Impacts of climate change: challenges of flooding in coastal East Asia

Over recent years a body of evidence has grown to suggest that East Asia is experiencing the effects of climate change. Allied to this is that coastal populations and economic assets are becoming more vulnerable to flood hazards. Flood vulnerability has increased owing to the combination of a number of human and physical variables: a) rapid coastal urban growth, b) anthropogenic changes to the environment, such as land subsidence through natural resource extraction or the removal of natural protective barriers, and c) increase in frequency and magnitude of coastal hazards associated with typhoons, storm surges, and sea-level rise. East Asia’s population is highly concentrated on low-lying coastal regions and deltaic cities are especially at risk. However, effective adaptation to climate impacts on many coasts is yet to develop. In this chapter, the drivers of coastal vulnerability are reviewed and examined in East Asia, exemplified by the Pearl River Delta (PRD), and its megacities of Guangzhou, Hong Kong and Shenzhen. The population of the PRD is expected to reach 120 million by 2050 and the delta is one of the most important economic centres in East Asia. Flood risk is substantial in the PRD, but flood-risk management appears to suffer from a lack of sufficient strategic planning to prepare for future climate extremes. Drawing on international experience of climate change adaptation and flood risk management, we suggest a path forward to develop adaptation strategies for deltaic and coastal cities in East Asia

Social capital and community preparation for urban flooding in China

Social capital can enhance community resilience to environmental change. Productive and trusted relations among social actors and effectual social norms can help local residents share resources, information and risks. The main objective of our study is to understand the ways in which social attributes and risk considerations influence adoption of resilient economic measures by individuals for reducing potential losses due to catastrophic rainstorm and flooding. This article provides evidence from China on how social capital contributes to anticipatory adaptation to environmental change. The inquiry is based on structured interviews with local residents of Tianjin, a flood-prone port city in China, and a standard regression analysis. Findings show that the intention to make preparation increases with the levels of social expectation, social relationship, and institutional trust. Perceived risk and damage experience, however, have no significant impacts. This suggests that building social capacity and trust will be more effective in enhancing community resilience than merely increasing awareness of hazard risks. We call for greater efforts on strengthening the capacity of formal and informal communal institutions. The structural changes required, however, are challenging.postprin

Differentiation in key learning areas for gifted students in regular classes: A project for primary school teachers in Hong Kong

Gifted students usually require much less time spent in practising and revising basic skills; instead, they benefit greatly from opportunities to work through the curriculum at a faster pace (acceleration). Teachers currently working with mixed-ability classes do not always find it easy to differentiate their teaching approach in this way, so there is a need to facilitate in-service professional development to provide teachers with practical strategies for implementing effective differentiation for gifted learners. In response, a project for primary school teachers was organized by a university in Hong Kong. The purposes of the project were (a) to enhance the confidence of teachers in planning and delivering differentiated lessons in specific key learning areas (KLAs) with particular reference to gifted students; (b) to empower teachers with knowledge and strategies necessary for designing and implementing a differentiated curriculum in KLA domains and (c) to establish a professional development practice that connects local academics with schools and teachers. The project was implemented by inviting curriculum leaders, panel chairpersons and subject teachers from primary schools to attend a 3-hour lecture and a 6-hour workshop in which differentiation practices were explored. The project was later evaluated based on feedback from participants and university consultants. Overall, the feedback was positive, but suggestions are provided here for enhancing future projects of a similar nature.postprin

It's the product not the polymer: Rethinking plastic pollution

Mismanaged plastic waste poses a complex threat to the environments that it contaminates, generating considerable concern from academia, industry, politicians, and the general public. This concern has driven global action that presents a unique opportunity for widespread environmental engagement beyond the immediate problem of the persistence of plastic in the environment. But for such an opportunity to be realized, it is vital that the realities of plastic waste are not misrepresented or exaggerated. Hotspots of plastic pollution, which are often international in their source, present complex environmental problems in certain parts of the world. Here we argue, however, that the current discourse on plastic waste overshadows greater threats to the environment and society at a global scale. Antiplastic sentiments have been exploited by politicians and industry, where reducing consumers' plastic footprints are often confused by the seldom‐challenged veil of environmental consumerism, or “greenwashing.” Plastic is integral to much of modern day life, and regularly represents the greener facilitator of society's consumption. We conclude that it is the product, not the polymer that is driving the issue of plastic waste. Contemporary consumption and disposal practices are the root of much of the anthropogenic waste in the environment, plastic, or not. Effective environmental action to minimize plastic in the environment should be motivated by changes in consumption practices, policies, and product design, and should be informed by objective science and legislation

Stroke patients with cancer are at increased risk of recurrent stroke and cardiovascular mortality

Background: Cancer patients are at increased risk of cardiovascular and cerebrovascular events. It is unclear whether cancer confers any additional risk for recurrent stroke or cardiovascular mortality after stroke. Methods: This was a single-centre, observational study of 1105 consecutive Chinese ischaemic stroke patients recruited from a large stroke rehabilitation unit based in Hong Kong. We sought to determine whether patients with cancer are at higher risk of recurrent stroke and cardiovascular mortality. Results: Among 1105 patients, 58 patients (5.2%) had cancer, of whom 74% were in remission. After a mean follow-up of 76 ± 18 months, 241 patients developed a recurrent stroke: 22 in patients with cancer (38%, annual incidence, 13.94%/year), substantially more than those without cancer (21%, 4.65%/year) [P < 0.01]. In a Cox regression model, cancer, age, and atrial fibrillation were the three independent predictors of recurrent stroke with a hazard ratio (HR) of 2.42 (95% confidence interval [CI], 1.54-3.80), 1.01 (1.00-1.03), and 1.35 (1.01-1.82), respectively. Likewise, patients with cancer had a higher cardiovascular mortality compared with those without cancer (4.30%/year vs 2.35%/year; P = 0.08). In Cox regression analysis, cancer (HR = 2.08; 95% CI, 1.08-4.02), age (HR = 1.04; 95% CI, 1.02-1.06), heart failure (HR = 3.07; 95% CI, 1.72-5.47), and significant carotid atherosclerosis (HR = 1.55; 95% CI, 1.02-2.36) were independent predictors for cardiovascular mortality. Conclusions: Cancer patients who develop ischaemic stroke are at increased risk of recurrent stroke and cardiovascular mortality.published_or_final_versio

Variants, clinical characteristics and prognostic factors of Guillain-Barre syndrome in Chinese

INTRODUCTION: The variants, clinical characteristics, and prognostic factors of Guillain-Barre syndrome (GBS) in Hong Kong Chinese has not been widely studied previously. METHODS: We performed a retrospective review of adults with GBS admitted to Queen Mary Hospital, Hong Kong during the peri…published_or_final_versio

Long-term prognostic implications of visit-to-visit blood pressure variability in patients with ischaemic stroke

Background: Both blood pressure (BP) and its variability (BPV) are established risk factors for the development of atherosclerotic diseases and are associated with an increased risk of cardiovascular and all-cause mortality. The long-term prognostic implications of out-patient clinic visit-to-visit BPV among patients with ischaemic stroke are nevertheless unknown. Methods: We prospectively followed up the clinical outcome of 632 consecutive ischaemic stroke patients without atrial fibrillation. The mean BP and BPV, as determined by the coefficient of variation of the systolic and diastolic BP, were recorded during a mean of 12 ± 6 outpatient clinic visits. Results: The mean age of the patients was 71 ± 11 years. After a mean of 76 ± 18 month’s follow-up, 161 (26%) patients died, 35% (56/161) were due to cardiovascular causes. 16% and 5% developed recurrent stroke and acute coronary syndrome (ACS), respectively. After adjusting for mean systolic BP and confounding variables, patients with a high systolic BPV were at significantly greater risk of cardiovascular mortality (hazard ratio [HR] = 2.36; 95% confidence interval [CI], 1.02-5.49; P < 0.05). A high systolic BPV also predicted all-cause mortality after adjusting for mean systolic BP (HR = 1.79; 95% CI, 1.16-2.75; P < 0.05). There was no association between systolic BPV with non-fatal recurrent stroke nor non-fatal ACS. A raised diastolic BPV did not predict recurrent non-fatal stroke, non-fatal ACS nor mortality. Conclusions: Visit-to-visit systolic BPV predicts long-term all-cause and cardiovascular mortality in patients with ischaemic stroke without atrial fibrillation, independent of other conventional risk factors including average BP control.published_or_final_versio

Visit-to-visit systolic blood pressure variability predicts all-cause and cardiovascular mortality after lacunar infarct

Background: Both blood pressure (BP) and its variability (BPV) are established risk factors for development of atherosclerotic disease and are associated with an increased risk for cardiovascular and all-cause mortality. The prognostic implications of out-patient clinic visit-to-visit BPV among patients with lacunar infarction are nevertheless unknown. Methods: We prospectively followed up the clinical outcome of 281 patients with lacunar infarction. The mean BP and BPV, as determined by the standard deviation of the systolic and diastolic BP, were recorded during a mean of 13 ± 6 out-patient clinic visits. Results: The mean age of the population was 70 ± 10 years. After a mean of 78 ± 18 month’s follow-up, 65 (23%) patients died, 31% (20/65) were due to cardiovascular causes. 14% and 7% developed recurrent stroke and acute coronary syndrome, respectively. After adjusting for age, sex, mean systolic and diastolic BP, cardiovascular risk factors and co-morbidities, patients with a systolic BPV of the third tertile had significantly higher risk of all-cause (hazard ratio [HR] = 1.97; 95% confidence interval [CI], 1.02-3.80; P = 0.04) and cardiovascular mortality (HR = 7.64; 95% CI, 1.65-35.41; P < 0.01) compared to those with systolic BPV of the first tertile. Nevertheless, systolic BPV did not predict recurrent stroke or acute coronary syndrome. Diastolic BPV did not predict various adverse clinical outcomes. Conclusions: Visit-to-visit systolic BPV predicts long-term all-cause and cardiovascular mortality after lacunar infarct, independent of conventional risk factors including average BP control.published_or_final_versio

Urban flood risks and emerging challenges in a Chinese delta: The case of the Pearl River Delta

By the 2050s, more than 120 million people are predicted to settle in the Pearl River Delta (PRD), which covers large coastal cities such as Guangzhou, Shenzhen and Hong Kong. Cities in the PRD are vitally important to China in relation to their socio-economic contributions. From recent evidence, this strongly urbanized area is vulnerable to, and currently facing bigger incidences of, coastal and urban flooding. Flood risk is growing in low-lying coastal areas due to rapid urbanization and increasing flood hazards exacerbated by climate change. Frequent intensive rainstorms, sea-level rise, typhoons and surges threaten large populations and their economic assets, causing severe socio-economic and ecological impacts in the PRD cities. Current flood risk management (FRM) in the delta is still predominately focused on using traditional techno-fixes and infrastructure paradigms, lacking sufficient strategic planning and flood protection to develop adequate flood resilience. Recent urban floods, enhanced by storm surges and intensive rainstorms, have affected multiple PRD cities and drawn attention to flood risk as a major challenge in the PRD’s coastal cities. This review encourages development of long-term FRM practices with provincial and municipal authorities working together more closely to develop better-integrated regional FRM strategies for the PRD

Myasthenic crisis in patients with generalised myasthenia gravis

INTRODUCTION: Myasthenia gravis (MG) is an important autoimmune disease causing generalised weakness and even mortality, which is amenable to immunotherapies. Myasthenic crisis (MC) is the most serious presentation of MG typically requiring ventilator support under the care of intensive care unit. We studied factors which predict development of MC in generalised MG (gMG) patients and patients’ serum cytokine levels as potential biomarkers for MG exacerbation and crisis ...published_or_final_versio