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Benninger, Emanuel*; Laschke, Matthias W.†; Cardell, Markus*; Holstein, Joerg H.†; Lustenberger, Thomas*; Keel, Marius*; Trentz, Otmar*; Menger, Michael D.†; Meier, Christoph*
*Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, Switzerland; and †Institute for Clinical & Experimental Surgery, University of Saarland, Homburg/Saar, Germany
Received 18 Feb 2012; first review completed 15 Mar 2012; accepted in final form 10 May 2012
Address reprint requests to Christoph Meier, MD, Division of Trauma Surgery, Department of Surgery, Zurich General Hospital, Waid, Tièchestrasse 99, 8037 Zurich, Switzerland. E-mail: firstname.lastname@example.com.
None of the authors has a relevant conflict of interest.
ABSTRACT: The aim of this study was to evaluate microdialysis of the rectus abdominis muscle (RAM) for early detection of subclinical organ dysfunction in a porcine model of critical intra-abdominal hypertension (IAH). Microdialysis catheters for analyses of lactate, pyruvate, and glycerol levels were placed in cervical muscles (control), gastric and jejunal wall, liver, kidney, and RAM of 30 anesthetized mechanically ventilated pigs. Catheters for venous lactate and interleukin 6 samples were placed in the jugular, portal, and femoral vein. Intra-abdominal pressure (IAP) was increased to 20 mmHg (IAH20 group, n = 10) and 30 mmHg (IAH30, n = 10) for 6 h by controlled CO2 insufflation, whereas sham animals (n = 10) exhibited a physiological IAP. In contrast to 20 mmHg, an IAH of 30 mmHg induced pathophysiological alterations consistent with an abdominal compartment syndrome. Microdialysis showed significant increase in the lactate/pyruvate ratio in the RAM of the IAH20 group after 6 h. In the IAH30 group, the strongest increase in lactate/pyruvate ratio was detected in the RAM and less pronounced in the liver and gastric wall. Glycerol increased in the RAM only. After 6 h, there was a significant increase in venous interleukin 6 of the IAH30 group compared with baseline. Venous lactate was increased compared with baseline and shams in the femoral vein of the IAH30 group only. Intra-abdominal pressure–induced ischemic metabolic changes are detected more rapidly and pronounced by microdialysis of the RAM when compared with intra-abdominal organs. Thus, the RAM represents an important and easily accessible site for the early detection of subclinical organ dysfunction during critical IAH.
At a consensus conference in 2004, the World Society of the Abdominal Compartment Syndrome defined intra-abdominal hypertension (IAH) as an intra-abdominal pressure (IAP) of 12 mmHg or greater and abdominal compartment syndrome (ACS) as an IAP of 20 mmHg or greater with a previously not apparent single or multiple organ dysfunction (1).
According to the hypothesis of the two-hit model, IAH induced by a first hit provokes the release of proinflammatory cytokines, which induces a systemic inflammatory response (second hit) triggering fatal multiple organ failure (MOF) (2, 3). In line with this, traumatized patients with subsequent ACS after damage-control surgery develop MOF more often than do patients without ACS (32% vs. 8%) (4). Furthermore, mortality reaches 43% in patients with ACS compared with 12% in patients without ACS. Most impressively, mortality is 85% in patients with ACS and subsequent MOF (4).
Once organ dysfunction is triggered by the second hit, it is not connected to the actual pressure level in the abdomen anymore. Although immediate improvement or even normalization of organ dysfunction upon surgical decompression is seen in patients with full-blown ACS, the development to MOF may not be prevented. Thus, for a successful treatment of ACS, the decrease in IAH must take place before the crucial cytokine release has occurred.
In the presence of IAH, pressure monitoring alone may not be sufficient to guide the modality and timing of therapy. Additional functional monitoring such as microdialysis may refine diagnosis and monitoring of critical IAH to guide a timely decompression (5). Improved monitoring may also decrease the number of unnecessary abdominal decompressions with subsequent temporary abdominal closure.
Microdialysis is an established technology to monitor energy metabolism in the experimental and clinical setting. This technique allows a continuous or periodic measurement of extracellular metabolites of virtually any tissue. Bedside monitoring with this technique is well established in clinical practice. Accordingly, it has been used in severe brain injury (6), liver transplantation (7), plastic surgery (8), and cardiovascular surgery (9). Moreover, intestinal ischemia can successfully be monitored by microdialysis (10, 11). Thereby, glycerol has evolved as a good marker to monitor cell membrane damage, whereas an increased lactate/pyruvate (LP) ratio indicates ischemia (12–15).
In a previous study, we could show that the compartment pressure of the rectus sheath was similar to the IAP in rats (16). Recently, CRPS was further evaluated in a pig model as an alternative to indirect IAP measurement techniques such as intravesical pressure (IVP) measurement (17). Introducing microdialysis with this new concept, we could demonstrate in a rat model that microdialysis of the rectus abdominis muscle (RAM) shows an early and more pronounced increase in lactate, LP ratio, and glycerol compared with intra-abdominal organs during IAH (5). In the present study, we analyzed now, whether these interesting findings are also valid in a porcine model, which may be more appropriate to simulate a clinically relevant setting than a rodent model. For this purpose, we evaluated microdialysis at a normal physiological IAP as well as in the situation of critical IAH (IAP = 20 mmHg) and full-blown ACS at 30 mmHg.
All experiments were performed in accordance with the German legislation on protection of animals and the National Institutes of Health Guide for the Care and Use of Laboratory Animals. Thirty domestic male pigs (Swabian Hall strain; mean body weight, 34 ± 3 kg) were used for the study. The animals were kept at 21°C ± 1°C with daylight and free access to tap water and daily standard chow. After an acclimation period of 8 days, the animals were kept fasting overnight with free access to water.
After an intramuscular injection of ketamine hydrochloride (30 mg/kg, Ketavet; Pfizer, Karlsruhe, Germany), xylazine hydrochloride (2.5 mg/kg, Rompun; Bayer Schering, Leverkusen, Germany), and 1 mg atropine (Braun, Melsungen, Germany) for premedication, general anesthesia was induced by i.v. injection of etomidate (1 mg/kg, Etomidat-Lipuro; Braun). Analgosedation was maintained by continuous i.v. administration of thiopental sodium (Trapanal; ALTANA Pharma Deutschland GmbH, Konstanz, Germany) and piritramide (Dipidolor; Janssen-Cilag, Neuss, Germany). Oral intubation was performed (7.5 ET tube; Portex, Hythe, UK), and the animals were mechanically ventilated (Evita; Dräger, Lübeck, Germany), volume cycled with a tidal volume of 10 mL/kg, an inspiratory oxygen concentration of 30%, and a positive end-expiratory pressure of 2 cmH2O. These ventilation settings were kept unchanged throughout the experiment. The respiratory rate was adapted between 10 and 15 breaths/min according to arterial blood gas analysis to keep PaCO2 constant between 30 and 45 mmHg. O2 saturation was monitored by pulse oximetry. A triple-lumen 7F central line in the left jugular vein (JV) served for fluid replacement (Ringer's lactate [10 mL · kg-1 · h-;1]), administration of i.v. medication, and monitoring of mean central venous pressure (CVP).
Femoral vein pressure (FVP) and IVP measurements were performed as described by Gudmundsson et al. (18). The bladder catheter was placed by a suprapubic mini–midline laparotomy. For IVP measurement, the bladder was primed with 10 mL of physiological saline solution (18). A midline laparotomy was performed. The superior mesenteric artery (SMA) was identified cephalad of the renal vein, and a 4-mm ultrasound flow probe (small animal blood flow meter, T206; Transonic System Inc, Ithaca, NY) was placed without restriction of the vessel approximately 10 mm distally to its root. The portal vein (PV) was identified in the hepatoduodenal ligament, and a small inflowing gastroduodenal vein was cannulated with a Portex catheter, with its tip being placed in the PV (Portex fine bore, polyethene tubing, internal diameter 0.58 mm/outer diameter 0.96 mm; FA Smiths Medial ASD Inc, Keene, NH).
Microdialysis catheters (CMA/20; CMA Microdialysis AB, Stockholm, Sweden) were carefully placed in the parenchyma of the liver and the right kidney, as well as in the ventral aspect of the gastric wall and underneath the serosal layer of the jejunum. Another catheter was placed into the RAM about 50 mm caudal to the xiphoid process and 20 mm lateral to the midline. This catheter was placed through a small incision of the anterior rectus sheath. The last microdialysis catheter, which served as a distant control, was placed within the substance of the anterior cervical muscles.
A laparoscopy port (Endopath 512 mm; Ethicon Endosurgery Inc, Cincinnati, Ohio) was inserted at the upper end of the laparotomy. Here, the fascia was closed in a purse string manner around the port to seal the peritoneal cavity. The remaining laparotomy incision was closed with a running suture of the fascia.
After surgical preparation, the animals were allowed to stabilize for 30 min. The midaxillary line served as zero reference for IAP measurement. The IAP was measured before CO2 insufflation (baseline). Either IAP was then kept at the physiological pressure (sham group), or it was increased to 20 mmHg (IAH20 group) and 30 mmHg (IAH30 group) by CO2 insufflation, respectively. The increase in IAP was established by an automatically controlled insufflator (Electronic Laparoflator 264300 20; Karl Storz GmbH & Co, Tuttlingen, Germany). The pressure readings from the insufflator served as direct IAP measurement values. Intra-abdominal pressure was then kept at the designated levels (either 20 or 30 mmHg) over 6 h.
Hemodynamic and pulmonary parameters such as mean arterial pressure (MAP), systolic and diastolic blood pressure, CVP, FVP, heart rate (HR), blood flow of the SMA, and peak inspiratory pressure (PIP) were recorded at baseline conditions and measured every 60 min thereafter throughout the entire experiment. Abdominal perfusion pressure (APP) was calculated as APP = MAP − IAP. Arterial blood gas analysis, urinary output (UOP), and body core temperature were also recorded hourly.
The interstitial concentrations of lactate, pyruvate, and glycerol were measured as previously described in detail (19). For our experiments, we used microprobes (CMA/20; CMA Microdialysis AB) carrying a microcell, which was perfused by a microinjection pump (CMA/100; CMA Microdialysis AB). The membrane of the microcell had a molecular cutoff of 20,000 Da. An outlet tube was connected to a fraction collector (CMA/200 F; CMA Microdialysis AB). To reduce fluid loss, we used a colloid (albumin 3%) for continuous perfusion of the microcell (20, 21). The flow rate was set to 0.8 μL/min for the entire experiment. Microdialysis samples were collected in 30-min fractions for baseline measurements followed by 60-min fractions for the 6-h observation period.
Repetitive blood samples from the different venous inflow regions were taken every 60 min, i.e., femoral vein (FV) for lower extremity, PV blood for intestine, and JV as control. Lactate levels were measured under baseline conditions and every 60 min during the experiment. Interleukin (IL) 6 concentrations were measured at baseline as well as after 3 and 6 h of IAH. Samples from the JV were taken at baseline and at the end of the experiment for platelet counts and the determination of serum bilirubin and creatinine according to standard methods. At the end of the experiment, the animals were killed with an overdose of thiopental sodium.
In the clinical setting, organ failure may be defined using the Sepsis-Related Organ Failure Assessment (SOFA) score (22). This score ranges for each organ (respiratory system, nervous system, cardiovascular system, liver, coagulation, renal system) from 0 (normal) to 4 (most abnormal). According to Malbrain et al. (23), organ failure was defined as a SOFA organ subscore of 3 or greater. However, we are well aware that the use of this clinical score may not be used in a large animal model without restrictions. Subclinical organ dysfunction was defined as detection of anaerobic metabolism or cell membrane damage by microdialysis with a SOFA organ subscore of 2 or less in the presence of IAH. The subscore for the nervous system was not applied.
All data are given as mean (SD). After proving the assumption of normality and equal variance, differences between the different study groups (sham, IAH20, IAH30) at corresponding time points were compared using one-way analysis of variance with Bonferroni post hoc test. One-way analysis of variance for repeated measures with Bonferroni post hoc test was used to compare different time points with baseline conditions within individual groups. When only one measurement was performed during the experiment, such as for certain blood tests, we used the paired t test to compare those values with baseline conditions within individual groups. Statistics were performed using the SigmaStat software package (Jandel, San Raphael, Calif). P < 0.05 was considered statistically significant.
In sham animals, cardiovascular parameters such as MAP, HR, CVP, FVP, and APP remained at baseline levels throughout the experiment (Table 1). In contrast to the IAH20 group, there was a continuous decrease in MAP in the IAH30 group. This decrease was consistent with a SOFA subscore of 3, thus fulfilling the criteria for organ failure. Central venous pressure significantly increased in both IAH20 and IAH30 animals compared with baseline. Femoral vein pressure was significantly higher in the IAH20 and IAH30 groups compared with CVP throughout the experiment (Table 1).
Of interest, APP, which is a clinically relevant and a prognostic parameter in the situation of IAH (24), dropped significantly in both IAH groups compared with baseline conditions (Table 1). However, APP did not fall below 50 mmHg in the IAH20 group, which is considered a resuscitation end point and predictor for patient survival in the clinical setting (24). In the IAH30 group, APP already fell below this value shortly after induction of IAH and further declined continuously throughout the experiment, reaching levels below 40 mmHg after 5 h of IAH.
Impaired abdominal circulation was also demonstrated by the results recorded from the SMA flow measurement probe (Table 1). In the sham group, the flow of the SMA increased up to levels of 120% of baseline levels. In the IAH20 group, the flow was found reduced with values around 80% of baseline. In contrast, in the IAH30 group, the flow decreased markedly throughout the experiment, falling below 50% after 6 h (Table 1).
The hourly measured UOP remained constant in the sham group. In the IAH20 group, UOP was significantly reduced after 2 to 6 h compared with baseline. However, UOP remained above the threshold of 1 mL · kg-1 · h-1 throughout the experiment (Table 1). In contrast, UOP dropped significantly and below this threshold in IAH30 animals already 1 h after induction of IAH. Serum creatinine did not show any inner or intergroup differences (data not shown). Thus, organ dysfunction (SOFA subscore of 3) was evident only in the IAH30 group because of the decreased UOP.
In the presence of IAH, PIP was significantly increased when compared with sham animals (Table 1). Arterial blood gas analysis demonstrated the development of a mixed respiratory and metabolic acidosis in the groups of IAH20 and IAH30 animals (Table 1), whereby the acidosis was more pronounced in the IAH30 group. Mean PaO2 remained constantly above 100 mmHg, and mean SO2 did not drop below 93% in all groups during the entire experiment (data not shown). No organ dysfunction greater than 1 was observed according to the SOFA organ subscore in any of the study groups.
We did not find any inner or intergroup statistical differences between the study groups regarding serum bilirubin concentration and platelet counts (data not shown).
The lactate concentration was significantly higher in the superficial femoral vein (SFV) throughout the entire experiment in the IAH30 group when compared with baseline values and with the sham group (Fig. 1A). Noteworthy, we found a first peak after 1 h of IAH, followed by a slight recovery and a rather steep increase after 4 h of IAH. In the IAH20 group, a similar course of the lactate concentration was observed during the first 3 h of the experiment. However, in contrast to the IAH30 group, the recovery continued in the second half without recurrent increase. In the PV, no difference was evident between sham animals and the two IAH groups (Fig. 1B). In the JV, the lactate concentration was significantly increased only in the IAH30 group at 5 and 6 h after induction of IAH when compared with the IAH20 animals (Fig. 1C).
The comparison of IL-6 levels from the SFV between the different study groups showed a significant elevation in the IAH30 group after 3 and 6 h of IAH compared with baseline conditions (Fig. 2A). In the other two groups, IL-6 levels remained constant throughout the experiment. Similar results were found for the IL-6 measurements in the PV and the JV (Fig. 2, B and C).
Microdialysis of the anterior cervical muscles demonstrated that IAH did not affect concentrations of lactate, LP ratio, and glycerol in this distant control tissue (Fig. 3A, 4A, and 5A).
Analysis of lactate concentrations in the RAM and in all investigated intra-abdominal organs except for the jejunum did not show any relevant alterations compared with baseline and between the study groups (Fig. 3, B–E). The jejunal wall demonstrated a significant difference of the tissue lactate concentration in the IAH30 group compared with sham animals starting at 2 h after induction of IAH and lasting throughout the time of elevated IAP (Fig. 3F). In the IAH20 group, the difference to sham reached a significant value not before 6 h of IAH. This difference originated mainly from a continuous decrease in the tissue lactate concentration in the sham animals and less from an increase in the IAH groups.
In sham animals, the LP ratio of the RAM remained at baseline values throughout the experiment (Fig. 4B). In contrast, in the IAH20 group, the RAM exhibited a 2.5-fold increase in the LP ratio after 6 h when compared with baseline (Fig. 4B). In the IAH30 group, this increase amounted to almost 700%. In the liver and the gastric wall, the LP ratio was significantly increased compared with baseline throughout the duration of IAP elevation in the IAH30 group (Fig. 4, C and E). This increase was less pronounced in the kidney (Fig. 4D) whereas no difference at all was observed in the jejuna wall (Fig. 4F).
In the IAH30 group, the RAM revealed a continuous increase in the glycerol concentration throughout the entire experiment (Fig. 5B). After 3 and 4 h, the difference reached a significant level compared with the sham and the IAH20 groups, respectively. In all the other analyzed organs, the glycerol concentrations showed only minor changes (Fig. 5, C–F).
In summary, in the IAH30 group, the RAM demonstrated an early and distinguished increase for ischemia (LP ratio) and cell membrane damage (glycerol) markers compared with intra-abdominal organs. In the IAH20 group, tissue ischemia but no structural damage was detected, whereas conventional parameters such as APP, UOP, blood gas analysis, or the SOFA organ subscores failed to pick up the deterioration.
The main findings of our study are that in the porcine model (a) an IAH of 20 mmHg for 6 h does not provoke any significant organ derangements detectable by either conventional monitoring, or by selective lactate or IL-6 measurements; (b) an IAH of 30 mmHg shows pathophysiological alterations consistent with ACS in otherwise healthy animals; (c) subclinical organ impairment is detectable by microdialysis; and (d) the RAM is more susceptible to IAH than all the other analyzed intra-abdominal organs. As in our model, the increase in the ischemia marker LP was more pronounced than that of the other microdialysis parameters under investigation (lactate, glycerol); LP monitoring of the RAM may be a potential tool for early detection of critical IAH before the development to full-blown ACS with its fatal consequences occurs.
In the herein presented porcine model, we could see all the known deleterious effects of IAH such as depression of MAP and APP when the IAP was increased to 30 mmHg for 6 h. We also found a significant reduction of SMA blood flow in our study groups compared with sham animals. Central venous pressure and PIP were significantly increased, and UOP diminished in the presence of IAH. Blood gas analysis demonstrated the typical picture of a mixed respiratory and metabolic acidosis with reduced pH, bicarbonate levels, and a negative base excess.
Of interest, an IAH of 20 mmHg applied for 6 h in the previously healthy animals did not provoke the classic pathophysiological changes consistent with the established definition of ACS (1, 23). Although we could observe some effects, most of them were rather mild and would not justify the criteria for organ dysfunction and the diagnosis of ACS. These observations are in accordance with previous reports on large animal models (25). In this respect, the IAH20 group of our experimental study represented a condition with increased IAP but with no obvious organ dysfunction detectable by conventional monitoring tools currently in use.
In the clinical setting, venous lactate levels are routinely used to assess ischemia and to monitor the effects of fluid resuscitation in hypovolemic patients. However, lactate levels may also be elevated in hypermetabolism. Thus, lactate alone may not be a reliable marker of ischemia (14). This may be valid not only for venous lactate levels but also tissue lactate concentrations. In fact, in the present study, tissue lactate levels were elevated only in the jejunum of the IAH30 group compared with sham animals. However, when compared with baseline conditions, the alterations were not significant.
Of interest, venous lactate samples taken from three different veins (SFV, PV, and JV) did not show any relevant alterations in sham animals and in the IAH20 group. The lactate levels increased significantly only in the IAH30 group after 4 to 6 h of IAH. This increase is in line with earlier observations from experimental works (26). Serum lactate concentrations showed a similar course in all sampled veins but were most pronounced in the SFV in our study. Increased IAP increases FVP. Recent clinical research has shown that FVP correlates well with IAP in the situation of IAP of greater than 20 mmHg (27). Thus, perfusion pressure of the lower extremities is similar to APP in critically elevated IAP. In contrast, perfusion pressure of the head and upper extremities is higher because of the lower CVP compared with FVP. Together with our results from tissue lactate measurements, this would support the view that lactate acidosis origins more from the muscle-rich lower extremities than from the intra-abdominal organs. Because of the increased FVP and lowered MAP microcirculation, these tissues may be impaired with subsequent ischemia.
In contrast to tissue lactate measurements, the LP ratio demonstrated a more pronounced increase in the RAM compared with all abdominal organs studied. The increase was less prominent but still significant in the IAH20 group. As the LP ratio has been proven to be a superior marker of ischemia than lactate alone (14), this observation may indicate that the metabolic deterioration in the RAM starts earlier and is more severe than that in other organs. However, these alterations were not as pronounced as observed in our previous rodent study (5). Thus, it may be speculated that the surgical procedure and the experimental burden are less tolerated by rodents, making them more susceptible to IAH. As mentioned before, an IAH of 20 mmHg over 6 h did not cause pathophysiological alterations consistent with ACS in the previously healthy large animals. The increase in the LP ratio with progressing time of IAH may indicate that—besides the magnitude of IAH—the duration of IAH is also a relevant factor for the development of organ ischemia and dysfunction (28).
Previous studies could demonstrate that glycerol is a good marker for cell membrane damage, ischemia, and energy failure (14, 15). We could demonstrate a continuing rise of glycerol concentrations in the RAM of the IAH30 group, whereas no relevant changes were seen in all other organs studied. In the IAH20 group, the glycerol levels of the RAM were not different from those of the sham group, indicating that this level of IAH may have caused tissue ischemia but did not cause any cell membrane damage following insertion trauma. Thus, ischemia but no cell damage was observed when the animals were exposed to an IAP of 20 mmHg. Accordingly, an IAH of 20 mmHg may represent the threshold between compensated IAH and beginning organ dysfunction, which was not yet detectable by conventional means in our experimental setting.
Shah et al. (29) described a clinically relevant pig model of ACS. An initial hemorrhage was induced followed by standardized fluid resuscitation. The effects of peritoneal packing with increased mesenteric pressure up to 30 mmHg were simulated by tightening a previously placed PV snare. Analysis of the peritoneal fluid demonstrated increased concentrations of IL-6 and TNF-α levels. Rezende-Neto et al. (2) showed that IAH provokes the release of proinflammatory cytokines. It is well known from experimental and clinical studies that excessive levels of IL-1β, IL-6, and TNF-α are associated with increased morbidity and mortality. The potential sources of increased IL-6 are multiple and include the gut (30, 31), liver (32), and lung (33). Bathe et al. (34) investigated the role of the gut as a source of cytokine release in a porcine endotoxemia model. They observed a significant increase in IL-6 3 h after application of endotoxin. However, there was no difference between IL-6 levels taken from the PV and carotid artery. They concluded that ischemic gut is not associated with gut release of IL-6. In our study, we could not identify a clear source of IL-6 release, either. There was no significant difference between the samples from the FV, the PV, and the JV, respectively. Intra-abdominal hypertension did provoke an increase in IL-6, but only in the IAH30 group. In line with the analysis of other parameters, an IAH of 20 mmHg did not cause relevant IL-6 alterations.
Our animals were previously healthy, and thus, the effect of IAH may be different from the clinical situation in which most patients develop IAH due to severe multiple trauma, rigorous fluid resuscitation, major surgery, an overwhelming infection, or other serious pathological conditions (2, 3, 35). Critical IAH has been identified to act as a potential second hit. In this situation, IAH provokes an overwhelming release of proinflammatory cytokines such as IL-6 by primed granulocytes, leading to fatal MOF. Because we studied formerly healthy animals, which were not exposed to a first hit, we do not know about the magnitude of IL-6 release in these animals at different IAH levels with formerly primed granulocytes. To evaluate the value of microdialysis, in particular of the RAM as a potential "early warning organ," microdialysis and its relationship to cytokine release need to be evaluated and compared with monitoring modalities currently in use in a clinically relevant two-hit model.
Different large animal models have been described in the literature (36–43). Whereas severe hemorrhage, administration of bacteria, or endotoxic shock were used to act as first hits, IAP as a second hit was mainly artificially increased to study the effects of IAH and ACS. In contrast, Shah et al. (44) described a very interesting model in which ACS was reproduced without artificial IAP increase. They used a hemorrhage-resuscitation sequence followed by subtotal obstruction of the PV to create bowel edema, causing critical IAH with organ dysfunction. Their findings regarding physiological alterations during IAH were comparable to our results. However, mortality was as high as 33% in their experimental setting.
We observed the effects of IAH only for 6 h. Longer times of observation may be necessary to analyze IAH particularly in the "gray zone" with IAP values between 15 and 20 mmHg. In fact, Schachtrupp et al. (28) showed that even a slight increase in the IAP to 15 mmHg but maintained for as long as 24 h causes a decrease in UOP as well as an increase in PIP and low-grade necrosis of liver, kidney, and bowel mucosa.
The key to lower morbidity and mortality of critical IAH lies in the early detection of critical IAH and the initialization of countermeasures to effectively decrease IAP before the sequence cascades to full-blown ACS with the fatal development to MODS have been started. A refinement of our diagnostic tools and monitoring techniques such as those demonstrated in our study may allow the early identification of those patients exposed to critical IAH in the future.
The authors appreciate the excellent technical assistance of Elisabeth Gluding and Janine Becker.
This article has been cited 1 time(s).
Intra-abdominal hypertension; abdominal compartment syndrome; microdialysis; porcine model
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Into the fire
By JIM HUGHES
For the Mirror
Heroes made here is the claim made via a large banner in the main bay of the Louis F. Garland Department of Defense Fire Academy at Goodfellow Air Force Base in Texas.
An airman from Federal Way may or may not be a hero after graduating from a 13-week firefighter apprentice course, but he will have all of the tools to become one if circumstances ever call for it.
Ross Anderson, son of Brian and Cynthia Anderson of Federal Way, is at the beginning of what many who teach at the academy describe as a journey to become a military firefighter.
Since I was a child, Ive had dreams of being a firefighter, said the 2002 graduate of Federal Way High School. And Ive always looked up to those people who actually accomplished those same dreams.
He and his classmates at Goodfellow march to and from classes, where they put on full firefighter bunker gear with a self-contained breathing apparatus and pull or carry 100-pound dummies to safety, wade into fires with flames leaping above their heads and drag heavy fire hoses for 300 yards.
My day starts at 4 a.m. when I wake up and usually doesnt end until around 4:30 p.m. This course is so physically and mentally demanding that at the end of the day, all I want to do is sleep, Anderson said.
By the end of the school, Anderson will be a certified firefighter, fully trained in fire protection fundamentals, emergency medical care, handling of hazardous materials and airport firefighting.
Before starting the apprentice course, Anderson and others are tested to see if theyre claustrophobic and if they can lift at least 140 pounds.
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ALBANY, N.Y. (AP) -- Gov. David Paterson is considering a new interpretation of the state constitution by good-government advocates and legal scholars that would allow him to appoint a lieutenant governor to address the monthlong standoff in the Senate.
A Republican-dominated coalition says that even if the Democratic governor appoints a lieutenant governor to preside over the Senate, the result would be lawsuits and no real resolution to the conflict.
Meanwhile, senators who've been at odds since June 8 are scheduled to have their first paycheck withheld Wednesday.
In court filings today, Comptroller Thomas DiNapoli is asking a state judge to confirm the comptroller has the power to hold up lawmakers' pay and determine who in the Senate has the power to authorize paychecks.
Top links
» Follow coverage of the New York State Senate power struggle
» Analysis of the monthlong standoff
» New York's comptroller says our fiscal situation is getting nearly as bad as California
» PostScript: New York state government is on the fritz, but the IT office is working


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NHL Games
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Chicago Blackhawks left wing Daniel Carcillo celebrates his winning goal during the third period of an NHL hockey game against the Colorado Avalanche, Wednesday, March 6, 2013, in Chicago. The Blackhawks won 3-2. (AP Photo/Charles Rex Arbogast)


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Dr. Bruce Albrecht specializes in reproductive endocrinology, obstetrics & gynecology in Englewood, Colorado.
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GRAND RAPIDS, MI — Heartside Ministry received a $5,000 dollar grant from the Grand Rapids Community Foundation that will allow its GED program to be open five times a week instead of two. Thanks to the donation, the organization also inaugurated a new space where the GED program will take place.
Before Heartside Ministry received the grant, the GED program met two afternoons a week for two and a half hours and didn't have a permanent space. Volunteers and students pushed around a rolling cart looking for any available space.
"We are already outgrowing the enhanced space. Sometimes up to 18 people come to the GED classes," said Jan Gockerman, 65, who volunteers at the program.
Jamie Rykse, 35, head volunteer coordinator for the GED program, said the new space and the increased number of classes in a week will allow Heartside Ministry to educate more people.
"Get your GED. You will feel better about yourself. You can't do anything without an education. So come, we don't judge," she said.
Rykse got her GED while she was incarcerated and later enrolled in Grand Rapids Community College. She studied four years there and was on her way to obtain a double major in Criminal Justice and Social Work, but wasn't able to complete her classes.
"I heard about Heartside and they helped me get on my feet. So I started volunteering in the computer lab and later tutoring for the GED," she said.
Rykse said her students range from 17 to 66 years of age.
"It's gratifying," she said.
There is no cost to students for the classes or the exams. The GED consists of five exams at a cost of $25 a piece, which Heartside Ministry pays for after the students have passed a pre-test.


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The Newton County Water & Sewerage Authority was created by the state legislature in 1970. The Authority began with one full-time employee and 52 customers. Today the Authority has a staff of forty-eight full-time employees and serves 22,122 water customers and 6,048 sewer customers. Learn More About Us >>
Customer Lobby Hours:
~ Monday-Friday 8:30-4:30
Main Office and Drive Thru Hours:
~ Monday-Friday 8:00 am-5:00 pm
Main Switchboard:
~ 770-787-1375
After Hours Emergency:
~ Water: 678-618-7283
~ Sewer: 678-776-1295
Sewer line right-of-ways will be mowed September 12 to October 31.
Please ensure right-of-ways on your property are accessible and clear of any obstructions.
Thanks for your cooperation.
Helpful Hints:
How To Read Your Meter
When looking at the water meter, locate the BLACK numbers on the LEFT side of the meter dial with the WHITE background. These numbers count the number of gallons of water that have passed through your meter.Read More >>
How to Check For Leaks
A small leak, about the size of a pin head, dripping at one drop per second can add up to 7 gallons of water a day. A large leak, the kind most often found in toilets, can waste 200 gallons of water or more per day! Read More >>
Backflow Prevention
A connection between your drinking water and another source of water that combines the two when a backflow condition occurs. When this occurs, your drinking water can become contaminated. Read More >>
Water Quality Report
Latest News:
~ We offer several payment options including Online Bill Pay and Bank Draft services.
~ Billing: All meters are read electronically, thus eliminating the possibility of a visual misread.
~ Learn more about our Engineering Department and Services. Download various forms and checklists...
~ Water Reclamation: The Authority's pre-treatment process is a 24/7 operation...
~ Newton County Water and Sewerage Authority, Newton County and its municipalities Covington,
~ Mansfield, Newborn, Oxford, Porterdale Designated As Georgia's Twenty-fifth WaterFirst® Community
Newton County Water and Sewerage Authority permanent restrictions are is follows:
Please note: On June 24, 2015, the DNR Board adopted Drought Management Rules
that replaced former rule provisions relating to outdoor water use as well as the 2003
Drought Management Plan.
As of December 1, 2010, state law allows residents in Georgia to water any day of the
week, regardless of your address, but only between the hours of 4:00pm and 10:00am.
Outdoor water use not related to landscape irrigation, the customer may use water
any time of the day, any day of the week. Such as washing cars or pressure washing.
The even/odd rules no longer apply during non-drought conditions. They are reinstated
only when a Level Two Drought is declared by the State of Georgia. (You will be notified
if GA EPD enacts these restrictions.)
Hand watering with a shut-off nozzle is allowed any time of the day, any day of the week.
Newly installed landscape is also exempt from the hourly restrictions for the first 30
days following installation. However, 4:00pm to 10:00am is still the most efficient
time to water outdoors. During the heat of the day, sun and wind can cause up to 50
percent of the water to evaporate before it is absorbed by plants.
Drip irrigation is highly efficient and therefore it is exempt from the 4:00pm to 10:00am
rule. It may be used any time, any day.
All open records requests must be made to Ms. Mills in writing through one of the following three methods:
1) email: email@example.com
2) fax: (770) 786-4536 or
3) by mail addressed to: Emily Mills, Open Records Officer
Newton County Water & Sewerage Authority
11325 Brown Bridge Road, Covington, Georgia 30016.


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It's the second straight morning the highway was shut by a crash in the Allentown area.
PennDOT said the crash involved more than one vehicle. It sent out notice of the accident and closure at 5:44 a.m.
WFMZ reported nine vehicles including a truck were involved in the crash just west of the Lehigh River. The backup extended beyond 15th Street in South Whitehall Township.
Pennsylvania State Police at Bethlehem are investigating the crash, but a trooper at the barracks said they had multiple accidents and were too busy at the moment to provide information.
A light rain fell across the region before daybreak.


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This deal has ended.
Jewelry.com offers this Emerald and Sapphire Ring in 14K Gold for an exclusive price of $340.43 with free shipping. Better still, code BRADSDEALS drops the price to $199, also an exclusive for our readers. This ring features an emerald circled by white sapphires, set in 14K gold. Sales tax is not charged in most states.No longer available


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7 Responses to Levi Bryant and Naturalism
Hello David, I think my problem with Levi Bryant's post can be summarised as follows
1) it is virtually contentless: your rendering above is giving him the benefit of the doubt by spelling out a contentful position that you attribute to him but in fact belongs to you
2) it is even so spelled out very much a promise rather than a present accomplishment and rests on a horizon of the unity of science (the unity of at least physics, chemistry, biology and astronomy – but he needs psychology and sociology as well – hence the empty call for a Lacanian memetics). This unity does not exist as there exist incommensurable paradigms between each of these disciplines and inside each one: even "physics" is not a unified corpus.
3) this unity even supposing that it is conceivable is typically thought to be achievable by some sort of reductionism (usually physicalist). Bryant has repeatedly denounced reductionism but propounds a reductionist metaphysical research programme.
4) it is just not true that recent post-structuralist philosophy is anti-naturalist. On my reading Deleuze, Foucault, Lyotard, Stiegler, Serres and even Derrida are favourable to naturalism. Merleau-Ponty's anti-naturalism is in fact an anti-redductive scientism. According to Deleuze, Bergson is a naturalist to be grouped with Lucretius and Nietzsche. The critique of scientism is a critique of reductionism, not a recourse to entities and causes "outside the world".
5) Bryant's vision of the history of science is false. Theological motives have propelled researchers and still do. Even today a very secularised and immanentised religiosity concerning seeing the thoughts in the mind of God inspires physicists who are in any ordinary sense atheists (Einstein, Hawking). Bryant's disinfected (ie: commensurabilised) naturalism has trouble accomodating such elements, thus his desperate bluff of appealing to a revamped Lacanian unconscious whenever he is in a tight spot (ie in danger of falling into physicalistic reductionism).
NB: a useful rule of thumb with Bryant is that whenever he refers to Lacan he is pulling a fast one, there is no intellectual content there any more and he knows it himself.
[…] post can be summarised as follows 1) it is virtually contentless: David Roden's rendering here is giving him the benefit of the doubt by spelling out a contentful position that you attribute to […]
All this is music to my ears – of course, of course. Freud's 'three great narcissistic wounds' is a favourite trope of mine discussing these issues, but I definitely agree that Levi's description of the Continental tendency to prioritize the manifest over the scientific as a 'reaction formation' is more than a little puzzling.
He also simply bulldozes over the Hard Problem, and simply assumes that any number of very savvy theorists and researchers simply have no argument, when such is not the case. The Hard Problem (despite people like me, who think they've dissolved it) remains very, very, very hard, and as such as open an issue as any can be in philosophy. So long as that issue is open, semantic autonomy and/or semantic priority positions remain entirely viable, even if restricted to a shrinking portion of the discursive dance floor.
And he's also mistaken in his conflation of naturalism with materialism. I'm a naturalist, and I think the mere fact that materialism finds itself half of a dichotomy including idealism suggests that something hinky is going on. In my view, naturalism (that is, science) *outruns* materialism, as it should, since the latter is the artifact of heuristic cognition. Information, nonsemantically defined, is the theoretical idiom that allows us to slip all these ancient dichotomies, and see that this tug of war between the material and the semantic is in fact a battle between two very different cognitive heuristics (or families of heuristics) which, thanks to informatic neglect, confuse themselves for universal problem-solvers, and remain blind to the way they stamp problems they never evolved to consider, let alone solve, in their own image.
Either way, the best way to show semantic priority thinkers the error of their ways is to show them not only why it is they their positions are so intuitive, but how the specifics of their 'inferential' schemes arise out of empirical facts of human cognition. This is the route I'm taking, anyway.
On the by and by, I had a chance to plug your forthcoming posthuman book this weekend, David, whilst taking another swipe at transhumanism: http://rsbakker.wordpress.com/2012/10/29/less-human-than-human-the-cyborg-fantasy-versus-the-neuroscientific-real/
[…] numerous critical responses across the web: Agent Swarm, An und fur sich, and one of my faves, Enemy Industry. People are unimpressed, and for good reason. Freud's metaphor of the narcissistic wound is not a […]
Or even conceptual chasm! Here's my two cents Bryant's posts: http://rsbakker.wordpress.com/2012/10/31/another-goddamn-anti-transcendentalist-manifesto/
I'll keep chipping away at your incipient representationalism! Have you had a chance to check out Carruther's review of Plato's Camera? http://ndpr.nd.edu/news/32035-plato-s-camera-how-the-physical-brain-captures-a-landscape-of-abstract-universals/
I've noticed you've been mentioning Papineau lately. Any place I should begin?


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Vidya Balan's take on The Dirty Picture, Aamir and beau Siddharth Kapoor
While Vidya's character in Dirty Picture is very different from her real life character, Vidya is very confident. Speaking to a leading newspaper, Vidya said that as an actor she wants to live the characters of different people through her films. Seeing these unconventional films as an opportunity to be grabbed, Vidya said, "I want people to come out after watching each and every film of mine and say, 'This is not the Vidya we know' or 'This is not the Vidya we saw last time'."
Vidya Balan sees Aamir Khan and Vidhu Vinod Chopra as actors and filmmakers who defy rules. She said that whenever she has to take a risky decision, she thinks of Aamir Khan and Vidhu Vinod Chopra.
Speaking about her romantic relationship with filmmaker Siddharth Kapoor, Vidya Balan said that she was extremely happy with Siddharth. However, before signing off, she clearly stated that though she wanted to marry and become a bride, she was not married yet.


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This deal has ended.
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Our friends are ours to choose and that sets them apart from our family but it seems that people still gravitate towards those who are genetically similar, according to a study.
Researchers found that on average friends share as much DNA as fourth cousins, or people with great-great-great-grandparents in common — well above the level of relatedness in the general population.
Nicholas Christakis, a professor of sociology at Yale University, said: "We are somehow, among a myriad of possibilities, managing to select as friends the people who resemble our kin."
Previous studies have shown that friends tend to look more similar


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The Blue and Gold Club at Franklin Elementary School in Rahway recently donated 'Mugs of Love' to the Rahway Food For Friends Soup Kitchen.
The mugs were filled with individual packages of coffee, tea, sugar, crackers, soup, and spoons, which were all donated by students at the school.
The Blue and Gold Club members assembled the mugs and brought them to the soup kitchen.
They enjoyed working at the soup kitchen, passing out the mugs, and helping their community.


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The 8th annual 4th Street Art and Music Festival will take place tomorrow at Fourth Street between Newark and Merseles streets from 12 p.m. to 10 p.m.
The event is in conjunction with the Jersey City Artists Studio Tour and offers exhibits, vendors, music and activities for children. Founded in 2004, the sponsoring organization continues to grow as does the festival.
The music portion will feature two stages of continuous sound: The Village Stage and The Garden Stage. The lineup includes the largest number of performers in festival history. The non-stop music is from 12:30 p.m. until closing.
Wenye Fang, a recent graduate of St. Peters Prep, will have his first solo show during the festival. Fang received a visual arts scholarship from the festival last year which took him to Jersey City Art School from March 2011 through August 2011. Fang's show will be in the 4th Street Studio located at 371 4th St.
Tanisha Boon, 15, winner of last year's performance scholarship, will perform her poetry and spoken word on the Village stage at 12:45 p.m. Her scholarship sent her to Art House for a 6-week intensive workshop, "Say What," where she studied different styles ranging from slam to short form to cutting-edge multimedia. Tanisha is in her junior year in County Prep High School and has been writing for about 3 years.
Also showing at the festival will be Joe Churchirillo who will offer a variety of interactive kinetic sculptures that he has created over the past few years. He also plans to show drawings about the sculptures.
Franc Palaia will exhibit a selection of hand colored SX-70 Polaroid photographs that will include images from all parts of Europe and the US focusing on classical architecture and urban scenes as well as contemporary structures. Palaia received a Polaroid sponsorship from 1985-87 for his original technique of hand coloring and has several prints in Polaroid's permanent collection.
Not Yo Mama's Craft Fair organizes 25 unique, local artisans, with items that run from re-purposed doll parts to eco-friendly and elegant accessories.
The children's area will include festival related art projects as well as face painting by professional makeup artist Heidi Crow for Studio 365.
Two dozen comics will perform each hour on the hour from 1 p.m. to 8 p.m. at a dedicated stage created just for the festival. No two shows will be identical. Joe D'Allegro, the producer of the Shut Up & Laugh comedy show, is staging the event.
In addition, a community collage will be created on boards supplied by Hudson County Art Supply (http://hudcoart.com). A new board will be introduced every hour and participants are invited to bring collage materials: glue, paper, markers and paint.
Other activities include a live mural painting by Jersey City artist Norman Kirby, a scavenger hunt, live silk screening by Matt Caputo, and plenty of food offered by Lucindas Crepes, The Krave Truck, Home on the Range, and Lucky Sevens. Treats will be available from Made With Love and With Love from the Cupboard, which also will offer mini-demonstrations.


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This year, Rafael Nadal will win his fifth Roland Garros singles title.
Sorry, did I give away the ending for you? If I did, then you haven't been watching much tennis -- or reading this blog -- in the past month.
There is a caveat, of course. One hundred and twenty-seven other tennis players are in the men's draw and, you know, anything can happen. (See 2009 French Open, Round 4.) I am legally required to point this out.
The outcome might be all but decided, but there still will be some excitement on the way to Rafa's coronation. This especially will be the case in the Get Out of Jail Free half of the draw -- that is, the one that doesn't have Nadal in it. Reaching a Grand Slam final is no small thing to put on a CV, and so 64 players are going to viciously scratch and punch each other for the right to get clocked by Rafa on the tournament's last day. Let's make some calls:
Big breakthrough of the tournament: Ernests Gulbis. There's something about the Latvian -- the bedheaded slacker-prince fashion sense? the blank-eyed air of entitlement he gives off like B.O.? -- that rubs me the wrong way. He just doesn't strike me as someone who has that certain something of which champions are made. Whether or not my view of Gulbis is correct, this much cannot be denied: the kid can flat-out play. And his run in Rome gave him an injection of confidence at exactly the right time. In Paris, he'll post three or four impressive wins and then take one of the Big Four to the brink of ruin.Big disappointment of the tournament: Marin Cilic. He raised expectations with his semifinal showing in Melbourne, but that was more a result of happenstance than anything else. He's not yet ready for prime time.
Guy most likely to give Nadal a scare: Gael Monfils. I was about to put Novak Djokovic here, but that was year-old muscle memory talking. Monfils is the man, trust me. He fell quietly to Nadal in Madrid, but unlike Amelie Mauresmo, the Frenchman and former Roland Garros semifinalist thrives in the role of home-town hero. He was also built for claycourt tennis like no one else on tour -- and that includes Nadal. He has the game and the enthusiasm to give the four-time champion a serious fight. What he's lacked so far in his career is self-belief when it matters most. Sooner or later, he's going to push past that barrier.
Best match of the tournament: Roger Federer vs. Rafael Nadal. Could there really be a fourth French Open final between our living legends? A lot of people believe Federer's record semifinal streak in majors finally will come to an end at Roland Garros this year. The World No. 1 has indeed been scratchy of late, but a spring swoon has never affected his Grand Slam results before. More to the point, he's the defending champion in Paris and he has his pride. My prediction: He'll force himself to care against the Almagros and Andreevs of the world and bull his way to yet another major final. Once there, he'll give Rafa all he can handle. He'll get that backhand slice to bite, which will take some of the high-bouncing boom off of Nadal's forehand. He'll use the drop shot to play with Nadal's mind and win the battle for court position. It will be a bravura performance -- for a set and a half. Then Nadal's relentless focus and determination will take over. The match won't be a classic, but because the two great rivals probably aren't going to face each other too many more times with big titles on the line, it will be a tense, thrilling and ultimately melancholic affair.
OK, that was the easy part of this French Open preview. Now we move on to Mission Impossible: The women's draw.
I've already made the case for this being the year an underdog actually could come through and steal a Grand Slam title. It could be a true underdog like Flavia Pennetta or Patty Schnyder or Italian Open champ Maria Jose Martinez Sanchez, or it could be a pseudo-underdog like Victoria Azarenka, Samantha Stosur or Elena Dementieva.
I believe it really might happen, but I won't be putting any money down on the Cinderella story.
That's because Serena Williams is in the draw. And though she may be a tad rusty, she always comes to play. If she goes down, it'll most likely happen early -- that's where the underdogs mentioned above come into play. But if she survives the first few rounds, she'll be as easy to stop as a runaway train.
I know what you're thinking: What about Justine Henin? Yes, with Kim Clijsters on the sidelines, Henin falls into the No. 2 slot on the list of favorites. But except for her Australian Open run, which can be chalked up to a combination of comeback enthusiasm (Justine never looked so fresh and happy) and big-time chokes (we're talking about you, Elena Dementieva and Yanina Wickmayer), Henin has been consistently inconsistent all season. Most recently, she won Stuttgart but bombed out of Madrid. That inconsistency will suddenly and unexpectedly catch up to her in Paris.
You don't know what I'm thinking: Which is, I believe Caroline Wozniacki and Jelena Jankovic are going to do very well in Paris. Sure, you can argue that if Jankovic was going to win a major it probably would have been a year or two ago. But she is a two-time semifinalist at Roland Garros and she's playing good tennis, including beating Serena in Italy. Despite her loss to Aravane Rezai in Madrid, she'll be coming into Paris feeling confident -- and that good attitude will pay off. Wozniacki, on the other hand, doesn't have confidence on her side, having lost early in each of the big claycourt warm-up tournaments. But she is determined. She knows clay is her best surface, that even though she's a U.S. Open finalist, Paris is where she's going to make her name -- if she's going to make it. Said the Dane after losing in Madrid: "I'll go back on the practice courts tomorrow and start working my butt off, and the results will come back. ... The French Open, that's the goal at the moment."
So shall we flip a coin to pick the women's champion? Yes, let's do it. I say both Williams sisters and young Miss Wozniacki will make the semifinals. The fourth wheel will be some no-name player out of the clear blue sky who manages to bump off Jankovic in the quarters. Venus has had a good spring (she's the new No. 2), but we all know she can only win majors played in England. And the Final Four is as far as the Surprise Girl, whoever that turns out to be, is going to go. OK, the quarter is up in the air, turning over and over. And the winner is ...
Caroline Wozniacki.
-- Douglas Perry; Twitter


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Tuesday, January 8, 2008
Left Behind
(See how I wrote that without gagging even once? Will power, people. Will power and a LOT of nervous swallowing.)
Mama is a proud Mama indeed, but Mama cut her proudness teeth on her nieces and nephews.
My eldest niece and nephew, at nearly 12 and 10 respectively, have recently started their own blogs. I know! I cannot TELL y'all how thrilled I was to read their first posts and get to comment on them. Two more happy bloggers in the family, and a special way (hopefully they'll blog more regularly than I have recently!) to keep up with what's goin' on in those two brilliant minds. Oh, it does make an Aunt well up with happy tears. My lil babies, all grown up and bloggin'!
Daniel blogged the following sad paragraph today. Y'all get your tissues because this one will jerk up those heartstrings and tie them in a knot, for sure.
Unfortunately yesterday our flight to San Antonio was completely sold, so we couldn't go. But then today, I woke up with the same cold Dad, Little O, and and my baby brother had. My mom planned on going to Chicago, the second place we were supposed to go to see my Aunt, Uncle, and my cousin. I couldn't go, so I'm stuck here with Dad, Little O, and my baby brother. Mom said that she would take the camera with her so I could see what they did there. Fortunately for me, I am going to see my Aunt, Uncle, and my cousin in February when we rent a Suburban and go down to the beach.
You rest up and get well, Baby Daniel (who's not a baby anymore, sniffle). When we get to the beach, I'm going to hug you until you almost can't breathe anymore! Oh yes sir, I am!
19 comments:
I, too, have a very special little boy in my life named Daniel. Glad you're having company and sorry you're missing your Daniel.ReplyDelete
Oh, that's too bad! He sounds like a sweet guy.ReplyDelete
Sounds like a very mature young man to me... I'm sure the trip in Feb will be loaded with fun. I have a Daniel in my family to my baby brother. He's a special guy too.ReplyDelete
Poor guy. I am so sorry he missed the trip up--for both of you. Have a good time with your sister and nieces over the next few days.ReplyDelete
Oh my goodness, I can't believe that the kids are getting to be that big!! So glad that Jackie and the girls are visiting! Please give her a hug from your old Bratty friend :0ReplyDelete
I should have signed my name. I am the old Bratty friend, now BerryBusyMom.ReplyDelete
Aww - what a sweet kid. I hope he feels better fast. I've been wondering about you too - are you still feeling crummy? That little peanut is sure making himself/herself known!ReplyDelete
So, that means that you have an empty seat at the table, right? I'll be there in a flash for some of Nana's sauce, etc.!ReplyDelete
Rats! Foiled again. I hope you do have a great visit with your sister and her girls, though. I'd be upset if I were Daniel too. No one wants to miss out on a visit with Megan! :)ReplyDelete
That is special little boy! Poor thing. Hope he feels better soon!!ReplyDelete
Oh, goody! The beach in February! Hopefully you will feel fit and snazzy enough to run and romp and play and be that crazy favorite aunt that makes everyone snort with laughter. :o)ReplyDelete
Aw shame! That hug'll be even bigger for him by the time he gets there.ReplyDelete
Hope he gets well soon!
P.S. nice to see you back :D
Thank you, Aunt Megan, and I can't WAAAAAAAAAAAIT to see you in February!ReplyDelete
Love, Daniel
I've been missing you Megan. You have such a sweet nephew there. :) so sorry he couldn't come see you.ReplyDelete
The part about his mama promising to take lots of pics got me sniffling! What a strong little man! Have a great visit with your sister! I never thought I'd be a mom until I fell head over heels in love with my niece and nephew! Who wouldn't want a piece of that!?ReplyDelete
Glad you're back! Have fun with your family.ReplyDelete
Aw, so sweet. I found my nieces myspace page where she listed me as one of her heros! Love those kids!!ReplyDelete
Glad you weren't making sauce out of Nana lol!
Poor guy!! That's pitiful. Thank goodness you have a beach trip planned for February because it would have been even harder for you to be without him during this visit. Have a great time with your sister and her children!! I'm glad you're back- I hope that means you feel better. I loved your post where you referenced some funny things that had happened to you in the last few months. I read every one of them one night, and just couldn't stop myself. I kept reading, chuckling, reading, laughing out loud, reading late into the night, sleeping late the next morning... You are one funny chic!! I was trying to figure out who you reminded me of (besides a friend of mine's sister). I finally figured it out because I saw one of her movies the other night...Claire Daines. Has anyone ever told you that??ReplyDelete
- AnonymousJanuary 15, 2008 at 2:24 PM
Man, I shore could use me a heapin'helpin' of some good ole Fried Okra right now. Where are you OkraMama? Your blog is like a fix! I check several times a day at work and again at home at nite! Please just let us know that you haven't moved in permanently with the porcelain god!!!!ReplyDelete


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Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention
Pleurisy is an inflammation of the pleura, the double-layered membrane that surrounds each lung and the rib cage. The pleura protects and lubricates the surface of the lungs as they inflate and deflate within the rib cage. When they become inflamed, the diseased surfaces rub painfully together.
Pleura of the Lungs
There are several causes for either acute or chronic pleurisy.
- Viral infection such as influenza and cold viruses
- Lung infections from bacteria like tuberculosis or parasites like amebiasis
- Pleural effusions
- Pulmonary embolism
- Autoimmune diseases, such as lupus or rheumatoid arthritis
- Collapsed lung—pneumothorax
- Cancer in the lung
Risk Factors
Factors that increase your chance of pleurisy include:
- An underlying lung condition, such as cystic fibrosis or emphysema
- Systemic lupus erythematosus (SLE)
- After a heart attack such as Dressler syndrome
- Asbestos
- Chest injury
- Heart failure
- Inflammatory bowel disease
- Pancreatitis
- Rheumatoid arthritis
- Cancer
- Chronic liver and kidney disease
- Sickle cell disease
- Drug reaction
Symptoms of pleurisy include:
- Sharp, stabbing pain towards the side and lower part of the chest
- Pain along the shoulders, neck, and abdomen
- Pain during any movement of the chest, such as breathing and coughing
- Dry coughing
- Fever
- Rapid pulse
- Rapid and shallow breathing
You will be asked about your symptoms and medical history. A physical exam will be done. The pain associated with pleurisy can be enough to diagnose the condition. A stethoscope will be used to listen for abnormal chest sounds, such as a friction rub or pneumonia sounds. The next step is determining the illness that caused the pleurisy.
Images may be taken of your bodily structures. This can be done with:
- Chest x-ray
- CT scan
- Ultrasound
Your bodily fluids may be tested. This can be done with:
- Blood test
- Fluid analysis after thoracentesis—removal of lung fluid with a needle
- Biopsy of the pleura with video-associated thoracic surgery (VATS)
Your heart's activity may be tested. This can be done with an EKG.
Treatment will depend on the cause of the pleurisy. Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Pain Management
Pain relievers, such as acetaminophen and anti-inflammatories, are used to treat the pain. Anti-inflammatories may also relieve symptoms related to inflammation. Some people can reduce their pain by lying on the painful side, holding a pillow tightly, or wrapping the chest with elastic bandages. Codeine-based cough syrup may be prescribed to treat a painful cough if it is safe to do so.
Treating the Source of Pleurisy
If pleurisy is the result of a bacterial infection, antibiotics may be prescribed. If it is the result of a viral infection, the virus will get better naturally. If the cause is due to an autoimmune disease such as SLE, then steroid treatment will relieve pain. Pulmonary embolism or pneumothorax may be treated by surgery.
To help reduce your chances of getting pleurisy, take the following steps:
- Seek early medical attention for conditions that can cause pleurisy.
- Ask your doctor if you should get a pneumonia vaccine and the flu shot, especially if you are elderly, have a chronic illness, or weakened immunity.
American Lung Association
National Heart, Lung, and Blood Institute
Health Canada
The Lung Association
Kass SM, Reamy BV. Pleurisy. Am Fam Physician. 2007;75(9):1357-1364.
Pleurisy. Cedars-Sinai website. Available at: http://www.cedars-sinai.edu/Patients/Health-Conditions/Pleurisy.aspx. Accessed May 12, 2016.
Pleural effusion. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/pulmonary-disorders/mediastinal-and-pleural-disorders/pleural-effusion. Updated September 2014. Accessed May 12, 2016.
Last reviewed June 2016 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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Tickets are $8. This is the first musical production in ES-M's newly remodeled auditorium. Tickets will be sold with specific, assigned seating.
The musical is set in tsarist Russia in 1905, and the story is about Tevye, his wife, Golde, and their five daughters. It follows Tevye and his attempts to maintain family and religious traditions under the pressure of outside influences.
The original Broadway production opened in 1964, featuring the popular songs "If I Were a Rich Man," "Sunrise, Sunset" and "Matchmaker." The cast includes: Trevor Pokrentowski as Tevye, Alexandra Durantini (Golde), Steph Iannotta (Tzeitel), Katie Burgwin (Hodel), Emily Bousquet (Chava), Kaeli Agans and Sara Stevenson (youngest daughters), Abby Adebola (Yente), Asa Cole (Motel), Kevin Rogers (Perchik), Jimmy Grosso (Lazar Wolfe), Sam Rossborough (Mordcha, Innkeeper), Kyle Finch (Rabbi), Vinny Sardo (Mendel, Rabbi Son), Ryan Wood (Avram, Bookseller), Cole LaVenture (Nachum, Beggar), Brittany Miller (Grandma Tzeitel), Mysti Harrington (Fruma-Sarah), Mike Glisson (Constable), Andy Troast (Fyedka) and Kirstin White (Shaindel, Motel's Mother).
Villagers include: Jessica Barbini, Cassandra Beechner, Colton Bready, Kathleen Brown, Kala Bush, Bella Calabria, Chris Caldwell, Kourtney Day, Rebecca DeJohn, Maddy Fowler, Alyssa Fullana, Tricia Honors, Allison LaChanse, Chris Lupia, Lauren Mannerberg, Kassy Melendez-Ramirez, Veera Nylander, Antoinette Parks, Victoria Schaefer, Becky Schultz, Rhiannon Sherlock, Jason Wieczorek and Samantha Zimnock. For more information, call 434-3300.


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The two incumbents were re-elected along with two new board members.
Democrat Brady J. Totten received the most votes at 1,760, followed by Republican Sheridan with 1,493, Republican Pam Moore with 1,475 and Democrat Magnus with 1,429 votes.
The three remaining candidates, Republican incumbent Michael Marr, Democrat incumbent William D. Nelson and Democrat challenger Fred Jimenez received 1,377, 1,214 and 1,282 votes, respectively.


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An 18-year-old Dauphin County man was shot to death last night in Middletown, the Dauphin County coroner said, in an incident that was drug-related.
The man's identity hasn't been released pending notification of next of kin.
Coroner Graham Hetrick said the death was drug-related but wouldn't go into specifics. He said it was not a random home invasion. Early reports about the shooting were that the man was killed robbing a home.
Hetrick said the 18-year-old was shot three times, twice in the chest, and died on the way to Hershey Medical Center.
Middletown police were not at Hetrick's press conference on the case this morning and have not commented. Borough spokesman Chris Courogen says they're still investigating.
The shooting happened in an apartment building in the first block of Main Street, near the town square. The victim was found in a stairwell.
Last night, the alleged shooter, a man, and a woman were questioned at the scene. Their identities haven't been released.
None of the three involved lived in the apartment building, Hetrick said.
A woman who does live there said she heard what sounded like gunshots and ran up the stairs and saw the victim gasping for air. "That was the first time I've ever seen anything like this. It had me freaking out all night," Jennifer Komanski said.
Witnesses last night said they heard at least three shots fired shortly after 9 p.m. and saw a man and a woman run outside.


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A year ago, a co-worker gave me her cat to pet sit while she went on vacation. When she got back from vacation, she promised weekend after weekend that she would get the cat, but never did.
Weeks go by and then one night, my mother hears a crying noise coming from under her bed. It was kittens! We had no idea the cat was pregnant.
My mother quickly awakened me and when I looked under the bed, I noticed that the mother cat was not cleaning one of the kittens. Normally, you are not supposed to touch the kittens, as this could upset the mother cat. But since she was not cleaning the kitten, I picked up the kitten and moved her closer to her mother. She was still wet and sticky and had the umbilical cord attached. Thankfully, the mother then began to care for the kitten.
That kitten, who I named Miracle, had a litter of her own this past New Year's Day. This time around, we were better prepared because we knew she was pregnant. Her belly sagged, her hips got wider, and she cried constantly. We prepared a comfortable space for her to have her kittens - a cardboard box with towels and a heating pad inside. Funny thing is, she decided not to give birth in there. She had her first born kitten in the litter box!
We moved Miracle into the cardboard box, where she had the rest of the kittens. Miracle did not want to clean the first born kitten initially because the kitten was covered in litter. So we cleaned the kitten the best we could with a damp paper towel. That kitten still had the umbilical cord attached for several weeks until it fell off naturally. Normally the mother cat chews off the umbilical cord.
The best advice I can give if you have a pregnant cat is to be prepared, but do not intervene too much, and do your research. It is truly a beautiful, special and intriguing moment when you see a kitten being born and taken care of its mother.


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Anyone saying beats pros won't be driven is full of it. They are way to damn loud even at 50% on my iPhone. In the end I think you should look into cheaper headphones. If the sound on the beats pros don't drive you crazy the comfort will. It's like having bricks on your ears. But I think they sound alright if they were under $300. If they went for $250 they would be average.
You do realize that "loud" doesn't mean fully driven. I can make the HD650s sound loud at 75% or so on my iPhone, but that doesn't mean they are fully driven


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The St. Tammany Home Builders Association's March general membership dinner will be March 11 at Benedict's Plantation, 1144 North Causeway Blvd., Mandeville. Sponsored by Washington-St. Tammany Electric, the meeting will feature a presentation by Eric Skrmetta of the Louisiana Public Service Commission.
The meeting will begin with networking at 5:30 p.m., with the dinner program starting at 6 p.m. The cost is $20 per person, payable to Benedict's. For information, call the office at 985.882.5002.
Submit information for the north shore Community Connection to firstname.lastname@example.com.


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Nb: infants must be under the age of 2 and
children must be under the age of 12 at the time of
The modern hotel Sport is one of the best hotels in Poiana Brasov. Situated among pine trees at the foot of Bradul ski slope, it is next to the Poiana Brasov ski school, 50 metres from the ski lifts and 200 metres from the resort centre. The hotel Sport offers a high standard of accommodation and modern interior perfect for a ski holiday to Poiana Brasov.
89 bedrooms. Twin room with bath, WC, minibar, cable TV, telephone and hairdryer. Child age - 11 years.


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Hitting icy patch, driver loses control before rollover
Authorities are blaming road ice for a rollover crash on Interstate 380 that sent an Illinois man to the hospital.
The Black Hawk County sheriff's office says 52-year-old John B. Adkins, of Highland, Ill., lost control of his vehicle Sunday morning while merging onto the interstate. Adkins had been traveling west on U.S. Highway 20.
Authorities say Adkins was turning northbound onto interstate when he hit an icy spot. He entered the median and rolled his Jeep several times before coming to a rest in the interstate's southbound lanes.
Investigators say Adkins was taken to a local hospital with what appeared to be non-life-threatening injuries. There were no other passengers, and no citations were issued.
Copyright 2012 by The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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39 - Proc/Buff + Cooldown in one bar
Say for example you get a Buff/Proc, It'll show the Buff/Proc Bar when you gain it, then once the Buff/Proc wears off it will switch to a Cooldown Bar showing how long till it is ready again.
Using this method, you could create a lot less bars to show the same information.
|May 04, 2010 at 13:54 UTC
|Changed priority from Medium to High
|Mar 31, 2010 at 16:24 UTC
|Changed status from New to Accepted
|Mar 16, 2010 at 01:14 UTC
dinesh Jan 16, 2011 at 18:29 UTC - 0 likes
Might I suggest having the cooldown tracking run in the opposite direction of the bar movement? i.e. you cast the spell/effect, and the bar starts, moving from right to left. Once the effect ends, it switches to tracking the CD, and now the bar goes from left to right. Have the color be muted as well, or switch to gray shading, or some such as well. This way you know that all bars going in the wrong direction are counting cooldowns.
You might also generally add an option to control the direction the bars work in (and cooldowns would always count in the opposite direction).
Retlaw Apr 19, 2010 at 04:07 UTC - 0 likes
What i had been doing to work around it is creating one group of bars that shows the procs, and another group of bars that shows the cooldowns and placing them in the exact same location, so that after the proc wears off, the cooldown bar is already in it's place counting down.
What i'm thinking is that for these dual-use bars, it blends the alpha in and out, so the buff fades away as it wears off, and the cooldown is fading in as it's replacement.
For the config ui, possibly just give it a menu option where you use the default buff config ui, and another where it has the default cooldown config ui, and it just uses both of those as needed for displaying the apprpriate bar at the time.
Beutju Mar 26, 2010 at 02:10 UTC - 0 likes
+3 from me =)
- Last updated
- Jul 27, 2012
- Reported
- Mar 16, 2010
- Status
- Accepted - Problem reproduced / Need acknowledged.
- Type
- Enhancement - A change which is intended to better the project in some way
- Priority
- High - Strongly want to resolve in the specified milestone.
- Votes
- 8


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BAY COUNTY, MI — Their garden has been a 10-year labor of love for Gene and Janet Cianek.
Working side by side, the two Monitor Township residents have manged to carve out a little piece of heaven right in their own backyard.
That's not to say, the front yard isn't impressive, is just that those wandering through the garden gate may well find themselves with mouths hanging open groping for words to describe it.
Beautiful doesn't begin to do it justice. Gardening with perennials, annuals, and flower trees, the couple have created a space that invites visitors to take a stroll on the lush green lawn pathways and follow them wherever they lead.
Visitors will get to do just that on Aug. 3-4 when the couple, along with five other couples, open their outdoor spaces for "A Weekend Stroll in our Gardens."
This brand new garden walk comes compliments of a brand new garden club, the Valley Garden Club of Bay County, which got off the ground two years ago. Although it started with a group of Master Gardeners, with the purpose of sprucing up and maintaining the Heartland Children's Memorial Garden at the Kantzler Arboretum, the club is growing and is open to all who have a love of gardening. The club expanded has taken on two other pocket parks in the arboretum and they would like to take on more.
But that takes more members and funds, thus the group is hosting its first ever walk to raise funds to take care of gardens throughout Bay County. This year's goal is $5,000, said Gene Cianek.
"We're hoping people who have an interest in getting involved will join us so we can expand and do more," he said. "We want people to see you don't have to be an expert to have a beautiful garden. You just need time and patience."
The club goes beyond the public gardens. Meeting at 6:30 p.m. the second Tuesday of each month at the Good Samaritan Rescue Mission, 713 Ninth St., the group discusses horticulture, shares gardening tips and plans volunteer outings.
"We give each other encouragement and help each other solve problems we're having in our own gardens," Cianek said. "In between, the group mixes in social events and tours of area gardens, including several of the members' own."
Those taking the walk will have the chance to chat with members of the group. At least one will be stationed at each home to answer questions from those on the tour.
Take the tour:
What: 'A Weekend Stroll in our Gardens'
Hosts: Valley Garden Club of Bay County
When: 1-7 p.m. Aug. 3, 1-5 p.m. Aug. 4
Tickets: $8 in advance, $10 day of the event
Info: 989-686-3803, Valley Garden Club
Featured Gardens
The Richards garden, 6052 Old Hickory, Frankenlust Township
The gardens feature perennials and annuals in multiple beds. The gardens blend herbs, vegetables, a "square foot" garden and a fairy garden or two. Members of the Old Thyme Herb Society will field questions on growing and cooking with herbs.
The Heinz garden, 6044 Old Hickory, Frankenlust Township
The homeowners enjoy a relaxed, natural setting with an open field offering wildlife, including deer, rabbits, butterflies, and a variety of birds. Many of the accent stones are from the shores of Lake Huron near Port Sanilac. The current owners have been gradually adding more plants native to Michigan, including lilacs, boxwood, columbine, and much more. Keits Greenhouse & Floral will feature a selection of garden ornaments and statues to complement your landscaping and highlight your gardens.
The Cianek garden, 5387 Brookway, Monitor Township
The gardens at the Cianek home have evolved in the 10 years since the home was originally constructed. Landscape design is by the homeowners, and features a variety of annuals, perennials and flowering trees. Nature paths allow for exploration, and lead over the dry creek bed to a fire pit. New for 2013 is the Garden Room addition by R. L. Zuzula Builders, offering panoramic views of the garden in all seasons.
The Liebrand garden, 5320 Brookway, Monitor Township
Starting 10 years ago with an empty lot with no original plantings, the owners have created a pleasant and inviting landscape with a welcoming atmosphere. This house goes beyond curb appeal to create a friendly place to gather family and friends and enjoy the great outdoors. The gardens reflect a love of roses and include a wide variety of trees, shrubs, ornamentals, perennials and annuals. Members of the Rosarian Society will answer questions about rose horticulture.
The Weiler Garden, 1604 Carla Dr, Essexville
Hidden in a quiet, wooded court, this garden features an abundance of perennials and annuals complemented by elevated gardens, arbors, decorative statues, a fountain and a fire pit. The garden is enhanced by beautiful trees, bushes, shrubs and wildlife throughout. This garden invites visitors to sit back, relax and enjoy the pleasant scents and the magnificent colors. Bay Fabrication & Restoration (Zach Deary) will be present at this home with his collection of lawn art.
The Giffel Garden, 805 N. Powell, Essexville
This garden features the latest varieties of annuals and perennials, the result of careful experimentation and tender cultivation by the owner, a lifelong gardener and professional in the field of perennials. Tucked away from the road, this quintessential "Secret Garden" is a labor of love, and a hidden treasure. Staff from Abele Greenhouse & Landscape Center in Saginaw will discuss perennials zoned for our area.
Ticket sites
Begick Nursery and Garden Center, 5993 West Side Saginaw Road; Keit's Greenhouse & Floral Center, 1717 S. Euclid Ave.; Monitor Pharmacy, 2981 Midland Road; Maplewood Pharmacy, 920 N. Johnson St. Utermalen Furniture, 921 N. Johnson St.; Main Street Seed and Supply (Bay Farm, 401 Main St.; My Secret Garden, 600 Saginaw St.; Violet's Blue, 115 Fourth St.; Herman Hiss, 905 Washington Ave.; in Essexville at From Buds to Blooms, 1515 E. Center Road; in Auburn at Warmbier Farms, 5300 S. Garfield Road; and in Saginaw at Abele's Greenhouse & Garden Center, 3500 Wadsworth Road.


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St. Joseph Hill (6-0-2) took a major step forward in its quest for the Hilltoppers' first Island CHSAA title since 1990 on Saturday when they came away with a hard-fought 1-0 win over St. Joseph by-the-Sea in Huguenot.
The game's lone goal came eight minutes into the second half when Meghan Siller found Victoria Chirico for what proved to be the game-winner. The loss is the first of the season for Sea, which is now 5-1-2.
Check out a photo gallery from the game with shots from the Advance's Hilton Flores, and be sure to follow all the high school soccer action right here on the high school pages of SILive.com.


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January 15th, 2013
Tigers scheduled for two Sunday night games already
Remember when the Tigers were left out of the Sunday Night Baseball schedule when the first-half slate came out last year? Not surprisingly, the American League champions will get some early looks this season.
ESPN announced 10 more Sunday night broadcasts following the March 31 season opener between the Rangers and Astros, welcoming Houston to the American League. The Tigers will take part in two of those 10 — one at home against the Braves on April 28, the other on the road at Texas May 19. Both games will start around 8:05pm ET.
The April 28 game against the Braves comes in the middle of a 10-game homestand. Like most Sunday games, it was originally scheduled for a 1:05 start.
The game against the Rangers will close out a four-game series in Texas, after which the Tigers have an off-day to travel to Cleveland. The other three games in the series are also 8:05 ET starts, so it shouldn't be a big deal for them.
Seven eligible Tigers file for arbitration
It's a formality, but still worth noting that the seven Tigers eligible for arbitration all filed on Tuesday. The list includes three members of rotation (Doug Fister, Max Scherzer, Rick Porcello), two members of the starting lineup (Alex Avila, Austin Jackson), lefty Phil Coke and outfielder Brennan Boesch.
Basically, what it means is that none of them have apparently reached deals yet to avoid arbitration. There's still plenty of time for that, but the next big milepost in the process will come on Friday, when they'll exchange arbitration figures with the team. That's usually the step that gets both sides moving towards a deal, because it provides a range to use to find a middle ground. From there, the two sides have until at least Feb. 4 to negotiate before hearings begin taking place.
The Tigers have not had to go to an arbitration ruling since Dave Dombrowski took over as GM in 2002. They've come close a couple times, but usually they settle soon after the two sides exchange numbers.
Dombrowski: Tigers never made Soriano an offer
As many expected, Scott Boras got another team in on free-agent closer Rafael Soriano for a multi-year deal. As very few expected, it wasn't the Tigers.
While Soriano's two-year, $28 million deal with the Nationals made headlines around baseball Tuesday afternoon, the Tigers were left as observers. Whether they were ever actively involved on Soriano is now up for debate.
Team president/general manager Dave Dombrowski says they were not.
"We never made him an offer," Dombrowski told MLB.com in an email Tuesday. "Also, our conversations were exploratory like any other free agent player."
All along, it was apparent that agent Scott Boras' best chance at drawing the Tigers into the bidding was to bypass Dombrowski and engage owner Mike Ilitch, the same play he ran to get the Tigers in on Johnny Damon three years ago. Boras also went back to the playbook to try to engage the Tigers in public, strongly hinting that the Tigers shouldn't trust their ninth-inning leads to a rookie closer.
The exchange through the media, both Boras' address to reporters and Dombrowski's response to reporters the next day became one of the better shows of last month's baseball winter meetings in Nashville.
"It's a philosophical cliff in baseball that you can bring Minor League talent to the big leagues and know what you've got," Boras said at the time. "The evidence says that there are many young players in our game that are 20, 21 that can hit 30 home runs and drive in 100 runs and they're extraordinary talents. Or win 15 games. But there's never been closers that can come in and get 30 saves. I think you count on one hand the number of closers under the age of 23 that have ever gone to the big leagues and at a young age put together 30 saves, let alone pitch in the postseason and be effective."
When asked about the remarks a day later, Dombrowski said, "He's entitled to his opinion, as everybody else is, but it's one of those things where we like our situation."
None of that completely extinguished the speculation that the Tigers would eventually get involved. As recently as this morning, Richard Justice suggested on MLB Network that industry people expected the Tigers to eventually express interest. Maybe, maybe, they eventually would have on a short-term deal, but they weren't going to make a multi-year offer.
Even that, however, was far from secure, because signing Soriano would've required the Tigers to give up their first-round pick. They've gone without one for the last three drafts, but with the new draft rules and salary pool implications, they didn't want to do it now.
Soriano's deal with Washington pretty much guarantees the Tigers will keep the pick, currently scheduled as the 21st overall selection. Though speedy outfielder Michael Bourn and right-handed starter Kyle Lohse are still free agents requiring draft compensation, the Tigers are not believed to be involved on either one. They have six starting pitchers as it is.
All offseason, Dombrowski has stuck to the same plan. Bruce Rondon and his 102 mph fastball projects as the closer of the very near future, and the Tigers weren't going to commit long-term to a free agent that blocked his path. Between Rondon, who turned 22 years old last month, and veteran setup man Joaquin Benoit, Phil Coke and Octavio Dotel, the Tigers believe they're covered in the ninth inning. If the bullpen struggles early, they could try to swing a deal at the deadline, much as they did with their rotation the last couple years.


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By telegramsam
November 26, 2010
A. B. Yehoshua in Haaretz makes the excellent point that if you want to really, really be a Zionist, there's only one place for it: Israel.
Zionism is not a concept that is supposed to replace patriotism or pioneering. Patriotism is patriotism, and pioneering is pioneering. An officer who extends his military service, or someone who settles in the Negev, is no more of a Zionist than a grocer in Tel Aviv, but they are perhaps more pioneering or more patriotic, depending on the meanings allotted to these concepts.
The concept of Zionism is dear to us, and therefore it is important that it find expression only in its rightful place: in the difference between us and the Jews of the Diaspora or the exile. The exaggerated and superfluous use of the term also blurs the ethical debate between Jews who have decided to be responsible, for good or for ill, for every aspect of their lives within a defined territory and under self government, and those who live enmeshed in other nations and practice their Jewish identity partially, through study, religious texts and limited communal activities.
Perhaps those, from the left, right and centre, whose communal life is dominated by Israel this and Israel that, should go there, pay its taxes, vote in its elections, have their sons and daughters serve in its military.


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LEONIA — The northern end of the New Jersey Turnpike by the George Washington Bridge is open again, more than two hours after emergency repairs to a dangling power line shut the roadway and created a traffic nightmare during the evening rush.
The Turnpike had been closed in both directions from Exit 71 in Leonia to the George Washington Bridge, north of the Vince Lombardi Service Area, while PSE&G did emergency work on a power line that crossed the roadway, Turnpike spokesman Tom Feeney said.
The roadway was reopened just before 7 p.m.
It's only a 2-mile stretch, but a critical link of the Turnpike in the heavily traveled Interstate 95 corridor of New York City.
Outbound delays of an hour were reported on the George Washington Bridge, and traffic was detoured to Route 4, Routes 1&9 and Route 46, officials said.
The delays were part of two days of travel hell in New Jersey in the workweek after Hurricane Sandy, and came on the heels of a day in which trains were so full that some passengers stood in the bathrooms.
Related coverage:
• Downed power lines close NJ Turnpike near George Washington Bridge


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Filing time nears for candidates
By Dennis Box-The Courier-Herald
The election bells are ringing and the filing period is right around the corner.
The first day for candidates seeking public office to file is June 4 and the period runs through June 8.
According to Lori Augino, Pierce County election manager, people must either come into the office or file by mail. Candidates filing by mail must send a notarized application with the correct filing fee.
There are four City Council position open this year in Bonney Lake. The filing fee is $48 for council seats.
Council seat No. 2, which is at-large and currently occupied by Mark Hamilton, is open. Ward No. 2 seat is open, Jim Rackley is the current member, and Ward No. 3 is up, represented by Cheryle Noble. Phil Deleo's seat in Ward No. 5 is also up this year.
Each of the council positions are four-year terms.
There are three Sumner School Board seats up for election: District 2, held by Jeff DeMarre; District 3, represented by Antoni H. Froehling; and District 4, Greg Hanon.
There is no filing fee for school board seats and the terms are four years.
Fire Commission seat No. 1 in East Pierce Fire and Rescue Fire District 22 is open. There is no filing fee and it is a six-year term.
Port Commission Position No. 3 is open. The term is four years and the filing fee is $60.
The filing period was moved this year to June from the end of July because the state Legislature set the state primary for Aug. 21, about a month earlier then in previous years.
"When the Legislature move the primary we had to move the filing date," Augino said. "The primary was moved so we get ballots mailed to military personnel and people living overseas. With the old primary dates we only had a couple of days to mail the ballots, so any delays in certification would affect overseas voters."
The Pierce County Auditor's office is at 2401 S. 35th St. Room 200, Tacoma. The phone number is 253-798-7427 and the Web site is www.piercecountywa.org.
Dennis Box can be reached at email@example.com.
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