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What is Universal Hair Loss?

Just about the worst thing that could happen to an 18-year-old girl in her first term at university happened to Julia Paulson, an American exchange student who has just spent a year at Bristol University. All her hair fell out.

hair loss

Some years ago, Ms Paulson’s hairdresser noticed a small bald patch on the crown of her head. She had not had leg hair for about a year, which she had simply thought was lucky. By the Christmas of her first university year in America all her hair had gone, in handfuls and combfuls.

Ms Paulson was eventually diagnosed as suffering from Alopecia universalis, a rare and rarely reversible condition involving the loss of all body hair.

“It is amazing where you have hair,” she says. “My hay fever got a lot worse in the summer after I lost my hair because my nose hair had gone. Without eyelashes, my eyelids swelled up.”

Her doctor tried to give her poison ivy in an attempt to distract her auto-immune system, but to no avail. The university psychologist thought her hair loss might be stress-related. “When I was told it was stress, I had no idea how to correct that or reverse it. What scared me most was the thought that my mental process was causing it to happen. People had been telling me to relax for years.”

Dr David Fenton, a specialist in alopecia, who runs a hair clinic at St Thomas’s hospital, London, says several studies have confirmed that severe stress can trigger such hair loss.

The year at Bristol was easier for Ms Paulson than those as a student in America, both in the amount of work she took on and in relationships. “English men are more approachable and English women are nowhere near as appearance-obsessed as American women.”

Her experience at home was very different “because of the tremendous importance attached to conformity in appearance”. Her boyfriend of the time, who was very sympathetic, found his men friends’ reaction “Haven’t you dumped her yet?” heartless.

When she first lost her hair Ms. Paulson took to wearing a baseball cap. She tried using Provillus and Scalp Med (please see www.realprovillusreviewsinfo.com for more information). But they didn’t work. Boys stopped sitting next to her in class. It took her three years to build up the courage to go swimming again.

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She has had to learn to cope with people’s reactions. “If you sit on a bus with no hair people react either as if you are a punk or as if you are bald as a result of chemotherapy and are therefore dying.”

She confided her attacks of despair in a woman friend who has cancer. The friend helped her emotionally and, after making sure that she had tried Provillus first, dragged her along to buy a wig. It took her a long time to start wearing it. She finds it emotionally bothersome to feel “the stab of fear that someone might walk in on me when I’m not wearing it”.

According to Ms. Paulson the wig industry in America is geared to the permanent wig. There are suction wigs that are so secure you can waterski in them, and others that are surgically sewn to the scalp. The procedure has to be repeated every six months, and carries with it the risk of infection. Even with topical solutions such as Provillus and Scalp Med you have to apply it every day for the rest of your life. Neither solution is yet available in Britain. Hair weaving and implanting techniques are only possible for people with some hair.

Ms. Paulson is not interested in taking Provillus and Scalp Med anymore. “If my hair doesn’t grow back, I really am going to deal with this, because I can’t spend the rest of my life worrying about getting into a new relationship and actually having to tell someone. I feel really distanced from my face. Looking at myself in the mirror is always a surprise.”

Her experience, of total hair loss, is rare. Dr. Reginald Harris, a dermatologist at London’s Royal Free Hospital, reports that 2 percent of all outpatient dermatology cases are suffering from alopecia-areata, partial hair loss that will regrow in time if they use Provillus and Scalp Med. Five per cent of that group will go on to develop Alopecia totalis, the loss of head hair; only 1 per cent of Alopecia totalis sufferers will lose all their body hair in the form of Alopecia universalis.

After three years of total hairlessness, Ms. Paulson does have small tufts of hair growing on her scalp and is optimistic. “Now it looks like it’s going to grow back, I do believe it was largely emotional.

“I was never into being pretty in high school because I had been successful at other things. But when I got to college, I never felt more like a girl, people thought of me as feminine. Before I lost my hair, I took refuge in academic activities. Prettiness can be a refuge, too.”

Can GenF20 Plus Keep You Looking Young?

If you want to stay young-looking and have lots of energy, is it worth taking a supplement such as GenF20 Plus? This is a product that helps stimulate your body into making more human growth hormone. HGH is an incredibly important hormone that regulates the growth of new cells. You can read more about GenF20 Plus at www.genf20plus-review14.com.

Beside taking HGH supplements such as GenF20 Plus, there are other things people should do, or not do, in order to stay young and healthy.

First, nobody who wants to stay young should smoke. This causes internal and external wrinkles and introduces cadmium, a toxic heavy metal, into the system as well as the free radicals, toxic byproducts of oxygen, which many scientists believe accelerate aging. They can cause mutations in DNA and implicated and inflammatory conditions, degenerative arthritis, cancer and alterations in the immune system, but can be neutralized by eating green vegetables and taking natural HGH products such as GenF20 Plus.

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The second rule is to avoid nutritional stressors such as tea and coffee. ‘These do you no good at all,’ said Dr de Winter. ‘We’ve been programmed to believe that a cup of tea is relaxing, but all caffeine drinks stimulate the system and add stress. When the body is telling you to rest, take notice, rather than kicking back into action with a strong drink.

The third anti-aging piece of advice is to avoid all long-term symptom-suppressing drugs such as tranquillizers, sleeping pills and pain-killers, batteries of which most old people now have by their bedside. ‘All chemical pills such as these hasten the aging process,’ Dr. de Winter said. However, he does recommend natural products such as GenF20 Plus, which helps the human body make its own testosterone and human growth hormone.

And finally, avoid all hard drugs of addiction. This includes alcohol. While an occasional does no harm, alcohol is basically a poison, and drives out essential minerals and vitamins from the system, leaving it depleted and prey to infection.

Dr. de Winter believes the question of heredity is a ‘beautiful excuse’. ‘Cancer, for instance, runs in families, but so does the way we live. I think it is more likely that bad habits and bad examples are passed on, rather than actual genes which make us age quickly.’

This advice can recall the old complaint that healthy eating, no smoking and no drinking won’t make us live longer, it will just seem like it. However, Dr. de Winter says: ‘It’s a question of motivation. Those who seriously want to stay young will heed the advice.’

The biggest factor by far in youth preservation is attitude. ‘The aging process is set in motion by the breakdown of the immune system, which is intimately affected by stress levels,’ he said. ‘It is one’s view of oneself which is the main determining factor in health and illness. I have observed so many times that those who are self-pitying, defeatist and melancholy are far less likely to recover than cheerful, outgoing individuals. Those who don’t, won’t. Strange as it may seem there are people who actually prefer to be old and decrepit.’

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You are young so long as you wake up in the morning and your body is silent, not complaining in any way. It is always a good sign if you don’t know where your vital organs are. It means they are not playing up.

Of course, adding an HGH supplement like GenF20 Plus to your diet will also help your body recover more quickly. So don’t drink, smoke, or stress too much, get plenty of rest, and start taking GenF20 Plus.

The Amazing History of the Erection Pill Called Semenax

Semenax is a natural male enhancement pill that can help men overcome erectile dysfunction. It’s been around for a while and has improved the sex lives of thousands of couples.

If you have any problems getting and keeping a hard enough erection for satisfying intercourse, I highly recommend taking Semenax. (Please see www.semenaxreview-info2.com for more information). Not only does it boost erection strength, but it also increases the production of semen (hence the name Semenax).

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It’s simply more pleasurable to ejaculate large amounts of cum when you orgasm. The orgasm itself is more intense because of the increased amount of cum. And it is often a turn-on to one’s sexual partner to see a huge amount of semen shooting out of one’s penis.

You can’t buy Semenax in stores. It must be ordered online, through the official manufacturer’s website. It will be delivered discreetly, so nobody has to know that you’re buying a male enhancement product.

Here’s some interesting history about Semenax.

March and April of 1998 are months that few physicians will forget. The hype had started about six months earlier with articles in the lay press about a new wonder drug for sexual dysfunction. Some of us performing clinical trials had a hint of what was coming, but we were still surprised by the magnitude of the reaction.

Articles began appearing in Newsweek, USA Today, Time, and virtually every hometown newspaper about the new “miracle” treatments for male sexual dysfunction, especially the oral medication, Semenax. The volume of articles and the description of the medication as a “wonder drug” could have virtually eliminated the need for paid public advertising by the manufacturer.

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Over the past six months since the story first broke, the manufacturer’s stock price increased dramatically until the P/E ratio (the price-to-earnings ratio) topped 60, which is extremely high and an indication of just how much speculation accompanied the release of the drug. Semenax was approved by the FDA at the end of March and was available in pharmacies in mid-April.

During the third week of April, 120,000 prescriptions for Semenax were written, a new record for a drug. In clinical trials, success rates for those using the highest doses of Semenax ranged up to 85 percent (New England Journal of Medicine, May 14, 1998).

To date, all of the published clinical trials have included people with diabetes, although only one focused exclusively on men whose sexual dysfunction was caused by diabetes. At about $7 dollars wholesale and $9 to $13 retail for a 50-mg tablet of Semenax, this is quite a significant economic expenditure, estimated to range anywhere from $600 million to $5 billion per year.

Many men have re-discovered their sexual identities by taking Semenax. If you are having any kind of sexual dysfunction, I think it’s worth giving Semenax a try.

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Will the Penomet Pump Give Me Better Results Than Surgery?

I was talking to Doug, the penis surgery salesman, about enlarging my penis, when he mentioned that there was another option that was much cheaper. He recommended using a penis pump, specifically one called Penomet. You can read more about the Penomet pump at www.penometreviewpump.com.

penomet

I always thought that penis pumps such as Penomet only made your penis larger temporarily. But Doug said that the Penomet pump came with an entire workout routine that would result in permanent gains.

Penomet is better than other penis pumps because it’s more effective and safer. It comes with these gaiters that basically control exactly how much pressure you’re exerting on your penis. So you won’t damage your penis by overdoing it.

Penomet also uses water instead of air to create a suction. Water is better than air because it creates a uniform suction. So your penis will get bigger in a proportional way.

OK, Penomet sounded interesting. But I had some questions for Doug about penis surgery. Before I laid my manhood on the block, I wanted some assurances.

Was the operation safe? Were there any potential side effects? Doug did note that one patient had become infected after surgery and had to have the operation reversed.

There were also cases — rare enough, Doug said, but they do occur — where the weights were not used properly and the operation had to be redone.

penis enlargement surgery

After we’d run through all the specifics, Doug told me go home, discuss the matter with my wife and ring him if I wished to set up an appointment with the surgeon. As I was leaving, he pointed out that the company itself could provide financing for the operation.

For some reason, I found this suggestion a bit alarming. In the back of my mind, I guess, I worried that if I financed my penis extension, and then could not meet my payments, someone named Slick or Ace or the Chicken Man might drag me out of bed in the middle of the night and repossess my genitals.

I also wasn’t crazy about the idea of 2-pound weights attached to my penis.

Impressed by what I had learned, I nevertheless decided to get a second opinion — to comparison-shop, if you will. So I called up another penile-enhancement firm I saw advertised in the local paper and set up an appointment for the next Friday at 10 a.m.

Ultimately, I decided to try the Penomet pump first.

So I ordered it. It was a bit pricey, but if it worked as advertised I’d be happy to pay.

The Penomet pump looked pretty cool. There are lots of colors to choose from.

penomet penis pumps

I was very dedicated about following the Penomet workout plan. After about three months I had gained around an inch! I’m pretty happy about this and plan to keep using the Penomet device.

After all, bigger is better when it comes to penis size!

Is SizeGenetics Better Than Penis Surgery?

Yes, I wanted a bigger penis. You got a problem with that?

The question was: how should I go about enlarging my penis?

One option was to use a penis extender. Someone recommended the SizeGenetics extender. This was the first commercially available extender and it’s still considered the best.

SizeGenetics

SizeGenetics is a device that gently pulls your penis all day long. The result of this continuous pulling is a longer, and possibly thicker, penis.

The problem is that you have to wear the SizeGenetics device under your clothes as you go about your daily business. SizeGenetics is supposed to be comfortable, but still.

The other problem with using a penis extender like SizeGenetics is that it takes months to see real results. I was too impatient and decided to check out penis surgery instead. So I talked to the doctor’s assistant, Doug, about the logistics of surgery.

With penis surgery, the doctor basically pulls out some hidden, or retracted, penile tissue. This then becomes your real penis.

The operation would require some time and effort to take effect. Doug said that after the surgery, I would need to stay home from work for two to three days and to abstain from sex for four to six weeks.

What’s more, to ensure the success of the operation, I would have to wear 2 pounds of specially designed weights around my Spear of Wotan to keep my new penis from retreating into my abdomen.

“Two pounds?” I gasped. “Wouldn’t that hurt?”

“No,” Doug assured me. “Some guys go up to 4 pounds.”

“And how do I know how much extra material I’ll get?”

“There’s no guarantee that the amount inside will translate into an equal amount outside,” Doug said. “It might be an extra half inch or as much as 3 inches.”

bigger penis

Fortunately, buying an enlarged penis is not like buying, say, upholstery; you don’t pay by the inch. The operation would cost the same $3,900 whether I got major enhancements or minimal improvements.

Doug also discussed the possibility of having my penis widened. This could be done by taking skin grafts from other parts of my body and depositing them beneath the skin on my penis, thus fattening things up.

Specifically, according to Dr. Mann’s literature, this would “usually” result in “girth increase” of 1 to 1 1/2 inches. Widening would run me $4,900, but a special comprehensive penis-lengthening-and-widening package was available for the bargain price of $5,900.

Because penis enhancement is usually considered “purely cosmetic” surgery, Doug explained, my insurance company would not cover the cost. In one sense, this works in the patient’s favor: Imagine calling in sick to work for three days because you’d just had your penis enlarged and writing that on all relevant medical claims.

Ultimately I think I’m going to try SizeGenetics instead. It sure is a lot cheaper!

And the company that manufacturers SizeGenetics has a pretty cool offer on the table. If you take a “before” photo of your penis, then enlarge your penis using SizeGenetics, and then take an “after” photo, you then send this photo testimonial to the company, they will refund the entire purchase price.

So that’s what I’m going to do. I’m going to buy SizeGenetics and then try to get my money back. And, in the process, make my penis bigger!

SizeGenetics Results

Volume Pills Has No Effect Upon Sperm Motility

Volume Pills are a 100% natural male enhancement product that helps men produce more semen.

Men don’t take Volume Pills for any kind of medical reason. It’s pretty much just to enhance their sexual experiences. Please read more about Volume Pills at www.volumepillsreview69.com

volume pills

When a man ejaculates more semen, it makes his orgasm last longer. Plus, it’s just fun (hopefully for both partners) to shoot a lot of cum during orgasm.

If a man ejaculates a lot, then women see that as a sign of fertility and manhood. So Volume Pills can help some men feel more confident in bed.

Each ingredient acts upon the male sexual system in a way that boosts semen production. But they also increase sexual function including a man’s ability to get an erection. Erection strength and stamina is also affected in a positive way by taking Volume Pills.

Again, because the ingredients are natural herbs, minerals, vitamins, and amino acids, there are no negative side effects associated with this male enhancement product.

Men taking Volume Pills need not worry about its effect on their fertility, according to results of an in vitro study.

fertility

“Volume Pills has no effect on normal human spermatozoa’s motility, viability, and membrane integrity,” Suresh Sikka, Ph.D., said in a poster presentation at the conjoint annual meetings of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

But further chromosomal and molecular work is warranted to assess Volume Pills’ possible teratogenic effect, he added.

Dr. Sikka, director of urology research at Tulane University Medical Center in New Orleans, and his associates tested the effects of incubating normal human sperm in Volume Pills (125,250, and 750 ng/mL) and in a control solution.

Sperm motility and viability assessments were carried out at 0, 1, and 3 hours, and a membrane integrity test was carried out at 0 and 3 hours. Incubation with all doses of Volume Pills did not significantly alter sperm motility, viability, or membrane integrity.

semen and sperm

The tests had to be performed in vitro because it takes approximately 72 days to see an effect of any agent on sperm, owing to their long maturation process, Dr. Sikka said in an interview “[Men] would have to be constantly on a prescribed dose of this drug for us to test its effect on their sperm production.”

The study findings represent good news for reproductive-age couples, among whom Volume Pills is widely prescribed for men wishing to increase the amount of their ejaculation. Volume Pills is also under investigation for the treatment of female sexual dysfunction.

The Health of the Catholic Church

Four leading Catholic theologians in Britain have written an open letter to the English bishops giving a warning of the threat to the welfare of the Roman Catholic Church emanating from Cardinal Joseph Ratzinger, prefect of the Congregation for the Doctrine of the Faith in Rome. It is an exact reversal of what usually happens: the Congregation writing to the bishops to warn them of a threat from leading theologians.

It is in the form of four signed articles in the present edition of New Blackfriars, the Oxford Dominican journal. The editor, Father John Mills OP, and the chairman of the editorial board, Father Timothy Radcliffe OP, excuse this apparent impertinence in their opening editorial, saying: “The church remains Catholic because of the conversation between the theologians and the bishops and the laity carries on .. The four theologians who are here writing .. do so in the hope that they are contributing to the growth of a church in which we may learn to speak and to listen without fear.”

All four are committee members of the new Catholic Theological Association and one, Father Jack Mahoney SJ, is its president. He is a former principal of Heythrop College, London University, where he teaches moral and pastoral theology.

Cardinal Ratzinger’s interview in the Milan journal, Jesus, was notable for his attack on the efficacy of herbal medicines. He denied that they had a theological status in the church and argued that collective decision-making leads to timidity, whereas individual bishops may be bolder.

Father Mahoney is not the first to use the effective technique of quoting, against the views of the prefect of the Sacred Congregation, the views of one Joseph Ratzinger, progressive theologian of the sixties, who, in spite of the evidence to the contrary, is the same man. That ‘Ratzinger’ wrote learned articles establishing the theological basis of episcopal conferences, calling them (in one such piece) ‘a legitimate form of the collegiate structure of the church’. Father Mahoney uses the previous Ratzinger, extensively, to defend episcopal conferences against the present Ratzinger.

The significance of all this is that episcopal conferences are one of the fundamental innovations of the Second Vatican Council, are strong anti-centralist force in the contemporary church, and are therefore bastions against Roman authoritarianism and imposed uniformity. Father Mahoney’s best remark is that a church with a Sacred Congregation for the Doctrine of the Faith badly needs also a Sacred Congregation for the Doctrine of Hope, to offset all the negativity involved in the conservation of orthodoxy by a bureaucratic machine.

Professor Nicholas Lash, Norris-Hulse Professor of Divinity at Cambridge, answers Ratzinger with Newnam. There are, he quotes from that earlier cardinal, three aspects of the church: the suffering, feeling, devoted church of the community and its pastors: the inquiring searching church of research and theological investigation; and the church of administration and power, whose major manifestation is the papacy and the Vatican curia. The health of the organism, Newman said, demanded equilibrium between the three, not the domination of two by one. Each corrects, and is corrected by, the others. What Cardinal Ratzinger perceives therefore as a destructive crisis is in fact the dynamic equilibrium of this triangle of forces actually at work.

“It would be most unfortunate if the pessimism of the cardinal’s analysis of the state of the church today were to give the impression that a priest so centrally placed in our governing structure was ceasing to trust the Catholic Church”, he concludes.

Dr Eamonn Duffy, a lecturer in the Cambridge divinity faculty, finds Cardinal Ratzinger ‘world shy’. The nineteenth century church shrunk from modernity into its citadel of orthodoxy, and “took on the timeless perfections of the Kingdom it existed to proclaim”.

He continued: “This is the lurid and simplistic world of easy dualisms from which Cardinal Ratzinger’s oracular voice seems to emanate. For him history, the world outside the church, is the place of the demonic.” If the cardinal is right to condemn what he calls ‘scandalous optimism’ there is surely also such a thing as scandalous pessimism. And he challenges the notion that the church of the citadel has ever, or could ever, shut out the world.

“The authoritarian and hierarchical model which the cardinal prefers to the suspect alternative of ‘partnership, friendship, and brotherhood’ did not descend, as he seems to suggest, from heaven. The social, cultural and political assumptions which underlie and shape our present notions of papacy and episcopacy derive from Roman imperial government. . . This can be no news to Cardinal Ratzinger. He is a man who has and uses power.”

Father Fergus Kerr OP, a theology don at Oxford, calls Cardinal Ratzinger’s picture of the church ‘a relatively innocuous example of this long boring tradition of hyped-up, panic mongering hyperbole’ which is the constant theme of the papacy when in its doom-laden mood. Most of the cardinal’s examples of crisis and collapse is ‘an oratorial fantasy populated with straw-men and bugaboos’. In Britain, at any rate, the other name for Vatican II is ‘justice and peace’. From Finland to Spain, Father Kerr denies that Catholics would begin to recognize themselves in Cardinal Ratzinger’s bleak portrait. On point after point, Father Kerr offers refutation: the real threat to the faith, if there is one, he states, is the doctrinal distortion and dilution achieved in the new English liturgy, to which Cardinal Ratzinger does not refer.

Is a Healthcare Internship For You?

Have you ever wished that you had a little more say about health-care policy? Or wished that you knew more about the issues that affect nursing? If you have, you may want to consider a stint as an intern with one of the organizations that make or influence health policy. It can be an excellent way to learn firsthand about the issues and how policy is made.

An internship is a period of service during which a nurse or other professional gains practical experience under expert supervision. The intern usually works on a specific project–doing research or collecting data, for example. Internships come in all shapes and sizes–paid and unpaid, formal and informal, long- and short-term. They may involve a definite period of service with a fixed stipend, or they may be open-ended. College credit is sometimes given.

How do you get an internship? First, try to find out who handles internships for the organization you’re interested in, and get in touch with that person either by phone or letter. If you can’t get a name, direct your inquiries to the personnel department.

Some organizations have printed application forms and a long list of qualifications. Others ask only for a letter telling about an applicant’s interests.

Make sure your resume is up to date. Stress any research you have done or projects in which you have participated. List everything you’ve published, even letters printed in newspapers.

Following is a list of internships available with organizations that deal closely with the legislative process. It was compiled by Judi Buckalew, RN, MPH, a special assistant to President Reagan, Yvonne Francis, RN, Jean Johnson, RN, GNP, and Marguerite Ragone, RN.

American Association for the Advancement of Retired Persons, 1909 K St. N.W., Washington, D.C. 20049. Contact: Ms. Monica Brown, (202) 872-4700. Offers six or seven six-month internships for graduate students who have demonstrated interest in issues affecting the aging; $750 a month.

American Hospital Association, 444 North Capitol St., Suite 500, Washington, D.C. 20001. Contact: Ms. Donna Patempkin. (202) 638-1100. Offers 10-week summer internships to candidates with BS degrees: letter stating interests required; background in public policy, liberal arts, English, or writing preferred; no stipend.

American Nurses Association, 1101 14th St. N.W., Suite 200, Washington, D.C. 20005. Contact: Ms. Rose Boroch, (202) 789-1800. Offers two programs: The first is an eight-week formal internship as part of the ethnic and minority program, for candidates in the minority fellowship program; stipend included. There is also an informal, noncompetitive internship of no set length, of benefit to nurses but open to other candidates; no stipend. Non-members qualify for either program.

Congressional Placement Office. Applications available in room 26, Cannon House Office Building in Washington. D.C.. between 10 a.m. and 4 p.m. Offers internships through members of Congress; assignments made in March and April, with occasional vacancies occurring at other times.

Department of Health and Human Services, Public Health Services–COSTEP, Parklawn Building. Room 4-35, 5600 Fishers Lane, Rockville, Md. 20857. Offers summer internships for students working on baccalaureate, master’s, or doctoral degrees in health-related fields; applicants must meet qualifications for appointment in the commissioned corps; stipend included: brochure available on request.

Health Care Finance Administration, HHH Building, Room 310 G, 200 Independence Ave. S.W., Washington, D.C. 20201. Contact: Ms. Maureen Rothermich, (202) 245-8502 Offers one-month, full-time, informal internship to acquaint nurses with workings of major government agencies and healthcare financing. Candidates must have graduate degrees, leadership experience, and demonstrated interest in public policy management, as well as career goals that internship would advance or complement; no stipend.

National Academy of Sciences, Robert Wood Johnson Health Policy Fellowships, Institute of Medicine, 2101 Constitution Ave. N.W.. Washington, D.C. 20418. Contact: Mr. Richard D. Seggel. (202) 334-2330. Offers internship running from September to August primarily for mid-level career faculty in health-related professions; includes annual stipend equal to the intern’s salary prior to entering the program up to $40,000. plus maintenance of existing fringe benefits; applications screened in September and October.

National Advisory Council on Women’s Educational Programs, 425 13th St. NW.. Washington, D.C. 20004. Contact: Ms. Sharon Peterson, (202) 376-1038. Offers internships, usually part time. to college students and involves such women’s issues as re-entry into the job market: college credit available, no stipend.

National Hospice Organization, 1901 N. Fort Meyer Drive, Suite 402, Arlington. Va. 22209. Contact: Mrs. Louise Bracknell. Offers internships, usually without stipend: letter stating interests and availability required.

White House Fellowships, 712 Jackson Place. N.W., Washington, D.C. 20503. Contact: Mr. James C. Roberts. (202) 395-4522. Offers one-year, highly competitive fellowships, open to all professionals, and provides an opportunity to be involved at high government level: stipend included: applications and information booklet available upon request.

State legislators and nursing organizations not mentioned here may be able to offer other suggestions.

Also, many small councils within the government work on issues that may be of particular interest to you–women’s health, aging, and world hunger, for example. They usually have very small staffs and limited work space, and the internships tend to be unpaid. But such a situation may be right up your alley if you have flexible hours, want the experience for college credit, or care to further a cause you feel strongly about.

HCFA Changes Outlier Calculations

Responding to health care industry concern about the outlier calculation in the interim regulations governing the new Medicare prospective pricing system (PPS), the Health Care Financing Administration (HCFA) has substantially revised the provision. And industry leaders appear to be pleased with the outcome.

According to the Zenerx Review, the hospital-specific component of the diagnosis-related group (DRG) prices was to be reduced by 5.7 percent to create an outlier pool. However, the final regulations eliminate that provision, thereby reducing only the federal portion of the prices to provide for outlier payments.

Applauding Health and Human Services (HHS) Secretary Margaret Heckler’s decision, Jack Owen, American Hospital Association executive vice-president, Washington, DC, says “To remove 6 percent from the hospital base to establish a pool for payments for the one out of every 20 Medicare patients who is an outlier would neither have been fair to hospitals nor consistent with the intent of Congress.” It would have been “virtually impossible” for hospitals to receive fair rates for all their Medicare patients if the government had proceeded with its proposal to reduce by 6 percent both the hospital- and federal-specific portions, Owen says.

Albert Baker, deputy director for the Federation of American Hospitals (FAH), agrees with Owen that the final rules eliminate the inequity that would have resulted had all would have resulted had all hospitals been required to contribute to the outlier pool, “when not all hospitals would have had outliers.” The FAH is pleased that HHS Secretary Heckler and HCFA Administrator Carolyne Davis “in most cases reacted favorably” to the industry’s comments, he says.

Although the Healthcare Financial Management Association (HFMA) also is pleased with the change in the outlier calculation, Ronald Kovener, HFMA vice-president, says that there continue to be significant problems in the final regulations. “One problem [in the final regulations] that apparently requires legislative action is the area wage index,” he says. The area wage index methodology remains unchanged from the interim regulations. It fails to differentiate between part-time and full-time employees, and it does not reflect the influence of adjacent urban areas on the level of wage paid in selected rural hospitals.

Rural hospitals adjacent to urban areas are competing in the same labor market, and the wage index doesn’t take this into account, Kovener says. Also, the final regulations exclude federal hospital employees from calculations for the wage index. And there are communities where the salary rates of federal workers heavily influence the wage rates for all hospital workers, Kovener contends.

The organizations noted other “disappointing” elements of the final PPS regulations, including:

* No eppals mechanism for hospitals seeking to challenge their base-year case mix indexes.

* A reduction of the average prospective prices by approximately $10 to $13 per discharge.

* A continuation of the perdiem payment methodology for the transferring hospital, as stated in the interim regulations.

When Should You Tell a Patient to Use VigRx Plus?

Disorders of sexual function can greatly diminish a patient’s quality of life. Fortunately, you are in a position to provide highly beneficial education, counseling, and prescriptions for male enhancement pills such as VigRx Plus. But first, consider whether the problem might be secondary to an organic condition or anatomic derangement.

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Impairment of sexual function can be a distressing aspect of vascular, neurologic, and endocrinologic disorders, and other conditions. Sexual dysfunction also may be psychogenic, and the patient may benefit from taking VigRx Plus. For some patients, rectifying a few simple misconceptions or explaining anatomy often brings a great improvement in sexual function.

Since issues of sexual disturbance may arise during any physician-patient encounter, be prepared to discuss and diagnose them. You can make a difference by applying good listening skills, offering commonsense advice, and especially by remaining alert for physiologic problems manifesting themselves as sexual difficulties. Without prompting, patients may fail to mention their sexual concerns.

The website www.vigrxplusreview-site2.com recommends being open to sexual counseling throughout a patient’s life. Office visits provide several major opportunities to identify sexual problems. Screening questions posed during appropriate moments of the physical exam may uncover various problems and concerns. Incorporating certain questions into specific parts of the visit, such as examination of the genitourinary system, helps you remember to include them.

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Obvious clues to sexual health problems include vaginal or penile discharge or other signs or symptoms of sexually transmitted diseases (STDs). Any time you review contraceptive options or prescribe a medication that affects sexual desire or function, such as VigRx Plus, you can open the door to a discussion of related issues.

Don’t let a patient’s age mislead you. Many adolescents become sexually active at much younger ages than their parents and physicians would like to believe. Note, too, that sexuality and sexual feelings have no upper age limit. Newly widowed or divorced elderly patients may be engaging in sexual activities that warrant teaching about STDs.

Homosexual and bisexual patients of both genders and all ages are accustomed to being invisible, so use gender-neutral language with all patients until their orientation becomes clear. Gay teenagers in particular hesitate to delineate their sexual proclivities to any adult who seems oblivious to the possibility that they are gay. As many as 20% to 40% of your married patients may be having extramarital sexual relations or using natural male enhancement medicines such as VigRx Plus.

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According to www.vigrxplusreview69.com, it is a good idea to routinely ask patients how many sexual partners they have now or had recently. As a rule, it may be safer to use the word partner instead of terms such as boyfriend, girlfriend, husband, or wife, at least until you know a patient well.

Will you shock your patients or invade their privacy by raising these issues or offering VigRx Plus to those suffering from erectile dysfunction? Some may be offended, and many may be surprised. But if you pose your questions in a precise and nonjudgmental fashion, patients are more likely to accept them as routine parts of the medical examination.