I mostly just use reflow--after I add tags to the PDF. Without them, it keeps the original line breaks, and sometimes breaks lines mid-word. Sometimes I just crop the pages down so there's less white space; I can read 6x9 books on my 505 fairly comfortably after I crop them down a bit.
If I want to convert them (happens sometimes), I'll convert to Word, fix the formatting there, and then re-convert to another format--probably LRF because that's fastest. I'm not yet comfortable enough with BookDesigner to get the formatting all fixed up.
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