Operating theatre is a cold environment and hypothermia (core body temperature lower than 36C) is prevalent among patients undergoing operations. Possible causes of this adverse condition include anesthetic effect, body part exposure, blood loss, and the low room temperature in the theatre. Hypothermia can impair wound healing, decrease drug metabolism, increase oxygen consumption, which in turn causing respiratory distress, bradycardia as well as atrial fibrillation. In extreme cases, it can be lethal. Numerous research studies have explored ways of interventions and new technologies to maintain normal body temperature of patients during operations. However, perhaps without proper translation to clinical practice, the rate of postoperative hypothermia still remains high in many hospital setting. The objectives of this thesis are to systematically review the current literature on the effectiveness of preoperative warming on reducing postoperative hypothermia of patients undergoing general anesthesia. Data from the relevant literature is extracted for setting up a table of evidence. Also, quality assessment is performed. An evidence-based practice guideline for preoperative warming is developed and its feasibility and transferability to the target patients is examined. The purpose of the guideline is to provide better care for patients undergoing general anesthesia. In this thesis, preoperative forced air warming is proposed. The target setting is the operating theatre department and day surgery centre in a local public acute hospital. The target population is patients who undergo general anesthesia. Data is extracted from six articles. The implementation potential of the proposed guideline is high, because of the high transferability, feasibility and cost-effective ratio. An evidence-based practice guideline is developed based on the evidence. Well-designed implementation and evaluation plan are developed for the implementation of the proposed guideline. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Introduction: Colposcopy is a gynaecological invasive day procedure involving visualization of cervix for diagnostic and therapeutic purpose. Women who are waiting for this procedure often experience high anxiety. Several studies have demonstrated that adopting pre-colposcopy patient education strategy can relieve such psychological distress. In this translational research, a relevant evidence-based education guideline is formulated for a colposcopy clinic in a local public hospital. Objectives: The objectives of this translational research proposal include (1) extracting the current empirical evidence on the education intervention for minimizing the psychological distress among women waiting for their first colposcopy examination; (2) developing an educational protocol; (3) and developing a plan of intervention and evaluation for the proposed protocol. Methods: A literature search for studies dealing with patient education of women at risk of cervical cancer was performed in PubMed and PsycINFO. After data extraction from the identified studies, the methodology quality of the studies was appraised by the methodology checklist of Scottish Intercollegiate Guidelines Network (SIGN) (2011). Then, an evidence-based protocol was formulated according to the recommendations drawn from the evidence. Before putting the protocol into practice, a systematic implementation potential assessment was done by evaluating the transferability of the findings, and the feasibility and cost-benefit ratio of the protocol. Both communication and evaluation plan were developed for a smooth implementation of the protocol. Results: 10 studies fulfilled the inclusion criteria of the literature search and were used for developing an evidence-based protocol of pre-colposcopy patient education. After the assessment, distributing written and audio-visual education materials at patients’ first colposcopy appointment is concluded to be a feasible innovation in the target setting. Conclusion: Based on the extracted evidence from the systematical review, patient education strategy can potentially benefit the first-time colposcopy patient in the target setting to alleviate their anxiety during their wait for the examination. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Chemotherapy is one of the major treatments for cancer patients to cure or palliate their disease. Cancer patients experience physiological and psychological distress during chemotherapy treatment. Anxiety is the most common symptom observed in cancer patients undergoing chemotherapy. Anxiety has also proven to be highly associated with anticipatory nausea and vomiting (ANV). In the local chemotherapy day ward, almost half of the cancer patients verbalize that they feel anxious and are afraid of turning up for chemotherapy due to the fear of its side effects. However, clinical measure for treating patients’ anxiety during chemotherapy is limited. One of the complementary and alternative medicines (CAM), massage therapy, becomes a useful means for cancer patients to relieve their physical and psychological distress. Yet, massage is not a routine CAM being integrated into the cancer treatment in Hong Kong, including the target center. Thus, a translational study is proposed in order to develop a massage program for cancer patients receiving chemotherapy to relieve their anxiety. A systematic search of five electronic journal databases identified 9 randomized controlled trials (RCTs) on the use of massage therapy for cancer patients in relieving their anxiety. The appraisal tool developed by the Critical Appraisal Skills Programme was used to evaluate the quality of the selected studies. The findings of the selected studies concluded that massage therapy is effective in relieving anxiety for cancer patients. A massage program is proposed to be implemented in a chemotherapy day ward. This translational research proposal will illustrate how such a massage program is planned. The implementation potential has been assessed and the potential benefits of massage do outweigh its risks and the costs of running this program. An evidence-based guideline has been developed to ensure patient safety and increase effectiveness of the massage program. The communication process with stakeholders has been planned in order to gain their support for this massage program. Staff training will be organized and a pilot study has been designed to test the feasibility of this program. An evaluation plan has also been developed to assess the effectiveness of this program. Anxiety level, measured by using State Trait Anxiety Inventory-State (STAI-S), is set as the primary patient outcome of this study. In addition, Numerical Rating Scale (NRS), rating from 0 to 10, will be used as the secondary patient outcome to measure the severity of nausea and vomiting. Lastly, the satisfaction level of patients, volunteers and nurses will be measured using a 4-point Likert scale. Therefore, the proposed massage program can be improved and refined according to the evaluation findings. It is believed that the proposed massage program can reduce anxiety for cancer patients receiving chemotherapy and thus improving their quality of life. / published_or_final_version / Nursing Studies / Master / Master of Nursing

The evolution and spread of influenza virus impose great impact on the society in the past century. Humans are still facing the zoonotic threat arising from animal influenza viruses; however, the existing knowledge is not sufficient to provide an accurate prediction of the next pandemic strain. My objective is to put forward the preparedness for influenza pandemics in two ways: molecular diagnosis and cross-protective vaccine. Influenza gene reassortment can take place during co-infection and produce novel viruses. While the pig is regarded as the potential mixing vessel for influenza viruses, it is important to develop rapid diagnostic assays to identify reassortment events in swine surveillance. In this study, rapid diagnostic assays were developed for genotyping pandemic H1N1/2009 and closely related swine influenza viruses. Eight real-time SYBR green-based reverse transcription-polymerase chain reactions (RT-PCR) containing locked nuclei acid (LNA) probes differentiated segments derived from pandemic H1N1/2009, Eurasian avian-like (EA), and triple reassortant (TR) swine virus lineages. With the help of these assays, 41 swine isolates collected during January 2009 to January 2010 in an ongoing swine surveillance programme in Hong Kong were successfully genotyped. Ten of these viruses were pandemic H1N1/2009 viruses, suggesting zoonotic transmissions of the virus from humans to pigs. A novel pandemic reassortant was also discovered during the course of surveillance. This study is the first to show pandemic H1N1/2009 virus has reassorted with other endemic swine viruses in the pig population. The genotyping assays provide a rapid and high throughput screening method to select viruses of interesting segment combination for downstream sequencing analysis and characterization. They will be useful for understanding viral reassortment and complex evolutionary dynamics in routine swine surveillance activities. Current influenza vaccines are strain-specific and the production schedule shows significant delay to reach the general population. The study aims at engineering a novel live attenuated virus vaccine which offers cross-subtypic protection. The feasibility for the conserved hemagglutinin (HA) stalk domain to induce broadly neutralizing antibodies was investigated. By manipulating the segment-specific packaging sequences, a nine-segment A/Puerto Rico/8/1934 (H1N1) (PR8) influenza virus carrying the headless HA of a different subtype (A/Hong Kong/1/1968 (H3N2)) (HK68) was generated by reverse genetics. The virus showed attenuated growth in in vitro cell culture and reduced pathogenicity in mice. Although mice vaccinated with this vaccine were better protected in the challenge of HK68 virus in comparison to unvaccinated mice, there is not enough evidence to verify cross-reactive immunity conferred by the HK68 headless HA immunogen, due to the heterosubtypic response induced by live virus administration. The absence of cross-neutralizing antibodies in immune sera may be explained by sub-optimal folding of the HK68 headless HA. Further studies are needed to modify the immunogen into its native conformation and elucidate the underlying vaccine-host interactions. These two studies have resulted in a useful diagnostic tool to increase influenza surveillance capacity at the swine-human interface, and the foundation for better universal vaccine design based on the conserved HA stalk domain. / published_or_final_version / Public Health / Master / Master of Philosophy

Youth tobacco use is a major public health problem worldwide. Studies show that there is an association between exposure to anti-smoking advertising and youth smoking prevalence. Anti-smoking advertising can be used as an important tobacco control measure to prevent youth smoking. The objectives of this review mainly focus on evaluating the effectiveness of anti-smoking advertising on youth smoking, analyzing the influential factors that may affect the effectiveness. 4 main databases, PubMed, EBSCO, Scopus and Google Scholar were included for literature searching, as well as the reference lists, and 483 related articles were found initially. After restricted by the inclusion and exclusion criteria, 11 articles were included for analysis ultimately. According to this review, the influential factors included the exposure rate, sponsor, promotion approaches and the theme of anti-smoking advertising. Those factors have significant effects on youth’s smoking behavior and smoking prevalence. Non-tobacco industry sponsored, high exposure rate, the theme of negative life circumstance and using humor as a vehicle to deliver anti-smoking messages can be effective in reducing the smoking rate among youth. However, the methods used in the included articles were uneven, and the mechanism of the anti-smoking advertising on youth smoking is still unclear, further research should be conducted. The results of this review can still have some instructions to policy-makers on formulating tobacco control measures in the future, especially the anti-smoking program. / published_or_final_version / Public Health / Master / Master of Public Health

Our research laboratory has recently reported that mucosal priming with a replicating modified vaccinia Tiantan virus (MVTTgpe)-based vaccine elicits durable protection against pathogenic SIVmac239 infection in rhesus monkeys. However, the protective role of vaccine-elicited antibody responses remains poorly understood. Here, a novel yeast surface displayed (YSD) antigen library was established to quantitatively map the antigenic determinants presented by MVTTgpe-based and control vaccines as well as by SIVmac239 infection. The YSD-library allows the mapping of linear and some conformational epitopes as a major technical innovation, as validated by testing SIV-specific mAbs KK65, KK8 and VM-18S. While eight antigenic domains are characterized covering the entire SIVmac239 gp160, the MVTTgpe/Ad5gpe regimen uniquely induces antibody responses against a distinct major antigenic determinant (MAD) in V2 region as compared with the Ad5gpe/Ad5gpe vaccination and SIV infection. This MAD is associated with a higher titer of anti-V2 antibody responses, which inversely correlates with peak viral load. Unexpectedly, the MVTTgpe/Ad5gpe vaccine- challenge. The results showed that instead of recalling B cell memory response to V2, viral infection presents a distinct set of antigenic determinants with anti-V1V2 antibodies primarily directed to V1 region. Moreover, the anti-V1V2 antibody responses disappear in two infected macaques after they enter the stage of simian AIDS. SIVmac239 infection, therefore, can modulate vaccine-elicited B cell immunity by diminishing anti-V2 antibody memory responses in rhesus monkeys. These findings implicated that vaccine efforts with focus on V2 region would require periodic vaccinations to maintain a long-lasting high level of antibody responses for protection. In the absence of an effective vaccine for eliciting HIV-1-specific broadly neutralizing antibodies (bNAbs), passive immunization with bNAbs or Ab-like agents (e.g. immunoadhesin) becomes an attractive alternative for HIV-1 prevention. In this study, we aimed to design, optimize and produce secretory immunoadhesins (IAs) based on gene engineering of existing HIV-1 specific bNAbs for potency and production improvements. IAs are chimeric, antibody-like molecules that combine the functional domain of bNAb with immunoglobulin constant domains, including the hinge and Fc regions. We found that the modified secretory IAs not only preserved the neutralization activity of the parental bNAbs, but also had enhanced expression and smaller molecular size that is suitable for antibody gene-based in vivo delivery. Furthermore, we defined the synergistic effects of five IAs against HIV-1 infection and subsequently engineered two types of bi-specific IAs by combining the functional domains of Hu5A8, a humanized anti-CD4 antibody, and the bNAb PGT128. Significantly, one of the bi-specific IA, namely Bi-IA-Mono, neutralized 100% of the 33 viruses tested, including the transmitted/founder viruses and viruses resistant to both parental IAs. The remarkably enhanced neutralization activity of Bi-IA-Mono, either in potency and breadth, indicated the great potential of modified bi-specific IA to provide complete or nearly complete protection against major HIV-1 subtypes. Overall, our results demonstrated that the engineering of IA and bi-specific IA is an attractive way to improve anti-HIV-1 properties of existing bNAbs, which have significant implications for antibody-based prophylactics in blocking diverse HIV-1 transmissions and infections. / published_or_final_version / Microbiology / Doctoral / Doctor of Philosophy

Background: The Gail Model is a statistical and risk assessment tool for women with given age and risk factors to estimate their probability that will develop invasive breast cancer. An accurate assessment of individual risk for developing breast cancer would be useful for health care providers to facilitate their risk communication with women at average risk and to make decision on taking chemoprevention for high-risk women in clinical practice. Currently, there are several validation studies of the Gail Model in western populations, however, model validity on Chinese people has not yet to be studied. Objective: To conduct a systematic review on the studies that validated the performance accuracy of the Gail model for predicting risk of developing breast cancer at population level and individual level. Methods and results: The literature search on the PubMed database and additional articles retrieved by hand searching reference lists. After applying the inclusion and exclusion criteria, a total of 11 studies met the criteria and finally include in the systematic review. Quality of review studies was assessed follow the STROBE checklist. The PRSMA guidelines were used to produce this review. Conclusions: The Gail model was validated in general American white women with annual screening. However, there is insufficient evidence to approve that the Gail model can be applied to Chinese women in China widely. / published_or_final_version / Public Health / Master / Master of Public Health

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