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LuMINN Hotel Minneapolis is Elevating Guest Engagement via Intelity/INNCOM Integration
Guests are controlling room lighting, temperature, alarm clock and more PLUS accessing hotel services and information directly from the Intelity bedside tablet
Guests staying at the LuMINN Hotel Minneapolis, an Ascent Hotel Collection Member, are controlling their room environments and engaging with the property in exciting new ways. Since adding Intelity in-room tablets to each guestroom – which are interfaced to the INNCOM by Honeywell Integrated Room Automation Systems (IRAS) – guests are controlling room temperature, lighting, and alarm clock directly from their guestroom tablets. Guests can also access the hotel's mobile app, powered by Intelity, which provides a direct link to hotel information, services, concierge, transportation, maps, directions and more.
"Adding in-room tablets to each room brings another element to the guest experience," said LuMINN Hotel Minneapolis Owner Harshal Patel. "Today, everyone is tech savvy and has a smartphone or tablet. Enabling guests to use an in-room iPad as an alarm clock or to request amenities or control elements of the room like temperature and lighting is an engaging way to exceed their expectations, and it's a service that not many hotels are offering.
"LuMINN isn't the biggest hotel and adding in-room tablets wasn't in my budget, but I believed it was a necessary investment that would instantly add differentiation and boost guest satisfaction and loyalty. The Intelity ICE platform is extremely intuitive, and it came with an already-established interface to INNCOM. Partnering with Intelity just made sense."
While saving energy is of the utmost importance to Patel, he said it was not the key reason he was eager to offer room-control functionality on the in-room tablet.
"Being able to turn off lights or raise or lower room temperature through the tablet is a perk, especially if it lowers my energy bills, but it's not the reason I was excited about the technology integration," Patel said. "I'm more concerned with providing convenience to my guests and not requiring them to get up from our comfortable beds to turn off the lights or turn on the Do-Not-Disturb button in the hallway. Many travelers already have 'connected homes.' With Intelity + INNCOM, they can now be connected to their rooms in the same way. It's fun, it's interactive and it's elevating the LuMINN Hotel Minneapolis experience."
Solid Integration Partnership
INNCOM began working with the LuMINN Hotel Minneapolis in early 2017 when it was previously known as the Federal Plaza Hotel. Installation included the INNCOM E528 thermostat that provides energy control, humidity monitoring and motion detection for a more efficient HVAC system. The E528 series thermostat serves as the network gateway for guestroom controls, including the Intelity in-room tablet interface. Also featured in LuMINN guestrooms is the INNCOM EVORA Switch Series. EVORA enables guests to control lighting independently in the Entry, Cove and Window areas of the room or all together.
Michael Asmussen, Engineering Manager for INNCOM by Honeywell, said the company has a "healthy partnership" with Intelity and explained that any property with a networked INNCOM system can leverage the EMS to connect to Intelity in-room tablets that INNCOM does not offer.
"The synergies between INNCOM and Intelity are beneficial for all hoteliers," Asmussen said. "Whether a hotel starts with INNCOM and adds Intelity or vice versa, our proven and compatible interface gives guests to control their room environment. The two-way communication is completely transparent to the guest. All they see is a fun, new, and interactive way to connect to the room. For guests, it's nothing short of magic; for owners and operators, it means better efficiencies and lower energy costs."
Gregg Hopkins, Intelity's Chief Sales & Marketing Officer, said the two companies have been working together for almost eight years.
"The Intelity / INNCOM relationship is very strong," Hopkins said. "We are giving hoteliers the ability to offer a flexible user interface that gives guests more control over their stay experience. It's the next generation of self-service that today's modern travelers are looking for. We are thrilled that the LuMINN Hotel Minneapolis is LIVE with Intelity's in-room tablets, and we look forward to working with INNCOM at more properties soon."
Small Inn is Big on Guest Engagement with Intelity
Mobile app powered by Intelity is improving communications and streamlining check in at the Jackson's Falls Country Inn in Milford, Canada
This month the Jackson's Falls Country Inn in Milford, Canada, began engaging with its guests via a custom mobile app powered by Intelity. Equipped with the Intelity mobile app, guests staying at the nine-bedroom boutique inn and restaurant in Prince Edward County (PEC) have more control over their stay, including the flexibility to use their mobile devices to check themselves in and out.
"Jackson's Falls Country Inn is a small family business," said Lee Lewis, property owner and chef. "In the past, it was difficult to connect with guests. If I was in the kitchen preparing dinner, I wasn't easily accessible to answer questions. Also, travelers seldom arrive right at check-in time. Because we are in the heart of wine country, guests may stop at a winery, tour a local brewery or just sightsee around PEC before arriving at the Inn. They shouldn't be rushed or feel stressed because they are running late. The beauty of being on vacation and staying at a small country inn is having the freedom to roam, relax and enjoy life on your own terms. With Intelity's mobile app, I don't have to wait around for people to check-in; I can be off tending the organic garden, preparing a meal or refreshing a room. And, when guests do arrive on property, rather than searching me out, they can check themselves in using the mobile app. They don't have to engage with staff unless they want to."
The mobile app from Intelity gives guests greater control over their stay by turning their mobile devices into guest service tools, whether they are physically on premises or offsite – literally anywhere else in the world. Orders and requests can be placed even before guests arrive at the Inn. The app facilitates room service requests, schedules wake-up calls and valet assistance makes a restaurant reservation, and easily checks guests in and out.
"The mobile app isn't replacing personalized service, it's enhancing it," Lewis said. "Perhaps a couple that just checked-in gets to their room and realizes they're hungry, but they want some downtime in the room before venturing out again. Through the app, they can order a bottle of wine with a local cheese plate to be delivered to the room. Without the app, that service wasn't previously available. We are so happy to have found Intelity. There are a lot of mobile app developers out there, but few have the functionality of the Intelity mobile app."
By June, Lewis said she plans to add the lobby tablet solution from Intelity. By placing a tablet computer in the lobby, those guests who prefer not to download the Inn's app will have access to the same services via the tablet. Intelity's lobby solution will provide a resource for guests to find information to frequently asked questions and solve common needs. It will reduce strain on staff and enable them to focus on more detailed guest requests and operating procedures. Intelity's lobby solution will provide general information on Jackson's Falls Inn and Restaurant, offer maps to local attractions and much more.
"We are delighted that this rustic, casual and cozy country inn is relying on Intelity to better engage with its guests," said Gregg Hopkins, Intelity chief sales and marketing officer. "This is a one-of-a-kind lodging experience that fuses European and First Nation cultures in its dining room and décor. Through our app, Jackson's Falls Country Inn and Restaurant can share its rich history with guests. The Public House Restaurant, comprised of a dining room, bar and guest lounge, was originally built in 1870 as a one-room public school house. Guests enjoy local wines and craft beers on tap here while indulging on indigenous wild foods prepared by Lee. Then, they can retreat to the inn which lodges the nine guestrooms. It is the perfect venue for small events, corporate retreats or travelers just looking for some quiet, country charm. More importantly, Jackson's Falls Country Inn is proof that you don't need to be a large resort to benefit from Intelity's guest-service tools. Size doesn't matter; it's guest engagement that counts."
Hilton Inn at Penn Named Winner of Intelity's 'ICEvoice Challenge'
Property to receive Intelity's voice concierge solution enabling them to make voice requests via Amazon Alexa devices in guest rooms
Why are hoteliers eager to add voice-command technology to guestrooms? Just ask the Hilton Inn at Penn, winner of Intelity's ICEvoice Challenge. Earlier this month, Intelity asked its customers to state how they envision using the company's newest solution that enables guests to use voice commands for requesting services and controlling the in-room environment. The reply from the Hilton Inn at Penn was short, sweet and on point: "We currently use Intelity with our guestroom iPads and are looking to grow from that success." And grow they will. Within the next six weeks, the AAA four-diamond hotel, located on the University of Pennsylvania campus, will receive ICEvoice FREE, forever.
As the ICEvoice Challenge winner, the Hilton Inn at Penn will receive:
Amazon Echo voice activated speakers for every guestroom, including integration to Intelity's trademarked, award-winning ICE HUB: Control Panel, at no charge.
Development and implementation of unique phrases and commands the hotel desires.
User training, integration coordination, installation, and configuration.
24/7/365 technical support from Intelity's team of experts to ensure services work as planned.
"We are thrilled to be the Intelity ICEvoice Challenge winner," said Hilton Inn at Penn Director of Operations Wesley Clark. "We were always proud to be featuring Intelity iPads in every room; it's something not many hotels can boast about and we see it as an elevated service differentiator. It's so cool that now we will be adding a voice concierge to our rooms. It's going to bring that 'wow' factor to service delivery. ICEvoice won't replace the bedside tablets by any means; it will simply do things faster. Being able to speak a request vs. place one through the iPad will save our guests time and it will add personalization. We'd like to thank Intelity for making this opportunity possible. It shows us that Intelity really values our partnership – and we share that sentiment. We can't wait to be live with ICEvoice."
Other ICEvoice Challenge submissions from customers said they would use Intelity's voice solution to greet the guest by name when a guest enters the room and provide them with the hotel's Wi-Fi password, introduce itself to guests as their virtual butler when they first enter the room and detail the intricacies of the property, order the hotel's car service for a specific time, and, speak to international guests in their preferred language.
Webinar Answers 'Voice' Questions
In addition to announcing the contest winner during its "Say Hello to ICEvoice" webinar yesterday, Intelity Chief Sales and Marketing Officer Gregg Hopkins showed participants why migrating to voice technology is so important to hotels today. According to statistics released by the Smart Audio Report:
3 million U.S. adults have access to a smart speaker; 19.7% of U.S. adults use smart speakers of which 57.8% are male and 42.2% are female
Amazon is leading the smart speaker market with 71.9% penetration, followed by Google at 18.4% and others at 9.7%
Two-thirds of U.S. voice-activated speaker owners said they are using them to entertain friends and family, with 60 percent using the devices to play music for guests, 30 percent asking it to answer a general question, and 28 percent asking it for weather updates.
31 percent of smart speaker owners are asking their virtual assistants to control other devices in the home, with 61 percent controlling devices in the living room and 38 percent controlling devices in the kitchen.
"One in six adults in the United States own voice-activated smart speakers," Hopkins told webinar participants. "The adoption rate of such speakers over the last three years is now outpacing that of smartphones and tablets. People are replacing time spent with other devices to use smart speakers. Just over a third of Americans are ditching their smartphones to spend time with the speakers, while 30 percent are using the devices instead of watching television."
What does this mean for hotels?
Intelity Chief Technology Officer Chris Grey explained that voice technology is becoming widely popular because of its speed and convenience; voice search is much faster than web or mobile search, citing that humans speak 150 words per minute vs. typing 40 words in the same amount of time. Voice-enabled devices are responsible for 1 billion searches performed every month on devices like Amazon Echo, according to Smart Audio Report.
"Adding a voice concierge solution isn't as easy as just buying an Echo for every guestroom, plugging them in and hoping they work," Grey said. "It takes a lot of integration to funnel voice requests into the operating system to become a text ticket, then sends it to Intelity's request manager so the right staff member fulfills the request and delivers it to the guest in a timely manner. This level of service is one of the most exciting things to come along in the last 5 or 10 years, but it doesn't happen by magic.
"It took Intelity 10 years to build a robust platform that makes voice requests possible," he said. "If a guest realizes while unpacking her suitcase that she forgot a toothbrush, she doesn't have to stop what she is doing to call the front desk to have a toothbrush brought to the room – or leave the room and walk down to the gift shop to purchase a new one. The guest simply says 'Alexa, ask the hotel to bring me a toothbrush.' Within minutes, the toiletry arrives. In this case, voice technology is not just informational, it's interactive with the guest, making their experience more personalized than ever. Soon, integration between ICEvoice and our ICEbedside tablets will enable guests to say 'Alexa, ask the hotel restaurant what's on the menu.' And, Alexa can reply 'See the iPad in the room for a complete menu listing.' It's simple, as long as a hotel has the Intelity Interactive Customer Experience – or ICE – platform."
Art Ovation Hotel Elevates its Gallery Experience with Intelity
Guests take Intelity's portable In-Room Tablets with them as they tour the hotel, learn about each piece of art and its artist, and purchase the works.
Something extraordinary is happening in Sarasota, Fla. This month the Art Ovation Hotel Autograph Collection® opened its doors at 1255 North Palm Avenue as an active host, facilitator, patron, and partner of the arts. To enhance the hotel's art gallery experience, the property equipped each of its 162 guestrooms with portable in-room tablets from Intelity. Guests can click on the Ovation Arts icon in the hotel's mobile app, powered by Intelity, to see objects on display throughout the property, and they are encouraged to take the in-room tablets with them as they tour the gallery. Uploaded videos provide details on each work and its artist, and guests can purchase pieces directly through the mobile app.
Using Intelity tablets, our guests are engaging more closely with local artists and learning about their artistic expressions on display throughout our hotel," said Front Office Manager Egemen Alici. "Together with the Ringling College of Art and Design, we are presenting an evolving array of unique, immersive, artistic experiences supported by exceptional hospitality in a dynamic, art-centric environment. Intelity is helping us bring these art experiences to life through the mobile app they created. Guests can view videos of the displays on their tablets prior to seeing them face-to-face, or they can tour our exhibitions with tablets in hand – and even buy art on the spot using the Ovation mobile app."
At Art Ovation Hotel, guests are invited to interact and be part of the rotating art exhibitions that include live performances, tours, classes, talks, and workshops. All artists are local, and most originated from Ringling College. Works are donated to the hotel and exhibited throughout the property. Eighty percent of art sold goes to the artists and 20 percent is given to the Ringling College Fund. Artists visit the property daily; some perform while others draw in front of guests to get them more engaged.
Soon hotel staff will begin using Intelity's new mobile messaging portal. Part of the ICE platform, the messaging portal will enable guests to place requests with hotel staff via the messaging channel they choose, whether it be SMS text or social media. Whether the guest is at home, in route to the hotel, or touring the art exhibit, staff will have the messaging tools they need to reply to guest requests instantly and deliver on requests efficiently.
"The Art Ovation Hotel offers something imaginative, inspiring and extraordinary," said Gregg Hopkins, Intelity Chief Sales, and Marketing Officer. "It presents an evolving array of unique, immersive, artistic experiences supported by inspired technology in a dynamic, art-centric environment. What's really cool for guests is that they can preview all art on display first from their guestrooms by using our convenient iPads. They can also use them to request room service, set wake-up calls, request valet service, make dining reservations, facilitate check out and much more. But even before they step foot into the hotel, guests can use Intelity's ICEweb to get a more complete, personalized look at the property. No matter how visitors prefer to interact with Art Ovation Hotel, Intelity is powering the engagement process every step of the way.
"We are thrilled that Art Ovation Hotel is a new Intelity customer," he said. "We look forward to expanding our relationship and bringing the hotel's dynamic art environment to life with our ICE solutions."
Intelity Solutions Helping Hotels Achieve Higher AAA Diamond Ratings
Recent updates to AAA Diamond Rating Guidelines reflect the importance of connecting travelers and hoteliers via mobile technologies such as mobile apps, mobile keys, and mobile concierge
AAA has revised its Approval Requirements and Diamond Rating Guidelines to now "reflect the importance of connective technologies that allow guests and lodging operators to interact on an increasingly personalized basis." What this means to hoteliers looking for a higher AAA Diamond Rating is they will now be expected to connect their guests to hotel staff and services by smartphones and tablets and keep them engaged via mobile apps, mobile keys, and mobile concierge services.
Here are a few ratings criteria that AAA inspectors will be looking for when reviewing property technologies:
Guest Services Category – Guest service is available by alternate means (digital application, texting, in-room device)
In-Room Dining – Service number is answered within three rings, or instant access is available through other device/system
Check-Out Services – Alternative check-out methods are available (mobile/online/in-room device)
"As developer of the world's first and most widely used integrated guest-services platform, Intelity's award-winning Interactive Customer Experience
(ICE) technology is equipping hotels with the guest-facing tools they need to improve their AAA Diamond Rating," said David Adelson, Intelity CEO. "ICEapp, ICEweb, ICElobby, and ICEbedside are giving guests fingertip connectivity to the hotel along every step of their journey, from the moment reservations are made till long after travelers check out. By giving guests direct digital access to request things like room service, housekeeping or wake-up calls, hoteliers are revolutionizing and personalizing the guest experience."
Connective Technology & Lodging Approval Requirement
To be classified as a "Distinguished" hotel and achieve a 3-Diamond rating, hotels much provide wireless Internet access throughout the property and include an additional connectivity option, such as a mobile device available for check-in/out.
A "Refined" hotel with a 4-Diamond rating must provide superior Internet speed and capacity throughout the property, must support remote guest-service access through mobile devices PLUS offer one additional technology feature, such as mobile key access.
The "Ultimate Luxury" classification for a 5-Diamond hotel rating requires "leading-edge technology" and must provide advanced guest connectivity capability across all guest interactions including front-desk, bell service, concierge, maintenance, food and beverage, housekeeping, and recreation, PLUS the hotel must offer one additional technology feature, such as mobile key access.
"Intelity has developed the guest services technologies that AAA inspectors are looking for to allow guests and lodging operators to interact on an increasingly personalized basis," Adelson said. "Our MiKEY module facilitates Mobile Check-in, Mobile Check-out, and Mobile Key functionality. When guests download the hotel's mobile app onto their devices of choice, as long as the app is powered by Intelity, they can book a hotel, check-in remotely, skip the traditional front-desk check in and use their smart device to securely unlock their room door. Even more exciting, our new ICEvoice virtual concierge solution enables guests to make service requests, adjust room controls or listen to music with just a few simple voice commands.
"We encourage any hotel looking for innovative, fun and interactive ways to improve their AAA Diamond rating to reach out to Intelity," he said. "We've got the tools needed to connect hoteliers to guests, thereby serving them better than ever before. You don't have to be a luxury hotel to offer AAA 5-Diamond service. All you need is Intelity."
Marmara Park Avenue Opens with Intelity's ICE in Guest Rooms
New luxury boutique hotel, Marmara Park Avenue, aims to provide the quintessential New York experience, and to further this, the hotel has partnered with leading hospitality technology provider Intelity. This partnership allows the hotel to offer guests modern, high-tech touches to enhance their stay using ICE (Interactive Customer Experience
) guest service technology.
"It's important to us to offer guests everything they need or want to take advantage of their time in this beautiful city, and our hotel's digital amenities will play an integral role," said Nur Ercan-Magden, General Manager of Marmara Park Avenue. "The entire hotel is mainly outfitted with items and art created locally, but for our guest services technology, we chose to work with Intelity because of its reputation for sophisticated, world-class solutions."
Each of the hotel's 128 guest rooms comes with an Intelity in-room tablet installed with ICE that functions as a digital alarm clock-radio and a personal virtual concierge. Guests can access and request a full array of services, from scheduling wake-up calls to reviewing restaurant menus.
A new mobile guest app downloadable to personal devices also provides guests with a digital portal to key information for planning their stay and communicating directly with hotel staff. Even before they arrive at the property, guests can use the app to enhance their stay.
The benefits extend beyond just the guest-facing features. Automatically included with ICE is the ICE Control System (ICS), a management system that allows staff to easily update content and track usage of both the in-room and mobile applications. A built-in ticketing system notifies managers of new guest requests via desktop or mobile devices and also allows the requests to be assigned to specific departments. Staff can also message guests with important information or marketing promotions.
Intelity CEO and President David Adelson said, "Marmara Park Avenue is a perfect fit for our technology because guests who stay there will find it to be perfect tool for staying connected with not only the hotel staff but also the surrounding area in a city that can be overwhelming to some with so much to see and do. ICE will enable the hotel to give the support and attention each individual guest needs."


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Pharmacotherapy of erectile dysfunction: Current standards
Kew-Kim Chew
Keogh Institute for Medical Research, Australia
Keogh Institute for Medical Research, 'A' Block Queen Elizabeth II Medical Centre, Nedlands Australia 6009
Pharmacotherapy is currently the therapeutic option of choice for erectile dysfunction. Comprising mainly intracavernosal injection therapy using alprostadil or alprostadil combined with phentolamine and/or papaverine and oral phosphodiesterase-5 inhibitors, it is safe and effective if appropriately prescribed and administered. The medications in current use produce satisfactory erectile responses by enhancing cavernosal vasodilatation mainly through their ability to promote relaxation of the smooth muscle cells in the corpora cavernosa involving the synthesis and activity of nitric oxide via the cyclic guanosine monophosphate and cyclic adenosine monophosphate biochemical pathways. The main side-effects and complications of intracavernosal injections are postinjection pain, prolonged erections, priapism and penile fibrosis. There may be a variety of side-effects with phosphodiesterase-5 inhibition but these are usually inconsequential. Recent serious ill health and the need for ongoing long-acting nitrate therapy or frequent use of short-acting nitrates for angina are absolute contraindications to the use of phosphodiesterase-5 inhibitors. Caution has to be exercised in prescribing phosphodiesterase-5 inhibitors for patients with impaired renal or hepatic functions or receiving multi-drug therapy for any systemic disease. All patients presenting with erectile dysfunction should be investigated and treated for cardiovascular risk factors. They should also be counseled regarding lifestyle factors particularly healthy balanced diet, regular physical exercise and inappropriate social habits.
Keywords: Erectile dysfunction, intracavernosal injection therapy, pharmacotherapy, phosphodiesterase-5 inhibitors
Chew KK. Pharmacotherapy of erectile dysfunction: Current standards. Indian J Urol 2006;22:235-40
Chew KK. Pharmacotherapy of erectile dysfunction: Current standards. Indian J Urol [serial online] 2006 [cited 2020 Jan 23];22:235-40. Available from: http://www.indianjurol.com/text.asp?2006/22/3/235/27631
The management of erectile dysfunction (ED)[1],[2] evolved from its fatalistic acceptance and use of folk medicine through the ages to testosterone supplementation, psychotherapy and prosthetic surgery in the 1970s. Then, heralded by Giles Brindley's dramatic demonstration of his personal response to intracavernosal phenoxybenzamine at the American Urological Association Meeting in Las Vegas in 1983, came the era of pharmacotherapy. Alprostadil, the synthetic equivalent of prostaglandin E 1 (PGE 1 ) soon became the medication of choice in intracavernosal injection (ICI) therapy, until its dominance in the treatment of ED was supplanted by the orally effective phosphodiesterase-5 inhibitors.
The debut of each of the modern innovative pharmacotherapeutic options for ED represented a remarkable quantum leap in medical therapeutics. As a result, not only has there been a periodic paradigm shift in the management strategy for ED, but a plethora of scientific and clinical research has also contributed to new knowledge and better understanding of general and cardiovascular health as well as sexual and reproductive health.
This review covers the various topical issues pertinent to the pharmacotherapy of ED and its current standards.
Therapeutic options for ED
Not every man with ED requires therapeutic intervention for his affliction. Some may want only explanation and reassurance. In all men, however, the presentation of ED should be taken as a window of opportunity for the search for, and the identification of, cardiovascular and other risk factors with which ED is commonly associated. Regardless of how his ED may be managed, it is important, in the patient's overall and long-term interests, to diagnose and treat any cardiovascular disease which may still be asymptomatic and previously unrecognized. As for his ED, the decision to treat has to be made by the patient, guided by the attending clinician with information and advice tailored to his needs. Partner participation in the decision-making process, where possible, would be highly desirable and may help improve treatment outcome as well as patient and partner satisfaction.
When the informed decision to treat has been made, all available options (namely, psychosexual counseling, use of external mechanical devices, pharmacotherapy, complementary medicine, prosthetic and vascular surgery), including possible benefits, precautions, side-effects and complications, should be fully discussed with the patient. Therapeutic goals should be set and unrealistic expectations resolved.
In the absence of contraindications, pharmacotherapy will usually be the therapeutic option of choice. Appropriately prescribed and administered and if available and affordable, it is safe and is effective in most patients with ED.
Pharmacotherapy: Rationale and choices
The physiology of the smooth muscle cell (SMC) in the trabeculae of the cavernosal sinusoids and in the walls of the cavernosal and helicine arteries is central to the unique erectile function of the penis. The functional state of the penis is a neuro-vascular event representing the balance between the degree of relaxation and that of contraction of the SMC.[3]
Nitric oxide (NO), produced by the vascular endothelium and the nonadrenergic noncholinergic parasympathetic nerve endings under the influence of the various isoforms of NO synthase, is the principal chemo-mediator for SMC relaxation, thus penile erection, through the production of cyclic guanosine monophosphate (cGMP).[4] While neuronal NO initiates erection, endothelial NO maintains the erectile response.[4] Alongside this, through the cyclic adenosine monophosphate (cAMP) pathway, prostanoids and vasoactive intestinal polypeptide also contribute to SMC relaxation.[3]
SMC contraction, on the other hand, is brought about principally by noradrenaline via the a 1 sympathetic pathway and is responsible for penile flaccidity and detumescence. Other chemo-transmitters for SMC contraction include endothelin, neuropeptide Y and prostanoids.[3]
Currently available pharmacotherapeutic agents for ED act mainly by enhancing SMC relaxation through the selective and nonselective inhibition for the phosphodiesterases which are involved in the degradation of cGMP and cAMP to GMP and AMP respectively. a 1 adrenergic blockers are used to decrease SMC contraction.
Pharmacological manipulation of the biochemical processes involved in SMC relaxation and contraction therefore provides the rational basis for the pharmacotherapy of ED.
Phamacotherapeutic agents for ED may be categorized according to their modes of action, routes of administration and mechanisms of selectivity.[5] In general, those in current use are either centrally acting or peripherally acting agents, with the latter targeting mainly SMC relaxation via the cGMP or cAMP pathways [Table - 1]. Some may have more than one route of administration or delivery.
In day-to-day clinical practice, pharmacotherapy of ED really boils down to a choice between ICI therapy using alprostadil, alone or in combination with other vasoactive agents and oral phosphodiesterase-5 inhibitors (sildenafil, tadalafil, vardenafil and, in Korea, udenafil). Sublingual apomorphine is a commercially available centrally acting agent. Like topical and transurethral alprostadil and other medications, including yohimbine, it has limited use and success.
Intracavernosal injection therapy
Since the use of PGE 1 for ED was first reported in 1986, alprostadil, its synthetic equivalent, has been the main agent employed in ICI therapy. Other vasoactive agents for ICI include phentolamine and papaverine, which may be used in combination with alprostadil (Double mix: alprostadil + phentolamine; Trimix: alprostadil + phentolamine + papaverine). On account of its significantly higher risk of priapism and penile fibrosis, papaverine was replaced by alprostadil as a single agent for ED. Intracavernosal injection therapy was the only pharmacotherapeutic option available for the management of ED for well over a decade.
The aim of ICI therapy is to produce an erectile response of sufficient quality and duration so that the patient is able to achieve satisfactory sexual intercourse. Adverse drug reaction, infection, bleeding disorders, severe pain, predisposition to priapism (e.g. myeloproliferative disease) and presence of penile abnormality (such as Peyronie's disease) may preclude patients from ICI therapy. Anticoagulant therapy is not a contraindication to ICI provided the prothrombin time or the international normalized ratio (INR) is within the therapeutic range. It is important that patients are meticulously instructed on the injection technique and, for those with impaired vision and poor manual dexterity, their partners, if agreeable, may perform the injection and be tutored accordingly.
Both the success and satisfaction rates of intracavernosal alprostadil therapy were in excess of 90%[6] and no significant associated systemic side-effects were reported,[7] the latter probably related to the rapid metabolism of alprostadil in the penis and its first pass clearance in the lungs and liver. Side-effects comprise only infrequent nonspecific complaints of headache and dizziness.
Possible side-effects or complications of ICI therapy are confined to the penis and include postinjection penile pain, prolonged erection, priapism and penile fibrosis.[6],[7] Postinjection pain may involve the scrotal, perineal and gluteal areas and occasionally the lower limbs.
Intracavernosal injection therapy should usually cause no more than some penile discomfort if it is performed correctly using an ultra-fine gauge-30 needle. Patients with diabetic neuropathy and after radical lower abdominal and pelvic surgery are more likely to experience postinjection pain.[6] Using papaverine in preference may be an option when significant postinjection pain occurs in spite of good injection technique.
Prolonged erection and priapism from intracavernosal alprostadil may be effectively avoided by commencing treatment with a discreet dose of alprostadil (5 mcg in most patients and 2.5 mcg in patients with spinal cord injury). The dose may then be judiciously gradually increased if necessary, up to a maximum of 50 mcg, to achieve the desired erectile response. Only 5% of men with ED treated with alprostadil reported prolonged erections and 1% had priapism.[7]
Penile fibrosis was reported in 12-23% in various studies and spontaneous regression and resolution of the fibrotic changes occurred in 47-52% of these patients.[6],[8]
Patients should be specifically warned about all these possible complications, prior to commencing ICI therapy. Clear written instructions should be given regarding measures for detumescence in the event of a prolonged response. Arrangements and facilities must be available for the urgent treatment of priapism.
Phosphodiesterase-5 inhibitors
Sexual stimulation leads to the release of NO in the corpora cavernosa and results in an increase of cGMP which produces smooth muscle relaxation and increases blood flow. Sildenafil, tadalafil and vardenafil are the currently commercially available selective inhibitors of cGMP-specific Type 5 phosphodiesterase (PDE-5), the enzyme responsible for the degradation of cGMP in the corpora cavernosa. They therefore enhance the effects of cGMP and permit an erectile response to be achieved or sustained.
The mechanism of phosphodiesterase-5 inhibition is shown in [Figure - 1].
The efficacy of sildenafil in the treatment of ED had been demonstrated in 21 randomized, double-blind, placebo-controlled trials involving more than 3000 patients aged 19-87 years with ED of various etiologies.[9] A low incidence of serious or clinically significant adverse events, including cardiovascular events, was reported.[9]
Studies with similar outcome have been reported for tadalafil and vardenafil.[10],[11]
When a patient is considered for PDE-5 inhibition, it is important that his fitness for physical and sexual activity be assessed and that he be appropriately counseled if sexual activity is inadvisable. In general, sexual intercourse should be safe if a patient can cope with an effort of 5-6 metabolic equivalents (METS) such as climbing 20 stairs in 10-15 seconds without increasing the heart rate by more than 20-30 beats per minute or provoking symptoms such as shortness of breath or chest pain.[12] Post-infarction patients who reach 5-6 METS without ischemia or arrhythmia on stress electrographic testing can in all likelihood resume their normal sexual activity without any risk and none of the patients with negative exercise test had ischemia during sexual intercourse on Holter monitoring.[12]
Adequate sexual stimulation is essential for maximizing the treatment outcome of PDE-5 inhibition. PDE-5 inhibitors should be avoided in patients with myocardial infarction, serious arrhythmia or stroke within the preceding six months, with systolic blood pressure of < 90 mmHg, with cardiac failure or coronary artery disease causing angina and with retinal disorders. Caution is advocated in patients receiving complicated multi-agent anti-hypertensive therapy. Concurrent use of cytochrome P450 3A4 (CYP3A4) inhibitors (e.g., cimetidine, erythromycin, ketoconazole, saquinavir, ritonavir) or CYP3A4 inducers (e.g., rifampicin) may alter the plasma levels of PDE-5 inhibitors.
Nitrates are contraindications to PDE-5 inhibition. While PDE-5 inhibitors are absolutely contraindicated in a patient needing and receiving ongoing long-acting nitrate-containing medications, the use of a PDE-5 inhibitor following a dose of a short-acting nitrate such as sublingual glyceryl trinitrate or sublingual (or transdermal) isosorbide dinitrate may be permissible, provided the patient is well-motivated and understands fully all that may be involved and provided the use of the short-acting nitrate is infrequent and has preceded by not less than eight (preferably 24) hours the intention of using the PDE-5 inhibitor.[13] The re-dosing of a nitrate-containing medication subsequent to the use of PDE-5 inhibitor should follow the Second Princeton Consensus.[14] The attending doctor has the duty of care to fully review the medications of his/her patients, particularly those with known cardiovascular diseases, to identify any pharmacologically incompatible medication in the patients' therapeutic regimen. It is possible that many such medications, including nitrate-containing medications, may be discontinued or replaced with suitable alternatives, so that the patient regains his eligibility for PDE-5 inhibition.[15] Any such change in a treatment regime should be undertaken with the knowledge and concurrence of the respective specialists concerned.
Although the mechanism of action of sildenafil, tadalafil and vardenafil is identical, treatment outcome and side-effect profile may be different in different patients. It would be helpful if the patient is able to indicate which of the three PDE-5 inhibitors suits him best. The advantage of tadalafil is its long terminal half-life, which gives the responder a longer period of responsiveness. The characteristics of these PDE-5 inhibitors and their possible side-effects are shown in [Table - 2].
Response to PDE-5 inhibitors initially may be inadequate in some patients. A patient should not be regarded as having failed treatment unless at least six-eight recommended maximum doses have been tried with adequate sexual stimulation. Poor responders may sometimes achieve a better response after a lapse of time. This may be seen in patients with diabetes who may return with much improved glycemic control and in those who had undergone radical surgery for prostate cancer and are recovering from neuropraxia or intra-operative nerve injury which may have occurred in spite of attempts at nerve conservation.[16]
For the patient recovering from radical prostate or other pelvic surgery where erectile function may have been compromised, early erectogenic penile rehabilitation with PDE-5 inhibitors or with intracavernosal alprostadil in the case of nonresponders to PDE-5 inhibition, should be initiated. This offers effective prophylaxis against the possibility of permanent cavernosal tissue changes and results in a higher rate of spontaneous recovery of erectile function and better response to treatment with erectogenic medications.[16] Compared to PDE-5 inhibition, in patients with diabetes and after radical lower abdominal and pelvic surgery or radiation therapy, treatment outcome of ICI therapy is generally more favorable.
Opportunistic or on-demand dosing, usually 45-60 minutes prior to intended sexual activity, has been how PDE-5 inhibitors are prescribed. No evidence of tolerance or tachyphylaxis has been reported with repeated use of PDE-5 inhibitors.[17] Chronic or scheduled dosing, daily or at other appropriate frequency, may improve treatment outcome and increase the response rate.[18] It will, however, be prudent to exclude the risk of untoward side-effects on account of chronic PDE-5 inhibition.
The role of testosterone in ED
Testosterone modulates the expression of NO synthase in the corpus cavernosum and the production of NO and acts on the cavernosal arterioles enhancing penile rigidity. It influences genital sensitivity and the pleasurable enhancement of erectile activity.
Testosterone deficiency is an infrequent cause of ED.[19] However, if it is the confirmed cause, treatment with testosterone supplementation is rewarding. Correction of androgen deficiency not only restores erectile function but also improves general well-being and libido. As it influences NO production through its modulating effect on NO synthase, testosterone enhances the treatment outcome for ED with PDE-5 inhibitors.
Notwithstanding this, age-related testosterone deficiency is a clinical diagnosis based on a remarkably nonspecific symptom-complex which has to be corroborated with repeated appropriate confirmatory laboratory serum testosterone estimations. It commits the patient to a lifelong treatment regime requiring a careful surveillance program for possible serious side-effects. Other confounding factors, such as obesity, depression and obstructive sleep apnea, have to be excluded or treated. These, in themselves, are known independent risk factors for ED.
Combination pharmacotherapy for the hard-to-treat ED
Although response to the currently available pharmacotherapy is mostly satisfactory, a significant number of patients with ED are unable to achieve an adequate response. There is, therefore, the need to explore if there may be beneficial outcome from a rational combination of the therapeutic agents in current use, until newer agents become available.[20]
At least three plausible combinations would merit consideration:
a.	Combination of a centrally acting with a peripherally acting agent e.g. sublingual apomorphine with oral PDE-5 inhibitor.
b.	Combination of an agent acting via the cGMP pathway with one via the cAMP pathway e.g. oral PDE-5 inhibitor with intracavernosal alprostadil.
c.	Combination of an agent enhancing SMC relaxation with one decreasing SMC contraction, e.g. oral PDE-5 inhibitor with a 1 adrenergic blocker.
Alprostadil combined with phentolamine and/or papaverine (Double Mix and Trimix) has in fact been part of the protocol in ICI therapy when response to alprostadil alone is inadequate. Combination pharmacotherapy had been studied using research animal models and in various human clinical settings, generally with favorable treatment outcome.
Further research will be needed to confirm the usefulness of such combinations as intracavernosal alprostadil and oral PDE-5 inhibitor and to provide rational guidelines for this and other combinations of proven value to be part of the management strategy for ED. The risk of possible side-effects may be minimized if the relevant exclusion criteria and prerequisites, based on a sound understanding of the pharmacological properties of the agents used, are strictly observed and treatment protocol meticulously followed.
Algorithm for pharmacotherapy of ED
An algorithm [Figure - 2] is presented for the pharmacotherapy of ED. This captures most of the issues that have been discussed and suitably reflects the current standards for the management strategy of this prevalent, under-diagnosed and under-treated affliction.
Pharmacotherapy is currently the main therapeutic option for ED. When appropriately prescribed, it is safe and effective. This comprises mainly ICI therapy using alprostadil,or alprostadil combined with phentolamine and/or papaverine, and PDE-5 inhibitors.
For the nonresponders, there is a need for newer pharmacotherapeutic options for ED and opportunities exist for further research so that new therapeutic guidelines may be established.
As well as treating ED, it is imperative that possible cardiovascular risk factors in patients with ED be investigated for, identified and treated. Where appropriate, lifestyle changes such as diet, exercise and social habits, need to be discussed and initiated.
1. NIH Consensus Development Panel on Impotence: Impotence. JAMA 1993;270:83-90.
2. Lewis R, Hatzichristou D, Laumann E, McKinlay J. In: Epidemiology and natural history of erectile dysfunction: Risk factors including iatrogenic and aging. Erectile dysfunction. Jardin A, et al , editor. Health Publications Ltd: 2000. p. 19-51.
3. Eardley I, Sethia K. Erectile dysfunction: Current investigation and management. Mosby-Wolfe Medical Communications: London; 1998.
4. Burnett AL. Novel nitric oxide signaling mechanisms regulate the erectile response. Int J Impot Res 2004;16:S15-9. [PUBMED] [FULLTEXT]
5. Heaton JP, Adams MA, Morales A. A therapeutic taxonomy of treatments for erectile dysfunction: An evolutionary imperative. Int J Impot Res 1997;9:115-21. [PUBMED]
6. Porst H, Buvat J, Meuleman E,Michal V, Wagner G. Intracavernous alprostadil Alfadex: An effective and well tolerated treatment for erectile dysfunction. Results of a long-term European study. Int J Imp Res 1998;10:225-31. [PUBMED]
7. Linet OI, Ogrinc FG. Efficacy and safety of intracavernosal alprostadil in men with erectile dysfunction. N Eng J Med 1996;334:873-7. [PUBMED] [FULLTEXT]
8. Chew KK, Stuckey BG, Earle CM, Dhaliwal SS, Keogh EJ. Penile fibrosis in intracavernosal prostaglandin E1 injection therapy for erectile dysfunction. Int J Imp Res 1997;9:225-30. [PUBMED]
9. Morales A, Gingell G, Collins M, Wicker PA, Osterloh IH. Clinical safety of sildenafil citrate (Viagra) in the treatment of erectile dysfunction. Int J Impot Res 1998;10:69-74.
10. Brock GB, McMahon CG, Chen KK, Costigan TM, Shen W, Watkins V, et al . Efficacy and safety of tadalafil for the treatment of erectile dysfunction: Results of integrated analyses. J Urol 2002;168:1332-6.
11. Bischoff E. Vardenafil preclinical trial data: Potency, pharmacodynamics, pharmacokinetics and adverse events. Int J Impot Res 2004;16:S34-7. [PUBMED] [FULLTEXT]
12. Fact Sheet for Prevention of myocardial infarction and for angina. National Heart Foundation of Australia. Curr Ther 1999;39:63.
13. Chew KK, Stuckey BG, Thompson PL. Erectile dysfunction, sildenafil and cardiovascular risk. Med J Aust 2000;172:279-83. [PUBMED] [FULLTEXT]
14. Jackson G, Rosen RC, Kloner RA, Kostis JB. The Second Princeton Consensus on sexual dysfunction and cardiac risk: New guidelines for sexual medicine. J Sex Med 2006;3:28-36. [PUBMED] [FULLTEXT]
15. Jackson G, Martin E, McGing E, Cooper A. Successful withdrawal of oral long-acting niutrates to facilitate phosphodiesterase type 5 inhibitor use in stable coronary disease patients with erectile dysfunction. J Sex Med 2005;2:513-6. [PUBMED] [FULLTEXT]
16. Mulhall J, Land S, Parker M, Waters WB, Flanigan RC. The use of an erectogenic pharmacotherapy regimen following radical prostastectomy improves recovery of spontaneous erectile function. J Sex Med 2005;2:532-42. [PUBMED] [FULLTEXT]
17. McMahon CG, Carson CC, Fischer CJ, Wang WC, Florio VA, Bradley JD. Tolerance to the therapeutic effect of tradalafil does not occur during 6 months of treatment: A randomized, double-blind, placebo-controlled study in men with erectile dysfunction. J Sex Med 2006;3:504-11. [PUBMED] [FULLTEXT]
18. McMahon C. Comparison of efficacy, safety and tolerability of on-demand tadalafil and daily dosed tadalafil for the treatment of erectile dysfunction. J Sex Med 2005;2:415-27. [PUBMED] [FULLTEXT]
19. Earle CM, Stuckey BG. Biochemical screening in the assessment of erectile dysfunction: What tests decide future therapy? Urol 2003;62:727-31. [PUBMED] [FULLTEXT]
20. Chew KK. Combination pharmacotherapy in the management of patients with hard-to-treat erectile dysfunction. J Sex Med 2006;3:185-7. [PUBMED] [FULLTEXT]
[Figure - 1], [Figure - 2]
[Table - 1], [Table - 2]
1 Diabetes-induced erectile dysfunction: Epidemiology, pathophysiology and management
Thorve, V.S., Kshirsagar, A.D., Vyawahare, N.S., Joshi, V.S., Ingale, K.G., Mohite, R.J.
Journal of Diabetes and its Complications. 2011; 25(2): 129-136
Vrushali S. Thorve,Ajay D. Kshirsagar,Neeraj S. Vyawahare,Vipin S. Joshi,Kundan G. Ingale,Reshma J. Mohite
Journal of Diabetes and its Complications. 2011; 25(2): 129
3 Novel phosphodiesterase-5 inhibitors: Current indications and future directions
Sharma, R.
Indian Journal of Medical Sciences. 2007; 61(12): 667-679
Chew KK
Therapeutic opti...
Intracavernosal ...
Phosphodiesteras...
The role of test...
Algorithm for ph...
Combination phar...

redpajama_set_name: RedPajamaCommonCrawl


ai i know that, im sure tombomb does the same thing on his mk4, i just dnt like it!!
No no no, we need no plates at all!
You don't even have to have a "licence plate" on the front in America. They're usually just on the back ... and Hodge, they're right, it looks really good mate! Not usually a fan of Lupos, you've changed my opinion anyway!
Ffwc o fan genti Owain haha.


The Netherlands has to remain well-accessible. This also accounts for the region east of Amsterdam, which is expected to face several bottlenecks on, and surrounding the A1 highway in the future. In order to address this mobility issue in an integrated manner, the Ministry of Infrastructure & Environment, together with the region, initiated the so-called MIRT Study (Multi-Year Programme Infrastructure, Spatial Planning and Transport). The goal of the MIRT is to address infrastructural projects in their broader spatial and economic context to develop integrated plans with broad public support.
In the analytical phase, the challenges with regards to mobility and the related assignments concerning economy, landscape, nature and water are considered integrally. This is done in collaboration with different local parties. The research aims to result in an adaptive perspective for the region that provides a set of potential measures, which should contribute to a functioning traffic flow on the highways on the East of Amsterdam, and more specific on the A1 highway between the Muiderberg and Eemnes nodes. Additionally, the measures will be assessed on their economic and spatial impact and potential.
In a series of expert sessions and regional workshops, various potential measures are explored through research-by-design. The so-called mobility ladder is deployed as a conceptual framework to include a wide variety of possible measures. The ladder considers the construction of new infrastructure to be a last resort, only to be deployed when unable to address mobility issues spatially, by providing public transport or by influencing travel behavior. Subsequently, effective measures are taken together in different, logical combinations, which together provide a foundation for possible integrated development perspectives.
For more information about this project, please visit the project page (in Dutch only): www.mirtoostkantamsterdam.nl.


This morning on Continuous Discussions we talked all things Build Automation, as our team of panelists addressed some of the most challenging aspects of your build pipeline (represented below in our Astroids Belt of Doom). Check out the recording below to learn how to support quality and velocity at scale.
Anthony has experience on the support desk, in QA, as a developer, and a configuration engineer. Hes in a hurry to learn as much as possible!
Senior Software Architect @ Segue Technologies, always dev, sometimes admin, likes things automated and well-controlled.
Join us on Tuesday, May 19th, at 10am PST, when we'll be talking about ARA in Regulated Industries.
Delivering better software faster is the goal, but when millions of dollars and lives are at stake how do you enable teams to go fast and not break things?
And if something does break, or auditors come calling, how do you prove compliance?
an accomplished technical manager with over 20 years of medical device experience including high volume process and product development projects.
Rex Morrow Marketing Director at Datical, whose solution, Datical DB, simplifies database schema change management to support complex, high velocity application releases across any environment, for any database.


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Gefitinib, a drug used for treatment of cancers, has been found to have enhanced anti-cancer properties when delivered encapsulated inside nanoparticles. The difference in property arises from the fact that the nanoparticle-covered drug acts as a 'histone acetyltransferase' rather than a 'tyrosine kinase inhibitor', which gefitinib is in its free form, new research says1.
Gefitinib is a widely used drug for treatment of non-small cell lung cancer (NSCLC). It is a tyrosine kinase inhibitor, meaning it inhibits the enzymes tyrosine kinases, responsible for triggering cancer signals. Researchers have now shown that gefitinib behaves as a histone acetyltransferase (HAT) activator when coated in poly lactic-co-glycolic acid (PLGA) nanoparticles.
The new complex — nano-gefitinib — exhibits completely different anti-cancer mechanism as compared to the free drug, which stalls cell proliferation primarily by inhibiting the Epidermal Growth Factor Receptor (EGFR).
The researchers evaluated the molecular mechanism behind this enhanced activity. They found that the nanoparticles "hyperacetylate the histone H3 via activation of histone acetyltransferases p300/CBP, which further increases the expression of cell cycle arrest protein p21."
"We were intrigued to observe that a tyrosine kinase inhibitor behaved as HAT activator merely by choosing a nano-sized transporting vehicle," says Kulbhushan Tikoo, lead researcher from the National Institute of Pharmaceutical Education and Research, Mohali. The findings suggest that the activity of drugs may completely change when they are delivered in nano form, he told Nature India.


Our most luxurious rooms, the Deluxe Suites at Matakauri Lodge deliver an unforgettable experience.
The Deluxe Suites are largest in size with the bedroom set apart on a mezzanine floor and a truly spectacular mountain outlook from their generous bathrooms and oversized baths. Of the seven Deluxe Suites, six are outlying while one is housed within the main lodge building.
Would you like to reserve the Deluxe Suite?


text:
Featured ArticlesFeatured Articles » Home » Melchizedek, Jesus, And Us
Melchizedek, Jesus, And Us
By Jack Kelley
The LORD says to my Lord: "Sit at my right hand until I make your enemies a footstool for your feet." The LORD will extend your mighty scepter from Zion; you will rule in the midst of your enemies. (Psalm 110:1-2)
The LORD has sworn and will not change his mind: "You are a priest forever, in the order of Melchizedek." (Psalm 110:4)
While the Pharisees were gathered together, Jesus asked them, "What do you think about the Christ? Whose son is he?"
"The son of David," they replied.
He said to them, "How is it then that David, speaking by the Spirit, calls him 'Lord'? For he says, " 'The Lord said to my Lord: "Sit at my right hand until I put your enemies under your feet."
If then David calls him 'Lord,' how can he be his son?" No one could say a word in reply, and from that day on no one dared to ask him any more questions. (Matt 22: 41-46)
It's pretty clear that both the Lord and the Pharisees he was addressing believed that Psalm 110 referred to the Messiah and that the Holy Spirit had inspired King David to write it. Where they differed was in their understanding of the Messiah's origins. The Pharisees believed he would be a human descendant of King David, and nothing more. The Lord knew He was also God in the flesh, and quoted Psalm 110 to remind them that David knew this too.
Many translations show the first appearance of Lord in Psalm 110 all in caps (LORD) and the second one in lower case except for the first letter (Lord). This is to show that David was writing of a conversation he overheard, through the power of the Holy Spirit, between the Father and the Son.
There are two facts to support this conclusion. First, Lord is a title one uses in addressing a superior, and only two were superior to the King. One was God the Father, represented by LORD and the other was God the Son, called Lord. In effect Jesus reminded the Pharisees that David would have referred to a merely human descendant as his son, not as his Lord.
And second, in Hebrew the "word" translated LORD is YHWH, the four initials of the unpronounceable name of God, and used only of Him, while the one translated Lord is a different word, Adonai.
Responding truthfully to the Lord's question would have forced the Pharisees to agree with David, something they weren't prepared to do. Not then, not ever. At His trial before the Sanhedrin, the Lord's declaration that He was the Messiah and that they would all see Him seated at the right hand of the Mighty One and coming on the clouds of Heaven is what stirred them to convict Him of blasphemy, a capital crime. (Matt. 26:64)
Their only problem was that the Romans wouldn't let them execute anyone without permission. So they took him to Pontius Pilate. Pilate wasn't concerned about the charge of blasphemy. That was an internal matter among the Jews. But in calling Himself a King (John 18:33-37), Jesus was confessing to treason under Roman law, also a capital crime (Matt.27:11). Even then Pilate was inclined to release Jesus, but when the crowd became adamant, he saw a way to yield to their wishes while remaining within Roman Law. That's why he had them place a sign on the Lord's cross that said, "Jesus of Nazareth, King of the Jews." He was announcing that the crime for which Jesus was being executed was treason.
King Jesus, Our High Priest
David had written that the Messiah would be both a king and a priest just like Melchizedek had been. From Genesis 14:18 we learn that Melchizedek, whose name means King of Righteousness, was both a priest of the Most High God and the King of Salem, a Jebusite city that later became known as Jerusalem. When David conquered the Jebusites he made Jerusalem the capital of Israel, and purchased the land on nearby Mount Moriah where Abraham had sacrificed Isaac several hundred years earlier for the Temple location.
Never since the founding of Israel had one man been both a king and a priest. It was forbidden. Kings came from the tribe of Judah, while priests were descended from Levi. One king who tried to function as a priest earned the Lord's immediate displeasure, and serves to illustrate the point. Daring to offer incense in the Temple, King Uzziah immediately contracted leprosy and was quarantined till his dying day (2 Chron. 26:16-21). Some prophets were also priests, Ezekiel and Zechariah for example, and David was a king and a prophet. But no one was ever both a king and a priest in Israel.
However, prophecies in Ezekiel 21:25-27 and Zechariah 6:9-13 tell us the two offices will eventually be united when Messiah comes and that He will be both a king and a priest. And of course in the Book of Hebrews Jesus is called our King (Hebr. 1:8) and Our High Priest (Hebr. 4:14). This is possible because Jesus is not a priest in the Levitical sense but in the higher order of Melchizedek. All of Hebrews 7 is devoted to this topic.
I Know I Am But What Are You?
In Exodus 19:6 Israel is called a kingdom of priests but in 1 Peter 2:9 we read, "But you are a chosen people, a royal priesthood, a holy nation, a people belonging to God, that you may declare the praises of him who called you out of darkness into his wonderful light." He was speaking to the Church, calling us a royal priesthood. Only kings are considered royalty.
And in Revelation 1:5-6 it's even clearer. And from Jesus Christ, who is the faithful witness, and the first begotten of the dead, and the prince of the kings of the earth. Unto him that loved us, and washed us from our sins in his own blood, and hath made us kings and priests unto God and his Father; to him be glory and dominion for ever and ever. Amen. (KJV)
Some of the modern translations prefer the word kingdom over kings in the passage above, and it's true, the Greek word there can be translated either way. They try to compare the Revelation passage with Exodus 19:6 to bolster their replacement theology bias, making the Church look like Israel. But to most conservative scholars it's clear that both the context and the grammatical structure of the passage require that the Greek word be translated kings. (The same is true in Revelation 5:10 where the same phrase is repeated.)
Kings Of What?
The Bible doesn't have a specific answer for this, but in Ephesians 2:6-7 Paul wrote, "And God raised us up with Christ and seated us with him in the heavenly realms in Christ Jesus, in order that in the coming ages he might show the incomparable riches of his grace, expressed in his kindness to us in Christ Jesus."
The "coming ages" alludes to the time of the Millennium and beyond where we'll serve as living examples of the incomparable riches of God's grace, seated with our King and High Priest on His throne.
Throughout human history the best kings have always been the ones most sincerely devoted to the well being of their subjects. And the priests were not just religious officials. In most generations they were their society's repository of knowledge in philosophy, literature, religion, art, music, history and language. If these can serve as worldly models of our heavenly future, then we can assume there's a lot more to being a king and a priest than sitting on a throne or conducting a worship service.
In the USA we don't have a royal family so many of us don't know what that's like. But people from other countries do, and they know that for the most part, "royals", as they're called, don't work. Many of them don't even help run the countries their families rule. They follow a higher calling, pursuing personal interests and living lives of service. They have no need to support themselves, so they're free to devote all their time, energy, and intellect to the things they find to be the most fulfilling.
On Earth we all have a sin nature, so we can be drawn off the path of righteousness, and we've seen that happen with many royals. And because of our fallen nature even the best of us can only achieve a small percentage of our nearly limitless potential. But in our perfected state, these things won't be a problem. We'll discover that God created us with capabilities we've barely used. Now we're like a thoroughbred race horse that has been consigned to pulling a child's cart. But all that will change forever at the rapture. Finally there will be nothing to prevent us from achieving our full potential in any undertaking we can imagine.
Both Paul (1 Cor. 15:42-44) and John (1 John 3:2) made it clear that we won't know in advance exactly what we'll be like after the rapture/resurrection. Our motives, our capabilities, and our appearance may all be different. But they both said we'll be like Jesus. That means whatever we do will be pleasing to God and done for His glory. We can only speculate about the specifics.
Does all this exceed the limits of your imagination? Of course it does. That's why Paul called it "the incomparable riches of His grace." He also said, "No eye has seen, no ear has heard, no mind has conceived what God has prepared for those who love him" (1 Cor. 2:9). Having been there and seen our future (2 Cor. 12:2-4) he knew it was beyond the ability of our sin-contaminated minds to imagine. But know this. Being both a king and a priest will be by far the most rewarding, fulfilling calling we've ever had. Selah.
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Some trends in staffing are all flash and no substance, but there are some Seattle staffing trends worth adopting.
These trends can help you adapt quickly to changing circumstances in recruiting and hiring. They will help you attract and retain top talent in a tough hiring market.
Seattle has been one of the hottest hiring markets in the country, and this market is likely to continue into 2018. Competition for top talent will remain fierce, with the best candidates regularly considering multiple job offers.
Even though the candidate market is in full swing, it's never too late to coordinate with a recruiting firm to improve your access to quality candidates. Staffing firms specialize in knowing where to find top talent – including which key players aren't actively looking for jobs, but would consider a move to a company that offered an outstanding workplace culture or real opportunities for advancement.
Despite the fact top talent is scarce, many Seattle companies are still extending the hiring process to an average of 4.5 weeks. This trend creates a key opportunity to stand out from competitors – and pick up the best talent – by streamlining your hiring process. Your recruiter plays a key role in shortening time to hire, from screening candidates, to helping you improve the interview process, to making the best decision. While dragging your feet isn't a trend to adopt, a more efficient hiring process is.
Automation isn't killing Seattle-area jobs (yet), but it is changing the skills that top candidates need to stay nimble and relevant in their fields. Coordinating with your recruiter can help you understand the ways in which automation is placing new demands on the workforce, so you can hire candidates with the skills to keep pace with changing technology.
At TERRA Staffing, our recruiters can help you identify which Seattle staffing trends are worth following. We can help you implement them to improve your candidate reach in the new year.


Translator (English / Arabic) and Interpreter (Simultaneous / Consecutive), specialized in Education, Business and Military.
Lectures and blogs about translation and Interpreting of Arabic with a keen interest in promoting the profession and elevating its standards.
Ahmad holds a BA in English Literature, an MA in Curriculum and Instruction, and more than 20 years of experience in the field of languages. He is currently a Ph.D. Fellow (Translation Studies) at Kent State University.


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Home • Euthanasia
Euthanasia in New Zealand
Over the last few years, there have been several events that have generated an active public discussion on euthanasia and assisted suicide in New Zealand. In 2012, then Labour List MP Maryan Street prepared a Private Members Bill, the "End of Life Choice Bill". It was subsequently withdrawn from the ballot box prior to the 2014 election campaign as the Labour Leadership did not want it debated during an election year.
Then, in 2015, Wellington lawyer Lecretia Seales, who was suffering from terminal brain cancer, sought a ruling from the High Court that "assisted dying" was not unlawful under the Crimes Act, and that a ban on "assisted dying" contravened her human rights under the New Zealand Bill of Rights Act 1990. The Court ruled that any assistance, whether in the form of assisted suicide or euthanasia by her doctor, would be unlawful and that the relevant provisions of the Crimes Act 1961 were consistent with the rights and freedoms contained in the Bill of Rights Act. It further suggested that changes to the law sought by Ms Seales could only be made by Parliament. Justice Collins referred specifically to the complexity and broad nature of the issues that are implicated in changing the law, stating that: "The complex legal, philosophical, moral and clinical issues raised by Ms Seales' proceedings can only be addressed by Parliament passing legislation to amend the effect of the Crimes Act.".
Following this ruling, a petition organised by the Voluntary Euthanasia Society (VES) was presented to Parliament in June 2015 by former MP and VES President Maryan Street and Matt Vickers, the husband of Lecretia Seales. It asked that the House of Representatives investigate public attitudes towards the introduction of legislation permitting "medically-assisted dying". The Select Committee investigated 1) factors that contribute to the desire to end one's life, 2) the effectiveness of services and support available to those who desire to end their own lives, 3) the attitudes of New Zealanders towards the ending of one's life and the current legal situation, and 4) international experiences.
ACT Party Leader and MP David Seymour submitted his own "End of Life Choice Bill" in October 2015. The key difference from Street's Bill was that it did not include End of Life care directives. While this Select Committee inquiry was still in process, Seymour's Bill was drawn from the private members ballot box on 8 June 2017. The Bill seeks to legalise euthanasia and assisted suicide in New Zealand for people 18 years and over with either a terminal illness or "grievous and irremediable medical condition" (effectively people with disabilities, chronic, and mental health conditions).
Meanwhile, the Health Select Committee released their report on the VES petition in August 2017. The submission process received over 21,000 unique submissions from around the country between 27 August 2015 and 1 February 2016, and heard 944 oral submissions (read the submissions here). 80% of the submissions were opposed to the legalisation of euthanasia and assisted suicide in New Zealand. The Report echoed Justice Collins' observation that the issue "is clearly very complicated, very divisive, and extremely contentious", but made no clear recommendations about legislation on euthanasia or assisted suicide in New Zealand, stating that it was a usually a matter of a conscience vote. Instead, the Report encouraged "everyone with an interest in the subject to read the report in full, and to draw their own conclusions based on the evidence presented in it".
Seymour's Bill had its first reading just before Christmas on the 13 Decmeber 2017. You can read the transcript or watch the videos from the first debate here. It is currently before the Justice Select Committee, who received over 35,000 submissions from New Zealanders. The Committee are now hearing from everyone who indicated that they wanted to be heard in person by the Committee. Information about hearing times and locations can be found here. Videos from some of the hearing sessions so far can be found here. Submissions for the Bill can be found here (not all submissions have been posted yet).
It is important to understand that personal choices that people make are always contextually bound. The current New Zealand context, characterised as it is by 'functionalism', increasing ageism that is manifesting itself in growing elder abuse and an increase in the social isolation of the elderly, and a deficit understanding and fear of disability means, in our view, that there has never been a more dangerous time to make suicide and/or euthanasia more easily available.
The answer to the existential suffering that many people experience, and which drives requests for euthanasia and assisted suicide in overseas jurisdictions, is not to make it easier for people to end their lives but to continue to improve access to palliative care for all New Zealanders. It is our informed view that when all of the risks are objectively assessed and weighed up, any perceived benefits for a small minority of persons would be far outweighed by far larger numbers being exposed to the very real dangers of a premature death.
The current legal status quo remains the most responsible option for New Zealand at this time.
Download: Quick Facts: Euthanasia and Assisted Suicide.
A Timeline of the euthanasia debate in NZ
Call to action - What you can do
Nathaniel Centre Submission to Health Select Committee
New Zealand Catholic Bishops Conference Submission to Health Select Committee
One in every 45 deaths in the Netherlands comes about through euthanasia. In New Zealand this would translate to 700 deaths per year.
Euthanasia: The right to die will all too quickly become a duty to die.
I am firmly against euthanasia because it is not physical suffering that guides the desire to die but a moment of discouragement, feeling like a burden … All those who ask to die are mostly looking for love. - Maryannick Pavageau - suffers from locked-in syndrome for 30 years


text:
Sergueï Vassilievitch Loukianenko (en ), né le  à Karataou en RSS du Kazakhstan (alors en U.R.S.S.), est un écrivain populaire russe de science-fiction et de romans fantastiques.

Biographie
Né à Karataou, (RSS du Kazakhstan, U.R.S.S.) , d'un père russo-ukrainien et d'une mère tatare. Il termine l'Institut d'État de médecine d'Alma-Ata, spécialité psychiatrie, où il rencontre son épouse Sonia, spécialiste en pédo-psychiatrie. Ils auront deux fils, Artemy et Daniil.

Après son diplôme en 1992, il travaille dans un hôpital à Alma-Ata, spécialisé dans la psychiatrie de l'enfant, mais il abandonne rapidement le métier, du fait de son faible salaire, qui ne lui permet pratiquement pas de faire vivre sa famille. Ayant commencé à écrire en tant qu'étudiant et à gagner de l'argent de sa plume, il se lance dans la carrière d'écrivain, non sans avoir durant plusieurs années, de grandes difficultés à joindre les deux bouts. Au milieu des années 90, sa situation s'améliore, et bientôt sa popularité croissante en tant qu'écrivain lui permet de fréquents voyages en Russie. En 1996, il s'installe à Moscou, où il réside actuellement.

Ces premiers ouvrages s'inscrivent dans la tradition de l'auteur de récits pour enfants Vladislav Krapivine.

Le succès remporté par l'adaptation cinématographique des Sentinelles de la nuit le fait connaître à l'international. Les droits ont été achetés dans une dizaine de pays.

Sergueï Loukianenko dit avoir été influencé par les œuvres d'Arcadi et Boris Strougatski et de Robert A. Heinlein.

Œuvres

Série Watch
 Night Watch : Les Sentinelles de la Nuit (Ночной Дозор) - 1998
 Day Watch : Les Sentinelles du Jour (Дневной Дозор) - 2000
 Dusk Watch / Twilight Watch : Les Sentinelles du Crépuscule (Сумеречный дозор) - 2004
 Last Watch : Les Dernières Sentinelles (Последний дозор) - 2005
 The New Watch : Les Nouvelles Sentinelles (Мелкий дозор) - 2007
 The Sixth Watch (Шестой Дозор) - 2015

Trilogie
 Labyrinthe de réflexions
 Labyrinthe de réflexions (Лабиринт отражений) - 1997
 Faux mirroirs (Фальшивые зеркала) - 1999
 Les Vitraux transparents (Прозрачные витражи)

 Линия грёз
 Les Ombres des rêves (рассказ-приквел, 1998)
 Линия грёз [Ligne de rêve] (1995)
 Императоры иллюзий [Empereurs des illusions] (1995)

 Seigneur de la planète Terre
 Принцесса стоит смерти [Une princesse pour qui cela vaut la peine de mourir] (1992)
 Планета, которой нет [La Planète qui n'existe pas] (1993)
 Стеклянное море [La Mer de verre] (1994)

 Остров Русь
 Сегодня, мама! [Aujourd'hui, maman!] (1993)
 Остров Русь [L'Île Russie] (1994)
 Царь, царевич, король, королевич [Tsar, fils de tsar, roi, fils de roi] (1994)

 Геном
 Геном [Le Génome] (1999)
 Танцы на снегу [Danses sur la neige] (2001)
 Калеки [Les Mutilés] (2004)

Diptyques
 Les étoiles sont des jouets froids
 Les étoiles sont des jouets froids (Звёзды — холодные игрушки) - 1997
 Ombre d'étoile (Звёздная тень) - 1998

 Chercheurs du ciel
 Холодные берега [Froids rivages] (1998)
 Близится утро [Le Matin arrive] (2000)

 Les Chevaliers des quarante îles
 Les Chevaliers des quarante îles (Рыцари Сорока Островов) - 1992
 Les Guerres des quarante îles (Войны Сорока Островов) - 1993

 Черновик-чистовик
 Le Brouillon (Черновик) (2005)
 La Copie finale (Чистовик) (2007)

Romans indépendants
 (Мальчик и тьма) - 1997
 (Не время для драконов)  - 1997
 (Осенние визиты) - 1997
 Spectrum  (Спектр) - 2002

Nouvelles
 Rêve nucléaire (Атомный сон)
 (Восьмой цвет радуги)
 (Временная суета)
 (Принцесса стоит смерти. Повесть, фэнтези-вариант (рукопись утеряна).)
 (Пристань жёлтых кораблей)
 (Тринадцатый город)

Films adaptés de ses œuvres

Récompenses
 1993: Prix Aelita - "Start Award" pour sa nouvelle Rêve nucléaire (Атомный сон - Atomny son )
 2001: Prix du meilleur romancier de fantastique russe
 2003: Prix Golden Roscon pour son roman Spectrum

Annexes

Articles connexes
 Littérature russe
 Liste d'auteurs russophones

Liens externes

 Interview en français sur Russkaya Fantastika

Écrivain russe du XXe siècle
Écrivain russe du XXIe siècle
Écrivain russe de science-fiction
Écrivain russe de fantastique
Romancier russe du XXe siècle
Romancier russe du XXIe siècle
Nouvelliste russe du XXe siècle
Nouvelliste russe du XXIe siècle
Lauréat du prix Bob-Morane
Lauréat du Phantastik Preis
Naissance en avril 1968
Naissance dans l'oblys de Djamboul

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Natural stones and multi-surfaced porcelain create striking dimensional wall art in Midpark Mosaics. With dazzling combinations of color, texture, and sheen, this intricate, mesh-mounted mosaic makes a bold statement in any room. Utilized in full-sized pieces or cut into accent strips, Midpark Mosaics is suited for any trend-forward residential or commercial setting. Complementing marble, limestone, slate, metal and glass, it can serve as a striking focal point or create dramatic interplay with other design elements indoors or out.


text:
Military base of Çelebicihan battalion overrun
February 12 at about 20:00, armed people in military uniforms overrun the base of the Crimean Tatar battalion named after Noman Çelebicihan, which is located in the village of Chongar Kherson region.
CHONGAR (QHA) -
An APC rammed the battalion fence and a tent with people. The armed attackers captured the siting, all of the staff and those who were present in the territory at that time were put on the floor by force. The attackers also used firearms, making warning shots in the air and on the legs.
Chairman of the Mejlis of the Crimean Tatar people Abmesdzhit Suleymanov confirmed this information for a QHA representative. According to him, the incident looks like a local wrangle. Now the base "Asker" is cordoned off the by the officers of the Ukrainian Armed Forces and the system of law and order.
The information on the cause for the conflict is absent.
A delegation who would try to figure out the nature of the problem has already left Kherson. According to Abmedzhit Suleymanov, the conflict is currently being negotiated at the highest level. Refat Chubarov talks with the Minister of Defense to find out what happened.
Meanwhile, the press service of the Ukrainian Armned Forces has unveiled its version of the events.
"According to the publication of the "Ukrainian South" edition, the Armed Forces of Ukraine attacked the base "Asker" on Chongar. With reference to Abmedzhit Suleymanov, Head of the Crimean Tatar Mejlis Mission in the Kherson region, on the border with Crimea in Chongar, the public organization "Asker" was attacked by the Armed Forces of Ukraine.
Leaders of the operational command "South" and military unit commanders officially declare that squads comprising the operational command of the "South" military unit and perform combat missions in the Kherson region, on the border with Crimea, settled military positions under the commander's order. In carrying out the necessary work on the siting, the heavily armed representatives of the illegal armed formation arrived.
Regarding specifics of the units and circumstances, the formation has been detained, disarmed, in compliance with regulations and other legislative acts for dealing situations of the kind."
According to the press service of the Ukrainian Armed Forces, the message about the armed forces of Ukraine attacking the public organization "Asker" is a fake.
Photo: Internet
Crimea border Chongar APC Asker battalion overrun attack Abmesdzhit Suleymanov Armed Forces conflict
Sevastopol sailors captured by pirates
Border guards detained repentant defector from Crimea
Marchuk: Do not forget about threat from occupied Crimea
Occupants beating Crimeans to be treated for "depression"


When you claim Housing Benefit or Council Tax Support there are a number of additional elements that you might qualify for. In addition to this there are a number of different benefit schemes run by the DWP which you may be eligible for.
Attendance Allowance is a tax free weekly benefit for people aged 65 or over who need help with personal care because of illness or disability.
Disability Living Allowance is a tax free benefit for people under 65 years old, who need help with personal care, with getting around, or both.
Discretionary Housing Payment is for people in receipt of partial Housing Benefit or Council Tax Support but who are struggling to pay the shortfall.
Housing Benefit and Council Tax Benefit rules include help for people who have to pay child care costs.
A non-dependant deduction means that your Housing Benefit or Council Tax Support can be reduced if someone aged 18 years or over normally lives with you on a non-commercial basis, such as an adult son, daughter, relative or friend.
If you're a full-time student, you may be exempt from Council Tax if you're the liable person and in certain circumstances you may also be eligible for Housing Benefit.
This is a Benefit for people who are solely liable for Council Tax, but do not get a single person discount because there are other adults living in the property.
When you start work or increase your hours, you may be entitled to extra Housing Benefit and Council Tax Support.
Even if you're not eligible for Council Tax Support, in certain circumstances you may still be able to get a discount on your Council Tax bill.


Denver played host to the first presidential debate of 2012, but for TV viewers in the Rocky Mountain State, the political mudslinging has been going on for months, thanks in large part to the deluge of political ads from Super PACs and other third-party groups.
Since Aug. 1, these groups have joined with the official campaigns to buy time to air more than 26,000 political ads on the city's ABC, CBS, Fox and NBS affiliates.
The onslaught is wearing down many locals. "I have reduced drastically the amount of television I watch," Denver resident Larry Bahn said. "I have just about given up watching local news because the ads are almost continuous there."
But they've fallen far short of what's needed. And it's possible that the Denver affiliates, along with other stations around the country, may be liable under laws that forbid false or deceptive advertising over the airwaves.
In Free Press' report, Money, News and Deception in Denver, I investigated local coverage about the five groups that are spending the most in Denver: the Republican-leaning American Crossroads/Crossroads GPS, Americans for Prosperity and Restore Our Future, and the Democratic-leaning House Majority PAC and Priorities USA Action.
Since August, these groups have signed contracts with Denver's affiliates to air 4,954 ads in the local market, paying more than $6.5 million to secure the spots. And yet Denver's ABC, CBS and NBC affiliates devoted only 10 minutes and 45 seconds to fact-checking ads from these groups. The local Fox affiliate spent no time whatsoever examining these ads.
All told, that's a ratio of one minute of news for every 162 minutes of political ads.
On Sept. 11, KCNC CBS4 News political specialist Shaun Boyd labeled as "false" an ad by the Koch-funded group Americans for Prosperity. The spot compared President Obama's health-care reforms to the Canadian system. Boyd found this comparison misleading: "They are playing fast and loose with the facts to play on voter fears," she said.
By the time Boyd's segment had aired, Americans for Prosperity had spent $1,384,400 to place more than 700 ads on Denver's ABC, CBS, Fox and NBC affiliates, including 209 ads on KCNC.
Here's the catch. Local television stations are legally required to air federal candidates' ads, whether they're accurate or not. However, this requirement does not apply to ads from "non-candidate" groups like the Super PACs and tax-exempt 501(c)(4)s like Americans for Prosperity.
When it comes to ads from non-candidate groups, stations are allowed to reject inaccurate ads in the same way that they're allowed to reject consumer product ads that make false claims.
It's not entirely clear that stations can be held liable for knowingly airing false, misleading or deceptive advertising content in ads from third-party groups.
Broadcast industry attorney Michael D. Berg writes that stations are in a "balancing act," trying to respond to the heightened demand for ad placements while remaining on the right side of the law.
"The FCC has a long history of expecting stations, as part of their overall obligation to operate in the public interest, to avoid knowingly airing false claims in commercial advertising," Berg writes. "That principle spills over to political ads, at least by non-candidates when a station has been made aware of the alleged falsity."
Denver stations have done better than those in other markets at probing the claims in political ads, but they've stopped far short of refusing ads from groups that mislead viewers.
Stations that ignore these concerns and continue to profit from political lies should be held accountable to their viewers -- and the law.


text:
Q: Locating users within a radius of another users zip code I have a site and am allowing users to search for other users within a specified radius of their own zip code.  I first have to locate the latitude and longitude of the user and use that data to calculate and find other users.  I've prepared the following query based on the 2 required tables but am getting errors that another alias is needed.  If I hard code the values then parts of the query work find when I split them out, but with multiple joins and subqueries I've been unsuccessful.  Looking for any guidance or help. Query and table structures included below.
Edited query and data set based on feedback.  No longer receiving errors but am not getting any data returned for the query.
SQL Statement
SELECT u.username, u.zip, m.longitude,
  m.latitude,
  m.zip from users u, zipcodes m
LEFT JOIN (SELECT  s.zip,
  s.username from users s) t
 on m.zip =  t.zip
  and t.username = 'tester55'
  INNER join ( SELECT zip, city, state, ( 3959 * acos( cos( radians(@m.latitude) ) * cos( radians( latitude ) )
    * cos( radians( longitude ) - radians(@m.longitude) ) + sin( radians(@m.latitude) ) * sin(radians(latitude)) ) ) AS distance
FROM zipcodes
HAVING distance < 5000
ORDER BY distance) as RelevantCodes
  ON (t.zip=RelevantCodes.zip)

User Table
    username     zip
-----------------------
    tester55     60608
    Tester1      60608
    iosuser1     73120
    Tester3      60608

Zip Code Table
latitude     longitude     zip
--------------------------------
41.8515      -87.6694      60608
35.5835      -97.5638      73120
36.3169      -94.1545      72758

A: I don't have the time right now to work out a correct query, but I'll show what is wrong with the existing query at a first glance.
1) Regarding your actual question: The error message reads ERROR 1248 (42000): Every derived table must have its own alias and already tells what is wrong. The subquery in the following part
LEFT JOIN (select s.zip,
  s.username,
  m.longitude,
  m.latitude,
  m.zip
from users s) on u.zip =  s.zip

needs its own alias, so that should eventually be
LEFT JOIN (select s.zip,
  s.username,
  m.longitude,
  m.latitude,
  m.zip
from users s) t on u.zip =  t.zip

(note the t after the closing parenthesis and the replacement of s.zip by t.zip). But even if you do that, you will run into problem 2 (see next section).
2) The subquery
(select s.zip,
        s.username,
        m.longitude,
        m.latitude,
        m.zip
        from users s)

will throw another error because the table m is not known within that subquery.
If you are able to work it out correctly, I suggest you edit your question and let us know the result. If not, please post a comment or edit your question, describing what other problems you encounter.
EDIT
I now have worked out a solution for you:
SELECT zipcodes.zip,
       (3959 * acos(cos(radians(zipcodes.latitude)) *
                    cos(radians(center.latitude)) *
                    cos(radians(zipcodes.longitude ) -
                        radians(center.longitude)) +
                    sin(radians(zipcodes.latitude)) *
                    sin(radians(center.latitude)))) AS distance FROM
  ( SELECT users.username,
           users.zip,
           zipcodes.latitude,
           zipcodes.longitude FROM
    (users JOIN zipcodes ON users.zip = zipcodes.zip)
    WHERE (username='Tester1')
  ) center, zipcodes
HAVING (distance < 5000)
ORDER BY distance;

This selects all ZIP codes which are within the desired distance, ordered by distance.
As you may notice, I have simplified the code. Please note also that I have tested this based on your old data (the data you have shown before your edit), but using Tester1 instead of tester55.
You indeed need the HAVING instead of WHERE when filtering, so my initial statement regarding that was misleading. The reason is that MySQL does not allow computed columns (in this case: distance) in WHERE clauses, but in HAVING clauses. This is non-standard behavior; usually, you have to solve this problem another way. I won't elaborate on that because it is an additional possibly worrying thing which is not closely related to your original question.
EDIT 2
Finally, here is the version which gives the username in addition:
SELECT zipcodes.zip,
       users.username,
       (3959 * acos(cos(radians(zipcodes.latitude)) *
                    cos(radians(center.latitude)) *
                    cos(radians(zipcodes.longitude ) -
                        radians(center.longitude)) +
                    sin(radians(zipcodes.latitude)) *
                    sin(radians(center.latitude)))) AS distance FROM
  ( ( SELECT users.username,
             users.zip,
             zipcodes.latitude,
             zipcodes.longitude FROM
      (users JOIN zipcodes ON users.zip = zipcodes.zip)
      WHERE (username='Tester1')
    ) center, zipcodes) INNER JOIN users ON zipcodes.zip = users.zip
WHERE (users.username <> 'Tester1')
HAVING (distance < 5000)
ORDER BY distance;

Please note that you need the third from last line to filter out the user you are calculating the distances for. If you don't do that, the result will include a row with the user itself (in this case: Tester1) and a distance of (nearly) 0.
EDIT 3
The following is a version as requested by the comments below (desired seeking radius stored as additional field seekingdistance in table users):
SELECT zipcodes.zip,
       users.username,
       center.seekingdistance,
       (3959 * acos(cos(radians(zipcodes.latitude)) *
                    cos(radians(center.latitude)) *
                    cos(radians(zipcodes.longitude ) -
                        radians(center.longitude)) +
                    sin(radians(zipcodes.latitude)) *
                    sin(radians(center.latitude)))) AS distance FROM
  ( ( SELECT users.username,
             users.zip,
             users.seekingdistance,
             zipcodes.latitude,
             zipcodes.longitude FROM
      (users JOIN zipcodes ON users.zip = zipcodes.zip)
      WHERE (username='Tester1')
    ) center, zipcodes) INNER JOIN users ON zipcodes.zip = users.zip
WHERE (users.username <> 'Tester1')
HAVING (distance < center.seekingdistance)
ORDER BY distance;

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