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OBJECTIVES: Despite numerous studies in which various methods for arteriotomy closure after carotid endarterectomy (CEA) have been addressed, the optimum surgical technique to reduce complications and late carotid restenosis has yet to be firmly established. The purpose of this study was to prospectively compare the results of the eversion CEA technique with those of conventional CEA with either primary closure or carotid patch angioplasty, and to determine under clinical conditions whether eversion CEA influences the results and restenosis rate. PATIENTS AND METHODS: Over a 3-year period, 322 CEAs performed on 296 consecutive patients were concurrently evaluated. This study included 118 eversion CEAs, 97 CEAs with primary closure, and 107 CEAs with patch angioplasty. There were no differences in demographics, in surgical indications, or in the severity of carotid disease (not significant [NS]). The choice of CEA technique was not randomized because of technical considerations and surgeon preference. After entry into the protocol, no patients were excluded or withdrawn. Carotid restenosis was defined as a > 60% lumen reduction at the CEA site with established duplex ultrasonography criteria. RESULTS: The mean operative time for eversion CEA was 31 minutes, for CEA-primary closure it was 39 minutes, and for CEA-patch angioplasty it was 46 minutes (P <.01). The operative mortality rate for eversion CEA was 0.8% (1 patient), for CEA-primary closure it was 1.0% (1 patient), and for CEA-patch angioplasty it was 2.8% (3 patients) (NS). The postoperative stroke rate was 0.8% after eversion CEA, 1.0% after CEA-primary closure, and 2.8% after CEA-patch angioplasty (NS). The combined stroke and death rate in each group was thus 0.8% for eversion CEA (1 stroke-death), 1% for CEA with primary closure (1 stroke-death), and 5% for CEA with patch angioplasty (1 stroke-death, 2 fatal myocardial infarctions, and 2 nonfatal strokes) (NS). Transient ischemic attacks occurred in 2.5% after eversion CEA, in 5.2% after CEA-primary closure, and in 2.9% with CEA-patch angioplasty (NS). The mean clinical follow-up for all three groups was 23 months (range, 6-42 months) (NS). The restenosis rate was 1.7% after eversion CEA, 9.3% after CEA-primary closure, and 6.5% after CEA-patch angioplasty (P <.05). CONCLUSIONS: This prospective, nonrandomized clinical study indicates that eversion CEA is an effective surgical option comparable to conventional CEA with either primary arteriotomy closure or carotid patch angioplasty. No differences were found between eversion CEA and these more widely accepted CEA closure techniques with respect to operative morbidity and mortality. These data indicate, however, that eversion CEA has a lower restenosis rate than conventional CEA closure techniques and thus superior long-term durability.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

It is often important to detect an increase in the frequency of some event. Particular attention is given to medical events such as mortality or the incidence of a given disease, infection or birth defect. Observations are regularly taken in which either an incidence occurs or one does not. This dissertation contains the result of an investigation of prospective monitoring techniques in two distinct surveillance situations. In the first situation, the observations are assumed to be the results of independent Bernoulli trials. Some have suggested adapting the scan statistic to monitor such rates and detect a rate increase as soon as possible after it occurs. Other methods could be used in prospective surveillance, such as the Bernoulli cumulative sum (CUSUM) technique. Issues involved in selecting parameters for the scan statistic and CUSUM methods are discussed, and a method for computing the expected number of observations needed for the scan statistic method to signal a rate increase is given. A comparison of these methods shows that the Bernoulli CUSUM method tends to be more effective in detecting increases in the rate. In the second situation, the incidence information is available at multiple locations. In this case the individual sites often report a count of incidences on a regularly scheduled basis. It is assumed that the counts are Poisson random variables which are independent over time, but the counts at any given time are possibly correlated between regions. Multivariate techniques have been suggested for this situation, but many of these approaches have shortcomings which have been demonstrated in the quality control literature. In an attempt to remedy some of these shortcomings, a new control chart is recommended based on a multivariate exponentially weighted moving average. The average run-length performance of this chart is compared with that of the existing methods. / Ph. D.

The prospective student-athletes’ use of an online recruiting platform to seek college scholarships has become a norm. College coaches recruit prospective-student athletes often using tools like global personal contacts, on-site recruiting, and online recruiting platforms. Online recruiting platforms offer several services and vary in price. This study examines female student-athlete golfers’ use of the online recruiting platform to seek scholarships from a global perspective. Previous research suggests that prospective student-athletes prefer online recruiting platforms while college coaches often use other outlets which can lead to miscommunication and lost opportunities. The services, price, and usability of 20 sports online recruiting platforms in the United States were examined to find out what is offered to prospective-student athletes. Interviews of NCAA Division I collegiate coaches were conducted to examine the most common recruiting tools used by the coaches and their opinions of the use of online recruiting platforms.

In epidemiology it is often useful to monitor disease occurrences prospectively to determine the location and time when clusters of disease are forming. This aids in the prevention of illness and injury of the public and is the reason spatio-temporal disease surveillance methods are implemented. Care must be taken in the design and implementation of these types of surveillance methods so that the methods provide accurate information on the development of clusters. Here two spatio-temporal methods for prospective disease surveillance are considered. These include the local Knox monitoring method and a new wavelet-based prospective monitoring method. The local Knox surveillance method uses a cumulative sum (CUSUM) control chart for monitoring the local Knox statistic, which tests for space-time clustering each time there is an incoming observation. The detection of clusters of events occurring close together both temporally and spatially is important in finding outbreaks of disease within a specified geographic region. The local Knox surveillance method is based on the Knox statistic, which is often used in epidemiology to test for space-time clustering retrospectively. In this method, a local Knox statistic is developed for use with the CUSUM chart for prospective monitoring so that epidemics can be detected more quickly. The design of the CUSUM chart used in this method is considered by determining the in-control average run length (ARL) performance for different space and time closeness thresholds as well as for different control limit values. The effect of nonuniform population density and region shape on the in-control ARL is explained and some issues that should be considered when implementing this method are also discussed. In the wavelet-based prospective monitoring method, a surface of incidence counts is modeled over time in the geographical region of interest. This surface is modeled using Poisson regression where the regressors are wavelet functions from the Haar wavelet basis. The surface is estimated each time new incidence data is obtained using both past and current observations, weighing current observations more heavily. The flexibility of this method allows for the detection of changes in the incidence surface, increases in the overall mean incidence count, and clusters of disease occurrences within individual areas of the region, through the use of control charts. This method is also able to incorporate information on population size and other covariates as they change in the geographical region over time. The control charts developed for use in this method are evaluated based on their in-control and out-of-control ARL performance and recommendations on the most appropriate control chart to use for different monitoring scenarios is provided. / Ph. D.

Fragestellung: Die Symptome einer drohenden und die tatsächlich eingetretene Frühgeburt stehen am Ende eines pathophysiologischen Prozesses, der bislang ungenügend verstanden wird. So verwundert es nicht, wenn bisherige Präventions- und Therapiestrategien unzureichende Erfolge in der Prävention der Frühgeburtlichkeit gebracht haben. Ähnliches ist für die intrauterine Wachstumsretardierung festzustellen, die wohl das Ergebnis eines sehr früh in der Schwangerschaft beginnenden Prozesses darstellt. Es gibt eine Reihe von Studien, die die Bedeutung psychosozialer Bedingungen für den Verlauf von Schwangerschaft und Geburt belegen. Entscheidende Defizite bisheriger Untersuchungen liegen zum einen in der Vernachlässigung wichtiger psychosozialer Einflussfaktoren (insbesondere Ängste, Kindheitserfahrungen, soziale Netze und Partnerschaft) zum anderen beschränkt das retrospektive Design die Aussagekraft. Material und Methode: In der vorliegenden prospektiven Studie wurde 589 Frauen in der 16. - 22. SSW mittels eines im Projekt entwickelten Fragebogens untersucht. Von 508 Einlingsschwangeren konnten später Daten zum Schwangerschafts- und Geburtsverlauf aus den medizinischen Unterlagen entnommen werden. Zur Datenreduktion wurden Faktorenanalysen mit der Hauptkomponentenmethode und anschließender Varimax-Rotation gerechnet und die ermittelten Faktoren einer Reliabilitätsprüfung unterzogen. Als statistisches Auswertungsverfahren wurde die logistische Regression eingesetzt. Ergebnisse: Die vorliegende Untersuchung erbrachte erste interessante Hinweise auf gleichgerichtete aber auch unterschiedliche Ressourcen- und Risikokonstellationen bei verschiedenen, im Kontext der Frühgeburtlichkeit bedeutsamen Komplikationen. Schwangere, die wegen drohender Frühgeburt behandelt werden, scheinen stärker sozial belastet zu sein als diejenigen, die später tatsächlich vor der vollendeten 37. SSW gebären. Ein fehlendes weibliches Netzwerk und fehlendes emotionales Verständnis des Partners sind mit beiden Komplikationen korreliert, wobei die Paarbeziehung für die tatsächliche eintretende Frühgeburt eine besondere Bedeutung hat. Eine anamnestische Belastung durch gynäkologische Störungen war ebenfalls sowohl für die drohenden wie auch die tatsächlich eingetretene Frühgeburt prädiktiv. Ausgeprägte schwangerschaftsbezogene Ängste und eine geringe allgemeine Ängstlichkeit sind weitere signifikante Prädiktoren im Modell der Frühgeburt vor der vollendeten 37. SSW. Schwangere, deren Kinder intrauterin eine Mangelentwicklung erfahren, haben in der vorliegenden Studie eine unreflektierte Ambivalenz gegenüber Schwangerschaft und Mutterrolle. Sie betonen auf bewusster Ebene die Erwünschtheit ihrer Schwangerschaft, während unbewusste negative Emotionen auf potentielle somatische Probleme projiziert werden. Ein niedriger prägravider BMI wird sowohl durch andere Untersucher wie auch durch die eigenen Ergebnisse als Risikofaktor bestätigt. Neben den bekannten somatischen Einflüssen ist auch an einen Zusammenhang im Kontext der unbewussten Ablehnung weiblicher Körperlichkeit, wie sie z.B. von Anorexiepatientinnen bekannt ist, zu denken. Schlussfolgerungen: Paarbeziehung, weibliche Netzwerke, psychosomatische Reagibilität in Hinblick auf Erkrankungen der reproduktiven Organe und Ängste verdienen zur Prävention der Frühgeburt stärkere Aufmerksamkeit. Angebote psychosozialer Unterstützung sollten frühzeitig in der Gravidität und zielgruppenspezifisch gemacht werden und die Schwangeren in ihrem Kompetenz- und Autonomieempfinden stützen. / Research question: The symptoms of preterm labour and preterm delivery stand at the end of a pathophysiological process which is understood up to now insufficiently. So it does not amaze if previous preventive and therapeutic strategies have brought inadequate successes in the prevention of preterm delivery. Similar one is to be arrested for the intrauterine fetal growth retardation which represents presumably the result of a process beginning very early in the pregnancy. Some studies give evidence for psychosocial conditions for the process of pregnancy and birth. On the one hand fundamental deficits of previous investigations are in the disregard of important psychosocial performance-influencing factors (in particular fears, biographic factors, social network and partnership), on the other hand the retrospective design limits the informative value. Material and means: In the present prospective study 589 women between 16th and 22nd week of pregnancy were examined using a questionnaire that was designed for the study. This resulted in 508 women pregnant with a single child, whose pregnancy and delivery were examined based on their medical records. Factor analysis and main component analysis with subsequent varimax rotation resulted in factors that were subject to a proof of reliability. Statistical analysis was based on logistic regression. Results: The present investigation produced first interesting indications of rectified but also different resource and risk constellations in the context of the preterm delivery. Pregnant women with preterm labour seeming to be burdened more strongly socially than those that later in fact have a preterm delivery. A missing feminine net and missing emotional understanding of the partner are correlated with both complications. The partnership has a special importance for the preterm delivery. An anamnestic load through gynaecological troubles was predictive also both for the threatening labour ones as also the preterm delivery. Marked pregnancy related fears and a small general anxiety are further significant predictors in the model of the preterm delivery. Pregnant women with intrauterine fetal retardation have in the present study an unconscious ambivalence opposite pregnancy and motherhood. On conscious tier they stress the desire of their pregnancy while unconscious negative emotions are being projected onto potential somatic problems. Compatible with other investigations a low pre-pregnancy weight was a risk factor. Next to the known somatic influences also a connection is to be thought of in the context of the unconscious refusal of feminine body as for example is known from anorectic patients. Conclusions: Partner relationship, female networks, psychosomatic reactivity in terms of diseases/disorders of the reproductive organs, and anxieties appear to be worthwhile targets in the prevention of preterm delivery. Psychosocial support should be given oriented to different target groups from early in the pregnancy.

Les opérations d'aménagement dans le domaine de l'énergie (les réseaux de transport d'électricité et les éoliennes) font face, à partir des années 1990, à la multiplication des revendications esthétiques vis-à-vis desquelles les aménageurs répondent de plus en plus en termes de projet de paysage. Ces deux tendances témoignent de l'affirmation d'une préoccupation contemporaine pour le milieu. Cette thèse examine en quoi la question esthétique, loin de se résumer à une forme de protestation commode, pourrait être un terrain favorable pour la prise en compte du milieu par l'aménagement. Dans une première partie, en nous appuyant sur Kant et Jacques Rancière, nous proposons que les stratégies esthétiques modifient les modes d'appréhension du milieu et favorisent sa prise en compte en aménagement. Plutôt que la notion de controverse, la cohérence de cette approche est mise en valeur à travers la notion de mésentente, proposée par Jacques Rancière. Il apparaît, à travers la contestation du projet THT en Quercy Blanc, que les stratégies esthétiques contribuent à la reconnaissance des qualités du milieu par l'aménagement mais qu'elles se heurtent au contenu normatif de sa méthodologie de projet. Sommes-nous prisonnier d'un écart insurmontable entre la lecture esthétique du milieu et l'univers normatif de l'action ? Dans une seconde partie, nous avançons que l'aménagement peut tirer parti du milieu à condition de trouver une méthode prospective qui le conjecture comme un potentiel. À travers l'intérêt de Gilles Deleuze pour la symptomatologie, nous parvenons à approcher l'aménagement, non plus par sa capacité normative et anticipatrice à arrêter le sens des choses, mais comme l'art d'expérimenter de nouvelles possibilités d'existence. En étudiant deux exemples de planification éolienne, en Aveyron et dans l'Aude, il apparaît que si l'aménagement considère le milieu comme le lieu de validation d'une rationalité pratique, sa maîtrise du développement éolien est faible. Inversement, nous avons mis à jour qu'une prospective du milieu, fondée sur une approche multi-scalaire et une sémiologie cartographique non-déterminante, permettait d'asseoir une planification éolienne plus efficace.

本研究分析在2005年台北縣長選舉中，民眾是否以回顧性評價或是展望性評估來決定其投票對象。運用2006年「台灣選舉與民主化調查」的研究資料，分析民眾對於過去的家庭經濟情況、社會整體經濟狀況評價及施政表現；以及民眾對於未來家庭經濟、總體經濟狀況評估及主要政黨候選人展望性預期，是否影響其投票行為。 本研究發現：控制民眾的人口學背景以及其他政治態度之後，民眾認為過去整體經濟情況變差者，愈不傾向投給民進黨候選人。認為民進黨候選人愈具備執政能力者則愈傾向投給他。除此之外，民眾的政黨認同也具有重要的影響力。 從本研究的結果可以得知，民眾會運用理性的標準，判斷過過去總體經濟表現與未來哪位候選人較具執政能力而決定其投票對象。顯示執政者應該以總體經濟表現以及優秀的人才，才可以吸引選民持續的支持。 / In this Study, we employ individual-level survey data collected by ‘Taiwan’s Election and Democratization Study” in the 2005 Taipei Magistrate election to examine whether voters apply retrospective voting or prospective voting. We include variables such as personal well-being and national economics performance in the past ,candidate evaluation and expectations on future economic performance to see how these variables might affect their voting behavior. We demonstrate that, after controlling demographic variables and other political attitudes, when voters consider national economy is worse off, he/she voted against the incumbent party. However, voters give greater support to candidates of the incumbent party if he/she believes this candidate is competent to govern Taipei county. Additionally, party identification still exerts a powerful influence upon the individual vote decision. In the study, it is found that people decide their voting behavior is employ their rational calculations to examine sociotropic economic performance and candidate quality. Therefore, citizens are not fools, and the incumbent party has to realize the importance of governance and nominate qualified candidates to govern.

Les joueurs à risque modéré et pathologiques probables représentent respectivement 1,4 % et 0,4 % de la population dans la province de Québec (Kairouz, Paradis, Nadeau, Hamel, & Robillard, 2015). Bien que prolifique, la recherche sur les trajectoires des joueurs présente plusieurs limites méthodologiques menant à l'hétérogénéité des résultats et peu d’études ont empiriquement examiné les facteurs associés aux changements dans les habitudes de jeu. Par ailleurs, il est reconnu que les évènements de vie ont un impact sur le développement de la psychopathologie (Brown & Harris, 1989). L'objectif de cette thèse est d'étudier la façon dont les joueurs évoluent au fil du temps en fonction de la gravité de leurs comportements de jeu et des conséquences néfastes, et d'examiner de manière prospective les associations entre les évènements de vie et la sévérité des problèmes de jeu. Au cours d’un suivi de deux ans, comprenant trois temps de mesure, 179 joueurs sélectionnés à partir d'une enquête populationnelle ont été répartis dans quatre groupes (non-problème, à faible risque, à risque modéré et les joueurs pathologiques probables) selon leur score à l’indice canadien du jeu excessif (Ferris et al, 2001). La présence d'évènements de vie a également été évaluée chaque année. Nos analyses révèlent que les joueurs à risque modéré sont très hétérogènes, tant dans leur composition que dans leur évolution. Les joueurs pathologiques restent vulnérables et sont à risque de vivre des problèmes de jeu chroniques au fil du temps. Nos analyses ont également montré que certains évènements de vie spécifiques liés à la sphère professionnelle, financière, sociale et aux habitudes de vie, ainsi que le nombre cumulé d'évènements de vie, sont prospectivement associés à un niveau plus élevé de sévérité des problèmes de jeu un an plus tard. Cette thèse montre ainsi l'importance de tenir compte des spécificités du groupe des joueurs à risque modéré dans les programmes de prévention secondaire et de favoriser la continuité des soins et la prévention des rechutes dans les programmes de traitement. De plus, les circonstances sociales et le stress affectent les trajectoires de jeu et doivent également être pris en compte dans le champ de la prévention secondaire et du traitement. / Moderate risk and problem gamblers in the Province of Quebec represent 1.4% and 0.4% of the population, respectively (Kairouz et al., 2015). Albeit prolific, the research on gamblers’ trajectories has been hampered by several methodological shortcomings leading to heterogeneity in results. Moreover, few have empirically investigated factors that were associated with change. However, it is known that life events or significant changes in people's life have an impact on the development of psychopathology (Brown & Harris, 1989). The purpose of this thesis is to explore the ways in which gamblers evolve over time depending on the severity of their gambling behaviors and harmful consequences, and to examine prospectively associations between life events and problem gambling severity. Using a two-year follow-up prospective design including three measurement waves, 179 gamblers selected from a representative survey divided into the four categories (non-problem, low-risk, moderate-risk, and problem gamblers) of the Problem Gambling Severity Index (Ferris et al., 2001) were examined. Occurrence of life events was also assessed annually. Our analyses reveal that the moderate-risk gamblers are highly heterogeneous, both in their composition and their evolution. Problem gamblers remain vulnerable and are at-risk of experiencing chronic problems over time. Cross-lagged analyses showed that some specific life events related to work, financial, social and lifestyle arenas, as well as the cumulative number of life events, were prospectively associated with an increase in severity of problem gambling 12-months later. Thus, this dissertation shows the significance of addressing sub-group specificities in secondary prevention programs, and the necessity for continuity of cares and relapse prevention in treatment programs. Moreover, social circumstances and stress affect gambling trajectories and need to be taken into account in secondary prevention and treatment.