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Aims To evaluate patient management following stage pT1 colorectal cancer (CRC) diagnosis, and to determine if surgical resection improved outcome compared with local excision, within a population-based study. Methods Data were collected from the Northern Ireland Cancer Registry. Cases of stage pT1 CRC diagnosed from 2007 to 2012 were identified. Analyses were conducted using Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for cancer-specific and all-cause mortality for individuals undergoing formal surgery versus local excision. Results 394 patients with pT1 CRC were included. Of these, 37.1% were treated by local resection, 36.8% had biopsy followed by surgery and 26.1% had local excision followed by surgery. There were 60 deaths over a mean 4.8 years of follow-up, including 10 CRC-specific deaths. An additional 12 patients had a CRC recurrence or metastases during follow-up. Of the CRC-specific deaths or recurrences, 27.3% had local excision only. Individuals treated by formal surgery did not have a reduced risk of CRC-specific death (adjusted HR = 1.51, 95% CI 0.29, 7.89), but did have a reduced risk of all-cause mortality (adjusted HR = 0.51 95% CI 0.30, 0.87) compared with those undergoing local excision only. Conclusions Patients with stage pT1 CRC undergoing formal surgery had a reduced risk of all-cause mortality compared with those treated by local excision only. However, this was not explained by a reduced risk of recurrence/disease-free survival or CRC death, and suggests that the observed benefits may simply reflect selection of a healthier patient population in the formal surgery group.

There is a growing interest in the role of personality characteristics in describing financial outcomes. The Big Five personality traits have been shown to predict relevant financial outcomes including income and net worth. In the present research (n = 395), we move beyond individual Big Five personality traits to look at personality profiles in the prediction of financial outcomes. Using latent profile analyses, we identified three profiles—Under Controlled, Resilient, and Over Controlled—which were uniquely associated with income, risk tolerance, and life satisfaction. These patterns held even after controlling for gender, education, and age. The discussion focuses on the relative benefits of a personality approach over the common risk-tolerance approach.

An association between grandiose narcissism and self-esteem has been well established. While the two constructs are both associated with an agentic, approach-oriented style, their levels of agreeableness/antagonism and overall adaptivity diverge. Three samples (N = 1920; N = 855, N = 591) were utilized to test the hypothesis that self-esteem may show a curvilinear relationship with narcissism such that relations between self-esteem and narcissism are stronger at particularly high levels of self-esteem. Item Response Theory scoring methods were utilized to maximize power and minimize error. No curvilinear effects consistent with the hypothesis were found. These results are consistent with arguments for substantive differences between self-esteem and narcissism.

Scholars posit that economically prosperous times should produce higher individualism and narcissism, and economically challenging times lower individualism and narcissism. This creates the possibility that narcissism among U.S. college students, which increased between 1982 and 2009, may have declined after the Great Recession. Updating a cross-temporal meta-analysis of the Narcissistic Personality Inventory to 2013 (k = 164, N = 35,095) and adding two within-campus analyses to 2015 (Study 2: UC Davis, N = 58,287) and 2016 (Study 3: U South Alabama, N = 14,319) revealed a non-monotonic pattern, with increases in NPI scores between 1982 and 2008 and declines thereafter. The decline in NPI scores during and after the recession took narcissism back to their original levels in the 1980s and 1990s. Implications for the interplay between economic conditions and personality traits are discussed.

The Five-Factor Narcissism Inventory (FFNI) has exhibited strong construct validity and is the only measure that captures the three factors associated with recent models of narcissism. Unfortunately, the FFNI and its short form (FFNI-SF) may be too long to use in certain research protocols. To make the FFNI-SF even briefer while maintaining its structure and breadth, the FFNI-SF was administered to 2 samples of undergraduate students (N = 1009, N = 432) and 2 samples of adults recruited from Amazon's Mechanical Turk platform (N = 494, N = 591) along with commonly used measures of narcissism, antisocial behavior, and other related constructs. Fifteen items (one per FFNI subscale) were selected to constitute the FFNI “super-short” form (FFNI-SSF). Exploratory factor analyses of the items supported a three-factor (antagonism, agentic extraversion, and neuroticism) solution consistent with its longer parent instrument. Total, presentation (grandiose and vulnerable), and factor (antagonism, agentic extraversion, and neuroticism) scores showed strong associations with other narcissism measures and external criteria related to narcissism, and all of these relations were virtually identical for the SSF compared to the SF. The FFNI-SSF shows promise as a very brief but multifaceted measure of narcissism grounded in an empirically validated model of personality.

This article reported a meta-analysis of the relationships between social network site use and the Big Five (neuroticism, extraversion, openness, agreeableness, and conscientiousness) as well as the Big Two (plasticity and stability) personality meta-traits. A random effect meta-analysis model was used to calculate the meta-results of Big Five. Extraversion and openness were the strongest predictor of SNS activities (e.g. gaming, SNS interaction, etc.), while conscientiousness, neuroticism, and agreeableness only correlated with a few of the SNS activities. A meta-analytical structural equation model further demonstrated that plasticity was positively correlated with SNS activities, whereas stability was a negative predictor. Practical implications for social media industry and users were discussed.

Selfies, or pictures taken of oneself and shared on social media, have become a worldwide phenomenon. In the present research, we examine the relationship between narcissism, both vulnerable and grandiose, and the frequency of and motivations behind selfie-taking. The Dark Triad of personality (narcissism, psychopathy, and Machiavellianism) and self-esteem were also measured. In Study 1, 348 adults on Amazon Mturk completed measures of personality, demographics, and several questions about selfie behavior online. In Study 2, 491 undergraduate students completed the same measures and a subset of these provided access to their Instagram and Iconosquare accounts, which were rated for narcissism by naive judges. Results from both studies indicate that grandiose narcissism is associated with taking and posting more selfies, experiencing more positive affect when taking selfies, and self-reported self-presentation motives. The Dark Triad traits resembled grandiose narcissism. Vulnerable narcissism was associated with negative affect when taking selfies. Self-esteem was unrelated to selfie-taking.

Prior research has separately examined the influence that narcissism and power have on the general concept of overconfidence. In this article we examine the influence of narcissism on overconfidence utilizing three different methods to operationalize the overconfidence construct (Studies 1–4). In addition, we examine the role that power plays in the relationship between narcissism and overconfidence (Studies 2–4). Results indicate that both narcissism and power both individually and collectively exert an influence on overconfidence. Furthermore, when individuals who score relatively high on the Narcissistic Personality Inventory are in an elevated state of power, overconfidence is significantly higher than for individuals in a low state of power. This interaction effect, however, was only evident when high levels of narcissism were overweighted in the analyses, by, for example, oversampling (Study 4). We conclude by discussing implications and avenues for future research.

Recent research concerning sexual harassment has highlighted important individual differences in the tendency to engage in these behaviors. The present studies extend these findings by examining the connections between the Dark Triad of personality traits (i.e., narcissism, psychopathy, and Machiavellianism) and sexual harassment proclivity. Study 1 (N = 642 Israeli community members) revealed that the Dark Triad traits had unique positive associations with sexual harassment tendencies. Similar results emerged for Study 2 (N = 1909 Israeli community members) such that each of the Dark Triad traits had a unique positive association with the proclivity to engage in sexual harassment. In addition, Study 2 revealed differences in the connections that the Dark Triad traits had with perceived likelihood estimates concerning whether targets would be victims or perpetrators of sexual harassment. Discussion focuses on the implications of these results for understanding the links between Dark Triad personality traits and sexual harassment.

Display Omitted A graph database approach employing SNOMED CT as the semantic core of a patient data warehouse.SNOMED CT data queries demonstrating negation and disjunction using a graph database approach.Using multiple controlled medical terminologies without external terminology services. ObjectiveSNOMED CT is the international lingua franca of terminologies for human health. Based in Description Logics (DL), the terminology enables data queries that incorporate inferences between data elements, as well as, those relationships that are explicitly stated. However, the ontologic and polyhierarchical nature of the SNOMED CT concept model make it difficult to implement in its entirety within electronic health record systems that largely employ object oriented or relational database architectures. The result is a reduction of data richness, limitations of query capability and increased systems overhead. The hypothesis of this research was that a graph database (graph DB) architecture using SNOMED CT as the basis for the data model and subsequently modeling patient data upon the semantic core of SNOMED CT could exploit the full value of the terminology to enrich and support advanced data querying capability of patient data sets. MethodsThe hypothesis was tested by instantiating a graph DB with the fully classified SNOMED CT concept model. The graph DB instance was tested for integrity by calculating the transitive closure table for the SNOMED CT hierarchy and comparing the results with transitive closure tables created using current, validated methods. The graph DB was then populated with 461,171 anonymized patient record fragments and over 2.1 million associated SNOMED CT clinical findings. Queries, including concept negation and disjunction, were then run against the graph database and an enterprise Oracle relational database (RDBMS) of the same patient data sets. The graph DB was then populated with laboratory data encoded using LOINC, as well as, medication data encoded with RxNorm and complex queries performed using LOINC, RxNorm and SNOMED CT to identify uniquely described patient populations. ResultsA graph database instance was successfully created for two international releases of SNOMED CT and two US SNOMED CT editions. Transitive closure tables and descriptive statistics generated using the graph database were identical to those using validated methods. Patient queries produced identical patient count results to the Oracle RDBMS with comparable times. Database queries involving defining attributes of SNOMED CT concepts were possible with the graph DB. The same queries could not be directly performed with the Oracle RDBMS representation of the patient data and required the creation and use of external terminology services. Further, queries of undefined depth were successful in identifying unknown relationships between patient cohorts. ConclusionThe results of this study supported the hypothesis that a patient database built upon and around the semantic model of SNOMED CT was possible. The model supported queries that leveraged all aspects of the SNOMED CT logical model to produce clinically relevant query results. Logical disjunction and negation queries were possible using the data model, as well as, queries that extended beyond the structural IS_A hierarchy of SNOMED CT to include queries that employed defining attribute-values of SNOMED CT concepts as search parameters. As medical terminologies, such as SNOMED CT, continue to expand, they will become more complex and model consistency will be more difficult to assure. Simultaneously, consumers of data will increasingly demand improvements to query functionality to accommodate additional granularity of clinical concepts without sacrificing speed. This new line of research provides an alternative approach to instantiating and querying patient data represented using advanced computable clinical terminologies.

An understudied area of personality psychology is how personality traits might facilitate structuring of one’s environment toward goals like mating. In four studies ( N = 1325), we examined (1) self-reports of where individuals go to find long-term and short-term mates, (2) how personality traits are associated with the use of these locations, and (3) how the sexes differ in their selection of mate search locations. Men were more likely than women were to use short-term (e.g., bars) than long-term (e.g., community events) niches, but did not differ in success in those niches and agreed on the nature of those niches. Slow life history traits, conscientiousness and agreeableness, were linked to preferences for long-term niches whereas, fast life history traits, narcissism and dishonesty, were linked to preferences for short-term mating niches.

The present study examined the characteristics of individuals ( N = 104 undergraduate couples) who date grandiosely or vulnerably narcissistic individuals, including the experience of developmental trauma, general and pathological personality traits, and psychopathology, using multiple data sources. In addition, relationship duration was tested as a moderator of the relations between the narcissism dimensions and relationship adjustment. Actor–Partner Interdependence Models indicated that negative relationship adjustment was found when both partners had higher entitlement/exploitativeness traits and had been together for a longer period of time. Overall, there were no clear patterns of partner characteristics, although some evidence for homophily emerged for traits related to grandiose narcissism.

This study investigated the diagnostic accuracy of whole slide imaging (WSI) in breast needle biopsy diagnosis in comparison with standard light microscopy (LM). The study examined the effects of image capture magnification and computer monitor quality on diagnostic concordance of WSI and LM. Four pathologists rendered diagnoses using WSI to examine 85 breast biopsies (92 parts; 786 slides) consisting of benign and malignant cases. Each WSI case was evaluated using images captured at either ×20 or ×40 magnifications and viewed using a Digital Imaging and Communication in Medicine (DICOM) grade, color-calibrated monitor or a standard, desktop liquid-crystal display (LCD) monitor. For each combination, the WSI result was compared with the original, LM diagnosis. The overall concordance rate observed between WSI and LM was 97.1% (95% confidence intervals [CI]: 94.3%-98.5%). After a washout period, all cases were reviewed a second time by each pathologist after using LM, and the second LM diagnosis was compared with the WSI diagnosis rendered by the same pathologist. Intraobserver concordance between WSI and LM was 95.4% (95% CI: 92.2%-97.4%). The second LM diagnoses were also compared with the original LM diagnoses, and the observed interobserver LM concordance rate was 97.3% (95% CI: 93.1%-99.0%). The study data demonstrated that breast needle biopsy diagnoses rendered by WSI were equivalent to diagnoses rendered by LM. No diagnostic differences were detected between the underlying viewing system parameters of monitor quality and image capture resolution. The results of this study demonstrated that WSI can be effectively used in subspecialty diagnostic cases where a minimum amount of tissue is available.

We examined trends over time in vocabulary, a key component of verbal intelligence, in the nationally representative General Social Survey of U.S. adults (n = 29,912). Participants answered multiple-choice questions about the definitions of 10 specific words. When controlled for educational attainment, the vocabulary of the average U.S. adult declined between the mid-1970s and the 2010s. Vocabulary declined across all levels of educational attainment (less than high school, high school or 2-year college graduate, bachelor's or graduate degree), with the largest declines among those with a bachelor's or graduate degree. Hierarchical linear modeling analyses separating the effects of age, time period, and cohort suggest that the decline is primarily a time period effect. Increasing educational attainment has apparently not improved verbal ability among Americans. Instead, as educational attainment has increased, those at each educational level are less verbally skilled even though the vocabulary skills of the whole population are unchanged.

The use of high-resolution digital images of histopathology slides as a routine diagnostic tool for surgical pathology was investigated. The study purpose was to determine the diagnostic concordance between pathologic interpretations using whole-slide imaging and standard light microscopy. Two hundred fifty-one consecutive surgical pathology cases (312 parts, 1085 slides) from a single pathology service were included in the study after cases had been signed out and reports generated. A broad array of diagnostic challenges and tissue sources were represented, including 52 neoplastic cases. All cases were digitized at ×20 and presented to 2 pathologists for diagnosis using whole-slide imaging as the sole diagnostic tool. Diagnoses rendered by the whole-slide imaging pathologists were compared with the original light microscopy diagnoses. Overall concordance between whole-slide imaging and light microscopy as determined by a third pathologist and jury panel was 96.5% (95% confidence interval, 94.8%-98.3%). Concordance between whole-slide imaging pathologists was 97.7% (95% confidence interval, 94.7%-99.2%). Five cases were discordant between the whole-slide imaging diagnosis and the original light microscopy diagnosis, of which 2 were clinically significant. Discordance resulted from interpretive criteria or diagnostic error. The whole-slide imaging modality did not contribute to diagnostic differences. Problems encountered by the whole-slide imaging pathologists primarily involved the inability to clearly visualize nuclear detail or microscopic organisms. Technical difficulties associated with image scanning required at least 1 slide be rescanned in 13% of the cases. Technical and operational issues associated with whole-slide imaging scanning devices used in this study were found to be the most significant obstacle to the use of whole-slide imaging in general surgical pathology.

Millions of people use social networking sites (SNSs), but it is unclear how these sites shape personality traits and identity. In Experiment 1, college students were randomly assigned to either edit their MySpace page or complete a control task online (interacting with Google Maps). Those who focused on their MySpace page scored significantly higher on the Narcissistic Personality Inventory (NPI) than a control group. In Experiment 2, those who focused on their Facebook page scored significantly higher in general self-esteem, but not narcissism, than a control group. Thus, spending time on SNSs profiles causes young people to endorse more positive self-views, although the specific form this takes depends on the site. Consistent with previous research, narcissism was associated with a larger number of SNSs ''friends'' in both experiments.

A growing empirical literature documents the existence of two distinct dimensions of narcissism, grandiose and vulnerable. In order to better understand the nature of these dimensions, we examined them in the context of the interpersonal circumplex (IPC). Using a sample collected on-line ( N = 277), we examined the relations between these two narcissism dimensions – generated as a result of an exploratory factor analysis of 15 narcissism and narcissism-related scales – and two measures of the IPC. GN was most strongly linked with high agency and low communion. Conversely, vulnerable narcissism was most strongly linked with low communion. The data also suggest that the assessment of IPC can substantially influence the pattern of findings for vulnerable narcissism.

Rosenthal and Hooley (2010) suggested that the Narcissistic Personality Inventory (NPI) includes items that are tangential to narcissism. They demonstrated that the removal of these items resulted in scores that are not confounded by self-esteem. We tested whether NPI scales derived from Rosenthal and Hooley’s included (NPI-N) and excluded (NPI-X) items manifest divergent relations with self-esteem, entitlement, distress, NPD, and general traits in two samples of undergraduates. The scales generated similar patterns of correlations, although the NPI-N items were more strongly related to (dis)Agreeableness, whereas the NPI-X items were more strongly related to Extraversion. Ultimately, the NPI-X items bore significant relations to constructs central to grandiose narcissism and do not seem to have caused problems in the assessment of narcissism.

Two studies examined how narcissism, a personality trait marked by self-promotion, vanity, and grandiosity, related to how people communicate information about themselves online. We predicted that narcissists communicate in ways that draw attention to themselves. Specifically, we predicted that narcissistic people who used relatively few first-person singular pronouns (e.g., ‘‘I,’’ and ‘‘me’’) would display more self-promoting and sexy images of themselves on their Facebook.com profile pages (Study 1) and would use more profane and aggressive words in an online self-descriptive task (Study 2). Both studies supported this hypothesis. Implications for narcissism and online communication research are discussed.

Environmental impact alters assemblages by increasing species relatedness, thus reducing phylogenetic and functional diversity. We assessed whether different controlled grazing regimes influenced the recovery of plant phylogenetic diversity (Average Taxonomic Distinctness, ATD) and functional diversity based on plant growth habit (GH) and life cycle duration (LCD) [Shannon-Weiner Index (H’), −ln(Simpson's Index, D)] in pastures from previously unmanaged and highly overgrazed conditions. Plant presence/absence data were collected during August 2006 from a high altitude cold salt desert in south-western Utah, where controlled grazing has been maintained for over 70 years to study range restoration. Winter-spring and spring grazed pastures were examined at four grazing levels: ungrazed, light, medium, and heavy, with each level differing in the number of animal use days per hectare relative to available forage biomass. For winter-spring, animal use days were divided equally between the two seasons. Winter-spring grazing promoted recovery of plant phylogenetic and functional diversity compared to spring grazing as reflected by the consistently higher values of ATD, and the stability of species composition within each ecological trait and their similarity to values for ungrazed pastures. Spring grazing was detrimental to recovery efforts and resulted in the reduction of palatable non-grass species, ATD, and functional diversity with increased grazing intensity. Many significant positive correlations between phylogenetic and functional diversity indices existed during spring, but not winter-spring grazing. While H’(GH) was uncorrelated with ATD during winter-spring, it was positively correlated in spring, suggesting species in the plant community (based on growth habit) during spring were randomly assembled without influence from local species interactions, and that different growth habits are conserved within lineages so that communities randomly assembled from more lineages will have a greater diversity of growth habits than communities assembled from fewer lineages. H’(LCD) was negatively correlated with ATD during winter-spring, suggesting local species interactions naturally influence assemblage composition regarding life cycle duration. As such, species within the same lineage likely interact (compete) more for scarce resources because they share similar life cycle durations, thus leading to greater trait variation in communities with fewer lineages than in those with many lineages. Yet, this correlation was positive during spring, suggesting an overriding effect from grazing rather than local species interactions. Hence, sheep grazing at the DER appears to be a season-dependent driver of plant phylogenetic and functional diversity, and the correlations between them. We recommend Average Taxonomic Distinctness and functional diversity based on growth habit and life cycle duration be considered as significant developments in the construction of practical rapid assessment tools for biomonitoring and feedback regarding grazing impacts in similar ecosystems.

Previous studies have shown that extended length Earth-oriented tethers in the geosynchronous (GEO) region can be used to re-orbit satellites to disposal orbits. One such approach involves the extension of a GEO based tether, collection of a debris object, and retraction of the tether, which transfers the retracted configuration to a higher energy orbit for debris disposal. The re-extension of the tether after debris disposal returns the configuration to the near-GEO altitude. The practical feasibility of such a system depends on the ability to collect GEO debris objects, attach them to a deployed tether system, and retract the tethers for transfer to the disposal orbits. This study addresses the collection and delivery of debris objects to the deployed tether system in GEO. The investigation considers the number, type and the characteristics of the debris objects as well as the collection tug that can be ground controlled to detect, rendezvous and dock with the debris objects for their delivery to the tethers system. A total of more than 400 objects are in drift orbits crossing all longitudes either below or above the geostationary radius. More than 130 objects are also known to librate around the stable points in GEO with periods of libration up to five or more years. A characterization of the position and velocity of the debris objects relative to the collection tug is investigated. Typical rendezvous performance requirements for uncooperative GEO satellites are examined, and the similarities with other approaches such as the ESA's CX-OLEV commercial mission proposal to extend the life of geostationary telecommunication satellites are noted.

Two studies were conducted to test and explain the relation of mindfulness to the severity of gambling outcomes among frequent gamblers. In both studies, dispositional mindfulness related to less severe gambling outcomes as measured by a DSM-IV-based screen for pathological gambling, even after controlling for gambling frequency and dispositional self-control. Study 2 extended this finding in showing that the association between mindfulness and lower pathological gambling was partially mediated by better performance on two risk-taking tasks that capture overconfidence, risky bet acceptance, and myopic focus on reward. These studies suggest a role for mindfulness in lessening the severity of gambling problems and making adaptive decisions, especially in risk-relevant contexts.

Narcissism is typically viewed as a dimensional construct in social psychology. Direct evidence supporting this position is lacking, however, and recent research suggests that clinical measures of narcissism exhibit categorical properties. It is therefore unclear whether social psychological researchers should conceptualize narcissism as a category or continuum. To help remedy this, the latent structure of narcissism—measured by the Narcissistic Personality Inventory (NPI)—was examined using 3895 participants and three taxometric procedures. Results suggest that NPI scores are distributed dimensionally. There is no apparent shift from ‘‘normal’’ to ‘‘narcissist’’ observed across the NPI continuum. This is consistent with the prevailing view of narcissism in social psychology and suggests that narcissism is structured similar to other aspects of general personality. This also suggests a difference in how narcissism is structured in clinical versus social psychology (134 words). 2007 Elsevier Ltd. All rights reserved.

The purpose of this study was to examine the relationship between narcissism and romantic attraction in a collectivistic culture (i.e., Thailand). In Study 1, participants completed a measure of narcissism and rated their attraction to four potential romantic partners. There was an overall preference across participants for caring targets. Additionally, high narcissists were more attracted to admiring and high status targets than were low narcissists. A similar pattern of results was found in Study 2 with targets that were either high caring/low status or high status/low caring. Overall, caring in a partner was highly valued in a collectivistic culture, but narcissism still predicted attraction to targets who offered the potential for self-enhancement. These findings suggest that classically Western self-enhancement can be found in Eastern samples; however, to uncover these self-enhancement processes, researchers might need to use a personality variable such as narcissism.

This study examined the construct validity of narcissistic personality disorder (NPD) by examining the relations between NPD and measures of psychologic distress and functional impairment both concurrently and prospectively across 2 samples. In particular, the goal was to address whether NPD typically "meets" criterion C of the DSM-IV definition of Personality Disorder, which requires that the symptoms lead to clinically significant distress or impairment in functioning. Sample 1 (n = 152) was composed of individuals receiving psychiatric treatment, whereas sample 2 (n = 151) was composed of both psychiatric patients (46%) and individuals from the community. Narcissistic personality disorder was linked to ratings of depression, anxiety, and several measures of impairment both concurrently and at 6-month follow-up. However, the relations between NPD and psychologic distress were (a) small, especially in concurrent measurements, and (b) largely mediated by impaired functioning. Narcissistic personality disorder was most strongly related to causing pain and suffering to others, and this relationship was significant even when other Cluster B personality disorders were controlled. These findings suggest that NPD is a maladaptive personality style which primarily causes dysfunction and distress in interpersonal domains. The behavior of narcissistic individuals ultimately leads to problems and distress for the narcissistic individuals and for those with whom they interact.

Background It is traditionally taught that a pneumatic tourniquet is contraindicated for trans-tibial amputations in patients with peripheral arterial disease. However, tourniquets are used successfully during total knee arthroplasty in elderly patients. Vascular patients undergoing a trans-tibial amputation have a high perioperative mortality and morbidity—notably the need for wound revision or a higher amputation level. We hypothesised that a tourniquet, used during amputation, would reduce blood loss and subsequent complications without compromising healing. Methods This was a prospective non-randomized study of 89 adult patients who underwent a trans-tibial amputation between January 2001 and December 2003. The endpoints were: haemoglobin levels, the need for blood transfusion, perioperative morbidity, revision rate and mortality. Patients were divided into two groups: a group with a pneumatic tourniquet ( n =42) and a group without ( n =47). Results The haemoglobin fall was 14.8% in the non-tourniquet group and 5.6% in the tourniquet group, with a higher need for transfusion in the non-tourniquet group. The revision rate was 14.3% in the tourniquet group and significantly higher in the non-tourniquet group (38.3%). Mortality was similar in both groups: 7.1% for the tourniquet and 6.4% for the non-tourniquet group. Conclusion The use of a pneumatic tourniquet is safe and significantly reduces both blood loss and transfusion requirements during trans-tibial amputation. A pneumatic tourniquet reduces revision rates by over 50%, with subsequent cost savings.

Objective. To assess the accuracy of hand held Doppler (HHD) as a rapid screening test for selecting varicose vein patients for duplex imaging. Design. Prospective single blind study of consecutive patients in a randomised trial. Materials. Use of hand held Doppler and duplex ultrasound scanners. Methods. One thousand two hundred and eighteen legs (943 patients) were examined by HHD and then duplex. HHD examiners recorded whether they would normally have requested duplex. Results. HHD results of one Clinical Assistant (166 limbs) were significantly poorer than all others and his results were excluded from analysis. Duplex would not have been requested in 645 of 1052 (62%) limbs. Among these HHD missed significant reflux in the long saphenous vein in 18 (3%) and the short saphenous in 25 (4%). Reasons for requesting duplex were popliteal fossa reflux (202); recurrent (94) or atypical (86) varicose veins; and possible previous thrombosis (67). Differences were observed between staff and units in requests for duplex; and in thoroughness and style of duplex reporting. Conclusions. Selective use of HHD can avoid duplex imaging for many patients, with a low failure rate for detecting correctable venous reflux. Observed variations between individuals and units in results of HHD and duplex imaging have implications for the increasing use of duplex by clinicians.

It was hypothesized that narcissism would be associated with resistance to doubts concerning the commitment of romantic partners. Furthermore, this resistance might buffer against relationship dysfunction that sometimes follows such doubts. In support of our predictions, narcissism was associated with greater reported difficulty completing a task that involved listing reasons why current romantic partners might be less committed. Following the task, narcissism was associated with less relationship dysfunction, defined as lack of commitment, desire to accept an extra-partner dating invitation, and the desire to adopt a more game-playing (ludus) love style. The opposite pattern emerged in a second condition where participants were asked to list reasons why their current romantic partners might be more committed (i.e., narcissism associated with less difficulty and higher relationship dysfunction). Though narcissism is generally associated with lower relationship functioning, the present results illuminate a situation where narcissism may be beneficial particularly in the short-term.

It has been consistently observed that people are generally overconfident when assessing their performance. In the current study, participants completed Goldberg's Big Five personality inventory and then completed a cognitive task designed to assess overconfidence (defined as the difference between confidence and accuracy). Extraversion significantly predicted overconfidence (with the other Big Five factors controlled statistically). In addition, openness/intellectance significantly predicted confidence and accuracy but not overconfidence (again, with the other Big Five factors controlled statistically). Theoretical implications and implications for future research are discussed.

Objective. The outcome of short saphenous vein surgery is often unsatisfactory and the high litigation rate reflects this. The aim of this study was to explore the current management of short saphenous varicose veins in Great Britain and Ireland.Methods. This was a postal questionnaire survey of the surgical members of the Vascular Surgical Society of Great Britain and Ireland. Of 532 questionnaires 379 were returned (71.2%).Results. There was diversity of opinion about the management of short saphenous veins. Eighty nine per cent of surgeons requested duplex imaging for all patients and over 50% arranged additional duplex marking of the saphenopopliteal junction preoperatively. Only 10.4% formally exposed and identified the popliteal vein during saphenopopliteal ligation, the majority (75.7%) dissected down the short saphenous vein to visualise the junction. The short saphenous vein was stripped routinely by 14.5% of surgeons, the majority preferring to excise a proximal segment of up to 10 cm (55.1%). Compared with long saphenous vein surgery, surgeons were generally more likely to warn patients of nerve damage but equally likely to warn of deep vein thrombosis. A small number of surgeons failed to warn patients of these complications.Conclusion. The variation in management of short saphenous veins may be explained by the lack of definitive clinical trials in this area.

The present investigation examined associations among narcissism, age, ethnicity, world region, and gender, using a large ( n =3445) sample of participants representing several different world regions and ethnicities. The results suggest that (1) reported narcissism declines in older participants, (2) consistent with previous findings, males report being more narcissistic than females, (3) that ethnic differences in reported narcissism are generally comparable to those found in the self-esteem literature, and (4) that world region appears to exert influence on narcissism, with participants from more individualistic societies reporting more narcissism. The results are discussed in terms of how age and culture might impact narcissism and how future research might address this topic.

Super-dwarf wheat grown on the Mir space station using the Svet "Greenhouse" exhibited morphological, metabolic and reproductive abnormalities compared with Earth-grown wheat. Of prominent importance were the abnormalities associated with reproductive ontogeny and the total absence of seed formation on Mir. Changes in the apical meristem associated with transition from the vegetative phase to floral initiation and development of the reproductive spike were all typical of 'Super-Dwarf' wheat up to the point of anthesis. Observation of ruptured anthers from the Mir-grown plants revealed what appeared to be normally developed pollen. These pollen gains, however, contained only one nuclei, while normal viable pollen is tri-nucleate. A potentially important difference in the flight experiment, compared with ground reference studies, was the presence of a high level of atmospheric ethylene (1,200 ppb). Ground studies conducted by exposing 'Super-Dwarf' wheat to ethylene just prior to anthesis resulted in manifestation of the same abnormalities observed in the space flight samples. c2002 Published by Elsevier Science Ltd on behalf of COSPAR.

The purpose of this study was to determine whether pre-exercise ingestion of meals with moderate and high glycemic indexes (GI) affects glucose availability during exercise and exercise performance time. Six male volunteers (22 +/- 1 years; 80.4 +/- 3.7 kg; VO(2peak), 54.3 +/- 1.2 ml. kg(-1). min(-1)) ingested 75 g of carbohydrate in the form of 2 different breakfast cereals, rolled oats (moderate GI, approximately 61; MOD-GI) or puffed rice (high GI, approximately 82; HI-GI), combined with 300 mL of water; or water alone (control). The trials were randomized, and the meals were ingested 45 minutes before the subjects performed cycling exercise (60% VO(2peak)) to exhaustion. Venous blood samples were drawn to measure glucose, free fatty acids (FFAs), glycerol, insulin (INS), epinephrine (EPI) and norepinephrine (NE) concentrations. A muscle biopsy specimen was obtained from the vastus lateralis before the meal and immediately after exercise for glycogen determination. Before exercise, both test meals elicited significant (P

Advances in modeling and control will be required to meet future technical challenges in microelectronics manufacturing. The implementation of closed-loop control on key unit operations has been limited due to a dearth of suitable in situ measurements, variations in process equipment and wafer properties, limited process understanding, non-automated operational practices, and lack of trained personnel. This paper reviews the state-of-the-art for process control in semiconductor processing, and covers the key unit operations of lithography, plasma etching, thin film deposition, rapid thermal processing, and chemical-mechanical planarization. The relationship of process (equipment) models to control strategies is elaborated because recently there has been a considerable level of activity in model development in industry and academia. A proposed control framework for integrating factory control and equipment scheduling, supervisory control, feedback control, statistical process control, and fault detection/diagnosis in microelectronics manufacturing is presented and discussed.

Two experiments examined narcissism and comparative self-enhancement strategies. Participants either completed an interdependent (Experiment 1) or an independent (Experiment 2) achievement task and then received bogus success or failure feedback. Across experiments, narcissistic individuals self-enhanced. Nonnarcissists, however, showed more flexibility in self-enhancement. They did not self-enhance when doing so meant comparing themselves favorably to a partner (a comparative strategy). Otherwise, they did self-enhance, particularly when estimating the importance of the task (a noncomparative strategy). These findings are discussed from a narcissistic self-enhancement perspective and a strategic flexibility perspective.

Objectives: to identify and describe patients with advanced limb ischaemia who were selected for palliative care, rather than surgical intervention. Design: case-note review of patients identified from a prospective register. Materials and methods: thirty patients (22 female; median age 87 years) were identified during 1993–1998, for whom a clearly documented decision was made for palliative care, rather than major amputation or possible revascularisation.Results: two-thirds of the patients had limiting cardiac problems, two-thirds were immobile, and 47% had suffered a stroke. Half had three or more important co-morbidities. Twelve (40%) had unsalvageable acute ischaemia. There were clear records of the decision about non-intervention being made by a consultant in 87%; being discussed with the patient in 43%; and with known relatives in 90%. Survival after this decision ranged from

Objective: To evaluate our accuracy in predicting the use of prostheses by patients undergoing major lower limb amputation. Design: Prospective study, with multiple assessors, “blind” to the predictions made by each other. Materials: Sixty-one patients (35 male: age 51–91, median 79) having their first major lower limb amputation. Methods: Five members of the rehabilitation team (surgeon, specialist in prosthetics, nurse, physiotherapist and occupational therapist) each recorded predictions of prosthetic use and mobility before amputation and during the first 2 weeks thereafter. Patients were followed up 6–24 months later. Results: At follow-up 17 patients had died. Of the remaining 44 (25 below-knee and 19 above-knee amputees), 23 of 27 (85%) who had been predicted as using prostheses were doing so, while only 11 of 17 (65%) had been correctly predicted as non-users. Nevertheless, only two of the patients not using prostheses contrary to prediction had ever had prostheses made for them, and both had developed problems with the other leg at a later date. Different members of the rehabilitation team were similar in their ability to predict outcome. Conclusions: Inappropriate fitting of prostheses can be kept to a minimum by a team approach to rehabilitation, but amputees may defy careful prediction by the development of new medical problems.

Intestinal transplantation for treatment of irreversible intestinal failure is the newest of the transplantation operations to be developed for clinical use. Because the bowel is more vulnerable to rejection than heart, lung, kidney, liver, or pancreas, practical clinical intestinal transplantation has been relatively slow to develop and is still in its infancy. Imaging studies play an important role in the initial evaluation of the residual native gastrointestinal tract for patients who are potential candidates for enteric implant. After transplantation, gastrointestinal contrast studies help monitor the recovery of gastrointestinal function and permit early detection of postoperative technical complications. CT, ultrasound, and angiography are useful for diagnosis and in some cases treatment of a variety of posttransplantation complications.

The literature on narcissism in organizational contexts is reviewed. We begin by describing the context of narcissism and several relevant theoretical approaches to understanding it. We next describe research on narcissism in a range of organizational topics, from leadership to meta-organizational issues. We conclude by highlighting several reoccurring themes involving the role of narcissism in organizational contexts, with an emphasis on articulating directions for future research.

A subset of the published research on mood-congruent memory in normal nondepressed, subclinically depressed, clinically depressed, induced depressed, and induced elated persons is examined with meta-analytic techniques. We estimated the magnitude of mood-congruent recall for these mood states, examined their robustness, and studied within each mood state the extent to which the strength of mood-congruent recall was related to self-referenced encoding and mood intensity. Asymmetric recall favoring positive stimuli appears to be part of the normative pattern of memory performance among individuals that have been labeled normal nondepressed (dh = .15; p .20). Clinically depressed, induced depressed, and induced elated subjects display mood congruent recall (dh, = − .19; p < .05; dh = − .12, p < .05; dh = .08; p < .10). With the exception of induced elated mood, effect estimates derived from different studies are robust in that sampling error accounts for the entire variability among effect estimates obtained from different studies. In studies on induced-elated mood, self-referent processing was associated with stronger mood-congruent recall as compared to other studies. Caveats and implications for future research on mood and memory are discussed.

This study examined the necessity for an intensive care environment after abdominal aortic surgery. The detailed records of 45 consecutive patients were reviewed for the first 48 h after operation, recording the occurrence and numbers of episodes of defined medical events or prescription of non-routine drugs. Medical events were hypertension (greater than 200 mmHg), hypotension (less than 100 mmHg), obliguria (less than 20 ml/h) and pulmonary problems. Thirty-six patients (80%) had medical events (hypertension 20, hypotension 17, oliguria 31, hypoxia 10, chest complications 12), and 38 (84%) had medical interventions. Only two had no events or interventions. Twenty-seven (59%) had more than one episode of a medical event which would not have been predicated from their preoperative state. There were three deaths (mortality 6.7%). These results support the case for intensive monitoring and immediate access to experienced medical advice for these patients. In hospitals where the intensive care unit is the best place to provide these facilities, elective operation may need to be deferred if an intensive care bed is not available.

Study objectives: Patients presenting to the emergency department with chest discomfort are a difficult problem for emergency physicians. Nearly 50% of patients with acute myocardial infarction (AMI) will initially have nondiagnostic ECGs on ED presentation. The purpose of this study was to determine if patients with AMI having nondiagnostic ECGs could be identified using new immunochemical assays for serial CK-MB sampling in the ED. Design: Chest pain patients, more than 30 years old, with pain not caused by trauma or explained by radiographic findings, were eligible for the study. Serial serum samples were drawn on ED presentation (zero hours) and three hours after presentation, then analyzed for CK-MB using four immunochemical methods and electrophoresis. Standard World Health Organization criteria were used to establish the diagnosis of AMI, including new Q-wave formation or elevation of standard in-hospital serum cardiac enzyme markers. Setting: A tertiary cardiac care community hospital. Measurements and main results: The serum from 183 patients hospitalized for possible ischemic chest pain was collected and analyzed. Thirty-one of 183 patients (17%) were found to have AMI by standard in-hospital criteria. Sixteen of the 31 patients (52%) with AMI had nondiagnostic ECGs on presentation. Immunochemical determination of serial CK-MB levels provided a sensitive and specific method for detecting AMI in patients within three hours after ED presentation compared with standard electrophoresis. The four immunochemical methods demonstrated a range in sensitivity from 50% to 62.1% on ED presentation versus 92% to 96.7% three hours later. The immunochemical tests demonstrated specificities ranging from 83.0% to 96.4% at three hours, with three of the four tests having specificities of 92% or greater. Electrophoresis had a sensitivity of 34.5% on ED presentation, increasing to 76.9% at three hours, with a specificity of 98.6%. Conclusions: Immunochemical CK-MB methods allowed rapid, sensitive detection of AMI in the ED. Early detection of AMI offers many potential advantages to the emergency physician. Early detection of AMI, while the patient is in the ED, could direct disposition of this potentially unstable patient to an intensive care setting. Such information may prevent the ED discharge of patients with AMI having nondiagnostic ECGs. The diagnosis of AMI within a six-hour period after symptom onset may allow thrombolytic therapy to be given to patients with AMI not having diagnostic ECGs. This study served as a pilot trial for a multicenter study of the Emergency Medicine Cardiac Research Group, which is currently ongoing.

Back-propagation has been used to train a small network for the prediction of syllable-level duration in a text-to-speech system. Both input and output are in the form of analog values, and the net performs a multiple regression function.

Entrapment of the popliteal artery is an uncommon congenital anomaly that usually affects young men (aged 30 to 40 years) as the most common of several unusual entities that can cause intermittent claudication in young adults. It has been classified by the causes of compression of the artery which include congenital abnormalities of muscle insertion and acquired hypertrophy of surrounding structures. 1 Operation is normally advised because of the risk of embolisation from mural thromus on an intimal lesion in the compressed segment or from the wall of a post stenotic aneurysm. We present an unusual case with all the features of popliteal entrapment syndrome but with spontaneous resolution. film (Fig. 1) and corresponding distortion on lateral views both in flexion and extension of the knee (Figs 2 and 3). A diagnosis of popliteal entrapment was made and the patient was admitted 6 weeks later for surgery. On admission he reported that his symptoms had disappeared completely. Foot pulses were easily palpable and repeat Doppler pressures before and after exercise were normal. Duplex scanning was performed as a non-invasive alternative to arteriography and the appearances of the popliteal artery were normal with a normal pattern of flow. The patient was reviewed 12 months later and still

Objectives There is no evidence about patient preferences for treatment of abdominal aortic aneurysms (AAA) by endovascular aneurysm repair (EVAR) or open surgical repair (OSR). This study examined patient preferences for elective future aneurysm repair and factors that may influence such preferences. Methods Patients with small AAAs under ultrasound scan surveillance at two United Kingdom (UK) hospitals participated in a semi-structured telephone interview. Features of the two techniques were assessed with regard to their influence on the preferences of participants for EVAR or OSR, using a Likert scale. In addition, participants ranked the relative importance of 14 features against each other. Results Fifty-six out of 100 eligible participants (56%) completed the semi-structured telephone interview. Of those, 84% (47 patients) said they would prefer a future EVAR repair. Patients who expressed a preference for OSR were significantly younger. Risks of major organ failure and death were most commonly judged as important features in influencing patient preference (Likert scale score 5/5). Risk of death was also most frequently ranked above all other features. Postoperative morbidity and mortality were regarded by patients as more important than the need for surveillance and risk of long-term problems with EVAR. Type of incision and radiation exposure were both given low Likert scale scores of 1/5, and the risk of sexual dysfunction was most frequently ranked as the least important feature of either operation, out of 14 other features. Conclusion When presented with detailed information about EVAR and OSR, most patients with small aneurysms would prefer EVAR.

Congenital lymphedema occurs with intestinal lymangiectasia in several syndromes, including those described by Turner, Noonan, and Hennekam. We report a 16 year-old Filipino female with an unusual presentation of congenital lymphedema. She has had persistent right facial puffiness since birth. She later developed hypopigmented patches and increased circumference of her right extremities. Liver transaminases became persistently elevated at age 15 years. Laboratory evaluation for infectious and other causes of her hepatitis was negative. Past medical history was otherwise unremarkable. Family history was significant for a maternal aunt with hypopigmented patches and several relatives with premature graying. No relatives had lymphedema, autoimmune disorders, or liver disease. Physical examination revealed right facial fullness and scattered coarse, white scalp hairs but no dysmorphic features. Pretibial pitting edema was present on the right, with mild pitting and ridging of the nails. Right upper and lower extremity circumferences were increased compared to the left, with no limb length discrepancy. Multiple ½ to 1-cm areas of hypopigmentation were noted on the extremities. Radiographs of the extremities showed increased reticulation in the subcutaneous fat on the right. Magnetic resonance imaging revealed right-sided asymmetry of subcutaneous fat. Liver biopsy demonstrated chronic, nonspecific inflammation. Duodenal biopsy showed lamina propria lymphangiectasia. This patient's condition seemed unique in that she had lymphedema of her entire right side, with the left side clinically and radiographically spared. We postulate that a developmental field defect of the embryonic mesenteric lymph sac and the right thoracic duct and lymph sacs accounts for both her unilateral congenital lymphedema and her intestinal lymphangiectasia. The constellation of findings in this patient, lymphedema, intestinal lymphangiectasia, elevated liver transaminases, patchy hypopigmentation, and coarse, white scalp hairs, has not been described in the English-language literature and may represent a new syndrome.