Enhancing Clinical Learning Through an Innovative Instructor Application for ECMO Patient Simulators

© 2018 The Authors. Reprinted by permission of SAGE PublicationsBackground. Simulation-based learning (SBL) employs the synergy between technology and people to immerse learners in highly-realistic situations in order to achieve quality clinical education. Due to the ever-increasing popularity of extracorporeal membrane oxygenation (ECMO) SBL, there is a pressing need for a proper technological infrastructure that enables high-fidelity simulation to better train ECMO specialists to deal with related emergencies. In this article, we tackle the control aspect of the infrastructure by presenting and evaluating an innovative cloud-based instructor, simulator controller, and simulation operations specialist application that enables real-time remote control of fullscale immersive ECMO simulation experiences for ECMO specialists as well as creating custom simulation scenarios for standardized training of individual healthcare professionals or clinical teams. Aim. This article evaluates the intuitiveness, responsiveness, and convenience of the ECMO instructor application as a viable ECMO simulator control interface. Method. A questionnaire-based usability study was conducted following institutional ethical approval. Nineteen ECMO practitioners were given a live demonstration of the instructor application in the context of an ECMO simulator demonstration during which they also had the opportunity to interact with it. Participants then filled in a questionnaire to evaluate the ECMO instructor application as per intuitiveness, responsiveness, and convenience. Results. The collected feedback data confirmed that the presented application has an intuitive, responsive, and convenient ECMO simulator control interface. Conclusion. The present study provided evidence signifying that the ECMO instructor application is a viable ECMO simulator control interface. Next steps will comprise a pilot study evaluating the educational efficacy of the instructor application in the clinical context with further technical enhancements as per participants’ feedback.Peer reviewedFinal Accepted Versio

Economic and Social Impact of Globalisation of the Developing Countries

The objectives of the study are set to guide the investigation process and sharpen the focus on the problem. To develop the research, a method would be used to carry out the study focusing on the globalisation and the problem of poverty. In this connection, a simple model using Human Development Indexes will be used to highlight the case studies of Egypt and Jordan. This method will reflect the inter-relationship between development and growth. Indicators of Human poverty including variables such as percentage of adult illiteracy rate, life expectancy, external debt services payments and external trade are used. Following this chapter the second chapter reviews the literature relevant to the area of the study. The beginning of this chapter highlights the different views on globalisation. The chapter also investigates the relationship between globalisation and development. Though the chapter introduces the literature from a general perspective view, taking example from the scenes of world development, the sharp focus on the problem comes with the literature reviewing economic problems of developing countries. The third chapter focuses on the methodology and models. This chapter highlights the relationship between globalisation, development and poverty through variables that have strong effect on development and poverty reduction such as income growth, development and poverty. Chapter four will focus on the present and expected image of poverty in the era of globalisation. This will enable the author to review the state of poverty in the world with closer focus on the developing countries. Finally, the last chapter will focus on the Arab countries as part of the developing world in general and cases of Egypt and Jordan in particular. Then, will draw conclusion and lessons learned and suggest some recommendations for the developing countries with emphasis on Arab countries, wherever it is necessary, in finding ways to deal with such situation

The impact of board characteristics on firm performance: Evidence from nonfinancial listed companies in Kuwaiti Stock Exchange

The core aim of this study is to examine the relationship between board characteristics and the firm performance of non-financial listed Kuwaiti firms.To achieve the objectives of the study, the data were collected from a sample of 136 companies for the financial year 2009.Variables such as CEO duality, COE tenure, audit committee size, board size and board composition were considered as predictors of the firm performance that was measured employing the return on assets (ROA).By contrast, the effects of CEO tenure and leverage on firm performance were found to be negative and significant at the chosen level of significance.To test the hypotheses of the study, multiple linear regression analysis using SPSS 18.0 was utilized.Using the firm size and leverage as a control variable, the findings of the study support the positive effects of CEO duality and audit committee size on ROA.Other findings of the study were discussed in the discussion section and some other future study directions were provided

Extracorporeal membrane oxygenation simulation-based training: methods, drawbacks and a novel solution

Introduction: Patients under the error-prone and complication-burdened extracorporeal membrane oxygenation (ECMO) are looked after by a highly trained, multidisciplinary team. Simulation-based training (SBT) affords ECMO centers the opportunity to equip practitioners with the technical dexterity required to manage emergencies. The aim of this article is to review ECMO SBT activities and technology followed by a novel solution to current challenges. ECMO simulation: The commonly-used simulation approach is easy-to-build as it requires a functioning ECMO machine and an altered circuit. Complications are simulated through manual circuit manipulations. However, scenario diversity is limited and often lacks physiological and/or mechanical authenticity. It is also expensive to continuously operate due to the consumption of highly specialized equipment. Technological aid: Commercial extensions can be added to enable remote control and to automate circuit manipulation, but do not improve on the realism or cost-effectiveness. A modular ECMO simulator: To address those drawbacks, we are developing a standalone modular ECMO simulator that employs affordable technology for high-fidelity simulation.Peer reviewe

Addressing the challenges of ECMO simulation

This document is the Accepted Manuscript. The final, definitive version of this paper has been published in Perfusion, May 2018, published by SAGE Publishing, All rights reserved.Introduction/Aim: The patient’s condition and high-risk nature of extracorporeal membrane oxygenation (ECMO) therapy force clinical services to ensure clinicians are properly trained and always ready to deal effectively with critical situations. Simulation-based education (SBE), from the simplest approaches to the most immersive modalities, helps promote optimum individual and team performance. The risks of SBE are negative learning, inauthenticity in learning and over-reliance on the participants’ suspension of disbelief. This is especially relevant to ECMO SBE as circuit/patient interactions are difficult to fully simulate without confusing circuit alterations. Methods: Our efforts concentrate on making ECMO simulation easier and more realistic in order to reduce the current gap there is between SBE and real ECMO patient care. Issues to be overcome include controlling the circuit pressures, system failures, patient issues, blood colour and cost factors. Key to our developments are the hospital-university collaboration and research funding. Results: A prototype ECMO simulator has been developed that allows for realistic ECMO SBE. The system emulates the ECMO machine interface with remotely controllable pressure parameters, haemorrhaging, line chattering, air bubble noise and simulated blood colour change. Conclusion: The prototype simulator allows the simulation of common ECMO emergencies through innovative solutions that enhance the fidelity of ECMO SBE and reduce the requirement for suspension of disbelief from participants. Future developments will encompass the patient cannulation aspect.Peer reviewe

Influence of supervisor, self-efficacy, learning style and intention to transfer training effectiveness among universities in Saudi Arabia

The role of training for the improvement of employees' skills and knowledge has long been acknowledged. Employees who are exposed to effective training generally possess the technical knowledge, skills and attitudes to carry out their tasks. In Saudi Arabia, the government has been investing generously in training so as to enhance the employees‘ knowledge and skills. However, the present human capital, particularly in the tertiary institutions, falls way below expectations. The theoretical framework of this study was developed based on past research and the underpinning theory of planned behavior and social learning. This study examined the direct and indirect relationship between self-efficacy, learning style and supervisor support on intention to transfer training and training effectiveness among the managerial staff of the universities in Saudi Arabia. A total of 364 managerial staff representing six public universities in Saudi Arabia participated in the study by completing the survey questionnaire. The Partial Least Squares (PLS-SEM) approach was utilized to test the hypotheses. The results for the direct relationships between the independent variables (self-efficacy, learning style, supervisor support) and the dependent variable (training effectiveness) show that only learning style directly influences training effectiveness. At the same time, it was found that all the independent variables significantly influence the mediator, that is, intention to transfer training. Regarding the indirect relations between the independent variables and the dependent variable when the mediating variable was incorporated into the relationship, it was found that intention to transfer training partially mediated the relationship between learning style and training effectiveness but not self-efficacy and supervisor support. The theoretical contributions, policy implications, limitations of the study and suggestions for future research were discussed as well

The effect of board of directors and audit committee characteristics on firm performance : evidence from Malaysia

Corporate governance issues are under the attention of the researchers for over three decades due to the increasing global economic crisis. Hence, this study attempts to contribute towards literature by investigating relationships of corporate governance and firm performance in Malaysia as a developing country. In particular, the study investigates the relationship between the board of director’s characteristics and the audit committee characteristics and the performance of non-financial listed companies (excluding financial companies) in Malaysia for the two years (2014 and 2015). The model of this study is theoretically based on the agency theory. To examine the conceptual model, the required data were gathered from the annual reports of top 100 non-financial listed firms in Malaysia. In analyzing the data, this study utilized the liner multiple regression by taking the sample of 100 companies with 200 observations in order analyze the relationship between board of director’s characteristics and the audit committee characteristics and the performance (ROA and Tobin`s Q). Moreover, this study used firm size and leverage as control variables. Based on the liner multiple regression results that was used to examine the effect of the predictors of the firm performance measured by Return on Assets (ROA) and Tobin-Q. The statistical results showed that board size and foreigner board members were a positive determinant of Tobin-Q. While, the government link of board members was negative determinants of Tobin-Q. On the other hand, the government liking of the board and the audit committee meeting were negative predictors of ROA. While, the board size was a positive predictor of ROA. Besides providing suggestions for future research directions, this study also provides several recommendations for regulators, companies, stakeholders and in particular, the shareholders

Design And Analysis Of Single Balanced Diode Mixer For UWB Applications

In wireless communication systems,the development of ultra-wideband (UWB) Radio Frequency (RF) front-end sub-components (e.g. amplifiers,filters,switches,antennas and mixers) are highly desired,and they were developed to support several RF front-end systems.The main function of the RF mixer is frequency conversion,where the low conversion loss is one of the key parameters in RF mixer design.Mixer also act as critical components in modern RF and Microwave systems.The unique of the mixer is it can convert RF power from one frequency into another frequency.There are various forms of RF mixer designs which can be used to obtain a good conversion loss and good isolation where these mixer designs have trade off in performance and complexity.Hence,this research proposes an UWB Single Balanced Schottky diode mixer design using Coupled Line and Branch Line baluns for applications of ultra-wideband in 3 to 10 GHz frequency range.Basically,an UWB Single Balanced Schottky diode mixer was designed using two different baluns (Coupled Line and Branch Line).The usage of these two baluns aims to improve the bandwidth and producing a good performance in simple and inexpensive way.The used baluns are determined using a simple mathematical model where it can be combined from different multi sections of Coupled Line and Branch Line to achieve the desired bandwidth.The key advantage of the proposed UWB Single Balanced diode mixer with Coupled Line and Branch Line baluns is a wider bandwidth with low conversion loss and high isolation. Besides,low cost and small size as these mixers was designed in microstrip transmission line.As a result,the simulated and measured results showed conversion loss less than 19 dB and isolation of 50 dB over the frequencies between 3 to 10 GHz.Despite low conversion loss and high isolation performance, the proposed Single Balanced diode mixer (with Coupled Line and Branch Line baluns) used only two Schottky diodes compared to Double Balanced diode mixer to achieve good performance over UWB applications