A pediatric digital storytelling system for third year medical students: The Virtual Pediatric Patients

BACKGROUND: Computer-based patient simulations (CBPS) are common, effective, instructional methods for medical students, but have limitations. The goal of this project was to describe the development of a CBPS designed to overcome some of these limitations and to perform an online evaluation. METHODS: In 1996, patients and families experiencing a common pediatric problem were interviewed, photographed and a chart review completed. A digital storytelling template was developed: 1. patient's story, evaluation and clinical course, 2. problem-based approach to the evaluation, and 3. discussion of disease process. The media was digitized and placed onto the Internet. The digital stories and a 10-question online survey were pilot tested. Online survey responses were collected from 1999–2003. Overall use of the digital stories was measured by computer server logs and by the number of hyperlinks to the CBPS. RESULTS: Eight stories were created using this system. Over 4.5 years, 814,148 digital story pages were read by 362,351 users. Hyperlink citations from other websites to the CBPS were 108. Online survey respondents (N = 393) described the overall quality as excellent or very good (88.4%). The stores were clearly written (92%) at an appropriate level (91.4%). Respondents felt they could begin to evaluate a similar case presentation (95.4%), and would remember the case in the future (91%). CONCLUSIONS: A new type of CBPS, the digital storytelling system, has been developed and evaluated which and appears to be successful in overcoming some of the limitations of earlier CBPS by featuring patient's stories in their own words, by focusing on problems rather than diseases, and by having stories that are quick for students to work through

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Multimodal Indices To Japanese And French Prosodically Expressed Social Affects

Whereas several studies have explored the expression of emotions, little is known on how the visual and audio channels are combined during production of what we call the more controlled social affects, for example, “attitudinal” expressions. This article presents a perception study of the audovisual expression of 12 Japanese and 6 French attitudes in order to understand the contribution of audio and visual modalities for affective communication. The relative importance of each modality in the perceptual decoding of the expressions of four speakers is analyzed as a first step towards a deeper comprehension of their influence on the expression of social affects. Then, the audovisual productions of two speakers (one for each language) are acoustically (F0, duration and intensity) and visually (in terms of Action Units) analyzed, in order to match the relation between objective parameters and listeners' perception of these social affects. The most pertinent objective features, either acoustic or visual, are then discussed, in a bilingual perspective: for example, the relative influence of fundamental frequency for attitudinal expression in both languages is discussed, and the importance of a certain aspect of the voice quality dimension in Japanese is underlined