Social Welfare under Authoritarian Rule: Change and Path Dependence in the Social Welfare System in Mubarak's Egypt

This thesis is an attempt to answer the following question: how and why was the social welfare system in Egypt altered under the government of Hosni Mubarak (1981-2011)? Literatures on the determinants, objectives and structures of social welfare regimes predominantly assume democratic systems of government. They claim that the political influence of organised labour is the most important driving force for the expansion of social welfare systems. This driving force is effective only in open, democratic political arena. This thesis therefore argues that the case of Egypt requires us to consider social welfare regimes within the context of authoritarian resilience. According to this corpus of work, institutional change under authoritarian regimes can best be explained as a product of government survival strategies, strategies which seek to maximise the interests of the ruling elite, especially their political leaders (rather than the political influence of organised labour which drives social welfare systems in democratic countries). Although the ruling elite under authoritarian rule use social welfare systems in their survival strategies, the strategies differ in their context or ideology. Egypt’s first President, Gamal Abdul Nasser, designed and introduced a social welfare system which supported his primary goal of industrialisation. The income-redistribution aspects of his social welfare system were designed to mobilise popular political support for his regime from the middle and low-income classes, especially urban workers. His successor, Anwar al Sadat, relied still further on the income-redistribution function of the social welfare system, as a means of partially compensating those elements of society which could be considered ‘losers’ from his policy of economic opening (infitah). Whereas his policies expanded the economic base of regime support from the working class and the public sector to the growing business elites, he fortunately obtained several external resources, such as economic aid (from the United States, in particular), fees from the Suez Canal and oil exports. By exploiting these resources as sources to expand the social welfare system, Sadat was able to compensate the ‘losers’ and to maintain political legitimacy with these lower classes through welfare re-distribution instruments. His strategy strengthened the populist feature of the social welfare system. This thesis argues that change in the social welfare system during the Mubarak era was bounded by the logic of the ‘social contract’, which was reinforced by the expansion of populist welfare provision during the Sadat era. Sadat’s strategy led to fiscal deficit and prevented economic growth in the Mubarak era. Rationalisation of the programmes was indeed advocated by the international financial institutions and the Mubarak government did appear to initiate reforms. However, when looked at closely, the thesis reveals that these reforms did not result in significant reductions in government expenditures on social welfare as was supposedly intended. Despite a decline in external resources, the regime maintained expenditures, ‘thinning’ out the benefits of the welfare system where it could, but never fully engaging in deep structural reform. Mubarak’s government was caught in an unresolvable dilemma. Economic liberalisation in general created a new alliance between the ruling elite and the growing class of businessmen. However, the authoritarian regime still relied on a legacy of claims to redistributive justice for its legitimacy. As a decline in external resources cut away the regime’s capacity to deliver this through structural aspects of the economy, the regime increasingly relied on social welfare programmes to alleviate poverty and assuage political grievances. Regime fear of direct political protests increasingly drove social welfare policy, with the regime compensating for the effects of liberalisation in one side of the economy by spending money it could ill afford in another. The strategy was itself a fundamental contradiction and inherently unsustainable. As a result, a decline in distributive resources revealed a failure in the social welfare system – enduring fiscal misallocation and neglecting social problems (such as poverty and unemployment)

How should cardiac xenotransplantation be initiated in Japan?

The version of record of this article, first published in Surgery Today, is available online at Publisher’s website: https://doi.org/10.1007/s00595-024-02861-7.The world's first clinical cardiac xenotransplantation, using a genetically engineered pig heart with 10 gene modifications, prolonged the life of a 57-year-old man with no other life-saving options, by 60 days. It is foreseeable that xenotransplantation will be introduced in clinical practice in the United States. However, little clinical or regulatory progress has been made in the field of xenotransplantation in Japan in recent years. Japan seems to be heading toward a "device lag", and the over-importation of medical devices and technology in the medical field is becoming problematic. In this review, we discuss the concept of pig-heart xenotransplantation, including the pathobiological aspects related to immune rejection, coagulation dysregulation, and detrimental heart overgrowth, as well as genetic modification strategies in pigs to prevent or minimize these problems. Moreover, we summarize the necessity for and current status of xenotransplantation worldwide, and future prospects in Japan, with the aim of initiating xenotransplantation in Japan using genetically modified pigs without a global delay. It is imperative that this study prompts the initiation of preclinical xenotransplantation research using non-human primates and leads to clinical studies

Endoscopic Laryngeal Findings in Japanese Patients with Laryngopharyngeal Reflux Symptoms

Objective. To know the characteristics of endoscopic laryngeal and pharyngeal abnormalities in Japanese patients with laryngopharyngeal reflux symptoms (LPRS). Methods. A total of 146 endoscopic images of the larynx and pharynx (60 pairs for the rabeprazole group and 13 pairs for the control group) were presented to 15 otolaryngologists blinded to patient information and were scored according to several variables potentially associated with laryngopharyngeal reflux. The median value of the 15 scores for each item from each image was obtained. The mean pretreatment scores of each item and total score were assessed in both rabeprazole and control groups. In the rabeprazole group, the endoscopic findings before and after the 4-week treatment with rabeprazole were compared. Changes between corresponding duration in the control group were also evaluated. Results. The median and mean pretreatment total score was 3 and 3.02, respectively, from the 73 patients with LPRS. No significant differences were observed before and after treatment in either the rabeprazole or control groups for any item or total score. In 24 patients with a high pretreatment score (total score ≥ 4) from the rabeprazole group, significant decreases in scores for “thick endolaryngeal mucous” (0.54 to 0.17, P = 0.017) and total (4.77 to 3.58, P = 0.0003) were observed after the 4-week treatment

Cost Analysis of Screening for IgA Nephropathy Using Novel Biomarkers

[Objectives] IgA nephropathy (IgAN) is the most common primary chronic glomerulonephritis and a major cause of end-stage kidney disease worldwide. Novel biomarkers, including the aberrantly glycosylated IgA1 and glycan-specific antibodies, could be useful in the diagnosis of IgAN. The aim of this study was to assess the cost analysis of IgAN screening using novel biomarkers in addition to the conventional screening compared with conventional screening alone. [Methods] To estimate the medical expense of each strategy related to renal disease for 40 years, we developed an analytical decision model. The decision tree started at “40 years of age with first-time hematuria.” It simulated 2 clinical strategies: IgAN screening using the novel biomarkers (group N) and conventional screening (group C). The analysis results were presented as medical expenses from a societal perspective. Discounting was not conducted. [Results] The expected medical expense per person for 40 years was ¥31.2 million (~$291 000) in group N and ¥33.4 million (~$312 000) in group C; hence, expense in group N was lower by ¥2.2 million (~$21 000). In group N, the expected value of IgAN increased by 5.67% points (N 48.44%, C 42.77%) and that of dialysis introduction decreased by 0.85% points (N 19.06%, C 19.91%). In the sensitivity analysis, expenses could be reduced in almost all cases except when renal biopsy using conventional screening was performed at the rate of 73% or higher. [Conclusion] Screening for IgAN using novel biomarkers would reduce renal disease–related expenses