Accountability of Public Servants at the Street Level

Public servants are accountable to the public – as their name suggests. However, the question of accountability is not as clear as it seems. Public servants working at the street level of government bureaucracy enjoy discretion in the implementation of public policies (Thomann, van Engen and Tummers, J Public Adm Res Theory 28(4):583–601, 2018a). In the context of regulatory governance, policy implementers more often than not enforce regulation and hence are regulators at the street level. They use discretion to make decisions that ultimately define policies and regulation; and they do so along different reference systems (Thomann, Hupe, and Sager F, Governance 31:299–319, 2018b). Lipsky (Street-level bureaucracy: dilemmas of the individual in public services. Russell Sage Foundation, New York, 1980, 2010) famously conceptualized the resulting dilemmas for this stratum of public servants. Maynard-Moody and Musheno (J Public Adm Res Theory 10:329–358, 2000) capture the core dilemma of those public servants’ accountability when interacting with clients with the distinction between “state agents” primarily following the law and “citizen agents” first of all addressing clients’ needs. In their accountability regimes framework, Hupe and Hill (Public Adm 85:85–102, 2007) introduce profession as third key reference institution, alongside state and society. In the course of new modes of governance, in particular contexts, private actors have gained an additional role as implementation agents. Sager et al. (Public Manage Rev 16:481–502, 2014) and Thomann et al. (2018) therefore extend the accountability regimes framework with market as central in the fourth accountability regime at the street level. The chapter presents the extended accountability regimes framework, illustrates it with empirical cases, and discusses regulatory and policy implications of the accountability dilemmas of street-level implementers

Recent advances in the aetiology of adolescent idiopathic scoliosis

The aetiology of adolescent idiopathic scoliosis (AIS) is still unknown despite many years of research effort. Theories on AIS’s aetiology have included mechanical, hormonal, metabolic, neuromuscular, growth, and genetic abnormalities. Amongst these, some factors may be epiphenomena rather than the cause itself. Other factors may even contribute to curve progression, rather than curve initiation. Current views maintain that AIS is a multifactorial disease with genetic predisposing factors [Lowe et al. in J Bone Joint Surg [Am] 82:1157–1168, 2000]. With improvements in diagnostic methods, imaging and genomics, there has been considerable recent work on aetiology. This review aims to bring readers up-to-date with the latest developments in scoliosis research