ALICE: Study of Financial Hardship-Michigan

Through a series of new, standardized measurements, the United Way ALICE Reports present a broad picture of financial insecurity at the county and town level, and the reasons for why. What we found was startling -- the size of the workforce in each state that is struggling financially is much higher than traditional federal poverty guidelines suggest. The United Way ALICE Project is a grassroots movement stimulating a fresh, nonpartisan national dialogue about how to reverse the trend and improve conditions for this growing population of families living paycheck to paycheck

ALICE: Study of Financial Hardship-Indiana

Through a series of new, standardized measurements, the United Way ALICE Reports present a broad picture of financial insecurity at the county and town level, and the reasons for why. What we found was startling -- the size of the workforce in each state that is struggling financially is much higher than traditional federal poverty guidelines suggest. The United Way ALICE Project is a grassroots movement stimulating a fresh, nonpartisan national dialogue about how to reverse the trend and improve conditions for this growing population of families living paycheck to paycheck

ALICE: Study of Financial Hardship-Connecticut

Through a series of new, standardized measurements, the United Way ALICE Reports present a broad picture of financial insecurity at the county and town level, and the reasons for why. What we found was startling -- the size of the workforce in each state that is struggling financially is much higher than traditional federal poverty guidelines suggest. The United Way ALICE Project is a grassroots movement stimulating a fresh, nonpartisan national dialogue about how to reverse the trend and improve conditions for this growing population of families living paycheck to paycheck

Optimal phase for coronary interpretations and correlation of ejection fraction using late-diastole and end-diastole imaging in cardiac computed tomography angiography: implications for prospective triggering

A typical acquisition protocol for multi-row detector computed tomography (MDCT) angiography is to obtain all phases of the cardiac cycle, allowing calculation of ejection fraction (EF) simultaneously with plaque burden. New MDCT protocols scanner, designed to reduce radiation, use prospectively acquired ECG gated image acquisition to obtain images at certain specific phases of the cardiac cycle with least coronary artery motion. These protocols do not we allow acquisition of functional data which involves measurement of ejection fraction requiring end-systolic and end-diastolic phases. We aimed to quantitatively identify the cardiac cycle phase that produced the optimal images as well as aimed to evaluate, if obtaining only 35% (end-systole) and 75% (as a surrogate for end-diastole) would be similar to obtaining the full cardiac cycle and calculating end diastolic volumes (EDV) and EF from the 35th and 95th percentile images. 1,085 patients with no history of coronary artery disease were included; 10 images separated by 10% of R–R interval were retrospectively constructed. Images with motion in the mid portion of RCA were graded from 1 to 3; with ‘1’ being no motion, ‘2’ if 0 to <1 mm motion, and ‘3’ if there is >1 mm motion and/or non-interpretable study. In a subgroup of 216 patients with EF > 50%, we measured left ventricular (LV) volumes in the 10 phases, and used those obtained during 25, 35, 75 and 95% phase to calculate the EF for each patient. The average heart rate (HR) for our patient group was 56.5 ± 8.4 (range 33–140). The distribution of image quality at all heart rates was 958 (88.3%) in Grade 1, 113 (10.42%) in Grade 2 and 14 (1.29%) in Grade 3 images. The area under the curve for optimum image quality (Grade 1 or 2) in patients with HR > 60 bpm for phase 75% was 0.77 ± 0.04 [95% CI: 0.61–0.87], while for similar heart rates the area under the curve for phases 75 + 65 + 55 + 45% combined was 0.92 ± 0.02. LV volume at 75% phase was strongly correlated with EDV (LV volume at 95% phase) (r = 0.970, P < 0.001). There was also a strong correlation between LVEF (75_35) and LVEF (95_35) (r = 0.93, P < 0.001). Subsequently, we developed a formula to correct for the decrement in LVEF using 35–75% phase: LVEF (95_35) = 0.783 × LVEF (75_35) + 20.68; adjusted R2 = 0.874, P < 0.001. Using 64 MDCT scanners, in order to acquire >90% interpretable studies, if HR < 60 bpm 75% phase of RR interval provides optimal images; while for HR > 60 analysis of images in 4 phases (75, 35, 45 and 55%) is needed. Our data demonstrates that LVEF can be predicted with reasonable accuracy by using data acquired in phases 35 and 75% of the R–R interval. Future prospective acquisition that obtains two phases (35 and 75%) will allow for motion free images of the coronary arteries and EF estimates in over 90% of patients

Accuracy of the long-axis area-length method for the measurement of left ventricular volumes and ejection fraction using multidetector computed tomography

Multidetector computed tomography (MDCT) is useful for assessing left ventricular (LV) volumes and function. Validation has mainly been carried out using Simpson's method of summing up consecutive short-axis areas. Because the latter method is time-consuming, many users prefer using a quicker method, based on a single view or a pair of views. To evaluate the accuracy of the long-axis area-length method (AL), which has not been validated for MDCT, using Simpson's method as the gold standard, as well as right anterior oblique LV angiography as a clinical standard. Twenty-three patients admitted with acute chest pain were clinically evaluated with electrocardiogram-gated MDCT and invasive LV angiography. MDCT-based end-diastolic, end-systolic and stroke volumes, and ejection fraction (EF) were calculated using Simpson's method, biplane AL and single-plane AL. For LV angiography, EF was calculated using single-plane AL. A Bland-Altman analysis showed a close agreement between biplane AL and Simpson's method for EF, with 1% underestimation, 95% CI of ±11% and a correlation of 0.89. For end-diastolic, end-systolic and stroke volumes, overestimations of 7 mL, 4 mL and 2 mL, and 95% CI of ±27 mL, ±15 mL and ±26 mL, respectively were found. Correlation coefficients were 0.95, 0.97 and 0.82, respectively. Comparisons with LV angiography were considerably weaker. The vertical long-axis AL method by MDCT correlated better with both LV angiography and Simpson's method than the horizontal long-axis AL method. The biplane AL method gives results for EF, which correspond closely with the more cumbersome Simpson's method, although volumes are slightly overestimated. La tomographie à multidétecteurs (TGMD) est utile pour évaluer les volumes et la fonction ventriculaires gauches (VG). La validation a été pour une bonne part réalisée à l’aide de la méthode de Simpson établissant la somme des aires axe court consécutives. Parce que cette dernière méthode est fastidieuse, de nombreux utilisateurs préfèrent une méthode plus rapide basée sur une ou deux perspectives. Évaluer la précision de la méthode aire-longueur (AL) long axe, qui n’a pas été validée pour la TGMD, à l’aide de la méthode de Simpson comme étalon-or et à l’aide de l’angiographie VG droite antérieure oblique comme norme clinique. Vingt-trois patients admis pour DRS aiguë ont été évalués sur le plan clinique au moyen d’une TGMD synchronisée avec l’électrocardiogramme et d’une angiographie VG effractive. Les volumes télédiastoliques, télésystoliques, le volume d’éjection systolique et la fraction d’éjection (FÉ) ont été calculés à l’aide de la méthode de Simpson AL bidimensionnelle et AL unidimensionnelle. Pour l’angiographie VG, la FÉ a été calculée à l’aide de la méthode AL unidimensionnelle. Une analyse de Bland-Altman a montré une concordance étroite entre la méthode AL bidimensionnelle et la méthode de Simpson pour la FÉ, avec une sous-estimation de 1% et un IC à 95% de ± 11% et un coefficient de 0,89. Pour les volumes télédiastoliques, télésystoliques et d’éjection systolique, on a observé des surestimations de 7 mL, 4 mL, 2 mL, et des IC à 95% de ± 27 mL, ± 15 mL et ± 26 mL. Les coefficients de corrélation étaient de 0.95, 0.97 et 0.82, respectivement. Les comparaisons avec l’angiographie VG ont été considérablement plus faibles. La méthode AL long axe par TGMD a été en meilleure corrélation avec l’angiographie VG et avec la méthode de Simpson, comparativement à la méthode AL long axe horizontale. La méthode AL bidimensionnelle donne des résultats de FÉ qui correspondent étroitement avec la méthode de Simpson, plus fastidieuse, même si les volumes sont légèrement surestimés

Accuracy of the long-axis area-length method for the measurement of left ventricular volumes and ejection fraction using multidetector computed tomography

Multidetector computed tomography (MDCT) is useful for assessing left ventricular (LV) volumes and function. Validation has mainly been carried out using Simpson's method of summing up consecutive short-axis areas. Because the latter method is time-consuming, many users prefer using a quicker method, based on a single view or a pair of views. To evaluate the accuracy of the long-axis area-length method (AL), which has not been validated for MDCT, using Simpson's method as the gold standard, as well as right anterior oblique LV angiography as a clinical standard. Twenty-three patients admitted with acute chest pain were clinically evaluated with electrocardiogram-gated MDCT and invasive LV angiography. MDCT-based end-diastolic, end-systolic and stroke volumes, and ejection fraction (EF) were calculated using Simpson's method, biplane AL and single-plane AL. For LV angiography, EF was calculated using single-plane AL. A Bland-Altman analysis showed a close agreement between biplane AL and Simpson's method for EF, with 1% underestimation, 95% CI of ±11% and a correlation of 0.89. For end-diastolic, end-systolic and stroke volumes, overestimations of 7 mL, 4 mL and 2 mL, and 95% CI of ±27 mL, ±15 mL and ±26 mL, respectively were found. Correlation coefficients were 0.95, 0.97 and 0.82, respectively. Comparisons with LV angiography were considerably weaker. The vertical long-axis AL method by MDCT correlated better with both LV angiography and Simpson's method than the horizontal long-axis AL method. The biplane AL method gives results for EF, which correspond closely with the more cumbersome Simpson's method, although volumes are slightly overestimated. La tomographie à multidétecteurs (TGMD) est utile pour évaluer les volumes et la fonction ventriculaires gauches (VG). La validation a été pour une bonne part réalisée à l’aide de la méthode de Simpson établissant la somme des aires axe court consécutives. Parce que cette dernière méthode est fastidieuse, de nombreux utilisateurs préfèrent une méthode plus rapide basée sur une ou deux perspectives. Évaluer la précision de la méthode aire-longueur (AL) long axe, qui n’a pas été validée pour la TGMD, à l’aide de la méthode de Simpson comme étalon-or et à l’aide de l’angiographie VG droite antérieure oblique comme norme clinique. Vingt-trois patients admis pour DRS aiguë ont été évalués sur le plan clinique au moyen d’une TGMD synchronisée avec l’électrocardiogramme et d’une angiographie VG effractive. Les volumes télédiastoliques, télésystoliques, le volume d’éjection systolique et la fraction d’éjection (FÉ) ont été calculés à l’aide de la méthode de Simpson AL bidimensionnelle et AL unidimensionnelle. Pour l’angiographie VG, la FÉ a été calculée à l’aide de la méthode AL unidimensionnelle. Une analyse de Bland-Altman a montré une concordance étroite entre la méthode AL bidimensionnelle et la méthode de Simpson pour la FÉ, avec une sous-estimation de 1% et un IC à 95% de ± 11% et un coefficient de 0,89. Pour les volumes télédiastoliques, télésystoliques et d’éjection systolique, on a observé des surestimations de 7 mL, 4 mL, 2 mL, et des IC à 95% de ± 27 mL, ± 15 mL et ± 26 mL. Les coefficients de corrélation étaient de 0.95, 0.97 et 0.82, respectivement. Les comparaisons avec l’angiographie VG ont été considérablement plus faibles. La méthode AL long axe par TGMD a été en meilleure corrélation avec l’angiographie VG et avec la méthode de Simpson, comparativement à la méthode AL long axe horizontale. La méthode AL bidimensionnelle donne des résultats de FÉ qui correspondent étroitement avec la méthode de Simpson, plus fastidieuse, même si les volumes sont légèrement surestimés

Clinical evaluation of a fully automated model-based algorithm to calculate left ventricular volumes and ejection fraction using multidetector computed tomography

Objectives: To evaluate feasibility and accuracy of a fully automatic algorithm (FAA) for calculating left ventricular volumes and ejection fraction (LVEF) from multidetector computed tomography (MDCT) studies versus a previously validated method based on Simpson's method serving as our reference standard (RS), and left ventriculography (LVG), in patients with acute chest pain (ACP). Methods: 23 patients admitted with ACP underwent ECG-gated MDCT, as well as LVG during their hospitalization. MDCT based end-diastolic, end-systolic and stroke volumes (EDV, ESV, SV) and LVEF were calculated using the RS and the FAA. Results: One patient was excluded after FAA failure to detect contours. In the remaining 22 patients, mean±SD LVEF measurements were RS 61±11%, FAA 59±11% (r = 0.91 versus RS), LVG 57±16% (r = 0.6 versus RS). In comparison to RS, FAA overestimated EDV by 10.1±8.5 ml, ESV by 7.3±6.4 ml and SV by 3.6±8.6 ml, and underestimated LVEF measurements by 2.7±4.6%, related to contour smoothing. LVEF by FAA was within 8% of RS for all patients except one. In contrast, LVG differed significantly from RS. Conclusions: The evaluated FAA obtained accurate, clinically relevant results for left ventricular volumes and LVEF relative to the RS

Quantitative evaluation of regional left ventricular function by multidetector computed tomography

: Because most contemporary workstations offer quantitative analysis of regional function by multidetector computed tomography, we aimed to establish typical values for normal, hypokinetic, and akinetic regions, and to establish optimal thresholds to differentiate between normal and abnormal values. : For 33 patients, quantitative regional functional parameters were compared with visual analysis by both multidetector computed tomography and echocardiography. Normal values were established to normalize for segmental variability. Optimal thresholds were established to differentiate between normal and abnormal segments by receiver operating characteristic analysis. : Akinetic, hypokinetic, and normokinetic segments demonstrated significant differences (P < 0.0001) for end-systolic thickness (mean [95% confidence interval], 9.4 [4.5-14.3], 11.7 [7.2-16.2], and 14.3 mm [8.2-20.3 mm]), respectively; thickening, 24% [-22% to 71%], 45% [-16% to 106%], and 82% [10%-154%]), respectively; and motion, 3.5 [-2.0 to 8.9], 6.1 [-0.2 to 12.4], and 8.5 mm [1.8-15.3 mm], respectively). Thickening performed best with area under the curve of 0.87 and sensitivity equal to specificity of 82%. Intraobserver variability was good, but interobserver variability was only moderate. : Quantification of regional myocardial function can be performed to assist the physician in mapping left ventricular function