Opportunistic Content-Centric Data Transmission During Short Network Contacts

In this paper, we investigate content-centric data transmission in the context of short opportunistic contacts and base our work on an existing content-centric networking architecture. In case of short interconnection times, file transfers may not be completed and the received information is discarded. Caches in content-centric networks are used for short-term storage and do not guarantee persistence. We implemented a mechanism to extend caching on persistent storage enabling the completion of disrupted content transfers. The mechanisms have been implemented in the CCNx framework and have been evaluated on wireless mesh nodes. Our evaluations using multicast and unicast communication show that the implementation can support content transfers in opportunistic environments without significant processing and storing overhead.

Diversity and function of mutations in p450 oxidoreductase in patients with Antley-Bixler syndrome and disordered steroidogenesis

P450 oxidoreductase (POR) is the obligatory flavoprotein intermediate that transfers electrons from reduced nicotinamide adenine dinucleotide phosphate (NADPH) to all microsomal cytochrome P450 enzymes. Although mouse Por gene ablation causes embryonic lethality, POR missense mutations cause disordered steroidogenesis, ambiguous genitalia, and Antley-Bixler syndrome (ABS), which has also been attributed to fibroblast growth factor receptor 2 (FGFR2) mutations. We sequenced the POR gene and FGFR2 exons 8 and 10 in 32 individuals with ABS and/or hormonal findings that suggested POR deficiency. POR and FGFR2 mutations segregated completely. Fifteen patients carried POR mutations on both alleles, 4 carried mutations on only one allele, 10 carried FGFR2 or FGFR3 mutations, and 3 patients carried no mutations. The 34 affected POR alleles included 10 with A287P (all from whites) and 7 with R457H (four Japanese, one African, two whites); 17 of the 34 alleles carried 16 "private" mutations, including 9 missense and 7 frameshift mutations. These 11 missense mutations, plus 10 others found in databases or reported elsewhere, were recreated by site-directed mutagenesis and were assessed by four assays: reduction of cytochrome c, oxidation of NADPH, support of 17alpha-hydroxylase activity, and support of 17,20 lyase using human P450c17. Assays that were based on cytochrome c, which is not a physiologic substrate for POR, correlated poorly with clinical phenotype, but assays that were based on POR's support of catalysis by P450c17--the enzyme most closely associated with the hormonal phenotype--provided an excellent genotype/phenotype correlation. Our large survey of patients with ABS shows that individuals with an ABS-like phenotype and normal steroidogenesis have FGFR mutations, whereas those with ambiguous genitalia and disordered steroidogenesis should be recognized as having a distinct new disease: POR deficiency.

Ankle dorsiflexion arthrodesis to salvage Chopart's amputation with anterior skin insufficiency

BACKGROUND In Chopart-level amputations the heel often deviates into equinus and varus when, due to the lack of healthy anterior soft tissue, rebalancing tendon transfers to the talar head are not possible. Consequently, anterior and lateral wound dehiscence and ulceration may occur requiring higher-level amputation to achieve wound closure, with considerable loss of function for the patients. METHODS Twenty-four consecutive patients (15 diabetes, 6 trauma, and 3 tumor) had Chopart's amputation and simultaneous or delayed additional ankle dorsiflexion arthrodesis to allow for tension-free wound closure or soft tissue reconstruction, or to treat secondary recurrent ulcerations. Percutaneous Achilles tendon lengthening and subtalar arthrodesis were added as needed. Wound healing problems, time to fusion and full weight-bearing in the prosthesis, complications in the prosthesis, and the ambulatory status were assessed. Satisfaction and function were evaluated by the AmpuPro score and the validated Prosthesis Evaluation Questionnaire scale. RESULTS Five patients had successful soft tissue healing and fusions but died of their underlying disease 2 to 46 months after the operation. Two diabetic patients required a transtibial amputation. The other 17 patients were followed for 27 months (range, 13-63). The average age of the 4 women and 13 men was 53.9 years (range, 16-87). Postoperative complications included minor wound healing problems in 8 patients, wound breakdown requiring revision in 4, phantom pain in 3, residual equinus in 1, and adjacent scar carcinoma in 1 patient. The time to full weight-bearing in the prosthesis ranged from 6 to 24 weeks (mean 10). The mean AmpuPro score was 107 points (of 120), and the mean Prosthesis Evaluation Questionnaire scale was 147 points (of 200). No complications occurred with the prosthesis. Twelve patients lost 1 to 2 mobility classes (mean 0.9). The arthrodeses all healed within 2.5 months (range, 1.5 to 5 months). CONCLUSION Adding an ankle arthrodesis to a Chopart's amputation either immediately or in a delayed fashion to treat anterior soft tissue complications was a successful salvage in most patients at this amputation level. It enabled the patients to preserve the advantages of a full-length limb with terminal weight-bearing. LEVEL OF EVIDENCE Level IV, retrospective case series.

Is there good simulation basic training for end-to-side vascular microanastomoses?

BACKGROUND Microvascular anastomosis is the cornerstone of free tissue transfers. Irrespective of the microsurgical technique that one seeks to integrate or improve, the time commitment in the laboratory is significant. After extensive previous training on several animal models, we sought to identify an animal model that circumvents the following issues: ethical rules, cost, time-consuming and expensive anesthesia, and surgical preparation of tissues required to access vessels before performing the microsurgical training, not to mention that laboratories are closed on weekends. METHODS Between January 2012 and April 2012, a total of 91 earthworms were used for 150 microsurgical training exercises to simulate vascular end-to-side microanastomosis. The training sessions were divided into ten periods of 7 days. Each training session included 15 simulations of end-to-side vascular microanastomoses: larger than 1.5 mm (n=5), between 1.0 and 1.5 mm (n=5), and smaller than 1.0 mm (n=5). A linear model with the main variables being the number of weeks (as a numerical covariate) and the size of the animal (as a factor) was used to determine the trend in time of anastomosis over subsequent weeks as well as the differences between the different size groups. RESULTS The linear model shows a significant trend (p<0.001) in time of anastomosis in the course of the training, as well as significant differences (p<0.001) between the groups of animals of different sizes. For microanastomoses larger than 1.5 mm, the mean anastomosis time decreased from 19.3±1.0 to 11.1±0.4 min between the first and last week of training (decrease of 42.5%). For training with smaller diameters, the results showed a decrease in execution time of 43.2% (diameter between 1.0 and 1.5 mm) and 40.9% (diameter<1.0 mm) between the first and last periods. The study demonstrates an improvement in the dexterity and speed of nodes execution. CONCLUSION The earthworm appears to be a reliable experimental model for microsurgical training of end-to-side microanastomoses. Its numerous advantages are discussed here and we predict training on earthworms will significantly grow and develop in the near future. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Globale Akteure an den Randzonen von Souveränität und Legitimität

Der moderne Nationalstaat mit seinen Grenzlinien, welche die räumliche Reichweite des souveränen Gewaltmonopols fixierten und gleichsam einen Kulturraum mit homogenen sozialen und rechtlichen Normen abschlossen, war lange eine zentrale Orientierungsgröße für die Geschichtsschreibung. Die wirtschaftlichen, politischen und kulturellen Globalisierungsprozesse der letzten zwei Jahrzehnte haben jedoch das nationale Narrativ mit seinen eindeutigen Demarkationslinien in Frage gestellt. Stattdessen sind Randzonen und Zwischenräume in den Mittelpunkt des Interesses gerückt. Dieser Paradigmenwechsel in Methodik und Perspektive hat auch realhistorisch seine volle Berechtigung, denn solche Zwischenräume sind keine neuartigen Phänomene der Postmoderne mit ihren globalen Transfers und multikulturellen Gesellschaften. Sie hatten sich beispielsweise stets auch während des Epochen übergreifenden Prozesses der europäischen Expansion aufgetan, insbesondere an den fluiden imperialen Randzonen. Nach eurozentrischen Maßstäben handelte es sich dabei um rechtlich nicht regulierte und territorial undefinierte Räume. Aber selbst in der Hochphase des Imperialismus sowie auch in den postkolonialen Gesellschaften konnte das nationalstaatliche Modell nur partiell etabliert werden und konkurrierte stets mit „tribalen“ oder quasi-feudalen Formen sozio-politischer Organisation. Außerdem wurde selbst in den westlichen Nationalstaaten das staatliche Gewaltmonopol sowie die soziale, rechtliche und politische Ordnung bei innerstaatlichen Konflikten wie Revolutionen und Bürgerkriegen sowie internationalen Kriegen immer wieder in Frage gestellt oder sogar ausgehebelt. In solch gewaltbasierten Umfeldern des Ausnahmezustandes und der Insurrektion sowie in solch deregulierten Räumen, weitgehend frei von Hierarchien, bürokratischer Kontrolle und rechtlichen Einschränkungen, agierten stets auch besondere Akteurstypen. Sie hatten einerseits das Privileg einer geringen Kontrolle unterworfen zu sein oder völlig losgelöst davon zu handeln, waren aber andererseits überwiegend auf sich gestellt und konnten nur sehr beschränkt den Schutz des fernen Souveräns im Hintergrund beanspruchen oder hatten sich diesen durch ihre Verhaltensweise sogar zum Gegner gemacht. Diese Akteure an den Randzonen von Souveränität und Legitimität können grob in verschiedene Typen eingeteilt werden: Zu nennen sind die Avantgardisten der Expansion wie Entdecker und Eroberer, die klassischen „Men on the Spot“ an der Peripherie von Imperien wie Militärs und Administratoren, private Gewaltunternehmer und Söldner, Insurgenten und Revolutionäre, sowie Spione und Nachrichtenhändler. Anhand verschiedener Fallstudien soll diese Figur des Akteurs an den Randzonen in globaler Perspektive beleuchtet werden. Es stellt sich die Frage nach seiner Motivation für Sondermissionen, seiner ideellen Beweggründe und politischen Überzeugung sowie seiner Beziehung zum Auftraggeber oder Souverän im fernen Hintergrund. Insbesondere ist untersuchen, ob deren Interessen trotz beschränkter Kontrolle und Rückendeckung loyal verfolgt wurden oder ob für unsere Protagonisten vor allem materielle Interessen ausschlaggebend waren, womöglich sogar einfach das Streben nach einem Betätigungsfeld mit möglichst großer Handlungsfreiheit? Während entgrenzte Verhaltensweisen in der Regel auf rechtlich nur schwach regulierte Umfeldern zurückgeführt werden, ist auch zu untersuchen, ob sich gewisse Persönlichkeiten nicht gezielt Räume am Rande oder jenseits nationalstaatlicher Rechtsnormen als Agitationsfeld suchten oder ob sie sich sogar zur Verwirklichung ihrer persönlichen Bedürfnisse solche Räume durch Subversion staatlicher Ordnung gezielt schafften. Indem die Protagonisten mit den kulturellen, politischen und rechtlichen Ordnungen ihres Betätigungsfeldes in Beziehung gesetzt werden, kann auch eine Brücke von einer rein personenbezogenen Biographik zur Strukturgeschichte geschlagen werden. Die Grenzgänger wie auch die Zwischenräume, in denen sie agierten, sind wohl auch weniger als Randerscheinungen des Ausnahmezustandes zu verstehen, sondern vielmehr als die unmittelbar mit der sich intensivierenden Verrechtlichung und Homogenisierung der westeuropäischen Nationalstaaten einhergehende andere Seite dieses Prozesses: Einerseits brauchten Regierungen zuweilen für besondere Aufgaben Akteure, die nicht an die eigenen Rechtsnormen gebunden waren, andererseits gab es stets Persönlichkeiten, die sich in der engen Rechtswirklichkeit und sozialen Ordnung des Nationalstaates nicht zurechtfanden. Darüber hinaus sind diese Grenzgänger auch als Brückenköpfe politischer wie ökonomischer Machterweiterung sowie als Schlüsselfiguren von Interaktions-, Kooperations-, Vernetzungs- und Transformationsprozessen zu verstehen – nur in Extremfällen waren sie radikale Grenzüberschreiter sowie Träger der bloßen Zerstörung und Zersetzung. Da sie in einem kulturell fremden oder zerrütteten, krisengebeutelten Umfeld agierten, gilt ein besonderes Augenmerk ihrer Rolle als Makler von Interessen, Vermittler sowie Informationsbeschaffer. Schließlich soll auch die Außenwahrnehmung dieser Randfiguren in Betracht gezogen werden. Ihre Position am Rande der Gesellschaft und der Legalität löste in der Regel eine große Faszination beim „Normalbürger“ aus, die sich entweder in Bewunderung oder Abscheu wenden konnte. Teilweise veranlassten sie einen regelrechten Medienrummel, der den Staat wiederum in Zugzwang bringen konnte, oft mit beachtlichen Folgen.

Swiss Social Report: Generations in Perspective

Based on systematically prepared data and indicators, the Social Report 2012 informs about the current status and development trends in the Swiss society. This issue focuses on intergenerational relationships: How, for example, are intergenerational transfers carried out and what are they caused by? Does different cultural behaviour depend on the age group or do other social differences play a role? Do age-specific discriminations exist? Are young adults less politically involved than their parents? What impact has the demographic development of recent years had on the geographic structure? In addition to a selection of 75 indicators on these and other subjects, the Social Report contains five analytically oriented in-depth articles that are written from the perspective of the generational issue and which are dedicated to the following individual aspects: Equality of opportunities, cultural behaviour, age-specific discrimination, political involvement and the spatial reflection of the demographic changes. The Social Report 2012 is rooted in the tradition of the earlier issues of 2000, 2004 and 2008, which have been completely updated and supplemented with additional indicators. All the data are graphically presented and available in electronic form on this website. The five in-depth articles and all the short commentaries on the indicators were completely rewritten.

Cavovarus Foot Realignment to Treat Anteromedial Ankle Arthrosis

Background: Adult patients with cavovarus feet were seen with symptomatic anteromedial ankle arthrosis and, frequently, lateral hindfoot instability. Static and dynamic realignment was performed to redistribute joint contact pressures and restore stability. Methods: Thirteen patients with fixed cavovarus feet (6 neurogenic, 7 idiopathic; 6 with hindfoot instability, 7 without) and mild to moderate anteromedial ankle arthrosis were treated by osteotomies and tendon transfers but no lateral ligament reconstruction. Anteromedial cheilectomy of the ankle was added to increase dorsiflexion and alleviate anteromedial impingement. Results: Failure occurred in 2 patients, who required additional procedures. The remaining 11 patients improved from preoperative 45 to 71 points (American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale score) at the latest follow-up (average 84 months). Ankle dorsiflexion improved 7 degrees on average. There was no recurrent hindfoot instability and no progression of anteromedial ankle arthrosis over time. Conclusion: Cavovarus foot realignment with anteromedial ankle cheilectomy reliably improved patients’ symptoms related to ankle arthrosis, restored lateral hindfoot stability, and stabilized the extent of anteromedial ankle arthrosis when talar varus tilt was reduced. Level of Evidence: Level IV, retrospective case series.

Risk adjustment in aging societies

Background In Switzerland, age is the predominant driver of solidarity transfers in risk adjustment (RA). Concerns have been voiced regarding growing imbalances in cost sharing between young and old insured due to demographic changes (larger fraction of elderly >65 years and rise in average age). Particularly young adults aged 19–25 with limited incomes have to shoulder increasing solidarity burdens. Between 1996 and 2011, monthly intergenerational solidarity payments for young adults have doubled from CHF 87 to CHF 182, which corresponds to the highest absolute transfer increase of all age groups. Results By constructing models for age-specific RA growth and for calculating the lifetime sum of RA transfers we investigated the causes and consequences of demographic changes on RA payments. The models suggest that the main driver for RA increases in the past was below average health care expenditure (HCE) growth in young adults, which was only half as high (average 2% per year) compared with older adults (average 4% per year). Shifts in age group distributions were only accountable for 2% of the CHF 95 rise in RA payments. Despite rising risk adjustment debts for young insured the balance of lifetime transfers remains positive as long as HCE growth rates are greater than the discount rate used in this model (3%). Moreover, the life-cycle model predicts that the lifetime rate of return on RA payments may even be further increased by demographic changes. Nevertheless, continued growth of RA contributions may overwhelm vulnerable age groups such as young adults. We therefore propose methods to limit the burden of social health insurance for specific age groups (e.g. young adults in Switzerland) by capping solidarity payments. Conclusions Taken together, our mathematical modelling framework helps to gain a better understanding of how demographic changes interact with risk adjustment and how redistribution of funds between age groups can be controlled without inducing further selection incentives. Those methods can help to construct more equitable systems of health financing in light of population aging.

The Territoriality of Fiscal Solidarity: Comparing Swiss Equalisation with European Union Structural Funding

This article theorises the territorial solidarity and fiscal federalism and compares Switzerland with the European Union. While inter-territorial solidarity is a prerequisite for legitimate fiscal equalisation, such equalisation in turn also contributes to the legitimacy of and solidarity within federal political systems. By cutting across territorial and ethno-national communities, fiscal transfers often contribute to both a “civic” sense of belonging and a “cosmopolitan” identity. After placing types and degrees of (inter-)territorial solidarity at the heart of our conceptual perspective, we discuss the effects of such solidarity through an analysis of two different forms of “federal” equalisation. Comparing the recently reformed Swiss fiscal equalisation system with the EU structural funds allows us to infer if, and how, the fiscal dimension of federalism matters for feelings of solidarity, reciprocity, unity and, ultimately, for the legitimacy of the very (nation-state or Union) structures that are to contribute to the ever-growing prosperity and happiness of their people(s). In Switzerland, a civic understanding of nationhood and cross-cutting cleavages were necessary conditions for extensive, effective and legitimate fiscal equalisation. We infer that, for the EU, this means that strengthening the equalisation component of the structural funds would contribute to an ever closer Union in a political sense: because fiscal equalisation and inter-territorial solidarity are interdependent, reinforcing the one also means cementing the other. Future studies of the EU and federal-type arrangements are advised to pay more explicit attention to the solidarity-element of territoriality – or the territoriality of (fiscal) solidarity.

Energy and charge transfer dynamics in DNA based light harvesting antennae

DNA can serve as a versatile scaffold for chromophore assemblies. For example, light-harvesting antennae have been realized by incorporating phenanthrene and pyrene building blocks into DNA strands. It was shown that by exciting at 320 nm (absorption of phenanthrene), an emission at 450 nm is observed which corresponds to a phenanthrene-pyrene exciplex. The more phenanthrenes are added into the DNA duplex, the higher is the fluorescence intensity with no significant change in quantum yield. This shows that phenanthrene acts as a donor and efficiently transfers the excitation energy to the pyrene. Up to now, the mechanism of this energy transfer and exciplex formation is not known. Therefore, we first aim at studying the photo-cycle of such DNA assemblies through transient absorption spectroscopy. Based on the results, we will explore ways to manipulate the energy transfer by application of intense THz fields. Ground as well as excited state Stark effect dynamics will be investigated.