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Linear and volumetric analysis are the typical methods to measure tumor size. 3D volumetric analysis has risen in popularity; however, this is very time and labor intensive limiting its implementation in clinical practice. This study aims to show that an AI-led approach can shorten the length of time required to conduct 3D volumetric analysis of VS tumors and improve image processing accuracy. From Yale New Haven Hospital and public patient recruitment, 143 MRIs were included in the ground truth dataset. To create the tumor models for the ground truth dataset, an image processing software (Simpleware ScanIP, Synopsys) was used. The helper (DPP V1.0) was trained using proprietary AI- and ML-based algorithms and information. A proof-of-concept AI model achieved a mean DICE score of 0.76 (standard deviation 0.21). After the final testing stage, the model improved to a final mean DICE score of 0.88 (range 0.74–0.93, standard deviation 0.04). Our study has demonstrated an efficient, accurate AI for 3D volumetric analysis of vestibular schwannomas. The use of this AI will enable faster 3D volumetric analysis compared to manual segmentation. Additionally, the overlay function would allow visualization of growth patterns. The tool will be a method of assessing tumor growth and allow clinicians to make more informed decisions. [ABSTRACT FROM AUTHOR]

Patients impart their highest trust in the health care professionals from whom they might seek services, to provide the best quality care regardless of biases, predispositions worldview, and personal values. [...], Healthcare professionals from whom clients might seek services should provide the best quality care regardless of biases, predispositions, worldview, and personal values. The purpose of this study was to explore how the perceived cause of spinal cord injury (SCI) affected service delivery recommendations from bachelor-level rehabilitation services trainees. Specifically, causal attribution of disability was the dependent variable in two case vignettes, one where the person was personally responsible for the cause of the SCI (i.e., driving under the influence, leading to a motor vehicle accident) and one with an external cause (i.e., motor vehicle accident caused by another driver). The impact on acute care, lifelong care, and specific specialist recommendations was assessed. There was a significant difference in the scores for external cause (M = 1.85, SD = .89) and internal cause (M = 1.4, SD = .60) of SCI and recommendation for life-long care, t(245) = 4.62, p = .000. Acute care and specialist recommendations revealed no differences. Implications for training to address attitudes are discussed.. Keywords: Causal Attribution, Attitudes toward Disability, Rehabilitation Services, Spinal Cord Injury

Participation in competitive employment and other meaningful work activities is considered a fundamental human right, crucial to the health and well-being of people with disabilities and without disabilities (Chan, Shaw, [...], Participation in competitive employment and other meaningful work activities is considered a fundamental human right and crucial to the health and well-being of people with and without disabilities. Approximately less than 30% of the persons with a disability aged 16 to 64 were employed in 2017, which is a striking disparity given that 73.5 % of people in this age group without disabilities were employed. Several 2x2 Factorial Designs were used to determine how a job applicant's disability status (disability disclosed, disability not disclosed) and gender (female, male) impacted how Human Resource Managers' (N = 392) evaluated the job applicant in three areas, including (a) how likely are they to hire this job applicant, (b) how qualified do they view this job applicant, and (c) what would they recommend as a starting salary if the applicant was hired. Furthermore, there was an interest in investigating how knowledge of Title 1 of the Americans with Disabilities Act (ADA) influenced the Human Resource Managers' hiring-related decisions. Findings revealed that the starting salary was significantly lower for the applicant with a disability. Knowledge of the ADA did not control for any hiring-related decisions. Discussion and implications are provided.. Keywords: People with Disabilities, Employment, Americans with Disability Act (ADA), Discrimination, Labor Force Participation

Neurofibromatosis Type 1 (NF1) is an autosomal dominant genetic disorder that can cause an individual significant chronic pain (CP). CP affects quality of life and daily functioning, yet there are limited effective treatments for CP within NF1. The current study describes the impact of CP using the Neurofibromatosis Pain Module (NFPM). The NFPM is a self‐reported clinical assessment that evaluates the impact of CP across multiple domains (e.g., interference, severity, tolerance, and symptomology) and three prioritized pain regions. A cross‐sectional study (N = 242) asked adults with NF1 to describe and rate their pain using the NFPM. The results indicated that they reported moderate pain severity (M = 6.6, SD = 2.0) on a 0–10 scale, that 54% (n = 131) had been in pain at least 24 days in the last 30, for 75% (n = 181) sleep was affected, and 16% reported that nothing was effective in reducing their CP for their primary pain region. The current results extend previously published work on CP within adults with NF1 and indicate that more emphasis on understanding and ameliorating CP is required. The NFPM is a sensitive clinical measure that provides qualitative and quantitative responses to inform medical providers about changes in CP. [ABSTRACT FROM AUTHOR]

Background/Aims: Individuals with neurofibromatosis 1 may experience changes in their appearance due to physical manifestations of the disorders and/or treatment sequelae. Appearance concerns related to these physical changes can lead to psychological distress and poorer quality of life. While many neurofibromatosis 1 clinical trials focus on assessing changes in tumor volume, evaluating patients' perspectives on corresponding changes in symptoms such as physical appearance can be key secondary outcomes. We aimed to determine whether any existing patient-reported outcome measures are appropriate for evaluating changes in appearance concerns within neurofibromatosis 1 clinical trials. Methods: After updating our previously published systematic review process, we used it to identify and rate existing patient-reported outcome measures related to disfigurement and appearance. Using a systematic literature search and initial triage process, we focused on identifying patient-reported outcome measures that could be used to evaluate changes in appearance concerns in plexiform or cutaneous neurofibroma clinical trials in neurofibromatosis 1. Our revised Patient-Reported Outcome Rating and Acceptance Tool for Endpoints then was used to evaluate each published patient-reported outcome measures in five domains, including (1) respondent characteristics, (2) content validity, (3) scoring format and interpretability, (4) psychometric data, and (5) feasibility. The highest-rated patient-reported outcome measures were then re-reviewed in a side-by-side comparison to generate a final consensus recommendation. Results: Eleven measures assessing appearance concerns were reviewed and rated; no measures were explicitly designed to assess appearance concerns related to neurofibromatosis 1. The FACE-Q Craniofacial Module—Appearance Distress scale was the top-rated measure for potential use in neurofibromatosis 1 clinical trials. Strengths of the measure included that it was rigorously developed, included individuals with neurofibromatosis 1 in the validation sample, was applicable to children and adults, covered item topics deemed important by neurofibromatosis 1 patient representatives, exhibited good psychometric properties, and was feasible for use in neurofibromatosis 1 trials. Limitations included a lack of validation in older adults, no published information regarding sensitivity to change in clinical trials, and limited availability in languages other than English. Conclusion: The Response Evaluation in Neurofibromatosis and Schwannomatosis patient-reported outcome working group currently recommends the FACE-Q Craniofacial Module Appearance Distress scale to evaluate patient-reported changes in appearance concerns in clinical trials for neurofibromatosis 1-related plexiform or cutaneous neurofibromas. Additional research is needed to validate this measure in people with neurofibromatosis 1, including older adults and those with tumors in various body locations, and explore the effects of nontumor manifestations on appearance concerns in people with neurofibromatosis 1 and schwannomatosis. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of the study was to investigate factors that influence vocational rehabilitation program enrollment and employment at discharge of veterans with psychiatric and co-occurring alcohol and other substance use disorders enrolled at a veteran health administration (VHA) medical center. Methods: A sample of 2,550 veteran patients referred for VHA vocational rehabilitation between 2016 and 2021 were examined for the current study. The current study was classified as quality improvement/assurance, thus resulting in exempt research by the U.S. Department of Veteran Affairs Institutional Review Board. Results: Veterans with active alcohol use disorders (AUDs) and co-occurring depression, anxiety, post-traumatic stress disorder, or bipolar disorders were less likely to be enrolled for vocational rehabilitation program services compared to those without these co-occurring diagnoses. Veterans with AUD (active & inremission status combined into one category) and a diagnosis of anxiety were less likely to be employed at discharge compared to veterans with AUDs and no anxiety diagnosis (anxiety diagnosis - 3.5% vs. no anxiety diagnosis - 5.8%). Discussion: VHA vocational rehabilitation can be an effective intervention to assist veterans in reintegrating back into the community. Yet, there appears to be some disparities in the program enrollment and employment at discharge, dependingon the nature of the psychiatric diagnosis. Investigating the factors contributing (mediating or moderating) to these discrepancies are needed. Although it appears access is not the issue in being referred for vocational rehabilitation services, other factors are likely contributing to program entry. [ABSTRACT FROM AUTHOR]

Students with disabilities (SWD) entering a postsecondary program of study has been increasing (Christ & Stodden, 2005; Hadley, 2007; Stodden & Dowrick, 2000; Wehman & Yasuda, 2005; West, Kregal, Getzel, [...], The present study addresses the importance of the onset of disability, subjective well-being, and satisfaction with educational accommodations received through disability support services (DSS) for students with disabilities. A total of 116 participants receiving services from DSS at a Midwestern University completed a survey via online and/or paper format. The purpose of this study was (a) to determine whether onset of disability was independent of reported subjective well-being for postsecondary students with disabilities (SWD), and (b) to assess students' satisfaction with educational accommodations received through disability support services. Results indicate no significant relationship existing between subjective well-being and onset of disability for postsecondary SWD; however, findings revealed that the majority of students reported satisfaction with received accommodations from DSS. Discussion and implications are provided.

Medication-assisted treatment can reduce mortality and withdrawal symptoms, yet treatments can have side effects and are cost ineffective. Research has supported alternative approaches to withdrawal symptoms, specifically percutaneous nerve field stimulator (PNFS); yet, to date, there is a lack of understanding of the initial acceptability within treatment programs. A retrospective case series evaluated PNFS to reduce opioid withdrawal symptoms for five adult patients participating in an in-home withdrawal management program. The device was worn for five consecutive days, in which a licensed practical nurses monitored their care. Evaluation included the clinical opiate withdrawal scale (COWS) and clinical reviews based on self-report and clinician interview. Significant reductions were noted for all five participants, with the average COWS score for Day 1 at 19.1 reducing to 2.6 at Day 5. In addition, 2-day post-COWS scores demonstrated a continual reduction to 1.4. Qualitative feedback from the patients was recorded, and generalized themes were recorded and addressed. Future controlled, prospective studies should investigate the possibility that PNFS can significantly reduce negative symptoms of opiate withdrawal symptoms, along with providing alternatives to medication-assisted treatments for those who are suffering from opiate use disorder. [ABSTRACT FROM AUTHOR]

Musculoskeletal pain is a prominent complaint in primary care resulting in increased referrals to physical therapy (PT); however, the referral system often results in delays and discontinuation of care. Several models have been developed to improve the referral process including integrating PT into primary care clinics. The Veterans Health Administration (VHA) Center of Excellence in Primary Care Education (CoEPCE), which educates post-graduate trainees in interprofessional teams, began (in 2015) embedding physical therapists into primary care clinics enabling patients to see a physical therapist during their primary care visit. To evaluate the efficacy of this model we tracked the numbers of PT referrals, the number of completed referrals, and the length of time between referral and completion. PT referral parameters from PT-integrated trainees in the CoEPCE were compared to two traditional primary care training clinics at the same VHA site (Firm A and Firm B). Results indicate that the CoEPCE placed and completed more PT referrals and did so with a shorter turnaround time than was seen in the other two clinics. Further analysis suggests that the decreased turnaround time can be attributed to the integration of PTs into the primary care clinic. The results support extending the use of interprofessional clinics that integrate PT into primary care settings. [ABSTRACT FROM AUTHOR]

Summary: Background: Psychological trauma can have a significant impact on mental and physical health, and interpersonal relationships. Many physicians report discomfort addressing psychological trauma in the context of health care visits, and few training opportunities exist for health care trainees to learn about the relationship between trauma and health. The aim of this project was to develop and implement an educational curriculum to teach medical and nursing trainees about trauma‐informed primary care. Methods: We expanded upon pilot data from a brief interdisciplinary intervention to train medical residents in trauma‐informed primary care at a Veterans Affairs hospital. We generated a trauma‐informed care curriculum involving five 1‐hour didactic sessions, 10‐minute group reflection regarding patient interactions prior to each didactic session, and optional patient care observation and feedback. The curriculum aligned with internal medicine (n = 16) and nurse practitioner (n = 5) interprofessional primary care education sessions during the 2017/18 academic year. Results: The curriculum was feasible and associated with increased self‐reported knowledge, attitudes and practice around trauma‐informed care. Free text feedback indicated that residents found the topic important, appreciated a skills‐based approach and valued experiential educational activities. Conclusions: Training residents in trauma‐informed care results in improved knowledge, attitudes and practices in caring for patients with psychological trauma. Residents appreciated both experiential and skills‐based exercises. Next steps include continued exploration of using direct observation and feedback, and examining effects of training on patient outcomes (e.g. satisfaction with care). [ABSTRACT FROM AUTHOR]