Este estudo teve como objetivo avaliar o efeito da reflexologia podal sobre a integridade tissular dos pés de pessoas que apresentam o diagnóstico de enfermagem \"Risco de Integridade da Pele Prejudicada\". Tratou-se de um ensaio clínico randomizado, controlado e mascarado, desenvolvido em um ambulatório de especialidades de Ribeirão Preto, Estado de São Paulo. Dada a suscetibilidade para o diagnóstico de enfermagem mencionado, a população deste estudo foi constituída por pessoas com diabetes mellitus. No pré-teste (T0), foram coletadas as variáveis de caracterização, avaliado o resultado de enfermagem \"Integridade Tissular: pele e mucosas\" e seus indicadores relacionados aos pés de pessoas com diabetes mellitus (acompanhados por suas definições), estabelecido o diagnóstico de enfermagem \"Risco de integridade da pele prejudicada\", aplicada a Escala de Acurácia de Diagnóstico de Enfermagem (versão 2) e preenchido o Instrumento de avaliação dos critérios de elegibilidade. Os participantes elegíveis foram alocados em Grupo Intervenção e Grupo Controle. O Grupo intervenção recebeu, além das informações de rotina do serviço, 16 sessões de reflexologia podal, já o Grupo Controle recebeu apenas as informações de rotina do serviço. O pós-teste (T1) e o pós-teste (T2) ocorreram após o alcance da implementação de 12 e de 16 sessões de reflexologia podal, respectivamente, e consistiu na avaliação do resultado de enfermagem \"Integridade Tissular: pele e mucosas\" e de seus indicadores relacionados aos pés de pessoas com diabetes mellitus (acompanhados por suas definições). A amostra final do estudo foi composta por 78 participantes, sendo 40 do Grupo Intervenção e 38 do Grupo Controle. No pós-teste (T1) e no pós-teste (T2), ao se comparar os grupos, houve diferença nos escores do resultado de enfermagem \"Integridade Tissular: pele e mucosas\" (T1 e T2: valor p <0,001) e dos indicadores: Temperatura da pele (T1 e T2: valor p < 0,001), Hidratação (T1 e T2: valor p < 0,001), Textura (T1 e T2: valor p < 0,001), Perfusão tecidual (T1: Valor p = 0,008; T2: Valor p = 0,001), Distribuição de pelos na pele (T1: valor p = 0,039; T2: valor p = 0,031), Descamação da pele (T1 e T2: valor p < 0,001) e Edema (T1 e T2: valor p < 0,001). Ademais, ao se comparar o pós-teste (T1) e o pós-teste (T2) com o pré-teste (T0), o Grupo Intervenção apresentou melhora nos escores desses indicadores, enquanto o Grupo Controle apresentou piora ou manutenção dos mesmos. Nos demais indicadores - Sensibilidade, Elasticidade, Espessura, Integridade da pele, Pigmentação anormal, Lesões de pele, Tecido cicatricial, Crostas na pele, Eritema, Palidez, Necrose, Endurecimento e Varizes - diante da ausência de diferenças entre os grupos no pós-teste (T1) e no pós-teste (T2), não foi evidenciado efeito da terapia. Ao se comparar, contudo, o pós-teste (T1) e o pós-teste (T2) com o pré-teste (T0), nos indicadores \"Sensibilidade\", \"Elasticidade\", \"Endurecimento\" e \"Varizes\", o Grupo Intervenção apresentou melhora nos escores, enquanto o Grupo Controle apresentou piora nos escores do indicador \"Elasticidade\" e manutenção dos escores dos demais indicadores. O tamanho do efeito da intervenção sobre a integridade tissular dos pés dos participantes foi de grande magnitude tanto no pós-teste (T1) (ES = 1,370) quanto no pós-teste (T2) (ES = 1,538), o que sugere a manutenção do efeito de 12 sessões com 16 sessões da terapia. A guisa de conclusão, ao evidenciar os efeitos da reflexologia podal sobre a integridade tissular dos pés de pessoas com \"Risco de Integridade da Pele Prejudica\", esta investigação aprofundou os conhecimentos acerca da terapia e de sua utilização como uma possível estratégia de assistência à saúde. Ao mesmo tempo, a utilização de definições conceituais e definições e magnitudes operacionais no processo de avaliação dos efeitos da intervenção testada contribuíram para maior fidedignidade dos achados, visto que o emprego de tais definições auxiliam na diminuição de interpretações subjetivas acerca dos indicadores do resultado de enfermagem \"Integridade Tissular: pele e mucosas\" / This study aimed to evaluate the effect of foot reflexology on the tissue integrity of the feet of people with the nursing diagnosis \"Risk For Impaired Skin Integrity\". This was a randomized, controlled and masked trial, developed in an outpatient clinic of specialties at Ribeirão Preto, State of Sao Paulo. Given the susceptibility to the nursing diagnosis mentioned, the population of this study consisted of people with diabetes mellitus. In the pre-test (T0) were collected the characterization variables, evaluated the result of nursing \"Tissue Integrity: skin and mucous membranes\" and their indicators related to the feet of people with diabetes mellitus (accompanied by their definitions), established the diagnosis of nursing \"Risk For Impaired Skin Integrity\", applied the Nursing Diagnosis Accuracy Scale (version 2) and completed the evaluation instrument of the eligibility criteria. Eligible participants were divided into Intervention Group and Control Group. The Intervention Group received, in addition to the service routine information, 16 sessions of foot reflexology, since the Control Group received only routine information service. The post-test (T1) and the post-test (T2) occurred after the scope of the implementation of 12 and 16 sessions of foot reflexology, respectively, and consisted of the evaluation of nursing outcome \"Tissue Integrity: skin and mucous membranes\" and their indicators related to the feet of people with diabetes mellitus (accompanied by their definitions). The final sample consisted of 78 participants, 40 of the Intervention Group and 38 of the Control Group. In the post-test (T1) and post-test (T2), when comparing the groups, there were differences in the scores of nursing outcome \"Tissue Integrity: skin and mucous membranes\" (T1 and T2: p < 0.001) and indicators: Skin temperature (T1 and T2: p < 0.001) Hydratation (T1 and T2: p < 0.001), Texture (T1 and T2: p < 0.001), Tissue Perfusion (T1: p value = 0.008; T2: p value = 0.001), Hair growth on skin (T1: p = 0.039; T2: p = 0.031), Skin scaling (T1 and T2: p <0.001) and Edema (T1 and T2: value p < 0.001). In addition, when comparing the post-test (T1) and the post-test (T2) with pretest (T0), the Intervention Group showed improvement in the scores of these indicators, while the Control Group worsened or maintenance. In the other indicators - Sensation, Elasticity, Thickness, Skin integrity, Abnormal pigmentation, Skin lesions, Scar tissue, Skin flaking, Erythema, Blanching, Necrosis, Induration and Varicose veins - in the absence of differences between the groups in the post- test (T1) and post-test (T2) was not observed effect of therapy. By comparison, however, the post-test (T1) and the post-test (T2) with pretest (T0), the indicators \"Sensation\", \"Elasticity\", \"Induration\" and \"Varicose veins\", the Intervention Group showed improvement in scores, while the Control Group showed worse in score of \"Elasticity\" and maintenance of the others. The effect size of the intervention on the tissue integrity of the feet of the participants was of great magnitude in both the post-test (T1) (ES = 1,370) and the post-test (T2) (ES = 1.538), suggesting maintenance of therapy effect of 12 sessions with 16 sessions. Concludes that, by highlight the effects of foot reflexology on the tissue integrity of the feet of people with \"Risk For Impaired Skin Integrity\", this research deepened knowledge about the therapy and its use as a possible health care strategy. At the same time, the use of conceptual definitions and definitions and operational magnitudes in the evaluation of the effects of the tested intervention contributed to greater reliability of the findings, since the use of such definitions help in the reduction of subjective interpretations of the nursing outcome indicators \"Tissue Integrity: skin and mucous membranes\"

O presente trabalho apresenta um estudo sobre a continuidade da tortura no atual Estado Democrático de Direito existente no Brasil, destacando a dissonância entre a criminalização da tortura no ordenamento jurídico e político e a efetividade da punição desse crime pelo sistema de justiça criminal. Destaca-se o fato de que a lei 9.455/97, que tipifica o crime de tortura no Brasil, considera que qualquer pessoa pode ser responsabilizada por crime de tortura. Ela difere da Convenção Contra a Tortura e Outros Tratamentos ou Penas Cruéis, Desumanos e Degradantes, que especifica que a tortura é todo o ato praticado por agentes do Estado, restringindo a penalidade apenas para esses agentes. Sendo assim, a lei brasileira pode servir para punir tanto os agentes do Estado como os não agentes. Este dado é importante porque existe uma distinção entre os julgamentos em que figuram como réus os agentes do Estado daqueles em que os réus são não agentes do Estado. Essas distinções revelam que os julgamentos de crimes de tortura não se dirigem somente ao ato criminoso, mas aos agressores, vítimas e testemunhas. A pesquisa sustenta que a continuidade da tortura não está baseada apenas na recorrência e dinâmica dessa prática em delegacias, presídios e unidades de internação. Ela está ligada à forma como a tortura é interpretada, não somente pela sociedade, mas pelas instituições de segurança e justiça. Essa interpretação leva em conta o perfil dos acusados e das vítimas, as condições em que esses supostos crimes de tortura ocorreram, em que circunstâncias, quem são os responsáveis pelas denúncias, quem são os acusados, quem são as vítimas, etc. Desse modo, podemos dizer que o que está em julgamento não é o ato criminoso da tortura contra um ser humano, mas se este ser humano é titular de um direito, se ele é considerado um membro da comunidade, de um mundo comum em que as pessoas são vistas como iguais e como cidadãs. / This dissertation presents a study of the continual use of torture within Brazils contemporary democratic regime, drawing attention to the discord between the criminalization of torture in political and judicial ordinances and the effectiveness of punishment for that crime under the criminal justice system. The work highlights the fact that the Law 9.455/1997 (Torture Act), which categorizes torture in Brazil, considers that any individual can be held responsible for the crime of torture. This law differs from the 1984 Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment which specifies that torture is an act that can only be committed by agents of the State, thus restricting penalty only to those agents. Therefore, Brazilian Law can serve to punish both State agents and non-State agents. This is an important fact because there is a distinction between trials where the defendants are State Law Enforcement Officials and those where the defendants are not State agents. These distinctions reveal that trials for crimes of torture do not only address the criminal action but also the perpetrators, victims and witnesses. Research shows that the persistence of torture is not only based on the recurrence and dynamic of these practices in police stations, prisons, facilities belonging to the armed forces and juvenile detention centers. It is linked to the way torture is interpreted not only by society but also by the security and justice institutions. This interpretation takes into account the profile of the accused and of the victims, the conditions in which the alleged crimes occurred, in what respective circumstances, who are responsible for the denunciations, who are the accused, who are the victims, etc. Consequently, one can say that what is on trial is not the criminal act of torturing a human being but whether this human being is entitled to have rights, whether he or she is considered a member of the community, of a common world in which all people are should be seen as equal and as citizens.

The Role of the Public Prosecutor in the Court Proceedings Abstract The purpose of this thesis is to comprehensively analyze issue of the public prosecutor and its role, especially in the court proceedings. The reason for my research is my personal interest regarding criminal law and problematics of the public prosecutors in general, as well as, in my opinion, the great importance of such topic, especially in the context of a long-term expert discussion on the considered conceptual changes of the relevant Czech legislation - the Criminal Procedure and the Public Prosecution Act. The thesis is composed of four major chapters, each of them dealing with different aspects of role of the public prosecutors. Chapter One is introductory and defines basic terminology used in the thesis and further the historical development and transformation of bodies of public action in two different legal systems - common law and civil law. Chapter Two provides an outline of Czech, French, English and Welsh, U.S. and international bodies of the public action, their placement in the system of national legal systems, organization and scope of activities. Also describes the issues regarding proposals to the new Czech Public Prosecution Act. Chapter Three examines relevant Czech legislation regarding public prosecutor and its role...

This study compared the relative reinforcing efficacy of high-preferred and low-preferred stimuli, as determined by two types of preference assessments, on acquisition rates in three children diagnosed with an Autism Spectrum Disorder (ASD). The study also evaluated the indirect effects of preference on students’ stereotypy and problem behavior during instructional periods. Participants were presented with a task and provided high or low-preferred stimuli contingent upon correct responding. Results showed that acquisition occurred more rapidly in the highly preferred condition for some participants. Higher rates of problem behavior occurred in the low preferred condition for all participants. These results highlight the importance of utilizing preference assessment procedures to identify and deliver high-preferred items in skill acquisition procedures for individuals with ASD.

Introdução: As práticas clínicas baseadas em evidências utilizam resultados de estudos bem desenhados e bem conduzidos que, compilados em revisões sistemáticas, auxiliam os profissionais da saúde e orientam-os de modo sintético e atualizado no manejo dos tratamentos. Em um estudo bem conduzido, os dados coletados apresentarão boa qualidade se obtidos a partir de protocolos bem definidos que incluem as orientações para o acompanhamento dos pacientes e ações padronizadas pelos profissionais envolvidos. O monitoramento do estudo permite acompanhar e controlar a execução das ações definidas no protocolo de tal forma que os resultados finais não apresentem vieses de seleção, de desempenho (performance), de detecção, de atrito (attrition) ou de relato. Entre os instrumentos que avaliam a qualidade do relato de ensaios clínicos, nenhum deles destaca a avaliação de ações de monitoramento que, constitui, segundo nosso ponto de vista, um elemento importante para assegurar a qualidade dos dados. Objetivo: Apresentar uma reflexão sobre vieses em ensaios clínicos aleatorizados e sobre o papel do monitoramento do estudo no controle e prevenção destes. Métodos: Estudo metodológico que se propôs a avaliar a qualidade de ensaios clínicos aleatorizados incluídos em uma revisão sistemática escolhida ad hoc que tratou do uso de estatinas na prevenção primária de doença cardiovascular. Análise de vieses dos estudos originais incluídos na revisão sistemática utilizando a ferramenta para avaliação de risco de viés em ensaios clínicos aleatorizados descrita no Cochrane Handbook for Systematic Reviews of Interventions (Manual Cochrane para Revisões Sistemáticas de Intervenção), versão 5.1.0. Foram identificadas e descritas em detalhes as ações do monitoramento que poderiam colaborar na minimização ou possível eliminação dos vieses. Foi realizada uma busca nos artigos originais para verificar se existia a descrição das ações relacionadas ao monitoramento. Resultados: Considerando o critério para possibilidade de ocorrência de cada um dos sete tipos de viés, os estudos BONE, CARDS, METEOR e MRC/BHF apresentaram a maior porcentagem (85,7 por cento ) de baixo risco de ocorrência de vieses, indicando possivelmente boa qualidade metodológica. Em contrapartida, em quatro estudos esta porcentagem foi menor que 50 por cento (estudos ASPEN, CERDIA, HYRIM e KAPS), indicando menor qualidade metodológica. Todos os estudos foram classificados como risco incerto para outras fontes de vieses por apresentarem patrocínio por indústria farmacêutica representando, sob nossa avaliação, conflito de interesse. Observou-se que o estudo AFCAPS/TexCAPS indicou que uma empresa que organiza pesquisas foi contratada pelo patrocinador para manejo administrativo e clínico e também dos dados. Porém, não foram descritos maiores detalhes sobre o monitoramento. Neste estudo, observou-se risco incerto para a geração de sequência aleatória, ocultação da alocação e outros vieses. Os demais potenciais vieses foram classificados como baixo risco. Conclusões: No presente trabalho, verificou-se que mesmo um ensaio clínico bem desenhado, relatado e avaliado como baixo risco para a ocorrência de vieses também está sujeito a ocorrência destes durante a sua condução. Vê-se como necessária a inclusão de um item específico sobre viés de conflito de interesse nos instrumentos de avaliação de qualidade metodológica de estudos. Reforça-se o papel do monitoramento para evitar ou minimizar erros sistemáticos, garantindo que o estudo seja realizado conforme o que foi inicialmente proposto. / Background: The clinical practices based on evidences use results obtained from well designed and conducted studies that compiled in systematic reviews assist and guide health professionals to manage patient treatments. In a well conducted study, data collected will have good quality if obtained from protocols that include guidance for patients follow-up and standardized procedures for personnel involved in the study. The study monitoring allows follow-up and control regarding the execution of tasks required by protocol in order to avoid selection bias, performance bias, detection bias, attrition bias or report bias in study results. The available tools to evaluate the quality of reporting of randomized clinical trials do not describe the monitoring actions that we believe are very important for data quality assurance. Objective: To reflect about bias occurrence in randomized clinical trials and the role of study monitoring in its control and prevention. Methods: Methodological study that evaluated the quality of randomized clinical trials included in a systematic review chosen ad hoc regarding the statin use for the primary prevention of cardiovascular disease. Analysis of the original studies using the Cochrane Collaboration´s tool for assessing risk of bias in randomized clinical trials described in Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0. The monitoring actions that could avoid or minimize bias occurrence were identified and described in details. A search for actions related to monitoring was also performed in the original articles. Results: Considering the criteria for the possibility of occurence of each of the seven bias types, the studies BONE, CARDS, METEOR and MRC/BHF presented a higher percentage (85.7 per cent ) of low risk for bias, possibly indicating a good methodologic quality. However, this percentage was less than 50 per cent in four studies (ASPEN, CERDIA, HYRIM e KAPS), indicating a poor methodologic quality. All studies were classified as unclear risk for other bias considering that they were sponsored by pharmaceutical industries representing, according to our evaluation, conflict of interest. It was observed that AFCAPS/TexCAPS study indicated that a company responsible for research organization was contracted by the sponsor for data, administrative and clinical management. However, further information about monitoring was not described. In this particular study, random sequence generation, allocation concealment and other bias were classified as unclear risk. The remaining potential biases were classified as low risk. Conclusion: At the present work, it was verified that even clinical trials that are well designed, reported and with low risk for bias might have problems during the study conduction. We understand as necessary the inclusion of a specific item about the bias of conflict of interest in the tools for evaluation of methodology of studies.We emphasize the role of monitoring to avoid or minimize systematic bias, ensuring that the study is performed according to what was initially proposed.

Monitoring progress of athletes is an essential component of the training process. Collegiate distance running coaches often use field tests to assess progress because of a lack of time and resources to do laboratory testing. The purpose of this dissertation was to examine the relationships between physiological and strength variables measured in a laboratory and field testing measures in collegiate distance runners. Collegiate distance runners completed a series of tests in the Sport Science laboratory at East Tennessee State University to obtain physiological and strength parameters, such as V̇ O2max and vertical jump height. The athletes then completed one of two field tests (either a 3 km time trial or a 3 minute all out run test). There were strong correlations between the laboratory measures and the field test performances. These results indicate that strength is an important factor in run performance. Also, a 3 km time trial and a 3 minute all out run test are suitable for athlete monitoring.

Background: By 2050, it is estimated that 14 million older Americans will live with Alzheimer’s disease (AD), a progressive form of dementia with unknown cause or cure. Persons with AD and related dementias (ADRD) become increasingly dependent on others as they experience cognitive decline, which concomitantly undermines individuals’ functional skills, social initiative, and quality of life. The Alzheimer’s Association advocates for interventions that address cognition, mood, behavior, social engagement, and by extension, quality of life – goals music therapists often address. Although a small but growing body of literature suggests that clinical music therapy may be effective, the evidentiary support for the use and appropriate application of music as a form of treatment with this population is currently limited. Objectives: This thesis consisted of the development of a Clinical Practice Model of music therapy for persons with ADRD. It also examined the effectiveness of a specific, protocol-based music therapy intervention, grounded in this model, relative to a verbal discussion activity. Methods: The Clinical Practice Model is theoretically grounded in the biopsychosocial model of healthcare (Engel, 1980) and Kitwood’s (1997) personhood framework, and I developed it through extensive literature review and expert input. It includes an organizational schema for applying intervention strategies, per six themes: cognition, attention, familiarity, audibility, structure, and autonomy. The initial model predicts that an intervention built upon this schema will influence social-affective responses, quality of life, and in turn, psychosocial symptoms of ADRD. I tested a singing-based music therapy intervention, grounded in this model, through a randomized clinical crossover trial. I compared participants’ responses to music therapy to a non-music verbal discussion activity, and both conditions followed a protocol. Dependent variables included: (1) affective responses (self-reported feelings, observed emotions, and observed mood), (2) social engagement, and (3) observed quality of life. Thirty-two individuals with ADRD (n = 6 men, n = 26 women) ages 65-97 years old (μ̂ = 84.13) participated in this study. I randomly assigned treatment order; each treatment occurred in small-group format, three times per week in the afternoon (25 minutes each session), for two consecutive weeks. A two-week “wash-out” period occurred between conditions. Credentialed music therapists led both study conditions. This study followed recommendations from the National Institutes of Health Behavior Change Consortium (Bellg et al., 2004) to enhance quality assurance in protocol administration and data collection. Results and Significance: I used a linear mixed model approach to analysis. Music therapy exacted a significant, positive effect on self-reported feelings, observed emotions, and constructive engagement, particularly for individuals with moderate dementia. Results also suggested that men’s feelings improved in response to music therapy only, whereas women responded positively to both conditions. Weekly observations failed to indicate a significant change in mood or quality of life across the eight-week study. Based on these findings, I revised the Clinical Practice Model to include wellbeing (an outcome more concordant with psychosocial change in response to music intervention) rather than global quality of life (affected by numerous aspects of the care milieu). In addition to the Clinical Practice Model to the music therapy profession, contributions of this thesis include a rigorous clinical study and practical implications for music therapy practice, including the importance of considering patient characteristics and careful selection and implementation of music in a music therapy intervention.

Peppers (Capsicum) are a valuable commodity throughout the world. They provide food, coloring additives, vitamins, and ornamental aesthetics. Peppers can be grown in many different areas of the world and their success is based on variety selection. Breeding cultivars for superior performance is critical to success. Recent consumer desire for less chemical use throughout the growing process has resulted in new cultivar developments.. The objective of this research was to investigate how cultivar and type affect the yield and weight of field grown peppers. This study provides valuable information for growers in determining which cultivars are suitable for production in Kentucky. The research was conducted at the Western Kentucky University Agriculture Research and Education Complex in Bowling Green, Kentucky in 2016. Plants were provided by Ball Horticultural and Pan American Seed, Elburn, Illinois. The experimental design was a random design, with a 12 plant experimental unit consisting of four three plant rows. Thirty-six cultivars were divided into groups based on the type of pepper produced. Harvest occurred approximately every 7 days and were grouped into 3 periods. Data were obtained on yield, weight, and mean weight. Individual group selection is determined by the producers and their goals for production. There were wide differences in the types of peppers, including size, shape, and color. When comparing all groups, two of the thirty six cultivars, Cultivar 23 (Tapered) and Cultivar 34 (Chili) performed best for both yield and mean weight.

The purpose of this paper is to uncover a new level of thinking regarding the discourse and debate around the standard of reasonable doubt and how it is used in our court rooms. The current argument surrounding the reasonable doubt standard has become circular and reached an impasse. By introducing the lens of social control and using the writings of notable French philosopher Michel Foucault, this paper looks at the origins and development of the reasonable doubt standard and links it with the increasing methods of social control present in punishment as well as evaluating the cultural narrative around its origin and assessing why this standard was permitted to continue to be a cornerstone of the Anglo-American judicial system.

The purpose of this study was to evaluate the effects of a classroom teacher implementing trail-based functional analyses (FAs), experimentally evaluate the effects of a classroom teacher implementing differential reinforcement of alternative (DRA) procedures with participants diagnosed with autism spectrum disorder in the context of a natural setting, and assess the feasibility of the DRA for the classroom teacher. A multiple baseline with an embedded ABAB design was used for one participant and an ABAB design was used for the second participant to measure the percentage of the participants’ engagement in the alternative behavior and the target behavior. Results showed that the classroom teacher could implement the trail-based FAs with fidelity, DRA procedures were effective for both participants, and the teacher was neutral in regard to the feasibility of the procedures.