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A position statement of the International Pediatric Transplant Association endorsing prioritizing pediatric recipients for deceased donor organ allocation, examining the key ethical arguments that serve as the foundation for that position, and making specific policy recommendations to support prioritizing pediatric recipients for deceased donor organ allocation globally.

Purpose This study aims to examine the similarity of opinions regarding the stakeholder’s perception about the importance of the different aspects considered when measuring the sustainability of a tourism destination (through the assignment of weights to a previously established system of indicators). Besides, the use of stakeholder analysis networks is validated as a means to understand the different perceptions. Design/methodology/approach A combination of techniques is used. The stakeholders have been identified using a snowball sample. The network analysis examines the relationships. A power measure based on resource dependency theories is proposed. Possible tensions, as results of different perceptions among individual stakeholders in the context of the measurement of sustainability, are examined using a degree of similarity of opinions based on the Euclidean distance. Findings Although a large number of stakeholders communicate quite frequently to carry out their activities and believe that they greatly share viewpoints regarding sustainability, the social network analysis reveals that there are significant diversities of opinion. The power indicator and the degree of similarity measure proposed are found to be useful tools for studying the similarities of opinions among the stakeholders. Practical implications This approach is applied to sustainability governance conditions. Democratic processes are enhanced to measure sustainability. Directions to improve the sustainability of a tourist destination can be provided by achieving a consensus about sustainability policies. The conclusions about the similarities and differences among the perceptions of different stakeholders can be considered in decision-making processes about sustainability. Originality/value No previous studies have identified and analyzed the stakeholder network from the perspectives of measurement of sustainability of a tourism destination and the degree of similarity of their opinions.

Sustainability is a hot topic in our current society, and its effective measurement continues to be a challenge for researchers and practitioners. This issue is especially important, and at the sam...

Background Dexmedetomidine (DEX) is a sedative and analgesic medication that is frequently used postoperatively in children after liver transplantation. Hepatic dysfunction, including alterations in drug clearance, is common immediately after liver transplantation. However, the pharmacokinetics (PK) of DEX in this population is unknown. The objective of this study was to determine the PK profile of DEX in children after liver transplantation. Methods This was a single-center, open-label PK study of DEX administered as an intravenous loading dose of 0.5 μg/kg followed by a continuous infusion of 0.5 μg/kg/h. Twenty subjects, 1 month to 18 years of age, who were admitted to the pediatric intensive care unit after liver transplantation were enrolled. Whole blood was collected and analyzed for DEX concentration using a dried blood spot method. Nonlinear mixed-effects modeling was used to characterize the population PK of DEX. Results DEX PK was best described by a 2-compartment model with first-order elimination. A typical child after liver transplantation with an international normalized ratio (INR) of 1.8 was found to have a whole blood DEX clearance of 52 L/h (95% confidence interval [CI], 31-73 L/h). In addition, intercompartmental clearance was 246 L/h (95% CI, 139-391 L/h), central volume of distribution was 186 L/70 kg (95% CI, 140-301 L/70 kg), and peripheral volume of distribution was 203 L (95% CI, 123-338 L). Interindividual variability ranged from 11% to 111% for all parameters. Clearance was not found to be associated with weight but was found to be inversely proportional to INR. An increase in INR to 3.2 resulted in a 50% decrease in DEX clearance. Weight was linearly correlated with central volume of distribution. All other covariates, including age, ischemic time, total bilirubin, and alanine aminotransferase, were not found to be significant predictors of DEX disposition. Conclusions Children who received DEX after liver transplantation have large variability in clearance, which was not found to be associated with weight but is influenced by underlying liver function, as reflected by INR. In this population, titration of DEX dosing to clinical effect may be important because weight-based dosing is poorly associated with blood concentrations. More attention to quality of DEX sedation may be warranted when INR values are changing.

Monitoring of an electrical system requires storage and computational resources. For later diagnosis of possible defects, the system needs to store the parameter values of the circuit. Due to storage limitations, systems usually select which data shall be kept for further analysis. In case of complex systems with many monitored parameters, this selection comes with computational overhead. Such a complex system is the modular-multilevel- converter used for high-voltage DC transmission, because it monitors AC parameters, DC parameters as well as intermediary submodule values. This paper analyses the applicability of locality sensitive hashes as a mechanism for determining which data is relevant for further analysis. Moreover, we investigate if such an algorithm is suitable as an alarm mechanism in case of faults. Nevertheless, we propose a storage strategy based on this algorithm, which shall use the storage capacity in a more efficient manner for holding diagnosis data.

The abdominal vacuum-assisted closure (VAC) system has been introduced, providing a new possibility to treat an open abdomen. Abdominal compartment syndrome has a great relevance in surgical practice and patient care in critical condition due to the effects of increased pressure in the enclosed space of the abdomen can lead to multiple organ failure. A prospective study was conducted on a sample of 15 patients with severe acute pancreatitis (SAP) was retrospectively analyzed, following the incidence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS),the effectiveness of the therapeutic methods applied in reducing the intra-abdominal pressure (PIA), the evolution of severity scores, lenght of stay in intensive care unit between January 2014 - March 2017, following negative pressure therapy. There were used vacuum assisted closure devices (VAC � -Hartman) in order to apply negative pressure to the open abdomen, while complying with specified settings in accordance with patients� outcome. Surgery for abdominal decompression in PAS with SCA is an emergency and was imposed on 14 of the 15 patients . In the studied group, the first decompression procedure was performed on days 2 to 5 from intake, as PIA increased in evolution despite medical methods. Only 1 patient hospitalized with SAP PIA decreased by medical methods and after haemofiltration. Acute severe pancreatitis remains a serious pathology in spite of a maximum medical and surgical therapy.Continuous venous haemofiltration has contributed to lowering intraabdominal pressure. Surgery with decompression vacuum systems with negative pressure lead to a significant decrease in PIA.

A four-year-old female was admitted to a university-based children's hospital with a newly-diagnosed posterior fossa tumor. She was started on famotidine and high-dose dexamethasone and underwent gross total resection of a medulloblastoma. She was continued on dexamethasone and famotidine. She exhibited postoperative posterior fossa syndrome and was started on enteral feeds via the nasoduodenal tube. She had small gastrointestinal bleeds on postoperative days eight, 11, and 18, and was found to have a well-circumscribed posterior duodenal ulcer. On postoperative day 19, she suffered a massive life-threatening gastrointestinal bleed requiring aggressive resuscitation with blood products. She required an emergent laparotomy due to ongoing blood loss and she was found to have posterior duodenal wall erosion into her gastroduodenal artery. She recovered and subsequently began delayed chemotherapy. This case demonstrates a rare and life-threatening complication of high-dose dexamethasone therapy in the setting of posterior fossa pathology despite stress ulcer prophylaxis. We present a historical perspective with the review of the association between duodenal and intracranial pathology and the usage of high-dose dexamethasone in such cases.

A large number of studies have been carried out on the social carrying capacity of tourists regions. Most of these studies have examined protected natural areas, the best known being Shelby and Heberlein’s study. The research aim of this paper is to adapt the social carrying capacity model to a mature coastal destination, Costa del Sol. The empirical findings provide an indicator that allows us to establish the proportion of tourists who perceive overcrowding and are predisposed to leave. A cluster analysis was performed to better understand how overcrowding is perceived by tourists, the socioeconomic characteristics of tourists and the factors that may influence the capacity thresholds. The generating data will allow a scientific debate on the overcrowding problems and the growth limits.

Carnitine-acylcarnitine translocase (CACT) deficiency is a rare long-chain fatty acid oxidation disorder (LC-FAOD) with high mortality due to cardiomyopathy or lethal arrhythmia. Triheptanoin (UX007), an investigational drug composed of synthetic medium odd-chain triglycerides, is a novel therapy in development for LC-FAOD patients. However, cases of its safe and efficacious use to reverse severe heart failure in CACT deficiency are limited. Here, we present a detailed report of an infant with CACT deficiency admitted in metabolic crisis that progressed into severe cardiogenic shock who was successfully treated by triheptanoin. The child was managed, thereafter, on triheptanoin until her death at 3 years of age from a cardiopulmonary arrest in the setting of acute respiratory illness superimposed on chronic hypercarbic respiratory failure.

Between January 1999 and November 2005 there have been a number of 44 cases of cancers of the esophageal-gastric junction. Only 24 of them have been surgically removed. The carcinoma of the esophageal-gastric junction was defined on topographical and histological grounds, complemented by radiological, endoscopical and tomographical aspects. The authors analyzed the location of the tumor, compared the imaging with the intra-surgical findings and chose the surgical strategy. The authors widely used the classification proposed by Siewert and Stein, which should be the reference for such tumors. The distal esophagectomy for type I and II tumors should reach much closer, at a reasonable, oncologically sufficient, distance from the upper limit of the tumor; the transhiatal approach is as good as a trans-thoracic one for an accurate mediastinal lymphadenectomy; an esophago-jejunal anastomosis should not be carried out at any costs, reducing the height of the esophageal resection (a risk of positive resection margins), for the length of the jejunal segment to fit the gap.

Using the stomach as a substitution after oesophagectomy is the most common method. The stomach brought intra thoracic it seems that maintains or regains its capacity to secrete hydrochloric acid and therefore can develop specific conditions, despite total denervation following bilateral troncular vagotomy. We are presenting the case of a young patient who was operated on for a corrosive esophagitis. She had an oesophagectomy and a transposition of the stomach to the posterior mediastinum and anastomosed to the cervical esophagus. She presents with upper gastro-intestinal bleeding from gastric ulcer penetrating into the left atrium.