Maintenance Group Research Articles

55-OR: HSK7653, a Novel Ultralong-Acting DPP-4 Inhibitor, as Monotherapy in Patients With Type 2 Diabetes—A Randomized, Double-Blind, Placebo-Controlled Phase III Trial

Background: HSK7653 is a novel ultralong-acting DPP-4 inhibitor that maintains the average plasma DPP-4 inhibition over 80% for 14 days after 10mg or 25mg dosing. This randomized, double-blind, placebo-controlled phase III trial was conducted to evaluate the efficacy and safety of HSK7653 biweekly as monotherapy for 52 weeks in drug naive type 2 diabetes patients with inadequate glycemic control on diet and exercise. Methods: A total of 475 patients with a mean HbA1c level of 8.1% were randomized to HSK7653 10mg, 25mg or placebo biweekly at a ratio of 1:1:1 for 24 weeks of double-blind treatment, followed by 28 weeks of open-label extension treatment with HSK7653 25mg for all patients. The primary endpoint was the change in HbA1c from baseline at 24 weeks. Results: At week 24, the least-squares mean change in HbA1c from baseline was -0.96% in HSK7653 10mg, -0.92% in HSK7653 25mg and -0.33% in placebo. HSK7653 10mg and 25mg treatment resulted in significant placebo-subtracted changes in HbA1c of -0.63% (95% CI: -0.81%, -0.46%, p<0.0001) and -0.59% (95% CI: -0.77%, -0.42%, p<0.0001), respectively. The percentage of patients achieving HbA1c<7.0% was 44.2% in HSK7653 10mg group and 44.4% in HSK7653 25mg group versus 20.6% in placebo group (p<0.0001 for HSK7653 groups vs. placebo). No meaningful body weight changes were observed in all treatment groups. In the open-label extension treatment (from week 24 to week 52), the sustaining reduction of HbA1c from baseline were observed in HSK7653 10mg switched to 25mg group and HSK7653 25mg maintenance group. There were no excess hypoglycemia events in HSK7653 vs. placebo, and the incidence of adverse events was similar in all groups during the treatment. Conclusions: In people with type 2 diabetes who had inadequate glycemic control on diet and exercise, HSK7653 monotherapy significantly improved glycemic control with well tolerability and safety. Clinical trial information: NCT04556851. Disclosure L.Ji: Other Relationship; Eli Lilly and Company, Novo Nordisk, Merck & Co., Inc., Bayer Inc., Sanofi-Aventis U.S., Roche Pharmaceuticals, MSD Life Science Foundation, AstraZeneca, Boehringer Ingelheim Inc., Abbott, Metronics. F.Bian: None. T.Pan: None. H.Jiang: None. C.Jiang: None. Q.Ren: None.

Feedback Data Processing for Maintenance Optimization and Grouping—An Application to Road Markings

In recent years, the maintenance of multicomponent systems has been discussed in many papers. The aim of these studies is to use the maintenance duration of one component for the maintenance of other components to minimize the total maintenance cost of the system. The complexity of the maintenance of this kind of system is due to its structure and its large number of components. The present paper suggests a grouped maintenance policy for multicomponent systems in a finite planning horizon based on the systemic inspection feedback data. The system considered is periodically inspected. Then, the collected data are triply censored (left, right, and interval censored). The proposed grouped maintenance strategy starts by clustering the components into g clusters according to their degradation model. Then, an expectation minimization algorithm is applied to correct the censorship in the data and to associate a Weibull distribution with each cluster. The proposed grouped maintenance strategy begins by specifying an individual maintenance plan for each cluster by identifying an optimal replacement path. Then, this step is followed by finding an optimal grouping strategy using a genetic algorithm. The aim is to identify a point in time when the components can be maintained simultaneously. To illustrate the proposed strategy, the grouped maintenance policy is applied to the feedback data of the road markings of French National Road 4 (NR4) connecting Paris and Strasbourg.

THE ROLE OF UPFRONT LENALIDOMIDE MAINTENANCE FOR PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA PATIENTS RESPONDING TO FIRST‐LINE MTX TREATMENT

Background: Consolidation therapy improves duration of response in primary central nerves system lymphoma (PCNSL). Lenalidomide maintenance has shown potential activity in elder adults with PCNSL. However, the efficacy of front-line lenalidomide maintenance in non-elder PCNSL has never been elevated. We aim to evaluate the effect of lenalidomide maintenance on duration of response in newly-diagnosed PCNSLs Method: This is a retrospective, single-center analysis. The patients with PCNSL who achieved complete remission or partial remission after high-dose methotrexate induction therapy were enrolled. Lenalidomide maintenance of 25 mg/d was administered orally for 21 days of every 28-day for 24 months in 35 patients, and no further treatment in the observe group. The efficacy and safety data were analysis. Results: 69 patients were enrolled at Peking Union Medical College Hospital from 2003 to 2021. The median age was 58.0 years, and 50.7% (n = 35) were male. Patients totaling to 57 (82.6%) achieved CR and 12 (18.4%) achieved PR status. Thirty-five patients received lenalidomide maintenance, the median duration of lenalidomide was 18 (2–36) months. It was well tolerated and barely affected the quality of life. After a median follow-up of 32.6 months, there were fewer relapsing and death events in the maintenance group. However, the median PFS was similar between groups (36.1 months vs. 30.6 months, HR 0.78, p = 0.446), and so did the median OS (HR 0.4263, p = 0.091). In the PR patients after induction, lenalidomide maintenance improved PFS and OS significantly. Encore Abstract—previously submitted to EHA 2023 The research was funded by: CAMS Innovation Fund for Medical Sciences (CIFMS) 2021-I2M-C&T-B-005. Keywords: aggressive B-cell non-Hodgkin lymphoma, immunotherapy No conflicts of interests pertinent to the abstract.

S-1 maintenance therapy in Caucasian patients with metastatic esophagogastric adenocarcinoma–final results of the randomized AIO MATEO phase II trial

Platinum-fluoropyrimidine combinations are standard of care for treatment of metastatic esophagogastric adenocarcinoma. The optimal duration of first-line chemotherapy is unknown, however, and maintenance strategies have not yet been established. MATEO is an international randomized phase II trial exploring efficacy and safety of S-1 maintenance therapy in human epidermal growth factor receptor 2 (HER2)-negative advanced esophagogastric adenocarcinoma. After 3 months of first-line platinum-fluoropyrimidine-based induction therapy, patients without progression were randomized in a 2 : 1 allocation to receive S-1 monotherapy (arm A) or to continue combination chemotherapy (arm B). The primary objective was to show non-inferiority of overall survival in the S-1 maintenance group. Progression-free survival, adverse events, and quality of life were secondary endpoints. From 2014 to 2019, 110 and 55 patients were randomized in arm A and arm B, respectively (recruitment closed prematurely). Median overall survival from randomization was 13.4 months for arm A and 11.4 months for arm B [hazard ratio 0.97 (80% confidence interval 0.76-1.23), P= 0.86]. Median progression-free survival from randomization was 4.3 and 6.1 months for arm A versus arm B, respectively [hazard ratio 1.10 (80% confidence interval 0.86-1.39), P= 0.62]. Patients in arm A had numerically fewer treatment-related adverse events (84.9% versus 93.9%) and significantly less peripheral sensory polyneuropathy ≥grade 2 (9.4% versus 36.7%). S-1 maintenance following platinum-based induction therapy leads to non-inferior survival outcomes compared with the continuation of platinum-based combination. Toxicity patterns favor a fluoropyrimidine maintenance strategy. These data challenge the continued use of platinum combination chemotherapy after response to 3 months induction therapy in patients with advanced human epidermal growth factor receptor 2-negative esophagogastric adenocarcinoma.

Upadacitinib Induction and Maintenance Therapy for Crohn’s Disease

BackgroundUpadacitinib, an oral selective Janus kinase (JAK) inhibitor, is under investigation for the treatment of Crohn’s disease.MethodsIn two phase 3 induction trials (U-EXCEL and U-EXCEED), we randomly assigned patients with moderate-to-severe Crohn’s disease to receive 45 mg of upadacitinib or placebo (2:1 ratio) once daily for 12 weeks. Patients who had a clinical response to upadacitinib induction therapy were randomly assigned in the U-ENDURE maintenance trial to receive 15 mg of upadacitinib, 30 mg of upadacitinib, or placebo (1:1:1 ratio) once daily for 52 weeks. The primary end points for induction (week 12) and maintenance (week 52) were clinical remission (defined as a Crohn’s Disease Activity Index score of <150 [range, 0 to 600, with higher scores indicating more severe disease activity]) and endoscopic response (defined as a decrease in the Simple Endoscopic Score for Crohn’s Disease [SES-CD; range, 0 to 56, with higher scores indicating more severe disease] of >50% from baseline of the induction trial [or for patients with an SES-CD of 4 at baseline, a decrease of ≥2 points from baseline]).ResultsA total of 526 patients underwent randomization in U-EXCEL, 495 in U-EXCEED, and 502 in U-ENDURE. A significantly higher percentage of patients who received 45-mg upadacitinib than those who received placebo had clinical remission (in U-EXCEL, 49.5% vs. 29.1%; in U-EXCEED, 38.9% vs. 21.1%) and an endoscopic response (in U-EXCEL, 45.5% vs. 13.1%; in U-EXCEED, 34.6% vs. 3.5%) (P<0.001 for all comparisons). At week 52 in U-ENDURE, a higher percentage of patients had clinical remission with 15-mg upadacitinib (37.3%) or 30-mg upadacitinib (47.6%) than with placebo (15.1%), and a higher percentage had an endoscopic response with 15-mg upadacitinib (27.6%) or 30-mg upadacitinib (40.1%) than with placebo (7.3%) (P<0.001 for all comparisons). Herpes zoster infections occurred more frequently in the 45-mg and 30-mg upadacitinib groups than in the respective placebo groups, and hepatic disorders and neutropenia were more frequent in the 30-mg upadacitinib group than in the other maintenance groups. Gastrointestinal perforations developed in 4 patients who received 45-mg upadacitinib and in 1 patient each who received 30-mg or 15-mg upadacitinib.ConclusionsUpadacitinib induction and maintenance treatment was superior to placebo in patients with moderate-to-severe Crohn’s disease. (Funded by AbbVie; U-EXCEL, U-EXCEED, and U-ENDURE ClinicalTrials.gov numbers, NCT03345849, NCT03345836, and NCT03345823.)

Factors associated with weight loss by age among community-dwelling older people

BackgroundFactors associated with weight loss in community-dwelling older people have been reported in several studies, but few studies have examined factors associated with weight loss by age groups. The purpose of this study was to clarify factors associated with weight loss by age in community-dwelling older people through a longitudinal study.MethodsParticipants in the SONIC study (Longitudinal Epidemiological Study of the Elderly) were community-dwelling people aged 70 or older. The participants were divided into two groups: 5% weight loss and maintenance groups, and compared. In addition, we examined factors affecting weight loss by age. The analysis method used was the χ2 test, and the t-test was used for comparison of the two groups. Factors associated with 5% weight loss at 3 years were examined using logistic regression analysis with sex, age, married couple, cognitive function, grip strength, and the serum albumin level as explanatory variables.ResultsOf the 1157 subjects, the proportions showing 5% weight loss after 3 years among all subjects, those aged 70 years, 80 years, and 90 years, were 20.5, 13.8, 26.8, and 30.5%, respectively. In logistic regression analysis, factors associated with 5% weight loss at 3 years by age were influenced by BMI of 25 or higher (OR = 1.90, 95%CI = 1.08–3.34, p = 0.026), a married couple (OR = 0.49, 95% = 0.28–0.86, p = 0.013), serum albumin level below 3.8 g/dL (OR = 10.75, 95% = 1.90–60.73, p = 0.007) at age 70, and the grip strength at age 90 (OR = 1.24, 95%CI = 1.02–1.51, p = 0.034), respectively.ConclusionsThe results suggest that factors associated with weight loss by age in community-dwelling older people through a longitudinal study differ by age. In the future, this study will be useful to propose effective interventions to prevent factors associated with weight loss by age in community-dwelling older people.

Immunization status of patients with spinal muscular atrophy receiving nusinersen therapy

BackgroundChildren with chronic neurological diseases, including spinal muscular atrophy (SMA), are particularly susceptible to vaccine-preventable infections. We aimed to evaluate the age-appropriate immunization status and its relationship with nusinersen therapy in pediatric patients with SMA. MethodsChildren with SMA who received nusinersen treatment were included in this cross-sectional prospective study. Data were collected on SMA characteristics, nusinersen therapy, vaccination status according to the National Immunization Program (NIP), administration, and influenza vaccination recommendation. ResultsA total of 32 patients were enrolled. In patients with SMA type 1, the frequency of under-vaccination of hepatitis B, BCG, DTaP-IPV-HiB, OPV, and MMR was statistically higher than in patients with SMA type 2–3 (p<0.001). The influenza vaccine was administered to only 9.3% of patients and was never recommended to 13 (40.6%) parents. The frequency of under-vaccination of hepatitis B, BCG, DTaP-IPV-HiB, OPV, and MMR was statistically higher in patients receiving nusinersen maintenance therapy than in those with loading doses (p<0.001). Physician recommendations for influenza and pneumococcal vaccines were significantly higher in the nusinersen maintenance group (p = 0.029). There was no statistical significance between the groups in terms of administration of influenza and pneumococcal vaccines (p = 0.470). ConclusionChildren with SMA had lower immunization rates and poor compliance with immunization programs. Clinicians should ensure that children with SMA receive the same preventive health measures as healthy children, including vaccinations.

Grouping Maintenance Policy for Improving Reliability of Wind Turbine Systems Considering Variable Cost

Wind farms have gained wide attention due to unlimited resources and clean energy. Considering that wind turbine systems are always in harsh conditions, subsystem failures could reduce the reliability of wind turbine systems. At present, the maintenance behaviors for wind turbine systems are various (e.g., corrective maintenance, preventive maintenance) when reliability is reduced below the threshold. Considering the maintenance cost and downtime, it is impossible to repair each component in a timely manner. One of the key problems is dividing components into maintenance groups to improve maintenance efficiency. In this paper, a grouping maintenance policy considering the variable cost (GMP-VC) is proposed to improve direct-drive permanent magnet (DPM) turbine systems. Grouping modes are proposed to fully consider the stated transition probability of turbine components and the variable cost of turbine systems. A maintenance model is formulated to select components as members of the group based on a RIM-VC index. An instance is given to verify the proposed GMP-VC method. The result indicates that the proposed maintenance policy may save maintenance costs over baseline plans.

Maintenance modelling for work rolls in hot finishing mill group with constraint of thermal character

A maintenance model is specially developed for the work rolls equipped in the hot finishing mill group, with the purpose to decrease the total maintenance cost for the roll group under the constraint of the production batches and the roll thermal character. During the maintenance modelling at roll level, the impacts of the surface wear of the work roll on its failure rate state, the production quality and the preventive maintenance cost are deeply discussed. Then, a preventive maintenance grouping method is further proposed at roll group level, with the mutual restriction between the adjustable replacement time of the roll group and the optimal maintenance time of each work roll involved. The case study shows that the proposed maintenance model is practical for the maintenance scheduling of the work rolls in the real rolling production scenario. The total maintenance cost under the proposed maintenance method is always lower that the ones under the individual OM method and the maintenance window-based OM method.

Dynamic maintenance planning for autonomous marine systems (AMS) and operations

Compared to conventional marine systems, where the onboard crew can perform frequent and flexible maintenance, autonomous marine systems (AMS) only involve a limited (or, even no) crew during a voyage, and this challenges maintenance planning and execution. The current study identifies the relevant issues and proposes to solve these through developing a dynamic maintenance planning method for AMS. By considering economical dependencies among components, the study presents a dynamic grouping method to determine the optimum maintenance opportunities for AMS in the future. Stochastic dependencies of components are considered by using the Markov model. A multiphase Markov model is proposed for modeling stochastic dependencies between components where the limited and irregular maintenance opportunities are handled by the multiphase part of the model. A heuristic method is proposed to deal with the combinatorial challenge.To demonstrate the application of the proposed method, the maintenance planning of a cooling system of an autonomous ship is performed in a case study. To validate its performance, the proposed heuristic method is compared with existing ‘short-sighted’ methods for a selection of candidate groups for maintenance. In the validation, various scenarios with different component states and maintenance strategies are tested.

Impact of bortezomib-based versus lenalidomide maintenance therapy on outcomes of patients with high-risk multiple myeloma.

Lenalidomide maintenance after autologous stem cell transplant (ASCT) in multiple myeloma (MM) results in superior progression-free survival and overall survival. However, patients with high-risk multiple myeloma (HRMM) do not derive the same survival benefit from lenalidomide maintenance compared with standard-risk patients. The authors sought to determine the outcomes of bortezomib-based maintenance compared with lenalidomide maintenance in patients with HRMM undergoing ASCT. In total, the authors identified 503 patients with HRMM who were undergoing ASCT within 12months of diagnosis from January 2013 to December 2018 after receiving triplet novel-agent induction in the Center for International Blood and Marrow Transplant Research database. HRMM was defined as deletion 17p, t(14;16), t(4;14), t(14;20), or chromosome 1q gain. Three hundred fifty-seven patients (67%) received lenalidomide alone, and 146 (33%) received bortezomib-based maintenance (with bortezomib alone in 58%). Patients in the bortezomib-based maintenance group were more likely to harbor two or more high-risk abnormalities and International Staging System stage III disease (30% vs. 22%; p=.01) compared with the lenalidomide group (24% vs. 15%; p<.01). Patients who were receiving lenalidomide maintenance had superior progression-free survival at 2years compared with those who were receiving either bortezomib monotherapy or combination therapy (75% vs. 63%; p=.009). Overall survival at 2years was also superior in the lenalidomide group (93% vs. 84%; p=.001). No superior outcomes were observed in patients with HRMM who received bortezomib monotherapy or (to a lesser extent) in those who received bortezomib in combination as maintenance compared with lenalidomide alone. Until prospective data from randomized clinical trials are available, post-transplant therapy should be tailored to each patient with consideration for treating patients in clinical trials that target novel therapeutic strategies for HRMM, and lenalidomide should remain a cornerstone of treatment.

Gestational diabetes and breastfeeding-related pain as major contributors to early breastfeeding cessation

Purpose: This study aimed to determine the effects of gestational diabetes mellitus, breastfeeding-related pain, and infant growth on the cessation of breastfeeding. Methods: This is secondary data analysis. This study included 60 pregnant women from 3 prenatal breastfeeding clinics. Pregnant women aged 20–49 years, with or without a diagnosis of gestational diabetes mellitus were enrolled. The participants were administered four self-reported questionnaires, one at 5 days, 14 days, 3 months, and 6 months postpartum. A linear mixed model and Cox regression analysis were used. Data were collected between May 25, 2020 and June 14, 2021. Results: The rate of breastfeeding cessation was 55.0% (n=33). The average maternal ages were 32.30 (±4.61) and 31.33 (±7.05) years in the cessation and maintenance groups, respectively. The average duration of breastfeeding in the cessation group was 56.27 (±37.48) days. After adjusting for all covariates, the risk of breastfeeding cessation was 2.5 times greater among participants diagnosed with gestational diabetes mellitus (p=.042). Additionally, the risk of breastfeeding cessation was 1.3 times greater among those with severe breastfeeding-related pain (p=.015). Conclusion: The first two months postpartum is the most essential time for healthcare workers to provide support and address difficulties associated with breastfeeding for mothers with gestational diabetes mellitus.

Influencing factors of efficacy and long‐term use of amrubicin in patients with small cell lung cancer

Amrubicin (AMR) has become the standard of care for post-relapse small cell lung cancer (SCLC). It has also been reported to achieve long-term disease control in patients with good treatment response. However, the optimal patient population for whom AMR is effective and the factors associated with long-term disease control are yet to be identified. The aim of the study was to identify the clinical characteristics and factors associated with long-term disease control in patients with recurrent SCLC who would benefit from AMR therapy. The clinical records of 33 patients diagnosed with recurrent SCLC and treated with AMR were retrospectively reviewed. Clinical information was compared between patients who achieved disease control (effective group) and who developed disease progression (noneffective group) on the first efficacy assessment after AMR and between patients who continued AMR for more than seven cycles (maintenance group) and those who terminated treatment after 1-6 cycles (discontinuation group). The noneffective group included significantly more patients with AMR dose reductions after the second cycle (p = 0.006). AMR dose reduction was an independent risk factor for disease progression. The maintenance group had significantly lower pretreatment lactate dehydrogenase (LDH) levels than the discontinuation group (p = 0.046). A high LDH level was an independent risk factor for short AMR discontinuation. Overall survival was significantly longer in the effective group than in the noneffective group (p < 0.001). In AMR therapy for patients with relapsed SCLC, continuation of AMR without dose reduction after the second cycle may contribute to disease control and prolonged survival.

Tolerability and effectiveness of a dermocosmetic product containing Silybum marianum fruit extract in adolescents and young adults with acne-prone skin: An international, phase IV, longitudinal study.

Dermocosmetic products are often used to maintain or enhance the tolerance and effectiveness of medical anti-acne therapies. Recent discoveries about the pathophysiology of acne-prone skin indicate that skincare products may help maintain homeostasis around the sebaceous gland progenitor cells, thereby preventing microcomedone formation. To evaluate the tolerance and effectiveness of a dermocosmetic product containing Silybum marianum fruit extract (SMFE) in adolescents and young adults with acne-prone skin. This real-life, international, observational, multicenter study was conducted in patients aged 12-25 years with mild-to-moderate acne. Patients (N=4230) used the product twice daily for 8-12 weeks, either alone before ("initial group") or after an anti-acne therapy ("maintenance group"), or in association with their usual prescribed anti-acne therapies ("association group"). The tolerance, effectiveness, and cosmetic properties of the product were assessed. Patient quality of life (QoL) was also evaluated. Dermatologists rated the tolerance of the product as "good" or "very good" in about 95% of the patients and the effectiveness of the product as "effective" or "highly effective" in about 80% of the patients, with a significant reduction in the mean global evaluation of acne (GEA) grade (-36% ± 39%, p < 0.0001) at study end. The QoL of most patients (80%) improved by the end of the study, and the majority (79% to 94%) appreciated the cosmetic properties of the product. Overall, the product was a clinical success in >84% of patients. This dermocosmetic product can be used by adolescents and young adults with acne-prone skin to limit the initial or chronic use of medical anti-acne therapies.

Risk factors of loss of reduction after acromioclavicular joint dislocation treated with a hook plate

BackgroundAcromioclavicular joint fixation using a hook plate is effective for the treatment of acute acromioclavicular joint dislocation. However, several studies have reported some complications including loss of reduction after surgery for acromioclavicular joint dislocation. This study aimed to identify the risk factors associated with the loss of reduction after acromioclavicular joint dislocation surgery using a hook plate.MethodsThis was a retrospective study that assessed 118 patients with acromioclavicular joint dislocation, who were diagnosed between March 2013 and January 2019 and underwent surgical treatment using the hook plate (reduction loss group: n = 38; maintenance group: n = 80). The mean follow-up period was 29.9 months (range, 24–40 months). We assessed the range of motion, the American Shoulder and Elbow Surgeons score (ASES), visual analog scale score for pain, and a subjective shoulder value. Radiological assessment of coracoid clavicular distance was performed. The risk factors of reduction loss were analyzed using multivariable logistic regression analysis.ResultsAge (p = 0.049), sex (female, p = 0.03, odds ratio OR = 4.81), Rockwood type V (p = 0.049, OR = 2.20), and time from injury to surgery > 7 days (p = 0.018, OR = 2.59) were statistically significant factors in the reduction loss group. There were no significant differences in the clinical outcomes for range of motion, ASES, subjective shoulder value, and visual analog scale scores between the two groups. In the radiological results, preoperative coracoid clavicular distance (p = 0.039) and ratio (p = 0.001), and over-reduction (p = 0.023, OR = 0.40) were significantly different between the two groups. The multivariate logistic regression analysis identified the female sex (p = 0.037, OR = 5.88), a time from injury to surgery > 7 days (p = 0.019, OR = 3.36), and the preoperative coracoid clavicular displacement ratio of the injured shoulder (p < 0.001, OR = 1.03) as risk factors associated with reduction loss following surgery using a hook plate for acromioclavicular dislocation.ConclusionA delayed timing of surgery > 7 days, preoperative coracoid clavicular displacement ratio of the injured shoulder, and female sex were identified as risk factors for loss of reduction after surgery using a hook plate for acromioclavicular joint dislocation.Level of evidence: Level IV; retrospective comparison; treatment study

Singapore GE2020: the beginning of a new-old order?

ABSTRACT The principle of consent is an essential factor for Gramsci’s conception of ideological hegemony. For Gramsci, there must be consensus between the dominant and subordinated groups for the successful maintenance of ideological hegemony. Of note, consensus for Gramsci is a dynamic and continuous process of readjustment to altering conditions. Hence, an exchange is required between rulers and ruled as norm-making for hegemony, rather than coercion alone or at all. This article argues that the ideological hegemony necessary for continued PAP dominance of politics and governance in Singapore may be fraying as the General Elections of 2020 show how the consensus required between the hegemonic class and polity may be weakening. However, the article concludes by holding that these results while challenging may not herald the end of its hegemony as consensus may be retrieved among the broad electorate by addressing several key issues that arose during the elections.

Hypothesized model of the relationship between affective behaviour, emotional intelligence and success of out-of-school youths in cell phone maintenance enterprise

PurposeMany youths are out-of-school with few having the basic sustainable skills to earn a living. Some of the engaged ones have interpersonal relationship and other problems that can sustain the successes of their business. Therefore, this study is set to investigate the relationship between affective behaviour, emotional intelligence and success of out-of-school youths in cell phone maintenance enterprise.Design/methodology/approachPurposive sampling technique was used to select the sample. Of the total, 350 out-of-school youths who are engaged in cell phone maintenance enterprise in computer village Ikeja, Lagos State, Nigeria, were used as a sample, but 292 samples with completely filled research instrument were used for the study. Data collected were validated through the principal component analysis and the hypothesis tested through the confirmatory factor analysis using AMOS and SPSS.FindingsThe result of the study showed that affective behaviour and social skills do not necessarily predict but self-motivation predicts the career success of out-of-school youths in cell phone maintenance enterprise. Self-awareness, emotional regulation, social awareness and emotional receptivity significantly influence affective behaviour towards success in their chosen career.Practical implicationsThis study enhances the cell phone maintenance association or group to adopt the participation of on-the-job training of their members to help them build good relationship and self-esteem. The training will improve their emotional intelligence and further enhance the creation of a formidable emotional intelligent workplace team.Social implicationsThe study affirms that the constructs of emotional intelligence are predictors of career success among out-of-school cell phone maintenance. It boosts their moral and psychological behaviours towards building good customer relationship which culminates into success in their career area. This study also motivates the out-of-school youths that success is multifaceted that involves building adequate personal and social relationship within the circle of their co-maintenance personnel and customers.Originality/valueThis study showed that success in any chosen career involves adequate training, inter- and intra-personal relationship and building adequate emotional intelligence to overcome the varying challenges that may be encountered. Also it indicated that personal development in a chosen career is essential and career successes can be built around personal goal orientation rather than building it in circle of people around. The study does not totally neglect social relationship because no man can live and succeed in isolation.

COVID-19 Obesity: Differences in Infection Risk Perception, Obesity Stress, Depression, and Intention to Participate in Leisure Sports Based on Weight Change.

This study examined the impact of COVID-19 on individuals' weight change and mental health by analyzing differences in risk perception, obesity, stress, depression, and intention to participate in leisure sports during the COVID-19 pandemic. Data were collected in the Republic of Korea between June and August 2022. This study included 374 individuals aged ≥ 20 years who regularly participated in leisure sports. A comparative analysis subdivided the participants into two groups based on weight changes during the pandemic: weight loss and maintenance (Group 1) and weight gain (Group 2). These formed the independent variable. The dependent variables were (a) infection risk perception, (b) obesity stress, (c) depression, and (d) intention to participate in sports. The results revealed statistically significant differences between the two groups in infection risk perception, obesity stress, and depression factors, but not in the intention to participate in sports. This study demonstrated the impact of COVID-19 on weight changes and mental health. These findings can guide future quarantine strategies to control new infectious diseases and policies to prevent obesity and stress.

Partial SAA patients benefit from delayed response of IST.

Severe aplastic anemia(SAA)is a severe disease characterized by immune-mediated bone marrow failure and pancytopenia. Immunosuppressive therapy (ATG plus CsA, IST) is the standard treatment for patients who are not suitable for allogeneic hematopoietic stem cell transplantation (allo-HSCT). Some patients have a delayed response after 6 months of ATG, and unnecessary to be given secondary ATG or allo-HSCT. We attempted to distinguish patients who may get potential delayed response from those who were really not responsive to IST. We collected data from 45 SAA patients who were assessed no-response to IST at 6 months after rATG and failed to receive secondary ATG or allo-HSCT. CsA plus eltrombopag (EPAG) group has an extra 75% response rate while CsA maintenance group has an extra 44% response rate at 12 months. ATG was applied within 30 days after diagnosis, ATG dosage was suffificient (ATG/lymphocyte ≥2), and absolute reticulocyte count (ARC) was ≥30×109 /L at 6 months, indicated patients could get delayed response and benefifit from CsA maintenance. Addition of EPAG could give an even better response. Otherwise, secondary ATG or allo-HSCT treatment were recommended to be given immediately. https://www.chictr.org.cn/searchproj.aspx, identifier ChiCTR2300067615.

Health-related quality of life in patients with RAS wild-type metastatic colorectal cancer treated with fluorouracil and folinic acid with or without panitumumab as maintenance therapy: An analysis of the Panama trial (AIO KRK0212).

51 Background: The PANAMA study demonstrated superior progression-free survival (PFS) with the addition of panitumumab (Pmab) to fluorouracil and folinic acid (FU/FA) as maintenance therapy following first-line induction therapy with FOLFOX/Pmab in patients with RAS wild-type metastatic colorectal cancer. We report health-related quality of life (HRQOL) analyses of the PANAMA study. Methods: HRQOL was assessed by European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) at every cycle of therapy until disease progression. All patients who received at least one dose of induction therapy and completed at least one HRQOL assessment were included into the analysis. HRQOL outcomes were mean changes in EORTC QLQ-C30 from baseline (prior to cycle 1 of induction therapy) to each cycle of treatment (both induction and maintenance therapy). The trial is registered with ClinicalTrials.gov (NCT01991873). Results: In total, 349/377 (93%) of the induction and 237/248 pts (96%) of the maintenance group completed at least one HRQOL assessment and were included in the HRQOL analysis population. There were no significant differences in any of the EORTC QLQ-C30 items between both treatment arms before induction therapy and at randomization. From baseline to cycle 6 of induction therapy there was significant improvement in mean EORTC QLQ-C30 global health status (GHS)/QOL, functioning (except for cognitive functioning) and symptom (except for nausea and vomiting, dyspnea, appetite loss, constipation, and financial difficulties) scores in the randomized population. During maintenance therapy, no significant differences between FU/FA plus Pmab and FU/FA alone were observed. In both arms of the trial, GHS/QOL scores were maintained or trended to improve from baseline (start of induction therapy) to cycle 10 of maintenance therapy (FU/FA plus Pmab: mean difference 9.48 [95% CI 1.96-17.00]; p=0.014); FU/FA arm (mean difference 6.52 [95% CI –1.9-14.95]; p=0.128). Conclusions: Using the established EORTC QLQ-C30 assessment, the addition of Pmab to FU/FA as maintenance therapy in patients with RAS wild-type metastatic colorectal cancer did not impair the HRQOL endpoints analyzed compared to FU/FA alone. These results, along with previously reported improvement in PFS, may support clinical decision-making concerning maintenance treatments. Clinical trial information: NCT01991873 .