Beethoven, Sonata, Ab, Opus 26, a special sonata because in the first movement we have not the classical first movement in Allegro or Allegro Conbrio or whatever, we have a variation movement and very interesting it's written andante con variazioni and not tema con variazioni. So one could think about maybe even the andante can be as a tempo in variation especially for the third and fourth movement variation it is very important. Andante walking, you walk different if you had a wonderful day before or if you had a sad day or if you walk dreaming and so there is a kind of possibility to change the tempo and to play it in different attitudes. Could you just play it like you did in your performance? And of course it would be also possible, well maybe you have done three concerts and this is the fourth one and you feel very good and you think ah the world is without problems and play like this, can you try? So here as the interpreter you are free just to choose the tempo which is an andante for you. Then we have the situation where the phrase ends and the syncope interrupts in a way. You can think about there is a kind of monologue and then somebody is saying something or you can think it's a dialogue and you talk and the other just want to save something and comes very early it could be like this. Can you try? Take more time. So then the situation is really completely different but only with a slight waiting. First variation this. Also here I think the situation like the beginning is the same so it's not a kind of virtuoso variation. You just should take time. Can you try? Very good. I like this very much but it would be also possible to hurry a little bit and to be in time. Can you try this? Quite fast. Like I read in a book that Sviatoslav Richter is playing this variation like a list etude. Maybe imaginable. Like the F minor etude of list. Can you try? Yes, very good. But of course you know you just demonstrated the possibility but you played it slowly on more characteristic. Can you do your interpretation? It depends how you see it and I think from the title Andante con variazioni we are really free here to play different. Next variation is a kind of I think preparation for the funeral march and if you take time here on the one it is really heavy so you feel sad and you hardly can't can walk. Can you try?  Can you try? Next variation I think this is a kind of well I always think they are on a ballet of girls, little girls dressed in white and who walk very smooth and dense and almost flying but then interrupted by crescendo legato and the strong Sforzato. Can you just show it? Edwin Fischer writes in his book that one has to be careful not to play it as a scherzo and not in double tempo of the variations of the tema and the other variations and this indicates that at his time sometime it was played in double tempo like a scherzo but can you just show it how it would be play very fast. Yeah I think this is even a possibility it sounds I think it sounds interesting but well in tempo of two-three I think. Good then let's turn to the scherzo. Allegro molto I think this is even a little bit arabiato maybe kind of inner fighting and I would point out the Sforzati very strong. Can you try? I think this is still very polite. I would do the thirds maybe even also very strong we have the forte we have Sforzati and I would play it almost martellato. Here we find this moment where we have forte and then followed by piano subito piano this is something I forgot to mention at the beginning and but it is very important because this is a kind of I would say the musical grammar of Beethoven very often you have a crescendo you think it goes on and then it goes back. Let's just show this from the beginning and I would always exaggerate this. Can you try this? Twice we have this crescendo subito piano crescendo in one bar and piano again and that we find even in the very early bit of Sonatas and I would really look on this and always demonstrate this kind of like this. Okay then funeral march in the literature about this sonata very often is written it has to be completely strict in rhythm because this is a kind of a funeral of a hero maybe a general or a king or whatever and I think this is right. There is one thing where it is different I think this is the moment when we have the major chord and I remember in preparation for this production I watched some funerals and a very moving is the funeral of Winston Churchill where his coffin is lit through the streets and you see the politicians the famous politicians of this time standing there and for a second you see Charles de Gaulle and he of course without any moving of his face but a tear is going down and I think this is the moment here this is the tear in a normal very controlled funeral but I would show and point it out by taking some pedal and waiting on the chord. Can you try? Maybe from here where it's good for you. This is again maybe some timpani's in the march. I would really play and with the help of the arm and a little weight of the arm to point out this crescendo. Can you show? But be careful not to do an accelerando. Yes, yes. There is also I read about different interpretation and I heard it myself. Sometimes there are pianists who do double punctuation. I wouldn't do it because even in the early sonatas Beethoven really has moments where he has just one point and where he has two points so he would have indicated. One interpretation I heard where it is in the normal rhythm but here double point. I would not do it. I would really stay in the rhythm. Last movement Edwin Fischer writes this kind of imagination. The funeral is over you go home and it starts to rain and the figure is really kind of raining. Can you show it? You are in Kaiser the famous critic who wrote a wonderful book about Beethoven's sonatas. He discusses whether this is a kind of maybe a harmless end of a very intensive funeral march but I think this is a best possibility to finish such a sonata because the funeral march is so serious and so strict so something must happen. Even if you have attended the funeral yourself something must happen and you must relax. But the relax is only at the beginning because then it comes out dramatic. Can you show this. That is from the from the partitique. I think this is the same figures and when the tempo is the same it starts in piano. Very important is to point it out non legato with pedal. Can you try? And so for the end we have surprising sforzates on the beginning of a phrase. Normally one should not do it except it's indicated and here is it indicated so you should really point it out. Can I see? It could be even stronger. In the sonata opus 28 which will be also part of this production. There is a similar part but there are no sforzates so that is important not to do it. But here it's strong but so this is the last drama in the sonata. At the end the music disappears and it's like open a window and the music flies away. So you should really try out the most possible pianissimo so that one really cannot hear what you are really doing. It is disappearing. Can you try? Yes. So kind of farewell and when you talk about interpretation what could one do? At the end if you are on stage you could do and then or you could do well but this is an interesting end but this kind of end a bit of use is also in the D major sonata opus 10 number 3 and I think if you go back to the theme it's a wonderful connection and a flat with the most beautiful sound which is possible. Thank you. Thank you.


C&O and McPond visited USS Harry S. Truman this month for conversation with a shipmate. One of the topics was short notice PCS moves. How should sailors prepare themselves and their families to make these moves with significantly lower lead time? What I'd like to share with sailors and families is work closely with fleet and family services, work closely with our folks that handle our PCS moves, and hopefully in the very near future we can get back to that five and six month advance notice for PCS orders. That's our goal, that's what we're shooting for, because we don't like these short term orders either. C&O plans to travel around the fleet to have more conversations with shipmates. Watch the full video at navy.mil or on direct to sailor. From all hands update, thanks for watching.


DevCon Decisions by Clay Mackle episode 4 which FileMaker bag one of the benefits of going to the FileMaker developer Conference is that you'll get a bag of some sorts to carry around your electronics and swag Sometimes they have a nice slot for a laptop and other times it may just be big enough to carry a MacBook Air Which one should I take this year leave your comments wherever you see this


Welcome to the fourth video of module two in this practical guide to applying a multi-criteria decision-making framework. In this video, we're going to be really looking at how we work with stakeholders and maybe think about providing useful feedback for them. In the previous videos in module two, we think about recapping what we've looked at. We've considered about how we went about structuring the MCDM for our New Zealand example and the process by which those domains and sub-domains were selected and what we need to think about when we're doing this. And then in the last video, we reviewed the workings of the Excel spreadsheet and highlighted what's needed to undertake the analysis and how it can be used as part of this ongoing interview process. In this final video, we cover some issues around using the approach with different stakeholders, maybe individuals, groups, companies, versus individual farmers, etc. And think about how the information can be aggregated and presented to stakeholders in a useful way. But the key emphasis I think, you know, something we really need to emphasize is that the basis of this process, which is through interviews or workshops or whatever way we want to do it, is that stakeholder engagement is key because you need them to be brought into the process to get useful information. So right at the beginning, you need to know who are the key stakeholders within this problem that you're trying to address. And really, as fundamentally, you've got to be clear in your own head so you can be clear with them in a way, what are you trying to achieve? Why should they help? And what can be fed back to the, you know, so really, you know, what is it you're trying to achieve? Why should they actually help you? What's in it for them in a way? And what can you get back to them that may be of use to them as well? And also, you need to be very clear, you know, about how the process is going to work in a practical sense. If you're going to interview them, then they need to understand that maybe it involves this completion of the spreadsheet, you know, in the approach that we conducted. And the other thing I think we sort of emphasized a bit in earlier videos is sometimes it can get a little bit abstract. And so I think the more you can use concrete examples of where or what possible land use choices might be, or in the possible trade-offs that might be occur, then the better it is, you know. So when you're working with these stakeholders, keep them engaged by relating it to something, you know, to examples that they can relate to, and don't make it too abstract. Otherwise, that may create some challenges for you. So what we've highlighted, and the good thing about multi-criteria decision making, you know, is that you can work with a range of different types of managers with this approach. So, you know, for example, you could work with individual land managers who have, in a sense, the sole control over their land use decision, or you might work with a group of managers responsible for a particular area of land. So it might be a corporation or a trustees of an Iwi like we worked with here in New Zealand. But then you may also work with a group of land managers who share a common issue. And again, in New Zealand, as we've highlighted before, we worked about, worked with members of an irrigation scheme. So they have a common issue, waters coming to them through the irrigation scheme, and they all have a common interest in what to do with that water. But then, of course, you can also have a sort of different type, which may be working with a group of stakeholders who have an interest in a particular area of land and how it's managed. So they might not be jointly responsible for it, but they may all have an interest in it. So, for example, it could be the land manager themselves, but the government may have some interest, the public, and other stakeholders. So again, in theory, you can go through this process with them to understand their views on what they want to see from that land. So they can be applied through different types of managers and different types of stakeholders, really. One of the things we've done within this, and I do think as a strength of this, is that you can apply MCDM to a group. It's often being used to do this, and we did it as well within our study. And there are a number of ways it could be applied, and two possible ways, for example, you could, in a group setting or a workshop, get each member to individually score each pairwise comparison, say at the domain level, at this high level, with finance against environment, etc. Before facilitating discussion between the group, at which time they then kind of settle on an average figure. So you could just have one workshop. First of all, you ask them for their individual scores, and then you get them to discuss with each other, and they come to their agreed score. But an alternative would be to actually not to bring them together to start with, but to do the process individually with each one, and then aggregate their scores. And MCDM allows us to do that, HAP allows us to do that. And then basically, you could either present the average results back, or more usefully present, you know, each results back to the group, and allow them to discuss and come to a decision. You know, there's some pluses and minuses of these different approaches. The first one, for example, where they're in a group setting when they do it, we always have the problem that maybe strong personalities will sort of dominate. So, you know, there's a need for good facilitation to make sure that everybody has their say, and that there's not just being swayed by the person with the strongest voice. Again, the issue about if you're doing it in a group decision, a discussion group situation, and there's lots of discussion, then the time taken is going to extend considerably when compared to a single manager. But however, you know, if you try the second approach where you do it each individually, of course, the time then is going to be extended as well, because you have to do, you know, an interview with maybe five or six people individually in the group before you bring them together. So this may have some implications for the practicality of using it at group level, or the size of groups that can be applied to. But it's interesting, a lot of interest we've had in our approach has been from consultants and people who are working with relatively, you know, larger groups of land managers, and they feel that this would be a useful tool for facilitating the discussion with them. So it seems that it knows an attraction for working in this group way. And remember we showed this graph in an earlier video, and this is, you know, how we did it in our situation where they each ranked, each individual ranked each domain here, and then this red line here is the average of their outcomes, you know, with their rankings. And we can see, you know, this group were very closely aligned, as we mentioned before, in terms of their high weighting placed on the environment and social wellbeing. This is what the trustees were particularly concerned. And also we can see, you know, as I mentioned, they're quite close alignment between them. So it doesn't seem to be there was going to be a lot of disagreement in this group about what's important for the land that they're jointly managing as trustees. And as we said, this group here actually found it useful to clarify their views. And they then actually took it back to the group that they were trustees for, that they were representing to highlight what was, you know, to take that discussion further into that group. And that whole process actually worked quite well in this case. Again, that, maybe that, our example worked quite well, because they generally agreed with each other. You know, they generally had the same views on what was important for the land that they managed. Now, the question would be, would that still work quite well if there was very wide scale disagreement? No, some people really pushing for the financial side, some people saying, no, we've got to protect the environment, etc. Okay. But still, you feel this could be useful in this, and if nothing else, it brings to light those differences. Okay, and also then the discussion around that may clarify the nature and the extent of the disagreement. So it gives them an opportunity to talk about what it is that's driving these differences. And again, it may encourage discussion around what the issues and could facilitate mediation between different views. Now, you could think about it, could also think about it in terms of group situations. If people were thinking about working together, going through this process could actually highlight whether they have sort of compatible values that could be working together. You know, if once you said if one was very, very strongly concerned about environment and the other one was very strongly concerned about financial, maybe there's going to be a lot of disagreement each time they come to make a decision and perhaps they may be better off not working together. So again, it can give us some insights into these sorts of issues as well. So that was the first part, which really was really about concentrating on the stakeholders, identifying who they are, how you get them to work. But a key point about engaging people and bringing them into this process is how are we going to analyze what they've said, what we found from them, and what sort of feedback we're going to get. Because I know my experience on much of the survey work and other work I've done, not just in this area, is that if you can provide good feedback to people, then they can see further the value of, you know, if you can provide useful interesting feedback, they can see further the value of collaborating with you. So we're just going to concentrate that on in this in the second half of this presentation. So this video here, so let's think about how we might aggregate the results from the individual people that we meet with, what how we might provide feedback if it was to an individual or perhaps to a group. But one thing clearly, in order to provide good feedback, we need to be clear as to what our results mean and how we can interpret them. And we'll come back to that as we talk through this. So at its simple level, we can think about aggregating results. So here we have just the example at the domain level, the higher level for a number of interviewees that we, you know, a number of land managers that we interviewed and went through the process. And we can see here, the various weights that they gave to. One thing we could simply do from this is plot the chart of these individual results to get some feedback about the relative, you know, using a spider chart like this gives us some relative feedback, relative position for each other and can prompt discussion on that. Or you simply could average these depending on what you were interested in and aggregate them into one average score and discuss that again, depending what you're trying to look at. I mean, I'm quite a fan of the spider diagrams because I feel they do point us to where the really important things are, but they can get, you know, a little messy if you've got a large number of respondents. And so there may be other ways you want to present the results as well. Now that was at the domain level, but of course we can do a similar thing at the subdomain level. So for each individual component, right through from our capital investment down here, again, we, you know, we generate these weights from our tool and then we can plot these to say again, this is quite a, you know, a common, but there's a lot going on here, spaghetti diagram as we say, but again, it can begin to give us some insights of patterns that are going, going on in this situation. So in again, we can put all the results from each of our, you know, models into a single spreadsheet, each of our interviews, each of our land managers here, and then begin to play with that data to calculate averages and average results or to highlight them in this way. One thing I just want to touch on here is in a sense, you know, what's the sort of feedback? And I thought again, maybe using our next generation system project and the work we did in New Zealand as sort of an example of this. So we provide, you know, reproduced a template, which we would use to go back to those who helped us with the study. So first of all, you know, this sort of thing here is to have the partner who from our team was there, what they were up to at the moment, what were, you know, what was pushing them to try to change their system, their management system, and then maybe what were they interested in changing to sort of a general overview background about where they are now, what they're looking for. And then we would provide some sort of analysis of their decision-making criteria. So we'll talk about the domain levels and then thinking maybe comparing their results to the average here and then thinking about how that fits across different domains. And then you might go down within domains and see the weights that they've been given, you know, a number of charts here can do that in a bit of commentary trying to interpret what this might mean for them.  So we see for this example, we can see that, you know, important factors for them are a profit per hectare they can get, what return of investment needs have a high weight, but they also want to make sure there's advisory supports available to support them in this change. So we can hear a sort of a clear picture of what's important to this individual when they're considering changing their system. Now, you know, it's kind of interesting thinking about what's important in this way, but you can then begin to say, well, how do they vary in a way from the average from the people that we've looked at. So it may be more interesting to provide some comparative feedback. So here we see the orange lines here are the average for all your respondents. And then this is the individual person. And you can see here that they put much more weight on return on investment than the average. And then you can have a discussion with them about that. Or here we see generally, they follow quite closely the average for social on the environment, they are more concerned with greenhouse gas emissions than the average, you know, and again, so just ways you can present the results, which can prompt some discussion, maybe further discussion, or just some thoughts in the person's mind. Again, if you're working with a group that have common interests, so this, you know, potentially this, this was the example of the people with the Central Plains water and irrigation system, we in a sense presented feedback after we interviewed them individually, we came back and provided feedback in terms of the results for them. And again, you can, you know, have each individual and then you can think maybe about the average as well. And again, it just prompts discussion that they can think about where they sit and how they sit with the others in their group, and why you may have differences. And again, the point we're trying to make earlier about one of the advantages of this process is that you're discussing with them as you go through. So, you know, you probably want to record the interviews, and then you can begin to understand what's determining those choices. And so in this feedback, you know, we basically just put some quotes from them to highlight what, what sorts of things were being said in that, you know, we like to think we're more on the environmental side, but it can't do a return. We can't actually do it because there's no point going broke over it. So highlighting the key, you know, got to make a living. Yeah. Here we highlight social well-being is very important. And again, we can go through. So that was at the domain level, but we can go through and do this at the sub domain level as well. And again, it's all about prompting discussion, reflection, you know, consideration in the group and looking at how, you know, different land managers with a similar issue, how are they going to view this? You know, what one thing we're kind of interested in this thing is, can they see opportunities for working together collectively to maximize returns from the water and reduce the overall environmental footprint of those systems? And so, you know, again, you can discuss, for example, do they have common views on working collaboratively or not those sorts of things may be important. We highlighted a bit before about this, what happens if you have very conflicting reviews about what's important. So again, this was from another example we worked with where free groups were potentially considering working together on a land use issue. And once you've been through the process, again, just highlighting the domain level here, we do see they have quite different profiles in terms of their decision making. And what we can say here, it doesn't necessarily mean they can't work together, but it could be a conversation starter. So you could present these back to them in a group and they could then begin to discuss but what do they mean when they're saying regulation is very important, for example. And does that mean they wouldn't be able to work with someone who's put more weight on financial or actually do they concur more than this looks like. So it's a good way of getting a conversation starter in it. So again, by providing feedback, going through the process, providing them feedback, you can use this feedback in a range of ways. And I think this is an important element, you know, an advantage of this approach is that it does provide us, you know, with some form of quantification, but it obviously needs interpretation and the feedback and prompt that sort of discussion that we want to have. So I just really want to sort of summarize where we've been to, you know, in a sense where we've got to, you know, in this module, we've presented a practical application of MCDM using analytical hierarchical process procedure, AHP. We've highlighted in general how it's been used. We've considered how to structure the problem and mainly about the domains and subdomains. We sort of examined the spreadsheet and the tool that we've been using. We've highlighted that there are other tools obviously available, but we used our tool just to highlight the sort of insight you can get whilst undertaking the process. And we just consider some of the issues are working with stakeholders and generating results and feedback. Again, I just want to acknowledge that the work in New Zealand was funded through the MBs, our land and water national science challenge program, next generation systems. Thank you very much.


Hey yo, what's happening guys? It's your boy Nick Trey coming back at you guys with another video. I know it's been a little bit since I've sat down. I switched up the scenery a little bit. You know, this is my desk. I'm usually on my couch. Just want to switch things up a little bit today. School has been good, classes have been stressful and hard as always, which is why I haven't had as much time to make these videos, but I promise they are coming back. But today we're going to be talking about how to stand out in college. I know that this is a very common question that a lot of you guys might be feeling, and especially if you're at a big school with thousands of students, it's easy to feel overwhelmed and feel like you can't fit in, or that you're not doing something to stand out. So I've had my fair share of experiences with stuff like this, so let me just jump into my tips for today. All right, now by far, hands down, one of the easiest ways to stand out in college is to be kind and be a nice person. Now, I know this sounds super obvious and super simple, but in reality, at college you can be often overlooked. Everyone's stressed out, everyone has a busy schedule that being a nice person just doesn't seem like it's a common trait, which is why if you're a nice person, someone who's generous and kind with their time and cares about other people, then that's going to instantly make you stand out. People appreciate that, people notice that, and people respect that most importantly. I think it's one of the most important things to go out of your way and greet people with a smile and say, hello, how are you doing? How was your day? How was your weekend? How are your classes? You know, whenever you meet an old friend or an acquaintance, it's always important to just ask them how they've been doing. You know, like I said, college is hard and it's important to keep track of one another and make sure that everyone's doing all right. And I think that just makes you stand out and people will realize, oh wow, Nick is a great person, he just asked me how my day was. And you know, the little things, whether it's a compliment or a saying thank you, it can really go a long way, especially if you're talking to the people who cook your dinner, the people who clean your bathrooms, like just go out of your way and say thank you, say you're welcome, ask how you're doing. Like it's the little things in life that matter the most and it will take you the longest way. Now the second most important thing is to have good style. Now if you've been watching the channel for a while, now you know that fashion and style are very important to me and especially on a college campus, for me that's something that helps me stand out. It helps me differentiate myself from other people and let people know that I'm unique and that I put effort into my outfits and that style is just important. Like I said, I just woke up so I haven't had time to accessorize or anything, but one super important part about having good style is obviously accessorizing. I said this countless times, but having a watch priceless as a college student, it's super important when you need to keep track of your schedule, keep track of your time, but also things like jewelry. I've mentioned this before, but bracelets and necklaces can go a long way to instantly up your style game, which is why I have loved the products from our sponsor of this video, Rose Gold and Black. They're a men's jewelry and accessory company and they have seriously been changing the game. Like their name states, all of their products have Rose Gold or Black in their name and let me tell you guys that these are some of the sickest pieces I've seen on the market right now. The really cool thing about them is that they're all very adjustable and so they fit a lot of sizes. So right now this is one of their single band bracelets, but this bracelet along with this necklace, it instantly just shook my style game to another level. The coolest part about Rose Gold and Black is that they're a super affordable company, unlike a lot of the other jewelry companies out there that are charging premium prices for low quality products. But I can tell you that every product from Rose Gold and Black is such high quality and they're so unique. They make you stand out instantly in any crowd and I highly recommend picking one up for any college kid. They have dozens of different products, ranging from moderate to minimalist, that will suit any guy's style. So if you check out that link in my description, there's gonna be a promo code already applied so that you guys can save yourselves a little bit of money while you're purchasing this, but I highly recommend picking up any pieces and you guys won't regret it. Now the third thing to help you stand out is to be passionate about something. I said this time and time again, but having a passion is one of the most important things because it keeps you driven, it keeps you focused. It gives you a goal at the end of the finish line that you're working towards. For me, as you guys know, my passions are obviously photography and film. These are also great conversation starters.  It looks so crazy. You were traveling so much. What was it for? That gives you an opportunity to talk about what your summer was about or expand on your passions because other people care what other people are passionate about. That's the scene from La La Land. People love what other people are passionate about. It also makes you an expert in your field, whether it's on biochemistry or physics or neuroscience or any type of thing that you're passionate about. Being well-knowledgeed and having a lot of information about that makes you some kind of expert on it. And people are interested. It's a cool conversation starter and it gives you stuff to talk about rather than just, oh, the weather's nice. Oh, how are your classes? Oh, mine are hard, me too. I guarantee you that having passion is an instant standout.  This is super critical and something that I've constantly been working towards, especially this past year, to get better at. And that's because it's literally so critical to your college success.  In college, I actually think it's important to be busy, but what I mean by that is healthily busy. Not so much to the point where you're so stressed out that you can't do anything, but to the point where you have enough work that it keeps you driven and keeps you motivated all throughout the semester. Now, number five, not just in college, but in life in general, going the extra mile will instantly make you stand out. I guarantee it, whether it's for a school project or the little things in life, like going out of your way to do the best you can and giving it 100% will have exponential returns on your investment, I guarantee you that. Things that you think are so minute, whether it's holding the door open for someone or just saying, thank you, have a nice day, like that's what makes you stand out compared to your average Joe. All right, I hope you guys have enjoyed this quick video and that I was able to share some light on how to stand out in college because like I said, there are thousands of students on campus that it's easier to feel like you can't stand out or that you're just blending in with the crowd. But I hope this is how make sure you guys like, comment, and subscribe. Comment down below for any more videos you guys want to see and I will see you guys next time.


Good day everybody. This is Dr. Sanger Sanyal, Professor Department Chair. This is going to be a demonstration of the vertebral artery, transverse foremen, suboccipital triangle, the branches of the vertebral artery. So take a look at the model which I'm holding in front of you. This is an articulated skeleton of the vertebral column. So take a look at these red structures that you see on either side. This is the representation of the vertebral artery. The vertebral artery is a branch from the first part of the subclavian artery on this site. The vertebral artery, the other branches being the internal thoracic and the hierocervical trunk. The vertebral artery has got four parts. The first part, a little bit of that can be seen here, is called the cervical part. This cervical part, it runs in a pyramidal space between the longest collie muscle, which is here and the scalinus anterior muscle, which is on the side, both of them made at an apex. So it runs through that pyramidal space. So that is called the cervical part. Then that is also called V1. Then we have the V2 part, or the vertebral part. This vertebral part enters into the transverse foramen of the cervical vertebra. The transverse foramen of the cervical vertebra is located in the transverse process itself, that's why it's called transverse foramen. It is not present in the C7. It's either small or absent. So it goes through the transverse foramen of C6, 5, 4, 3, 2, 1. So that is called the vertebral part or V2. And then it enters into another place called the suboxibular triangle. And that is called the suboxibular part or V3. And after that, as it pierces through the posterior tlandoccipular membrane, which I should describe just now, it enters through the foramen diagram into the radial cavity and then it becomes known as the intracradiate part. And then it has got certain branches. So these are the four parts. The first part, the V1, it gives only a few muscular branches to the muscles of the neck, the deep muscles of the neck. The V2, the vertebral part, it gives spinal branches, which enters segmentally through the vertebral foramen along with the spinal nerves that you can see here, and it supplies the spinal cord. The V3, the suboxibular part, it again gives muscular branches to the muscles of the suboxibular triangle. And I'm going to demonstrate the suboxibular triangle just now. And then the V4 part, that is the intracradiate part, it gives the posterior inferior cerebellar artery, the two anterior spinal arteries, which unite to form a single anterior spinal, the two posterior spinal arteries, it also gives medullary branches to the medulla oblongata, and it also gives meningeal branches. And then the two of them unite, as you can see here, they run intramedially and unite at the lower end of the pons to form the posterior artery. That is the full course of the vertebral artery. Having mentioned that, now let me mention a few quick points about the transverse foramen and the suboxibular triangle, and then I'll mention a few clinical correlations. If you take a close look, the transverse foramen is located in the transverse process of the cell vertebrate. Transverse foramen has got two limps, an anterior limb and a posterior limb. Anttaria limb is formed from the costal element and it ends in the anterior tube BACKL, and the posterior limb is formed by the transverse element. Both of them are primordial elements and the posterior element ends in the posterior tube BACKL. That anterior tube BACKL gives attachment to the scalaneous anterior muscle, the posterior tube BACKL gives attachment to the scalaneous medius in the posterior muscle and the two cubicles are joined by a transverse bar that is called the cost of transverse bar and you can see that here and the cost of transverse bar is what a flat surface which gives passage to the ventral ramus of this spinal nerve which runs behind the vertebral artery. Dorsal ramus goes behind top of the posterior element so that is the transverse foramen and by the way fourth boundary of the transverse foramen is formed by the pedicle so that is about the transverse foramen transverse area through which this vertebral artery passes. If we do vigorous chiropractic manipulation of the cervical spine and it has been well documented it can produce dissecting aneurysm of the vertebral artery either on one side or both sides and that can produce occlusion and vertebro-pacilar ischemic symptoms. Now let's focus our attention to the suboccipital triangle so this region which I've lifted up here this is the region of the suboccipital triangle. What is the suboccipital triangle? As the term implies it is a very small triangle under the occipital bone so this is the base of the occipital bone and the triangle is located in this region. This suboccipital triangle has got the following boundaries. Most of the boundaries are muscular boundaries therefore we cannot see them in a skeleton but I shall demonstrate them to you. It's a triangular area it's got a supramedial boundary which is formed by the rectus capitus posterior major muscle which is a small muscle under the skull. It's got a supralateral boundary which is formed by the superior bleak of head and it's got an infrolateral boundary which is called the inferior bleak of head so the triangle is located here where my finger is touching. This triangle is roofed over by a muscle of the neck, a deep muscle of the neck called the semi spinalis capitus and the floor of the triangle is formed by a membrane which is actually a continuation of the ligament of flavor. Here it is called the atlantooccipital membrane, the posterior atlantooccipital membrane extends from the posterior atlas to the occipital bone and that is the floor and that floor is pierced by this tree that you can see which I mentioned just a little while back. This is the vertebral artery. The vertebral artery as it passes through the transverse foramen of C1 it makes a backward bend and you can see that backward bend here. Then it passes over the posterior arch of atlas. The posterior arch of atlas also forms part of the floor of the suboccipital triangle and then it pierces through the suboccipital membrane and immediately thereafter it enters into the foramen magnum which you can see here. So these are the boundaries of the suboccipital triangle and that is the importance of the suboccipital triangle and that is why this artery in this region is called the V3 portion is called the suboccipital part and here it supplies the muscles which I described just now. Another content of the suboccipital triangle is a very small nerve called the suboccipital nerve which is the dorsodermis of the C1 spinal nerve which supplies the muscles in that region. So these are the course of the vertebral arteries and finally as I mentioned it enters into the cranial cavity and that we can see here once it enters the vertebral artery it runs intermediately fuses with the opposite side to form the basilar artery and we can see the basilar artery here dividing into the two canal divisions the two posterior cerebral arteries. So this is the full course of the vertebral artery that we have seen in the transverse foramen and the transverse foramen itself and the suboccipital triangle. Thank you very much for watching. Dr. Sanjay Sanyal signing out if you have any questions or comments please put them in the comment section below. Have a nice day.


From around the globe, it's theCUBE with digital coverage of IBM Think 2021 brought to you by IBM. Welcome to theCUBE's coverage of IBM Think 2021. I'm Lisa Martin, exciting conversation coming up about vaccine cloud management. I've got two guests with me. Tim Elcott is here, the sales and delivery director of IBM services for Salesforce. And Fran Thompson joins us as well, the CIO of the Health Service Executive in Ireland. Gentlemen, welcome to the program. Hi there, good to be here. So we're very socially distant, Northern California, UK. Glad to have you guys here. We're gonna talk about what the Health Service Executive or HSE in Ireland has done with IBM and Salesforce to facilitate vaccine management. But Fran, let's go ahead and start with you. Talk to us a little bit about HSE. So the HSE provides public health and social services to everyone living in Ireland, okay? We, that's acute hospitals, community services nationally. We directly employ about 80,000 people and we fund a further about 40,000 people. And our annual budget is slightly north of 21.6 billion a year. We are the largest employer in the state and the largest organization in the state. And we provide a huge range of services right across the whole spectrum. And we also fund other organizations who provide those services as well. So we would fund some voluntary and charity organizations and we would also buy services from the like to say GP and other organizations as well. So talk to me about a year or so ago when the pandemic hit, what were some of the challenges that HSE faced? And then when it came time to, we have a vaccine, we have multiple vaccines, that rollout capability. What were some of the challenges that you faced initially? So from an organizational perspective, there were huge challenges in that. We were like every other health service worldwide facing an enormous pandemic that was impacting on people. And this is all about people. It's all about people's lives at the end of the day. People can talk about numbers and they can talk about costs and they can talk about other elements. But at the end of the day, this is about individuals, people's lives, their families and their communities. And for the HSE, our challenge was really about how do we manage to protect the totality of the population in Ireland as much as we can from the ravages of the virus. And the initial challenge we had was around contact tracing and managing that before a vaccine became available. And once a vaccine became available, it was then how do we stand up a national vaccine solution that we would be able to deliver and record vaccines to the totality of the population who were getting a vaccine? Yeah, so there was no pre-existing vaccination program of course, probably in most places, you needed to get healthcare workers vaccinated ASAP. And this also needed to be a national program. So what did you do next after determining, all right, we need to work with some partners to be able to build technology to facilitate equitable, efficient rollout of the vaccine. So we did have regional vaccine systems and we do have a number of vaccine programs out there that were managing flu vaccine, Hep C vaccine. But we needed, we didn't have a national program and we needed to vaccinate people immediately. And we also wanted to make sure that vaccine program was not dependent on the HSE infrastructure because we wanted to be able to vaccinate people in non-HSE sites and we wanted non-HSE staff to be able to vaccinate. And we didn't want a huge pre-dependence on our existing infrastructure. So the first thing we did, we looked at a number of enders and we chose IBM as our partner with Salesforce. And that partnership is really a strategic partnership and it's a partnership that we've worked through all the bumps and all the lumps of the program together. And there have been challenges but it's true working with Kim and his team and through our team that we've overcome some of those challenges. And we started off, I remember the very first conversation I had with Tim as I said to him, we need to vaccinate healthcare workers now. Okay, you've got two weeks to start and we need to configure a system, get it up and running and to be able to roll it out to the hospitals and to, and very quickly then to all of our nursing care homes now. And that was the challenge. And let's bring Tim in as this is a radically quick project from MPV to roll out in two weeks. Tim, talk to us about first about the IBM partnership with Salesforce and what you're building together. Absolutely, it's great. And Fran, it's interesting to hear you speaking about the run into this. Because from my perspective, a week before we all started this, we had a simple conversation called into the health service executive has some, they're talking about some vaccination program. How can we help? And then within a week, we've gone from zero to having how many calls with Fran and team just to understand and with the Salesforce team to really understand how the three parties can bring the best of IBM, the best of Salesforce and the best of HSE in terms of the adaptability and what we need to get done to get those vaccinations up and running for the healthcare workers now. You know, when Fran said to me, we need something in two weeks. There was absolutely clarity. If you can't do it in two weeks, there's the door, right? So we knew exactly the challenge and that's the kind of thing right before Christmas that we were so fortunate to really bring in the team. Like everyone, you think about this, everyone as of probably the 14th of December was thinking of winding down, thinking of having their Christmas holidays and the vacation time. And everybody from the Irish team and the English team said, no, we'll cancel Christmas. We'll cancel everything. So it's really Christmas came early and Christmas was canceled all at once. So, and the key bit here, the strategic partnership is IBM and Salesforce have been working together for years and years and years, growing out a partnership. We know their products really well. We've got huge capability in that space. But actually with the new health cloud part of it, the vaccine management parts are quite new to Salesforce as well. Only launched back in sort of August, September time. So it was quite new. So we had to go in together as a sort of a partnership there to say to just get this done. So we had the best people from Salesforce to know the product, the best people from IBM, all turning up on the 14th of December and saying, right, we've got to get this done by the 29th with Christmas holidays in the way and the vacation time in the way. I think we had 36 hours of time off to eat turkey and fill ourselves before getting back to the wheel and really getting this done. And to get, I think it was four acute hospitals we went into as of the 29th to start the vaccination program. So trying to do that, understanding everything is a compromise at that point. But it has to be secure. This is personal data going into these systems. So you can't forget about all the aspects. It's got this minimum, but minimum with those kind of constraints as a health system. So it needs to be secure. It needs to also be that national platform going forward as well. So basing on a great platform like Salesforce, you know you can scale out. You know you've got those options to grow in the future but yeah, not without a lot of challenge and then working out what's now, getting to know each other. Like that we only talked about twice before that we have to know each other pretty well now. But just trying to work out how we then structure what's it going to happen every two weeks afterwards? How's that going to move forward? We're going live every two weeks and we haven't done that now for the last three months. So good fun. So yeah, good fun. But so much work to get done and a huge coordinated effort in a very short time period during a very challenging time. Talk to me a little bit about Fran, but you launched this cloud management, vaccine cloud management in January, 2021. And to date, I think you told me one million people have been vaccinated so far. Talk to me about what the IBM Salesforce solution enables you to deliver to the HSC and to the Irish citizens. So we have delivered a million vaccines, okay, to two stages. There's a dose one and a dose two for most people in Ireland. And there's about 720,000 people who got their dose one and the balance I've got the dose two. That's about one in five of the population that has to be vaccinated. And one of the things we're very conscious of is that an organization like that, we need to take a risk-based approach to this. So we need to look at the most vulnerable groups. There were lots of people who were dying from this and a lot of people were elderly groups and people who were vulnerable with pre-medical conditions. So our challenge was how do we vaccinate those people quickly and effectively and also vaccinate healthcare workers who are going to care for these people? And that's where we prioritized the work. So we had to go into 50 acute sites, about 600 or so care homes. We set up a lot of what we call pop-up clinics, literally a tent in a location or we took over a sports hall or whatever we did. We rolled it out to the GP to about 2,500 GP sites. And all of that was being done while we were building the system. So we were building the system and designing the system on two-week sprints. We had to be agile, we had to be quick. We can make huge compromises when we know that. I mean, everyone wants a perfect system which is to make the compromise and look and say what do you need to do now to keep the program running and how you manage that? We had about 3,000 users all to be set up fairly quickly or a little over 2,500 users. So you have to manage all that as you're going through everything. I think agile is the name of the game here. Tim, talk to us about how you're delivering the agility in such a tenuous time. Well, we're all virtual, which is added to the mix, but the funny thing with that agility, we've got a span of people across all the countries and everywhere that we can bring to that party. And we're running a normal, what I would call a normal agile project, except normally it would take two, three months to really get that team working effectively, getting to know each other and we just not had time to do that. So there's been a core team here and we're bringing in the experts around it, but really just everything is working with Fran, with very hand in glove, trying just to work out what we need to do here to look at the next sprint, to look at the next go live, to look at the compromise. How do we compromise for two weeks? What can we live with for two weeks? What's in the backlog for now? And Fran and I have many conversations. What do we need to do this week? And then what's next week? And that's the level of fluidity and that's in part because of the way the pandemics and the response to pandemic is mapping out. As we sort of vaccines are changing, availability is changing, the rollout plan is changing, none of us have worked through a pandemic before. So agility is the name of the game at the highest level. I think we're all now very used to being, sorry, there's a problem, something's changed, can we adapt the system too? You know, we're normally in a sprint, I'd be thinking I've got some fixed requirements for two weeks, I'll build that and then do the next two weeks. Everything is up for grabs and we're just having to maintain quality at the pace, the responsiveness and balancing it all as an IBM team. And you think, and whilst we're also doing that on a platform that it takes time to configure and build these things as well. So it's, some of it is, you're going to have to wait a few days. So sorry, you know, and a few days is really probably sometimes the maximum amount of time that can be, you can defer. But as Fran and everyone in the HSE in the National Immunisation Office, everyone's pragmatic about realising we're all in this together and it's really just being one single team, one unit working out and very open and transparent about the art of the possible. And we're doing something, go ahead Fran. We had a phrase there with, like there was a piece that we just have to just do it now. And we did a lot of that, okay? You know, where there were things that were prioritised, we were in the middle of a sprint. There were changes in the programme or there were changes in how the vaccination was going to be delivered. And we couldn't wait the week. Just it wasn't available. So we have this thing of just got to do it now and him and the team, you know, drop what they were doing, you know, made the changes. We tested them fast and we put them in and that gave us then, you know, an extra time to actually then deliver the rest of the sprint. And we had to do that several, okay, several very, very late nights to deliver. And I imagine that's still going on, but to wrap here guys, and amazing work that you've done together so far with the Salesforce Vaccine Cloud Management, rolling out across the HSC, you said one million vaccinations delivered, many hundreds of thousands in the queue, I'm sure more iterative work and sleepless nights, but what you're doing for the country of Ireland is literally us friends of them being lifesaving. Gentlemen, thank you so much for joining me today on the programme. You're welcome, thank you. You're very welcome, thank you. Hi, Tim and Fran, I'm Lisa Martin. You're watching theCUBE's coverage of IBM Think 2021.


You can walk day by day, moment by moment, aware of the presence of your friend, the Holy Spirit, even in trying times, even when you're facing moments of sorrow, moments of loss, moments of frustration, even when you're facing things that anger you or even confuse you. Even in those moments, you can be keenly aware of the nearness of the presence of the Holy Spirit because He dwells in you.