The Millon Clinical Multiaxial Inventory-IV (MCMI-IV) and Millon Adolescent Clinical Inventory-II (MACI-II) in Legal Settings.

The MCMI-IV and MACI-II are the most recent iterations of the primary Millon clinical inventories and have become well-established instruments over the course of multiple editions. The MCMI, in particular in its prior editions, and to a lesser extent, the original MACI, have joined the canon of commonly-used psychological instruments in several forensic settings, though they have been met with significant controversy. This controversy is due in large part to complicated and sometimes questionable psychometric and normative referencing qualities that evaluators may find difficult to defend in a court setting. On balance, the instruments, unlike many others, are also supported by a rich though often less-than-understood theoretical backbone which lends depth and explanatory power, but which also can further complicate addressing psycho-legal questions. The authors, representing a mixed perspective on the inventories, generally conclude that while the MCMI-IV and MACI-II rely on a rich theoretical framework, the peer-reviewed literature is virtually non-existent, the need to rely on their predecessor instruments' research literatures are limiting, and the modifying indices have questionable utility in the detecting of response bias. In addition, the normative data and underreporting response styles in family court evaluations cause problems for the MCMI-IV's use in such contexts.

The impact of empathy on burnout in medical students: new findings.

INTRODUCTION: Research on medical students has shown they are at a higher risk for burnout and that this burnout may become more prevalent as they advance in medical school. The literature, thus far, has not explored the construct of ,emotional empathy and whether this can impact burnout in medical students. Objective: To understand the relationship  between empathy (Empathic Concern [EC] and Personal Distress [PD]) and burnout in medical students. METHOD: Five successive classes of medical students enrolled at a new medical school were given the Maslach Burnout Inventory and Davis' Interpersonal Reactivity Index  over the course of three successive  years (n = 353).  Two dimensions of  empathy were evaluated to determine if they have an impact on three dimensions of burnout (Emotional Exhaustion/EE, Depersonalization/DP, Personal Accomplishment/PA). RESULTS: data was analyzed using a linear mixed model for each of the three components of burnout based on gender, age, year in medical school, and two types of empathy: EC, and PD.  Conclusion: It was discovered that students with high levels of EC had statistically lower scores of burnout over time while students with high levels of PD empathy showed statistically higher scores of burnout over three years. Implications for these findings are discussed.

Evolution of the Millon Clinical Multiaxial Inventory.

Dr. Theodore Millon (1928-2014) was a primary architect for the personality disorders in the DSM-III, a structure that has endured into the DSM-5. His 1969 book, Modern Psychopathology, created an elegant framework into which the well-known personality prototypes could be fitted and understood. His theoretical work soon led into the creation of several psychological inventories, most notably the Millon Clinical Multiaxial Inventory (MCMI). The MCMI, now in preparation for its 4th major edition, has been a very popular instrument among clinicians. This article explores the history of the MCMI's development from its origins, through 2 distinct theoretical phases, and to its current status as the MCMI-IV is finalized.

Millon's Evolutionary Model of Personality Assessment: A Case for Categorical/Dimensional Prototypes.

Theodore Millon (1928-2014) was arguably one of the most influential figures in conceptualizing and detailing personality styles and disorders in the latter 20th and early 21st centuries. A prominent member of the Axis II Work Group of DSM-III, III-R, and IV, Millon continued refining his evolutionary model long after his active involvement with these committees, and remained focused on the future of personality assessment until his death in 2014. This article is an exploration of his latter works, critiques of recent DSM-5 developments, and commentary on the usefulness of his deductive methodology as it continues to apply to the study, classification, and clinical application of personality assessment.

Increased Risk of Infection in Obese Adolescents After Pedicle Screw Instrumentation for Idiopathic Scoliosis.

STUDY DESIGN: Original research. OBJECTIVE: To evaluate perioperative risk factors associated with obesity in children undergoing posterior spinal fusion for adolescent idiopathic scoliosis. The authors hypothesized that patients with a high body mass index (BMI) percentile would be associated with increased morbidity as measured by various intraoperative parameters. SUMMARY OF BACKGROUND DATA: Few studies have evaluated the effects of increased BMI in children undergoing surgery. Adolescent idiopathic scoliosis represents 80% of idiopathic scoliosis cases and is the most common indication for surgery. METHODS: Patients were divided into 3 groups: normal weight (n = 144) (5% < BMI < 85%), overweight (n = 25) (BMI > 85% to 95%), and obese (n = 38) (BMI > 95%). Patients with BMI less than 5% were excluded from this study because they were underweight. Perioperative data were collected and analyzed based on differences between groups. RESULTS: A total of 207 patients were included in this study. There was a significant difference in the length of anesthesia (p = .032). The rate of infection was 11% in the obese group, 12% in the overweight group, and 3% in the normal weight group (p = .03). CONCLUSIONS: Even with pedicle screw instrumentation, the researchers saw an increase in infection in overweight and obese patients. Patients should be counseled before surgery for weight loss to limit surgical complications such as possible risk of postoperative wound infection.

Anterior release generates more thoracic rotation than posterior osteotomy: a biomechanical study of human cadaver spines.

STUDY DESIGN: Biomechanical testing of human cadaveric spines. OBJECTIVE: To determine the effect of anterior and posterior anatomic structures on the rotational stability of the thoracic spine. SUMMARY OF BACKGROUND DATA: Historically, large and/or stiff spinal deformities were treated with anterior release to facilitate correction. However, anterior release increases risks and requires a 2-part procedure. Recently, large or rigid deformities have been treated with a single posterior procedure using pedicle screws and spinal osteotomies. No study has yet evaluated the effect of anterior release or posterior osteotomy on thoracic spinal column rotation. METHODS: Thoracolumbar spines were obtained from cadavers and segmented into upper, middle, and lower specimens. Specimens were cyclically loaded with a ±5 N·m moment in axial rotation for 10 cycles. Specimens were tested intact and then retested after sectioning or removal of each structure to simulate those removed during anterior release and posterior osteotomy. The total increases in axial rotation after posterior and anterior resections were calculated using a 3-dimensional motion capture camera system. For each ligament resection, the absolute and percent change in degrees of rotation was calculated from comparison with the intact specimen. The median data points were compared to account for outliers. RESULTS: Resection of anterior structures was more efficacious than resection of posterior structures. An 8.8% to 71.9% increase in the amount of axial rotation was achieved by a posterior release, whereas resection of anterior structures led to a 141% to 288% increase in rotation. The differences between the anterior and posterior resections at all levels tested (T2-T3, T6-T7, and T10-T11) were significant (P < 0.05). CONCLUSION: Anterior release generated significantly more thoracic rotation than posterior osteotomy in biomechanical testing of human cadaver spines. LEVEL OF EVIDENCE: N/A.

Clinical presentation of pulmonary embolus after total joint arthroplasty: do size and location of embolus matter?

Pulmonary embolism (PE) is a potentially fatal complication of total joint arthroplasty. Therefore, it is essential to have reliable means for diagnosis and evaluation of severity. In the study reported here, we evaluated the reliability of common clinical signs and symptoms in the diagnosis of PE. In addition, we used correlation analysis to assess for a correlation between clinical presentation and size and location of the embolus within the pulmonary vasculature. Included in this study were 13,133 patients who underwent total joint arthroplasty between 2000 and 2005. PE was diagnosed in 144 patients (1.1%). Shortness of breath (31.9%) and hypotension (30.6%) were the most frequent symptom and sign. Oxygen desaturation was the only indication for investigation of PE in 10% of patients. A pulse-oximetry reading of less than 90% was present in 63% of patients, and 92% of patients presented with an increased alveolar-arterial gradient. Overall, clinical signs and symptoms as well as severity of hypoxia did not correlate with size and location of PE. Patients with PE demonstrated a significant decrease in arterial oxygen content; an abnormal alveolar-arterial gradient was the most consistent finding in these patients. Common clinical signs and symptoms, as well as changes in vital signs, have a low sensitivity for diagnosis.

The inferior vena cava filter is effective in preventing fatal pulmonary embolus after hip and knee arthroplasties.

Thromboembolic disease is a relatively common and potentially devastating complication of joint arthroplasty. Mechanical and chemical prophylaxes are effective in reducing the incidence of this complication. Inferior vena cava (IVC) filters have been used to prevent the propagation and/or migration of venous emboli into the pulmonary circulation. This article reports on a cohort of joint arthroplasty patients either with confirmed pulmonary embolism or at high risk of developing pulmonary emboli in whom an IVC filter was implanted. Using the institutional database, 95 joint arthroplasty patients who received an IVC filter were identified. The IVC filter was effective in preventing fatal pulmonary emboli in all patients. The IVC filter is a valuable and effective modality in preventing a fatal outcome of thromboembolism in patients with established thromboembolism.

A network-reactive model for distributed telemicroscopy.

We have developed a network-reactive robotic telemicroscopy system that uses high-speed image processing and quality of service (QoS) feedback to maximize performance. In tests, four magnifications (4x, 10x, 40x, 60x) of a section stained with haematoxylin and eosin were used. Up to 25 clients, distributed across two Internet domains, accessed the server. When given control of the microscope, any of the clients could direct the microscope to change focus and objectives within 3 s and move the stage to any x-y position within 1 s. Transmission rates of 50-200 kbit/s were achieved for video (320 x 240 pixels at 24 bit/pixel). Performance varied according to the complexity of the images being transmitted. The 25 simultaneous users were supported without affecting the operation of the server and the system overhead was relatively small. The server's message-processing time and the network transmission delay amounted to 83 ms. The compression ratio of five previously stored video-sequences ranged from 336:1 to 1213:1. The underlying model for this system could serve a wide range of telemedicine and distance-learning applications.