Suchergebnisse

Testimony issued by the Government Accountability Office with an abstract that begins "The federal government holds more than 45,000 underutilized properties that cost nearly $1.7 billion annually to operate, yet significant obstacles impede efforts to close, consolidate, or find other uses for them. In January 2003, GAO designated federal real property management as a high-risk area, in part because of the number and cost of these properties. The Office of Management and Budget (OMB) is responsible for reviewing federal agencies' progress in real property management. In 2007, GAO recommended that OMB assist agencies by developing an action plan to address key obstacles associated with decisions related to unneeded real property, including stakeholder influence. The President's fiscal year 2012 budget proposed establishing a legislative framework for disposing of and consolidating civilian real property, referred to as a Civilian Property Realignment Act (CPRA), which may be designed to address stakeholder influences in real property decision making. This testimony identifies (1) obstacles to effectively managing federal real property, (2) actions designed to overcome those obstacles, including government actions and CPRA, and (3) key elements of the Department of Defense's (DOD) base realignment and closure (BRAC) process that are designed to help DOD close or realign installations and may be relevant for CPRA. To do this work, GAO reviewed GAO reports, other reports, and CPRA."

Testimony issued by the Government Accountability Office with an abstract that begins "The federal government's real property portfolio includes more than 900,000 buildings and structures worth hundreds of billions of dollars. Many of these properties are leased from private-sector owners, often at total costs that would exceed what the government would pay for ownership. Overreliance on costly leased space was one of several factors that contributed to GAO's designation of federal real property management as a governmentwide high-risk issue. The administration's proposed Civilian Property Realignment Act (CPRA) would reform federal real property management and disposal. For this subcommittee, GAO is currently examining opportunities for consolidating federal operations and moving them from leased space to federally owned sites. This statement identifies (1) the factors that contribute to the government's reliance on costly leasing, (2) how CPRA may provide an opportunity to reduce reliance on leasing, and (3) federal agencies' independent leasing authorities and General Services Administration's (GSA) delegations of leasing authorities. To do this work, GAO relied on its prior work and reviewed CPRA and other relevant reports."

Testimony issued by the Government Accountability Office with an abstract that begins "The federal government holds more than 45,000 underutilized properties that cost nearly $1.7 billion annually to operate, yet significant obstacles impede efforts to close, consolidate, or find other uses for these properties. GAO has designated federal real property management as a high-risk area, in part because of the number and cost of these properties. The Office of Management and Budget (OMB) is responsible for reviewing federal agencies' progress in real property management. In 2007, GAO recommended that OMB assist agencies by developing an action plan to address key obstacles associated with decisions related to unneeded real property, including stakeholder influences. In May 2011, the administration proposed legislation, referred to as the Civilian Property Realignment Act (CPRA), to, among other things, establish a legislative framework for disposing of and consolidating civilian real property and that could help limit stakeholder influences in real property decision making. This statement identifies (1) progress the government has made toward addressing obstacles to federal real property management, (2) some of the challenges that remain and how CPRA may be responsive to those challenges, and (3) key elements of the Department of Defense's (DOD) base realignment and closure (BRAC) process that could expedite the disposal of unneeded civilian properties. To do this work, GAO relied on its prior work, and reviewed CPRA and other relevant reports."

PharmD ; The pharmacy profession is a patient-centred practice, where the pharmacist translates science to regulated practice. Pharmacy practice has evolved from compliance and adherence to concordance. Could regulation adopt the same concept? The objectives of this research were to: (1) Retrospectively analyse community pharmacy regulatory audit (CPRA) reports, (2) develop, validate and implement an updated tool for CPRAs, and (3) identify and analyse case studies from CPRAs to recommend improvements in patient safety. The methodology involved: (1) retrospective analysis of CPRA reports to extract features that could lead to identification of patient-related deficiencies in community pharmacy practice, (2) development of an updated audit tool using data from the retrospective analysis and interviews with community pharmacists, (3) validation of the audit tool by eight auditors from the Malta Medicines Authority and two community pharmacists, (4) implementation of the audit tool in routine CPRAs, (5) identifying desirable patientrelated improvements through observation, and (6) engaging in informal educational discussions with the practicing pharmacists during CPRAs. Case studies on deficiencies related to patient safety were identified and evaluated. Dossiers, European Public Assessment Reports and consultation with the Marketing Authorisation Holders were sources that provided the background for the case studies analysis. A total of 512 CPRA reports for a 57-month period (January 2012-September 2016) were analysed. Interviews with 12 community pharmacists were performed extracting 14 patient-focused recommendations. The audit tool was implemented during CPRAs in 85 pharmacies over an 11-month period (January-November 2017). Seven case studies were evaluated and analysed including 4 dispensing problems (errors, near misses, lack of proper prescription, unsupervised pharmacy staff), 2 inventory deficiencies (expired items, inappropriate storage temperature) and 1 inequity of treatment between private and government-sponsored patients. Concordance with the pharmacist was reached and actions (N=46) with a patient-centred focus were taken to address the identified deficiencies. Standard operating procedures were developed, such as for temperature recording and for referral of patients to the pharmacist for ailments requiring medicines. Methods for alerts were devised and communication with patients, including when a possible error is detected, were identified. An educational approach by the auditor in CPRAs, reaching concordance to regulation as distinct to forceful compliance, may improve pharmacist motivation and patient care outcomes. ; N/A

Cover -- Title -- Biblography -- End User License Agreement -- Contents -- Preface -- List of Contributors -- Introduction -- Juan A. Sanchez and Robert S.D. Higgins* -- CONSENT FOR PUBLICATION -- CONFLICT OF INTEREST -- ACKNOWLEDGEMENTS -- REFERENCES -- The Organ Allocation System -- Karen Kennedy* and Charles Alexander -- INTRODUCTION -- Legislative, Regulatory and Accreditation History Highlights -- Uniform Anatomical Gift Act -- Organ Procurement Organization Accreditation Program -- Organ Donor Clinical Processes -- Referral and Evaluation -- Authorization Processes -- Clinical Donor Management -- Donor Management Priorities -- Organ Allocation Overview -- Heart and Lung Wait Lists and Allocation: Excerpts from UNOS Policies 6, 10 [2] -- Liver Wait List and Allocation: Excerpts from UNOS Policy 9 [2] -- Intestine Allocation Algorithm: Excerpts from UNOS Policy 7 [2] -- Geographic Location [2] -- Medical Urgency [2] -- Additional Considerations -- Kidney Wait List and Allocation: Excerpts from UNOS Policy 8 [2] -- KDPI Score [2] -- EPTS Score [2] -- CPRA Percentage [2] -- KAS System [2] -- Kidney Allocation Points Score [2] -- Antigen Mismatch [2] -- Geographic Proximity -- Double Kidney Allocation [2] -- Pancreas Wait List and Allocation: Excerpts from UNOS Policy 11 [2] -- CPRA Percentage [2] -- Antigen Mismatch [2] -- Geographic Proximity and Waiting Time -- Kidney - Pancreas Allocation: Excerpts from UNOS Policy 11 [2] -- ABO -- VCA Wait List and Allocation: Excerpts from UNOS Policy 12 [2] -- Surgical Recovery Processes -- Follow-up Activities -- CONCLUSION -- CONSENT FOR PUBLICATION -- CONFLICT OF INTEREST -- ACKNOWLEDGEMENTS -- REFERENCES -- Identification of the Brain Dead Donor -- Justin Zamoyski and Diana Greene-Chandos* -- INTRODUCTION -- PATHOLOGY AND PHYSIOLOGY -- PREPARATION FOR CLINICAL EXAM -- Coma -- Neuroimaging Correlates

A
little-noticed act from last year has helped to facilitate Republican Gov. Jeff Landry's
request to increase efficiency in how Louisiana handles its natural resources, including
the possibility that tens of billions of dollars will be spent more wisely over
the coming decades.

The new law changed, as of last
month, the name of the Department of Energy and Natural Resources by adding the
"Energy" designation. It also added some structure to it that will provide some
guardrails for a request by executive
order Landry made last week to reorganize natural resources functions from
three separate affiliated agencies and over a dozen independent commissions
into the defined functions of the department.

This law empowers Landry to solicit changes from
the department, with the first report due at the end of the month and all
wrapped up by the end of July. Likely some legislation will come forth concerning
this for the year's regular legislative session to begin Mar. 11 and to end
Jun. 3. Likely many of the entities listed in the order will be folded into
DENR management, the new law and text of the order suggests.

Output from the reports could improve administration
in a number of ways. For example, largely useless entities like the Climate
Initiatives Task Force, which produced
little in value and mostly poor policy recommendations with little scientific
merit while heavily politicized, can
be put out of its misery welcomed by citizens and taxpayers.

Other functions could benefit from streamlining.
The entities involved are governed by boards that, at best, could be made entirely
advisory, or perhaps eliminated entirely. One of the most prominent is the State Mineral and Energy
Board, whose main functions involved leasing of state lands for oil and gas
development, transferring those leases, and managing activity on others. Most
of its 11 members are appointed by the governor with Senate confirmation (the
governor and secretary, or their designees, also are members), required only to
have some connection to the energy industry, and who serve concurrently with
the governor. It uses DENR resources to do its job.

Landry hasn't made membership changes to that, perhaps
because it may face a radical overhaul as a result of his order. The majority
of states conduct these affairs within their DENR-equivalent agencies, although
some follow Louisiana's model in having appointed boards – even as often
representatives of government agencies solely comprise or make up the majority
of members – and a very few, including the large producing states of Oklahoma
and Texas, elect members. It would make more sense for the secretary, whose
department already determines tracts to be leased or transferred and
recommended parameters pertaining to that, to decide on deals and other matters
rather than political appointees.

Yet the biggest impact to the state and its
taxpayers that could come from these changes would be the consolidation of the
Coastal Protection and Restoration Authority into DENR. At present, CPRA exists
as an arm of the Governor's
Office of Coastal Activities that provides for CPRA administrative leadership.
Its board, comprised of appointees from various statewide elected and cabinet
officers and the Legislature plus regional planning agencies, provides for the
planning and execution of the coastal master plan, last updated in 2023, and
the annual plans derived from it, along with general oversight of protection and
restoration projects undertaken through CPRA.

Unfortunately, this structure has proven itself
susceptible to an ethos of climate alarmism, as
evidenced in the last two master plans. Regrettably, in formulating funding
priorities totaling $50 billion the reports rely upon the most pessimistic scenarios
driven by alarmist-based models, not by actual science. This approach can distort
the projects chosen and their priorities, risking the spending of billions on
things low in actual priority or even unnecessary while neglecting projects with
higher real payoffs, to the detriment of industry, residents, and taxpayers.

Folding governance of CPRA into DENR certainly
could encourage following the science to a higher degree and dispensing with
politicized fad and fashion that currently influences project choice, priority,
and spending decisions, both in sorting out the annual plan and in construction
of the next master plan due by 2028. The current model with its track record of
not preventing bad assumptions behind projects forwarded to the Legislature for
funding argues that a fresh approach only can improve matters, much
as this displeases the politics-as-usual crowd.

Landry is right to pursue these reforms that promise
better performance for fewer dollars. The sooner his administration can formulate
these and the Legislature acts upon them, the better for Louisiana.