Recognition, assessment and treatment of social anxiety disorder: summary of NICE guidance

Social anxiety disorder is one of the most persistent and common of the anxiety disorders, with lifetime prevalence rates in Europe of 6.7% (range 3.9-13.7%).1 It often coexists with depression, substance use disorder, generalised anxiety disorder, panic disorder, and post-traumatic stress disorder.2 It can severely impair a person’s daily functioning by impeding the formation of relationships, reducing quality of life, and negatively affecting performance at work or school. Despite this, and the fact that effective treatments exist, only about half of people with this condition seek treatment, many after waiting 10-15 years.3 Although about 40% of those who develop the condition in childhood or adolescence recover before adulthood,4 for many the disorder persists into adulthood, with the chance of spontaneous recovery then limited compared with other mental health problems. This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) on recognising, assessing, and treating social anxiety disorder in children, young people, and adults.5

The application of a domains based analysis to family processes: implications for assessment and therapy

Social domains are classes of interpersonal processes each with distinct procedural rules underpinning mutual understanding, emotion regulation and action. We describe the features of three domains of family life – safety, attachment and discipline/expectation – and contrast them with exploratory processes in terms of the emotions expressed, the role of certainty versus uncertainty, and the degree of hierarchy in an interaction. We argue that everything that people say and do in family life carries information about the type of interaction they are engaged in – that is, the domain. However, sometimes what they say or how they behave does not make the domain clear, or participants in the social interactions are not in the same domain (there is a domain mismatch). This may result in misunderstandings, irresolvable arguments or distress. We describe how it is possible to identify domains and judge whether they are clear and unclear, and matched and mismatched, in observed family interactions and in accounts of family processes. This then provides a focus for treatment and helps to define criteria for evaluating outcomes.

Selecting algorithms for Earth observation of climate within the European Space Agency Climate Change initiative: introduction to a special issue

This special issue is focused on the assessment of algorithms for the observation of Earth’s climate from environ- mental satellites. Climate data records derived by remote sensing are increasingly a key source of insight into the workings of and changes in Earth’s climate system. Producers of data sets must devote considerable effort and expertise to maximise the true climate signals in their products and minimise effects of data processing choices and changing sensors. A key choice is the selection of algorithm(s) for classification and/or retrieval of the climate variable. Within the European Space Agency Climate Change Initiative, science teams undertook systematic assessment of algorithms for a range of essential climate variables. The papers in the special issue report some of these exercises (for ocean colour, aerosol, ozone, greenhouse gases, clouds, soil moisture, sea surface temper- ature and glaciers). The contributions show that assessment exercises must be designed with care, considering issues such as the relative importance of different aspects of data quality (accuracy, precision, stability, sensitivity, coverage, etc.), the availability and degree of independence of validation data and the limitations of validation in characterising some important aspects of data (such as long-term stability or spatial coherence). As well as re- quiring a significant investment of expertise and effort, systematic comparisons are found to be highly valuable. They reveal the relative strengths and weaknesses of different algorithmic approaches under different observa- tional contexts, and help ensure that scientific conclusions drawn from climate data records are not influenced by observational artifacts, but are robust.

Biodiversity and green open space

Biodiversity has been defined as the totality of genes, species, and ecosystems that inhabit the earth with the field contributing to many aspects of our lives and livelihoods by providing us with food, drink, medicines and shelter, as well as contributing to improving our surrounding environment. Benefits include providing life services through improved horticultural production, improving the business and service of horticulture as well as our environment, as well as improving our health and wellbeing, and our social and cultural relationships. Threats to biodiversity can include fragmentation, degradation and deforestation of habitat, introduction of invasive and exotic species, climate change and extreme weather events, over-exploitation of our natural resources, hybridisation, genetic pollution/erosion and food security issues and human overpopulation. This chapter examines a series of examples that provide the dual aims of biodiversity conservation and horticultural production and service; namely organic horticultural cropping, turf management, and nature-based tourism, and ways of valuing biological biodiversity such as the payment of environmental services and bio-prospecting. Horticulture plays a major role in the preserving of biodiversity.

The relationship between size of living space and subjective well-being

Against a background of shrinking new homes and forebodings of “rabbit hutch Britain”, the relationship between size of living space and subjective well-being has never been more topical in the UK. Using the British Household Panel Survey (BHPS) and fixed effects regressions, this paper is the first to examine this relationship comprehensively. Two pathways are proposed between space and subjective well-being. First, space facilitates values and activities. Second, space signals wealth which in turn influences social status. It is proposed that wealth is a more important determinant of status for men than women, and that pathway two is therefore gendered. Part one of the paper examines the effect of a change in number of rooms per person on housing satisfaction and subjective well-being in the BHPS as a whole. Despite having a similar effect on the housing satisfaction of both genders, an increase in living space has only a (weak) positive linear effect on the life satisfaction and mental health of men. This suggests that space affects subjective well-being through pathway two, status. Part two of the paper tracks the housing satisfaction and subjective well-being over time of those individuals who move for “larger accommodation”. Consistent with various theories of adaptation, housing satisfaction increases in the year of the move; then decreases slightly before levelling out. Moving for “larger accommodation” has no positive impact on subjective well-being. Overall the results imply a weak positive relationship between size of living space and subjective well-being, but only for men.

Impact of socioeconomic and clinical factors on child oral health-related quality of life (COHRQoL)

Child oral health-related quality of life (COHRQoL) has been increasingly assessed; however, few studies appraised the influence of socioeconomic status on COHRQoL in developing countries. This study assessed the relationship of COHRQoL with socioeconomic backgrounds and clinical factors. This study followed a cross-sectional design, with a multistage random sample of 792 schoolchildren aged 12 years, representative of Santa Maria, a southern city in Brazil. Participants completed the Brazilian version of the Child Perceptions Questionnaire (CPQ(11-14)), their parents or guardians answered questions on socioeconomic status, and a dental examination provided information on the prevalence of caries, dental trauma and occlusion. The assessment of association used hierarchically adjusted Poisson regression models. Higher impacts on COHRQoL were observed for children presenting with untreated dental caries (RR 1.20; 95% CI 1.07-1.35) and maxillary overjet (RR 1.19; 95% CI 1.02-1.40). Socioeconomic factors also associated with COHRQoL; poorer scores were reported by children whose mothers have not completed primary education (RR 1.30; 95% CI 1.17-1.44) and those with lower household income (RR 1.13; 95% CI 1.02-1.26). Poor socioeconomic standings and poor dental status have a negative impact on COHRQoL; reducing health inequalities may demand dental programmes and policies targeting deprived population.

The bubbles or the boiling pot? An ecosystemic approach to culture, environment and quality of life

For the diagnosis and prognosis of the problems of quality of life, a multidisciplinary ecosystemic approach encompasses four dimensions of being-in-the-world, as donors and recipients: intimate, interactive, social and biophysical. Social, cultural and environmental vulnerabilities are understood and dealt with, in different circumstances of space and time, as the conjugated effect of all dimensions of being-in-the-world, as they induce the events (deficits and assets), cope with consequences (desired or undesired) and contribute for change. Instead of fragmented and reduced representations of reality, diagnosis and prognosis of cultural, educational, environmental and health problems considers the connections (assets) and ruptures (deficits) between the different dimensions, providing a planning model to develop and evaluate research, teaching programmes, public policies and field projects. The methodology is participatory, experiential and reflexive; heuristic-hermeneutic processes unveil cultural and epistemic paradigms that orient subject-object relationships; giving people the opportunity to reflect on their own realities, engage in new experiences and find new ways to live better in a better world. The proposal is a creative model for thought and practice, providing many opportunities for discussion, debate and development of holistic projects integrating different scientific domains (social sciences, psychology, education, philosophy, etc.).

Assessment of production efficiency, physicochemical properties and storage stability of spray-dried chlorophyllide, a natural food colourant, using gum Arabic, maltodextrin and soy protein isolate-based carrier systems

P>The aim of this research was to study spray drying as potential action to protect chlorophyllide from environmental conditions for shelf-life extension and characterisation of the powders. Six formulations were prepared with 7.5 and 10 g of carrier agents [gum Arabic (GA), maltodextrin (MA) and soybean protein isolate (SPI)]/100 mL of chlorophyllide solutions. The powders were evaluated for morphological characteristics (SEM), particle size, water activity, moisture, density, hygroscopicity, cold water solubility, sorption isotherms, colour and stability, during 90 days. All the powders were highly soluble, with solubility values around 97%. A significant lower hygroscopicity was observed for GA powders, whilst the lower X(m) values obtained by GAB equation fitting of the sorption isotherms was observed for the 7.5 g MA/100 mL samples. All formulations, but the 1 (7.5 g SPI/100 mL of chlorophyllide), provided excellent stability to the chlorophyllide during 90 days of storage even at room temperature.

An improved finite element space for discontinuous pressures

We consider incompressible Stokes flow with an internal interface at which the pressure is discontinuous, as happens for example in problems involving surface tension. We assume that the mesh does not follow the interface, which makes classical interpolation spaces to yield suboptimal convergence rates (typically, the interpolation error in the L(2)(Omega)-norm is of order h(1/2)). We propose a modification of the P(1)-conforming space that accommodates discontinuities at the interface without introducing additional degrees of freedom or modifying the sparsity pattern of the linear system. The unknowns are the pressure values at the vertices of the mesh and the basis functions are computed locally at each element, so that the implementation of the proposed space into existing codes is straightforward. With this modification, numerical tests show that the interpolation order improves to O(h(3/2)). The new pressure space is implemented for the stable P(1)(+)/P(1) mini-element discretization, and for the stabilized equal-order P(1)/P(1) discretization. Assessment is carried out for Poiseuille flow with a forcing surface and for a static bubble. In all cases the proposed pressure space leads to improved convergence orders and to more accurate results than the standard P(1) space. In addition, two Navier-Stokes simulations with moving interfaces (Rayleigh-Taylor instability and merging bubbles) are reported to show that the proposed space is robust enough to carry out realistic simulations. (c) 2009 Elsevier B.V. All rights reserved.

Narration, Visualization and Mind : Movies in everyday life as a resource for utopian self-reflection

The paper is analyzing how people in late modern society characterized by de-traditionalization, use moving images as a cultural resource for the construction of meaningful subjective world views. As a theoretical concept with several dimensions, “sacralization of the self” (Woodhead & Heelas 2000: 344), is related to media theory. With a critical focus on ‘the self’, as a core aspect in contemporary media society Eric W. Rothenbuhler labels the individual self as one of “the sacred objects of modern culture” (Rothenbuhler 2006: 31).I want to emphasize the need for case studies in order to undertake a critical investigation about ‘the self’ and how consumption of fiction film is interconnected to spectator´s creation of self images, but also to understand how film engagement elicits self-reflection (Giddens 1991, Axelson 2008, Vaage 2009a). The paper make use of empirical data to illustrate and theoretically develop perspectives on how the audience uses fiction film in every-day life for the construction of the self, as well for the construction of more profound and long-lasting ideas of being part of a moral community (Brereton 2005, Jerslev 2006, Klinger 2008, Mikkola et al. 2007, Vaage 2009b). Some empirical findings support a conclusion that moving images creates a transitional space for the human mind, with the capacity of transporting the spectator from real life to fiction and back to real life again, helping the individual with an ongoing process of transforming the self, dealing with who you actually are, and who you want to become (Axelson 2008, Vaage 2009b).

‘Being in a womb’ or ‘playing musical chairs’ : the impact of place and space on infant feeding in NICUs

Background: Becoming a parent of a preterm baby requiring neonatal care constitutes an extraordinary life situation in which parenting begins and evolves in a medical and unfamiliar setting. Although there is increasing emphasis within maternity and neonatal care on the influence of place and space upon the experiences of staff and service users, there is a lack of research on how space and place influence relationships and care in the neonatal environment. The aim of this study was to explore, in-depth, the impact of place and space on parents’ experiences and practices related to feeding their preterm babies in Neonatal Intensive Care Units (NICUs) in Sweden and England. Methods: An ethnographic approach was utilised in two NICUs in Sweden and two comparable units in England, UK. Over an eleven month period, a total of 52 mothers, 19 fathers and 102 staff were observed and interviewed. A grounded theory approach was utilised throughout data collection and analysis. Results: The core category of ‘the room as a conveyance for an attuned feeding’ was underpinned by four categories: the level of ‘ownership’ of space and place; the feeling of ‘at-homeness’; the experience of ‘the door or a shield’ against people entering, for privacy, for enabling a focus within, and for regulating socialising and the; ‘window of opportunity’. Findings showed that the construction and design of space and place was strongly influential on the developing parent-infant relationship and for experiencing a sense of connectedness and a shared awareness with the baby during feeding, an attuned feeding. Conclusions: If our proposed model is valid, it is vital that these findings are considered when developing or reconfiguring NICUs so that account is taken of the influences of spatiality upon parent’s experiences. Even without redesign there are measures that may be taken to make a positive difference for parents and their preterm babies.

Assessing the physical environment of older people’s residential care facilities: development of the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM)

Background There is emerging evidence that the physical environment is important for health, quality of life and care, but there is a lack of valid instruments to assess health care environments. The Sheffield Care Environment Assessment Matrix (SCEAM), developed in the United Kingdom, provides a comprehensive assessment of the physical environment of residential care facilities for older people. This paper reports on the translation and adaptation of SCEAM for use in Swedish residential care facilities for older people, including information on its validity and reliability. Methods SCEAM was translated into Swedish and back-translated into English, and assessed for its relevance by experts using content validity index (CVI) together with qualitative data. After modification, the validity assessments were repeated and followed by test-retest and inter-rater reliability tests in six units within a Swedish residential care facility that varied in terms of their environmental characteristics. Results Translation and back translation identified linguistic and semantic related issues. The results of the first content validity analysis showed that more than one third of the items had item-CVI (I-CVI) values less than the critical value of 0.78.  After modifying the instrument, the second content validation analysis resulted in I-CVI scores above 0.78, the suggested criteria for excellent content validity. Test-retest reliability showed high stability (96% and 95% for two independent raters respectively), and inter-rater reliability demonstrated high levels of agreement (95% and 94% on two separate rating occasions). Kappa values were very good for test-retest (κ= 0.903 and 0.869) and inter-rater reliability (κ= 0.851 and 0.832). Conclusions Adapting an instrument to a domestic context is a complex and time-consuming process, requiring an understanding of the culture where the instrument was developed and where it is to be used. A team, including the instrument’s developers, translators, and researchers is necessary to ensure a valid translation and adaption. This study showed preliminary validity and reliability evidence for the Swedish version (S-SCEAM) when used in a Swedish context. Further, we believe that the S-SCEAM has improved compared to the original instrument and suggest that it can be used as a foundation for future developments of the SCEAM model.

Gay and Lesbian Life at Colby 1969-1974

The history of a gay and lesbian student community at Colby seems to point to the difficulty of visibility. For students who were able to find others like themselves, their group of lesbian and gay friends had to remain underground. For students who were grappling with their newly found, socially stigmatized sexuality, the experience was isolating if they did not know where to find others like themselves. This paper seeks to address the social forces that kept sexually variant students from expressing their sexual identities openly on campus. Part of this difficulty is attributable to the compulsory heterosexuality assumed by general American society at the time, manifested in the silence or outright hostility directed against homosexuals. Naturally, Colby students replicated this assumption. Some of the students we interviewed seemed to internalize compulsory heterosexuality, while it was forced upon others. Religion and psychology were two methods of enforcing heterosexuality that were relevant to the people we interviewed. Another significant obstacle to visibility was Colby's location and the nature of Colby's student body. Waterville, unlike more urban cities, did not have a history of gay life, and thus an established gay community or gay identity into which one could be socialized. Colby, as a small, homogeneous and isolated space, posed difficulties in establishing a gay community as the population to draw from was small and regulated.

Dialectics of Diaspora Space: a Study of Contemporary, Diasporic, South Asian Fiction

In light of these continuing debates concerning immigration, national identity and belonging, re-examinations of immigrant and ethnic communities, often referred to as ‘diaspora,’ have become increasingly popular and prudent. Khachig Tololian, editor of Diaspora magazine, calls diaspora “exemplary communities of the transnational moment.”5 In an increasingly globalized world, where labor, capital, and resources are passed fluidly from continent to continent, diaspora are created by relocation or displacement of immigrant workers and their descendents.6 For these unskilled, immigrant laborers, middle class immigrants, and the children of both groups, adaptation to the culture, society, and life in a new ‘host’ country can be difficult, to say the least. So, in response to a new cultural landscape and a tenuous sense belonging, as well as to maintain a connection with a shared past, citizens of the world’s numerous diaspora replicate linguistic, cultural, and social norms, creating their own “cultural space[s]” that mirror and often replace a past relationship to their land of origin, or ‘home’.

An assessment of criteria to evaluate the graduate education program in Brazil

This study sought to identify criteria adequate for the evaluation of graduate programs in Brazil. A survey was the means for collecting the ratings and rankings given by faculty members at selected Brazilian graduate programs. A questionnaire using Likerttype and ranking items asked the importance attributed by each respondent to each of the 109 items listed. The data analysis reported in this dissertation indicates that the most highly rated criteria and indicators were: (1) Library: current periodicals; (2) Facilities: classrooms and laboratories; (3) Library: books and monographs; (4) Academic Environment: discussion, investigation, and expression; and (5) Facilities: research space and equipment. The study presents the means and standard deviations obtained for each indicator and also includes some figures obtained for a relational analysis. This dissertation was developed to provide useful information to educational planners, policy makers, administrators, and evaluators involved in Brazilian higher education or comparative studies. It is suggested that additional investigations concentrate on more specific and in-depth analysis and interpretation of the policymaking processes, i.e., on the study of social facts or organizational and academic variables in their relationships with aspects of the educational system. The appendices section includes a facsimile of the questionnaire and additional data.