Smart cities prioritize citizen participation by integrating Information and Communications Technology to develop human-centric solutions. Smart government systems facilitate inter-departmental data sharing, and foster transparency, collaboration and access to open data. These systems synthesize multiple administrative services into unified one-stop portals, streamlining access and enhancing service delivery. A framework is introduced to evaluate the non-market benefits of smart government systems, categorizing them into Foundational Benefits (derived from existing departmental portals) and Transitional Benefits (representing the added value of transitioning to a unified platform). To quantify these benefits, the study employs Contingent Valuation methods alongside econometric modelling techniques, including interval regression and Tobit analysis, using Willingness-to-Pay (WTP) as a proxy measure of perceived value. Based on a survey with over 1,000 respondents in Hong Kong, the WTP estimates are extrapolated to simulate the local internet population. The benefits are aggregated to inform a Cost-Benefit Analysis. The study further emphasizes continuous improvement needs in smart government, particularly by addressing factors found to be influencing intangible benefits, including usability, social norms, open data sharing and digital divide. These findings demonstrate that smart government systems generate measurable non-market welfare gains and provide an empirical foundation for evidence-based digital policy evaluation.

Background: Monocyte-derived dendritic cells (mo-DCs) play a vital role in the innate immune response by activating Th17 cells, which in turn release the pro-inflammatory cytokine IL-17. We hypothesised that following repetitive mechanical strain, tenocytes activate monocyte-derived dendritic cells, which in turn, drive the pathogenesis of tendinopathy. Aim: The aim of the study was to determine if monocyte-derived dendritic cells are upregulated in a human tendinopathy model. Method: Torn supraspinatus tendon and matched intact subscapularis tendon samples were collected from 7 patients undergoing arthroscopic shoulder surgery. Healthy control samples of subscapularis tendon were collected from 5 patients undergoing arthroscopic stabilization surgery. Tendon biopsy samples were evaluated immunohistochemically by quantifying the presence of monocyte-derived dendritic cells (CD11C and CD206). Results: Tendinopathic tendon samples exhibited significantly greater (2-3-fold) monocyte-derived dendritic cell expression when compared with healthy control tissue (P < .05). Conclusion: This study provides evidence for a monocyte-derived dendritic cell upregulation in early-stage human tendinopathy.

The study aimed to describe the changes in biomechanical properties of the supraspinatus tendon, deltoid muscle, and humeral head post arthroscopic rotator cuff repair using shear wave elastography. Shear wave velocity of the tendon, deltoid, and humeral head of 48 patients was measured at predetermined sites at 1 week, 6 weeks, 12 weeks, 6 months, and 12 months post repair. One-way ANOVA with Tukey’s correction and Spearman’s correlation were performed. Mean±SEM healing tendon stiffness, adjacent to tendon footprint, increased from 1 week (6.2±0.2 m/s) to 6 months (7.5±0.3 m/s) and 12 months (7.8±0.3 m/s) (P<0.001). Mean±SEM deltoid muscle stiffness was higher at 12 months (4.1±0.2 m/s) compared to 1 week (3.4±0.1 m/s) and 12 weeks (3.5±0.1 m/s) (P<0.05). Humeral head stiffness did not change. Following arthroscopic rotator cuff repair, supraspinatus tendon stiffness increased in a curvilinear fashion over 6 months. From 6 months, deltoid muscle stiffness increased, corresponding to when patients were instructed to return to normal activities.

Background: We have developed a novel technique for managing rotator cuff calcific tendonitis, involving arthroscopic debridement of calcific tendonitis with localization assistance from a breast biopsy needle under ultrasound guidance. While we have demonstrated encouraging results at six-month follow-up, the medium-term outcomes and the long-term outcomes of this technique at 2 years or beyond are unknown. The aim of this paper was to determine if this technique was successful in resolving symptoms after two years and beyond. Study Design: Retrospective Cohort Study. Methods: Patients who underwent arthroscopic debridement of calcific tendonitis with localization assistance from a breast biopsy needle under ultrasound guidance by a senior surgeon were evaluated using patient-rated pain scores and functional status with the use of the Likert scales and via examiner-rated shoulder range-of-motion and strength at the pre-operative visit, at 1, 6, 12, and 24 weeks post-operatively, and long-term at a mean of 249 weeks after surgery. Results: At a mean follow-up period of 4.8 years (range, 2-10 years), 31 patients (33 shoulders) experienced significant improvement in the severity of pain at rest, with overhead activities, and during sleep compared to their pre-operative presentation (p < 0.001). The patient experienced less frequent pain during activities and sleep, and a decreased frequency of extreme pain (p < 0.001). Passive range of abduction (p = 0.003), forward flexion (p < 0.001), and supraspinatus strength (p = 0.018) improved compared to the presurgical presentation. Out of 27 patients, 24 patients (89%) had complete resolution of calcific tendonitis, and 26 patients (96%) had an intact rotator cuff. Conclusion: Arthroscopic debridement of calcific tendonitis with localization assistance from a breast biopsy needle under ultrasound guidance was very effective. Patients had significant pain relief, improved range of motion, and a reduction in stiffness at a mean post-operative period of 4.8 years. Patients had a significant reduction in residual calcification, and rotator cuff integrity was largely preserved by long-term follow-up. What is known about this subject: Calcific tendonitis of the rotator cuff is one of the most painful and debilitating disorders of the shoulder. This condition is characterized by the deposition of calcium-phosphate crystals within the rotator cuff tendons. Arthroscopic debridement and excision of rotator cuff calcifications have proven to be efficacious treatments with regards to clinical and functional outcomes in the short and medium term. Identifying the calcific lesion intra-operatively, however, can prove to be challenging. Furthermore, inadequate excision of the calcific deposit has been shown to have poorer clinical outcomes. We designed a technique that utilizes the assistance of ultrasound to guide a localization-biopsy wire to the calcific lesion. This technique aids in precisely identifying the location of the lesion intra-operatively to optimize accuracy in removing the maximum amount of calcific deposit possible. A short-term follow-up study by us has demonstrated successful outcomes with regards to the return of function and relief of pain. However, there have been no studies evaluating the effectiveness of this particular technique beyond six months. What this study adds to current knowledge: At a mean of 4. 8 years, arthroscopic debridement of calcific tendonitis, using our technique, was successful in relieving the severity and frequency of pain with overhead activities, pain at rest, and pain during sleep, as well as improving range of motion.

Background: We intended to determine if an acromion or distal clavicle bone graft could restore large glenoid defects using two novel, screw-free graft fixation techniques. Methods: Twenty-four sawbone shoulder models were divided into four groups (n = 6 per group) according to fixation technique and bone graft: (1) modified buckle-down technique with clavicle graft, (2) modified buckle-down technique with acromion graft, (3) cross-link technique with acromion graft, (4) cross-link technique with clavicle graft. Testing was performed sequentially in (1) intact models, (2) after creation of a 30% by-width glenoid defect and (3) after repair. The shoulder joint was translated anteriorly, and glenohumeral contact pressures and load were measured to quantify the biomechanical stability. Results: Maximum contact pressures were restored to 42–56% of intact glenoid using acromion and clavicle grafts with novel fixation techniques. Acromion grafts attained higher maximum contact pressures than clavicle grafts in all groups. Peak translational forces increased by 171–368% after all repairs. Conclusions: This controlled laboratory study on sawbone models found that both the acromion and distal clavicle are suitable autologous bone graft options for treating large anterior glenoid defects, having appropriate dimensions and contours for reconstructing the glenoid arc. The modified buckle-down and cross-link techniques are two graft fixation techniques that restore stability to the shoulder joint upon repairing a large glenoid defect and are advantageous in being screw-free and simple to execute.

Introduction: A retrospective case-controlled study was performed to evaluate the outcomes of shoulder arthroplasty performed as a day case in carefully selected patients, compared to the traditional inpatient approach. Materials and Methods: Patients who had total or hemiarthroplasty of the shoulder performed as a day case or inpatient procedure were recruited. The primary outcome compared rates of uneventful recovery, defined by the absence of complications or readmission to the hospital within six months of surgery, between the inpatient and outpatient groups. Secondary outcomes included examiner-determined functional and patient-determined pain scores at one, six, twelve, and twenty-four weeks post-surgery. A further assessment of patient-determined pain scores was carried out at least two years post-surgery (5.8 ± 3.2). Results: 73 patients (36 inpatients and 37 outpatients) were included in the study. Within this time frame, 25/36 inpatients (69%) had uneventful recoveries compared to 24/37 outpatients (65%) (p = 0.17). Outpatients showed significant improvement over pre-operative baseline levels in more secondary outcomes (strength and passive range-of-motion) by six months post-operation. Outpatients also performed significantly better than inpatients in external rotation (p < 0.05) and internal rotation (p = 0.05) at six weeks post-surgery. Both groups showed significant improvement compared to pre-operative baselines in all patient-determined secondary outcomes except the activity level at work and sports. Inpatients, however, experienced less severe pain at rest at six weeks (p = 0.03), significantly less frequent pain at night (p = 0.03), and extreme pain (p = 0.04) at 24 weeks, and less severe pain at night at 24 weeks (p < 0.01). By a minimum of two years post-operation, inpatients were more comfortable repeating their treatment setting for future arthroplasty (16/18) compared to outpatients (7/22) (p = 0.0002). Conclusions: At a minimum of two years of follow-up, there were no significant differences in rates of complications, hospitalizations, or revision surgeries between patients that underwent shoulder arthroplasty as an inpatient versus an outpatient. Outpatients demonstrated superior functional outcomes but reported more pain at six months post-surgery. Patients in both groups preferred inpatient treatment for any future shoulder arthroplasty. What is Known About This Subject: Shoulder arthroplasty is a complex procedure and has traditionally been performed on an inpatient basis, with patients admitted for six to seven days post-surgery. One of the primary reasons for this is the high level of post-operative pain, usually treated with hospital-based opioid therapy. Two studies demonstrated outpatient TSA to have a similar rate of complications as inpatient TSA; however, these studies only examined patients within a shorter-term 90-day post-operative period and did not evaluate functional outcomes between the two groups or in the longer term. What This Study Adds to Existing Knowledge: This study provides evidence supporting the longer-term results of shoulder arthroplasty done as a day case in carefully selected patients, which are comparable to outcomes in patients that are admitted to the hospital post-surgery.

Purpose This study aims to identify the challenges facing innovative startups in the construction environment, recommending possible self-help measures and society support. Design/methodology/approach A comprehensive literature survey informed a questionnaire survey on built environment startups in Hong Kong, followed by a statistical analysis and supplemented by written views of respondents. Validation by experts confirms the survey results. Findings Triangulated findings highlight the problems of conservative policies, investors’ preference on short payback periods, price competition, high operation cost and a lack of promotion channels. The firm’s size and its age differentiate its networking and fund-raising capabilities. Research limitations/implications While the survey samples cover the spread of startups in Hong Kong’s construction/real estate industries well, the number is still limited because the city is relatively compact. The barriers and solutions may be particularly relevant to the built environment there, but also worth noting elsewhere. Practical implications Built environment startups are emerging and their path of development is obscured by industry barriers. While the findings reflect the current situation in Hong Kong, which is a metropolitan city with a vibrant construction market, government policies may present a varying factor in different economies. Conservatism in the construction industry may also be a hindrance, but gradual signs of improvements are seen. Originality/value The recommendations provided may help mitigate the problems of startup growth. They also provide insights into the construction “startup eco-system” worth the attention of policy makers and project managers, who may make better use of the innovative technology and services of built environment startups if the difficulties are alleviated.

Abstract: Introduction: A retrospective case-controlled study was performed to evaluate the out-comes of shoulder arthroplasty performed as a day case in carefully selected patients, compared to the traditional inpatient approach. Materials & Methods: Patients who had total or hemiarthro-plasty of the shoulder performed as a day case or inpatient procedure were recruited. The primary outcome compared rates of uneventful recovery, defined by the absence of any complications or readmission to hospital within six months of surgery, between Inpatient and Outpatient groups. Secondary outcomes included examiner-determined functional scores and patient-determined pain scores at one, six, twelve, and twenty-four weeks post-surgery. A further assessment of pa-tient determined pain scores was carried out at a minimum of two years post-surgery (5.8 ± 3.2). Results: 73 patients (36 Inpatients and 37 Outpatients) were included in the study. Within this time frame 25/36 inpatients (69%) had uneventful recoveries compared to 24/37 outpatients (65%) (p = 0.17). Outpatients showed significant improvement over pre-operative baseline levels in more of the secondary outcomes (strength and passive range-of-motion) by six months post-operation. Outpatients also performed significantly better than Inpatients in external rotation (p<0.05) and internal rotation (p=0.05) at six-weeks post-surgery. Both groups showed significant improvement compared to pre-operative baselines in all patient-determined secondary outcomes except level of activity at work and sport. Inpatients, however, less severe pain at rest at six weeks (p=0.03), sig-nificantly less frequent pain at night (p=0.03) and extreme pain (p=0.04) at 24 weeks; and less se-vere pain at night at 24 weeks (p<0.01). By minimum two years postoperation, inpatients were more comfortable repeating their treatment setting for future arthroplasty (16/18) compared to outpatients (7/22) (p = 0.0002). Conclusions: At a minimum of two years follow up, there were no significant differences in rates of complications, hospitalisations, or revision surgeries between pa-tients that underwent shoulder arthroplasty as an inpatient versus as an outpatient. Outpatients demonstrated superior functional outcomes but reported more pain at six months post-surgery. Patients in both groups expressed a preference for inpatient shoulder arthroplasty in future. What is Known About This Subject: Shoulder arthroplasty is a complex procedure, and has tradition-ally been performed on an inpatient basis, with patients admitted for six to seven days post-surgery. One of the primary reasons for this is the high level of postoperative pain, usually treated with hospital-based opioid therapy. Two studies demonstrated outpatient TSA to have a similar rate of complications as inpatient TSA, however these studies only examined patients within a shorter term 90 day postoperative period, and did not evaluate functional outcomes between the two groups or in the longer term. What This Study Adds to Existing Knowledge: This study provides evidence supporting the longer-term results of shoulder arthroplasty done as a day case in carefully selected patients, which are comparable to outcomes in patients that are admitted to hospital post-surgery.

Given various hindrances in the macro context, how to efficiently develop age-friendly community policies requires further research. Currently, such kinds of frameworks are lacking. This paper aims to develop a policy framework to minimise cost and resolve conflict of interest between different generations in age-friendly community development. The study adopted a scientometric method to review the theoretical development of age-friendly community studies. Firstly, with a search for the keywords "age-friendly" and "community" on Web of Science, 72 English academic papers were found containing explicit theories. Most of the studies were conducted in the Global North. Then, a mixed analytical method was used to find a suitable theory, "the production of space", to develop the policy framework. Lastly, a policy framework was developed to overcome barriers to age-friendly community development strategically. Echoing previous studies, this paper proposes a way to counter financial austerity in age-friendly initiative investment and balance the consideration for older and younger populations in urban development. For practice, the policy framework can provide a reference for more efficient age-friendly community policymaking in different regions. For future research, the framework provides a model for more empirical studies considering the social dynamics in age-friendly community development.

Objectives: It is unclear if concomitant glenohumeral osteoarthritis is protective or detrimental with respect to rotator cuff integrity after arthroscopic repair surgery. We hypothesized that the associated stiffness might protect the repaired tendon. In the alternate, arthritis might reflect a gradual degeneration of the joint including a degenerative tendon and therefore predispose the repair to re-tear. Therefore, the purpose of this study was to investigate whether concomitant osteoarthritic changes found intra-operatively during arthroscopic rotator cuff repairs (RCR) have a beneficial or detrimental effect on post-operative repair integrity. Methods: This study is a post-hoc analysis of prospectively collected data of patients who underwent primary arthroscopic RCR between 2005 and 2019 by a single surgeon. Patients were divided into an osteoarthritic group and a control group based on the presence or absence of intra- operative osteoarthritic changes respectively. The primary outcome measure was cuff integrity detected by post-operative ultrasound at 6-months. The secondary outcomes were patient-reported outcomes including shoulder pain, stiffness, level of activity at work and level of sport, and physician-reported outcomes including shoulder range of motion and strength. Results: A total of 2155 consecutive patients met the inclusion criteria with a mean age of 59 years (SD=0.2) and there were more males as compared to females (56% vs. 44%). 28% of patients undergoing RCR had osteoarthritic changes detected intra- operatively. Intra-operatively, the osteoarthritic group had more full-thickness tears (64% vs. 59%) (p<.001), a larger mean anteroposterior tear length [20mm (SD=0.5) vs. 17mm (SD=0.4)] (p<.001) and a larger mean mediolateral tear length [17mm (SD=0.5) vs. 15mm (SD=0.4)] (p<.001). Ultrasonographic evaluation at 6-months post-surgery demonstrated that the osteoarthritic group had a higher incidence of cuff re-tear rate as compared to the control group (15% vs. 11%) (p=.016) ( Figure 1 ). However, after performing a multiple logistic regression analysis, osteoarthritis was not found to be an independent predictor of re-tear. There were very marginal differences in patient-reported outcomes at 6-months after surgery between the two groups ( Table 1 ). The osteoarthritic group reported lesser post-operative frequency of activity pain [2.0 (SD=1.46) vs. 2.2 (SD=1.43)] (p=.005), frequency of extreme pain [0.8 (SD=1.35) vs. 1.0 (SD=1.41)] (p=.035) and level of pain during overhead activity [1.7 (SD=1.30) vs. 1.9 (SD=1.30)] (p=.021) as compared to controls. As compared to controls, the osteoarthritic group also experienced lesser post-operative stiffness [1.5 (SD=1.32) vs. 1.6 (SD=1.31)] (p=.019) and reported lower intensities of work-related activities [1.1 (SD=0.88) vs. 1.2 (SD=0.85)] (p=.038) and lower level of sport activity [0.4 (SD=0.62) vs. 0.5 (SD=0.70)] (p=.004). In terms of physical examination at 6-months following surgery ( Table 2 ), the osteoarthritic group were found to have lesser range of motion in forward flexion [146° (SD=33.1) vs. 151° (SD=31.2)] (p=.009), abduction [127° (SD=38.8) vs. 131° (SD=38.1)] (p=.034), external rotation [50° (SD=21.4) vs. 52° (SD=21.0)] (p=.024) and internal rotation (L1 vertebrae (SD=4.2) vs. T12 vertebrae (SD=4.2)] (p=.004) as compared to controls. The osteoarthritic group as weaker internal rotation strength [68N (SD=30.5) vs. 73N (SD=32.9)] (p=.004), external rotation strength [57N (SD=25.3) vs. 60N (SD=27.2)] (p=.026), supraspinatus flexion strength [45N (SD=26.8) vs. 50N (SD=27.9)] (p<.001), lift-off [40N (SD=24.3) vs. 44N (SD=25.3)] (p<.001) and adduction strength [76N (SD=36.5) vs. 81N (SD=39.3)] (p=.008) as compared to the control group. Conclusions: Patients with concomitant glenohumeral osteoarthritis who underwent arthroscopic RCR had higher re-tear rates at 6-months after surgery. However, osteoarthritis is not an independent predictor of rotator cuff re-tear at 6-months. Therefore, arthroscopic RCR is a viable surgical option for these patients. Figure 1: Proportion of intract vs. torn rotator cuff repairs between the osteoarthritic group (n=1552) and control group (n=603) at 6-months post-operative follow-up (p=.016). Table 1: 6-month post-operative pain scares and shoulder function in the osteoarthritic group vs. control group. Table 2: 6-month post-operative shoulder range of motion and strength in the osteoarthritic group vs. control group.

Smart government initiatives are being stimulated for smart city governance, employing various Information and Communication Technologies (ICTs). Citizens enjoy the intangible benefits of efficiency, policy effectiveness, transparency, etc., in the public administration process. However, smart government benefits are obscure to quantification due to their non-market nature, resulting in investment in smart government projects being questioned. This study evaluates smart government benefits of online public information and service provisions to citizens in the form of separate departmental platforms. A Contingent Valuation was conducted in Hong Kong, using interval regression to structure mathematical models. Willingness-to-Pay (WTP) is estimated as the quantitative proxy to monetize the non-market benefit. Possible factors affecting the WTP are also explored in the econometric analysis. The improvement measures associated with the digital divide, user interest and open data are emphasized. This empirical valuation assists public investment decision-making on smart government projects. The valuable insights and implications are provided to inform policy deliberation for sustainable urban development in smart cities.

Background: This study aimed to identify whether early postoperative shoulder stiffness is associated with improved healing following rotator cuff repair, and if so, how this factor might interact with other factors known to affect rotator cuff repair integrity.Methods: We conducted a retrospective analysis of prospectively collected data from 1,526 primary arthroscopic rotator cuff repairs. Six-week range of motion was assessed to determine shoulder stiffness, and repair integrity was evaluated at 6 months by ultrasound. Multiple logistic regression analysis was used to identify variables that affected retear, and receiver operating characteristic (ROC) curve analysis was used to evaluate predictive thresholds for retear.Results: Tear-size area was the most accurate predictor of retear (area under the curve [AUC] = 0.77; 95% confidence interval [CI] = 0.72 to 0.81), followed by 6-week passive external rotation (AUC = 0.67; 95% CI = 0.63 to 0.72), 6-week passive forward flexion (AUC = 0.67; 95% CI = 0.62 to 0.72), age (AUC = 0.65; 95% CI = 0.60 to 0.70), tear type (partial-thickness versus full-thickness) (AUC = 0.65; 95% CI = 0.61 to 0.69), and hospital type (public versus private) (AUC = 0.43; 95% CI = 0.37 to 0.49). Patients with smaller tears, reduced 6-week passive external rotation, reduced 6-week passive forward flexion, younger age, partial-thickness tears, and operations performed in a private day surgery or hospital setting were more likely to have an intact rotator cuff repair at 6 months. The AUC of this curve was 0.84 (95% CI = 0.80 to 0.87), which indicates that this combination of factors can accurately predict 84% of retears. Reduced range of motion at 6 weeks was associated with improved repair integrity for patients with tears of >1 to 6 cm(2); however, this effect was less pronounced in tears of <= 1 cm(2) or >6 cm(2).Conclusions: Early postoperative stiffness following arthroscopic single-row, inverted-mattress rotator cuff repair at 6 weeks was associated with an intact repair at 6 months. The protective effects of postoperative stiffness and tear size were additive. The chance of retear in patients with a tear of <= 1 cm(2) and external rotation of <= 27 degrees at 6 weeks was 1%, while those with tears of >6 cm(2) and external rotation of >27 degrees had a 40% chance.

Background: This study aimed to identify whether early postoperative shoulder stiffness is associated with improved healing following rotator cuff repair, and if so, how this factor might interact with other factors known to affect rotator cuff repair integrity. Methods: We conducted a retrospective analysis of prospectively collected data from 1,526 primary arthroscopic rotator cuff repairs. Six-week range of motion was assessed to determine shoulder stiffness, and repair integrity was evaluated at 6 months by ultrasound. Multiple logistic regression analysis was used to identify variables that affected retear, and receiver operating characteristic (ROC) curve analysis was used to evaluate predictive thresholds for retear. Results: Tear-size area was the most accurate predictor of retear (area under the curve [AUC] = 0.77; 95% confidence interval [CI] = 0.72 to 0.81), followed by 6-week passive external rotation (AUC = 0.67; 95% CI = 0.63 to 0.72), 6-week passive forward flexion (AUC = 0.67; 95% CI = 0.62 to 0.72), age (AUC = 0.65; 95% CI = 0.60 to 0.70), tear type (partial-thickness versus full-thickness) (AUC = 0.65; 95% CI = 0.61 to 0.69), and hospital type (public versus private) (AUC = 0.43; 95% CI = 0.37 to 0.49). Patients with smaller tears, reduced 6-week passive external rotation, reduced 6-week passive forward flexion, younger age, partial-thickness tears, and operations performed in a private day surgery or hospital setting were more likely to have an intact rotator cuff repair at 6 months. The AUC of this curve was 0.84 (95% CI = 0.80 to 0.87), which indicates that this combination of factors can accurately predict 84% of retears. Reduced range of motion at 6 weeks was associated with improved repair integrity for patients with tears of >1 to 6 cm2; however, this effect was less pronounced in tears of ≤1 cm2 or >6 cm2. Conclusions: Early postoperative stiffness following arthroscopic single-row, inverted-mattress rotator cuff repair at 6 weeks was associated with an intact repair at 6 months. The protective effects of postoperative stiffness and tear size were additive. The chance of retear in patients with a tear of ≤1 cm2 and external rotation of ≤27° at 6 weeks was 1%, while those with tears of >6 cm2 and external rotation of >27° had a 40% chance. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background Hospitalisation provides an opportunity for medication review and deprescribing. Patient-reported experience measures (PREM) for deprescribing in older patients in hospital are not well described. Aims To pilot test and describe PREM for deprescribing in older patients, compare PREM by patient characteristics and investigate patients' awareness of medication changes on hospital discharge. Methods This prospective, multicentre, observational cohort study at two tertiary hospitals in Sydney, Australia, evaluated the PREM questionnaire developed by the NSW Therapeutic Advisory Group. It was completed by patients (or their next of kin) recruited from acute geriatric medicine and orthogeriatric services. Association with nine patient characteristics was analysed using the Chi-squared test and multivariable regression. Awareness of medication changes and test-retest reliability were analysed using descriptive statistics. Results Overall, 201 participants completed the questionnaire, with 170 eligible for analysis; 34 (20%) of 170 were aware of reduction or cessation of their usual medications on discharge and reported involvement in decision-making and receiving enough information to reduce or stop one or more of their usual medications (positive PREM). Independent predictors of positive PREM included respondent (next of kin), hospital (Hospital 1), language (English) and specialty (acute geriatric medicine). Overall, 92 (59.4%) of 155 patients with medication changes were aware of those changes on hospital discharge. Conclusions These PREM are a feasible tool to examine older patients' experiences of deprescribing in hospital and might be applied to evaluate interventions to improve awareness, shared decision-making and provision of information when deprescribing for older patients.

Modular construction has attracted increasing attention due to its energy and environmental benefits. Digital technologies such as building information modelling (BIM) have also been explored to generate and manage data through the lifecycle of buildings. Although research has been performed in the area of integrating BIM and modular construction, BIM-based automated lifecycle assessment (LCA) of prefabricated buildings remains unexplored. This study therefore aims to develop a BIM-based LCA method for prefabricated buildings incorporating different assessment levels with unique system boundaries and functional units. The developed approach can support automated assessments through all lifecycle phases of a prefabricated building. It is achieved through an automated process of creating parameters to merge LCA data into the building model, systematic zoning, model setup and impact estimation. This approach is applied to evaluate the energy and environmental performances of a case building in Hong Kong. The case study validated the efficiency of the developed BIM-based LCA method in providing a systematic and detailed assessment of modularly designed buildings. This study extends the knowledge in automated BIM-based LCA by addressing specific characteristics of prefabrication and promotes the incorporation of comprehensive and detailed LCA data into BIM models for improved design robustness and holistic performances of buildings. This validated approach will enhance the willingness of designers to apply LCA during the design stages for minimizing the energy and environmental impacts of both new and renovated buildings with prefabrication.

Smart cities are spurred by rapid development of Information and Communication Technologies (ICTs). Cost justification has been a challenging but essential decision-making aspect for smart city projects. Whilst market costs are measurable, non-market costs are often obscure and even intangible. The adverse effects on individuals arising from ICT services are usually underestimated due to the exclusion of intangible elements. This study is devoted to the non-market costs of ICT to users (i.e. Privacy leak, Cyber-attack, Non-availability, and Impediment) and non-users (due to Digital divide) in smart cities. Contingent Valuation is conducted on representative ICT services in Hong Kong which is an emerging smart city. Ordinal regression is adopted to calculate Willingness-to-Pay (WTP) for avoiding detriments as the proxy of non-market cost. The results indicate that the WTPs increase with data input needs. Information overload is remarkable in smart cities. Age is identified as a significant determinant through a discussion of influential factors of WTP. The impacts of Age on digital divide are studied with further insights through supplementary interviews. The estimated non-market costs should be incorporated into the Cost-Benefit Analysis of smart city projects for decision-making. Accordingly, policy recommendations on ICT use and security are provided for smart city managers.

Smart cities are aimed at improving citizens’ life quality. However, they also bring unintended pitfalls of information insecurity, and these have not been studied sufficiently in an empirical way. System reliability as one of the quality attributes of information security, was investigated within the context of smart parking information system due to its close relevance with the ongoing smart city development globally. Through fuzzy fault tree analysis with the aid of structured interviews, it was found that a failure in a central system server may be caused by malicious attacks, human errors, and hardware and software failures. Survey results showed that improving firewalls and renewing recovery plans are necessary to defend against rampant malicious attacks; human errors as a non-technological factor may be reduced by well-planned training programs besides good operational governance and a timely recovery plan. Although system downtime is unavoidable, it can be reduced by proactive solutions including data backup and the provision of redundant servers and power supplies. All in all, an integrated approach is needed to mitigate against system unreliability.