A Comparison of Homemade Phantoms for Ultrasound Guided Peripheral Intravenous Catheter Insertion

Purpose: Ultrasound (U/S) guided peripheral intravenous catheter (PIV) placement is implemented in clinical settings across the medical field, with evidence supporting the use of point-of-care U/S as a procedural tool to improve patient outcomes. Non-commercial vascular access phantoms made of various materials have been described in published literature and online tutorials; however, there has been no comparison of the models. The primary objective of this study is to determine if non-commercial phantoms are useful for the education of U/S guided PIV placement. Methods: This prospective observational study trialed six unique phantom models: 1) the Amini ballistics gel model, 2) the Morrow ballistics gel model, 3) the University of California San Diego (UCSD) gelatin model, 4) the Rippey chicken model, 5) the Nolting spam model, 6) and the Johnson tofu model. Selected phantoms were assembled through instructions from the source reference. Six U/S fellowship trained Emergency Medicine physicians performed U/S guided PIV placement on each model to evaluate their effectiveness pertaining to phantom haptics, echogenicity properties, and utility for PIV practice. Results/ Conclusion: The Rippey model outperformed other models in this study, doing so with a mid-level cost and minimal preparation time. The Rippey model scored highest on aggregate scores pertaining to haptics, echogenicity, and utility for U/S guided PIV placement and comparability to commercial products. Non-commercial U/S phantoms may represent cost-effective and useful PIV insertion educational tools. Future studies should investigate the utility of these phantoms in teaching USIV to novice learners and direct comparison of non-commercial to commercial phantoms

Expert-quality Dataset Labeling via Gamified Crowdsourcing on Point-of-Care Lung Ultrasound Data

data interpretation. Building such tools requires labeled training datasets. We tested whether a gamified crowdsourcing approach can produce clinical expert-quality lung ultrasound clip labels. 2,384 lung ultrasound clips were retrospectively collected. Six lung ultrasound experts classified 393 of these clips as having no B-lines, one or more discrete B-lines, or confluent B-lines to create two sets of reference standard labels: a training and test set. Sets trained users on a gamified crowdsourcing platform, and compared concordance of the resulting crowd labels to the concordance of individual experts to reference standards, respectively. 99,238 crowdsourced opinions were collected from 426 unique users over 8 days. Mean labeling concordance of individual experts relative to the reference standard was 85.0% ± 2.0 (SEM), compared to 87.9% crowdsourced label concordance (p=0.15). Scalable, high-quality labeling approaches such as crowdsourcing may streamline training dataset creation for machine learning model development

Gamified Crowdsourcing as a Novel Approach to Lung Ultrasound Data Set Labeling:Prospective Analysis

Background:Machine learning (ML) models can yield faster and more accurate medical diagnoses; however, developing ML models is limited by a lack of high-quality labeled training data. Crowdsourced labeling is a potential solution but can be constrained by concerns about label quality.Objective:This study aims to examine whether a gamified crowdsourcing platform with continuous performance assessment, user feedback, and performance-based incentives could produce expert-quality labels on medical imaging data.Methods:In this diagnostic comparison study, 2384 lung ultrasound clips were retrospectively collected from 203 emergency department patients. A total of 6 lung ultrasound experts classified 393 of these clips as having no B-lines, one or more discrete B-lines, or confluent B-lines to create 2 sets of reference standard data sets (195 training clips and 198 test clips). Sets were respectively used to (1) train users on a gamified crowdsourcing platform and (2) compare the concordance of the resulting crowd labels to the concordance of individual experts to reference standards. Crowd opinions were sourced from DiagnosUs (Centaur Labs) iOS app users over 8 days, filtered based on past performance, aggregated using majority rule, and analyzed for label concordance compared with a hold-out test set of expert-labeled clips. The primary outcome was comparing the labeling concordance of collated crowd opinions to trained experts in classifying B-lines on lung ultrasound clips.Results:Our clinical data set included patients with a mean age of 60.0 (SD 19.0) years; 105 (51.7%) patients were female and 114 (56.1%) patients were White. Over the 195 training clips, the expert-consensus label distribution was 114 (58%) no B-lines, 56 (29%) discrete B-lines, and 25 (13%) confluent B-lines. Over the 198 test clips, expert-consensus label distribution was 138 (70%) no B-lines, 36 (18%) discrete B-lines, and 24 (12%) confluent B-lines. In total, 99,238 opinions were collected from 426 unique users. On a test set of 198 clips, the mean labeling concordance of individual experts relative to the reference standard was 85.0% (SE 2.0), compared with 87.9% crowdsourced label concordance (P=.15). When individual experts’ opinions were compared with reference standard labels created by majority vote excluding their own opinion, crowd concordance was higher than the mean concordance of individual experts to reference standards (87.4% vs 80.8%, SE 1.6 for expert concordance; P<.001). Clips with discrete B-lines had the most disagreement from both the crowd consensus and individual experts with the expert consensus. Using randomly sampled subsets of crowd opinions, 7 quality-filtered opinions were sufficient to achieve near the maximum crowd concordance.Conclusions:Crowdsourced labels for B-line classification on lung ultrasound clips via a gamified approach achieved expert-level accuracy. This suggests a strategic role for gamified crowdsourcing in efficiently generating labeled image data sets for training ML systems

Organizational and corporate identity revisited: Towards a comprehensive understanding of identity in business

ABSTRACT: Purpose – This paper provides a comprehensive and integrative review of academic literature analyzing identity in business. The literature review proposed by the authors helps clearing up theoretical and practical understanding of this concept. Design/methodology/approach – A review of existing literature in organizational behavior and marketing fields is proposed to clarify the meaning of organizational and corporate identity. On the basis of this review, the authors also identify an integrative perspective proposed for managers to identify and effectively manage all dimensions of their business identities. Findings – Literature on the identity of businesses is extensive and blurred, failing to provide useful guidance for practitioners to manage this concept. A new approach proposes understanding this kind of identity as a global concept that integrates proposals from diverse research fields in order to take advantage of cross-fertilization. Practical implications – This research allows identity and communication managers to understand dimensions of business identity for a more effective management of this concept in their organizations. Originality/value – The line of research that proposes an integrative multidisciplinary approach to the study of identity in business is quite new and, as so, it still needs further contributions to clarify this nascent domain. In this paper, the authors also classify previous studies on business identity according to the theoretical approach they assume just as no other research has done before. Borra

The corporate identity audit A set of objective measurement tools for your company's image and reputation

Part of a pack 'A Company Self-Assessment' (Pack ISBN 0273638882)SIGLEAvailable from British Library Document Supply Centre-DSC:m00/19007 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

A comparison of homemade vascular access ultrasound phantom models for peripheral intravenous catheter insertion

Background: Ultrasound (U/S) guided peripheral IV catheter (PIV) placement is often needed after unsuccessful traditional IV attempts. Commercial U/S PIV training phantoms are expensive and difficult to alter. Non-commercial phantoms have been described; however, there has been no comparison of these models. The primary objectives of this study were to compare the echogenic and haptic properties of various non-commercial phantoms. Secondary objectives were to characterize the cost and ease of making the phantoms. Methods: This prospective observational study trialed six unique phantom models: Amini Ballistics; Morrow Ballistics; University of California San Diego (UCSD) gelatin; Rippey Chicken; Nolting Spam; and Johnson Tofu. Total cost and creation time were noted. Emergency Ultrasound Fellowship trained physicians performed U/S guided PIV placement on each model to evaluate their resemblance to human tissue haptic and echogenicity properties, utility for training, and comparability to commercial phantoms (Likert scale 1–5; higher performance = 5). Results: The Rippey model scored highest for each primary objective with an aggregate score of 4.8/5. UCSD ranked second and Nolting last for all primary objectives, with aggregate scores 3.7/5 and 1.3/5 respectively. Cost of production ranged from $4.39 (Johnson) to$29.76 (UCSD). Creation times ranged from 10 min (Johnson) to 120 min (UCSD). Conclusion: In our study the Rippey model performed best and offered a mid-level cost and creation time. Non-commercial U/S phantoms may represent cost-effective and useful PIV practice tools. Future studies should investigate the utility of these phantoms in teaching U/S guided PIV to novices and compare non-commercial to commercial phantoms. </jats:sec

The role of packaging for consumer products: understanding the move towards ‘plain’ tobacco packaging

The Australian Government intends to introduce plain tobacco packaging in 2012. We consider whether such a move appears justified by examining the wider marketing literature in order to understand the role that packaging has for consumer goods. Packaging is often called the fifth ‘p’ of the marketing mix. It is an effective marketing medium for all consumer products and helps build consumer relationships through possession and usage. Common packaging strategies to promote the product, distinguish products from competitors, communicate brand values and target specific consumer groups include innovative, special edition, value and green packaging. These strategies, combined with the visual and structural aspects of packaging design, such as colour, size and shape, influence consumer perceptions and purchase and usage behaviour. This gives packaging an important role at point-of-purchase and also post-purchase. Packaging also has a close relationship with the product, influencing perceived product attributes, and is a key representative of the brand. We conclude that plain tobacco packaging appears justified, based on the importance of packaging as a promotional tool, and will fundamentally restrict the opportunity for tobacco companies to influence consumers through package design