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

ECG Signal Reconstruction on the IoT-Gateway and Efficacy of Compressive Sensing Under Real-time Constraints

Remote health monitoring is becoming indispensable, though, Internet of Things (IoTs)-based solutions have many implementation challenges, including energy consumption at the sensing node, and delay and instability due to cloud computing. Compressive sensing (CS) has been explored as a method to extend the battery lifetime of medical wearable devices. However, it is usually associated with computational complexity at the decoding end, increasing the latency of the system. Meanwhile, mobile processors are becoming computationally stronger and more efficient. Heterogeneous multicore platforms (HMPs) offer a local processing solution that can alleviate the limitations of remote signal processing. This paper demonstrates the real-time performance of compressed ECG reconstruction on ARM's big.LITTLE HMP and the advantages they provide as the primary processing unit of the IoT architecture. It also investigates the efficacy of CS in minimizing power consumption of a wearable device under real-time and hardware constraints. Results show that both the orthogonal matching pursuit and subspace pursuit reconstruction algorithms can be executed on the platform in real time and yield optimum performance on a single A15 core at minimum frequency. The CS extends the battery life of wearable medical devices up to 15.4% considering ECGs suitable for wellness applications and up to 6.6% for clinical grade ECGs. Energy consumption at the gateway is largely due to an active internet connection; hence, processing the signals locally both mitigates system's latency and improves gateway's battery life. Many remote health solutions can benefit from an architecture centered around the use of HMPs, a step toward better remote health monitoring systems.Peer reviewedFinal Published versio

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

Herpes Simplex Virus Type 2 Seroprevalence among Different National Populations of Middle East and North African Men

© 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Sexually Transmitted Diseases Association. Background There are limited data on herpes simplex virus type 2 (HSV-2) seroprevalence in the Middle East and North Africa (MENA). We examined country- and age-specific HSV-2 seroprevalence among select MENA populations residing in Qatar. Methods Sera were collected from male blood donors attending Hamad Medical Corporation between June 2013 and June 2016. Specimens were screened for anti-HSV-2 IgG antibodies following a 2-test algorithm: HerpeSelect 2 ELISA was used to identify HSV-2-positive specimens, and Euroline-WB was used to confirm positive and equivocal specimens for final HSV-2 status. Trends and associations with HSV-2 seropositivity were assessed. Results Of the 2077 tested sera, 61 were found and confirmed positive. The proportion of those confirmed positive increased steadily with HerpeSelect 2 ELISA index value, ranging from 16.3% for index values of 1.101 to 1.999 to 92.9% for index values of 4 or greater. Nationality-specific seroprevalence was 6.0% (95% confidence interval [CI], 4.1%-8.8%) in Qataris, 5.3% (95% CI, 2.5%-11.1%) in Iranians, 4.2% (95% CI, 1.8%-9.5%) in Lebanese, 3.1% (95% CI, 1.2%-7.7%) in Sudanese, 3.0% (95% CI, 1.4%-6.4%) in Palestinians, 2.2% (95% CI, 1.1%-4.3%) in Egyptians, 2.0% (95% CI, 1.0%-5.0%) in Syrians, 1.0% (95% CI, 0.3%-3.6%) in Jordanians, 0.7% (95% CI, 0.1%-3.7%) in Yemenis, and 0.5% (95% CI, 0.1%-2.8%) in Pakistanis. There was evidence for higher seroprevalence in older age groups. Conclusions The seroprevalence of HSV-2 was in the range of few percentage points. There were no major differences in seroprevalence by nationality. These findings add to our understanding of HSV-2 epidemiology in MENA and indicate unmet needs for sexual health and control of sexually transmitted infections.Funding text #1 From the *Infectious Disease Epidemiology Group, Weill Cornell Medicine—Qatar, Cornell University, Qatar Foundation—Education City; †Department of Biomedical Science, College of Health Sciences, and ‡BioMedical Research Center, Qatar University, Doha, Qatar; and §Department of Healthcare Policy and Research, Weill Cornell Medi-cine, Cornell University, Ithaca, NY Acknowledgments: The authors gratefully acknowledge the administrative support of Ms Adona Canlas. They are also grateful to Dr Asmaa Al-Marwani, Ms Maria Samatti, and Ms Sana Abohasera for their work on blood specimen collection. The authors are further grateful for sup-port provided by the Biostatistics, Epidemiology, and Biomathematics Research Core at Weill Cornell Medicine—Qatar. Funding text #2 Funding: Testing kits were provided through pilot funding by the Biomedical Research Program at Weill Cornell Medicine—Qatar. Funding text #3 G.K.N. acknowledges support by Qatar University internal grant No. QUST-CHS-SPR-15/16-7. L.J.A. and S.R.D. acknowledge study conception and design support through NPRP grant number 9-040-3-008 from the Qatar National Research Fund (a member of Qatar Foundation), and G.K.N. acknowledges support from the Qatar National Research Fund UREP grant number UREP18-001-3-001. The findings achieved herein are solely the responsibility of the authors

Revolutionizing ECMO simulation with affordable yet high-Fidelity technology

This document is the Accepted Manuscript version of the following article: Mohammed Al Disi, Abdullah Alsalemi, Yahya Alhomsi, Fayçal Bensaali, Abbes Amira, and Guillaume Alinier, ‘Revolutionizing ECMO simulation with affordable yet high-Fidelity technology’, The American Journal of Emergency Medicine, Vol. 36 (7): 1310-1312, July 2018. Under embargo until 15 November 2018. The final, definitive version is available online via doi: https://doi.org/10.1016/j.ajem.2017.11.036.Simulation-based training (SBT) is becoming a necessity in educating healthcare professionals who work in high-risk environments, such as the intensive care unit (ICU). This applies to extracorporeal membrane oxygenation (ECMO), a complication-burdened life support ICU modality employed to treat patients with circulatory and/or respiratory failure. Additionally, ECMO can quickly restore perfusion, and hence, used in the pre-hospital or emergency setting as an extracorporeal cardiopulmonary resuscitation (E-CPR) strategy or to maintain donors’ organs after circulatory death. Different ECMO simulation models have been reported in the literature. It ranges from simple mannequin and circuit modification with manual control, to hydraulically capable, remotely controlled mannequins, and high-fidelity simulators. However, the common factor in the incumbent practices is the reliance on a functioning ECMO console and circuit components, which introduces a colossal cost barrier and requires active spending to replace ECMO consumables. Reliance of such specialized and potentially scarce pieces of equipment also significantly reduces training opportunities. Furthermore, attempts to improve the simulation paradigm are faced with ever-increasing technical difficulties. For example, basic objectives such as controlling the displayed circuit pressures requires creating a sophisticated hydraulic model. It becomes even more problematic when considering higher level objectives such as simulating blood oxygenation color differentials, or remotely controlling blood gas parameters, displayed on in-line monitors. Hence, there is a need for lower cost, high-fidelity simulation systems with more customization capabilities that meet the expectations and increasing demand for ECMO therapy.Peer reviewedFinal Accepted Versio

CouchDB Based Real-Time Wireless Communication System for Clinical Simulation

Medical simulators are advancing in technology and complexity to enhance realism and hence implementing a real-time communication system for such simulators is a challenge that engineers face. This paper follows up on the Firebase communication system solution that was employed for the modular extracorporeal membrane oxygenation (ECMO) simulator and addresses its challenges and limitations by presenting an alternative CouchDB based communication system. Testing results shows that CouchDB overcomes Firebase limitations in terms of latency, compatibility, and ongoing maintenance costs. The new approach features automatic application program interfaces (APIs), extremely low latency, and long term reliability.This paper was supported by Qatar university Internal Grant No. QUCG-CENG-2018-1. The findings achieved herein are solely the responsibility of the authors.Scopu

P3. 210 Estimating the antibody prevalence of herpes simplex virus type 2 among select middle east and north africa populations

Introduction There are very limited data on herpes simplex virus type 2 (HSV-2) infection in the Middle East and North Africa (MENA). We examined the overall and age-specific HSV-2 antibody prevalence among select MENA populations currently residing in Qatar. Methods Sera were collected from blood donors attending Hamad Medical Corporation June 2013–2015. Specimens were screened for HSV-2 antibodies using HerpeSelect 2 ELISA IgG kits. All positive and equivocal specimens detecting presence of HSV-2 antibodies were retested for final HSV-2 status using Euroline Westernblot assays. Demographic information included nationality, age, and sex. Age was grouped into 8 bands:≤24, 25–29, 30–34, 35–39, 40–44, 45–49, 50–54, and ≥55. Age-specific trend of HSV-2 infection among Egyptian, Fertile Crescent (Iraq, Jordan, Lebanon, Palestine, and Syria) and Qatari nationals was described and assessed using the Cochran–Armitage test. Results Sera from 2165 blood donors were tested for HSV-2. Among 132 retested specimens, 66 were confirmed positive. Country-specific HSV-2 prevalence was measured at 5.5% (95% confidence interval (CI) 3.7%–8.2%) for Qataris, 4.5% (95%CI 1.9%–10.0%) for Iranians, 4.2% (95%CI 1.8%–9.5%) for Lebanese, 3.1% (95%CI 1.2%–7.7%) for Sudanese, 3.0% (95%CI 1.4%–6.4%) for Palestinians, 2.2% (95%CI 1.1%–4.3%) for Egyptians, 2.0% (95%CI 1.0%–5.0%) for Syrians, 1.0% (95%CI 0.3%–3.6%) for Jordanians, 0.7% (95%CI 0.1%–3.7%) for Yemenis, and 0.5% (95%CI 0.1%–2.8%) for Pakistanis. Age-specific HSV-2 prevalence was estimated for Egyptians, nationals of the Fertile Crescent, and Qataris. Overall, HSV-2 prevalence increased with age, but the trend was not always statistically significant in these populations. HSV-2 prevalence was significantly higher for females at 9.1% (95%CI 4.7%–16.9%) than males at 2.8% (95%CI 2.2%–3.6%) (χ2p-value<0.01). Conclusion HSV-2 prevalence among MENA nationals was found to be lower than that commonly found in other regions. However, these observed prevalence levels suggest unmet needs for sexual health and control of sexually transmitted infections (STIs) transmission. Programs need to be established to tackle STIs and their disease burden in this region