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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.

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.

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.

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.

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