Fiscal descentralization and the quality of government: evidence from panel data

In this paper we focus on the relationship between fiscal decentralization and government quality. In a sample of 29 developing and developed countries over the period 1984-1997, fiscal decentralization has a positive effect on institutional quality but this effect diminishes as countries become wealthier. Moreover, the positive effect of fiscal decentralization on government quality is reduced by electoral and decision-making decentralization in poor and medium income countries whereas these forms of decentralization seem to improve the impact of fiscal decentralization on government quality in rich countries.Quality of government, fiscal decentralization, political decentralization, panel data

Haemodynamic optimization of cardiac resynchronization therapy

Heart failure carries a very poor prognosis, unless treated with the appropriate pharmacological agents which, have been evaluated in large randomized clinical trials and have demonstrated improvements in morbidity and mortality of this cohort of patients. A significant proportion of these patients develop conduction abnormalities involving both the atrioventricular node and also the specialised conduction tissue (bundle of His and Purkinje fibers) of the ventricular myocardium which is most commonly evidenced by the presence of a wide QRS, typically left bundle branch block. The net effect of these conduction abnormalities is inefficient filling and contraction of the left ventricle. The presence of these conduction abnormalities is an additional strong marker of poor prognosis. Over the last 15 years pacing treatments have been developed aimed at mitigating the conduction disease. Large scale randomized multicentre trials have repeatedly demonstrated the effectiveness of cardiac pacing, officially recognized as cardiac resynchronization therapy (CRT). This mode of pacing therapy has undoubtedly had a positive impact on both the morbidity and mortality of these patients. Despite the large advancement in the management of heart failure patients by pacing therapies, a significant proportion of patients (30%) being offered CRT are classed as non-responders. Many explanations have been put forward for the lack of response. The presence of scar at the pacing site with failure to capture or delayed capture of myocardium, too much left ventricular scar therefore minimal contractile response, incorrect pacing site due to often limited anatomical options of lead placement and insufficient programming i.e optimization, of pacemaker settings such as the AV and VV delay are just some of the suggested areas perceived to be responsible for the lack of patients’ response to cardiac resynchronization therapy. The effect of optimization of pacemaker settings is a field that has been investigated extensively in the last decade. Disappointingly, current methods of assessing the effect of optimization of pacemaker settings on several haemodynamic parameters, such as cardiac output and blood pressure, are marred with very poor reproducibility, so measurement of any effect of optimization is close to being meaningless. Moreover, detailed understanding of the effects of CRT on coronary physiology and cardiac mechanoenergetics is equally, disappointingly, lacking. In this thesis, I investigated the acute effects of cardiac resynchronization therapy and AV optimization on coronary physiology and cardiac mechanoenergetics. This was accomplished using very detailed and demanding series of invasive catheterization studies. I used novel analytical mathematical techniques, such as wave intensity analysis, which have been developed locally and this provided a unique insight of the important physiological entities defining coronary physiology and cardiac mechanics. I explored in detail the application and reliability of photoplethysmography as a tool for non-invasive optimization of the AV delay. Photoplethysmography has the potential of miniaturization and therefore implantation alongside pacemaker devices. I compared current optimization techniques (Echocardiography and ECG) of VV delay against beat-to-beat blood pressure using the Finometer device and defined the criteria that a technique requires if such a technique can be used meaningfully for the optimization of pacemaker settings both in clinical practice and in clinical trials. Finally, I investigated the impact of atrial pacing and heart rate on the optimal AV delay and attempted to characterize the mechanisms underlying any changes of the optimal AV delay under these varying patient and pacing states. In this thesis I found that optimization of AV delay of cardiac resynchronization therapy not only improved cardiac contraction and external cardiac work, but also cardiac relaxation and coronary blood flow, when compared against LBBB. I found that most of the increase in coronary blood flow occurred during diastole and that the predominant drive for this was ventricular microcirculatory suction as evidenced by the increased intracoronary diastolic backward-travelling decompression wave. I showed that non-invasive haemodynamic optimization using the plethysmograph signal of an inexpensive pulse oximeter is as reliable as using the Finometer. Appropriate processing of the oximetric signal improved the reproducibility of the optimal AV delay. The advantage of this technology is that it might be miniaturized and implanted to provide automated optimization. In this thesis I found that other commonly used modalities of VV optimization such as echocardiography and ECG lack internal validity as opposed to non-invasive haemodynamic optimization using blood pressure. This finding will encourage avoidance of internally invalid modalities, which may cause more harm than good. In this thesis I found that the sensed and paced optimal AV delays have, on average, a bigger difference than the one assumed by the device manufacturers and clinicians. As a significant proportion of patients will be atrially paced, especially during exercise, optimization during this mode of pacing is equally crucial as it is during atrial sensing. Finally, I found that the optimal AV delay decreases with increasing heart rate, and the slope of this is within the range of existing pacemaker algorithms used for rate adaptation of AV delay, strengthening the argument for the rate adaptation to be programmed on.Imperial Users Onl

Essays in Macroeconomics

This dissertation consists of four separate essays on macroeconomics. The first three chapters present empirical contributions that focus on quantifying the impact of various shocks using time series models frequently used in modern macroeconomics. The last chapter has a different methodological scope. It develops a novel experimental format to simulate international climate change negotiations. In the first chapter, I quantify the role of autonomous fluctuations in consumer confidence in driving business-cycle fluctuations in the United States (US). This chapter concludes that confidence shocks play only a minor role in US business-cycle fluctuations. In the second chapter, I identify the main driver of business-cycle fluctuations in six advanced economies to establish a common international pattern. I find that business-cycles in advanced economies are all alike and driven by the same type of aggregate demand shock. In the third chapter, co-authored with Larissa Schwaller, we identify monetary policy shocks to investigate the cost central banks incur when attempting to lean against housing prices or credit aggregates using their interest rate instrument. We find that the effect of such policies is limited and associated with significant real economic costs. In the fourth chapter, co-authored with Klaus Schmidt and Elisa Hofmann, we develop a novel experimental format to simulate international climate change negotiations. We compare negotiations on individual commitments, as in the Paris agreement, with negotiations on a common commitment, such as a uniform global carbon price. We find that there is a significant and positive impact on long-term emissions when negotiations focus on a uniform global carbon price

Decentralization and Governance in Europe: Evidence from Different Expenditure Components

In this article, we consider the impact of fiscal decentralization on government quality by way of disaggregated measures of the former. Specifically, we break down fiscal decentralization into sub-central expenditure on public procurement and compensation of public sector employees. We find that decentralizing public procurement is bad for government performance while the decentralization of public sector wages improves governance. We relate the negative effect to the rent-seeking activity of interest groups and the positive effect to the informational advantage of sub-central provision. Moreover, we explore the impact of the Great Recession on our results and find that it is associated with stronger negative and positive effects of decentralization on governance, something which is consistent with the observed increased in the degree of decentralization since 2007

Individualism-Collectivism, Governance and Economic Development

While an individualist society prizes personal control, autonomy and individual accomplishments, a collectivist society puts a premium on loyalty and cohesion and imposes mutual obligations in the context of in-groups. It has been argued that individualism will promote economic development directly by sharpening individual incentives to invest, innovate and accumulate wealth. In this article, I argue that the individualist-collectivist dimension can also affect development through its impact on governance. The in-group favoritism inherent to collectivist societies is likely to engender corruption, nepotism and clientelism in the public sphere. In individualist societies, the relative weakness of in-group pressures and an emphasis on personal achievement and worth will contribute towards a more meritocratic and efficient public sector. My empirical evidence confirms the strong positive relationship between individualism and government quality. Moreover, I provide robust empirical evidence showing that the expected direct positive impact of individualism on economic development disappears when additionally controlling for governance, a finding which suggests that insofar as individualism affects development it does so because it promotes good governance

A ‘Just and Lasting Solution’ to the Cyprus Problem: In Search of Institutional Viability

This paper examines the possible nature of a ‘just and lasting solution’ to the Cyprus Problem. Four factors are seen to affect the viability of a solution namely, the relative capacity of the Greek and Turkish Cypriot sides to impose costs in the event of either breaking off from inter-ethnic co-operation, the extent to which each party perceives the solution to be fair, the continuous influence of informal rules which may promote ethnic identification and finally, the judicial enforcement and legislative maintenance of the agreed solution. The discussion generates a number of insights into several aspects of the dispute including, security guarantees, territorial adjustments, the freedom of movement and establishment and the right of property, a federal versus a confederal solution and finally, the desirable nature of the constitution of a multi-ethnic Cyprus

Property rights and the Cyprus Problem: insights from economics and social psychology

The issue of property rights goes to the heart of the Cyprus problem and for this reason it has been a highly contentious one. For Greek Cypriots, respect for property is an extension of the wider demand that any solution respect basic and inviolable human rights while Turkish Cypriots see property rights strictly within the confines of “bizonality” which is interpreted to mean a restricted right of restitution of Greek Cypriot property in the north (Gürel and Özersay, 2006). In this essay I will suggest that the way property rights are eventually handled in a settlement of the Cyprus issue is likely to have a direct impact on the viability of the post-solution state of affairs for specific reasons related to perceptions of fairness

A viable solution to the Cyprus Problem in the context of European Union accession

Through its pre-accession policy for Cyprus, the European Union is seeking to contribute towards a solution to the Cyprus Problem by emphasizing the security and economic benefits that would be enjoyed by all Cypriots from EU membership and by attempting to wring concessions from both the Greek and Turkish Cypriot sides. After identifying this strategy, this paper discusses several factors that may directly affect the viability of a final solution to the Cyprus conflict namely, the perceived fairness of a solution, the presence of effective security guarantees, the effects of a wider and more competitive market, the likelihood of majority tyranny of the minority and finally, the effects of an alternative source of identity. The first and second of these factors have important implications for the EU’s pre-accession strategy while the remaining three suggest that eventual membership of the EU is likely to increase the viability of a reunified Cyprus

On the viability of potentially divided multi-ethnic states

This paper examines the viability of inter-ethnic co-operation from the perspective afforded by the economic approach to institutional analysis. Four factors are seen to affect viability namely, the relative strength of each ethnic group in the non co-operative setting, the perceived fairness of the terms of co-operation, the continuing influence of informal rules which may be inimical to co-operation and finally, the judicial enforcement and legislative maintenance of the terms of co-operation. The discussion generates a number of insights into the desirable nature of the institutions of potentially divided multi-ethnic states

Economic integration, legitimacy and European Union enlargement

The enlargement of the European Union generates socio-economic costs and benefits for the citizens of new members and as such it is bound to affect their perceived legitimacy of the whole enterprise. The legitimacy of EU accession is likely to be enhanced by the inclusion of compensatory transfers and transition periods in the terms of accession, by the perception that EU membership represents the most favorable terms of exchange available and by the linking of accession to a sustained period of economic growth, a favorable movement in prices, improving relative incomes and the consolidation of a level playing field across new members