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Exam Code: 156-585 Practice exam 2022 by Killexams.com team
CheckPoint Certified Troubleshooting Expert
CheckPoint Troubleshooting basics
Killexams : CheckPoint Troubleshooting basics - BingNews https://killexams.com/pass4sure/exam-detail/156-585 Search results Killexams : CheckPoint Troubleshooting basics - BingNews https://killexams.com/pass4sure/exam-detail/156-585 https://killexams.com/exam_list/CheckPoint Killexams : Search Check Point Software Technologies Ltd. Courses No result found, try new keyword!and Check Point’s solutions for those challenges. The program will also enable you to perform a basic deployment and configuration of the various solutions under the CloudGuard umbrella. Wed, 15 Dec 2021 00:40:00 -0600 text/html https://www.usnews.com/education/skillbuilder/provider-search/check-point-software-technologies-ltd Killexams : How to schedule System Restore Points in Windows 11/10

System Restore is one of the most crucial but underrated features in Windows OS. A restore point can help the computer get back to a working condition in no time, and save a lot of time that goes into troubleshooting. System Restore Points capture resident program, their settings, and Windows Registry as an image and back up a few things that are necessary to reconstruct the system drive to the point if you opt to go back. While Windows creates System Restore Points frequently if you wish you can make your Windows PC create them at scheduled times.

I wish Windows had an inbuilt feature or setting, where users could easily set their PC to create restore points, daily or weekly easily with a click – but there is no such setting available. You will have to use the Task Scheduler to get this done. Now let us see how to schedule one at a particular time. It is a 3-step process:

  1. Enable System Restore Feature
  2. System Restore point Command
  3. Create a Task in Task Scheduler.

We have also talked about how to manually run the task to confirm its working and a quick tutorial to create a shortcut to that task. It will let you create Restore point quickly.

1] Enable System Restore Feature

Configure System Restore in Windows 10

While it should on by default, but it’s a good idea to check if it System Restore has been disabled. You will also have to configure System Restore for the individual drive, including the disk usage option.

Windows allows one to create System Restore only once in 24 hours. If it makes another attempt, it will skip. So, if you are planning to create multiple restore points, sometimes manually, then we need to remove this limitation.

Open Registry Editor and navigate to the following key:

HKEY_LOCAL_MACHINE\SOFTWARE\Microsoft\Windows NT\CurrentVersion\SystemRestore

Double click to edit SystemRestorePointCreationFrequency DWORD. Modify the value to 0.

automatically create System Restore Point at startup

This will make sure that Windows doesn’t skip creating a restore point ever.

2] System Restore Point Command

The command which we will use to create the restore point is

Checkpoint-Computer -Description "TWC-RestorePoint" -RestorePointType MODIFY_SETTINGS

You may change the name TWC-RestorePoint to anything else.

MODIFY_SETTINGS is a type of Restore point which includes Registry, local profiles, com+ DB, WFP.dll, IIS database, and file extensions.

I would recommend you execute this command on PowerShell to make sure it works properly.

Here is a quick demo of the command we suggested. Notice that it created a restore point with the description — TWC-RestorePoint.

schedule System Restore Points

Apart from this, you can also use the following arguments:

  • APPLICATION_INSTALL
  • APPLICATION_UNINSTALL
  • DEVICE_DRIVER_INSTALL
  • CANCELLED_OPERATION

You can also use the following argument with WMIC.EXE to create a restore point. We have explained this in detail in our post on How to automatically create a restore point with Windows Startup.

/Namespace:\\root\default Path SystemRestore Call CreateRestorePoint "Startup Restore Point", 100, 7

3] Create Task Scheduler

Now you will have to create & schedule a basic task and use the command mentioned above in the task scheduler with PowerShell

Type taskschd.msc in the Run prompt and hit the Enter key to open the Task Scheduler. Click on the Create Task link. Name it as Restore Point Creator, and check the box which says Run with highest privileges.

Create Task to run with highest privileges

If there are multiple users on the computer, select the radio button which says Run whether the user is logged on or not.

Switch to Triggers tab, and click on the New Button.  Here we will schedule the task to run once every day, or you can choose anything else you wish. Select daily, set the start date, and time.

Schedule Task to create restore point everyday

Switch to Actions Tab, and click on the New Button. Here we will add the command.

Type powershell.exe in the Program/script box. In the Argument box type the following:

Checkpoint-Computer -Description "TWC-RestorePoint" -RestorePointType MODIFY_SETTINGS

Click on the OK button.

Add Command to Task Scheduler to Create Restore Point

Next, switch to the Conditions tab if you are configuring this on a laptop. You can choose to skip creating a restore point if it is running on battery or stop if it switches to battery.

Lastly, switch to the Settings tab. Here you should configure on what happens if the task fails or if it misses as the computer was off. It can also take care of the situations in case the task fails, and so on.

If you have configured it to run even when the user is not logged in, you will be prompted to enter the password. If you are using a Microsoft account, then I will suggest that you create a local admin account, and use it for such settings where a password is needed.

Manually run the Task to check if it works

How to schedule System Restore Points in Windows 10

Select the task we created, and on the right panel, click on the Run button. It will instantly launch PowerShell and execute the command.

Read: How to create a System Restore desktop shortcut.

Create a Shortcut for the System Restore Task to run it anytime

The program, schtasks.exe, is responsible for executing the tasks when its time. We can use the following argument to create a desktop shortcut to run it on demand. In our case, it will look like this:

C:\Windows\System32\schtasks.exe /run /tn "Restore Point Creator"
  • Right-click on the desktop
  • Select New > Shortcut
  • In the location, paste the above-stated command
  • Give it a name, and click OK.

Now the next time you change something which can use an issue, create a restore using this shortcut.

In this, not only we have learned to schedule System Restore Points in Windows 10 but also create it anytime want using the shortcut. Do remember that every time you create a restore point, it will occupy part of the storage space. While Windows will automatically delete old restore points when the allocated disk space limit is reached, you can also delete older restore points manually.

schedule System Restore Points
Sun, 21 Mar 2021 20:36:00 -0500 en-us text/html https://www.thewindowsclub.com/how-to-schedule-system-restore-points-in-windows-10
Killexams : Microsoft appears to reverse VBA macro-blocking

Microsoft appears to have quietly, and without fanfare, reversed a February 2022 policy to block Visual Basic for Applications (VBA) macros by default across five of the most used Office applications, citing negative user feedback.

The new policy was initially introduced on the basis that by making it impossible for users to enable macros by clicking a button by throwing extra click-throughs and reminders in their path, it would make it harder for threat actors to trick them into opening malicious attachments containing malware payloads. The change was made at least in part because of the ongoing prevalence of remote working.

However, as first reported by Bleeping Computer, Redmond now appears to have put the brakes on the policy and begun a rollback – which may yet prove temporary.

The rollback was first spotted by Microsoft users puzzled as to why the old security warning had reappeared on documents containing VBA macros, as opposed to the new block notice that they were becoming used to.

UK-based user Vince Hardwick was first to query the change on Microsoft’s Tech Community forums after running into difficulties attempting to demonstrate the new policy for a YouTube video he was making.

Responding to Hardwick’s query on the forums, Angela Robertson, Microsoft 365 Office Product Group principal GPM for identity and security, said: “Based on feedback received, a rollback has started. An update about the rollback is in progress. I apologise for any inconvenience of the rollback starting before the update about the change was made available.”

Other users, including Hardwick, voiced frustration that Microsoft had failed to communicate the rollback to them.

The nature of the feedback that Robertson referred to is unclear, but if the decision to rollback is indeed based on user feedback, it is unlikely to be the feedback of the security community, which had generally welcomed the move in the hope that it would Improve organisational security by cutting off an easy way for cyber criminals to establish initial access into their targets, ie by emailing them malicious documents or spreadsheets.

Security experts have already responded, describing Microsoft’s move as a “terrible idea” and a “weird decision”:

In the short period since the change began to roll out, plenty of evidence has indeed stacked up that the change was forcing threat actors to evolve their tactics, techniques and procedures (TTPs).

At the end of April, Proofpoint reported that the group behind the Emotet botnet had turned to using tainted OneDrive URLs instead of macro-enabled attachments, likely because blocking macros by default makes it harder for the average user to fall for the trick.

Then in June, Check Point reported that the Snake Keylogger was shooting back up its monthly threat charts following a number of novel email campaigns that saw it distributed in a tainted PDF file – historically, Snake had arrived in Word documents or Excel spreadsheets.

Computer Weekly contacted Microsoft to seek further clarification on the nature of the rollback, but had not received a response at the time of writing.

Fri, 08 Jul 2022 08:40:00 -0500 en text/html https://www.computerweekly.com/news/252522508/Microsoft-appears-to-reverse-VBA-macro-blocking
Killexams : Kebab case

Kebab case -- or kebab-case -- is a programming variable naming convention where a developer replaces the spaces between words with a dash.

Programming variable names should be descriptive. Two or more words are often required to properly convey a resource's meaning. However, most programming languages don't allow spaces between words.

The kebab case naming convention attempts to overcome this limitation by replacing spaces between words with a dash.

The term comes from the associated imagery of a skewer in a kebab. The skewer pierces multiple piece of food together on a shish kebab. In code, the dash represents the skewer and keeps multiple words together to describe a resource's meaning, a la a shish kebab.

Kebab case examples

Here are three examples of the kebab case naming convention:

  • descriptive-variable-name
  • INTERESTING-TEXT-FILE
  • naming-conventions-webpage

Kebab case vs. snake case

Kebab case is a similar naming convention to snake case -- or snake_case. Both conventions help a developer read code because the white space -- either a dash in kebab case or an underscore in snake case -- between words reads like a normal sentence.

Snake case contrasts more distinctly with the CamelCase naming convention. In CamelCase, whitespace is removed between compound words. It replaces the dash or underscore with an uppercase letter to represent the start of the next word. For example:

  • snake_case_example
  • CamelCaseExample
  • kebab-case-example

Scream kebabs

If a developer uses all uppercase letters in a variable with the kebab case convention, it's known as a scream kebab. The term owes its name to the thought that when people on social media type sentences with upper case letters, they're screaming. For example:

  • THIS-IS-A-SCREAM-KEBAB
  • this-is-not-a-scream-kebab

Problems with kebab case

The biggest problem with kebab case lies mainly on the use of a dash. Many programming languages will interpret the dash as a minus sign, and it unintentionally creates software bugs that are difficult to isolate and troubleshoot.

Similarly, many programming languages -- such as Jekyll -- will assume numbers separated by a dash are dates. This misinterpretation can cause problems when a developer uses kebab case with spreadsheets or calendar-based applications.

In the software development community, snake case is typically the preferred naming convention. Snake case creates the maximum white space between compound words in a variable with an underscore.

While kebab case can be useful, a developer must be aware that a dash can cause unintentional issues with non-letter code.

Mon, 14 Dec 2020 08:22:00 -0600 en text/html https://www.theserverside.com/definition/Kebab-case
Killexams : NetBackup IT Analytics User Guide

Array Disk Class

Specify array disk classes to be included in the report scope.

Array RAID Types

Enables selection of specific, relevant RAID types, such as RAID_5_6+P.

Array States

Specify storage array states to be included in the report scope.

Arrays Scope

Specify storage arrays to be included in the report scope.

Byte Size

Select the units for capacity values; for example, TB or PB.

Celerra VNX Volume Types

Include specific Celerra volume types, such as Slice, Stripe, Meta, Disk, and Pool, in a report.

Custom Filter

Define free-form fields that enable data filtering at run time. When the report is run, the Scope Selector displays the fields that can be selected to specify values to filter the report results. When the Custom Filter is selected, the report template is restricted to one product only.

Data Point Image

Enable the display of a circle of each data point in a line chart. This allows for quick identification of roll-over information in the chart.

Disk Classes

Report on specific disk classes, such as enterprise fibre channel drives (ENT) or Nearline ATA drives (NL).

Disk Stages

Enable selection of specific disk states, such as Installing, Formatting, or Rebuilding.

Disk Type

Enable selection of specific disk types, such as FC, SCSI, or SATA.

Disk Usage

Enable selection of specific disk usage types, such as Unconfigured or Spare.

Extent Pool Storage Types

Enables selection of specific, relevant Extent Pool storage types, such as fixed block.

File System Types

Include specific file system types, such as Unix, Raw, and Mirror, in a report.

Group By

Enables selection of a time span to be used to group the data by: Hours, Days, Weeks, Months, Quarters, or Years. When using Group By, in general, an aggregation function, such as sum, min, or max, should be included in the report template definition.

Group Chart By

Enables selection of Chart Per Object (each chart is for a single object, with one or more metric lines) or Chart Per Metric (each chart is for one metric, with one or more objects represented as lines). This is a required scope selector component if the report template includes a field of type, Group by Object.

Hard Empty Percentage

For IBM XIV storage pools, enable the selection of a utilization % that provides an indicator of empty physical pool capacity.

Hard Near Capacity Percentage

For IBM XIV storage pools, enable selection of a utilization % that provides an indicator of reaching physical pool capacity.

Hard Over-Provisioned High Percentage

For IBM XIV storage pools, enable selection of a utilization % that provides the high-end indicator for the range of over-provisioned physical pool capacity.

Hard Over-Provisioned Low Percentage

For IBM XIV storage pools, enable selection of a utilization % that provides the low-end indicator for the range of over-provisioned physical pool capacity.

HDS DP Pool IDs

HDS dynamic provisioning pool IDs.

HDS DP Type

HDS dynamic provisioning type.

HDS Open Reserved

HDS Open Reserved.

Hosts

Specify hosts to be included in the report scope.

IBM Array Site Disk Classes

Enable specification of IBM array site disk classes in a report. For example, ENT or NL.

IBM Array Site States

Enable specification of IBM array site states in a report. For example, Assigned, Unassigned, or Unavailable.

IBM Extent Pool IDs

Unique Identifier for the IBM extent pool.

IBM Rank IDs

List of IBM rank IDs.

In Use

For EMC VNX (Celerra) SnapSure data, provide a selection to include data for checkpoints that are in use. A checkpoint is in use if a filesystem is registered in the mount table of a Data Mover.

Line Selector

If multiple lines are defined in a line chart template, this component enables the user to select the line to be shown in the chart.

LUN Status

Enable selection of the LUN status to be included in the report. For example, Allocated but Unused or Allocated but undiscovered.

Maximum Legends for Pie Chart

Specify the maximum number of sectors for pie chart rendering.

Qtree Status

Enable selection of the NetApp Qtree status to be included in the report. For example, Snap Vaulted or Read Only.

RAID State

Enable selection of one or more array states, such as partner, zeroing, or reconstructing.

RAID Status

Enable selection of one or more raid status, such as normal, copying, reconstruct.

RAID Type

RAID type.

Rank Array States

Enable specification of IBM Rank states in a report. For example, Below, Exceeded, or Full.

Rank RAID Types

Include specific IBM Rank RAID types, such as fixed block, in a report.

Rank Status

Select an IBM rank status for report filter; for example, normal, configuring, unassigned, or reserved.

Security Style

Enable selection of the NetApp security style to be included in the report. For example, Unix, NTFS, or Mixed.

Session ID

Unique Identifier for the HPDP Session

Snapshot Busy

Choose to report data for NetApp Snapshot busy state: Yes or No.

Snapshot Only

Snapshot Only

Soft Near Capacity Percentage

For IBM XIV storage pools, enable selection of a utilization % that provides an indicator of reaching virtual (thin-provisioned) pool capacity.

Space Guarantee

Select a space ensure for NetApp volumes; for example, volume, file, or none.

Thin-Provisioned

Included thin-provisioned array storage in the report scope.

Time Period

Provides a drop-down list to specify a time span, such as last 90 days or previous month.

Top/Bottom

Narrow the scope to the greatest/least values based on a given metric.

Volume Styles

Include specific volume style, such as flex, striped, infinitevol.

Volume Type

Select a NetApp volume type, such as flex or trad.

Thu, 07 Jul 2022 12:00:00 -0500 en text/html https://www.veritas.com/support/en_US/doc/140558946-150264672-0/pgfId-282382-150264672
Killexams : Cancer Research & Oncology 2018

 

Our 6th Annual Cancer Research & Oncology Virtual Event is now available On Demand!

This free online event will bring research professionals, scientists, and clinicians from around the world to learn and discuss recent advances in cancer research. As with all LabRoots events, the Cancer Research and Oncology Event encourages a worldwide collaboration and connections between colleagues and field experts.

Cancer research has made major advancements in diagnosis, treatments, and the basic understanding of the disease itself. Each year we see progress in immunotherapy, treatments involving nanotechnology, advances in targeted and personalized therapeutics and drug development, and a decrease in mortality rates due to a strong focus on learning more about the origination of the disease.

Topic's for this years event included:

  • Cancer Therapeutics and Vaccines
  • Cancer Epigenetics and Natural History
  • Cancer Microbiome
  • Cancer Diagnostics
     

Our virtual conference allows you to participate in a global setting with no travel or cost to you. You can participate in exactly those parts which you are interested in and be back at your desk or bench in an instant. Virtual events remove time and place restrictions and ensure that everyone who wants to participate can do so. This virtual conference also offers increased reach for the global cancer community with a high degree of interaction through live-streaming video and chat sessions.


Call for Speakers —  We are always looking to feature excellent research during our virtual events. If you’re working on some remarkable breakthroughs and would like to submit a speaker or panel for consideration, please submit your abstract here.

Don't forget to participate in our Leaderboard and Scavenger Hunt to win one of our Free Science T-shirts!  

Continuing Education
By participating in this virtual event and watching webcast presentations, you can earn Free Continuing Education (PACE). To earn educational credits, you must view an entire presentation. Following the presentation, you must click on the educational credit link provided for that particular speaker and follow the required process. Once you have completed the process, you will receive a certificate for the educational credit.

Use #LRcancer to follow the conversation!

Mon, 01 Aug 2022 12:00:00 -0500 text/html https://www.labroots.com/virtual-event/cancer-research-oncology-2018/Posters
Killexams : Major Shareholder Announcement

Genmab A/S

Company Announcement

COPENHAGEN, Denmark; August 2, 2022 Genmab A/S (Nasdaq: GMAB) announces under reference to Section 30 of the Danish Capital Markets Act that Wellington Management Group LLP has informed us that, as of August 1, 2022, Wellington Management Group LLP through shares and financial instruments holds the voting rights to 3,277,839 shares in Genmab A/S, which amounts to 4.98% of the share capital and voting rights in Genmab A/S.

About Genmab
Genmab is an international biotechnology company with a core purpose to Improve the lives of people with cancer. For more than 20 years, Genmab’s vision to transform cancer treatment has driven its passionate, innovative and collaborative teams to invent next-generation antibody technology platforms and leverage translational research and data sciences, fueling multiple differentiated cancer treatments that make an impact on people’s lives. To develop and deliver novel therapies to patients, Genmab has formed 20+ strategic partnerships with biotechnology and pharmaceutical companies. Genmab’s proprietary pipeline includes bispecific T-cell engagers, next-generation immune checkpoint modulators, effector function enhanced antibodies and antibody-drug conjugates.

Genmab is headquartered in Copenhagen, Denmark with locations in Utrecht, the Netherlands, Princeton, New Jersey, U.S. and Tokyo, Japan. For more information, please visit Genmab.com and follow us on Twitter.com/Genmab.

Contact:        
Marisol Peron, Senior Vice President, Communications and Corporate Affairs
T: +1 609 524 0065; E: mmp@genmab.com

Andrew Carlsen, Vice President, Head of Investor Relations
T: +45 3377 9558; E: acn@genmab.com

This Company Announcement contains forward looking statements. The words “believe”, “expect”, “anticipate”, “intend” and “plan” and similar expressions identify forward looking statements. genuine results or performance may differ materially from any future results or performance expressed or implied by such statements. The important factors that could cause our genuine results or performance to differ materially include, among others, risks associated with pre-clinical and clinical development of products, uncertainties related to the outcome and conduct of clinical trials including unforeseen safety issues, uncertainties related to product manufacturing, the lack of market acceptance of our products, our inability to manage growth, the competitive environment in relation to our business area and markets, our inability to attract and retain suitably qualified personnel, the unenforceability or lack of protection of our patents and proprietary rights, our relationships with affiliated entities, changes and developments in technology which may render our products or technologies obsolete, and other factors. For a further discussion of these risks, please refer to the risk management sections in Genmab’s most recent financial reports, which are available on www.genmab.com and the risk factors included in Genmab’s most recent Annual Report on Form 20-F and other filings with the U.S. Securities and Exchange Commission (SEC), which are available at www.sec.gov. Genmab does not undertake any obligation to update or revise forward looking statements in this Company Announcement nor to confirm such statements to reflect subsequent events or circumstances after the date made or in relation to genuine results, unless required by law.

Genmab A/S and/or its subsidiaries own the following trademarks: Genmab®; the Y-shaped Genmab logo®; Genmab in combination with the Y-shaped Genmab logo®; HuMax®; DuoBody®; DuoBody in combination with the DuoBody logo®; HexaBody®; HexaBody in combination with the HexaBody logo®; DuoHexaBody® and HexElect®.

Company Announcement no. 38
CVR no. 2102 3884
LEI Code 529900MTJPDPE4MHJ122

Genmab A/S
Kalvebod Brygge 43
1560 Copenhagen V
Denmark

Attachment

Tue, 02 Aug 2022 06:50:00 -0500 en-NZ text/html https://nz.finance.yahoo.com/news/major-shareholder-announcement-184600740.html
Killexams : A 70-year-old man in Gaza needed open heart surgery. It was a race against time

GAZA CITY, Gaza Strip — What does it take for a 70-year-old man to get heart bypass surgery in Gaza, when he is cordoned off from the rest of the world in a territory with just two heart surgeons left?

It takes jostling through crowds of patients facing their own heath crises. It takes a dire enough medical condition, or political connections, to convince Palestinian officials to spare limited funds to pay for his surgery abroad.

And it takes pleading with Israeli border officials for security clearance just to be allowed to drive an hour or two out of Gaza to a hospital that can perform his surgery easily.

No place on Earth has been spared a health crisis, as the last few years have shown. Yet Gaza's protracted emergency is driven not only by a pandemic but by people — enemies locked in a 15-year standoff with no end in sight. The victims of Gaza's deadly military conflicts capture headlines, but a frequent contributing factor to illness and death in Gaza are the barriers to health care.

Sometimes hospital patients are rushed past the Gaza border quickly, but other times they spend months begging for permission to leave, nursing ailments at home. Most patients with serious cases eventually do get to cross into Israel, according to World Health Organization statistics. But thousands each year face unpredictable Israeli delays and denials that a 2021 WHO study has shown to be deadly.

It wasn't always like this. Seaside Gaza used to be a portal to the outside world. Some believe the word "gauze" comes from Gaza, where it was made and exported centuries ago. Gaza even had an airport briefly in the late 1990s. But 15 years ago last month, the Palestinian Islamist group Hamas seized control of Gaza following an election victory, and neighboring Israel and Egypt locked down Gaza's borders, choking off trade and travel.

Israel says the blockade is still necessary to contain Hamas, which has waged attacks on Israel and is considered a terrorist group by the U.S. and European Union. Palestinians call the Gaza blockade collective punishment. Gaza is sinking in poverty, hunger, electricity cuts and contaminated water, the United Nations says. Basic health services are constrained even in the quiet times when there's no active fighting.

In a crowded Gaza hospital waiting room in late 2021, NPR journalists approached one man at random, then shadowed him and his family for months, as they begged for permission to leave Gaza for surgery widely available in hospitals a short drive away.

This is his story — and the story of many others.

The heart attack

Yousef Al-Kurd kept the soundtrack of daily life humming in Gaza.

He studied engineering in Germany before returning home to a 30-year career in Gaza fixing loudspeakers for mosques, schools and pushcart vendors.

"A legend," his son Raji says.

Yousef Al-Kurd waits with his son Ibrahim to be seen by a doctor in Gaza. After a sudden heart attack on April 1, 2020, Al-Kurd needed open heart surgery.

/ Fatima Shbair for NPR

/

Fatima Shbair for NPR

Yousef Al-Kurd waits with his son Ibrahim to be seen by a doctor in Gaza. After a sudden heart attack on April 1, 2020, Al-Kurd needed open heart surgery.

When he retired in 2018, he helped his sons with their own electronics workshop, which is where he had a sudden heart attack on April 1, 2020. Al-Kurd, a 70-year-old smoker with diabetes, survived, but he needed open heart surgery. Al-Kurd put it off, scared of the procedure and worried about COVID, his children say.

A year later, his health had worsened, and Al-Kurd's sons rushed him back to the hospital. They went looking for their physician, the head of cardiac surgery at Shifa Hospital, Gaza's main medical center.

"We discovered he had gone abroad," Al-Kurd's son Ibrahim said.

A document shows the medical condition of cardiac patient Yousef Al-Kurd.

/ Fatima Shbair for NPR

/

Fatima Shbair for NPR

A document shows the medical condition of cardiac patient Yousef Al-Kurd.

Gaza's top cardiac surgeon had emigrated to Spain. He and his family did not return requests for comment, but his colleagues said he joined a recent exodus of doctors. They have escaped through Egypt, which relaxed its border restrictions four years ago, seeking better lives in Europe and the United Arab Emirates.

Few surgeons remain

After the chief cardiac surgeon left Gaza, 40-year-old Dr. Saher Abu Ghali was promoted to the head of cardiac surgery at Shifa Hospital in June 2021. But a few months later, a doctor in the department died of cardiac arrest. Then another died of COVID.

"From four, we became three and now we became two," Abu Ghali said from his small office in the hospital.

Dr. Saher Abu Ghali is the head of cardiac surgery at Shifa Hospital. He is one of only two heart surgeons for the two million residents of Gaza. "This is not the only problem," he said. "You don't have all the instrumentation. You don't have all the resources."

/ Fatima Shbair for NPR

/

Fatima Shbair for NPR

Dr. Saher Abu Ghali is the head of cardiac surgery at Shifa Hospital. He is one of only two heart surgeons for the two million residents of Gaza. "This is not the only problem," he said. "You don't have all the instrumentation. You don't have all the resources."

That means there are only two heart surgeons for the two million residents of Gaza. In the U.S. and Europe, the accepted ratio to serve that population size is about 55 surgeons.

"This is not the only problem," Abu Ghali said. "You don't have all the instrumentation. You don't have all the resources."

Israel restricts the import of medical devices, like some X-ray equipment it says Hamas could convert for military uses. The Palestinian Authority in the West Bank, in charge of health services but rivals for power with Hamas, doesn't supply Gaza enough medical supplies, WHO says.

Take, for instance, the thin tubes used for heart bypass surgery called cannulas. In hospitals around the world, they are used once and discarded.

"Here, every cannula is re-sterilized more than 100 times," Abu Ghali said.

Dr. Saher Abu Ghali (center), the Gaza cardiac surgeon, meets with a patient's family.

/ Fatima Shbair for NPR

/

Fatima Shbair for NPR

Dr. Saher Abu Ghali (center), the Gaza cardiac surgeon, meets with a patient's family.

"This is true. This is Gaza," he said with a laugh. "If you want to use it once and throw it out, you will not operate. You will never operate."

Israel doesn't let Palestinian doctors out of Gaza very often to update their skills with training abroad. To compensate for the gaps in care, Israel does allow delegations of surgeons, Palestinian citizens of Israel, to enter Gaza to conduct surgeries a few days a month. Other foreign surgeons visit, too. But it's not enough to meet the demands.

Yousef Al-Kurd needed coronary artery bypass surgery, a fairly straightforward surgery for well-equipped hospitals around the world. But Dr. Abu Ghali, who trained in Italy, said he couldn't do it with Gaza's limited surgeons and supplies.

"It's difficult to be done safely in Gaza. We need heart surgeons. We need vascular surgeons. We need the instrumentations," Ghali said.

The doctor recommended that Al-Kurd go to a better-equipped Palestinian hospital in the Israeli-occupied West Bank, a Palestinian territory not controlled by Hamas and not under blockade.

It's less than two hours away by car, but getting there can be agonizing.

The first hurdle

To leave Gaza for medical treatment, a resident first needs approval from Palestinian health officials and then an Israeli travel permit.

Neither is easy to obtain.

The Palestinian Authority offers universal care under its public health-care system and pays for treatments when they are not available in Gaza. But the money, which comes from U.S. and international donors, is tight. And Israel only allows out the direst cases.

Most people seeking medical care outside Gaza are cancer patients; there's very little chemotherapy in Gaza and no radiation therapy. The second most common patients requesting treatment abroad are heart patients like Al-Kurd.

The triage is strict, even with very critical patients.

Take this case: on day in early December, at the Palestinian health ministry's headquarters in the West Bank, a health official rushed into the office of Dr. Haitham Al-Hidri, who at the time oversaw financial coverage for Palestinian medical referrals.

A doctor in Gaza had just called: a 25-year-old patient was on the operating table in Gaza with a life-threatening vascular problem in his jaw. The Gaza surgeon couldn't handle it and wanted Dr. Al-Hidri's approval to send him to an Israeli hospital right away.

Dr. Al-Hidri called the young man's doctor in Gaza to find out: is it truly urgent?

"If he's bleeding, I'll let him out. If he's not bleeding, I won't let him out. You're the doctor in charge of him. You must supply the last word," Al-Hidri told him on the phone.

They spoke for a few more moments, and Al-Hidri hung up the phone.

"He is not in active bleeding. Some oozing," the doctor explained. "So it's not top emergency. We can wait," he said.

But in the end, Al-Hidri decided not to take chances. He approved the coverage and coordinated the patient's quick transfer to an Israeli hospital. He said Israel does grant permits for most of the especially urgent cases.

Corruption

For years, it was an open secret that patients who wanted to get treatment outside of Gaza could bribe clerks in the Palestinian health ministry to advance the referral.

With the right connections, patients in public hospitals in the West Bank could get preferred treatment in private Palestinian and Israeli hospitals – paid for by the Palestinian Authority.

Dr. Al-Hidri said he cleaned house when he entered the job in 2019: he fired clerks who took bribes and blocked unnecessary medical referrals, saving the cash-strapped Palestinian Authority tens of millions of dollars.

Dr. Haitham Al-Hidri oversaw financial coverage for Palestinian medical referrals when Yousef Al-Kurd was seeking coronary artery bypass surgery outside of Gaza.

Daniel Estrin / NPR

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NPR

Dr. Haitham Al-Hidri oversaw financial coverage for Palestinian medical referrals when Yousef Al-Kurd was seeking coronary artery bypass surgery outside of Gaza.

Suddenly, early this year, Al-Hidri was removed from his post and reassigned.

The health minister, Mai Al-Kaila, called it a "normal rotation" of leadership for a "sensitive" role that oversees large expenditures.

But a health official, speaking on condition of anonymity to discuss the delicate issue, claimed the reason for the reshuffle was that Al-Hidri was preparing files alleging corruption in the health ministry, namely that several thousand patients, many of whom with important political clout, were transferred to private hospitals and granted unnecessary private medical treatment, costing tens of millions of dollars of international donor money.

Recent medical documents leaked to NPR by two health officials appear to support allegations of patronage. According to the documents, at least three patients with high-level ties to Palestinian Authority president's Fatah party received subsidized, costly private medical care in Israel or the West Bank to treat ailments like a stroke or kidney cyst, which officials say Palestinian public hospitals have the ability to treat.

"To be transferred," is the handwritten note in Arabic on each document, signed by Health Minister Mai Al-Kaila herself.

The health minister acknowledged she has approved private medical care for Palestinians, but denied the approvals were political favors. She said public hospitals are overburdened and her approach is "humanitarian," referring the "the poorest of the poor" to private hospitals when "prominent people in the country" lobbied on their behalf.

"In our system, the minister has the power (to grant) an exception," Al-Kaila told NPR. "I am working health and pure health, without discrimination for anyone."

A black hole

Heart patient Yousef Al-Kurd did not have political connections. But he did have a legitimate medical need to leave Gaza for bypass surgery.

His surgery was scheduled at Al Mezan, a Palestinian hospital in the West Bank city of Hebron. To get there, he needed to cross through Israel, which meant applying for an Israeli travel permit.

Israel is wary of letting in anyone from Hamas-controlled Gaza.

"It is not self-obvious that Israel will provide its enemy the treatment they need," said Harel Chorev, an Israeli researcher at Tel Aviv University. "They can go to Egypt, for example."

About 1 in 5 Gaza patients does go to hospitals in Egypt, according to the World Health Organization, but those hospitals are much farther away, and Palestinian health authorities prefer to keep patients inside their own system so public money is invested in the Palestinian territories instead of abroad.

There have been isolated cases where Israel has accused patients of smuggling explosives or spying for Hamas. Some patients have been given Israeli permission to leave for medical treatment and then never returned, going on the lam in the West Bank for better economic conditions or to escape family vendettas and personal troubles in Gaza.

"The whole thing is about trust. But once you break that trust — once you break it and you send someone with cancer with TNT (explosives), and he's been caught, you know, obviously, it does a lot of damage," Chorev said.

Israeli officials say they allow in only humanitarian and exceptional cases — more than 10,000 permits last year. Who is approved and who is denied on security grounds is often a mystery.

"It's really a black hole for us to understand the criterias," said Ron Goldstein of Physicians for Human Rights Israel, an advocacy group helping Gaza patients get permits. "Many, many ... cases are not really security issues because, when we intervene, suddenly the person receives the permit."

Israel does eventually grant most permits, but about a third of applications was delayed or denied in 2021, the World Health Organization said. WHO estimates thousands of people have had to reschedule surgery or chemotherapy as they await Israeli security clearance to travel. In the meantime, WHO said, these patients often grow more ill.

That's what happened with Yousef Al-Kurd. He applied for a permit from Israel on September 12, according to the Palestinian office that submits permit requests. But Israel didn't grant him an expedited permit in time for his surgery appointment on September 15. His son Ibrahim rebooked the surgery for October 12 but still received no final word on a permit. He made a third appointment for November 1 and did not get a permit in time for that one, too.

The whole time, Israel said it was reviewing his request. Al-Kurd just needed an Israeli permit for travel; Israel would not be involved in providing the treatment.

"The Israelis always postpone," Al-Kurd's son Ibrahim said. "This is just slaughtering us."

Al-Kurd's doctor said he shouldn't wait for surgery for more than a month. When six weeks passed with no answer, Al-Kurd's son turned to the Palestinian Centre for Human Rights in Gaza, whose lawyer Mohammed Al-Alami sent Israeli border authorities an urgent letter requesting travel approval.

Mohammed Al-Alami, a lawyer at the Palestinian Centre for Human Rights in Gaza, sent Israeli border authorities an urgent letter requesting travel approval to the West Bank for heart patient Yousef Al-Kurd.

/ Anas Baba for NPR

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Anas Baba for NPR

Mohammed Al-Alami, a lawyer at the Palestinian Centre for Human Rights in Gaza, sent Israeli border authorities an urgent letter requesting travel approval to the West Bank for heart patient Yousef Al-Kurd.

Two more weeks went by with no permit.

So the lawyer called his Israeli contact by phone, and asked her: Why the delay? What's the security risk with a 70-year-old man?

Al-Alami said the Israeli officer told him Al-Kurd had six phone numbers registered under his name. The lawyer thinks Israel reviews patients' phone calls, and that multiple phone numbers raise questions. The Al-Kurd family said there's a logical explanation: Each family member uses a different number, akin to a family phone plan. The lawyer sent that information to his Israeli contact.

"Every day, like this. Every day," Al-Alami said.

Pleading is part of the job in trying to get Israeli permits. One Palestinian official, who asked not to be named fearing repercussions to his job, told NPR he takes pictures of patients with their bulging neck tumor or their sick baby, which he said tends to win Israeli officers' sympathy.

For years, the World Health Organization has documented barriers to accessing health care for Palestinians. Advocate groups say it is easier to win exceptions to the rule than to change the rule, a principle that applies to the entire dynamic of Israel's supervision over Palestinian lives.

COGAT, the Israeli agency in charge of processing travel permits for Gaza patients, later told NPR that Al-Kurd's request was missing paperwork – which it said was a common reason for permit delays. But the family and their lawyer said nothing was missing and that COGAT never told them anything was.

As Al-Kurd awaited a permit, his blood pressure suddenly dropped. He lost the ability to urinate. A couple more days went by.

Then the family got a text message on a Saturday afternoon with some good news: The permit had been approved for the following day.

Finally, Al-Kurd could get to the hospital for the crucial surgery.

This glimmer of hope came after more than two months of pleading and waiting. But Al-Kurd's health was getting worse.

The journey

The next morning at 5:30 a.m., Yousef Al-Kurd and his wife, Fayeza, said goodbye to their children and left home. They waited hours at the Hamas checkpoint as thousands of Palestinian laborers with Israeli work permits crossed first.

Then they reached Israel's sole civilian border crossing with Gaza: the Erez crossing, one of the world's most heavily fortified border crossings.

Yousef Al-Kurd and his wife, Fayeza, on their way to a West Bank hospital.

/ Daniel Estrin/NPR

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Daniel Estrin/NPR

Yousef Al-Kurd and his wife, Fayeza, on their way to a West Bank hospital.

Hamas, committed to armed conflict with Israel, is contained on the other side. So are 2 million Palestinian civilians. Israel's stated policy since Hamas' takeover is "separation": sealing Gaza off from the West Bank and limiting passage between the two main Palestinian territories.

Inside the crossing, Al-Kurd was asked to raise his arms in a full-body scanner. He crumpled to the floor. Israeli attendants rushed him a wheelchair. No one told his family that they had the option to arrange a series of ambulances to ease his transport to the hospital.

But there was a driver on the other side of the border crossing: Arnon Avni, 69, an Israeli graphic designer and political cartoonist who volunteers with Road to Recovery, a group of Israelis who drive Palestinian patients to their medical appointments. The group was waiting at the checkpoint for patients coming through, and NPR pointed out Al-Kurd's arrival. Al-Kurd and his wife took up the offer for a ride.

"Let's get them in," Avni said, throwing his grandchildren's booster seat into the trunk and coaxing the seatbelt over Al-Kurd, who was moaning in pain.

The driver put the destination in his navigation app: an Israeli security checkpoint in the Israeli-occupied West Bank, a bit more than an hour away.

Arnon Avni, 69, an Israeli graphic designer and political cartoonist, volunteers with Road to Recovery, a group of Israelis who drive Palestinian patients to their medical appointments. Avni gave a ride to Yousef Al-Kurd, the Gaza resident seeking heart bypass surgery at a hospital in the West Bank.

Daniel Estrin / NPR

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NPR

Arnon Avni, 69, an Israeli graphic designer and political cartoonist, volunteers with Road to Recovery, a group of Israelis who drive Palestinian patients to their medical appointments. Avni gave a ride to Yousef Al-Kurd, the Gaza resident seeking heart bypass surgery at a hospital in the West Bank.

Al-Kurd and Avni didn't share a language but did have some things in common. They were about the same age, and Avni's father died of a heart attack.

"The pain is severe," Al-Kurd said as the car made its way along Israeli roads.

His wife, Fayeza, 58, was in Israel for the very first time.

"It's another world," she said. It's clean, it's wide, it's open, not like the cramped quarters of the Jabalia refugee camp where she lives in Gaza, she said.

"What's that bridge?" she asked Avni. It's just an overpass, he said. She chuckled; she'd never seen one before.

"I see the eyes of all of my passengers on my travels," Avni said from the driver's seat. "All of them feel the same...the roads, the cars, the new cars. It's something else. It's like for me to travel to New York, or something like that."

Avni lives right next to Gaza, in Kibbutz Nirim. Mortar shells landed outside his home last year, and five decades ago, a Palestinian from Gaza planted explosives in their kibbutz which killed his brother.

"Some people call me a traitor," he said. "I believe that we do the right thing for Israel."

At the Tarkumiya checkpoint near Hebron, an Israeli road sign warns Israelis not to enter the Palestinian territory, so Avni couldn't take Al-Kurd and his wife all the way to the hospital. He dropped them off on the other side of the checkpoint.

They said goodbye to each other, and a Palestinian van whisked the Al-Kurds to the hospital.

Hope quickly fades

Al-Kurd didn't end up getting the surgery he'd been waiting for.

Hours after he arrived in the hospital, he had multiple-system failure. Two days later, his son Ibrahim, in Gaza, got a phone call from the hospital, which he recorded.

"Ibrahim, how are you?" the doctor said.

"Oh, God," Ibrahim replied.

"I'm with your mother now," the doctor said, then pauses. "Your father, may he rest in peace."

What could have been done?

Health experts say it's hard to know whether Al-Kurd could have been saved if he'd received his Israeli travel permit more quickly. There were a lot of factors.

Al-Kurd himself was a high-risk patient with his diabetes and smoking habit. What's more, he went a year without getting the surgery in Gaza that his doctor had initially ordered, afraid of open-heart surgery and afraid of COVID. In Gaza, the medical system is poor, and there was very little patient follow-up when his condition got worse.

Al-Kurd's son Ibrahim blames the Palestinian doctor for not marking the case as urgent, compelling Israel to let his father cross immediately. But health experts say that may not have helped; even some urgent cases get delayed and denied by Israel.

The World Health Organization studied Gaza cancer patients from 2015 to 2017 and found they were nearly one and a half times more likely to die within months and years if their Israeli permits were delayed or denied.

"This is the only study that's been done at the population level to look at the impacts on survival or on health outcomes of these patients that face delays and denials of permits," said Benjamin Bouquet, a WHO doctor who co-authored the study.

There are new efforts by the international community to help Palestinians shore up their own health care. The International Monetary Fund said one of the biggest sources of a current Palestinian financial crisis is the exorbitant costs involved in sending patients elsewhere.

In May, the European Investment Bank inked a partnership with the WHO to help reduce Palestinian dependence on Israel and other countries for health care like oncology treatment.

"The whole referral system is an enormous burden on the Palestinian health sector," said Rik Peeperkorn, who directs the WHO office in the Palestinian territories.

Since Al-Kurd died, more Gaza medical patients, including young children with such conditions as cancer or a congenital heart defect, have died while waiting for permissions to get treatment outside Gaza.

Gathered with his family in their living room a few weeks after his father's death, Raji Al-Kurd, 24, posed a question.

"Put yourself in my shoes," he said. "Would you like to face those circumstances? Would you like to see one of your beloved facing those circumstances?"

Sami Sockol in Jerusalem and Nuha Musleh in Ramallah contributed to this report.

Copyright 2022 NPR. To see more, visit https://www.npr.org.

Thu, 07 Jul 2022 14:47:00 -0500 en text/html https://www.nhpr.org/2022-07-07/a-70-year-old-man-in-gaza-needed-open-heart-surgery-it-was-a-race-against-time
Killexams : Cancer Research & Oncology 2018

 

Our 6th Annual Cancer Research & Oncology Virtual Event is now available On Demand!

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Cancer research has made major advancements in diagnosis, treatments, and the basic understanding of the disease itself. Each year we see progress in immunotherapy, treatments involving nanotechnology, advances in targeted and personalized therapeutics and drug development, and a decrease in mortality rates due to a strong focus on learning more about the origination of the disease.

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Wed, 13 Jul 2022 05:01:00 -0500 text/html https://www.labroots.com/virtual-event/cancer-research-oncology-2018
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