“A Free-Range Chicken that Can Run Wherever the Majority Wants It To”: Budget Reconciliation and the Contemporary U.S. Senate

Since its early uses in the early 1980s, the budget reconciliation process has played an important role in how the U.S. Congress legislates. Because the procedures protect certain legislation from a filibuster in the Senate, the reconciliation rules both shape, and are shaped by, the upper chamber in significant ways. After providing a brief overview of the process, I discuss first how partisanship in the Senate has affected the use of the reconciliation procedures. Next, I describe two sets of consequences of the contemporary reconciliation process, on negotiation and on policy design. I conclude with some observations about the relationship of reconciliation to the prospects for broader procedural change in the Senate.

ARCHITECTURAL HERITAGE IN THE CITY OF ‎NAZNRETH DURING THE OTTOMAN ERA 1517-‎‎1918‎

This study aims to show the urban aspects of the ‎Nazareth during the Ottoman era 1517 – 1918 in the ‎light of the Ottoman documents and the drawings and ‎pictures of European travelers and its role in its ‎transformation from a small village to an urban city and ‎then a district center. And learn about the interest that ‎the city of Nazareth purified from the Ottoman ‎government in this field. And that is through studying ‎the urban monuments in the city, such as: the houses, ‎Islamic and Christian religious places, the Saraiya, the ‎markets, the khans, Mary's well.‎ It began with a discussion of historical geography, and I ‎presented the descriptions of Arab and European ‎travelers to Nazareth, then the study touched on the ‎presentation of the architectural style in the city of ‎Nazareth, the presentation of the survey and ‎reconciliation process for some historical monuments in ‎Nazareth, and finally the conclusion.

Different Voices and Luminosities

The author of this article will put an emphasis on museum practices that have encouraged the reconciliation process and dialogue in Bosnia and Herzegovina and the Western Balkans. Moreover, this article will contribute to the ongoing discussions in museum and cultural studies expressing the need for reconsidering the values and roles of museum practices. It is about the comprehensive range of innovative approaches that can foster dialogue and reconciliation processes in the context of today’s Western Balkans societies, which are marked by distrust, prejudices, misunderstandings and numerous divisions and indoctrinations. This will be an attempt to verify two clear examples of museum practices emphasising the specific thesis about museums as the ‘new educational institutions’, their comprehensive and alternative roles in the construction of ‘new knowledge’ nurturing dialogue, intercultural interactions and exchange of opinions, ideas and experiences. The main question is whether this concept is sustainable and broadly possible in Bosnia and Herzegovina and the Western Balkans, due to the lack of cultural policy and political consensus that will support this indispensable process.

Value of pharmacy services upon admission to an orthopedic surgery unit

Background In Lebanon, the role of the pharmacist remains underestimated in the medication reconciliation process, especially in surgical departments. This study aims to assess the impact of pharmacist-conducted medication reconciliation performed within 48 h of hospital admission to the orthopedic surgical department. Methods This was a prospective single-arm study conducted in a tertiary-care teaching hospital in Lebanon between October 2019 and April 2020. Participants were adult inpatients hospitalized for orthopedic surgeries with ≥ 1 outpatient medications. Properly trained pharmacy resident obtained the Best Possible Medication History (BPMH) and led the reconciliation process. The primary endpoint was the number of reconciliation errors (REs) identified. Descriptive statistics were used to report participants’ responses and relevant findings. Linear regression was performed with the number of REs as a continuous dependent variable using backward method. Results were assumed to be significant when p was < 0.05. Results The study included 100 patients with a mean age of 73.8 years, admitted for elective (54%) or emergency (46%) surgeries. Half of the study population had ≥ 5 home medications. The mean time for taking BPMH was around 8 min. A total of 110 REs were identified in 74 patient cases. The most common discrepancies consisted of medication omission (89.1%) and the most common medications involved were antihyperlipidemic agents. Twenty-four REs were judged as clinically significant, and four as serious. The most common interventions included the addition of a medication (71.9%). Most of the relayed interventions (84.5%) were accepted. The number of home medications was the only variable significantly associated with the number of REs (β 0.492; p < 0.001). Conclusion Pharmacy-led medication reconciliation upon admission to orthopedic surgery department can reduce reconciliation errors and improve medication safety. Trial registration Retrospectively registered in the Lebanon Clinical Trials Registry (LBCTR2020124680).

Quality improvement and reconciliation process for automated dispensing cabinet medication overrides

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To describe a pharmacist-led reconciliation process for automated dispensing cabinet (ADC) medication override setting maintenance at an academic medical center. Summary ADC override management requires alignment of people, processes, and technology. This evaluation describes system-wide improvements to enhance institutional medication override policy compliance by establishing a formalized evaluation and defined roles to streamline ADC dispense setting management. A pharmacist-led quality improvement initiative revised the institutional medication override list to improve medication dispensing practices across an academic medical center campus with a pediatric hospital and 2 adult hospitals. This initiative included removal of patient care unit designations from the medication override list, revision of institutional override policy, creation of an online submission form, and selection of ADC override metrics for surveillance. A conceptual framework guided decisions for unique dosage forms and interdisciplinary engagement. Employing this framework revised workflows for stakeholders in the medication-use process through clinical pharmacist evaluation, existing shared governance structure communication, and pharmacy automation support. The revised policy increased the number of medications available for override from 80 to 106 (33% increase) and unique dosage forms from 166 to 191 (15% increase). The total number of medication dispense settings was reduced from 5,600 to 541 (90% decrease). The proportion of override dispenses compliant with policy increased from 59% to 98% (P &lt; 0.001). Median monthly ADC overrides remained unchanged following policy revision (P = 0.995). ADC override rate reduction was observed across the institution, with the rate decreasing from 1.4% to 1.2% (P &lt; 0.001). Similar ADC override rate reductions were observed for adult, pediatric, and emergency department ADCs. Conclusion This initiative highlights pharmacists’ role in leading institutional policy changes that influence the medication-use process through ADC dispensing practices. A pharmacist-led reconciliation process that removed practice area designations from our medication override policy streamlined ADC setting maintenance, increased the compliance rate of ADC override transactions, and provided a formalized process for future evaluation of medication overrides.

Unconventional reconciliation path for quantum mechanics and general relativity

Physics in general is successfully governed by quantum mechanics at the microscale and principles of relativity at the macroscale. Any attempts to unify them using conventional methods have somewhat remained elusive for nearly a century up to the present stage. Here in this study, a classical gedanken experiment of electron-wave diffraction of a single slit is intuitively examined for its quantized states. A unidirectional monopole (MP) field as quanta of the electric field is pictorially conceptualized into 4D space-time. Its application towards quantum mechanics and general relativity in accordance with existing knowledge in physics paves an alternative path towards their reconciliation process. This assumes a multiverse at a hierarchy of scales with Einstein’s gravity defined to be of circular acceleration in time reversal mode within an MP field precessing into forward time for a rotating body into space. Such descriptions also provide an approximate intuitive tool to examine physics in general from alternative perspectives using conventional methods and this warrants further investigations.