Outcome at two years of age in a Swiss national cohort of extremely preterm infants born between 2000 and 2008.

BACKGROUND: While survival rates of extremely preterm infants have improved over the last decades, the incidence of neurodevelopmental disability (ND) in survivors remains high. Representative current data on the severity of disability and of risk factors associated with poor outcome in this growing population are necessary for clinical guidance and parent counselling. METHODS: Prospective longitudinal multicentre cohort study of preterm infants born in Switzerland between 24(0/7) and 27(6/7) weeks gestational age during 2000-2008. Mortality, adverse outcome (death or severe ND) at two years, and predictors for poor outcome were analysed using multilevel multivariate logistic regression. Neurodevelopment was assessed using Bayley Scales of Infant Development II. Cerebral palsy was graded after the Gross Motor Function Classification System. RESULTS: Of 1266 live born infants, 422 (33%) died. Follow-up information was available for 684 (81%) survivors: 440 (64%) showed favourable outcome, 166 (24%) moderate ND, and 78 (11%) severe ND. At birth, lower gestational age, intrauterine growth restriction and absence of antenatal corticosteroids were associated with mortality and adverse outcome (p < 0.001). At 36(0/7) weeks postmenstrual age, bronchopulmonary dysplasia, major brain injury and retinopathy of prematurity were the main predictors for adverse outcome (p < 0.05). Survival without moderate or severe ND increased from 27% to 39% during the observation period (p = 0.02). CONCLUSIONS: In this recent Swiss national cohort study of extremely preterm infants, neonatal mortality was determined by gestational age, birth weight, and antenatal corticosteroids while neurodevelopmental outcome was determined by the major neonatal morbidities. We observed an increase of survival without moderate or severe disability.

Ilmastonmuutoksen turvallisuusvaikutukset Euroopan unionin ja Yhdysvaltojen näkökulmasta

Ilmastonmuutos on yhteinen, ajankohtainen ongelmamme. Kiistattomasti ilmastonmuutokseksi kutsuttu ilmaston lämpiäminen tulee aiheuttamaan turvattomuutta sekä uhkia turvallisuudelle eri puolilla maailmaa yksilöille, valtioille ja muille toimijoille. Suhtautumisen ilmastonmuutokseen ”pitäisi kuitenkin olla toisenlainen kuin ydinaseisiin” – ilmastonmuutoksella ei saa pelotella. Ilmastonmuutos on tietyllä tapaa ajatellen vain luonnossa esiintyvä ilmiö, vakavasti otettava ja huolestuttava, mutta kuitenkin vain ilmiö. Nykyajan tiedonvälityksen ja tietämyksen aikana se on kuitenkin saanut jo nyt aivan eri mittasuhteet kuin esimerkiksi saman aihepiiriin lukeutuvat vuosikymmenten takaiset happosateet tai otsonikato – tämän päivän ilmastonmuutoksella pelotellaan ihmisiä. Johtaako tämä alkanut prosessi ilmastonmuutoksen sotilaallistamiseen? Tämän tutkielman tarkoituksena on selvittää vertailemalla kahta ilmastostrategiaa, miksi ilmastonmuutos on nostettu kansainvälisen yhteisön terminologiassa turvallisuuskategoriaan. Tutkielma on kirjallisuustutkimus. Tutkielmaan on valittu vertailtaviksi kansainvälisen yhteisön länsimaisten suurten toimijoiden edustajien laatimat ilmastostrategiat, joista toinen edustaa realistista (USA) ja toinen konstruktivistista tai liberalistista näkökulmaa (EU). Vertailtavat ilmastostrategiat ovat: 1. Eurooppa-neuvoston pyytämä selvitys EU:n pääsihteeriltä ja Euroopan komissiolta ilmastonmuutoksen vaikutuksista kansainväliseen turvallisuuteen Climate Change and International Security, Paper from the High Representative and the European Commission to the European Council (14. March 2008 S113/08) 2. Tutkimuslaitos CNA:n koolle kutsuma yhdentoista Yhdysvaltalaisen puolustusasiantuntijan ja evp-kenraalin tai -amiraalin muodostaman Military Advisory Boardin laatima ilmastostrategia. Raportin julkaisi tutkimuslaitos CNA. National Security and the Threat of Climate Change, a Report from Military Advisory Board, Center for Naval Analysis (CNA) Corporation 2007. Tutkielma osoittaa, että vertailtujen ilmastostrategioiden esiintulossa on eroja, jotka eivät ole pelkästään selitettävissä laatijakuntansa perusteella. Tutkielma päättelee, että Atlantin itä- ja länsilaidalla ilmaston lämpiämiseen turvallisuustekijänä suhtaudutaan eri tavoin. Tutkielmassa on löytynyt laatijakunnan mukaan selitettävissä olevia eroja keinovalikoimassa ilmastonmuutoksen turvallisuusvaikutusten torjumiseksi. Näiden lisäksi löytyy myös muita, laatijakunnan mukaan selittämättömiä eroja. Tutkielman johtopäätöksinä voidaan pitää yksilön ja yhteisön kulttuuritaustan vaikuttavan suhtautumiseen ilmastonmuutoksen turvallisuusvaikutuksiin. Ilmastonmuutoksella pelotteluun on laatijakuntakohtaisesti ja ympäröivien yhteiskuntien olemuksen kautta ainakin kaksi, Atlantin eri puolilta löytyvää, syytä. Toinen, joka painottaa ilmastonmuutoksen mahdollista käyttöä oman vaikutusvallan kasvattamiseen ja toinen, joka hakee kollektiivista turvallisuutta ja yhteisvastuuta ilmastonmuutoksen aiheuttaman uhkan kautta.

Les défis de la politique européenne de défense

"Thèse présentée à la Faculté des études supérieures en vue de l'obtention du grade de Docteur en droit (LL.D) et à l'Université Jean Moulin en vue de l'obtention du grade de Docteur en droit"

Explanations of the International Community Deadlock in Bosnia and Herzegovina

La Bosnie-Herzégovine est sous supervision internationale depuis 1995. Les principaux acteurs de cette communauté internationale soit l’Union Européenne (UE) et le Bureau du Haut-Représentant à la Communauté Internationale (OHR) ont exprimé à de nombreuses reprises leur intention de transformer la mission internationale en s’éloignant du pouvoir discrétionnaire du OHR en le remplaçant par la perspective d’intégration offerte par l’UE. Malgré les bonnes intentions, cette transition semble être dans une impasse. Depuis 2006, l’organisation et la distribution des responsabilités au sein de la communauté internationale sont restées inchangées. Ce mémoire s’intéresse à ces deux principaux acteurs et à leur rôle dans l’impasse. L’objectif est de tester trois cadres d’analyse soit le rationalisme, le constructivisme et la complexité des régimes pouvant expliquer cette impasse. En se basant sur des interviews avec des experts et des représentants des deux institutions, ce mémoire explore dans quelle mesure et dans quels contextes chaque cadre d’analyse est apte à expliquer le comportement des acteurs.

Beyond retrenchment over Iran: can the EU offer a framework for regional security? CEPS Commentary, 3 September 2012

A new and far-reaching round of sanctions imposed recently on Iran by the EU is starting to hurt the country, its economy and its citizens. Yet Iran’s leadership seems deaf to demands for international weapons inspectors to be allowed unhindered access to its nuclear enrichment facilities. With a regime that is not likely to sway to international and domestic pressure, and in view of the shifting strategic landscape in the Middle East, the question is whether the twin-track approach of sanctions and diplomacy should be kept up, or whether it should make way for an alternative set of policies that could preserve the fragile stability in the wider Middle East and turn a vicious circle into a virtuous one. In this new Commentary, CEPS Senior Research Fellow Steven Blockmans argues that the High Representative of the EU for Foreign Affairs and Security Policy, supported by the European External Action Service, is in a good position to offer a negotiated way out of this seemingly intractable situation.

The Gulf Cooperation Council as a New Regional Power: Time for the EU to Propose a Strategic Partnership. Bruges Regional Integration & Global Governance Papers 3/2012, November 2012

The Gulf Cooperation Council (GCC) is a de facto regional power in the Arab world. Its role has been crucial in some of the outcomes of the Arab Spring. The GCC countries have been very pragmatic in dealing with the uprisings, avoiding any revolutionary spill-over throughout the Gulf region. This paper examines to what extent the policies of the European Union (EU) in the Gulf have changed since the beginning of the Arab Spring. It argues that despite the calls by the European Parliament and by the High Representative Baroness Ashton to improve the relationship, the EU’s support for a new policy in the Gulf after the Arab Spring is stalling, and little new or concrete has been achieved. The paper concludes that the Union needs a reinforced partnership that merges the various EU policies in the region into a single strategic partnership with the Arab countries.

Status of Implementation of the Almaty Programme of Action in South America

Includes bibliography.

Outcome at two years of age in a Swiss national cohort of extremely preterm infants born between 2000 and 2008

Background While survival rates of extremely preterm infants have improved over the last decades, the incidence of neurodevelopmental disability (ND) in survivors remains high. Representative current data on the severity of disability and of risk factors associated with poor outcome in this growing population are necessary for clinical guidance and parent counselling. Methods Prospective longitudinal multicentre cohort study of preterm infants born in Switzerland between 240/7 and 276/7 weeks gestational age during 2000–2008. Mortality, adverse outcome (death or severe ND) at two years, and predictors for poor outcome were analysed using multilevel multivariate logistic regression. Neurodevelopment was assessed using Bayley Scales of Infant Development II. Cerebral palsy was graded after the Gross Motor Function Classification System. Results Of 1266 live born infants, 422 (33%) died. Follow-up information was available for 684 (81%) survivors: 440 (64%) showed favourable outcome, 166 (24%) moderate ND, and 78 (11%) severe ND. At birth, lower gestational age, intrauterine growth restriction and absence of antenatal corticosteroids were associated with mortality and adverse outcome (p < 0.001). At 360/7 weeks postmenstrual age, bronchopulmonary dysplasia, major brain injury and retinopathy of prematurity were the main predictors for adverse outcome (p < 0.05). Survival without moderate or severe ND increased from 27% to 39% during the observation period (p = 0.02). Conclusions In this recent Swiss national cohort study of extremely preterm infants, neonatal mortality was determined by gestational age, birth weight, and antenatal corticosteroids while neurodevelopmental outcome was determined by the major neonatal morbidities. We observed an increase of survival without moderate or severe disability.

Raiders of the Lost Art: Strategy-Making in Europe. Security Policy Brief No. 40, November 2012

Have Europeans lost the art of making grand strategy? In a reflection process initiated by Sweden, Poland, Italy and Spain, they are invited to rediscover it and draft a “European Global Strategy”. This policy brief argues that what the EU needs most is a short set of priorities for collective action, to be reassessed for each term of the High Representative.

Programming EU External Action Post-Lisbon: New Opportunities or Business as Usual?

Over 90% of the external relations budget of the EU is processed through its external financial instruments. With the Lisbon Treaty and the creation of the new European External Action Service (EEAS), the institutional architecture of these instruments was significantly reformed. This contribution analyses strategic programming both pre- and post-Lisbon, identifies ‘winners’ and ‘losers’, and examines the potential of the new provisions to increase the coherence of EU external action. The examination shows that the instruments can be categorised into three groupings: ‘the big three’ comprising the bulk of funding characterised by joint programming and responsibilities; the ‘Commission-only’ instruments where all powers remain with the Commission; and the ‘EEAS-led rest’ in which the High Representative and the EEAS play a strong role but only have limited financial resources available. The new system calls for strong coordination of all involved actors in order to make it work. Findings of a case study on the Instrument for Stability reveal, however, that so far the establishment of the EEAS has not made a substantial impact on strategic programming in its first two years.

EEAS 2.0. A legal commentary on Council Decision 2010/427/EU establishing the organisation and functioning of the European External Action Service. EIPA Working Paper, 2013

From the Preface. Pursuant to Article 13(3) of Council Decision 2010/427/EU of 26 July 2010 establishing the organisation and functioning of the European External Action Service, the High Representative is held to provide a review of the organisation and functioning of the EEAS by mid-­‐2013. This review will cover, inter alia, the implementation of Article 6(6), (8) and (11), so as to ensure an adequate geographical and gender balance and a meaningful presence of nationals from all member states in the EEAS. If necessary, the review will be accompanied by appropriate proposals for the revision of the 2010 Council Decision (e.g., suggestions for additional specific measures to correct possible imbalances of staffing). In that case, the Council will, in accordance with Article 27(3) TEU, revise the Decision in light of the review by the beginning of 2014. This short and user-­‐friendly legal commentary on the 2010 Council Decision is the first of its kind and is intended to inform those involved in the review process and to serve as a reference document for practitioners and analysts dealing with the EEAS. This commentary is not an elaborate doctrinal piece, but rather a textual and contextual analysis of each article, that takes account of i) other relevant legal provisions (primary, secondary, international), ii) the process leading to the adoption of the 2010 Council Decision (i.e. travauxpréparatoires), iii) the preamble of the Council Decision, and iv) insofar as it is possible at this stage, early implementation. Wherever relevant, cross-­‐references to other provisions of the EEAS Council Decision have been made so as to tie in the different commentaries and ensure overall consistency.