NORMAL BODY TEMPERATURE- CHANGING THE STANDARD

 COVID-19 is on our minds, incessantly and endlessly playing in our ears on every call, on the news, online-offline and everywhere.

Even though I am not a betting person, I think it is safe to bet we have all given in to the need to check our temperature at some point.

My moment of truth was a few days back when I felt feverish. I reached for the thermometer, and it showed  96.2 F (35.7 C). I thought my eyesight was playing up. So I reached for the digital thermometer and got the reading 96.2 F. Not high not even the normal  “98.6 F or 37 C (range: 97.2-99.5 F / 36.2-37.5C ) as established by the German Physician Carl R A Wunderlich in the 19^th century. Then I recalled that this had happened to me before although I never really bothered with it always considering the digital thermometer must not be accurate or the batteries must be weak.  But now I am more sensitive to such things as the temperature records, thanks to COVID-19. 

"Normal body temperature. 

Thermometer showing slightly above 36°C" by "Ivan Radic" 

 is licensed under a Creative Commons Attribution 2.0 Generic License.

I remembered an article titled “Decreasing human body temperature in the United States since the Industrial Revolution” by Myroslava Protisv that had momentarily caught my attention in early January  I had tagged it for a later read. I then forgot about it in the Covid-19 information deluge. 

A quick search and I found the article, which describes the previous values derived from the study of armpit temperature in 25000 patients is no longer appropriate, with the average American temperature now running more than a degree lower.  “The authors who analysed 677,423 human body temperatures from three cohorts spanning 157 years of measurement found a decrease of -0.03 C and -0.32 C in men and women respectively per birth decade.

What does this mean for diagnosing fever? So far nothing, as experts agree that a fever still remains a fever that is a rise in temperature to above 100 F  for adults and,  and high temperatures above 103 F( 39.4 C)  the level for causing concern and a need for visiting the emergency room for adults.

 On the other hand, the article’s findings are very significant to the normal body temperature values followed around the world.  The authors have related the fall to decrease in metabolic rate to different factors, mainly reducing population-level chronic inflammation due to reduction in mild persistent infections and changes in ambient temperatures in recent times.  The resting metabolic rate reflects the body temperature and ambient temperature. The body temperature increases when the ambient temperature falls and decreases when the ambient temperature rises.  So essentially, population-level presence of chronic inflammation and ambient temperatures control the body temperature.

Assuming these explanations are valid, and the authors make a compelling argument. The normal temperatures around the world’s different regions with vastly different climates, as seen in the map and levels of infections, was never the same as those that were found by Carl R A Wunderlich in Germany.

https://www.climate-charts.com/World-Climate-Maps.html#temperature

Although currently, experts agree that the changes to the normal temperature do not affect the level considered as fever, and that may very well be the case in severe fever, one has to wonder, if that is the case in establishing the presence of fever itself.

Multiple questions need to be answered.

What is the normal body temperature range of people from different climatic and hygiene level regions of the world?

Can individuals’ basic( normal) body temperature change within their lifetime by on relocating to a climatically different region?

Intriguing questions that we have the means to answer due to the COVID-19 pandemic.  

The spread of coronavirus disease (COVID -19) across the globe has made the simple thermometer a star gadget, with thermometers becoming the most often purchased gadget during the COVID-19 pandemic.    Temperature screening has taken an entirely new dimension, with more temperatures, checked and recorded per day than ever before.

This combination of availability of the equipment (thermometer), skill and awareness of the importance of recording the body temperature provides us with the exceptional opportunity to establish the new range of normal  body temperature region-wise around the world through extensive collaborative studies.

Please share your comments and thoughts. I would love to hear from you.

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TO SHARE OR NOT TO SHARE ? Creative Commons maybe your answer

You just saw a case that was so unique or so typical that you are dying to share with your colleagues, students or the World Wide Web at large.

Were you just asked to contribute a picture or content for a publication or presentation?

And now you are thorn between the natural academic, and professional desire to share for the greater good, and the practical realities of life that may cause you considerable problems if you do.

The content may not be yours to share. Today's academic and hospital settings ensure that patients are inevitably seen by at the very least two disciplines and often many more. Under those circumstances, ownership of the content to be shared needs to be agreed upon by all. The lack of agreement and clarity is perhaps the greatest cause of information not being shared at all, and remaining unused in departmental archives.

The next complication arises when after sharing the content; you realize that you no longer can use it due to copyright issues, with the person or publication that used the material having the ownership now.

 So, does all this mean we should stop sharing?

Thankfully, no.

There is a way out that is both cost-free and hassle-free.  You or your department/s can share content to be used anywhere while holding the copyright of the material.

Creative Commons (CC) as shared on their website "is a nonprofit organization that helps overcome legal obstacles to the sharing of knowledge and creativity to address the world's pressing challenges". Currently, over 1.6 billion works are registered under the creative commons, including free to access journals across all disciplines. 

https://creativecommons.org/share-your-work/ https://vimeo.com/13590841

Wanna Work Together? from Creative Commons on Vimeo.

With different licenses that allow various levels of freedom of sharing the work, a creative license is an excellent solution for sharing your work or findings without the risk of losing your rights to the content. 

I have been using creative commons licensing for some time now. Last year I received a request for a Carcinoma Cuniculatum picture, rather than worrying about all the possibilities, I licensed the image, and then shared it. 

Mandana Donoghue / CC BY-SA (https://creativecommons.org/licenses/by-sa/4.0)

I hope you will find this information useful; there is also excellent information available on the creative commons platform, and other sites on the nature, details and use of the licensing.

Happy sharing.

   # Creative Commons, 

POWERPOINT ETIQUETTES FOR A GREAT PRESENTATION

Following my earlier post on  live presentaions and online appearance it seems natural to tackle another critical and ever-present component of academic and research-related communications. The mighty PowerPoint. It also helped that I came across this compelling video titled "Death By PowerPoint"  by @ David PJ Philips. Although our audience usually is much more engaged and forgiving than those in the corporate world, the information being passed on is also meant to have a more significant longterm impact. 

Death By Powerpoint

Being from the last generation of teachers whose only visual aid was the chalk & blackboard, I am among those who can fondly recall those good old days where it was so easy to connect with the audience in a typical lecture setting. We could pace our lecture, not loose eye contact for managing the PowerPoint, emphasise, and stay over a topic as long as was necessary,  skimp over others or even just leave out some as the situation demanded. I recall an early morning lecture 25 odd years back when in the morning after the annual sports day,  I found the majority of the students nearly dozing. I abandoned teaching for 10 minutes or so, chatted with them about the events, woke up everyone with an animated discussion of the games, and then moved back to the topic. This, of course, meant I reorganised the lecture to make up for the 10 minutes. This sort of fluidity is what I miss with the typical PowerPoint presentation. 

Not everything was great though, presentations to larger audiences required slide projectors, which had the nasty habit of getting stuck, and the occasional mischance of slides that were upside-down. 

Powerpoint brought great freedom to all presentation. All of a sudden we could present data in very legible and attractive fonts rather than handwriting, I am quite sure my students must have celebrated the change. But, with no limits on the type of data, tables, graphs, visuals, related and unrelated pictures, the PowerPoint suddenly moved from being the visual aid for the presentation to being the presentation.

To be truthful, I  found matching the quality and engagement of pre-powerpoint era quite challenging whether the aim was just to teach, exchange or disburse information, and most importantly, to inspire greater learning and interest.  This made me make a constant effort to improve and update my skills in this field. Through years of study, and learning from more personal mistakes than I would like to recall, I have developed my list of what I like to call Powerpoint Etiquette, 

a set of actions that will hopefully produce a visual aid that supports a high impact, easy to understand, informative, and inspiring exchange of information in the least amount of time possible.

There are very handy points in the video: 

• Have only one message per slide.
• Don't repeat the exact contents of the slide  
• Gain focus on what matters by keeping:

• the slide heading or title smaller than the content
• use contrast to focus attention on each object on the slide
• Use a dark background for the slides to keep  the primary focus to yourself rather than the slide    
• keep the number of objects on each slide limited to six.

Besides those, I find the following useful:

• Limit the number of slides: While, it is never a good idea to jam a lot of content into fewer slides as mentioned by @David, an indiscriminate increase of the number of slides is not a good idea either. Presentations in the health sciences are different from the typical show and tell format or the what, where and when of the corporate presentations.  We often need to add, the why and the how, which requires description beyond the content of the slide. Slide such as the one below, with few objects is regularly used to introduce and explain broader concepts. 

https://www.flickr.com/photos/188986666@N05/50033041912/in/dateposted-public/

So, depending on how much explanation is necessary for each slide an average of 60-90 slides for a 45-minute lecture is plenty. A lot depends on how fast you can speak while being understandable. While most public speaking advisers consider 120-130  words per minute as acceptable, remember to account for the time needed to change the slides,  and pause for important points to make an impression. 

• Be prepared to abandon the PowerPoint: This is sometimes the hardest thing to do. Often we get so invested in the slides, that we forget they are just a tool in the presentation and not the presentation. So, why abandon the slides we prepared with so much effort? There can be many reasons. 
• The most common is running out of time. If you have limited time, it is best to abandon the remaining slides and just mention the highlights or list the main topics that were meant to be covered, with an apology and an offer to discuss it further with anyone interested (remember to share your email at the end of the lecture)
• Losing the audience: Maybe your's is the first lecture after lunch or the last one in the day, or something diverted everyone's attention, or possibly you misjudged the audience, and they are not as interested in the details. Whatever the reason, it is best to abandon the PowerPoint for a few minutes or entirely. Use the blank screen option, focus your attention totally to the audience, instead of dividing your attention between the audience and the PowerPoint. Make adjustments to the items being described and the number of details, in response to the audience. In general, anything that was text or graph can easily be conveyed by words alone, tables are more tricky if specifics are required. You can return to the PowerPoint once you have the audience's attention again. 

• Open with a high impact slide: The beginning often decides how the presentation goes. Avoid starting with the typical title slide that can come after you get everyone's attention. Eyecatching art, scenery, or a high-impact slide that relates to your lecture will be a good start too. 

• End Strong: The best way to end is on a summary message, a few ideas that summarise the talk, or a final message. Thank you, does not need to be a slide and can be just conveyed verbally.      However, if the topic has been too vast and the message too extensive to be put in a single slide, end the way you began. An interesting slide, a little bit of humour or something you care about (fight against cancer, wildlife preservation, or whatever matters to you) can make for a great end.

Please share your keys to making a great PowerPoint presentation in the comments.

Thank you for visiting the page, please follow and share the blog if you find it interesting.  

A LOT CAN GO WRONG WHEN YOU ARE LIVE ONLINE

The coronavirus forced us to move online in a big way. Placing many in very unfamiliar territory. Suddenly we are sharing videos, conducting meetings, presenting webinars, and lectures online. That too from home, a surrounding that provides perhaps too wide and detailed a  view of our personal life. In a way, social distancing has increased our physical space at the cost of our personal space.


There are so many videos on everything that can go wrong, from pets walking across and other more embarrassing stuff, to family members walking past in underwear, even one somewhere of a participant using the loo online (oops ...)

Here is one that is less scandalising but instructive.

There is a lot of advice from professionals, on avoiding some pitfalls and improving the overall quality of online interactions.

I have a list that has worked for me.

• Try and keep your camera at eye level, not only it helps by presenting you as looking directly at the viewers, but it also avoids unflattering views. Try looking into your camera positioned at different levels offline, to get an idea. If you don't like what you see, it is most likely others won't either.
• Check out your background. I feel the safest bet is to have your back to the wall, so no accidental views of family members. Also, there is really no need to broadcast the layout and contents of your home on the web.
• It is possible to accidentally turn on the back camera, so the best bet is to cover it.
• Use a light source that is in front of you.
• Use headphones and a mic to reduce the possibility of ambient sounds getting through.
• If you are not the presenter, you have the option of turning your video/ audio or both off.
• Never a good idea to be wearing something you wouldn't otherwise wear to a meeting. (in other words, get up and change to work clothes)
• If you are using your mobile, be mindful of where you walk with and position it.
• Finally, if you haven't done it already look for how-to- videos on web meetings. 

Flip the switch - polished events on webcam from the Bright Talk is a good video to watch.

Wishing you interesting, instructive and captivating presentations... 

I look forward to hearing your suggestions and thoughts,  please share as a comment or an email...

SCIENCE REFLECTS THE CONNECTIONS OF LIFE

Science is an interconnected web that duplicates life and its many interconnections.
This video from nature on their 150th year is a fantastic demonstration of the interconnectivity of life and science.

ORAL PATHOLOGY- CARCINOMA CUNICULATUM

This slow growing variant of squamous cell carcinoma (SCC) has features of both squamous and verrucous varaiants of SCC. A common form in the skin but rarely seen in the oral mucosa. Histopathologically displays the " Rabbit Burrow"  branching keratin filled crypts, that give it the name cuniculatus derived from cuniculus(small tunnel or burrow).

Mandana Donoghue [CC BY-SA 4.0], from Wikimedia Commons

ORAL PATHOLOGY- PARAMOLAR

DEVELOPMENTAL ANOMALY- SUPERNUMERARY TOOTH

Paramolars are developmental anomalies in the number of teeth. They presesnt as an extra tooth that resembles a rudimentary molar. 

Site: most common in maxillary arch, in relation to the buccal and less often palatal aspect of the molars. 

Symptoms: Mostly asymptomatic , unless soft tissue infringement occurs. 

Clinical significance : may cause displacement of neighbouring teeth or cause mucositis. 

In view of the current emphasis on  the role of chronic inflamation in carcinogenesis mucositis associated with the paramolar may be considered to increase malignant transformation risk in patients with high risk habits (smoking, tobacco, paan, or areca nut chewing). 

Advised treatment - extraction