Purpose
In response to the world’s rising awareness on sustainability, industry players and policymakers are devoting great efforts to bolster green building developments. Every green building ...project (GBP) involves numerous stakeholders and potentially incompatible concerns. Despite the associated environmental, economic and social benefits, GBP developments have often confronted managerial barriers which are actually emerged from stakeholders – the actual key determinants of a project. Holistically analyzing the complexity of stakeholders in GBPs is, therefore, crucial to improving GBP management and achieving greater sustainability for all involved. The purpose of this paper is to analyze stakeholder complexity in large GBPs using a holistic framework which integrates both empirical and rationalistic analytical perspectives.
Design/methodology/approach
The complexity of stakeholders in GBPs can be considered from three aspects – identifying stakeholders, assessing stakeholder interactions and analyzing stakeholder concerns. The proposed stakeholder analysis framework uses both empirical methods (e.g. interviews and surveys) and rationalistic methods (e.g. chain referral sampling and social network analysis) to analyze GBP stakeholder complexity. Case study of a lab-enabled commercial GBP in Hong Kong was undertaken to illustrate the framework.
Findings
The framework enables a holistic, objective and effective stakeholder analysis; leading GBP leaders toward a complete understanding of project stakeholder complexity. The case study findings bring managerial insights to GBP leaders on the general SNA-related stakeholder dynamics and the important stakeholder concerns, of large Hong Kong GBPs. The findings diagnose general connectivity structures of GBP stakeholders, identify influential and peripheral actors in GBP information exchange, and suggest clues to improve their dynamics. In addition, ten key stakeholder concerns were identified, including comprehensive governmental standards and procedures, clear sustainability goals at the outset, effective stakeholder engagement, adequate design flexibility, and a “can-do” attitude of contractors and consultants – which are all vital for successful GBP development. The underlying reasons of these concerns and recommendations to addressing them were also discussed.
Originality/value
Many existing GBP stakeholder studies appear to use a single analytical perspective to assess project stakeholder complexity, but this may not gain a full understanding. The holistic stakeholder analysis framework used herein combines empiricism and rationalism. It helps to bring GBP leaders and implementers toward a more informed project decision making, a more thorough understanding of stakeholder complexity, as well as a more effective engagement of stakeholders.
Bell's palsy is a rare adverse event reported in clinical trials of COVID-19 vaccines. However, to our knowledge no population-based study has assessed the association between the inactivated ...SARS-CoV-2 vaccines and Bell's palsy. The aim of this study was to evaluate the risk of Bell's palsy after BNT162b2 and CoronaVac vaccination.
In this case series and nested case-control study done in Hong Kong, we assessed the risk of Bell's palsy within 42 days following vaccination with BNT162b2 (Fosun–BioNTech equivalent to Pfizer–BioNTech) or CoronaVac (from Sinovac Biotech, Hong Kong) using data from voluntary surveillance reporting with the Hospital Authority, the COVID-19 Vaccine Adverse Event Online Reporting system for all health-care professionals, and the Hospital Authority's territory-wide electronic health records from the Clinical Data Analysis and Reporting System. We described reported cases of Bell's palsy among vaccine recipients (aged 18–110 years for CoronaVac and aged 16–110 years for BNT162b2). We compared the estimated age-standardised incidence of clinically confirmed cases among individuals who had received the CoronaVac or BNT162b2 vaccination (up to 42 days before presentation) with the background incidence in the population. A nested case-control study was also done using conditional logistic regression to estimate the odds ratio (OR) for risk of Bell's palsy and vaccination. Cases and controls were matched (1:4) by age, sex, admission setting, and admission date.
Between February 23 and May 4, 2021, 451 939 individuals received the first dose of CoronaVac and 537 205 individuals received the first dose of BNT162b2. 28 clinically confirmed cases of Bell's palsy were reported following CoronaVac and 16 cases were reported following BNT162b2. The age-standardised incidence of clinically confirmed Bell's palsy was 66·9 cases per 100 000 person-years (95% CI 37·2 to 96·6) following CoronaVac vaccination and 42·8 per 100 000 person-years (19·4 to 66·1) for BNT162b2 vaccination. The age-standardised difference for the incidence compared with the background population was 41·5 (95% CI 11·7 to 71·4) for CoronaVac and 17·0 (−6·6 to 40·6) for BNT162b2, equivalent to an additional 4·8 cases per 100 000 people vaccinated for CoronaVac and 2·0 cases per 100 000 people vaccinated for BNT162b2. In the nested case-control analysis, 298 cases were matched to 1181 controls, and the adjusted ORs were 2·385 (95% CI 1·415 to 4·022) for CoronaVac and 1·755 (0·886 to 3·477) for BNT162b2.
Our findings suggest an overall increased risk of Bell's palsy after CoronaVac vaccination. However, the beneficial and protective effects of the inactivated COVID-19 vaccine far outweigh the risk of this generally self-limiting adverse event. Additional studies are needed in other regions to confirm our findings.
The Food and Health Bureau of the Government of the Hong Kong Special Administrative Region, China.
For the Chinese translation of the abstract see Supplementary Materials section.
Delivery of chemotherapeutic drugs to the brain has remained a major obstacle in the treatment of glioma, owing to the presence of the blood-brain barrier and the activity of P-gp, which pumps its ...substrate back into the systemic circulation. The aim of the present study was to develop an intravenous formulation of HM30181A (HM) to inhibit P-gp in the brain to effectively deliver paclitaxel (PTX) for the treatment of malignant glioma.
Two formulations of solubilized HM were designed on the basis of different solid dispersion strategies: i) spray-drying polyvinlypyrrolidone (PVP)-HM and ii) solvent evaporation HP-β-cyclodextrin (cyclodextrin)-HM. The P-gp inhibition of these 2 formulations was assessed on the basis of rhodamine 123 uptake in cancer cells. Blood and brain pharmacokinetic parameters were also determined, and the antitumor effect of cyclodextrin-HM with PTX was evaluated in an orthotopic glioma xenograft mouse model.
Although both PVP-HM and cyclodextrin-HM formulations showed promising P-gp inhibition activity
, cyclodextrin-HM had a higher maximum tolerated dose in mice than did PVP-HM. Pharmacokinetic study of cyclodextrin-HM revealed a plasma concentration plateau at 20 mg/kg, and the mice began to lose weight at doses above this level. Cyclodextrin-HM (10 mg/kg) administered with PTX at 10 mg/kg showed optimal antitumor activity in a mouse model, according to both tumor volume measurement and survival time (
< 0.05).
In a mouse orthotopic brain tumor model, the intravenous co-administration of cyclodextrin-HM with PTX showed potent antitumor effects and therefore may have potential for glioma therapy in humans.
Age-related sporadic cerebral small vessel disease (CSVD) has gained increasing attention over the past decades because of its increasing prevalence associated with an aging population. The ...widespread application of and advances in brain magnetic resonance imaging in recent decades have significantly increased researchers' understanding in the in vivo evolution of CSVD, its impact upon the brain, its risk factors, and the mechanisms that explain the various clinical manifestation associated with sporadic CSVD. In this review, we aimed to provide an update on the pathophysiology, risk factors, biomarkers, and the determinants and spectrum of the clinical manifestation of sporadic CSVD.
The complex and uncertain nature of mega construction projects (MCP) require an effective stakeholder management (SM) approach to accommodate conflicting stakeholder interests. Previous reviews ...regarding SM in construction sector are generic as their attentions have been placed on relatively small scale projects. A systematic review on SM studies in relation to MCP seems to be lacking. This paper analyzes the latest research development of this domain by reviewing selected articles published from 1997 to 2014. Four major research topics are identified: “stakeholder interests and influences”, “stakeholder management process”, “stakeholder analysis methods” and “stakeholder engagement”. This study reveals that SM approaches in MCP are subject to national context of the project, indicating a need to identify the impact of national culture on this discipline. Moreover, traditional stakeholder analysis techniques are widely adopted in MCP notwithstanding their weaknesses; therefore a social network approach for managing stakeholder interrelationships in these projects is needed.
•A systematic review on SM studies in relation to MCP seems to be lacking.•Four main research topics regarding SM in MCP have been identified.•SM practice in MCP is subject to national or regional environment of the project.•An exploration into the impact of national culture on SM in MCP is needed.•Empirical studies using SNA to analyze stakeholder relationships in MCP are needed.
ObjectivesPatients admitted to hospitals represent an excellent teachable moment for smoking cessation, as they are required to abstain from tobacco use during hospitalisation. Nevertheless, smoking ...behaviours of hospitalised patients, and factors that lead to smoking abstinence thereafter, remain relatively underexplored, particularly in a Hong Kong Chinese context. This study aimed to examine the smoking behaviours of hospitalised patients and explore factors leading to their abstaining from cigarette use after being hospitalised.DesignA cross-sectional design was employed.SettingThis study was conducted in three outpatient clinics in different regions in Hong Kong.ParticipantsA total of 382 recruited Chinese patients.Primary and secondary outcome measuresThe patients were asked to complete a structured questionnaire that assessed their smoking behaviours before, during and after hospitalisation.ResultsThe results indicated 23.6% of smokers smoked secretly during their hospital stay, and about 76.1% of smokers resumed smoking after discharge. Multivariate logistic regression analysis found that number of days of hospitalisation admission in the preceding year (OR 1.02; 95% CI 1.01 to 1.27; p=0.036), patients’ perceived correlation between smoking and their illness (OR 1.08; 95% CI 1.01 to 1.17; p=0.032), withdrawal symptoms experienced during hospitalisation (OR 0.75; 95% CI 0.58 to 0.97; p=0.027) and smoking cessation support from healthcare professionals (OR 1.18; 95% CI 1.07 to 1.36; p=0.014) were significant predictors of smoking abstinence after discharge.ConclusionsThe results of this study will aid development of appropriate and innovative smoking cessation interventions that can help patients achieve more successful smoking abstinence and less relapse.Trial registration number NCT02866760.
Objectives
To study the factors associated with withdrawal of the and tumor necrosis factor alpha (anti‐TNFα) biologics in the treatment of rheumatic diseases.
Method
Data from the Hong Kong ...Biologics Registry were retrieved. The cumulative rates of withdrawal of different biological agents were studied by Kaplan–Meier plot and the incidence of serious adverse events (SAEs) was calculated. Factors associated with the withdrawal of the anti‐TNFα agents were studied by Cox regression.
Results
Between 2005 and 2013, 2059 courses of biologics were used in 1345 patients. After 3454 patient‐years, 1171 (57%) courses were terminated because of clinical inefficacy (38.1%), SAEs (22.3%) and financial reasons (15.9%). The most frequent SAEs (per 100‐patient‐years) were allergy (2.90), serious infections (1.34), tuberculosis (0.93) and infusion/injection site reaction (0.75). Among the anti‐TNFα agents, the cumulative probability of drug withdrawal for either inefficacy or SAEs in 5 years was highest with infliximab (IFX) (64.5%), followed by etanercept (ETN) (44.2%) and adalimumab (ADA) (36.9%). The incidence of serious infections and tuberculosis (per 100 patient‐years) for IFX, ETN and ADA users was 1.99, 0.85 and 0.63; and 1.68, 0.43 and 0.85, respectively. Infusion/injection site reaction was highest with IFX (1.38/100 patient‐years). Cox regression revealed increasing age, female sex, not having a diagnosis of spondyloarthritis (SpA) and IFX use were significantly associated with drug withdrawal for either inefficacy or SAEs. Rheumatoid arthritis (RA) had the highest hazard ratio for drug withdrawal but SpA was favorable for drug retention, after adjustment for age, sex, disease duration and the choice of anti‐TNFα agents.
Conclusions
In our registry, the retention rate of the anti‐TNFα agents was lowest but the incidence of tuberculosis, serious infections and infusion reaction was highest with IFX. Older female patients with RA and the use of IFX were independently associated with drug withdrawal.
The diversities of stakeholder concerns and intricate interdependencies between stakeholder concerns are important factors adding complexities to major public engineering projects (MEPs). Using case ...study and network-theory based analysis in a large reclamation project, this paper investigated the key stakeholder concerns and concern interdependencies of MEPs, and how they bring major challenges confronted by stakeholders. The network analysis identifies five major challenges of the case: “applying highly advanced and complex construction technology”, “mitigating project disruptions to the environment and marine ecology”, “conducting public and community consultation during construction phase”, “site constraints due to nearby air and marine traffic”, and “meeting government standard on the quality of new materials and equipment”. Recommendations are provided to alleviate these problems for future MEPs. This paper contributes to a new angle, the network perspective, of analyzing stakeholder concern interdependencies and their practical implications on MEPs. The findings provide useful insights on common pitfalls of MEPs.
•Stakeholder concerns and their interdependencies in MEPs are analyzed from a network perspective.•A case study of large reclamation project is conducted to illustrate the network analysis.•Five major challenges confronted by stakeholders in the case have been identified.•Recommendations are provided to alleviate these problems for future MEPs.
Data regarding protection against mortality and severe complications after Omicron BA.2 infection with CoronaVac and BNT162b2 vaccines remains limited. We conducted a case-control study to evaluate ...the risk of severe complications and mortality following 1-3 doses of CoronaVac and BNT162b2 using electronic health records database. Cases were adults with their first COVID-19-related mortality or severe complications between 1 January and 31 March 2022, matched with up-to 10 controls by age, sex, index date, and Charlson Comorbidity Index. Vaccine effectiveness against COVID-19-related mortality and severe complications by type and number of doses was estimated using conditional logistic regression adjusted for comorbidities and medications. Vaccine effectiveness (95% CI) against COVID-19-related mortality after two doses of BNT162b2 and CoronaVac were 90.7% (88.6-92.3) and 74.8% (72.5-76.9) in those aged ≥65, 87.6% (81.4-91.8) and 80.7% (72.8-86.3) in those aged 50-64, 86.6% (71.0-93.8) and 82.7% (56.5-93.1) in those aged 18-50. Vaccine effectiveness against severe complications after two doses of BNT162b2 and CoronaVac were 82.1% (74.6-87.3) and 58.9% (50.3-66.1) in those aged ≥65, 83.0% (69.6-90.5) and 67.1% (47.1-79.6) in those aged 50-64, 78.3% (60.8-88.0) and 77.8% (49.6-90.2) in those aged 18-50. Further risk reduction with the third dose was observed especially in those aged ≥65 years, with vaccine effectiveness of 98.0% (96.5-98.9) for BNT162b2 and 95.5% (93.7-96.8) for CoronaVac against mortality, 90.8% (83.4-94.9) and 88.0% (80.8-92.5) against severe complications. Both CoronaVac and BNT162b2 vaccination were effective against COVID-19-related mortality and severe complications amidst the Omicron BA.2 pandemic, and risks decreased further with the third dose.
Abstract
Background
In view of limited evidence that specifically addresses vaccine effectiveness (VE) in the older population, this study aims to evaluate the real-world effectiveness of BNT162b2 ...and CoronaVac in older adults during the Omicron BA.2 outbreak.
Methods
This case–control study analyzed data available between January and March 2022 from the electronic health databases in Hong Kong and enrolled individuals aged 60 or above. Each case was matched with up to 10 controls by age, sex, index date and Charlson Comorbidity Index for the four outcomes (COVID-19 infection, COVID-19-related hospitalization, severe complications, and all-cause mortality) independently. Conditional logistic regression was conducted to evaluate VE of BNT162b2 and CoronaVac against COVID-19-related outcomes within 28 days after COVID-19 infection among participants stratified by age groups (60–79, ≥80 years old).
Results
A dose–response relationship between the number of vaccine doses received and protection against severe or fatal disease was observed. Highest VE (95% CI) against COVID-19 infection was observed in individuals aged ≥80 who received three doses of BNT162b2 75.5% (73.1–77.7%) or three doses of CoronaVac 53.9% (51.0–56.5%) compared to those in the younger age group who received three doses of BNT162b2 51.1% (49.9–52.4%) or three doses of CoronaVac 2.0% (−0.1–4.1%). VE (95% CI) was higher for other outcomes, reaching 91.9% (89.4–93.8%) and 86.7% (84.3–88.8%) against COVID-19-related hospitalization; 85.8% (61.2–94.8%) and 89.8% (72.4–96.3%) against COVID-19-related severe complications; and 96.4% (92.9–98.2%) and 95.0% (92.1–96.8%) against COVID-19-related mortality after three doses of BNT162b2 and CoronaVac in older vaccine recipients, respectively. A similar dose–response relationship was established in younger vaccine recipients and after stratification by sex and Charlson Comorbidity Index.
Conclusion
Both BNT162b2 and CoronaVac vaccination were effective in protecting older adults against COVID-19 infection and COVID-19-related severe outcomes amidst the Omicron BA.2 pandemic, and VE increased further with the third dose.
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