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Hamilton described a classification of contour changes of facial skin It is based on four variables: clinical morphology (laxity, furrows, or wrinkles); tissue location (muscular, musculocutaneous, or cutaneous); clinical location (cheeks, neck, eyelids, forehead, etc); and etiology (genetic, repeated facial expression, or photoaging) Each type of change is then presented with a proper procedural treatment, such as rhytidectomy, soft tissue augmentation, resurfacing with lasers or chemical peels, or a combined approach (Tables 39-7A and B) III 7 9

While IT can generate considerable advantage when integrated into good processes, it is unwise to rely on IT to fix a broken process To quote Albert Einstein, insanity is doing the same thing over and over again and expecting different results Equally, doing the same thing, only automated and faster, is unlikely to yield any better results In fact, IT applied to a bad process locks in the non-value-add in the given process, driving up the costs of correcting it Which is why we have to tackle the complexity in our organizations with a process view to identify the complexity and develop rational, rigorous strategies for taking complexity-related cost out of our infrastructure Before you make any move on IT, create a Complexity Value Stream Map of the process, find all the value-add and non-value-add activities and costs, and apply the Complexity Equation to understand the intrinsic PCE Consider a different IT solution only after you have driven up the PCE Don t be afraid of little solutions You don t have to buy a $100 million IT system to generate value; once the non-value-add steps are eliminated, you may not want or need to add new IT (which is good news from shareholders perspective)

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red boat and some sailor with the same name (perhaps a di erent sailor) has reserved a green boat As we observed in 4, the problem arises because we are using sname to identify sailors, and sname is not a key for Sailors! If we select sid instead of sname in the previous query, we would compute the set of sids of sailors who have reserved both red and green boats (To compute the names of such sailors requires a nested query; we will return to this example in Section 544) Our next query illustrates the set-di erence operation in SQL (Q19) Find the sids of all sailors who have reserved red boats but not green boats SELECT FROM WHERE EXCEPT SELECT FROM WHERE Ssid Sailors S, Reserves R, Boats B Ssid = Rsid AND Rbid = Bbid AND Bcolor = red S2sid Sailors S2, Reserves R2, Boats B2 S2sid = R2sid AND R2bid = B2bid AND B2color = green

Principle #2: Reduce the complexity in your systems architecture (your customers won t pay for it!)

Adapted from Fitzpatrick RE, Goldman MP, Satur NM, et al Pulsed carbon dioxide laser resurfacing of photo-aged facial skin Arch Dermatol 1996;132:395 (Table 39-8) It was originally designed to evaluate treatment response with injectable fillers This classification addresses specific wrinkles on different anatomical areas The wrinkles assessed on this scale are horizontal forehead furrows, glabellar frown lines, periorbital lines, periauricular lines, cheek lines, nasolabial folds, radial upper lip lines, radial lower lines, corner of the mouth lines, marionette lines, the labiomental crease, and horizontal neck folds

Sailors 22, 64, and 31 have reserved red boats Sailors 22, 74, and 31 have reserved green boats Thus, the answer contains just the sid 64 Indeed, since the Reserves relation contains sid information, there is no need to look at the Sailors relation, and we can use the following simpler query: SELECT FROM WHERE EXCEPT SELECT FROM WHERE Rsid Boats B, Reserves R Rbid = Bbid AND Bcolor = red R2sid Boats B2, Reserves R2 R2bid = B2bid AND B2color = green

The case to simplify IT systems is an easier case to make than the case to integrate them (the theme of the 1990s) The process of simplification is one of moving towards common standards and platforms with lower maintenance costs, rather than connecting proprietary systems If you re one of the companies spending huge amounts of money maintaining cumbersome systems, which solution would you prefer McKinsey estimates that pruning the number of technologies in use can lead to IT cost savings of up to 20%11

The Larnier Photographic Scale was designed to rate photoaging of skin based on photographs4 It is a six-point photographic scale, with each point consisting of three separate photos to illustrate each level of severity Therefore, the scale consists of six grades of photoaging severity, with grade 1 corresponding to mild and grade 6 to very severe Larnier s scale has been validated for assessing photodamage in Caucasian subjects, but not other ethnic groups

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