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Presentation skills for the reluctant speaker.

Presentation skills are vital to clinical systems managers. This article covers four steps to successful presentations: 1) tailoring for an audience, 2) organizing a presentation, 3) mastering presentation techniques, and 4) creating effective visual aids. Tailoring for the audience entails learning about the audience and matching the presentation to their knowledge, educational level, and interests. Techniques to curry favor with an audience include: establishing common ground, relating through universal experiences, and pushing "hot buttons." Tasks involved in organizing the presentation for maximum audience interest begin with arranging the key points in a transparent organizational scheme. Audience attention is sustained using "hooks," such as graphics, anecdotes, humor, and quotations. Basic presentation techniques include appropriate rehearsal, effective eye contact with an audience, and anxiety-reducing strategies. Visual aids include flip charts, slides, transparencies, and computer presentations. Criteria for selecting the type of visual aids are delineated based on audience size and type of presentation, along with respective advantages and disadvantages. The golden rule for presentations is "Never show a slide for which you have to apologize." Rules to maximize visibility and effectiveness, including use of standard templates, sans serif fonts, dark backgrounds with light letters, mixed cases, and effective graphics, ensure that slides or projected computer images are clear and professional. Taken together, these strategies will enhance the delivery of the presentation and decrease the speaker's anxiety.

Clinical Competence↗

The determination of anatomical cross-sections using a radiotherapy simulator.

A system for obtaining anatomical cross-sections for treatment planning using a radiotherapy simulator is described. A fluorescent screen is viewed by a low light level Isocon television camera and the video signal is digitized and stored. Many projections of the phantom are obtained by rotating the simulator gantry. A convolution algorithm has been used to reconstruct chest sections in which skin and lung outlines are visible. The technique could also be used to make corrections to radiotherapy dose distributions where irradiation of lung tissue is involved.

Humans↗

Transurethral ureterorenolithotripsy using new automated irrigation/suction system controlling pressure and flow compared with standard irrigation: a randomized pilot study.

PURPOSE: To compare in a random fashion an automated irrigation/suction pump system with the standard pressurized technique during transurethral ureterorenolithotripsy. PATIENTS AND METHODS: Between July 2001 and December 2001, 47 patients were prospectively included. Prior to randomization, rigid instruments were allocated to 25 patients (group R) and flexible instruments to 22 patients (group F) according to stone location. The groups R and F were then randomized separately, and the pressurized technique was employed in groups R1 and F1, while the automated system was employed in groups R2 and F2. Operative time, amount of liquid consumed, and stone-free rate at the end of the procedure were analyzed. RESULTS: For the entire series, ureteroscopy time using the automated system (mean 42 +/- 17[SD] minutes; range 15-90 minutes) was 35% less than with the pressurized technique (mean 65 +/- 25 minutes; range 20-135 minutes) (P = 0.04 Wilcoxon score). The stone-free rate was significantly higher in groups R2 + F2 (92%) than in groups R1 + F1 (69%) (P = 0.048). CONCLUSION: With the ENDO FMS UROLOGY system, there was a significant reduction in the mean ureteroscopy time: 32% less with the rigid instrument and 53% less with the flexible instrument. This seems to be attributable to a wider working space and highly improved visibility. The integrated suction at constant flow allows efficient evacuation of stone fragments while limiting cavity pressure. These results, obtained on 47 patients, should be confirmed by larger randomized studies.

Humans↗

[What drugs users say and do not say, using experiences and the projective technique].

This study aimed to get to know some visible and hidden meanings in drugs users' experience. The interviews were associated with the Projective Technique (free and thematic drawing), based on which we analyzed the subjective content and what was expressed by the users. The results demonstrated the existence of family deterioration, stigma and prejudice.

Adult↗

Expanding occupational and environmental health nurse resources. Using community projects to inspire volunteerism.

1. Community involvement is becoming a natural extension of health and wellness services. Participation by occupational and environmental health nurses in community initiatives provides personal satisfaction, improves chapter cohesion, and increases visibility for the profession. 2. Variety in community projects enhances participation by appealing to the diversified interests and time constraints of members. 3. Volunteerism appeals to the basic beliefs of nurses helping to reach beyond individual health and wellness and target global issues.

Community-Institutional Relations↗

Replication of human tracheobronchial hollow airway models using a selective laser sintering rapid prototyping technique.

Exposures to toxic or pathogenic aerosols are known to produce adverse health effects. The nature and severity of these effects often are governed in large part by the location and amount of aerosol deposition within the respiratory tract. Morphologically detailed replica hollow lung airway casts are widely used in aerosol deposition research; however, techniques are not currently available that allow replicate deposition studies in identical morphologically detailed casts produced from a common reference anatomy. This project developed a technique for the precision manufacture of morphologically detailed human tracheobronchial airway models based on high-resolution anatomical imaging data. Detailed physical models were produced using the selective laser sintering (SLS) rapid prototyping process. Input to the SLS process was a three-dimensional computer model developed by boundary-based two-dimension to three-dimension conversion of anatomical images from the original National Institutes of Health/National Library of Medicine Visible Human male data set. The SLS process produced identical replicate models that corresponded exactly to the anatomical section images, within the limits of the measurement. At least five airway generations were achievable, corresponding to airways less than 2 mm in diameter. It is anticipated that rapid prototyping manufacture of respiratory tract structures based on reference anatomies such as the Visible Male and Visible Female may provide "gold standard" models for inhaled aerosol deposition studies. Adaptations of the models to represent various disease states may be readily achieved, thereby promoting exploration of pharmaceutical research on targeted drug delivery via inhaled aerosols.

Aerosols↗

Difficult mammographic needle localizations: use of alternate orthogonal projections.

Lesions deep within the breast are occasionally visible on only one standard mammographic projection and are therefore difficult to localize preoperatively. Such abnormalities can often be visualized on two orthogonal 45 degrees oblique views. In these cases, needle localizations may be performed in a routine manner without computed tomography or stereotactic methods.

Breast Neoplasms↗

Development of prestriate visual projections in the monkey and human fetal cerebrum revealed by transient cholinesterase staining.

Cholinesterase (ChE) staining was used to reveal the timing and pattern of development of afferents to the prestriate visual cortex (areas 18, 19, 20, and 21 of Brodmann) in a series of developing human and monkey fetal brains. This investigation was possible because the nucleus pulvinaris of the thalamus, the main source of subcortical projections to the prestriate cortex, displays positive reactivity after thiocholine incubation during the last three quarters of gestation, while neighboring thalamic nuclei that project to the adjacent neocortical areas are unstained. Staining of the pulvinar and its prestriate projections passes through six broad stages. Stage I begins in both species at the end of the first third of gestation. Positively stained fibers originate from the pulvinar and enter but do not extend beyond the hemispheric stalk. During stage II, pulvinar axons gradually invade the intermediate zone of the occipital lobe, and in stage III they reach the level of the subplate zone. In stage IV, which occurs around mid-gestation in both species, cholinesterase-positive fibers accumulate within the subplate zone subjacent to the developing prestriate cortex. During stage V, ChE-positive fibers penetrate the prospective prestriate cortex but do not yet form the alternating columnar pattern characteristic of pulvinar input to this area in the adults. Rather, ChE activity is concentrated in two continuous bands situated within prospective layers III-IV and VI; also a narrow band is visible in upper layer I. In stage V a clear histochemical border forms between prestriate and striate areas with ChE activity in prospective area 17 limited mostly to the superficial strata of layers I and II. This histochemical differentiation precedes the emergence of cytoarchitectonic landmarks. During stage VI, which begins in the last fifth of gestation in both species, the pulvinar become progressively less stainable and its projections can no longer be traced by ChE histochemistry.

Afferent Pathways↗

22. Some successes and failures with long-term care data systems: the Rhode Island experience.

A project by Rhode Island Health Services Research (SEARCH) to develop, adapt, and improve data systems in several Rhode Island long-term care settings includes skilled nursing and intermediate care facilities, two chronic care hospitals, mental health institutions, and home health agencies. A successful medical review system was developed for Medicaid nursing home patients which is now a program funded by the state, as well as a good abstracting system for the two chronic hospitals. Also, steps were taken to correct omissions and inaccuracies found in mental health data used in the Multi-State Information System (MSIS), and to modify a limited management information system used by home health agencies. In retrospect, the project would have been better served had it attempted to be less comprehensive and instead focused its resources in areas of high visibility and unequivocal public concern. The approach would have given the state population-based information of much greater power than is currently available, despite the recognized successes of the project in the nursing home and chronic hospital areas.

Chronic Disease↗

Human articular cartilage: in vitro correlation of MRI and histologic findings.

The aim of our study was to correlate MRI with histologic findings in normal and degenerative cartilage. Twenty-two human knees derived from patients undergoing amputation were examined with 1.0- and 1. 5-T MR imaging units. Firstly, we optimized two fat-suppressed 3D gradient-echo sequences. In this pilot study two knees were examined with fast imaging with steady precession (FISP) sequences and fast low-angle shot (FLASH, SPGR) sequence by varying the flip angles (40, 60, 90 degrees) and combining each flip angle with different echo time (7, 10 or 11, 20 ms). We chose the sequences with the best visual contrast between the cartilage layers and the best measured contrast-to-noise ratio between cartilage and bone marrow. Therefore, we used a 3D FLASH fat-saturated sequence (TR/TE/flip angle = 50/11 ms/40 degrees) and a 3D FISP fat-saturated sequence (TR/TE/flip angle = 40/10 ms/40 degrees) for cartilage imaging in 22 human knees. The images were obtained at various angles of the patellar cartilage in relation to the main magnetic field (0, 55, 90 degrees). The MR appearances were classified into five categories: normal, intracartilaginous signal changes, diffuse thinning (cartilage thickness < 3 mm), superficial erosions, and cartilage ulcers. After imaging, the knees were examined macroscopically and photographed. In addition, we performed histologic studies using light microscopy with several different stainings, polarization, and dark field microscopy as well as electron microscopy. The structural characteristics with the cartilage lesions were correlated with the MR findings. We identified a hyperintense superficial zone in the MR image which did not correlate to the histologically identifiable superficial zone. The second lamina was hypointense on MRI and correlated to the bulk of the radial zone. The third (or deep) cartilage lamina in the MR image seemed to represent the combination of the lowest portion of the radial zone and the calcified cartilage. The width of the hypointense second zone correlated weakly to the accumulation of proteoglycans in the radial zone. The trilaminar MRI appearance of the cartilage was only visible when the cartilage was thicker than 2 mm. In cartilage degeneration, we found either a diffuse thinning of all layers or circumscribed lesions ("cartilage ulcer") of these cartilage layers in the MR images. Early cartilage degeneration was indicated by a signal loss in the superficial zone, correlating to the histologically proven damage of proteoglycans in the transitional and radial zone along with destruction of the superficial zone. We found a strong effect of cartilage rotation in the main magnetic field, too. A rotation of the cartilage structures caused considerable variation in the signal intensity of the second lamina. Cartilage segments in a 55 degreesangle to the magnetic main field had a homogeneous appearance, not a trilaminar appearance. The signal behavior of hyaline articular cartilage does not reflect the laminar histologic structure. Osteoarthrosis and cartilage degeneration are visible on MR images as intracartilaginous signal changes, superficial erosions, diffuse cartilage thinning, and cartilage ulceration.

Aged↗

Designing and implementing an effective specialty pharmacy service program.

The universe of high-tech biologic medications is expanding rapidly, and health plans are struggling to control the rising costs associated with the use of these agents. Specialty pharmaceutical networks are gaining greater visibility as a helpful tool in this effort. The author describes how to write the request for proposal and begin the decision-making and implementation processes for specialty pharmacy services.

Biotechnology↗

The extended columellar strut-tip graft.

The extended columellar strut-tip graft is a structural unit used in endonasal rhinoplasty that combines the attributes of the columellar strut and the tip graft. It is used to provide projection and contour to the nasal tip. Our goal with this study was to evaluate a 15-year experience with 155 patients who underwent rhinoplasty with the extended columellar strut-tip graft. Of these, 110 underwent secondary rhinoplasty, and 45 underwent primary rhinoplasty. There were 6 patients in the secondary rhinoplasty group who experienced complications: in 3, the graft became visible postoperatively, and 3 patients had graft placement asymmetry. These 6 patients underwent surgery in the initial years of graft development. One patient with graft edge visibility and 1 patient with graft asymmetry underwent revision surgery with satisfactory results. The extended columella strut-tip graft is a reliable method to provide nasal tip projection and contour. The successful use of the graft requires precise diagnosis and surgical technique.

Adult↗

Reducing metal artifacts in cone-beam CT images by preprocessing projection data.

PURPOSE: Computed tomography (CT) streak artifacts caused by metallic implants remain a challenge for the automatic processing of image data. The impact of metal artifacts in the soft-tissue region is magnified in cone-beam CT (CBCT), because the soft-tissue contrast is usually lower in CBCT images. The goal of this study was to develop an effective offline processing technique to minimize the effect. METHODS AND MATERIALS: The geometry calibration cue of the CBCT system was used to track the position of the metal object in projection views. The three-dimensional (3D) representation of the object can be established from only two user-selected viewing angles. The position of the shadowed region in other views can be tracked by projecting the 3D coordinates of the object. Automatic image segmentation was used followed by a Laplacian diffusion method to replace the pixels inside the metal object with the boundary pixels. The modified projection data were then used to reconstruct a new CBCT image. The procedure was tested in phantoms, prostate cancer patients with implanted gold markers and metal prosthesis, and a head-and-neck patient with dental amalgam in the teeth. RESULTS: Both phantom and patient studies demonstrated that the procedure was able to minimize the metal artifacts. Soft-tissue visibility was improved near or away from the metal object. The processing time was 1-2 s per projection. CONCLUSION: We have implemented an effective metal artifact-suppressing algorithm to improve the quality of CBCT images.

Algorithms↗

Eight-dimensional methodology for innovative thinking about the case and ethics of the Mount Graham, Large Binocular Telescope project.

This paper introduces the Eight Dimensional Methodology for Innovative Thinking (the Eight Dimensional Methodology), for innovative problem solving, as a unified approach to case analysis that builds on comprehensive problem solving knowledge from industry, business, marketing, math, science, engineering, technology, arts, and daily life. It is designed to stimulate innovation by quickly generating unique "out of the box" unexpected and high quality solutions. It gives new insights and thinking strategies to solve everyday problems faced in the workplace, by helping decision makers to see otherwise obscure alternatives and solutions. Daniel Raviv, the engineer who developed the Eight Dimensional Methodology, and paper co-author, technology ethicist Rosalyn Berne, suggest that this tool can be especially useful in identifying solutions and alternatives for particular problems of engineering, and for the ethical challenges which arise with them. First, the Eight Dimensional Methodology helps to elucidate how what may appear to be a basic engineering problem also has ethical dimensions. In addition, it offers to the engineer a methodology for penetrating and seeing new dimensions of those problems. To demonstrate the effectiveness of the Eight Dimensional Methodology as an analytical tool for thinking about ethical challenges to engineering, the paper presents the case of the construction of the Large Binocular Telescope (LBT) on Mount Graham in Arizona. Analysis of the case offers to decision makers the use of the Eight Dimensional Methodology in considering alternative solutions for how they can proceed in their goals of exploring space. It then follows that same process through the second stage of exploring the ethics of each of those different solutions. The LBT project pools resources from an international partnership of universities and research institutes for the construction and maintenance of a highly sophisticated, powerful new telescope. It will soon mark the erection of the world's largest and most powerful optical telescope, designed to see fine detail otherwise visible only from space. It also represents a controversial engineering project that is being undertaken on land considered to be sacred by the local, native Apache people. As presented, the case features the University of Virginia, and its challenges in consideration of whether and how to join the LBT project consortium.

Arizona↗

Reduction mammaplasty with the "owl" incision and no undermining.

Reduction mammaplasty has traditionally been done using the Wise pattern of incision. Because of the box-like effect in breast shape, the lack of projection, and the long scars associated with the inverted T incision, two techniques have emerged as alternatives: the vertical reduction of Lassus/Lejour and the "round block" periareolar technique popularized by Benelli. Each of these techniques has its pros and cons. The "owl" incision combines the features of the large periareolar reduction (Benelli's) and the vertical reduction (Lassus/Lejour); the horizontal inframammary scar is either made very short or completely eliminated. Volume reduction is done through a heart-shaped parenchymal resection, leaving the nipple-areolar complex over a supero-central pedicle. Maintenance of the central parenchyma behind the nipple-areolar complex and mobilization of the vertical pillars toward the center of the breast give excellent projection and diminish the lateral fullness. Enlargement of the periareolar skin resection diminishes the length and pleating of the vertical scar; conversely, inclusion of the vertical component to the periareolar technique eliminates the pleating effect of the periareolar incision. The short horizontal excision eliminates any resultant "dog ears" in the new inframammary fold. Thus, the discrepancy in the length of scars is better distributed. There is no skin or parenchymal undermining, so drains are not needed. Excellent results are obtained immediately on the operating table, and large volumes of glandular resection and correction of severe ptosis can be accomplished without compromising vascularity of either the nipple-areolar complex or the skin flaps.Ninety-four patients in a 7-year period were operated upon using this technique. Seventy-two had bilateral reductions up to 1900 gm per breast, 12 had unilateral reduction for symmetry following breast reconstruction, and 10 were patients with severe ptosis. Complications were rare and of a minor nature. No conversion to free grafts was done, even in the larger resections. One case required minor revision under local anesthesia, one case required bilateral re-reduction, and another case required unilateral re-reduction for continued growth of breast tissue. Almost 90 percent of the patients underwent procedures as outpatients. The owl-type incision and the supero-central pedicle flap are elements of a reduction mammaplasty technique that provides excellent projection and shape with minimal visible scars. It takes advantage of the positive features of the periareolar and vertical reduction techniques and minimizes their negative features. The new design of parenchymal resection improves the vascularity of the residual flaps. Additionally, it may better preserve the sensation to the nipple-areolar complex and lactation is not compromised.

Breast↗

Characterization of the cord-like structures emerging from the surface of influenza C virus-infected cells.

When HMV-II cells (a human malignant melanoma cell line) infected with a newly isolated influenza C strain (Yamagata/1/88) were examined by simple light microscopy, it was found that a large number of cord-like structures which had lengths up to about 500 microns or greater were emerging from the cell surface. The existence of viral glycoproteins (hemagglutinin-esterase, HE) on the surface of these huge structures was confirmed by hemadsorption experiments with erythrocytes from a variety of species as well as by immunofluorescent staining with anti-HE monoclonal antibody. Furthermore, electron microscopy revealed that numerous filamentous particles in the process of budding, each covered with a layer of surface projections approximately 13 nm in length, aggregated with their long axes parallel to form a cord-like structure visible under a light microscope. An electron-dense layer, which presumably consists of membrane protein (M), was seen in cross-sections of all filamentous virions whereas internal nucleocapsids were rarely seen. SDS-polyacrylamide gel electrophoresis of the purified cords also showed that they contained HE and M polypeptides but not nucleoprotein, confirming that long filamentous particles are mostly devoid of nucleocapsids. The emergence of cords on the cell surface was observed in various cell cultures infected with C/Yamagata/1/88 though their number and length varied markedly depending on cell type. The production of cord-like structures was also evident in HMV-II cells infected with any of several different influenza C strains, which suggests that the cord formation is a common feature of influenza C virus group.

Adsorption↗

Refraction contrast 11x-magnified X-ray imaging of large objects by MIRRORCLE-type table-top synchrotron.

The high-quality aspects of magnified X-ray images recorded using MIRRORCLE-6X are reported. MIRRORCLE-6X is inherently suitable for hard X-ray imaging owing to its magnified projection X-ray imaging, micrometre-size X-ray source point, wide radiation emission angle, X-ray spectrum ranging from 10 keV to 6 MeV, natural refraction contrast imaging and high flux output. Images produced with 11x geometrical magnification display a sharply enhanced edge effect when generated using a 25 microm rod electron target. Image contrast is enhanced 2x owing to refraction when compared with absorption contrast images. An imitation tumour implanted in a human chest phantom was made clearly visible by using edge enhancement on images. Soft tissue becomes highly visible as a natural consequence of refraction contrast when using hard X-rays for imaging. The authors believe that novel imaging provided by MIRRORCLE makes it a superior instrument for medical diagnosis.

Absorption↗

[Localization of left ventricular myocardial lesions using 201Tl chloride scintigrams].

The authors propose some methodological approaches including stereometric methods, for determination of visible left ventricular walls in different projections of a gamma-chamber detector with relation to a position of the left ventricular anatomical axis (LVAA) in space to improve topographic diagnosis of left ventricular myocardial lesions with 201Tl. The above method can be implemented on computer.

Cardiomyopathies↗