In 2001, the Institute of Medicine stated that one of the parameters needing to be addressed to improve health care was the creation of electronic health records for all patients. This goal has proven to be very challenging to health care providers. Many barriers exist that prevent the goal of computerizing health records such as high costs, usability problems, interface incompatibility, and fear of change. The purpose of this feasibility project was to evaluate the usefulness and acceptability of a digital pen and paper (DPP) system for anesthesia documentation. The specific DPP technology used in this evaluation was a product developed by Shareable Ink®. Seven certified registered nurse anesthetists (CRNAs) evaluated the DPP system through a cognitive walkthrough procedure. During the cognitive walkthrough, the participants talked aloud as they carried out a series of anesthesia documentation tasks. Just prior to the cognitive walkthrough, participants were given a questionnaire that measured their perceived computer knowledge, attitudes and skills. After the cognitive walkthrough, a second questionnaire was used to determine their satisfaction with the DPP and their opinions about its usefulness for use in multiple anesthesia work settings. In the second phase of the project, I interviewed other stakeholders in the hospital environment who would also be affected by implementation of a DPP system. This portion of the study was conducted at a community hospital without electronic record-keeping capability. Participation from several departments was sought via contact with hospital administration and department heads. Among those departments targeted for interviews were: Information Technology, Chief of Anesthesia, Anesthesia Billing, Medical Records and Nursing. Semi- structured interviews were conducted and the responses of the participants recorded both as field notes and via audio recording. This intent of this study was to test the feasibility of the digital pen and paper system for various types of anesthesia work environments by means of descriptive, survey and qualitative data analysis. Overall, the device was not only found to be usable by providers but also acceptable to stakeholders. Therefore, this device could be deemed a feasible solution toward implementing and adopting electronic documentation in some anesthesia work settings.

<p>Military work-practice is a difficult area of research where paper-based approaches are still extended. This thesis proposes a solution which permits the digitalization of information at the same time as workpractice remains unaltered for soldiers working with maps in the field. For this purpose, a mobile interactive paper-based platform has been developed which permits the users to maintain their current work-flow. The premise of the solution parts from a system consisting of a prepared paper-map, a cellular phone, a desktop computer, and a digital pen with bluetooth connection. The underlying idea is to permit soldiers to take advantage of the information a computerized system can offer, at the same time as the overhead it incurs is minimized. On one hand this implies that the solution must be light-weight, on the other it must retain current working procedures as far as possible. The desktop computer is used to develop new paper-driven applications through the application provided in the development framework, thus allowing the tailoring of applications to the changing needs of military operations. One major component in the application suite is a symbol recognizer which is capable of recognizing symbols parting from a template which can be created in one of the applications. This component permits the digitalization of information in the battlefield by drawing on the paper-map. The proposed solution has been found to be viable, but still there is a need for further development. Furthermore, there is a need to adapt the existing hardware to the requirements of the military to make it usable in a real-world situation.</p>

Military work-practice is a difficult area of research where paper-based approaches are still extended. This thesis proposes a solution which permits the digitalization of information at the same time as workpractice remains unaltered for soldiers working with maps in the field. For this purpose, a mobile interactive paper-based platform has been developed which permits the users to maintain their current work-flow. The premise of the solution parts from a system consisting of a prepared paper-map, a cellular phone, a desktop computer, and a digital pen with bluetooth connection. The underlying idea is to permit soldiers to take advantage of the information a computerized system can offer, at the same time as the overhead it incurs is minimized. On one hand this implies that the solution must be light-weight, on the other it must retain current working procedures as far as possible. The desktop computer is used to develop new paper-driven applications through the application provided in the development framework, thus allowing the tailoring of applications to the changing needs of military operations. One major component in the application suite is a symbol recognizer which is capable of recognizing symbols parting from a template which can be created in one of the applications. This component permits the digitalization of information in the battlefield by drawing on the paper-map. The proposed solution has been found to be viable, but still there is a need for further development. Furthermore, there is a need to adapt the existing hardware to the requirements of the military to make it usable in a real-world situation.

L’objectif de ce travail de thèse est d’observer et d’analyser l’interaction entre un élève autiste, un logiciel éducatif et un enseignant dans des situations d’apprentissage de la lecture et de l’écriture. Étudier la manière dont les élèves autistes peuvent interagir avec des logiciels éducatifs en présence d’enseignants est très important, notamment pour comprendre comment mieux focaliser l’attention de ces enfants. Il faut alors étudier l’évolution des comportements des élèves et connaître les modes d’intervention des enseignants, favorisant ou non l’évolution de ces comportements. Pour analyser les modes d’interaction qui se mettent en place entre trois agents (un enseignant, un élève autiste et un logiciel éducatif), nous avons défini des observables, pouvant être recueillis durant les phases d’étude chez chacun des agents, et choisi des outils permettant de collecter les informations en temps réel (stylo numérique et logiciel Camtasia). Nous avons également synchronisé plusieurs sources de données. Les informations recueillies et synchronisées, les traces d’activités, ont ensuite été traitées afin de fournir des formes visuelles résumées de l’activité et de calculer différents indicateurs. Ces analyses ont été confrontées aux experts de l’autisme, pour interprétation et aux enseignants pour une meilleure prise en compte de leur propre comportement. Pour mener ce travail, nous avons, d’un premier temps, participé au projet ANR RobAutisTIC, autour d’une interaction ludique entre des enfants autistes, des thérapeutes suivant un protocole expérimental et un robot. Au cours de ce projet, nous avons élaboré les premières listes de gestes à observer, enregistrer et coder et effectué les premières analyses à l’aide du logiciel Elan. Ce travail a été repris avec des élèves autistes, des enseignants et des logiciels éducatifs, dans des situations d’apprentissage. Nous avons adapté pour cela les grilles utilisées dans le projet RobAutisTIC, à la situation d’apprentissage avec un logiciel éducatif. Nous avons conduit des observations préalables dans les classes ainsi qu’une analyse détaillée des logiciels éducatifs pour identifier les interactions possibles et classer les exercices selon un indicateur de complexité. Nous avons pu suivre quinze séances avec au total onze élèves.L’analyse des données nous a permis de repérer les gestes les plus fréquents, les séquences, etc. L’association entre le codage des gestes, l’enregistrement de la succession des écrans des logiciels et des dialogues entre l’enseignante et l’élève a permis de faire une analyse didactique des interactions dans le cadre de la théorie d’action didactique. Nous avons pu constater des modes fins d’interaction entre l’élève autiste et son enseignante, également des caractéristiques particulières de l’interaction élève-logiciel compte tenu du niveau de complexité de chaque exercice et du niveau de développement socio-communicatif de l’élève autiste. Enfin, les enseignants interviennent souvent dans le but de donner la bonne réponse à l’élève à travers le pointage de l’écran et l’interaction verbale. Ce travail ouvre des pistes d’une part dans l’observation et l’analyse de l’interaction avec des élèves autistes et d’autre part dans l’analyse de l’utilisation de logiciels éducatifs. / The objective of this thesis is to observe and analyze the interaction between students with autism, educational software and teachers in learning situations of reading and writing. Explore how students with autism can interact with educational software in the presence of teachers is very important, especially to understand how to better focus their attention. Then, we must study the evolution of student behaviour and know the teachers intervention methods, promoting or not the changes in these behaviours.To analyze the modes of interaction that are set up between three agents (a teacher, a student with autism and educational software), we defined “observable” that may be collected during the study phases in each of the agents and selected tools to collect real-time information (Digital Pen and Camtasia software). We also synchronized multiple data sources. The information collected and synchronized and traces of activities were then treated to provide visual forms summarized activities and calculate various indicators. These analyses were confronted with experts in autism, for interpretation and teachers to better take into account their own behaviour.To conduct this work, first, we participated in the project ANR RobAutiSTIC around a playful interaction between children with autism, therapist following an experimental protocol and a robot. In this project, we developed the first gestures lists to observe, record, encode and performed the first analysis with the Elan software.This work was implemented in the classroom where were present autistic students, teachers and educational software, in learning situations. We have adapted it for the grids used in RobAutiSTIC project, the situation of learning with educational software. We conducted preliminary observations in classrooms as well as a detailed analysis of educational software to identify potential interactions and classify the exercises in a complex indicator. We followed five sessions with a total of eleven students. Data analysis allowed us to identify the most frequent gestures, sequences, etc. The association between the coding of gestures, recording the sequence of screens software and dialogues between the teacher and the student has to do a didactic analysis of interactions in the context of the educational theory of action. We have seen the purpose modes of interaction between student and teacher autistic, also the special characteristics of the interaction student-software given the level of complexity of each year and the level of socio-communicative development of students with autism. Finally, teachers often intervene in order to give the right answer to the student through the pointing screen and verbal interaction.On the one hand, this work paves the way for the observation and analysis of the interaction with autism students (between themselves) and on the other hand, for the analysis of the uses of educational softwares.

La technologie de numérisation des données manuscrites a atteint son essor après l’invention du stylo numérique. Les recherches se sont concentrées alors sur le développement des applications IHM qui facilitent la manipulation des données encre numérique. Dans un contexte de recherche, la technologie du papier et stylo numériques s’avère utile pour la collecte des données expérimentales dans différents domaines. Notre but est de fournir une aide pour le traitement et la visualisation des données, notamment les données temps, recueillies avec un stylo numérique dans deux cas d’usage en sciences de l’éducation à savoir les tests d’évaluation et la prise de notes d’observation. Notre démarche consiste à étudier ces cas d’usage en terme de besoin dans quatre expériences concrètes et à développer, en participation avec l’utilisateur, des prototypes de système de traitement et de visualisation des données. Dans le but de concevoir un modèle général de tel système, nous avons analysé l’interface d’utilisation des prototypes en terme de fonctionnalités, de visualisation et d’interaction. Notre modèle décrit le processus de visualisation en mettant en œuvre trois types de tâches d’utilisateur à savoir les tâches d’analyses, les tâches de manipulation et les tâches d’interaction. / Scanning technology for handwritten data has reached its momentum after the invention of the digital pen. Research work focused on the development of HMI applications that facilitate digital ink data manipulation. In a research context, digital pen and paper technology is useful for collecting experimental data in various fields. Our goal is to provide support for the processing and the visualization of time stamped data collected by a digital pen in two cases of use : on one hand, in the educational science field, and especially for assessment tests and, on another hand, for taking observation notes. Our approach is to study these cases of use through four concrete experiences and to develop, with the participation of the user, prototypes for a system that aid to process and to visualize collected data. In order to abstract a general model of such a system, we analyzed prototypes user interfaces in terms of functionality, visualization and interaction. Our model describes the visualization process by implementing three types of user tasks namely analytic tasks, handling tasks and interaction tasks.

本研究旨在運用點讀筆輔助國中文言文補救教學，基於設計研究法迭代改進的過程，設計點讀筆輔助國中文言文補救教材及學習策略，並驗證其對於國文補救教學的效益。本研究以高雄市某國中二年級參與國文補救教學共6位八年級學生為研究對象，以設計研究法在教學實際現場基於學生學習過程中的質化觀測訪談紀錄，以及學習成效前後測與點讀筆內建學習歷程記錄等量化數據資料分析結果，進行包括準備（分析、設計）、執行（發展、實施）、評鑑（反省、產出）之循環迭代改進過程，以探究與發展結合點讀筆與紙本課文輔助文言文補救教學教材與學習策設計，為教師運用點讀筆發展文言文補救教學教材提供可行之實施模式。 結果顯示，本研究透過設計研究法發展出一套可有效輔以文言文補救學習之點讀筆搭配紙本教材與學習策略模式，並經由兩次循環修正歷程，產出一套較佳之點讀筆搭配紙本與學習策略模式之教材設計。本研究歸納在設計上應考量點讀的搭配性、自學的引導性、內容的適切性，並建立程序指引提醒，以發揮點讀筆搭配紙本輔助閱讀學習之功能。本研究產出之點讀教材，可透過碼點貼紙支援文言文學習所需之背景知識的補充、課文朗讀與背誦、文意理解、提出問題深入思考等學習需求，也搭配SQ3R學習策略流程引導，適合於學習者自學，並且可以進行重複學習，學生具有高度自主性，為學習落後學生搭建一有效之學習鷹架，培養學生帶得走的能力，為國文補救教學開創一有效且創新的學習模式。 / This study aims to apply digital pens to assisting in the literary Chinese remedial instruction in junior high schools. Based on the process of Design-based Research iterative improvement, the digital pen supported literary Chinese remedial teaching materials and learning strategies are designed, and the Chinese remedial learning efficiency is verified. Six G8 students in a junior high school in Kaohsiung City participating in the Chinese remedial instruction are studied. With Design-based Research, the qualitative observation and interview records of the students’ learning process and the quantitative data analyses of the pretest and posttest of learning performance and the digital pen built-in learning process records are preceded cyclic iterative improvement, including preparation (analysis and design), practice (development and implementation), and assessment (introspection and output) to explore and develop the design of digital pen supported and paper-based texts integrated literary Chinese remedial teaching materials and learning strategies. It is expected to provide a feasible model for teachers developing digital pen supported literary Chinese remedial teaching materials. The results show that an effective literary Chinese remedial instruction integrated with digital pen supported and paper-based materials and the learning strategies could be developed through Design-based Research. Furthermore, with two cyclic revision processes, the better digital pen supported and paper-based integrated material design and learning strategies could be generated. It is concluded in this study that the collocation of digital pen, the guiding for self-learning, and the content appropriateness should be taken into account of the design, and the procedural guideline reminder should be established to present the function of digital pen supported and paper-based reading learning. Through code stickers, the digital pen supported materials could supplement the required background knowledge for literary Chinese learning, text reading and recitation, content comprehension, and in-depth thinking with problems. With the guidance of SQ3R learning strategies, it is suitable for self-learning and could be proceeded repeated learning and the students present high autonomy so as to build a learning scaffold for the students fell behind in learning, to cultivate students with the abilities to take away, and to create an effective and innovative learning model for Chinese remedial instruction.

隨著科技的進步，兒童繪本不再侷限於傳統由印刷文字及靜態圖片組成的紙本繪本，而是逐漸發展為多種數位媒體整合之電子繪本，電子繪本具有優於傳統紙本繪本的互動性及多媒體元素，較能吸引兒童的閱讀興趣。但電子繪本也存在過多動畫可能使兒童沈迷於感官刺激，分散其閱讀注意力的疑慮。此外，電子繪本對兒童的視力可能造成傷害，紙本仍較適合長時間的閱讀，但紙本繪本在支援閱讀上的模式較為單調。因此，近年來可搭配紙本閱讀的數位點讀筆興起，並已發展出可同時融合聽、說、讀、寫的多元閱讀模式，具有融合紙本且具有多媒體與互動功能的優勢。本研究採用腦波注意力偵測技術及心跳變異情緒感知技術，基於預測策略，探討包括傳統紙本繪本、電子繪本及點讀筆輔助紙本繪本閱讀對於兒童閱讀動機、閱讀情緒、閱讀注意力與閱讀理解成效的影響。此外，也針對文字型和圖像型不同認知風格以及不同性別的兒童，探討採用上述三種不同閱讀模式進行閱讀時的閱讀動機、閱讀情緒、閱讀注意力與閱讀理解成效是否具有顯著差異。 研究結果發現：（1）運用點讀筆輔助閱讀紙本繪本搭配預測策略的兒童，在閱讀動機提升上顯著優於閱讀紙本繪本與閱讀電子繪本搭配預測策略的兒童；（2）運用點讀筆輔助閱讀紙本繪本搭配預測策略的兒童在閱讀注意力上顯著優於閱讀紙本繪本搭配預測策略的兒童，但與閱讀電子繪本搭配預測策略的兒童則無顯著差異；（3）閱讀電子繪本與運用點讀筆輔助紙本繪本搭配預測策略的閱讀模式在閱讀理解成效上均優於傳統紙本閱讀搭配預測策略，並且兩種閱讀模式具有相同的閱讀理解成效；（4）閱讀電子繪本搭配預測策略的兒童中在負面情緒上，女性顯著高於男性；（5）閱讀傳統紙本繪本搭配預測策略的兒童，在閱讀理解成效上女性顯著優於男性；（6）男性兒童採用點讀筆輔助紙本繪本搭配預測策略閱讀，在閱讀注意力上顯著優於傳統紙本繪本搭配預測策略閱讀；（7）男性兒童採用電子繪本閱讀與運用點讀筆輔助紙本繪本搭配預測策略閱讀，在閱讀理解成效上優於傳統紙本繪本搭配預測策略閱讀；（8）圖像型兒童採用傳統紙本繪本搭配預測策略閱讀，在負面情緒上顯著高於採用電子繪本閱讀與運用點讀筆輔助紙本繪本搭配預測策略閱讀；（9）文字型兒童採用電子繪本閱讀與點讀筆輔助紙本繪本搭配預測策略閱讀，在閱讀理解成效上顯著高於傳統紙本繪本搭配預測策略閱讀；（10）兒童以傳統紙本繪本閱讀、電子繪本閱讀與點讀筆輔助繪本閱讀三種模式進行閱讀學習，其閱讀動機、閱讀情緒、閱讀注意力與閱讀理解成效彼此之間不具有關聯性 最後，根據研究結果，本研究亦提出對父母、教師、相關推動兒童閱讀單位以及未來研究的建議，希望能對兒童的閱讀能力提升產生助益。 / With the progress of information technology, children picture books have no longer be restricted to traditional paper picture books composed of printed texts and static pictures; instead, various digital media integrated electronic picture books are gradually developed. Electronic picture books present the advantages of better interactivity and multimedia elements than traditional paper picture books and could better attract children’s reading interests. Nevertheless, electronic picture books also exist in excessive animation causing children indulging in sensory stimulation and diverting the reading attention. Moreover, electronic picture books could damage children’s visual acuity. Thus, paper picture books are considered more suitable for long-term reading. However, paper picture books show dull model on supporting reading. The combination of digital pens with paper-reading is therefore emerged in the past years and the plural reading model integrating listening, speaking, reading, and writing has been developed because integrating digital pen with paper reveals the advantages of multimedia and interactive functions. Based on prediction strategy, this study applies brain-wave attention detection system and heart rate variability emotion sensing technology to discussing the effects of traditional paper picture books, electronic picture books, and digital pen assisted paper picture books on children’s reading motivation, reading emotion, reading attention, and reading comprehension performance. Furthermore, the effects of on children with visualizer and verbalizer cognitive styles and different genders on reading motivation, reading emotion, reading attention, and reading comprehension performance when reading with the above reading models are also explored. The findings of the study are summarized as below. (1) Children applying digital pen supported paper picture books and prediction strategy present better reading motivation than the ones reading paper picture books and electronic picture books with prediction strategy. (2) Children utilizing digital pen supported paper picture books with prediction strategy reveal better reading attention than the ones reading paper picture books with prediction strategy, but do not appear significant difference from the others reading electronic picture books with prediction strategy. (3) Reading electronic picture books and digital pen supported paper picture books with prediction strategy shows better reading comprehension performance than traditional paper reading with prediction strategy, and such two reading models appear the same reading comprehension performance. (4) Female children reading electronic picture books with prediction strategy present higher negative emotion than males do. (5) Female children reading traditional paper picture books with prediction strategy reveal better reading comprehension performance than males do. (6) Male children applying digital pen supported paper picture books with prediction strategy show better reading attention than reading traditional paper picture books with prediction strategy. (7) Male children using electronic picture books and digital pen supported paper picture books with prediction strategy present better reading comprehension performance than reading traditional paper picture books with prediction strategy. (8) Visualizers utilizing traditional paper picture books with prediction strategy appear higher negative emotion than applying electronic picture books and digital pen supported paper picture books with prediction strategy. (9) Verbalizers using electronic picture books and digital pen supported paper picture book with prediction strategy show significantly higher reading comprehension performance than reading traditional paper picture books with prediction strategy. (10) The reading models of traditional paper picture books, electronic picture books, and digital pen supported picture books do not appear correlations on reading motivation, reading emotion, reading attention, and reading comprehension performance. Finally, the study also proposes several valuable suggestions for parents, teachers, children reading promotion units, and future researchers, tending to provide benefits in enhancing children reading abilities.