First degree relatives (FDRs) of subjects with early onset of coronary heart disease (CHD) have higher risk of developing cardiovascular disease. We verified early CHD by angiography in the index patients and extensively phenotyped their FDRs to investigate the relationship of traditional and non-traditional cardiovascular risk factors to carotid ultrasound and coronary calcium scoring findings. B-mode carotid ultrasound was used to assess the combined intima-media thickness and plaque burden in 111 FDRs. The biochemical and anthropometrical characteristics of the FDRs were compared with those of healthy controls matched for sex, age, ethnicity and BMI. Odds ratios indicate that FDRs are more likely to have positive carotid ultrasound findings compared to controls; 2.23 (95% CI 1.14 – 4.37) for intima-media thickness and 2.3 (95% CI 1.22 - 4.35) for average total thickness. In multivariate analysis positive carotid ultrasound findings were higher in FDRs independent of age, gender, total cholesterol over HDL-c ratio, systolic blood pressure and smoking but not homocysteine which had higher values in FDRs compared to controls. In conclusion FDRs of patients with angiographically confirmed CHD have higher burden of subclinical atherosclerosis even when considered in the context of traditional risk factors. Coronary artery calcium scoring (CAC), assessed by 64-slice multi-detector computed tomography (MDCT), was used to assess burden of subclinical atherosclerosis in 57 FDRs compared to controls. FDRs have a two-fold increase in risk of having CAC positive findings; odds ratios for the 75th percentile was 1.96 (95%CI 1.04 – 3.67, p<0.05) while for the 90th percentile odds ratio was 2.59 (95% 1.232 – 5.473, p<0.05). In summary, the risk of significant CAC findings, measured by 64-slice MDCT, is two-fold higher in FDRs than controls. These findings correlate highly with carotid ultrasound findings in the same cohort. Different thresholds for CAC may be appropriate when assessing male versus female FDRs. Together increased carotid ultrasound findings and CAC scoring results in FDRs of patients with validated early onset of CHD suggest these imaging techniques as potentially useful tools in cardiovascular risk assessment that will go above and beyond the current diagnostic algorithms.

Family history (FH) is a risk factor for many diseases. Disease guidelines often include family history as important in assessing chronic disease risks, but the empirical evidence base to inform the routine use of family history in primary care in practice appears largely lacking. An environmental scan of how family history is represented in prevention guidelines for five conditions showed that, while family history is often included in guidelines, there is variation in the definition used, recommendation given and evidence cited. A dataset on cardiovascular health in women was analyzed to examine whether family history offers useful discrimination value above standard risk factors. Regression results showed that family history is an independent risk predictor for coronary heart disease which improves discrimination beyond classical clinical factors. However, the absolute amount of discriminatory ability alone or with other factors is moderate at best, raising issues regarding clinical utility.

First degree relatives (FDRs) of subjects with early onset of coronary heart disease (CHD) have higher risk of developing cardiovascular disease. We verified early CHD by angiography in the index patients and extensively phenotyped their FDRs to investigate the relationship of traditional and non-traditional cardiovascular risk factors to carotid ultrasound and coronary calcium scoring findings. B-mode carotid ultrasound was used to assess the combined intima-media thickness and plaque burden in 111 FDRs. The biochemical and anthropometrical characteristics of the FDRs were compared with those of healthy controls matched for sex, age, ethnicity and BMI. Odds ratios indicate that FDRs are more likely to have positive carotid ultrasound findings compared to controls; 2.23 (95% CI 1.14 – 4.37) for intima-media thickness and 2.3 (95% CI 1.22 - 4.35) for average total thickness. In multivariate analysis positive carotid ultrasound findings were higher in FDRs independent of age, gender, total cholesterol over HDL-c ratio, systolic blood pressure and smoking but not homocysteine which had higher values in FDRs compared to controls. In conclusion FDRs of patients with angiographically confirmed CHD have higher burden of subclinical atherosclerosis even when considered in the context of traditional risk factors. Coronary artery calcium scoring (CAC), assessed by 64-slice multi-detector computed tomography (MDCT), was used to assess burden of subclinical atherosclerosis in 57 FDRs compared to controls. FDRs have a two-fold increase in risk of having CAC positive findings; odds ratios for the 75th percentile was 1.96 (95%CI 1.04 – 3.67, p<0.05) while for the 90th percentile odds ratio was 2.59 (95% 1.232 – 5.473, p<0.05). In summary, the risk of significant CAC findings, measured by 64-slice MDCT, is two-fold higher in FDRs than controls. These findings correlate highly with carotid ultrasound findings in the same cohort. Different thresholds for CAC may be appropriate when assessing male versus female FDRs. Together increased carotid ultrasound findings and CAC scoring results in FDRs of patients with validated early onset of CHD suggest these imaging techniques as potentially useful tools in cardiovascular risk assessment that will go above and beyond the current diagnostic algorithms.

[Abstract]: This study explores similarities and differences in the early family history of an adult group with schizophrenia, and a matched group with major depression. Attachment theory, trauma theory and their relation to serious mental illnesses are used to understand the clinical participants’ reported early traumatic experiences of emotional deprivation and neglect.A retrospective design includes self-report questionnaires from clinical participants, and semi-structured interviews with participants’ mothers/primary caregivers.Data analysis includes:1. Assessment of matched participants’ reported prevalence of emotional deprivation and neglect in four different age groups;2. Assessment of themes of early family trauma and sequelae from the mother interviews;3. Qualitative analysis of sample mother/primary caregiver interviews from each diagnostic group of the manner in which the interviewees construct their stories around trauma;4. Quantitative analysis of a conceptualised model representing the arguments developed in the body of this dissertation.The second and third forms of analysis above include a panel of three experts, blind to diagnosis, validating this researcher’s findings.Standard multiple regression analysis indicates participants’ reported neglect across all age groups significantly predicts emotional deprivation, with neglect contributing 27.4% of the variability, but with no individual age band contributing significantly to the equation.Themes from the mother interviews are clustered into three constructs, guided by the research questions and this researcher’s clinical experience, the mothers’ emphases and the expert panel into Early Family Trauma, Maternal Fatigue, and Clinical Participants’ Early Attachment Difficulties.The mothers’ manner of discussing early family trauma is defined via speech markers as dissociative (disorganised, incoherent, and unresolved) or coherent (grounded, sequential and resolved) according to Attachment Theory and the literature on dissociation. Speakers are assigned as using dissociation or not as a categorical variable.A model is conceptualised to represent the interrelatedness of data from the participants and their mothers, including the manner in which the mothers relate early family trauma. Canonical Discriminant Function Analysis indicates that early family trauma and maternal fatigue discriminate little between diagnostic groups and that maternal non-resolution of early traumatic events and (possibly related) participant offspring attachment difficulties contribute most to distinguishing between the two diagnostic groups. Finally, a greater number of participants from the schizophrenia sample than from the depression sample continue to live with mother, possibly indicating that the early attachment difficulties remain unresolved.Discussion offers a reconceptualisation of several major and/or established theories concerning risk factors in schizophrenia, and examines shortcomings in the literature, concluding with suggestions for future research.

abstract: The discipline of rhetoric and composition established the Writing Program Administrators Outcomes Statement (WPA OS) to fulfill a general expectation about the skills and knowledge students should be able to demonstrate by the end of first-year composition. Regardless of pedagogy used, academic preparation of the teacher, or preference of particular topics or types of assignments, the WPA OS is versatile. This dissertation employs a problem-solution argument showcasing methods to improve assignments through intentional use of the WPA OS for a fluid conversation throughout first-year composition and a more clear articulation of course goals. This dissertation includes summation, analysis, and synthesis of documents that inform first-year composition curriculum from foundational organizations within the field, including National Council of Teachers of English, Council of Writing Program Administrators, National Writing Project, and Conference on College Composition and Communication. This study uses the WPA OS as a lens to examine and revise writing assignments that aid in students' comprehension of the WPA OS with particular focus on the areas of rhetorical knowledge and critical thinking, reading, and writing. Framing assignment design with theoretically grounded content and the use of common topics throughout first-year composition is one way to operationalize the WPA OS. Using common topics throughout course content presents opportunities for teachers to include detailed scaffolding in assignments that expand students' literate practices and engage students as critical thinkers and writers. This study explores how using the topic of family, a common topic to all students, provides a rich bank of social, historical, and cultural elements for research and writing. The topic of family seamlessly employs multimodal composition, which presents students with opportunities for developing rhetorical knowledge and expanding students' literacies. This dissertation displays evidence of praxis of the WPA OS from assignment development to presentation of student samples. This study recommends the use of common topics and intentional application of the WPA OS to construct assignments that clearly articulate learning goals in first-year composition. / Dissertation/Thesis / Appendix H: Cecelia Sound Project / Ph.D. English 2011

Foram estudados 125 pacientes em idade escolar que procuraram o Posto de Atendimento Médico Especializado (PAME) da cidade de São Leopoldo, Rio Grande do Sul, Brasil, nos anos de 2003 e 2004, encaminhados pela escola, pelo pediatra ou Conselho Tutelar, por estarem apresentando dificuldades na escolarização. Realizaram-se entrevistas com os pais ou responsáveis, exame neurológico tradicional, exame neurológico evolutivo, eletroencefalograma em sono e vigília em todas as crianças e tomografia cerebral e ressonância magnética, quando necessário. Foram estudados aspectos neuropsicossociais dos indivíduos e de suas respectivas famílias. Encontraram-se famílias comprometidas em sua história prévia e atual: 29,30% com dificuldades escolares, 27,20% com doenças psiquiátricas, 26,10% com epilepsia, 21,70% com alcoolismo e 10,90% com deficiência mental. As comorbidades tiveram um papel relevante no desempenho escolar: 50,50% com hiperatividade, 17,20% com distúrbio de conduta e 17,20% com problemas emocionais (listados como queixa principal por ocasião do encaminhamento para a triagem). / A hundred and twenty five patients at school age referred to the Ambulatory of Specialized Diseases in the town of São Leopoldo, Rio Grande do Sul, Brazil, by the school, by the pediatricians or by Tutor Counsellor, due to learning disability, were followed during the years 2003 and 2004. Parents were interviewed; neurological examination was performed as well as electroencephalographic exams. In some cases, brain computadorized tomography and brain magnetic resonance was also done, when necessary. Neurological, psychological and social aspects of the patient and his family were investigated. Both past and current conditions were found in these families: 29.30% with learning disabilities, 27.20% with mental illness, 26.10% with epilepsy, 21.70% with alcoholism, 10.90% with mental handicap. Comorbidities also played an important role in school performance: 50.50% hyperactivity, 17.20% conduct problems, 17. 20% emotional problems all listed as complaints by the school, pediatricians, parents or Tutor Counsellor.

Esta tese tem como objetivo compreender de que modo o gênero melodrama – nas suas atualizações através da (tele)novela, do bumba-meu-boi e das práticas sócio-comunicativas familiares - se constitui numa matriz cultural para a identidade de uma família de classe popular. Trabalha-se com três gerações de uma família maranhense buscando identificar os usos, consumo e recepção de tele (novela), assim como outras práticas midiáticas e sócio-comunicativas através do tempo. A observação inicial do campo conduziu à hipótese de que o melodrama constitui matriz privilegiada para o entendimento da(s) identidade(s) familiar (es) em razão do intenso trânsito e intercâmbio de valores existentes na (tele) novela e em diversas expressões da cultura popular. Assim, discutem-se aspectos históricos e conceituais do melodrama e suas conexões com a telenovela e o bumba-meu-boi; discorre-se sobre diversas matrizes culturais do melodrama articuladas à produção e disseminadas por esses dois formatos narrativos; refletese o conceito de identidade a partir de diferentes perspectivas. No que concerne à questão metodológica, delinea-se um referencial que contempla tanto a reflexão teórica quanto a pesquisa metódica, de modo a optar pelo método da história oral a partir da técnica história de família. Para tanto foram realizadas entrevistas do tipo semiestruturada e entrevista em profundidade além do questionário e de observações etnográficas. Entre os principais resultados destacam-se: a família possui um repertório simbólico compartilhado, que se reconhece e se percebe também nos discursos midiáticos - de modo especial naqueles de matriz melodramática, entretanto, dispõe de outros saberes e de outras referências culturais não midiáticas para pensar e construir suas percepções de mundo e constituírem-se continuamente, desde diferentes gerações e a partir de identidades familiares. Tais identidades se caracterizam, sobretudo pelo sentimento de pertencimento quer da própria linhagem, quer da cidade ou do bairro em que vivenciam sua sociabilidade; e também pela forte relação entre a fé e o lúdico vivenciados nos modos de expressarem sua religiosidade e festividades. A investigação corrobora que as diversas aplicações do estudo dessa família permitem levantar hipóteses sobre outros fenômenos similares. / This thesis aims at understanding in what way the melodrama genre – in its updates through (tele)novela, the folk theatrical tradition bumba-meu-boi and the familiar socio-communicative practices – constitutes itself in a cultural matrix to the identity of a popular class family. We work with three generations of a family from Maranhão seeking to identify the uses, consumption and reception on tele (novela), as well as other socio-communicative and media practices throughout time. The primary observation of the field lead to the hypothesis that melodrama constitutes privileged matrix to the understanding of family(ies) identity (ies) because of the intense traffic and exchange of values that exist in tele (novela) and in a diversity of popular culture expressions. Therefore, we discuss historical and conceptual aspects of melodrama and its connections with telenovela and bumba-meu-boi; we debate about the various cultural matrixes of melodrama articulated to the production and disseminated by these two narrative formats; we reflect upon the concept of identity from different perspectives. In regard of the methodological issue, we outline a framework that contemplates both the theoretical reflection and the methodical research, choosing the method of oral history based on the technique of family history. For that, semi-structured and in-depth interviews were conducted, besides questionnaire and ethnographic observations. Among the main results, we point out: the family possesses a shared symbolic repertoire that recognizes and is aware of itself in media discourses – particularly in the ones of melodramatic matrix, however it has other knowledges and cultural references that don’t pertain to the media to reflect upon and build its perceptions of the world and continuously constitute itself, in different generations and based on family identities. Such identities are characterized, mainly, by the feeling of belonging to their own lineage, to a city or a neighborhood where they experience their sociability; and also by the strong relation between faith and ludic experienced in the ways their religiosity and festivities are expressed. The investigation corroborates that various applications of this family allows the bringing up of hypothesis concerning similar phenomena.

Foram estudados 125 pacientes em idade escolar que procuraram o Posto de Atendimento Médico Especializado (PAME) da cidade de São Leopoldo, Rio Grande do Sul, Brasil, nos anos de 2003 e 2004, encaminhados pela escola, pelo pediatra ou Conselho Tutelar, por estarem apresentando dificuldades na escolarização. Realizaram-se entrevistas com os pais ou responsáveis, exame neurológico tradicional, exame neurológico evolutivo, eletroencefalograma em sono e vigília em todas as crianças e tomografia cerebral e ressonância magnética, quando necessário. Foram estudados aspectos neuropsicossociais dos indivíduos e de suas respectivas famílias. Encontraram-se famílias comprometidas em sua história prévia e atual: 29,30% com dificuldades escolares, 27,20% com doenças psiquiátricas, 26,10% com epilepsia, 21,70% com alcoolismo e 10,90% com deficiência mental. As comorbidades tiveram um papel relevante no desempenho escolar: 50,50% com hiperatividade, 17,20% com distúrbio de conduta e 17,20% com problemas emocionais (listados como queixa principal por ocasião do encaminhamento para a triagem). / A hundred and twenty five patients at school age referred to the Ambulatory of Specialized Diseases in the town of São Leopoldo, Rio Grande do Sul, Brazil, by the school, by the pediatricians or by Tutor Counsellor, due to learning disability, were followed during the years 2003 and 2004. Parents were interviewed; neurological examination was performed as well as electroencephalographic exams. In some cases, brain computadorized tomography and brain magnetic resonance was also done, when necessary. Neurological, psychological and social aspects of the patient and his family were investigated. Both past and current conditions were found in these families: 29.30% with learning disabilities, 27.20% with mental illness, 26.10% with epilepsy, 21.70% with alcoholism, 10.90% with mental handicap. Comorbidities also played an important role in school performance: 50.50% hyperactivity, 17.20% conduct problems, 17. 20% emotional problems all listed as complaints by the school, pediatricians, parents or Tutor Counsellor.

Esta tese tem como objetivo compreender de que modo o gênero melodrama – nas suas atualizações através da (tele)novela, do bumba-meu-boi e das práticas sócio-comunicativas familiares - se constitui numa matriz cultural para a identidade de uma família de classe popular. Trabalha-se com três gerações de uma família maranhense buscando identificar os usos, consumo e recepção de tele (novela), assim como outras práticas midiáticas e sócio-comunicativas através do tempo. A observação inicial do campo conduziu à hipótese de que o melodrama constitui matriz privilegiada para o entendimento da(s) identidade(s) familiar (es) em razão do intenso trânsito e intercâmbio de valores existentes na (tele) novela e em diversas expressões da cultura popular. Assim, discutem-se aspectos históricos e conceituais do melodrama e suas conexões com a telenovela e o bumba-meu-boi; discorre-se sobre diversas matrizes culturais do melodrama articuladas à produção e disseminadas por esses dois formatos narrativos; refletese o conceito de identidade a partir de diferentes perspectivas. No que concerne à questão metodológica, delinea-se um referencial que contempla tanto a reflexão teórica quanto a pesquisa metódica, de modo a optar pelo método da história oral a partir da técnica história de família. Para tanto foram realizadas entrevistas do tipo semiestruturada e entrevista em profundidade além do questionário e de observações etnográficas. Entre os principais resultados destacam-se: a família possui um repertório simbólico compartilhado, que se reconhece e se percebe também nos discursos midiáticos - de modo especial naqueles de matriz melodramática, entretanto, dispõe de outros saberes e de outras referências culturais não midiáticas para pensar e construir suas percepções de mundo e constituírem-se continuamente, desde diferentes gerações e a partir de identidades familiares. Tais identidades se caracterizam, sobretudo pelo sentimento de pertencimento quer da própria linhagem, quer da cidade ou do bairro em que vivenciam sua sociabilidade; e também pela forte relação entre a fé e o lúdico vivenciados nos modos de expressarem sua religiosidade e festividades. A investigação corrobora que as diversas aplicações do estudo dessa família permitem levantar hipóteses sobre outros fenômenos similares. / This thesis aims at understanding in what way the melodrama genre – in its updates through (tele)novela, the folk theatrical tradition bumba-meu-boi and the familiar socio-communicative practices – constitutes itself in a cultural matrix to the identity of a popular class family. We work with three generations of a family from Maranhão seeking to identify the uses, consumption and reception on tele (novela), as well as other socio-communicative and media practices throughout time. The primary observation of the field lead to the hypothesis that melodrama constitutes privileged matrix to the understanding of family(ies) identity (ies) because of the intense traffic and exchange of values that exist in tele (novela) and in a diversity of popular culture expressions. Therefore, we discuss historical and conceptual aspects of melodrama and its connections with telenovela and bumba-meu-boi; we debate about the various cultural matrixes of melodrama articulated to the production and disseminated by these two narrative formats; we reflect upon the concept of identity from different perspectives. In regard of the methodological issue, we outline a framework that contemplates both the theoretical reflection and the methodical research, choosing the method of oral history based on the technique of family history. For that, semi-structured and in-depth interviews were conducted, besides questionnaire and ethnographic observations. Among the main results, we point out: the family possesses a shared symbolic repertoire that recognizes and is aware of itself in media discourses – particularly in the ones of melodramatic matrix, however it has other knowledges and cultural references that don’t pertain to the media to reflect upon and build its perceptions of the world and continuously constitute itself, in different generations and based on family identities. Such identities are characterized, mainly, by the feeling of belonging to their own lineage, to a city or a neighborhood where they experience their sociability; and also by the strong relation between faith and ludic experienced in the ways their religiosity and festivities are expressed. The investigation corroborates that various applications of this family allows the bringing up of hypothesis concerning similar phenomena.

Esta tese tem como objetivo compreender de que modo o gênero melodrama – nas suas atualizações através da (tele)novela, do bumba-meu-boi e das práticas sócio-comunicativas familiares - se constitui numa matriz cultural para a identidade de uma família de classe popular. Trabalha-se com três gerações de uma família maranhense buscando identificar os usos, consumo e recepção de tele (novela), assim como outras práticas midiáticas e sócio-comunicativas através do tempo. A observação inicial do campo conduziu à hipótese de que o melodrama constitui matriz privilegiada para o entendimento da(s) identidade(s) familiar (es) em razão do intenso trânsito e intercâmbio de valores existentes na (tele) novela e em diversas expressões da cultura popular. Assim, discutem-se aspectos históricos e conceituais do melodrama e suas conexões com a telenovela e o bumba-meu-boi; discorre-se sobre diversas matrizes culturais do melodrama articuladas à produção e disseminadas por esses dois formatos narrativos; refletese o conceito de identidade a partir de diferentes perspectivas. No que concerne à questão metodológica, delinea-se um referencial que contempla tanto a reflexão teórica quanto a pesquisa metódica, de modo a optar pelo método da história oral a partir da técnica história de família. Para tanto foram realizadas entrevistas do tipo semiestruturada e entrevista em profundidade além do questionário e de observações etnográficas. Entre os principais resultados destacam-se: a família possui um repertório simbólico compartilhado, que se reconhece e se percebe também nos discursos midiáticos - de modo especial naqueles de matriz melodramática, entretanto, dispõe de outros saberes e de outras referências culturais não midiáticas para pensar e construir suas percepções de mundo e constituírem-se continuamente, desde diferentes gerações e a partir de identidades familiares. Tais identidades se caracterizam, sobretudo pelo sentimento de pertencimento quer da própria linhagem, quer da cidade ou do bairro em que vivenciam sua sociabilidade; e também pela forte relação entre a fé e o lúdico vivenciados nos modos de expressarem sua religiosidade e festividades. A investigação corrobora que as diversas aplicações do estudo dessa família permitem levantar hipóteses sobre outros fenômenos similares. / This thesis aims at understanding in what way the melodrama genre – in its updates through (tele)novela, the folk theatrical tradition bumba-meu-boi and the familiar socio-communicative practices – constitutes itself in a cultural matrix to the identity of a popular class family. We work with three generations of a family from Maranhão seeking to identify the uses, consumption and reception on tele (novela), as well as other socio-communicative and media practices throughout time. The primary observation of the field lead to the hypothesis that melodrama constitutes privileged matrix to the understanding of family(ies) identity (ies) because of the intense traffic and exchange of values that exist in tele (novela) and in a diversity of popular culture expressions. Therefore, we discuss historical and conceptual aspects of melodrama and its connections with telenovela and bumba-meu-boi; we debate about the various cultural matrixes of melodrama articulated to the production and disseminated by these two narrative formats; we reflect upon the concept of identity from different perspectives. In regard of the methodological issue, we outline a framework that contemplates both the theoretical reflection and the methodical research, choosing the method of oral history based on the technique of family history. For that, semi-structured and in-depth interviews were conducted, besides questionnaire and ethnographic observations. Among the main results, we point out: the family possesses a shared symbolic repertoire that recognizes and is aware of itself in media discourses – particularly in the ones of melodramatic matrix, however it has other knowledges and cultural references that don’t pertain to the media to reflect upon and build its perceptions of the world and continuously constitute itself, in different generations and based on family identities. Such identities are characterized, mainly, by the feeling of belonging to their own lineage, to a city or a neighborhood where they experience their sociability; and also by the strong relation between faith and ludic experienced in the ways their religiosity and festivities are expressed. The investigation corroborates that various applications of this family allows the bringing up of hypothesis concerning similar phenomena.