Does size matter? Experiences and perspectives of BIM implementation from large and SME construction contractors

This paper presents the findings of a qualitative study into the experiences and perspectives of large and SME construction contractors towards the implementation of Building Information Modelling (BIM) within their organisations. Results of the survey were statistically analysed to test for similarity and significant variations between the two groups. The results confirmed that both groups were equally aware of the perceived benefits of BIM, but found that the largest barriers to implementation were the costs associated with the technology and training requirements. Significant differences between the groups included plans to implement BIM and concerns with legal and commercial barriers

Utilizing Temporal Information in The EHR for Developing a Novel Continuous Prediction Model

Type 2 diabetes mellitus (T2DM) is a nation-wide prevalent chronic condition, which includes direct and indirect healthcare costs. T2DM, however, is a preventable chronic condition based on previous clinical research. Many prediction models were based on the risk factors identified by clinical trials. One of the major tasks of the T2DM prediction models is to estimate the risks for further testing by HbA1c or fasting plasma glucose to determine whether the patient has or does not have T2DM because nation-wide screening is not cost-effective. Those models had substantial limitations on data quality, such as missing values. In this dissertation, I tested the conventional models which were based on the most widely used risk factors to predict the possibility of developing T2DM. The AUC was an average of 0.5, which implies the conventional model cannot be used to screen for T2DM risks. Based on this result, I further implemented three types of temporal representations, including non-temporal representation, interval-temporal representation, and continuous-temporal representation for building the T2DM prediction model. According to the results, continuous-temporal representation had the best performance. Continuous-temporal representation was based on deep learning methods. The result implied that the deep learning method could overcome the data quality issue and could achieve better performance. This dissertation also contributes to a continuous risk output model based on the seq2seq model. This model can generate a monotonic increasing function for a given patient to predict the future probability of developing T2DM. The model is workable but still has many limitations to overcome. Finally, this dissertation demonstrates some risks factors which are underestimated and are worthy for further research to revise the current T2DM screening guideline. The results were still preliminary. I need to collaborate with an epidemiologist and other fields to verify the findings. In the future, the methods for building a T2DM prediction model can also be used for other prediction models of chronic conditions

Comparison of Screening Methods for Pre-diabetes and Type 2 Diabetes Mellitus by Race/Ethnicity and Gender

INTRODUCTION/OBJECTIVES: Current screening guidelines for pre-diabetes and type 2 diabetes mellitus note that there are discrepancies in diagnosing the disease using the fasting plasma glucose test, oral glucose tolerance test, and HbA1c in high-risk populations. The objective of this study is to compare the effectiveness of screening methods for type 2 diabetes mellitus (T2DM) and pre-diabetes by race/ethnicity and gender. METHODS: Secondary analyses of the National Health and Nutrition Examination Survey (NHANES, 2005-2008) were performed using SPSS 19.0. Screening outcomes were assessed and compared for a sample of n=10,566, NHW, NHB, MA, and Multiracial/other men and women. Analyses included cross tabulations, ANOVA and partial correlations to establish disease prevalence, effectiveness of screenings, and statistical significance. RESULTS: It was found that the HbA1c test is comparable in precision, and is correlated with the FPG for racial and ethnic minorities. The specificities for detecting pre-diabetes using the HbA1c were higher (64-66%) for these groups than by using the standard, FPG screening method (42-49%). There were no strong, significant differences for screening effectiveness for men versus women. DISCUSSION: This study revealed that the HbA1c test might be an effective method for screening for pre-diabetes in racial and ethnic minorities instead of the FPG test alone. Screening in high-risk populations will help delay the onset of T2DM, with increased prevention during the pre-clinical phase

Metabolomics analyses to better understand complex phenotypes

In dieser Doktorarbeit werden drei Metabolomics-Studien der KORA Kohorte behandelt. Das Ziel dieser Doktorarbeit war, ein besseres Verständnis der Rolle des Metabolismus von komplexen Phänotypen anhand von Unterschieden im Blutbild, des Geschlechts und anhand von Veränderungen des Metabolitenprofils bei multifaktoriellen Krankheiten wie Typ 2 Diabetes mellitus zu erhalten. Um Artefakte auszuschließen wurden strikte Qualitätskontrollen aller gemessenen Metaboliten durchgeführt. Durch die Analyse von Blutplasma und -serum von 377 Personen konnten wir zeigen, dass die Konzentrationen der Metaboliten in Blutplasma und -serum stark korrelieren und darüber hinaus eine hohe Reproduktionsrate zeigen, bei der Blutplasma besser abschneidet. Im Gegensatz dazu zeigt das Blutserum höhere Metabolitenkonzentrationen und könnte deswegen besser für den Nachweis von Konzentrationsunterschieden geeignet sein. Ein weiteres Ergebnis dieser Doktorarbeit war der Nachweis von signifikanten geschlechtsspezifischen Unterschieden der Konzentrationen von 102 der ausgewerteten 131 Metaboliten. Dabei wurden die Daten von mehr als 3300 Personen der KORA Kohorte verwendet und die Analysen einer konservativen Bonferroni-Korrektur unterzogen. Darüber hinaus identifizierten wir potentielle Biomarker für Prä-Diabetes durch die Analyse von 140 Metaboliten in nüchtern abgegebenen Blutseren von 4297 Personen der KORA Kohorte. Wir konnten zeigen, dass Personen mit gestörter Glukosetoleranz (IGT) signifikant unterschiedliche Konzentrationen von drei Metaboliten (Glycin, lysoPhosphatidylcholine (LPC) 18:2 und acetylcarnitine) im Vergleich zu gesunden Personen aufweisen. Darüber hinaus konnten wir nachweisen, dass geringere Konzentrationen der Metaboliten Glycin und LPC bei Probanden mit Typ 2 Diabetes oder IGT vorhanden sind. Die in dieser Studie identifizierten Metaboliten sind biologisch unabhängig von zuvor entdeckten Diabetes Risikofaktoren. Durch weitere Analysen und die Einbeziehung systembiologischer Ansätze entdeckten wir sieben Diabetesrisiko Susseptibilitätsgene, welche durch Expressionsdaten bestätigt wurden. Metabolomics welches auf der Analyse von Stoffwechselzwischen- und Endprodukten basiert, ist eine wertvolle Methode besonders in der biomedizinischen Forschung, um Krankheitsmechanismen aufzuklären. Nachdem angemessene Qualitätskontrollen etabliert und der Einfluss von komplexen Störfaktoren (z.B. das Geschlecht) aufgeklärt wurden, konnte der Zusammenhang zwischen Krankheit und Metabolismus weiter an Klarheit gewinnen. Die Entdeckungen in unserer T2D Studie zeigen, dass die Analyse von Konzentrationsprofilen helfen kann neue Krankheitsrisikomarker genauso wie neue Wirkungspfade zu identifizieren, die möglicherweise das Ziel zur Heilung einer Krankheit sein könnten

Rationale and design of the ADDITION-Leicester study, a systematic screening programme and randomised controlled trial of multi-factorial cardiovascular risk intervention in people with type 2 diabetes mellitus detected by screening.

BACKGROUND: Earlier diagnosis followed by multi-factorial cardiovascular risk intervention may improve outcomes in type 2 diabetes mellitus (T2DM). Latent phase identification through screening requires structured, appropriately targeted population-based approaches. Providers responsible for implementing screening policy await evidence of clinical and cost effectiveness from randomised intervention trials in screen-detected T2DM cases. UK South Asians are at particularly high risk of abnormal glucose tolerance and T2DM. To be effective national screening programmes must achieve good coverage across the population by identifying barriers to the detection of disease and adapting to the delivery of earlier care. Here we describe the rationale and methods of a systematic community screening programme and randomised controlled trial of cardiovascular risk management within a UK multiethnic setting (ADDITION-Leicester). DESIGN: A single-blind cluster randomised, parallel group trial among people with screen-detected T2DM comparing a protocol driven intensive multi-factorial treatment with conventional care. METHODS: ADDITION-Leicester consists of community-based screening and intervention phases within 20 general practices coordinated from a single academic research centre. Screening adopts a universal diagnostic approach via repeated 75g-oral glucose tolerance tests within an eligible non-diabetic population of 66,320 individuals aged 40-75 years (25-75 years South Asian). Volunteers also provide detailed medical and family histories; complete health questionnaires, undergo anthropometric measures, lipid profiling and a proteinuria assessment. Primary outcome is reduction in modelled Coronary Heart Disease (UKPDS CHD) risk at five years. Seven thousand (30% of South Asian ethnic origin) volunteers over three years will be recruited to identify a screen-detected T2DM cohort (n = 285) powered to detected a 6% relative difference (80% power, alpha 0.05) between treatment groups at one year. Randomisation will occur at practice-level with newly diagnosed T2DM cases receiving either conventional (according to current national guidelines) or intensive (algorithmic target-driven multi-factorial cardiovascular risk intervention) treatments. DISCUSSION: ADDITION-Leicester is the largest multiethnic (targeting >30% South Asian recruitment) community T2DM and vascular risk screening programme in the UK. By assessing feasibility and efficacy of T2DM screening, it will inform national disease prevention policy and contribute significantly to our understanding of the health care needs of UK South Asians. TRIAL REGISTRATION: Clinicaltrial.gov (NCT00318032).RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Humor Perception: The Contribution of Cognitive Factors

Most of the extant humor research has focused on humor comprehension with only a few studies investigating humor appreciation as a separate construct. The purpose of this investigation was to determine the relation between humor and underlying cognitive processes. Literature on brain injured individuals has indicated that working memory, verbal and visual-spatial reasoning, cognitive flexibility, and concept formation are related to performance on comprehension tests of humor. In this study, cognitive processes underlying both verbal and nonverbal humor were investigated in a sample of healthy young adults. There is evidence that semantic and phonological humor are associated with different neural networks; therefore, both semantic and phonological humor were explored. Studies investigating physiological arousal and humor have indicated that arousal is necessary for the experience of humor. This suggests that the appreciation of humor may require the integration of cognitive and affective information, a process mediated by the ventromedial prefrontal cortex (VMPFC). Thus, a second goal of this study was to investigate the relationship between humor comprehension and appreciation and the VMPFC, by including experimental tasks that previously have been linked to VMPFC functioning. Participants included 94 undergraduate psychology students between the ages of 18 and 39 years. Participants watched film clips and listened to jokes. After the presentation of each joke and each film clip, they completed a humor comprehension/appreciation inventory developed for this study. They also completed measures assessing a range of cognitive abilities hypothesized to underlie humor perception. Hierarchical regression analyses revealed that verbal reasoning was predictive of semantic humor comprehension, indicating that verbal reasoning is a core cognitive ability for the comprehension of jokes in which the humor depends on factors other than simple word play. Cognitive measures were not predictive of phonological humor comprehension or nonverbal humor comprehension. Hierarchical regression analyses revealed that the indicators of VMPFC functioning did not correlate with either humor comprehension or humor appreciation and did not moderate the relation between humor comprehension and humor appreciation. Future research is necessary to elucidate the relationships between cognitive abilities and humor perception and to further explore the contribution of the VMPFC to humor appreciation

Evaluating sleep and circadian rhythm disturbances and symptoms of impulsivity and inattention: Implications for adult attention-deficit/hyperactivity disorder

Reports of sleep disturbances and delayed sleep timing in attentiondeficit/ hyperactivity-disorder (ADHD) are common however the aetiology of such features is poorly understood. There is substantial evidence pointing to dysfunction of the circadian timing system in ADHD, and individual differences in human chronotype and diurnal preference have been linked with impulsivity and attention problems in adults. In the work presented here we examined associations between a later circadian phase of entrainment, impaired sleep quality, and circadian misalignment and how they relate to core symptoms of ADHD distributed among the general population. We report novel evidence which suggests that ‘social jetlag’ – an index of circadian misalignment arising from discordance between endogenous circadian timing and the timing of the social clock – is a consistent predictor of poorer ADHD-like symptom outcomes. Furthermore, objective assessment of the rest-activity rhythm and sleep intervals of subjects show that a failure to precisely entrain to the 24 h circadian period is associated with ADHD-like symptom severity which was in turn predicted by delayed circadian phase/sleep phase, sleep quality, and duration. Candidate gene approaches did not replicate previous findings linking symptoms of impulsivity, inattention, and later chronotype with elements of the core molecular clock. However, we did find differential susceptibility to the previously identified risk factors; poor sleep quality and social jetlag which were both modified by genotype. Preliminary data from an exploratory study examining the neurophysiological correlates of response inhibition and selective attention revealed interesting patters of ERP elicitation in individuals with high levels of social jetlag. The current findings highlight how examination of sleep and circadian rhythm disturbances associated with ADHD may inform our understanding of the disorder risk and might in the future be factored into interventions designed for better symptom management

VMP1- Related autophagy induced by fructose rich diet in β-cells: its prevention by incretins

To demonstrate the role of autophagy and incretins on fructose‐induced alteration in β‐cell mass and function. Methods: Normal Wistar rats were fed (3 weeks) with commercial diet without (C) or with 10% fructose in drinking water (F) alone or plus sitagliptin (CS and FS) or exendin‐4 (CE and FE). Serum levels of metabolic/endocrine parameters, β‐cell mass, morphology/ultrastructure and apoptosis, VMP1 expression and glucose‐stimulated insulin secretion (GSIS) were studied. Complementary, islets isolated from normal rats were cultured (3 days) without (C) or with F and F plus exendin‐4 (FE) or chloroquine (FCQ). Expression of autophagy related‐proteins (VMP1 and LC3), apoptotic/antiapoptotic markers (caspase‐3 and Bcl‐2), GSIS and insulin mRNA levels were measured. Results: F rats developed impaired glucose tolerance (IGT) and a significant increase in plasma triglyceride, TBARS, insulin levels, HOMAIR and HOMA‐β indexes. Significant β‐cell mass reduction was associated to an increased apoptotic rate and morphological/ultrastructural changes indicative of autophagic activity. All these changes were prevented by either sitagliptin or exendin‐4. In cultured islets, F significantly enhanced insulin mRNA and GSIS, decreased Bcl‐2 mRNA levels and increased caspase‐3 expression. Chloroquine reduced these changes suggesting autophagy participation in this process. Indeed, F induced the increase of both, VMP1 expression and LC3‐II, suggesting that VMP1‐related autophagy is activated in injured β‐cell. Exendin‐4 prevented islet‐cell damage and autophagy development. Conclusions: VMP1‐related autophagy is a reactive process against Finduced islet dysfunction, being prevented by exendin‐4 treatment. This knowledge could help to use autophagy as potential target for preventing progression from IGT toT2DM.Centro de Endocrinología Experimental y Aplicada (CENEXA)Facultad de Ciencias Médicas (FCM