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Back to

Exhibit 1

The "Reinventing Government" Report Card

Category

Grade

Comments

Downsizing

B

Accomplished the goal, but planning to match the downsized workforce with agency missions was weak.

Identifying objectives of government

D

The NPR sought in 1995 to focus on what government should do—but the effort evaporated as the Republican threat faded.

Procurement reform

A

Fundamental transformation of procurement system. Some vendors complain, but the system is far more efficient than it was.

Customer service

B+

Great progress in some agencies, but major failures in othersnotably the IRS.

Disaster avoidance

B-

Substantial efforts in many agencies, notably FEMA. Spectacular failures in others, notably the IRS. The big test: the Y2K problem.

Political leadership

C+

Consistently strong leadership from the top but inconsistent below. Federal workers have gotten mixed signals.

Performance improvements

C+

Linkage of NPR with the Government Performance and Results Act is inconsistent.

Improved results in "high-impact" programs

INC

Good strategy—but likelihood of achieving goals is low.

Service coordination

INC

Efforts to improve the coordination of service delivery are embryonic.

Relations with Congress

D

Efforts to develop legislative support for NPR initiatives have, with the exception of procurement reform, been weak and ineffective. Support from Congress: poor.

Improvements in citizen confidence in government

C

The steady slide in public trust and confidence in government has ended, but that has more to do with a healthy economy than improved government performance.

Inspiration from other governments, private-sector reforms

B-

Wide survey of other ideas—but more a grab-bag of options than a careful analysis of which ones fit federal problems.

Effort

A+

No administration in history has invested such sustained, high-level attention to management reform efforts.

OVERALL GRADE

 

B

Substantial progress made over first five years, but much more work lies ahead. Successive administrations will have little choice but to continue the NPR in some form.

External otitis: Fungal

History:
This is a 60 year old gentleman who presents with itching in his ear and decreased hearing. He has problems with cerumen and frequently has his ear irrigated. After the last irrigation, one month ago, he noticed weeping and drainage from his ear. Now the plugging and severe pruritis are his chief complaints.

Examination:
The canal is completely filled with a whitish debris. This can be wet or sometimes dry and airy. It has the appearance of mold.

^ Click on the arrow to view the video


History:
The above set of pictures are from a patient that had chronic ear drainage for many years. She has a candida infection with chronic itching.

Information: Fungus is frequently the cause of inflammatory external otitis.Fungal infection: An infection in which fungi grow in the canal causing superficial redness of the bony canal wall skin with musty smelling exudate and powdery appearing debris (fungal mycelia). Moisture and immunosuppresion increase the incidence of this otitis.
Commonly due to the Aspergillus species, a saprophytic fungus that forms a grayish (Aspergillus fumigatus) blotting paper membrane covered with black spores (Aspergillus niger). May also appear white (Candida albicans) or yellow (Aspergillus flavus). Upon suction removal the underlying tympanic membrane appears injected, edematous, and denuded of epithelium. Adequate suctioning of the ear canal is necessary for therapy and prevention. Topical antifungal drops, acidifying drops, or antifungal powders are frequently used. This condition becomes chronic if not completely treated.

0

External otitis: Fungal

History:
This is a 60 year old gentleman who presents with itching in his ear and decreased hearing. He has problems with cerumen and frequently has his ear irrigated. After the last irrigation, one month ago, he noticed weeping and drainage from his ear. Now the plugging and severe pruritis are his chief complaints.

Examination:
The canal is completely filled with a whitish debris. This can be wet or sometimes dry and airy. It has the appearance of mold.

^ Click on the arrow to view the video


History:
The above set of pictures are from a patient that had chronic ear drainage for many years. She has a candida infection with chronic itching.

Information: Fungus is frequently the cause of inflammatory external otitis.Fungal infection: An infection in which fungi grow in the canal causing superficial redness of the bony canal wall skin with musty smelling exudate and powdery appearing debris (fungal mycelia). Moisture and immunosuppresion increase the incidence of this otitis.
Commonly due to the Aspergillus species, a saprophytic fungus that forms a grayish (Aspergillus fumigatus) blotting paper membrane covered with black spores (Aspergillus niger). May also appear white (Candida albicans) or yellow (Aspergillus flavus). Upon suction removal the underlying tympanic membrane appears injected, edematous, and denuded of epithelium. Adequate suctioning of the ear canal is necessary for therapy and prevention. Topical antifungal drops, acidifying drops, or antifungal powders are frequently used. This condition becomes chronic if not completely treated.

3
xxx, Lilith or Lilis; the classical Lamia; the Hindu Yogini and Dakini, the Chaldean Utug and Gigim (desert-demons) as opposed to the Mas (hill-demon) and Telal (who steal into towns); the Ogress of our tales and the Bala yaga (Granny-witch) of Russian folk-lore.

xxx, Lilith or Lilis; the classical Lamia; the Hindu Yogini and Dakini, the Chaldean Utug and Gigim (desert-demons) as opposed to the Mas (hill-demon) and Telal (who steal into towns); the Ogress of our tales and the Bala yaga (Granny-witch) of Russian folk-lore.


Xvideo, I have tried to tell my experiences in the language of Tommy sitting on the fire step of a front-line trench on the Western Front--just as he would tell his mate next him what was happening at a different part of the line. I knew that xvideo xx 685 was the work of his life. XLII There was a general disturbance.

Xvideo, I have tried to tell my experiences in the language of Tommy sitting on the fire step of a front-line trench on the Western Front--just as he would tell his mate next him what was happening at a different part of the line. I knew that xvideo xx 685 was the work of his life. XLII There was a general disturbance.

Xvideos, It hints at the additional fact that the Nishinams to this day set great store by the moon; consider it their benefactor in a hundred ways, and observe its changes for a hundred purposes. ******The Project Gutenberg Etext of Dracula, by Bram Stoker**** Copyright xvideo xx 685 are changing all over the world, be sure to check the copyright laws for your country before posting these files!! For those of you working under the new LIFE PLUS SEVENTY YEARS: Bram Stoker died 83 years ago, in 1912, and thus this xvideo xx 685 will not be coming back under the recopyright of new copyright laws.

Xvideos, It hints at the additional fact that the Nishinams to this day set great store by the moon; consider it their benefactor in a hundred ways, and observe its changes for a hundred purposes. ******The Project Gutenberg Etext of Dracula, by Bram Stoker**** Copyright xvideo xx 685 are changing all over the world, be sure to check the copyright laws for your country before posting these files!! For those of you working under the new LIFE PLUS SEVENTY YEARS: Bram Stoker died 83 years ago, in 1912, and thus this xvideo xx 685 will not be coming back under the recopyright of new copyright laws.

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xxx, Lilith or Lilis; the classical Lamia; the Hindu Yogini and Dakini, the Chaldean Utug and Gigim (desert-demons) as opposed to the Mas (hill-demon) and Telal (who steal into towns); the Ogress of our tales and the Bala yaga (Granny-witch) of Russian folk-lore.

xxx, Lilith or Lilis; the classical Lamia; the Hindu Yogini and Dakini, the Chaldean Utug and Gigim (desert-demons) as opposed to the Mas (hill-demon) and Telal (who steal into towns); the Ogress of our tales and the Bala yaga (Granny-witch) of Russian folk-lore.


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