Jumat, 10 Februari 2017

Download , by Stjepan Sejic

Download , by Stjepan Sejic

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, by Stjepan Sejic


, by Stjepan Sejic


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Product details

File Size: 249674 KB

Print Length: 264 pages

Publisher: Image - Top Cow (January 18, 2017)

Publication Date: January 18, 2017

Sold by: Amazon Digital Services LLC

Language: English

ASIN: B01ETYJKE4

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Amazon Best Sellers Rank:

#328,220 Paid in Kindle Store (See Top 100 Paid in Kindle Store)

I reached the end of Volume 4 and was heartbroken. So I had huge expectations for this book, and it delivered even more. The characters are so well developed, especially considering the medium and how little prose you can actually fit into a though bubble. I loved each of the characters in the book, even the tertiary characters. And the parallels that exist between the profession of the main character and the writers, and what you can read into yourself as the reader of the novel through the main character's eyes...I am gushing, and I know it. This book is a feel good story about some pretty heavy and heartbreaking events. The love and acceptance felt for and by each of the characters was palpable. The plot ending was given away in a previous book in the series, execution is just transcendent. I'm going to stop before unintentionally giving away spoilers, but I would give this 7 stars if I could.

By all means read this. But not first. Go back and catch up on 1-4.Yea, last two books had me worried and watching and ... yea.Good read. My series review from Sunstone 1 copied below for reference (I read them all before writing any reviews)The world is a wide place. Full of strangeness, and gems like this.First, address the elephant in the room: this series is set in context and world of BDSM and fetishwear. It is assuredly NSFW, and if kinks, homosexuality, nudity, erotic themes and situations, and dialog about nonstandard sexual preference and practice is going to bother you, ye have been warned.That being said, I started this on recommendation**, honestly because Sunstone had seriously outraged someone else so I figured it'd be good for at least a glance. And oh my, but there is a story there. This is a story addressing loneliness. About the communities around us, visible and otherwise. The connections we need, we crave to be human***. Too, it talks about consent, kinks, lifestyles, hobbies, and nerding out, treating them fairly.The artwork in the series is lovely, drawn in varying degrees of realistic tones and proportions (not chibi or cartoon-y, with occasional semi-photographic style or cartoonish look for bookends or emphasis)** If it helps, this was recommended by a librarian in charge of their graphic novel curation.*** not going for the obvious bondage joke there, but feel free to reference it if you wish

Beautifully illustrated, well-written finale to the "Sunstone" series. This final volume 5 mostly focuses its energy on the climax of the romantic story elements because though it revolves around BDSM and sexuality, Sunstone has always been at its heart, a love story. And sure, it may spend an unnecessarily long time drawing out the "will they, won't they" conclusion when the question has never at all been in doubt, but even if it doesn't break much new story-telling ground it's still solidly done and a beautiful story. Plus, it also happens to serve as a great introduction to certain kink communities that deserve to be well represented now and again!

Sejic finishes off his first major arc of Sunstone with the obligatory, but no less lovely, happy ending. Having fractured at the end of the previous volume, Lisa and Ally' relationship seems doomed. But thanks to help and perspective from their friends Alan and Anne (who also take their first steps towards a relationship that will be the focus of the next few volumes' new arc) the duo realize their shared love is mutual and Lisa grows up and starts healing the rift thanks to their original shared love of S&M fan fiction (how meta). From there it is only a few short steps towards the ending (for now) of Lisa and Ally's story. Sejic wraps things up on a lovely note and certainly satisfied fans of the first volumes. The final volume also includes plenty of bonus materials and notes from Sejic on how the series will progress from here on out (the next few volumes will be subtitled Mercy and focus on Anne and Alan's pasts and their growth towards each other).

It's finally the end (not really, but work with me) of Sejic's answer to Fifty Shades of Gray. The first arc of Sejic's sexual deviance/romance story wraps up as it should. This series has been funny, moving, and heartwarming at all the right points, and I'm glad to see it stick the landing.The story starts out with Ally and Lisa not speaking to each other, still reeling from the end of part four. slowly there lives start to reintegrate, a slow build that feels all too true to the real world. Sejic up the 'fantasy' aspects, with Lisa's fictional stories on her blog taking a large part of the narrative. It works much better than you would think. The artwork remains it's usually good at times and gorgeous at others you've seen up until now.Hope you enjoy the end as much as I did.

Having lived the club life, the goth/fetish scene, and been involved in some of the very situations Sunstone touches on, they are the most raw and real books on the emotional aspect of this subject matter that I have ever read. No overly-dramatic fluff to make the topics seem more taboo. And no dumbing down of the characters or the events to make them more accessible. Stjepan's art grabs my attention and makes me fall in love with the characters, and the writing makes the whole story come to life. A beautiful series by a very talented artist!

I wanted to say thank you Stjepan Sejic. Its been a long ride and a roller coaster of emotions. The story of two people learning to get over themselves and say I love you.It was beautifully written and immaculately detailed. I laughed, I cried and . . . I love.Cant wait for the next arc Mercy and I have my pre-order of the hard cover edition.

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Kamis, 09 Februari 2017

Free Download The Merriam-Webster Thesaurus

Free Download The Merriam-Webster Thesaurus

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The Merriam-Webster Thesaurus

The Merriam-Webster Thesaurus


The Merriam-Webster Thesaurus


Free Download The Merriam-Webster Thesaurus

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The Merriam-Webster Thesaurus

About the Author

For more than 150 years, in print and now online, Merriam-Webster has been America's leading and most-trusted provider of language information. All Merriam-Webster products and services are backed by the largest team of professional dictionary editors and writers in America, and one of the largest in the world.

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Product details

Mass Market Paperback: 772 pages

Publisher: Merriam-Webster Mass Market; 1 edition (February 1, 2006)

Language: English

ISBN-10: 9780877798507

ISBN-13: 978-0877798507

ASIN: 0877798508

Product Dimensions:

4.2 x 1.2 x 7 inches

Shipping Weight: 12.8 ounces (View shipping rates and policies)

Average Customer Review:

4.3 out of 5 stars

215 customer reviews

Amazon Best Sellers Rank:

#7,547 in Books (See Top 100 in Books)

Before I start to write, I always make sure I have 5 bookslined up next to my computer, and The Merriam-WebsterThesaurus is one of them.I know and use many words and phrases, but I still wear thecover off of this book.Why?Because, as a writer you never want to get zoned in on usingthe same words over and over.Your readers will pick up on that, and do the last thing you everwant them to do.........get bored and stop turning the pages.But, yes there is always a "but", a thesaurus is just another toolfor a writer to use, and you should take every advantage of it.YOU, as the writer, must sit down and WRITE.It always comes down to that.......you must write, and re-write.Take a good look at all the Merriam-Webster Thesaurus has in it,you may even find a few surprises.

Print incredibly small. I don't even use it. Sticking with my old Warner Books edition, 1982 (Original c 1961)Same with Webster's New College Dictionary, Fifth Edition, Updated. Incredibly small print and some new words not even in it. Sticking with my American College Dictionary, Fourth Edition, 2002. Easier to read and seems as "updated" as the newer Webster's.

This is NOT a full-sized thesaurus at all. It is only about a fourth of the size a regular dictionary is. I need a magnifying glass to be able to read anything in it because the print is sooo small. I thought I was buying a newer version on the dictionary I already own. I didn't read that it is a thesaurus at all. I just read "The Mirriam-Webster" and didn't go beyond that since I was looking for a dictionary. Duh Barb!

The size of the print in this book is just too small. See my photo - it's only a little bigger than the point of a #2 pencil. I like that it gives a brief definition plus synonyms, antonyms and related words. That would be a great resource for my kids doing homework but the text is so small it makes using this unpleasant. I'm off to go look for a better version at the store so I can see it in person first.

This is more a dictionary than a thesaurus. Almost useless considering I also bought a dictionary.

Tiny book with print so small you need a microscope to read it. Horribly designed. Terrible quality edition!!

Print is so small even someone with 20/20 vision has a hard time seeing the print.

This was purchased for my ten year old autistic son. He has enjoyed reading through it and it has helped him expand his vocabulary. He prefers actual books as opposed to digital copies. The size isn't too wide nor too tall making it easy to transport. He carries this either in his backpack to school or also with his other notebooks and dictionary when at home, in the van, etc. It is seemingly perfect for what he needs it for!

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Jumat, 13 Januari 2017

PDF Download A Long Way Gone: Memoirs of a Boy Soldier, by Ishmael Beah

PDF Download A Long Way Gone: Memoirs of a Boy Soldier, by Ishmael Beah

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A Long Way Gone: Memoirs of a Boy Soldier, by Ishmael Beah

A Long Way Gone: Memoirs of a Boy Soldier, by Ishmael Beah


A Long Way Gone: Memoirs of a Boy Soldier, by Ishmael Beah


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A Long Way Gone: Memoirs of a Boy Soldier, by Ishmael Beah

Review

“Everyone in the world should read this book. Not just because it contains an amazing story, or because it's our moral, bleeding-heart duty, or because it's clearly written. We should read it to learn about the world and about what it means to be human.” ―Washington Post“A breathtaking and unselfpitying account of how a gentle spirit survives a childhood from which all innocence has suddenly been sucked out. It's a truly riveting memoir.” ―Time“Beah is a gifted writer. . . Read his memoir and you will be haunted . . . It's a high price to pay, but it's worth it.” ―Newsweek.com“Deeply moving, even uplifting…Beah's story, with its clear-eyed reporting and literate particularity--whether he's dancing to rap, eating a coconut or running toward the burning village where his family is trapped--demands to be read.” ―People (Critic's Choice, Four stars)“Beah's memoir, A Long Way Gone (Farrar, Straus and Giroux), is unforgettable testimony that Africa's children--millions of them dying and orphaned by preventable diseases, hundreds of thousands of them forced into battle--have eyes to see and voices to tell what has happened. And what voices! How is it possible that 26-year-old Beah, a nonnative English speaker, separated from his family at age 12, taught to maim and to kill at 13, can sound such notes of ­family happiness, of friendship under duress, of quiet horror? No outsider could have written this book, and it's hard to imagine that many ­insiders could do so with such acute vision, stark language, and tenderness. It is a heart-rending achievement.” ―Melissa Fay Greene, Elle“When Beah is finally approached about the possibility of serving as a spokesperson on the issue of child soldiers, he knows exactly what he wants to tell the world: "I would always tell people that I believe children have the resilience to outlive their sufferings, if given a chance.Others may make the same assertions, but Beah has the advantage of stating them in the first person. That makes A Long Way Gone all the more gripping.” ―Christian Science Monitor“In place of a text that has every right to be a diatribe against Sierra Leone, globalization or even himself, Beah has produced a book of such self-effacing humanity that refugees, political fronts and even death squads resolve themselves back into the faces of mothers, fathers and siblings. A Long Way Gone transports us into the lives of thousands of children whose lives have been altered by war, and it does so with a genuine and disarmingly emotional force.” ―Minneapolis Star-Tribune“What Beah saw and did during [the war] has haunted him ever since, and if you read his stunning and unflinching memoir, you'll be haunted, too . . . It would have been enough if Ishmael Beah had merely survived the horrors described in A Long Way Gone. That he has written this unforgettable firsthand account of his odyssey is harder still to grasp. Those seeking to understand the human consequences of war, its brutal and brutalizing costs, would be wise to reflect on Ishmael Beah's story.” ―Philadelphia Inquirer“Beah speaks in a distinctive voice, and he tells an important story.” ―The Wall Street Journal“Hideously effective in conveying the essential horror of his experiences.” ―Kirkus Reviews“Extraordinary . . . A ferocious and desolate account of how ordinary children were turned into professional killers.” ―The Guardian UK“A Long Way Gone is one of the most important war stories of our generation. The arming of children is among the greatest evils of the modern world, and yet we know so little about it because the children themselves are swallowed up by the very wars they are forced to wage. Ishmael Beah has not only emerged intact from this chaos, he has become one of its most eloquent chroniclers. We ignore his message at our peril.” ―Sebastian Junger, author of A Death in Belmont and A Perfect Storm“This is a beautifully written book about a shocking war and the children who were forced to fight it. Ishmael Beah describes the unthinkable in calm, unforgettable language; his memoir is an important testament to the children elsewhere who continue to be conscripted into armies and militias.” ―Steve Coll, author of Ghost Wars: The Secret History of the CIA, Afghanistan, and Bin Laden, from the Soviet Invasion to September 10, 2001, winner of the 2005 Pulitzer Prize for general Nonfiction“This is a wrenching, beautiful, and mesmerizing tale. Beah's amazing saga provides a haunting lesson about how gentle folks can be capable of great brutalities as well goodness and courage. It will leave you breathless.” ―Walter Isaacson, author of Benjamin Franklin: An American Life“A Long Way Gone hits you hard in the gut with Sierra Leone's unimaginable brutality and then it touches your soul with unexpected acts of kindness. Ishmael Beah's story tears your heart to pieces and then forces you to put it back together again, because if Beah can emerge from such horror with his humanity in tact, it's the least you can do.” ―Jeannette Walls, author of The Glass Castle: A Memoir

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About the Author

Ishmael Beah was born in 1980 in Sierra Leone, West Africa. His writing has appeared in The New York Times Magazine, Vespertine Press, LIT, Parabola, and numerous academic journals. He is a UNICEF Ambassador and Advocate for Children Affected by War; a member of the Human Rights Watch Children's Rights Advisory Committee; an advisory board member at the Center for the Study of Youth and Political Violence at the University of Tennessee, Knoxville; visiting scholar at the Center for International Conflict Resolution at Columbia University; visiting Senior Research Fellow at the Center for the Study of Genocide, Conflict Resolution, and Human Rights at Rutgers University; cofounder of the Network of Young People Affected by War (NYPAW); and president of the Ishmael Beah Foundation. He has spoken before the United Nations, the Council on Foreign Relations, and many panels on the effects of war on children. His book A Long Way Gone: Memoirs of a Boy Soldier has been published in over thirty languages and was nominated for a Quill Award in 2007. Time magazine named the book as one of the top ten nonfiction books of 2007, ranking it at number three. Ishmael Beah is a graduate of Oberlin College with a B.A. in Political Science and resides in Brooklyn, New York. He is currently completing a novel set in his home country of Sierra Leone.

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Product details

Lexile Measure: 920 (What's this?)

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Paperback: 229 pages

Publisher: Sarah Crichton Books; 1st edition (August 5, 2008)

Language: English

ISBN-10: 9780374531263

ISBN-13: 978-0374531263

ASIN: 0374531269

Product Dimensions:

5.5 x 0.8 x 8.5 inches

Shipping Weight: 7.2 ounces (View shipping rates and policies)

Average Customer Review:

4.6 out of 5 stars

1,824 customer reviews

Amazon Best Sellers Rank:

#2,644 in Books (See Top 100 in Books)

I knew about the boys being used as soldiers in Africa,but this was a dose of what it is really like. The truth of the matter is we are all capable of what these young boys end up doing, given the circumstances. If we are raised with love it is natural to love and if we are raised to hate, it is more natural to hate. Look at the Muslim extremists. Their lives focus on hate on a day to day basis. It becomes very easy to kill and means nothing. This is how people lose their souls. It is hard enough for people to recover from participating in a just war, but the slaughter these kids are raised with is a nightmare and it is a miracle if any recover emotionally and spiritually. I was grateful this young man has survived, regained his soul, and lived to tell about it. I pray that this will happen to all the other youngsters.

A Long WayGone: Memoirs of a Boy Soldier is by Ishmael Beah. I was asked to read this book by a Mother whose child was required to read it over the summer. She wanted my view of the book. The book deals with child soldiers in Sierre Leone in the 80’s and 90’s. I found this book hard to deal with. The graphics of the rebel soldiers is too graphic. I question having this book or similar ones read over the summer by students. I feel it should be read in class with explanations for the students handy. The topic is definitely one that should be read and talked about by students today. Reading it alone with no chance to talk about it is a disservice to the students.Ishmael tells his story is a very straightforward way and in that manner shows his innocence and how it is taken from him. In his search for his family, he shows his innocence in comparison to what is going on around him. Even as he gives up on finding his family. His need and hope to survive is at the base of his actions.

I can't absolutely love a story like this. Heart-breaking, horrifying. I commend Beah with sharing his life in a way that challenges but isn't unnecessarily gruesome. The depths of evil...for what? The problem with mindless greed is that there is no goal, only lust, no victory, no need to better oneself, no ability to appreciate or even realize when the terrifying game is over. Instilling a desire to hurt others for immediate gratification makes us less than human. Crawling out of the pit and shining a light on evil makes Beah better than heroic.

Given the subject matter it feels almost wrong to not give this book a solid 4 or 5 star review, but to be honest I give it a solid 3.5I would've liked this memoir to include some brief history and background on the nature of the war. I took the time to look this up myself but I think it would've brought some more clarity and enriched the book some to have included this information.I know in the back the chronology was included but I was looking more for an answer as to why this war was occuring.I liked how he ended the book with the story his grandfather's friend used to tell but I wish beforehand he would've elaborated more on getting to New York and setting up a life there and bringing the reader to present day regarding his new life. The book gave me an unfinished incomplete feeling as it lacked this information.Also, I thought the book would include more information and inside into his emotions. It spent more time describing sensory facts of what he'd been theough and less on how he felt about it and even lesser on how he lives his life coming to terms with it.I have to admit I was expecting some internal dialogue regarding how he's reached a place of self forgiveness or tolerance for the craziness of this life and the situations we're put in.I suppose he did touch on this, in that he finally came to believe it wasnt his fault as the teachers kept repeating to him but I was just expecting more insight into his feelings regarding everything and less on just stated observations.Nonethless, it was a good book worth reading but because of the unfinished feeling I got from the ending I have to give it a solid 3.5

A Long Way Gone: Memoirs of a Boy Soldierby Ishmael BeahRating: ***** (5 Stars)Book Length: 229 pagesGenre: Memoir, War, Nonfiction, African NonfictionImagine your entire world changing one day while you are going about an innocent childhood day. That is what happened to Ishmael Beah. One day he was working on a rap group with his friends. The next he was struggling to survive.The story is one that everyone should hear.Unfortunately, Ishmael's story is not unique. What is unique is his gift to share that experience with the rest of the world. He is clearly a highly intelligent and communicative young man. This was realized long before the book was released when he was chosen to represent his country at the United Nations. That experience gave him a way to get out of his country. Yet, how many children were left behind?Once you read this book it will become a part of you. It is due to the topic, children as young a six picking up a gun to defend their country is not something that will leave your mind. Yet, it is also due to Ishmael Beah's gift with words.As reviewed on The Book Recluse Review

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Rabu, 21 Desember 2016

Free PDF Trigger Point Therapy for Repetitive Strain Injury: Your Self-Treatment Workbook for Elbow, Lower Arm, Wrist, & Hand Pain (New Harbinger Self-Help Workbook)

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Trigger Point Therapy for Repetitive Strain Injury: Your Self-Treatment Workbook for Elbow, Lower Arm, Wrist, & Hand Pain (New Harbinger Self-Help Workbook)

Trigger Point Therapy for Repetitive Strain Injury: Your Self-Treatment Workbook for Elbow, Lower Arm, Wrist, & Hand Pain (New Harbinger Self-Help Workbook)


Trigger Point Therapy for Repetitive Strain Injury: Your Self-Treatment Workbook for Elbow, Lower Arm, Wrist, & Hand Pain (New Harbinger Self-Help Workbook)


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Trigger Point Therapy for Repetitive Strain Injury: Your Self-Treatment Workbook for Elbow, Lower Arm, Wrist, & Hand Pain (New Harbinger Self-Help Workbook)

Review

“If you want to handle your repetitive strain injury, today is your lucky day. It is simple to apply Valerie DeLaune’s suggestions to your aching body. At the same time, this book is profound enough to teach an old dog like me a bunch of new tricks. If more people read and applied what is in this book, there would be fewer doctor visits and the world would be a happier place. Congratulations on your choice in reading this book and enjoy being pain-free.” —Steven Lavitan, chiropractor, acupuncturist, nutritionist, and writer in Teaneck, NJ “DeLaune has written a wonderful and comprehensive self-care book for upper limb and repetitive strain injuries. With easy-to-use self-diagnostic tools, treatment options, and helpful information on the prevention of musculoskeletal pain, this valuable resource is a must for everyone’s medicine cabinet.” —Wendy Larson, MSPT, physical therapist and owner of Centre Point Physical Therapy in Portland, OR “DeLaune adds another important pillar to the understanding of how ‘just a muscle problem’ can cause the pain and dysfunction we are taught to deal with or medicate. In this book, a reader/pain patient will experience a comprehensive approach to the self-treatment of myofascial pain caused by trigger points. This means that it addresses all the other considerations, including the ones surrounding the lives of chronic pain patients, which are most commonly overlooked, and offers simple-to-perform self-treatment approaches and techniques.” —Jeffrey A. Lutz LMT, CMTPT, president of the National Association of Myofascial Trigger Point Therapists (NAMTPT)

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About the Author

Valerie DeLaune, LAc, is a licensed acupuncturist and certified neuromuscular therapist with a master’s degree in acupuncture. She has written numerous books and articles on trigger points, health, and other topics. www.triggerpointrelief.com Foreword writer Renee Gladieux Principe, NCTMB, is a massage therapist and director of sales for The Pressure Positive Company, a family-owned, massage tool manufacturing company.

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Product details

Series: New Harbinger Self-Help Workbook

Paperback: 216 pages

Publisher: New Harbinger Publications; Workbook edition (May 3, 2012)

Language: English

ISBN-10: 1608821277

ISBN-13: 978-1608821273

Product Dimensions:

8 x 0.8 x 10 inches

Shipping Weight: 15.5 ounces (View shipping rates and policies)

Average Customer Review:

4.3 out of 5 stars

9 customer reviews

Amazon Best Sellers Rank:

#451,676 in Books (See Top 100 in Books)

Great book and book series. A lot of very useful info for both the average person and the professional bodyworker.

For a massage therapist, this is a must-have resource to prevent upper body work strains from becoming chronic problems. May be a bit too technical for the DIY user, though.

Perfect!!!

Excellent, very helpful.

The book is thorough and very well laid out with photographs indicating each pain area and what trigger points may be involved as well as clear instructions for working the points. Definitely useful for self help.

Book was very helpful in treating Trigger Points.Bob

Another Great Book From Valerie DeLaune! We'll Done.... everything I need to know about trigger points is here in this book. Thank you...

Designed for clinician-therapist, it was of littlevalue to me. I would not recommend thepurchase of this book as a self-help tool.

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Trigger Point Therapy for Repetitive Strain Injury: Your Self-Treatment Workbook for Elbow, Lower Arm, Wrist, & Hand Pain (New Harbinger Self-Help Workbook) PDF
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Senin, 12 Desember 2016

Get Free Ebook Basics of the U.S. Health Care System

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Basics of the U.S. Health Care System

Basics of the U.S. Health Care System


Basics of the U.S. Health Care System


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Basics of the U.S. Health Care System

About the Author

Associate Professor, Rollins College, Winter Park, Florida

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Product details

Paperback: 426 pages

Publisher: Jones & Bartlett Learning; 3 edition (December 26, 2016)

Language: English

ISBN-10: 1284102882

ISBN-13: 978-1284102888

Product Dimensions:

8.5 x 0.6 x 11 inches

Shipping Weight: 1.8 pounds (View shipping rates and policies)

Average Customer Review:

4.2 out of 5 stars

59 customer reviews

Amazon Best Sellers Rank:

#14,662 in Books (See Top 100 in Books)

Not only is the information just plain wrong half the time, but there are numerous typesetting and editorial issues which actually obscure the content. And the information that's technically correct is so poorly explained that it's usually faster to Google the definitions of key terms instead.What was that table supposed to read? I don't know. But I do know that the margin overflowed, since the text is replaced with "MARGIN OVERFLOW".If you have to use this textbook, I hope that you have a decent professor since otherwise the combination will leave you poor in both knowledge and money afterwards.

Full of great information. Very easy to look up important information and the work sections at the end of each chapter help you get a good grasp on the information

Great text for learning healthcare delivery - up to date info about information technology and enjoying it so far.

good book and met my needs

Outdated stats and resources,Grammatical errors,Factual errors,Extremely poor sentences structure,Reading level ranges from around grade five to twelve.

This book is hilighted and written on. This book looks like some one took it out of the trash can.

very informative your will learn a lot

Was great abd clean

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Minggu, 04 Desember 2016

PDF Ebook Crossing the Quality Chasm: A New Health System for the 21st Century

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Crossing the Quality Chasm: A New Health System for the 21st Century


Crossing the Quality Chasm: A New Health System for the 21st Century


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Crossing the Quality Chasm: A New Health System for the 21st Century

From The New England Journal of Medicine

The Institute of Medicine's Committee on Quality of Health Care in America has issued its second and final report, Crossing the Quality Chasm: A New Health System for the 21st Century. The committee has done an excellent job, but its report is as noteworthy for what it omits as for what it says. It identifies and analyzes with great insight and clarity deficiencies in the quality of our present medical care delivery system, and it is persuasive in outlining how the system ought to work. But it does not say much about the fundamental causes of those deficiencies. Nor does it address the central question: Can we really ``cross the quality chasm'' in medical care without major reform of the whole system? The committee's earlier report, To Err Is Human: Building a Safer Health System (Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, eds. Washington, D.C.: National Academy Press, 1999), was released in the fall of 1999. The report created an immediate sensation with its estimate of 44,000 to 98,000 deaths annually due to errors in hospital care, which it said were due more to error-prone institutional systems than to mistakes by individual health care workers. Predictably, the report launched a spate of governmental and private projects to study the cause and reporting of such events and the means of preventing them. The committee's second report moves beyond the initial focus on medical mishaps and takes a broader look at other problems with the quality of health care. It suggests, in general terms, a variety of ways in which the effectiveness and efficiency of health care should be improved. The report is thoughtful, painstaking, and totally reasonable, and yet it has attracted much less attention than its predecessor. Why hasn't Crossing the Quality Chasm had more impact? I think there are several reasons. First, it contains nothing nearly so sensational as the claim made in the first report that tens of thousands of deaths are caused by medical errors. Second, most of the problems in our health care system that are identified in the second report have been widely recognized for some time. For example, as important causes of reduced quality, the report cites fragmentation of responsibility and lack of continuity in the care of individual patients. It describes the lack of coordination and communication among providers and between providers and patients. And it faults the system for not sufficiently employing electronic-information technology. It criticizes the system's failure to rely on evidence-based guidelines as standards for practice and faults providers for failing systematically to record and report outcomes. It also finds the current health care delivery system insufficiently responsive to the needs of patients and not sufficiently accountable to payers or patients. All these problems are certainly important. But they have been described before, and this report offers little that is substantive in the way of new and practical ways to solve them. This omission is probably the chief reason for the lukewarm reception given this study. Granted, the study calls for greater attention to the need for improving the quality of care. It calls for workshops, more research and education, a reexamination of current payment methods, and many other general initiatives of this kind. It urges Congress to establish a ``Health Care Quality Innovation Fund'' to support projects on the improvement of quality, and it estimates that something ``on the order of $1 billion over 3 to 5 years'' would be needed. The report also suggests that the Agency for Healthcare Research and Quality should identify ``not fewer than 15 priority conditions'' and should convene a meeting to ``develop strategies, goals, and action plans for achieving substantial improvements in quality in the next 5 years for each of the priority conditions.'' But these recommendations, however well intended, do not go to the heart of the matter, and they offer little in the way of fundamental solutions. In fairness to the committee's meticulous and scholarly work, I should acknowledge that it did not set out to ``recommend specific organizational approaches to achieve the aims set forth.'' The committee was no doubt asked instead to concentrate on general aims, to suggest principles and guidelines for improving the quality of care, rather than confront the controversies that would result from suggesting basic reforms in the organization of the health system. So, what is wrong with the organization of our present health care system that accounts for its problems with quality? In my view, the central problem is that the system is being directed mainly by market forces, which are as ill suited to the achievement of the quality goals envisioned in this report as they are to the attainment of the equally important goals of cost control and universal access. The notion that health care is basically an economic commodity represents a radical change from earlier assumptions about the social purpose of health care. It has gained currency only during the past 10 to 20 years, but it has already produced public policies that are rapidly converting our health care system into a vast competitive marketplace. We now have a large and growing sector of health care delivery controlled by private business, to a degree unmatched in any other nation. As is the case with other markets in the U.S. economy, the part of medical service that is privately insured is distributed primarily according to the ability to pay. The multiple independent private insurers (mostly investor-owned) constantly seek to reduce their payments to providers and their financial obligations to sick patients. Similar economic pressures and incentives are at work in the governmental half of the system. In all parts of the system, the providers of care (i.e., hospitals and physicians) see themselves as competing businesses struggling to survive in a hostile economic climate, and they act accordingly. The predictable result is a fragmented, inefficient, and expensive system that neglects those who cannot pay, scrimps on the support of public health services and medical education, and has all of the deficiencies in quality that are so well described and analyzed in this report. It is a system that responds more to the financial interests of investors, managers, and employers than to the medical needs of patients. The best way to achieve substantial improvements in the quality of care, I believe, would be to change the system. Unfortunately, the committee does not say that. It concentrates instead on suggestions for modifying behavior in the current system. However, the prospects for persuading participants caught up in the present commercially dominated system to behave in a more socially responsible way are not very good. I suspect most members of the committee know that but that they felt constrained by the terms of their charge to focus on incremental improvements in the quality of the present system. Given those constraints, they have done all that could have been expected, and they have done it very well. A more definitive approach to the problems they address must await major reforms in the health care system. Arnold S. Relman, M.D. Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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Review

"...CommitteeÂ’s strong findings and bold vision will give new momentum to the processes of change in American health care." -- Institute for Healthcare Improvement website

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Product details

Series: Quality Chasm

Hardcover: 360 pages

Publisher: National Academies Press; 1 edition (August 19, 2001)

Language: English

ISBN-10: 0309072808

ISBN-13: 978-0309072809

Product Dimensions:

6.1 x 1 x 9.1 inches

Shipping Weight: 1.5 pounds (View shipping rates and policies)

Average Customer Review:

4.5 out of 5 stars

22 customer reviews

Amazon Best Sellers Rank:

#402,495 in Books (See Top 100 in Books)

The IOH, Institute of Health, published two exhaustive reports on healthcare: To Err is Human and Crossing the Quality Chasm. They are dry, academic, ponderous and difficult to read. However they are two of the most important books written about healthcare in the United States and mandatory reading for anyone in the field of medicine. Virtually every other book on improving healthcare quotes or uses the research from these two books.Healthcare is under a radical transformation based on enormous economic and demand pressures. In order to be successful we have to understand the system, warts and all. We have to have solutions based on empirical peer reviewed data. These IOH reports do just that. While they may seem dated and many of the initiatives advocated by these books are well underway, these books remain 'bibles' of a sort for understanding the US medical system. I strongly recommend reading this books because so much of the current reform, language, and subsequent published literature is based on these two reports.I recently attended a training by Intermountain Healthcare in UT - the hospital system discussed during the election debates. The CFO quoted from these books. That is just one illustration of how influential and important these books are. Even if you don't work in medicine these books will help you manage and direct your own care. Read also "Overtreated" by Shannon Brownlee, which also uses IOH data and research.Not easy reads but few important reads are.

This book is written as the product of an Institute of Medicine initiative to reduce the mortality and morbidity from errors in the American healthcare system. The Institute of Medicine is a private organization created by congressional charter to advise the federal government on specific matters. Their mission statement is to "advance and disseminate knowledge to improve human health." This book is the final report of the Committee on the Quality of Health Care in America. Their homepage is available by searching the Internet using the full committee name. Membership of the committee and sponsors of the project are available at that web site.The format of the book is to present evidence for quality problems in healthcare in America and make recommendations. The operational definition of quality used in the book is "The degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." There are thirteen recommendations presented initially and are discussed in relevant chapters. The recommendations vary in scope from suggesting that multiple parties need to be committed to quality as a way to decrease the burden of disease to suggestions that specific agencies fund pilot studies to look at how reimbursement can be aligned with quality. Six major parameters are discussed as guiding quality and it is suggested that 15 specific conditions be a focus for improving quality.There is no difficulty in identifying literature studies that demonstrate quality problems in hospital and clinical populations. A survey of current research is included in Appendix A. A review of the tables in this appendix show the types of quality markers that are typically studied in the literature. The authors make the argument that errors due to quality lapses or deficiencies need to be actively worked on and that the current high error rates are not acceptable. Health care has become a major political issue and the political factions are shaping up to be government and business on one side and physicians and other health care providers on the other. There has been a major revamping of the health care system in the past decade to control costs. That required the active cooperation of the insurance industry and government. There is still medical inflation and limited access with 40 million Americans uninsured. Should we believe that another cooperative effort between industry and government will improve quality any more than it has controlled cost or improved access?The authors acknowledge weaknesses in their suggestions about changing the face of American medicine, but they minimize the adverse impact of the current funding mechanisms for medical care and the issue of information systems integration and security. A good example can be found in their application of engineering principles to clinical settings - - where teams see patients for four hours of direct contact time and the remaining time is for documentation and returning calls. That plan would not be economically feasible in many settings. The high cost and lack of flexibility of the current reimbursement schemes are not mentioned as a potential reason why these plans won't work.Information technology is seen as a way to enhance both productivity and safety. The authors suggest that e-mail can lead to productive exchanges between physicians and patients. Many physicians have been doing this for years. Many have also stopped with the advent of security concerns about medical privacy. With larger IT systems the critical issue is backward compatability with older systems. That usually requires custom designs that are extremely expensive. Those problems usually need to be solved before bedside computing and decision support can be developed. Security is acknowledged as a problem that needs to be solved. In spite of a federal initiative in this area, the important precedent to remember is how the financial privacy of Americans was protected. The authors point out that medical privacy requirements need to be more stringent than other industries. At the same time they point out that some opinions suggest that there is a trade off between privacy protections and the need to advance information technology in health care. If they are suggesting that the Internet should be at the heart of this infrastructure and the Internet is not secure, what does that mean?A practical approach might be to focus on the areas where data is entered into computer systems and make sure that non-human analysis occurs at those levels. For example, all hospitals enter pharmacy orders into computer systems. Many hospitals require that physicians write separate discharge orders. Both of these points are areas where there could be immediate improvements in accuracy. A focused study and solution could be engineered now. The necessary software and hardware requirements could be placed on a central web site and available for download by hospital and clinic IT staff. Existing reviewers could be charged with documenting the baseline level of errors and the degree of improvement.This book succeeds as a broad survey of what has been done about quality in certain settings. It contains some interesting ideas about what can possibly be accomplished by applying conceptual advances from other fields. It does not discuss the significant drawbacks of evidence based medicine. It lacks a practical plan for transitioning to a new system and in effect creates a new chasm. With a work like this, whether you like the conclusions depends a lot on your interpretation of the evidence and your personal experience. As a practicing physician and a previous quality reviewer I have significant areas of disagreement with what is presented in this book. Areas of controversy are not elaborated upon. I suppose you could say that level of analysis is not required, but recommendations about the future of health care in America should at least meet the criteria of "evidence based" and all the evidence should be discussed.George Dawson, MD

The original book for healthcare reform! Tracks Institute of Medicine (IOM)'s diagnosis of root causes of healthcare costs and inffectiveness. Summarizes the results of workshops in which the best minds in healthcare, computer sciences and policy come together to understand and observe various dimensions of healthcare and its problems. Addressing root causes always better than addressing symptoms. That's what this book represents!

good reference book. Delivered as promised and on time.

Information is dry reading and information is a bit dated but the book is good overall.

Great reference for anyone interested in quality in our health care system. it is unfortunate that many of the policy makers haven't really read this and digested what the lessons were. It was written a decade ago and we are still struggling with recommendations that were made then. I would recommend this to anyone interested in this topic.

The healthcare challenge is one that will take a lot to change. I think the book outlines the issues really well and makes you think about what is required to change the healthcare system. The question now is how do undertake such a massive overhaul?

If you are in anyway involved in health care, this is essential reading. Physicians, hospital administrators, purchasers, health plan execs, and grad students must immediately put this on the top of their reading list. Lives may depend on it.In it, the highly respected Institute of Medicine builds a powerful case for how the current health care system is severely broken and how it has produced a "chasm" between what we known must be done for patients (based on current science of medicine) and what is actually done. The information conveyed is shocking but true. Even more importantly, the Institute gives us a plan for building a new, more accountable quality-driven approach to health care.Read it and perhaps you too will be motivated to take action to improve health care delivery in America.

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Senin, 28 November 2016

PDF Download Coloring Books for Kids & Toddlers: Animals Coloring: Children Activity Books for Kids Ages 2-4, 4-8 (Volume 1)

PDF Download Coloring Books for Kids & Toddlers: Animals Coloring: Children Activity Books for Kids Ages 2-4, 4-8 (Volume 1)

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Coloring Books for Kids & Toddlers: Animals Coloring: Children Activity Books for Kids Ages 2-4, 4-8 (Volume 1)

Coloring Books for Kids & Toddlers: Animals Coloring: Children Activity Books for Kids Ages 2-4, 4-8 (Volume 1)


Coloring Books for Kids & Toddlers: Animals Coloring: Children Activity Books for Kids Ages 2-4, 4-8 (Volume 1)


PDF Download Coloring Books for Kids & Toddlers: Animals Coloring: Children Activity Books for Kids Ages 2-4, 4-8 (Volume 1)

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Coloring Books for Kids & Toddlers: Animals Coloring: Children Activity Books for Kids Ages 2-4, 4-8 (Volume 1)

Product details

Series: Coloring Books for Kids & Toddlers (Book 1)

Paperback: 100 pages

Publisher: R., Jane J.; 1 edition (February 27, 2017)

Language: English

ISBN-10: 1544139039

ISBN-13: 978-1544139036

Product Dimensions:

8.5 x 0.2 x 11 inches

Shipping Weight: 9.6 ounces (View shipping rates and policies)

Average Customer Review:

4.7 out of 5 stars

140 customer reviews

Amazon Best Sellers Rank:

#875 in Books (See Top 100 in Books)

It's hard to find simple coloring books for children two- or three-years-old these days. This one fits the bill nicely with fun, not overly complicated images. The drawings have thick, clean lines to guide coloring. The paper is also sturdy and there's no printing on the back of the pages for easy pull-out and display. Highly recommended!

The photos of the animals are in large print so it is easy for toddlers to color in. Very simple drawings but my son loves looking through this coloring book so much it’s a staple in his book collection. He also spends so much time naming all the animals on the front and back cover.

The drawings are cute and easy to color, but for toddlers, I'd have preferred a bit thicker paper (this is fine but still not very thick so markers WILL bleed), with pre-perforated pages that can be torn out so the kids can choose one page at a time. Also, the spine is rather tight, so the pages do not lie all the way flat when the coloring book is opened (especially in the beginning and end of the book) so combined with the fact these pages aren't tear-able, little ones end up having to hold press open the book while coloring. If those issues were fixed, I'd have bought again and in more variations (there are a few of those books). We'll make do with this one, but it misses the point for me.

This is a perfect first coloring book. Pictures are large with lots of different themes. Some are very simple for beginners, others are a bit more detailed but not too difficult. Themes consist of animals- farm, domestic, wild and zoo, fish and sea and a circus theme. All are easy to identify for toddlers and pre-k. Backside of each page is plain for additional drawing. I hadn't purchased a coloring book in years so was a little surprised by the cost. Much more expensive than a discount store, but is a quality product that I likely wouldn't find there either.

Glad to have found a coloring book that doesn't contain cartoon characters! Two complaints though: 1) the pages could be thicker so you can't see the next picture behind the current one you're coloring in, and 2) some of the drawings are weird -- the picture of the dog also has a pile of poop next to it, unrelated pairs of animals are on the same page, and there several performing circus animals (do circuses even exist anymore?)

This book is great for a toddler just starting to color on her own. My 1.5 year old searches for this book on her shelf and loves to point out the different animals, even when she's not coloring. The pages are very thick, which is unusual for a coloring book. Combined with the fact that there is one image per page (no image on reverse), you can't see through the page. This makes the pages a good material for writing letters to friends/family and including a baby coloring art piece.The images themselves are very cute, with little details like pawprints and bubbles in addition to a central animal. The images seem to be grouped by theme, so ocean animals are first, then zoo animals, then barnyard, etc.Overall, I love this book best of the three coloring books we've purchased so far.

I have a 2.5 old, who is very interested in drawing and coloring.Books from dollar store have these thin brownish pages, that tear easily, not so smooth, it is harder to color. This book is exactly what I was looking for - white smooth pages, but I think still pencil coloring suits best! Cute drawings, no small details, perfect for starters. I bought it as a warehouse deal (the back of book bit wrinkled from humidity), it was even better price. Really recommend teaching the grip as soon you start coloring with little one. My older one skipped this part and he learned the proper grip only at 4.5. Younger was tought as soon as she started showing interest in drawing/coloring (I put it in hand over and over as a game), and now, though they have 2 year difference, their level is equal. So I am bit upset with myself, that I went with the flow with first born, not teaching him, only applauding for every effort :D :D Fine motor skills (hand movement center in brain is near language center) and I can see difference in their use of language too. (Of course, she is the second child also ;)) so thats my 2 cents, how I would change something :)But the book it self is great. Only thing it would make it perfect, if pages could tear easier from the back.

Cute pictures, good for young children and elderly. I bought this for a loved one with dimentia that loves to color. The pictures are basic and dark lines are easy for the young and old to see. There are several different animals on each page but not too overly stimulating.

Coloring Books for Kids & Toddlers: Animals Coloring: Children Activity Books for Kids Ages 2-4, 4-8 (Volume 1) PDF
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Coloring Books for Kids & Toddlers: Animals Coloring: Children Activity Books for Kids Ages 2-4, 4-8 (Volume 1) PDF

Coloring Books for Kids & Toddlers: Animals Coloring: Children Activity Books for Kids Ages 2-4, 4-8 (Volume 1) PDF

Coloring Books for Kids & Toddlers: Animals Coloring: Children Activity Books for Kids Ages 2-4, 4-8 (Volume 1) PDF
Coloring Books for Kids & Toddlers: Animals Coloring: Children Activity Books for Kids Ages 2-4, 4-8 (Volume 1) PDF