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Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.
National parks are different from other federal lands in the United States. Beginning in 1872 with the establishment of Yellowstone, they were largely set aside to preserve for future generations the most spectacular and inspirational features of the country, seeking the best representative examples of major ecosystems such as Yosemite, geologic forms such as the Grand Canyon, archaeological sites such as Mesa Verde, and scenes of human events such as Gettysburg. But one type of habitat--the desert--fell short of that goal in American eyes until travel writers and the Automobile Age began to change that perception. As the Park Service began to explore the better-known Mojave and Colorado deserts of southern California during the 1920s for a possible desert park, many agency leaders still carried the same negative image of arid lands shared by many Americans--that they are hostile and largely useless. But one wealthy woman--Minerva Hamilton Hoyt, from Pasadena--came forward, believing in the value of the desert, and convinced President Franklin D. Roosevelt to establish a national monument that would protect the unique and iconic Joshua trees and other desert flora and fauna. Thus was Joshua Tree National Monument officially established in 1936, with the area later expanded in 1994 when it became Joshua Tree National Park. Since 1936, the National Park Service and a growing cadre of environmentalists and recreationalists have fought to block ongoing proposals from miners, ranchers, private landowners, and real estate developers who historically have refused to accept the idea that any desert is suitable for anything other than their consumptive activities. To their dismay, Joshua Tree National Park, even with its often-conflicting land uses, is more popular today than ever, serving more than one million visitors per year who find the desert to be a place worthy of respect and preservation. Distributed for George Thompson Publishing
In 1976, a small group of soldiers at Fort Dix were infected with a swine flu virus that was deemed similar to the virus responsible for the great 1918-19 world-wide flu pandemic. The U.S. government initiated an unprecedented effort to immunize every American against the disease. While a qualified success in terms of numbers reached-more than 40 million Americans received the vaccine-the disease never reappeared. The program was marked by controversy, delay, administrative troubles, legal complications, unforeseen side effects and a progressive loss of credibility for public health authorities. In the waning days of the flu season, the incoming Secretary of what was then the Department of Health, Education and Welfare, Joseph Califano, asked Richard Neustadt and Harvey Fineberg to examine what happened and to extract lessons to help cope with similar situations in the future.
The author is convinced that there is a ruling class in America today. He examines the American power structure as it has developed in the 1980s. He presents systematic, empirical evidence that a fixed group of privileged people dominates the American economy and government. The book demonstrates that an upper class comprising only one-half of one percent of the population occupies key positions within the corporate community. It shows how leaders within this "power elite" reach government and dominate it through processes of special-interest lobbying, policy planning and candidate selection. It is written not to promote any political ideology, but to analyze our society with accuracy.
"Describes and analyzes the economic, national security, political, and social systems and institutions of Cuba."--Amazon.com viewed Jan. 4, 2021.
Richard Drake has skillfully woven together the various strands of the Appalachian experience into a sweeping whole. Touching upon folk traditions, health care, the environment, higher education, the role of blacks and women, and much more, Drake offers a compelling social history of a unique American region. The Appalachian region, extending from Alabama in the South up to the Allegheny highlands of Pennsylvania, has historically been characterized by its largely rural populations, rich natural resources that have fueled industry in other parts of the country, and the strong and wild, undeveloped land. The rugged geography of the region allowed Native American societies, especially the Cherokee, to flourish. Early white settlers tended to favor a self-sufficient approach to farming, contrary to the land grabbing and plantation building going on elsewhere in the South. The growth of a market economy and competition from other agricultural areas of the country sparked an economic decline of the region's rural population at least as early as 1830. The Civil War and the sometimes hostile legislation of Reconstruction made life even more difficult for rural Appalachians. Recent history of the region is marked by the corporate exploitation of resources. Regional oil, gas, and coal had attracted some industry even before the Civil War, but the postwar years saw an immense expansion of American industry, nearly all of which relied heavily on Appalachian fossil fuels, particularly coal. What was initially a boon to the region eventually brought financial disaster to many mountain people as unsafe working conditions and strip mining ravaged the land and its inhabitants. A History of Appalachia also examines pockets of urbanization in Appalachia. Chemical, textile, and other industries have encouraged the development of urban areas. At the same time, radio, television, and the internet provide residents direct links to cultures from all over the world. The author looks at the process of urbanization as it belies commonly held notions about the region's rural character.