Reading is one of the most important activities in most people’s life. For children, reading is a window to knowledge, good educational achievement and better job opportunities in the future. Thus reading fluency is a very important factor in the child’s education. Children and young adults with low vision usually use a close working distance to gain relative distance magnification. Unlike adults, they have active accommodation. Many studies, however, have shown that children and young adults with low vision have reduced accommodation response compared to the norms of their age. Reading additions (high plus lenses) can correct for this reduction in accommodation and may be an optimum method of prescribing magnification in younger adults with low vision. There have been no studies to verify the best method of prescribing reading additions in young adults with low vision and few studies of their effect on reading performance. This is the first study to compare different methods to determine reading additions and their effect on reading performance in young adults with low vision. The aims of the present study are 1) to investigate if three different methods to determine reading additions would lead to significantly different dioptric powers 2) to determine which method (if any) would lead to better reading performance. Reading performance was assessed by measuring the maximum reading speed, critical print size (CPS), print size threshold and the area under the reading speed curve. This was an experimental study involving thirty participants with low vision aged between 8 to 35 years. Participants were recruited from the Low Vision Clinic at the School of Optometry, University of Waterloo, Canadian National Institute for the Blind (CNIB) and the Vision Institute of Canada. All participants underwent a routine clinical examination including distance visual acuity, near visual acuity, Pelli-Robson contrast sensitivity, unilateral cover test, static retinoscopy, subjective refraction and measurement of the habitual reading distance. A questionnaire was used to determine their usage of any low vision aids, their perceived difficulty with reading and time spent reading. Reading additions were determined by 1) an objective method using Nott dynamic retinoscopy 2) an age-based formula 3) a subjective method based on the participant’s response to lenses. Reading tasks and dynamic retinoscopy were conducted at a fixed working distance of 12.5cm. Reading performance was assessed using MNREAD-style reading charts with each of the reading additions and without a reading addition, in a random order. Sentences were arranged in way that no sentence was repeated by the same participant. Participants were timed with a stop watch in order to calculate the reading speed in correct words per minute (CWPM). Reading speeds were plotted against print size to calculate the maximum reading speed, the critical print size, MNREAD threshold and the area under the reading speed curve. The participant’s mean age was 16 (± 6) years. There were equal number of males and females. The mean distance visual acuity of the tested eye ranged from 0.357 to 1.184 logMAR with a mean of 0.797 ± 0.220 logMAR. The near visual acuity ranged between 0.301 to 1.301 logMAR with a mean of 0.80 ± 0.26 logMAR. There were six participants who already had a reading addition. Maximum reading speed ranged between 52 to 257 wpm (165 ± 61 wpm). Critical print size ranged between 0.325 to 1.403 logMAR (0.965 ± 0.279 logMAR). Repeated measures ANOVA on the whole group showed that there was a significant difference between the reading additions (p=0.001). The retinoscopy reading addition power was significantly lower than the age add (p=0.002) and the subjective add (p=0.038). Repeated measures ANOVA did not show any improvement of any of the reading measures with the reading additions compared to without the reading addition. A re-analysis was undertaken excluding participants who had normal accommodation at 12.5cm. The results of repeated measures ANOVA showed that there was no significant difference in the dioptric powers obtained by the three methods, although, all reading addition power were significantly greater than zero (t-test <0.0005). There was a significant difference in the area under the reading speed curve (p=0.035), which was greater with the subjective addition than with no reading addition (p=0.048). The MNREAD threshold significantly improved with the age addition compared to no addition (p=0.012). There was a large variability between the participants in their response to a reading addition. Analysis of individual data showed that some participants showed a clear improvement in reading performance with a reading addition. Other participants did not demonstrate any obvious improvement in reading performance with reading additions. Of those participants who showed an improvement, all but one participant had abnormal accommodation. However, not all participants who did not show an improvement had normal accommodation. Univariate analysis and forward step-wise linear regression analysis were used to investigate if any improvement in reading performance and the habitual reading performance without a reading addition could be predicted by factors that were measured in the study. These factors included distance visual acuity, near visual acuity, contrast sensitivity, lag of accommodation, age, time spent on reading each day, perceived difficulty of reading regular print and whether or not the participant received training for the usage of his/her low vision aids. Improvement in reading performance could not be predicted by any of these factors. Habitual reading performance without a reading addition was correlated with some factors. Univariate analysis showed that critical print size was associated with MNREAD threshold (r=0.904. p<0.0005), distance visual acuity (r=0.681, p<0.0005) and contrast sensitivity (r=-0.428, p=0.018) and MNREAD threshold without an addition was associated with the contrast sensitivity (r=-0.431, p=0.017,) and distance visual acuity (r=0.728, p<0.0005). Difficulty of reading correlated with near visual acuity (Spearman correlation coefficient=0.620, p=0.0009), MNREAD threshold (Spearman correlation coefficient=0.450, p=0.02) and maximum reading speed (Spearman correlation coefficient=-0.472, p=0.014). Time spent on reading each day correlated with the area under the reading speed curve (Spearman correlation coefficient=0.659, p=0.0024). The multiple regression analysis showed that MNREAD threshold was best predicted by distance visual acuity (R=0.728, p <0.0005), critical print size could be predicted by distance visual acuity (R=0.681, p <0.0005) and age (R=0.748, p=0.022) and the power of the subjective addition could be predicted by age (R=0.583, p=0.001) and near visual acuity (R=0.680, p=0.028). There was evidence that a reading addition improved reading performance as measured by the area under the curve and MNREAD (reading acuity) thresholds, but this was not predicted by any visual factor, except that all those who gained improvement had poor accommodation. Therefore, it is recommended that an eye care practitioner should demonstrate a reading addition in a low vision assessment of children and young adults, particularly with patients who have reduced accommodation.

Implementing the legal mandate to accommodate students with impairments in higher education, particularly in fieldwork settings, poses a significant challenge to retaining academic integrity (Pardo, 1999). Currently, there is no consistent way of determining which academic requirements are “bona fide” (OHRC, 2004), and might not be altered for students with disabilities, and those which can be accomplished using a different method. Situating accommodation and accessibility within the Environmental Factors domain of the World Health Organization’s International Classification of Function, Disability and Health (ICF) as a theoretical framework, a set of questions are presented to determine whether academic requirements in fieldwork can be accommodated or not, and why. Combining an occupational therapy perspective on the importance of task analysis (Ashworth, 1995) with the means of identifying discrimination laid out in the human rights case law provides the required tools for such an analysis. This dissertation examines the intersection of legislated mandates for accommodation and academic integrity, by applying human rights legislation to higher education. Using the three-step test of discrimination set out in Meiorin (1999) and an additional question based on Granovsky (2000) to analyze academic tasks and requirements of fieldwork, bona fide requirements can be determined. The resulting model for determining accommodation for students with impairments is applicable to accommodation of disability in primary and secondary education, as well as in the employment sector and accessibility planning, and contributes to standards of practice in academic accommodation planning, a need identified by Reed, Lund-Lucas, & O'Rourke (2003). Following the introduction, six distinct chapters explore 1) the background of accommodation in post-secondary education, 2) the weaving together of models of disability with legislated requirements and curricula, 3) the human rights paradigm itself, 4) accommodation policies, 5) an experimental focus group investigation of the proposed model, and 6) an explication of when accommodation might not be appropriate. The conclusion draws these various threads together into a lifeline for accommodation analysis and planning. / Thesis (Ph.D, Education) -- Queen's University, 2013-02-04 19:28:14.838

The changes in the human crystalline lens shape and its internal structure during accommodation and with aging are a fundamental component of the dynamic mechanism of accommodation and presbyopia, the loss of near vision with age. A better understanding of the crystalline lens changes during accommodation will help in developing new treatments to correct for presbyopia. The goal of this dissertation is to design and develop an imaging system to study the dynamic changes in lens shape during accommodative response. An imaging system based on spectral domain optical coherence tomography (SD-OCT) was developed with long axial range, high axial and lateral resolution and high speed for in vivo imaging the anterior segment along its entire length at video-rate. A slit-lamp mounted optical delivery scanning device for the extended depth SD-OCT system was developed. The delivery system was combined with a custom made unit that provides accommodation and disaccommodation step stimuli. A method to correct for the distortions of the OCT images was also developed that provides corrected two dimensional biometric data at different accommodative states.

The structural basis for the fidelity of translation was modeled using computational methods. The flexibility of tRNA was explored using molecular dynamics and making a database of all crystallographic structures for tRNA. The modes of flexibility were compared based upon several metrics. A method for fitting cryo-EM with crystallographic structures was developed (MdMD), and also, for finding pathways between cryo-EM states. Biasing methods in molecular dynamics were used to model the pathway for the proofreading step of ribosomal translation. Atomic models were made for the Pre- and Post- accommodation state of the ribosome. These results indicated a new hypothesis for the mechanism of proofreading. There was no evidence for an induced fit mechanism in the large or small subunit of the ribosome during this step. The tRNA has a differential deformation in the kink during decoding that is based upon whether the tRNA is cognate or near-cognate. This difference in stored energy affects the outcome of proofreading, and the simulations of this step show that the ribosome presents some barriers, which would reject tRNA with insufficient stored energy.

O transtorno obsessivo-compulsivo (TOC) é uma doença crônica que causa prejuízos para o paciente, bem como para a maioria dos familiares. Frequentemente interfere no funcionamento familiar, pois muitas vezes os membros da família modificam suas rotinas devido aos sintomas do paciente. Esses comportamentos observados nos familiares são chamados de acomodação familiar (AF). Os comportamentos de AF podem reforçar os sintomas do paciente e, consequentemente, contribuir para a manutenção da doença. A AF tem sido correlacionada com maior gravidade dos sintomas obsessivo-compulsivos e está associada a resposta menos satisfatória a tratamento, por exemplo, terapia cognitivo-comportamental. No entanto, estudos que avaliam o impacto de intervenções para o TOC na AF em curto e longo prazos ainda são escassos. Esta tese é composta de três artigos com os seguintes objetivos: 1) analisar as propriedades psicométricas da versão adaptada para o Brasil da Escala de Acomodação Familiar para o TOC – versão pontuada pelo entrevistador (FAS-IR); 2) verificar o impacto da terapia cognitivo-comportamental em grupo (TCCG), com duas sessões destinadas a família, na AF e identificar as variáveis sociodemográficas e clínicas preditoras de redução da AF após as 12 sessões de tratamento (curto prazo); e 3) avaliar o impacto da TCCG na AF 3 anos após o término do tratamento e verificar a correlação entre a gravidade dos sintomas do TOC e AF em longo prazo. Trata-se de um estudo com pacientes com diagnóstico de TOC e seus respectivos familiares. Para a avaliação dos sintomas obsessivo-compulsivos, foram aplicados os seguintes instrumentos: Inventário de Obsessões e Compulsões – Revisado (OCI-R), Escala Obsessivo-Compulsivo de Yale-Brown (Y-BOCS) e Escala de Impressão Clínica Global (CGI). Também foram aplicados os Inventários de Beck para Depressão (BDI) e Ansiedade (BAI), além da Entrevista Clínica Estruturada para Transtornos de Eixo I do DSM-IV, Versão Clínica (SCID-I), para a verificação de possíveis comorbidades. Para a avaliação da AF, a FAS-IR foi aplicada nos familiares. Após o estudo de validação da FAS-IR, foi realizado um ensaio clínico randomizado com alocação aleatória dos pacientes para o grupo intervenção (12 sessões de TCCG, sendo duas com a participação dos familiares) ou para o grupo controle (lista de espera). Por fim, foi realizado um estudo de seguimento naturalístico 3 anos após o término da TCCG. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegre. Observou-se que a versão da FAS-IR em português brasileiro apresenta propriedades psicométricas satisfatórias, reforçando que este instrumento se mostra confiável para avaliar a participação e modificação da rotina dos familiares em decorrência dos sintomas dos pacientes. No que se refere ao tratamento realizado, o ensaio clínico randomizado compreendeu uma amostra de 98 pares de pacientes com TOC e seus respectivos familiares, sendo que 52 (53.1%) foram randomicamente alocados para o grupo intervenção e 46 (46.9%) para a lista de espera. Houve melhora significativa de todos os sintomas de TOC e também da AF após TCCG no grupo intervenção quando comparado ao grupo controle (p < 0,001). As seguintes variáveis foram preditoras de redução da AF após a análise multivariada: características dos pacientes – ausência de comorbidade com transtorno unipolar (β = 0,338; p = 0,014), pontuação mais baixa de obsessão (β = 0,244; p = 0,045) e maior nível de escolaridade (β = -0,351; p = 0,006); e características dos familiares – pontuação mais elevada de sintomas de colecionismo (β = -0,461; p = 0,001). O modelo explicou 47,2% da variação na AF após a TCCG. No estudo de seguimento, foi observado que os resultados de redução na AF obtidos ao final da TCCG se mantiveram ao longo do tempo (3 anos). Os resultados do presente estudo somam-se às evidências atuais, não somente confirmando que a TCCG é efetiva na redução dos sintomas do TOC, mas também por mostrar que a TCCG com uma breve participação dos familiares com foco na AF contribui para reduzir os níveis de envolvimento da família nos sintomas do paciente, e que esses resultados se mantêm ao longo do tempo. Algumas características dos pacientes e dos familiares foram preditoras da redução da AF, um resultado que pode contribuir para a qualificação dos protocolos de TCCG atualmente empregados. Este é o primeiro estudo a avaliar o impacto da TCCG (com a participação da família em duas sessões) na AF em curto e longo prazos. A partir dos resultados, pode-se concluir que é importante avaliar a AF permanentemente, assim como incluir a família no tratamento para o TOC. / Obsessive-compulsive disorder (OCD) is a chronic illness that negatively affects the lives of patients and usually of family members as well. It frequently interferes with family functioning, as very often family members modify their routines because of the patient’s symptoms. These behaviors observed among family members are referred to as family accommodation (FA). FA behaviors can reinforce the patient’s symptoms and thus contribute to maintain the disorder. FA has been correlated with an increased severity of obsessive-compulsive symptoms and is associated with poorer response to treatment approaches, e.g., cognitive-behavioral therapy. However, there is a scarcity of studies designed to assess the impact of interventions for OCD on FA in both short and long terms. The present thesis includes three research articles, which had the following objectives: 1) to analyze the psychometric properties of the Brazilian version of the Family Accommodation Scale for OCD – Interviewer-Rated (FAS-IR); 2) to assess the impact of cognitive-behavioral group therapy (CBGT) with the involvement of family members in two sessions on FA and to identify sociodemographic and clinical variables predictive of FA reduction after the 12 treatment sessions (short term); and 3) to assess the impact of CBGT on FA 3 years after completion of the program and to investigate the correlation between severity of OCD symptoms and FA in the long term. The study included patients with a diagnosis of OCD and their family members. Obsessive-compulsive symptoms were assessed using the following instruments: Obsessive-Compulsive Inventory – Revised (OCI-R), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and Clinical Global Impressions Scale (CGI). Beck Depression (BDI) and Anxiety (BAI) Inventories, as well as the Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-I), were also administered to investigate the presence of possible comorbidities. FA was assessed using the FAS-IR, administered to family members. Upon completion of the FAS-IR validation study, a randomized clinical trial was conducted, randomly assigning patients to either the intervention group (12 sessions of CBGT, of which two involved family members) or to a control group (waiting list). Finally, a naturalistic follow-up study was conducted 3 years after completion of the CBGT program. The study was approved by the Research Ethics Committee of Hospital de Clínicas de Porto Alegre. We found that the Brazilian Portuguese version of the FAS-IR had sound psychometric properties, reinforcing that this is a reliable instrument for assessing the participation and modifications of the routines of family members as a result of the patient’s symptoms. With regard to treatment outcomes, the randomized clinical trial included a sample of 98 pairs of patients with OCD and their family members, of which 52 (53.1%) were randomly allocated to the intervention group and 46 (46.9%) to the waiting list. There was a significant improvement of all OCD symptoms and also of FA levels after CBGT in the intervention group when compared to the control group (p < 0.001). The following variables were predictors of FA reduction after the multivariate analysis: patient characteristics – absence of comorbid unipolar disorder (β = 0.338; p = 0.014), a lower obsession score (β = 0.244; p = 0.045), and higher education level (β = -0.351; p = 0.006); and family member characteristics – a higher hoarding score (β = -0.461; p = 0.001). The model explained 47.2% of the variance in FA scores after CBGT. Finally, in the follow-up study, the FA reduction results obtained at the end of CBGT were found to remain in the long term (3 years). These results add to the current body of evidence not only by confirming that CBGT is effective in reducing OCD symptoms, but also by showing that CBGT with a brief family intervention focused on FA contributes to reduce the level of involvement of family members in the patient’s symptoms, and that these results are maintained over time. Some patient and family member characteristics were found to predict FA reduction, a finding that can contribute to qualify the CBGT protocols currently employed. This is the first study to assess the impact of CBGT (with the participation of family members in two sessions) on FA in both short and long terms. These findings underscore the importance of permanently assessing FA, as well as of involving family members in the treatment of patients with OCD.

Due to an increased flow of refugees, migration has become an important issue that hasraised a lot of concern during the past years. During 2015 alone European member statesreported almost two million migrants crossing their external borders. This study aims tobring into light how the refugees that arrived in Romania starting with late 2014 till present,after being granted asylum or subsidiary protection manage to accommodate themselveswithin the communities they choose to settle. It does so by exploring the way these refugeesconstruct and develop feelings of home and belonging abroad. This study research questionsare first: how do refugees experience local communities and establish feelings of home andbelonging? and second: how does the life course perspective help the refugees getaccommodated to their new urban environment? The empirical research to answer thesequestions is qualitative, relying on in depth, semi structured life history interviews held withrefugees that have been granted asylum or subsidiary protection by the Romanian statestarting with the late 2014 until present. The findings pointed out: 1) the effect of the lifecourse: (e.g. the events of being uprooted and relocated into a foreign land brought lifealtering changes in an individuals’ life course). 2) The individuals interviewed showedintimate emotions about their new home and feelings of belonging. 3) The informantsperceived their experience as a perceptual process of negotiation with themselves and thelocal community from which they belong.

The aim of this work is to identify economical approaches in the accommodation offers in surveyed area and to consider the importance of friendly approaches in the accommodation offer in a strategy of companies offering accommodation, to emphasise the importance of enviromentally sustainable tourism, to analyse requirements of tourists on the eco-friendly accommodation, and on the basis of these analyses, to suggest possible improvements of this accommodation.

O Transtorno Obsessivo-Compulsivo (TOC) é um transtorno crônico que causa prejuízos significativos tanto para o paciente como para os seus familiares. De um modo geral, interfere no funcionamento familiar, pois muitas vezes leva os membros de uma família a modificar suas rotinas em função dos sintomas do paciente. As mudanças de comportamentos dos familiares em decorrência desses sintomas são chamadas de Acomodação Familiar (AF). O presente estudo teve como objetivos: primeiramente traduzir e adaptar para o português a Family Accommodation Scale for Obsessive-Compulsive Disorder: Interviewer-Rated (FAS-IR) e, em segundo lugar, examinar se fatores sociodemográficos e clínicos estão ou não associados à AF. Após realizada a tradução e adaptação da escala, foi realizada a segunda etapa do trabalho com uma amostra ambulatorial constituída de 114 pacientes com TOC e seus respectivos familiares. Para avaliação dos sintomas obsessivo-compulsivos (OC) nos pacientes, foram aplicadas as seguintes escalas: DY-BOCS, Y-BOCS e CGI. Para analisar sintomas de depressão e ansiedade, foram aplicados o BDI e o BAI, e para a verificação de possíveis comorbidades, o SCID. Nos familiares, para avaliar a AF foi aplicada a FAS-IR, e para verificação de sintomas OC, a Y-BOCS e a OCI-R. Dois modelos de regressão linear múltipla foram utilizados: o primeiro modelo foi utilizado para avaliar a relação entre as variáveis do paciente e a AF; já o segundo foi utilizado para avaliar as variáveis do familiar e a AF. Averiguou-se que a AF era altamente prevalente entre os familiares na população em estudo. O fator do paciente associado positivamente com a AF foi gravidade do TOC, enquanto AF estava associada inversamente a pior dimensão do paciente ser obsessões com conteúdo agressivo. As características dos familiares associadas positivamente com AF foram sintomas OC nos familiares e o familiar ser o cônjuge do paciente. A AF é muito comum nas famílias de portadores do TOC, mas ainda são pouco conhecidas as razões que levam os familiares a mudarem seu comportamento. É importante estar atento a esse fato, pois tais comportamentos de acomodação podem servir de reforço aos sintomas do paciente e consequentemente contribuir para sua manutenção. / Obsessive-Compulsive Disorder (OCD) is a chronic disorder that causes significant impairments both to patient and his/her family members. Generally, it interferes with familiar functioning, since it frequently drives family members to modify their routines because of the patient‟s symptoms. Changes on family members‟ behaviors as a consequence of these symptoms are termed as Family Accommodation (FA). The present study aimed at: firstly translate into and adapt to Portuguese the Family Accommodation Scale for Obsessive-Compulsive Disorder: Interviewer-Rated (FAS-IR) and, secondly, to examine whether or not socio-demographic and clinical factors are associated to FA. After the scale was translated and adapted into Portuguese, the second step of the research was performed with an outpatient sample comprised 114 patients with OCD and their respective family members. To evaluate the obsessive-compulsive (OC) symptoms on patients, the following scales were applied: DY-BOCS, Y-BOCS, and CGI. To analyze depressive and anxiety symptoms, the BDI and BAI scales were used, and to verify possible comorbidities, the SCID. On family members, to evaluate the FA, FAS-IR was applied, and to verify the OC symptoms, the Y-BOCS and OCI-R scales. Two multiple linear regression models were used: the first one was used to evaluate the relationship between patient‟s variables and the FA; and the second one, to evaluate the relationship between family member‟s variables and the FA. It was noted that FA was highly prevalent among the family members in the studied population. The patient‟s factor positively associated with FA was OCD severity, whereas FA was inversely associated with the patient‟s worst dimension being obsessions with aggressive content. Family members‟ characteristics positively associated with FA were OC symptoms in family members and the family member being the patient‟s spouse. The FA is highly common among OCD carriers‟ families, but the reasons that drive family members to modify their own behaviors are not yet well known. It is important to be aware of this fact, since these accommodation behaviors may serve as a reinforcer of the patient‟ symptoms, and, consequently, contribute in keeping them.

O transtorno obsessivo-compulsivo (TOC) é uma doença crônica que causa prejuízos para o paciente, bem como para a maioria dos familiares. Frequentemente interfere no funcionamento familiar, pois muitas vezes os membros da família modificam suas rotinas devido aos sintomas do paciente. Esses comportamentos observados nos familiares são chamados de acomodação familiar (AF). Os comportamentos de AF podem reforçar os sintomas do paciente e, consequentemente, contribuir para a manutenção da doença. A AF tem sido correlacionada com maior gravidade dos sintomas obsessivo-compulsivos e está associada a resposta menos satisfatória a tratamento, por exemplo, terapia cognitivo-comportamental. No entanto, estudos que avaliam o impacto de intervenções para o TOC na AF em curto e longo prazos ainda são escassos. Esta tese é composta de três artigos com os seguintes objetivos: 1) analisar as propriedades psicométricas da versão adaptada para o Brasil da Escala de Acomodação Familiar para o TOC – versão pontuada pelo entrevistador (FAS-IR); 2) verificar o impacto da terapia cognitivo-comportamental em grupo (TCCG), com duas sessões destinadas a família, na AF e identificar as variáveis sociodemográficas e clínicas preditoras de redução da AF após as 12 sessões de tratamento (curto prazo); e 3) avaliar o impacto da TCCG na AF 3 anos após o término do tratamento e verificar a correlação entre a gravidade dos sintomas do TOC e AF em longo prazo. Trata-se de um estudo com pacientes com diagnóstico de TOC e seus respectivos familiares. Para a avaliação dos sintomas obsessivo-compulsivos, foram aplicados os seguintes instrumentos: Inventário de Obsessões e Compulsões – Revisado (OCI-R), Escala Obsessivo-Compulsivo de Yale-Brown (Y-BOCS) e Escala de Impressão Clínica Global (CGI). Também foram aplicados os Inventários de Beck para Depressão (BDI) e Ansiedade (BAI), além da Entrevista Clínica Estruturada para Transtornos de Eixo I do DSM-IV, Versão Clínica (SCID-I), para a verificação de possíveis comorbidades. Para a avaliação da AF, a FAS-IR foi aplicada nos familiares. Após o estudo de validação da FAS-IR, foi realizado um ensaio clínico randomizado com alocação aleatória dos pacientes para o grupo intervenção (12 sessões de TCCG, sendo duas com a participação dos familiares) ou para o grupo controle (lista de espera). Por fim, foi realizado um estudo de seguimento naturalístico 3 anos após o término da TCCG. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegre. Observou-se que a versão da FAS-IR em português brasileiro apresenta propriedades psicométricas satisfatórias, reforçando que este instrumento se mostra confiável para avaliar a participação e modificação da rotina dos familiares em decorrência dos sintomas dos pacientes. No que se refere ao tratamento realizado, o ensaio clínico randomizado compreendeu uma amostra de 98 pares de pacientes com TOC e seus respectivos familiares, sendo que 52 (53.1%) foram randomicamente alocados para o grupo intervenção e 46 (46.9%) para a lista de espera. Houve melhora significativa de todos os sintomas de TOC e também da AF após TCCG no grupo intervenção quando comparado ao grupo controle (p < 0,001). As seguintes variáveis foram preditoras de redução da AF após a análise multivariada: características dos pacientes – ausência de comorbidade com transtorno unipolar (β = 0,338; p = 0,014), pontuação mais baixa de obsessão (β = 0,244; p = 0,045) e maior nível de escolaridade (β = -0,351; p = 0,006); e características dos familiares – pontuação mais elevada de sintomas de colecionismo (β = -0,461; p = 0,001). O modelo explicou 47,2% da variação na AF após a TCCG. No estudo de seguimento, foi observado que os resultados de redução na AF obtidos ao final da TCCG se mantiveram ao longo do tempo (3 anos). Os resultados do presente estudo somam-se às evidências atuais, não somente confirmando que a TCCG é efetiva na redução dos sintomas do TOC, mas também por mostrar que a TCCG com uma breve participação dos familiares com foco na AF contribui para reduzir os níveis de envolvimento da família nos sintomas do paciente, e que esses resultados se mantêm ao longo do tempo. Algumas características dos pacientes e dos familiares foram preditoras da redução da AF, um resultado que pode contribuir para a qualificação dos protocolos de TCCG atualmente empregados. Este é o primeiro estudo a avaliar o impacto da TCCG (com a participação da família em duas sessões) na AF em curto e longo prazos. A partir dos resultados, pode-se concluir que é importante avaliar a AF permanentemente, assim como incluir a família no tratamento para o TOC. / Obsessive-compulsive disorder (OCD) is a chronic illness that negatively affects the lives of patients and usually of family members as well. It frequently interferes with family functioning, as very often family members modify their routines because of the patient’s symptoms. These behaviors observed among family members are referred to as family accommodation (FA). FA behaviors can reinforce the patient’s symptoms and thus contribute to maintain the disorder. FA has been correlated with an increased severity of obsessive-compulsive symptoms and is associated with poorer response to treatment approaches, e.g., cognitive-behavioral therapy. However, there is a scarcity of studies designed to assess the impact of interventions for OCD on FA in both short and long terms. The present thesis includes three research articles, which had the following objectives: 1) to analyze the psychometric properties of the Brazilian version of the Family Accommodation Scale for OCD – Interviewer-Rated (FAS-IR); 2) to assess the impact of cognitive-behavioral group therapy (CBGT) with the involvement of family members in two sessions on FA and to identify sociodemographic and clinical variables predictive of FA reduction after the 12 treatment sessions (short term); and 3) to assess the impact of CBGT on FA 3 years after completion of the program and to investigate the correlation between severity of OCD symptoms and FA in the long term. The study included patients with a diagnosis of OCD and their family members. Obsessive-compulsive symptoms were assessed using the following instruments: Obsessive-Compulsive Inventory – Revised (OCI-R), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and Clinical Global Impressions Scale (CGI). Beck Depression (BDI) and Anxiety (BAI) Inventories, as well as the Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-I), were also administered to investigate the presence of possible comorbidities. FA was assessed using the FAS-IR, administered to family members. Upon completion of the FAS-IR validation study, a randomized clinical trial was conducted, randomly assigning patients to either the intervention group (12 sessions of CBGT, of which two involved family members) or to a control group (waiting list). Finally, a naturalistic follow-up study was conducted 3 years after completion of the CBGT program. The study was approved by the Research Ethics Committee of Hospital de Clínicas de Porto Alegre. We found that the Brazilian Portuguese version of the FAS-IR had sound psychometric properties, reinforcing that this is a reliable instrument for assessing the participation and modifications of the routines of family members as a result of the patient’s symptoms. With regard to treatment outcomes, the randomized clinical trial included a sample of 98 pairs of patients with OCD and their family members, of which 52 (53.1%) were randomly allocated to the intervention group and 46 (46.9%) to the waiting list. There was a significant improvement of all OCD symptoms and also of FA levels after CBGT in the intervention group when compared to the control group (p < 0.001). The following variables were predictors of FA reduction after the multivariate analysis: patient characteristics – absence of comorbid unipolar disorder (β = 0.338; p = 0.014), a lower obsession score (β = 0.244; p = 0.045), and higher education level (β = -0.351; p = 0.006); and family member characteristics – a higher hoarding score (β = -0.461; p = 0.001). The model explained 47.2% of the variance in FA scores after CBGT. Finally, in the follow-up study, the FA reduction results obtained at the end of CBGT were found to remain in the long term (3 years). These results add to the current body of evidence not only by confirming that CBGT is effective in reducing OCD symptoms, but also by showing that CBGT with a brief family intervention focused on FA contributes to reduce the level of involvement of family members in the patient’s symptoms, and that these results are maintained over time. Some patient and family member characteristics were found to predict FA reduction, a finding that can contribute to qualify the CBGT protocols currently employed. This is the first study to assess the impact of CBGT (with the participation of family members in two sessions) on FA in both short and long terms. These findings underscore the importance of permanently assessing FA, as well as of involving family members in the treatment of patients with OCD.

Previous research done in sociophonetic variation of second language speakers has often looked at constraints of formality affecting degree of foreign accent and how this degree of formality can have effects on what speaking styles speakers choose to employ. Furthermore, other social constraints of convergence and divergence of speech affect speaker speaking style. However, no known previous research has examined interdental fricative /θ ð/ substitution based on each speaker's interlocutor. This study explores second language speakers' English interdental fricative substitution sounds in terms of sociophonetic variation of formality and speaker interlocutor(s). Five native language pairs of Arabic, Cantonese, French, Portuguese, and Vietnamese origin were part of the study, comprising ten participants in total. The study finds age of English onset, as verified by the literature, to be the most determining factor for accurate articulation of these marked fricatives. However, other constraints for substitution choice are at hand including phonological limitations and estimated linguistic experience based on demographic information given by survey participants. The primary aim of the study is to associate some of the interdental fricative substitutions with a social variable. Data for the study include recordings of each participant reading a poem by him/herself, a dialogue with the other same native language participant, and a dialogue with a native speaker of American English. The data analysis examined the replacement sounds in terms of native language background, linguistic experience variables, and phonological constraints. In addition, quantities and ratios of specific replacement sounds for each participant per recording and per native language pair were compared and contrasted to find if speech accommodation theory (SAT), as proposed by Giles et al. (1991), played a role in any of the participants' choices for substitution. The study finds both convergence and divergence of interdental fricative substitutions to be characteristic of speakers with less linguistic experience in English. An additional stronger finding is that most participants' most common sound substitutions for the voiced and voiceless interdental fricatives were independent in place and manner, the voiced most commonly replaced by dental and alveolar plosives [ḏ d] and the voiceless most commonly replaced by labiodental fricative [f], which could be an indication of each fricative's acoustic and phonemic representation in each non-native speaker's phonological component, supported by findings of Brannen (2002). Some literature suggests that varying values of [continuant] in speakers' native languages are the means by which speakers choose the replacement sounds they do. However, such an explanation cannot be the only valid one when inherent variability comes into play and different places and manners of articulation are chosen for both interdental fricatives.