Aligned Matching: Improving Small Object Detection in SSD.

Although detecting small objects is critical in various applications, neural network models designed and trained for generic object detection struggle to do so with precision. For example, the popular Single Shot MultiBox Detector (SSD) tends to perform poorly for small objects, and balancing the performance of SSD across different sized objects remains challenging. In this study, we argue that the current IoU-based matching strategy used in SSD reduces the training efficiency for small objects due to improper matches between default boxes and ground truth objects. To address this issue and improve the performance of SSD in detecting small objects, we propose a new matching strategy called aligned matching that considers aspect ratios and center-point distance in addition to IoU. The results of experiments on the TT100K and Pascal VOC datasets show that SSD with aligned matching detected small objects significantly better without sacrificing performance on large objects or requiring extra parameters.

Validity of OSCE Evaluation Using the FLEX Model of Blended Learning.

BACKGROUND: For OSCE (Objective Structured Clinical Examination) scoring, medical schools must bring together many clinical experts at the same place, which is very risky in the context of the coronavirus pandemic. However, if the FLEX model with the properties of self-directed learning and offline feedback is applied to OSCE, it is possible to provide a safe and effective evaluation environment for both universities and students through experts' evaluation of self-video clips of medical students. The present study investigated validity of the FLEX model to evaluate OSCE in a small group of medical students. METHODS: Sixteen 3rd grade medical students who failed on OSCE were required to take a make-up examination by videotaping the failed items and submitting them online. The scores between original examination and make-up examination were compared using Paired Wilcoxon Signed Rank Test, and a post-hoc questionnaire was conducted. RESULTS: The score for make-up examination was significantly higher than those for original examination. The significance was maintained even when the score was compared by individual domains of skills and proficiency. In terms of preference, students were largely in favor of self-videotaped examination primarily due to the availability of self-practice. CONCLUSION: The FLEX model can be effectively applied to medical education, especially for evaluation of OSCE.

The relationship between low survival and acute increase of tumor necrosis factor α expression in the lung in a rat model of asphyxial cardiac arrest.

Cardiac arrest (CA) is sudden loss of heart function and abrupt stop in effective blood flow to the body. The patients who initially achieve return of spontaneous circulation (RoSC) after CA have low survival rate. It has been known that multiorgan dysfunctions after RoSC are associated with high morbidity and mortality. Most previous studies have focused on the heart and brain in RoSC after CA. Therefore, the aim of this research was to perform serological, physiological, and histopathology study in the lung and to determine whether or how pulmonary dysfunction is associated with low survival rate after CA. Experimental animals were divided into sham-operated group (n=14 at each point in time), which was not subjected to CA operation, and CA-operated group (n=14 at each point in time), which was subjected to CA. The rats in each group were sacrificed at 6 hours, 12 hours, 24 hours, and 2 days, respectively, after RoSC. Then, pathological changes of the lungs were analyzed by hematoxylin and eosin staining, Western blot and immunohistochemistry for tumor necrosis factor α (TNF-α). The survival rate after CA was decreased with time past. We found that histopathological score and TNF-α immunoreactivity were significantly increased in the lung after CA. These results indicate that inflammation triggered by ischemia-reperfusion damage after CA leads to pulmonary injury/dysfunctions and contributes to low survival rate. In addition, the finding of increase in TNF-α via inflammation in the lung after CA would be able to utilize therapeutic or diagnostic measures in the future.

Decrease in glucose transporter 1 levels and translocation of glucose transporter 3 in the dentate gyrus of C57BL/6 mice and gerbils with aging.

In the present study, we compared the cell-specific expression and changes protein levels in the glucose transporters (GLUTs) 1 and 3, the major GLUTs in the mouse and gerbil brains using immunohistochemistry and Western blot analysis. In both mouse and gerbils, GLUT1 immunoreactivity was mainly found in the blood vessels in the dentate gyrus, while GLUT3 immunoreactivity was detected in the subgranular zone and the molecular layer of the dentate gyrus. GLUT1-immunoreactivity in blood vessels and GLUT1 protein levels were significantly decreased with age in the mice and gerbils, respectively. In addition, few GLUT3-immunoreactive cells were found in the subgranular zone in aged mice and gerbils, but GLUT3-immunoreactivity was abundantly found in the polymorphic layer of dentate gyrus in mice and gerbils with a dot-like pattern. Based on the double immunofluorescence study, GLUT3-immunoreactive structures in gerbils were localized in the glial fibrillary acidic protein-immunoreactive astrocytes in the dentate gyrus. Western blot analysis showed that GLUT3 expression in the hippocampal homogenates was slightly, although not significantly, decreased with age in mice and gerbils, respectively. These results indicate that the reduction in GLUT1 in the blood vessels of dentate gyrus and GLUT3 in the subgranular zone of dentate gyrus may be associated with the decrease in uptake of glucose into brain and neuroblasts in the dentate gyrus. In addition, the expression of GLUT3 in the astrocytes in polymorphic layer of dentate gyrus may be associated with metabolic changes in glucose in aged hippocampus.

Age-dependent decrease of Nurr1 protein expression in the gerbil hippocampus.

Nuclear receptor related-1 protein (Nurr1) serves important roles in hippocampal-dependent cognitive process. In the present study, the protein expression of Nurr1 was compared in the hippocampi of young [postnatal month 3 (PM 3)], adult (PM 12) and aged (PM 24) gerbils using western blot analysis and immunohistochemistry. Results indicated that the protein level of Nurr1 was significantly and gradually decreased in the gerbil hippocampus with increasing age. In addition, strong Nurr1 immunoreactivity was primarily observed in pyramidal neurons and granule cells of the hippocampus in the young group, which was determined to be reduced in the adult group and to a greater extent in the aged group. Collectively the data demonstrated that Nurr1 immunoreactivity was gradually and markedly decreased during normal aging. These results indicate that gradual decrease of Nurr1 expression in the hippocampus may be associated with the normal aging process and a decline in hippocampus-dependent cognitive function.

North Korean refugee doctors' preliminary examination scores.

PURPOSE: Although there have been studies emphasizing the re-education of North Korean (NK) doctors for post-unification of the Korean Peninsula, study on the content and scope of such re-education has yet to be conducted. Researchers intended to set the content and scope of re-education by a comparative analysis for the scores of the preliminary examination, which is comparable to the Korean Medical Licensing Examination (KMLE). METHODS: The scores of the first and second preliminary exams were analyzed by subject using the Wilcoxon signed rank test. The passing status of the group of NK doctors for KMLE in recent 3 years were investigated. The multiple-choice-question (MCQ) items of which difficulty indexes of NK doctors were lower than those of South Korean (SK) medical students by two times of the standard deviation of the scores of SK medical students were selected to investigate the relevant reasons. RESULTS: The average scores of nearly all subjects were improved in the second exam compared with the first exam. The passing rate of the group of NK doctors was 75%. The number of MCQ items of which difficulty indexes of NK doctors were lower than those of SK medical students was 51 (6.38%). NK doctors' lack of understandings for Diagnostic Techniques and Procedures, Therapeutics, Prenatal Care, and Managed Care Programs was suggested as the possible reason. CONCLUSION: The education of integrated courses focusing on Diagnostic Techniques and Procedures and Therapeutics, and apprenticeship-style training for clinical practice of core subjects are needed. Special lectures on the Preventive Medicine are likely to be required also.

Development of a Modified Korean East Asian Student Stress Inventory by Comparing Stress Levels in Medical Students with Those in Non-Medical Students.

BACKGROUND: Medical students are usually under more stress than that experienced by non-medical students. Stress testing tools for Korean medical students have not been sufficiently studied. Thus, we adapted and modified the East Asian Student Stress Inventory (EASSI), a stress testing tool for Korean students studying abroad, and verified its usefulness as a stress test in Korean university students. We also compared and analyzed stress levels between medical and non-medical students. METHODS: A questionnaire survey was conducted on medical and non-medical students of a national university, and the responses of 224 students were analyzed for this study. Factor analysis and reliability testing were performed based on data collected for 25 adapted EASSI questions and those on the Korean version of the Global Assessment of Recent Stress Scale (GARSS). A correlation analysis was performed between the 13 modified EASSI questions and the GARSS, and validity of the modified EASSI was verified by directly comparing stress levels between the two student groups. RESULTS: The 13 questions adapted for the EASSI were called the modified EASSI and classified into four factors through a factor analysis and reliability testing. The Pearson's correlation analysis revealed a significant correlation between the modified EASSI and the Korean version of the GARSS, suggesting a complementary strategy of using both tests. CONCLUSION: The validity and reliability of the EASSI were verified. The modified Korean EASSI could be a useful stress test for Korean medical students. Our results show that medical students were under more stress than that of non-medical students. Thus, these results could be helpful for managing stress in medical students.

Does Objective Structured Clinical Examinations Score Reflect the Clinical Reasoning Ability of Medical Students?

BACKGROUND: Clinical reasoning ability is an important factor in a physician's competence and thus should be taught and tested in medical schools. Medical schools generally use objective structured clinical examinations (OSCE) to measure the clinical competency of medical students. However, it is unknown whether OSCE can also evaluate clinical reasoning ability. In this study, the authors investigated whether OSCE scores reflected students' clinical reasoning abilities. METHODS: Sixty-five fourth-year medical students participated in this study. Medical students completed the OSCE with 4 cases using standardized patients. For assessment of clinical reasoning, students were asked to list differential diagnoses and the findings that were compatible or not compatible with each diagnosis. The OSCE score (score of patient encounter), diagnostic accuracy score, clinical reasoning score, clinical knowledge score and grade point average (GPA) were obtained for each student, and correlation analysis was performed. RESULTS: Clinical reasoning score was significantly correlated with diagnostic accuracy and GPA (correlation coefficient = 0.258 and 0.380; P = 0.038 and 0.002, respectively) but not with OSCE score or clinical knowledge score (correlation coefficient = 0.137 and 0.242; P = 0.276 and 0.052, respectively). Total OSCE score was not significantly correlated with clinical knowledge test score, clinical reasoning score, diagnostic accuracy score or GPA. CONCLUSIONS: OSCE score from patient encounters did not reflect the clinical reasoning abilities of the medical students in this study. The evaluation of medical students' clinical reasoning abilities through OSCE should be strengthened.

Can the multiple mini-interview predict academic achievement in medical school?

PURPOSE: The purpose of this study was to determine whether the multiple mini-interview (MMI) predicts academic achievement for subjects in a medical school curriculum. METHODS: Of 49 students who were admitted in 2008, 46 students finished the entire medical education curriculum within 4 years. We calculated the Pearson correlation coefficients between the total MMI score of the 46 graduates and their academic achievements in all subjects of the curriculum. RESULTS: The correlation coefficients between total MMI score and academic achievement in Medical Interview and History Taking, Problem-Based Learning, Doctoring I, and Clinical Practice of Surgery ranged from 0.4 to 0.7, indicating that they were moderately related. The values between total MMI score and achievement in Research Overview, Technical and Procedural Skills, Clinical Performance Examinations 1 and 3, Clinical Practice of Laboratory Medicine and Psychiatry, Neurology, and Orthopedics ranged from 0.2 to 0.4, which meant that they were weakly related. CONCLUSION: MMI score can predict medical student' academic achievement in subjects in the medical humanities and clinical practice.

A rank-ordered marginal filter for deinterlacing.

This paper proposes a new interpolation filter for deinterlacing, which is achievedby enhancing the edge preserving ability of the conventional edge-based line average methods. This filter consists of three steps: pre-processing step, fuzzy metric-based weight assignation step, and rank-ordered marginal filter step. The proposed method is able to interpolate the missing lines without introducing annoying articles. Simulation results show that the images filtered with the proposed algorithm restrain less annoying pixels than the ones acquired by other methods.

Effect of enhanced analytic reasoning on diagnostic accuracy: a randomized controlled study.

BACKGROUND: Diagnostic error can be caused by several types of cognitive bias, which may be reversed by enhancing analytic reasoning. AIMS: To evaluate whether enhancing analytic reasoning can increase diagnostic accuracy in objective structured clinical examination (OSCE) in medical students. METHODS: All fourth-year medical students, randomly assigned to the analytic reasoning or control groups, undertook the OSCE with four cases using standardized patients. The analytic reasoning group was requested to list differential diagnoses and findings compatible or not compatible with each diagnosis prior to providing a diagnosis, while the control group provided a diagnosis without these processes. Mean diagnostic accuracy scores (perfect score, 4.0) from four cases of OSCE were compared between the two groups. RESULTS: One hundred forty-five students were randomly assigned to the analytic reasoning group (n = 65) or the control group (n = 80). The baseline characteristics, including grade point average and the scores from each patient encounter, were comparable between groups. Mean diagnostic accuracy scores were significantly higher in the analytic reasoning group than in the control group (3.40 ± 0.66 versus 3.05 ± 0.98; p = 0.011). CONCLUSION: Enhancement of analytic reasoning may improve diagnostic accuracy in novice doctors.

The use of specially designed tasks to enhance student interest in the cadaver dissection laboratory.

Cadaver dissection is a key component of anatomy education. Unfortunately, students sometimes regard the process of dissection as uninteresting or stressful. To make laboratory time more interesting and to encourage discussion and collaborative learning among medical students, specially designed tasks were assigned to students throughout dissection. Student response and the effects of the tasks on examination scores were analyzed. The subjects of this study were 154 medical students who attended the dissection laboratory in 2009. Four tasks were given to teams of seven to eight students over the course of 2 weeks of lower limb dissection. The tasks were designed such that the answers could not be obtained by referencing books or searching the Internet, but rather through careful observation of the cadavers and discussion among team members. Questionnaires were administered. The majority of students agreed that the tasks were interesting (68.0%), encouraged team discussion (76.8%), and facilitated their understanding of anatomy (72.8%). However, they did not prefer that additional tasks be assigned during the other laboratory sessions. When examination scores of those who responded positively were compared with those who responded neutrally or negatively, no statistically significant differences could be found. In conclusion, the specially designed tasks assigned to students in the cadaver dissection laboratory encouraged team discussion and collaborative learning, and thereby generated interest in laboratory work. However, knowledge acquisition was not improved.

Experience of Teaching a Class with a Film: Cognitive Changes with Regard to HIV.

PURPOSE: The aim of this study was to describe our experience of a class, using a film that deals with the social issues of human immunodeficiency virus (HIV), and the results of surveys before and after the class. METHODS: One hundred fifty-six second-year medical students were surveyed with self-questionnaires (9-point Likert scale) before, immediately after, and 2 years after a class that viewed a film ('Philadelphia', 1993). The same survey, comprising 4 items, was administered to 81 non-medical students in the same university. RESULTS: In 156 medical students, 153 (98%) answered the questionnaires. Before the class, there was no significant difference between medical and non-medical students with regard to the cognition of social isolation of HIV-infected persons (4.13 vs. 4.43, p=0.307). immediately after the class, medical student' cognition changed significantly in the positive direction on all items, irrespective of age, sex, and course grade. Two years after the class, this positive effect remained significant on 2 items: 'social isolation of HIV-infected persons' and 'casual contact with an HIV-infected person.' CONCLUSION: A film can be used to reinforce medical education in the affective domain.

The use of standardized patients to teach medical students clinical skills in ambulatory care settings.

BACKGROUND: Ambulatory medicine is being increasingly emphasized in undergraduate medical education. Because of the limited availability of real patients, we introduced a standardized patient (SP) encounter program in an ambulatory care setting. AIMS: This study was undertaken to assess the usefulness of SPs for teaching undergraduate students clinical skills in ambulatory settings. METHOD: Third-year medical students met two different SPs, who presented common authentic problems, during internal medicine clerkship. Each SP encounter of 30 min was followed by SP and a tutor's feedback, using a video recording of the SP encounter. We surveyed students for program evaluation purposes at the end of their three-year internal medicine clerkships (from 2006 to 2008). RESULTS: Most students found that the consecutive SP sessions were instructive and helpful. Video recordings of clinical encounters allowed students to reflect on their behavior and receive feedback from tutors. However, students identified several weaknesses of these SP encounters. For example, pre-exposure to the SP scenario reduced tension of the experience and inconsistent feedback from tutors caused confusion. CONCLUSIONS: SP encounters in an ambulatory care setting, followed by tutor's feedback based on a video recording, can be used for teaching basic clinical ambulatory care skills.

Correlations of Communication and Interpersonal Skills between Medical Students and Residents.

PURPOSE: Medical students' communication and interpersonal skills can be evaluated by standardized patients in a clinical performance examination (CPX). The purpose of this study is to investigate which communication and interpersonal skills are more closely correlated between medical students and residents. METHODS: This study included 2nd-year residents in 2009 who took the eight-station CPX as 4th-year medical students in 2006. In-patients who were cared for by the residents were asked the seven items related to interpersonal and communication skills. The correlation between the scores of these seven items in the 2006 CPX and the scores in the 2009 patient survey was evaluated. RESULTS: Twenty-six residents, 11 in medical wards and 15 in surgical wards, participated in the study. The medical students' total scores tended to be correlated with the residents' scores (r=0.381, p=0.055). There was significant correlation between the scores for students and residents for 'Explaining more explicably' (r=0.470, p=0.015), and marginally significant correlation (r=0.385, p=0.052) for 'Listening attentively.' There was no significant correlation for the other five items. CONCLUSION: 'Explaining more explicably' and 'Listening attentively', these skills were more closely correlated between medical students and residents. These basic communication skills should be included in graduate or licensing evaluations.