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Introduction Methods Results Conclusion The cumulative impact of metabolic syndrome (MetS) components on micro‐ and macrovascular disease in metabolic dysfunction‐associated steatotic liver disease (MASLD) is unclear. We aimed to determine whether the number of the MetS components increases the risk of micro‐ and macrovascular disease in patients with MASLD.We performed a retrospective cohort study of electronic medical records using the TriNetX network, a global federated database. The exposure arm was patients with hepatic steatosis (defined via International Classification of Diseases, 10th Revision coding, or modified hepatic steatosis index), and ≥1 MetS components (obesity/central adiposity, insulin resistance, hypertension, or dyslipidaemia), compared with a reference arm of adults without any MetS components or hepatic steatosis. Our propensity score matched (1:1) for confounders with 5 years of follow‐up. Primary outcomes included microvascular (peripheral neuropathy, retinopathy, and nephropathy) and macrovascular (cardiovascular events, cerebrovascular accidents, and peripheral vascular disease) disease. Secondary analyses assessed the impact of additional MetS components on these outcomes, as well as the impact of sex.MASLD, defined by hepatic steatosis and insulin resistance (n = 15 937), carried the highest risk of microvascular disease (HR 13.93 (95% CI 8.55–22.68)), whilst MASLD, defined by hepatic steatosis and hypertension (n = 53 028), carried the highest risk of macrovascular disease (7.23 (6.45–8.13)). MASLD with all MetS components carried greatest risk of both micro‐ (31.20 (28.88–33.70) (n = 462 789)) and macrovascular (8.04 (7.33–8.82) (n = 336 010)) disease.We demonstrate a differential effect of MetS components on micro‐ and macrovascular disease risk in patients with MASLD, with a cumulative impact of multiple MetS on overall risk. The impact of MetS components was most pronounced in women. Aggressive metabolic risk factor management is critical for prevention of micro‐ and macrovascular complications. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the impact of denosumab on (i) the incidence of type 2 diabetes (T2D), and (ii) long‐term health outcomes (microvascular [neuropathy, retinopathy, nephropathy] and macrovascular [cardiovascular disease, cerebrovascular accident] complications, and all‐cause mortality) in patients with T2D, before (iii) combining results with prior studies using meta‐analysis. Methods: A retrospective analysis of data in a large global federated database (TriNetX; Cambridge, MA) was conducted from 331 375 patients, without baseline T2D or cancer, prescribed either denosumab (treatment, n = 45 854) or bisphosphonates (control, n = 285 521), across 83 healthcare organizations. Propensity score matching (1:1) of confounders was undertaken that resulted in 45 851 in each cohort. Secondary analysis further evaluated the impact of denosumab on long‐term health outcomes in patients with T2D. Additionally, we systematically searched prior literature that assessed the association between denosumab and T2D. Estimates were pooled using random‐effects meta‐analysis. Risk of bias and evidence quality were assessed using Cochrane‐endorsed tools. Results: Denosumab (vs. bisphosphonates) was associated with a lower risk of incident T2D over 5 years (hazard ratio 0.83 [95% confidence interval {CI} 0.78‐0.88]). Secondary analysis showed significant risk reduction in all‐cause mortality (0.79 [0.72‐0.87]) and foot ulceration (0.67 [0.53‐0.86]). Also, pooled results from four studies (three observational, one randomized controlled trial) following meta‐analysis showed a reduced relative risk (RR [95% CI]) for incident T2D in patients prescribed denosumab (0.83 [0.79‐0.87]) (I2 = 10.76%). Conclusions: This is the largest cohort study to show that denosumab treatment is associated with a reduced RR of incident T2D, as well as an associated reduced RR of all‐cause mortality and microvascular complications, findings that may influence guideline development in the treatment of osteoporosis, particularly in patients who are at a high risk of T2D. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion Sodium–glucose cotransporter 2 inhibitors (SGLT2is), used as a glucose‐lowering therapy in people with type 2 diabetes (T2D), have significant cardiorenal benefits, reducing hospitalization for heart failure (HF) and cardiovascular mortality in patients with and without T2D. Recent clinical trial evidence suggests their potential utility in preventing incident T2D among the high‐risk HF populations. Therefore, we aimed to assess whether this finding was reproducible in a real‐world setting.We performed a retrospective cohort analysis of 484 643 patients with HF, without baseline diabetes, prescribed either angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers with/without SGLT2is (treatment, n = 42 018; reference, n = 442 625) across 95 global health care organizations, using a large real‐world ecosystem. Propensity score matching balanced arms 1:1 for confounders (n = 39 168 each arm). Subgroup analysis further evaluated the impact on patients with prediabetes and the efficacy of dapagliflozin/empagliflozin, specifically, on incident T2D and secondary outcomes, including all‐cause mortality, acute pulmonary oedema and hospitalization.Treatment with SGLT2is significantly reduced incident T2D {hazard ratio (HR) 0.71 [95% confidence interval (CI) 0.63, 0.75]} in patients with HF. The analysis of patients with prediabetes found that SGLT2is further reduced incident T2D [HR 0.62 (95% CI 0.45, 0.80)]. The magnitude of reduction in incident T2D was higher in patients prescribed dapagliflozin [HR 0.47 (95% CI 0.39, 0.56)] versus empagliflozin [HR 0.81 (95% CI 0.70, 0.93)].Treatment with SGLT2is in patients with HF was associated with a reduced risk of incident T2D, most strikingly in people with prediabetes. [ABSTRACT FROM AUTHOR]

Background and Aims Methods Results Conclusions We examined the impact of a co‐diagnosis of metabolic dysfunction‐associated steatotic liver disease (MASLD) and type 2 diabetes (T2D) on patient outcomes.Using TriNetX, a global federated research network (n = 114 million), we undertook two retrospective cohort studies, using time‐to‐event analysis. Analysis 1 compared MASLD with T2D to MASLD alone; analysis 2 compared T2D with MASLD to T2D alone. Propensity score matching using greedy nearest neighbour (calliper .1) balanced the cohorts (1:1) for significant covariates. Primary outcomes were cardiovascular, liver, diabetes‐related, and cancer events over 5 years.Analysis 1 (n = 95 275): a co‐diagnosis of T2D significantly increased the risk of ischaemic heart disease (IHD) (HR 1.39; CI: 1.34, 1.44), ischaemic stroke (HR 1.45; CI: 1.35, 1.56), heart failure (HR 1.42; CI: 1.36, 1.49), atrial fibrillation (HR 1.09; CI: 1.03, 1.16), hepatocellular carcinoma (HR 1.96; CI: 1.69, 2.27), pancreatic cancer (HR 1.25; CI: 1.06, 1.48) and liver‐related complications over 5 years from MASLD diagnosis. Analysis 2 (n = 15 208): a co‐diagnosis of MASLD significantly increased risk of all‐cause mortality (HR 1.11; CI: 1.02, 1.22), IHD (HR 1.181; CI: 1.08, 1.29), hepatocellular (HR 50.31; CI: 6.94, 364.72), pancreatic (HR 1.78; CI: 1.12, 2.84), breast (HR 1.43; CI: 1.09, 1.88) and renal cancer (HR 2.01; CI: 1.24, 3.26), and diabetic neuropathy (HR 1.17; CI: 1.09, 1.27) over 5 years from metformin initiation.T2D significantly potentiates the risk of cardiovascular, malignancy and liver‐related outcomes in people with MASLD. The effect of MASLD on people with T2D, although less dramatic, still potentiated risk of death, IHD, malignancy and peripheral neuropathy. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to disseminate an innovative approach to sustainability education in construction-related fields in which teaching, research, and service are integrated to provide a unique learning experience for undergraduate students, faculty members, and community partners. Design/methodology/approach: The paper identifies the need for sustainability education in fields related to construction and describes an interdisciplinary course at Penn State that addresses this need. The goals, research, and applications of the course are detailed, as is the sustainable construction technology employed in course projects. Finally, the results from two course assessments are summarized to support the authors' hypothesis that knowledge best occurs and develops in an arena of negotiation, collaboration, and creation. Findings: Students who participate in the course experience well-rounded growth that includes, but is not limited to, increased research, design, communication, and collaboration skills, a finding that underscores the effectiveness of the course's holistic approach to engineering and architecture education. Practical implications: The paper demonstrates that engaged approaches to architecture and engineering education contribute to a heightened awareness among students of the importance of sustainability. It encourages other educators to adopt similar approaches to sustainability education in their courses. Originality/value: The paper addresses the need for sustainability education in construction-related disciplines by detailing an innovative course developed at Penn State to raise environmental and social awareness among architecture and engineering students. The engaged approach utilized in the course is replicable in any discipline and promises to have a significant impact on the commitment of today's students to creating a tomorrow in which sustainability is the norm rather than an anomaly. (Contains 1 note and 3 figures.)

Based on the author's work with the American Indian Housing Initiative, this essay presents the reflections of a faculty member whose experiences with public scholarship have shaped his views on teaching global citizenship.

To gain insights into the origin and genome evolution of the plague bacterium Yersinia pestis, we have sequenced the deep-rooted strain Angola, a virulent Pestoides isolate. Its ancient nature makes this atypical isolate of particular importance in understanding the evolution of plague pathogenicity. Its chromosome features a unique genetic make-up intermediate between modern Y. pestis isolates and its evolutionary ancestor, Y. pseudotuberculosis. Our genotypic and phenotypic analyses led us to conclude that Angola belongs to one of the most ancient Y. pestis lineages thus far sequenced. The mobilome carries the first reported chimeric plasmid combining the two species-specific virulence plasmids. Genomic findings were validated in virulence assays demonstrating that its pathogenic potential is distinct from modern Y. pestis isolates. Human infection with this particular isolate would not be diagnosed by the standard clinical tests, as Angola lacks the plasmid-borne capsule, and a possible emergence of this genotype raises major public health concerns. To assess the genomic plasticity in Y. pestis, we investigated the global gene reservoir and estimated the pangenome at 4,844 unique protein-coding genes. As shown by the genomic analysis of this evolutionary key isolate, we found that the genomic plasticity within Y. pestis clearly was not as limited as previously thought, which is strengthened by the detection of the largest number of isolate-specific single-nucleotide polymorphisms (SNPs) currently reported in the species. This study identified numerous novel genetic signatures, some of which seem to be intimately associated with plague virulence. These markers are valuable in the development of a robust typing system critical for forensic, diagnostic, and epidemiological studies. doi: 10.1128/JB.01518-09

Facility owners and project teams often struggle to engage 'green' or 'sustainable' requirements on building projects and can incur additional project costs as a result. Although 'investments' in high performance building features can be paid back through operational savings, the project delivery methods currently adopted by most teams are laden with process waste. Lean production principles have been proven to reduce waste and improve process performance in highly complex development and production environmerits. Adopting these lean principles, this paper reports a study that identified the presence of value and waste in a sustainable building project. Through an empirical investigation of the Real Estate and Facilities Division of Toyota Motor Sales, Toyota's capital facility delivery process was mapped to identify both the steps in project delivery critical for success (value) and those that are waste. The investigation focused on the South Campus Facility, which received U.S. Green Building Council's Leadership in Energy and Environmental Design Gold certification at a project cost equivalent to a conventional facility. Through post hoc process-based analysis, insight about what added value and waste in sustainable project delivery at Toyota was obtained. The results also identify further improvement opportunities to Toyota's delivery process. For corporate facility owners and the Architecture Engineering Construction industry, the results unearth insights about how to successfully and economically deliver sustainable facilities. DOI: 10.1061/(ASCE)0733-9364(2006)132:10(1083) CE Database subject headings: Delivery; Sustainable development: Construction industry.

The sequences in which work is completed bear significantly on the performance of electrical contractors in building construction projects. When project work sequences are poorly planned or poorly executed, electrician constructors often must contend with compressed schedules, trade stacking, and out-of-sequence work to ensure timely completion of a project. This paper analytically evaluates the importance of sequence planning to efficient electrical work. It describes changes that were made to crew-level planning procedures for an electrical contractor and the impact these had on crew performance. The analysis shows that sequence planning at both the project level and the crew level are important to the performance of electrical crews. Most notably, a strong correlation (0.73) was detected between crew planning performance one week and crew productivity performance in the following week. Results of the study are provided. Principles of sound sequences and guidelines for sequence planning are also captured from the analysis. These sequence guidelines are designed to avoid, where possible, the often adverse project conditions in which electrical contractors find themselves and to handle those conditions most effectively when they cannot be avoided. DOI: 10.1061/(ASCE)0733-9364(2006)132:4(363) CE Database subject headings: Construction management; Managers; Planning; Contractors; Electrical systems.

Change orders represent one of the largest sources of cost growth on building construction projects. Field generated, or 'unforeseen' change orders can also be highly disruptive to field productivity. Design-build delivery methods can potentially help minimize change orders on construction projects. This study was performed to closely examine the effects of delivery methods on the frequency and magnitude of change orders in mechanical construction, and how design-build business practices can be used to minimize the frequency of field generated chance orders. In a study of 598 change orders occurring on 120 construction projects performed by the same contractor, the total number of change orders was found to be close to the same on design-build and design-bid-build projects, however an 87% decrease in the average number of unforeseen change orders was observed on design-build projects versus design-bid-build projects. In addition, the average size of unforeseen change orders was 86% smaller on design-build projects. A detailed and qualified presentation of the research methodology and resulting data is provided. Key attributes and business practices leading to the results are discussed and practical applications of this research for owners and contractors are provided. DOI: 10.1061/(ASCE)0733-9364(2005) 131:9(953) CE Database subject headings: Change orders; Design/build; Mechanical systems; Cost control; Construction industry.

Design coordination of mechanical, electrical, and plumbing (MEP) systems in buildings is a multidisciplinary effort to locate equipment, route distribution systems, and resolve interferences between systems that can cause field conflicts. Absent from existing research are defined metrics of design coordination--how much it costs to perform depending on project variables, and the true costs of field conflicts that are eliminated by coordination. This research was performed to explore the costs of design coordination in concert with the benefits of eliminating coordination conflicts that arise in the field. A standard method to measure costs of coordination is developed for case study projects. Potential variables that affect this cost are evaluated, and the negative impacts of field conflicts are measured. Project variables that have strong relationships with coordination costs are identified to be MEP density [MEP cost/square foot (SF)], and plenum height, and exploratory models to predict coordination costs using these variables are presented. Three distinct types of coordination conflicts are identified with measurable increasing impacts and cost. These results help to quantify the level of effort needed to coordinate building systems, and help to provide a basis for detecting projects that are likely to have problematic MEP coordination processes. DOI: 10.106l/(ASCE)0733-9364(2005)131:8(877) CE Database subject headings: Construction industry: Building design: Benefit cost ratios: Plumbing: Electrical systems; Mechanical systems.

This paper was written to fill a void created by the absence of fundamental principles of site construction management. Efficient material management is essential to managing a productive and cost efficient site. For more than 25 years, the senior author has been observing and writing about inefficient labor productivity practices resulting from poor site material management. Using deductive reasoning, fundamental principles were developed to avoid poor practices. A construction site should be portioned into three areas or zones: semipermanent (exterior) storage, staging areas, and workface (interior) storage. Each has a unique function relative to site material management. Using these areas as a framework, fundamental principles are stated and illustrated using a case study project accompanied by numerous photographs and narratives. CE Database subject headings: Construction materials; Cost control; Project management; Resource management.

The Parade Game illustrates the impact work flow variability has on the performance of construction trades and their successors. The game consists of simulating a construction process in which resources produced by one trade are prerequisite to work performed by the next trade. Production-level detail, describing resources being passed from one trade to the next, illustrates that throughput will be reduced, project completion delayed, and waste increased by variations in flow. The game shows that it is possible to reduce waste and shorten project duration by reducing the variability in work flow between trades. Basic production management concepts are thus applied to construction management. They highlight two shortcomings of using the critical-path method for field-level planning: The critical-path method makes modeling the dependence of ongoing activities between trades or with operations unwieldy and it does not explicitly represent variability. The Parade Game can be played in a classroom setting either by hand or using a computer. Computer simulation enables students to experiment with numerous alternatives to sharpen their intuition regarding variability, process throughput, buffers, productivity, and crew sizing. Managers interested in schedule compression will benefit from understanding work flow variability's impact on succeeding trade performance.

This paper describes three structural steel erection projects that used different methods of delivering the structural steel members. Two projects scheduled daily deliveries. On one project, steel was erected directly from the truck. On the second project, steel was off-loaded, sorted, and then erected. On the third project, three bulk deliveries of steel were made. The steel was stored wherever space was available, and sorting was done as the steel was erected. The differences in labor productivity are quantified using the multiple regression technique. The analysis shows that the most efficient delivery method is to erect the steel directly from the truck. Double-handling, as was done on the second project, resulted in a loss of productivity of about 9%. Indiscriminate deliveries resulted in a loss of productivity of about 16%. The effects of weather are also quantified. Significant losses of productivity occurred because of snow (41%) and cold temperatures (32%).

This paper presents a space planning method for multistory building construction. Current formal space planning in practice is limited to site layout and logistics, where space is needed for activities for extended periods of time. The space planning needed to sequence activities inside a building under construction is often neglected. The proposed space planning method is a manual method that provides a logical order and priority for space planning decisions. This helps a construction planner to: (1) identify the specific spaces needed for activities; (2) define locations for these spaces on building floors; (3) develop a sequence of work that defines the order spaces are occupied; and (4) identify potential spatial conflicts. Detail is added to the plan as needed. Through evaluation of 74 activities on four case study projects, the proposed method was found to be an accurate representation of the planning needed in multistory building construction. Two applications of the planning method identified interference problems before they occurred in the field, This space planning method offers construction managers a useful technique to develop efficient interior sequences that minimize interference and work space congestion.

Electrochemical techniques help grow conductive polymer/high-Tc superconductor bilayers structures, blocking the surface degradation of the high-Tc compounds. Atomic force microscopy, scanning electron microscopy and electrochemical techniques help characterize the deposition of polypyrrole layers onto YBa2Cu3O(7-delta) films. Oxidation of the polymer to its conductive state suppresses the transition temperature (Tc) and critical current (Jc) of the superconductor variations in the transition temperatures. Jc and Tc return to values of the underivatized YBa2Cu3O(7-delta) film, when the conductive polymer layer is reduced to its nonconductive form.