Recumbent MRI
The role of cervical spinal instability in the genesis of spinal cord injury (cervical myelopathy) and the complete extent of
that instability over the full range of flexion and extension positions that a patient’s cervical spine occupies can now be measured
in the FONAR UPRIGHT® Multi-Position™ MRI. Additionally, the measurements can be performed in the FONAR
UPRIGHT® Multi-Position™ MRI with the patient in the UPRIGHT® position where the spine is supporting its full weight
load.
Upright MRI
The extent to which disc degeneration and the occurrence of spondylolistheses are correlated and the full extent of the
spondylolistheses that occur when cervical flexion and extension occur in the UPRIGHT® body position was measured in 168
patients suffering from neck pain.
Upright MRI
To evaluate the degree to which cervical vertebral slippage was a candidate for inflicting cervical cord injury, UCLA scientists
measured the extent to which cervical vertebra slippage (spondylolisthesis) increased as a function of disc degeneration. The
extent to which slippage increases as a consequence of disc degeneration is the first step in evaluating the potential of a patient’s
spine pathology for causing cervical cord impingement, cervical cord injury and ultimately cervical myelopathy.
Muhle, et al.,4 for example, in a flexion-extension recumbent MRI study of patients with neck pain concluded that “cervical
spinal motion may contribute to the development of cervical spondylitic myelopathy.” Their conclusion was the result of
their data that showed “at flexion and extension, the prevalence of spinal stenosis and cervical cord impingement increased
as the stage of degenerative disease progressed.”
Additionally, Muhle, et al. described the possibility of a “PINCER CONDITION” arising with respect to the patient’s cervical
cord wherein cervical disc degeneration and the consequent loss of disc height results in spinal cord pinching from intervertebral
disc bulging anteriorly and cord pinching from infolding of the ligmentum flavum posteriorly.
The Muhle, et al. study is compelling regarding the prospect of serious injury to the spinal cord when the cervical spine
with degenerative pathology engages in its normal range of flexion and extension motion.
The Muhle, et al. study, however, necessarily underestimates the injury potential of such degenerative pathology since the
study was performed with the patients recumbent when the full extent of the compressive forces of weight loading were not
engaged.
The UCLA study using the FONAR UPRIGHT® Multi-Position™ MRI evaluated the potential for cervical instability to
induce cord injury with the patients fully UPRIGHT® with the cervical spine subjected to its normal compressive gravitational
forces of body weight.
The study established that cervical spine translational and rotational instabilities increase as disc degeneration increases
finally reaching an ankylosing stage where translational and rotational mobility is reduced relative to normal. In their paper
“Multilevel cervical spondylosis: laminoplasty versus anterior decompression” Hirabyashi and Bohlmon report that “cervical
spondylosis is the most common cause of cervical spinal cord dysfunction in individuals older then 55.”5
The full range of motion analysis of the cervical spine made possible by the FONAR UPRIGHT® Multi-position™ MRI
further enables the future implementation of clinical treatments that limit cervical motion to positions that do not encroach on
the cord and cause injury. The FONAR UPRIGHT® MRI also now makes possible post-operative image analysis to verify that
cord impinging and cord injuring conditions have been successfully eliminated by surgery.
The study by UCLA of patients with neck pain was the first demonstration in the fully UPRIGHT® patient of the degree to
which the cervical spinal cord can be exposed to injury from spondylolithesis secondary to cervical disc degeneration. The
study proved that potential cord injuring cervical spine instability increased as a function of cervical disc degeneration, consistent
with the conclusion of Muhle, et al. that cervical spinal motion may be a contributor to the development of cervical
spondylitic myelopathy. The FONAR UPRIGHT® Multi-Position™ MRI technology was shown to be capable of quantifying
existing spondylolistheses and assessing the cord injuring potential of degenerative spine changes that exist in the neck pain
patient so the prospect of myelopathy can be assessed and surgical (or non-surgical) treatments implemented to prevent injury.
“POSITIONAL MRI: A VALUABLE TOOL IN THE ASSESSMENT
OF CERVICAL DISC BULGE” (PAPER 80)
UCLA scientists further assessed another major component of cervical spondylosis, namely the cervical disc degenerative
pathology manifest as disc bulges and the variation of these bulges with flexion and extension, when the criterion for designating
a disc prolapse as a bulge was a visible bulge 2 mm or greater.
The UCLA studies concluded that 25.08% of the time there was a failure to see disc bulges in the neutral sitting position
that became evident when these 163 patients with radicular signs and symptoms were additionally imaged in the flexion and
extension positions. 18.18% exhibited a bulge 2 mm or greater in flexion that was less than 2 mm in the neutral sit position and
23.75% exhibited a bulge 2 mm or greater on extension that was less than 2 mm in the neutral sit position (Table 2).
Additionally, in the UCLA study of patients with low back pain, “The Effect of Lumbar Flexion and Extension on the
Central Canal with Dynamic MRI” (Paper 79), Wei, et al. assessed the capability of the FONAR UPRIGHT® Multi-
Position™ MRI to quantify spinal stenosis, the most common reason for spinal surgery in patients older than 65 (Katz, J.,
et al., Rheum Dis Clin North Am 1994:20:471). In their study of 461 patients with low back pain, UCLA scientists reported
that they were able to measure spinal canal diameter in the vertical patient and quantify its changes with flexion and extension
“with high precision” using the FONAR UPRIGHT® MRI. They further reported the ability to measure the flexion and extension
changes in the spinal canal cross-sectional area “with the highest accuracy.”
Lumbar spinal canal stenosis and the entrapment of the cauda equina roots, which is a consequence of the constriction of
spinal canal dimensions produced by stenosis, results in the symptom complex intermittent neurogenic claudication – manifest
as debilitating pain in the back and lower extremities, weakness and difficulties in ambulation, and leg paresthesias. The
ability of the FONAR UPRIGHT® Multi-Position™ MRI to quantify key spinal canal dimensions with “high precision” in all
the UPRIGHT® body positions brings to the highly skilled and specialized craft of spine surgery a new and much needed technology
for quantifying the full extent of spinal stenosis in patients.
Additionally, the power of FONAR’s new UPRIGHT® Multi-Position™ MRI to measure spinal canal dimensions with the
body in its UPRIGHT® position and the spine fully weight-loaded, with the gravitational compressive forces responsible for
back pain fully engaged, means that FONAR’s new technology is now available to surgeons to quantify the full extent of
stenosis responsible for claudication symptoms in their patients and to do so with their patients fully UPRIGHT® and
occupying the full range of body positions they do normally.
It is self-evident that measurements of canal stenosis made in a conventional MRI with the patient lying down are an underestimate
of the full extent of the stenosis that exists when the patient is UPRIGHT® with his spine subject to the full extent of
gravitational forces that normally compress the spine.
Indeed, when conventional recumbent MRI scans do not visualize pathology that corresponds in severity with the intensity
of claudication symptoms, the likelihood is that recumbent MRI is not seeing the full extent of the stenosis the patient is experiencing
UPRIGHT® with his/her spine subjected to its full weight-load and occupying its normal flexion and extension positions.
Potential for Greater Precision in Optimizing Decompression
Moreover, current procedures for decompressing spinal stenosis can, from the surgeon’s perspective, be limited by the
expected impact of the procedure on spinal stability. It is likely that a full quantitative multi-position assessment of central
canal stenosis measured simultaneously with quantitative multi-position analysis of spinal stability – a combination that is
now possible using FONAR’s new UPRIGHT® Multi-Position™ MRI technology – will enable surgeons to achieve greater precision
in optimizing decompression while at the same time minimizing spinal instability.
IMPROVED SURGICAL OUTCOMES
DYNAMIC DIAGNOSIS OF THE SPINE TOTALLY WEIGHT-LOADED, UPRIGHT AND OCCUPYING ITS FULL
RANGE OF NORMAL PHYSIOLOGICAL POSITIONS MEANS A MORE ACCURATE DIAGNOSIS, IMPROVED
SURGICAL OUTCOMES AND, AS A RESULT, INCREASED PATIENT REFERRALS.

One of the things that I have come to love about my designer furniture is not only the fact that it has proven to be a very durable piece of furniture, but also one that has been constructed with a high degree of craftsmanship. Unlike cheaper furniture which is often mass-produced and where the maker has resorted to cutting corners, the barcelona still reflects its original old-world standards for materials and construction. There are no flimsy metals used in the construction of this chair — and you will never find one made with thin, cheap, easily worn-through materials either. Perhaps this is the secret that explains why the barcelona will outlast other types of chairs.

Water For Gas

How much you can save by running your car on water really depends on how much you drive your car, and how much mileage you normally get. The less fuel efficient your car is, the more you’ll save. Remember that you can potentially cut your gas costs in half by running your car on water, which is pretty significant.

Water 4 Gas

How does the technology to run your car on water actually work? Well, it’s really fairly simple. When you run your car on water, this is what happens:

A small amount of electicity is taken from your car’s battery to convert water into a gas called HHO (two hydrogen and one oxygen). HHO, also known as browns gas or hydroxy, has the atomic power of hydrogen and is NOT flammable — unlike pure hydrogen. It is also up to 3 times as efficient than regular gasoline, which is why you’ll get much better mileage by running your car on water.

You can’t run your car only on HHO, and you’ll still need gas. But you can typically cut your gas costs in half by running your car on water.

Hybrid Water Gas

Cars have definitely lead to a lot of problems, mostly because they consume so much gas and also pollute a lot. Thirty or fourty years ago, this wasn’t a problem, and no-one cared about global warming… but now it is a huge issue. There IS a solution, fortunately, in the way of hybrid cars. Hybrid cars have tons of benefits. They use less gas (obviously), pollute less, get more Miles Per Gallon and can even have better performance.

If you want a hybrid car but don’t have the cash, then you can just convert your current car to run on water. Think this is really hard? Well, you may be surprised. There is not *that* much you have to do - and you don’t need to be a professional mechanic or anything.

So how easy is it? Well, you can do it with $150-300 worth of parts, max. Most of the parts you’ll need are pretty commonplace, and there are several places online where you can get them (most hardware stores will stock them too). You’ll need a good guide to tell you what to do with the parts, and there are several of them around. The one you will see me constantly recommending is Water Car Pro.

It seems that the people of ancient Greece had a tremendous appreciation for artistic beauty. Indeed, the art objects produced back in those days are greatly admired by us, and constitute an important reason for our general interest in ancient Greek culture.

You may not be very interested in numismatics, but take a good look at a few ancient greek coins! These coins, from the classical period, are now about 2500 years old - yet they show a superb level of artistic skill.

The ancient Greeks must have been very proud of their coins. Typically, each city-state produced their own coinage; and one can imagine that the different cities were all aspiring to produce the most beautiful coins. In some cases, the artist designing the images on the coins were even allowed to put their names on them.

There is for instance some ancient Greek silver coins minted in the ancient Greek city of Syracuse which are signed by the artist “Eukledias”, his name appearing in tiny letters near the edge of the coin.

As the Mediterranian region was later dominated by the Roman empire, the Romans also produced many coins of great beauty. However, in my opinion none of the ancient Roman coins can quite match up to the freshness of the best Greek coins.

Are you an office manager or a business owner? If you are, you must know the importance of time management in the office. Did you know that when your employees donít know how to manage their time, they likely end up costing your company money? Whether you are a business owner or an office manager, you do not want to see this happen. See time management.

When it comes to poor time management at the office, there are many office managers and business managers who choose to provide their employees with time management training. If this sounds like a good idea to you, you may be looking for more information. You may be curious as to exactly what time management training its, how it works, and what your staff members will learn. If these are all questions that you have, you will want to continue reading on.

When understanding time management training, it is important to remember that it does come in a number of different formats. For example, most companies choose to hire outside specialists. These are individuals or teams of individuals who come in and teach staff members the importance of proper time management, as well as share tips on how to get the most done through the day. A good example of this is by showing or helping your staff members get their office desks better organized. This is key, as organization and time management go hand in hand.

As nice as it is to hire outside help from professional office organizers and time management specialists, the cost of doing so may be a put off for you. If it is, you may be able to host your own time management training sessions. Doing so is actually a lot easier than you may originally think. In fact, many business owners and office managers like this approach as it gives them complete control over what their staff members learn. Read about time management for employees.

Speaking of what your staff members will likely learn in time management training, it will vary. As previously stated, you can hire outside help or you can perform your own training sessions. Regardless of which approach you do take, there are some things that you will want to make sure that your staff members know. First, make sure that you not only tell them the importance of properly managing their time at the office, but show them ways that they can improve the use of their time. These ways may involve keeping a clean and organized office desk, completing a to do list each morning, and so forth.

It is also important that you outline the consequences for employees who continue to waste company time. After time management training as has been offered to all employees, there is no reason why employees should be seen standing around, socializing with each other, or using an office computer for personal use. State that these things are okay for break time, but not during normal work hours. You may want to go as far to show your staff members just how much their wasted time is costing the company. Let them know that additional warnings may come, with termination being a possibility.

As a reminder, time management training is not required by many means, but you may find it a relatively easy and effective approach, especially when compared to terminating and rehiring new employees. Read more at career development.

Something I have become more directly interested in recently is project management, within the field of leadership skills.

Here are some of my research notes:

project management can be defined by - The primary function of project management is to ensure that the project is implemented to meet the established budget, schedule, safety, and performance requirements to satisfy its objectives.

I like the idea of Performance Management - Total communication and pin-point accountability, for small teams. You might not have a rigidly established budget, you might simply be trying to use what you have to make more. You might not a specific scheduled deadline for project delivery, but you might have plans and goals that you want to reach faster and easier.

Getting Things Done Principles are basic practical personal steps for Project Management:

1. Collect
2. Process
3. Organize
4. Review
5. Do

Many possible aspects or divisions of Project Management

* Requirements management
* Subcontract management
* Deliverables management
* Risk management
* Scope management
* Performance management

Questions used in by project managers:

* How much will this project cost?
* When will it be done?
* What is the confidence in these estimates?
* How will I recognize done when it arrives?
* What skills, experiences, tools, and processes will be needed to successfully complete the project on-time, on-budget, on-technical and business specifications?

These questions are core to the principles of project management. The interpersonal activities are necessary but far from sufficient. Especially when considering career planning.

I will be expading these notes about project manager considerably.

What are the skills of good management?

I would be a fool to think I know all of them.

Project Management divides into Project planning and carrying out the Project execution. While training employees on Project Management, focus on:

1. Availability of resources.

2. Analysis of the various risks in the manipulation of the Project & lateral plans to solve the same.

3. Based on the availability of resources prudence in its usage.

4. Blue print of the Projects step by step proceedings and a review etc.,

Ken Blanchard uses the acronym PERFORM to explain the necessary characteristsics of high performing teams.

Your role in management is to develop the skills necessary to faciliate PERFORM.

* Purpose and Values
* Empowerment
* Relationships and communication
* Flexibility
* Optimal Performance
* Recognition and Appreciation
* Morale

You will find that they all share these three:

Planning the Project or Goal
Execution of the Goal including management
Measurement of the Goal

Additionally, these three supporting processes are present in part or in all of these definitions:

People or teamwork working together to achieve the goal
Goal Achievement to achieve the desired goal
Quality to ensure continuous improvement within the goa

Ultimately, project management represents DISCIPLINE, ORGANIZATION, and ACCOUNTABILITY; which are three areas people seem to have a natural aversion to these days.

So go to it: career planning.