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The study explores the unaddressed washback on the English-speaking test of the Hong Kong Diploma of Secondary Education Examination (HKDSE-English Language Paper 4). The HKDSE is a university entrance exam in Hong Kong which includes a group discussion speaking test known as English Language Paper 4. To identify ongoing washback effects, including sociocultural perspectives, the study analyses ongoing student washback of test-specific and non-specific preparation and how the mediating factors affect these preparations. One-hundred and ninety-nine secondary 4th to 6th grade students provided the questionnaire data in two rounds. Results from exploratory factor analysis indicate six major types of test preparation, which are categorised as two test specific, three non-specific, and one integrated type of preparation. Mediating factors comprise five categories of learner characteristics and stakeholders in and out of school. The cluster analyses identified four students' groups intertwined with the involvement of washback and the mediating factors. A strong relationship between extrinsic factors and explicit learning and intrinsic factors and implicit learning was found. The study concludes that students' washback is affected by mediating factors aside from the test; learning method choice by students (e.g. learning from entertainment content) has a strong relationship with specific mediating factors (e.g. interest in English).

The author introduces Hong Kong-based paper-tearing artist Sing Man Lee. Lee's paper-tearing art offers a lens for learning about traditional Chinese cultures as well as contemporary life in China. This instructional resource can serve as part of a multicultural art education curriculum, enriching students' art experiences by connecting their lives to various global cultures and societies. Through engagement in a multicultural art curriculum, teachers and students can work to decrease cultural stereotypes and myths about unfamiliar cultures.

This paper investigates whether paper and video triggers stimulate different social and cognitive processes during PBL. The study focused on how medical students identified and described problems, and how they built shared cognitions that lead them to diagnose and solve problems. The results showed that students who used video triggers put more effort into communicating their understanding of the problem and relevant knowledge than students who used paper triggers. The findings contribute to discussions on how to evaluate the effectiveness of different PBL triggers in order to better integrate them into the curriculum.

Waste paper disposed in landfills notably contributes to greenhouse gas (GHG) emissions and impedes more sustainable, circular alternatives, such as recycling. In Hong Kong, this unsustainable approach is currently dominant as 68% of waste paper products are treated in landfills in 2020. To contextualize the impact of local waste paper management and explore mitigation potentials of circular alternatives, this paper develops a quantitative assessment framework around GHG emissions development trajectories. Combining guidelines of the Intergovernmental Panel on Climate Change (IPCC), national GHG inventories, and local parameters from life cycle analysis, five GHG emissions projections were simulated along the Shared Socioeconomic Pathways (SSPs) until 2060. Most recent baselines indicate that Hong Kong's current waste paper treatment generated 638,360 tons CO 2 -eq in 2020, comprising 1,821,040 tons CO 2 -eq from landfill and 671,320 tons CO 2 -eq from recycling, and -1,854,000 tons CO 2 -eq from primary material replacement. Proceeding along a Business-as-Usual scenario under SSP5, GHG emissions will dramatically increase to a net 1,072,270 tons CO 2 -eq by 2060, whereas a recycling-intensive scenario will lead to a net saving of -4,323,190 tons CO 2 -eq. To complement the quantitative evidence on the benefits of waste paper recycling, field research was conducted to explore the feasibility of circular policy innovation from the perspective of recycling stakeholders. These empirical qualitative and quantitative findings from stakeholders' business routines and material transactions provide crucial indications for policy and institutional innovation: Essentially, for Hong Kong to improve waste paper recycling capacities and facilitate a circular economy (CE), local stakeholders require support via fiscal policy measures (financial subsidies or tax reductions) and infrastructure improvements (delivery access and material storage). In sum, this study employs a novel analytical framework combining original qualitative and quantitative evidence to provide policy innovation towards circular, GHG emission-saving waste paper management., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Competing Interests: All authors have disclosed no conflicts of interest.

How university students write from sources has been an issue of long-standing interest among researchers of advanced academic literacy. Previous research in this regard in the context of L2 writing has tended to focus on novices' textual borrowing; less attention has been given to exploring the potential light that theories from other intellectual domains may shed upon students' process of source-based academic writing. The study to be reported in this paper used activity theory as an analytic tool to examine three ESL students' activities of fulfilling a policy paper assignment at a university in Hong Kong. In the paper I present a description of the activity system concerned and its internal contradictions, characterize the sequences of actions that constituted the individual students' activities, and analyze the students' source-use practices in terms of their efforts to address a set of source-bound systemic tensions. At the end of the paper I propose a few lines of future explorations using activity theory as a heuristic to study literacy activities in academic contexts. (Contains 3 tables and 4 figures.)

Feedback processes are crucial in doctoral supervision but require adaptation to meet the changing nature of the doctorate, and increasing impetus to publish during the candidature. This study builds on concepts of authentic feedback and feedback literacy to chart possibilities for the development of feedback socialization in doctoral education. Semi-structured interviews with twenty doctoral supervisors in a faculty of education in Hong Kong aimed to investigate their understandings of feedback, its enactment within the doctoral process, and broader feedback inputs beyond the supervisor. Data were analyzed through reflexive thematic analysis and trustworthiness was enhanced through a member checking focus group with a sub-set of four of the interviewees. The analysis is informed by sociocultural theory with emphasis on co-construction of insights between supervisors and doctoral students. The findings highlight supervisors' understandings of feedback as comments, interaction and follow-up; and authentic feedback generated from presenting at conferences or submitting to journals. A contribution of the paper lies in bringing to bear conceptual insights from feedback research in undergraduate education to inform feedback in doctoral supervision. We deploy the concept of authentic feedback, practices that resemble those of the relevant workplace, to demonstrate how journal peer review facilitates the socialization of doctoral students into academic publishing norms. Key supervisor roles lie in guiding the enactment of responses to peer review, and supporting the development of resilience. Proposed features of supervisors' feedback literacy include sociocultural-based dialogue and co-construction, emphasis on the enactment of feedback and working with authentic feedback of different forms.

This article details an investigation into the onscreen marking (OSM) of Liberal Studies (LS) in Hong Kong--where paper-based marking (PBM) of public examinations is being phased out and wholly superseded by OSM. The study involved 14 markers who had previously rated Liberal Studies scripts on screen in the 2009 Hong Kong Advanced Level examination. In the study, the 14 markers re-marked, on paper, a number of the scripts they had marked on screen in the 2009 examination. Using multi-faceted Rasch analysis, a five-faceted design was employed, modeling markers, test takers, input questions, rating scales, and the marking medium. Results showed that all factors generally exhibited good data fit. With the major facet for investigation being the method of marking, logit values centred at zero emerged. The hypothesis that the method of marking does not intrude on scores awarded to test takers when scripts are marked on screen or on paper was therefore accepted. Since all public examinations in Hong Kong will be marked solely on screen in 2012, it is vital for professional and public confidence that the scores returned from the OSM marking system can be considered as reliable as those obtained from paper-based marking. Results from the current study suggest that this is so. Given that many countries and jurisdictions globally are considering the implementation of OSM technology--albeit not in the all-embracing manner of Hong Kong--the current study provides further validation for the worldwide adoption of such technology. (Contains 3 footnotes, 6 tables, and 1 figure.)

This paper describes a study comparing paper-based marking (PBM) and onscreen marking (OSM) in Hong Kong utilising English language essay scripts drawn from the live 2007 Hong Kong Certificate of Education Examination (HKCEE) Year 11 English Language Writing Paper. In the study, 30 raters from the 2007 HKCEE Writing Paper marked on paper 100 scripts that they had marked on screen 9 months previously. Subsequent to the rating, they completed a questionnaire, from which it was concluded that, technologically, raters had no problems with OSM. Statistical results indicated no bias favouring either form of rating. Attitudinal differences surfaced, however, between new raters who had solely rated on screen as against veteran raters, whose previous rating experiences had only been with paper-based rating. The paper concludes with the prediction that as OSM becomes more prevalent, it will be accepted as the norm, with prejudice about fairness or convenience gradually fading. (Contains 7 tables and 3 notes.)

This paper describes an English language listening test intended as computer-based testing material for secondary school students in Hong Kong, where considerable attention is being invested in online and computer-based testing. As well as providing a school-based testing facility, the study aims to contribute to the knowledge base regarding the efficacy and reliability of computer-based testing. The paper describes the construction of an item bank of over 400 short listening items calibrated on item response theory principles. Items from this bank were used to form a traditional paper-based listening test, and an adaptive computer-based test. Both forms of the test were administered to two Hong Kong Grade 11 and Grade 12 classes. Descriptive test statistics indicated that both test types discriminated effectively between school grades. In terms of comparability between test types, there was significant difference between the Grade 11 classes' performance although not with that of Grade 12. Test takers generally performed better on the computer-based test than on the paper-based test, confirming earlier research. Interviews with test takers after taking both tests indicated an even split in terms of preference, with boys opting for the computer-based test and girls the paper-based test. Correlations between test takers' performance on the two test types were high enough to indicate the computer-based test's potential as a low-stakes test (its intended purpose as a school-based testing facility), although not as a high-stakes test (for example, as a territory-wide test replacing a traditional paper-based test).

Collecting feedback from students through course, program and other evaluation questionnaires has become a costly and time consuming process for most colleges. Converting to data collection through the internet, rather than completion on paper, can result in a cheaper and more efficient process. This article examines several research questions which need to be answered to establish that results collected by the two modes of administration are equivalent. Data were gathered for a program evaluation questionnaire from undergraduate students at a university in Hong Kong. Students were able to choose between completion on paper or through the internet. In six of the seven Faculties the number of responses through each mode was roughly the same. Students in the Engineering Faculty favored the internet. Scores on the 14 out of 18 scales in the instrument showed small differences by mode of response, which became smaller still with controls for pertinent demographic variables. The main response question addressed in the study was whether there was any difference in the way respondents to the two modes interpreted the questions. The study demonstrated the equivalence of the two data sets by showing that both could be fitted to a common model with structural equation modeling (SEM). Five levels of tests of invariance further confirmed the comparability of data by mode of administration. This study, therefore suggests that changing to internet collection for course and program evaluations will not affect the comparability of ratings.

Introduction: Diabetes mellitus (DM) is a major non-communicable disease with an increasing prevalence. Undiagnosed DM is not uncommon and can lead to severe complications and mortality. Identifying high-risk individuals at an earlier disease stage, that is, pre-diabetes (pre-DM), is crucial in delaying progression. Existing risk models mainly rely on non-modifiable factors to predict only the DM risk, and few apply to Chinese people. This study aims to develop and validate a risk prediction function that incorporates modifiable lifestyle factors to detect DM and pre-DM in Chinese adults in primary care., Methods and Analysis: A cross-sectional study to develop DM/Pre-DM risk prediction functions using data from the Hong Kong's Population Health Survey (PHS) 2014/2015 and a 12-month prospective study to validate the functions in case finding of individuals with DM/pre-DM. Data of 1857 Chinese adults without self-reported DM/Pre-DM will be extracted from the PHS 2014/2015 to develop DM/Pre-DM risk models using logistic regression and machine learning methods. 1014 Chinese adults without a known history of DM/Pre-DM will be recruited from public and private primary care clinics in Hong Kong. They will complete a questionnaire on relevant risk factors and blood tests on Oral Glucose Tolerance Test (OGTT) and haemoglobin A1C (HbA1c) on recruitment and, if the first blood test is negative, at 12 months. A positive case is DM/pre-DM defined by OGTT or HbA1c in any blood test. Area under receiver operating characteristic curve, sensitivity, specificity, positive predictive value and negative predictive value of the models in detecting DM/pre-DM will be calculated., Ethics and Dissemination: Ethics approval has been received from The University of Hong Kong/Hong Kong Hospital Authority Hong Kong West Cluster (UW19-831) and Hong Kong Hospital Authority Kowloon Central/Kowloon East Cluster (REC(KC/KE)-21-0042/ER-3). The study results will be submitted for publication in a peer-reviewed journal., Trial Registration Number: US ClinicalTrial.gov: NCT04881383; HKU clinical trials registry: HKUCTR-2808; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Managing chronic musculoskeletal problems usually focuses on pain control using medications, but outcomes are often unsatisfactory and sometimes harmful. Information on a patient's health-related quality of life (HRQOL) may trigger a doctor to tailor management improving quality of life. The aim of this trial is to find out whether routine measurement and reporting of a patient's EuroQoL 5-Dimension 5-Level (EQ-5D-5L) HRQOL data using an electronic platform can improve HRQOL and pain in patients with chronic knee or back problems in primary care. We will also assess the acceptability of routine electronic measurements and reporting of the EQ-5D-5L in primary care settings., Methods: This is a multicentre, prospective, cluster randomised controlled trial set in six public primary care clinics in Hong Kong. At the intervention clinics, subjects will complete an electronic EQ-5D-5L form at recruitment and at each clinic follow-up over 12 months. A report of the patient's longitudinal EQ-5D-5L data will be provided to the doctor. Subjects in the control clinics will receive care as usual. All subjects will complete the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), a 10-point Pain Rating Scale and a structured questionnaire to collect sociodemographic information and data on morbidity and service utilisation at recruitment at baseline, 3, 6 and 12 months. Primary outcome is the change in WOMAC total score. Secondary outcomes are change in pain, other patient-reported outcome scores and doctor-rated severity of disease. Group differences in the changes in WOMAC and other outcome scores over time will be analysed using generalised estimating equation model with an intention-to-treat principle., Ethics and Dissemination: Ethics approval has been obtained from The University of Hong Kong/Hospital Authority Hong Kong West Cluster (IRB reference number: UW 18-270). The results of the trial will be submitted for publication in a peer-reviewed journal., Trial Registration Number: NCT03609762., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: Using an integrated model of health literacy, we discuss the importance of health literacy among foreign domestic workers in the provision of informal caregiving during outbreaks of communicable diseases. COVID-19 pandemic is used as an example., Background: Adequate health literacy in the population is known to be important for the prevention of communicable diseases. Foreign domestic workers, a group of marginalised caregivers in private households, are generally presumed to have limited health literacy because of numerous socio-cultural disadvantages. To date, there is limited evidence that these informal healthcare providers receive support from community-based nurses., Design: A discursive paper., Conclusion: Foreign domestic workers, with varying levels of health literacy, may be viewed either as a resource to break the chain of infection or as a potential reservoir of communicable diseases in the community. Meanwhile, restrictions imposed in response to diseases transmissions (e.g. stay-at-home measures for COVID-19) may directly exacerbate the social support received by these foreign domestic works and their ability to access health-related information. There are also concerns about their ability to appraise and evaluate information related to communicable diseases at a time when fake news and misinformation are being disseminated through social media. Language and cultural barriers are important issues that need to be addressed to ensure that foreign domestic workers are in a position to follow public health recommendations., Relevance to Clinical Practice: Nurses hold an important position in empowering foreign domestic workers with adequate health literacy, by engaging groups of foreign domestic workers in the community and their consulates in planning educational programmes and effectively disseminating information. At a time of global pandemic, an assessment of the health literacy levels of foreign domestic workers in places like Hong Kong is urgently required., (© 2020 John Wiley & Sons Ltd.)