From the Ground Up: Establishing Strong Core Policies for Infants, Toddlers, and Families

Because the earliest years of life are a period of incredible growth, they present an opportunity to shape strong and positive development. Good health, secure and stable families, and positive early learning environments are necessary to foster children's physical, intellectual, and social-emotional development during this significant period. Yet many young children and parents in the United States lack the needed resources to thrive, putting them at greater risk of material hardship, chronic stress, and poor health. Federal and state policies can support vulnerable families and provide a buffer against stress and instability, but most existing programs lack sufficient resources to reach the largenumbers of families who could benefit. Federal and state policymakers must be mindful of the unique needs of infants, toddlers, and families as they consider the policies and investments necessary to change the trajectories for our youngest children

Gender- and age-related differences in rest and post-stress left ventricular cardiac function determined by gated SPECT

Gender- and age-related changes of left ventricular (LV) function and dimensions have not been elucidated in a large population by gated SPECT. Thus, the aim of this study was to derive male and female reference limits for left ventricular functional parameters, and determine the effect of age on LV dimensions and systolic function for this imaging modality. 1,639 (53% males) subjects without cardiovascular disease who underwent cardiac SPECT between January 2002 and June 2012 were included in this study. Mean age at presentation was 61±12years (range 18-92years). A significant effect of age (p=0.011) and gender (p<0.0001) on resting LV ejection fraction (LVEF) was observed, with an increase in LVEF with age being more pronounced in women (ΔB-coefficient: −0.088, p=0.011). Overall, mean LVEF was higher in women compared to men (70.3±8.6% vs. 64.4±7.5%, p<0.0001). LVEF after pharmacological stress with adenosine was significantly lower than at rest in both women and men (∆LVEF=1.1% in males and ∆LVEF=1.6% in females, p=0.01), which was the result of a significant increase in end-systolic volume after stress (p=0.0001). With advancing age an increase in LVEF was observed that was more pronounced in women than in men. These findings indicate that the evaluation of cardiac function and volumes of patients by gated SPECT should consider age- and gender-matched normative values

Image quality of low-dose CCTA in obese patients: impact of high-definition computed tomography and adaptive statistical iterative reconstruction

The accuracy of coronary computed tomography angiography (CCTA) in obese persons is compromised by increased image noise. We investigated CCTA image quality acquired on a high-definition 64-slice CT scanner using modern adaptive statistical iterative reconstruction (ASIR). Seventy overweight and obese patients (24 males; mean age 57years, mean body mass index 33kg/m2) were studied with clinically-indicated contrast enhanced CCTA. Thirty-five patients underwent a standard definition protocol with filtered backprojection reconstruction (SD-FBP) while 35 patients matched for gender, age, body mass index and coronary artery calcifications underwent a novel high definition protocol with ASIR (HD-ASIR). Segment by segment image quality was assessed using a four-point scale (1=excellent, 2=good, 3=moderate, 4=non-diagnostic) and revealed better scores for HD-ASIR compared to SD-FBP (1.5±0.43 vs. 1.8±0.48; p<0.05). The smallest detectable vessel diameter was also improved, 1.0±0.5mm for HD-ASIR as compared to 1.4±0.4mm for SD-FBP (p<0.001). Average vessel attenuation was higher for HD-ASIR (388.3±109.6 versus 350.6±90.3 Hounsfield Units, HU; p<0.05), while image noise, signal-to-noise ratio and contrast-to noise ratio did not differ significantly between reconstruction protocols (p=NS). The estimated effective radiation doses were similar, 2.3±0.1 and 2.5±0.1mSv (HD-ASIR vs. SD-ASIR respectively). Compared to a standard definition backprojection protocol (SD-FBP), a newer high definition scan protocol in combination with ASIR (HD-ASIR) incrementally improved image quality and visualization of distal coronary artery segments in overweight and obese individuals, without increasing image noise and radiation dos

Imaging of heart disease in women: review and case presentation

Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide. Although major diagnostic and therapeutic advances have significantly improved the prognosis of patients with CVD in the past decades, these advances have less benefited women than age-matched men. Noninvasive cardiac imaging plays a key role in the diagnosis of CVD. Despite shared imaging features and strategies between both sexes, there are critical sex disparities that warrant careful consideration, related to the selection of the most suited imaging techniques, to technical limitations, and to specific diseases that are overrepresented in the female population. Taking these sex disparities into consideration holds promise to improve management and alleviate the burden of CVD in women. In this review, we summarize the specific features of cardiac imaging in four of the most common presentations of CVD in the female population including coronary artery disease, heart failure, pregnancy complications, and heart disease in oncology, thereby highlighting contemporary strengths and limitations. We further propose diagnostic algorithms tailored to women that might help in selecting the most appropriate imaging modality

Exclusion and reappropriation: Experiences of contemporary enclosure among children in three East Anglian schools

Transformations of the landscapes which children inhabit have significant impacts on their lives; yet, due to the limited economic visibility of children’s relationships with place, they have little stake in those transformations. Their experience, therefore, illustrates in an acute way the experience of contemporary enclosure as a mode of subordination. Following fieldwork in three primary schools in South Cambridgeshire, UK, we offer an ethnographic account of children’s experiences of socio-spatial exclusion. Yet, we suggest that such exclusion is by no means an end-point in children’s relationships with place. Challenging assumptions that children are disconnected from nature, we argue that through play and imaginative exploration of their environments, children find ways to rebuild relationships with places from which they find themselves excluded. This is the author accepted manuscript. The final version is available from SAGE via http://dx.doi.org/10.1177/026377581664194

Predicting genome-wide DNA methylation using methylation marks, genomic position, and DNA regulatory elements

Background: Recent assays for individual-specific genome-wide DNA methylation profiles have enabled epigenome-wide association studies to identify specific CpG sites associated with a phenotype. Computational prediction of CpG site-specific methylation levels is important, but current approaches tackle average methylation within a genomic locus and are often limited to specific genomic regions. Results: We characterize genome-wide DNA methylation patterns, and show that correlation among CpG sites decays rapidly, making predictions solely based on neighboring sites challenging. We built a random forest classifier to predict CpG site methylation levels using as features neighboring CpG site methylation levels and genomic distance, and co-localization with coding regions, CGIs, and regulatory elements from the ENCODE project, among others. Our approach achieves 91% -- 94% prediction accuracy of genome-wide methylation levels at single CpG site precision. The accuracy increases to 98% when restricted to CpG sites within CGIs. Our classifier outperforms state-of-the-art methylation classifiers and identifies features that contribute to prediction accuracy: neighboring CpG site methylation status, CpG island status, co-localized DNase I hypersensitive sites, and specific transcription factor binding sites were found to be most predictive of methylation levels. Conclusions: Our observations of DNA methylation patterns led us to develop a classifier to predict site-specific methylation levels that achieves the best DNA methylation predictive accuracy to date. Furthermore, our method identified genomic features that interact with DNA methylation, elucidating mechanisms involved in DNA methylation modification and regulation, and linking different epigenetic processes

Impact of age and sex on left ventricular function determined by coronary computed tomographic angiography

__Background__ Left ventricular (LV) volumetric and functional parameters measured with cardiac computed tomography (cardiac CT) augment risk prediction and discrimination for future mortality. Gender- and age-specific standard values for LV dimensions and systolic function obtained by 64-slice cardiac CT are lacking __Methods and results __ 1155 patients from the Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenterregistry (54.5% males, mean age 53.1 + 12.4 years, range: 18 – 92 years) without known coronary artery disease (CAD), structural heart disease, diabetes, or hypertension who underwent cardiac CT for various indications were categorized according to age and sex. A cardiac CT data acquisition protocol was used that allowed volumetric measuring of LV function. Image interpretation was performed at each site. Patients with significant CAD (.50% stenosis) on cardiac CT were excluded from the analysis. Overall, mean left ventricular ejection fraction (LVEF) was higher in women when compared with men (66.6 + 7.7% vs. 64.6 + 8.1%, P, 0.001). This gender-difference in overall LVEF was caused by a significantly higher LVEF in women ≥70 years when compared with men ≥70 years (69.95 + 8.89% vs. 65.50 + 9.42%, P ¼ 0.004). Accordingly, a significant increase in LVEF was observed with age (P ¼ 0.005 for males and P, 0.001 for females), which was more pronounced in females (5.21%) than in males (2.6%). LV end-diastolic volume decreased in females from 122.48+27.87 (,40 years) to 95.56+23.17 (.70 years; P, 0.001) and in males from 155.22+35.07 (,40 years) to 130.26+27.18 (.70 years; P, 0.001). __Conclusion__ Our findings indicate that the LV undergoes a lifelong remodelling and highlight the need for age and gender adjusted reference values