bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pengaruh Pendidikan dan Pelatihan terhadap Etos Kerja serta Implikasinya terhadap Kinerja
Authors: Mariatie Novtri , Hasanah Siti 
Published: August 2021

Penelitian bertujuan mengetahui pengaruh pendidikan dan pelatihan terhadap etos kerja serta implikasinya terhadap kinerja karyawan. Objek penelitian adalah karyawan yang berada di Kabupaten Bekasi. Sampel penelitian sebanyak 100 karyawan sebagai responden yang mengisi kuesioner. Analisis menggunakan model perbandingan struktural (SEM) dengan program perangkat lunak Smart PLS. Hasilnya menunjukan bahwa pendidikan dan pelatihan berpengaruh terhadap etos kerja, serta etos kerja berpengaruh terhadap kinerja karyawan. Dengan pendidikan dan pelatihan yang optimal maka akan meningkatkan etos kerja sehingga kinerja karyawan pun semakin meningkat.
This study aims to determine the effect of education and training on work ethic and its implications for employee performance. The object of research is employees who are in Bekasi Regency. The research sample was 100 employees as respondents who filled out the questionnaire. The analysis uses a structural comparison model (SEM) with the Smart PLS software program. The results show that education and training affect work ethic, and work ethic affects employee performance. With optimal education and training, it will improve work ethic so that employee performance will increase.
Making Nature Count
Authors: Srinivasan Umesh , Shanker Kartik 
Published: August 2021

Earth’s biodiversity is the ultimate engine of local and global economies and compromising the renewability of our natural resources will ultimately halt economic growth. Despite this, humankind has continued to exploit natural resources such as fisheries and forests at highly unsustainable rates in the pursuit of flawed development paradigms and simplistic metrics such as gross domestic product (GDP). This has already led to the loss of natural habitats and the decline and extinction of species as well as consequences such as an increase in zoonotic pandemics. The Economics of Biodiversity, a recent report by Sir Partha Dasgupta, addresses how the failure of our current institutions has brought us to where we stand and suggests ways by which we may reform our economic thought to mitigate the impacts on biodiversity. The report identifies important first steps: changing the way we measure economic “success”...
Autoantibodies Against Unmodified and Citrullinated Human Endogenous Retrovirus K Envelope Protein in Patients With Rheumatoid Arthritis
Authors: Wang Xiaoxing , Hefton Amanda , Ni Kathryn , Ukadike Kennedy C. , Bowen Michael A. , Eckert Mary , Stevens Anne , Lood Christian , Mustelin Tomas 
Published: August 2021

ObjectiveAutoantibodies against proteins encoded by human endogenous retrovirus K (HERV-K) have been reported in patients with rheumatoid arthritis (RA), but their relevance, if any, has remained unresolved. We revisited this question and tested if such autoantibodies may react with citrullinated epitopes on the envelope (Env) protein of HERV-K.MethodsImmunoblotting and ELISAs were conducted with unmodified Env protein and with Env citrullinated by protein arginine deiminase 4 (PAD4). Sera from 100 patients with RA, plasma from 32 patients with juvenile idiopathic arthritis (JIA), and healthy adult and pediatric controls were included. Antibody reactivity was evaluated for correlations with clinical and laboratory variables of the patients.ResultsWe replicated and expanded upon published data suggesting that patients with RA or JIA have autoantibodies against HERV-K Env, some with high titers. Anti-HERV-K antibodies correlated with cigarette smoking and with circulating myeloperoxidase-DNA complexes indicative of nonapoptotic neutrophil cell death. Further, most of the patients with RA, but not those with JIA, had autoantibodies that reacted more strongly with Env that was citrullinated by PAD4. These anticitrullinated Env autoantibodies correlated with seropositivity and tended to be higher in patients with erosive disease.ConclusionOur data suggest that anti-HERV-K immunity is elevated in RA and JIA and may have a connection with pathogenic protein citrullination in RA.
Persistence to Biologic Therapy Among Patients With Ankylosing Spondylitis: An Observational Study Using the OPAL Dataset
Authors: Griffiths Hedley , Smith Tegan , Mack Christopher , Leadbetter Jo , Butcher Belinda , Acar Mustafa , Ciciriello Sabina 
Published: August 2021

ObjectiveTo describe the treatment response and persistence to biologic disease-modifying antirheumatic drug (bDMARD) therapy in patients with ankylosing spondylitis (AS) in a real-world Australian cohort.MethodsThis was a retrospective, noninterventional cohort study that extracted data for patients with AS from the Optimising Patient outcomes in Australian RheumatoLogy (OPAL) dataset for the period of August 2006 to September 2019. Patients were classified as either bDMARD initiators if they commenced a bDMARD during the sampling window, or bDMARD-naïve if they did not. Results were summarized descriptively. Treatment persistence was calculated using Kaplan-Meier methods. Differences in treatment persistence were explored using log-rank tests.ResultsThere were 5048 patients with AS identified. Of these, 2597 patients initiated bDMARDs and 2451 remained bDMARD-naïve throughout the study window. Treatment with first-, second-, and third-line bDMARDs significantly reduced disease activity. Median persistence on first-line bDMARDs was 96 months (95% CI 85–109), declining to 19 months (95% CI 16–22) in second-line therapy, and 15 months (95% CI 11–18) in third-line therapy. Median persistence was longest for the golimumab (GOL) group in all lines of therapy and shortest for the etanercept (ETN) group. Differences in persistence rates according to the time period that bDMARDs were prescribed (pre- and post-2012) were also seen for ETN and adalimumab.ConclusionIn this cohort, all bDMARDs effectively reduced AS disease activity. Treatment persistence was sustained for up to 8 years for patients remaining on their first bDMARD, longer than on subsequent agents. Further research is needed to determine its influence on treatment recommendations.
Variations in Pediatric Rheumatology Workforce and Care Processes Across Canada
Authors: Lee Jennifer J.Y. , Laxer Ronald M. , Feldman Brian M. , Barber Claire E.H. , Batthish Michelle , Berard Roberta , Tucker Lori B. , Levy Deborah M. ,   on behalf of the Pediatrics Committee of the Canadian Rheumatology Association
Published: August 2021

ObjectiveTo examine the Canadian pediatric rheumatology workforce and care processes.MethodsPediatric rheumatologists and allied health professionals (AHPs) participated. A designee from each academic center provided workforce information including the number of providers, total and breakdown of full-time equivalents (FTEs), and triage processes. We calculated the clinical FTE (cFTE) available per 75,000 (recommended benchmark) and 300,000 (adjusted) children using 2019 census data. The national workforce deficit was calculated as the difference between current and expected cFTEs. Remaining respondents were asked about ambulatory practices.ResultsThe response rate of survey A (workforce information) and survey B (ambulatory practice information) was 100% and 54%, respectively. The majority of rheumatologists (91%) practiced in academic centers. The median number of rheumatologists per center was 3 (IQR 3) and median cFTE was 1.9 (IQR 1.5). The median cFTE per 75,000 was 0.2 (IQR 0.3), with a national deficit of 80 cFTEs. With the adjusted benchmark, there was no national deficit, but there was a regional maldistribution of rheumatologists. All centers engaged in multidisciplinary practices with a median of 4 different AHPs, although the median FTE for AHPs was ≤ 1. Most centers (87%) utilized a centralized triage process. Of 9 (60%) centers that used an electronic triage process, 6 were able to calculate wait times. Most clinicians integrated quality improvement practices, such as previsit planning (67%), postvisit planning (68%), and periodic health outcome monitoring (36–59%).ConclusionThis study confirms a national deficit at the current recommended benchmark. Most rheumatologists work in multidisciplinary teams, but AHP support may be inadequate.
Heterogeneity in Patient Characteristics and Differences in Treatment Across 4 Canadian Rheumatoid Arthritis Cohorts
Authors: Hazlewood Glen S. , Bombardier Claire , Li Xiuying , Movahedi Mohammad , Choquette Denis , Coupal Louis , Bykerk Vivian P. , Schieir Orit , Mosher Dianne , Marshall Deborah A. , Bernatsky Sasha , Spencer Nicole , Richards Dawn P. , Proulx Laurie , Barber Claire E.H. 
Published: August 2021

ObjectiveTo compare clinical characteristics and treatment of patients with rheumatoid arthritis (RA) across 4 Canadian cohorts.MethodsThe 4 longitudinal cohorts included the following: the Canadian Early Arthritis Cohort (CATCH; n = 2878), Ontario Best Practices Research Initiative (OBRI; n = 3734), RHUMADATA (Quebec, n = 2890), and the Rheum4U Precision Health Registry (Calgary, Alberta, n = 709). Data were from cohort inception (range 1998–2016) to 2020. Clinical characteristics and drug treatments were summarized descriptively.ResultsIn total, 10,211 patients with RA were included. The percentage of patients who entered the cohort with early RA (2 yrs of disease at enrollment) ranged from 29% (Rheum4U) to 100% (CATCH). Mean age (55 yrs), sex (74% female), and seropositivity (69%) were similar between cohorts. At the time of initial disease-modifying antirheumatic drug (DMARD) use, median Disease Activity Score in 28 joints (DAS28) varied, ranging from 2.99 (Rheum4U) to 5.19 (CATCH), but were more similar at the time of the first DMARD switch (range 3.57–5.03), first biologic (bDMARD) or targeted synthetic DMARD (tsDMARD) use (range 4.01–4.67), and second bDMARD or tsDMARD (range 3.71–4.39). The initial DMARD was most commonly methotrexate, either in monotherapy (32%, range 18–40%) or dual therapy (34%, range 29–42%). The first DMARD switch was to another DMARD monotherapy in 20% (range 10–32%), dual therapy in 49% (range 39–56%), and bDMARD or tsDMARD in 24% (range 15–28%). The first bDMARD was an anti–tumor necrosis factor in 79% (range 78–82%).ConclusionCanadian RA cohorts demonstrate some heterogeneity in treatment, which could reflect differences in inclusion criteria, calendar year, or regional differences. This project is a first step toward conducting harmonized analyses across Canadian RA cohorts.
Risk Factors for Diagnosis of Psoriatic Arthritis, Psoriasis, Rheumatoid Arthritis, and Ankylosing Spondylitis: A Set of Parallel Case-control Studies
Authors: Meer Elana , Thrastardottir Telma , Wang Xingmei , Dubreuil Maureen , Chen Yong , Gelfand Joel M. , Love Thorvardur J. , Ogdie Alexis 
Published: August 2021

ObjectiveTo compare potential risk factors for the diagnosis of psoriatic arthritis (PsA), psoriasis (PsO), rheumatoid arthritis (RA), and ankylosing spondylitis (AS).MethodsFour parallel case-control studies were conducted within The Health Improvement Network using data between 1994 and 2015. Patients with PsA, PsO, RA, or AS were identified using validated code lists and matched to controls on age, sex, practice, and year. Risk factors were selected in the time prior to diagnosis. Multivariable logistic regression models were constructed for each disease using automated stepwise regression to test potential risk factors.ResultsPatients with incident PsA (n = 7594), PsO (n = 111,375), RA (n = 28,341), and AS (n = 3253) were identified and matched to 75,930, 1,113,345, 283,226, and 32,530 controls, respectively. Median diagnosis age was 48 (IQR 38–59), 43 (IQR 28–60), 60 (IQR 48–71), and 41 (IQR 32–54) years, respectively. In multivariable models, there were some shared and some differing risk factors across all 4 diseases: PsA was associated with obesity, pharyngitis, and skin infections; PsA and PsO were associated with obesity and moderate alcohol intake; PsA and AS were associated with uveitis; and PsA and RA were associated with preceding gout. Both RA and AS were associated with current smoking, former moderate drinking, anemia, osteoporosis, and inflammatory bowel disease. All shared former or current smoking as a risk factor; statin use was inversely associated with all 4 diseases.ConclusionShared and different risk factors for PsA, PsO, RA, and AS were identified. Statin use was inversely associated with all 4 conditions.
Anxiety and Depressive Symptoms in Juvenile Idiopathic Arthritis Correlate With Pain and Stress Using PROMIS Measures
Authors: Fair Danielle C. , Nocton James J. , Panepinto Julie A. , Yan Ke , Zhang Jian , Rodriguez Martha , Olson Judyann 
Published: August 2021

ObjectiveDescribe anxiety and depressive symptoms in children with juvenile idiopathic arthritis (JIA) using Patient Reported Outcomes Measurement Information System (PROMIS) measures and evaluate potential correlations with disease manifestations.MethodsWe performed a cross-sectional study of children with JIA and a parent proxy who completed PROMIS measures on depression, anxiety, stress, and pain. The Childhood Health Assessment Questionnaire (CHAQ) measured mobility, and the clinical Juvenile Arthritis Disease Activity Score in 10 joints (cJADAS10) measured disease activity.ResultsEighty-four patients completed the study. Demographic median values included age (14 yrs), disease duration (4.73 yrs), CHAQ score (0), total active joint count (0), and cJADAS10 (2). Using cJADAS10, 57 patients (70%) had inactive or low disease activity. Mean PROMISt-scores for depressive and anxiety symptoms were lower in children with JIA compared to the reference population (P< 0.0001). Nineteen patients (23%) had moderate to severe symptoms of anxiety and/or depression. Age and CHAQ score (mobility) correlated with depressive symptoms (r= 0.36,P=0.0008 andr= 0.32,P =0.0029, respectively) but not anxiety. Depressive and anxiety symptoms correlated with pain (r= 0.64 andr= 0.47, respectively,P <0.0001) and stress (r= 0.79 andr= 0.75, respectively,P <0.0001) but not with sex, JIA subtype, disease duration, or disease activity.ConclusionApproximately one-quarter of children with JIA reported moderate to severe symptoms of anxiety and depression. These symptoms are associated with pain and stress, but they are not associated with other disease manifestations. Understanding how mental health symptoms and JIA affect each other is necessary in order to improve patient outcomes and provide well-rounded care.
Domains to Be Considered for the Core Outcome Set of Axial Spondyloarthritis: Results From a 3-round Delphi Survey
Authors: Boel Anne , Navarro-Compán Victoria , Boonen Annelies , Mease Philip , Kiltz Uta , Dougados Maxime , Landewé Robert , van der Heijde Désirée 
Published: August 2021

ObjectiveAdvances in the field of axial spondyloarthritis (axSpA) and the methodology to develop core sets have led the Assessment of SpondyloArthritis international Society (ASAS) group to update the ASAS–Outcomes in Rheumatology (OMERACT) core set. An important aspect was to ensure it would be applicable to the entire spectrum of axSpA. The first step was to define the most relevant disease domains.MethodsA 3-round Delphi survey was conducted to gather opinions of 188 patients and 188 axSpA experts to define the most relevant disease domains to be included in the core set. The Delphi survey evaluated 2 separate research settings: (1) studies assessing symptom-modifying therapies; and (2) studies evaluating disease-modifying therapies. Importance of the domains was rated on a 1–9 Likert scale. A domain was considered for inclusion if, for both stakeholder groups, ≥ 70% of participants scored the domain as critical (7–9) and ≤ 15% scored it as not important (1–3) after 3 rounds.ResultsA total of 132 (70%) patients and 135 (72%) experts completed at least 1 round. After 3 rounds, 7 domains (pain, physical function, stiffness, disease activity, mobility, overall functioning and health, peripheral manifestations) were selected for the symptom-modifying therapies setting. For the disease-modifying therapies setting, 6 domains (physical function, disease activity, mobility, structural damage, extramusculoskeletal manifestations, peripheral manifestations) were selected. All domains selected by experts were also selected by patients. Patients selected all offered domains except emotional function.ConclusionThis study provides the domains selected by patients and axSpA experts that should be considered for the core set for axSpA.
Screening for Hepatitis B Virus Prior to Initiating Tocilizumab and Tofacitinib in Patients With Rheumatic Diseases: A Cross-sectional Study
Authors: Mohareb Amir M. , Patel Naomi J. , Fu Xiaoqing , Kim Arthur Y. , Wallace Zachary S. , Hyle Emily P. 
Published: August 2021

ObjectiveHepatitis B virus (HBV) can reactivate among rheumatology patients initiating tocilizumab (TCZ) or tofacitinib (TOF). HBV screening is recommended by the Centers for Disease Control and Prevention (CDC), the American Association for the Study of Liver Diseases (AASLD), and the Canadian Rheumatology Association, but it is not explicitly recommended by the American College of Rheumatology.MethodsWe conducted a cross-sectional study to characterize HBV screening practices for adult rheumatology patients initiating TCZ or TOF before December 31, 2018, in the Greater Boston area. We classified appropriate HBV screening patterns prior to TCZ or TOF (i.e., HBV surface antigen [HBsAg], total core antibody [anti-HBcAb], and surface antibody [HBsAb]) as follows: complete (all 3 tested), partial (any 1 or 2 tests), or none. We determined the frequency of inappropriate HBV testing (HBV e-antigen, anti-HBcAb IgM, or HBV DNA without a positive HBsAg or total anti-HBcAb) and used multivariable regression to assess factors associated with complete HBV screening.ResultsAmong 678 subjects initiating TCZ, 194 (29%) completed appropriate HBV screening, 307 (45%) had partial screening, and 177 (26%) had none. Among 391 subjects initiating TOF, 94 (24%) completed appropriate HBV screening, 195 (50%) had partial screening, and 102 (26%) had none. Inappropriate testing was performed in 22% of subjects. Race was associated with complete HBV screening (White vs non-White: OR 0.74, 95% CI 0.57–0.95), whereas prior immunosuppression was not (conventional synthetic disease-modifying antirheumatic drugs [DMARDs]: OR 1.05, 95% CI 0.72–1.55; biologic DMARDs: OR 0.73, 95% CI 0.48–1.12).ConclusionPatients initiating TCZ or TOF are infrequently screened for HBV despite recommendations from the AASLD and CDC.
Guillain-Barré Syndrome After Acute Hepatitis E Infection: A Case Report and Literature Review
Authors: Rose Mariah Q. , Santos Christan D. , Rubin Devon I. , Siegel Jason L. , Freeman William D. 
Published: August 2021

IntroductionGuillain-Barré syndrome precipitated by hepatitis E virus infection is rare, yet its incidence is increasing.Clinical FindingsA 57-year-old man was transferred from another facility with fatigue, orange urine, and progressive weakness over 4 to 6 weeks. Initial laboratory results included total bilirubin, 9.0 mg/dL; direct bilirubin, 6.4 mg/dL; aspartate aminotransferase, 1551 U/L; alanine aminotransferase, 3872 U/L; and alkaline phosphatase, 430 U/L. Immunoglobulin M and quantitative polymerase chain reaction test results were positive for hepatitis E virus. Contrast-enhanced magnetic resonance imaging of the brain and spine showed no gross abnormalities. Analysis of cerebrospinal fluid obtained by lumbar puncture revealed the following (reference values in parentheses): total white blood cell count, 15/μL (0–5/μL), with 33% neutrophils and 54% lymphocytes; protein, 0.045 g/dL (0.015–0.045 g/dL); and glucose, 95 mg/dL (within reference range). Neurological examination revealed weakness in both upper extremities, with proximal strength greater than distal strength. The patient could not elevate either lower extremity off the bed and had areflexia and reduced sensation throughout all extremities.DiagnosisGuillain-Barré syndrome secondary to acute hepatitis E virus infection was diagnosed on the basis of clinical characteristics, serum and cerebrospinal fluid analyses, and nerve conduction studies.ConclusionsNurses and clinicians should obtain a thorough history and consider hepatitis E virus infection as a precipitating factor in patients with sensory and motor disturbances consistent with Guillain-Barré syndrome. The case gives insight into the diagnostic process for Guillain-Barré syndrome and highlights the vital role of bedside nurses in evaluating and treating these patients.
An Evidence-Based Initiative to Reduce Alarm Fatigue in a Burn Intensive Care Unit
Authors: Gorisek Rayna , Mayer Celeste , Hicks W. Braxton , Barnes Janey 
Published: August 2021

Background
Alarm fatigue occurs when nurses are exposed to multiple alarms of mixed significance and become desensitized to alarms to the point that a critical alarm may receive no response or a delayed response. In burn intensive care units, reducing the risk of alarm fatigue is uniquely challenging because of the critically ill patient population and the nature of burn skin injuries. Nurses and the interdisciplinary team can become fatigued and desensitized to alarms, decreasing response rates for necessary interventions.

Objective
To decrease the risk of alarm fatigue by using an initiative designed to reduce nonactionable and false alarms in a burn intensive care unit.

Methods
Baseline data (alarm count per patient-day by alarm type) were collected for 1 month before education and implementation of evidence-based interventions. Data were collected every 6 months for 2 years.

Interventions
A series of interventions included raising awareness of the risks associated with alarm fatigue, customizing alarm parameters and default settings, providing education on electrode placement and daily electrode changes, using physical reminders, and consistently sharing alarm data. The education, delivered in modules, aligned with the evidence-based interventions.

Results
Preintervention baseline data were compared to postintervention data at 6, 12, 18, and 24 months. The results showed a significantly sustained reduction (P &lt; .001) in total alarm rate over time.

Conclusion
A quality improvement initiative based on evidence-based practice can contribute to a sustainable reduction in nonactionable and false alarms, ultimately improving patient safety.