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This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
This complementary and alternative medicine (CAM) information summary provides an overview of the use of acupuncture as a treatment for individuals with cancer or cancer-related disorders. The summary includes a brief history of acupuncture practice, a review of laboratory and animal studies, the results of clinical observations and trials, and possible side effects of acupuncture therapy. Information presented in some sections of the summary can also be found in tables located at the end of those sections.
This summary contains the following key information:
Many of the medical and scientific terms used in this summary are hypertext linked (at first use in each section) to the NCI Dictionary of Cancer Terms, which is oriented toward nonexperts. When a linked term is clicked, a definition will appear in a separate window.
Reference citations in some PDQ CAM information summaries may include links to external Web sites that are operated by individuals or organizations for the purpose of marketing or advocating the use of specific treatments or products. These reference citations are included for informational purposes only. Their inclusion should not be viewed as an endorsement of the content of the Web sites, or of any treatment or product, by the PDQ Cancer CAM Editorial Board or the National Cancer Institute.
Acupuncture, a complementary and alternative therapy used in cancer management,[1,2,3,4] has been used clinically to manage cancer-related symptoms, treat side effects induced by chemotherapy or radiation therapy, boost blood cell count, and enhance lymphocyte and natural killer (NK) cell activity. In cancer treatment, its primary use is symptom management; commonly treated symptoms are cancer pain,[4,5] chemotherapy-induced nausea and vomiting (N/V),[6,7] and other symptoms that affect a patient's quality of life, including weight loss, anxiety, depression, insomnia, poor appetite, xerostomia, hot flashes, peripheral neuropathy, and gastrointestinal symptoms (constipation and diarrhea).[8,9,10] Acupuncture is generally accepted by children aged 10 years and older.[11]
More than 40 states and the District of Columbia have laws regulating acupuncture practice (see www.acufinder.com for a complete list). The National Certification Commission for Acupuncture and Oriental Medicine offers national certification examinations for practitioners of acupuncture and traditional Chinese medicine (TCM) (www.nccaom.org); most, but not all, states require this certification. More than 50 schools and colleges of acupuncture and Oriental medicine operate in the United States, many of which offer master's-level programs and are accredited by or have been granted candidacy status by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM). ACAOM standards for a master's-level degree require a 3-year program (approximately 2,000 hours of study) for acupuncture and a 4-year program for Oriental medicine, which includes acupuncture and herbal therapy (www.ACAOM.org). In recent years, some schools have begun to offer programs for Doctor of Acupuncture and Oriental Medicine with an additional 1,200 hours of clinical-based doctoral training. Some Western medical training, including the study of anatomy, physiology, and clean-needle technique is included in the curriculums of these schools. Postgraduate training programs in medical acupuncture for physicians also exist. In the United States, training to be a licensed acupuncturist is regulated according to individual state law. Because the educational and licensing requirements for acupuncture practice vary from state to state, one should inquire from each state board of acupuncture (or other relevant board) for particular information.[12] Third-party reimbursements also vary from state to state. Some insurance companies cover acupuncture or limited acupuncture treatment. Federal payers such as Medicare do not generally reimburse for acupuncture treatment.
Acupuncture has been practiced in China and other Asian countries for more than 4,000 years.[13,14,15] In China, acupuncture is part of a TCM system of traditional medical knowledge and is practiced along with other treatment modalities such as herbal medicine, tui na (massage and acupressure), mind/body exercise (e.g., qigong and tai chi), and dietary therapy.[16,17] In the United States, several different acupuncture styles are practiced in addition to TCM. These include Japanese acupuncture (e.g., meridian therapy), English acupuncture (e.g., five element or traditional acupuncture), French acupuncture (e.g., French energetic acupuncture), Korean acupuncture (e.g., constitutional acupuncture), and American medical acupuncture. Most of these are derived from ancient Chinese medical philosophy and practices. All are based on the view that the human body must be perceived and treated as a whole and as part of nature; health is the result of harmony among bodily functions and between the body and nature, and disease occurs when this harmony is disrupted. TCM therapeutic interventions, including acupuncture are used to restore the state of harmony.
Acupuncture is closely associated with Chinese meridian theory. According to this theory, there are 12 primary meridians, or channels, and eight additional meridians, each following a particular directional course along the body. A vital energy known as qi flows through these meridians and participates in the homeostatic regulation of various bodily functions. Along the meridians are approximately 360 points that serve as both pathognomonic signs of disorder and as loci for acupuncture treatments.[15,18] When the normal flow of energy over a meridian is obstructed (e.g., as a result of tissue injury or a tumor), pain or other symptoms result.
The purpose of acupuncture therapy is to re-open the normal energy flow, thereby relieving the symptoms by stimulating specific sites (acupuncture points) on the meridians.[19] In acupuncture treatment, stainless steel needles, usually ranging from 0.22 mm to 0.25 mm in diameter, are inserted into relevant acupuncture points to stimulate the affected meridians. A needling sensation known as de qi sensation, in which the patient feels heaviness, numbness, or tightness, is often required during an acupuncture treatment. Length and frequency of treatment vary according to the condition being treated. Chronic conditions usually require a longer treatment period. Typically, two or three sessions per week are required initially and may decrease to once a week after several weeks of treatment. Needles are typically left in place for 15 to 30 minutes after insertion, and their effects may be augmented with manual or electrical stimulation and/or heat (e.g., moxibustion or heat lamps).
Classical techniques of acupuncture include needling, moxibustion, and cupping. Acupressure, using fingers or mechanical devices to apply pressure on acupuncture points is based on the same principles as acupuncture. Moxibustion is a method in which an herb (Artemisia vulgaris) is burned above the skin or on an acupuncture point for the purpose of warming it to alleviate symptoms. Cupping promotes blood circulation and stimulates acupuncture points by creating a vacuum or negative pressure on the surface of the skin.[19] During the past several decades, various new auxiliary devices have been developed. Acupuncture devices such as electroacupuncture (EA) machines and heat lamps are commonly used to enhance the effects of acupuncture.
In addition to classical acupuncture techniques, other techniques have been developed and are sometimes used in cancer management. These include trigger point acupuncture, laser acupuncture, acupuncture point injection, and techniques focusing on particular regions of the body: auricular acupuncture, scalp acupuncture, face acupuncture, hand acupuncture, nose acupuncture, and foot acupuncture. Of these, auricular acupuncture is the most commonly used.
In clinical practice, most acupuncturists in the United States follow the traditional theories and principles of Chinese medicine. However, there are other schools of acupuncture practice, including medical acupuncture, which have different theories regarding meridians and acupuncture point locations.
Although acupuncture has been practiced for millennia, it has come under scientific investigation only recently. In 1976, however, the U.S. Food and Drug Administration (FDA) classified acupuncture needles as investigational devices (Class III) (www.fda.gov). This resulted in a number of research studies on the effectiveness and safety of acupuncture.[20] In November 1994, the Office of Alternative Medicine (the predecessor of the National Center for Complementary and Alternative Medicine) at the National Institutes of Health (NIH) sponsored an NIH-FDA workshop on the status of acupuncture needle usage. Two years later, the FDA reclassified acupuncture needles as medical devices (Class II) without, however, giving specific indications for their use.[21] In 1997, NIH held a Consensus Development Conference on Acupuncture to evaluate its safety and efficacy. The 12-member panel concluded that promising research results showing the efficacy of acupuncture in certain conditions have emerged and that further research is likely to uncover additional areas in which acupuncture intervention will be useful. The panel stated that "there is clear evidence that needle acupuncture treatment is effective for postoperative and chemotherapy N/V." It also stated that there are "a number of other pain-related conditions for which acupuncture may be effective as an adjunct therapy, an acceptable alternative, or as part of a comprehensive treatment program," and it agreed that further research is likely to uncover additional areas in which acupuncture intervention will be useful.[20]
These actions by the FDA and NIH have resulted in the establishment of a number of active programs of research into the mechanisms and efficacy of acupuncture, much of which is, or is potentially, relevant to cancer management. To date, the most extensively investigated aspect of these mechanisms has been the effect of acupuncture on pain management. The NIH Consensus Panel concluded that "acupuncture can cause multiple biological responses," local and distal, "mediated mainly by sensory neurons…within the central nervous system." Acupuncture "may also activate the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects," including "alterations in peptides, hormones and neurotransmitters and the regulation of blood flow."[20] Recent studies show the effect of acupuncture on chronic inflammatory pain.[22,23] Evidence suggests that acupuncture operates through the autonomic nervous system to balance the sympathetic and parasympathetic systems and suggests that the anti-inflammatory effects of acupuncture are mediated by its electrophysiologic effects on neurotransmitters, cytokines, and neuropeptides.[23,24,25,26,27,28,29,30,31,32] Reviewed in [1] Many studies provide evidence that opioid peptides are released during acupuncture and that acupuncture analgesia is mediated by the endogenous opioid system.[33,34]
Laboratory and animal cancer studies exploring the mechanisms of acupuncture have focused mainly on the activation and modulation of the immune system. Acupuncture treatment points are located by using standard anatomic landmarks and comparative anatomy. EA is the most commonly used treatment intervention; a few studies have used moxibustion.[35] These studies show that acupuncture may boost animal immune function by enhancing NK cell and lymphocyte activity.[35,36,37] According to one animal behavioral study, acupuncture may be a useful adjuvant for suppressing chemotherapy-induced emesis. [38]
Although several studies published in China examined the effect of acupuncture on the human immune system,[8,30,33,39,40,41,42] most cancer-related human clinical studies of acupuncture evaluated its effect on patient quality of life. These investigations mainly focused on cancer symptoms or cancer treatment–related symptoms, predominantly cancer pain [10,24,43,44,45,46,47] and chemotherapy-induced N/V.[26,28,48,49,50,51,52,53,54,55,56] Studies have also been done on the effect of acupuncture on radiation -induced xerostomia (dry mouth), proctitis, dysphonia, weight loss, cough, thoracodynia, hemoptysis, fever, esophageal obstruction, poor appetite, night sweats, hot flashes in women and men,[57] dizziness, fatigue, anxiety, and depression in cancer patients.[8,9,10,58,59,60,61] The evidence from most of these clinical studies is inconclusive, despite their positive results; either poor research design or incompletely described methodologic procedures limit their value. There is controversy about the most appropriate control for acupuncture, which also limits the interpretability of the results of clinical trials.[62] The positive results of the studies on chemotherapy-induced N/V, which benefit from scientifically sound research designs, are the most convincing.
The generally accepted history of acupuncture /moxibustion (known as zhen jiu) is part of traditional Chinese medicine (TCM), an indigenous, coherent system of medicine that has been practiced in China for thousands of years. The history of acupuncture/moxibustion in China can be traced back archeologically at least 4,000 years, when bian (stone needles) were in use. During the long history of recorded practice, acupuncture has been applied to many disorders. The earliest written medical text, the ancient classic Huang Di Nei Jing (Yellow Emperor's Inner Classic, second century BC), records nine types of needles and their therapeutic functions.
The dissemination of acupuncture and TCM to other regions dates back centuries: first to Korea and Japan and then to other Asian countries.[1] The use of acupuncture in Europe was documented in the middle of the 16th century.[2] The relatively brief history of acupuncture in the United States can be traced back about 200 years, when Dr. Franklin Bache published a report in the North American Medical and Surgical Journal on his use of acupuncture to treat lower back pain.[3] However, until the 1970s, when U.S.–Chinese diplomatic ties were resumed, the practice of acupuncture in this country was mainly limited to Chinatowns.[4]
For centuries, Chinese acupuncturists treated cancer symptomatically. Ancient literature and acupuncture textbooks classify cancer as a Zheng syndrome or blood stasis condition and document acupuncture treatment principles and methods.[5,6,7] Since the development of modern conventional medicine, acupuncture has been used clinically only as an adjunct to conventional cancer treatment.
At least seven animal studies investigating the effects of acupuncture in cancer or cancer-related conditions have been reported in the scientific literature.[1,2,3,4,5] Two of the studies were conducted in China, one of which was published in Chinese with an English abstract. One study was conducted in Japan, one in Sweden, and one in the United States. Four of the studies were ex vivo laboratory investigations using blood samples or tissues; [1,2,3,5] the remaining study was an animal behavioral study testing the effect of acupuncture on chemotherapy -induced nausea and vomiting. [4]
The four ex vivo studies suggested that acupuncture is useful in anticancer therapy either by actively stimulating immune activity or by preventing chemotherapy suppression of immune activity.
In a study involving normal rats, electroacupuncture (EA) (1 Hz, 5–20 V, 1-millisecond pulse width, 2 hours) applied at the point Tsu-Sanli (S36) for 2 hours daily on 3 consecutive days enhanced the cytotoxicity of splenic natural killer (NK) cells compared with a stimulation of a nonacupuncture control point in the abdominal muscle.[3]
Another study found that NK cell activity and T-lymphocyte transformation rate were increased in a mouse model of transplanted mammary cancer compared with a control (P < .05) after eight sessions of acupuncture and moxibustion.[2]
A study involving tumor -bearing mice (sarcoma S180) using moxibustion to warm the acupuncture point Guanyuan (CV4) once a day for 10 days found significantly increased production of erythrocytes, compared with a nontreatment control.[1]
The fourth ex vivo study used a rat model to investigate the effect of EA on nerve growth factor (NGF), which is associated with polycystic ovary syndrome (PCOS). Women with PCOS have an increased risk of endometrial cancer and other diseases. Repeated EA treatments (12 treatments administered over 30 days) in PCO rats significantly lowered the concentrations of NGF in the ovaries, compared with untreated PCO rats.[5]
A study of cyclophosphamide -induced emesis in a ferret behavioral model used acupuncture as an adjunct therapy in treating the emetic side effects of chemotherapy. EA at 100 Hz, 1.5 V, for 10 minutes in combination with subeffective doses of antiemetics such as ondansetron (0.04 mg/kg), droperidol (0.25 mg/kg), and metoclopramide (2.24 mg/kg) significantly reduced the total number of emetic episodes by 52%, 36%, and 73%, respectively (P < .01), in this ferret model.[4]
A rat model has been established by injecting AT-3.1 prostate cancer cells into the tibia of the adult male Copenhagen rat, which closely mimics prostate cancer-induced bone cancer pain.[6] The cancer-caused pain was treated with 10 Hz EA for 30 minutes a day at acupuncture point gallbladder 30 (GB30) from days 14 to 18 after cancer-cell injection. For sham control, EA needles were inserted into GB30 without stimulation. Thermal hyperalgesia, a decrease in paw withdrawal latency to a noxious thermal stimulus, and mechanical hyperalgesia, a decrease in paw withdrawal pressure threshold, were measured at baseline and 20 minutes after EA. EA significantly attenuated the hyperalgesia compared with sham control. Moreover, the EA inhibited up-regulation of preprodynorphin mRNA and dynorphin as well as interleukin-1beta (IL-1beta) and its mRNA compared with sham control. Intrathecal injection of antiserum against dynorphin A (1–17) and IL-1 receptor antagonist significantly inhibited the cancer-induced hyperalgesia. These data suggests that EA alleviates bone cancer pain at least in part by suppressing spinal dynorphin and IL-1beta expression.[7,8]
Another cutaneous cancer pain model has been established by injecting B16-BL6 melanoma cells into the plantar region of one hind paw of C57BL/6 mice. A single EA treatment showed significant analgesia on day 8 but not on day 20. EA treatments once every other day starting on day 8 showed analgesia at day 20, but EA starting on day 16 did not. The results indicate that EA exerts antihyperalgesic effects on early stage but not on late stage cutaneous cancer pain.[9] These animal studies support the clinical use of EA in the treatment of cancer pain.
The findings of these studies suggest that acupuncture may be effective in treating cancer-related symptoms and cancer treatment–related disorders and that acupuncture may be able to activate immune functions [1,2,3] and regulate the autonomic nervous system.[4,5] Only one study reported a decrease in tumor volume in animals treated with acupuncture compared with control animals; however, the scientific value of this report is limited because of insufficient information about the research methodology.[2]
Effect of Acupuncture on Immune Function
At least seven human studies have evaluated the effect of acupuncture on immune system function in patients with cancer.[1,2,3,4,5,6,7] These studies were all conducted in China. Five were reported in English,[1,2,3,6,7] and two were reported in Chinese with English abstracts.[4,5]
Four randomized controlled trials,[1,2,4,5] a nonrandomized clinical study,[3] and two case series [6,7] found that acupuncture enhanced or regulated immune function.
The first randomized controlled trial found that acupuncture treatment enhanced platelet count and prevented leukocyte decrease after radiation therapy or chemotherapy, in comparison with the control group.[1]
A second study involved a group of 40 postoperative cancer patients, 20 of whom received daily acupuncture treatment and 20 of whom served as a control group. After 3 days, leukocyte phagocytosis was enhanced in the treated group, compared with the baseline measurement (P < .01); no such enhancement was observed in the control group.[2]
A third study observed the effect of acupuncture on interleukin-2 (IL-2) and natural killer (NK) cell activity in the peripheral blood of patients with malignant tumors. The patients were divided into an acupuncture treatment group (n = 25), which received 30 minutes of acupuncture daily for 10 days, and a nonacupuncture control group (n = 20). The data showed that IL-2 level and NK cell activity were significantly increased in the acupuncture group, compared with the control group (P < .01).[4]
A fourth study observed the effect of acupuncture on T-lymphocyte subsets (CD3 +, CD4 +, and CD8 +), soluble IL-2 receptor (SIL-2R), and beta-endorphin (beta-EP) in the peripheral blood of patients with malignant tumors. The data showed that acupuncture treatment increased the proportion of the CD3 + and CD4 + T-lymphocyte subsets, the CD4 +/CD8 + ratio (P < .01), and the level of beta-EP. It decreased the level of SIL-2R (P < .01). The investigators suggested that the anticancer effect of acupuncture may be mediated via the mechanism of immunomodulation. [5]
The nonrandomized clinical study showed that microwave acupuncture (MAT), a newly developed technique in which a specially designed device attached to a normally inserted acupuncture needle is used to deliver microwave radiation to a given point, enhanced the immunologic function of cancer patients. Although there was an increase in white blood cell count in the MAT group, the change was not significantly different from that seen in the control group under drug treatment.[3]
In a clinical case series, 28 cancer patients who were treated with electroacupuncture (EA) while undergoing chemotherapy experienced no declines in T cells (CD3 +, CD4 +, CD8 +) or in NK cell activity, both of which are usually suppressed by chemotherapy.[7] Similar findings were reported in a study comparing EA to the control in patients receiving chemotherapy for breast, colorectal cancer, and non-Hodgkin lymphoma.[8]
In another clinical case series, 48 patients with leukopenia —including two cancer patients—who were treated with manual acupuncture experienced improvements in leukocyte count, intracutaneous phytohemagglutinin (PHA), and immunoglobulin (IgG, IgA, and IgM) levels after 14 daily acupuncture treatments, compared with their pretreatment levels.[6]
Effect of Acupuncture on Cancer Pain
Seven clinical studies of acupuncture as a treatment for cancer-related pain have been reported in the English language (refer to Table 1 at the end of this section).[9,10,11,12,13,14,15] Three studies were randomized controlled clinical trials, with two studies conducted in China and one in France.[10,14,15] Four studies were case series, with one each from England, France, Hong Kong, and the United States.[9,11,12,13]
One randomized trial compared classical Chinese acupuncture, acupuncture point injection with freeze-dried human transfer factor, and conventional analgesic treatment in patients with gastric cancer pain.[10] The investigators reported an equivalent analgesic effect among the three groups observed after 2 months of treatment; however, the conventionally treated group experienced significantly superior analgesia compared with both acupuncture treatment groups during the first 10 days of treatment. The researchers reported that the patients in both acupuncture treatment groups also experienced improved quality of life and a decrease in the side effects of chemotherapy, in addition to analgesia.
A nonrandomized, single-arm, observational clinical study evaluated the effect of auricular acupuncture in 20 cancer patients who were still experiencing pain after treatment with analgesics.[11] While patients continued their analgesic medication, auricular acupuncture needles were embedded in ear acupuncture points, chosen according to clinical symptoms and electrodermal response, and were left in place until they fell out. In some cases, the needles remained in place for 35 days, while in others they fell out after 5 days. Pain intensity was measured by a nurse on the Visual Analog Scale (VAS) on day 0 and day 60, and the data were analyzed using a t test. The results showed that pain intensity decreased or remained stable after auricular acupuncture in all patients, with a significant average pain intensity decrease of 33 mm (P < .001). The same investigators later reported a larger (n = 90) randomized, blinded, controlled trial in which cancer pain intensity was significantly decreased (by 36%) in an auricular acupuncture treatment group, in comparison with control groups (acupuncture at placebo points or auricular seeds placed at placebo points) after 2 months of treatment (P < .001).[14]
In a case series involving 183 cancer patients who were treated with acupuncture for cancer-related pain, 52% were significantly helped (P value not stated).[12] Multiple treatments at intervals of 1 to 4 weeks were nearly always necessary for significant and long-term pain control.
In another case series, 29 patients with malignant tumors who developed pain received EA treatment.[13]. All experienced various degrees of pain relief, and 25 out of 29 were able to either reduce or eliminate their analgesic requirements following multiple EA treatments.
A third case series produced similar results.[9] After auricular EA treatment, five patients with cancer pain reported improvements.
Although most of these studies were positive and demonstrated the effectiveness of acupuncture in cancer pain control, the findings have limited significance because of methodologic weaknesses such as small sample sizes, an absence of patient blinding to treatment in most cases, varying acupuncture treatment regimens, a lack of standard outcome measurements, and an absence of adequate randomization. Further investigations into the effects of acupuncture on cancer pain using rigorous scientific methodology are warranted.
Effect of Acupuncture on Cancer Treatment–related Side Effects
Five studies published in English have addressed the use of acupuncture for pain related to cancer treatment, mostly postsurgical pain (refer to Table 2 at the end of this section). A randomized clinical trial evaluated the effect of various combinations of auricular acupuncture, Chinese herbs, and epidural morphine to relieve postoperative pain in 16 patients with liver cancer.[16] The study design was complicated and had a very small sample size (n = 2 per group). On the basis of the VAS (0–100 mm), all of the combination treatment groups experienced better analgesia than did the placebo -treated control group.
A nonrandomized study investigated the effect of acupuncture in postoperative pain management and arm movement in breast cancer patients after surgical excision of the cancer and axillary lymph node dissection.[17] Forty-eight patients were treated with acupuncture on the third, fifth, and seventh days after surgery and on the day of patient discharge. Compared with a control group of 32 patients who had the same surgery but did not receive acupuncture treatment, the acupuncture group had significant pain relief during arm movement on the fifth and seventh days following surgery and at the time of discharge. The range of arm motion also increased significantly in the treatment group, compared with the control group, during the postoperative period (P < .001). The authors concluded that acupuncture point selection based on the state of the patient and obtaining a needling "de qi" sensation were important in achieving an effective acupuncture treatment. A small retrospective case review of acupuncture for chemotherapy-induced peripheral neuropathy in 18 patients showed benefit with reduced symptoms in 82%.[18]
Arthralgias and myalgias from aromatase inhibitors
A randomized, blinded study comparing true acupuncture with sham acupuncture for aromatase-related joint symptoms enrolled 51 patients, 38 of whom were evaluable. True acupuncture was significantly more effective than sham acupuncture, as measured by Brief Pain Inventory-Short Form scores in relieving joint symptoms.[19]
Nausea and vomiting
Chemotherapy-induced nausea and vomiting
Of all the investigated effects of acupuncture on cancer-related or chemotherapy-related symptoms and disorders, the positive effect of acupuncture on chemotherapy-induced nausea and vomiting (N/V) is the most convincing, as demonstrated by the consistency of the results of a variety of clinical study types, including randomized clinical trials (RCTs), nonrandomized trials, prospective consecutive case series, and retrospective studies (refer to Table 3 at the end of this section). Consistent with the findings from clinical studies of acupuncture on N/V due to other causes such as postoperative N/V and morning sickness, these studies showed acupuncture to be effective in the treatment of chemotherapy-induced N/V. A well-documented example is discussed below.
A systematic review of the effect of acupuncture on N/V describes five clinical trials of chemotherapy-induced N/V, conducted by different investigators on different groups of patients and using different forms of acupuncture point stimulation.[22] All five trials yielded positive results. These consistent results support the claim that acupuncture is useful for treating chemotherapy-induced N/V. More recently, the efficacy of acupuncture point stimulation for chemotherapy-induced N/V has been reviewed, suggesting that acupuncture is more effective for acute vomiting than for acute or chronic nausea.[23]
A number of clinical studies of the effect of acupuncture on chemotherapy-induced N/V have been reported.[24,25,26,27,28,29,30,31,32,33,34,35,36]
A randomized placebo-controlled clinical trial investigated the effect of EA on chemotherapy-induced emesis in 104 patients with breast cancer who were undergoing a highly emetogenic chemotherapy regimen. [26] The patients were randomly assigned to receive low-frequency EA at classic antiemetic acupuncture points once daily for 5 days (n = 37), minimal needling at control points with mock EA on the same schedule (n = 33), or no adjunct needling (n = 34). All patients received concurrent antiemetic drugs (prochlorperazine, lorazepam, and diphenhydramine) and high-dose chemotherapy (cyclophosphamide, cisplatin, and carmustine). The main outcome measures were the total number of emesis episodes and the proportion of emesis-free days occurring during the 5-day study period. The data revealed fewer emesis episodes in the EA treatment group than in the minimal needling and drug-only control groups (P < .001), although differences among the groups were not significant during the 9-day follow-up period (P = .18). These findings are consistent with results reported by other investigators.[24,25,27,28,30,31,34] However, another published study showed that acupuncture had no additional effect on the prevention of acute N/V in patients receiving high-dose chemotherapy combined with ondansetron.[36] One RCT of acupuncture and vitamin B6 versus acupuncture or vitamin B6 intramuscular injection alone for N/V in women with ovarian cancer undergoing highly emetogenic chemotherapy, found a statistically significant benefit of both vitamin B6 and acupuncture. Results also showed that acupuncture alone, compared with vitamin B6, had a greater benefit in reducing the frequency of emesis.[37] One study suggested decreased delayed nausea from acupressure at point p6 compared with sham acupressure.[38] One study involving 34 patients with gynecologic cancer suggested that the acupressure applied to P6 acupuncture point with wristbands may be effective in reducing chemotherapy-related nausea and may decrease the antiemetic use after chemotherapy.[39]
Radiation-induced nausea and vomiting
Acupuncture has also been used to relieve radiation-induced nausea and vomiting. In one randomized study, patients who were randomly assigned to receive either verum or sham acupuncture experienced fewer episodes of nausea and vomiting than did those who received standard care.[40]
Vasomotor symptoms
Some studies have reported that acupuncture may be effective in reducing vasomotor symptoms among postmenopausal women with breast cancer and prostate cancer patients on androgen-deprivation therapy.[43,44,45,46,47,48,49] One study randomly assigned 55 patients to acupuncture versus venlafaxine for management of vasomotor symptoms in women with hormone receptor–positive breast cancer. Acupuncture was just as effective as venlafaxine and caused fewer adverse effects.[45]
A phase I pilot study evaluated the effect of acupuncture on tamoxifen -induced menopause symptoms.[44] Fifteen patients with breast cancer who were taking tamoxifen were treated with acupuncture weekly for 3 months. The Greene Menopause Index was used for outcome assessments at baseline before treatment and at 1, 3, and 6 months. The results showed that anxiety, depression, and somatic and vasomotor symptoms, but not libido, were significantly improved in comparison with the baseline (P < .001).
An uncontrolled prospective case series of 50 women on tamoxifen for early breast cancer evaluated women receiving eight treatments of traditional acupuncture weekly. Mean frequency of vasomotor symptoms dropped by 49.8% (P < .0001) at the end of treatment. Seven domains of the Women's Health Questionnaire showed statistically significant improvement.[50]
A retrospective evaluation of 194 patients with predominantly breast or prostate cancer and experiencing vasomotor symptoms found long-term relief of vasomotor symptoms associated with acupuncture and self-acupuncture. The authors suggested that overall treatment dose may be more important than point location, but favored SP6.[51] A small RCT of EA compared with hormone therapy in women with breast cancer suggested a prolonged effect of EA on hot flushes after 24 months. Seven of 19 women initially randomly assigned to EA had 2.1 flushes in 24 hours compared with a baseline of 9.6 flushes in 24 hours.[52] In a prospective randomized study of 84 breast cancer patients on tamoxifen treated with acupuncture versus placebo, acupuncture showed a reduction of hot flashes in both the treatment and the control arms, but there was no difference between true acupuncture and sham acupuncture.[53] The findings from these studies are summarized in Table 4 below.
In a randomized controlled trial, 47 cancer patients with moderate to severe fatigue were randomly assigned to one of three groups. One group received six 20-minute sessions of acupuncture (n = 15); one group was instructed to use acupressure (n = 16); and the third group, the sham acupressure group (n = 16), was taught to apply pressure in three points unrelated to true acupressure. All three groups continued with the same techniques for 2 weeks. The study concluded that acupuncture was a more effective method than acupressure or sham acupressure.[54]
Other Treatment-related Side Effects
Many studies have reported on the effects of acupuncture on cancer or other cancer treatment–related symptoms, including weight loss, cough, hemoptysis, fever, anxiety, depression, xerostomia, proctitis, dysphonia, esophageal obstruction, hiccups, and postoperative lymphedema.[1,9,44,55,56,57,58,59,60,61] These studies were from China,[1,56,57,58,62] Japan,[59] England,[61] Italy,[44] Sweden,[63] and the United States.[9,19,54,55,60] The findings from these studies are summarized in Table 5 below.
In a randomized clinical trial,[1] 76 patients with various types of cancer, including 38 with esophageal cancer, 24 with gastric cancer, and 14 with lung cancer, were randomly assigned to two groups (n = 38 per group). The treatment group received acupuncture in combination with radiation therapy or chemotherapy, and the control group was treated with radiation therapy or chemotherapy alone. The data showed that the patients in the acupuncture group gained significantly more body weight than patients in the control group (P < .001). The acupuncture group also showed greater improvement than the controls in the symptoms of cough, thoracodynia, hemoptysis, and fever for patients with lung cancer and the symptoms of chest pain, mucus vomiting, and difficulty in swallowing for patients with esophageal cancer. In addition, the acupuncture group suffered fewer side effects (poor appetite, N/V, dizziness, or fatigue) from radiation therapy or chemotherapy than the control group. However, no statistical analysis was performed on these data. A RCT of 138 patients treated with acupuncture plus massage versus usual care showed decreased pain (P = .05) and a decrease in depressive mood (P = .003) in postoperative cancer patients.[20]
A retrospective survey study involved patients of an oncology clinic who were offered acupuncture treatment for potential palliation of symptoms.[55] Among 89 patients treated with acupuncture, 79 responded to a telephone questionnaire survey. The data indicated that the major reasons for referral included pain (53%), xerostomia (32%), hot flashes (6%), and nausea/loss of appetite (6%). Sixty percent of the patients showed at least 30% improvement in their symptoms, and about one-third had no change in the severity of symptoms. Patients were not questioned regarding acupuncture treatment expectations.
Current Clinical Trials
Check NCI's list of cancer clinical trials for cancer CAM clinical trials on acupuncture therapy, acupuncture-like transcutaneous electrical nerve stimulation, electroacupuncture therapy and acupressure therapy that are actively enrolling patients.
General information about clinical trials is also available from the NCI Web site.
Serious adverse effects of acupuncture are rare. Reported accidents and infections appear to be related to violations of sterile procedure, negligence of the practitioner, or both.[1,2] A systematic review of case reports on the safety of acupuncture, involving 98 papers published in the English language from 22 countries during the period from 1965 to 1999, found only 202 incidents. The number of incidents appeared to decline as training standards and licensure requirements were enhanced. Among the 118 (60%) reported incidents involving infection, 94 (80%) involved hepatitis, occurring mainly in the late 1970s and early 1980s. Very few hepatitis or other infections associated with acupuncture have been reported since 1988, when widespread use of disposable needles was introduced and national certification requirements for clean-needle techniques were developed and enforced as an acupuncture licensure requirement.[3,4] Because cancer patients who are undergoing chemotherapy or radiation therapy are immunocompromised, precautions must be taken and strict clean-needle techniques must be applied when acupuncture treatment is given.[5]
Minor adverse effects of acupuncture, such as pain at needling sites, hematoma, tiredness, lightheadedness, drowsiness, and localized skin irritation, have been reported.[6,7,8,9,10] These minor adverse effects can be minimized by appropriate patient management, including local pressing and massage at the needling site after treatment.[11,12] Acupuncture in children has not been studied extensively. However, adverse effects appear to be rare and limited to the same effects as observed in adults.[13,14]
It is noteworthy that almost all reported clinical studies on the effects of acupuncture on cancer or cancer therapy –related symptoms focus on symptom management rather than the disease itself. Investigations into the effects of acupuncture on chemotherapy -induced nausea and vomiting, many of which were randomized and well-controlled, produced the most convincing findings. Although a considerable number of favorable clinical acupuncture studies have been reported, most were case studies, clinical observations, or nonrandomized and poorly controlled clinical trials. In many studies, methodologic flaws in clinical study design hampered rigorous scientific efforts to evaluate the effects of acupuncture. Although pain relief is the most clinically common use of acupuncture, only a few studies on cancer pain are well-controlled or have sample sizes large enough to support their findings.
Separate levels of evidence scores are assigned to qualifying human studies on the basis of statistical strength of the study design and scientific strength of the treatment outcomes (i.e., endpoints) measured. The resulting two scores are then combined to produce an overall score. For additional information about levels of evidence analysis, refer to Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine.
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Revised text to state that acupuncture is used to treat a wide range of illnesses and ailments, including hot flashes xerostomia, and neuropathy; cancer patients use it for fatigue, pain management, and control of nausea and vomiting.
General Information
Revised text to state that the primary use of acupuncture in cancer treatment is symptom management; commonly treated symptoms are cancer pain, chemotherapy-induced nausea and vomiting, and other symptoms that affect a patient's quality of life, including weight loss, anxiety, depression, insomnia, poor appetite, xerostomia, hot flashes, peripheral neuropathy, and gastrointestinal symptoms.
This summary is written and maintained by the PDQ Cancer Complementary and Alternative Medicine Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the use of acupuncture in the treatment of people with cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Cancer Complementary and Alternative Medicine Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewer for Acupuncture is:
Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Cancer Complementary and Alternative Medicine Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary]."
The preferred citation for this PDQ summary is:
National Cancer Institute: PDQ® Acupuncture. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://www.cancer.gov/cancertopics/pdq/cam/acupuncture/healthprofessional. Accessed <MM/DD/YYYY>.
Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.
The information in these summaries should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Coping with Cancer: Financial, Insurance, and Legal Information page.
Contact Us
More information about contacting us or receiving help with the Cancer.gov Web site can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the Web site's Contact Form.
Last Revised: 2013-01-17
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
To learn more visit Healthwise.org
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1925 May
Several men gather in a dormitory room in North College. The calendar on the wall is turned to May 1925, and a football poster next to it is for a Williams College - Amherst College football game. Handwritten note on back reads: "North College Bullfest". Tiny print at top of photo reads "1928 - Albert C. Cook", a reference to Albert Cairnes Cook, Class of 1928.
Members of the first class of the Massachusetts Agricultural College pose in militia uniform in front of the original North College dormitory. Handwritten notes on back read,"Presented by Wilson M. Tucker '71" and "see article on uniform in Aggie Life I. 75 - claims no cap & dress coat until 1875".

subset: commoncrawl


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BOULDER — Colorado's touted freshman quarterback Shane Dillon, who underwent surgery on his right (throwing) shoulder in February, is likely to redshirt, CU coach Jon Embree announced Monday after the first practice of August camp.
Dillon, a 6-foot-6, 190-pounder from San Diego, will be limited in throwing drills during camp, Embree said.
Embree had said that, if recovered from the off-season surgery, Dillon would have been "in the mix" for the battle for starting quarterback.
Now, Embree said, it's a three-player competition among sophomore returnee Nick Hirschman and two transfers: sophomore Connor Wood from the University of Texas and junior Jordan Webb from the University of Kansas.
"They all had their moments today," Embree said.


text: Americans Who Tell the Truth :: David Korten Robert Shetterly posted Jul 14, 2007 Abbey Ali Anthony Baker Baldwin Barsamian Benjamin Berry Boggs Bonds Bourgeois Burkes Butler Carson Carter Chavez Chisholm Chomsky Coffin Corrie Davis Debs Douglass DuBois Edelman Eisenhower Ellison Farmer Gelbspan Goff Goldman Goodman Granny D Grossman Guthrie Hamer Hay Hightower Hughes Humphries Hurston Ivins Jensen Jones Jones Keller Kelly Kelly Kennedy King Kozol Kucinich LaDuke Lange Lappé Lincoln Macy Mann Mayers McKibben McKinney Miller Moyers Muir Munoz Nader Nearing Parks Phillips Rankin Robeson Roosevelt Rovics Seeger Sheehan Simon Smith Stanton Tenayuca Terkel Thomas Thompson Thoreau Truth Tubman Twain Waters Wells Wellstone Whitman Wicks Williams Williams Wilson Woodward Wright Malcolm X Yalektit Yeh Zinn "… our economic crisis is, at its core, a moral crisis. Our economic institutions and rules, even the indicators by which we measure economic performance, consistently place financial values ahead of life values. They are brilliantly effective at making money for rich people. Our children, families, and communities, and natural systems of Earth have paid an intolerable price." David Korten Economist, writer, publisher (1937- ) David Korten is a leading critic of corporate globalization and a visionary proponent of a planetary system of local living economies. His international best seller, When Corporations Rule the World (1995) helped frame the global resistance against corporate globalization. The Great Turning: From Empire to Earth Community (2006), illuminates the significance of this resistance by placing it in the historical context of 5,000 years of Empire and the organization of human relationships by dominator hierarchy. His latest book, Agenda for a New Economy: From Phantom Wealth to Real Wealth (2009, 2nd ed., 2010), offers bold economic proposals that address the underlying cause of the current economic collapse, not just its symptoms. David was born in Longview, Washington in 1937; during his 25-year establishment career, he became increasingly discouraged that the values he learned as a child and believed to be conservative—family, community, peace, justice, and nature were ignored or suffered terrible tolls as a result of policies and directives of the very institutions he served. David acquired a variety of establishment credentials, including MBA and Ph.D. degrees from the Stanford Business School, service as a captain in the US Air Force, and five years as a Harvard Business School professor, a Ford Foundation project specialist, and Asia regional adviser on development management to the U.S. Agency for International Development. Thirty years working as a development professional in Asia, Africa, and Latin America eventually opened his eyes to the devastating consequences of an economic system designed to make rich people richer without regard to the human and environmental consequences. He became a defector from the foreign aid establishment and joined the global resistance against flawed development models. While many people refer to David as an economist, he is by training and inclination a student of psychology and behavioral systems. From the time he began his graduate studies at Stanford in 1959, he has been seeking to deepen his understanding of how cultures and institutional structures shape human behavior and to search for ways by which we humans can do a better job of supporting one another in achieving the higher order potentials of our nature. While at Stanford, David met and married his life partner, Fran Korten. Their marriage gives potent testimony to the power of partnership as their careers developed in tandem, each making career choices that opened new opportunities for the other. Fran was a Ford Foundation program officer for 20 years in the Philippines, Indonesia, and New York and is now publisher/executive director of YES! magazine. David is co-founder and board chair of the Positive Futures Network, which publishes YES! magazine,founder and president of the People-Centered Development Forum, and founding board member of the Business Alliance for Local Living Economies. He is co-chair of the New Economy Working Group which aims to further frame the New Economy Agenda and build support for transformational change through grassroots and media outreach. He is also a founding associate of the International Forum on Globalization and a major contributor to its report on Alternatives to Economic Globalization. David recently told a reporter, "The work that's involved in creating a new economy and a new human civilization calls us to be our most creative and innovative, and it puts us in contact with the worlds most wonderful people. And it is a whole lot more fun and satisfying than allowing oneself to sink into the depths of despair and cynicism." See the full set of Robert Shetterly's portraits at www.americanswhotellthetruth.org. Tools for Teaching: see the acompanying curriculum materials with suggestions on how to use the portraits and biographies of these American truth-tellers in your classroom. BUY THE BOOK AND GREETING CARDS FROM THE YES! STORE: Americans Who Tell the Truth :: Robert Shetterly's series highlights Americans past and present whose dignity, courage, and honesty have shaped this country. This beautiful coffee-table book is an eloquent collection of portraits and stirring words of these brave citizens from all walks of life. Card Sets :: A special YES! selection of Greeting Cards from the series in sets of 8 (with envelopes).Sets feature high quality prints of the portraits, complete with quotes and biographies. also available from the artist. Help support our workBecome a Dedicated Friend of YES! and we'll send you a FREE copy of Americans Who Tell the Truth and three cards with YES! heroes.Interested? Agenda for a New Economy, 2nd editionBe the first to read David Korten's revised & expanded Declaration of Independence from Wall Street. :: 3 WAYS TO GET THE BOOK from the YES! Store: 22% discount : YES! Magazine covers the movement to create an economy that will truly serve people, their communities, and the planet.: Read his blog.


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Globe Trekker transports viewers to remarkable destinations via stunning cinematography and through the eyes of interesting and charismatic hosts Ian Wright, Justine Shapiro, Zay Harding, Megan McCormick, Brianna Barnes, Holly Morris, Judith Jones, and more. Live as the locals do, and explore with us off-the-beaten-path locations brimming with intoxicating culture, unique cuisine and extraordinary landscapes.
Click here to find out what's new at Globe Trekker, and join the global conversation on Facebook, Twitter + Instagram.
Explore your favourite episodes by using the drop down menu below.


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A war has broken out in volatile southern Yemen between the government and local militants, further threatening the Arab world's poorest country.
This weekend, the government launched air strikes in the Abyan city of Moudia, which followed last month's aerial raids on a suspected Al Qaeda stronghold in neighboring Shabwa province. And since the fighting erupted in August, there have been nearly weekly skirmishes between soldiers and militants the government says belong to Al Qaeda in the Arabian Peninsula (AQAP).
"The battle in Abyan and Shabwa is growing; this, after all, is the home region of AQAP's commander, Nasir al-Wihayshi," says Gregory Johnsen, a Yemen specialist at Princeton University, in an email. "AQAP is trying to convince – through both intimidation and persuasion – members of Yemen's security services and military to come over to its side. For its part, the Yemeni government is striking back both through military strikes and by attempting to turn the tribes against al-Qaeda."
Since the unification of north and south Yemen in 1990, the south has been marginalized both politically and economically. Despite proportionate representation in the central government, southern Yemenis say their interests are not well represented. And despite being home to the majority of Yemen's oil reserves, the south remains desperately poor. (Editor's note: The original version was unclear about the nature of southern Yemeni representation in the central government.)
Analysts worry that upset southern tribal factions have turned their backs on Yemen's President Ali Abdullah Saleh and are now harboring AQAP militants.
Assassination, then assault
The weekend clashes between the government and suspected AQAP militants in Abyan lasted until early Monday morning, according to tribal sources in the region.
"Confrontations between security forces and Al Qaeda resulted in the deaths of more than six militants during the past few days," Mohamed Khader, deputy director of security for Abyan, told local press on Monday. "[Security forces] are conducting operation to hunt down 20 terrorists who fled to mountains in the region."
The assault came just days after militants assassinated Moudia's security director, Osama Mohamed Salem, and attempted to kill the province's governor, Ahmed Al Misri.
Additionally, AQAP – a group that shares Osama bin Laden's worldview but is largely separate from his organization – released an online recording last week announcing the formation of an Aden-Abyan army.
"We have become closer to placing the first building blocks for the Aden Abyan army, and it is a line of defense for the nation and its religion," said AQAP leading figure Qassim Al Raymi in the audio recording.
Strategic landscape
Fouad Selahy, a political sociology professor at Sanaa University, says AQAP leaders chose Abyan for its strategic location. It sits next to large desert areas that facilitate the passage of militants from Saudi Arabia and it's close to the sea, providing another gateway for jihadis.
However, Prof. Selahy added that he doesn't believe every attack against the Yemeni military in southern Yemen is necessarily carried out by Al Qaeda, even though the Yemeni government may say otherwise.
"When the government attacks any governorate, the young people will retaliate and use weapons against the government," he says. "The planes are striking their regions, the planes are destroying their homes and farms. These people are not necessarily Al Qaeda."
One civilian was killed in the weekend attacks, while two women were injured, according to the local Yemeni press.
"Yesterday the planes hit the citizens, even women and children," says Abyan-resident Nasser Al Fadhli, brother of southern separatist leader Tariq Al Fadhli, in a phone interview. "There was nothing called Al Qaeda present in the place of the attacks."
The government calls everyone who opposes it "Al Qaeda" so they are able to attack the southerners, says Mr. Fadhli, indicative of the marginalization southerners feel regardless of their affiliation with a jihadist organization.
In addition to having an Al Qaeda presence, Abyan is a stronghold of Yemen's southern separatist movement. The separatists, who call for the recreation of an independent southern state, have used violence against security forces in the past. While they share a common enemy – the Yemeni government – with AQAP militants, there is no proof that separatist leaders work directly with AQAP.


text: Share: Comments Print May 5, 2014 at 10:30 AM Microsoft's "Wordament" sequel "Snap Attack" out Tuesday Posted by Brier Dudley One of Microsoft's best mobile apps is about to hatch a sibling. No — not Office on the iPad. Credit: Microsoft I'm talking about "Wordament," the ridiculously addictive word game that two Microsoft employees built at home in their spare time. The Boggle-like game was so good, Microsoft acquired it and moved the creators, Jason Cahill and John Thornton, into the entertainment group where they now have a five-person studio supplemented by five outside contractors. "Wordament" isn't in the same class as "Temple Run" or "Angry Birds." But since launching three years ago, it has kept growing and now draws about 1 million players a month. They compete against each other in a continuous series of two-minute matches that are orchestrated by the Xbox Live gaming service. The free, ad-funded game is now the 12th most-used "modern" app on Windows 8 and serves more ads than any Microsoft game because people spend so much time playing it. As an encore, the team is launching a sequel called "Wordament Snap Attack," which will be available for Windows Phones and Windows PCs on Tuesday, and later this summer for Android and iOS devices. Thornton, left, and Cahill. Credit: Times Staff Photograher Lindsey Wasson. "Snap Attack" is a free, Scrabble-type game in which players receive seven letters they can use over and over to make words during a 2½-minute session. The letters snap into place on the game board, which has a few words in place to build upon. At the end of each round players are shown words they could have created and how their score ranks on a global leaderboard. Then it starts all over again, with a new game board each time. Compared with "Wordament," "Snap Attack" is a bit more complicated, and it may take a few rounds to get the hang of it. But there's potentially a much bigger audience, Cahill said, since there are more Scrabble players than Boggle players in the world. The new game probably won't help Microsoft catch Apple and Google in the mobile space. But it may appeal to those who do use the platform and those who wonder if it's still possible for creative new projects to hatch and grow amid Microsoft's giant, established businesses. "Wordament" grew and grew in part because Cahill and Thornton showed up early for the "devices and services" party in Redmond — before Microsoft formally decided to get its online services onto as many devices as possible, whether or not they're running Windows. They initially built "Wordament" just for Windows Phone, after employees were encouraged to build apps to improve the platform's then-meager selection. Then they released versions for Android and iOS devices, where "Wordament" has become one of the top word games in several countries. It's also available on Windows 8, Kindle and the new Android-based Nokia X phones. At first the team built different versions for each platform. Then it turned to an outside vendor called Xamarin and used its tools to build a single version that runs on Windows, iOS and Android. Taking the game to competing platforms initially raised some eyebrows — and drew sharp emails from some executives — but the strategy proved out. About half the game play now happens on iOS and Android. But Windows usage also picked up, once players could share the game and compete with friends and family using different devices. "If you could only email other Windows Phones that would be terrible, right?" Thornton said. "It's kind of like that. You want to be able to play with anybody that has another phone." Windows is still the biggest platform for "Wordament" though, and it's especially popular among Microsoft employees. If you're on a bus or waiting for a Little League game to start on the Eastside, look at what people are doing with their phones. Chances are good that you'll see someone killing time with a few rounds of "Wordament." The game is also popular overseas, where Windows Phone's uptake is greater than in the U.S. It's now offered in 15 languages and 56 percent of its users are abroad. Keeping up with the growth and internationalization kept Cahill and Thornton from pursuing other game concepts they had until recently. A turning point came in September, when Cahill vacationed in Hawaii. Some people like to sunbathe or swim there, but Cahill thinks it's the perfect place to write puzzle-making software. "Writing puzzle-makers is actually my vacation. I enjoy that," he said. On the airplane? "On the beach, on the lanai, you're just like, wow, this is the best place in the world to make a puzzle-maker." Thornton doesn't get it either. "I was at the office getting Skypes from him. He was like, 'Check this out! Check this out!' " Thornton said, laughing. "I was like, dude, you need to go swim." But the project was rolling and soon they had playable prototypes. They reused about 80 percent of the "Wordament" code, including lexicons drawn from Microsoft's Office suite. The team also tapped Microsoft's cloud-computing service to run the complex program that generates "Snap Attack" boards. Cahill said it takes 240 virtual machines on Azure 22 hours to generate one month of puzzles for the game. "Snap Attack" is launching Tuesday on the Windows Store for Windows Phone 8 and 8.1 and Windows 8.1. Versions for iOS and Android are ready but they won't be released until summer. They're all-in on the devices and services strategy, but the home team still gets a head start. Credit: Times Staff Photographer Lindsey Wasson Comments | Topics: Microsoft, seattle, snap attack


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This particular park is situated on 7,500 square meters of land area with a 1,500 square meters man-made pond at the center. There are floating lotus leaves accentuated by a number of lights in the form of octopi and water fountains. Taman Ayodya is furnished with steps and chairs for sitting, gazebo, pendopo (similar to pavilion) and restrooms.
Important Information
Related Places
- Skyrink Skating
One of the largest ice skating rinks in Southeast Asia (1,248m2) and one of the most beautiful in Asia, is no doubt the right choice for you and your family for recreation in an environment that is fun and wholesomely healthy.
- Taman Impian Jaya Ancol
Ancol Dreamland or Taman Impian Jaya Ancol, is Jakarta's largest and complete multi-themes park. A vast beach resort in the North of Jakarta facing the Java Sea, Ancol Dreamland covers
a wide 80 hectares swathe of shoreline. This is an integrated park that offers everything from beach and water sports to fun rides, swimming pools to Eco-Park and spectacular shows where international stars perform.
- Ragunan Zoo
Located at Pasar Minggu in South Jakarta, the Ragunan Zoo is a favorite attraction for the entire family especially during weekends and school holidays. Covering an area of 140 hectares, the Ragunan Zoo has a collection of 295 species of animals, including Indonesia's own famous Komodo dragons.


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The Good Wife Benches Law & Order's Jill Hennessy
Feb 26, 2014 6:41 PM EST
The Good Wife is about to get a visit from one of New York's best ADAs. Jill Hennessy, who starred on Law & Order as ADA Claire Kincaid, will guest-star on the CBS legal drama next month, CBS announced Wednesday. The Good Wife's 10 biggest twists… Read more


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Take a Hike Program
The Forest Preserve District of Kane County invites you to "Take a Hike!"
We're inviting individuals and families to get to know Kane County's forest preserves better, as part of our Take a Hike program. Each month, we'll highlight different preserves and add a corresponding activity for each.
Activity Sheets will be posted during the first week of each month. You may complete them at any time during the year, but keep in mind that some activities are seasonal.
Complete 6 of the 12 Take a Hike activities, and you'll receive a free patch (while supplies last).
To earn credit for hikes, submit your answers or completed Activity Sheet(s) to our naturalist staff via:
Be sure to include your full contact information with your answers. All Take a Hike activities must be completed and turned in by
Take a Hike is perfect for scouts, youth groups, coworkers or families to complete together. It's also a great way to keep in shape, in touch, and in tune with nature — all while having fun recreating in the Kane County forest preserves! Scouts and group leaders: Please let us know if your group plans to complete at least 6 of the 12 Take a Hike activities this year, so that we can make sure we have enough patches on hand.
Here are preserves and activity sheets for our Take a Hike program:
January: Lake Run Forest Preserve
February: Helm Woods Forest Preserve
March: Kenyon Farm Forest Preserve
April: Binnie Forest Preserve
May: Oakhurst Forest Preserve
June: LeRoy Oakes Forest Preserve
July: Glenwood Park Forest Preserve
August: Blackberry Maples Forest Preserve
September: Hampshire Forest Preserve
October: Muirhead Springs Forest Preserve
November: Tyler Creek Forest Preserve
December: Fox River Bluff East Forest Preserve
Call our naturalist staff at (847) 741-8350 or e-mail email@example.com with questions or for additional information. We look forward to seeing you out on the trails!


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Pocket-lint is reporting that it's been sent images of the new HTC One X+ from a trusted source and... it looks almost identical to the existing HTC One X.
There's currently no official news from HTC about specs or release date — because the phone hasn't actually been officially announced yet. But these images suggest that it's going to look practically identical to the existing HTC One X.
Previous leaks have suggested that the phone will run Android 4.1 Jelly Bean, and come packed with an Nvidia AP37 1.6GHz quad-core processor, 32GB ROM and 1GB RAM. Judging by these pictures — if they are in fact real — it won't be long until it's officially announced. [Pocket-lint]


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Practical Aspects of Income Tax Allocation
by PRESLEY FORD, JR. Partner, Tulsa Office
Presented before the National Association of Accountants, Tulsa Chapter—December 1968
IN OPINION 11 the Accounting Principles Board sought to conclude the longstanding debate over income tax allocation by affirming that the interperiod allocation of income taxes should be continued, by deciding that comprehensive rather than partial allocation is called for, and by prescribing the deferred as contrasted with the liability method.
My assignment is to discuss briefly the practical aspects of applying these decisions. There has been placed in your hands a set of simple exhibits, which may help you to follow my comments more easily.
It is necessary that a few basic terms be understood before we plunge into our subject.
Income taxes means all taxes based on income, whether they be federal,
state, or foreign.
Income tax expense means the income taxes allocable to the period for purposes of determining book net income.
Pretax accounting income means book income before income tax expense.
Taxable income means the income (or loss) to be shown by the returns for the period.
Timing difference means an amount which enters into pretax accounting
income in one period and taxable income in another. Tax effects means the differences between income tax expense and taxes currently due arising from timing differences entering into the difference between pretax accounting income and taxable income. It does not include permanent differences. It does include initial tax effects which are tax differentials arising from timing differences originating in the period and the reversal of tax effects which are the tax differentials flowing from the reversal of timing differences


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Seib & Wessel: The Fed's Balancing Act
WSJ's Jon Hilsenrath says the Federal Reserve, which meets next week, is keeping an eye on potential asset bubbles -- but don't expect a tightening in monetary policy anytime soon, as unemployment remains high, and inflation fears are low.
This transcript has been automatically generated and may not be 100% accurate.
the ... he went to the state is the Federal Reserve gets to me to make it to decide what to do do it next week ... they don't have to worry about ... so what to do next ... well they have their foot firmly placed on the ... middle of the accelerator in there to keep it exactly there ... has been a lot of we were talking that smoke there's been a lot of smoke ... lately about whether the Fed ... was going to back off ... on these easy money policies that that that ... the park is there some worries are picking up about overheating in financial markets the economy might be picking up ... but there are a to do that you know that the view of a lot of people there is ... these policies are working were actually seen them work why would we ... back away from the policies when we finally paper gaining some traction on it ... so they keep going and they they I think acknowledges that meeting this week that are watching for ... signs of overheating in credit markets but they're not prepared to ... to react and you know ... the you made the point earlier ... does anybody notice is the SciQuest ration and the fiscal implications of that I'll tell you to do with that ... what the Fed sees is an economy a private sector is picking up the improving ... that are really worried about the ... dragon ... that the fiscal policies can have on growth for the rest of the year ... that's another reason why they wanna keep their foot price of ... a single bed ... thinking in tennis Like the Vatican and the College of Cardinals have ten ... more lycopene a hard time ... imagining Ben burn Anqi one of those Mitre said ... I'm ... I did it not only that the weak action life I would get a woman running the place ... and yes it did that that that that put the agenda don't rise to ... the Vatican hasn't ... quite caught up ... in a new and interesting with the stock market at all-time highs ... and the sequester kicking in ... it's can be hard to sort of measuring ... the sequester's impact ... in part because maybe ... just a resume or cover spending money to go to frequent experience a real expected couple months ago housing markets come back a little bit ... fortunately legal outgoing vacation this summer to secure a little better or they are so ... I knew that if anyone archetypal that this earlier and went around what if this is the year that they're wrong things are getting ... their families during the effects of the sequester and people are still spending on things us a little bit better ... anyway if it has played so it so every year the Fed has overestimated how strong the economy's going to be one of these years as you say ... they're going to get the wrong and again and go the way these things tend to play out as they get it wrong in exactly ... the wrong time when the need to be making a change in policy to send it on to any rise in exactly the right time ... I ... know it's only ... seven weeks hamper sentiment Monroe only for full employment ... and sentiment among them I think Denver Nanking zoo is ... the narrow the size of being too easy for now we have ... very little inflation of poems for high ... risk of overshooting is always there but it's not really into this exactly what what there what their view is right now that that that their ... inflation expectations have actually been in easing up ... the inflation numbers of come in below what they expected ... and out there happy see the stock market rising ... to one of the things that they say is this what will our policies and they wanted to create low interest rates ... they want people to be at their borrowing and refinancing their mortgages than they wanna see the stock market go up ... so people are more curses the ... bus but the summit is getting their wish ... to leave it that that will be back next week to see him for any clothes for an immigration bill ... whether the Fed does anything resembling what John said they would ... I'm sure we'll have another week of Budget Drama ... and who knows what the Middle East will ever before the president makes is that there ... you can join the conversation on Twitter at hashtag WS J live ... David Wessel for The Wall Street Journal ...


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Matt Drudge Is Mad at the Stimulus Bill for Not Keeping Kosher
Matt Drudge is pointing out that the stimulus package actually went to purchase pork and other crazy things like food by linking to some contracts on the Recovery.gov web site. We spent $5.7 million on "process cheese"? Crazy! Why?
Because people can't afford to eat, and cheese has nutritional value that can help sustain life. One of the stimulus contracts Drudge links to—the implication being that the expenditure is somehow inappropriate or wasteful or contrary to the stated purpose of the stimulus package—paid Bongard's Creameries, a Minnesota farmer's cooperative, $5.7 million for processed American cheese.
We called Bongard's to ask what the contract was for. Vikki Anderson, the company's sales director, said she wasn't 100% sure, but she assumed that it was for the USDA's Supplemental Nutrition Assistance Program—food stamps. "I think it was for SNAP," she told Gawker, "because most of our delivery locations are food banks."
Losers! What a waste. We assume that the various swine products that Drudge has searched for on Recovery.org—"$2,531,600 FOR 'HAM, WATER ADDED, COOKED, FROZEN, SLICED, 2-LB'"—are similarly intended to feed people who can't afford to buy food because they don't have jobs. Still—the porkulus is being used to buy pork! We thought it was supposed to stimulate the economy. How does using pork to buy pork stimulate the economy? Sean Hannity will ask this question in roughly 11 hours.
Well, one way would be by preventing people from starving, so that they might survive the recession and get jobs. Another way would be to employ people who slaughter and package pork for a living. Because when people can't afford to buy food, they don't buy food. So the people who make food don't have anyone to sell the food to, and so they lay people off, and then the people they laid off can't afford to buy food, etc.
Also: The stimulus package was intended to help people buy food. It says so right here on the same web site that Matt Drudge linked to in order to ridicule the notion of spending stimulus dollars to help people by food:
UPDATE: Agriculture Secretary Tom Vilsack has responded directly to Drudge. Which was a very bad idea, since a) all Drudge did was put up links, so there is no specific claim that needs a response, and b) now Drudge can put up a big headline bragging about how he dragged the secretary of agriculture into a fight about ham. Which of course he has. Also, Vilsack inexplicably zeroed in on the idea that Drudge is accusing the USDA of spending millions on one two-pound ham: "The references to '2 pound frozen ham sliced' are to the sizes of the packaging. Press reports suggesting that the Recovery Act spent $1.191 million to buy '2 pounds of ham' are wrong." It's crazy to think charges like that merit a response, and in doing so, Vilsack is just lending credibility to Drudge.


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We read the nonfiction book first. It brought up how a group of farmers had to hide the Liberty Bell during the war. Then we read Saving the Liberty Bell which combined truth and fiction to tell the story of how several men worked together to hide the Liberty Bell from the Redcoats.
The book told how the crack in the Liberty Bell is about the size of a yardstick.We pulled out a yardstick to demonstrate the size of the crack.
Then we made these liberty bells. This idea came from Deep Space Sparkle. First we sponge painted the background paper using white and blue paint.
We painted the bell shapes with gold paint. After they dried we used black paint to draw the cracks.
We used black and brown crayons to add wood details to the yoke. When everything was dry we put it all together. You can download the bell template for free here.
Next we are going to make Liberty Bell Cookies. You can find Liberty Bell cookie cutters from several online sites. This one is from Amazon. I bought pre-rolled sheets of Pillsbury sugar cookie dough. The kids are going to use tube icing to make the crack on the bell.
A few more great Liberty Bell Read-alouds...


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BOSTON, Mass. – With three of the starting five finishing in double-figures along with a game-high 15 points from Tom DeCiantis off the bench, the 18th ranked Anchormen of Rhode Island College (18-3, 9-1 Little East) defeated men's basketball (9-11, 3-7 Little East) by the final of 81-50 Saturday afternoon at the Clark Athletic Center in a Little East Conference match-up.
DeCiantis was red-hot all afternoon finished 5-for-7 from the floor, including a perfect 3-for-3 from behind the arc. Rhode Island as a whole was 27-for-61 from the floor and 7-for-17 from 3-point range. Its bench proved to be the biggest factor in the contest as they accounted for 43 points in Saturday's conference victory. Starters Chris Burton and Alex Cruz each dropped in 12 boards, while Tahrike Carter finished with 10 for the Anchormen.
Senior Mike Mitchell, Jr. (Boston, Mass.) was the lone Beacon to finish in double-digits as he recorded 13 points on 4-of-11 shooting, 5-of-6 at the free throw line. Vinny DeLucia (Miami, Fla.) added nine points, but early foul trouble sidelined the hot shooter for most of the second half.
Foul trouble was the story of the contest as three players ended the contest with four fouls. Freshman Jahleel Moise (Brockton, Mass.) who got the start in Saturday's contest was quickly called the bench after earning three fouls in the first 10 minutes of play. Junior Rahshjeem Benson (Boston, Mass.) also had to play through foul trouble and went on to finish with four points, six boards, and three blocks.
For the Beacons their afternoon consisted of 33.3% shooting from the floor (18-for-54). From behind the arc they were held to 18% by the Anchormen, who remain one of the top defensive teams in the entire Little East Conference. At the line UMB finished 11-for-18.
Rhode Island also won the battle on the glass pulling down 12 more rebounds than the Beacons (45-33). The Anchormen also did a solid job of possessing the ball totaling 18 assists in the contest, with six of those belonging to Carter.
Through the first 10 minutes of the contest, Rhode Island College never led by more than five points. The Beacons seemed to have an answer for the Anchormen on every possession and forced some key turnovers.
However at the 10:35 mark and with RIC leading by just three points, the nationally ranked Anchormen exploded offensively going on a 23-2 run to close out the first half and take firm control of the scoreboard (38-15).
After the break, Rhode Island used that late offensive surge to carry them throughout the final 20 minutes of play, quickly pushing their lead to more than 20. In the second half, UMB did outshoot the Anchormen, but the large deficit at the half proved too much for the Beacons to overcome.
Men's Basketball returns to action on Tuesday when they host the University of Southern Maine at 7:30 p.m. Tuesday's contest will mark the official reopening of the Clark Athletic Gym, which went through a major renovation prior to the start of the basketball season.


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