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ClinicalAccess is a clinical decision support tool released in early 2014. It incorporates some familiar aspects of other clinical decision support tools while adding new elements to its interface, such as the ability for users to submit their own questions. Answers provided by ClinicalAccess are supported by evidence and references from McMaster Plus, other McGraw-Hill products, and links to articles in PubMed, amongst other resources.

While most clients show improvement in therapy, anomalously, 5% to 10% actually worsen, and a significant minority of clients shows little or no response to therapy. Earlier studies developed clinical support tools (CSTs) designed to provide feedback to therapists about potential problem areas and to improve the likelihood of a positive outcome for clients identified as at-risk for a negative outcome in therapy (Harmon et. al. 2007; Slade, Lambert, Harmon, Smart, & Bailey, 2008; Whipple et al., 2003). While varying from study to study, the CSTs looked at five domains: therapeutic alliance, motivation to change, social support, life events, and perfectionism. More than 100 questions were used to assess these domains. The major goal of this study was to streamline the CST measures to increase efficiency. Toward that end, a new instrument consisting of 37 questions was developed by administering questionnaires to 169 patients at a rural Utah mental health center. In addition, the life events and social support questions were given to 76 students at Brigham Young University and 88 randomly selected residents of Utah County. Using item response analysis and mean scores for each dimension, subscale cut scores were developed for four dimensions: therapeutic alliance, motivation for therapy, social support, and life events. The perfectionism subscale was dropped from the questionnaire because perfectionism was deemed to be too stable to be useful for the intended use of the measure. Cut scores were also developed for each individual question. These subscale and individual item cut scores are intended to help clinicians identify potential problem areas to be explored during the course of therapy.

Chatbots are increasing in popularity and interacting with humans via written language. Previous research has looked at chatbots within several domains, but not towards women’s general sexual and reproductive health. This offers a need to extend the small body of current research.  This report aimed to do so by describing women’s experiences of a sexual and reproductive health chatbot used as a decision support tool. The chatbot was designed based on a user-centered approach, allowing women to express desired personality traits in a person when discussing the topic. This resulted in the design creation of two chatbots with two different personalities. Exploratory Wizard of Oz studies were conducted with 6 users by simulating interaction with both chatbots operated by a human. Users were followed up with a survey and interview creating insights to their experiences with each chatbot. Findings resulted in contributing to research with proposed guidelines for how to design a sexual and reproductive health chatbot. / Chatbots blir allt mer populära och interagerar med människor genom skriftligt språk. Tidigare forskning har utforskat olika användningsområden för chatbots, men kvinnors sexuella och reproduktiva hälsa har inte varit en av dessa områden. Detta skapar ett behov att expandera den nuvarande smala forskningen. Denna studie syftar till att göra det genom att beskriva kvinnors erfarenheter av en chatbot för sexuell och reproduktiv hälsa som används som ett beslutsstödsverktyg. Chatboten utformades utifrån ett användarcentrerat tillvägagångssätt, vilket tillät kvinnor att uttrycka önskade personlighetsdrag hos en person som man diskuterar ämnet med. Detta resulterade i ett design skapade av två chatbots med två olika personligheter. Wizard of Oz studier genomfördes med 6 användare genom att simulera interaktionen med båda chatbots drivna av en människa. Deltagarna följdes upp med en enkät, följt av en intervju för bättre insikt till deras erfarenhet med varje chatbot. Resultaten resulterade i att bidra till forskning med förslag på riktlinjer för hur man utformar en chatbot för sexuell och reproduktiv hälsa.

Infrastructure systems are critical to sustaining and improving economical growth. Poor condition of infrastructure systems results in lost productivity and reduces the quality of life. Today's global economy forces governments to sustain and renew infrastructure systems already in place in order to remain competitive and productive (GAO, 2008). Therefore, civil engineers and policymakers have been quite interested in the overall quality of the highways and bridges throughout the US (Miller, 2007). Transportation networks are essential parts of the Nation's infrastructure systems. Deterioration due to age and use is the main threat to the level of service observed in surface transportation networks. Thus, highway agencies throughout the United States strive to maintain, repair and renew transportation systems already in place (Miller, 2007). A recent disaster, the collapse of the Minneapolis I-35 W Bridge, once again revealed the importance of infrastructure preservation programs and resulted in debates as to how state departments of transportation (DOTs) should and can preserve the existing infrastructure systems. Therefore, it is essential to establish effective maintenance programs to preserve aging infrastructure systems. The major challenge facing the state highway maintenance managers today is to preserve the road networks at an acceptable level of serviceability subject to the stringent yearly maintenance and rehabilitation (M&R) budgets. Maintenance managers must allocate such limited budgets among competing alternatives, which makes the situation even more challenging. Insufficient use of available smart decision-making tools impedes eliciting effective and efficient maintenance programs. Hence, this thesis presents the development and implementation of a network-level pavement maintenance optimization model which can be used by maintenance managers as a decision-making tool to address the maintenance budget allocation issue. The network-level optimization model is established with the application of the Linear Programming algorithm and is subject to budget constraints and the agencies' pavement performance goals in terms of total lane-miles in each pavement condition state. This tool is developed with Microsoft Office Excel. The tool can compute the optimal amount of investment for each pavement treatment type in a given funding period. Thus, the model enables maintenance managers in highway agencies to develop alternative network-level pavement maintenance strategies through an automated and optimized process rather than using what-if analysis. / Master of Science

Water heating in the United States has the largest energy consumption of any residential related use. It uses more energy than all other home appliances combined. They have also been implicated as the source of waterborne disease outbreaks. With such high stakes, it is recommended that a Decision Support Tool (DST) be used prior to selection of a water heater for new construction or replacement. Although there are numerous tools available, it is challenging to find a tool that takes into account all factors critical to the selection of water heaters, addresses gaps and barriers, provides adequate information to all stakeholders and finally, assists in rational decision making towards more sustainable choices. The purpose of this research is threefold: (a) to inventory, organize and characterize web-based existing water heater Decision Support Tools (eDSTs) to highlight gaps and/or shortcomings; (b) to develop a Decision Support Tool Skeleton (DSTS) containing a comprehensive list of sustainability capital, criteria and indicators based on Multi-Attribute Decision Making (MADM) approach; (c) to create a stakeholder map comprising supply chain, stakeholder system, decision making process during water heater selections as well as other market factors, using metasynthesis of collected documents. The findings of this research indicate that considerable gaps and shortcomings exist in the current pool of water heater DSTs. To address these barriers, information was captured from various documents in a process of qualitative data analysis called coding. The coding process generated attributes which were used to generate a comprehensive set of capital, criteria, subcriteria and indicators using MADM approach. This organizing structure developed on lines of sustainability assessment will serve as a starting point towards achieving global sustainability in real life. Importantly, information asymmetry between various stakeholders is evidence of the fact that the existing tools are not addressed in an equitable manner. This study will help determine the stakeholder system and the decision making process for selection of water heaters in the residential sector, so as to effectively implement new tools being created. / Master of Science

The Complimentary Energy Decision Support Tool (CEDST) was conceived to be a renewable energy calculator designed specifically for rural sites and agricultural operations in Ontario, though could easily assess urban sites as well, and equipped with the ability to compare the feasibility of different technologies. The Wind Energy Calculator (WEC) component of the CEDST project was the focus of this thesis and was developed since research revealed no current wind prediction tools that met CEDST needs. Verification of WEC predictions found prediction accuracy to have bounds of +/- 60% on actual turbine energy production and was equivalent to the actual generation for 21% of cases. The discrepancy could have resulted from unusual annual wind speeds, which had no significant impact on project economics when analysed. Many cases revealed that 10 kW turbines are not feasible projects under the Feed-in Tariff program and that turbines begin to become economical around 35 kW. / University of Guelph, Natural Sciences and Engineering Research Council of Canada (NSERC), the Poultry Industry Council (PIC), Ontario Ministry of Agriculture, Food and Rural Affairs (OMAFRA), and Egg Farmers of Ontario

O planejamento da expansão do sistema elétrico é uma das principais atividades em uma distribuidora de energia elétrica, representando uma grande parcela dos investimentos realizados pelas distribuidoras para atender a demanda dos consumidores e os critérios estabelecidos pela agência reguladora (ANEEL). As empresas buscam o apoio de métodos multicritério no processo decisório de investimento, para otimizar e priorizar, com o intuito de obterem êxito na elaboração de um plano de obras que contemple aspectos técnicos e econômicos. A revisão sistêmica da literatura foi realizada em trabalhos de relevância para o tema em estudo, com auxílio de cinco bases de dados. O referencial teórico, que totaliza 52 publicações, apresenta conceitos teóricos sobre o processo decisório através de métodos multicritério de apoio à decisão, bem como exemplifica, através de aplicações práticas como os métodos estão sendo utilizados na área de energia. Com base nesta revisão foi possível estruturar a aplicação da Teoria da Utilidade Multiatributo (MAUT) em um processo decisório de investimento para fins de planejamento da expansão do sistema de distribuição em uma concessionária distribuidora de energia elétrica. Com a aplicação do método fica evidenciada a importância de um procedimento formal para auxiliar os decisores na hierarquização de forma objetiva dos alimentadores de energia elétrica mais críticos, proporcionando maior clareza e aprendizado em todo o processo de planejamento da expansão do sistema elétrico. Ao final, desenvolveu-se uma ferramenta para tratamento do grande volume de dados, que disponibiliza as informações depuradas para auxiliar na tomada decisão de investimento em ações eficientes, que melhorem a qualidade do fornecimento e atendam o crescimento do sistema. A partir da revisão bibliográfica e com a aplicação do método, oportunidades para estudos futuros foram identificadas. / The expansion planning of the electric system is one of the main activities in an electric energy distributor, representing a large part of the investments made by the distributors to meet the consumer demand and the criteria established by the regulatory agency (ANEEL). The companies seek the support of multi-criteria methods in the investment decision-making process, to optimize and prioritize, in order to succeed in the elaboration of a work plan which contemplates technical and economic aspects. The systemic review of the literature was carried out in current and relevant articles for the subject under study, with the aid of five database sources. The theoretical reference, which totals 52 publications, presents theoretical concepts on the decision process through multicriteria methods of decision support, as well as exemplifies through practical applications how the methods are have been used in the area of energy. Based on this review, it was possible to structure the application of the Multiattribute Utility Theory (MAUT) in an investment decision process for the purpose of planning the expansion of the distribution system in an electric power distribution concessionaire. The application of the method shows the importance of a formal procedure to assist decision makers in the objective hierarchy of the most critical electric power feeders, providing greater clarity and learning throughout the planning process of the expansion of the electric system. In the end, a tool was developed to treat the large volume of data, which provides the purified information to assist in the decision making of investment in assertive actions that improve the quality of supply and meet growth of the system. From the literature review and with the application of the method, opportunities for future studies have been identified.

Les dispositifs médicaux (DM) innovants offrent sans cesse de nouvelles options thérapeutiques et diagnostiques et contribuent à améliorer la prise en charge des malades à l’hôpital. Toutefois, ces innovations, potentiellement onéreuses, ne disposent pas toujours de données probantes garantissant leur efficience. Par conséquent, pour guider le choix des décideurs hospitaliers, une évaluation à l’échelle de l’hôpital est souvent nécessaire afin de lever le maximum d’incertitudes avant leur acquisition. Cette démarche, appelée évaluation des technologies de santé (ETS) en milieu hospitalier, s’est beaucoup développée à l’étranger, mais reste méconnue en France. A travers notre travail, nous avons montré que les CHU français proposaient des modèles d’organisation pour l’évaluation des DM innovants tout à fait comparables à ceux rencontrés dans d’autres pays. Parmi les modèles d’ETS en milieu hospitalier, la mini-ETS semble être le plus généralisable et pourrait concourir à l’harmonisation des pratiques entre CHU. Ce modèle en plein essor existe sous de multiples formes dans le monde. La confrontation des critères d’évaluation identifiés dans les modèles assimilables à la mini-ETS à ceux utilisés dans les CHU français nous a permis d’isoler 26 critères d’évaluation d’intérêt pour l’évaluation des DM innovants. Enfin, nous avons élaboré puis testé, en situation réelle, un outil d’aide multicritère à la décision dérivé des précédents critères identifiés. / Innovative medical devices offer solutions to medical problems. However, medical devices arriving on the European market have generally little evidence about efficiency. To manage the uncertainty surrounding the introduction of innovative medical devices, hospitals and university hospitals have developed worldwide hospital-based health technology assessment (HTA) processes to guide the selection of expensive and innovative products. Nevertheless, little is known about hospital-based HTA activities in France. We demonstrated that French models of hospital-based HTA are comparable to those found elsewhere and presented sometimes a combination of several HTA models. We also underlined that a mini-HTA like model could easily be applied to French university hospitals. Mini-HTA has become widespread in many different forms across the world. We compared criteria of different mini-HTA forms to criteria used in French university hospitals and identified 26 relevant criteria to assess innovative medical devices. Finally, we developed and tested in real conditions a multiple-criteria decision tool derived from these 26 criteria.

Rainwater harvesting (RWH) in the UK has seen a low level of uptake relative to similar settings such as Australia and Germany. The relatively low cost of municipal water in the UK limits the financial savings associated with RWH systems, especially in a domestic setting. Although financial benefits can be relatively low (in terms of reduced water bills), academic and practitioner studies have demonstrated the potential for RWH to significantly reduce potable water demands at typical UK houses. Hence, increased uptake of RWH has potential to contribute to mitigating droughts in water scarce regions. Stormwater management in the UK is receiving increasing attention at all levels; from grass-roots sustainable drainage systems (SuDS) such as downpipe disconnections and raingardens; through to implementation of urban realm attenuation schemes and continued development of guidance from UK policy makers. The public realm nature of most SuDS presents a need for partnership approaches to be fostered between infrastructure mangers and the general public. The application of RWH as a technology within the SuDS management train has been limited in the UK as policy makers have taken the view that RWH tanks may be full at the start of a design storm, and thus the potential for attenuation and peak discharge reduction has been largely ignored. However, in the last few years there has been a shift in emphasis; from RWH perceived purely as a water demand management technology to a focus on its wider benefits e.g. mitigating surface water flooding through improved stormwater management. RWH systems examined in this thesis are now available which offer multiple benefits to both end-users and water service providers. The application of RWH in a dual purpose configuration (to displace potable water demands and control stormwater discharges) has seen increasing interest during the development of this thesis. However, the successful design of RWH as a stormwater management tool requires a series of calculations to be completed. To date, practitioners have frequently relied upon low-resolution heuristic methods which lead to a small range of configurations being deployed, with minimal demonstrable stormwater control benefits. In this thesis, full details of novel and traditional RWH technologies were identified and described. Empirical data was collected, both in laboratory conditions and at field sites, to identify the real world operating characteristics of a range of RWH configurations. Additionally a new time series evaluation methodology was developed to enable RWH systems to be designed and analysed. This method quantifies water demand benefits and also focusses on stormwater management metrics (i.e. largest annual discharge and total discharge volume per year). The method was developed to enable a range of RWH configurations to be evaluated at a given site. In addition, a decision support tool (RainWET) was developed and tested which enabled the methods to be deployed in real world settings. The application of the RainWET software allowed a UK-wide, time series analysis of RWH configurations to be completed and the holistic benefits of a range of dual purpose RWH systems to be analysed and described. Evidence from the UK study suggests that a traditional RWH installation (3000l storage, 300l/day demand and 60m2 roof) installed at a house in a water scarce region (London, SAAR 597mm) was able to fully mitigate stormwater overflows over a 20 year analysis whilst providing a mean water saving of 31,255l/annum. An equivalent system located in the wettest region studied (Truro, SAAR 1099mm) saw mean reductions in the largest annual storm of 62% (range 35-86%) whilst satisfying a mean rainwater demand of 50,912l/annum. The study concluded that suitably designed dual purpose RWH systems offered better stormwater management benefits than those designed without a stormwater control device. In addition, the integration of smart RWH controls were shown to maximise stormwater control benefits with little or no reduction in a system’s ability to satisfy non-potable water demands.