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Book Nelson Textbook of Pediatrics

Download or read book Nelson Textbook of Pediatrics written by Richard E. Behrman and published by Elsevier España. This book was released on 2004 with total page 2694 pages. Available in PDF, EPUB and Kindle. Book excerpt: Accompanying CD-ROM contains: contents of book; continuous updates; slide image library; references linked to MEDLINE; pediatric guidelines; case studies; review questions.

Book Suicide behaviors

    Book Details:
  • Author : Campo Arias, Adalberto
  • Publisher : Editorial Unimagdalena
  • Release : 2023-04-05
  • ISBN : 9587466047
  • Pages : 135 pages

Download or read book Suicide behaviors written by Campo Arias, Adalberto and published by Editorial Unimagdalena. This book was released on 2023-04-05 with total page 135 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book updates knowledge about self-injurious behaviors for suicidal purposes concerning frequency, possibly biological, psychological, social, cultural, and political causes; that is, it approaches suicide from abroad non-reductive vision and considers the phenomenon's complexity. The source of information is the most recent scientific research —preferably systematic reviews and meta-analyses—given the wealth of data available on the subject of suicide. It includes novel topics such as non-suicidal self-injurious behaviors and suicidal behaviors in socially excluded groups due to ethnicity, sexual orientation, and immigrants. Likewise, it presents a comprehensive view of strategies for preventing suicidal behavior. Special attention was paid to the review and inclusion of research carried out in Colombia and other Latin American countries since studies published in Spanish are exceptionally considered in reviews in English. Each chapter is extensively referenced so that readers can delve into the details of each topic as they see fit. It is necessary to continue reviewing the evidence to reduce suicidal behaviors by implementing preventive programs in the most vulnerable social groups.

Book Suicide  A Global Perspective

Download or read book Suicide A Global Perspective written by Maurizio Pompili and published by Bentham Science Publishers. This book was released on 2012-09-19 with total page 294 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the year 2000, approximately one million people died from suicide: a "global" mortality rate of 16 per 100,000, or one death every 40 seconds. In the last 45 years suicide rates have increased by 60% worldwide. Suicide is now among the three leading causes of death among those aged 15-44 years (both sexes); these figures do not include suicide attempts up to 20 times more frequent than completed suicide. Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in1998, and 2.4% in countries with market and former socialist economies in 2020. Although traditionally suicide rates have been highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of countries, in both developed and developing countries. Mental disorders (particularly depression and substance abuse) are associated with more than 90% of all cases of suicide; however, suicide results from many complex sociocultural factors and is more likely to occur particularly during periods of socioeconomic, family and individual crisis situations (e.g., loss of a loved one, employment, honour). The economic costs associated with completed and attempted suicide are estimated to be in the billions of dollars. One million lives lost each year are more than those lost from wars and murder annually in the world. It is three times the catastrophic loss of life in the tsunami disaster in Asia in 2005. Every day of the year, the number of suicides is equivalent to the number of lives lost in the attack on the World Trade Center Twin Towers on 9/11 in 2001. Everyone should be aware of the warning signs for suicide: Someone threatening to hurt or kill him/herself, or taking of wanting to hurt or kill him/herself; someone looking for ways to kill him/herself by seeking access to firearms, available pills, or other means; someone talking or writing about death, dying or suicide, when these actions are out of the ordinary for the person. Also, high risk of suicide is generally associated with hopelessness; rage, uncontrolled anger, seeking revenge; acting reckless or engaging in risky activities, seemingly without thinking; feeling trapped – like there’s no way out; increased alcohol or drug use; withdrawing from friends, family and society, anxiety, agitation, unable to sleep or sleeping all the time; dramatic mood changes; no reason for living; no sense of purpose in life. Table 1: Understanding and helping the suicidal individual should be a task for all. Suicide Myths How to Help the Suicidal Person Warning Sights of Suicide Myth: Suicidal people just want to die. Fact: Most of the time, suicidal people are torn between wanting to die and wanting to live. Most suicidal individuals don’t want death; they just want to stoop the great psychological or emotional pain they are experiencing -Listen; -Accept the person’s feelings as they are; -Do not be afraid to talk about suicide directly -Ask them if they developed a plan of suicide; -Expressing suicidal feelings or bringing up the topic of suicide; -Giving away prized possessions settling affairs, making out a will; -Signs of depression: loss of pleasure, sad mood, alterations in sleeping/eating patterns, feelings of hopelessness; Myth: People who commit suicide do not warn others. Fact: Eight out of every 10 people who kill themselves give definite clues to their intentions. They leave numerous clues and warnings to others, although clues may be non-verbal of difficult to detect. -Remove lethal means for suicide from person’s home -Remind the person that depressed feelings do change with time; -Point out when death is chosen, it is irreversible; -Change of behavior (poor work or school performance) -Risk-taking behaviors -Increased use of alcohol or drugs -Social isolation -Developing a specific plan for suicide Myth: People who talk about suicide are only trying to get attention. They won’t really do it. Fact: Few commit suicide without first letting someone know how they feel. Those who are considering suicide give clues and warnings as a cry for help. Over 70% who do threaten to commit suicide either make an attempt or complete the act. -Express your concern for the person; -Develop a plan for help with the person; -Seek outside emergency intervention at a hospital, mental health clinic or call a suicide prevention center Myth: Don’t mention suicide to someone who’s showing signs of depression. It will plant the idea in their minds and they will act on it. Fact: Many depressed people have already considered suicide as an option. Discussing it openly helps the suicidal person sort through the problems and generally provides a sense of relief and understanding. Suicide is preventable. Most suicidal individuals desperately want to live; they are just unable to see alternatives to their problems. Most suicidal individuals give definite warnings of their suicidal intentions, but others are either unaware of the significance of these warnings or do not know how to respond to them. Talking about suicide does not cause someone to be suicidal; on the contrary the individual feel relief and has the opportunity to experience an empathic contact. Suicide profoundly affects individuals, families, workplaces, neighbourhoods and societies. The economic costs associated with suicide and self-inflicted injuries are estimated to be in the billions of dollars. Surviving family members not only suffer the trauma of losing a loved one to suicide, and may themselves be at higher risk for suicide and emotional problems. Mental pain is the basic ingredient of suicide. Edwin Shneidman calls such pain “psychache” [1], meaning an ache in the psyche. Shneidman suggested that the key questions to ask a suicidal person are ‘Where do you hurt?’ and ‘How may I help you?’. If the function of suicide is to put a stop to an unbearable flow of painful consciousness, then it follows that the clinician’s main task is to mollify that pain. Shneidman (1) also pointed out that the main sources of psychological pain, such as shame, guilt, rage, loneliness, hopelessness and so forth, stem from frustrated or thwarted psychological needs. These psychological needs include the need for achievement, for affiliation, for autonomy, for counteraction, for exhibition, for nurturance, for order and for understanding. Shneidman [2], who is considered the father of suicidology, has proposed the following definition of suicide: ‘Currently in the Western world, suicide is a conscious act of self-induced annihilation, best understood as a multidimensional malaise in a needful individual who defines an issue for which the suicide is perceived as the best solution’. Shneidman has also suggested that ‘that suicide is best understood not so much as a movement toward death as it is a movement away from something and that something is always the same: intolerable emotion, unendurable pain, or unacceptable anguish. Strategies involving restriction of access to common methods of suicide have proved to be effective in reducing suicide rates; however, there is a need to adopt multi-sectoral approaches involving other levels of intervention and activities, such as crisis centers. There is compelling evidence indicating that adequate prevention and treatment of depression, alcohol and substance abuse can reduce suicide rates. School-based interventions involving crisis management, self-esteem enhancement and the development of coping skills and healthy decision making have been demonstrated to reduce the risk of suicide among the youth. Worldwide, the prevention of suicide has not been adequately addressed due to basically a lack of awareness of suicide as a major problem and the taboo in many societies to discuss openly about it. In fact, only a few countries have included prevention of suicide among their priorities. Reliability of suicide certification and reporting is an issue in great need of improvement. It is clear that suicide prevention requires intervention also from outside the health sector and calls for an innovative, comprehensive multi-sectoral approach, including both health and non-health sectors, e.g., education, labour, police, justice, religion, law, politics, the media.

Book EMT Spanish  Atenci  n Prehospitalaria Basica  Und  cima edici  n

Download or read book EMT Spanish Atenci n Prehospitalaria Basica Und cima edici n written by AAOS, and published by Jones & Bartlett Learning. This book was released on 2019-01-15 with total page 1615 pages. Available in PDF, EPUB and Kindle. Book excerpt: En 1971, la Academia Americana de Cirujanos Ortopedistas (AAOS) publicó la primera edición de Los Cuidados de Emergencia y Transporte de Enfermos y Heridos y sentó las bases para el entrenamiento de los SEM. Hoy en día, vemos cómo la undécima edición transforma la educación en los SEM llevándola a todo el mundo y ayudando a un desarrollo superior de los proveedores del SEM alrededor del planeta. Con base en los Estándares Nacionales de Educación de los SEM de Estados Unidos de América de y las guías 2015 de RCP/CCE del 2015, la undécima edición ofrece una cobertura completa de cada declaración de competencia con claridad y precisión en un formato conciso que asegura la comprensión del alumno y fomenta el pensamiento critico. Presenta un nuevo material cognitivo y didáctico, junto con nuevas destrezas y características para crear una solución de formación completa e innovadora para proveedores prehospitalarios. Hoy, el paquete de recursos educativos en SEM de la AAOS, desde primeros auxilios y RCP hasta el transporte de cuidados críticos, es el estándar de oro en materiales de capacitación, ofreciendo contenido excepcional y recursos de instrucción que satisfacen las diversas necesidades de los estudiantes y educadores de hoy en día. Contenido medico actualizado de ultima generación La undécima edición se alinea con los estándares médicos actuales — desde PHTLS hasta ILCOR — e incorpora conceptos médicos basados en evidencia para garantizar que los estudiantes e instructores tengan una interpretación precisa y profunda de la ciencia médica y su aplicación en la medicina prehospitalaria de hoy en día. Aplicación al Mundo Real del SEM A través de la evolución de estudios de caso de pacientes en cada capítulo, la undécima edición proporciona a los estudiantes el contexto de mundo real para aplicar los conocimientos adquiridos en cada capitulo clarificando cómo la información se utiliza para la atención de los pacientes en el campo e impulsa a los estudiantes a participar en el pensamiento crítico y la discusión. Una Fundación de por Vida La undécima edición parte de la premisa de que los estudiantes necesitan una base de fundamentos solidos y posteriormente refuerzo apropiado. La undécima edición proporciona a los estudiantes una comprensión amplia de la terminología médica, anatomía, fisiología y fisiopatología. Los conceptos son examinados brevemente y son relacionados con los capítulos posteriores, fortaleciendo los conocimientos fundamentales y ofreciendo un contexto cuando se estudian las emergencias específicas.

Book TRASTORNOS BIPOLARES

    Book Details:
  • Author : E. VIETA
  • Publisher : Springer Science & Business Media
  • Release : 2000-12-19
  • ISBN : 9788407001738
  • Pages : 564 pages

Download or read book TRASTORNOS BIPOLARES written by E. VIETA and published by Springer Science & Business Media. This book was released on 2000-12-19 with total page 564 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Book Una vez fui t    Once I Was You Spanish Edition

Download or read book Una vez fui t Once I Was You Spanish Edition written by Maria Hinojosa and published by Simon and Schuster. This book was released on 2020-09-15 with total page 400 pages. Available in PDF, EPUB and Kindle. Book excerpt: “El punto de vista de María es poderoso y vital. Hace años, cuando In the Heights empezaba a presentarse en teatros off-Broadway, María corrió la voz en nuestra comunidad para que apoyáramos este nuevo musical que trataba sobre nuestros vecindarios. Ella ha sido una campeona de nuestros triunfos, una crítica de nuestros detractores y una fuerza clave para enfrentar y corregir los errores de nuestra sociedad. Cuando María habla, estoy listo para escuchar y aprender de ella.” —Lin-Manuel Miranda La periodista ganadora de cuatro premios Emmy y presentadora de Latino USA de NPR, María Hinojosa, cuenta la historia de la inmigración en los Estados Unidos a través de las experiencias de su familia y décadas de hacer reportajes, con lo cual crea un riguroso retrato de un país en crisis. María Hinojosa es una periodista galardonada que ha colaborado con las cadenas más respetadas y se ha distinguido por realizar reportajes con un toque humano. En estas memorias escritas con gran belleza, nos relata la historia de la política de inmigración de los EE.UU. que nos ha llevado al punto en que estamos hoy, al mismo tiempo que nos comparte su historia profundamente personal. Durante treinta años, María Hinojosa ha informado sobre historias y comunidades en los Estados Unidos que a menudo son ignoradas por los principales medios de comunicación. La autora de bestsellers Julia Álvarez la ha llamado “una de las líderes culturales más importantes, respetadas y queridas de la comunidad Latinx”. En Una vez fui tú, María nos comparte su experiencia personal de haber crecido como mexicanoamericana en el sur de Chicago y documentar el páramo existencial de los campos de detención de inmigrantes para los medios de comunicación que a menudo cuestionaban su trabajo. En estas páginas, María ofrece un relato personal y revelador de cómo la retórica en torno a la inmigración no solo ha influido en las actitudes de los estadounidenses hacia los extranjeros, sino que también ha permitido la negligencia intencional y el lucro a expensas de las poblaciones más vulnerables de nuestro país, lo que ha propiciado el sistema resquebrajado que tenemos hoy en día. Estas memorias honestas y estremecedoras crean un vívido retrato de cómo llegamos aquí y lo que significa ser una superviviente, una feminista, una ciudadana y una periodista que hace valer su propia voz mientras lucha por la verdad. Una vez fui tú es un llamado urgente a los compatriotas estadounidenses para que abran los ojos a la crisis de la inmigración y entiendan que nos afecta a todos. También disponible en inglés como Once I Was You.

Book Suicide   a silent threat

    Book Details:
  • Author : René López
  • Publisher : Centro de Investigación y Desarrollo Profesional
  • Release : 2024-10-04
  • ISBN :
  • Pages : 15 pages

Download or read book Suicide a silent threat written by René López and published by Centro de Investigación y Desarrollo Profesional. This book was released on 2024-10-04 with total page 15 pages. Available in PDF, EPUB and Kindle. Book excerpt: Suicide is defined as the deliberate act of taking one's own life, involving successively suicidal desire, suicidal ideation, and suicidal act. Worldwide, suicide is a public health problem. Suicide is the third leading cause of death among the youngest population (15-29 years old). It is estimated that for every completed suicide, there are at least 25 non-fatal suicide attempts. This indicates that it is often preventable. People who resort to suicide do so to solve a problem they perceive as irremediable or intolerable. The etiology is multifactorial, but sociodemographic, clinical, neurobiological and genetic factors can be identified. Suicidal behavior is a process that begins with ideation, continues with the threat, is affirmed by the attempt and is consummated by death. Treatment comprises a pharmacological and psychotherapeutic approach. During the intervention the family will play an important role, we must take care of avoidant attachment and codependency. The promotion of mental health to prevent suicidal behavior should involve not only health professionals, but also other people who are more closely related to patients, such as family members, teachers and friends. This article reviews the most important aspects of suicide: historical background, definition, epidemiology, causes, clinical manifestations, symptoms and warning signs, treatment and prevention. Key words: Suicide, Mental health.

Book Boletin de la Asociacion Medica de Puerto Rico

Download or read book Boletin de la Asociacion Medica de Puerto Rico written by and published by . This book was released on 2003 with total page 420 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Book AMLS Spanish  Soporte vital medico avanzado

Download or read book AMLS Spanish Soporte vital medico avanzado written by National Association of Emergency Medical Technicians (NAEMT), and published by Jones & Bartlett Learning. This book was released on 2016-07-06 with total page 487 pages. Available in PDF, EPUB and Kindle. Book excerpt: Soporte vital médico avanzado (AMLS) es el principal curso para los profesionales de la atención prehospitalaria médica avanzada para la evaluación y el tratamiento de los padecimientos médicos más comunes. Se enseña en todo el mundo desde 1999. AMLS fue el primer programa de educación de los SME completamente dirigido al mejor manejo de los pacientes en crisis médicas. AMLS es el único libro de texto avalado por la NAEMT para su uso en el curso de soporte vital médico avanzado, que hace énfasis en la evaluación por la vía del AMLS, es la guía más importante para la evaluación de pacientes con padecimientos médicos. La segunda edición de AMLS se distingue por:Características generalesLos escenarios de pensamiento crítico proporcionan a los estudiantes un contexto real para la aplicación del conocimiento presentado en el capítulo, incluyendo una solución del escenario. Los estudiantes serán capaces de evaluar, revisar y distinguir el posible diagnóstico del paciente.Las secciones Preguntas de repaso, Resumen y Conjuntando todo refuerzan los Términos clave y reúnen la información para ayudar a los estudiantes a retener lo que han aprendido.Avalado por la National Association of EMS Physicians, este curso enfatiza el uso del proceso de la evaluación AMLS, una herramienta de evaluación sistemática que permite a los profesionales de la salud diagnosticar a pacientes médicos con precisión urgente.Contenido médico actualizadoLa cobertura de las modalidades básicas y avanzadas del tratamiento incorpora los últimos acontecimientos de investigación que son adecuados para principiantes y proveedores de cuidado prehospitalario experimentados, enfermeros de cuidados críticos y de emergencias, así como médicos de urgencias.Una actualización del proceso de la evaluación AMLSEl camino de la revisión de la evaluación AMLS proporciona un enfoque sitemático a la evaluación de un paciente médico, así como orientación para los estudiantes de todos los niveles de la práctica.

Book PARA CONTINUAR LA VIDA

    Book Details:
  • Author : Gloria Sierra Uribe
  • Publisher : Editorial San Pablo
  • Release : 2011-11-17
  • ISBN : 958692999X
  • Pages : 118 pages

Download or read book PARA CONTINUAR LA VIDA written by Gloria Sierra Uribe and published by Editorial San Pablo. This book was released on 2011-11-17 with total page 118 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Book Latina Magazine

Download or read book Latina Magazine written by and published by . This book was released on 2000 with total page 1064 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Book Cuando los que escuchan hablan

Download or read book Cuando los que escuchan hablan written by María Esther Gilio and published by Libros del Zorzal. This book was released on 2020-09-25 with total page 258 pages. Available in PDF, EPUB and Kindle. Book excerpt: A los 14 años, con la lectura de Análisis profano de Freud, se produce un quiebre en la vida de María Esther Gilio: “Después de haber pasado mi primera infancia diciendo ‘quiero ser médica de locos’, después de ver un film de Claudette Colbert en que ésta, con todo su encanto francés, convertía a locos furiosos en santos de estampita, quise ser psicoanalista”. Este es el testimonio de alguien que sospecha que hablar de uno mismo en el pasado es como hablar de otra persona, y que el presente surge permanentemente como un espejo que no siempre queremos enfrentar de manera directa (“Llegamos a hoy. Y yo no quiero escribir sobre mí misma”). Como si la conversación con quienes compartimos preciados intereses mostrara nuestra identidad más genuina, la autora –abogada, escritora, biógrafa y periodista– nos habla de experiencias de vida a través de una serie de entrevistas. Aparecen aquí algunos de los más importantes y prestigiosos psicoanalistas contemporáneos: Jean Laplanche, Jacques Alain Miller, Emilio Rodrigué, Elisabeth Roudinesco, Benzión Winograd, Silvia Bleichmar, Janine Altounian, Lito Benvenutti, Mordechai Benyakar, César Botella, Françoise Davoine, Jean-Max Gaudilliere, Daniel Gil, Max Hernández, Philippe Jeammet, François Marty, Paul Roazen y Teresa Yuan. De manera paulatina, el lector encontrará en estas páginas una impresión de coherencia ética y profesional en el tratamiento de temas que le dan sentido a aquel primer deseo, y que revelan que “nuestras decisiones siempre están estrechamente unidas a lo que imaginamos”.

Book La Voz

Download or read book La Voz written by and published by . This book was released on 1992 with total page 476 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Book Human Development

Download or read book Human Development written by Grace J. Craig and published by Pearson Educación. This book was released on 1999 with total page 726 pages. Available in PDF, EPUB and Kindle. Book excerpt: Designed for students from a wide range of backgrounds, this text takes a chronological and interdisciplinary approach to human development. With its focus on context and culture, the 8/E illustrates that the status of human development is inextricably embedded in a study of complex and changing cultures.

Book S  lo Quien Se Siente Amado Puede Ser Educado

Download or read book S lo Quien Se Siente Amado Puede Ser Educado written by Juan Bosco Abascal Carranza and published by Palibrio. This book was released on 2012-10 with total page 413 pages. Available in PDF, EPUB and Kindle. Book excerpt: Se explica que para la salud humana la satisfacción de "Las Hambres Básicas" de Caricias, Tiempo y Reconocimiento es tan importante como la ingesta de alimentos, oxígeno y agua. Comprenderemos qué son las Endorfinas -la droga de salud, la alegría, el bienestar y el bienhacer. Conoceremos variadas formas de producirlas en nuestro organismo, pero ante todo la que nos proporciona las cinco ganancias más codiciadas: envejecer despacio, mantener un sistema inmunológico invencible, disponer de una gran energía, vivir alegremente, y poder superar cualquier dolor físico o corporal. Esta forma única es la práctica de las Virtudes: Prudencia, Justicia, Fortaleza, Templanza, Fe, Esperanza y Caridad. Queda demostrado que para educar a nuestros hijos en la Virtud, la receta no consiste en "hacer que ellos hagan lo que creemos que ellos deben hacer", ni mucho menos en lograr que "ellos hagan lo que los padres queremos", sino algo muy distinto: que dentro de un "Sistema Incondicional" de Caricias, Tiempo y Reconocimiento, les hagamos vivir la fuerza de nuestro Amor, para que "ellos quieran hacer habitualmente lo que conviene al Bien Común y al Bien Integral" de todos los involucrados en el proceso educativo. Para esto hace falta desarrollar un Liderazgo Transformador: sólo quien se siente amado puede ser educado. Se propone el justo medio entre los dos extremos en pugna: ni moralismo rígido, ni naturalismo hedonista o utilitario, sino del equilibrio entre esos dos extremos. Como estrategias auxiliares se plantea lo que es la Reingeniería de Valores y Virtudes, se analizan las Bases Filosóficas para Jerarquizar los Valores Operantes, Reales; y se propone la sana jerarquía de los Nueve Valores Universales, así como el rechazo de los Contravalores. El libro concluye con una explicación apasionante: ¿Quién Soy Yo? A la vez que se exponen los Fundamentos Filosóficos de la Dignidad de la Persona.

Book Psychological Intervention for Suicidal Ideation  Behavior  and Attempted Suicide

Download or read book Psychological Intervention for Suicidal Ideation Behavior and Attempted Suicide written by Tushar Singh and published by Frontiers Media SA. This book was released on 2024-10-24 with total page 135 pages. Available in PDF, EPUB and Kindle. Book excerpt: Taking one's own life is called suicide, and approximately 800,000 people worldwide commit suicide every year because of various reasons, according to the World Health Organization. Poor mental health is a major driver of suicide, especially in high-income countries. People who commit suicide perform impulsive destructive behaviors beyond their ability to cope with their stressors; currently, there is a need to establish effective psychotherapies for the same. Suicidal ideation and behavior are involved in attempted suicide, and psychotherapies that specifically intervenes in suicidal ideation may reduce suicidal risk. In this special issue, we would like to collect knowledge regarding psychotherapies/cognitive-behavioral models, wherein the evidence of their effectiveness has been generated by research and clinical trials. We expect the papers collected in this special issue to be a source of good ideas and solutions.

Book Upriver

    Book Details:
  • Author : Michael F. Brown
  • Publisher : Harvard University Press
  • Release : 2014-09-15
  • ISBN : 067436807X
  • Pages : 332 pages

Download or read book Upriver written by Michael F. Brown and published by Harvard University Press. This book was released on 2014-09-15 with total page 332 pages. Available in PDF, EPUB and Kindle. Book excerpt: In this story of one man’s encounter with an indigenous people of Peru, Michael Brown guides his readers upriver into a contested zone of the Amazonian frontier, where more than 50,000 Awajún—renowned for pugnacity and fierce independence—use hard-won political savvy, literacy, and digital skills to live life on their own terms, against long odds.