Application of Tele-Ultrasound in Emergency Medical Services

In emergency medical services, portable ultrasound scanners have the potential to become new-age stethoscopes for emergency physicians. For trauma cases in particular, portable ultrasound scanners can scan the chest and abdomen of emergency patients both rapidly and conveniently. This study describes the development of tele-ultrasound for pre-diagnosis in a medical emergency setting as a part of the updated Mobile Hospital Emergency Medical System (MHEMS). An emergency medical technician can provide an emergency physician with a patient’s ultrasound images and medical information during the patient’s pre-hospitalization and transportation period using a combination of the MHEMS, the portable ultrasound scanner, and the onboard 3G communication capabilities. The MHEMS includes a Dispatch and Mission Control Center that facilitates the communication between the Emergency Department of a specified hospital, the systems aboard the ambulance. Early receipt of information relevant to the patient will enhance pre-diagnosis options for on-duty emergency physicians and allow for a hospital’s emergency depart ment to promptly prepare necessary surgical instruments or beds. Furthermore, emergency medical technicians can also obtain instructions from on-duty physicians to enhance damage and disaster control ability in critical moments

In vitro and in vivo cytotoxicity of zearalenone

Zearalenone (ZEA), a mycoestrogen produced by Fusarium fungal species, is mainly found in contaminated corns and maize. Despite ZEA has been reported in air and waters, little is known about the toxic effects induced by ZEA in vitro or in vivo. As ZEA has a similar structure to estrogen, its potential risk as an endocrine disrupting chemical (EDC) has thus aroused both environmental and public health concerns. The purpose of the first part of the study is to identify the responses and underlying molecular changes that occur when human bronchial epithelial BEAS-2B cells are exposed to ZEA. Differential gene expression profiles were identified in cells that were treated with 40μM ZEA for 6h and 24h by high-throughput microarray analysis using Affymetrix Human Gene 2.0 GeneChip. The array results showed 262 genes at 6h and 1073 genes at 24h were differentially expressed (fold change ≥1.5, p<0.05). Pathway analysis of the differentially expressed genes revealed that diverse cellular processes, which include the induction of oxidative stress, impaired response to DNA damage, cell cycle arrest, suppression of inflammatory responses, altered responses of nuclear hormone receptors and epigenetic changes, were affected. esults of further experiments indicated that 40μM ZEA decreased cell viability, induced apoptosis and promoted reactive oxygen species (ROS) generation in a time-dependent manner. Immunomodulatory effects of ZEA were revealed through the suppression of lipopolysaccharide (LPS)-induced expression of pro-inflammatory cytokines (IL-6, IL-8 and IL-1β). Interestingly, the level of global DNA methylation was markedly decreased after 24h exposure to ZEA. In vitro study using BEAS-2B cell line over-expressing a free radical scavenger, cytoglobin, showed significant attenuation of ZEA-induced ROS and cell death confirming that ZEA is a potent free radical producer. Taken together, these observations suggested that a broad range of toxic effects are elicited by ZEA. Particularly, ROS may play a pivotal role in ZEA-induced cell death. These adverse consequences observed in lung cells suggest that exposure to ZEA may lead to the pathogenesis in lung tissues. Previous studies have shown that growth and reproduction of early life stages of fish are susceptible to a variety of EDCs. However, the ecotoxicological risk of ZEA to aquatic wildlife is still poorly understood. Using marine medaka (Oryzias melastigma) as a model, the disrupting effects of ZEA on the physio-biochemical and endocrine function in vivo were studied. No effects were observed on hatching success, time to hatching and mortality after incubation of medaka embryos with ZEA at sublethal concentration of 50μg/L. No changes were observed in the Bax/Bcl2 mRNA ratio or apoptotic patterns. These results suggest that ZEA do not affect the development of the medaka embryos. However, the expression of key steroidogenic enzymes (CYP19A, CYP19B) as well as known estrogenic biomarkers (ERβ and VTG) were up-regulated at mRNA levels in newly hatched fry, indicating ZEA can potentially cause endocrine disruption in fish and posed a risk on aquatic life.published_or_final_versionBiological SciencesDoctoralDoctor of Philosoph

Biomass and Community Structure of Epilithic Diatoms in Pool, Run, and Riffle of Streams in Wuling Area

溪流中瀨、流及潭等棲地單元在水深、流速、底質特徵上具有明顯差異，此環境上的差異可能造成生物群集組成的不同，本研究目的欲比較不同棲地單元間石附生藻類生物量及群集結構的差異，及此差異與環境因子的關係。在流量穩定時期(冬季)於武陵地區桃山北溪、七家灣溪、有勝溪選擇具有瀨、流及潭三種棲地單元的溪段共三處進行研究。每個溪段以5-6條橫越不同棲地單元的穿越線所形成的矩陣式採樣點進行環境因子測量及石附生藻類採集。 結果發現武陵地區冬季石附生矽藻以適應寡營養鹽、頻繁擾動環境的單殼縫藻種為主要組成，最優勢藻種為Achnanthes biasolettiana var. biasolettiana，其次為Planothidium lanceolatum及Achnanthidium minutissimum三種即佔總相對豐度的64.2%。但是有勝溪因上游有來自農耕區的營養鹽輸入，因此優勢物種組成上多了一些適應較高營養鹽、污染水域的藻屬如Nitzschia。 棲地單元間藻種群集分析結果顯示石附生矽藻生物量及群集結構在棲地單元間存在差異，而流速為造成此差異的最主要因子。生物量最低通常出現在流速最快的棲地單元(瀨區或流區)，因為急快的水流使得附生藻生物量難以累積。在流速偏低的桃山北溪(平均流速25cm/s)藻類群集組成在棲地單元間並無差異，但在流速相對較高的七家灣溪(平均流速47 cm/s)及有勝溪(平均流速35 cm/s)，棲地單元間藻種組成差異之形成主要因某些適應高流速的物種，如Cocconeis placentula var. euglypta、Mayamaea atomus及Reimeria sinuata等，在流速最快的棲地(有勝溪為瀨區、七家灣溪為流區)出現相對較高的豐度。 若以矽藻生長型式的功能群來區分，各棲地單元仍以低矮著生型為主要組成(相對豐度69-88%)，直立生長型及移動型相對豐度則低很多；各功能群相對豐度在溪段內的棲地單元間差異不大，但在不同的採樣溪段間則具有明顯差異，在流速最快的七家灣溪低矮黏著型有最高豐度(88%)；相較於其他兩溪段，直立生長型在流速較緩的桃山北溪有最高的相對豐度(22%)；而移動型在則營養鹽較高有勝溪有較高豐度(16%)。 由本研究結果指出，在武陵地區，流速為溪段尺度下造成棲地單元間石附生矽藻群集生物量及物種組成差異的重要因子，而流速的效應出現在較高流速的情況下。此外由我們的結果也了解到，當在評估湍急溪流的物種組成時，兼顧不同棲地單元間的採樣才能忠實反應該河段物種組成概況。Channel units that differ in water depth, velocity and substratum characteristics may influence the distribution of riverine organisms. In this study, I compared the biomass and composition of diatom communities in the riffle, run and pool of stream channels, and to determine the relationships between the heterogeneity of diatom community and environmental factors. Three reaches that consist of 3 types of channel units were selected from Taoshan North, Cijiawan and Yousheng stream in the Wuling Area. There were 5-6 transects across each reach, and sampling points separated at a distance of 50 cm along transects were set for periphyton sampling and environmental factors measurement. The results revealed that Achnanthes biasolettiana var. biasolettiana, Planothidium lanceolatum and Achnanthidium minutissimum that are adapted to low nutrient and high disturbance were the most abundant diatom species in the Wuling Area. They contributed to 64.17% of the total relative abundance. However, in Yousheng stream, there are more abundant of Nitzschia spp. that are the bioindicators of eutrophication and organic polluted water, which can be attributed to the stream draining from an intense agricultural area and suffering high nutrient loading. The results of community structure analysis show that eplithic diatom biomass and community structure was significantly different among channel units, and water velocity was the major factor to explain the differences. Biomass was lowest in runs or riffles with higher velocity, due to shear stress caused the lose of biomass under the condition of fast water velocity. When diatom community approached the late stage of succession, community structure did not differ among channel units in Taoshan North Stream where water velocity averaged 25 cm/s. However, community structure were significantly different among channel units in Cijiawan and Yousheng stream where water velocity averaged 47 cm/s and 35 cm/s, respectively. The diatom species, Cocconeis placentula var. euglypta、Mayamaea atomus and Reimeria sinuate, that are adapted to high water velocity, were more abundant in the channel units with higher water velocity. The epilithic diatoms were categorized into 3 ecological guilds based on their potential to tolerate nutrient limitation and physical disturbance, the low profile guild was most abundant in all microhabitats (relative abundance 69-88%). The relative abundance of guilds were similar among channel units within each sampling reach, but differed among sampling reaches. Low profile guild was most abundant in Cijiawan Stream (88%) with highest water velocity, High profile guild was most abundant in Taoshan North Stream (22%) with lowest water velocity and motile guild was most abundant in Yousheng Stream (16%) with highest nutrient concentrations. The results show that water velocity was the major factor determining the variations of biomass, abundance and community structure among channel units at the reach scale in the Wuling Area, and the effect of velocity emerged in the channel units where the water velocity was fast. In addition, the results show the importance of sampling in different channel units, particularly in streams with fast water velocity, in order to properly assess the diatom community of a reach in a stream.目 次 中文摘要………………………………………….…………………….............i 英文摘要………………………………………………………………………iii 目次…………………………………………………………………………….v 表目次………………………………………………………………………...vii 圖目次…………………………………………………………………………ix 第一章 前言 1-1 研究動機………………………………………………………………1 1-2 文獻回顧……...……………………………………………………….2 1-3 研究目的…………......…………......…………………………………9 第二章 材料與方法 2-1 研究地點……………………………………………………………. 11 2-2 採樣方法……………………………………………………………. 12 2-3 實驗室分析………...………………………………………………...14 2-4 統計分析……………………...……………………...……………... 16 第三章 結果 3-1 環境因子差異分析……………….………………………………….19 3-2 生物量分布差異分析…………………………..………..…………..21 3-3 矽藻功能群差異分析………………………...…..…….……………23 3-4 採樣溪段藻類群集組成……..……………………….............…….. 24 3-5 藻類群集組成差異比較…………………..………….…………...…25 第四章 討論 4-1 環境因子…..…………………..……………………......…………... 29 4-2 生物量分布差異與環境因子……………........………….………… 29 4-3 藻種組成差異……………………………………………..…...…….35 4-4 水棲昆蟲可能的影響………………….………...........…………….38 4-5 生態上的應用……………………..……………………...………….40 4-6 本研究之檢討…………………..…………………………...……….40 第五章 結論…………..……………………………………...………...……42 第六章 文獻參考……………..……………………………...…………...... 4

Study of diffusion behaviors of merocyanine 540 with fluorescence correlation spectroscopy

在本篇論文中，我們敘述了利用螢光異向性相關光譜技術研究merocyanine 540分子在不同黏度溶液中的平移與轉動擴散行為。我們的研究結果證明該分子為扁圓形分子。且所獲得之黏度與以黏度計的量測值相符。我們的研究說明螢光異向性相關光譜技術是研究微觀流體力學的有用工具。In this thesis, we report the investigation of translational and rotational diffusion behaviors of merocyanine 540 in viscous fluids with anisotropy fluorescence correlation spectroscopy (FCS). Our experimental result supports that the molecule is an oblate ellipsoid. The extracted viscosity values match almost perfectly with the ones measured by viscometer. Our study demonstrates that anisotropy FCS is indeed a powerful method to examine microscopic hydrodynamic behaviors.中文摘要 i 英文摘要 ii 內容目錄 iii 表格目錄 v 圖目錄 vi 第一章 簡介 1-1 螢光相關性光譜技術的發展與應用 1 1-2 螢光相關性光譜技術 1-2-1 相關光譜原理與分子動力學 8 1-2-2 螢光異向性相關光譜 11 第二章 實驗架設與樣品製備 2-1 螢光相關光譜實驗架設 2-1-1 光學架設 21 2-1-2 時間相關單光子計數量測架設 22 2-2 樣品製備與處理 23 第三章 實驗結果與討論 3-1 Rhodamine 6G分子平移擴散相關性光譜 28 3-2 Merocyanine 540分子相關性光譜 3-2-1 平移擴散研究 34 3-2-2 轉動擴散與三重態弛張研究 38 第四章 結論 6

魏晉南北朝志怪小說非常女故事之研究

本文以魏晉南北朝志怪小說中非常態女性為研究對象，溯源古代常與非常的概念源由，提出志怪小說中對於非常態女性之定義，分析故事情節與內容，並探討其社會與文化的深層意義，揭示出志怪小說非常態女性故事描寫之背後，所蘊含的時代及社會現象，分別有天界之女神仙、活動於人間之非常女以及幽冥界的女鬼。天界女神仙有守護類女神仙，與上巳日、七夕民俗節日及扶鸞等民事活動有關，豐饒女神仙則與蠶神的祭祀風俗有關，婚配女神仙反映著贅婚現象及人們渴望成仙的心理。另有幽冥界的女鬼，分別為贈物、復活、遊蕩、訴願、復仇等類型，贈物表現的是男性渴望藉此達到身分地位提升的心願，又與復活型故事皆為冥婚的風俗呈現，部分故事為盜墓及風水信仰的紀錄。活動於人間除了人之非常女外，仍有物魅一類，人之非常女為不符合社會及自然秩序者，藉由該類女性被視為非常女可見得當時代對於女性職能的約束與規範及人類生理的認識不足，物魅故事則透露男性對於性匱乏的滿足與渴望，本文從魏晉南北朝志怪非常態女性故事中分類、並從各類故事中探討故事深層結構的社會、文化與民俗意義。目次 第一章 緒論 ……………………………………………………… 1 第一節 研究概述……………………………………………………1 一、 研究緣起 ………………………………………………… 1 二、 研究動機與目的 ………………………………………… 5 第二節 研究範疇與材料……………………………………………5 一、 研究範疇 ………………………………………………… 5 二、 材料取資 ………………………………………………… 6 第三節 前人文獻回顧………………………………………………7 第四節 時代思維與歷史背景概述…………………………………8 一、 原始思維 ………………………………………………… 8 二、 宗教信仰………………………………………………… 10 三、 魏晉南北朝歷史與社會環境…………………………… 12 第二章 常與非常………………………………………………… 17 第一節 自然秩序與社會秩序 ……………………………………17 一、 先秦哲學自然變化之秩序觀…………………………… 17 二、 兩漢以降氣化論與陰陽五行之秩序觀………………… 21 三、 習俗規範與社會秩序…………………………………… 25 第二節 常與非常的現象觀照…………………………………… 25 一、「妖」之非常態現象…………………………………… 25 二、志怪之非常態現象……………………………………… 27 第三節 志怪小說非常態女性定義……………………………… 28 第三章 天界之女神仙 ……………………………………………31 第一節 神仙範疇 ………………………………………………… 31 一、 中國早期神的概念…………………………………………31 二、 仙的信仰……………………………………………………36 三、 神仙概念的釐清……………………………………………39 第二節 女神仙之故事及其涵義 ………………………………… 39 一、 守護類女神仙 …………………………………………… 40 二、 豐饒女神仙 …………………………………………… 45 三、 婚配女神仙 …………………………………………… 48 四、 性愛女神仙 …………………………………………… 55 第四章 幽冥界之女鬼…………………………………………… 59 第一節 釋鬼 ………………………………………………………59 一、 鬼之意義溯源…………………………………………… 59 二、 志怪小說中鬼之意義…………………………………… 60 第二節 女鬼之類型 ………………………………………………61 一、 贈物女鬼型故事與情節分析…………………………… 61 二、 復活女鬼型故事與情節分析…………………………… 62 三、 遊蕩女鬼型故事與情節分析…………………………… 64 四、 復仇女鬼型故事與情節分析…………………………… 65 五、 訴願女鬼型故事與情節分析…………………………… 66 第三節 女鬼故事之社會與文化意義探討 ……………………… 67 一、 門第觀所致之婚姻問題………………………………… 67 二、 冥婚婚俗之記錄………………………………………… 68 三、 盜墓現象及風水習俗之顯現…………………………… 69 四、 結語……………………………………………………… 71 第五章 活動於人間之非常女………………………………………73 第一節 喬裝為女身之物魅 ……………………………………… 73 一、 物魅釋義……………………………………………………73 二、 物魅類型之故事與情節分析………………………………74 三、 物魅故事深層文化意涵……………………………………82 四、 結語…………………………………………………………86 第二節 社會功能異常者 ………………………………………… 87 一、 釋巫、尼、道姑……………………………………………87 二、 巫、尼故事內容與社會意義 …………………………… 88 第三節 生理功能異常者……………………………………………89 一、 生理異常者介義……………………………………………89 二、 生理異常者故事內容與意義………………………………90 第六章 結論…………………………………………………………93 參考書目……………………………………………… 9

智慧型遠距健康照護資訊管理系統平台

The main idea of discharge planning services is to provide the patients from in hospital service with the continuous care while they discharge from the hospital. In year 2009, Taiwan's Ministry of Economic Affairs funded National Taiwan University Hospital (NTUH) a project &quot;Development of a TeleCare Center for Discharged Patients&quot;. This project aimed to develop and upgrade the NTUH's discharge planning services. It had integrated electronic medical records, information network communication and biosensor technology. The service provider of this telecare program was based from the NTUH's main campus, Bei-Hu Branch and Yun-Lin Branch. On the other hand, an option for discharged patients with continuous care in community based health care was developed with a newly open telehealth care center. Therefore, the discharged patients could have better access to health care service when they go back to their homes or communities. Thus, the quality of healthcare was also improved. Besides, an intelligent telehealth care information management system platform was also designed for case managers to monitor patients' vital signs and other related health information in needs. The platform also helped case managers to link the significant data in providing the online health consultations and further referral services, in order to achieve a comprehensive and continuous healthcare

A Telehealthcare System with Real-Time Health Information and Diagnosis Assistant

我國老年人口數量與比例在民國95年底已高過總人口之10%，達到聯合國所界定之「高齡化」水準，推估至民國101年時將為14%，民國120年時則將超過20%。中老年慢性病及相關的併發症、身心障礙、重症末期帶來龐大的醫療需求，甚至獨居、失智老人衍生的照護問題，已經成為社會沈重的負擔。因此我們藉著結合無線通訊網路、生醫感測器與醫療資訊系統，發展一個能解決緊急照護、長期照護，及預防性照護等各種遠距與行動照護問題及具即時健康資訊與診斷輔助能力之遠距健康照顧系統。此系統為結合遠距照護資訊網路、遠距醫療、與生醫感測技術提供病患個人化、可近性、即時的遠距與行動醫療照護服務，以減輕長期照護體系醫療人員與家屬的負擔，改善醫療服務品質並進而降低醫療成本。 本論文提出一模組化的遠距健康照護系統架構，以利往後相關的系統設計。此架構具功能再用(Function reuse)、元件再用(Component reuse)、模組再用(Module reuse)等功能，可清楚定義每個子系統之下的功能單元，其模組化設計可讓未來之系統在發展與擴張上更為容易。另透過導入適當XML (eXtensible Markup Language)與Web Service技術來解決異質資訊系統之建置，可達到加速整合系統建置的時程。此系統架構包括使用者端系統、行動服務端系統、健康照護中心資訊系統、醫院端系統、緊急醫療端系統。 我們所發展的行動醫院緊急醫療系統(MHEMS, Mobile Hospital Emergency Medical System) 結合遠距超音波診斷系統與外傷重點腹部超音波(FAST, Focused Assessment with Sonography for Trauma)，提供目前緊急醫療系統無法達到的預診與診斷評估，並且提供救護車預計到達時間 (ETA, Estimated Time of Arrival)，因此改進了緊急照護的品質進而提高存活率。 為解決居家訪視師出勤時常常得攜帶厚重病患紙本病歷的困擾，本論文提出一結合居家訪視師使用的電子病歷及可攜帶式生理量測儀之電子護理包(Nurse’s e-Bag)。同時病患家中的遠距健康系統，不只提供病患之遠距健康記錄，並可讓訪視師在做家訪時可得到遠端醫師的諮詢支援，加強病患病情的控制進而減少病情復發的機率。因此病患的健康照護品質將提升，醫療成本亦可降低。 另外本論文以資通訊技術建構之電子化個人健康紀錄，可提供一個民眾自我健康管理，以及專業健康管理師進行個案管理的共通資訊平台系統，以創新服務模式提升目前預防性照護效率。首先我們以臨床實驗探討遠距健康照護的系統與服務模式，再針對個別系統將遭遇的問題加以探討，嘗試作為標準化架構模式，以使系統更佳模組化，最後對遠距健康照護作服務模式的探討。 本論文所提出的具即時健康資訊與診斷輔助之遠距健康照顧系統，其整合與建置皆使用嵌入式系統與標準訊息架構發展，未來將可使用相同架構模式延伸發展至預防醫學之三段五級的預防性照護、亞急性照護、急性照護、長期照護、甚至末期照護，以提供一週全、持續性的健康照護(Continuum healthcare)。未來可結合軟硬體共同設計 (Hardware/Software Co-design) 或超大型積體電路系統晶片(System-on-Chip)的規劃與設計，即可改善生理訊號之偵測與回饋途徑、系統資料之傳送、轉換與接收速度等，以因應不同科別與疾病之照護需求，進而使日後健康照護系統之整合與應用更能迅速。By the end of 2006, the number of senior citizens in Taiwan had already exceeded 10% of the entire population and reaching the level of the &quot;aging society&quot;. Chronic diseases and complications, mental and physical handicaps, and terminal illnesses of elderly people have also created a huge medical need. These are all becoming heavy burdens of the society. In view of this, we have developed a Real-Time health information and Diagnosis Assistance System for Telehealthcare, which combines a radio communication network, biomedical sensors, and a medical information system to address the needs for emergency care, long term care, and preventive care. First, we propose a modular Telehealthcare framework that supports function reuse, component reuse, and module reuse. We define each sub-system clearly during the design of a Telehealthcare system. Through the import of Web Service technology and XML (Extensible Markup Language), we can integrate heterogeneous information systems into a framework and accelerate the establishment of our Telehealthcare system. For emergency care, our proposed Mobile Hospital Emergency Medical System (MHEMS) combines Tele-ultrasound and Focused Assessment with Sonography for Trauma (FAST) to provide pre-diagnosis and diagnosis assistance and ETA (Estimated Time of Arrival) of Ambulance, which cannot be done with current emergency care technology. With MHEMS, when patients are carried into the ambulance, the emergency medical technician can ask a doctor to make proper diagnosis for subsequent medical preparation, operations and/or sickbed assignment. Moreover, to improve the inconvenience of carrying paper patient records when a visiting nurse makes a visiting, we provide a home care record system integrated with portable bio-measurements as a Nurse’s e-Bag. Also, to let the patients record their health records, a tele-homecare system is installed at their home. Therefore, the visiting nurse can make healthcare service and obtain tele-consultation via such system. Based on the system that we provide, morbidity and medicine cost will be reduced. For preventive care, we have run a clinical trial for a Pilot Study on Community-Based Ubiquitous Healthcare for Current and Retired University Employees. Equipped with information and communications technologies, the system provides to the general public a different healthcare customized by changing the concept from receiving a medical staff’s service only in hospital to obtaining a medical group’s identical daily service outside a hospital, and without doctors or nurses around. The core technology of this Dissertation is to propose a systematic framework and functional units for Telehealthcare, then to develop a Telehealthcare system supporting emergency care, long-term care, and preventive care. The system framework complies with the standard embedded system and information system, and can be extended to include preventive healthcare, subacute care, acute care, long-term healthcare, and terminal healthcare. In the future, hardware/software co-design or VLSI chip design can also be adopted to improve the detection and feedback of physiological signals, system data transmission, conversion, and reception rate, so as to meet the needs of different medical departments, and facilitate a quicker integration and development of future healthcare systems

The Comparative Study of Government Publication Depository Library System Between Taiwan and United States

政府出版品是探討一國政府施政運作與績效的重要紀錄，也是民眾瞭解政府施政成果的主要憑藉，被視為現代圖書館重要的參考資料之一。此類出版品無論從內容、資料來源、出版及發行等層面來看，都具有相當程度的權威性、時效性、廣泛性及非營利性等特性，可視為國家重要的資產。由於政府出版品具備上述重要特性，使得一國政府能否建立公開、即時且平等的政府資訊傳佈政策，乃成為民主社會發展的重要指標及基本要求之一。從政府出版品管制度層面而言，先進國家對於政府出版品多規劃有「寄存」及「銷售」兩大途徑，作為提供政府出版品的主要服務窗口。審視美國地區政府出版品聯邦寄存制度建置迄今已擁有百餘年的發展經驗，而我國政府出版品寄存制度初期的規劃藍圖，大體輪廓皆源自於美國的經驗，惟受到國情、社會文化與經濟條件上的差異性，使兩地區在規劃寄存圖書館制度運作策略上仍各有特色，且彼此間具有可比性。因此，為瞭解中美寄存圖書館制度的形成與未來電子寄存服務的發展及角色定位，本研究擬以政府出版品寄存圖書館制度為論述主題，利用比較研究法對中美寄存圖書館制度相關議題，進行深入的比較分析，據以瞭解其制度的發展歷程。本研究採比較研究法，配合文獻分析法進行。分別運用「描述」、「解釋」、「併排」及「比較」四個主要研究步驟，探討中美兩國政府出版品寄存圖書館制度之發展。主要的研究目的有四：一、分析中美兩國寄存圖書館制度發展的歷史沿革及制度形成之宗旨、任務與功能；二、探討中美寄存圖書館制度運作的相關法源依據、主管機關組織、管理作業運作現況及電子化寄存服務之發展趨勢；三、探討中美政府資訊公開理念及政府出版品著作權的規範現況，對寄存圖書館制度發展之影響；四、比較中美寄存圖書館制度規劃與運作現況之異同與未來發展趨勢，並據以提出對國內未來規劃寄存圖書館制度之具體建議。為達成前述研究目的，研究者分析、報導中美政府出版品寄存圖書館制度之相關文獻後，綜合歸納制度的比較研究結果，提出六項結論暨十項建議，茲分項臚列如下：一、結論部份目的在於綜理上述各章所作的現況探討，具體比較中美兩國政府出版品寄存圖書館制度在規劃與現況運作上的差異性、現況發展及趨勢，並歸納提出免費提供政府出版品之寄存圖書館制度，未來仍有其繼續存在的必要性。比較分析的項目分別有：（一） 中美政府出版品寄存圖書館制度之發展歷史；　（二） 中美政府出版品寄存圖書館制度之相關法源；　（三） 中美政府出版品寄存圖書館制度管理現況；　（四） 中美政府資訊公開政策與寄存制度之發展；　（五） 中美政府出版品電子化寄存服務之發展趨勢；　（六） 政府出版品寄存圖書館制度之存與廢之探討。二、建議部份　（一）積極爭取上級機關重視與經費支援；　（二）健全政府出版品管理制度法源基礎；　（三）建立正確的政府資訊利用觀念；　（四）暢通寄存圖書館制度的溝通與合作管道；　（五）訂定明確的寄存圖書館作業標準及規範；　（六）釐清政府出版品著作權的授權與合理使用；　（七）建構完善的寄存制度績效與評估獎勵模式；　（八）規劃並建置我國電子化寄存服務環境；　（九）重視寄存館員在職訓練與服務內涵的提昇；　（十）強化政府出版品之灰色文獻的整理與利用

Introduction and Application of the Continuity Assessment Record and Evaluation (CARE) and Related Assessment Instruments for Post-Acute Care

[[abstract]]已開發國家多面臨社會高齡化及慢性病罹患人口的增加，造成醫療費用上漲，為能提高醫療資源使用效率，提供更好的照護品質，陸續發展急性後期照護（Post-Acute Care, PAC）；美國的急性後期照護包含技術性護理機構（skilled nursing facilities, SNFs）、居家健康服務單位（home health agency services, HHAs）、住院復健機構（inpatient rehabilitation facilities, IRFs）、及長期照護醫院（long term care hospital, LTCHs）四種型態，由於不同型態機構所使用評估表格不同，無法比較失能程度相似者利用四種不同型態服務，其花費與照護品質結果是否不同，因此美國先後發展「活動測量（Activity Measure for Post Acute Care, AM-PAC^TM）」、「社交參與測量（Participation measure for post-acute care, PM-PAC）」、及「連續性評估記錄（Continuity Assessment Record and Evaluation, CARE）」等評估工具讓不同型態服務機構能夠通用。美國政府2014年通過「The Improving Medicare Post-Acute Care Transformation Act of 2014」法案，提出2018 年將全面實施以「CARE」為評估工具，去檢測使用不同急性後期照型態但失能程度相似之個案，其費用及照護結果是否存在差異；本文擬介紹AM-PAC^TM、PM-PAC及CARE，並探討其對臺灣之啟示。 Medical expenses in developed countries are rising because of the aging society and the increased population of chronic diseases. In order to improve the efficiency of medical resource and the quality of care, post-acute care (PAC) has been developed. The PAC providers in the United States can be classified into four types, skilled nursing facilities (SNFs), home health agency services (HHAs), inpatient rehabilitation facilities (IRFs) and long term care hospital (LTCHs). Since different types of PAC providers use different assessment instruments, it is hard to compare the quality and medical expense between facilities that service PAC patients with similar case mix. The integrated assessment instruments such as Activity Measure for Post-acute Care (AM-PAC^TM), Participation Measure for Post-acute Care (PM-PAC), and Continuity Assessment Record and Evaluation (CARE) were developed to evaluate the differences in costs and outcomes for patients of similar case mix who use different types of PAC in the United States. The CARE will be fully implemented in each facility since 2018 by 'The Improving Medicare Post-Acute Care Transformation Act of 2014'. This article introduces the assessment instruments, AM-PAC^TM, PM-PAC and CARE, and its' implication for Taiwan