Using Macromedia Flash for Electronic Presentations: ANewAlternative

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1 Macromedia Flash for Electronic Presentations Computers Computers in Radiology Downloaded from by on 04/06/18 from IP address Copyright RRS. For personal use only; all rights reserved C D E M N E U T R Y L I M C I G O Chun-Shan Yam 1 Yam C-S F I N G Keywords: animation, computers, Macromedia Flash, movie loops, PowerPoint DOI: /JR Received November 12, 2005; accepted after revision January 24, Department of Radiology, eth Israel Deaconess Medical Center, WCC, Room 306, 330 rookline ve., oston, M ddress correspondence to C.-S. Yam (csyam@bidmc.harvard.edu). WE This a Web exclusive article. JR 2006; 187:W209 W X/06/1872 W209 merican Roentgen Ray Society Using Macromedia Flash for Electronic Presentations: Newlternative OJECTIVE. This article provides a step-by-step tutorial for creating electronic presentations using Macromedia Shockwave Flash, one of the recommended file formats for many radiologic society annual meetings, including the merican Roentgen Ray Society (RRS). CONCLUSION. lthough Flash and PowerPoint can be used for creating presentation slide shows, Flash is more appropriate for integrating and delivering animations for Internet applications such as radiologic electronic presentations. For this reason, detailed step-by-step instructions for creating Flash slide shows with common features such as text, images, arrows, buttons, movie loops, and transitions are provided. The approach used in this article is particularly appropriate for academic radiologists who have basic PowerPoint skills but lack programming experience. urrently, Macromedia Shockwave Flash (Flash) and Microsoft C PowerPoint are the most commonly used applications for electronic presentation at many radiologic society meetings such as the merican Roentgen Ray Society (RRS), Radiological Society of North merica (RSN), and European Congress of Radiology (ECR). lthough either of these two applications can be used for creating slide shows, Flash is more appropriate for integrating and delivering animations for Web-based presentations [1]. For instance, some PowerPoint animations such as transitions, effects, and linked movie clips, which can be projected from desktop computers, may not work properly in a networkbased presentation format. In an electronic presentation, a Flash file can either be embedded as part of the Power- Point file or as a complete stand-alone slide show. previous article described a simple use of Flash as a solution for displaying movie loops in PowerPoint [1]. Note: Movie loops created by Flash are embedded in the PowerPoint files, not linked. This article provides a step-by-step tutorial for creating entire slide shows using only Flash. lthough most Flash applications used on the Internet are created using ctionscript (a built-in programming language in Flash), simple slide shows made with Flash do not require any programming skill. Software and Hardware Requirements To create Shockwave Flash files (*.swf), users will need Macromedia Flash Pro installed on their computers (either pple Macintosh or PC systems). Detailed information on purchasing and installing this software is provided in a previous article [1]. In my case, I purchased a copy of Flash MX 2004 Professional (cademic version 7.2, $95) and installed it on my PC running Windows XP Professional (Microsoft). Macromedia recommends the following minimum system requirements: Pentium III 800 MHz, Windows 2000 or XP, 256 M of RM, 16-bit display at 1, resolution, and 710 M of available disk space for Windows; and 600-MHz PowerPC G3 and later, Mac OS 10.3/10.4, 256 M of RM (1 G recommended), thousands of colors at 1, resolution, and 360 M available disk space for Macintosh [2]. However, Flash performs significantly better on newer computer systems such as Windows XP Professional, Pentium IV 2.0-GHz processor, and 1 G of memory for PC; and Mac OS 10.4, Power Mac G5 2.0-GHz processor, and 1 G of memory for Macintosh. esides its capabilities for creating Internet-based applications such as splash screens, Web forms, wireless communications, and video conferences, Flash can also be used for generating slide shows using a special document: Flash Slide Presentation. This particular type of document is available only in the JR:187, ugust 2006 W209

2 Downloaded from by on 04/06/18 from IP address Copyright RRS. For personal use only; all rights reserved C Fig. 1 Screen captures of Macromedia Shockwave Flash (Flash) show process to begin presentation document., Screen capture of Flash shows available types of documents at New Document window., Screen capture of Flash shows screen layout for new presentation document. C, Screen capture of Flash shows document settings. Fig. 2 Screen captures of Macromedia Shockwave Flash (Flash) show process to create new screens., Screen capture of Flash shows context window for inserting new screen. Select Insert Screen for creating new screen at same level as selected screen and Insert Nested Screen at next level., Screen capture of Flash shows screen hierarchy. In this example, slide show contains six screens in three hierarchical levels. W210 JR:187, ugust 2006

3 Macromedia Flash for Electronic Presentations Downloaded from by on 04/06/18 from IP address Copyright RRS. For personal use only; all rights reserved Fig. 3 Screen captures of Macromedia Shockwave Flash (Flash) show process for working with gray scale and color., Screen capture of Flash shows process steps for choosing Gray-Scale Linear Fill pattern at Color Swatches., Screen capture of Flash shows process steps for creating dark blue gradient. professional version not the basic Flash. lthough the general process for creating slide shows is similar to PowerPoint (i.e., insert slides, import images, draw text and arrows, and so on), the terminology and process steps used in Flash are different from those used in PowerPoint. Flash Terminology Screen versus Slide In Flash Slide Presentation documents, screen is the technical term for naming individual frames in a slide show. Screen is equivalent to the term slide used in traditional PowerPoint presentations. When a screen is created, it can be defined either as a slide screen or a form screen. Slide screens are used for sequential presentations such as slide shows. Sequential screens can overlay one another so that the previous screen can be visible when the next screen (i.e., a nested screen) is viewed. This overlaying capability is particularly important for creating movie loop effects. Slide screens have built-in navigation functions (using arrow keys). Form screens are used for form-based applications such as online registration, quiz forms, and electronic commerce. lthough form screens are similar to slide screens, the main difference is that forms do not have any built-in navigation tools. ctionscript is usually required for creating navigation structure for form screens. For the purpose of creating a slide show, only slide screens are needed. Note: In Flash, slide screen is the default screen type. Screen Hierarchy In Flash Slide Presentation documents, screens are organized in a parent-and-child hierarchy, a relationship in which the child screens inherit the content from the parent screens. In other words, objects such as text, graphics, buttons, and images appearing on a parent screen also appear on the child screen. There can be multiple parent screens for a child screen and vice versa, depending on screen arrangement. The applications of these two types of screens are different, and they will be discussed in the following demonstration slide show. Demonstration This section will describe the basic steps for creating a demonstration slide show with features such as images, text, arrows, movie loops, buttons, and transitions that are commonly used in PowerPoint presentations by academic radiologists. lso, to serve as a first-hand user s tutorial, these steps are specifically organized in the following order: creating a new slide document, inserting new screens, customizing background color, adding navigation buttons, creating text objects, importing images, using lines and arrows, creating movie loops, applying transitions, and exporting Shockwave Flash. The instructions described in this demonstration are based on Flash Professional 7.2 and Windows XP, but they can also be applied to other versions (e.g., Flash 8.0) and operating systems. Creating a New Slide Document fter installing Flash, launch the application. t the main window, select New from the File pop-up menu. t the New Document window (Fig. 1), select the General tab and then select Flash Slide Presentation to create a new document with a default name Untitled-1.fla (Fig. 1). Save the source document using the filename Demo.fla by selecting Save s from the File pop-up menu. Next, select Document from the Modify pop-up menu to open the Document Properties window. Enter 800 px and 600 px for width and height, respectively (Fig. 1C). These are the recommended dimensions for Flash documents used at the RRS and RSN annual meetings. With these dimensions, the slide show is guaranteed to display within a Web browser on a standard screen (i.e., 1, pixel resolution). t the same window, use the color picker to select solid black (#000000) as the screen background, and enter 12 frames per second (fps) as the frame rate (Fig. 1C). Note: Frame rate does not apply to screen navigation but refers to animation speed. This parameter will be used to adjust the playback speed of a movie loop later in the demonstration. JR:187, ugust 2006 W211

4 Downloaded from by on 04/06/18 from IP address Copyright RRS. For personal use only; all rights reserved y default, as many as 10 function panels may be open when Flash is first launched. To simplify the layout and maximize the working area, select Hide Panels from the Window pop-up menu to close all the function panels except for Tools. This panel contains tools for drawing and formatting screen objects such as lines, text, and images. If the Tools panel is not yet displayed, select Tools from the Window pop-up menu to make it visible. lso, this panel is dockable, and it can be dragged away from the Flash window and placed anywhere on the monitor screen to further increase the working area. Inserting New Screens Similar to the PowerPoint layout, the main working area contains two sections: thumbnail screens on the left and current screen (the highlighted thumbnail) on the right (Fig. 1). In Flash, the current screen is called the Stage. y default, Flash automatically creates two screens for a new slide show (i.e., presentation and slide1). To show the steps for using other objects such as text, arrowheads, images, and movie loops, four additional screens (three standard screens and one nested screen) are required. First, click on slide1 (right-mouse) and choose Insert Screen to create a new screen, slide2. Similarly, click on the new screen slide2 to create slide3, and so on for slide4. Then, go back and click on slide3, and select Insert Nested Screen to create a new screen, slide5 (Fig. 2). The presentation now contains a total of six screens: presentation at the first hierarchical level, slide1 to slide4 at the second level, and slide5 at the third level. In this particular case, presentation is the parent screen containing 4 child screens, slide1 to slide4, and 1 grandchild screen, slide5 (Fig. 2). ecause the presentation screen is located at the topmost level, its contents will be visible on all other screens equivalent to the slide master in PowerPoint. This is the most appropriate location for placing common objects such as background color, institution logos, and navigation buttons for the entire presentation. Customizing ackground Color To change the screen background, use the color picker at the Document Properties window to choose a new color (Fig. 1C). However, this approach is limited to one single color. Other color patterns such as dark blue gradient, a common background used by many PowerPoint users, can be created with the following steps. Click on presentation (i.e., left-mouse) to make it the current screen. Select the Fill Color icon from the Tools panel (Fig. 3). t the bottom left of the pop-up window (Color Swatches), select the Gray-Scale Linear Fill icon. y default, this gradient is mixed linearly with black and white colors. For dark blue gradient, the white must be replaced with blue using the Color Mixer. Select Design Panels Color Mixer from the Window pop-up menu, and follow these steps: click the white pen click the Paint ucket choose blue (#0000FF) from the color table (see Fig. 3 for details). Now the current color is a precise dark blue gradient. Close the Color Mixer window and return to the stage. Use the Rectangle Tool from the Tools panel to draw a small rectangle onto the stage. The rectangle is now filled with the dark blue gradient. However, the gradient is in the wrong direction (left to right). The easiest way to correct this is by rotating the rectangle 90 counterclockwise using the Free Transform Tool from the Tools panel. Next, resize the rectangle by dragging its corners to cover the entire screen. This step can also be done precisely by changing the rectangle dimensions at the Properties panel. If this panel is not yet displayed, select Properties from the Window pop-up menu to make it visible. In this case, set the dimensions to the same size as the document (i.e., pixels). Finally, select Horizontal Center and Vertical Center from the Modify lign pop-up menu to center the rectangle to the stage. These alignment functions can also be accessed at the lign window (press the Control and K keys simultaneously). The presentation screen now contains the gradient fill. Fig. 4 Screen captures of Macromedia Shockwave Flash (Flash) show process steps to create buttons., In this example, Next button is created for advancing slides using function Go to Next Slide at ehavior panel., Figure shows the three navigation buttons created during this demonstration. W212 JR:187, ugust 2006

5 Macromedia Flash for Electronic Presentations Downloaded from by on 04/06/18 from IP address Copyright RRS. For personal use only; all rights reserved Fig. 5 Screen captures of Macromedia Shockwave Flash (Flash) show process for adding text., Screen capture of Flash shows process steps for creating text object., Screen capture of Flash shows content of slide1. Fig. 6 Screen captures of Macromedia Shockwave Flash (Flash) show process steps for dealing with images., Screen capture of Flash message box for loading all images from an image sequence., Screen capture of Flash shows process steps for resizing and repositioning an image using Free Transform tool. dding Navigation uttons lthough Flash presentation has built-in screen navigation functions (i.e., left arrow for previous and right arrow for next), buttons can also be used. dding navigation buttons to the stage is simple. While the presentation screen is still selected, open both the Components and ehaviors panels from the Window Development Panels pop-up menu. t the Components panel, drag and drop a utton object from the UI Components group onto the stage (Fig. 4). Resize and position the button as necessary. Then, enter Next for the button label and Nexttn for the Instance Name in the Properties panel at the Parameter tab (Fig. 4). Note: Instance Name is a unique name for identifying individual objects, and it can be any arbitrary name. t the ehaviors panel, click on the + sign to expand the drop-down list and select Go to Next Slide from the Screen section. Similarly, create another button, enter Previous for the button label and Prevtn for the Instance Name, and then select Go to Previous Slide. Now, the demonstration slide show contains the two commonly seen navigation buttons. In my experience, a Home button is particularly important for electronic presentations. slide show may have been left open by a previous viewer, and the Home button enables new viewers to rapidly reset the presentation to the first screen. Drag another button onto the stage, enter Home for the button label and Hometn for the Instance Name, and then select Go to First Slide. The presentation screen now contains three navigation buttons (Fig. 4). Creating Text Objects dding text to the stage is similar to inserting a text box to a PowerPoint slide. Select the Text Tool from the Tools panel, draw an outline box at the stage, and then type the text (Fig. 5). Text attributes (i.e., font, size, color, and style) can be modified in the Properties panel. They can also be aligned using the lign functions as discussed previously. For demonstration, I created three lines of bold text on slide1 using Times New Roman as the font JR:187, ugust 2006 W213

6 Downloaded from by on 04/06/18 from IP address Copyright RRS. For personal use only; all rights reserved Fig. 7 Screen captures of Macromedia Shockwave Flash (Flash) show process steps for symbols., Screen capture of Convert to Symbol window shows the three types of conversion format: Movie clip, utton, and Graphic. In this example, Graphic symbol is used., Screen capture of Flash shows content of slide2 with arrow imported from PowerPoint. rrow is then converted as Graphic symbol and stored in Library. C, Screen capture of slide2. In this slide, imported arrow was resized, rotated, and repositioned for annotation purposes. type. The top two lines are yellow with font size 32. The third is white with size 28. These three lines are centered to the stage (Fig. 5). Importing Images Common image files (e.g., *.jpg, *.bmp, and *.png) can be loaded into Flash using the Import function. Select Import Import to Stage from the File pop-up menu. t the Import window, navigate to the folder containing the image, select the image, and then click the Open button to load the image. message window will then prompt for importing all images in the same sequence (Fig. 6). For loading only one single image, select No to disable this option. Selecting Yes will load the entire image sequence and a movie loop will be created. This feature will be shown later. In my case, I imported a color image, Heart001.png, onto slide2, and then used the Free Transform tool to resize and center the image (Fig. 6). Other image functions such as Transform, rrange, and lign are also available in the Modify pop-up menu. These formatting functions operate in a manner similar to their PowerPoint equivalents. I also created the title Coronary CT using MDCT near the top of the stage. lternatively, an image can be loaded into the Library first by selecting the Import to Library option and then later dragged to the stage. If the Library panel is closed, select Library from the Window pop-up menu to make it visible. Loading an image into the Library is helpful for future use. For instance, if the same image will be used repeatedly, putting the image into the library not only shortens the process steps but also reduces the file size. However, for this demonstration case, using Import to Stage is adequate. s of this writing, Flash does not support file drag-and-drop for importing images. However, image data available at the Windows clipboard can be pasted onto the stage. In other words, images and graphics can be transferred from other applications into Flash using the simple copy-and-paste function. Using Lines and rrows Line objects can be created using the Line Tool from the Tools panel. Similar to other drawing objects, the properties of line objects such as color, thickness, and pattern can be adjusted in the Properties window. Currently, there is no function for drawing arrowheads in Flash, but arrowheads can be created by combining a triangle and a rectangle using the C W214 JR:187, ugust 2006

7 Macromedia Flash for Electronic Presentations Fig. 8 Screen capture of Macromedia Shockwave Flash (Flash) shows image sequence (n = 72) is distributed into individual time frames (one in each frame). Edit Multiple Frames and Modify Onion Markers must be used properly for simultaneous image adjustment (i.e., resize and reposition). Downloaded from by on 04/06/18 from IP address Copyright RRS. For personal use only; all rights reserved Fig. 9 Screen captures of Macromedia Shockwave Flash (Flash) show Transition effect., Screen capture shows cascaded context windows for applying Transition effect on text object. Note: This effect can also be used on other objects., Screen capture of Transition window shows effect parameters. PolyStar Tool (polygon) from the Tools panel. However, this process may be intimidating for many users and it is truly unnecessary. Instead, I recommend using the copyand-paste function to transfer an arrow object from another application such as PowerPoint. fter copying the arrow onto the stage, select Convert to Symbol from the Modify pop-up menu, and then select Graphic as the conversion format (Fig. 7). The arrow is then saved into the Library for future use (Fig. 7). When another arrow is needed, simply dragand-drop the arrow symbol from the Library onto the stage. In my case, I copied an arrow from PowerPoint, resized and rotated it using the Free Transform tool, and then used it to highlight the narrowing at the left anterior descending artery. I also created the text Narrowing as the annotation (Fig. 7C). Creating a Movie Loop One of the advantages of using Flash over PowerPoint is the seamless mechanism for creating movie loops within the presentation. Select slide3 as the active screen. Copy the title text Coronary CT using MDCT from slide2, and then paste this text object onto slide3 by selecting Paste in Place from the Edit pop-up menu. This particular function not only duplicates the object but also places it in the same position as the original. Next, click on slide5 (the child screen of slide3), and then select Import Import to Stage from the File pop-up menu. t the Import window, navigate to the folder containing the image sequence, and select the first image (e.g., Heart001.png, the same image used before). Then, click the Open button to continue. When a message box appears prompt- JR:187, ugust 2006 W215

8 Downloaded from by on 04/06/18 from IP address Copyright RRS. For personal use only; all rights reserved Fig. 10 Screen captures of Macromedia Shockwave Flash (Flash) tabs in Publish Settings window., Screen capture shows Formats tab window., Screen capture shows Flash tab window. ing the options for loading all images in the same sequence, click the Yes button. With this option, the entire image sequence is loaded with images distributed in separate time frames (Fig. 8). If the Timeline is not yet open, select Timeline from the Window menu to make it visible. If the Timeline is not fully extended, click on the word Timeline on top of the panel to open it. In my case, 72 color images were loaded (i.e., Heart001.png to Heart072.png, pixels). If the position and size of the imported images need to be adjusted, it is important to perform the actions globally for all of the images simultaneously. This global-editing mode can be achieved with the following steps (see Fig. 8 for details). t the Timeline, use the right mouse to click on the first time frame, and choose Select ll Frames from the context window. Click on Edit Multiple Frames, and select Onion ll from the Modify Onion Markers. (oth of these functions are located right below the Timeline.) Select all the images. (Press the Control and keys simultaneously.) Click on the Free Transform tool from the Tools panel, and adjust the images simultaneously. Note: These steps must be executed in the exact order shown. In Flash, Onion is a term referring to the range of the effective time frames. For instance, if frame # 10 is selected and Onion 5 is used, the Multiple Frame actions will only apply between frame # 5 and frame # 15, but not the others. So, it is necessary to select the first frame and then choose Onion ll. Select Test Movie from the Control menu (or press the Control and Enter keys simultaneously) to preview the slide show with the built-in Flash viewer. The image sequence now loops continuously and repeats every 6 seconds (i.e., total images = 72; document frame rate = 12 fps). Change the document s frame rate to adjust the playback speed of the movie loop if necessary. fter previewing, click the icon at the top right to close the viewer and return to the stage. Similarly, movie clips (e.g., *.avi, *.mov, and *.mpg) can also be used to create movie loops using the same steps, except select movie clip at the Import to Stage window rather than images. Currently, most common image and video file formats can be imported into Flash [1]. pplying Transitions lthough Flash provides a wide range of functions for creating interactive and dynamic animation effects, most of these functions require users to have a certain degree of programming knowledge. Fortunately, for simple presentation effects such as transitions, no programming is required. Next, this demonstration will describe the essential steps for applying a fading transition to a text object, one of the common features used in PowerPoint. t the last screen, slide4, create the text object The End at the center of the stage. Using the right mouse, click on the text object to W216 JR:187, ugust 2006

9 Macromedia Flash for Electronic Presentations Downloaded from by on 04/06/18 from IP address Copyright RRS. For personal use only; all rights reserved open the context window, and then select Timeline effects Transform/Transition Transition from the drop-down list (Fig. 9). t the Transition window, different parameters can be specified for the fading effect (Fig. 9). This example simply uses 30 frames (default value), Left to Right, and Fading In for the parameters. With this setting, the text The End will appear progressively from left to right in 2.5 seconds (frame rate = 12 fps). Note: lthough using a transition is one way of drawing attention, overuse of this feature may be distracting to viewers, so use this feature sparingly. To remove the transition effect, simply click on the object (right-mouse) and select Remove Transition from the context window. Exporting Shockwave Flash The final step is to export the slide show as a Shockwave Flash file (*.swf). This is the required file format for electronic presentation. Select Publish Settings from the File pop-up menu, click the Formats tab, and then choose both Flash and HTML (HyperText Markup Language) as the output options (Fig. 10). Then, click the Flash tab and specify the output settings as shown in Figure 10. In this example, the JPEG quality is set at 90%. ccording to the literature, setting this parameter to at least 80% is acceptable for most radiologic images [3]. djust this parameter if necessary. However, the output file size depends highly on this setting. Next, click on the Publish button at the bottom of this window to export the files. In this case, two files are generated: Demo.swf (file size = 2.2 M) and Demo.html. lthough it is not necessary to submit the HTML for electronic presentation, it is useful for Web publishing. In fact, double clicking on the HTML file will launch the Flash presentation in a Web browser. See supplemental Flash data demo (Demo.swf) at to view the demonstration slide show using Macromedia Flash Professional 7.2, containing common features such as text, images, arrows, buttons, movie loops, and transitions. This demonstration was created using the step-by-step instructions provided in this article. The file format is recommended for FOR YOUR INFORMTION electronic presentations by most of the radiologic society annual meetings, including RRS. lternatives collection of slide templates is included in the software installation. These templates can be accessed at the Templates tab from the New Document window (Fig. 1). lthough most of these templates are not designed specifically for radiology presentations, they can still be useful for reference. Flash provides a free software plug-in (Flash Video Exporter [4]) for converting video files created by common applications such as QuickTime (pple) and fter Effects (dobe) to Flash Video (*.flv), a special file format for importing movie content into the Flash Library or linking as an external data source. This plugin cannot be used to create slide shows. lso, some third-party companies offer conversion tools for converting documents such as Word, Excel, and PowerPoint (Microsoft Office) into Flash format (*.swf) [5 7]. However, my experience has been that most of these tools may not convert transitions, animations, effects, and movie clips correctly, and the converted files (*.swf) cannot be edited. Users should be cautious when attempting to use these types of conversion tools. lthough this article describes a general use of Flash for creating slide presentations as an alternative to PowerPoint, other types of media applications such as HTML documents may also be used for the same purpose. Different radiologic societies may require different types of media applications for electronic presentations. Therefore, users should always refer to the specific requirements published by the society. Discussion Flash is now one of the recommended file formats for electronic presentations in most of today s radiologic society meetings (e.g., RRS, RSN, and ECR). The advantage of Flash is its capability of integrating and delivering animations such as transitions and movie loops, which are known difficulties for PowerPoint. lthough there are plenty of Flash resources freely available on the Internet, most require programming skills in ction- Script. In this article, I provide a tutorial specifically for academic radiologists who have basic PowerPoint skills but lack programming experience. demonstration slide show containing common features such as text, images, arrows, movie loops, buttons, and transitions is provided with step-by-step instructions. lthough this article addresses the basic needs for creating slide presentations using Flash as an alternative to PowerPoint, no assumption is made that Flash is superior to PowerPoint. ecause electronic presentation is still in its emerging period, the pros and cons between these two applications are too early to be decided. For presentations containing only simple images and text, there should be no noticeable difference between PowerPoint and Flash. However, for presenters wishing to use animations (e.g., transitions and movie loops) in their presentations, particularly in an electronic presentation format, Flash seems to be the more appropriate choice. s mentioned previously, both PowerPoint and Flash are acceptable for electronic presentations. I hope this article provides useful insights for preparing successful presentations. References 1. Yam C-S. solution for presenting dynamic data sets in electronic presentations. JR 2006; 187: xxx xxx 2. Macromedia Flash support page. vailable at: ccessed May 19, Stern E, Richardson M. Preparation of digital images for presentation and publication. JR 2003; 180: Flash Video Exporter. vailable at: devnet/flash/articles/flv_exporter_print.html. ccessed May 19, Wondershare Web site. vailable at: ccessed May 19, FlashPoint Web site. vailable at: ccessed May 19, DreamingSoft Web site. vailable at: htm/. ccessed May 19, 2006 The data supplement accompanying this Web exclusive article can be viewed from the information box in the upper right corner of the article at: JR:187, ugust 2006 W217