Medical Students' Perceptions Towards Online Teaching During the Covid-19 Pandemic: A Cross-Sectional Study from Saudi Arabia.

Background: The Covid-19 has made a huge impact on higher education. Online teaching and learning became essential to deliver educational activities in all areas including medical education. In this study, we aimed to investigate medical students' perceptions on the role of online teaching and learning in facilitating medical education. Material and Methods: A cross-sectional study using a self-administered online questionnaire was conducted. Students eligible were medical students across all years at Imam Abdulrahman Bin Faisal University, Saudi Arabia. Perceptions analysis was conducted using SPSS software. Results: A total of 563 students participated in the study (prominent category female 64%, n = 361). There was a significant increase in the number of hours devoted to online learning during the pandemic. Live lectures/tutorials platform via zoom showed the highest rate of interaction compared to pre-recorded lectures and learning materials uploaded on blackboard. 50% of the students disagreed that online teaching is as effective as face-to-face teaching. The greatest perceived enjoyable aspect included the online accessibility of materials. Whereas the most frequent perceived barrier to online learning included internet connection. 17% of students reflected a poor understanding of scientific materials through online PBL. More than 50% of students revealed that online theoretical lectures are as good as classroom or better. Whereas the majority (70%) were unable to learn clinical skills online. The results indicated high impact on students' physical activities (80%). Impacts were higher on pre-clinical students' health and social life than on clinical students. Conclusion: Our findings reported that during emergency situations due to the pandemic, online teaching enables the continuity of medical education and provides adequate efficiency. The use of live online platforms showed high level of interaction. However, some barriers need to be addressed especially at the clinical skills development level to maximize the benefit of online teaching and learning.

Magnetic resonance imaging T1 indices of the brain as biomarkers of inhaled manganese exposure.

Excessive exposure to manganese (Mn) is linked to its accumulation in the brain and adverse neurological effects. Paramagnetic properties of Mn allow the use of magnetic resonance imaging (MRI) techniques to identify it in biological tissues. A critical review was conducted to evaluate whether MRI techniques could be used as a diagnostic tool to detect brain Mn accumulation as a quantitative biomarker of inhaled exposure. A comprehensive search was conducted in MEDLINE, EMBASE, and PubMed to identify potentially relevant studies published prior to 9 May 2022. Two reviewers independently screened identified references using a two-stage process. Of the 6452 unique references identified, 36 articles were retained for data abstraction. Eligible studies used T1-weighted MRI techniques and reported direct or indirect T1 measures to characterize Mn accumulation in the brain. Findings demonstrate that, in subjects exposed to high levels of Mn, deposition in the brain is widespread, accumulating both within and outside the basal ganglia. Available evidence indicates that T1 MRI techniques can be used to distinguish Mn-exposed individuals from unexposed. Additionally, T1 MRI may be useful for semi-quantitative evaluation of inhaled Mn exposure, particularly when interpreted along with other exposure indices. T1 MRI measures appear to have a nonlinear relationship to Mn exposure duration, with R1 signal only increasing after critical thresholds. The strength of the association varied depending on the regions of interest imaged and the method of exposure measurement. Overall, available evidence suggests potential for future clinical and risk assessment applications of MRI as a diagnostic tool.

A laser parameter study on enhancing proton generation from microtube foil targets.

The interaction of an intense laser with a solid foil target can drive [Formula: see text] TV/m electric fields, accelerating ions to MeV energies. In this study, we experimentally observe that structured targets can dramatically enhance proton acceleration in the target normal sheath acceleration regime. At the Texas Petawatt Laser facility, we compared proton acceleration from a [Formula: see text] flat Ag foil, to a fixed microtube structure 3D printed on the front side of the same foil type. A pulse length (140-450 fs) and intensity ((4-10) [Formula: see text] W/cm[Formula: see text]) study found an optimum laser configuration (140 fs, 4 [Formula: see text] W/cm[Formula: see text]), in which microtube targets increase the proton cutoff energy by 50% and the yield of highly energetic protons ([Formula: see text] MeV) by a factor of 8[Formula: see text]. When the laser intensity reaches [Formula: see text] W/cm[Formula: see text], the prepulse shutters the microtubes with an overcritical plasma, damping their performance. 2D particle-in-cell simulations are performed, with and without the preplasma profile imported, to better understand the coupling of laser energy to the microtube targets. The simulations are in qualitative agreement with the experimental results, and show that the prepulse is necessary to account for when the laser intensity is sufficiently high.

Antinuclear antibodies positivity is not rare during multiple sclerosis and is associated with relapsing status and IgG oligoclonal bands positivity.

INTRODUCTION: As an immune-mediated disease of the central nervous system, multifaceted aspects of a humoral immune response are widely described during multiple sclerosis (MS). However, the prevalence of different auto-antibodies, such as antinuclear antibodies (ANA), during MS is very variable and their clinical relevance remains controversial. Our aim was to evaluate the prevalence and clinical correlations of ANA positivity in South Tunisian MS patients. MATERIAL AND METHODS: We performed ANA screening using indirect immunofluorescence (IIF) on HEp-2 cells (Biosystems®) in 82 MS patients. For ANA positive samples (titer ≥1/160), anti-ds-DNA detection (IIF on Crithidia luciliae (Biosystems®)) and extractable nuclear antigen typing (immunodot (Euroimmun®)) were performed. RESULTS: ANA were positive in 35/82 MS patients (42.7%). The titer was ≥1/320 in 16/35 patients. The antigenic specificity of ANA was identified in 7/35 patients. None of the patients had extra-neurological manifestations. No correlation was found between ANA and age, gender, MS course, disease duration, disability, annual relapse rate nor IgG index. ANA positivity was more frequent in patients with IgG oligoclonal bands (OCB) (47.1%) than in patients without IgG OCB (16,6%) (p=0.049). Regarding disease activity, ANA positivity was significantly more frequent in patients with relapse (52.6%) than in patients in remission (25.9%) (p=0.031). CONCLUSION: Our results showed that ANA positivity in MS disease is not rare. This positivity was not associated with clinical expression of any connective tissue disease. ANA occurrence in MS was associated with IgG OCB+ profile and relapsing status, probably reflecting an ongoing immune dysregulation.

Periodic chemical cleaning with urea: disintegration of biofilms and reduction of key biofilm-forming bacteria from reverse osmosis membranes.

Biofouling is one of the major factors causing decline in membrane performance in reverse osmosis (RO) plants, and perhaps the biggest hurdle of membrane technology. Chemical cleaning is periodically carried out at RO membrane installations aiming to restore membrane performance. Typical cleaning agents used in the water treatment industry include sodium hydroxide (NaOH) and hydrochloric acid (HCl) in sequence. Rapid biofilm regrowth and related membrane performance decline after conventional chemical cleaning is a routinely observed phenomenon due to the inefficient removal of biomass from membrane modules. Since extracellular polymeric substances (EPS) make up the strongest and predominant structural framework of biofilms, disintegration of the EPS matrix should be the main target for enhanced biomass removal. Previously, we demonstrated at lab-scale the use of concentrated urea as a chemical cleaning agent for RO membrane systems. The protein denaturation property of urea was exploited to solubilize the proteinaceous foulants, weakening the EPS layer, resulting in enhanced biomass solubilization and removal from RO membrane systems. In this work, we investigated the impact of repeated chemical cleaning cycles with urea/HCl as well as NaOH/HCl on biomass removal and the potential adaptation of the biofilm microbial community. Chemical cleaning with urea/HCl was consistently more effective than NaOH/HCl cleaning over 6 cleaning and regrowth cycles. At the end of the 6 cleaning cycles, the percent reduction was 35% and 41% in feed channel pressure drop, 50% and 70% in total organic carbon, 30% and 40% in EPS proteins, and 40% and 66% in the peak intensities of protein-like matter, after NaOH/HCl cleaning and Urea/HCl cleaning, respectively. 16S ribosomal RNA (rRNA) gene sequencing of the biofilm microbial community revealed that urea cleaning does not select for key biofouling families such as Sphingomonadaceae and Xanthomonadaceae that are known to survive conventional chemical cleaning and produce adhesive EPS. This study reaffirmed that urea possesses all the desirable properties of a chemical cleaning agent, i.e., it dissolves the existing fouling layer, delays fresh fouling accumulation by inhibiting the production of a more viscous EPS, does not cause damage to the membranes, is chemically stable, and environmentally friendly as it can be recycled for cleaning.

Plasma mirror focal spot quality for glass and aluminum mirrors for laser pulses up to 20 ps.

High-intensity short-pulse lasers are being pushed further as applications continue to demand higher laser intensities. Uses such as radiography and laser-driven particle acceleration require these higher intensities to produce the necessary x-ray and particle fluxes. Achieving these intensities, however, is limited by the damage threshold of costly optics and the complexity of target chambers. This is evidenced by the Advanced Radiographic Capability (ARC) short-pulse laser at the National Ignition Facility (NIF) at the Lawrence Livermore National Laboratory, producing four high-energy $ \approx 1\;{\rm kJ} $≈1kJ laser pulses at 30 ps pulse duration, being limited to an intensity of $ {10^{18}}\;{\rm W}/{{\rm cm}^2} $1018W/cm2 by the large focal spot size of $ \approx 100\;{\unicode{x00B5}{\rm m}} $≈100µm. Due to the setup complexity of NIF, changing the location of the final focusing parabola in order to improve the focal spot size is not an option. This leads to the possible use of disposable ellipsoidal plasma mirrors (PMs) placed within the chamber, close to the target in an attempt to refocus the four ARC beams. However, the behavior of PMs at these relatively long pulse durations (tens of picoseconds) is not well characterized. The results from the COMET laser at the Jupiter Laser Facility carried out at 0.5 to 20 ps pulse durations on flat mirrors are presented as a necessary first step towards focusing curved mirrors. The findings show defocusing at longer pulse durations and higher intensities, with less degradation when using aluminum coated mirrors.

Neuromyelitis optica spectrum disorders in South of Tunisia: A rare entity with low seroprevalence of anti-aquaporin 4 autoantibodies.

INTRODUCTION: Screening for anti-aquaporin 4 (anti-AQP4) antibodies, a specific marker of neuromyelitis optica spectrum disorders (NMOSD), is part of the immunological investigation performed in a context of central nervous system (CNS) inflammation with optic neuritis and/or myelitis. The aim of our study was to evaluate the prevalence and the diagnostic value of anti-AQP4 antibodies in Tunisian patients with such inflammatory neurological conditions. METHODS: During 3years, 170 consecutive serum samples of Tunisian patients with CNS inflammatory disorders and optico-spinal involvement were tested in our laboratory for anti-AQP4 antibodies using indirect immunofluorescence on transfected cells. RESULTS: The global seroprevalence of anti-AQP4 in our study was 4.1% (7 cases/170). The diagnosis of NMOSD was made for the 7 seropositive patients and for 2 seronegative patients, which leads to a seroprevalence of 77.7% in our NMOSD subgroup. The detection of anti-AQP4 allowed the diagnosis of NMOSD in 4 patients with incomplete clinical presentation and 5 patients with positive antinuclear antibodies. In one case, seropositivity was detected in a second sample, one year after an initial seronegativity. CONCLUSION: NMOSD seem to represent a rare etiology of optic neuritis and/or myelitis in Tunisian patients. Despite its low global seroprevalence in our study population, anti-AQP4 appears to be a very clinically relevant marker for NMOSD diagnosis. Repeating the screening in case of initial negativity could be interesting in clinical practice.

Heat-release equation of state and thermal conductivity of warm dense carbon by proton differential heating.

Warm dense carbon is generated at 0.3-2.0 g/cc and 1-7 eV by proton heating. The release equation of state (EOS) after heating and thermal conductivity of warm dense carbon are studied experimentally in this regime using a Au/C dual-layer target to initiate a temperature gradient and two picosecond time-resolved diagnostics to probe the surface expansion and heat flow. Comparison between the data and simulations using various EOSs and thermal conductivity models is quantified with a statistical χ^{2} analysis. Out of seven EOS tables and five thermal conductivity models, only L9061 with the Lee-More model provides a probability above 50% to match all data.

Ionization injection of highly-charged copper ions for laser driven acceleration from ultra-thin foils.

Laser-driven ion acceleration is often analyzed assuming that ionization reaches a steady state early in the interaction of the laser pulse with the target. This assumption breaks down for materials of high atomic number for which the ionization occurs concurrently with the acceleration process. Using particle-in-cell simulations, we have examined acceleration and simultaneous field ionization of copper ions in ultra-thin targets (20-150 nm thick) irradiated by a laser pulse with intensity 1 × 1021 W/cm2. At this intensity, the laser pulse drives strong electric fields at the rear side of the target that can ionize Cu to charge states with valence L-shell or full K-shell. The highly-charged ions are produced only in a very localized region due to a significant gap between the M- and L-shells' ionization potentials and can be accelerated by strong, forward-directed sections of the field. Such an "ionization injection" leads to well-pronounced bunches of energetic, highly-charged ions. We also find that for the thinnest target (20 nm) a push by the laser further increases the ion energy gain. Thus, the field ionization, concurrent with the acceleration, offers a promising mechanism for the production of energetic, high-charge ion bunches.

Role of feed water biodegradable substrate concentration on biofouling: Biofilm characteristics, membrane performance and cleanability.

Biofouling severely impacts operational performance of membrane systems increasing the cost of water production. Understanding the effect of critical parameters of feed water such as biodegradable substrate concentration on the developed biofilm characteristics enables development of more effective biofouling control strategies. In this study, the effect of substrate concentration on the biofilm characteristics was examined using membrane fouling simulators (MFSs). A feed channel pressure drop (PD) increase of 200 mbar was used as a benchmark to study the developed biofilm. The amount and characteristics of the formed biofilm were analysed in relation to membrane performance indicators: feed channel pressure drop and permeate flux. The effect of the characteristics of the biofilm developed at three substrate concentrations on the removal efficiency of the different biofilms was evaluated applying acid/base cleaning. Results showed that a higher feed water substrate concentration caused a higher biomass amount, a faster PD increase, but a lower permeate flux decline. The permeate flux decline was affected by the spatial location and the physical characteristics of the biofilm rather than the total amount of biofilm. The slower growing biofilm developed at the lowest substrate concentration was harder to remove by NaOH/HCl cleanings than the biofilm developed at the higher substrate concentrations. Effective biofilm removal is essential to prevent a fast biofilm regrowth after cleaning. While substrate limitation is a generally accepted biofouling control strategy delaying biofouling, development of advanced cleaning methods to remove biofilms formed under substrate limited conditions is of paramount importance.

Enhanced biofilm solubilization by urea in reverse osmosis membrane systems.

Chemical cleaning is routinely performed in reverse osmosis (RO) plants for the regeneration of RO membranes that suffer from biofouling problems. The potential of urea as a chaotropic agent to enhance the solubilization of biofilm proteins has been reported briefly in the literature. In this paper the efficiency of urea cleaning for RO membrane systems has been compared to conventionally applied acid/alkali treatment. Preliminary assessment confirmed that urea did not damage the RO polyamide membranes and that the membrane cleaning efficiency increased with increasing concentrations of urea and temperature. Accelerated biofilm formation was carried out in membrane fouling simulators which were subsequently cleaned with (i) 0.01M sodium hydroxide (NaOH) and 0.1M hydrochloric acid (HCl) (typically applied in industry), (ii) urea (CO(NH2)2) and hydrochloric acid, or (iii) urea only (1340 g/Lwater). The pressure drop over the flow channel was used to evaluate the efficiency of the applied chemical cleanings. Biomass removal was evaluated by measuring chemical oxygen demand (COD), adenosine triphosphate (ATP), protein, and carbohydrate content from the membrane and spacer surfaces after cleaning. In addition to protein and carbohydrate quantification of the extracellular polymeric substances (EPS), fluorescence excitation-emission matrix (FEEM) spectroscopy was used to distinguish the difference in organic matter of the remaining biomass to assess biofilm solubilization efficacy of the different cleaning agents. Results indicated that two-stage CO(NH2)2/HCl cleaning was as effective as cleaning with NaOH/HCl in terms of restoring the feed channel pressure drop (>70% pressure drop decrease). One-stage cleaning with urea only was not as effective indicating the importance of the second-stage low pH acid cleaning in weakening the biofilm matrix. All three chemical cleaning protocols were equally effective in reducing the concentration of predominant EPS components protein and carbohydrate (>50% reduction in concentrations). However, urea-based cleaning strategies were more effective in solubilizing protein-like matter and tyrosine-containing proteins. Furthermore, ATP measurements showed that biomass inactivation was up to two-fold greater after treatment with urea-based chemical cleanings compared to the conventional acid/alkali treatment. The applicability of urea as an alternative, economical, eco-friendly and effective chemical cleaning agent for the control of biological fouling was successfully demonstrated.

Sulla carnosa modulates root invertase activity in response to the inhibition of long-distance sucrose transport under magnesium deficiency.

Being the principal product of photosynthesis, sucrose is involved in many metabolic processes in plants. As magnesium (Mg) is phloem mobile, an inverse relationship between Mg shortage and sugar accumulation in leaves is often observed. Mg deficiency effects on carbohydrate contents and invertase activities were determined in Sulla carnosa Desf. Plants were grown hydroponically at different Mg concentrations (0.00, 0.01, 0.05 and 1.50 mM Mg) for one month. Mineral analysis showed that Mg contents were drastically diminished in shoots and roots mainly at 0.01 and 0.00 mM Mg. This decline was adversely associated with a significant increase of sucrose, fructose and mainly glucose in shoots of plants exposed to severe deficiency. By contrast, sugar contents were severely reduced in roots of these plants indicating an alteration of carbohydrate partitioning between shoots and roots of Mg-deficient plants. Cell wall invertase activity was highly enhanced in roots of Mg-deficient plants, while the vacuolar invertase activity was reduced at 0.00 mM Mg. This decrease of vacuolar invertase activity may indicate the sensibility of roots to Mg starvation resulting from sucrose transport inhibition. 14 CO2 labeling experiments were in accordance with these findings showing an inhibition of sucrose transport from source leaves to sink tissues (roots) under Mg depletion. The obtained results confirm previous findings about Mg involvement in photosynthate loading into phloem and add new insights into mechanisms evolved by S. carnosa to cope with Mg shortage in particular the increase of the activity of cell wall invertase.

Effect of water temperature on biofouling development in reverse osmosis membrane systems.

Understanding the factors that determine the spatial and temporal biofilm development is a key to formulate effective control strategies in reverse osmosis membrane systems for desalination and wastewater reuse. In this study, biofilm development was investigated at different water temperatures (10, 20, and 30 °C) inside a membrane fouling simulator (MFS) flow cell. The MFS studies were done at the same crossflow velocity with the same type of membrane and spacer materials, and the same feed water type and nutrient concentration, differing only in water temperature. Spatially resolved biofilm parameters such as oxygen decrease rate, biovolume, biofilm spatial distribution, thickness and composition were measured using in-situ imaging techniques. Pressure drop (PD) increase in time was used as a benchmark as to when to stop the experiments. Biofilm measurements were performed daily, and experiments were stopped once the average PD increased to 40 mbar/cm. The results of the biofouling study showed that with increasing feed water temperature (i) the biofilm activity developed faster, (ii) the pressure drop increased faster, while (iii) the biofilm thickness decreased. At an average pressure drop increase of 40 mbar/cm over the MFS for the different feed water temperatures, different biofilm activities, structures, and quantities were found, indicating that diagnosis of biofouling of membranes operated at different or varying (seasonal) feed water temperatures may be challenging. Membrane installations with a high temperature feed water are more susceptible to biofouling than installations fed with low temperature feed water.

Morphometric Study of Nutrient Foramen in Adult Human Dry Left Humerus.

The major blood supply to long bones occurs through the nutrient arteries, which enter through the nutrient foramen. The supply of nutrient artery starts during the early phases of ossification. It is essential in operative procedures such as bone graft, tumour resection, trauma healing and bone transplant techniques both in orthopedics and micro vascular surgery. The present study is an observational analytic type of study which was performed on two hundred (n=200; male=117 & female=83) left sided dry humerus bones. In this present study the majority of the bones had a single nutrient foramen which may represent a single source of blood supply. The location of the nutrient foramen is predominant on the antero-medial aspect of humerus. The position of the nutrient foramen is predominant on the middle 1/5th of the shaft humerus. There was no significant difference (p=0.319) in presence, absence, number, location and position of nutrient foramen in male and female left human humerus. This study and recorded data may help in surgical procedures in orthopedics and in micro vascular surgery.

[Marfan syndrome in childhood and adolescence]. / Le syndrome de Marfan chez l'enfant et l'adolescent : cas clinique.

The Marfan syndrome is a systemic connective tissue disorder with autosomal dominant inheritance. A mutation of the fibrillin-1 gene, a glycoprotein which is the main constituent of the extracellular matrix, is the cause of the disease. The cardinal features involve the skeletal, ocular and cardiovascular systems. The expression of the Marfan syndrome varies from the severe neonatal presentation to the classical manifestations of the child and young adult, but also comprises isolated features. In children, phenotypical manifestations are age dependent. For these reasons, the diagnosis of Marfan syndrome might be lately revealed by its cardiovascular complications. We report the case of 2 siblings: it illustrates the phenotypic variability that might be observed in a same family, the phenotype evolution with age and the diagnosis challenge in childhood.

Le syndrome de Marfan est une maladie systémique du tissu conjonctif qui se transmet de façon autosomale dominante. Elle est due à une mutation du gène codant pour la fibrilline-1, une glycoprotéine, constituant principal des microfibrilles de la matrice extra-cellullaire. La maladie touche principalement le squelette, les yeux et le système cardiovasculaire. Son expression phénotypique est variable avec des formes néonatales sévères, un tableau classique chez l'enfant ou le jeune adulte ou des lésions isolées d'un seul organe. Chez l'enfant, le phénotype évolue avec l'âge. Ainsi, le syndrome de Marfan peut n'être reconnu que tardivement, par exemple à l'occasion de manifestations de ses complications cardiovasculaires. Le cas d'un adolescent et de sa jeune sœur que nous rapportons ici illustre la variabilité phénotypique au sein d'une même famille, l'évolution des manifestations cliniques et la difficulté diagnostique chez l'enfant.