Preventing the Immense Increase in the Life-Cycle Energy and Carbon Footprints of LLM-Powered Intelligent Chatbots

Intelligent chatbots powered by large language models(LLMs)have recently been sweeping the world,with potential for a wide variety of industrial applications.Global frontier technology companies are feverishly participating in LLM-powered chatbot design and development,providing several alternatives beyond the famous ChatGPT.However,training,fine-tuning,and updating such intelligent chatbots consume substantial amounts of electricity,resulting in significant carbon emissions.The research and development of all intelligent LLMs and software,hardware manufacturing(e.g.,graphics processing units and supercomputers),related data/operations management,and material recycling supporting chatbot services are associated with carbon emissions to varying extents.Attention should therefore be paid to the entire life-cycle energy and carbon footprints of LLM-powered intelligent chatbots in both the present and future in order to mitigate their climate change impact.In this work,we clarify and highlight the energy consumption and carbon emission implications of eight main phases throughout the life cycle of the development of such intelligent chatbots.Based on a life-cycle and interaction analysis of these phases,we propose a system-level solution with three strategic pathways to optimize the management of this industry and mitigate the related footprints.While anticipating the enormous potential of this advanced technology and its products,we make an appeal for a rethinking of the mitigation pathways and strategies of the life-cycle energy usage and carbon emissions of the LLM-powered intelligent chatbot industry and a reshaping of their energy and environmental implications at this early stage of development.

Reliability-based life-cycle cost seismic design optimization of coastal bridge piers with nonuniform corrosion using different materials

Reinforcement corrosion is the main cause of performance deterioration of reinforced concrete(RC)structures.Limited research has been performed to investigate the life-cycle cost(LCC)of coastal bridge piers with nonuniform corrosion using different materials.In this study,a reliability-based design optimization(RBDO)procedure is improved for the design of coastal bridge piers using six groups of commonly used materials,i.e.,normal performance concrete(NPC)with black steel(BS)rebar,high strength steel(HSS)rebar,epoxy coated(EC)rebar,and stainless steel(SS)rebar(named NPC-BS,NPC-HSS,NPC-EC,and NPC-SS,respectively),NPC with BS with silane soakage on the pier surface(named NPC-Silane),and high-performance concrete(HPC)with BS rebar(named HPC-BS).First,the RBDO procedure is improved for the design optimization of coastal bridge piers,and a bridge is selected to illustrate the procedure.Then,reliability analysis of the pier designed with each group of materials is carried out to obtain the time-dependent reliability in terms of the ultimate and serviceability performances.Next,the repair time of the pier is predicted based on the time-dependent reliability indices.Finally,the time-dependent LCCs for the pier are obtained for the selection of the optimal design.

Triglyceride-glucose related indices as predictors for major adverse cardiovascular events and overall mortality in type-2 diabetes mellitus patients

BACKGROUND Recent studies have indicated that triglyceride glucose(TyG)-waist height ratio(WHtR)and TyG-waist circumference(TyG-WC)are effective indicators for evaluating insulin resistance.However,research on the association in TyG-WHtR,TyG-WC,and the risk and prognosis of major adverse cardiovascular events(MACEs)in type 2 diabetes mellitus(T2DM)cases are limited.AIM To clarify the relation in TyG-WHtR,TyG-WC,and the risk of MACEs and overall mortality in T2DM patients.METHODS Information for this investigation was obtained from Action to Control Cardiovascular Risk in Diabetes(ACCORD)/ACCORD Follow-On(ACCORDION)study database.The Cox regression model was applied to assess the relation among TyG-WHtR,TyG-WC and future MACEs risk and overall mortality in T2DM cases.The RCS analysis was utilized to explore the nonlinear correlation.Subgroup and interaction analyses were conducted to prove the robustness.The receiver operating characteristic curves were applied to analysis the additional predicting value of TyG-WHtR and TyG-WC.RESULTS After full adjustment for confounding variables,the highest baseline TyG-WHtR cohort respectively exhibited a 1.353-fold and 1.420-fold higher risk for MACEs and overall mortality,than the lowest quartile group.Similarly,the highest baseline TyG-WC cohort showed a 1.314-fold and 1.480-fold higher risk for MACEs and overall mortality,respectively.Each 1 SD increase in TyG-WHtR was significantly related to an 11.7%increase in MACEs and a 14.9%enhance in overall mortality.Each 1 SD increase in TyG-WC corresponded to an 11.5%in MACEs and a 16.6%increase in overall mortality.Including these two indexes in conventional models significantly improved the predictive power for MACEs and overall mortality.CONCLUSION TyG-WHtR and TyG-WC were promising predictors of MACEs and overall mortality risk in T2DM cases.

Construction of project quality health monitoring system based on life-cycle theory

In order to more effectively assess the health status of a project, the monitoring indices in a project＇s life cycle are divided into quality index, cost index, time index, satisfaction index, and sustainable development index. Based on the feature of qualitative and quantitative indices combining, the PCA-PR （principal component analysis and pattern recognition） model is constructed. The model first analyzes the principal components of the life-cycle indices system constructed above, and picks up those principal component indices that can reflect the health status of a project at any time. Then the pattern recognition model is used to study these principal components, which means that the real time health status of the project can be divided into five lamps from a green lamp to a red one and the health status lamp of the project can be recognized by using the PR model and those principal components. Finally, the process is shown with a real example and a conclusion consistent with the actual situation is drawn. So the validity of the index system and the PCA-PR model can be confirmed.

基于改进Event模型的通用航空器碰撞风险分析

随着通用航空的发展,空中交通流量将持续扩大,航空器碰撞风险增加。对Event模型进行改进,将拼接四棱锥碰撞盒代替原长方体碰撞盒,曲面间隔层代替平面间隔层,建立通用航空器碰撞风险模型。最后将塞斯纳172及运5B通用航空器作为实例对所建模型进行验证,结果表明,在两组均采用广义帕累托分布的条件下,改进后Event模型碰撞风险值分别为改进前的31.65%、14.98%,碰撞风险值较改进前大大减少,结果精度更高,能更好地评估交叉航路碰撞风险。

Characterization and evaluation of brittleness of deep bedded sandstone from the perspective of the whole life-cycle evolution process

The quantitative determination and evaluation of rock brittleness are crucial for the estimation of excavation efficiency and the improvement of hydraulic fracturing efficiency.Therefore,a“three-stage”triaxial loading and unloading stress path is designed and proposed.Subsequently,six brittleness indices are selected.In addition,the evolution characteristics of the six brittleness indices selected are characterized based on the bedding effect and the effect of confining pressure.Then,the entropy weight method(EWM)is introduced to assign weight to the six brittleness indices,and the comprehensive brittleness index Bcis defined and evaluated.Next,the new brittleness classification standard is determined,and the brittleness differences between the two stress paths are quantified.Finally,compared with the previous evaluation methods,the rationality of the proposed comprehensive brittleness index Bcis also verified.These results indicate that the proposed brittleness index Bccan reflect the brittle characteristics of deep bedded sandstone from the perspective of the whole life-cycle evolution process.Accordingly,the method proposed seems to offer reliable evaluations of the brittleness of deep bedded sandstone in deep engineering practices,although further validation is necessary.

Life-cycle failure probability analysis of deteriorated RC bridges under multiple hazards of earthquakes and strong winds

Engineering structures may be exposed to one or more extreme hazards during their life-cycles.Current structural design specifications usually treat multiple hazards separately in designing structures and there is a limited probabilistic basis on extreme load combinations.Additionally,the performance of engineering structures will be deteriorated by the aggressive environments during their service periods,such as chloride attack,concrete carbonation,and wind-induced fatigue.This study presents a probabilistic methodology to assess the time-dependent failure probability of RC bridges with chloride-induced corrosion under the multiple hazards of earthquakes and strong winds.The loss of cross-section area of reinforcements and the reduction in strength of reinforcing steel and concrete cover induced by the chloride attack are considered.Moreover,the Poisson model is employed to obtain the occurrence probabilities of the individual and concurrent earthquake and strong wind events.The convolution integral is used to determine the joint probability distribution of combined load effects under simultaneous earthquakes and strong winds.Numerical results indicate that the structural failure probability under multiple hazards increases significantly during the bridge′s life-cycle due to the chloride corrosion effect.The contribution of each hazard event on the total structural failure probability varies with time.Thus,neglecting the combined influences of multiple hazards and chloride-induced corrosion may bring erroneous predictions in failure probability estimates of RC bridges.

Life-cycle Assessment of Carbon Dioxide Capture for Enhanced Oil Recovery

The development and deployment of Carbon dioxide Capture and Storage （CCS） technology is a cornerstone of the Norwegian government＇s climate strategy. A number of projects are currently evaluated/planned along the Norwegian West Coast, one at Tjeldbergodden. COe from this project will be utilized in part for enhanced oil recovery in the Halten oil field, in the Norwegian Sea. We study a potential design of such a system. A combined cycle power plant with a gross power output of 832 MW is combined with CO2 capture plant based on a post-combustion capture using amines as a solvent. The captured CO2 is used for enhanced oil recovery （EOR）. We employ a hybrid life-cycle assessment （LCA） method to assess the environmental impacts of the system. The study focuses on the modifications and operations of the platform during EOR. We allocate the impacts connected to the capture of CO2 to electricity production, and the impacts connected to the transport and storage of CO2 to the oil produced. Our study shows a substantial reduction of the greenhouse gas emissions from power production by 80% to 75 g·（kW·h）^-1. It also indicates a reduction of the emissions associated with oil production per unit oil produced, mostly due to the increased oil production. Reductions are especially significant if the additional power demand due to EOR leads to power supply from the land.

A Blockchain-Based Life-Cycle Environmental Management Framework for Hospitals in the COVID-19 Context

During the coronavirus disease 2019 (COVID-19) emergency, many hospitals were built or renovated around the world to meet the challenges posed by the rising number of infected cases. Environmental management in the hospital life cycle is vital in preventing nosocomial infection and includes many infection control procedures. In certain urgent situations, a hospital must be completed quickly, and work process approval and supervision must therefore be accelerated. Thus, many works cannot be checked in detail. This results in a lack of work liability control and increases the difficulty of ensuring the fulfillment of key infection prevention measures. This study investigates how blockchain technology can transform the work quality inspection workflow to assist in nosocomial infection control under a fast delivery requirement. A blockchain-based life-cycle environmental management framework is proposed to track the fulfillment of crucial infection control measures in the design, construction, and operation stages of hospitals. The proposed framework allows for work quality checking after the work is completed, when some work cannot be checked on time. Illustrative use cases are selected to demonstrate the capabilities of the developed solution. This study provides new insights into applying blockchain technology to address the challenge of environmental management brought by rapid delivery requirements.

Life-cycle CO_2 Emissions and Their Driving Factors in Construction Sector in China

As the construction sector is a major energy consumer and thus a significant contributor of CO_2 emissions in China,it is important to consider carbon reduction in this industry.This study analyzed six life-cycle stages and calculated the life-cycle CO_2 emissions of the construction sector in 30 Chinese provincial jurisdictions to understand the disparity among them.Results show that building materials production was the key stage for carbon reduction in the construction sector,followed by the building operation stage.External variables,e.g.,economic growth,industrial structure,urbanization,price fluctuation,and marketization,were significantly correlated with the emission intensity of the construction sector.Specifically,economic growth exhibited an inverted U-shaped relation with CO_2 emissions per capita and per area during the period examined.Secondary industry and land urbanization were negatively correlated with CO_2 emission intensity indicators from the construction sector,whereas tertiary industry and urbanization were positively correlated.Price indices and marketization had negative effects on CO_2 emission intensity.The policy implications of our findings are that cleaner technologies should be encouraged for cement providers,and green purchasing rules for the construction sector should also be established.Pricing tools(e.g.,resource taxes)could help to adjust the demand for raw materials and energy.

Projecting Spring Consecutive Rainfall Events in the Three Gorges Reservoir Based on Triple-Nested Dynamical Downscaling

Spring consecutive rainfall events(CREs) are key triggers of geological hazards in the Three Gorges Reservoir area(TGR), China. However, previous projections of CREs based on the direct outputs of global climate models(GCMs) are subject to considerable uncertainties, largely caused by their coarse resolution. This study applies a triple-nested WRF(Weather Research and Forecasting) model dynamical downscaling, driven by a GCM, MIROC6(Model for Interdisciplinary Research on Climate, version 6), to improve the historical simulation and reduce the uncertainties in the future projection of CREs in the TGR. Results indicate that WRF has better performances in reproducing the observed rainfall in terms of the daily probability distribution, monthly evolution and duration of rainfall events, demonstrating the ability of WRF in simulating CREs. Thus, the triple-nested WRF is applied to project the future changes of CREs under the middle-of-the-road and fossil-fueled development scenarios. It is indicated that light and moderate rainfall and the duration of continuous rainfall spells will decrease in the TGR, leading to a decrease in the frequency of CREs. Meanwhile, the duration, rainfall amount, and intensity of CREs is projected to regional increase in the central-west TGR. These results are inconsistent with the raw projection of MIROC6. Observational diagnosis implies that CREs are mainly contributed by the vertical moisture advection. Such a synoptic contribution is captured well by WRF, which is not the case in MIROC6,indicating larger uncertainties in the CREs projected by MIROC6.

Prediabetes: An overlooked risk factor for major adverse cardiac and cerebrovascular events in atrial fibrillation patients

BACKGROUND Prediabetes is a well-established risk factor for major adverse cardiac and cerebrovascular events(MACCE).However,the relationship between prediabetes and MACCE in atrial fibrillation(AF)patients has not been extensively studied.Therefore,this study aimed to establish a link between prediabetes and MACCE in AF patients.AIM To investigate a link between prediabetes and MACCE in AF patients.METHODS We used the National Inpatient Sample(2019)and relevant ICD-10 CM codes to identify hospitalizations with AF and categorized them into groups with and without prediabetes,excluding diabetics.The primary outcome was MACCE(all-cause inpatient mortality,cardiac arrest including ventricular fibrillation,and stroke)in AF-related hospitalizations.RESULTS Of the 2965875 AF-related hospitalizations for MACCE,47505(1.6%)were among patients with prediabetes.The prediabetes cohort was relatively younger(median 75 vs 78 years),and often consisted of males(56.3%vs 51.4%),blacks(9.8%vs 7.9%),Hispanics(7.3%vs 4.3%),and Asians(4.7%vs 1.6%)than the non-prediabetic cohort(P<0.001).The prediabetes group had significantly higher rates of hypertension,hyperlipidemia,smoking,obesity,drug abuse,prior myocardial infarction,peripheral vascular disease,and hyperthyroidism(all P<0.05).The prediabetes cohort was often discharged routinely(51.1%vs 41.1%),but more frequently required home health care(23.6%vs 21.0%)and had higher costs.After adjusting for baseline characteristics or comorbidities,the prediabetes cohort with AF admissions showed a higher rate and significantly higher odds of MACCE compared to the non-prediabetic cohort[18.6%vs 14.7%,odds ratio(OR)1.34,95%confidence interval 1.26-1.42,P<0.001].On subgroup analyses,males had a stronger association(aOR 1.43)compared to females(aOR 1.22),whereas on the race-wise comparison,Hispanics(aOR 1.43)and Asians(aOR 1.36)had a stronger association with MACCE with prediabetes vs whites(aOR 1.33)and blacks(aOR 1.21).CONCLUSION This population-based study found a significant association between prediabetes and MACCE in AF patients.Therefore,there is a need for further research to actively screen and manage prediabetes in AF to prevent MACCE.

Comparative Life-cycle Assessment of Sheet Molding Compound Reinforced by Natural Fiber vs. Glass Fiber

We present comparative life-cycle assessments of three fiber-reinforced sheet molding compounds （SMCs） using kenaf fiber, glass fiber and soy protein resin. Sheet molding compounds for automotive applications are typically made of unsaturated polyester and glass fibers. Replacing these with kenaf fiber or soy protein offers potential environmental benefits. A soy-based resin, maleated acrylated epoxidized soy oil （MAESO）, was synthesized from refined soybean oil. Kenaf fiber and polyester resins were used to make SMC 1 composites, while SMC2 composites were made from kenaf fiber and a resin blend of 20% MASEO and 80% unsaturated polyester. Both exhibited good physical and mechanical properties, though neither was as strong as glass fiber reinforced polyester SMC. The functional unit was defined as mass to achieve equal stiffness and stability for the manufacture of interior parts for automobiles. The life-cycle assessments were done on SMCI, SMC2 and glass fiber reinforced SMC. The material and energy balances from producing one functional unit of three composites were collected from lab experiments and the literature. Key environmental measures were computed using SimaPro software. Kenaf fiber-reinforced SMC composites （SMC1 and SMC2） performed better than glass fiber-reinforced SMC in every environmental category. The global warming potentials of kenaf fiber-reinforced SMC （SMCI） and kenaf soy resin-based SMC （SMC2） were 45% and 58%, respectively, of glass fiber-reinforced SMC. Thus, we have demonstrated significant ecological benefit from replacing glass fiber reinforced SMC with soy-based resin and natural fiber.

The Environmental Impacts and Economic Benefits on Comprehensively Promoting Alternative Fuel Buses in China: Life-Cycle and Scenario Analysis Based on LEAP Model

With the continuous development of urban public transportation, the harmful GHG emissions and pollutants generated by itself and the consequent issues such as the losses of residents’ health, economic value and residents’ welfare have become the focus of social attention. In order to study the impacts of promoting new energy vehicles on public transportation pollution mitigation and residents’ health benefits, this paper adopts the LEAP model to build some scenarios that fulfill different development needs to quantitatively analyze the ownership of new energy buses, the reduction of pollutants and the losses of residents’ health welfare. It is concluded that promoting new energy buses comprehensively can significantly reduce the emissions of atmospheric pollutants and the economic losses of residents’ health, but cannot fully realize the targets of greenhouse gas reduction under Life Cycle Analysis.

Anthropogenic Influence on Decadal Changes in Concurrent Hot and Dry Events over China around the Mid-1990s

The frequency and duration of observed concurrent hot and dry events(HDEs) over China during the growing season(April–September) exhibit significant decadal changes across the mid-1990s. These changes are characterized by increases in HDE frequency and duration over most of China, with relatively large increases over southeastern China(SEC), northern China(NC), and northeastern China(NEC). The frequency of HDEs averaged over China in the present day(PD,1994–2011) is double that in the early period(EP, 1964–81);the duration of HDEs increases by 60%. Climate experiments with the Met Office Unified Model(MetUM-GOML2) are used to estimate the contributions of anthropogenic forcing to HDE decadal changes over China. Anthropogenic forcing changes can explain 60%–70% of the observed decadal changes,suggesting an important anthropogenic influence on HDE changes over China across the mid-1990s. Single-forcing experiments indicate that the increase in greenhouse gas(GHG) concentrations dominates the simulated decadal changes,increasing the frequency and duration of HDEs throughout China. The change in anthropogenic aerosol(AA) emissions significantly decreases the frequency and duration of HDEs over SEC and NC, but the magnitude of the decrease is much smaller than the increase induced by GHGs. The changes in HDEs in response to anthropogenic forcing are mainly due to the response of climatological mean surface air temperatures. The contributions from changes in variability and changes in climatological mean soil moisture and evapotranspiration are relatively small. The physical processes associated with the response of HDEs to GHG and AA changes are also revealed.

Study on life-cycle risk management of high earth-rock dam project

Based on advanced computer technology, internet of things （lOT） technology, project management con- cept and professional technology and combined with the innovative theories, methods and techniques in earlier hy- dropower projects, the life-cycle risk management system of high earth-rock dam project for Nuozhadu project was developed. The system mainly includes digital dam, three-dimensional design, construction quality monito- ring, safety assessment and warning, etc, to integrally manage and analyze the dam design, constructional quality and safety monitoring information. It realized the dynamic updates of the comprehensive information and the safe- ty quality monitoring in the project life cycle, and provided the basic platform for the scientific management of the construction and operation safety of high earth-rock dam. Application in Nuozhadu earth-rock dam showed that construction safety monitoring and warning greatly helped accelerate the construction progress and improve project quality, and provided a new way for the quality safety control of high earth-rock dam.

Increased retinal venule diameter as a prognostic indicator for recurrent cerebrovascular events:a prospective observational study

Microvasculature of the retina is considered an alternative marker of cerebral vascular risk in healthy populations.However,the ability of retinal vasculature changes,specifically focusing on retinal vessel diameter,to predict the recurrence of cerebrovascular events in patients with ischemic stroke has not been determined comprehensively.While previous studies have shown a link between retinal vessel diameter and recurrent cerebrovascular events,they have not incorporated this information into a predictive model.Therefore,this study aimed to investigate the relationship between retinal vessel diameter and subsequent cerebrovascular events in patients with acute ischemic stroke.Additionally,we sought to establish a predictive model by combining retinal veessel diameter with traditional risk factors.We performed a prospective observational study of 141 patients with acute ischemic stroke who were admitted to the First Affiliated Hospital of Jinan University.All of these patients underwent digital retinal imaging within 72 hours of admission and were followed up for 3 years.We found that,after adjusting for related risk factors,patients with acute ischemic stroke with mean arteriolar diameter within 0.5-1.0 disc diameters of the disc margin(MAD_(0.5-1.0DD))of≥74.14μm and mean venular diameter within 0.5-1.0 disc diameters of the disc margin(MVD_(0.5-1.0DD))of≥83.91μm tended to experience recurrent cerebrovascular events.We established three multivariate Cox proportional hazard regression models:model 1 included traditional risk factors,model 2 added MAD_(0.5-1.0DD)to model 1,and model 3 added MVD0.5-1.0DD to model 1.Model 3 had the greatest potential to predict subsequent cerebrovascular events,followed by model 2,and finally model 1.These findings indicate that combining retinal venular or arteriolar diameter with traditional risk factors could improve the prediction of recurrent cerebrovascular events in patients with acute ischemic stroke,and that retinal imaging could be a useful and non-invasive method for identifying high-risk patients who require closer monitoring and more aggressive management.

Impact of body mass index on adverse kidney events in diabetes mellitus patients: A systematic-review and meta-analysis

BACKGROUND The incidence of chronic kidney disease among patients with diabetes mellitus(DM)remains a global concern.Long-term obesity is known to possibly influence the development of type 2 diabetes mellitus.However,no previous meta-analysis has assessed the effects of body mass index(BMI)on adverse kidney events in patients with DM.AIM To determine the impact of BMI on adverse kidney events in patients with DM.METHODS A systematic literature search was performed on the PubMed,ISI Web of Science,Scopus,Ovid,Google Scholar,EMBASE,and BMJ databases.We included trials with the following characteristics:(1)Type of study:Prospective,retrospective,randomized,and non-randomized in design;(2)participants:Restricted to patients with DM aged≥18 years;(3)intervention:No intervention;and(4)kidney adverse events:Onset of diabetic kidney disease[estimated glomerular filtration rate(eGFR)of<60 mL/min/1.73 m2 and/or microalbuminuria value of≥30 mg/g Cr],serum creatinine increase of more than double the baseline or end-stage renal disease(eGFR<15 mL/min/1.73 m2 or dialysis),or death.RESULTS Overall,11 studies involving 801 patients with DM were included.High BMI(≥25 kg/m2)was significantly associated with higher blood pressure(BP)[systolic BP by 0.20,95%confidence interval(CI):0.15–0.25,P<0.00001;diastolic BP by 0.21 mmHg,95%CI:0.04–0.37,P=0.010],serum albumin,triglycerides[standard mean difference(SMD)=0.35,95%CI:0.29–0.41,P<0.00001],low-density lipoprotein(SMD=0.12,95%CI:0.04–0.20,P=0.030),and lower high-density lipoprotein(SMD=–0.36,95%CI:–0.51 to–0.21,P<0.00001)in patients with DM compared with those with low BMIs(<25 kg/m2).Our analysis showed that high BMI was associated with a higher risk ratio of adverse kidney events than low BMI(RR:1.22,95%CI:1.01–1.43,P=0.036).CONCLUSION The present analysis suggested that high BMI was a risk factor for adverse kidney events in patients with DM.

Degradation process assessment of prestressed concrete continuous bridges in life-cycle

To accurately evaluate the degradation process of prestressed concrete continuous bridges exposed to aggressive environments in life-cycle,a finite element-based approach with respect to the lifetime performance assessment of concrete bridges was proposed.The existing assessment methods were firstly introduced and compared.Some essential mechanics problems involved in the degradation process,such as the deterioration of materials properties,the reduction of sectional areas and the variation of overall structural performance caused by the first two problems,were investigated and solved.A computer program named CBDAS(Concrete Bridge Durability Analysis System) was written to perform the above-metioned approach.Finally,the degradation process of a prestressed concrete continuous bridge under chloride penetration was discussed.The results show that the concrete normal stress for serviceability limit state exceeds the threshold value after 60 a,but the various performance indicators at ultimate limit state are consistently in the allowable level during service life.Therefore,in the case of prestressed concrete bridges,the serviceability limit state is more possible to have durability problems in life-cycle;however,the performance indicators at ultimate limit state can satisfy the requirements.

Sex and racial disparities in non-alcoholic fatty liver disease-related cardiovascular events: National inpatient sample analysis (2019)

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases cardiovascular disease(CVD)risk irrespective of other risk factors.However,large-scale cardiovascular sex and race differences are poorly understood.AIM To investigate the relationship between NAFLD and major cardiovascular and cerebrovascular events(MACCE)in subgroups using a nationally representative United States inpatient sample.METHODS We examined National Inpatient Sample(2019)to identify adult hospitalizations with NAFLD by age,sex,and race using ICD-10-CM codes.Clinical and demographic characteristics,comorbidities,and MACCE-related mortality,acute myocardial infarction(AMI),cardiac arrest,and stroke were compared in NAFLD cohorts by sex and race.Multivariable regression analyses were adjusted for sociodemographic characteristics,hospitalization features,and comorbidities.RESULTS We examined 409130 hospitalizations[median 55(IQR 43-66)years]with NFALD.NAFLD was more common in females(1.2%),Hispanics(2%),and Native Americans(1.9%)than whites.Females often reported non-elective admissions,Medicare enrolment,the median age of 55(IQR 42-67),and poor income.Females had higher obesity and uncomplicated diabetes but lower hypertension,hyperlipidemia,and complicated diabetes than males.Hispanics had a median age of 48(IQR 37-60),were Medicaid enrollees,and had non-elective admissions.Hispanics had greater diabetes and obesity rates than whites but lower hypertension and hyperlipidemia.MACCE,all-cause mortality,AMI,cardiac arrest,and stroke were all greater in elderly individuals(P<0.001).MACCE,AMI,and cardiac arrest were more common in men(P<0.001).Native Americans(aOR 1.64)and Asian Pacific Islanders(aOR 1.18)had higher all-cause death risks than whites.CONCLUSION Increasing age and male sex link NAFLD with adverse MACCE outcomes;Native Americans and Asian Pacific Islanders face higher mortality,highlighting a need for tailored interventions and care.