Loading

 
Viagra Professional

Stephanie A. Terezakis, MD

  • Assistant Professor
  • Department of Radiation Oncology and Molecular
  • Radiation Sciences
  • Johns Hopkins School of Medicine
  • Assistant Professor
  • Department of Radiation Oncology and
  • Molecular Sciences
  • Johns Hopkins Hospital
  • Baltimore, Maryland

She provided me with a memorable description of her sexual interaction with a male partner erectile dysfunction injections side effects order genuine viagra professional on-line, and her account graphically illustrates some of the ideas discussed by the informants above erectile dysfunction middle age generic 50mg viagra professional otc. She had been married twice to women and had been heterosexually active while living as a man erectile dysfunction treatment shots buy viagra professional with paypal. She had engaged in only incidental sexual interactions with men before transition erectile dysfunction in diabetes patients buy discount viagra professional 50 mg on-line. Attraction to Men Rarely Extends to Feelings of Romantic Love 133 She was familiar with and accepted Blanchards theories about autogynephilia erectile dysfunction protocol guide purchase 100mg viagra professional with mastercard, but she nevertheless claimed that after her transition erectile dysfunction killing me generic viagra professional 50 mg overnight delivery, her sexual interest had become directed primarily toward men impotence etymology purchase 50mg viagra professional free shipping. She explained that her preferred sexual activity with her partner was to kneel before him erectile dysfunction pills for sale buy viagra professional toronto, blindfolded and with her hands tied behind her back, and perform fellatio on him. Attraction to Men Rarely Extends to Feelings of Romantic Love Sexual orientation is usually assessed by asking subjects whether they are sexually attracted to men or women. An alternative approach, possibly a superior one, is to ask subjects whether the rst person they fell in love with was male or female or whether they habitually fall in love with men or women. Only one informant claimed that she sometimes fell in love with men; her unusual account is presented in detail toward the end of this chapter. One reported that she was aroused by the fantasy of having sex with men but fell in love only with women: I started having crushes, but only on girls. I dreamed and fantasized about having sex as a woman with a man penetrating my vagina, yet I still didnt see men as being at all attractive, even though I wanted to have sex with them. Why all the cruising of personal ads for men who like girls like me, when the people I fall in love with and like to look at are women Sex had more and more of an emotional component, and my connections with women keyed into that in a way I had never experienced before. This is a neglected area of clinical research, however, and I am not aware of any formal investigations of this issue. MtF transsexuals are hardly unique in having sexual fantasies about being mistreated or raped or in being sexually aroused by fantasies that they would never want to experience in reality; many natal women have similar fantasies and feelings (Bivona & Critelli, 2009; Critelli & Bivona, 2008). The point is simply that arousal to the fantasy of being mistreated or raped by a man seems to mediate some cases of autogynephilic transsexuals attraction to men: It is simply one more way to be a woman in relation to a man. One informant was aroused by the idea of being forced by a man to have sex against her will and being verbally degraded by men: the men in my fantasies are usually much larger than myself and extremely well-endowed. A feeling of Oh my God, I dont know if I can take this, but I have to continue submitting to this pseudo-rape (its scary, and the urge to beg him to stop is so strong) now that Ive let him start is the key to mind-blowing orgasms. My fantasies usually begin with the whole feminization process and proceed to my going out and prowling bars in a seedy neighborhood looking for my rst sexual encounter with a straight man. I often end up getting it from several men on a pool table after hours, reveling in the degrading way they talk to and about me. I will discuss sexual masochism in autogynephilic transsexuals in more detail in Chap. Whether this phenomenon represents a genuine change in sexual orientation or merely greater expression of the autogynephilic wish to have ones femininity validated by a male partner is open to dispute, although I consider the latter explanation far more plausible. Sexual orientation in males is probably essentially immutable in adulthood (Swaab, 2007). Whitam (1997) was willing to declare categorically that it is well known that sex reassignment surgery does not change sexual orientation (p. Accordingly, I hypothesize that all or almost all reports of changes in sexual orientation by autogynephilic transsexuals simply reect greater autogynephilic interest in validation of ones femininity by a male partner, not a genuine change in somatotypic preference. In this case, consistent with my hypothesis, measurement of neovaginal blood ow did not conrm the subjects reported change in sexual orientation. However one interprets self-reported change in sexual orientation in autogynephilic transsexuals, several informants stated that they had experienced such a change. They often described the change in a casual, unelaborated way, as though it were the most natural thing in the world: I have never been attracted to men, but lately, I have begun to look at men in a different light. I still have sex with women, but a sexual act with a man seems more satisfying day by day. My fantasies have evolved from my origins as male with a female before transition to me being female with a male. I never had a desire to be with a man ever before transition and I assume that this reversal is somewhat normal for my accepting and being a woman mentally and socially. My sexual preference after starting transition actually ipped over to liking men for the rst time in my life. It felt completely normal, and I now simply considered myself a heterosexual female. But now, as a woman, I have found great happiness and fulllment being in a relationship with a wonderful man for the last 10 months. Reality at this point is nally much closer to what I have always wanted and seen in my mind. Now I am the woman having her breasts fondled by a man who only sees her as a beautiful woman. Two informants explained that they believed it was possible to learn to be sexually oriented toward men, perhaps through a kind of conditioning process: If a MtF ts your description of an autogynephiliac, nds sexual relations to be the ultimate validation of femininity, and is an unapologetic heterosexual, then a migration in orientation is both necessary and logical. I will even go out on a limb here to further suggest that these MtFs can actually learn to be aroused directly by men through some sort of conditioning process. If an autogynephiliac believes that the ultimate validation of a female body is to have sexual relations with a man, she then learns how to be aroused by men. I would love him for accepting me and that would provide the motivation to become sexually attracted to him. After all, women are not attracted to all men, only certain ones; and if the man shows them that they are loved, they are attracted even more. Summarizing these data, Swaab (2007) concluded that there can be little doubt that sexual orientation has become xed in adulthood and is beyond in uencing later (p. Repression of Genuine Attraction to Men Due to Homophobia A few informants with a history of sexual attraction to women believed they had really been attracted to men all along (or had been destined to be so attracted) and had merely repressed their attraction to men because they had internalized the homophobic values of society: I am a pretty classic autogynephilic transsexual. Yet, I think I could have equally easily been a classic homosexual transsexual if circumstances had been slightly different. When I was younger, I was fearful of being known as a cross-dresser, but I was even more fearful of being gay. Though I had thoughts and feelings that I was attracted to men and not women, Repression of Genuine Attraction to Men Due to Homophobia 137 I kept them more suppressed than even my wish to be female. In hindsight, I was homophobic, probably because of the environment I was raised in. Had I had that experience, its possible that I would have realized I was not attracted to women and I might have sought relationships with men. I wonder how many of the transsexuals who eventually are attracted to men actually suppress their true orientation in order to t into society. If I was repressed and I was trained to prefer girls as acceptable behavior and trained not to prefer men, then I would outwardly and inwardly lie and prefer women. So, I would suggest that as I begin to acknowledge my transsexual nature and my true feelings, I nd myself more attracted to men and less to women. Why might it be important for some autogynephilic transsexuals to be able to tell themselves that they were really attracted to men all along or should have been Some other informants, whose accounts appeared earlier, were perfectly content to assert that their previous attraction to women had been genuine but that their sexual orientation had simply shifted toward men as a result of social transition or cross-sex hormone therapy. I think the answer lies in the fact that any deviation from the classic transsexual pattern (has felt and acted feminine from earliest childhood, has never been sexually aroused by womens apparel, and is romantically inclined toward males; Blanchard, Clemmensen, et al. Some of these deviations probably feel more consequential than others to particular individuals. Perhaps the informants who strongly believed that they were really attracted to men all along (or should have been) simply considered a history of sexual attraction to women to be a particularly discrediting feature. Interestingly, all of them acknowledged and most made no attempt to explain away their history of autogynephilic arousal, which many people would probably consider far more discrediting than a history of sexual attraction to women. There is still much to be learned about the elaborate explanations that autogynephilic transsexuals sometimes create to try to make sense of their feelings and histories. This informant also stated that she loved another MtF transsexual because she admired her condence and found her beautiful, despite not being attracted to her body. This informant further conjectured that her love for and attraction to some individuals might be mediated by their gender-atypical traits. Her account is lengthy but fascinating: Theres a boy where I go to school who I think is absolutely smashing. I was talking to another student, Heather, who is married with two children, saying how amazing I thought it was that she was able to balance all these things. But what I saw in him was such incredible support for his friend and such condence in himself without being fearful for his gender. I just thought he was the most magnicent and wonderful man I had ever met (although I have to admit that it doesnt hurt either that he holds doors open for me and wishes me a nice day all the time). The point is that, although there always seems to be a gender-bending connection, I am directly attracted to him. But I do concede that my attraction stems from an attraction to his spirit, not his body. Likewise, there is a transsexual woman of my acquaintance who I think is without a doubt the most beautiful woman Ive ever met. When I was a patient at the Clarke, they placed so much emphasis on are you attracted to men, or are you an autogynephile Perhaps, though, my autogynephilia is somehow connected with a love and appreciation of people who dont follow the gender scripts theyre handed. This is such an unusual and idiosyncratic use of the term sexual attraction that it renders the informants description of her sexual orientation almost meaningless. But the phrase exclusively sexually attracted to men has been widely used in the professional literature about MtF transsexualism, and it has historically functioned almost as a seal of approval in certain gender programs. It is understandable, then, why some autogynephilic transsexuals would want to claim this specic description, whether or not it is genuinely applicable to them according to conventional denitions. An Autogynephilic Transsexual with Substantial Sexual Experience with Men 139 It is also interesting to notice that this informant, generalizing from her attraction to an androgynous man and her love for another MtF transsexual, pointed to a gender-bending connection as the common thread. As one who accepts Blanchards theories, I tend to notice another common thread, some feminine traits in evidence. One might consequently assume that autogynephilic transsexuals who engage in sex with men are likely to have only a few male partners and that their sexual activity with men is likely to be rare and of little real importance. These latter respondents reported considerable experience with men by almost any measure. Some autogynephilic transsexuals not only report substantial sexual experience with men but may have had many more male than female partners and may even have identied as homosexual men in the past. The following narrative excerpt was submitted by an informant with such a history: I am 38 years old and 8 months postoperative. From puberty onwards, I was sexually aroused by the idea of being a woman, wearing womens clothes, and being made love to as a woman by a man. Throughout this time, I was most turned on by the idea of being made love to as a woman by a man. At this time, in my sexual fantasies, I rst conceived of myself as a female being made love to by a man. Today, I am powerfully sexually excited by the idea of being desired by men and by the notion of being thought of as beautiful. A clinician who did not elicit this informants history of sexual arousal with cross-dressing and cross-gender fantasy, lack of childhood effeminacy, numerous affairs with women, and falling in love with a woman might mistakenly conclude that the informant was a typical androphilic MtF transsexual. A clinician who elicited these historical details but was not attuned to the fact that the real turnon for the informant was not her male partners bodies but the idea that they accepted and treated her as a woman. Consequently, it is important for clinicians to bear in mind that some autogynephilic transsexuals have considerable sexual experience with men. Making Sense of Autogynephilic Attraction to Men A few years ago, I was consulted by a gender dysphoric male client with a history similar to those given by many of the informants in this chapter. He was married to a woman, and he had engaged in several romantic relationships with women before marriage. He had not been effeminate as a child, he had served in the military in an elite combat unit, and he held two advanced degrees in the physical sciences. By his own description, he experienced transvestic, anatomic, and behavioral autogynephilia, but the last of these predominated. His most intense erotic arousal came from engaging in sex with men while presenting himself as a woman. His intelligence was in the very superior range, and he had read most of what I had written and much of what Making Sense of Autogynephilic Attraction to Men 141 Blanchard had written about autogynephilia. It seemed evident to me that this client was not genuinely androphilic: He was clearly an autogynephilic man whose most intense source of erotic arousal involved the most common type of behavioral autogynephilia, autogynephilic interpersonal fantasy involving a male partner. But what was evident to me was not at all evident to this client, even though he was probably more intelligent than 99. The most intense and rewarding sexual experiences of this mans life had involved sex with male partners. His uncertainty about an issue that seemed so straightforward to me was a reminder of how profoundly confusing this type of behavioral autogynephilia can be, even to highly intelligent, well-informed people. Eventually, this client recognized that he was not genuinely androphilic, but this realization occurred only gradually. Unfortunately, I suspect the kind of confusion this client experienced is likely to remain widespread among autogynephilic gender dysphoric men for the foreseeable future, for several reasons. First, many professionals who specialize in the treatment of gender dysphoria dismiss Blanchards ideas about autogynephilia for reasons that are primarily political rather than scientic: that is, because his ideas directly contradict basic tenets of the worldwide transgender movement (Nuttbrock, Bockting, Mason, et al. Consequently, these professionals are not attuned to the concept of behavioral autogynephilia manifesting as a desire for sex with men; they are unlikely to ask about it or recognize it and are unlikely to be willing or able to educate their clients about it. Second, there exists a naive but prevalent belief that sexual orientation in nonhomosexual MtF transsexuals can sometimes genuinely change, especially after cross-sex hormone therapy, in contrast to the more skeptical view that this treatment merely sets the stage for more condent misinterpretation and misreporting of an underlying sexual orientation that not only remains unchanged but is, in fact, unchangeable. Consider this passage by Meyer-Bahlburg (2010), who is one of the smartest and best informed gender specialists in the world: One feature of animal models of the sexual differentiation of brain and behavior that has not yet found sufficient consideration in human research on gender development is the observation in rats that males have the neural circuitry of all aspects of female sexual behavior. That circuitry is usually blocked by perinatal sex-hormonal defeminization, but can be activated by the induction of an atypical sex-hormone milieu in adulthood (de Vries & Sodersten, 2009). Perhaps related mechanismscontribute to the sexual orientation change observed in many trans[sexual] persons after onset of cross-gender hormone treatment. What about the fact that the female sexual behavior that de Vries and Sodersten (2009) referred to had been elicited by a very specic combination of estrogen and progesterone that is quite unlike the type of cross-sex hormone therapy that most MtF transsexuals receive Meyer-Bahlburgs statement demonstrates that even knowledgeable 142 8 Sex with Men experts will sometimes clutch at straws to avoid the unpleasant conclusion that most or all nonhomosexual MtF transsexuals who report a change in sexual orientation after hormone therapy are simply engaging in unintentional self-deception. The willingness of some serious scholars to suggest that sexual orientation in nonhomosexual MtF transsexuals is potentially malleable lends an air of validity to the idea that a formerly heterosexual man could actually become genuinely androphilic. Third and nally, the belief that some nonhomosexual MtF transsexuals experience a change in their sexual orientation can serve as a basis for rejecting all sexual orientation-based typologies of MtF transsexualism (see Cohen-Kettenis & Pfaffiin, 2010), including Blanchards. Such a blanket rejection lends credence to the idea that Blanchards concept of autogynephilia and his MtF transsexual typology are simply inapplicable to many nonhomosexual MtF transsexuals. It thereby gives some clinicians a further excuse not to take the concept of autogynephilia seriously and not to learn about it, ask about it, or educate their clients about it. Perhaps the accumulation of more narratives like the ones in this chapter can eventually effect a change. These narratives demonstrate that the attraction to men that some autogynephilic transsexuals experience looks nothing like genuine androphilia. Unlike genuine androphilia, autogynephilic attraction to men is validation seeking rather than object seeking; it values faceless abstractions over real male bodies, which are experienced as unappealing or disgusting; and it rarely, if ever, extends to romantic love. These characteristics are indeed manifestations of a sexual orientation, but that sexual orientation is autogynephilia, not androphilia. Chapter 9 Other Aspects of Autogynephilic Sexuality the narratives submitted by the transsexual informants addressed several other aspects of autogynephilic sexuality in addition to those discussed in the previous chapters. Many informants observed that autogynephilic fantasies were always or almost always necessary to achieve orgasm in all sexual situations, including during masturbation. Some described autogynephilic arousal as being, at least at times, unpleasant, psychologically distressing, or unwanted. Informants reported a variety of unpleasant feelings immediately following orgasms that had been achieved with the help of autogynephilic fantasies. Several narratives discussed the effects of feminizing hormone therapy on autogynephilic arousal. Others described additional paraphilic sexual interests that co-occurred with autogynephilia. Still others observed that achieving orgasm was contingent on autogynephilic fantasies in all sexual situations, including during masturbation. Here are some representative excerpts: As an adolescent and young adult, I would often masturbate, but I couldnt get aroused without picturing myself as a woman.

Syndromes

  • Blood calcium test
  • Medicines to strengthen the heart muscle, control the heartbeat, or relieve pressure on the heart
  • Coma
  • Frequent displays of inappropriate anger
  • Scratch marks or signs of an infection, such as impetigo.
  • Shortness of breath
  • Loss of muscle control
  • Gastrointestinal bleeding

Of those 293 offenders with reported histories of sexual abuse in their own childhoods erectile dysfunction medication levitra 50 mg viagra professional with mastercard, 128 (43 erectile dysfunction symptoms causes generic viagra professional 100mg without a prescription. Of those 1 best herbal erectile dysfunction pills buy 100mg viagra professional amex,361 offenders with no reported history of childhood sexual abuse erectile dysfunction specialists order generic viagra professional on-line, 453 (33 impotence xanax order viagra professional with paypal. Such differences likely are explained at least in part by the charging policies of the 94 U online erectile dysfunction drugs reviews order viagra professional 50 mg with visa. As a federal prosecutor testified before the Commission impotence brochures purchase generic viagra professional line, certain offices prioritize high risk non94 production offenders for federal prosecution to a greater extent than other offices erectile dysfunction pump ratings buy 50 mg viagra professional amex. Another explanation for the differences in sentence length appears to be noticeably different rates of variances and departures from the applicable guideline ranges. Thus, including cases with unresolved allegations, 242 of the total 660 offenders (36. These differences may be explained in part by the manner in which offenders were detected during the two time periods. In a 1990 Commission staff study involving a much smaller number of cases, the study reported that 15 of 44 [child pornography trafficking cases] received by the Commission [in the prior two years] involve an offender who currently or at some time in the past has been involved in the sexual abuse of children. Subsequently, the Commissions 1996 report to Congress noted that 13 percent of [child] pornography defendants had a history of sexual misconduct. That difference may reflect that a larger percentage of non-production offenders in the earlier period were detected in sting operations whereby law enforcement pretended to be minors in Internet chat rooms (and offenders attempted to engage in travel offenses) and also that more nonproduction offenders today are detected using P2P file-sharing programs. Furthermore, an additional segment of non-production offenders engaged in other types of non-criminal yet sexual deviant conduct in addition to their nonproduction offenses that may indicate their sexual dangerousness. Of the offenders who engaged in one or more personal modes of distribution to other adults in fiscal year 2010. Over four out of five of those offenders did not receive either a guidelines pattern-of-activity enhancement or a statutory enhancement for a predicate conviction for a sex offense. As discussed elsewhere in this report, the sentencing scheme for non-production offenses has not been updated for nearly a 2 decade. Growing numbers of sentencing courts and parties believe that this sentencing scheme fails to distinguish 5 meaningfully among offenders in terms of their culpability and dangerousness. As the data analyses in this chapter show, many courts and parties have responded by engaging in a variety of charging and sentencing practices to distinguish among offenders in a manner that differs from the existing penalty scheme and often limits the offenders sentencing exposure under that scheme. Finally, as discussed in Part F below, appellate 7 review of sentences in non-production cases since United States v. Indeed, differing approaches among the circuit courts have contributed to the sentencing disparities. In passing the Act, Congress found that federal judges [had] mete[d] out an unjustifiably wide range of sentences to defendants with similar histories, convicted of similar crimes, committed under similar circumstances. The most serious offense of conviction not only determines the statutory minimums and maximums but also affects the 10 applicable guideline range. In fiscal year 2010, the statutory range of punishment was zero to ten years for possession offenses and five to 20 years for receipt, transportation, and distribution (R/T/D) offenses; defendants with predicate convictions for sex offenses were subject to increased statutory 11 imprisonment ranges (10 to 20 years for possession and 15 to 40 years for R/T/D offenses). However, a specific offense characteristic for defendants convicted of receipt who had no intent to distribute child pornography effectively creates three starting points in the guideline: 18 for defendants convicted of possession; 20 for defendants convicted of receipt (whose real offense conduct involved only receipt); and 22 for defendants convicted of transportation or distribution or defendants convicted of receipt who 13 intended to distribute child pornography. Otherwise, the statutory sentencing scheme remains identical to what it was in fiscal year 2010. Thus, for example, a defendant convicted of possession will have a base offense level of 18 even if the defendant distributed large volumes of child pornography to others. They include: a 2-level enhancement for possession of child pornography depicting prepubescent minors or children under 12 (P/P/M); incremental enhancements of 2 to 7 levels for different types of distribution of child pornography; a 4-level enhancement for possession of child pornography depicting sado-masochistic or violent conduct (S/M); a 5-level enhancement for engaging in a pattern of activity involving the sexual exploitation or abuse of a minor; a 2-level enhancement for use of a computer in connection with the offense; and incremental enhancements of 2 to 5 levels for possession of a certain quantity of images (with ten or more images receiving the 14 minimum enhancement and 600 or more images receiving the maximum enhancement). For non-production defendants with no predicate convictions for sex offenses, there were no statutory mandatory minimum penalties for possession offenses or R/T/D offenses, while statutory maximum penalties were five years of imprisonment for 15 possession and 15 years of imprisonment for R/T/D offenses. In addition, the base offense 16 levels for both possession offenses and R/T/D offenses were lower, and the impact of specific 17 offense characteristics was substantially less for typical defendants. Nearly 70 percent of offenders who received an enhancement based on the number of images that they possessed received the maximum 5-level enhancement. As discussed below, these ranges were calculated using the most commonly applied specific offense characteristics for possession, receipt, and transportation/distribution defendants. Because the vast majority of defendants sentenced under the non-production guidelines have no prior criminal record and plead guilty, the common ranges discussed below are for defendants in Criminal History Category I who received full credit for 19 acceptance of responsibility. On average, each 2-level increase in the offense level results in a 20 to 30 percent increase in the 22 minimum of the applicable guideline sentencing range. Common 2004 Guideline Ranges By comparison, common guidelines ranges for offenders sentenced under the nonproduction guidelines in fiscal year 2004 were significantly lower. The increasing number of sentences outside of the applicable guideline ranges reflects the belief of many stakeholders that the current guideline and statutory 33 penalty levels are excessive or are not based on relevant factors in non-production cases. In view of the steeply declining rate of within-range sentences, the Commission examined cases with the most frequently applied specific offense characteristics for possession, receipt, and transportation/distribution offenders sentenced in fiscal year 2010 to determine the extent of disparities among offenders who were similarly situated under the guidelines. The only difference in sentencing exposure under the guidelines and penal statutes for the members of the different case types analyzed relates to their offenses of conviction. Some defendants were convicted of R/T/D offenses (which, as noted, had guideline starting points of 20 or 22 and statutory ranges of five to 20 years of imprisonment), while others were convicted only of possession (and, thus, had a starting point of 18 under the guideline and a statutory range of punishment of zero to ten years based on the law then in effect). One group (157 offenders) was convicted of possession, while the second group (88 offenders) was convicted of receipt. The 157 defendants convicted of possession had a guideline range of 78 to 97 months, while the 88 defendants convicted of receipt had a guideline range of 97 to 121 months. Thus, the guidelines provided substantially different ranges for the two groups of defendants who engaged in substantially similar conduct. The top portion of the graph depicts the sentence lengths for the 157 defendants convicted of possession; the bottom portion of the graph depicts the sentence lengths for the 88 defendants convicted of receipt. The horizontal axes of both portions depict sentence lengths (in increasing increments, stated in months). The vertical axes of the two portions of the graph show the number of cases in each increment, as represented by blue or red bars; blue bars on the top portion together comprise the 157 defendants convicted of possession, and red bars on the bottom portion together comprise the 88 defendants convicted of receipt. Blue arrows on the horizontal axes mark 60 and 120 months, the statutory mandatory minimum term of imprisonment for receipt defendants (five years) and the statutory maximum term of imprisonment for possession defendants in 2010 (ten years). The average sentence for defendants convicted of possession was 52 months, while the average sentence for defendants convicted of receipt was 81 months. One group (62 offenders) was convicted of possession, while the second group (70 offenders) was convicted of distribution. However, because the two groups were convicted of different statutory offenses, their guideline ranges differed considerably as a result of different starting points under the guidelines and different statutory ranges of imprisonment. The 62 defendants convicted of possession had a guideline range of 97 to 120 months, while the 70 defendants convicted of distribution had a guideline range of 151 to 188 215 United States Sentencing Commission 36 months. The average sentence for defendants convicted of possession was 70 months, while the average sentence for defendants convicted of distribution was 109 months. Their guideline ranges differed both because of different starting points under the guidelines and also because of different statutory ranges of imprisonment. The 40 defendants convicted of possession had a guideline sentence of 120 months (135 to 168 months without the statutory maximum of 120 months), while the 81 defendants convicted of distribution had a 37 guideline range of 210 to 240 months. Thus, both the relevant penal statutes and the guidelines provide substantially different ranges for two groups of defendants who engaged in substantially similar conduct as found by sentencing courts. Similarly, because the statutory maximum punishment for transportation or distribution was 20 years (240 months), see 18 U. The average sentence for defendants convicted of possession was 78 months, while the average sentence for defendants convicted of distribution was 132 months. All but one of the defendants convicted of possession received sentences below the guideline range that would have been applicable but for the fact that they were charged with a single count of possession that carried a 38 statutory maximum sentence of 120 months. Charging Practices As explained below, a common method for limiting defendants sentencing exposure in fiscal year 2010 non-production cases was charging practices that permitted defendants who 219 United States Sentencing Commission committed R/T/D offenses to plead guilty to possession. The data analysis of charging practices that follows is based on the Commissions special coding project of all 1,654 non-production cases, including 1,310 cases that had plea agreements, in fiscal year 2010. The Commission examined cases with and without plea agreements to determine whether defendants avoided mandatory minimum penalties despite their actual offense conduct. Typically, in charge-bargain cases, the parties expressly agreed that the prosecution would dismiss (or not bring) an R/T/D offense carrying a mandatory minimum penalty in exchange for a defendants guilty plea to possession. In nearly 90% of fiscal year 2010 cases, law enforcement detected the offense in one of three ways: (1) by accessing the offenders child pornography files through a P2P file-sharing program used by the offender; (2) by directly receiving child pornography from an offender via email or an instantmessaging service during an Internet chat session with an undercover officer; or (3) by discovering that an offender had obtained child pornography from a website (typically using his own name as well as an email address and credit card associated with his true identity). In such cases, the evidence of the defendants act of receipt or distribution was directly related to the manner in which the defendant was detected by law enforcement and, thus, appeared readily provable. Nevertheless, the Commission recognizes that in some of those cases in which only possession charges were brought, there may have been limited forensic resources available to the prosecution (thus making it much easier to prove possession rather than receipt or distribution) or other forensic difficulties related to proving receipt or distribution in addition to possession. See Testimony of James Fottrell, Child Exploitation and Obscenity Section, Criminal Division, Department of Justice, to the Commission, at 58 (Feb. Guideline Stipulations in Plea Agreements Parties also used stipulations in plea agreements concerning the application of the guidelines (which were adopted by sentencing courts) to limit defendants sentencing exposure 45 in some non-production cases. An example of the latter type of stipulation is a plea agreement in 44 See Chapter 2 at 26. Government Sponsored Downward Variances and Departures A third practice that reduced defendants sentencing exposure in non-production cases 48 was a government motion for downward variance or departure from the otherwise applicable guideline range based on reasons other than a defendants substantial assistance to the 49 authorities. In the typical such case, no reason 51 was given in a plea agreement for such downward variances or departures. Non-Government Sponsored Downward Variances and Departures A final means of reducing a defendants sentencing exposure was a non-government downward variance or departure. Such downward variances or departures usually were initiated by the filing of a motion by the defendant, but it appears from the statement of reasons forms that sentencing courts occasionally downwardly varied or departed 53 sua sponte. Of the 733 cases involving downward variances or departures, the prosecution objected in 632 such cases (86. The three leading reasons given by courts for downwardly varying or departing from the applicable guideline ranges were: (1) a variance based on the nature and circumstances of the offense [and/or] the history and characteristics of the defendant under 18 U. For purposes of the analysis in this chapter, limited sentencing exposure cases only include those in which the parties or the court engaged in one or more of the above-mentioned four practices to limit a 225 United States Sentencing Commission defendants sentencing exposure under the statutory or guidelines sentencing schemes (other than based on a defendants substantial assistance). Variation in Sentence Lengths the four practices, individually or collectively, had significant effects on defendants sentence lengths and thereby resulted in disparate sentences for similarly situated defendants. The horizontal axes of Figure 8-13 depict sentence lengths in 24-month increments. Furthermore, because a mandatory minimum penalty did not apply to many of the defendants whose sentencing exposure was limited, a significant percentage of such defendants received sentences of less than 60 months. In contrast, relatively few defendants whose sentencing exposure was not limited received prison sentences below 60 56 months. Analysis of Possible Influences on Sentencing Practices Because of the significant differences in average sentence lengths for offenders based on whether their sentencing exposure was limited, the Commission analyzed a variety of offender and offense characteristics, as well as the geographical location of prosecutions, to help explain why most offenders benefited from limited sentencing exposure but some did not. Distribution Distributing child pornography is commonly cited as a primary basis for punishing nonproduction defendants who distributed more severely than non-production defendants who did 57 not. The Commission compared the incidence of distribution conduct in all cases to determine whether defendants whose sentencing exposure was limited had a lesser incidence of distribution conduct than defendants whose sentencing exposure was not limited. Sentencing exposure was limited in a slightly larger percentage of cases involving impersonal distribution (487 of 577 cases, or 84. However, this data suggest that the type of distribution offers only a partial explanation for whether sentencing exposure was limited, as the vast majority of offenders with both types of distribution had their sentencing exposure limited. Criminal History the Commission next examined whether the extent of a defendants criminal history was associated with different rates of limited sentencing exposure. Demographic Factors the Commission next compared cases with and without limited sentencing exposure to determine whether there were any significant differences regarding demographic characteristics of offenders.

discount viagra professional amex

No Since the information in the confidential files is empirical data exist what causes erectile dysfunction in 30s purchase viagra professional 100mg overnight delivery, but a database search of limited erectile dysfunction ed natural treatment cheap viagra professional master card, the effects of the abuse on the children major newspapers revealed six published are unknown erectile dysfunction treatment perth buy generic viagra professional 100 mg. As with the of the approximately 400 abuse cases he Boy Scouts best erectile dysfunction pills at gnc order viagra professional online from canada, the offenders hailed from a variety investigated erectile dysfunction causes and remedies purchase viagra professional 50 mg online, four victims attempted suicide and of professions erectile dysfunction daily pill buy 100mg viagra professional with mastercard, including a school principal and at least three leaders who were charged with naval officer erectile dysfunction treatment testosterone order 50mg viagra professional mastercard. As cited in Boyle (1994) erectile dysfunction medicine in pakistan viagra professional 50mg without prescription, Donald Wolff As public awareness concerning the reviewed 100 allegations of sexual abuse in the abuse grew, the Boy Scouts recognized the need Big Brother Organization and determined that, to combat this problem. Boyle claims that the much like Scouting, the majority of offenders organization has paid at least fifteen million were single and came from various professions. The training program, which is meant to raise the sexual abuse progressed from inappropriate awareness of both children and Scoutmasters. These offenders also 9 appeared to target emotionally vulnerable to 12 alleged victims, and the offending children. The Catholic Church, once criminal charges were perpetrators also groomed the victims filed, Wolff found that they often led to families, socializing with them in order to gain confessions or convictions. The cases showed that many of the perpetrators were also occurred in North America, the United Kingdom involved in educating and counseling children and Ireland, and a few included prominent other than the Boy Scouts. In many of the findings, the Big Brothers have instituted a strict cases, the coaches were suspended from the screening process, which involves a criminal organization or were subjected to criminal background check for all volunteers. The victims ranged in age; however, a majority of them appeared to be in their teens. The perpetrators children six years of age or younger; 270 worked for the organization in various institutions were so identified. Substantiation capacities, including camp counselors and sports was based upon the investigations of local coaches. The offenders targeted both girls and agencies including child protection, licensing, boys, and many of the articles illustrated that and police agencies. The study yielded 1,639 the perpetrator in question was a habitual victims (484 girls, 269 boys, and 859 victims for offender. One offender claimed he had targeted which gender was not unidentified) and 382 20 victims while another had been charged with perpetrators (222 males, 147 females, and 13 75 counts of sexual abuse, including 10 counts whose gender was not identified) over the time of rape. The authors urge that the records for sexual abuse, and some were data be interpreted with caution due to the fact employed in schools. There is no empirical data indicating the Despite these cautions, the researchers prevalence of sexual abuse within sporting were able to estimate the following statistics: organizations. The majority of the cases concluded that while a day-care center is more illustrate that the perpetrator was somehow likely to be reported for sexual abuse, the risk of involved with a school, either as a teacher or a child being abused is actually lower when principal. Many of the perpetrators appeared to enrolled in a center than in their own home due have multiple victims. In evaluating appeared to groom their victims over a period of the perpetrators, the following relationships time. One case involved a coach who was were revealed: 16% of perpetrators were charged with 400 counts of sexual abuse, directors/owners; 30% were teachers; 15% though most perpetrators had approximately 10 were nonprofessional child caretakers; 8% were 10 in a non-child care capacity; 25% were family 2002, more than 1,205 clerics had been named members of the staff; and 5% were outsiders. There also appeared to be a rather high number Forty-three percent of clerics are said to have of female perpetrators involved in day care offended against children younger than age 12, abuse, including 44% of child care workers, 6% and the majority of abusive acts were focused of family members, and 6% of multiple upon boys (80%). Half of the investigated clerics have been listed the prevalence of sexual misconduct within the as having multiple victims, and 16% accounted Catholic Church has been estimated by a for having five or more victims. In an empirical While these studies might begin to shed investigation of treatment efficacy, Loftus and some light upon the true state of affairs within Camargo (1993) concluded that in their clinical the Catholic Church, they are not sound enough sample of 1,322 priests and brothers, 27. This presents reported having engaged in a sexual relationship a very interesting conundrum in which lack of with an adult woman while 8. According to Jenkins (1995), the researcher, Anthony Sipe (1990), showed that emphasis upon sexual abuse committed by the 2% of priests engage in pedophiliac behavior clergy is a result of a shift in media coverage while an additional 4% of priests are sexually beginning during the 1980s. Sipe image of the pedophile priest (Jenkins, 1996) also concluded that 20% to 40% of priests was created and endorsed by the media and engage in sexual misconduct with adults. While the media has portrayed this caution due to the fact that they are based upon crisis as being centered solely in the Catholic the authors clinical experiences and not Church, Jenkins offers evidence through the empirical evidence. Like most studies the Catholic Church have undertaken the task of conducted on this population, these results assessing the true extent of the abuse. Plante should be cautiously interpreted since the small (2003) extrapolated from data presented by the sample size makes them unlikely to be St. However, Plante sound prevalence rate, journalists throughout noted that this figure may be comprised of men the nation have also posed various figures. In a literature review these figures are based upon Berrys coverage conducted by the Catholic League for Religious of the sexual abuse cases in Louisiana between and Civil Rights (2004), the figure for abusive 1984 and 1992. During this time period, Berry clerics cited in the media ranged anywhere from estimates that the Catholic Church spent nearly 1 to 1. A recent archival investigation is that they are based upon speculation about conducted by New York Times reporter Laurie the true nature and scope of child sexual abuse Goodstein (2003) postulates that by the end of in the Catholic Church. Researchers from John 11 Jay College of Criminal Justice (2004) conducted review of the available literature, Kafka stated a descriptive study of the nature and scope of that the typical child sexual abuser in the the problem, seeking information from all Catholic Church is a diocesan priest who is an dioceses and religious communities in the United ephebophile. They found that 4,392 priests and from clinical samples, clergy offenders seem to deacons had allegations of child sexual abuse differ from offenders in the general population. However, methodological limitations sexual abuse and the clergy into a proper preclude firm conclusions about groups of clergy perspective was undertaken by Kafka (2004) at who offend. Through a critical 12 Theories and Etiology of Child Sexual Abuse by Males Why men sexually abuse children has been one of androgens and androgen-releasing hormones, of the foremost questions guiding research on which are known to be related to physical sexually deviant behavior in the twentieth changes in the male. As with most forms of deviant behavior, androgens is controlled by the hypothalamus there are various explanations as to the etiology and the pituitary, and hormones are carried and maintenance of sexual offending. Within the from the anterior lobe of the pituitary to the specialist literature, biological, psychological and testes. The testes are an important contributor sociological theories have been designed to to the bodys output of testosterone, which, explain the onset of deviant sexual fantasies and once released, circulates in the blood. However, owing to the heterogeneity not bound to proteins, the testosterone is of the perpetrators of such abuse and the metabolically active; if bound, androgens can complex nature of this behavior, no one theory only become active when in contact with adequately explains: (a) the motivating factors receptors for testosterone. It is at this time that that lead an adult male to have sexual relations physical changes, such as increases in body hair, with a child and (b) the sustaining factors that muscle mass and penis enlargement, are caused contribute to the continuance of such relations through androgenic effects (Hucker and Bain, (Bickley & Beech, 2001). Table 1 at the end of at this time, there is generally believed to be a this section summarizes the theories on deviant correlation between testosterone levels and sex sexual behavior. Levels of plasma testosterone increase with erotic activity, which Biological theorists are concerned with organic has been measured in males before, during and explanations of human behavior. Therefore, after they view erotic films (Pirke, Kockott and when it comes to sexual behavior, these Dittmar, 1974). Although a review of biological theorists postulate that physiological factors, studies shows conflicting results about the such as hormone levels and chromosomal correlation between rising hormonal levels and makeup, have an effect on the behavior (Berlin, sexual activity, Bancroft (1978) stated that the 1983; Marshall & Barbaree, 1990). Androgens, results imply that hormone levels are affected by which are male sex hormones, promote sexual erotic stimulus. As a result, predisposing a male towards sexually abusive biological theories about deviant sexual behavior behavior. Klinefelters Syndrome is a condition usually pertain to rape because it is considered wherein males appear to be essentially normal an act of violence, and researchers have long boys until puberty. At puberty, 80% of males hypothesized that there is a correlation between with this syndrome display both the physical aggression and high testosterone levels (Money, characteristics and hormonal profiles of women. The Berlin proposes that males with Klinefelters theories that address pedophilia most often look Syndrome may experience problems with regard at abnormal hormonal and androgenic levels in to both their sexual orientation and the nature the brain. A review of the literature Biological theories of deviant sexual suggests that the prevalence of sexual deviation behavior are particularly concerned with the role among individuals who are diagnosed with Klinefelters Syndrome may be higher than it is 13 among individuals who have not been diagnosed part of Freuds model, the ego, is the conscious with Klinefelters Syndrome. Although Berlin part of the human psyche that serves as the cautions against making causal inferences mediator between the id and the external between sexual deviation and Klinefelters environment. This element is primarily Syndrome, he attempts to support his theory by conscious and is ruled by the reality principle citing evidence presented by Baker and Stroller that accepts that there is a time and a place for (1968). It is this Syndrome were reviewed, and Berlins aspect of the psyche that interacts with the conclusion was in concordance with Baker and external environment in order to ensure survival. Thus, the superego is bolstered by past problems experienced during the stages of experiences that clearly define the behaviors development. These brought about fixations or hindrances during notions are then internalized in such a manner stages of development, with consequent as to allow for the development of a system of distortion of a sexual object or a sexual aim morals. For example, psychoanalytic In summary, Freudian theory portrays theory proposes that boys experience what is the human psyche as being in a constant termed the oedipal conflict during the phallic struggle to fulfill the primal desires of the id and stage of development. This characterized by competition between father theory assumes that sexual aggressors are and son for the mothers affection. At the same lacking in a strong superego and have become time, boys discover the differences between overwhelmed by their primal id. While themselves and girls and conclude girls are psychologists generally once accepted this actually boys whose jealous fathers have cut off explanation, it has fallen out of favor due to its their penises (Schwartz, 1995). Schwartz lack of empirical evidence in favor of more (1995) states that castration anxiety leads to the testable theories, such as cognitive behavioral oedipal conflict, which is when boys no longer and integrated theories. Laws and Psychodynamic theory also asserts that Marshall (1990) presented a theoretical model of the human psyche is composed of three primary sexually deviant behavior that describes how elements: the id, the ego and the superego. In sexually deviant interests may be learned order to understand how all three elements through the same mechanisms by which interact, Freud proposed that all human conventional sexuality is learned. The model is behavior is motivated by wishes that often exist divided into two parts: the acquisition processes at a preconscious level (Holmes & Holmes, and the maintenance processes. The id is Chaining of Behavior); two social learning ruled by the pleasure principle that demands influences (General Social Learning Influences instant gratification of these urges. The second and Self-Labeling Influences); and three 14 maintenance processes (Specific Autoerotic restrict the possibility of attaining intimacy. The Influences, Specific Social Learning Influences evidence suggests that deficiencies in intimacy and Intermittent Reinforcement). The model are a distinctive and important feature of sex adopts the position that maladaptive behavior offenders. The rapists and non-familial child can result from quantitative and qualitative molesters in the sample appeared to be the combinations of processes that are intrinsically most deficient in intimacy. A secure attachment style is characterized by the individual having a positive According to attachment theory, humans have a concept of both himself and others. He is propensity to establish strong emotional bonds confident about his ability to make friends and with others, and when individuals have some interacts well with others. An individual utilizing loss or emotional distress, they act out as a a preoccupied attachment style has a negative result of their loneliness and isolation. As Marshall and Barbaree (1976) point He does not feel confident about his ability to out, the period surrounding pubescence and deal with problems without the help of others. With individual has a negative concept of himself and adequate parenting up to this point in others, finds that the individual is likely to blame development, boys should have by now acquired himself for problems in his life and finds it appropriate inhibitory controls over sexual and frightening to go to others for help and to trust aggressive behavior and, thus, the transition to people around him. Those engaging in a adult functioning, with both social constraints dismissing attachment style have a positive selfagainst aggression and the skills necessary to concept and a strong sense of self-confidence. This individual is likely to say that instilling a sense of self-confidence in the he does not care what others think of him and developing boy as well as a strong emotional rarely has a strong emotional involvement in attachment to others. Marshall (1989) found attachment style will characteristically court that men who sexually abuse children often the child and treats him or her as a lover. This failure causes frustration in these men that may cause When individuals commit deviant sexual acts, them to continue to seek intimacy with underthey often try to diminish their feelings of guilt aged partners. According to these rationalizing their behavior (Scott and Lyman, studies, sex offenders have deficiencies in social 1968; Scully, 1990; Sykes and Matza, 1957). Partial denial, as described by Marshall eventually believe the distortions as they et al. Though some researchers offending behavior for both rapists and child claim that denial is not an accurate predictor molesters because they serve the needs of the variable for recidivism (Hanson and Bussiere, offenders to continue their behavior without 1998), there is a substantial body of literature feeling guilt for their actions. Cognitivetheir offenses, sex offenders make excuses as to behavioral theorists have explained these why they committed the deviant acts. Commonly, they blame Additionally, sex offenders often lack victim the victims for their offenses or justify their empathy and show an inability to recognize the offenses through the victims actions. Scully and Marolla (1984), who attitudes of offenders who seek only to fulfill interviewed 114 incarcerated rapists, explain five their own desires (Hanson, Gizzarelli and Scott, ways in which rapists commonly justify their 16 behavior. They claim that the victim is a wherein people are not able to exert any seductress, and she provoked the rape; women major influence over their personal mean yes when they say no, or the victim did behavior and/or the world around them. The abuser considers women relax and enjoy it, and they are actually the degree of harm to his victim and fulfilling the womans desires; nice girls do not perceives sexual activity as beneficial get raped, and prostitutes, hitchhikers and and unlikely to harm a person. Instead, the offender may simply justifications of rapists, many of their findings reinterpret or reject it. For example, a childs are also evident in child sexual abusers, who friendly behavior might be evidence to the also justify their actions by neutralizing their offender that the child wants to have sex with guilt. Child molesters justify their actions in Similar to Ward and Keenans idea that many ways. Common justifications include the distortions of sexual offenders reflect their claims that they are helping the child to learn more general implicit theories about their about sex, that sexual education is good for the victims, Marshall et al. Like offenders with distortions, and the goals manifested by their adult victims, child molesters often assert that behaviors, that differentiates them. They fail to misread social cues by others and are poor at recognize any other explanations as to why the identifying emotions such as anger or fear in child might not have resisted, such as fear, their victims. Both rapists and child molesters uncertainty about what was happening or the often perceive their victims as initiating sexual idea that the perpetrator is someone they knew contact, and see their victims actions as and trusted. Child molesters misread Ward and Keenan (1999) claim that the cues from children in several ways, and the cognitive distortions of child sexual offenders better they know the victim the more likely this emerge from five underlying implicit theories is to happen. Children are naturally affectionate that they have about themselves, their victims towards adults, particularly those whom they and their environment. They adults, are motivated by a desire for also perceive any sexual curiosity displayed by pleasure and are capable of enjoying the child as a desire to know about sex, and and desiring sex. These misperceptions reinforce the abuser are paramount and those of the offenders narcissistic beliefs and detract the victim are either ignored or viewed from the ability for an offender to feel any as only of secondary importance. The abuser perceives model of the preconditions to child sexual his environment as uncontrollable abuse, which integrate the various theories 17 about why individuals begin to participate in looks to both psychoanalytic theory and sexually deviant behavior. With regard to adult model is on the internal barriers, or self talk, attachments, child molesters have failed to comments and observations of sex offenders develop the appropriate social skills and selfabout the world around them. This self talk confidence necessary to form effective intimate allows offenders to break through barriers relations with adults. Finkelhor further breaks which, until this time, had prevented them from down the theory of blockage to incorporate what acting out their feelings about perceptions of he calls developmental blockages and situational injustice, loneliness and other such stressors. Developmental blockages once again Once these barriers are diminished, this refer to psychoanalytic theory wherein an mistaken thinking can lead to actions, which are individual is psychologically prevented from the result of normal internal barriers being moving into the adult sexual stage of absent. Situational blockage refers to the In order to better explain this process, event wherein an individual, who has apparent Finkelhor constructed an organizational adult sexual interests, is blocked from normal framework consisting of four separate sexual expression owing to the loss of a underlying factors that explain not only why relationship or some other transitory crises. These factors include: (1) emotional refers to the factors that help a child molester congruence, (2) sexual arousal, (3) blockage overcome his inhibitions so that he allows and (4) disinhibition. Finkelhor looks to Finkelhor coined the term emotional cognitive-behavioral theories to explain this congruence to convey the relationship between component. Specifically, he considers the the adult abusers emotional needs and the influence of cognitive distortion in the facilitation childs characteristics. It is likely that comfortable relating to a child due to the sense individuals who offend have been able to cope of power and control. However, it is the combination of these Finkelhor looks to social learning theory in order problems, in addition to some type of demand to explain this phenomenon. One explanation is on their coping system that contributes towards that the child sexual abuser was molested when an attitude supportive of sexual offending, he was a child. That risk imprinting, he comes to find children arousing increases the likelihood that a person may act later in adulthood. An alternate explanation is out in a sexual fashion because his or her belief that the child sexual abusers experience of system has filtered out the normal inhibitions being victimized as a child is not conditioned, towards sexual offending. Sipe model in which experiences of shame interact concludes that offending behavior in this model with unrealistic, moral expectations conveyed is of a developmental nature and can be through Church teachings that have been resolved once the offender psychologically internalized. The Moral Lock displays no clear creation of a shame cycle, which stunts the explanation for the offending behavior other individuals psychosexual development and than the individuals in this model make a contributes to sexual misconduct. In discussing the causes of pedophilia, close friendships between priests, under the Sipes noted that a large number of sexually pretense that it may lead to homosexual abusive clerics had been victimized as youths. With this victimization as a child may lead the individual increased social isolation comes a greater to seek refuge in the clergy as a way of denying alienation from the body. Church contributes to the creation of a proSipe (1995) has proposed a model of offending environment. In concordance with clergy offending which consists of four specific the theories of Andrew Shupe, institutional categories. Those in Sipes Genetic Lock find religion is based upon hierarchies of unequal that their sexual attraction is inherently power, which span both spiritual and determined. Those in elite of priests who, as a result of their childhood positions within the institution have moral experiences, have been locked at a level of authority over the masses, which allows them to psychosexual development that makes them control privileges and ostracize individuals. Sipe hypothesizes that Church also engages in neutralization tactics in combinations of genetic and psychodynamic order to protect these offending priests and the factors contribute to one another and interact image of the institution. All of these variables pedophile approval from superiors to continue combine in such a manner as to influence the offending and establishes an environment in priests to sexually abuse a child. Social/Situational Lock, the priest is otherwise healthy, but the experience of celibacy suspends 19 Table 1. These determinants may include make a series of decisions prior to committing situational factors. These decisions may be made offend), affective states (depression, anger, over a period of time or on the spur of the isolation), past learning, biological influences moment if the opportunity to abuse presents and prevailing contingencies of reinforcement itself.

For a detailed description of how to complete this requirement impotence urology discount viagra professional master card, please see Global Awareness erectile dysfunction treatment guidelines buy viagra professional 50mg mastercard. For a detailed description of how to complete this requirement erectile dysfunction pump prescription buy online viagra professional, please see Integrated Learning impotence gandhi buy viagra professional 50 mg free shipping. Therefore erectile dysfunction treatments that work buy viagra professional 50mg without prescription, the faculty expects students to show increasing skill in stating logical erectile dysfunction treatment australia order cheap viagra professional, unifed ideas impotence curse discount 100 mg viagra professional amex, developing concepts erectile dysfunction caused by diabetes order viagra professional with visa, organizing appropriate formats, and using language both correctly and effectively. To help students attain this goal, the faculty expects that the regular instructional program of the College will teach writing skills throughout the students four-year program of study. All students must complete one full year of freshman composition, one course in sophomore literature, and the College Writing Intensive requirement. The faculty expects that these courses 52 will develop the fundamentals by which all students writing skills will improve during the junior and senior years. To support students in their development as writers, Ferrum College provides a faculty-staffed Writing Center where students can receive individualized professional assistance with any writing project. The College also offers a Fundamentals of Writing course for students who need additional preparation before entering the traditional freshman composition courses. Individual departments may establish additional writing elements for their classes. All courses used to satisfy the Writing Intensive requirement must be taken at Ferrum College. Students who wish to transfer courses specifcally designated as writing intensive at other institutions may appeal to the Dean of the School of Arts and Humanities. The list of Writing Intensive courses may vary from year to year; courses that can fulfll the requirement are not limited to those listed in the students catalog year of entry. Use the following link to access a list of courses that meet the Writing Intensive requirement. Those who transfer in with junior or senior standing must complete at least one experience from each of the three areas. Use the following link to access a list of courses that will meet the Quantitative Reasoning requirement. Use the following link to access a list of courses that will meet the Global Awareness requirement. Use the following link to access a list of courses that will meet the Integrated Learning requirement. Students may meet a Global Awareness, Integrated Learning, and/or Quantitative Reasoning experience by designing and executing a proposal that addresses the appropriate skills. Experiential Learning: Fulflling the Experiential Requirements Experiential Learning courses involve students in direct experiences combined with focused refection as a way to enhance knowledge and skills. This approach to education connects learning to the world beyond the classroom and links theory with practice. At Ferrum College, students must complete an Experiential Component, which is listed within each program of study in the College Catalog. In addition to the Experiential Component requirement, student must pass at least one course in the Experiential Term (E-Term). E-Term is conducted in the three weeks immediately following Commencement and includes a choice of both on-campus and travel courses in a variety of disciplines. E-Term courses may also apply to other General Education and/or Major/Minor requirements. Courses offered in E-Term vary from year to year; a complete list of choices will be available for consideration during registration for the Spring Semester. Credits for E-Term courses may also apply to other requirements in majors / minors and the General Education curriculum. Costs for E-Term: For full-time students, there are no additional tuition or room/board costs for the required E-Term session. Students are obligated to pay all non-refundable course fees if they do not drop the E-Term course by the fourth week of the spring semester. Part-time students will be charged for an E-Term course at the credit hour rate that is applied to regular semester courses. Limited scholarships for travel courses are available; contact the Director of E-Term for further information. If a student wishes to take more than the one required E-Term course, tuition and room/board costs will be applicable at the current per credit hour rate. Registering for E-Term: Currently enrolled full-time and part-time students will generally register for an E-Term course when they register for Spring Semester; the last possible date to register for E-Term is the last add date during the frst week of the Spring Semester. An E-Term course does not count as part of the 12-hour load required for full-time status. If a student is registered for 18-19 hours in the Spring Semester, adding an E-Term course may put the student in overload status for that semester, but overload fees will not be applied. Students academic standing will determine their eligibility for enrollment in E-Term travel courses (see guidelines in Standards of Satisfactory Academic Progress and Financial Aid Eligibility). Regardless of the timing of enrollment, all students must abide by specifc course enrollment requirements, which may include interviews or seeking the approval of the instructor. A student enrolling for an E-Term course after the typical November registration must accept decisions already made by the instructor in any missed class meetings and agree to any additional restrictions set by the course instructor to insure student safety. Satisfactory Academic Progress Impact on E-Term Participation Students who are in good academic standing or have been placed on academic warning may register for any E-Term course and are eligible for travel scholarship opportunities. Students who are on academic probation or who are on disciplinary probation or higher during the fall semester may not register for an E-Term course that has overnight or off campus travel but they will be eligible to register for on campus E-Term courses. If the student appeals the academic suspension and is allowed to return for the spring semester on probation, the student will not be allowed to enroll in any E-Term course involving overnight off campus travel. Students who were on probation during the fall semester and return to good standing by the beginning of the spring semester, may register for any E-Term course, including overnight off campus travel during add week in the spring semester. Students opting to do this will be responsible for payment of applicable deposits and fees. Students placed on disciplinary probation or higher after spring registration or during the spring semester will be removed from the E-Term overnight off campus travel course. Students who choose to drop an E-Term course due to poor performance in multiple Spring Semester classes may be responsible for all applicable deposits and fees. Students whose grades in spring semester (excluding the E-Term course) result in academic suspension will be withdrawn from the enrolled E-Term course. Graduation Requirements Students must utilize online Eight-Semester plans and assistance of faculty advisors in the formulation of an acceptable course of study leading to a degree. Students should review their progress frequently by using the Panther Portal Academic Planning link and Program Evaluation link to be sure they are in compliance with all degree requirements. Both the student and the advisor will review the catalog, program evaluation and academic planning tool each semester and adjust the academic plan based on the course rotations and schedule of offerings. Prior to registration, all second semester sophomore and junior students will be provided with an audit and pre-graduation clearance from the Offce of Advising. Students reaching Senior status will be required to complete a Graduation Clearance and Diploma Order form with their Advisor. The completed Graduation Clearance and Diploma Order forms must be submitted to the Offce of the Registrar for approval. The student is ultimately responsible for ensuring compliance with all degree requirements. A student may transfer a maximum of nine semester hours of work back to the College to complete the requirements for graduation. To participate in graduation, a student may not fall short of the required minimum of 121 credit hours by more than one course or an internship. Students lacking a course or internship must submit proof of summer registration to the Offce of the Registrar to complete the work prior to the beginning of the next fall term. Programs of Study (Majors) A major is a focused, disciplinary or interdisciplinary program of academic concentration. There are two kinds of majors at Ferrum College: those which require a minor and those which do not. If a program of study requires a minor, a student may choose to satisfy that minor by completing a second major. Programs of more than 39 hours are normally interdisciplinary with signifcant content drawn from two or more disciplines. A major may require up to 57 hours of which no more than 39 hours can be required in a single discipline or subject designation. In addition to the particular courses required in the major, a school may specify up to 20 hours within the general college Liberal Arts requirement. Note: At least 50% of the required courses for any major must be completed at the College. Minors Minors are groups of related courses with at least 9 hours at the 300-400 level (6-8 hours may be considered adequate depending upon the nature of student learning in the proposed courses in the minor, and upon a strong and compelling rationale for less than 9 hours). Note: At least 50% of the required courses for any minor must be completed at Ferrum College. The advisor will complete a Program Change Request Form available under Advising from Faculty & Staff Services on the Panther Portal. Students must discuss their desired program shifts with their advisors to insure complete understanding of the requirements and options involved and to avoid any loss of time and credits. The catalog for the year in which a student enters Ferrum College is the governing document for requirements for graduation. However, students who change their program of study after their frst year of enrollment must apply the regulations in the current years catalog. A second baccalaureate degree may be earned by persons who already hold a bachelors degree from Ferrum College or from another accredited institution. A student who enters Ferrum College to work on a second degree shall be classifed academically as a senior. All Liberal Arts Requirements in effect at the time of the second degree must be completed (either by current or previous coursework); 2. The student must meet all prerequisite and course requirements in the major feld of the second degree, with at least half of the required courses in the major taken at Ferrum College; 3. The student must complete at least 30 hours of additional coursework at Ferrum College beyond the earned hours of the frst degree; 4. A person seeking a second degree must be admitted through the regular admissions process. For a complete list of minors see page 122) Note: Students must complete at least 50% of the total hours required for a major at Ferrum College. Arts and Humanities Art Religion English Social Studies History Spanish Media and Communication Theatre Arts with Teacher Education minor Philosophy Note: In the state of Virginia students may not major in Teacher Education but may pursue teacher licensure through this offering. Natural Sciences and Mathematics Agricultural Sciences Environmental Studies Biology Mathematics Chemistry Pre-Professional Health Sciences Environmental Science Social Sciences and Professional Studies Accounting Liberal Arts Business Administration Political Science Computer Technology and Information Systems Psychology Criminal Justice Recreation Leadership General Business Studies Social Work Health and Human Performance Sociology International Studies Other Liberal Studies 60 Accounting B. Degree the accounting major is an interdisciplinary major designed to prepare students with the knowledge, the analytical ability and the skills to succeed in the managerial, governmental, non-proft or systems felds of accounting, or in graduate school. It is supported by a strong liberal arts education and an extensive selection of courses in business and economics. It is a very demanding and challenging major; students majoring in accounting are expected to achieve grades of C or better in their accounting courses in order to continue in the program. Degree the Agricultural Sciences program provides students with a diversifed four-year curriculum and the opportunity for practical experience. The curriculum stresses the theory and practice of animal science, agronomy, agribusiness, and horticulture. The curriculum includes numerous hands-on experiences, developing practical skills in students. A required internship furthers this facet by placing students in situations of responsibility and creativity. In addition, the Agricultural Sciences program at Ferrum College is unique among collegiate agricultural programs in that it is frmly integrated within the School of Natural Sciences and Mathematics, providing students with the opportunity to study within the broader contexts of biology, chemistry, and environmental and societal issues. This broad approach, combined with the strong liberal arts base, prepares graduates for a wide range of career opportunities. Agricultural Sciences graduates fnd employment in farm management and operation, agricultural extension and natural resources conservation agencies, agricultural supply businesses, marketing and distribution of farm products, teaching vocational agriculture, agricultural creditors, agricultural research, and numerous other areas. The broad hands-on approach and internship experience are invaluable preparations for this diverse industry. Students may choose emphasis areas within the program that allow them to concentrate their study in Agribusiness, Agronomy, Animal Science, Equine Studies or Horticulture. Agricultural Sciences is comprised of four emphasis areas: Agribusiness, Agronomy, Animal Science, Equine Studies and Horticulture. Degree the goal of the art program is to provide an excellent educational experience that develops technical skills, critical and aesthetic judgment, and a sound knowledge of the visual arts appropriate to students seeking a general appreciation of the arts as well as to aspiring fne arts professionals. The faculty engage students in the discipline of visual art as a major component in the liberal arts tradition including studio practice and art history. Students complete a common group of foundation and art history courses and then choose an emphasis area to develop a solid yet individualized program. Degree the Biology curriculum is designed to introduce students to the major areas of the biological sciences and to enable them to gain competence in using the concepts and investigative methods appropriate to each. Students may select a course of study suited to their particular interests with emphases in botany, zoology, cellular biology, or physiology. Students may pursue independent study and research in areas ranging from biotechnology to feld research, may assist professors in their investigations, and may serve as laboratory and teaching assistants in the courses. Biology students receive preparation that enables them to enter a variety of professional careers or to continue their studies in graduate and professional schools. Degree the Business Administration program provides an academic environment which prepares students for graduate school and for professional roles in a global economic system. It provides a broad background in basic business principles and is supported by a strong liberal arts education. The program incorporates extensive experiential learning opportunities for students including setting up and running a small business and mentoring local businesses. To be effective in a managerial role, one must be prepared to handle demanding and changing situations. The students who major in Business Administration have opportunities to develop the administrative skills and the background knowledge necessary for dealing with these situations. Business majors develop strengths in oral and written communications, and quantitative decision-making skills. During the freshman and sophomore years, the student concentrates in the liberal arts and receives an introduction to the basic functions and tools of business. In the junior and senior years, the student has fexibility in determining the area of professional concentration that will meet particular academic and career plans. Such award-winning organizations enhance the students understanding of theoretical concepts, provide a service to the community, and help build their resume. Business students are urged to take courses in languages, political science, and history, and to prepare for graduate school. The fve emphasis areas (Business Analytics, Financial Management, Management, Marketing and Sports Management) offer the business student an opportunity to emphasize an area of special interest and prepare for a specialized business career. The recommended off-campus internship gives students a real work experience prior to completion of their bachelors degree requirements. Business Analytics Emphasis the Business Analytics emphasis area focuses on the opportunity to achieve organizational goals, proft and non-proft, through the analysis of data and business processes. The application of data analysis has become integral to organizational competitiveness, customer satisfaction and growth as well of optimizing services to clients of non-proft agencies. Students studying Business Analytics will learn how to leverage data for improvement in organizational effciency and effectiveness. They will learn how to use analytical 70 skills to solve problems in an increasingly complex economic environment. Emphasis is placed on what data need to be investigated, interpreting the numeric results of the data, and writing concise reports. Application of the theories and principles from the required courses will be the hallmark of the Business Analytics program. Financial Management Emphasis Financial Management involves the effcient acquisition and use of funds. Every organization, whether it is a large corporation or a small business, must be concerned with fnancial management. There are a number of job opportunities for fnancial planners, budgeting offcers, analysts, and decision-makers. The fnancial management program prepares graduates for fnancially-oriented positions in business or in management of fnancial institutions such as banks, insurance companies, and brokerage houses. Management Emphasis Management involves achieving results by the combination and use of all available resources in an organization. Because this task is complex, all managers must possess technical and conceptual skills as well as interpersonal and communications skills. It is an appropriate program for those students planning to enter general management and for those whose career goal is to own their own businesses. Marketing Emphasis Marketing is the link between the organization and the consumer and involves planning and execution of the conception, pricing, promotion, and distribution of products. Ferrum Colleges marketing program gives students a basic understanding of marketing and its role in society and business. It prepares students for such felds as advertising, sales, marketing research, retail sales management, and Internet-based careers. Sports Management Emphasis the growth of sports as a major industry has increased the need and opportunity for well-trained professional managers. A well rounded business education which includes Finance, Accounting, Management, Marketing and Quantitative Skills with a focus on sport management skills is essential in this rapidly growing feld. Approved Electives (6-12 hours) Students choose 6-12 credits (depending on Emphasis) from Accounting, Business, or Economics.

Viagra professional 100mg without prescription. K24 Alfajiri: Causes and Prevention of Impotence with Dr. Kibe.