Democratic purgatory: The failure of democracy in Venezuela

This research provides an understanding of the conditions that presage the failure of consolidated democratic political regimes through constitutional processes. In seeking to answer the question of how democracy might fail through democratic means, this study has revealed a gap in the literature on democratization. Venezuela was selected as a heuristic case study to explain this phenomenon. Heuristic case studies place less emphasis on the more configurative or descriptive elements of the case itself, and instead see the case as a point of departure for the formulations of theoretical propositions. While in-case hypotheses are possible, heuristic case studies make it an explicit research plan to tease out mechanisms that exist in a particular case study that might survive in other situations. ^ This study demonstrates that the elements in society that act as direct participants in the establishment of a democratic political system are able to maintain their position in the new order largely through an expansion of their ability to meet popular demands through clientelistic arrangements. While these corporatist groups may serve to facilitate social mobilization during the establishment of democratic regimes, they do so only in so far as they can maintain social control of in-group membership without fully providing for representative democracy. Once these democratic institutions are consolidated as key parts of the democratic structure, these corporatist arrangements provide for a type of unstable democratic purgatory: democracy is not fully representative, yet it is not completely unresponsive to the demands of the electorate. ^ The condition of democratic purgatory produces a paradox whereby democracy can be undemocratic under certain conditions. The stability of these regimes allows for democratic consolidation, despite the undemocratic basis of legitimacy. While these regimes can undergo consolidation, ultimately, this condition is unstable: either these regimes must establish an endogenous basis of political legitimacy (one that is not simply a function of the corporatist/clientelistic political structure), or the democracy will suffer a qualitative decline that may result in a democratic breakdown. Furthermore, this study finds that the viability of any type of democratic regime rests upon its adaptability to ensure adequate representativeness. ^

An experimental and theoretical analysis of nitric oxide availability in the microcirculation

Nitric Oxide (NO) is produced in the vascular endothelium where it then diffuses to the adjacent smooth muscle cells (SMC) activating agents known to regulate vascular tone. The close proximity of the site of NO production to the red blood cells (RBC) and its known fast consumption by hemoglobin, suggests that the blood will scavenge most of the NO produced. Therefore, it is unclear how NO is able to play its role in accomplishing vasodilation. Investigation of NO production and consumption rates will allow insight into this paradox. DAF-FM is a sensitive NO fluorescence probe widely used for qualitative assessment of cellular NO production. With the aid of a mathematical model of NO/DAF-FM reaction kinetics, experimental studies were conducted to calibrate the fluorescence signal showing that the slope of fluorescent intensity is proportional to [NO]2 and exhibits a saturation dependence on [DAF-FM]. In addition, experimental data exhibited a Km dependence on [NO]. This finding was incorporated into the model elucidating NO 2 as the possible activating agent of DAF-FM. A calibration procedure was formed and applied to agonist stimulated cells, providing an estimated NO release rate of 0.418 ± 0.18 pmol/cm2s. To assess NO consumption by RBCs, measurements of the rate of NO consumption in a gas stream flowing on top of an RBC solution of specified Hematocrit (Hct) was performed. The consumption rate constant (kbl)in porcine RBCs at 25°C and 45% Hct was estimated to be 3500 + 700 s-1. kbl is highly dependent on Hct and can reach up to 9900 + 4000 s-1 for 60% Hct. The nonlinear dependence of kbl on Hct suggests a predominant role for extracellular diffusion in limiting NO uptake. Further simulations showed a linear relationship between varying NO production rates and NO availability in the SMCs utilizing the estimated NO consumption rate. The corresponding SMC [NO] level for the average NO production rate estimated was approximately 15.1 nM. With the aid of experimental and theoretical methods we were able to examine the NO paradox and exhibit that endothelial derived NO is able to escape scavenging by RBCs to diffuse to the SMCs.

Essays on Competition in the Pharmaceutical Industry

Chapter 1: Patents and Entry Competition in the Pharmaceutical Industry: The Role of Marketing Exclusivity Effective patent length for innovation drugs is severely curtailed because of extensive efficacy and safety tests required for FDA approval, raising concern over adequacy of incentives for new drug development. The Hatch-Waxman Act extends patent length for new drugs by five years, but also promotes generic entry by simplifying approval procedures and granting 180-day marketing exclusivity to a first generic entrant before the patent expires. In this paper we present a dynamic model to examine the effect of marketing exclusivity. We find that marketing exclusivity may be redundant and its removal may increase generic firms' profits and social welfare. Chapter 2: Why Authorized Generics?: Theoretical and Empirical Investigations Facing generic competition, the brand-name companies some-times launch generic versions themselves called authorized generics. This practice is puzzling. If it is cannibalization, it cannot be profitable. If it is divisionalization, it should be practiced always instead of sometimes. I explain this phenomenon in terms of switching costs in a model in which the incumbent first develops a customer base to ready itself against generic competition later. I show that only sufficiently low switching costs or large market size justifies launch of AGs. I then use prescription drug data to test those results and find support. Chapter 3: The Merger Paradox and R&D Oligopoly theory says that merger is unprofitable, unless a majority of firms in industry merge. Here, we introduce R&D opportunities to resolve this so-called merger paradox. We have three results. First, when there is one R&D firm, that firm can profitably merge with any number of non-R&D firms. Second, with multiple R&D firms and multiple non-R&D firms, all R&D firms can profitably merge. Third, with two R&D firms and two non-R&D firms, each R&D firms prefer to merge with a non-R&D firm. With three or more than non-R&D firms, however, the R&D firms prefer to merge with each other.

Overweight/Obesity and HIV Disease Progression in HIV+ Adults in Botswana

Studies indicate that overweight and obesity protect against HIV-disease progression in antiretroviral therapy (ART)-naïve patients. We examined retrospectively the relationship of overweight/obesity with HIV-disease progression in ART-naïve HIV+ adults in Botswana in a case-control study with 18-month follow-up, which included 217 participants, 139 with BMI 18.0-24.9 kg/m2 and 78 with BMI ≥25 kg/m2. Archived plasma samples were used to determine inflammatory markers: leptin and bacterial endotoxin lipopolysaccharide (LPS), and genotype single nucleotide polymorphisms (SNPs) of the Fat Mass and Obesity Associated Gene (FTO). At baseline, BMI was inversely associated with risk for AIDS-defining conditions (HR=0.218; 95%CI=0.068, 0.701, P=0.011), and higher fat mass was associated with reduced risk of the combined outcome of CD4+cell count ≤250/µL and AIDS-defining conditions, whichever occurred earlier (HR=0.918; 95%CI=0.847, 0.994, P=0.036) over 18 months, adjusting for age, gender, marriage, children, and baseline CD4+cell count and HIV-viral load. FTO-SNP rs17817449 was associated with BMI (OR=1.082; 95%CI=1.001, 1.169; P=0.047). Fat mass was associated with the risk alleles of rs1121980 (OR=1.065; 95%CI=1.009, 1.125, P=0.021), rs8050136 (OR=1.078; 95%CI=1.021, 1.140; P=0.007), and rs17817449 (OR=1.086; 95%CI=1.031, 1.145; P=0.002), controlling for age, gender, tribe, total energy intake, and activity. There were no associations of SNPs with markers of disease progression. Leptin levels were positively associated with BMI (β=1.764; 95%CI=0.788, 2.739; P=0.022) and fat mass (β=0.112; 95%CI=0.090, 0.135; P<0.001), but inversely with viral load (β=-0.305; 95%CI=-0.579, -.031; P=0.030). LPS levels were inversely associated with BMI (OR=0.790, 95%CI=0.630, 0.990; P=0.041), and fat mass (OR=0.852, 95%CI=0.757, 0.958; P=0.007) and directly with viral load (OR=2.608, 95%CI=1.111, 6.124; P=0.028), adjusting for age, gender, smoking and %fat mass. In this cohort, overweight/obesity predicted slower HIV-disease progression. Obesity may confer an advantage in maintaining fat stores to support the overactive immune system. FTO-SNPs may contribute to the variation in fat mass; however, they were not associated with HIV-disease progression. Our findings suggest that the obesity paradox may be explained by the association of increased LPS with lower BMI and higher viral load; while viral load decreased with increasing leptin levels. Studies in African populations are needed to clarify whether genetic variation and inflammation mediate the obesity paradox in HIV-disease progression.

On the Threshold of Paradise and Present: Memory in Contemporary Cuban – American Literature

The exile leaving his or her homeland for new and unknown territory travels with much more than just luggage and the clothes on his or her back. He or she carries a weighty collection of memories. Available for the exile in times when the harmony of the past is far removed from the difficult circumstances present during the process of cultural assimilation, these memories present an opportunity for the exile to fashion for him or herself an identity that mimics the realities of life in the home left behind. In this creative endeavor, I seek to examine the powerful potential of memory as it is exercised by a collection of Cubans and Cuban-Americans in different corners of the United States. Analyzing Achy Obejas’ Memory Mambo, Cristina García’s Dreaming in Cuban, Ana Menéndez’s In Cuba I Was a German Shepherd, and Elías Miguel Muñoz’s Brand New Memory, I aim to trace the suggestive potential of memory as it is used by each of the characters in these works in an effort to reconcile their Cuban identities with the ones that are in the process of creation in the U.S. I will borrow from a collection of literature dealing with identity and exile, relevant graduate-level theses on Cuban-American literature, as well as theoretical perspectives on memory formation and nostalgia in order to trace the various ways in which memory is relied on in the process of cultural assimilation and emotional coping. Being presented in Miami, which hosts the largest concentration of Cuban immigrants, this thesis aims to present itself as a reflective tool for Cubans and Cuban-Americans who may find value in seeing their personal sentiments portrayed in literature, thus allowing for a potential reevaluation of identity. If the existing literature on my topic of analysis reveals anything, it is that the scope of my project is one that has not been inspected previously, thus making my analytical contribution a new one that will add a new interpretive set of lens through which readers of contemporary Cuban-American literature can examine the works.

On the Threshold of Paradise and Present: Memory in Contemporary Cuban‐American Literature

The exile leaving his or her homeland for new and unknown territory travels with much more than just luggage and the clothes on his or her back. He or she carries a weighty collection of memories. Available for the exile in times when the harmony of the past is far removed from the difficult circumstances present during the process of cultural assimilation, these memories present an opportunity for the exile to fashion for him or herself an identity that mimics the realities of life in the home left behind. In this creative endeavor, I seek to examine the powerful potential of memory as it is exercised by a collection of Cubans and Cuban-Americans in different corners of the United States. Analyzing Achy Obejas’ Memory Mambo, Cristina García’s Dreaming in Cuban, Ana Menéndez’s In Cuba I Was a German Shepherd, and Elías Miguel Muñoz’s Brand New Memory, I aim to trace the suggestive potential of memory as it is used by each of the characters in these works in an effort to reconcile their Cuban identities with the ones that are in the process of creation in the U.S. I will borrow from a collection of literature dealing with identity and exile, relevant graduate-level theses on Cuban-American literature, as well as theoretical perspectives on memory formation and nostalgia in order to trace the various ways in which memory is relied on in the process of cultural assimilation and emotional coping. Being presented in Miami, which hosts the largest concentration of Cuban immigrants, this thesis aims to present itself as a reflective tool for Cubans and Cuban-Americans who may find value in seeing their personal sentiments portrayed in literature, thus allowing for a potential reevaluation of identity. If the existing literature on my topic of analysis reveals anything, it is that the scope of my project is one that has not been inspected previously, thus making my analytical contribution a new one that will add a new interpretive set of lens through which readers of contemporary Cuban-American literature can examine the works.

Overweight/obesity and HIV disease progression in HIV+ adults in Botswana

Studies indicate that overweight and obesity protect against HIV-disease progression in antiretroviral therapy (ART)-naïve patients. We examined retrospectively the relationship of overweight/obesity with HIV-disease progression in ART-naïve HIV+ adults in Botswana in a case-control study with 18-month follow-up, which included 217 participants, 139 with BMI 18.0-24.9 kg/m 2 and 78 with BMI ≥25 kg/m2. Archived plasma samples were used to determine inflammatory markers: leptin and bacterial endotoxin lipopolysaccharide (LPS), and genotype single nucleotide polymorphisms (SNPs) of the Fat Mass and Obesity Associated Gene (FTO). ^ At baseline, BMI was inversely associated with risk for AIDS-defining conditions (HR=0.218; 95%CI=0.068, 0.701, P=0.011), and higher fat mass was associated with reduced risk of the combined outcome of CD4+cell count ≤250/µL and AIDS-defining conditions, whichever occurred earlier (HR=0.918; 95%CI=0.847, 0.994, P=0.036) over 18 months, adjusting for age, gender, marriage, children, and baseline CD4+cell count and HIV-viral load. ^ FTO-SNP rs17817449 was associated with BMI (OR=1.082; 95%CI=1.001, 1.169; P=0.047). Fat mass was associated with the risk alleles of rs1121980 (OR=1.065; 95%CI=1.009, 1.125, P=0.021), rs8050136 (OR=1.078; 95%CI=1.021, 1.140; P=0.007), and rs17817449 (OR=1.086; 95%CI=1.031, 1.145; P=0.002), controlling for age, gender, tribe, total energy intake, and activity. There were no associations of SNPs with markers of disease progression. ^ Leptin levels were positively associated with BMI (β=1.764; 95%CI=0.788, 2.739; P=0.022) and fat mass (β=0.112; 95%CI=0.090, 0.135; P<0.001), but inversely with viral load (β=-0.305; 95%CI=-0.579, -.031; P=0.030). LPS levels were inversely associated with BMI (OR=0.790, 95%CI=0.630, 0.990; P=0.041), and fat mass (OR=0.852, 95%CI=0.757, 0.958; P=0.007) and directly with viral load (OR=2.608, 95%CI=1.111, 6.124; P=0.028), adjusting for age, gender, smoking and %fat mass. ^ In this cohort, overweight/obesity predicted slower HIV-disease progression. Obesity may confer an advantage in maintaining fat stores to support the overactive immune system. FTO-SNPs may contribute to the variation in fat mass; however, they were not associated with HIV-disease progression. Our findings suggest that the obesity paradox may be explained by the association of increased LPS with lower BMI and higher viral load; while viral load decreased with increasing leptin levels. Studies in African populations are needed to clarify whether genetic variation and inflammation mediate the obesity paradox in HIV-disease progression.^

Essays on competition in the pharmaceutical industry

Chapter 1: Patents and Entry Competition in the Pharmaceutical Industry: The Role of Marketing Exclusivity. Effective patent length for innovation drugs is severely curtailed because of extensive efficacy and safety tests required for FDA approval, raising concern over adequacy of incentives for new drug development. The Hatch-Waxman Act extends patent length for new drugs by five years, but also promotes generic entry by simplifying approval procedures and granting 180-day marketing exclusivity to a first generic entrant before the patent expires. In this paper we present a dynamic model to examine the effect of marketing exclusivity. We find that marketing exclusivity may be redundant and its removal may increase generic firms' profits and social welfare. ^ Chapter 2: Why Authorized Generics?: Theoretical and Empirical Investigations Facing generic competition, the brand-name companies some-times launch generic versions themselves called authorized generics. This practice is puzzling. If it is cannibalization, it cannot be profitable. If it is divisionalization, it should be practiced always instead of sometimes. I explain this phenomenon in terms of switching costs in a model in which the incumbent first develops a customer base to ready itself against generic competition later. I show that only sufficiently low switching costs or large market size justifies launch of AGs. I then use prescription drug data to test those results and find support. ^ Chapter 3: The Merger Paradox and R&D Oligopoly theory says that merger is unprofitable, unless a majority of firms in industry merge. Here, we introduce R&D opportunities to resolve this so-called merger paradox. We have three results. First, when there is one R&D firm, that firm can profitably merge with any number of non-R&D firms. Second, with multiple R&D firms and multiple non-R&D firms, all R&D firms can profitably merge. Third, with two R&D firms and two non-R&D firms, each R&D firms prefer to merge with a non-R&D firm. With three or more than non-R&D firms, however, the R&D firms prefer to merge with each other.^