How to Study for and Pass the Internal Medicine Boards

As the ABIM internal medicine certification exam approached, we received a large number of emails from our subscribers asking for suggestions on the best way to study for the boards. The truth is there is no one path to success though there are certainly ways to increase your likelihood of passing. Regardless of whether you are preparing for board certification or trying to achieve maintenance of certification (MOC), the best tried and true overall method is to “study early and study often.” Below we lay out possible strategies and tactics (in no particular order) for passing the ABIM board exam:

1. Know the basics of the internal medicine board exam

This is obvious but a lot of people simply don’t review this prior to starting their exam preparation and instead rely on their ABIM study source of choice to provide the information.

  • Review the ABIM exam blueprint and understand the topics covered on the exam
  • A large percentage (33%) of the exam is comprised of Cardiovascular Disease, Gastroenterology, and Pulmonary Disease
  • Over 75 percent are based on patient presentations – most take place in an outpatient or emergency department; others are primarily in inpatient settings such as the intensive care unit or a nursing home.
  • While it’s not a big part of the exam, be prepared and expect to interpret some pictorial information such as electrocardiograms, radiographs, and photomicrographs (e.g., blood films, Gram stains, urine sediments).

2. Use the in-training exam as a starting gauge

If you are a resident, the Internal Medicine in-training exam is a good starting point to see where you stand. It’s simply that – a barometer of where you stand. It will give you an idea where you may be weak and where you may be pretty strong. It will also give you an idea of how you compare with your peers. Don’t alter your ABIM study plan simply based on it but it does give you an early metric of the areas you need to focus on.

3. Get a study guide to prepare for the ABIM exam

It’s important to have a good study guide that is tailored for the exam. Some of the more popular and effective guides we’ve come across are the MedStudy Internal Medicine Board Review books and Harrison’s Principles of Internal Medicine Board Review.

4. Join a study group

Study groups, if utilized properly, are particularly effective because they allow you to learn from your colleagues and other exam takers. Oftentimes, people will form study groups with their colleagues (ideally limited to 3-4 people) at their residency program. Tactics to use in ABIM study groups may include:

  • Focus on a new internal medicine category by week. For example, focus one week on cardiology and the next on pulmonary care. The exam can be broken into a dozen or so categories (see the ABIM exam blueprint). The majority of the subspecialty questions on the Internal Medicine board exam will focus on cardiology, gastroenterology, and pulmonary care. However, do not neglect the other areas as the ABIM wants to ensure that internists have a broad base of medical knowledge.
  • Test each other with internal medicine questions you have written yourself. We are firm believers in the philosophy that the best way to learn is to teach. If you help others learn, your knowledge of medical concepts will be greatly strengthened.

We recognize that joining a study group is often not feasible – especially for those no longer in residency programs where everyone is preparing the boards. Fortunately, we live in a digital age where being part of a study group is much easier. You can connect with colleagues through Skype, Google hangout or a number of other channels. One of our favorite approaches is to remain informed and learn through the power of social media – in particular Twitter. In a previous post, we highlighted excellent Twitter handles to follow for ABIM exam review as you prepare for certification. If Twitter is not your cup of tea, you can also connect with colleagues through the Knowmedge ABIM community on Google+. Regardless of what approach you decide, studying alongside others preparing for the same exam is a great motivational tool for success.

5. Get a question bank that fits your personal needs

What is the value of an Internal Medicine question bank? This is a discussion near and dear to our heart, of course. Question banks have become a popular tool because they bring together a lot of material in a question format and help create a test taking environment. There are a lot of question banks to choose from – so what should you look for in an ABIM qbank?

  • High quality ABIM-style questions in a format similar to the exam: The exam is mostly filled with clinical vignettes and has straightforward questions as well. At a minimum, your ABIM exam question bank should have both of these types of questions. Quantity is important – but the quality of the questions and explanations is much more important.
  • Detailed explanations that review why the incorrect choices were wrong: A question bank that does not provide you detailed explanations is probably not worth the money and time spent. As you review questions, you will inevitably get some wrong – your choice of ABIM question bank should detail why your choice is incorrect and the reasoning behind the correct choice.
  • Ability to track your personal performance: Your choice of ABIM qbank should be able to tell you your performance overall and by category. Most – not all – question banks provide you a dashboard broken down by category. The Knowmedge question bank has gone an additional step to break the categories into subcategories as seen on the ABIM exam blueprint. This allows you to review your strengths and weaknesses at a granular level. Knowing you are weak at cardiovascular disease is great – knowing you are weak at arrhythmia questions is more valuable.
  • Add-ons – Notes, Lab values, Highlighting: Depending on how you study, these may be valuable features.

ABIM exam questions straight talk:

  • No question bank – not MKSAP, not Knowmedge, not any – knows what will be on the actual ABIM exam. Based on the ABIM Blueprint, you can make assumptions on what are the most high-yield areas to study. The point of a question bank is not to give you the exact questions that will be on the exam – it is to hopefully teach you concepts you may see on the exam and how to reason through what you don’t know immediately.
  • High-quality ABIM exam review questions can be found in many places – question banks are not the only place. There are study guides, books, and even free sources. So don’t simply base your decision on question bank on the questions. In addition to the quality of the questions, what truly differentiates one ABIM exam question bank from another is whether it will truly help you build a broad base of knowledge and help you retain information for the exam. If you are not comfortable reading a bunch of text – it won’t matter how great the questions are. If you are not an audio-visual learner, the Medstudy or Knowmedge videos won’t do anything for you (As clarity, the Knowmedge qbank contains text and audio-visual explanations for this exact reason). If you are an “old-fashioned” learner that prefers printouts – USMLEWorld is definitely not for you – those who have used them are well aware their software will block you from taking print screens or copying of their content. In short… don’t follow the herd – each one of us learns differently and you need to pick the best method for you.

6. Consider whether a review course is right for you

There are pros and cons to taking a review course for your ABIM exam prep. The pros are that it gives you a serious dose of review in a short period of time. It gets you focused if you weren’t focused and some courses are absolutely excellent – we know some internists are ardent supporters of some of the professors that teach these courses. The three most popular independent courses we are aware of are:

  • Awesome Review by Dr. Habeeb Rahman – The best known and most popular independent course. Dr. Rahman has a very unique style of teaching and accompanies his lectures with his own videos. During this six day course (Sunday – Friday), Dr. Rahman provides students his own set of notes and questions to practice.
  • iMedicineReview by Dr. Shahid Babar – This three day course (Friday, Saturday, Sunday) course comes with a set of 1,500 review questions.
  • Unique Course by Dr. Satish Dhalla – A six day course (Monday – Friday) taught by one of the Top Internists in the Nation as selected by U.S. News

The cons of a review course are that they are expensive (Often over $1,000 plus hotel stay) and can be inconvenient to travel to and from. Regardless of whether you attend a review course or not, it cannot replace the pre and post-course study time that is needed. It is complementary to study time and does not replace it.

7. Review our suggested ABIM test taking strategies

The ABIM exam questions are not intended to trick you – they are intended to challenge your knowledge and ability to bring together your understanding of many different concepts and topics. Below are some of the tactics you can use as you are practicing questions and/or taking the actual ABIM exam:

  1. For clinical vignettes, read the question (last line) first and then go back and read the scenario. This way you’ll know what to look for as you are reading the scenario.
  2. Try to answer the question even before seeing the answer choices.
  3. Pay attention for keywords that can clue you in on an etiology or physical exam.
  4. Watch for key demographic information – Geography, ethnicity, gender, age, occupation.
  5. The ABIM test is not intended to be tricky but we are all human so we miss keywords sometimes – such as “least likely” – pay attention to these.
  6. If you are challenged by a longer clinical vignette, note the key items and develop your own scenario – this may trigger an answer.
  7. Most internists we’ve spoken with say time is generally not an issue – but be aware that it is a timed exam and that you have approximately two minutes per question.

We cannot stress enough the mantra “study early and study often.” The exam is challenging but it can be conquered with diligence and proper preparation.

8. Understand and be prepared for ABIM test day

  • Be prepared and confident. No matter how you have chosen to study, on test day – confidence is critical!
  • Get a good night’s rest – last minute cramming and staying up late is only going to stress you out more.
  • Get there early – don’t risk getting caught in traffic. It’s much better to be a little early than be aggravated in traffic.
  • Take an extra layer of clothing. The last thing you want to do is be uncomfortable and cold because someone decided to turn on the air conditioner too high.
  • Test day is long! Be mentally prepared for it. From registration to the optional survey at the end, the day will be 8-10 hours long (depending on whether you are certifying for the first time or taking the maintenance of certification exam).
  • Keep some power snacks with you to take during break time.
  • Review the ABIM exam day schedule so you know exactly what to expect.

That’s a basic overview of how to study for and pass the ABIM board exam. As mentioned, there is no secret sauce or method to this – you simply need to have a broad base of knowledge. There is no substitute for studying early and studying often! If you are preparing for the ABIM Boards, we wish you well – we’re here to help so let us know if you have any questions! Happy studying!

Common Household Items Can Be a Threat to Your Dog!

Even in the cleanest and seemingly safest house or apartment can lurk a health threat for your dog. There are many common household items that we all keep around, that can be a threat to your dog, either making it sick or causing death,

Did you know that an environmental toxin could be any substance that is outside of an animal’s body and if ingested or otherwise exposed to – can cause harmful biological change.

We live in a world that we are trying to turn “green,” and yet many of our homes are filled with things that can cause harm to our dogs.

Did you know that second hand cigarette smoke could cause cancer in dogs? Rotting food found in a garbage can has the potential of either causing an illness or a fatality.

The substances found in a home that can become a lethal threat are varied from insecticides and tainted water that pollutes the environment to a multitude of other things that seem small and insignificant.

This article I hope in some small way will open the readers eyes and possibly prevent a dog or some other pet from having to suffer an illness or die.

Dogs as you know, are one of the most curious of household pets, a monkey may have more curiosity, but when it comes to putting things into their mouths, I believe dogs have all other critters beat.

Since a dog does not have hands to figure things out with, its first choice is its mouth and whether it tastes good or not, into its mouth it goes. I have never read anywhere that dogs are gourmet eaters. It seems their philosophy is, if it fits it can be chewed and/or swallowed. The problem with this philosophy is that toxins in the objects can cause illness and/or the objects may cause serious obstructions within the dog’s body.

So what is a dog owner to do? First of all there are some simple rules to follow that will prevent some accidents from happening. Especially if you have a puppy or a dog that loves to chew, keep small things out of your dog’s reach. Things like small rubber balls, jewelry, medicine bottles of all kinds (glass or plastic), ant or mouse poison containers, household cleaners, live wires laying on the floor that can be chewed, containers holding insecticides, fertilizers, automobile liquids like antifreeze, power steering fluid and the like. Anything you do not think you would like to swallow, consider it a “no-no” for your dog.

There are many foods that can cause a toxic reaction in a dog:

– Alcohol -besides causing intoxication can cause a coma or even be fatal.

– Avocados – a fatty acid found in avocado leaves, fruit, seeds, and bark called ‘persin” can cause difficulty in breathing, abnormal fluid accumulations in the chest, abdomen and the sac around the heart.

– Chocolate – this and any chocolate related product such as cocoa powder, cocoa beans, cocoa mulch are very dangerous for dogs. These products contain caffeine and theobromine, both are nervous system stimulants and since dogs metabolize theobromine more slowly than humans it can cause a multitude of problems including death. Dark chocolate has the highest concentration.

– Coffee, tea and cola – contain caffeine and can cause a caffeine toxicity, plus tea and cola contain theobromine.

– Grapes and raisins – are highly toxic to dogs – we do not know the toxic component, but eating large amounts can cause kidney damage or failure.

– Macadamia nuts – another toxic mystery, but a dangerous food for dogs, it can cause depression, hyperthermia, weakness, muscular stiffness, tremors and increased heart rate.

– Mushrooms – contain toxins which can be fatal if eaten by a dog.

– Nutmeg – I did not know this would affect a dog, but it is on the list of very dangerous foods for dogs, and if a dog eats enough it can be fatal. I do not know what enough is – so keep it away from your dog.

– Onions and garlic – it is not known how large a quantity of onions or garlic need to be consumed by a dog (or cat), but they are considered dangerous because they contain sulfoxides and disulfides, which can break apart red blood cells and cause anemia. According to what I have read consumed in large amounts can result in severe anemia and even death, if not treated by your veterinarian.

– Xylitol – this is a sugar substitute found in some gums and in sugar free candies that is extremely harmful to dogs. If a dog eats enough candy it can cause life-threatening low blood sugar, loss of coordination, depression, liver damage, collapse and seizures.

– Yeast Dough – rising yeast dough can cause gas to build up in a pet’s digestive system causing its stomach or intestines to rupture. Do not feed your dog any raw dough that has yeast in it. Once it is cooked a small amount of bread or rolls are okay for your pet.

Some plants are also very toxic to dogs. Puppies are usually the ones that are the most curious, but dogs that love to dig can run into problems, too.

The following plants in general, cause the same amount of problems and these are what the symptoms are: vomiting, diarrhea, depression, loss of appetite, abdominal pain, lethargy, drooling, tremors, seizures and upset stomach.

Amaryllis, Azaleas, Autumn Crocus. Christmas pine needles, Chrysanthemum, Cyclamen, Daffodils, some Ivies, Holly, Kalanchoe, and Lillies, Sago Palms, Oleander, Poinsettia, Tulip and Narcissus bulbs are the most common ones found in our gardens. However, the Caster Oil plant contains a highly toxic protein and one bean can kill a human and four beans can kill a horse, so I would rid my yard of such a plant just to be safe. If one bean can kill one of us, I would bet a serious chew by a puppy or dog could be lethal.

Also the new thing in the garden circle is the cocoa bean mulch that does smell like chocolate, dogs are attracted to it and will eat it. It can cause many problems including death, stick to our regular mulch to be on the safe side.

Do not let your dog swim in stagnant water or in any water that you are not certain if it is free from contamination.

Dogs are like children, they are very curious and are drawn to things because it smells good. If it smells good, it must taste good and that is where the problem lies.

All dogs are at risk when it comes to chewing or swallowing a toxic or obstructive object, especially old dogs, and young puppies. It is a good idea to “baby proof” your house by keeping things out of your dog’s reach and when outdoors, a watchful eye may prevent any mishaps.

Invest in an emergency first-aid kit for your dog. It should contain:

– a fresh bottle of hydrogen peroxide (3%) to induce vomiting

– a turkey baster or large syringe to administer the peroxide into the dog’s mouth

– saline eye solution

– artificial tear gel to lubricate eyes after flushing

– forceps (tweezers) to remove stingers

– a muzzle to protect yourself against fear or excitement induced biting

– mild grease cutting dishwashing liquid for bathing skin after any contamination

– a can of your pet’s favorite wet food

– a pet carrier

Keep your vet’s phone number posted near your telephone and also keep the ASPCA Poison Control number listed 888-426-4435 (there is a charge for this service.) The ASPCA’s Animal Poison Control Center Web Site has an alphabetical list of the most common plants, with information about their safety.

If at anytime you think your pet has ingested a toxic substance, call your vet at once. Time is of the essence and the life you save will be your pet’s.

Colored Diamonds – Are They Real Or Fake Diamonds?

Colored diamonds are high fashion nowadays. The trend for wearing them started on the celebrity Red Carpet, and when A-list figures, such as Jennifer Lopez and Victoria Beckham received pink diamond engagement and eternity rings, interest peaked. And where the celebrities go, everyday fashion follows. But most colored diamonds these days do not have celebrity price tags. This is because they are normally treated by irradiation and temperature. So does this mean they are fake diamonds?

Although most diamonds are colorless, fancy colored diamonds do form naturally in the Earth’s crust. But they are incredibly rare. Natural fancies get their color hues from different trace elements present within the crystal structure of the diamond. Trace nitrogen produces yellow diamonds. Other trace elements produce different colors including red, green, yellow, orange, blue, pink, purple and violet as well as many shades in between, and the color can be intense (saturated) or faint.

But their very rarity makes natural fancies prohibitively expensive for many. In fact some of the most famous diamonds in the world are natural fancies. The fabled Hope diamond, for example, is one of the most perfect examples of a blue diamond. The Tiffany diamond is yellow. Both are priceless.

To satisfy the demand for the stunning look of a fancy, but at more affordable prices, gemologists have pioneered techniques to enable them to create affordable gemstones. This is now normal practice for most colored diamonds found in jewelry today. The process is known as color enhancement and involves treating clean diamonds with a combination of irradiation and safe electron accelerator technology (intense heat) to replicate exactly the process by which Mother Nature forms fancy diamonds, only much quicker! This process enhances natural diamonds to intense hues but does not alter, dissipate or hide internal flaws.

The process yields a myriad of stunning colors including blue, green, red, orange, yellow, pink, purple and black diamonds, all of which are considered permanent.

These are real, mined diamonds, which have been treated with exactly the same conditions radiation and high temperature conditions that would have produced a natural fancy in the Earth’s crust. They are in every sense, real diamonds. The real beauty and popularity of these gemstones lies in the fact that they combine the unmistakable dazzle and brilliance of a diamond with the color saturation of colored gems, like rubies and emeralds.

However, there are laboratory created faux fancies too, where the diamond crystal was grown in a laboratory and not mined. So when you shop for colored diamond jewelry ask about the origin of the gemstones, and check the certificate of origin to verify authenticity. Make sure you know what you are buying.

Cancer Scorpio Compatibility

To understand the cancer scorpio compatibility, we should first understand the basic tendencies of Scorpio and Cancer personality. How do they approach love in life? How could these qualities help the cancer scorpio compatibility?

Scoprio Personality

Curious for what seems to be forever, people belonging to Scorpio are instigators of the Zodiac. Eager to understand and acknowledge everything and everyone, when somebody requires an answer, a Scorpio will chip in and help. However, it is known that Scorpios only view things in black and white: promoting their own causes as and when they can. They make their own past, present, and future as they know only how to live on their own terms. Although they do not live life, they will no doubt attack it. When they rarely receive a loss, they do not sulk around, but rather continue on their obstinate path with their sense that they will succeed.

Although they know what they want: they do not let others understand this easily. They are so secretive that people around them would never understand the true extent of their fiery passions. Thinking about the mindset of a Scorpio will only make them become agitated and run off the other way. No matter whether the actions relate to business or playing, they will compete until their last with their full energy. If they quit and surrender, then they are not a true Scorpio, as no task is too strenuous for somebody of Scorpio variety. This quality helps scorpio cancer compatibility as a cancer longs for strength which is provided by scorpio during tough times!

Cancer Personality

Cancers firmly show that their love lays at home with their family, and they truly do love to nurture those who live around them. They do not mind making any sacrifices in order to ensure that their loved ones are completely safe and away from danger. They enjoy sharing what they have, however they can me rather moody at times. They regenerate or even sulk at times. However, they can come back from such moments by nurturing others with the same saddened condition.

Forceful, emotion, moody, determined, passionate, powerful, exciting, magnetic, loving, jealous, resentful, compulsive, secretive, stubborn, touchy, caring, clingy, imaginative and magnetic are the range of words which seem to have no structure of rhythm to them.  Well, in fact, these are the few adjectives which describe the personality of Cancer.

Cancers, like Scorpios can be very iron-willed and enjoy having things fall their way. They are sensitive to things which may hurt them easily, and when pained they will retreat and consider the different tacks that should, and could have been taken. Although they often do not enjoy confrontation, they do take revenge against those people that hurt them or people who are close to them. Their compassion shows their affection for others and they set problems of their own aside in order to assist others in solving their own troubles. They are highly intuitive, therefore they know what is upsetting without being guided towards it. They are fantastic at communicating, and often enjoy helping those who are in trouble by just saying a few words. This compassionate nature helps the cancer scoprio compatibility as the scoprio needs to believe in the good part of life, Who can teach this better than the compassionate cancer?

How does Cancer Scorpio Compatibility Works?

Cancer is enchanted by the strength of Scorpio, While Scorpio enjoys to find shelter in Cancer’ emotional commitment. The sensuality of Cancer is enjoyed by the dynamic passions of a Scorpio. With Cancer’s loyalty, Scorpios have no need to be evoked in a flame of jealously. They both enjoy each others company, and are highly compatible with one another. The scorpio cancer compatibility is destined to be together and are true soul mates in every sense.

Possible Pneumonia Causes

There are many possible causes of pneumonia. The main cause and also the most common cause of pneumonia is bacteria. However, other infections caused by different microbial organisms can also cause pneumonia. Sometimes there it is impossible to determine what caused pneumonia.

Here is a list with some of the microbial organisms that are to blame in cases of pneumonia:
– bacteria: these too can be categorized by the procedure that is used to see the bacteria under a microscope. The stains that are seen under the microscope then tell us what type of bacteria is the one that cause pneumonia. There are two main types: gram positive bacteria and gram negative bacteria.
The gram positive bacteria that cause pneumonia appear colored blue on the strain. The most common gram positive bacteria that cause pneumonia are:
– streptococcus pneumonia: this is the most common of all pneumonia causes; researchers believed that this type of bacteria was the cause of almost ninety five percent of all pneumonia cases that were community- acquired; however, recent studies have shown that in fact this particular bacteria only accounts for less then thirty percent of all pneumonia cases that are community acquired;
– staphylococcus aureus is another gram- positive bacteria that is second on the most common causes of pneumonia list; however, this type of bacteria sits at the top of the list when it comes to pneumonia cases that are acquired in the hospital; this is rather uncommon in adults that are healthy, but it can develop almost five days after a person has suffered from a condition that has weakened his/ her defense system;
The gram- negative bacteria that cause pneumonia are colored pink. These type of bacteria that cause pneumonia are the most common agents of infection in hospitals. Some of the main gram- negative bacteria that cause pneumonia are:
– haemophilus influenzae: this generally affects people that suffer from chronic lung problems or they affect older people;
– klebisiella pneumoniae is the main bacteria responsible for pneumonia in people that are alcoholics or people who suffer from physical debilities;
– pseudomonas aeruginos is the most common bacteria that cause pneumonia in people that suffer from severe or chronic lung problems;
– neisseria meningitidis is another bacteria that is thought to play a very big role in pneumonia patients; this is one of the most important causes in developing meningitis, but recent studies have shown that this bacteria is also responsible for pneumonia;

You can find great content regarding walking pneumonia, walking pneumonia symptoms and many moreby visiting http://www.pneumonia-center.com/

Penile Injury First Aid – Urgent Care Tips for the Manhood

No one wants to think about a penile injury, much less live through one, but there’s no getting around the fact that the average, active guy will face at least the occasional penile emergency. The most common injuries are minor, and they can often be treated at home; but some are more serious and require the care of a trained medical professional. The following checklist offers some quick first aid tips for a variety of types of penis injuries; all of these should be followed up by a trip to the doctor for more intensive penis care.

1) Zipper trauma. When the oh-so-sensitive penis skin gets caught in a zipper, the pain can be immense and lead to instant panic. Unfortunately, a large number of men respond instinctively by yanking away from the zipper – a huge mistake that can result in painful lacerations.

The better approach is as follows:

– Remain calm and gently try to extract trapped skin; vegetable oil or baby oil may help this process.

– If the skin cannot be easily released, the next stop should be the doctor’s office – possibly embarrassing, but certainly better than tearing away at the skin.

– Once the skin has been released, keep the area clean and abstain from masturbation and sex until the area is healed.

– If the wound shows signs of infection, talk to a doctor about antibiotics.

2) Lacerations/cuts. A penis injury resulting in cuts or lacerations should be treated in the following manner:

– Apply moderate compression to stop any bleeding.

– Clean the area and apply a gauze bandage for protection.

– Seek emergency treatment for severe cuts or bleeding that will not stop.

– Talk to a doctor if the area becomes infected – antibiotics may be required.

3) Burns. Any burn should be considered a serious injury requiring medical attention. If a burn to the penis occurs, men should follow these guidelines:

– Immediately immerse the area in lukewarm to cool water. Immersion in a bath is better than running water to prevent further skin damage.

– If the burn appears to be more than superficial, call for emergency services. Do not attempt to remove clothing if it has adhered to the area.

– For less severe burns, apply a cool compress to the area. Do not place an ice pack or frozen gel pack directly onto the skin’s surface.

– Visit a doctor’s office or walk-in care center as soon as possible.

– Follow a doctor’s care plan closely – this may include applying antibiotic creams and other medications to the affected area.

4) Allergic skin reactions and insect bites. A sudden appearance of a rash, reddened skin, moderate to severe itching, and inflammation on the penis may be signs of an allergic skin reaction. This may occur on contact with certain plants or chemicals; insect bites may also produce similar symptoms. If this occurs, men should do the following:

– Wash the area thoroughly to remove all traces of the irritant in question.

– Apply an over-the-counter anti-itch medication such as hydrocortisone (the package directions should be followed carefully). Never apply a cream of any kind to inflamed or broken skin except on the advice of a doctor.

– Leave the area open, not covered with a bandage, to allow the skin to breathe.

– Follow up with a doctor.

5) Amputations. Difficult to think about – but it has to be mentioned… An amputation is a medical emergency, and emergency services should be called. In the meantime, the following steps should be taken:

– Apply compression to stop the bleeding.

– If possible, recover the severed portion of the member. Place in a plastic zip-lock type bag, then place this inside a second bag filled with ice.

– Give the severed portion to medical personnel for preservation and possible reattachment.

Ongoing treatment and daily care

Once the initial injury has healed up, men will want to give some thought to ongoing care of the penis, as well as to preventing further injury. Here are some steps to follow:

– Always wear underwear. A pair of supportive cotton briefs not only helps to prevent zipper injuries; they also protect against the constant friction of rougher clothing – a problem that can eventually lead to a deadening of sensation in the area.

– Always use a lube. A personal lubricant creates a slick surface that acts as a barrier between two layers of skin. Whether the second layer of skin belongs to a partner or his own hand, the friction that occurs without a lube can result in soreness and – again – loss of sensation.

– Exercise caution in the bedroom. Moving cautiously, speaking up if something feels uncomfortable, and avoiding acrobatic moves are recommended to avoid torsion or impact injuries.

– Use a penis health crème (health professionals recommend Man1 Man Oil). Quality products that are formulated specifically for the penis contain ingredients such as vitamins, amino acids and antioxidants, all of which are vital for the health and function of the penile tissue. A good penis cream also contains high-end emollients that can soothe dry skin, restore moisture, and leave the penis looking and feeling healthy and responsive.

Migration to Foreign Lands

The sustained migration of peoples, especially the essential human assets from the African continent in general and Nigeria in particular to other African nations, Europe, Asia and the Americas to seek asylum for enhanced opportunities in recent times ought to be a real source of concern to any responsible governments, businesses and the citizenry at large.

Although, the International Organisation for Migration (IOM) has divided international migrants into two groups: those who migrate of their own free will, leaving for study, work or to join their families, repression or natural disaster. Yet, the two categories have rapidly become interdependent because of their fairly interrelated motive of searching for “better employment opportunities” abroad, while contributing a great deal to the success of other economies outside theirs.

However, this objectionable trend invariably, becomes more worrisome in connection with wide-ranging effects of such massive movements abroad on the nation’s socio-economic, political, educational, and human capital growth and development on the country’s economic fortune.

Also, it’s has been observed that as a result of the continued but unwelcome evil of maladministration in the country, the overwhelming adverse effects of this evident lapse are real in decayed infrastructure, acute brain drain syndrome, low capacity utilisation in the local industries, low productivity, collapse of societal value system, systemic mediocrity in national affairs, widespread youth unemployment, armed banditry, kidnapping, deepening despair among other debilitating vices. Scores of Nigerians, old and young, are daily impelled to explore all manner of travel arrangements, legal and illegal, to leave the Nigerian shores for other countries at all costs.

Expressing his concern over the approach many Africans, including Nigerians, are migrating abroad in search of the proverbial Golden Fleece, Nigerian-born, United States-based Phillip Emeagwali, in his article titled: “Africa: Out-of-the-Box Thinking in an In-the-Box World”, years back, warns thus: “If ideas are indeed capital, then Africa should stem its brain drain and promote the African Renaissance, which will lead to the rebirth of the continent. After all, a renaissance is a rebirth of ideas. And knowledge and ideas are the engines that drive economic growth.”

Following what many have described as the aftermath of sheer frustration in the system, forcing many to migrate to foreign lands, such a desperate move to leave the country by particularly illegal immigrants by land or air, has no doubt led to horrendous experiences and consequences.

For most of such relentless illegal migrants who have continued to embark on an adventure to Eldorado at the risk of their lives in sometimes dehumanising conditions, while making frantic attempts at crossing over to foreign lands through the bottom of a ship’s hold, aircraft’s under carriage, or in the cold of refrigerated lorries.

Unfortunately, many have perished on journeys between the African continent and Europe as capsized launches and bodies of migrants are reportedly ripped in pieces by sharks. Some who, perhaps by providence, have survived long, tedious journeys through the deserts, having journeyed from Nigeria through especially Niger Republic to Libya or Morocco, have come back to relive their heart-rending, near-death experiences in the dusty and chilly deserts.

And, for most Nigerians who have made it to foreign lands perhaps illegally, it is, therefore, no longer news that in virtually every fortnight these days, batches of Nigerian deportees are airlifted back home from abroad, having allegedly committed offences ranging from criminality, prostitution, street fighting, hooliganism, human trafficking, drug trafficking, and forged travel papers among others.

Granted, a good number of Nigerians who even legitimately migrated to other countries on the African continent have had it heavy-going in recent times. A very handy instance is the latest unpalatable experiences of most Nigerian resident in Egypt, Libya and Cote d’Ivoire at the hands of armed forces loyal to discredited administrations in these countries.

Their lamentations of suffering and neglect upon their arrival, especially at the Murtala Muhammed International Airport, Lagos, indeed, should be a food for thought for the Nigerian leaders to get things right at home. Many of such Nigerians had wished they had not even left the country for such politically unstable nations in search of the proverbial “Golden Fleece”. Many regrettably have lost all they have laboured for to the pandemonium in the troubled regions.

The persistent migration, invariably, is stripping Nigeria of the cream of its society, as most migrants are usually regarded as the nation’s most energetic, go-getting and entrepreneurial citizens. Now the phenomenon of brain drain is being experienced in all the sectors of the nation’s economy.

Many students who genuinely travelled to receive education overseas have refused to return home in order to help in deploying their acquired skills in different fields of human endeavours for the good of the country because of the comparatively harsh economic environment in their fatherland.

Now, how do Nigeria and other African nations encourage their citizenry who are professionals in diverse sectors to come back home to assist in lifting the Black continent out of festering poverty? Emeagwali, again, grieves over the fate of the continent, as he said: “When African men and women of ideas, who will give birth to new ideas, have fled to Europe and the United States, then the so-called African Renaissance cannot occur in Africa. It can only occur in Paris, London and New York. There are more Soukous musicians in Paris, than in Kinshasha; more African professional soccer players in Europe, than in Africa. African literature is more at home abroad than it is in Africa.”

“Africans in Europe are alleviating poverty in Europe, not in Africa. Until the men and women of ideas -the true healers of Africa- start returning home, the African Renaissance and poverty alleviation will remain empty slogans,” he further declared.

That is not to mention thousands of Nigerian medical doctors, information and communication technology professionals, and professors to mention a few, making waves in foreign lands, just as their fatherland continues to suffer under the deadweight of bad governance, corruption, armed robbery, ineptitude, mediocrity, and rising cases of kidnapping, a hitherto nebulous criminal act now threatening the social fabric of the nation.

While appreciating the beauty of sojourning abroad and making a good living there, Gbenga Badejo, sounding like a prophet in his article, “Six Things Africans Living Abroad Must Note!” sometime ago stated that though his was not an attempt at scare-mongering, it is important that Africans who live abroad ponder on certain thought-provoking questions and get motivated to rebuild their home countries.

He had asked such critical questions as: “What if Africans or most immigrants for that matter are repatriated en masse back to Africa? What if EU (European Union) enlargement means mass unemployment for African immigrants in Europe? What if citizenship is redefined and differentiation introduced even to Western-born citizens? In the event of any of the above scenario, what will be the fate of children of Africans abroad, many of whom have little knowledge of their ethnic origin let alone speak or understand the language?”

Thus, how can such Nigerians already resident abroad but willing to come back home to join forces with their fellow country men and women at home to uplift the fortune of the people and make marked improvement in key human development indices? How about measures at encouraging more Nigerians striving daily to jet out of the country at the slightest opportunity and bid the nation so long until God knows when to reconsider their decision?

The clear propensity for both legal and illegal migration among a huge number of Nigerians today should serve as a strong wake-up call to the nation’s leadership. This is in respect to institutionalising purposeful, values-based leadership, not only to formulate credible policies but also to institute people’s oriented, poverty-alleviating programmes and projects that promise hope and a fresh face lift.

With much improved enlightenment programmes and people-engagement strategies, there is, indeed, no better time for particularly the Federal Ministries of Information and Communications, Culture and National Orientation, Foreign Affairs, and other related Government agencies to drive home the core message of the Re-branding Nigeria Project to the generality of the people at home and abroad than now, while bearing in mind that the image of nation still remains the beacon in the comity of nations.

It should be noted that that most Africans in general and Nigerians in particular are suffering predominantly because of the effects of identified dishonesty, corruption and greed in the character of the leadership and an unwillingness of the power brokers to improve the lot of the people.

This is the time for all to choose compliance with their conscience as against compliance with entrenched personal, egocentric interests in the nation’s affairs. In this way, we can give posterity a chance to experience true humanism and improve our common good.

Cascading Style Sheets and Email Display

Designing the HTML version of your email message can be difficult since there are so many different email client and operating system combinations out there – and they have their own way of rendering HTML. And there really is no way to be positively sure which client your readers will be using to view your messages.

If your reader has a Hotmail address, it’s generally safe to assume that he will be reading your message through the Hotmail web client. But what about your readers with private email addresses? Will they be using Microsoft Outlook? Will it be Outlook 2000, Outlook 2003 or Outlook 2007? Or maybe he’s using Lotus Notes? What if he had his TLD email forwarded to a Yahoo account? And is he using a Mac or a PC?

Since you don’t really know the answers to any of these questions, when designing your email campaigns it’s important that you always design for the most accessibility.

Cascading Style Sheets (CSS) offers the ability to make your email messages extremely graphic and enticing. Unfortunately, there is still limited support of r CSS with many email clients and across various platforms. One of the biggest CSS-offenders is Outlook 2007; and since studies show that up to 75% of email readers use Outlook, you just can’t ignore its rendering flaws.

Unfortunately, Outlook 2007 has no support for floating elements, which is widely used in CSS for positioning objects. So it’s based to use a table-based layout when designing your email campaigns. Think web design circa the year 2000. If you’re a new designer and have never dealt with tables before, you can get tons of how-to information from the W3C.

While Outlook 2007 does support the property, I don’t recommend that you use it to attach your style sheet. At least 50% of your readers will have their images turned off, which means any linked elements will not be linked – and this includes your external style sheet. Besides, Gmail, Live Mail and Hotmail don’t support linked elements, so it’s a good idea not to use them anyway. Instead, define all of your styles within your message and never rely on an external style sheet for your email messages.

Where, within the message, you should define your styles is another story altogether. Live Mail looks for the style sheet with the , Hotmail looks for the style sheet right below the tag. Outlook 2003, Outlook 2007, AOL, Yahoo, Entourage and Thunderbird will accept either placement, but Gmail doesn’t accept any of them.

The best option is to use in-line style tags. In-line style simply means that the style for each element must be defined individually. Instead of defining your style sheet within your head like this:

<link rel="STYLESHEET" type="text/css" href="https://www.mysite.com/style.css"/>

or even something like this:

</p> <style type="text/css" media="screen"> <p><!-- p {"urn:schemas-microsoft-com:office:smarttags" />georgia, serif; font-size: x-small;} hr {color: #ff9900; height: 1px } a:hover {color: #ff0000; text-decoration: none} --></p> </style> <p>

you would define each element individually, like this:

</p> <p x-small color:> <p>This is your paragraph text.</p> <p>

When you’re defining those elements, keep in mind that not all CSS properties are supported across the board on all email clients. If you want to present a consistent message to all of your readers no matter how they are reading your mail, limit yourself to these CSS properties:

. background-color

. border

. color

. font-size

. font-style

. font-variant

. font-weight

. letter-spacing

. line-height

. padding

. table-layout

. text-align

. text-decoration

. text-indent

. text-transform

Those properties are supported on both Macs and PCs in:

. AOL

. Entourage

. Gmail

. Live Mail

. Outlook 2003

. Outlook 2007

. Thunderbird

. Yahoo

Properties to avoid include:

. background-image

. background-position

. background-repeat

. border-collapse

. border-spacing

. bottom

. caption-side

. clear

. clip

. cursor

. direction

. display

. empty-cells

. float

. font-family

. height

. left

. list-style-image

. list-style-position

. list-style-type

. margin

. opacity

. overflow

. position

. right

. top

. vertical-align

. visibility

. white-space

. width

. word-spacing

. z-index

And now for even more bad news: Lotus Notes and Eudora have terrible CSS support and even many of the widely-accepted CSS properties may not render properly. And since more and more readers are now accessing email on PDAs and other handheld devices, you can never be 100% certain how or where your message will be read. So I suggest you always use Multipart-Mime messaging, and always include a link to your text version within the html version of your message.

*** Want to keep these tips handy?

Penis Exercises And Supplements – Guaranteed Ways To Increase The Size Of Your Penis

Penis exercises work very well on the their own when it comes to increasing the size of your manhood. In this article I will go through supplements that you can use with the penis exercises to see wonderful results and gains. All you have to do is sit back, relax and read about these two crucial methods. Many men across the globe have seen massive success by using these techniques.

The key to being successful with penis enlargement is consistency and focus. When you have both of these things penis enlargement becomes so much easier. When I first used these methods I was very surprised with how well it worked and even more surprised with how fast it worked. Normally with enlargement the process of enlargening is a steady journey but with these methods it will be a quick process.

Comparing Body Exercises

Weather it’s losing weight, burning fat, getting rid of cellulite, building muscle or just generally trying to stay fit, exercises alone will not be able to help you accomplish your goals. When you are trying to reach your goals with body exercises you will always need a good supplement product to help you improve in every aspect of your body exercises. The same goes for penis exercises because you also need great supplements for great results.

Below are a few minerals and vitamins that you need to take that will help you increase the size of your penis. Taking both of these things everyday will help maximize the blood flow in your penile area. When more blood flow is increased to your penile area, your erections will be much harder, thicker and longer then before. Doing exercises alone will help increase blood flow but doing them with vitamins and minerals makes the process twice as effective.

When trying to maximize the flowing of your blood these are some of the best vitamins and minerals that you can use to do that. These supplements do not only help increase the size of your penis but they are also very good for helping your overall health to improve..

L- Lysine – (Also gives you more vibrant skin, stronger bones, better digestion and more.)

Ginkgo Bilboa (Also gives your brain extra energy, heals wounds quicker, stops blood clots, stops yellowing of the nails and more.)

Zinc (Also gives you stronger blood cells, better muscle growth, gets rid of fat and more.)

Ginseng (Also gives you stronger immune system, better stamina, more flexible bones, reduces hair loss and more.)

Super B Complex (Also helps you heal wounds quicker, gets rid of bad bacteria, stops yellowing of teeth, healthier skin, whitens eyes and more.

Multi Mens Vitamins (Also gives you faster muscle growth, stronger bones, healthier ligaments, flexible tendons and more.)

Everything I have listed above is all natural and they will all help you increase the blood flow to your penis area.

Natural Penis Exercises – How To Exercises Properly

The first step to exercising properly is warming up. The warm up allows your body to get ready for all the intense exercises you will be doing. Warming up should never be skipped when attempting to do natural penis exercises. Some men try to skip the warm up because they think it’s not important but they soon find out that warming up is essential.

When exercising it’s always best to take it easy. A lot of men exercise very roughly and this can lead to a lot of problems. The best thing to do is to do it in a very comfortable speed so that you actually enjoy the exercises better. The last important thing to remember about these natural penis exercises is to always use lubrication. Lubrication is very important if you want to see maximum results and avoid injury.

5 Foods That Will Put Your Testosterone On Overdrive!

Testosterone is an essential hormone to have if you intend to build a lot of lean muscle. Numerous males suffer from low levels of testosterone and high levels of estrogen due to smoking, stress and most importantly, a poor diet. This is especially true for men who are older because not only do they have a lifetime of bad habits, but their age diminishes the testosterone levels in their body.

The result of a decrease in testosterone isn’t just a loss of mass; it includes a loss of muscle strength, erectile dysfunction, lack of libido, depression, and weight gain. It’s tremendously important to eat foods that are higher in zinc and B vitamins and below I will show you 5 foods that will rev up your testosterone levels to unbelievable highs.

Eggs

Eggs are rich in protein and cholesterol. Now I know most of you reading this believe that cholesterol is a bad thing; however, testosterone is synthesized from cholesterol and thus is essential to build high levels of this muscle-building hormone. In addition, eggs provide you with a rich source of protein and vitamins B5 and B6. Some people will take out the yolk and eat just the egg whites; however, eating the yolk is essential in ensuring that you get all of the nutrients in the egg.

Raw Oysters

Oysters contain an insane amount of protein, magnesium and importantly, zinc. They are so full of zinc that only six oysters will give you seven times the recommended daily amount. The raise in testosterone will, not only, help with the increase of muscle strength and mass building, but it will also increase your libido and sperm count.

Red Meat

Along with oysters, red meat also contains very high levels of zinc and protein. However, not only are the zinc and proteins levels high but, they come in a form that is much faster and easier to absorb by the body. It should also be noted that red meat is also high in saturated fat, therefore, it is good to have it a few times a week but it should not be eaten every day.

Brazil Nuts

Brazil nuts are packed with selenium, which has been proven to increase a man’s testosterone production. The really good thing about Brazil nuts is that you only have to have 1 or 2 in order to boost your selenium levels and thus increase testosterone levels. However, it is also important to note that the concentration of selenium found in Brazil nuts varies depending on what type of soil they were grown in. If the soil itself was rich in selenium the Brazil nuts will also be rich in the trace mineral. For example, nuts that grow in Manaus – Belem will have, approximately, selenium levels which are ten times higher than those that are grown in Acre – Rondia.

Garlic

Garlic contains allicin which is a compound that has been found to enhance testosterone levels. The research supporting this theory suggests that garlic stimulates the release of luteinizing hormone, which increases the circulation of testosterone.

How to Make Your Penis Bigger Without Using Pills and Pumps

Over 90% of men would like to increase the size of their penis. So this is a huge market for people to take advantage of and that is why there are so many male enhancement pills, supplements and devices, that are suppose to make your manhood bigger and stronger. But do you really need all those expensive male enhancement products? No you don’t! I will tell you, how to make your penis bigger without using pills or pumps.

How to Make Your Penis Bigger

The truth is that you don’t need any expensive equipment at all. The only things you need are your own two hands, some lubrication, and a hot towel to warm up. There are very effective penis enlargement exercises, that require only 20-30 minutes of your time in a day. And they are not boring and don’t take a long time, which makes them perfect for everyone.

One of the most effective and simplest routines, that affects the thickness of your penis, involves stretching the whole length of your manhood with pressure. To start this routine you first of all, have to lubricate your semi-erect penis. The next step is gripping the base of the penis shaft with your thumb and index finger of one hand. After that you apply some pressure to the organ and slowly move your grip down towards the tip of your penis and releasing your grip just before reaching the head.

This routines allows more blood to go to your penis and all the little spaces within it. The more blood your penis can store, the bigger it gets, especially the thickness. There are many many other such exercises, that are just as easy and effective. All of these complement each other and make penis bigger.

There are other reasons why penile exercises are a superior method. With other methods such as using pumps and stretching devices, there is a much greater risk of side-effects and injury. It does not take much to cause some injury to your penis. Some of the common side-effects with surgery and pumps and other tools are blisters, curved erection, impotence, penis disfigurement, scarring, bleeding etc.

For many guys the desire to achieve a larger penis is so strong, that they lose all common sense and opt for less effective and more dangerous methods. The best way to make your penis bigger without pills or pumps is penile exercising – period!

Another major issue that lots of men face, is the embarrassment issue. What if someone finds out? It is not so hard for others to find out what you are up to, if you have pumps or pills delivered to your house or if you get caught using some enlargement tool. This is not the case with penile exercises because there are no tools needed, except your hands and some lubrication.

It takes anywhere from 10-20 minutes to complete these exercises. You can do them any time of the day in privacy and no-one will ever know. Lots of husbands have exercised their penis for months, without their woman figuring out why the penis has become bigger all of a sudden.

The more such exercises you do and the more persistent you are, the bigger your penis gets. Don’t waste your time with expensive pills and pumps, there is no need for them. All you need is a good exercise program, your own hands and desire. There is nothing overly complicated about it. The main thing is to overcome the embarrassment that comes with it. There is a certain negative stigma when it comes to penis enlargement and you certainly might not want to tell everyone what you are up to. But you should not let this stand in your way.

Kidney Disease – The Hidden Cause of Chronic Resistant Hypertension (High Blood Pressure).

The kidneys are the key organs that regulate systemic blood pressure. The kidneys are the bean-shaped organs at the back of the abdominal cavity located below the lower margin of the rib cage and the upper limit of the pelvic cavity. The two kidneys regulate blood volume, excrete acidic wastes, metabolize drugs, balance electrolytes and produce hormones. Yes, the kidneys does a lot more than making urine. In Chinese medicine, it is even believed that the force of the kidneys control the bones as well as fertility. In this article, I will focus on how renal disease can cause or provoke intractable high blood pressure.

Hypertension accelerates renal insufficiency. The opposite is also true. In physiology, it is always thought that diseased kidneys need high blood pressure to maintain tissue perfusion. This simply means that for the rest of the body tissues to keep on receiving nutrients and oxygen through the blood, the kidneys has to raise blood pressure. This is a natural survival mechanism which is incompatible with optimum health.

The renal vasculature is a low pressure bed. In other words, the kidneys are very sensitive to changes in blood pressure and tend to react with renal artery spasm (sclerosis) and raising blood pressure through the renin-angiotensin-aldolsterone mechanism. Don’t let this throw you, I will explain it.

Renin is the hormone that is secreted by the juxtaglomerular cells in response to decreased blood volume, low potassium, low adrenaline, or decrease renal perfusion pressure. Renin then converts a 10-amino acid protein (packaged in the liver) called angiotensinogen to 8-amino acid polypeptide called angiotensin I. Angiotension I is still inactive but is activated in the lungs by angiotensin converting enzyme (ACE) to the active angiotension II. Angiotensin II is a potent vasoconstrictor. At the same time renin also stimulates the suprarenal glands (the adrenals) to secrete a hormone called aldosterone which in turn stimulate the kidney nephrons to reabsorb salt and water to expand blood volume. All in an attempt to raise blood pressure.

Now apart from atherosclerosis and blood viscosity, the greatest cause of essential hypertension is glomerulo-sclerosis. The glomerulus are the filtration apparatus of the kidneys. Glomerulo-sclerosis is fancy way of saying that the glomerulus are hardened with debris, fibrin clots (fibrosis), and acidic waste clogging the filters. As such the pressure builds up. The inflow is now more than the out-flow. The tubules or nephrons are also hardened at the same time. we call this nephrosclerosis. Diabetes can also accelerate this process as in diabetic nephropathy.

Please note that before hypertension is even diagnosed, half of the kidneys are gone. If your hypertension is accompanied by leg swelling, tiredness and puffy eyes in the absence of heart failure, you kidneys must have been sick. The sad part is that renal function tests like blood urea nitrogen and serum creatinine may still be normal at this point.

To avoid end-stage renal failure and attendant hypertension, an ounce of prevention is always better than a pound of cure. Stop all foods that hurt the kidneys like junk, fragmented and devitalized foods. All fried stuff, processed foods, drugs like asprin, too much refined sugar, heavy metals (lead and cadmium), heavy animal proteins, coffee and antihypertensives especially the diuretics.

To restore the kidney back to normal before it is too late, you must do some debridement with enzyme blend containing proteolytic enzymes like nattokinase, and serrapeptase. Kidney friendly herbs like milk thistle, uva ursi, parsley, corn silk, and buchu. Raw fruits and vegetables also help to restore renal vigor and function without harmful prescription drugs. To get rid of heavy metals, you do chelation with EDTA, malic acid, vitamin C, N-acetyl Cysteine, Magnesium, Vitamin B6, CoQ10 and Zinc.

Small Town vs. Big City Life

It’s a small world. I’ve been traveling for a couple of weeks and everywhere I go I meet people from Texas. Earth, Shamrock, Farwell, Littlefield. You are everywhere. When people ask me where I am from there are two responses. The first response is curiosity. That response is from people who have never been to West Texas. They wonder about my transition from big city life to small town life.

One woman described her daily 55 mile commute from Albuquerque to Santa Fe. For two years she drove an additional 20 miles to complete graduate school. On top of that she has a husband and two small children who require her attention. I remember those days. I commuted to work, class, and an internship while I was in graduate school in Philadelphia. Thousands of other people in the area drove from place to place. The travel seemed endless and the traffic was awful.

When I moved to upstate New York to work on my doctorate, I was conscious of how much stress I would leave behind. The simple life was very appealing. After I finished my studies I stayed for a while and enjoyed the peace and quiet. Going back to visit the city meant traffic, crowds, and unpredictable daily interactions. When I lived there I didn’t notice any of those things.

The second reaction I get when people ask me where I live is complete understanding. These people usually tell me that they are from somewhere close by. Often, they have moved elsewhere and returned to their West Texas towns. A judge from one small town described his commute. Ten minutes after he finishes tying his tie, he is on the bench hearing his first case. He and his wife raised three children in his town and are happy to stay there.

I believe that the flashiness and excitement of city life is fiction. In movies and television, people live fabulous lives and are always in the middle of an adventure. The daily grind is never depicted in an honest way. We see huge apartments, glamorous work, and beautiful people. In reality, there is more happening in the city, good and bad. There are more people, good and bad. The frequency of good and bad days is about the same. Is it exciting? Yes, there is constant activity. The rest is Hollywood fantasy. The police don’t look like Will Smith and the waitresses don’t look like Jennifer Aniston. It would be nice though!

One of the benefits of being a student at Wayland is the option to take classes at the external campuses. There are campuses in large cities like Phoenix, San Antonio, and Albuquerque where students can experience a change of atmosphere and see different lifestyles. The biggest difference is that those campuses cater to adult students. People with jobs, families, and other obligations take classes at night and on weekends. What we call “non-traditional” students are actually people who have interesting lives, maybe a few of them are even glamorous, but the priorities are the same. Getting an education and having a better life.

Now that I think of it there are fellow small town people who do not understand the appeal to people like me. They think it is too predictable and boring. They are realistic about the lack of opportunities in a closed community, but their ideas about bustling city life are usually based on television or movies. Their eyes glaze over and they ask why anyone would ever choose this over that. I would choose a TV life too, if I had a choice. Giant apartments, evening gowns, and exotic vacations are very attractive, that’s why we see them all the time! But people are people and I would choose small town people any time. In fact, I already have.

Trading Large Cap Stocks – Beginning

Like many stock market investors / traders, I too, lost my shirt in the nineties. High-tech stocks always seemed to offer such huge returns, and when you analyzed the charts they looked like can not miss opportunities. But as the decade wore on my stock portfolio value went on a steady nose dive. Until it actually became non-existent.

At the time I was looking for stocks to hold for a few months, and then sell. Stocks that were likely to increase in a short time. I read all the books, learned fundamental and technical analysis, created and back tested stock trading systems. Subscribed to all the newsletters, the services, the gurus, and jumped around in my opinions so much, that even when I was right, I did not allow my correctness time to pay off. Self-doubt, gut wrenching anxiety, not to mention unnecessary stress on an already dysfunctional marriage all added to my panicking. And the inevitable loss of my entire account.

Through it all I made right buys and short sells, but my convictions was never very strong, I could not stand the fluctuation of hi-tech stocks, and had no idea when to keep my position and when to dump it. Usually I would dump winners at the exact worst time, and keep losers for way too long. I tried system trading, but great weary of systems that worked when back testing but not in real time. In short, I went broke, lost my marriage, my house, and my confidence.

Around 2001, I began sniffing around the market again. Now, though I had no money to trade with. However I remembered a time right at the end of 1999. When I had traded GE, several times successfully, it was in a nice up trend, with sufficient timely dips that allowed buying opportunities, and timely spots to also sell. I began wondering if I could buy and sell large cap stocks, and make a profit. I began, again pouring over charts, it was easier now, with the Internet, you could do it for free. I studied household names, and not so household names but always stocks over 5 billion in capitalization. In 2002, I began paper trading, based on a few quick judgments I made about chart formations, and using a few basic indicators. I did this in real time

I had no money to trade, now going through an expensive divorce, that was to leave me actually broke for 3 years. I, still was fascinated with the idea of ​​using large cap stocks, and the fascination kept me paper trading. I found these advantages to large caps; One they had real value, not blue sky. So often, hi-tech and biotech's only had future earnings to offer. Large caps had real value, real property, real learning, etc. Information on them was readily available. I learned during the nineties, I will never have the latest information on stocks. But with large caps you do not really need it. Large caps charts were also more predictable, more reliable, upturns and down turns were within parameters, that were almost always followed. High tech could drop like a rock from the sky on rumors, rumors that I would not even know about until the end of the day.

But was there enough volatility to trade in large caps. I was always bored with buy and hold and hope for a 7% return over the next ten years type strategy, I wanted some action. But what I found was there is enough volatility, if you can figure out how to predict it. Consider my first real trade of this year, I bought All-State Insurance ticker symbol ALL. I bought it in March of 2005, at that time its 52 week low was 43, and its high was 52. If you had bought it at the exact low and sold it at the exact high you would have made, 20% annual return. Not bad for such a safe investment. Of course it is impossible to do that. But what is very possible is to hold it for about 39 days, and make around 3%, in that time. That is almost a 30% annual return while holding a very safe stock for a very short time. And that is what I did.

I paper traded large cap stocks for 3 years, averaging over 50% return on investment for 3 years. While I scrambled and saved, and hid money until I had a whopping total of $ 3000, to open a stock account. And then I bought All State. This year I again hope to make over 50% return on investment, only in real dollars. Which let me tell you is much more exciting, than paper trading. Oh, I have started a successful side business, which profts I place into my account. But more on this later. You can read my trades as they occur on my blog http://livingonlargecaps.blogspot.com/ . And watch as in real time I attempt to prove you can make huge profits on large cap stocks.

Aids Causes, Symptoms and Treatment for Aids

Aids Information

AIDS stands for Acquired Immune Deficiency Syndrome.

It represents the late stages of infection by a retrovirus called Human Immunodeficiency Virus (HIV). It is a disease in which the body’s immune system breaks down and is unable to fight off infections, known as “opportunistic infections,” and other illnesses that take advantage of a weakened immune system.

Hiv Aids Cause

HIV is CAUSED by a virus called the Human Immunodeficiency Virus.

Have unprotected sex with someone who is HIV-positive.
Have another sexually transmitted disease, such as syphilis, herpes, chlamydia, gonorrhea or bacterial vaginosis.
HIV can be spread during pregnancy from mother to fetus.

Symptoms Of Hiv

The symptoms of HIV and AIDS vary, depending on the phase of infection. When first infected with HIV, you may have no symptoms at all, although it’s more common to develop a brief flu-like illness two to six weeks after becoming infected. But because the signs and symptoms of an initial infection — which may include fever, headache, sore throat, swollen lymph glands and rash — are similar to those of other diseases, you might not realize you’ve been infected with HIV.

Once the immune system weakens, a person infected with HIV can develop the following symptoms:
Whitish coating on the tongue, throat or vagina
Forgetfulness, confusion and other signs of mental deterioration
Lack of energy
Weight loss
Frequent fevers and sweats

A number of people with these vague, indistinct symptoms have a more serious illness than the flu; these symptoms may signal the acute stages of HIV infection.

Treatment Of Hiv

Anti-HIV (also called antiretroviral) medications are used to control the reproduction of the virus and to slow or halt the progression of HIV-related disease. When used in combinations, these medications are termed Highly Active Antiretroviral Therapy (HAART). HAART combines three or more anti-HIV medications in a daily regimen, sometimes referred to as a “cocktail”. Anti-HIV medications do not cure HIV infection and individuals taking these medications can still transmit HIV to others.

AIDS has no cure and there are currently no FDA-approved vaccines to protect against HIV, but there are vaccines that are currently being studied. However, medications can slow the progress of the disease, which allows patients to stay healthier and live longer. The drugs used to treat HIV infection are called antiretrovirals, because they fight HIV, which is a type of “retrovirus.”

Protease Inhibitors (PIs), such as lopinavir/ritonavir (Kaletra), disable protease, a protein that HIV needs reproduce itself.

HIV antiviral drugs

Most medications have side effects, which your doctor will discuss with you. Individuals respond differently to medications and side effects may vary. Positive Health Practice doctors, nurses and pharmacists can help you manage these side effects.

Nucleoside analogue reverse transcriptase inhibitors (NRTIs). NRTIs were the first antiretroviral drugs to be developed. They inhibit the replication of an HIV enzyme called reverse transcriptase.

Protease inhibitors (PIs). PIs interrupt HIV replication at a later stage in its life cycle by interfering with an enzyme known as HIV protease.