bluuebunny/crossref_metadata_2025 huggingface dataset:
The Historical Development of AMA Guides Impairment Ratings for Asthma
Authors: Demeter Stephen L.
Published: December 2020

In 1956, the Board of Trustees of the American Medical Association convened an ad hoc Committee on Medical Rating of Physical Impairment that published thirteen articles in JAMA between 1958 and 1970, including one on pulmonary impairment rating on November 22, 1965. That article rated pulmonary impairment by radiographic abnormalities, the historical description of the degree of shortness of breath, the results of at least two of three spirometric tests (forced vital capacity, forced expiratory flow in one second, and the maximal ventilatory volume), the maximal ventilatory volume, and oxygen saturation (if performed). Use of the examinee's history has come full circle from being part of the impairment rating process to being excluded to being reintroduced in the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition. The concept that asthma is not easily rated using methods applicable to other pulmonary diseases was introduced in the fifth edition and was modified for use in the sixth edition. Since the publication of the fifth edition, several medications have been approved for treatment of asthma. Future editions likely will refine the medication usage table to reflect medications in clinical use at the time and, one hopes, also will eliminate the clumsy reference to “beclomethasone equivalents” and are likely instead to reference low, medium, and high doses of the inhaled corticosteroids.
Spinal Impairment Evaluation: Process Improvement
Authors: Brigham Christopher R. , Talmage James B. , Eskay-Auerbach Marjorie
Published: December 2020

Impairment evaluation of the spine has evolved notably since the 1958 publication by the American Medical Association of an article titled A Guide to the Evaluation of Permanent Impairment of the Extremities and Back. Significant differences exist among the editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) currently in use, including the third edition, revised (1988), fourth (1993), fifth (2000), and sixth (2008) editions. This article reviews exemplary cases according to the instructions and methods of each edition, beginning with a table that summarizes spinal impairment criteria by edition of the AMA Guides. Another extensive table presents seven exemplar cases that demonstrate the differences in impairment ratings between the fourth, fifth, and sixth editions; each example is discussed in terms of different approaches taken in each of these editions. In the AMA Guides, Sixth Edition, the process of rating impairment was simplified by the elimination of the range of motion method. In the examples presented, the impairment values calculated using the sixth edition fall between those obtained using the fourth and fifth editions. Evaluating physicians must know the appropriate edition of the AMA Guides to use in each case and must understand the differences between them, particularly the changes included in the sixth edition.
Impairment Rating for Non-Specific Back Pain Under the AMA Guides, Sixth Edition: The Legal Perspective
Authors: Haley Luann
Published: December 2020

The method for rating impairments for lumbar spine injuries has evolved over time and has changed with each edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). The AMA Guides, Sixth Edition, uses a diagnosis-based impairment rating system as the template for evaluating impairment ratings for spinal conditions. A majority of US states use the AMA Guides to determine an impairment rating for injured workers and use this impairment rating to determine financial compensation, but no state system is the same as another's, and each state has a unique statutory scheme. Some cases warrant the finding of a permanent impairment when the injured worker has significant residual pain complaints and limitations that have been verified by the evaluator as being consistently present from the injury date. The AMA Guides, Sixth Edition, allows an assignment of permanent impairment, at the discretion of the evaluator, in cases of chronic lumbar sprains/strains. Evaluators should carefully consider whether it is appropriate to assign an award of permanent impairment for spinal conditions without verifiable objective findings. An evaluator's decision of no impairment vs class 1 impairment is a significant determination in compensation claims and will continue to include subjective factors until advances in medical science permit a more accurate assessment of complaints of non-specific back pain.
Carpal Instability
Authors: Cohen Mark S.
Published: December 2020

The wrist is the articulation between the distal forearm bones (radius and ulna) and eight carpal bones. The most common carpal instability is between the scaphoid and lunate, termed scapholunate instability. Complete scapholunate dissociation results in a gap between the scaphoid and lunate on posterior–anterior (PA) radiographic projections (scapholunate gap). On lateral radiographs, the scaphoid assumes a flexed posture and the lunate extends, resulting in increased scapholunate and radiolunate angles. The second most common carpal instability patters is between the triquetrum and lunate, termed lunotriquetral instability. Ulnar translocation of the carpus, also known as carpal translation, refers to medial displacement of the entire carpus on the forearm (radius and ulna) and is the most common radiocarpal instability. In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, carpal instabilities are rated using Table 15-3, Wrist Regional Grid; the impairment class is determined using Table 15-9, Clinical Studies Adjustment: Upper Extremities. Measurements from plain radiographs are used in Table 15-9 to characterize the instability as mild, moderate, or severe; these characterizations, in turn, determine the class. The assessment of carpal instability using radiographic measurements has limitations, particularly that the radiographic parameters used to grade impairment are imprecise; angular measurements between individual bones are particularly variable, and carpal bone axes can be difficult to determine due to bony overlap on plain radiographs.
Left Ventricular Hypertrophy
Authors: Demeter Steven L.
Published: December 2020

The fourth, fifth, and sixth editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) use left ventricular hypertrophy (LVH) as a variable to determine impairment caused by hypertensive disease. The issue of LVH, as assessed echocardiographically, is a prime example of medical science being at odds with legal jurisprudence. Some legislatures have allowed any cause of LVH in a hypertensive individual to be an allowed manifestation of hypertensive changes. This situation has arisen because a physician can never say that no component of LVH was not caused by the hypertension, even in an individual with a cardiomyopathy or valvular disorder. This article recommends that evaluators consider three points: if the cause of the LVH is hypertension, is the examinee at maximum medical improvement; is the LVH caused by hypertension or another factor; and, if apportionment is allowed, then a careful analysis of the risk factors for other disorders associated with LVH is necessary. The left ventricular mass index should be present in the echocardiogram report and can guide the interpretation of the alleged LVH; if not present, it should be requested because it facilitates a more accurate analysis. Further, if the cause of the LVH is more likely independent of the hypertension, then careful reasoning and an explanation should be included in the impairment report. If hypertension is only a partial cause, a reasoned analysis and clear explanation of the apportionment are required.
Evaluating Lumbar Radiculopathy
Authors: Talmage James B. , Eskay-Auerbach Marjorie , Blaisdell J. Edward
Published: December 2020

For workers’ compensation, most requests for a permanent impairment rating of low back injuries involve the diagnostic labels of nonspecific chronic low back pain or intervertebral disk herniation. Use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, to choose the right diagnosis and class for these injuries is the first step and involves correctly choosing between “nonverifiable radicular complaints” and “residual radiculopathy.” Evaluators must be able to distinguish persisting radiculopathy, as defined in the sixth edition, from resolved radiculopathy and from nonverifiable radicular complaints and to support findings with objective clinical evidence. Clinical evidence of chronic radiculopathy might include motor weakness, muscle atrophy, impaired sharp–dull discrimination, and/or abnormal electrodiagnostic tests, provided the findings are persistent and there are reflex abnormalities. When considering radiculopathy in the appropriate spine grid of the AMA Guides, Sixth Edition, the evaluator must distinguish radicular (limb) symptoms that are continuous, intermittent, or completely resolved. Positive electromyography (EMG) studies for acute radiculopathy are a sufficient objective finding to state the person has radiculopathy on the date of the test; individuals with positive needle EMG do have persisting radiculopathy at maximum medical improvement, but this does not mean that radiculopathy must persist despite time and treatment.
Pulmonary Impairment Rating
Authors: Blaisdell Jay , Talmage James B. , Demeter Stephen
Published: December 2020

Nonspecific spinal pain and intervertebral disc herniations are common, and in evaluating spinal impairment physicians should carefully assess the significance of imaging findings, physical examination findings, and reports of limb pain. A case example illustrates key principles in assessing cervical pain in an individual with questionable arm complaints. A 62-year-old man had a slip and fall injury. Imaging studies revealed degenerative disc disease with disc bulges and without specific disc herniations according to the radiologists, but his physician reviewed magnetic resonance imaging (MRI) films and reported multiple disc herniations. The case example illustrates the significance of the finding of degenerative disc disease, determining whether to rate for “soft tissue and nonspecific conditions” or “motion segment lesions,” and assessing “nonverifiable radicular complaints.” The authors note that cervical degenerative disc “disease” is more aptly a radiologic diagnosis reflecting aging rather than a clinical syndrome and does not necessarily imply that the degenerative disc disease is the cause of the pain. To distinguish between nonverifiable radicular complaints without objective evidence of radiculopathy and unreliable vague complaints involving the extremity, evaluators should determine that the complaints are consistently and repetitively recognized in medical records and that they lie in the distribution of a single nerve root that the examiner can name. The diagnosis of “intervertebral disc herniation” cannot be made, and instead the “nonspecific chronic pain” diagnosis can be used. Nor can the diagnosis of alteration of motion segment integrity be used because the case lacks radiographically documented instability.
Carpal Tunnel Syndrome and Trigger Fingers in a Patient with Rheumatoid Arthritis and Systemic Lupus Erythematosus: Case Example
Authors: Brigham Christopher R. , Melhorn J. Mark , Brooks Charles N. , Feinberg Steven D. , Talmage James B.
Published: December 2020

Causation analysis involves determining what conditions are related to a compensable injury or illness; apportionment is the allocation of responsibility among two or more probable causes; and assessing impairment is based on the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). These three are separate activities, but sometimes all three must be addressed in a single evaluation and may be required for a specified jurisdiction (eg, California). Evaluators thus must ask if jurisdictional issues dictate or influence the approach to causation and apportionment; which edition of the AMA Guides to use; and how to approach causation and apportionment in the present case example: A 63-year-old woman with rheumatoid arthritis and systemic lupus erythematosus is assessed by an orthopedic surgeon who is the agreed medical evaluator (AME). In addition to her pre-existing rheumatoid arthritis and lupus, the individual also had Sjogren's syndrome, osteoarthritis, degenerative disc disease, left carpal tunnel syndrome, osteopenia, and obesity. She has undergone multiple surgical procedures, and treatment for her collagen vascular disease includes leflunomide (immunosuppressant), hydroxychloroquine, and prednisone. In this case, impairments were not the result of “cumulative trauma” but rather were secondary to underlying chronic inflammatory disease, and her occupational permanent impairment rating accordingly would be zero.
Communicating with Patients, Employers, and Insurers
Authors: Kertay Les
Published: December 2020

Disability is a prototypically biopsychosocial phenomenon, and the majority of workplace absences resolve easily and with an expedited return to work. In a minority of worker absences, recovery is delayed less by clinical factors and more by psychosocial variables that can take up an inordinate amount of time from the health care provider (HCP) and also may drive up total costs. Multiple stakeholders participate in this process—the HCP, the patient, the employer, and the insurer—each of whom has overlapping but distinct perspectives and agendas. Often HCPs find themselves in the middle of a complex set of interactions in which competing agendas may be played out. By engaging in effective communications with key stakeholders, the HCP can play a key role in ensuring that the most appropriate clinical outcomes occur. Despite the complexity of the underlying variables, the principles of effective communication are relatively straightforward: Apply a biopsychosocial model rather than a purely biomedical one; bear in mind that key psychosocial variables involved in delayed recovery include variables on the part of the individual, the employer, and the HCP; recognize that psychosocial factors that contribute to delayed return to work are not impairments that require medial or psychological treatment; listen; reach out to employers; and develop nonadversarial relationships with claims adjusters whenever possible.
Rating Cognitive Impairment, Part I: Case Example Illustrates Need for Adherence to AMA Guides, Sixth Edition Methodology
Authors: Barth Robert J.
Published: December 2020

The assessment of impairment due to alteration in mental status, cognition, and highest integrative function may be challenging. A review of impairment assessments performed by others can provide valuable insights, including an appreciation of how evaluators may misapply the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. As a teaching example, this article presents an erroneous rating for a claim of cognitive impairment. The authors point out that most of the misdirection in the case example could be identified with reference to the AMA Guides, Sixth Edition, which reveals discrepancies between the rating processes in this case and actual sixth edition methodology. Nevertheless, the case example involved certain components that were so unconventional that it would have been impossible for the sixth edition contributors to anticipate the need to write a text that would have prevented these errors. The process of sorting out this misdirected rating revealed a previously unanticipated need to clarify sixth edition methodology, and the present article provides such clarification. The concluding section of this article provides a step-by-step protocol for the AMA Guides, Sixth Edition, methodology that involves rating cognitive impairment using Section 13.3d, Mental Status, Cognition, and Highest Integrative Function. The fourteen steps outline a meticulous process based on appropriate clinical assessment, application of evidence-based medicine, and the process outlined in the AMA Guides, Sixth Edition.
Shoulder Pain at Work: Causation Analysis
Authors: Weddington Joel , Brooks Charles N. , Melhorn Mark , Brigham Christopher R.
Published: December 2020

In most cases of shoulder injury at work, causation analysis is not clear-cut and requires detailed, thoughtful, and time-consuming causation analysis; traditionally, physicians have approached this in a cursory manner, often presenting their findings as an opinion. An established method of causation analysis using six steps is outlined in the American College of Occupational and Environmental Medicine Guidelines and in the AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition, as follows: 1) collect evidence of disease; 2) collect epidemiological data; 3) collect evidence of exposure; 4) collect other relevant factors; 5) evaluate the validity of the evidence; and 6) write a report with evaluation and conclusions. Evaluators also should recognize that thresholds for causation vary by state and are based on specific statutes or case law. Three cases illustrate evidence-based causation analysis using the six steps and illustrate how examiners can form well-founded opinions about whether a given condition is work related, nonoccupational, or some combination of these. An evaluator's causal conclusions should be rational, should be consistent with the facts of the individual case and medical literature, and should cite pertinent references. The opinion should be stated “to a reasonable degree of medical probability,” on a “more-probable-than-not” basis, or using a suitable phrase that meets the legal threshold in the applicable jurisdiction.
Is a Condition a Ratable Impairment? Nuances in Assessing Preexisting Conditions
Authors: Brigham Christopher R. , Brooks Charles N. , Demeter Stephen , Direnfeld Lorne , Hoo Randy Soo
Published: December 2020

In order to answer questions posed by their clients, evaluating physicians must understand the context of a case or jurisdiction, in part because medical and legal perspectives may differ when an evaluator assesses issues such as causation and apportionment. A condition is not necessarily a ratable impairment, nor do symptomatic conditions necessarily prevent an individual from working. Attorneys may pose very specific apportionment questions based on laws unique to a given jurisdiction; for example, a patient may have an occupational injury or illness that results in impairment, but causation of the impairment may be multifactorial and may involve, for example, age-related degeneration, a pre-existing injury or illness, an occupational injury or illness, and/or subsequent trauma or disease. In some states, the presence of a pre-existing condition when an employee is injured may involve Second Injury Funds that were created to relieve a portion of the employer's/insurer's claim costs when the employer hired or retained an employee with a pre-existing medical condition who then suffered a “second” injury. The latter situation requires more extensive treatment and/or a greater disability due to the combined effects of both conditions. Apportionment of causation and impairment may be complex, requiring evaluation of nonoccupational and occupational risk factors and the natural history of the underlying condition.
Independent Medical Evaluation Best Practices
Authors: Brigham Christopher , Direnfeld Lorne K. , Feinberg Steven , Kertay Les , Talmage James B.
Published: December 2020

The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, states that an independent medical evaluation (IME) usually is a “one-time evaluation performed by an independent medical examiner who is not treating the patient or claimant, to answer questions posed by the party requesting the IME.” Evaluators must adhere to best practice standards and must know that these standards may change over time and must meet the needs of the relevant jurisdiction. IMEs take place in several arenas, including automobile casualty, workers’ compensation, personal injury, medical malpractice, and long-term disability and differ from traditional clinical evaluations. The evaluating physician must be independent and has no (or only a limited) physician–patient relationship. The qualifications required of an IME examiner vary by arena, jurisdiction, and issues. Medical evaluators should be board certified and can obtain a special credential from, eg, the American Board of Independent Medical Examiners or the International Association of Independent Medical Evaluators. In addition, evaluators should have demonstrated abilities in report writing and court testimony, and a section of this article provides a general outline of the topics that should be covered in a thorough report. Quality IME reports are the result of thoughtful, thorough evaluations performed by physicians who have knowledge, skills, and experience in both clinical medicine and the assessment of medicolegal issues.
Precision Matters in Behavioral Health, Too
Authors: Kertay Les
Published: December 2020

Behavioral health terminology is an area beset by imprecision that results from confusing claim determinations, unnecessary evaluations, and poor outcomes that result from inappropriate treatment. In medical evaluation reports, one notes references to depression, anxiety, and stress, which are not diagnoses but often are treated as such. Behavioral factors can affect claims in four ways: the presence of a formal clinical diagnosis that meets specific criteria, psychological symptoms, difficult life circumstances, and behavioral overlays. Only the first of these can be attributed to a workplace injury or illness, and determining a causal relationship requires, at minimum, a precise diagnosis. For example, by depression does the health provider mean major depressive disorder with specifiers, persistent depressive/dysthymic disorder, adjustment disorder with depressed mood, or some other specific condition? The behavioral layers can affect the outcome of the claims process and may or may not be appropriate targets of an evidence-informed intervention aimed at returning an injured or ill worker to a higher level of function. The point is not to argue whether or not behavioral interventions are appropriate in workers’ compensation, personal injury, and other claims; the point, rather, is that precise language is the first, necessary step in sorting out the myriad ways in which behavior affects claim incidence, duration, and cost.
Spinal Alteration of Motion Segment Integrity Using the Sixth Edition
Authors: Luers Patrick R.
Published: December 2020

Spinal impairment evaluation includes determination of the presence or absence of alteration of motion segment integrity (AOMSI). The diagnosis-related estimate (DRE) method is the principal methodology used to evaluate spinal AOMSI impairment in the fourth and fifth editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). In the AMA Guides, Sixth Edition, impairment ratings are calculated using the diagnosis-based impairment (DBI) method that uses five impairment classes determined by diagnoses and specific criteria, adjusted by consideration of non-key factors and grade modifiers. This article includes a correction of numbers in the AMA Guides, Sixth Edition, Figure 17-6. The following factors must be considered to determine if AOMSI is present: 1) flexion/extension radiographs are performed when the individual is at maximum medical improvement and are technically adequate; 2) the proper methodology is used in obtaining measurements of translation and angular motion; 3) normal translation and angular-motion thresholds consistent with the literature are used in determining AOMSI. Imaging modalities such as videofluoroscopy, digital fluoroscopy, and upright/motion magnetic resonance imaging cannot be used to establish an AOMSI permanent impairment using the AMA Guides. A number of technical factors can affect the image quality associated with measurements of AOMSI, including film centering, artifacts, poor edge resolution, endplate normal variations and spurring, and use of analog rather than digital radiography.
Rating Opioid Use Disorder for Permanent Impairment
Authors: Talmage James B.
Published: December 2020

The duration of opioid therapy after surgery is the strongest known predictor of ultimate misuse, and researchers have reported that the number of days for which medication was prescribed and the total number of postoperative prescriptions each predicts long-term use. This article addresses the question of rating the impairment for an individual with no history of substance use disorder before a work injury, who is prescribed opioids for this injury, and who subsequently develops opioid use disorder (OUD). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, should be used in conjunction with the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Sixth Edition. A person who is prescribed opioids is not yet at maximum medical improvement (MMI) and cannot be rated. Referral for substantiation of the diagnosis and for initiation of treatment are necessary before OUD is confirmed and the patient is at MMI. The AMA Guides is based on impairments of activities of daily living (ADL), so a patient's MMI should result in a happy outcome and no impairment, although the burden of treatment compliance may be a relevant consideration. The article concludes with an extensive literature review, including abstracts of published articles regarding OUD in various settings.
Medical Aspects of Causation for COVID-19
Authors: Snyder Robert B. , Talmage James B.
Published: December 2020

The decision about whether a case of documented COVID-19 illness is accepted as occupationally acquired and thus work compensable is made by insurers, or if contested, by judges or administrative bureaus. Causation for COVID-19 may be difficult to show because of the lack of accurate information and difficulty in meeting some of the criteria established by Bradford Hill. Nevertheless, physicians will be asked for medical records and documentation of illness. This article provides preliminary guidance to assist physicians in responding to insurers or workers compensation agencies' requests for information on the medial aspects of COVID-19.
International Use of the AMA Guides® to the Evaluation of Permanent Impairment
Authors: Ranavaya Mohammed I. , Brigham Christopher R.
Published: December 2020

Since its inception more than six decades ago, the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), has become internationally accepted as a global benchmark and is used in the United States, Canada, certain European countries, the Middle East, Australia, New Zealand, and Southern Africa, as well as by the United Nations. When the AMA Guides, Sixth Edition, adopted the terminology and conceptual framework of disablement developed by the World Health Organization, this paradigm shift let to an increase in the worldwide influence and use of the AMA Guides. In the United States, the AMA Guides is used primarily in state and federal workers’ compensation systems and sometimes in automobile casualty and personal injury arenas. Most workers’ compensation jurisdictions across Canada use the AMA Guides formally by statute or regulation, or they accept its use informally as a standard tool to rate impairment. In Australia, the AMA Guides is used in both federal and individual state or territory compensation schemes for personal injuries that arise from work, as well as motor vehicle accidents (a table presents uses of the AMA Guides in Australian jurisdictions). New Zealand uses the AMA Guides, Fourth Edition, and the ACC User Handbook to the AMA “Guides to the Evaluation of Permanent Impairment,” Fourth Edition. The AMA Guides is used in Hong Kong to evaluate all types of damages for personal injury claims and also is referenced in Southern Africa, Europe, and countries in the Middle East.
Performing Medical Evaluations for Subsequent Injuries Benefits Trust Fund in California
Authors: Feinberg Steven D.
Published: December 2020

Many states have benefit programs (e.g., special fund, second injury fund, subsequent injuries fund, special disabilities trust fund) for people with significant pre-existing impairment and/or disability who are injured. Each fund has different rules and regulations. Some of these funds provide benefits to the injured worker, while others reimburse eligible employers and insurers. Physicians need to understand the specific requirements of benefit programs in their states. Evaluating physicians who understand the uniqueness of these programs will be better able to provide valuable services. This article provides insights into one such program, the subsequent injuries benefits trust fund (SIBTF) in California. To be eligible for SIBTF benefits, the injured worker must meet an “overall threshold” and an “industrial threshold” of disability to qualify for benefits. If these thresholds are met, the injured worker may receive additional compensation based on pre-existing (labor-disabling) disability. The pre-existing disabilities can arise from any source, including congenital, developmental, or acquired disease, prior injury, war injury, non- industrial injuries, or prior industrial disabilities.
Prevalence of occupational exposure to needle-stick injury and associated factors among healthcare workers of developing countries: Systematic review
Authors: Mengistu Dechasa Adare , Tolera Sina Temesgen
Published: December 2020

Background

Healthcare workers are at high risk of infection from blood-borne pathogens, such as Hepatitis B and C Virus, and Human Immunodeficiency. Occupational exposure to needle-stick injuries (NSIs) continue to have a major health problem in the healthcare systems of developing countries. Thus, this review article aimed to provide the evidence on the prevalence of NSI and associated factors among healthcare workers of developing countries.

Methods

The studies published from 2012 to 2019 were identified through systematic searches of electronic databases such as PubMed, Google Scholar, CINAHL, MEDLINE, Scopus, Med Nar, and Science Direct. The MeSH terms and/or keywords was used in conjunction with “AND” or “OR” (Boolean logic operators). All identified keywords and an index terms were checked across the included databases. Assessment and evaluation were taken to confirm the quality and relevance of the included articles, followed by extraction and analysis of data.

Result

Overall, 2021 articles were identified using specified search terms from the initial searches of the literature (2012-2019). A total of 13 articles met eligibility criteria were included in the review. Among 6513 participants, 1009 and 2201 participants involved to determine 1-year and throughout career prevalence, respectively. The prevalence of NSI ranged from 19.9% to 54.0% with an overall prevalence of 35.7% and 38.5 to 100% with an overall prevalence of 64.1% in the previous 1 year and throughout career, respectively. Sex, workload, needle recapping, overuse of injection, and practice of universal precautions, training, occupation, working experience, and personal protective equipment were among the factors associated with the prevalence of NSIs in developing countries.

Conclusion

The review indicated that NSIs have been identified as one of the most serious issues that affect the health and well-being of healthcare workers in the majority of healthcare systems of developing countries. There is a need to apply safety practices or other measures to reduce the risk of NSIs.
Portal dosimetry in radiotherapy repeatability evaluation
Authors: Ślosarek Krzysztof , Plaza Dominika , Nas Aleksandra , Reudelsdorf Marta , Wendykier Jacek , Bekman Barbara , Grządziel Aleksandra
Published: December 2020

The accuracy of radiotherapy is the subject of continuous discussion, and dosimetry methods, particularly in dynamic techniques, are being developed. At the same time, many oncology centers develop quality procedures, including pretreatment and online dose verification and proper patient tracking methods. This work aims to present the possibility of using portal dosimetry in the assessment of radiotherapy repeatability. The analysis was conducted on 74 cases treated with dynamic techniques. Transit dosimetry was made for each collision‐free radiation beam. It allowed the comparison of summary fluence maps, obtained for fractions with the corresponding summary maps from all other treatment fractions. For evaluation of the compatibility in the fluence map pairs (6798), the gamma coefficient was calculated. The results were considered in four groups, depending on the used radiotherapy technique: stereotactic fractionated radiotherapy, breath‐hold, free‐breathing, and conventionally fractionated other cases. The chi2 or Fisher's exact test was made depending on the size of the analyzed set and also Mann–Whitney U‐test was used to compare treatment repeatability of different techniques. The aim was to test whether the null hypothesis of error‐free therapy was met. The patient is treated repeatedly if the P‐value in all the fluence maps sets is higher than the level of 0.01. The best compatibility between treatment fractions was obtained for the stereotactic technique. The technique with breath‐holding gave the lowest percentage of compliance of the analyzed fluence pairs. The results indicate that the repeatability of the treatment is associated with the radiotherapy technique. Treated volume location is also an essential factor found in the evaluation of treatment accuracy. The EPID device is a useful tool in assessing the repeatability of radiotherapy. The proposed method of fluence maps comparison also allows us to assess in which therapeutic session the patient was treated differently from the other fractions.
Prediction of maturity offset and age at peak height velocity in a longitudinal series of boys and girls
Authors: Malina Robert M. , Kozieł Sławomir M. , Králik Miroslav , Chrzanowska Maria , Suder Agnieszka
Published: December 2020

Background

Predicted maturity offset, defined as time before peak height velocity (PHV) is increasingly used as an indicator of maturity status in studies of physical activity, fitness, and sport.

Objective

To validate maturity offset prediction equations in longitudinal samples of boys and girls.

Methods

The original and modified maturity offset prediction equations were applied to serial data for 266 boys (8‐17 years) and 147 girls (8‐16 years) from the Cracow Growth Study. Actual age at PHV for each youngster was estimated with the SITAR protocol. In addition to maturity offset, the difference between CA at prediction and maturity offset provided an estimate of predicted age at PHV.

Results

Predicted maturity offset and age at PHV increased, on average, with CA at prediction. Variation in predictions was reduced compared to that in observed ages at offset and at PHV, and was more apparent with the modified equations. Relatively few predicted ages at PHV approximated observed age at PHV in early and late maturing youth of both sexes; predictions were later than observed among the former, and earlier than observed among the latter.

Conclusion

Predicted maturity offset and ages at PHV with the original and modified equations increase with CA at prediction, have reduced variation, and have major limitations with early and late maturing boys and girls.
JAAM Nationwide Survey on the response to the first wave of COVID‐19 in Japan. Part I: How to set up a treatment system in each hospital
Authors: Oda Jun , Tanabe Seizan , Nishimura Tetsuro , Muguruma Takashi , Matsuyama Shigenari , Sugawara Yoko , Ogura Shinji
Published: December 2020

Aim

To clarify how the medical institutions overcame the first wave of coronavirus disease 2019 (COVID‐19) in Japan and to discuss its impact on the medical labor force.

Methods

We analyzed questionnaire data from the end of May 2020 from 180 hospitals (102,578 beds) certified by the Japanese Association for Acute Medicine.

Results

Acute (emergency) medicine physicians treated severe COVID‐19 patients in more than half of hospitals. Emergency medical teams consisted of acute medicine physicians and other specialists. Frontline acute care physicians were concerned about their risk of infection in 80% of hospitals, and experienced stress due to a lack of personal protective equipment. Twenty‐six of the 143 hospitals that had a mental health check/consultation system in place indicated that there was a doctor who experienced mental health problems. Of the 37 hospitals without a system, only one hospital was aware of the presence of a doctor complaining of mental health problems.

Conclusion

Acute care physicians and physicians in other departments experienced high levels of stress as they fought to arrange COVID‐19 treatment teams and inpatient COVID‐19 wards for infected patients. Medical materials and equipment may be sufficient for a second or third wave; however, active support is needed for the physical and mental care of medical staff. Mental health problems may be missed in facilities without mental check and consultation system.
Preparation of activated porous glass adsorbent through thermochemical reforming of ampoules and eggshells for remediation of direct blue dye pollution
Authors: Hussain Zahid , Zada Amir , Hussain Khadim , Naz Muhammad Y. , AbdEl‐Salam Nasser M. , Ibrahim Khalid A.
Published: December 2020

The recycling of chemical containing glass bottles is generally not recommended due to high health risk. In this study, used glass ampoules were devitrified into a porous material by coprocessing with eggshells, salt, and soda at different temperatures. In this thermochemical reaction, eggshells decomposed into calcium, porogenic gases, and char. The calcium worked as a flux in the reaction while char and gases promoted the porosity of the devitrified glass. The thermochemically processed glass was treated with deionized water to clear the water‐soluble fractions and to improve the surface porosity. The final product was characterized for its chemical composition, functional groups, surface morphology, and pore sizes. The porous product revealed the pore volume of .010 cc/g, surface area of 32.0399 m2/g and pore radius of 1.522 nm. The well‐known Freundlich and Longmuir models were used to investigate the adsorption of blue dye onto the prepared porous glass adsorbent. The adsorbed amount of dye was found influenced by the contact time, adsorbent dose, pH of solution, and dye concentration. The porous glass adsorbed about 2.788 mg/g of dye at pH 2, which decreased to 1.938 mg/g at pH 7. The dye adsorption data followed the best fit for Freundlich model as compared to the Longmuir model.
Morphology control and ionic crosslinking of pectin domains to enhance the toughness of solvent cast PVA/pectin blends
Authors: John Jacob , Deshpande Abhijit P. , Varughese Susy
Published: December 2020

Blending water soluble synthetic polymers, such as polyvinyl alcohol (PVA), with natural polymers, such as pectin, has many advantages. However, due to the brittle nature of pectin, the mechanical properties become inferior in the blends. In this work, two strategies to enhance the toughness and tensile strength of solvent cast PVA/pectin blends are presented. This study shows that the tensile strength and toughness of PVA/pectin 80/20 blends can be enhanced by decreasing the solvent evaporation rate. The phase separation proceeds through 'nucleation and growth' and spinodal decomposition, respectively, at lower and higher rates of solvent evaporation. The equilibrium phase morphology has spherical domains of pectin dispersed in the PVA matrix. The size of the pectin domains and the separation between them are controlled by the solvent evaporation rate. At higher rates of solvent evaporation, pectin domains are larger and farther apart from each other and vice versa. Ionically crosslinking the pectin domains with calcium, further enhances the tensile strength and toughness of the blends compared to that of pure PVA. When the pectin domains are small, the failure happens at larger strains through 'cavitation' and 'shear yielding' and when pectin domains are large, the failure happens at smaller strains and the failure mechanism shifts to 'multiple crazing'.
Ionic liquid gated poly(triaryl amine) thin film field effect transistor
Authors: Rijos Luis M. , Figueroa Kelotchi S. , Porcu Angelo , Rivera Naomi M. , Meléndez Anamaris , Ramos Idalia , Pinto Nicholas J.
Published: December 2020

A poly(triaryl amine) thin film field effect transistor was investigated in air with ionic liquid (IL) gating for the first time. The transistor retained a high‐on/off ratio of ~700 and mobility of ~10−2 cm2/V‐s. When compared to a transistor based on the conducting polymer polyaniline under similar operating conditions, it was found to exhibit superior performance. Significantly low‐operating voltages (±1 V) enhances the possibility of its use in organic electronics. The device was successfully tested for binary operation, and we demonstrate its suitability for use in low‐power consumption electronic circuits.
Thermo‐oxidative degradation during sintering of polyethylene particles
Authors: Salehi Amirmehdi , Pircheraghi Gholamreza
Published: December 2020

Polymer sintering is not only a well‐established procedure for producing functional polymeric parts, but it is also the basis for the relatively new additive manufacturing technique, selective laser sintering. Although studying the impact of thermo‐oxidative degradation during sintering has significant practical importance, few studies have focused on this aspect of the sintering process. In the present work, we have investigated the active thermo‐oxidative degradation mechanisms during sintering of high‐density polyethylene (HDPE) particles, the conditions that promote them, and their respective impact on the morphological evolution of the polyethylene particles. To perform a comprehensive study, we have complemented the rheological, thermal, chemical, and morphological analysis of the sintered HDPE particles with the study of their ensemble pore structure. We observed two distinct degradation regimes. At the beginning, the relatively low concentration of oxygen in the particles led to the dominance of branching and resulted in a pore structure evolution limited to surface relaxation. In the second regime and with the diffusion of more oxygen, chain scission became the dominant route. In this regime, the emergence of highly mobile short chains markedly accelerated the pore evolution.
Importance of Mullins effect in commercial silicone elastomer formulations for soft robotics
Authors: Krpovic Sara , Dam‐Johansen Kim , Skov Anne Ladegaard
Published: December 2020

Silicone elastomers are used in a wide range of applications, including artificial muscles, biomedical devices, and soft robotics, for which chemical, thermal, and mechanical stability are important requirements that these elastomers must fulfill. However, to ensure that silicone elastomers' properties and performance remain constant under long‐term deployment, it is necessary to examine and account for the Mullins effect, which has the potential to significantly alter certain elastomer properties of interest. In this article, the mechanical properties of soft and hard commercial silicone elastomers and two blends of commercial silicone elastomers are investigated—specifically their softening behavior due to the Mullins effect. Ultimate stresses, ultimate strains, and Young's moduli are obtained from uniaxial tensile tests. Results show that the point of softening greatly depends on both the elastomer type and its strain history. Furthermore, a significant permanent set is observed in the softest commercial formulations.
Ontogenetic endocranial shape change in alligators and ostriches and implications for the development of the non‐avian dinosaur endocranium
Authors: Hu Krishna , King J. Logan , Romick Cheyenne A. , Dufeau David L. , Witmer Lawrence M. , Stubbs Thomas L. , Rayfield Emily J. , Benton Michael J.
Published: December 2020

Birds and crocodiles show radically different patterns of brain development, and it is of interest to compare these to determine the pattern of brain growth expected in dinosaurs. Here we provide atlases of 3D brain (endocast) reconstructions for Alligator mississippiensis (alligator) and Struthio camelus (ostrich) through ontogeny, prepared as digital restorations from CT scans of stained head and dry skull specimens. Our morphometric analysis confirms that ostrich brains do not change significantly in shape during postnatal growth, whereas alligator brains unfold from a cramped bird‐like shape in the hatchling to an elongate, straight structure in the adult. We confirm that birds exhibit paedomorphic dinosaur endocranial traits such as retaining an enlarged and compact brain shape in the adult, whereas crocodiles show peramorphic traits where the brain elongates with growth as the skull elongates. These atlases of ontogenetic stages of modern bird and crocodilian endocrania provide a basis for comparison of non‐avian dinosaur endocasts and consideration of the divergence of the “avian” and “crocodilian” modes of brain development and heterochronic change on phylogenies.
Computational drug repurposing study of the RNA binding domain of SARS‐CoV‐2 nucleocapsid protein with antiviral agents
Authors: Tatar Gizem , Ozyurt Ezgi , Turhan Kemal
Published: December 2020

The recent outbreak of coronavirus disease (COVID‐19) in China caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has led to worldwide human infections and deaths. The nucleocapsid (N) protein of coronaviruses (CoVs) is a multifunctional RNA binding protein necessary for viral RNA replication and transcription. Therefore, it is a potential antiviral drug target, serving multiple critical functions during the viral life cycle. This study addresses the potential to repurpose antiviral compounds approved or in development for treating human CoV induced infections against SARS‐CoV‐2 N. For this purpose, we used the docking methodology to better understand the inhibitory mechanism of this protein with the existing 34 antiviral compounds. The results of this analysis indicate that rapamycin, saracatinib, camostat, trametinib, and nafamostat were the top hit compounds with binding energy (−11.87, −10.40, −9.85, −9.45, −9.35 kcal/mol, respectively). This analysis also showed that the most common residues that interact with the compounds are Phe66, Arg68, Gly69, Tyr123, Ile131, Trp132, Val133, and Ala134. Subsequently, protein‐ligand complex stability was examined with molecular dynamics simulations for these five compounds, which showed the best binding affinity. According to the results of this study, the interaction between these compounds and crucial residues of the target protein were maintained. These results suggest that these residues are potential drug targeting sites for the SARS‐CoV‐2 N protein. This study information will contribute to the development of novel compounds for further in vitro and in vivo studies of SARS‐CoV‐2, as well as possible new drug repurposing strategies to treat COVID‐19 disease.