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When expressed on a weight basis birth control diarrhea 0.15 mg levlen with amex, the cardiac capacity for K1 uptake is comparable with that of skeletal muscle under conditions of K1 depletion and may actually exceed skeletal muscle under control conditions birth control late period purchase discount levlen on line. The bulk of filtered K1 is reabsorbed in the proximal tubule and loop of Henle birth control for women after 40 quality levlen 0.15mg, such that less than 10% of the filtered load reaches the distal nephron birth control pills 2 order levlen visa. In the proximal tubule, K1 absorption is primarily passive and proportional to Na1 and water (Figure 3). K1 reabsorption in the thick ascending limb of Henle occurs through both transcellular and paracellular pathways. The transcellular component is mediated by K1 transport on the apical membrane Na1-K1-2Cl2 cotransporter (Figure 4). K1 secretion begins in the early distal convoluted tubule and progressively increases along the distal nephron into the cortical collecting duct (Figure 5). Most urinary K1 can be accounted for by electrogenic K1 secretion mediated by principal cells in the initial collecting duct and the cortical collecting duct (Figure 6). An electroneutral K 1 and Cl 2 cotransport mechanism is also present on the apical surface of the Renal Potassium Handling distal nephron (15). Under conditions of K1 depletion, reabsorption of K1 occurs in the collecting duct. Under most homeostatic conditions, K1 delivery to the distal nephron remains small and is fairly constant. By contrast, the rate of K1 secretion by the distal nephron varies and is regulated according to physiologic needs. The cellular determinants of K1 secretion in the principal cell include the intracellular K1 concentration, the luminal K1 concentration, the potential (voltage) difference across the luminal membrane, and the permeability of the luminal membrane for K1. Conditions that increase cellular K1 concentration, decrease luminal K1 concentration, or render the lumen more electronegative will increase the rate of K1 secretion. Conditions that increase the permeability of the luminal membrane for K1 will increase the rate of K1 secretion. Two principal determinants of K1 secretion are mineralocorticoid activity and distal delivery of Na1 and water. Aldosterone is the major mineralocorticoid in humans and affects several of the cellular determinants discussed above, leading to stimulation of K1 secretion. Second, aldosterone stimulates Na1 reabsorption across the luminal membrane, which increases the electronegativity of the lumen, thereby increasing the electrical gradient favoring K1 secretion. Lastly, aldosterone has a direct effect on the luminal membrane to increase K1 permeability (17). K1 reabsorption in the proximal tubule primarily occurs through the paracellular pathway. Active Na1 reabsorption drives net fluid reabsorption across the proximal tubule, which in turn, drives K1 reabsorption through a solvent drag mechanism. As fluid flows down the proximal tubule, the luminal voltage shifts from slightly negative to slightly positive. The shift in transepithelial voltage provides an additional driving force favoring K1 diffusion through the lowresistance paracellular pathway. Experimental studies suggest that there may be a small component of transcellular K1 transport; however, the significance of this pathway is not known. An apically located K1 channel functions to stabilize the cell negative potential, particularly in the setting of Na1-coupled cotransport of glucose and amino acids, which has a depolarizing effect on cell voltage. Some of the K1 entering the cell through the cotransporter exits the cell across the basolateral membrane, accounting for transcellular K1 reabsorption. This enzyme maintains the mineralocorticoid receptor free to only bind aldosterone by metabolizing cortisol to cortisone, the latter of which has no affinity for the receptor. Conditions that cause a low luminal Cl2 concentration increase K1 secretion through this mechanism, which occurs with delivery of poorly reabsorbable anions, such as sulfate, phosphate, or bicarbonate. The resultant high cell K1 concentration provides a favorable diffusion gradient for movement of K1 from the cell into the lumen. In addition to establishing a high intracellular K1 concentration, activity of this pump lowers intracellular Na1 concentration, thus maintaining a favorable diffusion gradient for movement of Na1 from the lumen into the cell. Both the movements of Na1 and K1 across the apical membrane occur through well defined Na1 and K1 channels. A second principal determinant affecting K1 secretion is the rate of distal delivery of Na1 and water.
Within this construct birth control pills long-term effects order 0.15mg levlen mastercard, criminal insurgency is defined as a means of removing the criminal enterprise from the control of the state birth control pills 84 days discount levlen generic, enabling it to pursue its goals to dominate the illicit economy birth control pills 2 safe 0.15 mg levlen. Here the illicit economy and globalization converge birth control zy generic levlen 0.15 mg fast delivery, conferring advantages to criminal enterprises. Essentially, the chapter is concerned with the potential for illicit networks to reconfigure states. Such reconfiguration could include erosion of state capacity (or the exploitation of a 171 Sullivan state capacity gap), corrupting and co-opting state organs (government, the police, the judiciary) in all or part of the state through the development of criminal enclaves, or, at the extreme edge, state failure. State reconfiguration appears to be a more common outcome than abject state capture or state failure. State capture (StC) involves criminals subverting and seizing control of key political functions at the central or national level (politicians, judges, police, etc. Coercion, political alliances (complementing or replacing bribery), and impacts on all branches and levels of government are core features of this dynamic. When officials are being captured and manipulated from outside, it is reproduced as an StC situation. Deviant Social Networks and Deviant Globalization Social networks are important elements of contemporary social and political processes. Certainly this is not new; social networks have been around since man began assembling in political groups at all levels of society. Members of networks can communicate across vast distances in real time, changing the pace and shape of their individual and collective influence. The importance of information age networks is a key to understanding emerging conflict. David Ronfeldt has argued that societies have moved through four distinct (albeit overlapping) phases of organization: tribes, institutions, markets, and networks. Manuel Castells has also outlined the rise of the networked, information society in his landmark trilogy the Information Age: Economy, Society, and Culture. Networks currently take two shapes: positive networks that inform civil society and dark side or negative networks that exploit society. Maras are essentially gangs; they are separate from cartels (which are more evolved enterprises that generally seek to dominate the illicit economy), although both interact. Maras frequently interact with, and are allied with, cartels to serve as transnational subcontractors or mercenaries for cartel organizations. Generations of Gangs limited local 1st Generation turf gang turf protection proto-netwarrior Politicization Internationalization 2nd Generation drug gang market protection emerging netwarrior evolved global 3rd Generation mercenary gang power/ nancial acquisition netwarrior more sophisticated less sophisticated Sophistication Source: John P Sullivan, "Third Generation Street Gangs: Turf, Cartels, and Net Warriors,"Transnational. Some discount the complex, networked nature of these gangs, but sensitive investigations have shown intricate, networked command and control relationships operating along a line of communication known as the "Bloody Triangle," which refers to Los Angeles, San Salvador, and Northern Virginia, where jailhouse coordinators in all three locations collaborate to authorize "green lights" for gang assassinations. These dimensions are usually present within specific cliques (nodes or subelements) of the mara network rather than an enterprise-wide objective. The aim is to dominate criminal enterprise and control the "plazas" or drug corridors, as well as battles with the state-both police and military-in order to operate freely. As noted in one paper: the cartels are joined by a variety of gangs in the quest to dominate the global criminal opportunity space. But the ungoverned, lawless zones they leave in their wake provide fertile ground for extremists and terrorists to exploit. They can and do have insurgent potential and are actively challenging the state in parts of Mexico and Latin America. Los Zetas, initially an enforcement arm of the Gulf Cartel, now operates as an independent enterprise while cross-border gangs vie for a piece of the action and alliances morph and shift as the battle of "all against all" progresses. The shifting alliances of Mexican drug cartels seem to be leading to the rise of competing alliances or "mega cartels. Drug cartels threaten to turn Mexico into a "narco-state" with rising lawlessness that echoes 1990s-era Colombia.
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Deguchi T birth control pills definition cheap levlen 0.15mg with amex, Ohtsuki S birth control pills 999 effective buy levlen cheap online, Otagiri M birth control benefits purchase levlen online, Takanaga H birth control pills jazz order levlen from india, Asaba H, Mori S, Terasaki T: Major role of organic anion transporter 3 in the transport of indoxyl sulfate in the kidney. Takeda M, Babu E, Narikawa S, Endou H: Interaction of human organic anion transporters with various cephalosporin antibiotics. Hering-Smith* Abstract Acid-base homeostasis and pH regulation are critical for both normal physiology and cell metabolism and function. The importance of this regulation is evidenced by a variety of physiologic derangements that occur when plasma pH is either high or low. The kidneys have the predominant role in regulating the systemic bicarbonate concentration and hence, the metabolic component of acid-base balance. The capacity to excrete ammonium under conditions of acid loads is quantitatively much greater than the capacity to increase titratable acid. Multiple, often redundant pathways and processes exist to regulate these renal functions. Derangements in acid-base homeostasis, however, are common in clinical medicine and can often be related to the systems involved in acid-base transport in the kidneys. Normally, systemic acid-base balance is well regulated with arterial pH between 7. On a cellular level, many essential cellular processes, metabolic enzymes, and transmembrane transport processes are highly pH sensitive. Although this review will address systemic pH regulation and the role of the kidneys, individual cells also have a variety of mechanisms to regulate their intracellular pH (4). Overall concepts will be emphasized rather than specific pathways or processes, which are well covered elsewhere; references are selective. In fact, this latter aspect of independent regulation is the most powerful aspect of this system. Phosphoric acid and sulfuric acid are significant products of this normal metabolism of dietary nutrients, such as proteins and phospholipids. To maintain acid-base homeostasis, these nonvolatile acids must be excreted by the kidney. Other nonvolatile acids, such as ketoacids and lactic acids, are produced in pathologic conditions. Endogenous acid production may be regulated, at least under certain circumstances (7); for instance, lactic acid and ketoacid production are decreased by a low pH. This likely accounts for the 12- to 24-hour delay in the maximal ventilatory response to metabolic acid-base disturbances. Decreases in ventilation may be limited because of a variety of clinical circumstances, such as lung disease, fluid overload, and central nervous system derangements. The capacity of the nephron to excrete acid as free protons is limited as illustrated by the fact that the concentration of protons (H1), even at a urine pH 4. Under normal conditions, approximately one-third to one-half of net acid excretion by the kidneys is in the form of titratable acid. Most H1 secretion occurs through Na1/H1 exchange, although a component of an H1 pump is also present. Many of these regulatory processes function to maintain acid-base homeostasis and are seemingly quite redundant; this is true in both the proximal and distal nephron segments.
As quasi-independent operators birth control pills 852 best purchase for levlen, super fixers are the key links in the chains that move illicit commodities-cocaine birth control pills how to take cheap levlen, blood diamonds birth control pills young age cheap levlen 0.15 mg with amex, "conflict" timber birth control for diabetes cheap levlen 0.15 mg overnight delivery, human beings-because they have the relationships to reach out and connect to the next concentric circle of actors. These operators are vital links-both for rebels in the jungle or for Afghan warlords who have no understanding of the outside world-to the market for their illicit commodities. The geopolitical importance of super fixers is only likely to increase in the coming decade. Any book on transnational organized crime must address the importance of money and of following the money. Both criminal and terrorist groups must raise, move, and hide or integrate their money. Investment in real estate also provides the illicit network with safe house capacity from which to execute operations. The crime-terror nexus is thought to be growing because terrorist groups act to take advantage of the money-raising and movement strategies of criminal groups. Current strategies to map and combat threat finance-criminal money laundering and terrorist financing-use the authorities of law enforcement, intelligence operations, public designation, and international cooperation with partner nations. Realuyo show how all of these strategies are essential for fighting transnational organized crime. The Attack on Sovereignty Illicit networks, with their associated crime and violence, are undermining and co-opting whole states, capturing the instruments of statecraft and state power to use for their own benefit. Several authors in this book describe the causes and conditions that result in the loss of control by legitimate governments. Sullivan discusses "the reconfiguration of power within states" and the impact of narcocultura. Fragile and consolidating states are at the greatest peril from the growing efficacy of illicit networks. With weak state institutions and incompetent or corrupt law enforcement organs, fragile and weak states often enjoy little support from their citizens. The public goods that states should provide such as personal security, dispute resolution, financial opportunity, and employment are as likely to be provided by cartels, gangs, militias, or insurgencies as by weak or fragile states. In countries where economies are stagnant and unable to provide gainful employment for burgeoning youth populations, illicit networks-that is, the agents of deviant globalization-have arguably as great a claim on public loyalty as the impotent state. In such cases, state sovereignty is supplanted by a different kind of legitimacy heralding a new and likely less benign sociopolitical order. State corruption ranges from criminal penetration, infiltration, capture, and, in the direst cases, state criminalization. In many cases, weak states may simply not have the ability to resist co-option by illicit organizations and networks. In other cases, violent nonstate actors can become a de facto government and provider of state services. Indeed, power has diffused and devolved to a wide range of nonstate actors within the global system and alongside the traditional holders of power, the states. While some of those actors-for example, international nongovernmental organizations and commercial enterprises-are undoubtedly quite comfortable working within the international system of nation-states, others are less benign, and some are even dedicated to overthrowing that system. Fighting this challenge to the state system is ever more daunting as states come to terms with their limited and declining capabilities. In most states, government xviii Introduction bureaucracies remain hierarchical and stove-piped while illicit networks are node-centric, agile, and opportunistic. Fighting Back Though national and international responses to the challenges described in this book may not have yet met the hopes of the more pessimistic contributors, key players are beginning to recognize the threats that converging illicit networks pose, and they are fighting back. To find new ways to tackle these threats, we must take a holistic look at what is currently being done by governments around the world. Government and many multinational organizations are taking decisive steps to attack the networks. The result is a convergence of threats that have evolved to become more complex, volatile, and destabilizing.