Background An emergency waiting room is a place where conflicts often arise. Nervous relatives in a hostile, unknown environment force security and medical staff to be ready to deal with some awkward situations. Additionally, it has been said that the medical interview is the first diagnostic and therapeutic tool, involving both intellectual and emotional skills on the part of the doctor. At the same time, it seems that there is something mysterious about interviewing that cannot be formalized or taught. In this context, virtual conversational characters (VCCs) are progressively present in most e-learning environments. Objective In this study, we propose and develop a modular architecture for a VCC-based behavior simulator to be used as a tool for conflict avoidance training. Our behavior simulators are now being used in hospital environments, where training exercises must be easily designed and tested. Methods We define training exercises as labeled, directed graphs that help an instructor in the design of complex training situations. In order to increase the perception of talking to a real person, the simulator must deal with a huge number of sentences that a VCC must understand and react to. These sentences are grouped into sets identified with a common label. Labels are then used to trigger changes in the active node of the graph that encodes the current state of the training exercise. As a consequence, we need to be able to map every sentence said by the human user into the set it belongs to, in a fast and robust way. In this work, we discuss two different existing string metrics, and compare them to one that we use to assess a designed exercise. Results Based on the similarities found between different sets, the proposed metric provided valuable information about ill-defined exercises. We also described the environment in which our programs are being used and illustrated it with an example. Conclusions Initially designed as a tool for training emergency room staff, our software could be of use in many other areas within the same environment. We are currently exploring the possibility of using it in speech therapy situations.
Background: A single-centre cohort study was performed to identify the independent factors associated withthe overall survival (OS) of hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization with drug-eluting beads (DEB-TACE). Methods: A total of 216 HCC patients who underwent DEB-TACE from October 2008 to October 2015 at a tertiary hospital were consecutively recruited. The analysis of prognostic factors associated with DEB-TACE complications was performed. Results: The objective response (OR) rate (Modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria) to the first DEB-TACE (DEB-TACE-1) was 70.3%; the median OS from DEB-TACE-1 was 27 months (95% confidence interval (CI), 24-30). In the multivariate analysis, basal Barcelona Clinic Liver Cancer (BCLC) stage and serum alkaline phosphatase were independent factors for survival following DEB-TACE-1. The most important clinical event associated with poor survival was the development of early ascites after DEB-TACE-1 (median OS, 17 months), which was closely related to the history of ascites, albumin and hemoglobin but not to tumour load or to response to therapy. Conclusions: Early ascites post-DEB-TACE is associated with the survival of patients despite adequate liver function and the use of a supra-selective technical approach. History of ascites, albumin and hemoglobin are major determinants of the development of early ascites post-DEB-TACE.
UNSTRUCTURED Emergency waiting room is a place where conflicts raise quite often. Nervous relatives in a hostile, unknown environment force security and medical staff to be ready to deal with some awkward situations. Additionally, it’s been said that the medical interview is the first diagnostic and therapeutic tool, involving both intellectual and emotional skills on the practicing physician’s side. At the same time, seems that there is something mysterious about interviewing that cannot be formalized or taught. In this context, Virtual Conversational Characters (VCCs) are progressively present in most e-learning environments. Here we propose and develop a modular architecture for a VCC based Behavior Simulator to be used as a tool for Conflict Avoidance Training. Our behavior simulators are now being used in hospital environments, where Training Exercises must be easily designed and tested. We define Training Exercises as labeled, directed graphs that help an instructor in the design of complex Training Situations. In order to increase the perception of talking to a real person, the simulator must deal with a huge number of sentences that a VCC must understand and react to. These sentences are grouped into sets identified with a common label. Labels are then used to trigger changes in the active node of the graph that encodes the current state of the Training Exercise. As a consequence, we need to be able to map every sentence said by the human user into the set it belongs to, doing it in a fast and robust way. In this work we discuss two different existent String Metrics, and compare them to the one we finally use to assess a designed exercise. Based on the similarities found between different sets, the proposed metric gives us valuable information about ill-defined exercises. We also describe the environment in which our programs are being used, and illustrate it with an example. Initially designed as a tool for the training of the emergency room staff, our software could be of help in many other areas inside the same environment. We are currently exploring the possibility of using it in speech therapy situations
Background: A single-centre cohort study was performed to identify the independent factors associated withthe overall survival (OS) of hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization with drug-eluting beads (DEB-TACE). Methods : A total of 216 HCC patients who underwent DEB-TACE from October 2008 to October 2015 at a tertiary hospital were consecutively recruited. The analysis of prognostic factors associated with overall survival after DEB-TACE, stressing the role of post-TACE events, was performed. Results: The objective response (OR) rate (Modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria) to the first DEB-TACE (DEB-TACE-1) was 70.3%; the median OS from DEB-TACE-1 was 27 months (95% confidence interval (CI), 24-30). In the multivariate analysis, tumor size, AFP < 100 ng/mL and serum alkaline phosphatase were independent factors for survival following DEB-TACE-1. The most important clinical event associated with poor survival was the development of early ascites after DEB-TACE-1 (median OS, 17 months), which was closely related to the history of ascites, albumin and hemoglobin but not to tumour load or to response to therapy. Conclusions : Early ascites post-DEB-TACE is associated with the survival of patients despite adequate liver function and the use of a supra-selective technical approach. History of ascites, albumin and hemoglobin are major determinants of the development of early ascites post-DEB-TACE.
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