Substance use disorders (SUD) are among the most significant worldwide public health challenges. Isolation and separation are some of the more common indicators of SUD. Even though various music therapy interventions are used to address clinical goals when working with clients with SUD, voicework, specifically, has not been abundantly researched with this client group. Research has shown that the use of the voice has the ability to turn isolation into connection. This qualitative study therefore examined whether voicework with this client group could facilitate connection. Seven clients participated in six group music therapy sessions held at a halfway house over three weeks. The sessions as well as the one focus group were transcribed, and thick descriptions were written of musical excerpts; all were then analysed thematically. From the data, the following four themes were developed: (1) multiple forms of connection were afforded through voicework in music therapy; (2) music therapy offered multiple opportunities for facilitating connection; (3) particular techniques were useful for enhancing connection; (4) a music therapy process, centred around voicework, offered participants an experience in which they could reflect on connection and disconnection. The findings suggest that voicework can be a useful intervention within music therapy to create opportunities for connection to both the self and other. / Dissertation (MMus (Music Therapy))--University of Pretoria, 2021. / Music / MMus (Music Therapy) / Unrestricted

We show how physics-informed neural networks can be used to solve compressible \NS equations in protoplanetary disks. While young planets form in protoplanetary disks, because of the limitation of current techniques, direct observations of them are challenging. So instead, existing methods infer the presence and properties of planets from the disk structures created by disk-planet interactions. Hydrodynamic and radiative transfer simulations play essential roles in this process. Currently, the lack of computer resources for these expensive simulations has become one of the field's main bottlenecks. To solve this problem, we explore the possibility of using physics-informed neural networks, a machine learning method that trains neural networks using physical laws, to substitute the simulations. We identify three main bottlenecks that prevent the physics-informed neural networks from achieving this goal, which we overcome by hard-constraining initial conditions, scaling outputs and balancing gradients. With these improvements, we reduce the relative L2 errors of predicted solutions by 97% ~ 99\% compared to the vanilla PINNs on solving compressible NS equations in protoplanetary disks. / Graduate / 2022-12-10

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Informed consent can be considered, without any doubt, as a central issue in current bioethics and in medical law. The modern relationship between physician and patient has completely changed. Informed consent has dominated the theoretical discussions since the 1970s. Its importance is essential for both medical research and clinical practice. This work focuses mainly on clinical practice, on the relationship between a doctor (or more generally a healthcare professional) and a patient. The institute of informed consent has evolved similarly in medical ethics as well as in the medical law, but there are some significant differences. One of the basic issues of this work is to distinguish both positions and point out differences between legal and ethical aspects of this institute. The thesis sees the fundamental differences in the different purposes of both two key normative systems, in their function, in the values they represented and in the principles they emphasized. While trust and mutuality are essential to informed consent in ethics, the legal institute reflects more the protection of the subjects, especially the protection against abuse, thus providing legal certainty especially for the patient. The ethical level is primarily to ensure respect for the other person so that he or she is...

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Medical schools around the country are utilizing service-learning as a method of promoting cultural humility among future physicians and strengthening partnerships between academic institutions and their surrounding communities. Critical service-learning (CSL) is an approach which emphasizes the need to address the power dynamics inherent to service through guided critical self-reflection for student learners, and centers autonomy and self-determination for community stakeholders. STEM Stars is an afterschool STEM enrichment program at a community center in North Philadelphia which was piloted in the 2019-2020 academic year. It was created with a trauma-informed design to address the social and emotional needs of K-6 students at the community center and to introduce trauma-informed practices to staff at the center. STEM Stars also served as a more intensive CSL opportunity for medical student volunteers and a model for future service-learning programs at the medical school. This thesis is a gap analysis of STEM Stars: it will provide a background of the program, review the pilot year, assess its successes and shortcomings, and propose changes to be made in the coming years. / Urban Bioethics

Helping patients and their families prepare for the end of life is a privilege for physicians. Often these discussions are very sensitive; one must be able to navigate the complexities of dying while maintaining the strong, intimate relationship with a person who has entrusted the doctor with his or her final care. Many of the same principles of medical ethics still apply such as informed consent, acknowledging different degrees of health literacy, and cultural humility. With end-of-life care, physicians are responsible for providing their patients dignity in death. In doing so, it is important to decide how aggressive or intense medical treatment should be. There is evidence to suggest that early involvement of palliative care, foregoing invasive procedures or surgeries, and honest communication with families can improve the dying experience. The COVID-19 pandemic has only added more challenges to an already difficult art that physicians spend entire careers working on perfecting. Nevertheless, this provides even more reason to be proactive in determining what is most important for every individual in their final days. / Urban Bioethics

Trauma has been described as a pressing public health concern and research evidence demonstrates how unresolved trauma can lead to multiple co-morbidities including chronic medical conditions such as cardiovascular disease. Furthermore, epidemiological evidence demonstrates the high prevalence of trauma histories amongst service users seeking care across a range of systems including child welfare, education, health, social services and the criminal justice system. In response, the concept of trauma-informed care (TIC) has emerged, but how TIC can be conceptually defined and utilized remains unclear in the scholarly literature. This dissertation utilizes a variety of methodological approaches to explore how and under what conditions TIC can be utilized within and across systems of care to address the prevalence of trauma-affected individuals seeking care. First, a critical interpretive synthesis of the TIC literature provides an overview of how TIC can be defined and utilized through the development of a conceptual framework situating TIC within and across systems of care. A theoretical framework outlines important contextual factors, such as system arrangements as well as the political system, that can act as either barriers or facilitators to the operationalization of TIC. Second, a document analysis examines how and under what conditions TIC is utilized in adult mental health policy documents in Ontario, Canada. Finally, a case study explores what factors led to the exclusion of TIC from Ontario’s first province-wide strategy on mental health and addictions. Collectively, these three studies add several substantive, methodological and theoretical contributions regarding a cohesive understanding of what is trauma, how TIC can be defined and operationalized and the role of TIC at various levels within and across systems of care. Mobilizing sustainable and effective TIC has been demonstrated to improve the overall health and well-being of both service users and services providers, leading to stronger systems of care and healthier communities and societies at large. / Thesis / Candidate in Philosophy / The concept of trauma-informed care (TIC) has emerged in response to increased awareness regarding the prevalence and impact of trauma. A growing body of empirical literature has demonstrated the effectiveness of TIC within specific programs and services as well as at the organizational and system levels. What constitutes trauma, however, and how TIC can be defined and operationalized at various levels remains unclear. This thesis aims to address these gaps in the literature by: (1) developing a conceptual framework on TIC and a theoretical framework outlining the barriers and facilitators of TIC (2) examining how and under what conditions can TIC be utilized in mental health policy documents (3) exploring what are the political factors that can lead governments to decide against utilizing TIC.