Author Archives: yuan ade sukma, MD

About yuan ade sukma, MD

I'm an Indonesian doctor. I Believe that science and knowledge do not belong to anyone in the world. Science and knowledge is meant to be shared to make the world a better place to live. But if you find any material posted here is violating any copyrights, feel free to contact me and I will delete that. I believe that someday my blog can change the world. I BELIEVE in the POWER of WORDS! Do you..?

FDA Approvals: Avanafil for Erectile Dysfunction

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News Author: Robert Lowes CME Author: Laurie Barclay, MD Clinical Context Avanafil is the fifth branded oral drug for erectile dysfunction (ED) approved by the US Food and Drug Administration (FDA). Like tadalafil, vardenafil, and sildenafil, avanafil is a phosphodiesterase … Continue reading

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Efficacy and safety of mirodenafil, a new oral phosphodiesterase type 5 inhibitor, for treatment of erectile dysfunction.

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Paick JS, Ahn TY, Choi HK, Chung WS, Kim JJ, Kim SC, Kim SW, Lee SW, Min KS, Moon KH, Park JK, Park K, Park NC, Suh JK, Yang DY, Jung HG. Source Department of Urology, Seoul National University Hospital, … Continue reading

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How to measure penis length, is my penis too small/ too big?

Penis Size: What’s Normal, What’s Not You might think that as long a man’s penis works, he would have no problem with it. You would be wrong. Penis size is a key element of a man’s self-image. Yet when he’s … Continue reading

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Daftar Alamat dan No Telepon Klinik Fertilitas di Indonesia

Jakarta 1. Klinik Yasmin, Immunoendokrin reporoduksi dan menopause. Paviliun Cendrawasih RSCM. Jl. Diponegoro no. 71 Jak-Pus. Telp. 021-3928567/021-3918301 2. Klinik Melati, Rumah Sakit Anak dan Bunda Harapan Kita Jl. Let. Jen S. Parman Kav 87, Jakarta. Telp 021 – 5668284 … Continue reading

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PERATURAN MENTERI KESEHATAN REPUBLIK INDONESIA NOMOR 028/MENKES/PER/I/2011 TENTANG KLINIK

DENGAN RAHMAT TUHAN YANG MAHA ESA MENTERI KESEHATAN REPUBLIK INDONESIA, Menimbang : a. bahwa perkembangan penyelenggaraan fasilitas pelayanan kesehatan semakin kompleks baik dari segi jumlah, jenis maupun bentuk pelayanannya; b. bahwa klinik sebagai salah satu bentuk fasilitas pelayanan kesehatan dibutuhkan … Continue reading

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Testosterone Therapy is Safe for The Prostate

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Is Testosterone a Friend or a Foe of the Prostate? Emmanuele A. Jannini MD1,*, Giovanni L. Gravina MD, PhD1, Abraham Mortengaler MD2, Alvaro Morales MD3, Luca Incrocci MD, PhD4, Wayne J.G. Hellstrom MD, FACS5 Article first published online: 1 APR … Continue reading

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Penile revascularization shows high success rates in treating vasculogenic ED

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January 20, 2012 New research suggests that penile revascularization surgery may offer an effective alternative to phosphodiesterase type 5 inhibitors in the treatment of men with vasculogenic erectile dysfunction (ED). Efficacy of surgery was evaluated in 110 men who underwent … Continue reading

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List of Medications that May Cause Erectile Dysfunction

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Medications that can cause erectile dysfunction (ED) Many commonly prescribed medications can cause erectile dysfunction (ED) in men and female sexual dysfunction in women. If you find a medication that you are currently taking on the list below and it … Continue reading

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Despite All the Benefits, Lipid-Lowering Drugs Cause Erectile Dysfunction, a Systematic Review

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Do lipid-lowering drugs cause erectile dysfunction? Authors: Kash Rizvi, John P Hampson and John N Harvey, 2002 Abstract Background. Erectile dysfunction (ED) is common although under-reported by patients. Along with the better known causes of ED, drug-induced impotence needs to … Continue reading

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Foods That Improve Sperm Quality

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What foods should I eat to improve my sperm quality? Before we continue, we should know first about How is sperm quality measured? The World Health Organization identified five factors to assess sperm quality. All five are necessary for the … Continue reading

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Propecia® for Male Pattern Baldness (MPB), with Picture

Is it safe to use Finasteride as a therapy for MPB? Male pattern baldness or androgenetic alopecia is caused by the effects of the male hormone dihydrotestosterone (DHT) on genetically susceptible hair follicles that are present mainly in the front, … Continue reading

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Finasteride May Prevent Prostate Cancer But Is It Worth the Sacrifice?

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Pros, cons of drug proven to prevent prostate cancer should be considered, researchers say As men earn the rank of senior citizens, their chances of prostate cancer increase tremendously. There is a drug, however, finasteride, that has a proven ability … Continue reading

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What is TUMT, (Trans Urethral Microwave Thermotherapy) with Videos

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What is TUMT? Transurethral microwave thermotherapy (TUMT) is a treatment for benign prostate enlargement. The procedure shrinks the prostate to relieve the symptoms associated with an enlarged prostate. There are a number of treatments available to address prostate enlargement and … Continue reading

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Green Light Laser Surgery, The Latest Therapy for Benign Prostate Hyperplasia (BPH)

For the numerous men suffering from the uncomfortable effects of BPH (Benign Prostatic Hyperplasia), there is new hope for a successful BPH treatment: Green Light Laser Prostate treatment (GLLP). Often referred to as PVP (photo-vaporization) treatment, Green Light Laser technology … Continue reading

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PSA Velocity Shouldn’t be Used as Basis for Biopsy

Don’t Use PSA Velocity as Basis for Biopsy This is an interesting information from Dr Gerald Chodak from Medscape, regarding PSA velocity. He is the Director, Midwest Prostate and Urology Health Center, Michiana Shores, Indiana. Hello. I am Dr. Gerald … Continue reading

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Can We Predict Prostate Cancer Solely Based on PSA Velocity ?

An empirical evaluation of guidelines on prostate-specific antigen velocity in prostate cancer detection. Vickers AJ, Till C, Tangen CM, Lilja H, Thompson IM. Feb 24th,2011 Source Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. … Continue reading

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15 Percent Men with PSA Less Than 4 ng/mL is Having Prostate Cancer

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Should Men With Serum PSA Levels of 4.0 ng/mL or Less Undergo a Prostate Biopsy? J Brantley Thrasher; William L Valk Posted: 12/21/2004; Nat Clin Pract Urol. 2004;1(1) © 2004 Nature Publishing Group Synopsis Background There is a general consensus among clinicians that a … Continue reading

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Prostate Cancer after Radical Prostatectomy? How Is It Possible?

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Post Operative Treatment and Treatment Upon Recurrence Radical prostatectomy involves removing the entire prostate and any immediately adjacent tissue that is thought to be cancerous. Additionally, lymph nodes in the area of the prostate can be removed if thought necessary. … Continue reading

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All Questions about Priapism

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Definitions Known also as Hulseyism, is a potentially harmful and painful medical condition in which the erect penis or clitorisdoes not return to its flaccid state, despite the absence of both physical and psychological stimulation, within four hours. The condition … Continue reading

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You Must Know Article about Penile Injection Therapy

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Penile Injection Therapy Highlights of Injection Therapy First FDA-approved medication for the treatment of E.D. 80 percent of men in clinical trials achieved firm erections Individualized dosage determined for each patient’s needs Works for men with a broad range of … Continue reading

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Step by Step on How to Do Self Intra Cavernous Injection

Penile Injection Therapy Diagrams 1. Hold the medication bottle so that your fingers do not touch the rubber stopper through which the needle is inserted. Check expiration date of medication. 2. Using a circular motion, wipe off the top of … Continue reading

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Guidelines on The Management of Erectile Dysfunction, 2009

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British Society for Sexual Medicine, Guidelines on The Management of Erectile Dysfunction, 2009 Epidemiology and risk factors Erectile dysfunction (ED) has been defined as the persistent inability to attain and/or maintain an erection sufficient for sexual performance. The risk factors … Continue reading

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SHIM, Sexual Health Inventory for Men or IIEF-5, Sexual Health Inventory for Men, an abridged version of the IIEF

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The IIEF-5 Sexual Health Inventory for Men, is an abridged version of the IIEF, contains a shorter questionnaire of 5 items which takes into account the latest six months instead of the latest four weeks considered by the IIEF. The … Continue reading

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Is Male Infertility a Risk Factor for Prostate Cancer?

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The relationship between prostate cancer and reproductive function is poorly understood, but there have been reports of paternity increasing the risk for prostate cancer. The relationship between male infertility and occurrence of prostate cancer was evaluated in an observational cohort … Continue reading

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What is the Difference between Total Testosterone Level, Free Testosterone, and Bio Available Testosterone ?

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In healthy adult men, about 44% of the circulating testosterone is specifically bound to sex hormone–binding globulin (SHBG), 5 50% is non-specifically bound to albumin, and 3.5% is bound to cortisol-binding globulin, indicating that only 2%–3% is unbound or free. … Continue reading

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Paroxetine is Superior than Dapoxetine for the Treatment of Premature Ejaculation ?

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Comparison of Dapoxetine Versus Paroxetine in Patients With Premature Ejaculation: A Double-blind, Placebo-controlled, Fixed-dose, Randomized Study Safarinejad MR. Urology Nephrology Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. Clin Neuropharmacol. 2006 Sep-Oct;29(5):243-52. PURPOSE: To compare the efficacy and … Continue reading

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Dapoxetine ( Priligy © ) is an Effective Treatment for Premature Ejaculation

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Efficacy and safety of dapoxetine for the treatment of premature ejaculation: integrated analysis of results from five phase 3 trials. McMahon CG, Althof SE, Kaufman JM, Buvat J, Levine SB, Aquilina JW, Tesfaye F, Rothman M, Rivas DA, Porst H. … Continue reading

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Testosterone Replacement Has Little Effect on prostate gland in older men

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Effect of Testosterone Replacement Therapy on Prostate Tissue in Men With Late-Onset Hypogonadism A Randomized Controlled Trial Leonard S. Marks, MD; Norman A. Mazer, MD, PhD; Elahe Mostaghel, MD, PhD; David L. Hess, PhD; Frederick J. Dorey, PhD; Jonathan I. … Continue reading

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Testosterone Replacement Therapy is Proven Safe For Prostate

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February 08, 2011 A new study has shown that hypergonadal patients undergoing testosterone replacement therapy (TRT) do not experience increased risk of worsening prostate health and safety parameters compared with eugonadal age-matched controls. Hypergonadal patients (n = 154; baseline average … Continue reading

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The addition of testosterone therapy improves erectile function in hypogonadal men who fail to respond to phosphodiesterase type 5 inhibitor (PDE5-I) therapy alone

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Hypogonadal men nonresponders to the PDE5 inhibitor tadalafil benefit from normalization of testosterone levels with a 1% hydroalcoholic testosterone gel in the treatment of erectile dysfunction (TADTEST study). Buvat J, Montorsi F, Maggi M, et al. J Sex Med 2011;8(1):284-293. … Continue reading

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Androgen Therapy Increases Responses to Sildenafil in Hypogonadal Patients

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Ti-S Hwang1,2,3, H-E Chen1, T-F Tsai1 and Y C Lin1 1Division of Urology, Department of Surgery, Shin Kong WHS Memorial Hospital, Taipei, Taiwan 2Department of Urology, Taipei Medical University, Taipei, Taiwan 3Department of Urology, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan Correspondence: Dr … Continue reading

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Treatment Options for Prostate Cancer, with Videos

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Prostate cancer is the most common type of cancer affecting men. Rates of detection of prostate cancers vary widely across the world, with South and East Asia detecting less frequently than in Europe, and especially the United States. Prostate cancer … Continue reading

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Zoraxel, The Latest NON-PDE5 Inhibitor Drug for the Treatment of Erectile Dysfunction

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Zoraxel is a developmental stage drug for sexual dysfunction that directly modulates the sexual activity control center in the brain. Zoraxel enhances the action of serotonin and dopamine, brain signaling molecules that play a key role in three phases of … Continue reading

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Safety Aspects of 36 Months of Administration of Long-acting Intramuscular Testosterone Undecanoate for Treatment of Female-to-Male Transgender Individuals

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Safety aspects of 36 months of administration of long-acting intramuscular testosterone undecanoate for treatment of female-to-male transgender individuals. Jacobeit JW, Gooren LJ, Schulte HM. Source Endokrinologikum Hamburg, Center for Hormonal and Metabolic Diseases, Reproductive Endocrinology, Lornsenstrasse 4-6, Hamburg 22767, Germany. … Continue reading

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Udenafil / Zydena®, The Latest PDE5 Inhibitor, For the Treatment of Erectile Dysfunction

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Udenafil / Zydena® Udenafil has a trade name Zydena. This is one of the four famous molecules investigated for the treatment of erectile dysfunction (ED). It is well-known with proven clinical efficiency, high safety and acceptability to the patient. The … Continue reading

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Which is the best PDE5 Inhibitor? Viagra, Levitra, or Cialis?

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Comparison of Viagra, Levitra and Cialis Male sexual dysfunction is one of the most common health problems affecting men and is more common with increasing age. Chronic ED affects about 5% of men in their 40s and 15–25% of men … Continue reading

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PSA (Prostate Spesific Antigen) Test Interpretation, with Very Good Video

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What is PSA test? PSA stands for prostate-specific antigen, a protein produced by the cells of prostate gland, a gland about the shape and size of a walnut that sits below a man’s bladder. PSA is not just an ordinary … Continue reading

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10 Top Causes of Prostate Cancer and How to Avoid Them

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Prostate cancer is the second most common cancer among men (skin cancer is the first), according to the American Cancer Society (ACS). In 2007 alone, nearly 219,000 new cases of prostate cancer are expected in the United States, and over … Continue reading

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Prostate Cancer Staging /Grading, with Video

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Prostate cancer staging is the process by which physicians categorize the risk of cancer having spread beyond the prostate, or equivalently, the probability of being cured with local therapies such as surgery or radiation. Once patients are placed in prognostic … Continue reading

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Boosting Testosterone Improves Mood and Other ‘Quality of Life’ Measures in Older Men

Boosting testosterone improves mood and other ‘quality of life’ measures in older men A Russian study, published in the Journal of Sexual Medicine in July 2010, looked at how men with metabolic syndrome (Met S) and hypogonadism responded to treatment … Continue reading

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Low Testosterone is Common in Men with Cardiovascular Disease and Decreases Survival

Low testosterone is common in men with cardiovascular disease and decreases survival A study in the United Kingdom observed 930 men with confirmed coronary artery disease over an average of nearly 7 years to find out how many had testosterone … Continue reading

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Increased risk of dying from cardiovascular disease for men with erectile dysfunction and low testosterone

Increased risk of dying from cardiovascular disease for men with erectile dysfunction and low testosterone 1 April 2011. Nearly 1700 men attending an andrology clinic for erectile dysfunction were monitored for an average of 4.3 years to find out whether … Continue reading

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Testosterone Roles in Diabetes and Obesity

Testosterone replacement therapy improves glucose control and reduces central obesity in men with metabolic syndrome and low testosterone May 5th, 2011. This study carefully evaluated available good quality studies that compared the levels of testosterone in men with or without … Continue reading

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About Penis Size, It Doesn’t Matter, Err..Wait, It Does Matter…Which One’s True? My Personal Thought Sharing

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Well..umm penis size… We all know that this kind of thing is HUGE thing in the internet., also in daily life. It is still a very debatable topics which is I think a very interesting topic to talk also, “Does … Continue reading

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A Standardized Algorithm for the Diagnosis, Monitoring, and Treatment of Male Hypogonadism/ Testosterone Deficiency Syndrome/ Andropause

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Below is a standardized algorithm for the diagnosis, monitoring, indications, contraindications, and treatment of male hypogonadism. This guideline is only for health care professional and SHOULD NOT be used to treat yourself. You must contact your doctor before you start … Continue reading

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Do You Have Testosterone Deficiency Syndrome? With ADAM Test and Video

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TESTOSTERONE DEFICIENCY SYNDROME (TDS) New campaign aims to raise awareness A new health campaign, “Revive Your Drive” has launched to raise awareness of Testosterone Deficiency Syndrome (TDS). The campaign, sponsored by Bayer Schering Pharma, encourages men to answer 10 quick … Continue reading

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The Power of Words !

The Power of Words !. Great Video, bring tears to my eyes 🙂

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Sperm Disorders, Causes, and Treatments, with Video

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Sperm disorders include defects in quality or quantity of sperm produced and defects in sperm emission. Diagnosis is by semen and genetic testing.   Pathophysiology Spermatogenesis occurs continuously. Each germ cell requires about 72 to 74 days to mature fully. … Continue reading

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Intra Uterine Insemination (IUI), with Video

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Intra Uterine Insemination (IUI) This video shows a well animated 3D, of how IUI works Intra Uterine Insemination (IUI) is a method of Artificial insemination, is the process by which sperm is placed into the reproductive tract of a female … Continue reading

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In Vitro Fertilization (IVF), (Bayi Tabung), with Video

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In Vitro Fertilization (IVF) This video shows a well animated 3D, of how IVF works IVF may be used to overcome female infertility in the woman due to problems of the fallopian tube, making fertilisation in vivo difficult. It may … Continue reading

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Intra Cytoplasmic Sperm Injection (ICSI), with Video

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INTRA CYTOPLASMIC SPERM INJECTION (ICSI) This video shows a well animated 3D, of how ICSI works Intracytoplasmic sperm injection (ICSI, pronounced “eeksee” or “icksy”) is an in vitro fertilization procedure in which a single sperm is injected directly into an … Continue reading

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Erectile Dysfunction Video, The Causes, and The Treatments

Erectile dysfunction (ED, “male impotence“) is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance. To achieve and maintain and erection, you need 1. Healthy penile nerves 2. Strong blood flow … Continue reading

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Human Sperm Made From Bone Marrow, A New Hope for Male Infertility, Also for Lesbians?

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Immature sperm cells have been created from stem cells in human bone marrow – they might one day lead to treatments for male infertility. The study, outlined Last week in the journal Reproduction: Gamete Biology, was however unable to produce … Continue reading

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Easy Quick Self Test for Your Prostate Health !

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The International Prostate Symptom Score (IPSS) is an 8 question (7 symptom questions + 1 quality of life question) written screening tool used to screen for, rapidly diagnose, track the symptoms of, and suggest management of the symptoms of the … Continue reading

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Practical and Step by Step Ways to Do Kegel Exercises

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Kegel exercises for men Controlling ejaculation is a huge issue for many men, one that they are often too embarrassed to bring up. How do I control myself? How can I last longer, be firmer and do better? The answer … Continue reading

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Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline

CLINICAL PRACTICE GUIDELINE Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline Shalender Bhasin, Glenn R. Cunningham, Frances J. Hayes, Alvin M. Matsumoto, Peter J. Snyder, Ronald S. Swerdloff and Victor M. Montori Boston … Continue reading

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Is It Safe to Give Testosterone After Treatment for Prostate Cancer ?

TESTOSTERONE REPLACEMENT THERAPY AFTER PRIMARY TREATMENT FOR PROSTATE CANCER PIYUSH K. AGARWAL, MICHAEL G. OEFELEIN ABSTRACT  Purpose: A history of prostate cancer has been an absolute contraindication for testosterone supplementation. We studied a cohort of hypogonadal patients treated with radical retropubic prostatectomy … Continue reading

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Exercise Can Increase Testosterone Level

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Can You Increase Your Testosterone Level By Exercising? Because of testosterone’s effect on muscle growth, testosterone supplements have become a huge business. This is especially true now that it is no longer possible to buy testosterone precursors, except for DHEA, … Continue reading

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Foods That increase Testosterone, Libido and Sex Drive

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What Foods Will Help Increase Low Libido? Libido is usually taken to mean sexual desire, a person’s sex drive or sexual urge. Libido does vary from person to person, from female to male. General levels of libido & sex drive … Continue reading

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Erection Hardness Score (EHS)

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Erection Hardness Score (EHS) is a much simple than the International Index of Erectile Function (IIEF) scoring. Therefore it is much easier and faster to use when we need to diagnose patient with erectile dysfunction. EHS rates the hardness of … Continue reading

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Premature Ejaculation Diagnostic Tool (PEDT)

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PEDT Questionnaire is the most commonly tool to diagnose premature ejaculation. This tool was developed by Pfizer Inc. It is simple and worldwide approved as a standard to confirm a diagnosis of premature ejaculation in a patient. This questionnaire to … Continue reading

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Premature Ejaculation, Definition, Mechanism, and How to Overcome It

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Videos Presented by: Dr Andrew L. Siegel. He is a urological surgeon at Hackensack University Medical Center, and is the director of The Center of Continence Care. Part 1 of 2 Part 2 of 2 Premature ejaculation (PE) is a … Continue reading

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Pelvic Floor Muscle Exercise

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Dr. Andrew Siegel, a urologist in Hackensack, New Jersey, discusses pelvic floor muscle exercises. Part 1 of 2. Part 2 of 2. A Kegel exercise, named after Dr. Arnold Kegel, consists of contracting and relaxing the muscles that form part … Continue reading

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Kadar Testosteron Normal dan Beberapa Parameter Lain, pada Laki-laki Dewasa

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Tabel ini menunjukkan kadar normal dalam darah, pada laki-laki dewasa (>18 th). Kadar ini bisa bervariasi tergantung dari usia dan kondisi klinis masing masing orang. -bagi yang mau kopi paste harap menyertakan link ke blog ini ya- Malang, May 3rd, … Continue reading

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International Index of Erectile Function Questionnaire (IIEF)

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The International Index of Erectile Function Questionnaire (IIEF) Please complete and bring this questionnaire to your appointment (circle your answers and add up the total). The first five questions refer to erectile function Q1. Over the last month, how often … Continue reading

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Where Is The Female G Spot Located?

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-This video shows the easiest way to find the Female G-Spot- Have you ever discovered it by yourself? The Gräfenberg Spot, often called the G-Spot, is the bean-shaped area of the vagina. Many women report that it is an erogenous … Continue reading

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Testosteron Treatment Options: Choices and Non Choices in The World. By: Prof Ronald S. Swerdloff, MD (UCLA)

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Berikut adalah hasil dari Pertemuan Ilmiah Tahunan Persandi V-Pandi XIX, dengan judul Current Hopes in Sexual Dysfunction and Infertility Solution, yang bertempat di Grand Sahid Jaya Hotel Jakarta, 27-29 April 2011 Testosteron Treatment Options: Choices and Non Choices in The … Continue reading

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Hormonal Male Contraception, by: Prof . Dr. Nukman Moeloek, dr, SpAnd

Berikut adalah hasil dari Pertemuan Ilmiah Tahunan Persandi V-Pandi XIX, dengan judul Current Hopes in Sexual Dysfunction and Infertility Solution, yang bertempat di Grand Sahid Jaya Hotel Jakarta, 27-29 April 2011 Kontrasepsi Hormonal Pada Pria Abstrak Penelitian Kontrasepsi pria akhir-akhir … Continue reading

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WHO Indonesia, Health Profile

WHO Indonesia, Health Profile Reference: http://www.ino.searo.who.int/en/Section3_24.htm The general decentralization process implemented in 2001 has had many impacts on the health system, even though it was not designed specifically with the health sector in mind. In particular, health financing, health information … Continue reading

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SISTEM KESEHATAN DI DUNIA

SISTEM KESEHATAN DI DUNIA Kita mengenal 2 sistem dalam sistem penyelenggaraan kesehatan yaitu KURATIF dan PREVENTIF-PROMOTIF. Dalam sistem kuratif, penyelenggara kesehatan bersikap pasif dan menunggu seseorang menjadi sakit. Pada pola preventif-promotif, penyelenggara kesehatan berperan aktif mempromosikan dan mencegah terjadinya penyakit, … Continue reading

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INDONESIA: Healthcare system failing millions

Indonesia’s decentralised healthcare system is in need of reform Reference: http://www.irinnews.org/Report.aspx?ReportId=85600 JAKARTA, 6 August 2009 (IRIN) – Indonesia’s health system is failing to provide even the most basic care to vast swathes of the population, say specialists. Many who cannot … Continue reading

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How Indonesia’s Health Care System Let Me Down

By Jason Tedjasukmana / Jakarta Wednesday, Feb. 17, 2010 Reference: http://www.time.com/time/world/article/0,8599,1964611,00.html I never thought I would let the grim stories I’d heard about Indonesia’s health care system turn me into one of those expats who left the country at the … Continue reading

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The Power of Words !

With words, we can change the world, that’s for SURE! -so, lets share our words, our dreams, our hope, for this lonely world, and hope for a better place for all of us-

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