Using AI Text-to-Image Generation to Create Novel Illustrations for Medical Education: Current Limitations as Illustrated by Hypothyroidism and Horner Syndrome

Our research letter investigates the potential, as well as the current limitations, of widely available text-to-image tools in generating images for medical education. We focused on illustrations of important physical signs in the face (for which confidentiality issues in conventional patient photograph use may be a particular concern) that medics should know about, and we used facial images of hypothyroidism and Horner syndrome as examples.

Illustrations of rheumatoid arthritis symptoms to promote communication between patients and physicians

OBJECTIVES

To develop an illustrative tool presenting visualized rheumatoid arthritis (RA) symptoms using pictures to promote better understanding between patients and physicians.

METHODS

A tool named 'Okomarigoto Sheet' was developed through an internet survey of patients with RA and certified rheumatologists by repeated in-person interviews.

RESULTS

An internet survey on the reality of communication between patients with RA and physicians in 200 patients and 200 certified rheumatologists revealed various local and systemic symptoms of RA and difficulties in sharing those symptoms between patients and physicians during a short consultation. Interviews from patients and certified rheumatologists suggested that illustrations of symptoms would be helpful for better communication between them; therefore, an illustrative tool presenting visualized RA symptoms was drafted. The draft illustrations were refined through multiple rounds of interviews with the patients. The final version of the tool was discussed and evaluated at a joint meeting of patients and rheumatologists.

CONCLUSIONS

A picture sheet presenting RA symptoms was developed. Future prospective studies should evaluate the usefulness of the sheet in clinical practice to promote better communication between patients and physicians.

Ottoman plants, nature studies, and the attentiveness of translational labor

Translations, whether in the form of text, illustration, or interpretive analysis, served knowledge-making in multiple ways. It offered a refuge, severed contexts, and concealed the various workers that created it. Over the course of the seventeenth century, European naturalists in Istanbul, such as Luigi Ferdinando Marsigli (1658-1730), procured illustrations of Ottoman nature as fundamental resources to identify, collect, and compare indigenous plants and newly bred varieties. Despite maintaining an actual mediation for cross-cultural interactions, these sources of virtual communication remain largely forgotten in modern scholarship. This article argues that this curious yet invisible corpus was not a nonagentive medium in an alienated leisure of a gentleman-scholar; instead, these illustrations were designed to call upon the viewer's constant attention in self-motivated scientific labor. Such handy tools responded and contributed to early modern scholars' modes of working, and in exchange they determined these sources' own function, position, and visibility - either as a by-product or as a derivative. It is therefore only when integrated into the labor history of science that the degrees of invisibility pertaining to both Ottoman nature studies and self-directed labor can come into a granular view.

Surgical illustration: the role, the reason, and the route

Surgical illustration plays a fundamental role in the surgical field, being able to convey imagery in a more comprehensive way. However, its utility has seen a decline and being slowly replaced by photographs and 3D models. Surgeons are in a unique position that is optimum for producing surgical illustrations due to having direct contact and possesses a deep knowledge of the subject being drawn. The process of producing an illustration may also be valuable to the long-term conceptual understanding of that surgeon. This article aims to highlight the field of surgical illustration, its future potential, and act as a guide for surgeons to start illustrating.

Two new species of Amaurobius C.L. Koch, 1837 from China (Araneae, Amaurobiidae)

Two new species of the genus Amaurobius are described from China: A.guangwushanensissp. nov. (♂♀) from Sichuan and A.wulongdongensissp. nov. (♂♀) from Shaanxi. With the addition of two new species, the number of Amaurobius species endemic to China now reaches four. Morphological descriptions, photos, and illustrations of copulatory organs, as well as a map of distribution records, are provided.

A Simple Method for Creating Medical Illustrations Using Tablets

Medical illustrations are defined as illustrations that contain and convey medical information. Illustrations in surgical records play a pivotal role not only in recording medical information but also in sharing surgical information, improving own surgical skills, and teaching young doctors. However, we believe that creating a medical illustration from a blank sheet of paper is challenging for beginners. The computer-assisted illustration technique proposed in this article not only saves time but also provides accurate and easy-to-understand medical illustrations. This technical note aims to introduce a simple and easy method for creating medical illustrations by tracing intraoperative photographs using an iPad™ and an Apple Pencil™. We believe that "anyone can draw" detailed, easy-to-understand medical illustrations using the present method, and we hope that many young doctors will actively create medical illustrations.

Design - a new way to look at old molecules

We discuss how design enriches molecular science, particularly structural biology and bioinformatics. We present two use cases, one in academic practice and the other to design for outreach. The first case targets the representation of ion channels and their dynamic properties. In the second, we document a transition process from a research environment to general-purpose designs. Several testimonials from practitioners are given. By describing the design process of abstracted shapes, exploded views of molecular structures, motion-averaged slices, 360-degree panoramic projections, and experiments with lit sphere shading, we document how designers help make scientific data accessible without betraying its meaning, and how a creative mind adds value over purely data-driven visualizations. A similar conclusion was drawn for public outreach, as we found that comic-book-style drawings are better suited for communicating science to a broad audience.

Cross-sectional representations of the central nervous system in Pirogov's "Ice Anatomy"

Russian surgeon Nikolay Ivanovich Pirogov (Pirogoff; 1810-1881) introduced the teaching of applied topographical anatomy in Russia. Pirogov's monumental four-part atlas, Anatome topographica sectionibus per corporis humanum congelatum triplici directione ductis illustrate (An Illustrated Topographic Anatomy of Saw Cuts Made in Three Dimensions Across the Frozen Human Body), colloquially known as the "Ice Anatomy," was published in Latin in folio in the 1850s. Pirogov sought to investigate "the normal and pathological positions of different organs and body parts using sections made in the three principal directions [anatomical planes] … throughout all regions." To accomplish this, he froze cadavers "to the density of the thickest wood" and then cut them into thin plates with a special mechanical saw. His approach was reportedly inspired by his observations of butchers sawing across frozen pig carcasses at the meat market in St. Petersburg during winter. Pirogov systemically obtained full-size representations of more than 1,000 sections. A painter made a representative copy of the cross-sectional contours of each section, using ruled glass overlain on the sections. The final lithographs were of high artistic quality and execution, resembling modern high-resolution medical imaging (i.e., CT or MRI). Moreover, structures were serially sectioned and systematically illustrated along all three anatomical planes, something that had never previously been attempted. This allowed clinicians and anatomists to scrutinize the spatial relationships of structures from multiple perspectives and at a much more detailed level than was previously possible, although the cost, massiveness, and complexity of the completed work precluded wide dissemination.

Laypeople's interpretation of, and preference for, orthodontic images

Background:

Good communication is fundamental to provision of information and patient engagement in orthodontic treatment. Images can be used to support verbal and written information, but little is known about how laypeople interpret orthodontic images.

Objective:

To explore laypeople’s understanding and preferences for images (clinical photographs and medical illustrations) relating to orthodontic diagnoses and treatments.

Design:

Cross-sectional survey.

Setting:

UK.

Population:

Laypeople aged ⩾16 years.

Methods:

Participants were recruited through social media to complete an online questionnaire containing six pairs of images (clinical photograph and medical illustration) relating to orthodontic diagnoses and treatment. Photographs were selected from a bank with input from laypeople, then a matching medical illustration was created. Images were presented with questions relating to interpretation, preferences and reasons for preferences.

Results:

A total of 898 people completed the questionnaire. Interpretation of images by laypeople was variable and, in some cases, normal intra-oral features and image orientation caused confusion. A combination of photograph and illustration were preferred for images representing diagnosis (by 41%–50% participants), whereas the illustration alone or both photograph and illustration together was preferred for explaining treatment (43%–48% and 35%–44%, respectively). Photographs were liked for their realism and relatability, while illustrations were often found to be clearer. Arrows aided participants’ understanding of the images, but annotations were requested to further improve the value of images. Only 26% of participants reported having previously been shown dental images, but 96% felt they would be helpful to support verbal and written information.

Conclusion:

Laypeople may not interpret orthodontic images in the way that professionals expect, and unfamiliar intra-oral features may distract people from the intended focus of the image. A combination of photographs and illustrations together may improve the usefulness of images, alongside annotation or explanation.

Acceptance of Supportive Illustrations for Preparation of Patients for an Orthopedic Telemedical Consultation

Introduction: Telemedical video consultations are a powerful support for patient–doctor interactions. For optimal digital settings, explanatory illustrations may be helpful for patients. This study analyzed patients' the attitude of patients to illustrations preparing for an orthopedic telemedical consultation (OTC).

Methods: A leaflet with eight illustrations was designed and their acceptance and estimated necessity was evaluated among patients who had experienced an OTC (EXP-group) and others who had not (NOV-group) with a 12-item-questionnaire.

Results: Sixty patients participated (n = 30 each group). All illustrations were evaluated positively. The EXP-group gave significantly higher ratings than the NOV-group for improved understanding by the given keywords of the illustrations (p = 0.046), preference for being informed by illustrations than by merely by a pure text (p = 0.023), better feeling of preparation for an OTC by the illustrations (p = 0.005), and the impression of a simplified process of the OTC by the illustrations (p = 0.012).

Discussion: While the illustrations were well-accepted by the participants, significant differences were revealed between the valuation of single aspects by patients, depending on a previous experience with an OTC. Therefore, a leaflet with explanatory illustrations may be helpful in preparing patients for an OTC to support the digital patient–doctor contact.

Visible Labour? Productive Forces and Imaginaries of Participation in European Insect Studies, ca. 1680-1810*

The practice of early modern natural history depended on the collective collecting activities of a great variety of people. Among them, artisans played a major role in acquiring and distributing knowledge about the natural world and they contributed significantly to the scholarly labour in natural history. This distributed labour was both acknowledged by contemporaries as well as hidden from sight, reflecting the period's dominant norms for class and gender. By combining an interpretation of the visual representation of labour in European insect studies with an examination of written sources about natural history practices from about 1680 to 1810, this article decodes the often-codified frontispieces and other more symbolic illustrations to offer new insights into the labour of natural history. Those who identified as scholars and artisans (or both) conceptualised their own intellectual and practical engagement with natural history within the semantic field of work. Some seemed to have even envisioned a new social role for academics as well as artisans. This article analyses the diversity of the "productive forces" in insect studies as they changed over time and it reconstructs what I will call the social imaginaries of participation.

Image guidance using two-dimensional illustrations and three-dimensional modeling of donor anatomy during living donor hepatectomy

BACKGROUND

For living donor liver transplantation, preoperative imaging is required for the safety of both the donor and the recipient. We previously initiated our image-guidance program using two-dimensional illustrations and three-dimensional modeling in September 2018; herein, we analyzed the resultant changes in the clinical outcomes.

METHODS

Living donors and recipients who underwent liver transplantation between September 2017 and August 2019 were included. Cases with image guidance were compared to those without image guidance regarding the operative outcome, especially bile-duct opening in the graft as well as surgical complications.

RESULTS

Among 200 living donor transplantation, 90 transplantations were completed with image guidance. The image-guidance group had a higher rate of laparoscopy (80.9% vs. 97.8%; p < .001) as compared with the group without image guidance. Although there was no difference in the type of bile duct (p = .144), more grafts with single bile-duct openings were found in the image-guidance group (52.7% vs. 80.0%; p = .001). Consequently, achievements in bile-duct openings were superior in the image-guidance group (p = .022). There were no differences in bile leakage, graft failure, or number of deaths during the first month post-transplantation.

CONCLUSION

As we initiated our image-guidance program for living donor liver transplantation, clinical outcomes, especially bile-duct division, were improved relative to before implementation.

(In)visible materialities in the context of dementia care

Seemingly mundane materialities are intertwined with important, but often neglected, care interactions. It has been argued that if healthcare professionals paid more attention to the roles materialities can have, everyday routines could become important occasions for care. In response to such proposals, we argue that it is relevant to examine how materialities are currently understood. In this article, we explore materialities as part of work in a dementia unit. Using abstracted illustrations of everyday materialities to elicit reflections, we conducted 11 individual interviews with certified nursing assistants. Through phenomenographic analysis we explain our findings as three different categories conceptualising understandings of materialities as: 'tools for care', 'a set of principles for care' and 'caring relationships'. Our analysis indicates that understanding materialities as instruments was reinforced and made visible through the healthcare organisation while understanding materialities as part of specific relationships with residents appeared informal and less visible. How materialities were understood seemed to have several implications for residents. While care practices could benefit from nursing assistants' abilities to alternate between ways of understanding materialitites, such competence seemed dependent on how professional care was organised, structured and materialised.

Investigation of suitable illustrations in medical care

Visual representation methods have long been used as tools to communicate information in health education settings, and their effect on improving health literacy has been investigated. The question arises: How should an illustration function in relation to the textual information it illustrates? Medical illustrations are likely to be featured in media such as brochures and textbooks. If the textual information in such materials is so complex, what function should illustrations play? We reviewed the sociological literature on illustrations to obtain findings potentially applicable to health education and the improvement of health literacy. We then evaluated these tools to determine the types of illustrations that are suitable for the information. Of the three topics for which we developed the materials-cancer, food allergies and HEV light-only for the HEV light topic were earlier findings replicated. One key factor behind this result was that the illustrations for the HEV topic underwent a more thorough deliberative process than those for the other two topics. The results of our study also highlight the importance of third-party opinion in the illustration design process.

A review and illustrated description of Musca crassirostris, one of the most neglected haematophagous livestock flies

Tabanids, stomoxyine flies, hippoboscids and tsetse flies are the most well-known brachyceran biting flies of livestock. Only a few other higher Diptera have developed the unique mouthparts required for blood feeding. These neglected blood feeders can also have direct effects on hosts through blood loss, and are likely to contribute to the transmission of pathogens. Musca crassirostris (Diptera: Muscidae) is one of the most abundant of the muscid flies with this haematophagous lifestyle; it is widespread in the Palaearctic, Afrotropical and Oriental regions. The present study reviews and summarizes the biology and morphology of this species, and its potential for impact on animals and humans. The study also provides a fully illustrated description of the fly to facilitate its identification, and reviews information on abundance, with a focus on recent trapping surveys in Thailand. When sampled using traps designed for other biting flies, M. crassirostris appears to be four and 45 times more abundant than stomoxyines and tabanids, respectively. High numbers of M. crassirostris in the vicinity of livestock have also been associated with outbreaks of disease, such as that of a fatal plague in bovine farms in Egypt. This calls for a reconsideration of its potential impacts on livestock economics and health, and thus the development of suitable control methods.

A review of the genus Apronopa van Achterberg (Hymenoptera, Braconidae, Alysiinae) with a key to species

A review of the genus Apronopa van Achterberg, 1980 with illustrated re-descriptions of the known species and a key for their identification is provided.

Interleukins and their signaling pathways in the Reactome biological pathway database

BACKGROUND

There is a wealth of biological pathway information available in the scientific literature, but it is spread across many thousands of publications. Alongside publications that contain definitive experimental discoveries are many others that have been dismissed as spurious, found to be irreproducible, or are contradicted by later results and consequently now considered controversial. Many descriptions and images of pathways are incomplete stylized representations that assume the reader is an expert and familiar with the established details of the process, which are consequently not fully explained. Pathway representations in publications frequently do not represent a complete, detailed, and unambiguous description of the molecules involved; their precise posttranslational state; or a full account of the molecular events they undergo while participating in a process. Although this might be sufficient to be interpreted by an expert reader, the lack of detail makes such pathways less useful and difficult to understand for anyone unfamiliar with the area and of limited use as the basis for computational models.

OBJECTIVE

Reactome was established as a freely accessible knowledge base of human biological pathways. It is manually populated with interconnected molecular events that fully detail the molecular participants linked to published experimental data and background material by using a formal and open data structure that facilitates computational reuse. These data are accessible on a Web site in the form of pathway diagrams that have descriptive summaries and annotations and as downloadable data sets in several formats that can be reused with other computational tools. The entire database and all supporting software can be downloaded and reused under a Creative Commons license.

METHODS

Pathways are authored by expert biologists who work with Reactome curators and editorial staff to represent the consensus in the field. Pathways are represented as interactive diagrams that include as much molecular detail as possible and are linked to literature citations that contain supporting experimental details. All newly created events undergo a peer-review process before they are added to the database and made available on the associated Web site. New content is added quarterly.

RESULTS

The 63rd release of Reactome in December 2017 contains 10,996 human proteins participating in 11,426 events in 2,179 pathways. In addition, analytic tools allow data set submission for the identification and visualization of pathway enrichment and representation of expression profiles as an overlay on Reactome pathways. Protein-protein and compound-protein interactions from several sources, including custom user data sets, can be added to extend pathways. Pathway diagrams and analytic result displays can be downloaded as editable images, human-readable reports, and files in several standard formats that are suitable for computational reuse. Reactome content is available programmatically through a REpresentational State Transfer (REST)-based content service and as a Neo4J graph database. Signaling pathways for IL-1 to IL-38 are hierarchically classified within the pathway "signaling by interleukins." The classification used is largely derived from Akdis et al.

CONCLUSION

The addition to Reactome of a complete set of the known human interleukins, their receptors, and established signaling pathways linked to annotations of relevant aspects of immune function provides a significant computationally accessible resource of information about this important family. This information can be extended easily as new discoveries become accepted as the consensus in the field. A key aim for the future is to increase coverage of gene expression changes induced by interleukin signaling.

Developing the Brain-Early Illustrations of Cerebral Cortex and Its Gyri

BACKGROUND

Throughout the Middle Ages, most representations of the brain amounted to highly schematized ventricles housed within abstract squiggles of neural tissue. The works by the pre-eminent Flemish anatomist Andreas Vesalius in his De Humani Corporis Fabrica (1543) added considerably more accuracy and detail; still, his drawings of cerebral hemispheres do not exhibit the gyral-sulcal pattern recognized today. Identifiable cortical landmarks would not be featured in print until Cerebri Anatome (1664) by the English physician Thomas Willis.

METHODS

A review of primary and secondary sources on the subject.

RESULTS

Medieval doctors understood neurophysiology according to the cell doctrine, whereby the first cell (modern-day lateral ventricles) was responsible for sensation, the second cell (third ventricle) for cognition, and the third cell (fourth ventricle) for memory. Vesalius challenged this ventricle-centric model and resolved to portray physical form only, without the influence of conceptual function. A century later, Willis and his illustrator, Christopher Wren, citing limited clinical evidence, proposed that the corpus striatum, the white matter, and the gray matter replace the three cells, finally allowing the cortex a physiological rather than a structurally supportive role. This relocation of executive function demanded the more meticulous rendering of the brain provided in the Cerebri Anatome.

CONCLUSIONS

Thomas Willis produced anatomic drawings of the brain depicting previously ill-defined surface features, as in Fabrica by Vesalius, because of a paradigm shift in neurophysiology, emphasizing the cortex over the ventricles, not because of advances in techniques of dissection or illustration. Perhaps, as the study of the brain continues, another future revelation in neurophysiology will drive another unexpected, enduring change in the study of the structures of the nervous system.

A Web Tool for Generating High Quality Machine-readable Biological Pathways

PathWhiz is a web server built to facilitate the creation of colorful, interactive, visually pleasing pathway diagrams that are rich in biological information. The pathways generated by this online application are machine-readable and fully compatible with essentially all web-browsers and computer operating systems. It uses a specially developed, web-enabled pathway drawing interface that permits the selection and placement of different combinations of pre-drawn biological or biochemical entities to depict reactions, interactions, transport processes and binding events. This palette of entities consists of chemical compounds, proteins, nucleic acids, cellular membranes, subcellular structures, tissues, and organs. All of the visual elements in it can be interactively adjusted and customized. Furthermore, because this tool is a web server, all pathways and pathway elements are publicly accessible. This kind of pathway "crowd sourcing" means that PathWhiz already contains a large and rapidly growing collection of previously drawn pathways and pathway elements. Here we describe a protocol for the quick and easy creation of new pathways and the alteration of existing pathways. To further facilitate pathway editing and creation, the tool contains replication and propagation functions. The replication function allows existing pathways to be used as templates to create or edit new pathways. The propagation function allows one to take an existing pathway and automatically propagate it across different species. Pathways created with this tool can be "re-styled" into different formats (KEGG-like or text-book like), colored with different backgrounds, exported to BioPAX, SBGN-ML, SBML, or PWML data exchange formats, and downloaded as PNG or SVG images. The pathways can easily be incorporated into online databases, integrated into presentations, posters or publications, or used exclusively for online visualization and exploration. This protocol has been successfully applied to generate over 2,000 pathway diagrams, which are now found in many online databases including HMDB, DrugBank, SMPDB, and ECMDB.

OC39 - The efficacy of a participatory approach in reducing pain related to venepuncture in children

Theme:

ETHICAL ISSUES

dignity and humanity.

INTRODUCTION

Venepuncture represents traumatic experience in childhood due to pain and discomfort.

AIMS

To compare the efficacy of a participatory approach with preliminary ice application to the skin.

METHODS

Two age-groups (respectively 3-7 and *8 years) were considered during day-hospital, hospitalization, and ER accesses. Venepuncture was described to patients with fables or illustration according to the age-group. Ice or cool-water-pack was randomly applied to skin for one minute before venepuncture. Pain measurement scales were Wong-Baker and VAS.

RESULTS

Preliminary data (55 patients) showed that the 3-7 years age group had better pain tolerance with a participatory approach, whilst ice was better in the older group. Generally previous venepunctures seem to worsen pain feeling.

DISCUSSION

Imagination seems to influence pain feeling in the 3-7 age group, while ice is more important in the older group. Previous experiences mark negatively successive venepunctures.

CONCLUSIONS

Participatory approaches can be cost-effective and influences positively venepuncture in the future.

A taxonomic study of the genus Panesthia (Blattodea, Blaberidae, Panesthiinae) from China with descriptions of one new species, one new subspecies and the male of Panesthiaantennata

One new species Panesthiaguizhouensis sp. n. and one new subspecies Panesthiastellataconcava ssp. n. are described and illustrated. The male of Panesthiaantennata Brunner von Wattenwyl, 1893 and its brachypterous form are described and illustrated for the first time. Panesthiastrelkovi Bey-Bienko, 1969 is redescribed and illustrated. Three known species, Panesthiabirmanica Brunner von Wattenwyl, 1893, Panesthiasinuata Saussure, 1839 and Panesthiaangustipenniscognata Bey-Bienko, 1969 are illustrated. In addition, a key to all species of the genus Panesthia from China is presented.

Improving health Professional's knowledge of hepatitis B using cartoon based learning tools: a retrospective analysis of pre and post tests

BACKGROUND

Hepatitis B serology is complex and a lack of knowledge in interpretation contributes to the inadequate levels of screening and referral for highly effective hepatitis antiviral treatments. This knowledge gap needs to be addressed so that current and future healthcare professionals are more confident in the detection and assessment of hepatitis B to improve the uptake of treatment and reduce long-term complications from the disease. Cartoons have been used effectively as a teaching tool in other settings and were considered as a potentially useful teaching aid in explaining hepatitis B serology. This study examines the impact of cartoons in improving healthcare professionals' knowledge.

METHODS

A cartoon based learning tool designed to simplify the complexities of hepatitis B serology was developed as part of an online learning program for medical practitioners, nurses and students in these professions. A retrospective analysis was carried out of pre and post online test results.

RESULTS

An average improvement of 96% of correct answers to case study questions in hepatitis B serology was found across all ten questions following the use of an online cartoon based learning tool.

CONCLUSION

The data indicates a significant improvement of participants' knowledge of hepatitis B serology from pre-test to post-test immediately following an online cartoon based learning tool. However, further research is required to measure its long term impact.

The history and illustration of anatomy in the Middle Ages

This article reviews the influence of key figures on the pictorial representation of anatomy and the evolution of anatomical illustration during the Middle Ages until the time of the Renaissance, based on medical history books, journals and ancient medical books. During the early period in the Middle Ages, most illustrations were traditional drawings of emblematic nature, oftentimes unrealistic, not only because the precise knowledge of anatomy was lacking but also because the objective was to elucidate certain principles for teaching purposes. Five figure-series that came down to us through ancient manuscripts and textbooks represent the best examples of such traditional illustrations. With the advent of human dissection in the 13th and 14th centuries, a significant transformation in the depiction of anatomy began to project the practice of human dissection, as we see in the works of Mondino de Luzzi, Henri de Mondeville and Guido de Vigevano. After the invention of book printing in the second half of the 15th century, the reproduction of books was commonly practised and the woodcut made multiplication of pictures easier. Peter of Abano, Hieronymous Brunschwig, Johannes de Ketham, Johannes Peyligk, Gregory Reisch, Magnus Hundt, Laurentius Phryesen and many more included several anatomical illustrations in their treatises that demonstrated the development of anatomical illustration during the later Middle Ages.

Revealing the invisible: the paradox of picturing a phantom limb

Illustrations of phantom limbs are intriguing as they depict an invisible perception. But such illustrations are also important: they provide a form of objectivity to phenomena, which particularly in the past, have often stretched credulity. Acknowledging the paradox of using images to reveal an absent though sensate body part, depictions of phantom limbs are discussed from the neurological perspective, starting with medieval pictures that showed the miraculous restoration of limbs, and which possibly represented pictorial metaphors for a phantom limb. Centuries later, phantom limbs-whether resulting from amputation or deafferentation-became illustrated, and some reasons for their illustration are considered. Although often depicted by others, the most precise and perhaps revealing illustrations of these phantoms have been those made when patients guide the artist, or draw the phantom themselves. In the case of phantom pains, the painful component too is sometimes illustrated, again, as with the miraculous, in metaphorical terms. More recently, depictions of phantoms have also been revealing in studies of some underlying mechanisms of phantom phenomena, notably in demonstrating novel patterns of referred sensations after amputation and attributable to cortical plasticity. Mention is made of photographs of phantom hands visualized using a mirror box, such visualization recalling full circle the miraculous restoration of limbs pictured in the past. The nature of the outline of the phantom is included in a discussion of demarcation of an invisible body part, before concluding that images of phantom limbs provide an invaluable background to understanding and studying these remarkable sensory phenomena.

Intensive care delirium - effect on memories and health-related quality of life - a follow-up study

AIMS AND OBJECTIVES

To investigate the effects of delirium in the intensive care unit on health-related quality of life, healthcare dependency and memory after discharge and to explore the association between health-related quality of life and memories, patient diaries and intensive care unit follow-up.

BACKGROUND

Up to 83% of intensive care unit patients experience delirium. In addition to increased risk of mortality, morbidity and cognitive impairment, the experience itself is unpleasant. A number of studies have focused on memories associated with delirium, but the association between delirium, memories and health-related quality needs further investigation.

DESIGN

We used an observational multicentre design with telephone interviews.

METHODS

Adult intensive care unit patients (n = 360) were consecutively recruited and interviewed using the intensive care unit-Memory Tool one week after intensive care unit. Interviews were repeated after two and six months and supplemented with Short Form-36 and the Barthel Index.

RESULTS

Delirium was detected in 60% of the patients in our study, and delirious patients had significantly fewer factual memories and more memories of delusion than nondelirious patients up to six months postintensive care unit discharge. Delirium, memories and intensive care unit diaries with follow-up did not affect health-related quality of life and healthcare dependency. Memories of delusions might have an impact on patients assessed as nondelirious.

CONCLUSIONS

More than half of the patients in intensive care unit experience delirium, which is associated with fewer factual memories and more memories of delusions. Short Form-36 might not be sensitive to delirium-related outcomes. Future research should include the development of better assessment tools to determine the long-term consequences of intensive care unit delirium.

RELEVANCE TO CLINICAL PRACTICE

We recommend regular assessment to prevent, detect and treat delirium. We also recommend an intensive care unit follow-up programme providing an opportunity for postintensive care unit patients, particularly previously delirious patients, to discuss their memories and experiences with intensive care unit professionals.

A revision of the Megachile subgenus Litomegachile Mitchell with an illustrated key and description of a new species (Hymenoptera, Megachilidae, Megachilini)

The species of Megachile subgenus Litomegachile are revised with a review of the species morphology, biology, and plant associations. A new species, Megachile pankus, is described and illustrated. Megachile mendica snowi Mitchell is elevated to species. Megachile var. nupta Cresson and Megachile texana var. cleomis Cockerell are synonymized with Megachile brevis and Megachile texana, respectively. An illustrated key for Litomegachile is also provided.

Hybrid visibility compositing and masking for illustrative rendering

In this paper, we introduce a novel framework for the compositing of interactively rendered 3D layers tailored to the needs of scientific illustration. Currently, traditional scientific illustrations are produced in a series of composition stages, combining different pictorial elements using 2D digital layering. Our approach extends the layer metaphor into 3D without giving up the advantages of 2D methods. The new compositing approach allows for effects such as selective transparency, occlusion overrides, and soft depth buffering. Furthermore, we show how common manipulation techniques such as masking can be integrated into this concept. These tools behave just like in 2D, but their influence extends beyond a single viewpoint. Since the presented approach makes no assumptions about the underlying rendering algorithms, layers can be generated based on polygonal geometry, volumetric data, point-based representations, or others. Our implementation exploits current graphics hardware and permits real-time interaction and rendering.

Preparation of a Mastership thesis

A detailed account is given of the mechanics of converting the manuscript results from a period of research into a thesis that is also a first-class, readable book.