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Surgically treated hydrocephalus patients are frequently imaged with head computed tomography (CT), and risk/benefit communication with families is inconsistent and unknown. We aimed to educate patients and caregivers about radiation safety in CT and explore their communication preferences. We conducted a pediatric CT radiation safety and diagnostic imaging educational workshop for patients and caregivers at a national conference on hydrocephalus to characterize current practice and desired communication about CT imaging. Our workshop consisted of an interactive educational intervention with pre-/post-session surveys followed by feedback from participants. Our session included 34 participants (100% response rate for surveys) with 28 being parents of individuals with hydrocephalus. A total of 76% (n = 26) participants showed an increase in knowledge after the session (p 100 CT scans for shunt evaluation with the median being 25 scans (IQR 20). Caregivers desire and deserve to be empowered through education and social support, and continuously engaged through sharing decisions and co-designing care plans. The neurosurgical community is in an ideal position to collaborate with radiologists, primary care providers, and parents in the development and testing of credible, high-quality online and social media resources.

PURPOSE To assess the safety and efficacy of genicular artery embolization (GAE) compared with a sham procedure in the treatment of knee pain secondary to mild to moderate osteoarthritis (OA). MATERIALS AND METHODS A multicenter, single-blinded, randomized controlled trial was conducted to evaluate knee OA symptom reduction after GAE versus sham procedure. Subjects (n = 21) with mild to moderate OA and intractable knee pain were randomized 2:1 to either GAE or a sham procedure. Subjects who were randomized to the sham procedure and did not report clinical improvement in both the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS) scores were unblinded and able to crossover to treatment at 1 month. Longitudinal data were collected for 12 months, and subjects were excluded if they required additional analgesics at follow-up. Reductions in the VAS and total WOMAC scores were compared using mixed-effects linear regression models. RESULTS All subjects in the sham group failed to show significant improvements at 1 month and crossed over to the treatment arm. There was a statistically significantly greater pain reduction in the treatment group than in the sham group at 1 month (VAS, 50.1 mm; standard error [SE], 10.6; 95% confidence interval [CI], 29.0, 72.3; P

Differentiating malignant from benign breast lesions remains a challenge that may be met by a new imaging biomarker: lesion-to-background mechanical anisotropy assessed by VisR ultrasound. VisR is an ultrasound imaging method that uses 2 consecutive acoustic radiation force excitations, separated in time and delivered to the same region of excitation, to directionally interrogate peak displacement (PD), relative elasticity (RE), and relative viscosity (RV). From these directional measurements, mechanical degree of anisotropy is measured. In a pilot clinical study involving 29 women with BIRADS-4 or −5 breast masses, VisR PD, RE, and RV were measured in lesions and in surrounding tissue at 0°, 30°, 60°, and 90° concentric orientations. From these measurements, lesion DoA (LDoA), surrounding tissue DoA (SDoA), and log(LDoA/SDoA) were assessed per parameter and compared between biopsy-confirmed malignant versus benign masses. Across all patients, PD-, RE-, and RV-based LDoA or SDoA alone did not achieve statistical difference between malignant and benign masses (Wilcoxon, $\mathrm{p} > 0.05$ ). However, PD-, RE-, and RV-based log(LDoA/SDoA) statistically differentiated malignant from benign masses (Wilcoxon, $\mathrm{p} ), with AUC values of 0.96 for PD-based, and 0.94 for RE- and RV-based outcomes. These results demonstrate the relevance of lesion-to-background mechanical anisotropy assessed by VisR ultrasound for differentiating malignant from benign breast masses in women, in vivo.

Relatively few interventions target the home food environment of adults for weight gain prevention. Using a pretest/posttest design, this study describes the adaptation and pilot testing of Healthy Homes/Healthy Families, a research-tested home food environment intervention, for telephone delivery to 2-1-1 clients (n = 101). The Healthy Eating Index-2015, a measure of diet quality, improved significantly at 4-month follow-up, as did the home food environment, with energy consumption improving in the expected direction. Overall findings suggest the simplified intervention will still be effective, although results may be attenuated and additional efforts may be needed for participant retention among 2-1-1 clients.

Breast cancer screening is beneficial when it averts progression of disease to metastasis, but adverse effects to patients and unnecessary medical expense may result downstream from false positives. Achieving early breast cancer detection with high sensitivity and specificity remains a challenge that may be met by using acoustic radiation force to assess the mechanical properties of tissue. The objective of this study is to evaluate in vivo the diagnostic relevance of Viscoelastic Response (VisR)-derived metrics for mechanical anisotropy. We compare our in vivo human results against biopsy findings. This study analyzed 9 breast lesions (4 malignant, 5 benign) imaged in vivo in women with BIRADS-4 or -5 ratings after standard screening. VisR relative elasticity (RE), relative viscosity (RV), and peak displacement (PD) were measured for each transducer orientation, and fit to a sinusoid by least-squares minimization, extrapolating to 360°. The fits were phase-aligned, and the point-wise differences in each parameter between lesion and background were integrated over angle. Finally, the ratio of the maximum to the minimum parameter value was calculated to reflect the degree of anisotropy (DoA). DoAs by PD, RE, and RV were statistically significantly greater in background than in lesion for all malignant cases but statistically significantly smaller in background than in lesion for all benign cases (Wilcoxon, p < 0.05). Additionally, differences between lesion and background integrated over angle by RE, RV and PD were statistically significantly different (Wilcoxon, p < 0.05) for malignant and benign lesions across all examined patients. These results suggest that VisR-derived mechanical anisotropy assessment could be diagnostically relevant for discriminating malignant from benign breast lesions.

In recent years, there has been a movement toward more judicious use of computed tomography (CT) imaging in an attempt to limit exposure of pediatric patients to ionizing radiation. The Image Gently Alliance and like-minded movements began advocating for safe and high-quality pediatric imaging worldwide in the late 2000s. In the context of these efforts, we evaluate CT utilization rates in the pediatric emergency department at a major academic medical center. We tracked utilization in several categories of CT, magnetic resonance imaging (MRI) and ultrasonography (US) between July 2008 and June 2017 and compared them with utilization rates from 2000 to 2006. A total of 4,955 pediatric patients underwent a total of 5,973 CT scans, 2,775 US studies and 293 MRI scans while in the pediatric emergency department during the 2008–2017 study period. We observed decreases in CT scans across all categories, ranging from a 19% decrease in abdominal CT to a 66% decrease in chest CT. Relatively greater decreases in CT scans were observed in patients younger than 3 years of age as compared to older children and adolescents. Abdominal and pelvic US increased. Brain MRI also increased over the final two years of the study. CT utilization decreased throughout the 2008–2017 study period.

To evaluate the efficacy and safety of embolization of hyperemic synovial tissue for the treatment of knee pain secondary to osteoarthritis (OA).Twenty patients with radiographic knee OA and moderate-to-severe pain refractory to conservative therapy were enrolled in a prospective, 2-site pilot study. Genicular artery embolization (GAE) was performed with 75- or 100-μm spherical particles. Patients were assessed with magnetic resonance imaging at baseline and at 1 month and with the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and at 1, 3, and 6 months. Adverse events were recorded at all timepoints.Embolization of at least 1 genicular artery was achieved in 20/20 (100%) patients. Mean VAS improved from 76 mm ± 14 at baseline to 29 mm ± 27 at 6-month follow-up (P.01). Mean WOMAC score improved from 61 ± 12 at baseline to 29 ± 27 at 6-month follow-up (P.01). Self-limiting skin discoloration occurred in 13/20 (65%) patients. Two of 20 (10%) patients developed plantar sensory paresthesia that resolved within 14 days.GAE to treat knee pain secondary to OA can be performed safely and demonstrates potential efficacy. Further randomized comparative studies are needed to determine true treatment effect versus placebo effect.

“I am not young enough to know everything.” Oscar Wilde Background: There is insufficient knowledge among providers and patients/caregivers of ionizing radiation exposure from medical imaging examinations. This study used a brief, interactive educational intervention targeting the topics of best imaging practices and radiation safety early in health professions students’ training. The authors hypothesized that public health, medical, and physician assistant students who receive early education for imaging appropriateness and radiation safety will undergo a change in attitude and have increased awareness and knowledge of these topics. Materials and methods: The authors conducted a 1.5-hour interactive educational intervention focusing on medical imaging utilization and radiation safety. Students were presented with a pre/postquestionnaire and data were analyzed using t tests and multivariate analysis of variance. Results: A total of 301 students were enrolled in the study. There was 58% ( P Conclusions: A brief educational session provided to health professions students early in their education showed an increased awareness and knowledge of the utility, limitations, and risks associated with medical imaging. Incorporation of a best imagining practice educational session early during medical education may promote more thoughtful imaging decisions for future medical providers.

BACKGROUND Prenatal folic acid supplementation is recommended to prevent birth defects. Some foods are fortified in the USA to ensure sufficient intake among reproductive-aged women. However, high prenatal folate exposure may be a risk factor for childhood atopic diseases. We investigated associations between prenatal folate and early childhood wheeze and atopic dermatitis in a US cohort. METHODS We studied 858 mother-child dyads, enrolled prenatally. Folate was measured in 2nd and 3rd trimester maternal plasma. Parents reported current wheeze (previous 12 months) and healthcare provider diagnosis of atopic dermatitis at 3 years. We examined associations using logistic regression, modeling folate continuously and dichotomously (< or ≥20 ng/mL), a level often considered supraphysiologic. RESULTS Over half of women were African American and on Medicaid. Median (interquartile range) folate levels were 22.6 (15.9-30.0) and 23.1 (16.1-30.0) ng/mL for 2nd and 3rd trimesters, respectively. Current wheeze and atopic dermatitis were reported for 20.4% and 26.8% of children, respectively. Second trimester folate as a continuous exposure was not significantly associated with outcomes. Decreased odds of current wheeze were observed in children born to mothers who had 2nd trimester folate ≥20 ng/mL (adjusted odds ratios = 0.67, 95% confidence interval = 0.46, 0.97) compared to children with maternal levels

Twelve patients underwent balloon-occlusion prostatic artery embolization (PAE) at a single center. Bilateral prostatic artery catheterization was achieved in all patients, but unilateral embolization was performed in 1 patient as a result of the presence of a prostatic arteriovenous fistula. Mean International Prostate Symptom Score and quality-of-life score decreased by 15 ± 7 (P < .01) and 4 ± 1 (P < .01) points, respectively, over a mean follow-up period of 22 weeks ± 8. Only self-limiting minor complications were encountered. The initial experience with balloon-occlusion PAE suggests that it is technically feasible and can be performed safely.

Objective To determine whether a systematic evaluation of facial soft tissues of patients with cleft lip and palate, using facial video images and objective three-dimensional measurements of movement, change surgeons' treatment plans for lip revision surgery. Design Prospective longitudinal study. Setting The University of North Carolina School of Dentistry. Patients, Participants A group of patients with repaired cleft lip and palate (n =21), a noncleft control group (n = 37), and surgeons experienced in cleft care. Interventions Lip revision. Main Outcome Measures (1) facial photographic images; (2) facial video images during animations; (3) objective three-dimensional measurements of upper lip movement based on z scores; and (4) objective dynamic and visual three-dimensional measurement of facial soft tissue movement. Results With the use of the video images plus objective three-dimensional measures, the operating surgeon changed the problem list of the surgical treatment plan for 86% of the patients (95% confidence interval, 0.64 to 0.97) and the surgical goals for 71% of the patients (95% confidence interval, 0.48 to 0.89). The surgeon group varied in the percentage of patients for whom the problem list was modified, ranging from 24% (95% confidence interval, 8% to 47%) to 48% (95% confidence interval, 26% to 70%) of patients, and the percentage for whom the surgical goals were modified, ranging from 14% (94% confidence interval, 3% to 36%) to 48% (95% confidence interval, 26% to 70%) of patients. Conclusions For all surgeons, the additional assessment components of the systematic valuation resulted in a change in clinical decision making for some patients.

Background Phytoestrogens are estrogenic compounds that occur naturally in plants. Phytoestrogens can cross the placenta, and animal studies have found associations between in utero exposure to phy...

ObjectiveTo compare commonly used dietary screeners for fat intake and fruit and vegetable intake with 24 h dietary recalls among low-income, overweight and obese African-American women.DesignThree telephone interviews were completed; measures included two 24 h dietary recalls (a weekday and weekend day) using the Nutrition Data System for Research software, the Behavioral Risk Factor Surveillance System’s (BRFSS) Fruit and Vegetable Consumption Module and the National Cancer Institute’s (NCI) Percentage Energy from Fat Screener.SettingParticipants were recruited from three federally qualified health centres in south-west Georgia, USA.SubjectsParticipants (n260) were African-American women ranging in age from 35 to 65 years. About half were unemployed (49·6 %) and 58·7 % had a high-school education or less. Most were obese (88·5 %), with 39·6 % reporting a BMI≥40·0 kg/m2.ResultsMean fruit and vegetable intake reported from the 24 h dietary recall was 2·66 servings/d compared with 2·79 servings/d with the BRFSS measure. The deattenuated Pearson correlation was 0·22, with notable variation by weight status, education level and age. Mean percentage of energy from fat was 35·5 % as reported from the 24 h dietary recall, compared with 33·0 % as measured by the NCI fat screener. The deattenuated Pearson correlation was 0·38, also with notable variation by weight status, education level and age.ConclusionsValidity of brief dietary intake measures may vary by demographic characteristics of the sample. Additional measurement work may be needed to accurately measure dietary intake in obese African-American women.

“Eighty percent of success is just showing up.”Woody AllenPediatric CT radiation dose optimization is a challenging process for pediatric-focused facilities and community hospitals alike. Ongoing experience and trial-and-error approaches to dose reduction in the large academic hospital setting may position these centers to help community hospitals who strive for CT quality improvement. In this pilot project, we describe our hands-on approach to develop a partnership between an academic medical center and a community hospital to develop a toolkit for implementing CT dose reduction. Our aims were to 1) assess the acceptability of an interactive educational program and electronic toolkit booklet, 2) conduct a limited test of the efficacy of the toolkit in promoting knowledge and readiness to change, and 3) assess the acceptability and practicality of a collaborative approach to implementing dose-reduction protocols in community hospitals. In partnering with the community hospital, we found that they had size specific radiation doses 2 to 3 times higher than those at our center. Survey results following a site visit with interactive educational presentations revealed an increase in knowledge, stronger opinions about the health risks of radiation from CT scans, and willingness and perceived ability to reduce pediatric CT doses.

Patients with cleft lip have trouble in communication because of facial disability resulting in both facial disfigurements and impairments in movement. Consequently, for individuals with facial functional impairments, lip tracking methods for analyzing these impairments are useful in treatment planning and diagnosis. In comparison with non-cleft control subjects, facial landmarks for lip tracking of patients with cleft lip need to be widely defined in the circumoral area in order to reflect an irregularly shaped mouth. In this paper, we discuss the idea of facial landmark extraction for lip tracking in patients with cleft lip. The idea is based on facial features, identified by using AAM (Active Appearance Model) algorithm for finding facial landmarks in the circumoral area. These landmarks are composed of the outer and inner contours of the mouth in the circumoral area. The inner contour of the mouth is represented as landmarks on the mouth. The outer contour of the mouth is divided into the upper outer contour and lower outer contour on the basis of the center line. Here, the center line is defined as an intersecting line which connects from the left corner to the right corner of the mouth. The distance from the lower lip to the jaw line in general is twice that from the bottom of the nose to the upper lip. Therefore, a set of artificial landmarks, the upper and lower outer contours, have been defined using a set of pre-determined distances. The distance from the lower lip to the lower outer contour used is twice that from the upper lip to the upper outer contour. Using these landmarks, we gathered objective measures of facial form in patients with cleft lip who have both form and functional deficits. All subjects were recruited from patients attending at the University of North Carolina School of Dentistry Craniofacial Center, Orthodontic, Pedodontic Clinics. Supported by: NIDCR GRANT #DE013814 & #DE019742.

s / Annals of Epidemiology 25 (2015) 702e719 715 P53. Dietary Flavonoid Intake and Incident Coronary Heart Disease in the Reasons for Geographic and Racial Differences in Stroke Study (REGARDS) Margarethe Goetz MS, Suzanne Judd PhD, MPH, Monica Safford MD, Terry Hartman PhD, MPH, RD, William M. McClellan MD, MPH, Viola Vaccarino MD, PhD. Emory University Purpose: Flavonoids are dietary polyphenolic compounds with a variety of proposed beneficial cardiovascular effects, but rigorous prospective data in representative samples are limited. We assessed the association between dietary flavonoid intake and incident coronary heart disease (CHD) in a biracial cohort. Methods: Participants were 17,121 black and white, men and women, enrolled in the REGARDS study, without CHD at baseline, who completed a Block-98 food frequency questionnaire (FFQ). Total flavonoid and flavonoid subclass (anthocyanidin, flavan-3-ol, flavanone, flavonol, flavone, proanthocyanidin and isoflavone) intakes were estimated from USDA flavonoid databases. Incident CHD events were captured by participant report and adjudicated by experts. Quintiles of flavonoid intake were examined as predictors of incident CHD using Cox proportional hazards regression models. Tests for trend used the quintile medians. Results: Over a mean 6.0 years ( 1.9 yrs) of follow-up, 605 CHD events occurred. High flavonoid intake was associated with self-identified white race, exercise, smoking, education and income. In fullyadjusted models (including age, caloric intake, sex, race, income, education, exercise, smoking, and intake of sweets) there was an inverse association between anthocyanidin and proanthocyanidin intake and incident CHD (Q5 v Q1: anthocyanidins HR1⁄40.72 (0.54-0.95), p-trend1⁄40.01; proanthocyanidins HR1⁄40.68 (0.50-0.92), p-trend1⁄40.003). There was no association between total flavonoid or other flavonoid subclass intakes and incident CHD. There was no effect modification by sex, race or region of residence. Conclusions: Dietary anthocyanidin and proanthocyanidin intake is inversely associated with incident CHD. Other Chronic Disease P54. Predicting Emergency Department Visits for Asthma: A Poisson Regression Analyses Using Data from the 2012 Asthma Call Back Survey Albert Botchway PhD, Applied Experimental Psychology, Wiley Jenkins PhD, MPH. Southern Illinois University School of Medicine Purpose: Approximately 1.3 million visits to U.S emergency departments (ED) have asthma as the primary reason. Using the 2012 Asthma Call Back Survey (ACBS), this paper identified predictors of ED visits due to Asthma and reported incidence rate ratios for each predictor. Methods: This was a cross-sectional design relying on the Behavioral Risk Factor Surveillance System (BRFSS). The ACBS relies on the BRFSS sampling frame to collect follow-up information on BRFSS participants on asthma including ED visits. ED visits was measured by self-report. Results: About 10.42% individuals reported ED visits due to Asthma. Out of those reporting ED visits, the breakdown was: 53.26% (1 visit), 23.71% (2 visits) and 11.01% (3 visits). The health-related of quality of life model guided this study. Using Poisson regression, the results revealed that possessing knowledge on the signs of asthma attacks interestingly increased the incidence of ED visits, IRR1⁄41.74 (1.18-2.56). Depression led to more ED use, IRR1⁄41.47 (1.06-2.03). Compared to Whites, Blacks and Hispanics used the ED more frequently, IRR1⁄41.89 (1.18-3.03) and IRR1⁄41.61 (1.01-2.56) respectively. Asthmatics in urban areas used the ED at a higher rate compared to rural, IRR1⁄41.56 (1.39-1.81). Asthmatics who were divorced/separated/widowed had a higher incidence of ED visits compared to married individuals, IRR1⁄41.48 (1.04-2.11). Proportion of environmental exposures, gender, smoking status and obesity were not significant factors in predicting ED visits. Conclusions: Interestingly, knowledge of signs of asthma attack increased the incidence of ED visits. It is suggested that knowing attack signs cognitively and behaviorally prepared individuals to visit the ED. P55. Sleep Duration, Obesity, and Asthma in Florida High School Students: Analysis of the Florida Youth Risk Behavior Survey (2009-2013) Chighaf Bakour MD, MPH, Kathleen O’Rourke PhD, Skai W. Schwartz PhD, Wei Wang PhD, William M. Sappenfield MD, MPH, Marisa Couluris DO. University of South Florida Purpose: To examine the association between sleep duration and asthma among Florida high school students, and whether body mass index (BMI) is an effect modifier of the association. Methods: Cross-sectional analysis of 16728 high school students participating in the Florida Youth Risk Behavior Survey (20092013). We used logistic regression to obtain odds ratios (OR) and 95% confidence intervals (CI) of the association between sleep duration and current asthma, after controlling for potential confounders, followed by stratified analyses by BMI categories. Results: Both short and long sleep durations were associated with increased odds of asthma. Compared with 7 hours of sleep per night, odds ratios (95% CI) for sleeping for 4, 5 hours, and 9 hours per night were 1.37 (1.11, 1.70), 1.37 (1.10,1.70), and 1.39 (1.027,1.87) respectively. Associations were stronger in overweight adolescents, with sleep durations 4 hours, 5 hours, and 9 hours resulting in OR1⁄41.75 (1.25, 2.72), 1.85 (1.29, 2.65), and 2.06 (1.15, 3.68) respectively. These associations were not significant in normal weight adolescents, with ORs of 1.25 (0.98, 1.59), 1.21 (0.94, 1.55) and 1.20 (0.83, 1.73) for 4 hours, 5 hours, and 9 hours of sleep respectively. Results for 6, 8, and 10 hours of sleep were non-significant. Conclusion: The association between sleep duration and asthma in adolescents is modified by BMI. Short and long sleep durations are associated with increased odds of asthma in overweight adolescents, but not in normal weight ones. Lowest odds of asthma occurred with 7-8 hours of sleep. P56. The Association Between Exhaled Nitric Oxide in Exhaled Breath Condensate and Chronic Obstructive Pulmonary Disease Colin Mitchell PhD, Ahmed A. Arif PhD. UNC Charlotte Purpose: Chronic obstructive pulmonary disease (COPD), a progressive and nonreversible disease, is a leading cause of mortality and morbidity throughout the world. Because airway inflammation is a hallmark of COPD, it has been proposed that measuring exhaled nitric oxide, a marker of inflammation, in exhaled breath condensate could prove to be an inexpensive and efficient method to detect COPD in outpatient settings. Methods: This study used data from the National Health and Nutrition Examination Survey2007 to 2010 to test the associationbetween exhaled nitric oxide (eNO), COPD, and COPD severity (defined based on the GOLD standard). In addition, this study explored whether occupation modifies the association between eNO and COPD. Descriptive statistics, univariable and multivariable binary logistic Regression and proportional odds logistic regression analyses were used to analyze data from a sample size of 10,214 individuals. Results: The prevalence of COPD was 7.2%, based on self-reported physician diagnosed COPD and 11.4% based on pre-bronchodilator spirometry analysis. Whereas, the prevalence of COPD severity was 6.9% for Stage I, 4.8% for Stage II, and 0.7% for Stage III/IV. This study found no statistically significant association between eNO quartiles, COPD, and COPD severity, and occupational status did not appear to modify the association between eNO and COPD. Conclusions: The findings of this study highlight the importance of using objective measures such as spirometry in clinical settings for early diagnosis and management of COPD. The results weaken the prospect of using eNO as a biomarker for COPD. P57. Diabetes-Related Complications Among American Indians/ AlaskaNativesd Idaho,Oregon, andWashingtonState, 2001-2011 Jessica Marcinkevage PhD, MSPH, Edward Gregg, Kerri Lopez, Victoria Warren-Mears, Thomas Weiser. Northwest Portland Area Indian Health Board Purpose: We examined incidence of diabetes-related complications for 2001-2011 among Idaho, Oregon, and Washington American Indians/Alaska Natives (AI/ANs). Abstracts / Annals of Epidemiology 25 (2015) 702e719 716s / Annals of Epidemiology 25 (2015) 702e719 716 Methods:Weanalyzeddata fromthe IndianHealth Service (IHS)NationalData Warehouse (NDW), a repositoryof demographic, clinical, andbillingdata from IHS, tribal, and urban Indian clinics, with a user population representing w70% of all Pacific Northwest AI/ANs. Using International Classification of Diseases, 9th Revision codes, we calculated the 2001-2011 prevalence of diabetes diagnoses in theNDWamongAI/ANpatients in the PacificNorthwest and calculated annual and cumulative incidence overall and individually for 5 diabetes-related complications: acute myocardial infarction (MI), lower extremity amputation, stroke, end-stage renal disease (ESRD), and sepsis. Results: During 2001-2011, the prevalence of diabetes within the NDW user population increased from 3.1% (95% confidence interval [CI]: 3.0-3.2) to 5.0% (95% CI: 4.8-5.1). The annual incidence of amputations/10,000 patients with diabetes decreased from 28.6 (95% CI: 13.3-54.2) in 2001 to 1.9 (95% CI: 0.19.2) in 2011; no significant change was detected for MI, stroke, ESRD, or sepsis. During 2001-2011, the cumulative incidence of all 5 diabetes-related complications was 1,635.9 (95% CI: 1,568.0-1,705.0)/10,000 patients with diabetes. The 3 conditions with highest cumulative incidence were ESRD (919.2 [95% CI: 866.8-973.8]), followed by stroke (372.2 [95% CI: 338.3408.4]), and MI (199.0 [95% CI: 174.4-226.1]). Conclusions: The burden of diabetes persists among Pacific Northwest AI/ ANs. Clinical and community programs promoting diabetes management are needed to improve outcomes and prevent complications.

Background/AimsMetabolic syndrome (MetS) increases risk for developing serious health conditions, but MetS is rarely recorded as a diagnosis in clinical practice. The purpose of this study was to compare an electronic data extraction process to a manual chart review in identifying patients with MetS.MethodsElectronic health records (EHR) of 48 randomly selected Geisinger Rural Aging Study (GRAS) participants (24 males, 24 females; age =65) were selected for review. A trained auditor collected information for each participant on biochemical measurements (including triglycerides, HDL-cholesterol, glucose); blood pressure and measured height and weight. MetS was defined as having three of the five criteria based on ATP III guidelines. However, since waist circumference was not available for all participants, BMI >30 kg/m2 was used. Records were reviewed for a 48-month period, starting at date of GRAS study entry. Demographics, diagnosis codes, laboratory data, past medical history, medications, progress notes, and physician comments were included in the audit. Independently, an electronic data extraction of the EHR was used to identify subjects with MetS. Rates of agreement between the manual chart review and data extraction process were calculated. Discrepancies were examined for sources of disagreement and statistical agreement was assessed with Cohen?s Kappa.ResultsAs expected, very few subjects with an ICD-9 diagnosis code for MetS were identified (n=2).The manual chart review identified 27 subjects (56%) that met criteria based on ATP III guidelines. The independent electronic process identified 25 of these 27 subjects as having MetS and found an additional 2 subjects (inadvertently missed during manual chart review). The two cases that were missed using the electronic process had abnormal glucose values that were not available from the electronic data extraction. Agreement between the two methods was almost perfect (kappa=0.92).ConclusionsThis validation study demonstrates that an electronic data extraction process for identifying MetS has substantial agreement with the gold standard, a manual review of health records for clinical data. This process has the advantage of quickly querying large amounts of data that may be missed by manual chart review and can aid in collection of data for health outcomes research.

Serum levels of specific IgG and the sensitization of peripheral blood T-lymphocytes were measured in guinea pigs after single-dose antigenic sensitization by two routes-, intratympanic and intradermal injection. Keyhole limpet hemocyanin (KLH) served as the antigen. Intratympanic injection of antigen resulted in much lower levels of circulating anti-KLH IgC than intradermal injection. When KLH was conjugated with alum to produce nonspecific inflammation and serve as an adjuvant, the intratympanic route was considerably enhanced, but remained much less effective than the intradermal route. Development of an IgG response was also somewhat less rapid following intratympanic than following intradermal administration. Marked sensitization of circulating T-lymphocytes was seen after intradermal injection of alum-precipitated KLH. A much weaker, though still positive, response was seen after intradermal injection of KLH alone and with the intratympanic injection of alum-precipitated KLH. No T-lymphocyte sensitization could be detected after intratympanic injection of KLH alone. It was concluded that the afferent limb of both humoral (IgG) and cell-mediated immunity was operative in the middle ear. Therefore, the middle ear does not represent an immunologically “privileged” site. On the other hand, the afferent limb from the middle ear appears to operate less effectively and rapidly than that from the dermis. This observation is consistent with observations in other mucosal systems.