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.

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).

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).

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).

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).

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).

Immunodominance of Antibody Recognition of the HIV Envelope V2 Region in Ig-Humanized Mice.

In the RV144 gp120 HIV vaccine trial, decreased transmission risk was correlated with Abs that reacted with a linear epitope at a lysine residue at position 169 (K169) in the HIV-1 envelope (Env) V2 region. The K169 V2 response was restricted to Abs bearing Vλ rearrangements that expressed aspartic acid/glutamic acid in CDR L2. The AE.A244 gp120 in AIDSVAX B/E also bound to the unmutated ancestor of a V2-glycan broadly neutralizing Ab, but this Ab type was not induced in the RV144 trial. In this study, we sought to determine whether immunodominance of the V2 linear epitope could be overcome in the absence of human Vλ rearrangements. We immunized IgH- and Igκ-humanized mice with the AE.A244 gp120 Env. In these mice, the V2 Ab response was focused on a linear epitope that did not include K169. V2 Abs were isolated that used the same human VH gene segment as an RV144 V2 Ab but paired with a mouse λ L chain. Structural characterization of one of these V2 Abs revealed how the linear V2 epitope could be engaged, despite the lack of aspartic acid/glutamic acid encoded in the mouse repertoire. Thus, despite the absence of the human Vλ locus in these humanized mice, the dominance of Vλ pairing with human VH for HIV-1 Env V2 recognition resulted in human VH pairing with mouse λ L chains instead of allowing otherwise subdominant V2-glycan broadly neutralizing Abs to develop.

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).

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).

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

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

Combined HIV-1 Envelope Systemic and Mucosal Immunization of Lactating Rhesus Monkeys Induces a Robust Immunoglobulin A Isotype B Cell Response in Breast Milk.

UNLABELLED: Maternal vaccination to induce anti-HIV immune factors in breast milk is a potential intervention to prevent postnatal HIV-1 mother-to-child transmission (MTCT). We previously demonstrated that immunization of lactating rhesus monkeys with a modified vaccinia Ankara (MVA) prime/intramuscular (i.m.) protein boost regimen induced functional IgG responses in milk, while MVA prime/intranasal (i.n.) boost induced robust milk Env-specific IgA responses. Yet, recent studies have suggested that prevention of postnatal MTCT may require both Env-specific IgA and functional IgG responses in milk. Thus, to investigate whether both responses could be elicited by a combined systemic/mucosal immunization strategy, animals previously immunized with the MVA prime/i.n. boost regimen received an i.n./i.m. combined C.1086 gp120 boost. Remarkably, high-magnitude Env-specific IgA responses were observed in milk, surpassing those in plasma. Furthermore, 29% of vaccine-elicited Env-specific B cells isolated from breast milk were IgA isotype, in stark contrast to the overwhelming predominance of IgG isotype Env-specific B cells in breast milk of chronically HIV-infected women. A clonal relationship was identified between Env-specific blood and breast milk B cells, suggesting trafficking of that cell population between the two compartments. Furthermore, IgA and IgG monoclonal antibodies isolated from Env-specific breast milk B cells demonstrated diverse Env epitope specificities and multiple effector functions, including tier 1 neutralization, antibody-dependent cellular cytotoxicity (ADCC), infected cell binding, and inhibition of viral attachment to epithelial cells. Thus, maternal i.n./i.m. combined immunization is a novel strategy to enhance protective Env-specific IgA in milk, which is subsequently transferred to the infant via breastfeeding. IMPORTANCE: Efforts to increase the availability of antiretroviral therapy to pregnant and breastfeeding women in resource-limited areas have proven remarkably successful at reducing HIV vertical transmission rates. However, more than 200,000 children are infected annually due to failures in therapy implementation, monitoring, and adherence, nearly half by postnatal HIV exposure via maternal breast milk. Intriguingly, in the absence of antiretroviral therapy, only 10% of breastfed infants born to HIV-infected mothers acquire the virus, suggesting the existence of naturally protective immune factors in milk. Enhancement of these protective immune factors through maternal vaccination will be a critical strategy to reduce the global pediatric AIDS epidemic. We have previously demonstrated that a high magnitude of HIV Env-specific IgA in milk correlates with reduced risk of infant HIV acquisition. In this study, we describe a novel HIV vaccine regimen that induces potent IgA responses in milk and therefore could potentially protect against breast milk HIV MTCT.

Human Non-neutralizing HIV-1 Envelope Monoclonal Antibodies Limit the Number of Founder Viruses during SHIV Mucosal Infection in Rhesus Macaques.

HIV-1 mucosal transmission begins with virus or virus-infected cells moving through mucus across mucosal epithelium to infect CD4+ T cells. Although broadly neutralizing antibodies (bnAbs) are the type of HIV-1 antibodies that are most likely protective, they are not induced with current vaccine candidates. In contrast, antibodies that do not neutralize primary HIV-1 strains in the TZM-bl infection assay are readily induced by current vaccine candidates and have also been implicated as secondary correlates of decreased HIV-1 risk in the RV144 vaccine efficacy trial. Here, we have studied the capacity of anti-Env monoclonal antibodies (mAbs) against either the immunodominant region of gp41 (7B2 IgG1), the first constant region of gp120 (A32 IgG1), or the third variable loop (V3) of gp120 (CH22 IgG1) to modulate in vivo rectal mucosal transmission of a high-dose simian-human immunodeficiency virus (SHIV-BaL) in rhesus macaques. 7B2 IgG1 or A32 IgG1, each containing mutations to enhance Fc function, was administered passively to rhesus macaques but afforded no protection against productive clinical infection while the positive control antibody CH22 IgG1 prevented infection in 4 of 6 animals. Enumeration of transmitted/founder (T/F) viruses revealed that passive infusion of each of the three antibodies significantly reduced the number of T/F genomes. Thus, some antibodies that bind HIV-1 Env but fail to neutralize virus in traditional neutralization assays may limit the number of T/F viruses involved in transmission without leading to enhancement of viral infection. For one of these mAbs, gp41 mAb 7B2, we provide the first co-crystal structure in complex with a common cyclical loop motif demonstrated to be critical for infection by other retroviruses.

Examining moderators of discrimination and subjective well-being among LGB individuals.

Research has found perceived discrimination to be a risk factor for mental health concerns among lesbian, gay, and bisexual (LGB) people, but less clarity exists linking perceived discrimination with well-being outcomes. Building from Meyer's (2003) minority stress model, the present study examined the links between perceived discrimination and the 3 components of subjective well-being: positive affect, negative affect, and life satisfaction. Self-esteem and stigma consciousness were explored as empirically and theoretically implied moderators. In a sample of 368 LGB people, structural equation modeling results suggested that discrimination was not significantly associated with positive affect or life satisfaction but had a significant positive relation with negative affect. Self-esteem moderated the associations between discrimination and positive and negative affect, and stigma consciousness moderated the link with negative affect. Practical implications and directions for future research are discussed. (PsycINFO Database Record

Examining the psychology of working theory: Decent work among sexual minorities.

Research has found heterosexist discrimination negatively relates to vocational outcomes among lesbian, gay, and bisexual (LGB) people, but no known study has examined how heterosexist discrimination relates to the attainment of decent work. Building from the Psychology of Working Theory, which proposes that specific forms of marginalization coupled with economic constraints limit a person's ability to secure decent work, the present study examined theoretically hypothesized pathways to decent work among a sample of employed sexual minority adults. Heterosexist discrimination and social class were examined as direct predictors of decent work, and indirect links were examined via work volition and career adaptability. Among our sample of 218 sexual minority people, structural equation modeling results suggested heterosexist discrimination and social class directly-and indirectly through work volition-predicted decent work. Practical implications and directions for future research are discussed. (PsycINFO Database Record

The development and initial validation of the Decent Work Scale.

Decent work is positioned as the centerpiece of the recently developed Psychology of Working Theory (PWT; Duffy, Blustein, Diemer, & Autin, 2016). However, to date, no instrument exists which assesses all 5 components of decent work from a psychological perspective. In the current study, we developed the Decent Work Scale (DWS) and demonstrated several aspects of validity with 2 samples of working adults. In Study 1 (N = 275), a large pool of items were developed and exploratory factor analysis was conducted resulting in a final 15-item scale with 5 factors/subscales corresponding to the 5 components of decent work: (a) physically and interpersonally safe working conditions, (b) access to health care, (c) adequate compensation, (d) hours that allow for free time and rest, and (e) organizational values that complement family and social values. In Study 2 (N = 589), confirmatory factor analysis demonstrated that a 5-factor, bifactor model offered the strongest and most parsimonious fit to the data. Configural, metric, and scalar invariance models were tested demonstrating that the structure of the instrument did not differ across gender, income, social class, and majority/minority racial/ethnic groups. Finally, the overall scale score and 5 subscale scores correlated in the expected directions with similar constructs supporting convergent and discriminant evidence of validity, and subscale scores evidenced predictive validity in the prediction of job satisfaction, work meaning, and withdrawal intentions. The development of this scale provides a useful tool for researchers and practitioners seeking to assess the attainment of decent work among employed adults. (PsycINFO Database Record

Vaccine-Induced Linear Epitope-Specific Antibodies to Simian Immunodeficiency Virus SIVmac239 Envelope Are Distinct from Those Induced to the Human Immunodeficiency Virus Type 1 Envelope in Nonhuman Primates.

To evaluate antibody specificities induced by simian immunodeficiency virus (SIV) versus human immunodeficiency virus type 1 (HIV-1) envelope antigens in nonhuman primate (NHP), we profiled binding antibody responses to linear epitopes in NHP studies with HIV-1 or SIV immunogens. We found that, overall, HIV-1 Env IgG responses were dominated by V3, with the notable exception of the responses to the vaccine strain A244 Env that were dominated by V2, whereas the anti-SIVmac239 Env responses were dominated by V2 regardless of the vaccine regimen.