abstract: Sexual assault at colleges and universities in the United States is a significant health and human rights issue that impacts somewhere between one-in-four and one-in-five students. Despite the alarmingly high burden, overall rates of disclosing to crisis, health, and victim services, and reporting to schools and law enforcement remain low. In order to buffer students from associated short- and long-term harm, and help them reestablish safety and pursue justice, empirically-supported, innovative, and trauma-informed secondary prevention strategies are needed. To address this pressing issue, the current study used a trauma-informed, feminist community research approach to develop and design a prototype of an internet-based decision aid specifically tailored to assist students at Arizona State University who experience sexual assault with making informed choices about reporting and seeking care, advocacy, and support on and off campus. Results from preliminary alpha testing of the tool showed that: 1. It is feasible to adapt decision aids for use with the target population, and 2. While aspects of the tool can be improved during the next phases of redrafting and redesign, members of the target population find it to be acceptable, comprehensible, and usable. / Dissertation/Thesis / Doctoral Dissertation Global Health 2018

Purpose: To synthesize evidence on decisional needs assessments and patient decision aid (PtDA) trials based on the Ottawa Decision Support Framework (ODSF) in order to validate the concepts and test the main assertion in the ODSF. Decisional Needs: The systematic review studies (n=45) validated all of the decisional needs identified in the ODSF. Nine new manifestations of ODSF decisional needs emerged (e.g. information overload, unreceptive to information/deliberation, relationship barriers with practitioner). PtDAs: The sub-analysis identified 24 ODSF PtDA trials. Compared to usual care, ODSF PtDAs improved decision quality, addressed decisional needs and reduced decision delay. Further evaluation is needed on downstream impacts of these improvements on decision-making. Conclusions: Using Walker and Avant’s theory testing steps, the integrated findings from the systematic review and sub-analysis validated the ODSF decisional needs concepts and tested the main assertion in the ODSF (that PtDAs address decisional needs and improve decision quality).

Background: Patients with head and neck cancer (HNC) carry a clinically significant symptom burden, alterations in function (e.g. impaired ability to chew, swallow, and talk), and decrease in quality of life. Furthermore, treatment impacts social activities and interactions as patients report reduced sexuality and high rates of depression. Patients may suffer undue anxiety because they find treatment incomprehensible, which is partially a function of limited, understandable information. This can be particularly challenging for patients with limited health literacy. Furthermore, a globalized world consisting of cultural differences increases the need to enhance transparent communication of risk. Research on risk literacy and medical decision-making validates that across different cultures, people often have severe obstacles in grasping a host of prerequisite concepts for understanding health-related risk information such as numbers, graphs, and basic medical facts. Patients’ perceptions of having obtained adequate information prior and during treatment are predictive of positive outcomes. Providing patient-centered decision-support, utilizing visual images, may increase understanding of treatment options and associated risks to improve satisfaction with their decision and consultation, while reducing decisional conflict. A scoping review was conducted on electronic, decision aids (DAs) for oncology patients that returned 4217 articles, but only 167 for HNC, with 12 meeting the inclusion criteria. Three themes were identified: (1) both patients and physicians valued the DA; (2) DAs should be visually supported by images; and (3) use of a DA lessened decisional conflict and anxiety while improving knowledge, satisfaction and shared decision-making. This informed the design of a prototype DA. Semi-structured interviews were conducted with 12 survivors of HNC who completed treatment at BC Cancer- Victoria on their experiences, feedback on the utility of a DA, and insights into design features. Thematic analysis resulted in 12 themes that were organized into 3 categories. The first category, “the patient experience,” included three themes: “patients have high, through varying information needs”; “an emotional experience”; and “stories of coping, strength and resiliency.” The second category, “electronic DAs and decision support,” also included three themes: “familiarity with decision aids”; “support of concept: usefulness and of visual aids”; and “versatility of the prototype.” The last category, “evaluation of prototype”, contained six themes: “reaction to prototype”; “favourited features”; “complexity”; “preference for customizability”; “suggestions for improvement”; and “presentation device.” Key Message: The use of DAs have been shown to better inform and increase patients’ knowledge, accuracy of risk perception, and congruency between informed values and care choices allowing them to take part in active decision-making, compared to usual care. Survivors of HNC were in unanimous support of using visual images to help explain treatment and assist in decision making on treatment options. Furthermore, they contributed invaluable feedback on the prototype design, demonstrating the value of a co-design methodologies. / Graduate

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This dissertation presents a body of research consisting of 5 scientific papers with an overarching objective to develop and test interventions that can enhance the dissemination, access and use of current best evidence at the point of care. Questions constantly arise from clinicians’ interactions with their patients, but more than 60% remain unanswered. The first 4 papers therefore focused on evidence dissemination to clinicians and trainees looking for answers and trying to stay alert to new evidence. We used as our “laboratory” an online tool developed at McMaster University’s Health Information Research Unit, the MacPLUS Federated Search (MacPLUS FS), which allows busy clinicians to search multiple top high quality resources simultaneously and display a 1-page output with the most clinically useful results at the top. Guided by effective models for the teaching of clinical skills at the point of care, we designed 3 web-based interventions addressing logistical and educational barriers to increase the quantity and quality of searching for current best evidence. These interventions were: (A) a web-based Clinical Questions Recorder and Reminder; (B) an Evidence Retrieval Coach composed of 8 short videos embedded in MacPLUS; (C) and a Gamified Audit & Feedback based on the allocation of “badges” and “reputation scores” for evidence searching. We tested these interventions in 4 factorial randomized-controlled trials among 1,868 heath care professionals and students currently registered in MacPLUS FS, namely: 477 medical faculty members, 431 postgraduate medical trainees, 725 nursing students and 235 medical students. Results showed that these target populations substantially differed both in their baseline frequency of search and access to alerts, as in their responsiveness to the 3 web-based interventions on evidence utilization. Evidence summaries have traditionally been tailored to meet the educational needs of clinicians, but are seldom provided in a format that supports shared decision-making. Our fifth paper explored a potential solution, which constitutes another route for evidence dissemination and use. In a project called SHARE-IT, we developed a new framework and online prototype for the generic production of decision aids, which allow physicians and patients to discuss the evidence together in the clinical encounter. We present the framework, design methods and early testing of this generic approach, which showed promising results for the translation of evidence summaries into useful tools for shared decision-making. / Thesis / Doctor of Philosophy (PhD)

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No description available.

No / Relatives of people with dementia report that proxy decision-making is difficult and distressing. We systematically reviewed the literature about barriers and facilitators to family carers of people with dementia making proxy decisions, and interventions used to facilitate their decision-making. We searched electronic databases and references of included papers up to February 2014. Two authors independently evaluated study quality using a checklist. We included the 30/104 papers from our search which fitted predetermined criteria and prioritized higher quality papers. Family carers report that proxy decision-making is challenging and can be distressing, especially when decisions are made against the wishes of the care recipient and support from healthcare professionals is lacking. Decision-specific manualized aids have been developed, and while results for those supporting decisions about respite and percutaneous endoscopic gastrostomy (PEG) feeding have shown promising results in pilot trials, no intervention has yet been shown to significantly reduce decisional conflict or carer burden, or increase knowledge in randomized controlled trials; a decision aid for advance care planning increased decisional conflict. We recommend development and testing of decision aids targeting the decisions carers report finding most distressing, including those around where people should live, accessing services, and end of life treatments. Being provided with information to make decisions which have not previously been considered may increase feelings of conflict, suggesting these aids should be carefully targeted.

Approved for public release; distribution in unlimited. / In Littoral Warfare (LW), naval operations face a whole new range of missions and types of threats. In such situations, Electronic Warfare (EW) systems are extremely important, yet constantly challenged to perform faster and more accurate detection and recognition of potential threats. However, meteorological and oceanographic (METOC) factors can severely modify the effectiveness of EW systems, particularly against low detectable targets in warm waters. Therefore, this thesis analyzes the effects of tropical littoral environments in the expected performance of generic RF and IR systems when used under these scenarios. It analyzes the outputs of propagation models included in the software suites AREPS and TAWS when using actual data from different sources in the Yucatan Channel. The results of this study demonstrated how radically the environmental conditions can change, clearly modifying the efficiency of surveillance and detection systems in shipborne platforms. Further, several issues related to the need of valuable data and additional research are addressed, while providing useful insights to operational commanders and decision makers for the use of EW systems and available Tactical Decision Aids (TDAs) at the typical scenarios of Littoral Warfare in tropical waters. / Lieutenant Commander, Mexican Navy

Cette recherche porte sur l'évaluation de la durabilité en phase amont d'un projet architectural. Cette thèse argumente la nécessité d'évaluer l'impact sur les aspects de développement durable en phase de préconception. La phase amont est très importante en raison de son faible coût et des degrés de liberté qu'elle permet lors des prises de décisions. Ainsi l'élaboration d'un outil ou d'un modèle pouvant aider les architectes à identifier les potentiels de durabilité en préconception, représente un enjeu important pour l'aide à la décision architecturale. En prenant en compte les impacts de la durabilité en phase amont, le concepteur peut s'astreindre à une vision différente et peut aborder des espaces de solutions visant à augmenter le niveau de durabilité de son projet. La méthode de conception à objectif désigné (COD) est utilisée en tant que démarche pour structurer l'outil d'aide à la décision. Cet outil aide les architectes à guider leur choix en fonction d'objectifs pré-établis. De plus, grâce à la COD, tous les acteurs du domaine de la construction peuvent participer à la phase de la programmation. D'autre part, l'accent peut être mis sur l'aspect socioculturel que les méthodes existantes ont négligé. Notre outil a été développé sous forme de logiciel puis a été expérimenté sur quatre projets réels en Iran. Les résultats bruts attestent de la pertinence de l'outil en phase de préconception / This research focuses on sustainability assessment in the upstream phase of an architectural project. This thesis points out the need to assess the impacts of pre-design's phases decisions on the sustainable development aspects. The upstream phase is very important because of their low cost and the large range of possible solution. As a consequence a tool or model is required that can help designers/Architects to identify sustainability potential in pre-design phase : this will constitute a "Decision aids tool" for architecture. Taking into account the impacts of sustainability in the upstream phase, the designer/Architects can achieve a different view and take advantage of these environmental effects to increase the level of sustainability of the project. The "Design to Objective" method (DTO) is used as an approach to provide a tool for decision support. This approach helps architects making decision. In addition, due to the DTO, all stakeholders in the field of construction can contribute to the programming phase. On the other hand, attention is directed toward the socio-cultural aspect which has been neglected by existing methods. This tool / software (SustainPro) has been experimented on four real projects in Iran. Experimental outcomes attest of the pertinence of the proposed approach