Associations Books

This book is very readable. Morton Sobell illustrates the unfairness of the whole "justice" system and of life in prison. His eye is always on how the frameups and the brutal treat the ordinary people trapped in these system face, rather than on on the special features he faced as the victim of a cold war frameup as an "atom bomb spy." Sobell is a very wise and observant man. As an engineer with a Master's degree, has seems to be quite able to take things apart, analyze them, and tell us how they work. Yet, he also is very honest, very frank, and very revealing about his personal and emotional struggles.

I really liked Sobell's depiction of the trial that Julius and Ethel Rosenberg and he faced as "atom bomb spies." Exposes have been published about how the prosecution and the judge with the backing of the Eisenhower administration and the FBI framed up Sobell and the Rosenbergs. However,Sobell's picture of the difficulty of finding a decent lawyer, the struggle he had having any say so about his defense, and his continued struggle to secure better attorneys, speaks to the problems that ordinary working people have with the legal system.

My favorite part of the book was Sobell's description about doing time in his five years at Alcatraz. He takes apart the prison system, and highlights the injustice and irrationality of the wardens, the humanity of the prisoners, and how the system degrades and tortures the inmates. He also gives a picture of struggle inside the prisons, including a successful strike at Alcatraz that did win prisoners better food and treatment.

Sobell is quite frank and very moving in the way he reveals his emotional struggles during the trial and his inprisonment. He's not afraid to admit there were times when depression or dispair overcame him. He is quite frank about the ways he and his wife tried to keep a flame of sexuality going, but also about their decision to allow his wife other partners. Here as elsewhere, Morton Sobell isn't afraid to admit weaknesses he had that he is ashamed of.

Even though this is a fairly long book, I wished it had gone on and on to give more detail on his years in priosn after Alcatraz.

The book also comes with a CD with copies of freedom of Information Act files documenting the government frameup Sobell and the Rosenbergs face.

This is an excellent book and details of how a man that would in this day and time be considered a "white collar criminal" was treated like the most hard criminals.Like being sent to Alcatraz.Its goes into every detail of how he delt with being locked up for 18 years( 6+ years on Alcatraz).Unlike many criminals who had no family on the outside, this man did.It would be interesting for him to "undate" this book by adding a chapter on his 31+ years out of prison. (That is how sucessful was he or any further and later views on his being in prison.)

This is a magnificent book about the US Tennis background held in NY every year. The book is large and extremely informative. There are numerous photos of the past players etc. It is well worth reading and keeping in any library.

This is a lovely book, which will we will want to own, but also makes a great gift.

The first thing I did when I opened this book was to look at the pictures; all of them! The photography is so spectacular that I couldn't stop until I saw them all. The Open Book is a history of the US Open Tennis Championships during the 40 years of the "open" (professional) era of tennis. It covers each decade since the beginning of the open era in 1968, using photos, statistics, and articles by famous tennis journalists. The photographs, as mentioned above, are amazing, and lead you through the story of the Open, with a few thrown in "out of order" to make you think about the connections between players of different decades, and to marvel at the way the game of tennis has changed over the years. I found it interesting to read the articles and opinions written during each phase of the change over from the amateur to professional era, through the institution of the tie break, equal prize money for women players, and the birth of the National Tennis Center. The statistics are interesting, but don't make your eyes glaze over if you're not a stats person, and there is also a dvd with information about the players immortalized on the Us Open Court of Champions. This book has so much information, that I expect to find something I "missed the first time", every time I open the book. As an avid tennis player and fan, I highly recommend "The Open Book" to anyone who has an interest in the game.

Michael Gorman's book provides an inspiration and rejuvenation for mid-career professionals as well as motivation for anyone just entering the field. The meditations can be considered one at a time, with plenty of time for thought, or read one after another for a deluge of professional wisdom. This book is recommended for all librarians, anyone desiring to learn more about becoming a librarian, and everyone who loves books, reading, and libraries.

Just recently I was trying to explain to someone, not familiar with library work, what it was I did, and why I did what I did. I recommended Gorman's book to them to read. You can read the book straight through or just open it up anywhere and receive ideas and inspirations.

Michael Gorman has achieved prominence in librarianship, first through his major role in the total revision of cataloging rules, and second, more recently, as the co-author of the provocative Future Libraries: Dreams, Madness and Reality. This new work is a total departure from anything he has done before, being a collection of 144 "meditations" for librarians. Each meditation consists of a quotation, from authors as diverse as Jean Anouilh and Justice Potter Stewart, a short essay, and a final resolution. Topics range from "Occam's Management Theory" to "Burnout." As is all of Gorman's writing, this is first-rate, and recommended for lovers of books and libraries, as well as for librarians.

Ourika, by Claire De Duras, is a unique depiction of an African American during the French Revolution. Previous portrayals of Africans in French Tradition are reportedly vague and are not frequently described as individuals. The story of Ourika is a true story about an African woman who is rescued from slavery at a young age by the governor of Boufflers and is raised in a wealthy aristocratic white family.

Claire De Duras was born in France in 1777 and was forced to flee her homeland shortly after the execution of her father. She doesn't return until 1808 with her French husband, the Duke of Duras. De Duras doesn't have the desire to publish the story of Ourika until she sees what an interest is provoked by telling it orally to the customers in her salon. When De Duras does publish it in 1823, she does so gradually because female authors were not given much, if any, credibility at this point in time. The first edition had no author or date printed on it and consisted of only 25 private copies. The book did not remain a secret for long and several thousand copies were printed over the next few years. De Duras wrote four other novels the same year as Orika, but only two others were published before she passed away in 1828.

The story of Ourika is quite personable. The story is told by a doctor whom Ourika is one of his patients. At this point, Ourika's depression has taken a severe toll on her health and the doctor (who remains unnamed throughout the text) is determined to cure her despite her poor physical state. The doctor is initially taken by her gentle and eloquent manner, curious as to where an African woman had learned to be so proper. She insists that he can not cure her without knowing what troubles have ailed her health. Ouirka tells him the struggles she has had to face as an outcast throughout the course of her entire life as a black woman raised in a white person's world.

As Ourika gets older, she is reminded daily of how alone she is. She has no family and no white man will marry her. She doesn't understand the culture of her own people since she has never experienced it, so she doesn't fit in anywhere. The only male friend Ourika has ever had marries a beautiful wealthy white woman. Ourika is constantly sneered at by those who do not know her, so she limits her time away from home. The accounts of Ourika's life are told in dramatic detail and give the reader much sympathy for her. Her depression causes frequent fevers and she falls unconscious on numerous occasions. All of Ourika's oppression is eventually relieved as she turns to God and becomes a nun, but at this point her body is too frail to continue much longer.

Ourika is a remarkable story for someone who is interested in nineteenth century Europe or studying inequality between races throughout history. Ourika touches deeply on subjects not commonly written about in the early nineteenth century and paints a vivid picture of how difficult life was for women and minorities during the French Revolution.

Written by a woman in 1823, Ourika is a fascinating short work set during the French Revolution. Ourika is an attractive, intelligent young black woman who was rescued as a child from slavery. She is raised as any wealthy white child would have been. She excels in her pursuits and charms all. By chance, she discovers who she is, and what it means to be black. The truth changes her. This work raises many questions, and provides some haunting insights into human nature. Highly recommended

Lillian Lewis, the reviewer, has not read this book if she can call it "delightful." Nor is Ourika's happiness, actually ever "restored." This is a devastating tale about a young woman who hopes to be part of her mainstream culture, only to find that her black skin and Senegalese heritage will forever bar her from the only culture she's ever been a part of--aristocratic France. Duras writes a compelling novella, full of anguish and the unfairness of her contemporary French society (and one that resonates today worldwide). It is an extraordinary tale, but it is absolutely not "delightful."

I have started reading the book for the second time , I couldn't put it down. The author really knows how to explain the bible in layman's terms. I am back online to find more books by Dewight Nelson.

if you are looking for a forever friendship with God, this book is a wonderful way to learn more about him... was it the same God who created this world and flushed it with flood? to know me is to love me....

Outrageous Grace: Finding a Forever Friendship With God is not a long book, but it is overflowing with illumination and inspiration. Dwight K. Nelson addresses some of the hardest questions posed by sinners and believers alike concerning God, and he delivers eloquent and persuasive answers to those questions. Even many Christians find it hard to reconcile the jealous God of the Old Testament with the meek and loving Jesus Christ and His Father of the New Testament. On several occasions, the God of the Old Testament meted out divine punishment, struck fear in the hearts of his earthly children, and sometimes appeared more like a consuming fire than a loving Father. He denied Moses and Aaron the right to enter the Promised Land after forty years of wandering in the desert after a seemingly minor transgression on Moses' part. Even in the New Testament, in the early days of the church, God struck down Ananias and Sapphira when they conspired to secretly keep a portion of the money they made by selling a piece of property. If God is Love, how could He have done these troubling things? Taking the idea even further, how can a loving God allow so much misery and suffering in the world today? These are questions all Christians ponder at some point.

Nelson does a fantastic job of tackling these hard issues. In each and every case he examines, he puts forth convincing reasons for God's actions and shows they were all borne of love. In formulating his central argument, Nelson goes all the way back to Lucifer's fall from grace and the introduction of sin in this world. He does a wonderful job explaining why God did not simply destroy the rebel angels; moving from this, he blames Satan for spreading the lie that God should be feared. He devotes a chapter to explaining just what sin really is, making brilliantly illuminating use of the parable of the prodigal son in this regard. He backs up his argument that God meets us where we are and as we are, extrapolating from this notion a brilliant explanation for the frightful appearances of God to the Israelites of Moses' day. In cases such as the seemingly extreme deaths of Ananias and Sapphira, Nelson explains God's actions as a form of "accelerated judgment" made so as to protect the larger body of followers from the dangers it would otherwise be exposed to. In each and every case, no matter how cruel God's action may seem on the surface, Nelson certainly proves to my satisfaction that God acted out of love and not jealousy or rage.

God is not to blame for suffering and pain on earth, Nelson argues; He in fact shares all of our afflictions with us, and He proved the depth of his relentless love beyond doubt on Calvary some two thousand years ago. God wants his children to love Him, but true love cannot exist unless men and women have the freedom to say No to divine love. That is the heart of Nelson's explanation for the existence of pain and suffering among believers and non-believers alike. I found two of Nelson's related arguments very interesting. Nelson does not think the existence of pain and suffering can be explained completely in terms of God using pain and suffering in order to teach us some valuable lesson or to somehow reach someone else in a special way. I know many Christians who react to hard times by thinking God is punishing them for something, but Nelson warns against such thinking. Such thoughts lead to a fear of God, which is exactly what Satan wants to achieve in the hearts of men. In the pages of Outrageous Grace, Nelson shows that the God of the Old Testament is the same God of Jesus' day and our own time, a loving Father who acts only out of undying love for his children. I believe all Christians would benefit enormously from reading this book.

This book is an excellent reference manual. It can be used by engineers or water operators with complete and easily understandable concepts. We have been operating an ozone plant for water treatment for approximately 4 years now and use this book as a source for new concepts and references for our existing operational data.This book is an excellent resource for process design, operations, and system optimization.

This book is a valuable resource that I refer to daily in my work with ozone systems for drinking water treatment. It is written in manner that is easy to understand and it is packed with relevant, practical information about ozone system design, operation and optimization. This book is a "must read" for any engineer, operator or manager involved with or considering ozone as a water treatment process!

This book is the definitive resource for ozone in water treatment. It presents timely information in a clear and concise manner. Well worth the price.

This book is great "airplane" reading. Each chapter is self contained --- usually about 10 to 15 pages, and written by world renowned experts in their field. Partnering is the common theme, but the authors cover a lot of territory.

This book is timely and relevant to today's environmnet. I especially like the idea that all the authors (as if these people need the money) are donating the royalities from sales to the victims of September 11, 2001.

Great book! Partnering is the way to do business now and in the future. The book is a fine collection of tools and strategies in leadership and management. It's educational, inspiring and engaging at the same time. A must read for anybody who manages fast pace, competitive businesses

This is a book for people who are concerned for building a better future. As someone who has spent a great deal of time studying leadership, I find the focus on doing it better that is found in this book to be quite refreshing. Here we move beyond evolutionary changes to ideas that are quite revolutionary. This is not a book about maintaining the status quo power structures. This is a book about creating new leadership styles where partnership with knowledgeable workers will be needed to ensure organizational success.

The command and control style of leadership is coming to an end. For a leader to succeed in the future they will have to rely on their ability to pull together the talents of many individuals. This will be a leader who respects others, who helps coach and develop real talent, who shares success, and who continuously reinvents her/himself. The book gives us hope for a future where we can be productive without sacrificing our humanity.

The books 30 essays by 42 thought leaders are works derived from a passion for helping others. The inspiration for this book comes from an awareness for new leadership made more apparent by the events of 9/11. All of the royalties from this book will go to help the victims of that tragic day.

Dr. Kovach's book is an excellent introduction to the principles of people management for new managers and students. It will also help experienced managers seeking to improve the performance of their people.
The book is a concise guide to creating a positive organizational culture.

I expect readers will retain the book as a handy reference for reviewing the techniques that "get things done the right way- through people!"

Dr. Kovach's book is very concise on a subject matter that could easily take many books to describe. It is a very hands-on approach that managers or would-be managers can use immediately.

I found Dr. Kovach's book, People Power: Getting Things Done Through People Using Good Management Techniques, utilizes a very thoughtful, effective approach to teaching managers how respect for all employees creates positive results for the entire organization. It's a classic example of the old saying, "What goes around comes around." Dr. Kovach uses a humorous, allegorical approach to teaching a subject that can oftentimes be boring and overly technical.

It's a quick but very effective read. I recommend it wholeheartedly.

Terry Sullivan
Director of Sales & Marketing
Creatorsoft Corporation

I recommend this book to anyone from physicians to workers' compensation adjusters. It is a great reference for anyone that deals with returning injured employees to work.

This book is better than "Occupational Medicine Practice Guidelines, Evaluation and Managemtn of Common Health Problems and Funcitonal Recovery of Workers" published by the American College of Occupational and Environmental Medicine. They cover simelar topics. The AMA book is shorter, more specific and has sharpter definitions. The ACOEM book frequently is more a commentary than a summary of the material they reviewed.

Here is a summary, from a mental health perspective.

Talmage, J.B. and Melhorn, J.M. (2005). A Physician's Guide to Return to Work. AMA Press.
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1. Why Staying at Work or Returning to Work Is in the Patient's Best Interest
This book focuses on the less obvious and less severe illness and injury situations in which many patient with similar problems work, and yet some patients consult with physicians, seeking disability certification.

Rest should have a black box warning. Warning: This drug is detrimental to your patient's mental, physical and social well-being! Therefore, you will harm the patient by giving them excess time off.

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2. How to Think About Work Ability and Work Restrictions: Risk, Capacity and Tolerance
Risk = Chance of harm to the patient or the general public. In response to risk are work restrictions. A work restriction stops a patient doing something even if they can do it and want to do it. There is little objective evidence for this stuff but there are consensus documents.

If there is not objective evidence of substantial risk or significant harm, the patient may choose whether or not to work despite symptoms. This means that, logically, it is still the patient's decision when they request disability certification.

Capacity = an individuals theoretical maximum ability. It includes things such as strength, flexibility and endurance. Current ability = an individual's current ability and is equal to or less than their capacity. Current ability and capacity can be higher, equal to or lower than the demands of a job. Work and other treatment improve current ability. Fitness can be measured in terms of metabolic equivalents. Functional capacity evaluation (FCE) does not measure capacity unless the person is already at maximum fitness. In the only published test of FCE for back pain, things were best when the results were ignored and the patient returned to work.

Tolerance = ability to tolerate sustained work or activity at a given level. It is a psychophysiological concept. It is dependent on rewards. It is not scientifically measurable. Tolerance will always be less than ability. When doctors hold differing opinions on this, they look stupid/dishonest and are trying to answer an unscientific question.

When objective pathology is dramatic, poor tolerance is more believable.

Where there is no objective pathology and symptoms are disproportional to pathology, most physicians agree working poses no major risk and can work if they wish. "... alleges intolerable pain when attempting to lift a postage stamp has an issue of tolerance rather than risk or ability."

Physicians can play secretary, try to assess tolerance, abstain and leave the decision to the patient. Should say "... there is no problem with risk or ability, just with pain. Only you can determine if working with the pain is worthwhile."

Evaluating Work Ability
1. Find about what the job requires.
2. Find out about the medical problem
a. Objective features
b. Subjective features
c. Relationship between objective and subjective features
d. Permanent/temporary
e. Helped with work/treatment/time or stable and stationary
3. Risk and restrictions
4. Current ability and limitations
5. Tolerance
6. Decision
a. If risk/restrictions acceptable and wants to return to work, they can
b. If risk ok, does not want to work and objective pathology is present: Specify that the patient is disabled but can work if they wish.
c. If risk ok, does not want to work and objective pathology is absent: medically unanswerable question.

Criticism of the chapter
1. The difference between a scientific question and a value judgment is not as clear as made out here. For example, acceptable risk is not a scientific question, just what the risk is.

2. The cascade they have is: risk, pathology, tolerance (where different decisions are made according to pathology). The cascade they should have is: risk, pathology, somatiform disorder, tolerance. In other words, the authors discount the existence of psychogenic pain treat the same pain differently depending on if it is due to a physical disorder or to hysteria. I suppose you could argue that tolerance, by their definition, depends on rewards, so it makes no difference if the decision is made consciously or unconsciously (!) but that is a bit of a stretch. It is not clear if the authors ignore hysteria for convenience, because they do not believe it exists as a disorder (beyond tolerance) (it is in DSM IV) or because they are following a societal convention in ignoring it.

In Australia, hysterical disorders are regarded as real. If a doctor has to make a value judgment about what it is reasonable to ask one to tolerate, giving more credence to someone with greater objective pathology has some intuitive appeal. On the other hand, this intuitive appeal might be because the presence of objective pathology is short hand for risk of exacerbation of the injury with work and it is intuitive forget that it is not ethical to worsen a patient's condition by allowing them to not return to work when they could (issues of autonomy aside).

3. With psychological injuries, insufficient tolerance is excessive risk, because distress is what is driving the condition. In other words, in psychological injury, capacity and tolerance blur into one another. Notwithstanding the central role of exposure to all psychological treatments.

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3. How to Negotiate Return to Work
Fundamentals: risk, capacity, tolerance. Focus on retained capacity rather than deficits. Accommodate while you remediate. Some bosses do not want the worker back until the worker is "100%," and some workers do not want to go back until they are "100%." First element of motivational interviewing is education. Negotiation and agreement.

Occupational injuries/occupational illnesses. Probability has a legal, rather than medical, definition. Impairment = loss of use or derangement of any body part, system or function. Disability = loss of capacity to meet personal, social or occupational demands (or statutory stuff). (Alternative: disability function and handicap role.) Might need to do an impairment rating.

Return to work can be delayed by communication, litigation, disputes, administration, lack of desire. Most common reason by Drs: not want to force back, employer has a policy against light duty work, caught between versions of events, conflict between two physicians, emotionally uncomfortable, differing opinions between stake-holders.

ENGAGE THE WORK PLACE CASE MANAGER. Modified work is the cornerstone or rehabilitation.

Job satisfaction, demands/autonomy, single supportive telephone call, happy to be rid of them, demarcation dispute. Look for the 5Ds: dramatisation, dysfunction, dependency, disability and drugs. Most people do not need any time off work at all.

Essential functions are those bits of jobs that can not be easily modified.

Motivational interviewing: in order to get the patient back at work fast, you must 1) educate them that you are on their side and 2) educate them that rapid return to work is in their best interest. Be firm on the science and soft on the patient.

Note: nociception, suffering, pain behaviour, and disability.

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4. Return to Work: Forms, Records and Disclaimers
Work guides allow a doctor to make recommendations that are not initially specified as limitations, restrictions or reasonable tolerance. Contents of files will end up with lawyers.

Initial report: in addition to usual stuff: onset of symptoms, relationship to the workplace, causation/aggravation/exacerbation, job in detail, current ability, accommodations, prognosis.

Interval reports: response to treatment, admin and relationship stuff that is impacting, treatment options, work guides.

Final report: if stable and stationary, if need vocational rehabilitation, work guides, determination of permanent impairment.

In records:
1. Return to work
i. Is the injury going to make it hard to go back
ii. Is the boss/workers going to make it hard
iii. Figured out a way to return despite the injury
2. The grocery store
3. The molehill sign
4. The obstacle

Terminology
* limited 0 to 12% of the day
* occasional 0 to 33% of the day
* frequent 34 to 66% of day
* constant 67% to 100% of the day

Each physician should develop their own standard return-to-work form.

Disclaimer. The above statements have been made within a reasonable degree of medical probability. The opinions rendered in this case are mine alone. Recommendations regarding treatment, work and impairment ratings are given totally independently from the requesting agents. These opinions do not constitute per se a recommendation for specific claims or administrative functions to be made or enforced.

This evaluation is based upon the history given by the patient, the objective medical findings noted during the examination and information obtained from the review of the prior medical records available to me, with the assumption that this material is true and correct. If additional information is provided to me in the future, a reconsideration and an additional report may be requested. Such information may or may not change the opinions in this report.

Medicine is both an art and a science, and although the patient may appear to be fit to work with the abilities and restrictions described above, there is no guarantee that they will not be injured or sustain a new injury if they chose to return to work.

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5. Evidence-based Medicine

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6. Causation Analysis
By Genovese, E.

Hill Criteria of Causation Analysis
* Temporality
* Biological plausibility
* Predictive performance
* Gradient
* Reversibility
* Strength of association (not frequency)
* Consistency of association (coherence)
* Experimental evidence / Analogy (from animal studies)
* Specificity

Presumption = disease process is legislatively determined to result from an exposure or in association with a particular occupation.

Precipitation = injury or exposure causes a "latent" or potential disease process to become manifest. For example, having a MI at work that would have occurred anyway.

Aggravation = a particular event or exposure permanently worsens a condition.

Exacerbation = an exposure or event temporarily worsens a condition.

Recurrence = signs or symptoms attributable to a prior illness or injury occur in the absence of a new provocative agent. For example a return of radicular symptoms in a situation that would not be expected to cause such symptoms.

Probable = 51% chance or greater.

Possible = Between 0 and 50% chance.

Causality determination
* What happened
* What happened since
* Other workers?
* Happened before?
* Medical problems?
* Hobbies and stuff?
* Like job, supervisor, coworkers?
* Doing now?
* Past problems with depression or drug use?

And
* Get collateral records
* Get history from employer
* Hill criteria consider and/or research

Later
* Progressing as expected?
* If Sx resolved, will they return if they return to work?
* If Sx not resolved, is there a physiological explanation?
* If there is a physiological explanation for symptoms, will return to work exacerbate them? If not, are there objective reasons why the patient is not back at work?
* If there are no physiological explanation for symptoms, is there a medical reason the person is not back at work?

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7. The Functional Capacity Evaluation: Is it Helpful?

20 separate functions can be measured, including walking, sitting, lifting, seeing, hearing, tasting and fingering. FCEs test tolerance, occasionally capacity and not risk. FCE can help measure progress, set goals and measure disability. FCE can measure current ability and match them to a job.

If someone reports pain during the test, vital signs at the time should be recorded to see if there is physiologic correspondence to pain levels. Vitals should confirm the stated ability to, for example, lift. Should have data, conclusions and reccomendations that are related to each other.

Validity = measures what it is supposed to measure. Reliability = reproducibility of test. Most FCE systems do not have these. Not good at detecting submaximal effort. On was sensitivity of 67% and specificity of 84%.

Avoid confrontation by always having the patient do useful stuff from the start, and have RTW on the agenda right from the start. This will mean that work-centered stuff will be on the agenda from the start. Better outcome if ignore the FCE of back pain and go back to work anyway.

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8. The Medical and Legal Aspects of Return-to-Work Decision Making
Waldner, P.F et al.

It is rumored that a lawyer might tell a patient not to go back to work. Can end up as a scam.

Questions
* Agree best to return to old function
* Agree job more important than claim
* Do you want me to be truthful

Find out the physical requirements of the job from the patient and the employer. If want to know when they can return to work, ask the insurer or employer.

In the USA, the doctor does not have a duty to third parties; if the worker's knee collapses and they drop a girder on someone's head, no problem. Form a friendly relationship with a trial lawyer.

The patient's confidentiality always belongs to the patient. On the other hand, if the court insists on records, make sure they are subpoenaed.

The disclaimer if you see the file and not the patient is: The opinions in this case are the opinions of the reviewer. The review has been conducted without a medical examination of the individual reviewed. The review is based on documents provided with the assumption that the material is true and correct. If more information becomes available at a later date, an additional service/report/consideration may be requested. Such information may or may not change the opinions rendered i this report. This report is a clinical assessment of documentation and the opinions are based on the information available. This opinion does not constitute per se a recommendation for specific claims for administrative functions to be made or enforced.

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9. Can This Patient Work? A Disability Perspective
LoCascio, J.

WHO disability definition: "... any restriction or lack... of ability to perform an activity in the manner within the range considered normal for a human being."

The patient is disabled if their current ability does not meet the needs of the job. Not the doctor's job to determine if stuff can be "reasonably accommodated." The physician does not determine if a patient is disabled, just what they can do.

Diagnosis does not equal disability. Diagnoses with pathology or less capacity for hysteria are better but not needed.

Impairment does not equal disability. By the above definition of impairment, an elite athlete who gets asthma and can only run an eight minute mile has impairment. They are not disabled, but, yet.

Functional capacity = current ability. Patient must be capable of something before they can be restricted. Symptoms in excess of findings are the hallmark of subjective R/Ls. Doctors usually assume that the patient is telling the truth and consciously and unconsciously wants to get better.

The test of symptoms in excess of findings in consistency. Dimensions to be consistent in include: time, observers, known syndromes, situations.

Psychiatric diagnoses are syndromic in character. On the other hand, can have neuropsychiatric tests and tests with faking scales built in done. Axis V becomes important (!)

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10. Medications, Driving and Work
Aronoff, G. M. et al.

Consider: medication, condition the medication is for, synergistic effects of medication, if ability is already reduced. Not able to drive does not mean not able to work unless driving is an essential part of the job. Benzos can increase risk by 50% and TCAs by 100%. Impairment in ability can also impair ability to judge ability. OTCs cam also be a big problem. You must warn the patient about the risk of driving, or you are liable.

Effected by
* Insight, judgment and poor insight into these
* Alertness, reaction time
* Vision, dizziness
* BP, EPSE

Synergy with shift work and drowsiness.

Ax: Sight, vision (acuity and fields), cognitive and motor. MMSE, using a calculator, trail making B, clock drawing. timed walking 10 feet and turning around, manual test of range of motion, motor strength. Guides are in HCP's Guide to Assessing and Counseling Older Drivers. Others: Aronoff test of reaction time, attn concentration, attention span, concentration, mood/affect.

Same rules apply to other stuff where you need to be alert, too.

Benzos: impair. Muscle relaxants such as cyclobenzaprine or carisoprodol impair. Opioids probably don't with long-term use.

CNS stimulants: should not drive commercially if need these for adult ADHD. The decreased alertness that frequently occurs with dropping blood levels can lead to mistakes.

Can enter in the chart "Based on today's evaluation, I find no basis to restrict this patient from driving or working, if he/she so chooses. They know that if at any time, they are not fully alert or if they experience any decrease in mental acuity, they are not to drive or engage in potentially hazardous activities."

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11. How the Primary Care Physician Can Help Patients Negotiate the Return-to-Work/Disability Dilemma.
Know the secondary gain and the expectations of the extended family. Communicate expectation of recovery. "Early activation" helps. Health and wellbeing of entire family at stake.

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16. Working with Common Neurologic Problems
Klimek, E.H.

Need an enabling philosophy. All return to work will involve some risk. Gainful employment (here) means competitive employment with reasonable accommodations.

Work autonomy means the ability of a worker to pace the work to suite the limitations and is related to the idea of workplace modifications. Without undue hardship to the employer.

Can be static or slowly deteriorating. Determination, motivation and effort can overcome established neurological handicaps. Shift work will make worse. Fear avoidance accounts for 70% of back-pain non returns to work.

Headache
Migraine: headache, autonomic, stereotypic, +/- aura. Will be persistent and debilitating rare without: infection, increased ICP, temporal arteritis and head trauma.

Acute PTH, up to 8 weeks, otherwise, chronic PTH.

In primary headache, risk is not an issue. Capacity is not effected by pain, nausea, fatigue(!) Tolerance is the issue.

With return to work, have a challenge of graded activity and exercise with a headache diary and headache scale. The failure to adhere to the graded increase allows social and personal barriers to emerge and be addressed without being complicated by workplace stressors. So start exposure with work-like activities. Identify that work helps headaches.

Debilitating chronic headache rarely occurs without amplification of other, normal body sensations. Patient who experience chronic headache also seem to confuse responsible therapeutic drug use with drug misuse for symptoms common to everyday life, which they understand as warning signs of serious disease. Some thereby express emotional distress constrained only by cultural and familial rules.

Epilepsy
In the UK, 53% of employed people with epilepsy chose to conceal their illness. The reasonableness of accommodation is not a medical issue. Crux is prognostication for recurrence for work tasks to be addressed. Patients with first seizures are not a homogenous group. Recurrence within 2 years of first tonic/clonic seizure is as high as 40%.

Ask about previous epilepsy-like Sx, EEG within 24hrs of seizure, sleep deprived EEG, MR. Most people have a standard letter about driving and other risks.

Consider predictability and aura when considering return to work. The major risk factor might be poor attendance and productivity. Drug side effects can decrease productivity.

Risks: driving, heights, machinery. Capacity is usually ISQ. Tolerance is an issue of patient choice.
Brain Injury
Mild traumatic brain injury (MTBI): headache, dizziness, lethargy, memory loss, irritability, personality changes, cognitive deficits, perceptual changes. If able to follow commands less than one hour after the injury, some studies say no long term problems, other says only 49% chance of "good recovery." MBTI paradox is that can have # and contusions and get back to work, or nothing much and not get back to work.
MS
Kurtzke Extended Disability Status Scale. No risk to self. Tolerance: no mental fatigue in early stages. Fatigue/weakness that can not be objectively defined is a matter of tolerance. Personality changes can be a problem through motivation and effort. Without a limitation of walking (EDSS 4.0 or greater), this is rarely an obstacle to function.
Polyneuropathy
Driving skills will rarely be effected, but hypoglycaemia and retinal disease can be issues. Risk of falls and hazardous equipment and skin ulceration are risks that might need work restrictions. Capacity and work limitations. Usually no issues of tolerance.

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18. Working with Common Psychiatric Problems
Pro, J.D.

See AMA guidelines for evaluation of permanent impairment.

Presenteeism is a common problem. More than 80% of lost production occurs with patients who are at work. Understand how symptoms interfere with functioning.

Find out about: ADLS, social fn, concentration, ability to tolerate stress, and if

Find out
* ADLs +/- instrumental
o Self Care
o Communication
o Physical activity
o Sensory function
o Nonspecialised hand functions
o Sexual function
o Sleep
o Travel
o Shopping, banking, cleaning
* Role function
o Work
o Social
o Family
o Spiritual
* Ability to tolerate stress
* Ability to tolerate work-like events (some instrumental ADLs)
o Personal affairs
o Meetings
* MSE
o General MSE, cognitive testing and psychiatric neurological examination and...
o Concentration
Attention
Memory
o Persistence
o Pace
o Pain behaviours
o Beliefs about injuries and other's responsibility

Risk: Occurs in safety-sensitive jobs. Note homicidal ideation to coworkers - not to return home. Paedophilia...

Capacity assessment: decreased with psychotic disorders.

Tolerance assessment: as discussed.

Major Depression
Capacity: cognition, judgment, motor retardation, sleep deprivation. Those with mild depression can work - issue is tolerance.
Pain Disorder
Distorted beliefs about pain common. Can become suicidal with work. Capacity is not usually decreased but can become reconditioned. Tolerance: involve with setting goals.
PTSD
Half resolves in three months. 80% comorbid with other mental disorders such as panic, agoraphobia, MDD and substance abuse. Capacity... modifications and accommodations. Tolerance: desensitization.
Adjustment Disorder
Risk: if the stressor is conflict with a person at work or a situation at work, the physician may be justified is restricting work. Analogy: occupational asthma. May chose to change employers or careers.
Treatment Planning
Moderate or marked impairment in work ability without concomitant at least moderate impairment in other areas of mental function does not occur. A few people, because of their job description, might need to be taken off work.
Return to Work
Do this when most ADLs are ok and has adequate social stuff, concentration, persistence and pace. Demonstrate tolerance in a work-like setting. Be in control of anger. Side effects of medication should be ok. Stuff organised with the case manager and supervisor. Arrange discussions between the patient and his supervisor as this can dramatically improve work stress tolerance. Patients should agree that they are ready to return to work.

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19. Working with Common Functional Syndromes: Fibromyalgia and Chronic Fatigue Syndrome
Talmage, J.B.
Risk is not an issue. Capacity is generally not an issue in fibromyalgia. F and CF can have a decreased exercise capacity documented on treadmill testing. See if the test is stopped by fatigue/tolerance long before the predicted maximal heart rate is reached (exercise testing) or anaerobic threshold is crossed (cardiopulmonary exercise testing). If cognitive complaints effect the job, get formal neuropsychological testing. There is no logical reason for temporary work modification because the conditions are long-term.

The patient's plight is similar to that of patients with nonspecific regional arm pain or mechanical lower back pain. Tolerance is not an area of medical science, so reasonable doctors will disagree.

This book is written by physicians for physicians to give some guidance about work restrictions/limitations and uses common sense, art as well as the science in work-related injuires and illnesses. At the same the authors helps to translate and make sense our of the legal definitions of the work comp world of lawyers, case managers, and employers. I wish I had read a book like this in medical school or residency. Easy to read and understand.

I missed Ty Cashion's book "Pigskin Pulpit" when it was first released a few years ago but with the re-release in paper back this year (2006) I had the opportunity to read it. I think the reason I didn't read it the first time was the title. I thought it was another "Glory" of High School Football book. Had I just paid attention to the subtitle "A Social History of Texas High School Football Coaches" my history buff inclination would have made reading this book a no brainer.

Ty Cashion was ordained to write this book. A professor of history at Sam Houston State University and more importantly the son of a Texas High School football coach, Ty had the knowledge to tell the story and the access to interview, by my count, at least 82 different Texas High School football coaches, many of which are no longer with us.

Some 40+ years ago, when I was a kid, I would listen to Texas High School football play off games on the radio. The radio announcer start by saying something like this: "Broadcasting from P.E. Shotwell stadium in Abilene, Texas ...".

P. E. Shotwell, Darrell Tully, and Gordon Wood may just be the name of Texas High School football stadiums for football fans of the current generation but they are just three of the many coaches that made Texas High School football what it is today. Many young athletes dream of "going pro" and signing multimillion dollar contracts. School boy football players born into the depression era of the early twentieth century just dreamed of the chance to play college football, get an education and coach football. It was their ticket off the farm and a way to a better life.

Ty Cashion chronicles the path to their goal and how the experiences that they had impacted several generations of young men in Texas.

If you ever knew a coach, if you ever played for a coach, if you ever learned from a coach, if you ever cussed a coached, if you ever idolized a coach ..., you need to read this book.

This is a great book. It tells the story of how High School Football has become the number one event in Texas. I am glad someone put these stories into print because sadly many of these great men are leaving us but their stories and the impact they have had, and continue to have, will be passed on. This is a must read for any football fan.

Aren't history books supposed to be dull as dishwater? I gave this book to my 80+ year-old Father for Christmas. He really enjoyed it! So did I, for that matter. Dr. Cashion must have spend untold hours interviewing old-time Texas High School football coaches and those who played under them. This book is as close to listening to those old timers as the written word can be. Growing up in football crazy Garland, Texas (back-to-back state championships in the 1960's under Chuck Curtis), I remember as a child "high school football fever." This hits the mark, or should I say is a "two point conversion."