Reporter\u27s Occupation and Source of Adverse Device Event Reports Contained in the FDA\u27s MAUDE Database

Introduction: A review of the medical device adverse events submitted to the United States Food & Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was undertaken to determine the major sources of the information. Methods: The reporter’s occupation and source of the medical device report were determined for acquisition dates Jan 1, 1997 to Dec 31, 2018. A total of 7,766,737 adverse event records were analyzed. Results: 96.6% of reports originated with the manufacturer. Patients (patients/family/friend) were the most frequent submitter of reports directly to the FDA, almost five times as often as physicians. Nurses submitted reports directly to the FDA 2.77 times as often as physicians. Only 0.49% of physician reports were submitted directly to the FDA, representing 0.09% of total MAUDE reports. Conclusion: Increasing physician reporting directly to the FDA and MAUDE through the MedWatch reporting system is an imperative. Incorporating information from the perspective of the physician has the potential of increasing the quality of the data and improving the reliability of post-market surveillance

Spitzer Observations of Long-term Infrared Variability among Young Stellar Objects in Chamaeleon I

Infrared variability is common among young stellar objects, with surveys finding daily to weekly fluctuations of a few tenths of a magnitude. Space-based observations can produce highly sampled infrared light curves, but are often limited to total baselines of about 1 month due to the orientation of the spacecraft. Here we present observations of the Chameleon I cluster, whose low declination makes it observable by the Spitzer Space Telescope over a 200-day period. We observe 30 young stellar objects with a daily cadence to better sample variability on timescales of months. We find that such variability is common, occurring in ~80% of the detected cluster members. The change in [3.6]–[4.5] color over 200 days for many of the sources falls between that expected for extinction and fluctuations in disk emission. With our high cadence and long baseline we can derive power spectral density curves covering two orders of magnitude in frequency and find significant power at low frequencies, up to the boundaries of our 200-day survey. Such long timescales are difficult to explain with variations driven by the interaction between the disk and stellar magnetic field, which has a dynamical timescale of days to weeks. The most likely explanation is either structural or temperature fluctuations spread throughout the inner ~0.5 au of the disk, suggesting that the intrinsic dust structure is highly dynamic

Associations between reliable changes in depression and changes in BMI, total body fatness and visceral adiposity during a 12-month weight loss trial.

We investigated associations between changes in depression and body composition over a 12-month weight loss trial. Of the 298 adults (BMI > 27 m/kg2), 219 with complete depression and body composition data were included. A 10-item Center for Epidemiologic Studies Depression Scale measured depression; dual-energy X-ray absorptiometry measured body composition. Multinomial logistic regression predicted reliable changes in depression by BMI, body fat (BF) and visceral adiposity (VAT). Multiplicative interaction terms tested modification by sex and ethnicity. Participants with increases in body composition were less likely to experience improvements in depression (BMI: RRR = 0.79 (0.68-0.91), p < 0.01; BF: RRR = 0.97 (0.94 - 0.99), p = 0.01; VAT: RRR = 0.99 (0.98-1.00), p = 0.02), but not worsening of depression (BMI: RRR = 1.29 (0.96-1.73), p = 0.10; BF: RRR = 1.04 (0.99-1.09), p = 0.15; VAT: RRR = 1.01 (1.00-1.03), p = 0.18). Sex and ethnicity interaction terms were not significant. However, the relationship was only significant among females, among non-Latinos for BMI and BF, and among Latinos for VAT. Our study supports the association between depression and obesity and highlights the need for longitudinal studies investigating VAT and depression in diverse ethnic groups

Performance of ICD‐10‐CM diagnosis codes for identifying children with Sickle Cell Anemia

ObjectiveTo develop, test, and validate the performance of ICD‐10‐CM claims‐based case definitions for identifying children with sickle cell anemia (SCA).Data SourcesMedicaid administrative claims (2016) for children <18 years with potential SCA (any D57x diagnosis code) and newborn screening records from Michigan and New York State.Study DesignThis study is a secondary data analysis.Data Collection/Extraction MethodsUsing specific SCA‐related (D5700, D5701, and D5702) and nonspecific (D571) diagnosis codes, 23 SCA case definitions were applied to Michigan Medicaid claims (2016) to identify children with SCA. Measures of performance (sensitivity, specificity, area under the ROC curve) were calculated using newborn screening results as the gold standard. A parallel analysis was conducted using New York State Medicaid claims and newborn screening data.Principal FindingsIn Michigan Medicaid, 1597 children had ≥1 D57x claim; 280 (18 percent) were diagnosed with SCA. Measures of performance varied, with sensitivities from 0.02 to 0.97 and specificities from 0.88 to 1.0. The case definition of ≥1 outpatient visit with a SCA‐related or D571 code had the highest area under the ROC curve, with a sensitivity of 95 percent and specificity of 92 percent. The same definition also had the highest performance in New York Medicaid (n = 2454), with a sensitivity of 94 percent and specificity of 86 percent.ConclusionsChildren with SCA can be accurately identified in administrative claims using this straightforward case definition. This methodology can be used to monitor trends and use of health services after transition to ICD‐10‐CM.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154614/1/hesr13257.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154614/2/hesr13257_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154614/3/hesr13257-sup-0001-Authormatrix.pd

Folding and organization of a contiguous chromosome region according to the gene distribution pattern in primary genomic sequence

Specific mammalian genes functionally and dynamically associate together within the nucleus. Yet, how an array of many genes along the chromosome sequence can be spatially organized and folded together is unknown. We investigated the 3D structure of a well-annotated, highly conserved 4.3-Mb region on mouse chromosome 14 that contains four clusters of genes separated by gene “deserts.” In nuclei, this region forms multiple, nonrandom “higher order” structures. These structures are based on the gene distribution pattern in primary sequence and are marked by preferential associations among multiple gene clusters. Associating gene clusters represent expressed chromatin, but their aggregation is not simply dependent on ongoing transcription. In chromosomes with aggregated gene clusters, gene deserts preferentially align with the nuclear periphery, providing evidence for chromosomal region architecture by specific associations with functional nuclear domains. Together, these data suggest dynamic, probabilistic 3D folding states for a contiguous megabase-scale chromosomal region, supporting the diverse activities of multiple genes and their conserved primary sequence organization

Spitzer Observations of Long-term Infrared Variability among Young Stellar Objects in Chamaeleon I

Infrared variability is common among young stellar objects, with surveys finding daily to weekly fluctuations of a few tenths of a magnitude. Space-based observations can produce highly sampled infrared light curves, but are often limited to total baselines of about 1 month due to the orientation of the spacecraft. Here we present observations of the Chameleon I cluster, whose low declination makes it observable by the Spitzer Space Telescope over a 200-day period. We observe 30 young stellar objects with a daily cadence to better sample variability on timescales of months. We find that such variability is common, occurring in ~80% of the detected cluster members. The change in [3.6]–[4.5] color over 200 days for many of the sources falls between that expected for extinction and fluctuations in disk emission. With our high cadence and long baseline we can derive power spectral density curves covering two orders of magnitude in frequency and find significant power at low frequencies, up to the boundaries of our 200-day survey. Such long timescales are difficult to explain with variations driven by the interaction between the disk and stellar magnetic field, which has a dynamical timescale of days to weeks. The most likely explanation is either structural or temperature fluctuations spread throughout the inner ~0.5 au of the disk, suggesting that the intrinsic dust structure is highly dynamic

A missense TGFB2 variant p.(Arg320Cys) causes a paradoxical and striking increase in aortic TGFB1/2 expression.

Loeys-Dietz syndrome (LDS) is an autosomal dominant connective tissue disorder with a range of cardiovascular, skeletal, craniofacial and cutaneous manifestations. LDS type 4 is caused by mutations in TGFβ ligand 2 (TGFB2) and based on the family pedigrees described to date, appears to have a milder clinical phenotype, often presenting with isolated aortic disease. We sought to investigate its molecular basis in a new pedigree. We identified a missense variant p.(Arg320Cys) (NM_003238.3) in a highly evolutionary conserved region of TGFB2 in a new LDS type 4 pedigree with multiple cases of aortic aneurysms and dissections. There was striking upregulation of TGFB1 and TGFB2 expression on immunofluorescent staining, and western blotting of the aortic tissue from the index case confirming the functional importance of the variant. This case highlights the striking paradox of predicted loss-of-function mutations in TGFB2 causing enhanced TGFβ signaling in this emerging familial aortopathy.Raya Al Maskari has a PhD studentship funded by the Omani government.This is the author accepted manuscript. The final version is available from Nature Publishing Group via https://doi.org/10.1038/ejhg.2016.14

Current and cumulative malaria infections in a setting embarking on elimination: Amhara, Ethiopia.

BACKGROUND: Since 2005, Ethiopia has aggressively scaled up malaria prevention and case management. As a result, the number of malaria cases and deaths has significantly declined. In order to track progress towards the elimination of malaria in Amhara Region, coverage of malaria control tools and current malaria transmission need to be documented. METHODS: A cross-sectional household survey oversampling children under 5 years of age was conducted during the dry season in 2013. A bivalent rapid diagnostic test (RDT) detecting both Plasmodium falciparum and Plasmodium vivax and serology assays using merozoite antigens from both these species were used to assess the prevalence of malaria infections and exposure to malaria parasites in 16 woredas (districts) in Amhara Region. RESULTS: 7878 participants were included, with a mean age of 16.8 years (range 0.5-102.8 years) and 42.0% being children under 5 years of age. The age-adjusted RDT-positivity for P. falciparum and P. vivax infection was 1.5 and 0.4%, respectively, of which 0.05% presented as co-infections. Overall age-adjusted seroprevalence was 30.0% for P. falciparum, 21.8% for P. vivax, and seroprevalence for any malaria species was 39.4%. The prevalence of RDT-positive infections varied by woreda, ranging from 0.0 to 8.3% and by altitude with rates of 3.2, 0.7, and 0.4% at under 2000, 2000-2500, and >2500 m, respectively. Serological analysis showed heterogeneity in transmission intensity by area and altitude and evidence for a change in the force of infection in the mid-2000s. CONCLUSIONS: Current and historic malaria transmission across Amhara Region show substantial variation by age and altitude with some settings showing very low or near-zero transmission. Plasmodium vivax infections appear to be lower but relatively more stable across geography and altitude, while P. falciparum is the dominant infection in the higher transmission, low-altitude areas. Age-dependent seroprevalence analyses indicates a drop in transmission occurred in the mid-2000s, coinciding with malaria control scale-up efforts. As malaria parasitaemia rates get very low with elimination efforts, serological evaluation may help track progress to elimination

Broadband velocity modulation spectroscopy of HfF^+: towards a measurement of the electron electric dipole moment

Precision spectroscopy of trapped HfF^+ will be used in a search for the permanent electric dipole moment of the electron (eEDM). While this dipole moment has yet to be observed, various extensions to the standard model of particle physics (such as supersymmetry) predict values that are close to the current limit. We present extensive survey spectroscopy of 19 bands covering nearly 5000 cm^(-1) using both frequency-comb and single-frequency laser velocity-modulation spectroscopy. We obtain high-precision rovibrational constants for eight electronic states including those that will be necessary for state preparation and readout in an actual eEDM experiment.Comment: 13 pages, 7 figures, 3 table