The first semester of practicum is a difficult time for counseling students as they learn to integrate knowledge and theory into clinical practice, often evoking high levels of anxiety (Barbee, Scherer, & Combs, 2003; Ronnestad & Skovholt, 1993) and limiting counselor selfefficacy (Bernard & Goodyear, 2009; Melchert et al., 1996). Practicum is the first opportunity counselors-in-training have to apply theoretical knowledge in a professional setting, use new clinical skills, and test how well they fit into the field of counseling (O‟Connell & Smith, 2005). Additionally, if counselor educators do not fully understand the process counselors in training develop counselor self-efficacy, they may be overlooking opportunities to educate a new generation of counselors or using their time, energy and resources in areas that may not be the most efficient in counselor development. The purpose of this study was to examine the effect of an embedded, rich-media distributed learning environment added to practicum had on the development of counselor self-efficacy, reduction of anxiety and effect on treatment outcomes for counselors in training in their first semester of practicum. This study found the use of distributed learning to extend education beyond the classroom significantly and positively affected the development of counselor selfefficacy, had mixed statistical results on the reduction of anxiety and did not have an affect on treatment outcome. Furthermore, the study used hierarchical linear modeling to see if the characteristics of individual practicums affected the three main constructs, the results did not find a significant effect from the groups. iv The results of the study produced several implications for counseling. First, if counselor educators help counselors in training become more aware of counselor self-efficacy, the students can better understand how the construct affects their anxiety, their comfort with expanding or improving their clinical skills and the approach they take to a client, session or treatment plan. A second implication is that using an embedded, rich-media learning environment may help the counselors in training to develop their clinical skills. The results of this study imply that utilizing technology and discussions beyond the classroom is beneficial for (a) increasing the students‟ counselor self-efficacy, (b) normalizing the emotions the students may experience and (c) improving the methods for development through vicarious learning. Also, as technology continues to evolve and as education continues to adapt by integrating technology into the classrooms, counselor educators should begin exploring how to best use technology to teach students during practicum. Traditionally, based on the nature of counseling, practicum has been an interpersonal experience, but the results of the current study imply the methods of extending learning beyond the traditional class time is beneficial. Finally, as counselor educators strive to increase students‟ counselor self-efficacy early in practicum, in an environment that contains anxiety and self-doubt (Bernard & Goodyear, 2009; Cashwell & Dooley, 2001) using vicarious learning through video and online discussions can assist in accomplishing the goal.

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Politically interested individual citizens often use information and communication technology (ICT) to facilitate and augment their civic and political participation. At the local level, ICT plays an important role for communication and information sharing in order for local groups to create awareness and draw citizens into public deliberation about local issues and concerns. This research examines the interplay of individual and local group level factors in order to better understand the relationship between civic engagement and ICT, especially the internet, by using household survey data from the town of Blacksburg, Virginia and environs in 2005 and 2006. It seeks to reconcile those different levels of analysis relating to the use and impact of the internet on civic engagement in local governance. This study identifies the distinctive influences at both the individual citizen level and the group level by applying a multilevel statistical model (the Hierarchical Linear Model). First, this study found the effects of internal and external political efficacy and community collective efficacy as significant individual level influences on internet use for civic and political purposes. Second, group internet use—which includes new internet technologies—and group political discussion were revealed as key influences on citizens' perspectives on the helpfulness of the internet for civic and political purposes at the group level of analysis. Finally, in multilevel analysis, those recognized group level variables (group internet use and group political discussion and interests) led to positive agreement with the following statements: 1) the internet has helped me feel more connected with people like myself in the local area; 2) the internet has helped me feel more connected with a diversity of people in the local area; and 3) the internet has helped me become more involved in local issues that interest me when taking individual level variables into account. / Ph. D.

The purpose of this research was to compare results from two approaches to measuring change over time. The multilevel model (MLM) and latent growth model (LGM) were imposed and the parameter estimates were compared, along with model fit. The study came out of education and used data collected from 191 teachers as part of a professional development intervention in science, which took place over four years. There were missing data as a result of teacher attrition. Teachers reported use of reform-oriented practices (ROP) was used as the outcome, and teacher-level variables were examined for their impact on initial ROP and change in ROP from baseline to one year after the intervention. Change in ROP was examined using a piecewise change model where two linear slopes were modeled. The first slope estimated the change from baseline to T1, or the initial change after the intervention while the second slope estimated the change from T1 to T3, or the secondary change. Parameter estimates obtained from MLM and LGM for a model using the error covariance structure commonly assumed in MLM (i.e., random slopes, homogeneous level-1 variance) were nearly identical. Models with various alternative covariance structures (commonly associated with the LGM framework) were examined, and results were nearly identical. Most of the model fit information was in agreement regarding the best fitting model being the model that assumed the typical MLM error covariance structure with the exception of the standardized root mean square residual (SRMR) fit index. The results from the models demonstrated that ROP increased after participating in the first year of the intervention and this level was sustained, though did not increase significantly in subsequent years. There was more variation in ROP at baseline. This information tells us that the intervention was successful in that after participating in the intervention the teachers' used ROP more frequently. The success of the intervention did not depend on any of the predictors that we assessed, and, as a group, the teachers became more similar in their use of reform-oriented practices over time.

To increase real estate values, developers often apply designs on the land. In the case of a single family housing development, the designs are applied to the unit of subdivisions. In this study, the designs are defined as “value creation concepts,” which increase housing values at the subdivision level. The value creation concepts are classified into five categories – the sense of arrival, product mix, walkability, circulation system, and amenity. This cross-sectional study focuses on exploring the effects of value creation concepts in the subdivision. Two methodologies – the Hedonic Price Model (HPM) and the Hierarchical Linear Model (HLM) – are used to test whether or not the value creation concepts would increase or decrease single family housing values. The study sample is composed of 6,562 single family houses nested in 85 subdivisions in College Station, Texas. Data are composed of two levels: the housing level and the subdivision level. The scores of the sense of arrival were provided by sixtyone graduate students at Texas A&M University using photograph evaluations. Most structural variables were obtained from the Brazos County Appraisal District, and physical environmental variables were objectively measured using the Geographical Information System. In the both models, sense of arrival, greenway connectivity, sidewalk connectivity, and median length of cul-de-sac variables have positive effects on single family housing values while phased project, the number of accessible entrances, street density, single family density, and median length of block variables have negative effects on single family housing values. At the housing level, several structural variables (e.g. bathrooms, attached garage, porches, etc), attached to a golf course, sports facilities, network distance from the nearest elementary school, population density, and personal variables (i.e., tenure, workable age, employment) were significant (p<.05) predictors of single family housing value. Findings support that the value creation concepts have effects on increasing housing values at the subdivision level, which would provide thoughtful insights for developers in residential areas. In addition, the HLM can be used as the complement of the HPM by controlling interaction terms between housing variables and subdivision variables, or among the subdivision variables themselves.

Due to the inherently hierarchical nature of many natural phenomena, data collected rests in nested entities. As an example, students are nested in schools, school are nested in districts, districts are nested in counties, and counties are nested within states. Multilevel models provide a statistical framework for investigating and drawing conclusions regarding the influence of factors at differing hierarchical levels of analysis. The work in this paper serves as an introduction to multilevel models and their comparison to Ordinary Least Squares (OLS) regression. We overview three basic model structures: variable intercept model, variable slope model, and hierarchical linear model and illustrate each model with an example of student data. Then, we contrast the three multilevel models with the OLS model and present a method for producing confidence intervals for the regression coefficients. / text

Receiver operating characteristic (ROC) curves have been widely used in evaluation of the goodness of the diagnostic method in many study fields, such as disease diagnosis in medicine. The area under the ROC curve (AUC) naturally became one of the most used variables in gauging the goodness of the diagnosis (Mossman, Somoza 1991). Since medical diagnosis often is not dichotomous, the ROC curve and AUC need to be generalized to a multi-dimensional case. The generalization of AUC to multi-class case has been studied by many researchers in the past decade. Most recently, Nakas & Yiannoutsos (2004) considered the ordered d classes ROC analysis by only considering the sensitivities of each class. Hence, their dimension is only d. Cha (2005) considered more types of mis-classification in the ordered multiple-class case, but reduced the dimension of Ferri, at.el. from d(d-1) to 2(d-1). In this dissertation we are trying to adjust and calculate the VUS for an ordered multipleclass with Cha’s 2(d-1)-dimension method. Our methodology of finding the VUS is introduced. We present the method of adjusting and calculating VUS and their statistical inferences for the 2(d-1)-dimension. Some simulation results are included and a real example will be presented. Intellectual outcomes in pediatric brain-tumor patients were investigated in a prospective longitudinal study. The Standard-Binet Intelligence Scale-Fourth Edition (SB-IV) Standard Age Score (SAS) and Composite intelligence quotient (IQ) score are examined as cognitive outcomes in pediatric brain-tumor patients. Treatment factors, patient factors and time since diagnosis are taken into account as the risk factors. Hierarchical linear/quadratic models and Gompertz based hierarchical nonlinear growth models were applied to build linear and nonlinear longitudinal curves. We use PRESS and Volume Under the Surface (VUS) as the criterions to compare these two methods. Some model interpretations are presented in this dissertation.

本研究旨在探討猝睡症患者生活品質受症狀變化及神經認知功能改變的影響情況，以及不同層次影響因素對患者生活品質的初始狀態及後續變化軌跡的影響效果。 本研究於北部一所醫學中心睡眠障礙科及兒童心智科募集確診為猝睡症之患者，經同意後進行為期五年的長期研究，募集總人數168人，完成五年資料收集人數85人。本研究使用睡眠多項檢驗（polysomnography, PSG）、多段入睡測試（multiple sleep latency test, MSLT）、人類白血球抗原檢驗（human leukocyte antigen, HLA）為基本檢驗工具，以電腦化第二版康氏持續注意力測驗（Continuous Performance Test- II）及威斯康辛卡片分類測驗（Wisconsin Card Sorting Test, WCST）為檢測神經認知功能之工具，以自填艾普渥斯嗜睡程度量表（Epworth sleepiness scale, ESS）、史丹佛睡眠問卷（Stanford sleep inventory, SSI）及簡式生活品質量表（short from-36 items of health related quality of life, SF-36）做為症狀嚴重度及生活品質的依據。資料分析以描述統計及階層線性模式（hierarchical linear models , HLM）統計方法進行。主要結果如下： 一、 猝睡症患者生活品質分為生理與心理兩個層面，患者生理層面在五年期間維持相對穩定沒有顯著變化；心理層面中之不同向度則有不同變化趨勢，心理健康與活力向度隨時間有逐漸提高的趨勢，患者此二向度生活品質接受治療後有穩定上升的趨勢，而社會功能及情緒角色限制則呈現二次方曲線變化，以及呈現先增後減的發展軌跡，患者此二向度接受治療後顯著上升，第三年後有逐年下降的趨勢。 二、 患者嗜睡程度及猝倒嚴重度變化隨時間有顯著成長軌跡，呈二次方曲線發展，轉折點在第三年，接受治療前三年症狀呈現穩定降低的軌跡，但自第三年起逐年增加，此結果與藥物治療初期症狀獲得顯著改善，後期改善幅度相對減少，及藥物效果具有關聯。 三、 個體間層次變項僅疾病持續時間、HLA對患者生活品質具顯著解釋力，其中疾病持續時間越長，患者可能發展因應症狀之策略，從而降低疾病對生活品質之衝擊。而HLA則對症狀有不同影響，HLA陽性患者初始嗜睡程度較陰性者為低，且接受治療後改善效果較陰性者顯著，猝倒嚴重度起始值較陰性者高，且接受治療後的趕善幅度較陰性者小。 四、 疾病嚴重度變化對生活品質具顯著影響，完整模式分析中，時間主效應未達顯著，但可由症狀變化及神經認知功能改變進行更佳的解釋。嗜睡程度變化僅對身體疼痛向度變化不具有解釋力外，對其餘七個向度均具顯著影響；猝倒影響層面不及嗜睡程度，但亦可解釋生理量表、生理角色限制、心理量表、心理健康、情緒角色限制、活力等向度上的變化。 五、 神經認知功能改變與否對患者生活品質具有加成效果，分析顯示患者神經認知功能改善時，其生活品質提升速率較未改善者高，影響較顯著的包括注意力、警覺度及概念反應，此結果與下視丘泌素參與的維持注意力及前額葉功能有關。 本研究依據分析結果提出猝睡症患者生活品質受嗜睡症狀及猝倒嚴重度改變直接影響，同時受人類白血球抗原屬性及神經認知功能改變調節之假設模型，作為未來研究參考依據。並根據研究結果與限制，提出對臨床實務的應用與心理介入的建議，並對未來提升猝睡症患者生活品質相關研究提供建議。 / The current study aims to: (1) examine the change of eight domains of quality of life in narcoleptics within five years, (2) investigate the impact of the change of symptom severity on different dimension of quality of life, as well as the influence associated with the change of neuro-cognitive function. There were 168 participants recruited from a medical center in northern Taiwan. 85 of them completed the 5-year annual follow-up data collection. During the follow-ups, polysomnography (PSG), multiple sleep latency test (MSLT) and human leukocyte antigen (HLA) test were conducted. Computerized neuropsychological tests of Conners’ Continuous Performance Test- II (CPT-II) and Wisconsin Card Sorting Test (WCST) were also administered to obtain attention and executive function data. The short from-36 items of health related quality of life (SF-36), Stanford sleep inventory (SSI) and Epworth sleepiness scale were applied to assess quality of life and symptom severity. Descriptive statistics and hierarchical linear models were applied for data analysis. The main results were: 1. The quality of life was divided into physical and psychological domains. The physical domain kept relatively stable during the 5-year follow up as opposed to the psychological domain. In psychological domain, the vitality and psychological health showed increasing tendency overtime. However, the social function and role functioning-emotion increased during the first 3 years then declined afterward. 2. The symptom severity also showed a tendency corresponded to quadratic curve. The daytime sleepiness together with cataplexy severity reduced immediately after treatment but rose after the third year. 3. The variables of individual characteristics that showed significant impact on quality of life were disease duration and HLA type. The longer the duration, the better quality of life one had. Positive HLA typing seemed to be a protective factor on severity of sleepiness. It also predicted better treatment outcomes, but worsen the severity of cataplexy and treatment effects. 4. The symptom severity could be a good explanation as a variable of quality of life. The daytime sleepiness altered all domain of SF-36 expect body pain. Cataplexy affected only psychological domain of SF-36. 5. The neuro-cognitive function was also found to affect quality of life. Those who improved in attention and executive function test got greater improvement on SF-36 as well. The vigilance on CPT-II and conceptualized response on WCST had most significant impact. I proposed a model of change of quality of life in patients with narcolepsy based on the results obtained. Several suggestions were also proposed for clinical and psychological intervention for narcolepsy to improve their quality of life.

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No description available.