Aspects of presence in telerelating.

Communication technologies afford new dimensions of presence for telerelating not available face-to-face including history, temporal and spatial ubiquity, self-monitoring, progressive embodiment, anonymity, and involuntary feedback. These and other concepts are explored using examples from affordable present day technologies.

Personal stories within virtual environments: embodiments of a model for cancer patient information software.

Two new cancer patient information CD-ROMs extend the personal stories within virtual environments model of cancer patient information developed for Breast Cancer Lighthouse. Cancer Pain Retreat and Cancer Prevention Park: Games for Life are intended to inform and inspire users in an emotionally calming and intimately informative manner. The software offers users an experience--of visiting a virtual place and meeting and talking with patients and health care professionals.

Prospective assessment of presenting serum markers for cardiac risk stratification.

OBJECTIVE: To quantify the association of initial ED serum cardiac markers with the risk for life-threatening events (LEs) or need for lifesaving interventions (LIs) or administration of IV nitroglycerin. METHODS: A prospective, observational study was performed using a cohort of hemodynamically stable, hospitalized patients (age > or = 25 years) presenting with nontraumatic chest discomfort. Patients with ST-segment elevation on their initial ECGs were excluded. Presenting serum samples were assayed for serum myoglobin and creatine kinase-MB isomer (CK-MB) using the Opus and Stratus systems. Target cases were defined as patients having LEs (e.g., cardiogenic shock, ventricular fibrillation, cardiac arrest), requiring LIs (e.g., intubation, cardioversion, pacing, reperfusion therapy), or needing IV nitroglycerin within 48 hours. Manufacturer's thresholds defined abnormal marker levels. Abnormal ECGs were defined using the Brush criteria. RESULTS: Of the 178 eligible patients, 44 (25%) were target cases. Most (55%) target cases had blood drawn for assays within four hours of chest discomfort onset. The relative risk and sensitivity of the serum markers and the ECG for target cases follow: [table: see text] Of the seven patients with an LE/LI, six had blood drawn four hours or less after symptom onset; two LE/LI patients had abnormal myoglobin levels--no LE/LI patient had an abnormal CK-MB level. CONCLUSIONS: Isolated serum myoglobin and CK-MB levels obtained at patient ED presentation were not strongly associated with the 48-hour risk for LEs, LIs, or the use of IV nitroglycerin. Future studies of risk stratification should address the merits of serial serum marker measurements that extend up to 12 hours beyond patient symptom onset.

The forehead lift.

Clients desiring to decrease a tired, worried appearance may be candidates for a forehead lift. Often, clients inquire about a facelift or blepharoplasty when a forehead lift would be the procedure most likely to produce the results that the client desires. Providers caring for clients undergoing a forehead lift must use a holistic approach and assess all aspects of the client to ensure a positive health care experience.