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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

健保部分負擔與支付標準調整政策效果分析

韓幸紋 Unknown Date (has links)
內政部於2002年實施「三歲以下兒童醫療補助計畫」。該計劃期望以減免部分負擔方式來降低就醫門檻,增加幼兒醫療利用。雖然此政策頗受好評,但在健保低部分負擔的前提下,額外減免部分負擔是否增加幼兒醫療利用,有待進一步商榷。由於北市率先於1995年針對3歲以下兒童減免部分負擔,並於1998年將對象擴及4-6歲兒童,這個補助政策的擴充,提供了一個機會瞭解減免部分負擔對幼兒醫療利用的影響。本論文使用1997至2000年健保資料庫中六歲以下兒童的西醫門診資料,分析補助政策擴充至4-6歲兒童時,該年齡組幼兒門診次數是否增加。為了控制估計的可能偏誤,本研究進一步以北縣同年齡兒童為控制組,採用「差異中的差異」(difference in difference)法進行分析。實證結果顯示減免部分負擔平均增加兒童門診次數1.6次,佔全年醫療利用7.8%,所估計的價格彈性為 -0.08。 至於支付標準調整的政策效果,我們以自然產給付調整為例進行分析。基於台灣居高不下的剖腹產率,健保局於2005年5月,將自然產支付點數加倍至和剖腹產點數一致,期望藉由增加自然產給付來降低剖腹產比率。本研究分析該給付調整是否達到其政策目的。我們利用2003~2007年健保資料庫的生產案件。估計上採用邏輯機率模型(logistic model)和固定效果模型(fixed-effect model)來分析提高自然產支付對降低剖腹產率的效果,並觀察這效果是否在長(前後兩年)、短(前後一年)期有所差異。本文並將剖腹案件依剖腹原因區分為預定剖腹及必要剖腹兩種,分別觀察自然產給付調整對預定剖腹及必要剖腹產比率之影響是否有所不同。結果發現,在控制產婦年紀、前胎剖腹產、醫師工作時間考量等因素下,提高自然產給付後,邏輯機率模型顯示,短期時不論整體或頭胎剖腹產率皆無顯著變化;相同的,在控制醫院及醫師固定效果後,固定效果模型也顯示整體剖腹產率,不論是在長短期,均無顯著下降。這結果隱含醫師所得可能不是決定生產方式的主要因素,健保局需考慮其他方法來降低剖腹產。 不僅如此,我們更進一步以誘發性需求的角度,分析自然產給付調整政策失效的原因。自然產給付調整後大幅提昇醫師所得,對於醫師接生行為是否造成影響,這個問題和文獻上所謂的「誘發性需求」息息相關。本文主要目的,在於瞭解醫療供給者所得增加後能否減少對剖腹生產的誘發需求,進而降低剖腹產率﹖我們使用1996-2007年健保資料,來檢驗誘發性需求的存在。在進行實證分析中,我們面對三個問題。第一,不同醫師可能具有不同但難以觀察的特性,這些特性可能會影響產婦的就醫院所選擇。忽略這些特性,可能造成內生性的偏誤。第二,供給者所獲得生產健保給付和其剖腹產率高低有相當明顯的關係,以同一時期的供給者所得和其剖腹產比例來分析,亦有引發內生性偏誤的可能性。第三,自然產給付調整是外生變動的價格變化,所產生的效果包含「所得效果」與「替代效果」,而替代效果不應視為誘發性需求。為了解決上述問題,我們採取下列方法。我們使用「一階差分」來控制供給者自身特性。其次,我們以前期所得作為當期所得的替代變數。最後,我們排除價格調整所產生的替代效果。由其估計結果可知,自然產給付調高使得醫師所得增加,卻未明顯使得剖腹產率下降,這個結果與理論推論並不吻合。因此,我們進一步探究其原因。結果發現,醫師在所得損失的情況下, PID效果仍屬有限。
2

從眼動控制探討中文閱讀的訊息處理歷程:應用眼動誘發呈現技術之系列研究 / The reading processing of eye movements in Chinese: Serial studies with eye movement contingent display technique.

蔡介立, Jie-Li Tsai Unknown Date (has links)
在閱讀文句的過程中,隨著文字內容的不同語言特性,眼睛凝視位置與時間也會有所不同;而使用眼動儀(eye tracker)可以精確記錄眼睛凝視的位置和停留時間,研究者可藉此瞭解閱讀歷程中不同的訊息處理機制。此外,眼動誘發呈現(eye movement contingent display)技術精確且快速的刺激呈現控制,能根據眼球凝視的位置,在特定時間與特定位置立即更換螢幕呈現的文字,如此對於閱讀歷程中訊息處理的動態運作,能夠提供更準確的掌握。實驗一以移動視窗的方式,測量中文閱讀的知覺廣度,發現眼睛每次凝視能知覺並處理的文字範圍,包括凝視點及右側四個中文字。實驗二亦採用移動視窗的方式,並操弄視窗週邊文字遮蔽的時間,發現週邊文字在凝視開始的90毫秒內即被提取;週邊文字遮蔽時間的長短不會影響凝視時間,而是影響在下個凝視點訊息整合之凝視時間。實驗三以邊界技術的方式,探討週邊文字被提取的特性,操弄預視字與目標字在字形與字音的相似或相異;結果顯示在一定的條件下,能獲得字音訊息在早期階段被提取之證據,而字形訊息在整合不同訊息的階段產生明顯的影響。實驗四則以快速促發作業的方式,探討凝視位置促發字的文字特性對目標字訊息整合的影響;結果顯示促發字呈現時間較短的情況下,字音效果只在形異的情況下產生,同樣獲得字音訊息在早期階段被提取之證據。本論文應用所發展的眼動誘發呈現技術進行一系列實驗,分別就中文閱讀的知覺廣度、凝視點對於週邊訊息之處理時序、以及週邊與凝視點位置對文字提取之特性和訊息整合機制加以探討,藉此推論中文閱讀時眼動所引發的動態文字處理歷程。 第一章 眼球運動與閱讀歷程的關係 I 第二章 閱讀的眼動控制之運作與影響因素 10 第三章 中文閱讀的眼動研究回顧 20 研究目的 30 第四章 眼動誘發呈現技術的發展 31 第五章 中文閱讀的知覺廣度與呈現改變的影響 34 實驗一 39 第六章 凝視點對週邊訊息的提取時間 45 實驗二 48 第七章 凝視點對週邊文字提取的特性 54 實驗三 55 第八章 凝視點上文字的語音提取 62 實驗四A 64 實驗四B 65 綜合討論 68 參考文獻 76 附錄一:實驗一與實驗二使用的文章材料 109 附錄二:實驗三與實驗四的句子與操弄單字 113 / In the process of reading, the location and duration of eye fixations varied accroding the language properties of the text. Using the eye tracker nowdays, it precisely records the location and fixation duration of eye movements. That gives an opportunity to understand the cognitive operations of reading. Furthermore, the eye movement contingent display technique is capable to change the display with both the speed and precision. It changes the text on the computer screen at specific location and time, according the location where the eyes are fixating. This advanced technique provides the possibility to explore the nature of dynamic processing of reading. Experiment One uses the moving window paradigm to measure the perceptual span of Chinese reading. It showed that the range of perceived characters in reading includes four characters to the right of fixations. Experiment Two also uses the moving window paradigm but the time of showing "window" is varied. It showed that the characters in peripheral were perceived within 90 msec in the beginning of fixations. The time to mask the peripheral text did not affect the fixation duration of display change, but the time of next fixation. Experiment Three uses the boundary paradigm to show the type of character information can be retrieved in peripheral and integrated with the information on the next fixation. It showed the phonological code can be retrieved in peripheral, but the orthographic code is dominated when integrating information across fixations. Experiment Four uses the fast priming paradigm to show the type of information can be retrieved on fixations. It showed the same pattern for both the third and forth experiment. The phonological effect can be obtained under certain circumstances, when the availability or validity of orthographic information is reduced. The dynamic processing of eye movements in reading and a general model for cognitive operation are discussed.
3

台灣以中文為母語的小孩的誘發過度泛化現象 / Priming overextensions in Taiwan Mandarin children

陳采君, Chen, Tsai Chun Unknown Date (has links)
本篇研究的目的是要去比較中文跟英文小孩的誘發過度泛化現象的不同之處。誘發過度泛化現象指的是小孩子因為受到之前誘發過的字的影響進而造成對物品過度泛化現象的情況而稱之。Gershkoff-Stowe et al. (2006) 認為Dell (1986) 提出的擴散激活機制 (spreading activation mechanisms) 可用來解釋小孩的三種泛化錯誤類型: 類別錯誤 (category errors) 、語用錯誤 (pragmatic errors) 跟提取錯誤 (retrieval errors),此三種泛化錯誤的基底機制應該都是同樣的。另外,他們也認為最近激活跟形狀的類似對小孩的命名應該都扮演了很重要的角色。年紀較大的小孩也應該會擁有比較成熟的心理詞彙所以會比起年紀較小的小孩比較不容易受到之前提取過的字的影響。因為中文跟英文心理詞彙的不同,我們想去檢視是否一樣的理論也可套用在中文小孩身上。實驗方法沿用了Gershkoff-Stowe et al. (2006)的相同實驗法,做了與他相同的兩個實驗。第一個實驗是熟悉物與不熟悉物的命名,兩歲小孩要做六次的試驗,然後我們是用三張圖片做為誘發圖片,然後請小孩去命名一個真實的物品。第二個實驗是虛構物品命名,我們在這個實驗裡比較兩歲小孩跟四歲小孩的不同表現。實驗過程跟實驗一是一樣的,只是實驗二是看虛構物品不是真實物品,且有八個試驗機會而不是六個。結果顯示有一個跟英文大致上類似的結果。然而我們仍有發現一些不同之處。第一,我們發現熟悉物在中文裡比起英文似乎有更強的力量。第二個則是兩個語言不同的構詞法可能會對於比較成熟的心理詞彙造成不一樣的誘發方式。 / This purpose of this study is to compare the difference of priming overextension phenomena between Mandarin Chinese children and English children. Priming overextension means that children overextend some words due to the effects of the previously primed words. Gershkoff-Stowe et al. (2006) found that spreading activation mechanisms (Dell, 1986) should be the underlying mechanisms of three types of children’s overextension errors, i.e., category errors, pragmatic errors, and retrieval errors. Moreover, they thought that recent activation and perceptual similarity both play an important role on children’s object naming. Besides, older children should have a more mature mental lexicon and thus less susceptible to previously retrieved words than younger children. Due to the difference of the lexicon networks between Mandarin Chinese and English, we want to examine whether the same theory also could apply to Mandarin children. Two experiments which followed Gershkoff-Stowe et al. (2006) were conducted. The first one was familiar or unfamiliar object naming. 2-year-old Children underwent six trials and were primed by three pictures and then were asked to name a real object. The second experiment was novel object naming. We compared the performances of children aged 2 and aged 4 together. The procedure was the same as the experiment 1 despite the fact that children in experiment 2 named novel objects rather than real ones and they underwent 8 trials rather than six. And results showed a generally similar finding with English. However, there are still something different between these two languages. First, we found that familiar objects should have stronger strengths in Mandarin than in English. Second, different morphology in two languages may result in different priming way for more mature mental lexicons.
4

台灣地區公共圖書館危機管理之研究:以人為誘發型危機為例 / A Study on Crisis Management of the Public Libraries in Taiwan: Based on the Human-induced Crisis

劉家寶, Lau, Ka-po Unknown Date (has links)
任何開放性的公共服務組織,都必須承擔由環境或其他因素帶來的風險。隨著社會環境日趨複雜,不確定因素提昇,增加了危機發生的機會,對組織或個人的緊急應變及管理能力造成嚴峻考驗。公共圖書館作為開放性的全民社區資訊中心,除了肩負起文化傳承、推廣教育的任務外,確保所有讀者能在安全、舒適的環境下安心地使用各項圖書資源與服務,亦是所有圖書館的責任。如何在緊急或突發的危機狀況下及時作出適當的控制及處理,並迅速進行善後及復原措施,皆顯示出危機管理的重要性。 本研究旨在瞭解國內公共圖書館發生人為誘發型危機的經驗及危機管理相關發展概況,以期結合實務需求與文獻理論,提出適用於公共圖書館危機管理的參考模式,作為未來相關單位修訂或規劃危機管理工作,以及圖書資訊相關專業學會與系所規劃相關教育訓練及課程之參考指引。 本研究首先透過問卷調查法,探討目前國內公共圖書館的危機管理實施概況、曾發生的人為誘發型危機及管理階層的危機管理經驗與態度。接著針對管理階層進行深度訪談,以進一步瞭解國內公共圖書館危機管理相關工作的執行概況,並探討相關人員對危機管理的看法及建議。最後結合文獻與上述研究發現進行分析與歸納,提出適用於公共圖書館的危機管理模式。 根據本研究發現,提出的結論如下:一、讀者與館員素質的良莠不齊,雙方在危機意識上的不足,加上公共圖書館本身的服務性質、軟硬體設施、管理政策上的限制,都是構成國內公共圖書館人為誘發型危機之相關因素;二、國內公共圖書館管理階層的危機意識及處理態度仍有待加強及改變;三、國內公共圖書館己規劃並實施危機管理的公共圖書館仍屬少數,相關教育訓練、違規處理措施之規劃與執行上,未能發揮應有功能;四、國內公共圖書館較著重危機處理,在危機偵測及預防工作上略顯不足。故在安全及違規管理政策不清的情況下,未能發揮危機管理應有的效能;五、國內公共圖書館在進行危機管理工作時所面臨的困難與障礙,主要為:(1)缺乏足夠經費與人力(2)缺乏足夠的危機管理教育訓練及危機處理經驗(3)公共圖書館人員流動率高,危機處理經驗傳承與培訓不易(4)民眾公權利的意識上昇,申訴浮濫構成的壓力 (5)公共圖書館屬社教單位,基於教育觀點與服務立場的不同,往往容易造成執法上的衝突。 最後,根據前述之研究結果提出下列建議:一、政府相關單位及圖書館主管機關應為公共圖書館提供適當支援、輔導與補助,儘速將安全管理納入圖書館法及營運標準,並協助建置相關合作交流機制;二、公共圖書館應就現行的危機管理政策進行適當檢討及調整,並定期切實執行危機管理教育訓練,提高人員的危機意識;三、國內圖書資訊學系所及專業學會,應儘速規劃危機管理相關課程,以強化圖書資訊人員的危機意識及素養。 / Public libraries are the public access institutions, which always face lots of different risks that arose from the social environment. As the uncertain factors have been rising, which made the society became more complicated, and increased the probability of crises, it also caused the ordeals and challenges for organizations and individuals. Public libraries are the community information centers for the whole people, undertaking the mission of preserving culture and promoting education, which also have the responsibilities to ensure and provide a safe environment for the readers. Therefore, how to deal with the crisis and emergency situations, revealed the importance of the crisis management for each library. The purpose of this thesis was to investigate the general situation of the human-induced crisis which occurred on the public libraries in Taiwan, and also expected to combine the theory and practical needs. The result of this study would provide a reference model of crisis management for the public libraries. In addition, it could also give suggestions for on-the-job training and curriculum development to the Library Association and the schools of Library and Information Science. This thesis applied a questionnaire investigation associated with the in-depth interview approach. The interviewers included library directors and decision supervisors of the public libraries. This study further expected to gather the attitude, experience, crisis management plan, related strategies, and the comments from the administers in the public libraries. The findings of this thesis are as follows: (1) both the characteristics of the readers and librarians were different, and both of their consciousnesses of crisis were not enough. Furthermore, the nature of the public libraries service, the inappropriate facilities, and management strategies also became the related factors of the human-induced crisis of the public libraries. (2) The administrators of public libraries in Taiwan need to be conscious about crisis. (3) Only a minority of the public libraries in Taiwan had drawn up the crisis management plan, and the implementation of the training courses and costumer charters also couldn’t fully accomplish the purposes desired. (4) The public libraries in Taiwan paid much attention on the crisis handling, but usually neglected both the detection and prevention works of the crisis, which also lowered the whole efficiency of the crisis management plan. (5) The main difficulties and obstacles confronted with the public libraries were: (i) Lack of sufficient funds and human resources. (ii) Lack of sufficient crisis management training courses and related experience. (iii) For a long time, the position of the librarian of public libraries in Taiwan was instable. The staffs turn over also made the crisis management training courses not easy to conduct, either of the impartation of related experiences. (iv) As the sense of the public rights had increased recently, the abusive complain also brought serious stress and anxiety to public libraries. (v) Public libraries were a part of social education institutions, based on their service and education standpoint, which always brought conflicts when they enforced the rules and laws. The suggestions included: (1) The government and the chief administers of the public libraries should provide supports and funds to all public libraries, and must take the security issue into account of the library laws and operational standard as soon as possible. Thus, related units must help the public libraries to share experience and form cooperative partnership. (2) The public libraries should review their current crisis management strategies, and make an appropriate revision and augment. Moreover, the public libraries also need to put the trainings into effect, and must enhance the consciousness of crisis for each staff. (3) Both of the association of library and schools of library and information science should try to put the crisis management issues into the library management curriculum to fulfill the practical need of the public libraries, and reinforcing the crisis management knowledge and capacity for the librarians.

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