performance of Bolt's theme song, "I Thought I Lost You". She also reprised her role as Miley Stewart/Hannah Montana in Hannah Montana: The Movie (2009). The Hannah Montana: The Movie' soundtrack introduced her to new audiences within country and adult contemporary markets.


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|Card No.: ZX-032
|Shien-Seiten Maito (Maito, Celestial of Four Flames)
|Power Level: 10 Battle Potential: A-Class
|Full Name: Nanjouin Kaito <age 17>
|Race: Wingfolk <Male>
|Affiliation: Phoenix Academy, Suzaku House: 2nd Year Student
|Artifact: Enkin (Lyre of Flames) "Ame-no-Uzume" <Suzaku Attribute>
|Spirit: Dancestar
|Abilities: Flaming Body, Melting Matter
|This student serves as the secretary of the Phoenix Academy Student Council. Bearing the rare genes for both four wings and wings of fire, this child prodigy is the eldest son of the Nanjouin Family.
|Maito: "So you must be Kai? I've heard about you from Kiriko. Indeed, you are a suitable match for my good-for-nothing failure of a little sister….
"Kai: "Correction… Our Class President is no failure!"
|<Story: Part 19> And so the Spring Semester passed as Yamato City headed into Summer. Kai was swamped with so many requests and missions from his new job at Amagahara that he spent most of his summer days without doing anything towards his original objective.


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Making bread from scratch is not easy, and neither is slicing it without the right kitchen supplies. When using our bread slicer, each slice is perfection.
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This article, Machine Newspaper, was written by Queen-of-the-Living-Dead. Please do not edit this fiction without the writer's permission.
- This article is a part of the Code Genesis Continuity.
At around 7 PM to 8 PM, on the 11th, a man waiting on a subway platform was abruptly shot in the chest. He then fell onto the tracks and was immediately decapitated by the arriving subway train coming in from St. Michael's Street, killing him instantly.
The police have not yet made any connections to the Bedford murder, but it has added to the recent shootings committed in the last few months.
Remember this: "A bazooka in the hands of a woman PMS'ing can cause mass mayhem in a zombie apocalypse." --Queen-of-the-Living-Dead 02:07, March 9, 2011 (UTC)


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Charlton Heston's Family Reveals How His Faith In God Helped Him Make It In Hollywood
He is most remembered for the many roles he portrayed on stage and film, but Charlton Heston's most famous words came from a speech in 2000, where he told Al Gore he could take his guns "from my cold, dead hands."
Having lived in a time before the 24-hour news cycle, there are many details of Heston's life that many would be absolutely shocked to discover.
The man led God's people out of Egypt as "Moses" in the 1956 film The Ten Commandments, and he walked with Dr. Martin Luther King, Jr. during the March on Washington in 1963. Very few can attest to both feats in the same lifetime, but this is just scratching the surface as to who Charlton Heston was.
While it seems today that everyone's lives are available for inspection, Heston lived in a time where privacy meant something, and political correctness wasn't even a concern. Heston represents a time when Americans acted on injustice, tried to do the right thing, and didn't expect the government to take care of them.
Today's youth might not have any idea who he was, but Charlton Heston may be the most politically influential man Hollywood has ever seen (aside from Reagan). While his abilities on-screen were matched by few, it was his off-screen contributions to society that are still being felt today.
Born Charlton John Carter on October 4, 1923 in Illinois, the young thespian claims to have always been eccentric. Soon after his birth, the family packed up and moved to a small town in Michigan, until his parents divorced. When he was 10-years-old, his mother remarried, and the family moved to Chicago. There, Heston claims to have had a tough time making friends because he was so different from the other kids.
"All kids play pretend games, but I did it more than most. Even when we moved to Chicago, I was more or less a loner. We lived in a North Shore suburb, where I was a skinny hick from the woods, and all the other kids seemed to be rich and know about girls."
After his parents divorced, Charlton changed his last name from Carter, to his stepfather's last name: Heston. This was the last name he used for his first movie, a 1941 amateur film adaptation of Ibsen's Peer Gynt.
Heston would recount numerous times where, as a child, he would go into the forest and act out his favorite characters from stories he would read. This "pretending" led Heston to pursue theatre, and he would eventually earn a drama scholarship from Northwestern University.
Then Pearl Harbor happened, and the United States began sending all of its boys to war, Heston being no exception. In 1944, Heston joined the United States Air Force, and for two years served as a radio operator, and aerial gunner on-board a B-25 Mitchell bomber.
That same year Heston would marry fellow Northwest University student Lydia Marie Clarke, and would enlist in the military where he would go on to narrate highly classified videos involving subjects such as nuclear weapons. In fact, Heston was even granted the highest level of security clearance during that time, giving him access to information the general public couldn't even fathom.
After World War II, Heston would settle with his wife in New York with hopes of making it as television and stage actors. After years on Broadway, and numerous television roles, Heston was given the leading role for his first movie, Dark City in 1950. Two years later Heston would be cast in The Greatest Show On Earth, which won the Academy Award for Best Picture that year.
Heston would go on to star in iconic films such as The Secret Of The Incas (1954), The Ten Commandments (1956), Touch Of Evil (1958), and Ben-Hur (1959) where he would go on to win an Academy Award for Best Actor (Ben-Hur won 11 Oscars that year).
Amidst all of this success, Heston somehow found time to pursue other endeavors. More specifically, Heston was a very active member of the Democratic party during his early days in the spotlight. In one instance in 1961, Heston stood outside and picketed his own film as it was being shown at a segregated theatre.
In 1963, Heston traveled with Dr. Martin Luther King, Jr. during his March on Washington, and would continue to accompany Dr. King as he traveled across the country delivering speech after speech, stating that he was in the business of civil rights "long before Hollywood found it fashionable." The following year, Heston would endorse Lyndon B. Johnson for president, after LBJ was able to pass the 1964 Civil Rights Act.
Heston would soon begin to shift political alliances after Johnson was elected. While Heston was in favor of gun rights, following the 1968 assassination of Robert F. Kennedy, Heston joined fellow actors Kirk Douglas, James Stewart, and Gregory Peck in voicing support for Johnson's 1968 Gun Control Act.
In 1969, Charlton Heston was asked to run for Senate by the Democratic party, but the actor couldn't give up on what he loved for a career as a politician. He would much rather work on his acting, as opposed to 'act like he's working.' Plus, he was already serving as president of the Screen Actors Guild (which he held from 1965-1971).
Amidst his activism, Heston would continue to star in motion pictures during that time, appearing in films such as 1968's Planet Of The Apes, its 1970 sequel Beneath The Planet Of The Apes, and a 1970 film adaptation of William Shakespeare's Julius Caesar.
Even though his passion was for the arts, Heston was always a major figure in American politics. After endorsing Democratic candidate Hubert Humphrey in 1968, Heston completely switched sides, and began endorsing Republican candidates. When he was asked about why he changed his views, Heston claimed that he "didn't change," but that "the Democratic Party changed."
In 1972, Heston would endorse Richard Nixon for president, and in the 1980's Heston would take a strong position for gun rights. Heston would finally register as a Republican for good in 1987, and would go on to campaign for Ronald Reagan, George H.W. Bush, and George W. Bush, respectively.
As he grew older, Heston became even more involved in shaping American culture. While he would continue to act, and provide narration to films such as Armageddon, and Disney's Hercules, Heston was not one to let his perceived injustices go by without speaking up.
One shining example of Heston standing up for what he believed to be right came during, of all things, a Time Warner shareholder's meeting. Heston criticized the company for releasing an album by the rapper Ice-T that included a song titled "Cop Killer."
As a man who once stated that "political correctness is tyranny with manners," it's safe to say that Heston was never afraid to speak his mind. In a 1997 speech called "Fighting the Culture War in America," Heston said that the media and politicians were trying to turn society against:
"..the God-fearing, law-abiding, Caucasian, middle-class Protestant – or even worse, evangelical Christian, Midwestern or Southern – or even worse, rural, apparently straight – or even worse, admitted heterosexuals, gun-owning – or even worse, NRA-card-carrying, average working stiff – or even worse, male working stiff – because, not only don't you count, you are a down-right obstacle to social progress. Your voice deserves a lower decibel level, your opinion is less enlightened, your media access is insignificant; and frankly, Mister, you need to wake up, wise up, and learn a little something from your new America; and until you do, would you mind shutting up?"
Heston stood up for what he believed, including strongly opposing Affirmative Action for being, as he thought, an act of reverse discrimination. He felt as though this was just another example of cultural warfare, and said as much during that same 1997 speech:
"The Constitution was handed down to guide us by a bunch of wise old dead white guys who invented our country! Now some flinch when I say that. Why? It's true – they were white guys! So were most of the guys that died in Lincoln's name opposing slavery in the 1860s. So why should I be ashamed of white guys? Why is "Hispanic Pride" or "Black Pride" a good thing, while "White Pride" conjures shaven heads and white hoods? Why was the Million Man March on Washington celebrated by many as progress, while the Promise Keepers March on Washington was greeted with suspicion and ridicule? I'll tell you why: Cultural Warfare!"
A staunch supporter of the Second Amendment, in 1998 Heston was named the president of the NRA. He would hold the position until stepping down in 2003. When he announced his resignation, he raised his rifle above his head and said they could take his gun "from his cold, dead hands!" That same year Heston retired from acting for good after being diagnosed with Alzheimer's Disease.
In 2008, Charlton Heston passed away after battling a severe case of pneumonia. He was 84-years-old, but he had lived more than 20 men combined. While he is often remembered for being a strong conservative, Christian man, his children give a different account of their father. His son, Fraser, said the following on his late father:
"A lot of people look at him as this overly-conservative, rigid, Old Testament guy, but he wasn't that sort of person at all. He was understanding, forgiving and loving as a husband, father and grandfather."
During an interview with Closer, Heston's daughter, Holly, opened up about her father as well:
"He had a big personality and a deep, passionate laugh. He loved life. He was warm, outgoing and all encompassing. He would walk into a room and it would change because he had such a presence. His life was his family in many ways. He loved his work, but his family meant so much to him."
In his later years, Heston spent much of his time with his family, and his grandchildren in particular. Fraser reflects on his father's relationship with his grandkids:
"They were the apples of his eye, as it should be. He spoiled them with good things. He didn't just give them toys and extravagant gifts. He gave them his time, which is the most valuable thing you can possibly give a child."
Many unfamiliar with Heston may have perceived him to be a strict, hardcore conservative, concerned with politics, but the accounts by his children paint a different picture of the beloved actor. They describe him as a loving father, who would do anything for his family, and those he loved.
While today's celebrities like to play activist on social media, and during talk shows, Charlton Heston was a constant figure in American politics for over half a century. He was able to influence people both on and off-screen, and did his best to leave a positive impact on the world. He walked the Ten Commandments down the mountain, and he marched with Dr. Martin Luther King, Jr. for civil rights.
For those of us who were able to enjoy his career, we should consider ourselves lucky to have been witness to such an accomplished man of God. While we may never get another Charlton Heston in our lifetimes, the influence he had on society has left a huge impact. Maybe we will get lucky, and someone cut from the same mold will come along, and change the world for the better. Until then we will continue to admire the incredible career, and life of Charlton Heston.


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Ryu Ryu
Racerback Dress, Black
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"A Process to Teach Values through a process of self enquiry, using stories."
Teaching Values through stories and parables have been the most sought after way since time immemorial. But teaching values have always been associated with 'Morals', 'the Right Vs Wrong'. With the ushering in of the 'Consciousness Age' is there a process which can instill the much needed process of self-enquiry? Help children to make their own decisions? Share their views and thoughts? Make their choices?
'Discovery', a unique tool enables all the above. It initiates a process of self-enquiry, which encourages a need 'to Learn to Learn'. It aims at giving the different facets of the same value and in the process widens one's understanding of each value or value related attribute.
The workshop aims the following:
1. To understand the meaning of Values
2. To understand the importance of imparting Life skills to children in value education
3. To gain clarity on formation of values
4. To understand the cause and effect relationship in value formation
5. To learn how to work with cause than with effect to bring about a deep change
6. To learn the impact of story telling in initiating a process of self enquiry
7. To understand 'Discovery', its usage in various context.
The methodology adopted is primarily semi-structured wherein enough scope is provided for the deeper human processes to emerge. The small group activities are designed so as to enable an individual to look into their own inner self with a clear purpose to understand themselves and human processes.
1. Better clarity on the meaning of Values.
2.Clarity on why one does, what one does and the way one does things.
3. Improved ability to identify and understand values in self and others.
4.Ability to use the tool 'Discovery' and initiate a process of self-enquiry in self and others.
Duration of the Workshop: One full day
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One of the most elusive Scotch whiskies, Brora has gained a cult status only after it was closed in 1983. Today I try a single cask bottling from Signatory Vintage. Read More
Diageo announced their Special Releases today, so I thought it time to review one from 2010: a great whisky from Brora. Read More
Then like us on Facebook or follow us on Twitter!


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Community Health Systems Engineer I-PRN in Starke, Florida
Independently performs corrective and preventive maintenance on plumbing, electrical,
mechanical, and HVAC systems throughout the hospital. Accomplishes carpentry and painting as needed. Assists as required in other tasks related to maintenance and repair. Works to complete all jobs safely andefficiently. Sets up and performs all work independently. Serves as duty mechanic. Functions as on callduty mechanic for after hours, weekends and holidays. Functions in a security capacity as needed. Initiates, grades and participates in drills and training. Uses menu driven computer programs to enter andretrieve data. Ensures all documentation for man hours and maintenance actions are recorded accurately. Ensures compliance with all regulatory agency guidelines in work and in documentation. Maintains closeworking relationship with vendors as well as internal and external customers.
High School Diploma or equivalent. Able to read and comprehend drawings / blue prints for electrical, plumbing, and mechanical systems. Five years experience as a maintenance mechanic, preferably in a hospital. Ability to demonstrate some proficiency in all of the following areas: Air conditioning / refrigeration, carpentry, painting, mechanical maintenance, electrical work, and plumbing. Prefer licensing in at least one area as applicable. Be knowledgeable in appropriate building codes and standards in effect and preferably knowledgeable in hospital related codes.
Job: Facilities Management (Engineering / Maintenance / Housekeeping / Security)
Organization: Shands Starke Regional Medical Center
Location: FL-Starke
Requisition ID: 1736804


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Shipping Containers for
Pipeline Monitoring Equipment
While shipping containers can be used for an infinite number of industrial applications, the Oil and Gas industry has found unique uses – one of which is equipment housing along pipelines.
Energy Transfer, the operator of the Dakota Access Pipeline (DAPL) and the Energy Transfer Crude Oil Pipeline (ETCOP), utilizes 317 10ft shipping container equipment enclosures from North Dakota to the Gulf Coast. Each remotely placed enclosure houses sensitive pipeline monitoring equipment accessed only once per month.
Why Choose a Shipping Container for an Equipment Enclosure?
Energy Transfer had previously used traditional steel structures for their pipeline equipment enclosures. However these buildings could not meet critical requirements that shipping containers inherently provide:
- Security: Each container is water, wind and rodent resistant as well as protected from potential break-ins.
- Reduced footprint. A traditional steel structure could not meet the 10ft x 8ft requirement.
- Quick deployment: Units are manufactured more quickly that alternative structures.
- No need for foundation: Installation time is significantly reduced.
- Ease of equipment installation: Predetermined equipment pass-through design meant no guesswork during fabrication and no delays due to fluctuating measurements.
- Cost: Lower initial cost.
- Low cost of ownership: Reduced maintenance costs over time.


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Doncaster's exciting young half-back Richard Wilkinson is set to miss Sunday's South Yorkshire derby against Sheffield Eagles and could be facing a lengthy spell on the sidelines.
The scrum-half, who scored a try and set one up for winger Nev Morrison, injured his knee late in Sunday's 44-32 Championship defeat at Keighley and left the ground on crutches.
"He'll be seeing the physio and we'll also get him to see a specialist if we need to, to see what the problem is," said player-coach Paul Cooke.
"It is always concerning when a player's knee buckles and there is no-one near him, as happened to Richard, because it can be serious and that's what we need to get checked out.
"First of all it is really disappointing for the player, and he was feeling really down with himself yesterday and probably will be until he gets some results.
"It will be a big loss to the team if he is out for any length of time because he has worked his way up and will go into 2015 as the No 1 scrum-half at the club."
With Danny Nicklas, who started the season as the club's first choice scrum-half already ruled out for the season with a serious knee problem, Cooke could find his options limited in the coming weeks.
Super League club Hull FC, with whom the Dons have a dual-registration agreement, also suffered injury problems to their half-backs in Thursday's draw with Castleford at the KC Stadium, and Cooke is unlikely to be able to call on out-of-favour Australian Jacob Miller this weekend.


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