本研究旨在探討猝睡症患者生活品質受症狀變化及神經認知功能改變的影響情況，以及不同層次影響因素對患者生活品質的初始狀態及後續變化軌跡的影響效果。 本研究於北部一所醫學中心睡眠障礙科及兒童心智科募集確診為猝睡症之患者，經同意後進行為期五年的長期研究，募集總人數168人，完成五年資料收集人數85人。本研究使用睡眠多項檢驗（polysomnography, PSG）、多段入睡測試（multiple sleep latency test, MSLT）、人類白血球抗原檢驗（human leukocyte antigen, HLA）為基本檢驗工具，以電腦化第二版康氏持續注意力測驗（Continuous Performance Test- II）及威斯康辛卡片分類測驗（Wisconsin Card Sorting Test, WCST）為檢測神經認知功能之工具，以自填艾普渥斯嗜睡程度量表（Epworth sleepiness scale, ESS）、史丹佛睡眠問卷（Stanford sleep inventory, SSI）及簡式生活品質量表（short from-36 items of health related quality of life, SF-36）做為症狀嚴重度及生活品質的依據。資料分析以描述統計及階層線性模式（hierarchical linear models , HLM）統計方法進行。主要結果如下： 一、 猝睡症患者生活品質分為生理與心理兩個層面，患者生理層面在五年期間維持相對穩定沒有顯著變化；心理層面中之不同向度則有不同變化趨勢，心理健康與活力向度隨時間有逐漸提高的趨勢，患者此二向度生活品質接受治療後有穩定上升的趨勢，而社會功能及情緒角色限制則呈現二次方曲線變化，以及呈現先增後減的發展軌跡，患者此二向度接受治療後顯著上升，第三年後有逐年下降的趨勢。 二、 患者嗜睡程度及猝倒嚴重度變化隨時間有顯著成長軌跡，呈二次方曲線發展，轉折點在第三年，接受治療前三年症狀呈現穩定降低的軌跡，但自第三年起逐年增加，此結果與藥物治療初期症狀獲得顯著改善，後期改善幅度相對減少，及藥物效果具有關聯。 三、 個體間層次變項僅疾病持續時間、HLA對患者生活品質具顯著解釋力，其中疾病持續時間越長，患者可能發展因應症狀之策略，從而降低疾病對生活品質之衝擊。而HLA則對症狀有不同影響，HLA陽性患者初始嗜睡程度較陰性者為低，且接受治療後改善效果較陰性者顯著，猝倒嚴重度起始值較陰性者高，且接受治療後的趕善幅度較陰性者小。 四、 疾病嚴重度變化對生活品質具顯著影響，完整模式分析中，時間主效應未達顯著，但可由症狀變化及神經認知功能改變進行更佳的解釋。嗜睡程度變化僅對身體疼痛向度變化不具有解釋力外，對其餘七個向度均具顯著影響；猝倒影響層面不及嗜睡程度，但亦可解釋生理量表、生理角色限制、心理量表、心理健康、情緒角色限制、活力等向度上的變化。 五、 神經認知功能改變與否對患者生活品質具有加成效果，分析顯示患者神經認知功能改善時，其生活品質提升速率較未改善者高，影響較顯著的包括注意力、警覺度及概念反應，此結果與下視丘泌素參與的維持注意力及前額葉功能有關。 本研究依據分析結果提出猝睡症患者生活品質受嗜睡症狀及猝倒嚴重度改變直接影響，同時受人類白血球抗原屬性及神經認知功能改變調節之假設模型，作為未來研究參考依據。並根據研究結果與限制，提出對臨床實務的應用與心理介入的建議，並對未來提升猝睡症患者生活品質相關研究提供建議。 / The current study aims to: (1) examine the change of eight domains of quality of life in narcoleptics within five years, (2) investigate the impact of the change of symptom severity on different dimension of quality of life, as well as the influence associated with the change of neuro-cognitive function. There were 168 participants recruited from a medical center in northern Taiwan. 85 of them completed the 5-year annual follow-up data collection. During the follow-ups, polysomnography (PSG), multiple sleep latency test (MSLT) and human leukocyte antigen (HLA) test were conducted. Computerized neuropsychological tests of Conners’ Continuous Performance Test- II (CPT-II) and Wisconsin Card Sorting Test (WCST) were also administered to obtain attention and executive function data. The short from-36 items of health related quality of life (SF-36), Stanford sleep inventory (SSI) and Epworth sleepiness scale were applied to assess quality of life and symptom severity. Descriptive statistics and hierarchical linear models were applied for data analysis. The main results were: 1. The quality of life was divided into physical and psychological domains. The physical domain kept relatively stable during the 5-year follow up as opposed to the psychological domain. In psychological domain, the vitality and psychological health showed increasing tendency overtime. However, the social function and role functioning-emotion increased during the first 3 years then declined afterward. 2. The symptom severity also showed a tendency corresponded to quadratic curve. The daytime sleepiness together with cataplexy severity reduced immediately after treatment but rose after the third year. 3. The variables of individual characteristics that showed significant impact on quality of life were disease duration and HLA type. The longer the duration, the better quality of life one had. Positive HLA typing seemed to be a protective factor on severity of sleepiness. It also predicted better treatment outcomes, but worsen the severity of cataplexy and treatment effects. 4. The symptom severity could be a good explanation as a variable of quality of life. The daytime sleepiness altered all domain of SF-36 expect body pain. Cataplexy affected only psychological domain of SF-36. 5. The neuro-cognitive function was also found to affect quality of life. Those who improved in attention and executive function test got greater improvement on SF-36 as well. The vigilance on CPT-II and conceptualized response on WCST had most significant impact. I proposed a model of change of quality of life in patients with narcolepsy based on the results obtained. Several suggestions were also proposed for clinical and psychological intervention for narcolepsy to improve their quality of life.

本論文從教育社會學角度探討造成數學成就性別差異現象的成因，以班級的性別環境為研究脈絡，研究影響國中女生數學成就的可能原因。假設數學成就的性別差異是受到後天學習歷程影響，班級環境中隱含的性別刻板印象為其中一個重要社會文化影響因素。透過比較國一到國三階段女生班和一般男女合班女生數學成就的異同，嘗試找出造成數學成就性別差異現象的成因，是否與班級性別環境、師生的性別刻板印象等因素有關。利用階層線性模式（Hierarchical Linear Models，HLM）統計方法，分析資料取自由中央研究院、教育部和國科會共同規劃的全國性長期的調查計畫：「台灣教育長期追蹤資料庫」（Taiwan Education Panel Survey，簡稱TEPS）。研究結果發現女生班、數學老師性別及班級學業氣氛等因素對於國中女生數學成就有顯著影響力，但進一步考慮學校公私別變項之後，女生班的影響力即消失。 / The main purpose of this study is to assess the magnitude of individual and contextual influences to explain gender differences in math achievements. Adopting the hierarchical linear model analysis to determine whether or not statistically significant differences between the mathematical achievements of 7th grade students who attend all-girls classes compared with those who attend coeducational classes at the same time, and their academic performance after two years. The result shows that there are three factors that have significant influences on girls’ math achievement in junior high schools, which are the single-sex classes, female math teachers and the academic climate of each class. However, if private schools are taken into consideration, the significant influence of the gender composition of classes will disappear.

本研究以TIMSS 2003台灣數學科資料為資料來源，使用階層線性模式為統計分析方式，探討國小四年級及國中二年級，學生數學家庭作業完成時間與教師指派數學家庭作業頻率，對於學生數學學習成就的影響。研究結果顯示：在國小四年級，學生數學家庭作業完成時間與學生數學學習成就為負相關；教師指派數學家庭作業頻率與學生數學學習成就之間為正相關，但並不顯著。在國中二年級，學生數學家庭作業完成時間與教師指派數學家庭作業頻率，對學生數學學習成就皆有正向的影響。在國小四年級中，學生數學家庭作業完成時間與教師指派數學家庭作業頻率的交互作用，對學生數學學習成就為負相關，但不顯著。在國中二年級中，學生數學家庭作業完成時間與教師指派數學家庭作業頻率的交互作用，對學生數學學習成就為正相關，但不顯著。 / The research was to explore the effects of mathematics homework time and mathematics homework frequency on mathematics achievement in the fourth and eighth grades, using TIMSS 2003 Taiwan mathematics data as the resources and Hierarchical Linear Modeling as the statistical analysis method. The results showed that in the fourth grades, mathematics homework time had a negative relationship with mathematics achievement while mathematics homework frequency had a positive, but non-significant, relationship with mathematics achievement. In the eighth grades, both mathematics homework time and mathematics homework frequency had positive effects on mathematics achievement. In the fourth grades, the interaction between mathematics homework time and mathematics homework frequency had negative, but non-significant, effects on mathematics achievement while in the eighth grades, the interaction between mathematics homework time and mathematics homework frequency had positive, but non-significant, effects on mathematics achievement.

知識不同於一般的商品，其具有無形、內隱與價值不易判斷等特質，組織很難以權威、命令、或單以金錢的方式來要求員工主動分享其專屬的知識，以提高組織內知識運用與創造的循環。人力資源制度涵蓋整體企業，各項措施與內部員工息息相關，而員工個人主觀的支持知覺和對上司的信任態度，對其知識分享(Knowledge sharing)的行為存在可能的影響。本研究以社會交換理論為基礎，透過階層線性模式(Hierarchical Linear Modeling)的統計方法，以Snell & Dean(1992)提出的五種高承諾人力資源措施構面為組織層次變項，同時參考Eisenberger(1986）與Robinson(1994)所提出的知覺組織支持(POS)與信任(Trust)為個體層次的預測變項和中介變項，驗證跨層次與單一層次的變項對組織員工知識分享行為的影響。 本研究將問卷分為主管問卷與基層問卷，透過書面郵寄與電子郵件的方式進行發放，對象為台灣國內27家金融機構的管理人員與一般員工，參與本研究的公司涵蓋銀行、證券、保險、投信、郵局與期貨公司。我們經由實證分析，得到了以下的研究發現： 一、 員工的知覺組織支持的認知程度愈高，其採取知識分享的意願與行為也會愈高。 二、 員工的知覺組織支持的認知程度愈高，其對直屬上司的信任也會跟著增加。 三、 員工對直屬上司的信任程度增加，其採取知識分享的意願與行為也會愈高。 四、 對直屬上司的信任在員工的知覺組織支持與知識分享之間存在中介效果。 五、 高承諾人力資源措施對知覺組織支持之間的跨層次影響有顯著，個別措施中嚴格甄選、績效評估、外部競爭與內部公平薪酬制度對員工的知覺組織支持之間存在正向關係。 六、 高承諾人力資源措施對信任之間的跨層次影響不顯著，個別措施的關係皆不顯著。 七、 高承諾人力資源措施對知識分享之間的跨層次影響不顯著，個別措施中僅嚴格甄選對員工的知識分享之間存在正向關係。 依據本研究結論，提供具體建議予相關單位及後續研究者參考。 / Knowledge has the characteristics of being intangible, tacit and difficult to evaluate. So an organization can’t force its employees to actively share their own knowledge to others by using the ways of authority, command or high payment only. High Commitment Human Resource Management (HCHRM) system includes many practices which closely influence the whole company and individuals in the organization context. And in individual level, the knowledge-sharing behavior of employees may be changed by the factors of perception organization support (POS) for company and the Trust for supervisors. In this study, we use Hierarchical Linear Modeling (HLM) to investigate the relationship among HCHRM practices, POS, Trust and Knowledge Sharing (KS) in both single level and cross level. The research hypotheses all base on the theory of Social Exchange. We collected 956 valid questionnaires from the employers and employees in 27 financial companies in Taiwan. According to the results of our analysis, we found that POS and Trust in individual level were significantly and positively associated with the employees’ behavior of knowledge sharing. And Trust also had intervening effect between POS and KS. In cross-level analysis, HCHRM practices can only affect the variable of POS. Finally, we conclude with a brief discussion of the interpretations and implications of the results in the context of single-level and cross-level. We also provide some practical and reasonable suggestions for company supervisors and further research.