CONTENTS COVER STORY The Pressure Paradox Pros and Cons of Work Stress Let It Go Surviving the Pressures of Childhood Help Is at Hand RESEARCH AbundANTS HKU Scientists Discover Deafness Master Genes China’s Pollution Successes Less Pain, More Gain An Historian Who Looks to the Future Golden Oldies The Distance between Us TEACHING AND LEARNING Virtual Visibility Serious Gaming Students as Partners Changing Old Attitudes A Garden Grows at HKU KNOWLEDGE EXCHANGE Spotting Abnormalities, Saving Lives Voyage of Discovery Oral Surgeons Bring AI Tool to Nigeria Connecting through Campusland Living with Loss Cutting-Edge Choral PEOPLE Landing in the Sweet Spot Levelling up Breaking down Barriers HKU’s New Head of Data Science BOOKS Modern Families in Turbulent China ARTS AND CULTURE Music, Maestro, Please! 02 04 06 08 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 The Pressure Paradox Stress can motivate us to action, but it can also have a negative impact on our well-being. Factor in COVID-19, geopolitical events and the constant presence of technology – on top of personal issues – and it seems increasingly difficult to find peace of mind. HKU scholars have been exploring the positive and negative effects of stress in the workplace, in childhood and in reaction to external events like pandemics, while also identifying ways to build resilience to withstand the pressures of 21st-century life. 12 AbundANTS A Garden Grows at HKU Music, Maestro, Please! China’s Pollution Successes Less Pain, More Gain Spotting Abnormalities, Saving Lives Voyage of Discovery 34 58 16 18 02 36 38
Stress can motivate us to action, but it can also have a negative impact on our well-being. Factor in COVID-19, geopolitical events and the constant presence of technology – on top of personal issues – and it seems increasingly difficult to find peace of mind. HKU scholars have been exploring the positive and negative effects of stress in the workplace, in childhood and in reaction to external events like pandemics, while also identifying ways to build resilience to withstand the pressures of 21st-century life. The Paradox Pressure 02 The University of Hong Kong Bulletin | May 2023 COVER STORY 03
If you think anxiety is a bad thing, consider deadlines. They often induce anxiety yet they also motivate people to complete tasks. To Dr Bonnie Hayden Cheng of the Faculty of Business and Economics, they are an example of the positive potential of anxiety. Dr Cheng has constructed a theory of workplace anxiety that breaks down how anxiety can be managed to positive ends. She has also worked with industry partners to put into practice the ideas that have emerged from her research. “Most research on workplace anxiety is about how it hurts your performance. I wanted to approach it from a positive angle because anxiety can also make you more vigilant and laser-focussed,” she said. Her theory explains how normal ranges of anxiety experienced at work, which can fluctuate from low to high but not tip into clinical concern, can manifest. Some people are anxious by nature (the trait condition), while others become anxious when faced with stressful situations such as doing a presentation or interview (the state condition). “In the state condition, if you have an interview and you’re feeling anxious and your mind is constantly running, you have less cognitive resources to devote to the task at hand. Over the long term, if we accumulate that into trait levels, it becomes exhaustion. That’s a key element of burnout,” she said. Stopping the cycle But if people can learn how to effectively regulate their emotions, their thinking and their behaviours, they can view their anxiety as a motivator to get focussed on their task – “getting really comfortable with your anxiety by naming it and taming it,” she said. Dr Cheng is working on new research showing how this can play out in proactive behaviours in which employees go beyond their job requirements, such as re-arranging workloads or their immediate environments to enhance productivity. Those who see their anxiety as a positive challenge rather than a barrier are more likely to be proactive. The question then arises: how can people and companies cultivate this state? Dr Cheng is examining one particular strategy around how mindfulness can relieve anxiety, which is anticipatory and often irrational. “Mindfulness can help people be more focussed on the present. It’s not about stopping thoughts entirely, but being aware of them without judgement. Focussing on the here and now creates space for self-acceptance, and that brings anxiety relief,” she said. One of the ironies is that the people most in need of anxiety relief are the least likely to pursue it, she said. They are overworked and overwhelmed, and rather than recover from stress, they work overtime, think about work all the time and lose sleep over it, feeding an unhealthy cycle. “What we really need to do when we are under stress is consciously step back and say, no, this is not conducive to my recovery,” she said. Take a micro-break The literature supports the idea that taking a break is beneficial to both wellbeing and job performance – especially frequent breaks. Waiting for a holiday Research on anxiety has only recently focussed on the workplace. One of the instigators behind this is Dr Bonnie Hayden Cheng, who looks at the ‘bright and dark’ sides of anxiety at work, which can motivate us to get more done but also feed into worry or negative rumination that undermines productivity. PROS AND CONS OF WORK STRESS or the weekend or even the evening probably will not be enough to stop the rumination. “New research has been looking at micro-breaks that you can take during the day. You can set alarms to prompt you to walk away from your desk every hour or so, or to get up and stretch and detach for a moment. Pursuing activities you enjoy outside work is also useful because it can separate you from thoughts of work,” she said. Dr Cheng’s research is based on multiple studies within companies that use self-reported feedback on stress recovery over time, as well as reports by colleagues and supervisors on stress indicators and performance. She also gives workshops to companies on topics related to her research, to ensure the findings benefit those who most need it. Recently, she has focussed on how to cultivate ‘servant leadership’, which means leading from behind and putting people first. This circles back to her research on stress. “Change starts from the top. We can teach employees how to relieve their anxiety all we want, but at the end of the day, if they’re working in toxic cultures, there’s only so much you can do before that’s not going to work,” she said. Most research on workplace anxiety is about how it hurts your performance. I wanted to approach it from a positive angle because anxiety can also make you more vigilant and laser-focussed. DR BONNIE HAYDEN CHENG 04 05 The University of Hong Kong Bulletin | May 2023 COVER STORY
“Previous research had identified depressive rumination as a sort of selective focus on repetitive negative thoughts surrounding one’s distress that prevents you from updating the contents in your awareness,” Professor Chen said. “We have broadened this idea to accommodate our observation that a relatively strong influence of external events can also trigger such fixated, repetitive thoughts.” Smartphones don’t help These loops of thoughts can be worsened by smartphone use. Professor Chen and his team found links between smartphone overuse and poorer mental health among youths. Their latest research further showed that higher levels of smartphone overuse are also associated with eventbased rumination but not depressive rumination, suggesting the intake of information via smartphones may keep one fixated even more on negative events beyond one’s control. “When we feel distressed, it is now common for us to try to seek comfort or an outlet through information or activities via our smartphones. But often, negative and sometimes exaggerated news will come up, which may form another ‘external’ technological loop of rumination that further aggravates mental health problems,” he said. Rumination’s role in suicide – specifically, rumination about suicide – was also investigated in youths between 2019 and 2022. That epidemiological study also sought to examine the roles of other factors such as hopelessness, family functioning, cognitive functioning, and COVID-19 on suicidal ideations, plans and attempts. “We found each of those factors was related either to suicidal ideation or plan, Professor Eric Chen Yu-hai, Chi-Li Pao Foundation Professor in Psychiatry, and Research Officer Dr Stephanie Wong Ming-yin identified this phenomenon in a study involving over 10,000 people who participated in a large-scale online survey conducted in the wake of the 2019 social events in Hong Kong and the COVID-19 pandemic. Over half reported frequent rumination on these events to the extent their thoughts disrupted their tasks at hand. Such ‘event-based’ rumination was also associated with higher levels of depressive and post-traumatic stress disorder symptoms. Rumination, in which one’s thoughts are stuck in a loop on one subject, can at times be useful in helping us concentrate and solve problems. But living too much in one’s mind is by no means healthy. Scientists have known for decades that ‘inward-focussed’ rumination is linked to depression and other psychiatric disorders. There is now evidence that the mental health of people who ruminate excessively on events impacting the whole population can also be affected. and COVID-19 stressors were related to suicide attempt; but importantly, suiciderelated rumination was the only factor associated with all three outcomes,” Dr Wong said. “This gave more support towards the transdiagnostic nature of rumination and the need to look at rumination beyond the depressive type.” The team has also looked at how rumination may be disrupted before it becomes harmful. Normally, our thoughts flow spontaneously from one to another, but ruminators become stuck in one place. This often happens imperceptibly, so it is important to use methods that penetrate daily life, Professor Chen said. Their data showed that event-based rumination often involves anger and a sense of injustice, which can further perpetuate the feelings of frustration and cycles of rumination. It is important to support people in being aware of their rumination processes, realising that the problems could not be solved merely by fixating on these thoughts, and exploring whether there could be alternative perspectives, he said. Need for intervention Professor Chen further noted that rumination can also induce changes in the brain and those with higher levels of rumination may require more intensive interventions. Evidence has shown the positive impact of exercise-based intervention on the brain, which may be a promising future direction. Bringing these two ideas together, Dr Wong is studying the effectiveness of smartphone-based ‘ecological momentary intervention’ – providing prompts in everyday life to engage a person in simple in-the-moment interventions designed by the team that engage both body and mind, such as guided finger-tapping. “It may sound a little contradictory to use smartphones but we’re very aware that complete abstinence from smartphone use is not possible – and probably also not ideal – in today’s world. So we are looking at how to utilise it optimally as a mode of intervention to help reduce rumination and improve mental health of the population more generally,” she said. Professor Chen added: “We do need to develop new habits of using the smartphone healthily in terms of having more control over the device rather than being at the mercy of whatever information comes up. This would be important in understanding mental health and future intervention strategies in many societies.” Previous research had identified depressive rumination as a sort of selective focus on repetitive negative thoughts surrounding one’s distress that prevents you from updating the contents in your awareness. We have broadened this idea to accommodate our observation that a relatively strong influence of external events can also trigger such fixated, repetitive thoughts. PROFESSOR ERIC CHEN YU-HAI Ruminating excessively on the negative aspects of your life or condition is a well-known feature of depression. But research from the Department of Psychiatry has found that ruminating about external stressors, such as COVID-19 and other societal events, can also tip people into an unhealthy state of mind. LET ITGO 06 07 The University of Hong Kong Bulletin | May 2023 COVER STORY
In 2015, the first International Survey of Children’s Well-Being was published by Children’s Worlds and it immediately caught the attention of Dr Lee Juyeon. The pilot study surveyed 10- and 12-year-olds in 15 countries across five continents. The country where children reported the lowest life satisfaction? Dr Lee’s homeland of South Korea, sitting well behind such nations as Ethiopia, Nepal and South Africa that have more troubles and lower income levels. “Korean children have consistently low subjective well-being indicators, like happiness, self-satisfaction and positive affects. I wanted to find out the reasons behind this result,” said Dr Lee. She and her collaborators zeroed in on the highly competitive academic environment as an aggravator but decided to study the bigger picture beyond academic demands, by focussing on the moderating role of parents and teachers in students’ stress levels. They found that the more children perceived they were being treated unfairly – such as being subjected to unrealistic expectations – the more unhappy they became. “Our findings suggest that the fairness of significant adults in childhood years could be a buffer to the negative effects of academic stress on their subjective well-being,” she said. The study is part of a body of work by Dr Lee that looks at factors affecting childhood well-being and how these can be addressed by building up children’s capacity and improving their social environments. Negative body image Following on from the academic stress study, she also studied body image satisfaction among Korean children. She found that if children perceived themselves as being overweight – even when they were not – their well-being was affected. Moreover, girls who perceived themselves as underweight had a boost to well-being, unlike boys whose happiness levels were negatively affected. “For children in early adolescence, body image perception is really important for their self-esteem and self-satisfaction, and ultimately for their mental health. But this perception is also influenced by society’s ideals or expectations, which are different for each gender,” she said. “Mental health in childhood and adolescence is important for adult life, not necessarily in a linear or determinant way, but because it is the time when children start to develop their identity and self-perception and think about who they are as a member of society.” The importance of children’s well-being is recognised not only by the Children’s Worlds studies (subsequent surveys have been held, including in 2016–2019 for 35 countries and regions; South Korea placed 29th for overall well-being and Hong Kong 34th, just ahead of Vietnam), but also by the Organisation for Economic Co-operation and Development (OECD). The latter organises the Programme for International Student Assessment, which surveys the academic abilities of 15-year-olds across dozens of countries every three years and recently launched a new international survey on students’ social and emotional skills. Stress management for children “Social and emotional competence encompasses different domains such as self-regulation, emotion and stress management, and social and communication skills. Brain science and other research supports the idea that this competence is malleable, SURVIVING THE PRESSURES OF CHILDHOOD Academic demands, unfair treatment by parents and teachers, and negative body images can contribute to stress and poor mental health in childhood. Dr Lee Juyeon of the Department of Social Work and Social Administration has examined the impact of these factors on Korean children and is exploring how child well-being can be cultivated. especially throughout the school years, and can be cultivated with effective interventions,” Dr Lee said. “Stress and emotional management on the individual level is an important part of this but so are things like anti-bullying initiatives and making more inclusive, pro-social environments in schools, which circles back to my previous findings on fairness.” Dr Lee has analysed one intervention called Toolbox, which is popular in northern California. Its premise is that even young children have the tools within themselves to manage their emotions and stress, such as using breathing or going to a quiet place on their own to calm down, and to build positive relationships, such as remembering to thank people and apologise for mistakes. Dr Lee and her team studied four elementary schools that adopted Toolbox and compared them with two non-intervention schools of similar demographics. Using teacher assessments of students throughout the year, they found teachers in the intervention group reported greater social and emotional competence among their students, such as managing strong emotions, being kind to others and persisting when they encountered difficulties. “The academic stress and body shape studies show that societal environments can affect children’s stress and wellbeing. But children can also learn how to manage their stress and live more fulfilling lives if there is effective intervention through social and emotional learning [SEL],” she said. Dr Lee is now studying the OECD data to understand cultural differences in social and emotional competence in Western and Asian children, and ultimately hopes to implement SEL initiatives in Asia that are effective, sustainable and equity-enhancing. Mental health in childhood and adolescence is important for adult life, not necessarily in a linear or determinant way, but because it is the time when children start to develop their identity and self-perception and think about who they are as a member of society. DR LEE JUYEON 08 09 The University of Hong Kong Bulletin | May 2023 COVER STORY
societies and other times, especially during hardships and calamities. “Before the advent of psychiatry and psychology, there were tools and resources in the community that people used, knowingly or inadvertently, to support themselves through hardship,” he said. Many of these tools are well known to researchers – diet, exercise, relationships, sleep, exposure to nature and finding meaning in life. Dr Chan has compiled them into a six-facet framework, the Health Hexagon Model, to guide his own research and hopefully guide others in their daily lives. “For some reason, the idea of lifestyle medicine has not gained much traction. Maybe in part because these things by and large cannot be commodified. But they have sustained civilisations and we should not neglect them to the point that we get sick and need professional help,” he said. The benefits of exercise, sleep and constructive relationships to mental health have been extensively researched and reported. Dr Chan has also been exploring the role of diet, not so much in terms of intake but when and how people with the COVID-19 situation – insufficient resources and people overwhelmed. Both situations forced people to get on with looking after themselves and each other. “One thing that became very clear to me during the pandemic is that you can’t always rely on having access to professional support. If we use that perspective to understand the mental health crisis, there’s a lot to be learned,” he said. One takeaway is that professional mental health resources are essential but will never be sufficient to meet all needs. Another is that awareness can lead to hypersensitivity about one’s condition. “During the pandemic, if you started coughing or had a fever, the first thing you would think is, do I have COVID? This is also true in mental health. When people feel down or anxious, very quickly they wonder if they are mentally unwell. This reflects on one hand a destigmatisation of mental health, which is a good thing. But it can also lead to over self-diagnosis or worse, with increasing demand flooding the existing medical system,” he said. “The question is, how do we educate people to have a certain level of awareness without overwhelming the system?” Lifestyle medicine That inspired Dr Chan to think about how mental health has been handled in other The COVID-19 pandemic was a stressful time for everyone. The World Health Organization estimates depression and anxiety increased 25 per cent globally during its first year alone. In Hong Kong, as hospitals became overwhelmed, people were asked to stay home unless their symptoms were severe. And therein, Dr Christian Shaunlyn Chan of the Department of Psychology saw a lesson. Dr Chan had worked previously on disaster relief in the Philippines following destructive typhoons. He saw parallels eat and with whom. In an outreach exercise, he organised a film screening and discussions for Kerry Group staff during the 2019 social movement that focussed on the role family meals can play in bridging differences and mending divisions. He has also done work on the mental health benefits of exposure to nature. One published study looked at the effects of mandatory hotel quarantine during COVID-19 and found perceived stress was somewhat mitigated by having a view of nature out the window versus a city view. Another published study used virtual reality to increase enjoyment of nature among people who did not like to spend time outdoors. Creating a safety net Dr Chan is also interested in the idea of ‘sacredness’ in people’s lives, such as having special days or events that are protected from everyday concerns. There is less and less of this in Hong Kong, he notes, as people deem it acceptable to miss important days, such as a grandparent’s 90th birthday banquet, due to work. “What are the consequences when we chip away at the sense of sacredness so nothing remains sacred? This is an important question to be explored,” he said. His goal is not to eliminate stress or mental disorders but, as a community clinical psychologist, to find ways of helping people try to work through them before they think of turning to therapies or medicines. The approach is also more aligned with different cultural approaches where the mind and body are regarded as unified, rather than separate entities. “It’s quite unproductive to tell people that what they’re dealing with is psychological, it’s not physical. We need to take care of the person holistically and help them build routines and habits that weave a safety net for when hardship comes and they are stressed out,” he said. Poor mental health is a growing problem globally. Psychologist Dr Christian Shaunlyn Chan proposes a simple and accessible solution: go back to the basics to ease stress, improve well-being, and reduce the growing burden on health services. HELP IS One thing that became very clear to me during the pandemic is that you can’t always rely on having access to professional support. If we use that perspective to understand the mental health crisis, there’s a lot to be learned. DR CHRISTIAN SHAUNLYN CHAN Dr Chan has compiled diet, exercise, relationships, sleep, exposure to nature and finding meaning in life into a six-facet framework – the Health Hexagon Model. Dr Chan (first from left) organised a film screening and discussions in 2019, focussing on the role family meals can play in bridging differences and mending divisions. AT HAND 10 11 The University of Hong Kong Bulletin | May 2023 COVER STORY
language that they could read besides English (e.g. Chinese, French, German, Japanese, Spanish), which was possible thanks to the international nature of the team.” Over two years, they compiled data from nearly 500 different studies, enabling them to quantify the density of ants in various areas of the globe, and to estimate the total number of ants on Earth. “We compared the different biomes,” said Dr Guénard, “and expected rainforests to harbour particularly high abundance and biomass as we already know their importance for species richness – but the high numbers of ants encountered in savannahs and some other more arid areas were a surprise.” They also compared different habitat types and found that areas modified by humans, such as urban areas, have significantly lower abundance. “People don’t necessarily want ants around, but this means the environment degrades – as they are not fulfilling their usual roles in decomposition, pest control or soil enrichment – and ultimately we’ll have to pay to get the services that ants do for free. It’s crucial to recognise not only how many services ants provide but also the importance of their continued abundance to do so efficiently.” Sustaining other species “Ants bring massive value,” said Dr Guénard. “First, they are food for other organisms shaping the ecology and evolution of bird, herp or even some mammal species – therefore the more ants you have, the more other species can be sustained. Second, ants are major ecosystem engineers, modifying the soil structure and quality, acting as gardeners maintaining plant diversity and health. These processes are essential for plant growth and survival, supporting entire communities of animals and bacteria, and ultimately fostering healthy ecosystems. As they bring food underground, they further enrich soils – and the more ants, the more action, the more enrichment. “Third, decomposition – they play a vital role in ridding us of decomposing dead animals, burying them underground and thus limiting pathogenic spread. Fourth, predation [the preying of one animal on another] which results in control of herbivores, and that in turn increases plant productivity as they keep more leaves to do photosynthesis.” Dr Guénard hopes that the study findings will prompt further research, particularly into potential consequences should the ant population fall. “There are still many gaps in our knowledge – particularly geographical ones since there are parts of the world for which no data are available. Similarly, we still have very limited information on the abundance of ants underground or for those living in the tree canopy. Therefore, it is likely that 20 quadrillion ants is a conservative estimate. We hope that other people, including schools, could start working on this, as counting ants is something that most can do.” The findings have been published in the Proceedings of the National Academy of Sciences of the USA (PNAS), and relayed by media all over the world. “This helped us get our message across. As humans, we see things at a certain scale which differs from the vast majority of life, including groups like insects that are so important – not by their size but through what they do because of their abundance. Insect populations are in decline in many parts of the world and with it all the functions they fulfil. If those can’t be fulfilled then this may lead to consequential changes in ecosystems and for our own lifestyles.” Carebara is a genus of myrmicine ants mainly within the tropical regions of Africa and Asia. (Courtesy of François Brassard) On a daily basis, we tend not to pay these tiny creatures much heed but ants play a vital role across ecosystems and regions, and the Insect Biodiversity and Biogeography Laboratory (IBBL) within the School of Biological Sciences recently initiated a global census to find out just how abundant they are. The answer? At least 20 quadrillion ants inhabit the planet and, in terms of biomass, all the ants on Earth weigh more than all the wild birds and mammals combined, or about 20 per cent of human biomass. “The number has massive implications because of the significance of ants as crucial players in our environment, with multiple important functions and countless interactions with all kinds of organisms worldwide,” said the study’s senior author Dr Benoit Guénard, head of the IBBL. Despite many estimates over the centuries, nobody has carried out this kind of census before. Asked the reason, Dr Guénard replied: “It was about the effort required to identify and compile decades of research into a single coherent database that would allow both ecological and global analyses.” In 2012, Dr Guénard began a database on ant abundance. “A substantial amount of data existed, scattered in scientific literature as many researchers already had this information. However, these kinds of data were treated mainly as a collateral product of the study being conducted. Here, we wanted these data to be the key focus and obtain something valuable about the global patterns of ant abundance.” The question of how to go about it remained. “I had a eureka moment about partitioning the world into different types of biomes (for example tropical rainforest/desert) to ultimately gain a global understanding of ant abundance and biomass. But could we get enough data to be able to compare biomes? To do so, the different laboratory members were responsible for searching literature within specific continents, based on the A first-of-its-kind census into the distribution of abundance and biomass of ants on Earth has yielded surprising results and underlined the massive role these tiny insects play in the earth’s well-being. The global ant census initiated by the School of Biological Sciences estimates that there are at least twenty quadrillion ants dominating global ecosystems. The ant highlighted above is Gesomyrmex howardi, a rarely known arboreal ant from the Oriental subtropics. (Courtesy of François Brassard) Abund ANTS The number has massive implications because of the significance of ants as crucial players in our environment, with multiple important functions and countless interactions with all kinds of organisms worldwide. DR BENOIT GUÉNARD 12 13 The University of Hong Kong Bulletin | May 2023 RESEARCH
master genes that may also be related to more common conditions. Consider that one in 10 people is expected to experience hearing loss by 2050, that about one-to-three newborns per 1,000 born are hearing impaired with half of those cases due to genetic causes, and that malfunction in the ionic composition in the endolymph is the most common cause of deafness. Problems associated with a swollen endolymphatic system include deafness, vertigo and tinnitus (ringing in the ear). “Our study reveals how the development of the normal ear is controlled and which genes are essential for the normal ear to be formed and for the correct composition of the endolymph. Since SOX9 and SOX10 are master genes controlling other genes, our study also provides a rich resource for discovering other candidate congenital deafness genes or identifying disease genes regulated by other SOXEgene factors,” Professor Cheah said. Ultimately, this can lead to new directions for developing treatments for hearing loss. Professor Cheah and her team published their findings in the Proceedings of the National Academy of Sciences, together with a list of all the genes they found to be affected by the SOX9 mutation to help other researchers identify additional deafness genes. Her research could even aid in the study of age-related hearing loss, which may be caused by variants in other genes in the pool, by less severe mutations in the master genes or by a combination of other genes controlled by SOX9 and SOX10. The findings will also be useful for the future development of transplantable stem cells and/ or artificial organs or tissues as regenerative medicine for hearing loss. But the identities of other master genes controlling the development of the endolymphatic system went largely undiscovered. Last year, however, Professor Cheah and her team reported two other master genes, SOX9 and SOX10, that play this role. The latter discovery was also unexpected and arose from her work on campomelic dysplasia (CD), a rare and severe genetic disorder caused by mutation in the gene SOX9 that affects the development of a baby’s airway, lungs, bones and reproductive organs. Few babies survive birth so she and her team developed mouse models to study how the mutation causes CD in humans. “Much to our surprise, we found that the mice were both deaf and had a vestibular problem,” she said. The vestibular Our senses of hearing and balance are determined by the inner ear, which has six organs made up of sensory hair cells and the endolymphatic system whose fluid carries sound, gravity and linear acceleration signals to the brain. Defects in any of these can affect our hearing and balance. Professor Kathryn Cheah, Chair Professor of Biochemistry and Jimmy and Emily Tang Professor in Molecular Genetics, has done groundbreaking work to pinpoint genetic causes for these defects. In 2005, while studying the development of the skeleton, she accidentally created a mouse model that was deaf and unable to balance. Her subsequent investigations led to the landmark discovery of a gene, SOX2, that controls the six sensing organs within the inner ear and is therefore a master gene essential for hearing. function enables a person to balance themselves in space and is controlled from the inner ear. When there is a disturbance there, the mice are deaf and unable to balance. Problem with fluid control Professor Cheah and her team isolated the cause of the CD deafness to a problem in their endolymphatic system, which was very swollen, suggesting a problem with fluid control. Further investigation through both biochemistry and genetic investigations, with collaborators from HKU, The Chinese University of Hong Kong, the Francis Crick Institute in London and the University of Iowa, showed that genes controlled by SOX9 were causing the defect of the endolymphatic system. “We discovered that SOX9 [of the same family as SOX2] is a master transcription factor that controls both how stem cells in the endolymphatic system develop and, at the molecular level, the expression of many genes that are important for producing the correct ionic composition in the endolymph fluid,” she said. “What is even more interesting is that among the genes affected by the mutation was SOX10, which is another transcription factor and a sister gene of SOX9 belonging to the SOXE family. The mice deficient in SOX10 also had a similar problem with the endolymphatic system, implicating it as another master factor. We showed that SOX9 and SOX10 work together to control the development of stem cells for the endolymphatic system in the inner ear.” Implications for common conditions The finding has implications beyond the case of CD. Rare diseases are by definition severe, making it simpler to identify HKU SCIENTISTS DISCOVER DEAFNESS MASTER GENES Two master genes related to congenital deafness have been uncovered by an international team of scientists led by Professor Kathryn Cheah. Our study reveals how the development of the normal ear is controlled and which genes are essential for the normal ear to be formed and for the correct composition of the endolymph. PROFESSOR KATHRYN CHEAH Cross section of the inner ear in a normal mouse, which can balance itself and stretch to reach the ground when falling. Swollen inner ear chambers are observed in SOX9 and SOX10 mutants which cannot balance themselves and are deaf. 14 15 The University of Hong Kong Bulletin | May 2023 RESEARCH
of Chicago [EPIC-China]), found definitive links between particulate matter (PM2.5) in the air and life expectancy. The team had compared data from north of the Huai River, where residents were receiving free or subsidised heating through coal-fired boilers, and south of the river where they were not. People north of the river had a reduction in lifespan of 3.1 years and a 37 per cent greater incidence of death from heart disease and stroke. The findings contributed to a change in government policy to use natural gas or electricity wherever possible instead of coal. Dr He then did follow-up studies which showed that China’s PM2.5 level had fallen more than 40 per cent by 2021 and that Until 10 years ago, China’s approach to environmental pollution was to place it a distant second in the rush to accelerate economic development. But growing evidence of the health impact motivated a change of tune. A ‘war on pollution’ was launched in 2013. As environmental economist Dr He Guojun has shown, that war has been a success, offering lessons for other countries trying to reduce their own pollution. Dr He has documented the impact of reducing pollution on both health and the environment. His first major study, conducted with the University of Chicago in 2017 (he is also the research director of the Energy Policy Institute at the University the average Chinese citizen could add two years to their life expectancy if these pollution reductions were sustained. “We also compared China with other countries and found that in most other developing countries, air quality has been deteriorating rather than improving over the past decade. China alone actually contributed to more than 75 per cent of the total global reduction in particulate matter in that period,” he said. “Another interesting observation is that in the US, it took three decades for them to achieve a similar level of emission reductions through the Clean Air Act. China, in comparison, did all this in eight years.” Reasons for improvements Changes in policy have been a major contributor to China’s anti-pollution success, but so has improved technology, he said. Another study found that automated environmental monitoring networks reduced cheating behaviours by regulators (such as manipulating data) and improved the accuracy of air quality measurements. Furthermore, this improved accuracy motivated individuals to protect themselves as pollution problems became apparent, with immediate increases in sales of face masks and air filters on Taobao. But Dr He felt more could be achieved. “Although the government might have the data, without public pressure, local regulators may be reluctant to enforce federal regulations,” he said. That concern led to a nationwide field experiment that itself contributed to measurable reductions in air and water pollution. The research team recruited volunteers in 2020 to monitor data from more than 25,000 major polluters. These polluters are required to have monitoring equipment installed and the resulting measurements are published online in real time. The volunteers monitored the data and were assigned to file either a public or private complaint when they came across violations. The study found that public appeals to regulators through social media substantially reduced both violations and pollution emissions, especially when the ‘like’ and ‘share’ buttons were activated. Cost-effective option “Our team filed more than 3,500 complaints that involved more than 2,000 companies. We found that when people complained on social media, the firms reduced emission violations by 60 per cent. At the same time, we also observed that air pollution reduced by 12 per cent and water pollution by four per cent,” Dr He said. “There are quite large improvements that show the positive impact of citizen participation in environmental governance. This can be a cost-effective way of encouraging firms to comply with environmental standards.” To underscore the benefits to human health of reduced pollution, Dr He also led a study that looked at how COVID-19 lockdowns in China inadvertently reduced non-COVID deaths due to cardiorespiratory failure, especially in heavily-polluted cities. Dr He’s work has influenced policymakers in China and helped inform the rest of the world about the country’s anti-pollution successes. His work also contributed to the creation of an Air Quality Life Index by EPIC that applies his approach to understand the impact of PM2.5 pollution on life expectancy in the rest of the world. He has also disseminated his findings widely in media and to governments and organisations, including at a webinar that attracted more than 244,000 online participants. His achievements were honoured this year with the HKU Knowledge Exchange Excellence Award. CHINA’S POLLUTION SUCCESSES China launched its war on pollution a decade ago. Research by Dr He Guojun of the HKU Business School has shown that it is saving lives and reducing pollution across the country. His research has also demonstrated how citizen watchdogs can improve the results further. The Air Quality Life Index measures the loss in life years due to air pollution. Dr He (right) receiving the Knowledge Exchange Excellence Award from Provost and Deputy Vice-Chancellor Professor Richard Wong. Our team filed more than 3,500 complaints that involved more than 2,000 companies. We found that when people complained on social media, the firms reduced emission violations by 60 per cent. DR HE GUOJUN 16 17 The University of Hong Kong Bulletin | May 2023 RESEARCH
One of the biggest problems with tooth replacement – particularly for the patient – is the amount of time it takes and the discomfort involved. Multiple fitting procedures can be tedious and uncomfortable. From the dentist’s viewpoint, existing design processes can involve a great deal of manual inputting on the computer. Researchers from the Faculty of Dentistry at HKU have teamed up with the Department of Computer Science of Chu Hai College to investigate the effectiveness of using AI technology based on 3D Generative Adversarial Network algorithms to automate the design of artificial teeth to a very high degree of accuracy. They tested their ideas on 175 participants recruited at HKU. Principal Investigator Dr Walter Lam, who is Clinical Assistant Professor in Prosthodontics, said: “Designing artificial teeth is labour-intensive and therefore expensive. Clinically, dentists need to record patients’ features – such as how the opposing teeth work in static and in function – and then send this clinical information to a dental technician to simulate the patient’s mouth. “Dental technicians design and fabricate artificial teeth, and some already use computer-aided design (CAD) software. However, most of the resulting designs do not fit into the patient’s mouth properly and require significant and often lengthy adjustment by dentists at the chairside. In addition to being unpleasant for patients, the adjustment often weakens the artificial teeth.” He describes the biting (occlusal) surface of teeth as being like ‘hills and valleys’ – with cusps and fissures – that are particularly complicated. “The slope/ steepness of these cusps are different in different individuals, making this more complex as teeth will occlude (bite) with opposing teeth and patients can sense a minute difference in the biting surface up to a hair-like thickness,” he said. “We believe that it is difficult – if not impossible – for humans to identify such minute details.” At the same time, however, teeth within an individual do share similar features, since they are controlled by the same set of genes and share similar environmental factors. Hence, the team proposed using AI to learn the features of individual teeth in a subject and apply these features to design artificial teeth for that subject. “We hoped that the AI-designed artificial teeth would mimic the healthy natural teeth in morphology as well as function,” said Dr Lam. “Treatment costs will be reduced and the function and longevity of artificial teeth will increase.” For the research, the team selected subjects who had healthy natural teeth with almost full dentition – that is, almost no missing teeth. The subject’s teeth were then digitised via 3D scanning, and one back tooth, the right first permanent molar, removed from the resulting digital teeth models. “We then input one digital teeth model (with one tooth removed) and its original model (all teeth) as a pair and the AI is able to design artificial teeth based on learning the features of the remaining teeth,” said Dr Lam. “We are the first team in the world to use AI to design artificial teeth that mimic nature’s teeth. We believe nature is the best and only AI is able to learn such minute features for an individual in an effective way.” LESS PAIN, MORE GAIN Study shows artificial intelligence (AI) can help automate the design of artificial teeth accurately and efficiently, meaning less time and discomfort for the patient and less expense too. Following the success of the study, a start-up company has already been set up with support from the Technology Start-up Support Scheme for Universities (TSSSU) and Hong Kong Science and Technology Parks Corporation. AI design service “When making artificial teeth, dentists provide all clinical information including teeth models to the dental technician for fabrication of artificial teeth,” said Dr Lam. “We plan to launch an AI crown design service in the near future, by which dentists can tick a box in the prescription form to use AI design service (versus manual design with or without CAD software). Then the dental technicians send us the teeth model with missing teeth and our AI can design artificial teeth by learning features of the remaining teeth. “Expenditure should be low because we only need to set up an AI system, which is a normal server costing only about HK$100,000 plus system maintenance fees. After that, there is no cost difference between designing one or one million crowns. We plan therefore to charge only a few hundred Hong Kong dollars. Moreover, our AI system can provide services not only in Hong Kong but all over the world via the use of the digitalised teeth model.” Now, the team plans to move from single tooth design, to multiple teeth design and finally to patients who have no teeth. “But whether it is one tooth or many,” said Dr Lam, “AI design benefits all patients by shortening the treatment time, reducing labour and therefore treatment costs, and producing better quality artificial teeth and reducing the need for re-treatment.” The study has been published in both PLOS ONE and the Journal of Prosthetic Dentistry, and the preliminary results were presented at the recent International Association of Dental Research (IADR) General Session. The study also won the IADR Neal Garrett Clinical Research Prize and was First Runner-up in the 2022 IADR-SEA Hatton Award – Senior Category. From left: Dr Richard Hsung, Professor Colman McGrath, Dr Reinhard Chau, Dr Khaing Myat Thu and Dr Walter Lam. The research team uses the 3D Generative Adversarial Network (GAN) algorithm to learn the relationship of teeth in a dental arch on 175 student participants. After training, 3D GAN is able to generate a tooth (red) based on the feature of remaining teeth (dark grey). We are the first team in the world to use AI to design artificial teeth that mimic nature’s teeth. We believe nature is the best and only AI is able to learn such minute features for an individual in an effective way. DR WALTER LAM 18 19 The University of Hong Kong Bulletin | May 2023 RESEARCH
but also their assistants and even people who were mistreated by companies. Explorations on data storage are also part of this project – he hopes to store the output in the Arctic World Archive in Norway – as well as a separate subject of study at his lab. “People tend to think big data is just a structured Excel sheet with a billion rows, but it is incredibly large and complex and it cannot possibly fit on a single computer. There are serious logistical challenges such as how to archive primary sources that are not printed or circulated in the way we traditionally associate with books. And how to preserve that data properly,” he said. Physical limitations Befitting an historian, Dr Cha is also interested in the impact of the concept of time in the age of digital technology. People experience the internet as boundless and unifying – a single entity accessible to all at all times. The experience on Zoom calls are one example of the flaw in that perspective. There is always a millisecond delay, which is detectable, especially compared to voice or text messaging. This is because data transmissions are limited by the speed of light. Moreover, data does not zip along one line, it jumps across multiple points in multiple jurisdictions In 2019 he established the Big Data Studies Lab – subtitled ‘The humanities in uncharted waters’ – at Seoul National University to explore this further and brought the initiative with him when he joined HKU last year. His approach is to apply traditional teachings about book history and how ideas travelled, to 21st-century historical research and the age of digital materials. Future orientation “As an historian interested in today’s technology, I want to show that historians should be partially future oriented. We should think about what interesting materials of today should be collected and curated, while keeping in mind that they should be diverse enough for someone in the future to explore something obscure or something that we may have missed,” he said. That role requires not only an analysis of content but the creation of archives themselves. One of his projects is focussed on Korean webtoons, where he is scraping available materials such as ratings and comments, while also digging deeper to provide context by interviewing not only the famous creators, Dr Javier Cha is an unlikely combination of Korean medievalist and digital historian, two seemingly unrelated subjects that were brought together by the fact that his medieval research had too much data for one person to comfortably compute on his own. Starting 15 years ago, and spurred on by a mentor during his doctoral studies at Harvard University and a lifelong interest in computers, he began to adopt digital tools into his work at a time when digital humanities had not yet gained traction. Dr Cha not only used the tools to solve his immediate problem – which was how to consolidate raw data on kinship formation, political associations, marriage alliances and the like to show how Korea’s highest social class, the yangban, consolidated power for over 500 years – but he also began to develop an interest in data as a topic of study. “Historians draw information from many sources. I’m interested in how to draw links from multiple heterogeneous data sources so that we can make new discoveries with the aid of software tools,” he said. before it reaches the user, raising issues about digital sovereignty and content protection. “Rather than timeless time, we are seeing the physical limitations of digital infrastructure,” he said. Dr Cha believes these issues all call for the role of the historian to be revisited. Since the second half of the 20th century, historians have tended to shun archiving and focussed on analysing and interpreting events and trends, and writing books. But now there are all these new kinds of sources, such as webpages and online platforms, that could be useful references in future. What should be collected and who should do the collecting? “Archivists have tended to be treated like support staff in recent times, but that is not how history has always operated. Digital historians argue that we should go back to the previous paradigm, where historians cared about curating and archiving materials, and be partially professional archivists as well. Because historians are best placed to know best what future historians might want to look for,” Dr Cha said. He is also cultivating a future orientation in students through his teaching in the new Bachelor of Arts in Humanities and Digital Technologies. AN HISTORIAN WHO LOOKS TO THE FUTURE How might future historians access the digital archives of today when they are produced using a variety of hardware and software? And what should go into those archives? Digital historian Dr Javier Cha is trying to figure this out. We should think about what interesting materials of today should be collected and curated, while keeping in mind that they should be diverse enough for someone in the future to explore something obscure or something that we may have missed. DR JAVIER CHA Biographical data of medieval Korean personalities in Dr Cha’s medieval yangban Neo4j database. Dr Cha at his Bachelor of Arts in Humanities and Digital Technologies class. Dr Cha hopes to store the output in the Arctic World Archive, which is a secure underground vault located deep inside an Arctic mountain on the isolated archipelago in Norway, storing the world’s digital memory and treasures. 20 21 The University of Hong Kong Bulletin | May 2023 RESEARCH
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