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Introduction: We delineated Canadian regional differences in practice patterns in the management of upper tract urothelial carcinoma (UTUC) after nephroureterectomy and relate these to patient outcomes.Methods: A database was created with 1029 patients undergoing radical nephroureterectomy for UTUC between 1994 and 2009 at 10 Canadian centres. Demographic, clinical and pathological variables were collected from chart review. Practice pattern variables were defined as: open versus laparoscopic nephroureterectomy, management strategy for the distal ureter, performance of lymphadenectomy and administration of chemotherapy and/or radiation therapy. The outcome measures were overall (OS), disease-specific (DSS) and recurrence-free survival (RFS). The centres were divided into three regions (West, Central, East). Cox proportional multivariable linear regression analysis was used to determine the association between regional differences in practice patterns and clinical outcomes.Results: There was a significant difference in practice patterns between regions within Canada for: time from diagnosis to surgery (p = 0.001), type of surgery (open vs. laparoscopic, p < 0.01) and method of management of the distal ureter (p = 0.001). As well, there were significant differences in survival between regions across Canada: 5-year OS (West 70%, Central 81% and East 62%, p < 0.0001) and DSS (West=79%, Central=85%, East=75%, p = 0.007) were significantly different, but there was no difference in RFS (West 47%, Central 48%, East 46%, p = 0.88). Multivariable linear regression analysis demonstrated that the differences in survival were independent of region OS (p = 0.78), DSS (p = 0.30) or RFS (p = 0.43).Conclusion: There is significant disparity in practice patterns between regions within Canada, but these do not appear to have an effect on survival. We believe that the variability in practice is a reflection of the lack of standardized treatments for UTUC and underlines the need for multi-institutional studies in this disease.

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?Open radical nephroureterectomy (ORNU) with excision of the ipsilateral bladder cuff is a standard treatment for upper tract urothelial carcinoma (UTUC). However, over the past decade laparoscopic RNU (LRNU) has emerged as a minimally invasive surgical alternative. Data comparing the oncological efficacy of ORNU and LRNU have reported mixed results and the equivalence of these surgical techniques have not yet been established. We found that surgical approach was not independently associated with overall or disease-specific survival; however, there was a trend toward an independent association between LRNU and poorer recurrence-free survival (RFS). To our knowledge, this is the first large, multi-institutional analysis to show a trend toward inferior RFS in patients with UTUC treated with LRNU.To examine the association between surgical approach for radical nephroureterectomy (RNU) and clinical outcomes in a large, multi-institutional cohort, as there are limited data comparing the oncological efficacy of open RNU (ORNU) and laparoscopic RNU (LRNU) for upper urinary tract urothelial carcinoma (UTUC).Institutional RNU databases containing detailed information on patients with UTUC treated between 1994 and 2009 were obtained from 10 academic centres in Canada. Data were collected on 1029 patients and combined into a relational database formatted with patient characteristics, pathological characteristics, and survival status. Surgical approach was classified as ORNU (n = 403) or LRNU (n = 446). The clinical outcomes were overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS). The Kaplan-Meier method and Cox proportional regression analysis were used to analyse survival data.Data were evaluable for 849 of 1029 (82.5%) patients. The median (interquartile range) follow-up duration was 2.2 (0.6-5.0) years. The predicted 5-year OS (67% vs 68%, log-rank P = 0.19) and DSS (73% vs 76%, log-rank P = 0.32) rates did not differ between the ORNU and LRNU groups; however, there was a trend toward an improved predicted 5-year RFS rate in the ORNU group (43% vs 33%, log-rank P = 0.06). Multivariable Cox proportional regression analysis showed that surgical approach was not significantly associated with OS (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.63-1.27, P = 0.52) or DSS (HR 0.90, 95% CI 0.60-1.37, P = 0.64); however, there was a trend toward an independent association between surgical approach and RFS (HR 1.24, 95% CI 0.98-1.57, P = 0.08).Surgical approach was not independently associated with OS or DSS but there was a trend toward an independent association between LRNU and poorer RFS. Further prospective evaluation is needed.

Whole-gland high-intensity focused ultrasound (HIFU) has been used as salvage therapy for local recurrence following external beam radiation therapy for decades. This article describes the use of the Sonablate 500 HIFU system in the salvage setting.An evaluation was performed of a consecutive group of men with biochemical failure after external beam radiation therapy with histologically proven local recurrence and bone-scan and pelvic magnetic resonance imaging to exclude macroscopic metastases, and who chose to have whole-gland salvage HIFU (Sonablate 500) at 2 centers (3 expert HIFU surgeons at each center). The modified Clavien system was used to categorize adverse events and validated questionnaires for functional outcomes. Progression following HIFU treatment was defined as ASTRO-Phoenix criteria (prostate serum antigen [PSA]nadir+2 ng/mL) and/or a positive biopsy and/or start of hormone therapy.Eighty-four men underwent whole-gland salvage HIFU (2004-2009). Median age, pretreatment serum PSA, and biopsy Gleason score was 68 years (range, 64-72 years), 4.3 ng/mL (range, 1.9-7.9 ng/mL), and 7 (range, 6-7), respectively. Mean follow-up was 19.8 months (range, 3.0-35.1 months). After salvage HIFU, 62% of the men were pad-free and leak-free. Mean International Index of Erectile Function-5 point score fell from 8.8 to 4.7 (P.001). International Prostate Symptoms Score and RAND-SF36 scores were not affected. Two men developed rectourethral fistulae after 1 salvage procedure. A further 2 fistulae occurred in the 6 men undergoing a second salvage HIFU. Intervention for bladder outlet obstruction was needed in 20% (17 of 84 patients). If PSA nonresponders were included, 1- and 2-year progression-free survival rates were 59% (50 of 84 patients) and 43% (36 of 84 patients), respectively. If PSA nonresponders were excluded, 1- and 2-year progression-free survival rates were 62% (48 of 77 patients) and 48% (37 of 77 patients), respectively.Salvage whole-gland HIFU is a high-risk procedure. Although its use in early cancer control is promising, strategies to better identify metastatic disease prior to salvage therapy and reduce local toxicity are needed to improve on this.

Biopsy of the prostate using ultrasound guidance is the clinical gold standard for diagnosis of prostate adenocarcinoma. The current prostate biopsy procedure is limited to using 2D transrectal ultrasound (TRUS) images to target biopsy sites and record biopsy core locations for postbiopsy confirmation. Localization of the 2D image in its actual 3D position is ambiguous and limits procedural accuracy and reproducibility. We have developed a 3D TRUS prostate biopsy system that provides 3D intrabiopsy information for needle guidance and biopsy location recording. The system conforms to the workflow and imaging technology of the current biopsy procedure, making it easier for clinical integration. In this paper, we describe the system design and validate the system accuracy by performing mock biopsies on US/CT multimodal patient-specific prostate phantoms. Our biopsy system generated 3D patient-specific models of the prostate with volume errors less than 3.5% and mean boundary errors of less than 1 mm. Using the 3D biopsy system, needles were guided to within 2.3 +/- 1.0 mm of 3D targets and with a high probability of biopsying clinically significant tumors. The positions of the actual biopsy sites were accurately localized to within 1.5 +/- 0.8 mm.

As Malaysia prepares for its twelfth general elections, scheduled for 8 March 2008, most pundits and observers agree that it is unlikely that the 2004 performance can be reproduced. Public opinion has homed in on the unfulfilled promises of the 2004 campaign, party warlords continue to dominate the BN, and minority rights continue to be eroded. Aware of the weaknesses in the BN, the opposition has signaled their intention to deny the BN a two-thirds parliamentary majority. This paper looks to assess the key issues, themes, and actors as the script to Malaysia’s twelfth general election unfolds. While it is widely expected that the BN will retain its two-thirds majority, its hold on parliament as well as many state legislatures is likely to be eroded. Unlike the previous two elections, the manner in which the ruling government has managed minority issues will see a discernible shift in the non-Malay ground, where the ethnic minority vote is likely to go to the opposition, even as the UMNO-PAS competition battles itself into a stalemate.

A successful pilot study of a videoconferenced multidisciplinary genitourinary tumor board involving 21 physicians over six geographic sites for a 6-month period is reported. The majority of cases presented at the tumor board were of prostate or bladder origin. Specific recommendations around management, patient referral or clinical trial eligibility were made in the majority of cases presented. Physician satisfaction with the rounds was high and participation beyond the pilot has continued. Scheduling in order to provide maximum access/participation has been the main logistical challenge with the rounds.

When Prime Minister Abdullah Ahmad Badawi dissolved the Malaysian Parliament on 4 March 2004, it was an indication that general elections will be held in Malaysia within the next 60 days. The forthcoming general elections will be the 11th in Malaysian history. Given that it will be his first general election at the helm of the Malaysian government, this election has been billed as a test of Prime Minister Abdullah's mandate by the local and international media. Beyond that however, the elections will also put to test UMNO's performance over the past 4 years. Since losing substantial Malay support to the Islamic opposition PAS, UMNO had embarked on a "rejuvenation" exercise that gained impetus on the back of economic recovery, peaked with the resignation of Dr. Mahathir Mohamad and the ascension of Abdullah Badawi as Prime Minister of Malaysia. UMNO's revival has also been aided by external factors such as the fallout from the events of September 11. Indeed, recent developments do indicate that UMNO and the National Front will enter the 2004 general elections from a much stronger position than in 1999, and is likely not only to secure a two-thirds parlimentary majority, but also to repel the challenge from PAS and the opposition alliance nationalwide.

The politicisation of Islam has become a key feature of the Malaysian political terrain in recent years, and has found dominant expression in the so-called "Islamisation race" between UMNO and PAS. This paper studies the religio-political dialectics and responses that continue to define UMNO-PAS rivalry, focusing primarily on the strategies and flaws of UMNO's attempts to out-Islam PAS. It suggests that UMNO's representation of PAS as conservative fundamentalists belies the fact that the struggle to define the role of Islam in contemporary Malaysian society has created fissures within UMNO itself, resulting in an incoherent strategy that has prevented it from undermining PAS's burgeoning popularity.

Given the emergency of the reform movement in Malaysia, speculation has been rife that as Malaysia prepares to take to the polls, the increasing popularity of the reform movement will see the opposition parties blocking the National Front from winning a two-thirds parlimentary majority. This paper argues that because of the current nature of Malaysian politics, the signs of economic recovery, the disorganized nature of the opposition coalition and the ability of the incumbent to use the entire state machinary to support its position, such a scenario seems unlikely for this upcoming election. Nevertheless, the prospect of a two-thirds majority victory for the National front cannot hide the fact that Malaysian politics may be undergoing some changes, and these changes might pose challenges for the ruling National Front to contend with.

Introduction: Most small renal masses (SRMs) are diagnosed incidentally and have a low malignant potential. As more elderly patients and infirm patients are diagnosed with SRMs, there is an increased interest in active surveillance (AS) with delayed intervention. Patient and tumour characteristics relating to aggressive disease have not been well-studied. The objective was to determine predictors of growth of SRMs treated with AS.Methods: A multicentre prospective phase 2 clinical trial was conducted on 207 SRMs in 169 patients in 8 institutions in Canada from 2004 to 2009; in these patients treatment was delayed until disease progression. Patient and tumour characteristics were evaluated to determine predictors of growth of SRMs by measuring rates of change in growth (on imaging) over time. All patients underwent AS for presumed renal cell carcinoma (RCC) based on diagnostic imaging. We used the following factors to develop a predictive model of tumour growth with binary recursive partitioning analysis: patient characteristics (age, symptoms at diagnosis) and tumour characteristics (consistency [solid vs. cystic] and maximum diameter at diagnosis.Results: With a median follow-up of 603 days, 169 patients (with 207 SRMs) were followed prospectively. Age, symptoms at diagnosis, tumour consistency and maximum diameter of the renal mass were not predictors of growth. This cohort was limited by lack of availability of patient and tumour characteristics, such as sex, degree of endophytic component and tumour location.Conclusion: Slow growth rates and the low malignant potential of SRMs have led to AS as a treatment option in the elderly and infirm population. In a large prospective cohort, we have shown that age, symptoms, tumour consistency and maximum diameter of the mass at diagnosis are not predictors of growth of T1a lesions. More knowledge on predictors of growth of SRMs is needed.

Cellular toxicity resulting from nucleation-dependent polymerization of amyloid beta-peptide (Abeta) is considered to be a major and possibly the primary component of Alzheimer's disease (AD). Inhibition of Abeta polymerization has thus been identified as a target for the development of therapeutic agents for the treatment of AD. The intrinsic affinity of Abeta for itself suggested that Abeta-specific interactions could be adapted to the development of compounds that would bind to Abeta and prevent it from polymerizing. Abeta-derived peptides of fifteen residues were found to be inhibitory of Abeta polymerization. The activity of these peptides was subsequently enhanced through modification of their amino termini with specific organic reagents. Additional series of compounds prepared to probe structural requirements for activity allowed reduction of the size of the inhibitors and optimization of the Abeta-derived peptide portion to afford a lead compound, cholyl-Leu-Val-Phe-Phe-Ala-OH (PPI-368), with potent polymerization inhibitory activity but limited biochemical stability. The corresponding all-D-amino acyl analogue peptide acid (PPI-433) and amide (PPI-457) retained inhibitory activity and were both stable in monkey cerebrospinal fluid for 24 h.

While scholars, journalists, politicians, even laymen, recognize the recurrent theme of enmity in Malaysia's relationship with Singapore, few have attempted to identify the causes. Of those who have, their perfunctory use of the idea of "historical baggage" to explain the causes of enmity belie the complexities and vagaries of this term and its implications. This study is an attempt to address these issues. Master of Science (Strategic Studies)

The study begins by drawing on several sources to define entreprenurial infrastructure as the collection the facilities and services present within a given geographic area which encourage the birth and development of small and medium-sized businesses (SMEs). Master of Business Administration

Skeletal-related events (SREs) are a common complication of bone metastases, and have serious negative consequences for patients with castrate-resistant prostate cancer (CRPC). SREs can lead to severe pain, increased risk of death, increased health care costs and reduced quality of life. Until recently, zoledronic acid has been the sole standard of care for the prevention of SREs in men with CRPC with bone metastases. Denosumab, a receptor activator of nuclear factor kappa-B ligand (RANK-L) inhibitor, has been recently approved for use in Canada for this indication, thus presenting another option for these patients. Denosumab was shown to be superior to zoledronic acid in delaying the time to first or subsequent SREs in CRPC patients with bone metastases. This review discusses current and previous trials examining agents designed to prevent SREs in men with CRPC and bone metastases. It also discusses the practical aspects of administering a bone-targeted therapy, including choosing a bone-targeted therapy, monitoring at the onset and during therapy, switching from one therapy to another, and assessing potential complications.

The Papua province is a territory whose political status has long been subject to debate. Papua first appeared as a part of the Netherlands East Indies. This situation changed following the end of the Second World War, when the Netherlands retained Papua after Indonesia won its independence on 17 August 1945. In the Round Table Conference in 1949, The Netherlands transferred over Papua territory to Indonesia but its political status would be determined within a year through negotiation between the Netherlands and Indonesia. Master of Science (International Relations)

The fall of Soeharto's regime in 1998 has brought drastic changes in Indonesia's political life; one of them is the nature of civil-military relations. As the journey toward democracy starts, the civil-military relation in Indonesia also fluctuates. To guard Indonesia democratization, the existence of "civilian supremacy" and "objective civilian control" are necessary conditions. Post Soeharto civil-military relations demonstrate improvement toward those conditions. The military role in politics is declining; its influence over socio-political life is not as dominant as in Soeharto's era. The civilians have also showed its confidence in exercising authority over the military. As a result, a suitable civil-military relation for democracy to grow has appeared. Master of Science (Strategic Studies)

Examining the relationship between Vietnamese Communist ideology, nationalism and foreign policy of Vietnam since 1976 with a focus on the current Vietnam’s foreign policy to their former foe - the United States. Master of Science (Strategic Studies)

This dissertation is about the failure of negotiations in peace processes and the probable causes for this failure. This will be done with two specific case studies, namely the Israel-Palestine conflict and the Irish conflict. With a historical review of the conflicts and peace processes in both the regions, I will examine the areas for possible improvement in peace processes. In order to suggest areas for improvement, I will bring together points that elaborate factors that may need to be collectively or individually considered during the negotiation process. This paper is an attempt to layout the groundwork for theory that suggests a systematic study of the factors that influence negotiations in any conflict around the world. Master of Science (International Relations)

This paper makes a case for an instrumentalist and modernist logic to fundamentalism and argues that the environment frames fundamentalism. Fundamentalism is not new per se, but its form has evolved through time and varies in different contexts. I will show how fundamentalisms work as strategies of adapting to the international system and how they employ various means to ensure their survival in the ongoing "war of fundamentalisms". Religious violence is thus a survival strategy that is used in this war, which is currently being fought between the hegemonic fundamentalism -Western modernity, and the other "peripheral fundamentalisms". Master of Science (Strategic Studies)