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Adherence to and acceptability of artemether-lumefantrine as first-line anti-malarial treatment: evidence from a rural community in Tanzania
Malaria Journal volume 9, Article number: 48 (2010)
Controlled clinical trials have shown that a six-dose regimen of artemether-lumefantrine (AL) therapy for uncomplicated Plasmodium falciparum malaria results in cure rates >95% with good tolerability.
Materials and methods
A prospective study was carried out to document the adherence to and acceptability of AL administration. This was undertaken in the context of the ALIVE study, a prospective, community-based, observational study in a rural, malaria-endemic area of Tanzania. Following microscopic confirmation of P. falciparum infection, the first AL dose was taken under supervision, with the subsequent five doses taken unsupervised at home. Patients were randomized to receive a home-based assessment close to the scheduled time for one of the unsupervised doses, but were blinded to which follow-up visit they had been allocated. A structured questionnaire was administered by trained staff and AL consumption was confirmed by inspection of blister packs.
A total of 552 patients were recruited of whom 352 (63.8%) were <13 years old. The randomization process allocated 112, 109, 110, 100 and 111 patients to a follow-up visit after doses 2, 3, 4, 5 and 6, respectively. For dose 2, 92.0% of patients (103/112) correctly took AL at 8 ± 1 hours after dose 1. The remaining doses were taken within four hours of the correct time in 87-95% of cases. Nine patients (1.7%) missed one dose. Blister packs were available for inspection in 548 of cases (99.3%) and confirmed patient-reported data that the previous dose had been administered. Nearly all patients took AL with water (549/552 [99.5%]). Two patients (0.4%) took the drug with food. The dosing pictogram and clustering of tablets within the blister packs was considered helpful by 91.8% and 100.0% of patients, respectively. Overall, 87.1% of patients (481/552) found AL easier to take/administer than sulphadoxine-pyrimethamine (SP) and 87.7% (484/552) believed that AL was more effective than SP.
Factors contributing to adherence were likely to be helpful packaging, pictorial dosing instructions and patients' conviction that AL is effective.
Adherence to the dosing regimen and timing of AL administration was very good.
Malaria is the leading cause of outpatient and inpatient admissions in most sub-Saharan African countries, including Tanzania, and continues to exert a high burden in terms of mortality [1–3], morbidity [1, 4] and health expenditure [5, 6]. The use of anti-malarial drugs for chemotherapy and chemoprophylaxis is a critical component in the fight against malaria, but Plasmodium falciparum resistance to conventional anti-malarials, such as chloroquine and sulphadoxine-pyrimethamine (SP), is high [1, 7–10]. It is for this reason that the World Health Organization (WHO) has been recommending artemisinin-based combination therapy (ACT) as first-line therapy to replace failing anti-malarial drugs .
The ACT artemether-lumefantrine (AL, Coartem®) combines the short-acting artemisinin derivative artemether with long-acting lumefantrine. Giving the second dose of AL eight hours after the first dose quickly achieves and maintains the blood concentration of artemether above the minimum effective concentration  to help ensure that malaria parasites are exposed to high levels during the middle third of their life cycle, when they are most susceptible to anti-malarial agents . AL has demonstrated a high level of efficacy and a good tolerability profile [14–18]. As a result, the national treatment policy of Tanzania was revised in November 2006 to adopt AL as first-line treatment for uncomplicated malaria.
AL is administered as a six-dose regimen over a period of three days . Controlled trials using this regimen have demonstrated cure rates of over 95% [20–23], consistent with recommendations from WHO that cure rates for uncomplicated P. falciparum malaria should be at least 90% and preferably exceed 95% . Evidence regarding the adherence to the AL dosing regimen and feasibility of its use in programmatic conditions remains limited [24–29]. Nevertheless, proper evaluation of adherence and acceptance outside the context of controlled clinical studies is important as AL is widely deployed throughout malaria endemic sub-Saharan countries.
Following the inclusion of AL within the national Tanzanian treatment policy, the ALIVE ('artemether-lumefantrine in vulnerable patients: exploring health impact') study was undertaken in a rural, malaria-endemic area of the country with the aim of evaluating the impact of introducing AL as first-line malaria treatment on malaria-related morbidity and mortality. As part of ALIVE, a prospective study was conducted under routine conditions to document the adherence to and acceptability of AL drug administration in this setting.
The ALIVE study
ALIVE is a prospective, observational, community-based, longitudinal, demographic surveillance study taking place in two rural districts of Tanzania (Ulanga and Kilombero). The primary objective is to assess the effect of AL on all-cause mortality in infants and children ≥3 months of age (and >5 kg) and <5 years old, using historical data based on the former first-line treatment with SP as comparator. Secondary objectives include assessment of adherence to the AL regimen, knowledge of correct AL intake and patient satisfaction.
The conduct of the ALIVE study complies with the Declaration of Helsinki. The study protocol was approved by the institutional review board of the Ifakara Health Institute (IHI), which implements the ALIVE study, and the Tanzanian National Institute for Medical Research (NIMR).
Administration of AL
As per the instructions from the manufacturer (Novartis Pharma AG, Basel, Switzerland), AL is dosed according to body weight: 5 to <15 kg, one tablet per dose; 15 to <25 kg, two tablets per dose; 25 to <35 kg, three tablets per dose; ≥35 kg, four tablets per dose. The first two doses of AL are to be given eight hours apart on day 1. On days 2 and 3, AL is to be given twice daily, 12 hours apart; with the morning dose being administered 24 hours after the first dose was taken.
In this study, the first dose of AL was taken under supervision at the health facility, with the subsequent five doses taken unsupervised at home. Dosing and time of taking/administering the drugs was explained and the time was clearly marked on the AL blister packs by the dispensing healthcare provider. Patients or caregivers were advised to ensure AL was not taken/given on an empty stomach.
Assessment of adherence and acceptability
Assessment of adherence to and acceptability of AL was conducted within the context of the ALIVE study and was undertaken at the Mlimba Health Center in the Kilombero District during the period March to April 2008, i.e. approximately one year after the new treatment policy was introduced in Tanzania (January 2007). Patients living in villages no further than six kilometers from the Mlimba Health Center were eligible to take part in the assessment if they had no clinical signs of complicated malaria and P. falciparum infection was confirmed by blood smear. Informed consent was obtained from all patients.
A computer-generated randomization list was used to allocate eligible patients to a home visit for one of the five doses of AL to be taken after the initial, supervised dose. It was planned that all patients be visited at home at a time close to the scheduled time of AL administration. In the event that patients were due to be visited late in the evening or at night following an evening dose, visits were scheduled for the following morning. Patients or caregivers were informed that there would be a follow-up visit but were blinded as to which of the five possible follow-up visits they had been allocated.
Each visit was undertaken by one of two IHI field workers or three local field assistants, after appropriate training based on standard AL training materials provided by the drug manufacturer (Novartis) which had been field tested by researchers from IHI in Ifakara. For patients younger than 13 years, the patient's caregiver was interviewed instead of the patient.
A structured questionnaire (see Additional file 1) was developed by researchers from IHI and the Swiss Tropical Institute and Novartis, after which it was field tested by researchers from IHI in Ifakara, and then administered to the patient or caregiver at each visit. This included questions on the number of doses to be administered, the number of tablets per dose, the exact time at which the last dose was given, reason for any missed doses, appropriate action if a dose was vomited, consumption of concomitant food or drink at the time of AL dosing, and how patients/caregivers remembered that AL doses should be taken. Additional questions included whether the instructions/drawing on the AL pack were considered useful, how patients/caregivers perceived the clustered doses in the blister packs, how easy it was for them to take/administer AL, how effective they judged AL as compared to SP (the previous first-line therapy for uncomplicated malaria in Tanzania), and their preference for AL over other treatments (antibiotics, analgesics/antipyretics, quinine injection, herbs from traditional healer or remedy from witchdoctor). Consumption of the dose was confirmed by inspection of the AL blister packs.
A total of 552 patients met the eligibility criteria and were recruited for the study (Table 1). The majority of patients (352/552 [63.8%]) were aged less than 13 years. All included patients had come to the medical facility to seek medical attention for fever. Almost all patients (544/552, 98.6%) were reported to be unwell or moderately unwell at the time of presentation to the health facility.
The randomization process allocated 112, 109, 110, 100 and 111 patients to a follow-up visit after doses 2, 3, 4, 5 and 6, respectively.
Adherence to AL
AL was dispensed at the Mlimba Health Center in all cases. When asked, 100% of patients/caregivers reported that they had received an explanation of how to use AL. Results of the questionnaire confirmed that all patients/caregivers understood the number of doses required, and the number of tablets that should be taken/administered per dose (Table 2). All but one patient responded that five doses in total were to be taken, an answer that was correct when referring only to the doses for which they were responsible (the first dose was given by the healthcare provider). AL was taken at the correct time in approximately 90% of cases for each dose (Table 2). For dose 2, 92.0% of patients (103/112) took AL at 8 ± 1 hours after dose 1. The remaining doses were taken within four hours of the correct time in 87-95% of cases. In total, nine out of 522 patients (1.7%) reported missing a single dose of AL. In two out of these nine cases, the patient had forgotten to take the final dose. One patient used the intended dose to replace a dose vomited previously, and one patient ceased to take the drug after vomiting. In the remaining five patients there was no apparent reason for missing prescribed doses. AL blister packs were available for examination at the randomized visit in 548 cases (99.3%), and the reported number of doses taken corresponded with actual pill count at each visit. No patient missed more than one dose, and no patient missed dose 2. In case of a dose being vomited, the majority of patients correctly understood that they should return to the health facility for a replacement dose (316/552, 57.3%). However, a relatively high proportion of patients (42.7%) incorrectly believed that a replacement dose could be taken from the existing blister pack or that no action was required.
Nearly all patients took AL with water (549/552 [99.5%]). Two patients (0.4%) took the drug with food. The most frequently reported factor that positively influenced adherence to the timing of AL dosing was the impact of the current illness (Table 2).
Acceptability of AL
Almost all patients (91.8%) found the dosing pictogram helpful, and all patients reported that clustering of tablets within the blister packs was useful (Table 3). In total, 87.1% of patients (481/552) found AL easier to take/administer than SP and 484/552 (87.7%) believed that AL was more effective than SP (Table 3). Approximately 90% of patients (495/552) would not have preferred other medications than AL to treat the current illness, although 5.6% (31 patients) would have chosen quinine injections. Two patients would have preferred to receive herbs from a traditional healer.
Adherence to the standard AL regimen was very good in this population of patients in a rural area of sub-Saharan Africa. The full six-dose regimen was taken by 98% of patients, with the dose being taken at a satisfactory time in ~90% of cases. These results were obtained without any additional training for staff at the dispensing health center beyond the standard National Malaria Control Programme training initiative, and no special guidance was given to patients other than that which is routinely offered by the local healthcare personnel. The proportion of patients taking all five unsupervised doses was consistent with other reports for ACT in general [24, 25] and AL in particular [26–29]. This is, however, the first study to provide data related to the timing of AL administration, and the first to apply a randomized study design to the assessment of AL adherence.
Although multiple doses of AL are required, there is no need for individual dose calculations according to body weight; instead, complete treatment packages are available for each body weight group. Thus, AL is simpler to prescribe than SP, the previous first-line therapy, which requires weight-adjusted dosing. However, patients need to take five doses of AL unsupervised over a three-day period compared to a single dose of SP. The findings, however, indicate that adherence to the AL regimen is very good following standard instructions from the dispensing healthcare provider, as confirmed by pill counts at the randomized visits. According to the patient responses to the questionnaire, the clustering of tablets for each dose within the AL blister packets is likely to have contributed to the correct number of tablets being taken, and the pictogram shown on the packaging was considered as a helpful supplement to the instructions provided by healthcare workers. The pictogram made the timing of drug administration clear in this rural area where few individuals have a clock or wrist watch . Care should be taken, however, that dispensing staff explain that the 'sun' and 'moon' symbols refer to daytime and night-time, and not sunrise and sunset as believed in a few isolated cases among the study population. Finally, the wide-held response that AL is effective may also have played a role in supporting adherence to the regimen.
It was notable that responses indicated that AL was virtually never taken with food, despite the fact that health providers emphasized that AL works better if not taken on an empty stomach. Based on responses to the question about timing of tablet intake, it appears that some patients may have eaten shortly before or after taking the AL dose and did not consume additional food at the time of dosing, but specific information was not collected. It is encouraging, however, that a recent analysis of data from a large-scale study of AL in five African countries found that although concomitant food intake increased lumefantrine absorption in children with malaria, there was no tendency for lower food intake in the few patients in whom treatment failure was recorded . Indeed, all 37 patients who were unable to eat food with any dose achieved PCR-corrected cure at day 28. Nevertheless, food consumption, or resuming food consumption as soon as possible, at the time of AL dosing remains advisable in order to maximize effectiveness, in view of the observed association between lumefantrine exposure and clinical and parasitological outcomes . This can, of course, be challenging since initially patients may be reluctant to eat due to symptoms of nausea and vomiting during the acute phase of malaria.
Fewer than 60% of patients or caregivers understood the need to return to the health clinic for a replacement if a dose was vomited. Although the number of patients in whom a dose was reported to have been vomited was low (n = 2), the findings that more than 40% of patients or caretakers did not know what to do if this happens is of concern.
The current findings provide detailed evidence of the timely intake of AL under programmatic conditions. Other analyses of unsupervised adherence have all involved home visits after the three-day course was completed [26–29]. Encouragingly, however, no study has reported fewer than 90% of patients taking all six doses by the end of the three-day treatment period, based on pill counts. In this case, it was possible to validate oral information about pill administration in over 99% of cases, and found no difference between reported consumption and the remaining number of pills. Such validation is essential given the known limitations of self-reporting . The findings of this study concur with those described recently by Bell et al, based on a study in Malawi in which children or adults with uncomplicated P. falciparum malaria were randomized to receive AL or chorproguanil-dapsone . Of the patients randomized to receive AL, 100% reported correct pill consumption during oral interviews. However, in a subpopulation of 87 patients in whom pills were dispensed from an electronic pill container that recorded the time of opening, Bell et al found that the rate of adherence was only 92%. Thus, the adherence rate obtained using this different measurement approach was the same as that observed in this study population (92%), where we assessed adherence by randomized, scheduled visits shortly after each dose was due to be taken. Clinically, the high adherence rates observed when AL is self-administered after the first dose have been shown to result in excellent efficacy rates irrespective of whether the drug is given supervised or unsupervised .
Certain aspects of the study design merit consideration. The study was undertaken in the context of routine use of AL therapy in a rural area of sub-Saharan Africa. The healthcare providers who dispensed AL did not receive any special training in addition to the standard training provided through the National Malaria Control Programme, when first-line treatment with AL was introduced, approximately one year prior to this assessment. Also, the randomization approach helped ensure comparability of groups for each AL dose assessed, and minimized the influence of interviews by avoiding expected or repeated visits. However, we are aware that responses may be due to the phenomenon that patients or caregivers provided answers they thought would be expected or desired by the interviewer. Whether or not a pill had been removed from the blister pack could be checked through pill counts, but other questions - e.g. those in which the acceptability of AL was compared to other treatment options - could not be validated. Furthermore, responses for children under 13 years were given by parents or caregivers, not by the patient. Therefore, the views expressed in cases of children under 13 are those of their parents/guardians and may not necessarily reflect the patient's perspective. We also recognize that the questions posed could be refined, particularly those which resulted in 100% or near-100% responses, such as 'Was the clustering of AL doses useful to remember how to take the drug?'. Moreover, there is a need to standardize questionnaires that assess adherence and acceptability to improve the quality and subtlety of the information gained and to improve comparability between studies.
In conclusion, adherence to the AL regimen as standard first-line treatment of uncomplicated P. falciparum malaria was high among this rural study population. Patients adhered closely to the dosing regimen, partly due to effective packaging and pictorial dosing instructions and to patients' conviction that AL is effective. These results may be helpful for future training of healthcare providers by National Malaria Control Programmes in sub-Saharan Africa before and during implementation of ACT therapy as first-line anti-malarial treatment.
Conflicts of interests
Funding for this study was provided from Novartis Pharma and Novartis Foundation for Sustainable Development. A M Kabanywanyi, B Genton and C Lengeler received honoraria and travel expense reimbursement from Novartis Pharma to present study findings at various international conferences. R Schlienger and N Mulure are employees of Novartis Pharma. P Kasim and S King'eng'ena have no conflicts of interest. A medical writer, funded by Novartis Pharma, provided editorial support based on the draft manuscript prepared by A M Kabanywanyi.
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We are grateful to the healthcare providers at Mlimba Health Center for their support. We thank F Mpolo, S Salehe and B Kasongolo for their invaluable time in conducting interviews. We extend our gratitude to all members of the Mlimba community for their participation in the study. We also thank Anne-Claire Marrast, Marc Cousin, Chemtai Kipkeu, Fiyinfolu Oladirani and Jacqueline Mills of Novartis for their contributions, as well as Alex Schulze of the Novartis Foundation for Sustainable Development for his input to the manuscript.
AMK contributed to study design, was a study investigator and drafted the manuscript for input by the other authors. CL participated in questionnaire design, data interpretation and writing of the manuscript. PK and SK undertook data collection. RS contributed to study and questionnaire design and provided input to the manuscript. NM contributed to questionnaire design and acted as the medical advisor to the project. BG contributed to study and questionnaire design and provided input to the manuscript. All authors read and approved the final manuscript.
Electronic supplementary material
Additional file 1: Questionnaire. COA566A2422/ALIVE: A community-based study to assess the impact of Coartem (ALu) when used as national policy first-line treatment on malaria mortality and morbidity in Tanzania (DOC 108 KB)
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Cite this article
Kabanywanyi, A.M., Lengeler, C., Kasim, P. et al. Adherence to and acceptability of artemether-lumefantrine as first-line anti-malarial treatment: evidence from a rural community in Tanzania. Malar J 9, 48 (2010). https://doi.org/10.1186/1475-2875-9-48
- Falciparum Malaria
- Pill Count
- National Malaria Control Programme


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With 2 bedrooms and 1 bath this California Arts and Crafts bungalow has been newly infused with modern details and style. The original features create charm and character but have been designed and modernized for easy living. The living room features dark stained wood floors, charming fireplace and period woodwork. Amply sized, the dining room features boxed beam ceiling and charming build-in cabinet. Fully renovated, the open kitchenâs stone counters, farm sink, and gas stove are gracious additions to the home. Updated and tiled, the bath features shower over tub and pedestal sink. The front bedroom is perfect with picture molding and the master has a large closet and leads out via French doors to the decked garden and modern newly constructed separate office. Creating indoor/outdoor living at its finest, the rear yard is accented with built-in patio seating perfect for Sunday lounging or summer entertaining. Near shopping and freeway access and Bart.
Visiting her home town of Oakland, Gertrude Stein said, “There’s no there there.” With all the changes over the past decade, Oakland has finally become a destination of its own. The Uptown Project, Jerry Brown’s 10K Housing Initiative, new housing development and the rising value of condominiums, lofts and single-family homes have contributed to Downtown Oakland’s success.
Downtown is the heart of Oakland, and the city’s changes are most evident here. San Francisco Magazine named it "the" place to live and play. The area now offers all the benefits of other metropolitan centers. Civic and cultural centers, residential and retail buildings—both new and historic&md...
More About Oakland


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The White House has invited recently retired NFL Coach Tony Dungy to join the Advisory Council for the Office of Faith-Based and Neighborhood Partnerships, Dan Gilgoff reports.
Dungy led the Indianapolis Colts to the Super Bowl in 2007. Known for his strong Christian faith commitment to family, Dungy retired to spend more time with his family and in volunteer work. He has long been involved with groups like Family First, All-Pro Dad, Fellowship of Christian Athletes and the Prison Crusade Ministry, Big Brothers Big Sisters, and the United Way.
Christianity Today's Stan Guthrie recently interviewed Tony Dungy (listen here). CT also covered Dungy in "A Kinder, Gentler Coach" and "Christian Coaches Face Off for Super Bowl XLI."
Support Our Work
Subscribe to CT for less than $4.25/month

domain: news


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Poll: Who wins B’s-Caps Game 7?
|04.25.12 at 8:01 am ET|
The Bruins are back where they found themselves three times last season en route to their Stanley Cup championship: Game 7 of a playoff series. How do you think Wednesday’s game will play out?
Who wins Bruins-Capitals Game 7?
- Bruins in a close game in regulation (59%, 153 Votes)
- Bruins in a rout (18%, 47 Votes)
- Bruins in overtime (14%, 35 Votes)
- Capitals in a close game in regulation (6%, 15 Votes)
- Capitals in overtime (3%, 7 Votes)
- Capitals in a rout (0%, 1 Votes)
Total Voters: 258
- Tuesday Morning Skate: 71 million new things to talk about
- Hockey's Culture of Revenge
- Fresh Links: Homecoming Edition
- Monday Morning Skate: Survivor Alberta
- Dougie Hamilton headed back to Boston; Miller OK; could Boychuk be back?
- Bruins vs. Maple Leafs Recap: Bruins win 5-2, Kevan Miller scores first...
- Public Skate: Third Period, Bruins 3 Leafs 1

domain: game


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NAGATO, Japan >> One of my relatives was once detained in Siberia during World War II.
He returned to Japan through Maizuru Port in Kyoto Prefecture in the mid-1950s. He had no opportunity to see the devastated state of Japan, and yet he was beaten by his family when he asked them whether the damage Japan suffered from the war had been small.
So when I heard of the story of Painter Yasuo Kazuki (1911-74), who was from the Misumi district of Nagato, Yamaguchi Prefecture, and returned home from Siberia through the port in May 1947, I was intrigued.
Kazuki later produced the “Siberia Series” of paintings based on the memory of his detention. The series is owned by Yamaguchi Prefectural Art Museum.
|SENZAKI PORT WELCOMED THOUSANDS HOME
Senzaki Port in Nagato, Yamaguchi Prefecture, was one of the ports chosen to receive ships carrying people detained abroad after the war.
Maizuru Port in Kyoto Prefecture and Hakata Port in Fukuoka were other such ports.
By the end of 1946, about 410,000 people had returned home through Senzaki Port.
Nearby temples and schools were used to house detainees, while others stayed in the homes of nearby civilians.
A memorial at the port honors the detainees who landed there, while a photography studio nearby exhibits pictures that show the conditions of the bygone era.
His small works which were the basis for the “Siberia Series” were on display at the Kazuki Yasuo Museum in Misumi, along with his sketches.
The exhibition, titled “Watashi no Shiberiya, Sore zore no Shiberias” (My Siberia, each of our Siberias) was on exhibit through Oct. 14, as part of a collaboration with the Memorial Museum for Soldiers, Detainees in Siberia and Postwar Repatriates in Tokyo.
Though Kazuki is known for his earth-toned abstract paintings and portraits of people with blank looks, he also created contrasting works — wood-block prints of soft-colored pretty flowers.
Kazuki, who traveled to Europe and throughout the South Pacific, produced dolls from wood offcuts, rusty iron plates and other waste materials.
The museum features a skylight, designed by his architect son to create an environment similar to the artist’s light-filled studio.
“I feel affection and warmth in his works,” said Ito Maruo, 42, a curator at the museum. “Kazuki must have been a sensitive person, and he had his own joyful world, too,” Maruo said.
Near the museum is Yumen onsen, one of the hot spring areas that is sustaining the bathing culture of Nagato. Legend has it that a wounded rabbit cured itself with spring water at this hot spring.
After taking an outdoor bath at Yumen Fureai Center, an onsen facility, I headed to the Seifu Murata Memorial Museum. Murata was a prominent figure in the reformation of the Choshu domain at the end of the Edo period (1603-1867).
Misumi Sanso, the former residence of Murata, is a national historical site. The main building with a thatched roof has a unique charm.
In April, the first “michi no eki,” a roadside rest area, was opened on the beach side of Senzaki in the city of Nagato. Called Senza Kitchen, it comprises a variety of eateries including those selling the local specialties of yakitori or himono dried fish.
“Nagato is now enjoying some momentum,” said Yoshiko Nono, 45, of the Nagato Tourism Convention Association.
The number of tourists sharply increased at Motonosumi Inari Shrine after it was featured on CNN in 2015. Last year, 1.08 million people visited the shrine, which overlooks the Sea of Japan.
As I arrived at the shrine in the evening, the red torii gates looked beautiful against a backdrop of the sky and sea.
According to shrine priest Yoriki Okamura, 70, the line of 123 torii gates was completed three years ago. “We increased the number of gates as a way to show our gratitude to people who helped with weeding at the shrine before the bon season.”
An offering box is affixed 16 feet off the ground at the torii gate located at the highest point. It took me four tries to get my five-yen coin to land in the box.
A sunset visit to the Higashiushirobata Tanada rice terraces yields views of the isaribi fires burning on fishing boats, luring the glowing squid to fishermen.

domain: artistic


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Harry Potter by J.K. Rowling
Excellent that is the best word to describe this series. a great read for all ages! it no way encourages the practice of witchcraft it is just a set of books that will get everyone into reading.... my sister did not read one book until this series came out because she's dyslexic but now u will never see her without a book close --- that's how good these books are.
Submitted by BooBoo Tayls@Aol.com
I have read many books and series, and many of them were wonderful. But the Harry Potter series, seemed to top them all. It is packed with imagination, and she knows how to keep a reader's interest. People seem to think that the books get darker as Harry proceeds through his magical education, and that might be true. But it is not something that children can't read. Finally there is a book, that adults and children can enjoy. If I could give the books a rating, I would give it the highest possible. I can't wait till the next book comes out!
Submitted by Anonymous
Hi! I am 13 years old. I absolutely love every single one of the Harry Potter books! J.K. Rowling is the best writer ever! And I mean it! She puts so much detail on every single word that I feel like I am actually there. I am actually disappointed that I am not a wizard. Haha! But, I just know that Danial Radcliffe is going to be awesome Harry Potter! If you don't think you will like the Harry Potter books, you are making a big mistake! I have read every book at least 10 times! I never get tired of them. Please, if you haven't read them! You will see what I mean! Thanks! From, JA
Submitted by Anonymous
When I first picked up the book Harry potter and the sorcerers stone I thought "how stupid people are to read about this witchcraft" But I read the first chapter... just to see what it was like, I couldn't put it down... I went from being a couch potato to being a very fast reader.. for instance today I started reading the third book (for the second time) and read it in three hours (seriously!)J.K.Rowling is SUCH a great author that when your finished with the series, You think that you can take platform nine-and-three-quaters in London to Hogwarts. I'm impatiently awaiting the Harry Potter and the order of the pheonix and the movie (VERY IMPAIENTLY) Keep it going J.K. Rowling..you are the best author, that I have ever heard of. I have a friend. her parents think its a very bad book because its got (witchcraft as you call it) in it. I told her it was nothing bad, and Now Her Parents Are Reading It! I absolutely love Harry, Ron, and Hermoine's adventures..And like Hermoine, I have memorized the books! :)
Submitted by Anthony
I love the Sorcerers Stone because Harry defeats Professor Quirrel and the quidditch game that was awesome and the way Ron played chess was great.Hermione was very smart.I just finished the book today.Now, I've started on the chamber of secrets, so far it is great, I'm on chapter 2.I'm getting the third one tommorow.I can't wait till J.K. Rowlings comes out with the fifth one.I hope there's hundreds more to come out.At first I was reading books by C.S. Lewis, but they got boring.When I found out about Harry Potter I was amazed.I think people should read because it helps you with your vocabulary, I'm ten and its helped me.

domain: entertainment


|Also Known As: ||
||October 28, 1927
||Cause of Death:
||Middlesex, England, GB
RATE AND COMMENT
Cast as an extra in "The Thief of Baghdad"
Began her career as a singer and actress in the 1950s
Made her TV debut on "The Benny Hill Show" (BBC)
Performed in the musical adaptation of Ronald Firbank's novel Valmouth
Appeared as a singer in "The Third Alibi" and "The Roman Spring of Mrs. Stone"
Appeared in the play "A Time to Laugh" with Robert Morley and Ruth Gordon
Won raves for her album Shakespeare and All that Jazz
Along with husband John Dankworth, founded The Stables Theatre
Cast as Julie in a production of "Show Boat" at the Adelphi Theatre in London
Launched her career in the U.S. with a concert at New York's Lincoln Center
Starred in the musical "Colette" at the Comedy Theatre in London
Released Cleo at Carnegie: The 10th Anniversary Concert; won Grammy Award for Best Jazz Vocal Performance, Female
Appeared with Frank Sinatra for a week of concerts at the Royal Albert Hall in London
Published her autobiography Cleo
Made a cameo appearance in the HBO movie "The Last of the Blonde Bombshells" opposite Judi Dench and Olympia Dukakis
Featured in the British documentary series "Legends"


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BRIO My First Railway Light Up Rainbow Set Review
This interactive toy train set introduces toddlers to basic sequencing and “cause and effect” patterns in a fun and engaging way. The aim of the game is simple – light up the rainbow with all of its beautiful colors. To do so, just follow the blinking lights on the tracks with the little wooden train. Each time you correctly follow the lights through the cloud and complete the challenge, the rainbow will light up one of its four colors and a cute melody will play.


Marcelo Cruz is one lucky guy. Cruz, a wheelchair user, was going across the Minneapolis bridge that collapsed on Wednesday. He was on his way to a wheelchair racing class when he felt the bridge buckle. "The bridge started shaking like an earthquake. I saw the bridge going up and down a little bit," he told reporters. Then he saw people hanging on the side of the bridge, and then he realized the bridge’s incline was now so steep he couldn’t brake his van. So he drove his van into a concrete barrier and finally, it came to a stop. Because of the steep incline of the bridge, Cruz couldn’t get out of the van by himself, but was able to get help from two other men, and then made it to safety.
Lucky, lucky guy.
I’m drawn to stories like Cruz’ for a few reasons. First, of course, what happened in Minneapolis is horrific, so much like 9/11, and can happen anywhere. True, Hurricane Katrina was more of a disaster, but I live in Pennsylvania. Hurricanes happen elsewhere. But we have a lot of bridges here. And now, like many others, I’m going to speed up when I’m crossing one. Second, I’m drawn to Cruz’ story because it’s such a typical human story. We like to identify with survivors -- they're “every man.” The stories of those who die are heart-breaking and compelling and make us cry, but the stories of those who live … they’re about all of us because everyone alive is a survivor of something. And third, hey, Cruz is a guy with a disability, a wheelchair-user with an SCI.
Let’s look at that last point a bit more.
There’s a core of folks in our community, and I’m one of them, who think deeply about how the general public’s attitudes toward disability is reflected by the media. We work with media outlets to get them to see our lives the way we do – which, yes, varies from person to person … which, actually, is kinda the point. Yesterday saw a flurry of e-mails among media activists examining how Cruz’ story has been handled by the press. Yes, some reporters said he’s confined, some said he’s bound. Some said he’s a quad, some said he’s a para, some just said he’s paralyzed. Let’s put all that language stuff to the side for a minute and look at some other stuff they said.
Newspapers around the nation reported that a guy, just a guy, who happens to use a wheelchair, through quick thinking and decisive action survived a horrific disaster that is reminiscent of 9/11. No one’s surprised he had his own van, no one questioned whether he should have been driving by himself. And his story is portrayed as one of many beautiful survival stories, like the ones about the young woman who helped save school children, and so on and so forth.
Here’s the bigger story Cruz is part of: People, just people, were put under enormous pressure to survive. And people, as people tend to do, rose to the challenge. At least one of those people, and this is no surprise, was a guy with a disability who happens to use a wheelchair.
In the early 1900s, the first pens with http://www.deluxe4less.com matching pinwere made to wear on a lady'slapel. In 1915, the lapel [url=http://www.deluxe4less.com]fake pens[/url] was improved: The watch face was upside down so the replica pens wearer could read it more easily http://www.deluxe4less.com.


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LeptoVax® 4 Canine Vaccine 25x1ml
For subcutaneous vaccination of healthy dogs, six weeks of age or older, as an aid in the prevention of disease caused by Leptospira canicola, Leptospira grippotyphosa, Leptospira icterohaemorrhagiae and Leptospira Pomona. Leptospira Canicola-Grippotyphosa-Icterohaemorrhagiae-Pomona Bacterial Extract
Not intended for use as diluent for live vaccines.
Dosage and Administration:
Dogs, inject one 1 mL dose subcutaneously using aseptic technique. All dogs 6 weeks of age or older should receive one dose of LeptoVax® 4 and a second dose 2 to 3 weeks later. Annual revaccination with one dose is recommended. The PEEL-OFF LABEL I.D. SYSTEM provides a simple and effective method of recording pertinent information on the vaccines administered to animals in a veterinary practice. For vaccines requiring reconstitution, remove label from both vials and affix both labels to the animal's medical chart.
25 x 1 ml vials of vaccine

domain: pet


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Terms and Conditions
Welcome to InvestBegin.com. These terms and conditions outline the rules and regulations for the use of InvestBegin's website and services. By accessing this website, you accept these terms and conditions in full. Do not continue to use InvestBegin's website if you do not accept all of the terms and conditions stated on this page. The following terminology applies to these Terms and Conditions: "Client", "You" and "Your" refers to you, the person accessing this website and accepting the Company's terms and conditions. "The Company", "Ourselves", "We", "Our" and "Us", refers to our Company, InvestBegin.
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The content, organization, graphics, design, and other matters related to the site are protected under applicable copyrights and other proprietary laws, including but not limited to intellectual property laws. Copying, redistributing or publishing any part of this site is prohibited without the express written consent from InvestBegin.
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These terms and conditions are governed by the laws of India. You hereby irrevocably consent to the exclusive jurisdiction and venue of courts in India in all disputes arising out of or relating to the use of this website.
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The information on this website is provided "as is". InvestBegin makes no warranties, expressed or implied, and hereby disclaims and negates all other warranties, including without limitation, implied warranties or conditions of merchantability, fitness for a particular purpose, or non-infringement of intellectual property or other violation of rights.
You agree to indemnify, defend, and hold harmless InvestBegin.com, its officers, directors, employees, agents, licensors and suppliers from and against all losses, expenses, damages and costs, including reasonable attorneys' fees, resulting from any violation of these terms and conditions or any activity related to your account (including negligent or wrongful conduct) by you or any other person accessing the site using your internet account.
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domain: law


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Jim’s Daily Email Alerts:
Juggling With Knives
This website is based on my book, Juggling with Knives. Both the book and website are about volatility in everything from stocks and bonds to real estate, and real life topics such as jobs and education.
This website keeps the content of the book fresh and the advice and strategies up to date. If you've purchased the book, you've earned a one year free subscription. Use the Coupon Code in the book to start your FREE subscription when you Subscribe on this website.
Top CommentsOpinions Matter!
- Jean Notestein

domain: finance


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Oscar Ramiro Ortega-Herndandez
The man wanted in connection with shots that were fired at the White House is expected in federal court today following his arrest Wednesday afternoon in Indiana County. Investigators say Oscar Ortega-Hernandez was taken into custody at the Hampton Inn in White Township just after noon on Wednesday.
A man wanted in connection with shooting at the White House has been arrested in Indiana County. According to Pennsylvania State Police Lt. Bradley Shields of Indiana, Oscar Ortega-Hernandez is in the custody of the FBI and Secret Service.


But why are you more likely to be penalised for taking your rental van or car into some towns’ bus lanes more than others?
Bus lanes. Long have they been the bane of any road user who isn’t behind the wheel of a taxi or the number 42. Jeremy Clarkson wants them ripped up. And if you’re sat in traffic, trying to com-plete that final delivery or just bring your hire van back to the depot, it can be soul destroying to look at all that pristine and largely unused tarmac sitting next to you.
Which is, of course, one of the reasons why every now and again drivers decide they can’t take anymore and nip into the bus lane, even if it’s only for just a little way to get to the next junction.
You can guess what’s coming next.
Fines for incorrectly driving in a bus lane range from £60 to £90 (and are higher still in London), but the numbers (compiled following a freedom of information request to Confused.com and report-ed by the RAC) suggest there’s more going on here than simply impatience.
In 2017, 888,760 fixed penalty notices were issued, yet a whopping 16% of those were issued in Aberdeen and Glasgow. Are Scots more likely to drive in bus lanes? Or is it more likely that confus-ing signage is enabling drivers to accidentally end up in the wrong lane at the wrong time?
It’s the discrepancy that is concerning. As more towns and cities have switched to shared space or bus lanes that only operate certain hours it can sometimes be difficult to know which lane you need to be in. If you’re in an unfamiliar town, as many of our car hire and van rental drivers will be, those problems can be compounded.
We’re fortunate that TJS’ car and van rental depots don’t appear to be in bus lane blackspots – but there’s every chance that many of our drivers will be encountering them on their journeys. So we’d encourage local authorities to improve the clarity of bus lane signage, so that any fines issued in future aren’t earned by accident.
Talk to us now about finding the right hire car or van for your next journey.


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|Howard Johnson Portland properties are listed below. Search for cheap and discount Howard Johnson hotel rooms in Portland, WA for your upcoming meeting or individual travels. We list the best Howard Johnson Portland properties so you can review the Portland Howard Johnson hotel list below to find the perfect place.
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domain: travel


Johannesburg – JJ Senekal became the third maiden winner on this year's Origins of Golf Tour when he won the final tournament at St Francis Links on Friday.
Senekal beat Titch Moore on the second hole of a sudden-death playoff and following an incredible finish to his round.
The young golfer birdied his final two holes for a 72, including a 25-foot putt for his birdie on the last. Moore bogeyed the final hole, also for a 72, to see them both tied on four under.
Both golfers birdied the tough par-four 18th as the first playoff hole.
Playing it again, Moore hit his approach into the left greenside bunker and was faced with an incredibly difficult lie right up against the lip. It took him three shots to get out. Senekal found the green with his approach and two-putted for par and the victory.
“I've been dreaming about winning on Tour and now I've done it,” said Senekal.
He was surrounded by some of the most experienced professionals on the Sunshine Tour as he went into the final round one stroke off the lead, with Moore, Jean Hugo and Jake Roos all challenging for the title.
And it took a phone call from his father for Senekal to start believing in himself.
“The night before the final round my dad phoned me and said, 'you're up there for a reason. Don't stand back for anyone. You've got the game. You've got everything. Just go for it'.”
Senekal had also taken inspiration from his fellow professionals.
“I've been inspired by a lot of the guys. I caddied for Justin Harding at the Open Championship this year and that really motivated me a lot.
“I look up to Justin because he's quite successful and it's where I want to be.”
Senekal's victory came with the major summer portion of the Sunshine Tour only a few weeks away.
“This win means everything to me. It gives me confidence going into the summer, knowing that I can win and win well.” – Sapa


As an avid balletomane , I read Clive Barnes's historical review of the Kirov Ballet's new/old Sleeping Beauty with great interest.
I suspect that the Iron Lady was probably as much of a balletomane as yours truly..
What does a well-bred balletomane do in a strange town over Christmas?
Lest you wonder, I am just a balletomane ; this letter will come as a surprise to NBC, to which I am sending a copy.
The Israel Ballet is celebrating its thirty-fifth anniversary this season with a showcase of programs to whet the appetite of many a balletomane .
‘It'll be exciting for the confirmed balletomane , but it is also a popular, spectacular piece of dance that will give a lot of people a lot of pleasure,’ says McMaster.
There is nothing to ruffle the tutus of any local balletomane in this year's Royal New Zealand Ballet's Tutus on Tour programme.
Mania, not just balletomania , reigned, with visits by companies from the Bolshoi to the Royal through the 70's.
The news that The Royal Ballet's artistic director had resigned in September set balletomanes buzzing and journalists digging.
I don't experience such balletomania with other ballet companies, but these unique Kirov dancers have constantly renewed my passion in ballet.


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Gas prices are at their highest in months and expected to rise further. The rocky mountain region of the U.S.is known for its shale oil production.
Oil prices extended gains on Thursday as a weaker USA dollar made the dollar-priced commodity more attractive for holders of other currencies.
Saudi energy minister Khalid al-Falih, who chairs a six-country monitoring committee overseeing the OPEC/non-OPEC production cut agreement, suggested at a January 21 meeting in Oman that the coalition may need to be more nimble with its inventories target and tweak it to take into account crude grades and regional inventories.
Texas' November production of 3.9 million barrels a day accounted for almost 40 percent of US output. Royal Dutch Shell Plc said improved exploration and production lifted its quarterly profit to a three-year high, while refining and trading fell short of expectations as margins shrank. This 10 million number is a big deal, as it puts the United States on par with the production of Oil giant Saudi Arabia and is eclipsed only by that of Russian Federation, who put in an average of 10.98 million barrels per day past year. At 418.4 million barrels, US crude oil inventories are in the middle of the average range for this time of year.
Oil prices have been rising strongly on the global market. Yet the size of these inventories can not be predicted yet, especially with the long string of draws during the winter, when demand for fuel is usually lower. A decade ago, falling domestic production and a USA ban on exports meant that WTI served mostly as a proxy for US inventory levels."There was a time when the USA was disconnected from the global market", said Greg Sharenow, portfolio manager at PIMCO, who co-manages more than $15 billion in commodity assets.
The West Texas Intermediate for March delivery increased 1.07 USA dollars to settle at 65.80 dollars a barrel on the New York Mercantile Exchange, while Brent crude for April delivery added 0.60 dollar to close at 69.65 dollars a barrel on the London ICE Futures Exchange. WTI prices have been on an upward trend since February 2016. In fact, Canadian oil exports have surged as US refineries especially on the Gulf Coast prefer heavier Canadian oil over light shale.
Oil prices had earlier been supported by strong compliance with output cuts by OPEC and its ally Russian Federation, as well as expectations for strong demand growth in 2018.
OPEC oil output has risen in January from an eight-month low as higher output from Nigeria and Saudi Arabia offset a further decline in Venezuela and strong compliance with a supply reduction pact, a Reuters survey found on Tuesday. The bank's bullish outlook is driven by its revised demand forecasts, reflecting stronger economic growth in emerging markets.
Today, crude oil is gaining to recover some of the gains it had yesterday.


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Best Life Insurance for Munds Park, AZ
Compare multiple Munds Park, AZ life insurance quotes in order to find the most affordable and best-quality coverage. Enter your Zip above and you will be able to choose from the best options available in Coconino county. Life insurance comparison is the best way to save money on your coverage and ensure you are not overpaying.If you want to buy Munds Park, Arizona life insurance you need to make sure you purchase the best policy for the best rate. Insurance can be expensive depending on the type of policy and the policy amount.
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Go online and get life insurance quotes. The amount of the quote will be determined by many factors including your age, health conditions, and the coverage amount. If you choose term insurance it will cost less than whole life insurance. You should get quotes from several insurance companies.
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When comparing policies make sure to look at the benefits and disadvantages of each type of policy. If you do not understand the terms of the policy, then you should talk to an insurance agent or broker. Allow them to explain the terms of the policies so that you can understand what you're paying for.
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It might look like it is you from the entire world occasionally when it comes to working with existence insurance. With the vast amount of data offered online, it can be practically overpowering at initial. This report will provide helpful details for you to get started on the proper path
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When you are thinking about how significantly life insurance policy to buy, it really is a excellent idea to get at least eight or 10 times the quantity of your once-a-year income. With this amount, if some thing happens to you, your dependents will be able to invest sensibly and carry on to just take care of their living expenses in the extended term.
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Transcranial magnetic stimulation during positron emission tomography: a new method for studying connectivity of the human cerebral cortex.
We describe a new technique permitting the mapping of neural connections in the living human brain. The method combines two well established tools of brain research: transcranial magnetic stimulation (TMS) and positron emission tomography (PET). We use TMS to stimulate directly a selected cortical area while simultaneously measuring changes in brain activity, indexed by cerebral blood flow (CBF), with PET. The exact location of the stimulation site is achieved by means of frameless stereotaxy. In the first study using this technique, we found significant positive correlations between CBF and the number of TMS pulse trains at the stimulation site, namely the left frontal eye field (FEF) and, most importantly, in the visual cortex of the superior parietal and medial parieto-occipital regions. The pattern of these distal effects was consistent with the known anatomic connectivity of the monkey FEF. We suggest that the combined TMS/PET technique offers an objective tool for assessing the state of functional connectivity without requiring the subject to engage in any specific behavior.
Pubmed ID: 9096152 RIS Download
Adult | Brain Mapping | Cerebral Cortex | Cerebrovascular Circulation | Female | Humans | Male | Tomography, Emission-Computed | Transcranial Magnetic Stimulation

domain: biology


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domain: design


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Above: Dominica (CJ Photo)
By the Caribbean Journal staff
It’s a romantic notion of Caribbean travel — arrive in one destination, then travel to another two or three islands by sea or small plane.
And the OECS regional subgrouping wants to make island-hopping easier for travelers in the Caribbean.
The OECS, whose integration efforts have been finding praise within the wider region, is looking to develop a common tourism policy, and that means in part creating a regional identity for OECS tourism, according to Rodinald Soomer, head of the economic development policy unit at the OECS.
The plan is to collaborate with the region’s immigration outfits to help facilitate both interregional tourism — that is, travel between the islands by OECS nationals, and island-hopping for international tourists.
The plan for the latter in particular is to eliminate multiple border checkpoints for “seamless travel.”
It’s about grouping the islands together and encouraging island hopping — come to the OECS, and see Antigua, St Kitts and Montserrat, for example.
So can the OECS develop its own tourism identity within the larger Caribbean?
“Ultimately what we would like to see is for an OECS brand to be developed, “ Soomer said this week. “The ministers have gone through that idea, but it was at a time when everyone was buying into the wider Caribbean brand. A decision was taken that this was not the right time for us to go for an OECS brand. we needed to build a reputation in the marketplace of presenting ourselves as a unit.”
The aim, he said, is to end the idea of tourism competition in the region, and “recognize the rivalry as being out of the Caribbean.”


According to details, the youthful leader was found dead a few metres to his home hours after having left a meeting organised by his boss Kanduyi Constituency Member of Parliament Honourable Wamunyinyi.
MP Wamunyinyi has already broken silence on the death of his staff asking police officers to ensure that they do their level best to being to books those who killed him.
The Ford Kenya lawmaker said that he would be later called by a police officer, informing him that one of his staff members had been attacked and was in a serious condition.
The youthful musician whose roots are in Uganda produced a number of songs which received massive airplay on local media. Some of his songs include Popo, Birikicho, Covid-19, Hustle, Landlord, vindu vichenjanga.
Several high profile leaders have come out to mourn him among them his former boss Kimilili Constituency Member of Parliament Honourable Didmus Barasa.
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SERVICE OVERVIEW: DUE DILIGENCE
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Portugal Golden Visa vs D7 Visa: Detailed Comparison
Understanding Portugal's Golden Visa and D7 Visa can be confusing. One of the main differences is tax residency. A D7 visa requires a person to move to Portugal and become the country's tax resident. At the same time, with the Golden Visa, you are not obliged to live in Portugal: the required stay is 7 days a year..
In this article, we explain all the differences between a Golden Visa and a D7 Visa.
Portugal Golden Visa and D7 Visa: Key Information
Portugal Golden Visa is an opportunity to obtain a Portuguese residence permit by contributing to the country’s economy. There are several investment options starting from €250,000. The residence permit is issued for 2 years. To maintain the status, one must spend at least 7 days a year in Portugal.
Portugal D7 Visa is also known as a Passive Income Visa that leads to a residence permit. This visa is granted to financially independent foreigners with passive income outside Portugal. The resources can be different: pension, rentals, dividends or others.
The validity period of a D7 Visa is 4 months. Within that time, its holder must enter Portugal and apply for a residence permit valid for two years. To remain a resident under this option, foreigners must live either 1.5 years in a row, or at least 16 months in total in the country.
5 Benefits of Portugal Residence Permit
Having a residence permit in Portugal can offer various benefits to individuals who choose to live in this beautiful country. It doesn’t matter whether they obtained the status under a Golden Visa program or a D7 Visa program. Here are five key advantages:
1. Access to the Schengen Area. Portugal is part of the Schengen Agreement, which allows residents with a Portuguese residence permit to travel freely within the Schengen Area. This includes most European countries, making it easier to explore Europe without the need for additional visas.
2. Tax benefits. Portugal offers attractive tax incentives for new residents, including the Non-habitual resident (NHR) status. NHR status can lead to reduced tax rates on foreign income and pensions for a specified period, making it an appealing option for retirees and expatriates.
3. Education and healthcare. Portugal has a strong public education system and universal healthcare. Residents can access quality education and healthcare services. Foreigners with a Portuguese residence permit study and get treatment in EU countries under the same conditions as EU citizens.
4. Safety and stability. Portugal is known for its political stability and low crime rates. It is considered one of the safest countries in Europe, providing a secure environment for residents and their families.
5. High quality of life. Portugal consistently ranks high in global quality of life indexes. The country offers a pleasant climate, beautiful landscapes, a rich cultural heritage, and a welcoming atmosphere, all contributing to a high quality of life for residents.
Requirements for Obtaining Golden Visa and D7 Visa
Main applicant. Requirements for the main applicant are similar under both programs. One must be over 18, buy medical health insurance, prove the legality of their income and have no criminal record. Both investment money and passive income must come from outside Portugal.
Family members. An investor participating in the Golden Visa program can add:
children aged 18—26 if they are financially dependent on the investor and study at the university;
financially dependent parents of any age;
financially dependent siblings under 26 if they are in the investor’s custody.
Under the D7 Visa program, the main applicant can add their spouse, minor children, unmarried children aged 18—21 if they are unemployed, and financially dependent parents.
Costs of Getting Golden Visa and D7 Visa
Under the Golden Visa program, there are five investment options. They are:
supporting the cultural heritage — €250,000+.
investment in science research — €500,000+.
investment in local business with the creation of at least 5 jobs — €500,000+;
purchase of investment fund units — €500,000+;
opening a company with the creation of at least 10 jobs.
Besides investing, the applicant must pay €400+ for medical insurance, €533 per family member for an application fee, and €5,340 per family member for issuing residence permit cards.
D7 Visa requires having a passive income of at least €760 a month. As the sum is tied to the minimum salary in Portugal, it changes every year. €760 is required for a sole applicant.
Applicants are allowed to invite close family members to move to Portugal with them. If they decide to do so, the minimal monthly income increases by 50% for a spouse or a parent and 30% for a child.
Besides having passive income, a financially independent person must rent or buy a residential property. There are no minimum sum requirements.
Other expenses under the D7 Visa program include:
medical insurance — €14+ per family member;
visa application fee — €90 per family member;
residence card processing fee — €83 per family member;
residence card issuance fee — €72 per family member.
Documents for Obtaining a Golden Visa and D7 Visa
The package of documents for obtaining both visas is similar. It includes:
filled out government forms;
a birth certificate;
a marriage certificate if applicable;
police clearance certificate.
Depending on each person’s situation, they might be required to provide additional papers. For example, applicants for a D7 visa must submit a document proving their passive income, and applicants for the Golden Visa — proof of investment fulfillment.
Documents must be translated by a certified translator and notarized.
Step-by-step Process of Obtaining a Golden Visa by Investing in Fund Units
The process of getting a Golden Visa is similar for every investment option and takes at least 8 months.
How to Obtain a D7 Visa and a Residence Permit After
The process of obtaining a Portugal D7 visa takes at least 4 months. It can be prolonged depending on the applicant’s situation. The procedure is the following:
1. Check eligibility criteria and contact a reputable agent. First, you need to make sure you’re eligible for obtaining a D7 visa. Then get an agency that specializes in obtaining Portuguese visas.
2. Get a Portuguese taxpayer number. A taxpayer number — NIF (Número de Identificação Fiscal) is required to open a bank account in Portugal and rent or buy a property. Foreigners obtain it through a tax representative in Portugal remotely.
3. Open a bank account by providing NIF and a passport. After it’s open, transfer a sum of money sufficient for your family to live in Portugal for a year.
4. Rent or buy real estate. An applicant can select a property remotely through an agency or in person. The process of renting is faster than purchasing.
5. Gather documents and apply for a D7 visa. The applicant gathers all the documents and fills out government forms. It is also required to translate and notarise some papers. The documents are submitted to a Portuguese consulate in the country of residence. There, the applicant must also pass fingerprinting.
6. Enter Portugal. The D7 visa is valid for 4 months. During this period, its holder must come to Portugal and apply for a residence permit card.
7. Apply for a residence permit. The applicant books an appointment and then submits documents for a residence permit to the Agency for Integration, Migrations and Asylum of Portugal (AIMA). Everything must be done in person.
8. Get a residency card. A residency card can be sent to the applicant’s address in Portugal. The document is valid for two years and can be extended to three years.
You can switch your D7 visa to a Golden Visa at any point in the application procedure. To do that, you just need to make an investment and follow the process described in the previous chapter.
Obtainment of Citizenship
Portuguese citizenship can’t be obtained by investment or through passive income. A foreigner can get a Portugal passport by naturalization only.
However, naturalization requirements are different for D7 visa and Golden Visa holders. To become eligible for citizenship, foreigners with Passive Income Visa must live in the country for five years while investors can just hold a residence permit for five years, spending only 7 days per year in Portugal.
In both cases, applicants for citizenship must pass a Portuguese language test at A2 or higher level.
Portugal allows its citizens to have dual citizenship, which means you don’t need to renounce your other one unless your country of origin requires it.
Taxes for Golden Visa and D7 Visa Holders
New Portugal residents can participate in the Non-Habitual Resident (NHR) program that offers a flat 20% tax on income earned in Portugal and 0% — on income from abroad.
The program lasts for 10 years and is available to anyone who has a residence permit in Portugal and has recently become a tax resident. A tax resident is a person who lives in Portugal for at least 183 days a year.
D7 visas require its holders to spend in the country for either 1.5 years in a row, or at least 16 months in total during the residence permit validity. Therefore, they are eligible to participate in the Non-Habitual Resident program.
Golden Visa holders are not obliged to live in Portugal to maintain their status. So, if they come to the country just for a few days, they can’t be Non-Habitual Residents. However, they still need to pay taxes on income earned in Portugal, but at an ordinary rate.
Choosing between Golden and D7 Visa: Which One Is Better?
Which visa to choose depends on your situation and preferences. Both of these documents grant a residence permit and eventually lead to Portuguese citizenship.
However, they have different requirements, processing procedures and periods of obtainment.
Minimum sum of money
€760+ per month
Who can qualify besides investor
A spouse, children under 26, parents, siblings under 26
A spouse, children under 21, parents
2 years with a right to extend
4 months with a right to convert into a 2-year residence permit
Required residing in Portugal
7 days a year
16 in 24 months
In 5 years
In 5 years
A foreigner can obtain a Portuguese Golden visa if they invest at least €250,000 in Portugal’s economy.
A D7 visa might be obtained by financially independent people with a passive income of at least €760 monthly. D7 visa applicants don’t need to make any investment.
Under both programs main applicants may add their close family members. However, the requirements differ.
The list of required documents for an application often includes: a passport, a birth certificate, a marriage certificate if applicable, health insurance, bank statements, police clearance certificate.
Obtaining a D7 visa often takes around 4 months. Getting a Golden Visa typically takes 8—10 months. Both of these visas eventually can lead to Portuguese citizenship.
Which Is Better: D7 or Golden Visa to Portugal?
It is impossible to say which visa is better as both have different requirements and are aimed at different people.
D7 Visa is suitable for foreigners who have passive income outside Portugal. The Golden Visa is designed for people who have enough investment money and want to contribute to the Portuguese economy.
Who Is Eligible for a Portugal D7 Visa in 2023?
People with a passive income outside Portugal are eligible for a D7 visa. The required sum must exceed €760 per month per person.
The applicant must be over 18, buy medical health insurance, have no criminal record and have proof of legality of the income. The main applicant can also add their spouse, minor children, unmarried children aged 18—21 if they are unemployed and financially dependent parents.
Is Portugal D7 Visa Easy to Get?
What Are the Benefits and Disadvantages of a D7 Visa in Portugal?
Benefits of D7 Visa are:
no investment requirements;
fast and easy process of obtainment;
an opportunity to add family members to the application;
a right to live in Portugal and a path to citizenship.
Some disadvantages are the need to live in the country for either 1.5 years in a row, or at least 16 months in total during residence validity and buy or rent residential property.
What Are the Disadvantages of Portugal's Golden Visa?
One of the main disadvantages is the cost of a Golden Visa. You must invest at least €250,000, and you’re not guaranteed to get your money back if you contribute to support of cultural heritage or science research.
Another con is Due Diligence. It is a strict check that every person over 16 must undertake. Usually, it lasts for several months and includes different types of investigations.
What Is the Alternative to a D7 Visa in Portugal?
Besides the D7 visa, Portugal offers a Golden Visa that is obtained by investment of at least €250,000 and a Digital Nomad Visa that is designed for digital nomads earning more than €3,040 per month.
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Jun In Kwon and Dok2 Collaborate on New Track For “Punch” OST
Veteran rocker Jun In Kwon and rapper/producer Dok2 have released a new song for the first OST of SBS drama “Punch.” The collaborative track, titled “It’s My World,” was released December 29 along with a music video. The two came together to work on the track for the album, and the mix of the two artists’ complementary musical abilities resulted in a very unique sounding track.
“It’s My World” is a fusion of rap and rock and a remake of a song by the same title that was originally written by Choi Sung Won and performed by the band Deulgukhwa. The music video was released on 1theK’s official YouTube channel and features various scenes from “Punch,” which airs Mondays and Tuesdays on SBS.
Check out the music video below:
[tv]Watch Punch right here on SoompiTV[/tv]


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The U.S. Army Medical Research and Materiel Command, looking to reduce stress fractures and preserve bone health among its young recruits, is funding a four-year, $1.72 million project through the Department of Defense Peer Reviewed Medical Research Program that scientists hope will lead to a better understanding of the molecular and cellular events by which androgen influences the skeleton.
"It turns out that one of the most common injuries sustained in basic training in both men and women is stress fracture in long bones. In this population, there's also anabolic steroid abuse," said the study's lead investigator, Kristine Wiren, Ph.D., associate professor of medicine (endocrinology, diabetes and clinical nutrition) and behavioral neuroscience, OHSU School of Medicine, and research biologist, Portland Veterans Affairs Medical Center.
"The goal of the Army in funding this grant is to identify factors that promote a healthy skeleton, that influence stress fractures, and to treat and prevent bone-weakening osteoporosis in the aging population."
Of the 1.3 million bone fractures attributed to osteoporosis each year, 150,000 are hip fractures that occur in men with a 15 percent lifetime risk for the development of fracture. Hip fractures tend to occur over the age of 70; nearly a fourth of the patients who suffer a hip fracture die within the first year; half of patients are unable to walk without assistance; and a third are totally dependent.
Osteoporosis is characterized by a relative decrease in bone formation, mediated by osteoblast cells, versus bone resorption, mediated by osteoclast cells. Androgen testosterone is best-known type and estrogen both contribute to adult bone mass maintenance: Androgen is a
Contact: Jonathan Modie
Oregon Health & Science University