Reforming the Westminster Model of Agency Governance: Britain and Ireland after the Crisis

Conventional understandings of what the Westminster model implies anticipate reliance on a top-down, hierarchical approach to budgetary accountability, reinforced by a post-New Public Management emphasis on re-centralizing administrative capacity. This paper, based on a comparative analysis of the experiences of Britain and Ireland, argues that the Westminster model of bureaucratic control and oversight itself has been evolving, hastened in large part due to the global financial crisis. Governments have gained stronger controls over the structures and practices of agencies, but agencies are also key players in securing better governance outcomes. The implication is that the crisis has not seen a return to the archetypal command-and-control model, nor a wholly new implementation of negotiated European-type practices, but rather a new accountability balance between elements of the Westminster system itself that have not previously been well understood

COUNTY AND MUNICIPAL GOVERNMENTS ACCOMMODATIONS TAX GUIDELINES

These are the procedures for reporting accommodations taxes by county and municipal governments

安静時エネルギー消費量の測定に影響を及ぼす要因の検証

本研究の目的は、健康な女子大学生を対象に、特定の因子が空腹時の安静時エネルギー消費量にどの程度影響するかを検討した。特定の因子として、測定中の睡眠の影響、測定前日の夕食の食事内容の違い、前日の食事からの絶食時間の違いを検討した。その結果、1)睡眠時のエネルギー消費量は覚醒時と比較して14%低値であった。2)前日の夕食が、全員統一の決められた食事か、各自で自由に摂取した食事かの違いで、安静時エネルギー消費量に影響するとは言えない。3)前日の食事を自由に摂取した場合でも、前の夕食から13時間以上経過していれば、食事の影響が少ないエネルギー消費量値が得られる。また、脈拍の増加はエネルギー消費量に影響を与えることから、安静状態における代謝の測定時は、脈拍をモニターし安静状態であるか確認する必要がある。"The purpose of this study varidate some factors which influence to the resting energy expenditure in healthy volunteers. At some factors, we measured the difference of meal contents of the day before and fasting time. In addition, we measured the difference between sleeping time and awaking time on energy expenditure. As a result, 1) Sleeping energy expenditure was 14% lower than awaking time. 2) We could measure energy expenditure with a little influence of a meal, if it pasted 13hours fasting time. 3) It was known that energy expenditure increase according to pulse increase. For measurement of resting energy expenditure which is near to basal energy expenditure, we needed to monitor the pulse and to confirm resting condition. For more correct measure of energy expenditure, we took rest time more than 90 minutes for exclude exercise influence."原著Original国立情報学研究所で電子

Risk-adjusted cesarean section rates for the assessment of physician performance in Taiwan: a population-based study

BACKGROUND: Over the past decade, about one-third of all births nationwide in Taiwan were delivered by cesarean section (CS). Previous studies in the US and Europe have documented the need for risk adjustment for fairer comparisons among providers. In this study, we set out to determine the impact that adjustment for patient-specific risk factors has on CS among different physicians in Taiwan. METHODS: There were 172,511 live births which occurred in either hospitals or obstetrics/gynecology clinics between 1 January and 31 December 2003, and for whom birth certificate data could be linked with National Health Insurance (NHI) claims data, available as the sample for this study. Physicians were divided into four equivalent groups based upon the quartile distribution of their crude (actual) CS rates. Stepwise logistic regressions were conducted to develop a predictive model and to determine the expected (risk-adjusted) CS rate and 95% confidence interval (CI) for each physician. The actual rates were then compared with the expected CS rates to see the proportion of physicians whose actual rates were below, within, or above the predicted CI in each quartile. RESULTS: The proportion of physicians whose CS rates were above the predicted CI increased as the quartile moved to the higher level. However, more than half of the physicians whose actual rates were higher than the predicted CI were not in the highest quartile. Conversely, there were some physicians (40 of 258 physicians) in the highest quartile who were actually providing obstetric care that was appropriate to the risk. When a stricter standard was applied to the assessment of physician performance by excluding physicians in quartile 4 for predicting CS rates, as many as 60% of physicians were found to have higher CS rates than the predicted CI, and indeed, the CS rates of no physicians in either quartile 3 or quartile 4 were below the predicted CI. CONCLUSION: Overall, our study found that the comparison of unadjusted CS rates might not provide a valid reflection of the quality of obstetric care delivered by physicians, and may ultimately lead to biased judgments by purchasers. Our study has also shown that when we changed the standard of quality assessment, the evaluation results also changed