HOUSING AFFORDABILITY STRESS: A LITERATURE SURVEY AND SOME EVIDENCE FROM MALAYSIA

Housing affordability stress has become an economic challenge to households in several countries, including Malaysia. Housing quality is the fundamental factors that affecting the wellbeing of the households. However, the rise in house price has squeezed the purchasing power of households in housing ownership and significantly diminishing the quality of life. The extensive gap between house prices and household’s affordability and therefore some households forced to rent poor-quality housing and neigbourhood, thus lead to housing stress and weakening a household’s well-being. In addition, housing needs to be equipped basic standard, providing reasonable access to employment and community services that is available at a cost which does not cause substantial hardship to the occupants. Thus, the aim of this paper is to explore the theoretical review of housing stress and empirical literature. There are associations between the housing stress measure on affordability and wellbeing, including financial stress, health and neighbourhood quality. Further, governments need to adopt more effective housing policies if they are to meet the needs of the households

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013

Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries

Background: To better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study. Methods: This is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1-2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort. Results: Of the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1-Q3, 7-21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample. Conclusions: Most patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study

OBJECTIVES: To describe the characteristics and outcomes of patients with acute respiratory distress syndrome with or without spontaneous breathing and to investigate whether the effects of spontaneous breathing on outcome depend on acute respiratory distress syndrome severity. DESIGN: Planned secondary analysis of a prospective, observational, multicentre cohort study. SETTING: International sample of 459 ICUs from 50 countries. PATIENTS: Patients with acute respiratory distress syndrome and at least 2 days of invasive mechanical ventilation and available data for the mode of mechanical ventilation and respiratory rate for the 2 first days. INTERVENTIONS: Analysis of patients with and without spontaneous breathing, defined by the mode of mechanical ventilation and by actual respiratory rate compared with set respiratory rate during the first 48 hours of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Spontaneous breathing was present in 67% of patients with mild acute respiratory distress syndrome, 58% of patients with moderate acute respiratory distress syndrome, and 46% of patients with severe acute respiratory distress syndrome. Patients with spontaneous breathing were older and had lower acute respiratory distress syndrome severity, Sequential Organ Failure Assessment scores, ICU and hospital mortality, and were less likely to be diagnosed with acute respiratory distress syndrome by clinicians. In adjusted analysis, spontaneous breathing during the first 2 days was not associated with an effect on ICU or hospital mortality (33% vs 37%; odds ratio, 1.18 [0.92-1.51]; p = 0.19 and 37% vs 41%; odds ratio, 1.18 [0.93-1.50]; p = 0.196, respectively ). Spontaneous breathing was associated with increased ventilator-free days (13 [0-22] vs 8 [0-20]; p = 0.014) and shorter duration of ICU stay (11 [6-20] vs 12 [7-22]; p = 0.04). CONCLUSIONS: Spontaneous breathing is common in patients with acute respiratory distress syndrome during the first 48 hours of mechanical ventilation. Spontaneous breathing is not associated with worse outcomes and may hasten liberation from the ventilator and from ICU. Although these results support the use of spontaneous breathing in patients with acute respiratory distress syndrome independent of acute respiratory distress syndrome severity, the use of controlled ventilation indicates a bias toward use in patients with higher disease severity. In addition, because the lack of reliable data on inspiratory effort in our study, prospective studies incorporating the magnitude of inspiratory effort and adjusting for all potential severity confounders are required

Does vocational training meet the construction industry needs in Malaysia? Feedback from ex-trainees of the basic electrical wiring course from one training institution

Purpose – Malaysia has been facing a shortage of construction craftworkers since the late 1980s. This is despite the fact that various public vocational training institutes have been established by the government ever since independence. This study aims to determine whether ex-trainees of National Youth Skills Institutes (NYSIs) in the One Phase Electrical Wiring course had joined the construction industry to determine whether the shortage is in any way contributed by them. The reasons why they took up the course and why they chose to work as electricians were among the specific matters that were looked into to help in understanding their industry choice. Design/methodology/approach – Data were collected through postal questionnaire survey. Findings – The study found that half of the respondents joined the construction industry, the other half in other economic sectors. Research limitations/implications – The

Laser-induced incandescence particle image velocimetry (LII-PIV) for two-phase flow velocity measurement

We demonstrate the use of laser induced incandescence (LII) of submicron tungsten carbide (WC) particles as a method for particle image velocimetry (PIV). The technique allows a single laser to be used for separate measurements of velocity of two phases in a droplet-laden flow. Submicron tungsten carbide (WC) particles are intentionally seeded into a two-phase flow, and heated by a light sheet generated by a double-pulsed PIV laser operating at sufficiently high pulse energy. The small size and large absorption cross-section allows particles to be heated up to several thousand degrees Kelvin to emit strong incandescence signals, whilst the laser-induced temperature increase in liquid droplets/large particles is negligible. The incandescence signal from WC and Mie scattering from droplets/large particles are separately captured by deploying different filters to a PIV camera. The consecutive images of the laser-induced incandescence (LII) are used to determine the velocity field of the gas-phase flow, and those of Mie scatter are used to extract the velocity of droplets/large particles. The proposed technique is demonstrated in an air jet first and compared with the result given by a normal PIV test, which shows that submicron WC particles can accurately follow the gas flow, and that the LII images can be used to perform cross-correlations. We then apply this technique on an ethanol droplet/air jet (non-reacting), demonstrating the resulting slip velocity between two phases. The proposed technique combining PIV and LII with a single laser requires little additional equipment, and is applicable to a much higher droplet/particle density than previously feasible. Finally the possibility of applying this technique to a flame is demonstrated and discussed.Newton-Ungku Omar Fund: Advanced Fellowship (NA160115

The multidimensional impacts of external price shocks on macroeconomic variables: Malaysian experiences from recession to economic instability

The 2008 to 2009 global external price shocks on foods and oil exert worldwide impacts on production, expenditure pattern, trade, welfare, internal resource allocation and ultimate impacts diverted to global recession, Malaysia is not an exception. Centering the world's (2008 to 2009) oil and food price catastrophe, here we investigate Malaysian experiences from recession to economic instability. An applied computable general equilibrium model is utilized in our study to simulate the Malaysian economic impacts by three scenarios. First is food import price increase by 20% (Scenario 1), second is the oil price catastrophe by 40% (Scenario 2) and finally a scenario that combines Scenarios 1 and 2 simultaneously (Scenario 3). Our results depict the multidimensional impacts on major macroeconomic indicators from recession to economic instability. Our results indicate that, price catastrophe either in Scenario 1 or 2, or in Scenario 3, depress overall Malaysian domestic outputs and exports. Reduced output also reduces employment, thus causing a fall in household's income. Overall imports also decreased by 0.2, 1.5, and 1.7% respectively, in all scenarios that specify consumers can afford less quantity of both domestic and imported goods; is the clear indication of recession and economic instability. Our study can be a message to policy makers, who are considering recession and trade policy together

Laser-induced incandescence particle image velocimetry (LII-PIV) for two-phase flow velocity measurement

We demonstrate the use of laser-induced incandescence (LII) of submicron tungsten carbide (WC) particles as a method for particle image velocimetry (PIV). The technique allows a single laser to be used for separate measurements of velocity of two phases in a droplet-laden flow. Submicron WC particles are intentionally seeded into a two-phase flow, and heated by a light sheet generated by a double-pulsed PIV laser operating at sufficiently high pulse energy. The small size and large absorption cross section allows particles to be heated up to several thousand degrees Kelvin to emit strong incandescence signals, whilst the laser-induced temperature increase in liquid droplets/large particles is negligible. The incandescence signal from WC and Mie scattering from droplets/large particles are separately captured by deploying different filters to a PIV camera. The consecutive images of the laser-induced incandescence (LII) are used to determine the velocity field of the gas-phase flow, and those of Mie scatter are used to extract the velocity of droplets/large particles. The proposed technique is demonstrated in an air jet first and compared with the result given by a normal PIV test, which shows that submicron WC particles can accurately follow the gas flow, and that the LII images can be used to perform cross-correlations. We then apply this technique on an ethanol droplet/air jet (non-reacting), demonstrating the resulting slip velocity between two phases. The proposed technique combining PIV and LII with a single laser requires little additional equipment, and is applicable to a much higher droplet/particle density than previously feasible. Finally, the possibility of applying this technique to a flame is demonstrated and discussed

The effect of fine droplets on laminar propagation speed of a strained acetone-methane flame: Experiment and simulations

In this study, we investigate the e ffect of the presence of fuel droplets, their size and concentration, on stretched laminar flame speeds. We consider premixed strained methane/air mixtures, with the addition of small acetone droplets, and compare the flame velocity eld behavior to that of the fully vaporized mixture. An impinging stagnation flame con figuration is used, to which a narrowly distributed polydisperse mist of acetone droplets is added. Total acetone molar concentrations between 9% and 20% per mole of methane are used, corresponding to 18.6% and 41.4% of the total fuel energy. The Sauter Mean Diameter (SMD) of acetone droplets is varied from 1.0 to 4.7 m by carefully tuning the air ow rate passing through an atomizer. The droplet size distribution is characterized by a Phase Doppler Anamometry (PDA) system at the outlet of the burner. The flame propagation speed is measured using Particle Image Velocimetry (PIV) for overall equivalence ratios ranging from 0.8 to 1.4 at various strain rates, and the result is compared with a reference case in which acetone was fully vaporized. Unlike the fully vaporized flame, a two-stage reaction flame structure is observed for all droplet cases: a blue premixed flame front followed by a reddish luminous zone. Comparison of the results between gas-only and droplet-laden cases shows that the mean reference burning velocity of the mixture is signi cantly enhanced when droplets are present under rich cases, whereas the opposite is true for stoichiometric and lean cases. The mean droplet size also changes the relationship between flame speed and strain rate, especially for rich cases. The result suggests that with typical conditions found in laminar strained flames, even for the finest droplets that may have been vaporized before reaching the flame front, the resulting inhomogeneities may lead the flame to behaves di fferently from the well-premixed gaseous counterpart. Simulations at similar conditions are performed using a two-phase counter flow flame model to compare with experimental data. Model results of reference velocities do not compare well with observations, and the possible reasons for this behaviour are discussed, including the di culties in determining the pre-vaporization process and thus the boundary conditions, as well as the fi delity of the current point-source based 1D model.The authors gratefully acknowledge the nancial support from Universiti Teknologi Malaysia under grant number RG84263, and a UK Newton Advanced Fellowship (NA160115) for C. T. Chong

The effect of fine droplets on laminar propagation speed of a strained acetone-methane flame: Experiment and simulations

In this study, we investigate the effect of the presence of fuel droplets, their size and concentration, on stretched laminar flame speeds. We consider premixed strained methane/air mixtures, with the addition of small acetone droplets, and compare the flame velocity field behaviour to that of the fully vaporized mixture. An impinging stagnation flame configuration is used, to which a narrowly distributed polydisperse mist of acetone droplets is added. Total acetone molar concentrations between 9% and 20% per mole of methane are used, corresponding to 18.6% and 41.4% of the total fuel energy. The Sauter Mean Diameter (SMD) of acetone droplets is varied from 1.0 to 4.7 μm by carefully tuning the air flow rate passing through an atomizer. The droplet size distribution is characterized by a Phase Doppler Anamometry (PDA) system at the outlet of the burner. The flame propagation speed is measured using Particle Image Velocimetry (PIV) for overall equivalence ratios ranging from 0.8 to 1.4 at various strain rates, and the result is compared with a reference case in which acetone was fully vaporized. Unlike the fully vaporized flame, a two-stage reaction flame structure is observed for all droplet cases: a blue premixed flame front followed by a reddish luminous zone. Comparison of the results between gas-only and droplet-laden cases shows that the mean reference burning velocity of the mixture is significantly enhanced when droplets are present under rich cases, whereas the opposite is true for stoichiometric and lean cases. The mean droplet size also changes the relationship between flame speed and strain rate, especially for rich cases. The result suggests that with typical conditions found in laminar strained flames, even for the finest droplets that may have been vaporized before reaching the flame front, the resulting inhomogeneities may lead the flame to behaves differently from the well-premixed gaseous counterpart. Simulations at similar conditions are performed using a two-phase counterflow flame model to compare with experimental data. Model results of reference velocities do not compare well with observations, and the possible reasons for this behaviour are discussed, including the difficulties in determining the pre-vaporization process and thus the boundary conditions, as well as the fidelity of the current point-source based 1D model