Condet

Katharina M. Busl, MD

• Neurology Chief Resident
• Brigham and Women? Hospital
• Massachusetts General Hospital
• Harvard Medical School
• Boston, Massachusetts

Senior leaders ultimately are responsible for these limitations hiv infection asymptomatic albendazole 400mg without a prescription, but it is also important to acknowledge that leaders are not in complete control of outcomes and that they are constrained to make their decisions within an organizational and political system with behaviors they do not fully control hiv infection in zambia generic 400mg albendazole amex. For these reasons hiv infection symptoms in tamil purchase 400 mg albendazole with visa, good outcomes are not always the result of great decisionmaking personal hiv infection stories buy discount albendazole 400mg on-line, and bad outcomes are not always the result of flawed decisionmaking. It also is important to note that the criteria and standards for judging senior leader decisionmaking are biased toward high-profile failure and tend to shift depending on whether commentators are looking forward or backward. However, when advising on future courses of action, pundits are more likely to sympathize with the difficulty of predicting developments and assert that leaders have to adjust quickly because some assumptions always prove wrong and unexpected developments always arise. Recognizing these biases, we examined the decisionmaking process as senior leaders experienced and described it, and we assessed their national-level decisionmaking with more enduring criteria. We asked whether they had a strategy, implemented it with unified effort, and provided the means for its execution. We believe it would have been much easier for the United States to make the right decisions or recover from poor ones if these criteria were met. These national-level coordination and implementation handicaps are so serious that many senior leaders conclude the U. And while there are people who are tasked to do parts of this job, nobody brings it all together. Secretary Rumsfeld, Secretary Gates, Ambassador Neumann, Admiral Blair, Admiral Olson, and others agree and propose reforms to fix the problem. Thus, as many argue, it is imperative for rising senior leaders to understand the system we have, work within its limits, and attempt to mitigate its shortcomings. Many seem to believe the United States is too large or powerful to fail, or hope the kinds of problems identified here could be corrected with a simple change of leadership. As one expert notes, we have a pronouncement-practice gap; we promulgate strategy documents that postulate unified effort as an essential precondition for success, even though "as a government we have proven incapable of `whole of government operations. He received Presidential guidance emphasizing the need for "the closest cooperation and mutual support"339 among departments and agencies working in the field, but he was not given the means to generate it. Similarly, we intone the virtues of jointness but do not require it in the planning and execution of military operations. We have to hope they can be managed better if they are well understood by a new generation of national security leaders. In this vein, it is worthwhile enumerating some key insights from the analysis in this chapter that can assist future leaders in managing complex national security problems. General Casey correctly notes national-level decisionmaking was not as rigorous as the process military officers used, but that does not mean it is incomprehensible. Senior leaders need to study the national security system, its processes, and its strengths and weaknesses so they can better participate in the process. This suggests that departments have deep capacities to execute their core missions, but that we must recognize when a mission demands interagency collaboration and make special provisions for it. We pay so much lip service to strategy, and so readily embrace public policy documents as a substitute for strategy, that many senior leaders do not recognize its absence. Real strategy is not the result of compromise, even though its execution can involve compromise. Real strategy requires exacting depictions of the essential problem and a clear choice among competing solutions to guide means developed and employed. Not agreeing on the nature of the terrorist threat we are n 246 How System Attributes Trumped Leadership trying to defeat cripples our performance. Instead, political and organizational proclivities make this a common strategy failing. Real strategy in the current system must emerge from the minds of senior leaders who agree on its essential elements. The President and his national security staff have no greater responsibility than ensuring this happens, but busy and inexperienced Presidents and National Security Advisors overwhelmed with managing day-to-day activities often fail to perform this task. Trust must be cultivated among senior leaders because the decisionmaking environment in Washington and organizational cultures throughout the national security system militate against it.

The idea for the station had grown out of the need for a remote facility where experimental reactor designs could be tested without endangering population centers antiviral garlic 400 mg albendazole otc. There in the remoteness of southeastern Idaho anti viral sore throat cheap 400 mg albendazole with amex, the Commission would build a dozen experimental reactors over the next decade anti viral enzyme cheap 400 mg albendazole free shipping. Establishing the national testing center presented the Commission with an unusual organizational problem antiviral substance cheap 400mg albendazole free shipping. Scientists and engineers at several laboratories would at different times be proposing to build experimental reactors at Idaho. The groups which designed these reactors would have to bear the responsibility for building and operating them. At the same time, the Commission needed a local office to manage the site and coordinate activities. The functions of the Idaho office could hardly follow those prescribed for Chicago or Schenectady. Specifically he hoped to negotiate area-wide agreements with local contractors, suppliers, and labor unions. In this way he hoped to make the testing station an integral part of the community, a goal he could reach only if he had full control over all facilities on the site. Rickover fully intended-and the contract so specified-that Westinghouse would build the Mark I. The company not only would control all activities at Bettis but would also hire construction subcontractors for the Mark I facilities at Idaho. Rickover would not be able to hold Westinghouse responsible if the construction contracts were negotiated and administered by Johnston and his staff. Rickover was determined not to let Johnston disperse the responsibility he had carefully concentrated. Rickover-speaking as a Navy officer rather than a member of the division-also threatened to find another site for the Mark I. This was not a practical idea if Westinghouse was to meet the schedule for Mark I, but the threat was effective. By acting in his Navy capacity, Rickover was suggesting that he would take the matter to the Commissioners if Hafstad and Johnston did not resolve the issue, and none of the Commission staff wanted that. Thus Johnston was given theoretical authority while actual control remained in the original structure of responsibility from Hafstad to Rickover, Geiger, and Weaver. To Rickover the 119 the Structure of Responsibility titles and organization charts meant nothing; only the realities of responsibility mattered. On the technical side, he and his staff in Washington set the goals and specifications which guided the laboratory studies and development projects at Argonne, Bettis, and Knolls. Because he quickly sensed the possibilities of this arrangement, he was able to turn it to his advantage. Instead of a double infringement on his authority, the dual organization became a vehicle for unusual independence. Rickover achieved this independence, however, by avoiding routine procedures that would fix organizational patterns. In one instance he would act as a naval officer, in another as a Commission official. Another source of imprecision in organizational practice was the great variety in the groups which made up the Navy project. The organizational structure and style of Westinghouse contrasted sharply with that of General Electric. Although Argonne and Knolls were both Commission laboratories, they had few other similarities. Some of these differences were the result of varied responsibilities; others were the consequence of conditions existing at the time the Navy project was established. This diversity prevented Rickover from following any uniform or fixed pattern of organization. He passionately believed that success in building a submarine reactor lay in flexibility. He would not be committed to a fixed structure because every new situation involved a unique combination of personalities, talents, and technical considerations. Rickover himself made the decisions in the sense that he acted on all the evidence available and took personal responsibility. He did not simply ratify as administratively acceptable the proposals submitted by the contractors.

Unit 4-Subpopulation E Unit 4-subpopulation E consists of 22 hiv infection australia albendazole 400mg lowest price,278 ac (9 hiv transmission statistics canada purchase albendazole 400mg,016 ha) of marl prairie habitat in an area that lies along the eastern margin of Shark River Slough symptoms of hiv reinfection order 400mg albendazole free shipping. The area is bordered to the south by the pine rocklands of Long Pine Key and by an area dominated by dwarf cypress trees hiv infection rate in us generic albendazole 400mg fast delivery. The sawgrass marshes and deepwater slough vegetation communities of Shark River Slough comprise the western and northern boundary of the area, and the Rocky Glades comprise the eastern boundary. When sparrows were discovered in this area, they were relatively widespread (Werner 1975, p. It is centrally located among the areas supporting other subpopulations, and its central location probably plays an important role in aiding dispersal among subpopulations, particularly movements from the eastern subpopulations to the subpopulations west of Shark River Slough. Since 1997, this area has supported the second largest sparrow subpopulation, ranging from 576 to nearly 1,000 individuals in recent years (Pimm et al. The magnitude of any managed water releases is generally dampened by the time their influences reach this area. However, the proximity of this area to Shark River Slough may make the habitats and the sparrows that they support vulnerable to hydrologic effects during wet periods. The western portions of the area may become too deeply inundated to provide good habitat for sparrows under some deep water conditions. Large-scale fires may detrimentally affect this area, and there are no intervening features in the region that would aid in reducing the potential impacts on this subpopulation. The 2001 Lopez fire was a human-caused fire that affected a portion of this unit (Lockwood et al. Risk from fire may also require management in this area to prevent impacts to this large sparrow subpopulation. Its southern boundary is defined by the sparse vegetation and shallow soils of the Rocky Glades. These trees have reduced the suitability of some portions of the habitat for sparrows and have reduced the amount of contiguous open habitat. Aggressive management programs have been implemented by management agencies to address this issue, and control of woody vegetation will continue to be required. Effects of Critical Habitat Designation Section 7 Consultation Section 7 of the Act requires Federal agencies, including the Service, to ensure that actions they fund, authorize, or carry out are not likely to destroy or adversely modify critical habitat. Such alterations include, but are not limited to , alterations adversely modifying any of those physical or biological features that were the basis for determining the habitat to be critical. Section 7(a) of the Act requires Federal agencies, including the Service, to evaluate their actions with respect to any species that is proposed or listed as endangered or threatened and with respect to its critical habitat, if any is proposed or designated. If a species is listed or critical habitat is designated, section 7(a)(2) of the Act requires Federal agencies to ensure that activities they authorize, fund, or carry out are not likely to jeopardize the continued existence of such a species or to destroy or adversely modify its critical habitat. If a Federal action may affect a listed species or its critical habitat, the responsible Federal agency (action agency) must enter into consultation with us. When we issue a biological opinion concluding that a project is likely to result in jeopardy to a listed species or the destruction or adverse modification of critical habitat, we also provide reasonable and prudent alternatives to the project, if any are identifiable. Reasonable and prudent alternatives can vary from slight project modifications to extensive redesign or relocation of the project. Costs associated with implementing a reasonable and prudent alternative are similarly variable. Consequently, some Federal agencies may request reinitiation of consultation with us on actions for which formal consultation has been completed, if those actions may affect subsequently listed species or designated critical habitat or adversely modify or destroy proposed critical habitat. Federal activities that may affect the Cape Sable seaside sparrow or its designated critical habitat will require section 7 consultation under the Act. Activities on State, Tribal, local or private lands requiring a Federal permit (such as a permit from the U. Based on their limited mobility and dispersal capabilities and the presence and persistence of suitable habitat, we believe that the sparrows have occupied this locality since at least the time of listing. These same areas have remained occupied by sparrows since their discovery over 30 years ago.

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