Tesi sul tema "Homebond"

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Architecture, 2008.<br>Pages 116 and 117 blank.<br>Includes bibliographical references (p. 113-115).<br>This thesis represents a foundation of research and ideas upon which I build my practice as an artist. By closely examining my chosen artistic site, the home, and my artistic medium, the body in performance, I hope to clarify the Submitted to the Department of Architecture on August 8, medium, the body in performance, I hope to clarify the 2008 intentions of my practice.The homebody project analyzes the dynamic relationship of in partial fulfillment of the requirements for the degree of Master of Science in Visual Studies the individual body to the individual home site in the cycliat the Massachusetts Institute of Technology cal process of everyday identity production. This involves an interrogation of habit, the choreography of repeated gestures over time that confirm inscribed cultural norms, and the habitual topographies of the private sphere.I rely on both personal and theoretical histories and discourses to develop an understanding of the homebody situation and its larger implications. Establishing the home-body relationship as both deeply intimate and culturally determined, I show how a creative practice sited in the home can disrupt or even reinvent the habit continuum, and suggest new modes of operation within the cycle of home-body coproduction.<br>by Kate James.<br>S.M.

Thesis (Ed. D.)--Illinois State University, 2005.<br>Title from title page screen, viewed September 26, 2006. Dissertation Committee: Dent M. Rhodes (chair), Robert L. Dean, Barbara B. Meyer, Cheri A. Toledo. Includes bibliographical references (leaves 187-196) and abstract. Also available in print.

Food consumption patterns and their association with nutrient intake in 290 homebound elderly living in Sherbrooke, Quebec were: investigated. Dietary data were collected using three repeated non-consecutive 24-hour recalls and sociodemographic, physical, physiological and psychosocial characteristics were measured. Factor and cluster analyses were used to define food patterns. Due to the homogeneous dietary patterns of this population, neither the five factors nor six clusters formed were distinct. There were few dietary predictors of nutrient intake as mean intakes of energy, folacin, calcium, vitamin D and zinc by subjects in all clusters were inadequate. Protein intakes were also marginal. Eating beef predicted higher intakes of protein, niacin and zinc for women. Smoking predicted both poorer food choices and nutrient intake. A diagnosis of emphysema predicted higher food intakes. Recommended dietary changes for this population include increased consumption of dairy products and other protein sources as well as energy-dense foods in order to increase micronutrient intake and prevent weight loss in some individuals.

With more than 700,000 new diagnoses annually, congestive heart failure (CHF) is a chronic condition that affects the chambers of the heart. When not managed correctly, the disease rapidly progresses to substantial fluid volume overload that impacts activities of daily living and the overall quality of life. The financial implications for poor CHF management cost a mean annual medical expenditure of $33,427 per patient per year. The need for a diagnostic and prognostic at-home protocol is needed in the medical community, as there is currently no such tool on the market. Donabedian's framework was used to guide the formulation and interpretation of this research. The purpose of this project was to design a CHF protocol using evidence-based research for clinicians making home visits to homebound patients with a primary diagnosis of CHF with an individualized protocol focusing on disease management, in home support system, knowledge base and financial factors for homebound patients. The protocol was released through a snowballing campaign to clinicians who work with CHF, transitional care, or homecare who then evaluated the protocol on its perceived efficacy if integrated into practice. Findings were analyzed using simple descriptive statistics by 32 nurses and other health care professionals who responded work in home care, cardiology, medical surgical nursing hospitalists, or skilled nursing facilities. Thirty-one of the 32 respondents deemed the protocol useful and stated a clinical need of protocol as evidenced by completed the AGREE II Questionnaire. The findings demonstrate that the CHF Practice Protocol provides clinicians with an evidence-based guidance to manage homebound patients with CHF on a small scale.

Food distribution (FD) is a part of the public social and care service in Sweden aiming to prevent improper food intake for persons that they are unable to do their own shopping, and prepare their own meals, and in that way ensure reasonable standard of living. Before a person can be granted the FD service, from any municipality, an assessment of their individual requirements has to be made by a public home care officer. The aim of this study was to explore how public home care officers reason when they make a needs assessment for homebound elderly people. The data was collected through individual interviews (n=18). The transcribed interview material was analysed by means of the grounded theory method. The findings showed that the public home care officers were confronted with many challenges when making an assessment of a person’s individual needs. They are influenced by their subjective feelings related to their personal views as to what should be the right solution for the individual. However, they remained aware that they needed to be guided by the legal requirements.  Further, they described that the level of an individual’s living standard is a leading concept in the governing laws that they need to interpret. Interpretation of this concept is very subjective with the possible consequence that an assessment result may lead to inefficient support. In conclusion, the concept of a reasonable standard of living needs to be clearly defined, decision regarding FD should not take long time, need assessment and decision should be based on the whole picture behind each individual case and there are needs to develop general guidelines for making needs assessment. The findings in this study have implications for public administration, nursing and gerontology.

<p> The purpose of this project was to write a grant proposal and identify a potential funding source for the creation and implementation of a mental health intervention program for homebound older adults who experience depression and/or generalized anxiety disorders in Irvine, California (CA). An extensive literature review was performed, which helped understand the special needs of this population. A search for potential funding sources was conducted using the Internet and a grant database located in Orange County, CA. The California Wellness Foundation was chosen as the most appropriate funder because it meets all of the required criteria of the host agency, the City oflrvine, Lakeview Senior Center (LSC). The proposed program's goal is to provide mental health services to Irvine's homeboundolder adults to help them manage their challenges with mental health illness so as to live independent and productive lives. The actual submission and/or funding of this grant was not a requirement for the successful completion of the project.</p>

<p>The purpose of this project was to find a potential funding agency and create a grant for an in-home visitation program for homebound, older adult veterans. The goal of the program is to promote enriching relationships, increase levels of compassion by both parties, and decrease levels of depression/loneliness and/or social isolation among the older adult veteran population within Los Angeles County, California. The program will offer visitations by community college students and weekly activities addressing depressive symptoms while incorporating access to case management support for additional needs, such as medical and psychiatric referrals. The host agency for the program will be Home-Based Primary Care in the U.S. Department of Veteran Affairs. The Archstone Foundation was selected as the funding source for this grant. The actual submission and/or funding of this grant were not a requirement for the successful completion of the project.

Thesis (Ed.D.)--Teachers College, Columbia University, 1995.<br>Includes tables. Typescript; issued also on microfilm. Sponsor: Jeannette Fleischner. Dissertation Committee: Thurston Atkins. Includes bibliographical references (leaves 117-125).

This study examined the impact of school reform on the homebound/ hospital education program before and after the implementation of the Quality Basic Education Act. The impact of school reform was in relationship to the location of the school district and delivery modes of services. It also examined teacher preparation, types of funding sources, selected biographic factors of special education directors and certification of special education directors. Participants included 52 directors in the state of Georgia with responsibility for homebound/ hospital delivery services. The study revealed that contract teaching is on the increase. The study recommended that special attention should be given to the written contract.

<p> This qualitative multi-case study explored the perceptions and beliefs of teachers of students in Grade 9 and 10, at a high school in south-central New Jersey, who taught traditional classroom courses that incorporated technology, regarding their lived experiences delivering homebound instruction for the same curriculum. Technology used in the classroom was compared to the use or lack of use of technology in the homebound setting. Similarities and differences were identified in instructional design, as well as teacher perceptions of efficiency and effectiveness for the student. The study revealed a disparity between the classroom instruction using technology and the homebound instructional setting. Five specific insights for leadership emerged from this study. The insights include (a) providing technology for the homebound instructor; (b) increase parental involvement in homebound instruction; (c) increase the amount of time for homebound instruction; (d) educate instructors in instructional technologies; and (e) to provide the homebound student with time management and organizational skills. These insights are helpful for recommending steps organizational leaders can take to increase the effectiveness of homebound instruction.</p>

<p> Gang intervention is crucial to improving the lives of Latino males in Los Angeles. The effectiveness of these programs is dependent on society&rsquo;s perspective of gang members, and its ability to support the work of gang intervention programs. As documented in this research, Latinos face unique obstacles and situations, in education and in life. This qualitative research study aimed to provide insight as to the perceived impact of a Gang Intervention Program, Homeboy Industries, on Latino males. This study also provided insight as to the methods, behaviors, strategies, and situated learning perceived to positively affect former gang members at Homeboy Industries. The protocol included open-ended, in-depth interviews with former gang members now affiliated with Homeboys that met specific criteria. The data from the interviews provided insight about the impact of the past, the struggles of the present, and the aspirations of the future for former gang members in the Homeboys intervention program. Homeboy Industries utilizes a holistic approach to define clear expectations, and enable a collaborative decision making process to develop a shared vision that cultivates trust among former gang members to improve their lives. This shared vision was rooted in the Ignatian paradigm, espoused by Homeboys Industries founder, Father Greg Boyle, S.J. This study validated the need for gang intervention programs similar to the Homeboys Industries model, and a reconstruction of society&rsquo;s understanding of the former gang member, and his ability to contribute to society.</p>

Energy and nutrient intake from agency meals (AM), other meals (OM) and total daily intake (TDI) of 61 day care and homebound subjects was studied for differences associated with age, income, education, marital status, living arrangements, gender, race, vitamin-mineral supplementation, Body Mass Index (BMI), Health Assessment (HA), Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL).The AM provided more than one-third of the recommended allowances for all nutrients except vitamin B6 plus energy for men. TDI was low because of inadequate OM intake. TDI was less than 100 percent of recommended amounts for zinc plus fiber for women. were most significantly associated with intake from OM and TDI followed by education and income. No age, marital status or racial effects were noted.The ADLs and the IADLs were problematic for most of the participants. They were positively correlated with energy and nutrient intake, as intakes increased so did functional difficulties.Ball State UniversityMuncie, IN 47306<br>Center for Gerontology

Background: Among patients with multiple chronic conditions, care coordination and integration remains one of the major challenges facing the U.S. health care system. A home-based, patient-centered primary care program has been offered through the Veterans Health Administration (VHA) since the 1970s for frail veterans who have difficulty accessing VHA clinics. The VHA Home Based Primary Care (VHA HBPC) aims to integrate primary care, rehabilitation, disease management, palliative care, and coordination of care for frail individuals with complex, chronic diseases within their homes. Early research suggested that VHA HBPC was associated with positive outcomes (e.g., reduced resource use and patient satisfaction). However, evidence regarding the effect of the VHA HBPC program on health services use (especially hospital and nursing home use), expenditures, and other patient outcomes remains limited. The present study is designed to fill this gap as the rise in the number of veterans with complex health care needs will likely increase in the coming decades. Objectives: The current study aimed to examine the impact of VHA HBPC on health services use, expenditures, and mortality among a cohort of new VHA HBPC enrollees identified in the national VHA data system. The specific aims of this study were: 1) to examine the effect of VHA HBPC on major health service use (hospital, nursing home, and outpatient care) paid for by the Veterans Administration; 2) to examine the effect of VHA HBPC on total health services expenditures; and 3) to examine whether VHA HBPC enrollees experienced similar mortality and survival as compared to a matched concurrent cohort. Methods: This study used a retrospective cohort design. A new VHA HBPC enrollee cohort (the treatment group) and a propensity matched comparison cohort (the comparison group) were identified from VHA claims in fiscal years (FY) 2009 and 2010 and were followed through FY 2012. Data on health service use, expenditures, and mortality/survival data were obtained via the VHA administrative datasets (i.e., Decision Support System, Purchased Care, and Vital Status Files). Propensity scores of being enrolled in the VHA HBPC were generated by a logistic regression model controlling for potential confounders. After 41,244 matched pairs were determined adequate through several diagnostic methods, means tests, relative risk analyses, and generalized linear models were used to estimate the effect of VHA HBPC on outcomes. Additionally, a Cox proportional hazards regression model was used to estimate the effect of VHA HBPC on survival. Subgroup analyses were conducted stratifying by age (85 and older), comorbidities (2 or more), and the receipt of palliative care. Based on the results of the original analyses, a series of sensitivity analyses were conducted that modified the described sample selection criteria and matching algorithm. Results: Analyses of the original cohort revealed that VHA HBPC patients had significantly higher risks of being admitted into a hospital (RR 1.53, 95% CI 1.51-1.56) or nursing home (RR 1.65, CI 1.50 - 1.81). The average total expenditures during the study period were significantly higher for the VHA HBPC group as compared to the control group ($85,808 vs. $44,833, respectively; p < .001). In terms of mortality and survival, VHA HBPC enrollees had higher mortality (RR 1.45, CI 1.43 - 1.47), and shorter survival (HR 1.89, CI 1.86 - 1.93) as compared to those in the comparison group. Subgroup analyses found that these relationships generally remained when stratified by age 85 or older or having two or more comorbidities. However, for those who received palliative care, VHA HBPC participants had significantly lower risk of VHA hospitalization overall (RR 0.84, CI 0.81 - 0.87) and immediately prior to death. Finally, exploratory post-hoc analysis suggested that VHA HBPC recipients were at higher risk of VHA hospitalization at 30 (RR 1.11, CI 1.06 - 1.16), 60 (RR 1.16, CI 1.11 - 1.20), and 90 days (RR 1.16, 1.12 - 1.21) prior to death relative to the comparison group. After selecting only those that had a baseline hospitalization and refining the matching algorithm to account for time to death and additional comorbidities, VHA HBPC participants who had been enrolled in the program for at least six months had lower risks for hospital (RR 0.89, CI 0.88 - 0.90) and nursing home admissions (RR 0.74, CI 0.67 - 0.81). However, total expenditures remained significantly higher among those in VHA HBPC relative to the comparison group ($89,761 vs. $85,371, respectively; p < .001). Discussion: This study found that without accounting for important covariates such as initial hospitalization, time to death, and a range of comorbidities, VHA HBPC was associated with higher health service use, higher expenditures, higher mortality, and shorter survival as compared to a similar group of patients not receiving VHA HBPC. After accounting for these factors, VHA HBPC was associated with a lower risk of nursing home use, and after six months, VHA HBPC was associated with lower risk of both nursing home and hospital use. These findings suggest that while VHA HBPC may improve quality of life and patient satisfaction through patient-centered integrated primary care, it may not generate cost savings for the healthcare system. Future research is needed to understand variation in program implementation and how this affects the impact of VHA HBPC on service use and cost.

The rising cost of health care and changes in healthcare delivery have prompted a need to improve continuity from the hospital to home. This scholarly project was initiated to assess the impact on patient outcomes related to initiation of a nurse practitioner-led transitional care program (TCP). Using the Diffusion of Innovations and Health Belief Models, the purpose of this study was to identify the impact of a TCP on improving the health of patients with congestive heart failure (CHF), diabetes mellitus Type II (DM II), and chronic obstructive pulmonary disorder (COPD). The impact of the TCP was evaluated by a review of patient satisfaction results, reduction in patient readmission rate, and emergency room consults. Two years of data from a community-based health care program were collated from a sample of 819 individuals with chronic disease between 65- and 85-years-old who had a 30-day hospital readmission after a nurse practitioner home visit and a 30- day readmission for an exacerbation of their CHF, DM II, or COPD. The secondary data were analyzed, using SPSS, to determine changes in rates of readmission. Descriptive statistics were used to represent and compare changes in rates. After implementation of the nurse practitioner home visit program, the 30-day readmission demonstrated an 81.07% reduction and the 30-day readmission for exacerbation of COPD, CHF, and DM II was reduced by 36.77%. The project findings contribute to social change by identifying how a reduction in the frequency of hospitalizations could contribute to decreased health care expenses and improved health outcomes. Home care and chronic health care organizations, as well as advanced-practice nurses working in home care settings, may use the results of the study to establish effective community interventions that reduce health care costs.

<p> Using autoethnographic research for this study, I intimately explore my experiences in school as a Detroit Latino male and the relationship with my family, community, and school and how they intersected and helped me achieve academic success. I excavate the indigenous roots that characterizes my family&rsquo;s way of knowing and explore how that foundation laid the ground work for the values that have shaped my identity. I select a personal narrative that relies on memories, photos, school yearbooks, and news clippings to describe my journey within the southwest Detroit Latina/o community. I identify the community institutions and their influences on me that contributed to my sense of belonging and eventual academic success.</p><p>

Ministry research project (D. Min.)--Midwestern Baptist Theological Seminary, 2004.<br>Submitted in partial fulfillment of the requirements for the Doctor of Ministry Degree. Includes bibliographical references (leaves 220-225).

O carcinoma epidermóide de boca, neoplasia maligna de boca mais comum, pode originar-se de lesões potencialmente malignas. O ácido retinóico, que atua no crescimento e diferenciação celular, tem sido comumente estudado como um possível quimioterápico na prevenção dessa progressão. Embora o mecanismo pelo qual o ácido retinóico previne essa progressão, e promove a parada do crescimento celular, não esteja estabelecido, sabe-se que os genes homeobox são importantes alvos do ácido retinóico durante o desenvolvimento embrionário e diferenciação tecidual. Este estudo visa determinar se a modulação da expressão desses genes está envolvida na inibição do crescimento pelo ácido retinóico em carcinoma epidermóide de boca. Para isso, foi realizado PCR array para avaliar a expressão de 84 genes homeobox na linhagem celular de carcinoma epidermóide de boca sensível ao ácido retinóico SSC-25, comparando com a linhagem resistente, SSC-9, após o tratamento com ácido retinóico por sete dias. Os resultados mostraram nove genes com perda de expressão e quatro com alta expressão. A validação por qPCR de 7 desses genes confirmou os resultados. Desses, três genes(ALX1, DLX3, TLX1) foram selecionados para terem a expressão avaliada em amostras tratadas por 3, 5 e 7 dias. O gene ALX1 apresentou baixa expressão apenas no dia 7. O gene DLX3 apresentou baixa expressão no terceiro dia com maior decréscimo no sétimo. Já o gene TLX1, mostrou baixa significativa no quinto dia, com valores semelhantes no sétimo. Os dados mostram genes homebox são modulados pelo ácido retinóico em linhagens de carcinoma epidermóide de boca. No entanto, esses genes não parecem ser alvo direto da inibição do crescimento promovida pelo ácido retinóico.<br>Oral squamous cell carcinoma, the most frequent oral cancer, may arise from potentially malignant oral lesions. Retinoic acid, which plays a role in cell growth and differentiation, has been frequently studied as a possible chemotherapeutic agent in the prevention of this progression. While the mechanism by which retinoic acid prevents progression and suppresses cell growth has not been completely elucidated, it is known that homeobox genes represent important targets of retinoic acid during embryogenesis and differentiation. The present study aims to determine if modulation of the expression of these genes is involved in inhibition of OSCC cell growth by retinoic acid. In order to achieve this goal a PCR array was performed to evaluate the expression of 84 homeobox genes in retinoic acid sensitive SCC-25 cells compared to retinoic acid resistant SCC-9 cells following treatment with retinoic acid for 7 days. Results showed that 9 homeobox genes are downregulated and 4 are upregulated by retinoic acid. The validation confirmed these results. Three genes (ALX1, DLX3, TLX1) were selected for having their expression evaluated on samples treated with retinoic acid for 3, 5 and 7 days. Three different patterns of gene expression were observed. Gene ALX1 showed down-regulation only on day 7. Homeobox gene DLX3 showed reduced expression on day 3 and decreased expression on day 7. TLX1 showed a substantial down-regulation on day 5 with similar values on. The data presented show that a number of homeobox genes are modulated by retinoic acid in oral squamous cell carcinoma cell lines. However, these genes do not appear to be direct targets of growth suppression trigged by retinoic acid.

INTRODUÇÃO Para a pessoa com deficiência nem sempre o restabelecimento funcional significa aquisição de habilidades para que se possa viver de maneira a exercer sua cidadania. Este estudo tem como objetivo compreender de que maneira a aquisição da deficiência física altera as relações de convivência estabelecidas pelas pessoas e busca apresentar a atenção domiciliar como proposta de cuidado que pode lidar com as necessidades advindas dessa alteração. PROCEDIMENTOS: Pesquisa qualitativa realizada a partir de histórias de vida de adultos. Realizou-se de 1 a 3 encontros dependendo da quantidade de informações disponibilizadas. Foram acompanhados 1 homem e 3 mulheres com deficiências físicas com idades entre 30 e 77 anos. A escolha da amostra procurou representar as pessoas com deficiência física cadastradas na Unidade Básica do Jardim Boa Vista e que não realizavam acompanhamento terapêutico ocupacional. Também foram considerados idade, deficiência e seqüelas. A análise dos dados foi baseada na teoria de rede social significativa de Sluzki. RESULTADOS E DISCUSSÃO: Através das narrativas constatou-se diminuição das relações de convivência percebidas nas redes sociais compostas pela família, amigos, relações de trabalho e de práticas sociais/comunitárias atribuídas principalmente à redução de oportunidades de circulação social. Constatou-se diminuição das atividades de lazer, de itinerários de circulação social e o surgimento de novos como a inserção em serviços de saúde e reabilitação. Devido à redução das relações de convivência e da dificuldade de equipamentos de saúde e familiares em se promover iniciativas de ativação da rede social, o terapeuta ocupacional pode utilizar a atenção domiciliar como estratégia de atuação, pois oferece meios para obter aproximação da realidade da pessoa com deficiência. Esta compreensão pode auxiliar na construção de propostas tanto para conhecer como para ativar a rede social de pessoas com deficiências físicas. CONCLUSÃO: A manutenção e ampliação das relações de convivência a partir do acompanhamento domiciliar em atenção comunitária de pessoas com deficiências físicas pode ser um caminho para ampliação da participação social.<br>INTRODUCTION: For the person with physical disabilities, the functional recovery does not always lead to the acquisition of skills that would provide them means to exercise their citizenship. This study aims to understand how physical disability changes the relations among people and tries to present home care as a type of health care that can address the needs resulting from this change. PROCEDURES: It was a qualitative research developed from analysis of the life stories of adults. There were 1 to 3 meetings with the subjects depending on the amount of information available. The subjects were 1 man and 3 women with physical disabilities aged between 30 and 77 years. The choice of this sample sought to represent the universe of people with physical disabilities who attend the Basic Health Care Unit of Jardim Boa Vista and who are not being treated by any occupational therapist. Other characteristics considered on the choice of the sample were age, type of disability and sequelae. Data analysis was based on the theory of significant social network of Sluzki. DISCUSSION: Through the narratives it was detected a decrease in the number of relations of coexistence in social networks composed by family or friends, work relations and social / community activities. This decrease was mainly attributed to the reduction of opportunities for social interaction.There was also a decrease in leisure activities and patterns of transportation, and the emergence of new patterns with the inclusion in health care and rehabilitation services. Due to the reduction of relations of coexistence and the difficulty of ordinary health care and family in promoting the reactivation of social networks, the occupational therapist may use home care as a strategy of action, as it offers the means to get closer to the reality of the person with disabilities. This can help on the elaboration of suggestions for knowing and reactivating the social networks of disabled persons. CONCLUSION: Home care of persons with disability with focus on maintaining and expanding the relations of coexistence can be a way to increase social participation.

Submitted by Edineia Teixeira (edineia.teixeira@unioeste.br) on 2018-04-24T14:22:41Z No. of bitstreams: 2 Vanessa _Rossetto2017.pdf: 1693675 bytes, checksum: b6a8d5fcadb47331df5a0c41af1630f5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)<br>Made available in DSpace on 2018-04-24T14:22:41Z (GMT). No. of bitstreams: 2 Vanessa _Rossetto2017.pdf: 1693675 bytes, checksum: b6a8d5fcadb47331df5a0c41af1630f5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-12-20<br>Introduction: Technological advances and the qualification of health professionals in the last decades have reflected in the epidemiological transition of childhood, with a reduction in infant mortality. In contrast, there was an increase in chronic conditions in childhood, evidencing Children with Special Health Needs - CRIANES. These require differentiated care, ranging from psychomotor and social rehabilitation, devices and technologies, drugs and differentiated care - to feed, sanitize and dress. Given this scenario, the need for changes in health care emerges and, in this context, Home Care (HC) can be considered as one of the responses of the system to meet the demands present in the chronic conditions. Objectives: To know and describe the care provided to the CRIANES in the services of Paraná State and to propose a protocol of home care flow, specific for these children. Methodology: Quantitative, case-study, descriptive and exploratory research. Data collection was performed through the application of an instrument developed for the research, to the professionals of all the Home Care Services - SAD of Paraná, by telephone and electronic mail, from October 2016 to January 2017. The data analysis was descriptive statistics. Secondly, a specific care flow protocol was developed for the CRIANES in the SAD, being guided by the methodology of reality analysis Strengths, Weaknesses, Opportunities and Threats (SWOT), from the diagnosis of the services. All the ethical precepts for human research were followed and the study was approved by an ethics committee in research. Results: The state of Paraná has accredited SAD in eight municipalities. Among the children attended by these, 25.7% of them have cerebral palsy and 60% are tracheostomized. Among the practices of the services it was observed that 25% of them use a therapeutic project, however 75% communicate inconstantly with primary care. It was highlighted as important points for the care of children in SAD2: scheduled hospital discharge, organized referral to the home care service, evaluation of effective eligibility, adequate preparation of the caregiver, organized sanitary transportation, systematic itinerary for admission, unique therapeutic project, shared care with primary care, systematized follow-up, organized telephone counseling, electronic and interconnected medical records, and specific flow in the emergency and emergency network. The weaknesses are mainly related to the low use of the therapeutic project and the counter reference to primary care. The method employed allowed a careful evaluation of each point involved and thus develop an action plan and flow chart that neutralizes weaknesses and threats and potentiates strengths and opportunities. Conclusions: Many successful practices are developed, but isolated in the municipalities. Thus, disseminating the positive experiences, this study fosters reflection and improvement of the work process and the development of the protocol offers subsidies to give robustness to the care of children with special health needs in home care.<br>Introdução: Os avanços tecnológicos e a qualificação dos profissionais de saúde, nas últimas décadas, refletiram na transição epidemiológica da infância, com diminuição da mortalidade infantil. Em contraponto, houve crescimento das condições crônicas na infância, evidenciando-se Crianças com Necessidades Especiais de Saúde (CRIANES). Estas demandam cuidados diferenciados, que variam entre reabilitação psicomotora e social, dispositivos e tecnologias, fármacos e cuidados diferenciados - para alimentar-se, higienizar-se e vestir-se. Frente a este cenário, emerge a necessidade de mudanças na atenção à saúde e, neste contexto, a Atenção Domiciliar (AD) pode ser considerada uma das respostas do sistema para atender às demandas presentes nas condições crônicas. Objetivos: Conhecer e descrever o cuidado prestado às CRIANES nos serviços paranaenses de AD e propor protocolo de fluxo de cuidado domiciliar, específico para estas crianças. Metodologia: Pesquisa quantitativa, do tipo estudo de casos múltiplos, descritiva e exploratória. A coleta de dados foi realizada por meio de aplicação de instrumento desenvolvido para a pesquisa, aos profissionais de todos os Serviços de Atenção Domiciliar (SAD) do Paraná, por telefone e correio eletrônico, no período de outubro de 2016 a janeiro de 2017. A análise dos dados foi estatística descritiva. Em um segundo momento, foi elaborado um protocolo de fluxo de cuidados específico às CRIANES na AD, orientando-se por meio da metodologia de análise da realidade Strengths, Weaknesses, Opportunities e Threats (SWOT), a partir do diagnóstico dos serviços. Resultados: O estado do Paraná tem serviços de AD credenciados em oito municípios. Dentre as crianças atendidas por esses, 25,7% delas tem paralisia cerebral e 60% são traqueostomizadas. Entre as práticas dos serviços observou-se que 25% deles utilizam projeto terapêutico, no entanto 75% comunicam-se de modo inconstante com a atenção primária. Destacou-se como pontos importantes para o cuidado às crianças na AD2: alta hospitalar programada, encaminhamento organizado para o serviço de atenção domiciliar, avaliação de elegibilidade efetiva, preparo adequado do cuidador, transporte sanitário organizado, roteiro sistematizado para admissão, projeto terapêutico singular, cuidado compartilhado com a atenção primária, acompanhamento sistematizado, orientação via telefone organizada, prontuário eletrônico e interligado, e fluxo específico na rede de urgência e emergência. As fragilidades encontradas relacionam-se principalmente à baixa utilização do projeto terapêutico e da contrarreferência à atenção primária. O método empregado permitiu avaliar criteriosamente cada ponto envolvido e assim, desenvolver um plano de ação e fluxograma que neutralize as fraquezas e ameaças e potencialize as forças e oportunidades. Conclusões: Muitas práticas de sucesso são desenvolvidas, porém isoladamente nos municípios. Dessa forma, divulgando as experiências positivas, este estudo fomenta reflexão e aprimoramento do processo de trabalho e o desenvolvimento do protocolo oferece subsídios para dar robustez ao atendimento de crianças com necessidades especiais de saúde na atenção domiciliar.

This capstone seeks to assess and support Homeboy Industries (HBI), a leader in wrap-around services for formerly gang-involved and incarcerated men and women, in their co-creation of a youth services committee and a comprehensive system of care for young people. In doing so, my strategic project consists of conducting stakeholder interviews, focus groups, and synthesizing those findings to present to the organization. The second part of the strategic project involves building and working with a team of individuals from various departments, including case management, mental health, education, job services within two separate agencies, Homeboy Industries and Learning Works Charter School Network, to create a youth services committee that can carry the work forward. In service of evaluating the progress of the strategic project, I will utilize the 4I Framework of Organizational Learning, developed by management professor, Mary Crossan, and her associates from the Ivey School of Business. The 4I Framework contains “four related (sub)processes-intuiting, interpreting, integrating, and institutionalizing-that occur over three levels: individual, group, and organization” (Crossan et al., 1999, p. 524). Ultimately, the goal is to help an already successful leader in wrap-around support services for adults, Homeboy Industries, create an “organized system of care for young people” (Torres, 2015). This goal can be achieved by maximizing its strengths, coupling them with best practices in youth development, and in creating a team that can place the needs of young people in its core mission. Creating an organized system of care, Homeboy Industries-style, can have national implications as the new secretary of education, John King, has made it a point to visit with the leaders of Homeboy Industries (August 2015, Appendix A) in search of models for empowering the youth in a non-traditional way. If clecha, or knowledge that is passed down in prison is the old way of empowering young people, as it often goes in one ear and out the other, then this capstone seeks to capture the experience of Homeboy Industries and Learning Works, the profound work of founder Father Greg Boyle and many amazing practitioners on site at HBI, and combine it with the wisdom of young people, to offer a new approach to empower youth in gangs, the ever-evolving, Homeboy Industries Way. See, the idea of clecha or street wisdom has been passed down for generations as the way that older homies “lace” (give) younger homies advice. In the research on best practices to reach gang involved youth, this clecha notion dates back to the curbside counselor of the 1930s from the seminal work of psychologist Clifford Shaw, but often times, that form of advice has not worked. This has created what Reed Larson, a pioneer in positive youth development, calls the Intentionality Paradox. According to Larson, the paradox lies in that adults want to be intentional with their advice-giving to young people because “it is easier to think about molding clay than about helping the clay mold itself.” (Larson, 2006, p. 682) Larson along with many other experts in the field of youth development are telling us, what young people have been saying for a long time, “stop telling me what to do.” They don’t care to know how much we know (about life or the struggle), they need to know (and feel) how much we actually care. Many adults care so much that they struggle to balance letting youth learn on their own, and sharing their own experiences or clecha. While we are trying to figure it out in the field of youth development and education, too many young people are dying. Every 26 seconds a young person drops out of school in the U.S. (American Graduate, 2016). Over 1 million youth per year are system-involved in “courts with juvenile jurisdiction handling delinquency cases.” (Hockenberry, 2015, p. 6) Thousands of those youth are ending up caged in juvenile halls and prison, and many are dying in our cities nationwide. We must search for new ways to engage and walk with youth in gangs. This is part of that search.

O objetivo desta pesquisa foi investigar as percepções dos cuidadores informais de pacientes de um serviço de assistência domiciliar sobre o cuidar e seu impacto, estudando aspectos positivos e negativos associados a este papel e a influência da assistência domiciliar para o seu desempenho. Participaram 50 cuidadores de pacientes inscritos no NADI Hospital das Clínicas da FMUSP, que responderam uma entrevista semi-dirigida e a Caregiver Burden Scale. Os cuidadores referem aspectos positivos dos cuidados, associados ao aprendizado e ao ganho narcísico, bem como aspectos negativos, como a perda de liberdade. Conclui-se que cuidar traz perdas e ganhos ao cuidador, relacionados ao seu envolvimento com a atividade e que as orientações da equipe são importantes para o sentimento de segurança do mesmo<br>The objective of this research was to investigate the perception of informal caregivers of patients attended by a home care program, about the care and its impact, studying positive and negative aspects associated with this role and the influence of home care and its development. Fifty caregivers of patients registered at NADI Hospital das Clínicas of FMUSP, participated in the study, answering the questions of a semi-structured interview and the Caregiver Burden Scale. Caregivers refer to positive aspects of caring related to learning and narcisistic gains, as well as to negative ones, such as the loss of freedom. It includes that caring brings losses and gains to the caregiver which are related to his involvment with the activity and that the staff´s orientation is very important for their feeling of security

The growing accessibility of quantum mechanics and chaos theory over the past eighty years has opened a new mode of world-creating for dramatists. An increasingly large collection of plays organize their fictional worlds around such scientific concepts as quantum uncertainty and chaotic determinism. This trend is especially noticeable within dramatic texts that emphasize a fictional, not material or metafictional, engagement. These plays construct fictional worlds that reflect the increasingly strange actual world. The dominant theoretical approaches to fictional worlds unfairly treat these plays as primarily metafictional texts, when these texts construct fictional experiences to speculate about everyday ramifications of living in a post-quantum mechanics world. This thesis argues that these texts are best understood as examples of speculative fiction drama, and they speculate about the changes to our understanding of reality implied by contemporary scientific discoveries. Looking at three plays as exemplary case studies—John Mighton’s Possible Worlds (1990), Tom Stoppard’s Arcadia (1993), and Tony Kushner’s Homebody/Kabul (2001)—this thesis demonstrates that speculative fiction theories can be adapted into fictional worlds analysis, allowing us to analyze these plays as fiction-making texts that offer nonclassical aesthetic experiences. In doing so, this thesis contributes to speculative fiction studies, fictional worlds studies, and the dynamic interdisciplinary dialogue between aesthetic and scientific discourses.

Este estudo de inspiração genealógica, inserido na vertente pós-estruturalista, objetivou problematizar o acontecimento da atenção domiciliar, para conhecer os saberes e as condições de possibilidade que sustentam sua rede discursiva. O material empírico foi constituído por documentos legais como: políticas públicas, decretos, portarias, resoluções que se referiram a atenção domiciliar em saúde, publicados no Diário Oficial da União, desde o início do século XX. A primeira etapa para organização do material se constituiu na busca de documentos que se referiam à atenção domiciliar no sitio Jus Brasil, sendo encontradas 1059 páginas que mencionavam atenção domiciliar. A leitura do material selecionado buscava identificar a relação dos documentos com o tema e foi organizada em pastas identificadas pelo ano de publicação. Na segunda etapa, após leitura aprofundada, os excertos que teriam poder de fazer circular determinadas verdades foram organizados em planilha eletrônica, com informações sobre a referência do documento, quem falava e os procedimentos de limitação. A terceira etapa consistiu na leitura da planilha para identificação das relações de poder e saber. Na quarta etapa, as unidades analíticas foram construídas, sendo utilizadas para a análise documental algumas ferramentas propostas por Michel Foucault, como forma de martelar o pensamento, tais como: poder, governamento, biopolítica, saber, discurso, norma e dispositivo. Foram organizadas quatro unidades analíticas: Vigilância no domicílio: tecnologia disciplinar; Serviço médico domiciliar e a população operária: nascimento da biopolítica; Saúde para todos: tecnologia regulamentadora da vida e Melhor em Casa: dispositivo de segurança. A primeira unidade trata da vigilância do doente no domicílio. Tendo em vista a incidência da tuberculose, foi organizado um serviço de enfermeiras visitadoras que produziam saberes registrados em relatórios acerca das pessoas e suas doenças naquele período. A segunda unidade foi organizada acerca do Serviço de Assistência Médico Domiciliar, que teve como condições de possibilidade a mobilização dos operários e a organização dos sindicatos a partir da segunda década do século XX. Tal medida, a partir da medicalização do corpo do operário, se constituiu em uma estratégia de controle do absenteísmo. A terceira unidade aborda o Sistema Único de Saúde como estratégia da biopolítica, que teve como condições de possibilidade as lutas contra um modelo de saúde centrado no hospital, na tecnologia, e era excludente, já que incluía apenas os contribuintes da previdência social. Tal sistema público e democrático previa a participação de todos, em oposição ao sistema anterior que contemplava apenas os trabalhadores. A atenção domiciliar como dispositivo de segurança, a partir dos anos 2000, teve como condições de possibilidade o aumento das doenças crônico-degenerativas e a “crise” no hospital, que pretende liberar leitos para a alta tecnologia, prestando atendimento ao paciente com condições crônicas e incuráveis no domicílio, apontando a casa como lugar mais seguro e melhor para o paciente que fica próximo da família e longe do risco de infecção hospitalar. Ao longo deste estudo genealógico, apresento as descontinuidades e diferentes configurações que a atenção domiciliar apresentou no Brasil, apontando que a prioridade destas políticas não foram as pessoas, mas a Economia.<br>This study of genealogical inspiration, inserted in the poststructuralist area of knowledge, aimed to problematize the event of home care to know the knowledge and the conditions of possibility that support its discursive network. The empirical material was constituted by legal documents, such as: public policies, decrees, ordinances, dictums that refer to the home care in health, which were published in the Diário Oficial da União, since the beginning of century XX. The first step to the organization of material was constituted on searching documents that referred themselves to home care in the Jus Brasil place, which enabled the finding of 1059 pages that mentioned home care. The material selected through reading, which focused on identifying the relation from the document with the issue, was organized in folders identified by the year of publication. In the second step, with a deep reading, excerpts that would have power to make circulating determined truths were organized in electronic charts, which had information about reference from the document, the excerpt, who was talking about, and procedures of limiting. The third step constituted on the reading of the chart to the identification of power and knowledge relations. In the fourth step, the analytical unities were being construed, and for the documental analysis was used some tools from Michel Foucault, as a way to hammer the thought, such as: power, governmentality, biopolitics, knowledge, discourse, norm, and dispositive. Four analytical unities were formed: surveillance at home: disciplinary technology; Home Medical Assistance and the worker population: birth of biopolitics; health for everybody: a statutory technology of life and The Best at Home: security dispositive. The first unity is about the oversight of the sick at home. Having the focus on tuberculosis, it was organized a services of nurses who were visitors, and that produced knowledge recorded about people and their diseases in that period. The second one was organized about the Home Medical Assistance, which had as conditions of possibility the mobilization of workers and the organization of syndicates from the century XX. This step, through the medicalization of the worker body, constituted in a control strategy of absenteeism. The third one approaches the Unique Health System as a strategy of biopolitic, which had as conditions of possibility to fight against a model of health centralized on hospital, on technology, and it was exclusionary, since it included just the contributors of welfare. This public and democratic system wanted the participation of everybody, which was opposite to the previous system, which attained just the workers. The home care as a security dispositif, after 2000, had as conditions of possibility the chronic-degenerative diseases, due to the increase of life expectancy; the “crisis” in the hospital, which aims to release beds to the high technology, assisting the patient with chronic and incurable conditions at home. Therefore, the discourse constitutes house as the safer place, and the best for the patient, who stays in their home, close to the family, far away from the risk of hospital infection. During the performance of this genealogical study, I present the discontinuities and different configurations that home care presented in Brazil, which states that the priority of these polices weren’t people, but the economy.<br>Este estudio de inspiración genealógica, inserido en la vertiente pos-estructuralista, objetivó problematizar el acontecimiento de la atención domiciliaria, para conocer los saberes y las condiciones de posibilidad que sustentan su red discursiva. El material empírico fue constituido por documentos legales como: políticas públicas, decretos, portarías, resoluciones, que refirieran a la atención domiciliaria en salud, publicados en el Diário Oficial da União, desde el inicio del siglo XX. La primera etapa para la organización del material se constituyó en la busca realizada en mayo de 2013, siendo encontradas 1059 páginas que mencionaban atención domiciliaria en el sitio Jus Brasil, siendo encontradas 1059 páginas que mencionaban la atención domiciliaria. El material seleccionado a partir de la lectura, que buscaba identificar la relación del documento con el tema, fue organizado en pastas identificadas por el año de publicación. En la segunda etapa, con lectura profundada, extractos que habían de tener poder para hacer circular determinadas verdades fueron organizados en planilla electrónica, con informaciones sobre la referencia del documento, extracto, quién hablaba, y procedimientos de limitación. La tercera etapa consistió en la lectura de la planilla para identificación de las relaciones de poder y saber. En la cuarta etapa, las unidades analíticas fueron siendo construidas, y para el análisis documental se utilizó algunas herramientas de Michel Foucault, como forma de martillar el pensamiento, como: poder, gobernamiento, biopolítica, saber, discurso, norma y dispositivo. Fueron formadas cuatro unidades analíticas: vigilancia del enfermo en domicilio: tecnología disciplinar; Asistencia medico domiciliaria y la población operaria: el nacimiento de la biopolitica; salud para todos: una tecnología reguladora de la vida; Mejor en Casa: dispositivo de seguranza. La primera unidad trata de la vigilancia del enfermo en el domicilio. Teniendo en vista la incidencia de la tuberculosis, fue organizado un servicio de enfermerías visitadoras que producían saberes registrados en informes acerca de las personas y sus molestias en aquel periodo. La segunda, acerca del Servicio de Asistencia Medico-Domiciliaria, que tuve como condiciones de posibilidad las movilizaciones de los operarios y la organización de los sindicatos a partir de la segunda década del siglo XX. Tal medida, a partir de la medicalización del cuerpo del operario, se constituyó en una estrategia de controle del absentismo. La tercera aborda la visita domiciliaria en el Sistema Único de Salud, como estrategia de la biopolitica, que tuve como condiciones de posibilidad las peleas contra un modelo oneroso de salud, centrado en el hospital e en la tecnología; las peleas contra un modelo de salud excluyente que incluía a penas los contribuyentes de la previdencia social; los ideales de un sistema público de salud, democrático, con participación de todos, en oposición al que la dictadura militar había proporcionado. La atención domiciliaria como dispositivo de seguridad, a partir de los años 2000, tuve como condiciones de posibilidad las molestias crónico-degenerativas debido al aumento de la expectativa de vida; la “crisis” en el hospital, que pretende liberar camas para la alta tecnología, prestando atendimiento al paciente en casa como lugar más seguro y mejor para el paciente, que quedase en su casa, próximo de la familia, lejos del risco de infección hospitalaria. Al pasar de este estudio genealógico, presento las discontinuidades y distintas configuraciones que la atención domiciliaria presentó en Brasil, apuntando que la prioridad de estas políticas no fueran las personas, pero la Economía.

碩士<br>國立彰化師範大學<br>特殊教育學系<br>86<br>This study was intended to evaluate the effects of homebound educationalservice from the perspectives of homebound students'' parents homebound teachers.The self-developed Effect of Homebound Educational Service Opinion Survey was used in the study. Data were collected by surveying the 189homebound teachers and 172 homebound students'' parents from 21 counties/ cities in Taiwan. The collected data were analyzed by using frequency, percentage, Pearson product-moment correlation, independentt-test, and one-way ANOVA. The main conclusions drawn from the study areas follows:1.There are significant correspondence differences among tehachers with different official duties in the entirety, input, and process evaluation results homebound educaitonal sevice.2.Teachers'' correspondence and satisfaction of product evaluations are lower than the results of input, process, and administrative-support evaluations. It indicates that teachers are not satisfied with the effects of product of homebound educational service.3. There are significant satisfaction differences among parents of students with different age ranges in entirety, input, process and administrative-support evaluations of homebound educational service.4.Parents''correspondence and satisfaction of administrative-support evaluations are lower than the results of the input, process, and product evaluations. It indicates that parents are not satisfied with the effects of administrative-support of homebound educational service. Results are also discussed regarding the continued need to evaluateother domains for extending research advances pertaining to quality of homebound program into routine practice in administrations providing supports and resloving problems for teachers, parents, and students with severe/profound disabilities.

碩士<br>靜宜大學<br>食品營養學系<br>89<br>The purpose of this study was to compare the nutritional status between normal activity and disable elderly in Taichung County. One hundred and seventy-five subjects age over 65 years and living in home were included in this study. Demographic characteristics, activities of daily living, health status, nutritional knowledge and nutrient intakes of homebound elderly were investigated by interview method. Anthropometric, hematological and biochemical parameters were also measured. The results showed the disable elderly had higher average age and percentage living with families. The triceps skinfold valus, diastolic pressure, systolic pressure, activities of daily living, energy and carbohydrate intakes, RBC, hemoglobin, serum iron, TIBC, transferrin saturation, transferring, albumin, total protein of disable group were lower than the normal activity group. The intakes of energy, protein and carbohydrate in disable elderly were lower than Taiwanese RDNA, and this group had high ratio of anemia and protein malnutrition. However, the percentages of abnormal HDL-cholesterol value, total cholesterol/ HDL-cholesterol ratio and Waist/Hip ratio were high in both normal and disable elderly showed the homebound elderly had high risk of cardiac-vascular disease. Correlation analysis found there were significantly negative correlations between HDL-cholesterol with triceps skinfold and waist / hip ratio in normal activity elderly. Hemoglobin was positively related to triceps skinfold and negatively related to protein intake in disable elderly, and the significant positive correlations between albumin and activities of daily living in female disable elderly were also found. In summary, we conclude that the disable homebound elderly was malnutrition, the maintenance of triceps skinfold, waist / hip ratio, activities of daily living and the proper nutrient intakes may be the important factors to the nutritional status of homebound elderly.

碩士<br>國立臺北教育大學<br>特殊教育學系碩士班<br>97<br>The purpose of this study was to probe into the service quality of Homebound Teachers, and to develop “The questionnaire of Service Quality for the Homebound Teachers” according to PZB mode, then proceeding empirical study, investing the opinions of the Homebound Teachers about Itinerant service quality. In order to acknowledge the gap states of teacher service quality, and proposing suggestions for reference. Through documents researched for collecting the realty contents of Service Quality for the Homebound Teachers, and developing questionnaire by the major dimensions of PZB service mode and procedure of Servqual, and censored by specialist, pre-tests, refined questions, to get the formal questionnaire, conducting the questionnaire survey, collecting the opinions of national Homebound Teachers about itinerant service quality. Though descriptive statistical, t-test, ANOVA, and the analysis method to analyze data. The major conclusions of this research are: 1. The expectations about the itinerant service quality of Homebound Teachers are high, especially in Reliability and Assurance. 2. There is no difference in expectation about service quality of the different backgrounds Homebound Teachers. 3. The actual appraises about the itinerant service quality of Homebound Teachers are positive, especially in Reliability and Assurance. 4. The itinerant service quality of the Homebound Teachers on actual appraises will differ by the sex, the age, the seniority, the educational background, and the school scale. 5. There is a gap in the itinerant service quality of the Homebound Teachers, especially in Resource. 6. The sense of the gap on itinerant service quality of the Homebound Teachers will differ by the sex, the age, the educational background, and the school scale.

There is a growing phenomenon in a sector of the United States population where senior citizens and disabled persons that are deemed as homebound are becoming increasingly dependent on their caregivers and as a result, they are experiencing an evolving disconnection from their occupational identity. The problem being considered is that as older adults become homebound, they begin to receive support services for assistance with self-care and home management. From this, the experience of the homebound consumer reducing engagement in necessary tasks in the home causes a decline in functional abilities which then reduces engagement in portions of the functional tasks that they may still possess the skills to participate in safely. To address this issue, research has explored how function and restorative based training for caregivers can improve quality of life, health, and function, as well as reduce health care costs. The Home Able program is a caregiver training program designed to promote occupational engagement for persons living in the community in private residences. This program has been developed as an evidence-based health promotion program designed to increase physical and mental health of persons that are homebound. The format of the program will include individual and group format training for state funded caregivers on the positive health impact of occupational engagement. Then, homebound consumers who are participants in the Home Able program will receive a series of six weekly in-home sessions focusing on identification of barriers that are impeding participation in meaningful functional activities in the home and education on compensatory strategies that can be implemented for the homebound consumer to achieve participation in meaningful occupations. A research project has also been developed to coincide with program implementation to determine how participation in the Home Able Program will impact fear of falling, depression and self-perceived quality of life. The design of the study with compare the homebound consumer’s fear of falling, depression and self-perceived quality of life using standardized measurement tools prior to program participation, and after completion of the Home Able program. The results of this research project will help substantiate the positive health impact on functional mobility, mental health and enrollment in the Home Able program to help foster buy-in from local and national stakeholders.

碩士<br>中華大學<br>資訊管理學系<br>105<br>This research is to realize the need for homebound bus in Chung Hua University. We use a two-steps questionnaire analysis to analye of the shuttle bus schedule. A web questionnaire is utilized for all the students to find out the appropriate time and transfer station. The second step is paper questionnaire for Freshman and Sophomore who need shuttle bus to return home. The senior grades students who already familiar with the transportation and have more flexible time returning home. In this research, the needs for homebound bus are analysized and summarized as follows. 1. The top three returning home weekday student number statistics are Friday 664，the day before hiday 267 and everyweek 122。 2. The top three returning home trasfer station for student number statistics are: Freeway Schedule Bus Service 384，Hsinchu City shuttle bus 373 and Taiwan railway 337。 1. The top three returning home trasfer station for student number statistics are:XiangShan transfer station 629，Hsinchu railway station(Hsinchu transfer station) 338，and Hsinchu high spped rail station 66。 2. The top three returning home time slot for student number statistics are，15:00~16:00 144，16:00~17:00 168 and 17:00~18:00 213。 The second questionnaire analysis found out Taoyuan-Chung Li line (every Friday and theday before holiday), I-Lan line, Changhua line, High Speed Rail Hsinchu line and Hsinchu railway line. Trial operation ran for three weeks to Hsinchu railway station and one week to Hsinchu high spped rail station. We will perform another trial operation for Taoyuan-Chung Li line, I-Lan line and Changhua line is the next semester.

碩士<br>嘉南藥理科技大學<br>營養與保健科技研究所<br>96<br>The purpose of this study was to assess comprehensively the nutrition status of elderly individuals in homebound and to compare it with institutionalized elderly in Chiayi area. A total of 231 elderly persons (homebound 84, institutionalized 147), 65 years old and older were included in the study, their nutritional status was assessed by anthropometric measurements, mini nutritional assessment (MNA) and dietary food intake for a 3-day period, dietary intake was analyzed by food composition software. Energy, macro and micronutrient intakes were compared with dietary reference intakes (DRIs) as appropriate. Total and male elderly in the homebound had significantly higher height, weight and calf circumference (CC) values than those institutionalized elderly, and the female elderly in homebound also had higher CC value than with institutionalized female elderly (p<0.05). The prevalence of underweight in institutionalized elderly and both genders was greater than those in homebound. On the other hand, the prevalence of obesity of total and female elderly in homebound was higher than those institutionalized elderly. Malnutrition proportion were higher in institutionalized elderly and both genders than those homebound elderly. Mean intakes of carbohydrate and micronutrient vitamin E, vitamin B6, calcium and magnesium were lower than DRIs for whole participants. Farther, inadequate intake with energy, vitamin B2, phosphorous and iron was noted in institutionalized elderly. Total homebound elderly had higher energy, macro and micro nutrient intakes than with institutionalized elderly, except for vitamin E and vitamin B1. Furthermore, excess sodium consumption was noted in both groups, the institutionalized elderly take more sodium than in homebound elderly. Higher energy, macronutrient and mineral intakes were observed in homebound male elderly than in institutionalized male elderly except for vitamin A, vitamin E, vitamin B1 or vitamin C. There were no significant differences or lower energy and nutrient intakes for females between both groups, except for fiber, vitamin B6 , vitamin C and mineral which were significantly higher in homebound female elderly. The homebound elderly and both genders had higher ADL and IADL values and lower GDS value than those institutionalized elderly. In summary, the results of the present study showed the proportion of malnutrition or at risk malnutrition was 4.7-17.7% or 35.7-51.7 % detected by the MNA in Chiayi area, it was also found that elder people living in institutionalized have more risk for malnutrition, these individuals are more likely to have a decrease energy, carbohydrate and micronutrient intakes. It is recommended that to increased energy, cereal and cereal products, milk and milk products intakes for both homebound and institutionalized elderly in Chiayi area.

碩士<br>中原大學<br>特殊教育研究所<br>105<br>The purpose of this study is to investigate the working stress and coping strategies for homebound itinerant teachers in Taiwan. This study also examined the relationship between homebound itinerant teachers background and their job stresses and coping strategies. Furthermore, in the present paper we investigated the relationship between the ways of coping with job stresses and the various stress levels. Survey research was conducted in this study. We took a data that was included 142 homebound itinerant teachers in Taiwan. Data were collected by questionnaires of job stresses and coping strategies for homebound itinerant teacher, in which 127 available to be analyzed by descriptive statistics, t-test, one-way ANOVA and regression analysis. The major findings were as follows: 1.The homebound itinerant teachers job stress and coping strategies was belonged to medium level. 2.In terms of the personal background variables, part of the working stress on the homebound itinerant teachers has significant differences in “gender”, “age”, and “teaching years”. 3.In terms of the personal background variables, part of the coping strategies on the homebound itinerant teachers has significant differences in “age”, and “teaching years”. 4.High working stress group significantly higher than the low working pressure group stress at frequency of use of coping strategies. homebound itinerant teachers job stress was significant positive correlation to coping strategies. Finally, related suggestions for further studies were provided for educational authorities, schools, homebound itinerant teachers and general affairs directors.

碩士<br>立德大學<br>資訊傳播研究所<br>97<br>Home visit, parent-teacher discussion, class papers, phone communication and homebooks are the common ways for the communication between parents and teachers. Primarily, phone communication and homebooks are frequently used in the elementary schools. Homebooks, like the class diaries, are read by students, parents and teachers every day. As a result, homebooks not only play a major role for parent-teacher communication but also a tool for parenthood relation improvement as well as student counseling. With the society changes, the technology development, and the Open Education implementation by the government, parent-teacher communication is much highlighted than before. Consequently, enhancing the uses in homebooks becomes a crucial topic nowadays. Through the widespread Internet, e-homebooks are extensively applied in the different fields and they are expected to bring an effective and convenient way of communicating between teachers and parents. The research designed a simple and user-friendly e-homebook which based on Web interface. Through the Internet and SMS, the e-homebooks improve the traditional homebook difficulty that teachers cannot communicate with parents immediately. Applying the e-homebooks to communicate between parents and teachers is of instantaneity and convenience. Accordingly, e-homebooks are expected to build a preferable communication between parents and teachers in the complicated society nowadays.

碩士<br>國立彰化師範大學<br>特殊教育學系所<br>97<br>The purpose of this study is to investigate the family-needs about homebound educational service in junior high school. There were seventy parents, from six counties in central Taiwan area , participated in this study. The questionnaire of the Family-needs about homebound educational service in junior high school in central Taiwan area was used to investigate and data were analyzed through descriptive statistics , t-test and one-way ANOVA. The major findings of this research are as follows: A. The needs of economic support：the degree of the assistance about subsidization, transportation service and social insurance is high. B. The needs of special education：regular service from homebound education. C. The needs of related professional services：the assistance of home services and transportation. D. The needs of family support services： teachers of homebound educational have to provide the assistance about counseling and parenting education. E. The differences of different background variables and family-needs are： 1. In the degree of the needs of related professional services , studying years “above six ”is higher than studying years “below six”. In the degree of the needs of family support services , studying years “below six ”is higher than studying years “above six”. 2. The variable reasons of homebound educational: in the needs of economic and the needs of family support services , the other groups are obviously higher than high level disability. 3. The variable of main care giver: there are obvious differences in the needs of economic support , and the parents group is obviously higher than other groups. 4. The variable of family monthly income: there are obvious need differences in the need of economic support , and the group of income“20,000~40,000N.T.” is obviously higher than the group of income “above 40,000N.T.”.

碩士<br>國立陽明大學<br>社區護理研究所<br>88<br>The purpose of this cross-sectional study which combined structured questionnaires with open-ended question interview was to analysis the hope status and its correlators of the homebound cancer patients. The behavior of unconventional medicine associated to hope status was also explored. This research was conducted in the radiation oncology centers of two teaching hospitals during the period from November 1999 to January 2000. Subjects of this study consisted of 137 homebound cancer patients. Research instruments were consisted of Nowotny Hope Scale which was translated into Chinese by Ren-Jeng Hwang and a self-designed behavior of unconventional medicine questionnaire. The mean age of homebound cancer patients was 51.9. The major religious preference of patients was Buddhism. The most common educational level of subjects was collage. Half of patients didn’t participate religious activities. The perceived of control for patients were medium, the highest subscale was ” relationship of family”; ”relationship of spouse” was the next; the lowest one was “prognosis of disease”; “ physical discomfort” was the next; “over all of disease” was the third one. Significant characteristics for patients were female, primary stage of medical diagnosis, and with the diagnosis of breast. Most of them have received radiation therapy and combined with chemotherapy and surgery therapy. The average duration of diagnosis was 26.63 months. Most of the symptom distress level of patients was belong to low and the physical functions of patients was self-maintain. The hope status of patients was medium. The order of according to their important level was as follows: “come form within”, “confidence”, “active involvement”, and “future is possible”. There were 84 patients (61.31%) who had used at least one kind of combined unconventional treatments with an average number of 2.54. The most common one was Chinese herbal medicine, diet and the food was the second. According to results of open-ended interviews, the motivation of patients who used unconventional medicine was relationship interaction within environment. Many patients can felt improvement from their physical status after using these treatments. Correlators to the hope status of cancer patients were age, religion preference, marriage status, job, perceived of control, diagnosis phase, symptom distress level and physical self-maintain status. The perceived of control, physical self-maintain status, religion preference and marriage status were significant predictors for hope status, which accounted for 57% of the variances. The hope status of patients who used unconventional medicine was lower than patients who didn’t, but spiritual belief of users were higher than non-users. Result of the worse the physical status and symptom distress level of patients, the lower the hope status was shown. By using the unconventional medicine, patients hope to relieve their distress and improve their condition by increasing the relationship interaction. After using these treatments, they felt peaceful. From the results of this study, the following suggestions are made. 1) to strength the support system for patients in order to improve their perceived of control; 2) to establish communication channel related to medical information; 3) to develop the program of case manager for making cancer patients’ continuous care; 4) to design multiple activities at outpatient centers; 5) to train and teach health professional on the topic of spiritual care; 6) to integrate cancer outpatient from other disciplines. To explore more information about cancer patients’ perceived of control and unconventional treatment was the proposed concern for future study.

碩士<br>國立彰化師範大學<br>特殊教育系所<br>104<br>This research conducts qualitative research method, aiming at the working experience and progress of itinerant teachers, their mental state and attitude encountering situations like children passing away or about to pass away, and sources of support when encountering students and children with poor health. The research objects were six in-service itinerant teachers and their experience and feelings were collected by in-depth interviews, documents, and research diary, and the conclusion was concluded as follow with references integration and analysis: Itinerant teachers’ working experiences changed from uncertainty to ask others for advices and gradually accumulate the essentials of this work. Every itinerant teacher’s experience in guiding students with poor health is different and has its unique and special experience and feelings. Moreover, itinerant teachers generally find it heartbreaking to learn that children passed away or about to pass away while thinking it might be a relief due to the serious health conditions. To cope with the work dilemma due to unique itinerary features, itinerant teachers accumulate more sufficient energy for the work via enhancing professional knowledge and ability and seeking for community resources and supports of partners, students’ parents, school staffs, other itinerant teachers, and the education administration units. Based on the research results, this research proposes suggestions targeting itinerant teachers, administration units, vestibule teacher training units, and related researches in the future, expecting itinerant teachers to gain understanding and attention in many ways and further elevate the efficacy of homeschooling.

碩士<br>輔仁大學<br>資訊管理學系<br>91<br>Traditionally, parents rely on “Homebook”or making personal phone calls to interact with teachers to know their children’s behaviors at schools. Recently, due to the internet technology, new ways of parent-teacher communication such as “Internet Homebook”, “Voice Box Homebook”, and “Mobile Internet Homebook” had been developed. However, all of them are not very popularized because of different kinds of limitations existed. For some parents with poor computer literacy or limited internet access, they cannot utilize the “Internet Homebook” as they wished. “Mobile Internet Homebook” can be accessed only through mobile internet cellular phone. “Voice Box Homebook” simply provides school announcements pre-recorded by teachers. No customized information about particular child was provided. One of the purposes of this study was to develop an “IVR/Internet Homebook” system which can be accessed either by internet or by regular phones. For parents with limited computer or internet literacy, they can just dial to school and access the database to acquire customized information about their children. Problems mentioned above are overcome in this new system. To evaluate the usability, an IVR/Internet Homebook system was deployed at Chun-yi elementary school in Taipei County, Parents’ and teachers’ suggestions of the system were collected through a paper-pencil type of questionnaire developed by the researcher. The results of the study indicated that both teachers and parents had positive attitudes toward the using of the IVR/Internet Homebook system. Inteface of the system was user friendly and the learning time was short. Parents were satisfied with the clear announcements provided by the teachers using the new system. Actually, both parents and teachers agreed with that the IVR/Internet Homebook system is an effective communication tool between the two parties.

碩士<br>國立臺灣師範大學<br>特殊教育學系在職進修碩士班<br>96<br>The purpose of this study  was  to investigate the needs of itinerant teachers for homebound education of health impairment students in Taiwan. Descriptive statistics, t-test, and one-way ANOVA, and certain other statistical methods are employed to process and analyze the data collected through questionnaire, which was targeted at the teachers providing the services for homebound education and from which 169 valid responses were recovered. Conclusions drawn from the analysis are listed below: 1. There are certain needs for itinerant teachers. Among various needs, administrative support is most needed, which followed with professional development and instruction counseling. 2. Among three dimension, the dimension of administrative supports , the need of “consideration of safety of female teachers” is the highest. In the dimension of professional development, the need for “added basic medical knowledge” is the highest. In the dimension of “instruction guidance” the highest one is “the needs of looking after the health condition of students”. 3. Among the 41 questions for itinerant teachers, the top 5 needs are “consideration of safety of female teachers”, “reducing scope of guidance for reducing time spend”, “government paid casualty insurance”, “specific stipulation for protecting the interests of itinerant teacher” and “students shall be provided by the registered school with textbooks and instruction CD and other learning resources”.4. Because there are many variants such as genders, educational pursuit, teaching experience, and geographic location, every individual itinerant teacher has different degree of needs. Male itinerant teachers, who are in poor health condition, need more support on instruction guidance then female itinerant teachers. Itinerant teachers majored in special education have higher needs from administrative supports than those having only 30 credits (incl. 20 and 40 credits) in special education. In addition, dedicated itinerant teachers require more instruction guidance than substitute itinerant teacher. Itinerant teachers in service for one to three years have higher needs for instruction guidance than younger and less-experienced teacher. Geographically, Eastern Taiwan has higher need in instruction guidance than Northern regions, Northern Taiwan has higher need than Central areas, Southern Taiwan has higher need than Central zone, Eastern Taiwan has higher need than Central area. The need for administrative support of itinerant teachers in Central Taiwan is higher than those in Northern Taiwan. Based on the results and the restriction identified in this research, suggestions are provided for the reference in administration decision, practices and future research. Keywords: health impairment, homebound education, teacher needs,itinerant teachers

碩士<br>國立嘉義大學<br>輔導與諮商學系研究所<br>99<br>The purpose of this study was to explore the conditions of family stress , coping, and family quality of life for parents with homebound children. Also, it analyzed the dissimilarities in family quality of life with different backgrounds. Furthermore, this research found out the relations among family stress , coping, and family quality of life for parents with homebound children. The data obtained were statistically analyzed by descriptive statistics, t-test, one-way ANOVA, Pearson’s product-moment correlation, and multiple stepwise regression. The major findings of this study were as follows: 1. Parents with homebound children feel most stressed in “education and upbringing”. The family quality of life has the lowest scores in the domains of “material well-being” and “support for disabilities”. 2. There are discrepancies among the family quality of life with different backgrounds. 3. There is negative correlation between the family stress and family quality of life for parents with homebound children. Among them, the stress of “marriage relationship” has higher correlation with the family quality and every domain. 4. There is positive correlation between the patterns of coping strategies and the family quality of life. Among them, “the problem-oriented coping” has the highest correlation with the family quality of life. 5. The family quality of life for the parents with homebound children can be predicted by the family stress of “marriage relationship” ,stress of “community/social participation”, “problem-oriented coping” and “coping by dealing with emotions ”. The total percentage of explained variance is 44.9%. Based on the research results and conclusions, the practical suggestions were provided for families with children with disabilities or diseases, related people and the further academic research.