Thank you for viewing my products. If you are considering a purchase, please take a moment to read my profile, even briefly. This is a textbook for an online lecture on respiratory therapy. There are handwritten notes only in the places where the instructor told me to make corrections. Otherwise, there is nothing written (as far as I remember). I think it's recommended for those who want to learn about respiratory therapy. Thank you. - If you would like to negotiate a price, please state your immediate purchase price. If the item is not purchased within 12 hours after the price is changed, I will block you. I will prioritize the person who purchases the item, even during negotiations. I will decline requests for exclusive sales or holds to prevent any trouble.