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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

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.

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.

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.

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.