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The feasibility of achieving sustainable building development, an eco-friendly environment, and building investment conservation by integrating technological intelligence in buildings is highly viable. Intelligence features are, therefore, increasingly being incorporated in new designs and existing buildings to enhance the useful life, productivity and satisfaction of occupants, and a greener environment. This article evaluates the use of intelligent building systems in Nigeria. Primary data were obtained with the use of structured questionnaires that were self-administered to construction professionals in the private and public sectors in Lagos State. Data collected were analysed using descriptive and inferential statistics. Findings established that 90.24% of the respondents were aware of intelligent building systems, while practitioners who have worked or were working on buildings with intelligent features were limited to 51.2%. Approximately 64.60% of the respondents have used intelligent buildings previously, but only thirteen (13) notable buildings were identified to have employed intelligent building systems to a reasonable extent in the study area. The features of intelligent buildings with top level of awareness were CCTV system; access control and locks (mean = 3.96); alarms and alerts (mean = 3.92); HVAC system (mean = 3.90), and fire alarm system (mean = 3.89). Features with high level of utilisation include lighting system, which was the most utilised feature (mean = 3.57); fire alarm system (mean = 3.48); access control and lock; CCTV system (mean = 3.45), and HVAC system (mean = 3.43). The results showed that most of the features with a high level of awareness were also those with a high level of utilisation. The study established that the level of awareness and utilisation of intelligent building systems in the study area is high, but full adoption of the system is still low.  

Organisations are required to possess certain capabilities in order to implement Building Information Modelling (BIM), one of the emerging technologies for overcoming the problem of fragmentation in the construction industry. This study examines the organisational capability attributes required for the implementation of BIM in construction projects, with a view to enhancing the performance of public sector projects. The study adopted a quantitative descriptive analysis based on primary data obtained from public sector organisations in Lagos State, Southwestern Nigeria. One hundred and ninety-eight (198) valid questionnaires, obtained from construction professionals within the organisations, provided quantitative data for the assessment. Data collected were analysed, using both descriptive and inferential statistics. The findings indicate that public sector organisations possess the capability attributes for BIM implementation in building projects at different levels of availability (LAv) and adequacy (LAq), with adequate power supply rated at (LAv = 76.00%; LAq = 75.80%); speedy internet connection (LAv = 70.20%; LAq = 69.80%); change from traditional workflow (LAv = 69.80%; LAq = 64.60%); adequate work environment for workers (LAv = 69.60%; LAq = 64.40%); standardised process (LAv = 66.00%; LAq = 63.40%); sufficient number of workers (LAv = 65.60%) and data-sharing skills (LAv = 65.00%); standardised process (LAq = 63.40%), and collaborative team culture (LAq = 63.00%). The study established that the organisational capability attributes with high availability rating also have high adequacy rating. The research concludes that the general organisational capability attributes of the public sector for BIM on construction projects are not yet sufficiently developed and thus suggests the need to strengthen specific capability attributes that are required to implement BIM.

This study examines the capability improvement measures of the public sector client for enhancing the implementation of building information modeling (BIM) in construction project delivery. The study adopted a quantitative descriptive analysis based on primary data obtained through a structured questionnaire. A total of 198 valid questionnaires obtained from construction professionals within public sector organizations in Lagos State, Nigeria, provided primary quantitative data for the assessment. Data collected were analyzed using descriptive and inferential statistics. The findings indicated the measures to enhance the capacity of the public sector for BIM implementation including the following: team-based structure and recruitment of adequate number of staff (with mean score [MS] = 3.66), government support and involvement (MS = 3.64), government policies, adoption of process open to innovation, and investment in equipment and technology (MS = 3.60) had been considerably entrenched. However, measures that resulted in improved efficiency were limited to the following: reward system for performance (MS = 3.81), government policies, and education and training of staff (MS = 3.74), government support and involvement (MS = 3.73), and clear job description (MS = 3.71). Most of the measures with high level of impact were not necessarily those that are frequently used. On this basis, the public sector needs to differ from the status quo by adopting improvement measures that are appropriate for enhancing its capabilities for BIM in project delivery. The findings indicate implications that could enable the public sector to adjust and make necessary policies in a bid to improve BIM implementation in project delivery.

PurposeConcrete workers perform physically demanding work in awkward postures, exposing their backs to musculoskeletal disorders. Back-support exoskeletons are promising ergonomic interventions designed to reduce the risks of back disorders. However, the suitability of exoskeletons for enhancing performance of concrete workers has not been largely explored. This study aims to assess a passive back-support exoskeleton for concrete work in terms of the impact on the body, usability and benefits of the exoskeleton, and potential design modifications.Design/methodology/approachConcrete workers performed work with a passive back-support exoskeleton. Subjective and qualitative measures were employed to capture their perception of the exoskeleton, at the middle and end of the work, in terms of discomfort to their body parts, ease of use, comfort, performance and safety of the exoskeleton, and their experience using the exoskeleton. These were analyzed using descriptive statistics and thematic analysis.FindingsThe exoskeleton reduced stress on the lower back but caused discomfort to other body parts. Significant correlations were observed between perceived discomfort and usability measures. Design modifications are needed to improve the compatibility of the exoskeleton with the existing safety gears, reduce discomfort at chest and thigh, and improve ease of use of the exoskeleton.Research limitations/implicationsThe study was conducted with eight concrete workers who used the exoskeleton for four hours.Originality/valueThis study contributes to existing knowledge on human-wearable robot interaction and provides suggestions for adapting exoskeleton designs for construction work.

PurposeAs video-based interventions are continuously utilized as alternatives to physical site visits, directing students' attention to specific learning contents within videos could increase their comprehension and stimulate their interest. Students' knowledge of construction practice can be reinforced, misconceptions and improper inferences can be reduced by calling out significant learning concepts. However, few studies have formalized practice concepts that could be beneficial in preparing students for the workplace. This paper presents an investigation of construction practice concepts, based on site visits that would be beneficial in complimenting classroom teaching to prepare students for the realities of practice.Design/methodology/approachA mixed methods research approach was employed combining qualitative and quantitative data collection and analysis. An online questionnaire, semi-structured interviews and a focus group were conducted with industry practitioners and instructors to identify the topics and practice concepts significant for supporting classroom teaching with site visits.FindingsThe findings suggest that the most relevant topics typically supported with site visits are preconstruction management, excavation and foundation work, construction equipment, construction means and methods, project management, road construction, sustainability, building systems, structures, construction technology, building construction, capstone, site logistics and safety. Practice concepts were identified for each of these topics.Research limitations/implicationsThe study will guide researchers in the design of video-based pedagogical tools to be used as an effective complement of or alternative to site visit experiences. The findings will support instructors on how to structure their teaching practices to prepare students for some of the complexities of the workplace.Originality/valueThis study adds value to the existing literature by providing insights into industry perception of practice concepts for complementing classroom teaching.

PurposeThis study examined factors influencing the organisational capabilities of the public sector for building information modelling (BIM) implementation in construction projects with a view to enhancing the performance of public sector projects.Design/methodology/approachThe study adopted a quantitative descriptive analysis that was based on primary data. In total, 198 valid questionnaires obtained from construction professionals within the public sector provided primary quantitative data for the assessment. The respondents provided the responses on the factors which were identified through an in-depth synthesis of literature relating to organisational capabilities of the public sector. Data collected were analysed using descriptive and inferential statistics.FindingsThe findings established that the potential of the public sector to deploy BIM in construction projects is greatly influenced by varying degree of organisational capability attributes with bureaucratic culture (mean score, MS = 3.37), structural complexity (MS = 3.17), lack of skilled and trained staff (MS = 3.12), personnel stability (MS = 3.11), staff cooperation (MS = 3.09) and political constraint (MS = 3.07) ranked highest. Through factor analysis, these and other highly influential factors were grouped into eight components, namely management-related, policy-related, technical-related, attitude-related, work structure-related, work ethic-related, decision-related and feedback-related factors. This grouping reflects the various components of organisational capability attributes which the public sector needs to efficiently develop to benefit from project management paradigm introduced by BIM.Practical implicationsThis study provided information for improving specific capability attributes with respect to human and technical resources as well as other soft infrastructure to support BIM implementation on building projects by the public sector client. The study also serves as a guide for understanding BIM implementation by the public sector in similar socio-political and economic contexts.Originality/valueThis assessment indicates various degrees by which the organisational attributes of public sector have influenced the attributes' capability to implement BIM on construction projects. Thus, findings provide information on areas of improvement for better implementation of BIM by the public sector in project delivery.

This study assessed the organisational capability attributes of the public sector for Building Information Modelling (BIM) implementation; determined the maturity level of capability attributes of the public sector in relation to BIM implementation; assessed the factors influencing the organisational capabilities of the public sector for BIM implementation and investigated the capability improvement measures required by the public sector for BIM implementation. These were with a view to providing information that could enhance the performance of public sector projects in Lagos, Nigeria.Primary data were used for the study. The data were collected through copies of structured questionnaire. Random sampling technique was used to administered the questionnaire on one hundred and ninety-eight (198) construction professionals in Lagos State Public Service. Data were collected on the organisational capability attributes of the public sector for BIM implementation, the maturity level of capability attributes of the public sector in relation to BIM implementation, factors influencing the organisational capabilities of the public sector for BIM implementation and capabilities improvement measures required by the public sector. The data collected were analysed using mean score, factor analysis and Kruskal-Wallis test.The results showed that adequate power supply with level of availability (LAv), LAv = 76.00%, speedy internet connection (LAv = 70.20%), change from traditional workflow (LAv = 69.8%) and adequate work environment (LAv = 69.60%) were the organisational capability attributes of the public sector rated with high level of availability. The results also showed that these four organisational capability attributes were also rated with high level of adequacy (LAq), with LAq = 75.80%, 69.80%, 64.60%, and 64.40% respectively. The organisational capability attributes with high maturity levels were adequate power supply (ML = 75.60%), speedy internet connection (ML = 69.40%), data sharing skills (ML = 63.80%), adequate work environment for workers and continuous on the job training (ML = 63.20%). Further results of the analysis showed that bureaucratic culture (MS = 3.37), structural complexity (MS = 3.17), lack of skilled and trained staff (MS = 3.12), personnel stability (MS = 3.11), staff cooperation (MS = 3.09), and political constraint (MS = 3.07) were the most significant factors influencing the capability attributes of the public sector. The result of this study also showed that team-based structure and adequate number of staff (MS = 3.66), government support and involvement (MS = 3.60) were the most frequently used capability improvement measures. Reward system for performance (MS = 3.81), government policies (MS = 3.74), education and training of staff (MS = 3.74), government support and involvement (MS = 3.73) were identified as the most efficient capability improvement measures used by the public sector.The study concluded that the overall maturity level of organisational capability attributes of the public sector in relation to BIM implementation is on the average and these capability attributes are significantly influenced by organisational framework, government support and involvement. As such reward system based on employees’ performance, government policies and the culture of investment in employees will improve the capabilities of the public sector for BIM implementation to enhance public project delivery.

Patients with STEMI were assigned to primary PCI with or without thrombectomy. At 180 days, there was no significant between-group difference in the primary outcome of death or cardiovascular events. Patients in the thrombectomy group had a higher rate of stroke at 30 days. Primary percutaneous coronary intervention (PCI), when available, is the most effective method of achieving reperfusion in patients with ST-segment elevation myocardial infarction (STEMI). 1 However, a major limitation of primary PCI is the possibility of distal embolization of thrombus and failure to restore flow at the microvascular level. Measures of microvascular tissue reperfusion, such as the degree of ST-segment resolution or angiographic myocardial blush grade, have been shown to predict the rate of death after primary PCI. 2 , 3 Removal of the thrombus by manual thrombectomy before stent deployment has the potential of reducing distal embolization and improving microvascular perfusion. Small, randomized . . .

This Review is intended to help clinicians, patients, and the public make informed decisions about statin therapy for the prevention of heart attacks and strokes. It explains how the evidence that is available from randomised controlled trials yields reliable information about both the efficacy and safety of statin therapy. In addition, it discusses how claims that statins commonly cause adverse effects reflect a failure to recognise the limitations of other sources of evidence about the effects of treatment. Large-scale evidence from randomised trials shows that statin therapy reduces the risk of major vascular events (ie, coronary deaths or myocardial infarctions, strokes, and coronary revascularisation procedures) by about one-quarter for each mmol/L reduction in LDL cholesterol during each year (after the first) that it continues to be taken. The absolute benefits of statin therapy depend on an individual's absolute risk of occlusive vascular events and the absolute reduction in LDL cholesterol that is achieved. For example, lowering LDL cholesterol by 2 mmol/L (77 mg/dL) with an effective low-cost statin regimen (eg, atorvastatin 40 mg daily, costing about £2 per month) for 5 years in 10 000 patients would typically prevent major vascular events from occurring in about 1000 patients (ie, 10% absolute benefit) with pre-existing occlusive vascular disease (secondary prevention) and in 500 patients (ie, 5% absolute benefit) who are at increased risk but have not yet had a vascular event (primary prevention). Statin therapy has been shown to reduce vascular disease risk during each year it continues to be taken, so larger absolute benefits would accrue with more prolonged therapy, and these benefits persist long term. The only serious adverse events that have been shown to be caused by long-term statin therapy—ie, adverse effects of the statin—are myopathy (defined as muscle pain or weakness combined with large increases in blood concentrations of creatine kinase), new-onset diabetes mellitus, and, probably, haemorrhagic stroke. Typically, treatment of 10 000 patients for 5 years with an effective regimen (eg, atorvastatin 40 mg daily) would cause about 5 cases of myopathy (one of which might progress, if the statin therapy is not stopped, to the more severe condition of rhabdomyolysis), 50–100 new cases of diabetes, and 5–10 haemorrhagic strokes. However, any adverse impact of these side-effects on major vascular events has already been taken into account in the estimates of the absolute benefits. Statin therapy may cause symptomatic adverse events (eg, muscle pain or weakness) in up to about 50–100 patients (ie, 0·5–1·0% absolute harm) per 10 000 treated for 5 years. However, placebo-controlled randomised trials have shown definitively that almost all of the symptomatic adverse events that are attributed to statin therapy in routine practice are not actually caused by it (ie, they represent misattribution). The large-scale evidence available from randomised trials also indicates that it is unlikely that large absolute excesses in other serious adverse events still await discovery. Consequently, any further findings that emerge about the effects of statin therapy would not be expected to alter materially the balance of benefits and harms. It is, therefore, of concern that exaggerated claims about side-effect rates with statin therapy may be responsible for its under-use among individuals at increased risk of cardiovascular events. For, whereas the rare cases of myopathy and any muscle-related symptoms that are attributed to statin therapy generally resolve rapidly when treatment is stopped, the heart attacks or strokes that may occur if statin therapy is stopped unnecessarily can be devastating.

In randomised controlled trials, fixed-dose combination treatments (or polypills) have been shown to reduce a composite of cardiovascular disease outcomes in primary prevention. However, whether or not aspirin should be included, effects on specific outcomes, and effects in key subgroups are unknown. We did an individual participant data meta-analysis of large randomised controlled trials (each with ≥1000 participants and ≥2 years of follow-up) of a fixed-dose combination treatment strategy versus control in a primary cardiovascular disease prevention population. We included trials that evaluated a fixed-dose combination strategy of at least two blood pressure lowering agents plus a statin (with or without aspirin), compared with a control strategy (either placebo or usual care). The primary outcome was time to first occurrence of a composite of cardiovascular death, myocardial infarction, stroke, or arterial revascularisation. Additional outcomes included individual cardiovascular outcomes and death from any cause. Outcomes were also evaluated in groups stratified by the inclusion of aspirin in the fixed-dose treatment strategy, and effect sizes were estimated in prespecified subgroups based on risk factors. Kaplan-Meier survival curves and Cox proportional hazard regression models were used to compare strategies. Three large randomised trials were included in the analysis (TIPS-3, HOPE-3, and PolyIran), with a total of 18 162 participants. Mean age was 63·0 years (SD 7·1), and 9038 (49·8%) participants were female. Estimated 10-year cardiovascular disease risk for the population was 17·7% (8·7). During a median follow-up of 5 years, the primary outcome occurred in 276 (3·0%) participants in the fixed-dose combination strategy group compared with 445 (4·9%) in the control group (hazard ratio 0·62, 95% CI 0·53–0·73, p<0·0001). Reductions were also observed for the separate components of the primary outcome: myocardial infarction (0·52, 0·38–0·70), revascularisation (0·54, 0·36–0·80), stroke (0·59, 0·45–0·78), and cardiovascular death (0·65, 0·52–0·81). Significant reductions in the primary outcome and its components were observed in the analyses of fixed-dose combination strategies with and without aspirin, with greater reductions for strategies including aspirin. Treatment effects were similar at different lipid and blood pressure levels, and in the presence or absence of diabetes, smoking, or obesity. Gastrointestinal bleeding was uncommon but slightly more frequent in the fixed-dose combination strategy with aspirin group versus control (19 [0·4%] vs 11 [0·2%], p=0·15). The frequencies of haemorrhagic stroke (10 [0·2%] vs 15 [0·3%]), fatal bleeding (two [<0·1%] vs four [0·1%]), and peptic ulcer disease (32 [0·7%] vs 34 [0·8%]) were low and did not differ significantly between groups. Dizziness was more common with fixed-dose combination treatment (1060 [11·7%] vs 834 [9·2%], p<0·0001). Fixed-dose combination treatment strategies substantially reduce cardiovascular disease, myocardial infarction, stroke, revascularisation, and cardiovascular death in primary cardiovascular disease prevention. These benefits are consistent irrespective of cardiometabolic risk factors. Population Health Research Institute.