Embodied Conversational Agents (ECAs) are promising software to communicate with patients but no study has tested them in the diagnostic field of mental disorders. The aim of this study was 1) to test the performance of a diagnostic system for major depressive disorders (MDD), based on the identification by an ECA of specific symptoms (the MDD DSM 5 criteria) in outpatients; 2) to evaluate the acceptability of such an ECA. Patients completed two clinical interviews in a randomized order (ECA versus psychiatrist) and filled in the Acceptability E-scale (AES) to quantify the acceptability of the ECA. 179 outpatients were included in this study (mean age 46.5 ± 12.9 years, 57.5% females). Among the 35 patients diagnosed with MDD by the psychiatrist, 14 (40%) patients exhibited mild, 12 (34.3%) moderate and 9 (25.7%) severe depressive symptoms. Sensitivity increased across the severity level of depressive symptoms and reached 73% for patients with severe depressive symptoms, while specificity remained above 95% for all three severity levels. The acceptability of the ECA evaluated by the AES was very good (25.4). We demonstrate here the validity and acceptability of an ECA to diagnose major depressive disorders. ECAs are promising tools to conduct standardized and well-accepted clinical interviews.

1. Measles eradication is the ultimate goal but it is premature to set a date for its accomplishment. Existing regional elimination goals should be vigorously pursued to enable setting a global target by 2020. 2. The basic strategic approaches articulated in the Global Measles and Rubella Strategic Plan 2012-2020 are valid to achieve the goals but have not been fully implemented (or not appropriately adapted to local situations). 3. The report recommends a shift from primary reliance on supplementary immunization activities (SIAs) to assure two doses of measles-containing vaccine (MCV) are delivered to the target population to primary reliance on ongoing services to assure administration of two doses of MCV. Regular high quality SIAs will still be necessary while ongoing services are being strengthened. 4. The report recommends a shift from primary reliance on coverage to measure progress to incorporating disease incidence as a major indicator. 5. The report recommends that the measles/rubella vaccination program be considered an indicator for the quality of the overall immunization program and that measles/rubella incidence and measles and rubella vaccination coverage be considered as primary indicators of immunization program performance. 6. Polio transition presents both risks and opportunities: risks should be minimized and opportunities maximized. 7. A school entry immunization check could contribute significantly to strengthening overall immunization services with assurance that recommended doses of measles and rubella vaccines as well as other vaccines have been delivered and providing those vaccines at that time if the child is un- or under-vaccinated. 8. Program decisions should increasingly be based on good quality data and appropriate analysis. 9. The incorporation of rubella vaccination into the immunization program needs to be accelerated - it should be accorded equivalent emphasis as measles. 10. Outbreak investigation and response are critical but the most important thing is to prevent outbreaks.

No abstract

International audienceExcessive daytime somnolence (EDS) is defined as the inability to stay awake in daily life activities. Several scales have been used to diagnose excessive daytime sleepiness, the most widely used being the Epworth Sleepiness Scale (ESS). Sleep disorders and EDS are very common in the general population. It is therefore important to be able to screen patients for this symptom in order to obtain an accurate diagnosis of sleep disorders. Embodied Conversational Agents (ECA) have been used in the field of affective computing and human interactions but up to now no software has been specifically designed to investigate sleep disorders. We created an ECA able to conduct an interview based on the ESS and compared it to an interview conducted by a sleep specialist. We recruited 32 consecutive patients and a group of 30 healthy volunteers free of any sleep complaints. The ESS is a self-administered questionnaire that asks the subject to rate (with a pen and paper paradigm) his or her probability of falling asleep. For the purpose of our study, the ECA or real-doctor questionnaire was modified as follows: Instead of the “I” formulate, questions were asked as “Do you.” Our software is based on a common 3D game engine and several commercial software libraries. It can run on standard and affordable hardware products. The sensitivity and specificity of the interview conducted by the ECA were measured. The best results (sensibility and specificity >98%) were obtained to discriminate the sleepiest patients (ESS ≥16) but very good scores (sensibility and specificity >80%) were also obtained for alert subjects (ESS<8). ESS scores obtained in the interview conducted by the physician were significantly correlated with ESS scores obtained in the interview the ECA conducted. Most of the subjects had a positive perception of the virtual physician and considered the interview with the ECA as a good experience. Sixty-five percent of the participants felt that the virtual doctor could significantly help real physicians. Our results show that a virtual physician can conduct a very simple interview to evaluate EDS with very similar results to those obtained by a questionnaire administered by a real physician. The expected massive increase in sleep complaints in the near future likely means that more and more physicians will be looking for computerized systems to help them to diagnose their patients