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V. Ford, M.B.A., M.B.B.S., M.H.S.

Professor, University of North Dakota School of Medicine and Health Sciences

His research has focused on the effects of diet on blood pressure: specifically, the effects of a reduced sodium intake, increased potassium intake, weight loss, and dietary patterns. Appel has been actively involved in several policy-making committees, including the U. He has published over 450 peerreviewed articles on the metabolism and requirements of various nutrients, including sulfur amino acids and sulfate. He has served on the editorial boards for the Journal of Nutrition, Journal of Animal Science, Poultry Science, and Nutrition Reviews. He was founder and director of the Department of Research and Sports Medicine at the Wingate Institute for Physical Education and Sport in Israel until assuming his current position in Canada. He has served as president of the Canadian Association of Sports Sciences and vice president of the American College of Sports Medicine. A major part of his research has focused on dehydration in children who exercise in the heat. Bar-Or is currently an editorial board member for a number of scientific journals. He has published numerous articles related to physiological changes related to aging and hydration in the elderly. He has received a number of awards and is a fellow of the Royal College of Physicians and Surgeons of Canada. He currently also serves as an associate professor of medicine and Director for Research at Harvard Medical School and its Division on Aging. Morris has published numerous scientific articles related to electrolytes, renal function, and hypertension and has testified on the role of dietary electrolytes in health before the U. He is also a member of several professional organizations, including the American Society of Hypertension and the American Society of Nephrology. He has published over 250 scientific papers and a graduate textbook on environmental physiology. Sawka is a member of several editorial boards, including those of the American Journal of Physiology, Journal of Applied Physiology, Medicine and Science in Sports and Exercise, and the International Journal of Sports Medicine. He serves on many scientific panels and professional committees and is an adjunct associate professor, Sargent College of Health and Rehabilitation Sciences, Boston University. Prior to her appointment at the University of Pennsylvania, she was an associate professor in the Department of Nutrition and director of the Center for Nutrition in Sport and Human Performance at the University of Massachusetts, Amherst. Volpe has published a number of research articles, reviews, and book chapters in her research areas of sports nutrition, mineral metabolism and exercise, weight loss, and body composition and has been invited to speak internationally and nationally on her research areas. Volpe is a fellow of the American College of Sports Medicine and a member of the American Society for Nutritional Sciences, the American Society of Clinical Nutrition, and the American Dietetic Association. Volpe was president of the New England American College of Sports Medicine from 2002 to 2003. Weinberger is a member of several editorial boards, including those of Hypertension and Journal of the American College of Nutrition. He has published over 200 scientific articles on hypertension, many of which relate to the roles of sodium and/or potassium. Weinberger received the Robert Tigerstedt Award from the American Society of Hypertension and the Page-Bradley Lifetime Achievement Award from the Council for High Blood Pressure Research of the American Heart Association for his research in hypertension. He was previously dean of the School of Public Health and Tropical Medicine and of the School of Medicine, both at Tulane University. He is an internationally recognized expert in the epidemiology, prevention, and treatment of cardiovascular and renal diseases. He has conducted a series of major research studies on hypertension prevention and management. Whelton has served as a consultant to many national and international health agencies and governments. See also Human milk; Lactation recommendations, 29-30, 43, 384 and water intakes from weaning foods, 526 Bronchitis, 372 C Caffeine, 7, 133-134, 226, 458 Calcium, 33 and blood pressure, 388, 389, 390 and bone mineral density, 190, 372, 374-375, 377 dietary intakes, 309 in drinking water, 127 epidemiological studies, 374-377 gender differences, 369 high-protein diet and, 369 intervention studies, 370-371 and kidney stones, 122, 123, 223, 372, 374-377 potassium and, 189, 190, 194, 218, 219, 221, 222, 224, 228, 229, 230, 240 sodium chloride and, 222, 299, 369372, 374-375, 377, 388, 389 supplements, 299, 389 urinary excretion, 240, 377 urolithiasis, 221-222 Calcium for Prevention of Preeclampsia trial, 245, 322-323 Canada dietary intake data, 48, 187, 245, 320, 394-395, 527-533 flavor preference in beverages, 103104 hypertension prevalence, 351 potassium intakes, 187, 245 reference nutrient values, 1, 449, 478 sulfate standard for drinking water, 442 water intakes, 6, 74, 160, 528-529 weights and heights, reference, 482483 Canadian National Institute of Nutrition, 478 Canadian Paediatric Society, 29-30, 43, 44 Carbamazepine, 299 Carbohydrate, 135, 309. See also Insulin and blood pressure, 16, 271, 272, 391-392 and cardiovascular disease, 300, 380 and dehydration, 136-137, 139 and hyperkalemia, 241, 242, 243, 252-253 and hyporeninemic hypoaldosteronism, 301 sodium and chloride and, 16, 300301, 380, 391-392 urine osmolality and, 100, 136 Diarrhea, 78, 94, 303, 424, 427, 433438, 440, 441 Dietary Approaches to Stop Hypertension. See also Formula, infant Framingham Heart Study, 365-566 Furosemide, 241, 299, 311 G Gallstones, 124 Gastric cancer, 372-373, 377, 395 Gastric emptying rate, 131-132 Gastrointestinal potassium-related discomfort, 247249, 252 water losses, 81-83 Gender differences. See also Blood pressure; Cardiovascular disease caffeine and, 134 children, 386 defined, 473 and diuretics, 227, 241 drug therapy thresholds, 325 guidelines for prevention and management, 378 interactions of electrolytes and, 229 intervention studies, 284-287 plasma renin activity, 284-287 prevalence, 354 prevention of, 197, 201, 203, 208211, 351-357, 378 and renal disease, 325-326, 392 sodium chloride and, 136, 195, 197, 201, 203, 208-211, 271, 282, 283, 301, 351-357, 380, 382, 391, 455 Hypertension Prevention Trial, 336337, 355, 356-357 Hyperthermia, 111 Hyperthyroidism, 442 Hypoaldosteronism, 243, 301 Hypocalciuria, 222, 229, 230 Hypochloremia, 280, 299 Hypocitraturia, 224-225 Hypohydration, 79, 473 Hypoinsulinemia, 243 Hypokalemia, 8, 38, 186, 192, 194-195, 227, 228, 238, 239, 241, 249, 280, 473 Hyponatremia, 74, 161-164, 281, 299, 300, 301, 315, 473 Hyporeninemia, 243 Hypotension, 136, 300 Hypovolemia, 98, 105, 115, 119 Hypoxia, 80, 83, 132 I Indicators of nutrient adequacy. See also specific indicators, nutrients, and life stages methodological considerations, 31, 42 risk reduction-based, 28-29 Infants, ages 0-12 months.

Primary and druginduced disorders of water homeostatis in psychiatric patients: Principles of diagnosis and management. Effects of weight reduction on selected anthropometric, physcial, and performance measures of wrestlers. Intake of fluids and methylxanthine-containing beverages: Association with colon cancer. Response to a fluid load in athletes with a history of exercise induced hyponatremia. The diuretic effects of alcohol and caffeine and total water intake misclassification. The effects of different levels of water deficit on physiological responses during heat stress. Oral water causes emptying of the human gallbladder through actions of vagal stimuli rather than motilin. Patterns of human drinking: Effects of exercise, water temperature, and food consumption. Role of plasma vasopressin in changes of water balance accompanying acute alcohol intoxication. The effect of acute thermal dehydration and rapid rehydration on isometric and isotonic endurance. The effect of weight loss by dehydration and the withholding of food on the physiologic responses of wrestlers. Validation of the deuterium dilution technique for the measurement of fluid intake in infants. Density of fat-free body mass: Relationship with race, age, and level of body fatness. Saliva flow rate, total protein concentration and osmolality as potential markers of whole body hydration status during progressive acute dehydration in humans. Angiotensin-converting enzyme inhibitor inhibits dehydration-enhanced fever induced by endotoxin in rats. Indices of dehydration among frail nursing home patients: Highly variable but stable over time. The limiting rate of assimilation of glucose introduced intravenously at constant speed in the resting dog. Effect of drink flavor and NaCl on voluntary drinking and hydration in boys exercising in the heat. Risk factors for lower urinary tract cancer: the role of total fluid consumption, nitrites and nitrosamines, and selected foods. Gallbladder dynamics and plasma cholecystokinin responses after meals, oral water, or sham feeding in healthy subjects. Yonemura K, Hishida A, Miyajima H, Tawarahara K, Mizoguchi K, Nishimura Y, Ohishi K. Water intoxication due to excessive water intake: Observation of initiation stage. Human vascular fluid responses to cold stress are not altered by cold acclimation. The adverse consequences of hypokalemia include cardiac arrhythmias, muscle weakness, and glucose intolerance. Moderate potassium deficiency, which typically occurs without hypokalemia, is characterized by increased blood pressure, increased salt sensitivity, 1 an increased risk of kidney stones, and increased bone turnover (as indicated by greater urinary calcium excretion and biochemical evidence of reduced bone formation and increased bone resorption). In unprocessed foods, the conjugate anions of potassium are mainly organic anions, such as citrate, that are converted in the body to bicarbonate. Hence an inadequate intake of potassium is also associated with reduced intake of bicarbonate precursors. Acting as a buffer, bicarbonate neutralizes diet-derived noncarbonic 1 In general terms, salt sensitivity is expressed as either the reduction in blood pressure in response to a lower salt intake or the rise in blood pressure in response to sodium loading. In the setting of an inadequate intake of bicarbonate precursors, buffers in the bone matrix neutralize the excess diet-derived acid, and in the process, bone becomes demineralized. Excess diet-derived acid titrates bone and leads to increased urinary calcium and reduced urinary citrate excretion. The resultant adverse clinical consequences are possibly increased bone demineralization and increased risk of calcium-containing kidney stones. Because the demonstrated effects of potassium often depend on the accompanying anion and because it is difficult to separate the effects of potassium from the effects of its accompanying anion, this report primarily focuses on research pertaining to nonchloride forms of potassium-the forms found naturally in fruits, vegetables, and other potassium-rich foods.

Death quickly follows when the midbrain centers controlling respiration and cardiac activity fail. Furthermore, animals presumably experience less fear and anxiety with methods that require little preparatory handling. However, physical methods usually require a more direct association of the operator with the animals to be euthanized, which can be offensive to , and upsetting for, the operator. Physical methods must be skillfully executed to ensure a quick and humane death, because failure to do so can cause substantial suffering. In summary, the cerebral cortex or equivalent structure(s) and associated subcortical structures must be functional for pain to be perceived. If the cerebral cortex is nonfunctional because of neuronal depression, hypoxia, or physical disruption, pain is not experienced. Reflex motor activity that may occur following loss of consciousness, although distressing to observers, is not perceived by the animal as pain or distress. Given that we are limited to applying euthanasia methods based on these 3 basic mechanisms, efforts should be directed toward educating individuals involved in the euthanasia process, achieving technical proficiency, and refining the application of existing methods. In small animals, particularly in animal shelter settings, verification of death may be supplemented by percutaneous cardiac puncture after the animal is unconscious. Failure of the needle and attached syringe to move after insertion into the heart (aspiration of blood provides evidence of correct location) indicates lack of cardiac muscle movement and death. Use of pentobarbital invokes legal responsibilities for veterinarians, animal shelters, and animal owners to properly dispose of animal remains after death. Animal remains containing pentobarbital are potentially poisonous for scavenging wildlife, including birds (eg, bald and golden eagles, vultures, hawk species, gulls, crows, ravens), carnivorous mammals (eg, bears, coyotes, martens, fishers, foxes, lynxes, bobcats, cougars), and domestic dogs. The Migratory Bird Treaty Act, the Endangered Species Act, and the Bald and Golden Eagle Protection Act may carry civil and criminal penalties, with fines in civil cases up to $25, 000 and in criminal cases up to $500, 000 and incarceration for up to 2 years. Rendered protein is used in animal feed for cattle, swine, poultry, fish, and companion animals, but products rendered from ruminants are prohibited by law for use in ruminant feed. Many pet food manufacturers have lowered their acceptance thresholds for barbiturate concentrations in rendered product. Advances in analytical chemistry have spawned increasingly sensitive assays, and pet food manufacturers are using these techniques to ensure the purity of the rendered protein incorporated in their products. Accordingly, increased analytical sensitivity has led many renderers to reconsider accepting horses euthanized using barbiturates. This places renderers and those wishing to employ rendering as a means of disposal for animals euthanized using pentobarbital in a difficult position, and may result in renderers being reluctant to accept more animal remains than they can reasonably manage without creating residue concerns. Alternatives for disposal of animal remains must be considered in advance, in case the renderer cannot or will not accept animal remains containing barbiturate residues. Composting is another means of disposing of animal remains that is becoming increasingly common. Studies examining the persistence of barbiturate residues in composted animal remains are few, but those that do exist suggest the persistence of the drugs in composted material. While the implications of this are still unclear, it does raise questions about potential environmental impacts in the case of animal health emergencies or mass mortality events. For example, pharmaceutical residues in animal remains other than barbiturates (eg, xylazine) may affect scavengers and can reduce the acceptability of the animal remains for renderers. Unfortunately, specific guidance from regulators regarding the use of such alternatives is limited. The persistence of antimicrobials in animal remains presents parallel concerns, particularly for animal remains that will be rendered. Appropriate diagnostic samples should be collected for testing, regulatory authorities must be contacted, and the animal remains must be incinerated (if possible). Personal protective equipment and precautions for handling biohazardous materials are recommended. Anthony R, University of Alaska Anchorage, Anchorage, Alaska: Personal communication, 2011.

A typical head and facies include low-set ears with overfolded helices, proptosis, and large cheeks, nose, mouth, and tongue. Other defects may involve a short neck, vertebral abnormalities, a shortened thorax, a large thymus, pulmonary hypoplasia, and deformations of the limbs such as clubfeet (talipes). The pituitary fossa is usually flattened; and the optic nerves are usually small or absent. Hypoplasia of the adrenal cortex is a constant finding from 16 weeks of development. It is due to hypoplasia of the fetal zone caused by the absence of the hypothalamus and the consequent abnormal regulatory function of the pituitary gland. Renal defects consist of hydronephrosis, polycystic kidney, unilateral and bilateral agenesis, and unilateral hypoplasia. Esophageal atresia and intestinal malrotation are among the gastrointestinal defects. Usually the neck and thorax are shortened due to vertebral defects, and there may be scoliosis, which reduces the volume of the thorax and the abdomen. Major defects in anencephaly with rachischisis are: renal defects ­ 17% cleft lip/palate ­ 10% gastrointestinal defects ­ 9% spleen abnormalities ­ 2% omphalocele ­ 5% diaphragmatic defect ­ 5% heart defects ­ 4% Rarely, anencephaly with spinal rachischisis is accompanied by cyclopia, proboscis, microphthalmia, a single nostril, and other features of holoprosencephaly. The face skin is continuous with the chest skin, and the posterior scalp is directly connected to the skin of the back (Figure 13. The cervical vertebrae are always abnormal (abnormalities of shape and fusion), and the other vertebrae are often also abnormal. There may be face abnormalities such as cyclopia, an absent mandible, and a cleft lip and palate. Renal malformations ­ for example, a horseshoe, ectopic, or polycystic kidney ­ are common. Cardiovascular and gastrointestinal malformations are also frequent, as is a diaphragmatic hernia. If the neural tissue is enclosed in a sac covered with arachnoid and dura, it is called a myelomeningocele or a meningomyelocele. In older conceptuses, myelocele and meningomyelocele have been associated with trisomy 13 and trisomy 18. Cases with lower spine defects usually are not associated with other abnormalities. The primitive prosencephalon undergoes cleavage then the two hemispheres rotate medially to form the interhemispheric fissure. In alobar holoprosencephaly, failure of cleavage results in a single ventricular cavity (H). The degree of subsequent inward rotation of the cortex determines the morphologic type. In the intermediate form-cup type, the cortex rolls over to partially cover the diencephalic roof. In the ball type, full rotation has occurred, and the single ventricle is completely covered. The prechordal mesenchyme induces the development of the anterior brain (prosencephalon) and there is an intimate relationship between midface development and the development of the optic and olfactory bulbs and the growth of the cerebral hemispheres. Many different chromosome abnormalities have been reported with holoprosencephaly, the most common being trisomy 13 or (del)13q. Other chromosome abnormalities observed in holoprosencephaly include duplications and deletions of chromosome 18, trisomy 21, and triploidy. Holoprosencephaly may be caused by an autosomal recessive gene or by a dominant mutation. The least severe form of holoprosencephaly is arrhinencephaly with absence of the olfactory bulbs and tracts. The most severe end of the spectrum is aprosencephaly (atelencephaly) when the brain consists of a brainstem and cerebellum with absence of the structures derived from the prosencephalon/telencephalon.