Reproducibility of thoracic kyphosis measurements in patients with adolescent idiopathic scoliosis

BACKGROUND: Current surgical treatment for adolescent idiopathic scoliosis (AIS) involves correction in both the coronal and sagittal plane, and thorough assessment of these parameters is essential for evaluation of surgical results. However, various definitions of thoracic kyphosis (TK) have been proposed, and the intra- and inter-rater reproducibility of these measures has not been determined. As such, the purpose of the current study was to determine the intra- and inter-rater reproducibility of several TK measurements used in the assessment of AIS. METHODS: Twenty patients (90% females) surgically treated for AIS with alternate-level pedicle screw fixation were included in the study. Three raters independently evaluated pre- and postoperative standing lateral plain radiographs. For each radiograph, several definitions of TK were measured as well as L1–S1 and nonfixed lumbar lordosis. All variables were measured twice 14 days apart, and a mixed effects model was used to determine the repeatability coefficient (RC), which is a measure of the agreement between repeated measurements. Also, the intra- and inter-rater intra-class correlation coefficient (ICC) was determined as a measure of reliability. RESULTS: Preoperative median Cobb angle was 58° (range 41°–86°), and median surgical curve correction was 68% (range 49–87%). Overall intra-rater RC was highest for T2–T12 and nonfixed TK (11°) and lowest for T4–T12 and T5–T12 (8°). Inter-rater RC was highest for T1–T12, T1-nonfixed, and nonfixed TK (13°) and lowest for T5–T12 (9°). Agreement varied substantially between pre- and postoperative radiographs. Inter-rater ICC was highest for T4–T12 (0.92; 95% CI 0.88–0.95) and T5–T12 (0.92; 95% CI 0.88–0.95) and lowest for T1-nonfixed (0.80; 95% CI 0.72–0.88). CONCLUSIONS: Considerable variation for all TK measurements was noted. Intra- and inter-rater reproducibility was best for T4–T12 and T5–T12. Future studies should consider adopting a relevant minimum difference as a limit for true change in TK. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13013-017-0112-4) contains supplementary material, which is available to authorized users

Survey of oral hygiene behaviour, knowledge and oral hygiene status among Hong Kong adults : a pilot study

Objectives: To study the correlation between oral health behaviour and knowledge with respect to the oral hygiene status of Hong Kong Chinese adults. Materials and methods: Subject selection was by convenience sampling. A total of four outreach visits were arranged in March 2015. The participants’ oral health behavior and knowledge were evaluated through a self-reported questionnaire, while existing oral conditions were recorded following clinical examination using Visible Plaque Index (VPI) and Gingival Bleeding Index (GBI). Data analysis was carried out using SPSS on results obtained from the questionnaire as well as clinical examination. Results: A total of 147 subjects participated in this research project, of which 72% (103/147) were female while 28% (44/147) were male. Male subjects had statistically significantly higher mean VPI scores compared to female subjects interproximally, buccally and lingually (t-test, p<0.05). Furthermore, there exists a statistically significant negative correlation between oral health knowledge score (mean = 9.3, SD = 3.1) and VPI score (Pearson correlation test, p=0.025). Subjects who agreed accumulation of plaque or bacteria as a contributing factor to caries and periodontal diseases are statistically significantly lower than subjects who disagreed this statement in terms of mean VPI scores (53% vs 63%, t-test, p<0.05). Conclusion: Participants with better oral health knowledge who also recognized accumulation of plaque or bacteria as one of the contributing factors to dental caries and periodontal disease had better oral hygiene levels in terms of VPI.published_or_final_versio

Temporal trends and patterns of infective endocarditis in a Chinese population:A territory-wide study in Hong Kong (2002-2019)

BACKGROUND: The characteristics of infective endocarditis (IE) in Asians are poorly understood. Therefore, we aim to describe the epidemiological trends and clinical features of IE in Hong Kong. METHODS: All patients with incident IE from 2002–2019 in a territory-wide clinical database in Hong Kong were identified. We studied the age- and sex-adjusted and one-year mortality of IE between 2002 and 2019 and identified significant contributors to 1-year all-cause death using the attributable fraction. We used propensity score and inverse propensity of treatment weighting to study the association of surgery with mortality. FINDINGS: A total of 5139 patients (60.4 ± 18.2years, 37% women) were included. The overall incidence of IE was 4.9 per 100,000 person-year, which did not change over time (P = 0.17). Patients in 2019 were older and more comorbid than those in 2002. The one-year crude mortality rate was 30% in 2002, which did not change significantly over time (P = 0.10). Between 2002 and 2019, the rate of surgery increased and was associated with a 51% risk reduction in 1-year all-cause mortality (Hazard Ratio 0.49 [0.28–0.87], P = 0.015). Advanced age (attributable fraction 19%) and comorbidities (attributable fraction 15%) were significant contributors to death. INTERPRETATION: The incidence of IE in Hong Kong did not change between 2002 and 2019. Patients with IE in 2019 were older and had more comorbidities than those in 2002. Mortality of IE remains persistently high in Hong Kong. Together, these data can guide public health strategies to improve the outcomes of patients with IE. FUNDING: This work was supported by Sanming Project of Medicine in Shenzhen, China [No. SZSM201911020] and HKU-SZH Fund for Shenzhen Key Medical Discipline [No. SZXK2020081]

The van Hiele Phases of Learning in studying Cube Dissection

Spatial sense is an important ability in mathematics. Formula application is very different from spatial concept acquisition. But it is often observed that in schools students learn spatial concepts by memorizing instead of understanding. In the past academic year we had tried out and developed a series of learning activities based on van Hiele’s model for guiding learners to explore the cube and its cut sections. The ideas in origami, and mathematical modelling by manipulative as well as mathematical software are integrated into our study. This paper gives a brief account on our works. We start by presenting a sequence of math-rich learning tasks, followed by some related folding ideas and mathematical background analysis. Finally we round up our paper with a concise discussion on some major elements of our design based on the van Hiele learning phases

The van Hiele Phases of Learning in studying Cube Dissection

Spatial sense is an important ability in mathematics. Formula application is very different from spatial concept acquisition. But it is often observed that in schools students learn spatial concepts by memorizing instead of understanding. In the past academic year we had tried out and developed a series of learning activities based on van Hiele’s model for guiding learners to explore the cube and its cut sections. The ideas in origami, and mathematical modelling by manipulative as well as mathematical software are integrated into our study. This paper gives a brief account on our works. We start by presenting a sequence of math-rich learning tasks, followed by some related folding ideas and mathematical background analysis. Finally we round up our paper with a concise discussion on some major elements of our design based on the van Hiele learning phases

(Out)Focus: a community node in Yuen Long

published_or_final_versionArchitectureMasterMaster of Architectur

Improving street walkability: Biometeorological assessment of artificial-partial shade structures in summer sunny conditions

© 2019, ISB. Recent rapid urbanization has rendered outdoor space a key quality-of-life factor, yet walkability studies especially in hot-humid climates have seldom considered human biometeorology. This site-level study investigated microclimatic functions of an overhead structure in improving walkability, and identified biometeorology-related factors influencing pedestrian behaviour. A walkway with overhead tinted glass cover, demarcated into sunny zone and shaded zone, was equipped with hanging aluminium fins. Human thermal sensation was approximated by physiologically equivalent temperature (PET) and universal thermal climate index (UTCI), both closely related to global solar radiation and black-globe temperature. Pedestrian flow was tallied by demographic factors to assess the choice between shaded or sunny zones. Compared with sunny zone, shaded zone slashed maximum global solar radiation by 432 W/m2 in full effect to achieve 90% solar radiation reduction. The maximum cooling in air and black-globe temperatures reached 0.8 °C and 6.1 °C respectively. The overhead structure imposed minimal effect on wind field in both zones. Contrast in maximum PET and UTCI between the two zones reached 8.2 °C and 5.3 °C respectively. In shaded zone, the dominant biometeorological condition was moderate heat stress or slightly warm sensation in contrast to strong heat stress or warm sensation in sunny zone. An overall preference for shaded zone was detected. Pedestrian gender and age, namely female and elderly, were significantly associated with shaded zone preference. The findings could inspire a biometeorological perspective in understanding walking behaviour and pedestrian-friendly facilities. Biometeorological-sensitive design of artificial shade could improve walkability in urban environment that increasingly demands climate change proofing

Water smart cities increase irrigation to provide cool refuge in a climate crisis

Abstract Water smart cities are increasing their use of irrigation and misting to cope with extreme heat and drought. This is being enabled by widespread use of rainwater tanks, stormwater capture and storage systems, and recycled sewage wastewater to irrigate street trees as well as private and public green spaces. These alternative water resources provide new options for cities to better withstand and function under extreme summer heatwave conditions with little or no impact on drinking water supplies. Small‐scale approaches to evaporatively cool urban animals, vegetation habitat, and people are showing initial success. However, ongoing testing and modeling are needed to understand the impacts of scaling up these interventions and to evaluate their cost‐effectiveness. We describe current innovations in irrigation of Australian cities to help policy development in other countries and cities experiencing similar climates with episodic summer heatwaves

Assessing the risk of dengue virus transmission in a non-endemic city surrounded by endemic and hyperendemic areas

Objective: To assess the potential risk of dengue transmission in a non-endemic city using a spatial epidemiological approach. Methods: Past dengue exposure of the general population was examined by dengue virus (DENV) IgG testing of archived samples from voluntary blood donors. Vector intensities were determined by local ovitrap index (OI). Analyses were made in the context of population statistics at both the district and sub-district level. Results: The overall prevalence of DENV IgG was low at 2.25%. Positive donors were more likely to be older, non-Chinese, and female. Neither the OI nor the location of residence was associated with DENV serology. The sub-district level OI was clustered, but no correlation could be confirmed with the location of residence of positive blood donors. Conclusions: The cumulative exposure of Hong Kong residents to dengue has so far been low. Coupled with the lack of a spatial relationship between exposed cases and vector intensities, a high risk of local transmission of DENV is not supported. The apparently higher exposure likelihood of females could be explained by past infection in workers from dengue endemic countries, while frequent travel could have exposed older adults to DENV. Continued surveillance, risk assessment, and intensive vector control remain essential to prevent the transformation of a non-endemic to an endemic city

Rod Lengthening with the Magnetically Controlled Growing Rod

Study Design. Prospective study. Objective. To identify the factors that are associated with rod slippage and to study the pattern of achieved length gain with a standard distraction methodology. Summary of Background Data. Ability to achieve successful magnetically controlled growing rod (MCGR) distraction is crucial for gradual spine lengthening. Rod slippage has been described as a failure of internal magnet rotation leading to a slippage and an inability to distract the rod. However, its onset, significance, and risk factors are currently unknown. In addition, how this phenomenon pertains to actual distracted lengths is also unknown. Methods. A total of 22 patients with MCGR and at least six distraction episodes were prospectively studied. Patients with rod slippage occurring less than six distraction episodes were considered early rod slippage whereas those with more than six episodes or have yet to slip were grouped as late rod slippage. The association of parameters including body habitus, maturity status, age of implantation, total number of distractions, months of distraction from initial implantation, initial and postoperative Cobb angle, T1-T12, T1-S1, T5-T12 kyphosis, curve flexibility, instrumented length, and distance between magnets in dual rods and between the magnets and apex of the curve with early or late onset of rod slippage were studied. Differences between expected and achieved distraction lengths were assessed with reference to rod slippage episodes and rod exchanges to determine any patterns of diminishing returns. Results. Patients had mean age of 7.1 years at diagnosis with mean follow-up of 49.8 months. A mean 32.4 distractions were performed per patient. Early rod slippage occurred in 14 patients and late rod slippage occurred in eight patients. Increased height, weight, body mass index, older age, increased T1-12 and T1-S1 lengths, and less distance between magnets were significantly associated with early rod slippage. Expected distraction lengths did not translate to achieve distraction lengths and reduced gains were only observed after achieving one-third of the allowable distracted length in the MCGR. Length gains return to baseline after rod exchange. Conclusion. This is the first study to specifically analyze the impact of rod slippage on distraction lengths and the risk factors associated with its onset and frequency. Increased body habitus and reduced distance between internal magnets significantly influenced rod slippage events. Diminishing returns in distracted length gains were only observed after a period of usage. Level of Evidence: 3 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved