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Totalitarianism
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Totalitarianism is a term employed by political scientists, especially those in the field of comparative politics, to describe modern regimes in which the state regulates nearly every aspect of public and private behavior.
The most influential scholars of totalitarianism, such as Karl Popper, Hannah Arendt, Carl Friedrich, Zbigniew Brzezinski, and Juan Linz have each described totalitarianism in a slightly different way. Common to all definitions is the attempt to mobilize entire populations in support of the official state ideology, and the intolerance of activities which are not directed towards the goals of the state, entailing repression or state control of business, labour unions, churches or political parties. Totalitarian regimes or movements maintain themselves in political power by means of secret police, propaganda disseminated through the state-controlled mass media, personality cult, regulation and restriction of free discussion and criticism, single-party state, the use of mass surveillance, and widespread use of terror tactics.
Critics of the concept say that the term lacks explanatory power. They argue that governments which may be classified as totalitarian often lack characteristics said to be associated with the term. They may not be as monolithic as they appear from the outside, if they incorporate several groups, such as the army, political leaders, industrialists, which compete for power and influence. In this sense, these regimes may exhibit pluralism through the involvement of several groups in the political process.[1]

Usage of the term
The term, employed in the writings of the philosopher Giovanni Gentile, was popularized in the 20th century by the Italian fascists under Benito Mussolini. The original meaning of the word as described by Mussolini and Gentile (G. Gentile & B. Mussolini in "La dottrina del fascismo" 1932) was a society in which the main ideology of the state had influence, if not power, over most of its citizens. According to them, thanks to modern technologies like radio and the printing press, which the state could, and probably would, use to spread its ideology, most modern nations would naturally become totalitarian in the above stated sense.
While originally referring to an 'all-embracing, total state,' the label has been applied to a wide variety of regimes and orders of rule in a critical sense. Karl Popper, in The Open Society and Its Enemies (1945) and The Poverty of Historicism (1961) developed an influential critique of totalitarianism: in both works, he contrasted the "open society" of liberal democracy with totalitarianism, and argued that the latter is grounded in the belief that history moves toward an immutable future, in accord with knowable laws. During the Cold War period, the term gained renewed currency, especially following the publication of Hannah Arendt's The Origins of Totalitarianism (1957). Arendt argued that Nazi and Stalinist regimes were completely new form government, and not the updated versions of the old tyrannies. According to Arendt, the source of the mass appeal of totalitarian regimes was their ideology, which provided comforting, single answer to the mysteries of the past, present and future. For Marxism all history is the history of class struggle, and for Nazism all history is the history of race struggle. Once that premise was accepted by public all actions of the regime could be justified by appeal to the Law of History or Nature.[2]

[edit] Cold War-era research
The political scientists Carl Friedrich and Zbigniew Brzezinski were primarily responsible for expanding the usage of the term in university social science and professional research, reformulating it as a paradigm for the Soviet Union under Joseph Stalin as well as fascist regimes. For Friedrich and Brzezinski, the defining elements were intended to be taken as a mutually supportive organic entity comprised of the following: an elaborating guiding ideology; a single mass party, typically led by a dictator; a system of terror; a monopoly of the means of communication and physical force; and central direction and control of the economy through state planning. Such regimes had initial origins in the chaos that followed in the wake of the World War I, at which point the sophistication of modern weapons and communications enabled totalitarian movements to consolidate power in Italy, Germany, and Russia.

[edit] Criticism and recent work with the concept
In the social sciences, the approach of Friedrich and Brzezinski came under criticism from scholars who argued that the Soviet system, both as a political and a social entity, was in fact better understood in terms of interest groups, competing elites, or even in class terms (using the concept of the nomenklatura as a vehicle for a new ruling class). These critics pointed to evidence of popular support for the regime and widespread dispersion of power, at least in the implementation of policy, among sectoral and regional authorities. For some followers of this 'pluralist' approach, this was evidence of the ability of the regime to adapt to include new demands. However, proponents of the totalitarian model claimed that the failure of the system to survive showed not only its inability to adapt but the mere formality of supposed popular participation. Its proponents do not agree on when the Soviet Union ceased to be describable as totalitarian.
The notion of "post-totalitarianism" was put forward by political scientist Juan Linz. For certain commentators, such as Linz and Alfred Stepan, the Soviet Union entered a new phase after the abandonment of mass terror on Stalin's death. Discussion of "post-totalitarianism" featured prominently in debates about the reformability and durability of the Soviet system in comparative politics.
As the Soviet system disintegrated in the late 1980s and early 1990s, opponents of the concept claimed that the transformation of the Soviet Union under Mikhail Gorbachev, and its subsequent sudden collapse, demonstrated that the totalitarian model had little explanatory value for researchers. Several decades earlier, for example, Bertram Wolfe in 1957 claimed that the Soviet Union faced no challenge or change possible from society at large. He called it a "solid and durable political system dominating a society that has been totally fragmented or atomized," one which will remain "barring explosion from within or battering down from without." Many classic theories of totalitarianism discounted the possibility of such change[citation needed]; however, later theorists not only acknowledged the possibility but in fact encouraged and welcomed it[citation needed]. Any suggestions of the indefinite stability of states labeled totalitarian among proponents of the term were largely discredited when the Soviet Union fell by the wayside.

[edit] Political usage
While the term fell into disuse during the 1970s among many Soviet specialists, other commentators found the typology not only useful for the purposes of classification but for guiding official policy. In her 1979 essay for Commentary, "Dictatorships and Double Standards", Jeane Kirkpatrick argued that a number of foreign policy implications can be drawn by distinguishing "totalitarian" regimes from autocracies in general. According to Kirkpatrick, typical autocracies are primarily interested in their own survival, and as such have allowed for varying degrees of autonomy regarding elements of civil society, religious institutions, court, and the press. On the other hand, under totalitarianism, no individual or institution is autonomous from the state's all-encompassing ideology. Therefore, U.S. policy should distinguish between the two and even grant support, if temporary, to non-totalitarian autocratic governments in order to combat totalitarian movements and promote U.S. interests. Kirkpatrick's influence, particularly as foreign policy adviser and United Nations ambassador, was essential to the formation of the Reagan administration's foreign policy and her ideas came to be known as the "Kirkpatrick Doctrine."[3]

National exhibit celebrating Women in Medicine comes to KC
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UMKC is currently co-hosting the national traveling exhibition “Changing the Face of cheap viagra: Celebrating America’s Women Physicians.” Our city is one of only 61 sites nationwide to host this exhibit, which runs through Nov. 11. The exhibit is a collaborative effort of the four libraries of the three Kansas City-area medical schools: Dykes Library and Clendening History of cheap cialis Library of the University of Kansas Medical Center, Kansas City University of Medicine and Biosciences Library, and the UMKC Health Sciences Library.

The National Library of Medicine (NLM), Bethesda, Md., and the American Library Association, Chicago, IL, organized the traveling exhibition with support from the National Library of Medicine, the National Institutes of Health Office of Research on Women’s Health, and the American Medical Women’s Association. The traveling exhibition is based on a larger exhibition that was displayed at the NLM from 2003–2005. The local exhibit received additional support through grants from the National Network of Libraries of Medicine and the Health Sciences Library Network of Kansas City.

Along with the exhibit, which is housed at the Dykes Library on the KU Med campus, there will be a number of special events highlighting the evolving role of women in medicine. UMKC will host a special Changing the Face of Medicine lecture at noon on Tuesday, October 20, in the UMKC School of Law Courtroom. The event will feature Dr. Diane Buckingham, an adolescent psychiatrist featured in the national exhibit and current faculty member at the UMKC School of Medicine. The topic of Dr. Buckingham’s presentation will be “Opening the Doors to Multicultural Diversity and the Changing Faces of Color: Patient and Women Empowerment.”
For more information about the Changing the Face of Medicine exhibit and related events, view the UMKC news release.

Submitted by: Amrita J. Burdick, MALS, MA Ed., AHIP
Clinical Medical Librarian, UMKC Health Sciences Library

A Doctor's story of his journey with Erectile Dysfunction
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Ben PreOp










Pre Op
Ben Post Op






Ben's Post Op






Bob,
We exchanged emails several months ago, which was very helpful--as were the first person accounts on your blog. I had an implant (AMS CX) done 4 days ago, 3/3/10. I have written the following account to share with others on a few different sites, as well as the pictures. Please feel free to use on your site. I cut and pasted from the first site I posted to, so there is some blue background on part of it I couldn't figure how to get rid of.


Regards,
Ben


I'm 61, and very happily married, with my 40th anniversary coming up in June. I have been dealing with ED since I was in my mid-40s. By the mid-90s, I could still get a firm erection, but it would go away with lightning speed (I'm sure that was what I eventually learned was called venous leakage going on), so I had to get it in quickly and never stop moving at a good pace (which I hated, we both prefer a style of intercourse with a slow in and out, accompanied by lots of kissing and touching). The refractory period after orgasm was hours, so more than once in the same session was no longer possible.

Being a physician, I was aware of Viagra when it first came out and started using it in 1998. What a miracle that was! Firm erections and a refractory period as short as a few minutes. 2 orgasms became my norm, extending to 3 occasionally, and 4 on one special occasion. I would get mild headaches and slight blueing of my vision from the Viagra, but I hardly cared--I was more capable than I had been even in my 20s.

This continued to work beautifully for 3 years or so, and then the effectiveness began to fall off. Over a 5-6 year period beginning in 2002 I consulted urologists for the first time, and eventually figured out that the average urologist knew less than I did about ED by this time, so I told them whatever I wanted to try and they prescribed it.

I tried cheap cialis and Levitra and found the Cialis slightly better than the others for me and started using that. I tried the intra-urethral Muse product, which felt awful and didn't produce an erection. My testosterone level was steadily dropping during this period of time, and got below 200, so we added first Andro-gel, then Testim to the mix. That clearly improved my libido (which had really dropped dramatically), but had no effect on the quality of my erections, which was sufficient for "stuffable" intercourse, but not very firm at all.

I tried tri-mix injections into my penis which improved things somewhat for a while, but is the most likely reason I developed Peyronie's disease (in which scar tissue on the inside of the penis bends it in different directions). Prior to my recent implant surgery (which straightens the penis and essentially cures Peyronie's), my penis was curving upward approximately 15-20 degrees, and 10-15 degrees to the right--on those fleeting occasions when I had an erection firm enough to see it, or while under vacuum.

I tried a vacuum erection device combined with a cock ring. I never could get this to work very well and both of us really hated it. Besides, you can't leave the cock ring on very long, and it leaves your penis numb.

In late 2007 I became aware that a Dr. Larry Lipshultz, here in Houston, Texas, was one of the pre-eminent specialists in the treatment of ED. I learned of him from a couple of patients who sang his praises.

With him, I underwent a quite thorough evaluation. He determined from injecting the penis and doing a Doppler ultrasound that blood flow into my penis was relatively normal, but that the mechanism to capture the blood flow to produce an erection was not--the dreaded venous leakage. Venous leakage doesn't respond well to typical ED treatments. He didn't push the idea of an implant and I wasn't yet ready to consider that. He had a regimen of medications which he said had been successful in reversing venous leakage in some individuals--so over an 18 month period I took 25 mg of Viagra every day, Cialis when intending to have sex, and 2 or 3 other supplements he recommended as good for penis health.

By the fall of 2009, it was clear that I had no significant improvement from that, and I asked him about an implant. He thought I was a perfect candidate--I had tried all the other options, I had conditions which an implant is optimal for--venous leakage and Peyronie's disease, and I was otherwise in excellent health. My fall and early winter schedule simply didn't allow time for having the procedure done, so I saw him again in January and scheduled an implant for 3/3/10.

Around 85% of implants are the 3 piece type, and that is what I chose. They are mechanically more complicated than other types, but produce the firmest and most natural looking erection of any of the choices. More than 90% of men and their partners are satisfied with implants when all is said and done, which is far higher than the satisfaction levels with any other ED treatment.

As I type this, I am 4 days post-op. I have essentially been pain-free at rest since the catheter was removed on Thursday morning, 3 days ago. I have had minimal swelling and bruising, no pain at the incision site (3-4 cm horizontal incision high in the scrotum underneath the penis). I have mild to moderate discomfort from the pump in my scrotum, but others who have had this procedure say you eventually will be unaware it is there. I would just like to fast forward through the next 4-6 weeks, and ride my new bicycle.

Hardly anything is written about the psychological side of ED these days, and most ED is now thought to be organic rather than psychogenic in origin. However, whatever the cause, failure to perform certainly results in some degree of performance anxiety in probably everyone, which doesn't help. I think, however, that it would be unlikely that a primarily psychogenic cause of ED would end up in an implant. I would think that the pharmaceutical approaches would typically handle that well. But in the end, it doesn't matter, if nothing else works, then an implant will--barring surgical complications, infection, etc.

I think that my story is a fairly common one, based on what I have read on a variety of sites on the web. If I had it to do over again, I would have found a top specialist in ED much sooner, and probably had my implant 5 years ago. That is also a quite common comment by those who have had implants--that their only regret is that they did not do it sooner.

Your average doctor, or even average urologist, isn't much help past the point of prescribing Viagra, Cialis, or Levitra. Once you educate yourself about ED, you will know more than most of those doctors on the subject. If one of the pills works well, I see no reason to do anything more for as long as it continues to work. If one of those doesn't take care of the issue, then I would find the nearest real specialist I could find. If you have to drive a long way, so be it. From this website, and others similar to it, you should be able to find what top ED doc is nearest you. Don't choose a doctor for implant surgery who isn't doing them every week. It is critical that your surgeon be very knowledgeable and very experienced. This is not a place to cut corners!!

My wife has been 100% supportive of whatever I wanted to do each step of the way in dealing with ED. We have certainly become better lovers as our focus has been less on penis-in-vagina sex. However, one of the clinching moments for going ahead with the implant was a conversation in which I asked her how long she envisioned us having sex and how important it was to her. She couldn't come up with a specific number but said she was nowhere near ready to do without sex in the forseeable future, so I should plan on 15 years or more! And, like the majority of women, she has never been able to achieve orgasm from intercourse alone, but loves the feel of it nonetheless. I know younger people don't like to think about their parents or grandparents having sex, but given good health, the majority of people are sexually active into their eighties or even older that that. And let me promise you that you never feel as old as you look, and that for most of us, desire never goes away.

Although I think it is foolish, guys tend to be obsessed with the size of their penis. I think women would tell you that the 5 most important things about a penis are:

1. Hardness (outstanding with a 3 piece implant)
2. Hardness
3. Hardness
4. Hardness
5. Girth (which the implant will most likely increase noticeably)

I don't think length is something your partner is likely to be concerned about if you are 3" longer or more. As a physician who has done pelvic exams on women, I can feel their cervixes with my middle finger, which is 3.5" long (I have long fingers). The only spot inside the vagina which possibly causes pleasurable sensation for the woman is the famous "G spot", but it is only about 2" inside (and on the front wall of the vagina for the geographically impaired). A penis which is too large will typically be a much greater concern for a woman than one which is too small. Comments are welcomed on this point from any women who lurk on this site.

You can NOT increase your length with an implant, and you risk some nasty complications if am implant which is too large is used. The head of your penis may be softer (thus smaller) than previously, and the biggest implant which isn't too big might be slightly shorter than your natural cavity, but I would think the most you would lose in good hands is 1-2 cm.

My implant is an AMS CX, which has the capability to expand in girth, but not length. Probably the most common implant currently is the AMS LGX, which has the capability to expand in both girth and length--to the maximum size of your natural cavity. This might give a slight increase in length in some cases compared to the CX (likely not more than 1 cm). My surgeon's opinion is that the CX has fewer complications than the LGX for patients with Peyronie's, such as myself.

The best predictor of your post-op length is your stretched flaccid length. Stretch it out, plant the butt of the ruler firmly against your pubic bone and measure. This is the most you should expect.

I think that men who say they have lost substantial length are thinking of their penis as it once was, before being shortened by disease, disuse, or as a consequence of prostate surgery. Unless of course, they had an incompetent surgeon. I think that those who claim to have increased size have not obtained their natural maximum in so long that doing so seems like an increase in length.

Also remember that the more belly fat you have, the more of your penis is concealed. Reaching a trim weight will maximize the apparent size of your penis. Lots of other good medical reasons to maintain an optimal weight, but perhaps this one will register more than some of those other very good reasons.

My pre-op flaccid length was about 3 inches, post-op partially flaccid length is 4.5 inches and clearly more girth. My implant was kept inflated to around 80% until the day following the surgery. I didn't have my ruler at the hospital (imagine that), but partially inflated it felt stiffer than I have attained in a long time, very straight, and appeared to be 5.5 to 6". My stretched flaccid length pre-op was about 6.25 inches with the base of the ruler pressed firmly against the pubic bone. I'm totally confident that size will be fine. Now comes the really hard part, impatiently waiting while things heal before I can use it.

I hope this information and the pictures which follow are useful. I certainly pored over every account I could find anywhere on the web before making my decision, and greatly appreciate everyone who has shared their story.


My surgery was on 3/3/10. The first week went well, more or less daily improvement. On day 7 post-op (3/10) I had a really good day, did quite a bit of walking and thought maybe I was capable of doing my office-based job as a physician. That night I had more significant aching in the testicles than I had experienced in a while. I put a cold pack over my testicles and penis when I went to bed, which relieved the discomfort nicely, BUT when I woke up in the morning, I had a aching, moderately nauseating pain, as if I had been kicked in the balls 30 seconds before, only it persisted for a couple of hours. I ended up taking hydrocodone for the first time in 3 or 4 days, slept for a couple of hours, and have basically not had a return of that kind of discomfort--but I have also not applied cold to the region again..

Application of cold tightens (and shrinks LOL) everything up in the genital region, as we all know. What I am wondering is if by applying cold for a sustained period, that the ultimate result was to basically pull the pump harder against my testicle, resulting in the discomfort I had on day 8 post-op. Anybody wish to comment on this and the use of heat and cold in general?

Day 9 and day 10 I have ambulated more, and I drove for the first time (my surgeon wanted me to wait at least a week for that) today. I drove about 30 minutes each way, which didn't seem to bother me, shopped for about 30 minutes, and had lunch at a restaurant. By the time I got back home I was having minor discomfort, which is responding well to the use of a heating pad, as that sort of discomfort has the last few days. It seems that being vertical and having gravity dragging on the new junk in the trunk bothers me more than anything else.

Actually the shopping was to find some briefs which work best while my recuperation continues and my body gets used to my larger package. I am not a boxer guy, and I think boxers wouldn't be good during recovery. However my briefs seem to be of 2 types--too large/loose (gravity pulls on me) and too small/tight (initially feels good, but compresses the pump against the testicle too much). I have lost 29 pounds (deliberately) over the last 3-4 months, which explains the briefs which are too loose, and the too tight ones are ones I have left from when I weighed another 15 pounds less than I do now. Any practical words of wisdom from the vets on underwear choices, or the general management of the recovering package? I have seen some comments that it takes weeks to months before you stop noticing the new equipment--anyone wish to comment on that?

And lastly, what about return to work? I will be returning to work on Monday, 12 days post-op. I feel confident that I will be able to manage my office-based work, which doesn't require any prolonged standing (and fortunately I am at a lovely point in my life where I work 4 days, 30 hours), but I suspect by the end of the day I will be eager to get home, put my feet up, and apply my heating pad. My doctor has said that I should not do any significant lifting, vigorous exercise, and the like for 4-6 weeks post-op. So, generally speaking, I would guess that for the average person, return to office work can likely be done in 7-14 days (sooner for working from home--I have been responding to emails and phone calls since the 2nd day post-op). Probably 14-28 days for returning to work requiring a lot of walking or standing or driving, and probably 28-42 days for returning to heavy work (climbing ladders, lifting heavy objects, turning big valves, etc.). This is all a guess on my part, and there is probably significant individual variation. Again I would welcome comments from those who have been through this.

Best wishes to all,
Ben


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