Palestinian Health Institutions: Finding a Way Forward in the Wake of the Second Intifada

The strength of Hamas in Palestinian elections in early 2006 reshuffled the cards in the game of Middle East politics. Many astonished observers have sought an explanation for this political change. But the election result should not have been so surprising. Hamas has earned a reputation of clean governance and compassion for the poor, unlike the Fatah-led Palestinian Authority. Hamas has had a strong presence in the health sector which helped establish its legitimacy and popularity. This paper reviews bilateral and multilateral aid to Palestinians following the second intifada and argues that not enough was done by the international community to bolster health services of the Palestinian Authority. This left a void that Hamas and other charitable organizations have filled. The health sector remains strategic and its assimilation with the Palestinian Authority should be sought. Comprehensive policy toward the Middle East and other developing regions should integrate social welfare programs with global security interests

Robust stability of discrete time systems under parametric perturbations

Cataloged from PDF version of article.Stability robustness analysis of a system under parametric perturbations is concerned with characterizing a region in the parameter space in which the system remains stable. In this paper, two methods are presented to estimate the stability robustness region of a linear, time-invariant, discrete-time system under multiparameter additive perturbations. An inherent difficulty, which originates from the nonlinear appearance of the perturbation parameters in the inequalities defining the robustness region, is resolved by transforming the problem to stability of a higher order continuous-time system. This allows for application of the available results on stability robustness of continuous-time systems to discrete-time systems. The results are also applied to stability analysis of discrete-time interconnected systems, where the interconnections are treated as perturbations on decoupled stable subsystems

Long-term safety of siltuximab in patients with idiopathic multicentric Castleman disease: a prespecified, open-label, extension analysis of two trials.

BACKGROUND:Siltuximab is recommended by international consensus as a first-line treatment for idiopathic multicentric Castleman disease on the basis of durable efficacy and safety data. This study was done to assess the long-term safety and activity of siltuximab over up to 6 years of treatment. METHODS:This study is a prespecified open-label extension analysis of a phase 1 trial (NCT00412321) and a phase 2 trial (NCT01024036), done at 26 hospitals worldwide. Patients in both studies were at least 18 years old with histologically confirmed, symptomatic Castleman disease. This extension study enrolled 60 patients who completed the previous trials without disease progression on siltuximab. Patients received siltuximab infusions of 11 mg/kg every 3 weeks (which could be extended to 6 weeks) for up to 6 years. Descriptive statistics were used to summarise the data. No formal hypothesis testing was performed. The primary endpoint was the safety of siltuximab, assessed at each dosing cycle. The study was registered with ClinicalTrials.gov, number NCT01400503 and with EudraCT, number 2010-022837-27. FINDINGS:Patient enrolment into the phase 1 trial was from June 20, 2005, to Sept 15, 2009, and enrolment into the phase 2 trial was from Feb 9, 2010, to Feb 3, 2012. Patients were enrolled in this long-term extension from April 1, 2011, to Jan 15, 2014. Median follow-up was 6 years (IQR 5·11-7·76). Median treatment duration, from the beginning of the previous trials to the end of the present study, was 5·5 years (IQR 4·26-7·14). Siltuximab was well tolerated; however, adverse events of grade 3 or worse were reported in 36 (60%) of 60 patients with the most common being hypertension (eight [13%]), fatigue (five [8%]), nausea (four [7%]), neutropenia (four [7%]), and vomiting (three [5%]). 25 (42%) patients reported at least one serious adverse event, which most commonly was an infection (eight [13%]). Only two serious adverse events, polycythaemia and urinary retention, were considered related to siltuximab treatment. 18 patients discontinued before study completion, either to receive siltuximab locally (eight) or because of progressive disease (two), adverse events (two), or other reasons (six). No deaths were reported. INTERPRETATION:These results show that siltuximab is well tolerated long term and provides important evidence for the feasibility of the life-long use required by patients with idiopathic multicentric Castleman disease. FUNDING:Janssen R&D and EUSA Pharma

Not All Comments are Equal: Insights into Comment Moderation from a Topic-Aware Model

Moderation of reader comments is a significant problem for online news platforms. Here, we experiment with models for automatic moderation, using a dataset of comments from a popular Croatian newspaper. Our analysis shows that while comments that violate the moderation rules mostly share common linguistic and thematic features, their content varies across the different sections of the newspaper. We therefore make our models topic-aware, incorporating semantic features from a topic model into the classification decision. Our results show that topic information improves the performance of the model, increases its confidence in correct outputs, and helps us understand the model's outputs

Trans-arterial therapy for Fibrolamellar carcinoma: A case report and literature review

Introduction: Fibrolamellar carcinoma (FLC) is a rare pathologically distinct primary liver cancer. Surgical resection is the only treatment associated with prolonged survival. Trans-arterial embolization (TAE), which is a recognised treatment for hepatocellular carcinoma has been used to treat FLC. We present a case and performed a literature review of patients with FLC treated with TAE. Case presentation: We present a 19-year old female with a large potentially resectable FLC which was initially treated with trans-arterial chemo-embolization (TACE) with drug eluting beads. The TACE was followed by surgical resection. Histology confirmed tumour necrosis related to the previous TACE. Discussion & literature review: We identified seven case reports and one case series of TAE for FLC. TAE was either used as a neo-adjuvant therapy to facilitate subsequent tumour resection or as a palliative treatment modality. We propose an algorithm for the treatment of FLC that includes TAE. Conclusion: The rarity of FLC and the paucity of data precludes establishing clear evidence-based standards of care. We propose an algorithm for the treatment of FLC. The establishment of an international registry may facilitate the collection of better quality evidence

Roulette-Wheel Selection-Based PSO Algorithm for Solving the Vehicle Routing Problem with Time Windows

The well-known Vehicle Routing Problem with Time Windows (VRPTW) aims to reduce the cost of moving goods between several destinations while accommodating constraints like set time windows for certain locations and vehicle capacity. Applications of the VRPTW problem in the real world include Supply Chain Management (SCM) and logistic dispatching, both of which are crucial to the economy and are expanding quickly as work habits change. Therefore, to solve the VRPTW problem, metaheuristic algorithms i.e. Particle Swarm Optimization (PSO) have been found to work effectively, however, they can experience premature convergence. To lower the risk of PSO's premature convergence, the authors have solved VRPTW in this paper utilising a novel form of the PSO methodology that uses the Roulette Wheel Method (RWPSO). Computing experiments using the Solomon VRPTW benchmark datasets on the RWPSO demonstrate that RWPSO is competitive with other state-of-the-art algorithms from the literature. Also, comparisons with two cutting-edge algorithms from the literature show how competitive the suggested algorithm is

Cervicofacial Actinomycosis in the Pediatric Population: Presentation and Management

Background: Infection caused by Actinomyces species is a rare cause of head and neck infection in children. This chronic cervicofacial infection can present with localized swelling, abscess formation, sinus drainage and can be complicated by osteomyelitis. Methods: Presented are 2 pediatric cases of secondary actinomycosis in the context of congenital lesions: 1 patient with a previously excised preauricular sinus and another with a persistent sublingual mass. A comprehensive literature search was conducted for reported cases of pediatric actinomycosis in the cervicofacial region. Results: Both cases presented were successfully treated with a combination of complete surgical excision of the lesions and prolonged antibiotic therapy. Thirty-four pediatric cases of cervicofacial actinomycosis are reviewed, 2 presented herein, and 32 from the published literature. There was equal gender distribution and the median age was 7.5 years. The most common site for infection was the submandibular area. Four (12%) of cases arose in pre-existing congenital lesions. Most patients were treated with penicillin-based antibiotics for a median duration of 6 months following surgical excision or debridement. Conclusions: Actinomycosis is a rare infection of the cervicofacial region; secondary infections arising from congenital lesions of the head and neck are even more rare. A previously excised pre-auricular sinus and a sublingual dermoid cyst are not previously reported sites of infection. Actinomycosis should be suspected in chronically draining sinuses of the head and neck region and confirmed through anaerobic culture. Osteomyelitis is a potential complication and magnetic resonance (MR) imaging is warranted. Long-term antibiotic therapy with a penicillin-based antibiotic and surgical excision should be considered