Fairfield Hospital

OBJECTIVE: To develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA. METHODS: We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind-body, and pharmacologic therapies for OA. Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations. RESULTS: Based on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal antiinflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid injections for knee OA. Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA, orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA, acupuncture, thermal modalities, radiofrequency ablation for knee OA, topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, acetaminophen, duloxetine, and tramadol. CONCLUSION: This guideline provides direction for clinicians and patients making treatment decisions for the management of OA. Clinicians and patients should engage in shared decision-making that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

Objective To develop an evidence‐based guideline for the comprehensive management of osteoarthritis ( OA ) as a collaboration between the American College of Rheumatology ( ACR ) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA . Methods We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA . A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind‐body, and pharmacologic therapies for OA . Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations. Results Based on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self‐efficacy and self‐management programs, tai chi, cane use, hand orthoses for first carpometacarpal ( CMC ) joint OA , tibiofemoral bracing for tibiofemoral knee OA , topical nonsteroidal antiinflammatory drugs ( NSAID s) for knee OA , oral NSAID s, and intraarticular glucocorticoid injections for knee OA . Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA , orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA , acupuncture, thermal modalities, radiofrequency ablation for knee OA , topical NSAID s, intraarticular steroid injections and chondroitin sulfate for hand OA , topical capsaicin for knee OA , acetaminophen, duloxetine, and tramadol. Conclusion This guideline provides direction for clinicians and patients making treatment decisions for the management of OA . Clinicians and patients should engage in shared decision‐making that accounts for patients’ values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

In the cases reported here, the response of Class II mandibular molar furcation defects to guided tissue regeneration (GTR) versus sham operation was evaluated. Base-line information, including probing pocket depth (PD) and clinical attachment level (CAL) measurements, was recorded after completion of the hygienic phase. Eleven experimental and six control furcations, randomly assigned, are included in this report. The furcations were surgically exposed, using a flap approach and the areas were debrided. On the experimental teeth, Gore-Tex periodontal material was adapted and sutured, using a suspensory suture. The flaps were then sutured tightly, assuring complete coverage to the material. For 1 month all patients were seen weekly and rinsed their mouths with an 0.12% chlorhexidine solution daily. After 4 to 6 weeks the Gore-Tex membranes were removed. Clinical measurements were repeated at 3 and 6 months following surgery. Changes from baseline in PD and CAL were calculated for each case. Results indicated that PD measurements were reduced by both procedures, but the reduction was better for GTR at 3 and 6 months. At six months the test sites showed 2.8 +/- 1.0 mm pocket reduction, while the control sites showed an average of 1.6 +/- 0.9 mm reduction in pocket depth. CAL recordings were improved by both treatments, but were better for GTR at 6 months, with an average gain in CAL of 1.8 mm for the GTR and 0.6 mm for the controls. These cases in which GTR was compared to sham-operated controls indicate that GTR can improve the response to therapy of Class II furcation defects.

A replication of Alexander's behavioral-systems family therapy model was attempted for lower socioeconomic status juvenile offenders, most of whom had multiple offenses, including misdemeanors and felonies. Twenty-seven male and female delinquents who had either recently been placed out of the home or for whom placement was imminent were court referred to in-home time-unlimited family therapy (mean sessions=16). A comparison group of 27 lower risk delinquents received only probation. Outcome was measured by the number and severity of offenses during a 2½-year period following group assignment. The delinquents receiving the family therapy had a recidivism rate of 11% vs. 67% for the comparison group. Sex differences are presented, as well as differences between Alexander's studies and the present one which may account for the improved outcomes with more difficult families.

PURPOSE: The purpose of this study was to test effects of a culturally competent, dietary self-management intervention on physiological outcomes and dietary behaviors for African Americans with type 2 diabetes. METHODS: A longitudinal experimental study was conducted in rural South Carolina with a sample of 97 adult African Americans with type 2 diabetes who were randomly assigned to either usual care or the intervention. The intervention consisted of 4 weekly classes in low-fat dietary strategies, 5 monthly peer-professional group discussions, and weekly telephone follow-up. The culturally competent approach reflected the ethnic beliefs, values, customs, food preferences, language, learning methods, and health care practices of southern African Americans. RESULTS: Body mass index and dietary fat behaviors were significantly lowered in the experimental group. At 6 months, weight decreased 1.8 kg (4 lb) for the experimental group and increased 1.9 kg (4.2 lb) for the control group, a net difference of 3.7 kg (8.2 lb). The experimental group reduced high-fat dietary habits to moderate while high-fat dietary habits of the control group remained essentially unchanged. A trend in reduction of A1C and lipids was observed. CONCLUSIONS: Results suggest the effectiveness of a culturally competent dietary self-management intervention in improving health outcomes for southern African Americans, especially those at risk due to high-fat diets and body mass index >or= 35 kg/mm(2). Given the burgeoning problem of obesity in South Carolina and the nation, the time has come to focus on aggressive weight management. Diabetes educators are in pivotal positions to assume leadership in achieving this goal for vulnerable, rural populations.

Rosmarinus officinalis is a potent antioxidant herb rich in polyphenols. Ultra-high-performance liquid chromatography, coupled with electrospray ionization and quadrupole-time of flight mass spectrometry (UHPLC-ESI-QTOF-MS), enables an exhaustive, full-spectrum analysis of the molecular constituents of natural products. The study aimed to develop a rapid UHPLC method to contribute new insights into the phytochemical composition of rosemary and to assess the performance of nine different procedures for extraction. These include fresh tissue homogenization, fresh and dry leaf decoction, and their respective fermentation, Soxhlet extraction, and sonication using water and methanol. Different extraction methods were found to recover quite different groups of polyphenols within 11 min during 20 min of analysis. Soxhlet extraction, yielded very high concentrations of rosmarinic acid (33,491.33 ± 86.29 µg/g), luteolin-7-O-glucoside (209.95 ± 8.78 µg/g), carnosic acid (2915.40 ± 33.23 µg/g), carnosol (22,000.67 ± 77.39 µg/g), and ursolic acid (5144.27 ± 28.68 µg/g). UHPLC-ESI-QTOF-MS enabled the detection of more than 50 polyphenols, including phenolic acids, flavonoids, and terpenoids in the various extracts. Of these, sagerinic acid ([M − H]−m/z 719.16), salvianolic acid A ([M − H]−m/z 493.11) and B ([M − H]−m/z 717.15), and a pentacyclic triterpenoid corosolic acid ([M − H]−m/z 471.34) were detected for the first time in rosemary. Soxhlet extraction was found to be the most efficient method, followed by dry leaf decoction. The UHPLC-ESI-QTOF-MS methodology for the analysis proved to be very efficient in the identification and characterization of targeted and untargeted bioactive molecules in the rosemary.

PURPOSE: The purpose of this article was to describe lessons learned about recruitment and retention of rural African Americans from published literature, the authors' research, and research experience. Two rural, community-based research studies with African Americans with diabetes are used to illustrate different issues and strategies in recruitment and retention. METHODS: Relevant MEDLINE articles and clinical studies were reviewed, and the design, implementation, and results of the 2 community-based studies were evaluated. Information from the literature, research results, and sample selection, participation, and attrition experiences were synthesized to determine effective approaches for recruitment and retention. RESULTS: Research funding, design, and implementation; recruitment methods; culturally competent approaches; caring, trusting provider-patient relationships; incentives; follow-up; and factors in the rural environment emerged as important issues influencing recruitment and retention. CONCLUSION: Recruitment and retention of African Americans in rural diabetes research is a significant challenge, and adequate funding should be sought early in the research process. Culturally competent approaches; caring, trusting relationships; incentives; and follow-up are important concepts in successful recruitment, participation, and retention of African Americans. The lessons learned may be applicable to the more widespread issue of recruitment and retention of rural African Americans in diabetes education programs.

Biophysical and biochemical analysis of hepatitis A virus has shown it to be a 27- to 32-nm icosahedral particle with 32 capsomers. The mature virion has a buoyant density of 1.33-1.34 g/cm3, a sedimentation coefficient of 156-160S, and is composed of four polypeptides with molecular weights of 30,000-33,000 (VP1), 24,000-27,000 (VP2), 21,000-23,000 (VP3), and 7,000-14,000 (VP4). The genome of hepatitis A virus consists of a single piece of single-stranded RNA which sediments at 32-35S and has a buoyant density of 1.64 g/cm3. The molecular weight of RNA is 2.25 x 10(6) when measured under nondenaturing conditions and 2.8 x 10(6) when measured under fully denaturing conditions. The genome contains a 40-80 nucleotide sequence of polyadenylic and is capable of infecting cell cultures. These findings, together with the observation that the virion is stable at pH 3.0 and resistant to ether and a temperature of 60 degrees for 1 h, indicate that hepatitis A virus should now be classified as an Enterovirus within the family Picornaviridae.

Three types of borderline psychopathology are differentiated. Borderline schizophrenia, like schizophrenia, is characterized by impairment in the articulation of fundamental boundary differentiations. Cognitive disturbances in borderline schizophrenia are manifested as Rorschach contamination-tendency responses, wherein independent percepts tend inappropriately to fuse. Two relatively stable types of borderline personality disorder are also distinguished, both types characterized by impaired evocative constancy. Cognitive disturbances in borderline personality disorders are manifested as Rorschach confabulation responses, wherein exaggerated reactions and associations disrupt realistic thinking and perception. Anaclitic borderline personality disorder involves central concerns with abandonment and rejection; introjective boderline personality disorder involves central concerns with criticism and censure. In anaclitic borderline personality disorder, confabulatory thinking expresses intense affect elaborations and preoccupations with dependence and relatedness. In introjective borderline personality disorder, confabulatory thinking is overspecific, grandiose, and/or oversymbolic, and expresses concerns about self-worth and self-definition. These various cognitive disturbances have significant implications for differential diagnosis and for understanding both interpersonal relationships and potential for psychosis among the three borderline conditions.

Accumulation of reactive oxygen and nitrogen species (RONS) can induce cell damage and even cell death. RONS are short-lived species, which makes direct, precise, and real-time measurement difficult. Biologically-relevant RONS levels are in the nM-μM scale; hence, there is a need for highly sensitive RONS probes. We previously used hybrid gold-core silver-shell nanoparticles with mM sensitivity to H2O2. These particles reported the presence of RONS via spectral shifts which could easily be quantified via photoacoustic imaging. Here, we used halide doping to tune the electrochemical properties of these materials to better match the oxidation potential of RONS. This work describes the synthesis, characterization, and application of these AgI-coated gold nanorods (AgI/AuNR). The I : Ag molar ratio, pH, and initial Ag shell thickness were optimized for good RONS detection limits. Halide doping lowers the reduction potential of Ag from to resulting in a 1000-fold increase in H2O2 and 100 000-fold increase in ONOO- sensitivity. The AgI/AuNR system also etches 45-times faster than undoped Ag/AuNR. The AgI/AuNR easily reported the endogenously produced RONS in established cells lines as well as murine models.

A growing set of studies show that an organic diet is associated with reduced levels of urinary pesticide analytes. However, with the exception of one pilot study of two individuals, diet intervention studies to date have not analyzed glyphosate, the most commonly used herbicide in the United States and globally. To investigate the impact of an organic diet intervention on levels of glyphosate and its main metabolite, AMPA (aminomethyl phosphonic acid), in urine collected from adults and children. We analyzed urine samples from four racially and geographically diverse families in the United States for five days on a completely non-organic diet and for five days on a completely organic diet (n = 16 participants and a total of 158 urine samples). Mean urinary glyphosate levels for all subjects decreased 70.93% (95% CI -77.96, −61.65, p<0.010) while mean AMPA levels decreased by 76.71% (95% CI -81.54, −70.62, p < 0.010) within six days on an organic diet. Similar decreases in urinary levels of glyphosate and AMPA were observed when data for adults were examined alone, 71.59% (95% CI -82.87, −52.86, p < 0.01) and 83.53% (95% CI -88.42, −76.56, p < 0.01) and when data for children were examined alone, 70.85% (95% CI -78.52, −60.42, p < 0.01) and 69.85% (95% CI -77.56, −59.48, p < 0.01). An organic diet was associated with significantly reduced urinary levels of glyphosate and AMPA. The reduction in glyphosate and AMPA levels was rapid, dropping to baseline within three days. This study demonstrates that diet is a primary source of glyphosate exposure and that shifting to an organic diet is an effective way to reduce body burden of glyphosate and its main metabolite, AMPA. This research adds to a growing body of literature indicating that an organic diet may reduce exposure to a range of pesticides in children and adults.

This study compares the mental symptoms of two groups of aged mental hospital patients. One group had senile brain disease but no brain infarcts. The other group had brain infarcts but no positive evidence of senile brain disease.

Discussion regarding the regulatory status of genome-edited crops has focused on precision of editing and on doubts regarding the feasibility of analytical monitoring compliant with existing GMO regulations. Effective detection methods are important, both for regulatory enforcement and traceability in case of biosafety, environmental or socio-economic impacts. Here, we approach the analysis question for the first time in the laboratory and report the successful development of a quantitative PCR detection method for the first commercialized genome-edited crop, a canola with a single base pair edit conferring herbicide tolerance. The method is highly sensitive and specific (quantification limit, 0.05%), compatible with the standards of practice, equipment and expertise typical in GMO laboratories, and readily integrable into their analytical workflows, including use of the matrix approach. The method, validated by an independent laboratory, meets all legal requirements for GMO analytical methods in jurisdictions such as the EU, is consistent with ISO17025 accreditation standards and has been placed in the public domain. Having developed a qPCR method for the most challenging class of genome edits, single-nucleotide variants, this research suggests that qPCR-based method development may be applicable to virtually any genome-edited organism. This advance resolves doubts regarding the feasibility of extending the regulatory approach currently employed for recombinant DNA-based GMOs to genome-edited organisms.

We report 3 cases of Helicobacter cinaedi bacteraemia in different hosts representing a spectrum of clinical illness associated with this infection. The first was an AIDS patient with relapsing H. cinaedi bacteraemia despite antibiotic treatment. The second was an HIV seronegative homosexual man with end-stage renal failure, receiving haemodialysis and a previous history of chronic lymphoedema of his legs. He developed H. cinaedi bacteraemia with cellulitis of his left leg. Patient 3, an HIV seronegative homosexual man, had transient H. cinaedi bacteraemia 2 days after the completion of a course of chemotherapy for bilateral testicular carcinoma. The clinical spectrum of disease associated with H. cinaedi is broad, with few specific clinical features. Successful recovery of this fastidious organism from blood aids in the diagnosis of this unusual infection.

PURPOSE: The purpose of this article is to describe a culturally competent, dietary self-management intervention designed to improve physiological outcomes, diabetes self-management, and costs of care for high-risk African Americans with type 2 diabetes. METHODS: A longitudinal, quasi-experimental design was used to evaluate the effectiveness of the intervention for 23 adult African Americans from a physician practice group in rural South Carolina. The intervention consisted of 4 low-fat dietary education classes, 6 discussion groups, and follow-up. Intervention sessions were provided by a dietitian and nurse case managers and framed as social events; families were encouraged to participate. RESULTS: Data suggest that the intervention significantly improved fat-related dietary habits, A1C values, fasting blood glucose, and frequency of acute care visits. A trend in reduction of lipids and weight also was observed. CONCLUSIONS: Culturally competent dietary self-management provides a meaningful approach to focused diabetes education for rural African Americans. Integrating nursing case management provides an innovative method of addressing the more global issues of delivery of care to underserved rural populations and decreasing the high costs of care.

A new, low-density trilobite body cluster from an Upper Ordovician Kope Formation mudstone in the Cincinnati region is characterized by well-preserved, articulated specimens. This cluster is polytaxic, size-segregated, and shows an unusual variety of flexure postures in the most common taxon, Flexicalymene aff. granulosa. Specimens show internal pyritization and associated pyritefilled tubular burrows, and were preserved by rapid deposition of mud from a sediment-laden flow. Size-segregation among species, but size-consistency within species, coupled with sedimentological data and apparently haphazard body orientation data, suggest that the trilobites represent a biological association, rather than the product of mechanical sorting. While the majority of specimens are inverted, many are dorsal-up, and some are inclined to bedding. Postures include prone (i.e., nonflexed), simple dorsal or ventral flexure, and complex stances that combine both dorsal and ventral flexure. Flexure pattern appears largely unrelated to sediment compaction. We interpret the cluster as an association of live trilobites that were entombed in situ. Specimens may have inverted prior to burial as a behavioral posture, or as a response to onset of burial. The animals were likely preserved in the process of escaping, as they tried to free themselves from being buried. This is in contrast to the tightly enrolled stance in some trilobites, especially other Flexicalymene , commonly associated with rapid burial events, and indicates a new behavioral aspect of trilobite paleobiology. The distribution of associated burrows suggests that the rotting carcasses attracted scavengers.

The purpose of this study was to determine a convenient communication tool to help educate parents about varying the positions of their new babies. Eighty-eight percent of babies whose parents had received a brochure explaining the importance of early and regularly scheduled "tummy time" were placed in the prone position more than one time a day. Seventeen of 34 babies were started prone before the second week of life. The average Peabody Developmental Motor Scales-2 locomotion score of the babies regularly placed in prone was significantly higher than that of the babies not regularly placed in prone when tested at 6 months and again at 18 months of age.

A new general seismic attribute has been developed based on wavelet transform decomposition and singularity analysis of migrated seismic data. The new attribute provides a layered model of the subsurface that is rich in structural and stratigraphic detail, and thus compliments coherence and impedance attributes.

Phytoremediation has been implemented at an industrial site in Wisconsin to promote in situ remediation of No. 2 fuel oil-contaminated soil. The goal of the project is to utilize microbial-enhancing processes within the rhizosphere of trees to stimulate biodegradation of diesel range organics (DROs) within four contaminated hot spots at the site. Between 40 and 90% reductions in the concentrations of the DROs were observed over the course of a 24-week bench-scale bioventing study performed in 1994. In addition to a reduction in the concentration of DROs, the chromatograms for those analyses exhibited a relative decrease in the proportion of the more water soluble and available shorter chained or lower molecular weight DROs compared to their higher molecular weight counterparts in the fuel. In addition to a decrease in concentration, this observed change in the pattern of the chromatograms over time is consistent with biodegradation of DROs. An agronomic assessment performed in 1995 indicated that conditions were favorable for tree growth. Phytoremediation was implemented as a low-cost in situ alternative for remediation of the site. Willow trees were planted in the four hot spots in May 1996 and trees have exhibited fair to excellent growth in the first season.

Background/Objectives: Reinforcement learning (RL), a subset of machine learning, has emerged as a promising tool for supporting precision medicine and dynamic treatment regimes by enabling adaptive, data-driven clinical decision making. Despite its potential, challenges such as interpretability, reward definition, data limitations, and clinician adoption remain. This review aims to evaluate the recent advancements in RL in precision medicine and dynamic treatment regimes, highlight clinical fields of application, and propose practical frameworks for future integration into medical practice. Methods: A systematic review was conducted following PRISMA guidelines across PubMed, MEDLINE, and Web of Science databases, focusing on studies from January 2014 to December 2024. Articles were included based on their relevance to RL applications in precision medicine and dynamic treatment regime within healthcare. Data extraction captured study characteristics, algorithms used, specialty area, and outcomes. Results: Forty-six studies met the inclusion criteria. RL applications were concentrated in endocrinology, critical care, oncology, and behavioral health, with a focus on dynamic and personalized treatment planning. Hybrid and value-based RL methods were the most utilized. Since 2020, there has been a sharp increase in RL research in healthcare, driven by advances in computational power, digital health technologies, and increased use of wearable devices. Conclusions: RL offers a powerful opportunity to augment clinical decision making by enabling dynamic and individualized patient care. Addressing key barriers related to transparency, data availability, and alignment with clinical workflows will be critical to translating RL into everyday medical practice.