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BackgroundA multicenter study of pectus excavatum was described previously. This report presents our final results.Study designPatients treated surgically at 11 centers were followed prospectively. Each underwent a preoperative evaluation with CT scan, pulmonary function tests, and body image survey. Data were collected about associated conditions, complications, and perioperative pain. One year after treatment, patients underwent repeat chest CT scan, pulmonary function tests, and body image survey. A subset of 50 underwent exercise pulmonary function testing.ResultsOf 327 patients, 284 underwent Nuss procedure and 43 underwent open procedure without mortality. Of 182 patients with complete follow-up (56%), 18% had late complications, similarly distributed, including substernal bar displacement in 7% and wound infection in 2%. Mean initial CT scan index of 4.4 improved to 3.0 post operation (severe >3.2, normal = 2.5). Computed tomography index improved at the deepest point (xiphoid) and also upper and middle sternum. Pulmonary function tests improved (forced vital capacity from 88% to 93%, forced expiratory volume in 1 second from 87% to 90%, and total lung capacity from 94% to 100% of predicted (p < 0.001 for each). VO2 max during peak exercise increased by 10.1% (p = 0.015) and O2 pulse by 19% (p = 0.007) in 20 subjects who completed both pre- and postoperative exercise tests.ConclusionsThere is significant improvement in lung function at rest and in VO2 max and O2 pulse after surgical correction of pectus excavatum, with CT index >3.2. Operative correction significantly reduces CT index and markedly improves the shape of the entire chest, and can be performed safely in a variety of centers.

The experiences of a first-time community college library director during the initial three months on the job are detailed. The process of automation software migration is used as a vehicle for demonstrating activities performed to improve knowledge. Marketing, customer service, and identification of core library supporters are addressed. Concern for preparation paths of 2-year college library directors and the ability to attract quality applicants is expressed.

South Korean President Moon Jae-In's administration has sought sanctions relief for North Korea, but South Korea's allies have rejected those solicitations. This paper formalizes the allies' anti-relief impulses. It argues both against sanctions critiques and on behalf of sanctions. First, it disputes common sanction critiques, arguing that: 1) the humanitarian crisis in North Korea is the fault of the regime's choices, not sanctions; 2) sanctions have in fact been somewhat effective; and 3) North Korean leader Kim Jong Un is not a reformer. Second, this paper defends sanctions, because they: 1) express the international community's moral rejection of North Korean totalitarianism; 2) constrict North Korean economic growth in the strategic interest of South Korea and its partner democracies; 3) deter other states from following North Korea's nuclear and missile path; 4) give teeth to United Nations Security Council resolutions; and 5) punish North Korea for international law (UNSCR) violations. [ABSTRACT FROM AUTHOR]

South Korean President Moon Jae-In pushed harder for a transformational inter– Korean détente than any of his predecessors. That his tremendous effort still failed demands explanation. This paper suggests four interlocking reasons, derived from bargaining theory applications in foreign policy analysis: 1) The North Korean Kim Jong Un regime, secure behind its nuclear weapons and domestic repression, preferred its status quo BATNA (best alternative to a negotiated agreement) to the capacious American demand for complete, verifiable, irreversible disarmament. Pyongyang can afford to wait for the Americans to offer better terms. 2) South Korean centrist and conservative ‘veto-players,’ trading on the high popularity of the U.S. alliance in South Korea, blocked Moon from pursuing a Korea––only negotiating track after U.S.–North Korea negotiations stagnated––including a ‘future veto’ threat to roll back Moon’s détente when conservatives next won the South Korean presidency. 3) U.S. domestic players, of unique importance in South Korea because of the tight alliance, also resisted. Moon and U.S. President Donald Trump were unable to win over the deeply skeptical U.S. foreign policy community. 4) Cognitively, Trump himself undercut Moon’s effort as much he helped it. Trump’s impatience, disinterest in detail, and general disorganization crippled him as a reliable negotiating counterparty for Moon (and Kim). This paper concludes with a narrative of these causes dynamically interacting to illustrate the collapse of Moon’s initiative. [ABSTRACT FROM AUTHOR]