Random Forests Highlight the Combined Effect of Environmental Heavy Metals Exposure and Genetic Damages for Cardiovascular Diseases

Heavy metals are a dangerous source of pollution due to their toxicity, permanence in the environment and chemical nature. It is well known that long-term exposure to heavy metals is related to several chronic degenerative diseases (cardiovascular diseases, neoplasms, neurodegenerative syndromes, etc.). In this work, we propose a machine learning framework to evaluate the severity of cardiovascular diseases (CVD) from Human scalp hair analysis (HSHA) tests and genetic analysis and identify a small group of these clinical features mostly associated with the CVD risk. Using a private dataset provided by the DD Clinic foundation in Caserta, Italy, we cross-validated the classification performance of a Random Forests model with 90 subjects affected by CVD. The proposed model reached an AUC of 0.78 ± 0.01 on a three class classification problem. The robustness of the predictions was assessed by comparison with different cross-validation schemes and two state-of-the-art classifiers, such as Artificial Neural Network and General Linear Model. Thus, is the first work that studies, through a machine learning approach, the tight link between CVD severity, heavy metal concentrations and SNPs. Then, the selected features appear highly correlated with the CVD phenotype, and they could represent targets for future CVD therapies.

Penerapan Standar Operasional Prosedur Pada Klinik Utama Vincentius Kristus Raja Surabaya

Vincentius Kristus Raja (KR) Main Clinic aims to serve patients effectively and economically in an effort to improve the quality of public health services, especially in Surabaya. This type of research is descriptive qualitative in the form of a case study, to assess the implementation of standard operating procedures at the Vincentius Kristus Raja Main Clinic. Relevant data collection was carried out using questionnaires distributed to personnel related to standard operating procedures. The results of the research study according to the questionnaire indicate that the operational implementation is in accordance with the standard operating procedures that have been set based on the policies of the leadership and the Vincentius Kristus Raja Main Clinic Foundation. Compliance with standard operating procedures is very important because standard operating procedures are guidelines or references for carrying out tasks and work in accordance with their functions. The conclusions and suggestions from this study are that although compliance with standard operating procedures is adequate, the Vincentius Kristus Raja Main Clinic needs to develop and improve the quality of services, especially better communication with patients, both new patients and patients who have been on treatment for a long time at the Vincentius Kristus Raja Main Clinic. Considering that there are now many new health clinics that can be competitors for the Vincentius Kristus Raja Main Clinic, there must be a good response to this phenomenon. The emergence of these new competitors requires the Vincentius Kristus Raja Main Clinic to be able to be competitive in order to face the existing competition by improving the quality and quality of service for patients.

MEDICAL TOURISM AND DIABETES CARE: EXPERIENCE FROM A TERTIARY REFERRAL CENTER

Objective: Medical tourism, a form of patient mobility across international borders to seek medical services, has gained significant momentum. We aimed to assess the outcomes of medical tourism consultations on chronic diseases, more specifically diabetes mellitus, amongst a cohort of international patients, originating from different healthcare systems, and referred to the United States for medical care. Methods: We identified international adults with established diabetes mellitus, referred globally from 6 countries to the United States between 2010 and 2016 for medical care, and were seen at the Cleveland Clinic Foundation (CCF). Group 1 included adults seen by an endocrinology provider during their CCF medical stay, whilst group 2 included those not seen by an endocrinology provider. To assess the impact of our consultations, changes in hemoglobin A1c (HbA1c) were assessed between visit(s). Results: Our study included 1,108 subjects (771 in group 1, 337 in group 2), with a mean age (± SD) of 61.3 ± 12.7 years, 62% male, and a median medical stay of 136 days (interquartile range: 57, 660). Compared to group 2, group 1 had a higher baseline mean HbA1c (8.0 ± 1.8% [63.9 mmol/mol] vs. 7.1 ± 1.4% [54.1 mmol/mol]; P<.001). After 1 visit with endocrinology, there was a significant decrease in mean HbA1c from 8.44 ± 1.98% (68.3 mmol/mol) to 7.51 ± 1.57% (58.5 mmol/mol) ( P<.001). Greatest reductions in mean HbA1c were −1.47% (95% CI: −2.21, −0.74) and −1.27% (95% CI: −1.89, −0.66) after 3 and 4 visits, respectively ( P<.001). Conclusion: Short-term diabetes mellitus consultations, in the context of medical tourism, are effective. Abbreviations: CCF = Cleveland Clinic Foundation; GCC = Gulf Cooperation Council; HbA1c = hemoglobin A1c; IQR = interquartile range; U.S. = United States

EVALUASI PENYAJIAN LAPORAN KEUANGAN ORGANISASI NIRLABA DALAM KAITANNYA DENGAN PENERAPAN PSAK 45 (Studi Kasus pada Yayasan Panti Wredha GPIB Hanna)

Increase of the number of non profit organization, such as political party, clinic, foundation et cetera makes the role of PSAK 45 becomes more important. To respond the society’s demand on transparency and public accountability of non profit organization, Ikatan Akuntansi Indonesia (IAI) has published PSAK 45 which regulates as to how the presentation of financial statements of private non-profit organization is to be made. The purposes of this research is to know the process of accounting in relation to presentation of financial statements of non profit organization and to know how far the presentation of financial statements follows PSAK 45.The method of analysis used in this research is qualitative descriptive which collects theoretical data to compare against the practice applied by Panti Wredha GPIB Hanna.The results of the research indicate that the financial statements of Panti Wredha GPIB Hanna does not follow PSAK 45, both process and presentation of financial statements. Financial reports presented by Panti Wredha GPIB Hanna just consist of three financial statements, such as balance sheet, income statement, and cash flow statement. The presentation of the financial reports of Panti Wredha GPIB Hanna are similar to that used by profit oriented organizations. Name of financial statements in Panti Wredha GPIB Hanna does not follow PSAK 45. Likewise, the classification of accounts does not follow PSAK 45, provided there are no distinction between unrestricted assets, temporary restriction, and permanent restriction. Liabilities and net assets are not classified properly as to whether included into unrestricted, temporary restriction, and permanent restriction either. Also for revenues are not classified in accordance with PSAK 45.Keywords: Non-profit Organization, PSAK 45, Financial Statements

Neutrophil KLF2 Regulates Arterial and Venous Thrombosis

Experimental, clinical and pathological studies support an important link between inflammation and thrombosis. Although accumulating evidence suggests that cells of the innate immune system contribute to the thrombotic process, the identity of nodal molecular determinants operative in immune cells remains poorly understood. Our previous work in mice bearing global deletion of the transcription factor KLF2 identifiedthis factor as a critical mediator of thrombosis). Here, using cell-specific KLF2 deleted murine models (endothelial, platelet, and myeloid- deleted KLF2) we identify myeloid KLF2 as the major determinant of thrombosis. Complete blood counts and coagulation assays in myeloid KLF2 deleted mice (MY-K2-KO) were similar to those in control LysM cre mice. Using two models of vascular thrombosis (carotid artery thrombosis assay, Rose Bengal model and complete inferior vena cava ligation model of venous thrombosis) we observed a robust prothrombotic phenotype in the MY-K2-KO mice as compared to control Cre mice. As LysM Cre deletes in both neutrophils and monocyte/macrophages, we next sought to determine whether one subset was dominantly responsible for the observed phenotype. Adoptive transfer of KLF2-KO neutrophils in control mice conferred both the arterial and venous pro-thrombotic phenotype. Conversely, neutrophil depletion with Ly6G antibody (>90% depletion achieved) reversed the prothrombotic phenotype in MY-K2-KO mice. By contrast, depletion of monocytes/macrophages using clodronate liposome injection did not affect arterial or venous thrombosis. Next, we evaluated the effect of KLF2 deficiency on critical neutrophil functions that may contribute to the pro-thrombotic phenotype. As compared to controls, MY-K2-KO neutrophils demonstrated more pronounced recruitment to the endothelium. In microflow chamber assays, MY-K2-KO neutrophils showed decreased rolling and increased P-selectin induced adhesion. The importance of this was affirmed by the observation that adoptive transfer of MY-K2-KO neutrophils incubated with PSGL-1 antibody was unable to generate a prothrombotic phenotype in control mice. In addition, MY-K2-KO neutrophils demonstrated enhanced neutrophil extracellular traps generation associated with increased myeloperoxidase and neutrophil elastase expression. And finally, MY-K2-KO neutrophils (but not monocytes) demonstrated increased tissue factor expression and activity. Collectively, these studiesidentify neutrophil KLF2 as a critical determinant of both arterial and venous thrombosis and suggest that modulation of neutrophil KLF2 may be a fruitful approach to the management of thrombosis. Disclosures Schmaier: Alnylam: Research Funding; Biomotiv: Consultancy; Cleveland Clinic Foundation: Research Funding; Temple University: Patents & Royalties; Enzyme Research Laboratories: Honoraria; Shire: Consultancy, Honoraria, Research Funding.