If this was a pill, you’d do anything to get it - Washington Post

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">When Ken Coburn has visitors to the cramped offices of Health Quality Partners in Doylestown, Pa., he likes to show them a graph. It's not his graph, he's quick to say. Coburn is not the sort to take credit for other's work. But it's a graph that explains why he's doing what he's doing. It's a graph he particularly wishes the folks who run Medicare would see, because if they did, then there's no way they'd be threatening to shut down his program.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">The graph shows the U.S. death rate for infectious diseases between 1900 and 1996. The line starts all the way at the top. In 1900, 800 of every 100,000 Americans died from infectious diseases. The top killers were pneumonia, tuberculosis and diarrhea. But the line quickly begins falling. By 1920, fewer than 400 of every 100,000 Americans died from infectious diseases. By 1940, it was less than 200. By 1960, it's below 100. When's the last time you heard of an American dying from diarrhea?</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">"For all the millennia before this in human history," Coburn says, "it was all about tuberculosis and diarrheal diseases and all the other infectious disease. The idea that anybody lived long enough to be confronting chronic diseases is a new invention. Average life expectancy was 45 years old at the turn of the century. You didn't have 85-year-olds with chronic diseases."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">With chronic illnesses like diabetes and heart disease you don't get better, or at least not quickly. They don't require cures so much as management. Their existence is often proof of medicine's successes. Three decades ago, cancer typically killed you. Today, many cancers can be fought off for years or even indefinitely. The same is true for AIDS, and acute heart failure and so much else. This, to Coburn, is the core truth, and core problem, of today's medical system: Its successes have changed the problems, but the health-care system hasn't kept up.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Kenneth Thorpe, chairman of the health policy and management school at Emory University, estimates that 95 percent of spending in Medicare goes to patients with one or more chronic conditions — with enrollees suffering five or more chronic conditions accounting for 78 percent of its spending. "This is the Willie Sutton rule," he says. "If 80 percent of the spending is going to patients with five or more conditions, that's where our health-care system needs to go."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Health Quality Partners is all about going there. The program enrolls Medicare patients with at least one chronic illness and one hospitalization in the past year. It then sends a trained nurse to see them every week, or every month, whether they're healthy or sick. It sounds simple and, in a way, it is. But simple things can be revolutionary.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Most care-management systems rely on nurses sitting in call centers, checking up on patients over the phone. That model has mostly been a failure. And while many health systems send a nurse regularly in the weeks or months after a serious hospitalization, few send one regularly to even seemingly healthy patients. This a radical redefinition of the health-care system's role in the lives of the elderly. It redefines being old and chronically ill as a condition requiring professional medical management.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Health Quality Partners' results have been extraordinary. According to an independent analysis by the consulting firm Mathematica, HQP has reduced hospitalizations by 33 percent and cut Medicare costs by 22 percent.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Others in the profession have taken notice. "It's like they've discovered the fountain of youth in Doylestown, Pa.," marvels Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Now Medicare is thinking of shutting it off.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; "><strong style="margin: 0px; padding: 0px; ">Lucrative potential</strong></p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">The origin of Doylestown's fountain of youth is not particularly mysterious or mythic. It can be found on Page 93 of the 1997 Balanced Budget Act. Under "Subchapter D — Other Projects," there are two pages of dull legislative language authorizing Medicare "to conduct demonstration projects for the purpose of evaluating methods, such as case management and other models of coordinated care, that (A) improve the quality of items and services provided to target individuals; and (B) reduce expenditures."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">In the health-care world, however, these yawn-inducing paragraphs sounded like the beginning of a revolution — or, perhaps, a gold rush.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">The project was remarkable in two ways. First, it used the gold standard of experimental design: Randomized-controlled trials. Each of the 15 programs — of which HQP was one — would see some seniors enrolled in the program and some left out. The assignment would be random, and the groups similar — that would let the researchers be certain that whatever differences they saw between the groups were attributable to the care they received rather than, say, the company's success at signing up healthier seniors. "We did it that way so nobody would ever question the validity of the findings," says Randall Brown, a senior fellow at Mathematica Policy Research, the outside evaluator Medicare hired to judge the programs.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">The second unusual feature was that the secretary of Health and Human Services had the authority to scale it up. Typically, Congress keeps tight hold of the reins on these kinds of experiments. But not this time. As long as the programs were increasing quality without increasing costs, the secretary could "continue the existing demonstration," "expand the number of demonstration projects," or even "issue regulations to implement, on a permanent basis, the components of the demonstration project that are beneficial to the Medicare program." It was, for an experiment of this type, an extraordinary, and extraordinarily rare, amount of authority.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">That made it potentially very, very lucrative. A midsize care-management company that proved itself in this demo could, theoretically, get the green light to provide services to every chronically ill Medicare patient. Everyone understood the implications immediately: There were billions of dollars on the table. And there were plenty of for-profit companies who were certain they'd be able to get them.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">"I was at conferences when this was all getting underway," Brenner says. "These huge vendors from these really big companies had gotten into this. I remember all these really well-dressed people strutting on the stage. They thought they were going to get access to the gold mine of health care. I remember seeing them speak and thinking, 'I can't be this dumb.' I couldn't understand how their models would work. I've never seen a telephone call change behavior."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Their models — and their telephone calls — didn't work. Program after program either failed to help patients, save money or both. "You'll see some disease management programs out there led by MBAs or people who used to be doctors and are now businessmen," Brown says. "They're totally different kettles of fish. They tend to be telephonic, and the telephone centers might be in California or Missouri. They don't work. We've shown it time and time again."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">But Health Quality Partners, with its emphasis on continuous nurse-to-patient contact, did work. Of the 15 programs, four improved patient outcomes without increasing costs. Only HQP improved patient outcomes while cutting costs. So Medicare extended it again and again — now it's the only program still running under the demo. But Medicare has notified Coburn that it intends to end HQP's funding in June.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Medicare's official explanation is carefully bureaucratic. "The authority that CMS had to conduct this specific demonstration, which predated the health care law, did not allow us to make the program permanent and limited our ability to expand it further," says Emma Sandoe, a spokeswoman for the Centers on Medicare and Medicaid Services. "As we design new models and demonstrations, we are integrating lessons from this experience into those designs."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Every expert I spoke to — as well as a plain reading of the law — disagrees. If they wanted to make HQP permanent, or scale it up in a big way, Medicare has the power to do so. Then there's this: "Thanks to the health care law, we can now test new, innovative models for delivering health care and expanding models that show promise," Sandoe continues. "With this new authority, we can take best practices to scale and provide more incentives to deliver high-quality health care at lower costs."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Medicare is referring to the newly created Center for Medicare and Medicaid Innovation, which gives the program power to create and expand projects without congressional authorization. This authority could also be used to create projects based on HQP's lessons. It's not. Instead, Medicare has created a raft of projects and experiments meant to move the system from fee-for-service toward pay-for-quality — with the hope that if they can get the payment incentives right, then the market will have reason to support programs like HQP.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">To Health Quality Partners and its defenders, Medicare's decision is ludicrous. "We're spending tens of billions of dollars now on Medicare innovation where Medicare already discovered something amazing and now they're forgetting what they discovered?" Brenner says. "It's an amazing government moment."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">But to Medicare, it's not so much forgetting as being realistic. After all, HQP worked, but most of the programs in the demonstration didn't. It notes that HQP is a relatively small program that only ever treated a couple of thousand people. For a program the size of Medicare, working to scale up a small operation like HQP seems less likely to deliver a big return than working to change the payment structure that governs the entire system.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">This drives Coburn crazy. "People always ask if what we do is scalable. Well, define scalable. It's less difficult than open-heart surgery, which is one of the most common surgeries in the country, and it's more difficult than giving a vaccine. There's this amazing double standard in medicine. For the kind of thing we do, if it's more difficult than making a phone call once in awhile, then it's not scalable. But you provide enough economic incentives and all of a sudden every hospital has an open-heart surgery program."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Brenner puts it more vividly. "There is a bias in medicine against talking to people and for cutting, scanning and chopping into them. If this was a pill or or a machine with these results it would be front-page news in the Wall Street Journal. If we could get these results for your grandmother, you'd say, 'Of course I want that.' But then you'd say, what are the risks? Does she need to have chemotherapy? Does she need to be put in a scanner? Is it a surgery? And you'd say, no, you just have to have a nurse come visit her every week."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; "><strong style="margin: 0px; padding: 0px; ">Making the house call</strong></p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Here's what I thought would happen when I went with Patty Graefe, a Health Quality Partners' nurse, on her daily rounds: I thought I would see a highly skilled medical professional showing off her success stories. I thought I would meet seniors who were overwhelmed by their illnesses a few years back, but since signing up for the program, were now carefully protecting their health. Nothing else, I figured, could possibly justify the numbers HQP seemed to be producing.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Instead, I met Paul and Betty Bradfield.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Getting to the Bradfield's house is harrowing. You drive over a stone bridge that looks neither wide enough nor structurally sound enough to support a car. You nose up a curving road that has been cut into a steep hill. You walk past a giant pile of wood into the sort of old, rickety farmhouse that quickens the step of kids on Halloween. It's a place I might be scared to live. It's a place I'm definitely scared to find Paul and Betty living.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Paul, at 83, suffers from serious heart failure and mild cognitive impairment. A year ago, he climbed a ladder to change a birdfeeder at 10 o'clock at night. He fell, breaking his neck. Betty, at 80, is legally blind and has diabetes.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">The Bradfields are warm hosts, and clearly glad to see Patty. But their situation isn't good. "I messed up on my medication this week," Paul says, shortly after we walk in the door. He's not sure how. It's possible he took a double dose. Or it's possible that he skipped a dose. And he's already thrown away the evidence. "I'm not worried about the mess-up," Graefe says kindly. "I just need to figure out if you took a double dose." She makes a note to call Paul's doctor.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Graefe has been a nurse for 28 years. She has worked in cardiac wards and with patients in rehab. She has been in hospitals, in call centers, and now on home visits. "This is the best nursing I've ever done in my life," she says. "And that's because it's really all about nursing."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">As a hospital nurse, Graefe worried she wasn't able to build the trust she needed with her patients. "I dealt with a lot of heart failure," she says. "A patient would come in, filled with fluid. You'd ask them whether they were taking their medicine. Or if they were eating right. The patient gets almost defensive because we always assume they're doing something wrong. I found that the hospital setting wasn't the best place for these conversations."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">I asked a half-dozen seniors what difference Health Quality Partners made in their lives. Every one of them began the same way: They could ask their nurse questions, they said with evident relief. They could get help understanding and navigating their doctor's orders. They didn't feel like they were being a burden if they needed to ask one more thing, or have their medications explained to them again.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Physicians are brusque, and harried, and they talk quickly and confidently, and chronically ill seniors often leave with complicated instructions and a hazy understanding of how to follow them. "In a doctor's office, a lot of people, especially older people, feel pressure to get out because they know the doctor is busy and they're a bit intimidated," says Bill Allen, a friendly 78-year-old who is also a patient of Graefe's. "Because she's here in our home, you can feel more free to ask her anything. It's great."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">As a nurse, Graefe's style is practical and nonjudgmental. It seems obvious that chronically ill seniors should take their medicine. But Graefe doesn't see the situation as quite so black-and-white. "You have to find out why a patient isn't taking their medicine," she says. "In the case of heart failure, the water pill has a lot of side effects. Imagine losing control of your bladder. Not being able to go out because you always need a bathroom. We're talking about adults here."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">This is, to me, the surprise of accompanying Graefe on her rounds. Despite the years-long relationships, she's not turned her patients into highly effective self-<br style="margin: 0px; padding: 0px; ">caregivers. Everyone we see admits to missing their medicine or making bad diet decisions or slacking on exercise routines. Graefe just laboriously pushes them to make slightly better decisions on the margins. The Bradfields, for instance, are, after years of cajoling, finally readying themselves to enter assisted living — something that might not have happened at all without Graefe's nudging.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Because she has been to patients' homes so many times before, she can see when something has changed and things are about to go very wrong. And she's got the personal relationship to intervene. Allen, who suffers from lung problems but hates to take medicine, recalls a bad cold he had a few weeks ago. "Because of Patty's insistence, I ended up using the — what do you call it? — the nebulizer. I probably wouldn't have done it without her. And I probably would have ended up with pneumonia again. I'm sure that's what got me through." It also saved Medicare money, and perhaps saved Allen's life.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">We think of the hospital as a place people go to get better. At Health Quality Partners, the view is that a hospital is a place where seniors get worse. "Being in the hospital for three days or five days sets them back to a point where they'll never regain what they were," says Sherry Marcantonio, chief program architect of HQP. "That's where the scales tip. That's where people end up needing a nursing home." Keeping seniors out of the hospital, which is a core focus of its program, cuts costs and saves lives, but it also preserves quality of life — a measure often ignored in these discussions. There's a good argument to be made that if a program like HQP cost slightly more than traditional Medicare but cut hospitalizations by a third, it would still be worth it. The point of health care, after all, is to keep people healthy. But HQP saves money — and lots of it.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">If there is a secret to the success of Health Quality Partners at preventing hospitalizations, it's this: No one else is checking in with the Bradfields or the Allens every week. Medical technology — from pills to devices to surgical procedures — is so advanced and so competitive that making further gains requires enormous investment and rarely brings high returns. But the exciting field of knocking-on-the-Bradfield's-<wbr style="margin: 0px; padding: 0px; ">farmhouse-door is almost totally empty. Medicine has been so focused on what doctors can do in the hospital that it has barely even begun to figure out what can be done in the home. But the home is where elderly patients spend most of their time. It's where they take their medicine and eat their meals, and it's where they fall into funks and trip over the corner of the carpet. It's where a trained medical professional can see a bad turn before it turns into a catastrophe. Medicine, however, has been reluctant to intrude into homes.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">For the most part, the medical system treats the old very much like it treats the young. It cares for them when they're sick and ignores them when they're well. Coburn's basic insight is a discomfiting one. He doesn't really believe in "better," at least not for elderly, chronically ill patients. He wants someone going over frequently to see if they're depressed, if their color is good, if they understand their medications, if there's anything they need. This isn't medicine so much as it's supervision.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">At another time, these functions would have been filled by the family, who would be right in the other room, and who would know if their mother looked different than she had a few weeks ago. But few of today's elderly live with their children. Many don't even live in the same state, or they don't have any contact with their children, or they don't have children.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">A recent study in the Proceedings of the National Academy of Sciences found that after adjusting for demographic factors and underlying health, social isolation increased the likelihood of death among the elderly by a stunning 26 percent. "People with few social contacts may not have people around them who can give them advice, recommend that they go to a doctor with symptoms, ensure that they maintain healthy lifestyles, or perhaps they don't have anyone around when they experience acute symptoms," says Andrew Steptoe, the lead author on the study.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">We've been conditioned by "Grey's Anatomy" and hospital rooms to believe that saving lives is a complicated, heroic business. And it is — after people get very sick. But keeping them from getting very sick doesn't necessarily require the discovery of new molecules. It requires someone who has a relationship with them to stop by once a week to see how they're doing. The problem is, it's hard to make money off it.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; "><strong style="margin: 0px; padding: 0px; ">The uneven legacy</strong></p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">If you go into the hospital for heart surgery and you end up getting a central-line infection, you'd hope that the hospital would be penalized for it. The opposite, in fact, is true. According to a new study in the Journal of the American Medical Association, surgical complications increase the margin the hospital makes on the patient by 330 percent for the privately insured and 190 percent for Medicare patients.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">This, too, is a legacy of a health system built for acute care. Hospitals make money when they do more to patients. They lose money when their beds are empty. Put simply, Health Quality Partners makes hospitals lose money. "There's no doubt that it's a hit to the bottom line," says Rich Reif, the former CEO of Doylestown Hospital, which worked with HQP.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Reif's answer for why he worked with a group that cost him money is simple: His hospital was unusual. In 1895, 14 women came together to form Doylestown's "Village Improvement Association," which was dedicated to "the health and beauty" of the community. The association actually owned Doylestown Hospital, and its mission was the hospital's mission. "I did get some heat from my senior management team," Reif says. "When you're doing annual budgets you see reduction in revenue. But I could always come back and say, 'Wasn't that our responsibility?' "</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">But not all hospitals are run by the local Village Improvement Association. Many seek to turn a profit. That makes models like Health Quality Partners something of a threat. "If we scaled what Ken is doing," Brenner says, "you would probably shut down a third of the hospitals in the country. It's a disruptive innovation. It just guts the current business model."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">This is where Medicare's focus on changing that payment model could help programs like HQP. It's pushing providers to band together into accountable care organizations, or ACO, that get a flat fee for all care related to a patient. If they spent less, they could keep the difference. In theory, this should push them to partner with tested organizations like HQP that have a proven ability to help them spend less. But many experts are skeptical that ACOs will be the game changer Medicare hopes.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">"I don't have a lot of confidence in the ACOs working out," Mathematica's Brown says. "None of the ACOs you talk to are willing to say which hospital they'll close. And the only way to save big money in a system is to reduce hospitalizations. That means you need fewer hospital beds. You can't make money off of an empty hospital. So until they're talking about closing some local hospitals to realize the gains from reducing hospitalization, they're not going to be saving much money."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">Robert Berenson, a Medicare expert at the Urban Institute, is also skeptical. "To understand ACOs, you have to go back to the physician group practice demo. That was the basis for the ACOs. It was the model adopted into law in the Affordable Care Act. It was these 10 multispecialty groups, and the idea was we'll pay you fee-for-service and if your total spending comes in under the control group's costs, you get to share the savings. Everybody thought it was a great success, but when the results came in, it didn't save any money at all. The one exception was a plan called Marshfield, perhaps because it wasn't based in a hospital and so could keep people out of hospitals."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">This is a tough truth of the health-care system: It's got a lot of incumbents, and a lot of fixed costs, and reforming the way care is delivered will mean creating a lot of losers. "This is about power and money," Brenner says. "The largest group in the top one percent of income in America are physicians."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">The chronic-care focused system that Coburn is pioneering is more about nurses than doctors, more about home visits than hospitals, and more about human interaction than high-tech intervention. A system based on managing chronic care is a truly different system from the one we have today. Health Quality Partners was lucky to find a hospital that wanted to work with it. But many hospitals wouldn't want to work with a program dedicated to sharply reducing their revenue stream. And without cooperation from the hospital and a patient's doctors, the HQP model would fail.</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">The only payer with the size and the incentives to push something like HQP is Medicare. "For them to say it's not their responsibility to scale a program like this is ridiculous," Brenner says. "They send market signals all the time. One day it's an experimental oncology procedure and the next day everyone is using biologicals. That's because of them and what they pay. They're the ones who scale this stuff. It feels to me like they're scared to pull a lever on a very clear market signal. But if they said here's Ken Coburn's model, here's the code for it, here's how much we'll pay for it, and, by the way, we'll overpay for it, because we think it's important, the marketplace would drive that."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">They could stop far short of that, of course. They could begin another demonstration project that took the lessons of HQP and used them to seed 15 more programs. There is, after all, a flip-side to the skepticism over whether the program can scale. It's possible Coburn's model, which has been run on a shoestring budget, could, with real resources, be improved. Coburn is quick to agree. "I really think we're just at base camp. There are so many contributors to health the system isn't addressing right now. As proud as I am of what we're doing, I think we're just scratching the surface of this stuff."</p><p style="margin: 0px 0px 15px; padding: 0px; color: rgb(0, 0, 0); font-family: Times; font-size: 16px; 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; ">It wouldn't cost Medicare very much to find out. Quests for the fountain of youth have been launched from far flimsier maps.</p></div><a href="http://www.washingtonpost.com/blogs/wonkblog/wp/2013/04/28/if-this-was-a-pill-youd-do-anything-to-get-it/?">http://www.washingtonpost.com/blogs/wonkblog/wp/2013/04/28/if-this-was-a-pill-youd-do-anything-to-get-it/?</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

If this was a pill, you’d do anything to get it - Washington Post

When Ken Coburn has visitors to the cramped offices of Health Quality Partners in Doylestown, Pa., he likes to show them a graph. It's n...

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Matt Said, Jay Said, Miley Gets Sexy

<div dir="ltr" style="text-align: left;" trbidi="on"><br /><div class="MsoNormal">Jay yammers, Matt pops off, You shrug your shoulders. <o:p></o:p></div><div class="MsoNormal"><br /></div><div class="MsoNormal">Matt: This here be the Matt and Schmoop digs. <br />Jay: STOP BEING MEAN TO *NAME REDACTED*<br />Matt: I can’t do that. <br />Jay: Okay that’s cool. <br />Matt: You didn’t try that hard. <br />Jay: That’s because it’s not really my problem. <br />Matt:  Then why did you tell me to be nice to *NAME REDACTED*<br />Jay: Cause she told me to. Kinda. <br />Matt: Oh, she just didn’t tell you to try hard. <br />Jay: Or care. <br />Matt: You just like to get involved. <br />Jay: I keep to myself. <br />Matt: That keeps you out of trouble, I guess. <br />Jay: I get a little lonely though. <br />Matt: This isn’t gonna get awkward is it? <br />Jay. No! Not at all. <br />Matt: That’s good. <br />Jay: Do you WANT it to get awkward? <br />Matt: HELP! <o:p></o:p></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwATyvfdfCoHNRSeTgJ6aKMJazsZfGvY8NxKGv_de7WyvFZfXFCxAksbtDYJTAm5OWbKnMP7mj9iTYi-xfPGMn4tl-fPCUe_LDGYUXQZ6o43LQw-CsG4Win_a8OQkcZ9RGLL3Pvoz_3xQ/s1600/Miley-Cyrus-Legs-Short-Shorts-Nude-Hot-Slut.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwATyvfdfCoHNRSeTgJ6aKMJazsZfGvY8NxKGv_de7WyvFZfXFCxAksbtDYJTAm5OWbKnMP7mj9iTYi-xfPGMn4tl-fPCUe_LDGYUXQZ6o43LQw-CsG4Win_a8OQkcZ9RGLL3Pvoz_3xQ/s400/Miley-Cyrus-Legs-Short-Shorts-Nude-Hot-Slut.jpg" width="193" /></a>Jay: Miley Cyurs is running around damn near naked these days. Matt: Is that a problem. Jay: Well, not for me. <br />Matt: Me either! <br />Jay: She got a whole drawer full of really short shorts. <br />Matt: I think she buys them at kid’s clothing stores. <br />Jay: And those shoes she’s always wearing! <br />Matt: Shoes?<br />Jay: Yeah. Super high-heeled shoes. <br />Matt: What about them. <br />Jay: Kind of freaky. Stripper shoes. <br />Matt: Wait. Miley wearing tiny shorts and you’re focusing on her shoes? <br />Jay: Well, her hair is distracting too. <br />Matt: Her hair and her shoes? <br />Jay: Yeah. Why? <br />Matt: Oh nothing.<br />Jay: Okay. <o:p></o:p></div><br />Matt: So HUGE show this week!<br /><div class="MsoNormal">Jay: An absolute MOSTER of a show! <br />Matt: TWO GUESTS! <br />Jay: Just like professionals do it. <br />Matt: Damn right! <br />Jay: First guest will be Dana Lu! <br />Matt: Her Sleeve Gastrectomy<br />Jay: What went into making that decision. <br />Matt: And, her action plan moving forward. <br />Jay: Fascinating. <br />Matt: Inspiring! <br />Jay: Very much so. Then …<br />Matt: The Ice Man! <br />Jay: Ice, Ice, Baby! <br />Matt: No, let’s not do that. <br />Jay: I got carried away. <br />Matt: It’s okay. <br />Jay: Anyway, Luis! <br />Matt: Cinco de Mayo! <br />Jay: He’s from Mexico, right?<br />Matt: Yes, a really dangerous town.<br />Jay: He probably thinks Detroit is nice and quiet. <br />Matt: Baltimore is paradise to him.<br />Jay: New Orleans is a clean, well lit place to him. <br />Matt: Memphis doesn’t scare him at all. <br />Jay: It scares me! <br />Matt: Me too! <br />Jay: We’ve been so sheltered. <br />Matt: Thank God. <br />Jay: Okay, we’re ready for a big un! <br />Matt: That’s hot! <o:p></o:p></div><div class="MsoNormal"><br /></div><div class="MsoNormal">This is gonna rock the internet radio world y’all! Join us for “<a href="http://www.blogtalkradio.com/im-with-stupid/2013/05/05/losing-it-with-dana" target="_blank">Losing it with Dana</a>” on I’m With Stupid this Sunday at 12 Noon ET!! <o:p></o:p></div><div class="MsoNormal"><br /></div></div>

Matt Said, Jay Said, Miley Gets Sexy

Jay yammers, Matt pops off, You shrug your shoulders. Matt: This here be the Matt and Schmoop digs. Jay: STOP BEING MEAN TO *NAME REDACTED* ...

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Comedian Tig Notaro Shared Her Personal Tragedy With The World And Made Us Laugh - Business Insider

<base href="data:"><div style="color: black; text-align: left; "><span style="color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); display: inline !important; float: none; "><font class="Apple-style-span" face="'Helvetica Neue'">The comedian Tig Notaro did something truly revolutionary in August 2012.</font></span><div style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">She'd just been diagnosed with cancer in both breasts, and she stepped onto a stage in Los Angeles where she'd originally planned to tell jokes. The jokes didn't come, though.</font></div><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">Instead, Notaro talked about her cancer and the string of tragedies she'd experienced in the span of just four months. This is not the typical formula for an evening comedy show.</font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">"With humor, the equation is tragedy plus time equals comedy," Notaro said that night. "I am just at tragedy right now."</font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">Notaro — an androgynous 41-year-old with deadpan humor — continued to go over the truly crappy things that were still troubling her during a set that has since become legendary. The cancer diagnosis. The sudden death of her mother. A breakup. To top it all off, Notaro got a <a href="http://www.mayoclinic.com/health/c-difficile/DS00736" style="text-decoration: none; color: rgb(29, 99, 125); ">life-threatening intestinal disease</a> that left her frighteningly thin.</font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">"The condition I had in the hospital is called C diff. And so I just refer to it as the C diff diet. You just sit there and watch the pounds melt away. Don't like exercising? Who does, girlfriend? This diet does all the work for you. Just clear all the bacteria from your intestines and let the C diff whittle way at your waistline," <a href="http://www.thisamericanlife.org/radio-archives/episode/476/transcript" style="text-decoration: none; color: rgb(29, 99, 125); ">she said that night.</a></font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">A week after she got out of the hospital, her mother died.</font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">"I know, it's hilarious. Then I went through a break up, right in the middle of it all. It's tough times. You can't stick around for that. <a href="http://www.thisamericanlife.org/radio-archives/episode/476/transcript" style="text-decoration: none; color: rgb(29, 99, 125); ">Got to get out before the cancer comes,</a>" she added.</font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">The audience was rapt. People looked on sympathetically, but they also laughed. At one point, she suggested telling goofy jokes instead of talking about her cancer, to which one man shouted, "This is f---ing amazing."</font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">Notaro's dry take <a href="http://www.amazon.com/Live-digital-booklet/dp/B009Y4E9QO" style="text-decoration: none; color: rgb(29, 99, 125); ">on her cancer that night</a> was indeed funny. It was also incredibly raw and one of the most emotionally honest performances in recent memory. (You can listen to the <a href="http://www.amazon.com/Live-digital-booklet/dp/B009Y4E9QO" style="text-decoration: none; color: rgb(29, 99, 125); ">entire thing here</a>.)</font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">"It's OK. It's going to be OK. It might not be OK. But I'm just saying, it's OK. You're going to be OK. I don't know what's going on with me," she said.</font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">She didn't plan on going on stage to talk about her tragedy. The first part of her performance — "Good evening. Hello. I have cancer." — popped into her head in the shower an hour and a half before the performance, Notaro told <a class="hidden_link" href="http://www.businessinsider.com/blackboard/business-insider" style="text-decoration: none; color: rgb(29, 99, 125); ">Business Insider</a>.</font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">Once she got on stage, she says, she was consumed with thoughts of dying.</font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">"I was just so scared that my life was about to slip away. When I went on stage I didn't have all the information yet," she told us. "It [The cancer] was bilateral. It was invasive. I just didn't know a lot. It was standup but it was also just me being on my knees in a way."</font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">It turns out Notaro will probably be fine. She had a double mastectomy, and there's only a 7% chance that her cancer will come back.</font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">But her few moments on her knees before a live audience have touched a lot of people. She gets letters every single day from people with cancer, and from people who are dying of other diseases. People tell her she's helped them get through their own impossibly rough times.</font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">"This one guy he was in his early 30s and he had pancreatic cancer he said he felt like it [her set] gave him courage, like he could do this," Notaro said. "And it was terminal cancer."</font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">If it's difficult to imagine how somebody who's dying can get courage from a comedy set, <a href="https://buy.louisck.net/news/about-tig-notaro" style="text-decoration: none; color: rgb(29, 99, 125); ">consider these observations on Notaro's set</a> from the comic Louis C.K.</font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">"Tig took us to a scary place and made us laugh there," he writes. "She proved that everything is funny. And has to be."</font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">By taking everybody to that scary place, Notaro showed us that we can stare tragedy in the face and laugh despite our terror. Notaro admits the cancer has changed her. She's more honest than ever, and she doesn't stay angry at people. But one thing won't change.</font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'">"I love silliness," she says. "That will never go away."<br></font></p><p style="margin-top: 1em; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><font class="Apple-style-span" face="'Helvetica Neue'"><br></font></p><font class="Apple-style-span" face="'Helvetica Neue'"><span style="color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 16px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "></span></font></div><a href="http://www.businessinsider.com/tig-notaro-profile-2013-4?"><font class="Apple-style-span" face="'Helvetica Neue'">http://www.businessinsider.com/tig-notaro-profile-2013-4?</font></a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Comedian Tig Notaro Shared Her Personal Tragedy With The World And Made Us Laugh - Business Insider

The comedian Tig Notaro did something truly revolutionary in August 2012. She'd just been diagnosed with cancer in both breasts, and she...

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Flower bedding

Yesterday I put down some topsoil in what constitutes our front garden. Today I planted some pansies and geraniums. Hopefully they don't die like the last flowers I planted!! <br/><br/><div class="separator"style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjR-ttCIzDj3Sfb78c7vgwPj4M1d8s7LQRCME0SagXWkLZTSt3oeq_W-2vqm_TCgFm8eMzCSRU6ShB_9rvr_MLMVkVQ5gtxdHF724iprJKlll5RNH_Wz4VeMllNRDxPqmcQnfGRIda84ie5/s640/blogger-image--1149571294.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjR-ttCIzDj3Sfb78c7vgwPj4M1d8s7LQRCME0SagXWkLZTSt3oeq_W-2vqm_TCgFm8eMzCSRU6ShB_9rvr_MLMVkVQ5gtxdHF724iprJKlll5RNH_Wz4VeMllNRDxPqmcQnfGRIda84ie5/s640/blogger-image--1149571294.jpg" /></a></div> <br/><br/><div class="separator"style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg166U02bbHoYhuDly1HpgXPemGWCetYzWBxNEBVn1D2lAMHT8SaupVO1bjvaTwR0nPxYXdo6aUm7RDtZhC_Uvgc8w5CwwdpjAcLM26vK-QIS734zSW7MxANM4MfX8l0xnhg8F1sCAQpTxb/s640/blogger-image--575212729.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg166U02bbHoYhuDly1HpgXPemGWCetYzWBxNEBVn1D2lAMHT8SaupVO1bjvaTwR0nPxYXdo6aUm7RDtZhC_Uvgc8w5CwwdpjAcLM26vK-QIS734zSW7MxANM4MfX8l0xnhg8F1sCAQpTxb/s640/blogger-image--575212729.jpg" /></a></div> <br/><br/><div class="separator"style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnlks3xdr1fbWkfV0OTbIi3-QfxaQ6j7t8JIRKOLYMkKnF0C54p5W2SiA_3nBHq24nWkrZKaXttE0z7QxHHpPAZQ6Kmlw0vcrrbeYRkwmS-n9k_hYhZ5lCS_hvN8hkhDPHHyX05n-0-tEs/s640/blogger-image-1682936603.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnlks3xdr1fbWkfV0OTbIi3-QfxaQ6j7t8JIRKOLYMkKnF0C54p5W2SiA_3nBHq24nWkrZKaXttE0z7QxHHpPAZQ6Kmlw0vcrrbeYRkwmS-n9k_hYhZ5lCS_hvN8hkhDPHHyX05n-0-tEs/s640/blogger-image-1682936603.jpg" /></a></div> <br/><br/><div class="separator"style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4MEiwoKrEndAHvTBTVofc8yTbOfswtEXZCDBaYq7A2wHes7jpLDt7c9OCvf2lPJCwracI4LOYbBnOp8dD1iNqLvuQJ2okLut-sRaAyYak7Tbsssu7jgyInYMqpwZjSms-Pg0A9Tu5whfh/s640/blogger-image--887219296.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4MEiwoKrEndAHvTBTVofc8yTbOfswtEXZCDBaYq7A2wHes7jpLDt7c9OCvf2lPJCwracI4LOYbBnOp8dD1iNqLvuQJ2okLut-sRaAyYak7Tbsssu7jgyInYMqpwZjSms-Pg0A9Tu5whfh/s640/blogger-image--887219296.jpg" /></a></div>

Flower bedding

Yesterday I put down some topsoil in what constitutes our front garden. Today I planted some pansies and geraniums. Hopefully they don'...

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Webinar recording: Add your story to PowerPoint and illustrate it (03/05/2013)

<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEh_5iyL6b2hYAbJyVXbr7ocRJ_v9i80nduDlfMwIKhuUCz4wZdNWAaqRskm1eo-W_UneYKfCYm32fr0rM3YQRFzqRmS-RQeWK7O4RCBMZAlr9W8E25hIh4FbCVXeoJZmO5jlY4Ynxnrg/s1600/webinar+recording.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="53" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEh_5iyL6b2hYAbJyVXbr7ocRJ_v9i80nduDlfMwIKhuUCz4wZdNWAaqRskm1eo-W_UneYKfCYm32fr0rM3YQRFzqRmS-RQeWK7O4RCBMZAlr9W8E25hIh4FbCVXeoJZmO5jlY4Ynxnrg/s400/webinar+recording.JPG" width="400" /></a></div><br /><div dir="ltr" style="text-align: left;" trbidi="on"><b><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">The webinar summary</span></b><br /><span style="font-family: Arial, Helvetica, sans-serif;">In this webinar, which supports our online course on Digital Storytelling, we will add our already created story to PowerPoint and find ways of illustrating it.<b></b></span><br /><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><b><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">Webinar recording</span></b><br /><span style="font-family: Arial, Helvetica, sans-serif;">The webinar attempts to pull together the different aspects for this week.  Thank you to those who attended. I am adding the 6pm webinar:</span><br /><a href="http://meet78641452.adobeconnect.com/p16xkoenx12/" style="font-family: Arial, Helvetica, sans-serif;">http://meet78641452.adobeconnect.com/p16xkoenx12/</a><br /><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;"><br /><strong>The presentation used for the webinar</strong></span><br />I have put the presentation used in the webinar into Slideshare and here it is:</span><br /><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><iframe allowfullscreen="" frameborder="0" height="356" marginheight="0" marginwidth="0" mozallowfullscreen="" scrolling="no" src="http://www.slideshare.net/slideshow/embed_code/20551003" style="border-bottom: #ccc 0px solid; border-left: #ccc 1px solid; border-right: #ccc 1px solid; border-top: #ccc 1px solid; margin-bottom: 5px;" webkitallowfullscreen="" width="427"> </iframe><span style="font-family: Arial, Helvetica, sans-serif;"> </span><br /><div style="margin-bottom: 5px;"><span style="font-family: Arial, Helvetica, sans-serif;"><strong><a href="http://www.slideshare.net/fionabeal/add-your-story-to-powerpoint-and-illustrate-it" target="_blank" title="Add your story to PowerPoint and illustrate it">Add your story to PowerPoint and illustrate it</a> </strong>from <strong><a href="http://www.slideshare.net/fionabeal" target="_blank">Fiona Beal</a></strong> </span></div><strong><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></strong><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;"><b>A contribution on avatars from Thaiurie  Govender</b></span><br /><span style="font-family: Arial, Helvetica, sans-serif;">During the webinar Thaiurie mentioned another possibility as far as illustrating a story goes – namely the use of avatars and speech bubbles, and kindly sent me a presentation with ideas about creating avators which I am embedding here. Thank you SO much Thaiurie. </span><br /><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><iframe allowfullscreen="true" frameborder="0" height="389" mozallowfullscreen="true" src="https://docs.google.com/presentation/d/1S0PN-WBjquOIUaImPU3ZxNeJCaRHDG7G1_3zCRPmClk/embed?start=false&loop=false&delayms=3000" webkitallowfullscreen="true" width="480"></iframe></span></div></div>

webinars Webinar recording: Add your story to PowerPoint and illustrate it (03/05/2013)

The webinar summary In this webinar, which supports our online course on Digital Storytelling, we will add our already created story to Powe...

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Applications Development Engineer (Optics | Physics | Ellipsometry | Critical Dimension) (#109445)

<div dir="ltr" style="text-align: left;" trbidi="on"><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;"> </span></span><br /><div><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;"><b>Position</b>: Applications Development Engineer</span></span><br /><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;"><b>Location</b>: Portland, OR</span></span><br /><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;"><b>Duration</b>: Full time</span></span><br /><br /><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;"><b>Job Description</b>:</span></span><br /><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;">The Film and Scatterometry Technology (FaST) Division provides industry leading metrology solutions for worldwide semiconductor IC manufacturers. The FaST Division portfolio of metrology products includes hardware and software solutions for optical film thickness, optical critical dimension (CD), composition, and resistivity measurement systems. These products are essential for the IC manufacturers as they provide critical metrology capabilities for the development and implementation of their advanced IC processes. The FaST division is committed to support our customers to achieve performance entitlement of our solution and we effectively partner with our customers from their early research and development phase to the high volume in-line manufacturing implementation specific for their process needs. The division consists of a global team located in US, Israel, China, and India.</span></span><br /><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;"><br /></span></span><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;"><b>Responsibilities:</b> </span></span><br /><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;">The applicant will be working in a highly fast paced product development and customer service environment with other groups. The applicant will work on optical film and/or CD characterization and methodology for specific tool utilization and product demonstration. The applicant is expected to travel to customer sites to support and/or develop customer use cases, by working with local team members and customers.</span></span></div><div><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;"><br /></span></span><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;"><b>Preferred Qualifications:</b> </span></span><br /><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;">The applicant is expected to have solid knowledge on physics and optics. Experience on semiconductor manufacturing is highly desired. The applicant shall demonstrate strong data analysis and presentation skill.</span></span></div><div><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;"><br /></span></span><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;"><b>Minimum Qualifications:</b><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;"> </span></span></span></span><br /><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;"><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;">Bachelor's Level Degree with at least 3 years of experience</span></span> </span></span><br /><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;">OR</span></span><br /><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;">Master's Level Degree with at least 2 years of experience</span></span><br /><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;">OR<span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;"> </span></span></span></span><br /><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;"><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;">Doctorate (Academic)</span></span></span></span><br /><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;"><br /></span></span><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;">Kindly send your resumes to<span style="color: navy;"> </span><span style="color: blue;"><b><a href="mailto:Sivaram.bose@kla-tencor.com"><u>raju.balaji@kla-tencor.com</u></a></b></span><span style="color: navy;"><u><span style="color: blue;"><b> </b></span></u></span></span></span></div><span style="font-family: Arial; font-size: x-small;"><span style="font-size: 10pt;"></span></span> </div>

Applications Development Engineer (Optics | Physics | Ellipsometry | Critical Dimension) (#109445)

Position : Applications Development Engineer Location : Portland, OR Duration : Full time Job Description : The Film and Scatterometry Tec...

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If Common Core Standards become our straight jacket, we'll hate what education becomes #ccchat

A sad teacher last night talked to me about how she's having to cut out two great units of study. One unit is on <a class="zem_slink" href="http://maps.google.com/maps?ll=39.9166666667,116.383333333&spn=10.0,10.0&q=39.9166666667,116.383333333%20(China)&t=h" rel="geolocation" target="_blank" title="China">China</a> and another is on <a class="zem_slink" href="http://maps.google.com/maps?ll=30.0333333333,31.2166666667&spn=10.0,10.0&q=30.0333333333,31.2166666667%20(Egypt)&t=h" rel="geolocation" target="_blank" title="Egypt">Egypt</a>. Why? They aren't in the <a href="http://www.corestandards.org/">Common Core standards</a>.<br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody><tr><td style="text-align: center;"><a href="http://farm5.staticflickr.com/4068/4684237119_3fc50bf5da.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="213" src="http://farm5.staticflickr.com/4068/4684237119_3fc50bf5da.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span class="ccIcn ccIcnSmall" style="background-color: #fefefe; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 18px; text-align: left;">My students aren't wearing straight jackets,<br />they have wings. And that, my friends<br />makes all the difference.<br /><a href="http://creativecommons.org/licenses/by-sa/2.0/" style="color: #0063dc; text-decoration: none;"><img alt="Attribution" border="0" src="http://l.yimg.com/g/images/cc_icon_attribution_small.gif" style="border: 0px; vertical-align: middle;" title="Attribution" /><img alt="Share Alike" border="0" src="http://l.yimg.com/g/images/cc_icon_sharealike_small.gif" style="border: 0px; vertical-align: middle;" title="Share Alike" /></a></span><span style="background-color: #fefefe; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 18px; text-align: left;"> </span><a href="http://creativecommons.org/licenses/by-sa/2.0/" style="background-color: #fefefe; color: #0063dc; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 18px; text-align: left; text-decoration: none;" title="Attribution-ShareAlike License">Some rights reserved</a><span style="background-color: #fefefe; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 18px; text-align: left;"> by </span><a href="http://www.flickr.com/photos/ammgramm/" style="background-color: #fefefe; color: #0063dc; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 18px; text-align: left; text-decoration: none;">ammgramm</a></td></tr></tbody></table><br />Savvy schools will know that Common Core standards are guidelines. <b>Struggling schools will interpret Common Core standards as straight jackets.</b> Already demoralized, they are afraid to do ANYTHING not in the standards. There's the problem.<br /><br /><a href="http://asiasociety.org/education/partnership-global-learning/making-case/what-global-competence">Global competency</a> is vital part of being an educated 21st century citizen. <br /><br /><br /><br />Two kinds of people exist today: people who build bridges and people who blow them up. Kids must be global citizens capable of building bridges.<br /><br />Even if you are under Common Core standards, I hope you have the maturity to see them as guidelines. The <a href="http://www.corestandards.org/resources/frequently-asked-questions">Common Core F</a>AQ says:<br /><br /><blockquote class="tr_bq">"Teachers will continue to devise lesson plans and tailor instruction to the individual needs of the students in their classrooms."</blockquote><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody><tr><td style="text-align: center;"><a href="http://farm3.staticflickr.com/2061/2243080071_196dbf2afc.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="http://farm3.staticflickr.com/2061/2243080071_196dbf2afc.jpg" width="213" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span class="ccIcn ccIcnSmall" style="background-color: #fefefe; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 18px; text-align: left;"><a href="http://creativecommons.org/licenses/by-sa/2.0/" style="color: #0063dc; text-decoration: none;"><img alt="Attribution" border="0" src="http://l.yimg.com/g/images/cc_icon_attribution_small.gif" style="border: 0px; vertical-align: middle;" title="Attribution" /><img alt="Share Alike" border="0" src="http://l.yimg.com/g/images/cc_icon_sharealike_small.gif" style="border: 0px; vertical-align: middle;" title="Share Alike" /></a></span><span style="background-color: #fefefe; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 18px; text-align: left;"> </span><a href="http://creativecommons.org/licenses/by-sa/2.0/" style="background-color: #fefefe; color: #0063dc; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 18px; text-align: left; text-decoration: none;" title="Attribution-ShareAlike License">Some rights reserved</a><span style="background-color: #fefefe; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 18px; text-align: left;"> by </span><a href="http://www.flickr.com/photos/photophilde/" style="background-color: #fefefe; color: #0063dc; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 18px; text-align: left; text-decoration: none;">photophilde</a></td></tr></tbody></table><div style="text-align: center;"><br /></div>Use your head when evaluating curriculum. Just because it doesn't specifically say "Egypt" or "China" doesn't mean you have to cut those from your curriculum. You can incorporate standards into such studies.<br /><br />Most straight jackets worn in education are fabrications of the mind.<br /><br />While some are wearing straight jackets, my students are collaborating globally. They aren't wearing straight jackets, they have wings. And that, my friends will make all the difference.<br /><br /><br /><br /><br /><br /><br />-----------------------------<br /><b>Further Reading:</b><br />ASCD Educational Leadership. <a href="http://www.ascd.org/publications/educational-leadership/sept09/vol67/num01/Leading-for-Global-Competency.aspx">Leading for Global Competency</a><br />Common Core State Standards <a href="http://www.corestandards.org/resources/frequently-asked-questions">Frequently Asked Questions</a><br />Curriculum 21 Global Partnership: <a href="http://www.c21hub.com/globalpartnership/global-competencies/investigate-the-world/">Investigate the World</a><br />Edutopia <a href="http://www.edutopia.org/files/existing/pdfs/guides/edutopia-parents-guide-21st-century-learning.pdf">Parents Guide to 21st Century Learning</a> (PDF)<br /><a href="http://www.amazon.com/gp/product/0132610353/ref=as_li_ss_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=0132610353&linkCode=as2&tag=httpwwwbrighc-20" id="static_txt_preview" style="background-color: white; color: #996633; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: small; text-align: center;" target="_blank">Flattening Classrooms, Engaging Minds: Move to Global Collaboration One Step at a Time</a> (disclosure, I coauthored this book)<br />Asia Society: <a href="http://asiasociety.org/education/partnership-global-learning/making-case/what-global-competence">What is global competence?</a><br /> <div class="zemanta-pixie" style="height: 15px; margin-top: 10px;"><a class="zemanta-pixie-a" href="http://www.zemanta.com/?px" title="Enhanced by Zemanta"><img alt="Enhanced by Zemanta" class="zemanta-pixie-img" src="http://img.zemanta.com/zemified_c.png?x-id=473c04f0-b55b-44f2-8b7b-7541bfb741da" style="border: none; float: right;" /></a></div>

If Common Core Standards become our straight jacket, we'll hate what education becomes #ccchat

A sad teacher last night talked to me about how she's having to cut out two great units of study. One unit is on China and another is o...

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Sarah Palin™ Kicks Off The Weekend for IWS

<div dir="ltr" style="text-align: left;" trbidi="on"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfbLG1HUdlHM1nX9pgIzYtrB8na6drK84vua48UZYFlqtC55ozyZFhVVbiJt9PwKUcLOXtPGuPoLOXE4Mz5mO3FyJaoySyoN1bHukEhNzZgXnoL5qLXRoOF-gErIiFICeoR5smoxtO7rk/s1600/Sarah+Palin+Begich+2014+U.S.+Senate+Race.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="267" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfbLG1HUdlHM1nX9pgIzYtrB8na6drK84vua48UZYFlqtC55ozyZFhVVbiJt9PwKUcLOXtPGuPoLOXE4Mz5mO3FyJaoySyoN1bHukEhNzZgXnoL5qLXRoOF-gErIiFICeoR5smoxtO7rk/s400/Sarah+Palin+Begich+2014+U.S.+Senate+Race.jpg" width="400" /></a>Hi Y’all, and Happy Weekend to ya!!<br /><br />You’re probably askin’ yourself…<br /><br />Is that Sarah Palin™ on the IWS website?  And I have to tell ya…<br /><br />Darn Right it is!!  Ha!!  You thought I was gonna say, <i>“You Betcha!!”</i>, didn’t ya?<br /><br />I’m fillin’ in for Matt-Man today because he drank a bottle of Wild Irish Rose last night and he doesn’t drink it very often anymore.  Well let this mama bear tell ya…It knocked him on his derri--, um his dery--, er…his…ass.<br /><br />Seems to me that Matt-Man should have had a tea party last night rather than a gutter wine party, but that’s just me.  Thank God Bristol Palin™ wasn’t there with him, because she would be waking up pregnant right about now.  Anyhoo….<br /><br />We have a huge weekend on tap this weekend.  Tomorrow is the running of the 2,013 Kentucky Derby.  Can you even imagine that?  The earliest Kentucky Derbies involved powerful horses pulling chariots piloted by the likes of Ben-Her and Julius Kaiser.  It’s true.<br /><br />And guess what?  There is going to be not only a cowgirl riding one of the horses this year, there is going to be a black fella riding one.  Which can mean only one thing…<br /><br />President Obama has instituted oppressive government quotas on one of the last remaining pieces of Americana and freedom that is the Kentucky Derby.  It wasn’t good enough that black people happily jockey lawns, Obama mandated that they be put atop fine thoroughbreds as well.<br /><br />I think that since the President failed to take the guns from the hands of white people, he decided to put Mexican jockeys out of work.  Which is funny, since he seems to want to let every darn wetback into this country.  What a freedom hating feminine hygiene product he is.<br /><br />But I digest…<br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqPpJ7o9f7BNuRU686KtpS58c8XUk5JxXlLhhbmQALBhZXc8Jx5iB9EYO7or0ghD6AlakB2bYEvqpk_YJbm-eTVPLChjlGsEeSeRH391mHcPymz-gOMusNUhe4f9ZzFKXDrTVnDkZ7-bA/s1600/Hellmanns-Mayo-Cinco+de+Mayo.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqPpJ7o9f7BNuRU686KtpS58c8XUk5JxXlLhhbmQALBhZXc8Jx5iB9EYO7or0ghD6AlakB2bYEvqpk_YJbm-eTVPLChjlGsEeSeRH391mHcPymz-gOMusNUhe4f9ZzFKXDrTVnDkZ7-bA/s400/Hellmanns-Mayo-Cinco+de+Mayo.jpg" width="300" /></a>On Sunday, there will be a lot of parties taking place in honor of Cinco de Mayo.  In case you are unfounded, Cinco de Mayo is the celebration of Richard Hellmann’s invention of mayonnaise in 1905.  I have no idea why, but I think the celebration should be referred to as 19-0-Cinco!!<br /><br />But that’s just me, Sarah Palin™<br /><br />I am always amazed as to why so many Mexicans celebrate Cinco de Mayo because I have never seen anyone put mayo on a taco or burrito, or that one thing…a….chimney chonga?  Crazy names!!<br /><br />Another big thing on Sunday?  Jay and Matt will be doing their wacky <a href="http://www.blogtalkradio.com/im-with-stupid/2013/05/05/losing-it-with-dana" target="_blank"><span style="color: blue;">IWS Radio</span></a> show from Noon-2 P.M. ET on Blog Talk Radio.  Ha!!  Those two are crazy funny, and they have a couple of guests this week.<br /><br />They will be hanging out with<a href="https://twitter.com/Dana_Lu" target="_blank"> <span style="color: blue;">Dana</span></a> who recently had sleeve gastrectomy surgery in order to get her weight under control.  She is going to talk about they whys, hows, and wheretofores that she did this.  It’s goin’ to be interesting, but I already know one thing.  The why?<br /><br />Obamacare forced her against her will to have it done, and you and I are paying for it!!  Yep, Sarah Palin™ just said that out loud.<br /><br />They will also be talking to a real live Mexican named Luis who is one of the Latino types that celebrates Cinco de Mayo.  I bet Luis, if that’s his real name, will be talking to Jay and Matt on his Obama Phone while eating tacos and burritos purchased with is EBT Card!!<br /><br />Anyhoo…As you know now, it’s gonna be a HUGE weekend and I hope y’all hang out with IWS Radio Sunday and enjoy your Derby de Cinco de Dana de Luis de<span style="color: blue;"> </span><a href="http://www.blogtalkradio.com/im-with-stupid/2013/05/05/losing-it-with-dana" target="_blank"><span style="color: blue;">IWS Radio</span> </a>weekend.<br /><br />My man-slave Todd and I, Sarah Palin™ will be in Houston for the NRA Conference, enjoying trigger finger excitement and Chik-fil-A sammiches.<br /><br />Until Matt-Man passes out early again,<br /><br /><i>Sarah Palin™</i><br /><br /><a href="mailto:mattmaniws@ymail.com">mattmaniws@ymail.com</a><br /><a href="https://twitter.com/MattMan_IWS" target="_blank"><span style="color: blue;">@mattman_iws</span></a></div>

Sarah Palin™ Kicks Off The Weekend for IWS

Hi Y’all, and Happy Weekend to ya!! You’re probably askin’ yourself… Is that Sarah Palin™ on the IWS website?  And I have to tell ya… Darn R...

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TURKEY: WEST OR EAST?

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mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} </style><![endif]--> <br /><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 1;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;"><br /></span></b></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitH02ewwX0MUUfADeg8u8XCSMasdtK5uIx2LxU6c7m_wfIYcr8w94_w1coAH5EiEjyb_fnCNH5FMllioP-jRS91hMbZxz-FwIyZOMeBXYPUHTGT49UXLj9p_C-TYDj5OfFDwxhd6OJ0Etx/s1600/images.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="291" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitH02ewwX0MUUfADeg8u8XCSMasdtK5uIx2LxU6c7m_wfIYcr8w94_w1coAH5EiEjyb_fnCNH5FMllioP-jRS91hMbZxz-FwIyZOMeBXYPUHTGT49UXLj9p_C-TYDj5OfFDwxhd6OJ0Etx/s400/images.jpg" width="400" /></a></div><div class="MsoNormal" style="line-height: normal; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;"><br /></span></b></div><div class="MsoNormal" style="line-height: normal; text-align: center;"><span style="color: red;"><span style="font-size: large;"><b><span style="font-family: "Times New Roman","serif";">TURKISH AIR BANS RED LIPSTICK, NAIL POLISH</span></b></span></span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 1;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 1;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Via Airwise</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 1;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">TURKEY'S national airline has barred female flight attendants from wearing red lipstick and nail polish, striking a nerve among secular TURKS worried the country is becoming more Islamic.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">TURKISH Airlines, EUROPE'S fourth-biggest carrier, said the ban was aimed at keeping crews "artless and well-groomed with makeup in pastel tones", as a natural look improved communication with passengers.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">"As a consequence of our current cabin uniforms not including red, dark pink, et cetera, the use of lipstick and nail polish in these colours by our cabin crew impairs visual integrity," the statement said.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZRTAI99o98WYWUB5gJcIXVY7wIkOsk59y1UtBjmCFlCnYXfa8UjQWo-YZiP_LsD3fFxH8AUiPHaR5GPkZvXkvNzwuyyg8iYogQTEgqenskVpAa3HTY0HD1MnJBMlzplx-RuMhhF0IxEME/s1600/00075090-642.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZRTAI99o98WYWUB5gJcIXVY7wIkOsk59y1UtBjmCFlCnYXfa8UjQWo-YZiP_LsD3fFxH8AUiPHaR5GPkZvXkvNzwuyyg8iYogQTEgqenskVpAa3HTY0HD1MnJBMlzplx-RuMhhF0IxEME/s400/00075090-642.jpg" width="400" /></a></div><div class="MsoNormal" style="line-height: normal; text-align: center;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="color: red;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">DECISION REFLECTS GROWING INFLUENCE OF THE GOVERNMENT'S CONSERVATIVE RELIGIOUS VALUES</span></b></span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Turkish airlines declined a request for comment.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">The guideline follows other restrictions on employees' appearance and on serving alcohol. Critics say they reflect the influence of the government's conservative religious values at the fast-growing state-run airline.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">"This new guideline is totally down to TURKISH Airlines management's desire to shape the company to fit its own political and ideological stance," said Atilay Aycin, president of the airline's Hava-Is union.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">"No one can deny that TURKEY has become a more conservative, religious country."</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Turkey is 99 percent Muslim but the NATO state and EUROPEAN UNION candidate has a secular constitution.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Prime Minister Tayyip Erdogan's ruling AK Party, which traces its roots to a banned Islamic party, has relaxed the state's control over the expression of religion, such as once-strict limits imposed on wearing the Islamic headscarf.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Such restrictions were aimed at reining in Islamism and improving women's rights, but effectively prevented many devout women from studying at university or taking government jobs.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">TURKISH Airlines scrapped its own ban on the headscarf more than a year ago, and covered women now work at check-in counters and at other positions in the company, Aycin said.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Other Turkish carriers also have guidelines on the appearance of cabin personnel.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="color: red;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">HIDDEN AGENDA?</span></b></span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">The flag carrier caused a stir earlier this year when newspapers published mock-ups of a new Ottoman-style uniform for stewardesses with ankle-length dresses, a proposal the airline's management appears to have since abandoned.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">That was followed by a ban on alcohol on planes flying to most domestic destinations and some Islamic countries.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">"They are objecting to the lipstick and nail polish that we have been using for years," said Asli Gokmen, 30, a flight attendant who lost her job with more than 300 others last year during a union protest and is petitioning for her position back.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">No current employees were available for comment.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">TURKS worried the government is undermining the country's secular order see a hidden agenda.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">On Twitter, women posted pictures after applying red lipstick. One wrote: "Why not just ban stewardesses altogether so we can all breathe a sigh of relief?"</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Some male Twitter users were indignant over the insinuation that red lipstick would induce a sexual frenzy.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Turkish Airlines passenger Ahmet Yerli, 33, said he did not think the new guideline was a sign of creeping Islamisation but that the ban was still "absurd."</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">"I've never heard of a plane crashing because of a women's lipstick," he said before his flight.</span></div>

TURKEY: WEST OR EAST?

TURKISH AIR BANS RED LIPSTICK, NAIL POLISH Via Airwise TURKEY'S national airline has barred female flight attendants from wearing red l...

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healing and a blog party

<span style="background-color: white; font-family: 'Old Standard TT'; line-height: 24px;">Sorry for the radio silence my friends. It appears that I've developed a case of carpal tunnel and it has totally ruined my quality blogging time. I'll be back at it next week but was told to take the next few days off. (I'm going to pretend that doesn't include being on my iPhone). </span><br /><span style="background-color: white; font-family: 'Old Standard TT'; line-height: 24px;"><br /></span><span style="background-color: white; font-family: 'Old Standard TT'; line-height: 24px;">In the meantime, </span><a href="http://blog.simplybabyfurniture.com/2013/05/02/blogpartyweek3/" target="_blank">head over to the Simply Baby's spring blog party today</a><span style="background-color: white; font-family: 'Old Standard TT'; line-height: 24px;">. My fellow style contributors Cindi and Emily from <a href="http://scrappyloveblog.blogspot.com/" target="_blank">Scrappy Love</a> are hosting</span><span style="background-color: white; font-family: 'Old Standard TT'; line-height: 24px;"> today and I can't wait to see what they put together. And look forward to these style contributors in the weeks to come too.</span><br /><br /><div style="background-color: white; color: #222222; font-family: 'Old Standard TT'; line-height: 24px;"><ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;"><div class="im" style="color: #500050;"><br /><li style="margin: 0px 0px 0.25em 15px; padding: 0px;"><span style="font-family: Times, 'Times New Roman', serif;"><a href="http://vividhuehome.blogspot.com/" style="color: #1155cc; text-decoration: none;" target="_blank" title="Vivid Hue Home">Vivid Hue Home</a>- Heather</span></li><li style="margin: 0px 0px 0.25em 15px; padding: 0px;"><span style="font-family: Times, 'Times New Roman', serif;"><a href="http://www.rhymeswithsmile.blogspot.com/" style="color: #1155cc; text-decoration: none;" target="_blank" title="Rhymes with Smile">Rhymes with Smile-</a> Katherine</span></li><li style="margin: 0px 0px 0.25em 15px; padding: 0px;"><span style="font-family: Times, 'Times New Roman', serif;"><a href="http://www.foreverslikeadream.com/" style="color: #1155cc; text-decoration: none;" target="_blank" title="Forever's Like a Dream">Forever's Like a Dream</a>- Kelley</span></li><li style="margin: 0px 0px 0.25em 15px; padding: 0px;"><a href="http://fancyfreeme.com/" style="color: #1155cc; font-family: Times, 'Times New Roman', serif; text-decoration: none;" target="_blank">Fancy Free Me</a><span style="font-family: Times, 'Times New Roman', serif;">- Elisa</span></li><li style="margin: 0px 0px 0.25em 15px; padding: 0px;"><a href="http://designpostdaily.com/" style="color: #1155cc; font-family: Times, 'Times New Roman', serif; text-decoration: none;" target="_blank">Design Post Daily</a><span style="font-family: Times, 'Times New Roman', serif;">- Beth</span></li></div></ul></div><br style="background-color: white; font-family: 'Old Standard TT'; font-size: 18px; line-height: 24px;" /><div class="separator" style="background-color: white; clear: both; font-family: 'Old Standard TT'; font-size: 18px; line-height: 24px; text-align: center;"><a href="http://blog.simplybabyfurniture.com/2013/04/26/blog-partyweek2/" style="color: #c27ba0; text-decoration: none;" target="_blank"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqAK0ou_ARhpIX2yGFFDlbnWKpHpEe3jy_8Z8lerVtbyCrU7ZDF7qM9vcPXAeWx-IEfAqLF7gSk5z198wwdyOlSm6AJ5-kLQ6vO7Y62sTUPTkkHKKZZoWPKv1q_j0nA5Uu969tFB1HU3m2/s320/Mom-Blog-Party-Badge.jpg" style="-webkit-box-shadow: rgba(0, 0, 0, 0.0980392) 1px 1px 5px; border: 1px solid rgb(255, 255, 255); box-shadow: rgba(0, 0, 0, 0.0980392) 1px 1px 5px; padding: 5px; position: relative;" width="320" /></a></div><br style="background-color: white; font-family: 'Old Standard TT'; font-size: 18px; line-height: 24px;" /><br />Have a great weekend!

healing and a blog party

Sorry for the radio silence my friends. It appears that I've developed a case of carpal tunnel and it has totally ruined my quality blog...

Read more »