Assessing the Microbiota of Black Soldier Fly Larvae (Hermetia illucens) Reared on Organic Waste Streams on Four Different Locations at Laboratory and Large Scale.

This study aimed to gain insight into the microbial quality, safety and bacterial community composition of black soldier fly larvae (Hermetia illucens) reared at different facilities on a variety of organic waste streams. For seven rearing cycles, both on laboratory-scale and in large-scale facilities at several locations, the microbiota of the larvae was studied. Also samples of the substrate used and the residue (= leftover substrate after rearing, existing of non-consumed substrate, exuviae and faeces) were investigated. Depending on the sample, it was subjected to plate counting, Illumina Miseq sequencing and/or detection of specific food pathogens. The results revealed that the substrates applied at the various locations differed substantially in microbial numbers as well as in the bacterial community composition. Furthermore, little similarity was observed between the microbiota of the substrate and that of the larvae reared on that substrate. Despite substantial differences between the microbiota of larvae reared at several locations, 48 species-level operational taxonomic units (OTUs) were shared by all larvae, among which most belonged to the phyla Firmicutes and Proteobacteria. Although the substrate is assumed to be an important source of bacteria, our results suggest that a variety of supposedly interacting factors-both abiotic and biotic-are likely to affect the microbiota in the larvae. In some larvae and/or residue samples, potential foodborne pathogens such as Salmonella and Bacillus cereus were detected, emphasising that decontamination technologies are required when the larvae are used in feed, just as for other feed ingredients, or eventually in food.

Dynamics of Salmonella inoculated during rearing of black soldier fly larvae (Hermetia illucens).

The black soldier fly is currently the most produced edible insect on industrial scale, with its larval stage being processed into animal feed as the main application. As this insect species enters the feed and food chain, good hygiene and monitoring practices are needed to avoid the entrance of foodborne pathogens via the larvae. However, insufficient data on the risk of such introductions via industrial larvae production are available. To address this gap, a range of rearing trials were conducted in which the substrate, chicken feed, was inoculated with different levels of Salmonella and in which total viable counts and Salmonella counts were determined during the following days. The outgrowth of Salmonella was slower in those experiments with a lower initial contamination level than in experiments with a higher level. No significant reducing effect originating from the larvae on the substrate Salmonella counts was observed, in contrast to previous studies using other substrates. Our study also revealed that airborne transmission of Salmonella is possible under rearing conditions corresponding to those applied at industrial production sites. Based on our results, we recommend insect producers to use substrate ingredients free of Salmonella, and not to count on the antimicrobial activities that BSFL may exert in some situations towards food pathogens. More inoculation studies using other Salmonella serotypes, other zoonotic bacteria, other substrates, larvae of other ages and including variations on rearing protocols are needed in order to obtain a general view on the dynamics of food pathogens in this insect species and to support comprehensive risk assessments.

A uniaxial force and stiffness model of the vagina during laparoscopic sacrocolpopexy.

BACKGROUND: Laparoscopic sacrocolpopexy is the preferred procedure for restoring vaginal vault prolapse. An assistant uses a vaginal manipulator to position and tension the vault such that the surgeon can dissect the bladder, rectum and vault to eventually suture a synthetic mesh used to suspend the vagina to the longitudinal anterior vertebral ligament. Vaginal vault manipulation requires application of high forces for long periods of time. METHODS: This work quantifies the task by measuring and analyzing the interaction forces and the workspace during vaginal vault manipulation. From the measurements we developed a uniaxial model, expressing the increase in interaction force and stiffness of the vagina. By adapting the model parameters, the difference in interaction force and stiffness between moderate and severe prolapse is predicted. FINDINGS: For moderate prolapse the average interaction force and stiffness start at 2.56 N and 0.11 N mm-1 in the tensionfree state, and go up to 20.14 N and 0.53 N mm-1 after complete insertion of the instrument. For severe degrees of prolapse, tissue interaction is much lower starting at 1.68 N and 0.06 N mm-1 while staying limited to 12.20 N and 0.30 N mm-1 at full extension. INTERPRETATION: Population data shows that the stage of prolapse and total vaginal length increase with age and parity. The interaction force and stiffness of the vagina are correlated with this degree of prolapse. By adapting the model parameters a good estimation of the tissue interaction is found for patients with mild and severe prolapse.

Staphylococcus aureus in Substrates for Black Soldier Fly Larvae (Hermetia illucens) and Its Dynamics during Rearing.

Black soldier fly larvae (BSFL; Hermetia illucens) are promising insects for the conversion of organic waste streams into valuable biomolecules. Such waste streams can contain foodborne pathogens. To assess this risk factor, this study evaluated the presence of Staphylococcus aureus in waste streams as a substrate ingredient for BSFL production as well as in the rearing process. First, the general microbiological quality and the occurrence of S. aureus were investigated for different waste streams. Staphylococcus aureus was abundantly present. Control of pH and water activity should avoid pathogens, which cannot grow in single-substrate ingredients, redeveloping when mixing streams for optimal substrate conditions for BSFL production. Next, it was investigated whether S. aureus present in the substrate was ingested and/or eradicated by BSFL. In inoculation trials, with S. aureus added to chicken feed as the substrate at 3 or 7 log CFU/g, the larvae showed a reducing effect on S. aureus. After 6 days, S. aureus counts were below the detection limit (2.0 log CFU/g) in all larvae samples and decreased in the substrate to <2.0 and <3.1 log CFU/g for inoculation levels of 3 and 7 log CFU/g, respectively. While this is promising, it is still recommended to monitor and control this pathogen in BSFL rearing. Intriguingly, screening of antimicrobial activity of dominant microorganisms associated with BSFL showed a clear activity of Trichosporon isolates against S. aureus. Future research should explore whether Trichosporon, which is frequently observed in BSFL, plays a role in controlling specific microorganisms, such as S. aureus. IMPORTANCE Given the increasing need for (more sustainable) methods to upcycle organic waste streams, the interest to rear insects, like black soldier fly larvae (BSFL), on such streams is increasing. This study reveals that S. aureus is abundantly present in such waste streams, which might be a point of attention for insect producers. At the same time, it reveals that when S. aureus was inoculated in chicken feed as the substrate, it was not detected in the larvae and was reduced in the substrate after 6 days. Future inoculation trials should investigate whether this reduction is substrate dependent or not. Toward the future, the role of the BSFL microbiota in controlling intestinal bacterial community homeostasis should be explored, because one of the dominant microorganisms associated with BSFL, Trichosporon spp., showed clear activity against S. aureus.

Errors involved in the existing B-term expressions for the longitudinal diffusion in fully porous chromatographic media Part I: computational data in ordered pillar arrays and effective medium theory.

Numerically solving the effective diffusion in a simplified representation of a chromatographic bed, it was found that the B-term expressions that have up to now been used in the literature, and which can all be reduced to either Deff=(gamma mDm+k'gamma sDs)/(1+k') or Deff=(gamma meDm+k''Dpart)/(1+k''), can no longer be considered to be unconditionally valid. This could be demonstrated by showing that the simulated diffusion data are in agreement with the mathematically sound effective medium theory (EMT), whereas the B-term expressions used up to now in literature are in conflict with the EMT, a theory that is widely accepted in all other fields of science. It is also shown that the use of the existing B-term expressions can lead to very large measurement errors (up to a 100% and more) for the determination of the stationary phase diffusion coefficient gamma sDs from peak parking experiments. The representation of the B-term diffusion should in the future hence be based on the Deff expressions that can be derived from the EMT. These are physically sound and are also more accurate than the classical B-term expressions used up to now.

Guidelines for quality improvement in cardiac surgery. The College of Cardiac Surgery : results of the 2007 survey.

Optimal delivery of health care is a common goal of individual physicians, professional organizations, hospital structures and governmental authorities. A growing concern has emerged from the public, media and third payer organizations concerning the quality of care and the amount of resources spending. In the United States, large databases, guidelines and performance evaluation have been elaborated by medical societies, particularly in the area of cardiac surgery. These tools are useful for improvement of patients' care, resources distribution, pay for performance and public and practitioners' awareness. The evaluation of quality is based on composite models combining structure, process and outcome indices. However, pitfalls such as patients' selection, and risk avoidance in order to improve results must been prevented by adjustment of the treated populations' risk factors by specific scores. The Belgian Health authorities have built a structure directed at delivery of care improvement based on "Care Programs", monitored by Colleges formed by delegates of professional organizations. The College of Cardiac Surgery has promoted several studies aimed at data collection and evaluation. In 2007, a survey was addressed to all the Belgian Cardiac surgeons to define their opinion as to the best indicators of care in their specialty. These results will serve to define further avenues of research. By maintaining the responsibility of care evaluation in the hands of the involved professionals, this kind of cooperation between governmental and physicians' organizations seems to serve the best interests of the public and the practitioners.

On the 3-dimensional effects in etched chips for high performance liquid chromatography-separations.

In an attempt to quantify the potential of photolithographically etched micro-pillar arrays as a perfectly ordered alternative for the packed bed of spheres, the additional band broadening originating from the top and bottom plate has been investigated using computational fluid dynamics simulations. These calculations provide insight in the theoretical expectations that can be made for the experimental work that is currently being conducted by a number of groups. The calculations show that the additional band broadening contribution can be expected to go through a transient regime as a function of the axial distance along the array. In its fully developed regime and in the most relevant velocity range, the top and bottom wall contribution almost doubles the band broadening compared to the band broadening in a perfectly ordered array of non-porous, non-retentive pillars without top and bottom wall. Compared to the band broadening in an array of porous, retentive pillars on the other hand, the top and bottom wall-effect can be expected to become negligible. A simplified, phenomenological model yielding a first principles prediction of both the transient and the steady-state top and bottom wall band broadening as a function of the inter-pillar distance and the pillar height is proposed and shows good qualitative agreement with the exact calculations.

[Sudden onset of hemoptysis during (coil) embolization of a Swan-Ganz catheter induced pseudoaneurysm of the pulmonary artery]. / Survenue d'une hémorragie bronchique lors de l'embolisation d'un pseudo-anévrysme pulmonaire consécutif a un cathétérisme par Swan-Ganz.

We report the embolization of a pulmonary artery pseudoaneurysm consecutive to Swan-Ganz catheterization. Embolization was successful despite an iatrogenic rupture and a massive hemoptysis.

On the optimisation of the bed porosity and the particle shape of ordered chromatographic separation media.

We report on a theoretical study wherein we considered a large number of ordered two-dimensional porous pillar arrays with different pillar shapes and widely varying external porosity and calculated the flow resistance and the band broadening (under retentive conditions) over the complete range of practical velocities using a commercial computational fluid dynamics software package. It is found that the performance of the small porosity systems is very sensitive to the exact pillar shape, whereas this difference gradually disappears with increasing porosity. The obtained separation impedances are very small in comparison to packed bed and monolithic columns and decrease with increasing porosity. If accounting for the current micromachining limitations, a proper selection of the exact shape and porosity even becomes more critical, and different design rules are obtained depending on whether porous or non-porous pillars are considered.

Unilateral pallidotomy in PD: a controlled study of cognitive and behavioral effects. The Netherlands Pallidotomy Study (NEPAS) group.

OBJECTIVE: To investigate whether unilateral pallidotomy affects cognitive and behavioral functioning. METHODS: At baseline and after 6 months we assessed neuropsychological functioning in 35 patients with advanced PD. After baseline examination, patients were randomized to pallidotomy within 1 month (6 left-sided, 13 right-sided) or to pallidotomy after follow-up assessment 6 months later (n = 16; control group). We performed neuropsychological tests of language, visuospatial function, memory, attention, and executive functions. Self ratings and proxy ratings of memory problems and dysexecutive symptoms were also collected. RESULTS: No significant differences over time were found between pallidotomy and control groups, with the exception of a decrease of verbal fluency in the left-sided pallidotomy group. CONCLUSIONS: Unilateral pallidotomy is relatively safe with respect to cognition and behavior. Left-sided pallidotomy may lead to minor deterioration in verbal fluency. The sample size of this study is too small, however, to rule out the possibility of infrequent but clinically important side effects.

PEEP inhibits hypoxic pulmonary vasoconstriction in dogs.

The effects of an increase in alveolar pressure on hypoxic pulmonary vasoconstriction (HPV) have been reported variably. We therefore studied the effects of positive end-expiratory pressure (PEEP) on pulmonary hemodynamics in 13 pentobarbital-anesthetized dogs ventilated alternately in hyperoxia [inspired O2 fraction (FIO2) 0.4] and in hypoxia (FIO2 0.1). In this intact animal model, HPV was defined as the gradient between hypoxic and hyperoxic transmural (tm) mean pulmonary arterial pressure [Ppa(tm)] at any level of cardiac index (Q). Ppa(tm)/Q plots were constructed with mean transmural left atrial pressure [Pla(tm)] kept constant at approximately 6 mmHg (n = 5 dogs), and Ppa(tm)/PEEP plots were constructed with Q kept constant approximately 2.8 l.min-1.m-2 and Pla(tm) kept constant approximately 8 mmHg (n = 8 dogs). Q was manipulated using a femoral arteriovenous bypass and a balloon catheter in the inferior vena cava. Pla(tm) was held constant by a balloon catheter placed by left thoracotomy in the left atrium. Increasing PEEP, from 0 to 12 Torr by 2-Torr increments, at constant Q and Pla(tm), increased Ppa(tm) from 14 +/- 1 (SE) to 19 +/- 1 mmHg in hyperoxia but did not affect Ppa(tm) (from 22 +/- 2 to 23 +/- 1 mmHg) in hypoxia. Both hypoxia and PEEP, at constant Pla(tm), increased Ppa(tm) over the whole range of Q studied, from 1 to 5 l/min, but more at the highest than at the lowest Q and without change in extrapolated pressure intercepts. Adding PEEP to hypoxia did not affect Ppa(tm) at all levels of Q.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison between muscarinic receptor occupancy, adenylate cyclase inhibition, and inotropic response in human heart.

Binding to muscarinic receptors was compared with adenylate cyclase inhibition in membranes derived from human heart auricles, and with inhibition of the contraction of auricular muscle fibers. In the absence of GTP, agonists recognized two classes of receptors both of which bound antagonists with the same affinity. In the presence of GTP, both classes of receptors for agonists were converted into a single low affinity state. Carbachol and oxotremorine inhibited adenylate cyclase activity by 43%, pilocarpine being less efficient (-28%). The 3 agonists exerted similar inhibitory effects on the inotropic response, in 7 out of 9 preparations of electrically- and norepinephrine-stimulated fibers. Dose-effect curves suggested that spareness (or an amplification mechanism) was implicated in the occupancy of low affinity binding sites by carbachol and oxotremorine (but not by the partial agonist pilocarpine) and the resulting inhibition of both adenylate cyclase activity and contractile force.

Computational study of the band broadening in two-dimensional etched packed bed columns for on-chip high-performance liquid chromatography.

The chromatographic performance of several straightforward two-dimensional etched packed bed column lay-outs (equilaterally staggered arrays of, respectively, circular, hexagonal, and diamond-like pillars) has been compared using commercial computational fluid dynamics software. In all cases, the bed porosity was kept at epsilon = 0.4 and a retained component with zone capacity ratio k" = 2 was considered. Exploring the use of six different possible characteristic dimensions to bring the Van Deemter plots of the three different considered particle shapes into agreement, none of them yielded a perfect agreement. Using the pillar volume-based equivalent cylinder diameter (deq) as the characteristic dimension, the diamond-like pillars yielded a significantly smaller h(min) value than the cylinders and the hexagons (h(min) approximately equal to 0.74 for the former versus h(min) approximately equal to 0.83 for the two latter). Including the flow resistance into the analysis, it was found that the "hydrodynamic" shape of the particles has an important influence on the separation impedance E. The more axially elongated diamond pillars yielded an Emin number as small Emin = 180 (for a retained component with k" = 2), i.e. about 40% smaller than the cylinders and the hexagons (Emin = 300-330). The obtained h(min) and Emin values are also significantly smaller than the values often cited for the best possible packed bed HPLC columns. We believe this is a consequence of the assumed perfect homogeneity of the etched structures, and hence hints at the potential benefits of perfectly ordered chromatographic columns, as was already inferred by Knox [J. Chromatogr. A 831 (1999) 3; 960 (2002) 7] and He et al. [Anal. Chem. 70 (1998) 3790].

A survey of nine years heart transplantation at Erasme Hospital, University of Brussels.

Between March 1982 and March 1991, 225 heart transplantations (HTx) have been performed in 220 patients suffering end stage cardiac disease. Thirteen percent were females and 87% were males. Age range was from 5 to 68 years. The underlying cardiac disease was ischemic cardiopathy in 51.5%, congestive dilated cardiomyopathy in 42%, valvular cardiomyopathy in 3.5%, toxic myocarditis (post-adriamycin) in 1.5% and chronic rejection in 2.5% (retransplantation). Selection of the recipients was done following the currently well established criteria also taking into account the absolute major contraindications for HTx. Due to the still increasing demand of donor organs, currently donor age has been extended up to 50 years for male and 55 years for female donors. One quarter of the grafts were harvested on site in our institution, two other quarters were harvested somewhere else in Belgium and the last quarter provided by other countries cooperating with Eurotransplant. All patients have undergone orthotopic cardiac transplantation using the standard Lower and Shumway technique. Immunosuppression protocols have changed four times throughout the years. Nevertheless all were based on the use of Ciclosporine variously combined with other current immunosuppressive drugs. Rejection monitoring relied on routine endocardiac biopsy and was diagnosed according to the Billingham criteria. The in-hospital mortality is currently 11%. Infection, early right heart graft failure and acute rejection were the leading causes of death. The major causes of early morbidity were several curable infections, reversible rejection episodes, transient acute renal failure and controllable arterial hypertension. Among the survivors followed for at least one month up to nine years, half of late mortality was caused by chronic rejection followed by infection, sudden death, metabolic disorders, stroke and malignancy. Late morbidity involves cases of mild coronary graft diseases, biological renal insufficiency, some degree of arterial hypertension, dislipidemia. Current actuarial survival rate is 87% at one year, 76% at 5 years up to 9 years. Our experience confirms that HTx represents today and effective therapy for selected patients suffering end stage cardiac disease.

Absence of cardio-depressant effects of CGP 17582 B, a new beta-blocking agent, in patients after coronary surgery.

The hemodynamic effects of CGP 17582 B, a new cardio-selective beta-blocking agent with moderate intrinsic sympathomimetic activity and minimal effects on myocardial contractility, were studied in patients after cardiac surgery for coronary artery bypass graft. Each patient had been treated preoperatively with beta-blocking agents and had a cineangiographic left ventricular ejection fraction between 40 and 60%. Fourteen patients were randomized to receive either 10 mg of propranolol or 50 mg of CGP 17582 B orally. Both drugs resulted in a significant and a similar decrease in heart rate. However, this was associated with a significant decrease in stroke volume after propranolol but not after CGP 17582 B, so that cardiac output significantly decreased only after propranolol. Thermodilution right ventricular ejection fraction significantly decreased after propranolol but not after CGP 17582 B. Each drug was well tolerated during the 10 following days and the recovery was uneventful in each patient. These results indicate that CGP 17582 B is a promising beta-blocking agent susceptible to reduce heart rate without altering cardiovascular function after cardiac surgery.

Conversion from ministernotomy to full sternotomy in aortic valve replacement.

Conversion (C) from ministernotomy (M.S.) to full sternotomy was necessary in 5% of the cases in a series of 100 patients consecutively operated for Aortic Valve Replacement (A.V.R.) Analysis of the demographics and surgical techniques indicate older age, aortic fragility, diffuse coronary disease, chronic renal failure and left vent insertion as contributing factors. Despite increased operative blood losses, extra-corporeal circulation (E.C.C.) times, intensive care unit (I.C.U.) stay and hospital stay, no mortality was observed in the conversion group, as compared to 4.2% mortality in the total ministernotomy (MS) population. Preoperative patients selection, avoidance of technical pitfalls, and knowledge of alternative surgical measures are suggested to further decrease the incidence of conversions.

[Continuous emission Doppler study with spectrum analysis in the evaluation of aortic stenosis in adults. Apropos of 30 cases]. / Le Doppler à émission continue avec analyse spectrale dans l'évaluation des sténoses aortiques de l'adulte. A propos de 30 cas.

The value of continuous wave doppler with spectral analysis for the evaluation of aortic stenosis in adults being controverted, we analyzed prospectively the results obtained in 30 consecutive elderly patients (mean age 63 years) investigated by invasive and non-invasive methods. In 24 patients who underwent both ultrasonic and catheter examinations, the correlation between mean gradients measured by catheterization and calculated separately by doppler was 0.80. For a semi-quantitative evaluation of the aortic valve area, we suggest to use an additional severity index R calculated from doppler data (R = mean gradient/maximal instantaneous gradient) which correlated well (r = -0.68) with the aortic valve area. In our experience, this index makes it possible to separate patients with a less than 0.75 cm2 aortic valve area, as calculated from Gorlin's formula (R greater than 0.65) from patients with a more than 0.75 cm2 aortic valve area (R less than 0.65), irrespective of the associated cardiac index. It is concluded that the doppler ultrasound method provides a highly satisfactory evaluation of transaortic gradient, as well as a semi-quantitative evaluation of the stenotic aortic ostium in the majority of elderly patients with aortic stenosis.

Results of mitral valve reconstruction. Experience of Hôpital Erasme, ULB, Brussels.

BACKGROUND: Reconstructive surgery of the mitral valve has been an alternative to mitral valve replacement in patients with mitral regurgitation. In order to evaluate the early results of mitral valve reconstruction, 38 consecutive cases were analyzed. METHODS: Between January 1985 and May 1993, 38 patients with mitral valve incompetence were treated with a system of reconstructive techniques. Nineteen (52%) of the patients were in NYHA functional class II and seventeen (45%) in class III or IV preoperatively. The cause of the mitral disease was degenerative in 25 (66%), rheumatic in 6 (15%) and ischaemic in 5 (13%) patients. Isolated mitral valve repair was performed in 25 patients (66%); the remainder underwent associated procedures that included a myocardial revascularization in 9 patients (23.6%). Thirty-eight patients (100%) underwent a ring annuloplasty. Resection of the posterior leaflet was performed in 24 patients (63%). RESULTS: There was one operative death (2.6%) and two late deaths (5.3%). Postoperatively, four patients sustained embolic events (incidence 10.5%). Six patients (15.8%) were precociously reoperated within the following month; two patients required valve replacement, one had mediastinitis and three other ones needed a pericardial drainage. Patients routinely received acenocoumarol anticoagulation for two months. Mean follow-up was 33 months (range 6 to 104) and one patient was lost to follow-up. Two years actuarial survival was 91.4%. There were no thromboembolic complications in the follow-up period. No patient was reoperated for valvular insufficiency beyond this time limit. One patient had late endocarditis and has been reoperated for mitral replacement (2.6%). After surgery, 34 survivors (89.5%) were in the NYHA functional class I or II. CONCLUSIONS: These results demonstrate that mitral valvuloplasty is associated with lower operative mortality rates. Preservation of the mitral valve mechanism raised the performance of the left ventricle after reconstructive surgery. The incidence of reoperation and thromboembolism was low.

[Extensive intramural hematoma of the thoracic aorta]. / Hématome intramural extensif de l'aorte thoracique.

A[TRACE;del] 53-year-old hypertensive patient presenting with acute chest pain was found to have an intramural haematoma (IMH) of both ascending and descending aorta associated with a 6 cm ascending fusiform aortic aneurysm. Six weeks of antihypertensive treatment allowed complete resolution of the intramural haematoma of the descending aorta. Limited surgical repair of the ascending aorta by Gore-Tex graft prosthesis interposition was then performed. The patient was in good health with a one-year follow-up.

[Functional non-invasive cardio-respiratory evaluation a month and a year after orthotopic heart transplantation]. / Evaluation fonctionnelle cardio-respiratoire non invasive un mois et un an après transplantation cardiaque orthotopique.

Cardio-respiratory stress tests of 14 patients, performed one month and one year after orthotopic heart transplant, are compared in order to demonstrate the functional and metabolic improvements of their adaptation to stress. At maximal stress, we note a 33 p. cent increase of the oxygen consumption (p 0.001), an 11 p. cent increase of the heart rate (p 0.025) and an 18 p. cent increase of the systolic arterial pressure (p 0.005). Respiratory quotients and respiratory equivalent for oxygen are significantly lower (p 0.008) while there was no significant variation of ventilation/minute, respiratory rate, and the normal capacity. At the sub-maximal level, the only significant differences observed are the decrease of the respiratory quotient (p 0.01), the ventilation/minute (p 0.025), the respiratory equivalent for oxygen (p 0.005) and the respiratory rate (p 0.03). The improvement of the physical condition observed in heart transplants seems related to a better peripheral adaptation to stress (lower respiratory quotients, reflection of the decreased demand on anaerobic metabolism) permitting a lesser demand on the ventilatory response to stress.