This study evaluated the predictive and concurrent validity of the Tiered Fidelity Inventory (TFI). Structural equation modeling was applied to test the associations between the TFI and student outcomes. First, a total of 1,691 schools with TFI Tier 1 in 2016-17 and school-wide discipline outcomes in 2015-16 and 2016-17 were targeted, finding a negative association between TFI Tier 1 and differences between African American and non-African American students in major office discipline referrals (ODR) per 100 students per day in elementary schools. A sensitivity test with schools with TFI Tier 1, 2, and 3 was conducted, showing a negative association between TFI Tier 1 and the square root of major ODR rates in elementary schools. Second, TFI Tier 1 was positively related to the proportions of students meeting or exceeding state-wide standards in reading from 1,361 schools with TFI Tier 1 and academic outcomes in 2014-15 and 2015-16. Also, the association between TFI Tier 1 and academic outcomes was found to be stronger when schools implemented SWPBIS for 6 or more years. A sensitivity test with schools with TFI Tier 1, 2, and 3 indicated positive associations between TFI Tier 1 and the proportions of students meeting or exceeding state-wide standards in both subjects. Third, TFI Tier2 was positively associated with the logit of proportions of students with CICO daily points from 570 schools with TFI Tier 2 in 2016-17 and CICO outcomes in 2015-16 and 2016-17. Fourth, correlations between the Evaluation subscale of TFI Tier 1 or 2 and relevant measures in 2016-17 were tested from 2,379 schools. TFI Tier 1 Evaluation was positively correlated with counts of TFI administrations, number of fidelity measures, and counts of viewing SWIS Reports. These correlations were significant except for ODRs by staff. Also, TFI Tier 2 Evaluation was significantly positively correlated with years of SWPBIS implementation, years of CICO-SWIS implementation, and counts of viewing CICO Reports except student period, and negatively with counts of viewing student single period. These findings were discussed by comparing them with previous research findings, suggesting implications for future research and practice, and addressing research limitations.

Empathetic communication enhances the nurse-patient relationship and improves patient outcomes and needs to be taught and evaluated during simulated clinical experiences. Experience in healthcare education has shown students' empathy levels decrease over time. The purpose of this quasi-experimental pretest posttest, study was to compare nursing students' empathy levels, self-confidence, and satisfaction with simulation between the use of the high-fidelity manikin simulator (HFMS) and a standardized patient (SP) used during their simulated clinical experience. Kolb's experiential learning theory was used to guide the study through the four phases specific to simulation and learning. Convenience sampling was used to recruit 135 nursing students in the pre-simulation survey; 123 participants completed the post-simulation survey with 64 in the control group (HFMS) and 59 in the experimental group (SP). Data were analyzed using an independent t-test to determine if there were any mean differences between the HFMS and SP groups in terms of empathy, satisfaction, and self-confidence. Empathy was measured using the Jefferson Scale of Empathy-Health Professions Student and the NLN's Satisfaction and Self-Confidence Scales. Results revealed there were no significant difference in students' empathy levels, self-confidence, and satisfaction. Positive social change through prioritizing nursing students' empathetic communication in patient care may be enhanced in the simulated clinical environment with various approaches. Recommendations for future research are to determine what interventions best develop nursing students' empathy, satisfaction, and self-confidence in patient care .

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BACKGROUND:Integrative medicine (IM) is a patient-centered, healing-oriented clinical paradigm that explicitly includes all appropriate therapeutic approaches whether they originate in conventional or complementary medicine (CM). While there is some evidence for the clinical and cost-effectiveness of IM practice models, the existing evidence base for IM depends largely on studies of individual CM therapies. This may in part be due to the methodological challenges inherent in evaluating a complex intervention (i.e., many interacting components applied flexibly and with tailoring) such as IM.METHODS/DESIGN:This study will use a combination of observational quantitative and qualitative methods to rigorously measure the health and healthcare utilization outcomes of the University of Arizona Integrative Health Center (UAIHC), an IM adult primary care clinic in Phoenix, Arizona. There are four groups of study participants. The primary group consists of clinic patients for whom clinical and cost outcomes will be tracked indicating the impact of the UAIHC clinic (n=500). In addition to comparing outcomes pre/post clinic enrollment, where possible, these outcomes will be compared to those of two matched control groups, and for some self-report measures, to regional and national data. The second and third study groups consist of clinic patients (n=180) and clinic personnel (n=15-20) from whom fidelity data (i.e., data indicating the extent to which the IM practice model was implemented as planned) will be collected. These data will be analyzed to determine the exact nature of the intervention as implemented and to provide covariates to the outcomes analyses as the clinic evolves. The fourth group is made up of patients (n=8) whose path through the clinic will be studied in detail using qualitative (periodic semi-structured interviews) methods. These data will be used to develop hypotheses regarding how the clinic works.DISCUSSION:The US health care system needs new models of care that are more patient-centered and empower patients to make positive lifestyle changes. These models have the potential to reduce the burden of chronic disease, lower the cost of healthcare, and offer a sustainable financial paradigm for our nation. This protocol has been designed to test whether the UAIHC can achieve this potential.TRIAL REGISTRATION:Clinical Trials.gov NCT01785485.

Over the history of interaction design, concepts and methods of prototyping have been significantly developed to address new challenges faced by the field and the ever-going advancement of new technologies. Some of the important developments are related to the notions of mixed-fidelity prototyping, experience prototyping, and prototypes as filters. Building upon these developments, this study explores a multiple-fidelity prototyping approach, that is, using progressively higher fidelity prototypes in iteration. The study focused particularly on the design of user engagement. It documented, and contributed to, an actual design process of Xplore, an augmented reality game-based learning application. Three participatory design-style workshops employing low-, mixed-, and high-fidelity prototypes were conducted respectively. Thematic analyses of participants’ interactions revealed sets of themes in the workshops, which reflected the changing focus and scope of the design space. The implications of the results obtained in the study highlighted the role of prototypes of each fidelity level in engaging users in a design process, as well as the potential benefits of combining multiple fidelity prototypes when designing for user engagement.

This study developed a summative scale that could be administered in a short time period to determine the Quality of Use (QOU) of an intervention used by teachers. The scale can be completed in less than an hour using easily attainable information. The QOU scale was applied to an elementary reading program to determine if the program results were dependent upon the quality of the fidelity of teacher use. The study focused on use of the Linguistic Pattern Series (LPS) portion of the Integrated Skills Method (ISM) Reading Program by 20 special education teachers in 13 elementary schools in San Antonio, Texas. Progress is measured by the use of the Decoding Skills Test (DST) (ISM Teaching Systems, Inc., 2004-b). To determine each teacher's QOU, a summative scale was developed composed of five items (Initial Placement, Frequency of Direct Instruction, Materials – LPS, Materials – Literature/Test Prep, and Scheduling) that possessed low-moderate cohesiveness of Alpha=.71. Results of the study showed a correlation between QOU summary scores and residualized DST Raw Score Grade Equivalent (RSGE) gains. The QOU could predict .771^2 = 50 percent of score variance. This is a strong prediction for a non-student external measure in education.

Tystnad kan användas som ett kognitivt verktyg för att påverka en filmupplevelse och för att förhöja vissa audiovisuella aspekter. Denna studie undersöker hur tystnad som berättargrepp inom genren sci-fi kan användas genom två koncept för ljudinspelning: fidelity, som är en trogen ljudinspelning av vad som visas i bild, och intelligibility, som adderar ljud för narrativ information. Koncepten lät oss som ljuddesigners analysera och kontrollera tystnadsögonblicken i varje scenario. Point of audition användes som ett adderat designverktyg för att fokusera tystnadsögonblicken i narrativet. Genom diskussion i fokusgrupper kunde vi utvärdera hur tystnaden upplevdes i varje separat klipp. Studien visade att tystnad som berättargrepp föredrogs vid en kombination av de två koncepten. / Silence can be used as a cognitive tool to influence a film experience and to elevate certain audiovisual aspects. This study examines how silence as a narrative technique in the sci-fi genre can be used through two concepts for sound recording: fidelity, which is a faithful sound recording of what is shown on screen, and intelligibility, which adds sound for narrative information. The concepts allowed us as sound designers to analyze and control the moments of silence in each scenario. Point of audition was used as an added design tool to focus the moments of silence in the narrative. Through discussions in focus groups, we were able to evaluate how the silence was experienced in each separate clip. The study showed that silence as a narrative approach was preferred in a combination of the two concepts.

I conducted demographic and behavioral studies of Western Sandpipers (Calidris mauri) breeding on the Yukon-Kuskokwim River Delta, Alaska (1998-2005). In chapter one, I estimated apparent annual survival (product of true survival and site fidelity) while correcting for the probability of encounter for 237 males and 296 females. Overall return rates (individual returned to the site in a subsequent season) were lower for females (40%) than males (65%), as was apparent annual survival (± SE, females = 0.65 ± 0.05, males = 0.78 ± 0.03), and encounter rate (females = 0.51 ± 0.07, males = 0.74 ± 0.04). In chapter two, I examined the effects of mate and site fidelity on nesting success (N = 430 nests). Annual divorce rate ranged between 37-83%, with 17-63% of pairs reuniting annually. Reuniting pairs initiated clutches earlier than newly formed pairs, and clutches that were initiated early in the season had higher nest success rates compared to late-season nests. When I controlled for clutch-initiation date, nests tended by individuals with prior breeding-site experience had higher daily survival rates compared to birds breeding at the site for the first time. The effect of site experience was greater for males than females. In chapter 3, I reported that Western Sandpipers exhibited aggregated breeding behavior on a 36 ha plot. Breeding aggregations occurred when dominant and/or older individuals excluded younger, subordinate individuals from preferred habitat. The pattern of habitat occupancy conformed to an ideal despotic distribution with aggregated nesting birds in less preferred habitat experiencing lower reproductive success. In chapter 4, I described and demonstrated the form and function of parent-chick communication in the Western Sandpiper. Through experimental playback of adult vocalizations to chicks in the field, I demonstrated: (1) chicks respond to the alarm call by vocalizing relatively less often and moving away from the signal source, (2) chicks respond to the gather call by vocalizing relatively more often and moving toward the signal source, (3) and chicks respond to the freeze call by vocalizing relatively less often and crouching motionless on the substrate for extended periods of time. I also describe two distinct chick vocalizations (chick-contact and chick-alarm calls). / Ph. D.

Företag kan använda webbsidor för att förmedla information och erbjuda stöd i användningen av deras produkter. En ökad tillgång till relevant information skapar en större förståelse hos kunder för de produkter de använder. Genom att öka kunders individuella kunskap kan de känna att de har makt och kontroll, ”empowerment”, över sin egen situation. Strategin kallas för ”customer empowerment”. Studien utfördes som en fallstudie på ett informations- och mjukvaruföretag där studien centrerade kring en av företagets produkter. Syftet med denna studie var att skapa underlag i form av en konceptuell modell för en framtida utveckling av en användbar och informativ customer empowerment-portal där centrala teman som användbarhet, informationskvalitet samt användarupplevelse beaktades. En litteraturgenomgång inleddes för att anskaffa kunskap om ämnet som sedan sammanfattades i en konceptuell modell. Sex slumpmässigt utvalda kundrepresentanter deltog i kvalitativa intervjuer för att ta reda på befintliga kunders uppfattningar och behov gällande information och kommunikation. Baserat på svaren togs en low fidelity-prototyp fram som avsåg att konkretisera den konceptuella modellen. Studiens undersökningsfrågor har besvarats genom en analys av resultatet som utfördes med stöd av den konceptuella modellen. Utifrån analysen skapades en reviderad konceptuell modell för att på ett bättre sätt spegla kunders behov. Slutsatserna är att respondenterna var nöjda med den muntliga kommunikation de erhöll från kontaktpersonerna, men webbsidan gav inget stöd för kommunikation utöver att förmedla kontaktuppgifter till företagets växel. I dagsläget har webbsidan en låg informationskvalitet, eftersom informationen inte tillgodoser befintliga kunders behov, utan riktar sig snarare till potentiella kunder. För att kunna skapa en användbar och informativ customer empowerment-portal behöver den skapas utifrån följande förutsättningar: utöka kommunikations- och supportmöjligheterna med en chattfunktion; skapa förutsättningar för kunder att förmedla feedback; förmedla relevant information för befintliga kunder; information om funktioner i Produkten skall förmedlas på ett enkelt och tydligt sätt, exempelvis genom att tillhandahålla enkla guider och instruktionsvideos; integrera portalen med Produktens gränssnitt; placera kontaktuppgifter mer lättillgängligt; anpassade vyer baserat på användare; samt en sökfunktion för att enklare hitta information.

Divergence in the face of gene flow is perhaps the most wildly disputed subject among researchers through time. The debate is an old one and we find its origin as far back as the era of Darwin. The theories dealing with sympatric and parapatric speciation, its processes and ecological conditions, are numerous and the empirical data supporting the ideas is constantly growing. However, the reach of a consensus almost seem as distant as ever. Two fundamental prerequisites can be identified for the evolution of divergence with gene flow, the act of disruptive selection, and the development of assortative mating. A set of models in which speciation with gene flow seem particularly likely is when a shift occurs in host preference in phytophagous insects and mating takes place on the host. In the work behind this thesis, the role of assortative mating in the initial stages of sympatric and parapatric speciation has been studied, as has the interaction between assortative mating and inbreeding and how it effects speciation in small sympatric populations, an aspect not much attended to earlier in the literature. My results show that assortative mating based on resource preference, can evolve rapidly upon secondary contact, and even in parapatric populations with a migration rate of 8% (13-15 individuals) per generation. However for assortative mating to be maintained selection against hybrids is needed. My results also suggests that small inbred populations have a hard time coping with strong assortative mating an as a consequence tend to relax their mating preferences to avoid inbreeding depression. Based on these results, I advocate for the importance of considering not only assortative mating in itself, but also the joint effects of assortative mating and inbreeding when dealing with theories of speciation with gene flow.