Babe of the Week: Jenny McCarthy

<div dir="ltr" style="text-align: left;" trbidi="on">IWS is proud to announce that our Babe of the Week for this week is none other than Jenny McCarthy!<br /><br />Jenny began her amazing career as a Playboy Centerfold way back in 1993. <br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnRgFhXpsi_Rmmw74dPIK2VQeOKuUJRyjiKegEa4UZ9DwTZABYGCV6WAfzrFmDF_R25ANrboH9U0UNi3fU8wnLScfsiFgSgG7T-utFl-vr-_nhOldosYPXDWeNN1D3EKdUUo0ggUCZKWw/s1600/Jenny+McCarthy+Nude+Bikini+Hot.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnRgFhXpsi_Rmmw74dPIK2VQeOKuUJRyjiKegEa4UZ9DwTZABYGCV6WAfzrFmDF_R25ANrboH9U0UNi3fU8wnLScfsiFgSgG7T-utFl-vr-_nhOldosYPXDWeNN1D3EKdUUo0ggUCZKWw/s400/Jenny+McCarthy+Nude+Bikini+Hot.jpg" width="265" /></a></div><br />From there she landed a spot on one of my favorite game shows of all time, MTV’s “Singled Out!” <br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZiL2Rl-m3_hDTzMYsn624dzWV5TC76YqhzzZlOU74Sgmkc0a2tMDUkRN0jfRM_btiEyTIHvoH1CP66hfmX9SGR-GDqz9F_poA0PzH2WYws0SGaCOgjIa8m_yPevoRkWbCCKmeYtBVt7I/s1600/Jenny+McCarthy+Upskirt.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZiL2Rl-m3_hDTzMYsn624dzWV5TC76YqhzzZlOU74Sgmkc0a2tMDUkRN0jfRM_btiEyTIHvoH1CP66hfmX9SGR-GDqz9F_poA0PzH2WYws0SGaCOgjIa8m_yPevoRkWbCCKmeYtBVt7I/s400/Jenny+McCarthy+Upskirt.jpg" width="276" /></a></div><br />After that she married comedic actor Jim Carrey and became a movie star. <br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8whX0-1KQfGcefKBUTZV3lz-sabsxsFCcCgCBC0dmjtCZirtN0bEIBS82hEh7rdFwN2LA3gY6QhGva3PvWobBq9HHE68g0dbKKWN02kg0LeGs4By4aN9orPNGuQ2SN6BQoJviwA9X4_o/s1600/Jenny+McCarthy+Yoga+Abs+Hot.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8whX0-1KQfGcefKBUTZV3lz-sabsxsFCcCgCBC0dmjtCZirtN0bEIBS82hEh7rdFwN2LA3gY6QhGva3PvWobBq9HHE68g0dbKKWN02kg0LeGs4By4aN9orPNGuQ2SN6BQoJviwA9X4_o/s400/Jenny+McCarthy+Yoga+Abs+Hot.jpg" width="281" /></a></div><br />Now she’s a correspondent for Dick Clark’s Rockin’ New Year’s Eve and is also one of the world’s leading authorities on Autism. <br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSzWHEmR0784822uzM_HxCJsUtBOYh08JjSW9pt54iCHiAGiIPAkoarFMoG7RssCiGCGgJotsciKHEIOoZ3HdFXWMPrQnYl4dcdavtkaK15_03ddyCa4zkZ2sY02x9-xhaS1vHESWlwm4/s1600/Jenny+McCarthy+Dance+Sexy+Drunk.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSzWHEmR0784822uzM_HxCJsUtBOYh08JjSW9pt54iCHiAGiIPAkoarFMoG7RssCiGCGgJotsciKHEIOoZ3HdFXWMPrQnYl4dcdavtkaK15_03ddyCa4zkZ2sY02x9-xhaS1vHESWlwm4/s400/Jenny+McCarthy+Dance+Sexy+Drunk.JPG" width="200" /></a></div><br /><br />So, as you can see, there’s more to Jenny than great boobs and a hot ass. She smart, hard-working and very accomplished. And now she has IWS Babe of the Week to add to her trophy case! <br /><br />In other news we had a sad, yet still wonderful show last night on I’m With Stupid. Man, did we bring the heartache! It was just one sad story after another. Everything from losing basketball games to Lance Armstrong to people who personally have let us down. Make sure you have a box of tissues close by when you listen to this one. <br /><br /><object classid="clsid:D27CDB6E-AE6D-11cf-96B8-444553540000" codebase="http://download.adobe.com/pub/shockwave/cabs/flash/swflash.cab#version=9,0,0,0" height="105" id="143577" name="143577" width="210"><param name="movie" value="http://www.blogtalkradio.com/btrplayer.swf?file=http://www.blogtalkradio.com%2Fplaylist.aspx%3Fshow_id%3D4226361&autostart=false&bufferlength=5&volume=80&corner=rounded&callback=http://www.blogtalkradio.com/flashplayercallback.aspx" /><param name="quality" value="high" /><param name="wmode" value="transparent" /><param name="menu" value="false" /><param name="allowScriptAccess" value="always" /><embed src="http://www.blogtalkradio.com/btrplayer.swf" flashvars="file=http://www.blogtalkradio.com%2Fplaylist.aspx%3Fshow_id%3D4226361&autostart=false&shuffle=false&callback=http://www.blogtalkradio.com/FlashPlayerCallback.aspx&width=210&height=105&volume=80&corner=rounded" width="210" height="105" type="application/x-shockwave-flash" pluginspage="http://www.macromedia.com/go/getflashplayer" quality="high" wmode="transparent" menu="false" name="143577" id="143577" allowScriptAccess="always"></embed></object><br /><div style="font-size: 10px; text-align: center; width: 220px;">Listen to <a href="http://www.blogtalkradio.com/">internet radio</a> with <a href="http://www.blogtalkradio.com/im-with-stupid">Im With Stupid</a> on Blog Talk Radio<br /><br /><br /></div></div>

Babe of the Week: Jenny McCarthy

IWS is proud to announce that our Babe of the Week for this week is none other than Jenny McCarthy! Jenny began her amazing career as a Play...

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Homeward bound.....

<p>We had a lovely last KW meal in Santiago's Bodega. </p><p>Sadly we get on the road for Fort Lauderdale tomorrow morning. After spending a night there we then fly back to Ireland on Monday and will arrive in to Dublin on Tuesday morning.  We are sad to leave the island after a wonderful holiday.</p>

Homeward bound.....

We had a lovely last KW meal in Santiago's Bodega. Sadly we get on the road for Fort Lauderdale tomorrow morning. After spending a night...

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Home Spa Review and Giveaway

<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj30tQrlNed1yijd7iuZom1K2_of8kwwYz59FzPfxnik9JNvQ_4FWnkKTwjiiA0RYeA4EM0wJtTp1_APUvJHS0WoKlK9U5jcumw3wH7rhhzqyAdPH04a8uUB5XOkqmsgT-SnKDt2nr2_30/s1600/home+spa.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="112" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj30tQrlNed1yijd7iuZom1K2_of8kwwYz59FzPfxnik9JNvQ_4FWnkKTwjiiA0RYeA4EM0wJtTp1_APUvJHS0WoKlK9U5jcumw3wH7rhhzqyAdPH04a8uUB5XOkqmsgT-SnKDt2nr2_30/s320/home+spa.jpeg" width="320" /></a></div><div style="text-align: center;"><u><span style="font-family: Verdana, sans-serif;"><br /></span></u></div><div style="text-align: center;"><u><span style="font-family: Verdana, sans-serif;"><br /></span></u></div><div style="text-align: center;"><u><span style="font-family: Verdana, sans-serif;">Home Spa </span></u></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Feel like all you do all day long is run around?</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">I get it, you just want time to relax and unwind with a great book, a spa treatment, a movie or a hot bath.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">With going to the spa it gets pricey.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Why not have the aroma of a spa in your own home with Home spa shower sprays!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">With the scent of these  100% all natural shower sprays  they clear your mind  and make you feel at ease,using the treatments found within spas.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiS_rQx426fy9sm9q14F36UUp8SFzqIC13m_PzE8AP2B4zo9My_aL1hKNziJ_G8NvRbNWYA9Vo_tJmo4xb4oK1aBeximYo-hJcsza9nLGJZtzdtiERJ5xG0zXhqHniGvHT-6ACn5DQJenQ/s1600/homespa.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiS_rQx426fy9sm9q14F36UUp8SFzqIC13m_PzE8AP2B4zo9My_aL1hKNziJ_G8NvRbNWYA9Vo_tJmo4xb4oK1aBeximYo-hJcsza9nLGJZtzdtiERJ5xG0zXhqHniGvHT-6ACn5DQJenQ/s320/homespa.jpg" width="320" /></a></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Give the bottle a little shake first, start the shower, bath or whirlpool tub,then pump three sprays into your shower stream then hop in and let the scents of the home spa take you away.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">You will feel so relaxed and like you are at a spa in no time.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Scents:</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u>Lavender:</u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7EulzpIMwR0KfX059cuCanYdyxjDU92zj75mOI6rgWkHwSL-sNN_rlCbUSmIdgrZ1im9OQfo1jYptff8LrY0mP_kCnZjK03cpiDocuQxLcsUk-mKv8ldOUUbw8U2in1IiARv2YgpyvRw/s1600/lavender.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7EulzpIMwR0KfX059cuCanYdyxjDU92zj75mOI6rgWkHwSL-sNN_rlCbUSmIdgrZ1im9OQfo1jYptff8LrY0mP_kCnZjK03cpiDocuQxLcsUk-mKv8ldOUUbw8U2in1IiARv2YgpyvRw/s320/lavender.jpg" width="320" /></a></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"> let all of your worries be put to rest and relax and unwind with the sweet and relaxing scent of Lavender.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u>Pink Grapefruit:</u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTzNzbYoHplqTRxvNJ2jICwdV1CkTv01D3pcYnzaweqm9hoobkuKYvrYM-yHmj_DjyiXdgeohRVtVviLjfQpvRiWvl2wdvX3WUI2R-HXvJYLyAleKxS8-TD5nTj6mtgtNSLOQMTHd3vxA/s1600/pink+grapefruit.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTzNzbYoHplqTRxvNJ2jICwdV1CkTv01D3pcYnzaweqm9hoobkuKYvrYM-yHmj_DjyiXdgeohRVtVviLjfQpvRiWvl2wdvX3WUI2R-HXvJYLyAleKxS8-TD5nTj6mtgtNSLOQMTHd3vxA/s320/pink+grapefruit.jpg" width="320" /></a></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Love the smell of the candles burning inside of the spa while your getting a massage?</span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Your bathroom will be smelling like it in no time with the exotic scent of Pink Grapefruit!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u>Eucalyptus: </u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimctQhnwOKs_xhBIV_JOoeYnlWpZv7nXJ_nvUfs8ZWLuVJahHQR14yuMJeD_lMw_7SqsJv2nepPgcZw1-8ukBqvA5S4T4I6zPF7UMQThIwjQUaTYxaui8ZkjB4tJSB9x8K1q4pHYSlUEc/s1600/Eucalyptus.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimctQhnwOKs_xhBIV_JOoeYnlWpZv7nXJ_nvUfs8ZWLuVJahHQR14yuMJeD_lMw_7SqsJv2nepPgcZw1-8ukBqvA5S4T4I6zPF7UMQThIwjQUaTYxaui8ZkjB4tJSB9x8K1q4pHYSlUEc/s320/Eucalyptus.jpg" width="320" /></a></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Have a sinus infection?</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Put on a pot of tea or coffee, grab a book and relax and unwind.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Pump some spray in the shower stream, then get in and relax</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">with the detoxifying scent of Eucalyptus to help you say goodbye to those pesky sinus infections! </span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u>Tangerine:</u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLuwiMwoyEdr9a7PEpPEsum4IGO5gega6-WfudZuYx0g4x-67yNQ9Sxc2DMxfjIoAkxR6XViW08JJSebGLFwSPGEteMfTfqqcD4PEHw_FHoQoCYykwFaqZa9IwoYGbBGdMEisaRIkmFrQ/s1600/tangerine.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLuwiMwoyEdr9a7PEpPEsum4IGO5gega6-WfudZuYx0g4x-67yNQ9Sxc2DMxfjIoAkxR6XViW08JJSebGLFwSPGEteMfTfqqcD4PEHw_FHoQoCYykwFaqZa9IwoYGbBGdMEisaRIkmFrQ/s320/tangerine.jpg" width="320" /></a></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Not only will you feel like your at a spa but you will feel like you are on a tropical vacation!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Talk about soothing!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">1. Enter to win by telling me what do you do to unwind after a long day?</span></div><br /><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Want an extra entry? </span></div><br /><br /><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">2. Follow my blog.</span></div><br /><br /><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">3.Then also follow me via Twitter, here. https://twitter.com/kelli_bliss </span></div><br /><br /><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">4. then tweet about the giveaway and make sure you use #HomeSpa</span></div><br /><br /><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">5. leave me a link here to your tweet.</span></div><br /><br /><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Note that 5 winners will be selected and best of all you get to pick the scent of your choice! </span></div><br /><div style="text-decoration: underline;"><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Good Luck!</span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Best of all they are online and you can order these wonderful amazing shower sprays and they will be shipped to your house the next day!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">Winners are Gina, Tricia, Janette, Meg and Jennie! Congratulations ladies!! </span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Check them out here!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><a href="http://homespashowerspray.com/">http://homespashowerspray.com/</a></span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Or Here on Face Book!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><a href="https://www.facebook.com/pages/Home-Spa-Shower-Spray/281369181923788?ref=tn_tnmn">https://www.facebook.com/pages/Home-Spa-Shower-Spray/281369181923788?ref=tn_tnmn</a></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div>

Home Spa Review and Giveaway

Home Spa  Feel like all you do all day long is run around? I get it, you just want time to relax and unwind with a great book, a spa treatme...

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Book Review: Cabinet Issue 47: Logistics

<a href="http://cabinetmagazine.org/issues/47/index.php"><b><i>Cabinet Issue 47: Logistics</i></b></a><br />Cabinet Magazine, 2012<br />Paperback, 112 pages<br /><br /><img alt="book-cabinet47.jpg" src="http://www.archidose.org/Blog/book-cabinet47.jpg" title="Cover of Logistics" /><br /><br />I've seen <a href="http://cabinetmagazine.org/"><i>Cabinet</i></a> magazine in bookstores a number of times, but it wasn't until issue 47 that I went ahead and bought one. It's partly the cover that lured me into it—a photograph by Christoph Morlinghaus "of a plant outside Los Angeles that manufactures metal beverage cans." Strongly linked to the issue's theme of "Logistics," the peek into hidden yet crucial spaces in our consumer culture is very appealing to me. Fortunately, the issue is not limited to visually revealing the spaces for the storage and transport of goods, as in the cover; it explains how these spaces work and their crucial roles in the global economy.<br /><br />The editors do not attempt to encapsulate the essays with an introduction, instead letting each author or interviewee add their voice to the mix. While logistics can be defined as "the detailed coordination of a complex operation involving many people, facilities, or supplies," the eight contributors hone in on storage, shipping, and retail. The companies one might expect in these terms are well represented: UPS, FedEX, USPS, Amazon.com, but so are things like the Traveling Salesman Problem, <a href="http://cabinetmagazine.org/issues/47/twilley.php">cold storage for food</a>, and the Universal Product Code, or UPC, what might be the key to all of today's logistical possibilities.<br /><br />As a "magazine of art and culture," I'm glad to see <i>Cabinet</i> tackle a theme that has the potential to be great, zonk-yourself-out-at-bedtime reading. But <a href="http://cabinetmagazine.org/issues/47/index.php">the authors</a> skillfully illustrate the complexity of logistics, as well as how the polar scales of it all—the enormity of warehouses, networks, and infrastructure versus the individual items that we buy at the store or arrive at our door. It gives me a greater understanding of just what happens when I buy something (and makes me questions just such an act), but it also leaves me wondering what the theme for Issue 48 might be.<br /><br /><b>US: <a href="http://www.amazon.com/gp/product/1932698469/ref=as_li_qf_sp_asin_il_tl?ie=UTF8&tag=aweeklydoseof-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=1932698469" target="_blank"><img alt="Buy from Amazon.com" border="0" src="http://www.archidose.org/books/buy-from-tan.gif" /></a> CA: <a href="http://www.amazon.ca/gp/product/1932698469/ref=as_li_qf_sp_asin_il_tl?ie=UTF8&tag=aweeklydoseof-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=1932698469" target="_blank"><img alt="Buy from Amazon.ca" border="0" height="28" src="http://www.archidose.org/books/buy-from-tan-ca.gif" width="90" /></a> UK: <a href="http://www.amazon.co.uk/gp/product/1932698469/ref=as_li_qf_sp_asin_il_tl?ie=UTF8&tag=aweeklydoseof-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=1932698469" target="_blank"><img alt="Buy from Amazon.co.uk" border="0" height="28" src="http://www.archidose.org/books/buy-from-tan-uk.gif" width="90" /></a></b>

Book Review: Cabinet Issue 47: Logistics

Cabinet Issue 47: Logistics Cabinet Magazine, 2012 Paperback, 112 pages I've seen Cabinet magazine in bookstores a number of times, but...

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Better, if Not Cheaper, Care for the Dying - NYTimes.com

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><div id="opinionator" style="color: rgb(0, 0, 0); font-family: Georgia, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div align="left"><div class="entry-content"><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">It is conventional wisdom that end-of-life care is an increasingly huge proportion of health care spending. I've often heard it said that people spend more on health care in the year before they die than they do in the entire rest of their lives. If we don't address these costs, the story goes, we can never control health care inflation.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">Wrong. Here are the real numbers. The roughly 6 percent of Medicare patients who die each year do make up a large proportion of Medicare costs: 27 to 30 percent. But this figure has not changed significantly in decades. And the total number of Americans, not just older people, who die every year - less than 1 percent of the population - account for much less of total health care spending, just 10 to 12 percent.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">The more important issue is that just because we spend a lot on end-of-life care does not mean we can save a lot. We do know that costs for dying patients vary widely among hospitals, which suggests that we can do better. And yet no one can reliably say what specific changes would significantly lower costs. There is no body of well-conducted research studies that has proved how to save 5, 10, much less 20 percent.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">Recent studies find that hospice may reduce costs in the last year of life for cancer patients by 10 to 20 percent. But they find no savings from hospice care for patients who die of other conditions, like emphysema or heart failure. No one is sure why hospice care doesn't save more. It may be because patients are enrolled in hospice care too late, or because hospice services themselves are labor-intensive and not cheap.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">Even if we can never save a dime, however, there are good reasons to think about changing end-of-life care practices. While end-of-life care has improved considerably over the last 30 years, many Americans still die in hospitals when they would rather die at home. Nearly 20 percent of deaths occur in an intensive care unit or immediately after discharge, and too many patients experience symptoms like pain that are controllable with appropriate palliative care.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">Here are four things the health care system should do to try to improve care for the dying, even if they won't save money.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">First, all doctors and nurses should be trained in how to talk to patients and families about end-of-life care. When I was starting out, I was lucky enough to be able to witness how a great oncologist communicated with patients and their families when it was clear they were going to die, but I received no formal training whatsoever. It is hard to improve care for the dying if health professionals don't know how to talk about it. Fortunately, there are excellent communication techniques and training programs available - they don't have to be invented from scratch.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">A related intervention - an idea that never actually was in the Affordable Care Act but inspired the death panel accusation - is that physicians should be paid a one-time fee to talk with patients about their preferences for end-of-life care. Even if physicians are well trained in communication, these conversations take time and are emotionally draining. This should be recognized through compensation.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">Third, every hospital should be required to have palliative care services available both in the hospital and at the homes of dying patients who are discharged. Over 40 percent of hospitals with more than 50 beds do not have palliative care services. And we don't know how many actually have palliative care services once patients are sent home. These services should be delivered by trained experts in diagnosing and managing common symptoms of the dying, like pain, nausea, insomnia, shortness of breath, fatigue and depression.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">Finally, we need to revise eligibility for hospice care. Right now doctors must certify that patients have six months or less to live and patients must agree to forgo life-sustaining treatments. The decision about whether to put a patient in hospice care should not be based on unreliable predictions about how long he has left to live but rather on his needs for specialized care, like morphine infusions.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">These changes could be made in at least two ways. <a href="http://www.jointcommission.org/about_us/about_the_joint_commission_main.aspx" style="color: rgb(0, 0, 102); text-decoration: none; ">The Joint Commission</a> - the nonprofit group that certifies health care organizations - could make training physicians and nurses to talk about end-of-life care and having palliative care available a requirement for hospital accreditation. Alternatively, Medicare, private insurers and, after 2014, state exchanges could require hospitals to provide communication training and palliative services as a condition for payment.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">Unfortunately, there is no evidence that these interventions will save money. And I can't definitively prove they will make the care of dying patients better. But doing nothing to try to help the dying when the rest of the health care system is improving care is not an option.</div></div></div></div></div><a href="http://opinionator.blogs.nytimes.com/2013/01/03/better-if-not-cheaper-care/?pagewanted=print">http://opinionator.blogs.nytimes.com/2013/01/03/better-if-not-cheaper-care/?pagewanted=print</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Better, if Not Cheaper, Care for the Dying - NYTimes.com

It is conventional wisdom that end-of-life care is an increasingly huge proportion of health care spending. I've often heard it said tha...

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God's Surgeons in Africa - Brian Till - The Atlantic

<base href="data:"></base><br /><div style="color: black; font-family: Helvetica; font-size: 14px; text-align: left;"><div style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: white; color: black; font-family: Georgia, 'times new roman', times, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px;"></div><div style="border: 0px; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 24px; margin-bottom: 10px; margin-top: 10px; outline: 0px; padding: 0px; vertical-align: baseline;">In 1994, God told David Thompson to start training surgeons in Africa. Thompson was in the fifteenth year of a mission to Gabon at the time, in West Africa. "I just realized that I couldn't keep up with the demand," Thompson told me. "I was just operating night and day and I knew I was going to burn out. And I knew that when I burned out I was going to leave, and that everything would go back to the way it was before I arrived."</div><div style="border: 0px; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 24px; margin-bottom: 10px; margin-top: 10px; outline: 0px; padding: 0px; vertical-align: baseline;">Thompson is tall. He wears a mustache, and has deep creases alongside his eyes and mouth. I asked him how God had spoken to him. "I had a habit of spending about an hour a day early in the morning reading the Bible and praying and meditating on it and listening to see what God said to me," he said. Thompson grew up at a mission in Cambodia, and while he was a senior in college, in Pittsburgh, both of his parents were killed amid the Tet Offensive in Vietnam, where they were serving as missionaries. "Often times, in those moments, when I would be saying, 'God what are you telling me?' I would just get a very clear thought in my mind: 'You need to do this, this is how you can solve this problem.'"</div><div style="border: 0px; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 24px; margin-bottom: 10px; margin-top: 10px; outline: 0px; padding: 0px; vertical-align: baseline;">The need for surgeons in sub-Saharan Africa is so profound that it's genuinely difficult to comprehend. "I was born by C-section, and when I was two months old I had an emergency operation on my stomach. When I was 23, I had appendicitis," Adam Kushner, a lecturer at Columbia Medical School, told me. "Those are three relatively simple procedures. A lot of people that have problems like those in say, Sierra Leone, just die," he said. "I mean, can you imagine a kid falling out of a tree, and then being disabled for the rest of their life because they couldn't get their arm fracture fixed? It's insane." Kushner's organization, <a href="http://www.humanitariansurgery.org/" style="border: 0px; color: #00598c; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">Surgeons OverSeas</a>, estimates 56 million people are in need of surgical care on the continent -- twice the population suffering from HIV/AIDS.</div><div style="border: 0px; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 24px; margin-bottom: 10px; margin-top: 10px; outline: 0px; padding: 0px; vertical-align: baseline;">In 2009, Kushner worked with the Ministry of Health in Sierra Leone on an audit of the country's surgical capacity. Sierra Leone has a population of six million, roughly the size of Los Angeles and Houston combined, and the study found nine surgeons practicing in the country. The World Health Organization (WHO) estimates that a health system needs one surgeon for every 20,000 citizens to meet the burden of disease. By that measure, Sierra Leone has a shortage of 291 surgeons.</div><div style="border: 0px; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 24px; margin-bottom: 10px; margin-top: 10px; outline: 0px; padding: 0px; vertical-align: baseline;">The deficit is equally dire elsewhere in Africa. Kenya and Uganda, with two of the continent's strongest medical education systems, have 355 and 100 surgeons respectively, meeting 19 percent and 7.4 percent of need based on WHO projections. Rwanda has 35. "Everyday I see things that just make me rage inside," Jim Brown, a missionary surgeon in Cameroon, told me.</div><div style="border: 0px; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 24px; margin-bottom: 10px; margin-top: 10px; outline: 0px; padding: 0px; vertical-align: baseline;">The results of these deficits are often horrific, as surgical procedures that should be safe and routine -- appendectomies, caesarian sections, and amputations, for instance -- are carried out by general practitioners with little or no training, rather than surgeons. "Every week, almost every day, we have someone in here draining stool from an abdominal incision, or a ureter tied off, or the wrong operation done somewhere else," Brown said, standing atop a ward with 70 beds stretching in three directions. "And very often they die." Brown is slight, with an insufferably honest face and a subtle trace of southern to his locution.</div><div style="border: 0px; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 24px; margin-bottom: 10px; margin-top: 10px; outline: 0px; padding: 0px; vertical-align: baseline;">"The ones that really get me are the ones that are told they had surgery -- they get anesthesia and incisions and they take their money, but they don't actually operate. They usually come up here after their third or fourth attempt somewhere else, and they've never had a fistulectomy, or a myomectomy, or whatever it is they need." At another hospital where Brown worked, prior to moving to Mbingo, he found that O.R. staff members were performing surgeries themselves after hours and on weekends.</div><div style="border: 0px; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 24px; margin-bottom: 10px; margin-top: 10px; outline: 0px; padding: 0px; vertical-align: baseline;">"One of the biggest problems I see," Kushner told me, "is that ministries of health are hesitant to pursue surgical programs because the donors don't want it. The money is coming in and earmarked for certain programs. And even though you see a need for another type of program, you don't want to piss off your donors. There's this perception that surgery is expensive."</div><div style="border: 0px; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 24px; margin-bottom: 10px; margin-top: 10px; outline: 0px; padding: 0px; vertical-align: baseline;">In 1994, David Thompson took the message he received -- to pivot from performing surgery to teaching it -- to a meeting of missionary surgeons in Brackenhurst, Kenya. The vision was to post a U.S. board-certified surgeon at a Christian hospital with reasonable capacity, and to augment the teaching by luring other surgeons, perhaps 10 or 15 each year, to visit the hospital for short-term teaching stints. Almost no one thought it could work.</div><div style="border: 0px; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 24px; margin-bottom: 10px; margin-top: 10px; outline: 0px; padding: 0px; vertical-align: baseline;">Thompson took on his first resident in 1997, in Gabon, as a pilot program. "Within about five years I had enough help that I got my life back. And the other hospitals saw that it was working and it kind of starting spreading," Thompson said. The organization grew in fits and starts, some early programs going under while others managed to flourish. In 2011, Thompson's organization, the <a href="http://www.cmda.org/wcm/CMDA/Navigation/Missions/PanAfricanAcademyofSurgeons/PAN_AFRICAN_ACADEMY_.aspx" style="border: 0px; color: #00598c; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">Pan African Academy of Christian Surgeons </a>(PAACS), was training 43 residents at 10 hospitals across the continent. It has 28 graduates, all of whom remain in Africa, working for underserved populations. The organization's operating budget for 2011 was $550,000.</div><div style="border: 0px; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 24px; margin-bottom: 10px; margin-top: 10px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="background-color: white;">Mbingo Hospital is tucked high in a lush valley near Bamenda, a city of half a million in northwest Cameroon. It's the home of the largest residency run by PAACS, and Jim Brown, from South Carolina, is the program's associate director. The site was founded as a leprosy clinic in 1952, and became a hospital a decade later. Today, it's a sprawl of low yellow buildings with red metal roofs. The entire place looks like it was laid with perfect rolls of sod, millennia ago, and then left to grow wild.</span></div><div style="border: 0px; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 24px; margin-bottom: 10px; margin-top: 10px; outline: 0px; padding: 0px; vertical-align: baseline;">On my first night at the hospital, I asked a visiting pediatric surgeon, Jacob Stephenson, who trained at UCSF and University of Washington, how the skill of the PAACS trainees compared to that of his residents at home in Virginia. "In terms of technical skills, I would say they're comparable, maybe even a little better," he said. "In other ways I'd say they're stronger." Overwhelmingly, the string of surgeons that visited Mbingo while I was there agreed with Stephenson's assessment, particularly on the strength of the residents' diagnostic skills and judgement. "They are very good at problem solving and making clinical decisions with much less technology to rely on," Stephenson said. "You can't just tick a box and order a CT scan. That means you have to get very good with other ways of assessing a patient."</div><br /><div style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: white; color: black; font-family: Georgia, 'times new roman', times, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; position: static; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; z-index: auto;">More ...</div></div><a href="http://www.theatlantic.com/health/archive/2012/12/gods-surgeons-in-africa/266635/?src=longreads">http://www.theatlantic.com/health/archive/2012/12/gods-surgeons-in-africa/266635/?src=longreads</a><br /><div style="color: black; font-family: Helvetica; font-size: 14px; text-align: left;"><br class="webkit-block-placeholder" /></div>

God's Surgeons in Africa - Brian Till - The Atlantic

In 1994, God told David Thompson to start training surgeons in Africa. Thompson was in the fifteenth year of a mission to Gabon at the time,...

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