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Geopolitical competition is increasingly playing out in the space beyond diplomacy and short of conventional war, sometimes referred to as the gray zone, which is forcing the United States to confront the liabilities of its strengths. This report assesses current U.S. government actions to deter, campaign through, and respond to competitors’ gray zone tactics. Using the campaign planning framework established in By Other Means Part I, it also provides recommendations aimed at ameliorating U.S. liabilities and building on its asymmetries to improve U.S. national security in the presence of rivals’ gray zone approaches.
The United States is being confronted by the liabilities of its strength. Competitors are finding avenues for threatening U.S. interests without triggering escalation. Their approaches lie in the contested arena between routine statecraft and open warfare—the "gray zone." The United States has yet to articulate a comprehensive approach to deterring competitors in the gray zone. A concrete and actionable campaign plan is needed to deal with the gray zone challenge; in order to do so, the United States must identify and employ a broad spectrum of tools and concepts to deter, and if needed, to compete and win contestations in the gray zone.
Special edition of the Federal Register, containing a codification of documents of general applicability and future effect ... with ancillaries.
Policymakers and program managers are continually seeking ways to improve accountability in achieving an entity's mission. A key factor in improving accountability in achieving an entity's mission is to implement an effective internal control system. An effective internal control system helps an entity adapt to shifting environments, evolving demands, changing risks, and new priorities. As programs change and entities strive to improve operational processes and implement new technology, management continually evaluates its internal control system so that it is effective and updated when necessary. Section 3512 (c) and (d) of Title 31 of the United States Code (commonly known as the Federal Managers' Financial Integrity Act (FMFIA)) requires the Comptroller General to issue standards for internal control in the federal government.
Advances in medical, biomedical and health services research have reduced the level of uncertainty in clinical practice. Clinical practice guidelines (CPGs) complement this progress by establishing standards of care backed by strong scientific evidence. CPGs are statements that include recommendations intended to optimize patient care. These statements are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options. Clinical Practice Guidelines We Can Trust examines the current state of clinical practice guidelines and how they can be improved to enhance healthcare quality and patient outcomes. Clinical practice guidelines now are ubiquitous in our healthcare system. The Guidelines International Network (GIN) database currently lists more than 3,700 guidelines from 39 countries. Developing guidelines presents a number of challenges including lack of transparent methodological practices, difficulty reconciling conflicting guidelines, and conflicts of interest. Clinical Practice Guidelines We Can Trust explores questions surrounding the quality of CPG development processes and the establishment of standards. It proposes eight standards for developing trustworthy clinical practice guidelines emphasizing transparency; management of conflict of interest ; systematic review-guideline development intersection; establishing evidence foundations for and rating strength of guideline recommendations; articulation of recommendations; external review; and updating. Clinical Practice Guidelines We Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care. This book contains information directly related to the work of the Agency for Healthcare Research and Quality (AHRQ), as well as various Congressional staff and policymakers. It is a vital resource for medical specialty societies, disease advocacy groups, health professionals, private and international organizations that develop or use clinical practice guidelines, consumers, clinicians, and payers.