Electoral management and the organisational determinants of electoral integrity

Achieving the ideals of electoral democracy depends on well-run elections. Persistent problems of electoral integrity in transitional and established democracies have prompted a burgeoning literature seeking to explain the determinants of electoral integrity around the world. However, the study of the organisations responsible for managing the electoral process has been limited to isolated national case studies. This article opens up an interdisciplinary and international research agenda on the global study of the organisational determinants of electoral integrity. It defines the concept of electoral management and provides a framework to understand how electoral management body (EMB) institutional design, EMB performance and electoral integrity are related. Findings from new data derived from cross-national surveys of EMBs are described, providing new insights into how elections are managed worldwide

The effects of centralising electoral management board design

The public administration of elections frequently fails. Variation in the performance of electoral management boards around the world has been demonstrated, illustrated by delays in the count, inaccurate or incomplete voter registers, or severe queues at polling stations. Centralising the management of the electoral process has often been proposed as a solution. There has been little theorisation and no empirical investigations into the effects that centralising an already decentralised system would have, however. This article addresses this lacuna by conceptualising centralisation through the literature on bureaucratic control and discretion. It then empirically investigates the effects through a case study of centralisation in two UK referendums. Semi-structured interviews were used with those who devised the policy instrument and those who were subject to it. The introduction of central directions had some of the desired effects such as producing more consistent services and eliminating errors. It also had side effects, however, such as reducing economic efficiency in some areas and overlooking local knowledge. Furthermore, the reforms caused a decline of staff morale, job satisfaction and souring of relations among stakeholder organisations. The process of making organisational change therefore warrants closer attention by policy makers and future scholarship on electoral integrity

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701