bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Aging on Impairment Ratings: Part 2: Internal Medicine Issues
Authors: Demeter Stephen L. 
Published: December 2020

Abstract
This is the second of four articles that explore the effects of age-related changed in impairment evaluations according to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth and Sixth Editions; specifically, this article completes the review of the internal medicine sections. With respect to the digestive system, the normal aging process affects gastrointestinal impairment ratings as found in the AMA Guides, Fifth and Sixth Editions, for gastroesophageal reflux disease, peptic ulcer disease, pancreatitis, diverticulitis, irritable bowel syndrome, fecal incontinence, and hemorrhoids. Cancers of the digestive system and infectious hepatitis were reviewed by the National Institutes of Health in The Burden of Digestive Diseases in the United States (2008), which should be reviewed when an impairment rating or apportionment is needed or for an individual with these conditions alleged to be the result of a compensable injury or illness. The normal aging process does not significantly affect the impairment ratings for renal disease (upper urinary tract disease), but, for individuals over 70, an age adjustment should be incorporated into the impairment rating. The AMA Guides, Fifth and Sixth Editions, also do not provide age-related modifications for urinary incontinence, but a rating physician may apply a discretionary apportionment. For diseases of the scrotum, testicles, epididymis, and spermatic cord, as well as for prostatic hypertrophy, neither edition of the AMA Guides makes age-related modifications; neither are modifications because of aging are made for the female reproductive tract, although raters are told to consider the physiological differences.
Symptom Validity Testing
Authors: Ensalada Lee H. 
Published: December 2020

Abstract
Symptom validity testing (SVT), also known as forced-choice testing, is a means of assessing the validity of sensory and memory deficits, including tactile anesthesias, paresthesias, blindness, color blindness, tunnel vision, blurry vision, and deafness. The common feature among these symptoms is a claimed inability to perceive or remember a sensory signal. SVT comprises two elements: a specific ability is assessed by presenting a large number of items in a multiple-choice format, and then the examinee's performance is compared to the statistical likelihood of success based on chance alone. These tests usually present two alternatives; thus the probability of simply guessing the correct response (equivalent to having no ability at all) is 50%. Thus, scores significantly below chance performance indicate that the sensory cues must have been perceived, but the examinee chose not to report the correct answer—alternative explanations are not apparent. SVT also has the capacity to demonstrate that the examinee performed below the probabilities of chance. Scoring below a norm can be explained by fatigue, evaluation anxiety, inattention, or limited intelligence. Scoring below the probabilities of chance alone most likely indicates deliberate deceptions and is evidence of malingering because it provides strong evidence that the examinee received the sensory cues and denied the perception. Even so, malingering must be evaluated from the total clinical context.
Effects of Aging on Impairment Ratings: Part 1: Internal Medicine Issues
Authors: Demeter Stephen L. 
Published: December 2020

Abstract
This article is the first of four to explore the effects of age-related changes in impairment evaluations as defined by the fifth and sixth editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). With respect to the cardiovascular system, impairment ratings for the following conditions commonly are affected by the aging process: coronary artery disease, valvular heart disease, arrhythmias/dysrhythmias, hypertension, and peripheral vascular disease. Impairment ratings in the fifth and sixth editions of the AMA Guides for the pulmonary system apply corrections for age with respect to certain measurements such as forced vital capacity. The normal aging process does not significantly affect impairment ratings for either hematological impairments or the endocrine system, nor does normal aging significantly affect the impairment ratings for mammary glands. With careful attention to the diagnosis and causative factors, evaluators may find that the normal aging process can affect impairment ratings associated with metabolic bone disease. Evaluating physician typically must determine impairment secondary to a specific cause (eg, injury or exposure) and therefore must consider if other factors are contributing to the impairment.
Effects of Aging on Impairment Ratings: Part 3: Neurological and Associated Issues
Authors: Demeter Stephen L. 
Published: December 2020

Abstract
This article is the third in a series of four that explore the effects of age-related changes in impairments as defined by the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth and Sixth Editions. Specifically, this article focuses on evaluation of disturbances of the nervous system, divided for discussion here into four parts—the central nervous system (CNS), the peripheral nervous system, vision, and hearing—and offers guidance in using the AMA Guides, Fifth and Sixth Editions, in a variety of specific disorders within each group. For example, the CNS discussions address disorders of consciousness and awareness; sleep and arousal disorders; alterations in metal status, cognition, and highest integrative function; aphasia or dysphagia; emotional or behavioral disorders resulting from CNS causation (fifth edition only); chronic pain; and others. One of the most challenging issues in evaluating peripheral neuropathy regards carpal tunnel syndrome, and rating physicians should provide references in their reports to justify their position. Rating visual problems usually requires attention to the medical records to document preinjury visual status. The AMA Guides, Fifth and Sixth Editions, do not use age-adjusted corrections in assessing age-related diminished hearing, but local jurisdictions and circumstances may apply apportionment. In apportioning impairment due to aging, the examiner must understand both the science and the specific legal processes involved.
Amputation Evaluation: Sixth Edition Approaches
Authors: Blaisdell Jay , Talmage James B. 
Published: December 2020

Abstract
Upper extremity amputations are rated in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, Section 15.6, Amputation Impairment, where text, tables, and figures guide evaluators in combining proximal diagnosis-based impairments (DBIs) and proximal range-of-motion impairments. The AMA Guides provides impairment grids for lower and upper extremity amputations, which are divided into five impairment classes (0 through 4), and each impairment class is further divided (except class 0) into five grades (A through E), each with its respective impairment rating that is expressed as a percentage of the extremity. Determining impairment class, and thus the default value of impairment, is straightforward if the amputation occurred directly at one of the points in the relevant grid; if the amputation occurred at another point, the evaluator should consult the appropriate figure to assess how the specific level of amputation corresponds with impairment percentages. An individual's proximal problems may lead to an increase in the impairment value because of the application of grade modifiers. Except in rare instances of bilateral upper extremity amputation or when the patient is unable to wear a prosthesis for a lower extremity amputation, the evaluator usually uses the default rating value within the selected impairment class as the final percentage rating. Evaluators are advised to re-read the amputation section in the AMA Guides before conducting an amputation evaluation.
Part I: Psychological Factors in Delayed and Failed Recovery and Unnecessary Disability
Authors: Caruso Garson , Kertay Les 
Published: December 2020

Abstract
The first part of this two-part series discusses psychological influences in delayed and failed recovery and resulting unnecessary work disability; the second part discusses theoretical and practical aspects of the issue, including evaluation and treatment. Delayed and failed recovery and unnecessary disability (DFRUD) refers to a lag in, or lack of, expected recovery from a medical condition and/or unnecessary resultant disability. Causation is complex, and we are not doing well at managing this group of workers using a biomedical model. The traditional biomedical model posits that disease or injury produces symptoms and signs that cause impairment and result in disability. This approach too strictly separates mental phenomena and bodily function (Cartesian dualism) and leads to scientific reductionism when actually six domains are active in worker disability: medical, personal, psychological, sociocultural, systematic (including compensation and insurance), and workplace elements. Medically unexplained physical symptoms (MUPS) should be understood as a disturbance of normal neurological and/or psychological processes underlying symptom production, perception, and experience and cannot be better explained by another physical or psychiatric illness. Within this system of evaluation, administrative and medical iatrogenicity are associated with unnecessary medical care and poor outcomes for individuals. In addition to determining industrial causality and apportionment, if evaluators accept some psychological factors, MUPS, and central sensitization, they must explain to what extent these are compensable. Part two of this article will discuss theoretical and practical approaches, including specific evaluation and treatment methods.
Range of Motion Extremity Evaluation: Sixth Edition Approaches
Authors: Blaisdell Jay , Talmage James B. 
Published: December 2020

Abstract
Examiners use range-of-motion (ROM) testing to help calculate the physical examination modifier when they use the diagnosis-based impairment (DBI) method in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. DBI is the preferred method for calculating upper and lower extremity ratings, but, in instances specified by the regional grid, the evaluator may choose to use the ROM method, typically because it yields a higher impairment rating relative to the DBI method. In rare lower-limb cases when the injury is not fully articulated by the regional grid (eg, severe crushes, burns, and scarring), ROM may be used instead of diagnosis. In cases of amputation, ROM may be used for the remaining portion of the limb and combined with amputation rating as explained in sections of Chapter 15. Note that, in the AMA Guides, the extended anatomic position is 0° rather than 180°, and evaluators can consult the detailed diagrams of the planes of the thumbs, fingers, wrists, elbows, and shoulders. Invalid results are declared if, after three consecutive efforts, the three measurements for a given plane of motion vary more than 10° from the mean (average) of these three measurements. The article also discusses adjustments for functional history when the ROM method does not adequately capture the full impairment.
Effects of Aging on Impairment Ratings: Part 4: Musculoskeletal Issues
Authors: Demeter Stephen L. , Brooks Charles N. , Melhorn J. Mark 
Published: December 2020

Abstract
This article is the fourth of five in a series on the effects of age-related changes in impairment evaluations as defined by the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth and Sixth Editions. The present article addresses the musculoskeletal system and differs from the first three articles, which focused on apportionment of an impairment rating between aging and other causes. The medical literature supports the notion that age-related osteoarthritis (OA) changes in the hand and digits frequently are associated with injury and/or repetitive motion. Thus, apportionment is indicated, but deciding which came first, the imaging abnormality or the injury, requires consummate skill on behalf of the rating physician. OA also occurs in the knees and hips of older individuals. Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory disorder characterized by calcification and ossification of spinal ligaments and entheses and is unique, in the authors’ opinion, because of a positive correlation between aging and back pain caused by this condition. The article also addresses the association—or the lack thereof—between pathology and aging, as well as degenerative changes and symptoms, to facilitate causation analysis. For a fuller discussion of causation analysis for the spine, readers can consult the AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition.
Entrapment Neuropathies: Electrodiagnostic Criteria
Authors: Blaisdell Jay , Talmage James B. 
Published: December 2020

Abstract
Like the diagnosis-based impairment (DBI) method and the range-of-motion (ROM) method for rating permanent impairment, the approach for rating compression or entrapment neuropathy in the upper extremity (eg, carpal tunnel syndrome [CTS]) is a separate and distinct methodology in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. Rating entrapment neuropathies is similar to the DBI method because the evaluator uses three grade modifiers (ie, test findings, functional history, and physical evaluation findings), but the way these modifiers are applied is different from that in the DBI method. Notably, the evaluator must have valid nerve conduction test results and cannot diagnose or rate nerve entrapment or compression without them; postoperative nerve conduction studies are not necessary for impairment rating purposes. The AMA Guides, Sixth Edition, uses criteria that match those established by the Normative Data Task Force and endorsed by the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM); evaluators should be aware of updated definitions of normal from AANEM. It is possible that some patients may be diagnosed with carpal or cubital tunnel syndrome for treatment but will not qualify for that diagnosis for impairment rating; evaluating physicians must be familiar with electrodiagnostic test results to interpret them and determine if they confirm to the criteria for conduction delay, conduction block, or axon loss; if this is not the case, the evaluator may use the DBI method with the diagnosis of nonspecific pain.
Comorbid Conditions in Workers' Compensation
Authors: Iglesias Marcos 
Published: December 2020

Abstract
A comorbidity is a concomitant but unrelated pathological or disease process, and comorbid conditions are coexisting medical conditions that are not necessarily compensable in a work-related injury but may affect the individual's treatment and recovery. Many comorbid conditions also are chronic health conditions that may interact with the sequelae of a compensable injury or illness and/or may affect the individual's health and abilities. In addition to the normal physiological changes of age, advancing age increases the number and severity of comorbid conditions, and this article examines three: obesity, diabetes, and heart disease. Obesity is associated with increasing workers’ compensation claims, medical and indemnity claim costs, and lost workdays; it is also a risk factor for type 2 diabetes, cancer, heart disease, and numerous other chronic and serious diseases. Hypoglycemia associated with diabetes can lead to falls and accidents, and diabetes may delay healing, predispose to infection, and cause peripheral neuropathies. Uncontrolled hypertension may be present in half of people with hypertension, leading to increased cardiac risk, especially if procedures or operations are needed. Claimants with comorbid conditions should be identified early in the claims process so claim handlers can use available comorbidity calculators to better plan for higher costs, longer disability, and more complex medical management. Nurse case managers can help the injured worker navigate the health system and act as a liaison between claims staff and medial providers.
Nonspecific Chronic Back Pain: Sixth Edition Approaches
Authors: Blaisdell Jay , Talmage James B. 
Published: December 2020

Abstract
Ratings for “non-specific chronic, or chronic reoccurring, back pain” are based on the diagnosis-based impairment method whereby an impairment class, usually representing a range of impairment values within a cell of a grid, is selected by diagnosis and “specific criteria” (key factors). Within the impairment class, the default impairment value then can be modified using non-key factors or “grade modifiers” such as functional history, physical examination, and clinical studies using the net adjustment formula. The diagnosis of “nonspecific chronic, or chronic reoccurring, back pain” can be rated in class 0 and 1; the former has a default value of 0%, and the latter has a default value of 2% before any modifications. The key concept here is that the physician believes that the patient is experiencing pain, yet there are no related objective findings, most notably radiculopathy as distinguished from “nonverifiable radicular complaints.” If the individual is found not to have radiculopathy and the medical record shows that the patient has never had clinically verifiable radiculopathy, then the diagnosis of “intervertebral disk herniation and/or AOMSI [alteration of motion segment integrity] cannot be used.” If the patient is asymptomatic at maximum medical improvement, then impairment Class 0 should be chosen, not Class 1; a final whole person impairment rating of 1% indicates incorrect use of the methodology.
The Medical Benefits of Work and the Health “Cost” of Unemployment
Authors: Talmage James B. 
Published: December 2020

Abstract
In 2011, the American Medical Association published the AMA Guides to the Evaluation of Work Ability and Return to Work (AMA's Return to Work), Second Edition, which began with a review of consensus statements attesting that, in general, work is good for a person's health and well-being. Since publication of AMA's Return to Work, the Australian Royal College of Physicians has issued a consensus statement about the negative health consequences of becoming unemployed and the health benefits of returning to work. Key points include: for most individuals, working improves general health and well-being and reduces psychological distress; even musculoskeletal and mental health conditions attributed to work can benefit from activity-based rehabilitation and an early return to suitable work; long-term work absence is harmful to physical and mental health and well-being; the negative effects of remaining away from work include stress on the worker's families, including children. Of the potential consequences of unemployment in mid-adult life, the worst is premature death. In causation research, unlike medical treatment studies, individuals cannot be randomly assigned to a group that is forced to remain at work and a group that is forced to be unemployed. Even so, causation research has found strong evidence for a protective effect of employment on depression and general mental health. In performing evaluations, physicians must accurately assess work ability and recognize the healthy benefits of work.
The AMA Guides in Pennsylvania “Post-Protz”: Act 111 and Case Law Update
Authors: Beck Justin D. , Torrey Judge David B. 
Published: December 2020

Abstract
Medical evaluators must understand the context for the impairment assessments they perform. This article exemplifies issues that arise based on the role of impairment ratings and what edition of the AMA Guides to the Impairment of Permanent Impairment (AMA Guides) is used. This discussion also raises interesting legal questions related to retroactivity, applicability of prior precedent, and delegation. On June 20, 2017, the Supreme Court of Pennsylvania handed down its decision, Protz v. WCAB (Derry Area Sch. Dist.), which disallows use of the “most recent edition” of the AMA Guides when determining partial disability entitlement under the Pennsylvania Workers’ Compensation Act. An attempted solution was passed by the Pennsylvania General Assembly and was signed into law Act 111 on October 24, 2018. Although it affirms that the AMA Guides, Sixth Edition, must be used for impairment ratings, the law reduces the threshold for total disability benefits from 50% to 35% impairment. This legislative adjustment benefited injured workers but sparked additional litigation about whether, when, and how the adjustment should be applied (excerpts from the laws and decisions discussed by the authors are included at the end of the article). In using impairment as a threshold for permanent disability benefits, evaluators must distinguish between impairment and disability and determine an appropriate threshold; they also must be aware of the compensation and adjudication process and of the jurisdictions in which they practice.
Downregulation of Glutamine Synthetase, not glutaminolysis, is responsible for glutamine addiction in Notch1‐driven acute lymphoblastic leukemia
Authors: Nguyen Tra Ly , Nokin Marie‐Julie , Terés Silvia , Tomé Mercedes , Bodineau Clément , Galmar Oriane , Pasquet Jean‐Max , Rousseau Benoit , van Liempd Sebastian , Falcon‐Perez Juan Manuel , Richard Elodie , Muzotte Elodie , Rezvani Hamid‐Reza , Priault Muriel , Bouchecareilh Marion , Redonnet‐Vernhet Isabelle , Calvo Julien , Uzan Benjamin , Pflumio Françoise , Fuentes Patricia , Toribio Maria L. , Khatib Abdel‐Majid , Soubeyran Pierre , Murdoch Piedad del Socorro , Durán Raúl V. 
Published: December 2020

The cellular receptor Notch1 is a central regulator of T‐cell development, and as a consequence, Notch1 pathway appears upregulated in > 65% of the cases of T‐cell acute lymphoblastic leukemia (T‐ALL). However, strategies targeting Notch1 signaling render only modest results in the clinic due to treatment resistance and severe side effects. While many investigations reported the different aspects of tumor cell growth and leukemia progression controlled by Notch1, less is known regarding the modifications of cellular metabolism induced by Notch1 upregulation in T‐ALL. Previously, glutaminolysis inhibition has been proposed to synergize with anti‐Notch therapies in T‐ALL models. In this work, we report that Notch1 upregulation in T‐ALL induced a change in the metabolism of the important amino acid glutamine, preventing glutamine synthesis through the downregulation of glutamine synthetase (GS). Downregulation of GS was responsible for glutamine addiction in Notch1‐driven T‐ALL both in vitro and in vivo. Our results also confirmed an increase in glutaminolysis mediated by Notch1. Increased glutaminolysis resulted in the activation of the mammalian target of rapamycin complex 1 (mTORC1) pathway, a central controller of cell growth. However, glutaminolysis did not play any role in Notch1‐induced glutamine addiction. Finally, the combined treatment targeting mTORC1 and limiting glutamine availability had a synergistic effect to induce apoptosis and to prevent Notch1‐driven leukemia progression. Our results placed glutamine limitation and mTORC1 inhibition as a potential therapy against Notch1‐driven leukemia.