Small Penis Size Naturally and Increase Sexual Power
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The average erect viagra cialis online pharmacy pharmacy is predictable to be somewhere around six inches in length. If you’re one of the millions who fall a bit short of this statistic, you may have concern about size in relation to your sexual performance.

Fret not: While it’s true that size can have its compensation, it’s not really the length that matters -- it’s the width.

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Most people assume that when it comes to sex, men are only worried with satisfying themselves. But in reality, men are often too stressed and troubled about their penis' characteristics to truly enjoy the moment.

This sex-related anxiety, can lead to evils such as erectile dysfunction (part I), that can be cured with erection drugs (part II).

In most cases, however, no drugs are needed. All that is required is that men stop perturbing about their penis size.

To increase penis size you have to understand exactly how the penis grew naturally during puberty. It didn’t grow because of some fluke, or by doing not natural things to it. You never went to bed at 14 with an extender emotionally involved to you. You never took pills.

If guys are really worried about the size of his penis, there are several penis size exercises that can be done to help to enlarge the penis. It is significant for guys to know that most of the issues related to penis size are in the guys head.

Women have without fail said that penis size is unimportant. The more critical issue is how the guys use his penis and the entire lovemaking situation.

A guy that may have a slightly smaller than average penis might make a girl feel so much better that she does not even notice and difference.

In fact, most women would say that they even prefer this sort of situation because the guy will be less inhibited. Even if a guy has a large penis, he may be a complete head case in bed and could screw the situation up.

Home Remedies to Get a Bigger Penis

1. Make sure you only use a professional natural penile enlargement exercise program.

http://www.stherbb.com/men-health/improves-erection-and-penis-size.htm

2. Use a program that visually illustrates the use you need to do, so you can easily perform each step in the comfort of your home.

3. Also try to find a program that comes with customer support.

4. A support forum where you can ask questions and exchange opinions with other people who are trying the same thing is even more important. As you will be interacting with some more experienced members that have already gained inches. This helps in giving you that added motivation to achieve your preferred penis size.

5. A money back guarantee gives you peace of mind and makes it risk free to you.

The good news is there is no longer any confusion over which method is the best natural male enhancement for men.

Specialists in the field of male augmentation worldwide now consider natural penile swelling exercises as the most effectual method to getting a bigger and thicker penis with permanent results. So you can use this simple method with complete peace of mind.


Read more on Penis Enlargement Cream and Male Sexual Enhancement and Premature Ejaculation

Enchong Dee- Men’s Health Philippines September 2010 Issue Cover!
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 Enchong Dee- Men’s Health Philippines September 2010 Issue Cover!

Tablets, the Clipboard of the 21st Century
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We shouldn't be surprised at the appeal the iPad, as the first mass market tablet, has encountered.  Many of us have had touch screen smartphones for over a year or more now.  My Samsung Instinct, other's iPhones or Android phones are really nothing more than mini-tablets.  The iPad, and the many cheap viagra that will follow it to market really just give us more real estate on which to work.



The iPad is aimed as a media consumption device.  You read books, magazines, web sites, and watch videos easily on it.  It hasn't really been pushed for any kind of business setting, although many are using already at work.



I have been thinking about how every job that needs a clipboard can benefit from a tablet.  The most obvious is a doctor's office or hospital.  My doctor walks into the examining room and immediately sits at the computer and pelting me with questions.  After the exam, he sits down again at the computer.



When I was last in the ER (ice, parking lot, head on pavement, no worries), the doctor walked into the examining room with a laptop on a nifty rolling cart.



When I last visited someone in the hospital, I found their doctor having just come from their room, awkwardly writing up his notes in her chart, while standing.  Those notes I assumed would get entered into a computer somewhere by someone other than he; a point of failure if ever their was one.



Imagine a doctor roaming around with an iPad?  The hospital or office setting is a highly controlled environment so wi-fi coverage is simple to arrange.



They pull up a patient's record on the way to their room, see nursing and medication notes since their previous visit.   During the visit, if the doctor needs to check medication interaction, or even look up something in their old text book, it is right their on their tablet.  Any changes to treatment, they can enter in right there, and it is sent to a central system for archiving, and sent out as a "work order" of sorts to a nurse's tablet.



The Washington Post talks about this, and more, including pulling up x-rays and other test results right on the iPad.



The iPad isn't that readable in sunlight, but other screen technologies are.  I can see cheap cialis designed for daylight useful to Auto Shops.  As the in-take person walks around the car with the owner figuring what is needed, he enters it on tablet.  Again, work orders appear on base stations in the repair bays.



Coaches can have a ready catalog of plays, stats on performance, scouting reports, etc. all on their magical clipboards.  They can make notes during practice and more.



Walk onto a car lot, and the salesperson can check stock for your needs right there in the lot.



Touch user interfaces, whether on tablets, phones, or dedicated units are going to change a lot of our already rapidly changing world.

Are Surgeons the Best Looking Doctors? Dr. Shepherd Vs. Dr. House!
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Are Surgeons the Best Looking Doctors? Dr. Shepherd Vs. Dr. House!



VS





So I can across this study in the BMJ that compared the height and looks of surgeons and physicians (See below). Will have to agree with the study's conclusion that the film stars are better looking than either!

Phenotypic differences between male physicians, surgeons, and film stars: comparative study

Antoni Trilla, director of preventive medicine and epidemiology unit, Marta Aymerich, consultant, haemopathology unit, Antonio M Lacy, consultant, general and digestive tract surgery unit, Maria J Bertran, specialist, preventive medicine and epidemiology unit

1 Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain

Correspondence to: A Trilla atrilla@clinic.ub.es

Abstract

Objectives To test the hypothesis that, on average, male surgeons are taller and better looking than male physicians, and to compare both sets of doctors with film stars who play doctors on screen.

Design Comparative study.

Setting Typical university hospital in Spain, located in Barcelona and not in a sleepy backwater.

Participants Random sample of 12 surgeons and 12 physicians plus 4 external controls (film stars who play doctors), matched by age (50s) and sex (all male).

Interventions An independent committee (all female) evaluated the "good looking score" (range 1-7).

Main outcome measures Height (cm) and points on the good looking score.

Results Surgeons were significantly taller than physicians (mean height 179.4v 172.6 cm; P=0.01). Controls had significantly higher good looking scores than surgeons (mean score 5.96 v 4.39; difference between means 1.57, 95%confidence interval 0.69 to 2.45; P=0.013) and physicians (5.96 v 3.65; 2.31, 1.58 to 3.04; P=0.003). Surgeons had significantly higher good looking scores than physicians (4.39 v 3.65; 0.74; 0.25 to 1.23; P=0.010).

Conclusions Male surgeons are taller and better looking than physicians, but film stars who play doctors on screen are better looking than both these groupsof doctors. Whether these phenotypic differences are genetic or environmental is unclear.

Introduction

We finished our medical training at the University of Barcelona more than 25 years ago, and have enjoyed our work ever since. At medical school we noted certain differences between male trainees who selected either surgery or medicine as their specialty. The tallest and most handsome male students were more likely to go for surgery, and the shortest (and perhaps not so good looking) ones were more likely to become physicians (including doctors of internal medicine and its subspecialties).

Now, after all these years we hypothesise that, on average, surgeons are taller and better looking than physicians. We conducted a comparative study to test this hypothesis.

Methods

We selected a random sample of senior staff surgeons and physicians working at the University of Barcelona Hospital Clinic (a 700 bed public hospital), matched by age (52 ±7 years) and sex (all men), from the staff payroll of the surgical and medical departments. We contacted all eligible participants by email. If they agreed to participate, their height (in cm) was recorded and they were asked to submit a digital picture. Age (in years) was registered and checked against that recorded in the payroll database. The external controlswere four well known film stars, mostly in their 50s—Harrison Ford as Dr Richard Kimble (a neurosurgeon in the film The Fugitive), George Clooney as Dr Doug Ross (a paediatrician in the television series ER), Patrick Dempsey as Dr Derek Shepherd (a surgeon in the television series Grey's Anatomy), and Hugh Laurie as Dr Gregory House (a nephrologist and infectious disease specialist in the television series House).

We randomly organised the pictures of all surgeons, physicians, and external controls and showed them to an independent group of eight female observers—three doctors and five nurses from our hospital. All observers were in the same age group as the participants (no further checking of this information was attempted). We decided to avoid (for the time being) male observers, because of potential bias. Observers used the "good looking score" to classify each participant. This score measures the degree of handsomeness on a seven point Likert scale (1, ugly; 7, very good looking).

We discarded the highest and lowest score (outliers) for each participant and used the six remaining scores for our study. Mean scores, differences in means with 95% confidence intervals, and standard deviations were used to compare the three groups. We used the standard t test to compare age and the non-parametric (Mann-Whitney U) test to compare height and mean good looking scores.

Results

We contacted 14 surgeons and 16 physicians (24 surgeons and 38 physicians were eligible). Only two surgeons and two physicians did not answer the questionnaire or send a picture (their out of office auto reply was switched on).Two additional physicians were dropped from the final analysis because of the poor quality (technical, of course) of their pictures. The final analysis therefore comprised 12 physicians and 12 surgeons plus four external controls.

The mean age of physicians was 50.6 years (SD 4.02) and of surgeons 51.1 years (SD 4.11) (P=0.76). The mean height of physicians was 172.6 cm (95% confidence interval 170.2 to 175.4) and of surgeons 179.4 cm (175.1 to 184.0) (P=0.01).

Film stars (external controls) had significantly higher good looking scores than surgeons (5.96 v 4.39; difference between means 1.57, 95% confidence interval 0.69 to 2.45; P=0.013) and physicians (5.96 v 3.65; 2.31, 1.58 to 3.04; P=0.003). Surgeons had statistically significantly higher good looking scores than physicians (4.39 v 3.65; 0.74, 0.25 to 1.23; P=0.010). We found small, non-significant differences between film stars who played either surgeons or physicians. Incidentally, we noted a higher proportion of baldness (surrogate marker) among physicians.

The figureGo shows a control, a surgeon, and a physician from our study (the physician and surgeon are by chance authors of this study) to provide a snap shot summary of the main study findings.


Figure 1 Sample of participants. Left, surgeon; middle, physician; right, control (George Clooney)


We did not make individual results public. However, widespread rumours, discussions, polls, and illegal bets arose throughout the institution as a by-product of our study. If they requested, participants were privately told about their personal score compared with the average score of the relevant group.

Discussion

Our study shows that, on average, senior male surgeons are significantly taller and better looking than senior male physicians. It also shows that film stars who play doctors are significantly better looking than real surgeons and physicians.

Differences between surgeons and physicians
Perhaps because of their training, surgeons have a different attitude and approach to the practice of medicine compared with physicians. The surgeon's image is that of competence, trust, expertise, and compassion.1 Surgeons are the only doctors who practise what has been called "confidence based medicine," which is based on boldness.2 They are often practical and fastacting, and they exert tight control on their natural turf—the operating theatre. Being taller and better looking has several evolutionary advantages for surgeons. Their extra height makes them more likely to be masters and commanders, and gives them a better view of the operating room, including the patient lying on the table. Also, as the senior male surgeon is normally surrounded by junior surgical staff, training fellows, nurses, anaesthetists, and the like, his height and appearance make him easily identifiable as their leader.

How do surgeons become taller and better looking than physicians?
There are several potential explanations for the phenotypic changes between surgeons and physicians. Firstly, surgeons spend a lot of time in operating rooms, which are cleaner, cooler, and have a higher oxygen content than theaverage medical ward, where physicians spend most of their time.Furthermore, surgeons protect (but not always properly) their faces with surgical masks, a barrier to facial microtrauma, and perhaps an effective anti-ageing device (which deserves further testing). They often wear clog-type shoes, a confounding factor that adds 2-3 cm to their perceived height. The incidental finding that fewer surgeons are bald might be related to theseenvironmental conditions and to the use of surgical caps.

In contrast, senior physicians are surrounded by fewer people in their habitat (the patient's bedside and the office), and they therefore have less need to be easily identified or spotted by families and nurses in the middle of a swarm. Physicians tend to hang heavy stethoscopes around their necks, which bows their heads forward and reduces their perceived height. They also complain of a (clearly abnormal) need to endlessly update their knowledge in accordance with the current evidence based approach to medicine by reading and studying heaps of medical journals; this overload of information further grinds them down. Although a prospective study found that doctor's white coats decrease in weight with increasing seniority, no significant difference was found between the mean weight of physicians' coats and surgeons' coats (1.4 v 1.5 kg).3

Limitations and future studies
Firstly, we did not independently assess the height of the study subjects. However, we trust in their honesty and believe that any potential bias would always point in the same direction, as people tend to overestimate rather than underestimate their height. Secondly, we did not check if the submitted photographs had been improved using the latest technology. The members of the evaluating committee know all the study subjects well, and would easily have spotted any gross attempt at cheating (such as submitting photographs taken when the subject was younger or photographs of another person). Thirdly, the evaluation process of the good looking score is subjective, but we have no reliable alternative. The best known alternative published in the literature (asking a mirror, "Mirror, mirror on the wall, who is the fairest of them all?") works only for queens, a notable shortcoming of this test.4 Although it iswidely known that the mirror always spoke the truth, at present we do not have access to this device (not currently supplied by the Spanish national health system).

Further studies are needed to assess whether our findings also apply to junior male surgeons and physicians, as well as to senior and junior female staff. Currently the number of female surgeons in their 50s at our institution is small, and we cannot enrol enough study subjects, a situation that will change no doubt over the next five to 10 years. We believe also that a non-crossover design deserves further testing (good looking score of men evaluated by men and a similar system for women).

Conclusions
Male surgeons are taller and better looking than physicians, but whether these differences are genetic or environmental is unclear. However, most surgeons and physicians are pleased with their career choices and even with their looks(personal communications).

Thanks to all participants in our study who provided a breath of fresh air and a touch of humour. Thanks also to the members of the evaluating committee for taking the risk and having some fun together. Finally, thanks to Sarah Lafuente and Beatriz Serrano for help in the statistical analysis.

Contributors: All authors designed the study. MA and MJB designed the good looking score. AT and AML are guarantors.

Funding: None

Competing interests: AT is a physician and AML is a surgeon. AT and MA have been happily married for 25 years. MA's good looking score for AT was not requested to avoid any problems at home for Christmas.

Ethical approval: Submitted to the institutional review board (IRB) but transferred for approval by the institutional beauty review (IBR), an ad hoc subcommittee of our institution.

References

  1. Rowland PA, Coe NPW, Burchard KW, Pricolo VE. Factors affecting the professional image of physicians. Curr Surg 2005;62:214-6.[CrossRef][Medline]
  2. Isaacs D, Fitzgerald D. Seven alternatives to evidence based medicine.BMJ 1999;319:1618.[Free Full Text]
  3. Gordon PM, Keohane SG, Herd RM. White coat effects. BMJ1995;311:1704.[Free Full Text]
  4. Wikipedia. Snow White. http://en.wikipedia.org/wiki/Snow_White.
(Accepted 20 October 2006)




Sildenafil
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order cialis (suatu PDE 5 inhibitor) merupakan obat yang digunakan untuk mengatasi impotensi. Adapun mekanisme kerjanya adalah sbb : Saat stimulasi seksual muncul, nitrit oksida dilepaskan oleh saraf atau sel endotelium di jaringan penis, yang nantinya akan mengaktivasi guanylate cyclase, yang merupakan enzim untuk mengubah guanylate triphosphat membentuk cGMP. cGMP merupakan vasodilator di jaringan corporal. Katabolisme cGMP menjadi GMP diperantai oleh phosphodiesterase. Phosphodiesterase tipe 5 terdapat di corpus carvenosum. Penginhibisian phosphodiesterase tipe 5 menyebabkan penurunan katabolisme cGMP sehingga penis dapat mempertahankan ereksinya dengan mempertahankan aliran darah ke penis. Phosphodiesterase inhibitor mempunyai efektifitas yang tinggi, mudah dalam penggunaan, dan mempunyai insidensi yang rendah terhadap adverse effect sehingga dapat menjadi first line therapy untuk disfungsi ereksi, terutama untuk pasien yang muda dan aktif berhubungan seksual.
Phosphodiesterase inhibitor type 5 tidak boleh diberikan kepada pasien yang mempunyai fungsi ereksi yang normal, dan tidak boleh digunakan secara kombinasi (dengan anti impotensi yang lain) karena dapat mengakibatkan prolonged erection (priapism).
Sildenafil tidak boleh digunakan oleh pasien yang sedang mengkonsumsi nitrogliserin, isosorbid mono atau di nitrat; karena akan menyebabkan terjadinya hipotensi. Dosis penggunaan adalah 50 mg, dan dikonsumsi 0,5-4 jam sebelum melakukan hubungan seksual, maksimum 50 mg/hari. Pasien yang menderita gangguan jantung dihimbau tidak menggunakan obat ini. Untuk pengguna yang mengalami ereksi lebih dari 4 jam setelah pemakaian obat ini dimohon untuk segera menghubungi dokter

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