SEARCH · PubMed Health

Results for “Diaphragmatic function”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,333 records · Page 74Linked to original sources

PubMed1995

Venovenous extracorporeal membrane oxygenation affects renal function.

OBJECTIVE: We evaluated the effect of venovenous extracorporeal membrane oxygenation (ECMO) on renal function and fluid balance in neonates with severe respiratory failure. DESIGN: We retrospectively reviewed the charts of 30 consecutive patients who met criteria for treatment with ECMO. Twelve were managed without ECMO (comparison group) and 18 were treated with venovenous ECMO (treatment group). SETTING: The study was conducted in a single level III neonatal intensive care unit in a regional children's hospital accepting medical and surgical neonatal transfers. Our hospital does not have an inborn service. PATIENTS: Neonates were included if their gestational age was more than 34 weeks, they weighed more than 2 kg, and their respiratory failure was severe enough to warrant consideration of ECMO as a mode of support. All the neonates in this study were treated with high-frequency ventilation before being considered for ECMO; none were treated with nitric oxide. Criteria used to determine whether a neonate was a candidate for ECMO included: (1) alveolar-arterial oxygen difference greater than 60 kPa (610 torr) for 8 hours; (2) alveolar-arterial oxygen difference greater than 59 kPa (605 torr) and a peak airway pressure greater than 3.7 kPa (38 cm H2O) for 4 hours; (3) oxygenation index greater than 40 on three of five postductal blood gases obtained at least 30 minutes apart and unstable patient condition; or (4) refractory, severe respiratory failure with sudden decompensation (partial pressure of arterial oxygen 3.4 kPa or lower, 35 torr) despite maximal medical management for 2 hours. We did not include patients with congenital diaphragmatic hernia. MAIN RESULTS: There were no differences between the groups in gestational age, birth weight, age at admission, gender, or diagnoses. Over the course of the 108 hours reviewed for each case, neonates treated with ECMO had higher positive fluid balance (P < .001), lower urine flow rates (P < .01), and higher blood urea nitrogen (P < .01) and creatinine (P < .01) levels than neonates managed without ECMO. There were no differences in mean blood pressure, protein intake, serum albumin, or use of diuretic therapy that might explain the differences between the groups. CONCLUSION: We conclude that venovenous ECMO is associated with transient impairment in renal function and marked fluid retention.

Blood Pressure↗

PubMed1988

[Bronchiolitis in infants. Respiratory functional exploration in the acute phase].

Respiratory function tests were performed in infants hospitalized for bronchiolitis immediately after the acute stage, in order to appreciate the function of the respiratory muscles. A study of the ventilatory mechanics, of the transdiaphragmatic pressure, of the ventilatory rate and of the blood gases was performed. Results were compared with those obtained in 10 "healthy" infants. They showed: a decrease in the dynamic compliance (DYN.C) (p less than 0.001) and an increase in the total pulmonary resistances (TPR) (p less than 0.05) providing evidence for the intensity of bronchial and bronchiolar obstruction; an increase in the abdominal and intrathoracic pressures difference (Pdi) (p less than 0.01) which may reach 3 times the normal value and which is proportional to the decrease in DYN.C. (r = 0.74; p less than 0.001), providing evidence for the intensification of the inspiratory diaphragmatic effort and of its adjustment to the degree of obstruction; a reverse of the abdominal pressure curve with respect to that in normal subjects, with an increased pressure level, providing evidence for abdominal distension and increased pressure during all the expiration, suggesting the active participation of the abdominal muscle to expiration; a change in the ventilatory rate, characterized by a high respiratory frequency, a decreased tidal volume, a shortened inspiratory time and a normal inspiratory time/total time ratio. this rate is opposed to that observed in older children with bronchial obstruction. It might optimize the respiratory muscles output, as at this age, they have not yet reached all their contractile capacity.

Acute Disease↗

PubMed1989

Diltiazem, verapamil, and nifedipine inhibit theophylline-enhanced diaphragmatic contractility.

The ability of theophylline to limit diaphragmatic fatigue and to improve contractility appears to be dependent upon alterations in calcium metabolism. The mechanism responsible for these actions, however, remains unclear. We used perfused, contracting, intact rat diaphragm to measure the influence of therapeutic theophylline levels (10(-4) M) on tension development, in the presence or absence of the three most commonly used calcium channel blocking agents, or in the absence of calcium. Concentrations of diltiazem (10(-4) M), verapamil (10(-5) M), or nifedipine (10(-6) M) sufficient to completely block transmembrane calcium channels, were used. During the experiment, each diaphragm preparation was subjected to one of two fatiguing procedures: one to mimic that encountered during tachypnea and one to mimic that encountered during increased respiratory resistance. Our findings showed that therapeutic levels of theophylline were related to statistically significant (p less than 0.0005) increases in diaphragmatic contractility under control conditions and to statistically significant reductions in the sensitivity of the preparation to fatigue. All three calcium channel blockers negated the positive influence of theophylline. Zero calcium also prevented theophylline from enhancing the contractile properties of the diaphragm. It is our conclusion that theophylline enhances the contractile properties of the diaphragm by altering the transmembrane movement of calcium. Calcium antagonists, in turn, inhibit the beneficial effects of theophylline on diaphragm function.

Animals↗

PubMed2000

Prediction of outcome by computer-assisted analysis of lung area on the chest radiograph of infants with congenital diaphragmatic hernia.

BACKGROUND/PURPOSE: Pulmonary hypoplasia is a major cause of mortality and morbidity in infants with congenital diaphragmatic hernia (CDH). Pulmonary hypoplasia is characterized by low volume lungs, and affected infants are likely to have a low lung area on their chest radiograph. The authors assessed whether, in CDH infants, computer-assisted analysis of the chest radiograph lung area gave an accurate indication of lung volume, and if a low lung area was a better predictor of poor outcome (death or oxygen dependency at 28 days) than other test results. METHODS: Comparisons were made of the radiographic lung area derived by computer-assisted analysis and lung volume, assessed by measurement of functional residual capacity (FRC) on day 1 before surgical intervention and on the first postoperative day. Compliance was measured, and the maximum and modified ventilation indices and maximum Paco2 also was noted. Twenty-five CDH infants with a median gestational age of 38 weeks were studied; 18 had FRC measurements preoperatively. RESULTS: Both preoperatively and postoperatively, the lung areas and FRCs correlated significantly (r = 0.51, P<.05; r = 0.76, P<.02, respectively). Eleven infants had a poor outcome (5 infants died without an operation); that group preoperatively differed significantly from those with a good outcome with respect to having a lower compliance (P<.02) and higher maximum ventilation index (P<.01) and maximum modified ventilation index (P<.05). Only postoperatively did infants with a poor outcome versus good outcome have a significantly lower lung area (P<.05); they also had a lower increase in lung area preoperatively to postoperatively (P<.01). Receiver operator characteristic curves were constructed; comparison of the areas under the curves showed that preoperatively, a low compliance and high ventilation index were the best predictors of poor outcome. Postoperatively, a low lung area performed as well as the ventilation indices. CONCLUSION: Computer-assisted analysis of the lung area on the chest radiograph is useful in predicting outcome in CDH infants postoperatively but not preoperatively.

Hernia, Diaphragmatic↗

PubMedDate not supplied

Neonatal lung remodeling: structural, inflammatory, and ventilator-induced injury.

The developing lung is subject to events, both prenatal and postnatal, that alter the normal developmental process. The degree of insult or injury affects how the lung functions at birth and then responds to the insult throughout childhood. In this article, only 3 of the influences are examined: structural, inflammatory, and mechanical. It is recognized that there is a plethora of other factors that influence lung remodeling.

Bronchopulmonary Dysplasia↗

PubMed2003

Cardiovascular and pulmonary effects of epidural anaesthesia.

The cardiovascular effects observed with epidural anaesthesia are complex and are predominantly related to the extent of sympathetic denervation, autonomous balance, baseline blood volume and cardiovascular function of the patient. With epidural anaesthesia the pharmacological effect of systemically absorbed local anaesthetic agents and inclusion of adrenaline to the local anaesthetic solution may play a role. Individual cardiovascular response to different levels of sympathetic blockade varies widely, depending on the degree of sympathetic tone prior to the block. Epidural anaesthesia per se has little effect on respiration in patients with pre-existing lung disease. Thoracic epidural anaesthesia appears to reverse the diaphragmatic dysfunction which is a major determinant of the decrease in lung volumes observed after upper abdominal surgery. This article summarizes cardiovascular and pulmonary responses to epidural anaesthesia.

Anesthesia, Epidural↗

PubMed2006

Computer-aided diagnosis of emphysema in COPD patients: neural-network-based analysis of lung shape in digital chest radiographs.

Several abnormalities of the shape of lung fields (depression and flattening of the diaphragmatic contours, increased retrosternal space) are indicative of emphysema and can be accurately imaged by digital chest radiography. In this work, we aimed at developing computational descriptors of the shape of the lung silhouette able to capture the alterations associated with emphysema. We analyzed two-sided digital chest radiographs from a sample of 160 patients with chronic obstructive pulmonary disease (COPD), 60 of which were affected by emphysema, and from 160 subjects with normal lung function. Two different description schemes were considered: a first one based on lung-silhouette curvature features, and a second one based on a minimal-polyline approximation of the lung shape. Both descriptors were employed to recognize alterations of the lung shape using classifiers based on multilayer neural networks of the feed-forward type. Results indicate that pulmonary emphysema can be reliably diagnosed or excluded by using digital chest radiographs and a proper computational aid. Two-sided chest radiographs provide more accurate discrimination than single-view analysis. The minimal-polyline approximation provided significantly better results than those obtained from curvature-based features. Emphysema was detected, in the entire dataset, with an accuracy of about 90% (sensitivity 88%, specificity 90%) by using the minimal-polyline approximation.

Humans↗

PubMed1993

Recruitment of some respiratory muscles during three maximal inspiratory manoeuvres.

BACKGROUND: A study was undertaken to determine the level of recruitment of the muscles used in the generation of respiratory muscle force, and to ascertain whether maximal diaphragmatic force and maximal inspiratory muscle force need to be measured by separate tests. The level of activity of three inspiratory muscles and one expiratory muscle during three maximal respiratory manoeuvres was studied: (1) maximal inspiration against a closed airway (Muller manoeuvre or maximal inspiratory pressure (MIP)); (2) maximal inspired manoeuvre followed by a maximal expiratory effort (combined manoeuvre); and (3) maximal inspiratory sniff through the nose (sniff manoeuvre). METHODS: All the manoeuvres were performed from functional residual capacity. The gastric (PGA) and oesophageal (POES) pressures and their difference, transdiaphragmatic pressure (PDI), and the integrated EMG activity of the diaphragm (EDI), the sternomastoid (ESTR), the intercostal parasternals (ERIC), and the rectus abdominis muscles (ERA) were recorded. RESULTS: Mean (SD) PDI values for the Muller, combined, and sniff manoeuvres were: 127.6 (19.4), 162.7 (22.2), and 136.6 (24.8) cm H2O, respectively. The pattern of rib cage muscle recruitment (POES/PDI) was similar for the Muller and sniff manoeuvres (88% and 80% respectively), and was 58% in the combined manoeuvre, confirming data previously reported in the literature. Peak EDI amplitude was greater during the sniff manoeuvre in all subjects (100%) than during the combined (88.1%) and Muller (61.1%) manoeuvres. ESTR and EIC were more active in the Muller and the sniff manoeuvres. The contribution of the expiratory muscle (ERA) to the three manoeuvres was 100% in the combined, 26.1% for the sniff, and 11.5% for the Muller manoeuvre. CONCLUSIONS: Each of these three manoeuvres results in different mechanisms of inspiratory and expiratory muscle activation and the intrathoracic and intra-abdominal pressures generated are a reflection of the interaction between the various muscle groups. The Muller and sniff manoeuvres reflect mainly the force of the inspiratory muscles and the combined manoeuvre that of the diaphragm.

Adult↗

PubMed1983

Contribution of hypoventilation to sleep oxygen desaturation in chronic obstructive pulmonary disease.

The purpose of this study was to determine whether hypoventilation contributes to the sleep hypoxemia observed in chronic obstructive pulmonary disease (COPD) patients and to examine breathing pattern and respiratory muscle electromyographic (EMG) activity during these episodes. Seven COPD patients who experienced at least a 10% decrease in arterial O2 saturation (SaO2) during rapid-eye-movement sleep (REM) sleep, six COPD patients with a minimal fall in SaO2, and five healthy subjects were studied. An inductance vest was used to quantitate ventilation. Skin electrodes were used to estimate diaphragmatic and intercostal electromyographic activity. Minute ventilation and EMG activity decreased in all three groups during sleep. Ventilation was irregular during REM sleep in the patients. During REM sleep, desaturating patients had longer episodes of hypopneic breathing [30 +/- 8 s (SE)] than nondesaturating patients (13 +/- 1 s, P less than 0.01). Desaturating patients spent a greater proportion of REM time hypopneic (53 +/- 5 vs. 28 +/- 5%, P less than 0.01) and had a greater decrease in functional residual capacity during hypopnea (P less than 0.05). SaO2 followed the hypopneic and hyperpneic breathing in REM sleep so that desaturating patients had more time for desaturation to occur. Thus hypoventilation appears to be a primary factor in sleep O2 desaturation in these patients. Because of the fall in lung volume, maldistribution of ventilation may also contribute.

Adult↗

PubMedDate not supplied

Surgical treatment of giant left ventricular aneurysms. The intraventricular resection technique.

The intraventricular resection technique for giant aneurysm of the left ventricle decreases anoxic cardiac arrest time and controls the detachment of intramural thrombus. To perform this technique, it is necessary to expose only a longitudinal segment on the anterior aspect of the aneurysm to permit a ventriculotomy parallel to the anterior descending coronary artery 4-5 cm away. In the same way, to resect a giant aneurysm of the diaphragmatic aspect, only a segment parallel to the posterior descending coronary artery needs to be exposed. Then with the clear intraventricular vision of the limit between the fibrous sac and the contracting left ventricle, the surgeon rapidly detaches the aneurysm. In any case besides the relation of this limit, the transecting line must keep away at least 4 cm from the implantation of the papillary muscle of the mitral valve, in order to leave an adequate functional chamber for the left ventricle. The early visualization of the mitral apparatus during the resection of giant aneurysm is another basic advantage of the intraventricular approach. The ventriculotomy is closed with a running suture and coronary circulation is restored. Anoxic cardiac arrest averaged 15 minutes in the five out of six cases of giant aneurysm treated with this technique. In the period July 1972-December 1973, 28 aneurysms of the left ventricle with varied associated pathology have been treated in this surgical unit, with 14% (4 cases) mortality. By contrast, no death has been registered in this severely ill group of six patients with giant left ventricular aneurysm. In cases I and VI myocardial revascularization was added. Two important aspects contribute to the excellent long term result in this group. 1. Correction of the altered geometry and consequent dysfunction of the left ventricle. 2. Correction of the functional ischemia of the contracting myocardium. The presence of giant aneurysm increases the left ventricle wall tension, including the contracting mass, and consequently the myocardial oxygen consumption.

Aged↗

PubMed1990

Alteration in breathing of the awake rat after laryngeal and diaphragmatic muscle paralysis.

The respiratory rate (f), tidal volume (VT) and ventilation (V) were measured in 3 groups of rats: 10 rats before and after cutting both recurrent laryngeal nerves (RLNX), 10 rats before and after bilateral phrenicotomy (PNX) and 5 sham transected (SHAMX) rats. All rats were exposed to air and gas mixtures, deficient in O2 and/or enriched with CO2. The barometric method was used to measure ventilatory parameters. The sham operation did not affect breathing pattern or ventilation. In RLNX rats, breathing the various gas mixtures exhibited no changes in V because f uniformly increased as VT declined. Therefore, loss of the neural control of the respiratory functions of the larynx in awake rats exposed to selected gas mixtures has no untoward effects on alveolar ventilation. Changes in ventilation of PNX rats, compared with SHAMX rats, depends on the gas composition breathed. With increasing severity of hypoxia and/or hypercapnia, PNX rats show a marked reduction in alveolar ventilation over that of the SHAMX rats. Thus, when the diaphragm is no longer able to participate in ventilatory responses, gas exchange is likely to become deficient.

Airway Resistance↗

PubMed1997

[Surfactant treatment of acute pulmonary failure. Other indications than neonatal distress syndrome].

In 1959 Avery and Mead suggested internationally that respiratory failure in premature infants is due to lack of surfactant. Surfactant is a phospholipid protein complex that is synthesised and stored in alveolar type II pneumocytes in the lungs. The main function of surfactant is to reduce surface tension in the lungs and make respiratory effort easier. Since 1959 much of scientific work has been done in this field, and there is now increasing evidence to support the theory that surfactant is important for normal lung function. Therefore surfactant insufficiency plays a major role in acute respiratory failure of any etiology. In this paper we focus on other possible indications for surfactant replacement therapy, and describe a patient with meconium aspiration syndrome which was treated successfully with exogenous natural surfactant.

Asthma↗

PubMed2006

[Strategies to avoid complications and to solve technical problems during the implantation of CRT and CRT-D systems].

Cardiac resynchronization with or without antitachycardiac treatment is now an established option to improve the functional status, morbidity and mortality of patients with severe symptomatic systolic heart failure, ventricular conduction delay and asynchrony. Increasing implant numbers are to be expected. The transvenous left ventricular lateral lead placement can now be achieved in up to 97% of patients. But due to the coronary venous anatomy it may still constitute a challenge even for experienced pacemaker and ICD implanters. In addition, it confers a considerable risk for complications like coronary sinus dissection and perforation, diaphragmatic stimulation and lead dislodgement. An overview is given on possible technical problems, solutions, complications and preventive strategies.

Cardiac Catheterization↗

PubMed2004

Neonatal anesthesia.

The physiology of the preterm and term neonate is characterized by a high metabolic rate, limited pulmonary, cardiac and thermoregulatory reserve, and decreased renal function. Multisystem immaturity creates important developmental differences in drug handling and response when compared to the older child or adult. Neonatal anesthetic management requires an understanding of the pharmacophysiologic limitations of the neonate as well as the pathophysiology of coexisting surgical disease. This review addresses the pertinent aspects of neonatal physiology and pharmacology, general considerations in the anesthetic care of surgical neonates, and concludes with a brief review of the anesthetic management of neonates with necrotizing enterocolitis, diaphragmatic hernia, and tracheoesophageal fistula.

Anesthesia↗

PubMed1987

Monophasic action potential mapping in human subjects with normal electrocardiograms: direct evidence for the genesis of the T wave.

T wave concordance in the normal human electrocardiogram (ECG) generally is explained by assuming opposite directions of ventricular depolarization and repolarization; however, direct experimental evidence for this hypothesis is lacking. We used a contact electrode catheter to record monophasic action potentials (MAPs) from 54 left ventricular endocardial sites during cardiac catheterization (seven patients) and a new contact electrode probe to record MAPs from 23 epicardial sites during cardiac surgery (three patients). All patients had normal left ventricular function and ECGs with concordant T waves. MAP recordings during constant sinus rhythm or right atrial pacing were analyzed for activation time (AT) = earliest QRS deflection to MAP upstroke, action potential duration (APD) = MAP upstroke to 90% repolarization, and repolarization time (RT) = AT plus APD. AT and APD varied by 32 and 64 msec, respectively, over the left ventricular endocardium and by 55 and 73 msec, respectively, over the left ventricular epicardium. On a regional basis, the diaphragmatic and apicoseptal endocardium had the shortest AT and the longest APD, and the anteroapical and posterolateral endocardium had the longest AT and the shortest APD (p less than .05 to less than .0001). RT was less heterogeneous than APD, and no significant transventricular gradients of RT were found. In percent of the simultaneously recorded QT interval, epicardial RT ranged from 70.8 to 87.4 (mean 80.7 +/- 3.9) and endocardial RT ranged from 80 to 97.8 (mean 87.1 +/- 4.4) (p less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Action Potentials↗

PubMed1995

Low-dose dopamine in severe right heart failure and chronic obstructive pulmonary disease.

OBJECTIVE: To describe the beneficial effects of low-dose dopamine infusion (2-5 micrograms/kg/min) in a patient with severe cor pulmonale complicating chronic obstructive pulmonary disease (COPD). CASE SUMMARY: A 53-year-old woman with severe cor pulmonale and generalized edema complicating COPD received low-dose dopamine to stabilize blood pressure and, perhaps, improve cardiac output. Low-dose dopamine also improved her renal function and enhanced the diuretic response to furosemide therapy. DISCUSSION: Previous studies of dopamine in such patients were reviewed. Both dopamine infusion (4 micrograms/kg/min) and oral administration of its precursor, L-dopa, can increase the cardiac output, decrease pulmonary vascular resistance, and enhance oxygen delivery in patients who are stable with cor pulmonale secondary to COPD. In patients with COPD during acute respiratory failure, high-dose dopamine (10 micrograms/kg/min) has been shown to increase the diaphragmatic blood flow and contraction. Low-dose dopamine also has been reported to be useful in patients with congestive heart failure or cirrhosis of the liver. CONCLUSIONS: Low-dose dopamine is useful in the acute management of patients with severe cor pulmonale complicating COPD because of the drug's beneficial effects on blood pressure, cardiac output, renal perfusion, natriuresis, and diuresis. Low-dose dopamine also may enhance the natriuretic and diuretic response to loop diuretics, decrease pulmonary vascular resistance, and enhance oxygen delivery.

Cardiac Output, Low↗

PubMed1985

Unity of costal and crural diaphragmatic activity in respiration.

In chronically implanted rats, we examined the respiratory EMG activity of the two parts of the diaphragm, costal and crural, during sleep and wakefulness. Their activity was compared and contrasted with that of the EMG activity of the cricothyroid muscle. Whether in wakefulness, while grooming and drinking, or in nonrapid eye movement (non-REM) sleep, and independent of the gas mixture breathed (4 to 5% CO2 or 10% O2 in nitrogen), the two parts of the diaphragm paused during REM apnea episodes whereas the cricothyroid muscle ceased its activity or exhibited sustained activity. We conclude that the diaphragm, mainly an inspiratory muscle, acts as a single functional unit when under the respiratory control system. The cricothyroid muscle functions as an inspiratory and/or expiratory muscle, also under the respiratory control systems. Both muscles in the rat come under other neural control mechanisms governing nonrespiratory functions, e.g., swallowing, defecation, and coughing, but not vomiting.

Animals↗

PubMed1999

Living-related liver transplantation in children: the 'Parisian' strategy to safely increase organ availability.

PURPOSE: The aim of the authors was to report their experience with living related liver transplantation (LRLT) in children, particularly focusing on the safety of the two-center "Parisian" strategy. METHODS: The records of donors and recipients of 26 pediatric living-related donor liver transplantations performed between November 1994 and March 1998 were reviewed retrospectively. Donors were assessed 1 year after transplantation for medical and overall status. RESULTS: Indications for LRLT included biliary atresia (n = 18), Byler's disease (n = 5), alpha-1-antitrypsin deficiency (n = 1), Alagille syndrome (n = 1), and undefined cirrhosis (n = 1). Liver harvesting consisted of either a complete left hepatectomy (n = 14) or left lateral hepatectomy (n = 12) without vascular clamping. The recipient procedure essentially was the same as in split liver transplantation. Mean overall cold ischemia time averaged 140 minutes (range, 90 to 230 minutes). Twenty-four of 26 patients had end-to-end vascular anastomoses without interposition. Biliary reconstruction consisted of a Roux-en-Y choledochojejunostomy in all patients. All recipients except one received cyclosporine A (CSA). Mean donor hospitalization was 8 days (range, 6 to 13) with normalization of all liver function assays by the time of discharge. There were no donor deaths and two postoperative complications (perihepatic fluid collection and bleeding from the wound). One year after donation, the initial 19 donors had resumed their pretransplant status. Two of the children who underwent transplant died. Thirteen of the recipients required reoperation for hepatic artery thrombosis (n = 2), portal vein thrombosis (n = 2), biliary complications (n = 6), fluid collection (n = 3), small bowel perforation (n = 1), and plication for diaphragmatic eventration (n = 1). With mean follow-up of 2 years, 24 of 26 patients are alive and well (patient and graft survival rate, 92%). CONCLUSIONS: LRLT is still controversial, even with minimal and decreasing donor risk. The "Parisian" strategy consists of harvesting the liver in an adult unit by an adult hepatic surgery team. The transplantation is then performed in a pediatric hospital by the pediatric liver transplantation team. The two steps of the procedure allow units specialized in adult surgery, on one hand, and pediatric liver transplantation, on the other hand, to dedicate themselves completely to their respective procedures, improving the safety of the harvest, and alleviating stress for both the medical staff and the families.

Adolescent↗