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<p>Stroke is a devastating event for a patient. Patients undergoing cardiac surgery are at risk of both peri-operative and delayed stroke. This thesis comprises 8 chapters that highlight the rate of stroke in cardiac surgery patients and its risk predictors. It justifies the need for a randomized controlled trial of left atrial appendage (LAA) occlusion on top of usual antithrombotic therapy for stoke prevention in patients with atrial fibrillation or flutter.</p> <p>Chapter 1 is a preface that provides the rationale for undertaking each of the studies included within this thesis.</p> <p>Chapter 2 presents a large cohort study that examines the predictors of early and long-term stroke in patients undergoing cardiac surgery with emphasis on the impact of atrial fibrillation as well as the CHADS₂ score.</p> <p>Chapter 3 has been published in the journal <em>Circulation </em>in a modified form. A review of the current literature is presented, highlighting that although LAA occlusion holds promise for stroke prevention in AF, there is currently insufficient evidence that it can replace the gold standard of oral anticoagulation.</p> <p>Chapter 4 is a long-term follow-up study of the first Left Atrial Appendage Occlusion Study. This trial included patients undergoing coronary artery bypass grafting with or without AF. By performing a long-term follow-up of these patients, an estimate of stroke risk and risk of developing new AF was obtained.</p> <p>In Chapter 5, the results of LAAOS II are presented. This registry and pilot trial was used to assess the rate of recruitment into a novel design of a trial comparing LAA occlusion to antithrombotic therapy, LAA amputation safety, and the rate of a composite outcome of death, myocardial infarction, stroke, non-cerebral systemic emboli, and major bleeding.</p> <p>Chapter 6 presents the design for the LAAOS III trial. The data presented in the previous chapters is used to create the definitive trial of LAA occlusion on top of usual antithrombotic therapy using a prospective, randomized open trial with blinded end-point study (i.e., PROBE) design.</p> <p>Chapter 7 presents the health economic analysis plan for LAAOS III.</p> <p>Finally, Chapter 8 presents the conclusion, limitations, and implications of the research presented in my PhD thesis</p> / Doctor of Philosophy (PhD)

The goal of this study was to better understand the perspective of administrators on accountability and high stakes testing - what effect it has, if any, on his/her ability to serve as building administrator. Through a series of in-depth interviews and analysis of the perception of principals that lead schools that are on various levels of No Child Left Behind sanctions, this study will help the reader to understand how high stakes testing and accountability have impacted the leadership of the school principal. As presented by Allen (2008) are we focusing curriculum on preparation for high-stakes testing versus the philosophy of letting the high stakes testing evaluate the effectiveness of what is being taught as a method for supporting learning? From budgeting and organizational structure, to local curriculum and classroom instruction, efforts from external sources to ensure "accountability" in public schools have impacted virtually every aspect of school operations in America. No Child Left Behind is the initiative most often associated with the current accountability movement. While this study did not aim to measure the effectiveness of initiatives like No Child Left Behind, it did aim to analyze how these measures have impacted the role of the building principal. This study used a semi-structured interviews with eleven elementary school principals who lead schools on a sampling of the No Child Left Behind sanction continuum. In addition to interviews, pertinent documents and artifacts will be analyzed. The constant comparative method (Glaser & Stauss, 1967) will be used to analyze the data in terms of the study's two theoretical frameworks: Turbulence Theory (Gross, 1998) and Multiple Ethical Paradigm. / Educational Administration

This qualitative case study is designed to document the impact of No Child Left Behind (NCLB) on career and technical education (CTE) in Pennsylvania. The research was conducted utilizing a qualitative case study protocol on two specific CTE Centers in the suburban Philadelphia area. The study centered on the following question. Has compliance to the accountability components of NCLB impacted the delivery of secondary education in CTE centers in the Pennsylvania? The study identified the changes that have occurred to selected CTE centers in the NCLB era. The assessment mandates of federal policy NCLB are narrowly focused in academic curriculum. The data used to answer the questions was accumulated through interviews with facility staff and the examination of archival records at the two specific centers to be researched. This study determined the impacts of NCLB on the facilities. The impacts included; decreased enrollment, increased academic and testing focus, reduction in technical budgets, increase in academic budgets, increase of special education students, staff changes for the increase of academic areas, morale issues, program changes, shifts in staff development, facility changes, negative publicity and public image due to academic reporting in the media. Questions for future study. What are the costs, financial and opportunity related to the reduction in CTE for increased academics? How many students have been denied the opportunity of attending or completing CTE programs? Why there isn't an alignment of NCLB and IDEA goals? What is the emotional impact to our students who keep getting told they are below basic? The conclusion from this study suggests that the public education system in this country needs to be more centered on actual student outcomes and preparing students with marketable skills and not based on the narrow focus of academic test scores. / Educational Leadership

京都大学 / 新制・課程博士 / 博士(地球環境学) / 甲第24858号 / 地環博第241号 / 新制||地環||47(附属図書館) / 京都大学大学院地球環境学舎地球環境学専攻 / (主査)教授 星野, 敏, 准教授 鬼塚, 健一郎, 准教授 落合, 知帆 / 学位規則第4条第1項該当 / Doctor of Global Environmental Studies / Kyoto University / DGAM