Proporsjonalitetsprinsippet og den militærteknologiske revolusjon: har prinisippet overlevd revolusjonen?

Proportionality is an essential principle of the Law of Armed Conflict (LOAC). This principle acknowledges that incidental harm to civilians and civilian objects inevitably occurs in war. According to the proportionality rule, the expected collateral damage from an attack on a lawful target must not be excessive in relation to the concrete and direct military advantage anticipated. That is easily stated, but what implications it has on a high-tech actor on today’s battlefield is more complex. This paper considers the current law regarding proportionality and what implications technology has on those making targeting decisions. It has not been possible to identify clear guidelines on the practical application, but one conclusion is the standard of the “reasonable military commander”. Officers are thus expected to make decisions in accordance with what would be expected of an officer of the same age, rank, experience and education. It is also evident that the standards for compliance with the precautions in attack rules are higher for those that have access to the latest technology. The law does not require states to acquire such technology, but once they are fielded they should be used when available, and there is a risk of civilian harm. The paper then goes on to examine how technology has affected the principle itself. Although new technologies certainly can provide less collateral damage it has also increased the number of targets that can be attacked, which makes compliance more difficult. At the same time, officers are seeing traditional excuses for causing collateral damage being removed, and decisions made available for scrutiny, which in turn increase the willingness to comply with the principle

Femtosecond spectral and anisotropy study of excitation energy transfer between neighbouring α-80 and β-81 chromophores of allophycocyanin trimers

Polarization pump-probe femtosecond spectroscopy was used to investigate photoinduced optical density changes in allophycocyanin (APC) trimers at 635–690 nm after excitation with 230-fs pulses at 618 nm. The initial bleaching observed at λ < 645 nm is followed by subpicosecond absorption recovery corresponding to 430 ± 40 fs recovery kinetics measured at 615 nm with 70-fs pulses. Only the red part of the APC absorption band remains strongly bleached at 3 ps after excitation. The spectral and kinetic results can be described in terms of two different models of interaction between neighbouring α-80 and β-81 chromophores of APC trimers. According to the first one, the observed subpicosecond kinetics corresponds to relaxation between the levels of excitonically coupled, spectrally identical α-80 and β-81 chromophores. Excited state absorption to doubly excited excitonic state should in this case contribute to the measured difference spectra. According to the second one, the femtosecond excitation energy transfer in APC trimers takes place between a donor chromophore absorbing predominantly at 620 nm and an acceptor chromophore absorbing at 650 nm. The high anisotropy value observed at 615 nm during the first 1.2 ps is in good agreement with the donor-acceptor model. Anisotropy values calculated in the 635–675 nm spectral region at 3 ps after excitation are in the 0.1–0.25 range corresponding to an angle of 30°–45° between donor and acceptor transition dipole orientations. The high anisotropy obtained at 658 nm during the excitation is probably due to stimulated emission of the donor chromophore

Outcome after surgical treatment of cerebrospinal fluid leaks in spontaneous intracranial hypotension-a matter of time.

OBJECTIVE Spinal cerebrospinal fluid (CSF) leaks cause spontaneous intracranial hypotension (SIH). Microsurgery can sufficiently seal spinal CSF leaks. Yet, some patients suffer from residual symptoms. Aim of the study was to assess predictors for favorable outcome after surgical treatment of SIH. METHODS We included consecutive patients with SIH treated surgically from January 2013 to May 2020. Subjects were surveyed by a questionnaire. Primary outcome was resolution of symptoms as rated by the patient. Secondary outcome was postoperative headache intensity on the numeric rating scale (NRS). Association between variables and outcome was assessed using univariate and multivariate regression. A cut-off value for continuous variables was calculated by a ROC analysis. RESULTS Sixty-nine out of 86 patients (80.2%) returned the questionnaire and were analyzed. Mean age was 46.7 years and 68.1% were female. A significant association with the primary and secondary outcome was found only for preoperative symptom duration (p = 0.001 and p < 0.001), whereby a shorter symptom duration was associated with a better outcome. Symptom duration remained a significant predictor in a multivariate model (p = 0.013). Neither sex, age, type of pathology, lumbar opening pressure, nor initial presentation were associated with the primary outcome. ROC analysis yielded treatment within 12 weeks as a cut-off for better outcome. CONCLUSION Shorter duration of preoperative symptoms is the most powerful predictor of favorable outcome after surgical treatment of SIH. While an initial attempt of conservative treatment is justified, we advocate early definitive treatment within 12 weeks in case of persisting symptoms

The influence of residential and workday population mobility on exposure to air pollution in the UK

Traditional approaches of quantifying population-level exposure to air pollution assume that concentrations of air pollutants at the residential address of the study population are representative for overall exposure. This introduces potential bias in the quantification of human health effects. Our study combines new UK Census data comprising information on workday population densities, with high spatio-temporal resolution air pollution concentration fields from the WRF-EMEP4UK atmospheric chemistry transport model, to derive more realistic estimates of population exposure to NO2, PM2.5 and O3. We explicitly allocated workday exposures for weekdays between 8:00 am and 6:00 pm. Our analyses covered all of the UK at 1 km spatial resolution. Taking workday location into account had the most pronounced impact on potential exposure to NO2, with an estimated 0.3 μg m−3 (equivalent to 2%) increase in population-weighted annual exposure to NO2 across the whole UK population. Population-weighted exposure to PM2.5 and O3 increased and decreased by 0.3%, respectively, reflecting the different atmospheric processes contributing to the spatio-temporal distributions of these pollutants. We also illustrate how our modelling approach can be utilised to quantify individual-level exposure variations due to modelled time-activity patterns for a number of virtual individuals living and working in different locations in three example cities. Changes in annual-mean estimates of NO2 exposure for these individuals were considerably higher than for the total UK population average when including their workday location. Conducting model-based evaluations as described here may contribute to improving representativeness in studies that use small, portable, automatic sensors to estimate personal exposure to air pollution

Förster energy transfer between neighbouring chromophores in C-phycocyanin trimers

The excitation-energy transfer in C-phycocyanin (C-PC) trimers and monomers isolated from phycobilisomes of Mastigocladus laminosus has been studied by polarization femtosecond laser spectroscopy. Excitation with 70-fs pulses at 615 nm gave rise to a 500-fs energy-transfer process that was observed only in trimeric preparations. The rate of the process is in agreement with earlier calculated Förster energy transfer rates between neighbouring α-84 and β-84 chromophores of different monomeric subunits. This process is most clearly seen in the anisotropy decay kinetics. As a result of femtosecond excitation-energy transfer, the anisotropy relaxes from 0.4 to 0.23. The final anisotropy value is in fair agreement with the results of calculations based on the crystal structure and spectroscopic data of C-PC trimers. Our results support the conclusion that Förster energy transfer can occur between excitonically coupled chromophores

Idiopathic Ventral Spinal Cord Hernia—A Single-Center Case Series of 11 Patients

BACKGROUND: Idiopathic spinal cord herniations (ISCH) are rare defects of the ventromedial or mediolateral dura mater with herniation of the spinal cord through the defect with approximately 350 described cases worldwide. Patients usually become symptomatic with motor or sensory neurological deficits and gait disturbances. OBJECTIVE: To describe characteristic symptoms and clinical findings and to evaluate the postoperative course and outcomes of ISCH. METHODS: We present a single-center data analysis of a case series of 11 consecutive patients who were diagnosed with ISCH and underwent surgery in our department between 2009 and 2021. RESULTS: All herniations were located in the thoracic spine between T2 and T9. In most cases, gait ataxia and dysesthesia led to further workup and subsequently to the diagnosis of ISCH. A “far-enough” posterior-lateral surgical approach, hemilaminectomy or laminectomy with a transdural approach, was performed under intraoperative neurophysiological monitoring which was followed by adhesiolysis, repositioning of the spinal cord and sealing using a dura patch. After surgery, clinical symptoms improved in 9 of 11 patients (81.8%), while only 1 patient experienced deterioration of symptoms (9.1%) and 1 patient remained equal (9.1%). The median preoperative McCormick grade was 3 (±0.70), while the median postoperative grade was 2 (±0.98) (P = .0047). CONCLUSION: In our case series of ISCH, we found that in most patients, neurological deficits improved postoperatively. This indicates that surgery in ISCH should not be delayed in symptomatic patients

The impact of spontaneous intracranial hypotension on social life and health-related quality of life

Objective Spontaneous intracranial hypotension (SIH), which is often caused by a spinal cerebrospinal fluid leak, is an important cause of disabling headaches. Many patients report devastating changes in their quality of life because of their symptoms. This study aimed to evaluate the impact of SIH on patients' social/ working life and health-related quality of life (HRQoL). Methods We included consecutive patients with proven SIH treated at our institution from January 2013 to May 2020. Patients were contacted and asked to complete the 15D questionnaire for the collection of HRQoL data and to provide additional information on their social life status. Results Of 112 patients, 79 (70.5%) returned the questionnaire and were included in the analysis. Of those, 69 were treated surgically (87.3%), and 10 were managed non-operatively (12.7%). Twenty-five (31.6%) patients reported a severe impact on their partnership, 32 (41.5%) reported a moderate or severe impact on their social life. Forty (54.8%) patients reported sick leave for more than 3 months. The mean 15D score was 0.890 (+/- 0.114) and significantly impaired compared to an age- and sex-matched general population (p = 0.001), despite treatment. Patients with residual SIH-symptoms (36, 45.6%) had significantly impaired HRQoL compared to those without any residual symptoms (41, 51.9%) (p < 0.001). Conclusion SIH had a notable impact on the patients' social life and HRQoL. It caused long periods of incapacity for work, and is therefore, associated with high economic costs. Although all patients were appropriately treated, reduced HRQoL persisted after treatment, underlining the chronic character of this disease.Peer reviewe

Epidural Blood Patching in Spontaneous Intracranial Hypotension-Do we Really Seal the Leak?

PURPOSE Epidural blood patch (EBP) is a minimally invasive treatment for spontaneous intracranial hypotension (SIH). Follow-up after EBP primarily relies on clinical presentation and data demonstrating successful sealing of the underlying spinal cerebrospinal fluid (CSF) leak are lacking. Our aim was to evaluate the rate of successfully sealed spinal CSF leaks in SIH patients after non-targeted EBP. METHODS Patients with SIH and a confirmed spinal CSF leak who had been treated with non-targeted EBP were retrospectively analyzed. Primary outcome was persistence of CSF leak on spine MRI or intraoperatively. Secondary outcome was change in clinical symptoms after EBP. RESULTS In this study 51 SIH patients (mean age, 47 ± 13 years; 33/51, 65% female) treated with non-targeted EBP (mean, 1.3 EBPs per person; range, 1-4) were analyzed. Overall, 36/51 (71%) patients had a persistent spinal CSF leak after EBP on postinterventional imaging and/or intraoperatively. In a best-case scenario accounting for missing data, the success rate of sealing a spinal CSF leak with an EBP was 29%. Complete or substantial symptom improvement in the short term was reported in 45/51 (88%), and in the long term in 17/51 (33%) patients. CONCLUSION Non-targeted EBP is an effective symptomatic treatment providing short-term relief in a substantial number of SIH patients; however, successful sealing of the underlying spinal CSF leak by EBP is rare, which might explain the high rate of delayed symptom recurrence. The potentially irreversible and severe morbidity associated with long-standing intracranial hypotension supports permanent closure of the leak

Preoperative prediction of spinal cord ischemia after thoracic endovascular aortic repair

ObjectiveSpinal cord ischemia (SCI) is a devastating but potentially preventable complication of thoracic endovascular aortic repair (TEVAR). The purpose of this analysis was to determine what factors predict SCI after TEVAR.MethodsAll TEVAR procedures at a single institution were reviewed for patient characteristics, prior aortic repair history, aortic centerline of flow analysis, and procedural characteristics. SCI was defined as any lower extremity neurologic deficit that was not attributable to an intracranial process or peripheral neuropathy. Forty-three patient and procedural variables were evaluated individually for association with SCI. Those with the strongest relationships to SCI (P < .1) were included in a multivariable logistic regression model, and a stepwise variable elimination algorithm was bootstrapped to derive a best subset of predictors from this model.ResultsFrom 2002 to 2013, 741 patients underwent TEVAR for various indications, and 68 (9.2%) developed SCI (permanent: n = 38; 5.1%). Because of the lack of adequate imaging for centerline analysis, 586 patients (any SCI, n = 43; 7.4%) were subsequently analyzed. Patients experiencing SCI after TEVAR were older (SCI, 72 ± 11 years; no SCI, 65 ± 15 years; P < .0001) and had significantly higher rates of multiple cardiovascular risk factors. The stepwise selection procedure identified five variables as the most important predictors of SCI: age (odds ratio [OR] multiplies by 1.3 per 10 years; 95% confidence interval [CI], 0.9-1.8, P = .06), aortic coverage length (OR multiplies by 1.3 per 5 cm; CI, 1.1-1.6; P = .002), chronic obstructive pulmonary disease (OR, 1.9; CI, 0.9-4.1; P = .1), chronic renal insufficiency (creatinine concentration ≥ 1.6 mg/dL; OR, 1.9; CI, 0.8-4.2; P = .1), and hypertension (defined as chart history or medication; OR, 6.4; CI, 2.6-18; P < .0001). A logistic regression model with just these five covariates had excellent discrimination (area under the receiver operating characteristic curve = .83) and calibration (χ2 = 9.8; P = .28).ConclusionsThis analysis generated a simple model that reliably predicts SCI after TEVAR. This clinical tool can assist decision-making about when to proceed with TEVAR, guide discussions about intervention risk, and help determine when maneuvers to mitigate SCI risk should be implemented

Environment Constrains Fitness Advantages of Division of Labor in Microbial Consortia Engineered for Metabolite Push or Pull Interactions

Fitness benefits from division of labor are well documented in microbial consortia, but the dependency of the benefits on environmental context is poorly understood. Two synthetic Escherichia coli consortia were built to test the relationships between exchanged organic acid, local environment, and opportunity costs of different metabolic strategies. Opportunity costs quantify benefits not realized due to selecting one phenotype over another. The consortia catabolized glucose and exchanged either acetic or lactic acid to create producer-consumer food webs. The organic acids had different inhibitory properties and different opportunity costs associated with their positions in central metabolism. The exchanged metabolites modulated different consortial dynamics. The acetic acid-exchanging (AAE) consortium had a “push” interaction motif where acetic acid was secreted faster by the producer than the consumer imported it, while the lactic acid-exchanging (LAE) consortium had a “pull” interaction motif where the consumer imported lactic acid at a comparable rate to its production. The LAE consortium outperformed wild-type (WT) batch cultures under the environmental context of weakly buffered conditions, achieving a 55% increase in biomass titer, a 51% increase in biomass per proton yield, an 86% increase in substrate conversion, and the complete elimination of by-product accumulation all relative to the WT. However, the LAE consortium had the trade-off of a 42% lower specific growth rate. The AAE consortium did not outperform the WT in any considered performance metric. Performance advantages of the LAE consortium were sensitive to environment; increasing the medium buffering capacity negated the performance advantages compared to WT