BACKGROUND: There is no consensus regarding the definition of frailty for clinical uses. METHODS: A modified Delphi process was used to attempt to achieve consensus definition. Experts were selected from different fields and organized into five Focus Groups. A questionnaire was developed and sent to experts in the area of frailty. Responses and comments were analyzed using a pre-established strategy. Statements with an agreement more than or equal to 80% were accepted. RESULTS: Overall, 44% of the statements regarding the concept of frailty and 18% of the statements regarding diagnostic criteria were accepted. There was consensus on the value of screening for frailty and about the identification of six domains of frailty for inclusion in a clinical definition, but no agreement was reached concerning a specific set of clinical/laboratory biomarkers useful for diagnosis. CONCLUSIONS: There is agreement on the usefulness of defining frailty in clinical settings as well as on its main dimensions. However, additional research is needed before an operative definition of frailty can be established.

This experiment investigated social referencing as a form of discriminative learning in which maternal facial expressions signaled the consequences of the infant's behavior in an ambiguous context. Eleven 4- and 5-month-old infants and their mothers participated in a discrimination-training procedure using an ABAB design. Different consequences followed infants' reaching toward an unfamiliar object depending on the particular maternal facial expression. During the training phases, a joyful facial expression signaled positive reinforcement for the infant reaching for an ambiguous object, whereas a fearful expression signaled aversive stimulation for the same response. Baseline and extinction conditions were implemented as controls. Mothers' expressions acquired control over infants' approach behavior for all participants. All participants ceased to show discriminated responding during the extinction phase. The results suggest that 4- and 5-month-old infants can learn social referencing via discrimination training.

A three-year-old, 30-kg, spayed female German wirehaired pointer was presented for coughing, pyrexia and lethargy. Thoracic radiographs showed mild right-sided pleural effusion, moderate pneumothorax and a pulmonary lesion in the right middle or caudal lung lobe. A diagnosis of pyothorax was established by fine needle aspiration of the pleural effusion. Thoracoscopic exploration was performed using one-lung ventilation. A vegetal foreign body (grass awn) and an abscess were observed in the distal part of the right middle lung lobe. The foreign body was removed and a right middle lung lobectomy was performed, both thoracoscopically. No complications were noted. The dog was discharged 48 hours after surgery, and no recurrence of the clinical signs was observed during the follow-up time period (three years and three months). Thoracoscopy is a minimally invasive alternative to thoracotomy to explore and successfully treat some non-chronic pyothoraces in dogs, including lesions affecting the right middle lung lobe.

The destruction of the commonly found cyanobacterial toxin, microcystin-LR (MC-LR), in surface waters by UV-C/H(2)O(2) advanced oxidation process (AOP) was studied. Experiments were carried out in a bench scale photochemical apparatus with low pressure mercury vapor germicidal lamps emitting at 253.7 nm. The degradation of MC-LR was a function of UV fluence. A 93.9% removal with an initial MC-LR concentration of 1 μM was achieved with a UV fluence of 80 mJ/cm(2) and an initial H(2)O(2) concentration of 882 μM. When increasing the concentration of MC-LR only, the UV fluence-based pseudo-first order reaction rate constant generally decreased, which was probably due to the competition between by-products and MC-LR for hydroxyl radicals. An increase in H(2)O(2) concentration led to higher removal efficiency; however, the effect of HO scavenging by H(2)O(2) became significant for high H(2)O(2) concentrations. The impact of water quality parameters, such as pH, alkalinity and the presence of natural organic matter (NOM), was also studied. Field water samples from Lake Erie, Michigan and St. Johns River, Florida were employed to evaluate the potential application of this process for the degradation of MC-LR. Results showed that the presence of both alkalinity (as 89.6-117.8 mg CaCO(3)/L) and NOM (as ∼2 to ∼9.5 mg/L TOC) contributed to a significant decrease in the destruction rate of MC-LR. However, a final concentration of MC-LR bellow the guideline value of 1 μg/L was still achievable under current experimental conditions when an initial MC-LR concentration of 2.5 μg/L was spiked into those real water samples.

In an attempt to face serious environmental hazards, the degradation of microcystin-LR (MC-LR), one of the most common and more toxic water soluble cyanotoxin compounds released by cyanobacteria blooms, was investigated using nitrogen doped TiO(2)(N-TiO(2)) photocatalyst, under UV-A, solar and visible light. Commercial Degussa P25 TiO(2), Kronos and reference TiO(2) nanopowders were used for comparison. It was found that under UV-A irradiation, all photocatalysts were effective in toxin elimination. The higher MC-LR degradation (99%) was observed with Degussa P25 TiO(2) followed by N-TiO(2) with 96% toxin destruction after 20min of illumination. Under solar light illumination, N-TiO(2) nanocatalyst exhibits similar photocatalytic activity with that of commercially available materials such as Degussa P25 and Kronos TiO(2) for the destruction of MC-LR. Upon irradiation with visible light Degussa P25 practically did not show any response, while the N-TiO(2) displayed remarkable photocatalytic efficiency. In addition, it has been shown that photodegradation products did not present any significant protein phosphatase inhibition activity, proving that toxicity is proportional only to the remaining MC-LR in solution. Finally, total organic carbon (TOC) and inorganic ions (NO(2)(-), NO(3)(-) and NH(4)(+)) determinations confirmed that complete photocatalytic mineralization of MC-LR was achieved under both UV-A and solar light.

A survey of laboratory diagnosis of Clostridium difficile infection (CDI) was conducted in 103 Spanish hospitals. A mean of 23.2 stool specimens/1000 admissions were processed to detect CDI. Overall, 35.9% of the laboratories specifically selected stool specimens for diagnostic C. difficile toxin testing. The most commonly used criteria were loose or watery stools, previous antibiotic therapy and nosocomial diarrhoea. Most laboratories (95.1%) processed the stool specimens in house, mainly five to seven days/week. All laboratories except one detected toxins directly in stool specimens, and 94.9% used enzyme immunoassays (EIAs). Only 16.3% of the laboratories used toxigenic culture as a diagnostic tool, and most of them used EIAs to detect toxins in isolates. The most common diagnostic strategy was toxin detection in stool specimens using EIA alone (79.6%), and the second most common strategy was the combination of toxin detection in stool specimens and isolates (10.2%). The estimated annual incidence of CDI was 1.71 cases/1000 admissions, and this was significantly higher in large hospitals. CDI is underdiagnosed in Spain because most laboratories use EIAs performed directly on stool specimens as the only diagnostic procedure. A national laboratory survey of diagnostic methods and testing protocols for the diagnosis of CDI is simple and inexpensive, and could act as the first step towards implementing national standardized criteria for optimal diagnosis of CDI.

A study was performed to determine the effect of pH, alkalinity, natural organic matter (NOM) and dissolved oxygen in the performance of nitrogen and fluorine doped TiO(2)(NF-TiO(2)) for the degradation of hepatotoxin microcystin-LR (MC-LR) in synthetic and natural water under visible light irradiation. The initial degradation rate of MC-LR was fastest under acidic conditions (3.50 ± 0.02 × 10(-3) μM min(-1) at pH 3.0) and decreased to 2.29 ± 0.07 × 10(-3) and 0.54 ± 0.02 × 10(-3) μM min(-1) at pH 5.7 and 7.1, respectively. Attractive forces between the opposite charged MC-LR and NF-TiO(2) are likely responsible for the enhancement in the photocatalytic decomposition of MC-LR resulting from increased interfacial adsorption. For carbonate buffered solutions, the photocatalytic activity of NF-TiO(2) was reduced when increasing the carbonate concentration up to 150 mg CaCO(3) L(-1). The scavenging of radical species by the bicarbonate ion at pH 7.1 is discussed. In the presence of NOM, the degradation rates decreased as pH and initial concentration of the NOM increased. The inhibition was higher with fulvic acid than humic acid under alkaline conditions. Oxygenated solution yields higher NF-TiO(2) photocatalytic degradation of MC-LR compared to nitrogen sparged solution at pH 5.7. The involvement of specific reactive oxygen species implicated in the photodegradation is proposed. Finally, no significant degradation is observed with various natural waters spiked with MC-LR under visible light (λ > 420 nm) but high removal was achieved with simulated solar light. This study provides a better understanding of the interactions and photocatalytic processes initiated by NF-TiO(2) under visible and solar light. The results indicate solar photocatalytic oxidation is a promising technology for the treatment of water contaminated with cyanotoxins.

Maternal vocal imitation of infant vocalizations is highly prevalent during face-to-face interactions of infants and their caregivers. Although maternal vocal imitation has been associated with later verbal development, its potentially reinforcing effect on infant vocalizations has not been explored experimentally. This study examined the reinforcing effect of maternal vocal imitation of infant vocalizations using a reversal probe BAB design. Eleven 3- to 8-month-old infants at high risk for developmental delays experienced contingent maternal vocal imitation during reinforcement conditions. Differential reinforcement of other behavior served as the control condition. The behavior of 10 infants showed evidence of a reinforcement effect. Results indicated that vocal imitations can serve to reinforce early infant vocalizations.

OBJECTIVE We have studied the effect of moderate physical activity that is performed by healthy women during their entire pregnancy on their perception of health status. STUDY DESIGN Eighty sedentary women were assigned randomly to either an exercise group (n = 40) or a control group (n = 40). Maternal perception of health status and several pregnancy outcomes were recorded. RESULTS Significant differences (P =.03) were found between study groups in the percentage of women who perceived their health status as "very good"; the values that corresponded to the exercise group (n = 18; 54.5%) were better than those of the control group (n = 9; 27.3%). In addition, the women of the exercise group gained less weight (11,885 ± 3146 g) than those of the control group (13,903 ± 2113; P =.03). CONCLUSION A moderate physical activity program that is performed over the first, second, and third trimester of pregnancy improves the maternal perception of health status.

Microcystins are cyclic heptapeptide toxins produced by a number of genera of cyanobacteria. They are ubiquitous in bodies of water worldwide and pose significant hazard to human, plant, and animal health. Microcystins are primarily hepatotoxins known to inhibit serine-threonine phosphatases leading to the disruption of cascade of events important in the regulation and control of cellular processes. Covalent binding of microcystins with phosphatases is thought to be responsible for the cytotoxic and genotoxic effects of microcystins. In addition, microcystins can trigger oxidative stress in cells resulting in necrosis or apoptosis. Their cyclic structure and novel amino acids enhance their stability and persistence in the environment. Humans are primarily exposed to microcystins via drinking water consumption and accidental ingestion of recreational water. Recreational exposure by skin contact or inhalation to microcystins is now recognized to cause a wide range of acute illnesses which can be life-threatening. Microcystins are primarily degraded by microorganisms in the environment, while sunlight can cause the isomerization of the double bonds and hydroxylation in the presence of pigments. Attempts to utilize these organisms in sand and membrane filters to treat water contaminated with microcystins showed complete removal and detoxification. Conventional water treatment processes may not fully eliminate microcystins when there are high levels of organic compounds especially during harmful bloom events. Combination of conventional and advanced oxidation technologies can potentially remove 100% of microcystins in water even in turbid conditions. This review covers selected treatment technologies to degrade microcystins in water.