Short-term psychoanalytic psychotherapy with a depressed adolescent with borderline personality disorder: an empirical, single case study

While clinical descriptions of psychotherapy with depressed adolescents with traits of borderline functioning exist, they are not yet supported by empirically-grounded research. This single-case study aims to identify meaningful therapist-patient interaction in the course of short-term psychoanalytic psychotherapy with an adolescent girl who meets diagnostic criteria for both Borderline Personality Disorder (BPD) and Major Depressive Disorder (MDD). Twenty-eight sessions of psychotherapy were coded, using the Adolescent Psychotherapy Q-Set. Five interaction structures were identified, which were distinguished by the nature of the adolescent’s emotional expression during sessions, and how the therapist responded to the young person. Exploration of the clinical and theoretical meaning of these interaction structures suggests that core elements of a young person’s depression and borderline functioning can be identified in sessions, and that the therapeutic process overall shows some significant departures from some of what is usually recognised as a typical psychoanalytic approach. The paper discusses whether these changes in technique can be understood as responses to the clinical challenges associated with working with adolescents with borderline features

Sensitivity of nonlinear photoionization to resonance substructure in collective excitation

Collective behaviour is a characteristic feature in many-body systems, important for developments in fields such as magnetism, superconductivity, photonics and electronics. Recently, there has been increasing interest in the optically nonlinear response of collective excitations. Here we demonstrate how the nonlinear interaction of a many-body system with intense XUV radiation can be used as an effective probe for characterizing otherwise unresolved features of its collective response. Resonant photoionization of atomic xenon was chosen as a case study. The excellent agreement between experiment and theory strongly supports the prediction that two distinct poles underlie the giant dipole resonance. Our results pave the way towards a deeper understanding of collective behaviour in atoms, molecules and solid-state systems using nonlinear spectroscopic techniques enabled by modern short-wavelength light sources

Renormalization of the tunnel splitting in a rotating nanomagnet

We study spin tunneling in a magnetic nanoparticle with biaxial anisotropy that is free to rotate about its anisotropy axis. Exact instanton of the coupled equations of motion is found that connects degenerate classical energy minima. We show that mechanical freedom of the particle renormalizes magnetic anisotropy and increases the tunnel splitting.Comment: 4 pages, 3 figure

Education for collaboration: the influence of the third space on professional boundaries

The delivery of integrated care requires the establishment of effective professional relationships that foster collaborative working across health systems. Evidence for how to prepare practitioners to work in those settings is limited. By exploring an innovative postgraduate Programme for Integrated Child Health (PICH) this article highlights the conditions by which effective collaboration can be encouraged. Our qualitative evaluation of PICH involved one-to-one semi-structured interviews with 23 postgraduate general practice and paediatric trainees and their mentors. We analysed the data using the concept of the ‘third space’, where multiple discourses between individuals with diverse professional backgrounds occur, enabling creative exploration of tensions inherent in new ways of working in order to identify enablers and barriers to collaboration. Our analysis identified three themes that enabled collaboration: effective communication, boundary work and educational spaces; and four themes that were barriers: traditional hierarchical professional identities, curriculum design, financial systems and workplace spaces. PICH demonstrated the value of educational spaces and their role in enabling collaborative practice, as participants explored their professional identities and those of other disciplines. Structural factors in the workplace which inhibit collaborative practice were also evident. We conclude by proposing a model for collaborative learning in third spaces based upon the recognition that, while educational programmes alone will not lead to change, they have the potential to inform the development of productive workplace spaces that will be required if collaborative practice in healthcare is to become a reality

Tight-Binding Theory of Manganese and Iron Oxides

The electronic structure is found to be understandable in terms of free-atom term values and universal interorbital coupling parameters, since self-consistent tight-binding calculations indicate that Coulomb shifts of the d-state energies are small. Special-point averages over the bands are seen to be equivalent to treatment of local octahedral clusters. The cohesive energy per manganese for MnO, Mn2O3, and MnO2, in which manganese exists in valence states Mn2+, Mn3+, and Mn4+, is very nearly the same and dominated by the transfer of manganese s electrons to oxygen p states. There are small corrections, one eV per Mn in all cases, from couplings of minority-spin states. Transferring one majority-spin electron from an upper cluster state to a nonbonding oxygen state adds 1.67 eV to the cohesion for Mn2O3, and two transfers adds twice that for MnO2 . The electronic and magnetic properties are consistent with this description and appear to be understandable in terms of the same parameters.Comment: Submitting to Phys. Rev.

Limitations of predicting substrate classes on a sedimentary complex but morphologically simple seabed

The ocean floor, its species and habitats are under pressure from various human activities. Marine spatial planning and nature conservation aim to address these threats but require sufficiently detailed and accurate maps of the distribution of seabed substrates and habitats. Benthic habitat mapping has markedly evolved as a discipline over the last decade, but important challenges remain. To test the adequacy of current data products and classification approaches, we carried out a comparative study based on a common dataset of multibeam echosounder bathymetry and backscatter data, supplemented with groundtruth observations. The task was to predict the spatial distribution of five substrate classes (coarse sediments, mixed sediments, mud, sand, and rock) in a highly heterogeneous area of the south-western continental shelf of the United Kingdom. Five different supervised classification methods were employed, and their accuracy estimated with a set of samples that were withheld. We found that all methods achieved overall accuracies of around 50%. Errors of commission and omission were acceptable for rocky substrates, but high for all sediment types. We predominantly attribute the low map accuracy regardless of mapping approach to inadequacies of the selected classification system, which is required to fit gradually changing substrate types into a rigid scheme, low discriminatory power of the available predictors, and high spatial complexity of the site relative to the positioning accuracy of the groundtruth equipment. Some of these issues might be alleviated by creating an ensemble map that aggregates the individual outputs into one map showing the modal substrate class and its associated confidence or by adopting a quantitative approach that models the spatial distribution of sediment fractions. We conclude that further incremental improvements to the collection, processing and analysis of remote sensing and sample data are required to improve map accuracy. To assess the progress in benthic habitat mapping we propose the creation of benchmark datasets

Structural stability of Fe5Si3 and Ni2Si studied by high-pressure x-ray diffraction and ab initio total-energy calculations

We performed high-pressure angle dispersive x-ray diffraction measurements on Fe5Si3 and Ni2Si up to 75 GPa. Both materials were synthesized in bulk quantities via a solid-state reaction. In the pressure range covered by the experiments, no evidence of the occurrence of phase transitions was observed. On top of that, Fe5Si3 was found to compress isotropically, whereas an anisotropic compression was observed in Ni2Si. The linear incompressibility of Ni2Si along the c-axis is similar in magnitude to the linear incompressibility of diamond. This fact is related to the higher valence-electron charge density of Ni2Si along the c-axis. The observed anisotropic compression of Ni2Si is also related to the layered structure of Ni2Si where hexagonal layers of Ni2+ cations alternate with graphite-like layers formed by (NiSi)2- entities. The experimental results are supported by ab initio total-energy calculations carried out using density functional theory and the pseudopotential method. For Fe5Si3, the calculations also predicted a phase transition at 283 GPa from the hexagonal P63/mcm phase to the cubic structure adopted by Fe and Si in the garnet Fe5Si3O12. The room-temperature equations of state for Fe5Si3 and Ni2Si are also reported and a possible correlation between the bulk modulus of iron silicides and the coordination number of their minority element is discussed. Finally, we report novel descriptions of these structures, in particular of the predicted high-pressure phase of Fe5Si3 (the cation subarray in the garnet Fe5Si3O12), which can be derived from spinel Fe2SiO4 (Fe6Si3O12).Comment: 44 pages, 13 figures, 3 Table

Quality and impact of appraisal for revalidation: the perceptions of London’s responsible officers and their appraisers

BACKGROUND: To evaluate NHS England London region's approach to the revalidation appraisal of responsible officers in London, exploring perceptions of the quality and impact of the appraisal process. Revalidation is the process which aims to ensure doctors in the UK are up-to-date and fit to practice medicine thus improving the quality of patient care. Revalidation recommendations are largely premised on the documentation included in annual appraisals, which includes the professional development a doctor has undertaken and supporting information about their practice. METHODS: A pan-London qualitative study exploring the views of responsible officers and their appraisers about the revalidation appraisal process. The study aimed to gain an in-depth understanding of the experiences and perceptions of the participants. Responsible officers were purposefully sampled to represent the broadest range of designated bodies. Data analysis generated themes pertaining to quality and impact of appraisal for revalidation with the potential to feed into and shape the evolving system under investigation. RESULTS: The central importance of highly skilled appraisers was highlighted. Both groups reported educational opportunities embedded within the appraisal process. Independent appraisers, not matched by clinical speciality or place of work, were considered to take a more objective view of a responsible officer's practice by providing an 'outsider perspective'. However, covering the breadth of roles, in sufficient depth, was challenging. Participants reported a bias favouring the appraisal of the responsible officer role above others including clinical work. Appraisal and revalidation was perceived to have the potential to improve the healthcare standards and support both personal development and institutional quality improvement. CONCLUSIONS: Responsible officers play a central role in the revalidation process. Getting responsible officer appraisal right is central to supporting those individuals to in turn support doctors and healthcare organisations in continuous quality improvement. The complexity and importance of the role of responsible officer may make achieving an appraisal of all roles of such individuals problematic. This evaluation suggests responsible officer appraisal was perceived as educational and effective

Abbreviated MDS-UPDRS for Remote Monitoring in PD Identified Using Exhaustive Computational Search

Background. The Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) comprises 50 items, consisting of historical questions and motor ratings, typically taking around 30 minutes to complete. We sought to identify an abbreviated version that could facilitate use in clinical practice or used remotely via telemedicine. Methods. To create an 8-item version we conducted an “exhaustive search” of all possible subsets. We measured explained variance in comparison to the 50-item version using linear regression, with the “optimal” subset maximising this while also meeting remote assessment practicality constraints. The subset was identified using a dataset collected by the Parkinson’s Progression Markers Initiative and validated using an MDS Non-Motor Symptoms Scale validation study dataset. Results. The optimal remote version comprised items from all parts of the MDS-UPDRS and was found to act as an unbiased estimator of the total 50-item score. This version had an explained variance score of 0.844 and was highly correlated with the total MDS-UPDRS score (Pearson’s r = 0.919, p -value <0.0001). Another subset that maximised explained variance score without adhering to remote assessment practicality constraints provided similar results. Conclusion. This result demonstrates that the total scores of an abbreviated form identified by computational statistics had high agreement with the MDS-UPDRS total score. Whilst it cannot capture the richness of information of the full MDS-UPDRS, it can be used to create a total score where practicality limits the application of the full MDS-UPDRS, such as remote monitoring. Further validation will be required, including in specific subgroups and advanced disease stages, and full validation of clinimetric properties