Primary localized rectal/pararectal gastrointestinal stromal tumors: results of surgical and multimodal therapy from the French Sarcoma group.

BACKGROUND: Rectal and pararectal gastrointestinal stromal tumors (GISTs) are rare. The optimal management strategy for primary localized GISTs remains poorly defined. METHODS: We conducted a retrospective analysis of 41 patients with localized rectal or pararectal GISTs treated between 1991 and 2011 in 13 French Sarcoma Group centers. RESULTS: Of 12 patients who received preoperative imatinib therapy for a median duration of 7 (2-12) months, 8 experienced a partial response, 3 had stable disease, and 1 had a complete response. Thirty and 11 patients underwent function-sparing conservative surgery and abdominoperineal resection, respectively. Tumor resections were mostly R0 and R1 in 35 patients. Tumor rupture occurred in 12 patients. Eleven patients received postoperative imatinib with a median follow-up of 59 (2.4-186) months. The median time to disease relapse was 36 (9.8-62) months. The 5-year overall survival rate was 86.5%. Twenty patients developed local recurrence after surgery alone, two developed recurrence after resection combined with preoperative and/or postoperative imatinib, and eight developed metastases. In univariate analysis, the mitotic index (≤5) and tumor size (≤5 cm) were associated with a significantly decreased risk of local relapse. Perioperative imatinib was associated with a significantly reduced risk of overall relapse and local relapse. CONCLUSIONS: Perioperative imatinib therapy was associated with improved disease-free survival. Preoperative imatinib was effective. Tumor shrinkage has a clear benefit for local excision in terms of feasibility and function preservation. Given the complexity of rectal GISTs, referral of patients with this rare disease to expert centers to undergo a multidisciplinary approach is recommended.

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.

OBJECTIVE: To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," published in 2004. DESIGN: Modified Delphi method with a consensus conference of 55 international experts, several subsequent meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. This process was conducted independently of any industry funding. METHODS: We used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations. A strong recommendation (1) indicates that an intervention's desirable effects clearly outweigh its undesirable effects (risk, burden, cost) or clearly do not. Weak recommendations (2) indicate that the tradeoff between desirable and undesirable effects is less clear. The grade of strong or weak is considered of greater clinical importance than a difference in letter level of quality of evidence. In areas without complete agreement, a formal process of resolution was developed and applied. Recommendations are grouped into those directly targeting severe sepsis, recommendations targeting general care of the critically ill patient that are considered high priority in severe sepsis, and pediatric considerations. RESULTS: Key recommendations, listed by category, include early goal-directed resuscitation of the septic patient during the first 6 hrs after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm potential source of infection (1C); administration of broad-spectrum antibiotic therapy within 1 hr of diagnosis of septic shock (1B) and severe sepsis without septic shock (1D); reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate (1C); a usual 7-10 days of antibiotic therapy guided by clinical response (1D); source control with attention to the balance of risks and benefits of the chosen method (1C); administration of either crystalloid or colloid fluid resuscitation (1B); fluid challenge to restore mean circulating filling pressure (1C); reduction in rate of fluid administration with rising filing pressures and no improvement in tissue perfusion (1D); vasopressor preference for norepinephrine or dopamine to maintain an initial target of mean arterial pressure > or = 65 mm Hg (1C); dobutamine inotropic therapy when cardiac output remains low despite fluid resuscitation and combined inotropic/vasopressor therapy (1C); stress-dose steroid therapy given only in septic shock after blood pressure is identified to be poorly responsive to fluid and vasopressor therapy (2C); recombinant activated protein C in patients with severe sepsis and clinical assessment of high risk for death (2B except 2C for postoperative patients). In the absence of tissue hypoperfusion, coronary artery disease, or acute hemorrhage, target a hemoglobin of 7-9 g/dL (1B); a low tidal volume (1B) and limitation of inspiratory plateau pressure strategy (1C) for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure in acute lung injury (1C); head of bed elevation in mechanically ventilated patients unless contraindicated (1B); avoiding routine use of pulmonary artery catheters in ALI/ARDS (1A); to decrease days of mechanical ventilation and ICU length of stay, a conservative fluid strategy for patients with established ALI/ARDS who are not in shock (1C); protocols for weaning and sedation/analgesia (1B); using either intermittent bolus sedation or continuous infusion sedation with daily interruptions or lightening (1B); avoidance of neuromuscular blockers, if at all possible (1B); institution of glycemic control (1B), targeting a blood glucose < 150 mg/dL after initial stabilization (2C); equivalency of continuous veno-veno hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1A); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding using H2 blockers (1A) or proton pump inhibitors (1B); and consideration of limitation of support where appropriate (1D). Recommendations specific to pediatric severe sepsis include greater use of physical examination therapeutic end points (2C); dopamine as the first drug of choice for hypotension (2C); steroids only in children with suspected or proven adrenal insufficiency (2C); and a recommendation against the use of recombinant activated protein C in children (1B). CONCLUSIONS: There was strong agreement among a large cohort of international experts regarding many level 1 recommendations for the best current care of patients with severe sepsis. Evidenced-based recommendations regarding the acute management of sepsis and septic shock are the first step toward improved outcomes for this important group of critically ill patients.

Impact of duration of chest tube drainage on pain after cardiac surgery.

OBJECTIVE: This study was designed to analyze the duration of chest tube drainage on pain intensity and distribution after cardiac surgery. METHODS: Two groups of 80 cardiac surgery adult patients, operated on in two different hospitals, by the same group of cardiac surgeons, and with similar postoperative strategies, were compared. However, in one hospital (long drainage group), a conservative policy was adopted with the removal the chest tubes by postoperative day (POD) 2 or 3, while in the second hospital (short drainage group), all the drains were usually removed on POD 1. RESULTS: There was a trend toward less pain in the short drainage group, with a statistically significant difference on POD 2 (P=0.047). There were less patients without pain on POD 3 in the long drainage group (P=0. 01). The areas corresponding to the tract of the pleural tube, namely the epigastric area, the left basis of the thorax, and the left shoulder were more often involved in the long drainage group. There were three pneumonias in each group and no patient required repeated drainage. CONCLUSIONS: A policy of early chest drain ablation limits pain sensation and simplifies nursing care, without increasing the need for repeated pleural puncture. Therefore, a policy of short drainage after cardiac surgery should be recommended.

Interstitial pregnancies' diagnosis and management: an eleven cases series.

PRINCIPLES: Interstitial pregnancy represents 2% of ectopic pregnancies, but it is a highly morbid condition with a 2.5% of maternal mortality. Its diagnostic and therapeutic management remains controversial. The aim of this review is to describe the management of interstitial pregnancy in our institution between 2001 and 2011 and to define some general rules for the clinical practice. METHODS: Single institution retrospective study. RESULTS: Eleven women were treated for interstitial pregnancy. The median age was 33 years and the median gestity was 4. Seven patients had a history of gynaecological surgery and four interstitial pregnancies followed in vitro fertilisation. The diagnosis was made at a median gestational age of seven weeks with a median beta-HCG level of 5,838 U/l. Six of the eleven patients received an initial treatment with intracornual methotrexate, three with intramuscular methotrexate and two with surgery. The median time to beta-HCG resolution was 58 days. Three of the eleven patients needed a second line treatment: two after intramuscular methotrexate and one after intracornual methotrexate. Six patients had further pregnancies and delivered by caesarean section. CONCLUSIONS: A high prevalence of previous ectopic pregnancies, gynaecological surgery and of pregnancies resulting from in vitro fertilisation was observed. The earliness of the diagnosis was the factor that allowed a conservative treatment in most cases. Beta-HCG level follow up was fundamental in allowing a second line therapy but beta-HCG can persist over a long period of time and this must be taken into account due to its possible psychological impact. Intracornual methotrexate seems to be more efficacious than intramuscular methotrexate in our series.

Management of transitional-cell carcinoma of the renal pelvis and ureter.

Transitional-cell carcinoma of the renal pelvis or ureter is a relatively rare disease. Several risk factors are smoking, occupational carcinogens, analgesic abuse or Balkan nephropathy. The grade and stage of the disease have the most significant impact on the outcome. The treatment of renal pelvis and ureter tumours is open or laparoscopic surgery varying from conservative to more extensive surgical procedures, i.e. radical nephroureterectomy including removal of the contents of Gerota's fascia with ipsilateral ureter and a cuff of bladder at its distal extent. Most available data are from retrospective studies and surgery is the mainstay of treatment. Chemotherapy and/or radiation therapy are possible adjuvant or primary treatment for selected patients; however, prospective studies are needed to confirm their use.

The battle over deficits : the struggle to maintain Canada's social welfare state : a thesis /

Abstract This thesis seeks to answer a number of questions concerning the deficit and debt in Canada. It focuses pri.arily on the federal level of government but with SOBe discussion of provincial governaent policy as well. In ~997, Canada's federal debt caae close ro six hundred billion dollars - $594 billion or 74.4 % of Gross Do.estic Product (GDP) to be exact. The purpose of this theses is threefold: To find out why Canada accu.ulated such a debt, to discover if there is a so-called debt crisis; and to discover if it is possible to preserve Canada's national welfare state given the financial restraints that have been adopted by both federal and provincial governments. Politicians are torn between economist' two contrasting views regarding deficits: Neo-Keynesian and neo-conservative. The neoKeynesian school focuses al1llOst exclusively on the short term stability of the economy and tends to dismiss concerns regarding the level of debt. Neo conservatives focus almost exclusively on the perceived costs of growth in the national debt and are willing to forego any stabilization benefits to ensure that the debt is controlled. These polar view do have one thing in coa.on; both confix-. that deficits influence govermaent policies. Both of these econoBic theories will have far-reaching influences on the federal gover1lJlJent's decision-making process. These economic theories will be discussed throughout this thesis.

Heroes on the home front : heroism and virtue in post-9/11 American cinema /

This thesis is intended to contribute to critical discussion of the American male hero in mainstream American war and action films post September 11, 2001 . The thesis investigates how these heroes' behaviour echoes a patriotic, conservative construction of the modern American as created through speeches given by George W. Bush in the wake of the events of September 11, 2001 . The thesis examines the hero in six primary sources: the war films We Were Soldiers, Behind Enemy Lines and The Great Raid and the action films Collateral Damage, Man on Fire and The Punisher. By analyzing the ideological subtext, political content, visual strategies and generic implications of the films, as well as the binary constructions of a selection of Bush speeches, and by reviewing historical representations of American male heroes on film produced in the wake of political events, the thesis concludes that the six films mobilize the USA's conservative viewpoint towards war and military action, and in concert with the speeches, contribute to an ongoing militarization of visual culture. Both systems echo a dangerous ideological fantasy of American history, life and patriotism.

Why are people liberal? : a motivated social cognition perspective

The present dissertation examined why people adopt or endorse certain political ideologies (i.e., liberal or conservative). According to a motivated social cognition perspective (Jost, Glaser, Kruglanski, & Sulloway, 2003a; Kruglanslconservatives, it was proposed that four social-cognitive needs (Need for Inclusiveness, Need for Understanding, Need for Change, and Avoidance of Decisional Commitment) would be associated with liberalism. Moreover, research suggests that the relations between the needs and liberalism might be moderated by political sophistication (e.g., Converse, 1964). University students (Study 1; n == 201) and community adults (Study 2; n == 197) completed questionnaires assessing political liberalism, political sophistication, and individual differences 're~ective of the four proposed needs. As predicted, correlation and hierarchical regression analyses in both Studies 1 and 2 indicated that political liberalism was related to Need for Inclusiveness, Need for Understanding, and Need for Change. 11 Avoidance of Decisional Commitment uniquely predicted political liberalism in Study 2; however, contrary to predictions, it was unrelated to political liberalism in Study 1. Furthermore, some of these relations were moderated by political sophistication, such that among individuals with a greater knowledge of politics, the relation between certain needs and liberalism was positive. To explore the role of situationally induced needs on political liberalism, each of the four proposed needs were manipulated in Study 3. Participants (n == 120) completed one of five scrambled-sentence tasks (one for each need condition and control condition), measures of explicit and implicit political liberalism, political sophistication, and state and trait measures indicative of the four proposed needs. The ~anipulation did not successfully prime participants with the needs. Therefore, a replication of the analyses from Studies 1 and 2 was conducted on the dispositional needs. Results showed that Need for Inclusiveness, Need for Understanding, and Need for Change were linked with greater explicit and implicit political liberalism. Study 4 examined the effect of manipulated Need for Inclusiveness on participants' endorsement ofpolitical liberalism, independent of conservatism. Participants (n == 43) were randomly assigned to a Need for Inclusiveness or control condition, and completed separate measures of political liberalism and conservatism, and political sophistication. Participants in the Need for Inclusiveness condition reported greater liberalism than those in a control condition; this effect was not moderated by political sophistication. Generally, the findings from this dissertation suggest that there might be other needs underlying political ideology, especially political liberalism. Thus, consistent with others' (Jost, Glaser et aI., 2003a), individuals might adopt political liberalism as a way of gratifying certain psychological needs. Implications and future research are discussed.

Multinational drug corporations, intellectual property rights and the Canadian state : a historical and critical analysis

This study critically analyzes the historical role and influence of multinational drug cotpOrations and multinational corporations in general; the u.s. government and the Canadian state in negotiating the global recognition ofIntellectual Property Rights (IPR) under GATT/NAFTA. This process began in 1969 when the Liberal government, in response to high prices for brand-name drugs amended the Patent Act to introduce compulsory licensing by reducing monopoly protection from 20 to seven years. Although the financial position ofthe multinational drug industry was not affected, it campaigned vigorously to change the 1969 legislation. In 1987, the Patent Act was amended to extend protection to 10 years as a condition for free trade talks with the u.s. Nonetheless, the drug industry was not satisfied and accused Canada of providing a bad example to other nations. Therefore, it continued to campaign for global recognition ofIPR laws under GATT. Following the conclusion of the GATTI Trade-Related aspects of Intellectual Property Rights agreement (TRIPS) in 1991, the multinational drug industry and the American government, to the surprise of many, were still not satisfied and sought to implement harsher conditions under NAFTA. The Progressive Conservative government readily agreed without any objections or consideration for the social consequences. As a result, Bill C-91 was introduced. It abandoned compulsory licenses and was made retroactive from December 21, 1991. It is the contention of this thesis that the economic survival of multinational corporations on a global scale depends on the role and functions of the modem state. Similarly, the existence of the state depends on the ideological-political and socioeconomic assistance it gives to multinational corporations on a national and international scale. This dialectical relation of the state and multinational corporations is explored in our theoretical and historical analysis of their role in public policy.

The role of a minor party : a comparative study of the British Liberal Party and the Australian Country Party since 1918

and the Australian Country Party since 1918. 2. The thesis examines the proposition that the role of a minor party is determined, not by its total strength expressed as a percentage of the national vote, but by how its strength is concentrated. Australia and Britain were chosen for the comparison because of the many similarities in political culture and in the extent of class voting. Each country has a party - the Country Party in Australia and the Liberal Party in Britain - which has had a distinct impact on the political scene in their respective countries. In the period from 1918 to the present day neither party, at the national level, has ever held the largest number of seats in parliament let alone a majority of seats, and it is in this sense that they are herein defined as minor parties. In the thesis the constitutional background of and differences between Australia and Britain are reviewed, followed by a brief historical picture of each of the two parties being studied. The sources of supporc of the two parties are analysed and it is here that real differences emerge. The Country Party in Australia is a deliberately sectional party with a narrow rural base, whereas the British Liberal Party is more broadly based than either the Labour or Conservative Parties in Britain. 3. Party leadership and organisation are then discussed. Both parties have had outstanding leaders, Earle Page and McEwen for the Country Party; Asquith, Lloyd George and Grimond for the Liberal Party. Both parties have had relatively fewer leaders than their major party opponents. However, whereas the Country Party has been free of serious splits the Liberal Party was shattered on the leadership struggles of Asquith and Lloyd George. Both parties have been identified with decentralisation of state power, the Country Party through its support, albeit sometimes lukewarm of the New States Movement; the Liberal Party through its espousal of a federal system for Britain with separate Welsh, Scottish and regional assemblies. Unfortunately for the British Liberal Party the beneficiaries of their policies in this area have been relatively new nationalist parties in both Wales arid Scotland. The major part of the thesis is devoted to a study of how the electoral systems in the two countries have, in practice, worked to the advantage or disadvantage of the Country Party and the British Liberal Party. The Country Party has been as consistently over-represented in the House of Representatives as the Liberal Party has been under-represented in the British House of Commons. With the even distribution of its support the introduction of the single transferable vote, in itself, would bring little benefit to the British Liberal Party in terms of seats. Multimember urban constituencies combined with some type of list system are the only way the Liberals are likely to obtain House of Commons seats in proportion to their votes. 4. Finally, the relations of the two minor parties with their respective major parties are considered. In the conclusion the future of the two parties is reviewed. In general terms it appears that the Country Party is faced with a slow decline. Although the British Liberal Party made a major breakthrough, in terms of votes, in the February 1974 election, they were unable to maintain this momentum in the October election, even though they lost very little ground. In the long term they must make an inroad into Labour held seats if they are to progress further.

John Smith, M.P fonds, 1930, 1949-1950, 1954, 1957-1962, n.d.

John Smith (1894-1977), son of Daniel Smith and Annie Douglas was a native of Scotland, immigrating to Canada in 1913. He first worked as a coach builder, then as a carpenter, finally developing his own contracting business. During WWI he served overseas with the 10th Battery, RCA as a sergeant. In 1924 Smith married Jean Wood, and together they had a daughter Irene (Hugh Langley). Smith first entered politics in 1940 serving as an alderman for the next 11 years. In 1954 he was elected mayor of the city of St. Catharines, and was twice returned to office by acclamation, serving until 1957 when he successfully ran as the Progressive Conservative candidate representing Lincoln County in the federal election. He won the election by a 10 000 vote majority. He served his constituents in Ottawa until he was defeated in the 1962 election. After leaving politics Mr. Smith was active in his community. He spearheaded the establishment of the St. Catharines Museum, and then was appointed its first director in 1966, serving in that capacity until 1972. He was an active member of the board of governors of the St. Catharines General Hospital and a life member and former president of the Lincoln County Humane Society. In 1971 he was voted Citizen of the Year for the city of St. Catharines. John Smith died on February 8, 1977 and was buried at Victoria Lawn Cemetery. Source: The St. Catharines Standard, February 9, 1977, page 1

F. R. Lalor and Wm. Jaques Papers, 1910

F.R. [Francis Ramsey] Lalor (1856-1929) was born in St. Catharines, Ont. but lived most of his life in Dunnville, Haldimand County, Ont. He was a merchant and manufacturer. In 1903 he and a few partners founded the Monarch Knitting Co. Lalor was also an exporter of hardwood ashes used for agricultural purposes as fertilizer. Lalor was active in politics, he was a Conservative and the member of parliament for Haldimand, having been elected in the 1904, 1908, 1911 and 1917 elections. William Jaques lived in Simcoe, Norfolk County, Ontario. He was a junk dealer by profession.

Ontario's curriculum for individuals with disabilities : a textual analysis

The purpose of this study was to examine the disability discourses present in Ontario elementary schools curriculum. The study used a critical social analysis perspective to employ a textual discourse analysis on the Planning [title of subject] Programs for Students with Special Education Needs (PPSSEN) section of the curriculum. The present study utilized Parker's (1992) seven criteria for distinguishing discourses and discovered five main discourses; Independent, dependent, legal, scientific and agency discourses. The second step to this research was the placement and discussion of these five discourses on three diverse texts, Paulo Freire's (2008) Pedagogy o/ the Oppressed, Psychiatry Inside Out, Selected writings of Franco Basaglia, written by Scheper-Huges and Lovell (1987) and Aronowitz and Giroux's (1985) Education Under Siege: The Conservative, Liberal and Radical Debate over Schooling. These unique perspectives were used as methods of analysis tools to further analyze the dominate disability discourses. The texts provided textual support in three major areas; dialectics, critical education and structural conditions of power and language of traditional roles and responsibilities. The findings and discussions presented in this project contain significant implications for anyone involved with students with disabilities in any education system.

Hoosiers on the Hardwood: A Critical Examination of Indiana Basketball Culture and its Effect on Identity Formation

The purpose of this research was to examine the nexus at which Indiana basketball and the state’s ‘hoosier’ identity meet. More specifically, this thesis interrogates the romanticization of this sporting culture for its pedagogical role in the creation of twenty-first century ‘hoosier’ bodies. Adopting a theoretical orientation rooted in critical race theory, I argue that Indiana’s basketball culture represents a normalized / normalizing structure underneath which Otherness is reified to produce hypervisible “different” outsiders (‘non-hoosiers’), and invisible “disciplined” insiders (i.e. ‘hoosiers’). Utilizing data gleaned over a two-month period spent conducting fieldwork in the “hoosier state” (document analysis, unstructured interviewing, and participant observation), I specifically tailor my analysis to uncover people’s understanding, negotiation, and performance of this regional and national subject position. From this point of inquiry, authentic ‘hoosierness’ comes to be represented, known, practiced, and felt in relation to hierarchies of power that privilege white, hypermasculine, rural, and conservative bodies.

William B. Rollason fonds, 1930-1934, 1936, 1941-1947, 1950-1952, 1956-1958.

William B. Rollason was a businessman from St. Catharines. His business interests included insurance sales, real estate and housing development. He was an active Rotarian, serving as president from 1945 to 1946. He served on the Niagara Parks Commission Board from 1944 until his death in 1959. Mr. Rollason was the president of the St. Catharines Chamber of Commerce, president of the Lincoln County Conservative Association, a member of the Navy Island Peace Capital Group, vice chairman of the War Savings Committee and part owner of the Welland House Hotel in St. Catharines.