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Objective: To compare the angle of progression (AoP) measured by transperineal ultrasonography before indicating an instrumental delivery or cesarean delivery.Methods: A prospective observational study was conducted among women with singleton term pregnancies with prolonged second stage of labor at Kwong Wah Hospital, Hong Kong, China, between May 16, 2011, and May 25, 2016. Transabdominal and transperineal ultrasonography were performed to determine fetal head position and AoP, respectively, both at rest and during uterine contraction with pushing. Mode of delivery was decided after vaginal examination without relying on ultrasonography.Results: Of 143 women, 116 underwent successful instrumental delivery and 27 underwent cesarean delivery. Median AoP was 153.0° in the instrumental group versus 139.0° in the cesarean group at rest (P<0.001), and 182.5° in the instrumental group versus 156.5° in the cesarean group during contraction (P<0.001). The best predictive cutoff AoP for successful instrumental delivery was 138.7° at rest (sensitivity 86.2%, specificity 51.9%) and 160.9° during contraction (sensitivity 87.1%, specificity 74.1%). No between-group differences in AoP were found for ease of vacuum extraction at rest (P=0.457) or during contraction with pushing (P=0.095).Conclusion: The AoP predicted approximately 80% of successful instrumental deliveries performed for prolonged second stage of labor. [ABSTRACT FROM AUTHOR]

Tended to view disability inclusion as merely another mandate, building and construction practitioners have yet to recognize its value in social sustainability. In academia, similarly, it has received less attention than other building performance attributes such as environmental friendliness and indoor air quality. With rights to access now acknowledged as basic human rights, there is demand for a tool to assess building disability inclusiveness, indicating the extent to which building considerations include persons with disabilities (PWDs). This paper proposes a Building Inclusiveness Assessment Score (BIAS) to fill the existing gap. The BIAS framework comprises two hierarchies of inclusion attributes identified from literature, guides, and standards of barrier-free access and universal design. The final product consists of two building disability inclusiveness assessment tools: the Physical Disability Inclusion Sub-score (PDIS) and the Visual Impairment Inclusion Sub-score (VIIS). These are simple, quantitative, objective tools for assessing buildings. We performed a Monte Carlo simulation to validate the assessment protocols. Following the validation, we assessed 48 university buildings at four universities in Hong Kong to illustrate the real-life application of the tools. [ABSTRACT FROM PUBLISHER]

Objective: To determine any change in adverse neonatal/maternal outcomes after increasing the rate of vaginal twin delivery by comparing vaginal twin delivery and caesarean delivery with our previous cohort study.Methods: In a retrospective cohort study, all twins booked at a Hong Kong regional obstetrics unit were evaluated during a 3-year period from 1 April 2009 to 31 March 2012.Results: Out of the 269 sets of twins who eventually delivered in our unit, 68 (25.3%) of them were delivered vaginally, compared to 15.8% in our previous cohort study (p = 0.02). For those who were suitable for vaginal delivery, significantly more women attempted vaginal delivery: 93/133 (69.9%) versus 47/100 (47%) (p = 0.0005). The success rate for vaginal delivery and rate of requiring caesarean delivery for the 2nd twin were similar between these two periods. There were significantly more 2nd twins with cord blood pH < 7.2 when both twins were delivered by vaginal delivery. Otherwise, there was no significant difference between other neonatal/maternal morbidities.Conclusion: With proper counseling, significantly more women who were suitable for vaginal twin delivery would opt to do so. There was no significant increase in neonatal/maternal morbidities despite the increased rate of vaginal twin delivery. [ABSTRACT FROM AUTHOR]

The USEPA and the WHO now advocate the use of enterococci as indicators for marine water quality. This study investigated the outcomes for Hong Kong beach water quality assessment by comparing enterococcus measures with data from the HKEPD's monitoring programme. Six beaches were tested once every 2–3 months from November 2013 to June 2014 in order to identify the most contaminated sites, followed by intensive water sampling in sites found to have the highest enterococci densities (Clear Water Bay Second and Golden) every five to six days for six sampling events over a 30-day period in 2014. The geometric means of enterococci were found to be 124 and 41 cfu/100 mL at Clear Water Bay Second and Golden respectively, indicating that there may be higher risks of illness associated with swimming at both beaches than previously known. Moreover, beach sediments contained higher concentrations of enterococci than water, and warrant further study. [ABSTRACT FROM AUTHOR]

Abstract: This study evaluated the psychometric properties of a widely used self-report anxiety scale—the Spence Children''s Anxiety Scale (SCAS) and the associated parent-report version (PSCAS)—in a Hong Kong Chinese community sample. While good psychometric properties of SCAS and PSCAS had been documented in Western cultural contexts (e.g., Australia), no systematic psychometric evaluation of the Chinese-translated SCAS and PSCAS has been published. In this study, psychometric properties of SCAS and PSCAS were examined with respect to four criteria: (a) factor structure, (b) descriptive statistics, (c) convergent validity with an anxiety cognition measure, and (d) internal consistency. Psychometric properties of SCAS and PSCAS for a Chinese community sample were found to be highly comparable with those published on Australian samples, thus providing a solid conceptual foundation for use of the Chinese version of SCAS and PSCAS. [Copyright &y& Elsevier]

Acquired hemophilia A (AHA) is a rare bleeding disorder with destruction of factor VIII by autoantibodies. Comprehensive data for Chinese patients are lacking. Predictors of hospital stay have not been investigated. A territory-wide review of patients diagnosed with AHA from January 1, 2012, to December 31, 2021 was performed by retrieving patients' information from an electronic database system in Hong Kong. Overall, 165 patients were included in this 10-year study, and the estimated incidence was 2.4 per million/year, which was higher than those reported from Caucasian cohorts. The median age of diagnosis was 80 years old. Patients had a long hospital stay (median: 25 days) and high mortality (55.2 %). The majority of deaths were caused by immunosuppression-related sepsis (49.5 %). Age was an independent predictor of overall survival (Hazard ratio: 1.065, 95 % CI: 1.037–1.093, p < 0.001), complete remission (CR) status (odd ratios (OR): 0.948, 95 % CI: 0.921–0.976, p < 0.001) and time to achieve CR (OR: 1.043, 95 % CI: 1.019–1.067, p < 0.001). Higher hemoglobin level on presentation was associated with shorter time to achieve CR (OR: 0.888, 95 % CI: 0.795–0.993, p = 0.037). Factor VIII level < 1 % normal, high inhibitor titer and intensive immunosuppressive regimen predicted long hospital stay. We presented comprehensive data of Chinese patients with AHA which comprised predominantly frail elderly who required long hospital stay and had high sepsis-related mortality. This posed challenges in managing AHA in such patients. Individualized immunosuppressive therapy is needed to balance the benefits and risk of septic complications. • A comprehensive review of AHA patients in Hong Kong which represented the disease characteristics of Chinese patients. • High mortality rate (55.2%) was recorded in our cohort and majority of death were sepsis relating to immunosuppression. • Age was an independent predictor of overall survival, CR status and time to achieve CR. • Factor VIII level <1% normal, high inhibitor titre and intensive immunosuppression were predictors of long hospital stay. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of rupture of membranes and labour on the risk of hepatitis B virus (HBV) vertical transmission.Study Design: A prospective multicentre observational study was carried out in Hong Kong between 2014-2016. Pregnant HBV carriers were recruited. The duration of rupture of membranes, labour and mode of delivery were collected prospectively. HBV DNA was examined at 28-30 weeks of gestation. All newborns received standard HBV vaccination and immunoglobulin. Hepatitis B surface antigen of infants was tested at 9-12 months of age.Results: 641 pregnancies were recruited and analyzed. No statistically significant difference was found in gravida, parity, gestational age at delivery, mode of delivery, duration of rupture of membranes, duration of labour, preterm delivery, preterm rupture of membranes or birth weight (p > 0.05). Subgroup analysis in viral load > 7log10IU/ml and 8log10IU/ml also did not find a significant association between duration of rupture of membranes and labour with immunoprophylaxis failure.Conclusions: Duration of rupture of membranes and labour would not affect the risk of HBV vertical transmission in infants following standard HBV vaccination and hepatitis B immunoglobulin administration. [ABSTRACT FROM AUTHOR]

Background End-stage renal failure patients often fail to attend scheduled renal palliative care clinic (RPCC) follow-up because of acute hospital admissions, causing negative impact on patients' well-being and health care burden. Measures The rates of RPCC attendance, emergency department (ED) attendance, and acute hospital admission per patient from January 2013 to June 2013 were analyzed. Intervention Patients who had more than one ED visit within three months were invited to intensify their RPCC follow-up schedule for symptom assessment, medical advice, psychosocial-spiritual care, and social worker support in the subsequent three months. Outcomes Nineteen patients were included. The rate of ED attendance (2.63 vs. 0.63, P < 0.007) and acute hospital admission (1.59 vs. 0.58, P < 0.009) was reduced significantly after intensified follow-up. Clinic attendance rates improved from 56% to 85%. Conclusions/Lessons Learned Our pilot results suggested that intensifying RPCC follow-up minimized the utilization of acute medical services and improved outpatient attendance at RPCC. [ABSTRACT FROM AUTHOR]