Induction of labor with titrated oral misoprostol solution versus oxytocin in term pregnancy: randomized controlled trial

PURPOSE: To evaluate the effectiveness and the safety of orally administered misoprostol in comparison to intravenously infused oxytocin for labor induction in term pregnant women. METHODS: Between 2008 and 2010, a total of 285 term pregnant women whom were candidate for vaginal delivery were assessed for eligibility to enter the study. Twenty five patients were excluded for different reasons; and 260 included women were randomly assigned to one of the two groups according to the method of treatment, misoprostol or oxytocin. The misoprostol group received 25 µg every 2 hours for up to 24 hours for induction. The oxytocin group received an infusion of 10 IU which was gradually increased. The time from induction to delivery and induction to the beginning of the active phase and successful inductions within 12, 18, and 24 hours were recorded. The trial is registered at irct.ir, number IRCT2012061910068N1. RESULTS: Failure of induction, leading to caesarean section was around 38.3% in the oxytocin group and significantly higher than that of the misoprostol group (20.3%) (p<0.001). Despite the more prevalent failure in the oxytocin group, the mean time intervals from induction to active phase and labor of this group were both significantly less than the misoprostol group (10.1±6.1 and 13.2±7.7 versus 12.9±5.4 and 15.6±5.1 hours respectively, both p-values were <0.05). Maternal and fetal complications were comparable between groups except gastrointestinal symptoms which were encountered more frequently in the misoprostol (10.9 versus 3.9%, p=0.03). CONCLUSIONS: Misoprostol is a safe and effective drug with low complications for the induction of labor. Failure is seen less with misoprostol and caesarean sections are less frequently indicated as compared to oxytocin.

Estimation of Fetal Weight during Labor: Still a Challenge

Objective To evaluate the accuracy of fetal weight prediction by ultrasonography labor employing a formula including the linear measurements of femur length (FL) and mid-thigh soft-tissue thickness (STT). Methods We conducted a prospective study involving singleton uncomplicated term pregnancies within 48 hours of delivery. Only pregnancies with a cephalic fetus admitted in the labor ward for elective cesarean section, induction of labor or spontaneous labor were included. We excluded all non-Caucasian women, the ones previously diagnosed with gestational diabetes and the ones with evidence of ruptured membranes. Fetal weight estimates were calculated using a previously proposed formula [estimated fetal weight = [1] 1687.47 + (54.1 x FL) + (76.68 x STT). The relationship between actual birth weight and estimated fetal weight was analyzed using Pearson's correlation. The formula's performance was assessed by calculating the signed and absolute errors. Mean weight difference and signed percentage error were calculated for birth weight divided into three subgroups: < 3000 g; 3000-4000g; and > 4000 g. Results We included for analysis 145 cases and found a significant, yet low, linear relationship between birth weight and estimated fetal weight (p < 0.001; R2 = 0.197) with an absolute mean error of 10.6%. The lowest mean percentage error (0.3%) corresponded to the subgroup with birth weight between 3000 g and 4000 g. Conclusions This study demonstrates a poor correlation between actual birth weight and the estimated fetal weight using a formula based on femur length and mid-thigh soft-tissue thickness, both linear parameters. Although avoidance of circumferential ultrasound measurements might prove to be beneficial, it is still yet to be found a fetal estimation formula that can be both accurate and simple to perform.

Pursuing substantive participation in Russia : a perspective from international legal obligations and comparative law

Så som är fallet för många andra stater, kan vissa delar av den ryska förvaltningen ännu utvecklas för att till fullo uppfylla internationella standarder. Internationella fördragsorgan som övervakar förverkligandet i Ryssland av fördrag om mänskliga rättigheter framför ibland kritiska anmärkningar om den demokratiska utvecklingen i Ryssland. Enskilda fall där politiska rättigheter möjligen kränkts av ryska myndigheter har utan tvivel placerat Ryssland i fokus för internationell media. Exempel på sådana fall är mordet på journalisten Anna Politkovskaya, Sergei Magnitskys död i fängelse och fängslandet av medlemmarna i "Pussy Riot”. Likväl anser författaren av denna studie att politiska rättigheter i Ryssland förverkligas inom rimliga gränser och i enlighet med internationell människorättslagstiftning. Denna studie fokuserar på förverkligandet av den individuella rättigheten att delta i det politiska beslutsfattandet i Ryssland genom andra mekanismer för deltagande än val och folkomröstningar. Studien utgörs av en sammanställning av forskningsartiklar som har publicerats i olika internationella tidskrifter. Sammanställningen föregås av ett fristående inledande kapitel. Författaren koncentrerar sig på frågan om Rysslands invånare ges effektiva möjligheter att delta i handhavandet av allmänna angelägenheter och om det finns användbara rättsmedel till hands för skydd av de politiska rättigheterna. Författaren tar sig an en juridisk analys av rysk lagstiftning gällande olika sätt för direkt deltagande i beslutsfattande samt analyserar rättsfall angående direkt deltagande från domstolarna i Moskva, Perm Krai och Sverdlovsk Oblast. Denna studie använder sig även av en rättshistorisk infallsvinkel för att visa på den positiva dynamiken hos den historiska utvecklingen beträffande d e väsentligaste plattformarna för offentligt deltagande. Det bevisas att rysk lagstiftning som garanterar rätten att delta i beslutsfattande är väl utvecklad i enlighet med internationella människorättsfördrag, och att åtminstone domstolarna i de utvalda ryska områdena fattar beslut som stöder deltaganderättigheter som eventuellt kränkts av myndigheter inom den verkställande makten. Författaren kommer till den slutsatsen att de i denna studie inkluderade enskilda dokumenterade händelserna gällande administrativ felbehandling inte nödvändigtvis tillåter den direkta slutsatsen att det begås systematiska och grova kränkningar av medborgares deltaganderättigheter i Ryssland.

Opportunistisen sopimusrikkomuksen ongelmasta, erityisesti Suomen vahingonkorvaus- ja rikoslainsäädännön näkökulmasta tarkasteltuna. Law and Economics -näkökulma.

Tämä pro gradu -tutkielma käsittelee opportunistisen sopimusrikkomuksen ongelmaa erityisesti Suomen vahingonkorvaus- ja rikoslainsäädännön näkökulmasta tarkasteltuna. Tutkielman lähestymistapa on oikeustaloustieteellinen (engl. Law and Economics). Opportunistisella sopimusrikkomuksella tarkoitetaan toimintaa, jossa sopimusosapuoli rikkoo sopimuksen tarkoituksellisesti, pyrkimyksenään tällä toiminnalla saavuttaa enemmän hyötyä kuin sopimuksessa pysymällä. Opportunistinen sopimusrikkomus on mahdollista toteuttaa tilanteessa, jossa sopimusasetelma itsessään antaa mahdollisuuden enemmän hyödyn saavuttamiseen rikkomus toteuttamalla kuin sopimus asianmukaisesti täyttämällä. Suomalaisessa vahingonkorvausjärjestelmässä sovelletaan sopimusrikkomusten osalla positiivisen sopimusedun mukaista vahingonkorvausta, joka hyvittää rikotulle osapuolelle sopimussuhteeseen ryhtymisestä syntyneet kustannukset sekä sopimusrikkomuksen johdosta saamatta jääneen tuoton. Positiivisen sopimusedun soveltaminen ei kuitenkaan ole opportunistisen sopimusrikkomuksen ehkäisemiseksi riittävää, sillä opportunistisesti toimiva sopimusosapuoli voi jäädä rikkomuksensa johdosta voitolle vielä sen jälkeenkin, kun kärsineelle osapuolelle on jo positiivista sopimusetua noudattaen korvattu sopimussuhteessa syntyneet kustannukset sekä rikkomuksen johdosta saamatta jäänyt tuotto. Keskeinen ongelma koskien opportunististen sopimusrikkomustilanteiden syntyä onkin juuri vallitsevan sääntelyn liiallinen keskittyminen rikotun osapuolen kärsimän vahingon kompensoimiseen, ei rikkomustilanteiden synnyn ennaltaehkäisemiseen. Suomen vahingonkorvausjärjestelmää tulisi kehittää suuntaan, jossa järjestelmä paremmin ennaltaehkäisisi opportunististen sopimusrikkomustilanteiden syntyä. Common law -oikeusjärjestelmässä käytössä olevan disgorgement principle -suuntaisen ajattelun, jossa korvauksen perustana toimisi rikkomuksella saatu hyöty kärsityn vahingon sijaan, omaksuminen olisi yksi mahdollinen kehityskulku. Olennaista olisi kuitenkin se, että järjestelmää kehitettäisiin suuntaan, jossa rikkomus ei enää voisi tulla rikkojalle kannattavaksi. Opportunistisen toiminnan kannustimet tulisi lainsäädäntöä tarkistamalla poistaa. Tällä olisi sekä sopimusinstituutiota turvaavaa että vaihdantaa edistävää vaikutusta.

Coping with international atrocities through criminal law : a study into the typical features of international criminality and the reflection of these traits in international criminal law

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A law of the wall formulation for recirculating flows

This work presents a new law of the wall formulation for recirculating turbulent flows. An alternative expression for the internal length which can be applied in the separated region is also presented. The formulation is implemented in a numerical code which solves the k-epsilon model through a finite volume method. The theoretical results are compared with the experimental data of Vogel and Eaton (J. of Heat Transfer, Transactions of ASME, vol.107, pp. 922-929, 1985). The paper shows that the present formulation furnishes better results than the standard k-epsilon formulation.

Rocket tracking and decoupling eigenstructure control law

A control law was designed for a satellite launcher ( rocket ) vehicle using eigenstructure assignment in order that the vehicle tracks a reference attitude and also to decouple the yaw response from roll and pitch manoeuvres and to decouple the pitch response from roll and yaw manoeuvres. The design was based on a complete linear coupled model obtained from the complete vehicle non linear model by linearization at each trajectory point. After all, the design was assessed with the vehicle time varying non-linear model showing a good performance and robustness. The used design method is explained and a case study for the Brazilian satellite launcher ( VLS Rocket ) is reported.

The European Union and Assembling Biofuel Development – topological investigations concerning the associations between law, policy and space

Biofuels for transport are a renewable source of energy that were once heralded as a solution to multiple problems associated with poor urban air quality, the overproduction of agricultural commodities, the energy security of the European Union (EU) and climate change. It was only after the Union had implemented an incentivizing framework of legal and political instruments for the production, trade and consumption of biofuels that the problems of weakening food security, environmental degradation and increasing greenhouse gases through land-use changes began to unfold. In other words, the difference between political aims for why biofuels are promoted and their consequences has grown – which is also recognized by the EU policy-makers. Therefore, the global networks of producing, trading and consuming biofuels may face a complete restructure if the European Commission accomplishes its pursuit to sideline crop-based biofuels after 2020. My aim with this dissertation is not only to trace the manifold evolutions of the instruments used by the Union to govern biofuels but also to reveal how this evolution has influenced the dynamics of biofuel development. Therefore, I study the ways the EU’s legal and political instruments of steering biofuels are coconstitutive with the globalized spaces of biofuel development. My analytical strategy can be outlined through three concepts. I use the term ‘assemblage’ to approach the operations of the loose entity of actors and non-human elements that are the constituents of multi-scalar and -sectorial biofuel development. ‘Topology’ refers to the spatiality of this European biofuel assemblage and its parts whose evolving relations are treated as the active constituents of space, instead of simply being located in space. I apply the concept of ‘nomosphere’ to characterize the framework of policies, laws and other instruments that the EU applies and construes while attempting to govern biofuels. Even though both the materials and methods vary in the independent articles, these three concepts characterize my analytical strategy that allows me to study law, policy and space associated with each other. The results of my examinations underscore the importance of the instruments of governance of the EU constituting and stabilizing the spaces of producing and, on the other hand, how topological ruptures in biofuel development have enforced the need to reform policies. This analysis maps the vast scope of actors that are influenced by the mechanism of EU biofuel governance and, what is more, shows how they are actively engaging in the Union’s institutional policy formulation. By examining the consequences of fast biofuel development that are spatially dislocated from the established spaces of producing, trading and consuming biofuels such as indirect land use changes, I unfold the processes not tackled by the instruments of the EU. Indeed, it is these spatially dislocated processes that have pushed the Commission construing a new type of governing biofuels: transferring the instruments of climate change mitigation to land-use policies. Although efficient in mitigating these dislocated consequences, these instruments have also created peculiar ontological scaffolding for governing biofuels. According to this mode of governance, the spatiality of biofuel development appears to be already determined and the agency that could dampen the negative consequences originating from land-use practices is treated as irrelevant.

The collective dimension of freedom of religion or belief in international law : the application of findings to the case of Turkey

Pertinent domestic and international developments involving issues related to tensions affecting religious or belief communities have been increasingly occupying the international law agenda. Those who generate and, thus, shape international law jurisprudence are in the process of seeking some of the answers to these questions. Thus the need for reconceptualization of the right to freedom of religion or belief continues as demands to the right to freedom of religion or belief challenge the boundaries of religious freedom in national and international law. This thesis aims to contribute to the process of “re-conceptualization” by exploring the notion of the collective dimension of freedom of religion or belief with a view to advance the protection of the right to freedom of religion or belief. The case of Turkey provides a useful test case where both the domestic legislation can be assessed against international standards, while at the same time lessons can be drawn for the improvement of the standard of international review of the protection of the collective dimension of freedom of religion or belief. The right to freedom of religion or belief, as enshrined in international human rights documents, is unique in its formulation in that it provides protection for the enjoyment of the rights “in community with others”.1 It cannot be realized in isolation; it crosses categories of human rights with aspects that are individual, aspects that can be effectively realized only in an organized community of individuals and aspects that belong to the field of economic, social and cultural rights such as those related to religious or moral education. This study centers on two primary questions; first, what is the scope and nature of protection afforded to the collective dimension of freedom of religion or belief in international law, and, secondly, how does the protection of the collective dimension of freedom of religion or belief in Turkey compare and contrast to international standards? Section I explores and examines the notion of the collective dimension of freedom of religion or belief, and the scope of its protection in international law with particular reference to the right to acquire legal personality and autonomy religious/belief communities. In Section II, the case study on Turkey constitutes the applied part of the thesis; here, the protection of the collective dimension is assessed with a view to evaluate the compliance of Turkish legislation and practice with international norms as well as seeking to identify how the standard of international review of the collective dimension of freedom of religion or belief can be improved.

Maternal serum progesterone, estradiol and estriol levels in successful dinoprostone-induced labor

Hormone-mediated quiescence involves the maintenance of a decreased inflammatory responsiveness. However, no study has investigated whether labor induction with prostanoids is associated with changes in the levels of maternal serum hormones. The objective of this study was to determine whether labor induction with dinoprostone is associated with changes in maternal serum progesterone, estradiol, and estriol levels. Blood samples were obtained from 81 pregnant women at term. Sixteen patients had vaginal birth after spontaneous labor, 12 required cesarean section after spontaneous labor and 16 underwent elective cesarean. Thirty-seven patients had labor induction with dinoprostone. Eligible patients received a vaginal insert of dinoprostone (10 mg) and were followed until delivery. Serum progesterone (P4), estradiol (E2) and estriol (E3) levels and changes in P4/E2, P4/E3 and E3/E2 ratios were monitored from admission to immediately before birth, and the association of these measures with the resulting clinical classification outcome (route of delivery and induction responsiveness) was assessed. Progesterone levels decreased from admission to birth in patients who underwent successful labor induction with dinoprostone [vaginal and cesarean birth after induced labor: 23% (P < 0.001) and 18% (P < 0.025) decrease, respectively], but not in those whose induction failed (6.4% decrease, P > 0.05). Estriol and estradiol levels, P4/E2, P4/E3 and E3/E2 ratios did not differ between groups. Successful dinoprostone-induced labor was associated with reduced maternal progesterone levels from induction to birth. While a causal relationship between progesterone decrease and effective dinoprostone-induced labor cannot be established, it is tempting to propose that dinoprostone may contribute to progesterone withdrawal and favor labor induction in humans.

The house that the Court built. The retained powers case law of the European Court of Justice and the constitutional structure of the Union

Euroopan unionin perustamissopimusten katsotaan muodostavan EU:n valtiosäännön, jonka rajat ovat kuitenkin perustamissopimusten määräysten väljän muotoilun sekä Euroopan unionin tuomioistuimen tulkintakäytännön valossa epätarkat. Etenkin kysymys unionin ja sen jäsenvaltioiden välisestä toimivallanjaosta on EU-oikeudellisen tutkimuksen klassikoita. Tarkastelen pro gradu -tutkielmassani unionin valtiosääntörakennetta ja unionioikeuden kokonaisvaikutusta jäsenvaltioiden toimivaltojen käyttöön erityisesti EU-tuomioistuimen ratkaisukäytännössään kehittämän niin kutsutun retained powers -doktriinin valossa. Kyseisen opin mukaan EU-oikeus asettaa vaatimuksia jäsenvaltioiden toimivaltojen käytölle myös niillä aloilla, joilla sääntelytoimivalta on jäänyt jäsenvaltioille eikä sitä ole jaettu unionin kanssa. Aiheen teoreettisen tarkastelun pohjalta analysoin Euroopaun unionin tuomioistuimen ratkaisukäytäntöä erityisesti yhtä säilytetyn toimivallan alaa, koulutusta, koskevissa tapauksissa pyrkien havaitsemaan typologioita tuomioistuimen ratkaisutoiminnassa. Tutkimus noudattaa EU-valtiosääntöoikeuden metodologiaa. Keskeisenä lähdemateriaalina on siten käytetty unionituomioistuimen ratkaisukäytäntöä, joka heijastaa perustamissopimuksia tarkemmin unionin valtiosääntörakennetta. Oikeuskäytännön analyysi ja tulkinta on suoritettu peilaten sitä vasten unionin kehitystä markkinaorientoituneesta organisaatiosta yleismaailmalliseksi poliittiseksi unioniksi. Tutkielmani loppupäätelmä on, että jäsenvaltiot ovat tietyissä rajoissa hyväksyneet unionituomioistuimen kehittämän doktriinin, ja unionituomioistuin on siten saanut aikaan tosiasiallisen muutoksen EU:n valtiosääntörakenteessa. Retained powers -doktriini on omiaan syventämään eurooppalaista integraatiota ja nostaa kysymyksiä toimivallanjaon merkityksestä unionioikeudessa, perustamissopimusten kyvystä heijastaa unionin valtiosääntörakennetta sekä unionituomioistuimen toiminnan poliittisesta luonteesta.

Inclusion or Exclusion? Trade union strategies and Labor migration

Inclusion or Exclusion? Trade Union Strategies and Labor Migration This research identified and analyzed immigration-related strategies of the Finnish Construction Trade Union (FCTU) and the Service Union United (SUU); e.g. how the unions react to labor immigration, whether unions seek to include migrants in the unions, and what is migrants’ position in the unions. The two unions were chosen as the focus of the research because the workforce in the sectors they represent is migrant-dense. The study also analyzed the experiences that migrants who work in these sectors have with trade unions. The Estonian labor market situation –including the role of Estonian trade unions– was also examined as it has a considerable impact on the operating environment of the FCTU. The results of the study indicate that immigration is a contradictory issue for both unions. On the one hand, they strive to include migrants as trade union members and to defend migrants’ labor rights. On the other hand, they, together with their umbrella organization the Central Organisation of Finnish Trade Unions (SAK), seek to prevent labor immigration from outside the EU and EEA countries. They actively defend current labor immigration restrictions by drawing atten- tion to high unemployment figures and to the breaches of working conditions migrants encounter. In contrast, the employer organizations promote a more liberal state policy on labor immigration because they see it as a boost for business. Both the unions and the employer organizations ground their arguments on national interest. However, the position of the trade union movement is not uniform: unions belonging to the Confederation of Unions for Professionals and Managerial Staff in Finland (Akava) embrace more liberal labor immigration stances than the SAK. A key trade union strategy is to try to guarantee that migrants’ working condi- tions do not differ from those of the natives. The FCTU and the SUU inform migrants about Finnish collective agreements and trade union membership in the most common migrant languages. This is important for the unions because it is not in their interest that migrants’ working conditions are undercut. The interviewed migrants said that natives had more negotiating power with employers, which is often negatively portrayed in migrants’ working conditions. Migrants perceive that trade unions have an important role in protecting their working conditions. However, they stressed that migrants’ knowledge of unions is often very limited. The number of migrants in both two unions studied here is increasing. Espe- cially in the SUU, a considerable proportion of the new members are migrants. The FCTU is in a more challenging situation than the SUU because migrant construc- tion workers often work only for short periods in Finland and are consequently not interested in becoming union members. The unions’ strategies partly differ: the FCTU was the first Finnish trade union to establish a trade union branch/lo- cal for migrant members. The goal is to facilitate migrants’ inclusion in the union and to highlight the specific problems they face. The SUU, for its part, insists that such a special strategy would exclude migrants within the union organization. Despite the unions’ strategies, migrants are still underrepresented as union members and officials, which some of the interviewed migrants saw as a problem. Immigrants’ perception of trade unions was pragmatic: they had joined unions when membership yielded concrete benefits. In spite of the unions’ strategies, migrants –and temporary migrants– encoun- ter specific problems in terms of working conditions. Both unions demand more state intervention to protect migrants’ labor rights because overseeing working conditions consumes union resources. However, without the unions’ intervention, these problems would be more common than is currently the case. For instance, some of the interviewed migrants had received trade union assistance in claim- ing unpaid wages. The study demonstrated with the help of building on Walter Korpi’s power resources theory, that immigration is a power resource issue for the unions: suc- cessful immigration-related strategies strengthen unions –and vice versa. The research also showed how the unions’ operating environments constrain and enable their immigration-related strategies. This study has illuminated a previously ignored dimension: the immigrant- inclusive strategies of the Finnish trade unions. The research material consists of 78 qualitative interviews, observation in trade union events, and trade unions’ and employer organizations’ public state- ments.