Why Don’t Employers Hire and Retain Workers with Disabilities?

Introduction Despite persistently low employment rates among working-age adults with disabilities, prior research on employer practices and attitudes toward workers with disabilities paints a generally rosy picture of successfully accommodated workers in a welcoming environment. Findings from previous studies might have been biased because of either employer self-selection or social desirability, yielding non-representative or artificially positive conclusions. Methods In this study, a novel approach was used to survey human resource professionals and supervisors working for employers known or reputed to be resistant to complying with the ADA’s employment provisions. Attendees of employer-requested ADA training sessions were asked to assess various possible reasons that employers in general might not hire, retain, or accommodate workers with disabilities and to rate strategies and policy changes that might make it more likely for employers to do so. Results As cited by respondents, the principal barriers to employing workers with disabilities are lack of awareness of disability and accommodation issues, concern over costs, and fear of legal liability. With regard to strategies employers might use to increase hiring and retention, respondents identified increased training and centralized disability and accommodation expertise and mechanisms. Public policy approaches preferred by respondents include no-cost external problem-solving, subsidized accommodations, tax breaks, and mediation in lieu of formal complaints or lawsuits. Conclusions Findings suggest straightforward approaches that employers might use to facilitate hiring and retention of workers with disabilities, as well as new public programs or policy changes that could increase labor force participation among working-age adults who have disabilities

Advice to clinicians on communication from adolescents and young adults with cancer and parents of children with cancer

Effective communication is integral to patient and family-centered care in pediatric and adolescent and young adult (AYA) oncology and improving healthcare delivery and outcomes. There is limited knowledge about whether AYAs and parents have similar communication preferences and needs. By eliciting and comparing communication advice from AYAs and parents, we can identify salient guidance for how clinicians can better communicate. We performed secondary analysis of semi-structured interviews from 2 qualitative communication studies. In one study, 80 parents of children with cancer during treatment, survivorship, or bereavement were interviewed. In the second study, AYAs with cancer during treatment or survivorship were interviewed. We asked AYAs and parents to provide communication advice for oncology clinicians. Using thematic analysis, we identified categories of advice related to three overarching themes: interpersonal relationships, informational preferences, and delivery of treatment, resources, and medical care. AYAs and parents provided similar advice about the need for compassion, strong connections, hopefulness, commitment, and transparent honesty However, AYAs placed additional emphasis on clinicians maintaining a calm demeanor

AGNs on the Move: A Search for Off-nuclear AGNs from Recoiling Supermassive Black Holes and Ongoing Galaxy Mergers with the Zwicky Transient Facility

A supermassive black hole (SMBH) ejected from the potential well of its host galaxy via gravitational wave recoil carries important information about the mass ratio and spin alignment of the pre-merger SMBH binary. Such a recoiling SMBH may be detectable as an active galactic nucleus (AGN) broad-line region offset by up to 10 kpc from a disturbed host galaxy. We describe a novel methodology using forward modeling with The Tractor to search for such offset AGNs in a sample of 5493 optically variable AGNs detected with the Zwicky Transient Facility (ZTF). We present the discovery of nine AGNs that may be spatially offset from their host galaxies and are candidates for recoiling SMBHs. Five of these offset AGNs exhibit double-peaked broad Balmer lines, which may have arisen from unobscured accretion disk emission, and four show radio emission indicative of a relativistic jet. The fraction of double-peaked emitters in our spatially offset AGN sample is significantly larger than the 16% double-peaked emitter fraction observed for ZTF AGNs overall. In our sample of variable AGNs we also identified 52 merging galaxies, including a new spectroscopically confirmed dual AGN. Finally, we detected the dramatic rebrightening of SDSS 1133, a previously discovered variable object and recoiling SMBH candidate, in ZTF. The flare was accompanied by the reemergence of strong P Cygni line features, indicating that SDSS 1133 may be an outbursting luminous blue variable star

AGN on the move: A search for off-nuclear AGN from recoiling SMBHs and ongoing galaxy mergers with the Zwicky Transient Facility

A supermassive black hole (SMBH) ejected from the potential well of its host galaxy via gravitational wave recoil carries important information about the mass ratio and spin alignment of the pre-merger SMBH binary. Such a recoiling SMBH may be detectable as an active galactic nucleus (AGN) broad line region offset by up to 10\,kpc from a disturbed host galaxy. We describe a novel methodology using forward modeling with \texttt{The Tractor} to search for such offset AGN in a sample of 5493 optically variable AGN detected with the Zwicky Transient Facility (ZTF). We present the discovery of 9 AGN which may be spatially offset from their host galaxies and are candidates for recoiling SMBHs. Five of these offset AGN exhibit double-peaked broad Balmer lines which may arise from unobscured accretion disk emission and four show radio emission indicative of a relativistic jet. The fraction of double-peaked emitters in our spatially offset AGN sample is significantly larger than the 16\% double-peaked emitter fraction observed for ZTF AGN overall. In our sample of variable AGN we also identified 52 merging galaxies, including a new spectroscopically confirmed dual AGN. Finally, we detected the dramatic rebrightening of SDSS1133, a previously discovered variable object and recoiling SMBH candidate, in ZTF. The flare was accompanied by the re-emergence of strong P-Cygni line features indicating that it may be an outbursting luminous blue variable star.Comment: Accepted by ApJ. 31 pages, 16 figure

Impact of PEWS on Perceived Quality of Care During Deterioration in Children With Cancer Hospitalized in Different Resource-Settings

BackgroundChildren with cancer are at high risk for clinical deterioration and subsequent mortality. Pediatric Early Warning Systems (PEWS) have proven to reduce the frequency of clinical deterioration in hospitalized patients. This qualitative study evaluates provider perspectives on the impact of PEWS on quality of care during deterioration events in a high-resource and a resource-limited setting.MethodsWe conducted semi-structured interviews with 83 healthcare staff (nurses, pediatricians, oncology fellows, and intensivists) involved in recent deterioration events at two pediatric oncology hospitals of different resource levels: St. Jude Children’s Research Hospital (SJCRH; n = 42) and Unidad Nacional de Oncología Pediátrica (UNOP; n = 41). Interviews were conducted in the participant’s native language (English or Spanish), translated into English, and transcribed. Transcripts were coded and analyzed inductively.ResultsProviders discussed both positive and negative perspectives of clinical deterioration events. Content analysis revealed “teamwork,” “experience with deterioration,” “early awareness,” and “effective communication” as themes associated with positive perception of events, which contributed to patient safety. Negative themes included “lack of communication,” “inexperience with deterioration,” “challenges with technology”, “limited material resources,” “false positive score,” and “objective tool.” Participants representing all disciplines across both institutions shared similar positive opinions. Negative opinions, however, differed between the two institutions, with providers at UNOP highlighting limited resources while those at SJCRH expressing concerns about technology misuse.ConclusionProviders that care for children with cancer find PEWS valuable to improve the quality of hospital care, regardless of hospital resource-level. Identified challenges, including inadequate critical care resources and challenges with technology, differ by hospital resource-level. These findings build on growing data demonstrating the positive impact of PEWS on quality of care and encourage wide dissemination of PEWS in clinical practice

A new measure for multi-professional medical team communication: design and methodology for multilingual measurement development

BackgroundAs implementation science in global health continues to evolve, there is a need for valid and reliable measures that consider diverse linguistic and cultural contexts. A standardized, reproducible process for multilingual measure development may improve accessibility and validity by participants in global health settings. To address this need, we propose a rigorous methodology for multilingual measurement development. We use the example of a novel measure of multi-professional team communication quality, a determinant of implementation efforts.MethodsThe development and translation of this novel bilingual measure is comprised of seven steps. In this paper, we describe a measure developed in English and Spanish, however, this approach is not language specific. Participants are engaged throughout the process: first, an interprofessional panel of experts and second, through cognitive interviewing for measure refinement. The steps of measure development included: (1) literature review to identify previous measures of team communication; (2) development of an initial measure by the expert panel; (3) cognitive interviewing in a phased approach with the first language (English); (4): formal, forward-backward translation process with attention to colloquialisms and regional differences in languages; (5) cognitive interviewing repeated in the second language (Spanish); (6) language synthesis to refine both instruments and unify feedback; and (7) final review of the refined measure by the expert panel.ResultsA draft measure to assess quality of multi-professional team communication was developed in Spanish and English, consisting of 52 questions in 7 domains. This measure is now ready for psychometric testing.ConclusionsThis seven-step, rigorous process of multilingual measure development can be used in a variety of linguistic and resource settings. This method ensures development of valid and reliable tools to collect data from a wide range of participants, including those who have historically been excluded due to language barriers. Use of this method will increase both rigor and accessibility of measurement in implementation science and advance equity in research and practice

Relative sea-level change in northeastern Florida (USA) during the last ~8.0 ka

An existing database of relative sea-level (RSL) reconstructions from the U.S. Atlantic coast lacked valid sea-level index points from Georgia and Florida. This region lies on the edge of the collapsing forebulge of the former Laurentide Ice Sheet making it an important location for understanding glacio-isostatic adjustment and the history of ice-sheet melt. To address the paucity of data, we reconstruct RSL in northeastern Florida (St. Marys) over the last ∼8.0 ka from samples of basal salt-marsh sediment that minimize the influence of compaction. The analogy between modern salt-marsh foraminifera and their fossil counterparts preserved in the sedimentary record was used to estimate paleomarsh surface elevation. Sample ages were determined by radiocarbon dating of identifiable and in-situ plant macrofossils. This approach yielded 25 new sea-level index points that constrain a ∼5.7 m rise in RSL during the last ∼8.0 ka. The record shows that no highstand in sea level occurred in this region over the period of the reconstruction. We compared the new reconstruction to Earth-ice models ICE 6G-C VM5a and ICE 6G-C VM6. There is good fit in the later part of the Holocene with VM5a and for a brief time in the earlier Holocene with VM6. However, there are discrepancies in model-reconstruction fit in the early to mid Holocene in northeastern Florida and elsewhere along the Atlantic coast at locations with early Holocene RSL reconstructions. The most pronounced feature of the new reconstruction is a slow down in the rate of RSL rise from approximately 5.0 to 3.0 ka. This trend may reflect a significant contribution from local-scale processes such as tidal-range change and/or change in base flow of the St. Marys River in response to paleoclimate changes. However, the spatial expression (local vs. regional) of this slow down is undetermined and corroborative records are needed to establish its geographical extent

Analysis of shared heritability in common disorders of the brain

ience, this issue p. eaap8757 Structured Abstract INTRODUCTION Brain disorders may exhibit shared symptoms and substantial epidemiological comorbidity, inciting debate about their etiologic overlap. However, detailed study of phenotypes with different ages of onset, severity, and presentation poses a considerable challenge. Recently developed heritability methods allow us to accurately measure correlation of genome-wide common variant risk between two phenotypes from pools of different individuals and assess how connected they, or at least their genetic risks, are on the genomic level. We used genome-wide association data for 265,218 patients and 784,643 control participants, as well as 17 phenotypes from a total of 1,191,588 individuals, to quantify the degree of overlap for genetic risk factors of 25 common brain disorders. RATIONALE Over the past century, the classification of brain disorders has evolved to reflect the medical and scientific communities' assessments of the presumed root causes of clinical phenomena such as behavioral change, loss of motor function, or alterations of consciousness. Directly observable phenomena (such as the presence of emboli, protein tangles, or unusual electrical activity patterns) generally define and separate neurological disorders from psychiatric disorders. Understanding the genetic underpinnings and categorical distinctions for brain disorders and related phenotypes may inform the search for their biological mechanisms. RESULTS Common variant risk for psychiatric disorders was shown to correlate significantly, especially among attention deficit hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder (MDD), and schizophrenia. By contrast, neurological disorders appear more distinct from one another and from the psychiatric disorders, except for migraine, which was significantly correlated to ADHD, MDD, and Tourette syndrome. We demonstrate that, in the general population, the personality trait neuroticism is significantly correlated with almost every psychiatric disorder and migraine. We also identify significant genetic sharing between disorders and early life cognitive measures (e.g., years of education and college attainment) in the general population, demonstrating positive correlation with several psychiatric disorders (e.g., anorexia nervosa and bipolar disorder) and negative correlation with several neurological phenotypes (e.g., Alzheimer's disease and ischemic stroke), even though the latter are considered to result from specific processes that occur later in life. Extensive simulations were also performed to inform how statistical power, diagnostic misclassification, and phenotypic heterogeneity influence genetic correlations. CONCLUSION The high degree of genetic correlation among many of the psychiatric disorders adds further evidence that their current clinical boundaries do not reflect distinct underlying pathogenic processes, at least on the genetic level. This suggests a deeply interconnected nature for psychiatric disorders, in contrast to neurological disorders, and underscores the need to refine psychiatric diagnostics. Genetically informed analyses may provide important "scaffolding" to support such restructuring of psychiatric nosology, which likely requires incorporating many levels of information. By contrast, we find limited evidence for widespread common genetic risk sharing among neurological disorders or across neurological and psychiatric disorders. We show that both psychiatric and neurological disorders have robust correlations with cognitive and personality measures. Further study is needed to evaluate whether overlapping genetic contributions to psychiatric pathology may influence treatment choices. Ultimately, such developments may pave the way toward reduced heterogeneity and improved diagnosis and treatment of psychiatric disorders

Genomic Relationships, Novel Loci, and Pleiotropic Mechanisms across Eight Psychiatric Disorders

Genetic influences on psychiatric disorders transcend diagnostic boundaries, suggesting substantial pleiotropy of contributing loci. However, the nature and mechanisms of these pleiotropic effects remain unclear. We performed analyses of 232,964 cases and 494,162 controls from genome-wide studies of anorexia nervosa, attention-deficit/hyper-activity disorder, autism spectrum disorder, bipolar disorder, major depression, obsessive-compulsive disorder, schizophrenia, and Tourette syndrome. Genetic correlation analyses revealed a meaningful structure within the eight disorders, identifying three groups of inter-related disorders. Meta-analysis across these eight disorders detected 109 loci associated with at least two psychiatric disorders, including 23 loci with pleiotropic effects on four or more disorders and 11 loci with antagonistic effects on multiple disorders. The pleiotropic loci are located within genes that show heightened expression in the brain throughout the lifespan, beginning prenatally in the second trimester, and play prominent roles in neurodevelopmental processes. These findings have important implications for psychiatric nosology, drug development, and risk prediction.Peer reviewe