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Ovarian Hyperstimulation Syndrome (OHSS)
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What is Ovarian Hyperstimulation Syndrome?
Ovarian hyperstimulation syndrome (OHSS) is an excessive response to taking the medicines (especially injectable gonadotropins) used to make eggs grow. Rarely, OHSS can result from taking other medications, such as clomiphene citrate or gonadotropin-releasing hormone.
Women with OHSS have a large number of growing follicles along with high estradiol levels. This leads to fluid leaking into the abdomen (belly), which can cause bloating, nausea, and swelling of the abdomen. When OHSS is severe, blood clots, shortness of breath, abdominal pain, dehydration, and vomiting are possible. Rare deaths are reported.
How severe can OHSS get?
OHSS can be classified as mild, moderate, or severe. One out of three women has symptoms of mild OHSS during controlled ovarian stimulation for in vitro fertilization (IVF). These symptoms may include mild abdominal bloating, nausea, and weight gain due to fluid. Women with moderate OHSS typically have more of these same symptoms. Women with severe OHSS usually have vomiting and cannot keep down liquids. They experience significant discomfort from swelling of the abdomen. They can develop shortness of breath, and blood clots can form in the legs.
In all cases of OHSS, the ovaries are enlarged. The size of the ovary is a marker of the degree of OHSS. If symptoms are present, a transvaginal or abdominal ultrasound can be done to measure ovary size and the amount of fluid collected.
How is OHSS treated?
OHSS can be serious, so careful monitoring and managing the symptoms are important whenever it occurs. Office visits for ultrasound exams to measure the ovaries and fluid in the abdomen, and blood tests, are routinely done. Decreased activity and drinking lots of electrolyte-rich fluids (over ounces per day) are recommended. Medicines for nausea are available. If there is fluid in the abdomen, drainage of fluid using a syringe (paracentesis) can provide significant relief in most cases. On occasion, more than one drainage is helpful. A medicine called cabergoline also can reduce the fluid accumulation. There is rarely a need for hospitalization.
If OHSS does not improve with outpatient care, the woman may be treated in the hospital with close monitoring. The doctor may order intravenous (IV) fluids and medicines for nausea and may remove fluid from the abdomen. Other supportive therapy may be given as needed.
What other complications occur with severe OHSS?
Complications from OHSS can be severe. You may become dehydrated and pressure in your abdomen may increase from too much fluid. These problems can lead to blood clots forming within the blood vessels. Blood clots can travel to your lungs or to other important organs. This can be potentially life-threatening.
These complications can usually be avoided by recognizing the signs, symptoms, and laboratory evidence that OHSS is getting worse and getting appropriate treatment.
How long does it take for OHSS to get better?
OHSS symptoms usually appear a few days after ovulation. Symptoms usually resolve within two weeks, unless pregnancy occurs. Pregnant women often continue to have symptoms for weeks or more after a positive pregnancy test. The symptoms gradually go away, and the rest of the pregnancy is not affected.
Is there anything that can reduce the risk of having OHSS?
There are several strategies used to lower the risk of OHSS. Reducing the dose of ovarian stimulation medications may reduce the risk of OHSS. Use of a medicine called leuprolide instead of human chorionic gonadotripin (hCG) to prepare the eggs for release can prevent OHSS. Another medicine called cabergoline also can help reduce the fluid accumulation.
Pregnancy can make OHSS worse or last longer. If a woman develops OHSS, avoiding immediate pregnancy by freezing her eggs/embryos for transfer at a later time can help the OHSS resolve more quickly and keep it from progressing.
Some patients who are at high risk for OHSS may be given extra IV fluids at the time of egg retrieval. Giving IV fluids early can help prevent worsening of symptoms later on.
- OHSS is relatively common after ovulation induction or ovarian stimulation for IVF.
- Women with symptoms of OHSS should see a doctor familiar with assisted reproduction as soon as they have symptoms.
- A standard pelvic exam is NOT generally recommended because the ovaries are enlarged and the cysts that are present may burst under pressure.
- Women should notify their doctor when they have:
- Difficulty breathing
- Continued vomiting or nausea
- Difficulty tolerating fluids
- Abdominal swelling
- Decreased urination
- Weight gain of over 3 pounds in 2 days
- Sudden onset of abdominal pain
- Other symptoms such as facial numbness, weakness, lower extremity swelling, or redness
- OHSS often can be managed with decreased activity, drinking electrolyte-rich fluids, draining fluid that accumulates in the abdomen, medication for nausea and pain, careful monitoring, and frequent doctor visits.
- Severe OHSS (continued vomiting, severe swelling of the abdomen, shortness of breath, inability to drink fluids or abnormal laboratory results) may require hospitalization for intensive monitoring and treatment. The risk of OHSS can be reduced by use of lower doses of gonadotropins, leuprolide (vs. hCG) to trigger ovulation, and cabergoline.
Ovarian hyperstimulation syndrome
Ovarian hyperstimulation syndrome (OHSS) is a medical condition that can occur in some women who take fertility medication to stimulate egg growth, and in other women in very rare cases. Most cases are mild, but rarely the condition is severe and can lead to serious illness or death.
Signs and symptoms
Symptoms are set into 3 categories: mild, moderate, and severe. Mild symptoms include abdominal bloating and feeling of fullness, nausea, diarrhea, and slight weight gain. Moderate symptoms include excessive weight gain (weight gain of greater than 2 pounds per day), increased abdominal girth, vomiting, diarrhea, darker urine, decreased urine output, excessive thirst, and skin and/or hair feeling dry (in addition to mild symptoms). Severe symptoms are fullness/bloating above the waist, shortness of breath, pleural effusion, urination significantly darker or has ceased, calf and chest pains, marked abdominal bloating or distention, and lower abdominal pains (in addition to mild and moderate symptoms).
OHSS may be complicated by ovarian torsion, ovarian rupture, venous thromboembolism, acute respiratory distress syndrome, electrolytes imbalance, thrombophlebitis and chronic kidney disease. Symptoms generally resolve in 1 to 2 weeks, but will be more severe and persist longer if pregnancy occurs. This is due to human chorionic gonadotropin (hCG) from the pregnancy acting on the corpus luteum in the ovaries in sustaining the pregnancy before the placenta has fully developed. Typically, even in severe OHSS with a developing pregnancy, the duration does not exceed the first trimester.
Sporadic OHSS is very rare, and may have a genetic component. Clomifene citrate therapy can occasionally lead to OHSS, but the vast majority of cases develop after use of gonadotropin therapy (with administration of FSH), such as Pergonal, and administration of hCG to induce final oocyte maturation and/or trigger oocyte release, often in conjunction with IVF. The frequency varies and depends on a woman's risk factors, management, and methods of surveillance. About 5% of treated women may encounter moderate to severe OHSS. Risk factors include polycystic ovary syndrome, young age, low BMI, high antral follicle count, the development of many ovarian follicles under stimulation, extreme elevated serum estradiol concentrations, the use of hCG for final oocyte maturation and/or release, the continued use of hCG for luteal support, and the occurrence of a pregnancy (resulting in hCG production). Mortality is low, but several fatal cases have been reported.
Ovarian hyperstimulation syndrome is particularly associated with injection of a hormone called human chorionic gonadotropin (hCG) which is used for inducing final oocyte maturation and/or triggering oocyte release. The risk is further increased by multiple doses of hCG after ovulation and if the procedure results in pregnancy.
Using a GnRH agonist instead of hCG for inducing final oocyte maturation and/or release results in an elimination of the risk of ovarian hyperstimulation syndrome, but a slight decrease of the delivery rate of approximately 6%.
OHSS has been characterized by the presence of multiple luteinized cysts within the ovaries leading to ovarian enlargement and secondary complications, but that definition includes almost all women undergoing ovarian stimulation. The central feature of clinically significant OHSS is the development of vascular hyperpermeability and the resulting shift of fluids into the third space.
As hCG causes the ovary to undergo extensive luteinization, large amounts of estrogens, progesterone, and local cytokines are released. It is almost certain that vascular endothelial growth factor (VEGF) is a key substance that induces vascular hyperpermeability, making local capillaries "leaky", leading to a shift of fluids from the intravascular system to the abdominal and pleural cavity. Supraphysiologic production of VEGF from many follicles under the prolonged effect of hCG appears to be the specific key process underlying OHSS. Thus, while the woman accumulates fluid in the third space, primarily in the form of ascites, she actually becomes hypovolemic and is at risk for respiratory, circulatory (such as arterial thromboembolism since blood is now thicker), and renal problems. Women who are pregnant sustain the ovarian luteinization process through the production of hCG.
Avoiding OHSS typically requires interrupting the pathological sequence, such as avoiding the use of hCG. One alternative is to use a GnRH agonist instead of hCG. While this has been repeatedly shown to "virtually eliminate" OHSS risk, there is some controversy regarding the effect on pregnancy rates if a fresh non-donor embryo transfer is attempted, almost certainly due to a luteal phase defect. There is no dispute that the GnRH agonist trigger is effective for oocyte donors and for embryo banking (cryopreservation) cycles.
OHSS is divided into the categories mild, moderate, severe, and critical. In mild forms of OHSS the ovaries are enlarged (5–12cm) and there may be additional accumulation of ascites with mild abdominal distension, abdominal pain, nausea, and diarrhea. In severe forms of OHSS there may be hemoconcentration, thrombosis, distension, oliguria (decreased urine production), pleural effusion, and respiratory distress. Early OHSS develops before pregnancy testing and late OHSS is seen in early pregnancy.
Criteria for severe OHSS include enlarged ovary, ascites, hematocrit > 45%, WBC > 15,, oliguria, creatinine mg/dl, creatinine clearance > 50 ml/min, liver dysfunction, and anasarca. Critical OHSS includes enlarged ovary, tense ascites with hydrothorax and pericardial effusion, hematocrit > 55%, WBC > 25,, oligoanuria, creatinine > mg/dl, creatinine clearance < 50 ml/min, kidney failure, thromboembolic phenomena, and ARDS.
Physicians can reduce the risk of OHSS by monitoring of FSH therapy to use this medication judiciously, and by withholding hCG medication.
Cabergoline confers a significant reduction in the risk of OHSS in high risk women according to a Cochrane review of randomized studies, but the included trials did not report the live birth rates or multiple pregnancy rates. Cabergoline, as well as other dopamine agonists, might reduce the severity of OHSS by interfering with the VEGF system. A systematic review and meta-analysis concluded that prophylactic treatment with cabergoline reduces the incidence, but not the severity of OHSS, without compromising pregnancy outcomes.
The risk of OHSS is smaller when using GnRH antagonist protocol instead of GnRH agonist protocol for suppression of ovulation during ovarian hyperstimulation. The underlying mechanism is that, with the GnRH antagonist protocol, initial follicular recruitment and selection is undertaken by endogenous endocrine factors prior to starting the exogenous hyperstimulation, resulting in a smaller number of growing follicles when compared with the standard long GnRH agonist protocol.
A Cochrane review found administration of hydroxyethyl starch decreases the incidence of severe OHSS. There was insufficient evidence to support routine cryopreservation and insufficient evidence for the relative merits of intravenous albumin versus cryopreservation. Also, coasting, which is ovarian hyperstimulation without induction of final maturation, does not significantly decrease the risk of OHSS.
Volume expanders such as albumin and hydroxyethyl starch solutions act providing volume to the circulatory system
Treatment of OHSS depends on the severity of the hyperstimulation. Mild OHSS can be treated conservatively with monitoring of abdominal girth, weight, and discomfort on an outpatient basis until either conception or menstruation occurs. Conception can cause mild OHSS to worsen in severity.
Moderate OHSS is treated with bed rest, fluids, and close monitoring of labs such as electrolytes and blood counts. Ultrasound may be used to monitor the size of ovarian follicles. Depending on the situation, a physician may closely monitor a women's fluid intake and output on an outpatient basis, looking for increased discrepancy in fluid balance (over 1 liter discrepancy is cause for concern). Resolution of the syndrome is measured by decreasing size of the follicular cysts on 2 consecutive ultrasounds.
Aspiration of accumulated fluid (ascites) from the abdominal/pleural cavity may be necessary, as well as opioids for the pain. If the OHSS develops within an IVF protocol, it can be prudent to postpone transfer of the pre-embryos since establishment of pregnancy can lengthen the recovery time or contribute to a more severe course. Over time, if carefully monitored, the condition will naturally reverse to normal– so treatment is typically supportive, although a woman may need to be treated or hospitalized for pain, paracentesis, and/or intravenous hydration.
- ^ abShmorgun, Doron; Claman, Paul (). "The diagnosis and management of ovarian hyperstimulation syndrome"(PDF). Journal of Obstetrics and Gynaecology Canada. 33 (11): – doi/s(16)x. PMID Archived from the original(PDF) on Retrieved
- ^Ovarian hyperstimulation syndrome Updated by: Linda J. Vorvick and Susan Storck Update. Also reviewed by David Zieve. Date: 7/27/
- ^Humaidan, P.; Kol, S.; Papanikolaou, E. (). "GnRH agonist for triggering of final oocyte maturation: time for a change of practice?". Human Reproduction Update. 17 (4): – doi/humupd/dmr PMID
- ^ abcdefTextbook of Assisted Reproductive Techniques, Laboratory and Clinical Perspectives, edited by David K. Gardner, [pageneeded]
- ^Severi, F.M.; Bocchi, C.; Vannuccini, S.; Petraglia, F. (). "Ovary and ultrasound: from physiology to disease"(PDF). Archives of Perinatal Medicine. 18 (1): 7– Archived from the original(PDF) on Retrieved
- ^ abcdFarquhar, Cindy; Marjoribanks, Jane (17 August ). "Assisted reproductive technology: an overview of Cochrane Reviews". The Cochrane Database of Systematic Reviews. 8: CD doi/CDpub5. ISSNX. PMC PMID
- ^Gomez, Raul (). "Low-Dose Dopamine Agonist Administration Blocks Vascular Endothelial Growth Factor (VEGF)-Mediated Vascular Hyperpermeability without Altering VEGF Receptor 2-Dependent Luteal Angiogenesis in a Rat Ovarian Hyperstimulation Model". Endocrinology. (11): – doi/en PMID
- ^Youssef MA, van Wely M, Hassan MA, etal. (March ). "Can dopamine agonists reduce the incidence and severity of OHSS in IVF/ICSI treatment cycles? A systematic review and meta-analysis". Hum Reprod Update. 16 (5): – doi/humupd/dmq PMID
- ^ abLa Marca, A.; Sunkara, S. K. (). "Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: From theory to practice". Human Reproduction Update. 20 (1): – doi/humupd/dmt PMID
- ^Youssef, M. A.; Mourad, S. (). "Volume expanders for the prevention of ovarian hyperstimulation syndrome". The Cochrane Database of Systematic Reviews (8): CD doi/CDpub3. PMID
- ^Ovarian Hyperstimulation Syndrome~treatment at eMedicine
Ovarian Hyperstimulation Syndrome (OHSS)
Being familiar with the symptoms of ovarian hyperstimulation syndrome (OHSS) is key to preventing a severe case. Ovarian hyperstimulation syndrome is typically mild, but it can become life-threatening. Catching the symptoms early, along with careful monitoring of your treatment cycle by your doctor, can lower the risk of serious complications.
OHSS is a potential side effect of fertility drugs, particularly with injectables (gonadotropins) taken during an IVF treatment cycle. Anywhere from 20% to 33% of women going through IVF treatment will experience ovarian hyperstimulation syndrome. However, most of these are mild cases—moderate cases occur in between 3% and 6% of IVF cycles and severe cases occur less than 1% of the time.
Some enlargement of the ovaries is normal during fertility drug treatment. With OHSS, though, the ovaries become dangerously enlarged with fluid. This fluid can leak into the belly and chest area, leading to complications. But the majority of the fluid doesn't come from the follicles themselves. Most of it comes from blood vessels that are "leaky" due to substances released from the ovary.
What to Expect Along the Path to Conceiving With IVF
Ovarian hyperstimulation syndrome can only occur after ovulation has taken place. Symptoms may occur a few days after ovulation or IVF egg retrieval, or they may not show up for a week or more after ovulation.
Mild symptoms include:
- Mild nausea
- Mild pain or discomfort in the abdomen
- Mild weight gain
More serious symptoms include:
- Rapid heartbeat
- Rapid weight gain, more than 10 pounds in 3 to 5 days.
- Severe abdominal pain
- Severe bloating
- Severe nausea (so much that you can't keep down any food or fluids)
- Shortness of breath
- Trouble with urinating
If you experience mild symptoms, you should contact your doctor as soon as possible, so he or she can monitor the situation.
If you experience any of the serious symptoms, contact your doctor immediately.
Some women are at a higher risk of developing OHSS than others. Your doctor should take these factors into account before your treatment cycle begins.
Your risk for OHSS may be higher if:
- You have PCOS.
- You're age 30 or younger.
- Your AMH levels are high.
- You've developed OHSS in the past.
- You're thin or underweight.
Prescribing lower dosages of hormones, or using alternative treatment protocols, can reduce your risk. Your doctor may also more closely monitor your cycle. Even though OHSS can only occur after ovulation, there are signs your doctor can watch for that may indicate your risk is higher during a particular treatment cycle.
For example, if your ovaries develop "too many" follicles in response to the fertility drugs, or your levels of estradiol are rising rapidly, this may indicate your risk for OHSS this cycle is high.
Your doctor may cancel your treatment cycle if they suspect your risk is high. If you're having an IUI cycle, this may mean canceling the insemination and asking you not to have sexual intercourse. If you're having IVF, any fertilized embryos from the IVF treatment cycle can be frozen and saved for use during a future cycle.
What to Do With Extra Frozen Embryos After IVF
One reason for canceling the treatment cycle is because if you get pregnant, recovery from OHSS may take longer. Pregnancy can worsen OHSS.
Another option your doctor can take is to delay ovulation by a few days. They may prescribe a GnRH antagonist, which will prevent the body's natural LH surge, preventing or delaying ovulation. Or, your doctor may simply delay administering the hCG trigger shot, a fertility drug that triggers ovulation.
Delaying ovulation to lessen the risk of ovarian hyperstimulation syndrome is sometimes referred to as "coasting." This delay of a few days can lower the risk and severity, without seriously decreasing your chances of a successful pregnancy.
Behind the Scenes of an Infertility Diagnosis
Having your treatment cycle canceled can be very disappointing. You may be tempted to have sexual intercourse against the instructions of your doctor, not wanting to "waste" the cycle. Don't do this.
OHSS can be dangerous and even life-threatening. If you develop a severe case of OHSS and get pregnant, your risk of miscarriage may also be higher.
Some of the possible complications of OHSS include:
- Dangerous blood clots (usually in the leg)
- Death (extremely rare)
- Difficulty breathing
- Fluid build-up in the lungs or abdomen
- Kidney failure
- Pregnancy loss
- Ruptured ovarian cyst
- Twisted ovary (the ovary gets so heavy with fluid, it twists on its own weight)
Prevention and Treatment
Your doctor should monitor your body's response to fertility drugs with blood tests and ultrasounds. Rapidly increasing estrogen levels or ultrasounds that show a large number of medium-sized follicles are all possible indicators of ovarian hyperstimulation syndrome risk.
If you develop a mild case of ovarian hyperstimulation syndrome, you probably won't need special treatment.
Here are some things you can do at home to feel better:
- Don't drink alcohol or caffeinated drinks, such as coffee, colas or caffeinated energy drinks.
- Don't overexert yourself; take it easy while you recover.
- Drink plenty of fluids, around 10 to 12 glasses a day. Drinks with electrolytes, such as Gatorade, are a good choice.
- Put your feet up. This can help your body get rid of the extra fluid.
- Sex should be avoided until you feel better. Sexual activity may increase your discomfort, and in the worst-case scenarios, may cause ovarian cysts to leak or rupture.
- Take over-the-counter pain relievers, such as Tylenol.
- While you shouldn't overexert yourself, you should maintain some light activity. Total bed rest can increase the risk of some complications.
Your doctor will give you instructions on what to watch for and when to contact him. If your symptoms get worse, you should definitely let them know. She may ask you to weigh yourself daily, to monitor weight gain. If you find yourself gaining 2 or more pounds per day, you should call your doctor.
How to Talk About Infertility and Miscarriage
A Word From Verywell
In rare cases, you may need to be hospitalized. Hospitalization may include receiving fluids intravenously (through an IV), and they may remove some of the excess fluids in your belly via a needle. You may also be kept in the hospital for careful monitoring until your symptoms lessen. Usually, symptoms will decrease and go away once you get your period.
If you get pregnant, though, your symptoms may be prolonged. It may take several weeks to feel completely better. Pregnancy can also make the symptoms worse, so your doctor will want to monitor your situation carefully.
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Ovulation cramp symptoms and what they mean
Cramps that occur outside of a menstrual period might be a sign that a person is ovulating. Being aware of the symptoms of ovulation may help a person identify when they are most fertile.
Ovulation cramps occur when one of the ovaries releases an egg, which typically happens halfway through a person’s cycle. Doctors sometimes call them “mittelschmerz,” which translates as “middle pain.”
In this article, we explore what ovulation cramps feel like and what they mean for fertility. We also look at other symptoms of ovulation and other causes of mid-cycle cramps.
What are ovulation cramps?
An ovary typically releases an egg about midway through a person’s menstrual cycle. This is ovulation.
For some people, ovulation creates a sensation of cramping or pain once a month on one side of the abdomen. If a person has these cramps every month, the sensation may switch sides from month to month, depending on which ovary releases the egg.
Ovulation cramping may happen before, during, or shortly after the release of an egg.
Not everyone who menstruates has ovulation cramps. According to the University of Florida, about 1 in 5 people who menstruate have cramping around the time of ovulation.
Some people do not experience the cramping every month or do not have the same amount of discomfort every month.
Ovulation cramping may occur if:
- the follicle where the egg develops stretches the ovary
- the release of blood and other fluid from the ovary irritates surrounding tissue
The sensation of ovulation cramping can range from mild discomfort to intense pain. It may be difficult to identify the cause of the pain, especially if ovulation cramps do not occur every month.
The primary symptom of ovulation cramping is pain on one side of the abdomen, and this typically lasts . However, a person who has had ovarian surgery may experience the pain until menstruation.
Below are characteristics of ovulation cramping:
- pain or cramping on one side of the abdomen
- pain or cramping that starts midway through the menstrual cycle
- pain or cramping that switches sides, month by month
- pain that is sharp and may be severe
Ovulation pain and fertility
Ovulation pain occurs right before, during, or right after the release of an egg, which is also when a female is most likely to become pregnant. As a result, the sensation may help with recognizing fertility.
However, people who do not want to conceive should not use ovulation cramps to determine when it is safe to have unprotected sex — this method is not accurate, the University of California note, and could result in unintended pregnancy.
Other ovulation symptoms
Some people who menstruate do not experience any discomfort during ovulation.
A person might also recognize that they are ovulating by the following signs:
- increased cervical mucus
- breast tenderness
- spotting or light bleeding
- increased libido
- increased basal body temperature
Ovulation cramps vs. implantation cramps
Ovulation cramps occur when one ovary releases an egg. If sperm do not fertilize the egg, the menstrual cycle continues: the egg breaks and the uterus sheds its lining.
If sperm do fertilize the egg, the fertilized egg attaches to the lining of the uterus. This attaching is called “implantation.”
Implantation can cause cramping. It can also cause a small amount of bleeding or spotting, which can occur 3–14 days after fertilization. Implantation bleeding is typically brownish and the flow is light.
Beyond implantation bleeding and cramping, early pregnancy can cause:
- a frequent urge to urinate
Other causes of cramps
Various health conditions cause abdominal cramps, which may happen to occur in the middle of the menstrual cycle and resemble ovarian cramping.
Some other causes of abdominal cramping or pain include:
- acute appendicitis, which can present with to ovulation cramps
- endometriosis, which involves uterine lining tissue growing outside the uterus and affects at least of females in the United States ages 15–44
- uterine fibroids, which are noncancerous growths in the walls of the uterus and can cause pain, bleeding, and a feeling of fullness in the abdomen
Ovulation cramps typically go away on their own. To relieve the pain, the following can often help:
- over-the-counter pain medications, such as ibuprofen (Advil)
- a warm compress or bath
- hormonal contraceptives that prevent ovulation
When to see a doctor
If ovulation cramps go away within a few hours, a person usually does not need medical attention.
A person should contact a healthcare provider if they have cramping and:
- pain that lasts longer than 24 hours
- unusual vaginal bleeding
- painful urination
- have missed a period
Ovulation cramping is often mild and goes away after a few hours. It can let people who want to conceive know that the time might be right.
However, people who do not want to conceive should not rely on ovulation cramps to indicate fertility. This is not an effective way to time unprotected sex.
If the cramping or pain is intense, a warm bath and over-the-counter pain medication may help. Anyone who experiences severe pain or cramps accompanied by vomiting or unusual bleeding should contact a doctor.
Symptoms pain hyperovulation
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Have you ever noticed a twinge or ache on one side of your lower abdomen? Did it happen a couple of weeks before your period? It could be ovulation.
Ovulation pain, sometimes called mittelschmerz, can feel like a sharp, or like a dull cramp, and happens on the side of the abdomen where the ovary is releasing an egg (1–3). It generally happens days before the start of your period, is not dangerous, and is usually mild. It generally lasts a few hours, and for some people can last a few days.
Tracking ovulation pain in the Clue app can help you determine when to expect it.
Clue’s research finds that 1 in 3 people regularly track ovulation pain.
Ongoing research by Clue collaborator Ruben Arslan at the Max Planck Institute has found that about 1 in 3 people—36% to be exact—regularly track ovulation pain in Clue. (This is of Clue users not taking hormonal birth control who track relatively consistently).
Other interesting findings about ovulation pain:
People will often not feel it in every cycle. This is similar to what's been found in other small-sample research.
People who track ovulation pain often reported in about half of their cycles. Others report it in every cycle.
Most people track ovulation pain for just one day per cycle, but some track it for two or more.
Download Clue to track ovulation pain.
Can ovulation pain help predict the timing of ovulation?
Statistically, the timing of ovulation pain tracked in Clue seems to be fairly promising as a predictor of ovulation. This doesn’t mean you should incorporate it into your fertility awareness method just yet—but it’s interesting for researchers.
In alignment with previous research that used ultrasounds to determine the day someone ovulated, people in Clue most often tracked ovulation pain on the day just before an estimated ovulation. This may be an additional finding to support one theory of why ovulation pain happens—follicular growth pressure (we describe this below). But more research is needed to know for sure.
Others track ovulation pain on the same day as their estimated ovulation in Clue, or outside of that window altogether. The timing of ovulation is estimated by luteinizing hormone (LH) tests, or retroactively by the date of the start of the next period. Both these methods can be inexact (ultrasound is considered the gold standard).
This is the largest dataset of recorded ovulation pain to be included in research, ever.
Seeing what aligns with or differs from small-sample studies is a novel and exciting endeavor that will help pave the way for future findings.Thanks to all Clue users who contribute to this research through tracking.
How to treat ovulation pain
There are no official treatment recommendations for ovulation pain, and for most people it’s not painful enough or too short-lived to bother with pain treatment.
If that’s not the case for you, an over-the-counter pain medication might help. A hot compress or a bath may also help relieve the pain for some people. If the pain is severe enough, talk to your healthcare provider. Hormonal medications are sometimes used to stop ovulation if other methods haven’t worked and the pain is getting in the way of someone’s day-to-day life.
What causes ovulation pain?
Researchers still don’t know exactly what causes ovulation pain. Attempts to answer this question in medical literature date back to the mids. Over a century later, the answer is still unclear.
Here are some theories for the cause.
Tension of a growing follicle on the ovary, and the inflammatory response that tension creates (4).
Follicles are sacs that contain your eggs. They typically grow to be about two centimeters in diameter before they’re released into the fallopian tube (5–8). Prostaglandins (the same inflammatory compounds involved in menstruation) are produced as the ovarian muscle contracts around the growing follicle, possibly causing pain.
Research that used ultrasounds to determine the timing of ovulation found that ovulation pain was typically felt around the time of the luteinizing hormone (LH) peak, about hours before ovulation (4). The pain came and went before the follicle ruptured. This has been challenged in other studies.
The release of the egg itself is also an inflammatory event, but it’s not considered as a probable source of ovulation pain. Prostaglandins may help facilitate the release of the egg as the follicle's tissue breaks down so the egg can pass (9). Research has found that taking high doses of anti-inflammatory pain medication leading up to ovulation may actually prevent it from occurring (10).
Irritation of the abdominal cavity from the follicle’s blood when it ruptures to release the egg (1).
Ultrasound evidence in one study found that in 2 in 3 cycles, 5ml of fluid was visible in the abdomen. These cycles were more likely to be associated with ovulation pain. The “fluid” is suspected to be blood, and is released when the follicle releases an egg. They found this fluid could be seen for up to two days after ovulation (1).
There was also a theory that cramps in the uterus, fallopian tubes, or large bowel caused the pain (4), but this has been largely disregarded.
How to know whether you’re feeling ovulation pain
Track the timing of it with your cycle
Some people feel ovulation pain for the first time when they first begin menstruating. For others it begins later in life, but is most common in people under the age of 30 (3).
For some people, ovulation pain happens around the same time each cycle (when it does happen). For others, it’s more irregular. This depends on the regularity of ovulation. The pain is typically reported just before ovulation occurs.
For some people, ovulation pain is also accompanied by ovulation bleeding (3).
2. Track whether you feel it on the left side, right side, or both
Ovulation pain is typically felt on the side of the ovary that is releasing an egg that cycle.
For about half of women, ovulation alternates between the left and right ovary (11), which may explain why some people report that it alternates from side to side (3).
In the other half, ovulation side is more random, meaning it doesn’t just go back and forth between. Even so, each ovary usually ends up ovulating just as much as the other overall (11).
Most people feel the pain on one side or the other, but others have reported feeling it on both sides at the same time, but with more pain on one side than the other (12). People have also reported equal ovulation pain on both sides in some cycles, possibly indicating cycles in which each ovary releases its own egg.
Some people might only ever feel pain on one side or another, since it’s possible that only one ovary is a source of pain. One early (read: macabre, cringeworthy) study found that the pain was sometimes resolved in early treatments where a single ovary was surgically removed (3). A theory is that some people may have adhesions on only one of two ovaries (2). Adhesions could restrict the follicles or ovary somehow, and pain is felt when the LH spike occurs to trigger ovulation.
3. Track how long it occurs
Most people report that their ovulation pain lasts between 6 and 12 hours (4). In Clue, the majority of people who track ovulation pain do so for only one day. Others track it for two or more days, but it’s difficult to know to what extent other factors play a role, such as ovulatory pain due to endometriosis.
4. Track the sensation or severity
The sensations or pain of ovulation is as unique as the person who experiences it. For some, it’s not painful, but just uncomfortable—some have described it as a sense of fullness or tension (3). For others, it’s been described as cramp-like, sharp, dull, and intermittent. It’s mild for most but more acute and painful for others (1,3).
You can track severity of ovulation pain by using the custom Tags option in Clue.
Other causes of pain in the general area of your ovaries
An appendicitis, ectopic pregnancy, or complications of an ovarian cyst can all have similar symptoms as ovulation pain, but tend to be more severe and unexpected. These conditions require immediate medical treatment. Ongoing pelvic pain can be a sign of a condition or infection such as pelvic inflammatory disease or endometriosis, which also require treatment or management from a healthcare provider.
People with ovarian cysts have follicles that grow large and can rupture. Ovarian cyst ruptures are similar to ovulation, but they are associated with irregular ovulation, involve abnormally large cysts, and tend to be more severe. The rupture causes moderate to severe pain and can lead to other complications (13). Ovarian cysts are not uncommon, and can be caused by some types of hormonal birth control, like hormonal IUDs (14, 15). Other types of hormonal birth control that stop ovulation are sometimes used to treat persistent ovarian cysts. Talk to your healthcare provider about any moderate to severe abdominal pain.
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- Hann LE, Hall DA, Black EB, Ferrucci JT. Mittelschmerz: sonographic demonstration. JAMA. Jun 22;(25)
- Marinho AO, Sallam HN, Goessens L, Collins WP, Campbell S. Ovulation side and occurrence of mittelschmerz in spontaneous and induced ovarian cycles. British medical journal (Clinical research ed.). Feb 27;()
- Wharton LR, Henriksen E. Studies in ovulation: the operative observations in periodic intermenstrual pain. Journal of the American Medical Association. Oct 31;(18)
- O'Herlihy C, Robinson HP, De Crespigny LJ. Mittelschmerz is a preovulatory symptom. British medical journal. Apr 5;()
- Lujan ME, Kepley AL, Chizen DR, Lehotay DC, Pierson RA. Development of morphologically dominant follicles is associated with fewer metabolic disturbances in amenorrheic women with polycystic ovary syndrome: a pilot study. Ultrasound in Obstetrics & Gynecology. Dec 1;36(6)–
- Macklon NS, Fauser BC. Regulation of follicle development and novel approaches to ovarian stimulation for IVF. Human Reproduction Update. Jul 1;6(4)–
- Ojengbede OA, Abidogun KA, Fatukasi UI. Ultrasound monitoring of ovarian follicular growth during spontaneous cycles in Nigerian women. African journal of medicine and medical sciences. Dec;21(2)–
- Kerin JF, Edmonds DK, Warnes GM, Cox LW, Seamark RF, Matthews CD, Young GB, Baird DT. Morphological and functional relations of Graafian follicle growth to ovulation in women using ultrasonic, laparoscopic and biochemical measurements. BJOG: An International Journal of Ob stetrics & Gynaecology. Feb 1;88(2)–
- Jones RE, Lopez KH. Human reproductive biology. Academic Press; Sep
- Norman RJ. Reproductive consequences of COX-2 inhibition. The Lancet. Oct 20;()
- Ecochard R, Gougeon A. Side of ovulation and cycle characteristics in normally fertile women. Human Reproduction. Apr 1;15(4)
- Krohn PL. Cyclical intermenstrual pain: The Mittelschmerz. The Journal of Clinical Endocrinology & Metabolism. Jun 1;14(6)
- Bottomley C, Bourne T. Diagnosis and management of ovarian cyst accidents. Best practice & research Clinical obstetrics & gynaecology. Oct 1;23(5)
- Product monograph Mirena. Mississauga: Bayer; Available from: https://www.bayer.ca/omr/online/mirena-pm-en.pdf
- Inki P, Hurskainen R, Palo P, Ekholm E, Grenman S, Kivelä A, Kujansuu E, et al. Comparison of ovarian cyst formation in women using the levonorgestrel-releasing intrauterine system vs. hysterectomy. Ultrasound Obstet Gynecol. Oct;20(4)
Horror !!!), I thought: would I like to see them ALL now ?. The answer is: I would like to. But NOT ALL.
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Letting her go in a circle in the company and putting her in different poses with an approach from all sides. Sex with the guest this time was banal and not long, and after they finished her again, they just got dressed and sat in their places in waiting for my return.
Of course, after having smoked what I saw, our friend quickly got ready and unfortunately left. Although, as I understood from the words of my wife and her desire, we could try to fuck her together all night, and I even think, at the same.


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12-28-2013, 04:24 PM
| || | Betta Types
I have a male twin tail betta and would like to breed him, but assuming the only type of female I could get is just your average veil tail from the pet store, would I just end up with some funky tail type, or would it be 50/50 split of the two?
I really want to breed bettas, but don't want to end up with a bunch of unsellable/deformed bettas.
Thx, Cass :)

domain: hobby


text:
PanamaDaPrince is a famous Rapper, Singer, Entrepreneur, and producer from the United States. He is known for his Energetic music and vibrant personality. He aims to push the boundaries of music by engulfing his ethnic roots and intertwining them with his grasp on western music culture. Since childhood, he had a passion for music. He officially started his Music career at the early age of 14. He has earned a lot of fame, admiration, and recognition for his incredible talent. He has continued to increase her popularity across several social media platforms. Singers like Panama have taken music to a whole new level. Panama takes time to make sure his music is something that isn’t forgotten. He strives to make sure that his music is understood beyond mere translation, but rather, in a way that leaves a mark with the listener. His massive following can be largely attributed to his ingenuity and creativity that has attracted the attention of several music lovers from across the globe.
PanamaDaPrince was born on 31 October 1991. He lives in Brooklyn, NY. His Zodiac sign is Scorpio. He is American by Nationality.
|Nick Name||Pana Fuego, Papi Pana Fuego, Panama, ALPHA|
|Date Of Birth||31 October 1991|
|Birth Place||Brooklyn, NY|
Since childhood, he was surrounded by various influences in Music. Much like the aforementioned artists, Panama is armed with a life-long passion for great music, and the ability to let his beautiful melodies speak for themselves, connecting with listeners of all walks of life in a very seamless way.
PanamaDaPrince Age, Height, Weight
PanamaDaPrince’s height is 6’ 2″ inches tall and his weight is 156 lbs. His Age is 30 years old as of 2021. His eyes color is Brown and his hair color is Black. He has a very attractive personality.
|Height(approx)||In centimeter- 187 cm
|Weight(approx)||In kilogram- 70 kg
|Age in 2021||27 Years|
PanamaDaPrince Family & Relationships
Not much is known about his family and his relationships. He is rumored to be in a Relationship, Name not Disclosed yet.
Some Interesting Facts
- He has over 12k+ followers on Instagram.
- Panama rising popularity is very much deserved by the young man not only because of his talent but because of his dedication and hard work.
- He is the owner of a lifestyle brand Alpha.
- He has collaborated with various influencers including Fatman Scoop, Swizz Beatz, Chris Robinson, Dreezy, Teyana Taylor, Iman Shumpert, Latto, and Shaun Ross.
- He graduated from Long Island University.
- Social media has allowed young but promising artists all over the world to be discovered by casual audiences and major companies.
- He has been invited to various brand launches and red carpet events.
- His fans gravitate toward his content because it’s so entertaining.
- His magnetic personality has gained him friends across the globe and the growing respect of ears in the industry.
- He is also a firm believer in freedom of artistry and the notion that music is one of the best tools to communicate.
- he writes down his music based on real-life experience and everyday struggles that he mixed up into rap
- He іѕ а creative thinker, wіth positive attitude, and self-motivated individual whо works wіth focus аnd determination tо turn dreams іntо reality
- His obsession with aesthetics is an endless road he pursues, the simple lifestyle that he desires only helps him dim down the complexities that he only wishes to express.
- He has collaborated with various other Artists
- You can also check out his music on Spotify, Apple Music & Youtube
- He enjoys fashion, singing & acting
- He endorses various Brands
- He has Performed in Various Music Fest and events
- His NET WORTH is around 400k -500k as of 2021.
- He has been featured in various Media Articles
- Check out his music video: “Annihilation”
|Does PanamaDaPrince, Consume Alcohol?||No|
|Does PanamaDaPrince, Smoke?||No|
|Does he Drive?||No|
|Does PanamaDaPrince, Swims?||No|
|Does he know cooking?||Yes|
|Is PanamaDaPrince Yoga Practitioner?||No|
|Is PanamaDaPrince, a Jogger?||Yes|

domain: artistic


text:
The first recorded use of the term "playwright" is from 1605, 73 years before the first written record of the term "dramatist". It appears to have been first used in a pejorative sense by Ben Jonson to suggest a mere tradesman fashioning works for the theatre. Jonson uses the word in his Epigram 49, which is thought to refer to John Marston :
A playwright is a person who writes plays for the stage. Because the name of such a text is drama, another word for this person is dramatist. Sometimes, dramas are written to be read and not played. In that case, they are called closet dramas.
William Shakespeare (bapt. 26 April 1564 – 23 April 1616) was an English playwright, poet, and actor, widely regarded as the greatest writer in the English language and the world's greatest dramatist. He is often called England's national poet and the "Bard of Avon" (or simply "the Bard").
People also ask
What does a playwright do?
What does playwright means?
What is an example of one act play?
- Early life
Robert Patrick is an American playwright, poet, lyricist, short story writer, and novelist. He was born Robert Patrick O'Connor in Kilgore, Texas.
O'Connor was born to migrant workers in Texas. Because his parents constantly moved around the southwestern United States looking for work, he never went to one school for a full year until his senior year of high school, in Roswell, New Mexico. Books, film, and radio were the only constants in his early life. His mother made sure he learned to read, and arranged for him to start school a year early. He lacked friendships due to the constant moving, and didn't do well in school. He dropped out o
Patrick has written and published over sixty plays.
- Dramas, comedies, musicals
- Kennedy's Children, Camera Obscura
- Early years
- Personal life
Jason Miller was an American playwright and actor. He received the 1973 Pulitzer Prize for Drama and Tony Award for Best Play for his play That Championship Season and was nominated for the Academy Award for Best Supporting Actor for his performance as Father Damien Karras in the 1973 horror film The Exorcist, a role he reprised in The Exorcist III. He later became artistic director of the Scranton Public Theatre in Scranton, Pennsylvania, where That Championship Season was set. Jason Miller Mil
Miller was born John Anthony Miller Jr. in Queens, New York City to Mary Claire, a teacher, and John Anthony Miller Sr., an electrician. His ancestry was primarily Irish Catholic, with some German.
Miller attracted fame in 1972 by winning a Pulitzer Prize for his play, That Championship Season, which also won the 1973 Tony Award for Best Play. The original Broadway cast featured Charles Durning, Richard Dysart, and Paul Sorvino. That same year, he was offered the role of the troubled priest, Father Damien Karras, in William Friedkin's horror film The Exorcist, for which he was nominated for an Academy Award for Best Supporting Actor. After his nomination for The Exorcist, he was offered th
Miller was the father of actors Jason Patric and Joshua John Miller.
- Life and career
Peter Richard Nichols CBE FRSL was an English playwright, screenwriter, director and journalist.
Born in Bristol, England, he was educated at Bristol Grammar School, and served his compulsory National Service as a clerk in Calcutta and later in the Combined Services Entertainment Unit in Singapore where he entertained the troops alongside John Schlesinger, Stanley Baxter, and Kenneth Williams, before going on to study acting at the Bristol Old Vic Theatre School. He later claimed to have studied acting because there were no dedicated courses for playwrights. While he was working as a teache
His plays include: 1. Promenade, an original play for television 2. Ben Spray, an original play for television 3. The Hooded Terror 4. A Day in the Death of Joe Egg 5. The Gorge, a play in The Wednesday Play series, 6. The National Health 7. Forget-Me-Not-Lane 8. Chez Nous 9. Harding's Luck 10. The Freeway 11. Privates on Parade 12. Born in the Gardens 13. Passion Play 14. Poppy 15. A Piece of My Mind 16. Blue Murder 17. So Long Life 18. Nicholodeon 19. Lingua Franca
'Whatever interest my life may have had must have been exhausted. Yet there were better reasons than vanity – I needed the advance the publishers offered, which was far more generous than any given to me for a play; the theatre itself, once so alluring, now seemed past its best, the wrinkles showing, the kisses dry and dutiful; it would be a bitter pleasure to describe my disenchantment and blame the people who'd done me down; and if I didn't write a book about me, it was clear no one ...
From Wikipedia, the free encyclopedia For other people with the same name, see Michael Stewart. Michael Stewart (August 1, 1924 – September 20, 1987) was an American playwright and librettist for the stage.

domain: entertainment


By Jay MacDonald
4) Business befuddlement
Fiction: All businesses will be required to provide employee health insurance.
Fact: The Affordable Care Act does not require employers to provide health coverage.
However, it does impose a penalty on larger employers that either do not offer a plan or offer unaffordable coverage.
“The law specifically exempts all firms that have fewer than 50 employees — 96 percent of all firms in the United States, or 5.8 million out of 6 million total firms — from any employer responsibility requirements,” says Chiglinsky. “More than 96 percent of firms with 50 or more employees already offer health insurance to their workers. Less than 0.2 percent of all firms (about 10,000 out of 6 million) may face employer responsibility requirements.”
The health care law features a variety of incentives meant to encourage small businesses to insure their employees, including tax credits and access to more affordable plans through new Small Business Health Options Programs, or SHOPs, that will be part of the state insurance exchanges.
The SHOPs will give small businesses “the clout that big businesses already enjoy when purchasing insurance,” Chiglinsky adds.
5) Immigrant inaccuracy
Fiction: Undocumented immigrants will receive federal aid to purchase health insurance.
Fact: Undocumented immigrants are excluded from health care reform.
And not only that, but they also are ineligible to receive Medicaid insurance for the poor or to purchase health insurance with their own money in the state exchanges when those open in 2014.
Legal immigrants who have resided in the United States for less than five years are similarly ineligible for federal assistance, though the states have the option of extending coverage to pregnant women and children while they await legal status.
“Undocumented immigrants are still in the same difficult situation they have always been in,” says Chollet.
6) ‘Death panels’ notion lives on
Fiction: Health reform creates a “death panel” to make decisions about end-of-life care for seniors.
Fact:Early drafts of health care reform would have allowed Medicare to reimburse physicians for time spent talking with older patients about advance care planning. But these provisions were eliminated in subsequent revisions.
“Given some political space, (the reimbursement) would have been something that families and their doctors would have appreciated having. But it became so politicized so fast that it just threatened to sink the entire bill, so it was struck,” says Chollet.
Stoll says savvy Medicare-eligible consumers who want to have these discussions already have discovered a cost-free workaround provided by a previous president.
“In 2003, President George W. Bush signed into law the Medicare Modernization Act, which allows Medicare to cover advance care planning as part of the Welcome to Medicare physical exam,” she explains. “Also, if you visit your doctor, for example, to check your diabetes and you also discuss your end-of-life care preferences during that visit, Medicare will cover the appointment.”
7) Medicare scare
Fiction: Health care reform will reduce Medicare benefits to all seniors.
Fact: Traditional Medicare benefits will be unaffected by the law, and some seniors will even enjoy better coverage.
“It improves prescription drug coverage for people with Medicare Part D by gradually closing the coverage gap, or ‘doughnut hole,'” Stoll says. “Seniors with high drug costs who fall into the doughnut hole are now receiving 50 percent discounts on their brand-name drugs at the pharmacy and other discounts on generics. These discounts will increase each year until the gap is completely closed in 2020.”
Health care reform does reduce payments to privately-administered Medicare Advantage plans and requires them to spend at least 85 percent of premiums directly on patient care in order to bring their costs more in line with the average cost of traditional Medicare. These plans may then charge higher premiums and reduce added benefits such as eye and dental care, but all plans will still be required to provide all benefits currently covered under traditional Medicare.
8) States on the sidelines?
Fiction: States that don’t set up health exchanges will be exempt from the Affordable Care Act.
Fact: If states fail to establish a health exchange, the federal government will set up and run one for them.
“On Jan. 1, 2014, consumers in every single state will have access to private health insurance options on an Affordable Insurance Exchange, regardless of whether that exchange is run by the state, the federal government or a partnership between the two,” says Chiglinsky.
But the Supreme Court’s ruling on the Affordable Care Act said states may, in fact, opt out of another part of the health care reform law: its expansion of Medicaid, which is designed to make health insurance affordable for an additional 16 million Americans.
States that do decide to opt out would be turning down millions of dollars in Medicaid funding, because the federal government plans to foot the entire bill for expanding Medicaid in the first few years. After that, states will be expected to pick up 10 percent of the costs.


S’ólh Téméxw, our Stó:lō world, has a wet and rainy climate. Ancient Stó:lō women perfected the art of making waterproof clothing and matting that would clothe and cover them. Our mothers and grandmothers wove us capes and hats from split redcedar roots to keep us dry as we worked, played, and traveled in the rain. These photos are examples of these carefully constructed garments. They were found along the muddy banks of the Harrison River, and then cleaned, preserved, and stored for our viewing.


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Skatepunk band FLADDERPUCK can be now found from the FAST DECADE RECORDS roster!
This fast playing quintet from Tampere, Finland has been really active in the skatepunk / punkrock scene these past few years and you couldn’t not run in to their name while talking about punk rock bands in Finland. What it seems to come to their ethic, it’s no miracles, just hard work. Really happy to a part of their mission to conquer the hills of skatepunk. You’re going to keep hearing from them for years to come!
The guys are hitting the studio in the beginning of next year to record some new songs. While itching and waiting for the new record, their self-published EP “KINGS & BEGGARS” from 2016 can be found from our webstore!
KINGS & BEGGARS is also available in Spotify
Follow FLADDERPUCK in Facebook and Instagram


text:
With little fanfare, international pop star Justin Bieber has graduated from his Ontario high school.
The Guardian reports that Bieber graduated from St Michael Catholic Secondary School in Stratford, Ontario late last week alongside another 192 students.
He left the school at 13 to pursue his pop career but studied online to complete his diploma. The superintendent of the local school board Dan Parr said “Justin chose to keep aspects of his education quiet,”
St Michael’s principal Tim Doherty said, “We are very proud of Justin and all of the other 192 graduates of St Michael school”.
It’s almost quaint that he bothered completing his studies, since he’s been a megastar for years and his second album Believe was the biggest US debut of the year and hit number one in Australia, Canada, Ireland, Italy, New Zealand, the UK, Spain, Sweden, Austria, Denmark, Mexico and Norway.
Check out his latest single ‘As Long As You Love Me’ below.

domain: celebrity


text:
Tuesday, September 25, 2007
Today we became tourists and hit Boston full force! I know you’ve all seen old buildings, so I’ll spare you those photos. (and plentiful they are) First, we took the “Duck” tour, a tour bus that goes on land and then into the Charles River. From there we saw many things, one of them being the ship the “Constitution”.
Next day we took the dry land tour trolley, as we were able to get on an off as we pleased. This allowed us to walk part of “The Freedom Trail” , where we saw and old graveyard and Paul Revere’s house. We also took time out to enjoy some nice dinners.

domain: geography


Furnace Circuit Board -- The furnace circuit board controls a variety of functions. It not only handles the regular operation of the furnace, it also monitors the furnace's various safety circuits. Over time, vibrations from the furnace can weaken solder point and cause them to separate. Dirt and debris can cause short-circuits that damage the board. Failure of the circuit board can cause a variety of effects ranging from the fan not turning on to the complete shutdown of the furnace.
I am NADCA Certified Air Systems Cleaning Specialist. Over the years I have learned on simple answer to this questions: there air duct cleaners and there are pretenders. There will be no benefit at all if you use on the very cheap pretender because they will not really clean anything. On the other hand if you call a qualified air duct cleaner with a NADCA Certification you will, like 99% of my customers, report improvement with your respiratory problems, you will see less dust and the job will pay for itself with energy savings and repair prevention.
Though this installation is not always complicated, it's best to work with an air conditioning contractor to ensure it's done correctly. Permits are usually required for this type of work and can be obtained by a state-licensed contractor. You should not attempt to install central air conditioning on your own since you need a license to handle the refrigerant chemicals (Freon) involved.
Be careful of dishonest HVAC contractors. There’s no magical formula to see if an HVAC contractor is scamming you, unfortunately, but remember that they typically do this in one of two ways: first, they are charging grossly low prices (far below everyone else), or second, they aren’t including what everyone else is. In the first situation, they will charge you change fees, other hidden fees, or they stole the equipment and are passing themselves off as legitimate contractors (very common in California these days). In the second situation, they are charging you a very fair price, but aren’t including what the other contractors are (i.e. charging $10,500 for the installation which is fair, but not including the ductwork which is a scam unless there is some other, complex stuff going on there).
Ventilating or ventilation (the V in HVAC) is the process of exchanging or replacing air in any space to provide high indoor air quality which involves temperature control, oxygen replenishment, and removal of moisture, odors, smoke, heat, dust, airborne bacteria, carbon dioxide, and other gases. Ventilation removes unpleasant smells and excessive moisture, introduces outside air, keeps interior building air circulating, and prevents stagnation of the interior air.
WELL, this summer when I opened them up we had black dust spewing from one of the upstairs vents. It resembled the fuzz that comes off new towels. This prompted us to look into duct cleaning. We heard from someone who had it done several times, said it was worthwhile, and knew of a firm that did a good job. Clean Air America sent a single technician for the appointment and after counting registers and ducts gave me a price of $360.00 which included “sanitizing” the system (a $99 additional fee per can used). The small size of the plenum forced him to connect the 8” round vacuum hose from the truck to the 10” square opening from our humidifier unit. In hindsight, a mistake since it reduced the “negative” pressure in the system.
Most people are now aware that indoor air pollution is an issue of growing concern and increased visibility. Many companies are marketing products and services intended to improve the quality of your indoor air. You have probably seen an advertisement, received a coupon in the mail, or been approached directly by a company offering to clean your air ducts as a means of improving your home's indoor air quality. These services typically — but not always — range in cost from $450 to $1,000 per heating and cooling system, depending on:


04 April, 2020
BCAA office closures
In an effort to protect the health and safety of our staff and our community, our physical office spaces are now closed. The team, working remotely, and are still operating as normal to service our clients. All staff can continue to be contacted by email, office phone or mobile phone as usual. See our contact list here.
We do not expect that this shift in the way we are operating to affect our clients' requirements. More details on safety measures implemented at BCAA can be found here.
We wish you good health and safety during this time.


text:
Our patient's testimonials
The patient's at My Similia share their stories of getting successfully treated from varied chronic diseases. Do read their wonderful journey towards health.
Chhaya Joshi -
I had allergic dermatitis over my back since 3 years which was not responding to any treatment. I was unable to visit any beauty parlors due to these allergies. Every time I came in contact with ammonia I used to get rashes. Online treatment helped me recover completely and I can visit freely to any beauty clinics without worrying for allergies.
Uploaded on 21-Sep-2017

domain: medical


text:
Updated: Nov 27, 2022
Baby, I want you to overdose on me…
I’ll walk miles barefooted in windy rain before I let go of love. Let our passion pour in between all the layers of me. Unearthing parts of me you keep learning… Your love became my home when you brought me peace in a world of wars.
Your love is what consoles me on dark nights when owls hoot their love between trees. Adoring my laidback personality… When I close my eyes my soul is clouded of our memories. Where laughter and joy greet us in the sight of each other. When the birds woke me from wet dreams of you. When my reflection, mirrored you. We’ve been the enigma of each other. The most fascinating form of love that continue to evolve into stories. Rebirthing this love in new lunars… I think, feel and breathe of you. I can taste you, and when I need hugs your touch embrace me. You taught me something I lost along the way, to love myself first. Which is why I couldn’t stay! You gave me the greatest love. Returning what was stolen in life proverbial phases. I only want to reward you in love.
Opening the corridor to new beginnings. Escaping mistakes and outgrown seasons… I became one with you from a distance. I felt your emotions entangled into mines, as one. I never been alone. I never been single. You captured my heart many years ago and the only thing I needed was nourishment.
You’re dwelling in the center of my passion. Everything I spawn is surrounded by love. You encouraged me to be better, to be stronger. Days when I’m feeling weak just the thought of you get me going. I only want to rest on your breasts, but never put this love to rest. I can’t let love die if I wanted to. Our love keep being reborn in segments. I’m not in charge of the universe’s destiny. Our love is the passion that will forever rotate in the galaxy… An explosion of passion. Out of our control, so why fight it… A passion forever burning, like magic… By Shana A. #shanaa #lesbianeroticpoetry #lesbianlove #lgbtq #lesbianromance #vacation

domain: literature


text:
KVL teams finish soccer seasons with a trip to state quaterfinals
The Kaw Valley League's two playoff teams didn't advance to the final four in Class 4-3-2-1A last week.
Bonner Springs fell to Maranatha Academy (Shawnee), 2-0, in the state quarterfinals Nov. 1, while Piper fell to Kansas City Christian, 2-1, in its quarterfinal game.
Bonner Springs ended its season at 15-4, while Piper finished the year at 11-6-1.
KC Christian went on to win the 4-3-2-1A state title with a 5-3 victory against Rose Hill on Saturday at Topeka's Hummer Sports Complex. Maranatha Academy defeated Trinity Academy (Wichita), 3-1, in the consolation game and placed third in the state.
In 6A, Olathe East won the state crown with a 2-1 victory against Blue Valley North in Olathe. Maize defeated Washburn Rural (Topeka), 2-1, in the consolation game.
And in 5A, St. Thomas Aquinas (Overland Park) won the state title with a 6-1 victory against Liberal at the Blue Valley Sports Complex in Overland Park. In the consolation game, Shawnee Heights (Topeka) defeated Kapaun-Mount Carmel in triple overtime, 2-1.
More like this story
- Face to Face: Tonganoxie's Derek Sparks
- Antler broker flourishes in his Delphos business
- Tonganoxie HIgh teammates sign to play volleyball on collegiate level
- Tonganoxie High School presenting 'Charlie Brown' musical
- Education focus: JCCC CDL training puts students in the driver's seat for a new career

domain: news


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I recently received a revised assessment notice for my residential property in Tallokas Trail Subdivision. The increase in assessed value was a shocking 15%. So my first move was to call the county assessor for an explanation. We had a lengthy, cordial conversation, and I will share what I learned with you. I made no notes during our conversation, so the following is stated to the best of my memory along with my occasional thoughts.
The state, and specifically the State Revenue Department, sets parameters into which the county’s assessed value of the actual sales value of properties must fall. Failure to maintain compliance with this requirement will result in a substantial fine to the county. This is required in every Georgia county to provide a stabilization standard to prevent numerous, and possibly unfair, assessment methods. The state receives no part of the property taxes resulting from these assessments.
The revised assessments were done on all residential and commercial properties. Without getting too detailed, the assessor’s office tracks sales in each subdivision and other defined areas over a specific time period. When the required number of sales in an area are made within that time period, a sales trend can be established. When the sales price trend exceeds the existing assessed values enough, the county’s assessed value must be raised to keep the ratio within the state’s parameters. The assessed values of all other properties in that subdivision, or identified area, are then adjusted in accordance with that sales trend. The same procedure applies to commercial properties, but the process is somewhat more involved.
Now why do you need to know this? Well, the amount of your property taxes is a function of the millage rates applied to the assessed value of your property. So if your assessed value increases with a constant millage rate, your taxes will increase. But there is an easy solution!
This county-wide assessment was done to bring the county into compliance with the state’s regulation, and not to raise more money for the county’s various governing boards. Therefore, I call on the County Board of Commissioners, the Colquitt County Board of Education and the City of Moultrie to roll-back millage rates to neutralize any increase in property taxes.
Businesses are hurting and many are closing. People are suffering. Many are getting fewer work hours and many have lost their jobs. Seniors are already struggling to make ends meet and can afford no more taxes. Now is not the time for increased taxes!

domain: finance


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The distance is 330 English miles, 80 of which, however, are performed by steam on the lakes Miösen and Losna. He lauds the civility and honesty of both postmasters and peasants. The scenery throughout is nowhere characterized by Alpine sublimity, though certain parts are almost grand. The Miösen lake forms the receptacle of the noble river Lougen, which has already run a course of 130 miles before it finds its haven of repose at Lillehammer. This lake is deficient in lofty background, and its banks are monotonous. “We miss those lateral vistas through which the eye may wander and the fancy speculate, until the receding ranges of mountains are confounded with the clouds." Further on we pass through the ravine of Kringelen, interesting to our countrymen as the fatal spot where Colonel Sinclair, who commanded a body of troops raised in Scotland in 1612, for service under Gustavus Adolphus, was cut off with almost all his men. Along this line, as indeed everywhere else in Norway, a marked peculiarity consists of the absence of villages, which, except it may be sparingly along the western coast, are scarcely known. The view of the Dovre-field is dreary enough even in summer, and when winter “rages loud and long,” must be wild indeed. It consists of a table-land of an average height of rather more than 3000 feet above the sea, with loftier mountains rising from it, some of them, as Snee-hätten, attaining to an elevation of 7000 feet or more. But the greater portion is of much lower height, and the summits being rounded, and the bases of great extent, the picturesque effect is inferior to that of most mountain chains of the same magnitude. The drive from Fogstuen (a solitary farm-house) across the table-land, is nearly level, and resembles the moorland scenery of some of our own wild highland wastes. The hollows are filled up by desolate tarns or dreary swamps, while the drier spots bear a stunted brushwood. The last station on the ascent of the Dovre-field is Jerkind, a substantial dwelling, possessed by people of some wealth, and standing at a height 3100 feet above the sea. For the occupation of travellers, who often pass this way, a separate
, building has been erected on the opposite side of the road, where, however, our philosopher found the management not so good as he had anticipated from previous report.
Snee-hätten rises from an already lofty base, about 14 English miles from Jerkind. The country is nearly trackless, and the traveller, or rather his sagacious pony, (we think again of Shetland, and its sure-footed shelties,) must "pursue the Arimaspian," through swamps and heather, amongst holes and shingle, dangerous for man or beast ; he must ford rapid streams, nearly ice-cold; and, worst of all, must pass over many large patches of treacherous snow, in which his pony will often founder up to
Summit of Snee-hütten.
the saddle. Although it requires about four hours' toilsome scramble to reach the base, the ascent of this field is so gradual, that an elevation of not more than 1900 feet is gained in that time, after a ride of not less than 14 miles. The ascent of the mountain itself is both disagreeable and dangerous, the foot sinking among interstices at every step," threatening dislocation or broken bones.” There is firmer footing near the summit, but the wind is very cold. The form of the mountain, as observed from the top, is that of a ridge running nearly east and west, precipitously broken towards the scuth, and sloping steeply in other directions.
“ The chasm on the south side has been compared to a craterthe mountain ridge bending partly round it like the cliffs of Monta Somma, with which in steepness it may compare ; whilst the elevation is much greater. It has been stated that a lake exists in the hollow, but at this time it was no doubt frozen, and concealed by beds of snow. The ridge itself is wildly serrated, and like the entire mountain is composed of a rather friable mica slate. The part on which we stood was a cone of pure snow, cleft vertically on the side of the precipice."-P. 21. “On our return to Jerkind, we supped on rein-deer soup, and found it excellent.”—P. 26.
The chiefest discomfort connected with Norwegian travel, arises from the melting of the snow at certain seasons. Not enough of it remains for sledges—too much for carrioles. The roads become snow-pits, not broad enough for carriage-wheels, and retaining pools of ice-cold water. In places where the snow is still deep, it has become incapable of bearing the weight of a horse, and the animal sinks to the girths or more, while the traveller, left to his own resources, endeavours to advance on foot, and plunges first one leg and then another into the chill abyss, and is only relieved by finding himself sitting astride upon a more compacted piece of snow, his extremities dangling in a too-refreshing stream of running water. The end of April and beginning of May are therefore the worst times to travel in Norway.
The passes of the Vaarstige, in the Dovre-field, present some noble scenery, scarcely Alpine, but comparable to the finest parts of the Scottish Highlands. The summit-level is soon after gained, and the onward journey is by descent to Drivstuen, a small hamlet basking on a sunny spot among productive meadows, overhung on both sides by precipitous mountains, and presenting fine
views of the ravine and lower valley of the Driva, adorned by the sweet tracery of birch woods, and their silvery stems. Here a large collection of country people had assembled for some object of local interest.
“We had consequently a good opportunity of observing the characteristics of the male inhabitants of this district of Norway. The opinion of a passing traveller ignorant of the language, is, perhaps, hardly worth stating ; but having some faith in physiognomy, I will venture to record my impression at the time, that I had never in any country seen so fine a peasantry, in point both of general appearance and of expression, as on this journey, and more particularly on the north descent of the Dovre. The younger men are tall and muscular, and their deportnient unites manliness with gentleness in a remarkable degree. . As the hair is worn long at all ages, the appearance of the aged men is venerable, and occasionally highly striking. The costume is extremely becoming, being of pale brown home-manufactured woollen cloth slightly embroidered in green, with a belt, curiously jointed with leather and brass, from which hangs a knife (also made in the rural districts) with a carved handle, which is used in eating. A hanging red woollen cap completes the dress. Some travellers declaim against the slowness and stupidity of the Norwegians. Slow they may be as regards the deliberateness of their actions, but, so far as the experience of this journey extends, I should describe them as in general more than commonly intelligent and courteous.”—P. 32.
In addition to this favourable testimony, and preceding it, we need scarcely refer to the well-known opinions of Mr. Laing.
Spruce and pine trees reappear in the valley of the Oerkel, the higher and preceding forest vegetation being birch. Those more sombre woods clothe the precipitous banks of a noble river, but a mountainous ridge must be crossed to the Guul, en route to Trondhiem. This town, though wide, regular, and well kept, is almost entirely built of wood. It is interesting as the most northern city of civilisation, latitude 63° 26'. Although the oak has ceased to grow, and few fruits come to perfection, it is a cheerful and pleasant place, and the culture of flowers, so strong an affection with Norwegians, is carried on with great success. Fine natural terraces, or “raised beaches," may be here examined, and have been well described by Mr. Robert Chambers, and other recent writers. No mountains of great elevation are visible from the shore, and the character of the scene again resembles that of our beloved Scottish Highlands, where the “great sea-waters” wind their restless way through long narrow inlets amid the silence of the lonely hills.
Northwards of this station Norway soon becomes little else than a mountainous shore, intersected by deep fiords, and guarded by great insular masses detached from the main-land. Ås roads almost immediately cease, it may easily be conceived how various and invaluable are now the uses of constant steam navigation for more than 700 miles northwards to Hammerfest.
"Taking advantage of this arrangement, I left Trondhiem with the companions of my journey from Christiania, on board the steamer
“Prinds Gustav,' bound for Hammerfest. Having been for a fortnight almost continually on board this well-appointed and well-officered vessel, I cannot but record my obligations to Captain Lous of the Norwegian navy, who commanded it, who exerted no common assiduity and no common talents, to render the voyage agreeable and instructive, to all his passengers, and for his courtesy to myself I retain feelings of the liveliest gratitude.”—P. 42.
The English friends or fellow-travellers with whom our Professor had journeyed hitherto, were on their way to the far
" north for salmon-fishing,” and they parted only under the 70th degree. We fear from the very casual and inadequate reference made here and there throughout his volume to this great subject, that Professor Forbes is not sufficiently impressed with the dignity and importance, either of angling in general, or of salmon-fishing in particular. Thus, while voyaging along a particular portion of the shore, he merely notes, that “the Namsen river, well known to English salmon-fishers, falls into the Folden-fiord.”-P. 44. And further onwards, in describing Reipas on the river Alten, as a very nest of mosquitoes, he observes :
“ But for my veil I should have passed a night of torment, and even with it I had great difficulty in falling asleep, from the loudness of their hum, the sharpness of their bite even through the veil, and the broad daylight, which, as usual, streamed in at all the windows. It appeared to me difficult to imagine that custom could reconcile any one to such a continuous infliction. Yet summer is a period so ardently desired by all, whether natives or strangers, who dwell in these high latitudes, that the plague of flies is perhaps considered an insignificant deduction from their gratification. More paradoxical still it does appear to every one but an angler, that the charms of sport should be sufficient to induce English gentlemen every year to spend their days and nights an unprotected prey to these savage insects; and, most unexpected of all, to find a delicate English lady surrendering herself to her husband's passion for fishing so completely, as to become a willing prisoner in this terrible locality.”—P. 95. What a charming creature she must have been! We wish
a we knew her.
Hestmando, or the Horseman's island, is interesting as commencing the entrance into the arctic circle. The existence of a peculiarly fresh and verdant vegetation is now perceptible, the result of rapid development by the unceasing presence of the sun. Though barren of aspect from a distance, the grass on Hestmando is knee deep. From the Bay of Rödö to the right, and onwards, the coast now rises with more than its accustomed majesty, and over the snowy summits of Fondalen, seen through the clearest air, the rich glow of an arctic summer's midnight prevailed in all its splendour, and detained the passengers on
deck, entranced by admiration of so solemn and glorious a scene. We are now in a region which, during the summer season, knows not night, at least if night means darkness,
“A sleepless summer of long light,
The snow-clad offspring of the sun." Of course, the great difficulty is to discover when to go to bed, especially in fine weather, while gliding so serenely over the smoothest water, among long serried ranges of fantastic islands, or into the still haven of the interior fiords, rock-bound, or bordered by the sombre majesty of immernorial woods.
“We lingered on deck," says our philosopher, " long after midnight had passed, and thus gained a sight of the magnificent headland of Kunnen, a mountain with an almost precipitous face towards the ocean, whilst its mass is connected with the mainland only by a strip of flat alluvium, giving to it the appearance of an island. During the whole night there was shed from the northern sky a warm sunset tint over the scenery- -sea, rock, and verdure, (for much beautiful verdure there is even here,) and snow, and glacier,whose continuing effect was indescribably harmonious and peaceful. Thus, in one day's voyage, beginning with Torghattan, and ending with Kunnen, we had enjoyed, under the most favourable circumstances of calm sea and cheerful weather, and a glowing midnight, an amount of majestic scenery, with which, in its kind, perhaps no European coast can compare.”—P. 53.
Although potatoes and barley are still successfully cultivated along these northern shores, and the flocks rejoice in green pastures, it is believed that less agricultural exertion is made than might be, especially in respect to winter provender, such as turnips, which must surely thrive well in Scandinavia, else the name of “Swedes” must be a misnomer. The venerable priest of Bodo, who had formerly resided as far north as Carlző, in latitude 70°, found that turnips throve there adınirably. Yet several degrees farther south the horses and cattle are fed in winter, partly on the dried leaves of the birch-tree, but chiefly on sea-weed, and the heads of boiled fish! The old clergyman admitted that much might be done in ameliorating the state of stock, but criticism was disarmed by his returning to the primary difficulty,--" here we have nine months of winter, and three weeks of summer!"
The coast scenery between Folden-fiord and the great western inlet, bounded sea-wards by the Lofodden Islands, is varied and magnificent, and is well described by Professor Forbes, in his own peculiar and observant way.
" As the steamer pursued its rapid course through a tranquil sea, and under the very rocks, new forms of mountains rose in succession,


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‘’Thanks to my family, friends, and fans for their interest and well wishes. I’m doing great and getting excellent care from my medical team. I will be out of the hospital and back home soon. Shout out to all the great medical professionals at Cedars. One love,’’ he shared on Tuesday night adding a photo of himself at a mixing board.
The 55-year-old ‘’California Love’’ performer is now stable, but doctors are still uncertain about what caused the brain injury. They are, however, administering all necessary tests to make sure they determine the root cause to avoid further problems.
A number of the star’s famous friends and collaborators shared their support on social media to console Dre’s family and wish him a quick recovery.
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The news of Dr. Dre’s brain injury came at a difficult time in the star’s life. His wife, Nicole Young filed for divorce in July last year after 24 years of marriage, citing irreconcilable differences. The two are parents to two adult children, son Truice and daughter Truly.
- Reality TV Star Kim Kardashian To Divorce Husband Kanye West
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Family Medicine | Medical Education | Pediatrics
This presentation is part of the PEER Liberia Pediatrics Lecture Series. It provides an overview for physicians of child development, including gross motor development, locomotor skills, fine motor development, speech and language, social and behavioral development, cognitive development, and developmental delays.
child development, motor skills, speech, language, social, behavior, developmental delays
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Copyright 2022 The Author(s)
DOI of Published Version
PEER Liberia Pediatrics Lecture Series
Bryant M. (2022). Child Development. PEER Liberia Project. https://doi.org/10.13028/vkjn-6g65. Retrieved from https://escholarship.umassmed.edu/liberia_peer/97

domain: psychology


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Back in 1964, the Beatles took part in a spoof of Act 5, Scene 1 of William Shakespeare’s “A Midsummer Night’s Dream” for Britain’s ITV network. For the record, Paul McCartney played Pyramus, John Lennon played Thisbe, George Harrison essayed Moonshine and Ringo Starr played the lion.
Yup. Really happened. They wore the traditional doublet and hose.
And as the “Beatles Bible” helpfully notes, McCartney even later named his cat Thisbe. Perhaps there’s a clue there as to how why McCartney has been talking of late as to who really broke up the band.
Either way, it’s certainly prima facie evidence of a bonafide connection between the Bards of Stratford-upon-Avon and Liverpool, as now exploited by the adaptive director Daryl Cloran, who has stuffed 23 Beatles songs inside the comedic vessel known as “As You Like It.”
This is how it goes: You get most of the traditional story, scenes and characters but then, at various points, characters break into everything from “Let it Be” to “When I’m 64,” as accompanied by a live band on stage.
It’s like a Shakespearean version of “Mamma Mia!” Only the Beatles were better lyricists than ABBA.
And this entire show works way, way better than at least this critic imagined it would. In fact, Chicago Shakespeare Theater’s production on Navy Pier is a total blast, a pandemic-blasting gust of fresh, joyous air that does the spirit good.
“Little darling, it’s been a long cold lonely winter. Little darling, it seems like years since it’s been here. Here comes the sun do, do, do. Here comes the sun. And I say it’s all right ...”
Yeah, yeah, yeah.
How is all this achieved? First, Cloran makes sure that the show is genuinely funny. And let’s be honest, most productions of “As You Like It” are not exactly knee-slappers. But this one has some exceptionally adept comic performers, especially Kayvon Khoshkam, whose exquisitely timed, emcee-like, tickling stick of a Touchstone comes off as a manic version of Elton John and really anchors the show.
Heidi Kettenring (who plays Phoebe, et al), Lachrisa Grandberry (Audrey) and Melanie Brezill (Celia) also keep the laughs coming, as does the band, posing on and off their podium to do their stuff. The milieu, as gorgeously rendered in Carmen Alatorre’s costumes) is one of wacky 1960s pageantry, replete with a psychedelic set from Pam Johnson. Much of the singing is a blast. Liam Quealy, who plays Orlando, drives his way through songs like “Do You Want to Know a Secret?” and “Can’t Buy Me Love.” He is also a very generous performance, since he helps Lakeisha Renee (Rosalind), a less confident vocalist but charming actor, find her way into the show’s musical demands.
But at the same time, Cloran (who co-conceived this show with the savvy Bard on the Beach Shakespeare Festival) doesn’t neglect the play’s emotional resonance. In this employ, he relies heavily on Kevin Gudahl (Duke Frederick) and, especially, Deborah Hay, who plays the sardonic Jacques.
Hay’s rendition of the famous “all the world’s a stage” monologue truly is a jaw-dropper. Looking like a Warholian Cassandra, Hay switches the mood of the theater on a dime and reminds us first why it remains important that we still have something called Chicago Shakespeare Theater and, second, that the big laughs of life invariably are undercut by the decline and death that awaits us all. As the actor Anthony Hopkins once remarked, “none of us are getting out of here alive,” and that awareness is a constituent part of all Shakespeare, comedies or otherwise.
Happily, it’s a consciousness that also shoots through Beatles lyrics, making the essential that this combination meal comes with thematic logic.
The best example of how Cloran puts things together? Jacques moving from “second childishness and mere oblivion” to “The Fool on the Hill.”
Hearing those two great artistic achievements together is alone worth the price of admission.
Ergo, you get a very accessible show (ideal for kids and teens who otherwise hate Shakespeare) and poignant resonances for the Shakespeare superfans. No small feat, that. Most productions manage only one. Plenty neither.
Other theaters already have this show on their docket. It’s a fine candidate, in fact, for Broadway.
Sure, you don’t get the whole play, but you don’t miss the rest (and rest assured it is still there for next time). The show finds just the right self-referential tone: characters say they are going to go hide “because it’s Shakespeare.” But unlike so many other textual mashups at this and other theaters, this one comes with a remarkable sense of unity, as if you can’t quite tell where the Bard is ending and contemporary lines beginning.
That’s because the Beatles were, of course, poets on a Shakespearean level, similar masters of high- and low-comedy, of sadness and ecstasy, joy and rebellion, populism and formative experimentation.
And, like Shakespeare, they knew all you need is love.
You know, given all the givens right now.
Chris Jones is a Tribune critic.
Review: “As You Like It”
When: Through Nov. 21
Where: Chicago Shakespeare Theater on Navy Pier
Running time: 2 hours, 40 minutes
Tickets:$49-$90 at 312-595-5600 or www.chicagoshakes.com
COVID protocol: Audience members must provide proof of vaccination, or a negative COVID-19 PCR test from the last 72 hours, or a negative COVID-19 antigen from the last 6 hours. Masks required in the theater.


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CFS currently has a 5 per cent target allocation to direct infrastructure for the younger members in its FirstChoice Lifestage membership.
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Magellan co-founder and chair Hamish Douglass has outlined areas of focus for investors as the US election creeps closer, warning there are ...

domain: economics


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The relationships between race and IQ is a sensitive topic for many good reasons. It also raises a lot of deep questions about how to assess the role of genetics and environment. A good summary of the literature on Intelligence with a discussion of racial differences can be found in the article "Intelligence: Knowns and Unknowns" (FREE PDF). Within-group ...
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