Sudden Transition in Anatomy Education: Assessing the Perception of Anatomy Course Delivery among Medical Students during COVID-19 Pandemic

Coronavirus disease 2019 (COVID-19) pandemic has undoubtedly impacted anatomy education. This has led to a vast shift from a face to face (F2F) session to a complete online session and practical demonstration. Nonetheless, this pandemic provides an opportunity for anatomy educationists to embark on an alternative delivery of anatomy education via an online platform. The aim of this study was to evaluate the students’ perception of the online teaching and learning in anatomy course delivery among the first-year medical students in Universiti Sains Islam Malaysia (USIM). A total of 90 first-year medical students partook in an online questionnaire-based survey after semester completion of online anatomy course delivery. Synchronous online lectures conferred positive responses from the students with 73.0% of the students perceived effective communication with lecturers through the online platform. Out of these, 71.6% inclined towards online lectures as it allows them the flexibility to record the lecture and revisit it. Gross anatomy practical sessions were executed asynchronously via pre-recorded video with an additional supplementary quiz on USIM’s Global Open Access Learning system (GOALS) while histology practical was executed synchronously via virtual slide demonstration. A total of 80.1% students felt convenient with histology practical, however, only 48.3% students responded positively to the gross practical. Overall, 76.4% students favoured the conventional practical compared to the online sessions. Meanwhile, an online examination had disputable responses between the different exam formats whereby 71.9% students perceived that Multiple Choice Questions (MCQ) were conducted conveniently contradictory to the Modified Essay Questions (MEQ) in which only 34.9% students responded positively. In addition, 57.3% students disclosed multiple setbacks during the Objective Structures Practical Exam (OSPE). The extensive and impromptu changes in the study technique have received multiple responses from the students. Overall, the students preferred an online platform for didactic sessions but a real live classroom for practical sessions.

Phosphomolybdic Acid Prevents Nonspecific Nuclear Staining by Picrosirius Red but Is Converted to Molybdenum Blue by Blue Light

Picrosirius red (PSR) staining is generally used to evaluate liver fibrosis; however, PSR sometimes causes nonspecific nuclear staining. In this study, we evaluated the ability of phosphomolybdic acid (PMA) pretreatment to prevent nonspecific nuclear staining by PSR. In a manual evaluation of 27 non-tumor samples from patients with hepatocellular carcinoma, nonspecific nuclear staining was observed in 3.7% of PMA-treated specimens, compared with 85.2% of untreated specimens. Conversely, computer-assisted image analysis (CAIA) identified nonspecific nuclear staining in 0% of PMA-treated samples, vs 44.4% of untreated samples. Surprisingly, after mounting, PMA-treated specimens exhibited a blue tinge because of molybdenum blue (MB) production following sunlight exposure or virtual slide scanning. Using UV cut film, MB production induced by sunlight exposure was prevented; however, the film did not prevent MB production during virtual slide scanning. Moreover, only blue light–emitting diode exposure resulted in a blue tinge in PMA solution. Our data indicated that PMA pretreatment is effective for evaluating liver fibrosis using CAIA. Meanwhile, improvements in virtual slide scanning protocols would directly improve the quality of PMA-pretreated specimens subjected to CAIA:

Pathology Image Exchange: The Dutch Digital Pathology Platform for Exchange of Whole-Slide Images for Efficient Teleconsultation, Telerevision, and Virtual Expert Panels

Among the many uses of digital pathology, remote consultation, remote revision, and virtual slide panels may be the most important ones. This requires basic slide scanner infrastructure in participating laboratories to produce whole-slide images. More importantly, a software platform is needed for exchange of these images and functionality to support the processes around discussing and reporting on these images without breaching patient privacy. This poses high demands on the setup of such a platform, given the inherent complexity of the handling of digital pathology images. In this article, we describe the setup and validation of the Pathology Image Exchange project, which aimed to create a vendor-independent platform for exchange of whole-slide images between Dutch pathology laboratories to facilitate efficient teleconsultation, telerevision, and virtual slide panels. Pathology Image Exchange was released in April 2018 after technical validation, and a first successful validation in real life has been performed for hematopathology cases.

Adoption of diagnostic digital pathology in Finland

Digital pathology (DP) means digitizing histological glass slides for the assessment on a computer screen. In clinical diagnostics, DP is expected to reduce costs due to improved pathologist productivity with the aid of image analysis, workload distribution, and more accurate subspecialty-based diagnoses. The digital workflow also provides many advantages to research and education. However, the adoption of DP into clinical diagnostics has been slow. In this study, the current state and attitudes of the adoption of DP were explored with a questionnaire sent to the persons in charge of digitalization in all public pathology laboratories in Finland. Most of the respondents (75.0%) considered that there is a sufficient amount of validation studies about the safety of DP. The benefits of DP were seen in e.g. tumor boards (64.3%), logistics (64.3%), diagnostic quality (50.0%), and consultations (64.3%). All but one (92.9%) expected the level of digitalization to reach 100% in the following 12 years. The price of digitalization, specifically the cost of storage, was considered to be the most important barrier to a large-scale adoption of DP. The results suggest that there is a need for a substantial governmental financing: the virtual slide images could be stored in a central national image archive (e.g. Kvarkki) after diagnostics, leading to a remarkably reduced cost of local storage and an accelerated large-scale adoption of DP in the Finnish pathology laboratories. This would lead to improved diagnostic efficacy and quality by enabling better workload management locally and nationally. A central DP repository could serve as an invaluable database for e.g. biobank research

Iconicity and Structure in the Emergence of Combinatoriality

One design feature of human language is its combinatorial phonology, allowing it to form an unbounded set of meaningful utterances from a finite set of building blocks. Recent experiments suggest how this feature can evolve culturally when continuous signals are repeatedly transmitted between generations. Because the building blocks of a combinatorial system lack independent meaning, combinatorial structure appears to be in conflict with iconicity, another property salient in language evolution. To investigate the developmental trajectory of iconicity during the evolution of combinatoriality, we conducted an iterated learning experiment where participants learned auditory signals produced using a virtual slide whistle. We find that iconicity emerges rapidly but is gradually lost over generations as combinatorial structure continues to increase. This suggests that iconicity biases, whose presence was revealed in a signal guessing experiment, manifest in nuanced ways. We discuss implications of these findings for different ideas about how biases for iconicity and combinatoriality interact in language evolution.

CytoProcessorTM: A New Cervical Cancer Screening System for Remote Diagnosis

Background: Current automated cervical cytology screening systems still heavily depend on manipulation of glass slides. We developed a new system called CytoProcessorTM (DATEXIM, Caen, France), which increases sensitivity and takes advantage of virtual slide technology to simplify the workflow and save worker time. We used an approach based on artificial intelligence to identify abnormal cells among the tens of thousands in a cervical preparation. Objectives: We set out to compare the diagnostic sensitivity and specificity of CytoProcessorTM and the ThinPrep Imaging System (HOLOGIC, Marlborough, MA, USA). Methods: A representative population of 1,352 cases was selected from the routine workflow in a private laboratory. Diagnoses were established using the ThinPrep Imaging System and CytoProcessorTM. All discordances were resolved by a consensus committee. Results: Compared to the ThinPrep Imaging System, CytoProcessorTM significantly improves diagnostic sensitivity without compromising specificity. The sensitivity of detection of “atypical squamous cells of undetermined significance (ASC-US) and more severe” and “low-grade squamous intraepithelial lesion and more severe” was significantly higher using CytoProcessorTM. Considering that cases with a truth diagnosis of ASC-US or more severe required clinical follow-up, 1.5% of the cases (21/1,360) would have been missed if the CytoProcessorTM diagnosis had been used for clinical decision-making. In contrast, 4% of the cases (54/1,360) were missed when the ThinPrep Imaging System diagnosis was used for clinical decision-making. There were 2.6 times fewer false negatives using CytoProcessorTM. The CytoProcessorTM workflow was 1.5 times faster in terms of worker time. Conclusions: CytoProcessorTM is the first of a new generation of automated screening systems, demonstrating improved sensitivity and yielding significant gains in processing time. In addition, the fully digital nature of slide presentation in CytoProcessorTM allows the remote diagnosis of Papanicolaou tests for the first time.

Digital Microscopy, Image Analysis, and Virtual Slide Repository

Advancements in technology and digitization have ushered in novel ways of enhancing tissue-based research via digital microscopy and image analysis. Whole slide imaging scanners enable digitization of histology slides to be stored in virtual slide repositories and to be viewed via computers instead of microscopes. Easier and faster sharing of histologic images for teaching and consultation, improved storage and preservation of quality of stained slides, and annotation of features of interest in the digital slides are just a few of the advantages of this technology. Combined with the development of software for digital image analysis, digital slides further pave the way for the development of tools that extract quantitative data from tissue-based studies. This review introduces digital microscopy and pathology, and addresses technical and scientific considerations in slide scanning, quantitative image analysis, and slide repositories. It also highlights the current state of the technology and factors that need to be taken into account to insure optimal utility, including preanalytical considerations and the importance of involving a pathologist in all major steps along the digital microscopy and pathology workflow.