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Strengthening of composite beams is highly needed to upgrade the capacities of existing beams. The strengthening methods can be classified as active or passive techniques. Therefore, the main purpose of this study is to provide detailed FE simulations for strengthened and unstrengthened steel–concrete composite beams at the sagging and hogging moment regions with and without profiled steel sheeting. The developed models were verified against experimental results from the literature. The verified models were used to present comparisons between the effect of using external post-tensioning and CFRP laminates as strengthening techniques. Applying external post-tensioning at the sagging moment regions is more effective because of the exhibited larger eccentricity. In the form of an initial camber and compressive stresses in the bottom flange prior to loading, this reasonable eccentricity induces reverse loading on the reinforced beams, reducing the net tensile stress induced during loading. Using CFRP laminates on the concrete slab for continuous composite beams is more effective in enhancing the beam capacity in comparison with using the external post-tension. However, reductions in the beam ductility were obtained.

Introduction: This study aimed to determine the prevalence and factors associated with psychological distress following the COVID-19 pandemic among medical students at one of the public universities in Malaysia. Method: From August to October 2020, a web-based cross-sectional study was conducted among undergraduate medical students at a public university. DASS-21, Brief Resilience Scale and WHOQOL-Bref questionnaires were used in this study. Results: The prevalence of depression was 40.5%, anxiety 46.0% and stress 30.9%. Based on multivariate logistic regression, a higher quality of life score is associated with a lower likelihood of depression (AOR=0.583, p

This study presents an experimental investigation on composite beams (CB) to explore the effectiveness of adding external post-tensioning (EPT) force, as a strengthening technique, on the monotonic flexural performance of composite samples. Two experiments on CB were conducted under three-point loading. High-strength steel strands post-tensioned to 46% of the ultimate strength were used to apply the EPT. Moreover, a finite element (FE) model is developed to present numerical investigations on the monotonic and fatigue behaviors of the CB with and without EPT by considering the slip between the concrete slabs and steel beams as well as the fatigue deterioration in the concrete slabs. A FE parametric study is conducted using the proposed FE model to investigate the effect of steel beam grade, tendon eccentricity, span-to-depth ratio, and fatigue loading. The optimum span-to-depth ratio to obtain the maximum contribution of the EPT force in improving the CB capacities is 9.0.

Connections between steel beams and concrete slabs that reduce the number of shear connectors by using studs with a larger size or partial shear connections could be advantageous by reducing installation time and provide additional working space for construction workers to move on the top steel flange. In this paper, steel and concrete composite beams with different headed stud shear connector arrangements were tested under fatigue loading to evaluate the crack patterns in concrete slabs, deformations, and strains in the composite sections and shear connectors. These arrangements included full shear connections achieved by 22.2 mm and 15.9 mm diameters headed stud connectors arranged in one and two rows, respectively, and a partial shear connection with two rows of 15.9 mm diameter shear connectors. Distributing the required resistance of shear to a larger population of smaller studs produced more beneficial behavior over that of a smaller population of larger diameter studs. The concrete slab fully shear connected by the one-row arrangement experienced longitudinal cracks during fatigue loading, which led to more stiffness degradation and strength deterioration, while such cracks were eliminated in the two-row arrangement. Therefore, 77.1%, 177.7%, and 152.5% increase in the incremental deflection, slippage, and studs’ strains, respectively, were obtained for this specimen. Moreover, reductions of 83.0% and 66.7% were obtained in the composite action in terms of the cyclic slippage for the specimens with the one- and two-row arrangements, respectively. Final residual static tests up to failure were conducted to explore the residual behavior of the fatigued specimens. Degradations in the residual stiffness and strength of the fatigued specimens occurred and more partially composite effects were obtained, which led to higher residual strains in the headed stud connectors and extreme fibers of the composite sections of 12.6% and 16.6%, respectively.

Implementing asthma guideline recommendations is challenging in low- and middle-income countries. We aimed to explore healthcare provider (HCP) perspectives on the provision of recommended care. Twenty-six HCPs from six public primary care clinics in a semi-urban district of Malaysia were purposively sampled based on roles and experience. Focus group discussions were guided by a semi-structured interview guide and analysed thematically. HCPs had access to guidelines and training but highlighted multiple infrastructure-related challenges to implementing recommended care. Diagnosis and review of asthma control were hampered by limited access to spirometry and limited asthma control test (ACT) use, respectively. Treatment decisions were limited by poor availability of inhaled combination therapy (ICS/LABA) and free spacer devices. Imposed Ministry of Health programmes involving other non-communicable diseases were prioritised over asthma. Ministerial policies need practical resources and organisational support if quality improvement programmes are to facilitate better management of asthma in public primary care clinics.

Background Digital health can support health care in low- and middle-income countries (LMICs) by overcoming problems of distance, poor infrastructure and the need to provide community practitioners with specialist support. We used five RESPIRE countries as exemplars (Bangladesh, India, Indonesia, Malaysia, Pakistan) to identify the digital health solutions that are valuable in their local setting, worked together with local clinicians and researchers to explore digital health policy, electricity/ICT infrastructure, and socio-cultural factors influencing users’ ability to access, adopt and utilise digital health. Methods We adopted the Joanna Briggs Institute’s scoping review protocol and followed the Cochrane Rapid Review method to accelerate the review process, using the Implementation and Operation of Mobile Health projects framework and The Extended Technology Acceptance Model of Mobile Telephony to categorise the results. We conducted the review in four stages: (1) establishing value, (2) identifying digital health policy, (3) searching for evidence of infrastructure, design, and end-user adoption, (4) local input to interpret relevance and adoption factors. We used open-source national/international statistics such as the World Health Organization, International Telecommunication Union, Groupe Speciale Mobile, and local news/articles/government statistics to scope the current status, and systematically searched five databases for locally relevant exemplars. Results We found 118 studies (2015-2021) and 114 supplementary online news articles and national statistics. Digital health policy was available in all countries, but scarce skilled labour, lack of legislation/interoperability support, and interrupted electricity and internet services were limitations. Older patients, women and those living in rural areas were least likely to have access to ICT infrastructure. Renewable energy has potential in enabling digital health care. Low usage mobile data and voice service packages are relatively affordable options for mHealth in the five countries. Conclusions Effective implementation of digital health technologies requires a supportive policy, stable electricity infrastructures, affordable mobile internet service, and good understanding of the socio-economic context in order to tailor the intervention such that it functional, accessible, feasible, user-friendly and trusted by the target users. We suggest a checklist of contextual factors that developers of digital health initiatives in LMICs should consider at an early stage in the development process.

This paper investigates the long-term response of reinforced concrete (RC) beams strengthened with CFRP subjected to sustained static loads. The beams were strengthened using two different configurations of CFRP with different steel reinforcement ratios and web reinforcement. Two RC beams and five CFRP-RC beams were evaluated under static short-term bending, and five additional CFRP-RC beams were evaluated under sustained loads for 332 days. The sustained loads were maintained at around 60% of the static capacity of the beams strengthened with CFRP. The residual strength of the CFRP-RC beams after long-term creep testing was evaluated experimentally under static loads to failure. CFRP sheets were attached to the transverse and tension faces of the beams. The test results show that CFRP strengthening of beams is effective in enhancing their static capacities. The residual strength of the long-term creep-tested beams was 5–18% lower than the strength of the short-term beams except for the steel over-reinforced beam. In addition, the residual stiffness did not change significantly. However, the residual toughness was 22% to 64% of the toughness of the short-term beams due to creep damage. The web steel reinforcement played an important role in improving the overall performance and failure mode of the strengthened beams.

BACKGROUND: Adjusting to life with a chronic condition is challenging, especially for people with limited health literacy, which is associated with low compliance with self-management activities and poor clinical outcomes.OBJECTIVE: We explored how people with limited health literacy understand asthma and undertake self-management practices.DESIGN: We adapted the arts-based qualitative methodology Photovoice.SETTING AND PARTICIPANTS: We sampled ethnically diverse adults with asthma and limited health literacy from four primary healthcare clinics in Malaysia. After a semistructured in-depth interview, a subset of participants took part in the Photovoice component in which participants undertook a 2-week photo-taking activity and subsequent photo-interview. Interviews, conducted in participants' preferred language, were audio-recorded, transcribed verbatim, translated and analysed thematically. We used the Sorensen's framework (Domains: access, understand, appraise, apply) to describe participants' experience of living with asthma, what they understood about asthma and how they decided on self-management practices.RESULTS: Twenty-six participants provided interviews; eight completed the Photovoice activities. Participants with limited health literacy used various sources to access information about asthma and self-management. Doctor-patient communication had a pivotal role in helping patients understand asthma. The lack of appraisal skills was significant and experiential knowledge influenced how they applied information. Self-management decisions were influenced by sociocultural norms/practices, stigmatizing experiences, and available social support.CONCLUSION: Locally tailored multilevel interventions (interpersonal, health system, community and policy) will be needed to support people with limited health literacy to live optimally with their asthma in an ethnically diverse population.PATIENT/PUBLIC CONTRIBUTION: Patients were involved in the study design, recruitment, analysis and dissemination.

Fingerplate expansion devices are commonly used to account for movements and rotations of two bridge deck slabs. Under high traffic volumes, these devices experience premature damage that affects the structural integrity of the bridge superstructure. In this paper, a group of experimental tests and 3D elastic–plastic finite element models (FEMs) were conducted to study the structural behavior and modes of failure of this type of joints. The experimental results were also used to validate the FEMs, from which additional FEM models were employed to study the effects of various design parameters. The parametric study results showed that the finger thickness did not influence the response in the absence of stiffeners. On the other hand, the presence of stiffeners increased the finger joint stiffness while decreased the device ductility. Welding zones were the sites of crack initiation in most of the studied cases. The numerical results showed that the locations of the highest stress concentrations were in the weld between the fingerplate and the supporting beam top flange and in the weld between the stiffeners and the top flange.

Steel-concrete composite beams in highway bridges are susceptible to various types of damage during their service life. These damages can greatly affect the structural performance and shorten the fatigue life of bridges. The efficacy of adding external post-tensioning, as a strengthening technique, to steel–concrete composite beams that are subjected to fatigue loading is not well investigated. Therefore, this study includes fatigue testing of post-tensioned steel–concrete composite beams with various types of pre-damage. Three of the tested samples were subjected to outdoor environmental changes, cyclic preloading, and static overloading as pre-damages before applying the external post-tensioning. The strengthened samples were exposed to fatigue tests to a million cycles under four-point bending. Samples without pre-damage were tested as references to those with pre-damages. The crack patterns in the concrete decks were evaluated during these tests. Static tests to failure were performed to explore the residual capacities, deformations, and strains of all fatigued samples. The crack patterns in concrete decks were significantly affected by the type of pre-damage that was applied before the post-tensioning. The static overloading pre-damage reduced the number of cracks and their rate of propagation while the exposure to outdoor environment pre-damage induced more cracks, which negatively affected the crack patterns during fatigue loading. Subjecting the sample to plastic deformation pre-damage slightly improved its performance in terms of residual stiffness and ultimate load. The residual ultimate load was increased by 7% relative to the fatigued sample without pre-damage. However, the ductility was reduced by 40% due to the initial plastic deformation. This reduction in ductility was combined with a decrease in the interface slippage between the concrete deck and steel flange.

Supported self-management reduces asthma-related morbidity and mortality. This paper is on a feasibility study, and observing the change in clinical and cost outcomes of pictorial action plan use is part of assessing feasibility as it will help us decide on outcome measures for a fully powered RCT. We conducted a pre–post feasibility study among adults with physician-diagnosed asthma on inhaled corticosteroids at a public primary-care clinic in Malaysia. We adapted an existing pictorial asthma action plan. The primary outcome was asthma control, assessed at 1, 3 and 6 months. Secondary outcomes included reliever use, controller medication adherence, asthma exacerbations, emergency visits, hospitalisations, days lost from work/daily activities and action plan use. We estimated potential cost savings on asthma-related care following plan use. About 84% (n = 59/70) completed the 6-months follow-up. The proportion achieving good asthma control increased from 18 (30.4%) at baseline to 38 (64.4%) at 6-month follow-up. The proportion of at least one acute exacerbation (3 months: % difference −19.7; 95% CI −34.7 to −3.1; 6 months: % difference −20.3; 95% CI −5.8 to −3.2), one or more emergency visit (1 month: % difference −28.6; 95% CI −41.2 to −15.5; 3 months: % difference −18.0; 95% CI −32.2 to −3.0; 6 months: % difference −20.3; 95% CI −34.9 to −4.6), and one or more asthma admission (1 month: % difference −14.3; 95% CI −25.2 to −5.3; 6 months: % difference −11.9; 95% CI −23.2 to −1.8) improved over time. Estimated savings for the 59 patients at 6-months follow-up and for each patient over the 6 months were RM 15,866.22 (USD3755.36) and RM268.92 (USD63.65), respectively. Supported self-management with a pictorial asthma action plan was associated with an improvement in asthma control and potential cost savings in Malaysian primary-care patients.Trial registration number: ISRCTN87128530; prospectively registered: September 5, 2019, http://www.isrctn.com/ISRCTN87128530.

Background: Asthma has a significant impact on people of all ages, particularly children. A lack of universally accepted case definition and confirmatory tests and a poor understanding of major risks interfere with a global response. We aimed to provide global estimates of asthma prevalence and cases in 2019 across four main epidemiological case definitions - current wheezing, ever wheezing, current asthma, and ever asthma. We further investigated major associated factors to determine regional and national distributions of prevalence and cases for current wheezing and ever asthma.Methods: We identified relevant population-based studies published between January 1, 1990, and December 31, 2019. Using a multilevel multivariable mixed-effects meta-regression model, we assessed the age- and sex-adjusted associations of asthma with study-level variables, including year, setting, region and socio-demographic index (SDI). Using a random-effects meta-analysis, we then identified risk factors for current wheezing and asthma. From a "risk factor-based model", which included current smoking, and biomass exposure for current wheezing, and rural setting, current smoking, biomass exposure, and SDI for ever asthma, we estimated case numbers and prevalence across regions and 201 countries and territories in 2019.Results: 220 population-based studies conducted in 88 countries were retained. In 2019, the global prevalence estimates of asthma in people aged 5-69 years by various definitions, namely current wheezing, ever wheezing, current asthma, and ever asthma were 11.5% (95% confidence interval (CI) = 9.1-14.3), 17.9% (95% CI = 14.2-22.3), 5.4% (95% CI = 3.2-9.0) and 9.8% (95% CI = 7.8-12.2), respectively. These translated to 754.6 million (95% CI = 599. 7-943.4), 1181.3 million (95% CI = 938.0-1,471.0), 357.4 million (95% CI = 213.0-590.8), 645.2 million (95% CI = 513.1-806.2) cases, respectively. The overall prevalence of current wheezing among people aged 5-69 years was the highest in the African Region at 13.2% (95% CI = 10.5-16.5), and the lowest in the Americas Region at 10.0% (95% CI = 8.0-12.5). For ever asthma, the estimated prevalence in those aged 5-69 years was also the highest in the African Region at 11.3% (95% CI = 9.0-14.1), but the lowest in South-East Asia Region (8.8, 95% CI = 7.0-11.0).Conclusions: Although varying approaches to case identification in different settings make epidemiological estimates of asthma very difficult, this analysis reaffirms asthma as a common global respiratory condition before the COVID-19 pandemic in 2019, with higher prevalence than previously reported in many world settings.

Carbon fiber-reinforced polymer (CFRP) has many advantages as a construction/structural-strengthening material. However, there are still concerns regarding the long-term performance of these materials when used with reinforced concrete (RC) structures. Environmental conditions have an adverse effect on the behavior of CFRP and the bond between these sheets and concrete. Therefore, the durability of CFRP used for strengthening RC beams was evaluated under different environmental scenarios, including subjection to immersion in deicing agents, tap water, and saltwater, freeze-and-thaw cycles, and outdoor environmental changes. Laboratory tests were performed to examine the influence of these environmental scenarios on the bonding behavior between CFRP sheets and concrete in terms of deformations and modes of failure. Two types of test setups were performed in this study, namely pull-off shearing and three-point bending. Forty-two concrete prisms with CFRP were prepared and tested by using the pull-off shearing setup. It was observed that as the period of exposure increased, noticeable effects on the CFRP sheet as well as the bond stiffness were observed. Exposure to tap water had a greater impact than saltwater on the CFRP–concrete bond strength as well as the CFRP. In addition, eighteen notched concrete beams strengthened with an external CFRP were tested under three-point bending. The tap water exposure showed a 3.6% increase in the bond strength compared to the control specimen. However, the saltwater exposure showed a 10% increase.

Prevalence, awareness and control of hypertension in Malaysia from 1980-2018: A systematic review and meta-analysis

Family history has long been recognised as a non-invasive and inexpensive tool to identify individuals at risk of genetic conditions. Even in the era of evolving genetic and genomic technology, the role of family history in predicting individual risk for genetic testing and guiding in preventive interventions is still relevant, especially in low-resource countries. The aim of this study was to explore primary care doctors' views and experiences in family history taking and how they utilised family history in day-to-day clinical consultations in Malaysia. Four focus group discussions and six in-depth interviews involving 25 primary care doctors were conducted. Three themes emerged from the analysis: (1) primary care doctors considered family history as an important part of clinical assessment, (2) proactive versus reactive approach in collecting family history and (3) family history collection was variable and challenging. Family history was documented in either free text or pedigree depending on the perception of its appropriateness during the consultation. This study highlighted the need to improve the approach, documentation and the implementation of family history in the Malaysian primary care settings. Integrating family filing concept with built-in clinical decision support into electronic medical records is a potential solution in ensuring effective family history taking in primary care.

ObjectiveWe aimed to explore the views of Malaysian children with asthma and their parents to enhance understanding of early influences on development of self-management skills.DesignThis is a qualitative study conducted among children with asthma and their parents. We used purposive sampling and conducted focus groups and interviews using a semi-structured topic guide in the participants’ preferred language. All interviews were audio-recorded, transcribed verbatim, entered into NVivo and analysed using a grounded theory approach.SettingsWe identified children aged 7–12 years with parent-reported, physician-diagnosed asthma from seven suburban primary schools in Malaysia. Focus groups and interviews were conducted either at schools or a health centre.ResultsNinety-nine participants (46 caregivers, 53 children) contributed to 24 focus groups and 6 individual interviews. Children mirrored their parents’ management of asthma but, in parallel, learnt and gained confidence to independently self-manage asthma from their own experiences and self-experimentation. Increasing independence was more apparent in children aged 10 years and above. Cultural norms and beliefs influenced children’s independence to self-manage asthma either directly or indirectly through their social network. External influences, for example, support from school and healthcare, also played a role in the transition.ConclusionChildren learnt the skills to self-manage asthma as early as 7 years old with growing independence from the age of 10 years. Healthcare professionals should use child-centred approach and involve schools to facilitate asthma self-management and support a smooth transition to independent self-management.Trial registration numberMalaysian National Medical Research Register (NMRR-15-1242-26898).

Research on health literacy is expanding worldwide. Health literacy has been recognised as a critical determinant of health at the 2016 Shanghai Declaration. Little is known about health literacy research in Malaysia. This scoping review aims to identify and summarise published studies on health literacy in Malaysia. PubMed, Scopus and the Malaysian Medical Repository (MyMedR) databases were searched for published work by Malaysian researchers. Searches were conducted up to November 2019. The search terms used are related to ‘health literacy’ and ‘Malaysia’. Studies included were those involving Malaysian citizens and reporting on various aspects of health literacy. Studies were reviewed by two independent reviewers to determine their eligibility. Data extraction for the year of publication, name of authors, geographical location, research focus, and summary of findings from the full-text articles was carried out independently and any disagreement was resolved by consensus. A total of 29 articles were included with the earliest article published in 1985. Fifteen of the articles are on general health literacy, four on medication literacy, five on mental health literacy, three on media and e-health literacy and four on oral health literacy. Four articles are qualitative studies and the rest are quantitative studies. A few of the studies used validated health literacy tools such as Newest Vital Signs and HLS-EU-Q47. Therefore, we can conclude that there are only a limited number of articles published in the field of health literacy in Malaysia. Future work using validated international tools to allow comparison of the findings should be considered.

Several steel bridges in Egypt were built during the late nineteenth to early twentieth centuries. At this time, riveted construction was the method used for building up members and for the connection of one member to another. In this paper, field measurements were performed to find the actual dimension of an existing old riveted steel bridge (El-Ministerly Bridge, Egypt). The inspection of the steel bridge did not find any clear cracks. Finite element models were created to predict the response of the steel bridge. The finite element model was used to identify the location of the stress concentration. A static field test was performed using a 49-ton truck to evaluate actual strain measurements in different locations over the bridge. The strain measurement was used to validate the finite element model while was able to predict the experimental data closely. As an application of the use of the finite element model, evaluate the bridge was executed using AASHTO standards, Egyptian code (ECP) and S–N curves from the literature. It was observed that all stress ranges for this bridge were less than the ECP limits (Fsr) and the estimated remaining fatigue life is about 11 years if it is environmentally protected.

Sandwich wall systems provide resistance over a large deformation range, making them useful for blast resistance. This paper analyzed three sandwich panel systems: walls with symmetric conc...

Background Technology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic). Objective The aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop. Methods We recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues. Results The stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout. Conclusions This study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing.

Background Limited health literacy among people with asthma is associated with poor adherence to self-management activities, thus poor clinical outcomes. This study aimed to determine the prevalence of health literacy level and its determinants among people with asthma in the Malaysian primary healthcare settings. Method A cross-sectional study was conducted among participants aged > 18 years with asthma who attended five primary health clinics in Malaysia. Systematic random sampling was employed with a final sample of 550 participants. The questionnaires included the validated Malay version of Health Literacy Scale (HLS) and asthma control questionnaire (ACQ). Statistical analysis was done using SPSS version 25. Multiple logistic regression was performed to determine the determinants for limited health literacy. Results The participants mean age of the participants was 48 (SD15.4) years. Most of the participants were women (64%) and of Malay ethnicity (51.1%). Nearly half had a secondary level of education, n = 112, (45.8%). Mean duration of asthma diagnosis is 20.6 (SD 15.9) years. More than half (62.5%) had a family history of asthma. About half (50.9%) had uncontrolled asthma, with 87.3% self-rated themselves as having controlled asthma. About a third (29.1%) received education on of asthma action plan, but only 7.1% of these owned a written version an asthma action plan. Limited health literacy accounts for 60.5% of the participants. The significant determinants for limited health literacy included lower educational attainment (p p = 0.034), p = 0.031) and not receiving asthma action plan education (p Conclusion In this study population, more than half of the people living with asthma were found to have limited health literacy, which was associated with not having received self-management education supported by an asthma action plan. Future interventions should include strategies that ensure they meet the needs of people with limited health literacy.

Ginkgo Biloba (GB) is a widely used finished herbal product. Due to its natural source there is no demand to evaluate its quality before marketing. Although GB products have shown promising potential with the efficacy, many of these products remain untested. The Current work aims to evaluate some quality parameter of GB finished products like total flavonoid content (TFC), microscopic, Loss On Drying (LOD) and microbial tests in comparison with GB crude plant. The TFC ranged from (22.86 to78.74 mg/g). Microscopic findings revealed the presence of large amounts of starch grains in product A. Furthermore, most of the products were heavily contaminated with bacteria and fungi. As bacterial colony counts ranged from (103 to 7.5 × 105 CFU/g) and from (1.7 × 103 to 0.75 × 107 CFU/g) for fungal colony counts. Most of the products exceeded the reference limits for LOD. thus may pose a threat to consumer's health.

Asthma self-management is a crucial component of asthma management. We sought to explore healthcare professionals’ (HCPs’) perceptions on barriers to asthma self-management implementation in primary care. We recruited 26 HCPs from six public primary care clinics in a semi-urban district of Malaysia in 2019. The analysis was done inductively. HCPs described barriers that resonated with the “COM-B” behaviour change framework. Capability-related issues stemmed from a need for specific self-management skills training. Opportunity-related barriers included the need to balance competing tasks and limited, poorly tailored resources. Motivation-related barriers included lack of awareness about self-management benefits, which was not prioritised in consultations with perceived lack of receptiveness from patients. These were compounded by contextual barriers of the healthcare organisation and multilingual society. The approach to implementation of asthma self-management needs to be comprehensive, addressing systemic, professional, and patient barriers and tailored to the local language, health literacy, and societal context.

Pre-stressed steel-concrete composite beams are widely used in bridges around the world. Loads during the service life of bridges may cause failure in the form of fracture in the studs near the ends of the bridge girders. The effect of stud failure on the residual static capacity and residual fatigue life of composite girders is not well investigated. Therefore, this study presents numerical investigations into the effects of the progressive failure of stud shear connectors on the residual static performance and remaining fatigue life of post-tensioned steel-concrete composite beams. The Finite Element (FE) model was validated using existing experimental work. Moreover, the effects of the progressive failure of stud shear connectors on the steel-concrete interface slippage, shear stress range, and compressive and tensile strains were investigated. The behavior of the composite girders in terms of the estimated fatigue life and residual capacity was inversely affected by the number of fractured studs. The AASHTO theoretical equation conservatively estimated the remaining fatigue life until 15% of the rows were removed and then the FE model predicted fewer remaining fatigue cycles than the theoretical equation. Until 15% of the rows were removed, the strengthened sample had a better response in terms of the stress range, tensile and compressive strains, and residual capacity. After that, both the strengthened and non-strengthened samples exhibited similar responses to the failure of studs. Subsequently, the positive effects of the post-tensioning vanish as the end studs fail. Therefore, designers should pay special attention to the ends of post-tensioned composite beams where the local failure of studs is expected.

Introduction: Adjusting to life with a chronic condition is particularly challenging for people with limited health literacy. We aimed to explore the views and experiences of people with limited health literacy on managing their asthma. Methods: We purposively sampled adults with asthma and limited health literacy (using HLS-Q47) from 5 primary healthcare clinics in Malaysia. We conducted semi-structured interviews in participants’ preferred language, and invited participation in Photovoice: (1) One-week photo-taking (2) Post-photo interview. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Results: 26 participants provided interviews. 8 of whom completed Photovoice activities providing additional insights. The understanding of asthma and its treatment has a significant impact on acceptance and negotiation of their identity as a person with asthma (and thence of adoption of asthma action plans). Non-acceptance to asthma diagnosis which is profound in people who were subjected to stigmatising experiences (i.e. shaming on use of inhaler in public), affects asthma control. In contrast, social support shaped a more positive understanding and experience of asthma. Conclusion: Good communication with primary care practitioners, and helping people with limited health literacy living with asthma to understand their illness better is crucial to improving self-management skills. Promoting awareness of asthma in the society may improve the level of social support and potentially lessen stigmatising experiences. Funding: HS is a PhD student with the UK NIHR Global Health Research Unit (RESPIRE).

In this paper, experimental investigations for strengthening reinforced concrete (RC) continuous beams were performed. Eighteen T-beams were cast, twelve of which were inverted T-beams where the flange portion of the T-beam was subjected to positive flexure to represent the support region of a continuous beam. Six of the T-beams were non-inverted where the web is subjected to positive flexure. Carbon fiber reinforced polymer (CFRP) sheets with different widths were considered, and different strengthening configurations with the same area of CFRP were investigated. The use of one-layer, multiple layers, or multiple strips of CFRP were evaluated to investigate the effect of these configurations on the ultimate capacity and ductility of the strengthened beams. From the experimental observation of the non-inverted beams, it was found that the ultimate load capacities of the CFRP-strengthened beams were enhanced by 4% to 90% compared to the control beam. Using multiple layers of CFRP sheets enhanced the stiffness of the beams by 4% to 46%, depending on the CFRP area and configurations. The debonding of CFRP before the ultimate failure provided additional ductility to the tested beams. For the strengthening of the inverted beams, it was found that the addition of CFRP strips did not increase the strength of the beams when the width of CFRP to beam width ratio was less than 0.25, but the ductility of the beam was enhanced slightly. The use of multiple strips was found to be a more effective way for the strengthening of the negative moment region than using multiple layers. This can also provide more desirable modes of failure than when applying CFRP in multiple layers. Ductility was found to be lower if multiple layers were used compared to other configurations. Moreover, it was observed that as the compressive strength of concrete increased the addition of the CFRP improved the beams ductility.

Background: Supported asthma self-management improves health outcomes. However, people with limited health literacy, especially in lower-middle-income countries (LMICs), may need tailored interventions to enable them to realise the benefits. We aimed to assess the clinical effectiveness of asthma self-management interventions targeted at people with limited health literacy and to identify strategies associated with effective programmes. Methods: Following Cochrane methodology, we searched ten databases (January 1990 - June 2018; updated October 2019), without language restriction. We included controlled experimental studies whose interventions targeted health literacy to improve asthma self-management. Selection of papers, extraction of data and quality assessment were done independently by two reviewers. The primary outcomes were clinical (asthma control) and implementation (adoption/adherence to intervention). Analysis was narrative.Findings: We screened 4318 titles and abstracts, reviewed 52 full-texts and included five trials. One trial was conducted in a LMIC. Risk of bias was low in one trial and high in the other four studies. Clinical outcomes were reported in two trials, both at high risk of bias: one of which reported a reduction in unscheduled care (number of visits in 6-month (SD); Intervention:0.9 (1.2) vs Control:1.8 (2.4), p=0.001); the other showed no effect. None reported uptake or adherence to the intervention. Behavioural change strategies typically focused on improving an individual’s psychological and physical capacity to enact behaviour (e.g. targeting asthma-related knowledge or comprehension). Only two interventions also targeted motivation; none sought to improve opportunity. Less than half of the interventions used specific self-management strategies (e.g. written asthma action plan) with tailoring to limited health literacy status. Different approaches (e.g. video-based and pictorial action plans) were used to provide education. Conclusion: The paucity of studies and diversity of the interventions to support people with limited health literacy to self-manage their asthma meant that the impact on health outcomes remains unclear. Given the proportion of the global population who have limited health literacy skills, this is a research priority.

This study evaluated the effect of carbon nanofibers (CNFs) coated by aluminum oxide Al2O3 as a reinforcement on compressive strength, frost resistance, and drying shrinkage of cement mortars. Three weight ratios of 0.125%, 0.25%, and 0.5% of Al2O3/CNFs and bare CNF cement mortars were compared with reference cement mortar samples. The reactive porous and high surface area layer of alumina induced the hydration reaction and promoted the production of well-distributed hydration gel. Derivative thermal analysis–differential thermogravimetric (TGA-DTG) and X-ray powder diffraction (XRD) characterization showed that Al2O3/CNFs reinforcement led to greater hydration gel production than bare CNFs. Transmission electron microscopy (TEM) and scanning electron microscopy (SEM) were performed to study the coating and microstructure of the cement mortars evaluated in this paper. The results show that the optimum enhancement of the cement mortar properties was obtained at ratios of 0.125% for Al2O3/CNFs and 0.25% for CNFs. This enhancement was greater with Al2O3/CNFs-reinforced specimens in terms of high compressive strength, less compressive strength degradation after 150 cycles, and less drying shrinkage. The low use of the CNFs in Al2O3/CNFs samples indicates the coating is an economical and promising approach for improving the performance of cement mortars.

The evaluation of the crack tip deformation is essential to the estimation of crack growth under either static or cyclic loading. A 3-D elastic–plastic finite element analysis was developed to simulate the crack tip deformation along mixed mode inclined edge cracks in a steel plate subjected to either monotonic or cyclic loading at selected R-ratios. In this paper, two types of crack configurations were investigated: inclined cracks with equal inclined lengths (EICL) and inclined cracks with equal horizontal projection length (ECHP). The development of the monotonic (Δm) and cyclic (Δc) crack tip plastically zones and the monotonic (CTOD) and cyclic (ΔCTOD) crack tip opening displacements were traced to find the effect of the crack inclination angle, which significantly affected the size and shape of the crack tip plastic zone. The finite element results compared well with the analytical results based on modified Dugdale’s model. It was observed that Mode II has a significant effect on the plastic zone in the case of equal inclined crack length (EICL), i.e., Mode II increases as the crack angle decreases. Also, it is interesting to note that for the EICL case, the magnitude of Δc is delayed to appear with decreasing the inclination angle, for example, for θ = 90° the cyclic plastic zone appeared at Δσ = 103.32 MPa, while for θ = 45° the cyclic plastic zone appeared at Δσ = 132.84 MPa. Whereas, the variation of monotonic and cyclic plastic zone size in the equal crack horizontal projection (ECHP) case is not affected by the crack inclination angle. Furthermore, it was observed that the static crack tip opening displacement (CTOD) and the cyclic (ΔCTOD) are independent of the crack inclination angle in case of ECHP, due to such cracks take into consideration the effect of inclination angle through its length.

The monotonic behavior of externally post-tensioned steel–concrete composite girders was numerically studied in this paper. A three-dimensional numerical model was developed and validated using experimental test results that were conducted by the authors and using an existing analytical model. A parametric study using this validated numerical model was performed to investigate the effects of various parameters on the monotonic performance of composite girders strengthened with external post-tensioned tendons. The parameters investigated include variations in the degree of shear connection, layout and diameter of shear connectors, the initial post-tensioning force, the depth of the steel beam, the eccentricity of the tendons, the compressive strength of concrete, and the shear capacity of the studs. The numerical model provided a better understanding of the effect of these parameters on the behavior of the strengthened beams. The results of the parametric study show that as the degree of shear connection decreased, the stud strains increased and the slippage between the concrete deck and steel beam increased. As the full degree of shear connection was reduced to 80%, 60%, and 40%, the stud strains were increased by 20%, 46%, and 94%, respectively. Also, as the shear connection degree decreases, its effect on the slippage behavior increases. As the degree of shear connection was reduced to 80%, 60%, and 40%, the slippage values were increased by 23%, 48%, and 102%, respectively. The study also shows that, for the same degree of shear connection, beams with one row of shear studs had up to 10% higher flexural capacity than beams with two rows of studs. A 100% increase in the stud diameter caused a 28% reduction in the ultimate load capacity and a 160% increase in the maximum slippage. The higher the post-tensioning force, the higher the ultimate load capacity and the lower the tensile strains in the steel beam. A 118% increase in the post-tensioning force resulted in a 9% increase in the ultimate load capacity and a 13% reduction in the tensile strains. Increasing the depth of the steel beam by 40% resulted in a reduction in the tensile strains at midspan by 20%. The lowest midspan tensile strains were obtained from the combination of increasing the depth of the steel beam and tendon eccentricity.

During a blast event, the polymeric interlayer of laminated glass used in windows and curtain walls plays an essential role in protecting buildings and occupants. In this research, the dynamic constitutive behavior of ultraviolet (UV) cured one-component acrylic resin (UVEKOL-S), Polyvinyl butyral (PVB), and virgin PVB extracted from heat strengthened laminated glass panes were investigated at an average strain rate of 30–40 s−1 using impact drop-weight apparatus. An analytical procedure was developed to simulate the drop weight device and calculate the drop height required for a certain strain rate. A new technique was used to investigate the mechanical properties of PVB, and UVEKOL-S before and after the breakage of the laminated glass, including each material energy absorption capacity. The results show that both PVB and UVEKOL-S, at strain rates of 30–40 s−1, had an initial rise in strength. However, after the maximum stress point, both materials followed a noticeable difference in their response to failure. Comparing the high-strain and static results showed that the dynamic loading significantly affects the material response and the energy absorption characteristics of the interlayer materials, and subsequently, the blast response of laminated glass panels. Sufficient data was obtained from the tests to evaluate alternative approaches to modeling PVB and UVEKOL-S materials in the blast event.

This study investigates the improvement in the flexural capacity and cracking resistance of continuous steel-concrete composite beams strengthened with carbon-fiber-reinforced polymers (CFRP) laminates at the hogging moment regions. The experimental program involves flexural testing of three specimens in an inverted position under four-point loading to simulate a part of continuous steel-concrete composite beams at the hogging moment region. The experimental findings are used to develop and validate a finite element (FE) model to simulate the nonlinear flexural performance of strengthened beams as well as plain beams. The good agreements between the proposed model and the test data assure an accuracy for the proposed model to predict the influence of various parameters that affect the beam capacity. The CFRP laminates enhance the beam capacity by 18% and 22% when using one and two layers, respectively. Yielding in steel rebars followed by a rupture in the CFRP laminates accompanied by diagonal cracking in the vicinity of supports is the mode of failure for the strengthened beams. To achieve optimum performance of CFRP strengthening, it is recommended that the technique be used for bridges with at least 80% composite action between the steel beam and concrete slab.

The response of cold-formed steel roof trusses undergoing large deformations resulting from unconventional loading is not totally known. Roof truss end-connections are one structural component that can cause premature failure. This paper investigates the failure capacities and the energy absorption capabilities of roof truss end-connections. Experimental tests were performed to obtain the capacities of these connections under quasi-static vertical and horizontal (tension and shear) loadings. Numerical simulations were developed to predict the connection response to failure for any configuration. Implicit and explicit dynamic procedures were used in the analysis of the numerical simulations. A deformable screw behavior with failure criterion was used in the numerical modeling to predict the progressive failure of the connection. The paper includes four verifications that validate the deformable behavior of #10 TEK screw used in the simulations. Results showed that the toughness (energy absorbed to failure) of the end-connection is greatly affected by the screw configuration and the direction of loading.

Externally post-tensioned tendons can cause an initial compressive stress in steel–concrete composite sections at the hogging moment region, and then a part of the tensile stress in the concrete fl...

Children with poor asthma control have poor health outcomes. In Malaysia, the Malays have the highest asthma prevalence and poorest control compared to other ethnicities. We aimed to explore Malay children with asthma and their parents’ perceptions on asthma and its control. We conducted focus group discussions (FGD) using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Sixteen children and parents (N = 32) participated. The perception of asthma was based on personal experience, cultural and religious beliefs, and there was mismatch between children and parents. Parents perceived mild symptoms as normal, some had poor practices, raising safety concerns as children were dependent on them for self-management. Conflicting religious opinions on inhaler use during Ramadhan caused confusion in practice. Parents perceived a lack of system support towards asthma care and asthma affected quality of life. Urgent intervention is needed to address misconceptions to improve asthma care in children.

Background: Self-management of asthma improves asthma control and reduces exacerbations. Children are expected to independently self-manage asthma, as they get older. However, the transition from parental to independent self-management among children remains unclear. Aim: To explore the views of children with asthma and their carers regarding self-management of asthma. Methods: We identified children aged 7-12 years, diagnosed with asthma from seven suburban primary schools in Malaysia. We used purposive sampling and conducted focus groups supplemented by interviews using a semi-structured topic guide in participants’ preferred language. All interviews were audio-recorded, transcribed verbatim, entered into NVivo, and analysed using a grounded theory approach. Results: 99 participants (46 caregivers, 53 children: 34 Malays, 45 Indians, 20 Chinese) contributed to 22 focus groups and 7 interviews. Carers’ view and actions emerged as an important influencer. Children mirrored their carers’ actions and views but in parallel learnt from their own experiences, and gained more confidence to independently self-manage. External influences e.g. support from school and healthcare also played a role in the transition. Cultural norms and beliefs influenced children’s independence to self-manage asthma either directly or indirectly through their social network. Conclusion: Children gain skills to independently self-manage asthma based on their experiences and influences of surrounding people. Thus, interventions to improve self-management of childhood asthma should include childrens’ networks and incorporate elements based on good understanding of cultural beliefs in the community. Funding: NIHR RESPIRE

Supported self-management for asthma (written action plans and regular review) is highly effective at improving control and reducing acute attacks;1–3 however, globally this is challenging to implement both in adults and children.4–7 One particular challenge is the need to tailor support for people with limited health literacy. Limited health literacy is a universal problem, especially (but not only) in low-and-middle-income countries (LMICs).8–10 For example, nearly 90% of adults with type 2 diabetes attending primary care clinics in Malaysia11 and a third of teachers in Sri Lanka12 were assessed as having limited health literacy compared to about half the general population in a European survey.9 Use of different assessment techniques and sampling of different populations make it difficult to compare these results, though it is clear that this is a problem in all countries. Derived from a systematic content analyses of 19 papers, Sorensen et al.13 describes health literacy as people’s knowledge, motivation and competence to assess, understand, appraise and apply health information (see Table ​Table11 for definitions). These processes are vital to enable people to make considered judgments and decisions about healthcare and health promotion, which can improve quality of life and health outcomes such as reducing morbidity.13,14 Table 1 Definition of terms

Current shear stud fatigue capacity recommended for design of shear connectors is based on experimental data from push-out tests, and there is a need to experimentally evaluate the fatigue ...