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1.
J. Health Biol. Sci. (Online) ; 10(1): 1-5, 01/jan./2022. tab
Artigo em Inglês | LILACS | ID: biblio-1358203

RESUMO

Objectives: The present study was designed to examine the efficacy of Cissus quadrangularis paste on fracture healing in artificially induced fractured rabbits. Methods: Fifteen rabbits were separated into three groups namely A, B, and C. Veldt grape paste was applied in groups B and C (Treatment Group) by close reduction and open reduction methods of fracture management; respectively, while group A was kept as control. The blood parameter and fracture healing properties in all animals have been monitored and examined routinely during the study period. Results: Both treated groups revealed lower serum calcium levels (SCL) than the control group after 24 hours of fracture that became within the normal range on the 14th day. Fracture healing in the treated groups has been commenced more rapidly than the control group with complete bridging of discontinuity by a distinct osseous callus in the fracture line on day 7 and complete effacing of fracture line on day 14. Conclusion: We did not find any type of anomalousness, clinical deviations, and alteration of serum calcium level on the 14th day of the fracture in treated animals hence Veldt Grape paste could be readily applicable to the management of the fracture in animals.


Objetivos: avaliar a eficácia da pasta de Cissus quadrangularis na consolidação de fraturas em coelhos fraturados artificialmente. Metodos: quinze coelhos foram separados em três grupos (A, B e C). A pasta foi aplicada nos grupos B e C (Grupo de Tratamento) pelos métodos de redução fechada e redução aberta de gerenciamento de fraturas; respectivamente. O grupo A foi mantido como controle. O parâmetro sanguíneo e as propriedades de cicatrização de fraturas em todos os animais foram monitorados e examinados, rotineiramente, durante o período do estudo. Resultados: ambos os grupos tratados revelaram níveis séricos de cálcio (SCL) mais baixos do que o grupo controle, após 24 horas de fratura que se tornou normal no 14º dia. A cicatrização da fratura nos grupos tratados foi iniciada mais rapidamente do que o grupo controle, com ponte completa de descontinuidade por um calo ósseo distinto na linha de fratura no dia 7 e apagamento completo da linha de fratura no dia 14. Conclusao: não encontramos nenhum tipo de anomalia, desvios clínicos e alteração do nível sérico de cálcio no 14º dia da fratura nos animais tratados, portanto, a pasta Veldt Grape pode ser aplicável ao manejo da fratura em animais.


Assuntos
Consolidação da Fratura , Cissus , Pomadas , Terapêutica , Calo Ósseo , Fraturas Ósseas , Objetivos , Animais de Laboratório , Métodos
2.
BMJ Open ; 12(8): e060226, 2022 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-35922109

RESUMO

INTRODUCTION: In partnership with Cancer Council Western Australia (WA), the East Metropolitan Health Service in Perth, WA has developed a clinical simulation training programme 'Talking Together' using role play scenarios with trained actors as patients/carers. The aim of the training is to improve clinicians' communication skills when having challenging conversations with patients, or their carers, in relation to goals of care in the event of clinical deterioration. METHODS AND ANALYSIS: A multisite, longitudinal mixed-methods study will be conducted to evaluate the impact of the communication skills training programme on patient, family/carer and clinician outcomes. Methods include online surveys and interviews. The study will assess outcomes in three areas: evaluation of the 'Talking Together' workshops and their effect on satisfaction, confidence and integration of best practice communication skills; quality of goals of patient care conversations from the point of view of clinicians, carers and family/carers; and investigation of the nursing/allied role in goals of patient care. ETHICS AND DISSEMINATION: This study has received ethical approval from the Royal Perth Hospital, St John of God and Curtin University Human Research Ethics Committees. The outputs from this project will be a series of research papers and conference presentations.


Assuntos
Objetivos , Treinamento por Simulação , Comunicação , Hospitais Públicos , Humanos , Assistência ao Paciente , Austrália Ocidental
3.
Science ; 377(6606): 594-598, 2022 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-35926035

RESUMO

Grasslands, which constitute almost 40% of the terrestrial biosphere, provide habitat for a great diversity of animals and plants and contribute to the livelihoods of more than 1 billion people worldwide. Whereas the destruction and degradation of grasslands can occur rapidly, recent work indicates that complete recovery of biodiversity and essential functions occurs slowly or not at all. Grassland restoration-interventions to speed or guide this recovery-has received less attention than restoration of forested ecosystems, often due to the prevailing assumption that grasslands are recently formed habitats that can reassemble quickly. Viewing grassland restoration as long-term assembly toward old-growth endpoints, with appreciation of feedbacks and threshold shifts, will be crucial for recognizing when and how restoration can guide recovery of this globally important ecosystem.


Assuntos
Ecossistema , Pradaria , Animais , Biodiversidade , Florestas , Objetivos , Humanos
4.
J Extra Corpor Technol ; 54(2): 128-134, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35928338

RESUMO

Small increases in serum creatinine postoperatively reflect an acute kidney injury (AKI) that likely occurred during cardiopulmonary bypass (CPB). Maintaining adequate oxygen delivery (DO2) during CPB, known as GDP (goal-directed perfusion), improves outcomes. Whether GDP improves outcomes of patients at high risk for acute renal failure (ARF) is unknown. Forty-seven adult patients undergoing cardiac surgery with CPB utilizing GDP with Cleveland Clinic Acute Renal Failure Score of 3 or greater were compared with a matched cohort of patients operated upon using a flow-directed strategy. CPB flow in the GDP cohort was based on a DO2 goal of 260 mL/min/m2. Serum creatinine values were used to determine whether postoperative AKI occurred according to AKIN (Acute Kidney Injury Network) guidelines. We examined the distribution of all variables using proportions for categorical variables and means (standard deviations) for continuous variables and compared treatment groups using t tests for categorical variables and tests for differences in distributions for continuous and count variables. We used inverse probability of treatment weighting to adjust for treatment selection bias. In adjusted models, GDP was not associated with a decrease in AKI (odds ratio [OR]: .97; confidence interval [CI]: .62, 1.52), but was associated with higher odds of ARF (OR: 3.13; CI: 1.26, 7.79), mortality (OR: 3.35; CI: 1.14, 9.89), intensive care unit readmission (OR: 2.59; CI: 1.31, 5.15), need for intraoperative red blood cell transfusion (OR: 2.02; CI: 1.26, 3.25), and postoperative platelet transfusion (OR: 1.78; CI: 1.05, 3.01) when compared with the historic cohort. In patients who are at high risk for postoperative renal failure, GDP was not associated with a decrease in AKI when compared to the historical cohort managed traditionally by determining CPB flows based on body surface area. Surprisingly, the GDP cohort performed significantly worse than the retrospective control group in terms of ARF, mortality, intensive care unit readmission, and RBC and platelet transfusions.


Assuntos
Injúria Renal Aguda , Procedimentos Cirúrgicos Cardíacos , Injúria Renal Aguda/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Creatinina , Objetivos , Humanos , Perfusão , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco
5.
Elife ; 112022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35929412

RESUMO

To decide whether a course of action is worth pursuing, individuals typically weigh its expected costs and benefits. Optimal decision-making relies upon accurate effort cost anticipation, which is generally assumed to be performed independently from goal valuation. In two experiments (n = 46), we challenged this independence principle of standard decision theory. We presented participants with a series of treadmill routes randomly associated to monetary rewards and collected both 'accept' versus 'decline' decisions and subjective estimates of energetic cost. Behavioural results show that higher monetary prospects led participants to provide higher cost estimates, although reward was independent from effort in our design. Among candidate cognitive explanations, they support a model in which prospective cost assessment is biased by the output of an automatic computation adjusting effort expenditure to goal value. This decision bias might lead people to abandon the pursuit of valuable goals that are in fact not so costly to achieve.


Assuntos
Tomada de Decisões , Objetivos , Humanos , Motivação , Estudos Prospectivos , Recompensa
6.
Span J Psychol ; 25: e22, 2022 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-35950797

RESUMO

This study analyses the publications by Spanish institutions indexed by the Web of Science in the thematic category of "Psychology, Social". The objectives are to determine whether such publications address topics related to the Sustainable Development Goals (SDGs) and to what extent the research conducted contributes to achieving the goals proposed in each of the SDGs. Publications were classified by their relationship with the SDGs using OSDG tool, and an in-depth content analysis was performed to validate the results. A corpus of 1,632 papers published by Spanish institutions was identified. The results show that 34% percent of the papers address matters related to the SDGs; 23% of these are related to Goal 3 (good health and well-being), and 5%, to Goal 5 (gender equality). For achieving SDG 3 goals, the reviewed papers evidence the need that institutions, governments and society to provide, especially for children and adolescents, healthy social environments to prevent harmful social relationships while improving individual skills to manage emotions in everyday life and promoting cultural integration. Regarding SDG 5, it should be a priority the application of effective strategies to change stereotypes, assigned sexual roles and sexist attitudes that sustain inequality and violence against women.


Assuntos
Psicologia Social , Desenvolvimento Sustentável , Adolescente , Bibliometria , Criança , Feminino , Objetivos , Nível de Saúde , Humanos , Comportamento Sexual
7.
Health Aff (Millwood) ; 41(8): 1142-1152, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35914199

RESUMO

This study aimed to determine levels of health insurance coverage in low- and middle-income countries and how coverage varies by people's sociodemographic characteristics. We conducted a population size-weighted, one-stage individual participant data meta-analysis of health insurance coverage, using a population-based sample of 2,035,401 participants ages 15-59 from nationally representative household surveys in fifty-six countries during the period 2006-18. One in five people (20.3 percent) across the fifty-six countries in our study had health insurance. Health insurance coverage exceeded 50 percent in only seven countries and 70 percent in only three countries. Substantially more people had public health insurance than private health insurance (71.4 percent versus 28.6 percent). We found that men and older, more educated, and wealthier people were more likely to have health insurance; these sociodemographic gradients in health insurance coverage were strongest in sub-Saharan Africa and followed traditional lines of privilege. Low- and middle-income countries need to massively expand health insurance coverage if they intend to use insurance to achieve universal health coverage.


Assuntos
Países em Desenvolvimento , Cobertura Universal do Seguro de Saúde , Adolescente , Adulto , Objetivos , Humanos , Renda , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
J Contin Educ Nurs ; 53(8): 355-363, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35914275

RESUMO

This article proposes an integrative model for the psychological resources of grit. The growing body of work in nursing on the topic of grit indicates considerable interest in achieving long-term goals, especially amidst uncertainty from the COVID-19 pandemic. Motivational behaviors are thought to influence engagement in continuing education in nursing, thereby improving clinical practice and patient outcomes. The model was informed by a comprehensive review of the literature. Sixteen attributes for acquiring and strengthening four psychological resources of grit were identified. Each attribute is discussed along with interrelationships and implications for professional nursing development. Given the complex demands placed on health professionals, this model is both timely and relevant for all nurse and education providers interested in enhancing personal characteristics that may mitigate against stress and build capabilities for goal achievement. [J Contin Educ Nurs. 2022;53(8):355-363.].


Assuntos
COVID-19 , Pandemias , Educação Continuada em Enfermagem , Objetivos , Pessoal de Saúde , Humanos , Incerteza
9.
J Contin Educ Nurs ; 53(8): 341-343, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35914278

RESUMO

Nursing professional development practitioners and nurse planners lead the charge in providing and evaluating nursing continuing professional development (NCPD) to achieve strategic goals. Organizations accredited by the American Nurses Credentialing Center (ANCC) have well-structured nursing professional development departments uniquely positioned to leverage NCPD to achieve organizational goals. This column will demonstrate how ANCC Accreditation in NCPD, in conjunction with the Association for Nursing Professional Development's Nursing Professional Development: Scope & Standards of Practice, underpins the critical role of NCPD and the nurses within the specialty of NCPD. [J Contin Educ Nurs. 2022;53(8):341-343.].


Assuntos
Educação Continuada em Enfermagem , Recursos Humanos de Enfermagem no Hospital , Credenciamento , Atenção à Saúde , Objetivos , Humanos , Estados Unidos
11.
Am J Health Behav ; 46(3): 337-346, 2022 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-35794752

RESUMO

Objective: In this study, we explored the characteristics of moral disengagement in sport and its mediating role in athletes' goal orientations and their attitudes towards doping We enrolled 203 athletes in the study. Methods: The Task and Ego Orientation in Sports Questionnaire, Moral Disengagement in Sport Scale and Performance Enhancement Attitude Scale were used to assess athletes' goal orientations and attitudes toward doping. Results: Our findings revealed that: (1) male athletes' scores for moral disengagement were significantly higher than those of female athletes; and (2) moral disengagement completely mediated the relationship between ego orientation and attitude towards doping, and partially mediated the association between task orientation and attitude towards doping. Conclusions: Changing the moral cognition and lowering the level of moral disengagement in athletes may be important issues to include in anti-doping education.


Assuntos
Objetivos , Esportes , Atletas , Atitude , Feminino , Humanos , Masculino , Princípios Morais
13.
BMJ Open ; 12(7): e063061, 2022 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-35868829

RESUMO

OBJECTIVES: (1) Identify the healthcare settings in which goal attainment scaling (GAS) has been used as an outcome measure in randomised controlled trials. (2) Describe how GAS has been implemented by researchers in those trials. DESIGN: Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews approach. DATA SOURCES: PubMed, CENTRAL, EMBASE and PsycINFO were searched through 28 February 2022. ELIGIBILITY CRITERIA: English-language publications reporting on research where adults in healthcare settings were recruited to a randomised controlled trial where GAS was an outcome measure. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers completed data extraction. Data collected underwent descriptive statistics. RESULTS: Of 1,838 articles screened, 38 studies were included. These studies were most frequently conducted in rehabilitation (58%) and geriatric medicine (24%) disciplines/populations. Sample sizes ranged from 8 to 468, with a median of 51 participants (IQR: 30-96). A number of studies did not report on implementation aspects such as the personnel involved (26%), the training provided (79%) and the calibration and review mechanisms (87%). Not all trials used the same scale, with 24% varying from the traditional five-point scale. Outcome attainment was scored in various manners (self-report: 21%; observed: 26%; both self-report and observed: 8%; and not reported: 45%), and the calculation of GAS scores differed between trials (raw score: 21%; T score: 47%; other: 21%; and not reported: 66%). CONCLUSIONS: GAS has been used as an outcome measure across a wide range of disciplines and trial settings. However, there are inadequacies and inconsistencies in how it has been applied and implemented. Developing a cross-disciplinary practical guide to support a degree of standardisation in its implementation may be beneficial in increasing the reliability and comparability of trial results. PROSPERO REGISTRATION NUMBER: CRD42021237541.


Assuntos
Objetivos , Avaliação de Resultados em Cuidados de Saúde , Adulto , Idoso , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes
14.
Turk J Gastroenterol ; 33(7): 554-564, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35879912

RESUMO

BACKGROUND: Inflammatory bowel disease is a chronic recurrent disease, and the treatment goals of inflammatory bowel disease are mainly based on doctors' perspective, but there are some differences between the doctor's perspective and the patient's perspective. The aim of this study is to understand the treatment goals and the related factors from the patients' perspective during the coronavirus disease 2019 pandemic. METHODS: A total of 212 participants were recruited to fill out the questionnaires including clinical characteristics and treatment goals. Eleven treatment goals were measured by a Short-Form 34 questionnaire. Univariate and multivariate regression analyses were used to explore the related factors about these treatment goals. RESULTS: A total of 212 inflammatory bowel disease patients were enrolled in this study. The most concerned treatment goal was the improvement of quality of life (mean score was 8.54), while mean score of ulcerative colitis patients and Crohn's disease patients was 9.10 and 8.45, respectively. We had also found some related factors such as the type of disease, the course of disease, the frequency of hematochezia, and defecation. CONCLUSION: Our survey showed that inflammatory bowel disease patients pay more attention to the improvement of quality of life and few drugs during the coronavirus disease 2019 pandemic. There are some related factors such as the type of disease, the course of dis- ease, the frequency of hematochezia, and defecation. Our results help clinicians understand the patients' treatment goals, which can contribute to better management of inflammatory bowel disease patients.


Assuntos
COVID-19 , Colite Ulcerativa , Doenças Inflamatórias Intestinais , COVID-19/epidemiologia , China/epidemiologia , Doença Crônica , Hemorragia Gastrointestinal , Objetivos , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/terapia , Pandemias , Qualidade de Vida , Autorrelato , Inquéritos e Questionários
15.
Semin Speech Lang ; 43(4): 277-298, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35896406

RESUMO

On any given day, the social mind is taxed with attending to and making sense of a myriad of social events. The social mind is at work when trying to imagine the experiences of others and their inner mental worlds, and is equally active when people seek to approach, connect with, and sometimes avoid one another. Ultimately, the social mind is responsible for thinking about (social) thinking, or social metacognition. Social metacognitive teaching strategies can be helpful for supporting social learners as they observe social landscapes, interpret what is observed to problem solve, or decide whether and how to produce social responses. This article describes how social metacognitive strategies from the Social Thinking Methodology have been used to support the self-determined social goals of two autistic students. Visual frameworks and their underlying theories are provided as evidence-aligned tools for supporting clinical journeys.


Assuntos
Transtorno Autístico , Metacognição , Adolescente , Transtorno Autístico/terapia , Objetivos , Humanos , Autonomia Pessoal , Estudantes
16.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 34(3): 235-240, 2022 Jul 08.
Artigo em Chinês | MEDLINE | ID: mdl-35896486

RESUMO

Currently, the national schistosomiasis control program of China is moving from transmission interruption to elimination, and there are multiple challenges during the stage moving towards the progression of schistosomiasis elimination, including a high difficulty in shrinking snail-infested areas, unstable achievements for infectious source control, imperfect surveillance system and a reduction in schistosomiasis control and administration. Based on the core suggestions proposed in the 2022 WHO guideline on control and elimination of human schistosomiasis, recommendations on schistosomiasis surveillance system building, development of novel diagnostics, adjustment of the schistosomiasis control strategy and maintaining and improvements of the schistosomiasis control capability are proposed for the national schistosomiasis control program of China in the new era according to the actual status of schistosomiasis control in China. Formulation of the national schistosomiasis control strategy and goal from One Health perspective, verification of transmission interruption and elimination of schistosomiasis, precision implementation of schistosomiasis control interventions with adaptations to local circumstances, development and application of highly sensitive and specific diagnostics are recommended for elimination of schistosomiasis in China. In addition, the implementation of the 2022 WHO guideline on control and elimination of human schistosomiasis may guide the elimination of schistosomiasis in China.


Assuntos
Objetivos , Esquistossomose , Animais , China/epidemiologia , Humanos , Esquistossomose/epidemiologia , Esquistossomose/prevenção & controle , Caramujos , Organização Mundial da Saúde
17.
Artigo em Inglês | MEDLINE | ID: mdl-35886174

RESUMO

A major threat to the achievement of the Sustainable Development Goals and Universal Health Coverage continues to be malnutrition [...].


Assuntos
Desnutrição , Saúde Pública , Saúde Global , Objetivos , Humanos , Cobertura Universal do Seguro de Saúde
18.
Artigo em Inglês | MEDLINE | ID: mdl-35886319

RESUMO

BACKGROUND: An important aspect of achievement goals is the persistence and determination that the person possesses in order to achieve it. Spain does not have an adequate instrument for its measurement. First, this article had the aim of adapt and validate the Motivational Persistence Scale of Constantin et al. in a Spanish population and athletes. Second, it had the aim of prove the relationship with deliberate practice and performance. METHODS: In this study, 384 university students participated, where the factor structure was analyzed by means of a Confirmatory Factor Analysis (CFA). In study 2 of 169 athletes was used to confirm its validity in a homogeneous population and its predictive capacity on the hours of deliberate practice (DP) and performance. RESULTS: The AFC showed a two-factor structure, reducing the original three-factor structure, presenting a good fit in both Spanish and homogeneous population of athletes and achieving a significant predictive capacity on deliberate practice. The new dimensions were Purpose Pursuing (PP) and Recurrence of Unattained Purposes (RUP). CONCLUSIONS: Overall, our results provide evidence that this scale could be a useful tool for the assessment of Persistence in the Spanish adult and athlete population.


Assuntos
Logro , Objetivos , Adulto , Análise Fatorial , Humanos , Psicometria , Reprodutibilidade dos Testes , Espanha , Inquéritos e Questionários
19.
BMC Psychol ; 10(1): 171, 2022 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-35831897

RESUMO

BACKGROUND: Goal setting and goal-focused work is widely used in young people's mental health settings. However, little is known about how, why or for whom this is helpful. This study aims to explore the mechanisms of collaborative goal setting as part of therapeutic relationships: is it helpful for young people experiencing anxiety and/or depression, how and why/not, for whom, and under what circumstances? METHODS: Online database searches generated 10,907 records. Seven unique studies are included, combined with insight analysis from directed discussions with international advisors with lived experience of anxiety and/or depression and therapy (N = 8; mean age = 20.8), and mental health academics/clinicians (N = 6). RESULTS: Findings are presented as a narrative synthesis and suggest that goal setting is helpful to young people experiencing anxiety and/or depression because it helps build good therapeutic relationships through open communication and building trust. Goal setting helps make things more manageable, enabling young people to feel supported and have ownership of their care. Individual preferences, or high levels of distress, trauma, low confidence, hopelessness, negative past experiences of goal setting, perfectionism, and rumination are considered limiting factors to goal setting. Additionally, contextual factors including country and long-term therapy are explored. CONCLUSION: Whilst the resultant sample is small, emphasis on the voices of young people in the research is both prominent and of paramount importance. Several key literature gaps are identified, including evidenced links to the reduction in symptoms. Priority must be given to researching unhelpful mechanisms of goal setting for young people experiencing anxiety and/or depression, to avoid any potential iatrogenic effects.


Assuntos
Depressão , Objetivos , Adolescente , Adulto , Ansiedade/terapia , Transtornos de Ansiedade/terapia , Depressão/terapia , Humanos , Saúde Mental , Adulto Jovem
20.
Exp Brain Res ; 240(7-8): 2191-2203, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35796858

RESUMO

Temporal binding is an illusion in which the temporal interval between two events appears compressed. In the context of intentional actions, this effect is observed as a compression of the perceived interval between these actions and their causal outcomes. This 'intentional binding effect' has been used to investigate the Sense of Agency, which is the experience of intentionally causing an outcome through volitional action. Intentional binding is reduced for negative outcomes such as error feedback, but the role of mistakes (e.g., errors of commission) for binding and agency has not been extensively studied. In our study, participants played a virtual game in which they attempted to 'splat' (hit) visual stimuli that looked like coloured bugs, using mouse clicks. On some trials, stimulus colours changed unpredictably immediately before actions were made, sometimes inducing mistakes. Actions were thus clearly identifiable as mistakes at the time of their onset before any outcome feedback had been provided. Participants reported shorter action-outcome intervals when stimuli changed, but only when this change caused a mistake according to the game's rules. This suggests that intentional binding is strengthened by errors of commission. We discuss how this effect may be accounted for by agency itself and via more general processes such as changes in arousal.


Assuntos
Desempenho Psicomotor , Percepção do Tempo , Nível de Alerta , Objetivos , Humanos , Intenção , Volição
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