Dissecting multiple accountabilities: A problem of multiple forums or of conflicting demands?

The necessity for public sector actors to manage multiple accountabilities in their work has been linked to a number of problems and failures, yet we lack an understanding of how multiple accountabilities affect the decision-making behavior of civil servants. Here we argue that the main issue is not only the existence of multiple forums as such but the presence of conflicting demands between multiple forums or within a single forum. Drawing on sociopsychological research, we develop hypotheses regarding two types of behavioral strategies (high-effort and low-effort) to cope with accountability pressures. We test this using a realistic vignette experiment on a sample of 270 Dutch regulators. Results show that both the multiplicity of forums and the conflict of demands affect the likelihood that regulators seek help and procrastinate. The main issue is the conflicting demands that have a stronger effect on behavior than forum multiplicity

Дилема со двојна дијагноза: Разоткривање на спондилодисцит и инфективен ендокардит кај пациент со замор, болка во грб и треска

Инфекциите на рбетниот столб може да се презентираат со широк спектар на клинички симптоми. Најчест симптом е болка во грбот, но невролошки дефицити не се реткост. Целта на овој труд е да се акцентира на неспецифичните симптоми на замор, грбна болка и покачена телесна температура, кои се среќаваат кај различни болести и е потребно детално испитување со цел нивно етиолошко разјаснување. Презентираме случај на 67 годишен пациент кој беше примен на одделение за неврологија поради замор, долногрбна болка, покачена телесна температура и нестабилност во одот. Беа спроведени серија на дијагностички испитувања за да се утврди точната причина. Неспецифичните симптоми на малаксаност, слабост, екцесивното ноќно потење и треска разбудија сомнеж за можно кардијално потекло. Лабораториските анализи покажаа покачени вредности на СЕ и ЦРП, а хемокултурите беа негативни. MR на Л-С рбет откри хипосигнална, делумно лобулирана промена на ниво на Л-1 прешленско тело и хетеросигнален приказ на ИВ диск. Промената би можела да одговара на состојба на спондилодисцит. ЕМНГ наодот укажува на хронична лезија на проксималниот дел од моторниот неврон. Ехокардиографијата откри дилатирана лева предкомора, со задебелен митрален залисток и присутна хиперехогена топчеста маса во предел на врвот на преден митрален куспис. Иста таква формација се прати на интравентрикуларниот септум, суспектни за ендокардијални маси и тешка митрална инсуфициенција. Спондилодисцитот е честа придружна компликација на инфективниот ендокардит, најверојатно поради хематогената дисеминација на инфективниот агенс. Затоа, во сите случаи на спондилодисцит , присуството на инфективен ендокардитис треба темелно да се испита и да се исклучи. Kлучни зборови : спондилодисцит, инфективен ендокарди

Ponovljena intravenska tromboliza kod bolesnika s recidivom ishemijskog moždanog udara – prikaz slučaja i prikaz iz literature

Background Recurrent strokes occur in 25% of the cases during the first 5 years after the initial event. Each recur- rent stroke increases the risk for severe disability and mortality. Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rtPA) is one of the therapeutic options when secondary prevention is not efficient and recurrent stroke occurs. Aim Aim of this paper is to present the first ever case of repeated IVT with rtPA in a female patient with recurrent stroke, hospitalized at the Department for Urgent Neurology, University Clinic of Neurology in Skopje, North Macedonia with a review from the literature. Case presentation A 59 years old female patient was admitted due to acute onset of motor and sensory dysphasia and right-sided hemiplegia. The symptoms occurred 1,5 hours before admission. Urgent computed tomography (CT) of the brain showed chronic cerebral infarction in the left and parietal regions, which causing traction of the left lateral ventricle. The patient experienced her first ischemic stroke 2,5 years ago and she was treated with IVT at the time. At the second hospital admission, the patient was conscious, with vital signs and urgent laboratory parameters within normal range. NIHSS score was 13 and a decision for IVT treatment was made. During the application of rtPA, her vital parameters were stable and no side effects were observed. Neurological status of the patient also improved, with NIHSS of 7 at the end of the IVT treatment. Control CT scan performed 24 hours after was without any new lesions. The patient was discharged in a stable condition, with a NIHSS of 4 and mRS of 3. Conclusion Repeated IVT in recurrent stroke is feasible and safe in carefully selected patients. Assessment of risk factors and neuroimaging are crucial when deciding on repeated IVT.Uvod Recidivi moždanih udara javljaju se u 25% slučajeva tijekom prvih 5 godina nakon inicijalnog događaja. Svaki ponovljeni moždani udar povećava rizik za težu onesposobljenost i smrtnost. Intravenska tromboliza (IVT) s rekombinantnim tkivnim aktivatorom plazminogena (rtPA) jedna je od terapijskih mogućnosti u slučajevima kada sekundarna prevencija moždanog udara nije učinkovita te nastupi recidiv moždanog udara. Prikaz slučaja Predstavljamo prvi slučaj na našoj klinici s recidivom moždanim udarom liječenim ponovljenim IVT. 59-godišnja pacijentica primljena je zbog akutne pojave senzomotore disfazije i desne hemiplegije. Simptomi su se javili 1,5 sata prije prijema u bolnicu. Hitna kompjuterizirana tomografija (CT) mozga nije pokazala nove lezije, dok su se prikazale malacijske lezije u lijevoj frontalnoj i parijetalnoj regiji uzrokujući retraktilne promjene na lijevu lateralnu moždanu klijetku. Pacijentica je prvi ishemijski moždani udar doživjela prije 2,5 godine i tada je liječena IVT-om. Pri ovom prijemu u bolnicu, paci- jentica je bila pri svijesti, s vitalnim znakovima i hitnim laboratorijskim parametrima unutar normal- nih granica. NIHSS rezultat je bio 13 i donesena je odluka o IVT liječenju. Tijekom primjene rtPA, vitalni su joj parametri bili stabilni i nisu primijećene nuspojave. Neurološki status pacijenta također se poboljšao na NIHSS od 7 na kraju IVT-a. Kontrolno CT snimnanje mozga nakon 24 sata nije poka- zalo novih lezija. Pacijentica je otpušten u stabilnom stanju, s NIHSS 4 i mRS 3. Zaključak Ponovljeni IVT kod ponovljenog moždanog udara izvediv je i siguran kod pažljivo odabranih bole- snika. Procjena čimbenika rizika i nalaz neuoslikovnih metoda prikaza mozga presudni su pri odluci o ponovljenoj primjeni IVT-a

Research report: Effects of regulatory instruments and enforcement styles on citizen trust

This report presents the preliminary analysis of the six experiments on citizens’ trust conducted as part of the work package WP5. The experiments test the effects of regulatory enforcement style on citizens’ trust in both regulators and regulatees in six countries: the Netherlands, Germany, Israel, Norway, Denmark, and Belgium, and in three domains: food safety, finance, and data protection. In this document we first outline the structure and rationale of the experiments. We then report on the main analysis testing the effects of three dimensions of regulatory enforcement: formalism, coerciveness, and accommodation on citizens’ trust in regulators and regulatees in the three domains. Finally, we present a covariate analysis exploring the potential effects of a range of variables on the relationship between regulatory enforcement style and citizens’ trust. The findings show variations in the observed levels of trust: citizens’ trust in both regulatees and regulators in the three regulated sectors is the highest in the Netherlands and Norway, while the lowest in Israel. Regulators are consistently seen as more trustworthy than regulatees; and trust in the data protection and food safety sector is generally somewhat higher than trust in the finance sector. When it comes to the effects of the three dimensions of enforcement style on citizens’ trust, we observe a rather mixed picture. We find very limited evidence that the degree of formalism displayed by the regulator affects citizens’ trust in either the regulator or the regulatees. The evidence with regard to the positive effect of coerciveness on citizens’ trust is stronger in the case of regulators, but less so with regard to the regulatees. The level of accommodation affects the levels of trust in regulators and regulatees in different ways in different contexts. We find very limited evidence that enforcement in general increases trust in either regulators or regulatees. Curiously, we observe that the enforcement effects on trust are consistently stronger in the countries where the overall levels of trust are comparatively lower: Israel and Denmark. This suggests the presence of a ceiling effect. Finally, the covariate analysis indicated a consistent and positive relationship between generalized trust, preferences about (stronger) regulation, and knowledge of the work of the regulator with the levels of trust citizens place both in the regulator and the regulatees in the three investigated sectors

Research report: Citizen perceptions of regulatory instruments and enforcement styles

This report presents the data collection and preliminary analysis of the twelve focus groups on citizens’ trust in regulation, conducted as part of the TiGRE work package WP5 which focuses on regulatory instruments and enforcement styles of regulatory agencies and how they affect citizen trust in regulatory regimes. The focus groups explore citizens’ views on what constitutes a trustworthy regulator, perceptions regarding the trustworthiness of the food safety regulator, and citizens’ evaluations of particular enforcement styles in six countries: Belgium, Denmark, Germany, Israel, the Netherlands, and Norway. This data collection effort builds on the previous work in WP5, specifically, the survey experiment reported in the deliverable D5.21 , and aims to provide further insights on how citizens’ trust in regulatory agencies is shaped by the behaviours of the regulators. In this report we first discuss the rationale of the focus groups, the data collection approach, and the structure of the focus group discussions. We then present six country reports, which provide summaries of the focus group discussions in each of the six countries. Finally, we provide a preliminary comparative analysis, outlining the similarities and differences emerging from the country reports, and discuss their implications. The results show that citizens consider transparency, integrity, and expertise to be the key traits of a trustworthy regulator. The knowledge of citizens regarding the work of the food safety regulator in their country is rather limited, however, this does not appear to prevent them from placing high levels of trust in its work. When it comes to specific enforcement styles, it does not appear that they have a direct effect on citizens’ trust. What citizens consider to be an appropriate regulatory action in a given situation, would largely depend on the specifics of the situation

Accountable for What? The Effect of Accountability Standard Specification on Decision-Making Behavior in the Public Sector

This study investigates how civil servants’ decision-making behavior is affected by what they are held accountable for. We look into the effects of specification of the accountability standard, and analyze the behavioral changes that might arise by holding civil servants accountable for the implementation of specific rules, as opposed to more loosely defined standards, or no predefined standards at all. Drawing on existing debates in public administration, as well as on theoretical accounts from social psychology, we develop two hypotheses outlining advantages and drawbacks of moving to either side of the accountability standard specification continuum. Specifically, we hypothesize a tradeoff between decision-making effort and decision impartiality. We perform our investigation using an online vignette and a classroom experiment. The results from the investigation do not offer clear support for our expectations. The hypothesis suggesting that accountability for general standards has positive effects on decision processes in terms of effort receives some tentative support, while the one linking specific standards to decision impartiality does not. We discuss possible reasons for this outcome, and draw recommendations for further research aiming to integrate psychological insights into public accountability research

Under Watchful Eyes : Experimental Studies on Accountability and Decision-Making Behavior in the Public Sector

A myriad of effects have been attributed to the operation of accountability mechanisms in the public sector. From preventing the abuse of power to improving the effectiveness of public service provision. Many of these suggest causal chains in which accountability mechanisms are expected to stimulate specific behaviors by individuals leading to desirable outcomes in the public domain. Yet, many of these links have been assumed rather than established. This dissertation aims to develop a better understanding of the behavioral consequences of accountability mechanisms in the public sector. It does so by surveying the experimental behavioral literature on accountability, as well as through three experimental studies. These three experiments offer insights on the importance of specifying the accountability standard for public sector decision-making, the prioritization of account-holders in responding to accountability demands, as well as on the coping of public sector professionals with multiple accountabilities. These insights will help decision-makers in government and elsewhere to make evidence-based decisions to calibrate and improve existing accountability mechanisms

Under Watchful Eyes : Experimental Studies on Accountability and Decision-Making Behavior in the Public Sector

A myriad of effects have been attributed to the operation of accountability mechanisms in the public sector. From preventing the abuse of power to improving the effectiveness of public service provision. Many of these suggest causal chains in which accountability mechanisms are expected to stimulate specific behaviors by individuals leading to desirable outcomes in the public domain. Yet, many of these links have been assumed rather than established. This dissertation aims to develop a better understanding of the behavioral consequences of accountability mechanisms in the public sector. It does so by surveying the experimental behavioral literature on accountability, as well as through three experimental studies. These three experiments offer insights on the importance of specifying the accountability standard for public sector decision-making, the prioritization of account-holders in responding to accountability demands, as well as on the coping of public sector professionals with multiple accountabilities. These insights will help decision-makers in government and elsewhere to make evidence-based decisions to calibrate and improve existing accountability mechanisms