![]() The diaphragm of the stethoscope should be used to auscultate breath sounds in the following systematic fashion. Once the above preparation criteria have been considered the healthcare professional will be in a position to effectively conduct the assessment. The data collected will therefore be influenced by the quality of the equipment available. It should also be noted that stethoscopes are manufactured by a number of different companies. Furthermore, nursing staff may wish to consider adjusting the level of beds or table heights, optimising lighting or generally ensuring the environment allows for a professional assessment to be conducted. Respiratory auscultation must be conducted in a quiet environment. ![]() Staff using stethoscopes regularly may consider owning their own equipment as sharing equipment requires careful cleaning between staff, particularly of the ear-pieces. Nosocomial infections related to poor infection control policies with stethoscopes are well documented (Panhotra et al, 2005). Stethoscopes should be cleaned between use with different patients or by different members of staff. Respiratory auscultation will therefore require privacy. Patients have their chests and backs exposed and consequently nurses must be sensitive to issues related to dignity. Emphasising patient dignity is a theme that should always be considered by health professionals respiratory auscultation is no exception. Patients must be properly undressed for examination and chest pieces should not be placed over clothing. Maintaining dignityĪssessments involve careful patient preparation. Nursing staff also need to consider the length of time assessments take as, for example, leaning forward for prolonged periods of time can cause distress. In acute care the position will be influenced by the patient’s presentation and stability. Patients should be placed in a comfortable position, either sitting upright leaning forward for cardio respiratory assessments or lying supine or lateral for abdominal auscultation (O’Neill, 2003). Patient position is also extremely important. Awkwardly bending or twisting over patients should be avoided. When conducting respiratory auscultation it is important that nursing staff position themselves optimally. ![]() Positioningīack injuries are an occupational hazard for the nursing profession. Infection controlĪcute care patients are at significant risk of infection so the strictest infection control policies should be adhered to when conducting respiratory auscultation. Consequently key requirement when using a stethoscope is an ability to demonstrate communication skills. This is not only a professional stipulation but also helps develop a positive therapeutic relationship. The NMC’s Code of Professional Conduct emphasises that before, for example, conducting respiratory auscultation, consent should be sought and explanations offered. The personal safety of nursing staff should be a central priority when delivering direct care. Placing stethoscopes around the neck, hanging loosely and freely, should be avoided. Specifically in relation to stethoscope use there are documented incidents of healthcare workers being assaulted and experiencing attempted strangulation with stethoscope tubing (Keep and Glibert, 1995). The basic life support algorithm (Resuscitation Council UK, 2000) states that assessing areas for safety/danger is the first consideration when approaching patients. Issues related to personal safety in the acute setting require the same degree of attention as client assessment and management. ![]() Ensure all required equipment is clean and ready to use Position yourself and the patient optimally Wash your hands, put on gloves and an apron Auscultation of the lungs should be carried out for baseline assessments, for patients in acute respiratory distress and for patients with known lung disease (Docherty, 2002).Īuscultation of the respiratory system fits within Hudak et al’s (1998) guidelines on conducting physical assessments: A fundamental ability to use a stethoscope comes with many nursing roles ranging from respiratory nurse specialist and outreach roles to intensive care nursing, A&E nursing and when practising in operating theatres.Īuscultation of the lungs should form part of the respiratory assessment as the stethoscope allows the practitioner to assess a patient’s cardiac, respiratory and intestinal state (O’Neill, 2003). Competently utilising a stethoscope in clinical practice is one such skill. The role of the nurse has continued to evolve and tasks traditionally associated with the medical profession are increasingly being adopted by nursing staff. Terry Ferns, MA, BSc, DipHE, RGN, is senior lecturer at the School of Health and Social Care, University of Greenwich, London ![]()
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![]() ![]() They are 26 and 24 years old, respectively, honed to fine edges. Call up highlights of Evert and Navratilova’s match at the 1981 U.S. On some slow or rainy day, when the tennis at Wimbledon is banging and artless as a metronome or suspended by weather, do yourself a favor. After a 15-year rivalry, they somehow reached a perfect equipoise of 18 Grand Slam victories each. They contested 80 matches - 60 of them finals - riveting for their contrasts in tactics and temperament. 1 in the world at the direct expense of the other. They first met as teenagers in 1973, became friends and then split apart as each rose to No. The shape of the relationship is an hourglass. ![]() No one else could possibly understand it. And afterward they would return to that small room of two, where they showered and changed, observing with sidelong glances the other’s triumphalism or tears, states beyond mere bare skin. Then they would play a match that seemed like a personal cross-examination, running each other headlong into emotional confessions, concessions. ![]() They waited together, sometimes ate together and entered the arena together. For so many years, Chris Evert and Martina Navratilova were almost invariably the last two, left alone in a room so empty yet intimate that they could practically hear what was inside the other’s chest. At first the locker room is a hive of 128 competitors, milling and chattering, but each day their numbers ebb, until just two people are left in that confrontational hush known as the final. There is an audible rhythm to a Grand Slam tennis tournament, a thwock-tock, tock-thwock of strokes, like beats per minute, that steadily grows fainter as the field diminishes. Deep Reads features The Washington Post’s best immersive reporting and narrative writing. ![]() ![]() Quicksand can also occur where underground springs are common or places where the water underground seeps upwards.Ī walking stick can be handy in the early detection of quicksand (aside from its many other uses). While there’s a way to get out of quicksand, it’s better to not take any chances and avoid being sucked in altogether.īe wary of places where groundwater can mix with sandy soil such as swamps, marshes and tidal flats. ![]() ![]() Once you’re free, clean up and use a different, more inland route to your destination. Freaking out or rushing it can disturb the loose ground you’re in even further and push your body deeper into the muck, making extraction more difficult. It may take you from a couple of minutes to an hour or more to safely extract yourself from the situation you’re in, but taking it slowly is the safest way. Remember, when dealing with quicksand, “slowly, but surely” is key. Once you can move your feet more freely, slowly paddle yourself on your back to “shore”. Be on the lookout and take note of the warning. Areas where quicksand may occur usually have warning signs nearby. With more water than soil, you’ll be able to move your feet more easily until you can free them. Slowly wiggle your feet to increase the space for water around them. With your weight distributed more evenly, you’ll sink slower and at the same time provide you an opportunity to free up and raise your legs from the mud. If you don’t have a stick or a pole with you, you can slowly lean back to spread your weight around. The pole will help keep you from sinking by stabilizing you. Lay it horizontally behind you and slowly lean back and set yourself on top of it. If you have a walking stick or a trekking pole with you, this is a good time to use it. Being stuck in quicksand can also put too much pressure on the body, much like being crushed, and may induce discomfort, exhaustion and even nerve damage. The danger of being stuck in quicksand is in exposure to the elements or drowning once the tide rises and the water completely engulfs you if you’re unable to extract yourself in time. While rare, there have been documented cases of people dying from being stuck in quicksand. However, just because you can’t drown in it doesn’t mean it can’t be fatal. The less weight on you, the slower you’ll sink and the easier it will be to get out. If you’re in too deep, like knee-deep, and taking a step back is too difficult and isn’t an option anymore, ditch the backpack and whatever loose articles you might have on you and throw them to the side. Be careful when getting help! While it may sound easier if another person is helping you to get yourself out of quicksand, be careful- the other person can get pulled in and find themselves stuck like you. In the process, you may have to ditch your shoes, but it’s better to lose them than sink any deeper. Do not take big steps forward-while you may be able to get one of your feet free, lunging steps will use up too much energy and sink your other foot deeper into the hole and take you farther away from solid ground. If you still can, take a couple steps back to solid ground. So the first step is to keep calm, resist the urge to flail around, and act fast. Sudden big movements will also disturb the soil underneath you more and get you stuck even deeper. While it can be frightening, panicking will only unnecessarily drain you and put you in a much worse situation. Usually found near bodies of water, sinking in quicksand often takes just a couple of seconds and getting out of one by yourself can be difficult without help. Quicksand is loose soil saturated with water. But don’t worry, here are a couple of steps that you can take so you can try to extract yourself from one. While it isn’t usually as dangerous as you may think, being in one can still be panic-inducing. Quicksand can usually be found near bodies of water like rivers and lakes, and some of them can even “move around” depending on different conditions. ![]() Quicksand is loose, fine soil that’s saturated with water and may appear solid until it’s abruptly disturbed by changes in the environment and it liquefies. Are you getting that sinking feeling? It may not be just anxiety, you might have stepped on quicksand. ![]() ![]() Co-Star lacking things like degrees or all of the house placements is a fatal flaw in the app because house placements, degrees, and transits are just as crucial as different planet placements. Co-Star gives the bare minimum of the birth chart, while Charts goes into precise detail regarding transits in your chart, planets, houses, and degrees. To show this disparity in Co-Stars birth charts, the image below is the exact same birth chart, the one on the left is from Co-Star, and the one on the right is from the app Charts. ![]() Co-Star, on the other hand, provides a meek table that once again has an aesthetically pleasing look but lacks essential components to the chart. There is a reason the website CafeAstrology or the app Charts shows you that circular natal chart, and while it looks daunting and complicated, it gives you a real full idea of your chart. Moving on through the app, I also find an issue with how the birth chart is presented. There is no “This placement of yours is squared with this placement right now, which means you should keep an eye out for someone taking advantage of you.” It’s instilling unnecessary fear and anxiety, and it doesn’t need to be there. The app just plainly told me, “someone is taking advantage of you,” but it provides no astrological reason why someone is taking advantage of me. If I know little to nothing about astrology, I also won’t pick up on the fact that there is no backing for this claim. The very first claim in big, bold words, the one mentioned previously, “If you feel like someone is taking advantage of you, they probably are,” is, as I said, alarming. However, I personally find a discomforting issue with this first opening page of the app. Now, on a surface level, this is all in good fun. ![]() Mine today tells me to learn from people with Earth Mercuries and avoid Air Venuses. The learn from and avoid sections works when you have friends on the app. The dos and don’ts section gives three dos and three don’ts, often one word, and from my experience, doesn’t always make a lot of sense. Scrolling on, there is more pretty black text, including “Dos and Don’ts,” and “Learn from” and “Avoid” sections. This particular time, mine reads, “If you feel like someone is taking advantage of you, they probably are.” A pretty bold and almost alarming claim, and to someone who doesn’t know too much about astrology, why wouldn’t they listen to the pretty, visually pleasing, alarming message? The app then tells me where I’m having trouble, power, strength, etc. ![]() It then proceeds to show me my “Day at a Glance,” which is a sentence supposedly about how my day is going to go. “Good evening, It’s 53० and mostly clear in Los Angeles.” Those are the first words I see when opening Co-Star. Its cover on the home screen is a beautifully simple photo of the moon a click on the app and a clean white screen appears with soft black text. It’s modern, sleek, and overall just pretty to look at. The app has a beautiful and aesthetically pleasing look. The app has seemingly taken over astrology’s online presence in recent years, and at first glance, it’s clear why. If you scrolled through the apps of almost every teenager that owns TikTok, you’d most likely find the astrology app “Co-Star” as well. ![]() ![]() ![]() This UK escape game has gone virtual and is one of the most popular escape games online right now. Heists, escape rooms and magical quests all feature in these online escape games available now Twinwoods Adventure This video gives you more of an idea of how it works… It’s another that runs via video link, and allows multiple connections. The online escape game starts after the friend calls you and you start trying to help him get out. Before locking him in, he detonates a bomb which he says will explode in 60 minutes and which is impossible to diffuse. He locks him inside, stating he is a puzzle psychopath who has prepared a series of puzzles which need to be solved for him to escape. By the time your friend realizes there might be trouble, he finds a masked man pointing a gun at him. As he takes the first sip, your friend realises that the barman has also vanished. There’s no one except for your friend and a weird looking barman. On the last night, he decides to head to the Pub. Of all the online escape games online, this storyline is the most intriguing! It’s titled The Pub: A Puzzle Psychopath’s Trap and according to the website, this is the premise: It’s time for you to solve what went on, using clues and codes to plot your escape.Ĭhallenge your friends with these escape games online, including this one about Sherlock Holmes Can You Escape? In The Dentist, the storyline follows you waking up in a dentist’s surgery, wondering what happened. The games on offer right now are The Dentist, Alex’s Bathroom, The Supervillains Lair and The Witches Tower. There’s a set price per game and no player limit.Īgain, the games are played via video link, with a real games master who you control. Now they’ve gone virtual, with several escape games online to choose from. This UK escape room brand has branches across the south of England. You can play one game on its own, but remember to cancel the subscription after! Know Escape It’s worth noting that these games are offered as part of a subscription service via Patreon. They’ve popped together a video which gives you an idea of how it all works. You can have up to eight people playing across four different screens, so they’re good fun if you’re looking for a unique way to catch up with friends. YouEscape has one of the biggest selections of online group escape rooms of any company I’ve come across, you’re bound to find one that takes your fancy. How will you fare at playing these online escape games? YouEscape We’ve played a lot of escape rooms, and thought this one was pretty difficult – in a good way! A fun challenge that really made us think! All the games are priced at £7.99, and this one took us almost two hours to complete, so it’s good value too. I played Lockdown Breakout with my fiancé as a fun date night activity. There are several games to choose from, with different themes and difficulty levels. Since then, it’s taken off in a big way and the games are now amongst the most popular virtual escape rooms around right now. This series of virtual escape rooms was originally created by a guy in London as a bit of entertainment for his girlfriend during lockdown. Unlike many on this list, you can play Trapped In The Web whenever you want, as it doesn’t use a live games master or livestream setup. If you’re missing the realtime escape room thrills, definitely check out one of these games.Ĭlick here to find out more about the remote adventures offered by The Escape Game. I’d recommend using a laptop so you can look at the dashboard as well as the Zoom video chat. You can have up to 8 people on the virtual games, and they run via Zoom. I also thought that The Escape Game had a great setup with the real-time dashboard where you could see a 360-degree view of the room as well as the locks that needed to be unlocked and the inventory of items found so far. The Escape Game – The Heist remote adventure I found it handy to have my laptop ready too, as there were criminal records to review, webcams to watch, maps to search and even a radio link to my partner in crime. ![]() The game is very cleverly designed, using real-time text messages and phone calls as the main form of storytelling and communication. The goal? To uncover secrets and track down one of London’s most dangerous villains. When I heard they’d set up an online game, I was first in line to play! My role? That of a field investigator, working on my first criminal case. They have several experiences based in London, all in a treasure hunt style, finding clues and unravelling a story as you race around the city. ![]() HiddenCity is top of the class when it comes to interactive and immersive games. Mystery Escape Room: Online Escape Roomsīest Virtual Online Escape Games To Play Moriarty’s Game: A Killer In The Hive by HiddenCity.Bewilder Box: B.R.U.C.E Saves Christmas.Moriarty’s Game: A Killer In The Hive by HiddenCity.Best Virtual Online Escape Games To Play. ![]() ![]() New User-Interface: Man圜am has a completely redesigned look and feel! Our UI is more intuitive and everything is now organized under three main tabs: Video, Effects and Gallery, along with convenient placements of different tools in the lower tabs. Users who recently purchased Man圜am Pro after November 1 st are eligible to get a free license, in this case you can contact us for details. If you are already a Man圜am Pro user, you are eligible to purchase the update at 50% off, click here for more details. Please note that version 4.0 is not compatible with previous versions of Man圜am Pro, so you will need a new license code for Man圜am 4 Pro. Man圜am 4 Pro is also available, and can be purchased on our website. Our website even has a fresh new look as well! We’ve also improved our audio and video core functionality, and made taking snapshots and recording videos easier for our users. ![]() This major release is a huge improvement from our 3.X software and includes several awesome new features and functionalities as well as a fresh new look! Some of the major updates include a new user-interface, a new Gallery tab to easily store pictures and videos, drag and drop functionality, the ability to share your photos and videos to social media sites directly from the software, as well as a new search feature to easily find effects. 0 for Windows is now available for download. We are very excited to announce that Man圜am 4. (Check out Man圜am 6, the newest version: What you need to know about the new Manycam 6 ) ![]() ![]() ![]() I am able to still eat the food I want be finding substitutions, logging it into myfitnesspal and prepping. ![]() ![]() This app is a savor and helps me find substitution in food by simple scanning the label or taking a photo of my food. I have tried before to understand reading the nutrition fact but was reading it so wrong. I was on a weight lost journey before but was force to stop due to an allergic reaction that trigger an autoimmune disease that force me to stop walking for a couple of years. I am new to tracking macros and a semi rookie at the weight lost journey. Using it for a couple of weeks, it has help me tremendously. I am a beginner and I was referred to this app by a few YouTubers and then my doctor. Track With Apple Watch – A calorie tracker, water tracker, and macro tracker on your watch face. Protein Counter – Set your protein goals and track how much you eat during the dayĪdd Your Own Foods/Meal Tracker – Save recipes and meals for quick loggingĬonnect 50+ Apps & Devices – From fitness tracker and smartwatch apps, including the Health app Net Carbs Mode/Carb Tracker – To simplify a low carb or keto diet, view net (not total) carbs Personalized Dashboards – Pick stats you want to see at a glance Water Logging – Easily keep track of your water intake.Ĭhoose settings that help you achieve your goals.Ĭustom Goals – Track calories by meal or day, set up macro goals & more Nutrition Tracker and Insights – Analyze nutrition intake and set specific goals for macros, cholesterol, sodium, fiber & more Macro Tracker – See carbs, fat & protein breakdown by gram or percentage-no need for a separate carb tracker or keto diet app! 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Emilia Jones and Eugenio Derbez in CODA, premiering globally on Apple TV+ on August 13, 2021. 'For the Damaged Coda' is a song written and performed by American indie rock band Blonde Redhead. Another fellow developer of mine, whom you may know already is Damaged Coda and his astonishing and beautiful game 'The Office'. Louis, MO - Delmar Hall 02-29 Detroit, MI - El Club 03-01 Lakewood, OH - The Roxy 03-02 Millvale, PA - Mr. Get ready for ‘CODA,’ the feel-good movie that will emotionally destroy you. 'For the Damaged Coda' / Blonde RedheadComposer : Kazu Makino, Amedeo Pace, Simone Pace(1 Hour extended Music box Arr.) Full ver. Start your search now and free your phone. She is a street-smart lady who came from humble beginnings. 11-14 Brooklyn, NY - National Sawdust 11-20 Genève, Switzerland - PTR L’Usine ^ 11-21 Parma, Italy - Teatro Regio di Parma 11-23 Cologne, Germany - Gebaude 9 ^ 11-24 Berlin, Germany - Heimathafen Neukölln ^ 11-25 Hamburg, Germany - Bahnhof Pauli ^ 11-27 Lille, France - Aeronef ^ 11-28 Paris, France - La Cigale ^ 11-29 Nantes, France - Stereolux ^ 12-01 Rennes, France - Antipode ^ 12-02 La Rochelle, France - La Sirene ^ 12-03 Toulouse, France - Le Bikini ^ 12-05 Brussels, Belgium - Orangerie (at Botanique) ^ 12-06 Amsterdam, Netherlands - Paradiso ^ 12-07 Leffinge, Belgium - De Zwerver ^ 12-09 Leeds, England - Brudenell Social Club # 12-10 Bristol, England - Thekla # 12-12 London, England - Village Underground # 02-20 Baltimore, MD - Ottobar 02-21 Saxapahaw, NC - Haw River Ballroom 02-22 Atlanta, GA - Terminal West 02-23 Jacksonville, FL - Winterland Festival 02-24 Asheville, NC - The Grey Eagle 02-26 Nashville, TN - The Basement East 02-27 St. Search free for the damaged coda Ringtones on Zedge and personalize your phone to suit you. Another fellow developer of mine, whom you may know already is Damaged Coda and his astonishing and beautiful game 'The Office'. ![]() ![]() Obturator internus and the superior and inferior gemelli muscles contact the joint capsule separating it from the sciatic nerve Obturator externus spirals obliquely to the posterior aspect of the hip joint accompanied by the ascending branch of medial circumflex femoral artery Reflected head of rectus femoris medially More laterally, iliopsoas with its underling bursa separates the hip joint from the common femoral artery and femoral nerve Pectineus separates the hip joint from the common femoral vein Subtendinous, iliopectineal and greater trochanteric bursae, and bursae between gluteus maximus and vastus lateralis exist near the joint 1. There are a number of different muscles that permit flexion/extension, adduction/abduction, and internal/external rotation of the hip joint. Ischiofemoral ligament (weakest): arises from the body of ischium behind and below the acetabulum with fibers directed laterally and upwards to attach to the posterosuperior part of the base of the femoral neck, covering the posterior aspect of the hip joint Pubofemoral ligament: from the iliopubic eminence and the obturator crest to the capsule on the inferior part of the femoral neck Iliofemoral ligament of Bigelow (strongest): inverted V/Y shaped in appearance, it arises from the lower half of the anterior inferior iliac spine and the acetabular rim with diverging limbs attached to the upper and lower ends of the intertrochanteric line Thickenings of this capsule constitute the ischiofemoral, iliofemoral and pubofemoral ligaments: The ligament of the head of the femur and the surrounding fat are enclosed in a reflecting layer of the synovium. The synovial membrane is attached to the articular margins and lines the inner capsule. Retinacular fibers are the reflected part of the capsule traveling back to the femoral head from its distal attachment to the neck, binding down the nutrient arteries arising from the trochanteric anastomosis. The zona orbicularis is a set of internal circular fibers forming a collar around the femoral neck and partly blended with pubofemoral and ischiofemoral ligaments There are circular (internal) and longitudinal (external) fibers. It extends to the femur to attach anteriorly to the intertrochanteric line but as not as extensive posteriorly, attached halfway to the intertrochanteric crest. The joint is surrounded by a fibrous capsule, which is attached to the margins of the labrum and the transverse ligament on the acetabulum. Through the fovea, the head is attached to ligamentum teres. It is covered with hyaline cartilage except at the convexity of the head where the fovea exists. The femoral head is attached to the body of the femur via the neck, which holds it at an angle. The central non-articular part of the acetabulum is filled with the Haversian fat pad (also known as the pulvinar). This notch is traversed by the transverse ligament. The actual hyaline articular cartilage-covered area (lunate surface) is C-shaped and forms an incomplete ring due to the acetabular notch. ![]() The acetabulum covers nearly half of the femoral head. The acetabular labrum increases the depth of the joint 1, thereby increasing the stability of the joint but causes a reduction in the movement at the joint. In comparison to the shoulder joint, it permits less range of movement due to the increased depth and contact area but displays far more stability. The acetabulum is formed by the three bones of the pelvis (the ischium, ilium and pubis). Between them is a Y-shaped cartilaginous growth plate (the triradiate cartilage) which is usually fused by age 14-16. The ball and socket articulation allows for a high degree of mobility. ![]() The rounded femoral head sits within the cup-shaped acetabulum. The hip joint is a ball and socket joint that represents the articulation of the bones of the lower limb and the axial skeleton ( spine and pelvis). Innervation: femoral, obturator and superior gluteal nerves, and nerve to quadratus femoris 2 Movements: thigh flexion and extension, adduction and abduction, internal and external rotationīlood supply: branches of the medial and lateral circumflex femoral, superior and inferior gluteal arteries and obturator arteries 2 Ligaments: ischiofemoral, iliofemoral, pubofemoral and transverse acetabular ligaments, and the ligamentum teres 1 ![]() Articulation: ball and socket joint between the head of the femur and the acetabulum ![]() ![]() Make sure to design and export your file using CMYK colors, which are optimized for print, rather than RGB colors, which are optimized for on-screen viewing. However, your colors won’t print correctly if you’re not using the correct color space for your document. Design your poster in CMYK: Thomas Group offers black-and-white and full color printing services, as well as a wide array of paper types and weights.Following best practices for print design will help ensure your poster printing job rolls off the press perfectly the first time. Our aim is to provide better context for designers and teams producing assets for final printed designs.įollow Print Design Best Practices When Producing Your PosterĪside from poster size, there are other design elements to consider when printing your poster. To make the guide more helpful for both US-based designers and for designers using international paper sizes, we’ve included information about the closest international size equivalents for our standard poster sizes. What you’ll find in this blog postīelow, we’ll display the most common or standard poster sizes that are available for print, provide you with an idea of how large the standard poster sizes are in relation to one another, and help you understand how sizing can affect your print budget. We believe that having a basic understanding of our poster sizes can help you zero in on the right poster size sooner, avoiding the costly process of printing posters at several different sizes to decide. ![]() Whether for decorative purposes or advertising and marketing campaigns, knowing how to scale your poster for peak impact adds a professional element to any project, but it can be hard to conceptualize the correct poster size for your project without seeing a few compared side by side.Īs a full-service commercial print shop offering poster printing, we’ve seen it all, so we created this guide to help print designers and buyers easily reference the most common poster sizes and see how they compare to one another at a glance. In a time where much of what we see is presented in digital formats, posters continue to be an effective and high-impact way to widely share information. ![]() |
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