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Patent ductus arteriosus in preterm infants; experience of a tertiary referral neonatal intensive care unit: prevalence, complications, and management
Egyptian Pediatric Association Gazette volume 68, Article number: 34 (2020)
Patent ductus arteriosus poses diagnostic and therapeutic dilemma for clinicians, diagnosis of persistent PDA, and determination of its clinical and hemodynamic significance are challenging. The aim of this study is to determine the prevalence of PDA in preterm infants admitted to our NICU, to report cardiac and respiratory complications of PDA, and to study the management strategies and their subsequent outcomes.
Echocardiography was done for 152 preterm babies admitted to neonatal intensive care unit (NICU) on day 3 of life. Eighty-seven (57.2%) preterms had PDA; 54 (62.1%) non-hemodynamically significant PDA (non-hsPDA), and 33 (37.9%) hemodynamically significant PDA. Hemodynamically significant PDA received medical treatment (paracetamol 15 mg/kg/6 h IV for 3 days). Follow-up echocadiography was done on day 7 of life. Four babies died before echo was done on day 7. Twenty babies (68.9%) achieved closure after 1st paracetamol course. Nine babies received 2nd course paracetamol. Follow-up echo done on day 11 of life showed 4 (13.7%) babies achieved successful medical closure after 2nd paracetamol course; 5 babies failed closure and were assigned for surgical ligation. The group of non-hsPDA showed spontaneous closure after conservative treatment. Pulmonary hemorrhage was significantly higher in hsPDA group. Mortality was higher in hsPDA group than non-hsPDA group.
Echocardiographic evaluation should be done for all preterms suspected clinically of having PDA. We should not expose vulnerable population of preterm infants to medication with known side effects unnecessarily; we should limit medical closure of PDA to hsPDA. Paracetamol offers several important therapeutic advantages options being well tolerated and having more favorable side effects profile.
Patent ductus arteriosus (PDA) is a vital structure in fetal life where the systemic and pulmonary circulations function in parallel and thus, cardiovascular function is dependent on the presence of shunts. However, after birth and transition to postnatal circulation, where the systemic and pulmonary circulations are in series, the presence of shunts between the two circulations is non-physiological and, if sustained and significant, may lead to hemodynamic compromise. Indeed, the ductus arteriosus closes in the vast majority of term infants within the first 48 h after delivery. However, in about 50–70% of the extremely low birth weight infants, the ductus arteriosus remains patent . In the extreme premature population born at 24 weeks of gestation, only 13% of infants are found to have their ductus closed by the end of the first week .
Hemodynamic and respiratory consequences of PDA is related to the magnitude of left right shunt volume through PDA which leads to pulmonary congestion and respiratory function deterioration. This duct steal phenomenon causes a reduction in cardiac output which may lead to vital organs perfusion impairment, such as brain, kidney, and bowel .
This makes PDA an important issue from the clinical management perspective in the first few days of life in preterm infants . Management of PDA is one of the most controversial topics in neonatal medicine. Hemodynamically significant PDA (hsPDA) in preterms may be associated with prolonged need for assisted ventilation, pulmonary hemorrhage, bronchopulmonary dysplasia (BDP), necrotizing enterocolitis (NEC), impaired renal functions, intraventricular hemorrhage (IVH), periventricular leukomalacia (PLV), and cerebral palsy .
The big dilemma about PDA management that still persists among neonatologists is who, when and what to treat with. Prophylactic therapy has gradually fallen out of favor and neonatal units have shifted towards a more conservative approach by treating only the clinically and echocardiographically significant PDA .
Prophylactic treatment involves the administration of indomethacin to all high-risk infants within the first 6 h. Prophylactic indomethacin showed significant reductions in intraventricular hemorrhage, later symptomatic PDA and reduced PDA ligation rates but had little effect on other morbidities particularly respiratory outcomes .
Pre-symptomatic treatment involves using a variety of diagnostic methods, clinical and echocardiography, to detect ducts in the pre-symptomatic period and then treating medically at this time. The timing of the intervention is usually between 24 h and day 5 of life. There is significant reduction in later symptomatic PDA and reduction in duration of supplemental oxygen . However, another opinion proposes that preterm PDAs should only be treated if there are clear signs of cardiac failure or compromise that can only be explained by the presence of a significant PDA . Cyclooxygenase inhibitors, indomethacin, and ibuprofen are the most studied pharmacologic agents for the treatment of PDA . Both drugs block prostaglandin synthesis, inducing ductal closure. Indomethacin will close the duct in most cases but at the expense of some side effects including: transient reduction of cerebral blood flow, oliguria, hyponatraemia, and gastro-intestinal complications. Most of these side effects are transient and self-limiting. Infusing the dose over 20 to 30 min may reduce but does not eliminate the effect on cerebral blood flow . Oral ibuprofen is an alternative for the treatment of PDA. Oral ibuprofen was more effective than IV ibuprofen (84.6%versus 62%) for ductal closure in VLBW infants. Oral, but not IV, ibuprofen was associated with rise in cystatin-C levels, a marker of impaired renal function, in preterm infants indicating that infants with borderline renal function may need careful monitoring .
The role of paracetamol (acetaminophen) as an alternative therapy for hsPDA closure has gained attention in recent years because of the potential adverse effects of COX inhibitors Moreover, paracetamol in oral form can be used successfully as the primary choice in PDA closure. Intravenous (IV) paracetamol could be an alternative treatment in patients in whom feeding was contraindicated or who had feeding intolerance. Paracetamol dose ranges from 10–15 mg/kg/dose every 6–8 h for 72 h . Paracetamol can be administered to infants with contraindications to cyclooxygenase inhibitors .
The aim of this study is to determine the prevalence of PDA in preterm infants admitted to our NICU; to report cardiac and respiratory complications of PDA and to study the management strategies and their subsequent outcomes.
This prospective interventional study was conducted in the Neonatal ICUs of Cairo University, over 6 months period from April 2018 to October 2018. Preterm neonate ≤ 34 weeks gestation with patent ductus arteriosus were enrolled in our study. Exclusion criteria included babies suffering from perinatal asphyxia, complex congenital heart disease, lethal congenital anomalies, and/or chromosomal abnormalities. All the cases were subjected to history taking and clinical examination.
Complete blood picture, CRP, electrolytes, liver functions, kidney functions, capillary blood gases, and lactate level in blood were done for all included babies.
Chest X-ray was done to assess cardiac size and check for the presence of pulmonary edema, prominent main pulmonary artery or left atrial enlargement.
Baseline echo was done to all preterm babies ≤ 34 weeks admitted to NICU during study period on day 3 of life; with special emphasis on: PDA size, pulmonary artery pressure, and left atrium aortic ratio. Follow-up echo was done on days 7 and 11 of life.
PDA was considered hemodynamically significant if three or more of the following were present.:
Clinical and radiological parameters
Wide pulse pressure > 25 mmHg, hypotension: blood pressure below 3rd centile for gestational age, serum lactate > 4 mg/dl, pulmonary edema, or cardiomegaly evident in chest radiograph.
Ductal size ≥ 3 mm, LA/AO ratio > 1.5.
Bedside trans thoracic echo was done while the neonate was placed in the supine position without sedation. Ductal diameters were measured using two-dimensional and color flow at the pulmonary end, the median section, and the aortic end of the ductus on high left parasternal view. The size of the ductus was measured in mm at its narrowest part on a color Doppler image.
M-mode measurements of the left atrium/aortic root were assessed from parasternal views. IVRT (ms) by inserting PWD (pulse wave Doppler) between mitral and aortic valves .
According to the results of echo done on day 3 of life; preterm babies ≤ 34 weeks gestation included in the study were divided into two groups: PDA group (87 babies) and non-PDA group (65 preterms). PDA group were further subdivided into hemodynamically significant (33 babies), hemodynamically non-significant PDA (54 babies).
All eligible preterms enrolled in the study were started in the delivery room on continuous positive airway pressure (CPAP) 6–8 cm H20 via a T piece device (Neopuff Infant T-piece Resuscitator, Fisher and Paykel Healthcare, Inc., Irvine, CA) using face mask if needed .
In NICU babies having non-hsPDA received conservative management in the form of respiratory support using bubble CPAP and pressure adjusted at 6–8 cm H2O and appropriately sized nasal masks. Fio2 levels were adjusted to maintain oxygen saturation levels within 90% to 95%. Surfactant was administered whenever the fraction of inspired oxygen (Fio2) was greater than 0.3 or 0.4 for babies with a GA less than or greater than 28 weeks respectively. Non-invasive positive pressure ventilation was applied in infants with apnea or as an intermediate step before mechanical ventilation. Intravenous fluid therapy in the first week of life was closely monitored and restricted if needed. Parenteral nutrition was started from day one of life.
Babies with hsPDA received paracetamol 15 mg/kg/dose every 6 h for 3 days in addition to the conservative management. Babies were followed up until PDA closure or discharge whatever comes first. If failed duct closure after second course paracetamol, our cardiology team was consulted and baby was referred for device closure by catheterization or surgical ligation.
The collected data was revised, coded, tabulated and introduced to a PC using Statistical package for Social Science (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.). Data were presented and suitable analysis was done according to the type of data obtained for each parameter. Data was summarized using mean, standard deviation, median, minimum, and maximum in quantitative data and using frequency (count) and relative frequency (percentage) for categorical data.
One hundred and fifty-two preterm infants were enrolled in the study; 87(57.2%) babies had PDA. There were no statistically significant differences between PDA and non-PDA groups regarding gender, gestational age, birth weight mode of delivery, resuscitative measures, and maternal risk factors, apart from APH which was more frequent among mothers of PDA group. PDA group showed statistically significant higher frequency of poor APGAR scores< 5 at 1 min when compared to non-PDA group (P = 0.04) (Table 1).
PDA group have increased sepsis and pulmonary hemorrhage (P = 0.oo9, 0.0016 respectively). NEC, apnea, IVH, and BPD did not differ significantly between the two groups (Table 2).
Thirty-three preterms (38%) had hsPDA, and 54 babies (62.1%) had non-hsPDA. There were no statistically significant differences between the two groups regarding gender, gestational age, birth weight, mode of delivery, resuscitative measures, and maternal risk factors; apart from pregnancy-induced hypertension (PIH) which was more frequent among mothers of non-hsPDA group (P = 0.03). Mother receiving antenatal steroid were significantly higher in non-HSPDA group when compared to hsPDA group (P = 0.03) (Table 3).
Figure 1 represents the pulmonary hypertension frequency in the studied population documented by echocardiography on third day of life.
Preterm babies having hsPDA had more RDS, pneumonia and pneumothorax evidenced by X-ray findings compared to non-hsPDA group (P = 0.007).
The need for CPAP support (38.9% vs 12.1%, P = 0.007), mechanical ventilation (87.9% vs 57.4%, P = 0.003), and duration of mechanical ventilation (4 vs 9 days, P = 0.001) were higher in hsPDA compared to non-hsPDA.
Pulmonary hemorrhage was associated with hsPDA when compared to non-hsPDA (P = 0.03). Sepsis, NEC, apnea, IVH and BPD did not differ between the two groups (Table 4).
Echocardiography was done on day 3 of life; 33 babies (38%) were considered to have hsPDA according to our criteria, they received 3 days course of IV paracetamol 15 mg/kg/6 h. Four of them started paracetamol course but died before second echo assessment on day 7. One died because respiratory failure, two of them died because of septic shock and the other died because of pulmonary hemorrhage. Twenty-nine babies (87.9%) did echo on day 7 of life to assess duct closure. Twenty (69%) babies achieved PDA closure after completing first course paracetamol. Nine babies (31%) received second course paracetamol, echo was done on day 11 of life, 4 babies (44.5%) achieved PDA closure after 2nd course paracetamol, and 5(55.5%) babies failed PDA closure after receiving two courses paracetamol. Our cardiology team was consulted and they were referred for duct closure by catheterization or surgical ligation (Table 5).
PDA’s prevalence is inversely proportional to the gestational age with the prevalence of 20% at 32 weeks gestational age and exceeding 90% at 26 weeks gestational age. Prematurity not only increases the likelihood of PDA but also decreases the likelihood of its closure .
Management of PDA range from a less aggressive approach of modest fluid restriction and “watchful waiting,” to pharmacologic and/or surgical intervention. Pharmacotherapy includes the cyclo oxygenase inhibitors; indomethacin or ibuprofen, these agents have side effects including renal failure, brain white matter injury, spontaneous intestinal perforation, necrotizing enterocolitis, and increased bleeding tendency secondary to reduced platelet function, all in the face of treatment failure rates as high as 40% in very premature infants .
Clinical trials did not provide clear evidence to support the practice of closing PDA to improve short-term and long-term outcomes of premature infants. Trials conducted to introduce pharmacological treatment of PDA demonstrated the efficacy of these medications in closing PDA, but did not impact major outcomes such as mortality, CLD, NEC, and neurodevelopmental outcome .
In spite of the findings that acetaminophen showed promising results in closing PDA, there have been concerns about its effect on brain development and function. Without long-term outcome studies, the use of acetaminophen is still investigational .
Similarly, surgical ligation has not been shown to improve mortality and the incidences of certain morbidities associated with the procedure including vocal cord paralysis, thoracotomy, chylothorax, pneumothorax, scoliosis, retinopathy of prematurity (ROP), and most importantly increased incidences of cognitive delay and neurosensory/neurodevelopmental impairment are not uncommon. These findings caused reluctance to expose premature infants to the possible risks associated with surgical ligation whereas the benefit of PDA closure is still considered theoretical. For these reasons, a recent clinical report from the American Academy of Pediatrics attested that early and routine PDA treatment does not improve long-term outcome and that the value of selective treatment remains uncertain .
Hemodynamically significant PDA (hsPDA) is observed in more than 30% of premature infants with gestational age of 32 weeks . Early identification of preterm infants who will subsequently fail to achieve ductal closure allows early initiation of intervention and reduces treatment failure. The diagnosis of hemodynamically significant ductal patency requires echocardiographic assessment. However, the definition of hemodynamically significant patent ductus arteriosus remains controversial .
Sehgal and Meneham  considered PDA as hemodynamically significant according to the following echocardiographic criteria: PDA diameter> 3 mm, LA:Ao > 1.5, LVO:SVC ≥ 4, PDA:LPA ≥ 1, EDLPAv > 30 cm/s, PDA Vmax < 1.5 m/s .
Yoo et al.  defined hsPDA if PDA had a transductal diameter ≥ 1.4 mm/kg with significant left to right shunt confirmed by echocardiography. Presence of clinical symptoms due to hsPDA was defined as at least one of the three following clinical symptoms: oliguria ≤ 1 mL/kg/h in the preceding 8 h before ibuprofen treatment, hypotension caused by PDA requiring inotropics more than 10 μg/kg/min or respiratory difficulty requiring invasive mechanical ventilation.
Schwarz et al.  defined hsPDA if there was a left-to-right shunt through PDA confirmed by echocardiography and at least 3 of the following 6 criteria were met: LA/Ao-ratio > 1.5, PDA diameter ≥ 1.5 mm/kg bodyweight, need of respiratory support (mechanical Ventilation or continuous positive airway pressure with supplemental oxygen), reverse, or zero end diastolic flow in ACA (= RI_ACA ≥ 1), LVPEP/LVET < 0.32.
The complications of hsPDA transcend heart failure to involving several organs leading to need for respiratory support, need for supplemental oxygen, prolonged mechanical ventilation, bronchopulmonary dysplasia, pulmonary hemorrhage, intraventricular hemorrhage, abnormal cerebral perfusion, necrotizing enterocolitis, and increased mortality .
Although none of the studies could prove a cause-and-effect relationship between PDA and these morbidities, it is biologically plausible that a significant shunt across PDA causes fluctuation in cerebral blood flow contributing to the pathogenesis of IVH, persistently increased volume in pulmonary vascular bed leading to CLD, and steal from splanchnic circulation producing NEC .
One hundred fifty-two preterm babies ≤ 34 weeks gestation admitted to NICU over 6 months period were included in the present study, 87 babies (57.2%) had PDA, 33 (37.9%) of them had hemodynamically significant PDA, while 54 (62.1%) babies had hemodynamically non-significant PDA and 65 babies (42.8%) did not have PDA.
Our results came in concordance with Danfang et al.  who studied 105 neonates ≤ 34 weeks gestational age and found 34 (43.5%) having hsPDA, 44 (56.5%) having non-hsPDA and 27 (25.7%) having no PDA.
Khositseth et al.  reported that prevalence of hsPDA among his preterm population babies was 29.3%, non-hsPDA was 20.7%, and 50% did not have PDA.
On the other hand, El-Saiedi et al.  found that prevalence of hemodynamically significant PDA among her study population was 52% which was higher than in our study (37.9%). This may be explained by that the gestational age of included preterms was 32 weeks versus 34 weeks in the current study.
When we compared demographic data of PDA vs non-PDA group and hsPDA vs non-hsPDA we did not find any significant difference between the two groups, apart from APH which was higher among mothers of PDA group and PIH which was higher among hsPDA group (P = 0.002,0.039 respectively).
Okur et al.  studied a total of 119 patients with gestational age ≤ 32 weeks and birth weight ≤ 1500 gms, his results contrasted with ours regarding birth weight which was lower in hsPDA but agreed with our results concerning length of NICU stay which did not differ significantly between the two groups.
The number of babies who needed CPAP or were mechanically ventilated and duration of mechanical ventilation were significantly higher in hsPDA when compared to non-hsPDA group (P = 0.007, 0.003, 0.001, respectively). This came in agreement with Okur et al  who found that the duration of mechanical ventilation was longer in the hsPDA group when compared to non-hsPDA group.
Our study revealed more babies suffered metabolic acidosis and had high lactate level in PDA and hsPDA groups (P = 0.001, < 0.001, respectively). This came in contrast with El-Saiedi et al.  study which did not find difference in serum lactate level between hsPDA and non-hsPDA.
According to the present study, hemodynamic parameters: tachycardia, hypotension, wide pulse pressure measured on day 3 of life, were found significantly higher in the PDA and hsPDA group vs non-PDA and non-hsPDA (P = 0.009, 0.005, 0.001, 0.038, 0.001, 0.001), respectively; these results coincided with those of Seghal and Menahem  who found that diastolic and mean blood pressure in his studied population were significantly lower whereas pulse pressure was significantly higher in hsPDA when compared to non-hsPDA and no PDA group (P = 0.005). On the other hand, Benitz et al.  did not find any difference in the heart rate between hsPDA and non-HSPDA.
Lee JA et al.  stated that the core issue in management of PDA is to select patients who will benefit from the pharmacological and surgical ligation using epidemiological, clinical, and echocardiographic data, to avoid the unnecessary adverse consequences of such modalities. Controversy still remains regarding the benefit of treating PDA in preterm infants and studies are providing contradictory results.
Sehgal and Menahem  recommended that in practice PDA size on echocardiogram, chronic lung disease, and prolonged ventilation should be taken into consideration regarding the management of PDA.
In the current study, 29 preterm infants had hemodynamically significant PDA and received first course of paracetamol 15 mg/kg/6 h for 3 days. Of them, 20 (68.9%) cases closed, 9 babies failed closure and received 2nd course paracetamol. Four of them (13.7%) closed, 5 babies (50%) failed closure after 2nd course paracetamol and were assigned for device closure by catheterization or surgical ligation.
Our treatment strategy coincided with Pharandi et al . Twenty babies whose gestational age ≥ 25 weeks suffering from PDA were included in his study; 10 babies (50%) closed after first course paracetamol; 10 babies failed closure and received second course paracetamol; of them, 4 closed and 6 failed closure after second course .
On the other hand, Bagheri et al.  treated 67 babies whose gestational age < 37 weeks with paracetamol for duct closure; 82% of his studied population closed after first course. Second course was given to those who failed closure; of them, 50% closed. We attributed difference between our results and this is regarding PDA closure rate after 1st course paracetamol to the higher gestational age of his studied population which was < 37 weeks gestation vs ≤ 34weeks of our population. Accordingly, some of his babies would have undergone spontaneous closure regardless of paracetamol administration .
Regarding comorbidities and complications reported in the current study, sepsis and pulmonary hemorrhage were significantly associated with PDA when compared to non-PDA group (P = 0.009, 0.016, 0.07), respectively. Pulmonary hemorrhage was significantly associated with HS PDA when compared to non-hsPDA (P = 0.031). This data came in agreement with Okur et al.  who reported no difference in early neonatal sepsis, IVH, BPD between hsPDA and non-hsPDA groups.
However, Lee et al.  found more infants suffering from early sepsis in the PDA group when compared with the non-PDA group. Visconti et al.  concluded that late sepsis was significantly coexisting with hsPDA. In his study, four infants had re-opening of ductus arteriosus and three other infants developed PDA in the course of late sepsis attacks which may be explained by the effects of cytokines released during sepsis.
We found that more babies died in PDA group when compared to non-PDA group and more babies suffering from hsPDA died compared to non-hsPDA; however, we do not attribute this to PDA nor can we prove a cause effect relationship.
This data comes in agreement with the studies of Okur et al. and Visconti et al. [26, 30] which revealed that hsPDA patients have higher mortality rate compared with non-hsPDA patient. On the other hand, Okur et al.  reported no significant difference between hsPDA group and non-hsPDA groups regarding mortality.
Management of patent ductus arteriosus in preterm infants is controversial topic. There are no generally accepted guidelines for diagnosis, management, or follow-up. Echocardiographic evaluation should be done for all preterm babies. The definition of hemodynamic significance varies because of the use of different echocardiographic criteria. The detailed risks and benefits of available treatment alternatives are still under investigation. An individualized therapeutic strategy with especial emphasis on identification of hemodynamically significance seems to be the way forward. There has been a general shift in the management of PDA in preterm neonates from the aggressive approach to a more conservative approach. Paracetamol offers several important therapeutic advantages over current treatment options being well tolerated and having more favorable side effect profile. Future prospective studies are needed to determine if conservative management of PDA without medical or surgical intervention is associated with increased mortality or chronic lung disease and which sector of preterm babies would benefit from PDA treatment. We should not expose vulnerable population of premature infants to medication with known side effects unnecessarily, we should limit medical closure of PDA to hsPDA.
Availability of data and materials
The corresponding author had full access to all of the data and takes full responsibility for the veracity of the data and statistical analysis.
Continuous positive airway pressure
Hemodynamic significant patent ductus arteriosus
Isovolumic relaxation time
Left atrium aortic ratio
Neonatal intensive care unit
Non-steroidal anti-inflammatory drugs
Patent ductus arteriosus
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I would also like to thank the whole members of the NICU Department, at
Abuelrish Pediatric Hospital for their true support and help.
The authors have no financial relationships relevant to this article to disclose.
Ethics approval and consent to participate
The trial was based on Master of Science thesis approved by Pediatric Department Committee for Post-Graduate Studies and Research, and by Post-Graduate Studies and Research administration, Faculty of Medicine, Cairo University, Egypt. The reference number is not applicable as this was applied 5 months ago while our research was done before that. Thesis was approved in 20 May 2018. Written consents were obtained from parents of study participants.
Investigations and all lines of treatments were clarified.
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Soliman, R.M., Mostafa, F.A., Abdelmassih, A. et al. Patent ductus arteriosus in preterm infants; experience of a tertiary referral neonatal intensive care unit: prevalence, complications, and management. Egypt Pediatric Association Gaz 68, 34 (2020). https://doi.org/10.1186/s43054-020-00046-8
- Patent Ductus Arteriosus

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Vampire therapy: young blood may reverse ageing
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The researchers believe young blood may contain natural chemicals that turn back the clock to rejuvenate the ageing brain.
In the study, blood from three-month-old mice was repeatedly injected into 18-month-old mice near the end of their natural life span. The "vampire therapy" improved the performance of the elderly mice in memory and learning tasks. Structural, molecular and functional changes were also seen in their brains.
Writing in the journal Nature Medicine, the US team led by Dr Tony Wyss-Coray, from Stanford University, said: "Our data indicate that exposure of aged mice to young blood late in life is capable of rejuvenating synaptic plasticity and improving cognitive function.
"Future studies are warranted in aged humans and potentially those suffering from age-related neurodegenerative disorders."
Evidence was seen of new connections forming in the hippocampus, a brain region vital to memory and sensitive to ageing.
Ageing mice given eight infusions of young blood over three weeks improved their performance in mental tests. Infusions of blood from other elderly mice had no effect.
What caused the changes is still unknown, but it appears to involve activation of a protein called Creb in the hippocampus that helps regulate certain genes.
The scientists wrote: "One possibility is that introducing 'pro-youthful' factors from aged blood can reverse age-related impairments in the brain, and a second possibility is that abrogating pro-ageing factors from aged blood can counteract such impairments.These two possibilities are not mutually exclusive, warrant further investigation, and may each provide a successful strategy to combat the effects of ageing."
Dr Eric Karran, from the dementia charity Alzheimer's Research UK, described the results as "interesting", but added that the study "does not investigate the type of cognitive impairment that is seen in Alzheimer's disease".
- 2 Qataris pledge to expand Canary Wharf
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domain: biology


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Poker is a card game played by two or more players. It is a game of chance, but also involves skill and psychology. A good poker player makes intelligent decisions based on probability and strategy.
There are many different poker games, but the basic rules are the same for all of them. Each player is dealt cards, and the highest hand wins. Poker is typically played with a standard deck of 52 cards (although some games use multiple decks or add jokers).
The first step in learning how to play poker is to understand the basic rules. The game starts with the ante, an amount of money that each player must put up before being dealt any hands. After the ante is placed, players can choose to fold, call, or raise their bets.
A raised bet is an indication that the player has a good hand and is willing to risk his or her entire stack. It is important to note that raising with a weak hand can backfire and lead to a bad beat.
When making a bet, a player should always consider the other players’ position at the table and their cards in order to make the best decision. A good poker player knows how to read his or her opponents and will often take advantage of their mistakes.
In addition, a good poker player will know how to bet in a way that increases his or her chances of winning the pot. A player should consider how much he or she owes to the pot, the size of the other players’ bets, and his or her own chip stack when betting.
While most people will tell you to only play the best of hands, this is not the right approach to the game. Even pros will sometimes play a hand with an inferior kicker, such as a pair of kings paired with a six. In most cases, you will be better off folding those types of hands unless you have a high pair or a good one-eyed jack.
Another great tip is to always try to guess what other players are holding when it’s your turn to act. This will allow you to make educated guesses about the strength of their cards and improve your overall odds of winning. For example, if everyone checks on a flop that’s A-2-6, you can assume that someone probably has a pair of fives. It’s not as hard as it seems at first glance, but it will significantly improve your poker skills.

domain: hobby


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Sleep imagery in macbeth is used to develop the theme of innocence, nature, conscience and guilt and reinforces the images of night, darkness, and evil sleep is a symbol of innocence and goodness, one of the main themes in the play. An essay on imagery in macbeth first draft: be sure to use the plan page provided for your essay you need to decide how you will organize your essay on imagery: 1 by specific image strands, such as animals, blood, clothing, or the. Read this english essay and over 88,000 other research documents imagery in macbeth imagery in macbeth in all of shakespeare's plays he uses many forms of imagery imagery, the art of making images.
Darkness imagery in macbeth this essay will prove that in the play macbeth, the author of the play william shakespeare uses darkness imagery for three dramatic purposes those three purposes are, to create atmosphere, to trigger the emotions of the audience and to contribute to the major theme of the play. Imagery of blood in macbeth macbeth is the story of a nobleman, who, while trying to fulfill a prophecy told to him by three witches, murders his king to cause his ascension to the throne of scotland after the king's murder, macbeth reigns as a cruel and ruthless tyrant, who is forced to kill. (click the symbolism infographic to download) after king duncan is murdered by macbeth, we learn from the old man and ross that some strange and unnatural things have been going on. Published: mon, 5 dec 2016 macbeth is a short play written by william shakespeare in the early 1600s it is set in medieval scotland and tells the story of macbeth, a nobleman who is loyal to the king, but is misdirected by the witches’ prophecies and by his and lady macbeth’s ambition.
Bird imagery in macbeth throughout shakespeare’s tragedy, macbeth, shakespeare uses metaphors and imagery to create a picture through words the images that are used are instrumental in creating the tone. Imagery and symbolism in macbeth essay revise all the themes of macbeth to improve your grade - duration: how to study for an essay exam // extended response study tips - duration:. The imagery of sleeping or lack off sleeping symbolizes guilt and conscience in macbeth these quotes are after macbeth and lady macbeth kill duncan the killing of king duncan leads to macbeth and lady macbeth feeling guilty and becoming restless. - essay- the use of imagery in macbeth, act 1 and 2 macbeth is a powerful play filled with finest shakespeare’s imagery techniques the play is based on a true story and is well portrayed through a variety of well-used imagery approaches.
Visual imagery is the most comfortable form of imagery for most writers describing that particular shade of pink found at the eraser tip of your pencil, or the blinding white you see when you look directly at the sun easily brings forth the images described. In all of shakespeare's plays he uses many forms of imagery imagery is the art of making images, the products of imagination in the play macbeth, shakespeare applies the many images, most of which are of clothing, blood and darkness. In william shakespeare's macbeth the ambition for power leads to the dark and mysterious realm of witchcraft, murders, insomonia, and madness and, the imagery used to inspire the experiences of.
From the use of blood imagery, readers can see the inevitable guilt of macbeth and lady macbeth by the end of the play, the roles of macbeth and lady macbeth have been switched macbeth seems to be much stronger than before, while lady macbeth has slowly shriveled away to nothing from all the guilt. Darkness imagery in william shakespeare's macbeth ambition and evil are the basic elements in william shakespeare’s macbeth macbeth is a tragedy which was written by shakespeare in the elizabethan era. Images and imagery in shakespeare's macbeth essay - imagery in macbeth in shakespeare's tragic play, macbeth, the use of imagery is connected with character development as well as theme throughout the play. Read this literature essay and over 88,000 other research documents imagery of blood in macbeth as the play opens, macbeth’s army has just defeated norwegian invaders in a gruesome battle as a badly shot sergeant.
Though imagery is widespread throughout macbeth, it is most dominant in clothing imagery, light and darkness imagery, and blood imagery through these images, shakespeare shows the development of macbeth's character. In macbeth shakespeare uses all sorts of imagery including avian and animal however the most predominant imagery in macbeth involves blood blood is used as a symbol to represent different attributes of the characters in the play.
How to write an appendix images essay there are a number of procedures and steps you have to follow when you want to write an appendix images essay take for example when writing macbeth blood imagery essay. Dark images and imagery in shakespeare's macbeth essay dark imagery in macbeth shakespeare uses a lot of imagery of night and darkness in macbeth this imagery is used to portray an image of a desolate, deranged place, full of tumult and disorder. In shakespeare's play macbeth, imagery is skillfully used to give readers a deeper look into the true character of macbeth, and in some instances, the character of lady macbeth though numerous images are used throughout the play, one of the most dominant is blood.


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- Odisha has the most lightning activity but West Bengal has the highest lightning density, explains the report.
Lightning kills more people than cyclones in India, says the Earth Networks India Lightning Report, 2019. And it could increase as much as 12% with every 1 degree increase in global warming. According to Science News, increased lightning in the Arctic is an outcome of climate change. Well, now we’re in the peak lightning season in India- from June to September-with peaks in these two months. I looked at the maps in the report: Clearly, states of the Eastern Coast, Jharkhand and Meghalaya are the most vulnerable. Odisha has the most lightning activity but West Bengal has the highest lightning density, explains the report.
Some aspects of lightning are noteworthy. For example, India Climate Dialogue reports lightning strikes farmers in the field as they toil. One reason is the warnings don’t reach the hyper-local level. Another fact is taking shelter under a tree is very unsafe. Using wired equipment can also enhance the risk during lightning. So if you must, use only battery operated devices, says the Government of Canada. And touch nothing metallic, even indoors.
What are we doing about this climate change-driven phenomenon? Ensuring timely information to the last farmer is obvious as is wider education. So are ‘safe structures’ in the most vulnerable districts, for protection against a range of events – lightning, intense rain, heat and other events that don’t require evacuation. Where viable, homes can include lightning rods or be retrofitted for safety.
Climate change is throwing new challenges at India. We need to address them rapidly and nimbly.
(The writer is Founder and Director Chintan Environmental Research and Action Group)

domain: geography


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As equal opportunity is set in America, it is a matter of who is ready to find those opportunities. The American dream is alive and well, but only a possibility for those who are willing to. The american dream manifests the power of hard work. Many may see it as cliche, but it is a valid point that society overlooks- that people who are motivated and driven will always find a way to achieve their goals. Marie Curie, who conducted in pioneering research on
The American Dream in The Death of a Salesman by Arthur Miller The notion that anyone can achieve financial success and material comfort depends mainly on the foundation of the main theme in this story. Willy Loman is portrayed as a man on a mission to create a comfortable and an acceptable life for him and his family. He works hard and even tries to mentor his son to change his life and work towards self-improvement and financial fulfillment. The author uses this story to analyze the concept of the American dream and how it is interpreted by different people in the society. Miller uses the life of Willy Loman, a mediocre salesperson who believes that personality is the key to achieving the American dream.
There are many themes exist in the novel of The Great Gatsby by Scott Fitzgerald. The most significant theme in this novel is the American dream. The meaning of the American Dream is someone who starting low on the social level or economic, which then working hard and try their best towards wealth and fame. In other word, it stand for one’s independence to strive in order to achieve desired wealth and fame with hard work, but it ends up being more about selfish and materialism pursuit of pleasure. American dream is achieve when a person having a car, money, big house, happy family and nice clothes.
“The American Dream is “ that dream of a land in which life should be better and richer and fuller for everyone, with opportunity for each according to ability or achievement.” James Truslow Adams first stated in his book The Epic of American. He emphasized that, “the American dream does not represent a quest for wealth or material abundance, but rather a version for self-actualization and personal fulfillment.” In the years after the Second World War, America was defined by an unprecedented period of economic prosperity. Perhaps most importantly, those at the bottom of the economic ladder shared in the bounty as much as those at the top. By the 70s, however, as the postwar economic boom began to deflate, did the idea that government had a role to play in stewarding the economy or protecting workers from the vicissitudes of the free market. After the first and the second world war and the Great Depression, more and more people have called American Dream into question.
For a great amount of United States citizens know about the American Dream, and everyone set it as their life target. The American Dream is a national known character of the United States, the main ideas are the focus on democracy, rights, liberty, opportunity, and equality. The American Dream is about freedom that includes the opportunity for success and prosperity for family and children in the society, through hard work. The American Dream is tied to the Declaration of Independence, which claims the point “all men are created equal” with the right to “life, liberty and the pursuit of happiness.” The American Dream is not about how rich you are it is about the environment where people were born or position that they stand. Many immigrants saw the Statue of the Liberty when they have their first view of United States.
Saving the American Dream When the United States was founded, the American dream was a dream where hard working people could be financially profitable, and set their children up to hopefully, better off. This dream, although seeming achievable then, has slowly gotten out of reach from most American people. So, what is the American dream now? The American dream is to rebuild the middle class in a way that anyone, no matter their age, background, ethnicity, etc. can achieve the absolute best according to their abilities and by mending the distance between the ordinary man and the rich by changing the focus of the government from the wealthy to the middle class, we can inspire The easiest way to give everyone an equal opportunity to succeed
Faith Volpi Mrs. McLellan English III The American Dream is to succeed in making everyone feel equal and supported. People 's view about the American Dream are different everywhere one goes. The American Dream does indeed still exist in todays society, and it is one 's job to try their hardest to succeed the values of their own American Dream. Because with everyone united one can succeed at achieving one’s own idea of the American Dream. In the Declaration of Independence, Thomas Jefferson talks about quote, “The American Dream, and how life should be different”.
The Declaration of Independence states “We hold these truths to be self-evident that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” Consequently, James Adams, both a historian and a writer, derived this idea to a term so-called the ‘American Dream’. The amelioration of a genuine need for security, a steady employment, and a solid living historically established the groundworks of the American Dream. The definition of American Dream was to accomplish these factors or straight to the point, attain joy in life which is ultimately known to set one successful. However, through great technological and industrial changes and the changes of living of the American citizens, the inconsistency of American Dream tarnished its meaning and authors’ intention in an historic light, which led many Americans in losing mind of this term compared to the 1930s. It may seem paradoxical,
The Great Gatsby is a story about love, and the necessities of what living the American dream is really about. In the Great Gatsby by “Scott Fitzgerald” the author uses ways to express the American Dream by showing how love and money play a major role in becoming successful. Nick in the Great Gatsby comes from the West egg which is a much lower class than others, he hopes to find money and live the American dream. For example, “I lived at the west egg, well the less fashionable of the two”(Fitzgerald 14)”. As you can see he doesn’t come from a high quality area.
A land in which dreams are made, where the poor man can become rich, and the starved can become full. America, the land in which people travel from far away places, in hopes of a better world. Immigrants, the people who built this country out of a desire for a better life, once hopeful and dreaming of prosperity in the future. People from far and wide come in search of the American Dream, an idea that has made the United States a saving grace for foreigners. All are meant to be welcomed here, those in desperate need, and those who simply crave the freedom America offers.

domain: library


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In a world of innocence and wonder, where the most endearing moments unfold, the meeting of a newborn baby and a loyal dog has the profound power to capture the hearts of all who are lucky enough to witness it. This charming connection between these two unlikely companions is a tapestry woven with gestures of tenderness that speak volumes without the need for words. The opening encounter between a child and a dog is a truly magical moment, leaving everyone who witnesses it completely awestruck.
Picture this intimate scene: a little angelic baby resting peacefully in his bed, and a cute, furry dog approaching with wary curiosity. It is as if an invisible thread of affection attracts the baby's little fingers to reach into the dog's velvety coat and touch it. The dog responds with gentle sniffs, exuding warmth and a reassuring feeling of protection. This painting leaves parents, family members and onlookers alike in deep awe. Innocence in a child's gaze and unwavering love in a dog's waving tail combine to create an atmosphere of intimate tenderness that irresistibly captures the heart. This initial connection often lays the foundation for a beautiful friendship that is destined to last a lifetime.
As baby grows, so does the bond with his furry companion. A baby's early smiles are often reserved for his or her closest dogs, as if they share a secret language that only they understand. The joyful laughter that bursts from the baby brings happiness not only to his parents, but also to the dog who enjoys the joy of the company of his young friend.
As the child becomes more able to move, crawl and explore the world around him, the dog turns into a constant guard. With a watchful eye, the dog follows every step, ready to offer assistance or a reassuring presence when needed. It's as if they have become inseparable playmates, embarking on endless adventures within the safe haven of their home.
These intimate interactions are often captured in precious photos and videos, and are frequently shared on various social media platforms. These fleeting moments touch the hearts of countless individuals around the world. The sight of a child gently patting a dog's head or seeing an affectionate dog on a child's cheek resonates universally, evoking feelings of warmth and happiness.
In a world that can sometimes feel turbulent and challenging, the pure and tender relationship between a child and a dog offers a glimpse into the innate beauty that surrounds us. It serves as a reminder that love transcends barriers, uniting us across species, generations and languages.
The encounter between a newborn baby and a loyal dog is a testament to the inherent goodness of all living things. It embodies the simple joys found in the company of kindred spirits. Witnessing such an intimate moment is an invitation to appreciate the tenderness and purity that life has to offer.
In conclusion, the precious gestures shared between a newborn baby and a loyal dog are heart-melting and awe-inspiring. The bond formed at their first meeting is a living testimony to the magic of love and companionship. This beautiful affair is a poignant reminder that the world is a better place when we embrace and celebrate the sweetness within every living being.
The adorable gestures a newborn made towards a dog during his first meeting touched the hearts of millions.


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Who needs a Rehab ?
Rehab-an often maligned word is in reality a place where problem drinking or drug addiction is treated. All those who find unmanageability in their lives with or without drinking need to experience getting treated at a rehab.Mood swings, getting used to hangovers, tremors, and feeling an imbalanced body are signs and symptoms that result in living in a dysfunctional family environment. Emotional unmanageability is the result.
I have already been to other rehabs and relapsed, how will it help ?
There could be many reasons for a relapse- maybe the person was treated against their wishes, or did not follow up. Some find a life away from addiction in a flow, and some take time. It is very relative.If a rock cracks on the 14th stroke, it does not mean that the first 13 strokes were wasted.
Isn’t Addiction a bad habit the result of moral weakness and over-indulgences?
Addiction is a chronic, life-threatening condition, like hypertension, atherosclerosis, and adult diabetes. Addiction has roots in genetic susceptibility, social circumstance, and personal behavior. Certain drugs are highly addictive, rapidly causing biochemical and structural changes in the brain. Others can be used for longer periods of time before they begin to cause inescapable cravings and compulsive use.
How Long Does Rehab Take?
There isn’t a set period of time that applies to everyone when it comes to rehabilitation. Many rehab facilities offer 30-day programs. However, some individuals benefit from longer treatment programs, such as 60-day, 90-day, or even longer-term treatment at residential or inpatient treatment centers to further develop and maintain a steady recovery path. When determining the appropriate length of treatment, treatment professionals will take into consideration the history and severity of the addiction, specific substances used, any co-occurring medical, mental, or behavioral health conditions, and the physical, mental, emotional, social, cultural, and spiritual needs of the individual.
Does Rehab Cure Addiction?
There is no cure for addiction, but it can be managed effectively. Regardless of its duration, drug and alcohol addiction recovery doesn’t conclude after the patient completes a rehabilitation program. Recovery from substance use is an ongoing, lifelong process. Managing an addiction involves learning how to navigate through daily life without using, and involves hard work and dedication.
What Happens If I Relapse?
Relapse should not be viewed as a failure but should instead be seen as an obstacle to overcome on one’s lifelong journey to sobriety. It provides an opportunity to reassess one’s path and get back into a program that offers the support and help needed to maintain sobriety. Many people who are struggling with addiction complete more than one stay in rehab before they are able to find their footing in their recovery journey. The only person who can manage your addiction is you, and rehab will help you build the skills necessary to maintain sobriety.
Should I Choose Inpatient or Outpatient Treatment?
Inpatient facilities differ from outpatient facilities in a number of ways — from costs involved and intensity of treatment to the overall environment and support structure throughout the recovery process.
Can I Lose My Job for Attending Addiction Rehab?
While you may experience some fear of losing your job if you attend rehab, you may, in fact, be more likely to lose your job if you don’t get help. If you are struggling with a substance abuse problem, it is possible that your boss may already suspect it. By avoiding addiction help, your struggle may eventually become apparent since the consequences of your substance abuse may cause your work performance to suffer.
Using substances while on the job is legal grounds for termination, but there are several federal laws protecting your right to obtain treatment. Under these laws, it is illegal to terminate employment as a consequence of an employee seeking treatment.
Can I have visitors at rehab?
Many treatment centers will not allow visitors initially because it is important for the patient to bond with their group members and therapists. Also, seeing loved-ones can cause undue stress to a patient who is just starting the process. After the initial period of treatment, many centers allow visitors during visiting hours and have designated spaces for the patient to visit with loved ones. After the patient has progressed, some treatment centers also allow patients to leave the center for short periods of time.

domain: psychology


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When the moderators at the Democratic debate Tuesday night finally asked about abortion, many of the candidates were ready with a simple plan. Congress, they argued, should pass legislation codifying the right to an abortion established in Roe v. Wade—a move that could take the matter out of the hands of the Supreme Court and Republican state legislatures altogether.
Amy Klobuchar, Cory Booker, Julián Castro, and Elizabeth Warren all embraced versions of the idea. Booker, Warren, and Kirsten Gillibrand, who has since exited the race, were among the first to adopt such a plan earlier this year.
Of course, the president wouldn’t be able to do this alone; the idea would almost certainly require Democratic majorities—perhaps large ones—in Congress. Earlier this year, Rep. Judy Chu (D-Calif.) introduced such a bill, but it has not advanced in the Democratic-controlled House and would almost certainly be dead-on-arrival in the Republican-majority Senate. A version of this measure was first introduced in 2013.
In arguing for legislation protecting abortion rights, the candidates made clear that the matter is inseparable from issues of economic inequality. “I lived in an America where abortion was illegal, and rich women still got abortions…What we’re talking about now is that the people who are denied access to abortion are the poor, are the young,” Warren said. “When you’ve got three out of four Americans supporting [Roe v. Wade], we should be able to get that passed through Congress. We should not leave this to the Supreme Court, we should do it through democracy because we can.”
The issue has grown more urgent over the past year, as a handful of states in the South passed bans on abortion during their spring legislative sessions, and as the president has appointed two Supreme Court justices thought to be hostile to abortion rights. Last week, the court announced it would rule on a case involving a Louisiana law that requires abortion providers to have admitting privileges at a nearby hospital; if allowed to stand, that law would shutter most of the state’s remaining abortion clinics.
Not all of the Democrats on the debate stage won plaudits from abortion rights advocates. Hawaii Rep. Tulsi Gabbard drew criticism when she expressed support for banning abortion in the third trimester—with exceptions for the health of the woman and the fetus. She repeated Hillary Clinton’s famous line that abortion should be “safe, legal, and rare”—a sentiment that many reproductive rights advocates have shied away from in light of the fact that nearly 1 in 4 American women will have had an abortion by age 45. In a survey of the candidates by BuzzFeed News in May, Gabbard did not respond a question about whether or not she supported codifying Roe.

domain: sociology


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- What are the 4 phases of the moon?
- What are the 12 phases of the moon?
- What planets can we live on?
- Why does the moon change its shape everyday?
- Why do moon phases occur Class 8?
- What are the phases of the moon How do they occur?
- What is the sunlit portion of the moon?
- Can life exist on the moon?
- Who owns the moon?
- What is a wolf moon?
- What are the full moons for 2020?
- When was the last full moon 2020?
- Why can I only see half the moon?
- Why did we stop going to the moon?
- How many phases of the moon are there?
- Does the Moon really change its shape?
- What is the shape of moon today?
What are the 4 phases of the moon?
The four primary moon phases are:New Moon.First Quarter.Full Moon.Third Quarter (Last Quarter).
What are the 12 phases of the moon?
How many phases of the Moon are there?new Moon.waxing crescent Moon.first quarter Moon.waxing gibbous Moon.full Moon.waning gibbous Moon.last quarter Moon.waning crescent Moon.
What planets can we live on?
A 2015 review concluded that the exoplanets Kepler-62f, Kepler-186f and Kepler-442b were likely the best candidates for being potentially habitable. These are at a distance of 1,200, 490 and 1,120 light-years away, respectively.
Why does the moon change its shape everyday?
The Moon doesn’t emit (give off) light itself, the ‘moonlight’ we see is actually the Sun’s light reflected off the lunar surface. So, as the Moon orbits the Earth, the Sun lights up different parts of it, making it seem as if the Moon is changing shape.
Why do moon phases occur Class 8?
The phases occur because the Sun lights up different parts of the moon as it circles around the Earth. The phase visible to us depends on the position of moon, in relation to the Sun and the Earth.
What are the phases of the moon How do they occur?
As the Sun sets, the Moon rises with the side that faces Earth fully exposed to sunlight (5). The Moon has phases because it orbits Earth, which causes the portion we see illuminated to change. The Moon takes 27.3 days to orbit Earth, but the lunar phase cycle (from new Moon to new Moon) is 29.5 days.
What is the sunlit portion of the moon?
The lunar phase or Moon phase is the shape of the Moon’s directly sunlit portion as viewed from Earth. The lunar phases gradually change over a synodic month (about 29.53 days) as the Moon’s orbital positions around Earth and Earth around the Sun shift.
Can life exist on the moon?
The moon may have more water and oxygen than Earth and an oxygen exosphere. Thought to have a subsurface liquid water ocean due to tidal heating or geothermal activity. Free molecular hydrogen (H2) has been detected, providing another potential energy source for life.
Who owns the moon?
The Outer Space Treaty means therefore that – no matter whose national flags are planted on the lunar surface – no nation can ‘own’ the Moon. As of 2019, 109 nations are bound by the Treaty, and another 23 have signed the agreement but have yet to be officially recognised.
What is a wolf moon?
The January full moon is often called the Wolf Moon, according to the Old Farmer’s Almanac, which may date back to Native American tribes and early Colonial times when wolves would howl outside villages.
What are the full moons for 2020?
Full moons of 2020Jan. … Feb. … March 9 – Worm moon (supermoon)April 7 – Pink moon (supermoon)May 7 – Flower moon (supermoon)June 5 – Strawberry moon and a penumbral lunar eclipse (not visible in U.S.)July 5 – Buck moon and a penumbral lunar eclipse.Aug.More items…•Feb 3, 2020
When was the last full moon 2020?
December 30, 2020The moon reaches the crest of its full phase on December 30, 2020, at 03:28 UTC (translate UTC to your time). Yet, for the United States, the moon turns precisely full on December 29, at 10:28 p.m. EST, 9:28 p.m. CST, 8:28 p.m. MST, 7:28 p.m. PST, 6:28 p.m. Alaskan Time and 5:28 p.m. Hawaiian Time.
Why can I only see half the moon?
Only one side of the Moon is visible from Earth because the Moon rotates on its axis at the same rate that the Moon orbits the Earth—a situation known as synchronous rotation, or tidal locking.
Why did we stop going to the moon?
But in 1970 future Apollo missions were cancelled. Apollo 17 became the last manned mission to the Moon, for an indefinite amount of time. The main reason for this was money. The cost of getting to the Moon was, ironically, astronomical.
How many phases of the moon are there?
eight phasesThese eight phases are, in order, new Moon, waxing crescent, first quarter, waxing gibbous, full Moon, waning gibbous, third quarter and waning crescent. The cycle repeats once a month (every 29.5 days).
Does the Moon really change its shape?
Our Moon’s shape doesn’t really change — it only appears that way! The “amount” of Moon that we see as we look from Earth changes in a cycle that repeats about once a month (29.5 days). The relative positions of our Sun, Earth, and Moon, cause these changes.
What is the shape of moon today?
Waxing Gibbous Moonrise and Moonset.


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27th October, 2021
Nollywood actress Linda Osifo said she has no regrets relocating from Canada back to Nigeria, looking at how she has been able to build herself and her career.
The actress who studied Psychology from York University in Toronto relocated to Nigeria in 2013.
She got her first major television break on a series, Desperate Housewives Africa in 2015.
In a recent interview, Linda spoke about her foray into Nigerian entertainment and her experience since returning.
According to her, there’s nothing like regrets in her life as she has better understanding of what motivates and inspires her to make certain decisions.
Hence there’s no way she would regret any of that especially moving from Canada where she could do better to Nigeria.
“I have no regrets. At the level that I am now, I do not use such words like regret. I have a better understanding of what motivates me and what inspires me to make certain decisions.
“I relocated to Nigeria in 2013. I made my final decision to stay through thick and thin in 2015. That was when I got my first major television break on a series, Desperate Housewives Africa.
“When I got my first official break, I was seen as an actor, which was an amazing feat to me. That was when I thought that I had a reason to keep pressing and keep going,” she added.
Speaking about her reason for returning to the country, Linda said “I was at a very sensitive point in my life when I left Canada for Nigeria.
“It was that stage of becoming a young adult. I had to pursue life. No more living on mom and dad. It was a stage where you go into the world to find out who you truly are. I had just graduated from the university and I was 22 years-old.
“I had to ask myself questions to know what I really wanted to do. I had to make my own decisions at that point. My parents could not help me. I had to search deep within me to know what I really loved to do. I had to search for the things that came effortlessly and gave me utmost joy.
“In relation to entertainment, it was not acting alone because I was engaged in everything as a young child. I have participated in a beauty pageant, hosted an awards show and hosted a television show in Toronto, Canada.
“I have also gained some experience from my first movie set in New Jersey, USA. I have all those highlights and of course, growing up in church, I was involved in the drama department. I was living my life.
The humanitarian and founder of The Love And Oneness Foundation further said she was engaged in some community work before returning to the country as well.
“You know, those kinds of stuff. It is those kinds of community work that truly define who you really are. I just had to choose when I got the opportunity to come to Lagos to host a show. I decided to take the opportunity and see what it brings,” she said.
Linda Osifo is one of the top female actresses in the Nigerian movie industry with a lot of films to her credit.
She was first runner-up Miss Nigeria Entertainment Canada 2011 and 2nd runner-up Miss AfriCanada 2011 beauty pageant.
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Introduced in August 1994 to satisfy a yearning for a fresh, breezy and entertaining afternoon paper in Lagos and its environs, P.M.News is positioned as a paper for everyone.
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text: Great movie from 2007. I will grant that my expectations were very low before watching Straightheads. Nowadays, fresh movies entering the cinemas, do not have 'something' what this movie got. In my opinion, some of the actors roles were just a masterpieces which made an amazing impression on me. Whoever has not seen let it rush in front of the TV, because this movie just has to be seen. I hope you're excited, so start watching it now!.

domain: entertainment


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When we start talking about National Parks in the United States one of the first few you’ll likely discuss is Yosemite National Park. There are many reasons for this but beyond any, it’s the breathtaking views that Yosemite Valley provides. From the top of Glacier Point to the waterfalls and meadows along the valley, there are so many reasons why you should spend some time exploring Yosemite and the areas around it.
While there is so much to explore in the area you can also get a taste of what the region has to offer in just a few days. If you’re based in California or looking to add it to a road trip through the region you’ll want to spend some time exploring Yosemite National Park and the South Sierra area around it.
Note: Thank you to the Tenaya Lodge in Yosemite for hosting my trip to the area. As always, all opinions remain my own.
Why You Should Choose the Southern Entrance for Exploring Yosemite
No matter where you’re driving in from, the Southern Entrance of the Yosemite National Park offers a unique way to enjoy both the drive in and the park itself. When you enter the park you’ll quickly hit some of the highlights of the park, without having to add to your drive time.
First, you’ll find Mariposa Groves, which is about to reopen after some rehab, that is just a few miles from the Southern Park entrance. Here you can walk through the grandeur that are the giant sequoias.
Next, you have easy access to Glacier Point and all the trails that lead around this area. This is one of my favorite places I’ve visited in the park. Giving you long views of the valley and as soon as you step away from the main vista you’ll lose a lot of the crowds and get a chance to enjoy a little more peaceful of a setting.
A unique thing about driving in through the southern entrance when you’re exploring Yosemite is that as soon as you head into the valley you reach Tunnel View. This is where you see the quintessential view of Yosemite we all know. It’s the perfect way to start your journey into the park.
The Can’t-Miss Spots in Yosemite National Park
There are so many ways to enjoy exploring Yosemite National Park. Whether you’ll spend your time driving and popping out at the sites or if you’re looking to get in some solid hiking. There isn’t really a wrong way to explore the park.
With a weekend, you might want to spend a morning with a good hike. I’d recommend around Glacier Point. And then spend the afternoon and next morning driving to many of the highlights. Finding a good vista for sunset or sunrise is also worth planning into your schedule. You can also get started nice and early and head all the way into the Tuolumne Meadows and the work your way back to the entrance. With a stop at Tunnel View on your way in.
Starting at the southern entrance and heading into the park, some of the spots you’ll want to make sure you get a chance to explore are:
This is the best place to find the giant sequoias in the park. While you should also consider heading down to Sequoia National Park, you’ll get a good feel for how awe-inspiring these giants are. You’ll also find an easy and short trail to hike through the trees.
Glacier Point and the Trails Around It
The views from Glacier Point can only be beaten by hiking Half Dome, but here you only have to take a short walk from your car. You’ll also get a great view of Half Dome and across the valley. It’s a short walk to get a good view, but this area also has a wide variety of trails. You can even hike all the way down to the valley and then take the shuttle bus back up to your car.
If that’s more than you’re looking for, take the hike over to Seminal Dome for more unique views of the valley. If you’re hoping to escape some of the crowds, these trails tend to have fewer folks on them and you’ll have a chance to feel like you’ve escaped out in nature a little more than down in the valley.
You’ll want to stop here for a breathtaking view along the floor of the valley. It’s a perfect spot to grab a photo of yourself in the valley or just capture the breathtaking landscape. Also, keep an eye on your drive back. The light might be very different in the valley, especially if you’re leaving around the golden hour and it’s worth a second stop for a different take on the view.
You’ll find a variety of stunning falls when you’re down in the valley. While Bridalveil Falls is not the biggest it is the easiest to get to. It’s only a short walk out to get a great look at this fall. It’s definitely worth making the stop for.
On the north side of the valley is Yosemite Falls. The walk here also gives you a chance to wander through the visitor center and some of the village, which is worth a quick stop. This trail tends to be rather busy if you’re just heading to the lower falls but you’ll get a great view.
If you want more of a hike. Take the trip up to the Upper Yosemite Falls for an impressive sight of the falls.
If you’re looking for a solid hike down in the valley, heading your way out to Vernal Falls might be a good fit. It is only a 2.4 miles hike to the top of the falls but it is a steep and difficult hike along the Mist Trail. Or make it the 1.6 miles to the footbridge and you can nice view from the bottom of the falls.
Once you get through the valley keep driving North and you’ll head along route 120 that will take you to a few more spots worth visiting. If you’re driving back North it’s a great path to take on your way out of the park. Or head here first thing and then hit the valley in the afternoon. Either way, even in a weekend, you have a chance to explore this part of the Park as well.
For another unique lookout over Yosemite, you’ll want to take the short walk out to Olmstead Point. Here you’ll get another angle on Half Dome and also be able to see along the Tenaya Valley.
A perfect place to relax and have a picnic while you are exploring Yosemite. You’ll want to spend a little time wandering the area where you’ll get a different view from much of what the park has to offer.
Much of Yosemite is breathtaking for it’s stark changes in elevation from the mountains to the valley. In many ways, Tuolumne Meadow’s beauty comes from the opposite, a beautiful flat landscape along a riverbed. You’ll also be able to get lost (in a good way) wandering the trails in the area without having to worry much about elevation change.
Adding A Little Luxury to Your Stay
While the nature that makes up the Yosemite National Park is wonderful to experience you also might want to come back to a place at the end of the day where you can relax a little and enjoy some luxury. There is nothing better than exploring Yosemite and all it has to offer and then being able to rest your feet with a nice soak in the hot tub and a delicious meal.
The Tenaya Lodge at Yosemite is the perfect place to spend your evenings after exploring the park. The property is surrounded by beautiful views and is right tucked up in the forest itself. You’ll also find a variety of top-notch dining experiences right on the property, which tends to be in short supply around the park. Staying at Tenaya for a weekend allows you to experience fine dining, a delicious breakfast buffet, and a casual chance to dine by a firepit.
After a few days of hiking, you’ll want to spend some time at the Ascent Spa at Tenaya. A relaxing massage and some time in the sauna is the perfect way to recover from hiking a few miles while exploring the park.
Exploring the Southern Sierras Beyond the Park
Using the southern entrance to explore Yosemite National Park not only allows you the opportunity to relax at Tenaya Lodge you’ll have the chance to explore more of what the Southern Sierras have to offer. While the national park itself is breathtaking many of the areas on national forest surrounding the park are just as worth exploring.
One of my favorite things to do in California is to explore the different wine regions and the Southern Sierras isn’t an exception. You’ll want to check out some of the wineries in the area including the Yosemite Sierra Wine Road.
If you’re looking to get out on the water or enjoy some waterfront dining you’ll want to head just 20 minutes from the Tenaya Lodge and visit Bass Lake. Within the national forest, it’s a great place to relax by the lake, take a boat ride, or get a chance to try some water sports.
That’s just the start of outdoor activities you’ll find outside of Yosemite in the Southern Sierras. They also offer the opportunity to try zip lining, fly fishing, horseback riding, mountain biking, and more.
The area is also rich in California history. If you’re looking to learn more about the area and have a little fun, consider trying out the Sugar Pine Railroad and a variety of museums in the area.
Or Stay Beyond the Weekend in the Southern Sierras
While a weekend is a great way to start exploring Yosemite and the Southern Sierras, as you can tell from above there is so much to explore. Think about making it a long weekend on your trip to find time to fit in a few extra activities or maybe an extra spa treatment at Tenaya.
If you have an entire week to explore the area you might want to visit two of my other favorite National Parks, the Sequoia & Kings Canyon National Parks. You’ll get a chance to walk within the giant sequoias and the second largest canyon in North America.
Whether it’s just for two nights or a dozen you’ll want to plan a trip exploring Yosemite and the Southern Sierras.


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Sicilian designer Domenico Dolce, alongside business partner Stefano Gabbana, is in the business of creating dreams, a fact one look at Dolce & Gabbana’s fairytale autumn/winter 2014 collection can confirm. So after 30 years spent building a name around magical, evocative fashion, he’s not about to let a marathon tax trial turn his dream into a nightmare.
In Melbourne this week, just hours before an Italian appeals court upheld the decision to sentence Dolce and Gabbana to jail time for tax evasion, Dolce explained that as company owners and designers they are still very much committed to their vision. “Sometimes you want to cry, you want to sleep for one week and wake up the day after, but we are two designers, Domenico and Stefano, and we work with this label, Dolce & Gabbana. For us, Dolce & Gabbana is our baby, together we work every day, very hard, for respect, for the idea of the brand.
“For us, it’s not just clothes, it’s a sense of the life. This is important,” he says. “Dolce Gabbana for the world now is a sense of life, a sense of beauty. But for us it’s not the obvious beauty, it’s the beauty inside where you have a sense of freedom, a sense of food, family.” Despite their treatment at the hands of Italian tax authorities since the case began (investigations started back in 2008), Dolce and Gabbana’s homeland remains their guiding light, with Sicily at the core of their inspiration season after season on the runway. “We are a very Italian label. We are so happy we work with Italian culture, Sicilian culture. Because we are unique, I think.”
Dolce slotted in a getaway to Australia with his boyfriend that saw them land in Sydney on Good Friday, travel to Wolgan Valley and the Great Barrier Reef, and then end their trip with a cocktail party at the Dolce & Gabbana store on Melbourne's Collins Street. Kylie Minogue turned out in support, and many fans dressed head-to-toe in the brand’s designs, demonstrating the designer’s far-reaching influence. Next stop is New York’s Met Ball, and then onto finalising the resort collection. “I love if tomorrow I wake up, I start to work, and I’m surprised by myself. When this finishes, I need to come for a holiday forever!”
Under Italian laws, Dolce and Gabbana will reportedly not have to serve jail time because their sentences are below the two-year minimum. The appeal will now be presented to Italy’s equivalent to the Supreme Court.


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In the Name of the FatherHD Closed Captioning
Open iTunes to preview, buy, and download this movie.
About the Movie
Academy Award winner Daniel Day-Lewis gives an impassioned performance in this riveting drama that mirrors one man's 15-year struggle and ultimate triumph over a terrible injustice. Oscar winner Emma Thompson co-stars in this gripping film the Los Angeles Times calls, "A politically charged 'Fugitive.'" In the Name of the Father tells the true saga of Gerry Conlon. A petty thief in strife-torn '70s Belfast, Gerry's main interests are getting drunk and partying, much to the dismay of his quiet, frail father Giuseppe (Pete Postlethwaite). When Gerry angers the IRA, his father sends him to England, where his antics land him in the wrong place at the wrong time. Innocent, but forced to confess to a savage terrorist bombing, he is sentenced to life imprisonment as one of the "Guildford Four." An innocent Giuseppe is also arrested and jailed, and while behind bars, Gerry slowly learns that his father's seeming weakness masks an unmatched inner strength and wisdom. Working with a fiercely dedicated lawyer (Thompson), Gerry determines to prove his innocence, clear his father's name and expose the truth behind one of the most shameful legal events in recent history.
Rotten Tomatoes Movie Reviews
- Reviews Counted: 50
- Fresh: 47
- Rotten: 3
- Average Rating: 7.8/10
Top Critics' Reviews
Fresh: The film offers layers of dramatic detail for those who might be confused at points but teased to inquire further.
Fresh: [Sheridan] works with such piercing fervor and intelligence that In the Name of the Father just about transcends its tidy moral design.
Fresh: By the end of the movie, whether or not you're a member of Sinn Fein, the Brits' brutality toward the Conlons will get your Irish up.
Fresh: Miscarried justice often provides the vehicle for emotionally wrenching drama and histrionic fireworks, and such is the case in spades with In the Name of the Father.
Incredible, Outstanding performances as well as an amazing movie!
Bet on "In the Name of the Father": This action packed fact based movie is one to bet on. You get academy award winning actor Daniel Day-Lewis slong side with Emma Thompson, Pete Postlethwaite. This passionate action/drama takes you back in time to the 1974 bombing of a London pub by the IRA. Anyone who has ever been falsely accused or knows someone who was falsely accused will fall in love with the poetic justice and the conviction of the Guilford four.You are sure to be inspired, moved and touched by this guaranteed good time! Bet On It!
Fantastic, moving film
This is one of Daniel Day-Lewis's best films. He and Pete Postlethwaite, one of the most underated actors of all-time, are fantastic as a father and son falsely imprisoned for terrorists acts they had no part of. A very emotional, gripping film, this is DDL at his best.
Daniel Day- Lewis gives another riveting performance as an innocent man longing for freedom of himself and his father. Anyone who has ever been falsely accused of something, no matter what it is will feel for the characters in this film.
- Genre: Drama
- Released: 1993
- © 1993 Universal City Studios, Inc. All Rights Reserved.