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Advancing clinical research accessibility is at the core of NIHR Great Ormond Street Hospital (GOSH) Clinical Research Facility (CRF)’s strategic priorities. However, traditional research methodologies and models often create significant barriers to patient engagement and participation. In response to this challenge, our CRF has embraced decentralised clinical trials (DCT) model to break down these barriers and enhance equitable access to research.Some or all trial activities in a DCT not only occur at locations other than sites but also by non-site providers or instruments such as homecare nurses, telephone visits, wearable technology devices, and participants themselves. Using DCT model, NIHR-GOSH-CRF have successfully increased patient access, reach, and diversity, thereby minimising inequality, and fostered inclusivity in research participation. By decentralising trial activities, we have alleviated patient burdens associated with travel time, time off work and/or school or college, and logistical challenges, making participation more feasible and convenient for both patients and our site.Moreover, this model has enabled our CRF teams to optimise their time, allowing them to concentrate on critical patient interactions and enhancing the overall quality of care provided during the research process. For example, GOSHLink facilitated remote independent trials monitoring significantly cut staff time spent on organising and conducting monitoring visits when compared to previous processes.We continue to replicate this model within other research operation areas, such as site file maintenance and self-dosing to empower our teams, best manage resources, and improve efficiency. This positions our CRF at the forefront of promoting accessibility for the benefit of all.Abstract 88 Figure 1Acknowledgements for Funding or Support This work is supported by the Joint R&D and NIHR GOSH CRF. The views expressed are those of the author(s) and not necessarily those of the NHS, UCL, the NIHR or the Department of Health.

Seeks to develop understanding of the notion of multi‐level governance through a critical exploration of its definitions and applications by scholars with very different concerns within the broad discipline of Political Studies. Despite the different concerns of different authors, four common strands emerge that provide a parsimonious definition of multi‐level governance that raises clear hypotheses for future research. First, that decision‐making at various territorial levels is characterized by the increased participation of non‐state actors. Second, that the identification of discrete or nested territorial levels of decision‐making is becoming more difficult in the context of complex overlapping networks. Third, that in this changing context, the role of the state is being transformed as state actors develop new strategies of coordination, steering and networking that may protect and, in some cases, enhance state autonomy. Fourth, that in this changing context, the nature of democratic accountability has been challenged and need to be rethought or at least reviewed. The book concludes that future research on multi‐level governance should pay particular attention to the implications for democracy of empirical developments and, related to this, to the design of frameworks of accountability that adopt a positive‐sum gain in relation to the accountability versus efficiency debate.

This paper examines the process of decentralization and district level decentralization programs in the Amhara region. It addresses the decentralization processes in Imperial, Derg, and EPRDF regimes. The depth and degree of decentralization in the three consecutive regimes were different as the process of decentralization in the current government meant to be deeper and extensive and pushed powers, functions, and roles into the local government. The process of decentralization in the current government has transferred powers and functions to the districts. However, the district level decentralization process has faced many challenges. The paper revealed that unclear assignments of powers and functions, executive dominations, upward accountabilities, top-down planning, lack of skilled manpower, lack participatory systems, failure of the councils in holding the executive accountable, lack of adequate budget, lack of revenue mobilization capacity, lack of responsiveness, and accountability among councils were the main challenges that impede in the process of the DLD process.

How did today's rich states first establish modern fiscal systems? To answer this question, Political Transformations and Public Finances by Mark Dincecco examines the evolution of political regimes and public finances in Europe over the long term. The book argues that the emergence of efficient fiscal institutions was the result of two fundamental political transformations that resolved long-standing problems of fiscal fragmentation and absolutism. States gained tax force through fiscal centralization and restricted ruler power through parliamentary limits, which enabled them to gather large tax revenues and channel funds toward public services with positive economic benefits. Using a novel combination of descriptive, case study and statistical methods, the book pursues this argument through a systematic investigation of a new panel database that spans eleven countries and four centuries. The book's findings are significant for our understanding of economic history and have important consequences for current policy debates.

In the last two decades of the twentieth century, many countries in Latin America freed themselves from the burden of their authoritarian pasts and developed democratic political systems. At the same time, they began a process of shifting many governmental responsibilities from the national to the state and local levels. Much has been written about how decentralization has fostered democratization, but informal power relationships inherited from the past have complicated the ways in which citizens voice their concerns and have undermined the accountability of elected officials. In this book, Andrew Selee seeks to illuminate the complex linkages between informal and formal power by comparing how they worked in three Mexican cities. The process of decentralization is shown to have been intermediated by existing spheres of political influence, which in turn helped determine how much the institution of multiparty democracy in the country could succeed in bringing democracy “closer to home.”

The decentralised provision of social services raises concerns about cn'ailability of sendees in different geographical areas, particularly in low- and middleincome countries with weak governance and fiscal redistributive capacities. Yet the interconnection of different decentralisation regimes and territorial inequalities in the provision of social services remains underexplored. This article engages with one aspect of this puzzle, the implications of the fiscal conditions on exacerbating (or overcoming) territorial inequalities in services provision. Using the Croatian system of early childhood education and care (data for the 2005-2018 period) as an empirical lens, the article shows that in the absence of a well-established policy andfiscal framework sensitive to regional inequalities in administrative and fiscal capacities, decentralised systems can only institutionalise territorial inequalities in services provision. Next to the legal entitlement to a certain service, inter-territorial fiscal equalisation policies are crucial in overcoming fragmentation in social rights along territorial lines.

All societies face a key question: how to empower governments to perform essential governmental functions while constraining the arbitrary exercise of power. This balance, always in flux, is particularly fluid in today's China. This insightful book examines the changing relationship between that state and its society, as demonstrated by numerous experiments in governance at subnational levels, and explores the implications for China's future political trajectory. Ann Florini, Hairong Lai, and Yeling Tan set their analysis at the level of townships and counties, investigating the striking diversity of China's exploration into different governance tools and comparing these experiments with developments and debates elsewhere in the world. China Experiments draws on multiple cases of innovation to show how local authorities are breaking down traditional models of governance in responding to the challenges posed by the rapid transformations taking place across China's economy and society. The book thus differs from others on China that focus on dynamics taking place at the elite level in Beijing, and is unique in its broad but detailed, empirically grounded analysis. The introduction examines China's changing governance architecture and raises key overarching questions. It addresses the motivations behind the wide variety of experiments underway by which authorities are trying to adapt local governance structures to meet new demands. Chapters 2-5 then explore each type of innovation in detail, from administrative streamlining and elections to partnerships in civil society and transparency measures. Each chapter explains the importance of the experiment in terms of implications for governance and draws upon specific case studies. The final chapter considers what these growing numbers of experiments add up to, whether China is headed towards a stronger more resilient authoritarianism or evolving towards its own version of democracy, and suggests a series of criteria by which China's political trajectory can be assessed. Contents 1. China at a Crossroads 2. Streamlining the State 3. The Evolution of Voting Mechanisms 4. Civil Society 5. From Local Experiments to National Rules: China Lets the Sunshine In 6. Where is China Going?

As far as the Indian sub-continent is concerned local governance/panchayat has an elaborate history. The rural population have for long practiced this system of governing themselves through their representatives. The mode of working and the powers vested in the local bodies, have not been uniform throughout. The federation conferred constitutional status to the local governance bodies in 1993 and this system has progressed in an interesting way. Karnataka, a southern State in India has been ahead of time in enacting legislations dealing with local governance. Even before the amendment inserting provisions to the Constitution of India was passed, Karnataka had and was implementing extravagant laws pertaining to panchayats. Since democracy and decentralisation are closely associated with the panchayats, the idea of representation has a key role to play. The concerns with respect to involvement and influence of political parties in the local body elections are an important aspect as well. This paper ventures out to understand the panchayat system in Karnataka, pre and post the Constitutional amendment. The paper intends to throw light on the essence of the legislations relating to panchayats in Karnataka and understand the idea of democracy, representational factor and the concept of elections on a non-party basis. The researchers have keenly pondered upon the implementation of apolitical elections in Karnataka, the flaws in the proposed phenomenon. The paper also aims to look into hurdles in the way of these local bodies and propose suggestions to get over the same.   Purpose: To Analyze the panchayat system in Karnataka, both before and after the 1993 constitutional amendment. Examine the essence of Karnataka's panchayat-related legislation. Explore the concepts of democracy, representation, and non-party elections in the context of panchayats. Evaluate the implementation of non-partisan elections in Karnataka and identify potential flaws. Analyze the challenges faced by panchayats and propose solutions.   Theoretical Reference: Mainly Doctrinal research methodology. Relies on primary sources like the Indian Constitution, relevant statutes relating to panchayaths, and relevant data. Draws on secondary sources like articles and research papers.   Method: Analyzes relevant legal documents and scholarly works. Analytical Method of Study Comparative Studies in relation to various factors pertaining to the research between the three levels of Panchayat (Gram Panchayat, Taluk Panchayat and Zilla Panchayat)   Results and Conclusion: Non-partisan elections in Karnataka are largely theoretical; political parties influence local elections. Political interference hinders effective panchayat functioning. The paper likely proposes recommendations for strengthening panchayats and minimizing political influence.   Implications of Research: Provides insights into the challenges and potential of decentralized governance in India. Informs policymakers and stakeholders about improving panchayat effectiveness. May contribute to debates on non-partisan elections and local democracy.   Originality/Value: The study offers a focused analysis of Karnataka's panchayat system within a specific theoretical framework. Its findings on the limitations of non-partisan elections could be valuable for other regions considering similar approaches.

Yanis Varoufakis wrote a science fiction novel, Another Now: Dispatches from an Alternative Present, to encourage post-capitalist political projects in our so-called real world. Costa, a protagonist from the novel, invents a portal that enables communication between his universe and a parallel universe. The two universes diverged after the global financial crisis in 2008. Private money networks like Bitcoin emerged in Costa’s capitalist universe, while in the alternative universe, a post-capitalist society uses blockchain technology for “a plain vanilla public payments system”. Our essay draws a sophistic comparison between liberal-cum-libertarian blockchain narratives from our universe and the science-fictional blockchain narrative from Another Now. We distinguish tokenistic decentralisation (a liberal-cum-libertarian notion) and non-tokenistic distributism (a post-capitalist concept). Liberal-cum-libertarian narratives treat blockchain as a cause of decentralisation and self-sovereignty (individual empowerment). Varoufakis’s science-fictional narrative, by contrast, describes the use of blockchain for a distributist political cause.