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[MR coronary angiography with MS-325, a blood pool contrast agent: comparison of an inversion recovery steady-state free precession with an inversion recovery fast low angle shot sequence in volunteers].

PURPOSE: To compare the signal-to-noise and contrast-to-noise ratio as well as the image quality of 3D inversion recovery steady-state free precession (IR-SSFP) and 3D inversion recovery fast low angle shot (IR-FLASH) sequences for contrast-enhanced breath-hold MRCA. MATERIALS AND METHODS: 24 healthy volunteers (10 female, 14 male, mean age 29.8 +/- 6.1 years) were involved in this study. All examinations were performed on a 1.5 T MR scanner (Magnetom Sonata, Siemens, Germany) after injection of 0.05 mmol/kg body weight MS-325 (EPIX Pharmaceuticals, Cambridge, MA and Schering AG, Berlin, Germany). MRCA was performed using IR-SSFP (TR 3.8 ms, TE 1.6 ms, FA 65 degrees , 35 phase encoded steps, bandwidth 540 Hz/pixel, slice thickness 1.5 mm, in-plane resolution 1.2 x 0.9 - 1.4 x 1.0 mm) and IR-FLASH (TR 3.8 ms, TE 1.6 ms, FA 25 degrees , bandwidth 490 Hz/pixel, slice thickness 1.5 mm, in-plane resolution 1.2 x 0.9 - 1.4 x 1.0 mm) sequences. For all scans the inversion time was set to null the signal intensity of the myocardium. Signal-to-noise ratio (SNR) as well as contrast-to-noise ratio (CNR) measurements (blood versus myocardium) were performed. The image quality was assessed based on a 5-point scale ranging from 1 (excellent) to 5 (non-diagnostic) by two radiologists in consensus. RESULTS: The mean signal-to-noise ratio of blood (27.7 +/- 4.7 vs. 22.6 +/- 4.9, P < 0.0001) and the contrast-to-noise ratio (21.0 +/- 4.3 vs. 15.8 +/- 4.3, P < 0.0001) showed significantly higher values for IR-SSFP sequences. The mean image quality scores were significantly higher for SSFP (3.6 +/- 0.7) than FLASH (2.8 +/- 0.9) sequences (P < 0.05). CONCLUSION: IR-SSFP sequences show a considerable overall improvement in image quality compared to IR-FLASH sequences for MRCA after injection of a gadolinium-based blood pool contrast agent.

Adult↗

Mechanisms of recovery from a generalized viral infection: mousepox. II. Passive transfer of recovery mechanisms with immune lymphoid cells.

The following passive transfer experiments evaluated the contributions of the various host responses in recovery from mousepox. (a) Immune spleen cells transferred highly efficient antiviral activity, but preinfected recipients of these cells made no detectable splenic interferon or antibody in the 24 hr interval after cell transfer. (b) Passively administered interferon was ineffective. (c) Recipients of hyperimmune serum had much more antibody than recipients of immune spleen cells but significantly less antiviral activity. (d) Immune spleen cell populations with antiviral activity contained mediators of CMI to virus antigens. (e) The antiviral activity of immune spleen cells was specific; it was inhibited by in vitro treatment with ATS, anti-light chain serum, and anti-theta ascitic fluid, but not by removal of mononuclear phagocytes from the immune population. These results are interpreted to mean that recovery mechanisms conferred by immune spleen cells were triggered by specifically sensitized, thymus-derived lymphocytes, and that antibody and interferon responses were of less importance. A radiosensitive recipient component was necessary for the full expression of the antiviral activity of both immune cells and immune serum. It seemed likely that this component was the blood monocyte.

Animals↗

Immune recovery of malnourished children takes longer than nutritional recovery: implications for treatment and discharge.

Protein-energy malnutrition decreases cellular immunity yet immune recovery has rarely been investigated during nutritional rehabilitation. Malnourished children from low income families of Cochabamba (Bolivia) were hospitalized for 2 months in the Center for Immune and Nutritional Rehabilitation (CRIN), of the German Urquidi Materno-Infantil Hospital. They received a special four-step diet. Nutritional status was determined by a daily clinical examination and weekly anthropometric measurements. Immune status was assessed by weekly ultrasonography of the thymus. The classical criterion for discharge (90 per cent of median reference weight for height) was reached after the first month, whereas a 2-month period was required for complete immunologic recovery. The children belonged to disadvantaged population groups with high exposure to disease. In such an environment, discharge based only on nutritional status after 1 month of treatment could explain frequent relapses because the children were still immunodepressed.

Anthropometry↗

Effect of the ganglioside GM1, on cerebral metabolism, microcirculation, recovery kinetics of ECoG and histology, during the recovery period following focal ischemia in cats.

The effect of the ganglioside GM1 on the recovery of local cerebral glucose metabolism (lCMRgl), recovery kinetics of cerebrocortical electrical activity, cerebral blood flow and redox state as well as histological changes following focal ischemia has been studied in the cat. Ischemia was produced by occlusion of the left middle cerebral artery (MCA), and GM1 (30 mg/kg) was injected intravenously at 30 min after the MCA occlusion or at the time of release of the occlusion, at 120 min. Another group of animals were subjected to the same ischemic insult, but without GM1 treatment, and sham-operated treated and not treated cats were also studied. The animals of both GM1-treated and non-treated stroke groups were classified into 2 groups (severe and moderate) depending on the depression of electrocortical activity in the ischemic hemisphere at 30 min of the ischemia. There was a significant increase in local cerebral blood flow in the ischemic area in the treated animals. Additionally there was a significant treatment effect on the left peripheral MCA territory for lCMRgl in the 30 min treated moderate group, (p less than .05). This group of animals showed decreased lCMRgl accompanied by less severe histological damage suggesting that GM1 may produce metabolic depression so as to maintain a normal flow-metabolism couple and prevent ischemic structural damage. The possible mechanism of metabolic depression induced by GM1 is briefly discussed.

Animals↗

Clinical significance of the dispersion of the activation--recovery interval and recovery time as markers for ventricular fibrillation susceptibility in patients with Brugada syndrome.

Brugada syndrome (BS) is associated with sudden cardiac death and the markers for ventricular fibrillation (VF) remain unclear, so the activation-recovery interval (ARI) dispersion and recovery time (RT) dispersion were investigated as possible markers in 20 subjects with BS (BS group) and 22 healthy individuals (H group). The 20 BS subjects were divided into 8 cases with documented VF (BS-VF group), 3 of which had recurrences, and 12 without (BS-N group). The corrected dispersion measurements from the standard 12-lead ECG of the QT interval (QTcd), ARI (ARIcd) and RT (RTcd) were compared among the groups. There were significant differences noted between the BS-VF and BS-N groups for the ARIcd and the RTcd, but not for the QTcd. Further, there were critical differences, 150 ms(1/2), observed for the ARIcd and RTcd, and these were associated with a prolongation of the maximum ARI or RT, shortening of the minimum ARI or RT, and prolongation only of the maximum QT for the QTcd. Susceptibility to VF may be predicted by the ARIcd or RTcd in BS.

Arrhythmias, Cardiac↗

Grants for hospital construction and modernization; federal right of recovery and waiver of recovery--PHS. Notice of proposed rulemaking.

As a result of recent amendments to sections 609 and 1622 of the Public Health Service Act, the Public Health Service proposes to amend its regulations to provide for (1) written notification to the Secretary when a grant-assisted hospital is sold or no longer used as a health facility eligible for a grant under Title VI or XVI of the Act, (2) waiver of the Government's right of recovery under certain circumstances, and (3) interest on recovery amounts.

Financial Management↗

[Recovery of left ventricular function after mitral valve replacement for chronic mitral regurgitation: optimal timing of operation according to long-term recovery].

OBJECTIVES: Surgical outcome for mitral regurgitation has significantly improved in recent years, so consideration of the optimal operative timing to achieve long-term quality of life for the patients has become more important. Preoperative indices that predict postoperative left ventricular function are very important for decision of the operative timing. To reassess the optimal operative timing for mitral regurgitation, long-term recovery of the postoperative left ventricular function was correlated with preoperative left ventricular end-systolic volume index(LVESVI). METHODS: One hundred eighty-two patients with mitral regurgitation underwent standard mitral valve replacement between January 1973 and June 1993. The patients were divided into 3 groups according to the preoperative LVESVI: Group I (LVESVI > or = 100 ml/m2) included 23 patients, Group II (60 < or = LVESVI < 100 ml/m2) 81 patients and Group III (LVESVI < 60 ml/m2) 78 patients. Two-dimensional echocardiography was performed to measure left ventricular diastolic dimension, systolic dimension, fractional shortening, end-systolic wall stress and mass index before operation(pre), and 1 month(early) and 3 years(late) after the operation. RESULTS: Left ventricular diastolic dimension in each group decreased in the early period, but Group I returned to the abnormal range in the late period. Left ventricular systolic dimension in Groups I and II was at the upper limit of the normal range in the early period and returned to the abnormal range in the late period, but Group III remained within the normal range throughout the study. Fractional shortening in all groups decreased to the abnormal range in the early period, but only Group III returned to the normal range in the late period. End-systolic wall stress in Group I tended to increase, but Group II had no change, and Group III returned to the normal range during the early and late periods. Mass index in Groups I and II remained within the abnormal range, but Group III returned to the normal range in the late period. CONCLUSIONS: Long-term recovery of the left ventricular function in Group I showed a continuous deterioration due to irreversible change of the left ventricular myocardium and Group II showed no significant change. In contrast, Group III demonstrated a significant improvement after standard mitral valve replacement. Patients with preoperative LVESVI of more than 100 ml/m2 have already lost the optimal timing for surgical treatment of mitral regurgitation.

Chronic Disease↗

[A study of recovery factor about drug addiction recovery center "DARC"].

This study examines the effectiveness of the 'DARC' (Drug Addiction Rehabilitation Center) and its program in treating patients with drug dependence. DARC is the only rehabilitation facility group managed by recovered drug users in Japan. It uses the 'Twelve Step Program' as part of its recovery regime. Through structured questionnaires, the changes of participants' and ex-participants' everyday behavior, their acceptance of spirituality, attitude toward drugs, self-esteem, their coping skills and loneliness were examined. The results revealed: a.. Negative partial correlation between loneliness and everyday behavior. b.. Negative partial correlation between loneliness and positive/effective coping skills. c.. Positive partial correlation between acceptance of 'spirituality' and attitude toward drugs. d.. Positive partial correlation between acceptance of 'spirituality' and positive/effective coping skills. These results suggest that the acceptance of 'spirituality' and decreasing loneliness are important factors in the recovery from drug dependence.

Adaptation, Psychological↗

[Effects of glucose-insulin-potassium cocktail on cardiac myocyte death and post-ischemic recovery cardiac functional recovery: the critical role of insulin].

OBJECTIVE: To study the effect of glucose-insulin-potassium (GIK) cocktail on cardiac myocyte death (i.e., necrosis and apoptosis) and cardiac functional recovery following myocardial ischemia/reperfusion (MI/R), and to further investigate the role of insulin in the GIK-induced cardioprotective effect. METHODS: Male Sprague-Dawley rats were subjected to 30 min myocardial ischemia followed by reperfusion for 4 h (for cardiac function and cardiomyocyte apoptosis study) or 6 h (for myocardial infarction measurement). Anesthetized rats were randomly treated with continuous infusions of saline, GIK (Glucose: 200 g/L, Insulin: 60 U/L and KCl: 60 mmol/L), GK or insulin at 4 ml.kg(-1).h(-1), beginning 5 min before reperfusion and continuing through the 4-h reperfusion. Arterial blood pressure, ECG and left ventricular pressure were monitored throughout the experiment. Myocardial DNA fragmentation and myocardial infarction were determined at the end of reperfusion. RESULTS: MI/R caused significant cardiac dysfunction and myocardial death (both necrosis and strong DNA ladder formation). Compared with the vehicle treated rats, the GIK-treated rats showed protection against MI/R injury as evidenced by reduced myocardial infarction [(41.3 +/- 8.3)% vs. (54.4 +/- 10.4)% of vehicle, P < 0.05, n = 10], marked decrease of DNA fragmentation, and improved recovery of cardiac systolic/diastolic function at the end of reperfusion [left ventricular developed pressure: (94 +/- 6) mm Hg vs. (86 +/- 5) mm Hg of vehicle, P < 0.05; +LVdP/dt(max): (2 940 +/- 114) mm Hg/s vs. (2 733 +/- 132) mm Hg/s, P < 0.05; -LVdP/dt(max): (2 629 +/- 156) mm Hg/s vs. (2 463 +/- 133) mm Hg/s, P < 0.05]. Insulin exerted the similar cardioprotective effects with GIK; whereas the rats receiving GK failed to show any significant, cardioprotection against MI/R injury. CONCLUSIONS: GIK exerts cardioprotective effect against postischemic myocardial injury. Insulin, mainly through its anti-apoptotic effect, plays a critical role in the GIK-elicited myocardial protection in MI/R.

Animals↗

[Drug Addiction Self-Help Recovery scale (DASH-scale): an approach to the measurement of recovery from drug addiction in self-help program among drug addicts].

The purpose of the study was to develop a scale for measuring the recovery in self-help program for drug addicts. Our study sites were fourteen self-help groups for drug addicts called "DARC: Drug Addiction Rehabilitation Center". DARC activities were based on Narcotics Anonymous types of self-help program. The 25-items DASH-scale questionnaire was developed using data, which were obtained through in-depth interview among DARC staff. A cross-sectional study among recovering addicts participating in "DARC" activities was implemented from Jan 2004 to Feb 2004. 164 subjects were responded to our questionnaire. Factor analysis was carried out and items with weaker or split loadings were removed. Factor analysis of DASH-scale results produced a surprisingly clean four-factor solution. 19-items were left to form the final DASH-scale; regular life-style (6 items), acceptance of drug addiction (5 items), sympathy with member (5 items), reborn (3 items). The internal consistency (Cronbach's Alpha) of these scales was very high (0.87). Low but significant concurrent correlations were observed between the DASH-scale and the Rosenberg Self-Esteem Scale (0.22), Purpose in Life Test (0.35). Discriminant validity of the DASH-scale was supported by significant increase with exposed period of self-help program. Evidence supports the DASH-scale was possible to measure recovery in self-help program.

Adult↗

Phase shift due to inversion recovery process and chemical shift effect in inversion recovery prepared gradient-echo magnetic resonance imaging.

PURPOSE: The purpose of this study was to assess phase shift due to the inversion recovery process and the chemical shift effect in inversion recovery prepared gradient-echo magnetic resonance imaging. MATERIALS AND METHODS: The signal intensities of three phantoms, composed of physiologic saline solution with Gd-DTPA, olive oil, and fat emulsion, were measured on a 1.5 Tesla unit. The sequence was single-shot two-dimensional. The parameters were as follows: TI 100-2500 msec at 100 msec intervals, TR 11.25 msec, TE 2.250 msec, 3.375 msec, and 4.500 msec. The k-space was filled with the centric view order. RESULTS: The signal intensity curves of the emulsion showed various patterns. At a TE of 2.250 msec, TI at the minimum value of signal intensity was 1500 msec. At a TE of 4.500 msec, TI at the minimum value was 500 msec. Up to a TI of 1000 msec, the signal intensity at a TE of 2.250 msec was stronger than that at a TE of 4.500 msec, and from a TI of 1000 msec, the signal intensity at a TE of 4.500 msec was stronger than that at a TE of 2.250 msec. CONCLUSION: We concluded that fat emulsion showed paradoxical phase shift.

Contrast Media↗

Incomplete recovery of inequality of ventilation after clinical recovery from acute asthma.

Studies of lung function were carried out on 8 asthmatics during and after an acute attack. Inequality of ventilation as measured by the argon alveolar plateau (Ar(1-2] showed gradual improvement during the period of observation in most of these asthmatic subjects. Residual inequality of ventilation was detected in these subjects during clinical 'remission' when compared to values for Ar(1-2) in normal subjects (P less than 0.01). The degree of inequality of ventilation observed correlated with hypoxaemia (P less than 0.05). All subjects tested with helium-oxygen flow-volume curves were initially 'non-responders', but 7 out of 8 became responders during their clinical recovery. This suggests that the main site of airflow obstruction may be in the peripheral airways in acute severe asthma but that this improves during clinical recovery and then the main site of airflow limitation switches to the larger airways. The mean respiratory exchange ratio difference between one and two litres of expiration R(1-2) was raised in the first 4 days of observation (P less than 0.05) reflecting the presence of ventilation-perfusion imbalance. However no residual imbalance was detected in the mean R(1-2) after day 11.

Adult↗

MR evaluation of vertebral metastases: T1-weighted, short-inversion-time inversion recovery, fast spin-echo, and inversion-recovery fast spin-echo sequences.

PURPOSE: To compare the detectability of vertebral metastatic disease on T1-weighted, short-inversion-time inversion recovery (STIR), fast spin-echo (FSE), fat-saturated FSE, and inversion recovery FSE (IRFSE) MR sequences using percent contrast and contrast-to-noise ratios. METHODS: Patients with proved metastatic disease underwent imaging on a 1.5-T MR system with sagittal T1-weighted (800/20/2 [repetition time/echo time/excitations]) (91 patients), STIR (1400/43/2; inversion time, 140) (91 patients), FSE (4000/180/2) (46 patients), fat-saturated FSE (4000/180/2) (16 patients), and IRFSE (29 patients) sequences. Percent contrast and contrast-to-noise ratio were calculated for the lesions. The number of metastatic lesions detected with each of the pulse sequences was also calculated. RESULTS: Mean percent contrast was, for T1-weighted sequence, -42.2 +/- 1%; STIR, 262 +/- 34%; FSE, 121 +/- 21%; fat-saturated FSE, 182 +/- 6%; and IRFSE, 272 +/- 47%. The mean contrast-to-noise ratio for T1-weighted was -4.63 +/- 1.7; STIR, 10.8 +/- .98; FSE, 4.16 +/- .76; fat-saturated FSE, 4.87 +/- .19; and IRFSE, 5.2 +/- .87. STIR and IRFSE showed the highest number of lesions, followed by T1-weighted, fat-saturated FSE, and FSE sequences. T1-weighted sequences showed 94%, FSE 55%, and fat-saturated FSE 78% of the lesions detected. Epidural metastatic lesions were better depicted on T1-weighted, FSE, and fat-saturated FSE sequences. CONCLUSION: STIR was superior to both T1-weighted and FSE (with and without fat saturation) for detection of metastatic lesions, in terms of both percent contrast and contrast-to-noise ratio and visibility. IRFSE was equal to STIR for the detection of metastasis by both subjective and objective criteria. T1-weighted, FSE, and fat-saturated FSE sequences were superior to STIR and IRFSE in the detection of epidural metastatic disease. IRFSE provided faster scanning time, which could be translated into greater resolution.

Adolescent↗

Recovery of cerebral blood flow and energy state in piglets after hypothermic circulatory arrest versus recovery after low-flow bypass.

A miniature piglet model that replicates clinical hypothermic (14 degrees C nasopharyngeal) circulatory arrest and low-flow (50 ml/kg per minute) bypass was used to study carotid blood flow with electromagnetic flow probe, cerebral blood flow by microsphere injection, cerebral metabolic rate by arteriovenous oxygen and glucose extractions, lactate production by cerebral arteriovenous difference, and cerebral edema. Data from five animals that underwent circulatory arrest and five animals that underwent low-flow bypass (aged 28.8 +/- 0.4 [mean +/- standard error of the mean] days) were analyzed. The duration of circulatory arrest and low-flow bypass was 1 hour. In a parallel study with the same animal model, phosphorus 31 magnetic resonance spectroscopy was used to assess cerebral phosphocreatine, nucleoside triphosphate (adenosine triphosphate), and intracellular pH. Five animals (aged 31.8 +/- 1.1 days) underwent circulatory arrest, and five underwent low-flow bypass. A brief phase of hyperemic carotid blood flow was seen immediately after the onset of reperfusion in the circulatory arrest group but not in the low-flow group. In the circulatory arrest and low-flow bypass groups, cerebral blood flow (percentage of baseline 71.2% +/- 8.3% and 69.1% +/- 5.8%, respectively), cerebral oxygen consumption (45.6% +/- 10.0%, 44.5% +/- 7.6%), and cerebral glucose consumption (31.5% +/- 30.7%, 83.5% +/- 24.2%) remained depressed after 45 minutes of reperfusion and rewarming to normothermia. However, after 3 more hours of pulsatile normothermic reperfusion, cerebral oxygen consumption and cerebral glucose consumption had returned to baseline. Phosphocreatine, adenosine triphosphate, and pH were maintained at or above baseline levels throughout low-flow bypass and throughout 3 hours of normothermic reperfusion. In contrast, both phosphocreatine and adenosine triphosphate became undetectable 32 +/- 3.7 minutes after onset of circulatory arrest. During and early after circulatory arrest, pH decreased to a minimum of 6.506 +/- 0.129 at 40 minutes after reperfusion. After 3 hours of normothermic reperfusion, phosphocreatine and adenosine triphosphate recovered to 98.6% +/- 9.0% and 90.1% +/- 13.5% of baseline, respectively, and pH was 7.087 +/- 0.051, similar to baseline (7.1755 +/- 0.041). In the low-flow bypass group, the disparity between the depressed level of cerebral oxygen consumption and normal high-energy phosphate levels may reflect incomplete cerebral rewarming or decreased energy consumption. In the circulatory arrest group, the parallel recovery of oxygen consumption and high-energy phosphates eventually achieving baseline levels suggests that the degree of hypothermia used provides adequate protection for acute cerebral recovery after 1 hour of circulatory arrest.(ABSTRACT TRUNCATED AT 400 WORDS)

Adenosine Triphosphate↗

[Biographical structure of illness and recovery processes. The recovery history of a women with epilepsy].

Medical treatment generally focuses on the elimination of symptoms. This study of an epileptic woman documents the importance of taking the patient's entire biography into consideration in order to attain a full understanding of the illness. The healing process, accordingly, is not an attempt to repress the symptoms by means of medical treatment. Instead the patient works through her life history, beginning with group therapy over an extended period; this process finally leads to psychic and clinical recovery. The regaining of psychic viability and the forming of future perspectives prove to be particularly important moderators in the recovery process.

Adaptation, Psychological↗

Recovery after day-case anaesthesia. A 24-hour comparison of recovery after thiopentone or propofol anaesthesia.

Sixty patients who presented for day-case dilatation and curettage were allocated randomly to receive either thiopentone or propofol for induction and maintenance of anaesthesia. One anaesthetist administered all the anaesthetics whilst all assessments were made by one other. The results indicate that early recovery of memory function, critical flicker fusion frequency and subjective feelings of tiredness, drowsiness and alertness were superior in the propofol group. There was a significant difference in subjective feelings of tiredness and drowsiness recorded by the two study groups at 24 hours. Memory function assessed by Wechsler logical memory function passages at 24 hours was impaired in the propofol group in comparison to a group of 'reference' subjects.

Adolescent↗

Moving beyond illness to recovery: the recovery is for everyone Grants Program (RIFE).

The RIFE Grants Program offers funding to individuals in recovery from mental health and substance abuse problems for innovative projects to help them take steps toward achieving their life aspirations. Twenty-one people who received awards participated in an evaluation using the MDS and EPQ with significant increases in items related to empowerment from the beginning to mid study and a decrease in the empowerment factor from mid to end study. Ninety-one percent of participants reported improvements in daily life, 82% in thoughts of self, 80% in belief in capabilities, 60% in social roles, 80% in socializing, and 50% in values.

Capital Financing↗

The influence of freeze duration on postfreeze recovery by caterpillars of Pyrrharctia isabella (Lepidoptera: Arctiidae): when is survival enough to qualify as recovery?

The effects of freeze exposure at -4.5 degrees C for as long as 6 weeks on long-term postfreeze survival and body fluid composition were investigated in caterpillars (woolly bears) of the arctiid moth Pyrrharctia isabella. Woolly bears routinely survived the initial postfreeze period with little difference between the 1-week (100%) and 6-week (95%) freeze treatments. Caterpillars in the latter treatment, however, reached the pupal stage almost one half as often as woolly bears in the 1-week freeze treatment. The success rate for adult emergence was not different for pupae from the two treatments (ca. 50%). Woolly bears responded to cold acclimation by accumulating glycerol to levels exceeding 300 mM although this was not augmented by extending the acclimation period to 6 weeks. There was a significant (P<0.05) rise in hemolymph [K+] during the first week of the freeze (23.4-37.8 mM), which then remained stable over the remainder of the 6-week freeze period. Hemolymph [Na+] did not change from the prefreeze level over the course of the freeze treatment. Body water content showed a modest rise during the course of the freeze treatment but the underlying cause for this change was uncertain. Prolonged freeze exposure had a major impact on long-term survival of the woolly bears but this was not reflected by any instability in body fluid composition. Moreover, short-term recovery was not an effective indicator of the tolerance of P. isabella caterpillars to prolonged freezing.

Adaptation, Physiological↗