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Background: Delirium in advanced cancer inpatient ranges between 13% and 85%. Reasons for this variability on the reported data could be related to the setting where they are admitted. Methods: Thi...

Models of mixture distributions are of great interest in many areas where several populations are mixed up. If the response is binary there is a mixture of Bernoulli distributions, which has practi...

Bioassays are applied to workers and other people exposed to radiation through routine or accidental intake of radioactive isotopes. The quantity of the isotope intake by an individual can be estimated from the measured quantities in the bioassays using the corresponding retention or excretion function. A retention (excretion) function represents the predicted activity of a radionuclide in the body, organ, or tissue or in a 24-h excreta at a particular time after the intake. The International Commission on Radiological Protection provides these biokinetic models. We have used these functions to compute optimal experimental designs for estimating the intake quantity in workers following radionuclide inhalation or ingestion. In particular, we have considered the case where the individual is exposed to a constant intake during some periods followed by other periods without intakes, which we called multiple constant intakes. The main aim of this work is finding the best times where the bioassay samples should be obtained in order to estimate optimally the actual intake of the last period. The problem is also extended to compute the next two or more bioassays to be performed. Measurements on the same worker are modeled through a correlation structure. The outline of the problem is established for a general case and results are given for a typical case as a real example. The methodology given in the paper can be applied to other cases with multiple constant intakes, e.g. in medical treatments where the patient is exposed to successive doses during particular periods.

Objective: Recognizing delirium phenomenology (DP) aids the early diagnosis of this syndrome and improves quality of life in patients with advanced cancer. The aim of this study was to identify the neurobehavioral and cognitive patterns of delirium-related symptoms in persons with advanced cancer. Methods: We conducted an observational comparative prospective study on delirium in patients with advanced cancer in different palliative care settings, assessing the presentation/evolution of DP with the Memorial delirium assessment scale (MDAS). Results: Two hundred twenty-seven patients were enrolled on hospital/hospice admission. Of these, 57 were admitted with delirium, 170 without delirium, and 31 developed delirium during hospitalization. Of the 88 patients admitted with delirium or who developed it during hospitalization, only 32 underwent two consecutive MDAS evaluations (at diagnosis and after one week). Delirium resolved in 22 patients (first average MDAS score 10.08 vs. second 3.6 [p < 0.001]). Disorientation, short-term memory, and memory span were altered in all patients with unresolved delirium. The same features were altered in 18 (80%), 17 (80%), and 16 (70%) of the patients with resolved delirium, respectively, and in 58 (35%), 114 (67%), and 38 (23%) of no-delirium patients, respectively. Conclusion: Cognitive-related symptoms appear to be the most prevalent and earliest signs of DP in patients with advanced cancer.

ObjectivesThe 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.MethodsThis 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.ResultsThe 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).ConclusionsDemoralisation 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.

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.

Background Obesity is a major public health problem, which continues to be diagnosed and classified by BMI, excluding the most elemental concepts of the precision medicine approach. Obesity does not equally affect males and females, even with the same BMI. Microalbuminuria is a risk marker of cardiovascular disease closely related to obesity. The aim of this study was to evaluate the gender-dependent differences in the development of early obesity-related disease, focusing on pathologic microalbuminuria (PMA). Material and methods We developed a single-centre cross-sectional study including 1068 consecutive adults from May 2016 to January 2018, divided into two groups: one including the first 787 patients attended, evaluated as a description population; the second group included 281 subjects analysed as an external validation population. Collected data included medical history, anthropometric measures, abdominal bioimpedance and routine laboratory tests. Results First, we confirmed the lack of accuracy of classic obesity measures in predicting microalbuminuria. Second, we tested the utility of a tailored evaluation to predict PMA, with an area under the ROC curve of 0.78 for females and 0.82 for males. We also confirmed the different physiology of visceral adiposity for males when compared to females, in which small variations of fat mass entail major changes in the clinical repercussion. Third, we performed an external validation of our results, achieving a 77% accuracy rate. Conclusions Our findings support that there is an individual threshold of fat amount necessary to develop obesity-dependent PMA and that gender plays a major role in the interplay between PMA and adiposity.

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-FDG-PET/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.

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.

The detection of occult cancer in patients suspected of having a paraneoplastic neurological syndrome (PNS) poses a diagnostic challenge. The aim of our study was to perform a systematic review and meta-analysis to assess the diagnostic performance of FDG PET for the detection of occult malignant disease responsible for PNS. A systematic review of the literature (MEDLINE, EMBASE, Cochrane, and DARE) was undertaken to identify studies published in any language. The search strategy was structured after addressing clinical questions regarding the validity or usefulness of the test, following the PICO framework. Inclusion criteria were studies involving patients with PNS in whom FDG PET was performed to detect malignancy, and which reported sufficient primary data to allow calculation of diagnostic accuracy parameters. When possible, a meta-analysis was performed to calculate the joint sensitivity, specificity, and detection rate for malignancy (with 95% confidence intervals [CIs]), as well as a subgroup analysis based on patient characteristics (antibodies, syndrome). The comprehensive literature search revealed 700 references. Sixteen studies met the inclusion criteria and were ultimately selected. Most of the studies were retrospective (12/16). For the quality assessment, the QUADAS-2 tool was applied to assess the risk of bias. Across 16 studies (793 patients), the joint sensitivity, specificity, and detection rate for malignancy with FDG PET were 0.87 (95% CI: 0.80–0.93), 0.86 (95% CI: 0.83–0.89), and 14.9% (95% CI: 11.5–18.7), respectively. The area under the curve (AUC) of the summary ROC curve was 0.917. Homogeneity of results was observed for sensitivity but not for specificity. Some of the individual studies showed large 95% CIs as a result of small sample size. The results of our meta-analysis reveal high diagnostic performance of FDG PET in the detection of malignancy responsible for PNS, not affected by the presence of onconeural antibodies or clinical characteristics.

In this paper, the tools provided by the theory of Optimal Experimental Design are applied to a nonlinear calibration model. This is motivated by the need of estimating radiation doses using radiochromic films for radiotherapy purposes. The calibration model is in this case nonlinear and the explanatory variable cannot be worked out explicitly from the model. In this case an experimental design has to be found on the dependent variable. For that, the inverse function theorem will be used to obtain an information matrix to be optimized. Optimal designs on the response variable are computed from two different perspectives, first for fitting the model and estimating each of the parameters and then for predicting the proper dose to be applied to the patient. While the first is a common point of view in a general context of the Optimal Experimental Design, the latter is actually the main objective of the calibration problem for the practitioners and algorithms for computing these optimal designs are also provided., Comment: 17 pages, 3 figures, 2 tables

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.

ObjectiveCultural 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.MethodsA 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.Results201 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).ConclusionsOne 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.

Context Palliative care is gaining ground globally and is endorsed in high-level policy commitments, but service provision, supporting policies, education, and funding are incommensurate with rapidly growing needs. Objectives The objective of this study was to describe current levels of global palliative care development and report on changes since 2006. Methods An online survey of experts in 198 countries generated 2017 data on 10 indicators of palliative care provision, fitted to six categories of development. Factor analysis and discriminant analysis showed the validity of the categorization. Spearman correlation analyses assessed the relationship with World Bank Income Level (WBIL), Human Development Index (HDI), and Universal Health Coverage (UHC). Results Numbers (percentages) of countries in each development category were as follows: 1) no known palliative care activity, 47 (24%); 2) capacity-building, 13 (7%); 3a) isolated provision, 65 (33%); 3b) generalized provision, 22 (11%); 4a) preliminary integration into mainstream provision, 21 (11%); 4b) advanced integration, 30 (15%). Development levels were significantly associated with WBIL (rS = 0.4785), UHC (rS = 0.5558), and HDI (rS = 0.5426) with P < 0.001. Net improvement between 2006 and 2017 saw 32 fewer countries in Categories 1/2, 16 more countries in 3a/3b, and 17 more countries in 4a/4b. Conclusion Palliative care at the highest level of provision is available for only 14% of the global population and is concentrated in European countries. An 87% global increase in serious health-related suffering amenable to palliative care interventions is predicted by 2060. With an increasing need, palliative care is not reaching the levels required by at least half of the global population.

Background: Service provision is a key domain to assess national-level palliative care development. Three editions of the European Association for Palliative Care (EAPC) Atlas of Palliative Care monitored the changes in service provision across Europe since 2005. Aim: To study European trends of specialized service provision at home care teams, hospital support teams, and inpatient palliative care services between 2005 and 2019. Design: Secondary analysis was conducted drawing from databases on the number of specialized services in 2005, 2012, and 2019. Ratios of services per 100,000 inhabitants and increase rates on number of services for three periods were calculated. Analysis of variance (ANOVA) analyses were conducted to determine significant changes and chi-square to identify countries accounting for the variance. Income-level and sub-regional ANOVA analysis were undertaken. Setting: 51 countries. Results: Forty-two countries (82%) increased the number of specialized services between 2005 and 2019 with changes for home care teams (104% increase-rate), inpatient services (82%), and hospital support teams (48%). High-income countries showed significant increase in all types of services ( p Conclusion: Specialized service provision increased throughout Europe, yet ratios per 100,000 inhabitants fell below the EAPC recommendations. Western Europe ratios’ achieved half of the suggested services, while Central–Eastern countries achieved only a fourth. High-income countries and Western European countries account for the major increase. Central–Eastern Europe and low-to-middle-income countries reported little increase on specialized service provision.

Introduction: Quality medical education, centered on a patient&rsquo, s needs, is crucial to develop the health professionals that our society requires. Research suggests a strong contribution of palliative care education to professionalism. The aim of this study was to design and validate a self-report inventory to measure student&rsquo, s professional development. Method: Sequential exploratory strategy mixed method. The inventory is built based on the themes that emerged from the analysis of four qualitative studies about nursing and medical students&rsquo, perceptions related to palliative care teaching interventions (see Ballesteros et al. 2014, Centeno et al. 2014 and 2017, Roj&iacute, et al. 2017). The structure and psychometrics of the inventory obtained is tested in two different surveys with two different groups of medical students. Inventory reliability and construct validity are tested in the first survey group. To verify the inventory structure, a confirmatory factor analysis is performed in a second survey group. Results: The inventory has 33 items and seven dimensions: a holistic approach, caring for and understanding the patient, personal growth, teamwork, decision-making, patient evaluation, and being a health care professional. Cronbach&rsquo, s-alpha was 0.73&ndash, 0.84 in all seven domains, ICC: 0.95. The confirmatory factor analysis comparative fit index (CFI) was 1 with a standardized root mean square Index 0.088 (SRMR) and obtained a 0.99 goodness-of-fit R-square coefficient. Conclusions: this new inventory is grounded on student&rsquo, s palliative care teaching experiences and seems to be valid to assess student&rsquo, s professional development.

Several common general purpose optimization algorithms are compared for finding A- and D-optimal designs for different types of statistical models of varying complexity, including high dimensional models with five and more factors. The algorithms of interest include exact methods, such as the interior point method, the Nelder–Mead method, the active set method, the sequential quadratic programming, and metaheuristic algorithms, such as particle swarm optimization, simulated annealing and genetic algorithms. Several simulations are performed, which provide general recommendations on the utility and performance of each method, including hybridized versions of metaheuristic algorithms for finding optimal experimental designs. A key result is that general-purpose optimization algorithms, both exact methods and metaheuristic algorithms, perform well for finding optimal approximate experimental designs.

Vapor pressure is a temperature-dependent characteristic of pure liquids, and also of their mixtures. This thermodynamic property can be characterized through a wide range of models. Antoine Equation stands out among them for its simplicity and precision. Its parameters are estimated via maximum likelihood with experimental data. Once the parameters of the equation have been estimated, vapor pressures between known values of the curve can be interpolated. Other physical properties such as heat of vaporization can be predicted as well. This paper presents optimal designs to estimate the unknown parameters of the Antoine Equation as accurately as possible, considering a normal homoscedastic and heteroscedastic variance for the response. The aim is to improve the precision of inferences using optimality criteria to address different questions, such as fitting the whole model, focusing on some parameters of interest, or making predictions in a specific part of the space. In particular, the experimenter may choose between minimizing: the confidence region of the parameters, the variance of a subset of the parameters, the average of the variance of the parameters, or the variances of the predictions in a defined region. Optimal designs are often criticized by experimenters for their small number of experimental points. However, once the optimal designs are known, and given the idea of efficiency of a design, some strategies are presented here to improve their usual experimental designs. This study is complemented by an online tool that allows the user to replicate the calculations presented and extend them to any substance and temperature range.

During the discharge of a two-dimensional silo, the flow of grains through an opening is arrested if the size of the outlet is not large enough. In the outpouring of grains, jamming occurs due to the formation of an arch at the outlet. After breaking the arch, the grains fall until a new arch is formed. Several models have been proposed to explain this process. The goal of this work is twofold. First, we developed a comparative study of the models proposed by Janda et al. (Europhys Lett 84(4):44002-1–44002-6, 2008) and To (Phys Rev E 71(6):060301-1–060301-4, 2005). We have computed D-optimal and c-optimal designs for the most important parameter of the models. Secondly, using the criterion of KL-optimality developed by Lopez-Fidalgo et al. (J R Stat Soc Ser B 69(2):231–242, 2007), optimal designs for discriminating between these models have been computed.

To analyze the relationship of clinical variables related to prognosis and tumor burden, with metabolic variables obtained in the staging (18)F-FDG PET/CT, and their value in the prognosis in follicular lymphoma (FL).82 patients with FL, a (18)F-FDG PET/CT at diagnosis and a follow-up for a minimum of 12 months, were retrospectively enrolled in the present study. Clinical variables (Tumor grade, Follicular Lymphoma International Prognostic Index (FLIPI) and Tumor burden) were evaluated. Metabolic variables such as SUVmax in the highest hypermetabolic lesion, extralymphatic locations, number of involved lymph node locations, bone marrow (BM) involvement, PET stage and diameter of the biggest hypermetabolic lesion, were analyzed in order to establish a PET score and classify the studies in low, intermediate and high metabolic risk. Clinical and metabolic variables (included metabolic risk) were compared. The relation among all variables and disease-free survival (DFS) was studied.The 28% of patients had a high-grade tumor. The 30.5% had FLIPI risk low, 29.3% intermediate y 40.2% high. The 42.7% presented a high tumor burden. The PET/CT was positive in 94% of patients. The tumor grade did not show significant relation with metabolic variable. FLIPI risk and tumor burden showed statistical relations with the SUV max and the PET score (p0.008 and p=0.003 respectively). With respect to DFS, significant differences were detected for the PET stage and FLIPI risk (p=0.015 and p=0.047 respectively). FLIPI risk was the only significant predictor in Cox regression analysis, with a Hazard Ratio of 5.13 between high risk and low risk.The present research highlights the significant relation between metabolic variables obtained with FDG PET/CT and clinical variables although their goal as an independent factor of prognosis was not demonstrated in the present work.

To assess the diagnostic impact of 18F-FDG-PET/CT in patients suspected of paraneoplastic neurological syndrome (PNS) based on our own pre-test risk classification (PRC). A multicenter retrospective longitudinal study was conducted from 2006 to 2014. We designed a seven-point scoring system using the clinical syndrome characteristics [classical (CS) and non-classical syndromes (NCS)] and its location (central, peripheral, in the neuromuscular junction or combined), onconeural antibodies and tumor markers. Patients were classified as low (score 0–2), intermediate (3–4) and high (5–7) pre-test risk of PNS. FDG-PET/CT was classified as negative or positive. Final diagnosis according Graus’ criteria (definite, possible or no PNS) was established. Relations between clinical and metabolic variables with the final diagnosis were studied. 73 patients were included, with a follow-up time of 33 months. Eleven (15 %) patients were finally diagnosed with neoplasm (8 invasive cancers). Ultimately, 13 (18 %) and 24 (33 %) subjects were diagnosed as definite or possible PNS. All the patients with final diagnosis of neoplasm had a CS (p = 0.005). PET/CT was helpful to diagnose 6/8 (75 %) invasive cancers. PET/CT findings were associated with the final diagnosis of neoplasm (p = 0.003) and the diagnosis of PNS attending to Graus’ criteria (p = 0.019). PRC showed significant association with the final diagnosis of neoplasm and PET/CT results. A majority of patients (10/11) diagnosed of neoplasm had intermediate/high-risk. Our PRC seems to be a valid tool to select candidates for PET/CT imaging in this setting. PET/CT detected malignancy in a significant proportion of patients with invasive cancer.

In a Pharmacokinetic reaction a ligand may be bound to different types of macro-molecules, each with different number of binding sites. They are frequently involved in certain diseases diagnostics. Adair equation is used very often to model the reactions of biological macro-molecules with a ligand. This equation relates the saturation ratio with the free ligand concentration when the equilibrium is reached and it depends on some association constants of the chemical reaction, which have to be estimated. The main problem considered in this paper is the computation of optimal experimental designs for a mixture of Adair models when different types of macromolecules are mixed in the experiment. The main contribution of this work is obtaining the Fisher Information Matrix for a model with a mixture of probability distributions. Since this is not anymore in the Exponential family the expectation cannot be obtained analytically. Then the computation of optimal designs through the information matrix cannot be done with traditional methods. In data analysis when one has the data this expectation can be computed empirically from the data. But in experimental design data are not available when the experiment is being scheduled. Assuming nominal values of the parameters, as is usually done for nonlinear models, simulations were performed for each point in a suitable discretized design space. The number of simulations and the sample size used in each simulation were empirically tuned for both. A sensitivity analysis was performed for different possible true values of the parameters. Since this meant an important computational burden fractional designs were used to cover a reasonable neighborhood of the nominal values of the parameters. In order to display the results in a friendly way for the practitioner, “safe” neighborhoods of the optimal designs are provided.

This article focuses on analyzing the process of jam formation during the discharge by gravity of granular material stored in a two-dimensional silo. The aim of the article is two-fold. First, optimal experimental designs are computed, in which four approaches are considered: D-optimality, a combination of D-optimality and a cost/gain function, Bayesian D-optimality, and sequential designing. These results reveal that the efficiency of the design used by the experimenters can be improved dramatically. A sensitivity analysis with respect to the most important parameter is also performed. Second, estimation of the unknown parameters is done using least squares, that is, assuming normality, and also via maximum likelihood assuming the exponential distribution. Simulations for the designs considered in this article show that the variance, the mean squared error, and the bias of the estimators using maximum likelihood are in most cases lower than those using least squares. Supplementary materials for this arti...

This study delved on the role of semi-outdoor spaces (SOS), as form-based strategies, in providing enhanced, thermally comfortable environments in highly dense urban contexts. A sample of sixty-three (63) SOS was studied, within four different mid-rise and high-rise buildings located in the warm-humid tropical city of Singapore. It was found: (i) that SOS may act as thermal buffer spaces; (ii) that microclimate creation in SOS is linked to form, specifically to geometrical variables such as void-to-solid ratio, height, height-to-depth ratio, height from ground level, green plot ratio and open space ratio, which influence significantly the environmental factors of air temperature, mean radiant temperature, air velocity and relative humidity; (iii) that some aforementioned geometrical variables (height-to-depth ratio and open space ratio) are linked to thermal comfort when estimated with SET* and PMV* thermal indices; (iv) and that thermal comfort (between −1 and +1 PMV*) can be achieved in SOS considering a typical Singaporean outdoor CLO of 0.3, especially for 1 MET (85.7% of SOS). In the context of Singapore, this study demonstrates that incorporating SOS to mid-rise and high-rise building forms promotes the creation of thermally comfortable microclimates suitable for human activity, even during the hottest hours.

Context To date, there is no study comparing palliative care (PC) development among African countries. Objectives To analyze comparatively PC development in African countries based on region-specific indicators. Methods Data were obtained from the African PC Association Atlas of PC in Africa, and a comparative analysis was conducted. Nineteen indicators were developed and defined through qualitative interviews with African PC experts and a two-round modified Delphi consensus process with international experts on global PC indicators. Indicators were grouped by the World Health Organization public health strategy for PC dimensions. These indicators were then sent as a survey to key informants in 52 of 54 African countries. Through an expert weighting process and ratings from the modified Delphi, weights were assigned to each indicator. Results Surveys were received from 89% (48 of 54) of African countries. The top three countries in overall PC development were, in order, Uganda, South Africa, and Kenya. Variability existed by dimension. The top three countries in specialized services were Uganda, South Africa, and Nigeria; in policies, it was Botswana followed by parity among Ethiopia, Rwanda, and Swaziland; in medicines, it was Swaziland, South Africa, then Malawi; and in education, it was equivalent between Uganda and Kenya, then Ghana and Zambia. Conclusion Uganda, South Africa, and Kenya are the highest performing countries and were the only ones with composite scores greater than 0.5 (50%). However, not one country universally supersedes all others across all four PC dimensions. The breakdown of rankings by dimension highlights where even high-performing African countries can focus their efforts to further PC development.

In the literature, different optimality criteria have been considered for model identification. Most of the proposals assume the normal distribution for the response variable and thus they provide optimality criteria for discriminating between regression models. In this paper, a max---min approach is followed to discriminate among competing statistical models (i.e., probability distribution families). More specifically, k different statistical models (plausible for the data) are embedded in a more general model, which includes them as particular cases. The proposed optimal design maximizes the minimum KL-efficiency to discriminate between each rival model and the extended one. An equivalence theorem is proved and an algorithm is derived from it, which is useful to compute max---min KL-efficiency designs. Finally, the algorithm is run on two illustrative examples.