Telehealth Sustainability in a Neurosurgery Department During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has shifted the dynamics of health care and neurosurgical practice. Elective surgeries were suspended for 8 weeks in Kentucky. Our objective was to determine if telehealth (TH) visits could be sustained as an alternative to in-person visits. METHODS: Deidentified data on TH usage, in-person clinic visits, and inpatient and neurosurgical case volumes from March 2, 2020 to June 26, 2020 were obtained for retrospective analysis. RESULTS: TH use increased soon after the case suspension started and then decreased to little usage. The number of in-person visits were significantly lower during elective case suspension compared with when cases were resumed. Twenty-five percent of all visits during the suspension were conducted using TH. Thirty-nine percent of TH-visit patients were new patients, 11% were preoperative, 10% were postoperative, and 39% were other existing patients. Forty-eight percent of TH visits resulted in a later in-person clinic visit. After the suspension, in-person visits rebounded to 98% of the prepandemic numbers and TH visits were low. CONCLUSIONS: TH visits were challenging due to the need for in-person physical examinations in neurosurgery. TH temporarily accommodated patient needs during the pandemic but could not totally replace in-person visits and was not sustained after 3.5 months of use. Video TH visits worked well for nonurgent issues, such as minor visual examinations. Our findings could help guide the implementation of TH should similar circumstances arise again.

A Model for Analyzing Disability Policy.

This article describes a 12-step model that can be used for policy analysis. The model encompasses policy development, implementation, and evaluation; takes into account structural foundations of policy; addresses both legal formalism and legal realism; demonstrates contextual sensitivity; and addresses application issues and different conceptualizations of IDD.

A brief overview of special education law with focus on autism.

This article reviews the provisions of Individuals with Disabilities Education Act as they apply particularly to students with autism. It also refers to the antidiscrimination provisions of the Rehabilitation Act Amendments (Sec. 504) and to their relevance to students with autism. It attempts to answer specific questions posed by the National Academy of Science.

Elaborating the AAIDD public policy framework.

The AAIDD's 11th edition of Intellectual Disability: Definition, Classification, and Systems of Support describes a framework for understanding the relationship between public policy and practice. The framework incorporates three inputs into public policy and practice affecting quality-of-life outcomes for individuals and families, society, and systems. The inputs are social factors, the core concepts of disability policy, and changing conceptualizations of disability. We accept the framework's basic premises, but we propose amendments to make the framework more useful for its stated purposes of elaborating on the "context" ( Schalock et al., 2010 , p. 17) that affects people with intellectual disability and "promot[ing] changes in public policy that will lead to the achievement of desired policy outcomes" ( Schalock et al., 2010 , p. 171).

Control of four-level quantum coherence via discrete spectral shaping of an optical frequency comb.

We present experiments demonstrating high-resolution and wide-bandwidth coherent control of a four-level atomic system in a diamond configuration. A femtosecond frequency comb is used to excite a specific pair of two-photon transitions in cold 87Rb. The optical-phase-sensitive response of the closed-loop diamond system is studied by controlling the phase of the comb modes with a pulse shaper. Finally, the pulse shape is optimized resulting in a 256% increase in the two-photon transition rate by forcing constructive interference between the mode pairs detuned from an intermediate resonance.

Precise control of molecular dynamics with a femtosecond frequency comb.

We present a general and highly efficient scheme for performing narrow-band Raman transitions between molecular vibrational levels using a coherent train of weak pump-dump pairs of shaped ultrashort pulses. The use of weak pulses permits an analytic description within the framework of coherent control in the perturbative regime, while coherent accumulation of many pulse pairs enables near unity transfer efficiency with a high spectral selectivity, thus forming a powerful combination of pump-dump control schemes and the precision of the frequency comb. Simulations verify the feasibility and robustness of this concept, with the aim to form deeply bound, ultracold molecules.

Federal family and disability policy: special relevance for developmental disabilities.

The article reviews the federal statutes and relevant decisions of the U.S. Supreme Court that constitute the core concepts of disability policy and their application to persons with disabilities (especially developmental disabilities) and their families.

High resolution atomic coherent control via spectral phase manipulation of an optical frequency comb.

We demonstrate high resolution coherent control of cold atomic rubidium utilizing spectral phase manipulation of a femtosecond optical frequency comb. Transient coherent accumulation is directly manifested by the enhancement of signal amplitude and spectral resolution via the pulse number. The combination of frequency comb technology and spectral phase manipulation enables coherent control techniques to enter a new regime with natural linewidth resolution.

The Supreme Court, "Our Town," and disability policy: boardrooms and bedrooms, courtrooms and cloakrooms.

In this discussion of recent key disability-related decisions of the U.S. Supreme Court (1995- 2004), we (a) assess whether the Court has supported or undermined certain core concepts of disability policy and (b) examine how the Court balances the comparative rights of those with and those without disabilities. In cases involving employment discrimination, family law, and access to courts and other public decision-making entities, the Court adopts an idealized version of a previous America. We explain the Court's "reverie" for that version, resorting to the constructs known as (a) compelled confrontation and remission to majoritarian processes and (b) advancement of personal relationships.

Tapered semiconductor amplifiers for optical frequency combs in the near infrared.

A tapered semiconductor amplifier is injection seeded by a femtosecond optical frequency comb at 780 nm from a mode-locked Ti:sapphire laser. Energy gains of more than 17 dB(12 dB) are obtained for 1 mW(20 mW) of average input power when the input pulses are stretched into the picosecond range. A spectral window of supercontinuum light generated in a photonic fiber has also been amplified. Interferometric measurements show sub-Hertz linewidths for a heterodyne beat between the input and amplified comb components, yielding no detectable phase-noise degradation under amplification. These amplifiers can be used to boost the infrared power in f-to-2f interferometers used to determine the carrier-to-envelope offset frequency, with clear advantages for stabilization of octave-spanning femtosecond lasers and other supercontinuum light sources.

Direct frequency comb measurements of absolute optical frequencies and population transfer dynamics.

A phase-stabilized femtosecond laser comb is directly used for high-resolution spectroscopy and absolute optical frequency measurements of one- and two-photon transitions in laser-cooled 87Rb atoms. Absolute atomic transition frequencies, such as the 5S1/2 F=2-->7S1/2 F"=2 two-photon resonance measured at 788,794 768,921 (44) kHz, are determined without a priori knowledge about their values. Detailed dynamics of population transfer driven by a sequence of pulses are uncovered and taken into account for the measurement of the 5P states via resonantly enhanced two-photon transitions.

United time-frequency spectroscopy for dynamics and global structure.

Ultrashort laser pulses have thus far been used in two distinct modes. In the time domain, the pulses have allowed probing and manipulation of dynamics on a subpicosecond time scale. More recently, phase stabilization has produced optical frequency combs with absolute frequency reference across a broad bandwidth. Here we combine these two applications in a spectroscopic study of rubidium atoms. A wide-bandwidth, phase-stabilized femtosecond laser is used to monitor the real-time dynamic evolution of population transfer. Coherent pulse accumulation and quantum interference effects are observed and well modeled by theory. At the same time, the narrow linewidth of individual comb lines permits a precise and efficient determination of the global energy-level structure, providing a direct connection among the optical, terahertz, and radio-frequency domains. The mechanical action of the optical frequency comb on the atomic sample is explored and controlled, leading to precision spectroscopy with an appreciable reduction in systematic errors.

Service Lines, Neurology, and Academic Medicine: Departmental Perspectives, Implementation Strategies, and Keys to Success.

Service lines are increasingly common for organizing multidisciplinary patient care. Concerns regarding impacts of neuroscience service lines were voiced at several national neurology department chair summits, prompting the American Academy of Neurology to convene a Service Lines Workgroup. Neurology department leaders nationally at institutions that had created or considered a neuroscience service line were interviewed to elicit their experiences and lessons learned. Potential benefits identified stemmed from additional resources that the service line structure yielded (patient navigators, quality improvement staff, technicians) and strengthening of cross-department collaboration. Potential pitfalls included top-down institutional decision-making regarding service line creation, lack of explicit goals, late involvement of neurology, imbalances in neurology representation in leadership, unclear impacts on department finances, and lack of education and research mission integration into service lines. Establishing a satisfactory decision-making structure in a matrixed arrangement and ensuring that funds flow allocations acknowledged neurology's "upstream" contributions were also challenges.