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Guillen could be out a while
As it turned out, the news on Carlos Guillen sounded a little worse today than it did last night, at least from Guillen's standpoint. He said he felt some discomfort and numbness going up and down his right leg, the same type thing he felt when he had a pinched nerve from back spasms last homestand, and that he's hurting in both hamstrings. He felt fine over the weekend, but it apparently flared up Monday.
If Guillen's out for a while, it's uncertain what they could do. In theory, the Tigers could send Chris Lambert back to Toledo after his start tonight and call up an extra position player (Larish? Hessman?), push up the other starting pitchers and then call up Lambert when the spot comes back around Tuesday — the same day rosters expand. However, I don't think that has been discussed.
Marcus Thames is fine, as his presence in the lineup suggests.
- Granderson, CF
- Polanco, 2B
- Ordonez, RF
- Cabrera, 1B
- Sheffield, DH
- Thames, LF
- Renteria, SS
- Raburn, 3B
- Inge, C
- Grady Sizemore, CF
- Franklin Gutierrez, LF
- Ben Francisco, RF
- Jhonny Peralta, SS
- David Dellucci, DH
- Ryan Garko, 1B
- Jamey Carroll, 3B
- Kelly Shoppach, C
- Asdrubal Cabrera, 2B
31 Comments
This might be a good time to finally bring Hessman up. He deserves the shot it would seem they have his natural position available for a little while. But knowing DD and JL, this won't happen. (sigh)
Sheff in the 5 hole. Looks like we're going to try this to the bitter end. If I'm Cabrera I'm thinking that I'm not going to get much to hit tonight because Shef is behind me. So, they'll tend to throw the off speed stuff and nibble a bit. Worse thing to happen is that Cabrera goes to first and you get the double play in order from Sheffield.
Going to be a long night. We hit Lee last time as I recall. But it is going to be a long night.
Bad backs is bad business. That's what ended my active playing days. Hope this works out for Carlos.
I'd just as soon replace him with Dusty Ryan myself.
Lambert looked like he had things under control, but I don't know if those two homers he couldn't recover. But the lazy no good idiots behind him didn't help him at all. I hope they are happy those freaking idots.
Why would JL leave that boy out there for 49 pitches in one inning?!?!? FORTY-NINE!!!!! Good luck recovering his confidence. Leyland's a joke.
And that "obstruction" they just called was a joke too. That's when JL should have got himself ejected, but no.
They just can't catch a break can they? Two errors that led to 4 unearned runs and a bad call by the umpires and they are out of the inning. Too bad they played so poorly behind Lambert, I think he was pitching pretty well even after the two home runs, if I were him I'd be headed back to Toledo and a team that wants to win a game! One more home run! I can't take it! I think I am going to watch the Cubs, although Zambrano didn't have a very good start tonight either.
The only one who can eject JL is DD and he better do it, loyalty or not. Down 8-0, 3rd place gone, last place next? Any other team would be looking for a new manager and coaches. They obviously can't fire a whole team so what other steps can they take? Certainly some trades need to be made and maybe even some free agent signings but
you can't unload every player and they all seem to be leaderless. If something isn't done, maybe the season ticket holders need to drop out for 2009 to show their displeasure at the status quo. I canard(ly) envision going another season with this mess.
I need to add that except for the first half of 2006, and the 2006 playoffs, the Tigers have not been a good team. For 3 years in a row they have come apart in August and September. This year they had a horrendous start to top it off.
I was watching the Dodgers and Phillies last night and the announcers were saying the Dodgers just don't have that spark, they are laxadaisical in their efforts offensively and defensively. They just don't look like they have the fire to win. As I was listening to the announcers I thought WOW!! they are discribing the Tigers to a T! They don't have the fire, I don't know if it is the management or if they had such a poor start that they just could not come back, also since DD gave Pudge away it seems like they have just given up!
Way to take one for the team Granderson, a base runner is a base runner!
Good thing the Tigers have those big sluggers to get the outs! Go Mags!!!
This is one god-awful looking ball club right now. Sepetember can't come fast enough for me. I know JL has indicated that he doesn't like too many guys on the bench and that he will play his guys right through to the end.
But he won't. He will play some of the kids and make it look like they are filling in for an injury. He may be stubborn but he also must be pretty sick of being criticized for putting out a listless team, losing and being embarassed.
He is showing everyday that he is not the right man to run this ball team. I don't know if Illitch or DD are paying much attention but the signs are pretty obvious this guy has negative impact on the team.
Lopez must be real thrilled chucking in this game. JL has humiliated him all season long by putting him into "stinkers". I am not a huge Lopez fan, but he has been one of those guys that JL has abused IMO. Santiago, Thames, and to a lesser degreee, Raburn being the others.
This team looks like they have given up and that is unfair to to do that to their loyal fans. If they lie down like this and JL doesn't play the kids, the fans will not be so eager to fill the seats the way they did this year. They are becoming again what they had become earlier this year, a laughing stock.
Down in Erie tonight Guillermo Moscoso (remember that name?) has pitched 5 innings so far giving up 1 hit, no runs and 6 Ks.
Like I said before, he must be doing something right! Why not bring a kid like that up? The Bonines, Lamberts and Bazardos of the world ain't gonna cut it in the show.
I feel bad for Thames. He has had such a polarized year and a very difficult one out in left. He changed himself last year for the team, learning how to play 1st, and calmly sat back while Leyland paraded Jacque Jones in front of him out to LF, then Thomas, Sheffield, Guillen and Joyce. I guess you could throw Raburn in there too. Kudos for what he has been able to do in what must have been humiliating (for him) circumstances. As great a guy as he is, he is not a solution for our problem in LF.
Santiago has also had to endure a certain amount of insult himslef. There is no question in my mind that he should have had a lot more playing time. One could argue that he probably should have been given a chance to play short regularly. I don't think he is a solution, for us, at short, but if I had to choose between him and Renteria for next year, he would be my man, hands down.
Rich, speaking of "Canards", I actually used to live on one!.
Years ago I lived just outside Windsor Ont. (where I learned to love the Tigers) and had a home on the banks of the River Canard.
It has been a really trying season for Tiger fans. They do have a right to expect better from their team.
Leyland has failed miserably to cobble together a decent team from a collection of All Stars. Someone's head should roll and as much as I like JL ( I like him a lot) as a baseball character, he has had a bad season and should not be given the chance to have another one. We don't need another year of blind loyalty, double talk, poor managing, failure to utilize player strengths, inability to convey the idea and importance of fundamenta baseball etc etc etc.
He has quit the game before and IMO, he should be honourable enough to offer his resignation.
with guillen out they should try something different with the line up:
….With Guillen back put Joyce between Ord and Cabby and shep last… if he gets on … You got granderson and Polanco and then back to Guillen.
I don't think it matters in what order JL has his lineup they are not producing. My opinion is they need pitching. They have gotten rid of a lot of good pitchers from the bull pen and pinned all their hopes on Zumaya and Rodney which has not worked out as DD and JL had hoped. I have watched quite a few pitchers around the majors this year that were in Detroit within the last couple of seasons and they have been getting it done. Maybe a new pitching coach is the answer.
Matt Joyce is going to play winter ball in Mexico this off season, do they have winter instruction for managers? Maybe DD can send JL to something like that over the winter if he is going to be here next year (which Rod and Mario are sure that he will be).
Obviously everyone likes to win, but the majority of people realize you don't win every year. What bothers me most about this team is that they're just plain dull. Win or lose, they're no fun to watch. Last winter, I thought and said that this group could do some exciting things, push the envelope a little, do some things on the bases to kickstart the offense. None of this has happened. Granderson, Polanco, Sheffield, Renteria, Guillen and Inge, to name a few, are all experienced and intelligent baserunners, but this facet of the game has been entirely ignored this season. This is not what I expected. This is really boring stuff. Even when we win.
the idea of moving joyce up is because he has one of the highest Slugging % in the mlb. It makes them pitch to matt.. they are not going to pitch to Maggs or Cabby. I think shep should be moved to last as i said above.
It has been very tough the last month and half… all those leads lost.
The lost of pudge took the heart out of the team. their pitching has been terrible. To make it worse Maggs is slumping bad… if .307 is bad.
I thought they would shake of the loss of pudge but the pitching failed them.
I hope they take on the spoilier role…. as i said before here the team needs an identity.
the last time they played with spark was the spanish celebration. WE SHOUD HAVE ONE EVERY NIGHT.
Well theres 2, 7 more to go!! Go Tigers!!
Good night Detroit, maybe tomorrow will be better.
How nice, Jim felt bad for his starter tonight because the inning went so bad! He left him in for 49 pitches!!!! and when asked what said to him after he took him out? Well I didn't say ANYTHING, just a pat on the butt and hang in there!!!! He can't figure out what the problem is this year, we are a lot better than we have been playing, I have it figured out JIM, it's the manager!!!
What you are seeing is a bunch of guys with guaranteed contracts who have packed it in vs. a team with a bunch of guys trying to impress their manager for next year. It's no wonder they are getting whipped. I wouldn't mind seeing a lot of new faces next year. Boring, Rich ? They were boring in May. Now they are just downright pathetic.
There aren't many games left, so it's not hard to project the final record. Looks like it will be 77-85. As I've documented, I didn't expect them to make the postseason this year, but I didn't expect this either.
Calling up Ryan would be good move. I hope they aren't foolish enough to go with brandon behind the plate next year. That is a capitualation from the gitgo. Means we get an inferior catcher and an inferior 3rd sacker.
Guillen is on borrowed time. His knees, his hammies, his back. He's getting on in baseball age and as nice a guy and as close to a leader as he is, I don't think he is an everyday infielder anymore. As to this year I think they should shut him down. What's the point of pushing it?
They'll likely Frankenstein Larish along as a 3rd baseman and hope Inge can masquerade as a MLB catcher.
Now there's a formula for a championship!
As mentioned, most of this does boil down to pitching where we have been lousy but this team has not really benn "good" in any department this year. If the pitching and defense aren't improved it will be another long season, and by long, I mean losing.
Hitting is said to be contagious and I think it is. It's not just hitting that begets hitting. I think good teams that play good defense hit better because they simply are playing better ball and become better all around keen, interested, motiivated players.
We're in 4th place now and fading fast. We have 6 games left with K.C. and I can gurantee you they think they have a chance to escape the cellar. Hard to fathom but last place is not out of the realm of possibility. Wonder how the front office and Illitch would handle that?
Dan, I'm starting to warm up to your idea about trading Magglio for a starter. Who were the reccomended pitchers again?
The thing is, baseball is a very hard sport to win at. Look at starting pitchers, who are the backbone of a good team. One year they are superstars, the next year they are average. There are very few pitchers who have won consistently for 10 or 15 years. Basically it's a crap shoot.
What we DO know is that Nate and Kenny are probably not going to be 15-game winners next year. JV maybe. Bondo maybe. AG maybe.
Willis could come back and perform. Who knows!!
The main thing is to get rid of the dead weight. Goodbye JL, Sheff, Kenny, Nate.
I really think there are too many teams in the MLB. It's almost as bad as JApanese soccer. There are maybe 20 or 30 really good pitchers and 50 or 60 pretty good guys. After that, it's not so pretty. I miss the days of two divisions per league. But after all, America is based on making money and perpetual growth, so there was no way to stop the league from growing. Too bad the pitching talent couldn't keep up.
Your absolutely right this season, Rich DULL. I unlike you thought that they had a good chance to make the post season. Not that they would get past the ALDS but that they had a pretty good shot to get there. However like you I didn't expect this team of superstars not to even get anywhere close to the playoffs. UNDERACHIEVERS.
They are really look aweful out there most nights. Magglio couldn't hit a beach ball right now. (I take that back, he could hit it, but he would softly ground out to the infield) Our pitchers couldn't hit the side of a barn, yet a guy in Cleveland who hasn't had a homer all year hits one out of the yard last night. Someone said it earlier. Cleveland looks like they are playing for their lives and Tigers look like they are just trying to get the season over with, win or lose THEY DON"T MUCH CARE. And since most of them aren't playing for contracts next year it doesn't really matter how they do.
And I don't want to lump all of them into one group but I think we all know who we are talking about. Going to the game tonight, Sunday, Monday, Tuesday and Thursday. Can't wait for that?????? NOT
Hard to believe I watched that game – grueling. Sometimes being a die hard fan takes a toll on you. It was awful, just awful, and now being knocked down to 4th place.
I don't quite agree with the statement about Lopez being put into poor situations. In my opinion, any time a player gets put into a game it is there chance to show what they got. Even if they are being blown out like last night, if Lopez can go in and pitch good, he is pitching good and showing his wares. I feel the same way for any player, and even with a season done, these guys should want to showcase their talent if they are hoping to be traded or used for next year. I get the ones that have guaranteed contracts for next year are already making their plans for October for vacations, but plenty of these guys should have the desire to at least show their individual talents.
I will stupidly watch again tonight and cheer for the team and be happy if they win.
On another subject, am going to the last Mud Hens home game this Friday night. too bad they didn't have the season they wanted, they have been so good over the last couple of years, just wasn't their year. but the games there are terrific, the venue is awesome plus we get to sit in a suite provided by my husband's employer.
I have been on this blog since Scratch and Rube (that guy could write) and have always liked reading everyone's comments. Ty, good to hear from you and great writing! I have this week off with a honey do list and could not wait for the game to start. After the second home run, I said (ok I yelled my wife said) go out there and settle the kid down. Lambert hits the next guy. Guess he did not want to throw it down the middle. I won't mention my thoughts on the pitch count! Ant then the baseline call on Inge? If I was the manager I would have said so many words and stomped so hard. At least that would not have been dull. Did the Wings play like that to get the Cup? Come on Mr. I. Yes, I will be watching tonight. Go Justin! Go Tigers! –Dave
anyonebutbush (great name BTW), I haven't researched the needs of other teams but I can arbitrarily toss out some names of what I consider to be front-line starters that I would trade for Magglio.
Johan Santana
Rich Harden (I am aware he seems injury prone)
Danny Haren
The problem with attracting a front line starter may not be so much about the money as it may be with the direction the team is headed. I'm still naive enough to believe that free agents want to go to a situation in which they can win (in addition to getting paid the dough). So, when you are talking about a Lincecum and a Halladay, as their agent I would have a column on the piece of paper about whether this club wants to win.
This past winter, the team made a significant move forward by doing some things and signing some players. It was a signal that this team wanted to do something to win today. I don't know whether that remains true. And thus, I don't know whether front line pitching will want to come to Detroit, despite the money.
Finally, over the winter DD and JL, to his credit, knew that the pitching was going to be an issue. But DD did nothing about it, even after Rodney went down. AG fell into his lap, but otherwise there was no contingency. No moves, no anything. So DD has to be complicit in all this.
I hate being late signing in and giving my two cents worth, but …. so disgusting.. no chemistry on this team, even with half of them speaking S. American? ….
Where was the hook on Lambert. Poor kid! I mean, I was thoroughly impressed with first two innings, then he self destructed and the bad luck came in the third. That was like punishment, not a privelidge, for doing so well in Toledo!… He was done, get him out… its like the pitchers all took a consensus one night, discussed, and nobody wanted to pitch up against Cliff Lee…. told Leyland, and he said, okay, we will find somebody from the minors for that night. Like all of you said…49 pitches! That crushed him. Certainly we have a bullpen made up with somebody who can pitch to the Indians. I thought Nate went into the pen.. stick him in..could it have been worse to have got him warmed up and pull the youngster out after 3 runs? We lost 10-4? .. I know, hindsight.. 20-20 perfect seeing it today.
The poor decisions all have to tear down the team, and make them play half hearted. Inge is good at catcher, but excellant at third.. and move him in outfield in spring? Why?Maybe Shef should have been thrown in outfield. THe worst to have happened was he could have been gone on DL , and could have used others in that spot on lineup that WAS able to hit. Rentaria has been lousy all season. I've notice some balls that just get to Cabby, for the out, but been 6-7ft high? Good Grief! Throw it away why don't you?
Guillen was good at short, but would have been crippled and out on DL by July if left there.. So why not put Inge back at third base? Call up Ryan, or use Sardina for crying out loud. Yes , proably a good cost cutting move to have made the deal for Pudge, and gotten Farnsworth. (To me, He doesn't want to be back in Detroit, and will leave even for less!)..I know that trade probably wouldn't have happened this winter involving Pudge- nobody would have wanted him or the other old veterans, and screwups, SHef, Rogers, Jones, Rentaria, Rodney, Zoom-Zoom, and now on my list Nate Robertson!
We definately need some new direction in the Tigers. Maybe some new players too. Something is wrong and they are not telling us.. Your folks are right.. Nobody is playing like they want to comeback to this next year! Nobody is even hungry. Just biding thier time till retirment, just like so many on thier jobs! (Big diff- I would love to trade paychecks!)
this is a young mans game lets look to 2009 bye sheff bye thames bye jones, rogers, renteria, leyland?
put inge back at third and go get a catcher now you dont need to make a million ayear to figure that out.
matt joyce should be our starter in left field next year
if these things happen maybe you see 40000 anight at the corner but mark my words without these changes people will sit home and listen to rod and mario, who i believe agree with the above but dont comment


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Finland's Mikko Hirvonen won the Rally of Italy on Sunday in the absence of Citroen team mate and nine-times world champion Sebastien Loeb.
Frenchman Loeb hit rocks and retired on Friday on the first full day of the rally in Sardinia, the penultimate round of the championship and first event since he retained his title in France earlier this month.
Russian Evgeny Novikov was second, one minute 20 seconds behind, with Estonian Ott Tanak third, both in privately-entered Fords.
The victory was Hirvonen's first for Citroen, and 15th of his career, and secured second place overall in the standings. Loeb has an unassailable 244 points, Hirvonen 198.
"It feels a bit like I've won my very first rally," said the Finn, who will be Citroen's main works driver next year with Loeb not defending the title.
"Maybe it wasn't such a big fight but there will be more in future."
Ford works drivers Petter Solberg and Jari-Matti Latvala finished ninth and 12th respectively, after also crashing out on Friday and restarting with time penalties, but picked up bonus points for first and second places in the closing Power Stage.
The final round of the season is in Spain on 8-11 November.

subset: commoncrawl


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HADDON TWP. — A pickup truck believed to be used in the hit-and-run death of a Blackwood woman has been located in Gloucester City, and its driver has been identified, according to the Camden County Prosecutor's Office.
The 67-year-old woman, Joyce Putmon, was crossing the Black Horse Pike near Washington Avenue when she was hit at about 7 p.m. Sunday, police said.
She was pronounced dead 24 minutes later at Cooper University Hospital in Camden, said authorities.
The truck was white with a gray back and had what was described as a homemade structure in the flatbed, said authorities.
It's now missing a headlamp lens and amber turn-signal lens, authorities said. It may be a Chevrolet or GMC truck.
It turned right onto Main Street toward the American Asphalt Co. after sticking Putmon, authorities said.
Anyone who has more information about the hit-and-run is asked to contact Camden County Prosecutor's Office Investigator Doug Rowand at (856) 225-8400 or Haddon Township Police at (856) 854-1176. Information may also be emailed to email@example.com.


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HALIFAX – Nova Scotians will have an opportunity to show their appreciation for people who have put themselves at risk to protect others.
Nominations are now open for Nova Scotia's Medal of Bravery. This is the sixth year for the award.
"This award is our way of thanking those people who have demonstrated courageous and selfless acts of bravery," Premier Darrell Dexter said in a news release. "Nova Scotians pride themselves on helping their neighbours. I would encourage anyone that knows someone who deserves to be recognized to please take the time to nominate them."
Nomination forms are available at Access Nova Scotia Centres, offices of members of the legislative assembly and at www.gov.ns.ca/bravery . The deadline to nominate someone for the award is May 1.
"I was extremely honoured to receive the Medal of Bravery in 2012," said Harry Fraser of Trenton. "At the time, I gave no thought when rescuing my neighbour from a burning home so it was a pleasant surprise to be acknowledged in such a meaningful way. I am, and continue to be, a very proud recipient."
An advisory panel, chaired by retired vice-admiral Duncan Miller, will select the recipients.
Other committee members are: CEO of the Emergency Management Office, deputy minister of Justice, Nova Scotia Fire Marshal, president of the Nova Scotia Chiefs of Police Association, commander of Land Force Atlantic Area, Ann MacLean, former mayor, Town of New Glasgow, and Paul Pettipas, CEO Nova Scotia Home Builders Association.
For more information, contact Nadia Gardin at 902-424-5941, e-mail email@example.com or visit www.gov.ns.ca/bravery.
Completed nomination forms should be sent to: Provincial Secretary, Medal of Bravery, Department of Justice, 4th floor, 5151 Terminal Rd., Halifax, N.S., B3J 2L6.


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The recent surge in the popularity of craft beer has pushed the number of breweries in the U.S. to 2,500 -- as many as existed before Prohibition, the Wall Street Journal notes.
The statistic is included in a story about the popularity of the "growler," a 64-ounce refillable jug often used to purchase and bring home small-batch beers not available in bottles or cans.
Laws that govern the brewing, buying, and selling of beer have recently changed in many states, the Journal notes. Alabama put itself on that list after home brewing became legal earlier this year.


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St. Louis NFL Stadium Backers Gain Power of Eminent Domain"We really at this point do not expect that we will need eminent domain," said RSA Chairman Jim Shrewsbury. "However, when the time comes, if that has to be used as a tool to acquire property, we want the authority to take that action."
Proposed Metrolink Expansion Gains Support in South CountySt. Louis County is looking at a proposed expansion of the Metrolink system that has some people worried in South County.
More Land Deals to Clear Way for New NFL Stadium in St. LouisBackers of a proposed new NFL stadium on the riverfront in downtown St. Louis continue to buy property in the path of the development, despite a lawsuit seeking a public vote on the project.
Shrewsbury, Mo. Fire Chief DiesBill Fox served residents of St. Louis County for more than 40 years.
Shrewsbury Police Looking for Public's HelpHoping to identify stolen credit card suspect
Man Who Set Fire in Shrewsbury Park was Seminary StudentPolice say William Holmes was remorseful.
Suspected Arson at Shrewsbury PlaygroundPlayground equipment set on fire after earlier attempt to ignite picnic table.
Help Wanted: Consultant to Decide if Rams Stadium is DoableRams owner Stan Kroenke has been laying the groundwork to move the team to Los Angeles.
Arrest Made in Shrewsbury Road Rage IncidentA driver says he was punched in the face by a man on a motorized bike who claimed that the victim's car had "clipped" him.
Motorist Hit in the Face by BikerMotorist claimed the biker first told him "you clipped me."
St. Louis Archbishop to Testify in Priest Abuse CaseThe case involves a longtime Carlson associate, Father Joseph Jiang, is accused of molesting an underage girl and attempted witness tampering.
Residents Question Wisdom of Proposed South County Connector "Why are we building a road to help people move farther out?" questioned one resident at a public meeting put on by Trailnet.


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Roller Coaster day in Altoona, PA
The Sea Dogs and Altoona Curve (Pirates affiliate) continue their three-game series on Wednesday night at Peoples Natural Gas Field…Portland took the opener last night 5-2 behind seven strong innings from RHP Keith Couch.
Deven Marrero makes his Double-A debut on Tuesday night in Altoona, PA.
SS Deven Marrero makes his Double-A debut on Tuesday night…Marrero was the 24th overall pick by Boston in last year's draft.
Congrats to INF Heiker Meneses, who makes his Triple-A debut with Pawtucket…Meneses hit .255 in 92 games with Portland…Former Sea Dog INF Oscar Tejeda is hitting .257 in 25 games with the Curve.
Pre-Game coverage begins at 6:40 PM on the U.S. Cellular Sea Dogs Radio Network.
Sea Dogs Spotlight thanks to Jeff Schools of WCSH Channel 6 in Portland on OF Shannon Wilkerson
2013 Video Interviews and Highlights
Starting Lineups
Portland: Gibson 4, Marrero 6, Cecchini 5, Linares 9, Almanzar DH, Vazquez 2, Shaw 3, Bermudez 8, Dent 7, Hernandez LHP
Altoona: Hanson 6, Santos 5, Polanco 8, Dickerson 9, Howard 3, Cunningham 4, Rojas Jr. 7, Paulino 2, Tejeda DH, Kingham RHP
Notes for Wednesday
NICE START: The Sea Dogs opened up a six-game roadtrip with a win on Tuesday night, and resume their three-game series with the Altoona Curve (Pirates affiliate) at Peoples Natural Gas Field…With a win tonight, the 'Dogs will clinch their second series against the Western Division (took two of three at Bowie, August 2-4)…LHP Chris Hernandez (0-0, 1.42 ERA) makes his second start with Portland, and the second of his career against the Altoona Curve.
SCORED EARLY, COUCH SOLID: RHP Keith Couch (9-3) tossed seven strong innings on run and 1B Travis Shaw went 4-for-4, leading the Sea Dogs to a 5-2 win over the Curve in the series opener…Portland scored all five runs in the first 3 innings off losing pitcher Casey Sadler (10-6)…2B Ryan Dent finished 3-for-4, knocking in two runs with two outs…Shaw reached base five times, driving in his 48th run with a single in the third…3B Garin Cecchini and C Christian Vazquez added sacrifice flies…Couch gave up eight hits, one walk and four strikeouts.
NEW KID ON THE BLOCK: SS Deven Marrero went 2-for-4 with a walk in his Double-A debut on Tuesday night…Marrero was the 24th overall pick in the 2012 June draft by Boston and ranks the #10 prospect in the system according to Baseball America and MLB.com.
THAT WAS CLOSE: Vazquez extended his team-high hitting streak to 10 games with an infield single in his final at-bat…The hitting streak is the longest by a Sea Dog since Jeremy Hazelbaker's 13-game hitting streak from July 28- August 14, 2012…Hazelbaker turned 26 today.
NINE LIVES: Couch joins LHP Henry Owens and RHP Anthony Ranaudo for the most wins (nine) in the system…Owens leads the organization with 142 strikeouts between Portland and High-A Salem.
ALMOST A WHOLE ROSTER: The Sea Dogs have had 16 players promoted to Pawtucket this season: OF Ronald Bermudez, INF Xander Bogaerts, LHP Drake Britton, RHP Keith Couch, INF/OF Ryan Dent, RHP Charlie Haeger, RHP Brock Huntzinger, RHP Jeremy Kehrt, LHP Will Latimer, OF J.C. Linares, RHP Chris Martin, INF Heiker Meneses, RHP Anthony Ranaudo, C Alberto Rosario, OF Tony Thomas and RHP Brandon Workman.
WHAT'S ON DECK: Portland and Altoona meet for the final time in the regular season on Thursday night…The Sea Dogs are 6-11 during a 22-game stretch against the Western Division (12-20 overall)…Portland finishes the season with 16 straight games against New Hampshire and Trenton.


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But what if you're not a traditional bride and groom? Why on earth would you want to have a traditional favor if you're getting married on a roller coaster or officiate the ceremony with an Elvis impersonator?
1) The Valentine Heart Stress Ball Keychains make very affordable and adorable customized wedding favors. You've got the whole love thing going on with the heart, plus the fact that it's a keyring makes it more likely that your guests will have it nearby at all times.
2) A 9" Custom Flyer is another cool choice for a personalized wedding favor. You can even hand these out at the ceremony, so attendees will have something to do in the time between the ceremony and the reception while the happy couple is taking pictures. They come in tons of different colors, and this product even allows for some mixing and matching. This item also has the added bonus of keeping the kiddies occupied.
3) Day Tripper Gift Sets are a thoughtful choice. You may have your love to keep you warm, but what about your guests? This attractive set comes with a Thermos-Go bottle, a matched set of mugs, and a handy carrying case. You can also include a quotation about love keeping you warm or something corny like that so really amp up to the hankie-rating on your nuptials.
With plenty of engagements occurring right around the holidays, choosing a customized wedding favor might come sooner than you think. So go ahead, you crazy kids, and find a lovely gift to help you and your guests celebrate the big day.
Okay, that's about as mushy as I get. Time to watch Die Hard.
Until next time, keep expanding your brand.
Jana Quinn
An old 'G' that's been working for QLP since it was in Bret's basement – Jana has been writing since she made up a story about a Jana-Tiger that liked rocky road ice cream and got straight A's. She enjoys writing about marketing and pop culture, posting a 'Die Hard' article as often as she's allowed. She is inspired by the articles at Cracked and frequently wears a Snuggie in the office. You can also connect with Jana on Google+.
Thumbs up to this article, Die Hard, and open bars. Nice post.


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by Michele Borba
Let's face it, some kids just seem to make friends easily. They're invited to all the birthday parties, attend the sleep-overs, are chosen first for teams, and are sought after as everyone's friend. If we could peek into their future, we'd see them continuing to succeed socially throughout their school years, as well as for the rest of their lives.
Child psychologists find popular kids have one thing in common: they've learned the skills of social competence at an early age. Like most skills, the skills of friendship are refined through trial and error. So, the more opportunities kids have to try out what works with others and what doesn't, the greater likelihood social competence will develop.
That puts a lot of kids at a disadvantage. Kids who hang back and are shy, kids who haven't had many social experiences, kids who never learned these first critical friendship-making steps, or kids who have poor social models to copy are kids handicapped from developing the skills of social competence. Not knowing how to join a group or meet new friends will haunt them the rest of their lives. As well-liked kids continue practicing their social skills, kids lacking the skills will continue to lag socially behind others. Finally, the pain of social rejection will set in.
The good news is that social skills can easily be taught. Studies from UCLA and Duke University (as well as countless of other child development institutions) prove that even children with the lowest skills in social competence can be helped. And teaching those skills can do nothing but enhance children's social confidence and expand their potential interpersonal fulfillment.
Four Proven Ways to Help Kids Learn Friendship-Making Skills
These next steps show you how to teach your child any skill you think he needs to enhance help him get along with others. The examples are based on one of my clients to help you see how to apply the strategy.
Zoe's father volunteered to go on the class field trip to see for himself if the other kids really were as mean to his daughter as she said. Just sitting in the back of the bus and watching how Zoe interacted with the other girls convinced him he wasn't hearing the whole story. He instantly saw how bossy she was, and how she always bulldozed herself into groups without watching to see what the other kids were doing. She was obviously turning the other girls off. Now that he knew her problem, how could he help her change?
Child development experts, Sherri Oden and Steven Asher worked for years with children who had problems fitting in. They discovered their social successes dramatically improved when taught specific friendship-making skills. You can use the same steps to help your child learn any social skill. By teaching your child one new skill at a time and practicing it over and over until she can use it on her own, you can help your child make new friends and improve her social confidence. Here's how Zoe's father taught his daughter new social skills.
Step One: Focus on a Skill Your Child Lacks
Look over the Friendship Building Skills Test and choose one skill your child lacks. Choose the easiest one to teach!
Zoe's father knew his daughter needed to learn many skills: she was bossy, used a loud voice, argued frequently, didn't take turns, and played too aggressively. The first thing he needed to help her learn was to wait and watch the group, before barging in.
Friendship-Making Skills: Here are a few top friendship-making skills that researchers say are critical to our children's social competence (and ALL are teachable):
- Apologizing
- Sharing and taking turns
- Bouncing back
- Problem solving
- Etiquette and manners
- Suggesting an activity
- Identifying and expressing your emotions
- Sticking up for yourself
- Expressing feelings
- Accepting criticism and being teased
- Compromising
- Negotiating
- Eye contact
- Listening to a conversation
- Resolving conflicts
- Introducing self
- Meeting new people
- Starting a conversation
- Joining in
- Handling rejection
- Staying calm
- Saying no
- Encouraging
- Asking permission
Step Two: Coach Your Child in This Skill
Find a private moment to model the new skill to your child. Talk with her about why the skill is important, and then be sure she can show you how to do the skill correctly. It's helpful to go with your child to a public place such as a playground or school yard, so she can observe other kids actually using the skill. Seeing the skill in action helps your child copy it, so she can try it on her own.
Remember: Kids learn skills best when you SHOW not TELL them what it looks like. You can also help your child look for the skill on a television show or movie ("Let's look for kids who introduce themselves to a new group.")
Zoe's father took his daughter to a park pretending he wanted her to play ball with her. He really wanted to point out how kids joining new groups watch before barging in. He found a spot to throw her the ball near a group of kids playing baseball.
As soon as a new child walked up to their group, he quietly said, "Hey, Zoe, see the girl with the braids over there? She looks like she's trying to play ball with the group."
When he had Zoe's attention he added, "Watch her to see what she does first; it looks like she's waiting before barging in." Zoe paused to watch.
Her father added, "Wow, she's still standing there. I guess she's waiting for the end of the inning before asking if she can play. That's a great idea, because kids don't like to be interrupted during a game."
Step Three: Provide Opportunities to Practice the Skill
Just telling your child about the skill is not enough. Your child needs to try out the skill with other children. The best kids for your child to practice with are kids she doesn't already know and are younger or less skilled. Then keep the practice session short, and stand back at a comfortable distance! If your child is having problems in the group, offer suggestions only privately -- never in front of other kids.
The next day Zoe went straight to the baseball diamond with her dad. Her father figured this would be a good place for Zoe to practice waiting before barging in since she didn't know the girls and was a pretty good baseball player. If the kids let her on the team, Zoe would feel comfortable playing.
"Remember, what you're going to do, Zoe," said her dad. "Yeah," Zoe said, "I'm going to first watch what the kids are doing and see which side's not winning, because they'll probably need me most. I'll wait until the end of an inning before asking."
"Sounds good," admitted her father. "Why don't you try it? The worse that can happen is they'll say no. If they do, just walk away without saying anything."
Step Four: Review the Practice and Offer Feedback
Child development experts, Oden and Asher, discovered that a critical part of teaching social skills is evaluating the child's performance with her. As soon as you can, discuss how the practice session went asking questions such as: "How did it go?, What did you say?, How do you think you did?, What would you do differently next time?" Don't criticize what your child didn't do, instead praise what your child did right. If your child wasn't successful, talk through what didn't go well, so she can try it differently the next time. As soon as your child feels comfortable with the skill, you're ready to teach another one. Gradually your child's social competence will grow.
Zoe stuck to their plan and was asked to play second base. When the game ended, she and her dad went for ice cream and reviewed how things went. "Looks like you had a good time, Zoe. How do you think it went?," her dad asked.
"Pretty good," Zoe admitted, "but it was hard waiting that long."
"Yes, but you did it, Zoe. Kids like it more if you don't barge in on them if they're already playing a game. Next time we'll practice saying nice things to the kids while you're playing. Kids like that, too."
Don't Give Up!
Remember: it takes a minimum of 21 days for children to learn a new skill, so continue helping your child rehearse the skill until she can use the skill in real life with peers. If you do not see change, your child's self-esteem plummets, or you notice a marked change in your child's personality (she pulls back, withdraws, acts out, lacks focus, etc), then seek help! Many counselors are trained in social skill development and can offer solutions. Friendship plays an enormous part of your child's self-esteem and success. Don't give up!
Michele Borba, Ed.D., is an educational psychologist, former teacher, and mom who is recognized for offering research-driven advice culled from a career of working with over one million parents, educators, and children. A frequent Today show contributor she also appears on Dr. Phil, The View, CNN American Morning, and The Early Show, Michele is the author of 22 books including her latest release, "The Big Book of Parenting Solutions: 101 Answers to Your Everyday Challenges and Wildest Worries." Visit her daily blog.
Copyright © Michele Borba. Permission to republish granted to Pregnancy.org. Image © Shannon Pifko.


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Hot Air Jubilee
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text:
Halladay Says Williams 'Completely Out of Line'
Mitch Williams appeared on 94.1 WIP this morning and ripped into Phillies pitching coach Rich Dubee, saying the Phillies need a new man for the job.
He said Roy Halladay's problems were a simple mechanical fix that Dubee simply could not find. He mentioned an encounter he had with Dubee in Spring Training, when Dubee yelled at him for trying to talk to his pitchers, although he claimed that did not make his criticism this morning personal. Williams, the former Phillies closer who currently is an analyst for MLB Network, also said he showed Kyle Kendrick his current change up grip, which has brought him great success. Kendrick denied that. It's been well known Kendrick gives credit to former pitcher Justin Lehr, who learned the grip from Tim Hudson.
"He didn't like the fact that I spoke with his pitchers at all about anything," Williams told Angelo Cataldi. "It may be time for a new voice."
Halladay answered back before tonight's game at Citizens Bank Park.
"Coming from the mechanical wonder," Halladay said. "Yeah, I strongly disagree. To come from a guy who's not around, who's not involved. He's not involved in the conversations … honestly has no idea what's going on. He really doesn't. He has no idea what's going on in the clubhouse, on the field between coaches and players. To make comments like that, it's completely out of line. It really is. Rich Dubee, when I first came over, he taught me a change up. If I hadn't had that coming over here I wouldn't have had the success I've had over here. Especially dealing with the injuries I've dealt with, if I didn't have that pitch, if I didn't have him working with me, I really would have been in a lot of trouble. In my opinion, it's a statement that I feel like he needs to make amends for. I really do. There's very few pitching coaches that I respect more than Rich Dubee. Watching Kyle Kendrick, the stuff that he's learned, the way he's grown, is because of Rich Dubee and it's because of his work ethic and the way he goes about things. It really does upset me. It upsets me that guys outside of our group of guys that don't understand what's going on here make comments like that. Hopefully, it's something he'll learn from. I'm not sure if that's the case, but he couldn't be further from the truth. And I don't think it's the first time he's been a little off base."
Halladay was asked about the other times Williams has been off base.
"I've heard him criticize a lot of guys for mechanics," Halladay said. "For a guy who's never been a pitching coach, I wouldn't do that. I wouldn't go and look at any player in the Major Leagues and say, well, he should do it this way. I just don't understand where that comes from. I really don't. Former players, there were guys that had certain success doing it certain ways. There's no one way to do things. To think that you know the one way to do it is a little bit arrogant. … What matters is your success and how guys get it done. It's not mechanical. It's a matter of confidence. There's a lot of things that go into it. I really just feel he's wrong on this one. I'm sure he's not a bad guy. I'm sure he's trying to do the best he can at his job, but I really feel like he was kind of off the mark on this one."
Said Dubee: "That's good. Maybe I hurt his feelings with the dust up, but I don't know. Mitch has got a chance. He can apply to 30 teams (to be a pitching coach). You know? I've got no comment to that. Maybe he got upset because I spoke to him about getting involved in our pitching, where I don't think he belongs. Maybe he's upset at that. But I don't think other people belong in our pitching. Again, like I said, he's got a chance to submit a resume."
Read the details about Williams' altercation with Dubee here.
22 Comments
Well, he was talking to Cataldi who has it out for Dubee because he protects his players and doesn't give excuse to WIP. I'm sure there was some kind of talk around that to start all this nonsense off. I say good on ya' Dubee for standing up for your guys. WIP can go screw.
It needs to be asked, is Dubee protecting his players or himself?
Well if Mitch is wrong than I guess Doc should have no problem solving his problem before his next start.
Whether or not Williams is the man to deliver it, I do think Dubee should be getting more criticism for the pitchers' performance this year. How is it that all these immensely talented players are struggling so much?! What's the common denominator? Dubee! How many hitting coaches have been fired for less? I think Dubee's feet should be held to the fire!
I am still trying to figure out exactly what Rich Dubee's function is. Kyle Kendrick seems to me to be the only pitcher developed under Dubee's stint as pitching coach and my conclusion is Kyle has developed in spite of Dubee and Charlie not because of either of them.
And, in Kendrick's case, most of the stories reported that he was hanging out with Halladay, doing his workouts. They have been through several hitting coaches, yet when the pitching struggles, they stick with Dubee. I think Mitch might be right.
I would agree with this assessment. I think if anything Dubee has been holding Kendrick back. KK really started to shine when he finally was told that he was strictly a starter last August. It only took them 3-4 years to get there.
BTW, WIP has a morning show? I wouldn't know.
Mitch is an arrogant ass. Wild Thing as a pitching analyst? Just STFU.
Really? What is Dubee's status as a major leaguer? Zero years.
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Mitch Williams giving someone pitching advice is like Judge Smails telling Tiger how to putt.
I guess Mitch was right, huh?
doc is a big fat dirty pussy
Doc is washed up. Dubee should get the boot.
Star athletes "acting tough" believing that they are helping their team by playing injured reminds of the Black Knight in Monty Phython. The "gamer" mentality rarely helps the situation and only postpones the inevitable DL stint after costing the team a win or few. Doc has a great past that gets (got) him some leway, but in the end it hurt the team and probably ended his career. I wish him well, but I think the news is going to be such that no repair is possible. Even it is I doubt he returns this year and to what quality if he does. This isn't an elbow….so no quick fix available.
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Mockumentary sparks Korean spy controversy
Wednesday 10 Apr 2013 10:13 a.m.
It's a bizarre story – a businessman living in Christchurch ousted by his own community for allegedly being a North Korean spy.
Eugene Chang says all he did was play a part in a movie on propaganda, made by a Kiwi filmmaker and it's all a misunderstanding.
Now he's the subject of top level investigations by the South Korean Government and the Catholic Church.
The film is an underground movie translated from Korean, harshly critical of life in the west and the so-called propaganda we are exposed to.
North Korean agents making a propaganda film in Christchurch sounds bizarre, event outlandish – could it be true?
Well no it's not. The so-called spies are just the producer and actor in a mockumentary. But the consequences are very real.
To gain publicity, filmmaker Slavko Martinov concocted a preposterous back story. He wanted people believe the film was smuggled out of North Korea and that's where Mr Chang comes in. He was hired as an actor to play the part of a communist agent.
Mr Chang is actually a pro-Western capitalist trying to start a truffle farm – ridiculously expensive delicacies for the very rich, which grow on roots of oak trees .
He has blown up the odd building in the West but that was when he worked as an explosives engineers in Northern England more than 12 years ago, before he came to New Zealand.
So why is he being treated so poorly?
Watch the video for Phil Vine's full report.
- Reporter: Phil Vine
- Producer: Phill Prendeville
- Editor: Toby Longbottom
Since filming this story, 3rd Degree has received a response from the Korean Society of Christchurch expressing concern that the full story has not been told. They asked that the story not be screened.
A member of the Korean community of Christchurch has also contacted 3rd Degree about Mr Chang.


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Alda Haddad, 86, who taught music to Toledo elementary and high school students, died Tuesday in Marion, Ohio, General Hospital of congestive heart failure.
Formerly of Sylvania Township, she moved three years ago to Marion, where her son, Dale, lives. She retired in 1983 from Rogers High School, where she was choir teacher. A colleague for several years was her son Robert, who was band and orchestra director.
"She was a great support to him in his teaching career," son Ted said. Robert, who later taught at Start High School, was 49 when he died Feb. 25, 2003.
Earlier, Mrs. Haddad was a traveling elementary music teacher.
"She loved everything about music, and she loved imparting that knowledge, and the kids responded to that," said Susan Hanna, a former Rogers teacher and a friend of Robert's whom Mrs. Haddad adopted, informally, as a daughter.
"She was one of those teachers who was firm but fair," Ms. Hanna, a Toledo schools hearing officer, said.
She held leadership posts with the Toledo Symphony League and its Remembrance Fund and the Toledo Youth Orchestra.
She was born in Beaver Falls, Pa., June 28, 1923, the daughter of Ethel and Dale Douthett. She grew up in Toledo and was a 1941 graduate of Scott High School.
Her mother was a pianist. "Innately, she loved music," her son Ted said.
Mrs. Haddad received a bachelor's degree from Bowling Green State University and taught in the Perrysburg schools. She received a master's degree from Ohio State University in 1969. She was a member of First Baptist Church for 73 years and sang in the choir for 50 years.
"She was just a fabulous listener," Ms. Hanna said. "She was vivacious. She was unbelievably bright right until the end."
She and her husband, Theodore, married in 1949. He died in 1986.
Surviving are her sons, Ted and Dale Haddad; brother, Walton Douthett, and three grandchildren.
Services will be at 1:30 p.m. today in the Ansberg-West Funeral Home.
The family suggests tributes to the Robert and Alda Haddad Remembrance Fund of the Toledo Symphony League.


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Copper Mountain College pinned its Spring 2012 graduates of the Vocational Nursing (VN) Program during a ceremony on May 23, 2012, at 6:00 p.m. in the Bell Center Gym.
The following students received their pins: Linda V. Alvarado, Jazmin Estrada-Camacho, Jennifer L. De Tinne, Lorena Del Toro, Dawn V. Espinoza, Misty D. Evans, Tabitha Fitzgerald, Priscilla Y. Gomez, Kristi L. McCracken, Sandra L. Mendez, Kristal G. Morales, Angel S. Ross, Anna M. Urban & Michelle D. Watts.
The speakers for the pinning were John White, Retired CMC Professor of Mathematics & Science, Peggy Marcelo, LVN at Robert E. Bush Naval Hospital and student speaker Misty Evans.
Anyone interested in enrolling in the Nursing Program should contact the Health Sciences Department at Copper Mountain College at 760.366.3791 ext. 5801. For general information about Copper Mountain College visit www.cmccd.edu or call 760.366.3791.
"Take the next step"


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NORTH ROYALTON - Dan France's mother, Julie, and his brother, Matthew, watched with pride today at North Royalton, where Dan re-enacted his morning signing to attend Michigan State on a football scholarship.
Dan's father, John, shared the moment, following college football's national signing day via the Internet, while he was out of town on business.
Dan, a 6-6, 275-pounder who could play defensive or offensive tackle at Michigan State, wore a big smile as friends took photos and milled around.
It might not have happened without Matthew.
"He's been my biggest influence," Dan said of his brother, a 2006 North Royalton graduate and former Bears' lineman. "He's the reason I started playing football. I was playing soccer in seventh grade, and my brother said I should play football, so I started to."
Said Matthew: "It's like a dream to have a brother go to the Big Ten. If I could have done something like that, I would have, and I'm sure Dan would have felt the same way I do today."
Dan has a 3.5 grade-point average. He also played tight end for North Royalton, a quality Division I team coached by Nick Ciulli.
"Coach Ciulli told me during my sophomore year that I could play college football," Dan said. "I started to believe it during the spring of my junior year, when I got my first offer [from Akron]."
Ciulli has always been impressed with Dan's character and work ethic.
"He's been here four years, and he's never done anything wrong," Ciulli said.
Ciulli said he thought Dan had never got even one detention, and asked him.
"Yeah, I had one this year, for my cell phone," Dan said, grinning.
The player and his coach laughed.
"It's good when it happens for the good ones," Ciulli said about Dan's success. "There are no complaints."


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The neurology of liver failure
That there is a relationship between the brain and the liver has been known for many years,1 and patients with chronic liver disease frequently experience neurological problems. The commonest and most widely recognized is the reversible syndrome of hepatic encephalopathy,2 and we will deal with this in some detail. There are also of course many conditions that affect both the liver and the nervous system, Wilson's disease being one of the best known.2–,8 This condition is a genetic disorder of copper metabolism; the abnormal gene is located on chromosome 139 and most of the symptoms seem to be due directly to the deposition of copper in various organs. Patients typically present early with liver disease or later with the neurological syndrome,2 which consists of various subtle neuropsychiatric symptoms such as a change in behaviour or performance at school10 and abnormality of movement.3,,4 There are many other conditions where the brain and liver are damaged by the same or similar mechanisms,2 but these will not be examined by this review, which concentrates on the effect of a poorly functioning liver on the nervous system.
Overt hepatic encephalopathy
Overt hepatic encephalopathy is generally taken to refer to a syndrome of neuropsychiatric, neuropsychological and neurological disturbances that may arise as a complication of liver disease, and which is reversible.2 This definition is not entirely consistent with the current state of knowledge, however, as there is growing evidence that the reversibility of the syndrome is not complete.11,,12
A recent consensus statement, published following the World Congress of Gastroenterology in 1998, suggested that hepatic encephalopathy be divided into three main types, with further subdivisions within one of the categories (Table 1).13
|HE type
|Encephalopathy associated with acute liver failure
|Encephalopathy associated with portal-systemic bypass, but no intrinsic hepatocellular disease
|Encephalopathy associated with
|Episodic HE
|cirrhosis and portal hypertension or
|Persistent HE
|portal-systemic shunts
|Minimal HE
Between 10 and 50% of patients with cirrhosis and/or porto-caval shunts will experience an episode of overt hepatic encephalopathy at some time during their illness, with the prevalence varying across the spectrum of severity of the cirrhosis.14,,15 The true incidence and prevalence of overt hepatic encephalopathy in these patients is difficult to establish, because of the considerable heterogeneity in aetiology and disease severity. It is also difficult to diagnose the more subtle forms of hepatic encephalopathy such as stage 1 (Table 2) and minimal hepatic encephalopathy. The lack of a gold standard for assessing the presence of hepatic encephalopathy means that the incidence of these more minor forms is difficult to ascertain.13
|Mental state
|Mild confusion, euphoria or depression, decreased attention, mental slowing, untidiness, slurred speech, irritability, reversal of sleep pattern, possible asterixis.
|Drowsiness, lethargy, gross mental slowing, obvious personality changes, inappropriate behaviour, intermittent disorientation, lack of sphincter control, obvious asterixis.
|Somnolent but rousable, unable to perform mental tasks, persistent disorientation, amnesia, occasional attacks of rage, incoherent speech, pronounced confusion, asterixis probably absent.
The factors that can precipitate overt hepatic encephalopathy are well recognized, and include an oral protein load, gastrointestinal bleeding, electrolyte imbalance, infection and deteriorating liver function.2,,16
It is unlikely that a single mechanism underlies the whole syndrome of hepatic encephalopathy in all its various forms; a multifactorial pathogenesis is much more likely.17–,20 Current thinking suggests that a combination of chronic low-grade glial oedema17 and potentiation of the effects of gamma amino butyric acid (GABA) on the central nervous system by ammonia may be responsible for many of the symptoms of hepatic encephalopathy.
GABA is the major inhibitory neurotransmitter in the human brain.19 Increased GABA-mediated neurotransmission is known to cause impaired consciousness and psychomotor dysfunction.19 In animal models of hepatic encephalopathy, an increase in GABA-ergic tone has been demonstrated due to both an increase in GABA release and enhanced activation of the GABA-A receptor complex.18 Benzodiazepines can act at the GABA-A receptor complex, and increased concentrations of endogenous benzodiazepines are found in the brain in liver failure.18,21,,22
Ammonia is known to be neurotoxic, but usually at much higher levels than those found in liver failure, and even then it does not produce a syndrome like that seen in hepatic encephalopathy; in fact, it tends to cause neuronal excitation.2,,19 However, at the lower concentrations seen in hepatic encephalopathy, ammonia potentiates the actions of GABA, possibly by enhancing ligand binding to the GABA-A receptor complex.19 It is probably for this reason that some patients with hepatic encephalopathy improve following administration of the GABA-A receptor antagonist flumazenil.20,,23
In addition there is some evidence for involvement of the glutamatergic system in hepatic encephalopathy. Glutamate is the major excitatory neurotransmitter in the human brain, and ammonia reduces its synthesis and down-regulates the glutamate receptor in vitro. This would result in reduced excitatory transmission in the brain.18 The dopaminergic, serotonergic and opioid neurotransmitter systems have also been implicated in the pathogenesis of hepatic encephalopathy, and it is likely that all of them and possibly others are involved in this complex syndrome.2,,18
In fulminant hepatic failure where hepatic encephalopathy develops within 8 weeks of the onset of liver disease,24 autopsy reveals brain oedema and astrocyte swelling.20 In patients with cirrhosis and portal-systemic shunts, the typical finding is the Alzheimer type II astrocyte, which is the pathological hallmark of hepatic encephalopathy.2,,20 They are found in many locations, including the cortex and the lenticular, lateral thalamic, dentate and red nuclei.24 In turn, these abnormal astrocytes have been shown to be produced by ammonia.25 These findings are similar to those in the acquired hepatocerebral degeneration syndrome.26–,29
Recent studies have also shown increased levels of manganese in the basal ganglia and to a lesser extent other areas of the brain,30–,32 but the relevance of these findings is undetermined.
Overt or symptomatic hepatic encephalopathy is traditionally graded into four stages (Table 2). The clinical picture is of a derangement of consciousness accompanied by decreased (or occasionally increased) psychomotor activity that if left untreated progresses through increasing drowsiness, stupor and coma.33 Sleep disturbance is one of the more common early signs and occurs in nearly 50% of cases.34
As the encephalopathy progresses along this path, signs of pyramidal tract dysfunction such as hypertonia, hyperreflexia and extensor plantar responses are common, eventually being replaced by hypotonia as coma develops.2 The familiar sign of asterixis is well described in hepatic encephalopathy, but unfortunately also occurs in other metabolic encephalopathies and is not therefore pathognomonic.20 One of the areas in which hepatic encephalopathy can differ from other metabolic encephalopathies is in the early stages when the psychomotor retardation that occurs can produce a striking Parkinsonian syndrome.2 In one study, these Parkinsonian features were shown to correlate with the degree of T1 hyperintensity seen in the basal ganglia on cerebral magnetic resonance imaging and the changes in choline/creatine ratios in the basal ganglia on cerebral magnetic resonance spectroscopy.35
Focal neurological deficits and signs have been described in hepatic encephalopathy, but are probably rare,36,,37 although a recent study has described fairly subtle abnormal neurological signs occurring quite frequently.38 Visual disturbances have also been reported in association with hepatic encephalopathy, both as a result of cortical39 and retinal dysfunction. The retinal dysfunction has been termed 'hepatic retinopathy' and probably results from damage to retinal glia or Muller cells.40,,41
Although seizures may occur, they are unusual outside the setting of fulminant hepatic failure, and should prompt the search for an alternative explanation. This relative rarity probably represents the balance of neurotransmitters being tipped in favour of inhibition as discussed above.
The diagnosis of overt hepatic encephalopathy is largely clinical, but some investigations are of use. Arterial blood ammonia is usually raised in hepatic encephalopathy, although not always, and the absolute level bears little relation to the severity of the encephalopathy.42 The use of the electroencephalogram is limited, as the alterations are non-specific, and triphasic waves are found in many other metabolic encephalopathies.43 The role of evoked potentials in the diagnosis and management of hepatic encephalopathy is controversial, and a complete discussion of these techniques is beyond the scope of this review. Visual (VEP), sensory (SEP) and brainstem auditory (BAEP) evoked potentials can all be recorded, and show various abnormalities depending on the waveforms analysed and the liver disease under examination. Generally speaking, these tests demonstrate delayed latencies (a slower response) which become more prolonged in relation to the degree of encephalopathy.44 They may therefore be of use in detecting minimal hepatic encephalopathy or monitoring treatment in established encephalopathy.44–,52 In addition, marked prolongation or absence of various waveforms can be an indicator of poor prognosis.4,53,,54 Other tests such as lumbar puncture and neuroimaging are not usually indicated in overt hepatic encephalopathy unless the diagnosis is in doubt.
Treatment is largely supportive. Precipitating factors should be treated or removed, and absorption of nitrogenous substances from the bowel should be reduced.2,,20 Treatments aimed at reversing the neurotransmitter defects such as by the use of flumazenil are unproven and remain experimental.23
The outlook for patients who develop overt hepatic encephalopathy is grim.55,,56 Following the first episode of overt hepatic encephalopathy, the 1-year survival is about 40%, falling to about 15% after 3 years.56,,57 Interestingly, the studies by Saunders et al. and Bustamante et al. show very similar mortality rates, despite the improvements in intensive medical support that have occurred over the intervening 20 years.
Minimal hepatic encephalopathy
Minimal hepatic encephalopathy is the term that has replaced the old terms of latent or sub-clinical hepatic encephalopathy. It was felt that these older terms did not reflect the important effects of this syndrome on patients' lives.13 It has been recognized for some time that with appropriate neuropsychological tests, patients who were felt clinically to be free from hepatic encephalopathy do in fact demonstrate signs of cognitive impairment.58,,59 Only quite recently, however, were these more subtle deficits shown to affect patients lives,60 and the current consensus is that they should be treated.14,,61 Depending on the tests used and the population studied, minimal hepatic encephalopathy seems to affect between about 20% and 70% of patients with liver disease.15,61–,64
The pathogenesis of minimal hepatic encephalopathy is not understood. It would seem likely, however, that the same mechanisms affecting neurotransmission in overt hepatic encephalopathy also underlie minimal hepatic encephalopathy. There is no reason to think that hepatic encephalopathy is an all-or-nothing phenomenon, and a continuous scale of impairment would seem more likely.14,,61 Alterations in the pattern of cerebral blood flow have been demonstrated in patients with minimal hepatic encephalopathy, and it would seem likely that this also plays a role in its pathogenesis.65
Because the syndrome of minimal hepatic encephalopathy has only recently been defined, its clinical characteristics are poorly described. If different neuropsychological tests are used to identify the syndrome in each study, then different cognitive deficits might be detected.64 A common finding in most of the studies however, is impairment of visuo-spatial functioning, attention and psychomotor speed.14,59,,64 Unfortunately this is not universal, and others have not demonstrated visuo-spatial dysfunction.66 The causes of liver failure are heterogeneous and the severity of liver disease within even a single cause can vary hugely. This could explain the difficulty in establishing the nature of the cognitive dysfunction that exists in these patients.
It is now generally agreed that neuropsychological tests offer the best option for diagnosing minimal hepatic encephalopathy, but there is considerable debate about which tests should be used and how the results should be interpreted.13 Generally, any battery of neuropsychological tests should assess a broad range of cognitive functions,67 and in the case of liver dysfunction, should probably include tests of psychomotor speed, visuopraxis, attention and concentration.13,,64 It has been suggested that tests of language and memory need not be included in assessing minimal hepatic encephalopathy.64 We believe that at the moment we do not know enough about the characteristics of the cognitive impairment in these patients to exclude major areas of cerebral function from any assessment.
The role of the EEG and evoked potentials in making the diagnosis is also uncertain, but the current feeling is that neuropsychological tests are more sensitive and specific.13 However, in the absence of a 'gold standard', these comparisons are very difficult. It could be that the neurophysiological tests are actually achieving the correct level of sensitivity and specificity, and the neuropsychological tests are overdiagnosing the condition. A recent study has suggested that using the technique of critical flicker frequency might be effective in identifying cases of minimal hepatic encephalopathy.68 This technique establishes the frequency at which a flashing light appears to stop flashing and becomes continuous (fusion frequency). The authors plotted this against the severity of hepatic encephalopathy and also for normal controls, and showed that the fusion frequency dropped with increasing cognitive impairment. They went on to suggest appropriate cut-off scores for identifying minimal and overt hepatic encephalopathy with varying degrees of sensitivity and specificity. This is a promising technique, and will probably have a role in screening patients who may then need more formal neuropsychological assessment.61,,69
Neuroimaging techniques such as magnetic resonance spectroscopy (MRS) and positron emission tomography (PET) have been used in the assessment of minimal hepatic encephalopathy, but at the moment they are more useful in research and in further establishing the pathophysiology of the condition.13,70,,71
How these patients should be treated is uncertain.14 Studies have shown an improvement in cognitive functioning with dietary protein restriction or lactulose treatment.58,69,,72 If there is a scale of neurological and cognitive dysfunction with minimal hepatic encephalopathy at one end and overt hepatic encephalopathy at the other, it would seem reasonable that similar treatments would work in each condition.
The prognosis of minimal hepatic encephalopathy has recently been studied, and 30% of patients who showed signs of minimal hepatic encephalopathy went on to develop overt hepatic encephalopathy.15 Unfortunately, in this study the authors do not make it clear over what period this occurred, as they followed patients until one of three end-points occurred (death, transplantation or overt hepatic encephalopathy). The mean time taken to develop hepatic encephalopathy was about 2 years from the initial assessment. This is of limited use, as we can not know when these patients actually developed their initial cognitive impairment. Other studies have also shown that minimal hepatic encephalopathy is an independent predictor of poor survival in patients with liver disease.73
These findings are not consistent with another study that showed that the presence of minimal hepatic encephalopathy was of limited prognostic significance.74 In this study however, patients with minimal hepatic encephalopathy had more episodes of overt hepatic encephalopathy, and as we know that overt hepatic encephalopathy is associated with a very poor prognosis,55,,56 it could be that the authors' negative findings simply reflect a lack of long-term follow-up.
Hepatic encephalopathy and liver transplantation
The effect of liver transplantation in patients with varying degrees of hepatic encephalopathy is uncertain. There have been few studies in this area and none in the UK. The work that has been done suggests a significant improvement in cognitive function following liver transplantation, but patients do not return to normal.75–,79
A recent study has suggested that these improvements occur quickly after transplantation and are maximal by about 3 months.75 In some respects the fact that patients do not return to normal is not surprising, but it is somewhat at odds with the current theory regarding the complete reversibility of hepatic encephalopathy.12,,24
Fulminant hepatic failure
Patients with fulminant hepatic failure form a distinct group, compared to patients with chronic liver disease. The syndrome is said to occur when hepatic encephalopathy develops within 8 weeks of the onset of liver disease.24 The most prominent neurological problem is cerebral oedema and subsequent raised intracranial pressure. The exact mechanism by which the cerebral oedema occurs is unknown, but once again ammonia is thought to play a role. This time, levels of ammonia tend to be higher, and may contribute to the neuroexcitatory symptoms seen in this state, such as agitation, seizures and multifocal muscle twitching, via direct toxicity. In these situations ammonia also has an adverse effect on osmoregulation via its reaction with glutamate to form glutamine, thus exacerbating cerebral oedema.17,,18 Mortality is high at around 70–80%,80–,83 but many of these patients are now being transplanted, and survival rates are improving.81,84–,87 In addition, there is also evidence that if provided with support, the native liver can regenerate, and auxiliary partial liver transplantation is sometimes used to treat these patients.88
Acquired hepatocerebral degeneration and hepatic myelopathy
Acquired (non-Wilsonian) hepatocerebral degeneration (AHCD) is a clinico-pathological syndrome of brain dysfunction associated with a variety of liver diseases, originally characterised by Victor et al. in 1965.26 The typical clinical features of this chronic and largely irreversible syndrome are dementia, dysarthria, ataxia of gait, intention tremor and choreoathetosis.26,,29 The main neuropathological findings include diffuse but patchy cortical necrosis, diffuse proliferation of Alzheimer type II glial cells and uneven neuronal loss in the cerebral cortex, basal ganglia and cerebellum.26–,29
A hepatic or portal-systemic myelopathy (HM) has also been described, initially by Zieve et al. in 1960,89 and is characterized clinically by a spastic paraparesis with minimal sensory involvement.89,,90 The pathology is somewhat different, however, and consists mainly of symmetrical demyelination, predominantly of the lateral pyramidal tracts, sometimes associated with axonal loss, generally going no higher than cervical cord level.89,,90
The pathogenesis of both acquired hepatocerebral degeneration and hepatic myelopathy are poorly understood, although it is usually thought that nitrogenous products bypassing the liver through the porto-caval shunt play an important role.90 There have been suggestions, however, that the acquired hepatocerebral degeneration syndrome simply represents the damage accumulated from multiple episodes of hepatic encephalopathy.29
In most of the reported cases, episodes of overt hepatic encephalopathy have preceded the development of the myelopathy or the hepatocerebral degeneration.26,91–,94 However, there have been cases where this has not occurred,90 and thus another mechanism may be at work.
It would seem most likely that it is chronic exposure to toxic substances bypassing the liver that causes both AHCD and HM. Or more specifically, that these toxins are resulting in one pathological response in the brain and a different pathological response in the spinal cord.26–28,92–,95
Treatment of these patients is difficult. There have been case reports of transplantation being used with varying degrees of success,90,91,96,,97 but if liver transplantation does have a role to play in the management of this condition, one needs to bear the underlying pathology in mind. In the early stages, demyelination seems to predominate, but as the disease progresses axonal loss occurs, and this is likely to be irreversible.26,94,,95 This might go some way towards explaining the different experiences reported in the literature. In the case reported by Counsell et al.,91 liver transplantation was performed at least 18 months after the onset of symptoms, and there was no improvement in the myelopathy. In a more recent case, the liver transplant was performed after no more than 10 months of neurological symptoms, and the authors documented good improvement.97
If, as seems likely, it is the portal-systemic venous shunting that underlies these conditions, then with the development of procedures such as transjugular intrahepatic portal-systemic shunting (TIPSS), and the increasing survival of these patients, such long-term neurological sequelae may be encountered more often. In fact there is growing evidence that this is already starting to occur, with several studies reporting neurological and neuropsychological dysfunction in patients who have undergone shunting procedures such as TIPSS.98–,101 As the time between shunting and the development of AHCD can be many years,90,,95 we will need to wait and see whether this syndrome becomes a common and significant problem for these patients.
Osmotic demyelination disorders
Central pontine myelinolysis and extrapontine myelinolysis are now collected together under the term osmotic demyelination disorders.102 These syndromes are not exclusive to liver disease, and can occur from a variety of causes.103 They are however more common in association with liver disease, particularly alcoholic liver disease.
Central pontine myelinolysis manifests as a rapidly evolving paraparesis or quadraparesis, pseudobulbar palsy and impaired responsiveness. It is characterized pathologically by loss of myelin in the basis pontis, often in a strikingly symmetrical fashion33,,103 (Figure 1). The degree of neurological impairment can range from minimal symptoms to a full 'locked in' syndrome, where the patient can experience the horror of being fully aware but be unable to move.104 The underlying cause is not fully understood, but most cases involve a change in osmolality, often rapid and often involving correction of hyponatraemia.33,,103 This does not explain all the cases, however,105 and in addition many patients survive rapid correction of hyponatraemia without developing signs and symptoms of central pontine myelinolysis. Other conditions are likely to predispose to development of the syndrome, and liver disease and transplantation are commonly described in this role.106–,108 The prognosis of this condition has probably been described in overly bleak terms, with many standard texts suggesting that most patients die. However, this has not been our experience, and in a recent large series, 32 out of 44 patients with central pontine myelinolysis survived. Twenty-one had various degrees of permanent neurological impairment, but 11 recovered completely.109
Other neurological disorders in liver disease
There has also been recent interest in two other symptoms that can occur in liver disease and that might have a neurological basis. The pruritus of cholestasis may at least in part have its origins in the central nervous system.110 The authors suggest several mechanisms whereby this might be the case: opioid agonists induce pruritus by a central mechanism, central opioidergic tone is increased in cholestasis and opioid antagonists can improve the symptom. Clearly this theory remains to be proven.
Many patients with chronic liver disease also complain of fatigue, and the mechanisms of this symptom are poorly understood. It would seem unlikely to have a single cause, but may be due in part to altered central neurotransmission involving the serotonergic system.2 Fatigue is a common complaint in many medical and psychiatric conditions. It is particularly common in neurological disorders such as multiple sclerosis, and the mechanisms involved may be similar.111
There is an increased incidence of neuromuscular dysfunction in patients with liver disease. Whether the liver disease itself causes these problems is difficult to establish. Many of the causes of liver disease, such as alcohol, hepatitis C, porphyria and so on, are also known to cause peripheral neuropathies and myopathies.103,,112 There is some evidence, however, that the worse the liver disease, the worse the neuropathy, independent of the aetiology of the liver disease.113 This suggests that the liver disease itself is causing, or at least contributing to, the neuropathy.
Neuroimaging abnormalities associated with liver disease
It is becoming widely recognized that patients with chronic liver disease and portal-systemic shunts exhibit typical abnormalities on cerebral magnetic resonance imaging (MRI).114–,117 These consist of an abnormally high signal on T1-weighted imaging in the basal ganglia, particularly the globus pallidus (Figure 2). This high signal is now believed to be due to manganese deposition,30,32,118,,119 and post-mortem studies have shown levels up to seven times normal in the globus pallidus.30,,32 Interestingly, chronic manganese poisoning produces a syndrome very similar to the acquired hepatocerebral degeneration syndrome, with mental slowing, tremor and bradykinesia. It also has very similar neuroimaging characteristics, and chelation therapy has been effective in improving both the clinical syndrome and the globus pallidus high signal.120,,121 With successful liver transplantation, the abnormalities seen in liver disease also resolve.118–119
In the acquired hepatocerebral degeneration syndrome, the typical findings described above are found, often with more extensive high signal in the white matter, best seen on T2-weighted imaging.90 In hepatic myelopathy, there are usually no MRI abnormalities, and this probably represents the current technical limitations of this technique and the relatively small magnet strengths of current clinical scanners.90,118,,119
Neurological syndromes are common in patients with liver failure, and are an important cause of morbidity. Our understanding of their pathogenesis is improving, but much work remains to be done, particularly as regards management of these problems. The link between the liver and the brain, described many years ago by Dr Friedrich Frerichs,1 is still only partially understood.
- © Association of Physicians 2003; all rights reserved


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A talented cast of River Parishes residents will present a fun family musical that touches on developing and using talents this weekend when St. John Theatre stages "Dear Edwina." The show runs Feb. 20-22 at 7 p.m. and Feb. 23 at 2:30 p.m. at the theater, 115 W. Fourth St., in Reserve. Tickets are available at Allied Express in LaPlace. The cost is $12 adults, $10 for senior citizens and veterans and $8 for children under 12.
In the show, 13-year-old Edwina Spoonapple would do just about anything to be a part of the Kalamazoo Advice-a-palooza Festival. She is distressed because she believes her siblings are more talented than she is. When a talent scout from the festival visits her hometown, she decides to give advice through production numbers. Performing shows live from the family garage, she hopes to find her place in the spotlight. Joining Edwina is her older siblings, quirky friends, and neighbors. Together, they give advice on a variety of topics from birthday party etiquette to how to set a dinner table, in one production number after another.
Told through a show-within-a-show, Edwina and her friends share wisdom that will delight audiences, said Cary Berthelot, who plays Edwina Spoonapple.
"The real message is about friendship and accepting yourself for who you are…that everyone has unique gifts and talents," Berthelot said. "It's basically about having fun with friends and learning from each other. The big closing number is a song called, "Sing Your Own Song."
Children who plan to attend the show may write letters to Edwina and bring them to the show. In the letters, they can ask questions for Edwina and the cast to answer, or they can just say hello. They also may decorate their envelopes. The letters should be placed in the wheelbarrow that will be used for the selection process, and some children's letters will be featured on stage.
Director Darryl P. Clement said SJT's "Dear Edwina" is "absolutely adorable."
"It's great to do a show that speaks to kids without talking down to them," he said. "One of the reasons we chose 'Dear Edwina' was because while it is a children's show, adults will not be bored. There are 16 clever songs in this 70 minute non-stop musical. It's been a joy to work on."
Clement said children will enjoy watching adults and teenagers playing silly little kids who sing and dance.
Joining Berthelot in the cast are Jeremy Guidry who plays Scott; Marcy Bordelon as Kelli Poshkonozovich; Deborah Brown as Annie Smith; Daniel Brown playing Bobby Newsome; and Logan Viverito performing as Billy Vanderploonk.
Berthelot said she is excited about the show.
"I truly am thrilled beyond words to be performing with this cast," she said. "It's always exciting to be on this stage. I performed on this stage as a child in the first show when this theater opened (South Pacific) and as high school student and most recently in the summer productions. This is my first lead role in forever, and I am nervous, and excited. I am so happy to see this show come to the SJT stage."


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Where the Healing Begins
Home Health Care provides patients with skilled health care in the comfort of their home.
Lakeview Medical Center's Home Health Care department was named to the 2009 HomeCare Elite, a compilation of the most successful Medicare-certified home healthcare providers in the United States. LMC Home Care has earned this recognition every year since the award's inception in 2006.
Nurses, physicians, therapists, social workers, dietitians and home health aides provide the services patients need, allowing them to stay living independently and saving them frequent and often inconvenient trips to medical facilities. People using Home Health Care services include the disabled, persons recovering from an accident or surgery and those with chronic illnesses.
Our Home Health Care services are available seven days a week and we offer individualized care to meet our patients' individual needs.
Home Health Care can:
Home Health Care Services
Each Home Health Care patient has unique needs and often combinations of the following services are used to meet those needs.
Home Health Care
Who Is Eligible
Persons living in Barron, Washburn, Sawyer, Burnett, Polk, Dunn and Rusk Counties who are homebound and under the care of a physician are eligible for Home Health Care.
Physicians, hospital social workers, discharge planners or nurses may refer patients to Home Health Care. Patients may also refer themselves or be referred by friends or family.


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Following the death of Salem Hyde Elementary School pupil in a fire Wednesday morning, the school will make grief counselors available to its pupils on Monday, the principal said Thursday.
Tony Nguyen, 12, who was a sixth grader at the school, died from injuries caused at the fire at his Carbon Street home. His mother, Linh Nguyen, is in critical condition at University Hospital.
The cause of the fire is still under investigation, Lt. Ken Heffernan, city fire investigator, said.
Counselors will be at the school from 2 to 4 p.m. Monday, Principal Octavia Wilcox said. Counselors will also be available at the school on the day of the services and the day after, Wilcox said. The day of the funeral service have not yet been set, she said.
In addition, anyone who wishes to make a donation to the family may do so by sending a check to the Tony Nguyen Memorial Fund, in care of Principal Octavia Wilcox, Salem Hyde Elementary School, 450 Durston Ave., Syracuse, NY 13203.


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Foreign travel advice
The Occupied Palestinian Territories
This travel advice covers Israel and the Occupied Palestinian Territories
The Foreign and Commonwealth Office (FCO) advise against all travel to:
the Sheba'a Farms and Ghajjar and within 500m of the border with Lebanon (the 'Blue Line') east of Metula, including the northern edge of the town
east of Route 98 along the Syrian border.
The FCO advise against all but essential travel to:
- 10km either side of Route 60 south of Gush Etzion Junction including the city of Hebron in the southern West Bank.
The security situation in Israel and the Occupied Palestinian Territories is fast moving, tense and unpredictable. You should keep up to date with local media and travel reports.
There have been several violent incidents in the northern West Bank area (north of Tappuah) including throwing of stones and other objects on Route 60. There have been arrests of individuals carrying weapons in Nablus. You should be especially vigilant in this region.
In northern Israel there have been an increased number of incidents of accidental or deliberate artillery, rocket or mortar fire from Syria into the Israeli-controlled Golan Heights. Take care when travelling in areas in the Upper Galilee and the Golan Heights.
There have been a number of violent incidents including attacks on vehicles, shootings and stabbings on Route 60 within the West Bank (the main road connecting Jerusalem with Nablus and Hebron). Be vigilant, follow advice of security forces and keep up to date with local media and travel reports.
There have been a number of serious incidents along Route 443 (between Tel Aviv and Jerusalem), including shootings, stabbings, vehicle ramming attacks and reports of stones and Molotov cocktails being thrown at cars. British Government staff are being advised to use Route 1 where possible. If you use Route 443, be vigilant and avoid stopping between the Maccabim check point and Jerusalem if possible.
There have been a number of violent incidents on public transport and near public transport lines in Jerusalem. You should avoid using buses in Jerusalem. There have been a number of violent incidents on the Light Rail network. Only use the Light Rail between Mount Herzl and Ammunition Hill. Avoid travel on the Light Rail north of Ammunition Hill.
Take extra care and be vigilant when using public transport in Tel Aviv, in particular at transport hubs, and when using buses in the greater Tel Aviv area. You may wish to consider using other forms of transport.
There are ongoing violent incidents in Israel and the West Bank, including Tel Aviv, East Jerusalem and the Old City (particularly in the Damascus Gate area), and Hebron. There have been numerous stabbing, shooting, arson and stone throwing attacks on people and vehicles, as well as violent clashes between protestors and Israeli security forces. There's a risk that tourists or bystanders could be caught up in any incident. You should be vigilant at all times.
Tensions remain high and you should consider the possibility of further incidents before undertaking travel to the West Bank including East Jerusalem and the Old City. Expect road closures and numerous checkpoints across the West Bank. The entrances to the Old City may be subject to checks or closures.
There have been violent demonstrations in Arab municipalities across Israel and there's potential for more demonstrations. Take extra care if a demonstration is taking place nearby and avoid large gatherings.
Rockets have been fired from Gaza towards Israel on a number of occasions in 2016. Further rocket fire is possible and you should familiarise yourself with the safety actions that you should take in the event of a warning siren.
The security situation on the border with Egypt remains volatile. Take extra care and be vigilant when using Route 10 which runs along the Israeli border with Egypt and is subject to closures by the Israeli authorities. You may wish to consider using other routes.
You should be especially vigilant after Friday prayers and on religious holidays. There is a risk of increased tension around Jewish high holidays (Rosh Hashana, Yom Kippur and Succoth), which take place this year in October. Demonstrations and other forms of civil unrest can occur at short notice and often turn violent. A heavy Israeli security presence is likely. Be extra vigilant and take great care, particularly at the Qalandiya checkpoint between East Jerusalem and Ramallah, in areas close to refugee camps, in and around Israeli settlements and in the cities of Jenin, Nablus and Ramallah. See Safety and security
Visa and other entry requirements are complex. Make sure you're aware of Israeli immigration policies before you travel. Allow extra time for increased security measures and checks at airports during Israeli holidays and during the peak summer tourist season. See Entry Requirements
There is a high threat from terrorism. See Terrorism
The Overseas Business Risk service offers information and advice for British companies operating overseas on how to manage political, economic, and business security-related risks.
Take out comprehensive travel and medical insurance before you travel.


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Gov. Bobby Jindal signed three bills into law Monday that will make changes to higher education scholarship eligibility, college testing rules and the Baton Rouge-area community and technical college system.
Under House Bill 343, schools will be prohibited from administering any LEAP tests, or college exams, such as the ACT, to students with disabilities who are not pursuing a regular high school diploma. The student would still have to take the tests if their individual education plan, or IEP, calls for it or if the student's parents choose to "opt in" their child for the testing.
The legislation, one of the most-widely discussed in the halls of the Capitol during the legislative session, had strong support from parents of special education students who called the mandatory testing for unprepared students "tantamount to abuse."
During committee testimony in April, bill sponsor Rep. John Bel Edwards, D-Amite, said requiring these students to take the ACT "doesn't capture anything that is meaningful or relevant about that kid, about those teachers, about that school."
Under Edwards' bill, the state Department of Education will also be prohibited from downgrading the annual letter grades given to schools because students choose to opt out of taking the ACT. Under changes instituted last year, 25 percent of school letter grades are based on ACT scores. Any student that scores under 18 or chooses not to take the test nets their school 0 points for the annual letter grade.
A nearly identical Senate bill was also sent to the governor.
Jindal also signed a Senate bill into law Monday that will merge four technical colleges in Baton Rouge with Baton Rouge Community College. The move will bring in an additional $7 million in tuition and fees over five years, according to the bill's fiscal note.
In the near-term, the money will be used to carry out repairs and building upgrades. Starting in 2017, the increased tuition and fees for technical college students -- around $450 per year per student -- will be used both for repairs and to "expand technical and academic course offerings."
The four technical college campuses that will be merged under the legislation are Baton Rouge, Folkes, Jumonville Memorial, and Westside. The change will be effective July 1, 2013.
Finally, Jindal signed a bill into law to enact a small change the state's higher education scholarship eligibility rules to include international baccalaureate, or IB, students. The Taylor Opportunity Program for Students scholarship, or TOPS, is a state-funded scholarship that pays for tuition and some fees for students that attend in-state colleges.
Since most American IB programs are accredited, students who complete these programs in the U.S. and meet the other TOPS requirements for GPA, ACT and core curriculum can apply for the scholarship. However, some overseas IB programs do not have an accreditation process recognized by the state.The bill's fiscal note says the legislation will have minimal effect -- less than $5,000 a year -- since the problem only currently effects one scholarship applicant. The legislation went into force upon the governor's signature.
Another bill seeking to expand TOPS eligibility to graduate students returning to Louisiana failed in committee.