bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Graphic Novels on EFL Learners’ Reading Comprehension
Authors: Aldahash Reema , Altalhab Sultan
Published: December 2020

Saudi EFL learners struggle to read English and encounter obstacles that prevent improvement. Recently, graphic novels were introduced as alternative teaching and learning materials in academic settings. Nevertheless, research in this area remains limited. Therefore, this study examines the effect of reading a graphic novel on reading comprehension and investigates the perceptions of EFL teachers and students regarding the deployment of graphic novels in their classrooms. Sixty-six intermediate school students were divided into experimental and control groups. After the reading sessions, both groups completed reading comprehension tests. Results revealed that reading graphic novels positively affects reading comprehension as the experimental group achieved superior results to the control group. Both EFL teachers and students believe that graphic novels help in improving reading skills. The study concludes by discussing related implications.
A Study on the Transmission of Implicit Information in Chinese Tang Poetry Translation under the Guidance of Frame Theory
Authors: Lingling Lou
Published: December 2020

As Chinese is a language focusing on parataxis, and China is a country with a largely different culture from the western world, the implicit information contained in poems could not be easily perceived by target language readers if it is not properly delivered. As a result, the faithful transmission of the implicit information contained in Tang poetry has always been a hotspot in the research of the translation of Chinese classical poetry. The aim of the research is to study the transmission of implicit information in Tang poetry translation under the frame theory. To achieve this, the thesis would be discussed in six parts. After a brief introduction to the current situation of Tang poetry translation, the guiding theory would be illustrated in detail. Then the author will try to analyze the reasons for the failure of transmission of implicit information in Tang poetry translation, which leads to the examination of the feasibility of using frame theory in the guidance of the implicit information transmission. And then specific translation strategies are put forward by the author together with some examples in accordance with frame theory. In the end, a conclusion is drawn based on the discussion of the previous chapters. The study of the transmission of implicit information from the angle of frame theory is a creative and bold try, which provides a theoretic reference for the research on this subject in the future, and a practical experience for the implicit information transmission in Tang poetry translation activities.
Prospect of Bay Leaf (Syzygium Polyanthum) Extract in Reducing Ischemia and Inflammation in Animal Model of Myocardial Infarction: An Experimental Study
Authors: Hasan Refli , Siregar Gontar Alamsyah , Lindarto Dharma
Published: December 2020

Introduction: Bay leaf (Syzygium polyanthum) was thought to have potential to treat cardiovascular disease traditionally. Myocardial Infarction (MI) characterised by sudden blockage of coronary artery due to atherosclerosis rupture and following MI, several changes could happen such as expression of Hypoxia-Inducible Factor (HIF) 1α, immune cell infiltration, cytokine release, and fibrosis. Aim: To study the effect of bay leaf extract on HIF-1α, immune cell infiltration, IL-10 level, and fibrosis in animal model of MI. Materials and Methods: An Experimental study using animal model of MI was conducted in December 2019. Thirty two Wistar rats were surgically manipulated to have MI. Rats were then divided into two groups: treatment group (with bay leaf extract administration) and control group. Neutrophil and macrophage distribution, collagen (fibrosis) distribution, and HIF-1αexpression were examined in infarcted muscle. Additionally, serum was taken to measure IL-10 level. Observation was conducted on day 1, day 4, day 7, day 14 after MI episode. Independent t-test was used to compare serum IL-10 level between groups. Statistical significance was set at p<0.05. Results: Lower HIF-1α expression was seen in treatment group since day 1, showing better response to ischemia. As for inflammation, decreased neutrophil distribution, increased macrophage distribution was observed in treatment group. Significant increases in IL-10 level were also noticed since day 1 in treatment group (p<0.05 in all observation day). Lower fibrosis was also noticed from day 1 in treatment group. All these effects were further seen in day 4, day 7, and day 14. Conclusion: Bay leaf extract has potential in reducing ischemia, inflammation, and cardiac fibrosis in animal model of MI.
Comparing Correlation Coefficients and Path Analysis in Different Populations of Rice (Oryza sativa L.)
Authors: Kumar Anjani , Singh D. N. , Prasad Krishna , Pandey Avinash
Published: December 2020

This study performed to determine the correlation, their comparison and path coefficients of yield and yield contributing characters by using F2 (BPT-5204 /IR-64Drt1) their two parents separately and the joint parental populations. In this study, the computations for testing the significance of the difference between the 15 traits of different populations of rice determined from 324 F2, 9 IR-64Drt1 (P1), 9 BPT-5204 (P2) and 18 joint parental population. Results showed that the correlation of F2 indicated that the number of total tillers per plant, number of panicles per plant, plant height, panicle length, biomass, harvest index and yield per panicle were positive and significant association with yield per plant. Correlation of IR-64Drt1 stated that the plant height, panicle length, biomass and harvest index were positive and significant association with yield per plant. Correlation of BPT-5204 shown that the secondary branches per panicle and hundred-grain weight exhibited positive and significant association with yield per panicle. Correlation of the joint parent indicated that the plant height, panicle length, grain length, grain width, hundred-grain weight, biomass, harvest index and yield per panicle had exhibited positive and significant association with yield per plant. Path coefficient analysis indicated that harvest index had the highest direct positive effect (0.582) on yield per plant in the F2 population. However, the panicles per plant had the highest direct positive effect (1.481) on yield per plant IR-64Drt1 population. The total tillers per plant had the highest direct positive effect (1.821) on yield per plant in BPT-5204 population. In the joint population of BPT-5204 and IR-64Drt1, path analysis of yield components revealed that the biomass had the highest direct positive effect (0.658) on yield per plant. Information obtained in this study revealed that traits, the harvest index, biomass and panicles per plant are suggested as selection indices for grain yield improvement at segregating populations of rice.
Socio-Ecological Correlates of Attitude towards KVK Functioning: A Multivariate Analytical Approach
Authors: Acharya S. K. , Ghosh Arindam , Mahato Mrityunjoy , Haque Monirul , Mazumder Debashis , Ghoshal Swagata , Biswas Amitava
Published: December 2020

Krishi Vigyan Kendra was established initially to impart training to the different stakeholders of the farming community as a method of technology delivery system. As the time passed by this grass root institution has undergone a tremendous change, starting from technology generation, testing, verification and ultimately onwards transmission to the end users for the enhancement of the productivity in particular and for the overall socio- economic development of the rural people in general with its mandated programmes.  The work was conducted with 10 independent variables and one dependent variables- Attitude towards KVK activities (y).Purposive as well as simple random techniques were adopted for the study. For selection of state & district purposive sampling techniques and for block & villages simple random technique were employed for selection of respondents. Among 50 adopted KVK farmers of the selected villages only 22 adopted farmers have been randomly selected and more 22 non adopted farmers and thus altogether 44 farmers have been randomly selected for the study. Analyzing the data using the statistical tools range, mean, coefficient of variation, coefficient of correlation, regression analysis, path analysis, factor analysis, canonical discriminate (Unstandardized) Function results were obtained. So it is clear that KVK is an institutional project of ICAR to demonstrate the application of science and technology input of agricultural research and education in the farmers field in the rural areas and today KVK stands as a bridge between the research laboratories and application of modern agricultural science in rural India through the technology the development and delivery system.
Influence of Antioxidant Supplementation on High Fat Diet-Streptozotocin (HFD-STZ) Induced Type 2 Diabetes Mellitus in Albino Rats
Authors: Chuku L. C. , Chinaka N. C.
Published: December 2020

The influenceof antioxidant supplementation on high fat diet-streptozotocin (HFD-STZ) induced type 2 diabetes mellitus in Wistar albino rats was investigated. Appropriate (RDA) proportions of some antioxidant rich substances which includes; vitamins (A, B3, B6, B12, C and E), minerals (calcium, selenium, chromium, magnesium, potassium and zinc), α-lipoic acid, cinnamon powder, curcumin (Meriva®), cordyceps, resveratrol, quercetin, D-ribose-L-cysteine were pulled together in corn oil and stored at 4°C for use. Serum glutathione (GSH) and malondialdehyde (MDA) levels, as well as activities of antioxidant enzymes: superoxide dismutases (SOD), catalase (CAT), glutathione-s-transferase (GST), glutathione peroxidise (GPx) and glutathione reductase (GR) were measured using standard methods. Data analysis was done with SPSS version 20.0 and significant level was set at P≤0.05. Results of in vitro oxidative stress indices and antioxidant enzyme activity indicate that after 4 weeks of treatment, there was no significant change (p≥0.05) in serum FBS levels of treated groups compared to the normal control group, but there was a significant decrease (p≤0.05) after 8 and 12 weeks of treatment when compared to the diabetic control group. There was no significant difference (p≥0.05) in the activities of antioxidant enzymes when compared to the normal control group, while in the diabetic control there was significant increase (p≤0.05) compared to the other groups. The results after 4, 8 and 12 weeks of treatment showed a significant increase (p≤0.05) in serum GSH level of normal and treated groups compared to diabetic control group, whereas there was a significant decline (p≤0.05) in serum MDA level of treated and normal control groups when compared to diabetic control. The results therefore suggest that the supplement may possess significant (p≤0.05) free radical scavenging potentials which could be beneficial to health.
Study of Groundwater-river Interactions Using Hydrochemical Tracers in Fissured Rock: Case of the Lobo Watershed at Nibéhibé (Central-West, Côte d’Ivoire)
Authors: Ouattara Gningnéri Souleymane , Dibi Brou , Waidhet Arthur Brice Konan- , Mangoua Jules Mangoua Oi , Kamagate Bamory
Published: December 2020

Water is a vital resource for all populations. However, there are warning signs that the water from the Lobo River used by SODECI to supply drinking water to the population is declining in quantity during the dry season and its quality is becoming poor due to climate variability and anthropogenic activities. However, the river is able to maintain a certain flow, probably with the contribution of groundwater. It is therefore a question of whether there is really a connection between surface water and groundwater. The aim of this study is to characterize the groundwater-river interactions based on the physico-chemical parameters of the Lobo watershed in Nibéhibé. The approach adopted is a coupled statistical-geochemical approach applied on data from two sampling campaigns (dry and rainy season). This coupled approach consisted, on the one hand, in understanding the chemical specificities within the water classes using the piper diagram and, on the other hand, in classifying the waters according to their physico-chemical similarity and highlighting the phenomena at the origin of the water mineralization using the Kohonen self-organized map (SOM). The results obtained from the piper diagram show that in both the wet and dry seasons, the chemical signature of the waters remains controlled by two main hydrochemical facies: the chlorinated calcium-magnesium nitrate hydrofacies and the bicarbonate calcium-magnesium hydrofacies. Kohonen's self-organized map has established that the mineralization of groundwater, under natural conditions, comes from the nature of the rocks crossed during infiltration and from the contact time between water and minerals. This work provides managers with decision-support tools for planning and searching for groundwater in support of surface water to reinforce the drinking water supply of the populations in this watershed.
Online Learning Using Google Classroom: Undergraduate Medical Students and Paediatric Residents Perspectives in the University of Port Harcourt, Nigeria
Authors: Yarhere I. E. , Obuzor I. O. , Fomsi E.
Published: December 2020

Schools in Nigeria were shut down and lectures stopped altogether. The capacity of the Nigerian educational environment to carry out these online interactions may be stretched thin with many foreseeable challenges.

Objectives: To identify the current familiarity and use of online classroom platforms by medical students and Paediatric residents, and to identify the barriers to its use for medical education.

Methods: A descriptive comparative study design using a semi-structured online questionnaire Google survey of 128 medical students and residents in training in University of Port Harcourt Teaching Hospital assessing demographics, availability of tools for online learning and application.

Results: Both groups had high familiarity, but low use, of Google classroom, and preferred mobile devices to laptops. There was high familiarity 90.6%, but low use 42.2%, of Google classroom and the ease of using Google classroom for interphasing or interacting between learners and facilitators was affected by Internet availability, Pearson correlation, 0.185, p = 0.037, but not electric power availability, Pearson correlation, 0.135, p = 0.133.

Conclusions: There is an overall high awareness of a range of the Google classroom LMS platform by both medical students and residents. However, constant electric energy supply, availability of internet and competence in preparing multimedia presentations and uploading these for assessment may enhance the use of online learning platforms in Nigeria for undergraduate and post graduate medical education.
Impact of Aluminium on Nutrient Profile of Soil under Various Genotypes of Garden Pea
Authors: Ansari Mohd Talha , Sarma Pranabjyoti , Mailappa A. S. , Deo C. , Singh A. K. , Wangchu L. , Hazarika B. N.
Published: December 2020

The aim of this study was to examine the influence of Al on nutrient profile of soil grown with various pea genotypes. The study involved growing two tolerant pea (Kashi Samrath and Kashi Samridhi) and two susceptible (Matar Ageta-7 and AP-3) genotypes with increasing added rate of Al (0, 12 ppm and 24 ppm) in soil. Al application in soil resulted in significant decrease in nutrient availability of soil mainly nitrogen, phosphorus and potassium. The addition of Al caused decrease in soil pH causing a negative effect on the yield of susceptible pea genotypes. However, in tolerant genotypes, there was no significant effect on yield, despite a decrease in soil pH and an imbalance of nutrients.
Curvatures of the Factorable Hypersurface
Authors: Güler Erhan
Published: December 2020

The curvatures    of a factorable hypersurface are introduced in the four-dimensional Euclidean space. It is also given some relations on  of the factorable hypersurface.
Chronic Distal Radioulnar Instability- Diagnosis and Treatment: A Review
Authors: Younes Sanad , Saad Ahmad , Buahlaika Zeyad
Published: December 2020

The distal radioulnar joint is one of the inherently unstable joint in the body, its injury is commonly missed and the patient may present later with pain and restricted movement because of joint instability.  The distal radioulnar joint instability could be dorsal , volar , or bidirectional, and it could be caused by soft tissue injury or bony injury and malunion. It is fundamentall to recognize the type of injury and the cause of instability to be able to provide the proper form of treatment to get the best results.
An Investigation on Students’ Perception and Expectation from Hospitality Internship Program in Dhaka
Authors: Shetu Samia Afrin , Sayeda Takrima
Published: December 2020

The main objective of the study is to describe the intern students’ perceptions about their internship experience at hospitality industry in Dhaka. The respondents came from 22 educational institutes. The study used structured questionnaire (40 closed ended questions assessed using 5 point likert scale) comprised of three parts: Part I about internship placement, Part II factors influencing the internship program comprising with internship program planning, industry involvement and students’ self commitment, Part III pursuing a career in hospitality industry, along with demographic information. The study employed descriptive analysis to consider demographic information and central tendencies of the responses. A Cronbach’s alpha value of 0.93 is found and which indicates a good scale reliability. The study finds that students’ value their internship program planning and training notably. The successful completion of the training program has positive impact on future career in hospitality industry. However, the job hierarchy and long working hours create dissatisfaction among the interns.
Performance Efficiency Evaluation of Information and Communication Technology (ICT) Application in Human Resource Management during COVID-19 Pandemic: A Study on Banking Industry of Bangladesh
Authors: Rahman Md. Habibur , Mutsuddi Prantika , Roy Sanjoy Kumar , Amin Md. Al- , Jannat Fatema
Published: December 2020

With the things that go towards the efficiency of ICT usage in HRM, measuring and evaluating have become one of the key goals for researchers and practitioners. When it is related to crisis moments like the COVID-19 pandemic whereas considering the performance of organizations it becomes practically important to examine the level of performance efficiency in HRM. Therefore, in this study, some aspects are explored to know the efficiency of HRM performance with the application of Information and Communication Technology (ICT) in its functions maintaining social distance during the COVID-19 pandemic. While using the regression model, people management, regular HR activities, HR payroll and rewards, and performance evaluation and promotion are taken as independent variables while the HR performance efficiency is taken as a dependent variable. Correlation and regression analyses were conducted to examine the efficiency of HR functions during the pandemic following principal component analysis. The use of ICT assures Human resource management performance efficiency without taking face-to-face interaction during the pandemic. Further, the findings will help practitioners to adopt ICT in the HRM perspective of all organizations and to make the decision about how much modification needs to be done to maximize overall efficiency within the limited resources during any pandemic.
Simulation-Based Training in Basic Surgical Skills: Experiences From a Repeat Cross-Sectional Study in Saudi Arabia
Authors: Almarhabi Yahya
Published: December 2020

Introduction

The conventional surgical apprenticeship has been challenged by patient safety concerns, cost of lengthy operation, and surgical complications. Simulation-based training (SBT) has emerged as a realistic option for surgical skills acquisition outside the operating room (OR). The study aimed to document our experience in implementing SBT to acquire basic surgical skills, offered as an educational course, known as the Basic Surgery Skill Course (BSSC).

Methods

This was a repeated cross-sectional study conducted between January 2017 and December 2019 at King Abdulaziz University Hospital (KAUH) in Saudi Arabia, including all participants who participated during BSSCs. A pretested questionnaire was used to collect data on age, sex, training level, institution, overall experience, course overload, course duration, best feature of the course, and whether participants would recommend the course to their colleagues. Whenever possible, self-reported data were compared with registration records, and any conflict was resolved by discussion.

Results

BSSC was found in a total of 489 participants. More than 58% of the participants were men. Majority of students came from out of KAUH (61%) and were medical interns (63%). Overall experience of the course was very beneficial (57%). The course workload and duration were rated as about right by 82% and 75% of participants, respectively. Majority of participants found that the “hands-on practice” as the best segment of the course (76%).

Conclusion

The study showed a positive perception of this surgical education modality among participants. This study will help guide the future research on advanced simulation-based surgical training in the region.
Rating Post-Operative Backs (Part I)
Authors: Talmage James B.
Published: December 2020

The AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition, uses the Injury Model to rate impairment in people who have experienced back injuries. Injured individuals who have not required surgery can be rated using differentiators. Challenges arise when assessing patients whose injuries have been treated surgically before the patient is rated for impairment. This article discusses five of the most common situations: 1) What is the impairment rating for an individual who has had an injury resulting in sciatica and who has been treated surgically, either with chemonucleolysis or with discectomy? 2) What is the impairment rating for an individual who has a back strain and is operated on without reasonable indications? 3) What is the impairment rating of an individual with sciatica and a foot drop (major anterior tibialis weakness) from L5 root damage? 4) What is the rating for an individual who is injured, has true radiculopathy, undergoes a discectomy, and is rated as Category III but later has another injury and, ultimately, a second disc operation? 5) What is the impairment rating for an older individual who was asymptomatic until a minor strain-type injury but subsequently has neurogenic claudication with severe surgical spinal stenosis on MRI/myelography? [Continued in the September/October 1997 The Guides Newsletter]
Key Principles in Using the Guides (Part II)
Authors: Roth Henry J. , Brigham Christopher R.
Published: December 2020

This article (continued from the previous issue) discusses and clarifies 21 key principles for using the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fourth Edition. Tests of inconsistency are good but imperfect indicators of patients’ efforts, and if observations or test results are insufficient, the physician should explain the modified impairment assessment in writing. The AMA Guides includes rules for interpolating, measuring and rounding, and evaluating, and physicians should be familiar with them. In general, impairment percentages allow for pain that may accompany the impairing condition. If possible, the evaluator should remove a patient's protheses during evaluation. Physicians should consult the Combined Values Chart if the effects of treatment prevent adequate impairment management. A patient's decision to decline therapy for a permanent impairment should neither increase nor decrease the estimated impairment. The AMA strongly encourages use of the most recent of the AMA Guides. Impairment percentages derived according to AMA Guides criteria should not be used to make direct financial awards or direct estimates of disabilities. Combining, compared to adding, is a mathematical process to prevent estimating impairments greater than 100%, and the Combined Values Chart provides guidance for use. Divergent ratings should be matters of fact, not opinion.
The Challenge of Evaluating Asthma Impairment and Disability
Authors: Ranavaya Mohammed I.
Published: December 2020

The diagnostic criteria for asthma usually are straightforward and generally follow the Guidelines of the American Thoracic Society (ATS). The assessment of impairment and disability from asthma is complex because of the variable nature of the disease, and the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) gives physicians discretion to adjust the class of impairment based on the frequency of asthma attacks and the physician's judgment. A physician with expertise in lung disease may use the ATS Guidelines for impairment along with the AMA Guides to determine respiratory and whole person impairment, and a table compares the AMA Guides and the ATS Guidelines in support of assessing whole person impairment. An evaluation protocol addresses the steps in the process (all should be well documented): confirm the presence of asthma; determine its severity; estimate the permanent whole person impairment (a table lists classes of whole person impairment based on the AMA Guides and the ATS Guidelines); and assess work-related asthma. In some cases, an individual with airway hyperresponsiveness may not have an impairment but may have disability for specific jobs. The protocol and suggestions offered here may be practical in most circumstances for evaluating asthma impairment and disability.
Employability
Authors: Engelberg Alan
Published: December 2020

The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, provides useful definitions of employability, employability determination, and medical determinations related to employability. As the AMA Guides notes, and the term medical determination related to employability has supplanted the use of employability. Clearly, factors unrelated to health status affect both employability and its determination, but the physician's role is limited to providing useful medical information, culminating in a statement of risk to the employer. The physician's purview never includes a determination of employability, nor does it justify an opinion that an individual is or is not employable. Managers in human resources departments can clarify the basic principles of equal employment opportunity and thereby minimize the risk of intentional or inadvertent discriminatory actions. Disability evaluation covers the interplay of the injured employee, the human resources function, and the health care providers. When a worker's health status is a factor, the physician's assistance in helping an employer determine employability is crucial, but physicians must never voluntarily state that a person is or is not employable. Physicians can assist an employer in determining if a medical condition precludes travel to work, being at work for a specified time, and assignment of appropriate tasks with or without reasonable accommodation.
Impairment Tutorial: The Challenge of Evaluating RSD Impairment and Disability (Part I)
Authors: Ensalada Leon H.
Published: December 2020

Reflex sympathetic dystrophy (RSD) refers to subjective complaints of pain associated with soft-tissue changes that may not be caused by sympathetic nervous system dysfunction and for which no reflex has been demonstrated. One definition indicates that RSD, like causalgia, is manifested by pain, allodynia, hyperalgesia, and hyperesthesia and, frequently, by vasomotor and sudomotor disturbances and skeletal muscle hypotonia. The diagnosis of RSD depends on the patient's response to regional sympathetic blockade but does not take into account the questionable validity of the sympathetic mediation hypothesis, the placebo effect, or inadequately performed regional sympathetic blockade. These confounders have contributed to the misdiagnosis and overdiagnosis of RSD and causalgia. Since the publication of the AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition, the International Association for the Study of Pain has proposed a new term, complex regional pain syndrome (CRPS) that replaces RDS and causalgia. Dissenting views suggest that the criteria for RDS are vague or that patients with RSD are not a homogeneous population. Evaluators should eliminate alternative diagnoses and then base a finding of RSD, causalgia, or CRPS on a preponderance of clinical evidence. [Part 2 of this article in the next issue of The Guides Newsletter will address impairment due to RSD/causalgia/CRPS.]
Evaluating Impairment from Allergic Disorders
Authors: Welch Laura
Published: December 2020

More than 15 million Americans have allergic rhinitis alone, and approximately 12 million have other allergic manifestations such as urticaria, angioedema, eczema, or sensitivity to food, drugs, or insect bites. Almost 10% of patients who seek care at a physician's office do so for one of the common allergic diseases, but rating impairment for allergic disorders is uncommon because typically they do not produce “permanent” impairment and are not work- or liability-related. Section 9.3a, Respiration in Chapter 9, Ear, Nose, Throat, and Related Structures, of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) addresses the process of assessing impairment due to allergic rhinitis, the first type of allergy. Because allergic rhinitis is seasonal, the examiner must determine if permanent impairment is present and if the patient is at maximum medical improvement. The second major manifestation of allergy is allergic skin disease, including urticaria-angioedema and is discussed in Chapter 13, The Skin, where a table classifies skin disorder impairments. The third primary manifestation of allergic disease is eczema, also called atopic dermatitis, which also is discussed in Chapter 13. Allergic diseases are common but generally are quite treatable. Evaluators should ensure that the patient has had an appropriate trial of therapeutic agents before assigning a permanent partial impairment; because of treatment options, the latter should be rare.
Letter to the Editor
Authors: Mueller Kathryn
Published: December 2020

This letter responds to “Evaluating impairment from allergic disorders” in the March/April 1999 issue of The Guides Newsletter. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) does not provide clear direction about whether allergies themselves constitute impairment. Consider a worker whose symptoms of asthma subsequent to workplace exposure to toluene diioscyanate resolve when he or she is removed from the job and is no longer exposed to the chemical. Because everyday exposure to diisocyanates is not common and the patient no longer requires medication, one could conclude the patient has no impairment. In contrast, consider a patient who has developed latex allergies as a result of being a health care worker and has experienced two anaphylactic reactions at work after entering rooms where powdered latex gloves had been used and must travel with an epinephrine pen. This person would have a minimum of a Class I impairment because of the few limitations of this person's activities of daily living (ADLs) and the condition requires no or intermittent treatment. Both patients might feel they had permanent changes in their body functions that required permanent changes in their ADLs. Clinicians who make evaluations should be aware of patients’ need for medications or monitoring, the severity of the patient's reactions, and limitations on social activities (eg, need for medications and need to avoid seasonal pollens).
Impairment and Disability Compensation Systems in the United States
Authors: Ranavaya Mohammed I. , Talmage James B.
Published: December 2020

Although several states use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) when they evaluate individuals with impairments and disabilities, various disability systems exist in the United States. Disability and compensation systems have arisen to ensure that disadvantaged members of society with a medically determinable impairment, which may lead to a disability, have recourse to compensation from various sources, including state and federal workers’ compensation laws, veterans’ benefits, social welfare programs, and legal avenues. Each of these has differing definitions of disability, entitlement, benefits, procedures of claims application, adjudication, and the roles and relative weights assigned to medical vs administrative deliberations. Workers’ compensation statutes were enacted because of inadequacies of recovery from claims for injured workers under common law. Workers’ compensation is a no-fault system adopted to resolve the dilemmas of tort claims by providing automatic coverage to employees injured during the course of employment; in exchange for coverage, employees forego the right to sue the employer except for wanton neglect. Other workers’ compensation programs in the United States include the Federal Employees Compensation Act; the Federal Employers Liability Act (railroads); the Jones Act (Merchant Marine Act); the Longshore and Harbor Workers’ Compensation Act; the Department of Veterans Affairs; Social Security; and private, long-term disability insurance.
Literature Review
Authors: Mueller Kathryn
Published: December 2020

Before the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, spine impairment was based on range of motion (ROM) testing combined with ratings for specific spine disorders and neurologic impairment. The AMA Guides, Fourth Edition, uses the Injury or Diagnosis-related Estimates (DRE) Model to rate spinal impairment. This model is based on history, physical examination (but not ROM unless ROM is used as a differentiator), and other test data. Table 71, DRE Impairment Category Differentiators, lists DRE impairment category differentiators and discusses the differences between ratings, choosing between differentiators, and their reliability and validity. Guarding is “a spasm of muscles to minimize motion or agitation of sites affected by injury or disease,” and spasm often is overreported by physicians who are unaware of its definition. Loss of reflexes, presenting as diminished or absent deep tendon reflexes, remains the hallmark of objective physical evidence. Decreased circumference is associated with atrophy. Loss of motion segment integrity is measured on lateral flexion and extension x-rays. Loss of bowel or bladder control suggests significant spinal cord injury. The final differentiator is bladder studies, measured using a cystometrogram and showing unequivocal neurologic compromise of the bladder with resulting incontinence.
Clinical Update: Spinal Cord Impairments
Authors: Direnfeld Lorne K.
Published: December 2020

Lower urinary tract dysfunction may result from a variety of neurologic disorders, including traumatic spinal cord injury, head injury, a cauda equina syndrome, or trauma to the peripheral lumbosacral nerves. Urinary incontinence can be divided into five categories: stress incontinence, urge incontinence, mixed incontinence, overflow incontinence, and total incontinence. A table lists each type, provides a description, and gives both common and neurological examples. Evaluation of voiding dysfunction should not be based on symptoms alone, and urodynamic evaluation is required also. Indeed, urodynamic evaluation is the only means to establish a functional interrelationship of the components of the lower urinary tract. Most ratings of neurogenic bladder dysfunction are performed using Section 4.3d, Urinary Bladder Dysfunction, and Table 17, Criteria for Neurologic Impairment of the Bladder in the AMA Guides to the Evaluation of Permanent Impairment. Ratings for whole-person permanent impairment depend on symptomatology (ie, urgency, dribbling, or incontinence), voluntary control, and bladder reflex activity. If problems with urinary system dysfunction are related to a combination of neurologic and urologic pathology, including pathology in the upper urinary tract, ratings from both sections can be combined using the Combined Values Chart.
Questions and Answers
Authors: Brigham Christopher R. , Talmage James B.
Published: December 2020

Workers’ compensation in Canada is a legislated system of social insurance that is funded by assessments levied on employers. Thirteen established Workers’ Compensation Board (WCB) systems have regional jurisdiction and responsibility for administering and adjudicating compensation for the injured worker. Disability awards for certain injuries are determined by statute; others are determined using an acceptable reference or impairment schedule such as the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). On August 22, 1960, Dr D. E. Bell presented to the Association of Workers’ Compensation Boards of Canada an impairment rating schedule to represent the loss of earning capacity and fulfill the spirit of workers’ compensation. Dr Bell's schedule has served as the basis for many Canadian WCB Primary Rating Schedules. Most jurisdictions refer to the AMA Guides in instances when the primary schedule is inadequate. A table in this article lists the current primary and secondary schedules for assessment of impairment in Canada; another table shows the differences in the ratings between Dr Bell's schedule and the AMA Guides. The AMA Guides is used principally only in Yukon and Prince Edward Island and is used for impairment estimations of more complicated injuries in all regions but Quebec.
Editorial Comment: The Dangers of Diagnosis
Authors: Brigham Christopher R. , Talmage James B. , Ensalada Leon
Published: December 2020

Physicians are rewarded during their medical training for making diagnoses, particularly if the diagnosis is of a rare disorder. Unfortunately, the diagnosis—specifically, the disease label—may have undesirable consequences: the disease label categorizes a person as a patient, reducing their autonomy; the label legitimizes medical intervention that may or may not be beneficial; the disease label sanctions the “sick role,” with concomitant relief from social obligations, which may become an established behavior pattern; and “having a disease” classifies an individual as abnormal and may entail diminished employability or even deprivation of liberty by institutionalization. Multiple chemical sensitivity (MCS), an illness belief system manifested by culturally shaped illness behavior, raises questions regarding how symptoms become diseases of fashion, and the process seems to involve two phases: A genuine organic disease whose cause is challenging to detect and substantiate is appropriated as a template, and the template is broadcast to others who may have quite different symptoms but embrace the template as the explanation for their problems. Sympathetic physicians, patient support groups, and the media facilitate this broadcasting. Physicians who want to be patient advocates should encourage function, not impairment, and ability, not disability. The authors suggest that MCS is a form of illness behavior magnified by the medical model for care, not a consequence of underlying organ system dysfunction.
Letter to the Editor: The Continuing Challenge of Evaluating Carpal Tunnel Syndrome Impairment
Authors: Martin J. True
Published: December 2020

The author responds to The Continuing Challenge of Evaluating Carpal Tunnel Syndrome Impairment in the March/April 2000 issue of The Guides Newsletter. Carpal Tunnel Syndrome (CTS) is a clinical diagnosis based on the patient's history and objective findings on examination. Patients present with dull, aching discomfort of the hand, forearm, or upper arm; paresthesias and tingling of the hand; subjective weakness or numbness; and, occasionally, autonomic changes. Nerve conduction velocity studies are highly accurate in documenting median nerve entrapment at the level of the wrists, but this is an anatomic finding and does not mean that the entrapment produces any symptoms. An electrophysiologic study does not predict if or when the median nerve entrapment will become symptomatic, which is based on the patient's history. Electromyography (EMG) and nerve conduction velocity (NCV) studies do not help distinguish among the many etiologies of CTS. EMG/NCV testing can provide significant, highly accurate information regarding the physiologic function of the median nerve at the level of the wrist, but physicians must know how to interpret this information in the clinical setting. [The Editor responds: Several traditional findings of CTS have little or no diagnostic value, and electrodiagnosis is the diagnostic test of choice, although reported sensitivities range from 49% to 84% with specificities of 95% to 97%.]
Clinical Update: Evaluation of Low Back Pain
Authors: Martin True , Brigham Christopher R. , Brooks Charles N.
Published: December 2020

This article provides an overview of the neurological examination and diagnostic studies commonly used in the evaluation of low back pain, information that is essential for both clinical assessment and impairment rating in the AMA Guides to the Evaluation of Permanent Impairment. Clinical evaluation begins with a careful review of medical records. After taking a thorough history, the physician performs the physical examination, including neurological testing, on the patient. The clinical evaluation also determines data needed for impairment evaluation. Neurological examination helps distinguish among the various types of pathology suggested by the history, but to some extent the neurological examination lacks sensitivity and specificity and only about two-thirds (69%) of patients with documented L4-L5 or L5-S1 disc herniations demonstrated weakness or deep tendon reflex changes. To maximize information from the evaluation, physicians routinely test for nonorganic physical signs. Isolated positive signs have no clinical or predictive value, and only a score of three or more positive signs is considered clinically significant. Further, these tests were not designed to detect malingering. Used in isolation, the history, neurological examination, and various diagnostic studies do not have the necessary sensitivity and specificity to diagnose and identify the structural pathology responsible for lumbar radiculopathy. Integrating these components into a logical, unbiased evaluation, physicians usually can perform an accurate assessment.
Fifth Edition: Asthma Impairment Evaluation
Authors: Talmage James B. , Ranavaya Mohammed
Published: December 2020

The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, uses approaches to respiratory system impairment rating that are similar to those of previous editions, with two significant changes: First, criteria for asthma impairment were updated to incorporate guidelines recently published by the American Thoracic Society (ATS), and, second, respiratory impairment criteria now incorporate the lower limit of normal for forced vital capacity, forced expiratory volume in the first second (FEV1), and diffusing capacity for carbon monoxide. In 1993, the ATS published Guidelines for the Evaluation of Impairment/Disability in Patients with Asthma that recommended evaluating three parameters: degree of airflow limitation (postbronchodilator FEV1); the degree of reversibility of the airflow limitation; and the minimum amount of medication needed to maintain maximal medical improvement (MMI). The ATS Guidelines contained a scoring system that was used to place the individual into one of six impairment classes. The Fifth Edition uses the same method of scoring the three clinical parameters and using the point score to determine which of the four impairment classes best describes the impairment. The Fifth Edition discussion of occupational asthma indicates the importance of removing the individual from further exposure to the sensitizing agent; MMI usually occurs within 2 years after removal from exposure.
Independent Medical Evaluations: The Client Perspective
Authors: Christian Jennifer , Siktberg David , Brigham Christopher R. , Brooks Charles N.
Published: December 2020

Independent medical evaluations (IMEs) are widely—and often, inappropriately—used in the claims management process. An IME includes a review of all pertinent medical records; an interview (history) and physical examination; a review of laboratory results and test results; and an edited and signed written report. The primary value of an IME is the report, because a credible medical opinion obtained at the right time can provide information necessary to initiate appropriate action in claims management, both for insurers, who will have a solid basis for acceptance or denial of a claim, and for claimant attorneys, who may use the evaluation to gain acceptance of a claim. A list of common problems in IMEs shows issues about which evaluators should be particularly careful, including questions of use, timing, choice of examiner, adequacy of questions asked and information received, expectations not defined, and framing the evaluation in a negative manner. From a client perspective, IMEs can be improved in several ways, and physicians should understand these opportunities for improving the quality, effectiveness, and value of evaluations. Because referral letters sometimes fail to ask detailed, focused, and probing questions, examiners who have any doubt about the conduct or objectives of the IME should contact the referral source. Detailed checklists and specifications can help ensure completeness and compliance. The article includes a box with definitions of frequently used IME terminology.
Legal Update: Catastrophic Impairment: Catastrophic Impairment: Use of the AMA Guides in Ontario
Authors: Klimek Edward
Published: December 2020

Chapter 18, Pain, is the first attempt in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, to define comprehensive pain evaluation and rating. Chapter 18 focuses on situations in which the pain itself is a major cause of suffering, dysfunction, or medical intervention even though an examining physician can find no demonstrable active disease or autonomic changes. These statements likely would be rejected by rating systems that require a physiologic basis for rating. Other chapters in the AMA Guides typically account for pain as part of specific impairment ratings; for example, a physician who rates cervical spine impairment must decide if a rating for pain beyond the original rating is appropriate. Many rating systems would reject such a rating for pain because of its subjective nature, but, despite these difficulties, even restrictive rating systems may require the use of Chapter 18 because, according to the AMA Guides, no other available method exists for considering impairment of certain conditions such as postherpetic neuralgias or migraines. As the AMA Guides acknowledges, Chapter 18 seems to allow impairment ratings caused by pain and suffering but at the same time to forestall actually assigning a number. One hopes for refinements in our understanding of chronic pain treatment and outcomes; in the interim, knowledgeable raters should guide nonmedical personnel toward a reasonable understanding of this chapter.