bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Functional Restoration on Disability and Impairment
Authors: Feinberg Steven 
Published: December 2020

Abstract
The treatment of chronic pain conditions is difficult, time consuming, expensive, and, all too often, unsuccessful. An effective alternative is chronic pain rehabilitation or functional restoration (FR). An FR team works together to help patients achieve better outcomes with reduced disability. The basic treatment goals of early and chronic FR rehabilitation programs are functional improvement; improved abilities in performance of activities of daily living (ADL); a return to leisure, sport, and vocational activities; and improved pharmacologic management of pain and related affective distress. Individuals at risk of developing chronic pain conditions may benefit from an FR program because physical and psychological interventions can be used before the disability becomes chronic. FR programs emphasize a multidisciplinary, biopsychosocial approach in which physicians, psychologists, and occupational, physical, and relaxation therapists work in concert. FR treatment includes quantification of physical deficits, psychosocial and socioeconomic assessment, and an emphasis on reconditioning the injured area or body part. The team-centered approach includes simulation of work or activity; disability management using cognitive–behavioral approaches; psychopharmacologic management that focuses on improving analgesia, sleep, and affective distress; and, in appropriate cases, detoxification. FR is a patient-centered, whole-person, team approach that focuses on helping patients achieve individual goals that enable them to improve physical and psychosocial function, decrease pain, lessen disability, and improve quality of life, including return to work.
Apportionment of Musculoskeletal Injuries
Authors: Demeter Stephen L. , Brigham Christopher , Talmage James B. , Melhorn J. Mark , Feinberg Steven D. 
Published: December 2020

Abstract
When they apportion impairment in musculoskeletal cases, evaluators encounter a variety of unique issues and problems. The first step in apportionment is scientifically based causation analysis. Arbitrary or opinion-based unscientific apportionment estimates that amount to little more than speculation should be avoided. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth and Fifth Editions, are similar in their assessment of orthopedic impairment, but significant differences exist between these and the Sixth Edition. Individuals may experience impairments on several occasions. For example, if the first injury was rated using an earlier edition of the AMA Guides and a second injury occurs and is rated using a more current edition, then the most recent edition in the current jurisdiction is used to recalculate the rating for the first injury. Regarding which edition of the AMA Guides to use, evaluators should be aware of the jurisdictional requirements and also the timing to ensure that the individual is at maximum medical improvement. If the issue to be determined is apportioning the cause of the injury and not the impairment rating, then different criteria are used and the AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition, is an invaluable resource. Extensive sidebars discuss qualitative vs qualitative apportionment and steps that evaluators can take to ensure that body regions and conditions are not confused (ie, that an apples-to-apples comparison is taking place).
Job Validation Studies and Physical Agility Testing: Is the Vendor Telling You What They Think You Want or Are You Telling Them What You Need?
Authors: Soo Hoo E. Randolph , Demeter Stephen L. 
Published: December 2020

Abstract
Referring agents may ask independent medical evaluators if the examinee can return to work in either a normal or a restricted capacity; similarly, employers may ask external parties to conduct this type of assessment before a hire or after an injury. Functional capacity evaluations (FCEs) are used to measure agility and strength, but they have limitations and use technical jargon or concepts that can be confusing. This article clarifies key terms and concepts related to FCEs. The basic approach to a job analysis is to collect information about the job using a variety of methods, analyze the data, and summarize the data to determine specific factors required for the job. No single, optimal job analysis or validation method is applicable to every work situation or company, but the Equal Employment Opportunity Commission offers technical standards for each type of validity study. FCEs are a systematic method of measuring an individual's ability to perform various activities, and results are matched to descriptions of specific work-related tasks. Results of physical abilities/agilities tests are reported as “matching” or “not matching” job demands or “pass” or “fail” meeting job criteria. Individuals who fail an employment physical agility test often challenge the results on the basis that the test was poorly conducted, that the test protocol was not reflective of the job, or that levels for successful completion were inappropriate.
The AMA Guides, Fifth Edition—the California Experience
Authors: Feinberg Steven , Kingdon Kenneth , Rassp Robert 
Published: December 2020

Abstract
Over the past thirteen years, physicians have experienced a learning curve regarding how to use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) with a “California flavor.” Physicians are mandated by law to provide the court with the “most accurate” ratings that apply in a given case based on permanent objective medical evidence and the education, skills, knowledge, and experience of the physician. Two cases, commonly known as Almaraz–Guzman, profoundly changed how California interprets and uses the AMA Guides, Fifth Edition. Under Almaraz–Guzman, the evaluating physician is tasked with first providing a whole person impairment using a “standard” AMA Guides impairment rating. If the physician believes that this rating “is not the most accurate” and does not adequately reflect the extend of the disability, an alternative rating “within the four corners” of the AMA Guides can be provided based on “reasonable medical probability.” In many cases, this has resulted in the use of tables, charts, methods, measurements, and descriptions from chapters and text materials that were not originally intended to apply to other parts of the body. The AMA Guides tells us that when there is no clear impairment rating, rating by analogy or use of other impairments that create a similar effect on ADLs should be considered, and the opinion must reach the level of substantial evidence.
Medical and Legal Issues Raised by the Protz Decision Issued by the Pennsylvania Supreme Court
Authors: Haley LuAnn , Eskay-Auerbach Marjorie 
Published: December 2020

Abstract
Pennsylvania adopted the impairment rating provisions described in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) in 1996 as an exposure cap for employers seeking predictability and cost control in workers’ compensation claims. In 2017, the Supreme Court of Pennsylvania handed down the Protz decision, which held that requiring physicians to apply the methodology set forth in the most recent edition of the AMA Guides reflected an unconstitutional delegation of legislative power to the American Medical Association. The decision eliminates the impairment-rating evaluation (IRE) mechanism under which claimants were assigned an impairment rating under the most recent edition of the AMA Guides. The AMA Guides periodically are revised to include the most recent scientific evidence regarding impairment ratings, and the AMA Guides, Sixth Edition, acknowledges that impairment is a complex concept that is not yet defined in a way that readily permits an evidence-based definition of assessment. The AMA Guides should not be considered standards frozen in time simply to withstand future scrutiny by the courts; instead, workers’ compensation acts could state that when a new edition of the AMA Guides is published, the legislature shall review and consider adopting the new edition. It appears unlikely that the Protz decision will be followed in other jurisdictions: Challenges to using the AMA Guides in assessing workers’ compensation claims have been attempted in three states, and all attempts failed.
Peripheral Nerve and Brachial Plexus Impairment, AMA Guides, Sixth Edition
Authors: Talmage James B. , Blaisdell Jay 
Published: December 2020

Abstract
Physicians use a variety of methodologies within the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, to rate nerve injuries depending on the type of injury and location of the nerve. Traumatic injuries that cause impairment to the peripheral or brachial plexus nerves are rated using Section 15.4e, Peripheral Nerve and Brachial Plexus Impairment, for upper extremities and Section 16.4c, Peripheral Nerve Rating Process, for lower extremities. Verifiable nerve lesions that incite the symptoms of complex regional pain syndrome, type II (similar to the former concept of causalgia), also are rated in these sections. Nerve entrapments, which are not isolated traumatic events, are rated using the methodology in Section 15.4f, Entrapment Neuropathy. Type I complex regional pain syndrome is rated using Section 15.5, Complex Regional Pain Syndrome for upper extremities or Section 16.5, Complex Regional Pain Syndrome for lower extremities. The method for grading the sensory and motor deficits is analogous to the method described in previous editions of AMA Guides. Rating the permanent impairment of the peripheral nerves or brachial plexus is similar to the methodology used in the diagnosis-based impairment scheme with the exceptions that the physical examination grade modifier is never used to adjust the default rating and the names of individual nerves or plexus trunks, as opposed to the names of diagnoses, appear in the far left column of the rating grids.
Life Expectancy: A Primer with a Focus on Neurological and Psychiatric Conditions
Authors: Katz Richard T. , Katz Robert B. 
Published: December 2020

Abstract
In the interface between medicine and law, physicians may be asked to comment on a patient's life expectancy. Life expectancy is based on life tables, eg, from the US census, and are published in National Vital Statistics reports. The life expectancy for a particular patient with a serious medical illness or disability cannot be determined from such tables; rather one must investigate the life expectancies associated with the patient's particular disease or condition. Standardized mortality ratios have a complex relationship to life expectancy, depending on the patient's age and specific conditions. For example, excellent data are available regarding life expectancy for individuals with spinal cord injury (SCI) and are sorted in various ways, eg conditional life expectancy calculated for persons who have survived the first year after an SCI. Major depressive disorder is associated with increased mortality due to suicidality and other causes (eg, cardiovascular disease or respiratory disease); men with mental disorders live twenty years less and women live fifteen years less compared with the general population. To testify about life expectancy in a person with neurological or psychiatric disability, the experience of a personal physician is not adequate—familiarity with epidemiological data is a prerequisite. This article is based on a wide and recent body of literature concerning life expectancy and gives an indication of some of the complexities regarding life expectancy.
Somatization
Authors: Ensalada Leon , Brigham Christopher R. , Kertay Les 
Published: December 2020

Abstract
An evaluator's failure to recognize illness behavior and to adjust for its effect on symptom presentation can lead to erroneous conclusions regarding impairment or disability; here the authors review the associated phenomena of somatization, disorders that arise from it, and factors that contribute to somatization. Somatization is an individual's unconscious use of the body or bodily symptoms for psychological purposes or psychological gain. As the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, notes, somatization is a “tendency to experience and report somatic complaints (physical symptoms) in response to psychosocial stress and seek health care services for them.” The AMA Guides also advises evaluators that “exclusion or inclusion of somatization disorder, factitious disorder, and/or malingering must be done with care.” A table lists developmental factors that may dispose to somatization (eg, somatizers are present in the family of origin, or coping mechanisms other than illness behavior are absent or unacceptable); a second table compares disorders that may involve somatization. Somatization is prevalent in clinical practice and is likely to occur with equal, or higher, frequency in the evaluation setting. The presence of somatization distorts symptom presentation and can exert a confounding effect on impairment assessment methodologies that rely on the accuracy of patients’ self-presentations.
Longshore and Harbor Workers' Compensation Act: Use of the AMA Guides1
Authors: Brigham Christopher R. , Richardson Eric 
Published: December 2020

Abstract
The US Congress passed the Longshore and Harbor Workers’ Compensation Act (LHWCA) in 1927; it is administered by the US Department of Labor, Division of Longshore and Harbor Workers’ Compensation (DLHWC), and provides medical benefits, compensation for lost wages, and rehabilitation services to longshoremen, harbor workers, and other maritime workers such as pier, wharf, dock, or terminal workers who are injured during employment or suffer diseases caused or worsened by employment conditions. The LHWCA and the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) similarly define many terms (eg, injury, disability, impairment, permanent). Under the LHWCA, impairment ratings are performed for “scheduled injuries,” and disability benefits are determined by multiplying the percentage of “permanent disability” (eg, “permanent impairment”) for a specific body part by a specified number of weeks. For DLHWC impartial medical specialty evaluations, specific steps are taken to avoid prejudgment of a case, and contested cases are heard before administrative law judges. Physicians who perform impairment ratings should understand not only how to fairly rate permanent impairment according to the AMA Guides but also the specific needs of the groups that request these evaluations. Impairment ratings are required for scheduled injuries, hearing loss, and occupational disease cases covered by the LHWCA; physicians must express extremity ratings as the most distal body part applicable, not as a whole person impairment.
Shoulder Impairment Rating: Sixth Edition Clarifications (Authoritative Article*)
Authors: Melhorn J. Mark 
Published: December 2020

Abstract
A request for an impairment rating using both the fourth and sixth editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) demonstrated two interesting facts: In the sixth edition, Table 15-34, Shoulder Range of Motion has two typographical errors. First, Grade Modifier 3 (column 6) and the Internal Rotation (IR) (row 12) lists ≤20° ER = 8% UEI; this should be ≥20° ER = 8% UEI; and Grade Modifier 4 (column 7) and IR (row 12) lists: 20° to 50° IR = 6% UEI, ≥60° IR or 10° IR to ER = 0% UEI; this should be ≥60° IR or 10° IR to ER = 10% UEI. Second, the impairment rating using the fourth and sixth editions resulted in the same total impairment. A case example presents a 54-year-old male who experienced a right shoulder strain that was determined to be a right shoulder rotator cuff tear of the supraspinatus and infraspinatus muscles. The patient was evaluated for impairment based on the range-of-motion method in the fourth edition of the AMA Guides, and 13% upper extremity impairment was determined. Using the sixth edition produced similar results, demonstrating how similar impairment ratings can be based on the fourth and sixth editions.
Impairment of Face-, Nose-, and Throat-related Structures Sixth Edition Approaches
Authors: Blaisdell Jay , Talmage James B. 
Published: December 2020

Abstract
Facial disfigurements, including those caused by burns (thermal, chemical, or electrical) or trauma, are rated in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, Chapter 11, which also discusses occupational overexposure to sunlight, airborne chemicals, heavy metals, and allergens that may lead to head and neck cancers and degraded ability to breathe, chew, swallow, smell, or speak. Additional relevant impairments include those of olfaction and taste, chewing and swallowing, voice and speech, and of the upper respiratory passages. For upper air passage defects and voice and speech impairments, the evaluator assigns an impairment rating by selecting the relevant table or grid in Chapter 11 and then assigning the appropriate impairment class, as determined by the key factor. The patient's history is the key factor for upper air passage deficits, and the performance measures of audibility, intelligibility, and functional efficiency collectively act as the key factor for voice and speech impairments. Once they select an impairment class, evaluators can modify the rating within the impairment class by considering remaining variables. When rating the patient's ability to smell and taste or chew and swallow, raters do not use impairment classes or modifiers. Rather, they assign impairment within an allowable range largely based on professional judgment complemented by objective findings and a well-documented rationale.
Catastrophic Central Nervous System Injury Rating
Authors: Demeter Stephen L. , Direnfeld Lorne , Katz Richard , Talmage James B. , Brigham Christopher R. 
Published: December 2020

Abstract
We present a case involving a catastrophic injury that resulted from a completely obstructed airway when an examinee choked on food. She had cardiopulmonary arrest and developed a hypoxic-ischemic encephalopathy associated with profound neurological losses. The evaluation of the consequences of severe central nervous system injury necessitates evaluation and rating of all the sequelae of that injury. The first step is clinical assessment, followed by thoughtful application of these data to the processes and criteria provided in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). The approaches discussed in the fifth and sixth editions of the AMA Guides are similar.
Mitochondrial DNA copy number in human disease: the more the better?
Authors: Filograna Roberta , Mennuni Mara , Alsina David , Larsson Nils‐Göran 
Published: December 2020

Most of the genetic information has been lost or transferred to the nucleus during the evolution of mitochondria. Nevertheless, mitochondria have retained their own genome that is essential for oxidative phosphorylation (OXPHOS). In mammals, a gene‐dense circular mitochondrial DNA (mtDNA) of about 16.5 kb encodes 13 proteins, which constitute only 1% of the mitochondrial proteome. Mammalian mtDNA is present in thousands of copies per cell and mutations often affect only a fraction of them. Most pathogenic human mtDNA mutations are recessive and only cause OXPHOS defects if present above a certain critical threshold. However, emerging evidence strongly suggests that the proportion of mutated mtDNA copies is not the only determinant of disease but that also the absolute copy number matters. In this review, we critically discuss current knowledge of the role of mtDNA copy number regulation in various types of human diseases, including mitochondrial disorders, neurodegenerative disorders and cancer, and during ageing. We also provide an overview of new exciting therapeutic strategies to directly manipulate mtDNA to restore OXPHOS in mitochondrial diseases.
Evaluation of SORD mutations as a novel cause of Charcot‐Marie‐Tooth disease
Authors: Yuan Ru‐Ying , Ye Zi‐Ling , Zhang Xiao‐Rong , Xu Liu‐Qing , He Jin 
Published: December 2020

AbstractBiallelic mutations in the sorbitol dehydrogenase (SORD) encoding gene were recently identified as a common genetic cause in autosomal‐recessive CMT patients. Here, we investigated the clinical, genetic, and electrophysiological characteristics of three CMT patients with biallelic SORD mutations from a Chinese cohort. Two patients harbored c.757delG (p.A253Qfs*27) homozygous mutations, and one patient carried both c.757delG (p.A253Qfs*27) and c.625C>T (p.R209X) compound heterozygous mutations. Interestingly, the two patients homozygous for the c.757delG mutation exhibited positive responses for pinprick test. In conclusion, we confirmed SORD mutations as causative for CMT and further expanded the mutational and phenotypic spectrum of SORD‐related CMT.
Reactive or transgenic increase in microglial TYROBP reveals a TREM2‐independent TYROBP–APOE link in wild‐type and Alzheimer's‐related mice
Authors: Audrain Mickael , Haure‐Mirande Jean‐Vianney , Mleczko Justyna , Wang Minghui , Griffin Jennifer K. , St George‐Hyslop Peter H. , Fraser Paul , Zhang Bin , Gandy Sam , Ehrlich Michelle E. 
Published: December 2020

AbstractIntroductionMicroglial TYROBP (DAP12) is a network hub and driver in sporadic late‐onset Alzheimer's disease (AD). TYROBP is a cytoplasmic adaptor for TREM2 and other receptors, but little is known about its roles and actions in AD. Herein, we demonstrate that endogenous Tyrobp transcription is specifically increased in recruited microglia.MethodsUsing a novel transgenic mouse overexpressing TYROBP in microglia, we observed a decrease of the amyloid burden and an increase of TAU phosphorylation stoichiometry when crossed with APP/PSEN1 or MAPTP301S mice, respectively. Characterization of these mice revealed Tyrobp‐related modulation of apolipoprotein E (Apoe) transcription. We also showed that Tyrobp and Apoe mRNAs were increased in Trem2‐null microglia recruited around either amyloid beta deposits or a cortical stab injury. Conversely, microglial Apoe transcription was dramatically diminished when Tyrobp was absent.ConclusionsOur results provide evidence that TYROBP‐APOE signaling does not require TREM2 and could be an initiating step in establishment of the disease‐associated microglia (DAM) phenotype.