Dr. Schifitto's major interests are in the in the development and implementation of novel neuroimaging biomarkers applied in the investigation and treatment of, neuroinflammatory, neurodegenerative and cerebrovascular disorders.

Faculty Appointments

Professor - Department of Neurology, General Neurology (SMD)

Esther Aresty Granite Professor in Neurology - Department of Neurology, General Neurology (SMD)

Professor - Department of Imaging Sciences (SMD) - Joint

Credentials

Residency & Fellowship

Fellowship, Neurology, University of Rochester School of Medicine. 1994 - 1996

Residency, Neurology, University of Rochester School of Medicine. 1992 - 1994

Residency, Neurology, Mount Sinai School of Medicine. 1991 - 1992

Internship, Internal Medicine, Brookdale Hospital Medical Center. 1990 - 1991

Education

MD | Universita Degli Studi di Milano (Italy). 1988

Research

Dr. Schifitto's major research interests are in the in the development and implementation of novel neuroimaging biomarkers applied in the investigation and treatment of, neuroinflammatory, neurodegenerative and cerebrovascular disorders.

Publications

Journal Articles

Pregabalin for painful HIV neuropathy: a randomized, double-blind, placebo-controlled trial.

Simpson DM, Schifitto G, Clifford DB, Murphy TK, Durso-De Cruz E, Glue P, Whalen E, Emir B, Scott GN, Freeman R,

Neurology.. 2010 February 274 (5):413-20. Epub 1900 01 01.

Effects of nadir CD4 count and duration of human immunodeficiency virus infection on brain volumes in the highly active antiretroviral therapy era.

Cohen RA, Harezlak J, Schifitto G, Hana G, Clark U, Gongvatana A, Paul R, Taylor M, Thompson P, Alger J, Brown M, Zhong J, Campbell T, Singer E, Daar E, McMahon D, Tso Y, Yiannoutsos CT, Navia B

Journal of neurovirology.. 2010 February 16 (1):25-32. Epub 1900 01 01.

Neuroprotective activities of CEP-1347 in models of neuroAIDS.

Eggert D, Dash PK, Gorantla S, Dou H, Schifitto G, Maggirwar SB, Dewhurst S, Poluektova L, Gelbard HA, Gendelman HE

The Journal of immunology : official journal of the American Association of Immunologists.. 2010 January 15184 (2):746-56. Epub 12/04/2009.

Selegiline and oxidative stress in HIV-associated cognitive impairment.

Schifitto G, Yiannoutsos CT, Ernst T, Navia BA, Nath A, Sacktor N, Anderson C, Marra CM, Clifford DB,

Neurology.. 2009 December 873 (23):1975-81. Epub 11/04/2009.

Lopinavir cerebrospinal fluid steady-state trough concentrations in HIV-infected adults.

Dicenzo R, Difrancesco R, Cruttenden K, Donnelly J, Schifitto G

The Annals of pharmacotherapy.. 2009 December 43 (12):1972-7. Epub 11/24/2009.

Impact of combination antiretroviral therapy on cerebrospinal fluid HIV RNA and neurocognitive performance.

Marra CM, Zhao Y, Clifford DB, Letendre S, Evans S, Henry K, Ellis RJ, Rodriguez B, Coombs RW, Schifitto G, McArthur JC, Robertson K,

AIDS.. 2009 July 1723 (11):1359-66. Epub 1900 01 01.

Lithium therapy for human immunodeficiency virus type 1-associated neurocognitive impairment.

Schifitto G, Zhong J, Gill D, Peterson DR, Gaugh MD, Zhu T, Tivarus M, Cruttenden K, Maggirwar SB, Gendelman HE, Dewhurst S, Gelbard HA

Journal of neurovirology.. 2009 April 15 (2):176-86. Epub 1900 01 01.

Evaluation of measurement uncertainties in human diffusion tensor imaging (DTI)-derived parameters and optimization of clinical DTI protocols with a wild bootstrap analysis.

Zhu T, Liu X, Gaugh MD, Connelly PR, Ni H, Ekholm S, Schifitto G, Zhong J

Journal of magnetic resonance imaging : JMRI.. 2009 February 29 (2):422-35. Epub 1900 01 01.

Effects of minocycline and valproic acid coadministration on atazanavir plasma concentrations in human immunodeficiency virus-infected adults receiving atazanavir-ritonavir.

DiCenzo R, Peterson DR, Cruttenden K, Mariuz P, Rezk NL, Hochreiter J, Gelbard H, Schifitto G

Antimicrobial agents and chemotherapy.. 2008 September 52 (9):3035-9. Epub 06/23/2008.

Fatigue in levodopa-naive subjects with Parkinson disease.

Schifitto G, Friedman JH, Oakes D, Shulman L, Comella CL, Marek K, Fahn S,

Neurology.. 2008 August 1271 (7):481-5. Epub 1900 01 01.

Simplification of the Research Diagnosis of HIV-Associated Sensory Neuropathy

Evans,S.R.; Clifford,D.B.; Kitch,D.W.; Goodkin,K.; Schifitto,G.; McArthur,J.C.; Simpson,D.M.;.

HIV Clin Trials. 2008; 9(6): 434-439.

A multicenter trial of selegiline transdermal system for HIV-associated cognitive impairment.

Schifitto G, Zhang J, Evans SR, Sacktor N, Simpson D, Millar LL, Hung VL, Miller EN, Smith E, Ellis RJ, Valcour V, Singer E, Marra CM, Kolson D, Weihe J, Remmel R, Katzenstein D, Clifford DB,

Neurology.. 2007 September 2569 (13):1314-21. Epub 07/25/2007.

Memantine and HIV-associated cognitive impairment: a neuropsychological and proton magnetic resonance spectroscopy study.

Schifitto G, Navia BA, Yiannoutsos CT, Marra CM, Chang L, Ernst T, Jarvik JG, Miller EN, Singer EJ, Ellis RJ, Kolson DL, Simpson D, Nath A, Berger J, Shriver SL, Millar LL, Colquhoun D, Lenkinski R, Gonzalez RG, Lipton SA, , ,

AIDS.. 2007 September 1221 (14):1877-86. Epub 1900 01 01.

Determination of lopinavir cerebral spinal fluid and plasma ultrafiltrate concentrations by liquid chromatography coupled to tandem mass spectrometry.

DiFrancesco R, DiCenzo R, Vicente G, Donnelly J, Martin TM, Colon LA, Schifito G, Morse GD

Journal of pharmaceutical and biomedical analysis.. 2007 September 344 (5):1139-46. Epub 05/25/2007.

Platelet decline: an avenue for investigation into the pathogenesis of human immunodeficiency virus -associated dementia.

Wachtman LM, Skolasky RL, Tarwater PM, Esposito D, Schifitto G, Marder K, McDermott MP, Cohen BA, Nath A, Sacktor N, Epstein LG, Mankowski JL, McArthur JC

Archives of neurology.. 2007 September 64 (9):1264-72. Epub 1900 01 01.

Functional synergy between CD40 ligand and HIV-1 Tat contributes to inflammation: implications in HIV type 1 dementia.

Sui Z, Sniderhan LF, Schifitto G, Phipps RP, Gelbard HA, Dewhurst S, Maggirwar SB

The Journal of immunology : official journal of the American Association of Immunologists.. 2007 March 1178 (5):3226-36. Epub 1900 01 01.

Glycogen synthase kinase 3 beta (GSK-3 beta) as a therapeutic target in neuroAIDS.

Dewhurst S, Maggirwar SB, Schifitto G, Gendelman HE, Gelbard HA

Journal of neuroimmune pharmacology : the official journal of the Society on NeuroImmune Pharmacology.. 2007 March 2 (1):93-6. Epub 12/16/2006.

Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030.

Dorsey ER, Constantinescu R, Thompson JP, Biglan KM, Holloway RG, Kieburtz K, Marshall FJ, Ravina BM, Schifitto G, Siderowf A, Tanner CM

Neurology.. 2007 January 3068 (5):384-6. Epub 11/02/2006.

An evaluation of neurocognitive status and markers of immune activation as predictors of time to death in advanced HIV infection.

Sevigny JJ, Albert SM, McDermott MP, Schifitto G, McArthur JC, Sacktor N, Conant K, Selnes OA, Stern Y, McClernon DR, Palumbo D, Kieburtz K, Riggs G, Cohen B, Marder K, Epstein LG

Archives of neurology.. 2007 January 64 (1):97-102. Epub 1900 01 01.

Proton MRS and neuropsychological correlates in AIDS dementia complex: evidence of subcortical specificity.

Paul RH, Yiannoutsos CT, Miller EN, Chang L, Marra CM, Schifitto G, Ernst T, Singer E, Richards T, Jarvik GJ, Price R, Meyerhoff DJ, Kolson D, Ellis RJ, Gonzalez G, Lenkinski RE, Cohen RA, Navia BA

The Journal of neuropsychiatry and clinical neurosciences.. 2007 19 (3):283-92. Epub 1900 01 01.

Selegiline transdermal system (STS) for HIV-associated cognitive impairment: open-label report of ACTG 5090.

Evans SR, Yeh TM, Sacktor N, Clifford DB, Simpson D, Miller EN, Ellis RJ, Valcour V, Marra CM, Millar L, Schifitto G,

HIV clinical trials.. 2007 8 (6):437-46. Epub 1900 01 01.

A placebo-controlled study of memantine for the treatment of human immunodeficiency virus-associated sensory neuropathy.

Schifitto G, Yiannoutsos CT, Simpson DM, Marra CM, Singer EJ, Kolson DL, Nath A, Berger JR, Navia B,

Journal of neurovirology.. 2006 August 12 (4):328-31. Epub 1900 01 01.

Inhibition of mixed lineage kinase 3 prevents HIV-1 Tat-mediated neurotoxicity and monocyte activation.

Sui Z, Fan S, Sniderhan L, Reisinger E, Litzburg A, Schifitto G, Gelbard HA, Dewhurst S, Maggirwar SB

The Journal of immunology : official journal of the American Association of Immunologists.. 2006 July 1177 (1):702-11. Epub 1900 01 01.

HIV neuropathy natural history cohort study: assessment measures and risk factors.

Simpson DM, Kitch D, Evans SR, McArthur JC, Asmuth DM, Cohen B, Goodkin K, Gerschenson M, So Y, Marra CM, Diaz-Arrastia R, Shriver S, Millar L, Clifford DB,

Neurology.. 2006 June 1366 (11):1679-87. Epub 1900 01 01.

Valproic acid adjunctive therapy for HIV-associated cognitive impairment: a first report.

Schifitto G, Peterson DR, Zhong J, Ni H, Cruttenden K, Gaugh M, Gendelman HE, Boska M, Gelbard H

Neurology.. 2006 March 2866 (6):919-21. Epub 03/01/2006.

Is skin biopsy a predictor of transition to symptomatic HIV neuropathy? A longitudinal study.

Herrmann DN, McDermott MP, Sowden JE, Henderson D, Messing S, Cruttenden K, Schifitto G

Neurology.. 2006 March 2866 (6):857-61. Epub 1900 01 01.

A multicenter study of two magnetic resonance spectroscopy techniques in individuals with HIV dementia.

Sacktor N, Skolasky RL, Ernst T, Mao X, Selnes O, Pomper MG, Chang L, Zhong K, Shungu DC, Marder K, Shibata D, Schifitto G, Bobo L, Barker PB

Journal of magnetic resonance imaging : JMRI.. 2005 April 21 (4):325-33. Epub 1900 01 01.

Markers of immune activation and viral load in HIV-associated sensory neuropathy.

Schifitto G, McDermott MP, McArthur JC, Marder K, Sacktor N, McClernon DR, Conant K, Cohen B, Epstein LG, Kieburtz K,

Neurology.. 2005 March 864 (5):842-8. Epub 1900 01 01.

Evaluation of HIV RNA and markers of immune activation as predictors of HIV-associated dementia.

Sevigny JJ, Albert SM, McDermott MP, McArthur JC, Sacktor N, Conant K, Schifitto G, Selnes OA, Stern Y, McClernon DR, Palumbo D, Kieburtz K, Riggs G, Cohen B, Epstein LG, Marder K

Neurology.. 2004 December 1463 (11):2084-90. Epub 1900 01 01.

Levodopa and the progression of Parkinson's disease.

Fahn S, Oakes D, Shoulson I, Kieburtz K, Rudolph A, Lang A, Olanow CW, Tanner C, Marek K,

The New England journal of medicine.. 2004 December 9351 (24):2498-508. Epub 1900 01 01.

A multicenter in vivo proton-MRS study of HIV-associated dementia and its relationship to age.

Chang L, Lee PL, Yiannoutsos CT, Ernst T, Marra CM, Richards T, Kolson D, Schifitto G, Jarvik JG, Miller EN, Lenkinski R, Gonzalez G, Navia BA,

NeuroImage.. 2004 December 23 (4):1336-47. Epub 1900 01 01.

Effects of valproic acid coadministration on plasma efavirenz and lopinavir concentrations in human immunodeficiency virus-infected adults.

DiCenzo R, Peterson D, Cruttenden K, Morse G, Riggs G, Gelbard H, Schifitto G

Antimicrobial agents and chemotherapy.. 2004 November 48 (11):4328-31. Epub 1900 01 01.

Regional patterns of brain metabolites in AIDS dementia complex.

Yiannoutsos CT, Ernst T, Chang L, Lee PL, Richards T, Marra CM, Meyerhoff DJ, Jarvik JG, Kolson D, Schifitto G, Ellis RJ, Swindells S, Simpson DM, Miller EN, Gonzalez RG, Navia BA

NeuroImage.. 2004 November 23 (3):928-35. Epub 1900 01 01.

Attenuated central nervous system infection in advanced HIV/AIDS with combination antiretroviral therapy.

McArthur JC, McDermott MP, McClernon D, St Hillaire C, Conant K, Marder K, Schifitto G, Selnes OA, Sacktor N, Stern Y, Albert SM, Kieburtz K, deMarcaida JA, Cohen B, Epstein LG

Archives of neurology.. 2004 November 61 (11):1687-96. Epub 1900 01 01.

Epidermal nerve fiber density, axonal swellings and QST as predictors of HIV distal sensory neuropathy.

Herrmann DN, McDermott MP, Henderson D, Chen L, Akowuah K, Schifitto G,

Muscle & nerve.. 2004 March 29 (3):420-7. Epub 1900 01 01.

A multi-center 1H MRS study of the AIDS dementia complex: validation and preliminary analysis.

Lee PL, Yiannoutsos CT, Ernst T, Chang L, Marra CM, Jarvik JG, Richards TL, Kwok EW, Kolson DL, Simpson D, Tang CY, Schifitto G, Ketonen LM, Meyerhoff DJ, Lenkinski RE, Gonzalez RG, Navia BA,

Journal of magnetic resonance imaging : JMRI.. 2003 June 17 (6):625-33. Epub 1900 01 01.

Inter-rater reliability of a clinical staging of HIV-associated cognitive impairment.

Marder K, Albert SM, McDermott MP, McArthur JC, Schifitto G, Selnes OA, Sacktor N, Stern Y, Palumbo D, Kieburtz K, Cohen B, Orme C, Epstein LG

Neurology.. 2003 May 1360 (9):1467-73. Epub 1900 01 01.

Lamotrigine for HIV-associated painful sensory neuropathies: a placebo-controlled trial.

Simpson DM, McArthur JC, Olney R, Clifford D, So Y, Ross D, Baird BJ, Barrett P, Hammer AE,

Neurology.. 2003 May 1360 (9):1508-14. Epub 1900 01 01.

Oxidative stress in HIV demented patients and protection ex vivo with novel antioxidants.

Turchan J, Pocernich CB, Gairola C, Chauhan A, Schifitto G, Butterfield DA, Buch S, Narayan O, Sinai A, Geiger J, Berger JR, Elford H, Nath A

Neurology.. 2003 January 2860 (2):307-14. Epub 1900 01 01.

Effects of coenzyme Q10 in early Parkinson disease: evidence of slowing of the functional decline.

Shults CW, Oakes D, Kieburtz K, Beal MF, Haas R, Plumb S, Juncos JL, Nutt J, Shoulson I, Carter J, Kompoliti K, Perlmutter JS, Reich S, Stern M, Watts RL, Kurlan R, Molho E, Harrison M, Lew M,

Archives of neurology.. 2002 October 59 (10):1541-50. Epub 1900 01 01.

HIV-associated cognitive impairment before and after the advent of combination therapy.

Sacktor N, McDermott MP, Marder K, Schifitto G, Selnes OA, McArthur JC, Stern Y, Albert S, Palumbo D, Kieburtz K, De Marcaida JA, Cohen B, Epstein L

Journal of neurovirology.. 2002 April 8 (2):136-42. Epub 1900 01 01.

Severity of HIV-associated neuropathy is associated with plasma HIV-1 RNA levels.

Simpson DM, Haidich AB, Schifitto G, Yiannoutsos CT, Geraci AP, McArthur JC, Katzenstein DA,

AIDS.. 2002 February 1516 (3):407-12. Epub 1900 01 01.

A randomized clinical trial of CPI-1189 for HIV-associated cognitive-motor impairment

Clifford,D.B.; McArthur,J.C.; Schifitto,G.; Kieburtz,K.; McDermott,M.P.; Letendre,S.; Cohen,B.A.; Marder,K.; Ellis,R.J.; Marra,C.M.; Neurological AIDS Research Consortium;.

Neurol. 2002; 59: 1568-1573.

Reduced intraepidermal nerve fiber density in HIV-associated sensory neuropathy

Polydefkis,M.; Yiannoutsos,C.; Cohen,B.; Hollander,H.; Schifitto,G.; Clifford,D.B.; Simpson,D.M.; Katzenstein,D.; Shriver,S.; Hauer,P.; Brown,A.; Haidich,A.-B.; Moo,L.R.; McArthur,J.C.;.

Neurol. 2002; 58: 115-119.

Incidence of and risk factors for HIV-associated distal sensory polyneuropathy

Schifitto,G.; McDermott,M.P.; McArthur,J.C.; Marder,K.; Sacktor,N.; Epstein,L.; Kieburtz,K.; The Dana Consortium on the Therapy of HIV Dementia and Related Cognitive Disorders;.

Neurol. 2002; 58: 1764-1768.

Chronic stress in non-elderly caregivers: Psychological, endocrine and immune implications

Vedhara,K.; McDermott,M.P.; Evans,T.; Treanor,J.; Plummer,S.; Tallon,D.; Chen,D.; Cruttenden,K.; Schifitto,G.;.

J Psychosomatic Research. 2002; 53: 1153-1161.

Plasma carnitine in HIV-associated neuropathy.

Simpson DM, Katzenstein D, Haidich B, Millington D, Yiannoutsos C, Schifitto G, McArthur J,

AIDS.. 2001 November 915 (16):2207-8. Epub 1900 01 01.

Factors associated with incident human immunodeficiency virus-dementia.

Stern Y, McDermott MP, Albert S, Palumbo D, Selnes OA, McArthur J, Sacktor N, Schifitto G, Kieburtz K, Epstein L, Marder KS,

Archives of neurology.. 2001 March 58 (3):473-9. Epub 1900 01 01.

Clinical trials in HIV-associated cognitive impairment: Cognitive and functional outcomes

Schifitto,G.; Kieburtz,K.; McDermott,M.P.; McArthur,J.; Marder,K.; Sacktor,N.; Palumbo,D.; Selnes,O.; Stern,Y.; Epstein,L.; Albert,S.;.

Neurol. 2001; 56: 415-418.

Long-term treatment with recombinant nerve growth factor for HIV-associated sensory neuropathy

Schifitto,G.; Yiannoutsos,C.; Simpson,D.M.; Adornato,B.T.; Singer,E.J.; Hollander,H.; Marra,C.M.; Rubin,M.; Cohen,B.A.; Tucker,T.; Koralnik,I.J.; Katzenstein,D.; Haidich,B.; Smith,M.E.; Shriver,S.; Millar,L.; Clifford,D.B.; McArthur,J.C.; the AIDS Clinical Trials Group Team 291;.

Neurol. 2001; 57: 1313-1316.

A randomized, placebo-controlled trial of coenzyme Q10 and remacemide in Huntington's disease

Huntington Study Group.

Neurology. 2001; 57(3): 397-404.

Autonomic performance and dehydroepiandrosterone sulfate levels in HIV-1-infected individuals: relationship to TH1 and TH2 cytokine profile.

Schifitto G, McDermott MP, Evans T, Fitzgerald T, Schwimmer J, Demeter L, Kieburtz K

Archives of neurology.. 2000 July 57 (7):1027-32. Epub 1900 01 01.

A phase II trial of nerve growth factor for sensory neuropathy associated with HIV infection. AIDS Clinical Trials Group Team 291.

McArthur JC, Yiannoutsos C, Simpson DM, Adornato BT, Singer EJ, Hollander H, Marra C, Rubin M, Cohen BA, Tucker T, Navia BA, Schifitto G, Katzenstein D, Rask C, Zaborski L, Smith ME, Shriver S, Millar L, Clifford DB, Karalnik IJ

Neurology.. 2000 March 1454 (5):1080-8. Epub 1900 01 01.

Transdermal selegiline in HIV-associated cognitive impairment: pilot placebo-controlled study

Sacktor,N.; Schifitto,G.; McDermott,M.P.; Marder,K.; McArthur,J.C.; Kieburtz,K.;.

Neurol. 2000; 54: 233-235.

Randomized trial of the platelet-activating factor antagonist lexipafant in HIV-associated cognitive impairment. Neurological AIDS Research Consortium.

Schifitto G, Sacktor N, Marder K, McDermott MP, McArthur JC, Kieburtz K, Small S, Epstein LG

Neurology.. 1999 July 2253 (2):391-6. Epub 1900 01 01.

Disease progression in HIV-positive women with moderate to severe immunosuppression: the role of depression. Dana Consortium on Therapy for HIV Dementia and Related Cognitive Disorders.

Vedhara K, Schifitto G, McDermott M

Behavioral medicine.. 1999 25 (1):43-7. Epub 1900 01 01.

Cerebrovascular disease in patients with HIV-1 associated pulmonary hypertension.

Schifitto G, Holloway R

Journal of neuro-AIDS.. 1999 2 (2):57-64. Epub 1900 01 01.

A randomized trial of amitriptyline and mexiletine for painful neuropathy in HIV infection. AIDS Clinical Trial Group 242 Protocol Team.

Kieburtz K, Simpson D, Yiannoutsos C, Max MB, Hall CD, Ellis RJ, Marra CM, McKendall R, Singer E, Dal Pan GJ, Clifford DB, Tucker T, Cohen B

Neurology.. 1998 December 51 (6):1682-8. Epub 1900 01 01.

X-linked female band heterotopia-male lissencephaly syndrome

Berg,M.J.; Schifitto,G.; Powers,J.M.; Martinez-Capolino,C.; Fong,C.-T.; Myers,G.J.; Epstein,L.G.; Walsh,C.A.;.

Neurol. 1998; 50: 1143-1146.

A randomized, double-blind, placebo-controlled trial of deprenyl and thioctic acid in human immunodeficiency virus-associated cognitive impairment

Dana Consortium on the Therapy of HIV Dementia and Related Cognitive Disorders.

Neurology. 1998; 50(3): 645-51.

Schifitto G, Barbano RL, Kieburtz KD, Cohn SE, Zwillich SH

Journal of neurology, neurosurgery, and psychiatry.. 1997 August 63 (2):255-6. Epub 1900 01 01.

Safety and tolerability of the antioxidant OPC-14117 in HIV-associated cognitive impairment

The Dana Consortium on the Therapy of HIV Dementia and Related Cognitive Disorders.

Neurology. 1997; 49(1): 142-6.

Clinical confirmation of the American Academy of Neurology algorithm for HIV-1-associated cognitive/motor disorder

The Dana Consortium on Therapy for HIV Dementia and Related Cognitive Disorders.

Neurology. 1996; 47(5): 1247-53.

Books

Handbook of Neurologic Rating Scales (2006)

Chapter: Human Immunodeficiency Virus-Associated Cognitive Impairment

Handbook of Secondary Dementias (2006)

Chapter: HIV-1-Associated Dementia (HAD)

Principles of Neurologic Infectious Diseases (2005)

Chapter: HIV-Associated Neuropathy and Myelopathy

Baker's Clinical Neurology (2003)

Chapter: Neurological Complications Associated with HIV-1 Infection

Clinical Neurology (1996)

Chapter: HIV-1 Infection and the Nervous System

Ratings & Comments

At URMC, we believe that patients should be empowered to make the right decisions regarding their personal healthcare. To do so, transparency is critical. URMC partners with Press Ganey, to survey our patients about all aspects of their care experience. We are now putting this pertinent information at your fingertips by displaying star ratings for our providers along with anonymous patient comments on our website. This will help you make better-informed choices about how and with whom you seek care. Click here to learn more about the surveys used to generate this vital information. Learn more about our survey process.