Faculty Bibliography

Blindness and low vision are an urgent, steadily increasing public health concern. One of the most dramatic consequences of the debilitating conditions that cause visual impairment (VI) is the loss of mobility. Immobility is a grave impediment to quality of life. Orientation and mobility (O&M) training is a profession specific to VI that teaches safe, efficient, and effective travel skills to persons of all ages and in all types of environments. However, the lack of standardized best practices for objective assessment of performance and the exposure of trainees to harm during training are key hurdles for O&M education success. To partially mitigate these drawbacks, we propose a virtual reality platform that can support O&M trainers in the evaluation and refinement of O&M practice, help O&M trainees learn new O&M techniques in a completely safe, yet realistic, environment, and raise awareness for VI in the general public. The proposed platform is tested with a proof-of-concept experiment that evaluates the clinical utility of a custom VI simulation, the immersivity of the virtual reality experience"”a crucial attribute for training and educational purposes"”and participants"™ disability awareness and gained knowledge about the challenges faced by persons with VI in their daily life. The first concept is tested by assessing participants"™ performance in virtual reality-based wayfinding tasks while the second and third are tested through a series of dedicated questionnaires.

Disagreement is a powerful engine of scientific advance. It sharpens conceptual boundaries, directs attention to neglected issues, and, of course, prompts the design of would-be decisive experiments"”(Gilovich et al., 1998)

Objectives: While national medical guidelines recommend genetic testing for all individuals with non-syndromic autism spectrum disorder (ASD), there is underutilization of genetic testing. This study aims to define the perspectives and approaches to initial genetic testing of ASD diagnosticians in order to improve utilization. Methods: A prospective cross-sectional study was conducted using an anonymous online survey distributed to 59 staff neurologists, developmental-behavioral pediatricians, psychologists, post-graduate physician fellows, and nurse practitioners from a single academic medical center. Questions explored knowledge, attitudes, and practices of initial genetic testing for ASD among diagnosticians. Results: Among the 30 respondents (51% response rate), a lack of comprehensive pre-test genetic counseling was identified and forgetfulness was the most prevalent reason for not recommending genetic testing (n = 7/23, 30%). Insurance prior authorization (PA) for genetic testing was a major barrier for clinicians. More than half of respondents (n = 13/25, 52%) reported being uncomfortable with the PA process. Conclusions: Variability in knowledge and practices among ASD diagnosticians regarding genetic testing was identified. Therefore, potential interventions like clinician and administrative staff education, as well as genetic counselor integration into ASD clinics, may be useful to improve genetic testing utilization.

Background: We performed a focused review to determine the "non-inferiority", potential superiority, and relative safety/efficacy for performing cervical disc arthroplasty (CDA)/total disc replacement (TDR) in carefully selected patients vs. anterior cervical diskectomy/fusion (ACDF). Notably, CDA/TDR were devised to preserve adjacent level range of motion (ROM), reduce the incidence of adjacent segment degeneration (ASD), and the need for secondary ASD surgery. Methods: We compared the incidence of ASD, reoperations for ASD, safety/efficacy, and outcomes for cervical CDA/TDR vs. ACDF. Indications, based upon the North American Spine Society (NASS) Coverage Policy Recommendations (Cervical Artificial Disc Replacement Revised 11/2015 and other studies) included the presence of radiculopathy or myelopathy/myeloradiculopathy at 1-2 levels between C3-C7 with/without neck pain. Contraindications for CDA/TDR procedures as quoted from the NASS Recommendations (i.e. cited above) included the presence of; "Infection ", "Osteoporosis and Osteopenia", "Instability ", "Sensitivity or Allergy to Implant Materials", "Severe Spondylosis ", "Severe Facet Joint Arthropathy ", "Ankylosing Spondylitis"(AS), "Rheumatoid Arthritis (RA), Previous Fracture ", "Ossification of the Posterior Longitudinal Ligament (OPLL)", and "Malignancy ". Other sources also included spinal stenosis and scoliosis. Results: Cervical CDA/TDR studies in the appropriately selected patient population showed no inferiority/ occasionally superiority, reduced the incidence of ASD/need for secondary ASD surgery, and demonstrated comparable safety/efficacy vs. ACDF. Conclusion: Cervical CDA/TDR studies performed in appropriately selected patients showed a "lack of inferiority", occasional superiority, a reduction in the incidence of ASD, and ASD reoperation rates, plus comparable safety/efficacy vs. ACDF.