Definitive diagnosis of Craniosynostosis (CS) with computed tomography (CT) is readily available, however, exposure to ionizing radiation is often a hard stop for parents and practitioners. Lowering head CT radiation exposure helps mitigate risks and improves diagnostic utilization. The purpose of the study is to quantify radiation exposure from head CT in patients with CS using a ‘new’ (ultra-low dose) protocol; compare prior standard CT protocol; summarize published reports on cumulative radiation doses from pediatric head CT scans utilizing other low-dose protocols. A retrospective study was conducted on patients undergoing surgical correction of CS, aged less than 2 years, between August 2014 and February 2022. Cumulative effective dose (CED) in mSv was calculated, descriptive statistics were performed, and mean ± SD was reported. A literature search was conducted describing cumulative radiation exposure from head CT in pediatric patients and analyzed for ionizing radiation measurements. Forty-four patients met inclusion criteria: 17 females and 27 males. Patients who obtained head CT using the ‘New’ protocol resulted in lower CED exposure of 0.32 mSv ± 0.07 compared to the prior standard protocol at 5.25 mSv ± 2.79 (p < 0.0001). Five studies specifically investigated the reduction of ionizing radiation from CT scans in patients with CS via the utilization of low-dose CT protocols. These studies displayed overall CED values ranging from 0.015 mSv to 0.77 mSv. Our new CT protocol resulted in 94% reduction of ionizing radiation. Ultra-low dose CT protocols provide similar diagnostic data without loss of bone differentiation in CS and can be easily incorporated into the workflow of a children’s hospital.

New Institutional Economics (NIE) uses solutions from law, economics and organization. The purpose of this article is to link in a single analytical approach the institutional environment, its change in the organizations uniting in one, what is happening in contracts with agricultural lands. The explanation of this type of governance means to integrate: theoretical definitions; formal rules (laws, court decisions and other legal acts); economic institutions—means and mechanisms of exchange; legal and economic forms in which, through governance of transactions property rights are transferred and protected. In order to achieve this goal, it is necessary to present the elements of the institutional matrix that are the cause of changes in subordination and coordination. Following the process of implementing an approach for reconciling the legal and economic nature of the contract forms and integrating the states, contract organizations and transaction costs in a common model. In order to solve the research problems tasks are adapted methods from law, economics, statistics. Such are: (a) positive legal analysis of legislation; (b) historical (retrospective) method of analysis of changes; (c) discrete-structural analysis to explain the process; (d) comparative-institutional analysis to clarify alternatives and an explanation of any of the effects; (е) regression analysis to model the relationships and present possible one’s scenarios to show the direction in which changes are needed. Changes in legislation, legal forms, mechanisms and the amount of payments create new behavioral patterns that change the contract. Therefore, in retrospect, we are witnessing how the number of changes in legal acts, the amount of fees; the number of participants-administrators of the processes; the number and registers - change the number of transactions; the duration of the actions in the contracts, which ultimately predetermines the different amounts of transaction costs for agricultural lands. This interdependence was established by constructing an econometric model. The analysis presents opportunities for change that would lead to scenarios with a reduced level of transaction costs, that is, improving governance and showing the way to improve the institutional environment related to agricultural lands in Bulgaria.

This study aims to analyze, investigate the implications, and identify differences in the progress of the effect of institutional changes and organizational transformation in Indonesian higher education. The structuration analysis shows that examining the conditions that have resulted in the replication and modification of social systems is the focus of the structuration analysis. The image of structuration theory conveys both a sense of regularity and continuity, as well as respect for the labor that must be done daily and the mundane but essential tasks that must be completed. The finding of this study is that with the mandate that universities have been given to implement the three primary pillars that support Indonesia’s higher education system, the difficulty level of the problem facing Indonesia’s higher education system has increased. We suggest a future research agenda and highlight the changes and transformations in power, interests, and alliances that affect the evolution of higher education institutions.