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Friday, August 15, 2014
The basic health care transaction
My life changed dramatically 18 months ago when I started my new practice. The biggest change personally was a dramatic drop in my income as I built a new business using a model that is fairly new. That's a tough thing to do with 4 kids, 3 of whom were in college last fall. OK, that's a stupid thing to do, but my stupidity has already been well-established.
Yet even if the income stayed identical to what I earned before the switch, the change in my professional life would have been nearly as dramatic:
• I am no longer focused only on patients in my office.
• I am no longer focused on ICD and CPT codes.
• Saving patients money has become one of my top priorities.
• I feel like my patients trust me more, and see me as an ally.
• Patients accept my recommendations for less care (avoiding unnecessary testing and unnecessary medications) much easier.
• I focus far more on preventing problems or keeping them small.
• I laugh with my patients far more.
What is most interesting to me about all of this is what is at the center of all of these changes: I changed the way I am paid for my work. Instead of being paid largely by third-party payors, I am paid by my patients, and instead of being paid more for sickness and procedures, I am rewarded for having healthy and well-informed patients. (For those who don't know, patients pay me between $30 and $60 per month for my services, and there is no copay for office visits).
Since all of these positive changes stem from the incentives created by this different payment system, I've seen even clearer the reasons for all of the problems in our health care system: it's all about the payment system, or the basic transaction of health care. From this transaction flow all of the bad things about our system, the waste, the impersonal nature of care, the physician burn-out, the spending without consideration of cost, and the blatant profiteering by companies associated with health care. Changing our system for the better, therefore, can't happen without a basic change in the financial transaction at its center.
A business transaction involves 2 main participants: the buyer and the seller. The buyer gets a product or service they want from the seller in exchange for money.
What about the transaction of health care? Who are the participants in this transaction, and what is the product sold?
• The Seller: It's pretty clear that health care providers, doctors, hospitals, and ancillary care facilities, are the seller in this transaction.
• The Buyer: It would seem that the patient, the one getting the "care" is the buyer here, but this ignores an important fact: providers get almost all of their money from third-party payors (insurance companies and government organizations). I think it's pretty clear that doctors and hospitals are selling their "product" to these third-parties, not to the patients.
• The Product: Again, it would seem that the care given by the provider is the thing buyers are paying for, but this clearly isn't the case. Reimbursement for health services is based on two main things: codes (CPT and ICD), and the documentation required to support these codes.
So, the basic transaction of health care is this:
The health care provider is paid by third parties for codes and documentation.
The codes, which are the most valuable commodity for a provider, are two types: problem codes (ICD) and procedure codes (CPT, E/M). The payment is actually only given for procedures, not problems, but the problem codes are the immediate justification of those procedures, and failure to justify will reduce or eliminate payment. So, the provider is motivated to find the best paying procedures and find problems to justify their submission.
Using this, the transaction of health care becomes this:
The provider is rewarded for finding the best-paying procedure code to match the most severe problem codes.
Documentation is done after the fact as a bookkeeping tool to prove the validity of the problem and procedure codes.
Where is the patient in all of this? Patients are the raw materials used for the product. They are a source of problem and procedure codes. What about the actual patient care? It is a byproduct of this transaction. Care is presumed to be encompassed in the procedure codes (a presumptuous presumption, as many would attest).
Let that sink in: patients are raw materials, and patient care is a byproduct. That's pretty damning. It's also fact, not opinion. It flows from the basic transaction of health care.
So let's translate this to an office visit:
• The patient is nearly always required to come to the office for all "care" because this is the only place where payable "procedures" are done. For a primary care provider, the main "procedure" is the office visit itself.
• The patient history is done to find problems to which procedures can be applied.
• The bigger the problems, the better the reimbursement for procedures for the doctor.
• The main task of the office visit is to find problem and procedure codes, and to document those codes.
• "Customer service" in health care is not something that applies to patients, since patients are raw materials, not customers. Doctors are motivated to treat patients only well enough that they will continue to come and supply codes (much as a farmer would treat his/her cow who produces milk).
• True "customer service" from doctors applies to how quickly and accurately they produce codes for the customer: the payor.
Pretty brutal, isn't it? This gets worse when you consider some of the corollaries that come from these facts:
• Solving patient problems is bad for business.
• Priority is given to patients with the best-paying payors. Conversely, lowest priority is given to those with the worst payors (i.e. Medicare and Medicaid).
• The best paid physicians are those who are the most skilled at finding the most well-paying codes for the least amount of effort.
When explaining my practice to people, I often take a slightly different take on the transaction:
You are employed by whoever pays you.
The reality of my former practice, and those of most of my colleagues, is that they are employed by the third-party payors, and so will spend most of their time doing the job required by their employer. In my new practice, on the other hand, I am employed by my patients because I am paid by them. They are no longer a cow from which I can milk codes. They are no longer a well from which I can draw procedures. They are the one I am hell-bent on keeping happy so that they'll continue to pay for the care I give.
Finally, the care I give is no longer a byproduct of codes; it is the product for which I am paid. My kind of practice is the ultimate accountable care organization because we are accountable to our patients for the quality and value of what we do for them. If they don't like the product we sell, they leave. The end result is more time devoted to assuring the quality of care our patients see.
More time for patients? That's something I had to get used to when I started this practice. It's also something my patients are still getting used to.
Surely there's a catch.
No, I work for them, and that makes all the difference.
After taking a year-long hiatus from blogging, Rob Lamberts, MD, ACP Member, returned with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind), where this post originally appeared.
Labels: burnout, career, coding, concierge medicine, guest post, More Musings, patient satisfaction, practice management, quality of care, reimbursement, Rob Lamberts
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Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
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Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
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Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.
More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.
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Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.
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Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.
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Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.
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Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.
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PLoS Blog
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Completing an internship on the Elephant Reintroduction programme is one of my proudest achievements to date. It was a complete honour to have had the chance to experience the real authentic Thai culture, whilst living with my host family and being immersed into the community.
It was always a pleasure to hike and see the elephants every day, and completely mesmerizing to see these beautiful animals in their natural habitat.
There was always plenty of activities to get involved in on a daily basis, and I learnt more than I anticipated. The friends I made from around the world, during my time on project, I shall remember for the rest of my life. The elephants, mahouts (elephant keepers), villagers, staff and volunteers made my experience unforgettable and I am so thankful to have participated in the project.
You are hereHome › Global Vision International (GVI)
Global Vision International (GVI)
Completing an internship on the Elephant Reintroduction programme is one of my proudest achievements to date. It was a complete honour to have had the chance to experience the real authentic Thai culture, whilst living with my host family and being immersed into the community.
I completed the Marine and Wildlife Conservation program in Phang Nga, Thailand. GVI offers extensive support both prior to and during your program including pre-departure information, airport pick up and information about the local area.
The staff on base are amazing in not only helping us integrate into our program but also understand how our time contributes to the development of the community. They are very knowledgeable of the local culture and anthropological narratives that have shaped the community. They provided us with both Thai language and culture courses, to alleviate the stresses of adapting to a new country and integrating smoothly into the community.
The staff supported us beyond the program. When I fell ill, a staff member helped us organise transport to the hospital as we couldn't speak Thai. In addition, they helped us plan our short holidays and encouraged us to explore different parts of Thailand when we had days off.
We were even allowed to join in with other programs to get the most out of our experience. Thus even though I was in the conservation program, I joined the teaching and community teams in their orphanage visits and English classes.
The living conditions were modest, which is expected when you are volunteering at a developing country. Living in a village among villagers helped me appreciate the program and its contribution more and learn more about the locals.
Overall I highly recommend GVI and their volunteer programs.
I did the GVI internship on April last year. For that I spent 3 months on a game reserve and another 3 months in a work place.
First thing you should know: game reserves are, above everything else, a business. There's no truly wild place in South Africa. Being the property of someone and a profitable business, it must be managed. I would say the reserve is like a zoo without cages.
For that, we need to give way to the tourists satying at the lodges, going on game drives. As I said, the reserve is a business, and a lot of wrong decisions can be made, not regarding the well being of the wildlife. What we in our time in GVI is locating everyday the lions and the semi-imprinted cheetah (which sometimes you will get out of the vehicle and go into the block to locate her on foot). We take basic data as behaviour, location and wheater conditions and type it at the computer back at base. Only the volunteer responsible for data on that specific drive will do it, though. Other activities during drive include operating the telemetry equipment, doing vehicle check before drive, operating the spotlight on the way back to base when it's already dark.
We collect data on other animals we might come across, like rhinos, elephants, buffalos, hyenas, etc. But these we do not track, so it's not the priority to locate first, coming across them only by chance or if we have time left after finding the "key" animals.
Sometimes volunteers will do other tasks such as reserve work by cleaning the roads, educational bush walks, base work (which is a rotation of volunteers to look after the base - cooking, cleaning - during the day).
As an intern, you will have some extra activities that the common volunteers don't. That would be basically for your education about the bush and conservation through game reserves. You will have a few lectures and will have to do some assignments. You will have a mentor to talk about your goals. And you will learn about tracks, birds and trees. But most of your knowledge, will come from your own effort. There as several books available at base and staff members willing to answer your questions. But if you don't commit yourself with your self education, you won't learn as much as you could.
There's three bathrooms, two of them with shower (not the best of showers, but at least there's hot water). Currently there are three dorms for volunteers. Most of the matress are very old and used and you will sleep on bunk beds. It's something you can get used to quickly, sleep in a room full of people and later on you can even miss it. Most of volunteers go to bed early, before 9, as we need to get up before the sun rise. The meals are prepared by the volunteers in charge, a pre made menu that can be adjusted to any diet requirements.
My second part of the program was spent in CROW (Centre for Rehabilitation of Wildlife) based on Durban. Even if I had all the help from GVI to get there, with tips of flights, places to stay and transport, I had to deal with the costs.
CROW has nothing to do with GVI except the booking, so I won't give the feedback of my time there here. But I got there thanks to GVI. When calculating the fee for volunteering at CROW, through GVI the value is around 4 to 5 times more. So if you're interested, I recommend booking directly with CROW and not any travel or volunteering agency.
The cost for internship or volunteering with GVI is very high. There are plenty of game reserves that take volunteers for much less. Of course I can only talk about my experience with GVI, and in general I'm really thankful that it started a 2 year journey through South Africa. In the end was definetely worth it. I will always remember my time at the reserve and cherish deeply as one of the greatest moments of my life.
I recommend this program for whoever wants to do a safari in South Africa and take good pictures while making friends and getting closer to the environment. Is a much better way to know the wildlife and also to keep yourself busy during a trip. You will have an amazing experience. It just wouldn't be my first option for an educational internship.
On the first day we were met by the GVI staff members and treated to a delicious breakfast of local fruits. Before long, we were on our way across the lush, green island to the small village of Silana. Our arrival was eagerly anticipated by the other GVI volunteers, who welcomed us with smiles and lunch!
Our first Sunday was spent in church and getting to know our Fijian families. A traditional Fijian meal was prepared and we were supplied with pillows and told to 'take a nap' for the afternoon, happily following the local custom that no work can be done on a Sunday.
The following weeks involved getting to know our class at school. The level of spoken and written English varied dramatically throughout the class but all the children were keen to learn and practice, particularly if that involved gossiping about other class members or volunteers! I was struck by the enthusiasm of the children in my class – something that I never experienced whilst I was at school. They had dreams of being doctors or teachers in order to help out their community, but most of all, they wanted to travel.
My experience in Silana was one of the most treasured moments of my life. The village was so welcoming, always ready to teach you Fijian or inviting you into their house for dinner. The evenings were spent drinking kava in the community hall or watching exceptional performances of the Meke – a traditional Fijian dance.
Almost as soon as we arrived it was time to leave. The morning came for us to leave and the women of the village came to say goodbye in the traditional way – through song. By the time the stunning harmonies of Isa Lei had come to an end there wasn't a dry eye getting in the van to leave.
I know I speak for all the volunteers when I say that being in Silana was a truly special experience and that we would all do anything to go back. Four weeks was definitely not long enough and I would thoroughly recommend this program to anyone and everyone!
I took part in the gvi Island Conservation programme in Seychelles in August 2015. I loved living on the uninhabited island, Curieuse with the gvi staff and my group of volunteers. Seychelles has to be one of the most beautiful and unspoilt places on earth and the wildlife is unique. I loved the deserted beaches! I loved working with the giant tortoises and the green turtle hatchlings. I flew to Bird for part of my programme to spent 4 days exploring this wild and remote private island. Standing on the edge of the sooty tern colony on the North Point, listening to 800,000 pairs nesting was incredible! The remoteness and beauty of Bird is a recommended experience. Snorkelling with a green turtle on Praslin was unforgettable. I had a lot of fun making new friends and having new experiences out in the field. It was physically challenging at times, due to the heat and humidity so I would make sure you have increased your fitnness levels before you go! The camp is well equipped you don't need to take half of what you would expect. The gvi staff were really firiendly - very professional and loads of fun. I would recommend this conservation project with gvi - it may be expensive but it is definitely worth it.
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I found this cool site, you might have to copy and paste the link. It is legit. and I think it's an awesome way to give something back to those that have given everything
Asked by 1nglmom3 at 11:02 PM on Jan. 12, 2011 in Politics & Current EventsLevel 9 (306 Credits)
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- Please select a date to see the proper prices!
Description of the accommodation:
Rooms, services The guests of Qingdao New Tianqiao Hotel Qingdao may stay in 80 nicely furnished, comfortable rooms in Qingdao. Nearby table tennis opportunities will provide an excellent chance to spend your leisure time actively. The bar has excellent atmosphere for a relaxed evening talk or a personal meeting. Wireless Internet connection (WiFi) is available at the hotel, ensuring that you can stay up-to-date during your holiday. An exact and detailed list of equipment in the rooms and of the services provided by Qingdao New Tianqiao Hotel Qingdao you will find on the information sheet below, including any applicable additional fees.
Payment Credit card guarantee or advance bank card payment may be required for the reservation, depending on the chosen room, date and price.
Arrival, opening hours The personnel of the hotel can speak in Chinese - China and English with you.
Qingdao New Tianqiao Hotel Qingdao rooms Rooms
- Please select a date to see the proper prices!
Accommodation services
WiFi in public areas
Bar, Elevator
Desk in the room, Tea/coffee-maker


text:
Sent from my GT-I9100 using The Bub Hub mobile app
Sent from my GT-I9100 using The Bub Hub mobile app
Subbing for future reference teehee.
Promise I'll be quiet!
Way to come home and relax on a Thursday night, rainbow! Not.
Got home, did 2 loads of washing, brought in the washing, cleaned the rabbit's palace and the bathroom, beat the rug outside, vacuumed all the furniture and mopped all the floors.
Pooped now! But it means I get to enjoy my whole Friday off
I think I really need to invest in a new vacuum cleaner though especially with baby on the way, because my fur baby sheds so much, it's so hard to keep on top of and my vacuum is crap!
Rainbow if you can afford it its worth investing in a good quality vacuum that will really suck up your fur babies hair. We did just after River was born and its fantastic! Also I hope you enjoy your friday after all that work
I can't afford a dyson or anything. But anything will be better than my crappy thing. I'll go to the vacuum shop tomorrow..
Good luck finding one in your budget that works for you Rainbow ours was frightfully expensive but with a cat and a Tibetan spaniel both shedding we need it to get the hair off the rugs.
rainbow road (20-09-2013)
Thanks McB!!! I can't be the thought of spending $700 on a vacuum!!! I just want something that does a better job than my current one (which used to be MILs so I figure anything new no matter how cheap will be better!)
Well after my busy day yesterday I soaked in a hot bath and felt much better only to wake up and pull my groin muscle and have to hobble everywhere plus two blood noses all before 8:30am. Joy.
I got into the Holding Hands Midwife Program so have my first appointment there week after next and then go for my birthing classes there and again at the hospital and in two weeks I have my breastfeeding class... DF told me he wanted to come to that as well which I think is very cute
getting excited to meet our little girl... Hurry up December!!
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Version 1.0/ created on 22-11-94/Copr.1994 by Dutch Type Library/URW#
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Easy Spanish Vocabulary Puzzles
By (author) Jane Burnett Smith
Format: Paperback
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Easy Spanish Vocabulary Puzzles by Jane Burnett Smith
Book DescriptionLearn Spanish vocabulary through word games and puzzles! "Easy Spanish Vocabulary Puzzles" offers you an entertaining and effective way of expanding your knowledge of the Spanish language. The puzzles in this book are divided into six categories to cover basic topics of vocabulary: Flora and Fauna; Language; People, Places, and Things; Food; Daily Life; and, Recreation and Sports. Within the categories, puzzles are arranged in order of difficulty and come in a variety of entertaining formats, such as word searches, anagrams, labyrinths, and more. These puzzles are sure to keep you amused as you improve your Spanish vocabulary. While "Easy Spanish Vocabulary Puzzles" provides excellent review for intermediate students, all are within the reach of beginners. The vocabulary and grammar that appear in the puzzles all relate to subjects learned in beginning classes. Additionally, each puzzle is accompanied by clear instructions in both English and Spanish, so that you can do them in the order that suits you best. And, if you have any difficulty with a puzzle clue or wish to check your solutions, an answer key is included at the back of the book.
Buy Easy Spanish Vocabulary Puzzles book by Jane Burnett Smith from Australia's Online Bookstore, Boomerang Books.
Book DetailsISBN: 9780844272450
(226mm x 147mm x 7mm)
Pages: 96
Imprint: NTC Publishing Group,U.S.
Publisher: NTC Publishing Group,U.S.
Publish Date: 1-Nov-1990
Country of Publication: United States
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Author Biography - Jane Burnett Smith
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Community & Current Events
Texting 101
Community & Current Events
Texting 101
Texts are ubiquitous for the younger generation, but for the non-teens among us, it can be tricky to figure out what texts are and how to send them.
Not sure what texting is? Think of it as an abbreviated form of e-mail sent between cell phones. If you bought a new cell phone within the last few years, chances are it's able to send and receive text messages. Check your owner's manual or go to your service provider's shop for a quick tutorial on how to start texting on your phone. Ask about rate plans too: you may want to amend your current plan depending on how much you and your family members are texting.
Because text messages are limited to 140 characters, texting comes with its own language of shortcuts. "When you have a lot to say and a limited space in which to say it, abbreviations become popular," says Mark Carlin, Vice President of TeleMessage.
Until Rosetta Stone comes up with a multi-CD language lesson, the best way to learn this language is to wade in and start texting it.
For the most part, abbreviations follow these main rules:
Phonetic soundalikes: Letters and numbers that sound like the words you wish to write. "Before" becomes b4, "See you" becomes cu, "Later" becomes "l8r."
Acronyms: The first letters or words in a sentence or phrase. "In my opinion" becomes imo, "Be right there" becomes brt.
Disemvowelment: Remove the vowels for brevity, as in pls ("Please") or nvr ("Never").
Combinations: Others mix-and-match the above rules. ilu2 means "I love you, too."
Here are some common shortcuts you can use. (UPPER CAPS CONVEY SHOUTING, so avoid them unless you mean it.)
143 or 459 (I love you)
brb (Be right back)
cm (Call me!)
ct (Can't talk)
cyrma (Call your mother)
cyrpa (Call your father)
deti (Don't even think it!)
eol (End of lecture)
g1 (Good one)
gtgb (Got to go. Bye!)
ilu (I love you)
lvu (I love you)
18r (Later)
mu (miss you)
ruok (Are you okay?)
ptmm (please tell me more)
sry (sorry)
xoxo (Hugs and kisses)
yw (You're welcome)
Page 1 of 1


text:
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The Bogner Ninni-D Down Ski Jacket is a Bogner classic. Gorgeous fit, silky fabric, and decadent details are what make the Ninni Jacket unique. Even though this is a down jacket, Bogner's fit is like magic - it's incredibly feminine and flattering. At the cuff of each sleeve is a same-color leopard-pattern embroidery decorated with sparkly Swarovski crystals. Don't forget the Ninni Jacket is perfectly appropriate for skiing, with reliably waterproof fabric and some of the warmest insulation around. Add the Bogner Real Fur 2 Hood Trim for an extra touch of luxury and timeless appeal.
|Fabric Rating:
|10K Waterproof / 10K Breathable
|660-fill goose down insulation (80% down/20% feathers)
|Center back measures 25"
|Lining Material:
|100% polyester lining
|Shell Material:
|100% polyester ski taffeta fabric
$79.99 - $179.00
50% off


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Forum indexCanon EOS 7D / 10D - 80D TalkChange forum
Tamron SP 24-70mm F/2.8 Di VC USD
Started Nov 10, 2012 | Questions thread
Shop cameras & lenses ▾
MAC • Forum Pro • Posts: 13,258
Re: Tamron SP 24-70mm F/2.8 Di VC USD
In reply to Sailor Blue • Nov 18, 2012
Sailor Blue wrote:
This video comparison of various 24-70mm lenses might be of interest. I know it really caught my attention toward the end.
for a FF, agree On the tamy. But for a crop, the 15-85 is only 1/2 stop slower between the FF equivalent of 24mm - 37mm and has 4 stop IS - the price I paid was $660
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News about reggae music, artists, culture and more...
Polish producer and DJ duo Dreadsquad returns with another booming digital riddim paying tribute to the late 80's reggae scene in a contemporary style.
Their new riddim is titled Digital Rules and comes with twelve cuts, including an instrumental. Vocal duties are handled a number of mostly unknown singers and deejays from around the world, for example El Fata, Doubla J, Marky Lyrical and Face T & Mikey Dangerous.
Digital Rules is now available on digital platforms worldwide.
Mr Money Man Riddim
By Angus Taylor
New Albums from Etana and Protoje
By Erik Magni
Paint Jamaica
By Erik Magni
Straight to Hell by Horace Andy and Big Youth
By Erik Magni
Likes by Chronixx
By Erik Magni
Hardest Magazine - AnSWeR issue
By Howard Campbell
Pressing Matters in Jamaica
By Erik Magni
Life Goes On by Nelly Stharre
By Erik Magni
I'm Not a Criminal by Stephen Dajure
By Erik Magni
© 2007-2017 United Reggae. All Rights Reserved. Reproduction in whole or in part is prohibited. Read about copyright
Terms of use | About us | Contact us | Authors | Newsletter | A-Z


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We're listening. We would like to get your feedback and may use your comments in our publications.
- January 2016 – Customer Satisfaction Survey
The Customer Satisfaction Survey has been closed.
Thank you for participating!
Your input will now be reviewed and plans made wherever possible to put it into action as we continue to endeavor to make your Parks and Recreation department the best it can be!


text: We're sorry, Angel Wings Photo Picture Frame is no longer available Why not try one of these instead? Personalised Colour In Christmas Tree Poster by Claire Close £14$24.02€16.77$17.93 free UK delivery Travel Scratch Off ®'Push Pin ' Map Bundle by TheLittleBoysRoom £15.95$27.37€19.11$20.43 Personalised Baby Birth Date Print by Thispaperbook £12$20.59€14.38$15.37 free UK delivery Personalised Colour In Fairy Princess Poster by Claire Close £14$24.02€16.77$17.93 free UK delivery Pinch to zoom Angel Wings Photo Picture Frame by British and Bespoke £12.95$22.22€15.52$16.59 3 customer reviews(3) This item is no longer available Favourite Favourite View your favourites product choicesproduct choices (required)Buy One Angel FrameSAVE _ Buy 2 Frames & Save £1.00 (+ £11.95)product choices (required)Buy One Angel FrameSAVE _ Buy 2 Frames & Save £1.00 (+ $20.50)product choices (required)Buy One Angel FrameSAVE _ Buy 2 Frames & Save £1.00 (+ €14.32)product choices (required)Buy One Angel FrameSAVE _ Buy 2 Frames & Save £1.00 (+ $15.31) we're sorry we're sorry, This item is no longer available buy a gift voucher related categories prints & art > pictures & prints for children > canvas prints & art for children prints & art > pictures & prints for children > picture frames for children prints & art > picture frames by British and Bespoke Location: South Derbyshire, GB read seller's profile see seller's complete range more items from this seller Safari Animal Personalised Shape Sorter Lorry by British and Bespoke £29.95$51.40€35.89$38.37 Childrens Noahs Ark Skittles And Personali... by British and Bespoke £15.95$27.37€19.11$20.43 Striped And Spotty Decorative Name Letters by British and Bespoke £2$3.43€2.39$2.56 Personalised Teddy Bears And Gift Bag by British and Bespoke £19.95$34.23€23.91$25.56 Personalised Cookbook And Wooden Tablet Stand by British and Bespoke £22.95$39.38€27.50$29.40 Personalised Garden Trowel And Fork Set by British and Bespoke £29.95$51.40€35.89$38.37 view all you may also like PRODUCT DETAILS CUSTOMER REVIEWS DELIVERY RETURNS ask seller a question save for later Beautiful angel picture frames finished in a delicate matt white feather effect finish. This delightful angel frame has been designed with exquisite attention to detail and is the perfect way to display a photo of your own little angel. The frame is designed in the shape of a pair of angel's wings and has a delicate soft matt white finish to give the effect of feathers. Each frame comes complete with a glass front panel and a flip out support stand on the reverse. These angel frames are a beautiful and unique gift that will be a real talking point in any room. They are an ideal gift for newborn and christening gifts or for parents who will delight in displaying pictures of their own little angels in this frame! SAVE! Buy 2 frames and save £1.00! made from: Resin dimensions: Each angel frame measures approx 11cm x 10cm x 2cm. The window measures 7cm x 5cm. product code: 215262 3 customer reviews read about our product rating system ratings guide trusted independent customer feedbackforum excellent bad good poor This product is dispatched to you by British and Bespoke. You have 28 days, from receipt of cancellable goods, to notify the seller if you wish to cancel your order or exchange an item. Please note: goods that are personalised, bespoke or made-to-order to your specific requirements, perishable products and personal items sold with a hygiene seal (cosmetics, underwear) in instances where the seal is broken are non-refundable, unless faulty. Read more about our returns policy.Should you choose to return or exchange your order you will need to deliver the item(s) to the UK, where this seller is based. British and Bespoke's return policy Please see notonthehighstreet.com's returns policy.


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Kevan A. C. Martin; A Brief History of the "Feature Detector". Cereb Cortex 1994; 4 (1): 1-7. doi: 10.1093/cercor/4.1.1
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© 2017 Oxford University Press
The feature detector hypothesis, and its subsequent development into the doctrine that single neurons code for perceptually significant events, has been the leitmotiv of most work on sensory systems. In the face of strong competition from the alternative theories of neural networks and oscillating ensembles of neurons, the single neuron doctrine retains its grip on the imagination of those working on the neural mechanisms of perception.
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