Alginate-Capped Silver Nanoparticles as a Potent Anti-mycobacterial Agent Against Mycobacterium tuberculosis.

Tuberculosis (TB) is a leading cause of death from a single infectious agent, Mycobacterium tuberculosis (Mtb). Although progress has been made in TB control, still about 10 million people worldwide develop TB annually and 1.5 million die of the disease. The rapid emergence of aggressive, drug-resistant strains and latent infections have caused TB to remain a global health challenge. TB treatments are lengthy and their side effects lead to poor patient compliance, which in turn has contributed to the drug resistance and exacerbated the TB epidemic. The relatively low output of newly approved antibiotics has spurred research interest toward alternative antibacterial molecules such as silver nanoparticles (AgNPs). In the present study, we use the natural biopolymer alginate to serve as a stabilizer and/or reductant to green synthesize AgNPs, which improves their biocompatibility and avoids the use of toxic chemicals. The average size of the alginate-capped AgNPs (ALG-AgNPs) was characterized as nanoscale, and the particles were round in shape. Drug susceptibility tests showed that these ALG-AgNPs are effective against both drug-resistant Mtb strains and dormant Mtb. A bacterial cell-wall permeability assay showed that the anti-mycobacterial action of ALG-AgNPs is mediated through an increase in cell-wall permeability. Notably, the anti-mycobacterial potential of ALG-AgNPs was effective in both zebrafish and mouse TB animal models in vivo. These results suggest that ALG-AgNPs could provide a new therapeutic option to overcome the difficulties of current TB treatments.

International trainer perceptions of simulation-based learning: a qualitative study.

OBJECTIVES:  This study examined trainer perceptions of simulation-based learning for Continuing Professional Development in international settings. METHODS: A qualitative research methodology was used to gain insight into trainer perceptions. Seventeen international physician trainers involved in simulation training in cardiovascular catheterization and intervention were interviewed. An inductive thematic analysis was performed following steps described by Braun and Clarke; researchers inductively approached, and then carefully dissected the transcripts into individual stories, grounded the problems, and explored themes. RESULTS: Trainer perceptions are largely aligned with learning theories, even though they were not specifically educated in simulation-based learning and program design principles in advance. Trainers perceive their primary role as facilitators to be most important and consider structuring sessions, facilitating group learning, and stimulating reflection to be crucial themes in simulation-based learning. They believe that building trust is an underlying principle to function in their role and feel responsible for being prepared to improve trainee satisfaction as adult learners. Trainers believe that learning from making mistakes is an important mechanism in simulation-based learning, but they give less attention to giving feedback. CONCLUSIONS: Trainers with basic training in facilitation skills in a classroom may unconsciously follow teacher-student instructional models with which they are familiar. This study confirms that trainers in simulation-based learning need pedagogical and facilitating skills to guide trainees and facilitate group processes. Educational training for trainers should include building trust and giving feedback in a more explicit place. In future studies, a mixed-method methodology is suggested to evaluate multi-layered complexities of educational practices.

Optimised deep neural network model to predict asthma exacerbation based on personalised weather triggers.

Background - Recently, there have been attempts to develop mHealth applications for asthma self-management. However, there is a lack of applications that can offer accurate predictions of asthma exacerbation using the weather triggers and demographic characteristics to give tailored response to users. This paper proposes an optimised Deep Neural Network Regression (DNNR) model to predict asthma exacerbation based on personalised weather triggers. Methods - With the aim of integrating weather, demography, and asthma tracking, an mHealth application was developed where users conduct the Asthma Control Test (ACT) to identify the chances of their asthma exacerbation. The asthma dataset consists of panel data from 10 users that includes 1010 ACT scores as the target output. Moreover, the dataset contains 10 input features which include five weather features (temperature, humidity, air-pressure, UV-index, wind-speed) and five demography features (age, gender, outdoor-job, outdoor-activities, location). Results - Using the DNNR model on the asthma dataset, a score of 0.83 was achieved with Mean Absolute Error (MAE)=1.44 and Mean Squared Error (MSE)=3.62. It was recognised that, for effective asthma self-management, the prediction errors must be in the acceptable loss range (error<0.5). Therefore, an optimisation process was proposed to reduce the error rates and increase the accuracy by applying standardisation and fragmented-grid-search. Consequently, the optimised-DNNR model (with 2 hidden-layers and 50 hidden-nodes) using the Adam optimiser achieved a 94% accuracy with MAE=0.20 and MSE=0.09. Conclusions - This study is the first of its kind that recognises the potentials of DNNR to identify the correlation patterns among asthma, weather, and demographic variables. The optimised-DNNR model provides predictions with a significantly higher accuracy rate than the existing predictive models and using less computing time. Thus, the optimisation process is useful to build an enhanced model that can be integrated into the asthma self-management for mHealth application.

Exchange rate exposure in the South African stock market before and during the COVID-19 pandemic.

We examine the nature of exchange rate exposure before and during the COVID-19 pandemic. Using a multifactor arbitrage pricing model and daily data from South Africa, we show that, as compared with sectors, industries have been more exposed to the exchange rate risk during than before the pandemic. We further show that exchange rate exposure mostly hurts the sectors and industries, although a few sectors, such as beverages, mining, personal goods, and tobacco, and industries, such as basic materials, consumer goods, and technology, may benefit from it. Our estimates survived robustness checks.

Inflation, inflation uncertainty and the economic growth nexus: An impact study of South Africa.

Inflation and inflation uncertainty are instrumental in the determination of financial stability, and ultimately, economic growth. We investigated the impact of inflation and inflation uncertainty on growth in South Africa by applying the autoregressive distributed lag (ARDL) estimation techniques on quarterly data covering the period 1961Q1 to 2019Q4. Unlike previous studies on South Africa, we investigated the joint impact of inflation and inflation uncertainty in South Africa, and also, pioneered in comparing the impact of both variables on growth before, and after, inflation targeting. This provided an opportunity to assess the effectiveness of inflation targeting while also investigating any changes in the behavior of the variables. We found that inflation negatively harms growth in both the short and long run, while inflation uncertainty is a short-run phenomenon in South Africa with no bearing in the long run. To promote growth, policymakers should continue to pursue policies that ensure price stability. • The paper investigated the impact of inflation and inflation uncertainty on economic growth in South Africa covering the period 1961Q1 to 2019Q4. • Using the autoregressive distributed lag estimation techniques, the paper found that inflation harms economic growth in both the short- and long-run in South Africa while inflation uncertainty is a short-run phenomenon as it affects economic growth only in the short run, • Interestingly, after adoption of inflation targeting, inflation uncertainty lost it relevance as a factor determining economic growth in South Africa.

Literature review on income inequality and economic growth.

This paper provides a comprehensive literature review of the relationship between income inequality and economic growth. In the theoretical literature, we identified various models in which income inequality is linked to economic growth. They include (i) The level of economic development, (ii) The level of technological development, (iii) Social-political unrest, (iv) The savings rate, (v) The imperfection of credit markets, (vi) The political economy, (vii) Institutions and (viii) The fertility rate. Based on the transmission mechanisms of these models, we found that the relationship between income inequality and growth can be negative, positive or inconclusive. The first three models demonstrate that the relationship is inconclusive, the fourth shows that it is positive, while the remainder indicate that the relationship should be negative. In the face of theoretical ambiguity, we also noted that the empirical findings on the relationship between income inequality and growth are highly debatable. These findings can be broadly classified into four categories, namely negative, positive, inconclusive and no relationship. Based on these findings, we provide a critical survey on methodology issues employed in the prior studies and propose a better methodology to researchers for future studies.•Theoretical and empirical literature is reviewed and synthesis is done to understand the income inequality-growth nexus.

Investor attention on COVID-19 and African stock returns.

We examine the financial consequences of rising global investor attention or risk attitude related to the COVID-19 pandemic for African stock markets. Using daily investor attention indices, which are based on global COVD-19-related google search queries, and stock return indices for 14 African stock markets, we show that investor attention is an important determinant of stock returns. Our estimates suggest that an increase in investor attention consistently reduces stock returns in three stock markets, namely Botswana, Nigeria, and Zambia. In contrast, an increase in investor attention may enhance stock returns in Ghana and Tanzania. Our estimates imply that, in uncertain times like the current pandemic, stock markets like those of Ghana and Tanzania may offer potential diversification benefits to investors. We demonstrate that our estimates are broadly robust using a composite measure of investor attention.•We built a direct and unambiguous measure of investor attention or risk attitude related to the COVID-19 pandemic.•In an exponential generalised autoregressive heteroskedasticity of order one (i.e. EGARCH(1,1)) framework, we regressed stock returns on their first lags, investor attention, exchange rate returns, and commodity returns, and controlled for investor attention in the variance equation.

Characterization of Virus Replication, Pathogenesis, and Cytokine Responses in Syrian Hamsters Inoculated with SARS-CoV-2.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus which caused a global respiratory disease pandemic beginning in December 2019. Understanding the pathogenesis of infection and the immune responses in a SARS-CoV-2-infected animal model is urgently needed for vaccine development. METHODS: Syrian hamsters (Mesocricetus auratus) were intranasally inoculated with 105, 5×105, and 106 TCID50 of SARS-CoV-2 per animal and studied for up to 14 days. Body weight, viral load and real-time PCR amplification of the SARS-CoV-2 N gene were measured. On days 3, 6 and 9, lung, blood, liver, pancreas, heart, kidney, and bone marrow were harvested and processed for pathology, viral load, and cytokine expression. RESULTS: Body weight loss, increased viral load, immune cell infiltration, upregulated cytokine expression, viral RNA, SARS-CoV-2 nucleoprotein, and mucus were detected in the lungs, particularly on day 3 post-infection. Extremely high expression of the pro-inflammatory cytokines MIP-1 and RANTES was detected in lung tissue, as was high expression of IL-1ß, IL-6, IL-12, and PD-L1. The glutamic oxalacetic transaminase/glutamic pyruvic transaminase (GOT/GPT) ratio in blood was significantly increased at 6 days post-infection, and plasma amylase and lipase levels were also elevated in infected hamsters. CONCLUSION: Our results provide new information on immunological cytokines and biological parameters related to the pathogenesis and immune response profile in the Syrian hamster model of SARS-CoV-2 infection.

Stock return predictability over four centuries: The role of commodity returns.

We merge two unique historical datasets on commodity and stock prices covering four centuries and three leading stock markets (Netherlands, UK, and US) to show that, consistent with theoretical predictions, commodity returns can predict stock returns. We show that about 64% and 56% of the commodity returns can predict stock returns in-sample and out-of-sample, respectively. Aggregating commodity returns by market, returns from agriculture, energy, and livestock and meat markets appear to consistently predict stock returns. These results are robust to recessions and expansions.

Shear-wave sonoelastographic assessment of cervix in pregnancy.

INTRODUCTION: The aim of this study was to investigate the differences in shear-wave sonoelastography (SWS) scores between the different parts of cervix, explore the association between the cervical SWS scores with cervical length and evaluate repeatability of the measurement of cervical SWS scores. MATERIAL AND METHODS: This was a prospective study performed in women with singleton pregnancy at 11-13+6 (n = 676), 16-20+6 (n = 364), 21-24+6 (n = 338) and 28-32+6 weeks (n = 304). The SWS scores were obtained at the inner, middle and external parts of the cervix, using a transvaginal ultrasound approach. RESULTS: The SWS scores of the inner cervix were significantly higher than the measurements acquired at the middle and external parts (all P < .001). At 21-24+6 and 28-32+6 weeks, most regions of interest demonstrated a very weak positive correlation with cervical length (r = .125 to r = .299). In comparison with nulliparous women, parous women without prior preterm birth had higher SWS scores of the inner and middle parts of the cervix at 16-20+6 and 21-24+6 weeks. All regions of interest showed good intra- and inter-observer agreement. CONCLUSIONS: The assessment of the cervical SWS scores is highly reproducible. The stiffness of the cervix demonstrates a gradient that decreases from the inner part to the external part and a very weak positive correlation with cervical length.

Food preservative sorbic acid deregulates hepatic fatty acid metabolism.

Sorbic acid (SA) is one of the most commonly used food preservatives worldwide. Despite SA having no hepatotoxicity at legal dosages, its effect on hepatic lipid metabolism is still unclear. We investigated the effect of SA on hepatic lipid metabolism and its mechanism of action in C57BL/6 mice. Daily treatment with SA (1 g/kg in diet) for 4 weeks did not alter the body weight, organ weight, and blood lipids in mice. However, hepatic lipid accumulation, particularly that of triglycerides, fatty acids, and glycerol, but not cholesteryl ester and free cholesterol, was increased with SA treatment. Mechanistically, SA decreased the expression of proteins related to de novo fatty acid lipogenesis, fatty acid internalization, and very low-density lipoprotein (VLDL) secretion-related pathways, including sterol regulatory element-binding proteins, acetyl-coA carboxylase, fatty acid synthase, liver fatty acid-binding protein, CD36, and apolipoprotein E. In contrast, SA increased the expression of diacylglycerol O-acyltransferase 2, the key enzyme for triacylglycerol synthesis. Moreover, SA downregulated the protein expression of autophagy-related and ß-oxidation-related pathways, the two major metabolic pathways for lipid metabolism, including LC-3, beclin-1, autophagy related protein 5 (ATG-5) and ATG-7, acyl-CoA synthetase long chain family member 1, carnitine palmitoyltransferase Iα, peroxisome proliferator-activated receptor α (PPARα), PPARγ, and PPARγ coactivator-1. Collectively, SA deregulates de novo lipogenesis and fatty acid internalization, VLDL secretion, autophagy, and ß-oxidation in the liver, leading to impaired lipid clearance and ultimately, resulting in lipid accumulation in the liver.

The predictive value of cervical shear wave elastography in the outcome of labor induction.

INTRODUCTION: Bishop score, the traditional method to assess cervical condition, is not a promising predictive tool of the outcome of labor induction. As an objective assessment tool, many cervical ultrasound measurements have been proposed to represent the individual components of the Bishop score, but none of them can measure the cervical stiffness. Cervical shear wave elastography is a novel tool to assess the cervical stiffness quantitatively. MATERIAL AND METHODS: A total of 475 women who required labor induction were studied prospectively. Prior to routine digital assessment of the Bishop score, transvaginal sonographic measurement of cervical length, posterior cervical angle, angle of progression and shear wave elastography was performed. Shear wave elastography measurement was made at the inner, middle and outer regions of the cervix to assess homogeneity. Association of labor induction outcomes including the overall cesarean section and subgroups of cesarean section for failure to enter active phase, with cervical sonographic parameters and the Bishop score, were assessed using multivariate regression analyses. The predictive accuracy of the outcomes using models based on ultrasound measurement and the Bishop score was compared using the area under the receiver-operating characteristics curves. RESULTS: Among 475 women, 82 (17.3%) required cesarean section. Shear wave elasticity was significantly higher in the inner cervical region than in other regions, indicating a greater stiffness (P < 0.001). Both inner cervical shear wave elasticity and cervical length were independent predictors of overall cesarean section (respective adjusted odds ratio [95% CI] 1.338 [1.001-1.598] and 1.717 [1.077-1.663]) and cesarean section for failure to enter active phase (respective adjusted odds ratio [95% CI] 1.689 [1.234-2.311] and 2.556 [1.462-4.467]), after adjusting for other covariates. Outcome prediction models using inner cervical shear wave elasticity and cervical length, had increased area under curve compared with models using the Bishop score (0.888 vs 0.819, P = 0.009). CONCLUSIONS: The cervix is not a homogenous structure, with the inner cervix having the highest stiffness, which is an independent predictor of overall cesarean section, and specifically for those indicated because of failure to enter active phase. Models based on shear wave elastography and cervical length had higher predictive accuracy than models based on the Bishop score.

Leucocin C-607, a Novel Bacteriocin from the Multiple-Bacteriocin-Producing Leuconostoc pseudomesenteroides 607 Isolated from Persimmon.

Leuconostoc pseudomesenteroides 607, isolated from persimmon fruit, was found to have high inhibitory activity against Listeria monocytogenes and several other Gram-positive bacteria. Inhibitory substances were purified from culture supernatant by ion-exchange chromatography, Sep-Pak C18 cartridge, and reverse-phase high-performance liquid chromatography (RP-HPLC). Two antibacterial peptides were observed during the purification procedures. One of these peptides had a molecular size of 4623.05 Da and a partial N-terminal amino acid sequence of NH2-KNYGNGVHxTKKGxS, in which the YGNGV motif is specific for class IIa bacteriocins. A BLAST search revealed that this bacteriocin was similar to leucocin C from Leuconostoc mesenteroides. Leucocin C-specific primers were designed and a single PCR product was amplified. Analysis of the nucleotide sequence has revealed a putative peptide differing by only one amino acid residue from the sequence of leucocin C. No identical peptide or protein has been reported in the literature, and this peptide, termed leucocin C-607, was therefore considered to be a new variant of leucocin C produced by Leuc. pseudomesenteroides 607. Another antibacterial peptide purified from the same culture supernatant had a molecular size of 3007.7 or 3121.97 Da. However, detailed information regarding this second peptide remains to be determined. Distinct characteristics, such as heat stability and inhibitory spectrum, were observed for the two bacteriocins produced by Leuc. pseudomesenteroides 607. These results suggested that Leuc. pseudomesenteroides 607 produces leucocin C-607 along with another unknown bacteriocin.

Cardiac health knowledge and misconceptions among nursing students: implications for nursing curriculum design.

BACKGROUND: Cardiac misconceptions are common among healthcare professionals. The development of professional knowledge is considered an essential component of nursing education. Nurses, regardless of their grade, skills, and experience, should be updated with information so as to be able to rectify their misconceptions, as these could affect patient health outcomes. As the literature evaluating the cardiac knowledge and misconceptions of nursing students is sparse, a study of the subject seems warranted. METHODS: A cross-sectional sample survey was used to study the cardiac knowledge and cardiac misconceptions of nursing students in Hong Kong. The study sample included 385 senior nursing students from three universities. Their level of knowledge of cardiac disease was assessed using the modified Coronary Heart Disease Knowledge Test. The York Cardiac Beliefs Questionnaire (YCBQv1) was used to examine cardiac misconceptions. RESULTS: The scores for the nursing students' level of knowledge were diverse. Their mean score in the Cardiac Knowledge Test was 12.27 out of 18 (SD 2.38), with a range of 2-17. For cardiac misconceptions, their mean score in the YCBQv1 was 6.98 out of 20 (SD 2.84), with a range of 0-14. A negative correlation, r = -0.33 was found among students with more knowledge and fewer misconceptions. (p < 0.001). The Chi-square tests found some associations between the students' experiences of caring for cardiac patients and misconceptions about stress and physiology. CONCLUSIONS: The results of our analyses indicate a diversity in levels of knowledge among the nursing students. Students with higher scores in cardiac knowledge did not necessarily have fewer misconceptions. There were associations between the students' misbeliefs and their caregiving experiences with cardiac patients. This study presents a framework for designing the contents of cardiac nursing programmes and is a starting point for promoting research on misconceptions held by undergraduate nursing students. A new paradigm of teaching should include inputs from both perspectives to help students to make critical use of theoretical knowledge to rectify their misconceptions and pursue excellence in the working world.

Fulfilling the psychological and information need of the family members of critically ill patients using interactive mobile technology: A randomised controlled trial.

BACKGROUND: Intensive care nurses may have an important role in empowering families by providing psychological support and fulfilling the family's pivotal need for information. AIM: To determine whether 'education of families by tab' about the patient's condition was more associated with improved anxiety, stress, and depression levels than the 'education of families by routine'. RESEARCH DESIGN: A randomized control trial of 74 main family caregivers (intervention: 39; control: 35). SETTING: An adult intensive care unit. MAIN OUTCOME MEASURES: Depression Anxiety Stress Scale, and Communication and Physical Comfort Scale. RESULTS: Although information need satisfaction was not significantly different between intervention and control groups, the former reported significantly better depression score on Depression Anxiety Stress Scale comparing to the control group (p<0.01; η2=0.09) with a medium effect size. Reduction of anxiety in the intervention group were clinically significant. CONCLUSION: The results suggest that use of 'education of family by tab' is promising for intensive care nurses to provide psychological support for family members. More studies are needed to investigate this aspect of family care for better psychological support and information need satisfaction that contributes to the evidence-based practice of intensive care nursing.

Factors affecting the willingness of nursing students to receive annual seasonal influenza vaccination: A large-scale cross-sectional study.

Nursing students are at high risk of exposure to vaccine-preventable diseases such as seasonal influenza. However, due to the limited number of studies conducted in this area, the prevalence and factors affecting annual seasonal influenza vaccination (ASIV) uptake remain unclear. This was a large-scale cross-sectional survey study conducted among 902 nursing students in different years of study. The questionnaire was developed based on the Health Belief Model (HBM), and logistic regression was used to determine the predictors of ASIV uptake. The results of our study reveal that only 15.2% of nursing students declared having the vaccine in the previous year, and that ASIV uptake was self-reported. ASIV uptake was associated with perceived susceptibility (odds ratio=2.76), perceived seriousness (odds ratio=2.06) and perceived barriers (odds ratio=0.50). The odds of receiving ASIV were 17.96times higher for those participants having had ASIV at least once than those who had not received ASIV in the previous five years. In addition, the odds of receiving ASIV were 4.01times higher for master's than undergraduate students. Our study concludes that the ASIV uptake among nursing students is low. In order to increase vaccination uptake in subsequent years, future studies should promote vaccination based on HBM, focusing on nursing students in undergraduate studies by emphasizing not only vaccination knowledge, but also their social responsibility to protect patients. Influenza vaccination can be viewed as an ethical professional responsibility and a patient safety issue, as well as being an infection control strategy.

Effects of risk assessment and management programme for hypertension on clinical outcomes and cardiovascular disease risks after 12 months: a population-based matched cohort study.

OBJECTIVES: This study evaluated the effectiveness of a structured multidisciplinary risk assessment and management programme for patients with hypertension (RAMP-HT) who were managed in public primary care clinics but had suboptimal blood pressure (BP) control in improving BP, LDL-cholesterol (LDL-C) and predicted 10-year cardiovascular disease (CVD) risk after 12 months of intervention. METHODS: A total of 10 262 hypertension patients with suboptimal BP despite treatment, aged less than 80 years and without existing CVD were enrolled in RAMP-HT between October 2011 and March 2012 from public general out-patient clinics in Hong Kong. Their clinical outcomes and predicted 10-year CVD risk were compared with a matched cohort of hypertension patients who were receiving usual care in general out-patient clinics without any RAMP-HT intervention by propensity score matching. Multivariable linear and logistic regressions were used to determine the independent effectiveness of RAMP-HT after adjusting for potential confounding variables. RESULTS: Compared with the usual care group after 12 months, significantly greater proportions of RAMP-HT participants achieved target BP (i.e. BP < 140/90 mmHg) (OR = 1.18, P < 0.01) and LDL-C levels (i.e. <3.4 mmol/l for patients with CVD risk ≤20% or <2.6 mmol/l for CVD risk >20%) (OR = 1.13, P < 0.01). RAMP-HT participants also had significantly greater reduction in predicted 10-year CVD risk by 0.44% (coefficient = -0.44, P < 0.01). CONCLUSION: The structured multidisciplinary RAMP-HT was more effective than usual care in achieving target BP, LDL-C and reducing predicted 10-year CVD risk in public primary care patients with suboptimal hypertension control after 12 months of intervention. A long-term follow-up should be conducted to confirm whether the improvement in clinical outcomes can be translated into actual reductions in CVD complications and mortalities and whether such approach is cost-effective.

Development of a Health Empowerment Programme to improve the health of working poor families: protocol for a prospective cohort study in Hong Kong.

INTRODUCTION: People from working poor families are at high risk of poor health partly due to limited healthcare access. Health empowerment, a process by which people can gain greater control over the decisions affecting their lives and health through education and motivation, can be an effective way to enhance health, health-related quality of life (HRQOL), health awareness and health-seeking behaviours of these people. A new cohort study will be launched to explore the potential for a Health Empowerment Programme to enable these families by enhancing their health status and modifying their attitudes towards health-related issues. If proven effective, similar empowerment programme models could be tested and further disseminated in collaborations with healthcare providers and policymakers. METHOD AND ANALYSIS: A prospective cohort study with 200 intervention families will be launched and followed up for 5 years. The following inclusion criteria will be used at the time of recruitment: (1) Having at least one working family member; (2) Having at least one child studying in grades 1-3; and (3) Having a monthly household income that is less than 75% of the median monthly household income of Hong Kong families. The Health Empowerment Programme that will be offered to intervention families will comprise four components: health assessment, health literacy, self-care enablement and health ambassador. Their health status, HRQOL, lifestyle and health service utilisation will be assessed and compared with 200 control families with matching characteristics but will not receive the health empowerment intervention. ETHICS AND DISSEMINATION: This project was approved by the University of Hong Kong-the Hospital Authority Hong Kong West Cluster IRB, Reference number: UW 12-517. The study findings will be disseminated through a series of peer-reviewed publications and conference presentations, as well as a yearly report to the philanthropic funding body-Kerry Group Kuok Foundation (Hong Kong) Limited.