Bariatric surgery has emerged as the most effective method for producing substantial long-term weight loss and inducing remission or reducing severity of many comorbidities for individuals with severe obesity. However, maintaining these successes from surgery requires that individuals combine the surgical intervention with numerous behavioral changes including dietary, physical activity, and lifestyle behaviors. Despite the positive weight and health outcomes associated with bariatric surgery, a proportion of the population experiences insufficient weight loss or weight regain, which may depend on the individual’s adherence to the bariatric behavioral recommendations. Few studies have investigated specific bariatric behaviors and whether they are impactful on weight outcomes. The purpose of this study was to (1) examine the extent to which constructs of the extended Theory of Planned Behavior (TPB) predicted six bariatric behaviors: (a) eating protein at the start of a meal, (b) eating three to five daily servings of fruits and vegetables, (c) avoiding sweet foods, (d) avoiding salty snack foods, (e) avoiding sugar sweetened beverages, and (f) exercising for 30 minutes daily at moderate to vigorous intensity; (2) to evaluate the relationship of the aforementioned behaviors with excess weight loss outcomes; and (3) to explore the facilitators and barriers successful bariatric patients identify as factors that influence their adherence to bariatric dietary and exercise behaviors. A sequential explanatory mixed methods approach was used to address the purpose of this study. The first component consisted of collecting quantitative data from bariatric patients between 6-24 months post-operative while the second was completed by collecting qualitative data from participants, who based on certain criteria, were considered to be successful one year or more after their bariatric surgeries. Quantitative component: A cross sectional design examined a convenience sample of 136 mainly female (89.7%) and Hispanic (72.1%) bariatric patients that underwent either a Roux-en-Y gastric bypass or sleeve gastrectomy in one ethnically diverse New York City hospital. Instruments for this study were developed based on previous research and translated into Spanish. Reliability estimates and content validity were assessed with a sample similar to that used in the study for both the English and Spanish instruments. The variables found in the extended TPB were assessed through instrument items that measure intention, attitudes, subjective norms, perceived behavioral control, anticipated behavioral outcomes, normative beliefs, control beliefs, and the additional constructs of anticipated emotions and self-identity in relation to the six bariatric behaviors. Adherence to bariatric behaviors was measured by a frequency instrument. Pre- and post-operative weight measures were obtained from participants’ electronic medical records. Multiple regressions were used to establish the predictors for each behavior. For each behavior, attitudes towards the behavior contributed to the model for predicting behavioral intention. On the other hand, subjective norms were not found to be predictive for all behaviors with the exception of avoiding sweet foods. Behavioral intention for all behaviors was low and mainly non-significant, suggesting other constructs may be involved in order to adhere to the behavior. The level of adherence to these six behaviors remained consistent over the 6 to 24 post-operative months. To note, participants were not adherent to fruit and vegetable consumption and physical activity recommendations. Qualitative component: A purposeful sample of 11 bariatric patients that were considered successful based on study criteria participated in in-depth, semi-structured, individual interviews using a questionnaire developed from the main theoretical constructs of the TPB. In an effort to increase the understanding of the facilitators of and barriers to adherence, the addition of constructs found in the Health Action Process Approach framework were used to identitfy emerging themes. Content analysis of audio recording revealed (a) outcome expectations, (b) nutrition knowledge and skills, (c) social support, (d) attitudes towards adherence, (e) perceived behavioral control, (f) coping and planning strategies, and (g) recovery self-efficacy as major themes that influenced participants’ behaviors. A main facilitator to adhere to bariatric recommendations was outcome expectation, as post-operative patients saw the improvements in their health and quality of life following the bariatric surgery intervention as motivators to continue following recommendations and therefore preserve positive outcomes. At the same time, many participants stated difficulty in adhering to the recommendation of exercising at a moderate or vigorous intensity for 30 minutes on a daily basis. Conclusion: Using a behavioral change theory provides a valuable framework for explaining adherence to healthy dietary and physical activity behaviors for bariatric patients. Nutrition education and behavioral interventions should focus on improving adherence to the recommendations of consuming fruits and vegetable and exercising daily, aiming to enhance attitudes towards these post bariatric surgery behaviors and addressing barriers to physical activity.

A crise global do capitalismo eclodida no ano de 2008 evidenciou o risco sistêmico a que a atividade econômica ficou exposta a partir da sua desregulamentação, implementada, a partir dos anos 1980, pelo chamado neoliberalismo, e do desenvolvimento dos meios de comunicação e informáticos, que a interligou em nível planetário. Seus efeitos devastadores somente puderam ser contidos por meio de intervenção estatal, com a injeção de muito dinheiro público na atividade econômica privada, o que trouxe à tona a discussão quanto ao real papel regulatório do Estado sobre a economia nesse contexto. No panorama atual do desenvolvimento da sociedade capitalista e contemporânea, há, muitas vezes, verdadeiro divórcio entre os interesses do real proprietário da empresa (ausente ou passivo) e o corpo de gestores contratados da companhia, impondo a necessidade de maior confiabilidade e transparência na apuração e nos demonstrativos dos resultados empresariais. Surge daí o conceito de boas práticas de governança corporativa, do qual um dos pilares de sustentação é o denominado compliance, que funciona como uma estrutura verificadora e validadora do bom funcionamento, da correção e da confiabilidade da administração, prevenindo riscos imanentes à atividade empresarial. Surge, nesse cenário, uma concepção de autorregulação regulada ou forçada da atividade econômica, pela qual o Estado supera uma postura meramente repressora de desvios encontrados, que relegava ao particular sua própria organização, passando a impor uma pauta mínima de obrigações organizacionais, que necessita ser cumprida e implementada para prevenir riscos de condutas antiéticas ou mesmo criminosas. O papel do direito penal, sempre mais modesto do que dele se espera, acaba ganhando muita importância por atuar como norma de reforço à tutela de deveres organizacionais e de autofiscalização da atividade econômica. Os meios eleitos para atingir esses objetivos são a utilização de tipos penais de perigo abstrato, omissivos ou comissivos por omissão; a incriminação da corrupção privada; a promulgação de leis extraterritoriais que preveem a colaboração entre Estados no combate à criminalidade; a adoção de sistemas legais autodenominados administrativos, mas que são penais em sua essência; a crescente aceitação e utilização da responsabilidade penal da pessoa jurídica. Partindo de constatações criminológicas e proposições político-criminais, a presente tese visa a propor a criação de um sistema de imputação penal das pessoas jurídicas baseado na ideia de fato próprio culpável, com a culpabilidade atrelada ao conceito de defeito de organização, visando a superar o déficit na aplicação do modelo adotado pela Lei nº 9.605/1998, na qual não há o estabelecimento de quaisquer critérios para delimitar o âmbito das ações corporativas culpáveis. Para tanto, buscaram-se, em modelos jurídicos alienígenas (italiano, chileno e espanhol), experiências e exemplos que pudessem auxiliar na proposição de critérios reitores de um novo modelo adaptado à realidade brasileira, pelos quais se almeja a maximização das possibilidades de aplicação do instituto, de um lado, e a maior amplitude possível das garantias penais, de outro. / The global crisis of capitalism, which emerged in 2008, displayed the systemic risk that economic activity was exposed to. This risk occurs due to the deregulation implemented from 1980 by the so-called neoliberalism as well as due to the development of both the media and IT which have globally interconnected economic activity. The devastating effects of neoliberalism could only be restrained through state intervention, with the injection of great amounts of public money into private economic activity. In this context, this practice brought up the discussion on the actual regulatory role of the state in economy. In the current scenario of the development of contemporary capitalist society, there is often an actual separation between the interests of the real owner of the company (who is absent or passive) and the board of hired managers of the company. This fact generates the need for increased reliability and transparency in the calculation and statements of business results. The concept of good corporate governance practices is thus generated, which has compliance as one of its supporting pillars. Compliance works as a testing and validating structure of managerial functioning, correctness and reliability, thus, preventing risks that are inherent to business activity. In this scenario, the concept of regulated or forced self-regulation of economic activity was created. By this concept, the state goes beyond the previous position of merely repressing identified deviations, which meant that the organization could regulate itself. Now the state imposes an agenda of organizational duties, which need to be fulfilled and implemented to prevent risks of unethical or even criminal behavior. The role of criminal law, which has had a more modest scope than expected, ends up gaining importance because it acts as reinforcement rule for the protection of organizational duties and self-inspection of economic activity. The means chosen to achieve these goals are the use of criminal types of abstract danger, which may be either omissive or comissive by omission; incrimination of private corruption; enactment of extraterritorial laws that provide for collaboration among States in combating crime; adoption of legal systems in the administrative scope that are criminal in their essence; the increased acceptance and use of the criminal liability of legal entities. Starting from criminological findings and political-criminal propositions, this thesis aims at proposing the creation of a criminal imputation system of legal entities, based on the idea of a fact itself that can be considered as liable. The guilt is attached to the concept of organization defect in order to overcome the deficit in the implementation of the model adopted by Law No. 9.605/1998, which has not established any criteria to specify the scope of corporate actions that may be considered as liable to penalty for law offence. Therefore, we researched experiences and examples in foreign legal models (Italian, Chilean and Spanish legal models) that could help to propose criteria that lead to a new model adapted to the Brazilian reality, in which we aim, on the one hand, to maximize the possibilities of this new legal model, and, on the other hand, reach penal guarantees as widely as possible.

An instructor's power in the classroom is constructed and sustained through communication. The aim here is to examine how a teacher's power can be negotiated through a lens of servant leadership in hopes of furthering modes in which communication scholars can train future teachers to utilize their power in the classroom. I hypothesize that a teacher utilizing a servant leadership framework employs more pro-social behavioral alteration techniques (BATs). Participants were asked to answer an online survey with questions regarding a chosen instructor's attributes of servant leadership and behavioral alteration messages (BAMs). My hypothesis was partially supported in that that are perceived to use persuasive mapping a specific dimension of servant leadership engage in significantly more pro-social BATs; however, instructors with higher levels of emotional healing engage in significantly more anti-social BATs. Additionally, the gender of the participant and rank of the instructor evaluated influenced students' perceptions of compliance-gaining strategies. The discussion examines the specific dimensions of servant leadership as they relate to power and explores future directions for research examining professional development and training for future faculty and the need to examine gender of participant and instructors with an experimental research design.

Glaukom är än kronisk sjukdom i synnerven som medför synfältsdefekter, oftast i samband med förhöjt ögontryck. I västvärlden är glaukom den näst vanligaste orsaken till blindhet. Det uppskattas att mer än 60 miljoner människor i hela världen har glaukom och antalet väntas stiga till nästan 80 miljoner år 2020. Även om det finns flera orsaker till glaukom så finns det bara en orsak som kan behandlas, ögontrycket, som ska sänkas med hjälp av ögondroppar. För att kunna bromsa försämringen i patientens sjukdom så krävs det god medverkan av patienten, som noggrant behöver följa läkarens ordination. Trots allvarliga konsekvenser för synen finns det många brister i följsamheten. Syftet med denna uppsats är därför att beskriva faktorer som patienter med glaukom upplever påverkar deras följsamhet till den medicinska terapin. Som metod valdes en litteraturstudie. Åtta kvalitativa primärkällor valdes från databaserna PubMed och Cinahl. Resultatet presenterar fyra huvudteman, Att ha förståelse för sin sjukdomssituation, Att kombinera medicineringen med livet, Individuella förutsättningar och Att ha tillgång till vårdens resurser med tillhörande subteman. Det framkommer i studien att stor vikt ligger på information om sjukdomen och behandlingen. Kunskap om tilltagande försämring trots symtomfrihet samt vilka biverkningar medicineringen kan ge är en förutsättning för att patienten ska följa sin ordinerade terapi. Dessutom måste behandlingen kunna kombineras med patientens vardag för att möjliggöra för patienten att droppa regelbundet. Denna studie visar att flera faktorer ligger hos patienten själv men att även vårdpersonalen har möjlighet att påverka patientens följsamhet positivt. / Program: Fristående kurs

BACKGROUND: Homeless individuals have higher rates of cardiovascular disease when compared to the general population. Educational curricula in such communities have the potential to decrease the morbidity and mortality associated with hypertension and hypercholesterolemia. However, lifestyle changes from these educational sessions can be difficult for homeless individuals to implement because of competing priorities. OBJECTIVES: The objectives of the “Corazones Sanos” community project are to increase participant knowledge of hypertension and hypercholesterolemia and to counsel individuals on barriers to implementation of therapeutic lifestyle changes in the homeless population. Additional objectives include providing reinforcing support for implementation of lifestyle changes and creation of educational materials related to cardiovascular risk and lifestyle changes for the homeless population. METHODS: This community health education project was implemented with 66 patients from an urban transitional housing facility for homeless individuals recovering from substance abuse. Spanish-speaking patients >18 years old with unstable or lack of housing were eligible to participate in this study. Fifteen minute educational sessions were led by the project coordinator with the end knowledge goal of normal blood pressure and cholesterol values, daily exercise requirement, importance of medication compliance, and healthy diet practices. A reflective approach was utilized to assess participant quotations and themes of barriers to heart healthy living in the homeless population. RESULTS: Participants gained a better knowledge of cardiovascular disease risk factors after participating in education sessions. The main barriers to therapeutic lifestyle changes for prevention of cardiovascular disease included decreased access to healthy foods and fitness opportunities, mental health challenges, lack of social support, and recovering from addiction. About 30% of participants completed a follow-up individual education session. CONCLUSIONS: Casa Esperanza community members gained a better understanding of normal blood pressure and cholesterol ranges, healthy dietary practices, daily exercise requirement, and the importance of medication compliance through this education program. The findings from this project should assist healthcare clinicians with providing effective education for the homeless population to overcome the barriers identified and implement therapeutic lifestyle changes.

Objective: To explore 'Maternal Perception of Compliance in Adolescents Model.' The purpose of the model is to explore interrelated factors outside adolescents' agency, but which contribute to maternal perception of severity of compliance in adolescents. This model was originated from reflections on the practice of psychology. Methodology: This inquiry began with pilot studies consisting of a focus group with four parents and an interview. The pilot assisted the fine-tuning the instrument, addressing ethical concerns, forming analytical strategies and gathering a priori themes for the analysis of data from the thesis. The thesis is a qualitative inquiry, data was collected through interviews and utilised a 'maximum variation sampling' of ethnicity (Asian, White, and Black) with socioeconomic status (SES) (low, medium, and high), to recruit six mothers who had adolescent children. Analysis: There was a hybrid approach to the thematic analysis: a) in 'confirmatory analysis,' a priori themes were deductively confirmed and b) in 'exploratory analysis,' new emergent themes were inductively identified. In the first part of the analysis each participant's data was individually analysed, using the hybrid method, to explore the factors that contributed to the model. The second part of the analysis was a 'cross-case analysis,' in which factors identified as contributing to the model, in the first part of the analysis were consolidated to further explore the model. Results: Various types of knowledge (self-reflective, observational, academic, transgenerational, maternal), notions of an ideal child, expectations, style of parenting, style of attribution, maternal anxiety, SES, and single-motherhood were identified as having an effect on the model. In terms of exploration of the model: a) The expectations were largely affected by maternal ideals and standards about adolescents. b) These ideals and standards were derived from their previously acquired knowledge. c) Mothers used the resources at their disposal based on their SES and authoritative parenting style to nurture the child toward their notion of an ideal child. d) The maternal anxiety/single mother/permissive parenting style and some types of knowledge affected the expectation of degree of compliance. e) Mothers often rationalised or justified children's noncompliance through a system called the 'mediating mechanism.' f) Some types of knowledge, mixed parenting style, and external attribution were involved in the 'mediating mechanism.' g) Maternal perception of the extent of adolescents' compliance was based on their degree of expectation of compliance, i.e. the more divergence between the expectations and perception of compliance, the more severe or problematic the perception of compliance. h) Maternal views on compliance varied between mothers, based on their parenting styles. Conclusions: Maternal perception of severity of compliance is not entirely based on children's actual behaviour; rather it is influenced by number of factors that are outside the children's agency. The model, which illustrates how maternal perception of severity of compliance is formed, could have a significant impact on diagnosis and treatment options for compliance related disorders. The subjective diagnostic criteria for evaluating compliance in the DSM-5, augment this complexity in diagnosis and treatment. A larger scale replication of the study is warranted to elicit generalisation.

The scale of the compliance problem that the World Anti-Doping Agency (WADA) faces was recently highlighted by the exposure of state-sponsored doping in Russia and the series of doping scandals within athletics. This study aims to analyse the problems of achieving compliance with the World Anti-Doping Code. Specifically, the study explores the techniques for, and problems of, achieving compliance in three similar international agreements: the UN Convention on the Rights of the Child, the UN Convention on the Rights of Persons with Disabilities and the UN Convention Against Transnational Organised Crime. The Conventions were analysed to identify the range of strategies used to achieve (or at least enhance) the level of compliance with the international conventions, to evaluate their effectiveness as a way of generating ideas for improving compliance with the WADA Code and to assess the comparative success of the WADA. To evaluate compliance, three inter-related bodies of theory were used: regime theory, implementation theory and Mitchell and Chayes (1995) compliance system. Qualitative document analysis was used to analyse documents published by relevant organisations. Semi-structured interviews were also conducted with senior staff members responsible for monitoring compliance at the international and UK domestic level. The results identified a range of strategies used to achieve compliance, including a global annual index of compliance, independent monitoring institutions, whistleblowing and domestic lobbying. It is concluded that the identified strategies have had modest and variable success in improving compliance, yet have the potential to address the problems of achieving compliance with the WADA Code.

Background: Adherence to antiretroviral (ARV) medications in excess of 90-95% is necessary for optimal response to suppress HIV replication and to maintain and/or restore immune function. A number of interventions have been shown to improve ARV adherence, but no research has been conducted which evaluates proactive monitoring of pharmacy refill adherence and subsequent intervention when inadequate adherence is identified. Purpose: The purpose of this project was to compare treatment response, pharmacy refill adherence and self-reported medication adherence between two groups of patients: those participating in an AIDS Drug Assistance Program (ADAP) and those participating in a Medicaid-funded medication access program. The ADAP served as a structured adherence intervention (SAI) based on procedural and administrative processes required by the state-managed program Additionally, covariates that can impact adherence were studied including utilization of adherence services and interventions and factors related to HIV disease, antiretroviral agents and sociodemographic factors. Method: This retrospective comparative study examined secondary data to assess 424 patients who received clinical and pharmacy services at one treatment site in 2005. Analysis: Logistic regression was performed to test the effects of the SAI on treatment response (CD4 and HIV RNA response), self-reported adherence, and pharmacy refill adherence while controlling for the covariates. Results: Patients participating in the SAI demonstrated higher levels of both self-reported and pharmacy refill adherence compared to patients receiving usual care. Although patients participating in the SAI program demonstrated better virologic (HIV RNA) responses to HAART compared to patients receiving usual care, immunologic (CD4 lymphocyte) responses to HAART were not significantly different compared to subjects in the usual care program. Conclusion/Discussion: This study provides information on the effects of a structured programmatic intervention on medication adherence and response to treatment and will be used to inform policy decision making at the local and State level.

The purpose of this study was to explore the nature of reduced patient awareness of oropharyngeal dysphagia. While patient awareness of dysphagia has been explored in individuals before participating in formal swallowing assessments, no studies have been identified in the literature that have explored awareness after patients have participated in an examination and received information about their dysphagia. In addition, the relationship between patient compliance and reduced awareness, as well as the application of stages of change in this population were explored. Twenty-one inpatients and outpatients, newly diagnosed with oropharyngeal dysphagia, participated in this study. A retrospective analysis found that 40% of participants demonstrated reduced awareness of their dysphagia before participating in a videofluoroscopic swallowing examination. Reduced pre-examination awareness of dysphagia occurred most frequently in those with general medical diagnoses versus neurological or structural diagnoses. Reduced pre-examination awareness was not significantly associated with a reduced cough response following aspiration. Exploration of post-examination patient awareness of dysphagia, the primary intent of this study, revealed that 19% of patients demonstrated reduced awareness of their dysphagia, even after receiving specific verbal and visual information regarding their diagnosis. Reduced post-examination awareness of dysphagia occurred equally in those with structural and neurological diagnoses and was not noted in those with general medical diagnoses. Reduced post-examination awareness was not significantly associated with a reduced cough response following aspiration. Consistent with the literature on reduced patient awareness of deficit, patient awareness of dysphagia was modality specific. That is, some patients with reduced awareness of dysphagia demonstrated awareness of other deficits and vice versa. Overall, participants demonstrated more awareness of concomitant speech impairments than dysphagia and less awareness of concomitant cognitive impairments than dysphagia. No significant relationship between general cognitive impairment and reduced patient awareness of dysphagia was found. Exploration of diet compliance in inpatient participants revealed no instances of noncompliance, while hospitalized, from the day of the swallowing examination until the day of participation in the study. However, only 67% of these patients requested permissible foods or drinks when compliance was sampled during the study protocol, suggesting that inpatients with newly diagnosed dysphagia may be less compliant if restricted items become accessible. No significant relationship between patient awareness of dysphagia and diet compliance, as sampled during the study protocol, was found in both inpatients and outpatients. The relationships between patient awareness of dysphagia and patient compliance for both swallowing strategies and exercise regimens were also not significant, though these analyses were limited by the small number of participants who had been prescribed strategies and independent exercise programs at the time of their study participation. Lastly, analysis of the relationship between patient compliance and action or post-action stages of change, revealed no significant association between these variables.

In 2010, regulators established new rules for single-family mortgage services that tightened the loan amount consumers could qualify for, restricted fees lenders could charge, and placed numerous financial penalties for improper servicing of loans. Regulatory fee restrictions made it difficult for leaders to offset the compliance costs through the price of services provided. Leaders responsible for mortgage regulatory compliance experienced increased operating costs for single-family mortgage services due to the new regulations, and some leaders found it challenging to comply and remain competitive. The purpose of this multiple case study was to explore strategies leaders in the single-family mortgage services industry used to comply with federal regulations and remain competitive. The study population included 5 leaders responsible for single-family mortgage regulatory compliance from the southwestern and northern regions of the United States Porter's 5 forces analysis was the conceptual framework. Data were collected using semistructured interviews and analysis of data from a website hosted by government regulators. Data were analyzed using color-coded transcriptions, methodological triangulation, member checking, and coding software. Themes that emerged from data analysis revealed that costs and control methods for regulatory compliance strategies required leaders to change their infrastructure to remain competitive and profitable. The implication of this study for positive social change relates to competitive pricing for single-family mortgage loans for consumers yielding an increase in home ownership.