The article describes political and advocacy activity in nonprofit human service organizations for children, elderly people, women, and people with disabilities. On the whole, the level of their political activity was found to be moderate, as perceived by the directors of the organizations. The main findings reveal a significant positive correlation between advocacy and political activity in nonprofit organizations and their perceived influence on setting the public agenda. Analysis of the findings indicates that the larger the number of volunteers in the organization, the greater the organization's political influence. In addition, it was found that the more dependent the organizations were on funding from local authorities, the lower the level of advocacy and political activity. The effectiveness of strategies used to attain political influence was also analyzed. The most effective strategy was exerting pressure on decision makers, both on the national and local levels.

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Tremendous progress in the therapy of pediatric acute lymphoblastic leukemia (ALL) has been achieved through combination cytotoxic chemotherapy, leading to high cure rates, at the cost of significant life-threatening toxicity. The bispecific T-cell engager blinatumomab, recently approved for relapsed/refractory ALL, has a unique nonmyelotoxic toxicity profile. As blinatumomab causes B-cell depletion, the safety of its use during severe chemotherapy-induced toxicity is unclear. We report 11 pediatric patients with ALL, treated with blinatumomab following overwhelming chemotherapy-associated toxicity, with recovery of all patients and successful bridging to further antileukemia therapy. Blinatumomab can be considered for rare patients who cannot tolerate cytotoxic therapy. K E Y W O R D S blinatumomab, childhood acute lymphoblastic leukemia, immunotherapy, treatment-related toxicity Abbreviations: ALL, acute lymphoblastic leukemia; B-ALL, B-cell precursor acute lymphoblastic leukemia; DS, Down syndrome; MRD, minimal residual disease; R/R, relapsed/refractory.

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Summary This study investigated the prevalence of inherited thrombophilia, risk of venous thromboembolism (VTE) and benefit of low molecular weight heparin prophylaxis in 476 Israeli children with acute lymphoblastic leukaemia (ALL) treated between 2004 and 2016. Thrombophilia was found in 15·5%. Arab children had a higher prevalence of F5 R506Q (factor V Leiden) than Jewish children (19·4% vs. 2·9%, P < 0·01). Patients with thrombophilia had higher VTE rates VTE (26·5% vs. 5·6%, P < 0·001). None of the thrombophilic children given prophylaxis had severe VTE. Routine evaluation for inherited thrombophilia followed by thromboprophylaxis when findings are positive may benefit at‐risk patients with ALL.

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Mucormycosis has emerged as an increasingly important cause of morbidity and mortality in immunocompromised patients, but contemporary data in children are lacking. We conducted a nationwide multicentre study to investigate the characteristics of mucormycosis in children with haematological malignancies. The cohort included 39 children with mucormycosis: 25 of 1136 children (incidence 2Á2%) with acute leukaemias prospectively enrolled in a centralized clinical registry in 2004-2017, and an additional 14 children with haematological malignancies identified by retrospective search of the databases of seven paediatric haematology centres. Ninety-two percent of mucormycosis cases occurred in patients with acute leukaemias. Mucormycosis was significantly associated with high-risk acute lymphoblastic leukaemia (OR 3Á75; 95% CI 1Á51-9Á37; P = 0Á004) and with increasing age (OR 3Á58; 95% CI 1Á24-9Á77; P = 0Á01). Fifteen patients (38%) died of mucormycosis. Rhinocerebral pattern was independently associated with improved 12-week survival (OR 9Á43; 95% CI 1Á47-60Á66; P = 0Á02) and relapsed underlying malignancy was associated with increased 12-week mortality (OR 6Á42; 95% CI, 1Á01-40Á94; P = 0Á05). In patients receiving frontline therapy for their malignancy (n = 24), one-year cumulative mucormycosis-related mortality was 21 AE 8% and five-year overall survival was 70 AE 8%. This largest paediatric population-based study of mucormycosis demonstrates that children receiving frontline therapy for their haematological malignancy are often salvageable. ALL, acute lymphoblastic leukaemia; AML, acute myeloid leukaemia; SCT, stem cell transplantation. *Variables are presented as n (%), unless otherwise stated. † The dash indicates that the variable was entered into the initial multivariate logistic regression model based on its P value in the univariate analysis (≤0Á10), but it was removed from the final model through the backward elimination procedure. ‡ Lymphocytopenia and monocytopenia were not included in the multivariate analysis as only a subcategory of patients had evaluable data. Surgical interventions were not included in order to avoid possible selection bias. SCT was not included due to its high correlation with relapsed and refractory disease (phi coefficient = 0Á78 and 0Á65, respectively).

The aim of this study was to evaluate the effectiveness of computerized image enhancement, to investigate criteria for discriminating benign from malignant mammographic findings by computer-aided diagnosis (CAD), and to test the role of quantitative analysis in improving the accuracy of interpretation of mass lesions. Forty sequential mammographically detected mass lesions referred for biopsy were digitized at high resolution for computerized evaluation. A prototype CAD system which included image enhancement algorithms was used for a better visualization of the lesions. Quantitative features which characterize the spiculation were automatically extracted by the CAD system for a user-defined region of interest (ROI). Reference ranges for malignant and benign cases were acquired from data generated by 214 known retrospective cases. The extracted parameters together with the reference ranges were presented to the radiologist for the analysis of 40 prospective cases. A pattern recognition scheme based on discriminant analysis was trained on the 214 retrospective cases, and applied to the prospective cases. Accuracy of interpretation with and without the CAD system, as well as the performance of the pattern recognition scheme, were analyzed using receiver operating characteristics (ROC) curves. A significant difference (p < 0.005) was found between features extracted by the CAD system for benign and malignant cases. Specificity of the CAD-assisted diagnosis improved significantly (p < 0.02) from 14 % for the conventional assessment to 50 %, and the positive predictive value increased from 0.47 to 0.62 (p < 0.04). The area under the ROC curve (A(z)) increased significantly (p < 0. 001) from 0.66 for the conventional assessment to 0.81 for the CAD-assisted analysis. The A(z) for the results of the pattern recognition scheme was higher (0.95). The results indicate that there is an improved accuracy of diagnosis with the use of the mammographic CAD system above that of the unassisted radiologist. Our findings suggest that objective quantitative features extracted from digitized mammographic findings may help in differentiating between benign and malignant masses, and can assist the radiologist in the interpretation of mass lesions.