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151.
Joseph L Verheijde Mohamed Y Rady Joan McGregor 《Philosophy, ethics, and humanities in medicine : PEHM》2009,4(1):15-8
Organ donation after cessation of circulation and respiration, both controlled and uncontrolled, has been proposed by the
Institute of Medicine as a way to increase opportunities for organ procurement. Despite claims to the contrary, both forms
of controlled and uncontrolled donation after cardiac death raise significant ethical and legal issues. Identified causes
for concern include absence of agreement on criteria for the declaration of death, nonexistence of universal guidelines for
duration before stopping resuscitation efforts and techniques, and assumption of presumed intent to donate for the purpose
of initiating temporary organ-preservation interventions when no expressed consent to donate is present. From a legal point
of view, not having scientifically valid criteria of cessation of circulation and respiration for declaring death could lead
to a conclusion that organ procurement itself is the proximate cause of death. Although the revised Uniform Anatomical Gift
Act of 2006 provides broad immunity to those involved in organ-procurement activities, courts have yet to provide an opinion
on whether persons can be held liable for injuries arising from the determination of death itself. Preserving organs in uncontrolled
donation after cardiac death requires the administration of life-support systems such as extracorporeal membrane oxygenation.
These life-support systems can lead to return of signs of life that, in turn, have to be deliberately suppressed by the administration
of pharmacological agents. Finally, allowing temporary organ-preservation interventions without expressed consent is inherently
a violation of the principle of respect for a person's autonomy. Proponents of organ donation from uncontrolled donation after
cardiac death, on the other hand, claim that these nonconsensual interventions enhance respect for autonomy by allowing people,
through surrogate decision making, to execute their right to donate organs. However, the lack of transparency and the absence
of protection of individual autonomy, for the sake of maximizing procurement opportunities, have placed the current organ-donation
system of opting-in in great jeopardy. Equally as important, current policies enabling and enhancing organ procurement practices,
pose challenges to the constitutional rights of individuals in a pluralistic society as these policies are founded on flawed
medical standards for declaring death. 相似文献
152.
Ethicists and others who study and teach the social implications of science and technology are faced with a formidable challenge
when they seek to address “emerging technologies.” The topic is incredibly important, but difficult to grasp because not only
are the precise issues often unclear, what the technology will ultimately look like can be difficult to discern. This paper
argues that one particularly useful way to overcome these difficulties is to engage with their natural science and engineering
colleagues in laboratories. Through discussions and interactions with these colleagues ethicists can simultaneously achieve
three important objectives. First they can get a great deal of assistance in their research into the social implications of
future technologies by talking with people that are actively creating those futures. Second their presence in the lab and
the discussions that result can be a very powerful method for educating not only students, but faculty about the ramifications
of their work. And third, because the education is directly linked to the students’ everyday work it is likely that it will
not just be a theoretical exercise, but have direct impact on their practice.
相似文献
Jameson M. Wetmore (Corresponding author)Email: |
153.
154.
Susan Randall Armel Jeanna McCuaig Amy Finch Rochelle Demsky Tony Panzarella Joan Murphy Barry Rosen 《Journal of genetic counseling》2009,18(4):366-378
The number of individuals receiving genetic counseling for hereditary breast and ovarian cancer syndrome has steadily risen.
To triage patients for genetic counseling and to help reduce the amount of time needed by a genetic counselor in direct patient
contact, many clinics have implemented the use of family history questionnaires. Although such questionnaires are widely used,
scant literature exists evaluating their effectiveness. This article explores the extent to which family history questionnaires
are being used in Ontario and addresses the utility of such questionnaires in one familial cancer clinic. By comparing the
pedigrees created from questionnaires to those updated during genetic counseling, the accuracy and effectiveness of the questionnaires
was explored. Of 121 families recruited into the study, 12% acquired changes to their pedigree that led to a revised probability
estimate for having a BRCA1 or BRCA2 mutation and 5% acquired changes that altered their eligibility for genetic testing.
No statistically significant difference existed between the eligibility for genetic testing prior to and post counseling.
This suggests that family history questionnaires can be effective at obtaining a family history and accurately assessing eligibility
for genetic testing. Based on the variables that were significantly associated with a change in probability estimate, we further
present recommendations for improving the clarity of such questionnaires and therefore the ease of use by patients. 相似文献
155.
Martin P Baenziger J Macdonald M Siegler IC Poon LW 《Journal of Adult Development》2009,16(4):199-208
This study assessed engaged lifestyle activities (e.g., volunteering, traveling, and public speaking) for centenarians of
the Georgia Centenarian Study. A total of 285 centenarians and near-centenarians (i.e., 98 years and older) and their proxy
informants participated in this study. The Mini-Mental Status Examination (MMSE) was assessed for all centenarians, and proxy
informants reported on lifestyle activities and personality traits of the centenarians. Results suggested that participants
who had volunteered, traveled, and those who had given public talks and balanced their checkbooks were more likely to show
relatively high mental status scores (i.e., MMSE > 17). Personality traits were found to be moderators in the relationship
between engaged lifestyle and mental status: Participants with high levels of Emotional Stability, Extraversion, Openness,
and Conscientiousness and with high levels of engaged lifestyle were more likely to show relatively high mental status scores
(i.e., MMSE > 17), whereas participants with low levels of Emotional Stability, Extraversion, Openness, Agreeableness, and
Conscientiousness and with low levels of engaged lifestyle were more likely to show relatively low mental status scores (i.e.,
MMSE < 18). The results suggest that engaged lifestyle, particularly in combination with personality traits, plays an important
role in the level of cognitive functioning among oldest old adults. 相似文献
156.
Joseph L Verheijde Mohamed Y Rady Joan L McGregor 《Philosophy, ethics, and humanities in medicine : PEHM》2007,2(1):19
Advance health care directives and informed consent remain the cornerstones of patients' right to self-determination regarding
medical care and preferences at the end-of-life. However, the effectiveness and clinical applicability of advance health care
directives to decision-making on the use of life support systems at the end-of-life is questionable. The Uniform Anatomical
Gift Act (UAGA) has been revised in 2006 to permit the use of life support systems at or near death for the purpose of maximizing
procurement opportunities of organs medically suitable for transplantation. Some states have enacted the Revised UAGA (2006)
and a few of those have included amendments while attempting to preserve the uniformity of the revised Act. Other states have
introduced the Revised UAGA (2006) for legislation and remaining states are likely to follow soon. 相似文献
157.
Joan López-Moliner Eli Brenner Jeroen B. J. Smeets 《Attention, perception & psychophysics》2007,69(6):887-894
In the present study, we examined whether it is easier to judge when an object will pass one’s head if the object’s surface is textured. There are three reasons to suspect that this might be so: First, the additional (local) optic flow may help one judge the rate of expansion and the angular velocity more reliably. Second, local deformations related to the change in angle between the object and the observer could help track the object’s position along its path. Third, more reliable judgments of the object’s shape could help separate global expansion caused by changes in distance from expansion due to changes in the angle between the object and the observer. We can distinguish among these three reasons by comparing performance for textured and uniform spheres and disks. Moving objects were displayed for 0.5–0.7 sec. Subjects had to decide whether the object would pass them before or after a beep that was presented 1 sec after the object started moving. Subjects were not more precise with textured objects. When the disk rotated in order to compensate for the orientation-related contraction that its image would otherwise undergo during its motion, it appeared to arrive later, despite the fact that this strategy increases the global rate of expansion. We argue that this is because the expected deformation of the object’s image during its motion is considered when time to passage is judged. Therefore, the most important role for texture in everyday judgments of time to passage is probably that it helps one judge the object’s shape and thereby estimate how its image will deform as it moves. 相似文献
158.
Joan Rosenbaum Asarnow Martha Tompson Stephanie Woo Dennis P. Cantwell 《Journal of abnormal child psychology》2001,29(6):573-583
Five Minute Speech Sample Expressed Emotion (FMSS-EE) was examined in families of youth with depressive disorders, nondepressed youth with attention deficit/hyperactivity disorder (ADHD), and community controls screened for the absence of depression and ADHD. Consistent with the hypothesis that FMSS-EE shows some specificity as a risk factor for depression, rates of critical EE were significantly higher among mothers of youth with depression as compared to mothers of nondepressed youth with ADHD, or mothers of controls. When both mothers' and fathers' scores were used to generate family EE ratings, rates of overall EE and critical EE were significantly higher for the depressed group than the control group, but the nondepressed ADHD group did not differ significantly from the other groups. Results support the hypothesis that critical EE in mothers shows some specificity as a risk factor or correlate of depression in youth. 相似文献
159.
This three-sample study focused on changes in four key features of women's personalities (identity, generativity, confident power, and concern about aging) over the course of middle age. Based on women's retrospective and concurrent feelings about their lives in their 30s, 40s, and 50s, scales were developed and validated for the four themes. We found that identity certainty, generativity, confident power, and concern about aging all were experienced as more prominent in middle age (the 40s) than in early adulthood (the 30s). We also found that these elements of personality were rated even higher in the 50s than the 40s. Scores seemed to be a function of age more than historical period or particular experiences in social roles. Scores on identity certainty, generativity, and confident power were positively related to well-being, while concern about aging was negatively related to well-being. 相似文献
160.
Joan C. Chrisler 《Sex roles》2008,58(3-4):287-289