NURSING DNP 810 EMERGING AREAS OF HUMAN HEALTH ESSAYS

NURSING DNP 810 EMERGING AREAS OF HUMAN HEALTH ESSAYS

Nursing DNP 810 Emerging Areas of Human Health Essays

Genetic and environmental influences interact with age and sex in shaping the human methylome, and hence shapes an individual’s susceptibility to disease. The methylome is subject to genetic and environmental effects. Their impact may depend on sex and age, resulting in sex- and age-related physiological variation and disease susceptibility. Here we estimate the total heritability of DNA methylation levels in whole blood and estimate the variance explained by common single nucleotide polymorphisms at 411,169 sites in 2,603 individuals from twin families, to establish a catalogue of between-individual variation in DNA methylation. Heritability estimates vary across the genome (mean=19%) and interaction analyses reveal thousands of sites with sex-specific heritability as well as sites where the environmental variance increases with age. Integration with previously published data illustrates the impact of genome and environment across the lifespan at methylation sites associated with metabolic traits, smoking and ageing. These findings demonstrate that our catalogue holds valuable information on locations in the genome where methylation variation between people may reflect disease-relevant environmental exposures or genetic variation.

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Full Course GCU

Nursing DNP 810 Emerging Areas of Human Health Essays Discussions GCU

Topic 1 DQ 1

Name three essential structural elements of a functional eukaryotic chromosome and describe their functions. Discuss the implications related to research, health, and life span in terms of one of the structural elements.

Topic 1 DQ 2

Describe the difference among replication, transcription, and translation for both DNA and RNA.

Topic 2 DQ 1

Describe at least four factors that can be associated in a complex inheritance health issue.

Nursing DNP 810 Emerging Areas of Human Health Essays Topic 2 DQ 2

Compare two genomic tests used for screening, diagnosis, and management of a disease. Describe whether outcome data exists related to the utility of these tests and what the data shows, if available.

Topic 3 Discussions

DQ 1 Contrast two models used for multigenerational family health histories. Which do you prefer and why?

DQ 2 Describe the importance of a comprehensive health and physical assessment that includes information on environment, and genomic influences. Frame this answer through your current role, whether as an Advanced Registered Nurse Practitioner (ARNP) with a practice, or a nurse executive overseeing nursing practice in an organization.

Topic 4 DQ 1 Genetics testing is viewed as either positive or negative. When used to detect the genes for breast cancer, health insurance companies deny care based on genetics. Why? Describe one genetic test and its impact on health, prevention, screening, diagnostics, treatment selection, and treatment effectiveness.

DNP 810 Topic 4 DQ 2

Evidence-based practice and standardized clinical guidelines have improved organizations and the ability of providers to provide the care with the highest level of evidence to each patient. Describe one pharmacological agent with a protocol/clinical guideline that is used. Discuss how this protocol may not take into consideration genetic variations. What can be done to tailor care to each patient while providing standardized treatments?

Topic 5 DQ 1 Describe one health issue and discuss how nutrition can impact this health issue positively and negatively.

Topic 5 DQ 2 Choose one disorder of malnutrition. Discuss the genetic and environmental influences on this disorder, including prevalence rates, testing, treatment, and prognosis.

Nursing DNP 810 Emerging Areas of Human Health Essays Topic 6 DQ 1

Discuss how genetic and genomics can play a role in a demand for new health services and how it may impact health care expenditures in the aging population. Give one example.

Nursing DNP 810 Emerging Areas of Human Health Essays Topic 6 DQ 2

Describe one method that includes using evidence-based data to support a new or innovative ways to care for the aging now or in the future. How will it impact care and what are the anticipated outcomes?

Nursing DNP 810 Emerging Areas of Human Health Essays Topic 7 DQ 1

Discuss how genetic and genomics can play a role in a demand for new health services and how it may impact health care expenditures in the chronic disease population. Give one example.

Nursing DNP 810 Emerging Areas of Human Health Essays Topic 7 DQ 2

Describe one method that includes using evidence-based data to support a new or innovative way to care for those with chronic disease now or in the future. How will it impact care and what are the anticipated outcomes?

Topic 8 Discussions

DQ 2 Choose one recent (within last 2 years) news story about genetic or genomic technology. Describe the issue presented. From the perspective as an RN or APRN, describe the ethical, cultural, religious, legal, fiscal, and societal implication.

DQ 2 Describe two issues that undermine the rights of clients in genetic- and genomic-related decision making and action. Discuss a potential solution for each as well as your role in this issue as the patient advocate.

 

Nursing DNP 810 Emerging Areas of Human Health Essays Full Course Assignments GCU

Week 1 Individual Success Plan (ISP)

Details:

The Individual Success Plan (ISP) assignment in this course requires your collaboration with the course faculty early on to establish a plan for successful completion of mutually identified and agreed upon specific deliverables for your programmatic requirements. Programmatic requirements are: (1) completion of required practice immersion hours, (2) completion of work associated with program competencies, (3) work associated toward completion of your Direct Practice Improvement Project.

General Requirements:

Use the following information to ensure successful completion of the assignment as it pertains to deliverables due in this course:

  • Locate and download the Individual Success Plan (ISP) document in the DNP Program Documents folder in the DNP Program Materials section of the DC Network.
  • Review the DNP Program Milestones document in the DC Network and identify which milestones apply to this course. Note: Not all courses have milestones.
  • Determine what practice experiences you plan to seek in order to address each competency. Include how many hours you plan to set aside to meet your goals. Learners will apply concepts from each of their core courses to reflect upon, critically examine, and improve current practice, and are required to integrate scholarly readings to develop case reports that demonstrate increasingly complex and proficient practice.
  • Use the ISP to develop a personal plan for completing your practice hours and how competencies will be met. Show all of the major milestones and deliverables.

Within the ISP, ensure you identify specific deliverables which can include the following: Individualized DNP practice immersion contracts; comprehensive clinical log of hours applied to doctoral level learning outcomes; learner evaluations; mentor evaluations; current and updated CV; scholarly activities; GCU DNP competency self-assessment; reflective journal; course goals and plan for how competencies and practice immersion hours will be met; faculty and mentor approvals of course goals and documented practice immersion hours; and DPI project milestones.

  • Identify the specific deliverables you will complete throughout this course from those defined above or others negotiated with your faculty. You must turn in a new ISP in each course.
  • Identify the remaining deliverables you will complete in the upcoming courses.
  • List the challenges you expect to encounter as you continue the practice hour and competency requirements throughout this course? How might you overcome these challenges?
  • You can renegotiate these deliverables with your faculty throughout this course and update your ISP accordingly.
  • This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
  • Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
  • You not are required to submit this assignment to LopesWrite.

Directions:

Complete the Contact Information table at the beginning of the ISP document and type in your signature and the date on which you completed the table.

Read the information in the ISP document including the following:

  1. Learner Expectations
  2. Derivation of the ISP
  3. Instructions for completing the ISP

Follow the instructions and complete the ISP.

Nursing DNP 810 Emerging Areas of Human Health Essays Week 1 Reading Check for Understanding

Details:

Complete the questions listed in the “Problems” section of the textbook on pages 23, 39, and 58. Check your answers in the back of the textbook in the “Answers to Problems” appendix.

Week 2 Case Report Part 1

Details:

You will be creating a case report in stages over four course topics. Use an example from your own personal practice, experience, or own personal/family; however, simulated cases are not acceptable for practice hours and therefore not acceptable for this assignment. Examples might include a patient with Duchesne’s muscular dystrophy. Huntington’s disease, Down’s syndrome, sickle cell anemia, BRCA 1 or BRCA 2 mutations, or other genetic disorder that you and/or the organization in which you practice may specialize in treating.

General Requirements:

Use the following information to ensure successful completion of the assignment:

  • This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
  • Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
  • This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
  • You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Include the following:

  • Guidelines and reasons behind the FDA regulations for introducing new pharmaceutical agents (policy).
  • The role that money and grants play in scientific advances; the economics of health care (capitalism).
  • The role and involvement family plays into the health care decision.

Directions:

For this assignment (Part 1 of the Case Report), write a 1,000-1,250 word paper incorporating genetics information learned from assigned readings in Topics 1 and 2. Include the following:

  1. Describe the disease, its prevalence, and its incidence.
  2. Discuss the laboratory testing that is possible.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the student, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-810

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

Case Report: Part 1 

1
Unsatisfactory
0.00% 2
Less Than Satisfactory
74.00% 3
Satisfactory
79.00% 4
Good
87.00% 5
Excellent
100.00%
70.0 %Content
10.0 %Discussion of the Guidelines and Reasons Behind the FDA Regulations for Introducing New Pharmaceutical Agents (Policy) Discussion of the guidelines and reasons behind the FDA regulations for introducing new pharmaceutical agents (policy) is not present. Nursing DNP 810 Emerging Areas of Human Health Essays Discussion of the guidelines and reasons behind the FDA regulations for introducing new pharmaceutical agents (policy) is present but incomplete. Discussion of the guidelines and reasons behind the FDA regulations for introducing new pharmaceutical agents (policy) is present but done at a perfunctory level. Discussion of the guidelines and reasons behind the FDA regulations for introducing new pharmaceutical agents (policy) is clearly present and convincing. Information presented is from scholarly though dated sources. Discussion of the guidelines and reasons behind the FDA regulations for introducing new pharmaceutical agents (policy) is clearly present and insightful. Information presented is from current scholarly sources.

10.0 %Discussion of the Role That Money and Grants Play In Scientific Advances the Economics of Health Care (Capitalism) Discussion of the role that money and grants play in scientific advances; the economics of health care (capitalism) is not present. Nursing DNP 810 Emerging Areas of Human Health Essays Discussion of the role that money and grants play in scientific advances; the economics of health care (capitalism) is present but incomplete. Discussion of the role that money and grants play in scientific advances; the economics of health care (capitalism) is present but done at a perfunctory level. Discussion of the role that money and grants play in scientific advances; the economics of health care (capitalism) is clearly present and convincing. Information presented is from scholarly though dated sources. Discussion of the role that money and grants play in scientific advances; the economics of health care (capitalism) is clearly present and insightful. Information presented is from current scholarly sources.

10.0 %Discussion of the Role and Involvement Family Plays in Health Care Decisions Discussion of the role and involvement family plays in health care decisions is not presented. Discussion of the role and involvement family plays in health care decisions is presented but incomplete. Discussion of the role and involvement family plays in health care decisions is presented but done at a perfunctory level. Discussion of the role and involvement family plays in health care decisions is clearly presented and convincing. Information presented is from mostly current scholarly but some outdated sources are used. Discussion of the role and involvement family plays in health care decisions is clearly presented, insightful and detailed. Information presented is from current scholarly sources.

20.0 %Description of the Disease, Its Prevalence, and Its Incidence The disease, its prevalence, and its incidence are not described. The disease, its prevalence, and its incidence are described. Discussion is incomplete. The disease, its prevalence, and its incidence are described. Discussion is done at a perfunctory level. The disease, its prevalence, and its incidence are clearly described. Discussion is convincing. Information presented is from mostly current scholarly but some outdated sources are used. The disease, its prevalence, and its incidence are clearly described. Discussion is insightful and detailed. Information presented is from current scholarly sources.

20.0 %Discussion of the Possible Laboratory Testing Discussion of the possible laboratory testing is not present. Discussion of the possible laboratory testing is present but incomplete. Discussion of the possible laboratory testing is present but done at a perfunctory level. Discussion of the possible laboratory testing is clearly present and convincing. Information presented is from mostly current scholarly but some outdated sources are used. Discussion of the possible laboratory testing is clearly present and insightful. Information presented is from current scholarly sources.

20.0 %Organization and Effectiveness
Nursing DNP 810 Emerging Areas of Human Health Essays

7.0 %Thesis Development and Purpose Paper lacks any discernible overall purpose or organizing claim. Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear. Thesis and/or main claim are apparent and appropriate to purpose. Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose. Thesis and/or main claim are comprehensive. The essence of the paper is contained within the thesis. Thesis statement makes the purpose of the paper clear.

8.0 %Argument Logic and Construction Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use) Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present. Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.

10.0 %Format
5.0 %Paper Format (Use of appropriate style for the major and assignment) Template is not used appropriately or documentation format is rarely followed correctly. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style. All format elements are correct.

5.0 %Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment and style) No reference page is included. No citations are used. Reference page is present. Citations are inconsistently used. Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present. Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and citation style is usually correct. In-text citations and a reference page are complete and correct. The documentation of cited sources is free of error.

100 %Total Weightage

Week 2 Reading Check for Understanding

Details:

Complete the questions listed in the “Problems” section of the textbook on pages 84, 113, 147-149, 174, and 205. Check your answers in the back of the textbook in the “Answers to Problems” appendix.

DNP 810 Week 3 Case Report Part 2

Details:

You will be creating a case report in stages over four course topics. This assignment will add to your previous work in Topic 2. Use an example from your own personal practice, experience, or own personal/family; however, simulated cases are not acceptable for practice hours and therefore not acceptable for this assignment. Examples might include a patient with Duchesne’s muscular dystrophy. Huntington’s disease, Down’s syndrome, sickle cell anemia, BRCA 1 or BRCA 2 mutations, or other genetic disorder that you and/or the organization you practice in may specialize in treating.

General Requirements:

Use the following information to ensure successful completion of the assignment:

  • This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
  • Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
  • This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
  • You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Directions:

For this assignment (Part 2 of the Case Report), write a 1,000-1,250 word paper incorporating genetics information learned from assigned readings in Topics 1-3. Include the following:

  1. Describe if chromosomal analysis is/was indicated.
  2. Detail the causes of the disorder.
  3. Describe the disorder in terms of its origin as either a single gene inheritance, or as a complex inheritance and considerations for practice and patient education.
  4. Analyze the gene mutation of the disease, as well as whether it is acquired or inherited, and how the mutation occurs.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the student, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-810

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

Nursing DNP 810 Emerging Areas of Human Health Essays Case Report: Part 2  

  1
Unsatisfactory
0.00%
2
Less Than Satisfactory
74.00%
3
Satisfactory
79.00%
4
Good
87.00%
5
Excellent
100.00%
70.0 %Content  
10.0 %Description of Whether or Not Chromosomal Analysis Is/Was Indicated Discussion of whether or not chromosomal analysis is/was indicated is not present. Discussion of whether or not chromosomal analysis is/was indicated is present but incomplete. Discussion of whether or not chromosomal analysis is/was indicated is present but done at a perfunctory level. Discussion of whether or not chromosomal analysis is/was indicated is clearly present and convincing. Information presented is from scholarly though dated sources. Discussion of whether or not chromosomal analysis is/was indicated is clearly present and insightful. Information presented is from current scholarly sources.
20.0 %Discussion of the Causes of the Disorder Discussion of the causes of the disorder is not present. Nursing DNP 810 Emerging Areas of Human Health Essays Discussion of the causes of the disorder is present but incomplete. Discussion of the causes of the disorder is present but done at a perfunctory level. Discussion of the causes of the disorder is clearly present and convincing. Information presented is from scholarly though dated sources. Discussion of the causes of the disorder is clearly present and insightful. Information presented is from current scholarly sources.
20.0 %Description of the Disorder in Terms of Its Origin as Either a Single Gene Inheritance, or as a Complex Inheritance and Considerations for Practice and Patient Education Description of the disorder in terms of its origin as either a single gene inheritance, or as a complex inheritance and considerations for practice and patient education is not presented. Description of the disorder in terms of its origin as either a single gene inheritance, or as a complex inheritance and considerations for practice and patient education is presented but incomplete. Description of the disorder in terms of its origin as either a single gene inheritance, or as a complex inheritance and considerations for practice and patient education is presented but done at a perfunctory level. Description of the disorder in terms of its origin as either a single gene inheritance, or as a complex inheritance and considerations for practice and patient education is clearly presented and convincing. Information presented is from mostly current scholarly but some outdated sources are used. Description of the disorder in terms of its origin as either a single gene inheritance, or as a complex inheritance and considerations for practice and patient education is clearly presented, insightful and detailed. Information presented is from current scholarly sources.
20.0 %Analysis of the Gene Mutation of the Disease, as Well as Whether It Is Acquired or Inherited, and How the Mutation Occurs Analysis of the gene mutation of the disease, as well as whether it is acquired or inherited, and how the mutation occurs is not presented. Analysis of the gene mutation of the disease, as well as whether it is acquired or inherited, and how the mutation occurs is presented. Discussion is incomplete. Analysis of the gene mutation of the disease, as well as whether it is acquired or inherited, and how the mutation occurs is presented. Discussion is done at a perfunctory level. Analysis of the gene mutation of the disease, as well as whether it is acquired or inherited, and how the mutation occurs is clearly presented. Discussion is convincing. Information presented is from mostly current scholarly but some outdated sources are used. Analysis of the gene mutation of the disease, as well as whether it is acquired or inherited, and how the mutation occurs is clearly presented. Discussion is insightful and detailed. Information presented is from current scholarly sources.
20.0 %Organization and Effectiveness  
7.0 %Thesis Development and Purpose Paper lacks any discernible overall purpose or organizing claim. Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear. Thesis and/or main claim are apparent and appropriate to purpose. Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose. Thesis and/or main claim are comprehensive. The essence of the paper is contained within the thesis. Thesis statement makes the purpose of the paper clear.
8.0 %Argument Logic and Construction Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. Nursing DNP 810 Emerging Areas of Human Health Essays
5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use) Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present. Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.
10.0 %Format  
5.0 %Paper Format (Use of appropriate style for the major and assignment) Template is not used appropriately or documentation format is rarely followed correctly. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style. All format elements are correct.
5.0 %Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment and style) No reference page is included. No citations are used. Reference page is present. Citations are inconsistently used. Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present. Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and citation style is usually correct. In-text citations and a reference page are complete and correct. The documentation of cited sources is free of error.
100 %Total Weightage Nursing DNP 810 Emerging Areas of Human Health Essays

DNP 810 Week 3 Family History

Details:

Taking a family history is an important step in determining current and future health needs and education. There are many tools available to complete a comprehensive health history. The Surgeon General’s Family Health History tool is part of the larger Family Health History Initiative that encourages people to talk about and write down health issues that seem to run in the family, bringing a larger focus on this important issue. This assignment allows the learner to use the tool and become familiar with this initiative.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

  • This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
  • Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
  • This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.

Directions:

Use the Surgeon General’s Family History Tool (http://www.hhs.gov/familyhistory/portrait/index.html) to document your own family history.

Designate a proband for the pedigree with a disease or condition of interest.

Write a 750-1,000 word summary of your findings. Include the following information:

  1. Discussion of the heredity patterns discovered.
  2. Evaluate the risk of transmission to other/new family members.
  3. Propose the feasibility of using this tool in your own practice.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the student, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-810

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

Family History Rubric

1
Unsatisfactory
0.00% 2
Less Than Satisfactory
74.00% 3
Satisfactory
79.00% 4
Good
87.00% 5
Excellent
100.00%
70.0 %Content
25.0 %Discussion of the Heredity Patterns Discovered Discussion of the heredity patterns discovered is not present. Discussion of the heredity patterns discovered is present but incomplete. Discussion of the heredity patterns discovered is present but done at a perfunctory level. Discussion of the heredity patterns discovered is clearly present and convincing. Information presented is from scholarly though dated sources. Discussion of the heredity patterns discovered is clearly present and insightful. Information presented is from current scholarly sources.

25.0 %Evaluation of the Risk of Transmission to Other/New Family Members Evaluation of the risk of transmission to other/new family members is not present. Nursing DNP 810 Emerging Areas of Human Health Essays Evaluation of the risk of transmission to other/new family members is present but incomplete. Evaluation of the risk of transmission to other/new family members is present but done at a perfunctory level. Evaluation of the risk of transmission to other/new family members is clearly present. Discussion is convincing. Information presented is from scholarly though dated sources. Evaluation of the risk of transmission to other/new family members is clearly present. Discussion is insightful. Information presented is from current scholarly sources.

20.0 %Proposal of the Feasibility of Using This Tool in Your Own Practice Proposal of the feasibility of using this tool in your own practice is not presented. Proposal of the feasibility of using this tool in your own practice is presented but incomplete. Proposal of the feasibility of using this tool in your own practice is presented but done at a perfunctory level. Proposal of the feasibility of using this tool in your own practice is clearly presented. Discussion is convincing. Information presented is from mostly current scholarly but some outdated sources are used. Proposal of the feasibility of using this tool in your own practice is clearly presented. Discussion is insightful and detailed. Information presented is from current scholarly sources.

20.0 %Organization and Effectiveness
7.0 %Thesis Development and Purpose Paper lacks any discernible overall purpose or organizing claim. Nursing DNP 810 Emerging Areas of Human Health Essays Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear. Thesis and/or main claim are apparent and appropriate to purpose. Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose. Thesis and/or main claim are comprehensive. The essence of the paper is contained within the thesis. Thesis statement makes the purpose of the paper clear.

8.0 %Argument Logic and Construction Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use) Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present. Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.

10.0 %Format
5.0 %Paper Format (Use of appropriate style for the major and assignment) Template is not used appropriately or documentation format is rarely followed correctly. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style. All format elements are correct.

5.0 %Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment and style) No reference page is included. No citations are used. Reference page is present. Citations are inconsistently used. Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present. Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and citation style is usually correct. In-text citations and a reference page are complete and correct. The documentation of cited sources is free of error.

100 %Total Weightage

 

DNP 810 Topic Week 4 Genetic Counseling

Details:

With the increase in knowledge around genetic issues, it is important that all health care providers are prepared to have thorough genetic-based discussions now with their patients. In this assignment, you will synthesize your knowledge into a client case with a real or potential genetic health-related illness.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

  • This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
  • Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
  • This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.

Directions:

Write a 1,000-1,250 word paper addressing a client case that might benefit from the process of genetic counseling.

Describe the reason for the genetic counseling based on the findings from your completion of the history tool.

Discuss the possible reactions the patient may have to your counseling and how to avoid negative reactions.

Imagine this assignment as if you are giving this counseling to a patient. Discuss the following:

  1. Health.
  2. Prevention
  3. Screening
  4. Diagnostics
  5. Prognostics
  6. Selection of treatment
  7. Monitoring of treatment effectiveness

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the student, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-810

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

ORDER PLAGIARISM FREE PAPER NOW

Genetic Counseling RUBRIC 

  1
Unsatisfactory
0.00%
2
Less Than Satisfactory
74.00%
3
Satisfactory
79.00%
4
Good
87.00%
5
Excellent
100.00%
70.0 %Content Nursing DNP 810 Emerging Areas of Human Health Essays
25.0 %Discussion of the Reason for the Genetic Counseling Based on the Findings From Your Completion of the History Tool Discussion of the reason for the genetic counseling based on the findings from your completion of the history tool is not present. Discussion of the reason for the genetic counseling based on the findings from your completion of the history tool is present but incomplete. Discussion of the reason for the genetic counseling based on the findings from your completion of the history tool is present but done at a perfunctory level. Discussion of the reason for the genetic counseling based on the findings from your completion of the history tool is clearly present and convincing. Information presented is from scholarly though dated sources. Discussion of the reason for the genetic counseling based on the findings from your completion of the history tool is clearly present and insightful. Information presented is from current scholarly sources.
25.0 %Discussion of the Possible Reactions the Patient May Have to Your Counseling and How to Avoid Negative Reactions Discussion of the possible reactions the patient may have to your counseling and how to avoid negative reactions is not present. Nursing DNP 810 Emerging Areas of Human Health Essays Discussion of the possible reactions the patient may have to your counseling and how to avoid negative reactions is present but incomplete. Discussion of the possible reactions the patient may have to your counseling and how to avoid negative reactions is present but done at a perfunctory level. Discussion of the possible reactions the patient may have to your counseling and how to avoid negative reactions is clearly present. Discussion is convincing. Information presented is from scholarly though dated sources. Discussion of the possible reactions the patient may have to your counseling and how to avoid negative reactions is clearly present. Discussion is insightful. Information presented is from current scholarly sources.
20.0 %Proposal of What You Will Say to the Patient Including the Many Points Offered in the Assignment Proposal of what you will say to the patient including the many points offered in the assignment is not presented. Proposal of what you will say to the patient including the many points offered in the assignment is presented but incomplete. Proposal of what you will say to the patient including the many points offered in the assignment is presented but done at a perfunctory level. Proposal of what you will say to the patient including the many points offered in the assignment is clearly presented. Discussion is convincing. Information presented is from mostly current scholarly but some outdated sources are used. Proposal of what you will say to the patient including the many points offered in the assignment is clearly presented. Discussion is insightful and detailed. Information presented is from current scholarly sources.
20.0 %Organization and Effectiveness  
7.0 %Thesis Development and Purpose Paper lacks any discernible overall purpose or organizing claim. Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear. Thesis and/or main claim are apparent and appropriate to purpose. Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose. Thesis and/or main claim are comprehensive. The essence of the paper is contained within the thesis. Thesis statement makes the purpose of the paper clear.
8.0 %Argument Logic and Construction Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use) Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present. Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.
10.0 %Format  
5.0 %Paper Format (Use of appropriate style for the major and assignment) Template is not used appropriately or documentation format is rarely followed correctly. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style. All format elements are correct.
5.0 %Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment and style) No reference page is included. No citations are used. Nursing DNP 810 Emerging Areas of Human Health Essays Reference page is present. Citations are inconsistently used. Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present. Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and citation style is usually correct. In-text citations and a reference page are complete and correct. The documentation of cited sources is free of error.
100 %Total Weightage

 

Nursing DNP 810 Emerging Areas of Human Health Essays Topic Week 5 Case Report Part 3

Details:

You will be creating a case report in stages over four course topics. This assignment will add to your previous work in Topic 3. Use an example from your own personal practice, experience, or own personal/family; however, simulated cases are not acceptable for practice hours and therefore not acceptable for this assignment. Examples might include a patient with Duchesne’s muscular dystrophy. Huntington’s disease, Down’s syndrome, sickle cell anemia, BRCA 1 or BRCA 2 mutations, or other genetic disorder that you and/or the organization you practice in may specialize in treating.

General Requirements:

Use the following information to ensure successful completion of the assignment:

  • This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
  • Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
  • This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
  • You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Directions:

For this assignment (Part 3 of the Case Report), write a 1,000-1,250 word paper incorporating genetics information learned from assigned readings in Topics 1-5. Include the following:

  1. Examine how genetics can influence policy issues.
  2. Discuss any nutritional influences for the cause of this disease.
  3. Discuss the process of nutritional assessment and counseling as it relates to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness.
  4. Discuss the prevalence rates, testing, treatment, and prognosis as they relate to human nutrition.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the student, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-810

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

Case Report: Part 3 Rubric

  1
Unsatisfactory
0.00%
2
Less Than Satisfactory
74.00%
3
Satisfactory
79.00%
4
Good
87.00%
5
Excellent
100.00%
70.0 %Content  
25.0 %Examination of How Genetics Can Influence Policy Issues Examination of how genetics can influence policy issues is not present. Examination of how genetics can influence policy issues is present but incomplete. Examination of how genetics can influence policy issues is present but done at a perfunctory level. Examination of how genetics can influence policy issues is clearly presented. Discussion is convincing. Information presented is from scholarly though dated sources. Examination of how genetics can influence policy issues is clearly presented. Discussion is insightful. Information presented is from current scholarly sources.
25.0 %Discussion of Any Nutritional Influences for the Cause of This Disease Discussion of any nutritional influences for the cause of this disease is not present. Nursing DNP 810 Emerging Areas of Human Health Essays Discussion of any nutritional influences for the cause of this disease is present but incomplete. Discussion of any nutritional influences for the cause of this disease is present but done at a perfunctory level. Discussion of any nutritional influences for the cause of this disease is clearly present. Discussion is convincing. Information presented is from scholarly though dated sources. Discussion of any nutritional influences for the cause of this disease is clearly present. Discussion is insightful. Information presented is from current scholarly sources.
20.0 %Discussion of the Process of Nutritional Assessment and Counseling as It Relates to Health, Prevention, Screening, Diagnostics, Prognostics, Selection of Treatment, and Monitoring of Treatment Effectiveness The process of nutritional assessment and counseling as it relates to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness is not presented. The process of nutritional assessment and counseling as it relates to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness is presented but incomplete. The process of nutritional assessment and counseling as it relates to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness is presented but done at a perfunctory level. The process of nutritional assessment and counseling as it relates to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness is clearly presented. Discussion is convincing. Information presented is from mostly current scholarly but some outdated sources are used. The process of nutritional assessment and counseling as it relates to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness is clearly presented. Discussion is insightful and detailed. Information presented is from current scholarly sources.
20.0 %Organization and Effectiveness  
7.0 %Thesis Development and Purpose Paper lacks any discernible overall purpose or organizing claim. Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear. Thesis and/or main claim are apparent and appropriate to purpose. Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose. Thesis and/or main claim are comprehensive. The essence of the paper is contained within the thesis. Thesis statement makes the purpose of the paper clear.
8.0 %Argument Logic and Construction Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use) Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present. Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.
10.0 %Format  
5.0 %Paper Format (Use of appropriate style for the major and assignment) Template is not used appropriately or documentation format is rarely followed correctly. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style. All format elements are correct.
5.0 %Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment and style) No reference page is included. No citations are used. Nursing DNP 810 Emerging Areas of Human Health Essays Reference page is present. Citations are inconsistently used. Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present. Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and citation style is usually correct. In-text citations and a reference page are complete and correct. The documentation of cited sources is free of error.
100 %Total Weightage

DNP 810 Topic Week 6 Health Issues for the Aging

Details:

As of 2014 health care expenditures in the United States are near 17% of our gross domestic product (GDP), with a major portion of Medicare funding goes towards chronic illness and care at the last 6 months of life. The Patient Protection and Affordable Care Act has made some initial legislative changes in our health system, but not sufficient to address our growing expenditures and caring for our large aging population. In this assignment, learners will synthesize issues in aging with health policy solutions by writing a paper on one health issue for older individuals addressed in the topic and offering a policy solution. Example of issue: In 2014, over 50% of the costs of institutional long-term care for older persons are paid for with public funds from Medicaid.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

  • This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
  • Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
  • This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
  • You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Directions:

Write a 1,000-1,250 word paper that addresses a health issue for older individuals. Include the following:

  1. Evaluate what the literature suggests as a resolution to your chosen issue.
  2. Discuss any attempts to incorporate the solution into public policy.
  3. Determine the barriers to implementation of the solution.
  4. Analyze the options being discussed for public and/or private funding.
  5. Propose your own recommendation.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the student, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-810

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

Health Issues for the Aging Rubric

  1
Unsatisfactory
0.00%
2
Less Than Satisfactory
74.00%
3
Satisfactory
79.00%
4
Good
87.00%
5
Excellent
100.00%
70.0 %Content  
15.0 %Evaluation of What the Literature Suggests as a Resolution to the Selected Issue Evaluation of what the literature suggests as a resolution to the selected issue is not present. Evaluation of what the literature suggests as a resolution to the selected issue is present but incomplete. Evaluation of what the literature suggests as a resolution to the selected issue is present but done at a perfunctory level. Evaluation of what the literature suggests as a resolution to the selected issue is clearly presented. Discussion is convincing. Information presented is from scholarly though dated sources. Evaluation of what the literature suggests as a resolution to the selected issue is clearly present. Discussion is insightful. Information presented is from current scholarly sources.
15.0 %Discussion of Any Attempts to Incorporate the Solution Into Public Policy Discussion of any attempts to incorporate the solution into public policy is not present. Discussion of any attempts to incorporate the solution into public policy is present but incomplete. Discussion of any attempts to incorporate the solution into public policy is present but done at a perfunctory level. Discussion of any attempts to incorporate the solution into public policy is clearly present. Discussion is convincing. Information presented is from scholarly though dated sources. Discussion of any attempts to incorporate the solution into public policy is clearly present. Discussion is insightful. Information presented is from current scholarly sources.
15.0 %Determination of the Barriers to Implementation of the Solution Determination of the barriers to implementation of the solution is not presented. Determination of the barriers to implementation of the solution is presented but incomplete. Determination of the barriers to implementation of the solution is presented but done at a perfunctory level. Determination of the barriers to implementation of the solution is clearly presented. Discussion is convincing. Information presented is from mostly current scholarly, but some outdated sources are used. Determination of the barriers to implementation of the solution is clearly presented. Discussion is insightful and detailed. Information presented is from current scholarly sources.
15.0 %Analysis of the Options Being Discussed for Public and/or Private Funding Analysis of the options being discussed for public and/or private funding is not presented. Analysis of the options being discussed for public and/or private funding is presented but incomplete. Analysis of the options being discussed for public and/or private funding is presented but done at a perfunctory level. Analysis of the options being discussed for public and/or private funding is clearly presented. Discussion is convincing. Information presented is from mostly current scholarly but some outdated sources are used. Analysis of the options being discussed for public and/or private funding is clearly presented. Discussion is insightful and detailed. Information presented is from current scholarly sources.
10.0 %Recommended Solution A recommended solution has not presented. A recommended solution is presented but incomplete. A recommended solution is presented but done at a perfunctory level. A recommended solution is clearly presented. Sources used are mostly current and scholarly but some outdated. A recommended solution is clearly presented. Sources used as support are from current scholarly sources.
20.0 %Organization and Effectiveness

Nursing DNP 810 Emerging Areas of Human Health Essays

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7.0 %Thesis Development and Purpose Paper lacks any discernible overall purpose or organizing claim. Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear. Thesis and/or main claim are apparent and appropriate to purpose. Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose. Thesis and/or main claim are comprehensive. The essence of the paper is contained within the thesis. Thesis statement makes the purpose of the paper clear.
8.0 %Argument Logic and Construction Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use) Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present. Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.
10.0 %Format  
5.0 %Paper Format (Use of appropriate style for the major and assignment) Template is not used appropriately or documentation format is rarely followed correctly. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style. All format elements are correct.
5.0 %Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment and style) No reference page is included. No citations are used. Nursing DNP 810 Emerging Areas of Human Health Essays Reference page is present. Citations are inconsistently used. Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present. Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and citation style is usually correct. In-text citations and a reference page are complete and correct. The documentation of cited sources is free of error.
100 %Total Weightage

Nursing DNP 810 Emerging Areas of Human Health Essays Topic Week 8 Case Report Cumulative

Details:

You will be creating a case report in stages over four course topics. This assignment will add to your previous work in Topic 5. Use an example from your own personal practice, experience, or own personal/family; however, simulated cases are not acceptable for practice hours and therefore not acceptable for this assignment. Examples might include a patient with Duchesne’s muscular dystrophy. Huntington’s disease, Down’s syndrome, sickle cell anemia, BRCA 1 or BRCA 2 mutations, or other genetic disorder that you and/or the organization you practice in may specialize in treating.

General Requirements:

Use the following information to ensure successful completion of the assignment:

  • This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
  • Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
  • This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
  • You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Include the following:

  • Guidelines and reasons behind the FDA regulations for introducing new pharmaceutical agents (policy).
  • The role that money and grants play in scientific advances/the economics of health care (capitalism).
  • The role and involvement family plays into the health care decision.

Directions:

For this assignment (Conclusion of the Case Report), include previous Parts 1, 2, and 3 of the Case Report in one document, combined with additional genetics information learned from the assigned readings from all course topics. This final Case Report document should include the following:

  1. Describe the disease, its prevalence, its incidence and general knowledge of the disease.
  2. Discuss the laboratory testing that can be done.
  3. Describe if chromosomal analysis is/was indicated, and detail the chromosomal change that caused the disease if it is a chromosomal disorder.
  4. Describe the disorder in terms of its origin as either a single gene inheritance, or as a complex inheritance and considerations for practice and patient education.
  5. Describe the gene mutation of the disease, as well as whether it is acquired or inherited, and how the mutation occurs.
  6. Examine how genetics can influence policy issues.
  7. Discuss any nutritional influences for this disease.
  8. Process of nutritional assessment and counseling as it relates to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness.

Continue your paper with 1,000-1,250 words which include the following:

  1. Discuss any ethical considerations for this disease.
  2. Compare how genetics can improve care and health outcomes while reducing cost to usual practices.
  3. Discuss the changes in approaches to care when new evidence warrants evaluation of other options for improving outcomes or decreasing adverse events.
  4. Create a plan for how you might educate colleagues and/or patients on this genetic disorder.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the student, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-810

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

Nursing DNP 810 Emerging Areas of Human Health Essays Case Report: Cumulative Rubric

  1
Unsatisfactory
0.00%
2
Less Than Satisfactory
74.00%
3
Satisfactory
79.00%
4
Good
87.00%
5
Excellent
100.00%
70.0 %Content  
20.0 %Discussion of Ethical Considerations for This Disease Discussion of ethical considerations for this disease is not present. Discussion of ethical considerations for this disease is present but incomplete. Discussion of ethical considerations for this disease is present but done at a perfunctory level. Discussion of ethical considerations for this disease is clearly presented. Discussion is convincing. Information presented is from scholarly though dated sources. Discussion of ethical considerations for this disease is clearly present. Discussion is insightful. Information presented is from current scholarly sources.
20.0 %Comparison of How Genetics Can Improve Care and Health Outcomes While Reducing Cost to Usual Practices Comparison of how genetics can improve care and health outcomes while reducing cost to usual practices is not present. Nursing DNP 810 Emerging Areas of Human Health Essays Comparison of how genetics can improve care and health outcomes while reducing cost to usual practices is present but incomplete. Comparison of how genetics can improve care and health outcomes while reducing cost to usual practices is present but done at a perfunctory level. Comparison of how genetics can improve care and health outcomes while reducing cost to usual practices is clearly present. Discussion is convincing. Information presented is from scholarly though dated sources. Comparison of how genetics can improve care and health outcomes while reducing cost to usual practices is clearly present. Discussion is insightful. Information presented is from current scholarly sources.
15.0 %Discussion of the Changes in Approaches to Care When New Evidence Warrants Evaluation of Other Options for Improving Outcomes or Decreasing Adverse Events Discussion of the changes in approaches to care when new evidence warrants evaluation of other options for improving outcomes or decreasing adverse events is not presented. Discussion of the changes in approaches to care when new evidence warrants evaluation of other options for improving outcomes or decreasing adverse events is presented but incomplete. Discussion of the changes in approaches to care when new evidence warrants evaluation of other options for improving outcomes or decreasing adverse events is presented but done at a perfunctory level. Discussion of the changes in approaches to care when new evidence warrants evaluation of other options for improving outcomes or decreasing adverse events is clearly presented. Discussion is convincing. Information presented is from mostly current scholarly but some outdated sources are used. Discussion of the changes in approaches to care when new evidence warrants evaluation of other options for improving outcomes or decreasing adverse events is clearly presented. Discussion is insightful and detailed. Information presented is from current scholarly sources.
10.0 %Plan for How You Might Educate Colleagues and/or Patients on This Genetic Disorder A plan for how you might educate colleagues and/or patients on this genetic disorder is not presented. A plan for how you might educate colleagues and/or patients on this genetic disorder is presented but incomplete. A plan for how you might educate colleagues and/or patients on this genetic disorder is presented but done at a perfunctory level. A plan for how you might educate colleagues and/or patients on this genetic disorder is clearly presented. Discussion is convincing. A plan for how you might educate colleagues and/or patients on this genetic disorder is clearly presented. Discussion is insightful and detailed.
5.0 %Previous Case Reports are Included as the Beginning of this Paper Previous case reports are included as the beginning of this paper is not present. Nursing DNP 810 Emerging Areas of Human Health Essays Previous case reports are included as the beginning of this paper but missing two areas. Previous case reports are included as the beginning of this paper but missing one area. Previous case reports are included as the beginning of this Paper is completely present.
20.0 %Organization and Effectiveness  ORDER ORIGINAL PAPERS HERE
7.0 %Thesis Development and Purpose Paper lacks any discernible overall purpose or organizing claim. Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear. Thesis and/or main claim are apparent and appropriate to purpose. Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose. Thesis and/or main claim are comprehensive. The essence of the paper is contained within the thesis. Thesis statement makes the purpose of the paper clear.
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Nursing DNP 810 Emerging Areas of Human Health Essays Topic Week 8 Final Evaluation by Mentor

Details:

The mentor will perform a final clinical evaluation via the Typhon system. The mentor will receive an e-mail link at the beginning of Topic 6 to access the evaluation through Typhon.

Students will access the completed mentor evaluations in Typhon under the tab for “EASI: Evaluation and Survey Instrument” and print out the completed evaluation, sign it, and upload the signed evaluation into LoudCloud.

The course faculty will review the evaluation in LoudCloud and confirm in Typhon.

It is the student’s responsibility to ensure that the mentor has completed evaluation. If the mentor does not receive the evaluation via the e-mail address on file with GCU, the student should contact the course faculty immediately.

Nursing DNP 810 Emerging Areas of Human Health Essays Topic Week 8 Reflective Journal

Details:

Learners are required to maintain a Reflective Journal integrating leadership and inquiry into current practice.

In your journal, you will reflect on the personal knowledge and skills gained in the current course addressing a variable combination of the following: new practice approaches, intraprofessional collaboration, health care delivery and clinical systems, ethical considerations in health care, population health concerns, the role of technology in improving health care outcomes, health policy, leadership and economic models, and/or health disparities. Outline what you discovered about your professional practice, personal strengths and weaknesses that surfaced, what additional resources and abilities could be introduced to a given situation to influence optimal outcomes, and finally how you met the competencies aligned to this course.

Submit your Reflective Journal to both the instructor and the Typhon Tracking System under the corresponding course section. Learners must submit this deliverable in Typhon and LoudCloud. Failure to submit in both locations can result in an Incomplete for the course.

Nursing DNP 810 Emerging Areas of Human Health Essays Topic Week 8 Scholarly Activities

Details:

Throughout the DNP Program, learners are required to provide a report documenting participation in a minimum of four scholarly activities outside of clinical or professional practice. These reports will be due in specific courses throughout the program (listed below) and must be documented in your Practice Portfolio by the end of each course in which an activity report is due.

Examples of scholarly activities include attending conferences, seminars, grand rounds, participating in policy and quality improvement committees, writing scholarly publications, participating in community planning, serving as a guest lecturer, etc. Involvement and contribution to interdisciplinary initiatives are also acceptable scholarly activities.

Documentation of these activities is required in DNP-810, DNP-820, DNP-830, and DNP-840.

A summary report of the scholarly activity including who, what, where, when, and take home points will be submitted as the assignment. Include the appropriate program competencies associated with the scholarly activity and the future professional goals related to this activity. You may use the attached template to help guide this assignment.

Scholarly_ Activity_Summary_Template.doc

Nursing DNP 810 Emerging Areas of Human Health Essays Topic Week 8 Practice Hours Portfolio

Details:

The Typhon Tracking System will be used to document and follow the status of your practice immersion hours throughout this and every subsequent course. Learners must be able to document a minimum of 50 concurrently or previously logged practice hours in association with this course, which will contribute to fulfillment of the total required 1,000 post-baccalaureate practice hours by the conclusion of the program. Please review the Practice Hours Portfolio Required Elements below, then review the Guidelines for Graduate Field Experience Manual document in the DC Network for details on what may/may not qualify as practice hours.

Practice Hours Portfolio Required Elements

The Practice Hours Portfolio (using the Typhon Student Tracking System) will include all of the following elements:

  1. Individual Success Plan signed off by mentor.
  2. Comprehensive clinical log of hours applied to doctoral level learning outcomes.
  3. Learner evaluations (final).
  4. Practice mentor evaluations (final).
  5. Current and updated CV (update each course as necessary).
  6. Faculty approvals of the Individual Success Plan and documented practice immersion hours. (Learner is responsible for obtaining approvals.)
  7. Practice mentor’s approval of the Individual Success Plan and documented practice immersion hours. (Learner is responsible for obtaining approvals.)

Practice Hours Completion Statement

Learners will track their practice hours within the Typhon Tracking System throughout each course and via the Practice Hours Completion Statement assignment provided in this assignment.

Complete the following statement in a Word documen, submit to the instructor, and complete the Typhon Tracking System entries appropriate for this course.

Create a Word document with the following text:

Practice Hours Completion Statement DNP-810

I, (INSERT NAME), verify that I have completed (NUMBER OF) practice hours in association with the goals and objectives for this course. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor. Nursing DNP 810 Emerging Areas of Human Health Essays.

ORDER YOUR PAPER NOW – Nursing DNP 810 Emerging Areas of Human Health Essays

Genetic and environmental influences interact with age and sex in shaping the human methylome

Introduction

Of the many established epigenetic marks and mechanisms, DNA methylation is thought to contribute to stable long-term gene expression regulation and tissue differentiation1, and is ideally suited for genome-wide assessment in large human epidemiological studies2. A growing body of literature illustrates that traits and diseases are associated with DNA methylation variation3,4,5,6,7. DNA methylation differences between individuals may result from differences in environmental exposures8, stochastic variation and genetic influences9. Increasing evidence suggests that genetically induced epigenetic variation between individuals contributes to human disease susceptibility5,10,11,12. Methylation differences have been observed between the sexes13,14,15 and across age16,17,18,19, suggesting that epigenetic regulation may also be involved in the widely observed age and sex differences in life history traits and the aetiology of complex diseases20,21.

It is well-known that genetically identical model organisms such as cloned animals22, isogenic plants23 and inbred mice24 exhibit epigenetic and phenotypic differences. These organisms and human identical twins offer insight into the impact of environmental and stochastic influences on the epigenome. The overall contribution of genetic and environmental differences, from conception onwards, to variation in DNA methylation between humans may be estimated by contrasting the correlation between DNA methylation levels of monozygotic (MZ) and dizygotic (DZ) twins, who share 100% and 50% of segregating genetic variants that contribute to methylation differences, respectively (the classical twin design). Based on previous twin studies, the average heritability of methylation level on cytosine-guanine dinucleotides (CpGs) across the genome has been estimated between 5% and 19% for different tissues9,16,25,26, but it is unknown what part can be explained by common genetic variation and to what extent the impact of genetic and environmental influences on DNA methylation depends on sex and age. Studies of humans and rats have described sex-specific effects of prenatal dietary exposures on DNA methylation27,28 and sex-specific epigenetic effects of in utero exposure to an endocrine disruptor have been described in mice29. Some studies indicated that certain epigenetic marks including DNA methylation diverge in twin pairs with ageing, suggesting amplification of environmental or stochastic effects on DNA methylation across the lifespan30,31, although evidence for such effects is not always observed26,32. A study of neonatal MZ twins reported that twin pairs may show trajectories of divergent, convergent or longitudinally stable methylation patterns after birth33. Examples of sites where the relationships between age and DNA methylation depends on genotype34 and sex-specific methylation quantitative trait loci (QTL)35 have also been reported.

In the current study, we analyse data from a large cohort of twins and family members in whom DNA methylation was measured across the genome (Illumina 450k array) in whole blood. We establish an accurate catalogue (presented in Supplementary Data 1) of between-individual variation in DNA methylation due to environmental effects, total genetic effects and the effects of common genetic variants. We examine differences in epigenetic regulation between the sexes and across age, and test for interactions of genomic effects and environmental effects on methylation with sex and age. Subsequently, we relate our catalogue to previously published loci where DNA methylation is sensitive to smoking, and loci that are epigenetically associated with metabolic phenotypes, including serum metabolite levels, lipid levels and body mass index (BMI). We demonstrate that (1) many smoking-associated CpGs show epigenetic drift (changes in methylation due to deregulated maintenance36) with aging; (2) DNA methylation connected to complex traits is characterized by genetically and environmentally induced variation between individuals; and (3) the importance of the environment increases with age at many sites.

Results

Heritable and environmental influences on DNA methylation

We characterized the impact of genetic variation and environmental influences on DNA methylation based on genome-wide DNA methylation and SNP data from 2,603 individuals (mean age=37.2, s.d.=13.3; 66% females; Table 1). The study sample included twins (N=2,373), parents of twins (N=212), siblings of twins (N=16) and spouses of twins (N=3). DNA methylation data were available for 769 MZ and 424 DZ twin pairs. Methylation levels at 411,169 autosomal sites were analysed. Before analyses, DNA methylation levels were normalized and the normalized methylation M values were adjusted for sex, age, measured white blood cell percentages, the first ten principal components (PCs) from the genotype data, methylation array row and sample plate (see Methods section). Of all analysed methylation sites, methylation levels at 7% (N=29,783) showed a significant (α=1.2 × 10−7, gee model, z-test using robust estimates) association with sex (Supplementary Fig. 1), and 33% (N=135,775) showed a significant (cross-sectional) association with age (Supplementary Fig. 2). White blood cell proportions displayed the expected age-related trend, characterized by a small positive correlation between neutrophil-to-lymphocyte ratios and age (r=0.10, P=5.2 × 10−8, Pearson correlation; Supplementary Fig. 3). Averaged over genome-wide methylation sites, all predictors together explained on average 16% of the variance in DNA methylation between individuals (Supplementary Fig. 4). At most methylation sites, the s.d. of DNA methylation level across individuals was small (Supplementary Fig. 5).

Table 1 Characteristics of the subjects.

Twin correlations (Table 2) suggested that additive genetic influences mainly account for the resemblance of twins for DNA methylation level; the average correlation in MZ twins (r=0.20) is approximately twice as large as the average correlation in DZ twins (r=0.09). The data from twins were used to fit classical ACE and ADE twin models that estimate the variance explained by additive genetic effects (A), non-additive genetic effects (D), common environment (C) and unique environmental effects (E) at individual methylation sites (Supplementary Table 1). Note that the variance term E includes stochastic variation and measurement error. ACE models (Fig. 1a) showed that common environmental effects shared by twins explained on average 3% of the variance (s.d.=5%) across all 411,169 methylation sites, with significant C effects (α=1.2 × 10−7, likelihood ratio test) at 185 methylation sites (0.04%). ADE models (Fig. 1b) showed that non-additive genetics effects explained on average 8% of variance in DNA methylation (s.d.=12%), with significant effects at 241 methylation sites (0.06%). Additive genetic influences had a larger impact on the methylome, with significant effects at 169,013 methylation sites (41%) and accounting for 20% of the variance (s.d.=21%) on average across all methylation sites in the model including only A and E. In the same model, unique environmental effects explained on average 80% of the variance (s.d.=21%).

Table 2 Twin correlations, heritability and variance explained by common genetic variants for DNA methylation level at all autosomal CpGs.
Figure 1: Genetic and environmental influences on genome-wide DNA methylation levels.

NURSING DNP 810 EMERGING AREAS OF HUMAN HEALTH ESSAYS

Figure 1

Estimates from classical twin modelling in 769 MZ and 424 DZ twin pairs. (a) Histograms of genome-wide ACE model estimates: variance explained by additive genetic effects (a2, red), common environmental effects (c2, purple) and unique environmental effects (e2, green). (b) Histograms of genome-wide ADE model estimates: variance explained by additive genetic effects (a2, red), non-additive genetic effects (d2, dark purple) and unique environmental effects (e2, green). Y axes are truncated. (c) Scatterplots of DNA methylation levels in MZ and DZ twin pairs at four exemplary CpG sites. The DNA methylation level in twin 2 (y axis) is plotted against the DNA methylation level in twin 1 (x axis) for all MZ twin pairs and all DZ twin pairs. For illustrative purposes, methylation β-values (which represent methylation proportion) obtained after normalization are plotted in this figure, whereas all analyses were performed on normalized methylation M values, corrected for a number of covariates (see Methods section). Four examples of CpG sites were selected from the most variable CpG sites (s.d.>0.03) with high heritability (h2=0.56; upper left), high SNP heritability (h2SNPs=0.81; upper right), low heritability (h2=0.18; lower left) and low SNP heritability (h2SNPs=0.00, lower right). Note that the larger the difference between the correlation in MZ twins and in DZ twins (stronger correlation in MZ twins), the higher the total heritability. The resemblance of MZ and DZ twins is not informative with respect to the amount of variance explained by genome-wide SNPs. Additional examples are plotted in Supplementary Figs 10–13.

Next, we estimated the additive genetic and unique environmental variance by fitting linear mixed models in which the variance in DNA methylation was modelled as a function of measured genetic relationships37 among 2,603 individuals. To this end, we constructed a genetic relationship matrix (GRM) based on all common genotyped autosomal SNPs (Affymetrix6 array, minor allele frequency (MAF)>0.01). We applied the method of Zaitlen et al.38, which allows for simultaneous estimation of the total additive heritability of DNA methylation level (hereafter referred to as h2) and h2SNPs (variance in DNA methylation level explained by all variants in the genome tagged by genotyped SNPs)37 in cohorts that include both closely and distantly related individuals. Because of the limited evidence for common environmental effects and non-additive genetic effects genome-wide, all further analyses focused on additive genetic effects and unique environmental effects.

We obtained estimates of h2 and h2SNPs at 407,373 sites (98.5%; Fig. 2). The genome-wide average h2 was 0.19 (s.d.=0.20), similar to the estimate based on the classical twin method (mean h2twins=0.20), and the estimates of h2 and h2twins were strongly correlated (r=0.99). The results are similar to twin correlations and h2twins based on Illumina 450k methylation data from peripheral blood published previously based on smaller studies16,25. Twin correlations and h2twins were on average larger at methylation sites with a larger variance (Supplementary Table 2). Since annotated SNPs underlying methylation probe binding sites at positions other than the targeted CpG site did not have a substantial effect on the heritability of DNA methylation (Supplementary Fig. 6), we retained these methylation probes in the analyses.

Figure 2: Heritability of DNA methylation level across the genome.
figure2

Estimates of DNA methylation heritability from the GRM-based approach in 2,603 individuals. From inside to outside: the most inner circular diagram displays the average methylation level at each site, the second band shows the total heritability of DNA methylation level, the third band shows the SNP heritability of DNA methylation level, and the most outer circle shows the chromosome ideograms. Colours range from dark blue (0%) to dark red (100%).

Variance explained by common genetic variation in the genome

Across all sites, on average 7% (s.d.=12%) of the variance of DNA methylation was explained by common genetic variants in the genome (h2SNPsFig. 3a). On average the proportion of total heritability explained by SNPs (h2SNPs/h2) was 0.37 (s.d.=0.40) (Table 2). At many sites, a relatively large proportion of total estimated heritable variation in DNA methylation was explained by common genetic variants (methylation sites with >0.99 of the total heritability explained by SNPs: N=74,226, 18%). However, at many sites DNA methylation is heritable, but common genetic variants explain little of the genetic variance. The SNPs explained <0.01 of the total heritability at 159,299 sites (39%). Moreover, the proportion of variance explained by the unique environmental component (E) was 0.81, highlighting the importance of environmental and stochastic variation.

Figure 3: Variance explained by SNPs and longitudinal stability.
figure3

(a) Histogram of total additive heritability (h2 total) of DNA methylation (green) and variance explained by genome-wide SNPs (h2 SNPs, purple) for genome-wide CpGs. The y axis is truncated. (b) Density plot of methylation sites with a high versus low heritability. (c) Distribution of methylation sites grouped based on heritability and longitudinal stability relative to genes: DP, distal promoter; DS, downstream region; GB, gene body; IG, intergenic; PP, proximal promoter. (d) Distribution of methylation sites grouped based on heritability and longitudinal stability in relation to CpG density: CGI, CpG island; NC, non-CGI; SHE, CpG island shelf; SHO, CpG island shore. Asterisks denote significant enrichment or depletion (α=4.27 × 10−4, χ2-test). Results of DNA methylation heritability are from the GRM-based approach in 2,603 individuals. Longitudinal stability was assessed in 31 subjects with data from two longitudinally collected blood samples.

Differential heritability patterns across the genome

Methylation sites with high heritability (h2≥0.5), low heritability (h2<0.2), high SNP heritability (h2SNPs≥0.5) and low SNP heritability (h2SNPs<0.2) showed different distributions of average methylation level (Fig. 3b) and magnitude of variance across individuals (Supplementary Fig. 7). Sites with a high heritability more often showed intermediate methylation levels and their methylation levels were more variable. Sites with low heritability were usually hypo- or hypermethylated, and their methylation levels were less variable across individuals. We compared sites with a high or low heritability with respect to five gene-centric annotations by mapping them to proximal promoter and distal promoter region, gene body, downstream region and intergenic regions (Supplementary Data 2). We also compared high and low heritable methylation sites with respect to the CpG density of the underlying DNA sequence by mapping CpG islands (CGI), CGI shores, shelves and non-CGI regions (Supplementary Data 2). Across all assessed sites, highly heritable sites showed significant (α=4.27 × 10−4, χ2-test) enrichment in CGI shores (P<2.2 × 10−16, χ2-test), intergenic regions(P<2.2 × 10−16, χ2-test), distal promoter (P<2.2 × 10−6, χ2-test) and downstream region (P<2.2 × 10−16, χ2-test), which show more variation between people in general, and were depleted in proximal promoter (P<2.2 × 10−16, χ2-test), CGIs (P<2.2 × 10−16, χ2-test), and shelves (P<2.2 × 10−16, χ2-test), which generally display the smallest variation (Supplementary Figs 8 and 9). Importantly, sites with very small variation tend to be biologically invariable, implying that most observed variation may represent technical noise.

To compare highly heritable sites and sites where most variation is stochastic or environmental, we focused on 101,875 methylation sites (25% of all) showing most variation between individuals (standard deviation of the methylation proportion >0.03; hereafter called variable methylated sites), which included 33,329 sites with high heritability, 18,860 sites with low heritability, 5,623 sites with high SNP heritability and 71,788 with low SNP heritability. Exemplary scatterplots of DNA methylation levels in MZ and DZ pairs at sites from each of these categories are provided in Fig. 1c and in Supplementary Figs 10–13. Among variable methylated sites, sites with high heritability and sites with low heritability displayed comparable distributions of total methylation variance (Supplementary Fig. 14). Yet, they showed distinct distributions across genomic regions: Taking all variable methylated sites as reference (Fig. 3c,d), variable methylated sites with low heritability were over-represented in gene bodies (P<2.2 × 10−16, χ2-test), distal promoter (P=1.5 × 10−9, χ2-test), CGI shelves (P<2.2 × 10−16, χ2-test) and non-CGI regions (P<2.2 × 10−16, χ2-test), and were underrepresented in proximal promoter (P<2.2 × 10−16, χ2-test), intergenic (P<2.2 × 10−16, χ2-test), downstream (P=1.8 × 10−4, χ2-test), CGIs (P<2.2 × 10−16, χ2-test) and shores (P<2.2 × 10−16, χ2-test). Variable methylated sites with a low heritability were more often hypermethylated (Supplementary Fig. 15). By contrast, variable methylated sites with a high heritability showed an opposite pattern of enrichment compared with low heritability sites (Fig. 3c,dSupplementary Data 2), and included many sites with intermediate methylation levels (Supplementary Fig. 15). We also overlaid the most highly heritable and the least heritable variable methylated sites with locations of DNase I hypersensitive sites (DHSs) in 299 individual cellular samples from the Epigenomics Roadmap project39. Highly heritable methylation sites showed strong enrichment in DHSs across a number of cell types (Supplementary Data 3), while the least heritable methylation sites were depleted in DHSs of the majority of tissues (Supplementary Data 4). The large majority of probes on the Illumina 450k array target CpG sites, but a small percentage (0.6% of all probes on the array) measure non-CpG methylation. We observed enrichment of non-CpG probes among sites with low heritability (1.7% non-CpG, P<2.2 × 10−16, χ2-test, Supplementary Data 5), and depletion among sites with high heritability (0% non-CpG, P<2.2 × 10−16, χ2-test).

To further characterize sites with high versus low heritability, we analysed longitudinal peripheral blood DNA methylation data from 31 individuals (mean age 34 years; Table 1) collected with an interval of on average 5 years, and DNA methylation data from blood and buccal samples that were available for 22 individuals (age 18 years; Table 1). At highly heritable sites, the methylation level in blood on average was stable over time (mean r=0.73, median=0.76), as previously observed40 and correlated weakly on average with methylation level in buccal cells (mean r=0.28, median=0.28), whereas sites with a low heritability were not stable (longitudinal correlation: mean r=0.08, median r=0.08) and did not correlate with methylation level in buccal cells (correlation with buccal: mean r=0.00, median r=0.00). Thus, genetic influences may underlie stability and cross-tissue correlations for DNA methylation level41

Notably, we also observed variable methylated sites with low heritability and high stability across time. Sites that varied mostly due to environmental or stochastic influences and that were longitudinally stable (longitudinal r≥0.5, N=542) were significantly underrepresented in CpG islands (P<1.0 × 10−7, χ2-test). Longitudinally unstable sites with a large environmental component (longitudinal r<0.2, N=13,660) were significantly over-represented in shelves (P<2.2 × 10−16, χ2-test), non-CGI sites (P<2.2 × 10−16, χ2-test), gene bodies (P<2.2 × 10−16, χ2-test), and distal promoters (P<4.2 × 10−7, χ2-test) and were depleted in CGIs (P<2.2 × 10−16, χ2-test), shores (P<2.2 × 10−16, χ2-test), intergenic (P<2.2 × 10−16, χ2-test), proximal promoter (P<2.2 × 10−16, χ2-test) and downstream region (P<2.3 × 10−5, χ2-test).

Genetic and environmental effects vary by sex and age

We examined interaction effects between sex and total genetic effects and between sex and unique environmental effects on methylation levels (see Methods section). Sex interaction models were fitted successfully for 391,227 sites (95%). The genome-wide average heritability was nearly identical in males (mean h2=0.199, median=0.13) and females (mean h2=0.198, median=0.13). Significant interaction (α=1.3 × 10−7, χ2-test) between sex and genetic or environmental effects was evident at 2,667 sites (0.7%; Fig. 4a). At 59% of these sites (that is, 1,572) heritability was lower in women (Supplementary Fig. 16). In a similar manner, we fitted models that included age as a continuous interaction term. Age interaction models were fitted successfully for 379,638 sites (92%). We found significant interaction (α=1.3 × 10−7, χ2-test) between age and genetic or environmental effects on DNA methylation at 39,455 sites (10.4%; Fig. 4b). Sex- and age-related differences in heritability may be caused by a difference in the environmental variance or by a difference in the genetic variance. Although both may also occur simultaneously, this is not a general rule. In fact, we found that at 32,234 sites (82%) with significant age interaction, and at 2,034 sites (76%) with significant sex interaction, it was the environmental variance (rather than the additive genetic variance) that was subject to a significant effect of age or sex. This observation highlights that across the genome, environmental or stochastic influences are a more important determinant of sex-specific and age-specific methylation variation between individuals than genetic influences.

Figure 4: Main effects of age and sex and their interaction with genetic and environmental effects.
figure4

(a) Main and interaction effects of sex. The x axis denotes chromosomal position. The y axis denotes the β-value from the regression of methylation M value on sex (while correcting for age, white blood cell counts and technical covariates). Sites where the genetic variance showed significant sex interaction are indicated in blue. Sites where the environmental variance showed significant sex interaction are shown in green. The y axis is truncated at −1 and 1 to improve visibility, excluding a small number of sites with regression β-values up to −2.4 and 2.6. (b) Mean and interaction effects of age. The x axis denotes chromosomal position. The y axis denotes the β-value from the regression of methylation M value on age (while correcting for sex, white blood cell counts and technical covariates). Sites where the genetic variance showed significant age interaction are indicated in blue. Sites where the environmental variance showed significant age interaction are shown in green. Results are based on data from 2,603 individuals.

At sites with significant age interaction, the total variance in DNA methylation between individuals generally increases with age, whereas the proportion of variance explained by genetic influences (heritability) decreases, at least up to age 60 (Fig. 5a). While the environmental variance increases at most of these sites across the age range studied, the additive genetic variance initially decreases at most sites, but increases at later ages. At 90% of sites with significant age interaction, the heritability was lower at age 50 than at age 25 (Fig. 5b). At most sites, the change in heritability was modest (Supplementary Fig. 17), but large differences also occurred. For example, there were 104 sites where the change in heritability was larger than 0.5 between age 25 and age 50. Only 21 of these sites were longitudinally stable across 5 years.

Figure 5: Heritability of DNA methylation at sites with significant interaction between age and genetic variance or age and environmental variance.
figure5

(a) Total variance of DNA methylation, additive genetic variance, unique environmental variance and heritability plotted against age, based on estimates obtained in interaction models on data from 2,603 individuals. (b) Histogram of heritability at age 25 (green) and at age 50 (purple) for 39,455 CpGs with significant interaction between age and genetic variance or between age and unique environmental variance. Dark blue denotes the overlap of green and purple bars.

Genomic distribution of sex and age interaction effects

While a small proportion of sites shows multiple types of interaction (that is, age and/or sex by genetic and/or environmental influences, Fig. 6a), interactions involving genetic and those involving environmental influences were not equally distributed across genomic sites (Supplementary Data 2). Interactions between environmental effects and age occurred mainly at sites with an intermediate average methylation level (Fig. 6b), and were significantly over-represented (α=4.27 × 10−4, χ2-test) in intergenic regions, distal promoters, downstream regions (P values <2.2 × 10−16Fig. 6c) and CGI shores (P<2.2 × 10−16, χ2-test; Fig. 6d) and underrepresented in gene body, proximal promoter, CGI, non-CGI and shelf (P values<2.2 × 10−16, χ2-test). On the other hand, interactions between genetic effects and age occurred more often at hypomethylated sites (Fig. 6b) and were enriched in proximal promoters (P<2.2 × 10−16, χ2-test; Fig. 6c) and CGIs (P<2.2 × 10−16, χ2-test; Fig. 6d) and depleted in gene body (P<2.2 × 10−16, χ2-test), intergenic (P=2.2 × 10−9, χ2-test), non-CGI regions (P<2.2 × 10−16, χ2-test), shores (P=7.2 × 10−5, χ2-test) and shelves (P=1.3 × 10−7, chi-square test). Sites with sex by environment interaction were usually hypo- or intermediately methylated (Fig. 6b) and were enriched in proximal promoters (P<2.2 × 10−16, χ2-test) and CGIs (P<2.2 × 10−16, χ2-test), and underrepresented in gene bodies (P=3.6 × 10−13, χ2-test), non-CGI (P=3.0 × 10−13, χ2-test) and shelves (P=2.2 × 10−6). Sites with significant interaction between sex and total genetic effects were more often hypermethylated (Fig. 6b), were over-represented in gene bodies (P=1.3 × 10−4, χ2-test) and underrepresented in proximal promoters (Fig. 6c, P=1.4 × 10–5, χ2-test), and showed no significant differences in distribution relative to CpG density (Fig. 6d). Sites with significant age by genome or sex by genome interaction were not enriched or depleted in DHSs of any cell type from Epigenomics Roadmap data (Supplementary Data 6 and 7). By contrast, sites with significant interaction between environmental effects and age showed significant overlap with DHSs of several types of fetal cells, embryonic stem cells and IPS cells (Supplementary Data 8). Sites with interaction between environmental effects and sex showed enrichment for DHSs across all tissue types (Supplementary Data 9). Interaction between environmental effects and sex on methylation was also enriched among non-CpG sites, while interactions of both genomic and environmental effects with age were depleted among these sites (P values< 2.2 × 10−16, chi-square test, Supplementary Data 5).

Figure 6: Characteristics and overlap of sites showing interaction between age or sex and genetic or environmental variance.
figure6

(a) Venn diagram of the number of CpGs with significant interaction between sex and genetic variance (Sex × Va), between sex and unique environmental variance (Sex × Ve), between age and genetic variance (Age × Va) and between age and unique environmental variance (Age × Ve). (b) Density plot of CpGs with significant interaction effects. (c) Distribution of methylation sites with interaction effects relative to genes: DP, distal promoter; DS, downstream region; GB, gene body; IG, intergenic; PP, proximal promoter. (d) Distribution of methylation sites with interaction effects in relation to CpG density: CGI, CpG island; NC, non-CGI; SHE, CpG island shelf; SHO, CpG island shore. Asterisks denote significant enrichment or depletion (α=4.27 × 10−4, χ2-test). Results are based on data from 2,603 individuals.

Some smoking-associated CpGs show epigenetic drift with age

To further examine the biological relevance, and to gain insight into the causes that may underlie genetically and environmentally induced methylation variance, we compared our findings with genome-wide significant methylation hits from previously published epigenome-wide association studies (EWASs), that is; CpGs where the methylation level in blood is associated with a complex trait or exposure. We first focused on smoking, which has well-replicating associations with DNA methylation level at many CpGs. We examined 430 CpGs associated with current smoking based on the most recently published EWAS8. One smoking-associated CpG showed a sex difference in the environmental variance and two smoking-associated CpGs showed a difference in the additive genetic variance (Supplementary Data 10). Comparing smoking-associated locations with 39,455 sites with significant age interaction, overlapping sites included one site that showed age by genome interaction and 65 sites that displayed interaction between environmental effects and age (Supplementary Data 10). Methylation level at cg12803068 in MYO1G, associated with smoking and among our top hits for the interaction between age and environment (P<1 × 10−16, χ2-test), had a heritability of 0.91 at age 25 and a heritability of 0.71 at age 50. To verify the contribution of smoking to the changing environmental variance with age at all 65 sites, we examined their methylation level in monozygotic twins concordant and discordant for smoking (Fig. 7). Methylation levels were more strongly correlated in smoking-concordant monozygotic twins (concordant current smokers, mean r=0.64, concordant never smokers, mean r=0.63) than in smoking-discordant twins (discordant for smoking ever, mean r=0.44). This observation confirms the role of smoking in the increasing environmental variance with increasing age at these sites. Smoking-associated sites were on average moderately heritable (h2 mean=0.50, s.d.=0.15), illustrating the presence of both genetic and environmental effects on methylation. It is important to note that smoking itself is a heritable trait.

Figure 7: Boxplots of the correlations between DNA methylation levels in smoking-concordant and smoking-discordant MZ twins.
figure7

Correlations are plotted for DNA methylation level at 65 CpGs that showed significant interaction between age and environmental variance and that were previously found to be associated with smoking12. The boxes denote the 25th and 75th percentile (bottom and top of box), and median value (horizontal band inside box). The whiskers indicate the values observed within up to 1.5 times the interquartile range above and below the box.

Trends in variance at CpGs associated with metabolic traits

We next studied sites where DNA methylation level in blood is associated with metabolic traits, including two CpGs identified by an EWAS meta-analysis of BMI3 (h2=0.72, and h2=0.88, respectively), eight CpGs associated with lipid levels6 (triglycerides, high-density lipoprotein (HDL) or low-density lipoprotein (LDL), h2 mean=0.45, s.d.=0.12), and 1185 CpGs associated with the levels of a number of distinct serum metabolites42 (h2 mean=0.29, s.d.=0.17). Of metabolite-associated sites, 51 showed age by genome interaction, 70 showed age by environment interaction, one showed sex by genome interaction, and 7 showed sex by environment interaction (Supplementary Data 11). One of the 8 published CpGs associated with lipids showed an interaction effect in our data: at higher ages, unique environmental influences accounted for increasing variation in DNA methylation level at cg22178392 in the TNIP1 gene, of which DNA methylation level in blood and adipose tissue is associated with serum LDL cholesterol level6. The heritability of DNA methylation at this site in blood decreases from 0.54 at age 25 to 0.39 at age 50. Metabolite-associated CpGs displaying a sex difference in the environmental variance include two associated with tryptophan levels, two associated with mannose, and one associated with 5-oxoproline levels (Supplementary Data 11). These point to differences between men and women in the prevalence or impact of exposure to relevant environmental factors that act upon epigenetic regulation of metabolite loci.

Trends in variance across age at the epigenetic clock

Finally, we examined 353 CpGs included in the epigenetic clock algorithm that predicts DNA methylation age (DNAmAge) across a whole range of tissues18. ‘DNA methylation age acceleration’ of blood, defined as the difference between DNAmAge and chronological age, was previously found to predict mortality43 and to be associated with a number of physical and cognitive fitness measures44. Of the clock CpGs, 55 showed interaction between age and genetic or environmental effects (Supplementary Data 12); at 49 clock sites the heritability of DNA methylation level was lower at age 50 compared with age 25, illustrating that environmental and/or stochastic influences account for an increasing portion of the variance between people at higher ages at these sites. This observation is consistent with the finding that the heritability of ‘DNA methylation age acceleration’ predicted by these sites is lower in older populations18. It also illustrates that there are sites in the genome where the methylation level changes with age, and where there is an age-related shift in the causes of variation between people. This shift generally involves an increase in the impact of environmental or stochastic influences with increasing age. Importantly, our data suggest that this phenomenon not only affects sites where the mean methylation level changes with age (such as the ‘clock CpGs’) but also occurs at sites where the average methylation level remains stable across ages (Fig. 4b).

In conclusion, these findings illustrate that our catalogue (Supplementary Data 1) holds valuable information on locations in the genome where methylation variation between people may reflect disease-relevant environmental exposures or genetic variation. Our findings also illustrate that DNA methylation variation at single sites generally shows evidence of both genetic and environmental influences.

Discussion

We assessed DNA methylation levels in peripheral blood in a large population-based twin cohort, also including family members of twins, and provide a catalogue characterizing the methylation variance of loci along the genome according to genetic and environmental influences and the interaction of these influences with age and sex (Supplementary Data 1). The genome-wide average heritability (h2) of methylation level was 0.19. Our measured common genetic variants explained on average 7% (h2SNPs) of the methylation variance. Common genetic variants explained on average 37% of the total heritability of methylation level (that is, 0.07/0.19). At 18% of the 450k targeted sites, over 99% of the heritability was explained by common SNPs. Yet, our findings also emphasize that an important part of the heritability of DNA methylation in the genome is not explained by common genetic variants, highlighting the importance of rare variants and structural variants that are not or incompletely tagged by common SNPs on the genotype array.

These findings highlight the importance of environmental and stochastic influences on DNA methylation. Interaction analyses indicated that age and sex-specific heritability of DNA methylation at specific sites is mainly driven by age and sex-specific trends in the environmental variance. In support of previous indications that certain epigenetic marks may diverge between monozygotic twins with age30,31 (a phenomenon referred to as epigenetic drift), our study revealed a large number of methylation sites where the impact of environmental or stochastic influences on DNA methylation increased with age. Such sites may thus be used to monitor personalized effects of extrinsic and intrinsic factors influencing physiology. We hypothesize that interactions of genetic and environmental effects on DNA methylation with age may be driven by individual differences in intrinsic processes that change with ageing and by accumulating effects of the response to exposures to environmental influences during the lifespan.

Although methylation sites with high and low heritability were observed throughout the genome, comparison of their genomic distribution, taking the most variable sites between people as the reference, revealed that highly heritable sites were enriched, amongst others, in CpG islands and DHSs, while sites where most variation was due to environmental or stochastic influences were depleted in DHSs, CpG islands and proximal promoters and were over-represented in CGI shores, shelves, gene body and distal promoters, especially when longitudinally unstable across 5 years. Methylation sites showing significant interaction between environmental effects and age were most strongly enriched in CGI shores. CpG islands and proximal promoters generally show little variation in DNA methylation between people. It is thought that methylation at promoter CpG islands serves a role in long-term repression of genes such as developmental genes and imprinted genes45,46. By contrast, previous studies have shown that DNA methylation in CGI shores is the most dynamic across tissues and throughout development47,48,49. Our findings suggest that variation in DNA methylation at proximal promoter CGIs as well as DHSs is generally relatively low, leaving genetic differences as the main source for remaining variation between people, while methylation in shores, shelves, non-CGI sites and gene bodies may be more dynamic and more susceptible to environmental or stochastic influences.

This study has several strengths and limitations. Our study is the most comprehensive study to date examining the importance of genetic and environmental influences to individual variation in the human methylome. Yet, this study is limited to DNA methylation measured at a limited number of genome-wide sites in an accessible peripheral tissue. It remains to be examined how representative our findings are for the situation in other tissues, for DNA methylation genome-wide, and for epigenetic marks other than DNA methylation. Although our study included subjects in a very broad age range (17–79 years), it did not cover the entire human lifespan and our interaction analyses were limited to cross-sectional data. Because many human diseases are thought to originate early in life, further studies examining the pre- and postnatal causes of variation in DNA methylation during early development would be extremely valuable. Furthermore, more extensive longitudinal methylation datasets allow better assessment of the genetic and environmental influences on longitudinal stability of methylation levels. By examining sex and age, we considered only a minor subset of medically relevant covariates that may potentially moderate the impact of genetic and environmental influences on DNA methylation. A previous study reported several in utero environmental factors that influenced neonate DNA methylation levels in a genotype-specific way, highlighting the importance of genotype by environment interaction50. Extension of the interaction model that we used in this study51 would allow for the quantification of polygenic gene by environment interaction with measured environmental proxies.

We demonstrated the trends in genetic and environmental variance displayed by sites where DNA methylation level is associated with metabolic traits and smoking, highlighting sites where the environmental or genetic variance of DNA methylation shows differences between males and females or across the life span. Environmental influences on the epigenome may encompass many more types of exposures, including nutrition52, exposure to chemicals/pollutants29,53, stress54 and others55. In conclusion, we have provided a catalogue (Supplementary Data 1) of genetic and environmental influences on DNA methylation along the genome that can be used to obtain insight into the causes of (sex- and age-specific) variation in DNA methylation at (putative) disease loci.

Methods

Subjects and samples

The subjects in this study participated in the Netherlands Twin Register (NTR) biobank project56. Venous blood samples were drawn in the morning after an overnight fast, and multiple EDTA and other tubes were collected for isolation of DNA and assessment of haematological profiles. Blood, urine and buccal sample collection procedures were described in detail previously56.

The study also included parents of twins, siblings of twins and spouses of twins. In total, 3,264 blood samples from 3,221 NTR participants were assessed for genome-wide methylation, of which 3,089 samples from 3,057 subjects passed quality control. Only samples with good-quality DNA methylation data and with white blood cell counts were retained for analysis, leaving 3,006 samples from 2,975 subjects. This dataset included 769 MZ and 424 DZ pairs. In 31 subjects longitudinal methylation data were available (two time points, mean range=5.2 years, s.d.=1.1, range=2–7 years). All analyses that included genome-wide SNP data were performed on data from a subset of subjects who were genotyped and who were of Dutch origin (N=2,603).

For a small subset of 11 MZ pairs (male pairs=3, female pairs=8, age: 18 years), genome-wide methylation data were available for two types of samples: blood (as described above) and buccal. The buccal samples from 10 twins were assessed in 2013, as described by van Dongen et al.57. The 12 additional buccal samples were assessed using the same protocol in 2014. Buccal and blood samples were collected around the same date.

All subjects provided written informed consent. The study protocols were approved by the Central Ethics Committee on Research Involving Human Subjects of the VU University Medical Centre, Amsterdam, an Institutional Review Board certified by the US Office of Human Research Protections (IRB number IRB-2991 under Federal-wide Assurance-3703; IRB/institute codes, NTR 03-180).

Cell counts

The following subtypes of white blood cells were counted in blood samples: neutrophils, lymphocytes, monocytes, eosinophils and basophils56. Lymphocyte and neutrophil percentages were strongly negatively correlated (r=−0.93). Of these two white blood cell subtypes, the percentage of neutrophils showed the strongest correlation with DNA methylation levels (as evidenced by the correlation with PCs from the raw genome-wide methylation data). Basophil percentage showed little variation between subjects, with a large number of subjects having 0% of basophils. Therefore, the percentages of neutrophils, monocytes and eosinophils were used to adjust DNA methylation data for inter-individual variation in white blood cell proportions.

Genome-wide SNP data

Three distinct genotype data sets were available. The first consisted of previously collected genome-wide SNP data that were only used as part of the quality control (QC) procedure of the DNA methylation data. The second previously collected genome-wide SNP data were used only as part of the statistical analyses of the DNA methylation data. The third SNP dataset consisted of 65 common SNPs targeted by the Illumina 450k array that were only used as part of QC procedure of the DNA methylation data.

Genotype data used during QC of the DNA methylation data

Of the 3,221 subjects for whom peripheral blood methylation samples were assessed with the Illumina 450k array, 2,665 subjects had been previously genotyped or had a MZ co-twin who had been genotyped one or multiple times on any of the following genotype arrays: Affymetrix6, Affymetrix-Perlegen and Illumina660. One set of genotypes was selected (the one with the best quality) for MZ twins if both twins were genotyped and for individuals who had been genotyped on multiple platforms. In total, 1,870 genome-wide SNP data sets were available, which were informative for 2,665 individuals (including 795 MZ co-twins). For the DNA methylation data QC, the overlapping SNPs from the Affymetrix6, Affymetrix-Perlegen and Illumina660 arrays were selected. Because of the small overlap of SNPs on these three arrays, this data set was not used for the heritability analyses of DNA methylation.

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Genotype data used in the heritability analyses

The analyses of DNA methylation heritability were performed using genome-wide SNP data collected with the Affymetrix6 array and SNP data that were extracted from whole-genome sequence data that were available for a small subset of subjects (described previously)58. Of the 2,975 subjects with good-quality DNA methylation data and data on white blood cell counts, Affy6 genotype data were available for 2,289 subjects and sequence data for 341 individuals (numbers include both MZ twins). Only SNPs present on the Affy6 platform were extracted from the sequence data. For a subset of 84 subjects for whom sequence data and Affy6 data were available, the sequence data was selected. SNPs with an allele frequency difference between individuals genotyped on Affy6 and individuals who were sequenced were removed (N=2,645 SNPs, based on a P value<1 × 10−5 in a case-control genome-wide association analysis, where case-control status reflected whether a person was genotyped on Affy6 or whole-genome sequenced). The genome-wide SNP data were used to construct a GRM, which summarizes overall genetic relatedness between all subjects (N=2603) based on all genotyped autosomal SNPs (MAF>0.01) with genome-wide complex trait analysis (GCTA)59.

Infinium HumanMethylation450 BeadChip data

DNA methylation was assessed with the Infinium HumanMethylation450 BeadChip Kit (Illumina)60. Genomic DNA (500 ng) from whole blood was bisulfite treated using the ZymoResearch EZ DNA Methylation kit (Zymo Research Corp, Irvine, CA, USA), following the standard protocol for Illumina 450k micro-arrays, by the department of Molecular Epidemiology from the Leiden University Medical Center (LUMC), The Netherlands. Subsequent steps (that is, sample hybridization, staining, scanning) were performed by the Erasmus Medical Center micro-array facility, Rotterdam, The Netherlands.

DNA methylation quality control and probe filtering

Quality control and processing of the DNA methylation data from buccal samples has been previously described57. The following text describes the quality control and processing of the DNA methylation data from blood samples. The raw intensity files (idat) were imported into the R environment61, where further processing, quality control and normalization took place using a protocol developed by the LUMC Molecular Epidemiology department.

First, the methylation data were examined with the R-package MethylAid62, which marks outlier samples for a number of quality metrics that are computed based on sample dependent and sample independent quality metrics. The performance of the 3,264 samples is plotted for each of five quality metrics in Supplementary Figs 18–22. Only samples that passed all five quality criteria (using the default MethylAid thresholds) were kept for further analyses. In total, 70 low-performing samples were excluded (2.1%), the majority of which failed based on multiple criteria (Supplementary Table 3). Only the 3,194 samples showing good overall quality were taken on to further processing steps.

Several probe-level QC steps were performed to filter out probes with low performance. For all samples, ambiguously mapped probes were excluded, based on the definition of an overlap of at least 47 bases per probe from Chen et al.63, and all probes containing a SNP, identified in the Dutch population58, within the CpG site (at the C or G position) were excluded, irrespective of minor allele frequency. For each sample individually, probes with an intensity value of zero (not present on the array of a particular sample), probes with a detection P value>0.01 (calculated using the function detectionP from the minfi package64), and probes with a bead count <3 were excluded. After these steps, probes with a success rate <0.95 across samples were removed from all samples and the success rate across probes for each sample was computed (Mean per sample success rate=99.89%, range=97.86–99.96%). The total number of CpGs after these filtering steps was 421,119. Only autosomal sites were kept in the current analyses (N=411,169).

We performed several checks to confirm sample identity, by making use of previously collected genotype data, 65 SNP (control) probes targeted by the Illumina 450k array, and differential methylation patterns in men versus women. Previously collected raw genotype data was used as input for the programme MixupMapper, which computes the probability that a DNA methylation sample matches supplied genotype information based on mQTLs estimated from the dataset65. To confirm sex, we clustered samples based on their methylation data, by calculating the Euclidean distance from the pair-wise correlations between samples followed by hierarchical clustering (cluster method=complete linkage). Clustering based on all probes and clustering based on probes in the sex chromosomes yielded similar results. We computed the correlation between samples for 65 SNP (control) probes targeted by the 450 k array to confirm zygosity of twins, and to confirm that longitudinal samples indeed belonged to the same person. Finally, we used the 65 SNP probes to examine potential contamination of samples with foreign DNA, by computing the number of SNPs per sample with an unclear genotype (which we defined as SNPs where the proportion of signal from each allele lay between 0.2 and 0.4 or between 0.6 and 0.8, on a scale from 0 to 1, that is, a pattern not clearly supporting membership to any of the three genotype classes). The number of ‘unclear genotypes’ showed a mean of 3.3 across all samples (median=2, s.d.=3.5, Supplementary Fig. 23). We excluded samples with ≥15 unclear genotypes (99th percentile). The genome-wide methylation distribution of these excluded samples showed relatively more intermediate methylation levels (Supplementary Fig. 24). An example scatterplot of the 65 SNP probes in MZ twin samples illustrating DNA contamination of the sample of one of the twins, as detected by this method, is given in Supplementary Fig. 25.

In total, 132 samples were involved in at least one of the following issues: genotype mismatch, sex mismatch, DNA contamination, and inconsistent SNP probe correlation (either between twins or between longitudinal samples from the same person). After solving a swap between two methylation samples identified by MixupMapper (and confirmed by the other checks) by re-swapping methylation data IDs (leaving 128 samples with issues), 67 samples were excluded based on the following grounds: only sex mismatch (22 samples), only genotype mismatch (10 samples), only DNA contamination (27 samples), genotype + sex mismatch (6 samples), DNA contamination + sex mismatch (2 samples). After removal of these samples, there were still 38 samples with an inconsistent SNP probe correlation (that is a zygosity mismatch or mismatch between longitudinal samples), which were all excluded, giving a total of 105 samples (3.3%) excluded based on failed identity or contamination, on top of the 70 samples excluded based on bad quality of the methylation data.

Finally, for 22 persons with Illumina 450k methylation data available from blood and buccal samples, the 65 SNP probes confirmed that blood and buccal samples indeed belonged to the same individual.

Exploration of technical and biological confounding

To get an impression of the impact of technical and biological effects on overall variation in methylation, principle component analysis (PCA) was performed on the raw genome-wide methylation data (Supplementary Table 4Supplementary Fig. 26), and the correlation between PC scores and several known technical batches and biological outcomes were computed. PC1 related to sex (r=0.92), PC2 was strongly correlated with position on the array (in particular, array row, r=0.50), PC3 with several white blood cell counts (for example, lymphocytes: r=0.45), and PC4 with age (r=−0.59). Other batch variables (for example, 96-well plate, array, and scanner) correlated to a smaller degree with multiple components.

Methylation data normalization and covariates correction

To reduce technical variability between samples while retaining as much biological variation in DNA methylation as possible, the data were normalized with Functional Normalization, a between-sample normalization method that normalizes the data using PCs (the number of which is user specified) estimated from control probes that are specifically designed not to measure biological variation in samples66. There are several strategies to determine the number relevant PCs in a dataset, including inspection of the Eigen values or scree plot, and mathematical algorithms that estimate the number of significant PCs. We chose to perform Functional Normalization with the first 4 PCs, because PCA based on the data from control probes showed that in our data, the first 4 PCs correlated with technical variables (Supplementary Fig. 27), including array row (PC1, r=−0.71), scanner (PC2, r=−0.46), time (days) between blood sampling and hybridization (PC3, r=−0.39), and Illumina 450k array barcode (PC4, r=0.18), because the first four PCs had an eigen value >1 (Supplementary Table 5Supplementary Fig. 28), and because they explained a large proportion of the variance in control probes (89%), whereas each of the further PCs only explained a very small proportion of variance (Supplementary Table 5). We also applied the function EstDimRMT() implemented in the R-package isva, which uses Random Matrix Theory (RMT) to estimate the number of significant PCs67, to the control probe data. In convergence with the criteria outlined above, the RMT method retrieved four significant PCs.

Normalized intensity values were converted into beta-values (β) and M values11; β-values were used for descriptive purposes only because of their biological interpretability, while M values were used as input for all analyses. The β-value, which represents the methylation level at a CpG for an individual and ranges from 0 to 1, is calculated as:

where M=Methylated signal, U=Unmethylated signal and α represents a correction term (100 by default) to control the β-value of probes with very low overall signal intensity (that is, probes for which M+U0 after normalization).

The M value is equivalent to a log2 logistic transformation of β:

Genomic annotations

CpGs were mapped to five gene-centric regions: intergenic region (>10 kb from the nearest transcription start site (TSS)), distal promoter (minus(−)10 kb to−1.5 kb from the nearest TSS), proximal promoter (−1.5 kb to plus(+)500 bp from the nearest TSS), gene body (+500 bp to 3′ end of the gene) and downstream region (3′ end to +5 kb from 3′ end), and to CGIs (CG content >50%, length >200 bp and observed/expected ratio of CpGs >0.6), CGI shore (2-kb region flanking CGI), CGI shelf (2-kb region flanking CGI shore) and non-CGI regions, as described by Slieker et al41. Tests for enrichment among gene-centric and CGI-centric genomic categories were performed with chi-squared tests in R with the function chisq.test() and Bonferroni correction for the total number of performed χ2-tests (N tests=117) was applied to determine statistical significance (α=0.05/117=4.27 × 10−4). The eFORGE analysis tool (http://eforge.cs.ucl.ac.uk/) was used to test for enrichment among DHSs mapped by the Epigenomics Roadmap Consortium (http://www.ncbi.nlm.nih.gov/epigenomics,68), selecting the top 1,000 probes for analyses with >1,000 significant sites. We also annotated previously published CpGs that predict ‘DNA methylation age’18, CpGs associated with smoking status8, BMI3, lipid levels6 and metabolite levels42.

Heritable and environmental influences on DNA methylation

To facilitate computations, missing methylation data (0.04–2.14% of genome-wide probes per individual, mean=0.1%) were imputed with the R-package impute. Before analysis, the normalized methylation M values were corrected for sex, age, array row, 96-well plate (dummy coded), white blood cell percentages (neutrophils, monocytes and eosinophils; assessed at sample collection), and the first ten PCs derived from the genotype data, with the lm function in R. All analyses that included genome-wide SNP data were performed on the residuals derived after correcting for these covariates. All other analyses (that is, twin correlations and twin models, longitudinal analyses and blood–buccal comparison) were performed on the residuals derived after correcting for the afore mentioned covariates minus the genotype PCs.

The impact of heritable and environmental influences on the methylome was assessed with the classical twin design and with a SNP-based method. Based on the data from twins, a first impression of the classical twin heritability (h2twins) at each methylation site (CpGi) was obtained as follows:

where rMZ and rDZ are the correlations of DNA methylation level at one CpG site between the MZ, and between the DZ twins, respectively.

Next, genetic models that decomposed variation into additive genetic (A), non-additive genetic (D), common environmental (C) and unique environmental (E) components were fitted to the methylation data of the twins (classical twin method69) using maximum likelihood estimation in custom software. The statistical significance of the variance components was evaluated by means of likelihood ratio tests. These models allow estimation of the proportion of variance in DNA methylation attributable to total additive genetic effects (a2, which represents the same variance component as h2twins), non-additive genetic effects (d2), common environment (c2) and unique environment (e2). The variables a2, h2, c2, d2 and e2 represent variance components expressed as a proportion of total variance.

Having established that additive genetic (A) and unique environmental effects (E) are the main sources of variation in the methylome, we proceeded to estimate the proportion of variance attributable to the additive effects of all measured SNPs (h2SNPs), and to test for interactions of total additive genetic effects and environmental effects with age and sex. In these analyses, linear mixed models were fitted in which the covariance of DNA methylation between all individuals (including non-twin family members) was modelled as a function of measured genetic relationships based on SNP data. The approach outlined by Zaitlen et al.38 was applied, which makes use of two GRMs: a GRM describing the relationships between all individuals () and a second GRM in which all genetic relationships <0.05 IBS (distant genetic relationships) are set to zero (), making the estimates of genetic relatedness equivalent to the proportion in the genome shared identity-by-descent (IBD). In essence the covariance between individuals for DNA methylation level at CpGi is modelled as a function of the (very small) genetic covariance between individuals in the population and the (larger) genetic covariance between relatives. Genome-wide SNPs from the Affymetrix6 array (MAF>0.01) were used to construct a GRM with the software programme genome-wide complex trait analysis (GCTA)59. For each CpG, we modelled the expected covariance as a function of the GRMs, the additive genetic variance (), and the variance explained by genome-wide SNPs () as follows:

where cov(CpGi)n*n is the expected covariance of DNA methylation at CpGi between individuals, adjusted for covariates,  is the variance explained by all SNPs, the term  denotes the difference between the total genetic variance and the variance explained by SNPs, and  reflects the variance attributable to residual effects (‘unique environment’, which may include environmental influences unique to each individual, stochastic influences and measurement error). The total heritability (h2IBD) was calculated as: h2IBD=/+). The proportion of variance explained by genome-wide SNPs was calculated as: h2SNPs=/+) and the proportion of the heritability explained by SNPs was calculated as: h2SNPs/h2IBD.

Genome by sex interaction effects on DNA methylation were investigated with the following model, with sex coded 0/1:

where βIBD-sex is the regression coefficient for the interaction of genetic effects with sex, and βe-sex is the regression coefficient for the interaction of residual effects with sex. These methods are described in detail by Nivard et al.70 (MGN., Middeldorp C.M., Lubke G., JJH, Abdellaoui A., DIB., CVD. Detection of gene–environment interaction in pedigree data using genome-wide genotypes, under review). This parameterization of the interaction effect is equivalent the method proposed by Purcell71.

Genome by age interaction effects on DNA methylation were investigated with the following model, with age z-transformed:

where βIBD-Age is the regression coefficient for the interaction of genetic effects with age, and βe-Age is the regression coefficient for the interaction of residual effects with age.

Before the analyses based on genome-wide SNP data, methylation levels were standardized (z-transformation) to facilitate computations. A small proportion of CpGs for which a model could not be fitted successfully was discarded (see results). The P values of each of the four interaction effects (genetic and environmental variance by age and sex) were derived with a χ2-test (1 degree of freedom), where χ2=(β/s.e.)2. Statistical significance of interaction P values was assessed after Bonferroni correction for the number of CpGs for which estimates were successfully obtained (α=0.05/NCpGs; alpha ACE twin modelling=1.2 × 10−7, alpha interaction analyses=1.3 × 10−7). The correspondence between the classical twin model-based heritability (a2) and heritability estimated with the GRM approach (h2) was evaluated by computing the correlation between the value of a2 and the corresponding value of h2. Computer code is available upon request from the authors.

Longitudinal correlation and blood–buccal correlation

Data from individuals with blood samples obtained at two repeated measures were analysed to calculate the correlation between DNA methylation level at time point 1 and DNA methylation level at time point 2 for each CpG site (mean interval=5 years). After obtaining an estimate of heritability and a longitudinal correlation for each CpG, the correlation between genome-wide estimates of (twin-based) heritability and genome-wide estimates of the longitudinal correlation was estimated to examine the relationship between longitudinal stability and the heritability of DNA methylation level. Data from individuals with Illumina 450k methylation data from blood samples and buccal samples were analysed to calculate the correlation between DNA methylation level in blood and buccal for each CpG. Before this analysis, the buccal methylation data (M values) were corrected for sex, array row and assessment batch (two levels). Blood–buccal correlations for all CpGs were correlated with h2twins to examine the relationship between the heritability in blood and the extent to which between-individual variation in DNA methylation level is shared across tissues. Nursing DNP 810 Emerging Areas of Human Health Essays.

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