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However infection of the cervix purchase 400 mg norfloxacin visa, for such individuals who are unacclimatized to a heavy heat load over long periods of time-such as that resulting from infrequent heavy physical activity at high temperature and humidity over several hours-additional sodium may be needed virus life cycle order norfloxacin 400 mg with mastercard. Sodium intake invariably rises with increased energy intake in physically active individuals and this increase usually is enough to compensate for sweat sodium losses infection journal impact factor effective norfloxacin 400mg. While iodine from iodized table salt has been available in the United States and Canada since the 1920s antibiotics ear drops purchase 400mg norfloxacin overnight delivery, the extent to which iodized salt currently contributes to meeting iodine needs is unknown. Iodide was originally added to table salt in order to address the problem of endemic goiter, a problem found in the Great Lakes region and the Pacific Northwest. However, in the United States and Canada, the current food supply is not restricted to locally grown products and now includes foods grown in multiple regions and countries, thus making iodine more available. If iodine intakes appear to decline, food vehicles other than table salt can be considered as a means of providing additional iodine. Other forms of sodium that contribute to the total sodium content of food include monosodium glutamate (a constituent of soy sauce) and food additives, such as sodium benzoate, sodium nitrite, and sodium acid pyrophosphate. Sodium bicarbonate and sodium citrate (the anion of which is converted in the body to bicarbonate) are ingested as food additives and can be consumed, sometimes in substantial amounts, as antacids and as alkali therapy for correcting or preventing metabolic acidosis, such as that occurring in chronic kidney disease. A survey of commercially available North American and European bottled waters found an average sodium content of 0. Example of foods that contain high levels of sodium, primarily as sodium chloride added in processing, include luncheon meats and hot dogs (0. Sodium chloride and other sodium-containing food additives (such as those mentioned previously) are also present in condiments, such as Worcestershire sauce, soy sauce, ketchup, onion salt, garlic salt, sea salt, and bouillon cubes, usually to enhance the flavor of foods. While various forms of sodium are often added during food processing to improve flavor, many sodium-containing additives also have functional roles (Marsden, 1980). Sodium chloride added to yeast bread is essential for dough to rise and it helps control the growth of undesirable bacteria and molds. It also functions as a dough conditioner to strengthen the protein in dough (gluten), which allows it to hold air and not collapse. Other sodium additives, such as sodium bicarbonate and sodium aluminum phosphate, are used as leavening agents in nonyeast breads. Sodium chloride decreases the water activity of foods, thus helping to control the growth of pathogenic bacteria (Jay, 1996). Sodium chloride is thus used as a preservative in meats and is necessary to make fermented products. Only about 12 percent of the total sodium chloride consumed is naturally occurring (Mattes and Donnelly, 1991). It has been further estimated that the majority (77 percent of total salt) is consumed as a result of processing, while 6 percent is added while eating, 5 percent is added during cooking, and less than 1 percent is consumed from tap water. The estimated dietary sodium intakes of both white and African American men and women in the United States were similar (Appendix Tables D-9 and D-10). Median intakes for sodium based on survey data on usual intakes of sodium for ten provinces in Canada in 1990­1999 (Appendix Table F-3) ranged from 2. It should be emphasized that these estimates of self-reported sodium intake do not include salt added at the table and thus underestimate sodium intake for many individuals. This diet meets the Adequate Intake or Recommended Dietary Allowance for adult men and women for all nutrients for which one has been established (for fiber, it meets the ratio of 14 g /1,000 kcal), and provides energy nutrients within the acceptable macronutrient distribution ranges. To convert mg of sodium to mmol or mEq of sodium, divide the mg by 23 (the molecular weight of sodium). To convert mg of salt to mg of sodium, divide the mg by the percent of salt that is sodium (23/58. Worldwide, there has been even greater variation in sodium intake, ranging from an estimated mean intake of 0. There is a lack of data on average sodium intakes during pregnancy and only a few studies have reported sequentially measured urinary sodium excretion. In view of the interactive effects of sodium and potassium highlighted in this report, it is useful to examine intakes of sodium and potassium expressed as the ratio of sodium intake (in mmol/day) to potassium intake (mmol/day) for the various lifestage groups. The ratio then rises rapidly to just above two for children 4 through 8 years of age, and remains above two into adulthood, but then drops somewhat in middle- and older-aged adults. The progressive rise in this ratio at an early age reflects a greater increase in dietary sodium intake compared with the increase in dietary potassium intake. Other dietary factors that raise blood pressure are excess weight, inadequate potassium intake, high alcohol consumption, and a suboptimal dietary pattern (see the following sections).

This framework makes explicit four of the key ways that new technologies might be used to augment human performance: (a) outside the body (environmental); (b) outside the body (personal); (c) inside the body (temporary); (d) inside the body (permanent) antibiotics for acne dry skin order norfloxacin 400 mg amex. This framework will be shown to be largely about how and where information is encoded and exchanged: (i) info: bits and the digital 104 B infection x private server order 400mg norfloxacin. Expanding Human Cognition and Communication environment virus buster order norfloxacin 400mg on-line, (ii) cogno-socio: brains and memes and the social environments jm109 antibiotic resistance discount 400mg norfloxacin mastercard, (iii) nano-bio: bacteria and genes and the bioenvironment, (iv) nano-cogno: bulk atoms, designed artifacts, and the physical environments. The Outside-Inside Framework and Future Imaginings the Outside-Inside framework consists of four categories of human performanceenhancing technologies: · · · Outside the body and environmental Outside the body and personal Inside the body and temporary · Inside the body and permanent In this section, while briefly describing the categories and subcategories, some extremely speculative visions of the future will be discussed to help stretch our imaginations before "coming back to earth" in the last section to discuss more practical and near term possibilities. Readers are encouraged to view this section as a number of imagination challenges and to create their own answers to questions like what new materials, agents, places, mediators, ingestibles, senses, and species might come to be in the next few decades. Also, it is worth noting that while futurists may be overestimating the desirability and feasibility of how quickly, if ever, we can achieve many of their visions, we are probably collectively underestimating the impact of many of the smaller technological steps along the way. Finally, as an example of improving human performance, the task of learning will be considered, focusing on the way existing and imaginary technologies may improve our ability to learn and/or perform more intelligently. People perform tasks in a variety of environmental contexts or places, such as homes, offices, farms, factories, hotels, banks, schools, churches, restaurants, amusement parks, cars, submarines, aircraft, space stations, and a host of other environments that have been augmented by what is termed here environmental technologies. From the materials that are used to construct the buildings and artifacts at these locations to the agents (people, domesticated animals) that provide services in these locations to the very nature of the places themselves, environmental technologies account for most of the advances in human performance that have occurred in the past 500 generations of recorded history (most of us overlap and therefore experience only about five generations of perspectives from grandparents to grandchildren). For the task of learning, consider the important roles that the three innovations - paper (material), teachers (agents), and schools (places) - have had on education. For a thoughtprovoking vision of where new materials could lead, the reader is directed to the currently infeasible but intriguing notion of "utility fog" developed by Rutgers computer science professor J. Smaller than dust, "foglets" are speculative tiny interlocking machines that can run "programs" that make collections of billions of them work together to assume any shape, color, and texture, from flowing, clear water to fancy seat belt body suits that appear only when an accident has occurred. If utility fog were a reality, most artifacts could be made invisible until needed, making them quite portable. There would be no need to carry luggage on trips; one could simply create clothes out of utility fog. Materializing objects out of thin air (or fog), while wildly infeasible today, nevertheless provides an interesting springboard for imagining some of the ultimate human-computer interfaces (such as a second skin covering human bodies, eyes, ears, mouth, nose, and skin) that may someday exist. Perhaps these ultimate interfaces might connect us to telerobotic versions of ourselves assembled out of utility fog in distance places. For example, multi-cellular organisms provide a vast library of examples of the ways cells can be interlinked and grouped to produce shapes, textures, and macroscopic mechanical structures. Social insects like ants have been observed to interlink to solve problems in their environments. And while I`m unaware of any types of airborne bacteria that can spontaneously cluster into large groups, I suspect that mechanisms that bacteria and slime molds use for connecting in various arrangements may one day allow us to create new kinds of smart materials. Hopefully the notion of utility fog has served its brainstorming purpose of imagination stretching, and there are a number of related but nearer term investigations underway. Some of the most important agents we interact with daily are role-specialized people and businesses (organization as agent). The legal process of incorporating a business or nonprofit organization is essentially equivalent to setting up a fictitious person with specialized rights, responsibilities, and capabilities. The notion of new agents was an active area of discussion among the workshop participants: from the implications of digital personae (assumed identities on-line) to artificial intelligence and robotics, as well as the evolution of new types of organizations. Undoubtedly, as technology evolves, more digital cloning of aspects of human interactions will occur. An army of trusted agents that can interact on our behalf has the potential to be very empowering as well as the potential to be quite difficult to 106 B. Expanding Human Cognition and Communication update and maintain synchrony with the real you. What happens when a learning agent that is an extension of you becomes more knowledgeable about a subject than you? The exploration of the physical world (trade connecting ancient civilization, New World, the Wild West, Antarctica, the oceans, the moon, etc. Moving beyond the physical world, science fiction writer William Gibson first defined the term cyberspace. The free thinking artist and futurist Jaron Lanier, who coined the term virtual reality, and many other people have worked to transform the science fiction notion of cyberspace into working virtual reality technologies.

Furthermore infection hyperglycemia buy norfloxacin 400mg on-line, these trials highlight the potential benefit of increased potassium intake in African Americans antimicrobial jobs 400 mg norfloxacin, who have a higher prevalence of hypertension and of salt sensitivity and a lower intake of potassium than non-African Americans antibiotic mic generic norfloxacin 400mg without a prescription. Predictably antibiotics groups purchase 400mg norfloxacin with amex, over the range of dietary potassium evaluated in the study of salt sensitivity (Figure 5-1), the serum concentration of potassium remained well within the normal range, increasing only minimally (from 3. It has been postulated that such dose-dependent suppression of salt sensitivity might prevent or delay the occurrence of hypertension (Berenson et al. In hypertensive individuals, potassium supplementation can mitigate the pressor effect of sodium chloride (Iimura et al. The antipressor effect of dietary potassium may in part result from its natriuretic effects (Morris et al. As mentioned earlier, potassium acts directly on the renal tubule to increase the urinary excretion of sodium chloride (Brandis et al. Blood Pressure Epidemiological Evidence Numerous observational studies (Table 5-2) have examined the relationship between blood pressure and dietary potassium intakes, or urinary potassium excretion, used as a proxy of intake (Ascherio et al. Many, but not all, studies documented an inverse association-that is, a higher intake of potassium that was associated with lower blood pressure. While blood pressure is inversely associated with potassium intake and directly associated with sodium intake and the sodium:potassium ratio, blood pressure is typically more closely associated with the sodium:potassium ratio than intake of either electrolyte alone. Evidence from Intervention Studies Results from intervention studies demonstrate that potassium can reduce blood pressure in nonhypertensive (Tables 5-3 and 5-4) as well as hypertensive individuals (Tables 5-3 and 5-5). Table 5-3 provides corresponding results for studies in which potassium was increased through diet, while Tables 5-4 and 5-5 provide corresponding results for studies in which potassium was increased by use of potassium supplements. Although the trials in Tables 5-4 and 5-5 tested the effect of supplemental potassium, their findings are assumed to apply to potassium from foods as well. Because of the potential for confounding from concomitant changes in other nutrients. Hence, total intake of potassium from diet and supplements in some of the studies is unknown. It should also be recognized that none of the studies listed in Tables 5-3, 5-4, or 5-5 provide more than two levels of potassium; thus a doseresponse assessment within the same study is unavailable. In the absence of large-scale trials, pooling of the results of small clinical trials provides a more statistically precise estimate of intervention effects and allows for the exploration of the basis for heterogeneity in outcome effects. At least three major meta-analyses of the effects of oral potassium in the treatment and prevention of human hypertension have been conducted (Cappuccio and MacGregor, 1991; Geleijnse et al. Both assessed the potential input of confounders, while the analysis by Whelton presented data from individual trials, including estimates of potassium intake. Of the 33 trials included in the meta-analysis by Whelton and coworkers (1997) (see studies marked in Tables 5-3 and 5-5), there were 2,609 African-American and white participants (18 to 79 years of age). Hypertensive patients received antihypertensive medications concurrently in 4 of the 21 trials. As such, there was little capacity to compare the efficacy of different potassium salts. In this small, placebo-controlled trial, neither form of potassium significantly affected blood pressure. Average net change in urinary sodium excretion for the intervention versus control ranged from ­55 to +44 mmol (­1. There was an intervention-related trend toward a reduction in systolic blood pressure in 26 of the 32 trials (81 percent), and in 11 trials (34 percent) the reduction in blood pressure was statistically significant. For diastolic blood pressure, an intervention-related trend toward reduction in blood pressure was noted in 24 of 33 trials (73 percent), and in 11 trials (30 percent) the reduction was statistically significant. Overall pooled estimates of the effects of potassium supplementation on systolic and diastolic blood pressure were ­4. When the analysis was restricted to the 29 trials with a documented intervention-related net change in urinary potassium greater than or equal to 20 mmol (0. These effect size estimates were also higher when analyses were restricted to the 29 trials in nonhypertensive and hypertensive individuals in whom no antihypertensive medications were administered (Whelton et al. In subgroup analyses, there was a trend toward greater treatmentrelated reductions in systolic and diastolic blood pressure at higher levels of urinary sodium excretion during follow-up (p < 0.

In turn antimicrobial mouthwash order 400mg norfloxacin visa, this affects the reliability and reproducibility with which one oocyst or cyst can be enumerated in a sample volume antibiotic resistance uptodate cheap norfloxacin 400mg on line. Poor reproducibility contributes to increased uncertainty as the density approaches the minimum detection limit antibiotics for sinus infection in toddlers buy 400mg norfloxacin fast delivery. For these reasons antibiotics empty stomach cheap norfloxacin 400mg without a prescription, enumeration methods for microbes introduce a sufficiently high level of uncertainty that the details of those methods need to be discussed in the context of their effect on the risk assessment. Genetic Diversity of Pathogens Microorganisms are genetically diverse and allelic ratios in a population can change significantly within a few generations. In addition, microbial genomes can evolve quickly (within days or weeks) through mutation or horizontal gene transfer. Microbes can, thus represent a "moving target" because the distribution of strains and virulence factors can fluctuate rapidly in a given water body (Loewe et al. Variation found in the environment can also depend on different sources and types of microbial pollution. In addition microbes can acquire antibiotic resistance, which affects the range of clinical treatments that are possible and can render normally treatable illnesses life threatening. Host Immunity and Susceptibility Human hosts can have different susceptibilities to infection by particular pathogens, and levels of immunity against different pathogen species and strains may differ widely. Although body weight, age, and metabolic capacity differences are considered in the development of chemical criteria, genetic and acquired differences in susceptibility are not usually considered. Infection and illness due to pathogens are, in some cases, highly dependent on the immune status of the individual, which can fluctuate based on the time since the last exposure, presence of concurrent infections. For some pathogens, previous exposure may provide additional protection from that pathogen as a result of increased host immunity (Soller and Eisenberg, 2008). Dose-Response Range can be Broad the levels of pathogens required to cause infection and/or disease can vary substantially across pathogen species. Even within a particular species, those levels can vary by orders of magnitude, depending on the strain. The possible host responses may encompass asymptomatic infection, symptomatic infection (illness or disease, including chronic sequelae), and even death. For example, although human dose-response data for six isolates of Cryptosporidium are available. Secondary Transmission Microbial infections can be transmitted from an individual to other susceptible individuals, and even to some animals. With the exception of the mother-fetus relationship, chemicals in tissues of 15 Microbial Risk Assessment Tools U. Some microbes can remain viable for days, weeks, or months, in the environment, which increases the potential for transmission. For some pathogens, humans can become asymptomatic chronic carriers and thus can infect others and contaminate food and water sources without displaying symptoms themselves for prolonged periods. Heterogeneous Spatial and Temporal Distribution Pathogens are typically heterogeneous in environmental matrices. Whereas most soluble chemicals diffuse evenly in water matrices, pathogens may clump or may be embedded in or attached to organic and inorganic particulate debris, making density determinations difficult. Also, many types of pathogens occur only episodically in drinking and source waters (and in ambient waters as well) and typically can be found only during short-lived disease outbreaks. Seasonal increases in the environment cause water or wastewater to be contaminated episodically, through breakdowns in wastewater management or water contamination controls. Seasonal fluctuations are thought to occur due to fluctuations in factors such as precipitation, temperature, nutrient availability, human activity, and livestock events. The episodic nature of contamination makes calculation of relative sources of microbial contamination less useful than relative source contribution for chemicals. Zoonotic Potential Many, but not all pathogens also infect and amplify in animals. There is evidence that these zoonotic pathogens may change in infectivity, virulence, and the severity of disease caused in humans depending on their previous host environment. There is also evidence that some of these host-factor changes can influence subsequent infection cycles in exposed hosts (U. There are six key waterborne zoonotic pathogens in the United States, Salmonella, Campylobacter, pathogenic E.

Ventilatory volume is increased by physical activity antibiotic list norfloxacin 400 mg with mastercard, hypoxia antibiotic cream for dogs buy norfloxacin 400 mg lowest price, and hypercapnia viruses generic 400mg norfloxacin with amex, whereas the water vapor pressure is modified by the ambient temperature antibiotic for skin infection discount norfloxacin 400mg on line, humidity, and barometric pressure. Physical activity generally has a greater effect on respiratory water loss than do environmental factors. Daily respiratory water loss averages about 250 to 350 mL/day for sedentary persons, but can increase to 500 to 600 mL/day for active persons living in temperate2 climates at sea level (Hoyt and Honig, 1996). For these conditions, respiratory water loss (y = mL/ day) can be predicted from metabolic rate (x = kcal/day) by the equation y = 0. High altitude exposure (greater than 4,300 m, 448 mm Hg) can further increase respiratory water losses by approximately 200 mL/day (Hoyt and Honig, 1996). Breathing hot, dry air during intense physical exercise can increase respiratory water losses by 120 to 300 mL/day (Mitchell et al. Breathing cold, dry air during rest and stressful physical exercise (Table 4-3) can increase respiratory water losses by approximately 5 mL/hour and approximately 15 to 45 mL/hour, respectively (Freund and Young, 1996). Freund and Young (1996) have calculated that for a 24-hour military scenario (8 hours of rest, 12 hours of moderate activity, and 4 hours of moderate-heavy activity), the respiratory water losses increase by approximately 340 mL/day when breathing ­20°C versus +25°C air. Renal fluid output can vary depending upon the specific macronutrient, salt, and water load. However, for persons consuming an average North American diet, some of these effects may not be discernable (Luft et al. Since there is a limit to how much the kidneys can concentrate urine, the minimal amount of water needed is determined by the quantity of end products that need to be excreted. For dehydrated subjects living in hot weather, minimum daily urine outputs can be less than 500 mL/day (Adolph, 1947b). Urine output generally averages 1 to 2 L/day but can reach 20 L/ day in those consuming large quantities of fluid (West, 1990). Healthy older individuals, however, cannot concentrate urine as well as young individuals and thus have a higher minimum urine output. For example, older men and women (mean age 79 years) had lower maximal urine osmolalities of 808 and 843 mOsm/kg, respectively, compared with 1,089 mOsm/kg for young men (mean age 24 years). This corresponds to higher minimum urine outputs of 700 and 1,086 mL/day for the older men and women compared with 392 mL/day for the young men (Dontas et al. The apex of this hyperbolic relationship approximates a urine output of approximately 50 mL/hour. For example, investigators have reported that urine output can transiently increase to approximately 600 to 1,000 mL/hour with water loading (Freund et al. Urine output can vary widely to maintain total body water; however, there are clearly limits to the amount of conservation and excretion. Exercise and heat strain will reduce urine output by 20 to 60 percent (Convertino, 1991; Mittleman, 1996; Zambraski, 1996), while cold and hypoxia will increase urine output (Freund and Young, 1996; Hoyt and Honig, 1996). Gastrointestinal and thus fecal water loss in healthy adults is approximately 100 to 200 mL/day (Newburgh et al. Insensible and Sweat Losses Water loss through the skin occurs via insensible diffusion and secreted sweat. For the average adult, loss of water by insensible diffusion is approximately 450 mL/day (Kuno, 1956). During heat stress, eccrine sweat glands secrete sweat onto the skin surface, which cools the body when water evaporates from the sweat. For a given hot weather condition, the required sweating rate for evaporative cooling is dependent upon the physical activity level (metabolic rate). The following calculations provide the minimal sweat produced by persons performing moderately heavy (metabolic rate 600 W) exercise in the heat (Sawka et al. If the activity is 20 percent efficient, the remaining 80 percent of metabolic energy produced is converted to heat in the body so that 480 W (0. The specific heat of body tissue (amount of energy required for 1 kg of tissue to increase temperature by 1°C) approximates 3.

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