A Network Model Approach to International Aid

Decisions made by international aid donors regarding the allocation of their aid budgets to recipients can be mathematically modelled using network theory. The many countries and multilateral organisations providing developmental aid, mostly to developing countries, have numerous competing or conflicting interests, biases and motivations, often obscured by a lack of transparency and confused messaging. Using network theory, combined with other mathematical methods, these inter-connecting and inter-dependent variables are identified, revealing the complicated properties and dynamics of the international aid system. Statistical techniques are applied to the vast amount of available, open data to first understand the complexities and then identify the key variables, focusing principally on bilateral aid flows. These results are used to create a weighted network model which is subsequently adapted for use by a hypothetical aid recipient. By incorporating modern portfolio theory into this weighted network model and taking advantage of a donor's reasons for allocating their aid budgets to that recipient, a simulation is carried out treating the problem as an optimal investment portfolio of aid determinant 'assets' which illustrates how a recipient can maximise their aid receipts. Suggestions are also made for further uses and adaptations of this weighted network model.

Prospective trial of ifosfamide, paclitaxel, and cisplatin (ITP) in patients with advanced non-transitional cell (non-TCC) carcinomas of the urothelial tract

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Background: Non-TCC’s account for 5–10% of urothelial tract tumors and are each characterized by unique demographics, risk factors, and patterns of spread. A unifying feature of these malignancies is their aggressive course and poor outcomes with standard chemotherapeutic regimens. Given the rarity of these tumors, no prospective data are available to guide management. Methods: Patients with unresectable/metastatic adenocarcinoma, squamous cell, small cell, sarcomatoid, and poorly differentiated carcinomas of the urothelial tract were eligible. Treatment consisted of: Paclitaxel 200 mg/m2 IV on day 1, cisplatin 70 mg/m2 IV on day 1, ifosfamide 1500 mg/m2 IV on days 1–3 + mesna. GCSF was administered with each cycle. Treatment was recycled every 3 weeks for a maximum of 6 cycles. The primary endpoint was the response rate. Results: Twenty patients (pts) were enrolled with the following histologic types: adenocarcinoma 11/20, squamous cell carcinoma 8/20, small cell carcinoma 1/20. Pts received a median of 4 cycles (range, 1–6). The grade 3–4 toxicities included neutropenia (6/20), anemia (9/20), thrombocytopenia (4/20), confusion (1/20), seizure (1/20), neuropathy (1/20), renal insufficiency (2/20), fatigue (2/20), and hyponatremia (1/20). Thirteen of the 20 pts have died. The median survival for pts with adenocarcinoma is 24 months (95% CI 9.6–32.4) and with squamous cell carcinoma is 8.4 months (95% CI 5.3-NR). Five pts achieved durable disease-free survival (1+, 2+, 4+, 6+, and 8+ years) after ITP ± surgical consolidation. Conclusions: ITP is an active regimen in pts with advanced non-TCC’s of the urothelial tract. To our knowledge, this is the first prospective study of a chemotherapeutic regimen in this patient population.

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