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The digital darkroom, part 3: Digital presentations in plastic surgery
Scientific Forum
The Digital Darkroom, Part 3: Digital Presentations in Plastic Surgery Gregory M. Galdino, MD; Michael Chiaramonte, MD; and Stanley A. Klatsky, MD
Digital technology is becoming an increasing popular format for societal and other presentations. Part 3 of The Digital Darkroom reviews the kinds of equipment available, the advantages and disadvantages of digital projection, and the most common pitfalls encountered in preparing and presenting material in digital presentations. It closes with a series of recommendations for optimizing your digital presentation and avoiding mistakes that might decrease its effectiveness.
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he culmination of any academic or clinical research project is an invitation to present the material to one’s peers at the specialty’s national or regional society meetings. Recently, digital technology has permitted presentations to be delivered via liquid crystal display (LCD) projectors from laptop computers or central computer systems, eliminating the need for traditional 35-mm slide projection. During the past 5 years, the popularity of this technology has increased markedly at national meetings. At the 2000 Annual Meeting of the American Society for Aesthetic Plastic Surgery (ASAPS), 35 (33%) of 106 presentations were presented digitally; this was up from approximately 5 presentations 4 years ago, according to the ASAPS 2000 audiovisual coordinator (Eric Francis; personal communication). However, new technologies are often embraced blindly, without sufficient critical analyses of their impact. In the case of digital presentations, we have observed several common practices that detract from the presentation content, result in audience inattentiveness, and lead to failures in delivery of the presenter’s information. In this article, we will identify such practices and then propose a set of guidelines that we believe will result in clear, concise presentations with a strong impact on audiences. In addition, we will explore some of the advantages and disadvantages of digital presentations, discuss the equipment needed for digital presentations and some of the projection variables to be considered when one is presenting information digitally, and look briefly at some of the more common software programs available to designers of presentations.
Equipment for the Digital Presentation
From the Johns Hopkins Hospital, Baltimore, MD. Accepted for publication July 7, 2000. Reprint requests: Gregory M. Galdino, MD, Johns Hopkins Hospital, Division of Plastic Surgery, 601 N. Caroline Street, 8130A McElderry, Baltimore, MD 21234. Copyright © 2000 by The American Society for Aesthetic Plastic Surgery, Inc. 1084-0761/2000/$12.00 + 0
Figure 1 illustrates a common setup for a digital presentation. An LCD projector is connected to a laptop computer by means of the projector’s video input (VGA) and the lap-
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Figure 1. Typical setup for a digital presentation. A, LCD projector (1000 ANSI lumens, XGA resolution). B, A 4400-MHz Pentium II laptop computer. C, Port replicator with standard VGA out to LCD projector input. D, The infrared receiver connects to the laptop mouse remote control operation. E, Handheld remote controls for LCD projector operation and mouse control.
top’s video-out port (VGA adapter). For wireless control of the laptop (with mouse control, left and right clicking controls the advancing of slides) and wireless control of the projector, an infrared receiver is connected from the laptop’s P/S2 or serial port. If the projector and laptop have infrared ports for receiving data, there is no need for a cable connection between the two. The presentation can be “beamed” to the projector from across the room. (This type of data transmission is limited by the size of the presentation file; graphics-laden or video-rich presentations should not be made through use of the infrared port because this can dramatically slow the presentation.) A handheld control unit usually accompanies the projector.
Variables Associated With the Digital Projector
tal. Large projectors, most of which are ceiling mountable and may offer advanced features, such as interchangeable lenses, are termed integration projectors or large-venue projectors1; these weigh more than 20 lb. There are 4 types of imaging systems, distinguishable according to the technology used to produce the image.1 • Cathode ray tube (CRT). This common projector type has 3 tubes (red, green, and blue). An electron beam traces the image to produce scan lines. This form of display is strictly analog. Because scan lines are produced, the display is said to be resolution independent, or of variable resolution. In contrast, the digital display types (LCD, DLP, and PDP) use pixels switched off and on in rapid cycles to form an image; they are said to be resolution dependent (or flat matrix), or of fixed resolution.2 • Liquid crystal display (LCD). This type of projector uses LCD technology to form the image.1
Projectors differ from common monitors in that they contain lamps (as light sources) and lenses.1 Projectors are categorized into 3 classes by the projection industry on the basis of size and weight. Ultraportable projectors, which have recently become available on the market and are ideal for the traveling lecturer, weigh less than 8 lb and are often smaller than most laptop computers.2 Desktop projectors are relatively mobile, weighing in at 8 to 20 lb2; these projectors are ideal for the office or hospi-
4. Plasma display panel (PDP). This projector type involves
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• Digital light projector (DLP). This projector type uses very small micromirrors to reflect the light signal in various intensities to produce an image.1 The technology is reminiscent of the “card sections” seen at some football games, in which large images are formed from individually different cards that are displayed together.
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a new and up-and-coming technology that uses a combination of pixels and CRT phosphors filled with neon or xenon gas to produce an image.1 Projectors are characterized by two variables: (1) resolution and (2) light output, or brightness. These variables are important considerations when one is purchasing a projector or planning a presentation. Resolution is described in terms of horizontal and vertical dimensions of pixels on the display. The same terms are also used to describe resolution for computer monitors and laptops. For the best display results, it is highly recommended that the computer’s resolution match the projector resolution. The following acronyms are commonly used to describe resolution: VGA (640 × 480), SVGA (800 × 600), XGA (1024 × 768), SXGA (1280 × 1024), and UXGA (1600 × 1200). XGA is now becoming the standard resolution for display and projection. Resolution of the projector can be the limiting factor of quality for digital photographs, which may be of higher resolution. Thus, all pixels in the image would not be projected with a lower-resolution projector.
Table 1. Advantages of digital presentations 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Minimal equipment Immediacy of review and editing Incorporation of video, sound, graphics, and animation Accessibility Easy viewing Reliability Marketing and education Time savings Elimination of the cost of photographic services Advanced features
video [standard video out]), and black screen. Most functions are also controllable from the handheld unit. Prices of digital projectors have dropped dramatically during the past 2 years. Portable models are now available for as little as $3,000. Ultraportables and desktops generally fall in the range of $3,000 to $10,000. Larger desktops and large-venue projectors cost between $10,000 and $50,000 (or even more).
Brightness is measured and described in terms of ANSI (American National Standards Institute) lumens (a value determined from the product of average light readings measured and image size). Projector lamps affect brightness; the common lamp types used are incandescent, halogen, metal halide (the most common), and xenon arc (the brightest). In most of the portable projectors available today, brightness ranges from 800 to 2500 ANSI lumens. Large-venue projector light output can measure 8000 ANSI lumens. The brightness of the projector is most important when one is evaluating the ambient light in a presentation environment. The ability to project the presentation decreases dramatically as ambient light increases. A low-light environment might require a brightness of only 800 to 1000 ANSI lumens, whereas a well-lighted classroom might require a higher light intensity.
Advantages of Digital Projection
The projector should be level with and squarely aimed at the screen. When this is not possible, the result on the screen is a keystone display (an image wider at the top than on the bottom). A digital projector has an adjustment control for correcting keystoning. It also has controls (either on the projector itself or through use of on-screen menus) for brightness, contrast, and color adjustments, input selection, (some projectors allow multiple input sources, such as multiple computers and S-
• Immediacy of review and editing. Digital presentations can be easily reviewed on computers; additions, edits, and corrections can be made even moments before the presentation time.
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Digital projection offers several advantages over standard slide presentations (Table 1); these help to explain its increased popularity. The advantages are briefly discussed in the following paragraphs. • Minimal equipment. There is no longer any need to carry multiple slide trays to presentations. Today’s typical presentation venue is equipped with a projector and computer system; therefore, all that is required is some type of removable medium, such as a floppy disk, Zip disk, or CD-ROM. When one is going to use another type of computer or a centralized computer system, it is usually a good idea to check the types of media that the system can accommodate. If a projector or computer must be brought along, compact, lightweight equipment makes traveling easy.
• Incorporation of video, sound, graphics, and animation. When they are used effectively, multimedia features can greatly enhance a presentation. Video, accompanied by sound, can assist in the explanation of procedures. Graphic images can be arranged side by
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Table 2. Disadvantages of digital presentations 1. 2. 3. 4.
Cost of equipment Resolution limitations Projection distance Environmental conditions
Disadvantages of Digital Projection Digital projection is associated with several disadvantages as well (Table 2); they are briefly discussed in the following paragraphs.
side, eliminating the need for double projection. Animation, such as the highlighting of graphs and charts, can make the presentation more effective. • Accessibility. A digitally saved presentation can be easily duplicated by copying the file. In addition, individual slides can be copied and pasted from the original presentation to new ones; this obviates the scavenging of slide presentations, which would leave them incomplete. • Easy viewing. Digital presentations can be viewed in the slide layout format, allowing multiple slides to be viewed at one time; this facilitates their arrangement and organization. • Reliability. Traditional slide presentations are frequently plagued with slide jamming, failure of a slide to fall, and rotation and reversal of slides. Digital presentations eliminate mechanical slide problems and also offer much longer lamp life. • Marketing and education. Presentations can be set to run in autoplay mode (for timed automatic viewing and cycling) and can be run from laptops. Potential uses of this feature include patient education and the marketing of products and services. • Efficiency. Jewell and Tebbets2 state that once one has gone through approximately 2 hours of instruction designed to familiarize oneself with the software, the use of digital presentations can save a significant amount of time. In addition, the surgeon retains control over the design and content of the presentation without the need for a service bureau. • Cost effectiveness. The costs of slide duplication, conversion from digital format to slides, and other photographic services can be significant, depending on the volume of presentations given. Some photographic services charge as much as $5.40 per converted slide. For large practices or teaching institutions, digital presentations can offer significant potential savings by eliminating this expense.3 • Advanced features. Predesigned templates, autoformatting of presentations from outlines, and master slide
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design and editing are features of presentation software that can save time.
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• Cost of equipment. Until recently, the high cost of LCD projectors prohibited their purchase by individuals. Even though this cost has dropped dramatically, a projector still requires a significant initial investment. In addition, computers are required for most digital presentations. (Some of the newer projectors on the market are capable of directly accepting removable media, such as PC cards and compact flash cards, eliminating the need for a computer.) Large presentation rooms and auditoriums may require mountable, larger, and brighter projectors; this would increase the initial investment. • Resolution limits. The quality of the presentation— especially if it is graphics-laden or image-intensive—is directly dependent on the resolution of the digital projector if it is of the fixed resolution type. This was initially a problem when projectors were available only at VGA and SVGA resolutions. However, increasing projector resolution has made resolution much less of an issue, except in older projectors. Even the highest resolution available does not match the theoretical resolution of slide projection; it is debatable, however, whether the difference between the two is perceptible by the human eye. • Projection distance. Most digital projectors must be placed at a specific distance from the screen to fill the screen fully and maintain brightness; exceptional in this regard are some large-venue projectors that offer interchangeable lenses. • Environmental conditions. The environmental conditions can dramatically affect the appearance of the presentation, especially with respect to ambient light.
Ten Common Pitfalls in Digital Presentations Potential mistakes that can decrease the effectiveness of a digital presentations are discussed in the following paragraphs. 1.
Choice of text and background colors. One of the most common mistakes in digital presentations is failure to communicate effectively with the audience
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because the colors chosen for title and text do not contrast properly with the background color (light color on light background, dark color on dark background), making the text difficult to read, especially for those audience members farthest from the screen. To achieve the most effective results and communicate information successfully, certain color choices should be avoided when presentations are being designed (Figure 2). Although red text is often used for emphasis, we have observed that it is difficult to separate red text from background, especially at increased distances from the screen. 2.
Complex animations and slide transitions. Another major pitfall in graphics presentations is the practice of incorporating animation and complex slide transitions that can distract the audience from the topic at hand and result in loss of audience focus. There is often a large temptation to “wow” the audience with complex animations of text, movement of graphics or pictures across the slide, and inclusion of fancy slide transitions. We believe that these practices encourage the audience to focus on the action rather than on the information being presented. Text animation, when used sparingly, can effectively make a point of emphasis. However, there appears to be a trend toward overuse of this feaature in most of today’s slide presentations, which reduces their impact. Some of the most distracting uses of animation are the entrance of letters or words one at a time, swirling or spinning of text on the screen, and animations of text that are accompanied by sound effects.
3.
Use of graphics, charts, or pictures. Probably the most effective method of communicating material is through the use of graphics, charts, or pictures. However, certain practices may reduce the effectiveness and visual impact of these tools. As mentioned, color choices can have a profound impact on the effectiveness of the material being communicated. When graphics, charts, or pictures are being labeled, the text color might not contrast effectively with the graphics background, making the text difficult to read. In PowerPoint (Microsoft, Redmond, WA), graphics, charts, and/or pictures can be imported onto the slide and positioned as desired with text or other graphics. Because text and graphics are treated as different objects, the picture can overlap and partially hide the text. A related pitfall is the inclusion of extremely large graphics files (measured in megabytes) in the presentation. Depending on the
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Figure 2. These illustrations show the effects of text and background combinations on slides. A, This text and background combination is poorly chosen. B, The text and background choices on these slides (which follow the recommendations discussed in this article) clearly illustrate the information being presented.
speed of the computer and the random access memory (RAM) available, large-sized graphics files can reduce the speed of the computer and slow transitions between slides. When one is scanning or importing digital photographs for use in digital presentations, the size of the image should not exceed the dimensions of the slide in PowerPoint (width = 10 in; height = 7.5 in). When 2 graphics per slide are being used, the size of the image should approximate
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made before a presentation. PowerPoint treats a graphic (or image) and a block of text as 2 distinct objects acting as layers on the layout, each capable of overlapping and obscuring the other. The order of 2 overlapping objects can be adjusted (by right-clicking on the object and selecting “Order”) so that text can be used to label pictures and/or graphics, provided that the text overlies the graphic. Care must be taken, however, to avoid partially overlapping and obscuring text with graphics or other text boxes (Figure 3).
Figure 3. A, The graphic on this slide partially obscures the text. B, The text and graphic on this slide are correctly positioned.
4 × 5 in. In addition, the maximum resolution needed when a graphic image is being scanned and prepared for use with most LCD projectors is XGA (1024 × 768, or 96 pixels per inch). (See the explanation of LCD projector variables below.) 4.
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Positioning of text/pictures on slides. The dimensions of the slide layout can differ, depending on whether the mode of presentation is digital (on screen: 7.5 × 10 in) or 35-mm slide (on screen: 7.5 × 11.25 in). Changing between the 2 formats will change the dimensions of pictures/graphics and text (making them wider or narrower) if they have already been placed on the slide. The page layout should be determined before the presentation is created. If the format must be changed, pictures/graphics may have to be resized (width-adjusted) and text may have to be repositioned. In any case, the entire presentation should be reviewed and corrections
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5.
Design templates. Design templates are predesigned or custom-designed backgrounds that are offered in presentation software packages, such as PowerPoint. They can have detailed graphics or complex designs that might distract audience members by causing them to focus more on the slide graphics than on the information presented. In addition, custom-designed templates can incorporate pictures or graphics files to act as backgrounds; again, these may detract from the information presented and should be used only for emphasis or title slides.
6.
Computer settings. Although most major society meetings are moving toward use of a central computerized system for the larger sessions, there will still be occasions when presentations are given through use of individual laptop computers. The settings on a laptop can have a profound impact on the smoothness of presentation delivery, especially if the presenter is unfamiliar with thems.
• Screen saver/sleep function. Many laptops have a screen saver that is programmed to start running after the computer has been idle for a designated length of time. Having the screen saver become active during a presentation can be extremely distracting to both presenter and audience and might disrupt the presentation completely. The screen saver can be disabled by rightclicking on the desktop, selecting “Properties,” and then selecting “Screen Saver.” If this fails to prevent the computer from entering the sleep function, the energysaving feature might have to be disabled in the computer’s BIOS (instructions for entering the BIOS are available at start-up). • CRT/LCD. Most laptops have a combination of keys (such as Function/F8) that directs the output of the computer to the computer’s LCD screen, to the LCD projector or CRT monitor (through the VGA connection attached to the projector), or to both the computer
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and LCD projector at once. This setting should be adjusted before the presentation to avoid delays. • Presentation from removable media. Presentations with large graphics files may be slowed when the graphics are presented from removable media (Floppy Disk, Zip Disk, CD-ROM); this is because of the seek time necessary to locate the files and the transfer time to the computer. This can mean long delays (depending on the medium used, the file size, and the amount of computer RAM, as mentioned above). Presentations saved and delivered from the computer’s local hard disk have shorter delays because this setup decreases seek time and transfer time. • Button settings. PowerPoint allows the user to assign custom functions to the right and left mouse buttons on the laptop. Typically, the left button advances the presentation one slide and the right button returns to the previous slide. The presenter should be familiar with the settings so that unnecessary delays can be avoided. • Screen resolution setting. Most laptops allow the display resolution of the screen to be adjusted to different resolutions (VGA, SVGA, XGA). To avoid potential problems, the display resolution setting should match that of the LCD projector. Display resolution can be adjusted by right-clicking on the desktop, selecting “Properties,” and then selecting “Settings.” 7.
8.
9.
Timed presentations. Presentations may be delivered so that the advancing of slides is controlled by a timer. The timing can be adjusted in such a way that all slides advance after the same amount of time or can be set individually for each slide. This can help ensure that a presentation is delivered within an allotted amount of time. The problem with this method is that most presenters, no matter how often they rehearse, vary the timing of their presentations because of anxiety or other factors. We have seen presenters rush or appear confused and leave out important information. Inclusion of information on slides. When one is composing presentations on the computer, it is often tempting to crowd too much information on a slide (Figure 4). Using complex slides packed with data, charts, complex graphs, and/or multiple small images can ruin the effectiveness of the material. In addition, many presenters crowd too many lines of information on a single slide or fail to use bullets effectively. Incorporation of video files (MPEG, AVI, MOV) and
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Figure 4. Crowding of the slide with information obstructs the effectiveness of a presentation. A, An overcrowded slide. B, A slide with a correct layout (as described in the guidelines discussed in this article).
sound files (MPEG3, WAV). It is becoming more and more common to see video and/or sound files embedded in presentations. Used correctly, such files can clearly emphasize certain topics or demonstrate particular procedures. However, poor-quality video and the overuse of sound can detract from otherwise excellent presentations. Sound and video should be used sparingly and for demonstration or emphasis only. Clips should be prepared through use of high-quality equipment under the direction of someone experienced with video capture, editing, and preparation. It should be noted that when a video or sound file is embedded into presentation software, the software assigns a link to the file. Because the file remains separate from the presentation file, it must remain in the same location (in relation to the presentation file) during the actual presentation, or else the file (video
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Table 3. Ten recommendations for digital presentations 1. 2. 3. 4. 5.
Use contrasting colors for text and background. Keep background designs relatively simple. Avoid complex slide transitions. Format text so that it is easy to read. Avoid crowding slides with too much information or too many pictures. 6. Use preset animation use sparingly and only for emphasis. 7. Load and run presentations from the local hard drive. 8. Use timed presentations with caution. 9. Avoid displaying personal pictures. 10. Respect the time limits for your presentation.
software features can cause an audience’s attention to stray, making the impact of a digital presentation less than effective. Simplicity can be creative as well as effective. Following the guidelines listed below (and in Table 3) will ensure the presenter that the message is not lost in a technological light show. (Note: ASAPS, the American Society of Maxillofacial Surgeons (ASMS), the American Society of Plastic Surgeons (ASPS), and the Plastic Surgery Education Foundation (PSEF) have produced a pamphlet summarizing audiovisual guidelines for presenters. These guidelines are provided in brackets in the following paragraphs.) 1.
Use contrasting colors for text and background. Text should contrast sharply with background (dark backgrounds and yellow or white lettering are effective). [Use color for emphasis only; darker, saturated backgrounds work best. Avoid red and green text for the sake of viewers who are color blind].
2.
Keep background designs relatively simple. Avoid using background designs that have actions incorporated, such as PowerPoint’s “Pulse.” If these designs are used, the actions should be disabled. Avoid using designed or customized backgrounds with complex graphics or pictures. Remove the background design from picture image slides by right-clicking on the background and checking “Omit background graphics from master” (apply this only to the slide in question). [Whenever possible, test appearance of background on a projection system before presenting.]
3.
Avoid complex slide transitions. The best slide transition effect is no slide transition effect.
4.
Format text so that it is easy to read, even at the rear of the presentation room. The font size should be 32 to 44 points. The font style should be one that is easy to read. [Use a sans serif typeface such as Helvetica or Arial, 36 point.] Use both upper and lower case letters for better readability
5.
Digital technology can be used to make a good slide show into a great presentation. However, the overuse of
Avoid crowding slides with too much information or too many pictures. No more than 2 images should be placed on a computer slide. The images should be scaled from the corners to fit the slide. [Use 1 heading, no more than 7 lines of text per slide, and no more than 7 words per line.] [ Keep illustrations simple; rounded, simple graphs are recommended over tabular graphs.] [Two simple slides are better than one complicated slide.]
6.
Use preset animation (ie, text entrance) only sparing-
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or sound) will fail to play. For example, if during preparation, the video file was located on the local hard drive in the same folder as the presentation file, it must be present on the medium used to transport the presentation file (such as a Zip disk) in the same relationship (ie, in the same folder) as the PowerPoint presentation file. When video and sound files are being included, the computer used for the delivery must be equipped with the software required to play them (such as QuickTime, Windows Media Player, or Real Player). In addition, common file formats for video (.avi, .mpeg, .mov) and sound (.wav, .mp3) should be used to ensure compatibility. 10. Failure to understand software. Many presenters may choose to have their presentations prepared by third parties, including experts in the preparation of computer presentations. We have observed presentations in which the presenter was unfamiliar with the software by means of which the material was being presented; sometimes, this was software other than typical presentation software, such as PowerPoint. Failing to understand the software used to prepare and deliver the presentation can have unforeseen consequences, such as an inability to navigate through a presentation or even incompatibility with a central computer system’s or laptop’s software. To avoid potential problems, the user should understand the basics of the presenting software and use software that is widely accepted and compatible.
Recommendations
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ly (for emphasis) and in its simplest mode (ie, Appear). Excessive use of animation, graphics, effects, and add-ins such as video and sound intended for emphasis can quickly overshadow the content of a presentation. 7.
Load the presentation onto the hard drive so that no delay occurs when an image is being loaded. The local hard drive has a shorter search-and-access time and a shorter data transfer time than do removable media such as Zip disks and floppy disks. When presentations use large files or contain large graphics files, there may be a significant delay during the transfer or “loading” of the information unless these files are on the hard drive. The amount of RAM in the laptop can also affect performance during graphics-intensive presentations. To avoid any unnecessary delay during a presentation from the hard drive, graphics files should be compressed in JPEG format to reduce file size and ease data transfer and loading when the presentation is being prepared.
8.
Use the timer for automatic slide transitions with great caution, because any error can cause the presenter to appear confused or to rush the presentation if the timings are off. The automatic timer should be disabled to avoid any problems; this ensures a smooth presentation.
9.
Avoid displaying personal pictures. During most societal presentations, the audience is interested in learning the important information in a short amount of time. The presenter should get to the point and avoid the use of “cute” tactics.
10. Respect the time limits set for the presentation. Time
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constraints are usually in effect for a reason. Extending the time may cause the audience to lose interest.
Presentation Software There are several software programs that can be used to compose, edit, and make digital presentations. Two years ago, one of the most well-known presentation software programs, Adobe (formally, Aldus) Persuasion, went off the market. This left Microsoft PowerPoint as the most popular presentation software. Most presentations today are prepared through use of PowerPoint because of its popularity, compatibility, and availability, as well as because of its easy-to-use interface, customizable functions, and powerful organizational structure. The ASAPS/ASMF/ASPS/PSEF guidelines state that all presentations must henceforth be in the Microsoft PowerPoint for Windows format. Although other presentation software programs are available, using one of them may create compatibility issues with other computer systems, especially when a central computer system is involved in the presentation. If you use one of these other programs, check with the host of the computer system to be sure that there are no compatibility issues. Some of the other presentation software programs available (and used at ASAPS 2000) are Kai’s Power Show, Astound, and Macromedia Director. ■
References 1. ICIA/INFOCOMM “Projection Encounter.” Anaheim, CA; June 2000. 2. Jewell ML, Tebbetts JB. Get the picture? Using presentation software to convey your message. Aesthetic Surg Q 1996;16:24-25. 3. Galdino GM, Swier P, Manson PN, Vander Kolk CA. Conversion to digital photography: a model for a large group or teaching practice. Plast Reconstr Surg 2000;106119-124.
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The Digital Darkroom, Part 3: Digital Presentations in Plastic Surgery Gregory M. Galdino, MD; Michael Chiaramonte, MD; and Stanley A. Klatsky, MD
Digital technology is becoming an increasing popular format for societal and other presentations. Part 3 of The Digital Darkroom reviews the kinds of equipment available, the advantages and disadvantages of digital projection, and the most common pitfalls encountered in preparing and presenting material in digital presentations. It closes with a series of recommendations for optimizing your digital presentation and avoiding mistakes that might decrease its effectiveness.
T
he culmination of any academic or clinical research project is an invitation to present the material to one’s peers at the specialty’s national or regional society meetings. Recently, digital technology has permitted presentations to be delivered via liquid crystal display (LCD) projectors from laptop computers or central computer systems, eliminating the need for traditional 35-mm slide projection. During the past 5 years, the popularity of this technology has increased markedly at national meetings. At the 2000 Annual Meeting of the American Society for Aesthetic Plastic Surgery (ASAPS), 35 (33%) of 106 presentations were presented digitally; this was up from approximately 5 presentations 4 years ago, according to the ASAPS 2000 audiovisual coordinator (Eric Francis; personal communication). However, new technologies are often embraced blindly, without sufficient critical analyses of their impact. In the case of digital presentations, we have observed several common practices that detract from the presentation content, result in audience inattentiveness, and lead to failures in delivery of the presenter’s information. In this article, we will identify such practices and then propose a set of guidelines that we believe will result in clear, concise presentations with a strong impact on audiences. In addition, we will explore some of the advantages and disadvantages of digital presentations, discuss the equipment needed for digital presentations and some of the projection variables to be considered when one is presenting information digitally, and look briefly at some of the more common software programs available to designers of presentations.
Equipment for the Digital Presentation
From the Johns Hopkins Hospital, Baltimore, MD. Accepted for publication July 7, 2000. Reprint requests: Gregory M. Galdino, MD, Johns Hopkins Hospital, Division of Plastic Surgery, 601 N. Caroline Street, 8130A McElderry, Baltimore, MD 21234. Copyright © 2000 by The American Society for Aesthetic Plastic Surgery, Inc. 1084-0761/2000/$12.00 + 0
Figure 1 illustrates a common setup for a digital presentation. An LCD projector is connected to a laptop computer by means of the projector’s video input (VGA) and the lap-
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Figure 1. Typical setup for a digital presentation. A, LCD projector (1000 ANSI lumens, XGA resolution). B, A 4400-MHz Pentium II laptop computer. C, Port replicator with standard VGA out to LCD projector input. D, The infrared receiver connects to the laptop mouse remote control operation. E, Handheld remote controls for LCD projector operation and mouse control.
top’s video-out port (VGA adapter). For wireless control of the laptop (with mouse control, left and right clicking controls the advancing of slides) and wireless control of the projector, an infrared receiver is connected from the laptop’s P/S2 or serial port. If the projector and laptop have infrared ports for receiving data, there is no need for a cable connection between the two. The presentation can be “beamed” to the projector from across the room. (This type of data transmission is limited by the size of the presentation file; graphics-laden or video-rich presentations should not be made through use of the infrared port because this can dramatically slow the presentation.) A handheld control unit usually accompanies the projector.
Variables Associated With the Digital Projector
tal. Large projectors, most of which are ceiling mountable and may offer advanced features, such as interchangeable lenses, are termed integration projectors or large-venue projectors1; these weigh more than 20 lb. There are 4 types of imaging systems, distinguishable according to the technology used to produce the image.1 • Cathode ray tube (CRT). This common projector type has 3 tubes (red, green, and blue). An electron beam traces the image to produce scan lines. This form of display is strictly analog. Because scan lines are produced, the display is said to be resolution independent, or of variable resolution. In contrast, the digital display types (LCD, DLP, and PDP) use pixels switched off and on in rapid cycles to form an image; they are said to be resolution dependent (or flat matrix), or of fixed resolution.2 • Liquid crystal display (LCD). This type of projector uses LCD technology to form the image.1
Projectors differ from common monitors in that they contain lamps (as light sources) and lenses.1 Projectors are categorized into 3 classes by the projection industry on the basis of size and weight. Ultraportable projectors, which have recently become available on the market and are ideal for the traveling lecturer, weigh less than 8 lb and are often smaller than most laptop computers.2 Desktop projectors are relatively mobile, weighing in at 8 to 20 lb2; these projectors are ideal for the office or hospi-
4. Plasma display panel (PDP). This projector type involves
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• Digital light projector (DLP). This projector type uses very small micromirrors to reflect the light signal in various intensities to produce an image.1 The technology is reminiscent of the “card sections” seen at some football games, in which large images are formed from individually different cards that are displayed together.
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a new and up-and-coming technology that uses a combination of pixels and CRT phosphors filled with neon or xenon gas to produce an image.1 Projectors are characterized by two variables: (1) resolution and (2) light output, or brightness. These variables are important considerations when one is purchasing a projector or planning a presentation. Resolution is described in terms of horizontal and vertical dimensions of pixels on the display. The same terms are also used to describe resolution for computer monitors and laptops. For the best display results, it is highly recommended that the computer’s resolution match the projector resolution. The following acronyms are commonly used to describe resolution: VGA (640 × 480), SVGA (800 × 600), XGA (1024 × 768), SXGA (1280 × 1024), and UXGA (1600 × 1200). XGA is now becoming the standard resolution for display and projection. Resolution of the projector can be the limiting factor of quality for digital photographs, which may be of higher resolution. Thus, all pixels in the image would not be projected with a lower-resolution projector.
Table 1. Advantages of digital presentations 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Minimal equipment Immediacy of review and editing Incorporation of video, sound, graphics, and animation Accessibility Easy viewing Reliability Marketing and education Time savings Elimination of the cost of photographic services Advanced features
video [standard video out]), and black screen. Most functions are also controllable from the handheld unit. Prices of digital projectors have dropped dramatically during the past 2 years. Portable models are now available for as little as $3,000. Ultraportables and desktops generally fall in the range of $3,000 to $10,000. Larger desktops and large-venue projectors cost between $10,000 and $50,000 (or even more).
Brightness is measured and described in terms of ANSI (American National Standards Institute) lumens (a value determined from the product of average light readings measured and image size). Projector lamps affect brightness; the common lamp types used are incandescent, halogen, metal halide (the most common), and xenon arc (the brightest). In most of the portable projectors available today, brightness ranges from 800 to 2500 ANSI lumens. Large-venue projector light output can measure 8000 ANSI lumens. The brightness of the projector is most important when one is evaluating the ambient light in a presentation environment. The ability to project the presentation decreases dramatically as ambient light increases. A low-light environment might require a brightness of only 800 to 1000 ANSI lumens, whereas a well-lighted classroom might require a higher light intensity.
Advantages of Digital Projection
The projector should be level with and squarely aimed at the screen. When this is not possible, the result on the screen is a keystone display (an image wider at the top than on the bottom). A digital projector has an adjustment control for correcting keystoning. It also has controls (either on the projector itself or through use of on-screen menus) for brightness, contrast, and color adjustments, input selection, (some projectors allow multiple input sources, such as multiple computers and S-
• Immediacy of review and editing. Digital presentations can be easily reviewed on computers; additions, edits, and corrections can be made even moments before the presentation time.
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Digital projection offers several advantages over standard slide presentations (Table 1); these help to explain its increased popularity. The advantages are briefly discussed in the following paragraphs. • Minimal equipment. There is no longer any need to carry multiple slide trays to presentations. Today’s typical presentation venue is equipped with a projector and computer system; therefore, all that is required is some type of removable medium, such as a floppy disk, Zip disk, or CD-ROM. When one is going to use another type of computer or a centralized computer system, it is usually a good idea to check the types of media that the system can accommodate. If a projector or computer must be brought along, compact, lightweight equipment makes traveling easy.
• Incorporation of video, sound, graphics, and animation. When they are used effectively, multimedia features can greatly enhance a presentation. Video, accompanied by sound, can assist in the explanation of procedures. Graphic images can be arranged side by
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Table 2. Disadvantages of digital presentations 1. 2. 3. 4.
Cost of equipment Resolution limitations Projection distance Environmental conditions
Disadvantages of Digital Projection Digital projection is associated with several disadvantages as well (Table 2); they are briefly discussed in the following paragraphs.
side, eliminating the need for double projection. Animation, such as the highlighting of graphs and charts, can make the presentation more effective. • Accessibility. A digitally saved presentation can be easily duplicated by copying the file. In addition, individual slides can be copied and pasted from the original presentation to new ones; this obviates the scavenging of slide presentations, which would leave them incomplete. • Easy viewing. Digital presentations can be viewed in the slide layout format, allowing multiple slides to be viewed at one time; this facilitates their arrangement and organization. • Reliability. Traditional slide presentations are frequently plagued with slide jamming, failure of a slide to fall, and rotation and reversal of slides. Digital presentations eliminate mechanical slide problems and also offer much longer lamp life. • Marketing and education. Presentations can be set to run in autoplay mode (for timed automatic viewing and cycling) and can be run from laptops. Potential uses of this feature include patient education and the marketing of products and services. • Efficiency. Jewell and Tebbets2 state that once one has gone through approximately 2 hours of instruction designed to familiarize oneself with the software, the use of digital presentations can save a significant amount of time. In addition, the surgeon retains control over the design and content of the presentation without the need for a service bureau. • Cost effectiveness. The costs of slide duplication, conversion from digital format to slides, and other photographic services can be significant, depending on the volume of presentations given. Some photographic services charge as much as $5.40 per converted slide. For large practices or teaching institutions, digital presentations can offer significant potential savings by eliminating this expense.3 • Advanced features. Predesigned templates, autoformatting of presentations from outlines, and master slide
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design and editing are features of presentation software that can save time.
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• Cost of equipment. Until recently, the high cost of LCD projectors prohibited their purchase by individuals. Even though this cost has dropped dramatically, a projector still requires a significant initial investment. In addition, computers are required for most digital presentations. (Some of the newer projectors on the market are capable of directly accepting removable media, such as PC cards and compact flash cards, eliminating the need for a computer.) Large presentation rooms and auditoriums may require mountable, larger, and brighter projectors; this would increase the initial investment. • Resolution limits. The quality of the presentation— especially if it is graphics-laden or image-intensive—is directly dependent on the resolution of the digital projector if it is of the fixed resolution type. This was initially a problem when projectors were available only at VGA and SVGA resolutions. However, increasing projector resolution has made resolution much less of an issue, except in older projectors. Even the highest resolution available does not match the theoretical resolution of slide projection; it is debatable, however, whether the difference between the two is perceptible by the human eye. • Projection distance. Most digital projectors must be placed at a specific distance from the screen to fill the screen fully and maintain brightness; exceptional in this regard are some large-venue projectors that offer interchangeable lenses. • Environmental conditions. The environmental conditions can dramatically affect the appearance of the presentation, especially with respect to ambient light.
Ten Common Pitfalls in Digital Presentations Potential mistakes that can decrease the effectiveness of a digital presentations are discussed in the following paragraphs. 1.
Choice of text and background colors. One of the most common mistakes in digital presentations is failure to communicate effectively with the audience
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because the colors chosen for title and text do not contrast properly with the background color (light color on light background, dark color on dark background), making the text difficult to read, especially for those audience members farthest from the screen. To achieve the most effective results and communicate information successfully, certain color choices should be avoided when presentations are being designed (Figure 2). Although red text is often used for emphasis, we have observed that it is difficult to separate red text from background, especially at increased distances from the screen. 2.
Complex animations and slide transitions. Another major pitfall in graphics presentations is the practice of incorporating animation and complex slide transitions that can distract the audience from the topic at hand and result in loss of audience focus. There is often a large temptation to “wow” the audience with complex animations of text, movement of graphics or pictures across the slide, and inclusion of fancy slide transitions. We believe that these practices encourage the audience to focus on the action rather than on the information being presented. Text animation, when used sparingly, can effectively make a point of emphasis. However, there appears to be a trend toward overuse of this feaature in most of today’s slide presentations, which reduces their impact. Some of the most distracting uses of animation are the entrance of letters or words one at a time, swirling or spinning of text on the screen, and animations of text that are accompanied by sound effects.
3.
Use of graphics, charts, or pictures. Probably the most effective method of communicating material is through the use of graphics, charts, or pictures. However, certain practices may reduce the effectiveness and visual impact of these tools. As mentioned, color choices can have a profound impact on the effectiveness of the material being communicated. When graphics, charts, or pictures are being labeled, the text color might not contrast effectively with the graphics background, making the text difficult to read. In PowerPoint (Microsoft, Redmond, WA), graphics, charts, and/or pictures can be imported onto the slide and positioned as desired with text or other graphics. Because text and graphics are treated as different objects, the picture can overlap and partially hide the text. A related pitfall is the inclusion of extremely large graphics files (measured in megabytes) in the presentation. Depending on the
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Figure 2. These illustrations show the effects of text and background combinations on slides. A, This text and background combination is poorly chosen. B, The text and background choices on these slides (which follow the recommendations discussed in this article) clearly illustrate the information being presented.
speed of the computer and the random access memory (RAM) available, large-sized graphics files can reduce the speed of the computer and slow transitions between slides. When one is scanning or importing digital photographs for use in digital presentations, the size of the image should not exceed the dimensions of the slide in PowerPoint (width = 10 in; height = 7.5 in). When 2 graphics per slide are being used, the size of the image should approximate
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made before a presentation. PowerPoint treats a graphic (or image) and a block of text as 2 distinct objects acting as layers on the layout, each capable of overlapping and obscuring the other. The order of 2 overlapping objects can be adjusted (by right-clicking on the object and selecting “Order”) so that text can be used to label pictures and/or graphics, provided that the text overlies the graphic. Care must be taken, however, to avoid partially overlapping and obscuring text with graphics or other text boxes (Figure 3).
Figure 3. A, The graphic on this slide partially obscures the text. B, The text and graphic on this slide are correctly positioned.
4 × 5 in. In addition, the maximum resolution needed when a graphic image is being scanned and prepared for use with most LCD projectors is XGA (1024 × 768, or 96 pixels per inch). (See the explanation of LCD projector variables below.) 4.
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Positioning of text/pictures on slides. The dimensions of the slide layout can differ, depending on whether the mode of presentation is digital (on screen: 7.5 × 10 in) or 35-mm slide (on screen: 7.5 × 11.25 in). Changing between the 2 formats will change the dimensions of pictures/graphics and text (making them wider or narrower) if they have already been placed on the slide. The page layout should be determined before the presentation is created. If the format must be changed, pictures/graphics may have to be resized (width-adjusted) and text may have to be repositioned. In any case, the entire presentation should be reviewed and corrections
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5.
Design templates. Design templates are predesigned or custom-designed backgrounds that are offered in presentation software packages, such as PowerPoint. They can have detailed graphics or complex designs that might distract audience members by causing them to focus more on the slide graphics than on the information presented. In addition, custom-designed templates can incorporate pictures or graphics files to act as backgrounds; again, these may detract from the information presented and should be used only for emphasis or title slides.
6.
Computer settings. Although most major society meetings are moving toward use of a central computerized system for the larger sessions, there will still be occasions when presentations are given through use of individual laptop computers. The settings on a laptop can have a profound impact on the smoothness of presentation delivery, especially if the presenter is unfamiliar with thems.
• Screen saver/sleep function. Many laptops have a screen saver that is programmed to start running after the computer has been idle for a designated length of time. Having the screen saver become active during a presentation can be extremely distracting to both presenter and audience and might disrupt the presentation completely. The screen saver can be disabled by rightclicking on the desktop, selecting “Properties,” and then selecting “Screen Saver.” If this fails to prevent the computer from entering the sleep function, the energysaving feature might have to be disabled in the computer’s BIOS (instructions for entering the BIOS are available at start-up). • CRT/LCD. Most laptops have a combination of keys (such as Function/F8) that directs the output of the computer to the computer’s LCD screen, to the LCD projector or CRT monitor (through the VGA connection attached to the projector), or to both the computer
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and LCD projector at once. This setting should be adjusted before the presentation to avoid delays. • Presentation from removable media. Presentations with large graphics files may be slowed when the graphics are presented from removable media (Floppy Disk, Zip Disk, CD-ROM); this is because of the seek time necessary to locate the files and the transfer time to the computer. This can mean long delays (depending on the medium used, the file size, and the amount of computer RAM, as mentioned above). Presentations saved and delivered from the computer’s local hard disk have shorter delays because this setup decreases seek time and transfer time. • Button settings. PowerPoint allows the user to assign custom functions to the right and left mouse buttons on the laptop. Typically, the left button advances the presentation one slide and the right button returns to the previous slide. The presenter should be familiar with the settings so that unnecessary delays can be avoided. • Screen resolution setting. Most laptops allow the display resolution of the screen to be adjusted to different resolutions (VGA, SVGA, XGA). To avoid potential problems, the display resolution setting should match that of the LCD projector. Display resolution can be adjusted by right-clicking on the desktop, selecting “Properties,” and then selecting “Settings.” 7.
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Timed presentations. Presentations may be delivered so that the advancing of slides is controlled by a timer. The timing can be adjusted in such a way that all slides advance after the same amount of time or can be set individually for each slide. This can help ensure that a presentation is delivered within an allotted amount of time. The problem with this method is that most presenters, no matter how often they rehearse, vary the timing of their presentations because of anxiety or other factors. We have seen presenters rush or appear confused and leave out important information. Inclusion of information on slides. When one is composing presentations on the computer, it is often tempting to crowd too much information on a slide (Figure 4). Using complex slides packed with data, charts, complex graphs, and/or multiple small images can ruin the effectiveness of the material. In addition, many presenters crowd too many lines of information on a single slide or fail to use bullets effectively. Incorporation of video files (MPEG, AVI, MOV) and
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Figure 4. Crowding of the slide with information obstructs the effectiveness of a presentation. A, An overcrowded slide. B, A slide with a correct layout (as described in the guidelines discussed in this article).
sound files (MPEG3, WAV). It is becoming more and more common to see video and/or sound files embedded in presentations. Used correctly, such files can clearly emphasize certain topics or demonstrate particular procedures. However, poor-quality video and the overuse of sound can detract from otherwise excellent presentations. Sound and video should be used sparingly and for demonstration or emphasis only. Clips should be prepared through use of high-quality equipment under the direction of someone experienced with video capture, editing, and preparation. It should be noted that when a video or sound file is embedded into presentation software, the software assigns a link to the file. Because the file remains separate from the presentation file, it must remain in the same location (in relation to the presentation file) during the actual presentation, or else the file (video
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Table 3. Ten recommendations for digital presentations 1. 2. 3. 4. 5.
Use contrasting colors for text and background. Keep background designs relatively simple. Avoid complex slide transitions. Format text so that it is easy to read. Avoid crowding slides with too much information or too many pictures. 6. Use preset animation use sparingly and only for emphasis. 7. Load and run presentations from the local hard drive. 8. Use timed presentations with caution. 9. Avoid displaying personal pictures. 10. Respect the time limits for your presentation.
software features can cause an audience’s attention to stray, making the impact of a digital presentation less than effective. Simplicity can be creative as well as effective. Following the guidelines listed below (and in Table 3) will ensure the presenter that the message is not lost in a technological light show. (Note: ASAPS, the American Society of Maxillofacial Surgeons (ASMS), the American Society of Plastic Surgeons (ASPS), and the Plastic Surgery Education Foundation (PSEF) have produced a pamphlet summarizing audiovisual guidelines for presenters. These guidelines are provided in brackets in the following paragraphs.) 1.
Use contrasting colors for text and background. Text should contrast sharply with background (dark backgrounds and yellow or white lettering are effective). [Use color for emphasis only; darker, saturated backgrounds work best. Avoid red and green text for the sake of viewers who are color blind].
2.
Keep background designs relatively simple. Avoid using background designs that have actions incorporated, such as PowerPoint’s “Pulse.” If these designs are used, the actions should be disabled. Avoid using designed or customized backgrounds with complex graphics or pictures. Remove the background design from picture image slides by right-clicking on the background and checking “Omit background graphics from master” (apply this only to the slide in question). [Whenever possible, test appearance of background on a projection system before presenting.]
3.
Avoid complex slide transitions. The best slide transition effect is no slide transition effect.
4.
Format text so that it is easy to read, even at the rear of the presentation room. The font size should be 32 to 44 points. The font style should be one that is easy to read. [Use a sans serif typeface such as Helvetica or Arial, 36 point.] Use both upper and lower case letters for better readability
5.
Digital technology can be used to make a good slide show into a great presentation. However, the overuse of
Avoid crowding slides with too much information or too many pictures. No more than 2 images should be placed on a computer slide. The images should be scaled from the corners to fit the slide. [Use 1 heading, no more than 7 lines of text per slide, and no more than 7 words per line.] [ Keep illustrations simple; rounded, simple graphs are recommended over tabular graphs.] [Two simple slides are better than one complicated slide.]
6.
Use preset animation (ie, text entrance) only sparing-
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or sound) will fail to play. For example, if during preparation, the video file was located on the local hard drive in the same folder as the presentation file, it must be present on the medium used to transport the presentation file (such as a Zip disk) in the same relationship (ie, in the same folder) as the PowerPoint presentation file. When video and sound files are being included, the computer used for the delivery must be equipped with the software required to play them (such as QuickTime, Windows Media Player, or Real Player). In addition, common file formats for video (.avi, .mpeg, .mov) and sound (.wav, .mp3) should be used to ensure compatibility. 10. Failure to understand software. Many presenters may choose to have their presentations prepared by third parties, including experts in the preparation of computer presentations. We have observed presentations in which the presenter was unfamiliar with the software by means of which the material was being presented; sometimes, this was software other than typical presentation software, such as PowerPoint. Failing to understand the software used to prepare and deliver the presentation can have unforeseen consequences, such as an inability to navigate through a presentation or even incompatibility with a central computer system’s or laptop’s software. To avoid potential problems, the user should understand the basics of the presenting software and use software that is widely accepted and compatible.
Recommendations
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ly (for emphasis) and in its simplest mode (ie, Appear). Excessive use of animation, graphics, effects, and add-ins such as video and sound intended for emphasis can quickly overshadow the content of a presentation. 7.
Load the presentation onto the hard drive so that no delay occurs when an image is being loaded. The local hard drive has a shorter search-and-access time and a shorter data transfer time than do removable media such as Zip disks and floppy disks. When presentations use large files or contain large graphics files, there may be a significant delay during the transfer or “loading” of the information unless these files are on the hard drive. The amount of RAM in the laptop can also affect performance during graphics-intensive presentations. To avoid any unnecessary delay during a presentation from the hard drive, graphics files should be compressed in JPEG format to reduce file size and ease data transfer and loading when the presentation is being prepared.
8.
Use the timer for automatic slide transitions with great caution, because any error can cause the presenter to appear confused or to rush the presentation if the timings are off. The automatic timer should be disabled to avoid any problems; this ensures a smooth presentation.
9.
Avoid displaying personal pictures. During most societal presentations, the audience is interested in learning the important information in a short amount of time. The presenter should get to the point and avoid the use of “cute” tactics.
10. Respect the time limits set for the presentation. Time
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constraints are usually in effect for a reason. Extending the time may cause the audience to lose interest.
Presentation Software There are several software programs that can be used to compose, edit, and make digital presentations. Two years ago, one of the most well-known presentation software programs, Adobe (formally, Aldus) Persuasion, went off the market. This left Microsoft PowerPoint as the most popular presentation software. Most presentations today are prepared through use of PowerPoint because of its popularity, compatibility, and availability, as well as because of its easy-to-use interface, customizable functions, and powerful organizational structure. The ASAPS/ASMF/ASPS/PSEF guidelines state that all presentations must henceforth be in the Microsoft PowerPoint for Windows format. Although other presentation software programs are available, using one of them may create compatibility issues with other computer systems, especially when a central computer system is involved in the presentation. If you use one of these other programs, check with the host of the computer system to be sure that there are no compatibility issues. Some of the other presentation software programs available (and used at ASAPS 2000) are Kai’s Power Show, Astound, and Macromedia Director. ■
References 1. ICIA/INFOCOMM “Projection Encounter.” Anaheim, CA; June 2000. 2. Jewell ML, Tebbetts JB. Get the picture? Using presentation software to convey your message. Aesthetic Surg Q 1996;16:24-25. 3. Galdino GM, Swier P, Manson PN, Vander Kolk CA. Conversion to digital photography: a model for a large group or teaching practice. Plast Reconstr Surg 2000;106119-124.
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