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Enter your zip code above to find your hardiness zone, plants available for your area, and your estimated ship date.
To the left, you'll find all the topics covered in this Plant Manual. Select a topic to read its information.
Early and super juicy! Bite into one of these large red-skinned plums to reveal its sweet and juicy yellow flesh. Enjoy delicious plums sooner in the summer with Waneta. Start harvesting in late August through September. Trees are prolific producers so you'll have plenty of plums for snacks, desserts and canning. Pollinate with Methley.
The best way to succeed is to plan before you plant. Let's discuss location: Do you know where you want to plant your new trees? Avoid many future problems by considering all aspects of the planting spot, such as:
Is a pollinator variety present? Cross-pollination by a different variety, of the same type of tree, is key to the success of many fruit trees. In most cases, its absence is why trees don't bear fruit or produce poorly. Since insects and wind carry pollen from one blossom to the other blossoms the trees should be planted fairly close together, within 50 feet.
Your tree would love a sunny place with well-drained, fertile soil. But it will be quite satisfied with six to eight hours of sunlight. Good drainage is required to keep your trees "happy." If your soil has high clay content, use our Coco-Fiber Potting Medium or add one-third peat to the soil at planting time. We do not recommend planting fruit trees in heavy, pure clay soils.
Even if your yard isn't the most ideal location, take heart. Fruit trees are very adaptable and respond well to fertilizers, so they can get along well even where the soil is nutritionally poor. Just steer clear of sites with extremely heavy soils or very poor drainage.
If you'd like your tree to become a landscaping asset, choose the planting place with this in mind. Imagine it as a full-grown tree and check everything out: Wires overhead? Sidewalk underneath? Does it obstruct something you want to see? Can you keep an eye on it from the house? Will other trees be in the way, allowing for their additional growth in the meantime?
Even a year or two after planting, your tree will be very difficult to transplant. So take the time to plant it in just the right place.
First-time fruit tree growers often ask about recommended planting distances from patios, sewer lines, water pipes and so on. Ordinarily, patios will not be a problem because the soil beneath them will be dry and compacted. Therefore, the roots will not grow into this area as much. It's still recommended, however, that you plant at least 8-10' away from patios, water pipes and sewer pipes. You might not expect sewer and water lines to be affected since they are buried so deeply. But, since sewer and water lines tend to be wet, roots will grow to them and around them if the tree is planted too close. By planting your trees far enough away from these items, you can avoid this problem.
Once you've found out about fruit growing goodness firsthand, you'll want to expand your home orchard. It's important to plan for tree spacing so that the future growth areas will be ready when you are.
Dwarf, 8-10'
Semi-Dwarf, 12-15'
Standard, 18-20'
Successfully establishing a young fruit tree in your yard starts with your planting site and method. Once a fruit tree is established, it needs little assistance to grow and bear fruit; but you'll want to make sure you give your trees the right foundation.
Fruit trees require fertile soil for good growth, so before you plant, check your soil pH. Contact your local County Extension Office for information about soil testing in your area, or purchase one of our digital meters for quick and accurate results. If the soil pH where you plant your tree is 6.0-7.0, you're in good shape. Take a look at the established trees and plants around the site. If they look healthy and are growing well, just follow the recommended fertilization program for your fruit trees. Steer clear of soils that are extremely heavy or poorly drained.
Grafted trees need special planting attention. All Stark Bro's fruit trees are grafted or budded, the only methods for growing true-to-name planting stock. You can see where the fruiting variety on top is joined to the root variety on the bottom by a bump in the bark, change in the bark color or a slight offset angle. For certain dwarf trees, it's very important to keep this graft above the ground. Otherwise, roots could develop from above the graft; then your tree could grow to full size by bypassing its dwarfing parts.
Most Stark fruit trees are budded to specially selected clonal rootstocks. For dwarf, semi-dwarf and colonnade apple trees, the bud union should be planted 2-3" above the soil line. Standard size apple trees as well as our Custom Grafted trees should be planted 1-2" deeper than the soil lines from the nursery row.
For dwarf pears, peaches, nectarines, apricots, cherries and plums trees the bud-graft line should remain at or above the ground and for standard size trees they will do better with a slightly deeper planting.
Stark trees that are grown and shipped in bottomless pots are part of our continuing quest for producing better and stronger trees for the home grower. By following these simple instructions, you will be assured of getting your young tree off to the best possible start.
One final point: Please be sure to remove the name tag from your tree. As the tree grows, this small piece of plastic can choke off its circulation, damaging or killing the tree. If you'd like to keep the tag on your tree, retie it loosely with soft twine.
Preparing your soil before you plant will greatly improve your plant's performance and promote healthy, vigorous growth. It is a good idea to have your soil tested to determine if it is lacking in any essential minerals and nutrients. This can be done through your County Extension Office or with one of our digital meters.
The goal of soil preparation is to replenish vital minerals and nutrients, as well as break up and loosen any compacted soil.
Soil preparation can be done at any time that the ground is not too wet or frozen. Your trees may be planted even when temperatures are quite cool. If a hard frost is expected, it is advisable to delay planting for a while until temperatures become more moderate. Generally, as long as your soil is workable, it is fine to plant.
Your lawn can provide you with ideal organic materials such as grass clippings and shredded leaves. Not only will the grass and leaves break down to provide soil nutrients, but they will help loosen the soil as well. You can gather these in the fall with spring planting in mind.
Adding organic materials, such as our Coco-Fiber Potting Medium and compost will improve most every soil type. Organic materials bind sandy soil particles so they retain moisture and nutrients better. They also break apart clay and silt particles, so that water can infiltrate and roots can spread.
Fertilizing is an excellent way to replenish the natural nutrients in your plant's soil, especially nitrogen. Nitrogen encourages hardy green growth, which is exactly what you want to promote before your tree reaches its fruit-bearing years.
Every fruit tree has the future potential for disease and insect damage. Factors such as location and weather will play a part in which issues your tree encounters. Disease-resistant trees are the best option for easy care; and for all trees, proper maintenance (such as watering, fertilizing, pruning, spraying, weeding, and fall cleanup) can help keep most insects and diseases at bay.
Trees appear stunted and slow growing; leaves may be reduced in size, little or no fruit. If tree is dead, inspect roots for hard, woody 'tumors'. Note: many things can cause stunted trees.
Appears on branches and trunk as gummy cankers and water-soaked areas. Fruit develops dark, deeply sunken areas, causing them to be more likely to get 'Brown Rot'. Cool, wet weather after blooming favors development.
Appears as hard black knobby growths on twigs and branches. Will eventually girdle and kill branches.
Usually on bark of young twigs and branches, encrusted with small (1/16") hard, circular, scaly raised bumps with yellow centers, may also be on fruit. Sap feeding weakens the tree.
Yellow-brown winged insect may have black spot or red stripes. Injects toxins into the buds and shoots causing 'dwarfed' shoots and sunken areas (cat facing) on fruit.
Pale yellow or 'dirty' green worms. Leaves are rolled and webbed together where insects feed. Eventually becomes skeletonized.
They are the size of a pinhead and vary in color depending on the species. Clusters on stems and under leaves, sucking plant juices. Leaves then curl, thicken, yellow and die. Produce large amounts of a liquid waste called "honeydew". Aphid sticky residue becomes a growth media for sooty mold.
Fruit turns brownish with lighter spots. Quickly becomes soft, rotten and unusable.
Appears on the undersides of leaves as black or brown spots. Often the center falls out leaving a hole with a red halo. The leaves may turn yellow and fall. Fruits also get spots, sunken areas & cracks.
Bluish-gray moth. Larvae are 1' long, usually green or brown with white sports and body stripes. Feeds on young leaves and young fruits. Disfigures the fruit.
Adult is brownish-gray 1/5" long, hard-shelled beetle with long snout and 4 humps on back. Cuts a crescent shaped hole under the fruit skins and lays eggs. Worms hatch and tunnel into fruit. Premature dropping of fruit can occur.
Gray moth, 1/2" long. Larvae are white with a brown head, 1/2" long. Larvae burrow into twigs and fruits.
This fly is very similar to Apple Maggot. Adult similar to housefly but smaller, larvae are yellowish-white worms. Eggs lay under fruit skins, larvae tunnel making railroad pattern. Small pinpoint sting marks visible on fruit.
Pinpoint size, many different colors. Found on undersides of leaves. Sap feeding causes bronzing of leaves. Severe infestations have some silken webbing.
Beetle has ½" long, tan wings with reddish-brown edges. Long, thin hairy legs. Skeletonizes leaves and flowers. Present in large quantities in June & July. Worst on sandy sites near grassy areas.
Appears as a thick, gummy substance (sap) leaking from round holes on the trunk or in a crotch of the tree. Worms with brown heads and cream-colored bodies tunnel thru trunks that will kill the tree.
Adult is a metallic green beetle. It skeletonizes leaves. Larvae are a grub, which feeds on turf roots. Check turf product labels for timing of control of grubs. This is more of a problem east of the Mississippi river.
Whitish-gray powdery mold or felt like patches on buds, young leaves and twigs. Leaves may crinkle and curl upward. New shoots are stunted. Over winters in fallen leaves.
Various colors and similar to aphids this small, active, slender-winged insects are usually found on the underside of leaves. Retard growth, leaves become whitened, stippled or mottled. Tips may wither and die. This insect carries virus of certain very harmful plant diseases.
Tiny, slender, fringed wing insects ranging from 1/25 to 1/8" long. Nymphs are pale yellow and highly active and adults are usually black or yellow-brown, but may have red, black or white markings. Feed on large variety of plants by puncturing them and sucking up the contents.
Small reddish-purple spots appear on young leaves then enlarge and eventually dropping out of the leaf blade leaving a "shot hole." It appears on fruit, usually in clustered as light brown spots or lesions with dark purple margins.
Spots on young leaves are velvety and olive green turns black; leaves wither, curl and drop. Fruit also has spots, is deformed, knotty, cracked and drops.
Leaves become thickened, puckered and twisted with a reddish-purple color along puckered areas. Turn yellow and drop, may completely defoliate and causes weakening of tree. Any remaining dead leaves should be removed in the fall and all debris removed from the area.
Fungus disease that is spread by rain in spring and early summer and can appear as early as 2-3 weeks after petal fall. Patches of dark green to black, circular or irregular in shape, may merge together to cover a large area of the fruit surface. Sometimes it can be rubbed or washed off, but may leave a brown discoloration on fruit. Little damage is done to the flesh.
Pruning is a very important part of proper fruit tree care, but many people find the task overwhelming. It doesn't have to be! Keep these things in mind:
When your tree is dug up from our fields to be shipped to you, the root ball loses many of its tiny feeder roots, which are needed to absorb moisture and nutrients. Pruning helps balance the top growth of your tree with the root system, giving the roots time to re-establish in your yard before spring growth.
When your Stark Bro's bare root tree arrives, our professionals have already pre-pruned your tree for you. Because of this, you DO NOT need to prune them again when you plant. The only pruning done at this time would be any broken branches or roots.
Plan to prune your fruit trees during every dormant season. In Zone 6 and farther north, you should wait until late winter. A good reference book, such as Pruning Made Easy, can be invaluable for answering questions and guiding you through the pruning process.
Fruit trees develop better if they're pruned at the right times in the right ways. Here's how:
Remove weak, diseased, injured or narrow-angle branches, the weaker of any crossing or interfering branches, and one branch of forked limbs. Also remove upright branches and any that sweep back toward the center of tree. You want to keep your tree from becoming too thick and crowded; some thinning is necessary to permit light to enter the tree and to keep its height reasonable. All these objectives promote improved bearing, which is your overall aim. You'll be pleased with the results.
Select and maintain three to five main scaffold limbs arising from the trunk to control the shape of the tree. These limbs should point in different directions and originate no less than 18" and no more than 36" from the ground, balancing growth evenly between the scaffold limbs. Those branches remaining in the center above the primary scaffold branches or any growth below the scaffold branches should be cut off. Any growth arising on scaffold branches within 6" of the trunk should be removed.
If for some reason the primary scaffold branches could not be selected the previous season, they may be chosen at this time. All branches above or below the scaffold branches should be removed. Avoid cutting (heading) the main scaffold branches unless necessary to maintain balance in the tree. If one scaffold branch dominates the tree, it should be headed back to a size proportionate with the others. It is necessary to have all scaffold branches growing at approximately the same rate to maintain a well-balanced tree.
Prune back to 28-36" above the ground at planting time. After the new branches have grown 3-5", select a shoot to become the leader and scaffold limbs.
Sometimes pruning needs to be done even when the season isn't the best. If a branch is broken by the wind or by a heavy load of fruit, emergency treatment is necessary. Prune back the ragged edges; making a smooth cut that leaves no stubby stump. Fast-growing "water sprouts" can be removed as soon as you see them rather than waiting until winter.
There are several reasons to thin fruit:
Home gardeners thin fruit trees by hand. During May and June, many fruit trees will drop or abort fruit. This is a natural process that allows the tree to mature the crop load.
Trees may bear biannually, that is bear fruit every other year, bear heavy one year, then light the next year. Thin the heavy crop to correct bearing habit.
The best time to thin Japanese plum trees is when the fruit is large enough to be easily picked. Space plums 4 to 6 inches apart on the branch and break up clusters.
A proper and consistent spray schedule is important to the survival of your fruit tree. From diseases to pests, many potential issues can be prevented with spraying before they even begin! To reap its benefits, spraying should be done consistently and thoroughly following the guidelines below.
Before you begin, read and follow all instructions on labels.
Unless you're in an area where irrigation is usually needed for normal plant growth, you probably won't need to water after the first growing year. Until then, follow these guidelines to get your new trees off to a great start.
Are you ready to enjoy delicious homegrown fruit? Harvest is the time to enjoy the results of your hard work. Keep a few things in consideration as you reap the fruits of your labor: the best time to pick the fruit from your tree, and how to store the fruit.
Plum, pluot and plumcot trees will start bearing fruit in 3-6 years under normal growing conditions with proper maintenance and care.
Make sure to wait until just the right time to pick your fruit. Plums are ready to be picked when they separate easily from the tree with a little twist. They should not be picked when firm.
Harvest European plums when dead ripe.
Japanese plums are picked when they begin to soften.
Harvest season begins July thru September depending on the variety and location. Annual average yield per tree:
Harvest season begins mid-July thru early September depending on the variety and location. Annual average yield per tree:
Harvest season begins June depending on the variety and location. Annual average yield per tree is 3-4 bushels.
Cool storage preserves them for winter enjoyment. Fresh fruit is a special treat during the bleak winter months. Fortunately, many varieties of fruit keep their fine eating qualities for a long time with proper storage. If you're planning to store them, pick them a bit early, just as they start to ripen. Handle them carefully to avoid bruises that could develop into spoilage.
The ideal storage spot is humid and cool, from 32-40°F. Place them in perforated plastic freezer bags and keep them in any cool place. A refrigerator is the idea storage spot but any cool area in your house, the basement or an unheated porch might also be fine for a while. Bring them out to ripen at room temperature when you're ready to use them.
It's best to inspect stored fruit every week or so to check for any spoilage. That way, you can remove any that are developing soft spots or brown areas. This keeps spoilage from "spreading" to nearby fruit. Remember, "One bad apple spoils the whole barrel."
Our experts will help you find the answer!
Trees that are shipped without soil to ensure good contact with soil in your yard. When shipped, they are about 3-4' tall with 3/8" or larger trunk diameter. When they mature, they will be one of three sizes*:
Matures to be about 8-10' tall and wide. Provides an abundance of full-size fruit.
Matures to be about 12-15' tall and wide. Gives maximum fruit yield per square foot.
Matures to be about 15-25' tall and 20' wide. A multi-purpose fruit and shade tree.
Top-grade, bare-root trees that give you a head start on growing. When shipped, they are about 4-5' tall with 5/8" or larger trunk diameter.
Trees in bottomless pots that allow some roots to be air pruned, so that a dense mass of productive, feeder roots can grow within the pot to make transplanting easier. Mature sizes vary. When shipped, they are about 1-2' tall.
Top-grade, potted trees chosen to give you a head start on growing. When shipped to you, they are about 3-4' tall.
*Tree sizes may vary by variety. See our Growing Guide for details.


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EGCG from green tea accelerates fat loss*
To boost your metabolism, you get a high level of a unique fat-fighting compound from green tea called EGCG.*
One study showed that using a combination of EGCG (same amount as in our formulas) and caffeine resulted in an average weight loss of 7.7 pounds over a 12-week period.
Another study showed participants, without exercising, burned up to 200 more calories a day compared to a placebo (precise measurements were done in a metabolic chamber). That equates to almost a half a pound of body fat burned per week from green tea alone.*
Green coffee extract helps reduce after-meal glucose surges*
Each serving includes a special green coffee bean extract that contains a high level of chlorogenic acids (45%). This ingredient helps maintain healthy blood glucose levels already within the normal range. Without excess levels of glucose available, the body burns fat for energy rather than glucose, helping you stay in the fat-burning zone.*
Bitter orange attacks fat and boosts metabolism*
Bitter orange contains alkaloids (synephrine and four others) that directly stimulate the body's beta-3 receptors. These receptors act like sparks that ignite your metabolic rate and energy levels to help increase fat burning. Bitter orange also indirectly helps release body fat by stimulating your body's powerful natural fat burners, epinephrine and nor-epinephrine.
Our bitter orange extract is so effective, it's been awarded four United States patents for its ability to mobilize body fat and increase metabolism, increase lean muscle and decrease body fat, suppress appetite, and to improve overall athletic performance.*
L-tyrosine fuels your natural fat burners*
Without plenty of L-tyrosine, the body cannot support maximum fat burning regardless of how
few calories you eat or how much you exercise.
Sensoril® helps inhibit stress-induced overeating*
Sensoril® (ashwagandha extract) is a botanical that has been used in Ayurvedic medicine to help those with stress-related health issues. Exercise is known as occasional stress to the body and can shut down fat burning through various self preservation body processes. This is where ashwagandha really goes to work. It helps counteract some of the negative effects of exercise to maximize fat burning. In one study, participants taking ashwagandha experienced a 69% decrease in their overall measure of stress. It also helps inhibit stress-induced overeating and carb cravings.*
Chromium helps reduce carb cravings*
This trace mineral is a key factor for regulating metabolism of nutrients, such as glucose. By supporting healthy glucose levels, chromium may help reduce carb cravings.*
Directions: Take 2 capsules twice daily.

subset: commoncrawl


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Revisiting the Great Halle Berry Diabetes Ruckus
OMG... did you all know that Halle Berry is pregnant?!
The actress who is also a fellow PWD (person with diabetes) is having her second child. At age 46.
Seriously, the news is out. We tweeted it a few weeks ago. Everyone is talking about this -- magazines and entertainment news sources galore.
OK, celebrity dish fans may care more about this news than we do, but what makes it relevant to the Diabetes Community…


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I need more than a smile and good looks. I've been smitten with plenty of women on this board without ever viewing a photo of them.
I'm eating Indian food tonight. I hope there isn't some type of dream with a person with long arms holding a umami burger over my head and I'm jumping to reach for it.


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Topic Contents
- General Information About Chronic Myeloproliferative Neoplasms
- Chronic Myelogenous Leukemia
- Polycythemia Vera
- Primary Myelofibrosis
- Essential Thrombocythemia
- Chronic Neutrophilic Leukemia
- Chronic Eosinophilic Leukemia
- Changes to This Summary (07 / 03 / 2014)
- About This PDQ Summary
- Get More Information From NCI
Chronic Myeloproliferative Neoplasms Treatment (PDQ®): Treatment - Health Professional Information [NCI]
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.
Chronic Myeloproliferative Neoplasms Treatment
General Information About Chronic Myeloproliferative Neoplasms
The chronic myeloproliferative neoplasms (MPN) consist of chronic myelogenous leukemia, polycythemia vera (p. vera), primary myelofibrosis, essential thrombocythemia, chronic neutrophilic leukemia, and chronic eosinophilic leukemia. All of these disorders involve dysregulation at the multipotent hematopoietic stem cell (CD34), with one or more of the following shared features:
- Overproduction of one or several blood elements with dominance of a transformed clone.
- Hypercellular marrow/marrow fibrosis.
- Cytogenetic abnormalities.
- Thrombotic and/or hemorrhagic diatheses.
- Extramedullary hematopoiesis (liver/spleen).
- Transformation to acute leukemia.
- Overlapping clinical features.
Chronic MPNs usually occur sporadically; however, familial clusters of MPNs have been reported. These familial clusters include autosomal-dominant inheritance and autosomal-recessive inheritance.[1] Patients with p. vera and essential thrombocythemia have marked increases of red blood cell and platelet production, respectively. Treatment is directed at reducing the excessive numbers of blood cells. Both p. vera and essential thrombocythemia can develop a spent phase late in their courses that resembles primary myelofibrosis with cytopenias and marrow hypoplasia and fibrosis.[2,3,4] A specific point mutation in one copy of the Janus kinase 2 gene (JAK2), a cytoplasmic tyrosine kinase, on chromosome 9, which causes increased proliferation and survival of hematopoietic precursors in vitro, has been identified in most patients with p. vera, essential thrombocythemia, and idiopathic myelofibrosis.[5,6,7,8,9,10] Researchers are pursuing specific targeting of this aberrant protein.
Chronic Myelogenous Leukemia
Refer to the PDQ summary on Chronic Myelogenous Leukemia Treatment for more information.
Polycythemia Vera
Disease Overview
The proposed revised World Health Organization criteria for the diagnosis of polycythemia vera (p. vera) requires two major criteria and one minor criterion or the first major criterion together with two minor criteria.[1]
Major Criteria
|Hemoglobin of more than 18.5 g/dL in men, 16.5 g/dL in women, or elevated red cell mass greater than 25% above mean normal predicted value.
|Presence of JAK2 617V greater than F or other functionally similar mutations, such as the exon 12 mutation of JAK2.
Minor Criteria
|Bone marrow biopsy showing hypercellularity with prominent erythroid, granulocytic, and megakaryocytic proliferation.
|Serum erythropoietin level below normal range.
|Endogenous erythroid colony formation in vitro.
Other confirmatory findings no longer required for diagnosis include:[2,3,4]
- Oxygen saturation with arterial blood gas greater than 92%.
- Splenomegaly.
- Thrombocytosis (>400,000 platelets/mm3).
- Leukocytosis (>12,000/mm3).
- Leukocyte alkaline phosphatase (>100 units in the absence of fever or infection).
There is no staging system for this disease.
Patients have an increased risk of cardiovascular and thrombotic events and transformation to acute myelogenous leukemia or primary myelofibrosis.[5,6,7] Age older than 65 years, leukocytosis, and a history of vascular events (bleeding or thrombosis) are associated with a poor prognosis.[5,8,9]
Treatment Overview
The primary therapy for p. vera includes intermittent, chronic phlebotomy to maintain the hematocrit below 45%, and this recommendation has been confirmed in a randomized, prospective trial, which demonstrated lower rates of cardiovascular death and major thrombosis using this hematocrit target.[10,11] The target level for women may need to be lower (e.g., hematocrit <40%), but there are no empiric data to confirm this recommendation.[12]
Complications of phlebotomy include:
- Progressive and sometimes extreme thrombocytosis and symptomatology related to chronic iron deficiency, including pica, angular stomatitis, and glossitis.
- Dysphagia that is the result of esophageal webs (very rare).
- Possibly muscle weakness.
(Refer to the PDQ summary on Oral Complications of Chemotherapy and Head/Neck Radiation for more information.)
In addition, progressive splenomegaly or pruritus not controllable by antihistamines may persist despite control of the hematocrit by phlebotomy. (Refer to the PDQ summary on Pruritus for more information.) If phlebotomy becomes impractical, hydroxyurea or interferon-alpha can be added to control the disease.
The Polycythemia Vera Study Group randomly assigned more than 400 patients to phlebotomy (target hematocrit <45), radioisotope phosphorous-32 (2.7 mg/m2 administered intravenously every 12 weeks as needed), or chlorambucil (10 mg administered by mouth daily for 6 weeks, then given daily on alternate months).[13] The median survival for the phlebotomy group (13.9 years) and the radioisotope phosphorous-32 group (11.8 years) was significantly better than that of the chlorambucil group (8.9 years), primarily because of excessive late deaths from leukemia or other hematologic malignancies.[13][Level of evidence: 1iiA] Because of these concerns, many clinicians use hydroxyurea for patients who require cytoreductive therapy that is caused by massive splenomegaly, a high phlebotomy requirement, or excessive thrombocytosis.[13]
In a pooled analysis of 16 different trials, interferon-alpha therapy resulted in avoidance of phlebotomy in 50% of patients, with 80% of patients experiencing marked reduction of splenomegaly.[14][Level of evidence: 3iiiDiv] Interferon posed problems of cost, side effects, and parenteral route of administration, but no cases of acute leukemia were seen in this analysis. When patients are poorly compliant with phlebotomy or issues of massive splenomegaly, leukocytosis, or thrombocytosis supervene, treatment with interferon or pegylated interferon is considered for patients younger than 50 years (who are more likely to tolerate the side effects and benefit from a lack of transformation to leukemia), while hydroxyurea is considered for patients older than 50 years.[2,15]
In a Cochrane review of two randomized studies of 630 patients with no clear indication or contraindication for aspirin, those receiving 100 mg of aspirin versus placebo had reduction of fatal thrombotic events, but this benefit was not statistically significant (odds ratio, 0.20; 95% CI, .03–1.14).[16] A retrospective review of 105 patients who underwent surgery documented 8% thromboembolism and 7% major hemorrhage with prior cytoreduction by phlebotomy and postoperative subcutaneous heparin in one half of the patients.[17]
Guidelines based on anecdotal reports have been developed for the management of pregnant patients with p. vera.[3]
Treatment options:
|Hydroxyurea (alone or with phlebotomy).[12,13]
|Interferon-alpha [14,18,19] and pegylated interferon-alpha.[20,21]
|Rarely, chlorambucil or busulfan may be required, especially if interferon or hydroxyurea are not tolerated, as is often seen in patients older than 70 years.[2]
|Low-dose aspirin (≤100 mg) daily, unless contraindicated by major bleeding or gastric intolerance.[8,16]
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with polycythemia vera. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Primary Myelofibrosis
Disease Overview
Primary myelofibrosis (also known as agnogenic myeloid metaplasia, chronic idiopathic myelofibrosis, myelosclerosis with myeloid metaplasia, and idiopathic myelofibrosis) is characterized by splenomegaly, immature peripheral blood granulocytes and erythrocytes, and teardrop-shaped red blood cells.[1] In its early phase, the disease is characterized by elevated numbers of CD34-positive cells in the marrow, while the later phases involve marrow fibrosis with decreasing CD34 cells in the marrow and a corresponding increase in splenic and liver engorgement with CD34 cells.
As distinguished from chronic myelogenous leukemia (CML), primary myelofibrosis usually presents as follows:[2]
- A white blood cell count smaller than 30,000/mm3.
- Prominent teardrops on peripheral smear.
- Normocellular or hypocellular marrow with moderate to marked fibrosis.
- An absence of the Philadelphia chromosome or the BCR/ABL translocation.
- Frequent positivity for the JAK2 mutation.
In addition to the clonal proliferation of a multipotent hematopoietic progenitor cell, an event common to all chronic myeloproliferative neoplasms, myeloid metaplasia is characterized by colonization of extramedullary sites such as the spleen or liver.[3,4]
Most patients are older than 60 years at diagnosis, and 33% of patients are asymptomatic at presentation. Splenomegaly, sometimes massive, is a characteristic finding.
Symptoms include:
- Splenic pain.
- Early satiety.
- Anemia.
- Bone pain.
- Fatigue.
- Fever.
- Night sweats.
- Weight loss.
(Refer to the PDQ summaries on Pain; Fatigue; Hot Flashes and Night Sweats; and Nutrition for information on many of the symptoms listed above.)
The proposed World Health Organization criteria for the diagnosis of primary myelofibrosis requires all three major criteria and two minor criteria.[5]
Major Criteria
|Presence of megakaryocyte proliferation and atypia, usually accompanied by either reticulin and/or collagen fibrosis; or, in the absence of significant reticulin fibrosis, the megakaryocyte changes must be accompanied by increased bone marrow cellularity characterized by granulocytic proliferation and often decreased erythropoiesis (so-called prefibrotic cellular-phase disease).
|Not meeting criteria for polycythemia vera (p. vera), CML, myelodysplastic syndrome, or other myeloid neoplasm.
|Demonstration of JAK2 617V greater than F or other clonal marker; or, in the absence of a clonal marker, no evidence of bone marrow fibrosis caused by an underlying inflammatory disease or another neoplastic disease. About 60% of patients with primary myelofibrosis carry a JAK2 mutation, and about 5% to 10% of the patients have activating mutations in the thrombopoietin receptor gene, MPL. Almost 90% of the patients without JAK2 or MPL carry a somatic mutation of the calreticulin gene, which is associated with a more indolent clinical course than is seen with JAK2 or MPL mutations.[6,7]
Minor Criteria
|Increased serum level of lactate dehydrogenase.
|Palpable splenomegaly.
The median survival is 3.5 years to 5.5 years, but patients younger than 55 years have a median survival of 11 years.[3,4] The major causes of death include:[8]
- Progressive marrow failure.
- Transformation to acute nonlymphoblastic leukemia.
- Infection.
- Thrombohemorrhagic events.
- Heart failure.
- Portal hypertension.
Fatal and nonfatal thrombosis was associated with age more than 60 years and JAK2 617V positivity in a multivariable analysis of 707 patients followed from 1973 to 2008.[9] Bone marrow examination including cytogenetic testing may exclude other causes of myelophthisis, such as CML, myelodysplastic syndrome, metastatic cancer, lymphomas, and plasma cell disorders.[4] In acute myelofibrosis, patients present with pancytopenia but no splenomegaly or peripheral blood myelophthisis. Peripheral blood or marrow monocytosis is suggestive for myelodysplasia in this setting.
There is no staging system for this disease.
Prognostic factors include:[10,11,12,13,14]
- Age 65 years or older.
- Anemia (hemoglobin <10 g/dL).
- Constitutional symptoms: fever, night sweats, or weight loss.
- Leukocytosis (white blood cell count >25 × 109 /L).
- Circulating blasts of at least 1%.
Patients without any of the adverse features, excluding age, have a median survival of more than 10 to 15 years, but the presence of any two of the adverse features lowers the median survival to less than 4 years.[15,16] International prognostic scoring systems incorporate the aforementioned prognostic factors.[15,17]
Karyotype abnormalities can also affect prognosis. In a retrospective series, the 13q and 20q deletions and trisomy 9 correlated with improved survival and no leukemia transformation in comparison with the worse prognosis with trisomy 8, complex karyotype, -7/7q-, i(17q), inv(3), -5/5q-, 12p-, or 11q23 rearrangement.[9,18]
Treatment Overview
Asymptomatic low-risk patients (based on the aforementioned prognostic systems) should be followed with a watchful waiting approach. The development of symptomatic anemia, marked leukocytosis, drenching night sweats, weight loss, fever, or symptomatic splenomegaly would warrant therapeutic intervention.
The profound anemia that develops in this disease usually requires red blood cell transfusion. Red blood cell survival is markedly decreased in some patients; this can sometimes be treated with glucocorticoids. Disease-associated anemia may occasionally respond to the following:[4,19,20,21]
- Erythropoietic growth factors. Erythropoietin and darbepoetin are less likely to help when patients are transfusion dependent or manifest a serum erythropoietin level greater than 125 U/L.[22,23]
- Prednisone (40–80 mg/day).
- Danazol (600 mg/day).
- Thalidomide (50 mg/day) ± prednisone.[24] Patients on thalidomide require prophylaxis for avoiding thrombosis and careful monitoring for hematologic toxicity.
- Lenalidomide (10 mg/day) ± prednisone.[25,26,27] In the presence of del(5q), lenalidomide with or without prednisone, can reverse anemia and splenomegaly in most patients.[25,26,27] However, patients on lenalidomide require prophylaxis for avoiding thrombosis and careful monitoring for hematologic toxicity.
- Pomalidomide.[28] Patients on pomalidomide require prophylaxis for avoiding thrombosis and careful monitoring for hematologic toxicity.
Ruxolitinib, an inhibitor of JAK1 and JAK2, can reduce the splenomegaly and debilitating symptoms of weight loss, fatigue, and night sweats for patients with JAK2-positive or JAK2-negative primary myelofibrosis, post–essential thrombocythemia myelofibrosis, or post–p. vera myelofibrosis.[29]
In two prospective, randomized trials, 528 higher-risk patients were randomly assigned to ruxolitinib or to either placebo (COMFORT-I [NCT00952289]) or best available therapy (COMFORT-II [NCT00934544]). At 48 weeks, patients on ruxolitinib had a decrease of 30% to 40% in mean spleen volume compared with an increase of 7% to 8% in the control patients.[30][Level of evidence: 1iiDiv]; [31][Level of evidence: 1iDiv] Ruxolitinib also improved overall quality-of-life measures, with low toxic effects in both studies, but with no benefit in overall survival in the initial reports. Additional follow-up in both studies (1 year in COMFORT-I and 2 years in COMFORT-II) showed a survival benefit among ruxolitinib-treated patients compared with control patients (COMFORT-I hazard ratio [HR], 0.58; 95% confidence interval [CI], 0.36–0.95; and COMFORT-II HR, 0.48; 95% CI, 0.28–0.85).[32,33][Level of evidence: 1iiA] Clinical benefits were observed across a wide variety of clinical subgroups.[34,35] Discontinuation of ruxolitinib results in a rapid worsening of splenomegaly and the recurrence of systemic symptoms.[30,31,36] Ruxolitinib does not reverse bone marrow fibrosis or induce histologic or cytogenetic remissions. More selective JAK inhibitors are currently being evaluated in clinical trials.[37,38]
Painful splenomegaly can be treated temporarily with ruxolitinib, hydroxyurea, thalidomide, lenalidomide, cladribine, or radiation therapy, but sometimes requires splenectomy.[21,39,40] The decision to perform splenectomy represents a weighing of the benefits (i.e., reduction of symptoms, decreased portal hypertension, and less need for red blood cell transfusions lasting for 1 to 2 years) versus the debits (i.e., postoperative mortality of 10% and morbidity of 30% caused by infection, bleeding, or thrombosis; no benefit for thrombocytopenia; and accelerated progression to the blast-crisis phase that was seen by some investigators but not others).[4,39]
After splenectomy, many physicians use anticoagulation therapy for 4 to 6 weeks to reduce portal vein thrombosis, and hydroxyurea can be utilized to reduce high platelet levels (>1 million).[41] However, data from a retrospective review of 150 patients who underwent surgery provided documentation that 8% of the patients had a thromboembolism and 7% had a major hemorrhage with prior cytoreduction and postoperative subcutaneous heparin used in one-half of the patients.[42]
Hydroxyurea is useful in patients with splenomegaly but may have a potential leukemogenic effect.[4] In patients with thrombocytosis and hepatomegaly after splenectomy, cladribine has shown responses as an alternative to hydroxyurea.[43] The use of interferon-alpha can result in hematologic responses, including reduction in spleen size in 30% to 50% of patients, though many patients do not tolerate this medication.[44,45] Favorable responses to thalidomide and lenalidomide have been reported in about 20% to 60% of patients.[19,20,21,46,47,48][Level of evidence: 3iiiDiv]
A response defined as 50% reduction of splenomegaly or development of transfusion independence was attained by one-third of 34 symptomatic patients using tipifarnib.[49][Level of evidence: 3iiiDiv] A more aggressive approach involves allogeneic peripheral stem cell or bone marrow transplantation when a suitable donor is available.[50,51,52,53,54,55] Allogeneic stem cell transplantation is the only potentially curative treatment available, but the associated morbidity and mortality limit its use to younger, high-risk patients.[53,56] Detection of the JAK2 mutation after transplantation is associated with a worse prognosis.[57]
Treatment options:
|Clinical trials involving other JAK2 inhibitors.
|Allogeneic peripheral stem cell or bone marrow transplantation.[51,52,53,54,55]
|Splenic radiation therapy or radiation to sites of symptomatic extramedullary hematopoiesis (e.g., large lymph nodes, cord compression).[4]
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with primary myelofibrosis. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Essential Thrombocythemia
Disease Overview
The proposed revised World Health Organization (WHO) criteria for the diagnosis of essential thrombocythemia requires the following criteria:[1]
|Sustained platelet count of at least 450 × 109 /L.
|Bone marrow biopsy showing predominant proliferation of enlarged mature megakaryocytes; no significant increase of granulocytic or erythroid precursors. This finding distinguishes essential thrombocythemia from another entity with thrombocytosis, namely prefibrotic primary myelofibrosis, which is identified by increased granulocytic or erythroid precursors, atypical megakaryocytes, and increased bone marrow cellularity.
Patients with prefibrotic primary myelofibrosis have a worse survival than patients with essential thrombocythemia because of an increased progression to myelofibrosis and increased progression to acute myelogenous leukemia.[2,3] Patients with prefibrotic primary myelofibrosis may also have a higher tendency to bleed, which can be exacerbated by low-dose aspirin.[4]
|Not meeting criteria for polycythemia vera (p. vera), primary myelofibrosis, chronic myelogenous leukemia, myelodysplastic syndrome, or other myeloid neoplasm.
|Demonstration of JAK2 V617F mutation or myeloproliferative leukemia (MPL) exon 10 mutation.[5] In the absence of a clonal marker, there must be no evidence for reactive thrombocytosis. In particular, with a decreased serum ferritin, there must be no increase in hemoglobin level to p. vera range with iron replacement therapy. In the presence of a JAK2 or MPL mutation and exclusion of other myeloproliferative or myelodysplastic features, a bone marrow aspirate/biopsy may not be mandatory for a diagnosis.[6] About 60% of patients with essential thrombocythemia carry a JAK2 mutation, and about 5% to 10% of the patients have activating mutations in the thrombopoietin receptor gene, MPL. About 70% of the patients without JAK2 or MPL carry a somatic mutation of the calreticulin gene, which is associated with a more indolent clinical course than is seen with JAK2 or MPL mutations.[7,8]
Patients older than 60 years or those with a prior thrombotic episode or with leukocytosis have as much as a 25% chance of developing cerebral, cardiac, or peripheral arterial thromboses and, less often, a chance of developing a pulmonary embolism or deep venous thrombosis.[2,9,10] Similar to the other myeloproliferative syndromes, conversion to acute leukemia is found in a small percentage of patients (<10%) with long-term follow-up.
There is no staging system for this disease.
Untreated essential thrombocythemia means that a patient is newly diagnosed and has had no prior treatment except supportive care.
Treatment Overview
Controversy is considerable regarding whether asymptomatic patients with essential thrombocythemia require treatment. In a case-controlled, observational study of 65 low-risk patients (<60 years of age, platelet count <1,500 × 109 /L, and no history of thrombosis or hemorrhage) with a median follow-up of 4.1 years, the thrombotic risk of 1.91 cases per 100 patient years and hemorrhagic risk of 1.12 cases per 100 patient years was not increased any more than in the normal controls.[11]
|A randomized trial of patients with essential thrombocythemia and a high risk of thrombosis compared treatment with hydroxyurea titrated to attain a platelet count below 600,000/mm3 with a control group that received no therapy. Hydroxyurea was found to be effective in preventing thrombotic episodes (4% vs. 24%).[9][Level of evidence: 1iiDiv] A retrospective analysis of this trial found that antiplatelet drugs had no significant influence on the outcome. Resistance to hydroxyurea is defined as a platelet count of greater than 600,000/mcL after 3 months of at least 2 g per day of hydroxyurea or a platelet count greater than 400,000/µL and a white blood count of less than 2,500/µL or a hemoglobin less than 10 g/dL at any dose of hydroxyurea.[12]
|A prospective, randomized trial in the United Kingdom (UK) of 809 patients compared hydroxyurea plus aspirin with anagrelide plus aspirin.[13] Although the platelet-lowering effect was equivalent, the anagrelide group had significantly more thrombotic and hemorrhagic events (hazard ratio [HR], 1.57; P = .03) and more myelofibrosis (HR, 2.92; P = .01). No differences were seen for subsequent myelodysplasia or acute leukemia in this trial.[14][Level of evidence: 1iiD]
|Another prospective, randomized trial also compared hydroxyurea and anagrelide in 259 previously untreated and high-risk patients.[15] In this central European trial, the diagnosis of essential thrombocythemia was made by the WHO recommendations, not by the Polycythemia Vera Study Group criteria as in the UK study. This means that patients with leukocytosis and a diagnosis of early prefibrotic myelofibrosis (both groups with much higher rates of thrombosis) were excluded from the central European trial. In this analysis, there were no differences in outcome for thrombotic or hemorrhagic events.[15][Level of evidence: 1iiD]
These three randomized, prospective trials establish the efficacy and safety for the use of hydroxyurea for patients with high-risk essential thrombocythemia (age >60 years + platelet count >1,000 × 109 /L or >1,500 × 109 /L). For patients diagnosed by WHO standards (excluding patients with leukocytosis and prefibrotic myelofibrosis by bone marrow biopsy), anagrelide represents a reasonable alternative therapy. The addition of aspirin to cytoreductive therapies like hydroxyurea or anagrelide remains controversial, but a retrospective anecdotal report suggested reduction in thrombosis for patients older than 60 years.[16]
Many clinicians use hydroxyurea or platelet apheresis prior to elective surgery to reduce the platelet count and to prevent postoperative thromboembolism. No prospective or randomized trials document the value of this approach.
Among low-risk patients (defined as age ≤60 years with no prior thrombotic episodes), a retrospective review of 300 patients showed benefit for antiplatelet agents in reducing venous thrombosis in JAK2-positive cases and in reducing arterial thrombosis in patients with cardiovascular risk factors.[17] Balancing the risks and benefits of aspirin for low-risk patients can be difficult.[18] In an extrapolation of the data from trials of p. vera, low-dose aspirin to prevent vascular events has been suggested, but there are no data from clinical trials to address this issue.[19]
Treatment options:
|No treatment, unless complications develop, if patients are asymptomatic, younger than 60 years, and have a platelet count of less than 1,500 × 109 /L.
|Interferon-alpha [20,21] or pegylated interferon-alpha.[22,23]
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with essential thrombocythemia. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Chronic Neutrophilic Leukemia
Disease Overview
Chronic neutrophilic leukemia (CNL) is a rare chronic myeloproliferative neoplasm of unknown etiology, characterized by sustained peripheral blood neutrophilia (>25 × 109 /L) and hepatosplenomegaly.[1,2] The bone marrow is hypercellular. No significant dysplasia is in any of the cell lineages, and bone marrow fibrosis is uncommon.[1,2] Cytogenetic studies are normal in nearly 90% of the patients. In the remaining patients, clonal karyotypic abnormalities may include +8, +9, del (20q) and del (11q).[1,3,4,5] There is no Philadelphia chromosome or BCR/ABL fusion gene. CNL is a slowly progressive disorder, and the survival of patients is variable, ranging from 6 months to more than 20 years.
Treatment Overview
Until the last few years, the treatment of CNL focused on disease control rather than cure. Once the disease progressed to a more aggressive leukemia, there was typically little chance of obtaining a long-lasting remission because of the older age of most patients as well as the acquisition of multiple poor prognostic cytogenetic abnormalities. Allogeneic bone marrow transplantation represents a potentially curative treatment modality in the management of this disorder.[6,7,8] Varying success has been reported with the use of traditional chemotherapies including hydroxyurea and interferon.[9]
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with chronic neutrophilic leukemia. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Chronic Eosinophilic Leukemia
Disease Overview
Chronic eosinophilic leukemia (CEL) is a chronic myeloproliferative neoplasm of unknown etiology in which a clonal proliferation of eosinophilic precursors results in persistently increased numbers of eosinophils in the blood, bone marrow, and peripheral tissues. In CEL, the eosinophil count is greater than or equal to 1.5 × 109 /L in the blood.[1] To make a diagnosis of CEL, there should be evidence for clonality of the eosinophils or an increase in blasts in the blood or bone marrow. In many cases, however, it is impossible to prove clonality of the eosinophils, in which case, if there is no increase in blast cells, the diagnosis of idiopathic hypereosinophilic syndrome (HES) is preferred. Because of the difficulty in distinguishing CEL from HES, the true incidence of these diseases is unknown, although they are rare. In about 10% of patients, eosinophilia is detected incidentally. In others, the constitutional symptoms found include:[1,2]
- Fever.
- Fatigue.
- Cough.
- Angioedema.
- Muscle pains.
- Pruritus.
- Diarrhea.
No single or specific cytogenetic or molecular genetic abnormality has been identified in CEL.
(Refer to the PDQ summaries on Hot Flashes and Night Sweats; Fatigue; Cardiopulmonary Syndromes; Pain; Pruritus; and Gastrointestinal Complications for information on many of the symptoms listed above.)
Treatment Overview
The optimal treatment of CEL remains uncertain, partially on account of the rare incidence of this chronic myeloproliferative neoplasm and the variable clinical course, which can range from cases with decades of stable disease to cases with rapid progression to acute leukemia. Case reports suggest that treatment options include bone marrow transplantation and interferon-alpha.[3,4]
Treatment of HES has included the following:[5,6]
- Corticosteroids.
- Chemotherapeutic agents such as hydroxyurea, cyclophosphamide, and vincristine.
- Interferon-alpha.
Case reports suggest symptomatic responses to imatinib mesylate for patients with HES who have not responded to conventional options.[6,7,8][Level of evidence: 3iiiDiv] Imatinib mesylate acts as an inhibitor of a novel fusion tyrosine kinase, FIP1L1-PDGFR alpha fusion tyrosine kinase, which results as a consequence of interstitial chromosomal deletion.[6,9][Level of evidence: 3iiiDiv] HES with the FIP1L1-PDGFR alpha fusion tyrosine kinase translocation has been shown to respond to low-dose imatinib mesylate.[9]
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with chronic eosinophilic leukemia. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Changes to This Summary (07 / 03 / 2014)
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.
Polycythemia Vera
Added Quintás-Cardama et al. as reference 21.
Primary Myelofibrosis
Added text to state that about 60% of patients with primary myelofibrosis carry a JAK2 mutation, and about 5% to 10% of the patients have activating mutations in the thrombopoietin receptor gene, MPL. Also added that almost 90% of the patients without JAK2 or MPL carry a somatic mutation of the calreticulin gene, which is associated with a more indolent clinical course than is seen with JAK2 or MPL mutations (cited Klampfl et al. and Nangalia et al. as references 6 and 7, respectively).
Essential Thrombocythemia
Added text to state that about 60% of patients with primary myelofibrosis carry a JAK2 mutation, and about 5% to 10% of the patients have activating mutations in the thrombopoietin receptor gene, MPL. Also added that almost 90% of the patients without JAK2 or MPL carry a somatic mutation of the calreticulin gene, which is associated with a more indolent clinical course than is seen with JAK2 or MPL mutations (cited Klampfl et al. and Nangalia et al. as references 7 and 8, respectively).
Added Quintás-Cardama et al. as reference 23.
This summary is written and maintained by the PDQ Adult Treatment 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.
About This PDQ Summary
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of chronic myeloproliferative neoplasms. 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 Adult Treatment 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:
- be discussed at a meeting,
- be cited with text, or
- replace or update an existing article that is already cited.
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 reviewers for Chronic Myeloproliferative Neoplasms Treatment are:
- Steven D. Gore, MD (Johns Hopkins University)
- Mark J. Levis, MD, PhD (Johns Hopkins University)
- Eric J. Seifter, MD (Johns Hopkins University)
- Mikkael A. Sekeres, MD, MS (Cleveland Clinic Taussig Cancer Institute)
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 Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
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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® Chronic Myeloproliferative Neoplasms Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://cancer.gov/cancertopics/pdq/treatment/myeloproliferative/HealthProfessional. Accessed <MM/DD/YYYY>.
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text:
Alzheimer's Disease Health Center
Alzheimer's Disease Basics
In this article
How Is Alzheimer's Disease Diagnosed?
It is important to visit a doctor if you or a loved one experiences any of these symptoms of Alzheimer's disease so that you can receive the proper evaluation and diagnosis. There are other conditions -- such as depression, a head injury, stroke, certain chemical or vitamin imbalances, or the effects of some medications -- that can produce symptoms that are similar to Alzheimer's disease. Many of these conditions are treatable.
Your doctor can only determine if the symptoms are probably due to Alzheimer's disease after a thorough medical, psychiatric, and neurological evaluation. Positron emission tomography, or a PET scan, of the brain may be useful if the person meets certain criteria. Because drugs exist that may lessen the symptoms of Alzheimer's disease, the doctor will evaluate other possible causes of dementia to rule out all other factors before settling on Alzheimer's disease as a diagnosis.
Currently, no definitive diagnostic test for Alzheimer's disease exists. A definite diagnosis of Alzheimer's disease is possible only after death when a pathologist can more closely examine a patient's brain for the telltale changes associated with the disease.
What's the Prognosis for Alzheimer's Disease?
The course of Alzheimer's disease varies widely from person to person. The duration of the illness could be short (2-3 years) or long (up to 20 years). Usually, the parts of the brain that control memory and thinking are affected first, but over time, cells die in other areas of the brain.
Eventually, a person with Alzheimer's disease will need complete care. If the person has no other serious illnesses, the loss of brain function itself will eventually cause death.
Can Alzheimer's Disease Be Prevented?
Because the exact cause of Alzheimer's disease is not known, there is currently nothing that can be done to guarantee its prevention. Some interventions may be worth incorporating into your life as more research reveals some potentially controllable risk factors. Staying mentally and physically active, maintaining a normal blood pressure and avoiding head injury by wearing seat belts and helmets may decrease your chances of developing Alzheimer's dementia.
It is important to remember, however, that there are causes of dementia other than Alzheimer's disease that may be preventable by such means as eating properly, exercising, quitting smoking, and limiting how much alcohol you drink. Your doctor can advise you about other healthy lifestyle habits you can adopt that may help prevent dementia.
WebMD Medical Reference


text:
Phoronix: Wine 1.5.28 Improves PostScript Driver, Mac Driver
It's time for another bi-weekly development release of Wine...
Printable View
Phoronix: Wine 1.5.28 Improves PostScript Driver, Mac Driver
It's time for another bi-weekly development release of Wine...
Why have PostScript support at all, is it better in some cases than PDF? I read yesterday cups 1.6 makes PDF the default format.
The change to PDF is mostly because Apple OWNS CUPS and OSX primary 2D text and graphics rendering library uses PDF internally for composition, so it's easier for them to support only PDF than PDF and PostScript, allowing easier postprocessing and higher color depth. And for those printers not supporting PostScript (needing data translation anyway) a simpler printing pipeline.
But this isn't the only important change. They are removing everything not usefull for them.
The currently used, supported and tried network printer discovery method? Gone and replaced by their preferred method, even if it causes interoperability problems: http://cyberelk.net/tim/2012/02/06/c...changes-ahead/
Printing filters they don't use? Out with them: http://www.cups.org/str.php?L3930
There has even been talk about posibly forking cups in a not so distant future due to this kind of changes centered in what Apple wants/needs.
It wakes the computer (CPU and network adapter) from idle everytime it does it.
And its not standardized. Bring on mDNS (whether it be Bonjour-- Mac, or Avahi-- linux, Windows uses Bonjour until MS stops trying to shove WINS down everyones throat)
Filters are trivial to add back in. Arch even has a nice package called 'cups-filters' that adds in any filter that isnt shipped by default.Quote:
Printing filters they don't use? Out with them: http://www.cups.org/str.php?L3930
It wouldnt surprise me, Apple knows what it wants. As long as they implement the standard as well (eg they dont fork Zeroconf / mDNS) as their implementation / protocol, I dont really care.Quote:
There has even been talk about posibly forking cups in a not so distant future due to this kind of changes centered in what Apple wants/needs.
True, but see my post about "As long as they dont break the standard, who cares?" Thats the point of the standards. we can have different implementations (eg: they fork cups) but the standards ensure interoperability when necessary.Quote:
Easy to fix as this is, it's another signal of the current trend to remove everything they don't use/want/need, and to hell everybody else.
And where this is most useful, big companies and offices, it may require a security policy review/change that can take a long time, forcing them to keep an old CUPS or to rush an untested change. What's more, without support for the old standard, you can't implement a mixed environment for a progressive change. They would need additional servers (to do both things at the same time) or a full printing infrastructure replacement in one go. So directly removing the previous default is just WRONG.
As I've said before, I'm think this will be a good thing sometime in the future, and have no doubt about that, but what makes me angry is that it's been done the WRONG way, and for the WRONG reasons.
As for not caring about a fork... I do care, because that means a lot of work will be duplicated and that's a shame.
Whats my point? Corporations are gonna have a lot of warning that this is coming, it isnt gonna get shoved down their throats randomly, they have time to test and figure out if they are gonna have issues and do a gradual change and rollout. It isn't even really a security issue because you can edit what Avahi announces on the network and what it doesn't. So if you dont want your entire network knowing that your file server web server and ssh server are all broadcasting off the same IP...you just disable those broadcasts. Its not an all or nothing thing.


text:
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Who's there?
Nadia who?
Nadia head if you understand.


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The price of admiralty: war at sea from man of war to submarine
Hutchinson, 1988 - History - 292 pages
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49 pages matching battleships in this book
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Review: The Price of Admiralty: The Evolution of Naval Warfare from Trafalgar to MidwayUser Review - Pete - Goodreads
A bit slow in his overly-detailed way through Trafalgar. Pace picks up tremendously from Jutland and beyond. Basically "The Face of Battle" on the sea. If you liked one, you will like the other. Read full review
Review: The Price of Admiralty: The Evolution of Naval Warfare from Trafalgar to MidwayUser Review - sologdin - Goodreads
various useful discussions here. one wonders, for instance, how major naval combats ever occurred at all in the Napoleonic era, considering the difficulty of actually crossing paths with another ship ... Read full review
Common terms and phrases
5th Battle Squadron aboard action Admiral Admiralty aircraft Algesiras American armoured army Atlantic attack battle fleet battlecruisers battleships Beatty's boats Britain British ships broadside Bucentaure Cadiz capital ships captains carriers casualties Collingwood Combined Fleet command convoy crew damage deck defeat depth charges destroyers Donitz dreadnoughts Dutch enemy enemy's engagement engine-room escorts fight fire force fought Fougueux four France frigate German Grand Fleet gunnery guns High Seas Fleet hoists hull Indies Japanese Jellicoe's Jutland killed land launched Lieutenant light cruisers loss magazine manoeuvre marines masts Mediterranean midshipman Midway miles Napoleon naval Navy's Nelson North officers operations Pacific patrol port range Redoutable Royal Navy sailing sailors salvoes Santissima Trinidad Scheer seamen shell ship's shot signal sinking speed squadron steam strategic strike submarine suffered sunk survivors tactics targets Tirpitz torpedo torpedo-boat Toulon Trafalgar turret U-boat Victory Victory's Villeneuve Villeneuve's warfare warships wind wooden wounded yards


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Teen Employment at the Y
Teens can make a difference in the world too! The Y of Greater Boston is the largest employer of teens in Boston, hiring more than 500 each year.
There are endless employment and volunteer opportunities available year round. While working and volunteering at the Y you can make new friends, learn to work as a team, and do your part in helping the community.
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Flo Rida record a great song for the next disk David Guetta.
Flo Rida has said that just recorded a great song for the new album that prepares David Guetta. This has been declared the Daily Star: "I have a piece of club success for the new album from David, but I can not talk about it yet. "
@Droptopchevy882 Oh and nelly and fergie sound awesome for a flo rida album. Btw are those songs you mentioned out or just referenced. If you can please post a link that would be nice.
So who is gonna be on part 2 and when will we get a single or the album? I know lil Wayne is on it and I'd guess maybe briana or brisco would make an appearance. Is the track with lil wayne fresh I stay or a brand new track?
Ninjajuggalo i agree with what ya sayin....ive seen Chamillionaire metion Flo Rida in his interview on Youtube and he said if you want to be successfull and go worldwide and make the pop money then thats why Flo Rida is bigger that Chamillionare....if you go overseas people wouldnt know who Chamillionaire is he dont get radio play...but i do like Chamillionaire he the most underated rapper!! "Venom" dropping 2011
"Only One Rida" Dropping in Spring im guessing March thats when all his previous albums were released...
Ever since "Low" became that worldwide smash Flo Rida changed to pop but he still keeping it hood with "Part 2" Only One Rida got some sick tracks on their i heard a few watch out for "Roof On Fire feat. Brianna", "Eyez on You feat. Brisco" & "I Get the Paper" Guest Features: Lil wayne, Nelly & Fergie been lined up!


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Get The Latest Show Reviews Here!
Maynard James Keenan, lead singer for the rock bands A Perfect Circle and Tool, has played Lollapalooza five times, he informed the early-evening audience at the festival's Music Unlimited stage. The first time was with Tool and dated back to 1993, he said. Keenan turned his seniority into a joke -- "So you'll probably have to speak up; I'm a little old" -- but there was something poignant in the way he bowed to the crowd and thanked Chicago at the close of A Perfect Circle's roughly hour-and-15-minute set.
A Perfect Circle's Lollapalooza set comes after its first tour in years, and any rust that may have existed when the last superstars of what used to be called "modern rock" first reunited on Jimmy Kimmel Live! last October was clearly absent. Keenan crouched impassively in his corner of the stage, joined by guitarist/co-founder Billy Howerdel, former Smashing Pumpkins guitarist James Iha, bass player Matt McJunkins, and drummer Jeff Friedl. The set drew from each of the band's three albums, but may have disappointed some of the band's early fans by skipping 2000 radio hit "Judith."
The songs were intricately detailed, proggy, near-metal dirges that built to cathartic conclusions, with vocals that could quickly veer from decorous to furious; as a sheer display of lockstep precision, A Perfect Circle was impressive. As sheer rock, you could see the effects of their songs about suicide, forbidden love, and halos that choke all hitting their fans in some primordial region of the brain as they shouted along. This is a kind of music you don't hear as often anymore -- partly due to Keenan's bands' absence -- in the era of the quick mp3, but it belongs to the same epic, almost-Manichean strain as, say, The Lord of the Rings trilogy. Even their covers from critically derided 2005 album eMOTIVe, whether logical (Led Zeppelin's "When the Levee Breaks") or radically transformed (John Lennon's "Imagine") coalesced naturally enough tonight into their domineering aesthetic. Make it six?
-- Marc Hogan


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You've heard of rally caps in baseball, but did you know that they exist in basketball, too? When Philadelphia needs a big rally during the game, flip your beanie inside-out and cheer them on louder from the stands. This Reversible Team Logo beanie from adidas features a large 76ers logo on the front and, when flipped, shows the team wordmark. Start a new trend in the arena and watch how that flip of the hat can lead to a big Philadelphia winning streak.
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Photograph by Jim Richardson
Menhir stones erected along Galicia's coast by contemporary Galician artist Manolo Paz hark back to Celtic times.
Read more in "Galicia, Untamed" in the June/July 2013 issue of National Geographic Traveler.
More »
© 1996-2015 National Geographic Society. All rights reserved.


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True, but it was the way players were able to still get paid under the old cba. The owners just want to fvck the players.
It's a stretch to call it being fvcked by the owners. The majority of the players are so out of touch with reality that they don't even have a clue what the average family has to go through to just get by anymore. The owners and players are a joke and the hell to them both if this garbage keeps getting dragged out.


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I've been following the progress of electronic book readers, because they have the potential to revolutionize the efficiency of the book industry. If electronic books were used on a large scale, they would greatly reduce the world's consumption of paper, and eliminate the energy resources involved in printing, transporting and selling books. I do enjoy […][Read More]
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UPDATE: This game has been shutdown and is no longer available
Mythos Overview
Mythos combines traditional fantasy role-playing elements with fast paced hack n' slash infused gameplay. Players enter the enchanted world of Uld as adventurers. After a broken alliance between the Cyclops and the Humans the once peaceful land has now become a danger zone. Explore various territories of former allies. Slay wild beasts, monsters, and opposing nations. Unlock mysteries in complicated dungeons and complete endless quests. Similar to Diablo or Dynasty Warriors Online in terms of combat and graphics players transform their character into noteworthy hero. There are four distinct races to choose from and three primary classes. Each class features specialized skill trees.
Races – Gremlin, Styr, Human, and Cyclops
Bloodletter – Notorious for their powerful melee combat this class has the ability to summon blood minions from their fallen foes to serve as their own. Skill Tree consists of Crimsonate, Martialist, and Red Hand.
Pyromancer – Experts at long ranged attacks this class has also mastered the element known as fire. They are equipped with protective shields and enchanted weapons. Pyromancer's skill tree features Cinderblade, Flamecaster, and Coalsmasher.
Gadgeteers – Tech geniuses armed with an assortment of rifles and artillery at their disposal. This class has the ability to construct bombs as well as clever traps. Skill Tree has Marksman, Grenadier, and Tinkerer.
Mythos Screenshots
Mythos Featured Video
Mythos Review
By Ange Perdu
Mythos Europe is a 3D MMORPG where players step into the shoes of an ambitious adventurer in the mystical world of Uld. Prove your worthiness and create a name for your character by completing various quests. Destroy menacing supernatural forces. Kill zombies, skeletons, goblins, and gigantic reptiles. Explore complicated maze-like dungeons to find treasure chests and unravel the secrets of the legends. Fight other players in PvP battles or join a party to wage war together. Master unique skills and tap into the elements for additional power. Collect rare materials to craft your own weaponry. Become a hero for a land in despair.
Quest of a True Adventurer, the Gameplay
Most of the gameplay involves completing quests and exploring dungeons. There are plenty of quests to accomplish. Mythos Europe has a nice variety of tasks for adventurers to tackle. Missions can vary from delivering urgent messages to NPCs to killing monsters terrorizing townsfolk. Go to guards in another area and report recent attacks. Defeat beasts lurking in Shaman's Cave. Search under rocks for magical dust powder. Find cooper material nearby and forge a hammer. Players usually end up battling roaming monsters in combat. Much like Dynasty Warriors Online there's plenty of fast-paced action. The wildlife creatures and monsters are extremely hostile in Uld. Fight giant bears, tigers, snakes, flying eagles, lizards, spiders, and an assortment of critters gone mad. As players go further into the land they'll face more difficult species like Rock Tongues and Boulder Giants. The hack n' slash combat is intense. Users have to click repeatedly to initiate blows. Nothing gets passed these beasts. As soon as a hero is spotted they immediately attack. In a matter of seconds players are besieged by hordes of monsters. It can be annoying when you're in the middle of receiving a quest at a NPC and a pack of angry wolves attack.
Skills & Dungeon Grinding
During combat heroes can execute various skills depending on their chosen class. Each class has three specialized skill trees that players can master through leveling up and distributing points. Master the Piercing Flurry, Minotaur Stomp, Blade Breaker, or Foe Reaper. As characters move down their trees they can master skills with higher levels of damage. There are some cool moves like the Razor Aura that causes enemies to bleed within an eight meter radius. In Mythos Europe adventurers also explore dozens of dungeons in the form of massive caves, mysterious cellars, and abandoned sanctuaries. Some quests require heroes to clear dungeons in certain locations. In these zones treasure chests containing important items or potions are held. There are various floors and hundreds of monsters waiting to strike. The grinding is relentless. Players have to slay Decrepit Ones, Skeleton Warriors, Imp Kings, and an assortment of bosses to clear the area. The large complicated maze-like formation of many of the dungeons makes the gameplay challenging.
Crafting Mayhem
Players acquire most of their equipment from monster drops, mission rewards, and crafting items. Adventurers often have to complete crafting missions which consist of breaking down items with a hammer into usable materials that can later be forged into a new item or as an upgrade for a weapon. Sometimes players have to search distant forests, plains, deserts, and caves for materials to help create potions or tools. The game features a nicely integrated Achievement system which rewards players automatically with a boost in a particular attribute. It's a great way to enhance characters and keep busy in between missions. Achievements are divided into categories and different locales. Earn PvP, collections, hunting, or object destruction trophies. At any time during the game heroes can click on another player to initiate a PvP battle. Up to five players can form a party to fight together.
Lewyn the Bargain Hunter
There are NPC shops stationed throughout different villages. Players can buy or sell unwanted items. Every weapon and accessory requires a hero to be a certain class, level, or possess a specific attribute in order to wear. The selection in most of the shops is limited. Only a dozen or so items are available. Buy Forest Bows, Stale Hammers, Large Axes, Smithwrought Staff, Scimitar, Greywood Staff, Spiked Club, Scythe, Flourished mace, Halberd, Saber Sword, Springprod Crossbow, or a Boar sticker to bash foes. All of the armor and outfits look the same. Wear tattered breeches, Adventure's Trousers, slippers, Sharpshooter's Shoulder Armor, standard leather pants, helm, belts, Adept's Circlet, Mage gloves, Smuggler's Trench coat, Brigand's Drape, or a Soldier's Cape. Common tools such as enchanted rings, necklaces, and health potions can also be purchased.
In the official game shop users are able to buy a small selection of acceleration items and the infamous immediate revival. Unlike the NPC shops these gems require real cash in order to purchase. Players are automatically transported to the starting portal of the last village they entered before their unfortunate demise if they don't possess a revival token. Heroes willing to spend money receive the luxury of merchant summoning stones to make any NPC shop magically appear regardless of their location and the option not to trek back through towns while monster killing.
Final Verdict: Good
Mythos Europe is a solid hack n' slash MMO with a few unique twists. It plays similar to standard RPGs but mixes up the combat. The entire game is relatively fast paced. Beasts will sprint towards adventurers and attack in hordes. Players get to explore a massive virtual world filled with challenging dungeons and Ancient Warriors to battle. Accomplish countless quests. Master skills based on your character's class. Face off in intense PvP matches or conquer with a party of friends. Despite the extra security procedures and limited NPC shops Mythos Europe has a lot to offer. If you enjoy games such as Diablo or Dynasty Warriors Online this hack n' slash might be worth trying.
Mythos Links
Mythos System Requirements
Minimum Requirements:
OS: Windows XP / Vista / 7
CPU: 1.8 GHz Intel Pentium 4 / AMD Athlon
HDD: 500 mb
Graphics Card: nVidia GeForce 5200 / ATI Radeon 9500
Recommended Specification:
OS: Windows Vista / 7
CPU: Pentium Duel Core or better
RAM: 2 GB RAM or more
HDD: 1 GB Free
Graphics Card: nVidia GeForce 6600 GT or better


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Tales From The Royal BedchamberSaturday | 9 p.m.
Lucy Worsley gets into bed with Britain's past monarchs to uncover the secrets of the royal bedchamber. She reveals that the obsession with royal bedrooms, births and succession is nothing new. In fact, the rise and fall of the royals' magnificent beds reflects the changing fortunes of the monarchy itself.
Jackie Evancho: Awakening - Live in ConcertSaturday | 9 p.m.
Angelic Jackie Evancho returns to PBS with her latest collection of songs from her new CD, Awakening. Drawn from the best known pieces from the classical canon, Broadway, uplifting sacred music and pop songs, Jackie's astoundingly beautiful young voice soars again at the magnificent Longwood Gardens Open Air Theatre. Longwood Gardens is over 1,000 acres of gardens, woodlands and meadows in Pennsylvania's Brandywine Creek Valley, Jackie's home state. This is the first time Longwood Gardens has ever permitted a television special to be taped on site and, in addition to her on-stage performance, Jackie will be performing at various stunning locations throughout the Gardens such as the Chimes Tower and the spectacular Main Fountain. Jackie will be joined by Cheyenne Jackson who will both host and perform with Jackie. Cheyenne, star of Broadway, film and television, is perhaps best known for his starring and award-winning Broadway performance in Finian's Rainbow , his recurring role in NBC's 30 Rock, and his starring role in HBO biopic, Liberace, Behind the Candelabra. The two will also show us some of the splendid beauty of the Gardens as they tour some gorgeous key locations within it.
Is WEIU important to you? Become a member today! Also, send us a message and let us know what WEIU means to you!
Genealogy RoadshowNew Orleans - Board of Trade | Sunday, 8 p.m.
A team of genealogists uncovers fascinating family stories at the New Orleans Board of Trade. A local man seeks to recover essential history washed away in Hurricane Katrina; a woman discovers she has links to both sides of the Civil War; another unravels the mystery behind her grandfather's adoption; and one man explores a link to the famous New Orleans Voodoo Queen, Marie Laveau.
Motown 25Yesterday, Today, Forever | Sunday, 10 p.m.
Hosted by legendary comedian Richard Pryor, Motown 25: Yesterday, Today, Forever celebrates the 25th anniversary of Motown, with reunions of Smokey Robinson & The Miracles, Diana Ross & The Supremes, The Jackson 5, The Temptations, Four Tops, Marvin Gaye, Stevie Wonder, Martha Reeves, Mary Wells, Jr. Walker and more! Not seen on broadcast TV in more than 20 years, this incredible MY MUSIC special presentation finally comes to public television for one amazing night!
Is WEIU important to you? Become a member today! Also, send us a message and let us know what WEIU means to you!
A Night of GivingThursday, Nov. 20 | 7 p.m.
Showcasing Local Artists -- Supporting Local Public Television
Local artists include:
- Randy & Joy Turner from Larkfield Glass (Paris, IL)
- Jerry Rhoads (St. Joseph, IL) - Woodtuning
- Jeanette Huisinga (Casey, IL) - The Yarn Shop
- Pottery from Dwain Naragon (EIU Faculty)
This night of giving allows our viewers to give to their local public television station and in return WEIU will offer viewers a wonderful handmade thank you gift from a local artist.
Is WEIU important to you? Become a member today! Also, send us a message and let us know what WEIU means to you!
Classic GospelGod Bless the USA | Saturday, 6 p.m.
A Salute to the American Spirit with Bill & Gloria Gaither and their Homecoming Friends. Includes This Land Is Your Land, America The Beautiful, Lean On Me and God Bless America.
Globe TrekkerGreat Australian Hikes | Friday, 7 p.m.
Zay embarks on five of Australia's greatest hikes including Mount Bishop and Clerk in Maria Island, the six foot track in the Blue Mountains of New South Wales, the Great Ocean Road in Victoria, Mount Gower on Lord Howe Island and Lamington National Park in Queensland. Along the way he encounters the country's most exotic wildlife such as the spiny echidna and the wombat, experiences the most spectacular views and treks through the country's most historic regions.
The Jewel in the CrownThe Day of the Scorpion | Saturday, 8 p.m.
On her homeward journey Sarah meets Count Bronowsky, the Nawab's chief minister. He is taking the Nawab's secretary Ahmed Kasim to meet his father, the ex-chief minister of Ranpur, released from prison where he has been detained with other Congress leaders since 1942. Ahmed's elder brother Sayed has been captured fighting alongside the Japanese as a member of the Indian National Army, and he must break the news to his father. By the time Sarah returns to Pankot, Susan's baby has been born and Mabel has been buried - but not as Barbie believes she should have been. Merrick returns secretly to Pankot, badly disfigured by burns, to have an artificial arm fitted. Failure and pain drive him almost to the point of madness - but it is Susan whose hold on sanity suddenly snaps. Re-enacting an old ritual for dispatching a scorpion, she wraps her baby son in his christening gown and surround him with a ring of burning kerosene. As her terrified young ayah looks on, she chants 'Little prisoner, go free.'
Food ForwardGo Fish! | Wednesday, 7 p.m.
By mid-century, 90 percent of the world's commercial fish may be tapped out. But we're not sunk yet. FOOD FORWARD sets sail with a different breed of fishermen who make their living on the water while treading lightly upon it. Meet old school fishermen in the Pacific Northwest reviving the tuna industry, young fishermen (and women) creating Community Supported Fisheries along the Eastern seaboard and the next generation of fish farmers in western Massachusetts.
Masterpiece: Mystery!Inspector Lewis: The Lions of Nemea | Monday, 8 p.m.
After a difficult start, Lewis and Hathaway seem to have settled back into their former relationship, and Maddox has become integral to the team. Their abilities are tested as they investigate the brutal murder of Rose, an American Classics student. Suspicion immediately falls on a young professor who had recently broken off an affair with her, but as the detectives delve further into the case, they only find more secrets and murky motives.
Bill Hill - Charleston, IL
"Education has been my life. Learning has been my life ... and it's so important that we have the educational programs offered by WEIU. The opportunities (for students) to get hands on experience is immeasurable."
WEIU membership is important to Bill, and you can also be a proud member! Also, send us a message and let us know what WEIU means to you!
Sam Jones - Ashmore, IL
"I support WEIU because I know that at any time, day or night we can tune in and we can count on good, quality entertainment and good wholesome programming made available to us. WEIU is what I consider to be a family friendly television station because I know that if my children or grandchildren are visiting and they enter the room where I'm watching TV, I don't have to worry about anything inappropriate being on my TV screen. I know that I can trust WEIU and I love that!"
WEIU membership is important to Sam, and you can also be a proud member! Also, send us a message and let us know what WEIU means to you!
Jack Neal - General Manager
When Did You Start at WEIU? 2010
Favorite Show on WEIU-TV: This is a tough one! I'm a fan of everything we do both on the air as well as in the world of education. But truth be told, my favorites are locally produced programs. Heartland Highways gives me a chance to see some of the many amazing places in this wonderful area we call home. I've seen places on Heartland Highways that lifelong east central Illinois residents didn't know existed...and then made the short drive to see those places up close and personal myself. And I've learned so much about some of the most interesting people who are our neighbors.
Another of my top three would be Four Rivers Ag Report. Though I'm not a farmer, I live on a working farm and see the daily ag activity that drives our area. No matter what we do, we are a part of agriculture. And I find that fascinating. The things I've learned about our farm community as a result of Four Rivers are pretty amazing. And as much as Four Rivers Ag Report focuses on the farmers in our area, it does just as good a job of celebrating our rural lifestyle.
Last but not least is News Watch. There is nowhere else to find the kind of coverage News Watch provides our area. Even in a world of 24/7 online and cable/satellite news services, I find News Watch the only place to watch and learn what's happening in OUR community. It's unique.
What have you learned while working at WEIU? This could be a chapter in itself!In my case, I came to WEIU after working in public broadcasting for decades.I'd worked for many stations in many parts of the country. My fascination with WEIU was two-fold: The fact that WEIU is MORE than a PBS station, and the opportunity to live in this incredible community. Being a part of a non-commercial TV station that goes so far beyond programming what most PBS stations provide has allowed me to learn an amazing number of new things about our world. And being in the east central Illinois community has taught me just how special and unique this place is. I've learned that what may appear on the outside to be an unchanging environment becomes a wealth of different sights, sounds and experiences with the march of the seasons, the constantly varying weather and the beautiful lighting variations of each passing day.
Why should someone become a member of WEIU? WEIU is certainly not like most TV stations. We're obviously nothing like a commercial TV station which is funded by commercials based on the number of people watching each program. Yet, we're also different than most non-commercial TV stations, as well ... both in what we air and who we aim to serve. And that's important to me. As I've seen more of the media universe surround us with an array of programs, news, shopping channels and pretty much anything you could imagine, I still find WEIU the ONLY place where I can learn about MY neighbors and MY community. I know such a service is not going to be supported by other communities or by commercial sponsors. I frankly wouldn't expect it to be. So I find it important to support that service that serves me and the people who are my neighbors. It seems to be part of the American way of taking care of those things that are important to us. At least that's how I see it!
WEIU is very important to me and I hope to you, as well.
Is WEIU as important to you as it is to Jack? Become a member today! Also, send us a message and let us know what WEIU means to you!
We love to hear from you!
Most of TV is pathetic. I think your offering is outstanding and a lovely way spend an evening. Please, oh please, keep it up.
-- Nancy, Sigel
Is WEIU as important to you as it is to Nancy? Become a member today! Also, send us a message and let us know what WEIU means to you!
Angie Patrick - Mattoon YMCA
Angie Patrick chronicles the long history of the Mattoon YMCA. Once serving as 25 cent a night place to stay in 1871, today the YMCA serves the community through a number of programs for people of all ages.
Angie would love for you to tune in to Effingham: This is Our Story on Thursday, Oct. 2, at 7 p.m. We hope you'll join us!
Jamie Willis - Gee's Bend Quilters
Jamie Willis had the idea to bring the Gee's Bend Quilters to Mattoon after a visit to their home in Alabama. Hear the story of how this idea blossomed into two well-received visits by the quilters in 2012 and 2014.
Jamie would love for you to tune in to Effingham: This is Our Story on Thursday, Oct. 2, at 7 p.m. We hope you'll join us!