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.

The wealth of nations depends on the quality of their infrastructure. Often, however, infrastructure suffers from ineffective investments and poor maintenance. Proposed solutions, such as New Public Management or Public-Private Partnerships (PPPs) tend to develop into Politicians-Private Partnerships as politicians collude with private firms to exploit present and future tax-payers. Therefore, it is necessary to give citizens better control over collective decision making. While there is a significant economic literature on empowering citizens via decentralization and direct democratic institutions, the role of electoral rules has thus far been rather neglected. An interesting case in point is Switzerland, which is well known for its high-quality infrastructure, extensive decentralization, and direct democracy. However, this paper argues that there is an additional and previously neglected institution that moves Swiss politicians away from client politics towards better serving public interest: Switzerland’s unique electoral institutions which effectively combine proportional elections with multi-seat majority elections. We explain how these institutions work, how they enhance the relationships between citizens and public and private entities, and we argue that they could be implemented in other countries.

The study looks into how governance qualities of decentralized governments mediate the impacts of decentralization on development. Based on a set-oriented approach, the study analyzed data from a nation-wide survey conducted with business managers from all provinces in Indonesia, and found evidence that, despite the country’s uniform decentralization reform, individual provinces exhibited great variation in the qualities of their various physical and institutional infrastructures. Notably, these qualities assumed nested relations, with order and security as well as accountability and rule of law seemingly being the preconditions of basic infrastructure provision as well as local governments’ coordination. Moreover, business investment decisions (measured as staff expansion and product innovation) were found to vary with some specific combinations of these infrastructural conditions. The result provides evidence supporting the argument that both physical and institutional infrastructures are instrumental to realize the supposed benefits of decentralization and supports the recent call of the literature to look into the political-institutional complex in the process of decentralization reform.

This research delves into the correlation between institutional quality and tourism development in a panel of nine Mediterranean countries within the European Union spanning from 1996 to 2021. The study gauges tourism development by examining tourist arrivals, while considering GDP growth rate, inflation, higher education, environmental quality, and trade as control variables representing factors influencing tourism. Institutional quality is measured through indicators such as regulatory quality, rule of law, and control of corruption. Utilizing Fully Modified Ordinary Least Square (FMOLS) and Dynamic Ordinary Least Squares (DOLS) models, the study aims to quantify the impact of these factors on tourism development. The findings indicate a positive relationship between institutional quality and tourism, shedding light on the pivotal role of institutions in tourism management and their influence on the sector. These results have implications for shaping national development strategies.