Search

E-learning has become an increasingly important teaching and learning mode in educational institutions and corporate training. The evaluation of e-learning, however, is essential for the quality assurance of e-learning courses. This paper constructs a four-phase evaluation model for e-learning courses, which includes planning, development, process, and product evaluation, called the PDPP evaluation model. Planning evaluation includes market demand, feasibility, target student group, course objectives, and finance. Development evaluation includes instructional design, course material design, course Web site design, flexibility, student-student interaction, teacher/tutor support, technical support, and assessment. Process evaluation includes technical support, Web site utilization, learning interaction, learning evaluation, learning support, and flexibility. Product evaluation includes student satisfaction, teaching effectiveness, learning effectiveness, and sustainability. Using the PDPP model as a research framework, a purely e-learning course on Research Methods in Distance Education, developed by the School of Professional and Continuing Education at the University of Hong Kong (HKU SPACE) and jointly offered with the School of Distance Learning for Medical Education of Peking University (SDLME, PKU) was used as a case study. Sixty students from mainland China, Hong Kong, Macau, and Malaysia were recruited for this course. According to summative evaluation through a student e-learning experience survey, the majority of students were very satisfied/satisfied on all e-learning dimensions of this course. The majority of students thought that the learning effectiveness of this course was equivalent, even better, than face-to-face learning because of cross-border collaborative learning, student-centred learning, sufficient learning support, and learning flexibility. This study shows that a high quality of teaching and learning might be assured by using the systematic PDPP evaluation procedure. It is hoped that the PDPP evaluation model and its application can provide a benchmark for establishing a wider e-learning quality assurance mechanism in educational institutions. (Contains 6 tables and 1 figure.)

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

Competing Interests: All authors disclosed no conflicts of interest.

There is increasing public attention on exposure to PM 2.5 and its related health impacts. It is essential to study the pollution levels, sources, and health implications of indoor PM 2.5 , especially for residential homes, as people tend to spend most of their time indoors. The indoor PM 2.5 mass and organic/elemental carbon (OC/EC) during winter and early spring period of 2016-2017 at 68 residential households in four large Chinese cities (i.e. Hong Kong, Guangzhou, Shanghai, and Xi'an) were studied. Average indoor PM 2.5 varied by two-fold, lowest in Hong Kong (34.0 ± 14.6 μg m - 3 ) and highest in Xi'an (78.7 ± 49.3 μg m - 3 ), with comparable levels for Guangzhou (47.2 ± 5.4 μg m - 3 ) and Shanghai (50.3 ± 17.9 μg m - 3 ). Lowest air exchange rate (AER, 0.8 ± 0.8 h - 1 ) and PM 2.5 indoor/outdoor (I/O) ratio (0.72 ± 0.23) were found for Xi'an households, indicating the limited influence from indoor sources, while importance of indoor PM 2.5 sources is signified with the highest PM 2.5 and OC concentrations were identified for households with other indoor combustions (e.g., tobacco smoking, incense burning) compared to those with only cooking activities. For Hong Kong and Shanghai households, increments of 13.2 μg m 2.5 mass, indicating the significance of carbonaceous aerosols. Larger differences between indoor and outdoor OC (2.6-8.4%) than EC (-2.2-1.5%) indicate the presence of indoor OC sources. Decreasing trends of PM 2.5 I/O ratio and indoor OC proportion were found as the worsening ambient air quality. On average, 11.8 μg m - 3 (23.1%) and 3.02 μg m - 3 (18.7%) higher indoor PM 2.5 and OC concentrations were identified for households with other indoor combustions (e.g., tobacco smoking, incense burning) compared to those with only cooking activities. For Hong Kong and Shanghai households, increments of 13.2 μg m - 3 (54.1%) of PM 2.5 and 4.1 μg m - 3 (45.4%) of OC were found at households with cooking activities as compared to households with no specific indoor combustion., 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 © 2020 Elsevier B.V. All rights reserved.)

Humic-like substances (HULIS) are an important mixture of organic compounds, which account for a great part of water-soluble organic compounds in ambient aerosols. In this study, individual carboxylic and hydroxylic species in HULIS extracts of PM 2.5 samples collected in Hong Kong during summer were measured by gas chromatography mass spectrometry with prior chemical derivatization. Significantly higher levels of HULIS were observed on days mainly impacted by regional pollution (regional days, 4.11 ± 1.76 μg m -3 ) than on days under local emission influences (local days, 0.56 ± 0.30 μg m -3 ). Positive matrix factorization was applied to identify the major sources and apportion their contributions to HULIS. Simultaneous monitoring and analysis data from four different sampling sites showed that sources of HULIS in Hong Kong were mainly regional with small spatial variations. Secondary aerosol formation (both organic and inorganic) had a predominant contribution (52.7%) to HULIS during the whole sampling period. It accounted for 1.88 ± 0.91 μg m -3 of HULIS on regional days, which was about 5 times higher than its contribution (0.39 ± 0.34 μg m -3 ) on local days. Of the three identified primary sources, biomass burning had the largest contribution on both regional (34.9%) and local days (24.6%). Marine vessels were also a significant contributor, especially on local days (20.3%). Vehicle exhaust, on the other hand, showed a negligible contribution to HULIS (2.1%) in Hong Kong in this study.

Humic-like substances (HULIS) account for a considerable fraction of water-soluble organic matter (WSOM) in ambient fine particulates (PM 2.5 ) over the world. However, systemic studies regarding the chemical characteristics, sources and redox activity of HULIS are still limited. In this study, the mass concentration, optical properties, and reactive oxygen species (ROS)-generation potential of HULIS were investigated in PM 2.5 samples collected in Hong Kong during 2011-2012, and they all showed higher levels on days under regional pollution than on days under long range transport (LRT) pollution and local emissions. Positive matrix factorization (PMF) analysis was conducted regarding the mass concentration and dithiothreitol (DTT) activity of HULIS. Four primary sources (i.e. marine vessels, industrial exhaust, biomass burning, and vehicle emissions), and two secondary sources (i.e. secondary organic aerosol formation and secondary sulfate) were identified. Most sources showed higher contributions to both the mass concentration and DTT activity of HULIS on regional days than on LRT and local days, except that marine vessels had a higher contribution on local days than the other two synoptic conditions. Secondary processes were the major contributor to HULIS (54.9%) throughout the year, followed by biomass burning (27.4%) and industrial exhaust (14.7%). As for the DTT activity of HULIS, biomass burning (62.9%) and secondary processes (25.4%) were found to be the top two contributors. Intrinsic ROS-generation potential of HULIS was also investigated by normalizing the DTT activity by HULIS mass in each source. HULIS from biomass burning were the most DTT-active, followed by marine vessels; while HULIS formed through secondary processes were the least DTT-active. For the optical properties of HULIS, multiple linear regression model was adopted to evaluate the contributions of various sources to the light absorbing ability of HULIS. Biomass burning was found to be the only source significantly associated with the light absorbing property of HULIS., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: The aim of the present study was to calculate the prevalence of chromosomal abnormalities among antenatally diagnosed congenital heart diseases (CHDs), and the prevalence of 22q11.2 deletion in those with conotruncal CHDs versus isolated non-conotruncal CHDs., Methods: All patients with antenatal ultrasound finding of fetal CHDs in two obstetric units in a 5-year period were retrospectively reviewed. Detected CHDs were classified as conotruncal if the malformation involved either the aortic outflow tract or the pulmonary outflow tract; otherwise they were classified as non-conotruncal. Karyotyping, fluorescence in situ hybridisation for 22q11.2 deletion (22q11FISH), and array comparative genomic hybridisation (aCGH) results were retrieved from patient medical records. The primary outcome was prevalence of chromosomal abnormalities in CHDs. The secondary outcomes were prevalence of 22q11.2 deletion and its prevalence in conotruncal versus non-conotruncal CHDs., Results: A total of 254 Chinese patients were diagnosed to have fetal CHDs. In all, 50 (19.7%) were found to have chromosomal abnormalities with seven (2.8%) patients having 22q11.2 deletion, of whom all seven had conotruncal CHDs and none had non-conotruncal CHDs (P<0.05). Conventional karyotyping detected 35 (70%) cases of the chromosomal abnormalities. The 22q11FISH detected three cases of 22q11.2 deletion; aCGH was performed to detect four cases of 22q11.2 deletion and eight other cases of copy number variations., Conclusion: Our results suggest that invasive testing for karyotyping is recommended for fetal CHDs. Although the prevalence of 22q11.2 deletion was low, testing for 22q11.2 deletion should be offered for conotruncal CHDs., Competing Interests: All authors have disclosed no conflicts of interest.

Background: Extremely low birth weight (ELBW) infants exhibit high rates of mortality and morbidity. We retrospectively assessed factors associated with mortality and morbidity among ELBW infants., Methods: Perinatal demographic data were reviewed for all ELBW infants born between 2010 and 2017 at a tertiary neonatal unit., Results: For non-survivors (21% of ELBW infants) and survivors, the median gestational ages were 24.1 and 26.2 weeks, respectively, and median birth weights were 650 g and 780 g, respectively (all P<0.001). Regression analyses showed that non-survival was positively associated with lower gestational age (adjusted odds ratio [aOR]=6.71 for every 1-week decrease; 95% confidence interval [CI]=1.73-26.00; P=0.006) and grade 3 or 4 intraventricular haemorrhage (aOR=29.23; 95% CI=1.39-613.84; P=0.030); non-survival was negatively associated with the presence of bronchopulmonary dysplasia (aOR=0.01; 95% CI= <0.001-0.23; P=0.005); length of neonatal intensive care unit stay for survivors was positively associated with the presence of necrotising enterocolitis (B-coefficient=89.60; 95% CI=43.86-135.34; P<0.001); and length of hospital stay for survivors was positively associated with the presence of necrotising enterocolitis (B-coefficient=2.08; 95% CI=0.43-3.73; P=0.015) and a low Apgar score at 1 minute (B-coefficient=-0.63; 95% CI=-1.04 to -0.22; P=0.003)., Conclusion: Extremely low birth weight infants exhibited significant mortality and morbidity; there was no survival prior to 23.6 weeks' gestation or below 550 g birth weight. The presence of grade 3 or 4 intraventricular haemorrhage was independently associated with non-survival. Survivors were significantly more likely to exhibit bronchopulmonary dysplasia; survivors with necrotising enterocolitis were more likely to require longer stays in the neonatal intensive care unit and in hospital.

Objective: To assess the potential of screening for pre-eclampsia (PE) in a Chinese population., Design: Case-control study., Setting: Teaching hospital in Hong Kong., Population: A total of 3330 women having a viable singleton pregnancy attending first-trimester Down-syndrome screening., Methods: Mean arterial pressure (MAP), bilateral uterine artery pulsatility index (UtA-PI), and placental growth factor (PlGF) were measured. Screening markers were transformed to multiples of the gestational median (MoM) and adjusted for maternal and pregnancy characteristics. MoM distributions in PE and non-PE pregnancies were compared with published expected values. PE screening performance was assessed using area under receiver operating curves (AUROC)., Main Outcome Measures: PE detection rate., Results: A total of 30 (0.9%) women developed either early (<34 weeks) or late (≥34 weeks) onset PE. MAP was dependent on maternal BMI, UtA-PI on fetal crown rump length, uterine artery peak systolic velocity (UtA-PSV) on maternal age and gestation, and PlGF on gestation in non-PE pregnancies. MoM distributions determined using published Fetal Medicine Foundation models deviated significantly from one for both MAP (P < 0.0001) and PI (P < 0.0001), but not PlGF (P = 0.52) in non-PE pregnancies, whilst PlGF MoM distributions in those who developed early as opposed to late onset PE were significantly higher (P = <0.05). AUROC for any PE using multiple markers was 0.72 (95% CI: 0.64-0.81) with detection rates of 72 and 55% for early and late PE, respectively, for a 10% false positive rate., Conclusion: Detection rates for PE in our Chinese population were lower than the expected 90-95% even after adjusting MoM for local women's characteristics., Funding: General Research Fund (Project number 470513)., Tweetable Abstract: Pre-eclampsia screening in the Chinese population had detection rates lower than previously published results., (© 2017 Royal College of Obstetricians and Gynaecologists.)

Objective: To examine preferences for follow-up testing in women screened with high or intermediate risk for Down syndrome in the first or second trimester., Design: Prospective cohort study., Setting: Three public hospitals in Hong Kong, China., Sample: Women with pregnancies termed as high risk (≥1:250; HR) or intermediate risk (1:251-1200; IR) for Down syndrome., Methods: Women with pregnancies screened as HR were offered the choices of: (1) an invasive test plus chromosomal microarray (CMA) to obtain more detailed fetal genetic information; (2) non-invasive cell-free prenatal DNA screening (NIPT) to detect trisomies 13, 18 and 21, and to avoid procedure-related miscarriage; and (3) to decline any further testing. Women received standardised counselling informing them that the reporting times were identical, the procedure miscarriage risk was 0.1-0.2% and that there was no charge for screening. Women with IR pregnancies (1:251-1200) were offered NIPT as a secondary screening test., Main Outcome Measures: Uptake rate for NIPT., Results: Three hundred and forty-seven women had pregnancies deemed as HR; 344 (99.1%) women opted for follow-up testing, 216 (62.2%) of whom chose NIPT. Five hundred and seven of 614 women (82.6%) with IR risk chose NIPT. Seven (21%) of 34 women with nuchal translucency ≥3.5 mm opted for NIPT., Conclusion: In a setting where reporting times are similar and there is no cost difference between options, approximately 60% of women with pregnancies classed as HR would opt for NIPT, offering simple but limited aneuploidy assessment, over a diagnostic procedure with comprehensive and more detailed assessment., Tweetable Abstract: 60% of pregnant Chinese women prefer NIPT over CMA when screened as high risk for Down syndrome., (© 2018 Royal College of Obstetricians and Gynaecologists.)

Introduction: Triplet and higher-order multiple pregnancies are well known to be associated with increased adverse outcomes. This study reviewed the perinatal outcomes in women with a triplet pregnancy who underwent fetal reduction versus expectant management at a university hospital in Hong Kong., Methods: This was a retrospective review of triplet pregnancies at Prince of Wales Hospital in Hong Kong from 1 January 2008 to 30 September 2014. Women carrying a triplet pregnancy were classified as having had expectant management, fetal reduction to twins, or fetal reduction to a singleton. Maternal and pregnancy characteristics were compared. Outcome measures included fetal loss, gestational age at delivery, birth weight, neonatal survival rate, neonatal death, neonatal complications, and need for and length of neonatal intensive care unit stay., Results: A total of 52 triplet pregnancies were identified. One pregnancy that was lost to follow-up and one that was terminated were excluded. The majority of pregnancies (84%) were the result of assisted reproductive technology. Fetal reduction was performed in 26 (52%) pregnancies, of which 22 were reduced to twins and four to a singleton. The mean gestations at delivery were 32.6, 35.2, and 39.6 weeks in the expectant management, fetal reduction to twins, and fetal reduction to a singleton groups, respectively. Significantly more pregnancies with expectant management resulted in a preterm birth. All pregnancies with fetal reduction to a singleton resulted in a term birth. A higher mean birth weight, lower neonatal death rate, and reduced need for admission to and length of stay in the neonatal intensive care unit were observed in the fetal reduction groups., Conclusions: Approximately 50% of women with a triplet pregnancy in Hong Kong elected to undergo fetal reduction. This was associated with a significant reduction in extreme preterm delivery and associated morbidity and mortality.

Objective: To assess the impact of adopting the INTERGROWTH-21(st) biometry standards in a Chinese population., Design: Retrospective cohort study., Setting: A teaching hospital in Hong Kong., Population: A total of 10 527 Chinese women with a singleton pregnancy having a second- or third-trimester fetal anomaly or growth scan between January 2009 and June 2014., Methods: Z-scores were derived for fetal abdominal circumference (AC), head circumference (HC), and femur length (FL) using the INTERGROWTH-21(st) and Chinese biometry standards. Pregnancies with aneuploidy, structural or skeletal abnormalities, or that developed pre-eclampsia were excluded. Z-scores were stratified as <2.5th, <5th, <10th, >90th, >95th, or >97.5th percentile. Birthweight centile, adjusted for gestation and gender, was categorised as ≤3rd, 3rd to ≤5th, 5th to ≤10th, and >10th. Pairwise comparison and the McNemar test were performed to assess biometry Z-score differences and concordance between the INTERGROWTH-21(st) and Chinese standards., Main Outcome Measures: The sensitivity of both the local and INTERGROWTH-21(st) AC standards to identify pregnancies that were small-for-gestational-age (SGA) was assessed., Results: INTERGROWTH-21(st) AC, HC, and FL Z-scores were significantly lower than those obtained using our local reference for AC, HC, and FL (P < 0.0001 for all). The proportion of fetuses with biometry in the <2.5th, <5th, <10th, >90th, >95th, or >97.5th percentiles was statistically significant (P < 0.01 for all). A total of 1224 (15.5%) of the scans at 18-22 weeks of gestation had AC, HC, or FL below the 3rd percentile of the INTERGROWTH-21(st) standard., Conclusions: Adopting the INTERGROWTH-21(st) standard would lead to a significant number of fetuses being at risk of misdiagnosis for small fetal size, particularly when using HC and FL measures., Tweetable Abstract: INTERGROWTH-21(st) biometry assessment in Chinese leads to fetuses being at risk of misdiagnosis of small fetal size., (© 2016 Royal College of Obstetricians and Gynaecologists.)

Age-related macular degeneration (AMD) is a leading cause of irreversible central blindness among the elderly worldwide. We use exome sequencing to analyse nonsynonymous single-nucleotide variants (SNVs) across the whole genome of 216 neovascular AMD cases and 1,553 controls. As a follow-up validation, we evaluate 3,772 neovascular AMD cases and 6,942 controls from five independent cohorts in the East Asian population. Here we show strong evidence of an association at a novel, missense SNV, rs7739323, which is located in the ubiquitin protein ligase E3D (UBE3D) gene (Pmeta=1.46 × 10(-9), odds ratio (OR)=0.74, 95% confidence interval (CI): 0.63-0.88). Furthermore, ablation of the UBE3D protein lead to an abnormal amount of pigment granules deposited in retinal pigment epithelium microvilli area and an abnormal response on electroretinography (ERG) in UBE3D(+/-) heterozygous mice. Our findings indicate that the ubiquitin-proteasome system may play a role in the pathogenesis of neovascular AMD.

Background and Purpose: Low rates of thrombolysis for ischemic stroke in China have mainly been attributed to delays in presentation to the hospital. This study aimed to evaluate factors associated with these delays., Methods: Data were from a prospective, multicenter, hospital-based registry of patients with acute stroke (ChinaQUEST [Quality Evaluation of Stroke Care and Treatment]), which involved 62 hospitals across a variety of economic and geographic regions in China during 2006. Univariate and multivariate analyses were undertaken to determine associations between variables of interest and delays to hospital presentation., Results: Median time to hospital presentation was 15.0 hours for 6102 cases (interquartile range, 2.8-51.0 hours). A total of 1546 (25%) patients arrived within 3 hours and 2244 (37%) patients arrived within 6 hours after symptom onset. Factors that prolonged time to presentation were: visiting a local doctor before presenting at emergency (OR, 0.48; P<0.001), symptom onset at home (OR, 0.62; P<0.001), transfer to a large (Level III) hospital for management (OR, 0.70; P=0.04), and history of diabetes (OR, 0.78; P=0.01). In contrast, factors that accelerated presentation to the hospital were hemorrhagic stroke (OR, 2.25; P<0.001), history of atrial fibrillation (OR, 1.94; P<0.001), unconsciousness at presentation (OR, 1.91; P<0.001), transfer by ambulance (OR, 1.91; P<0.001), and history of coronary artery disease (OR, 1.20; P=0.04)., Conclusions: Health promotion strategies to improve community awareness of early symptoms of stroke, establishment of an alert system to cater for patients likely to experience stroke at home, and wider availability and use of ambulance services are promising methods to help expedite presentation to hospital poststroke and thereby improve the management of stroke in China.

Vehicular emission (VE) is one of the important anthropogenic sources for airborne carbonyls in urban area. Six types of VE-dominated samples were collected at representative locations in Hong Kong where polluted by a particular fueled type of vehicles, including (i) a gas refilling taxis station (liquefied petroleum gas [LPG] emission); (ii) a light-duty passenger car park (gasoline emission); (iii) a minibus station (diesel emission); (iv) a single-deck-bus depot (diesel emission); (v) a double-deck-bus depot (diesel emission); and (vi) a whole-food market entrance for light- and heavy-duty vehicles (diesel emission). A total of 15 carbonyls in the samples were quantified. Formaldehyde was the most abundant carbonyl among the VE-dominated samples, and its contribution to the total quantified amount on a molar basis ranged from 54.8% to 60.8%. Acetaldehyde and acetone were the next two abundant carbonyls. The carbonyls were quantified at three roadside locations in Hong Kong. The highest concentrations of formaldehyde and acetaldehyde, 22.7 +/- 8.4 and 6.0 +/- 2.8 microg/m3, respectively, were determined in the samples collected at a main transportation gate for goods between Hong Kong and Mainland China. The total quantified carbonyl concentration, 37.9 +/- 9.3 microg/m3, was the highest at an entrance of a cross-harbor tunnel in downtown area. The theoretical carbonyls compositions of the three roadside locations were estimated according to the VE-dominated sample profiles and the statistics on vehicle numbers and types during the sampling period. The measured compositions of formaldehyde were much higher than the theoretical compositions in summer, demonstrating that photochemical reactions significantly contributed to the formaldehyde production in the roadsides.

The mass concentrations of PM(1) (particles less than 1.0 μm in aerodynamic diameter), organic carbon (OC), elemental carbon (EC), water-soluble ions, and up to 25 elements were reported for 24h aerosol samples collected every sixth day at a roadside sampling station in Hong Kong from October 2004 to September 2005. Annual average PM(1) mass concentration was 44.5 ± 19.5 μg m(-3). EC, OM (organic matter, OC × 1.2), and SO(4)(=) were the dominant components, accounting for ∼ 36%, ∼ 26%, and ∼ 24% of PM(1), respectively. Other components, i.e., NO(3)(-), NH(4)(+), geological material, trace elements and unidentified material, comprised the remaining ∼ 14%. Annual average OC/EC ratio (0.6 ± 0.3) was low, indicating that primary vehicle exhaust was the major source of carbonaceous aerosols. The seasonal variations of pollutants were due to gas-particle partitioning processes or a change in air mass rather than secondary aerosol produced locally. Vehicle exhaust, secondary aerosols, and waste incinerator/biomass burning were dominant air pollution sources, accounting for ∼ 38%, ∼ 22% and ∼ 16% of PM(1), respectively. Pollution episodes during summer (May-August) which were frequently accompanied by tropical storms or typhoons were dominated by vehicle emissions. During winter (November-February) pollution episodes coincided with northeasterly monsoons were characterized by secondary aerosols and incinerator/biomass burning emissions., (Copyright © 2011 Elsevier B.V. All rights reserved.)

The effect of air exchange rate (ACH), temperature (T), and relative humidity (RH) on the formation of indoor secondary organic aerosols (SOAs) through ozonolysis of biogenic organic compounds (BVOCs) emitted from floor cleaner was investigated in this study. The total particle count (with D(p) of 6-225 nm) was up to 1.2 × 10(3)#cm(-3) with ACH of 1.08 h(-1), and it became much more significant with ACH of 0.36 h(-1) (1.1 × 10(4)#cm(-3)). This suggests that a higher ventilation rate can effectively dilute indoor BVOCs, resulting in a less ultrafine particle formation. The total particle count increased when temperature changed from 15 to 23 °C but it decreased when the temperature further increased to 30 °C. It could be explained that high temperature restrained the condensation of formed semi-volatile compounds resulting in low yields of SOAs. When the RH was at 50% and 80%, SOA formation (1.1-1.2 × 10(4)#cm(-3)) was the more efficient compared with that at RH of 30% (5.9 × 10(3)#cm(-3)), suggesting higher RH facilitating the initial nucleation processes. Oxidation generated secondary carbonyl compounds were also quantified. Acetone was the most abundant carbonyl compound. The formation mechanisms of formaldehyde and acetone were proposed., (Copyright © 2011 Elsevier B.V. All rights reserved.)

PM2.5 samples were collected in a regional sampling network with three sites in Hong Kong and four sites in the adjacent inland Pearl River Delta (PRD) or Guangdong Province during four months/seasons from 2002-2003. Trans-boundary transport between Hong Kong and the inland PRD is inevitable under the influence of Asian monsoon. In summer, Hong Kong serves as the upwind site of the inland PRD while during other seasons it is under the influence of continental emissions. Previous studies have recognized the importance of using chemical signatures to differentiate local vs. regional contributions to air pollutants in Hong Kong such as the CO/NOx ratio, ratios of different VOC species. In this study, detailed chemical speciation by gas chromatography-mass spectrometry was performed with PM2.5 samples to identify new chemical signatures to distinguish aerosols in Hong Kong from those from the inland PRD. Since Hong Kong is not influenced by the continental emissions from the inland PRD during summer, comparison focused on chemical data obtained from this season for chemical signatures. The new ratios developed from the current study include LCPI/HCPI ratio of alkanes (0.39 +/- 0.02 in Hong Kong vs. 0.78 +/- 0.08 in the inland PRD), pyrene to benzo[ghi]perylene ratio (0.97 +/- 0.21 in Hong Kong compared to 0.20 +/- 0.06 in the inland PRD), and the ratio of 1,2-benzenedioic acid to 1,4-benzenedioic acid (1.8 +/- 0.1 in Hong Kong vs. 0.6 +/- 0.05 in the inland PRD). Results from this study also revealed that Hong Kong was impacted by ship emissions as reflected by substantially high V/Ni ratio (9 +/- 2) while this ratio was about 1-2 at all sites in the inland PRD, which is very close to typical ratios from residual oil combustion.

PM(2.5) (particle with an aerodynamic diameter less than 2.5microm) was measured in different microenvironments of Hong Kong (including one urban tunnel, one Hong Kong/Mainland boundary roadside site, two urban roadside sites, and one urban ambient site) in 2003. The concentrations of organic carbon (OC), elemental carbon (EC), water-soluble ions, and up to 40 elements (Na to U) were determined. The average PM(2.5) mass concentrations were 229+/-90, 129+/-95, 69+/-12, 49+/-18microg m(-3) in the urban tunnel, cross boundary roadside, urban roadside, and urban ambient environments, respectively. Carbonaceous particles (sum of organic material [OM] and EC) were the dominant constituents, on average, accounting for approximately 82% of PM(2.5) emissions in the tunnel, approximately 70% at the three roadside sites, and approximately 48% at the ambient site, respectively. The OC/EC ratios were 0.6+/-0.2 and 0.8+/-0.1 at the tunnel and roadside sites, respectively, suggesting carbonaceous aerosols were mainly from vehicle exhausts. Higher OC/EC ratio (1.9+/-0.7) occurred at the ambient site, indicating contributions from secondary organic aerosols. The PM(2.5) emission factor for on-road diesel-fueled vehicles in the urban area of Hong Kong was 257+/-31mg veh(-1) km(-1), with a composition of approximately 51% EC, approximately 26% OC, and approximately 9% SO(4)(=). The other inorganic ions and elements made up approximately 11% of the total PM(2.5) emissions. OC composed the largest fraction (approximately 51%) in gasoline and liquid petroleum gas (LPG) emissions, followed by EC (approximately 19%). Diesel engines showed higher emission rates than did gasoline and LPG engines for most pollutants, except for V, Br, Sb, and Ba.

As nurses constitute the largest group of health-care providers, their readiness to respond to disasters and to participate in preparedness and disaster recovery activities will be significant for making a community more resilient against disaster. Concern is raised regarding how to build the capacity of all nurses with a knowledge base and a minimum set of skills in responding to various disasters. Drawing on the ICN Framework of Disaster Nursing Competencies and Global Standards for the Initial Education of Professional Nurses and Midwives, a training program entitled "Introduction to Disaster Nursing" was developed. Four teaching methods including action learning, problem-based learning, skill training, and lecture were used to orchestrate a series of planned activities for helping students develop the required disaster nursing competencies in a 2-week intensive training program held in Sichuan China in July 2009. The pre- and post-tests which were given to assess the students' perceived level of competencies demonstrated a significant gain in relevant knowledge and skills constituting the required competencies upon completion of the program. In the program evaluation, most students indicated their willingness and capability in disaster relief work under supervision, and they were keen to advance their competencies in the field of disaster nursing.

Objectives: To study the attitudes of both medical and non-medical students towards the do-not-resuscitate (DNR) decision in a university in Hong Kong, and the factors affecting their attitudes., Methods: A questionnaire-based survey conducted in the campus of a university in Hong Kong. Preferences and priorities of participants on cardiopulmonary resuscitation in various situations and case scenarios, experience of death and dying, prior knowledge of DNR and basic demographic data were evaluated., Results: A total of 766 students participated in the study. There were statistically significant differences in their DNR decisions in various situations between medical and non-medical students, clinical and preclinical students, and between students who had previously experienced death and dying and those who had not. A prior knowledge of DNR significantly affected DNR decision, although 66.4% of non-medical students and 18.7% of medical students had never heard of DNR. 74% of participants from both medical and non-medical fields considered the patient's own wish as the most important factor that the healthcare team should consider when making DNR decisions. Family wishes might not be decisive on the choice of DNR., Conclusions: Students in medical and non-medical fields held different views on DNR. A majority of participants considered the patient's own wish as most important in DNR decisions. Family wishes were considered less important than the patient's own wishes.

Background: Cervical lymphadenopathy is a typical feature in some children with Kawasaki disease, but whether its presence or absence delays diagnosis, thereby increasing the risk of coronary artery abnormalities, has remained uncertain., Aim: : The aim of this study is to review the clinical features of Kawasaki disease with particular reference to investigating the relationship of cervical lymphadenopathy to the development of coronary artery lesions., Methods: Demographic and clinical data from all the patients entered into the Hong Kong Kawasaki disease registry during 1994 to 2000 were reviewed. The presenting clinical features, echocardiographically monitored coronary artery lesions and influence of cervical lymphadenopathy (> or = 1 nodes > or = 1.5 cm diameter) on clinical onset-to-diagnosis time and response to immunoglobulin therapy are reported., Results: We studied 696 patients (99% Chinese, male/female ratio 1.7:1). Their distribution was inversely related to age. Twenty-four percent of the patients presented with cervical lymphadenopathy, the relative incidence of which was directly related to age. Five percent of patients had demonstrable coronary artery aneurysms at 8 weeks after disease onset. A slightly higher percentage of patients with absence of lymphadenopathy had late diagnosis. No significant positive or negative overall association between cervical lymphadenopathy and coronary artery lesions was observed. Time to resolution of fever after immunoglobulin administration did not differ between those with and without cervical lymphadenopathy., Conclusions: Cervical lymphadenopathy was present in only 24% of the patients with Kawasaki disease, correlating directly with age. Its absence may delay the timing of diagnosis. There was, however, no overall association between lymphadenopathy and coronary lesions.

It is important to establish valid field measures of lower body strength in the elderly, and to provide representative normative values that are culturally specific in order to help health professionals in the risk assessment of this group. A sample of 1,038 elderly Hong Kong Chinese undertook a 30-sec chair stand test (30CST), with a subsample of 143 completing isometric measures of maximal hip flexion and knee extension, plus a habitual physical activity questionnaire. The 30CST was significantly, yet only weakly, correlated with the isometric strength measures (r approximately 0.3-0.4), but accurately discriminated between levels of habitual physical activity and across ages in decades. The normative values generated provide useful data for health screening in this elderly Hong Kong population, but do not compare well with their healthier US counterparts.

Objective: To develop a local quality assurance program in cytopathology based on circulation of patient specimens on glass slides, with limited resources., Study Design: A working group was set up for design and running of the program. Participation is on a laboratory basis. The scope and frequency of testing are defined. Well-documented cases (including gynecologic, nongynecologic and fine needle aspiration cytology) with commonly encountered diagnoses are collected. Consensus concerning the diagnosis, interpretive menu and scoring system is sought before the actual slide circulations using express mail. After returning their answers to the program organizer, the participating laboratories receive immediate feedback on their scores, with reference answers, explanatory notes, "whole-mount" images of glass slides and cumulative responses of peer laboratories for on-site checking. At the end of each year, an electronic file containing representative photomicrographs of all cases examined is provided to individual laboratories for their permanent records and training purposes., Results: The program was launched in mid-2003. There were 24 and 27 participating laboratories from Hong Kong (and Macau) in 2003 and 2004, respectively. To date, >150 well-documented cytology cases are available in the slide pool and ready for circulation. As the revenue is mainly to cover the expenses of express mail, the program can be carried out at a relatively low cost., Conclusion: In order to have any cytology quality assurance program accepted by local laboratories, it has to be fair and practical. Strict confidentiality needs to be observed throughout the process. This program emphasizes both performance assessment and educational value. Adequate representation from experienced local cytology workers, detailed documentation support from authorities and assistance from dedicated staff are essential to the success of any external proficiency testing scheme. Regular review and evaluation are also necessary for continuous improvement. The Hong Kong experience can serve as an example of running a glass slide-based cytology quality assurance program in a small region with limited resources.

Objective: To describe the epidemiology, clinical characteristics, and management of Kawasaki disease in children in Hong Kong., Design: Retrospective survey of medical records from July 1994 to June 1997, and prospective data collection from July 1997 to June 2000., Setting: Hospitals with a paediatric unit in Hong Kong., Patients: Patients diagnosed with Kawasaki disease between July 1994 and June 2000 in public hospitals in Hong Kong., Main Outcome Measures: Incidence of Kawasaki disease and coronary artery aneurysm rates., Results: A total of 696 cases of Kawasaki disease were reported. There were 435 (62.5%) boys and 261 (37.5%) girls giving a male to female ratio of 1.7:1. The age ranged from 1 month to 15 years 5 months with a median of 1.7 years. Infants (<1 year) constituted the largest group of patients (223, 32.0%) and overall, 638 (91.7%) were younger than 5 years. Skin rash, conjunctivitis, and oral signs were among the principal clinical features present in over 80% of cases. Prominent cervical lymph nodes larger than 1.5 cm were less commonly found (24%). Coronary artery aneurysms or ectasia were present in 15.7% (109/696), 8.5% (59/696), and 5.0% (35/696) of patients at 2, 4, and 8 weeks, respectively. The incidence of Kawasaki disease per 100,000 children under 5 years was significantly higher in the prospective study period than in the retrospective period (39 vs 26, P<0.001)., Conclusion: The incidence of Kawasaki disease is high in Hong Kong and is 39 per 100,000 children below 5 years of age. The coronary artery aneurysm prevalence is 5%. Intravenous gamma-globulin and high-dose aspirin is the mainstay of treatment.

In order to evaluate the efficacy of convalescent plasma therapy in the treatment of patients with severe acute respiratory syndrome (SARS), 80 SARS patients were given convalescent plasma at Prince of Wales Hospital, Hong Kong, between 20 March and 26 May 2003. Good outcome was defined as discharge by day 22 following the onset of SARS symptoms. Poor outcome was defined as death or hospitalization beyond 22 days. A higher day-22 discharge rate was observed among patients who were given convalescent plasma before day 14 of illness (58.3% vs 15.6%; P<0.001) and among those who were PCR positive and seronegative for coronavirus at the time of plasma infusion (66.7% vs 20%; P=0.001).

Objective: To examine teachers' views of the first batch of graduates of a revised medical curriculum in Asia., Methods: A cross-sectional study using a structured questionnaire was carried out to obtain the views of all the clinical teachers involved in teaching final year students of the old curriculum in 2000-01 and the new curriculum in 2001-02 at the University of Hong Kong, which commenced curricular reform in 1997., Results: Nearly 62% of respondents felt that better graduates were being produced with the new curriculum. The majority of them rated the new curriculum students better in nearly all the major goals of the new curriculum, such as self-directed learning initiative, problem solving skills, interpersonal skills and clinical performance in patient care. However, the core knowledge of the new curriculum students was of concern to some teachers., Conclusion: This study focused on the first complete cycle of a revised medical curriculum in Asia. Teachers' views of the new curriculum students were highly positive and they felt that better graduates were being produced.

Background: Low literacy is common in Hong Kong and China, especially among the females and the elderly. These are often the patients with the greatest health care needs. However little is known about how low literacy affects the ability of patients to obtain adequate medical care and comply with the recommendations of health professionals., Methods: Qualitative study of subjects' opinions using semi-structured group and individual interviews. Thirty-six participants took part in 6 group and 9 individual interviews., Results: Participants' opinions towards low literacy were explored in the interviews. They expressed diverse views on how they perceived low literacy. Some thought they were handicapped by it but others felt it was not a problem. Age, gender, chronic illnesses and their attitudes towards self were found to be major factors affecting their perception. Despite their low literacy, some had their specific ways to overcome the difficulties, for example, drawing symbols to help with the timing of taking the medications. Most of them felt better explanation by the health care workers was most important., Conclusions: It is highly relevant for health care workers to be aware of the low literacy status of their patients and to explain information so that patients understand it.

Studies have documented that health and income are important variables affecting the quality of life in old age. However, there is little knowledge about whether perceived financial sufficiency affects the health of elderly persons. Recent research has documented that in addition to material and behavioural determinants, psychosocial pathways also have an influence on health inequalities. This is the first paper to examine the relation between self-rated economic condition (measured with a single item question) and reported health conditions (i.e., somatic complaints, diagnosed physical diseases, functional health (Activities of Daily Living), self-rated health, and mental health status (General Health Questionnaire-30 [GHQ-30]) among elderly persons in Hong Kong. The respondents of the study were persons aged 65 and over residing in public housing estates in the Southern District of Hong Kong Island. Four hundred and fifty respondents were interviewed in 1995 by means of a structured questionnaire. The study found that although it did not record the actual income levels of the respondents, the subjective measure vividly demonstrated the health differentials among the elderly respondents. Multiple regression analyses suggested that self-rated economic condition was a significant predictor of the number of somatic complaints and physical illnesses reported, as well as of functional health, self-rated health, and mental health status (controlling for socio-demographic variables). However, the measure explained a higher proportion of variance in models related to psychological health than those related to physical health. The findings substantiated the role of psychosocial processes in understanding perceived health and illness and health inequalities in particular.

In this paper, an attempt is made to explore how people respond to injuries at work among a group of hand-injured workers in the context of contemporary Hong Kong society. Qualitative research methods were adopted. A "focused interview" by means of open-ended questions was employed to investigate those workers who have suffered from work-related injury for over 10 years. Concerning the perceived cause of the injury, the industrial production process such as machine defects, piecework, limited working experience, and lack of supervision triggered the onset of the injuries which resulted in permanent disability. At the same time, respondents tellingly explained their injury in terms of magical-religious forces such as fate and luck. This kind of understanding is embraced in cultural beliefs that are commonly found among Chinese. Such understandings appear fatalistic but allow the individual to actively cope with such misfortune. The emphasis on harmony and stability among Chinese also affected what action they took against the employer for negligence. It was shown that in general many respondents were bound by kuan-hsi (personal relationship) and tended to preserve the harmony between themselves and their employer. In modern societies like Hong Kong, traditional values and modern practices are complementary to each other in coping with life stresses such as disablement. Modernity does not provide a solid means for people to have more control over their lives. Many people still stick to their habituated lifestyle as a guiding light in day-to-day matters. Concerning risk assessment in relation to work safety, workers' value systems and practices on the shopfloor should be taken into consideration.

A 3-hour seminar on tobacco was introduced to second year (pre-clinical) medical students in Hong Kong in 1994. The differences in knowledge and attitudes were measured by a self-administered and anonymous questionnaire with 14 items before the seminar (n = 145), and again 2 weeks after the seminar (n = 151). The students also completed an evaluation form at the end of the seminar. Before the seminar, the students were most deficient in their knowledge on the exact magnitude of the risks from smoking and on the risks from smoking relative to the risks from air pollution and asbestos. After the seminar, their knowledge increased significantly (P < 0.005). As for attitudes, in the pre-test 35% strongly agreed that tobacco advertising should be completely banned, and 50% did so in the post-test (P = 0.02). The corresponding figures for banning of all forms of tobacco promotion were 26% and 43% (P < 0.005). In the pre-test, one in four students strongly disagreed that doctor's advice to their patients to stop smoking is totally ineffective, with this proportion increasing to 70% in the post-test (P < 0.005). The majority of the students stated that the seminar was useful. The preclinical medical curriculum should, at the very least, include a tobacco seminar. Our survey shows that it is effective in improving students' knowledge and attitudes on tobacco control.

278 geriatric patients with fractured proximal end of the femur were studied retrospectively 1.5-5 years (average 3.5 years) after they received treatment in two hospitals. Of the survivors 63%, 56% were totally pain-free while 15% had varying degrees of hip pain. Only 26.5% could squat fully. The physical activity was inversely proportional to the age. The widowed were doing better than the married with living husbands. Of the three methods of treatment (Austin-Moore hemiarthroplasty, plating and Ender's nailing), the hemiarthroplasty group of patients was doing the best physically. In spite of some positive X-ray findings among the different groups, corresponding clinical manifestations were not encountered.