Is family medicine meeting the HIV/AIDS challenge? A national survey of family physicians' beliefs, clinical competence, and experience regarding HIV disease

A national sample of family physicians was surveyed to (1) assess family physicians' beliefs about the human immunodeficiency virus (HIV) and individuals at risk for infection, their clinical competence regarding HIV-related issues, and their experiences with HIV disease; (2) present conclusions to the American Academy of Family Physicians (AAFP) to effect the development of an early clinical care protocol and a continuing medical education curriculum; and (3) collect base-line data for use in the evaluation of an early clinical care protocol and a continuing medical education curriculum, in the case that such programs are developed and disseminated. After considering retired or deceased respondents, of the 2,660 physicians surveyed, 1,678 (63.7%) responded. The resulting sample was representative of the active members of the AAFP. About 77% of the respondents were unable to accurately identify the universal precautions for blood and body fluids to prevent occupational transmission of HIV or hepatitis B virus (HBV). Residency trained and board certified physicians expressed fewer "external constraints," such as fear of losing patients, obviating them from providing treatment to individuals with HIV disease (p =.004 and p $<$.001, respectively). These physicians also manifested fewer "internal constraints" to the provision of HIV treatment, such as fear of becoming infected (p $<$.001 and p =.012, respectively). Residency trained physicians also expressed a greater comfort with discussing sexually-related topics with their patients than did non-residency trained physicians (p $<$.001). There were 67.1% of the physicians surveyed who reported never providing treatment to an individual with HIV disease. Residency trained and board certified physicians expressed a greater likelihood to provide treatment to HIV-infected patients (p $<$.001) than non-residency trained and non-board certified physicians.^ Among the various primary care specialties, family medicine is especially vulnerable to the current challenges of HIV/AIDS. These challenges are augmented by the epidemiologic pattern that characterizes AIDS. For the past several years, we have seen AIDS in this country assume a similar pattern to that seen in most other countries; HIV is becoming increasingly prevalent in the heterosexual population as well as in locations removed from metropolitan centers. This current phase of the epidemic generates greater pressures upon primary care physicians, particularly family physicians, to become better acquainted with the means to provide early care to HIV/AIDS patients and to prevent HIV/AIDS among their patients. Family medicine is especially appropriate for providing care to HIV patients because family medicine involves treatment to all age groups and conditions; other primary care specialties focus on limited patient populations or specific conditions. Family physicians should be armed with the expertise to confront HIV/AIDS. However, family physicians' clinical competence and experience with HIV is not known. The data collected in this survey describes their competencies, attitudes, and experiences. ^

Global practice experience: A useful lens for understanding patient and staff perceptions of successful integration of health information technology in primary care

Making healthcare comprehensive and more efficient remains a complex challenge. Health Information Technology (HIT) is recognized as an important component of this transformation but few studies describe HIT adoption and it's effect on the bedside experience by physicians, staff and patients. This study applied descriptive statistics and correlation analysis to data from the Patient-Centered Medical Home National Demonstration Project (NDP) of the American Academy of Family Physicians. Thirty-six clinics were followed for 26 months by clinician/staff questionnaires and patient surveys. This study characterizes those clinics as well as staff and patient perspectives on HIT usefulness, the doctor-patient relationship, electronic medical record (EMR) implementation, and computer connections in the practice throughout the study. The Global Practice Experience factor, a composite score related to key components of primary care, was then correlated to clinician and patient perspectives. This study found wide adoption of HIT among NDP practices. Patient perspectives on HIT helpfulness on the doctor-patient showed a suggestive trend that approached statistical significance (p = 0.172). Clinicians and staff noted successful integration of EMR into clinic workflow and their perception of helpfulness to the doctor-patient relationship show a suggestive increase also approaching statistical significance (p=0.06). GPE was correlated with clinician/staff assessment of a helpful doctor-patient relationship midway through the study (R 0.460, p = 0.021) with the remaining time points nearing statistical significance. GPE was also correlated to both patient perspectives of EMR helpfulness in the doctor-patient relationship (R 0.601, p = 0.001) and computer connections (R 0.618, p = 0.0001) at the start of the study. ^

Trade Credits under Imperfect Enforcement: A Theory with a Test on Chinese Experience

It is widely recognized that trade credit is an important financial mechanism, particularly in developing economies and transition economies where institutions are weak. This paper documents theoretical analysis and empirical accounts on what facilitates an effective supply of trade credit based on original surveys conducted in P.R. of China. Our theory predicts that trade volume and trade credit are increasing function of cash held by the buyer and enforcement technology of the seller. Furthermore, if the state sector’s enforcement technology is high, it has positive external effect to expand the volumes of trade credit and trades in the whole economy. From the data, we found that government made active commitment in enforcement of trade credit contract and the government owned firms are main supplier and receivers of trade credit, which suggest that enforcement by government and state sector were effective against presumptions in the previous literatures.

Indian Patent Policy and Publich Health : implications from the Japanese Experience

The introduction of pharmaceutical product patents in India and other developing countries is expected to have a significant effect on public health and local pharmaceutical industries. This paper draws implications from the historical experience of Japan when it introduced product patents in 1976. In Japan, narrow patents and promotion of cross-licensing were effective tools to keep drug prices in check while ensuring the introduction of new drugs. While the global pharmaceutical market surrounding India today differs considerably from that of the 1970's, the Japanese experience offers a policy option that may profitably be considered by India today. The Indian patent system emphasizes the patentability requirement in contrast to the Japanese patent policy which relied on narrow patents and extensive licensing. R&D by local firms and the development of local products may be promoted more effectively under the Japanese model.

Communication Architecture for Tracking and Interoperable Services at Hospitals: A Real Deployment Experience

Any new hospital communication architecture has to support existing services, but at the same time new added features should not affect normal tasks. This article deals with issues regarding old and new systems’ interoperability, as well as the effect the human factor has in a deployed architecture. It also presents valuable information, which is a product of a real scenario. Tracking services are also tested in order to monitor and administer several medical resources.

Bicarbonato ingestion has no ergogenic effect on consecutive all out sprint test in MWX elite cyclists

The aim of the present study was to examine the effect of sodium bicarbonate ingestion on consecutive "all out" sprint tests, analyzing the acid-base status and its influence on performance and perceived effort. Ten elite bicycle motocross (BMX) riders (20.7 ± 1.4 years, training experience 8-12 years) participated in this study which consisted of two trials. Each trial consisted of three consecutive Wingate tests (WTs) separated by 15 min recovery. Ninety minutes prior to exercise subjects ingested either NaHCO(3) (-) (0.3 g kg(-1) body weight) or placebo. Blood samples were collected for the assessment of blood acid-base status: bicarbonate concentration ([HCO(3) (-)]), pH, base excess (BE) and blood lactate concentration ([La(-)]). Performance variables of peak power (PP), mean power (MP), time to peak power and fatigue index were calculated for each sprint. Significant differences (p < 0.05) were observed in acid-base variables [pH before WT1: 7.47 ± 0.05 vs. 7.41 ± 0.03; [HCO(3) (-)] before WT1: 29.08 ± 2.27 vs. 22.85 ± 0.24 mmol L(-1) (bicarbonate vs. placebo conditions, respectively)], but there were not significant differences in performance variables between trials [PP WT1: 1,610 ± 373 vs. 1,599 ± 370 W; PP WT2: 1,548 ± 460 vs. 1,570 ± 428 W; PP WT3: 1,463 ± 361 vs. 1,519 ± 364 W. MP WT1: 809 ± 113 vs. 812 ± 108 W; MP WT2: 799 ± 135 vs. 799 ± 124 W; MP WT3: 762 ± 165 vs. 782 ± 118 W (bicarbonate vs. placebo conditions, respectively)]. Rating of perceived effort (RPE) was not influenced nor ratings of perceived readiness. Sodium bicarbonate ingestion modified significantly the blood acid-base balance, although the induced alkalosis did not improve the Wingate test performance, RPE and perceived readiness across three consecutive WTs in elite BMX cyclists.

Analysis, monitoring, and management of quality of experience in video delivery services over IP

Esta tesis estudia la monitorización y gestión de la Calidad de Experiencia (QoE) en los servicios de distribución de vídeo sobre IP. Aborda el problema de cómo prevenir, detectar, medir y reaccionar a las degradaciones de la QoE desde la perspectiva de un proveedor de servicios: la solución debe ser escalable para una red IP extensa que entregue flujos individuales a miles de usuarios simultáneamente. La solución de monitorización propuesta se ha denominado QuEM(Qualitative Experience Monitoring, o Monitorización Cualitativa de la Experiencia). Se basa en la detección de las degradaciones de la calidad de servicio de red (pérdidas de paquetes, disminuciones abruptas del ancho de banda...) e inferir de cada una una descripción cualitativa de su efecto en la Calidad de Experiencia percibida (silencios, defectos en el vídeo...). Este análisis se apoya en la información de transporte y de la capa de abstracción de red de los flujos codificados, y permite caracterizar los defectos más relevantes que se observan en este tipo de servicios: congelaciones, efecto de “cuadros”, silencios, pérdida de calidad del vídeo, retardos e interrupciones en el servicio. Los resultados se han validado mediante pruebas de calidad subjetiva. La metodología usada en esas pruebas se ha desarrollado a su vez para imitar lo más posible las condiciones de visualización de un usuario de este tipo de servicios: los defectos que se evalúan se introducen de forma aleatoria en medio de una secuencia de vídeo continua. Se han propuesto también algunas aplicaciones basadas en la solución de monitorización: un sistema de protección desigual frente a errores que ofrece más protección a las partes del vídeo más sensibles a pérdidas, una solución para minimizar el impacto de la interrupción de la descarga de segmentos de Streaming Adaptativo sobre HTTP, y un sistema de cifrado selectivo que encripta únicamente las partes del vídeo más sensibles. También se ha presentado una solución de cambio rápido de canal, así como el análisis de la aplicabilidad de los resultados anteriores a un escenario de vídeo en 3D. ABSTRACT This thesis proposes a comprehensive approach to the monitoring and management of Quality of Experience (QoE) in multimedia delivery services over IP. It addresses the problem of preventing, detecting, measuring, and reacting to QoE degradations, under the constraints of a service provider: the solution must scale for a wide IP network delivering individual media streams to thousands of users. The solution proposed for the monitoring is called QuEM (Qualitative Experience Monitoring). It is based on the detection of degradations in the network Quality of Service (packet losses, bandwidth drops...) and the mapping of each degradation event to a qualitative description of its effect in the perceived Quality of Experience (audio mutes, video artifacts...). This mapping is based on the analysis of the transport and Network Abstraction Layer information of the coded stream, and allows a good characterization of the most relevant defects that exist in this kind of services: screen freezing, macroblocking, audio mutes, video quality drops, delay issues, and service outages. The results have been validated by subjective quality assessment tests. The methodology used for those test has also been designed to mimic as much as possible the conditions of a real user of those services: the impairments to evaluate are introduced randomly in the middle of a continuous video stream. Based on the monitoring solution, several applications have been proposed as well: an unequal error protection system which provides higher protection to the parts of the stream which are more critical for the QoE, a solution which applies the same principles to minimize the impact of incomplete segment downloads in HTTP Adaptive Streaming, and a selective scrambling algorithm which ciphers only the most sensitive parts of the media stream. A fast channel change application is also presented, as well as a discussion about how to apply the previous results and concepts in a 3D video scenario.

User Experience in Human-Technology Interaction. Communication, context and evaluation methodology

En esta Tesis se presentan dos líneas de investigación relacionadas y que contribuyen a las áreas de Interacción Hombre-Tecnología (o Máquina; siglas en inglés: HTI o HMI), lingüística computacional y evaluación de la experiencia del usuario. Las dos líneas en cuestión son el diseño y la evaluación centrada en el usuario de sistemas de Interacción Hombre-Máquina avanzados. En la primera parte de la Tesis (Capítulos 2 a 4) se abordan cuestiones fundamentales del diseño de sistemas HMI avanzados. El Capítulo 2 presenta una panorámica del estado del arte de la investigación en el ámbito de los sistemas conversacionales multimodales, con la que se enmarca el trabajo de investigación presentado en el resto de la Tesis. Los Capítulos 3 y 4 se centran en dos grandes aspectos del diseño de sistemas HMI: un gestor del diálogo generalizado para tratar la Interacción Hombre-Máquina multimodal y sensible al contexto, y el uso de agentes animados personificados (ECAs) para mejorar la robustez del diálogo, respectivamente. El Capítulo 3, sobre gestión del diálogo, aborda el tratamiento de la heterogeneidad de la información proveniente de las modalidades comunicativas y de los sensores externos. En este capítulo se propone, en un nivel de abstracción alto, una arquitectura para la gestión del diálogo con influjos heterogéneos de información, apoyándose en el uso de State Chart XML. En el Capítulo 4 se presenta una contribución a la representación interna de intenciones comunicativas, y su traducción a secuencias de gestos a ejecutar por parte de un ECA, diseñados específicamente para mejorar la robustez en situaciones de diálogo críticas que pueden surgir, por ejemplo, cuando se producen errores de entendimiento en la comunicación entre el usuario humano y la máquina. Se propone, en estas páginas, una extensión del Functional Mark-up Language definido en el marco conceptual SAIBA. Esta extensión permite representar actos comunicativos que realizan intenciones del emisor (la máquina) que no se pretende sean captadas conscientemente por el receptor (el usuario humano), pero con las que se pretende influirle a éste e influir el curso del diálogo. Esto se consigue mediante un objeto llamado Base de Intenciones Comunicativas (en inglés, Communication Intention Base, o CIB). La representación en el CIB de intenciones “no claradas” además de las explícitas permite la construcción de actos comunicativos que realizan simultáneamente varias intenciones comunicativas. En el Capítulo 4 también se describe un sistema experimental para el control remoto (simulado) de un asistente domótico, con autenticación de locutor para dar acceso, y con un ECA en el interfaz de cada una de estas tareas. Se incluye una descripción de las secuencias de comportamiento verbal y no verbal de los ECAs, que fueron diseñados específicamente para determinadas situaciones con objeto de mejorar la robustez del diálogo. Los Capítulos 5 a 7 conforman la parte de la Tesis dedicada a la evaluación. El Capítulo 5 repasa antecedentes relevantes en la literatura de tecnologías de la información en general, y de sistemas de interacción hablada en particular. Los principales antecedentes en el ámbito de la evaluación de la interacción sobre los cuales se ha desarrollado el trabajo presentado en esta Tesis son el Technology Acceptance Model (TAM), la herramienta Subjective Assessment of Speech System Interfaces (SASSI), y la Recomendación P.851 de la ITU-T. En el Capítulo 6 se describen un marco y una metodología de evaluación aplicados a la experiencia del usuario con sistemas HMI multimodales. Se desarrolló con este propósito un novedoso marco de evaluación subjetiva de la calidad de la experiencia del usuario y su relación con la aceptación por parte del mismo de la tecnología HMI (el nombre dado en inglés a este marco es Subjective Quality Evaluation Framework). En este marco se articula una estructura de clases de factores subjetivos relacionados con la satisfacción y aceptación por parte del usuario de la tecnología HMI propuesta. Esta estructura, tal y como se propone en la presente tesis, tiene dos dimensiones ortogonales. Primero se identifican tres grandes clases de parámetros relacionados con la aceptación por parte del usuario: “agradabilidad ” (likeability: aquellos que tienen que ver con la experiencia de uso, sin entrar en valoraciones de utilidad), rechazo (los cuales sólo pueden tener una valencia negativa) y percepción de utilidad. En segundo lugar, este conjunto clases se reproduce para distintos “niveles, o focos, percepción del usuario”. Éstos incluyen, como mínimo, un nivel de valoración global del sistema, niveles correspondientes a las tareas a realizar y objetivos a alcanzar, y un nivel de interfaz (en los casos propuestos en esta tesis, el interfaz es un sistema de diálogo con o sin un ECA). En el Capítulo 7 se presenta una evaluación empírica del sistema descrito en el Capítulo 4. El estudio se apoya en los mencionados antecedentes en la literatura, ampliados con parámetros para el estudio específico de los agentes animados (los ECAs), la auto-evaluación de las emociones de los usuarios, así como determinados factores de rechazo (concretamente, la preocupación por la privacidad y la seguridad). También se evalúa el marco de evaluación subjetiva de la calidad propuesto en el capítulo anterior. Los análisis de factores efectuados revelan una estructura de parámetros muy cercana conceptualmente a la división de clases en utilidad-agradabilidad-rechazo propuesta en dicho marco, resultado que da cierta validez empírica al marco. Análisis basados en regresiones lineales revelan estructuras de dependencias e interrelación entre los parámetros subjetivos y objetivos considerados. El efecto central de mediación, descrito en el Technology Acceptance Model, de la utilidad percibida sobre la relación de dependencia entre la intención de uso y la facilidad de uso percibida, se confirma en el estudio presentado en la presente Tesis. Además, se ha encontrado que esta estructura de relaciones se fortalece, en el estudio concreto presentado en estas páginas, si las variables consideradas se generalizan para cubrir más ampliamente las categorías de agradabilidad y utilidad contempladas en el marco de evaluación subjetiva de calidad. Se ha observado, asimismo, que los factores de rechazo aparecen como un componente propio en los análisis de factores, y además se distinguen por su comportamiento: moderan la relación entre la intención de uso (que es el principal indicador de la aceptación del usuario) y su predictor más fuerte, la utilidad percibida. Se presentan también resultados de menor importancia referentes a los efectos de los ECAs sobre los interfaces de los sistemas de diálogo y sobre los parámetros de percepción y las valoraciones de los usuarios que juegan un papel en conformar su aceptación de la tecnología. A pesar de que se observa un rendimiento de la interacción dialogada ligeramente mejor con ECAs, las opiniones subjetivas son muy similares entre los dos grupos experimentales (uno interactuando con un sistema de diálogo con ECA, y el otro sin ECA). Entre las pequeñas diferencias encontradas entre los dos grupos destacan las siguientes: en el grupo experimental sin ECA (es decir, con interfaz sólo de voz) se observó un efecto más directo de los problemas de diálogo (por ejemplo, errores de reconocimiento) sobre la percepción de robustez, mientras que el grupo con ECA tuvo una respuesta emocional más positiva cuando se producían problemas. Los ECAs parecen generar inicialmente expectativas más elevadas en cuanto a las capacidades del sistema, y los usuarios de este grupo se declaran más seguros de sí mismos en su interacción. Por último, se observan algunos indicios de efectos sociales de los ECAs: la “amigabilidad ” percibida los ECAs estaba correlada con un incremento la preocupación por la seguridad. Asimismo, los usuarios del sistema con ECAs tendían más a culparse a sí mismos, en lugar de culpar al sistema, de los problemas de diálogo que pudieran surgir, mientras que se observó una ligera tendencia opuesta en el caso de los usuarios del sistema con interacción sólo de voz. ABSTRACT This Thesis presents two related lines of research work contributing to the general fields of Human-Technology (or Machine) Interaction (HTI, or HMI), computational linguistics, and user experience evaluation. These two lines are the design and user-focused evaluation of advanced Human-Machine (or Technology) Interaction systems. The first part of the Thesis (Chapters 2 to 4) is centred on advanced HMI system design. Chapter 2 provides a background overview of the state of research in multimodal conversational systems. This sets the stage for the research work presented in the rest of the Thesis. Chapers 3 and 4 focus on two major aspects of HMI design in detail: a generalised dialogue manager for context-aware multimodal HMI, and embodied conversational agents (ECAs, or animated agents) to improve dialogue robustness, respectively. Chapter 3, on dialogue management, deals with how to handle information heterogeneity, both from the communication modalities or from external sensors. A highly abstracted architectural contribution based on State Chart XML is proposed. Chapter 4 presents a contribution for the internal representation of communication intentions and their translation into gestural sequences for an ECA, especially designed to improve robustness in critical dialogue situations such as when miscommunication occurs. We propose an extension of the functionality of Functional Mark-up Language, as envisaged in much of the work in the SAIBA framework. Our extension allows the representation of communication acts that carry intentions that are not for the interlocutor to know of, but which are made to influence him or her as well as the flow of the dialogue itself. This is achieved through a design element we have called the Communication Intention Base. Such r pr s ntation of “non- clar ” int ntions allows th construction of communication acts that carry several communication intentions simultaneously. Also in Chapter 4, an experimental system is described which allows (simulated) remote control to a home automation assistant, with biometric (speaker) authentication to grant access, featuring embodied conversation agents for each of the tasks. The discussion includes a description of the behavioural sequences for the ECAs, which were designed for specific dialogue situations with particular attention given to the objective of improving dialogue robustness. Chapters 5 to 7 form the evaluation part of the Thesis. Chapter 5 reviews evaluation approaches in the literature for information technologies, as well as in particular for speech-based interaction systems, that are useful precedents to the contributions of the present Thesis. The main evaluation precedents on which the work in this Thesis has built are the Technology Acceptance Model (TAM), the Subjective Assessment of Speech System Interfaces (SASSI) tool, and ITU-T Recommendation P.851. Chapter 6 presents the author’s work in establishing an valuation framework and methodology applied to the users’ experience with multimodal HMI systems. A novel user-acceptance Subjective Quality Evaluation Framework was developed by the author specifically for this purpose. A class structure arises from two orthogonal sets of dimensions. First we identify three broad classes of parameters related with user acceptance: likeability factors (those that have to do with the experience of using the system), rejection factors (which can only have a negative valence) and perception of usefulness. Secondly, the class structure is further broken down into several “user perception levels”; at the very least: an overall system-assessment level, task and goal-related levels, and an interface level (e.g., a dialogue system with or without an ECA). An empirical evaluation of the system described in Chapter 4 is presented in Chapter 7. The study was based on the abovementioned precedents in the literature, expanded with categories covering the inclusion of an ECA, the users’ s lf-assessed emotions, and particular rejection factors (privacy and security concerns). The Subjective Quality Evaluation Framework proposed in the previous chapter was also scrutinised. Factor analyses revealed an item structure very much related conceptually to the usefulness-likeability-rejection class division introduced above, thus giving it some empirical weight. Regression-based analysis revealed structures of dependencies, paths of interrelations, between the subjective and objective parameters considered. The central mediation effect, in the Technology Acceptance Model, of perceived usefulness on the dependency relationship of intention-to-use with perceived ease of use was confirmed in this study. Furthermore, the pattern of relationships was stronger for variables covering more broadly the likeability and usefulness categories in the Subjective Quality Evaluation Framework. Rejection factors were found to have a distinct presence as components in factor analyses, as well as distinct behaviour: they were found to moderate the relationship between intention-to-use (the main measure of user acceptance) and its strongest predictor, perceived usefulness. Insights of secondary importance are also given regarding the effect of ECAs on the interface of spoken dialogue systems and the dimensions of user perception and judgement attitude that may have a role in determining user acceptance of the technology. Despite observing slightly better performance values in the case of the system with the ECA, subjective opinions regarding both systems were, overall, very similar. Minor differences between two experimental groups (one interacting with an ECA, the other only through speech) include a more direct effect of dialogue problems (e.g., non-understandings) on perceived dialogue robustness for the voice-only interface test group, and a more positive emotional response for the ECA test group. Our findings further suggest that the ECA generates higher initial expectations, and users seem slightly more confident in their interaction with the ECA than do those without it. Finally, mild evidence of social effects of ECAs was also found: the perceived friendliness of the ECA increased security concerns, and ECA users may tend to blame themselves rather than the system when dialogue problems are encountered, while the opposite may be true for voice-only users.

Case study on mobile applications UX: effect of the usage of a crosss-platform development framework

Cross-platform development frameworks for mobile applications promise important advantages in cost cuttings and easy maintenance, posing as a very good option for organizations interested in the design of mobile applications for several platforms. Given that platform conventions are especially important for the User eXperience (UX) of mobile applications, the usage of framework where the same code defines the behavior of the app in different platforms could have negative impact in the UX. The objetive of this study is comparing the cross-platform and the native approach for being able to determine if the selected development approach has any impact on the users in terms of UX. To be able to set a base line under this subject, study on cross-platform frameworks was performed to select the most appropriate one from a UX point of view. In order to achieve the objectives of this work, two development teams have developed two versions of the same application; one using framework that generates Android and iOS versions automatically, and another team developing native versions of the same application. The alternative versions for each platform have been evaluated with 37 users with a combination of a laboratory usability test and a longitudinal study. The results show that differences are minimal in the Android version, but in iOS, even if a reasonable good UX can be obtained with the usage of this framework by an UX-conscious design team, a higher level of UX can be obtained directly developing in native code.

User experience with immersive and interactive media = Experiencia de usuario en entornos 3D inmersivos e interactivos

Estudios recientes promueven la integración de estímulos multisensoriales en activos multimedia con el fin de mejorar la experiencia de usuario mediante la estimulación de nuevos sentidos, más allá de la tradicional experiencia audiovisual. Del mismo modo, varios trabajos proponen la introducción de componentes de interacción capaces de complementar con nuevas características, funcionalidades y/o información la experiencia multimedia. Efectos sensoriales basados en el uso de nuevas técnicas de audio, olores, viento, vibraciones y control de la iluminación, han demostrado tener un impacto favorable en la sensación de Presencia, en el disfrute de la experiencia multimedia y en la calidad, relevancia y realismo de la misma percibidos por el usuario. Asimismo, los servicios basados en dos pantallas y la manipulación directa de (elementos en) la escena de video tienen el potencial de mejorar la comprensión, la concentración y la implicación proactiva del usuario en la experiencia multimedia. El deporte se encuentra entre los géneros con mayor potencial para integrar y explotar éstas soluciones tecnológicas. Trabajos previos han demostrado asimismo la viabilidad técnica de integrar éstas tecnologías con los estándares actualmente adoptados a lo largo de toda la cadena de transmisión de televisión. De este modo, los sistemas multimedia enriquecidos con efectos sensoriales, los servicios interactivos multiplataforma y un mayor control del usuario sobre la escena de vídeo emergen como nuevas formas de llevar la multimedia immersiva e interactiva al mercado de consumo de forma no disruptiva. Sin embargo, existen numerosas interrogantes relativas a los efectos sensoriales y/o soluciones interactivas más adecuadas para complementar un contenido audiovisual determinado o a la mejor manera de de integrar y combinar dichos componentes para mejorar la experiencia de usuario de un segmento de audiencia objetivo. Además, la evidencia científica sobre el impacto de factores humanos en la experiencia de usuario con estas nuevas formas de immersión e interacción en el contexto multimedia es aún insuficiente y en ocasiones, contradictoria. Así, el papel de éstos factores en el potencial de adopción de éstas tecnologías ha sido amplia-mente ignorado. La presente tesis analiza el impacto del audio binaural, efectos sensoriales (de iluminación y olfativos), interacción con objetos 3D integrados en la escena de vídeo e interacción con contenido adicional utilizando una segunda pantalla en la experiencia de usuario con contenidos de deporte. La posible influencia de dichos componentes en las variables dependientes se explora tanto a nivel global (efecto promedio) como en función de las características de los usuarios (efectos heterogéneos). Para ello, se ha llevado a cabo un experimento con usuarios orientado a explorar la influencia de éstos componentes immersivos e interactivos en dos grandes dimensiones de la experiencia multimedia: calidad y Presencia. La calidad de la experiencia multimedia se analiza en términos de las posibles variaciones asociadas a la calidad global y a la calidad del contenido, la imagen, el audio, los efectos sensoriales, la interacción con objetos 3D y la interacción con la segunda pantalla. El posible impacto en la Presencia considera dos de las dimensiones definidas por el cuestionario ITC-SOPI: Presencia Espacial (Spatial Presence) e Implicación (Engagement). Por último, los individuos son caracterizados teniendo en cuenta los siguientes atributos afectivos, cognitivos y conductuales: preferencias y hábitos en relación con el contenido, grado de conocimiento de las tecnologías integradas en el sistema, tendencia a involucrarse emocionalmente, tendencia a concentrarse en una actividad bloqueando estímulos externos y los cinco grandes rasgos de la personalidad: extroversión, amabilidad, responsabilidad, inestabilidad emocional y apertura a nuevas experiencias. A nivel global, nuestro estudio revela que los participantes prefieren el audio binaural frente al sistema estéreo y que los efectos sensoriales generan un aumento significativo del nivel de Presencia Espacial percibido por los usuarios. Además, las manipulaciones experimentales realizadas permitieron identificar una gran variedad de efectos heterogéneos. Un resultado interesante es que dichos efectos no se encuentran distribuidos de forma equitativa entre las medidas de calidad y Presencia. Nuestros datos revelan un impacto generalizado del audio binaural en la mayoría de las medidas de calidad y Presencia analizadas. En cambio, la influencia de los efectos sensoriales y de la interacción con la segunda pantalla se concentran en las medidas de Presencia y calidad, respectivamente. La magnitud de los efectos heterogéneos identificados está modulada por las siguientes características personales: preferencias en relación con el contenido, frecuencia con la que el usuario suele ver contenido similar, conocimiento de las tecnologías integradas en el demostrador, sexo, tendencia a involucrarse emocionalmente, tendencia a a concentrarse en una actividad bloqueando estímulos externos y niveles de amabilidad, responsabilidad y apertura a nuevas experiencias. Las características personales consideradas en nuestro experimento explicaron la mayor parte de la variación en las variables dependientes, confirmando así el importante (y frecuentemente ignorado) papel de las diferencias individuales en la experiencia multimedia. Entre las características de los usuarios con un impacto más generalizado se encuentran las preferencias en relación con el contenido, el grado de conocimiento de las tecnologías integradas en el sistema y la tendencia a involucrarse emocionalmente. En particular, los primeros dos factores parecen generar un conflicto de atención hacia el contenido versus las características/elementos técnicos del sistema, respectivamente. Asimismo, la experiencia multimedia de los fans del fútbol parece estar modulada por procesos emociona-les, mientras que para los no-fans predominan los procesos cognitivos, en particular aquellos directamente relacionados con la percepción de calidad. Abstract Recent studies encourage the integration of multi-sensorial stimuli into multimedia assets to enhance the user experience by stimulating other senses beyond sight and hearing. Similarly, the introduction of multi-modal interaction components complementing with new features, functionalities and/or information the multimedia experience is promoted. Sensory effects as odor, wind, vibration and light effects, as well as an enhanced audio quality, have been found to favour media enjoyment and to have a positive influence on the sense of Presence and on the perceived quality, relevance and reality of a multimedia experience. Two-screen services and a direct manipulation of (elements in) the video scene have the potential to enhance user comprehension, engagement and proactive involvement of/in the media experience. Sports is among the genres that could benefit the most from these solutions. Previous works have demonstrated the technical feasibility of implementing and deploying end-to-end solutions integrating these technologies into legacy systems. Thus, sensorially-enhanced media, two-screen services and an increased user control over the displayed scene emerge as means to deliver a new form of immersive and interactive media experiences to the mass market in a non-disruptive manner. However, many questions remain concerning issues as the specific interactive solutions or sensory effects that can better complement a given audiovisual content or the best way in which to integrate and combine them to enhance the user experience of a target audience segment. Furthermore, scientific evidence on the impact of human factors on the user experience with these new forms of immersive and interactive media is still insufficient and sometimes, contradictory. Thus, the role of these factors on the potential adoption of these technologies has been widely ignored. This thesis analyzes the impact of binaural audio, sensory (light and olfactory) effects, interaction with 3D objects integrated into the video scene and interaction with additional content using a second screen on the sports media experience. The potential influence of these components on the dependent variables is explored both at the overall level (average effect) and as a function of users’ characteristics (heterogeneous effects). To these aims, we conducted an experimental study exploring the influence of these immersive and interactive elements on the quality and Presence dimensions of the media experience. Along the quality dimension, we look for possible variations on the quality scores as-signed to the overall media experience and to the media components content, image, audio, sensory effects, interaction with 3D objects and interaction using the tablet device. The potential impact on Presence is analyzed by looking at two of the four dimensions defined by the ITC-SOPI questionnaire, namely Spatial Presence and Engagement. The users’ characteristics considered encompass the following personal affective, cognitive and behavioral attributes: preferences and habits in relation to the content, knowledge of the involved technologies, tendency to get emotionally involved and tendency to get absorbed in an activity and block out external distractors and the big five personality traits extraversion, agreeableness, conscientiousness, neuroticism and openness to experience. At the overall level, we found that participants preferred binaural audio than standard stereo audio and that sensory effects increase significantly the level of Spatial Presence. Several heterogeneous effects were also revealed as a result of our experimental manipulations. Interestingly, these effects were not equally distributed across the quality and Presence measures analyzed. Whereas binaural audio was foud to have an influence on the majority of the quality and Presence measures considered, the effects of sensory effects and of interaction with additional content through the tablet device concentrate mainly on the dimensions of Presence and on quality measures, respectively. The magnitude of these effects was modulated by individual’s characteristics, such as: preferences in relation to the content, frequency of viewing similar content, knowledge of involved technologies, gender, tendency to get emotionally involved, tendency to absorption and levels of agreeableness, conscientiousness and openness to experience. The personal characteristics collected in our experiment explained most of the variation in the dependent variables, confirming the frequently neglected role of individual differences on the media experience. Preferences in relation to the content, knowledge of involved technologies and tendency to get emotionally involved were among the user variables with the most generalized influence. In particular, the former two features seem to present a conflict in the allocation of attentional resources towards the media content versus the technical features of the system, respectively. Additionally, football fans’ experience seems to be modulated by emotional processes whereas for not fans, cognitive processes (and in particular those related to quality judgment) prevail.

Gene-experience interaction alters the cholinergic septohippocampal pathway of mice

Spatial learning requires the septohippocampal pathway. The interaction of learning experience with gene products to modulate the function of a pathway may underlie use-dependent plasticity. The regulated release of nerve growth factor (NGF) from hippocampal cultures and hippocampus, as well as its actions on cholinergic septal neurons, suggest it as a candidate protein to interact with a learning experience. A method was used to evaluate NGF gene-experience interaction on the septohippocampal neural circuitry in mice. The method permits brain region-specific expression of a new gene by using a two-component approach: a virus vector directing expression of cre recombinase; and transgenic mice carrying genomic recombination substrates rendered transcriptionally inactive by a “floxed” stop cassette. Cre recombinase vector delivery into transgenic mouse hippocampus resulted in recombination in 30% of infected cells and the expression of a new gene in those cells. To examine the interaction of the NGF gene and experience, adult mice carrying a NGF transgene with a floxed stop cassette (NGFXAT) received a cre recombinase vector to produce localized unilateral hippocampal NGF gene expression, so-called “activated” mice. Activated and control nonactivated NGFXAT mice were subjected to different experiences: repeated spatial learning, repeated rote performance, or standard vivarium housing. Latency, the time to complete the learning task, declined in the repeated spatial learning groups. The measurement of interaction between NGF gene expression and experience on the septohippocampal circuitry was assessed by counting retrogradely labeled basal forebrain cholinergic neurons projecting to the hippocampal site of NGF gene activation. Comparison of all NGF activated groups revealed a graded effect of experience on the septohippocampal pathway, with the largest change occurring in activated mice provided with repeated learning experience. These data demonstrate that plasticity of the adult spatial learning circuitry can be robustly modulated by experience-dependent interactions with a specific hippocampal gene product.

Narrative Therapy and Stigma Management: Restorying the Patient Experience of Being Told, “You have MS

The purpose of this investigation was to determine if the way patients are informed of the diagnosis of multiple sclerosis (MS) affects their feelings about themselves as people with MS. Building on illness narrative, I hoped to examine how patients “storied” their experience of being informed of the diagnosis of MS and whether this “storying” had a lasting impact on their self-concept. The alternative would be that no connection exists between how a neurologist informs a patient of the diagnosis and how a person makes sense of their diagnosis and life with MS. Due to study limitations (e.g., small sample size, threat of response bias), the results are unclear about whether the way in which the news is broken has a lasting effect on patients' perceptions. However, review of the literature and patient responses indicate that there is a need for psychological intervention when patients are diagnosed with MS.

The Effect of Discovery Systems on Online Journal Usage: A Longitudinal Study

Many academic libraries are implementing discovery services as a way of giving their users a single comprehensive search option for all library resources. These tools are designed to change the research experience, yet very few studies have investigated the impact of discovery service implementation. This study examines one aspect of that impact by asking whether usage of publisher-hosted journal content changes after implementation of a discovery tool. Libraries that have begun using the four major discovery services have seen an increase in usage of this content, suggesting that for this particular type of material, discovery services have a positive impact on use. Though all discovery services significantly increased usage relative to a no discovery service control group, some had a greater impact than others, and there was extensive variation in usage change among libraries using the same service. Future phases of this study will look at other types of content.

High-Resolution N2 Adsorption Isotherms at 77.4 K: Critical Effect of the He Used During Calibration

Accurate characterization of the microporous structure in porous solids is of paramount importance for several applications such as energy and gas storage, nanoconfinement reactions, and so on. Among the different techniques for precise textural characterization, high-precision gas adsorption measurement of probe molecules at cryogenic temperatures (e.g., N2 at 77.4 K and Ar at 87.3 K) is the most widely used, after appropriate calibration of the sample holder with a probe gas, which does not experience physisorption processes. Although traditionally helium has been considered not to be adsorbed in porous solids at cryogenic temperatures, here we show that even at 77.4 K (high above its boiling temperature, 4 K) the use of He in the calibration step can give rise to erroneous interpretations when narrow micropores/constrictions are present.

International Experiences – is there an effect on intercultural sensitivity? : An explorative study conducted at Stockholm University

The presented research is an explorative study, aimed to identify differences in intercultural sensitivity of Swedish students with international experience, Swedish students with no international experiences and international students studying at Stockholm University. The research is placed within the field of higher education. International experiences are seen to be a key to intercultural competences and it is universities who need to prepare students for the demands of the globalized job market. The research is of qualitative nature and relevant data was collected by the means of semi- structured interviews. The data was coded according to qualitative thematic analysis and then analyzed and discussed in accordance to the researcher questions and existing literature in this field. The study revealed that there is no general difference in intercultural sensitivity between the three groups analyzed. However, international students show higher sensitivity in terms of respect of cultural differences and open-mindedness, while students with no international experiences show less sensitivity in terms of interaction involvement and suspending judgment. The identified themes offer valuable information on individual perceptions of cultural differences. This information can be used to improve measures and actions to increase intercultural sensitivity at Stockholm University.