The purpose of this study was to explore whether and in what ways an intensive eight-week Mindfulness-Based Symptom Management (MBSM) program might shape the therapeutic experiences of therapists. I used a hermeneutic phenomenological approach to interview and develop in-depth descriptions of four therapists’ experiences in relation to mindfulness and their therapeutic practices. The data collection consisted of: (1) a telephone screening interview; (2) pre-mindfulness training interview; (3) post-mindfulness training interview; (4) field notes based on my observations, subjective experiences, and beginning analyses; (5) and member-checks to verify the accuracy of my interpretations of participants’ interview responses. The results pointed to several common themes indicating the changes therapists described after participating in the mindfulness program. Themes denoting the reported changes were organized into three categories: (1) personal relationship with mindfulness; (2) relationship between mindfulness and therapeutic experiences; and (3) mindfulness-oriented interventions performed in therapy. The findings indicated that mindfulness training is associated with the enhancement of important relational attitudes and skills of therapists, including more acceptance of where clients are at, more presence in therapy, increased capacity to listen, openness and curiosity, and more compassion and empathy. In addition, mindfulness training may be linked to improved reflexive abilities, which has implications for more intentional and ethical decision-making in therapy. Further, the findings also indicated that mindfulness training may be linked to improvements in emotion regulation by decreasing stress, increasing feelings of relaxation and calmness, improving awareness of negative emotional and cognitive states as well as the ability to interrupt these negative cycles. As such, this study pointed to several potential benefits for the inclusion of mindfulness training in therapists’ self-care practices as well as in therapist education.

ABSTRACT Patient's Informed Consent, Medicine Doctors' Responsibility, Patient's Protection This diploma thesis analysis the informed consent of patient, which is manifestation of the patient's right to decide about his own health freely. The main aim is to describe what laws is the informed consent based on, what it should contain, in which situations the doctor is allowed to act without the consent and what the consequences of acting without consent, in cases, in which the informed consent is required by law, are. Further problems, which are not adequately treated by the law, are also mentioned, and the obtaining of the informed consent in children and the informed consent in practice were described. It was found out, that registration of complaints should be kept by each medical facility separately in the Czech Republic. Except that, the complaints department is established at each regional office. Czech laws do not impose to register complaints or claims in national unified register. Number of complaints between 2008-2010 were obtained from the Czech Medical Chamber, Control Department of the Ministry of Health, Medical Department of Regional Office and from Prague City Hall. It can be stated, based on the study of all related resources and after comparing of the recquired information with the reality, that even if all regulations are abided, it is impossible for the doctor to inform patient about all risks and possible complications to avoid the complaints completely. The questionnaire survey shows, that the legal awareness of doctors in the issue of informed consent is inadequate and it is important to improve it.

This master's thesis deals with informed search algorithms. It's theoretical section summarizes basic theoretical ideas and terms which are related to this topic. It means especially discrete mathematics, graph theory, artificial intelligence and agent systems. Cardinal aim of this section is to provide theoretical analysis of search algorithms and to classify them into informed and uninformed classes. Theoretical section describes basic search strategies such as breadth first search, deep first search and modifications of these strategies, then it is focused on informed search algorithms, specifically A* (A-Star), IDA* (Iterative Deepening A-Star) and SMA* (Simplified Memory bounded A-star). It also describes topics related to informed search strategies -- heuristic functions and problem relaxation method. Given algorithms are analyzed in order to compare their time and space complexity. Main goal of practical part of this thesis is to design and implement software application, which will use informed and uninformed search strategies described in theoretical section. This application is intended to solve fifteen puzzle problem, so-called Lloyds fifteen puzzle game. First part of practical section analyses fifteen puzzle from mathematical and informatical perspective, then it examines possible implementation variants of algorithms and heuristics and proposes design of the application. Description of main interfaces and classes of the realized application follows. At the end of this section the analysis of informed algorithms and heuristics is performed using the implemented application and obtained results are compared to theoretical characteristics of these algorithms.

INTRODUÇÃO: Em ensaios clínicos o termo de consentimento livre e esclarecido é fundamental para a preservação da ética na pesquisa clínica e precisa ser lido e assinado pelos pacientes. No entanto, dada a sua complexidade este documento pode não ser entendido pelos mesmos. Para avaliar o entendimento destes sobre a pesquisa realizamos esta investigação. MÉTODOS: Convidamos os sujeitos participantes de ensaios clínicos de hipertensão arterial sistêmica e doença arterial coronária, fase II, III ou IV ambulatoriais e com fármacos, de jan/2002 a dez/2006, para responder questionário estruturado com 29 questões. Estes foram divididos em dois grupos, com uso (grupo I) ou não (grupo II) de placebo, após a randomização. Ao final, 80 pacientes compareceram de 106. Doutros 26 sujeitos, sete se recusaram, nove não foram localizados, oito foram excluídos e dois faleceram. As variáveis de cada questão foram consideradas por freqüência de ocorrência. A comparação entre as médias dos grupos foi realizada pelos testes t de Student ou Wilcoxon. Para avaliar associações utilizou-se o Qui-Quadrado, o teste de Razão de Verossimilhança ou Fisher. Para confirmar as informações, realizou-se também o grupo focal, tendo participado 8 do grupo I e 11 do grupo II. RESULTADOS: Avaliamos 80 sujeitos (grupo I- 47, grupo II- 33). As características sócio demográficas foram similares em ambos. Quanto à motivação para participar da pesquisa, 66,2% atribuíram-na ao benefício próprio, 42,5% pelo bem da ciência, e atendendo ao pedido médico 25,0%, em ambos os grupos. Quanto ao termo de consentimento livre e esclarecido, 50% não entenderam o seu conteúdo e 32,9% sequer o leram, mas o assinaram. No grupo I, 66,7% dos sujeitos não entenderam o significado de placebo e dos que afirmaram ter entendido (n=23) somente doze de fato comprovam o entendimento correto. Foram realizadas associações entre o não entender o significado do termo placebo com as variáveis de interesse para o estudo, e encontramos forte correlação com a escolaridade (p=0,022), evidenciando que quanto menor o nível de instrução menor também o entendimento. Houve também tendência entre ter um companheiro e ler o termo de consentimento livre e esclarecido antes de assinar (p=0,052), e o nível de escolaridade dos sujeitos e conversar sobre o termo de consentimento livre e esclarecido com o pesquisador (p=0,053). No que tange ao grupo focal, este corroborou os resultados e evidenciou que o termo de consentimento livre e esclarecido é considerado difícil pelos pacientes, porém a compreensão é favorecida pela equipe que complementa as informações de maneira clara e dispensa a leitura em virtude do vínculo de confiança estabelecido com esta. CONCLUSÕES: O termo de consentimento livre e esclarecido é pouco compreendido pelos sujeitos e para alguns a confiança no seu médico é crucial para a sua decisão em participar de um ensaio clínico com fármaco; evidenciou-se também influência do nível de instrução dos sujeitos no entendimento do termo placebo. Por outro lado, não houve repercussão na vida dos sujeitos em participar de ensaios clínicos com ou sem placebo, uma vez que a maior motivação para participar é pela expectativa do benefício terapêutico. / INTRODUCTION: To participate in a clinical trial patients have to sign an informed consent, often with misinterpretation words. Herein we addressed the issue of what do patients understand about the informed consent. METHODS: Patients that have participated in clinical trials in our institution were invited to an interview. From a data bank, between 2002 to 2006, patients were contacted by phone call. The questionnaire patients were submitted to was composed of 29 questions. To confirm some data, we did a second interview using the focal technique. Patients were allocated in two groups: Group 1- those that could have taken placebo for the treatment of their illness after a randomization, Group 2- those that did not take placebo during the treatment period but could have taken during the wash-out period. Statistics: were done with the t-Student test, or the Wilcoxon test. To evaluate associations we used the Qui-Square, Similarity test or the Fisher test and we considered a p value of 0,05. RESULTS: 80 patients, 60 (75%) males, age (average in years + SD) of 58.8 + 9.2; 47 in group 1 (58.3 ± 9.0) and 33 in group 2 (59.4 ± 9.8). Except for the job situation, both groups were similar. Of notice is the number of patients that were illiterate or have not completed the primary school. The most quoted motivation to participate was in their own benefit (66.2%), and second to the interest of science (42.5%). It is noteworthy that 50% of patients did not understand the informed consent but even in this case they did sign it. 66% did not understand the meaning of placebo that was correlated to the patients level of education (p= 0.02). Also, 36.2% of patients in group-I were not aware they could have taken tablets with no effect. In 19 patients (eight in group I and 11 in group II) submitted to the focal technique interview, what came out as the more important to their decision making to participate or not in a clinical trial, was the opinion of their assistant doctor. This was stood by almost all (90%) patients in this second interview. CONCLUSION: The informed consent was poorly understood, and for some patients the trust in their assistant doctors is crucial for their agreement to participate in a trial. This raised concerns about long and boring informed consent, and also how important are doctors´ words in the decision making of patients, probably due to their education level.

A pesquisa clínica patrocinada no Brasil vem crescendo cada vez mais e gerando conhecimento científico em diversas áreas da saúde. O desenvolvimento desses ensaios clínicos envolve aspectos que vão além da geração de fármacos e produtos mais avançados. O grande alicerce da pesquisa clínica está também nos pacientes que aceitam participar de um estudo científico. Estes precisam passar por um processo de consentimento que envolve ter conhecimento sobre todos os aspectos que envolvem a sua participação no ensaio clínico. Dentro desse contexto, surge um grande desafio na área que é como realizar o processo de consentimento de maneira adequada. É preciso levar em consideração aspectos como compreensão, motivações, influências, coerção, benefícios, riscos, entre outros aspectos. O objetivo deste trabalho foi identificar quais os fatores vivenciados pelos participantes de pesquisa clínica durante o processo de consentimento. Foram aplicados questionários a respeito da sua percepção no que envolve a participação na pesquisa clínica. Com os dados gerados foi possível desenvolver um conjunto de recomendações visando o aprimoramento do processo de consentimento em projetos de pesquisa clínica. / Clinical research sponsored in Brazil has been increasing and generating scientific knowledge in several areas of health. The development of these clinical trials involves aspects that go beyond the generation of drugs and more advanced products. The key of clinical research is also in patients who accept to participate in a scientific study. These need to undergo a consent process that involves having knowledge about all aspects that involve their participation in the clinical trial. Within this context, a great challenge arises in the area that is how to carry out the consent process in an appropriate way. It is necessary to take into account aspects such as understanding, motivations, influences, coercion, benefits, risks, among other aspects. The objective of this study was to identify the factors experienced by clinical research participants during the consent process. Questionnaires were applied regarding their perception regarding the participation in clinical research. With the data generated, it was possible to develop a set of recommendations aimed at improving the consent process in clinical research projects.

Introduction : La prise de décision concernant la préservation de la fertilité dans un contexte de prise en charge urgente de cancer du sein est complexe. Les objectifs de ce travail étaient de définir les attentes et les besoins des patientes en matière d’information, de concevoir un outil d’aide à la décision en ligne et d’évaluer sa validité apparente et son influence sur le choix éclairé des patientes.Méthodologie : Trois méthodes de recherche ont été menées pour répondre aux hypothèses : un focus group de cinq patientes pour l’étude qualitative, l’élaboration d’un outil d’aide à la décision selon la méthode d’Ottawa et une étude randomisée monocentrique. Cette dernière a été menée auprès de patientes âgées de 18 à 40 ans, adressées pour préservation de la fertilité dans un contexte de cancer du sein, randomisées au sein du groupe IRIS (information standard) ou du groupe DECISIF (avec outil d’aide à la décision en ligne). La mesure du choix éclairé était évaluée selon trois critères, à l’aide d’un questionnaire : les connaissances, l’attitude, et la mise en place ou non de techniques de préservation de la fertilité.Résultats : L’étude qualitative a permis de mettre en évidence que l’information transmise aux femmes et l’annonce de l’infertilité potentielle était à parfaire. L’outil d’aide à la décision en ligne a été élaboré suivant les recommandations des patientes et des professionnels de santé impliqués qui ont confirmé sa validité apparente. En ce qui concerne l’étude quantitative, au total 125 patientes ont été inclues et randomisées dans le groupe IRIS (n=65) ou DECISIF (n=60). Il a été mis en évidence une amélioration des connaissances dans le groupe DECISIF (8.6/10 (±1.34)) par rapport au groupe IRIS (6.49/10 (±1.89)). Dans les deux groupes, les patientes ont une attitude favorable envers la préservation de la fertilité (96 %). La décision finale n’est pas influencée par l’appartenance à un groupe ou un autre. Ainsi, à l’issue de la consultation de préservation de la fertilité, 73.6 % (92/125), soit 69.2 % (45/65) des patientes du groupe IRIS et 78.3 % (47/60) des patientes du groupe DECISIF vont choisir de conserver leurs ovocytes, embryons et/ou tissu ovarien. La proportion de choix éclairé était statistiquement plus élevée dans le groupe DECISIF que dans le groupe IRIS (respectivement 75 % versus 38.5 %, p<0.001). Par ailleurs, le niveau de conflit décisionnel chez les patientes du groupe DECISIF était moins élevé que chez celles du groupe IRIS (respectivement 14.4 (±2.94) versus 15.1 (±2.18), p=0.13).Conclusion : Nous avons conçu un outil d’aide à la décision en ligne pour accompagner les femmes atteintes d’un cancer du sein dans leur prise de décision concernant la préservation de la fertilité. Notre travail de recherche a permis de valider scientifiquement cet outil qui améliore les connaissances des patientes et leur autonomie de décision sans influencer leur attitude envers la préservation de la fertilité. / Introduction: Decision-making regarding fertility preservation in the context of urgent breast cancer management is complex. The objectives of this study were to define patients' expectations and information needs, develop an online decision support tool, and assess its apparent validity and influence on patients' informed choice.Methodology: Three research methods were used to address the hypotheses: a focus group of five patients for the qualitative study, the development of a decision support tool using the Ottawa method and a randomized, single-centre study. The latter was conducted with patients aged 18 to 40 years referred for fertility preservation in the context of breast cancer, randomized to the IRIS group (standard information) or the DECISIF group (with online decision support tool). The measurement of informed choice was evaluated according to three criteria using a questionnaire: knowledge, attitude, and whether fertility preservation techniques were available.Results: The qualitative study revealed that the information provided to women and the announcement of potential infertility needed to be improved. The online decision support tool was developed based on recommendations from the patients and health professionals involved, who confirmed its apparent validity. For the quantitative study, a total of 125 patients were included and randomized to the IRIS (n=65) or DECISIF (n=60) group. Better knowledge was found in the DECISIF group (8.6/10 (±1.34)) compared to the IRIS group (6.49/10 (±1.89)). In both groups, patients had a positive attitude towards fertility preservation (96%). The final decision was not influenced by membership in one group or another. Thus, at the end of the fertility preservation consultation, 73.6% (92/125), i.e. 69.2% (45/65) of patients in the IRIS group and 78.3% (47/60) of patients in the DECISIF group, chose to keep their oocytes, embryos and/or ovarian tissue. The proportion of informed choice was statistically higher in the DECISIF group than in the IRIS group (respectively 75% versus 38.5%, p<0.001). In addition, the level of decision-making conflict among patients in the DECISIF group was lower than in the IRIS group (respectively 14.4 (±2.94) versus 15.1 (±2.18), p=0.13).Conclusion: We have developed an online decision support tool to assist women with breast cancer in making decisions about fertility preservation. We have now validated this tool, which improves patients' knowledge and decision-making autonomy without influencing their attitude towards fertility preservation.

This thesis examines patient recruitment in clinical trials. It is a current and pressing issue, which is not sufficiently embedded in the thinking of doctors and patients, their patterns of communication, and more broadly in the traditional doctor-patient relationship, which continues to be burdened by post-socialist paternalism. The formal framework and ethics have been developed relatively recently, and their application causes confusion to all participants regarding how to proceed in specific situations. In addition, the choice of topic, and especially the form of dealing with the topic, was motivated by the relative lack of academic resources and publications in the field. The theoretical section of the thesis defines clinical research and its phases, and introduces basic terminology and documents closely linked to clinical research. In addition, it focuses on research ethics, thoroughly examining the issue of informed consent - a fundamental document necessary for recruiting a patient in a clinical trial. Finally, one chapter of the thesis focuses on the issue of medical literacy, the level of which is integral to the participants' understanding of the importance of clinical research, and directly affects participants' decision-making. The empirical section is divided into two parts. The...

Assembling different kinds of items, everything from furniture to hobby models, takes a certain process to complete and this process can vary in complexity. An interesting aspect of this process is what components are available during assembly. The optimal scenario would be to have all required components available but sometimes that might not be the case. For a computer, this problem can be difficult to solve and requires specific environments to complete an assembly task. In this thesis work, block puzzles with various blueprints were used to complete assemblies with two different lists of components; one whole set of correct components and one with mixed that may or may not work for a blueprint. Three different methods were used to conduct the assemblies, one random based method, one that used the informed search method iterative deepening A* and one reinforcement learning method that used dueling deep Q-networks. The assembly time and accuracy between a completed configuration and the blueprint were measured for each method, where the informed search performed best in terms of accuracy but had a long assembly time. The reinforcement learning method did not perform well in terms of accu-racy between blueprint and configuration, but had fast assembly time, and in its current state would not be suitable to use to solve the given problem. / <p>Examensarbetet är utfört vid Institutionen för teknik och naturvetenskap (ITN) vid Tekniska fakulteten, Linköpings universitet</p>

Many studies have noted the detrimental impact adverse childhood experiences (ACEs) can have on individuals’ developmental trajectories and, as a result, the utilization of trauma-informed practices has been of increasing interest within the field of education. Most research on trauma-informed pedagogy is derived from samples of children in grades K-12, whereas research on trauma-informed teaching practices within higher education is comparatively scarce. The specific aims of the current investigation are two-fold. The first aim is to explore the effect of postsecondary instructors’ disciplinary specialization (i.e., person-thing orientation) on their receptivity to compassionate teaching practices. The second aim is to implement a brief (i.e., one hour, single session), asynchronous intervention to inform instructors about ACEs, subsequent effects on learning, and evidence-based, trauma-informed teaching practices. Results indicated that participants’ thing-orientation scores negatively predicted their post-intervention receptivity scores and that there was a significant increase in knowledge about compassionate teaching practices from pre-assessment to post-assessment. Future studies should seek to replicate these findings and continue to identify factors that may influence one’s receptivity to compassionate teaching practices.

In this dissertation I explore how the international law principle of free, prior and informed consent (FPIC) can enhance public participation, to promote environmental justice for communities affected by environmental decision-making in the mining sector in South Africa. Public participation required in terms of the mining sector environmental regulatory framework in South Africa is underscored by a requirement to ‘consult’. In chapter one, I describe how the requirement to consult differs from a requirement to secure consent in terms of FPIC. I describe public participation (i.e. consultation) requirements related to applications for rights, permits, licences and authorisations that must be in place prior to commencement of mining operations. I argue that where the level of public participation requires mere consultation, it can easily amount to a regulatory tick-box exercise given that the views of mining-affected communities can be manipulated or overlooked, with mining developments proceeding despite devastating effects on communities. In chapter two I describe how FPIC has become part of the regulatory framework governing mining activities through the court’s purposive interpretation of the Interim Protection of Informal Land Rights Act 31 of 1996 (IPILRA) in Baleni and Others v Minister of Mineral Resources and Others and Maledu and Others v Itereleng Bakgatla Mineral Resources (Pty) Limited and Another. In chapter three, I engage with scholarly literature on FPIC to analyse why and how environmental justice should and can be enhanced by embedding FPIC into legislative public participation requirements. I argue that FPIC, which now forms part of South Africa’s law through the IPILRA, should be a prominent feature in public participation processes for mining-affected communities generally, and not only for informal land right holders. / Mini Dissertation (LLM)--University of Pretoria, 2021. / Public Law / LLM / Unrestricted