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Mental models like schemata buy 25mg doxepin with amex anxiety 4th, paradigms buy 75mg doxepin fast delivery anxiety symptoms 5 yr old, perspectives, beliefs and viewpoints, according to Nonaka and Takeuchi, help individuals perceive and define their world. The technical element of tacit knowledge includes concrete know-how, crafts, and skills. However, explicit knowledge is about past events or objects “there and then,” and is seen to be created sequentially by “digital” activity that is theory progressive. It derives from their model of the conversion process between tacit and explicit knowledge, and results in a cycle of knowledge creation. The conversion process involves four processes: socialization, externalization, combination, and internalization, all of which convert between tacit and/or explicit knowledge. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Typology of knowledge Expression of Explicit Knowledge Tacit Knowledge knowledge type Objective Subjective Nonaka and Rationality (mind) Experiential (body) Takeuchi Sequential (there and then) Simultaneous (here and now) Drawn from theory (digital) Practice related (analogue) Codified, formally transmittable in Personal, context specific, hard to formalize and systematic language. Cognitive (mental models), technical (concrete know-how), vision of the future, mobilization process Formal and transferable, deriving in part Informal, determined through contextual experience. It will Alternative from context related information be unique to the viewer having the experience. The transferable except through recreating the experiences context is therefore part of the patterns. The SECI cycle of knowledge creation (Nonaka & Takeuchi, 1995) Tacit Knowledge Explicit Knowledge Socialisation Externalisation Existential; face-to-face Reflective; peer-to-peer Tacit Creates sympathised Creates conceptual knowledge Knowledge knowledge through sharing through knowledge articulation experiences, and development using language. Language unnecessary Internalisation Combination Collective: on-site Systemic; collaborative Creates operational Creates systemic knowledge Explicit knowledge through learning through the systemising of ideas. Explicit knowledge May involve many media, and like manuals or verbal stories can lead to new knowledge helpful through adding, combining & categorising Socialization is the processes by which synthesized knowledge is created through the sharing of experiences that people have as they develop shared mental models and technical skills. Since it is fundamentally experiential, it connects people through their tacit knowledge. 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.

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ED is also associated with hypertension discount doxepin 10 mg online anxiety symptoms brain fog, an- In the United States approximately 10 million men tihypertensive therapy discount doxepin 10mg on-line anxiety while sleeping, and diabetes mellitus, particu- have ED. While many advances have oc- Several therapeutic agents, especially those that af- curred in the diagnosis and treatment of ED, other fect neurotransmitter activity (both agonist and antago- aspects remain poorly understood by the general popu- nist) are often associated with ED. ED is fre- have been anecdotal, although 25% of ED may be drug- quently assumed to be a physiological event associated related. The mechanism or mechanisms of 735 736 VII DRUGS AFFECTING THE ENDOCRINE SYSTEM 5-Hydroxytryptamine (5-HT), dopamine, and nor- TABLE 64. Still other substances or hormones, such as endorphins, oxytocin, vasopressin, Therapeutic Class Drug or Drug Class adrenocorticotropic hormone (ACTH) and related peptides, and prolactin, appear to participate in the Antihypertensives Thiazide diuretics, -blockers, clonidine, methyldopa complex and coordinated process of penile erection. Antidepressants SSRIs, MAOIs Central nonadrenergic neurons also may influence male Antipsychotics Phenothiazines, thioxanthenes sexual behavior. Antianxiety agents Benzodiazepines Nitric oxide (NO) released during nonadrenergic, Hormones Estrogens, antiandrogens noncholinergic (NANC) neurotransmission and from Miscellaneous Alcohol, metoclopramide, opioids the vascular endothelium is most likely the major neu- SSRI, selective serotonin reuptake inhibitor; MAOI, monoamine rotransmitter mediating penile erection. An endothelium-derived relaxing factor (EDRF) in the peripheral vasculature also can induce relaxation of vascular smooth muscles. ED seems to be most frequently associated with release from the endothelial cell relaxes vascular antihypertensive medications, particularly -blockers smooth muscle by activating soluble guanylate cyclase, and thiazide diuretics. Estrogen therapy (see Chapter thereby increasing the production of the intracellular 61) and the use of antiandrogens (see Chapter 63) can messenger cGMP. The role of NO in the physiology of male sexual Paradoxically, selective serotonin reuptake inhibitors function establishes its importance as the principal (SSRIs) can be associated with ED while also being modulator of penile erection. Although other types of phos- phodiesterases are present in the corpus cavernosum, PHYSIOLOGY OF PENILE ERECTION they do not appear to play a significant physiological The physiology of penile erection involves an interplay role in erection. Penile erection is the result of exert their pharmacological actions by inhibiting the a complex interaction between the central nervous sys- breakdown of cGMP. Vardenifil (Levitra) is a particularly effective inhibitor The penis is mainly supplied by the internal puden- of PD-5. It has a shorter onset of action and can be used dal artery, and three major sets of veins, superficial, in- in smaller doses than sildenafil. Drug-induced treatment of ED exert their effects through other bio- changes in neurotransmitter action can affect local chemical pathways, both central and peripheral. Vascular supply, intrinsic smooth muscles of the penis, and adjacent striated muscles are controlled by nerves arising from the thoracolumbar sympathetic, INDIVIDUAL AGENTS the lumbosacral parasympathetic, and the lumbosacral somatic systems. The pudendal nerve is the major so- The pharmacological agents useful in this disorder may matic pathway innervating the male genitalia. Such a classification system takes into ac- ripheral nerves, central neural pathways are involved in count the mode of drug action, the route of administra- the process. These central mechanisms interact during tion, and the means by which target organ selectivity is normal sexual activity and require complex coordina- achieved. Earlier measures often employed the intracaver- 64 Drugs Used in the Treatment of Erectile Dysfunction 737 TABLE 64. PGE1) III Central conditioner Compounds that act mainly to improve the internal milieu of the CNS so that pe- nile erection is enabled or enhanced, they do not on their own initiate an erec- tion (e. The injection does not appear to produce plications were frequently required for satisfactory any long-term side effects on penile smooth muscle. Compounds with relatively short dura- (alprostadil urethral suppository or medicated urethral tion of action were found to be less than satisfactory in system for erection) is also an effective therapeutic maintaining penile erections. The intracav- to take advantage of the differing onset and duration of ernosal injection of alprostadil (e. A rapid onset of ac- Edex, Viridal) is safe and effective in patients with ED tion and a sufficient duration are important characteris- when sildenafil is ineffective. MUSE can agents that are orally effective have been available for also be used in conjunction with a penile constrictor de- about 20 years, but sildenafil and apomorphine (buccal) vice (e. Apomorphine Apomorphine (Uprima) is a short-acting central and pe- Alprostadil ripheral dopamine receptor agonist that can elicit male Alprostadil (prostaglandin E1 [PGE1]; Edex, Topiglan) sexual responses. Dopamine appears to have an impor- exerts a number of effects, including systemic vasodila- tant role in normal erectile function. Apomorphine is a tion, inhibition of platelet aggregation, and stimulation D1-like, D2-like dopamine receptor agonist. PGE1 relaxes isolated smooth is not a new drug, and it has been used with limited suc- muscle cells contracted by norepinephrine.

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Multicellular organisms have cell layers that Anionic macromolecules like albumin order doxepin 25mg online anxiety symptoms quitting smoking, which are responsible for separating the “interior” must remain in the bloodstream because of its from the “exterior” of the organism and its colloidosmoticaction(! The epithelia of skin and by the wall charges at the intercellular spaces gastrointestinal 25mg doxepin mastercard anxiety relief techniques, urogenital and respiratory and, in some cases, at the fenestra. This requires selec- tive transcellular transport with import into the cell followed by export from the cell. Apical functional complex 1 Apical Microvilli Tight Para- junction cellular transport See (2) Cell 2 Actin- Zonula myosin adherens Cell 1 belt Epithelial cells (e. A1) in all (dC/dx)—decreases with distance, as was ex- directions throughout a solvent. Net diffusion plained above, the time required for diffusion or selective transport can occur only when the increases exponentially with the distance solute concentration at the starting point is traveled (t#x ). A2), but net diffusion is zero because there is equal if the above-water partial pressure of free O2 flux in both directions. A2)iskeptconstant,thePo2inthe diffusion is, therefore, a concentration gra- water and overlying gas layer will eventually dient. Hence, diffusion equalizes concentra- equalize and net diffusion will cease (diffusion tion differences and requires a driving force: equilibrium). B1) (Po )2 rises, and O2 can diffuse further containing different concentrations (Ca"C )b downwardintothenextO -poorlayerofwater2 of an uncharged solute. Since the steepness of the Po2 profile or gradient (dPo /2 pores are permeable to the molecules of the dx) decreases (exponentially) in each sub- dissolvedsubstance,themoleculeswilldiffuse sequent layer situated at distance x from the from a to b, with Ca–Cb = ∆C representing the O2 source (! Ifweconsideronlythe feasible for transport across short distances spaces a and b (while ignoring the gradients within the body. Diffusion in liquids is slower dC/dx in the pore, as shown in B2, for the sake than in gases. According to the Stokes–Einstein equation, When diffusion occurs through the lipid the coefficient of diffusion (D) is derived from T, membraneofacell,onemustconsiderthathy- η, and r as drophilic substances in the membrane are sparingly soluble (compare intramembrane R! Diffusion in homogeneous media 1 Brownian particle movement (~T) 2 Passive transport 3 PO2 profile Gas O2 PO2 O2 O2 O2 PO2 0 Slope=gradient P =dP/dx X PO2 x Water P x 0 Distance from O2 source (x) B. Diffusion through porous membranes 1 Porous membrane 2 Space a Space b Ca Cb Gradient Cb Pore Ca Space a Membrane Space b ∆x a b C –C =∆C C. Diffusion through lipid membranes 1 2 5nm Hydrophilic Hydrophobic substance X substance Y CXa (k<1) (k>1) CYa Gradient Gradient b CX CYb Lipid Lipid Water membrane Water Water membrane Water Equilibrium concentration in olive oil k = Equilibrium concentration in water 2121 (Partly after S. Schultz) Despopoulos, Color Atlas of Physiology © 2003 Thieme All rights reserved. Since the pH of a solution deter- stance will diffuse through a pure phospholipid mines whether these substances will be bilayer membrane. The electrical therefore have a decisive effect on the permeability potential difference can be a driving force of of the membrane. In that case, posi- tively charged ions (cations) will then migrate Since the value of the variables k, D, and ∆x to the negatively charged side of the mem- within the body generally cannot be deter- brane, and negatively charged ions (anions) mined, they are usually summarized as the will migrate to the positively charged side. The permeability coefficient P, where prerequisite for this type of transport is, of D –1 course, that the membrane contain ion chan- P! Facilitated diffusion 3•10–5 Methanol Triethyl citrate Ethanol Facilitated diffusion Trimethyl citrate (seeG. Passive carrier transport Carrier H+ + NH4+ protein NH4++ H+ NH3 NH3 H+ + HCOO– HCOO–+ H+ HCOOH HCOOH (after a conformational change) (! As in ration and is specific for structurally similar simple diffusion, a concentration gradient is substances that may competitively inhibit one necessary for such carrier-mediated transport another. They which allow the passage of small ions and can occur only if the membrane is water-per- molecules(σ=0;seebelow),butnotofplasma meable. Their concentra- pressure differences (∆π and ∆P) across the tion difference leads to an oncotic pressure membrane to drive the fluids through it. Therefore,fil- Osmotic flow equals the hydraulic conduc- tration can occur only if ∆P"∆π (! Since ∆Cosm, the Larger molecules such as proteins are entirely driving force for osmosis, is a negative value, JV reflected, and σ = 1 (!

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