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By M. Kor-Shach. Charter Oak State College.

Since it is fundamentally experiential cheap clarinex 5 mg with amex, it connects people through their tacit knowledge generic clarinex 5 mg without prescription. Here, the creation of conceptual knowledge occurs through knowledge articu- lation, in a communication process that uses language in dialogue and with collective reflection. The uses of expressions of communication are often inadequate, inconsistent, and insufficient. They leave gaps between images and expression while promoting reflection and interaction. The next process is combination, when explicit knowledge is transformed through its integration by adding, combining and categorizing knowledge. Finally, in the next process explicit knowledge is made tacit, by its internaliza- Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. This is a learning process, which occurs through the behavioral development of operational knowledge. The different types of knowledge process are seen as phases in a knowledge creation cycle. This can generate signals of ambiguity and redundancy that inhibits the “improvement” of knowledge. The sharing of redundant information promotes a sharing of tacit knowledge when individuals sense what others are trying to articulate. Thus, five factors condition the knowledge cycle enabling it to maintain developmental motion. A Viable Approach to Knowledge Creation The structured spiral of knowledge creation offered by Nonaka and Takeuchi adopts a positivist perspective. An alternative critical approach is possible that links closely with the viable system model of Figure 1. In addressing this, we note that each of the three domains have associated with them its own knowledge process, one connected with cognition, one with organizing, and one with behavior. This notion is consistent with Marshall (1995), whose interest lies in knowledge schema. For this purpose, Marshall identifies three types of knowledge: • Identification knowledge—the facts and concepts making up the knowledge domain • Elaboration knowledge—the relationships between the individual knowledge components and the way they are organized • Execution knowledge—the conceptual skills and procedures required to execute an activity Marshall does not attempt to address knowledge creation, though we shall do so through our own model. We consider that in social group situations, knowledge creation occurs through a process of knowledge migration from one worldview to another. It links to Table 1, and depicts the three fundamental phases of the knowledge process: migration, accommodation, and action. Migration is associated with the cog- nitive domain, accommodation with the organizing domain, and action with the behav- Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. The knowledge cycle Re-migration of knowledge(recursive) influence Knowledge contagion migration interconnection re-interconnection purpose (recursive) Knowledge accommodation Knowledgable action intention application re-appreciation (reursive) ioral domain. The way that migration occurs is conditioned by cognitive influence, accommodation though cognitive purpose, and action through cognitive intention. A feedback control process is able to condition each phase process directly, or through its input. The way that each phase process is conditioned by the feedback control is represented symbolically in Figure 6 by a loop around the process bubble, and we shall return to this in a moment. The structured spiral of knowledge creation offered by Nonaka and Takeuchi adopts a positivist perspective. An alternative critical approach is possible that links closely with the 3-domain model of Figure 7. Ontological expression for knowledge migration cycle Autogenesis and principles Autopoiesis and self- of contagion that guide the production logical network development of common of knowledge action shared knowledge processes involving tactics Existential domain Pattern of Phenomenal domain knowledge of Virtual domain Knowledgeable action actor A1 Knowledge supported by Structural accommodation through facilitating structures coupling shared models enabling knowledge Pattern of migration knowledge of through actor A2 Autopoiesis and regeneration of lifeworld logical networks of knowledge interconnection action processes to develop shared patterns Autogenesis and regeneration of knowledge principles of contagion through reformation of shared knowledge Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. This notion is consistent with that of Marshall (1995) in connection with knowledge schema. Marshall applies her ideas on knowledge schema to decision-making by people rather than by social groups.

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GPIIb/IIIA- successful blocker yes Standard therapy -blocker buy clarinex 5 mg line, ACE-inhibitor generic 5 mg clarinex with amex, optional heparin Blood pressure (BP) A. Treatment of hypotension Normal state Osteoporosis Organic bone matrix, Osteoid Bone mineral: hydroxyapatite In postmenopause Calcium-salts Estrogen 1 – 1. If we break up a living organism by isolating its different parts, it is only for the sake of ease in analysis and by no means in order to conceive them separately. Indeed, when we wish to ascribe to a physiologicalqualityitsvalueandtruesignificance,wemustalwaysreferittothewholeanddrawour final conclusions only in relation to its effects on the whole. This is Internal Environment achieved by moving its pseudopodia or The existence of unicellular organisms is the flagella, for example, in response to changes in epitome of life in its simplest form. Nonetheless, the individual cells of hydrophilic components in watery solutions the body still need a milieu like that of the inside and outside the cell. Today, the within the cell membrane ensure the perme- extracellular fluid is responsible for providing ability of the membrane barrier. B), but exist in the form of pores (channels) or as more the volume of the fluid is no longer infinite. In complex transport proteins known as carriers fact, it is even smaller than the intracellular (! Because of their metabolic tain substances, and their activity is usually activity, the cells would quickly deplete the regulated. The cell membrane is relatively well oxygen and nutrient stores within the fluids permeable to hydrophobic molecules such as and flood their surroundings with waste prod- gases. This is useful for the exchange of O2 and ucts if organs capable of maintaining a stable CO2 and for the uptake of lipophilic signal sub- internal environment had not developed. This stances,yetexposesthecelltopoisonousgases is achieved through homeostasis, a process by such as carbon monoxide (CO) and lipophilic which physiologic self-regulatory mecha- noxae such as organic solvents. The cell mem- nisms (see below) maintain steady states in brane also contains other proteins—namely, the body through coordinated physiological receptors and enzymes. Specialized organs ensure the con- nals from the external environment and con- tinuous absorption of nutrients, electrolytes vey the information to the interior of the cell and water and the excretion of waste products (signal transduction), and enzymes enable the via the urine and feces. Or- constant, although the organism absorbs gans such as the digestive tract and liver ab- nutrients from it and excretes waste into it. In sorb nutrients and make them available by 2 spite of its simple structure, the unicellular or- processing, metabolizing and distributing! Unicellular organism in the constant external environment of the primordial sea Substance absorption Primordial Signal reception and excretion sea Heat Ion exchange Genome Digestion Water O2 Exchange Motility of gases CO2 Excretion B. Maintenance of a stable internal environment in humans Integrationthrough External signals nervous system and hormones O2 CO2 Emissionof Exchange heat Internal of gases (water, salt) signals Behavior Regulation Lungs Blood Extra- Skin cellular Interstice space Intracellular space Uptake of nutrients, water, salts, etc. Kidney Distribution Excretion of excess – water Waste and – salts toxins Liver – acids Digestive Excretionof 33 tract waste and toxins Despopoulos, Color Atlas of Physiology © 2003 Thieme All rights reserved. The lung is re- Although behavioral science, sociology, and sponsible for the exchange of gases (O2 intake, psychology are disciplines that border on CO2 elimination), the liver and kidney for the physiology, true bridges between them and excretion of waste and foreign substances, and physiology have been established only in ex- the skin for the release of heat. In order to have useful cooperation between The specialization of cells and organs for the specialized organs of the body, their func- specific tasks naturally requires integration, tions must be adjusted to meet specific needs. Control implies that a humoral transfer of information (hormones), controlled variable such as the blood pressure and transmission of electrical signals in the is subject to selective external modification, nervous system, to name a few examples. Because many other factors and disposal and thereby maintain a stable in- also affect the blood pressure and heart rate, ternal environment, even under conditions of the controlled variable can only be kept con- extremely high demand and stress. Moreover, stant by continuously measuring the current they control and regulate functions that en- blood pressure, comparing it with the refer- suresurvivalinthesenseofpreservationofthe ence signal (set point), and continuously cor- species. If the blood pressure clude not only the timely development of re- drops—due, for example, to rapidly standing productive organs and the availability of fertil- up from a recumbent position—the heart rate izable gametes at sexual maturity, but also the will increase until the blood pressure has been control of erection, ejaculation, fertilization, reasonably adjusted. Others include the coordination has risen above a certain limit, the heart rate of functions in the mother and fetus during willdecreaseagainandthebloodpressurewill pregnancy and regulation of the birth process normalize. It consists of a controller signals from peripheral sensors (single with a programmed set-point value (target sensory cells or sensory organs), activates out- value) and control elements (effectors) that can wardly directed effectors (e. The system also includes sensors that continu- The CNS is the focus of attention when study- ously measure the actual value of the con- inghumanoranimalbehavior. Ithelpsustolo- trolled variable of interest and report it (feed- cate food and water and protects us from heat back)tothecontroller,whichcomparestheac- orcold. Thecentralnervoussystemalsoplaysa tual value of the controlled variable with the role in partner selection, concern for offspring set-point value and makes the necessary ad- evenlongaftertheirbirth,andintegrationinto justments if disturbance-related discrepancies social systems. The control system operates development, expression, and processing of eitherfromwithintheorganitself(autoregula- emotions such as desire, listlessness, curiosity, tion) or via a superordinate organ such as the wishfulness, happiness, anger, wrath, and central nervous system or hormone glands.

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Once ab- Lead Peripheral and central neurotoxicity buy clarinex 5mg otc, kid- sorbed generic clarinex 5mg on-line, they tend to concentrate in the brain, and CNS ney damage, anemia dysfunction is common at high exposures. Symptoms Mercury Pneumonitis, neuropsychiatric toxicity (ex- can range from confusion to unconsciousness. Solvents Elemental citability, emotional instability, depres- often undergo bioactivation and may cause systemic sion, insomnia), motor dysfunction (tremors) toxicity as a result of the formation of reactive interme- Organic Sensory neuropathy (dysarthia, paresthe- diates. Common targets for pesticides include insects, *Representative toxicities are presented; for most metals, other weeds (herbicides), fungi, and rodents. Nature of the toxici- pesticides often affects professional exterminators, agri- ties is dependent on level of exposure, whether the exposure is acute or chronic, and the route of exposure. In general, toxicity is related to the Insecticides form of the metal (inorganic, organic, or elemental), the route of exposure, and the route of excretion. This persistence allows toxic con- Solvents are generally classified as aliphatic or aro- centrations to build up in nontarget organisms. The respiratory distress syndrome appearing 1 or 2 weeks mechanism of inhibition is similar, but the reaction is re- after poisoning. Acute renal failure, liver toxicity, and gastroin- Herbicides and Rodenticides testinal damage are sequelae to diquat poisoning. Warfarin, a coumarin anticoagulant, is incorporated Herbicidal activity generally consists of interference into cornmeal for use as a rat poison. Thus, mam- sure results in sufficient inhibition of prothrombin syn- malian toxicity is generally low and not predictable thesis to cause fatal internal hemorrhage. In contrast, rodenticide target selectivity is not based on differences in biochemistry between humans and rodents but rather APPLICATIONS OF TOXICOLOGICAL on differences in physiology or behavior, especially PRINCIPLES feeding behavior. For example, an emetic may be in- cluded in a rodenticide formulation to promote vomit- Health professionals may be asked to provide an opin- ing in humans who accidentally consume the product; ion of the cause and effect relationship between expo- rodents do not have a vomit reflex. Certain noxyacetic acid (2,4-D) and 2,4,5-trichlorophenoxy- principles, including an assessment of temporality, acetic acid (2,4,5-T), were used in defoliating operations should be considered in such an evaluation. Do the 70 I GENERAL PRINCIPLES OF PHARMACOLOGY symptoms or disease follow the exposure within a properties, quantitative consideration of the total dose proper time frame? Was the dose high toxicological properties of the substance should be in- enough to produce health effects? Does the xenobiotic possess properties that can ity of alternate causes of the health problems must be logically be expected to cause the damage or disease in investigated carefully. If appropriate, drug side ation of the types of symptoms, injury, or disease that effects should be considered as a possible cause of the may occur after exposure can be predicted based on the adverse health effects. Lifestyle and avocations also available toxicological data or known biological activity must be evaluated. If the toxicity or disease does not fit ated by a thorough and frequently tedious review of into this known profile, a causal relationship between complete medical, occupational, and social records of the chemical and the problem should be questioned fur- the patient. Which of surrounded by chemical containers left by the pre- the following chemicals present in the workplace vious owners. On examination you noted bron- (A) Solvents used in dental adhesives choconstriction and profuse airway secretion, weak- (B) Fluoride used in oral rinses ness of the muscles, difficulty breathing, and CNS (C) Mercury used in the preparation of amalgams depression. A patient learned recently that she is about 5 weeks (A) Compound 1080 pregnant, but because she has been suffering from (B) Pyrethrin depression, she asks her physician for a prescription (C) Parathion for a drug to treat this problem. You are a staff physician at a major chemical manu- concerned that the fetus is at risk for toxicity from facturing company. What is the most crew has complained of being light-headed and likely adverse outcome if the woman began taking tired occasionally at work and that if it occurs, it the drug at this time? Exposure to one such pollutant, (B) Insecticide packaging area carbon monoxide, can result in which of the follow- (C) Label printing area ing conditions? The exposed work- fection due to impairment in phagocyte function ers were agitated and irritable and said to be having (C) Exacerbation of asthmatic episodes because of difficulty walking in a coordinated manner. Some bronchoconstriction feel quite hot as if they are burning up, and one had (D) Hypoxia due to displacing oxygen from hemo- a seizure. A 4-year-old boy is taken to the emergency depart- (B) Insecticide packaging area ment by his parents in the afternoon the first (C) Label printing area Saturday in June.

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