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You Can Leave the Younger Workers Out of It! Toward a Centered Paradigm for Studying Older Workers’ Employment Relationships and Late-Career Dynamics
Are late careers worth studying in their own right? The way we think and reason about older workers and late careers—in scholarship and in practice—has been disproportionately informed by a research paradigm that focuses on age differences among employees, which captures how older workers on average differ from younger workers on average. While this contrastive paradigm has been generative, it can also inaccurately portray older workers as a static, homogenous group. In contrast, older workers show considerable heterogeneity (older workers vary), meaningful dynamics (older workers change), and dynamic heterogeneity (older workers vary in how they change). In this paper, we propose that the contrastive paradigm be complemented with a centered paradigm that centers on how older workers vary and change. We develop a theoretical model of how older worker dynamics and older worker heterogeneity shape the quality of their employment relationship—in terms of psychological contracts—which in turn shape their career trajectories and work role enactment. By centering this line of research on older workers, we gain a higher-resolution view of these late careers as unfolding over time and varying among older workers.
Factors Affecting Request & Receipt of I-deals: An Investigation in the Context of Older Workers
I-deals are a key method for organizations to retain and motivate employees, yet little research has investigated employee motivations for seeking i-deals and antecedents to request and receipt. We examine these largely invisible antecedents of i-deals in the context of older workers, a cohort of increasing importance in the workplace. Through thematic analysis of 82 in-depth interviews with Australian workers over the age of 50, we develop a model of i-deal emergence that delineates the motivation, request, and receipt stages of i-deals. We identified four motivational influences to seek i-deals: to improve work–life balance, to repair psychological contract breach, and to craft satisfactory retirement pathways; high levels of existing job-role autonomy acted as a demotivator to request i-deals. We also identified three factors associated with an i-deal request being granted: an older worker’s value to the organization, positive employee–manager relationships, and emphasis of mutual benefit for employee and employer. We identified a novel antecedent for i-deals: feasibility—an older worker’s perception of how likely they are to be successful when requesting a desired i-deal. Feasibility perceptions are informed by organizational practices and policies around i-deals, co-worker i-deal experiences, and job-role constraints. Feasibility can influence an employee’s decisions to request an i-deal and also directly affect attitudes toward the employer, regardless of whether an i-deal is present, desired, or otherwise. Theoretical and practical implications are discussed and future directions outlined.
Antibodies to FXa and thrombin in patients with SLE differentially regulate C3 and C5 cleavage.
OBJECTIVES: The significance of antibodies directed against activated factor X (FXa) and thrombin (Thr) in patients with SLE and/or antiphospholipid syndrome (APS) is unknown. FXa and Thr are coregulated by antithrombin (AT) and activate complement. Therefore, we studied the ability of anti activated factor X (aFXa) and/or anti-(a)Thr IgG from patients with SLE±APS to modulate complement activation. METHODS: Patients with SLE±APS were selected on the basis of known aThr and/or aFXa IgG positivity, and the effects of affinity-purified aFXa/aThr IgG on FXa and Thr-mediated C3 and C5 activation were measured ±AT. Structural analyses of FXa and Thr and AT-FXa and AT-Thr complexes were analysed in conjunction with the in vitro ability of AT to regulate aFXa-FXa and aThr-Thr-mediated C3/C5 activation. RESULTS: Using affinity-purified IgG from n=14 patients, we found that aThr IgG increased Thr-mediated activation of C3 and C5, while aFXa IgG did not increase C3 or C5 activation. Structural analysis identified potential epitopes and predicted a higher likelihood of steric hindrance of AT on FXa by aFXa IgG compared with the AT-Thr-aThr IgG complex that was confirmed by in vitro studies. Longitudinal analysis of 58 patients with SLE (±APS) did not find a significant association between positivity for aFXa or aTHr IgG and C3 levels or disease activity, although there was a trend for patients positive for aFXa IgG alone or both aFXa and aThr IgG to have lower levels of C3 compared with aThr IgG alone during clinical visits. CONCLUSIONS: We propose a novel method of complement regulation in patients with SLE±APS whereby aFXa and aThr IgG may have differential effects on complement activation.
How are career adaptable and customer oriented employees treated? Examining career-situated factors that reduce customer mistreatment
Many service workers receive customer mistreatment—low-quality interpersonal treatment from customers—yet little is known about why employees differ in how much customer mistreatment they receive. Drawing upon career construction theory, we cast a spotlight on the service career-situated strengths and attributes that confer upon service workers both the ability and motivation to successfully fulfill service norms and avoid interpersonal mistreatment. Specifically, we focus on customer orientation and career adaptability as career-situated motivations and abilities, respectively, that explain which employees receive more customer mistreatment. The proposed model was tested and expanded programmatically in a series of three studies using dyadic and daily diary field studies. The results across all three studies show that employees who possessed high levels of career adaptability in tandem with high levels of customer orientation were less likely to experience customer mistreatment. These results held even after controlling for Big Five personality factors in Studies 2 and 3. We discuss theoretical implications for the antecedents of workplace mistreatment, the mixed blessing of customer orientation for service workers, and the role of career processes in workplace aggression.
A self-verification perspective on customer mistreatment and customer-directed organizational citizenship behaviors
Customer mistreatment events play a major role in employees' subsequent customer service behaviors, and is believed to have implications for employees' sense of self. We extend this line of research by developing a self-verification account of the relationship between customer mistreatment and customer-directed OCBs (OCB-Cs) by examining theoretically prescribed novel mechanisms (i.e., self-verification) and boundary conditions (i.e., self-esteem and entity customer appreciation) for this relationship. We conducted a programmatic series of studies using daily diary (Study 1), audio vignette (Study 2), and behavioral experiment (Study 3) designs to test the proposed model. The overall pattern of results showed that customer mistreatment led employees to feel less self-verified, especially among those with higher trait self-esteem. These employees in turn were more likely to withhold OCB-Cs, especially among those perceiving lower levels of entity customer appreciation. Overall, these results deepen our understanding of the role of the self-concept in how employees experience and react to customer mistreatment--depending on how employees see themselves and how they see their customers in general.
Patient characteristics in tardive COVID-19 pseudoperniosis: a case series of 16 patients.
BACKGROUND: Acute pseudoperniosis (PP) has a recognized association with COVID-19 and tends to occur without cold precipitation in young, healthy patients, often without a clear history of COVID-19. These lesions usually resolve within 2 weeks and without long-term sequelae. In the early months of 2021, patients with delayed and protracted PP began to emerge. We have called this presentation 'tardive COVID-19 PP (TCPP)'. AIM: To consolidate and expand knowledge on TCPP, we describe the clinical characteristics, treatments and outcomes of 16 patients with TCPP who were reviewed by our outpatient dermatology service. RESULTS: The initial clinical manifestations were erythema, swelling and PP of the fingers in 56.2%, and of the toes in 31.2%, desquamation in 56.2% and acrocyanosis in 12.5%. Ten patients had eventual involvement of all acral sites. The median duration of symptoms was 191 days. Six patients reported close contact with a confirmed or suspected case of COVID-19, but only two had positive COVID-19 tests. Four patients experienced complete or almost complete resolution of symptoms, while the rest remain under active treatment. CONCLUSION: Unlike acute PP, TCPP has a protracted and delayed presentation that is typically associated with profound acrocyanosis. Patients with TCPP represent a new phenomenon that is part of the post-COVID-19 syndrome, with risk factors and pathophysiology that are not yet fully understood. Our data indicate that likely predisposing factors for developing TCPP include young age, a preceding history of cold intolerance and an arachnodactyloid phenotype. Anorexia, connective tissue disorders or sickle cell trait may also predispose to TCPP. In addition, low titre antinuclear antibody positivity, the presence of cryoglobulins, or low complement levels may represent further risk factors. Finally, prolonged low temperatures are also likely to be contributing to the symptoms.
Perceived overqualification and experiences of incivility: Can task i-deals help or hurt?
We examined why overqualified employees may report heightened levels of experienced incivility, particularly when they have successfully negotiated task i-deals from their employers. Adopting a person-job fit perspective, we examined our proposed model in two studies with employees in the higher education industry (Study 1) and workers from a range of industries and occupations (Study 2). In Study 1 (N = 229), the moderated mediation model showed that task i-deals attenuated the positive relationship between perceived overqualification and boredom sensations, which was associated with reduced experienced incivility. In Study 2 (N = 222), using a time-lagged design, we expanded on Study 1 findings by examining dimensions of person-job fit, namely, demands-abilities fit and needs-supplies fit, as well as perceptions of being envied by coworkers as mechanisms. Supporting our theorizing, we showed that task i-deals buffered the negative relationship between perceived overqualification and demands-abilities fit. Ironically, the provision of i-deals intensified overqualified employees' perceptions of being envied by coworkers, which in turn explained their reported experiences of incivility. These results highlighted the complexity of reducing interpersonal stressors, wherein the provision of task i-deals minimized the misfit and associated boredom sensations of overqualified employees. Yet, such customized working arrangements intensified overqualified employees' feelings of being envied and their reports of experienced incivility. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Improving delirium screening and recognition in UK hospitals: results of a multi-centre quality improvement project.
BACKGROUND: delirium is an acute severe neuropsychiatric condition associated with adverse outcomes, particularly in older adults. However, it is frequently under-recognised. METHODS: this multi-centre quality improvement project utilised a collaborative approach to implementation of changes at sites, with the aim to improve delirium screening, recognition and documentation on discharge summaries. Resources, including delirium guidelines and presentations, were shared between sites, and broad details of local interventions were collected. Three timepoints of data collection (14 March 2018, 14 September 2018 and 13 March 2019) were conducted to assess screening, recognition and documentation of delirium in unscheduled admissions of adults aged ≥65 years old. The impact of local interventions and site-specific factors was assessed using logistic regression analysis, adjusting for patient factors. RESULTS: a total of 3,013 patients (mean age 80.2, 53.8% females) were recruited across the three timepoints. Screening for delirium was associated with increased odds of recognition (aOR 4.75, CI 2.98-7.56; P
Savvy investments or formative endowments? Disentangling causal direction in the association between parental support and self-efficacy in STEM university students.
Conventional wisdom views the parent-child relationship as unilateral: Parents' actions upstream flow downstream to shape their children's development. However, scholars have proposed that this view of parenting is lopsided; children may influence their parents no less than parents influence children. We apply this bilateral perspective in a reexamination of the robust finding that confident people report having had more supportive parents. The social-cognitive explanation for this finding is that parents endow their children with support that builds confidence. However, evolutionary accounts suggest that confident children-displaying more promise and potential-ought to attract their parents' investments of support. We examined these predictions in a four-wave longitudinal study drawing on both archival and field survey data from 350 STEM students (science, technology, engineering, and mathematics) in the Philippines. Results were consistent with the bilateral perspective, in which parental support endowed children with confidence, but also children's confidence attracted parental support in equal measure. These reciprocal relations also had implications for whether or not students persisted in their computer science degrees. The results indicate that parental endowments of confidence and parental investments of support form a virtuous cycle, consistent with the perspective that self-efficacy operates not only as an intrapsychic resource allocator but also as an interpersonal resource attractor. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Finding humor in work–life conflict: Distinguishing the effects of individual and co-worker humor
Work–life conflict is a ubiquitous challenge for employees juggling work and family roles, yet little research has examined individual strategies to manage and mitigate its negative effects. We direct attention in this literature to a common-yet-understudied practical strategy: humor. Further, we take next steps in this literature to distinguish between co-worker and employees' own use of coping humor. Integrating benign violation theory with the transactional theory of stress and coping, we develop and test a theoretical model of how both individual and co-worker coping humor may buffer the negative effects of work–life conflict on stress and subsequent withdrawal. In Study 1, we conducted an experiment to examine the causal effects of humor on the stress appraisals arising from work–life conflict. In Study 2, we conducted a three-wave survey to replicate these findings and disentangle the contributions of individual coping humor and co-worker humor. We found opposing effects of individual coping humor and co-worker humor; we further replicated and unpacked the unexpected stress-amplifying effects of co-worker humor in a post-hoc exploratory Study 3. Overall, these results suggest that we need to consider where humor is situated in order to understand when humor mitigates the negative consequences of work–life conflict on stress and withdrawal.
When support is unwanted: The role of psychological contract type and perceived organizational support in predicting bridge employment intentions
Organizations benefit from older workers' contributions even past the threshold of retirement, yet little is known about what motivates older workers to pursue bridge employment in their current organizations. Perceived organizational support (POS) typically helps organizations retain employees, yet some older workers may ironically be repelled by POS to the extent that it imposes an undesirable, excessive obligation. In this paper, we develop and test a model of how older workers' intentions to engage in bridge employment towards their current organization are contingent upon the interaction between two central elements of older workers' employment relationships: (1) perceived organizational support (POS), and (2) the type of psychological contract they endorse. In Study 1, using data from two samples (Study 1a N = 168; Study 1b time-lagged N = 157), we found that POS increased bridge employment intentions to the current organization among older workers endorsing a relational psychological contract. However, we also found that POS decreased bridge employment intentions to the current organization among older workers endorsing a transactional psychological contract. In Study 2 (N = 348), we unpacked the underlying mechanisms (role expansion and excessive obligation to the organization) that explain the interaction effects. The results indicate that how POS ‘fits’ with older workers' psychological contracts informs their motivation to engage in bridge employment.
Epstein-Barr virus associated haemophagocytic lymphohistiocytosis treated with anakinra and rituximab: A case report
Background: Haemophagocytic lymphohistiocytosis (HLH) is a severe, life-threatening syndrome characterised by hyperinflammation and macrophage activation. Viral infections such as Epstein-Barr virus (EBV) are a well-recognised trigger of HLH but the treatment of such cases is not well-defined. We present a case of primary EBV driven HLH that was successfully treated with the interleukin-1 inhibitor anakinra in addition to rituximab and high-dose steroids. Case: A 22-year-old female with no past medical history developed a mononucleosis-like illness lasting five days characterised by fevers, sore throat and neck swelling. Two weeks following this she presented with fevers, night sweats, fatigue and right upper quadrant pain. She was diagnosed with HLH based on high fevers with hyperferritaemia, hypertriglyceridaemia, pancytopaenia, abnormal liver function tests and hepatosplenomegaly. Extensive investigation revealed an EBV viral load of 23,000,000 copies/ml with nil other obvious triggers. A diagnosis of primary-driven EBV HLH was made. She was treated with the interleukin-1 inhibitor anakinra, methylprednisolone and IVIG and a single dose of rituximab. Following the commencement of treatment, the patient made a dramatic improvement. Her EBV viral load reduced to 660 within nine days and her blood counts and liver function returned to normal. She was discharged from hospital on day sixteen. She continued the anakinra for 5 weeks at a weaning dose and completed a 12-week weaning dose of steroids. She has returned to her studies and has no lasting complications from her illness. Discussion: This case highlights the potential of primary EBV infection to cause fulminant HLH. The prompt diagnosis and treatment of HLH using anakinra and rituximab in addition to conventional HLH treatment was safe, and associated with a dramatic clinical improvement. The use of anakinra has been documented in other cases of HLH but none, to our knowledge, of primary EBV-driven HLH with no underlying haematological or rheumatological condition.
The impact of psoriatic arthritis on quality of life: a systematic review.
BACKGROUND: Psoriatic arthritis (PsA) is a chronic inflammatory condition that can affect individuals of all ages. Patients may experience a range of physical and psychological issues. OBJECTIVE: To examine the impact of PsA on an individual's quality of life (QoL) and physical function. DESIGN: A systematic review of the literature. DATA SOURCES AND METHODS: A comprehensive search was conducted across seven electronic databases (Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, AMED, EMBASE, Global Health, MEDLINE and PsycINFO) to retrieve articles related to QoL and lifestyle in adults with PsA. The inclusion criteria were studies published between 2010 and 2021 that used outcomes validated in patients with PsA. The methodological quality was assessed using Joanna Briggs Institute Critical Appraisal Tools. Our primary outcomes were patient-reported outcomes (PROs) measuring QoL and the impact of disease on physical function. The secondary outcomes were assessments of fatigue, anxiety, depression, sleep, work productivity and employment. RESULTS: The study included 37 comprehensive studies that examined the impact of PsA on QoL and physical function. The findings revealed that the impact of PsA extends to various aspects of life, including activities of daily living, physical, and emotional aspects, such as fatigue, sleep disturbance, anxiety and depression. Notably, people with PsA experience reduced health-related quality of life (HRQoL), particularly in emotional, social and mental health aspects. The severity of pain and/or fatigue is directly linked to decreased HRQoL. Importantly, those who fail to achieve minimal disease activity face challenges in work productivity and employment status. CONCLUSION: To conclude, our review underscores the significant impact of PsA on patients' HRQoL beyond joint disease. The emotional, social, and mental aspects of PsA require compassionate and holistic management. TRIAL REGISTRATION: The PROSPERO international prospective register of systematic reviews - CRD42021257395.
Refinement of post-COVID condition core symptoms, subtypes, determinants, and health impacts: a cohort study integrating real-world data and patient-reported outcomes.
BACKGROUND: Post-COVID-19 condition (PCC) affects millions of people, and is an essential component of the long-term impact of COVID-19 during the post-pandemic era. Yet, consensus on clinical case definition and core components of PCC remains lacking, affecting our ability to inform research and evidence-based management. Our study aims 1) to identify the most specific symptoms for PCC, and identify clinical subtypes; 2) to evaluate both virus- and host-related determinants of PCC, and 3) assess the impact of PCC on physical and mental health. METHODS: We studied participants from UK Biobank who completed a health and wellbeing survey between June and September 2022. Participants reported the current conditions of the presence, duration, and functional limitations of 45 symptoms, using an online questionnaire designed specifically for COVID-19 research. SARS-CoV-2 infection status and disease history were obtained through linkage to surveillance data and electronic medical records, respectively. Participants reporting symptoms within 30 days after infection (acute phase) were excluded. The most specific PCC symptoms were defined using two criteria: statistical significance (P 5%). Propensity score weighting was used to control for confounding. Subtypes of PCC were then defined based on the specific symptoms among the COVID-19 infected individuals. A multivariable regression was used to study pathogen- and host-related risk factors for PCC, and its impact on 13 physical and 4 mental health patient-reported functional outcomes. FINDINGS: 172,303 participants (mean age 68.9, 57.4% female) were included in the analysis, of whom 43,395 had PCR-confirmed COVID-19. We identified 10 most specific symptoms and classified four PCC subtypes: ENT subtype (30.1%), characterized by alterations in smell, taste, and hearing loss; cardiopulmonary subtype (10.4%), characterized by shortness of breath, postural tachycardia, chest tightness, and chest pressure; neurological subtype (23.5%), characterized by brain fog and difficulty speaking; and general fatigue subtype (38.0%), characterized by mild fatigue. A higher PCC risk was observed for patients with Wild-type variant, multiple infections, and severe acute COVID-19 illness, consistently across the four PCC subtypes. In addition, a range of factors, including socioeconomic deprivation, higher BMI, unhealthy lifestyle, and multiple chronic health conditions, were associated with increased PCC risk, except for age and sex. Conversely, vaccination was associated with a largely reduced PCC risk, particularly for the cardiopulmonary subtypes. Individuals with PCC experienced a much worse physical and mental health. Specifically, the cardiopulmonary subtype had the most pronounced adverse impact on function impairments, followed by neurological, mild fatigue, and ENT subtype. The most affected functions included the ability to concentrate, participate in day-to-day work, and emotional vulnerability to health problems. INTERPRETATION: PCC can be categorized into four distinct subtypes based on ten core symptoms. These subtypes appeared to share a majority of pathogen and host-related risk factors, but their impact on health varied markedly by subtype. Our findings could help refine current guidelines for precise PCC diagnosis and progression, enhance the identification of PCC subgroups for targeted research, and inform evidence-based policy making to tackle this new and debilitating condition. FUNDING: NIHR Senior Research Fellowship (grant SRF-2018-11-ST2-004).