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By Jaideep Varma and Jatin Thakkar
During India's tour of Australia in January this year, Gambhir and Dhoni had a public spat (or at least a disagreement) about the latter's propensity to take a match right through till the last moments, even when it is not ostensibly required.
Clearly, Dhoni does that in tournaments too, as does his team (built in his image) – as the high failure rate of CSK players in IPL history suggests (their position at the end of the tournament on the impact charts in previous years has been 5, 3, 2 and 2 in previous IPL seasons, in that order). They have always been a transformed entity in the playoffs – when it is most required. And this year was looking no different till more than the halfway stage of the IPL final – until … a prolonged flash of individual genius from a highly unexpected source (Bisla) took the match away.
Interestingly, taking the performances of both CSK and KKR in the playoffs into account, CSK actually delivered a higher impact performance – that eventually also made CSK the highest impact team in IPL 2012. KKR, which had been the highest impact team at the league stages, had a victory with the bat in the final (after a poor outing with the ball), on the back of an inspired individual performance (which KKR was not the expected source of). In the end, KKR had the second-highest impact amongst all sides – thus becoming the 5th second-highest impact team in a row to win the IPL that year.
In our preview piece before the tournament started, we had KKR down as the second-most likely side to win IPL 2012 (after CSK). We did get 3 of the 4 semi-finalists right – but the real value of a tool like this is to be able to dig deeper at the post-mortem.
We provide some clues in this piece, starting with the Team IMPACT charts at the end of 2012 – a bird's-eye-view on which teams played closest to potential.
A quick recap of all the teams once more, in this order.
Chennai Super Kings
They were brilliant in the playoffs but when all seemed under control in the final, a singular individual performance KO'd them. Due to the big match performances in the playoffs, they spectacularly went to the top of the impact charts from a position of 6th on those charts at the league stages. Their bowling was a weak spot right till the end for them, despite the big match performances. They will consider themselves unlucky but if they do not address their bowling problems, their reign at the top might well be over.
They had 7 players above an IMPACT of 2 in IPL 2012 (minimum 5 matches) - DJ Bravo (IMPACT 3.01, 18 matches), MEK Hussey (2.98, 8), BW Hilfenhaus (2.86, 9), MS Dhoni (2.66, 18), F du Plessis (2.56, 12), SK Raina (2.50, 18) and JA Morkel (2.12, 15).
Kolkata Knight Riders
Despite the almost freakish performance in the end by Bisla which got them over the finish line, KKR faltered with the ball particularly in the final, which affected their overall impact numbers. Otherwise, they were a side dominated by all-rounders (who performed creditably), with a reliance on just two specialists - Gambhir with the bat and Narine with ball (and Balaji, who eventually played just 8 matches) – ironically, both failed in the final.
Their overall consistency was their hallmark which made them click as a team – they had the highest impact Indian players in the tournament and the second-highest impact overseas players.
They had 7 players above an IMPACT of 2 in IPL 2012 (minimum 5 matches) - MS Bisla (3.82, 7), G Gambhir (3.35, 17), JH Kallis (3.33, 17), BB McCullum (3.18, 12), SP Narine (2.72, 15), Shakib Al Hasan (2.60, 8) and L Balaji (2.26, 8).
Kings XI Punjab
It might surprise many to see them as the 3rd-highest impact side in IPL 2012. But they played like a team this year – despite constant setbacks that prevented their highest impact players from playing together – Gilchrist was out through injury, Mahmood had visa problems initially, Marsh was missing at the fag end. A lot of players delivered high impact performances - all the senior overseas players performed well – and a lot of Indian talent (like Mandeep Singh, Saini, Awana and Gurkeerat Singh) performed outstandingly in some games, delivering high impact. But, crucially, not often enough.
Consistency was a problem and their players overall had a high failure rate despite the many flashes of high impact. That, coupled with the bad luck they had, still could not hide their high impact (and unfulfilled potential). This is perhaps the most promising team of this IPL.
They had 8 players (the maximum amongst all teams) above an IMPACT of 2 in IPL 2012 (minimum 5 matches) - Azhar Mahmood (3.05, 11), AC Gilchrist (2.90, 7), RJ Harris (2.60, 5), P Awana (2.37, 12), DJ Hussey (2.35, 16), Mandeep Singh (2.21, 16), PP Chawla (2.16, 16) and SE Marsh (2.01, 13).
Royal Challengers Bangalore
We had been pilloried during our IPL Preview piece for daring to mention that they had the lowest impact batting line-up amongst all teams. What those people did not bother to understand was that this was based on the impact numbers of the entire squad – the fact is that other than Gayle, de Villiers and Dilshan, the Batting IMPACT of its players was low (Kohli not anywhere near as good an ODI player he is) – which has been borne out comprehensively.
Chris Gayle produced an absurdly high impact performance yet again – lightening struck two years in a row; just imagine what would have happened if he had not performed so brilliantly, and his performance had been in the realm of the humanly possible. Their Bowling IMPACT was high and it would have been even higher if Muralitharan and Vettori could have bowled together. Unfortunately, the lack of high impact Indian players did not allow them to do that, as the dependence on their overseas quota completely skewed
their balance.
This lack of quality Indian players (especially in batting) is their biggest weakness – something they need to urgently address. Gayle could not cover this up as he had last year.
They had 6 players above an IMPACT of 2 in IPL 2012 (minimum 5 matches) - CH Gayle (3.26, 14), M Muralitharan (2.78, 10), AB de Villiers (2.52, 15), TM Dilshan (2.14, 9), R Vinay Kumar (2.02, 14) and Z Khan (2.02, 15).
Rajasthan Royals
They were unlucky to miss their highest impact player – Shane Watson for more than half the tournament. Predictably, he performed outstandingly when he eventually joined the side, but it was not enough. Kevon Cooper, who was doing well, fell injured and had to go home at the half-way stage. They were consistent in a strange way – adequate performances, but not many players got high impact performances often enough. They also were unfortunate to lose a few close games.
Dravid was the most consistent batsman in the side. The bowling (Hogg, Pankaj Singh, Tait and Trivedi) was just about adequate (given that they were all rotated quite a bit). One of their highest impact players – Chandimal - did not get a single game. Getting some high impact Indian players should be their priority.
They had just 4 players above an IMPACT of 2 in IPL 2012 (minimum 5 matches) - SR Watson (3.21, 7), K Cooper (2.65, 6), R Dravid (2.42, 16) and AM Rahane (2.25, 16).
Delhi Daredevils
Before the tournament began, we had them down as the most imbalanced side – the highest impact batting and the lowest impact bowling side. The batting did fire, but not together – Sehwag was very consistent in the league phases, he failed in the playoffs. Pietersen was brilliant till he had to go, replaced by Warner who produced a couple of huge performances but overall did not deliver often enough. Neither till Taylor.
Ojha and Pathan delivered in all-round roles, but it was Morne Morkel above all, with very high
impact bowling performances (the highest impact run in his career) who made DD top the league stages, very effectively camouflaging the mediocre bowling around him (which is why DD were not the highest impact side then, in fact, they were 5th).
In the last eliminator, Morkel was inexplicably dropped – and the bowling was so horribly exposed that DD slid down the impact chart even more – it was like RCB batting without Gayle. The anticlimax they provided in the playoffs had sufficient warning at the league stages.
They had 6 players above an IMPACT of 2 in IPL 2012 (minimum 5 matches) - KP Pietersen (2.99, 7), V Sehwag (2.62, 16), M Morkel (2.54, 16), NV Ojha (2.08, 18), IK Pathan (2.06, 17) and P Negi (2.15, 8).
Deccan Chargers
With the highly notable exception of Shikhar Dhawan (and Parthiv Patel to a smaller extent), their biggest problem was their low impact Indian talent. Their batting was largely bolstered by Dhawan, Cameron White and Duminy, the bowling almost entirely by Steyn and there was Dan Christian's all-round impact in a few matches.
Unfortunately for them, their highest impact talent actually never came into the fore – Sangakkara was out-of-form, Darren Bravo absent on national duty and Daniel Harris not used enough. Amit Mishra was ordinary till the very fag end of the tournament. They never really struck the right team balance almost right through the tournament.
They had 6 players above an IMPACT of 2 in IPL 2012 (minimum 5 matches) - DT Christian (3.13, 7), S Dhawan (3.04, 15), DW Steyn (3.03, 12), CL White (2.53, 13), JP Duminy (2.37, 9) and PA Patel (2.14, 14).
Mumbai Indians
They were lucky to win 5 close games – which led to whispers of all kinds of conspiracy theories around them. Their bowling, largely around the fine efforts of Malinga and Pollard, was largely lacklustre otherwise (despite Kulkarni's brief sparkle in the playoffs, and occasional performances from Munaf Patel and Pragyan Ojha). Their batting, led by a consistent Tendulkar in an unspectacular sheet-anchor role, relied on high impact performances to get through (which came from Pollard, Rayudu, Dwayne Smith and Rohit
Sharma at different times).
Despite some memorable moments, most of them had a high failure rate (as did RP Singh, the impressionistic view on whom is much more positive than he deserves), all of which eventually did not amount to very much – which was brutally exposed at the playoffs. Their captain was sadly a liability – Harbhajan Singh did not even manage to register a Bowling IMPACT of 1 overall.
They had 6 players above an IMPACT of 2 in IPL 2012 (minimum 5 matches) - Malinga (2.80, 14), KA Pollard (2.31, 14), DR Smith (2.11, 7), SR Tendulkar (2.09, 13), KD Karthik (2.05, 17) and JEC Franklin (2.03, 12).
Pune Warriors
They quite simply did not have the talent – and it is unfair to be too harsh on them because they were always likely to struggle. That they could win 4 of their first 7 matches is quite astonishing – the credit perhaps squarely goes to Sourav Ganguly's early inspiration (and the players who responded to that). But a long tournament like this cannot be sustained on that, without the high impact talent to back it. They lost their last 9 games in a row, and as we had predicted were cannon-fodder eventually for most teams.
They had 4 players above an IMPACT of 2 in IPL 2012 (minimum 5 matches) - RV Uthappa (2.80, 16), SPD Smith (2.29, 15), MN Samuels (2.29, 8) and AD Mathews (2.18, 8).
On some individual parameters, the tightness of the tournament affected expected IMPACT numbers – leading to some unusual movement amongst the teams.
Here are 15 pointers to what panned-out by the end of IPL 2012 – which further explain why these teams fared as they did.
1. Strongest batting unit: Kolkata Knight Riders
2. Weakest batting unit: Mumbai Indians
3. Strongest bowling unit: Royal Challengers Bangalore
4. Weakest bowling unit: Pune Warriors
5. Most attacking batting unit: Delhi Daredevils
6. Most sluggish batting unit: Pune Warriors, Deccan Chargers
7. Team/s that absorbed maximum pressure while batting: Pune Warriors, Mumbai Indians
8. Strongest chasing team: Delhi Daredevils
9. Team/s most susceptible in a chase: Deccan Chargers, Rajasthan Royals
10. Most economical bowling unit: Delhi Daredevils
11. Most uneconomical bowling unit: Pune Warriors
12. Most mercurial side/s (high failure rates): Kings XI Punjab and Royal Challengers Bangalore
13. Team with highest impact Indian players: Kolkata Knight Riders
14. Team with highest impact overseas players: Royal Challengers Bangalore
15. Team with lowest impact Indian players: Royal Challengers Bangalore
For more information, please go to www.impactindexcricket.com.


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Video footage of MEGADETH mainman Dave Mustaine talking about the band's new track called "Sudden Death", which will serve as the finger-busting finale to the forthcoming "Guitar Hero: Warriors of Rock" game, can be viewed below.In a recent interview with RollingStone.com, Mustaine stated about the song, "I'm sure some fans will think it's the greatest thing we've ever done. But other people will say it sucks. That's just the way of the world." Mustaine told RollingStone.com the track has a "funky kind of polyrhythm to it" which will make it even more difficult for the Guitar Hero elite. "Just the sheer repetitiveness of it can blow people's minds. And, my guitar style is way different than [other MEGADETH guitarist] Chris Broderick's. Chris plays with a lot of love and I play with a lot of hate. My guitar playing is explosions, and his is more like fireworks. When you are trying to emulate the two kind of guitar styles, it's tricky. I don't care what anyone says, you've gotta be good." "I thought it was a great idea for us," said Mustaine. "We've had experience with games in the past, and our songs have been in sports games and Grand Theft Auto, but we never really got into the Guitar Hero thing. When they talked to us about doing this, I never imagined it would be something this honorable." "Only once in my career have I had this happen before," Mustaine said, referring to 1991's soundtrack for "Bill and Ted's Bogus Journey", to which MEGADETH contributed "Go to Hell". "We had written something and Interscope told me to make the lyrics even darker. Activision heard the track, and said, 'We want more solos on it.' And I said, OK, I can do that.'"
MEGADETH's DAVE MUSTAINE Talks About 'Sudden Death' Track (Video)
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subset: commoncrawl


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Items where Author is "Hua, Zhaolin"
|Up a level
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Brett, Christopher L. and Kallay, Laura and Hua, Zhaolin and Green, Richard and Chyou, Anthony and Zhang, Yongqiang and Graham, Todd R. and Donowitz, Mark and Rao, Rajini (2011) Genome-Wide Analysis Reveals the Vacuolar pH-Stat of Saccharomyces cerevisiae. PLoS ONE, 6 (3). e17619. ISSN 1932-6203


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Port Hueneme, CA
Language Arts, Writing, Public Speaking, ESL, Art History, History40/hour
...the artist to see form and contour and shading and perspective. Anyone who can see can learn to draw and it requires practice but mostly learning to observe. I have studied many methods of drawing starting... read moreSee Tutors Like This


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Debby Chang
- Profile
Debby Chang joined the Cal Lutheran family to develop and teach the Chinese language, culture and business culture program in 2006. Since then, she's introduced the Chinese traditions to the student body and the local community by organizing Chinese New Year celebrations, Moon Festival concerts and tea ceremonies at the university. Chang has taken the students to Chinese businesses to get a better understanding of the Chinese business culture. She has also connected CLU students to opportunities to study in China with Chinese government scholarships.
Chang was born in Taipei, Taiwan and is a native Mandarin speaker. She is also fluent in Cantonese. She has had a passion for sharing the Chinese language and culture with the community as a Chinese teacher for more than 20 years, part of which as the Thousand Oaks Chinese School principal. In 2007, the Overseas Chinese Affairs Office of the State Council awarded Chang with the Outstanding Chinese Language Teacher Award.
- Education
1970 - 1973 B.S. Northeastern University, Boston, MA
1972 - 1973 School of Medical Technology, New England Deaconess Hospital, Boston, MA
1969 - 1970 Warren Wilson College, Swannanoa, NC
- Publications
The Key to Learning Chinese (Co-author), Chinese Language Educators' Society and Shanghai Century Publishing Group, 2004


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Garnier Ultra-Lift Anti-Wrinkle Firming Eye Cream Reviews
I had hope judging from the name of this product.My hopes were dashed. It did not firm or help my wrinkles in any way. Very misleading. Just a rather low price and low quality moisturizer. — 6 years, 6 months agoCaroleVonAllten | 1401 reviews
This review is: Helpful | Not helpful | Inappropriate | 1 of 2 people said helpful
Not for deep wrinklesI started having fine and some deep wrinkles on the sides of my eyes and dark circles a few years ago. The first eye cream I bought was Clinique All About Eyes, but I was not too happy with the results. Ever since then, I have been shopping for a good eye cream/wrinkle treatment. Since I did not want to pay too much, I tried this Garnier eye cream next. For eye cream, I was surprised how light it ...read morewas. It was almost like Garnier Anti-Sun-Damage Daily Moisturizer. That's right, I felt that this was more like moisturizer than eye cream. I felt some improvement in the dryness around my eyes, so the puffiness and dullness of my under eyes seemed to get better. but I can't say I see any improvement in my wrinkles. Not intensive enough for me. BTW, their fruity/flowery scent was another slight minus point for me. — 7 years, 9 months agoluckybetty | 895 reviews
not bad for a drug-store brandbut i'm starting to think that if i really want to see a noticeable difference in de-puffing and wrinkle-reduction, i may have to splurge on a department store brand. that said, i think this is one of the better drug-store options. definitely hydrating for those who have dry, sensitive skin under their eyes (like myself); some might find it too greasy, but i like the rich feeling and it sinks in...read more nicely 5-10 minutes later, such that by the time i apply my tinted moisturizer and concealer, they don't slide off. i can detect some "firming" sensation but the mirror doesn't reflect much difference w/ the wrinkles =( — 8 years, 4 months agojenstar313 | 101 reviews
This review is: Helpful | Not helpful | Inappropriate | 0 of 1 people said helpful
didnt' notice a differenceI used the entire tub of this product and really did not notice a difference in my eye area. It smelled nice, but that's really not the point — 6 years agoLaurelJ | 153 reviews
This review is: Helpful | Not helpful | Inappropriate | 0 of 0 people said helpful
Did not work as I expectedI bought this like a year ago and tried for 2 weeks and I did not see any results so I stopped using it. I know that 2 weeks may sound a little but I have tried other eye treatments and I saw results in the first week..so yeah this did not work for me :( — 3 years, 6 months agomanzanita | 1 reviews
Great productI have tried a lot of different eye creams and i keep coming back to this one. It provides great amount of moisture. It really works at keeping the lines around my eyes not noticable.. A lot of other products dont have that ability. Worth the money for this awesome product — 5 years, 8 months agolaurie72 | 5 reviews
This review is: Helpful | Not helpful | Inappropriate | 2 of 2 people said helpful
Worked but with side effectsAt first I was really impressed with the product. It was the first wrinkle cream that actually worked. I noticed right away that my skin was firmer. After about a week I began to break out all over. Huge painful pimples everywhere. I stopped using it and my skin has since cleared up. I called the company to let them know that I had an allergic reaction to it and they fully reimbursed me. — 6 years, 5 months agosmejkald | 1 reviews
firming creamthis was like putting expensive lotion on my face it did nothing special — 6 years, 6 months agoAidenzmomma | 28 reviews
This review is: Helpful | Not helpful | Inappropriate | 0 of 0 people said helpful
Quick resultsI have only been using this cream for 3 days but i already see reults. My top lid is a little bit saggy and i already see it's firming up. Another thing is that i've tried other eye creams and they give me a bad reaction or terrible puffiness which i normally don't have, not this one, it tingles but is pretty gentle. — 6 years, 7 months agoNinas_mom | 25 reviews
Great Eye Creme for those w/ light wrinklesI've tried at least 5 different eye cremes, department and drug store and have found this one to work the best for about $15. I live in Hawaii and was an avid sun-worshipper and active in ocean sports. This creme took a few weeks for me to really see a difference in the softening of crows feet and the creapy little lines under my eyes. I am now 40 and realize that in a year or 2 I will have to us...read moree something more effective for deep lines but until then I'll keep using for sure. If you between 18-40,haven't had lots of sunexposure or wore sunscreen religiously in your early years pairing this w/ the nighttime version of the same brand should work well for you. It has for me! — 7 years, 7 months agoMahea | 3 reviews
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Dull as Dishwater
A little rudeness and disrespect can elevate a meaningless interaction to a battle of wills and add drama to an otherwise dull day. --Bill Watterson, The Complete Calvin and Hobbes
The most significant thing about the market lately has been how boring it has been. The market has had a positive bias as players are afraid of missing out on a 'fiscal cliff resolution rally' but it has been lacking in drama and painfully slow....439 more words left in this article. To read them, just click below and try Real Money FREE for 14 days.
There's no substitute for a trading floor to get great ideas, so Jim Cramer created a better one at Real Money and blogs there exclusively. We then added legendary hedge fund manager, Doug Kass, with his exclusive Daily Diary and best investing ideas. Staffed with more than 4 dozen investing pros, money managers, journalists and analysts, Real Money Pro gives you a flood of opinions, analysis and actionable trading advice found nowhere else, and allows you to interact directly with each expert.
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This morning, a flock of concerned people will gather at Magic Island for Charleston's fourth annual Walk For Suicide Prevention. We hope the walkers succeed in raising watchfulness against the menace of self-killing, a tragedy that inflicts grievous harm on families and society.
Suicides have risen ominously in America, according to the U.S. Centers for Disease Control. In 2011, they totaled 39,518 — more than the 32,479 killed in highway crashes — and they caused $34 billion loss, chiefly from lost wages and work productivity. That's a horrible waste of human lives and potential.
In the military, suicides now exceed combat deaths. Guns — highly effective killers — are used in more than half of instances. Men are four times more likely to take their lives than women are. Whites are almost three times more at risk than blacks or Hispanics.
"Ninety percent of people who die by suicide have a diagnosable and treatable psychiatric disorder at the time of their death," according to the American Foundation for Suicide Prevention. Depression is the chief factor.
In other words, nearly all the victims suffer temporary misery that could be cured by antidepressant pills — or even by sympathetic talking with relatives or friends — but self-killing wipes out any chance for healing. Once a trigger is pulled, it's too late. Talk show host Phil Donahue called it "a permanent solution to a temporary problem."
Alcohol or drugs are involved in many cases. They impair judgment, leading to deaths that might not have occurred, had the person been sober.
Experts list these warning signs: If someone talks about suicide — or mentions feeling worthless and hopeless — or seems noticeably depressed — or starts giving away possessions and making farewell comments — relatives and friends should intercede. Sincere talking or getting outside help may avert tragedy.
Assistance can be found via a toll-free call. The National Suicide Prevention Lifeline says:
"No matter what problems you are dealing with, we want to help you find a reason to keep living. By calling 1-800-273-TALK (8255) you'll be connected to a skilled, trained counselor at a crisis center in your area, anytime 24/7."
All the walkers at Magic Island this morning deserve praise for their effort to save lives.


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found a new home!
Plenty of my friends are looking
for one too. Find a pet to adopt.
I am already spayed, up to date with shots, and good with dogs.
Becky, a Waldorf Labrador Retriever puppy was adopted! Here's how you can benefit by looking at adoption as an option to buying a Labrador Retriever for sale in Waldorf, or seeking a Labrador Retriever puppy from a breeder in Waldorf.


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OAKLEY — Residents soon can get their first look at a sculpture the city commissioned for the veterans memorial that will be going in downtown.
An eagle hewed from white granite will be on display from 11 a.m. to 1 p.m. July 11 at Civic Center Park, 3231 Main St.
The public can meet sculptor Scott Luken, who will be on hand to apply finishing touches to the monument's centerpiece.
The eagle is a facsimile of a bronze sculpture commemorating the troops that fought in World War I; that original piece of art stood in Oakley until 1976, when it was moved to Antioch's fairgrounds.
Visitors will be able to take home small pieces of the granite used to make the eagle.
The rest of the monument will be built sometime between now and Veterans Day on Nov. 11.
The memorial, which will be installed at Main Street and Norcross Lane, will comprise five square columns in red granite that each bear the insignia of one of the branches of the military.
They will surround a granite base on which a U.S. flag will be mounted.
The estimated price tag for the project is $70,000, excluding foundation work, electrical wiring and landscaping.
To defray its costs, the city is accepting contributions: Individuals wanting to help can donate $125 to have a brick embedded in the memorial; businesses may support the endeavor with sponsorships starting at $1,000.
For more information, contact Nancy Marquez-Suarez at 925-625-7007 or email@example.com.


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Vallejo doesn't have an official "No Turkey Left Behind" program. But, thanks to various charitable organizations, residents won't be hurting for a free Thanksgiving meal this week.
Bad news for the birds. Good news for the homeless, hungry and possibly just someone seeking a comforting shoulder.
From a motorcycle club helping serve at Good Samaritan Baptist Church to bartenders and servers at Chris' Club dishing up the fixins, from the Salvation Army's annual distribution Monday to 500 turkeys handed out Wednesday at the Christian Help Center, to twice the usual lunch gathering expected Thursday at First Baptist Church.
"At Thanksgiving, there are people who don't have family who have a need to be with someone," said Pastor Al Marks, who heads the Sparrow Project at First Baptist. "And we do have quite a few who come in for the fellowship."
Because school is out, Marks said there will be far more children seeking a free meal than the usual free lunch at First Baptist.
It's that "family feeling" that drives a lot of adults to arrive Thursday, added Marks.
"People remember sitting around a big table as a kid with a lot of people and want to be around a table with a lot of people on Thanksgiving," he said.
Marks relies on the Solano/Contra Costa Food Bank, Lions' Club and individuals to assure the church can offer the traditional Thanksgiving meal.
"Nobody gets baloney loaf," he joked.
The Christian Help Center has already distributed 50 frozen turkeys and 450 vouchers for turkeys it hopes to have by Wednesday morning's giveaway, which means assistant director Jeff Podemski again relies on the community's last-minute generosity.
"We do it by faith," Podemski said.
Last Wednesday, the line started at 6 a.m. for the voucher and turkey distribution that didn't start until 8:30 a.m.
"People were waiting four hours in line to get a turkey ticket," Podemski said. "I think they're hurting."
The Salvation Army gets a head start by distributing Thanksgiving food Monday from 9 a.m. to 3 p.m.
Good Samaritan Missionary Baptist Church has hosted a free Thanksgiving meal for about 25 years, said Evelyn King, and gets a surprising hand this time around: About a dozen members of the "Kings of Cali" motorcycle club.
The bikers are expected to deliver about 20 or so turkeys this morning and return to join the Jesse Bethel High football team in serving on Thanksgiving, said King.
More than 300 people were served last year, King said, and another 150 seniors had meals hand-delivered.
The meal at Good Samaritan is available to anyone, King noted, and the church is open "for some who just want to come for fellowship."
The following venues host free Thanksgiving meals or offer free turkeys:
Chris' Club -- Thanksgiving Day, 12th Annual Feed the Need, 2 p.m. for 21 and older. "To Go" plates made for those under 21, 656 Benicia Road, Vallejo, (707) 552-2916.
Good Samaritan Baptist Church -- Thanksgiving Day, 11 a.m. to 2 p.m., 407 Capitol St., Vallejo. Service 9:30 a.m. Servers include members of Jesse Bethel High School football team and Kings of Cali motorcycle club.
First Baptist Church -- Thanksgiving Day, 11 a.m. to 1 p.m. 2025 Sonoma Blvd., Vallejo. Music by Praise Band of Benicia Fellowship. (707) 644-4064.
Christian Help Center -- Wednesday, turkey distribution, 8:30 a.m. to about noon, 2166 Sacramento St., Vallejo. (707) 553-8192.
Performing Arts and Events Center -- Thanksgiving Day meal sponsored by Vallejo Together, Area Agency on Aging and Dance Unlimited, 610 Georgia St., noon to 3 p.m. Reservations due today. Maria Guevara, (707) 655-5381.


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Former Citigroup CEO Sandy Weill's call to break up the big banks adds him to a growing roster of former financial giant executives who suddenly are embracing one of the core tenets of Glass-Steagall. Mr. Weill said on CNBC Wednesday that the nation's biggest banks should be separated, with investment banks free to take risk and deposit holders going back to old-fashioned lending. Coming from the man whose signature accomplishment led to the repeal of the Depression-era law that separated the businesses, the comments marked a stunning turnaround.
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Dierks named Rockies' Honorary Bat Girl
DENVER -- The Rockies announced the winner of their "Honorary Bat Girl" contest winner on Thursday, choosing Paz Dierks for the position as part of Major League Baseball's "Going to Bat Against Breast Cancer" campaign.
The contest recognizes baseball fans who have been affected by breast cancer and who have demonstrated a commitment to eradicating the disease.
Dierks will be recognized in a pregame ceremony on May 19, when the Rockies play the Giants. Each of the 30 Major League teams have selected honorary bat girls to take part in on-field ceremonies and to receive pink MLB merchandise and two tickets to the game.
Dierks, 35, learned she had stage 3A breast cancer last August, when she was 13 weeks pregnant. She met with an oncologist and a surgeon, and together they determined she would have to have a right breast mastectomy. After healing from her surgery, she started chemotherapy in the 19th week of her pregnancy. She also underwent chemotherapy during weeks 22, 25 and 28.
During week 32, Paz delivered a healthy baby boy. She recently finished her 11th of 12 infusions in her second round of chemotherapy.
Fans across the country shared inspirational stories that provide hope and motivation in the fight against breast cancer, as well as the reasons they or their nominees should represent their favorite team. The 30 Honorary Bat Girl winners were selected by fan votes on HonoraryBatGirl.com along with feedback from a panel that included CC Sabathia of the New York Yankees, Matt Kemp of the Los Angeles Dodgers, Andrew McCutchen of the Pittsburgh Pirates, Alex Gordon of the Kansas City Royals, Maria Menounos of Extra TV and Sam Ryan, MLB Network host and reporter.
Additional observances of MLB's "Going to Bat Against Cancer" campaign include hundreds of players using pink bats on Mother's Day and the opportunity for fans to get a personalized pink bat by going to shop.mlb.com or sluggergifts.com. Game-used Louisville Slugger pink bats from Mother's Day games will be auctioned exclusively on MLB.com to raise funds for the fight against breast cancer.
To further demonstrate their support for the breast cancer cause, players and on-field personnel will wear the symbolic pink ribbon on their uniforms along with pink wrist bands. Commemorative base jewels and dugout lineup cards will also be pink.
The Honorary Bat Girl program was introduced in 2009 to raise additional awareness and support for the annual "Going to Bat Against Breast Cancer" initiative. In four years, over 4,000 testimonials have been submitted and more than 10 million fan votes have been cast.
Partnering with Stand Up to Cancer, a charitable program of the Entertainment Industry Foundation, and Susan G. Komen for the Cure, the initiative has set out to raise awareness about breast cancer and to raise funds to support life-saving breast cancer research.
Owen Perkins is a contributor to MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.


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Would you like a chance to be featured on ni.com? We want to know how LabVIEW has made you better at your job, like it has for these engineers and scientists. In this thread, tell us what you've done and we may feature your story on our website.
LabVIEW is a blessing to a dyslexic developer.
Yes I am dyslexic. Cretified as learning disabled under the Americans with Disabilites Act. My dyslexia was one of the factors that originally drove me to teach myself to program (in VAX-Macro) to avoid the frequent errors I would make when filling out expense reports. Over time I moved to more common laguages and eventually to C. While working with text based langauges, I often found myself frustrated by not being able to "see" a typo even though the compiler was highlighting the line and pointing right at my error!
But when I first saw LabVIEW, I felt like a tremendous weight was lifted from off my shoulders. For the first time in my programming life I was able to express my designs as images rather than as series of alphanumerics. The fact that LabVIEW's diagrams look much like a circuit diagram allowed me start "reading" the diagram with little effort. With time I have learned to "read a diagram at a glance", which is something that simply can't be done in other languages.
I suspect that it it were not for LabVIEW's unique and intuative graphic development environment, I would not have persued a career in software.
Looking back that may seem a bit sappy but it's my story and maybe someone else has a more intersting twist.
Take care,
Note: I can provide an extensive list of what I have done with LV if that would serve any purpose beyond adding to "my brag list".
02-09-2011 04:03 AM - edited 02-09-2011 04:03 AM
LabVIEW has brought me great joy!
I use LabVIEW for 7 years.
Now "thinking-in-labview " group.
Expect more people to use LabVIEW!
Thanks for sharing your stories, guys! I'm passing them along to our folks here.
As system integrator, I normally write complete Apps to control a measurement setup in LV. Stuff that satisfies the manager, the PhD and the operator at the same time. A lot of software engineering (from design to proper error handling) and psychology.
But sometimes, I need to build an electronic circuit to interface the devices. And I want to know that it's working correctly before I travel to my customer. Then I just hack a Q&D testing VI together in no time.
So it's a pretty universal tool(*) through the complete process of getting high-precision measurement setups running.
To name some others: money, cable ties, allen keys & screws, iron nerves.
My entry into LabVIEW was in self defense.
Our one programmer at the time was swamped with work and couldn't be spared to make small tweaks to existing software or write simple code unless it was directly impacting our product. A big part of my job was to evaluate data obtained during testing, and I was spending gobs of time compiling data to look for trends.
So I obtained a copy of LabVIEW on my work computer and began to fiddle with it, doing text file management and compiling stuff at first. This was a huge timesaver for me. Eventually I was able to get enough ahead in my job to spare some time to play with hardware interfacing, to further ease my job. And it snowballed from there. The company eventually sent me to Basics 1 and 2.
I do not do well with text-based languages (I do remember some BASIC – that was a long time ago!) and being able to visually build code and watch it run is great!
LabVIEW made learning colorful and fun.
Writing code in text language (not that text languages are grey) was monotonous.
Intro to LabVIEW made learning fun and visuals of block diagram function helped in a way that it seems like playing game Of course coding in LabVIEW is faster and gives more time in hand for me to do other things.
I had never thought that I will one day hold a CLD in LabVIEW
These are great! Thanks for sharing!
Well first of all, LabVIEW gave me the current job I have today. I graduated as Bachelor Electronics, spring 2010. Then I aplied for a job opening at a local company. They wanted a person who was willing to create software for testing electronic circuits. I told them about LabVIEW, which I got familiar with in school, and they gave me the job. They also bought me LabVIEW 2009 and a DAQmx Usb-6225. I didn't have a clue about creating vi's and getting that DAQmx to work, but after getting introduced to a excellent forum and many helpful souls, I got the hang of it. Now I'm creating alot of software for different uses and I'm using LabVIEW every day. In March and April I'm attending the Core 2 and 3 courses and before summer vacation starts, I'm going to do the CLAD exam.
Not only have LabVIEW given me alot of experience and joy, it have also saved the company I work for alot of time and money. For instance I created a test- and measurement application that lowers the test time per circuit by 5 minutes. Previous test time was 5 minutes, now it's 2 seconds thanks to LabVIEW and the DAQmx. Since we produce many thousand of that circuit, you can easily see that we are saving time and money.
So here I am, 23 years old, and already employed in a big company. My salary is great, and I can do what I like the most every day; creating software with LabVIEW.
So thank you LabVIEW, for giving me the perfect start in a hopefully long career as software developer!
Greetings from Norway!
By helping other on this forum.
Of ALL the forums for programming languages, this is by far the best one. I learned a great deal from this forum as well.
And LabVIEW has helped me become a better "text-based" programmer by optimizing the code as we can do in LabVIEW.


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Filia Rheni II
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Read the best port reviews and tips for this cruise itinerary.
|Day 1
|Budapest, Hungary
|Day 2
|Budapest, Hungary
|Day 3
|At Sea
|Day 3
|Bratislava, Slovakia
|Day 4
|At Sea
|Day 4
|Durnstein, Austria
|Day 5
|Durnstein, Austria
|Day 5
|Melk, Austria
|Day 6
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|Day 9
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|Cologne, Germany
|Day 14
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|Day 15
|Amsterdam, Netherlands
A roll call is a space for members who are signed up for the same cruise (same ship & departure date) to connect.
Make friends BEFORE you sail, exchange tips on what to do onboard and in the ports and maybe even organize a shore excursion with your ship mates.


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This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
Prevention and control of nausea and vomiting (emesis) (N&V) are paramount in the treatment of cancer patients. Chemotherapy-induced N&V (CINV) is one of the most distressing acute side effects of cancer treatment; it occurs in up to 80% of patients and can have a significant impact on a patient's quality of life. N&V can also result in the following:
Health Care Costs
Severe N&V may result in prolonged hospitalizations, inability to continue usual activities, need for additional support, and depression, producing greater effects on health care costs. One review of 12 published studies [1] found that despite the high costs associated with prophylaxis against CINV, the direct cost of care was higher for patients who did not receive adequate CINV prophylaxis. Indirect costs related to lost work hours were also higher for patients with uncontrolled CINV. Another study examined 178 patients receiving highly or moderately emetogenic chemotherapy for their first chemotherapy course.[2] Despite prophylaxis, 61% still experienced CINV. Higher direct and indirect health care costs and lower Functional Living Index—Emesis (FLIE) scores for quality of life were seen in patients who failed prophylaxis. One group of investigators looked at the Premier Perspective database to study 19,139 patients, all of whom received prophylaxis. In those with uncontrolled CINV, the overall mean additional costs were $5,299 per episode.[3]
In this summary, unless otherwise stated, evidence and practice issues as they relate to adults are discussed. The evidence and application to practice related to children may differ significantly from information related to adults. When specific information about the care of children is available, it is summarized under its own heading.
Nausea is the subjective phenomenon of an unpleasant, wavelike sensation experienced in the back of the throat and/or the epigastrium that may culminate in vomiting (emesis). Vomiting is the forceful expulsion of the contents of the stomach, duodenum, or jejunum through the oral cavity. Retching involves the gastric and esophageal movements of vomiting without expulsion of vomitus and is also referred to as dry heaves.
Progress has been made in understanding the neurophysiologic mechanisms that control nausea and vomiting (N&V). Both are controlled or mediated by the central nervous system but by different mechanisms. Nausea is mediated through the autonomic nervous system. Vomiting results from the stimulation of a complex reflex that includes a convergence of afferent stimulation from the following:[1,2]
Neurotransmitters (including serotonin, substance P, and dopamine found in the CTZ), the vomiting center (thought to be located in the nucleus tractus solitarius), and enterochromaffin cells in the gastrointestinal tract then release efferent impulses that are transmitted to the abdominal musculature, salivation center, and respiratory center. The relative contribution from these multiple pathways culminating in N&V symptoms is complex and is postulated to account for the variable emetogenicity (intrinsic emetogenicity and mitigating factors [i.e., dosage, administration route, and exposure duration]) and emetogenic profile (i.e., time to onset, symptom severity, and duration) of agents.[3,4]
Although most patients receiving chemotherapy are at risk for nausea and vomiting (emesis) (N&V), the onset, severity, triggers, and duration vary. Tumor-related, treatment-related, and patient-related factors all contribute, including tumor location, chemotherapy agents used, and radiation exposure.[1,2,3]
Patient-related factors may include the following:
Additional causal factors unrelated to the chemotherapy treatment may include the following:
Clinicians treating N&V must be alert to all potential causes and factors, especially in cancer patients who may be receiving combinations of several treatments and medications. (Refer to the Adverse effects section in the Opioids section of the PDQ summary on Cancer Pain for more information about opioid-induced N&V.)
N&V has been classified as acute, delayed, anticipatory, breakthrough, refractory, and chronic, as outlined below:[7,8,9]
The prevalence of anticipatory nausea and vomiting (emesis) (ANV) has varied, owing to changing definitions and assessment methods.[1] However, anticipatory nausea appears to occur in approximately 29% of patients receiving chemotherapy (about one of three patients), while anticipatory vomiting appears to occur in 11% of patients (about one of ten patients).[2] With the introduction of new pharmacologic agents (5-hydroxytryptamine-3 or 5-HT3 receptor antagonists), it was anticipated that the prevalence of ANV might decline; however, studies have shown mixed results. One study found a lower incidence of ANV,[3] and three studies found comparable incidence rates.[2,4,5] It appears that the 5-HT3 agents reduce postchemotherapy vomiting but not postchemotherapy nausea,[2,5] and the resulting impact on ANV is unclear.
Classical Conditioning
Although other theoretical mechanisms have been proposed,[6] ANV appears to be best explained by classical conditioning (also known as Pavlovian or respondent conditioning).[7] In classical conditioning, a previously neutral stimulus (e.g., smells of the chemotherapy environment) elicits a conditioned response (e.g., ANV) after a number of pairings or learning trials. In cancer chemotherapy, the first few chemotherapy infusions are the learning trials. The chemotherapy drugs are the unconditioned stimuli that elicit postchemotherapy N&V (in some patients). The drugs are paired with a variety of other neutral, environmental stimuli (e.g., smells of the setting, presence of the oncology nurse, chemotherapy room). These previously neutral stimuli then become conditioned stimuli and elicit ANV in future chemotherapy cycles. ANV is not an indication of psychopathology but is rather a learned response that, in other life situations (e.g., food poisoning), results in adaptive avoidance.
A variety of correlational studies provide empirical support for classical conditioning. For example, the prevalence of ANV before treatment with any chemotherapy is very rare, and few patients ever experience ANV without previous postchemotherapy nausea.[8] Also, most studies have found (1) a higher probability of ANV with increasing numbers of chemotherapy infusions, and (2) the intensity of ANV increasing as patients get closer to the actual time of their infusion.[9] In one experimental study, it was shown that a novel beverage could become a conditioned stimulus to nausea when paired with several chemotherapy treatments.[10]
Variables Correlated with ANV
Many variables have been investigated as potential factors that correlate with the incidence of ANV in hopes of developing a list of risk factors. There is currently no agreement on which factors predict ANV. A patient with fewer than three of the first eight characteristics listed below, however, is unlikely to develop ANV, and screening after the first chemotherapy infusion could identify patients at increased risk.[11]
Variables Found to Correlate With ANV
Treatment of ANV
Antiemetic drugs do not seem to control ANV once it has developed;[2] however, a variety of behavioral interventions have been investigated.[19] These include the following:
Progressive muscle relaxation with guided imagery, hypnosis, and systematic desensitization has been studied the most and is the recommended treatment. Referral to a psychologist or other mental health professional with specific training and experience in working with cancer patients is recommended when ANV is identified. The earlier ANV is identified, the more likely treatment will be effective; thus, early screening and referral are essential. However, physicians and nurses underestimate the incidence of chemotherapy-induced N&V.[26][Level of evidence: II]
Clearly, the most important aspect of ANV is prevention of acute and delayed N&V associated with chemotherapy. Most antiemetics have not shown benefit for the treatment of ANV, but the use of antiemetics during chemotherapy may have a dramatic effect in decreasing the incidence of ANV. The only class of medication that has shown benefit in some studies is benzodiazepines, most commonly lorazepam.[27][Level of evidence: IV]
Acute Nausea and Vomiting (N&V)
The incidence of acute N&V with moderate- or high-risk chemotherapy ranges from 30% to 90%.[1,2,3] It can result in significant morbidity and can negatively affect quality of life. However, in recent years many new antiemetic medications and combinations have become available, dramatically decreasing the incidence and severity of this dreaded complication. Risk factors include the emetogenic potential of the specific drug, the dose used, the treatment schedule, and how chemotherapy agents are combined. For example, a drug with a low emetogenic potential given in high doses may cause a dramatic increase in the potential to induce N&V.[4] Standard doses of cytarabine rarely produce N&V, but N&V is often seen with high doses of this drug. Another influencing factor is the use of drug combinations. Because most patients receive combination chemotherapy, the emetogenic potential of all of the drugs combined and individual drug doses need to be considered.[5,6,7,8,9]
Other risk factors include the following:[10]
The American Society of Clinical Oncology has developed a rating system for chemotherapeutic agents and their respective risk of acute and delayed emesis.[11]
Delayed N&V
Delayed (or late) N&V occurs more than 24 hours after chemotherapy administration. Delayed N&V is associated with cisplatin, cyclophosphamide, and other drugs (e.g., doxorubicin and ifosfamide) given at high doses or given on 2 or more consecutive days.[1,12,13]
Several organizations—including the American Society of Clinical Oncology, the National Comprehensive Cancer Network, and the Pediatric Oncology Group of Ontario—have published antiemetic guidelines for their members. It is not the policy of PDQ to endorse specific guidelines, but examples can be found in the literature.[1,2,3,4]
Antiemetic agents are the most common intervention in the management of treatment-related nausea and vomiting (N&V). The basis for antiemetic therapy is the neurochemical control of vomiting. Although the exact mechanism is not well understood, peripheral neuroreceptors and the chemoreceptor trigger zone (CTZ) are known to contain receptors for serotonin, histamine (H1 and H2), dopamine, acetylcholine, opioids, and numerous other endogenous neurotransmitters.[5,6] Many antiemetics act by competitively blocking receptors for these substances, thereby inhibiting stimulation of peripheral nerves at the CTZ and possibly at the vomiting center.
Current guidelines [7,8] recommend that prechemotherapy management of chemotherapy-induced N&V (CINV) be based on the emetogenic potential of the chemotherapy agent(s) selected. For patients receiving regimens with high emetogenic potential, the combination of a 5-HT3 receptor antagonist, aprepitant, and dexamethasone is recommended prechemotherapy; lorazepam may also be used. Aprepitant and dexamethasone are recommended starting with chemotherapy for the prevention of delayed emesis.
For patients receiving moderately emetogenic chemotherapy, the combination of a 5-HT3 receptor antagonist and dexamethasone is used prechemotherapy, with or without lorazepam. Patients receiving the combination of an anthracycline and cyclophosphamide and select patients receiving certain other agents of moderate emetic risk, such as cisplatin (<50 mg/m2) or doxorubicin, may also receive aprepitant. Postchemotherapy, a 5-HT3 receptor antagonist, dexamethasone, or both are recommended for the prevention of delayed emesis.
For regimens with low emetogenic potential, dexamethasone is recommended with or without lorazepam. For regimens with minimal emetogenic risk, no prophylaxis is recommended.[7,8]
Antiemetic guidelines [7,8] have included the available oral 5-HT3 receptor antagonists as optional therapy for the prevention of delayed emesis, but the level of evidence supporting this practice is low.[9]
Studies have strongly suggested that patients experience more acute and delayed CINV than is perceived by practitioners.[9,10,11] One study suggested that patients who are highly expectant of experiencing nausea appear to experience more postchemotherapy nausea.[12] In addition, the current and new agents have been used as prophylaxis for acute and delayed CINV and have not been studied for use in established CINV. One study reported the effective use of intravenous (IV) palonosetron and dexamethasone for the prevention of CINV in patients receiving multiple-day chemotherapy.[13]
Pre- and postchemotherapy recommendations by emetogenic potential are summarized in Table 2.
Most drugs with proven antiemetic activity can be categorized into one of the following groups:
Although all routes of administration are listed for each of the following drugs, the intramuscular (IM) route is used only when no other access is available. IM delivery is painful, is associated with erratic absorption of drug, and may lead to sterile abscess formation or fibrosis of the tissues. This is particularly important when more than one or two doses of a drug are to be given.
Phenothiazines act on dopaminergic receptors at the CTZ, possibly at other central nervous system (CNS) centers, and peripherally. With the exception of thioridazine, many phenothiazines possess antiemetic activity, including chlorpromazine given in the 10- to 50-mg dose range orally, IM, IV, and rectally (pediatric dose for patients >12 years: 10 mg every 6–8 hours; for patients <12 years: 5 mg every 6–8 hours); and perphenazine.
The primary consideration in selecting phenothiazines are differences in their adverse effect profiles, which substantially correlate with their structural classes. Generally, aliphatic phenothiazines (e.g., chlorpromazine, methotrimeprazine) produce sedation and anticholinergic effects, while piperazines (e.g., prochlorperazine, perphenazine, fluphenazine) are associated with less sedation but greater incidence of extrapyramidal reactions (EPRs) (acute dystonias, akathisia, neuroleptic malignant syndrome [uncommon], and, rarely, akinesias and dyskinesias). Marked hypotension may also result if IV doses are administered rapidly at high doses. The concomitant use of H1 blockers, such as diphenhydramine, can often decrease the risk and severity of extrapyramidal side effects. Phenothiazines may be of particular value in treating patients who experience delayed N&V (postacute phase symptoms) on cisplatin regimens.[15,16,17,18,19][Level of evidence: I]
Droperidol and haloperidol represent butyrophenones, another class of dopaminergic (D2 subtype) receptor antagonists that are structurally and pharmacologically similar to the phenothiazines. While droperidol is used primarily as an adjunct to anesthesia induction, haloperidol is indicated as a neuroleptic antipsychotic drug; however, both agents have some antiemetic activity. Droperidol is administered IM or IV, typically from 1 to 2.5 mg every 2 to 6 hours, but higher doses (up to 10 mg) have been safely given.[20,21] Haloperidol is administered IM, IV, or orally, typically from 1 to 4 mg every 2 to 6 hours.[22] Results of a small, uncontrolled, open-label study showed some efficacy for haloperidol in palliative care patients.[23] Both agents may produce EPRs, akathisia, hypotension, and sedation.
Substituted Benzamides
Metoclopramide is a substituted benzamide, which, before serotonin (5-HT3) receptor antagonists were introduced, was considered the most effective single antiemetic agent against highly emetogenic chemotherapy such as cisplatin. Although metoclopramide is a competitive antagonist at dopaminergic (D2) receptors, it is most effective against acute vomiting when given IV at high doses (e.g., 0.5–3 mg/kg/dose), probably because it is a weak competitive antagonist (relative to other serotonin antagonists) at 5-HT3 receptors. It may act on the CTZ and the periphery. Metoclopramide also increases lower esophageal sphincter pressure and enhances the rate of gastric emptying, which may factor into its overall antiemetic effect. It can be administered IV at the U.S. Food and Drug Administration (FDA)–approved dose of 1 to 2 mg/kg every 2 hours (or less frequently) for three to five doses. Metoclopramide has also been safely given by IV bolus injection at higher single doses (up to 6 mg/kg) and by continuous IV infusion, with or without a loading bolus dose, with efficacy comparable to that of multiple intermittent dosing schedules.[24,25,26]
Metoclopramide is associated with akathisia and dystonic extrapyramidal effects; akathisia is seen more frequently in patients older than 30 years, and dystonic extrapyramidal effects are seen more commonly in patients younger than 30 years. Diphenhydramine, benztropine mesylate, and trihexyphenidyl are commonly used prophylactically or therapeutically to pharmacologically antagonize EPRs.[27] While cogwheeling rigidity, acute dystonia, and tremor are responsive to anticholinergic medications, akathisia—the subjective sense of restlessness or inability to sit still—is best treated by the following:
Although less commonly used in the United States, metoclopramide is still very commonly used in other countries.
5-HT3 Receptor Antagonists
Four serotonin receptor antagonists—ondansetron, granisetron, dolasetron, and palonosetron—are available in the United States. Tropisetron, while not approved by the FDA, is available internationally. Agents in this class are thought to prevent N&V by preventing serotonin, which is released from enterochromaffin cells in the gastrointestinal (GI) mucosa, from initiating afferent transmission to the CNS via vagal and spinal sympathetic nerves.[28,29,30] The 5-HT3 receptor antagonists may also block serotonin stimulation at the CTZ and other CNS structures. Major side effects of this class of medications include mild headache, constipation, and/or diarrhea. Multiple studies have shown that the 5-HT3 receptor antagonists are most effective when given in conjunction with steroids.
Comparison of agents
Studies suggest that there are no major differences in efficacy or toxicity of the three first-generation 5-HT3 receptor antagonists (dolasetron, granisetron, and ondansetron) in the treatment of acute CINV. These three agents are equivalent in efficacy and toxicity when used in appropriate doses.[31,32]; [33][Level of evidence: I] Although these agents have been shown to be effective in the first 24 hours postchemotherapy (acute phase), they have not been demonstrated to be effective in days 2 to 5 postchemotherapy (delayed phase).
Palonosetron, the second-generation 5-HT3 receptor antagonist, has been approved for the control of acute emesis with highly and moderately emetogenic chemotherapy and delayed emesis for patients receiving moderately emetogenic chemotherapy.[34]; [35][Level of evidence: I]
Despite the use of both first-generation and second-generation 5-HT3 receptor antagonists, the control of acute CINV, and especially delayed N&V, is suboptimal, and there is considerable opportunity for improvement with either the addition or substitution of new agents in current regimens.[9,36,37,38]
Several studies have demonstrated that ondansetron produces an antiemetic response that equals or is superior to that of high doses of metoclopramide, but ondansetron has an improved toxicity profile, compared with that of dopaminergic antagonist agents.[39,40,41,42][Level of evidence: I][43,44] Ondansetron (0.15 mg/kg) is given IV 15 to 30 minutes before chemotherapy and is repeated every 4 hours for two additional doses. Alternatively, for patients older than 18 years, a large multicenter study determined that a single 32-mg dose of ondansetron is more effective in treating cisplatin-induced N&V than a single 8-mg dose and is as effective as the standard regimen of three doses at 0.15 mg/kg given every 4 hours starting 30 minutes before chemotherapy.[45][Level of evidence: I] A single-center retrospective chart review has reported ondansetron-loading doses of 16 mg/m2 (maximum, 24 mg) IV to be safe in infants, children, and adolescents.[46] However, data reported to the FDA raises concern about QT prolongation and potentially fatal arrhythmias with a single IV dose of 32 mg. Current drug labeling calls for a maximal single IV dose of 16 mg.[47]
Currently, the oral and injectable ondansetron formulations are approved for use without dosage modification in patients older than 4 years, including elderly patients and patients with renal insufficiency. Oral ondansetron is given 3 times daily starting 30 minutes before chemotherapy and continuing for up to 2 days after chemotherapy is completed. Ondansetron clearance is diminished in patients with severe hepatic insufficiency; therefore, such patients receive a single injectable or oral dose no higher than 8 mg. There is currently no information evaluating the safety of repeated daily ondansetron doses in patients with hepatic insufficiency. Other effective dosing schedules such as a continuous IV infusion (e.g., 1 mg/h for 24 h) or oral administration have also been evaluated.[45]
The major adverse effects include the following:[48]
Ondansetron has been etiologically implicated in a few case studies involving thrombocytopenia, renal insufficiency, and thrombotic events.[49] In addition, a few case reports have implicated ondansetron in causing EPRs. However, it is not clear in some cases whether the events described were in fact EPRs; in other reports, the evidence is confounded by concurrent use of other agents that are known to produce EPRs. Nevertheless, the greatest advantage of serotonin receptor antagonists over dopaminergic receptor antagonists is that they have fewer adverse effects. Despite prophylaxis with ondansetron, many patients receiving doxorubicin, cisplatin, or carboplatin will experience acute and delayed-phase N&V.[50] A randomized, double-blind, placebo-controlled trial suggests that the addition of aprepitant, an NK-1 receptor antagonist, may mitigate N&V.[51] The optimal dose of aprepitant may be 125 mg on day 1 followed by 80 mg on days 2 and 3.[52,53][Level of evidence: I]
Granisetron has demonstrated efficacy in preventing and controlling N&V at a broad range of doses (e.g., 10–80 µg/kg and empirically, 3 mg/dose). In the United States, granisetron injection, transdermal patch, and oral tablets are approved for initial and repeat prophylaxis for patients receiving emetogenic chemotherapy, including high-dose cisplatin. Granisetron is pharmacologically and pharmacokinetically distinct from ondansetron; however, clinically it is equally efficacious and equally safe.[50,51,53,54][Level of evidence: I] Both granisetron formulations are given before chemotherapy, either as a single IV dose of 10 µg/kg (0.01 mg/kg) or as 1 mg orally every 12 hours.
Both granisetron formulations and ondansetron injection share the same indication against highly emetogenic chemotherapy. In contrast, the oral ondansetron formulation has been approved only for use against N&V associated with moderately emetogenic chemotherapy.
Currently, granisetron injection is approved for use without dosage modification in patients older than 2 years, including elderly patients and patients with hepatic and renal insufficiency. Oral granisetron has not yet been approved for use in pediatric patients.
Oral formulations of dolasetron are indicated for the prevention of N&V associated with moderately emetogenic cancer chemotherapy, including initial and repeat courses. Oral dolasetron may be dosed as 100 mg within 1 hour before chemotherapy. Dolasetron is given IV or orally at 1.8 mg/kg as a single dose approximately 30 minutes before chemotherapy. Injection formulations are no longer approved for CINV because of the risk of QTc interval prolongation.[55]
The effectiveness of oral dolasetron in the prevention of CINV has been proven in a large randomized, double-blind, comparative trial of 399 patients.[56][Level of evidence: I] Oral dolasetron was administered in the range of 25 to 200 mg 1 hour before chemotherapy. The other study arm consisted of oral ondansetron (8 mg) administered 1.5 hours before chemotherapy and every 8 hours after chemotherapy for a total of three doses. Complete response (CR) rates improved with increasing doses of dolasetron. Both dolasetron 200 mg and ondansetron had significantly higher CR rates than did dolasetron 25 or 50 mg. (CR was defined as no emetic episodes and no use of escape antiemetic medications.)
Palonosetron is a 5-HT3 receptor antagonist (second generation) that has antiemetic activity at both central and GI sites. Palonosetron is FDA approved for the prevention of acute N&V associated with initial and repeat courses of moderately and highly emetogenic cancer chemotherapy and for the prevention of delayed N&V associated with initial and repeat courses of moderately emetogenic cancer chemotherapy. Compared with the older 5-HT3 receptor antagonists, palonosetron has a higher binding affinity to the 5-HT3 receptors, a higher potency, a significantly longer half-life (approximately 40 hours, four to five times longer than that of dolasetron, granisetron, or ondansetron), and an excellent safety profile.[57][Level of evidence: I] A dose-finding study demonstrated that the effective dose was 0.25 mg or higher.[58,59,60,61,62]
In two large studies of patients receiving moderately emetogenic chemotherapy, CR (no emesis, no rescue) was significantly improved in the acute and the delayed period for patients who received 0.25 mg of palonosetron alone, compared with either ondansetron or dolasetron alone.[34]; [35][Level of evidence: I] Dexamethasone was not given with the 5-HT3 receptor antagonists in these studies, and it is not yet known whether the differences in CR would persist if dexamethasone was used. In another study,[63][Level of evidence: I] 650 patients receiving highly emetogenic chemotherapy (cisplatin ≥60 mg/m2) also received either dexamethasone and one of two doses of palonosetron (0.25 mg or 0.75 mg) or dexamethasone and ondansetron (32 mg). Single-dose palonosetron was as effective as ondansetron in preventing acute CINV with dexamethasone pretreatment; it was significantly more effective than ondansetron throughout the 5-day postchemotherapy period. In an analysis of the patients in the above studies who received repeated cycles of chemotherapy, one author [64] reported that the CR rates for both acute and delayed CINV were maintained with single IV doses of palonosetron without concomitant corticosteroids.
Substance P Antagonists (NK-1 Receptor Antagonists)
Substance P, found in the vagal afferent neurons in the nucleus tractus solitarius, the abdominal vagus, and the area postrema, induces vomiting. NK-1 receptor antagonists, including aprepitant, fosaprepitant, and netupitant, have been developed.
The initial clinical studies using the NK-1 receptor antagonists [65,66,67,68] demonstrated that the addition of aprepitant (CP-122,721, CJ-11,794, MK-0869) to a 5-HT3 receptor antagonist plus dexamethasone before cisplatin chemotherapy improved the control of acute emesis, compared with a 5-HT3 receptor antagonist plus dexamethasone; this regimen also improved the control of delayed emesis, compared with placebo. In addition, as a single agent, aprepitant had an effect similar to that of ondansetron on cisplatin-induced acute emesis but was superior in the control of delayed emesis.
Subsequent studies [69,70][Level of evidence: I] showed that the combination of aprepitant and dexamethasone was inferior in controlling acute emesis, compared with triple therapy (aprepitant, 5-HT3 receptor antagonist, and dexamethasone). These studies also confirmed the improvement of delayed emesis with the use of aprepitant, compared with placebo. Two studies [71,72][Level of evidence: I] have also shown an improvement in cisplatin-induced delayed emesis with the combination of aprepitant and dexamethasone, compared with dexamethasone alone, with the improvement maintained over repeat cycles of cisplatin chemotherapy.
In two randomized, double-blind, parallel, multicenter, controlled studies (520 patients in each study), patients received cisplatin (≥70 mg/m2) and were randomly assigned to receive either standard therapy with a 5-HT3 receptor antagonist (ondansetron) and dexamethasone prechemotherapy and dexamethasone postchemotherapy (days 2–4); or standard therapy plus aprepitant prechemotherapy and on days 2 and 3 postchemotherapy.[52,73][Level of evidence: I] The CR (no emesis, no rescue) of the aprepitant group in both studies was significantly higher in both the acute period (83%–89%) and the delayed period (68%–75%), compared with the CR of the standard therapy group in the acute period (68%–78%) and delayed period (47%–56%). Nausea was improved in the aprepitant group for some, but not all of the various specific measures of nausea.
The studies discussed above formed the basis for the approval of aprepitant by the FDA in March 2003. In combination with other antiemetics, aprepitant is indicated for the prevention of acute and delayed N&V associated with initial and repeat courses of highly emetogenic cancer chemotherapy, including high-dose cisplatin. An additional study confirmed the efficacy of aprepitant in the delayed period, when it was compared with ondansetron.[74][Level of evidence: I] Another randomized phase III trial studied the use of aprepitant, granisetron, and dexamethasone for the prevention of CINV in multiple myeloma transplant patients receiving high-dose melphalan with autologous stem cell transplantation. A statistically positive benefit, without an increase in side effects, was seen in patients who were given this regimen.[75,76,77,78,79]
Fosaprepitant is a prodrug for aprepitant and is available in IV formulation. It is indicated in patients who are unable to tolerate oral medications because of mucositis, swallowing difficulties, or GI disturbance. Preliminary studies have shown safety and efficacy similar to that of oral aprepitant. Fosaprepitant is approved at a dose of 115 mg on day 1, followed by oral aprepitant on days 2 and 3. Fosaprepitant dimeglumine, a water-soluble, phosphorylated analog of aprepitant, is rapidly converted to aprepitant after IV administration.[80] Fosaprepitant (115 mg) was approved by the FDA as an alternative to the 125-mg oral aprepitant dose on day 1 of a 3-day regimen. As demonstrated in a randomized, double-blind study of patients receiving cisplatin chemotherapy, single-dose IV fosaprepitant (150 mg) given with ondansetron and dexamethasone was noninferior to the standard 3-day dosing of oral aprepitant in preventing CINV.[81]
Netupitant is a competitive antagonist to the NK-1 receptor that is marketed as an oral fixed-combination product containing 300 mg of netupitant and 0.5 mg of palonosetron; it is dosed as a single product with dexamethasone before chemotherapy for the prevention of both acute and delayed CINV. This drug combination has been used successfully for prevention in both highly and moderately emetogenic chemotherapy regimens.[82,83]
Steroids are commonly used in combination with other antiemetics. Their antiemetic mechanism of action is not fully understood, but they may affect prostaglandin activity in the brain. Clinically, steroids quantitatively decrease or eliminate episodes of N&V and may improve patients' mood, thus producing a subjective sense of well-being or euphoria (although they also can cause depression and anxiety). Steroids are sometimes used as single agents against mildly to moderately emetogenic chemotherapy but are more often used in antiemetic drug combinations.[84,85][Level of evidence: I][86]
Steroids are often given IV before chemotherapy and may or may not be repeated. Dosages and administration schedules are selected empirically. Dexamethasone is often the treatment of choice for N&V in patients receiving radiation to the brain, as it also reduces cerebral edema. It is administered orally or IV in the dose range of 8 mg to 40 mg (pediatric dose: 0.25–0.5 mg/kg).[87,88] Methylprednisolone is also administered orally, or IV at doses and schedules that vary from 40 mg to 500 mg every 6 to 12 hours for up to 20 doses.[85,89]
Dexamethasone is also used orally for delayed N&V. Long-term corticosteroid use, however, is inappropriate and may cause substantial morbidity, including the following:[90,91,92]
A study that examined chemotherapy in a group of patients with ovarian cancer found that short-term use of glucocorticoids as antiemetics had no negative effects on outcomes (e.g., overall survival or efficacy of chemotherapy).[93] As previously shown with metoclopramide, numerous studies have demonstrated that dexamethasone potentiates the antiemetic properties of 5-HT3 –blocking agents.[90,94] If administered IV, dexamethasone may be given over 10 to 15 minutes because rapid administration may cause sensations of generalized warmth, pharyngeal tingling or burning, or acute transient perineal and/or rectal pain.[95,96,97,98]
Benzodiazepines such as lorazepam, midazolam, and alprazolam have become recognized as valuable adjuncts in the prevention and treatment of anxiety and the symptoms of anticipatory N&V associated with chemotherapy, especially with the highly emetogenic regimens given to children.[90,91,92] Benzodiazepines have not demonstrated intrinsic antiemetic activity as single agents; therefore, their place in antiemetic prophylaxis and treatment is adjunctive to other antiemetic agents.[99] Benzodiazepines presumably act on higher CNS structures, the brainstem, and spinal cord, and they produce anxiolytic, sedative, and anterograde amnesic effects. In addition, benzodiazepines markedly decrease the severity of EPRs, especially akathisia, associated with dopaminergic receptor antagonist antiemetics.
Lorazepam may be administered orally, IV, and sublingually. Dosages range from 0.5 to 3 mg (alternatively, 0.025–0.05 mg/kg, or 1.5 mg/m2, but ≤4 mg per dose) in adults and 0.03 to 0.05 mg/kg in children every 6 to 12 hours.[100][Level of evidence: I][101,102] Midazolam produces mild-to-marked sedation for 1 to 4.5 hours at doses equal to 0.04 mg/kg given IV over 3 to 5 minutes.[103,104] Alprazolam has been shown to be effective when given in combination with metoclopramide and methylprednisolone.[105]
The adverse effects of lorazepam include the following:[106]
Olanzapine is an antipsychotic in the thienobenzodiazepine drug class that blocks multiple neurotransmitters: dopamine at D1, D2, D3, and D4 brain receptors; serotonin at 5-HT2a, 5-HT2c, 5-HT3, and 5-HT6 receptors; catecholamines at alpha-1 adrenergic receptors; acetylcholine at muscarinic receptors; and histamine at H1 receptors.[107] Common side effects include the following:[108,109]
Olanzapine has also been associated with increased risk of hyperlipidemia, hyperglycemia, new-onset diabetes and, in rare cases, diabetic ketoacidosis.[110,111] Olanzapine is used with caution in elderly patients; it has been associated with increased risk of death and increased incidence of cerebrovascular adverse events in patients with dementia-related psychosis and carries a boxed warning to that effect. Olanzapine's activity at multiple receptors, particularly at the D2 and 5-HT3 receptors that appear to be involved in N&V, suggests that it may have significant antiemetic properties.[112][Level of evidence: II]; [113,114]
A phase I study used olanzapine for the prevention of delayed emesis in cancer patients receiving their first cycle of chemotherapy consisting of cyclophosphamide, doxorubicin, cisplatin, and/or irinotecan.[115] The protocol was completed by 15 patients, and no grade 4 toxicities were observed. The maximum tolerated dose was 5 mg/day for 2 days before chemotherapy and 10 mg/day for 7 days postchemotherapy. On the basis of these phase I data, olanzapine appeared to be a safe and effective agent for the prevention of delayed emesis in chemotherapy-naive cancer patients receiving cyclophosphamide, doxorubicin, cisplatin, and/or irinotecan.
Using the maximum tolerated dose of olanzapine in the phase I trial, a phase II trial was performed for the prevention of CINV in patients receiving their first course of either highly emetogenic or moderately emetogenic chemotherapy.[116][Level of evidence: II] Olanzapine was added to granisetron and dexamethasone prechemotherapy and to dexamethasone postchemotherapy. CR (no emesis, no rescue) was 100% for the acute period (24 hours postchemotherapy), 80% for the delayed period (days 2–5 postchemotherapy), and 80% for the overall period (0–120 hours postchemotherapy) in ten patients receiving highly emetogenic chemotherapy (cisplatin, ≥70 mg/m2). CR was also 100% for the acute period, 85% for the delayed period, and 85% for the overall period in 20 patients receiving moderately emetogenic chemotherapy (doxorubicin, ≥50 mg/m2). Nausea was very well controlled in the patients receiving highly emetogenic chemotherapy, with no patient having nausea (0 on a scale of 0–10 on the MD Anderson Symptom Inventory) in the acute or delayed periods. Nausea was also well controlled in patients receiving moderately emetogenic chemotherapy, with no nausea in 85% of patients in the acute period and in 65% of patients in the delayed and overall periods. There were no grade 3 or 4 toxicities. On the basis of these data, olanzapine appeared to be safe (sedation was the only dose-limiting toxicity) and effective in controlling acute and delayed CINV in patients receiving highly emetogenic and moderately emetogenic chemotherapy in these very small preliminary studies.[116][Level of evidence: II]
Subsequent studies have shown the effectiveness of olanzapine as an antiemetic. Olanzapine combined with a single dose of dexamethasone and a single dose of palonosetron was very effective in controlling acute and delayed CINV in patients receiving either moderately emetogenic chemotherapy or highly emetogenic chemotherapy.[117] A large end study [118][Level of evidence: I] demonstrated that in patients receiving either highly emetogenic chemotherapy or moderately emetogenic chemotherapy, the addition of olanzapine to azasetron and dexamethasone improved the CR of delayed CINV.
Other Pharmacologic Agents
The plant Cannabis contains more than 60 different types of cannabinoids, or components that have physiologic activity. The most popular, and perhaps the most psychoactive, is delta-9-tetrahydrocannabinol (delta-9-THC).[119] There are two FDA-approved Cannabis products for CINV:
With respect to CINV, Cannabis products probably target cannabinoid-1 (CB-1) and CB-2 receptors, which are in the CNS.[120] Another product, Sativex, contains a combination of delta-9-THC and cannabidiol and is a buccal spray; it is under clinical investigation.[121,122]
Much of the research on this class of agent was conducted in the late 1970s and 1980s and compared nabilone, dronabinol, or levonantradol to older antiemetic agents that targeted the dopamine receptor, such as prochlorperazine (Compazine) and metoclopramide (Reglan).[123,124,125,126,127] This group of studies demonstrated that cannabinoids were as effective for moderately emetogenic chemotherapy as dopaminergic antiemetics or were more effective than placebo.[119] Side effects included euphoria, dizziness, dysphoria, hallucinations, and hypotension.[119] Despite earlier reports of efficacy, in at least one study, patients did not significantly prefer nabilone because of the side effects.[123]
Since the 1990s, research in N&V has elucidated newer and more physiologic targets, namely 5-HT3 and NK-1 receptors. Subsequently, 5-HT3 and NK-1 receptor antagonists have become standard prophylactic therapy for CINV. Studies investigating the role of Cannabis extract and cannabinoids with these newer agents are few; therefore, limited conclusions can be drawn. In published trials, however, Cannabis extract and cannabinoids have not demonstrated more efficacy than 5-HT3 receptor antagonists, and synergistic or additive effects have not been fully investigated.[128,129]
In summary, the place of Cannabis and cannabinoids in today's arsenal of antiemetics for the prevention and treatment of CINV is not known. Discussions with patients about its use may include responses to available agents, known side effects of Cannabis, and an assessment of the risks versus benefits of this therapy.[130]
Refer to the PDQ summary on Cannabis and Cannabinoids for a broader discussion of the issues surrounding Cannabis use.
A phase III, randomized, dose-finding trial of 576 patients with cancer evaluated 0.5 g, 1 g, and 1.5 g of ginger versus placebo in twice-a-day dosing for the prevention of acute nausea (defined as day 1 postchemotherapy) in patients experiencing some level of nausea (as measured on an 11-point scale) caused by their current chemotherapy regimen, despite standard prophylaxis with a 5-HT3 receptor antagonist. Patients began taking ginger or placebo capsules 3 days before each chemotherapy treatment and continued them for 6 days. For average nausea, 0.5 g of ginger was significantly better than placebo; both 0.5 g and 1 g were significantly better than placebo for "worst nausea." Effects for delayed N&V were not significant. This trial did not control for emetogenicity of the chemotherapy regimens. Adverse events were infrequent and were not severe.[131]
Current Clinical Trials
Check the list of NCI-supported cancer clinical trials for supportive and palliative care trials about nausea and vomiting therapy that are now accepting participants. The list of trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI website.
Nonpharmacologic strategies are also used to manage nausea and vomiting (N&V). These include the following:
Guided imagery, hypnosis, and systematic desensitization as means to progressive muscle relaxation have been the most frequently studied treatments for anticipatory N&V (ANV) and are the recommended treatments for this classically conditioned response. (Refer to the Treatment of ANV section of this summary for more information.)
Patients receiving radiation to the gastrointestinal (GI) tract or brain have the greatest potential for nausea and vomiting (N&V) as side effects. Because cells of the GI tract are dividing quickly, they are quite sensitive to radiation therapy. Radiation to the brain is believed to stimulate the brain's vomiting center or chemoreceptor trigger zone. Similar to chemotherapy, radiation dose factors also play a role in determining the possible occurrence of N&V. In general, the higher the daily fractional dose and the greater the amount of tissue that is irradiated, the higher the potential for N&V. In addition, the larger the amount of GI tract irradiated (particularly for fields that include the small intestine and stomach), the higher the potential for N&V. Total-body irradiation before bone marrow transplant, for example, has a high probability of inducing N&V as acute side effects.
N&V from radiation may be acute and self-limiting, usually occurring 30 minutes to several hours after treatment. Patients report that symptoms improve on days that they are not being treated. There are also cumulative effects that may occur in patients receiving radiation therapy to the GI tract.[1]
Complete control rates with 5-HT3 receptor antagonists for total-body irradiation vary from 50% to 90%.[2,3,4] The role of corticosteroids in combination with 5-HT3 receptor antagonists has not been studied.
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.
Editorial changes were made to this summary.
This summary is written and maintained by the PDQ Supportive and Palliative Care Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the pathophysiology and treatment of nausea and vomiting (emesis) (N&V). 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 Supportive and Palliative Care Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Nausea and Vomiting are:
Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's Email Us. 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 Supportive and Palliative Care Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
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The preferred citation for this PDQ summary is:
National Cancer Institute: PDQ® Nausea and Vomiting. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://www.cancer.gov/about-cancer/treatment/side-effects/nausea/nausea-hp-pdq. Accessed <MM/DD/YYYY>.
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Junior guard Ryane Ortiz scored a career-high 23 points, helping the UC Santa Cruz women's basketball team beat visiting Occidental 63-62 on Monday.
Ortiz also had eight rebounds and finished 10-of-10 from the free-throw line. The Slugs (11-5) made 18 free throws and outrebounded the Tigers 50-34.
Sophomore forward Leah Parrish moved to center to cover for sick starter Sarah Mackey and scored seven points and pulled down a career-best 14 rebounds.
Mackey has missed the past two games with a flu.
Freshman point guard Jean Dulay added 10 points for the Slugs, who led 32-24 at the half.
Michelle Maito-Lo scored 15 points to lead the Tigers (8-4). All-American teammate Makenzie Brandon -- who has averaged a double-double this season while playing power forward -- was held to 12 points and six rebounds.
The Slugs host Cal State Maritime on Friday at 6 p.m.
Junior guard Morgan Green amde five 3-pointers and scored 33 points, as Pacific Collegiate School beat host King City 67-53 in a Mission Trail Athletic League game.
Eleni Pateras and sister Irini each scored 15 for the Pumas (8-3).
Kennedy Alexander had two points and eight rebounds and teammate Jenny Aguilar had seven points and five rebounds.
The Santa Cruz Warriors have acquired forward Shawn Taggart from the Springfield Armor in exchange for forward Paul Carter and a fifth-round pick in the 2013 NBA D-League Draft.
Taggart, 27, has played 13 games with the Springfield Armor this season, averaging 8.1 points and 4.8 rebounds per contest. The Memphis product played four games with the Toronto Raptors in NBA Summer League in the 2009-2010 season, averaging 6.3 points and 4.0 rebounds.
Carter, 25, was acquired last week in a trade with the Idaho Stampede.
Five local players, including four from Cabrillo, were named to the California Community College Football Coaches Association's 2012 Region III all-state team.
Cabrillo had two sophomores on offense, tight end Mario Rodriguez and lineman Tim Duran, and two sophomores on defense, Michael Schuhe and defensive back Derick Delucchi.
Monterey Peninsula College linebacker Kyle Todd, a San Lorenzo Valley High alum, also was honored on defense.
Both Schuhe -- who will play next season at NCAA Division II Ferris State University in Michigan -- and Delucchi are Santa Cruz High alums.
Rodriguez finished with 18 receptions for 220 yards and three touchdowns. Schuhe recorded 69 tackles, including 7½ sacks. Delucchi made 48 tackles with six interceptions.
Todd finished with 114 tackles, a sack and two fumble recoveries.


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Arp has not even voted regularly, which means he did not support, in the most basic way possible, the candidates for the very political party he says he wants to lead. The votes mattered — he did not support Paula Hughes for mayor, Marlin Stutzman for Congress or any of our other qualified and diligent candidates who ran for city, county, township, state and federal offices in 2010 and 2011.
The chairmanship is not a position someone should seek as a way to start his or her involvement, especially when so much is at stake. How can Arp possibly have the knowledge necessary to operate a political organization as expansive and influential as the Allen County GOP?
As for me, I'm supporting Steve Shine for re-election.
Mary Trausch


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The following deeds were recorded in August in the office of Greene County Register and Recorder Donna Tharp:
Seven criminal defendants pleaded guilty and were sentenced last week by Greene County Court Judge Lou Dayich.
A Spraggs man who was arrested in August for a burglary Emerald Mine in Franklin Township allegedly returned three days later and was arrested again.
The former president of Mepco LLC, whose affiliate, the Dana Mining Co., operates the 4 West Mine in Mt. Morris, was indicted by a federal grand jury in Morgantown, W.Va., Tuesday for allegedly devising a scheme to make illegal campaign contributions.
First Energy Corp. must make environmental improvements to the coal ash landfill at its shuttered Hatfield's Ferry Power Station in Greene County and begin closing portions of the site following a settlement reached with the Sierra Club.
Monessen police have arrested a suspect in a recent arson that injured firefighters.
City Hall is relocating in Monessen, a move that is expected to save the city a considerable amount of money.
Mosaic artist Rachel Sager is tackling her biggest project, repurposing old mine buildings into art.
Arson is suspected in a Tuesday night residential fire in Monessen that injured three firefighters.
A Carroll Township woman faces several charges filed last week by city police after she allegedly hit a basketball hoop and garage at the Valley Inn Fire Department, then nearly hit a man who tried to stop her from leaving the parking lot.
Motorcycle accident reroutes traffic on Route 136.
Emergency responders combed Washington Park after a 24-year-old woman who was reportedly threatening to commit suicide left her home early Sunday afternoon.
Off-leash dog parks have become popular, and more municipalities are creating areas for pet owners to let their dogs roam and play.
Washington Italian Heritage Festival was held Saturday in Community Pavilion on South Main Street.
About 100 people participated in the Together We Can recovery walk in Washington Saturday to celebrate victories in the battle against drug and alcohol addiction.
Teens are less likely to get in trouble as they once were, but they might be less prepared to stand on their own.
Editorial voices from newspapers across the country:
Farm Aid, in its 33rd year, made its second appearance in Washington County on Saturday. The annual concert has raised more than $50 million for family farmers across the U.S., while now raising awareness of sustainiable farming methods that are environmentally friendly.
The sale of the Washington County Health Center is generating concern among workers about the security of their jobs.
Pittsburgh has a lot to offer, and it could end up becoming the home to Amazon's second headquarters.
Check out this interview with McGuffey running back Christian Clutter.
The O-R Sports staff travel to McGuffey for this week's Week 4 high school football preview video.
The Donora Historical Society is hosting a free football game film event Saturday, showing preserved Donora High School football games.
Our Week 3 game of the week recap is Trinity vs. Laurel Highlands.
Penny Chenery, who bred and raced 1973 Triple Crown winner Secretariat as well as realizing her ailing father's dream to win the Kentucky Derby in 1972 with Riva Ridge, has died. She was 95.
Steelers say move not made as a protest, but to show unity.
Steelers will try to do something they've done just once before: Win in Chicago
Steelers defense will get boost from Tuitt.
Quarterback hopes cutting down on turnovers will help lead to more wins, especially on the road.
Steelers head coach says team just missing big plays in ground attack.
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