Clinician Diagnostic Ratings and Countertransference Reactions Towards Grandiose and Vulnerable Narcissism

Background Narcissistic personality disorder (NPD) is known to comprise two distinct but connected phenotypes related to ‘grandiosity’ and ‘vulnerability’, respectively. While evidence suggests differing countertransference responses to narcissism subtype expression, no study has examined this using a qualitative methodology and explored associations with ratings of personality disorder severity. Method Mental health clinicians (N = 180, 67% female, age = 38.9), completed qualitative clinical reflections and ratings of overall personality disorder severity towards two hypothetical vignettes displaying pathological narcissism (‘grandiose’ and ‘vulnerable’ narcissism respectively), as well as a rating of attitudes towards patients in their routine practice who resemble these vignettes. Results Distinct qualitative themes were identified between narcissistic subtype, with grandiose narcissism evoking anger, lack of empathy and hopelessness, compared to sympathy, sadness and discomfort in vulnerable narcissism. In terms of diagnostic category, the grandiose vignette was predominately identified as ‘narcissistic personality disorder’ (97%), whereas the vulnerable vignette was a mixture of ‘depressive disorder’ (29%), ‘narcissistic personality disorder’ (24%), ‘trauma and stressor related disorders’ (21%) and ‘borderline personality disorder’ (21%). Attitude scores differed significantly between subtypes, with more negative attitudes towards narcissistic grandiosity than narcissistic vulnerability. The grandiose vignette was also rated as displaying more overall personality impairment, with an association observed between negative clinician attitude scores and increased ratings of personality disorder severity. Discussion Two potential pathways are outlined to interpret these findings. The first is that inordinate stigma towards narcissistic grandiosity negatively biases clinicians when working with these patients due to feelings of anger and frustration. The second is that clinicians are drawn to minimise pathology of vulnerable patients due to their feelings of sadness and empathy. We propose that effective diagnosis and psychotherapy for pathological narcissism rely on clinicians' ability to balance these two dilemmas and resist either extreme

Coaches, Gurus and Influencers as Self-help and Lifestyle Experts: from Insta therapy to becoming “that girl” on TikTok

The twenty-first century has witnessed the proliferation of coaches, gurus and influencers sharing advice online about how to live. Scrolling on social media users are inundated by gurus sharing tips and secrets about how to improve their lives. This chapter contextualises the rise of lifestyle gurus in the history of self-help, exploring how technological developments have given rise to an industry of lifestyle gurus who offer advice about health, relationships and wealth creation. It examines how the new medium of short video platforms has impacted lifestyle journalism and the industry of self-help by analysing two emergent trends on these platforms: “That Girl” on TikTok and Instagram therapists. “That Girl” is an aspirational ideal and aesthetic that uses the genre of self-help to motivate and encourage self-improvement. Insta therapy offers bite-sized educational content to self-diagnose and treat mental health issues, often shared by self-appointed experts, therapists and healers, who are unregulated and possess limited or no formal certified training. In addition to analysing how short form videos have broadened the genre of self-help and blurred the boundary between influence and expertise, fact and opinion, this chapter explores the consequences of commodifying emotional experience in an attention economy incentivised by engagement

The MSPTDfast photoplethysmography beat detection algorithm: design, benchmarking, and open-source distribution

Objective: Photoplethysmography is widely used for physiological monitoring, whether in clinical devices such as pulse oximeters, or consumer devices such as smartwatches. A key step in the analysis of photoplethysmogram (PPG) signals is detecting heartbeats. The MSPTD algorithm has been found to be one of the most accurate PPG beat detection algorithms, but is less computationally efficient than other algorithms. Therefore, the aim of this study was to develop a more efficient, open-source implementation of the MSPTD algorithm for PPG beat detection, named MSPTDfast (v.2). Approach: Five potential improvements to MSPTD were identified and evaluated on four datasets. MSPTDfast (v.2) was designed by incorpo- rating each improvement which on its own reduced execution time whilst maintaining a high F1-score. After internal validation, MSPTDfast (v.2) was benchmarked against state-of-the-art beat detection algorithms on four additional datasets. Main results: MSPTDfast (v.2) incorporated two key improvements: pre-processing PPG signals to reduce the sampling frequency to 20 Hz; and only calculating scalogram scales corresponding to heart rates >30 bpm. During internal validation MSPTDfast (v.2) was found to have an execution time of between approximately one-third and one-twentieth of MSPTD, and a comparable F1-score. During benchmarking MSPTDfast (v.2) was found to have the highest F1-score alongside MSPTD, and amongst one of the lowest execution times with only MSPTDfast (v.1), qppgfast and MMPD (v.2) achieving shorter execution times. Significance: MSPTDfast (v.2) is an accurate and efficient PPG beat detection algorithm, available in an open-source Matlab toolbox

Impacts of Communication Type and Quality on Patient Safety Incidents

Background: Poor communication in health care increases the risk for patient safety incidents. However, there is no up-to-date synthesis of this data. Purpose: To synthesize studies investigating how poor communication between health care practitioners and patients (and between different groups of practitioners) affects patient safety. Data Sources: Ovid MEDLINE, CINAHL, APA PsycInfo, CENTRAL, Scopus, and the ProQuest Dissertations & Theses Citation Index from 1 January 2013 to 7 February 2024. Study Selection: Studies published in any language that quantified the effects of poor communication on patient safety. Data Extraction: Two independent reviewers extracted data, assessed risk of bias, and appraised strength of evidence. Study heterogeneity precluded meta-analysis, so results were reported with narrative description, reporting medians and IQRs. Data Synthesis: Forty-six eligible studies (67 639 patients) were included. Risk of bias was low for 20, moderate for 16, and high for 10 studies. Four studies investigated whether poor communication was the only identified cause of a patient safety incident; here, poor communication caused 13.2% (IQR, 6.1% to 24.4%) of safety incidents. Forty-two studies investigated whether poor communication contributed to patient safety incidents alongside other causes; here, poor communication contributed to 24.0% (IQR, 12.0% to 46.8%) of safety incidents. Study heterogeneity was high in terms of setting, continent, health care staff, and safety incident type. The strength of the evidence was low or very low. Limitation: There was important study heterogeneity, generally low study quality, and poor reporting of essential data. Conclusion: Poor communication is a major cause of patient safety incidents. Research is needed to develop effective interventions and to learn more about how poor communication leads to patient safety incidents. Primary Funding Source: Stoneygate Trust. NA is funded by the National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC). The views expressed are those of the author(s) and not necessarily those of the funders. (PROSPERO:CRD42024507578

Mitigating Skin and Proximity Effect in High-Voltage Underground Segmented Cables Through Individually Insulating Conductor Strings

High-voltage underground cables inevitably experience frequency-dependent electromagnetic (EM) losses, driven primarily by skin and proximity effects. These losses become more severe at higher harmonic frequencies, which are increasingly common in modern power networks. In traditional multi-segment cable designs, uninsulated conductor bundles enable large circular eddy current loops that elevate AC resistance and exacerbate both skin and proximity phenomena. This paper investigates the impact of introducing a thin insulating layer between individual conductor strings in a five-segment high-voltage cable model. Two insulation thicknesses, 75 µm and 100 µm, are examined via two-dimensional finite element (FE) harmonic analysis at 0, 50, 150, and 250 Hz. By confining eddy currents to smaller loops within each conductor, the insulating layer achieves up to a 60% reduction in AC losses compared to the baseline uninsulated model, lowering the ratio of AC to DC resistance from about 3.66 down to 1.47–1.49 at 250 Hz. The findings confirm that adding even a modest inter-strand insulation is highly effective at mitigating skin and proximity effects, with only marginal additional benefit from thicker insulation. Such designs offer improved energy efficiency and reduced thermal stress in underground cables, making them attractive for modern power distribution systems where harmonic content is pervasive

A Novel Postgraduate Diversity in Medical Education (DiME) Leadership Programme

Background Reduced retention and progression amongst ethnic minority staff is severely disrupting equality, diversity and inclusion (EDI) within healthcare with negative impacts on patient care. There is a lack of diversity in postgraduate leadership roles with systemic issues and insufficient support. To help address these issues at an individual level, we developed the Diversity in Medical Education (DiME) programme that aims to close the gap between ethnic minority individuals and training programme director (TPD) positions. Approach Over 6 months, the programme consisted of a series of learning days on action learning sets and effective meetings, mock interviews with associate deans, networking events, mentoring, access to coaching and subsequently forming a peer network. Participants were recruited from a wide range of primary and secondary care specialties and ethnic minority backgrounds. Evaluation A qualitative evaluation was undertaken. Lessons learned included providing protected time to participate in professional development, facilitating flexibility of opportunities and enhancing understanding and encouragement for individuals to progress as an ethnic minority leader. Interviews revealed programme benefits, barriers and challenges participants faced in reaching leadership positions and suggested recommendations to enhance DiME. Benefits included the development of technical and non‐technical skills, feeling valued and supported, and peer networking. Implications DiME is a novel postgraduate programme to support ethnic minority TPDs in overcoming barriers to leadership positions through building networks and sharing valuable skills. Systemic and institutional barriers impede ethnic minority individuals reaching senior leadership positions, yet this initiative provides a small step through the implementation of an innovative programme

Quantifying the Macroeconomic Impact of Credit Expansions

This paper studies how credit expansions affect economic activity and quantifies the relative role of household and firm-side channels in accounting for the aggregate effects. Using data from the quasi-natural experiment of bank deregulation across U.S. states in the 1980s, we document that deregulation led to an expansion of credit and economic activity. We use this causal evidence to estimate a small open-economy heterogeneous-agent New Keynesian model that replicates the effects of this shock. In the long run, reduced borrowing costs for firms account for the lion’s share of the rise in output and employment. In the short run, the firm-side and household-side channels are equally important in driving the expansion of output and employment. Household demand is mostly associated with consumption whereas the firm side is mostly associated with investment. The finding that employment and production—including tradable output—experiences sustained growth after a credit expansion is consistent with the role we attribute to the firm-side channel

Direct shear box tests on full-scale recycled aggregate used in temporary works

The use of recycled aggregate is widely seen as an option in civil engineering projects to meet carbon offset targets. This material is used for a range of applications (e.g. load distribution platforms, sub-bases, general backfill) and can consist of natural aggregates or recycled components. Therefore, its engineering characteristics can vary widely. It is important to characterise accurately the material properties of the aggregate to guarantee safe, economical solutions. The angle of friction is often the main parameter required for geotechnical design and usually obtained by laboratory tests. However, when using standard laboratory equipment there is an upper limit to the size of particle that can be tested, rendering such apparatus inappropriate for obtaining the shear parameters of recycled aggregate (specified size fraction of 0-125mm). A new unique Giant Shear Box Facility, capable of testing samples with particle sizes up to 190mm diameter, has been established at City St George’s, University of London. Series of tests were conducted to determine the strength parameters of the recycled aggregate currently being used for working platforms on HS2 – Euston Site. Three different material specifications were tested, the results indicating that the strength parameters were a function of both aggregate constituents and grading