RESUSCITATING ART

RESUSCITATING ARTtor ercleve

IntroThank youNot much time for an interactive sessionthe most popular and unoriginal slide in this entire conference (especially amongst us do-gooder FOAM lot)

No conflicts of interest

But to avoid bitter disappointment at the end of this talkand in order to bring things out in the open right at the startI do have something to declare

I am no great artist

X

Not particularly good at drawing pictures,And just in case you were hoping for lessons in animation and making video, I am not particularly good at motion pictures

X

X

And whilst this workshop will cover some elements of music and sound, I am also certainly no Leonard BernsteinIm just your average, mediocre

Which is good, because everything I show you here today, you can do,and probably a little bit better.

PreworkshopSoftwareVector vs raster graphicsResolutionFile compression3D anatomy graphics resourcesCopyright

Very dryVery dullNot covered todayQuestions after the workshop

OutlineCreating an infographicExamples of key conceptsProject briefWorking groupsReview

Thank you for filling in the survey monkeyFrom that survey I have decided that we are going to dive straight in and work through an infographic.

Information graphics or infographics are graphic visual representations of information, data or knowledge intended to present complex information quickly and clearly.[1][2] They can improve cognition by utilizing graphics to enhance the human visual systems ability to see patterns and trends.[3][4] The process of creating infographics can be referred to as data visualization, information design, or information architecture.[2]Infographics have been around for many years and recently the proliferation of a number of easy-to-use, free tools have made the creation of infographics available to a large segment of the population. Social media sites such as Facebook and Twitter have also allowed for individual infographics to be spread among many people around the world.In newspapers, infographics are commonly used to show the weather, as well as maps, site plans, and graphs for statistical data. Some books are almost entirely made up of information graphics, such as David Macaulay's The Way Things Work. The Snapshots in USA Today are also an example of simple infographics used to convey news and current events.[5]Modern maps, especially route maps for transit systems, use infographic techniques to integrate a variety of information, such as the conceptual layout of the transit network, transfer points, and local landmarks. Public transportation maps, such as those for the Washington Metro and the London Underground, are well-known infographics. Public places such as transit terminals usually have some sort of integrated "signage system" with standardized icons and stylized maps.In his 1983 'landmark book' The Visual Display of Quantitative Information, Edward Tufte defines 'graphical displays' in the following passage:"Graphical displays should:show the datainduce the viewer to think about the substance rather than about methodology, graphic design, the technology of graphic production or something elseavoid distorting what the data have to saypresent many numbers in a small spacemake large data sets coherentencourage the eye to compare different pieces of datareveal the data at several levels of detail, from a broad overview to the fine structure.serve a reasonably clear purpose: description, exploration, tabulation or decoration.be closely integrated with the statistical and verbal descriptions of a data set.Graphics reveal data. Indeed graphics can be more precise and revealing than conventional statistical computations."[6]While contemporary infographics often deal with 'qualitative' or soft subjects, generally speaking Tufte's 1983 definition still speaks, in a broad sense, to what infographics are, and what they dowhich is to condense large amounts of information into a form where it will be more easily absorbed by the reader.

InfographicWhat concepts do I want to bring togetherCollect informationCull, simplify and collateTranslate into an image

Information graphics or infographics are graphic visual representations of information, data or knowledge intended to present complex information quickly and clearly. They can improve cognition by utilizing graphics to enhance the human visual systems ability to see patterns and trends. The process of creating infographics can be referred to as data visualization, information design, or information architecture. (en.wikipedia.org/wiki/Infographic)

what image resources will you use?what software will you need?resolution?format / compression?

What concepts do I want to bring together?

what information is being conveyedheart > vasculaturevasculature > MIleads > heartleads > vasculatureleads > MI

Collect information

Collect all the information availableMay include many resources: Rule of 4 paper, Clinical Neuroanatomy, Instant anatomy, Visual Body 3DOnly then will you recognise patterns and understand how the information is related

PLAY NEXT SLIDE VOLUME SO VOICE IS STILL AUDIBLEvascular supply > brain stembrain stem > tractstracts > CN functiontracts > spinal cordspinal cord > peripheral nerve function

If you have ever wondered how a Horners syndrome could be associated with ipsilateral ataxia and contralateral alteration in temperature sensation? Or, why you should not be surprised to find a III nerve palsy, with a contralateral hemiparesis and loss of vibration sense? If you answered yes to these questions then you should read Peter Gates The Rule of 4 of the Brainstem (Int Med J 2005;263-266 PDF).

In this beautifully written paper, Gates devises a system of approaching clinical brainstem neuroanatomy in a series of 4 simple rules. It is elegant, by explaining only that which can be detected by a basic neurological examination, and it is practical, by offering a system that can be easily remembered.

Whilst well written, the illustrations unfortunately did not reflect the simplicity of the text. Given the limitations of the images, I found myself having to rewrite the text into several tables in order to grasp the concept of the paper.There are 4 cranial nerves in the medulla, 4 in the pons and 4 above the ponsThe 4 motor nuclei that are above the nuclei that are in the midline, are those that divide equally into 12, except for I and II, that is III, IV, VI and XII. V, VII, IX and XI are in the lateral brainstemThere are 4 columns in the midline beginning with M.There are 4 columns to the side beginning with S. (I added a fifth column to help visualize the location of the lateral 5 nerves)Originally, I wanted to draw these lines of latitude (rules 1 and 2) and longitude (rules 3 and 4) directly onto a picture of the brainstem (see background image). Whilst this would have been more accurate, I opted rather to accentuate the principles of latitude and longitude by using a 39 grid. The 3 being the medulla, pons and midbrain, and the 9 being the 4 medial columns and the 4+1 lateral columns.Next, I noticed that there were 4 columns that were in fact related to spinal tracts. Would it not be helpful to show that the medial lemniscus is the continuation of the posterior column, or that the spinothalamic pathway is in fact an extension of the lateral spinothalamic tract? Prior knowledge of spinal cord lesions would then facilitate an understanding of the brainstem pathology. It would also highlight why most clinical findings are contralateral to the cranial nerve lesion.

This leads us to the next aspect of the paper, the bringing together of form (neuroanatomy) and function (clinical findings). The illustration would have to show the clinical finding, for any given lesion on the grid. The image would have to include one side of the face and both sides of the body. For simplicity, I decided to concentrate on what you would expect to find, for a left sided brainstem lesion.Also, there were 2 columns, one medial and one lateral, which stuck out like a sore thumb. The medial longitudinal fasciculus and the (lateral) sympathetic pathway would require a separate note (top right) to illustrate the clinic findings of a Horners syndrome and internuclear opthalmoplegia.

Finally, something was still missing. A clue to that component is found on the opening line of the paper:The rule of 4 is a simple method developed to help students of neurology to remember the anatomy of the brainstem and thus the features of the various brainstem vascular syndromes

The rule of 4 does not just link neuroanatomical lesions to clinical signs, but also identifies the underlying vascular lesion causing them. The illustration would have to include a partial Circle of Willis divided into 6 vascular areas.

It is a known truth, that if you were to use the tube map of London to help navigate your walk from Paddington to Piccadilly Circus, you had better bring a compass, a packed lunch and camping gear. The tube map sacrifices geographical accuracy for coherent simplicity. Many more commuter hours were saved in providing a quick route planner, than there were wasted in encouraging commuters to wait for the next train from Leicester Square to Covent Garden. I hope I have done this paper justice in providing such a route planner of the brainstem. If only the London Underground could be as straightforward as clinical neuroanatomy.

Cull simplify collate

Wikipedia

wikipedia.org/wiki/French_invasion_of_Russia

Examples of width, vector and heightFrench invasion of Russia.The French Invasion of Russia (French: Campagne de Russie) or the Patriotic War of 1812 (Russian: 1812 ) began on 24 June 1812 when Napoleon's Grande Arme crossed the Neman River in an attempt to engage and defeat the Russian army. Napoleon hoped to compel Tsar Alexander I of Russia to cease trading with British merchants through proxies in an effort to pressure the United Kingdom to sue for peace. The official political aim of the campaign was to liberate Poland from the threat of Russia. Napoleon named the campaign the Second Polish War to curry favor with the Poles and provide a political pretense for his actions.The Grande Arme was a very large force, numbering approximately half a million men (sources differ) from several different nations. Through a series of long marches Napoleon pushed the army rapidly through Western Russia in an attempt to bring the Russian army to battle, winning a number of minor engagements and a major battle at Smolensk in August. Napoleon hoped the battle would mean an end of the march into Russia, but the Russian army slipped away from the engagement and continued to retreat into Russia, while leaving Smolensk to burn.Plans Napoleon had made to quarter at Smolensk were abandoned, and he pressed his army on after the Russians.As the Russian army fell back Cossacks were given the task of burning villages, towns and crops. This was intended to deny the invaders the option of living off the land. These scorched-earth tactics greatly surprised and disturbed the French, as the willingness of the Russians to destroy their own territory and harm their own people was difficult for the French to comprehend. The actions forced the French to rely on a supply system that was incapable of feeding the large army in the field. Starvation and privation compelled French soldiers to leave their camps at night in search of food. These men were frequently confronted by parties of Cossacks, who captured or killed them.The Russian army retreated into Russia for almost three months. The continual retreat and the loss of lands to the French upset the Russian nobility. They pressured Alexander I to relieve the commander of the Russian army, Field Marshal Barclay. Alexander I complied, appointing an old veteran, Prince Mikhail Kutuzov, to take over command of the army.On 7 September the French caught up with the Russian army which had dug itself in on hillsides before a small town called Borodino, seventy miles west of Moscow. The battle that followed was the largest and bloodiest single-day action of the Napoleonic Wars, involving more than 250,000 soldiers and resulting in 70,000 casualties. The French gained a victory, but at the cost of 49 general officers and thousands of men. The Russian army was able to extricate itself and withdrew the following day, leaving the French without the decisive victory Napoleon sought.Napoleon entered Moscow a week later. In another turn of events the French found puzzling, there was no delegation to meet the Emperor. The Russians had evacuated the city, and the city's governor, Count Fyodor Rostopchin, had ordered the city to be burnt. Napoleon's hopes had been set upon a victorious end to his campaign, but victory in the field did not yield him victory in the war. The loss of Moscow did not compel Alexander I to sue for peace, and both sides were aware that Napoleon's position grew worse with each passing day. Napoleon stayed on in Moscow looking to negotiate a peace, his hopes fed in part by a disinformation campaign informing the Emperor of supposed discontent and fading morale in the Russian camp. After staying a month Napoleon moved his army out southwest toward Kaluga, where Kutusov was encamped with the Russian army.The French advance toward Kaluga was checked by a Russian corps. Napoleon tried once more to engage the Russian army for a decisive action at the Battle of Maloyaroslavets. Despite holding a superior position, the Russians retreated following a sharp engagement, confirming that the Russians would not commit themselves to a pitched battle. His troops exhausted, with few rations, no winter clothing, and his remaining horses in poor condition, Napoleon was forced to retreat. He hoped to reach supplies at Smolensk and later at Vilnius. In the weeks that followed the Grande Arme starved and suffered from the onset of the Russian Winter. Lack of food and fodder for the horses, hypothermia from the bitter cold and persistent attacks upon isolated troops from Russian peasants and Cossacks led to great losses in men, and a general loss of discipline and cohesion in the army. When the remnants of Napoleon's army crossed the Berezina River in November, only 27,000 fit soldiers remained; the Grand Arme had lost some 380,000 men dead and 100,000 captured. Following the crossing of the Beresina Napoleon left the army, after much urging from his advisors and with the unanimous approval of his Marshals. He returned to Paris by carriage and sledge to protect his position as Emperor and to raise more forces to resist the advancing Russians. The campaign effectively ended on 14 December 1812, not quite six months from its outset, with the last French troops leaving Russian soil.The campaign was the decisive turning point in the Napoleonic Wars. The reputation of Napoleon was severely shaken, and French hegemony in Europe was dramatically weakened. The Grande Arme, made up of French and allied invasion forces, was reduced to a fraction of its initial strength. These events triggered a major shift in European politics. France's ally Prussia, soon followed by Austria, broke their alliance with France and switched camps. This triggered the War of the Sixth Coalition.At the start of the campaign, no march on Moscow was envisioned and so the preparations would have sufficed. However, the Russian armies could not stand singularly against the main battle group of 285,000 men and would continue to retreat and attempt to join one another. This demanded an advance by the Grande Arme over a network of dirt roads that would dissolve into deep mires, where ruts in the mud would freeze solid, killing already exhausted horses and breaking wagons. As the graph of Charles Joseph Minard, given below, shows, the Grande Arme incurred the majority of its losses during the march to Moscow during the summer and autumn. Starvation, desertion, typhus and suicide would cost the French Army more men than all the battles of the Russian invasion combined.

Perhaps the best example of culled, simplified and collated information are the greeting plates for extra terrestrials on the Pioneer 11 and 12 spacecrafts.The Pioneer plaques are a pair of gold-anodized aluminium plaques which were placed on board the 1972 Pioneer 10 and 1973 Pioneer 11 spacecraft, featuring a pictorial message, in case either Pioneer 10 or 11 is intercepted by extraterrestrial life. The plaques show the nude figures of a human male and female along with several symbols that are designed to provide information about the origin of the spacecraft.[1]The Pioneer 10 and 11 spacecrafts were the first human-built objects to achieve escape velocity from the Solar System. The plaques were attached to the spacecraft's antenna support struts in a position that would shield them from erosion by stellar dust.The Voyager Golden Record, a much more complex and detailed message using (then) state-of-the-art media, was attached to the Voyager spacecraft launched in 1977.History[edit]

The original idea, that the Pioneer spacecraft should carry a message from mankind, was first mentioned by Eric Burgess when he visited the Jet Propulsion Laboratory in Pasadena, California, during the Mariner 9 mission. He approached Carl Sagan, who had lectured about communication with extraterrestrial intelligences at a conference in Crimea.Sagan was enthusiastic about the idea of sending a message with the Pioneer spacecraft. NASA agreed to the plan and gave him three weeks to prepare a message. Together with Frank Drake he designed the plaque, and the artwork was prepared by Sagan's then-wife Linda Salzman Sagan.Both plaques were manufactured at Precision Engravers, San Carlos, California.The first plaque was launched with Pioneer 10 on March 2, 1972, and the second followed with Pioneer 11 on April 5, 1973.Hyperfine transition of neutral hydrogen[edit]

Hyperfine transition of neutral hydrogenAt the top left of the plate is a schematic representation of the hyperfine transition of hydrogen, which is the most abundant element in the universe. Below this symbol is a small vertical line to represent the binary digit 1. This spin-flip transition of a hydrogen atom from electron state spin up to electron state spin down can specify a unit of length (wavelength, 21 cm) as well as a unit of time (frequency, 1420 MHz). Both units are used as measurements in the other symbols.Figures of a man and a woman[edit]

Figures of a man and a womanOn the right side of the plaque, a man and a woman are shown in front of the spacecraft. Between the brackets that indicate the height of the woman, the binary representation of the number 8 can be seen (1000, with a small defect in the first zero). In units of the wavelength of the hyperfine transition of hydrogen this means 8 21 cm = 168 cm.The right hand of the man is raised as a sign of good will. Although this gesture may not be understood, it offers a way to show the opposable thumb and how the limbs can be moved.Originally Sagan intended for the humans holding hands, but soon realized that an extraterrestrial might perceive the figure as a single creature rather than two organisms. One can see that the woman's genitals are not really depicted; only the Mons pubis is shown. It has been claimed that Sagan, having little time to complete the plaque, suspected that NASA would have rejected a more intricate drawing [why?] and therefore made a compromise just to be safe.[2] However, according to Mark Wolverton's more detailed account, the original design included a "short line indicating the woman's vulva".[3] It was erased as condition for approval by John Naugle, former head of NASA's Office of Space Science and the agency's former chief scientist. [why?] [4]Sagan himself, however, later wrote:"The decision to omit a very short line in this diagram was made partly because conventional representation in Greek statuary omits it. But there was another reason: Our desire to see the message successfully launched on Pioneer 10. In retrospect, we may have judged NASA's scientific-political hierarchy as more puritanical than it is. In the many discussions that I held with such officials up to the Administrator of the National Aeronautics and Space Administration and the President's Science Adviser, not one Victorian demurrer was ever voiced; and a great deal of helpful encouragement was given The idea of government censorship of the Pioneer 10 plaque is now so well documented and firmly entrenched that no statement from the designers of the plaque to the contrary can play any role in influencing the prevailing opinion. But we can at least try."[5]Relative position of the Sun to the center of the Galaxy and 14 pulsars[edit]

Relative position of the Sun to the center of the Galaxy and 14 pulsars with their periods denotedThe radial pattern on the left of the plaque shows 15 lines emanating from the same origin. Fourteen of the lines have corresponding long binary numbers, which stand for the periods of pulsars, using the hydrogen spin-flip transition frequency as the unit. Since these periods will change over time, the epoch of the launch can be calculated from these values.The lengths of the lines show the relative distances of the pulsars to the Sun. A tick mark at the end of each line gives the Z coordinate perpendicular to the galactic plane.If the plaque is found, only some of the pulsars may be visible from the location of its discovery. Showing the location with as many as 14 pulsars provides redundancy so that the location of the origin can be triangulated even if only some of the pulsars are recognized.The data for one of the pulsars is misleading. When the plaque was designed, the frequency of pulsar "1240" (now known as J1243-6423) was known to only three significant decimal digits: 0.388 second.[1] The map lists the period of this pulsar in binary to much greater precision: 100000110110010110001001111000. Rounding this off at about 10 significant bits (100000110100000000000000000000) would have provided a hint of this uncertainty. This pulsar is represented by the long line pointing down and to the right.The fifteenth line on the plaque extends to the far right, behind the human figures. This line indicates the sun's relative distance to the center of the galaxy.The pulsar map and hydrogen molecule diagram are shared in common with the Voyager Golden Record.Solar System[edit]

The Solar System with the trajectory of the Pioneer spacecraft

Silhouette of the Pioneer spacecraft relative to the size of the humansAt the bottom of the plaque is a schematic diagram of the Solar System. A small picture of the spacecraft is shown, and the trajectory shows its way past Jupiter and out of the solar system. Both Pioneers 10 and 11 have identical plaques; however, after launch, Pioneer 11 was redirected towards Saturn and from there it exited the Solar System. In this regard the Pioneer 11 plaque is somewhat inaccurate. The Saturn flyby of Pioneer 11 would also greatly influence its future direction and destination as compared to Pioneer 10, but this fact is not depicted in the plaques.Saturn's rings could give a further hint to identifying the Solar System. Rings around the planets Jupiter, Uranus and Neptune were unknown when the plaque was designed; however, unlike Saturn the ring systems on these planets are not as easily visible and apparent as Saturn's. Pluto was considered to be a planet when the plaque was designed; in 2006 the IAU reclassified Pluto as a dwarf planet and then in 2008 as a plutoid. Other large bodies classed as dwarf planets, such as Sedna, are not depicted, as they were unknown at the time the plaque was made.The binary numbers above and below the planets show the relative distance to the sun. The unit is 1/10 of Mercury's orbit. Rather than the familiar "1" and "0", "I" and "-" are used.Silhouette of the spacecraft[edit]Behind the figures of the human beings, the silhouette of the Pioneer spacecraft is shown in the same scale so that the size of the human beings can be deduced by measuring the spacecraft.Criticism[edit]

One of the parts of the diagram that is among the easiest for humans to understand may be among the hardest for the extraterrestrial finders to understand: the arrow showing the trajectory of Pioneer. An article in Scientific American[6] criticized the use of an arrow because arrows are an artifact of hunter-gatherer societies like those on Earth; finders with a different cultural heritage may find the arrow symbol meaningless.According to astronomer Frank Drake, there were many negative reactions to the plaque because the human beings were displayed naked.[7]

translate into an image

Examples of direction and colourAlso shows how an image which is NOT GEOGRAPHICALLY CORRECT can improve navigation across the network.

Perhaps the most well known translation of complex reality into an image is the tube map of the London Underground.It is a known truth, that if you were to use the tube map of London to help navigate your walk from Paddington to Piccadilly Circus, you had better bring a compass, a packed lunch and camping gear. The tube map sacrifices geographical accuracy for coherent simplicity. Many more commuter hours were saved in providing a quick route planner, than there were wasted in encouraging commuters to wait for the next train from Leicester Square to Covent Garden.

translate into an image

PLAY NEXT SLIDE LOUD (I WONT TALK OVER IT)Before we break up into groups I wanted to show you one last example of a great infographic. It is the closest example a non-synesthete will come to experiencing an auditory hallucination through visual stimulation without the use of illegal drugs.It is particularly relevant not only in its translation between the senses of auditory complexity into visual simplicity, but in the fact that we will be trying to adapt some of Malinowskis concepts in our brainstorming session coming upLook at thisNow listen to this

visualising soundBeethoven 5th: courtesy Stephen Malinowski

What do the colours represent (instruments)What does the x and y axis represent (pitch and time)What could have been added (width of line, brightness of the line)

PLAY NEXT SLIDE AT MEDIUM VOLUME SO MY VOICE IS STILL HEARD

SYSTOLIC heartsoundsprojectThe cardiac cycleSystolic murmursRadiation of soundPeripheral signs

So we have seen how with the use of colour, line thickness, vectors, textures and the artificial distortion of geography, we can simplify complex ideas even to depict more abstract concepts like sound and music. Now lets put it to practice!I would like to invite you (in 3 separate groups) to create an infographic on systolic heart sounds, drawing together information which I feel until now has been poorly explained and illustrated.Whilst I am sure all of you are experts at heart sound interpretation, for those of you who are like me, who have no idea, or completely forgotten it all, I have summarised it for you.Play loud (AS)

So without further adoWith the queuing of the BritishThe discipline of the GermansAnd the Speed of the Italians

Try to avoid:The queuing of the GermansThe discipline of the ItaliansThe speed of the English

For example,if you thought youwere a great leaderDistribute available talentequally between groups

A picture is worth a 1000 words

heartsoundsGroup 1: Illustrate the normal heart sounds and how they relate to the auscultation areas (T, P, M, A)Group 2: Illustrate the systolic murmurs (TR, PS, MR, AS) and map it to the blood flow around the heartGroup 3: Illustrate the radiation of sound from the auscultation areas (T, P, M, A) of the systolic murmurs (TR, PS, MR, AS)

2. Pulmonary stenosis

3. Mitral regurgitation

4. Aortic stenosis

1. Tricuspid regurgitation

Workshop review

How do you diagnose a murmur from a clinical interaction with your patient?Concentric rings: History on the outside -this is taken firstThen peripheral clinical signs -perhaps marfans (MR), IVDU with BE (TR), a thoracotomy scar and central cyanosis in a young man (PS) or ascites and a large liver (TR)?Next inspection and palpation- look at the a (PS) and v (TR) waves of the JVP? Feel for an anacrotic pulse (AS)Finally we get to the murmur2 interlocking rings of the right (blue) and left (red) sides of the heartThe two rings forsake anatomical auscultatory accuracy. When I hear a murmur in the mitral area I want a picture that tells me it is the mitral valve (or HOCM), not the apex. -see the Tube map of LondonNext I have replaced S1 S2 for LUB DUB, because that is what I expect to hearThis is then used as a reference point for systolic and diastolic phases (in combination with the timing of the pulse)The rings are to be read like a sound track or sound loop (see the red and blue arrows) -as I track my finger around the ring (phnaaar) I get a feeling of the timing of the phases of systole and diastole, systole being shorter, with the timing of S3 and S4The murmurs lie in the systolic phases of their respective rings, but radiate forward or backward as dotted lines, across their respective valves, like satellites on a trajectory out of their orbitsI have added the effects of inspiration and expiration on the accentuation of the murmurs, as well as the effect of dynamic manoeuvres, with their resistance and assistance in circulation of the blood around each ring. alternatively you could get with the 21st century and get an ECHO

SummaryPreworkshopWhat concepts do you want to bring together?Collect informationCull simplify collateTranslate the patterns of information into an image

Pre workshopWhat media format do you want as your output?Vector / raster / resolution / colour depthSoftware resourcesImage resourcesWorkshop -creating an infographicWhat concepts do you want to bring together?Collect information to identify patterns, links and associationsCull the unnecessary, simplify the important and collate in a logical orderFeel the image through the eyes of a synestheteHave fun

ReferencesInternal Medicine Journal 2005, P GatesWikipedia: French Invasion of Russia, Charles Minard, Pioneer Plaques, Beethovens 5thTransport for London: www.tfl.gov.auStephen Malinowski: Beethven, Symphony 5An Aid to the MRCP PACES 3rd Edition, Ryder et alClinical Examination 5th Edition, Talley & OConnerVisible Body 3D

DRAFTDRAFTCourtesy of Dr A Tzannesnot for distribution

Used Quark for this vector graphic

Lavf54.63.100Blues24058.857