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31.
Sally McClean Jennifer Gillespie Lalit Garg Maria Barton Bryan Scotney Ken Kullerton 《European Journal of Operational Research》2014
Stroke disease places a heavy burden on society, incurring long periods of time in hospital and community care, and associated costs. Also stroke is a highly complex disease with diverse outcomes and multiple strategies for therapy and care. Previously a modeling framework has been developed which clusters patients into classes with respect to their length of stay (LOS) in hospital. Phase-type models were then used to describe patient flows for each cluster. Also multiple outcomes, such as discharge to normal residence, nursing home, or death can be permitted. We here add costs to this model and obtain the Moment Generating Function for the total cost of a system consisting of multiple transient phase-type classes with multiple absorbing states. This system represents different classes of patients in different hospital and community services states. Based on stroke patients’ data from the Belfast City Hospital, various scenarios are explored with a focus on comparing the cost of thrombolysis treatment under different regimes. The overall modeling framework characterizes the behavior of stroke patient populations, with a focus on integrated system-wide costing and planning, encompassing hospital and community services. Within this general framework we have developed models which take account of patient heterogeneity and multiple care options. Such complex strategies depend crucially on developing a deep engagement with the health care professionals and underpinning the models with detailed patient-specific data. 相似文献
32.
Raimund J. Ober Viswanath Ramakrishna E. Sally Ward 《Journal of mathematical chemistry》1999,26(1-3):15-26
It is shown that the system theoretic concepts of reachability and observability are relevant to the analysis of NMR experiments.
Moreover, the sets of reachable states are examined and Lie theoretic criteria are given for the reachability of the system.
The question is investigated how the set of reachable states depends on the class of input functions that are allowed. Both
one‐dimensional and multi‐dimensional NMR experiments are considered.
This revised version was published online in July 2006 with corrections to the Cover Date. 相似文献
33.
Audio taped discussions between three students have been examined to shed light on the way in which the behaviour of individual students may affect the shared construction of meaning with graphical calculators. These discussions revealed a complex pattern of interaction between the students. Each student was responsible for defining his or her own role within the discourse and these roles appeared to change as the discussion progressed. With reference to the framework offered by Winbourne and Watson (1998), it is proposed that local communities of practice have been established and that the individual student's positioning within the community of practice determines their success as a learner and contributes towards the creation of shared knowledge. 相似文献
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Richard C. Cambie Sally J. Janssen Peter S. Rutledge Paul D. Woodgate 《Journal of organometallic chemistry》1991,420(3):387-418
Double nucleophilic aromatic substitution reactions between (cyclopentadienyl)(η6-1,2-dichlorobenzene)iron(1 + ) salts and substituted 1,2benzenediols have been carried out under mild conditions to prepare [η6-dibenzo[b,e][1,4]dioxin]iron(1 + ) complexes functionalized in the 1- or 2-position with an alkyl, aldehyde, carboxylic acid, methoxycarbonyl, carboxamide, or hydroxy group. 3-Methyl- and 4-methyl-(η6-1,2-dichlorobenzene)iron complexes were treated with substituted 1,2-benzenediols to effect functionalization of both aromatic rings of the heterocycle. The dibenzodioxin ligands were liberated routinely by irradiation with ultraviolet light. Directed deprotonation of the free functionalized dibenzodioxins with an alkyllithium reagent followed by quenching with a variety of electrophiles yielded further derivatives, including two new isoindolone systems. 相似文献
39.
OBJECTIVES: Marfan syndrome (MFS) is a relatively frequent systemic connective tissue disorder with an important physical morbidity and mortality. The influences of MFS on physical problems, perception of severity, and impact on the quality of life and psychosocial well-being have been studied only limitedly. The aim of this study was to assess the association between the severity derived from the reported symptoms and subjectively experienced severity of MFS (expressed as a global judgment), with special emphasis regarding impact on relationships and pregnancies, psychosocial adjustment, and differences between the seven European countries. METHODS: A questionnaire designed specifically for this study and translated in each of the native languages was sent to 2,080 members of one of the patient support groups in Belgium, Denmark, France, Germany, The Netherlands, Switzerland, and the United Kingdom. 857 MFS patients of 13 years and older completed the questionnaire and were included in the data analysis. RESULTS: Physical impairments were scored by perception of severity of physical symptoms by the patients (physical severity perception score) and by their perception of the influence of MFS on their life (subjective severity score). Main discrepancy between physical severity perception and subjective severity score was the higher percentage of patients scoring in physical severity perception as severe (53.5%) compared to subjectively severe (26.5%). 61% of those who scored on the physical severity score as severely affected were designated as being mildly-moderately affected on subjective scoring. Both severity scores increased significantly with age. Two hundred-twenty women have carried 430 pregnancies (1.95 pregnancies/woman), with cardiovascular complications in 1.6%. Prenatal studies for MFS were rejected by 7.6% of MFS patients of 25 years and older, 33.6% were undecided, and 48.5% favored prenatal diagnosis for MFS if available. A positive general self-image was reported by 91.5% of patients. However, more than 90% stated that MFS had a negative influence on their sexual relationships, which they ascribed to negative perception of their body image. CONCLUSIONS: MFS has significant impact on daily life activities, but the majority of patients come to terms with their condition. Acceptance is mainly determined by subjective severity, and less by physical symptoms as reported by the patients themselves. It is important to stimulate a positive attitude towards MFS. 相似文献
40.
Sally M. McIntyre Jill Wisnewski Ferguson R.S. Houk 《Spectrochimica Acta Part B: Atomic Spectroscopy》2011,66(8):581-587
The method of comparing experimental and calculated ion ratios to determine a gas kinetic temperature (Tgas) characteristic of the origin of a polyatomic ion in inductively coupled plasma-mass spectrometry (ICP-MS) is applied to ArO+. Repeated measurements of ion ratios involving this species yield erratic Tgas values. Complications arise from the predicted presence of a low-lying excited electronic state (2Π) above the 4Σ ground state. Omission of this excited state yields unreasonably high temperatures (> 10,000 K) for nine out of nineteen trials. Inclusion of the excited electronic state in the partition function of ArO+ causes temperatures to increase further. The problem appears to be related to the prediction that ArO+ in the 2Π excited state dissociates into Ar+ and O, different products than ArO+ 4Σ which dissociates into Ar and O+. Adjustments to the calculations to account for these different products yield reasonable temperatures (2100 to 3500 K) that are consistent from day-to-day and similar to those seen for other weakly-bound polyatomic ions. 相似文献