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Health Interview Survey, 1970 (ICPSR 7838)
Principal Investigator(s): United States Department of Health and Human Services. Centers for Disease Control and Prevention. National Center for Health Statistics
The purpose of the Health Interview Survey is to obtain information about the amount and distribution of illness, its effects in terms of disability and chronic impairments, and the kinds of health services people receive. There are five types of records in this core survey, each in a separate data file. The variables in the Household file (Part 1) include type of living quarters, size of family, number of families in the household, presence of a telephone, number of unrelated individuals, and region. The Person file (Part 2) includes information on sex, age, race, marital status, Hispanic origin, education, veteran status, family income, family size, major activities, health status, activity limits, employment status, and industry and occupation. These variables are found in the Condition, Doctor Visit, and Hospital Episode files as well. The Person file also supplies data on height, weight, bed days, doctor visits, hospital stays, years at residence, and region variables. The Condition file (Part 3) contains information for each reported health condition, with specifics on injury and accident reports. The Hospital Episode file (Part 4) provides information on medical conditions, hospital episodes, type of service, type of hospital ownership, date of admission and discharge, number of nights in hospital, and operations performed. The Doctor Visit file (Part 5) documents doctor visits within the time period and identifies acute or chronic conditions. The Health Insurance file (Part 6) includes information on education level, family income, hospital visits and length of stay, and also data on medical coverage, hospital coverage, medicare coverage, and doctor visit coverage. The Medical Care Cost file (Part 7) includes information on hospital bill expenses, doctor and dental bill expenses, optical bill expenses, and total personal and family expenses. The X-Ray file (Part 8) includes information on x-ray records, doctor visits, height, weight, and total medical x-ray visits.
Access Notes
These data are freely available.
WARNING: This study is over 150MB in size and may take several minutes to download on a typical internet connection.
Study Description
United States Department of Health and Human Services. Centers for Disease Control and Prevention. National Center for Health Statistics. Health Interview Survey, 1970. ICPSR07838-v4. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2010-09-21. http://doi.org/10.3886/ICPSR07838.v4
Persistent URL: http://doi.org/10.3886/ICPSR07838.v4
Export Citation:
- RIS (generic format for RefWorks, EndNote, etc.)
- EndNote XML (EndNote X4.0.1 or higher)
Scope of Study
Subject Terms: chronic disabilities, chronic illnesses, disabilities, doctor visits, families, health, health care, health care services, health problems, hospitalization, household composition, illness
Geographic Coverage: United States
Time Period:
- 1970
Universe: Civilian noninstitutional population of the United States.
Data Types: clinical data, survey data
Data Collection Notes:
These data files contain weights, which must be used in any analysis.
Per agreement with the National Center for Health Statistics (NCHS), ICPSR distributes the data files and text of the technical documentation for this collection as prepared by NCHS.
Sample: A multistage probability sample was used in selecting housing units.
Weight: These data contain multiple weight variables for each part. Users should refer to the User Guide for further information regarding the weights and their derivation. Additionally, users may need to weight the data prior to analysis.
Mode of Data Collection: face-to-face interview
Data Source:
personal interviews
Original ICPSR Release: 1984-05-03
Version History:
- 2010-09-21 Frequencies and variable labels that were previously incorrect have been corrected.
- 2010-08-25 Updated bookmarks have been added to the Field Representative Manual and the Record Layout Documentation.
- 2010-06-28 SAS, SPSS, and Stata setup files have been added. Some corresponding documentation has been updated and pre-existing data files have been replaced.
- 2006-01-18 File CB7838.ALL.PDF was removed from any previous datasets and flagged as a study-level file, so that it will accompany all downloads.
Related Publications
- View publications for the study (~12)
- View publications for the series
Most Recent Publications
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Export Study-level metadata (does not include variable-level metadata)
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If you're looking for collection-level metadata rather than an individual metadata record, please visit our Metadata Records page.


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Diego can help your preschooler use colors and patterns to paint new shells for the hermit crabs!
Watch Diego only on Nick Jr.
The hermit crabs have outgrown their colorful shells and need your preschooler's help to create bigger shells that match their old ones. With guidance from Diego, your kids will use the mouse to select the correct colors and patterns to create a matching shell. They'll even get to design their own unique shell for the last hermit crab, and print a copy to keep.
Parent Tip: At the end of the game, your preschooler can play with the hermit crabs on the beach! For a laugh, click on a crab and then click on the sign with the arrow!
Up, up, and away--to save the baby dinosaurs!
Answer animal distress calls, drive Diego's rescue rover & save fierce animals
The mission: A risky river crossing! Al rescate!
Help Diego rescue the world's baby animals and bring them home
Help Roadie the Roadrunner win the Great Roadrunner Race!
Kids enter Diego's world of shapes, colors, & animals in this arctic adventure
Get ready for an exciting animal rescue!
It's the age of the Maiasaura. Help Diego rescue baby dinosaurs
Kids help Diego get the baby sea turtles back home to the ocean
Listen to the drum and help Diego break the spell on the animals in Africa.
All Aboard the Animal Rescue train!
Kids snowboard though the Arctic and save animals with Diego
Help Diego break the spell to release the African animals
Puzzling, isn't it? How will Diego get to the party?
This party can't start until Diego gets Baby Jaguar's growl back!
Go mudboarding on the muddy mudslide and save the animals with Diego!
Kids join Diego on an adventure of prehistoric proportions
Tuga is hungry! Help her gobble jelly fish--and avoid snacking on trash!
Diego's Field Journal is filled with fascinating facts about animals.
To deliver the animal science book, Diego must avoid slipping on banana peels.
Five games in one dino-adventure!
Save the lost little wolf pup!
Put kids' math powers into play--stop a scheming squid & save the day!
Kids create unique designs by adding groovy colors and glitter to spinning paper
It's stickermania! Create pics with the PAW Patrol pups & more Nick Jr. friends
Kids can color scenes and email their mini masterpieces to friends and family
Find the missing books from Story Castle and rescue the famous Don Quixote!
Kids can uncover countless surprises in this multi-world adventure game!
Where is Isa hiding? Follow the flowers to show Dora the way!
Kids can draw and sketch mini-masterpieces with this easy-to-use toolbox!
Kids pick the paper, decorate, & create a printable paper lantern with Kai-lan!
It's Doodle time! Can you help Blue guess what Doodle is drawing?
Coloring without crayons? You betcha.
These colorless critters need some color. Quick, click on a color!
Create and print your own masterpiece with this toolbox!
Build a custom bot with Plex!
Kids can paint their favorite color-by-computer pictures over & over again!
Come on down to Blue's Room for games galore with all Blue's friends
This hair-y game is lots of fun! Help Mr. Hairy find a wacky new disguise.

subset: commoncrawl


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To meet consumer demand for mobile devices with greater efficiency and functionality, Murata began focusing its R&D efforts on supercapacitors (EDLC*) in 2008, at which time we made a strategic decision to license leading-edge supercapacitor technology from CAP-XX Limited , an Australia-based firm. Working from this collaborative basis, Murata has enhanced the design and manufacturer of these high power (low ESR) supercapacitors in a compact, slim package, and we continue our research efforts to develop even better and higher performing products.
*Supercapacitor is also known as "EDLC" in academic parlance. EDLC stands for Electrical Double Layer Capacitor. In addition, supercapacitor is abbreviated as "supercaps." All are different terms for the same kind of capacitor.
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Piezoelectric Sounders are piezoelectric diaphragms assembled in plastic cases (Resonant cavity) and are classified into External Drive Type and Self Drive Type.
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Mad Max is a game about driving your car into stuff.
Modder Durante analyzes The Witcher 3 to find the techniques and settings needed for a perfectly smooth experience.
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We take a first look at The Witcher 3 on PC. How does it look? How does it run?
It's finally time for a good, up-close look at one of the Orcs who will headline the upcoming Warcraft film.
How Bioware build RPGs.
The fallout of the Mid-Season Invitational shapes the narratives of the summer split.
Rare veterans team up to make their dream game.
Everything you need to nana-nana-nana-know about the Bat's latest outing.
Time to turn Los Santos into your own personal playground.
How hobbyist PC builders try to turn their passion for cables and cooling into a full-time career.
Reflexive foliage sells The Witcher 3's glorious open world.
This visual guide will teach you how to set up your game for the maximum competitive advantage.
Enter our huge draw for a free copy of Culling of the Cows
A leaner, smarter take on Magicka's fascinating combat system, Magicka 2 is the co-op adventure you've been waiting for.
If you need some more RAM for your gaming rig, current prices are lower than they've been in two years.
Here's what I've learned after more than 12 months of playing PC games upright.
It's another Show Us Your Rig double feature, this time with the co-founders of Red Hook Studios.
13 games that will ensure the fruit of your loins grow up right.
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Once summer's warm breeze turns unbearably hot, Pearl Izumi's P.R.O. In-R-Cool Bib Shorts' heat-reflective technologies step in to help cool things down. When the mercury continues to climb, the Coldblack that's found in Pearl's lightweight and highly-elastic Transfer In-R-Cool fabric reduces absorption of sun rays.
This means not only excellent UFP ratings, but improved heat management too. Additionally, these bib shorts use Pearl Izumi's Transfer Dry fabric, which complements In-R-Cool with Minerale. This is a porous, highly-absorbent yarn infused with crushed volcanic rock to pull moisture away from the skin, accelerate dry time, and combat odor.
Moving on, the multi-panel design that Pearl's summer bib provides uses an anatomic fit, with structured leg openings that wrap and support your muscles. The inseam measures 9 inches (size Medium) with silicone hems to grip warmers and keep panels securely in place. Up top, wide Direct-Vent mesh bib straps seamlessly transition from the shorts and smoothly taper at the shoulders.
Finally, no bib shorts are complete without a quality chamois, which is something Pearl Izumi's well versed in. On these shorts, the Anatomic P.R.O. Seamless 1:1 insert incorporates variable density padding throughout its three-layer construction. The foam technology means that it's lighter and substantially thinner than previous generations. It maintains a pre-shaped, four-way stretch anatomic shape, and the chamois also incorporates Izumi's Pressure Relief Technology (PRT) and active carbon yarns in order to optimize riding comfort, blood flow, and thermo-regulation.
The Pearl Izumi P.R.O. In-R-Cool Bib Shorts are available in five sizes from Small to XX-Large and in four colors: Black, Black/mykonos blue, Black/true red, and Black/stillwater.
Tech Specs
Size chart
Pearl Izumi
|Regular Fit
|35 - 37.5in
(88.9 - 95.3cm)
|37.5 - 40.5in
(95.3 - 102.9cm)
|40.5 - 43.5in
(102.9 - 110.5cm)
|43.5 - 46.5in
(110.5 - 118.1cm)
|46.5 - 49in
(118.1 - 124.5cm)
|29 - 31.5in
(73.7 - 80cm)
|31.5 - 34.5in
(80 - 87.6cm)
|34.5 - 37.5in
(87.6 - 95.3cm)
|37.5 - 41.5in
(95.3 - 105.4cm)
|41.5 - 45in
(105.4 - 114.3cm)
|35 - 37.5in
(88.9 - 95.3cm)
|37.5 - 40.5in
(95.3 - 102.9cm)
|40.5 - 43.5in
(102.9 - 110.5cm)
|43.5 - 46.5in
(110.5 - 118.1cm)
|46.5 - 49in
(118.1 - 124.5cm)
|European Race Fit
| 36.5 - 38in
(92.7 - 96.5cm)
| 38 - 39.5in
(96.5 - 100.3cm)
| 39.5 - 41in
(100.3 - 104.1cm)
| 41 - 42.5in
(104.1 - 108.0cm)
| 42.5 - 44in
(108.0 - 111.8cm)
| 30.5 - 32in
(77.5 - 81.3cm)
| 32 - 33.5in
(81.3 - 85.1cm)
| 33.5 - 35in
(85.1 - 88.9cm)
| 35 - 36.5in
(88.9 - 92.7cm)
| 36.5 - 38in
(92.7 - 96.5cm)
| 36.5 - 38in
(92.7 - 96.5cm)
| 38 - 39.5in
(96.5 - 100.3cm)
| 39.5 - 41in
(100.3 - 104.1cm)
| 41 - 42.5in
(104.1 - 108.0cm)
| 42.5 - 44in
(108.0 - 111.8cm)
| 31.5in
| 32in
| 32.5in
| 33in
| 33.5in
- How to Measure:
- For best results, take measurements over your underwear.
- Chest:
- Measure under your arms, around the fullest part of your chest.
- Natural Waist:
- Measure around your natural waistline, keeping the tape a bit loose.
- Hip:
- Measure around the fullest part of your body at the top of your legs.
- Inseam:
- Using pants that fit well, measure the crotch seam to the bottom of the leg.
Reviews & Community
What do you think of the
Pearl Izumi P.R.O. In-R-Cool Bib Shorts - Men's
? Share a...
Nice bibs but smaller leg size
- Familiarity: I've used it several times
Pretty nice bibs, comfortable and the legs have a nice compression feel. I will say that these run small compared to other bibs. I wear an small in Assos, Capo, and Castelli but had to get a medium in these because my legs will not fit through the smalls. That tends to be a trend with PI, they all have small legs.
John Marrocco
Best $63.00 Bibs
- Gender: Male
- Familiarity: I've put it through the wringer
These are excellent bibs, good compression and the chamois is comfortable for longer rides. Only complaint is I wish the legs were a bit longer and I wish I could have gotten all black at the sale price. Otherwise they are one of my go to bibs.
Do these bibs run small compared to the...
Do these bibs run small compared to the 2013 and 2012 versions?
I have noticed comments on other sites that this years 2014 Pro In R Cool bibs run small and if I used a medium previously I need a large now.
Please assist.
Austin J
These bibs run true to the sizes shown on the fit chart. They are a compression fit and the correct sizing will yield a tight short. Over previous years the only changes are a slightly lower front that will make it easier on you when nature calls and a thin panel in the back that will improve ventilation properties.
I am 5'8" and 160lbs and tried both the medium and large 2014 bibs. The mediums fit too tight around my upper thighs and the large was too loose around my waist and clearly made for a taller and wider individual. I think these bibs are true to size as indicated in the charts, but I think you need regular to narrow thighs to comfortably fit into the product. I also tried on the P.R.O. Leader Bibs in medium and large, which have a slightly different stitching pattern, and the mediums fit well.
On a separate note, the material and stitching quality were excellent and the chamois is superb.
Excellent Bib for the Money!
- Familiarity: I gave it as a gift but have feedback to share
These are a top notch bib for their price. The materials are very comfortable, size is very true to chart and larger than typical Euro fittings. The chamois is comfortable for longer rides and the leg hems simply disappear while riding. There are lighter weight bibs, but I think that the PI Pro In-R-Cool has hit the mark for excellent fit, great material quality, very good chamois, very good looks all at a perfect price point, not to mention typical Pearl Izumi quality for durability.
J Sessions
Solid bib but on the short side
- Gender: Male
- Familiarity: I've used it several times
Solid bib in my opinion. No doubt that the chamois is placed slightly further forward than most but overall did not bother me. The chamois is very comfortable, especially on the long rides. The chamois pad is also smooth, no "anatomical" bumps, raised pads, etc which I really liked. The only complaint is that the inseam is on the short side. I'm 6' 2'', with a 32 waist, and a close to 36" inseam, and the Medium shorts tend to ride up a bit, almost to mid-thigh despite the shorts having some great leg grippers.
Not great
- Familiarity: I've used it several times
I tried a pair of these but they didn't work because the pad was sewn to far forward. This resulted in my sit bones sitting on the chamois stitching, which resulted in chaffing and an padded (uncomfortable feel). I wish manufactures would use a bigger pad in the bigger size shorts. I used a size XL. The rest of the shorts felt good though, although they are little too long for my liking. I prefer my short to not touch my knee caps.


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SWANSBORO — The town of Swansboro is known for being "The Friendly City by the Sea."
And being so close to the water the area has grown over the years, resulting in an increase of student population at its high school.
Swansboro High School is Onslow County's fourth biggest high school with its November 2012 average daily membership (
Thanks to NCHSAA realignment every four years, the Pirates' athletic programs will participate in the Coastal 3-A Conference after being in the East Central 2-A Conference since 1997.
Swansboro has joined Havelock, Jacksonville, Richlands, West Carteret, West Craven and White Oak in the league.
"We are constantly growing," athletic director and head baseball coach Rusty Ross said. "It seems like people move down here because they want to be close to the water and close to the beach. It wasn't like this almost 35 years ago when I went to school here.
"We were so small … and there wasn't a place to buy a burger. Now, it's like, 'Bam.' It's boomed. I think we kind of knew it (3-A) was coming because our numbers kept going up."
Ross certainly remembers life in Swansboro back then since he is a 1979 graduate of the school and has been a teacher in Swansboro for 30 years.
Nowadays Ross oversees the school's athletic programs. As he sat in his office during a recent interview, he spoke about the jump to 3-A from 2-A and how he felt it could affect the athletics at Swansboro.
"In football, we are jumping right into there with the likes of Havelock, the state champion. Football will be tough," Ross said. "Our soccer, particularly girls' soccer, that's going to be a dynamic conference and that's going to be tough, but it's going to be interesting."
Girls' soccer still looks to be good given it's traditionally been one of the best in the area and state. The Pirates won their fourth state title in program history last month. Other titles came in 2006, 2009 and 2010.
Meanwhile, the boys' soccer team is Onslow County's most successful program overall with seven state titles between the 1990s and 2000s while the volleyball team won crowns in 1986, 1990, 1993, 1994 and 1995.
Ross, though, believes these sports will remain successful along with others.
"We have been playing White Oak and Jacksonville for a good while in most sports. We will be forming new rivalries," Ross said. "Most of these teams (in the conference) we have played in nonconference. I think our conference in football and baseball are very strong. I don't want to say (baseball) will be any better off, but I don't think we will be worst off."
Assistant athletic director and longtime volleyball and girls' basketball coach Kim Miller agreed that all Swansboro sports will face tougher teams.
"We are excited as well as a little nervous because we are going up against larger schools with larger populations," she said. "We are excited about the prospect of playing better competition, but it's not that we didn't have good competition in 2-A.
"Plus, we will be playing teams we haven't played in years. It's going to be neat to move into a conference and play different opponents than we've played the last eight, 10 years."
The Pirates won't have to travel far to play those new opponents.
Swansboro's longest trip will be to West Craven, which shouldn't seem like a long haul given the sports teams traveled even further to Clinton while in the ECC.
"Travel-wise, this is going to be great," Ross said. "This is pretty much Highway 24. Our biggest trip is going to be at West Craven and that's an hour and 15, maybe. Now we are pretty much in the middle."
And that helped make scheduling easier, Ross said. That, despite Swansboro leaving an eight-team league for a seven-team conference that requires its teams to have open dates late in the season.
"In the old conference we had five different counties and they were all on different spring break schedules," Ross said. "I don't think it will be as bad in this one. We've never had to schedule for open dates deep in the conference season, but we've been able to fill in our open dates.
"We are leaving schools we've been with for a good while and so it's been a little easier contacting them and say, 'Hey, can we play baseball on this date?' and they have been willing to work with us."
The incumbent Coastal Conference ADs have also been receptive to Swansboro, Ross said. He said the league took a page from the
The previous four years saw the Coastal Conference have girls' soccer matches played on the same day as softball and baseball but at opposite sites.
"They brought that from us," Ross said.
However, home conference varsity football games will remain at 7 p.m., a change for Swansboro that Ross said "makes a big difference, particularly when you're traveling."
One other notable change is that admission for varsity football will be $7.
"We had been charging $5," Ross said. "We have to adapt to that."


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Notify Me! The product you are searching for is out of stock. If you wish us to notify you when the product is in stock please submit your name and email.
|The Spitfir Bighead T-Shirt features a large Spitfire graphic print at the front with a regular fit. 100% Cotton


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Oxford Bungee Net 17" X 17"This cargo net is a strong elasticized bungee net with 6 nylon coated hardened steel hooks. An indispensable accessory for transporting awkward items!
Dimensions:17" x 17" square
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Oxford Hothands Essential Heated OvergripsWrap these quickly and go! This heated grip solution allows you to keep the existing grips on your motorcycle and add heat when needed. Secured with a hook and pile grip strip. Learn More$69.99 $69.95
DrySpec Tool Tube Kit
This storage tube attaches directly to the outside of any flat-sided sidecases and can be used to carry our MSR 30oz Fuel Bottle or Twisted Throttle Water Bottle as well as any other gear that can fit inside of it.Learn More$16.99
SW-MOTECH Bags-Connection Slipstream Tail Bag
The Slipstream is a small, compact, 13-liter tail bag suitable for day trips. Fits the passenger seat of most bikes. Includes integrated backpack straps and bungee net.Learn More$162.95
MSR 30 oz. Fuel BottleExtend your riding range with this heavy-duty fuel canister! Air-tight seal allows fuel to be stored longer by preventing air from entering and degrading fuel. Made from single-piece, impact-extruded aluminum to prevent leaks and cracks. Bolstered shoulder and base to resist bulging when pressurized. Learn More$21.95
Garmin Zumo 660LM GPS Navigation System for MotorcyclesTake a ride on a new route and explore the open road with the zūmo 660. This motorcycle-friendly navigator was built to lead you on all of your two-wheeled adventures. Whether youre on a weekday ride just across town or a week long trip to an annual rally with friends, the zūmo 660 is ready to show you the way. Learn More$599.99


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Management of Nausea and Vomiting
Management of Nausea and Vomiting
Although marked progress in controlling chemotherapy-induced emesis has occurred over the past 25 years, nausea and vomiting remain among the most distressing side effects of cancer chemotherapy. With the increased use of chemotherapy in primary and adjuvant treatment settings, the need for improved control of emesis remains an important consideration in both medical oncology and supportive care.
Several major oncology groups have published consensus reports or guidelines on the prevention of chemotherapy-induced emesis. However, the introduction of new agents may change these paradigms. In addition, an understanding of the neuropharmacology of this problem is valuable in planning patient care.
Pathophysiology of Emesis
Stimulation of Neurotransmitter Receptors
The emetic reflex arc is activated by stimulation of receptors in the central nervous system (CNS) and/or gastrointestinal (GI) tract. These receptor areas relay information to the vomiting center in the medulla, which then coordinates the act of vomiting. The chemoreceptor trigger zone, also located in the medulla, serves as a "chemosensor" and is exposed to blood and cerebrospinal fluid. These areas are rich in a variety of neurotransmitter receptors.
For many years, the dopamine receptors were the main focus of interest in antiemetic research. Available antiemetics, such as phenothiazines (chlorpromazine and prochlorperazine) and substituted benzamides (metoclopramide), were known to affect these receptors, as were butyrophenones (haloperidol and droperidol).
The role of the neurotransmitter serotonin (5-hydroxytryptamine [5-HT]) has also been elucidated. The improved antiemetic activity of higher doses of metoclopramide was not explained by its dopamine-binding properties but by the fact that it also affects serotonin receptors. This finding led to the development of several highly specific compounds that interact solely with serotonin receptors, specifically the type 3, or 5-HT3, receptor subtype. Several compounds (ondansetron, granisetron, palonosetron [Aloxi]) from this family are currently available in the United States. The 5-HT3 receptor, which is found in both the GI tract and CNS, is an important mediator of the emetic reflex arc. Molecular studies have suggested that mutation of the 5-HT3B receptor subunit may affect antiemetic efficacy.
Substance P
Tachykinins, such as substance P, play an important role in emesis, as well as in pain and a variety of inflammatory conditions. These neurotransmitters are 11–amino acid molecules that bind to specific receptors. Substance P binds to the neurokinin type 1, or NK1, receptor.
Several NK1 receptor antagonists have been synthesized and used both preclinically and in clinical trials in patients receiving cancer chemotherapy. Results indicate that these agents are effective against a broad range of causes of emesis, particularly delayed emesis. The oral agent aprepitant and its intravenous prodrug fosaprepitant have been approved for clinical use. Clinical trials of netupitant and rolapitant are also in progress, with results from a large phase III trial of netupitant reported in early 2014.
Sidebar: In a recent large randomized, double-blind, parallel-group study, Hesketh et al assessed the efficacy and safety of NEPA, a new fixed-dose oral combination of the NK-1 antagonist netupitant and the 5-HT3RA palonosetron, for prevention of chemotherapy-induced nausea and vomiting following highly emetogenic chemotherapy. The aim of the study was to determine the appropriate clinical dose of netupitant to combine with palonosetron for evaluation in a phase III NEPA program. A total of 694 chemotherapy-naive patients undergoing cisplatin-based chemotherapy for solid tumors were randomized to three different oral doses of netupitant (100, 200, and 300 mg) plus 0.50 mg palonosetron, or to oral palonosetron at 0.50 mg, all given on day 1. A standard regimen of 3-day aprepitant plus IV ondansetron at 32 mg was included as an exploratory arm. All patients received oral dexamethasone on days 1–4. The primary efficacy end point was complete response (CR; no emesis, no rescue medication) during the overall phase (0–120 hours).
At each dose, CINV prevention with NEPA was superior to palonosetron following highly emetogenic chemotherapy (87.4%, 87.6%, and 89.6% CR for NEPA100, NEPA200, and NEPA300, respectively, vs 76.5% CR with palonosetron; P < .05); however, NEPA300 had an advantage over lower doses for all efficacy endpoints. The combination of NEPA was well tolerated, with a safety profile (eg, percentage of patients developing echocardiogram changes) similar to that of palonosetron and the combination of aprepritant plus ondansetron (Hesketh PJ et al: Ann Oncol, first published online March 7, 2014; updated June 26, 2014).
Emetic Problems
Emesis Related to Chemotherapy
Both nausea and vomiting are seen in patients receiving cancer chemotherapy. Nausea occurs at a higher frequency than vomiting and is more difficult to control. The control of vomiting is strongly correlated with the control of nausea, although some patients experience nausea without vomiting.
The three most common emetic patterns in patients receiving chemotherapy are outlined below.
Acute chemotherapy-induced emesis
Acute chemotherapy-induced emesis is defined as nausea or vomiting that occurs within the initial 24 hours of chemotherapy administration. The time of greatest risk is from 1 to 6 hours after chemotherapy with most agents.
Delayed emesis
Delayed emesis is emesis that begins 24 hours or more after chemotherapy administration. Delayed emesis is particularly likely to occur in patients who have received cisplatin, carboplatin, or cyclophosphamide. However, this problem may begin somewhat earlier than 24 hours in some patients.
Anticipatory emesis
Anticipatory emesis is defined as a conditioned vomiting response following inadequate antiemetic protection with prior courses of chemotherapy.
Emesis Unrelated to Chemotherapy
Patients receiving anticancer drugs may also develop emesis for other reasons. Emesis can be induced by concomitant medications (such as analgesics, anti-infectives, or bronchodilators) or by tumor-related complications (such as intestinal obstruction or brain metastases). In these instances, adjustment of medication or treatment of tumor-related complications is more important than selecting an antiemetic agent.
Patient Characteristics and Emesis
History of Poor Emetic Control
Poor control of emesis with past courses of chemotherapy predisposes a patient to unsatisfactory antiemetic results with any subsequent treatment, regardless of the emetic stimulus or antiemetic employed. Both delayed and conditioned anticipatory emesis are more likely to occur in such patients, and there is likely to be greater difficulty in controlling acute emesis.
History of Alcohol Intake
Emesis is easier to control in patients with a history of chronic, high alcohol intake (> 100 g/d of alcohol [approximately five alcohol units, or drinks]). In a prospective evaluation of 52 patients receiving high-dose cisplatin and an effective combination antiemetic regimen, 93% of those with a history of high alcohol intake had no emesis, as opposed to 61% of those without such a history. This difference in emesis control is independent of the patient's current alcohol intake.
Most trials have found that it is easier to control emesis in older patients than in younger ones. Younger patients have a predilection for developing acute dystonic reactions when dopamine-blocking antiemetics are administered (see section on "Antiemetic agents for high–emetic-risk chemotherapy"). Younger patients also have a greater tendency to develop anticipatory emesis than do older patients.
It is more difficult to control emesis in women than in men given the same chemotherapy and antiemetic regimen.
Motion Sickness/Morning Sickness
Patients with a history of motion sickness or morning sickness are more likely to develop chemotherapy-induced nausea and vomiting than are those without such a history.
The above predisposing factors appear to be additive. One can identify patients at particularly high risk for emesis, such as younger women without a history of high alcohol intake. Awareness of these factors is helpful in monitoring individual patients and interpreting the results of clinical trials.
Chemotherapeutic Agents and Emesis
Emetic Potential
The most accurate predictor of the risk of emesis is the chemotherapeutic agent that a patient is receiving. Several different classifications of commonly used chemotherapy agents have been devised. Table 1 is based on the consensus report of the Multinational Association of Supportive Care in Cancer (MASCC) as updated in April 2011.
The emetic potential of a chemotherapeutic combination is determined by identifying the most emetic agent in the combination. Other agents in a combination may also increase the risk.
In general, agents associated with the highest incidence of emesis also induce the most severe emesis. Differences occur among patients and even between identical treatment courses in the same patient. The dose, route, and schedule of administration of the chemotherapeutic agent can affect the incidence of nausea and vomiting.
Time of Onset of Emesis
In patients receiving initial chemotherapy of high emetic risk, nausea or vomiting typically begins between 1 and 2 hours after chemotherapy administration. Cyclophosphamide and carboplatin may be associated with a late onset of emesis (ie, 8 to 18 hours following chemotherapy administration).
Antiemetic Agents for High–Emetic-Risk Chemotherapy
Careful antiemetic research has shown that numerous agents are safe and effective. Dosage and administration schedules for some of these agents are given in Table 2. Antiemetic therapy is commonly administered either orally or intravenously.
Among the best-studied agents are ondansetron, granisetron, palonosetron, metoclopramide, haloperidol, dexamethasone, aprepitant, fosaprepitant, lorazepam, dronabinol, prochlorperazine, and chlorpromazine.
The combination of a single prechemotherapy dose of a 5-HT3 antagonist and dexamethasone is the most commonly used therapy to prevent emesis in patients receiving chemotherapy of high emetic risk (both cisplatin and noncisplatin) as listed in Table 1. Addition of an NK1 antagonist such as aprepitant will increase the rate of antiemetic protection.
Serotonin Antagonists: Ondansetron, Granisetron, and Palonosetron
Ondansetron, granisetron, and palonosetron are highly selective 5-HT3 receptor antagonists. Doses of these agents are given in Table 2. All are effective in controlling emesis induced by a variety of chemotherapeutic agents. Oral and intravenous routes of administration available for ondansetron, granisetron, and palonosetron are effective, as demonstrated in large randomized trials. Granisetron is also now available as a transdermal patch (Sancuso). Single-dose regimens given before chemotherapy appear to be as effective as more cumbersome multiple- or continuous-dose regimens.
Palonosetron has a significantly longer half-life (of approximately 40 hours) compared with the other serotonin antagonists, it and may exhibit more noncompetitive binding and greater efficacy against delayed emesis.
Sidebar: In a systematic review and meta-analysis of 16 randomized trials of approximately 6,000 patients treated with either palonosetron (Aloxi) (n = 2,896) or another 5-HT3RA (n = 3,187) for prophylaxis of CINV, Popovic et al found palonosetron to be consistently statistically superior to other agents in achieving complete response, complete control, no emesis, or no nausea, and sometimes superior in enabling patients to avoid taking rescue medication. Palonosetron also was statistically significantly safer in terms of 5-HT3RA-related adverse events including dizziness and mean QTc interval change. The investigators recommended consideration of palonosetron as first-line therapy in future antiemetic guidelines (Popovic M et al: Support Care Cancer 22:1685–1697, 2014).
Side effects
Ondansetron, granisetron, and palonosetron have all demonstrated excellent safety characteristics over a large dosing range. Toxicities have been minor and have included headache, mild transient elevation of hepatic enzyme levels, constipation and, with some agents, prolongation of cardiac conduction intervals (particularly QTc intervals).
Dystonic reactions and akathisia (restlessness), which may be treatment-limiting with antiemetic agents known to block dopamine receptors, are not seen with serotonin antagonists, even when given on consecutive days. This finding is of particular importance for younger patients, in that several regimens used to treat malignancies in this age group use a schedule of daily chemotherapy.
The serotonin antagonists have been reported to achieve complete control of emesis in 30% to 50% of patients receiving cisplatin. These agents have also proved to be at least as effective against other chemotherapeutic agents, with complete control rates of about 70%.
Many trials have examined the benefit of adding corticosteroids to a serotonin antagonist. Typically, the complete control of emesis is improved by 10% to 20% in patients receiving highly emetic chemotherapy. Both the American Society of Clinical Oncology and the MASCC guidelines recommend that a corticosteroid be added whenever a serotonin antagonist is indicated (ie, in all patients receiving chemotherapy of high emetic risk).
The antiemetic mechanism of action of dexamethasone remains unclear. Several randomized trials and a meta-analysis have all confirmed its effectiveness in controlling emesis and its safety. Other corticosteroids, such as methylprednisolone, are also effective; however, dexamethasone is the most widely studied corticosteroid and it is available in oral and parenteral dosage forms as an inexpensive generic product. Dexamethasone is an excellent agent for use in combination antiemetic regimens and as a single agent for patients receiving chemotherapy of low emetic risk (< 30% incidence).
Dexamethasone dosages have generally ranged from 4 to 20 mg/d. In a randomized trial in patients receiving chemotherapy of high emetic risk, a single 20-mg dose was superior in completely controlling both nausea and vomiting. Thus, the 20-mg dose is recommended in this setting. For patients receiving chemotherapy of moderate emetic risk, a single 8-mg dose may be used. In patients receiving aprepitant, which inhibits dexamethasone metabolism, a lower dose of dexamethasone may be sufficient.
Side effects
Toxicities associated with short courses of dexamethasone used for antiemetic therapy have been mild and generally consist of insomnia and mild epigastric burning. Care using this agent in patients with diabetes is particularly warranted.
Metoclopramide has proved to be generally safe and effective when given in high intravenous doses. Metoclopramide was thought to function as an antiemetic through blockade of dopamine receptors. However, high concentrations of this agent effectively block 5-HT3 receptors as well.
High-dose metoclopramide is a second-choice agent, after the serotonin antagonists, in patients receiving cisplatin.
Side effects
Commonly observed side effects with metoclopramide include mild sedation, dystonic reactions, akathisia, anxiety, and depression. Dystonic reactions are age-related and route-related. In a report summarizing the experience of nearly 500 patients receiving metoclopramide, the incidence of trismus or torticollis was only 2% in those older than 30 years; in contrast, a 27% occurrence was reported in younger patients. Also, such reactions are more common when metoclopramide is administered by the oral route or is given over several consecutive days.
Acute dystonic reactions are not allergic in nature. Dystonic reactions and akathisia can be prevented or controlled by administering diphenhydramine, benztropine (Cogentin), or a benzodiazepine. These reactions should not be viewed as a contraindication to further use of dopamine-blocking drugs.
Haloperidol exerts its antiemetic action through dopaminergic blockade. A formal study comparing haloperidol with metoclopramide in patients receiving cisplatin found both agents to be effective, although metoclopramide afforded better emetic control. Haloperidol should therefore only be used as a salvage agent.
Haloperidol in doses of 1 to 3 mg given intravenously every 4 to 6 hours has been used.
Side effects
Toxicities of haloperidol include sedation, dystonic reactions, akathisia, occasional hypotension, and cardiac conduction defects.
Although lorazepam and other benzodiazepines are potent anxiolytic agents that can be useful additions to antiemetic therapy, they should not be used as single agents for chemotherapy-induced emesis. Lorazepam has been shown to achieve a high degree of patient acceptance and subjective benefit but only minor objective antiemetic activity. However, the anxiolytic properties of benzodiazepines may be particularly useful in the treatment of anticipatory nausea and vomiting.
Lorazepam is usually given in doses of 0.5 to 1.5 mg/m2 intravenously or 0.5 to 2 mg orally. These doses, especially the higher intravenous doses, can be associated with marked sedation lasting for several hours.
Many trials have tested the antiemetic effects of dronabinol (delta-9-tetrahydrocannabinol), a component of marijuana. Dronabinol has modest antiemetic activity, similar to that seen with oral prochlorperazine, but it may have a greater effect against nausea.
Semisynthetic cannabinoids such as nabilone have been tested but appear to have no clear advantage over dronabinol. The modest antiemetic activity and significant toxicity of cannabinoids make them a second choice for the control of chemotherapy-related emesis.
Dronabinol has been tried in many doses and schedules. The most useful doses have ranged from 5 to 10 mg/m2 orally every 3 to 4 hours. The usual dose of nabilone is 1 to 2 mg orally twice daily.
Side effects
Side effects frequently associated with cannabinoids, particularly in older adults, include dry mouth, sedation, orthostatic hypotension, ataxia, dizziness, euphoria, and dysphoria.
Although phenothiazines were the first effective antiemetics, the results of antiemetic trials with this class of agents against highly emetogenic chemotherapy have been poor. Randomized trials have found standard-dose prochlorperazine, given orally or intramuscularly, to be less effective than metoclopramide or dexamethasone and equivalent to or less effective than dronabinol. Intravenous administration is more effective than oral administration but can rarely cause profound hypotension (unlike serotonin antagonists or metoclopramide). Phenothiazines are seldom used as first-line antiemetic agents for highly or moderately emetogenic chemotherapy.
Side effects
Side effects of phenothiazines include sedation, akathisia, hypotension, and dystonic reactions.
NK1 Antagonists
Aprepitant and fosaprepitant are the two NK1 antagonist antiemetics currently available. NK1 antagonists have demonstrated activity against a wide range of emetogenic stimuli. Although less effective than serotonin antagonists as single agents against acute emesis, NK1 antagonists have shown superior activity against delayed emesis, suggesting the value of combination therapy.
In a multicenter, randomized, double-blind, phase III trial, 866 breast cancer patients being treated with cyclophosphamide with or without doxorubicin or epirubicin were randomized to receive either a regimen of aprepitant (125 mg), ondansetron (8 mg bid), and dexamethasone (12 mg) on day 1 with aprepitant (80 mg/d) on days 2 and 3 or a standard regimen of ondansetron (8 mg bid) on days 1 to 3 and dexamethasone (20 mg) on day 1. Of the 857 evaluable patients, 50.8% in the aprepitant arm vs 42.5% in the standard-regimen arm achieved a complete response (P = .015). In addition, more patients in the aprepitant arm achieved a complete response during both acute (75.7% vs 69%; P = .034) and delayed (55.4% vs 49.1%; P = .064) phases. Both treatments were generally well tolerated.
In a recent randomized, double-blind, phase III trial, a single 150-mg dose of intravenous fosaprepitant was found to be equivalent to a 3-day oral aprepitant regimen when administered with ondansetron and dexamethasone against highly emetogenic chemotherapy.
Phase III trials of netupitant and rolapitant are ongoing.
Combination Antiemetic Regimens
Table 3 summarizes recommended antiemetic regimens, according to the emetic potential of the chemotherapy regimen.
Serotonin Antagonist Plus Dexamethasone
Combinations of a 5-HT3 antagonist and dexamethasone form the basis of the most effective regimens for controlling acute chemotherapy-induced emesis. Use of these two agents combined has proved to be more effective than either agent alone. Addition of an NK1 antagonist results in increased activity against highly emetogenic chemotherapy. However, inhibition by aprepitant or fosaprepitant of the cytochrome P-450 3A4 metabolic pathway may require a decrease in the dose of concomitantly administered dexamethasone.
The atypical antipsychotic agent olanzapine (Zyprexa) has shown promise in phase II and II clinical trials for prevention and treatment of CINV. A thiobenzodiazepine, it exhibits activity at multiple receptors, notably at the D2, 5-HT2c, and 5-HT3 receptors which appear to be involved in nausea and emesis, thus prompting investigation of its use in the treatment of nausea and vomiting refractory to standard antiemetics.
In a 2011 randomized phase III study, olanzapine combined with a single dose of palonosetron and a single dose of dexamethasone (OPD) effectively controlled acute and delayed CINV in patients receiving highly emetogenic chemotherapy. Rates of complete response (CR; no emesis or rescue treatment) with OPD were not significantly different from those of a similar group of patients receiving highly emetogenic chemotherapy and an antiemetic regimen of aprepitant, palonosetron, and dexamethasone (APD). For 121 patients randomized to OPD, the CR was 97% for the acute period (24 hours post chemotherapy), 77% for the delayed period (days 2–5 post chemotherapy), and 77% for the overall period (0–120 hours). CR rates for the 120 patients receiving APD were 87%, 73%, and 73%, respectively.
Sidebar: In a phase III double-blind randomized trial, Navari et al investigated olanzapine ([Zyprexa]10 mg orally daily for 3 days) vs the dopamine-2 receptor antagonist metoclopramide (10 mg orally tid for 3 days) for prevention of breakthrough chemotherapy-induced nausea and vomiting (CINV) in chemotherapy-naive patients being treated with highly emetogenic chemotherapy (cisplatin or doxorubicin, plus cyclophosphamide) who were refractory to prophylactic dexamethasone, palonosetron, and fosaprepitant (Emend) pre-chemotherapy and dexamethasone post-chemotherapy. Among the 276 enrolled patients, a total of 112 developed breakthrough CINV; 108 were evaluable and were monitored for nausea and emesis during a 72-hour observation period. During the 72-hour observation period, 70% of patients (39 of 56) randomized to olanzapine had no emesis vs 31% (16 of 52) of patients treated with metoclopramide (P < .01). There were no grade 3 or 4 toxicities (Navari RM et al: Support Care Cancer 21:1655–1663, 2013).
When used for several months, common side effects of olanzapine include weight gain and as an association with the onset of diabetes mellitus, but, according to a 2014 study by Navari et al, these effects have not been seen with short-term use of daily doses of < 1 week.
Because of these effects, however, and given that the 10 mg dose of olanzapine has been associated with grade 1/2 sedation, lower doses are under investigation in the setting of CINV. For example, in a recent randomized, placebo-controlled study from Japan, Mizukami et al assessed the benefit of addition of 5 mg/day of oral olanzapine to standard therapy from the day before chemotherapy to treatment day 5 for patients receiving highly or moderately emetogenic chemotherapy. A total of 44 patients were enrolled. All patients received a 5-HT3RA and neurokinin-1 receptor antagonist. Patients were randomly assigned to receive olanzapine (n = 22) or placebo (n = 22). More patients achieved total control (no vomiting, no rescue medications) on olanzapine (86% and 64% in the acute and delayed phases, respectively) vs the control group (55% [P = .045] and 23% [P = .014]). Patients randomized to olanzapine also experienced a better quality of life than the controls, based on their responses to the Functional Living Index-Emesis questionnaire (P = .0004).
Treatment of Emesis
Acute Emesis
A management strategy to prevent acute chemotherapy-induced emesis is outlined in Table 3. All patients should receive education and reassurance, as well as antiemetics tailored to the chemotherapy regimen. For regimens that commonly cause emesis (> 30%), antiemetic combinations are recommended; for regimens of low risk (10% to 30% incidence), a single agent will usually suffice. As stated in Table 3, chemotherapy of minimal risk typically does not require preventive treatment.
Delayed Emesis
Delayed emesis is defined as nausea or vomiting beginning or persisting 24 hours or more after chemotherapy administration. The pathophysiology of this problem is unclear, but it is particularly common after high-dose cisplatin (≥ 50 mg/m2), carboplatin (≥ 300 mg/m2), cyclophosphamide (≥ 600 mg/m2), or doxorubicin (≥ 50 mg/m2).
In one natural history study, 89% of patients experienced some delayed emesis from 24 to 120 hours after receiving high-dose cisplatin, with a peak incidence occurring between 48 and 72 hours. With anthracyclines or cyclophosphamide, the rate of delayed emesis without preventive antiemetics is about 30%.
Some observations suggest that delayed emesis may begin earlier. When combination antiemetic regimens for acute emesis "fail," the initial emetic episode is often at 17 to 23 hours following chemotherapy. In some trials, antiemetics to prevent delayed emesis have been initiated at 16 to 17 hours.
Treatment options
The combination of dexamethasone and an NK1 antagonist has demonstrated efficacy. Activity of palonosetron may also continue for several days. The recommended doses and schedules for the prevention of delayed emesis are given in Table 4.
Anticipatory Emesis
This problem is defined as nausea or vomiting beginning before the administration of chemotherapy in patients with poor emetic control during previous chemotherapy. Because this problem is a conditioned response, the hospital environment or other treatment-related associations may trigger the onset of emesis unrelated to chemotherapy. Strong emetic stimuli combined with poor emetic control increase the likelihood that anticipatory emesis will occur.
Treatment approach
Behavioral therapy involving systematic desensitization can be helpful in managing anticipatory emesis. Also, benzodiazepines appear to be useful. However, the best approach to anticipatory emesis is prevention of prior emesis, which underscores the need to provide the most effective and appropriate antiemetic regimens with the initial course of emesis-producing chemotherapy.
Radiation-induced nausea and vomiting
Emetogenicity of radiation therapy is dependent on anatomic site and dose. For example, total body irradiation is highly emetogenic, while upper abdominal irradiation is moderately emetogenic. Serotonin antagonists remain the mainstay of antiemetic therapy for highly or moderately emetogenic radiotherapy.
Suggested Reading
Gralla R, Lichinitser M, Van Der Vegt S, et al: Palonosetron improves prevention of chemotherapy-induced nausea and vomiting following moderately emetogenic chemotherapy: Results of a double-blind randomized phase III trial comparing single doses of palonosetron with ondansetron. Ann Oncol 14:1570–1577, 2003.
Grunberg S, Chua D, Maru A, et al: Single-dose fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with cisplatin therapy: Randomized, double-blind study protocol—EASE. J Clin Oncol 29:1495–1501, 2011.
Hesketh PJ, Rossi G, Rizzi G, et al: Efficacy and safety of NEPA, an oral combination of netupitant and palonosetron, for prevention of chemotherapy-induced nausea and vomiting following highly emetogenic chemotherapy: a randomized, dose-ranging pivotal study. Ann Oncol first published online March 7, 2014; updated June 26, 2014.
Kris MG, Gralla RJ, Clark RA, et al: Incidence, course, and severity of delayed nausea and vomiting following the administration of high-dose cisplatin. J Clin Oncol 3:1379–1384, 1985.
Mizukami N, Yamauchi M, Koike K, et al: Olanzapine for the prevention of chemotherapy-induced nausea and vomiting in patients receiving highly or moderately emetogenic chemotherapy: a randomized, double-blind, placebo-controlled study. J Pain Symptom Manage 47:542–550, 2014.
Navari RM: Olanzapine for the prevention and treatment of chronic nausea and chemotherapy-induced nausea and vomiting. Eur J Pharmacol 722:180–186, 2014.
Navari RM, Gray SE, Kerr AC: Olanzapine versus aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a randomized phase III trial. J Support Oncol 9:188–195, 2011.
Navari RM, Nagy CK, Gray SE: The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy. Support Care Cancer 21:1655–1663, 2013.
Poli-Bigelli S, Rodrigues-Pereira J, Carides AD, et al: Addition of the neurokinin 1 receptor antagonist aprepitant to standard antiemetic therapy improves control of chemotherapy-induced nausea and vomiting: Results from a randomized, double-blind, placebo-controlled trial in Latin America. Cancer 97:3090–3098, 2003.
Popovic M, Warr DG, Deangelis C, et al: Efficacy and safety of palonosetron for the prophylaxis of chemotherapy-induced nausea and vomiting (CINV): a systematic review and meta-analysis of randomized controlled trials. Support Care Cancer 22:1685–1697, 2014.
Rojas C, Stathis M, Thomas AG, et al: Palonosetron exhibits unique molecular interactions with the 5-HT3 receptor. Anesth Analg 107:469–478, 2008.
Tremblay PB, Kaiser R, Sezer O, et al: Variations in the 5-hydroxytryptamine type 3B receptor gene as predictors of the efficacy of antiemetic treatment in cancer patients. J Clin Oncol 21:2147–2155, 2003.


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Basketball's Fan Favorite Signs Pro Contract to Play Professionally in Japan League
August 15, 2011
MISENHEIMER, N.C. – Former Pfeiffer University basketball fan favorite Yuki Yamaguchi (Tokyo, JAPAN) has signed a contract to play professionally in the Japan Basketball League with the Hamamatsu Higashimikawa Phoenix. The Phoenix enter the 2011-2012 season having won back-to-back league titles, posting a 40-6 record a year ago.
The BJ league in Japan consists of 16 teams divided into an eastern and western conference. Rosters are limited to 15 players playing a 52-game schedule beginning on October 15th. "I'm so glad to be playing with the Hamamatsu Higashimikawa Phoenix and thank them for giving me a chance to play here," remarked Yamaguchi. "I want to get better and have a lot to learn from their coaches and players. This will be my rookie year in the pros, but I will do my best."
"Yuki is one of the finest young men to come through our program in some time," stated Falcons head coach Jeremy Currier. "When Yuki arrived on campus, he struggled to understand the English language, and within one year, he was a member of the NABC Honors Court for his academic achievement having one of the highest grade point averages in our program."
First year head coach Ryuji Kawai will guide the Phoenix in 2011-2012 after working in the assistant ranks for more than 10 years. Kawai takes over for longtime coach Kazuo Nakamura.
"Yuki's hard work and dedication to doing things the 'right way' was a tremendous example in his time here, and will be invaluable for the Hamamatsu Higashimikawa Phoenix club," said Currier. "Pfeiffer University is so proud of Yuki and his accomplishments, as he has earned everything through hard work and dedication to excellence."
The Hamamatsu Higashimikawa Phoenix will open up their 52-game slate in October against the Shinshu Brave Warriors.


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Villa El Banco 2 - Punta de Mita
Kristin Chenoweth shows off her bikini collection in Punta Mita Mexico
LA Times: Mexico: Riviera Nayarit amps up its resort scene
Bienvenidos a Paradise! The Magical World of Punta Mita: Part One
Puerto Vallarta / Punta de Mita Property Spotlight
SOLD : Casa de las Flores is at Los Veneros Beach
Beachy Keen - Punta Mita Real Estate Featured in Robb Report
Have you planned your Holidays?
SOLD! - LPR Luxury Punta Mita - Puerto Vallarta Real Estate Update
Foreign Affairs: Mexico Makes It - A Transformed Society, Economy, and Government
NY Times : How Mexico Got Back in the Game
New Video: Events at the Four Seasons Resort - Villa El Farallon 7 - Puerto Vallarta, Mexico
Merida: Mexican Revolution
Benittos Paninoteca - Puerto Vallarta Mexico
FIBRAs alter Mexico's hotel investment mindset
NPR : Mexico Wants U.S. To See Its Prosperity Not Violence
Of all the Punta Mita rentals Villa El Banco 4 is the THE MOST FUN of any vacation rental villa in Puerto Vallarta
Buying Real Estate in Mexico-Separating Fact from Fiction
A song for San Pancho Riviera Nayarit México - "El Aparato" by Café Tacuba
Mexico's President Alters Tactics Against Drug Crimes
The 10 Best Vacation Spots For Celebrity Run-Ins - Punta de Mita, Mexico
Punta Mita Resort in 2012: Over 50% increase in sales leading all sales in Puerto Vallarta / Riviera Nayarit.
We are excited to announce that Punta Mita Properties - Christie's International Real Estate had an extremely strong end of the year.
Comparing 2011, sales inside the Punta Mita Resort in 2012 have increased over 50%.
Joe Francis Attends Mario Lopez's Wedding in Mexico
Staff Pick: Great Value: Punta Vista 2
3 bedrooms / Sleeps 6 / $275 - $600 USD per night
This large, luxurious, 3,500 square foot beachfront condo with a 180 degree view of the beautiful, rugged, North Coast of the Bay of Bandaras and the Marrieta's Islands, which you can enjoy from our 65' x 12' balcony. The only thing that separates our condo from the white sand swimming beach is the 30+ yard swimming pool and jacuzzi.
Amore is...bathing with the Gods
Puerto Vallarta Real Estate Regions
New York Times - House Hunting in San Miguel de Allende, Mexico
2012 Real Estate in Puerto Vallarta
Thor to spend $500M in booming Mexico
First Look! Mario and Courtney's Wedding Video at the House of Joe Francis in Punta Mita, Mexico
New State Department Travel Warning Says Most Mexican Tourist Spots Safe
First Mexican hotel-focused REIT emerges
Construction progress of road - La Cruz de Huanacaxtle to Punta de Mita
New Listing - Casa Flores - Sayulita, Riviera Nayarit, Mexico
Sayulita, Riviera Nayarit, Mexico
3 bedrooms / Sleeps 6 / Inquire for price
Casa Flores is a fantastic choice in Sayulita rentals, perfectly located on Gringo Hill with expansive views of the village and Pacific ocean.
El Banco 5
9 Bedrooms / Sleeps 18
$7,000 - $12,000 per night
El Banco 5 is artful, bold, and harmonious. Equipped for family vacation bliss in nature with personal chef, clay tennis court, flat screens and wi-fi in every room with fancy fluffy white pillows / towels and attentive staff.
Puerto Vallarta and the Mexican Iguana Affair
New Luxury Listing - Villa Maria II at the Punta Mita Resort
Mexico's Navy on Point in Drug War on Land - PRI - The World
New Listing - Playa Amor - Development Beach Parcel
Villa One: Four Seasons Private Villas at the Punta Mita Resort - Mexico
CNN - Misreading Mexico - The Rise of the Mexican Middle Class
Luxury Real Estate: Notable Price Reductions - Punta de Mita, Riviera Nayarit, Mexico
3 Reasons Why Mexico Is The New Brazil
Mexico Rises from the Drug Ravages
A Vacation to Remember with Kim Kardashian and Kanye West in Punta Mita, Riviera Nayarit, Mexico
The Mexican Riviera - Costa Careyes - Costa Alegre
Punta Mita's Four Seasons Resort Ranked #1 Golf Course in World by Conde Nast Traveler Magazine
Casa del Lago - El Tigre Nuevo Vallarta
Viewpoint: Time to look beyond Mexico drug violence
Mexico sees increase in foreign travelers despite warnings, drug violence
Casa Calandria - Punta Mita Luxury Vacation Rental Villa
I LOVE Tulum
Are Americans safer in Mexico than at home?
A Book of Love - Holistika Tulum - Real Estate Enlightened
Casa Aramara - The Most Famous House in Punta Mita Built by Joe Francis Available to Rent
Joe Francis' super-exclusive Mexican resort has been the vacation destination of choice for Hollywood's rich-and-famous -- and now Francis is opening the doors of Casa Aramara to other clientele, too.


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Fly direct to Almaty with British Airways and enjoy our award-winning service with no hidden charges.
Find a British Airways flight for less, we'll refund the difference.
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Fly with British Airways and enjoy award-winning service, excellent value for money and no hidden charges:
Fly direct to Almaty with British Airways and enjoy our award-winning service with no hidden charges.
Fly direct to Almaty from the UK and discover one of Central Asia's most dynamic cities. The drab Soviet days are a distant memory.
The tree-lined streets of today's oil-rich Almaty are home to shopping malls and international fashion labels, museums, cocktail bars and cosmopolitan restaurants. But this is not just a destination for shopaholics and culture vultures. If you like adventure, the snow-capped mountains which surround the city lure skiers, hikers and wildlife spotters. Here in the extreme south-east of Kazakhstan the memories of the great Silk Road trade between China and Europe are as strong as ever.
Flights to Almaty (ALA) from London take around 9 hours 45 minutes. British Airways has three flights a week to Almaty making it ideal for a short break or a longer holiday.
British Airways flights to Almaty (ALA) leave from London Heathrow (LHR). British Airways offers you complimentary food and drinks and a generous 23kg checked luggage allowance. Additional benefits, such as a greater baggage allowance and fully flat beds are also available.
Fly non-stop from London Heathrow to (LHR) to Almaty for an unforgettable break in this former capital of Kazakhstan. Flying with British Airways you will be able to check-in on your mobile or online, as well as choose your seat 24 hours before departure, so you can start your holiday in Almaty in the most convenient way.
Almaty International Airport is around 10 miles (16km) north east of the city. The easiest way to get in to the centre is by taxi, which should cost no more than £10 and takes around 30 minutes. Fares should be agreed before you set off. Taking a bus into Almaty will cost around £3.
Almaty airport has all the essential facilities; there are bars and cafes, a bureau de change, a duty free store and gift shops for picking up last minute souvenirs. Travellers can also take advantage of free wireless internet access in the departure area.