Evaluating Therapeutic Inertia in Two Telehealth Interventions for Type 2 Diabetes: Secondary Analyses of a Randomized Trial.

Introduction: Although therapeutic inertia is a known driver of suboptimal type 2 diabetes control, little is known about how to combat this phenomenon. We analyzed randomized trial data to determine whether a comprehensive telehealth intervention was more effective than a less structured telehealth approach (telemonitoring and care coordination) at promoting treatment intensification in poorly controlled diabetes. Methods: Patients with poorly controlled type 2 diabetes were randomized 1:1 to telemonitoring/care coordination or a comprehensive telehealth intervention, which included an active, study provider-guided medication management component. Prospectively collected medication lists were used to determine whether treatment intensification occurred for each patient during 3-month intervals throughout the study period. To examine between-arm differences in treatment intensification over time, we fit a generalized estimation equation model. In each arm, hemoglobin A1c levels at the beginning and end of each 3-month interval were used to distinguish between therapeutic inertia and potentially appropriate nonintensification of treatment. Results: The mean, model-estimated likelihood of treatment intensification during 3-month intervals was 61.3% in the comprehensive telehealth group versus 48.6% for telemonitoring/care coordination (odds ratio 1.7, 95% confidence interval 1.2-2.2; p = 0.0007), with no evidence that treatment effect varied over time (p = 0.54). Treatment intervals with observed therapeutic inertia were more common in the telemonitoring/care coordination arm than the comprehensive telehealth arm (116/300, 39% vs. 57/275, 21%). Conclusions: A comprehensive telehealth approach that integrated protocol-guided medication management increased treatment intensification and reduced therapeutic inertia compared with a less structured telehealth approach. The studied approaches may serve as examples of how systems might use telehealth to combat therapeutic inertia. Clinical Trial Registration: ClinicalTrials.gov NCT03520413.

Underrecognition of Nonalcoholic Fatty Liver Disease in Poorly Controlled Diabetes: A Call to Action in Diabetes Care.

Individuals with type 2 diabetes (T2DM) are at high risk for nonalcoholic fatty liver disease (NAFLD), and evidence suggests that poor glycemic control is linked to heightened risk of progressive NAFLD. We conducted an observational study based on data from a telehealth trial conducted in 2018-2020. Our objectives were to (1) characterize patterns of NAFLD testing/care in a cohort of individuals with poorly controlled T2DM; and (2) explore how laboratory based measures of NAFLD (eg, liver enzymes, fibrosis-4 [FIB-4]) vary by glycemic control. We included individuals with poorly controlled T2DM (n = 228), defined as hemoglobin A1c (HbA1c) ≥ 8.5% despite clinic-based care. Two groups of interest were (1) T2DM without known NAFLD; and (2) T2DM with known NAFLD. Demographics, medical history, medication use, glycemic control (HbA1c), and NAFLD testing/care patterns were obtained by chart review. Among those without known NAFLD (n = 213), most were male (78.4%) and self-identified as Black race (68.5%). Mean HbA1c was 9.8%. Most had liver enzymes (85.4%) and platelets (84.5%) ordered in the outpatient department over a 2-year period that would allow for FIB-4 calculation, yet only 2 individuals had FIB-4 documented in clinical notes. Approximately one-third had abnormal liver enzymes at least once over a 2-year period, yet only 7% had undergone liver ultrasound and 4.7% had referral to hepatology. Among those with known NAFLD (n = 15), mean HbA1c was 9.5%. Only 4 individuals had undergone transient elastography, half of whom had advanced fibrosis. NAFLD is underrecognized in poorly controlled T2DM, even though this is a high-risk group for NAFLD and its complications.

Profiles of decent work: General trends and group differences.

Recent trends in the labor market-marked by instability and insecurity-have further ignited a discourse on the significance of decent work in people's lives. Scholars have mostly studied the multidimensional decent work construct using the composite scores of the Decent Work Scale (DWS; Duffy et al., 2017). However, there may be different combinations of decent work beyond the simple continuum of composite scores. Thus, we employed latent profile analysis to identify profiles of decent work using the 5 subscales of the DWS as indicators. As a result, 5 different groups with distinct profiles emerged: (a) average, (b) low health care, (c) indecent work, (d) only health care, and (e) decent work. Subsequent analyses comparing each group on demographics (gender, employment, education), theoretical predictors (economic constraints, marginalization, work volition), and theoretical outcomes (job satisfaction, life satisfaction) revealed notable differences across the 5 groups. Implications, limitations, and future directions of the results are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Unemployment in the time of COVID-19: A research agenda.

This essay represents the collective vision of a group of scholars in vocational psychology who have sought to develop a research agenda in response to the massive global unemployment crisis that has been evoked by the COVID-19 pandemic. The research agenda includes exploring how this unemployment crisis may differ from previous unemployment periods; examining the nature of the grief evoked by the parallel loss of work and loss of life; recognizing and addressing the privilege of scholars; examining the inequality that underlies the disproportionate impact of the crisis on poor and working class communities; developing a framework for evidence-based interventions for unemployed individuals; and examining the work-family interface and unemployment among youth.

Decent and meaningful work: A longitudinal study.

A fundamental proposition of the psychology of working theory is that for work to be meaningful, it must first be decent. The psychology of working theory also suggests that decent work leads to meaningful work partly by helping workers meet their needs for social connection. Therefore, the purpose of the current study was to contribute to both the meaningful work and psychology of working theory literatures by longitudinally examining the relation between decent and meaningful work and investigating 3 social connection mediators of this relation. We recruited a large online sample of working adults and surveyed them 4 times over a 9-month period. To test our hypotheses, we examined whether social contact, helping others, and community belonging explained the relation between decent and meaningful work at both the between-person and within-person levels. We found that overall levels of decent work were positively associated with overall levels of meaningful work and that positive changes in decent work were associated with positive changes in meaningful work. Moreover, we found that between-person community belonging and within-person helping others mediated the relation between decent work and meaningful work. These results have implications for identifying predictors of meaningful work and advancing the psychology of working theory by identifying specific social connection mediators of decent and meaningful work. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Women attaining decent work: The important role of workplace climate in Psychology of Working Theory.

Grounded in Psychology of Working Theory (PWT), the current study investigated predictors of decent work among a sample of employed women (N = 528). A structural equation model was examined finding that women's experiences of marginalization, work volition, and career adaptability all directly predicted the attainment of decent work, and economic constraints and marginalization experiences indirectly predicted decent work via work volition. Additionally, workplace climate for women employees was examined as both a predictor and moderator variable to explore best positioning of this additive construct. Workplace climate did not significantly moderate any model paths; however, it was a unique predictor of work volition and decent work, suggesting that this construct may be better positioned as a predictor variable in understanding the work experiences of women. These results highlight the importance of further investigating the role of workplace climate in PWT as well as the need for refining our understanding of how marginalized employees achieve decent work. Implications of the present study's results are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Beyond Happiness: Minority Stress and Life Meaning Among LGB Individuals.

Scholars have recently started to examine how minority stressors are associated with wellbeing outcomes among lesbian, gay, and bisexual (LGB) people. Such studies have examined mainly hedonic wellbeing, and those that have investigated eudaimonic wellbeing have tended to use composite measures. The present study draws from this literature to examine how minority stressors are associated with a key indicator of eudaimonic wellbeing: life meaning. Drawing from the minority stress model, we examined these associations using structural equation modeling among 266 LGB adults. Expectations of rejection and identity concealment, but not discrimination or internalized homophobia, had significant negative associations with life meaning. Discrimination had negative indirect associations with life meaning via expectations of rejection and concealment. Our results highlight the nuanced relations that exist between minority stressors and life meaning and highlight the need to move beyond composite measures of wellbeing. Implications for clinical practice and directions for research are discussed.

Testing a critical cultural wealth model of well-being among first-generation students.

The current study examined predictors of career choice and life satisfaction among a diverse sample of first-generation college students (N = 424). Grounded in the critical cultural wealth model (CCWM; Garriott, 2019), financial stress, sense of belonging, and work volition were found to directly predict life satisfaction and work volition was found to directly predict career choice satisfaction. Additionally, work volition and/or a sense of belonging were found to significantly mediate the relation of financial stress and experiences of discrimination to career choice and life satisfaction. Invariance testing revealed that the model fit equally well for students identifying as a racial/ethnic minority compared with White students, for freshman/sophomores compared with juniors/seniors, and for students who were part of a first-generation scholarship program versus those who were not. Overall, findings suggest that first-generation students' sense of career choice and life satisfaction is predicted primarily by feelings of work volition and belonging on campus, each of which may be negatively affected by experiencing higher levels of financial stress or discrimination on campus. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

A cross-cultural comparison of psychology of working theory among U.S. and Korean college students.

The cross-cultural validity of a modified version of psychology of working theory (PWT; Duffy, Blustein, Diemer, & Autin, 2016) was tested in samples of United States (n = 346) and Korean (n = 319) undergraduates. Participants completed measures of economic resources, work volition, career adaptability, occupational engagement, and future decent work perceptions. The results illustrated measurement invariance between the two samples. Thus, the hypothesized models were tested separately in the two samples and the results were compared regarding parameter significance, direction, and magnitude. Overall, the modified model generally fit well with both samples. However, there were notable cross-cultural differences: economic resources significantly predicted work volition, occupational engagement, and future decent work perceptions only in the United States sample and the future decent work perceptions and occupational engagement were negatively associated in the Korean sample. Explanations about the cross-cultural differences and invariances were provided and practical and research implications were discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Normal saline versus Normosol™-R in sepsis resuscitation: A retrospective cohort study.

OBJECTIVE: To determine the effect of Normosol™-R as compared to normal saline on the outcomes of acute kidney injury and the need for renal replacement therapy in the resuscitation phase of sepsis. DESIGN: Our study is a retrospective before-and-after cohort study. SETTING: The study occurred at a 700-bed tertiary academic level 1-trauma center. PATIENTS: A total of 1218 patients were enrolled through emergency department admissions. The normal saline (before) cohort was defined as the dates between 1 March and 30 September 2014 and the Normosol™-R (after) cohort was assessed from 1 March to 30 September 2015. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Intravenous fluid volumes received during the first 24 h, 72 h, and total hospital stays were compared. Sodium, chloride, potassium, and bicarbonate levels at 72 h were also compared. The medical coded diagnosis of acute kidney failure, need for renal replacement therapy, hospital LOS, ICU admission, ICU LOS, in-hospital mortality, and need for mechanical ventilation were all compared. There was no significant difference in intravenous fluid volumes between groups. Regression modelling controlling for baseline characteristics and 24-h fluid intake volume found no differences between groups for the primary outcomes of acute kidney injury (P = 0.99) and renal replacement therapy (P = 0.88). Patients in the Normosol™-R cohort were found to have a lower rate of hyperchloremia at 72 h post-admission (28% vs. 13%, P < 0.0001). There was a trend toward a decrease in the hospital and ICU LOS in the Normosol™-R cohort; however, the data were not statistically significant. CONCLUSIONS: This study was unable to detect any difference in outcomes between sepsis patients who received intravenous fluid resuscitation with either a balanced crystalloid (Normosol™-R) or normal saline, except for a decreased rate of hyperchloremia.

Application of the psychology of working theory with Korean emerging adults.

Psychology of Working Theory (PWT; Duffy, Blustein, Diemer, & Autin, 2016) is a recently developed framework aimed at documenting predictors and outcomes of decent work. To date, no studies have explored the applicability of the psychology of working perspective with emerging adults. The goal of the present study is to examine the predictor portion of PWT with a sample of Korean emerging adults from diverse economic backgrounds. Data were collected from a sample of 407 emerging adults attending a large junior college in Korea. Overall, most of the hypothesized direct paths were significant, with economic resources positively relating to both work volition and career adaptability and these positively relating to occupational engagement and future perceptions of securing decent work. Support for the hypothesized indirect effects was mixed. Overall, results suggest that the PWT is generally relevant and applicable to emerging adults when population-appropriate outcomes are included in the model and that the theory is supported in the Korean context. Based on the results, we also propose that interventions based on malleable psychological factors-the mediators in our study-may be targets when working with emerging adults experiencing economic constraints. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The development and initial validation of need satisfaction scales within the psychology of working theory.

The psychology of working theory (PWT; Duffy, Blustein, Diemer, & Autin, 2016) provides a framework to understand predictors and outcomes of decent work. Given that basic need satisfaction is hypothesized to be a primary mediator in the link between decent work and well-being, it is essential to have valid and reliable scales that are consistent with the PWT framework. In the current study, we developed the Work Needs Satisfaction Scales, a set of instruments designed to measure satisfaction of survival, social contribution, and self-determination needs from a PWT perspective. In Study 1 (N = 345), a pool of items was developed and exploratory factor analysis was conducted, resulting in five 4-item scales representing survival need satisfaction, social contribution need satisfaction, and three components of self-determination need satisfaction (i.e., autonomy, competence, relatedness). In Study 2 (N = 476), we used confirmatory factor analysis to test 4 different structural models, finding that there were no significant differences between models. Thus, results offer a flexible 5-factor model, the structure of which may be adapted based on theory and researcher needs. Authors provide theory-driven recommendations on how to best use choice of structural models for PWT research. Finally, we demonstrated convergent, discriminant, and concurrent validity for the structural model most consistent with the PWT. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

An initial examination of the work as calling theory.

Over the past decade, research on work as a calling has seen a rapid growth, with hundreds of empirical articles on the topic having been published. Until recently, however, there has been no comprehensive theoretical model of work as a calling to guide research. Duffy, Dik, Douglass, England, and Velez (2018) published the Work as Calling Theory (WCT), which provides a comprehensive model of the predictors and outcomes of living out a calling. The present study provides the first empirical examination of the 20 propositions outlined within the predictor portion of this model. Using data collected from a sample of 424 employed adults living in the United States, from diverse social class backgrounds and occupations, we conducted latent variable structural equation modeling to evaluate the model propositions. Overall, we found full (17) and partial (1) support for 18 of the 20 model propositions, which included direct effects along with mediating and moderating effects. Person-environment fit, career commitment, and work meaning appear to be critical in helping to translate a perceived calling and access to opportunity into a lived calling. Additionally, calling motivation, organizational support, and job crafting may play a key role in helping employees with a calling experience more fit with their work environments. Taking these findings into consideration, we explore practical implications for career counselors and employers and highlight future directions for scholars using the WCT. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Career development among undocumented immigrant young adults: A psychology of working perspective.

Undocumented immigrants are among the most vulnerable of workers in the U.S. and face a unique set of barriers to obtaining adequate education and decent work. In the current study, we conducted a qualitative examination of the career development of undocumented young adults. Drawing from the Psychology of Working Theory (PWT; Duffy, Blustein, Diemer, & Autin, 2016), we examined barriers (e.g., economic constraints, marginalization) and resources (e.g., social support, critical consciousness, proactive personality) to participants' career development and sense of work volition. As a secondary aim, we explored general work attitudes. Using Consensual Qualitative Research methods, we interviewed 12 undocumented young adults between the ages of 18 and 26. All participants were DACA recipients. Barriers that most impacted work volition were economic strain and limited mobility; resources that were most supportive for work volition were social support, institutional support, and public policy changes. Regarding work attitudes, participants endorsed a high value of a strong work ethic, a variety of motivations to work, and a high degree of resilience. Implications for counseling psychologists, career development specialists, educators, and policymakers are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Work as a calling: A theoretical model.

Perceiving work as a calling has been positioned as a key pathway to enhancing work-related well-being. However, no formal theory exists attempting to explain predictors and outcomes of living a calling at work. To address this important gap, this article introduces a theoretical, empirically testable model of work as a calling - the Work as Calling Theory (WCT) - that is suitable for the contemporary world of work. Drawing from research and theory in counseling, vocational, multicultural, and industrial-organizational psychology, as well as dozens of quantitative and qualitative studies on calling, the WCT is presented in three parts: (a) predictors of living a calling, (b) variables that moderate and mediate the relation of perceiving a calling to living a calling, and (c) positive (job satisfaction, job performance) and potentially negative (burnout, workaholism, exploitation) outcomes that result from living a calling. Finally, practical implications are suggested for counselors and managers, who respectively may seek to help clients and employees live a calling. (PsycINFO Database Record

An examination of the Psychology of Working Theory with racially and ethnically diverse employed adults.

The present study tested key tenets of the Psychology of Working Theory (PWT) in a sample of 526 racially and ethnically diverse employed adults. The authors investigated how economic resources and marginalization predicted decent work through experiences of work volition and career adaptability. Support for the hypotheses was mixed. There was a direct, negative relation between marginalization and decent work; a direct, positive relation between economic resources and work volition; and a direct, negative relation between marginalization and work volition. There was a positive relation between work volition and career adaptability as well as with decent work. Work volition was also found to significantly mediate the relations between marginalization and economic resources to decent work. These results suggest that the primary reason why greater economic resources and lower experiences of marginalization predict engaging in decent work is attributable to an increased sense of choice in one's career decision making. Results suggest the need for further investigation using the PWT to understand how racially and ethnically diverse employed adults secure decent work. Practical implications are discussed. (PsycINFO Database Record

Generation and characterization of a bivalent protein boost for future clinical trials: HIV-1 subtypes CR01_AE and B gp120 antigens with a potent adjuvant.

The RV144 Phase III clinical trial with ALVAC-HIV prime and AIDSVAX B/E subtypes CRF01_AE (A244) and B (MN) gp120 boost vaccine regime in Thailand provided a foundation for the future development of improved vaccine strategies that may afford protection against the human immunodeficiency virus type 1 (HIV-1). Results from this trial showed that immune responses directed against specific regions V1V2 of the viral envelope (Env) glycoprotein gp120 of HIV-1, were inversely correlated to the risk of HIV-1 infection. Due to the low production of gp120 proteins in CHO cells (2-20 mg/L), cleavage sites in V1V2 loops (A244) and V3 loop (MN) causing heterogeneous antigen products, it was an urgent need to generate CHO cells harboring A244 gp120 with high production yields and an additional, homogenous and uncleaved subtype B gp120 protein to replace MN used in RV144 for the future clinical trials. Here we describe the generation of Chinese Hamster Ovary (CHO) cell lines stably expressing vaccine HIV-1 Env antigens for these purposes: one expressing an HIV-1 subtype CRF01_AE A244 Env gp120 protein (A244.AE) and one expressing an HIV-1 subtype B 6240 Env gp120 protein (6240.B) suitable for possible future manufacturing of Phase I clinical trial materials with cell culture expression levels of over 100 mg/L. The antigenic profiles of the molecules were elucidated by comprehensive approaches including analysis with a panel of well-characterized monoclonal antibodies recognizing critical epitopes using Biacore and ELISA, and glycosylation analysis by mass spectrometry, which confirmed previously identified glycosylation sites and revealed unknown sites of O-linked and N-linked glycosylations at non-consensus motifs. Overall, the vaccines given with MF59 adjuvant induced higher and more rapid antibody (Ab) responses as well as higher Ab avidity than groups given with aluminum hydroxide. Also, bivalent proteins (A244.AE and 6240.B) formulated with MF59 elicited distinct V2-specific Abs to the epitope previously shown to correlate with decreased risk of HIV-1 infection in the RV144 trial. All together, these results provide critical information allowing the consideration of these candidate gp120 proteins for future clinical evaluations in combination with a potent adjuvant.

Helping others increases meaningful work: Evidence from three experiments.

The aim of the current research was to examine whether manipulating task significance increased the meaningfulness of work among students (Study 1), an online sample of working adults (Study 2), and public university employees (Study 3). In Study 1, students completed a typing task for the benefit of themselves, a charity, or someone they knew would directly benefit from their work. People who worked to benefit someone else, rather than themselves, reported greater task meaningfulness. In Study 2, a representative, online sample of employees reflected on a time when they worked to benefit themselves or someone else at work. Results revealed that people who reflected on working to benefit someone else, rather than themselves, reported greater work meaningfulness. In Study 3, public university employees participated in a community intervention by working as they normally would, finding new ways to help people each day, or finding several new ways to help others on a single day. People who helped others many times in a single day experienced greater gains in work meaningfulness over time. Across 3 experimental studies, we found that people who perceived their work as helping others experienced more meaningfulness in their work. This highlights the potential mechanisms practitioners, employers, and other parties can use to increase the meaningfulness of work, which has implications for workers' well-being and productivity. (PsycINFO Database Record

Multiple Mini Interview Performance and Career Maturity related to Medicine.

This article was migrated. The article was marked as recommended. Introduction: Multiple Mini Interview (MMI) is used to determine the most suitable candidates for the medical profession. It is also important to ensure students have the career maturity necessary to cope with the developmental tasks associated with medical training. This study explored if students stronger in their career decision of medicine perform better on the MMI. Methods: 119 students (72% response rate) completed a career maturity measure. Student MMI scores were matched to career maturity responses. Results: A significant positive correlation (p <.05) existed between MMI score and specify physician as a career preference (r =.177, N =112, p <.031). There was no significant correlation with the MMI score and crystalize a career preference (r =.046, N =119, p =.31) or implement physician as career choice (r =.039, N =114, p =.34). Mean scores for both crystalize career preference ( M = 18.91) and implement physician as career choice ( M = 17.46) indicate that students performing lower on the MMI continue coping with those tasks as compared to specify (M=20.65). Conclusion: Findings suggest a relation between medical student's career maturity and interview performance as measured using the MMI, with students in the intermediate stages of career development having higher MMI scores.

The Great Unknown-A systematic literature review about risk associated with intraoperative imaging during orthopaedic surgeries.

INTRODUCTION: Modern techniques in orthopaedic surgery using minimally invasive procedures, and increased use of fluoroscopic imaging present a potential increased risk to surgeons due to ionizing radiation exposure. This article is a systematic review of recent literature on radiation exposure of orthopaedic surgeons. MATERIALS AND METHODS: Pubmed and Cochrane searches were performed on intraoperative radiation exposure covering English and German articles published between 1.1.2000 and 11.8.2014. Inclusion criteria were clinical studies and systematic literature reviews focusing on radiation exposure of orthopaedic surgeons during surgical procedures of the musculoskeletal system reporting either effective dose (whole body) or equivalent dose at the organ level. All included articles were reviewed with focus on the surgical specialty, the procedure type, the imaging system used, the radiation measurement method, the fluoroscopy time, the radiation exposure, the use of radiation protection, and any references to specific safety guidelines. RESULTS: Thirty-four eligible publications were identified. However, the lack of well-designed studies focusing on radiation exposure of surgeons prevents pooling of data. Highest exposure and subsequent equivalent doses were reported from spinal surgery (up to 4.8mSv of equivalent dose to the hand) and intramedullary nailing (up to 0.142mSV of equivalent dose to the thyroid). Radiation exposure was reduced by 96.9% and 94.2% when wearing a thyroid collar and a lead apron. CONCLUSIONS: With the increasing use of intraoperative imaging, there is a growing need for radiation awareness by the operating surgeon. Strict adherence to radiation protection should be enforced to protect in-training surgeons. Strategies to reduce exposure include C-arm position, distance, protective wear, and new imaging technologies. Radiation exposure is harmful and action should be taken to minimize exposure.