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PubMed2002

Pulmonary hypertensive response to endotoxin in cellulose-primed and unprimed broiler chickens.

Previous studies indicate that individual broilers vary widely in their pulmonary vascular responsiveness to i.v. injections of endotoxin. This individual variability may reflect differences acquired during previous respiratory challenges or genetic variability that may be associated with susceptibility to pulmonary hypertension syndrome (ascites). In the present study, we compared the endotoxin responses of 4- to 5- wk-old control broilers (unprimed) and broilers in which the pulmonary vasculature had been immunologically challenged 48 h previously by an i.v. injection of cellulose micro-particles (primed). The injected cellulose micro-particles are carried in the venous blood to the lungs, where they become trapped in the pulmonary vasculature and initiate acute focal inflammatory responses within the surrounding lung parenchyma. Physiological variables (respiratory rate, heart rate, pulmonary and systemic arterial pressures) were evaluated prior to and following the i.v. administration of 1 mg of Salmonella typhimurium endotoxin. Prior to endotoxin injection, the respiratory rate was higher in primed than in unprimed broilers; however, the heart rate, pulmonary arterial pressure, and systemic arterial pressure did not differ between groups. Broilers in both groups exhibited similar ranges of individual variability in their endotoxin responses. The overall time of onset, magnitude, and duration of the pulmonary hypertensive responses were similar for both groups. Accordingly, the initiation of a preexisting inflammatory response within the lung parenchyma did not alter the timing, amplitude, or variability of the subsequent pulmonary hypertensive response to endotoxin in broilers.

Animals↗

PubMed1984

Reproducibility of aerobic and anaerobic thresholds in 20-50 year old men.

The reproducibility of the aerobic (AerT) and the anaerobic (AnT) threshold was studied in 33 men aged 20-50 years. They completed two maximal exercise tests on a bicycle ergometer. The thresholds, as VO2 (1 X min-1), were determined visually by two investigators using both the blood lactate and the respiratory indices. The respiratory variables were measured with a computerized breath-by-breath method; samples of venous blood were drawn every 2nd min and analysed enzymatically for lactate. The reproducibility of the AerT (r = 0.94) and of the AnT (r = 0.96) were equally good. The AnT can be determined either from blood lactate concentrations (AnTLa) or from ventilatory and gas exchange response (AnTr) during a 2-min incremental exercise test. They both also showed similar reproducibility: r = 0.93 for the AnTLa and r = 0.95 for the AnTr. The work rate and the measured physiological variables at the AerT and AnT, except for the blood lactacte concentration, were very reproducible. Age did not affect the reproducibility of the thresholds. The poor reproducibility of blood lactate concentration of the AnT confirmed our previous opinion that the fixed blood lactate levels of 2 and 4 mmol X 1(-1) are poor indicators of AerT and AnT.

Adult↗

PubMedDate not supplied

The incidence of gastrointestinal symptoms in cardiac surgery patients through six weeks after discharge.

OBJECTIVE: To determine the incidence and the effect of intraoperative and discharge variables on gastrointestinal (GI) symptoms after cardiac surgery during hospitalization and 2 and 6 weeks after discharge. DESIGN: Prospective and descriptive. SETTING: Two university-affiliated medical centers. PATIENTS: One hundred twenty-two adult patients undergoing cardiac surgery. OUTCOME MEASURES: Frequency of GI symptoms and level of distress caused by GI symptoms during hospitalization and 2 and 6 weeks after hospital discharge. INSTRUMENTS: GI symptoms were measured by The Gastrointestinal Symptom Frequency and Symptom Distress Scale. Depression was measured by The Center for Epidemiologic Studies Depression Scale. INTERVENTION: Demographic and physiologic variables were collected by chart review. Patients completed the Gastrointestinal Symptom Frequency and Symptom Distress Scale and The Center for Epidemiologic Studies Depression Scale in the hospital. Telephone interviews were used to collect 2- and 6-week data. RESULTS: Fifty-seven percent of patients after surgery reported poor appetite, 37% lack of taste, and 34% nausea during hospitalization. The frequency of all GI symptoms decreased with time; 19% of subjects reported poor appetite, 19% lack of taste, and 10% nausea at 6 weeks after discharge. Although poor appetite occurred with the greatest frequency, patients reported the greatest distress with lack of taste. When analyzed with a logistic regression model, use of antihypertensive agents was associated with lack of taste; use of diuretic and antiarrhythmic agents was associated with nausea; and level of depression was associated with all three GI symptoms. Length of cardiopulmonary bypass time mean arterial blood pressure during surgery, mixed venous oxygen saturation during surgery, and subject age did not significantly affect the frequency of GI symptoms at any data collection point. CONCLUSIONS: The incidence of GI symptoms after cardiac surgery is significant, but their etiology has yet to be determined.

Adult↗

PubMed2006

High-fibre pelleted rations decrease water intake but do not improve physiological indexes of welfare in food-restricted female broiler breeders.

1. A 3x2 factorial experiment was conducted with three diets and two lines of broiler breeder females to evaluate the contribution of low-energy rations for improving the welfare of feed-restricted birds during rearing. Experimental diets were fed from 6 to 16 weeks of age and were created by diluting a conventional grower (Control) ration containing 11.0 MJ ME/kg with 200 (8.8 MJ ME/kg) or 400 (6.6 MJ ME/kg) g oat hulls/kg using Optimoist to facilitate the pelleting process. Welfare was assessed by changes in behaviour and physiological variables at 8, 12 and 16 weeks of age. Birds were fed restricted quantities of feed to meet recommended body weight targets. 2. There was a decrease in the proportion of observations of drinking and an increase of preening in birds fed on the two experimental diets compared with the control. There was a linear decrease in litter moisture and the number of litter changes with increasing diet dilution, and water intake at 12 weeks was higher in the control than in the two experimental diets. There were no changes in physiological indexes of welfare (heterophil-lymphocyte ratio, plasma corticosterone and antibody responses) associated with the dietary treatments. 3. There were no important differences in the growth, behaviour or physiological responses to dietary treatment between the two lines of broiler breeders. Changes with age were similar to those reported in other experiments. 4. It was concluded that low-energy pelleted diets would improve litter conditions but not improve indexes of welfare in feed-restricted broiler breeders.

Animal Feed↗

PubMedDate not supplied

Toward a medical prolepsis by chronobiology.

Medicine today strongly aims at prevention and optimization of diagnosis and therapy Studies tried staging and standardization of clinical trials in diseases and made search of markers for early diagnosis, prognosis and therapy. Moreover, risk factors and other variables such as predictors are now investigated more often in groups or populations of apparently healthy subjects, especially for such diseases as atherosclerosis and neoplasia. This new aspect of increasing interest may be defined as medical prolepsis (from the Greek pi rho ómicron lambda eta psi iota zeta = anticipated idea). It includes early signals of disease (protopathology) as well as other signals the host shows as defence or alarm reaction. Hence, we suggest a chronobiological approach in this field, which allows to quantify health and reveals more subtle differences in many physiological variables. According to these views, we reported studies concerning humoral markers and other parameters considered as risk factors both in atherosclerosis and in some endocrine tumors.

Arteriosclerosis↗

PubMedDate not supplied

Physiologic status, coping, and hardiness as predictors of outcomes in chronic obstructive pulmonary disease.

The purpose of this study was to examine the relationship of physiologic status, coping, and hardiness to exercise ability and functional status in 96 adult patients with chronic obstructive pulmonary disease (COPD). Exercise ability was measured by the distance walked in 12 minutes (12MD) and functional status by the Pulmonary Functional Status Scale (PFSS). The mean FEV1 and FVC were 1.61 +/- .81 and 3.08 +/- .95 L, respectively. The commitment (r = -.18) and challenge (r = -.21) components of hardiness were significantly correlated with the 12MD. The commitment component of hardiness was significantly correlated with functional status (r = -.17). Control was not a significant variable. Physiological status, problem-solving coping, and challenge were the best predictors of exercise ability (R2 = .26). Physiological status and commitment were the best predictors of functional status (R2 = .149).

Adaptation, Psychological↗

PubMed1996

Widespread increase in brain protein synthesis following acute immobilization stress in adult rat brain.

The autoradiographic method with [L-35S]methionine was used to determine the effects of a 2 h acute immobilization stress followed by a 4 h recovery on local rates of protein synthesis in the adult rat brain. Methionine incorporation into proteins was significantly increased (from 17 to 86%) in 37 out of the 39 analyzed brain structures. These results show that the stress-induced activation of the overall rate of brain protein synthesis may persist for at least 4 h after cessation of the stimulus even though the stress-related physiological variables have returned to basal levels. They suggest that increased protein synthesis may play a key role in the molecular events which lead to the neuronal plastic changes following an acute stress.

Acute Disease↗

PubMed2000

Electrical cochlear stimulation in the deaf cat: comparisons between psychophysical and central auditory neuronal thresholds.

Cochlear prostheses for electrical stimulation of the auditory nerve ("electrical hearing") can provide auditory capacity for profoundly deaf adults and children, including in many cases a restored ability to perceive speech without visual cues. A fundamental challenge in auditory neuroscience is to understand the neural and perceptual mechanisms that make rehabilitation of hearing possible in these deaf humans. We have developed a feline behavioral model that allows us to study behavioral and physiological variables in the same deaf animals. Cats deafened by injection of ototoxic antibiotics were implanted with either a monopolar round window electrode or a multichannel scala tympani electrode array. To evaluate the effects of perceptually significant electrical stimulation of the auditory nerve on the central auditory system, an animal was trained to avoid a mild electrocutaneous shock when biphasic current pulses (0.2 ms/phase) were delivered to its implanted cochlea. Psychophysical detection thresholds and electrical auditory brain stem response (EABR) thresholds were estimated in each cat. At the conclusion of behavioral testing, acute physiological experiments were conducted, and threshold responses were recorded for single neurons and multineuronal clusters in the central nucleus of the inferior colliculus (ICC) and the primary auditory cortex (A1). Behavioral and neurophysiological thresholds were evaluated with reference to cochlear histopathology in the same deaf cats. The results of the present study include: 1) in the cats implanted with a scala tympani electrode array, the lowest ICC and A1 neural thresholds were virtually identical to the behavioral thresholds for intracochlear bipolar stimulation; 2) behavioral thresholds were lower than ICC and A1 neural thresholds in each of the cats implanted with a monopolar round window electrode; 3) EABR thresholds were higher than behavioral thresholds in all of the cats (mean difference = 6.5 dB); and 4) the cumulative number of action potentials for a sample of ICC neurons increased monotonically as a function of the amplitude and the number of stimulating biphasic pulses. This physiological result suggests that the output from the ICC may be integrated spatially across neurons and temporally integrated across pulses when the auditory nerve array is stimulated with a train of biphasic current pulses. Because behavioral thresholds were lower and reaction times were faster at a pulse rate of 30 pps compared with a pulse rate of 2 pps, spatial-temporal integration in the central auditory system was presumably reflected in psychophysical performance.

Age Factors↗

PubMed2003

Kinematic changes at intensities proximal to onset of lactate accumulation.

AIM: The purpose of this study was to examine changes in selected kinematic variables at 3 running intensities proximal to the onset of blood lactate accumulation (OBLA; 4 mM of blood lactate). It was hypothesized that greater changes in lower body mechanics would occur when running faster than normal race pace compared to when running slower than race pace. METHODS: Nine competitive male distance runners ran at 3 running intensities (RI): 1) each runner's VO(2) at 10% below the VO(2) at OBLA, 2) VO(2) at OBLA, and 3) VO(2) at 10% above the VO(2) at OBLA. Selected kinematic and physiological variables were measured at each RI. RESULTS: VO(2) at RI 1, 2 and 3 was highly correlated with running speed (r=0.93). The blood lactate (BL) showed a nonlinear increase from RI 1 (2.9+/-0.8 mM) to 2 (4.1+/-0.9 mM) to 3 (6.7+/-1.8 mM). The vertical oscillation of center of gravity (VOCOG), stride frequency (SF), range of motion (ROM) of trunk angle, and maximal knee flexion during flight phase (MKFF) changed nonlinearly as did the BL. Significant relationships between BL and VOCOG (r=0.44) and between BL and SF (r=0.51) were found (ps<0.05). CONCLUSION: The findings show a possibility that lower body running mechanics have a relationship with BL.

Adult↗

PubMed1990

Unsupervised learning and discriminant analysis applied to identification of high risk postoperative cardiac patients.

A set of 200 patients in the 6 hours immediately following cardiac surgery was analysed within a multidimensional space of 13 commonly monitored physiological variables in order to identify high risk patterns. The application of an unsupervised learning (clustering) method to these data clearly showed the existence of two well-separated classes of low and high risk patients. A stepwise discriminant analysis was then applied to patients representative of the two classes in order to find those variables which, over time, possessed the greatest separation power. The latter always included the oxygen delivery (DO2), an index related to the oxygen content in the blood (Pv(-)O2 or avO2D) and a myocardial contractility index (VF or LAP).

Algorithms↗

PubMed2000

Determinants of ventilatory instability and variability.

This paper reviews the major mechanisms that can give rise to various forms of variability in the ventilatory pattern. First, an elevated controller gain, coupled with the presence of delays and response lags in the chemoreflex loops, can lead to instability in feedback control and give rise to periodic breathing. This form of ventilatory stability can be assessed quantitatively by employing the concept of 'loop gain'. Several different methods of estimating loop gain from steady state or dynamic respiratory measurements are discussed. An inherently stable respiratory control system can also exhibit periodic behavior due to the influence of primary fluctuations in sleep-wake state and other physiological variables, such as cardiac output and cerebral blood flow. Self-sustained, irregular ventilatory fluctuations may be generated by nonlinear dynamic interactions between various components of the respiratory control system, such as the lung vagal afferents and the respiratory pattern generator, or through the propagation of stochastic disturbances around the chemoreflex loops.

Algorithms↗

PubMed1996

Clinical observations on tropical men during their sojourn over the Arctic region.

In the present study, besides a detailed clinical evaluation, roentgenographic changes in cardio-respiratory system in Indian soldiers (IS) during their 60 days stay at the arctic have been observed. These results have been compared with the responses at Delhi (before cold acclimatisation) and on return to Delhi (deacclimatisation). An attempt has also been made to compare the same physiological variables with those of Russian Migrants (RM) and Russian Natives (RN) in the arctic region to review significant differences if any. Heart Rate (HR) did not show much change; there was a tendency to increase in both systolic and diastolic blood pressure; and Kerdo's index inclined towards increased sympathetic activity in IS. X-ray chest (PA View) did not show any appreciable change in the lungs in the three groups. One subject amongst IS showed cardiac enlargement and RN subjects showed prominence of pulmonary artery and pulmonary vascular markings. All these physiological changes aim at increasing the cardiac output to overcome the ill effects of cold. Pneumopathy, a clinical condition of increased pulmonary haemodynamics could have resulted in the prominence of pulmonary artery and pulmonary blood flow in the RN. Most of the physiological changes reverted to the baseline value on return to Delhi thus proving that there were no permanent changes during short stay at extreme cold conditions.

Acclimatization↗

PubMed2000

Effects of activity-rest schedules on physiological strain and spinal load in hospital-based porters.

Workers in physically demanding occupations require rest breaks to recover from physiological stress and biomechanical loading. Physiological stress can increase the risk of developing musculoskeletal disorders and repeated loading of the spine may increase the potential for incurring back pain. The aim of the study was to assess the impact of an altered activity-rest schedule on physiological and spinal loading in hospital-based porters. An existing 4-h activity-rest schedule was obtained from observations on eight male porters. This schedule formed the normal trial, which included two 5- and one 15-min breaks. An alternative 4-h schedule was proposed (experimental condition) that had two breaks each of 12.5 min. It was hypothesized that the experimental trial is more effective in promoting recovery from physiological strain and spinal shrinkage than the normal trial, due to the 5-min breaks being insufficient to allow physiological variables to return to resting levels or the intervertebral discs to reabsorb fluid. Ten males performed both test conditions and oxygen uptake VO2, heart rate, minute ventilation VE, perceived exertion and spinal shrinkage were recorded. There were no significant differences in any of the measured variables between the two trials (p > 0.05). Median heart rates were 78 (range 71-93) and 82 (71-90) beats.min(-1) for the normal trial and the experimental trial respectively, indicating that the activity was of low intensity. The light intensity was corroborated by the oxygen uptakes (0.75, range 0.65-0.94 1.min(-1)). Spinal shrinkage occurred to the same extent in the two trials (2.12 +/- 3.16 mm and 2.88 +/- 2.92 mm in the normal trial and the experimental trial respectively). Varying the length and positioning of the rest breaks did not significantly affect the physiological responses or magnitude of spinal shrinkage between the two trials. More physically demanding work than the porters' schedule should induce greater physiological fatigue and spinal shrinkage. The ratio between activity and rest breaks would then become more important.

Adult↗

PubMed2004

Effect of acute physiologic derangements on outcome after subarachnoid hemorrhage.

OBJECTIVE: To determine the effect that acute physiologic derangements have on outcome after subarachnoid hemorrhage (SAH) and to design a composite score summarizing these abnormalities. DESIGN: Prospective observational study. SETTING: Neuroscience intensive care unit in a tertiary care academic center. PATIENTS: Consecutive cohort of 413 patients with SAH admitted within 3 days of SAH onset with 3-month modified Rankin Scale scores. INTERVENTIONS: None. RESULTS: Among 20 physiologic variables assessed within 24 hrs of admission, four were independently associated with death or severe disability (modified Rankin Scale score, 4-6) at 3 months in a multivariate analysis: arterio-alveolar gradient of >125 mm Hg (odds ratio [OR], 4.5; 95% confidence interval [CI], 2.7-7.6), serum bicarbonate of <20 mmol/L (OR, 2.9; 95% CI, 1.6-5.6), serum glucose of >180 mg/dL (OR, 2.8; 95% CI, 1.6-4.8), and mean arterial pressure of <70 or >130 mm Hg (OR, 1.7; 95% CI, 1.0-2.9). Based on their proportional contribution to outcome, we constructed the SAH Physiologic Derangement Score (SAH-PDS; range, 0-8) by assigning the following weights for abnormal findings: arterio-alveolar gradient, 3 points; bicarbonate, 2 points; glucose, 2 points; and mean arterial pressure, 1 point. After controlling for known predictors of death or severe disability (age, admission neurologic status, loss of consciousness, aneurysm size, intraventricular hemorrhage, and rebleeding), the SAH Physiologic Derangement Score was independently associated with poor outcome (OR, 1.3 for each point increase; 95% CI, 1.1-1.6). By contrast, the systemic inflammatory response syndrome score and the Acute Physiology and Chronic Health Evaluation II physiologic subscore did not add predictive value to the model. CONCLUSION: Acute interventions specifically targeting hypoxemia, metabolic acidosis, hyperglycemia, and cardiovascular instability may improve the outcome of SAH patients. The SAH Physiologic Derangement Score may prove useful for rapidly quantifying the severity of important physiologic derangements in acute SAH.

APACHE↗

PubMed1985

Pain and pain control in children.

Focused research on pain and pain control in children has developed primarily in the last 10 years and even now is woefully inadequate in relation to the magnitude of the problem. The available research, inferences from the adult literature, and anecdotal information all indicate the elusive nature of pain. Pain is not solely a fixed neurophysiologic response to a noxious stimulus but a product of the interaction of many variables such as age, cognitive set, personality, ethnic background, and emotional state. These factors exert a tremendous influence on the suffering which surrounds the pain message. Technology exists at present to eliminate or substantially reduce pain in almost all cases. There remains, however, a tendency, which is even more pronounced with respect to children, to underestimate or ignore pain. In an overall approach to pain in children, the following points should be considered: A high index of suspicion is necessary to determine if children are experiencing pain since they may have difficulty verbalizing their discomfort. In infants, physiologic variables should be considered (increased heart rate, palmar sweating, increased respiratory rate), and in preschoolers, time should be taken to ascertain that the child actually understands the word "pain" if it is used in questioning them. Some method of continuous monitoring, such as a visual analogue scan, should be considered as part of the treatment plan. Adequate analgesia should be provided. The appropriate dose should be administered at the appropriate pharmacokinetic time. Too little medication may cause obsessive attention to medication-related issues. Too much medication may cause sedation and lack of mental clarity, which is often anxiety-producing for both the parents and the child. The usefulness of p.r.n. medication has been seriously questioned and a time-contingent as opposed to pain-contingent strategy should be applied. Fears of addiction are generally unwarranted. Adjunctive medication may increase the value of offered narcotics and counteract some of their side effects. Although this monograph has focused more attention on pharmacologic than on nonpharmacologic approaches to pain, this is merely a reflection of available data and not necessarily of relative importance. The importance of distraction from pain by nursing, medical, or child life personnel using play techniques cannot be overestimated. Every attempt should be made to relax the child by using creative strategies. Preparation of the child for procedures is often helpful as some of the fear of the unknown is eliminated.(ABSTRACT TRUNCATED AT 400 WORDS)

Adjuvants, Pharmaceutic↗

PubMed2006

Atrial fibrillation burden during the post-implant period after crt using device-based diagnostics.

UNLABELLED: AF Burden After CRT Implantation. AIMS: Cardiac resynchronization therapy (CRT) is increasingly used in congestive heart failure (CHF) patients (with cardiac dyssynchrony). In addition to delivering therapy, CRT devices offer a variety of diagnostic tools for continuous long-term monitoring of clinically relevant information (i.e., occurrence and duration of arrhythmia episodes). METHODS AND RESULTS: Eighty-four patients with drug-refractory CHF in NYHA-class II-IV received a CRT device. The response to CRT was assessed by determining NYHA class at baseline and at 3 months follow-up. Atrial fibrillation (AF) burden (defined as time of AF per day) was continuously measured by the device. A significant gradual reduction of AF burden (from 9.88 +/- 12.61 to 4.20 +/- 9.24 [hours/day]) and number of patients experiencing AF episodes (from 26 to 13) were observed during CRT. CONCLUSIONS: (1) Diagnostic features for long-term monitoring of physiological variables provide useful information on the state and course of AF and may improve disease management. (2) AF burden reduces over time during the first 3 months after CRT implantation.

Aged↗

PubMed2006

Hemodynamic and respiratory effects of pediatric urological retroperitoneal laparoscopic surgery: a prospective study.

PURPOSE: Our understanding of the effects of retroperitoneal CO(2) insufflation on cardiopulmonary variables in children remains limited. This study was designed to investigate prospectively the effect of CO(2) insufflation in a pediatric population undergoing retroperitoneal laparoscopic surgery. MATERIALS AND METHODS: We prospectively evaluated a consecutive series of patients enrolled between July 2003 and August 2004. Anesthesia was administered following a standardized protocol. Data collection included respiratory rate, PAP, O(2) saturation, ETCO(2), HR, MAP, electrocardiogram and insufflation pressure. All variables were recorded before, during and after CO(2) insufflation at regular intervals of 1 to 2 minutes, with up to 23 measurements recorded for each period. RESULTS: A total of 18 participants were recruited. Mean +/- SD for age and weight were 79.4 +/- 53.2 months and 26.7 +/- 15.5 kg, respectively. Mean retroperitoneal CO(2) insufflation pressure was kept at 12 mm Hg. Significant differences (p <0.05) in average ETCO(2), PAP and MAP were noted after CO(2) insufflation compared to baseline (pre-pneumoretroperitoneum) values. HR and temperature did not change. At completion of the laparoscopic intervention physiological variables exhibited a trend to return to baseline values. CONCLUSIONS: This prospective study documents significant changes in systemic hemodynamic variables that seem to be directly associated with the insufflation of CO(2) during pediatric retroperitoneal laparoscopic surgery. This ongoing evaluation confirms the effect of laparoscopic urological surgery and CO(2) insufflation on cardiopulmonary function in children.

Child↗

PubMedDate not supplied

Influence of therapeutic doses of amoxicillin on aerobic work capacity and some strength characteristics.

The purpose of this study was to investigate whether or not amoxicillin in therapeutic doses could have an influence on maximal aerobic work capacity and some strength characteristics in trained subjects. Fifteen volunteers (men; age range, 21 to 38 years; mean, 28.8 years) were examined once weekly for 4 consecutive weeks, and on these occasions the following variables and parameters were measured: maximum workload attained on the bicycle ergometer, maximum heart rate, maximum serum lactate concentration, heart rate and serum lactate concentration after 10 min at 80% of the maximum workload attained, maximum isometric extension force of the legs, vertical jump height, and body weight. During the baseline period, the determined variables and parameters did not show any significant difference between Test 1 and Test 2. During the 3rd and 4th week of the test period, the subjects received at random either placebo (6-aminopenicillanic acid) or amoxicillin in therapeutic doses (375 mg, 3 times a day) every day for 5 days. After the third test in the 3rd week, there was a cross-over, ensuring that each volunteer was examined during placebo as well as during amoxicillin medication. The serum amoxicillin levels were determined. After statistical analysis, no influence of amoxicillin or placebo on the parameters and physiologic variables was demonstrable.

Adult↗