Just above ground level at one end is a roughly 4'-8"x4'-8" landing. The width at 8'-0" matches the width of the existing sun room. Originally the patio was smaller, but 14' is reaching the maximum joist span so the walkway was shortened and the patio lengthened. My deck is 150 square feet, consisting of an 8'x10' patio and then a 14'-3" x 4'-8" walkway. It's more efficient to span with a joist rather than a beam. As far as what direction for beams, spanning across my garage door dictated my beams would be perpendicular to the house. Joist size and spacing governs overhangs and the spacing of beams. The overall dimensions of your deck will determine the beam and joist length. To start with a deck design, design the deck you want in regards to size, then work back through the joist and beam sizes. One bit would be good for about six holes.įraming: tape measure, pencil, truck & trailer, circular saw, hand saw, corded drill, 3/8" drill bit, 1/2" drill bit, 5/8" forstner bit, rasp, hammer, 3/4" wrench, string, string level, level, framing angle, step ladder & scaffolding depending on the height of the deckĭeck and Railing: tape measure, pencil, cordless drill, circular saw, jig saw, framing angle, level, right angle drill attachment depending on joist spacign, die grinder/cut off wheel, welder (optional) Preliminary: tape measure, pencil/paper, Sketchupįootings: tape measure, pencil, 2x4s, framing angle, nails, spray paint, flat nose shovel, mattock, post hole diggers, angle grinder, vice, wheel barrow, bucket, rubber mallet, level, string, string level, oscillating dremel tool, corded drill, (6) 1/8" masonry bits I bought them from a big box home improvement store. In addition to concrete, hangers, lumber, and deck boards which I detail in a later step, I used the following tools as best I recall: It's a learning process and that takes time. I didn't take any prolonged breaks until December once the deck was mostly in place and usable. I worked most nights and many weekends, just a one person job. I broke ground in June 2019 and finished in October. While you should confirm local requirements, it's unlikely they would be more stringent than the IRC. The new deck is built right, according to the deck portion of the International Residential Code which is much more stringent than my local code. The deck should be independently supported. It's attached to the house rim joist, but the house rim joist cantilevers. The railings are insufficient and are surface mounted to the deck board. The joists span too far and are attached only with nails, no brackets. It just sits on a metal base The column is not attached to the beam either. The column is not attached to the footing. What's wrong with it? The "footing" is a concrete paver sitting on top of the ground. You can get a car through the door, but it's tricky. They even put a column in front of the garage door. Footings, columns, joists, bracing, railings. I hope the homeowner did this and not a hired professional. I planned to get rid of it anyway, but it is amazing the previous builder got every little detail wrong. Once I looked into it, I soon realized nothing on my current deck meets code. When I first bought my house, I knew I would replace the deck sooner or later.
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The fixation process has ‘tightened’ Mr Blobby’s skin so his ‘nose’ has shrunk, and he no longer retains his ‘cute’ look.” -Australian Museum. It was initially fixed in formaldehyde and is now preserved in 70% ethyl alcohol. The specimen now resides in the Australian Museum Ichthyology Collection (AMS I.42771-001). The fish’s body is flabby and not adapted to be out of water! The yellowish ‘blob’ on the right side of Mr Blobby’s mouth is a parasitic copepod. “The scientists and crew on board the RV Tangaroa, affectionately called this fish ‘Mr Blobby’. See what the blobfish looks like underwater and learn what’s inside the blobfish.” They even make an appearance in Animal Crossing. Psychrolutes microporos, Australian sculpin. Commonly mistaken for the blob sculpin (Psychrolutes phrictus) and named the world’s ugliest animal in 2013. Blobby)! Blobfish facts! Family Psychrolutidae. YouTube creator describes Blobfish as: “Quick facts about this gelatinous deep sea creature! The blobfish (Psychrolutes marcidus, Mr. It's filled with high tech and has to maintain a Blueooth connection when in use. It's important to keep in mind that the Wii Remote was designed as a game controller. From this, it calculates the position of the Wii Remote and places the mouse cursor at the respective position on your screen. Remote Buddy 2 uses this data to track the location of the IR light sources. Their location is then sent to Remote Buddy 2 via Bluetooth. These IR light sources are seen by the IR camera located at the front of the Wii Remote. It consists of a simple array of IR light sources (and thus the physically exact opposite of a sensor). The Sensor Bar - unlike its name suggests - does not contain any receiver or sensors at all. The Wii Sensor Bar emits the IR light required by the IR camera ("sensor") inside the Wii Remote itself. The Wii Sensor Bar (and why its name can be misleading) If, however, you just want to use the buttons of the Wii Remote with Remote Buddy 2, you do not need a Wireless Wii Sensor Bar. A Wireless Wii Sensor Bar is physically required for using the IR Mouse Mode. The IR Mouse Mode works by tracking the position of IR light sources - usually supplied by a Wireless Wii Sensor Bar located on top or below the display use with the Mac. Remote Buddy 2 can use the IR camera built into the front of the Wii Remote to implement a virtual mouse that can be moved by pointing the Wii Remote itself to a different position. For information on the successor, with "Wii MotionPlus inside" printed on the front, please see this page. For Remote Buddy, the commands for short and long button presses should always be identical.This page is exclusively about the original Wii Remote. The table that follows lists the commands the Harmony software assigns to the respective buttons by default - and how these need to be changed for Remote Buddy. Empty batteries: if you can't control any devices with your Harmony Smart Remote at all, while using the "Harmony Control" app on your iOS device still works, chances are the battery of your remote needs to be replaced.Since OS X caches the identity of Bluetooth devices, it may take some time, several attempts and maybe even a system restart before OS X sees your Harmony Hub as a "Consumer Control" device again and again allows Remote Buddy access to it. To properly remove the pairing as a keyboard, first use the Harmony in that mode, then remove "Harmony Keyboard" from System Preferences > Bluetooth - and finally remove the respective device from your Harmony's configuration. For keyboards, however, OS X only allows access to apps running with root/administrator priviledges, locking out Remote Buddy. For this class of devices, any app is allowed to exclusively capture all input. Why is this? In "Sony Playstation 3" mode, the Harmony Hub identifies as "Consumer Control" device to your Mac. If you also pair your Harmony Hub as a soft keyboard, Remote Buddy will no longer be able to capture input events coming from it.
Surveillance testing is no longer required for students and employees. Refer to the table for the new expiration date using the lot number printed on the test kit box. The Flowflex COVID-19 Antigen Home Test has an expiration date that is extended by 9 months. Food and Drug Administration (FDA) issued an amended EUA for several rapid antigen tests to extend the shelf-life. The first case of coronavirus in California was confirmed one year ago today.The U.S. “While we are proud of the framework we put out, the CDC put out and others, we recognize it has advantages and it has disadvantages and it relates to speed and efficiency.” “We realize we have got to increase throughput here.” he said. The state has been criticized for its slow rollout, which Newsom acknowledged. The state is still in the earlier phases of vaccine rollout, with healthcare workers, food and agriculture workers, education workers and Californians ages 65 years and older receiving doses first. Nearly 2.2m doses of the vaccine have been administered, about 45% of the total vaccines the state has received. But in barely a month, the total rose from 20,000 to 30,000, with 37,138 people dead as of Monday. It took California six months to record its first 10,000 deaths. “Seven weeks ago, our hospitals and frontline medical workers were stretched to their limits, but Californians heard the urgent message to stay home when possible and our surge after the December holidays did not overwhelm the healthcare system to the degree we had feared.”Īs of Monday, California had nearly 3.17m reported cases of Covid-19. “California is slowly starting to emerge from the most dangerous surge of this pandemic yet, which is the light at the end of the tunnel we’ve been hoping for,” said Dr Mark Ghaly, California health and human services secretary, in a statement. Statewide, just two regions had the stay-at-home order removed: the greater Sacramento region, which left the order on 12 January, and the northern California region, which never entered the order. Regions such as southern California, where one in three Los Angeles county residents are believed to have been infected with coronavirus, and the rural San Joaquin Valley, where hospital capacity was never much to begin with, have been under lockdown since the first week of December. Newsom instituted the regional stay-at-home order in December that was dependent on intensive care unit capacity. “My quintessential question: How are low income communities of color and essential workers being impacted by this order? Why do I have to keep asking this question?” “This new executive order is surprising,” tweeted Lena Gonzalez, a California state senator. Others expressed dismay at how the order will affect low-income communities of color that have already been disproportionately affected by the pandemic because so many work as essential workers in service industry jobs. In Los Angeles county, home to 10 million people, the Republican district supervisor Kathryn Barger expressed support for opening outdoor dining, personal care services and other industries and said the state must balance public health with “devastating social, emotional and economic impacts of this virus”.Los Angeles county public health officials are expected to hold a briefing later on Monday. Orange county planned to lift some restrictions as well, said Jessica Good, a spokeswoman for the county health agency. “We will be moving forward with some limited reopenings, including outdoor dining and personal services,” said the San Francisco mayor, London Breed, in a tweet. Public officials in some of California’s major cities and counties indicated they could soon lift local restrictions. It also comes as more than 50 wine country-based restaurants and wineries have filed a lawsuit against Newsomover the state’s restrictions on outdoor dining. Monday’s announcement follows months of a relentless case surge that exhausted the healthcare system statewide and made California the first US state to record 3m Covid-19 infections. Newsom said on Monday that California averaged 23,283 new coronavirus cases a day over the past week, and its positivity rate was down to 8%, below that of Texas, Florida and Arizona. The decision came amid improving trends in the state’s rate of infections, hospitalizations and intensive care unit capacity as well as vaccinations. Local officials still could choose to impose stricter rules. It lifts an evening curfew and, in many areas, will allow restaurants and churches to resume outdoor operations and hair and nail salons to reopen. Monday’s change moves counties back to a tiered system of reopening, with most regions across the state expected to move into the most restrictive tier. Note: In demo version you can create and manage room admins, Capacity 250, Ban list 200, Black room name in the listings. Long-time users can also apply to become Guides. Get a Guide to show you around Pal talk and answer any questions. Just Select " Capture Video or Photo" from the Actions Menu and attach it to your email or IM.Īccess hundreds of Games by clicking on "Games" from the Actions menu or by visiting Record and share a video message with 1 or more friends. Take a snapshot picture of your screen and share it by selecting "Capture Screen" from the Actions Menu or by clicking on the Screen Capture icon in the bottom navigation.Īrchive the Text from your IM conversation by selecting the 'Save IM Conversation' option under the "File" dropdown menu. Want to send the same message to more than one person? Select "Send IMs to Many Pals" from the Actions Menu. Send files up to 200 MB by selecting "Send Pal a file" from the Actions Menu. Add audio and video just by sending them a simple SuperIM link. Perfect for making friends online.īe everywhere at once! Text chat with your AOL, MSN, Y!, Gchat, and Facebook friends right from the Pal list. Choose from a huge selection of area codes. Get an online number that lets you make and receive calls without revealing your phone number. Conferencingvideo chat with up to 10 people for free simultaneously on SuperIM Some subscription plans also come with free PC to Phone minutes included. Save on calls to over 250 countries and cities! Select "Make a Phone Call" from the Actions Menu. The tool offers a richer, more enhanced audio experience See and be seen! Share your video with thousands of interested app members in your favorite discussion roomsīe smooth! Get over 20 frames a second for the most natural group video chat experience ever.īe yourself! Express your personality with different fonts, effects, and hundreds of emoticons in a group or one-on-one chats.īe heard! Voice chat one-on-one or with a group – as long as you have a mic and headset (or speakers), with the app you can chat for free with friends around the world! Use a fun collection of stickers to communicate with friends.Īdd interactive video to your site or blogPaltalk's Video Chat Widget lets you engage audiences of any size with a fully interactive video chat room embedded directly on your site or social network profile. Send a gift to break the ice with a new pal or an entire chatroom. Post YouTube and SoundCloud clips in chatrooms so everyone can watch and listen together.Īccess the software on iOS, Android, Windows, Mac, and Kindle. Video chat while you text, text while you video chat. Video chat and message your friends and family privately and instantly, outside of chat rooms. Interact with friendly members around current events, music, sports, and much much more.īrowse through Paltalk's 5,000+ public chat rooms and join the conversation. Looking for Online Voice Changer Software in Real-Time? Check out AV Voice Changer Software Diamond NOW!īrowse over 5,000 active group chat rooms. Interoperability with AIM, Yahoo, Facebook, GTalk, and ICQ-IM with all your friends from Paltalk. Virtual Gifts-fun animations that can be sent to other members in a chat room. Unlimited group video calls with up to 10 friends. Room categories include music, politics, sports, religion, and many more. The free Paltalk for PC download includes: Access to thousands of live video chat rooms. In version 0.9.Paltalk is the world's largest video chat community, with over 4 million members. it will show a window and hang there, nothing happen after that:. start Paltalk from say: "D:\Sandbox\LLED2\Paltalk\drive\D\Program Files (x86)\Paltalk Messenger\paltalk.exe".install it inside a sandbox using any sandboxie version from 0.9.8+.Download the classic Paltalk version from here:.I tested this new versions too but still not working: The Paltalk messenger was working fine with the old Sandboxie-plus versions, it stopped working exactly from the version Her English name is from her mother's love of the jewel. Her father was a businessman, and her mother a housewife. Lin was born and raised in Taipei, Taiwan, the eldest of four children, having one brother a year younger the other, six years younger, and a half-sister, ten years younger, from her father's second marriage. Lin ranked 30th on Forbes China Celebrity 100 list in 2013, 36th in 2014, 82nd in 2015, and 68th in 2017. Her production debut The Glamorous Imperial Concubine (2011) won her Best Producer at the 2012 TV Drama Awards Made in China, and her first Taiwanese drama production The Way We Were (2014) won three out of seven nominations, including Best Television Series at the 50th Golden Bell Awards.Īccording to Apple Daily, Lin was the third highest-earning Taiwanese drama actress in 2011, and the top-earning in 20. Since Lin started her own studio in 2009, she has been producing TV dramas and TV films starring herself, both in mainland China and Taiwan. In 1999, she also began a singing career with her debut album Heartbeat released in Hong Kong first amongst Asian countries, and has since released 5 albums. While focusing mostly on TV series, her works also include film such as The House That Never Dies (2014), The Devotion of Suspect X (2017) and Miss Andy (2020). She followed the success with other hit series including The Duke of Mount Deer (2000), Romance in the Rain (2001), Boy & Girl (2003), Affair of Half a Lifetime (2004), Beauty's Rival in Palace (2010), The Glamorous Imperial Concubine (2011) and The Way We Were (2014). My Fair Princess was highly popular in East and Southeast countries launching Lin as a household name in Asia. ģ years after Lin made her acting debut in a TV commercial, she rose to national and regional prominence overnight for her role as Xia Ziwei in the TV series My Fair Princess 还珠格格 (1998-1999). American entertainment critic Derek Elley named Lin as "Taiwan's TV Drama Queen". Ruby Lin Xin-ru ( Chinese: 林心如 pinyin: Lín Xīnrú born January 27, 1976) is a Taiwanese actress, television and film producer, and pop singer. Updates to mic volume in system settings are now properly reflected in the Recorder interface.ġ4 November 2023: Camtasia 2023.3.3 Feature Updates.Fixed a bug that could cause a detached Canvas to change size after an export is completed.Fixed a bug: Recorder can initialize webcam improperly sometimes.Fixed a bug that could cause warnings when exporting from Camtasia Rev that did not apply to the Camtasia Rev recording.Fixed an issue with a label being cut-off in the Media Bin in certain locales.Fixed a bug that could cause the video to flicker when transitions were applied to special annotations such as Blur or Spotlight.Fixed a memory leak related to video decoding.Thanks to Renwa Hiwa ( ) for reporting this issue. Fixed a security issue with the custom file handler protocol, which could result in arbitrary file downloads.Fixed a security issue where user interaction with a maliciously crafted project file could result in arbitrary code execution.Added the ability to resize the Tool Panel.Added a cursor pack with three new cursors (Christmas tree, candy cane, Santa Claus hand).Walk away and let Camtasia's Batch Exporter work through a number of projects, or keep working on a current project while your other projects export in the background. All of your standard and custom export presets are available, allowing you to export a series of projects in a variety of sizes and formats. Introducing a new set it and forget it experience for exporting videos in Camtasia! With the improved Batch Exporter, you can now add multiple projects to a queue and export them all together.Fixed a bug that could prevent proxying of MTS files.Ģ9 November 2023: Camtasia 2023.4.0 New Features.Fixed a potential crash that could occur when launching help documentation during signin.Users are now prompted to confirm the opening of project files containing network paths, addressing a potential security risk.Fixed an issue where audio volume tooltips would not show after splitting a media.Fixed a bug that could cause exports to introduce a black line in projects with dimensions not divisible by two. Fixed a bug that could result in cursors being recorded at an incorrect size.Fixed a bug that could cause media files to be missing when saving standalone projects to OneDrive.Fixed a bug that could prevent importing of assets via the Assets tab in some environments.Improved error handling when licensing errors occur due to permissions issues.The Emphasize audio effect is now automatically applied to microphone recordings.12 December 2023: Camtasia 2023.4.1 Feature Updates Not all items sold at Canadian Tire earn CT Money. Any bonus multiplier is based on the base rate of collecting CT Money. You cannot collect paper Canadian Tire Money on bonus offers. † In the form of electronic Canadian Tire Money® (CT Money®). Examples of borrowing costs (rounded to the nearest cent) assuming that all charges are purchases bearing interest at the regular annual rate of 20.99%, a 30 day month, no charges made on special payment plans and no other fees, additional payments or other changes are: The Triangle Mastercard and the Triangle World Elite Mastercard do not have an annual fee. The billing period covered by each statement can be from 28-33 days. For residents of Quebec, the period between the statement date and the due date for payment is 26 days. The minimum payment is the sum of (a) the greater of: (i) interest and fees shown on your statement + $10 or (ii) 5% of the New Balance, excluding amounts on special payment plans, (b) any balance over your credit limit, (c) any amounts past due not included in (b) above, and (d) the amount of any equal payments plan instalments then due. Some applicants may receive a higher or lower regular annual rate depending on a credit evaluation. Offer subject to change without notice.Īdditional information for residents of Quebec only: The regular annual rate for persons applying for the Triangle Mastercard and the Triangle World Elite Mastercard is 22.99% for cash transactions and related fees and 20.99% for all other charges. Any unpaid portion not received by the due date will no longer form part of the equal payments plan and interest will accrue on that amount from the day after the date of your next statement at the applicable regular annual rate. Each month during an equal payments plan you are required to pay in full by the due date that month’s equal payments plan instalment. There is no administration fee charged for entering into a special payments plan. However, if we do not receive the full minimum due on a statement within 59 days of the date of that statement, or any event of default (other than a payment default) occurs under your Cardmember Agreement, all special payment plans on your account will terminate and (i) you will then be charged interest on the balances outstanding on such plans at the applicable regular annual rate from the day after the date of your next statement, and (ii) the balances outstanding will form part of the balance due on that statement. Interest does not accrue during the period of the plan. Dealers may sell for less.įinancing available is “Equal payments, no interest” for 24 months (unless otherwise stated) and is only available on request, on approved credit and on purchases of $150 (unless otherwise stated) or more (Gift Cards excluded) made with your Triangle credit card at Canadian Tire, Sport Chek, Mark’s, L’Équipeur, Atmosphere, Sports Rousseau, Hockey Experts, L’Entrepôt du Hockey and participating Sports Experts. **Online prices and sale effective dates may differ from those in-store and may vary by region. ±Was price reflects the last national regular price this product was sold for. The tire producer / manufacturer and Canadian Tire uses this fee to pay for the collection, transportation, and processing of used tires.ĬANADIAN TIRE® and the CANADIAN TIRE Triangle Design are registered trade-marks of Canadian Tire Corporation, Limited. Am I missing or underestimating anything? The shelves themselves are white and I don't mind the white plastic look, but I do want to be able to adjust them so I'd like to avoid the "locking" type of supports.△The tire producer / manufacturer of the tires you are buying, and Canadian Tire is responsible for the recycling fee that is included in your invoice. Is it there to prevent the shelf from flipping if it is weighted too front-heavy, or if someone pulls on the front edge? Given that these are small cabinet shelves (12"-15" wide x 23" deep), I can't imagine that that is a big risk. I would be willing to pay for alternate shelf supports, but I want to make sure I'm not going to cause problems by giving up the "locking" part of the shelf support. It turns the advertised "adjustable shelving" into non-adjustable shelving, as far as I can tell. I have them in my current kitchen cabinets, and I hate them, because they make moving a shelf impossible once the inset door is attached: the lock prevents me from lifting the shelf to move it, and the cabinet door edge makes it impossible for me to slide the shelf out to move it. I know because my sister just redid her kitchen with the same company, and that's what she got. I know that the standard shelf supports that will come with my new kitchen cabinets are standard, economy plastic locking supports, like these. While lacking HDMI and digital audio coaxial inputs, this receiver remains a convenient and practical choice for those seeking wireless audio transmission capabilities. With its 3.5mm speaker connectivity, USB port, and digital audio optical and phono inputs, it offers flexibility in connecting to different audio devices. It provides a reliable and high-quality audio streaming experience with its Bluetooth version 5.0 and A2DP profile support. The iStream Universal Bluetooth Audio Receiver is the perfect solution to stream music wirelessly from any Bluetooth enabled device to any speaker system with an AUX IN or RCA IN port. Overall, the Aluratek ABCD54F is a versatile Bluetooth music receiver that offers wired and wireless connectivity options, making it suitable for various audio setups. Connectivity: 3.5mm (AUX) / Bluetooth v2.0 + EDR / Micro USB Package Contents iStream Universal Bluetooth Audio Receiver USB Charging Cable 3. User rating, 4.1 out of 5 stars with 3017 reviews. iStream Universal Bluetooth Audio Receiver - Black. I need the transmitter for one purpose: to broadcast audio from my home theater receiver to my Bluetooth headphones when I want to watch a video without disturbing. The goal he Learn about Aluratek - iStream Universal Bluetooth Audio Receiver - Black with 2 Answers Best Buy. I already owned a Bluetooth transmitter, the TaoTronics TT-BA01. Aluratek iStream Universal Bluetooth Audio Receiver: Easily add Bluetooth capability to your existing stereo system or speaker. User rating, 4.1 out of 5 stars with 3020 reviews. Moukey Home Audio Amplifier 220W Dual Channel Stereo Receiver System Bluetooth 5.0 w/Usb, Sd, Aux, Mic in w/Echo, Radio, LED - for Studio Use - MAMP1 79 4.7 out of 5 Stars. Answer No this is a receiver only not a transmitter you want the Aluratek - Bluetooth Audio Receiver and Transmitter. The use of Bluetooth version 5.0 ensures a stable and efficient connection between the receiver and your audio devices. Customer Ratings & Reviews See more images Aluratek - iStream Universal Bluetooth Audio Receiver - Black Model: AIS01F SKU: 6581843 4. First, full disclosure about why I acquired the Aluratek model ABC53F Bluetooth audio receiver and transmitter. Is compatible with Nintendo swich Learn about Aluratek - iStream Universal Bluetooth Audio Receiver - Black with 1 Answer Best Buy. Learn more with 194 Questions and 327 Answers for Aluratek - iStream Universal Bluetooth Audio Receiver - Black. While the Aluratek ABCD54F lacks Ethernet LAN and Wi-Fi capabilities, it makes up for it with its Bluetooth functionality, which enables seamless wireless audio transmission. It also has a single phono input (RCA), providing another alternative for audio connection. However, it does not have a digital audio coaxial input or HDMI input options. In terms of its input options, the Aluratek ABCD54F offers a single digital audio optical input, which allows for a direct connection to devices with optical outputs. In addition to its wireless capabilities, this receiver also offers a USB port for wired connectivity, allowing for more versatile audio options. With Bluetooth version 5.0 and support for the A2DP profile, this receiver offers a reliable and high-quality audio streaming experience.įeaturing a 3.5mm speaker connectivity type, the Aluratek ABCD54F can be easily connected to speakers or headphones with a compatible audio jack. I would recommend it for short distances and it is certainly worth the money and is made well.The Aluratek ABCD54F is a Bluetooth music receiver that allows users to connect their audio devices wirelessly to speakers or other audio equipment. Maybe if the receiver had an antenna or if the bluetooth adapter had an antenna, I've got the Receiver at about 20 feet away and if I try to raise the volume on the mini amp, the sound is intermittent ( breaks up ). The only problem is the bluetooth Dongle does not send a stronger signal to allow it to do the job. Details Application Reviews The iStream Universal Bluetooth Audio Receiver is the perfect solution to stream music wirelessly from any Bluetooth enabled device to any speaker system with an AUX IN or RCA IN port with crystal clear results. It seems to me the device does what it is intended to do. It nearly Bluetooth enables any speaker or receiver with crystal clear results You can even connect the iStream to your car auxiliary port and. I would recommend it for short distances and it is certainly worth the money and is made well. The only problem is the bluetooth Dongle does not send a stronger signal to allow it to do the job. It seems to me the device does what it is intended to do. We’ve been obsessed in medicine with having the best drugs, the best devices, the best specialists-but we’ve paid little attention to how to make them fit together well. If I want to give my patients the best care possible, not only must I do a good job, but a whole collection of diverse components must somehow mesh effectively. Among our most profound difficulties is making them work together. Medicine requires the successful function of systems-of people and of technologies. For those getting the best results-the hospitals and doctors measured at the top of the curve for patient outcomes-are not the most expensive. There is a bell curve for cost and quality, and it is frustrating-but also hopeful. Two communities in the same state with the same levels of poverty and health can differ by more than fifty per cent in their Medicare costs. There is remarkable variability in the cost and quality of care. For health care is not practiced the same way across the country. This is just what good medicine is like, we’re tempted to say. We in medicine have watched all this mainly with bafflement, even indifference. Our deficit problem-far and away-is the soaring and seemingly unstoppable cost of health care. But take both away and you’ve made almost no difference. One side says war spending is the problem, the other says it’s the economic bailout plan. By 2025, we will owe more money than our economy produces. And then there is the frightening federal debt we will face. State budgets will have to double to maintain current health programs. Health care will go from ten per cent to seventeen per cent of labor costs for business, and workers’ wages will have to fall. By the end of the decade, at the present rate of cost growth, the price of a family insurance plan will rise to $27,000. And the country is also struggling mightily with the costs. The result is that more than forty per cent of patients with common conditions like coronary artery disease, stroke, or asthma receive incomplete or inappropriate care in our communities. Diagnosis and treatment of most conditions require complex steps and considerations, and often multiple people and technologies. There is no industry in the world with 13,600 different service lines to deliver.īut this could not be further from the truth. Our job in medicine is to make sure that all of this capability is deployed, town by town, in the right way at the right time, without harm or waste of resources, for every person alive. But those remedies now include more than six thousand drugs and four thousand medical and surgical procedures. And for each one we’ve discovered beneficial remedies-remedies that can reduce suffering, extend lives, and sometimes stop a disease altogether. It has enumerated and identified, according to the international disease-classification system, more than 13,600 diagnoses-13,600 different ways our bodies can fail. Since then, however, science has combatted our ignorance. Half a century ago, medicine was neither costly nor effective. We’re talking about a problem rooted in scientific complexity. When we talk about the uncontrollable explosion in the costs of health care in America, for instance-about the reality that we in medicine are gradually bankrupting the country-we’re not talking about a problem rooted in economics. Worse, the fear is that the knowledge has grown beyond our capacity as a society. The truth is that the volume and complexity of the knowledge that we need to master has grown exponentially beyond our capacity as individuals. This is a deeper, more fundamental problem than we acknowledge. I didn’t feel much better equipped when my wife had two miscarriages, or when our first child was born with part of his aorta missing, or when my daughter had a fall and dislocated her elbow, and I failed to recognize it, or when my wife tore a ligament in her wrist that I’d never heard of-her velluvial matrix, I think it was. The information was not anywhere in the textbooks. “So tell me: where exactly is the solar plexus?” I remember one time when a friend came with a question. And, inevitably, they turn to the medical graduate in the house for advice and explanation. Since I graduated from medical school, my family and friends have had their share of medical issues, just as you and your family will. |
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