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economies according to 331 criteria measuring how nations create and maintain conditions favorable to businesses2 And despite the nancial body blows it has taken recently, the United States still has arguably the world s most sophisticated economy and nancial system Moreover, the United States is the global vanguard of venture capital and technology as well as the leader in measures of individual productivity across many key industries While the global credit crisis, bank failures, and mounting government de cits seem ominous, they are hardly intractable The United States has a uniquely entrepreneurial and pragmatic culture, nding the means to reinvent itself even at the darkest hour US business has always been adept at Joseph Schumpeter s creative destruction the Darwinian process whereby visionary, radical innovation continuously propels the economy forward; this must become an integral feature of our government as well For much of the last decade, the United States intoxicating postCold War con dence as the world s sole superpower deluded our government into believing that we could control globalization by sheer will This has proven to be a myopic and unfortunate miscalculation Now, the United States must begin to dismantle entrenched Micro Domestic attitudes Even if these strategies brought success 50 years ago, we must part with them in search of something more tting for today s very different world More important, these changes could serve as a model for the world to emulate The United States is still in many ways the world s leader, but clearly the recent administration has misconstrued the source of this power The esteem the United States has been afforded by the international community comes not from brute economic and military strength, as recent of cials have believed, but the enduring admiration, trust, and respect its pioneering form has garnered during the twentieth century The United States has long been viewed as both experiment and inspiration Even as early as 1630, famous Puritan preacher John Winthrop told the members of the Pilgrim settlement in Massachusetts that they would serve as a city upon a hill, a standard for the rest of the world As the United States settles into maturity after 230-plus years as an independent entity, it must ght off the inertia of old habits and remember its role as a great innovator and leader While global markets deal with the credit crisis triggered by America s subprime woes, United States leadership on the nancial front may be truly appreciated by the world.

Ejaculatory Disorders terminating intercourse due to pain), and reviewing the conditions under which the man is able to ejaculate, (eg during sleep, with masturbation, with partner s hand or mouth stimulation, or infrequently, with varying coital positions) Domains related to the psychologic and relationship issues commonly associated with IE (identi ed in the previous section) require investigation Thus, the developmental course of the problem, including predisposing issues of religiosity, and variables that improve or worsen performance, particularly those related to psychosexual arousal, should be noted Coital and masturbatory patterns, perceived partner attractiveness, the use of fantasy during sex, and anxiety surrounding performance, require exploration If orgasmic attainment had been possible previously, the clinician should review the life events/circumstances temporally related to orgasmic cessation events in question, which may be pharmaceuticals, illness, or a variety of life stressors and other psychologic factors previously highlighted in the section on etiology Generally, a complete evaluation should identify all possible predisposing, precipitating, and maintaining factors for the dysfunction Since many men attempt their own remedies, the patient s previous approaches to improving ejaculatory response should be investigated, including the use of herbal or folk therapies, prior treatments, and home remedies (eg using particular cognitive or behavioral strategies) Information regarding the partners perception of the problem and their satisfaction with the overall relationship is often helpful Once this body of knowledge is complete, an appropriate treatment plan, developed in conjunction with the couple, can be implemented

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The man who presents with inhibited ejaculation, in whom organic and pharmacologic causes have been eliminated by careful medical assessment and investigation, requires thorough psychosexual assessment If he is in a relationship, his partner, and the quality of the relationship, also require evaluation Numerous psychotherapeutic processes are described for the management of inhibited ejaculation, but none has been properly evaluated [11,18,89,93]

One factor preventing the United States from abandoning the Micro Domestic paradigm is simply how charmed and effortless our lives have been under this old perspective Few alive today remember rsthand the Great Depression or World Wars I or II Postwar babies have grown up bathed in prosperity, free to pursue individual happiness, but this has sometimes translated into unsustainable instant material grati cation, mountains of debt, and displays of angry, armed aggression Today, the circumstances have changed What if such attitudes were to spread globally How would we deal with a world where 67 billion people pursue happiness through thoughtless consumption, and countries ex their military muscles to enforce their national agendas Happiness is surely more than endless consumption with no regard for the true quantum costs to others So what policies do we craft to achieve a more thoughtful, responsible happiness To answer these questions requires new modes of thinking, and new ways of measuring where the United States stands, where it is going and how far it is from where it wants to be Many critics have noted the structural aws inherent in our economic metrics for measuring progress and failure Our Macro Quantum world requires different ways to analyze root causes to problems, identify possible solutions, and monitor and evaluate policies and their outcomes To move forward, we will need to view the world through radically different lenses and monitor ourselves on a new, multigauged dashboard Driving with only a speedometer might tell us how fast we re going, but it doesn t tell us if we re going in the right direction or if we have enough fuel to get there

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