text:
NAND Flash Memory Market - Growth, Trends, COVID-19 Impact, and Forecasts (2022 - 2027)
The NAND Flash Memory market is segmented by Type (SLC, MLC, and TLC), by Structure (2-D Structure and 3-D Structure), by Application (Smartphones, SSD, Memory Cards, and Tablets), and by Geography.
Home Industry Reports Electronics NAND Flash Memory Market - Growth, Trends, COVID-19 Impact, and Forecasts (2022 ...
Largest Market: Asia Pacific
CAGR: 11.27 %
The NAND flash memory market was valued at USD 46.62 billion in 2020, and it is expected to reach USD 85.36 billion by 2026, registering a CAGR of 11.27% during the forecast period (2021-2026). The current macro trends of AI and machine learning, mobility, and connectivity are favorable to the NAND markets and expected to increase its share in the semiconductor market.
With the rise of PCs and smartphones, NAND flash consumption is dramatically increasing, much of which is attributed to the growth of the average capacity in smartphones. This is expected to drive the demand for NAND flash packaging, thus influencing the demand for memory packaging.
According to the Micron, in 2017, the average smartphone contained 43 GB of NAND flash storage, and it is expected to grow substantially over the next four years. By the year 2021, the company estimates that the average phone will have 142 GB of NAND flash storage, with flagship devices having one terabyte of flash storage.
Other consumer products such as tablets and cameras, along with industrial equipment and sensors, automotive systems and medical devices rely upon flash memory, which are integrated alongside their processors, that stores both data and the code they execute. As demand for massive data processing for artificial intelligence and machine learning applications grows, the trend for flash-based storage will continue to evolve.
Production of China-based NAND flash vendors were not severely affected by the outbreak of novel COVID-19. This is because the plants are highly automated have relatively low demands for manpower and operators also stocked up with raw materials before the Chinese Lunar New Year. Foundry output were delivered to customers in China because semiconductor fabrication plants hold national special licenses. These allow them to ship their products throughout domestic China, even with cities under quarantine.
NAND Flash is a kind of non-volatile storage technology that does not require power in order to retain data. In other words, it is a form of electronically erasable programmable readonly memory (EEPROM). It is programmed, erased, and reprogrammed in large blocks. It's called NAND because at the circuit level, it's similar to the NAND logic function. The scope of the study covers the market on the basis of type of NAND and different applications in smartphones, SSD, Memory Card and Tablet PC across the globe.
SLC (One-Bit Per Cell)
MLC (Two-Bit Per Cell)
TLC (Three-Bit Per Cell)
Smartphone segment is Expected to Witness Significant Growth
Flash Memory storage has become an essential component in smartphones. The NAND flash demand has been growing exponentially, primarily driven by the growth of the average capacity in smartphones.
NAND flash memory in smartphones can significantly enhance the performance of web browsing, email loading, games, and even social network sites such as Facebook. With the increasing adoption of smartphones, companies are adding extra features and applications to differentiate their products from other manufacturers.
For instance, manufacturers are integrating features such as gesture control, fingerprint scanners, and GPS into the devices. This is boosting the demand for NAND flash memory, which is used as code storage media for smartphones.
With 5G wireless communication on its way, the use of smartphones would increase multifold, increasing the need for the latest models to raise the bar continuously. For instance, According to the Ericsson Mobility report, in the North American region, 5G subscriptions are expected to account for 55% of mobile subscriptions by the end of 2024.
Asia-Pacific to Hold Significant Market Share
Asia Pacific is one of the biggest markets for NAND flash memories across the globe. The region has a very high demand from almost all the end-user applications, primarily led by the demand for smartphones in multiple developing countries in the region, such as China, India and Indonesia.
Also, there is a high activity from the semiconductor fabrication facilities in countries like China, Korea, and Singapore. An immense amount of capital is directed into the Chinese market by several multinational memory manufacturers, especially boosted by the country's government initiatives, such as Made in China 2025. The country's ambitious goals is to reach USD 305 billion in semiconductor output by the year 2030 and meet at least 80% of the domestic demand for semiconductors, which is expected to draw more investments into the country, over the forecast period.
Owing to such development in multiple countries, various competitors in the region are intensifying their efforts for expansion. For instance, as of February 2019, SK Hynix, one of the world's largest memory-chip maker, announced that it is planning to invest a huge sum of USD 106 billion, primarily to establish four new semiconductor fabrication plants in South Korea.
The NAND flash memory market is dominated by major vendors, such as Intel, Micron Technology, Samsung Electronics, SanDisk, SK Hynix, and Toshiba. As the entry barriers in the market are high, the entry of new players is difficult. The existing vendors in the market are investing heavily in the R&D of new and innovative products.
November 2019 - SK hynix delivered the samples of its solution products based on its128-layer 4D NAND, developed in June 2019. SK Hynix made these recent moves to strengthen its competitiveness in the NAND solution business. As the number of chips required to realize 1TB product has halved compared with using 512Gb NAND, the 1TB could be produced with a package thickness of only 1mm, which is optimal for ultra-thin 5G smartphones. Smartphones equipped with this product are expected to be mass-produced around the second half of the next year.
August 2019 - Samsung introduced its sixth-generation V-NAND memory, which in a bid to further improve capacity and density, features over 100 active layers. To make V-NAND with over 100 layers viable from performance point of view, the company had to use new circuit design technology. The new memory features 10% lower latencies and consumes 15% lower amount of power when compared to Samsung's previous-generation V-NAND.
Samsung Electronics Co. Ltd
KIOXIA Corporation
Micron Technology Inc.
SK Hynix Inc.
1.1 Study Assumptions and Market Definition
4.4.1 Increasing Demand for Data Centers
4.4.2 Increasing Proliferation of 5G and IOT Devices
4.5.1 Reliability Issues
4.6 Assessment of Impact of Covid-19 on the Industry
5.1 Type
5.1.1 SLC (One-Bit Per Cell)
5.1.2 MLC (Two-Bit Per Cell)
5.1.3 TLC (Three-Bit Per Cell)
5.2 Structure
5.2.1 2D Structure
5.3 Application
5.3.1 Smartphone
5.3.2 SSD
5.3.3 Memory Card
5.3.5 Other Applications
6.1.1 Samsung Electronics Co. Ltd
6.1.2 KIOXIA Corporation
6.1.3 Micron Technology Inc.
6.1.4 SK Hynix Inc.
6.1.5 Intel Corporation
6.1.6 Renesas Electronics Corporation
6.1.7 SanDisk Corp. (Western Digital Technologies, Inc)
6.1.8 Powerchip Technology Corporation
6.1.9 Cypress Semiconductor Corporation
The NAND Flash Memory Market market is studied from 2018 - 2026.
What is the growth rate of NAND Flash Memory Market?
The NAND Flash Memory Market is growing at a CAGR of 11.27% over the next 5 years.
Which region has highest growth rate in NAND Flash Memory Market?
Which region has largest share in NAND Flash Memory Market?
Asia Pacific holds highest share in 2020.
Who are the key players in NAND Flash Memory Market?
Samsung Electronics Co. Ltd, KIOXIA Corporation, Micron Technology Inc., SK Hynix Inc., Intel Corporation are the major companies operating in NAND Flash Memory Market.
China Solid State Drive Market - Growth, Trends, COVID-19 Impact, and Forecasts (2022 - 2027)
Dynamic Random Access Memory (DRAM) Market - Growth, Trends, COVID-19 Impact, and Forecasts (2022 - 2027)
Global SRAM and ROM Design IP Market - Growth, Trends, COVID-19 Impact, and Forecasts (2022 - 2027)
Next Generation Memory Market - Growth, Trends, COVID-19 Impact, and Forecasts (2022 - 2027)
SSD Caching Market - Growth, Trends, COVID-19 Impact, and Forecasts (2022 - 2027)
Static Random Access Memory (SRAM) Market - Growth, Trends, COVID-19 Impact, and Forecasts (2022 - 2027)


text:
Select Campus Clearwater Daytona Beach Flagship Residential Campus Ft. Lauderdale Graduate School Ft. Lauderdale Online ( eCampus ) Ft. Lauderdale ( En línea en español ) Ft. Myers College of Golf Lakeland Jacksonville Miami Melbourne Naples New Port Richey Orlando Patrick Air Force Base Pembroke Pines Port St. Lucie Sarasota San Marcos, Carazo, Nicaragua Tallahassee Tampa West Palm Beach
High School Grad Year 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
By clicking submit, I consent to calls, emails and texts from Keiser University at the phone number that I have provided and some of these calls may occur from automated technology.

redpajama_set_name: RedPajamaCommonCrawl


text:
Mon-Fri 10 am - 2 pm EST
Journal's Content
Current Volume In Press Archives Case Reports Archives
Instructions for Authors Documents / Forms Submit Manuscript Payments
Journal's Information
Indexation Info Reviewers Editorial Board Editorial Office Advertising Policy Privacy Policy
19 October 2022: Articles
Chiropractic Management of Neck Pain Complicated by Symptomatic Vertebral Artery Stenosis and Dizziness
Unusual or unexpected effect of treatment, Rare disease
Eric Chun-Pu Chu 1ABCDE, Robert J. Trager 2CDEF*, Cliff Tao 3CDE, Linda Yin-King Lee 4CDE
DOI: 10.12659/AJCR.937991
Am J Case Rep 2022; 23:e937991
Authors information Article notes Copyright and License information
1New York Chiropractic and Physiotherapy Centre, EC Healthcare, Kowloon, Hong Kong
2Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA
3 Private Practice of Chiropractic Radiology, Irvine, USA
4School of Nursing and Health Studies, Hong Kong Metropolitan University, Kowloon, Hong Kong
*Corresponding Author: Robert Trager, e-mail: [email protected]
AStudy design/planning
BData collection/entry
CData analysis/statistics
DData interpretation
EPreparation of manuscript
FLiterature analysis/search
Submitted: 02 August 2022
In Press: 14 September 2022
This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
BACKGROUND: Vertebrobasilar insufficiency (VBI) is most often caused by vertebrobasilar atherosclerosis, often presenting with dizziness and occasionally neck pain. Little research or guidelines regarding management of neck pain in affected patients exists.
CASE REPORT: A 62-year-old male hypertensive smoker presented to a chiropractor with a 13-year history of insidious-onset neck pain, dizziness, and occipital headache with a Dizziness Handicap Inventory (DHI) of 52%. The patient had known VBI, caused by bilateral vertebral artery plaques, and cervical spondylosis, and was treated with multiple cardiovascular medications. The chiropractor referred patient to a neurosurgeon, who cleared him to receive manual therapies provided manual-thrust cervical spinal manipulative therapy (SMT) was not performed. The chiropractor administered thoracic SMT and cervicothoracic soft tissue manipulation. The neck pain and dizziness mostly resolved by 1 month. At 1-year follow-up, DHI was 0%; at 2 years it was 8%. A literature search revealed 4 cases in which a chiropractor used manual therapies for a patient with VBI. Including the present case, all patients had neck pain, 60% had dizziness, and all were treated with SMT either avoiding manual cervical manipulation altogether or modifying it to avoid or limit cervical rotation, yielding positive outcomes.
CONCLUSIONS: The present and previous cases provide limited evidence that some carefully considered chiropractic manual therapies can afford patients with VBI relief from concurrent neck pain and possibly dizziness. Given the paucity of research, cervical SMT cannot be recommended in such patients. These findings do not apply to vertebral artery dissection, for which SMT is an absolute contraindication.
Keywords: Chiropractic, Dizziness, Headache, Manipulation, Spinal, Neck Pain, Vertebral Artery
Vertebrobasilar insufficiency (VBI), also called posterior circulation insufficiency or vertebrobasilar transient ischemic attack, is defined as a transitory ischemia of the vertebrobasilar circulation [1–3] and is a risk factor for vertebrobasilar stroke [4,5]. VBI is most often caused by atherosclerotic vertebral or basilar artery stenosis and can also result from vertebral artery hypoplasia, rotational vertebral artery occlusion, vertebral artery dissection, coagulopathy, drug abuse, or migraine [1,6–9]. VBI related to atherosclerosis typically presents as dizziness, visual dysfunction, or cognitive dysfunction [10], and occasionally presents with posterior neck pain [11]. However, there is little research on how to best manage neck pain in patients with comorbid VBI.
The vertebrobasilar system is composed of the paired vertebral arteries, basilar artery, and the vascular territories that these arteries supply [12]. This includes the brainstem, cerebellum, thalamus, occipital lobes, other cortical regions, and the upper cervical spinal cord [13,14]. The vertebral artery ascends through the transverse foramina of the cervical spine, typically starting at C6, then joins its contralateral component, forming the basilar artery at the level of the brainstem [15].
Radiographic vertebral artery stenosis is uncommon in healthy people. One study using magnetic resonance angiography (MRA) reported that proximal vertebral artery stenosis was found in about 7% of individuals in their 60s with little or no symptoms of VBI, while distal vertebral artery or basilar artery stenosis was only found in 2% [16]. In contrast, the prevalence of proximal and distal stenosis increased to 13% and 7%, respectively, among patients with coronary artery stenosis [16]. Typical cardiovascular risk factors, including hypertension, smoking status, dyslipidemia, male sex, and age older than 40 years, are considered risk factors for vertebral artery stenosis [1,17].
As there are no clear diagnostic criteria for VBI, a diagnosis is established after ruling out other causes of dizziness, such as benign paroxysmal positional vertigo (BPPV), vestibular migraine, and vestibular neuritis [2]. This is typically done by assessing the timing and triggers of dizziness [18], followed by blood pressure evaluation, a cardiac and neurologic examination, and other select examination procedures when indicated, such as the Dix-Hallpike maneuver or head impulse, nystagmus, and test of skew (HINTS) examination [18,19]. In patients with neck pain and dizziness, it is also important to assess for cervicogenic dizziness, which may relate to degenerative cervical myelopathy or instability [20,21]. Neck pain and dizziness in those who have sustained trauma also warrants examination for cervical spine injury and concussion [22]. Cervical extension-rotation tests for vertebral artery function are no longer recommended due to their low reliability and diagnostic accuracy [23–26].
Several imaging tests can be useful for the diagnosis of VBI, and the strategy depends on the level of urgency and suspicion for concomitant stroke. For patients with non-urgent VBI and no suspicion of stroke, computed tomography angiography (CTA) and MRA are the imaging modalities of choice [1,2]. Transcranial doppler ultrasound and dynamic angiography are other options, yet are not performed frequently [1,2].
In general, there is no consensus regarding treatment for VBI [2]. However, common medical practices include anticoagulant and antiplatelet therapies, statins, blood pressure control [2,27], and lifestyle recommendations, including avoidance of smoking, and diet and exercise [17]. Endovascular treatments, including percutaneous transluminal angioplasty, stenting, and thrombectomy, are emerging as minimally invasive procedures for symptomatic vertebral artery stenosis [28,29]. However, a recent randomized controlled trial and systematic review found no significant differences with respect to stroke-related disability [29] and likelihood of stroke or transient ischemic attack with these therapies compared with standard medical treatment, suggesting that further research is needed [28]. Accordingly, endovascular treatments are typically reserved for those with a high grade of stenosis, persistent symptoms despite medical treatment, and/or stenosis at the vertebral artery origin [2,27]. To date, acupuncture has limited evidence for treating VBI [30].
There is also limited research to guide the treatment of neck pain in patients with VBI. In one study, patients with cervical spondylosis, neck pain, and VBI reported improvement following a protocol of soft tissue manipulation and acupuncture with moxibustion [31]. While application of a soft cervical collar [32], and cervical traction [33] have some evidence of safety and vascular benefit in the VBI population, these have not been studied with regards to neck pain. In one publication, VBI was considered as a contraindication to any form of cervical spine manual therapy [34]. In the chiropractic literature, VBI is listed as a contraindication to cervical SMT [35–38].
Chiropractors are providers that treat neuromusculoskeletal conditions, most often those of the spine, including low back and neck pain [39,40]. Chiropractors occasionally encounter patients with dizziness [40], and rarely, patients with VBI [41–43]. Researchers have suggested that a common treatment used by manual therapists and specifically by chiropractors, cervical spinal manipulative therapy (SMT), could worsen VBI by dislodging an atherosclerotic plaque from the vertebral artery or by causing hemostasis, vasospasm, or direct arterial injury, or by worsening a pre-existing arterial dissection [44–47]. Other research has shown that cervical spine rotation, which is often used in cervical SMT, leads to greater length changes in the vertebral artery than other movements, although these changes are small in magnitude [48]. However, recent evidence suggests that cervical spine manipulation does not affect the blood flow parameters of the vertebral arteries when performed in individuals without known VBI [26,49].
Given the lack of research and guidelines for treatment of neck pain in patients with VBI, we present a case in which a patient responded positively to a multimodal chiropractic manual therapy approach, including SMT, which was modified as a precaution due to concomitant vertebral artery stenosis.
PATIENT INFORMATION:
A 62-year-old man who worked as an attorney presented to a chiropractor complaining of a 13-year history of insidious-onset neck pain, dizziness, and headache (Figure 1). He rated his mean pain severity as 6/10 on the Numeric Pain Rating Scale. His Dizziness Handicap Inventory (DHI) was 52% (which indicates an upper range of moderate handicap) and his World Health Organization Quality of Life score (WHO-QOL) was 76%. His neck pain was axial and bilateral without radiating pain, numbness, or tingling in the upper or lower extremities. He described his dizziness as feeling clumsy, having jet lag, and noted being unable to walk quickly, and felt more prone to tripping during episodes. Dizziness lasted for one or more hours at a time and occurred multiple times per week. He denied having a distinct spinning sensation when dizzy but did have 2 distinct episodes of syncope which caused him to fall, once while walking down a flight of stairs; however, these did not further exacerbate the patient's symptoms or appear to cause any serious injury.
Typically, episodes of severe neck pain coincided with episodes of headache and dizziness. These symptoms were exacerbated by long hours of legal desk work and stress. His headache was described as occipital, and could be unilateral or bilateral, and was not associated with any nausea, vomiting, or aura. He denied any head injury, tinnitus, aural fullness, and hearing loss and had not noticed any exacerbation of dizziness or headache with turning his head. The patient had been previously prescribed acetaminophen and celecoxib, which provided some relief from his neck pain but did not improve his dizziness.
The patient endorsed a 10-year history of high blood pressure. He also had a family history of high blood pressure (father) and breast cancer (mother). The patient currently was taking aspirin, Exforge HCT (amlodipine/valsartan/hydrochlorothiazide), atorvastatin 40 mg, ezetimibe 10 mg, and clopidogrel 75 mg. He was a current smoker, with a 30 pack-year history; however, he was physically active and did cross-training in a gym 3 times per week. He formerly ran marathons but had stopped several years prior because of dizziness. The patient had seen several medical specialists prior to presenting to the chiropractor.
Thirteen years prior to his presentation to the chiropractor, the patient visited a sports medicine physician for neck pain. This provider ordered radiographs of the cervical spine, the report of which noted osteophytes at C4/5, C5/6, and C6/7 and narrowing of the intervertebral disc space at C6/7. Flexion extension views were also obtained, which did not reveal subluxation or instability. The patient's neck pain progressed, and by 10 years preceding his presentation, he began to develop dizziness.
Eight years prior, for evaluation of dizziness, the patient saw an ear nose and throat specialist, who performed caloric irrigation and ocular vestibular evoked myogenic potential tests, which revealed normal responses on both sides. Although these test results reduced the likelihood of BPPV, this specialist referred him for a course of vestibular therapy, which did not provide him with any relief.
Four years prior, his primary care provider ordered magnetic resonance imaging (MRI) of the brain, which identified white matter ischemia in the cerebral hemispheres bilaterally, with no focal lesion in the brainstem or cerebellum. This provider also ordered an MRA of the head and neck without and with contrast, which identified a short segment of mild to moderate stenosis in the left vertebral artery and another short segment of mild stenosis in the right vertebral artery. The patient then visited a neurologist who ordered a cervical spine MRI, the report of which noted degenerative changes without evidence of cervical canal stenosis or myelopathy. VBI was diagnosed at this time.
Six months prior, the patient saw an orthopedic surgeon, who ordered cervical radiographs. These images revealed degenerative spondylosis affecting the mid to lower cervical spine, with osteophytes at the posterior vertebral bodies, disc space narrowing from C4 to T1, and reversal of the cervical lordosis (Figure 2). The orthopedist considered these findings a potential contributor to the patient's symptoms and referred him for physical therapy. However, the patient reported that that rehabilitative neck exercises, including stretching and strengthening exercises, exacerbated his neck pain and dizziness and he discontinued the physical therapy. The exact details of this exacerbation were unclear, and the patient did not recall any specific positional triggers during therapy. He subsequently also tried acupuncture, which did not alleviate his symptoms.
Over the year preceding the patient's chiropractic visit, the patient had a weekly massage, which focused on the upper and mid back. This treatment had provided him with more relief from his neck pain and dizziness than any therapy he had tried previously. However, this relief was very transient, not lasting more than a day or so. As the patient had chronic symptoms that had resisted many forms of therapy, he sought chiropractic therapy for another opinion.
CLINICAL FINDINGS:
On initial evaluation by the chiropractor, the patient demonstrated a stiff, guarded neck posture with a forward head carriage. Palpation of the spine revealed restriction and tenderness at the C5/6, C6/C7, T1/2, T2/3, T4/5, and T6/7 levels, and limited active cervical range of motion with pain at 20° extension (normal >60°) and 45° of bilateral rotation (normal >80°). Muscle hypertonicity and tenderness was noted at the upper trapezius, scalenes, rhomboids, and levator scapulae bilaterally. A neurological examination, including cranial nerve testing, muscle stretch reflexes, and motor and sensory testing, was normal. The patient's blood pressure was 133/83 mm Hg and heart rate was 61 beats per min. Positional vertebral artery testing and head impulse testing were not performed given the patient's known history of vertebral artery stenosis and VBI and concern that prolonged rotation could exacerbate his condition.
Given the patient's history of VBI, the chiropractor referred the patient to another neurologist with the intent of obtaining updated head and neck vascular imaging. The neurologist ordered CTA of the head and neck without and with contrast (Figure 3). This revealed calcified plaques in the distal vertebral arteries bilaterally, with severe stenosis of the left vertebral artery (>70% diameter reduction; Figure 4) and moderate stenosis of the right vertebral artery (50–60% diameter reduction; Figure 5). Calcified plaques with minimal stenosis were also noted in the left subclavian artery, left carotid bulb, left proximal internal carotid artery, cavernous segment of left internal carotid artery, brachiocephalic trunk, and cavernous segment of right internal carotid artery (Figure 3). The patient had a normal variant of a fetal origin of the posterior cerebral arteries bilaterally, with the circle of Willis being otherwise unre-markable. There was no evidence of impingement of the vertebral arteries by cervical osteophytes. The neurologist considered the vertebral artery stenosis a clinically significant contributor to his VBI, while the other findings were deemed noncontributory.
The neurologist also ordered a coronary CTA, which revealed a coronary calcium score of 452.98, mild stenosis of the proximal left anterior descending and left distal circumflex arteries, and minimal stenosis of the proximal left circumflex and left main artery. The patient's coronary findings were ranked at 76%, indicating greater coronary disease than 75% of an age-matched population. While these findings were consistent with his cardiovascular risk factors and known atherosclerosis, they were not considered directly contributory to his VBI symptoms.
The chiropractor also referred the patient to a neurosurgeon employed in the same healthcare organization and consulted with this specialist regarding the case. The neurosurgeon deemed the patient to not be a surgical candidate, and preferred the patient continue with conservative care, including medical management. The neurosurgeon advised the chiropractor not to provide high-velocity, low-amplitude cervical spine manipulation given the patient's history of vertebral artery stenosis and VBI.
The patient was interested in receiving cervical SMT; however, he reported that previous providers had deterred him from receiving it, citing concerns about potential stroke given his VBI. After the neurosurgeon cleared the patient to receive SMT with certain restrictions, the patient returned to the chiropractor and gave written informed consent for treatment.
The chiropractor initially treated the patient with high-velocity, low-amplitude spinal manipulation directed to the mid-thoracic spine (Figure 6) and thermal ultrasound therapy directed to the cervical spine 3 times per week, with emphasis on alleviating pain and muscle hypertonicity and restoring spinal mobility.
After the first week, high-velocity, low-amplitude spinal manipulation was also administered to the upper thoracic spine (Figure 7). Instrument-assisted soft tissue manipulation (gua sha) was also applied to the levator scapulae, upper trapezius, and rhomboids using a massage tool (Strig, Korea; Figure 8).
At the 1-month follow-up, the patient reported that his dizziness was completely gone, and his neck pain was almost completely gone. He only reported neck stiffness and limited range of motion. His active cervical range of motion also improved (50° extension, 50° left and 60° right rotation) Given the patient's improvement, the chiropractor reduced the treatment frequency to once per month. After starting his care with the chiropractor, the patient discontinued receiving his usual massage therapy visits outside of the chiropractic office, as he had improved.
At a 1-year follow-up, the patient's DHI was 0% and his WHOQOL was 96%. His active cervical spine range of motion continued to improve slightly (rotation was now 70° bilaterally). At the 2-year follow-up, the DHI had slightly rebounded, being reported at 8%, while the WHO-QOL score remained at 96%. While the patient did have occasional re-appearance of symptoms of neck pain and dizziness, these typically resolved quickly with the treatments described above (ie, thoracic spinal manipulation, soft tissue manipulation). Aside from the patient's cardiovascular medications and anti-inflammatory medications, he did not take any additional pain medications during treatment. The patient continued working as an attorney and smoking; however, he became more involved with sports activities on the weekends. He returned to marathon running and wakeboarding. He noted that stress could still exacerbate his symptoms; however, it no longer interrupted his daily activities.
There were no adverse events in relation to the SMT or other therapies provided. The patient provided written consent for the publication of his case report and any accompanying images.
First, as a single case, the demonstrated results are not generalizable. Although the patient underwent several therapies and had taken multiple medications prior to chiropractic care without any lasting relief, it is possible that the combination of medications while he was receiving chiropractic treatments were synergistic, leading to an improved outcome. Second, while the follow-up period was long at 2 years, without major symptoms, it is possible that without monthly chiropractic treatments the patient's symptoms could return. Third, only some of the patient's previous imaging could be obtained digitally; the remainder was printed, which led to a decrease in quality upon scanning and had remaining overlying words. Fourth, our literature search terms focused on cases of VBI visiting a chiropractor, as this profession delivers the majority of SMT [61]. Accordingly, there may be cases in which a patient with VBI visited a physical therapist, osteopath, or other provider and received SMT [62,63]. Fifth, there was no follow-up vascular imaging to determine if there had been improvements in the patient's radiological vertebral artery stenosis or blood flow parameters after multimodal chiropractic treatments. Sixth, the different imaging modalities used in previously published similar cases hinders their comparability. Seventh, our findings should not be extrapolated to patients with VBI related to vertebral artery dissection, which is an acute medical emergency and absolute contraindication to SMT [47,64].
This case highlights a patient with neck pain and concurrent VBI, with confirmed VBI on imaging related to vertebral artery stenosis that responded positively to thoracic SMT and soft tissue manipulation. Four cases were reported in the literature in which chiropractors either avoided manual cervical SMT altogether or modified it to reduce or avoid cervical rotation as a safety precaution when treating neck pain among patients with VBI, yielding a positive outcome. However, as there is insufficient evidence that cervical SMT is safe for patients with VBI, this therapy should be avoided in these patients. As illustrated in the present case and supported by recent research, thoracic SMT or soft tissue manipulation may provide alternative means of alleviating neck pain in those with VBI. Practitioners considering these treatments should do so in collaboration with medical specialists and on a case-by-case basis.
Figure 1.. Timeline of care. Figure 2.. Cervical spine radiographs. Lateral view (A) and anteroposterior view (B). Degenerative changes are noted in the mid-to-lower cervical spine including posterior vertebral body osteophytes (arrowheads), disc space narrowing (*), and uncovertebral joint degeneration (arrows). In addition, the cervical lordosis is reduced as the neck is visibly straightened, and has a slight kyphosis at C3/4. Figure 3.. Computed tomography angiogram of neck, 3D volume-rendered image. Orientation: left (L), right (R), head (H), feet (F). Calcified plaques of the vertebral arteries are evident bilaterally (arrows), more prominently on the left than right. From superior to inferior, additional smaller calcified plaques are easily visible at the left carotid bulb (×2), left subclavian artery, and right brachiocephalic trunk (arrowheads). Figure 4.. Oblique computed tomography angiogram of the head showing calcified plaque of the left vertebral artery (LVA) at the transition between the V3 and V4 segment of the right vertebral artery RVA (arrow). Figure 5.. Oblique computed tomography angiogram of the head showing calcified plaque of the right vertebral artery (RVA) at the transition between the V3 and V4 segment of the RVA (arrow). Figure 6.. Thoracic spine high-velocity, low-amplitude manipulation. The clinician places their hands overlying the transverse processes of T4 and T5 and delivers a thrust oriented posterior to anterior and inferior to superior. Image from EC. Figure 7.. Upper thoracic manipulations. The clinician delivers a lateral to medial thrust using first digit, placed at the spino-laminar junction of T2 (arrow). The non-thrusting hand stabilizes the head against the head rest using slight lateral flexion in the opposite direction. Figure 8.. Instrument-assisted soft tissue manipulation. The clinician applies a thin layer of emollient to the skin surface, and utilizes a massage tool (Strig, Korea) to gently stroke along the targeted muscles. In the image shown, strokes are applied to the right levator scapula (arrows).
Table 1.. Patients with vertebrobasilar insufficiency treated by a chiropractor.
1.. Neto L, Cardoso A, Bittar R, Pathophysiology and diagnosis of vertebrobasilar insufficiency: A review of the literature: Int Arch Otorhinolaryngol, 2017; 21; 302-7
2.. Chandratheva A, Werring D, Kaski D, Vertebrobasilar insufficiency: An insufficient term that should be retired: Pract Neurol, 2020 [Online ahead of print]
3.. Naylor AR, Rantner B, Ancetti S, European society for vascular surgery (ESVS) 2023 clinical practice guidelines on the management of atherosclerotic carotid and vertebral artery disease: Eur J Vasc Endovasc Surg, 2022 [Online ahead of print]
4.. Hopkins LN, Martin NA, Hadley MN, Part 2: Microsurgical treatment of intracranial vertebrobasilar disease: J Neurosurg, 1987; 66; 662-74
5.. Marquardt L, Kuker W, Chandratheva A, Incidence and prognosis of ≥50% symptomatic vertebral or basilar artery stenosis: Prospective population-based study: Brain, 2009; 132(Pt 4); 982-88
6.. Savitz SI, Caplan LR, Vertebrobasilar disease: New Engl J Med, 2005; 352; 2618-26
7.. Luzzi S, Gragnaniello C, Marasco S, Subaxial vertebral artery rotational occlusion syndrome: an overview of clinical aspects, diagnostic work-up, and surgical management: Asian Spine J, 2021; 15; 392-407
8.. Caplan LR, Migraine and vertebrobasilar ischemia: Neurology, 1991; 41; 55-55, Wolters Kluwer Health, Inc on behalf of the American Academy of Neurology
9.. Nakagawa T, Shigeta T, Takashima T, Tomiyama K, Magnetic resonance angiography evaluation of basilar artery stenosis in patients with vertebrobasilar insufficiency: Eur Arch Otorhinolaryngol, 2000; 257; 409-11
10.. Moors C, Stapleton C, Signs and symptoms of vertebrobasilar insufficiency: A systematic review: Physiotherapy, 2022; 114; e155-56
11.. Searls DE, Symptoms and signs of posterior circulation ischemia in the New England Medical Center posterior circulation registry: Arch Neurol, 2012; 69; 346
12.. Banerjee G, Stone SP, Werring DJ, Posterior circulation ischaemic stroke: BMJ, 2018; 361; k1185
13.. Schulz UG, Fischer U, Posterior circulation cerebrovascular syndromes: Diagnosis and management: J Neurol Neurosurg Psychiatry, 2017; 88(1); 45-53
14.. Montalvo M, Bayer A, Azher I, Spinal cord infarction because of spontaneous vertebral artery dissection: Stroke, 2018; 49(11); e314-e17
15.. Campero A, Rubino P, Rhoton A, Anatomy of the vertebral artery: Pathology and surgery around the vertebral artery, 2011; 29-40, Paris, Springer
16.. Kim S, Lee J, Kwon O, Han M, Kim J, Prevalence study of proximal vertebral artery stenosis using high-resolution contrast-enhanced magnetic resonance angiography: Acta Radiologica, 2005; 46; 314-21
17.. Pirau L, Lui F, Vertebrobasilar Insufficiency: StatPearls [Internet], 2022, Treasure Island (FL), StatPearls Publishing [cited 2022 Jun 25]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK482259/
18.. Edlow JA, Gurley KL, Newman-Toker DE, A new diagnostic approach to the adult patient with acute dizziness: J Emerg Med, 2018; 54; 469-83
19.. Muncie HL, Sirmans SM, James E, Dizziness: Approach to evaluation and management: AFP, 2017; 95; 154-62
20.. Kadanka Z, Jura R, Bednarik J, Vertigo in patients with degenerative cervical myelopathy: J Clin Med, 2021; 10; 2496
21.. Chu EC, Zoubi FA, Yang J, Cervicogenic dizziness associated with craniocervical instability: A case report: J Med Cases, 2021; 12; 451-54
22.. Cheever K, Kawata K, Tierney R, Galgon A, Cervical injury assessments for concussion evaluation: A review: J Athl Train, 2016; 51; 1037-44
23.. Thiel H, Rix G, Is it time to stop functional pre-manipulation testing of the cervical spine?: Man Ther, 2005; 10; 154-58
24.. Côté P, Kreitz BG, Cassidy JD, Thiel H, The validity of the extension-rotation test as a clinical screening procedure before neck manipulation: A secondary analysis: J Manipulative Physiol Ther, 1996; 19; 159-64
25.. Hutting N, Antonius H, Kerry R, Yes, we should abandon pre-treatment positional testing of the cervical spine: Musculoskelet Sci Pract, 2020; 49; 102181 others
26.. Moll F, Sleiman M, Sturm D, Pre-manipulative cervical spine testing and sustained rotation do not influence intracranial hemodynamics: An observational study with transcranial Doppler ultrasound: J Man Manip Ther, 2022 [Online ahead of print]
27.. Dzhilkashiev BS, Antonov GI, Chmutin GE, Our experience in the treatment of vertebrobasilar insufficiency due to cervical spine disorders. International Journal of Biology and Biomedical Engineering: North Atlantic University Union NAUN, 2021; 15; 318-24
28.. Lattanzi S, Brigo F, Di Napoli M, Endovascular treatment of symptomatic vertebral artery stenosis: A systematic review and meta-analysis: J Neurol Sci, 2018; 391; 48-53
29.. Liu X, Dai Q, Ye R, Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): An open-label, randomised controlled trial: Lancet Neurol, 2020; 19; 115-22
30.. Li X, Liu M, Zhang Y, Acupuncture for vertebrobasilar insufficiency vertigo: Protocol for a systematic review and meta-analysis: Medicine, 2017; 96; e9261
31.. Xu J, Shen Z, Wu Y, Bian X, Clinical observation on warm needling moxibustion plus tuina for cervical spondylosis of vertebral artery type: J Acupunct Tuina Sci, 2019; 17; 111-15
32.. Jaspreet K, Manoj M, Inderpreet K, Effect of collar on balance in vertebrobasilar insufficiency patients. Indian J Physiother Occup: Institute of Medico-Legal Publications, 2014; 8; 198
33.. Xin W, Fangjian G, Hua W, Enhanced external counterpulsation and traction therapy ameliorates rotational vertebral artery flow insufficiency resulting from cervical spondylosis: Spine, 2010; 35; 1415-22
34.. Hutting N, Kerry R, Coppieters MW, Scholten-Peeters GG, Considerations to improve the safety of cervical spine manual therapy: Musculoskelet Sci Pract, 2018; 33; 41-45
35.. Terrett A, Neurological complications of spinal manipulation therapy: Principles and practice of chiropractic, 2005; 1156-61, New York, McGraw-Hill
36.. Henderson DJ: Vertebral artery syndrome. chiropractic standards of practice and quality of care, 1992; 115-43, Gaithersburg, MD, Jones & Bartlett Learning
37.. Bergmann TF, Peterson DH, Principles of adjustive technique: Chiropractic technique: Principles and procedures, 2010; 84-142, St. Louis, Mo, Mosby
38.. Souza T, Dizziness: Differential diagnosis and management for the chiropractor: Protocols and algorithms, 2009; 545-66, Mississauga, Jones & Bartlett Learning
39.. Beliveau PJH, Wong JJ, Sutton DA, The chiropractic profession: A scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided: Chiropr Man Ther, 2017; 25; 35
40.. Himelfarb I, Hyland J, Ouzts N: National Board of Chiropractic Examiners:Practice analysis of chiropractic 2020 [Internet], 2020, Greeley, CO, NBCE [cited 2020 Nov 7]. Available from: https://www.nbce.org/practice-analysis-of-chiropractic-2020/
41.. Terenzi T, Transcranial sonography and vertebrobasilar insufficiency: J Manipulative Physiol Ther, 2002; 25; 180-83
42.. Bolton P, Stick P, Lord R, Failure of clinical tests to predict cerebral ischemia before neck manipulation: J Manipulative Physiol Ther, 1989; 12; 304-7
43.. Ordet SM, Vertebrobasilar artery insufficiency in athletic injuries: Necessity for proper prescreening examination for preathletic physicals: Chiropr Sports Med, 1987; 1; 154-56
44.. Mann T, Refshauge KM, Causes of complications from cervical spine manipulation: Aust J Physiother, 2001; 47; 255-66
45.. Cagnie B, Barbaix E, Vinck E, Atherosclerosis in the vertebral artery: An intrinsic risk factor in the use of spinal manipulation?: Surg Radiol Anat, 2006; 28; 129-34
46.. Rothwell DM, Bondy SJ, Williams JI, Chiropractic manipulation and stroke: A population-based case-control study: Stroke, 2001; 32; 1054-60
47.. Arning C, Hanke-Arning K, Vertebral artery dissection after – and also before – chirotherapy: J Neurol, 2022; 269; 3353-54
48.. Gorrell LM, Kuntze G, Ronsky JL, Kinematics of the head and associated vertebral artery length changes during high-velocity, low-amplitude cervical spine manipulation: Chiropr Man Ther, 2022; 30; 28
49.. Kocabey B, Karagözoğlu Coşkunsu D, Güven K, Effects of manual versus instrumental spinal manipulation on blood flow of the vertebral and internal carotid arteries in participants with chronic nonspecific neck pain: A single-blind, randomized study: J Chiropr Med, 2022 [In press]
50.. Lempert T, Olesen J, Furman J, Vestibular migraine: Diagnostic criteria: J Vestib Res, 2012; 22; 167-72
51.. Trager RJ, Dusek JA, Chiropractic case reports: A review and bibliometric analysis: Chiropr Man Ther, 2021; 29; 17
52.. Michaud TC, Uneventful upper cervical manipulation in the presence of a damaged vertebral artery: J Manipulative Physiol Ther, 2002; 25; 472-83
53.. Rectenwald RJ, DeSimone CM, Sweat RW, Vascular ultrasound measurements after atlas orthogonal chiropractic care in a patient with bow Hunter syndrome: J Chiropr Med, 2018; 17; 231-36
54.. Jensen TW, Vertebrobasilar ischemia and spinal manipulation: J Manipulative Physiol Ther, 2003; 26; 443-47
55.. Haavik H, Kumari N, Holt K, The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function: Eur J Appl Physiol, 2021; 121; 2675-720
56.. Nim CG, Downie A, O'Neill S, Kawchuk GN, The importance of selecting the correct site to apply spinal manipulation when treating spinal pain: Myth or reality? A systematic review: Sci Rep, 2021; 11; 23415
57.. Chu ECP, Wong AYL, Sim P, Krüger F, Exploring scraping therapy: Contemporary views on an ancient healing-A review: J Fam Med Prim Care, 2021; 10; 2757
58.. Basu S, Edgaonkar R, Baxi G, Comparative study of instrument assisted soft tissue mobilisation vs ischemic compression in myofascial trigger points on upper trapezius muscle in professional badminton players: Indian J Physiother Occup Ther, 2020; 14; 3480
59.. Masaracchio M, Kirker K, States R, Thoracic spine manipulation for the management of mechanical neck pain: A systematic review and meta-analysis: PLoS One, 2019; 14; e0211877
60.. Young IA, Pozzi F, Dunning J, Immediate and short-term effects of thoracic spine manipulation in patients with cervical radiculopathy: A randomized controlled trial: J Orthop Sports Phys Ther, 2019; 49(5); 299-309
61.. Hurwitz EL, Epidemiology: Spinal manipulation utilization: J Electromyogr Kinesiol, 2012; 22; 648-54
62.. Chaibi A, Russell MB, A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: A comprehensive review: Ann Med, 2019; 51; 118-27
63.. Rushton A, Rivett D, Carlesso L, International framework for examination of the cervical region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy intervention: Man Ther, 2014; 19; 222-28
64.. Keser Z, Meschia JF, Lanzino G, Craniocervical artery dissections: A concise review for clinicians: Mayo Clin Proc, 2022; 97(4); 777-83
Background Case Report Discussion Conclusions References:
Related articles Metrics Order reprints Share article Share by email
Table 1.. Patients with vertebrobasilar insufficiency treated by a chiropractor. Table 1.. Patients with vertebrobasilar insufficiency treated by a chiropractor.
27 Jan 2023 : Case report
A 37-Year-Old Man with Familial Hereditary Hemorrhagic Telangiectasia and Pulmonary Arteriovenous Malformat...
Am J Case Rep In Press; DOI: 10.12659/AJCR.938548
A 39-Year-Old Woman with Endometriosis Who Developed a Subcapsular Liver Hematoma Following Laparotomic Sur...
Optic Neuritis as a Consequence of Long-Term Medical Treatment Using Anastrozole: A Case Report
A Rare Case of Ruptured Appendicitis Secondary to Metastatic Ovarian Cancer
Most Viewed Current Articles
13 Jul 2022 : Case report
Whistling Scrotum: An Unusual Presentation of Pneumomediastinum in the Setting of an Open Scrotal Wound
DOI :10.12659/AJCR.936441
06 Dec 2021 : Case report
Lipedema Can Be Treated Non-Surgically: A Report of 5 Cases
23 Feb 2022 : Case report
Penile Necrosis Associated with Local Intravenous Injection of Cocaine
Myocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of P...
We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.
American Journal of Case Reports eISSN: 1941-5923
About Am J Case Rep
Letter/Correspondence
ISI Journals
Annals of Transplantation
Medical Science Monitor
American Journal of Case Reports
Medical Science Monitor Basic Research
Clinical Practice Review and Meta-Analysis
International Scientific Information, Inc.
150 Broadhollow Rd., Suite 114
Melville, NY, 11747 | USA
www: www.isi-science.com
Case Reports Archives
About ISI
International Scientific Infromation, Inc.
International Scientific
Infromation, Inc.


text:
Remembering the Journey With the Sopranos: The End With Matt Zoller Seitz and Alan Sepinwall Tell Me About Your Father
Erin & Elizabeth solve the mystery of the final episode of the show, "Made in America," widely considered to be the greatest tv finale of all time. We talk to the critics and authors of The Sopranos Sessions, Matt Zoller Seitz (New York Magazine) and Alan Sepinwall (Rolling Stone), about the meaning of the ending, the evils of parallel parking, the importance of ambiguity in art, what makes David Chase tick, and the living legacy of the late actor James Gandolfini - his son Michael Gandolfini, who plays Tony Soprano as a young man in The Many Saints of Newark, 7 years after his father's sudden death. Come for the anecdotes about Alan's mom asking Gandolfini to make less violent shows for her to enjoy, stay for Matt describing the Soprano star's love for the Very Hungry Caterpillar.
Support this podcast: https://anchor.fm/tell-me-about-your-father/support
Erin Hosier, Matthew Phillp and Elizabeth Thompson


text:
The US-China Currency Rivalry: Choosing Sides
American Institute for Economic Research
The recent dollar-denominated financial sanctions on Russia by the United States inadvertently highlight the growing significance of the yuan (RMB) as an alternative currency. Although today's immediate concerns revolve around the potential for Moscow to avoid sanctions by transacting in RMB, the significance of the emerging US-China currency rivalry exhibits far broader implications. Many countries are reevaluating their commercial and strategic interests, including increasing their usage of the yuan. As a result, China's effort to internationalize the yuan is seeing increasing success after six years of stagnation. If the US is to protect its position in the world financial order, it must uphold its sound institutions underpinning the world's faith in the dollar.
At the beginning of January 2022, the Chinese yuan's share of world payments hit a record high, as shown in the graph below.
Countries blacklisted by the US transact in the yuan, which supports China's currency internationalization plans. For example, nearly half of North Koreans use the yuan for domestic transactions. Iran and Myanmar accept yuan-denominated purchases from China. After its ban from the Western financial system, Russia is now paying off its foreign debt in yuan. In all these cases, dollar-denominated sanctions pushed countries towards the dollar's competitor, the yuan.
Other countries that maintain trade relations with the US are reconsidering dollars as their trade and investment with China increases. Saudi Arabia, a major oil supplier for the US and China, is considering a yuan-denominated oil deal with Beijing. In 2018, officials from 14 African countries discussed using the yuan as a regional reserve currency. A large impetus likely stems from their involvement in Beijing's Belt and Road Initiative (BRI), a global economic program that seeks to reorient global commerce around China. In Zimbabwe, the yuan became legal tender after China canceled its debt. ASEAN, a Southeast Asian alliance, adopted bilateral currency swaps with China, which World Financial Review economist Dr. Kalim Siddiqui argues will be the "demise of the US dollar." Indonesia signed a bilateral agreement to promote the yuan's use. Baizhu Chen, a clinical finance and business economics professor at the University of Southern California, explains that such countries "feel their economies could be held hostage to US policies" and "want to diversify their risk."
China also plans to reshape its payment system with the rollout of a digital yuan, or e-CNY. In response, members of Congress raised concerns over the digital yuan's potential to circumvent US sanctions and threaten the dollar's status as a reserve currency. In addition, the digital yuan can facilitate cross-border payments without SWIFT, a global interbank messaging system, undermining US interests and bolstering China's financial power.
Be that as it may, China's financial structures hinder the internationalization process. Tight capital controls limit convertibility making capital withdrawals out of China extremely difficult for its citizens and investors alike. Foreign businesses registered in China are also bound by strict foreign exchange regulations which delay or restrict business capital transfers. Capital account liberalization is the prerequisite to widespread currency usage, but Peterson Institute for International Economics researchers Nicholas Lardy and Patrick Douglass note that "China does not yet meet any of the conditions necessary for convertibility."
The graph below shows that China's progress lags in promoting the usage of its currency in global commerce. The RMB plateaued at just 2 percent of global transactions, whereas the US dollar still commands 40 percent of all transactions. For now, the dollar remains king.
Source: CSIS China Power Project | SWIFT
What Do Countries Consider When Using a Currency
While sanctions may force some states to resort to yuan, most countries balance their use of RMB and USD based on their strategic and economic interests. For example, Japan holds a large percentage of its foreign reserves in US dollars despite China's being its largest trading partner. African countries, which predominantly hold dollars and euros, might add the yuan to their portfolios to pay their Chinese infrastructure loans. In Southeast Asia, Cambodia receives large Chinese investments and displays interest towards the RMB to decrease transaction costs. However, Cambodia still pegs its own currency to the dollar.
The yuan's political controls and difficulty of use in commerce explain these mixed results. China's weak foreign money exchange infrastructure makes it inconvenient for cross-border transactions. Rolling out a digital yuan makes it easier to conduct international payments, but only if other countries establish interoperability with their financial systems. The USD also maintains its first-mover advantage, network effect, and reliability over the Chinese yuan.
Countries also tend to favor the reserve currencies of states with strong diplomatic and military influence, like the US. This tendency exists because states desire to transact in the currency that promotes national security and mutual monetary stability among alliance members.
An American security-dependent state often purchases Washington's currency-denominated debt, such as US Treasury bonds. One study estimates that "military alliances boost the share of international units in foreign exchange reserve holdings by almost 30 percentage points." Another study finds that countries lacking nuclear weapons hold 35 percent more US dollars in reserve than those that do not.
In the context of the US-China rivalry, countries are fundamentally realist in their currency choice. Nations favor economic utility until security concerns become apparent. For some countries aligned with the US, like Australia and Japan, a strong trade relationship with China is increasingly less relevant in the face of geopolitical tension. Countries often prioritize national security, alliances, and values over maintaining economic relationships when taking sides in a conflict.
Other states, like those in Southeast Asia and Africa, find themselves caught in the middle of a strategic balancing game. As the Chinese economy grows, most countries may hold a diverse portfolio of foreign currencies to hedge against uncertainty. A prime example of this rebalancing act is Israel's central bank adding the yuan to its foreign currency reserve alongside three other currencies. The move comes as Jerusalem bolsters its trade relationship with Beijing and expands technology exports worldwide. Ultimately, the Israelis decreasing their ratio of dollars and euros while adding Chinese currency represents an objective observation about the shifting global balance of strategic and economic power.
A Bretton Woods III?
Another factor that may be contributing to the yuan's ascendancy is a global rethink on the foundation of the monetary status quo. The first Bretton Woods system sought to create a uniform global monetary system with currencies tied to the price of gold. After President Nixon took the US off the gold standard, however, Bretton Woods ceased to exist in its original form. As a result, the world transitioned to Bretton Woods II, a de facto system based on US Treasuries as the anchor. Now, analysts like Credit Suisse Managing Director, Zoltan Pozsar, predict the emergence of a Bretton Woods III backed by commodity prices.
Pozsar notes that a combination of loose monetary policy in the United States, surging commodity prices, and anxiety over the weaponization of the dollar are prompting countries to rethink their relationship with American currency. While the United States is sending Russian commodities into the ground with sanctions, China's central bank stands to benefit by purchasing Moscow's exports for a discounted rate. After the Russia-Ukraine war concludes, Pozsar predicts that the US dollar will emerge weaker and the RMB stronger and backed by commodities. As a result, reserve portfolios and currency-denominated transactions in Bretton Woods III are likely to be more diversified and dynamic than the status quo. This restructuring provides another opening for the yuan to gain prominence in international currency holding and usage.
Whether China's currency will shave off a sizable portion of the dollar's global usage is yet to be seen. Still, there is no doubt that the world is entering a new monetary rebalancing. But if China intends to establish currency dominance, it must develop trustworthy institutions, respectful diplomacy, and responsible stakeholdership in the international order. Whether Beijing possesses the capability to complete these objectives remains to be seen.
This article, The US-China Currency Rivalry: Choosing Sides, was originally published by the American Institute for Economic Research and appears here with permission. Please support their efforts.
More in Financial


text:
Joseph Reynaerts (Seraing, 24 juli 1955 - 5 november 2020), beter bekend onder zijn artiestennaam Reynaert, was een Belgische zanger.

Reynaert vertegenwoordigde België in 1988 op het drieëndertigste Eurovisiesongfestival, gehouden te Dublin, Ierland. Hij werd gedeeld achttiende in een veld met 21 deelnemers. Zijn lied, Laissez briller le soleil, kreeg vijf punten, allemaal van de Franse jury.

Bibliografie
Reynaert begon zijn zangcarrière als straatzanger op achttienjarige leeftijd. Vijf jaar later won hij in 1978, ex aequo met Renaud het Festival international de la chanson française van Spa met het nummer "Cerf-volant". Een tweede single, "Pas Assez" volgde in 1982. Zijn debuutalbum kwam uit in 1984. In 1988 werd hij door de Radio-Télévision belge de la Communauté française via de televisieshow Finale nationale - Eurovision op 27 februari 1988 in de RTBf-studio's te Brussel geselecteerd om België dat jaar te vertegenwoordigen op het Eurovisiesongfestival, twee maand later, op 30 april bracht hij Laissez briller le soleil in Dublin. Het nummer bracht hem ook weinig commercieel succes in België. Zijn zangcarrière doofde daarna langzaam uit en Reynaerts werd directeur van het cultureel centrum van Flémalle, en vervolgens in 2008 van dit van Soumagne.

Reynaerts overleed in de nacht van 4 op 5 november 2020 aan COVID-19.

Belgisch zanger
Deelnemer aan het Eurovisiesongfestival 1988
Belgisch deelnemer aan het Eurovisiesongfestival

redpajama_set_name: RedPajamaWikipedia


text:
<!DOCTYPE html>
<link rel="import" href="../../../../packages/polymer/polymer.html">
<polymer-element name="spinner-element">
  <template>

  </template>

</polymer-element>

redpajama_set_name: RedPajamaGithub


Our handmade and hand-sewn organic lavender and flaxseed eye pillows are perfect for post-yoga/meditation, afternoon naps, and deep relaxation. The soothing lavender scent promotes inner peace and wellbeing.
Place the pillow on top of your eyes to block light and provide gentle acupressure for peaceful, undisturbed rest.
The exterior pillow cover can be removed and washed (gentle cycle in cold water using mild detergent or simply hand-wash).
Each eye pillow is unique, just like you. There will be slight variations to what is pictured because every pillow is handmade and one-of-a-kind.


text:
> More News > Modulr expands into Edinburgh fintech scene to fuel business growth
Modulr expands into Edinburgh fintech scene to fuel business growth
20 Sep 18 | Author David Beach | More News | Business Payments
High-growth UK payments fintech, Modulr, has opened a new office in Edinburgh to take advantage of the city's burgeoning fintech scene and grow its software engineering, customer support, risk and compliance, and finance teams.
Modulr recently completed its latest funding round, led by the UK's leading digital venture builder, Blenheim Chalcot which brought the total investment in the company to £10.5m since its formation in January 2016. The investment in Edinburgh is enabling key additional capacity and capability to support Modulr's significant growth.
Modulr accounts provide an alternative to bank accounts for business payments, making them faster, easier and more reliable than legacy technology solutions.1 The Edinburgh team will be working to extend the current offering to existing and new customers in alternative lending, payments fintech, payroll services, finance software providers and marketplaces, as well as into new markets. Modulr's digital payments account, which automates and manages payments in real time, 24/7, will also be enhanced with new features that will open-up additional integrated ways for customers to get paid, reconcile and make payments instantly; with more functionality to be announced on this over the coming months.
Having undertaken a review of the various technology hubs across Europe, Modulr chose Edinburgh for its excellent talent pool, support from industry and government bodies such as FinTech Scotland and Scottish Enterprise, and for being the UK's 2nd largest financial services centre. Scotland has seen the number of people employed in the financial and related professional services industry grow by 6.6% from 151,000 to 161,000 in the last year.2 A recent review of global fintech hubs by Deloitte highlighted the city for its thriving fintech ecosystem.
Modulr identified that to meet its growth and product development targets, it would need to at least double its technology team in 2018 and further in future years. Edinburgh is the ideal home: its developer population grew by 8% in the second half of 2017, reaching nearly 20,000. Modulr will look to recruit directly from this talent pool, as well as from the city's three renowned academic institutions: The University of Edinburgh (including the world-leading School of Informatics), Edinburgh Napier University and Heriot-Watt University. The University of Edinburgh was one of 14 UK universities to be named a Centre of Excellence for Cyber Security Research in June 2017, which complements Edinburgh Napier University's Cyber Academy.
Myles Stephenson, CEO of Modulr, commented: "As a technology business, building high quality and scalable software engineering, risk and compliance, customer support and finance teams is critical to our current and future growth. Following our strong initial success, we identified the need to scale and we set about looking for a location with a strong talent pool and pipeline."
ob Devey – Chair, Modulr & Advisory Partner, Blenheim Chalcot, commented: "Modulr solves a real pain point – replacing outdated, slow and unreliable manual payment processes with an efficient and manageable payments platform. This is an important step on their growth journey and evidence of the growing demand for their solutions. Blenheim Chalcot is delighted to be supporting Modulr as the team expands to Edinburgh."
Stephen Ingledew, CEO of FinTech Scotland, commented: "Edinburgh is a burgeoning hub for talented software developers. Combine this with the city's unmatched financial services heritage, and we have a recipe for success for ambitious fintech leaders like Modulr."
In its first two years, Modulr has processed £4.2bn in business payments, while transaction volumes have been growing by an average of 11% month-on-month. With the opportunities presented by its new office in Edinburgh, Modulr expects to double the size of its team over the last six months of the year; reaching over 100 employees across both its Edinburgh and London offices.


This is a brand page for the WESTEX trademark by SCS Transportation, Inc. in OVERLAND PARK, , 66211.
Write a review about a product or service associated with this WESTEX trademark. Or, contact the owner SCS Transportation, Inc. of the WESTEX trademark by filing a request to communicate with the Legal Correspondent for licensing, use, and/or questions related to the WESTEX trademark.
On Friday, August 18, 1995, a U.S. federal trademark registration was filed for WESTEX. The USPTO has given the WESTEX trademark serial number of 74717568. The current federal status of this trademark filing is CONTINUED USE NOT FILED WITHIN GRACE PERIOD, UN-REVIVABLE. The correspondent listed for WESTEX is MALCOLM A. LITMAN of SHUGHART THOMSON & KILROY, 120 WEST 12TH STREET, KANSAS CITY, MO 64105 . The WESTEX trademark is filed in the category of Transportation & Storage Services . The description provided to the USPTO for WESTEX is common carrier freight transfer services by land motor vehicle.
Last Applicant/Owner: SCS Transportation, Inc.
2002-02-26 REGISTERED - SEC. 8 (6-YR) ACCEPTED & SEC. 15 ACK.
Trademarkia-Network law firms can help you incorporate a business around your WESTEX trademark in less than 5 minutes. Trademarkia makes the process easy and convenient, so start now!
MALCOLM A. LITMAN is a correspondent of WESTEX trademark.
WESTEX is providing common carrier freight transfer services by land motor vehicle.


text:
Campus Technology
Networking/Wireless
How CSU Global Designs for Inclusive Online Education from the Start
Gonzaga, Springboard Launch Cybersecurity, Software Engineering 'Bootcamp' Programs, Focusing on Career Prep
Who Do We Trust to Develop and Manage AI?
By Dian Schaffhauser
An intriguing survey on American attitudes to artificial intelligence found that more people in this country support development of AI (41 percent) than oppose it (22 percent). But there's no consensus on who should handle its governance: Americans place the greatest amount of trust in university researchers to build AI (50 percent), followed by the U.S. military (49 percent).
The research was led by Baobao Zhang and Allan Dafoe, both with the Center for the Governance of AI in the Future of Humanity Institute, which is part of the University of Oxford. The survey project interviewed 2,387 respondents who were then matched to a sample of 2,000, framed by gender, age, race, education and other factors, such as religion and political affiliation, to reflect the make-up of the country.
According to "Artificial Intelligence: American Attitudes and Trends," university researchers and the U.S. military are the most trusted groups to develop AI. About half of Americans expressed a "great deal" or even a "fair amount" of confidence in them. Americans showed slightly less confidence in tech companies, nonprofit organizations or American intelligence organizations. Nevertheless, opinions toward individual entities within each of these groups varied. For example, while 44 percent of Americans indicated they feel a "great deal" or even a "fair amount" of confidence in AI development the most well-known tech companies, they rated Facebook as the least trustworthy of all. More than four in 10 indicated they have no confidence in the company.
Also, support for developing AI varied greatly among demographic subgroups. It was highest among those who are younger, male, white, more educated, employed, with greater income, Democratic and educated or experienced on technology.
In spite of those distinctions, the "overwhelming majority" of Americans — more than eight in 10 — agreed that AI and/or robots should be carefully managed, while only 6 percent disagreed. But who should manage it? Once again, university researchers and the U.S. military came out on top. Fifty percent and 49 percent, respectively, of respondents expressed a "great deal" or "fair amount" of confidence in these institutional researchers and the defense branch of the government to handle the job, compared to just 30 percent showing comparable confidence in the U.S. civilian government. Among international entities, intergovernmental research organizations such as CERN beat out NATO: 41 percent to 29 percent. Among tech companies (proposed by 44 percent of survey participants, Microsoft scored 44 percent, beating every other contender, including Amazon (41 percent), Google (39 percent) and Apple (36 percent). One notable company came out on the bottom; again, just 18 percent of respondents said they were greatly or fairly confident that Facebook could manage AI.
These findings echoed surveys undertaken by other organizations. For example, the researchers noted, an "overwhelming majority" of Americans told Pew Research Center surveyors they had "a great deal" or "a fair amount" of confidence in the U.S. military and scientists to act in the best interest of the public. For elected officials, not so much; 73 percent of respondents indicated that they had "not too much" or "no confidence" in them.
The research project also tried to understand which AI governance challenges Americans think will most likely affect "large numbers of people" over the next decade and therefore are the ones that tech companies and government will need to tackle. The issues receiving the most attention were surveillance, digital manipulation, data privacy and cyber attacks. Data privacy also was at the top of the stack as being the most important area of risk.
In an interesting side note, the researchers discovered that Americans believed that all of the governance challenges other than data privacy and ensuring the safety of autonomous vehicles were more likely to impact people around the world than to affect people in the United States.
The recent survey also found that respondents underestimated the prevalence of AI, machine learning and robotics in their everyday technological applications. Among those uses assigned the term "AI," a majority thought that virtual assistants (63 percent), smart speakers (55 percent), driverless cars (56 percent), social robots (64 percent) and autonomous drones use AI (54 percent). And a majority of respondents also assumed that Facebook photo tagging, Google Search, Netflix or Amazon recommendations or Google Translate don't use AI.
The results of the survey are openly available on the Center for the Governance of AI website in a PDF format and as an HTML edition.
Dian Schaffhauser is a former senior contributing editor for 1105 Media's education publications THE Journal, Campus Technology and Spaces4Learning.
Oregon State University Pioneers a Move to the Cloud
View More Webcasts
Cyber Liability Insurance: What You Need to Know
View More Whitepapers
Upcoming Events, Webinars & Calls for Papers (Week of Jan. 23, 2023)
VE/COIL Transformation Lab Moves to AAC&U
Why Banning ChatGPT in Class Is a Mistake
Campus Technology 2022 New Product Award Winners Announced
WCET Survey: 6 Things Students Want to Know Before Enrolling in Digital Courses
14 Technology Predictions for Higher Education in 2023
Report Finds Distinct Gender Gap in College and Career Readiness
Call for Speakers Now Open for Tech Tactics in Education: Data and IT Security in the New Now
Flipped/Blended Learning
CAMPUS TECHNOLOGY NEWS
Email Address* Country* United States of America Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Azerbaijan Austria Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde (Cabo Verde) Cayman Islands Curaçao Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Pakistan Oman Palau Palestinian Territory, Occupied Panama Paraguay Papua New Guinea Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Eswatini (Swaziland) Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Viet Nam Venezuela, Bolivarian Republic of Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Select primary job title/function* Policy/Top Execs & Mgmt Admin/Admin Mgt IT Director/Management Instructional Program Mgt/Dept Institutes/Research Programs/Assoc Campus Services/Vendor/Consultant Other Select place of work* 4-year College/University 2-year College Vocational/Technical College Government Organization Other Organization
© 1105 Media Inc, Ed-Tech Group.
CA: Do Not Sell My Personal Info


I always loved the poem not ever seeing how it applied to me. An avid reader from my early childhood, I dreamed of someday becoming an author myself. Perhaps you share that dream as so many readers do. I was ecstatic when my first book, co-authored with Ruth Toor, The Elementary School Librarian's Almanac: A Complete Media Program for Every Month of the School Year (The Center for Applied Research in Education, 1979, 256 p. 0-87628-299-0) was published. It was followed by fourteen other books for school librarians. The latest being School Librarian's Career Planner (ALA, 2013, 126 p. 978-0-8389-1178—5). I am proud of all of them, but this wasn't the writing career of my dreams.
In 2004, I retired as a high school librarian (obviously, that's all I retired from) and the following June when I would have been working, my daughter took me with her to International Women's Writing Guild's summer workshops then held at Skidmore College. Along with lots of other writing I did during those five days, I started a novel in one of the classes. I completed it in fits and starts thanks to the gentle (and not-so-gentle) prodding of others.
Do you have a dream you think will never be realized? Try sharing it with others and find a plan to make it a reality. With a few weeks to go before the end of the year, now is a great time to put things in motion.


text:
You are here: Home / BANKING / World Bank Treasurer shares her story on 70 years of World Bank bonds
World Bank Treasurer shares her story on 70 years of World Bank bonds
July 19, 2018 By Tochukwu Leave a Comment
The World Bank Treasurers Perspectives Series is one of the World Bank Treasury's initiatives to commemorate the 70th Anniversary of the first bond transaction which was issued on 5th July, 1947.
World Bank Treasurer Arunma Oteh was a young girl growing up in northern Nigeria
The World Bank Treasurers Perspective Series is one of World Bank Treasury's initiatives to commemorate the 70th anniversary of the first bond transaction which was issued on 15th July 1947. We spoke with Arunma Oteh, Treasurer of the World Bank, to close off these series which started with Gene Rotberg Treasurer from 1968 to 1987.
We also interviewed all other subsequent Treasurers, namely Don Roth (1987-1992), Jessica Einhorn (1992-1995), Gary Perlin (1996-1999), Afsaneh Beschloss (1999-2001), Graeme Wheeler (2001-2006), Ken Lay (2006-2010) and Madelyn Antoncic (2011-2015).
All of the former Treasurers opened their homes to us, reflected on the importance of connecting capital markets to development and shared their own journey at the World Bank. For Oteh, the journey has been most meaningful.
World Bank Treasurer Arunma Oteh was a young girl growing up in northern Nigeria when she learned what impact capital markets can have on someone's life and on society in general. Her own education was partly funded by her parents' thoughtful investments in the Nigerian stock market. It is precisely these investments that supported their most important project – the education of their three daughters. Little did Arunma know then that her whole life will subsequently be devoted to connecting capital markets to development.
"Investing in the capital markets was the reason I got the education and the opportunities I have fortunately had. Therefore, my belief in the transformative power of the capital markets has only grown from strength to strength. People who know me know that I have profound optimism that world-class capital markets can transform societies and change lives," said Oteh.
It was hailed by many when the 'Iron Lady', as Oteh was called for her tough and courageous stance during her five-year term as the Director General of the Securities and Exchange Commission of Nigeria, decided to return to the role of Treasurer of a multilateral development bank as she was the Treasurer of the African Development Bank from 2001 to 2006.
"Going forward, we must continue to innovate. To ensure that we adequately leverage the capital markets for development, we must continue to listen carefully so that we can equally ensure that we understand what investor needs are, especially as more and more investors are seeking to connect financial returns and purpose."
"Being appointed the World Bank Treasurer for me was really special as being the Treasurer of any of the development banks gives you an opportunity to connect capital markets to development. This was something that always met my core desire to work on initiatives that have an impact on society in a very profound way," said Oteh.
From the inaugural World Bank (IBRD) bond issued 70 years ago, to the first formal currency swap in 1981, to last year's launch of the pandemic bond, pioneering innovation is a unique legacy that the World Bank Treasury continues to build on everyday.
Using innovation to tackle the most difficult development challenges as well as leveraging the capital markets for development have been Oteh's guiding principles since she became Treasurer on 30th September 2015. Oteh and her team have consequently enjoyed record successes in the last three years including administering over US$ 7 trillion as the bank to the World Bank and managing US$ 200 billion for the World Bank Group, Pension assets, official institutions and RAMP (Reserves Advisory & Management Program) clients. They manage a debt portfolio of about US$ 200 billion and have established the World Bank as a leader in the capital markets.
Under her leadership, the International Development Association (IDA) made a historic capital markets debut when the first bond in IDA's nearly 60-year history was issued on 17th April this year. IDA raised US$ 1.5 billion through a transaction that was hugely oversubscribed. This was transformative for development as IDA had historically relied primarily on contributions from donor governments.
Also, on 28th June 2017, the World Bank launched a pandemic bond, a unique catastrophe (CAT) bond to provide insurance against a pandemic outbreak in a developing country. It was the first time that pandemic risk in low-income countries was being transferred to the financial markets. The pricing call of this bond was an emotional event for Oteh.
"When Ebola struck Guinea, Liberia and Sierra Leone, I was still living in Nigeria. It was fortunate that Nigeria handled the outbreak with utmost diligence and that it didn't become a pandemic. If it had become a pandemic in Nigeria, it would probably have become a pandemic in the rest of the world," Oteh said. "I am grateful that Jim, our President and Task Team Leader, together with the Board, decided that it was important to work on a standby facility enabling us to move quickly in the event of another outbreak. It is tragic that so many people died in the three countries most affected and that important development gains were undone while the world was trying to mobilize resources."
The World Bank Treasury has also used CAT bonds to help various developing countries secure protection against natural disasters such as floods, hurricanes and earthquakes. In FY18 alone, they helped client countries transfer almost USD 2 billion of disaster risk to the financial markets. These included the USD 1.36 billion CAT bond transaction for the Pacific Alliance countries (Chile, Colombia, Mexico and Peru).
Oteh strongly believes that capital markets, when used innovatively and effectively, can be a powerful force for good. She and her team are already contemplating possibilities for a 'famine bond' and exploring ideas to generate the resources the world needs to continue to address the Sustainable Development Goals.
Indeed, in January, the World Bank Treasury issued a CAD 1 billion bond transaction that highlighted the importance of the empowerment of women. In February, they worked with an insurance company that invested USD 350 million bond transaction that highlighted four out of the 17 Sustainable Development Goals. The World Bank Treasury continues to innovate and expand the opportunities to promote the sustainable development goals, leveraging their pioneering experience with green bonds to develop other thematic bond markets and grow the sustainable development bond market.
Also important is that Oteh always remembers to look back at the Bank's history and the work of her predecessors for inspiration. "It has been great to reflect on the last 70 years on how the World Bank Treasury has leveraged the capital markets as we continue to work hard on the Bank's mission of ending extreme poverty and boosting shared prosperity," Oteh said.
Oteh also indicated that the World Bank Treasury must remain committed to the needs of clients, whether it is for our 65 RAMP clients, whether it is in respect of developing financial solutions for the most difficult development issues including the refugee crisis and building the resilience of client countries against global shocks and natural disasters.
"We must also make sure that we are promoting the Sustainable Development Goals and most importantly that we create an enabling environment for the private sector to come onboard in ensuring that we can all do well and do good."
Only Committed States Qualify for $400m World Bank YESSO Programme'
World Bank, CBN seek new law for model mortgage regime
Ondo State Partners with World Bank on Livestock Project
World Bank to introduce livestock project in Bauchi
World Bank, NNPC, finance ministry probe petrol consumption figure
FBNQuest has emerged a winner in the Best Sukuk House category
Ecobank to raise a 5-year dollar denominated bond


Feed My Starving Children – Trinity Lutheran Church of Freistadt!
In 2012, 2014 and 2017, Trinity hosted/organized successful Feed My Starving Children MobilePack events, packing more than 600,000 meals for children hungry in body and spirit overseas. Check out this video that explains this vital ministry.
The Reformation500 MobilePack has been accomplished. While we fell short of our goal of 500,000 meals, we praise God that we have been able to provide Feed My Starving Children with over 385,000 meals to send overseas to countries where the need is the greatest.
Thanks to everyone who supported this effort financially, as well as with your time and effort in participating in the event itself.
Watch for announcements about our next FMSC MobilePack.


#Could I injure my baby?# #Am I exercising too soon after pregnancy?# #What exercises should I do, and how do I know if I#m doing them correctly?" When implemented correctly, prenatal (during pregnancy) and postnatal (after pregnancy) exercises benefit everyone involved with the pregnancy.
Both have physiological benefits, including improved blood circulation (which increases the amount of oxygen and nutrients going to the baby and mother), increased aerobic capacity (which sustains the body during the demands of labor and delivery), increased energy and more restful sleep.
Muscular benefits include an improvement in muscular strength and endurance which aids in delivery and a quicker recovery. With increased muscle tone, the joints and pelvic organs are better supported and balance is improved. Also, strengthening of the abdominal muscles and back improves posture and can prevent back pain and postural deviations. Stretching exercises improve range of motion and flexibility (important during delivery) and helps your body return to its normal size.
Mental and emotional benefits also accompany prenatal and postnatal exercise. These include reduced fatigue, anxiety and tension and the promotion of well-being and self-image. Try participating in group classes for social support and to network and build friendships with other pregnant women.
During pregnancy, the goal of exercise should not be to make large fitness gains or to lose weight, but rather to maintain the highest fitness level consistent with a woman#s physical condition during pregnancy. Safety is most important for the mother and baby. Following a fitness program regularly can help the mother#s body adjust to the stages of pregnancy and post-pregnancy while lessening the discomforts associated with pregnancy. When exercising, a pregnant woman needs constant supervision to ensure correct form and to handle any problems that may occur.
Always consult your doctor before beginning an exercise program.
Exercise at a mild to moderate intensity and avoid exercise to the point of exhaustion.
Exercise at least three days a week unless directed otherwise by your doctor.
Exercise is safer and most beneficial when performed regularly.
Avoid any exercise that involves lying on your back or a sloping terrain after the first trimester because it can decrease blood flow to the uterus.
Avoid exercise in hot, humid environments, and stay well hydrated. Drink water during your workout and wear cool clothing.
Avoid exercise that can cause you to lose your balance, especially in the third trimester.
After you give birth, resume your pre-pregnancy routine gradually.
You need an additional 300 calories a day when exercising during pregnancy. Eat frequent, small, nutritious snacks.
Contact your doctor immediately or go to the nearest emergency room if you experience any of these symptoms.
For more information, call the Wellness Studio, a part of the Gwinnett Health System, at 678-584-7404.


Make a gift to family or friends that represents your values.
A memorial or honorary gift is a great way to show your appreciation.
Join our Legacy Society and make a planned gift that will support FINCA clients for generations to come.
Donating stocks is a tax-advantageous way of supporting entrepreneurs.
We value the energy and commitment of our volunteers. Find out how you can help us in the fight against poverty.
Work with us and feel good about your job every day. We're looking for skilled professionals in North America and overseas.


text:
Oja Kodar
Thriller > Film Noir
Drama > Tragedy
Visual Arts > Biography
Travel > Armchair Travel
Director: Orson Welles
Citizen Kane (1941)
directed by Orson Welles
featuring Orson Welles, Joseph Cotten, Everett Sloane, Dorothy Comingore, Ray Collins, Ruth Warrick, George Coulouris
F for Fake (1973)
featuring Orson Welles, Oja Kodar, Joseph Cotten, François Reichenbach, Paul Stewart
featuring Charlton Heston, Janet Leigh, Orson Welles, Joseph Calleia, Akim Tamiroff
featuring Rita Hayworth, Orson Welles, Everett Sloane, Ted de Corsia, Glenn Anders, Gus Schilling
The Magnificent Ambersons (1942)
featuring Joseph Cotten, Dolores Costello, Anne Baxter, Tim Holt, Agnes Moorehead
Mr. Arkadin (1955)
featuring Orson Welles, Jack Watling, Michael Redgrave, Patricia Medina, Akim Tamiroff, Mischa Auer, Robert Arden
featuring Orson Welles, Edward G. Robinson, Loretta Young, Philip Merivale, Byron Keith, Martha Wentworth
Macbeth (1948)
featuring Orson Welles, Jeanette Nolan, Dan O'Herlihy, Roddy McDowall, Edgar Barrier
featuring Orson Welles, John Gielgud, Jeanne Moreau, Norman Rodway, Keith Baxter
Othello (1952)
featuring Orson Welles, Michael MacLiammoir, Michael Laurence, Suzanne Cloutier, Robert Coote
Around the World with Orson Welles (1955)
featuring Juliette Greco, Jean Cocteau, Orson Welles
New from $103.00
The Immortal Story (1968)
featuring Orson Welles, Jeanne Moreau, Roger Coggio, Norman Eshley, Fernando Rey
featuring Anthony Perkins, Jeanne Moreau, Romy Schneider, Elsa Martinelli, Suzanne Flon, Akim Tamiroff
Too Much Johnson (1938)
featuring Joseph Cotten, Judy Holliday
The Dominici Affair (1999)
featuring Orson Welles
Don Quixote de Orson Welles (1992)
featuring Francisco Reiguera, Akim Tamiroff, Orson Welles, Patty McCormack
The Other Side of the Wind (2018)
featuring John Huston, Peter Bogdanovich, Robert Random, Susan Strasberg, Oja Kodar
Ted de Corsia
Suzanne Flon
Suzanne Cloutier


Do not have your pockets empty the next time you rent a vehicle. Here are five tips to save when renting a car that you can easily apply.
Eh, yes! There are all kinds of hidden fees related to rental.
The most expensive? When the rental company has to fill the gas tank. It charges much more per liter than if you did it yourself.
It adds a bunch of other fees like taxes, vehicle registration and other fees with sometimes-extravagant names. It is best to read the fine print on the company's reservation page.
It is convenient. Yes. It is expensive. Oh yeah! Rental companies generally charge you the privilege of renting so close to the baggage claim area.
If you can, rent a car from your hotel. Some hotels even offer shuttles from the airport that allow you to save on taxi charges.
It is very possible that you do not need the extra insurance of the rental company, even if it gives you the impression that it is essential.
The best advice? Check your existing auto and home insurance. You should also call your credit card provider. Very often, using the card to pay for your rental automatically provides protection in the event of a collision.
However, if you rent out of your country of residence, you may not be covered. Be sure to notify your supplier.
If you are traveling in North America, here is an expert advice: if your destination is a small establishment or a secondary airport, it is quite possible that the rental company does not have many compact cars on-site. Some days she could have none! This means that if you have booked one, the company is obliged to offer you a free upgrade.
Sometimes, you will move up to a category twice as high, at no extra cost. This is a risky tactic if you do not like small cars because the vehicle you are asked to be is likely to be there.
Of course, you can always move onto a higher category for a light supplement if it is worth it (and the cost).
This is not to be understood, but booking a car for a week (even if parked in an aisle or parking) is generally cheaper than a daily rate on a short-term rental. Without laughing.
When you book online, try different combinations by selecting the dates of packing and returning. Unbelievably, it may be wiser to take the car on Thursday, even if you only need it on Friday.
Rental on Friday could be accompanied by a higher weekend rate. Better to avoid it if you can.
You can also apply these tips if you intend to rent other types of vehicle or boat.


NaughtyL0VE Jennyfferrr livejasmin. mistressscat. SirenEyesX. sabrinaWetNWildx.
PauloXXcandyblackxEmilyMickelsona0HulkHurley .QUEENBATHROOM1THEqueenOFtop69NuyDollsabrinaWetNWildx .MonaDeluxeDirtyFckholesXLovelyEllaaQUEENBATHROOM1 .SophiaParisErotiqueAngelSusanConnorEmilyMickelson .Submissive0069TemptationEvaAllissaxxxUrBedroomEyes .NuyDollKendallAngelEmilyMickelsonSubmissive0069 .XnormHOTSEXpieCuteSelenaForULovelyEllaaAbrilRocks .ErotiqueAngelLindaMollyFELIEheli2812 .GabrieleDNuyDollJoeHotBoyXXXSuperbSerg .EmilyMickelsonKendallAngelurMistresLov2CumxJaninex .mistressscatLinda6X9SebbirourMistresLov2Cum .
LovelyEllaaFELIEChocoladeVickisweetyEmmaKiss .SightlyErikaSaraLooveSexxxyOliviaRini .RickZolyNastyWildSluTEmmaaTattooKissPrincess .MissAnaGSweetyGraceSophiaParisxJaninex .JoeHotBoyXXXMattPukgorgeousOLIVIAArizonaDream .AndrewcalIreneMarksAbrilRocksSofhiaTs .AnalQKissPrincessmhaffybellaSSofia4x .AbrilRocksSusanConnorLinda6X9ArizonaDream .a0MagneticEyesKatrin2AliceQUEENBATHROOM1sabrinaWetNWildx .DirtyFckholesXSightlyErikaBenAndManuGabrieleD .EmmaaTattooBenAndManuSexxxyMollyXSexxxyMollyX .


text:
Sideways: Wall Street's Washington takeover
The coming move towards a Volcker Rule 2.0 that relaxes monitoring of proprietary risk taking by bank dealing desks has been portrayed as a result of president Donald Trump's administration finally placing its preferred officials in key regulatory positions.
Craig Phillips was hired by Mnuchin as a counsellor in January 2017
It can instead be viewed as a takeover of Washington roles by Wall Street.
Trump shows little interest in the details of key foreign policy issues such as relations with North Korea and Iran, so the idea that he would form a view on the intricacies of proprietary trading or derivatives regulation is laughable.
Treasury secretary, Steven Mnuchin, isn't much of a policy wonk either, and many former colleagues now wonder how he ever managed to make partner at Goldman Sachs. Mnuchin knows where he stands on broad issues of regulation, however, and that is firmly in line with the interests of Goldman and other Wall Street firms.
The appointment of one of his key advisers indicates the extent to which Wall Street will tailor its views to co-opt Washington decision makers and secure its regulatory goals.
Craig Phillips was hired by Mnuchin as a counsellor in January 2017; an appointment that neatly avoided the need for congressional confirmation and seems to have been conducted with enough discretion to avoid provoking the ire of Trump.
OPINION OpinionBankingMacaskill on MarketsUnited StatesGoldman SachsNorth AmericaRegulationJune 2018


text:
Browsing the "Oakcliff Triple Crown" Tag
VIDEO: Stage 3 Oakcliff Triple Crown
Stage 3, the third and final stage of the Oakcliff Triple Crown Series, wrapped up with big breeze in five
Tokyo 2020: Nation before self
When the Mixed Multihull event was introduced for the Rio 2016 Olympics, it was a new class with a new
Ramping up Olympic sailing support
The third and final stage of the 2019 Oakcliff Triple Crown Series wrapped up with big breeze in five Olympic
Rewarding hard work and good sailing
The Oakcliff Triple Crown Series has been running for three years and has solidified its spot on the Olympic training
Better than a pickle dish
While we've yet to meet an aspiring Olympian that doesn't need money, making them earn it isn't usually how it
Competing for grants toward Tokyo 2020
The third and final stage of the 2018 Oakcliff Triple Crown Series attracted 32 teams competing in in five Olympics
Vital prize grants at Oakcliff Triple Crown
The second stage of the 2018 Oakcliff Triple Crown Series attracted 40 teams competing in in five Olympics classes –
Racing for bank at Oakcliff Triple Crown
Stage 1 of the Oakcliff Triple Crown Series brought together 44 of the top North American sailors in the 49er,
470 US National Championship 2018
Thirteen teams competed in the 470 US National Championship held July 14-15 in Oyster Bay, NY. Only five of the
Oakcliff Triple Crown Series Returns
Following the inaugural edition in 2017, the Oakcliff Triple Crown Series continues in 2018 to reward athletes for their hard


text:
<?php

namespace Dom\Node;

use Dom\Error;

/**
 * @package Dom\Node
 * @object  Dom\Node\ClassCollection
 * @author  Kerem Gunes <k-gun@mail.com>
 */
class ClassCollection extends \Dom\Collection
{
    /**
     * Check for item type.
     *
     * @param  string $item
     * @throws Dom\Error\Instance
     * @return parent
     */
    public function append($item) {
        // Overwrite for "DI" option
        if (gettype($item) != 'string') {
            throw new Error\Instance('Item type must be string!');
        }

        return parent::append($item);
    }
}