ABSTRACT
Natural resources-blessing or curse? Indonesia provides an excellent case study for an examination of this question. It is a major commodity exporter;the fourth most populous country in the world;and the world's largest archipelagic state with huge mineral, forest and maritime resources. Indonesia also has three distinctive features that are particularly relevant for such a study. First, with the exception of the Asian Financial and COVID-19 crises, it has had at least moderately strong economic performance for the past half-century. This distinguishes it from the majority of resource-rich developing countries, and therefore there are lessons to be learnt from its management of these boom and bust episodes, particularly the latter. Second, Indonesia has experienced two rather different resource booms-the first based mainly on oil and gas in the 1970s and the second based primarily on coal, palm oil and gas over the years 2005-11. The economic, social and environmental effects of these two booms have differed significantly. Third, the country experienced major regime change in 1998-99, from the centralized, authoritarian Soeharto regime in 1966-98, which presided over the first boom, to the subsequent democratic, decentralized regime during the second boom. The very different political and institutional arrangements had important implications for the management of the boom and its distributional effects. We examine these issues in a comparative context, employing as reference points two very large natural resource exporters, Brazil and Nigeria, and Malaysia, a smaller, more dynamic Southeast Asian comparator. © 2022 ISEAS - Yusof Ishak Institute.
ABSTRACT
The year 2022 got off to a relatively optimistic start for Indonesia's economic managers. Notwithstanding the serious health and social outcomes inflicted by the Covid pandemic, the government had successfully minimised the economic fallout. It could reasonably contemplate a period of sustained economic recovery and rising prosperity in preparation for the 2024 national elections. However, the outlook began to deteriorate in the face of heightened global economic volatility and uncertainty: the economic and geostrategic ramifications of the Ukraine War, a sudden slowdown in the global economy, rising interest rates, historically high and volatile prices for some key commodities, international trade and transport disruptions, uncertainty about China's current economic trajectory and persistent if (so far) manageable Covid challenges. Nevertheless, the Indonesian economy is continuing its steady post-Covid progress: the return to 5% growth in late 2021 continued through to second quarter 2022, inflation remains moderate and living standards are slowly recovering. However, there are potentially major macroeconomic challenges on the horizon. In fiscal policy, there are many demands on the budget, yet there is limited fiscal space, and much of the increased budget revenue this year is again being allocated to subsidies. In monetary policy, there is concern that, as in many countries, the monetary authorities could be ‘behind the curve' of rising inflationary pressures. In his 16 August 2022 speech, President Joko Widodo (Jokowi) emphasised the importance of the industrial sector and of ‘downstreaming' as a means of accelerating industrial growth. Against this backdrop, and the sector's sluggish growth for much of this century, the paper also surveys recent patterns of industrialisation and prospects for the future. © 2022 ANU Indonesia Project.
ABSTRACT
Introduction: Before the covid pandemic we provided community respiratory nursing support for patients with chronic lung diseases especially COPD, pulmonary rehabilitation (PR) and a home oxygen service supporting/assessing patients needing oxygen in the community. The pandemic has led to refocussing our services and staff, helping to keep patients out of hospital. Group pulmonary rehabilitation classes were no longer possible. Methods: We have refocussed our service to provide covid-safe services with PPE and early staff immunisation. Some staff were seconded to a rapid response unit for those acutely ill. Others carried out a care homes initiative to review all patients with respiratory disease in care homes. The oxygen team picked up patients discharged post covid from hospital requiring oxygen at home. We identified high risk patients for regular telephone contact. Results: Referrals after admission for non-covid respiratory infections fell as patients stayed at home and reduced contacts. 1.1-1.4 2020v 2021: 236 v 79;GP referrals also fell 1.1-1.4 2020-2021;87 v 35. Both have increased post lockdown. Referrals for PR fell. Total 1.1-1.4. 2020 v 2021, 373 v 107, GP referrals 226 v 54. Post lockdown 1.7.21-1.10.21 there has been an increase, total 139:GP 81. Group PR is starting up again. Oxygen referrals after covid admissions up to 1.10.20 were only 8 from the first wave of disease, but 119 from 15.10.20-10.5.21, and 18 from 9.8.21-1.11.21 (11 ambulatory alone): all patients discharged after covid requiring oxygen at home are contacted by telephone and visited at home. We identified 380 patients who were rated as high risk, either having <3 admissions in 12 months, recent oxygen required at home or PCO2 <7.5Kpa. These were contacted weekly as they sheltered at home. Our staff reviewed 163 patients in nursing homes, 116 with respiratory disease, 31/116 already known to the service. 75% of patients needed a new reliever inhaler or spacer. 58% did not have a rescue pack of antibiotics and steroids, 85% required a salbutamol inhaler. Conclusion: Identification of “high risk patients allowed us to provide telephone support to keep them safe at home. Reviewing all residents in care homes identified unmet needs for therapy and support. Prompt review of patients requiring oxygen after admission for covid helps them once discharged. Admissions for non covid exacerbations fell as patients remained at home with limited contacts, but on re-entering the outside world, admissions for COPD have risen again.
ABSTRACT
Background - The WINDOW-1 regimen introduced first-line ibrutinib with rituximab (IR) followed by 4 cycles of R-HCVAD for younger mantle cell lymphoma (MCL) patients (pts) demonstrating 90% CR on IR alone and we aimed to improve the CR rate with the addition of venetoclax. We therefore investigated the efficacy and safety of IR and venetoclax (IRV) followed by risk-stratified observation or short course R-HCVAD/MTX-ARA-C as consolidation in previously untreated young patients with mantle cell lymphoma (MCL). Our aim was to use a triplet chemotherapy-free induction to reduce the toxicity, complications and minimize chemotherapy exposure in MCL pts. Methods - We enrolled 50 previously untreated pts in this single institution, single arm, phase II clinical trial - NCT03710772. Pts received IR induction (Part-1) for initial 4 cycles. Pts were restaged at cycle 4 and received IRV for up to eight cycles (Cycle 5 to Cycle 12) starting with ramp up venetoclax dosing in Cycle 5. All pts who achieved CR prior to cycle 12 continued to receive IRV for 4 cycles (maximum 12 cycles) and then moved to part 2. Pts were stratified into three disease risk groups: high, moderate and low risk categories from the baseline data for assignment to R-HCVAD/MTX-ARA-C as consolidation in part 2 (4 cycles, 2 cycles, or no chemotherapy for high, medium and low risk pts respectively). Briefly, low risk pts were those with Ki-67 ≤30%, largest tumor mass <3 cm, low MIPI score and no features of high risk disease (Ki-67 ≥50%, mutations in the TP53, NSD2 or in NOTCH genes, complex karyotype or del17p, MYC positive, or largest tumor diameter >5 cm or blastoid/pleomorphic histology or if they remain in PR after 12 cycles of part 1. Medium risk are pts which did not belong to low or high-risk category. Those who experienced progression on part 1 went to part 2 and get 4 cycles of part 2. Patient were taken off protocol but not off study, if they remained in PR after 4 cycles of chemotherapy, these patients were followed up for time to next treatment and progression free survival on subsequent therapies. After part 2 consolidation, all pts received 2 years of IRV maintenance. The primary objective was to assess CR rates after IRV induction. Adverse events were coded as per CTCAE version 4. Molecular studies are being performed. Results - Among the 50 pts, the median age was 57 years (range - 35-65). There were 20 pts in high-risk group, 20 pts in intermediate-risk group and 10 pts in low-risk group. High Ki-67 (≥30%) in 18/50 (36%) pts. Eighteen (36%) had high and intermediate risk simplified MIPI scores. Six (12%) pts had aggressive MCL (blastoid/pleomorphic). Among the 24 TP53 evaluable pts, eight pts (33%) had TP53 aberrations (mutated and/or TP53 deletion by FISH). Forty-eight pts received IRV. Best response to IRV was 96% and CR of 92%. After part 2, the best ORR remained unaltered, 96% (92% CR and 4% PR). The median number of cycles of triplet IRV to reach best response was 8 cycles (range 2-12). Fifteen pts (30%) did not receive part 2 chemotherapy, two pts (4%) received 1 cycle, 16 pts (32%) 2 cycles and 13 pts (26%) got 4 cycles of chemotherapy. With a median follow up of 24 months, the median PFS and OS were not reached (2 year 92% and 90% respectively). The median PFS and OS was not reached and not significantly different in pts with high and low Ki-67% or with/without TP53 aberrations or among pts with low, medium or high-risk categories. The median PFS and OS was inferior in blastoid/pleomorphic MCL pts compared to classic MCL pts (p=0.01 and 0.03 respectively). Thirteen pts (26%) came off study - 5 for adverse events, 3 for on study deaths, and 2 for patient choice, 2 patients lost to follow up and one for disease progression. Overall, 5 pts died (3 on trial and 2 pts died off study, one due to progressive disease and another due to COVID pneumonia). Grade 3-4 toxicities on part 1 were 10% myelosuppression and 10% each with fatigue, myalgia and rashes and 3% mucositis. One pt developed grade 3 atrial flutter on part 1. None had grade 3-4 bleeding/bruising. Conclusions - Chemotherapy-free induction with IRV induced durable and deep responses in young MCL pts in the frontline setting. WINDOW-2 approach suggests that pts with low risk MCL do not need chemotherapy but further follow up is warranted. This combined modality treatment approach significantly improves outcomes of young MCL pts across all risk groups. Detailed molecular analyses will be reported. (Figure Presented).
ABSTRACT
IntroductionDuring the Covid epidemic the care of patients in care homes to optimize their therapy and prevent admission has become a national Priority. In the Basildon and Brentwood CCG area staff normally working in the community respiratory service were redeployed to visit all the care homes in the area and review all patients with respiratory disease to optimize therapy, advise flu immunisation and support their care.MethodsAll care homes in the area of Basildon, Brentwood , Billericay and Wickford were visited and a review carried out on all patients resident there with respiratory disease. This included reviewing both notes and patients to find patients with respiratory disease. Therapy was reviewed and optimised, including obtaining new inhalers, spacer devices and rescue packs.Results163 patients were reviewed, of whom 116 had evidence of respiratory disease. 31 of these were already known to the community respiratory services and 85 were not known. 75% of patients needed a new salbutamol inhaler or aero-chamber spacer device. 58% of patients did not have a rescue pack of antibiotics and steroids and this was provided. 85% of those not already known to the service required salbutamol,. A spacer and a rescue pack.These were all provided.ConclusionsIn this area there was a large unmet need for treatment in patients in care homes with respiratory disease as one of their diagnoses. This project untaken during the covid epidemic has demonstrated that it was possible to provide this in a covid-secure manner and found a need for education of care home staff and a need for a wider application of this project which is now being rolled out to the other CCG (Thurrock) in our area. Educational materials are being produced and distributed to all care homes in the area. The in-reach of community respiratory team staff into care homes can be used as an avenue to ensure good education of care home staff and increase vaccination of staff and residents and optimization of therapy for residents to reduce the risk of hospital admission