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1.
Aims: Patients with psoriasis often undergo treatment with a sequence of biologic agents because of poor/loss of response to initial therapy. With the availability of newer agents like ixekizumab and secukinumab, there is a need for cost-effectiveness analyses to better reflect current clinical practice. This study aimed to assess the cost-effectiveness of a sequence of biologic therapies containing first-line ixekizumab vs first-line secukinumab in patients with moderate-to-severe plaque psoriasis in the UK.

Materials and methods: A Markov model with a lifetime horizon was developed to compare the cost-effectiveness of ixekizumab and secukinumab treatment sequences: ixekizumab → ustekinumab → infliximab → best supportive care (BSC) vs secukinumab → ustekinumab → infliximab → BSC. The model used monthly cycles, and included four health states: trial period, treatment maintenance, BSC, and death. At the end of the trial period, responders transitioned to maintenance therapy; non-responders transitioned to the next biologic in the sequence. An annual discontinuation rate of 20% was assumed for maintenance therapy.

Results: The ixekizumab sequence provided cost savings of £898 (£176,203 vs 177,101) [year 2015 values] and gained 0.03 more quality-adjusted life-years (QALYs: 1.45 vs 1.42) vs the secukinumab sequence over the lifetime horizon. Probabilistic sensitivity analysis showed an 89.8% likelihood that the ixekizumab sequence would be cost-effective at a threshold of £20,000 per QALY gained.

Limitations: The analysis used list prices for drugs rather than confidential, preferentially priced Patient Access Scheme costs. In addition, efficacy input data were based on a network meta-analysis, as there were no head-to-head trials comparing ixekizumab and secukinumab.

Conclusion: First-line treatment with ixekizumab as part of a specific sequential biologic therapy for moderate-to-severe plaque psoriasis in the UK provided slight advantages in cost savings and QALYs gained over a similar treatment sequence initiated with secukinumab. In view of the small magnitude of these differences, factors such as patient preferences (e.g. for number of injections) and long-term safety (e.g. related to time on the market) may also be important for clinical decision-making.  相似文献   
2.
In recent years, cities have become ever more attractive to middle‐class families. On the one hand, middle‐class families tend to withdraw into (often newly built) socially homogeneous middle‐class neighbourhoods. On the other hand, they are also known to move into inner‐city and socially mixed areas, thus triggering processes of gentrification. Academic literature has often denounced these housing choices as being either ‘separatist’ or ‘revanchist’, more broadly categorized as strategies of ‘middle‐class disaffiliation’. Although there is a grain of truth in these interpretations, the reality is certainly more complicated. In our research on middle‐class parents’ housing and neighbourhood choices as well as their patterns of neighbourhood use, carried out in each of the two types of residential area mentioned above, we have only very rarely found an explicit desire to draw boundaries that exclude those ‘beneath’ them. We rather argue that the housing choices and neighbourhood‐related activities of middle‐class family households are heavily influenced by the specific dilemmas the interviewees face as (working) urban parents. While a significant number of respondents worry about the social sustainability, justice and cohesion of urban society, they are also concerned about the future prospects of their children. Many find it difficult to reconcile these conflicting normative demands under the prevailing circumstances.  相似文献   
3.
In the literature, the cooperation of the IMF and the EU in credit lending has been discussed either from a state-centric, bureaucratic or institutionalist perspective. In this article, we examine the Troika as a set-up of multiple organisational overlap providing bureaucratic agents with constraints and opportunities for strategic action. Taking Latvia and Greece as cases in point, we analyse who prevails in a situation of conflict and why. How do these international organisations manage to overcome their differences and reach consensus? Drawing on the Two-Level game approach, we argue that negotiators are more likely to prevail over each other when their respective win-set decreases. We find that different strategies to manipulate win-sets are decisive to explain both cooperation and assertiveness. Changing costs of no agreement during a lending programme as well as the institutional procedures for programme ratification facilitate the use of these strategies.  相似文献   
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5.
This study focuses on female and male students who succeed in engineering programmes in Sweden, and why they have success. Data were collected through a questionnaire sent to all engineering students in Sweden registered for their seventh semester during year 2012 and about 30 % of the students in the cohort responded on several questions. The answers were then analysed and interpreted using Pierre Bourdieu’s theory and the concept of capital. The female-students as well as the male-students emerged as homogeneous groups, but SPSS-clustering shows differences and similarities between four female student-profiles and five male students-profiles. The female students who come to graduate as engineers have experiences and resources that seem to be fruitful: well-educated parents, positive attitudes to the engineer students’ traditions, and a positive view of the engineering profession. In addition, they value the traditional teaching with lectures and self-studies. They seem not to have been inspired by compulsory school teaching or teachers there. The male students have the same experiences and resources but there are differences. Among female students, a profile emerges which is absent among the male students and which emphasises the importance of doing good for society, people, and the environment in their future professional roles. Among male students, the student profiles which emerge include one with a primarily practical and technical capital despite the lack of a high degree of educational or scientific capital.  相似文献   
6.
The article aims to explore and revise cause-related marketing (CRM) in light of an emerging concept of the market and the roles assigned to companies and consumers in marketing communication processes. Based on a dialogical reflexive approach to case studies, we take our point of departure in theoretically identifying key CRM constituents and their interrelations, and we show how current theories within CRM build upon axioms of a traditional firm-centric view on value creation and fail to meet the challenges of new market structures and relations. This tension of axioms provides a point of direction for introducing the Pepsi Refresh Project as a case illustration of an alternative CRM practice that redefines CRM from company-driven to community-driven – and points towards relocating CRM from an overt to a covert brand and marketing communication strategy. CRM becomes a joint value- and identity-constructing practice transforming consumer criticism into brand involvement and community commitment. By reflexively merging theoretical and case insights, the contribution of the article lies in the revisiting of existing CRM theories in the context of connected, critical and empowered consumers and the subsequent outlining of what we suggest to be CRM 2.0.  相似文献   
7.
The design of the tax system matters for economic growth. During times of economic crisis, tax instruments such as temporary tax cuts can be used to soften adverse effects on the economy by stimulating private and corporate spending. However, empirical evidence suggests that the overall impact of short term tax policies is limited. In the long run, the structure of the tax system is essential to building up an investment friendly and innovation-stimulating environment, which will promote sustainable economic growth.  相似文献   
8.
Inbound tourist arrivals into China have been declining in recent years, possibly in response to increasing levels of urban air pollution. To examine Westerners’ contemporary views on China as a travel destination, with a particular focus on air pollution, this research surveyed 600 US and Australian residents. An online panel survey collected data on cognitive and affective destination image, cognitive and affective risk perceptions, intention to visit China and key demographic variables. The findings show that, while China's cognitive image attributes were perceived positively, potential travellers expressed negative views about travel risks in China in general and about air quality in particular. Importantly, feelings towards the risk of air quality had a significant negative impact on destination image as well as intention to visit China. The research contributes to theory by highlighting the importance of considering affective risk perceptions in destination image studies. While some market segments seemed less sensitive to air pollution than others, this paper concludes that unless China proactively addresses the problem of air pollution, for example by seeking to stimulate positive feelings, international arrivals may continue to be compromised.  相似文献   
9.
In 2009 the German central health fund was implemented. It was the result of a political compromise. One political party intended to equalise the risk structure among 130 different health care funds, and the other wanted to intensify competition and to improve efficiency among the different health insurances. The fund is flanked by a health-based risk adjustment and is aimed at sustainably ensuring the funding of the statutory health insurance system. It also constitutes the basis for competition among statutory health care funds, securing quality and efficiency in health care provision. To cover additional expenditures, health insurers had to charge flatrate premiums. A new law, which will come into effect in January 2015, will oblige health insurers to charge income related contributions. It is not clear how this will change competition among insurers. The federal government will not need to finance subsidies to low income individuals anymore. Income redistribution will only take place within the public health insurance system, exempting the privately insured and public servants from supporting low income individuals. The authors claim that the health care fund will not succeed in its aim of securing a sustainable financial basis for the statutory health insurance system. Most of the authors argue that there is no evidence of greater efficiency thus far, and they offer proposals on how to achieve improved performance.  相似文献   
10.
Understanding the complex and adaptive nature of Pacific Island communities is a growing yet relatively unexplored area in the context of tourism development. Taking an ethnographic research approach, this study examines how over 40 years of tourism development have led to complex and multi-scale changes within an Indigenous Fijian village. The study establishes that tourism development has brought a range of ecological shifts that have, over time, spurred far-reaching changes within the embedded sociocultural constructs of the community. The development of the Naviti Resort, a water catchment dam, a causeway and a man-made island have created substantial changes in totemic associations, livelihood approaches, and traditional knowledge structures within Vatuolalai village. The emergence of internal adaptive cycles, and new behaviours, practices and values that redefine the cultural landscape will be discussed. This paper demonstrates the interconnectivity of nature, society and culture within Indigenous communal systems and asserts that ecological changes introduced in one part of a community stimulate complex, non-linear responses in other elements of the socio-ecological system of a Fijian village.  相似文献   
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