By H. Hjalte. Holy Cross College, Notre Dame Indiana.

More of the miner- GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1287 Manic depression see Bipolar disorder KEY TERMS tadacip 20mg discount erectile dysfunction doctor in pune. Marigold see Calendula Calcium—A mineral necessary for strong bones and the proper functioning of organs and muscles purchase 20 mg tadacip mastercard erectile dysfunction 5-htp. Osteoporosis—An age-related disease in which bones become fragile and prone to debilitating Marijuana fractures. Description Pancreas—An organ behind the stomach that pro- Marijuana (marihuana), Cannabis sativa L. The term hashish, is derived from the BOOKS name for the Saracen soldiers, called hashashins, who Murray, Michael T. Indian hemp cal Significance of Reduced Manganese and Zinc Levels grows to a height of about 4 ft (1. The hairy leaves are arranged Loss in Postmenopausal Women Supplemented with Cal- opposite one another on the erect and branching stem. The resinous blossoms have five NIH Osteoporosis and Related Bone Diseases National Re- sepals and five petals. Commerce in hemp, which was primarily valued for the Marijuana has been cultivated for thousands of years. By 1621, the British pharmacopoeia is a book containing a list of medicinal were growing cannabis in Virginia where cultivation of drugs, and their descriptions of preparation and use. In 1776, the Declaration of Inde- Cannabis was called a “superior” herb by the Emperor pendence was drafted on hemp paper. Cannabis was recommended as a treat- were advocates of hemp as a valuable cash crop. By period in Egypt, cannabis was used as a treatment for the 1850s, hemp had become the third largest agricultur- sore eyes. Census of that gious ceremonies, and recorded in Sanskrit scriptural year recorded 8,327 hemp plantations, each with 2,000 texts around 1,400 B. Restric- cannabis as a remedy to treat inflammation, earache, and tions on the personal use of cannabis as a mood-altering, edema (swelling of a body part due to collection of flu- psychoactive herb, were soon to come. They called the herb Controversy kannabis and inhaled the “intoxicating vapor” that result- The 1856 edition of the Encyclopedia Britannica, in its ed when it was burned. Utah was the first state to criminalize it, then Emperor Nero, named the herb Cannabis sativa and California and Texas. New York ry, the Chinese physician Hoa-Tho, used cannabis in sur- prohibited cannabis use in 1927. In ancient India, around 600, Sanskrit writers recorded a In 1937, the federal government passed the Marijua- recipe for “pills of gaiety,” a combination of hemp and na Tax Act, prohibiting the cultivation and farming of sugar. This use of cannabis as a Secretary of the Treasury Andrew Mellon, who was also durable and renewable source of paper fiber continued a banker for the DuPont Corporation. The By the 1300s, government and religious authorities, 1937 Marijuana Transfer Tax Bill prohibited industrial concerned about the psychoactive effects on citizens and medical use of marijuana and classified the flower- consuming the herb, were placing harsh restrictions on ing tops as narcotic, and restrictions on the cultivation its use. Cannabis cultivation con- United States, 1966 reported that 641,642 Americans tinued, however, because of its economic value. A little were arrested for marijuana offenses that year, with as more than a century later, the English Queen Elizabeth I many as 85% of these arrests for simple possession, issued a decree commanding that landowners holding 60 rather than cultivation or commerce. GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1289 In a reversal of the state-by-state progression of crim- stituents of cannabis displayed antimicrobial action and inalizing marijuana that led to the 1937 Marijuana Trans- antibacterial effects in research studies. The components fer Tax Bill, there is a movement underway, state by state, CBC and d-9-tetrahydrocannabinol have been shown to to endorse the legalized use of medical marijuana. By destroy and inhibit the growth of streptococci and 1992, 35 states in the United States had endorsed referen- staphylococci bacteria. A growing body of scientific re- In 2002, the Dutch government announced that a search and many thousands of years of folk use support small trial would begin in the country to study the effects the importance of medical marijuana in treatment of a va- of medical marijuana on patients with multiple riety of illnesses, and the economic value of hemp in the sclerosis. After extending the number of participants in textile, paper, and cordage industries has a long history. The World Health Organization, in a 1998 study, stated that the risks from Cannabis contains chemical compounds known as cannabis use were unlikely to seriously compare to the cannabinoids. Different cannabinoids seem to exert dif- public health risks of the legal drugs, alcohol and tobac- ferent effects on the body after ingestion. And despite thousands of years of human consump- search indicates that these substances have potential tion, not one death has been directly attributed to therapeutic value for pain relief, control of nausea and cannabis use. Bakalar, JD, in a 1995 Journal of the American agent identified to date is 9-tetrahydrocannabinol, known Medical Association article, “Marijuana is also far less as THC.

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The use of a dichotomous division of a continuous scale may help determine whether a patient has achieved a clinically significant benefit purchase 20mg tadacip fast delivery erectile dysfunction causes premature ejaculation. Studies must have sufficient statistical power to ensure that a lack of a treatment effect results from a lack of biological effect of the intervention and is not due to insufficient sample size generic 20 mg tadacip visa erectile dysfunction doctor in patna. The mean sample size per trial of the 178 controlled clinical trials for acute ischemic stroke performed up until 1999 was 415 patients. Phase I trials are conducted in healthy volunteers to determine whether untoward toxicity is present and to evaluate the maximal tolerated dose. Phase II studies are performed in persons who have the disease and include questions focused on dose finding, safety, and potential efficacy. In contrast, stroke patients are most frequently elderly, where age-related changes in cerebral dynamics and vasculature can significantly affect toxicity as well as pharmacokinetics and regional cerebral blood flow. Therefore, the inclusion of healthy elderly patients in Phase I trials may help avoid under-recognition of potential side effects in the eventual target population. Phase IIb trials are important for refining patient selection, dose, route, timing, duration of therapy, and for better understanding of side effects, pharmacokinetics, and drug interactions. A “cocktail” of therapies may need to be developed and tested to address these potential overlapping therapeutic windows. For example, the combination of a thrombolytic agent and a neuroprotectant may increase the chances of the latter drug reaching the site of injury within the required time window. For example, the admin- istration of insulin with the noncompetitive NMDA antagonist, dizocilpine, in dia- betic rats following ischemia resulted in additive neuroprotective effects. Hypoperfusion in the core and penumbra accounts for a greater proportion of the resulting injury than the subse- quent degradative processes that occur in the penumbral region. Other approaches include mechanical clot disruption and the use of suction devices, lasers, and ultrasound. In one study, the penumbral region accounted for 18% of the final infarct volume; the remaining 82% of the affected brain tissure was critically hypoperfused (70%) or sufficiently perfused (12%). MRI techniques such as diffusion–perfusion weighted imaging, MR spectroscopy, and CT perfusion may prove more useful in detecting salvageable brain as part of routine clinical practice. The combination of NMDA antagonists with AMPA or kainate receptor antagonists may confer protection to oligodendrocytes and GABAergic neurons with Ca2+-permeable AMPA receptors. For example, ifen- prodil acts on NR2B-containing NMDA receptors and they are expressed in greater proportions in the forebrain compared to the hindbrain. Calpains are also receiving attention because they are proteolytic enzymes acti- vated by calcium and may be potential targets for therapeutic agents. Calpain inhibitors including AK275, AK295, and MDL 28,170 are neuroprotective following ischemia in rats. The agents include superoxide dismutase, catalase, glutathione, iron chelators, vitamin E, alphaphenyl nitrogen (PBN), dimethylthiourea, oxypu- rinol, and tirilazad mesylate. They may act by reducing cytotoxic and vasogenic brain edema, aiding in Ca2+ homeostasis reestablishment, and antagonizing glutamate excitotoxicity. This leads to the activation of poly (ADP-ribose) polymerase (PARP), a repair enzyme that depletes cellular nicotinamide adenine dinucleotide (NAD+) and ATP. It has also been hypothesized that because PARP activation involves NAD+ that then depletes the metabolic pool of NADH, enhancing the pool of NAD+ may contribute to enhanced cell functioning. Several papers have suggested that direct nicotinamide treatment may be effective at replet- ing the pool of metabolic NADH and also facilitating the repair processes of PARP. FMK) that are not caspase selective and also block cathepsins reduce behav- ioral and cellular deficits as well as infarct volume following focal ischemia. For example, the combined administration of dextrorphan and cycloheximide reduced infarct volume following transient ischemia (MCAO) in rats by 87%, which was greater than the reduction resulting from the use of either agent alone (~65%). One consequence of zinc exposure is an increase in dihydroxy-acetone phosphate, a glycolytic intermediate, that in turn causes a decrease in neuronal ATP levels. It has been suggested that the administration of pyruvate, an energy substrate, can help ease the ATP loss. It has been postulated that the failure of calcium channel antag- onists may in part be due to perturbations in zinc levels following ischemic injury.

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Conclusions This is a good point to return to the hospital wing joke that we introduced this chapter with generic tadacip 20mg with visa erectile dysfunction icd 10. We have argued that for healthcare perspectives to be coordinated there is a need to share knowledge generic 20mg tadacip visa impotence age 40, and we have explored the knowledge sharing possibilities for healthcare staff. However, the capability for organizations to share knowledge requires that healthcare organizations need to develop a capacity to recognize and use knowledge for patients and staff as well as organizationally. Organizational knowledge exists by virtue of the individuals associated with it, and there is a need to recognize that knowledge creation and sharing involves processes of knowledge migration, where knowledge transmitted in a communication from one individual to another also may not be the knowledge that is assembled. There is a difference in the way knowledge creation is structured, whether one adopts a positivist or another epistemology. The ideas of Nonaka and Takeuchi would appear quite influential in the development of a theory of knowledge creation. While they are constructivist in their perception of each phase process, they are overall structurally positivist. It is not uncommon to have this type of usually benign methodological schizophrenia, though it may well be more aesthetic not to. An alternative approach that is fundamentally critical (even though it entertains the notion of control) and that does not suffer from the above problem derives from viable systems theory. This does not see knowledge creation as a set of sequential steps, but rather as a set of phases that are constantly tested and examined through possibly complex feedback. Shifts from one phase to another may occur according to the control phenomena that drive particular perspectives. There are parallels between our proposed knowledge cycle (Figure 4) and that of Nonaka and Takeuchi (Figure 3). In the former knowledge can be created spontaneously within a migration process, and any socialization process that occurs is through communication that may be seen to act as a trigger for new knowledge. Unlike that of Nonaka and Takeuchi, our cycle is not required to be sequential continuous relative to a conditioning process. Rather, the process of continuity is transferred to the communication process, and knowledge creation is cybernetic, passing through feedback processes that can change the very nature of the patterns of meanings that were initiated through the semantic communications. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Telemedicine and its role in improving communication in healthcare, Logistics Information Management, 15(4), 309-319. Knowledge management, organizational learning and HR strategy: A model and case studies. Total quality management in the national health service: Final report of an evaluation. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. The knowledge-creating company: How Japanese companies create the dynamics of innovation. The cult of information: A Neo-Ludite treatise on high-tech, artificial intelligence, and the true art of thinking. Do we practise what we preach: Are knowledge management systems in practice truly reflective of knowledge management systems in theory? Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Thus, it can be argued that issues such as Data Management, Data Modeling, and Knowledge Management have a long way to go before reaching the maturity level that other technologies have achieved in the medical sector. This chapter proposes to explore trends and best practices regarding knowledge management from the viewpoint of Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Key Performance Indicators and Information Flow 117 performance management, based upon the use of Key Performance Indicators in healthcare systems.

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