López-Fidalgo, J. (Jesús)
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- Passive cooling design strategies as adaptation measures for lowering the indoor overheating risk in tropical climates(Elsevier, 2021) Kishnani, N. (Nirmal); López-Fidalgo, J. (Jesús); Monge-Barrio, A. (Aurora); Gamero-Salinas, J. (Juan); Sánchez-Ostiz, A. (Ana)Year-round high temperatures and humidity in the Tropics, coupled with poor design decisions and climate change, can cause indoor environments to overheat, affecting health and increasing energy demand and carbon emissions. Passive cooling could help lower the indoor overheating risk. Given the gap in the relative influence of passive cooling design strategies on lowering the indoor overheating risk in tropical locations, this study investigated their impact in two warm tropical cities (i.e., Tegucigalpa and San Pedro Sula), considering both current and future climate scenarios, with a total of 3840 thermal simulations performed. Indoor overheating risk in apartment-type dwellings was assessed using two metrics (i.e., hours of exceedance and the indoor overheating degree), and considering fixed and adaptive thermal comfort limits. Simulation results show that the overheating risk can be significantly lowered in these tropical contexts using solely passive cooling strategies as heat adaptation measures. Multivariate regression models demonstrate that natural ventilation, wall absorptance, the solar heat gain coefficient, and semi-outdoor spaces have the greatest impact in lowering the risk in vertical social housing projects. This study emphasizes the importance of passive cooling and overheating protection design strategies in tropical building codes and building design while considering current and future risk.
- Optimal experimental design for cytogenetic dose-response calibration curves(2020-03-30) Howes, A. (Adam); López-Fidalgo, J. (Jesús); Higueras, M. (Manuel)Purpose: To introduce optimal experimental design techniques in the cytogenetic biological dosimetry practice. This includes the development of a new optimatility criterion for the calibration of radiation doses. Materials and Methods: The most typical optimal design criterion and the one developed in this research are introduced and applied in an example from the litera- ture. In another example from the literature, a simulation study has been performed to compare the standard error of the dose estimation using di erent experimental designs. An RStudio project and a GitHub project have been developed to repro- duce these results. Results: It is appreciated how the application of optimal experimental design tech- niques can reduce the standard error of biodosimetric dose estimations. Conclusions: Optimal experimental design techniques jointly with practitioners re- quirements may be applied. This practice would not involve an additional laboratory work.
- Cross-sectional survey of the wish to die among palliative patients in Spain: one phenomenon, different experiences(2021) Lama, M. (Marcos); Martinez-Garcia, M. (Marina); Santesteban, Y. (Yolanda); Olza-Moreno, I. (Inés); Rullán, M. (María); Centeno, C. (Carlos); Arantzamendi-Solabarrieta, M. (María); López-Fidalgo, J. (Jesús); Belar, A. (Alazne); Breeze, R. (Ruth)Objective: Cultural backgrounds and values have a decisive impact on the phenomenon of the wish to die (WTD), and examination of this in Mediterranean countries is in its early stages. The objectives of this study were to establish the prevalence of WTD and to characterise this phenomenon in our cultural context. Methods: A cross-sectional study with consecutive advanced inpatients was conducted. Data about WTD (Assessing Frequency & Extent of Desire to Die (AFFED) interview) and anxiety and depression (Edmonton Symptom Assessment System-revised (ESAS-r)) were collected through two face-to-face clinical encounters. Data were analysed with descriptive statistics, χ2 and analysis of variance. Results: 201 patients participated and 165 (82%) completed both interviews. Prevalence of WTD was 18% (36/201) in the first interview and 16% (26/165) in the second interview (p=0.25). After the first interview, no changes in depression (p=0.60) or anxiety (p=0.90) were detected. The AFFED shows different experiences within WTD: 11% of patients reported a sporadic experience, while 7% described a persistent experience. Thinking about hastening death (HD) appeared in 8 (22%) out of 36 patients with WTD: 5 (14%) out of 36 patients considered this hypothetically but would never take action, while 3 (8%) out of 36 patients had a more structured idea about HD. In this study, no relation was detected between HD and frequency of the appearance of WTD (p=0.12). Conclusions: One in five patients had WTD. Our findings suggest the existence of different experiences within the same phenomenon, defined according to frequency of appearance and intention to hasten death. A linguistically grounded model is proposed, differentiating the experiences of the ‘wish’ or ‘desire’ to die, with or without HD ideation.
- Experimental designs for controlling the correlation of estimators in two-parameter models(John Wiley & Sons, 2023) Benitez, E. (Edgar); López-Fidalgo, J. (Jesús)The state of the art related to parameter correlation in two-parameter models has been reviewed in this paper. The apparent contradictions between the different authors regarding the ability of D-optimality to simultaneously reduce the correlation and the area of the confidence ellipse in two-parameter models were analyzed. Two main approaches were found: (1) those who consider that the optimality criteria simultaneously control the precision and correlation of the parameter estimators and (2) those that consider a combination of criteria to achieve the same objective. An analytical criterion combining in its structure both the optimality of the precision of the estimators of the parameters and the reduction of the correlation between their estimators is provided. The criterion was tested both in a simple linear regression model, considering all possible design spaces, and in a nonlinear model with strong correlation of the estimators of the parameters (Michaelis–Menten) to show its performance. This criterion showed a superior behavior to all the strategies and criteria to control at the same time the precision and the correlation.
- Evaluation of thermal comfort and building form attributes in different semi-outdoor environments in a high-density tropical setting(Elsevier, 2021) Kishnani, N. (Nirmal); López-Fidalgo, J. (Jesús); Monge-Barrio, A. (Aurora); Gamero-Salinas, J. (Juan); Sánchez-Ostiz, A. (Ana)In highly dense tropical cities, a semi-outdoor space (SOS) is frequently used as a social space within tall building forms where people can interact and connect. Thermal comfort in SOSs within tall buildings, however, may vary depending on the type and form attributes that define it. This study classifies 63 SOSs in four tall buildings of Singapore into five types based on literature review: perimeter buffers, sky terraces, horizontal breezeways, breezeway atria and vertical breezeways. Findings suggest that the five SOS types perform differently in terms of thermal comfort (based on PMV*), environmental parameters (air temperature, mean radiant temperature, relative humidity, and air velocity), and building form attributes (height-to-depth ratio, open space ratio, and green plot ratio). Of these five, vertical breezeways and horizontal breezeways are the most thermally comfortable for all activities during a typically warm hour. It is postulated that higher thermal comfort levels in these SOS types are linked to form attributes that enhance air velocity. This study examines the pros and cons of each SOS type in terms of thermal comfort in their role as communal spaces in tall buildings situated within a highly dense tropical city.
- Wish to die and hasten death in palliative care: a cross-sectional study factor analysis(BMJ Publishing Group, 2021) Lama, M. (Marcos); Martinez-Garcia, M. (Marina); Santesteban, Y. (Yolanda); Centeno, C. (Carlos); Arantzamendi-Solabarrieta, M. (María); López-Fidalgo, J. (Jesús); Belar, A. (Alazne)Objectives The wish to die (WTD) is a complex experience sometimes accompanied by intention to hasten death. The aim of this study is to identify the predictive factors for WTD and hastening death intention (HDI) in Spanish patients with advanced illness. Methods This is a subanalysis of a larger cross-sectional study conducted on patients experiencing advanced illness (N=201). Sociodemographic data and data related to symptom burden (Edmonton Symptom Assessment System-Revised), depressive and anxious symptoms (Hospital Anxiety and Depression Scale), demoralisation (Spanish version of the Demoralisation Scale), perceived loss of dignity (Patient Dignity Inventory) and WTD (Assessing Frequency and Extent of Desire to Die) were collected. The analysis used univariate and multivariate logistic regression. Results The prevalence of WTD in the sample was 18%, with 8 out of 36 patients reporting HDI. The independent factors predictive of WTD were (1) knowledge of approximate prognosis (OR=4.78; 95% CI 1.20 to 10.8; p=0.001); (2) symptom burden (OR=1.05; 95% CI 1.00 to 1.09; p=0.038); and (3) the Demoralisation Scale subsection ‘lack of meaning and purpose in life’ (OR=1.61; 95% CI 1.30 to 1.99; p=0.000). An independent predictive factor for HDI was the Demoralisation Scale subsection ‘patients’ distress and coping abilities’ (OR=1.47; 95% CI 1.04 to 2.08; p=0.028), while having religious beliefs was a protective factor (OR=0.13; 95% CI0.17 to 0.97; p=0.047). Conclusions Demoralisation was found to be the only common triggering factor for WTD and HDI, although experiences share certain features. Identification of the predictive factors for WTD and HDI may contribute to their prevention and management.
- Elevated circulating metalloproteinase 7 predicts recurrent cardiovascular events in patients with carotid stenosis: a prospective cohort study(2020) Gállego-Culleré, J. (Jaime); Irimia, P. (Pablo); Domínguez-Echávarri, P.D. (Pablo Daniel); Moreno-Ajona, D. (David); Rodriguez, J.A. (José Antonio); Muñoz, R. (Roberto); Fernandez-Alonso, L. (Leopoldo); Garcia-Velloso, M. J. (María José); López-Fidalgo, J. (Jesús); Grochowitz, L. (Lukasz); Martinez-Vila, E. (Eduardo)Background: Major adverse cardiovascular events are the main cause of morbidity and mortality over the long term in patients undergoing carotid endarterectomy. There are few reports assessing the prognostic value of markers of inflammation in relation to the risk of cardiovascular disease after carotid endarterectomy. Here, we aimed to determine whether matrix metalloproteinases (MMP-1, MMP-2, MMP-7, MMP-9 and MMP-10), tissue inhibitor of MMPs (TIMP-1) and in vivo inflammation studied by 18F-FDG-PET/CT predict recurrent cardiovascular events in patients with carotid stenosis who underwent endarterectomy. Methods: This prospective cohort study was carried out on 31 consecutive patients with symptomatic (23/31) or asymptomatic (8/31) severe (> 70%) carotid stenosis who were scheduled for carotid endarterectomy between July 2013 and March 2016. In addition, 26 healthy controls were included in the study. Plasma and serum samples were collected 2 days prior to surgery and tested for MMP-1, MMP-2, MMP-7, MMP-9, MMP-10, TIMP-1, high-density lipoprotein, low-density lipoprotein, high-sensitivity C-reactive protein and erythrocyte sedimentation rate. 18F-FDGPET/CT focusing on several territories’ vascular wall metabolism was performed on 29 of the patients because of no presurgical availability in 2 symptomatic patients. Histological and immunohistochemical studies were performed with antibodies targeting MMP-10, MMP-9, TIMP-1 and CD68. Results: The patients with carotid stenosis had significantly more circulating MMP-1, MMP-7 and MMP-10 than the healthy controls. Intraplaque TIMP-1 was correlated with its plasma level (r = 0.42 P = .02) and with 18F-FDG uptake (r = 0.38 P = .05). We did not find any correlation between circulating MMPs and in vivo carotid plaque metabolism assessed by 18F-FDG-PET. After a median follow-up of 1077 days, 4 cerebrovascular, 7 cardiovascular and 11 peripheral vascular events requiring hospitalization were registered. Circulating MMP-7 was capable of predicting events over and above the traditional risk factors (HR = 1.15 P = .006). When the model was associated with the variables of interest, the risk predicted by 18F-FDG-PET was not significant. Conclusions: Circulating MMP-7 may represent a novel marker for recurrent cardiovascular events in patients with moderate to severe carotid stenosis. MMP-7 may reflect the atherosclerotic burden but not plaque inflammation in this specific vascular territory.
- Additional indicators to assess palliative care development(2019-02-22) Pons-Izquierdo, J.J. (Juan José); Garralda, E. (Eduardo); Centeno, C. (Carlos); Arias-Casais, N. (Natalia); Lima, L. (Liliana) de; López-Fidalgo, J. (Jesús); Rhee, J.Y. (John Y.)This is a short compilation of Health Indicators Assessing the Level of Palliative Care Development at the International Level. These are additional indicators to another published book: Brief Manual on Health Indicators Monitoring Global Palliative Care Development (http://hdl.handle.net/10171/56523).
- Multicenter Study of the Psychometric Properties of the New Demoralization Scale (DS-II) in Spanish-Speaking Advanced Cancer Patients(Elsevier, 2019) Santesteban, Y. (Yolanda); Centeno, C. (Carlos); Arantzamendi-Solabarrieta, M. (María); López-Fidalgo, J. (Jesús); Consigli, S. (Sara); Belar, A. (Alazne); Martínez, M. (Marina); Rodríguez-Núñez, A. (Alfredo)Context. Demoralization is a state of existential distress in patients with advanced illness, typically with coping difficulties, feelings of loss of sense, and purpose in life and despair, among other things. The New Demoralization Scale (DS-II) is an evaluation tool for this syndrome, which has recently been reformulated on a shorter scale. Objectives. The objective of this study was to obtain a Spanish version of the DS-II and to assess its psychometric properties in advanced cancer patients in Spain and a number of Latin American countries. Methods. Following a translationeback translation process, a validation study and a confirmatory analysis using structural equation models with their corresponding latent constructs were undertaken. Patients completed the DS-II in Spanish (DS-II (es)), the Hospital Anxiety and Depression Scale, and the Edmonton Symptom Assessment Systemerevised. Reliability was studied according to internal consistency; construct validity and concurrent validity with the Hospital Anxiety and Depression Scale and the Edmonton Symptom Assessment Systemerevised; discriminant validity using the Karnofsky Performance Status scale; and feasibility, with response ratio and required time. Cutoff points were established, and sensitivity and specificity were studied. Results. The DS-II (es) was obtained. One hundred fifty patients completed the validation study. The confirmatory analysis showed coherence, and all items correlated positively with their subscales and with the overall scale. Cronbach’s alpha for the DS-II (es) was 0.88, for the sense and purpose subscale 0.83, and for the coping ability 0.79. Demoralization correlated significantly with emotional distress (rho 1⁄4 0.73, P < 0.001). The tool distinguished between patients with diverse functional levels (rho 1⁄4 0.319, P 1⁄4 0.001). Cutoff points at 10 and 20 out of 32 were established. The scale showed high sensitivity (81.97%) and specificity (80.90%). The prevalence of demoralization was 33% in our sample. Conclusion. The Spanish version of the new Kissane DS-II demoralization scale has shown to be valid, reliable, and feasible with adequate psychometric properties. J Pain Symptom Manage 2019;57:627e634. 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
- Robust active learning with binary responses(Elsevier, 2022) López-Fidalgo, J. (Jesús); Wiens, D.P. (Douglas P.)We introduce a method of Robust Learning (‘robl’) for binary data, and propose its use in situations where Active Learning is appropriate, and where sampling the predictors is easy and cheap, but learning the responses is hard and expensive. We seek robustness against both modelling errors and the mislabelling of the binary responses. Thus we aim to sample effectively from the population of predictors, and learn the responses only for an ‘influential’ sub-population. This is carried out by probability weighted sampling, for which we derive optimal ‘unbiased’ sampling weights, and weighted likelihood estimation, for which we also derive optimal estimation weights. The robustness issues can lead to biased estimates and classifiers; it is somewhat remarkable that our weights eliminate the mean of the bias – which is a random variable as a result of the sampling – due to both types of errors mentioned above. These weights are then tailored to minimize the mean squared error of the predicted values. Simulation studies indicate that when bias is of significant concern, robl allows for substantial reductions, relative to Passive Learning, in the prediction errors. The methods are then illustrated in real-data analyses.