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51.
宋代共设有三等閤职,最初供职于閤门,后閤职官员出外任职情况变得普遍,直接推动了外任武官兼带閤职制度的发展,此后閤职作为武官兼带的一种职名,成为奖励军功以及控制武官的一种有效手段。而閤职制度的发展也使閤职作为武臣清选的地位逐渐确立,表现之一就是在磨勘叙迁上较一般武官而言具有一定的优越性。同时,内外不同的閤职在磨勘制度上也有一定的差异,这些差异的产生也加深了閤职作为武臣清选的内涵。  相似文献   
52.
当前我国医院间存在严重的"信息孤岛",医院参与医疗信息共享意愿不高,患者的诊疗信息被静态碎片化储存而无法充分有效地利用。考虑到医院进行医疗信息共享将降低患者转移成本,本文构建一个多阶段双寡头动态博弈模型研究医疗信息共享对医院竞争过程中患者转移数量和服务质量水平决策的影响。首先,根据是否存在转移成本,将患者分为新患者和经验性患者,借助Hotelling模型刻画患者的效用函数,分析患者就诊决策。然后,在政府价格规制和不考虑医院利他性情景下,构建了医院累积期望收益目标函数,使用动态规划方法,求解实现医院累积期望收益最大化的服务质量水平,获得了实现患者相互转移且医院在市场中共存的马尔可夫完美均衡。最后,根据医院参与医疗信息共享后患者转移成本降为零,分析与比较信息共享前后患者转移数量和服务质量水平变化。研究发现:在不同医院间本身存在患者转移背景下,医院参与信息共享后,患者转移数量增加但存在一个上限,增加的转移量与患者在医院间的转移成本呈正相关,与初始感知效用的差值范围呈负相关;医院参与信息共享后,均衡状态下的医院服务质量水平高于信息共享前的服务质量水平。因此,在不改变当前医保支付方式下,要加快推进医疗信息共享,政府部门可以根据医院的患者数量和服务质量水平变化对其进行定期补贴,以激励医院积极参与医疗信息共享,本文给出了这个补贴的量化表达。  相似文献   
53.
山东地方官对大刀会、拳会的宽容的政策与态度由来已久,早在甲午中日战争期间,官军就与大刀会形成默契,在共同缉捕盗匪方面取得显著成效,直至义和团在中外联合势力的绞杀下失败,在此期间,大刀会、拳会等名目的民间团体组织与官府的关系就处在一种半合作半破裂的游离状态,即这种宽容政策具有一定的延续性。就义和团运动而言,大刀会等民间会社势力仅仅是为义和团运动构筑的可能性力量而已,程度很高,却极不稳定,它们有待于官方的开掘、引导与锤炼及外力催逼,即官方对刀会、拳会的宽容态度与政策,以及西方列强、教会势力的威逼现实这两种因素,而前者更为重要。  相似文献   
54.
盖恩斯在《刑前一课》里从零视点与悬念的建构、外视点与悖论的建构、内视点与意识流、多视点聚焦与立体感等方面来研究小说视点与叙事层面的相互关联。他从零视点的角度建构人称悬念、瞬间悬念和期待性悬念,从外视点的角度设置了主题悖论、言辞悖论和语境悖论。为了克服零视点和外视点描述的单调性和乏味性,盖恩斯把内视点与意识流进行了有机结合,从触景生情式意识流、内心独白式意识流和交织式意识流等方面探究人物心理与社会环境的内在关联。他还在人物评述和场景氛围等方面采用了多视点策略,从多层次和多侧面的角度来聚焦于具体的人物、物件或场景,构建了叙事层面的立体感,拓展了现代黑人小说创作的美学认知空间。  相似文献   
55.
In 2015, the United Nations (UN) issued probabilistic population projections for all countries up to 2100, by simulating future levels of total fertility and life expectancy and combining the results using a standard cohort component projection method. For the 40 countries with generalized HIV/AIDS epidemics, the mortality projections used the Spectrum/Estimation and Projection Package (EPP) model, a complex, multistate model designed for short-term projections of policy-relevant quantities for the epidemic. We propose a simpler approach that is more compatible with existing UN projection methods for other countries. Changes in life expectancy are projected probabilistically using a simple time series regression and then converted to age- and sex-specific mortality rates using model life tables designed for countries with HIV/AIDS epidemics. These are then input to the cohort component method, as for other countries. The method performed well in an out-of-sample cross-validation experiment. It gives similar short-run projections to Spectrum/EPP, while being simpler and avoiding multistate modelling.  相似文献   
56.

Problem

Research suggests that the skill and experience of the attendant significantly affect the outcomes of vaginal breech births, yet practitioner experience levels are minimal within many contemporary maternity care systems.

Background

Due to minimal experience and cultural resistance, few practitioners offer vaginal breech birth, and many practice guidelines and training programmes recommend delivery techniques requiring supine maternal position. Fewer practitioners have skills to support physiological breech birth, involving active maternal movement and choice of birthing position, including upright postures such as kneeling, standing, squatting, or on a birth stool. How professionals learn complex skills contrary to those taught in their local practice settings is unclear.

Question

How do professionals develop competence and expertise in physiological breech birth?

Methods

Nine midwives and five obstetricians with experience facilitating upright physiological breech births participated in semi-structured interviews. Data were analysed iteratively using constructivist grounded theory methods to develop an empirical theory of physiological breech skill acquisition.

Results

Among the participants in this research, the deliberate acquisition of competence in physiological breech birth included stages of affinity with physiological birth, critical awareness, intention, identity and responsibility. Expert practitioners operating across local and national boundaries guided less experienced practitioners.

Discussion

The results depict a specialist learning model which could be formalised in sympathetic training programmes, and evaluated. It may also be relevant to developing competence in other specialist/expert roles and innovative practices.

Conclusion

Deliberate development of local communities of practice may support professionals to acquire elusive breech skills in a sustainable way.  相似文献   
57.
British Columbia’s treatment as prevention policy has provided free access to highly active antiretroviral therapy (HAART) to all HIV-positive provincial residents since 1996. One outcome is an increase in HIV-positive gay and bisexual men (GBM) with suppressed viral loads. Previous cross-sectional analyses indicated that some Vancouver GBM now recognize condomless anal sex with men on HAART who report a suppressed viral load as a seroadaptive strategy. To test the hypothesis that this new strategy, termed viral load sorting (VLS), is recognized and used among by GBM in the Momentum Health Study, we analyzed longitudinal data for HIV-negative/unknown (n = 556) and HIV-positive (= 218) serostatus participants. Analyses indicated that both groups reported VLS, and that serostatus and Treatment Optimism Scale scores were significant determinants in frequency and use. Results exemplify the medicalization of sex and Rogers’ Diffusion Of Preventative Innovations Model, and they have important implications for HIV research and GBM sexual decision-making.  相似文献   
58.
This study investigates staff and family attitudes towards the use of the fences that surround many aged care facilities in Australia, in the context of indefinite detention of people with dementia. This indefinite detention has been described in a report from an Australian Senate Inquiry as “a significant problem within the aged care context”, which “is often informal, unregulated and unlawful”. Five focus groups comprising direct care workers, family members, nurse unit managers and facility managers discussed the reasons for and their attitudes towards fences. The results show a tension between the provision of physical and emotional safety. This is to say that even while it is illegal to detain people with dementia against their will, and even while participants understood the negative impact of fences on the well‐being and emotional safety of people with dementia, they accepted and supported the presence of perimeter fences because they provided the perception that fences kept people with dementia physically safe. This has implications for redressing the balance between physical and emotional safety in policy and practice.  相似文献   
59.
Hybrid organizational forms that combine commercial and welfare institutional logics play an increasingly important role in addressing the grand societal challenges we face today. Building on the literatures on hybrid organizations and social business models, we explore the characteristics of social businesses from a business model perspective. This study seeks to better understand the particularities and value drivers of hybrid social purpose in contrast to purely commercial business models. We follow a grounded theory approach and our findings are based on interview data from 17 social business firms. Building on social businesses' identified particularities, we propose four value drivers of social business models: 1) responsible efficiency, 2) impact complementarities, 3) shared values, and 4) integration novelties. We link our findings to the literature, contributing new insights into social businesses models and implications for practitioners.  相似文献   
60.
This article estimates the value of a statistical life (VSL) for Chile under the hedonic wage method while accounting for individual risk preferences. Two alternative measures of risk aversion are used. First, risk aversion is directly measured using survey measures of preferences over hypothetical gambles, and second, over observed individual behaviors that may proxy for risk preferences, such as smoking status, are used. I reconcile the results with a theoretical model of economic behavior that predicts how the wage‐risk tradeoff changes as risk aversion differs across individuals. The VSL estimates range between 0.61 and 8.68 million dollars. The results using smoking behavior as a proxy for risk attitudes are consistent with previous findings. However, directly measuring risk aversion corrects the wage‐risk tradeoff estimation bias in the opposite direction. The results are robust to other observed measures of risk aversion such as drinking behavior and stock investments. Results suggest that, consistent with the literature that connects smoking behavior with labor market outcomes, smoking status could be capturing poor health productivity effect in addition to purely risk preferences.  相似文献   
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