The Dictator's Dilemma at the Ballot Box

Contrary to our stereotypical views, dictators often introduce elections in which they refrain from employing blatant electoral fraud. Why do electoral reforms happen in autocracies? Do these elections destabilize autocratic rule? The Dictator’s Dilemma at the Ballot Box argues that strong autocrats who can garner popular support become less dependent on coercive electioneering strategies. When autocrats fail to design elections properly, elections backfire in the form of coups, protests, and the opposition’s stunning election victories. The book’s theoretical implications are tested on a battery of cross-national analyses with newly collected data on autocratic elections and in-depth comparative case studies of the two Central Asian republics of Kazakhstan and Kyrgyzstan

Central banks and fiscal policy: why independent central banks can lead to lower fiscal deficits

Over recent decades it has become common for states in Europe and elsewhere across the world to establish independent central banks. The aim of independent central banks is typically to ensure low and stable rates of inflation, however can central bank independence also influence a state’s fiscal policy? Based on a recent study, Cristina Bodea and Masaaki Higashijima write that central bank independence can have a clear impact on fiscal policy, with democracies possessing independent central banks generally having lower fiscal deficits

The peril of parliamentarism? : executive–legislative relations and the transition to democracy from electoral authoritarian rule

Why do some electoral authoritarian regimes survive for decades while others become democracies? This article explores the impact of constitutional structures on democratic transitions from electoral authoritarianism. We argue that under electoral authoritarian regimes, parliamentary systems permit dictators to survive longer than they do in presidential systems. This is because parliamentary systems incentivize autocrats and ruling elites to engage in power sharing and thus institutionalize party organizations, and indirectly allow electoral manipulation to achieve an overwhelming victory at the ballot box, through practices such as gerrymandering and malapportionment. We test our hypothesis using a combination of cross-national statistical analysis and comparative case studies of Malaysia and the Philippines. Employing a cross-national dataset of 170 countries between 1946 and 2008, dynamic probit models provide supporting evidence that electoral authoritarianism within parliamentary systems is less likely to lead a country to democracy than within presidential systems. The results are robust to a battery of sensitivity tests, including instrumental variable estimation and additional controls. Two carefully selected case studies have been chosen for comparative analysis—Malaysia’s Barisan National (National Front) regime (1957 to present) and the Philippines's electoral authoritarian regime (1978 to 1986)—which elucidate causal mechanisms in the theory

Central Bank Independence and the Fate of Authoritarian Regimes

A large number of authoritarian regimes have reformed their central banks, increasing legal independence. Yet, it is unclear whether economic institutions – like independent central banks – can be effective in such regimes. We argue that when central bank independence overlaps with the collective decision-making in dominant-party regimes – one particular type of authoritarian ruling regime – dictators have diminished control over the central bank. Thus the central bank becomes effective enough to restrict expansionary fiscal policy, reducing the mobilization of supporters through patronage and increasing authoritarian breakdown risk. Analyses detailed in Bodea et al. (2019)4 using data from 1970 to 2012 in 94 authoritarian regimes find that high central bank independence in dominant-party regimes increases the likelihood of authoritarian breakdown. Moreover, independent central banks in dominant-party regimes contribute to lower fiscal expenditures. Our work shows that promoting central bank reforms in authoritarian regimes may lead to the expected economic effects, but the political effect of such institutions can be unexpected

Economic Institutions and Autocratic Breakdown: Monetary Constraints and Spending in Dominant-Party Regimes

In dominant party regimes, party cadres’ participation in decision-making constrains dictators from arbitrarily changing policy. Party based regimes are also better at mobilizing supporters in exchange for extensive patronage. The conventional wisdom is that these two mechanisms work together to prolong dominant party regimes. However, under certain conditions, the elite-level constraints restrict autocratic leaders’ ability to engage in patronage distribution. We focus on monetary institutions, arguing that when central bank independence overlaps with the collective decision-making in dominant party regimes, dictators have diminished control over the central bank. Thus the central bank is effective enough to restrict expansionary fiscal policy, reducing the mobilization of supporters through patronage and increasing authoritarian breakdown risk. Analyses on data from 1970 to 2012 in 94 autocracies find that high central bank independence in dominant party regimes increases the likelihood of breakdown. Moreover, independent central banks in party- based autocracies contribute to lower fiscal expenditures

Anastomotic recurrence after delta method

Delta-shaped anastomosis is nowadays an increasingly performed reconstruction method in laparoscopic distal gastrectomy for early gastric cancer. To date, anastomotic recurrence at the delta-shaped anastomotic site has not been reported. Surgery for this disease is more complicated than anastomotic recurrence at the site of conventional Billroth-I anastomosis. A 68-year-old female was referred to our institute with early gastric cancer on the posterior wall of the antrum. She underwent laparoscopic distal gastrectomy with delta-shaped Billroth-I anastomosis. Follow-up gastrofiberscopy 16 months after the operation revealed suspected anastomotic recurrence, and gastric biopsy revealed signet-ring cell carcinoma. Open total gastrectomy with reconstruction with the Roux-en-Y method was performed. At the distal part of the previous anastomosis, an adequate length of the duodenum was dissected from the pancreas. Then, the duodenum was transected 3 cm distal to the anastomosis using a linear stapler. The patient recovered well and was discharged on postoperative day 14. The patient is alive without re-recurrence 3 years postoperatively. We successfully treated a patient with anastomotic recurrence of gastric cancer after delta-shaped anastomosis. Adequate resection of the duodenal stump was performed without any residual tumor or injury to the pancreas

Pre-operative weight loss program

Background : The aim of this study was to investigate the influence of obesity and the usefulness of a pre-operative weight loss program (PWLP) for obese patients undergoing laparoscopic gastrectomy (LG) for gastric cancer (GC). Materials and Methods : Study1 : 219 patients who underwent laparoscopic distal gastrectomy (LDG) for GC were divided into 2 groups : body mass index (BMI) ≧ 28 and BMI < 28kg / m2. The influence of BMI in LG surgery was investigated. Study2 : The BMI ≧ 28 kg / m2 patients with a planned LG (n = 8) undertook a PWLP including calorie restriction and exercise. The effects of this program were evaluated. Results : Study1 : The BMI ≧ 28kg / m2 group showed significantly longer operation times, more blood loss and a higher frequency of post-operative complications than that of the BMI < 28kg / m2 group. Study 2 : The patients achieved a weight loss of 4.2%. The visceral fat area (VFA) was significantly decreased by 10.6%, whereas skeletal muscle mass was unaffected. The PWLP group showed shorter operation times, less blood loss and a lower frequency of post-operative complications compared with that of the BMI ≧ 28kg / m2 group. Conclusion : Obesity is an important risk factor and a pre-operative weight loss program is useful for obese patients undergoing a LG

The influence and countermeasure of obesity in laparoscopic colorectal resection

Background: The aim of this study was to investigate the influence of obesity and the usefulness of a preoperative weight loss program (PWLP) for obese patients undergoing laparoscopic colorectal resection (LCR). Methods: Study 1: 392 patients who underwent LCR for colorectal cancer were divided into two groups: those with a body mass index (BMI) ≥25 kg/m2 (n = 113) and those with a BMI <25 kg/m2 (n = 279). The influence of BMI on LCR was investigated. Study 2: Patients with a BMI ≥28 kg/m2 who were scheduled to undergo LCR (n = 7, mean body weight 87.0 kg, mean BMI 33.9 kg/m2) undertook a PWLP including caloric restriction and exercise for 29.6 (15–70) days. The effects of this program were evaluated. Results: Study 1: The BMI ≥25 kg/m2 group had a prolongation of operation time and hospital stay than the BMI <25 kg/m2 group. Study 2: The patients achieved a mean weight loss of 6.9% (−6.0 kg). The mean visceral fat area was significantly decreased by 18.0%, whereas the skeletal muscle mass was unaffected. The PWLP group had a significantly lower prevalence of postoperative complications compared with the BMI ≥25 kg/m2 group. Conclusion: Obesity affected the surgical outcomes in LCR. A PWLP may be useful for obese patients undergoing LCR