Emotion-aware conversational systems are increasingly adopted in healthcare, yet most emotion detection approaches rely on sentiment polarity, which fails to capture emotional nuance and intensity in short, informal chat messages. To overcome these limitations, this study develops an interpretable emotion-aware framework called Word Intensity Scoring Engine (WISE) that explicitly models emotional intensity in short-form conversational text. Grounded in Plutchik’s Wheel of Emotions, WISE integrates lexicon-based emotion labeling, synonym expansion, semantic similarity using word embeddings, and negation-aware feature extraction to calculate intensity-weighted emotion scores at the word level. The WISE framework is evaluated through experimental benchmarking and an expert review involving practicing healthcare professionals. Results show that WISE enhances the performance of ML and LLM-based classifiers. Further, expert evaluations indicate that WISE-derived responses are perceived as professional, contextually appropriate, and empathetic. This study contributes a transparent, theoretically grounded design artifact that advances affective computing research and informs the deployment of emotion-aware conversational agents in healthcare.
The late Early Miocene site of Buluk, Kenya, has yielded a rich mammalian fauna comprised of about 30 species in 20 genera, notably including a stem cercopithecoid and a range of primitive hominoids. This temporal interval is poorly represented in Africa but is important because it coincides with the Miocene Climatic Optimum (MCO), a previous period of global warming tied to a carbon excursion. As the only late Early Miocene fossiliferous locality in eastern Africa that falls within the MCO, Buluk is of singular value to paleontological studies for increasing understanding of faunal responses to climate change and related ecological transformations. Paleobotanical, geochemical, and dental isotopic investigations indicate that Buluk was a C3-dominated woodland ecosystem with a strongly seasonal subhumid to subarid climate and overall greater rainfall than at present. Depositional circumstances are primarily channel fills associated with a large fluviatile system with water transport of vertebrates over a limited distance, probably denoting an autochthonous fauna. The most abundant large mammals in the fauna are proboscideans. Comparative morphological and metric study of the proboscidean assemblage reveals the co-occurrence of at least six genera and species from three higher taxa, Deinotheriidae and the elephantimorph families Mammutidae and Gomphotheriidae. Three of these species are new, one of them marking the earliest appearance of Protanancus. Deinotheres and archaeobelodonts are equally the most common proboscidean taxa in the assemblage. Such diversity of megaherbivores was not unusual for African Miocene sites and may have been accommodated by faunal differences from modern conditions, resource partitioning, and physical competitive displacement. The relatively diminutive size of molars of proboscideans in the assemblage, most pronounced among female elephantimorphs, may have constituted coordinated dwarfing in response to either increasing temperatures or stresses on resources caused by the MCO.
To examine the use of radiation therapy (RT) in studies on de-escalation of axillary surgery for patients with early-stage breast cancer, the incorporation of pathologic nodal data in RT de-escalation, and current data on omission of both axillary surgery and RT. In the wake of the SOUND and INSEMA trials, the 2025 ASCO Guidelines on sentinel lymph node biopsy in early-stage breast cancer expanded the recommended eligibility for omission of axillary surgery. However, ongoing RT omission trials such as DEBRA and SWIFT RT, which offer enrollment to very similar cohorts of patients with breast cancer, require documented pathologically negative nodes. Despite a paucity of randomized controlled data on de-escalation of both axillary surgery and RT, CALGB 9343 and more recent retrospective studies have demonstrated few oncologic events in such patients who have omission of both axillary surgery and RT. The extent of axillary staging has been shown not to impact oncologic outcomes, yet pathologic nodal staging data is required in protocols for studies evaluating the de-escalation of RT. Modern data on omitting both axillary surgery and RT in women with low-risk breast cancers are limited to small, retrospective studies. However, the similarities between cohorts enrolled in single-modality omission studies suggest opportunities for further study identifying low-risk patients who may benefit from the omission of both therapies.
Anesthesiologist and surgeon experience are associated with improved outcomes and lower costs in various oncologic procedures. The role of the anesthesiologist-surgeon dyad on outcomes and charges for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has not been studied. We performed a retrospective cohort study of patients undergoing CRS-HIPEC at a single quaternary center from 2016 to 2023. High-volume anesthesiologists (ANES) and surgeons (SURG) were defined as those in the top quartile of cases for their respective position (ANES: 10 cases, SURG: 87 cases). The study cohort was then divided into four subcohorts based on anesthesiologist and surgeon volume: low-volume anesthesiologist and surgeon (LALS), high-volume anesthesiologist and low-volume surgeon (HALS), low-volume anesthesiologist and high-volume surgeon (LAHS), and high-volume anesthesiologist and surgeon (HAHS). The study cohort consisted of 237 patients undergoing CRS-HIPEC from 2016 to 2023. Median age was 59 years (interquartile range 48–66). Most patients were female (n = 135, 57
With the advent of new effective treatments for obesity, the field is rapidly changing creating an urgent need for evidence to guide best patient management. To help prioritise and plan for future trials, a meeting of experts was convened with the aim of reviewing the current literature to identify and prioritise current knowledge gaps; identify relevant research questions, and discuss appropriate trial methodologies that could be utilised to address the identified gaps in a timely and pragmatic manner. Participants included research-active academic surgeons and physicians, and industry representatives from various pharmaceutical and device companies. This report summarizes the key outcomes from this meeting. Treatment options for obesity are rapidly evolving. To provide best personalised care for patients, more evidence is required to understand how to best utilise currently available treatments as well as combine treatments. Trials focused on improving the treatment of obesity may need to be pragmatic and more agile than the traditional RCT to enable real time impact on patient care.
