People depend heavily on various forms of assistance, guidance, and care for survival, which leads many to view social support as definitively beneficial. However, recent studies have provided the counterargument that social support is not necessarily a panacea for coping with stress. A considerable number of studies have been conducted on social support, yet the majority of the theoretical models developed to understand its influence have focused on its benefits, with few exploring the negative support effects from the relational aspect. No studies have attempted to explain support effects from the perspective of individual differences. More importantly, the underlying social support mechanism and the roles played by the different modes of social support remain unknown. Building on the available theoretical insights, a relativistic approach is adopted here to study social support. A hybrid self-focus model of social support is proposed to understand the relationships between personality resources (specifically self-esteem) and levels of affect (positive and negative), the underlying mechanism of self-focus processes (public self-consciousness and social comparison), and the moderating role of the mode of social support (offline and online). The two studies incorporated correlational and quasi-experimental methodologies conducted to examine the proposed model among participants from diverse socioeconomic backgrounds. Study 1 was correlational and applied a naturalistic categorization method to the mode of social support. This study showed that the focus of social comparison varied based on the levels of self-esteem and engagement in the offline and mixed modes of social support, but the findings were inconclusive regarding social comparison as the underlying mechanism. In addition, the analyses of public self-consciousness revealed puzzling results. Hence, the findings only provided partial support for the hybrid self-focus model of social support. To clarify the counterintuitive findings revealed in Study 1, Study 2 adopted a quasi-experimental design to examine the mediating effects of self-focus processes on the relationship between self-esteem and levels of affect in two distinct modes of social support. One hundred and seventy-seven participants were included in the moderated mediation analyses, and the findings were largely consistent with the proposed model of public self-consciousness as the facilitating mechanism. People’s awareness of the self-referent aspects that were matters for public display explained the positive link between self-esteem and distress. Such a positive indirect effect of self-esteem mediated through public self-consciousness was particularly strong in offline social support. In summary, the present project demonstrates that support effects are influenced by self-esteem, public self-consciousness, and the mode of social support. These findings provide unique insights that have not been examined by previous studies on social support. This project is the first attempt to address knowledge gaps by adopting a relativistic approach to social support. The subsequent discussion, implications, and future directions focus on a relativistic approach and the hybrid self-focus model of social support. / published_or_final_version / Psychology / Doctoral / Doctor of Philosophy

Nasopharyngeal carcinoma (NPC) has distinctive ethnic and geographic distributions, with the highest incidence in Southern China. Epstein-Barr virus (EBV) infection, non-viral environmental risk factors, and host genetics contribute to the development of NPC. In our previous studies, Fibulin-2 (FBLN2), located at chromosome 3p25.1, has been identified as a candidate tumor suppressor gene (TSG) in nasopharyngeal carcinoma (NPC) by using a chromosome 3 NotI genomic microarray screen, followed by functional assays. FBLN2 belongs to the fibulin family of extracellular matrix glycoproteins. It encodes a large protein consisting of cysteinerich and cysteine-free segments, three anaphylatoxin (AT) modules, a series of cbEGFlike repeated, and a fibulin module. Although FBLN2 was also identified as a candidate TSG in other cancers, its molecular characterization is still largely unknown. In the present study, lentiviral constitutive and inducible transgene expression systems, fluorescent protein labelling and reporter systems, and shRNA-mediated knockdown system were optimized and established for studies in NPC. With the use of lentiviral systems, the FBLN2-mediated signaling pathways and the functions of FBLN2-related p65 signaling pathway were revealed. Lentiviral pWPI-FBLN2 infected HONE1, HK1, and C666 cell lines consistently reduced p65 phosphorylation at serine S536. Also, FBLN2 was shown to inactivate RhoA and Cdc42, resulting in decreased stress fiber and filopodia formation. Full-length and truncated FBLN2 fragments, with the exception of anaphylatoxin module, reduced phosphorylation of p65 as well as suppressed HUVEC tube formation. The p65 pathway was then chosen for in-depth studies. Inactivation of p65 by p65 stable knockdown and IκBα super repressor overexpression showed reduced cell migration, invasion, angiogenesis, in vitro cell growth, and in vivo tumor growth. In contrast, overexpression of wild type p65 and phospho-mimic S536E p65 promotes cell migration, invasion, angiogenesis, in vitro cell growth, and cell cycle progression. Molecular studies suggested that tumorassociated angiogenesis is regulated by p65 through expression of pro-angiogenic factors and the p65 activity controls epithelial-to-mesenchymal transition (EMT)-like properties in NPC. Western blotting and qPCR analyses showed that inactivation of p65 reduced expression of pro-angiogenic factors and mesenchymal markers. Overexpression of p65 induced expression of pro-angiogenic factors and mesenchymal markers as well as enhanced EMT-like properties. The elimination of the p65 feedback mechanism by IκBα knockdown largely induced expression of pro-angiogenic factors and mesenchymal markers, as well as changes in cell morphology. In conclusion, these results suggest that FBLN2 suppresses tumor growth, tumor-associated angiogenesis, migration, and invasion through the regulation of Erk1/2, p65, and Rho GTPase pathways. The important roles of the p65 pathway in angiogenesis and EMT were also revealed. These findings provide a strategic new insight into the understanding of mechanistic role of FBLN2 in NPC and provide a better understanding for the molecular genetic basis of NPC tumorigenesis. / published_or_final_version / Clinical Oncology / Doctoral / Doctor of Philosophy

Mental health has become a critical global issue over the last century, adversely impacting individual happiness, social costs and human capital, all of which devastate national competitiveness, urging government leaders to take immediate action to solve this problem. Caring professionals have studied medical and non-medicinal solutions, including counselling, which may interface with religion. The integration of Buddhist elements and therapies is increasingly prevalent, with positive effects. However, very few of these psychotherapeutic approaches adopt canonical evidence to support their theories, even though many are associated with Tibetan or early Buddhism. Focusing on first-hand data and employing interpretivism and plurality, this exploratory research interprets the ideas of bodhisattva and the four immeasurables within the Vimalakīrti Nirdeśa Sūtra, an influential Mahāyāna text, and translates them into a counselling framework from the Chinese Buddhist perspective, cross-referenced with qualitative fieldwork. Through purposive sampling, 38 participants were recruited through cold calls, social networks, and electronic mails, including helping practitioners, Buddhist masters, volunteers, and beneficiaries who have overcome life challenges through Buddhist wisdom. In addition to 44 semi-structured, in-depth individual as well as two focus group interviews analysed through interpretative phenomenological analysis, multiple resources were also utilised, such as participatory observations, expressive art, television programmes, and autobiographies. The ATLAS.ti 7 software package was used for both scriptural and interview data analyses. Triangulation was conducted to enhance rigour, involving expert consultation, member-checking, and a peer analysis that resulted in an inter-rater reliability of 92%, which reflects the credibility, dependability, confirmability, and transferability of this project. Results finalised two super-ordinate themes (philosophical concepts and propositions for counselling) from 14 emergent themes arising from 40 themes, proposing a bodhisattva-spirit-oriented counselling framework, highlighting the social dimension and illuminating constructs that are disregarded by the extant models. These outcomes correspond to research questions which achieve the research objective, and support the research assumption regarding the inherent therapeutic functionality of Buddhism. This mixed-method inter-disciplinary work not only supplies a direct Buddhist voice, which differs from available literature, but also provides theoretical underpinnings for researchers and practitioners to enrich their practice and expand the horizon of Buddhist-related interventions. This indicates the practicability of the bodhisattva path in the human service industry, as witnessed by the lived experience of the participants, implying the applicability of Mahāyāna wisdom, which has evolved over 2,000 years, to our modern society. In conceptualising this comprehensive counselling framework, this study opens up a doctrinal approach to substantiate Buddhist-informed interventions, revealing the significance of canonical data for such research and marking the originality and feature of this project. However, this proposed framework is being developed with little exploration of operational procedures. Future studies are suggested to develop non-medicinal and non-intrusive programmes based on this framework, and to explore other concepts of Chinese Buddhism for therapeutic purposes. In conclusion, this research, recapturing the Buddhist power of discourse in the caring field, sheds light on how the bodhisattva spirit can be put into practice via self-transcendence and a quest for well-being in contemporary cultures, through self-benefiting altruism. / published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

Introduction Ill-fitting footwear is one of the well-known risk factors causing foot ulceration in the diabetic population. Current literature for fitness of foot dimensions is insufficient, especially on foot-shoe length and foot-shoe width measurement in absolute numerical differences. The aims of the study were to compare and identify the footwear fitness in diabetic patients with peripheral sensory neuropathy, diabetic patients without peripheral neuropathy and non diabetes. Materials and Method 　　Diabetes patients were assessed for peripheral sensory neuropathy by two sensory tests, 10-g monofilament test using 10-g Semmes-Weinstein monofilament and vibration perception threshold test using neurotheisometer. Abnormal results of both tests indicated diabetes sensory neuropathy. The dimensions of foot length and foot width were determined by the Brannock device while internal shoe length and internal shoe width were measured by an inside caliper. The mean of internal shoe-length difference and shoe-width difference of three groups were calculated and compared. Reference ranges of 10-15mm of shoe-length difference and 0-7mm were selected from past literature. The values of shoe-length and shoe-width differences were dichotomized into correct and incorrect fit category. Footwear fitness of the three groups was compared. Demographics of patients, information on self foot care, shoe size check and footwear habit were collected for correlation analysis. Results Data was collected from 20 diabetes patients with sensory neuropathy, 60 diabetes patients without neuropathy and 40 non diabetes controls. There were significant difference in shoe-length difference among three groups, with larger shoe-length difference in diabetic neuropathy group (left: 21.9mm, / right: 21.7mm), followed by non neuropathy diabetes (left: 15.2mm, / right: 15.5mm) and controls (left: 13.4mm, / right: 14.5mm) (left p=0.002 / right p=0.008). The shoe-length differences of both diabetes groups exceeded the reference range, indicating long footwear. No significant difference was reported related to shoe-width difference. Analysis of shoe fit category showed around 15-17% of diabetes patients were wearing correctly fit shoes in both length and width. A high prevalence of diabetes patient had ill-fitting footwear while nearly half of them wear shoes with correct width but incorrect length. There is nearly no correlations between shoe-length fit, shoe-width fit and frequency of self foot check, frequency of footwear size check and frequency of diabetic footwear education. Discussion Most diabetes patients wear ill-fitting footwear, especially those with peripheral sensory neuropathy when compared to control group. There is significant difference in shoe-length difference among the three groups, with reference to the 10-15mm range as the gap length allowance. Diabetic patients tend to wear long and loose footwear in this study even they had past foot education and practice proper self foot check regularly. These might imply incomprehensive proper diabetic footwear education and self footwear assessment in current diabetes care pathway. These components are essential in diabetes foot care and people with diabetes are highly recommended to select a pair of good fit footwear. Further research is required to standardize the methodologies of measurement in foot dimensions and footwear fitness as well as investigate on relations of additional foot parameters in shoe fitting. / published_or_final_version / Orthopaedics and Traumatology / Master / Master of Medical Sciences

Background: Newer multimodality therapeutic interventions have resulted in dramatic survival rates in childhood cancers. However diverse treatment related morbidities affect the long term survivors. An Endocrine complication comprises 20-40% of these morbidities and affects the hypothalamic pituitary axis, growth, pubertal progression, fertility, bone health and glucose homeostasis. Objectives: The aim of our study was to enumerate and evaluate the frequency of endocrine complications arising as a late effect of treatment in childhood cancer survivors. Risk factors likely to be associated with these complications were also evaluated. Methodology: Retrospective analysis of medical records from the Long Term Endocrine Follow up clinic in the Department of Paediatrics and Adolescent Medicine of Queen Mary Hospital was done. Patients with a primary diagnosis of Cancer and Langerhans cell histiocytosis with endocrine sequelae arising from various treatment modalities who have survived 5 years after diagnosis were included in the study. Those who had endocrine complications arising from various treatment modalities for Thalassemia’s, Immunodeficiency’s were excluded from the study Results: 135 cases were included in the study and 27 were excluded. Leukemia and Brain tumor survivors were the majority accounting for 40% and 26.67% respectively. ALL formed majority of leukemia survivors, Medulloblastoma survivors accounted for 50% of brain tumor survivors. Most common endocrine problem was Hypogonadism in 51.1% of cases, followed by growth disturbances in 40%, Thyroid dysfunction in 23% and Hyperlipidemias in 18.5%. Pubertal problems, Central Diabetes Insipidus, Adrenal insufficiency, Obesity, Altered glucose homeostasis were rest of the problems in small frequencies. PHGN (Primary Hypogonadism) was present in 91.3% and mostly in prepubertal males. PHGN was statistically associated with Leukemia survivors with OR-2.06 (1.02- 4.15), p value 0.04. The risk factors associated were exposure to alkylating agents, radiotherapy, TBI prior to transplant. SHGN (Secondary HGN) was statistically associated with Brain tumor survivor OR - 15.8 (1.7-140.5), p value 0.013. Cranial irradiation was the major risk for SHGN. PGV (Poor growth velocity) was the major growth problem.GHD (Growth Hormone Deficiency) had a highly significant association with Brain tumors (p value ˂ 0.0001), and significantly associated when all 3 modalities of treatment given together (p value 0.01). Risk factors for GHD were cranial radiotherapy, exposure to cyclophosphamide and TBI. PH (Primary Hypothyroidism) had highly significant association with craniospinal radiotherapy (p value ˂ 0.0001), and significantly associated with brain tumors. Similar results were observed in patients of CH (Central Hypothyroidism). Hyperlipidemias were present in 18% with no statistical correlation with the type of cancer. Brain tumor survivors had a significant association of GHD, PH, CH, SHGN and CDI. Leukemia survivors had significant association with GHD and PHGN. Conclusions: Endocrine problems are frequent manifestations of late effects of cancer related treatments. Early detection and intervention of these potentially treatable problems could be done through structured long term surveillance. Increasing awareness among health care professionals to anticipate problems in suspected patients and education of patients would optimize health care and quality of life. / published_or_final_version / Paediatrics and Adolescent Medicine / Master / Master of Medical Sciences

The CLEC16A locus has been identified as a susceptibility gene for multiple autoimmune diseases, including multiple sclerosis, type-I diabetes and systemic lupus erythematosus (SLE), in genome-wide association studies. CLEC16A encodes a novel C-type lectin-like protein, by virtue of a predicted C-type lectinlike domain (CTLD), with unclear function. Studies on the disease-associated SNPs have suggested that CLEC16A polymorphisms affect the expression of neighboring genes, while the effect on its own expression is unclear. Several functional studies have interrogated the physiological role(s) of CLEC16A in disparate directions. The Drosophila ortholog of CLEC16A, Ema, has been reported to regulate endosomal protein trafficking and the autophagic process, while CLEC16A has been found to participate in LPS-induced inflammatory cytokine response in rat astrocytes. Since there is not a consenting role ascribed to CLEC16A, this study was undertaken to investigate the functional involvement(s) of CLEC16A in mammalian cells and the expression of CLEC16A in lupus patients, with the attempt to comprehend the association between CLEC16A and SLE. By overexpressing in non-immune epithelial cells, CLEC16A was revealed to be an intracellular protein of ~130 kDa in size. CLEC16A displayed a punctated expression pattern, which did not co-localize with endosomes, lysosomes, autophagosomes or endoplasmic reticulum in steady state. When treated with rapamycin or serum-starved, CLEC16A-overexpressing cells exhibited a reduced autophagic response, suggesting that CLEC16A may have an inhibitory role in autophagy. Besides the predicted CTLD, motif prediction has also implicated an immunomodulatory role for CLEC16A. Due to the observed inhibition on autophagy, coupled with recent findings linking autophagy and inflammasome activation, the involvement of CLEC16A in NLRP3 inflammasome was investigated. By knocking down CLEC16A in the human macrophage-like THP-1 cells, CLEC16A was found to potentially regulate NLRP3 inflammasome activation via inhibiting the LPS-induced pro-IL-1aasynthesis. Finally, the expressions of the long and short isoforms, CLEC16A_V1 and CLEC16A_V2 of CLEC16A in PBMCs were compared between healthy controls and SLE patients. A higher CLEC16A_V1 expression was observed in SLE patients, whereas the reverse was found for CLEC16A_V2. The expressions of the isoforms, however, were not correlated with the disease severity and clinical manifestations. The finding that CLEC16A may inhibit autophagy is in contrast with the reported function of Ema in supporting autophagy, and such discrepancy could be because of the different cell systems used. The finding that CLEC16A may downregulate NLRP3 inflammasome activation has not been previously reported, and the mechanism(s) of such regulation warrant(s) future studies. The molecular basis of how CLEC16A regulates autophagy and inflammasome waits to be delineated. Such knowledge, together with information of where endogenous CLEC16A is expressed, shall incite better understanding of the contribution of CLEC16A to SLE development. / published_or_final_version / Medicine / Doctoral / Doctor of Philosophy

Mobile phone addiction has become an important public health problem in recent years. As young people are more susceptible to this problem, effective interventions to tackle mobile phone addiction among youth are needed. This systematic review aims to identify the possible risk factors that contribute to mobile phone addiction and provide implications in this field. This reviewselected11 studies pertaining to the topic of mobile phone addiction among adolescent and young users published from 2003 to 2013. It combines and summarizes major risk factors that predict the occurrence of mobile phone addiction among youth. It categorizes risk factors identified in four dimensions: psychological characteristics (self-esteem, sensation seeking, leisure boredom, interpersonal anxiety, self-identity, in-group norms, the need to belong, loneliness, depression, personality traits: extraversion, neuroticism and disagreeableness);perceived maternal rearing attitudes and environmental factor such as socioeconomic background, school locations, school failure; health compromising behaviors including tobacco use, excess alcohol consumption and internet addiction; and gender difference. The discussion presents limitations of the review and the implications for policy and practices, and avenues for further research. / published_or_final_version / Public Health / Master / Master of Public Health

Introduction Due to its widespread use, toxicity and volatility, exposure to the chemical formaldehyde has important implications for human health. Asthma is a common chronic inflammatory disease with both genetic and environmental factors. The common symptoms of asthma include wheezing, coughing, and shortness of breath. The objective of the present study is to evaluate the association between exposure to formaldehyde and adult asthma through systematic review. Methods A literature search was conducted using PubMed with keywords of formaldehyde, adult asthma, and other relevant terms. The basic exclusion and inclusion criteria in this study are as follows: Original randomized controlled trials (RCTs) and observational studies were eligible, but not editorials, reviews, case-reports and case‐series. Studies that focused on behavioral change or other outcomes unrelated to asthma were excluded. Lastly, articles in which full text was unavailable were excluded. Finally, after 3 selection rounds, 7 studies were included in the present systematic review. Results: These 7 studies included 3 RCTs, 2 case‐control studies and 2 cross‐sectional studies, published from 1986 to 2013. The 3 RCTs examined participants with and without asthma and investigated the acute effects of formaldehyde on respiratory phenotypes; in contrast, the 4 observational studies examined the long‐term effects of low dose formaldehyde exposure on asthma. Only 1 RCT reported a strong association between formaldehyde and adult asthma, with the intervention group developed an immediate bronchial response at a significantly lower dose of mite allergen than that of the control group with air exposure. The other 2 RCTs found no significant deleterious effect on airway allergen responses after exposure to 500 μg/m3 formaldehyde; and the concentration of formaldehyde found in the indoor environment was of minor importance for developing pulmonary symptoms. Two case-control studies reported a positive association between formaldehyde exposure and asthma symptoms, while the results in the cross‐sectional studies suggested no significant association between formaldehyde exposure and adult asthma. Conclusions Among the 3 reviewed RCTs, only 1 reported a significant association between formaldehyde and asthma. In the 4 reviewed case‐control and cross‐sectional studies, 2 suggested that exposure to formaldehyde had significant effects on bronchial responses. However, these studies represented different characteristics, hence, after integration of them, this review suggests that exposure to formaldehyde in relative low concentration may not have strong association with adult asthma. However, further studies are required to A: Try to identify more potential confounders and choose most suitable model in various conditions; B: investigate multiple patterns of formaldehyde exposure and provide different outcome measurements in RCTs. In addition, this report indicates that it is important to increase the population awareness of choosing environmental friendly decoration materials for reducing formaldehyde exposure. / published_or_final_version / Public Health / Master / Master of Public Health

Objective: Chronic back pain is highly prevalent in orthopaedic clinics. The aim of the study was to investigate the relationship of psychological factors affecting disability and distress outcomes in chronic low back pain patients. Clinicians shared the impression that chronic pain patients resulted from Injury on Duty (IOD) were particularly difficult to manage. Profiles of IOD patients and non-IOD patients were compared. Methods: The present study is a prospective follow-up study. Fifty-four patients from a public orthopaedic out-patient clinic were assessed with low back pain as their primary complaint. Self-report inventories together with semi-structured interview were used to assess patients’ pain intensity, pain disability, psychological distress, positive and negative affect, as well as relevant pain-related parameters including pain catastrophizing thought, pain-related fear, pain self-efficacy and chronic pain acceptance. Patients were interviewed during their first visit to the orthopaedic out-patient clinic (i.e. Time 1), after 6 months (i.e. Time 2) and after 1 year (i.e. Time 3) of the first consultation. Both qualitative and quantitative analyses were conducted. Results: Chronic pain acceptance predicted mid-term and long-term pain disability and psychological distress at a period of one year after their initial assessment. However, the pain-related parameters of pain catastrophizing, pain-related fear and pain self-efficacy did not show a significant predictive effect on outcomes. Pain rating is an inadequate estimate to assess patients’ level of disability and psychological status. The meaning of pain is important for patients to make sense of their pain experience and employ appropriate coping strategies. Attaching a positive value to pain helps patients to accept their pain. In addition, half of the chronic pain patients showed a need for psychiatric services at one year follow-up, pointing to a high co-morbidity between chronic pain and psychiatric problems. Among the 54 patients, 17 (31.5%) were injured on duty (IOD). More IOD patients than non-IOD patients took sick leaves or were not working during the year. However, there is no significant difference between IOD group and non-IOD group on psychological distress, pain disability and other pain-related measures across 3 time points. Discussion and Conclusion: Pain problems in the context of chronic pain are different from those in the context of acute pain. Intervention focusing on pain relief is inadequate to treat patients’ chronic pain. A multi-factorial perspective is needed to understand and develop suitable models to account for chronic pain experience instead of just relying on the prevalent fear-avoidance model. A more comprehensive assessment that is tailored to patients’ needs is necessary for more effective rehabilitation. Chronic pain patients’ need for psychiatric intervention is also highlighted, with a focus on work-related issues for IOD patients. / published_or_final_version / Psychiatry / Doctoral / Doctor of Philosophy

This dissertation consists of two empirical essays about the cognitive limitation, herding behavior, and their association with investment performance. The essays utilize the detailed quotes and trades data in the Taiwan Futures Exchange with investor account identity, to study the cognitive limitation and herding behavior of the investors, and the association between the cognitive limitation, herding behavior, and the investment performance. In the first essay, I hypothesize that cognitive limitation maybe manifested in a disproportionately large volume of limit orders submitted at round-number prices if investors use these numbers as cognitive shortcuts., I find that investors with lower cognitive abilities, defined as higher limit order submission ratios at round numbers, suffer greater losses in their round-numbered and non-round-numbered limit orders, market orders, and round-trip trades. The positive correlation between cognitive ability and investment performance is monotonic and robust across futures and options markets. In addition, past trading experience helps mitigate the cognitive limitation. The second essay studies the herding behavior of investors. The second essay studies the herding behavior of investors. I find that individual investors trade in the same direction with other individual investors in the same branch of a broker. Individual investors’ tendency to herd is persistent, and it is negatively associated with their cognitive abilities and trading experience. The higher the herding tendency of an individual investor is, the worse she performs in her investments. Importantly, the negative association between herding and investment performance is driven by the orders that are traded in the same direction with other individual investors. Our results suggest that herding with other individuals imposes a direct cost to individual investors. / published_or_final_version / Economics and Finance / Doctoral / Doctor of Philosophy