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Information and Communication Technology and Peacebuilding: Summary of a Workshop: July 2008

by National Academy of Engineering of the National Academies

Those who would use information and communication technology (ICT) in the cause of peace need to be cognizant of the risks as well as the benefits. ICT can facilitate positive dialogue but also hate speech. It can be used to fight corruption but also facilitate it. Simply giving people more information does not necessarily lead to predictable or positive results. As people become more informed, they may become more motivated to change their circumstances and to do so violently. On December 14, 2007, the National Academy of Engineering (NAE) convened a group of experts in diverse fields to consider the role of ICT in promoting peace and conflict resolution. The one-day workshop was designed to consider current and emerging technologies and strategies for employing them in conflict management and diplomacy. It also aimed to explore how organizations with a role in promoting peace, like the U.S. Institute of Peace, can most effectively leverage technology in carrying out their missions. Information and Communication Technology and Peacebuilding: Summary of a Workshop reviews the group’s discussions on number of key issues, illuminates certain practitioner needs, and suggests possible next steps.

Ensuring the Climate Record from the NPOESS and GOES-R Spacecraft: Elements of a Strategy to Recover Measurement Capabilities Lost in Program Restructuring

by National Research Council of the National Academies

In 2000, the nation's next-generation National Polar-orbiting Operational Environmental Satellite System (NPOESS) program anticipated purchasing six satellites for $6.5 billion, with a first launch in 2008. By November 2005, however, it became apparent that NPOESS would overrun its cost estimates by at least 25 percent. In June 2006, the planned acquisition of six spacecraft was reduced to four, the launch of the first spacecraft was delayed until 2013, and several sensors were canceled or descoped in capability. Based on information gathered at a June 2007 workshop, "Options to Ensure the Climate Record from the NPOESS and GOES-R Spacecraft," this book prioritizes capabilities, especially those related to climate research, that were lost or placed at risk following the 2006 changes. This book presents and recommends a prioritized, short-term strategy for recovery of crucial climate capabilities lost in the NPOESS and GOES-R program descopes. However, mitigation of these recent losses is only the first step in establishing a viable long-term climate strategy-one that builds on the lessons learned from the well-intentioned but poorly executed merger of the nation's weather and climate observation systems.

Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation

by Institute of Medicine of the National Academies

The United States has the highest per capita spending on health care of any industrialized nation. Yet despite the unprecedented levels of spending, harmful medical errors abound, uncoordinated care continues to frustrate patients and providers, and U.S. healthcare costs continue to increase. The growing ranks of the uninsured, an aging population with a higher prevalence of chronic diseases, and many patients with multiple conditions together constitute more complicating factors in the trend to higher costs of care. A variety of strategies are beginning to be employed throughout the health system to address the central issue of value, with the goal of improving the net ratio of benefits obtained per dollar spent on health care. However, despite the obvious need, no single agreed-upon measure of value or comprehensive, coordinated systemwide approach to assess and improve the value of health care exists. Without this definition and approach, the path to achieving greater value will be characterized by encumbrance rather than progress. To address the issues central to defining, measuring, and improving value in health care, the Institute of Medicine convened a workshop to assemble prominent authorities on healthcare value and leaders of the patient, payer, provider, employer, manufacturer, government, health policy, economics, technology assessment, informatics, health services research, and health professions communities. The workshop, summarized in this volume, facilitated a discussion of stakeholder perspectives on measuring and improving value in health care, identifying the key barriers and outlining the opportunities for next steps.

Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention

by Institute of Medicine

Depression is a widespread condition affecting approximately 7.5 million parents in the U.S. each year and may be putting at least 15 million children at risk for adverse health outcomes. Based on evidentiary studies, major depression in either parent can interfere with parenting quality and increase the risk of children developing mental, behavioral and social problems. Depression in Parents, Parenting, and Children highlights disparities in the prevalence, identification, treatment, and prevention of parental depression among different sociodemographic populations. It also outlines strategies for effective intervention and identifies the need for a more interdisciplinary approach that takes biological, psychological, behavioral, interpersonal, and social contexts into consideration. A major challenge to the effective management of parental depression is developing a treatment and prevention strategy that can be introduced within a two-generation framework, conducive for parents and their children. Thus far, both the federal and state response to the problem has been fragmented, poorly funded, and lacking proper oversight. This study examines options for widespread implementation of best practices as well as strategies that can be effective in diverse service settings for diverse populations of children and their families. The delivery of adequate screening and successful detection and treatment of a depressive illness and prevention of its effects on parenting and the health of children is a formidable challenge to modern health care systems. This study offers seven solid recommendations designed to increase awareness about and remove barriers to care for both the depressed adult and prevention of effects in the child. The report will be of particular interest to federal health officers, mental and behavioral health providers in diverse parts of health care delivery systems, health policy staff, state legislators, and the general public.

Changes in the Sheep Industry IN THE UNITED STATES: MAKING THE TRANSITION FROM TRADITION

by National Research Council of the National Academies

The U.S. sheep industry is complex, multifaceted, and rooted in history and tradition. The dominant feature of sheep production in the United States, and, thus, the focus of much producer and policy concern, has been the steady decline in sheep and lamb inventories since the mid-1940s. Although often described as “an industry in decline,” this report concludes that a better description of the current U.S. sheep industry is “an industry in transition.”

Using the American Community Survey for the National Science Foundation's Science and Engineering Workforce Statistics Programs

by National Research Council of the National Academies

The National Science Foundation (NSF) has long collected information on the number and characteristics of individuals with education or employment in science and engineering and related fields in the United States. An important motivation for this effort is to fulfill a congressional mandate to monitor the status of women and minorities in the science and engineering workforce. Consequently, many statistics are calculated by race or ethnicity, gender, and disability status. For more than 25 years, NSF obtained a sample frame for identifying the target population for information it gathered from the list of respondents to the decennial census long-form who indicated that they had earned a bachelors or higher degree. The probability that an individual was sampled from this list was dependent on both demographic and employment characteristics. But, the source for the sample frame will no longer be available because the census long-form is being replaced as of the 2010 census with the continuous collection of detailed demographic and other information in the new American Community Survey (ACS). At the request of NSF’s Science Resources Statistics Division, the Committee on National Statistics of the National Research Council formed a panel to conduct a workshop and study the issues involved in replacing the decennial census long-form sample with a sample from the ACS to serve as the frame for the information the NSF gathers. The workshop had the specific objective of identifying issues for the collection of field of degree information on the ACS with regard to goals, content, statistical methodology, data quality, and data products.

Implementing COLORECTAL CANCER Screening: WORKSHOP SUMMARY

by Institute of Medicine of the National Academies

The IOM's National Cancer Policy Board estimated in 2003 that even modest efforts to implement known tactics for cancer prevention and early detection could result in up to a 29 percent drop in cancer deaths in about 20 years. The IOM's National Cancer Policy Forum, which succeeded the Board after it was disbanded in 2005, continued the Board's work to outline ways to increase screening in the U.S. On February 25 and 26, 2008, the Forum convened a workshop to discuss screening for colorectal cancer. Colorectal cancer screening remains low, despite strong evidence that screening prevents deaths. With the aim to make recommended colorectal cancer screening more widespread, the workshop discussed steps to be taken at the clinic, community, and health system levels. Workshop speakers, representing a broad spectrum of leaders in the field, identified major barriers to increased screening and described strategies to overcome these obstacles. This workshop summary highlights the information presented, as well as the subsequent discussion about actions needed to increase colorectal screening and, ultimately, to prevent more colorectal cancer deaths.

Assessing Accomplished Teaching: Advanced-Level Certification Programs

by National Research Council of the National Academies

The mission of the National Board for Professional Teaching Standards (NBPTS) is to establish “high and rigorous standards for what teachers should know and be able to do, to certify teachers who meet those standards, and to advance other education reforms for the purpose of improving student learning in American schools.” In response to a request from the U.S. Congress, the National Research Council developed a framework for evaluating programs that award advanced-level teacher certification and applied that framework in an evaluation of the impacts of the NBPTS. Specifically, this book addresses the impacts on students, teachers, and the educational system in this country. Assessing Accomplished Teaching finds that teachers who earn board certification are more effective at improving their students’ achievement than other teachers, but school systems vary greatly in the extent to which they recognize and make use of board-certified teachers. Many of the questions on the evaluation framework could not be answered because the data have not been collected, and the report makes recommendations for the kinds of research that are needed to fully evaluate the impacts of board certification by the NBPTS.

Hydrologic Effects of a Changing Forest Landscape

by National Research Council of the National Academies

Of all the outputs of forests, water may be the most important. Streamflow from forests provides two-thirds of the nation's clean water supply. Removing forest cover accelerates the rate that precipitation becomes streamflow; therefore, in some areas, cutting trees causes a temporary increase in the volume of water flowing downstream. This effect has spurred political pressure to cut trees to increase water supply, especially in western states where population is rising. However, cutting trees for water gains is not sustainable: increases in flow rate and volume are typically short-lived, and the practice can ultimately degrade water quality and increase vulnerability to flooding. Forest hydrology, the study of how water flows through forests, can help illuminate the connections between forests and water, but it must advance if it is to deal with today's complexities, including climate change, wildfires, and changing patterns of development and ownership. This book identifies actions that scientists, forest and water managers, and citizens can take to help sustain water resources from forests.

Transitions to Alternative Transportation Technologies -- A Focus on Hydrogen

by National Research Council of the National Academies

Hydrogen fuel cell vehicles (HFCVs) could alleviate the nation's dependence on oil and reduce U.S. emissions of carbon dioxide, the major greenhouse gas. Industry-and government-sponsored research programs have made very impressive technical progress over the past several years, and several companies are currently introducing pre-commercial vehicles and hydrogen fueling stations in limited markets. However, to achieve wide hydrogen vehicle penetration, further technological advances are required for commercial viability, and vehicle manufacturer and hydrogen supplier activities must be coordinated. In particular, costs must be reduced, new automotive manufacturing technologies commercialized, and adequate supplies of hydrogen produced and made available to motorists. These efforts will require considerable resources, especially federal and private sector funding. This book estimates the resources that will be needed to bring HFCVs to the point of competitive self-sustainability in the marketplace. It also estimates the impact on oil consumption and carbon dioxide emissions as HFCVs become a large fraction of the light-duty vehicle fleet.

BREAKTHROUGH BUSINESS MODELS: Drug Development for Rare and Neglected Diseases and Individualized Therapies

by Institute of Medicine of the National Academies

The process for developing new drug and biologic products is extraordinarily expensive and time-consuming. Although large pharmaceutical companies may be able to afford the cost of development because they can expect a large return on investment, organizations developing drugs to treat rare and neglected diseases are unable to rely on such returns. On June 23, 2008, the Institute of Medicine's Forum on Drug Discovery, Development, and Translation held a public workshop, "Breakthrough Business Models: Drug Development for Rare and Neglected Diseases and Individualized Therapies," which sought to explore new and innovative strategies for developing drugs for rare and neglected diseases.

Learning What Works: Infrastructure Required for Comparative Effectiveness Research: Workshop Summary

by Leighanne Olsen Claudia Grossman J. Michael Mcginnis

This collection of essays, drawn from the Institute of Medicine's Round Table on Value and Science-Driven Health Care, presents current scholarship in the development of infrastructure and methodologies for improving health system frameworks in the coming decades. Topics discussed include infrastructure; training and personnel; advanced technologies and communications; and policy, priories and implementations of a value driven agenda. Contributors are executive level health policy professionals. Annotation ©2012 Book News, Inc. , Portland, OR (booknews. com)

Engineering a Learninghealthcare System

by The National Academy of Sciences

Improving our nation's healthcare system is a challenge which, because of its scale and complexity, requires a creative approach and input from many different fields of expertise. Lessons from engineering have the potential to improve both the efficiency and quality of healthcare delivery. The fundamental notion of a high-performing healthcare system--one that increasingly is more effective, more efficient, safer, and higher quality--is rooted in continuous improvement principles that medicine shares with engineering. As part of its Learning Health System series of workshops, the Institute of Medicine's Roundtable on Value and Science-Driven Health Care and the National Academy of Engineering, hosted a workshop on lessons from systems and operations engineering that could be applied to health care. Building on previous work done in this area the workshop convened leading engineering practitioners, health professionals, and scholars to explore how the field might learn from and apply systems engineering principles in the design of a learning healthcare system. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summaryfocuses on current major healthcare system challenges and what the field of engineering has to offer in the redesign of the system toward a learning healthcare system.

Clinical Data as the Basic Staple of Health Learning: Creating and Protecting a Public Good - Workshop Summary

by Institute of Medicine of the National Academies

Successful development of clinical data as an engine for knowledge generation has the potential to transform health and health care in America. As part of its Learning Health System Series, the Roundtable on Value & Science-Driven Health Care hosted a workshop to discuss expanding the access to and use of clinical data as a foundation for care improvement.

The National Children's Study Research Plan: A REVIEW

by National Research Council Institute of Medicine of the National Academies

The National Children’s Study (NCS) is planned to be the largest long-term study of environmental and genetic effects on children’s health ever conducted in the United States. It proposes to examine the effects of environmental influences on the health and development of approximately 100,000 children across the United States,following them from before birth until age 21. By archiving all of the data collected,the NCS is intended to provide a valuable resource for analyses conducted many years into the future. This book evaluates the research plan for the NCS,by assessing the scientific rigor of the study and the extent to which it is being carried out with methods,measures,and collection of data and specimens to maximize the scientific yield of the study.The book concludes that if the NCS is conducted as proposed,the database derived from the study should be valuable for investigating hypotheses described in the research plan as well as additional hypotheses that will evolve. Nevertheless,there are important weaknesses and shortcomings in the research plan that diminish the study’s expected value below what it might be.

Review Of Secondary Waste Disposal Planning For The Blue Grass And Pueblo Chemical Agent Destruction Pilot Plants

by National Research Council of the National Academies

The U.S. Army Program Manager for Assembled Chemical Weapons Alternatives (PMACWA) is charged with disposing of chemical weapons as stored at two sites: Pueblo, Colorado, and Blue Grass, Kentucky. In accordance with congressional mandates, technologies other than incineration are to be used if they are as safe and as cost effective. The weapons are to be disposed of in compliance with the Chemical Weapons Convention. Although an element of the U.S. Army, the PMACWA is responsible to the Assistant Secretary of Defense for Acquisitions, Technology, and Logistics for completing this mission. This book deals with the expected significant quantities of secondary wastes that will be generated during operations of the facilities and their closure. While there are only estimates for the waste quantities that will be generated, they provide a good basis for planning and developing alternatives for waste disposal while the plants are still in the design phase. Establishing efficient disposal options for the secondary wastes can enable more timely and cost-effective operation and closure of the facilities.

Assessing the Role of K-12 Academic Standards in States: WORKSHOP SUMMARY

by National Research Council of the National Academies

The National Academies Press (NAP)--publisher for the National Academies--publishes more than 200 books a year offering the most authoritative views, definitive information, and groundbreaking recommendations on a wide range of topics in science, engineering, and health. Our books are unique in that they are authored by the nation's leading experts in every scientific field.

Department of Homeland Security Bioterrorism Risk Assessment: A CALL FOR CHANGE

by National Research Council of the National Academies

The mission of Department of Homeland Security Bioterrorism Risk Assessment: A Call for Change, the book published in December 2008, is to independently and scientifically review the methodology that led to the 2006 Department of Homeland Security report, Bioterrorism Risk Assessment (BTRA) and provide a foundation for future updates. This book identifies a number of fundamental concerns with the BTRA of 2006, ranging from mathematical and statistical mistakes that have corrupted results, to unnecessarily complicated probability models and models with fidelity far exceeding existing data, to more basic questions about how terrorist behavior should be modeled. Rather than merely criticizing what was done in the BTRA of 2006, this new NRC book consults outside experts and collects a number of proposed alternatives that could improve DHS's ability to assess potential terrorist behavior as a key element of risk-informed decision making, and it explains these alternatives in the specific context of the BTRA and the bioterrorism threat.

The Personal Protective Technology Program at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health

by National Research Council Institute of Medicine of the National Academies

Maintaining the health and safety of workers in the United States and globally is accomplished in part by reducing hazardous exposures through the use of personal protective equipment. Personal protective technologies (PPT) include respirators worn by construction workers and miners; protective clothing, respirators, and gloves worn by firefighters and mine rescue workers; and respirators and protective clothing worn by healthcare workers. An estimated 5 million workers are required to wear respirators in 1.3 million U.S. workplaces. For some occupations, such as firefighting, the worker’s protective equipment is the only form of protection against life-threatening hazards; for other workers, the PPT is a supplement to ventilation and other environmental, engineering, or administrative hazard controls. In the United States, federal responsibility for civilian worker PPT is integral to the mission of the National Institute for Occupational Safety and Health (NIOSH). This book examines the NIOSH Personal Protective Technology Program (PPT Program) and specifically focuses on the relevance and impact of this program in reducing hazardous exposures and improving worker health and safety.

Science Opportunities Enabled by NASA's Constellation System--Interim Report

by National Research Council of the National Academies

To begin implementation of the Vision for Space Exploration (recently renamed “United States Space Exploration Policy”), NASA has begun development of new launch vehicles and a human-carrying spacecraft that are collectively called the Constellation System. In November 2007, NASA asked the NRC to evaluate the potential for the Constellation System to enable new space science opportunities. For this interim report, 11 existing “Vision Mission” studies of advanced space science mission concepts inspired by earlier NASA forward-looking studies were evaluated. The focus was to assess the concepts and group them into two categories: more-deserving or less deserving of future study. This report presents a description of the Constellation System and its opportunities for enabling new space science opportunities, and a systematic analysis of the 11 Vision Mission studies. For the final report, the NRC issued a request for information to the relevant communities to obtain ideas for other mission concepts that will be assessed by the study committee, and several issues addressed only briefly in the interim report will be explored more fully.

EPIDEMIOLOGIC STUDIES OF VETERANS EXPOSED TO DEPLETED URANIUM: Feasibility and Design Issues

by Institute of Medicine of the National Academies

Depleted uranium, a component of some weapons systems, has been in use by the U.S. military since the 1991 Gulf War. Military personnel have been exposed to depleted uranium as the result of friendly fire incidents, cleanup and salvage operations, and proximity to burning depleted uranium-containing tanks and ammunition. Under a Congressional mandate, the Department of Defense sought guidance from the Institute of Medicine in evaluating the feasibility and design of an epidemiologic study that would assess health outcomes of exposure to depleted uranium. The study committee examined several options to study health outcomes of depleted uranium exposure in military and veteran populations and concluded that it would be difficult to design a study to comprehensively assess depleted uranium-related health outcomes with currently available data. The committee further concluded that the option most likely to obtain useful information about depleted uranium-related health outcomes would be a prospective cohort study if future military operations involve exposure to depleted uranium. The book contains recommendations aimed at improving future epidemiologic studies and identifying current active-duty military personnel and veterans with potential DU exposure.

Integrated Computational Materials Engineering: A Transformational Discipline for Improved Competitiveness and National Security

by National Research Council of the National Academies

Integrated computational materials engineering (ICME) is an emerging discipline that can accelerate materials development and unify design and manufacturing. Developing ICME is a grand challenge that could provide significant economic benefit. To help develop a strategy for development of this new technology area, DOE and DoD asked the NRC to explore its benefits and promises, including the benefits of a comprehensive ICME capability; to establish a strategy for development and maintenance of an ICME infrastructure, and to make recommendations about how best to meet these opportunities. This book provides a vision for ICME, a review of case studies and lessons learned, an analysis of technological barriers, and an evaluation of ways to overcome cultural and organizational challenges to develop the discipline.

Estimating Mortality Risk Reduction And Economic Benefits From Controlling Ozone Air Pollution

by National Research Council of the National Academies

In light of recent evidence on the relationship of ozone to mortality and questions about its implications for benefit analysis, the Environmental Protection Agency asked the National Research Council to establish a committee of experts to evaluate independently the contributions of recent epidemiologic studies to understanding the size of the ozone-mortality effect in the context of benefit analysis. The committee was also asked to assess methods for estimating how much a reduction in short-term exposure to ozone would reduce premature deaths, to assess methods for estimating associated increases in life expectancy, and to assess methods for estimating the monetary value of the reduced risk of premature death and increased life expectancy in the context of health-benefits analysis. Estimating Mortality Risk Reduction and Economic Benefits from Controlling Ozone Air Pollution details the committee’s findings and posits several recommendations to address these issues.

Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches - Workshop Summary

by Institute of Medicine of the National Academies

Recent scientific and technological advances have accelerated our understanding of the causes of disease development and progression,and resulted in innovative treatments and therapies. Ongoing work to elucidate the effects of individual genetic variation on patient outcomes suggests the rapid pace of discovery in the biomedical sciences will only accelerate. However,these advances belie an important and increasing shortfall between the expansion in therapy and treatment options and knowledge about how these interventions might be applied appropriately to individual patients. The impressive gains made in Americans' health over the past decades provide only a preview of what might be possible when data on treatment effects and patient outcomes are systematically captured and used to evaluate their effectiveness. Needed for progress are advances as dramatic as those experienced in biomedicine in our approach to assessing clinical effectiveness. In the emerging era of tailored treatments and rapidly evolving practice,ensuring the translation of scientific discovery into improved health outcomes requires a new approach to clinical evaluation. A paradigm that supports a continual learning process about what works best for individual patients will not only take advantage of the rigor of trials,but also incorporate other methods that might bring insights relevant to clinical care and endeavor to match the right method to the question at hand. The Institute of Medicine Roundtable on Value & Science-Driven Health Care's vision for a learning healthcare system,in which evidence is applied and generated as a natural course of care,is premised on the development of a research capacity that is structured to provide timely and accurate evidence relevant to the clinical decisions faced by patients and providers. As part of the Roundtable's Learning Healthcare System series of workshops,clinical researchers,academics,and policy makers gathered for the workshop Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches. Participants explored cutting-edge research designs and methods and discussed strategies for development of a research paradigm to better accommodate the diverse array of emerging data resources,study designs,tools,and techniques. Presentations and discussions are summarized in this volume.

Transitioning To Sustainability Through Research And Development On Ecosystem Services And Biofuels: Workshop Summary

by National Research Council of the National Academies

The National Research Council's Roundtable on Science and Technology for Sustainability hosted "Transitioning to Sustainability through Research and Development on Ecosystem Services and Biofuels: The National Academies' First Federal Sustainability Research and Development Forum" on October 17- 18, 2007. The forum discussed sustainability research and development activities related to ecosystem services and biofuels. The objective of the forum was to identify research gaps and opportunities for collaboration among federal agencies to meet the challenges to sustainability posed by the need to maintain critical ecosystem services, to support the development of alternatives to conventional fossil fuels, and to manage oceans and coastal areas. The forum focused primarily on federal activities, but included the participation of representatives from the private sector, universities, and nongovernmental organizations. This book is a summary the discussions from the forum.

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