Community-Based Asthma Intervention Programs and Their Impact on Childhood Health Outcomes and Burdens on the Healthcare System

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ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (12 download)

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Book Synopsis Community-Based Asthma Intervention Programs and Their Impact on Childhood Health Outcomes and Burdens on the Healthcare System by : Danika Ng

Download or read book Community-Based Asthma Intervention Programs and Their Impact on Childhood Health Outcomes and Burdens on the Healthcare System written by Danika Ng and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Since 1997, asthma prevalence rates have increased by 3% annually, leading to a current rate of 18.4 million adults and 6.2 million children with asthma, high hospitalization and emergency department visit rates, and an overall healthcare spending of 50 billion dollars. However, this increase in prevalence is disproportionately impacting children. Asthma is the third leading cause for hospitalization in children, have higher proportions of children being hospitalized with asthma symptoms, and have higher rates of asthma attacks. Recent literature shows that perceived lack of adequate education in areas such as medication adherence, medical device usage, asthma trigger avoidance, lack of accessible education resources, and overall education on understanding asthma symptoms are leading to this high disproportion of children adversely affected by asthma. Community-based education interventions provide essential and accessible education to children adversely impacted by their asthma symptoms. The Asthma Educators Institute (AEI) is one program that may improve childhood asthma health outcomes while reducing burdens on the healthcare system. Teaming up with American Lung Association's Greater Bay Area branch, this year's AEI focused on educating the healthcare provider to teach their patients, patient's families, and community members on the best ways to manage their asthma at home and provide essential asthma education in the hopes of improving these outcomes.

Improving Childhood Asthma Outcomes in the United States

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Publisher : Rand Corporation
ISBN 13 : 0833032429
Total Pages : 114 pages
Book Rating : 4.8/5 (33 download)

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Book Synopsis Improving Childhood Asthma Outcomes in the United States by : Marielena Lara

Download or read book Improving Childhood Asthma Outcomes in the United States written by Marielena Lara and published by Rand Corporation. This book was released on 2002-05-07 with total page 114 pages. Available in PDF, EPUB and Kindle. Book excerpt: One-liner: A set of policy recommendations to promote the development and maintenance of communities in which children with asthma can be swiftly diagnosed, effectively treated, and protected from exposure to harmful environmental factors. An estimated 5 million U.S. children have asthma. Too many of these children are unnecessarily impaired. Much of the money spent on asthma is for high-cost health care services to treat acute periods of illness. Many asthma attacks could be avoided--and much suffering prevented and many medical costs saved--if more children received good-quality, ongoing asthma care and if the 11 policy recommendations presented in this report were implemented in a oordinated fashion. A national call to action, the policy recommendations span public and private interests and compel integration of public health activities across local, state, and federal levels. This report summarizes the findings of an effort funded by the Robert Wood Johnson Foundation as part of the Pediatric Asthma Initiative, whose purpose is to address current gaps in national childhood asthma care. It is the first national initiative that simultaneously addresses treatment, policy, and financing issues for children with asthma at the patient, provider, and institutional levels. The purpose of RAND's effort was to:--identify a range of policy actions in both the public and private sectors that could improve childhood asthma outcomes nationwide--select a subset of policies to create a blueprint for national policy in this area--outline alternatives to implement these policies that build on prior efforts.The effort developed a comprehensive policy framework that maps the identified strategies to one overall policy objective: to promote the development and maintenance of asthma-friendly communities--communities in which children with asthma are swiftly diagnosed, receive appropriate and ongoing treatment, and are not exposed to environmental factors that exacerbate their condition. This report is intended as a working guide for coordinating the activities of both public and private organizations at the federal, state, and local community levels.

A Community Health Worker Model to Address Childhood Asthma

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ISBN 13 :
Total Pages : 20 pages
Book Rating : 4.:/5 (12 download)

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Book Synopsis A Community Health Worker Model to Address Childhood Asthma by : Lillian Jin

Download or read book A Community Health Worker Model to Address Childhood Asthma written by Lillian Jin and published by . This book was released on 2017 with total page 20 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 1997, Little Sisters of the Assumption Family Health Service (Little Sisters) established the Environmental Health Services program in response to high rates of asthma among East Harlem children. The program provides a continuum of services meant to mitigate the negative effects of poor living conditions on asthma-related health outcomes. Led by a team of community health workers (CHWs), program activities include assessments of the home environment, hands-on training and education on safe and effective ways to address unhealthy living conditions, and advocacy services for tenants to get necessary repairs form housing management. In 2011, with funding from the U.S. Department of Housing and Urban Development (HUD), Little Sisters began implementation of Controlling Asthma through Home Remediation (CAHR), a demonstration of their program model, specifically targeting families living in public housing. The demonstration included an evaluation of the program by The New York Academy of Medicine (the Academy) -- findings included statistically significant reductions in nighttime awakenings, emergency department visits, and use of rescue medications. As part of the evaluation, a sample of 17 caregivers participated in interviews, with questions that focused on their perception of program quality, impact, and lessons learned. As described in this report, caregivers noted that CHWs helped them to develop knowledge and skills to reduce household asthma triggers; in addition, CHWs and Little Sisters proved to be influential advocates, facilitating the settlement of complaints with housing management. As New York State and local health care systems adopt and promote more community-based health problems, CAHR represents a promising example of an intervention that can produce improvements in asthma-related health outcomes, while supporting grassroots efforts to create changes in policies and practice.

Collaboration Between Health Care and Public Health

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Publisher : National Academies Press
ISBN 13 : 0309374499
Total Pages : 105 pages
Book Rating : 4.3/5 (93 download)

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Book Synopsis Collaboration Between Health Care and Public Health by : Institute of Medicine

Download or read book Collaboration Between Health Care and Public Health written by Institute of Medicine and published by National Academies Press. This book was released on 2016-02-04 with total page 105 pages. Available in PDF, EPUB and Kindle. Book excerpt: On February 5, 2015, the Institute of Medicine Roundtable on Population Health Improvement hosted a workshop to explore the relationship between public health and health care, including opportunities, challenges, and practical lessons. The workshop was convened in partnership with the Association of State and Territorial Health Officials (ASTHO)-Supported Primary Care and Public Health Collaborative. Organized in response to the 2012 IOM report Primary Care and Public Health: Exploring Integration to Improve Population Health, this workshop focused on current issues at the interface of public health and health care, including opportunities presented by and lessons learned from the Centers for Medicaid and Medicare Services State Innovation Models program. The workshop featured presentations on several dimensions of the public health-health care relationship. Collaboration Between Health Care and Public Health summarizes the presentations and discussion of the event.

Communities in Action

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Publisher : National Academies Press
ISBN 13 : 0309452961
Total Pages : 583 pages
Book Rating : 4.3/5 (94 download)

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Book Synopsis Communities in Action by : National Academies of Sciences, Engineering, and Medicine

Download or read book Communities in Action written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2017-04-27 with total page 583 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

Working together so everyone can breathe better

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Publisher :
ISBN 13 :
Total Pages : 22 pages
Book Rating : 4.:/5 (318 download)

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Book Synopsis Working together so everyone can breathe better by :

Download or read book Working together so everyone can breathe better written by and published by . This book was released on 2003 with total page 22 pages. Available in PDF, EPUB and Kindle. Book excerpt:

The Effectiveness of Interventions to Address Childhood Asthma

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Publisher :
ISBN 13 :
Total Pages : 131 pages
Book Rating : 4.:/5 (16 download)

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Book Synopsis The Effectiveness of Interventions to Address Childhood Asthma by : Helen Lee

Download or read book The Effectiveness of Interventions to Address Childhood Asthma written by Helen Lee and published by . This book was released on 2016 with total page 131 pages. Available in PDF, EPUB and Kindle. Book excerpt: Asthma is the leading chronic health condition among children in the United States and a major cause of childhood disability. It also disproportionately affects low-income and racial and ethnic minorities. Although a wide range of interventions have been implemented to improve asthma-related outcomes among socioeconomically disadvantaged and minority children, disparities persist. This paper, which was commissioned by the JPB Foundation and conducted by MDRC in partnership with the National Academy for State Health Policy, standardizes and compares effects from rigorous evaluations across three main types of interventions: those that focus on improving education and self-management, those that focus on addressing remediation of the conditions that trigger asthma in the home environment, and those that focus on improving health care provider practice. While prior reviews have summarized findings for each intervention type, this review systematically compares findings across a range of outcomes and a spectrum of different approaches to addressing childhood asthma, drawing from about 30 independent studies and earlier published reviews. In addition, the paper includes case studies of various local programs and state-level policy initiatives to illuminate current efforts to address childhood asthma in low-income communities and barriers faced in sustaining asthma programs. Key findings include: (1) Providing education on how to manage asthma is fundamental to improving outcomes, but it may not be enough to alleviate disparities in asthma management; (2) Some local programs are clearly bridging informational gaps among low-income families and are helping them maintain a safe home environment for their children with asthma; (3) The health care benefits of interventions that go beyond education are unclear; (4) Barriers to medication management are complex and medication adherence is difficult to influence; and (5) The role of the state, and the Medicaid program in particular, is relevant for the financing and sustainability of asthma programs for low-income children. Although the long-run sustainability of some of the programs highlighted in this report is uncertain, what is clear is that combating the disparities in the prevalence of asthma among different populations will require more than an agreement on standard asthma management practices within the medical community. The following are appended: (1) Methodology for Literature Review; (2) Summaries of Asthma Studies; (3) Detailed Case Studies of Local Asthma Programs; and (4) Detailed State-Based Case Studies. [This working paper was written with Felicia Heider, Carrie Hanlon, and Taylor Kniffin.].

Asthma Management in Minority Children

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ISBN 13 :
Total Pages : 78 pages
Book Rating : 4.:/5 (7 download)

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Book Synopsis Asthma Management in Minority Children by :

Download or read book Asthma Management in Minority Children written by and published by . This book was released on 1995 with total page 78 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Asthma Adherence

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Publisher :
ISBN 13 : 9781876122041
Total Pages : 24 pages
Book Rating : 4.1/5 (22 download)

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Book Synopsis Asthma Adherence by :

Download or read book Asthma Adherence written by and published by . This book was released on 1999 with total page 24 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Reducing Childhood Asthma Triggers in Public Housing

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Publisher :
ISBN 13 :
Total Pages : 7 pages
Book Rating : 4.:/5 (944 download)

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Book Synopsis Reducing Childhood Asthma Triggers in Public Housing by :

Download or read book Reducing Childhood Asthma Triggers in Public Housing written by and published by . This book was released on 2015 with total page 7 pages. Available in PDF, EPUB and Kindle. Book excerpt: There are significant disparities in asthma prevalence and management in New York City (NYC). Children living in the low income, largely minority neighborhood of East Harlem are almost 13 times more likely to have an asthma related emergency department visit compared to children on the Upper East Side, an adjacent high income neighborhood. The disparities in asthma prevalence and control are in part attributable to environmental conditions, including housing, which in low-income communities is often poorly maintained, resulting in mold, pests, and other asthma triggers. Controlling Asthma through Home Remediation (CAHR), a program of LSA Family Health Service (LSAFHS), offers remediation and repair, training, and comprehensive case management to East Harlem families that have children with severe and/or persistent asthma and live in NYC Housing Authority (NYCHA) public housing. Preliminary findings, based on pre-post assessments of 60 CAHR children, include statistically significant reductions in nighttime awakenings, emergency department visits, and rescue medication use. There were reductions in daytime asthma symptoms and improvements in household conditions; however, they were not statistically significant. Recognizing the limited reach of individual level services, LSAFHS also advocates for system-wide changes across NYCHA. Citing the Americans with Disabilities Act and its relevance to individuals with asthma, LSAFHS, in partnership with other community-based organizations and public interest attorneys, reached a settlement with NYCHA in 2013 that resulted in policy changes mandating expedited repairs of leaks, mold, and related issues. Monitoring the impact of these changes is ongoing. A hope is for replication of advocacy efforts in other cities.

Clearing the Air

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Publisher : National Academies Press
ISBN 13 : 0309064961
Total Pages : 457 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis Clearing the Air by : Institute of Medicine

Download or read book Clearing the Air written by Institute of Medicine and published by National Academies Press. This book was released on 2000-05-24 with total page 457 pages. Available in PDF, EPUB and Kindle. Book excerpt: Since about 1980, asthma prevalence and asthma-related hospitalizations and deaths have increased substantially, especially among children. Of particular concern is the high mortality rate among African Americans with asthma. Recent studies have suggested that indoor exposuresâ€"to dust mites, cockroaches, mold, pet dander, tobacco smoke, and other biological and chemical pollutantsâ€"may influence the disease course of asthma. To ensure an appropriate response, public health and education officials have sought a science-based assessment of asthma and its relationship to indoor air exposures. Clearing the Air meets this need. This book examines how indoor pollutants contribute to asthmaâ€"its causation, prevalence, triggering, and severity. The committee discusses asthma among the general population and in sensitive subpopulations including children, low-income individuals, and urban residents. Based on the most current findings, the book also evaluates the scientific basis for mitigating the effects of indoor air pollutants implicated in asthma. The committee identifies priorities for public health policy, public education outreach, preventive intervention, and further research.

Children's Health, the Nation's Wealth

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Publisher : National Academies Press
ISBN 13 : 0309166608
Total Pages : 336 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Children's Health, the Nation's Wealth by : Institute of Medicine

Download or read book Children's Health, the Nation's Wealth written by Institute of Medicine and published by National Academies Press. This book was released on 2004-10-18 with total page 336 pages. Available in PDF, EPUB and Kindle. Book excerpt: Children's health has clearly improved over the past several decades. Significant and positive gains have been made in lowering rates of infant mortality and morbidity from infectious diseases and accidental causes, improved access to health care, and reduction in the effects of environmental contaminants such as lead. Yet major questions still remain about how to assess the status of children's health, what factors should be monitored, and the appropriate measurement tools that should be used. Children's Health, the Nation's Wealth: Assessing and Improving Child Health provides a detailed examination of the information about children's health that is needed to help policy makers and program providers at the federal, state, and local levels. In order to improve children's health-and, thus, the health of future generations-it is critical to have data that can be used to assess both current conditions and possible future threats to children's health. This compelling book describes what is known about the health of children and what is needed to expand the knowledge. By strategically improving the health of children, we ensure healthier future generations to come.

Impact of Asthma Self-management Education On Childhood Asthma Outcomes

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Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (915 download)

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Book Synopsis Impact of Asthma Self-management Education On Childhood Asthma Outcomes by : Jinman Pang

Download or read book Impact of Asthma Self-management Education On Childhood Asthma Outcomes written by Jinman Pang and published by . This book was released on 2015 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Asthma is one of the most common respiratory disorders in children. Asthma self-management education programs aim to improve asthma treatment, management, and control in the United States and help patients to develop the knowledge and skills about asthma. Previous studies have shown that asthma self-management education programs have improved quality of care for children and reduced medical care costs. However, most of these studies had small sample sizes or focused on children from one certain hospital or a selected region for analysis. To fill this gap, this study analyzes data from the 2006-2012 Behavioral Risk Factor Surveillance Survey (BRFSS) Asthma Call-back Survey (ACBS). ACBS is a nationally representative survey of children with asthma in the United States, which increases the generalizability of the findings. Multinomial logistic regression models are used to analyze the association between participation in asthma self-management education programs and health outcomes and healthcare utilization for children with asthma. The results indicate that receiving more asthma education is associated with fewer routine care visits, medical visits for asthma episodes, hospitalizations, emergency department visits, and urgent care visits, and better control of asthma symptoms. The benefits of asthma education on hospitalizations and emergency department visits did not differ by financial hardship or race/ethnicity. This study provides evidence that asthma self-management education improves health outcomes for children and reduces healthcare utilization.

An Evidence-Based Education Program to Promote Health Outcomes in Asthmatic Children

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Publisher :
ISBN 13 : 9781361284315
Total Pages : pages
Book Rating : 4.2/5 (843 download)

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Book Synopsis An Evidence-Based Education Program to Promote Health Outcomes in Asthmatic Children by : Yuk-Ling Ng

Download or read book An Evidence-Based Education Program to Promote Health Outcomes in Asthmatic Children written by Yuk-Ling Ng and published by . This book was released on 2017-01-26 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation, "An Evidence-based Education Program to Promote Health Outcomes in Asthmatic Children" by Yuk-ling, Ng, 伍玉玲, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Asthma is a common chronic disease for children and is a leading cause for their hospitalization. Despite its negative health impact, a local survey has shown that children with asthma as well as their parents have a lack of understanding for asthma management (Wong, Wong, Chung & Lau, 2001). However, to help asthmatic children to better cope with their condition, it is important for health care professional such as nurses to enhance their knowledge in asthma management. Recent empirical research has shown that education promoting knowledge of asthma management can improve health outcomes in asthmatic children. Therefore, it is important to develop an evidence-based asthma education guideline for them. This dissertation aims to evaluate the empirical evidence of the education program for asthmatic children, with the age ranging from 5 to 18, and their parents. The goal of the proposed program is to reduce their re-hospitalization rate by enhancing their knowledge of asthma care. A translational nursing research was conducted and 10 studies focusing on asthma education program for children and their parents were identified from electronic databases. Critical appraisal was performed using the recognized assessment tool, named the Scottish Intercollegiate Guidelines Network (SIGN) (2008). Recommendations were developed based on the data extracted from the review. Based on the literatures reviewed, it was found that a 45-to-60 minute one-to-one educational intervention conducted by nurses using self-management plan is the most effective method for improving the health outcomes for asthmatic children. A plan of translating the empirical information extracted from the review into practice was developed and the potential of implementation was assessed. Based on the assessment, it was found that there is high transferability of the findings from the review and the proposed innovation is feasible in the selected clinical setting. In addition, the benefits generated from the proposed innovation also outweigh its cost. An evidence-based guideline was then developed based on the high and medium level of evidence. The grades of the recommendation were stated as well. A comprehensive communication plan targeting on various stakeholders was prepared. A pilot study was designed to examine the feasibility of the proposed innovation before the full-scale implementation. The outcomes of the proposed innovation include the re-hospitalization rate of asthmatic children, the patients' and nurses' level of knowledge in asthma care, the satisfactory level of patients and nurses towards the innovation, the competency of nurses in conducting the innovation, and the utilization rate and the cost of the innovation. They would be evaluated using appropriate methodologies. The proposed innovation would be considered as effective if the primary outcome, the re-hospitalization rate of asthmatic children is reduced. DOI: 10.5353/th_b4833598 Subjects: Asthma in children Evidence-based nursing

Evaluation of a Web-enabled Interactive Multimedia Pediatric Asthma Education Program

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Publisher :
ISBN 13 :
Total Pages : 300 pages
Book Rating : 4.:/5 (487 download)

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Book Synopsis Evaluation of a Web-enabled Interactive Multimedia Pediatric Asthma Education Program by : Santosh Krishna

Download or read book Evaluation of a Web-enabled Interactive Multimedia Pediatric Asthma Education Program written by Santosh Krishna and published by . This book was released on 2001 with total page 300 pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction . Asthma is a chronic disease that affects millions of children. Many asthma education programs have been developed and evaluated. However, no Internet-enabled, asthma education program had been evaluated in a randomized controlled trial. This study investigated the effects of an Internet-enabled interactive multimedia asthma education program on asthma knowledge of children and their caregivers, on children's health outcomes and their use of health care resources. Methods . Two hundred and twenty-eight asthmatic children visiting a pulmonary clinic were randomly assigned to control and intervention groups. Children and caregivers in both groups received conventional verbal and printed information about asthma. Intervention group participants received additional asthma education through the Interactive Multimedia Program for Asthma Control & Tracking (IMPACT©). Knowledge, symptom history, resource utilization, and quality of life data were collected at the initial visit and at 3- and 12-month intervals. Results . Analysis of knowledge scores using one-group Student's t-tests showed a significant improvement in disease specific knowledge about asthma and its management between the initial visit and the 12-month follow-up visit among the three groups: caregivers of children 0-6 years old, caregivers of children 7-17 years old and children 7-17 years old. Comparison of control and intervention groups using the Cochran-Mantel-Haenszel statistic revealed significantly higher knowledge gains in the intervention groups among caregivers of children 0-6 years old (p = .0085) and 7-17 years old (p = .0073), and among children 7-17 years old (p = .0006). The intervention group children experienced fewer days of asthma symptoms (p = .0099), fewer emergency room visits (p = .0243), and a decreased daily dose of inhaled corticosteroids (p = .0069). Knowledge scores for children 7-17 years old correlated with fewer urgent physician visits (r = 0.37, p = .011) and less frequent use of quick-relief medicines (r = 0.30, p = .043). However, the two groups did not significantly differ in the frequency of quick relief medicine use, the days of activity limitation, the nights of disturbed sleep, the number of urgent visits to physicians, the number of hospitalizations due to asthma, the days of stay in hospital for all hospitalizations, the number of school days missed, the asthma related quality of life and in the Pulmonary Function Test measures. Conclusions . The Interactive Multimedia Program for Asthma Control & Tracking (IMPACT©) is effective in improving asthma knowledge of asthmatic children and their caregivers and in improving health of asthmatic children.

America's Children

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Publisher : National Academies Press
ISBN 13 : 0309173930
Total Pages : 216 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis America's Children by : Institute of Medicine and National Research Council

Download or read book America's Children written by Institute of Medicine and National Research Council and published by National Academies Press. This book was released on 1998-10-27 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: America's Children is a comprehensive, easy-to-read analysis of the relationship between health insurance and access to care. The book addresses three broad questions: How is children's health care currently financed? Does insurance equal access to care? How should the nation address the health needs of this vulnerable population? America's Children explores the changing role of Medicaid under managed care; state-initiated and private sector children's insurance programs; specific effects of insurance status on the care children receive; and the impact of chronic medical conditions and special health care needs. It also examines the status of "safety net" health providers, including community health centers, children's hospitals, school-based health centers, and others and reviews the changing patterns of coverage and tax policy options to increase coverage of private-sector, employer-based health insurance. In response to growing public concerns about uninsured children, last year Congress voted to provide $24 billion over five years for new state insurance initiatives. This volume will serve as a primer for concerned federal policymakers and regulators, state agency officials, health plan decisionmakers, health care providers, children's health advocates, and researchers.

The Impact of Aesculapian Authority at Point of Intervention on a Community-based Asthma Program

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Publisher :
ISBN 13 :
Total Pages : 196 pages
Book Rating : 4.:/5 (18 download)

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Book Synopsis The Impact of Aesculapian Authority at Point of Intervention on a Community-based Asthma Program by : Brian D. Callahan

Download or read book The Impact of Aesculapian Authority at Point of Intervention on a Community-based Asthma Program written by Brian D. Callahan and published by . This book was released on 2005 with total page 196 pages. Available in PDF, EPUB and Kindle. Book excerpt: