293 research outputs found
Human rights norms in 'other' international courts : part of studies on international courts and tribunals
No full textThis unique book examines the role and impact of human rights norms in international courts other than human rights courts. It covers a whole range of courts and jurisdictions, looking at the practice of prominent international courts, such as the International Court of Justice and the International Criminal Court, as well as various fora of economic adjudication, including the World Trade Organisation, regional integration organisations in Europe and Africa, and investment arbitration. The book systematically explores the role of human rights norms at the International Tribunal for the Law of the Sea, thereby providing an insight into the future evolution of environmental law towards judicial enforcement at the international level. Within each jurisdiction under study, the respective authors, who all are experts within their fields, address the role of different categories of human rights, as well as the range of available modes of operation of human rights norms.1. How and why to assess the relevance of human rights norms in 'other' international courts?, Martin Scheinin
2. The interpretation and development of international human rights law by the International Court of Justice, Gentian Zyberi
3. The International Court of Justice as an integrator, developer and globaliser of international human rights law, Başak Çalı, Lorna McGregor and Zeynep Elibol
4. The systemic effect of international human rights law on international criminal law, Alexandre Skander Galand
5. The emerging right to justice in international criminal law: a case study of Colombia, Marina Aksenova
6. Human rights at the reparations system of the International Criminal Court, Juan-Pablo Pérez-León-Acevedo
7. International human rights law and dispute settlement in the World Trade Organisation, Holger Hestermeyer
8. Invoking human rights: a useful line of attack or a defence tool for states in investor-state dispute settlement?, Freya Baetens
9. Human rights norms in the Court of Justice of the European Union, Vasiliki Kosta and Bruno De Witte
10. The uneven impact of international human rights law in Africa's subregional courts, Solomon T. Ebobrah
11. Human rights, constitutional justice and international economic adjudication: legal methodology problems, Ernst-Ulrich Petersmann
12. The International Tribunal for the Law of the Sea and human rights, Anna Petrig and Marta Bo
13. Forum shopping and human rights: staring at the empty shelves, Payam Akhavan
14. Taking stock: relevance of human rights norms in 'other' international courts, Martin Scheini
The impact of human rights law on general international law
No full textTraditional international law aims to protect the values and interests of states. The rapidly increasing corpus of international human rights law (including international humanitarian law and international criminal law) increasingly challenges the basic tenets of general international law. In order to become accepted as the law of the world community, general international law needs to better reflect the values and interests of a wider range of actors, including the individual.
This volume provides the first comprehensive examination of the impact of international human rights law on general international law. It considers areas including the structure of international obligations, the formation of customary international law, treaty law, immunities, state responsibility and diplomatic protection. The authors trace the extent to which concepts emanating from international human rights law are being incorporated by the guardians of traditional international law: the International Court of Justice and the International Law Commission.
The book contains work carried out by the Committee on International Law and Practice of the International Law Association (ILA) over a period of four years, including the Committee's Final Report on the Impact of International Human Rights Law on General International Law and in-depth contributions by Committee members on key areas of international law
Arpityrän kirurginen hoito : – tutkimuksia tähystysleikkaustekniikoista
No full textAbstractAn incisional hernia is a common complication following abdominal surgery. A hernia repair is recommended for the risk of incarceration. There are several operative methods. The laparoscopic technique is in wide use, but it is associated with a risk of enterotomy. Seroma formation is a common postoperative finding. In the hybrid technique, adhesions can be lysed and the fascial defect sutured through a mini-incision prior to mesh augmentation. In this thesis, we evaluate the complications associated with hernia repair operations, focusing on laparoscopic methods. We explore whether seroma formation and hernia recurrence could be diminished using the hybrid method.Study I was a descriptive analysis of 127 claims concerning ventral hernioplasties reported to the Finnish Patient Insurance Centre from 2003–2010. In Study II, we analysed 818 incisional hernia repairs, focusing on major complications. In Study III, the results of 38 laparoscopic and 24 hybrid operations in cases featuring complex adhesiolysis were compared. In prospective multicentre Studies IV–V, 193 operations randomised to either the laparoscopic or hybrid technique were analysed.In retrospective Studies I–III, we found that major complications were related to undetected enterotomies. Complex adhesions had a significant influence on major complications, enterotomies, and surgical site infections. In Studies IV–V, five enterotomies occurred in laparoscopic operations compared to one in hybrid operations. Adhesiolysis was described clearly more often complex in the laparoscopic group than in the hybrid group. After laparoscopy, there were significantly more seromas when compared to the hybrid operations. After one year, no difference in hernia recurrence was seen between the groups. Eleven (6.4%) recurrent hernias were detected: six in the laparoscopic group and five in the hybrid group.Laparoscopic operations carry a low complication rate, but the risk of enterotomy is still apparent, especially in cases in which intense adhesions are present. A hybrid operation offers a safe approach to lyse adhesions by hand, and therefore the risk of enterotomy low. Seroma formation is clearly diminished after hybrid operations, but its influence on hernia recurrence requires a longer follow-up period. Patients are pain-free following hernia repair, resulting in their better quality of life.Original papersOriginal papers are not included in the electronic version of the dissertation.Ahonen-Siirtola, M., Vironen, J., Mäkelä, J., & Paajanen, H. (2014). Surgery-related complications of ventral hernia reported to the Finnish Patient Insurance Centre. Scandinavian Journal of Surgery, 104(2), 66–71. https://doi.org/10.1177/1457496914534208Ahonen-Siirtola, M., Rautio, T., Ward, J., Kössi, J., Ohtonen, P., & Mäkelä, J. (2015). Complications in Laparoscopic Versus Open Incisional Ventral Hernia Repair. A Retrospective Comparative Study. World Journal of Surgery, 39(12), 2872–2877. https://doi.org/10.1007/s00268-015-3210-6Ahonen-Siirtola, M., Rautio, T., Biancari, F., Ohtonen, P., & Mäkelä, J. (2017). Laparoscopic versus Hybrid Approach for Treatment of Incisional Ventral Hernia. Digestive Surgery, 34(6), 502–506. https://doi.org/10.1159/000458713Ahonen-Siirtola, M., Nevala, T., Vironen, J., Kössi, J., Pinta, T., Niemeläinen, S., … Rautio, T. (2018). Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a prospective randomized multicenter study of 1-month follow-up results. Hernia, 22(6), 1015–1022. https://doi.org/10.1007/s10029-018-1784-2Ahonen-Siirtola, M., Nevala, T., Vironen, J., Kössi, J., Pinta, T., Niemeläinen, S., … Rautio, T. (2019). Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a prospective randomised multicentre study, 1-year results. Surgical Endoscopy. Advance online publication. https://doi.org/10.1007/s00464-019-06735-9Self-archived versionTiivistelmäArpityrä on yleinen leikkauskomplikaatio, ja sen korjaamista suositellaan kureutumisriskin vuoksi. Leikkaustekniikoita on useita. Suosittuun tähystysleikkaustekniikkaan tiedetään liittyvän vakavan komplikaation, suolivaurion riski. Leikkausalueen nestekertymä on yleinen löydös leikkauksen jälkeen. Hybriditekniikassa kiinnikkeiden irrottelu tehdään pienen avauksen kautta ja tyräaukko suljetaan ennen verkon kiinnittämistä. Tutkimuksessa arvioimme tyräleikkauskomplikaatioita keskittyen tähystysleikkaustekniikoihin. Selvitimme voiko hybriditekniikkaa käyttäen vähentää leikkauksen jälkeisen nestekertymän muo-dostumista ja tyrän uusiutumista.Osatyö I kuvaili Potilasvakuutuskeskukseen vuosina 2003–2010 ilmoitettuja vatsan tyräleikkauksiin liittyviä vahinkoja (n = 127). Osatyössä II analysoimme 818 tyränkorjausleikkauksen tulokset keskittyen vakaviin komplikaatioihin. Osatyössä III verrattiin 38 tähystys- ja 24 hybridileikkauksien tuloksia tilanteissa, joissa todettiin hankalat kiinnikkeet. Prospektiivisessa monikeskustutkimuksessa (osatyöt IV–V) 193 potilasta leikattiin satunnaistamisen mukaan tähystys- tai hybriditekniikkaa käyttäen.Retrospektiivisissä osatöissä I–III totesimme, että tähystysleikkauksien vakavat komplikaatiot liittyivät huomaamatta jääneisiin suolivaurioihin. Hankalilla kiinnikkeillä todettiin selkeä yhteys vakaviin komplikaatioihin, suolivaurioihin ja haavainfektioihin. Prospektiivisissa osatöissä IV–V kuvattiin viisi suolivauriota tähystysleikkauksien ja yksi hybridileikkauksien yhteydessä. Kiinnikkeiden irrottelu oli selvästi hankalampaa tähystysleikkauksissa. Tähystysleikkausten jälkeen todettiin selvästi enemmän leikkausalueen nestekertymiä verrattuna hybridileikkauksiin. Vuoden kohdalla tyräuusiutumien määrässä ei ollut eroja ryhmien välillä; 11 (6,4 %) tyräuusiutumasta kuusi todettiin tähystys- ja viisi hybridiryhmässä.Toteamme, että tähystysleikkauksiin liittyviä komplikaatiota on vähän, mutta suolivaurion riski on kohonnut leikkauksissa, joissa todetaan runsas kiinnikkeisyys. Hybriditekniikassa kiinnikkeiden irrottelu käsin voi vähentää suolivaurion riskiä. Nestekertymän ilmaantuminen leikkausalueelle on selvästi vähäisempää hybridileikkauksen jälkeen, mutta sen vaikutus tyrän uusiutumisriskiin vaatii pidemmän seuranta-ajan. Potilaat ovat kivuttomia tyränkorjausleikkauksen jälkeen, mikä näkyy elämänlaadun kohenemisena.OsajulkaisutOsajulkaisut eivät sisälly väitöskirjan elektroniseen versioon.Ahonen-Siirtola, M., Vironen, J., Mäkelä, J., & Paajanen, H. (2014). Surgery-related complications of ventral hernia reported to the Finnish Patient Insurance Centre. Scandinavian Journal of Surgery, 104(2), 66–71. https://doi.org/10.1177/1457496914534208Ahonen-Siirtola, M., Rautio, T., Ward, J., Kössi, J., Ohtonen, P., & Mäkelä, J. (2015). Complications in Laparoscopic Versus Open Incisional Ventral Hernia Repair. A Retrospective Comparative Study. World Journal of Surgery, 39(12), 2872–2877. https://doi.org/10.1007/s00268-015-3210-6Ahonen-Siirtola, M., Rautio, T., Biancari, F., Ohtonen, P., & Mäkelä, J. (2017). Laparoscopic versus Hybrid Approach for Treatment of Incisional Ventral Hernia. Digestive Surgery, 34(6), 502–506. https://doi.org/10.1159/000458713Ahonen-Siirtola, M., Nevala, T., Vironen, J., Kössi, J., Pinta, T., Niemeläinen, S., … Rautio, T. (2018). Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a prospective randomized multicenter study of 1-month follow-up results. Hernia, 22(6), 1015–1022. https://doi.org/10.1007/s10029-018-1784-2Ahonen-Siirtola, M., Nevala, T., Vironen, J., Kössi, J., Pinta, T., Niemeläinen, S., … Rautio, T. (2019). Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a prospective randomised multicentre study, 1-year results. Surgical Endoscopy. Advance online publication. https://doi.org/10.1007/s00464-019-06735-9Rinnakkaistallennettu versioAcademic Dissertation to be presented with the assent of the Doctoral Training Committee of Health and Biosciences of the University of Oulu for public defence in Auditorium 1 and 2 of Oulu University Hospital (Kajaanintie 50), on 13 March 2020, at 12 noonAbstract
An incisional hernia is a common complication following abdominal surgery. A hernia repair is recommended for the risk of incarceration. There are several operative methods. The laparoscopic technique is in wide use, but it is associated with a risk of enterotomy. Seroma formation is a common postoperative finding. In the hybrid technique, adhesions can be lysed and the fascial defect sutured through a mini-incision prior to mesh augmentation. In this thesis, we evaluate the complications associated with hernia repair operations, focusing on laparoscopic methods. We explore whether seroma formation and hernia recurrence could be diminished using the hybrid method.
Study I was a descriptive analysis of 127 claims concerning ventral hernioplasties reported to the Finnish Patient Insurance Centre from 2003–2010. In Study II, we analysed 818 incisional hernia repairs, focusing on major complications. In Study III, the results of 38 laparoscopic and 24 hybrid operations in cases featuring complex adhesiolysis were compared. In prospective multicentre Studies IV–V, 193 operations randomised to either the laparoscopic or hybrid technique were analysed.
In retrospective Studies I–III, we found that major complications were related to undetected enterotomies. Complex adhesions had a significant influence on major complications, enterotomies, and surgical site infections. In Studies IV–V, five enterotomies occurred in laparoscopic operations compared to one in hybrid operations. Adhesiolysis was described clearly more often complex in the laparoscopic group than in the hybrid group. After laparoscopy, there were significantly more seromas when compared to the hybrid operations. After one year, no difference in hernia recurrence was seen between the groups. Eleven (6.4%) recurrent hernias were detected: six in the laparoscopic group and five in the hybrid group.
Laparoscopic operations carry a low complication rate, but the risk of enterotomy is still apparent, especially in cases in which intense adhesions are present. A hybrid operation offers a safe approach to lyse adhesions by hand, and therefore the risk of enterotomy low. Seroma formation is clearly diminished after hybrid operations, but its influence on hernia recurrence requires a longer follow-up period. Patients are pain-free following hernia repair, resulting in their better quality of life.Tiivistelmä
Arpityrä on yleinen leikkauskomplikaatio, ja sen korjaamista suositellaan kureutumisriskin vuoksi. Leikkaustekniikoita on useita. Suosittuun tähystysleikkaustekniikkaan tiedetään liittyvän vakavan komplikaation, suolivaurion riski. Leikkausalueen nestekertymä on yleinen löydös leikkauksen jälkeen. Hybriditekniikassa kiinnikkeiden irrottelu tehdään pienen avauksen kautta ja tyräaukko suljetaan ennen verkon kiinnittämistä. Tutkimuksessa arvioimme tyräleikkauskomplikaatioita keskittyen tähystysleikkaustekniikoihin. Selvitimme voiko hybriditekniikkaa käyttäen vähentää leikkauksen jälkeisen nestekertymän muo-dostumista ja tyrän uusiutumista.
Osatyö I kuvaili Potilasvakuutuskeskukseen vuosina 2003–2010 ilmoitettuja vatsan tyräleikkauksiin liittyviä vahinkoja (n = 127). Osatyössä II analysoimme 818 tyränkorjausleikkauksen tulokset keskittyen vakaviin komplikaatioihin. Osatyössä III verrattiin 38 tähystys- ja 24 hybridileikkauksien tuloksia tilanteissa, joissa todettiin hankalat kiinnikkeet. Prospektiivisessa monikeskustutkimuksessa (osatyöt IV–V) 193 potilasta leikattiin satunnaistamisen mukaan tähystys- tai hybriditekniikkaa käyttäen.
Retrospektiivisissä osatöissä I–III totesimme, että tähystysleikkauksien vakavat komplikaatiot liittyivät huomaamatta jääneisiin suolivaurioihin. Hankalilla kiinnikkeillä todettiin selkeä yhteys vakaviin komplikaatioihin, suolivaurioihin ja haavainfektioihin. Prospektiivisissa osatöissä IV–V kuvattiin viisi suolivauriota tähystysleikkauksien ja yksi hybridileikkauksien yhteydessä. Kiinnikkeiden irrottelu oli selvästi hankalampaa tähystysleikkauksissa. Tähystysleikkausten jälkeen todettiin selvästi enemmän leikkausalueen nestekertymiä verrattuna hybridileikkauksiin. Vuoden kohdalla tyräuusiutumien määrässä ei ollut eroja ryhmien välillä; 11 (6,4 %) tyräuusiutumasta kuusi todettiin tähystys- ja viisi hybridiryhmässä.
Toteamme, että tähystysleikkauksiin liittyviä komplikaatiota on vähän, mutta suolivaurion riski on kohonnut leikkauksissa, joissa todetaan runsas kiinnikkeisyys. Hybriditekniikassa kiinnikkeiden irrottelu käsin voi vähentää suolivaurion riskiä. Nestekertymän ilmaantuminen leikkausalueelle on selvästi vähäisempää hybridileikkauksen jälkeen, mutta sen vaikutus tyrän uusiutumisriskiin vaatii pidemmän seuranta-ajan. Potilaat ovat kivuttomia tyränkorjausleikkauksen jälkeen, mikä näkyy elämänlaadun kohenemisena
Limits to freedom of expression : lessons from counter-terrorism
No full textThis chapter addresses the relationship between freedom of expression and countering terrorism mainly from the perspective of international (United Nations) human rights law, based on the experience of the author first (1997–2004) as a member of the above-mentioned independent expert body, the Human Rights Committee, and subsequently (2005– 11) as the Special Rapporteur on the promotion and protection of human rights and fundamental freedoms while countering terrorism, reporting as an individual academic expert to the intergovernmental Human Rights Council. For comparative purposes, however, reference is also made to certain European instruments and their application, as well as to the role of the United Nations Security Council in combating terrorism
Impact on State Succession in Respect of Treaties
No full textThis chapter examines practice under the european convention on human rights and under the international covenant on civil and political rights. It shows that practice under the european convention on human rights with regard to the former czechoslovakia provides ample support for the doctrine of automatic state succession in respect of human rights treaties. It also shows that the supervisory body of the international covenant on civil and political rights has devoted most attention to the questions of principle raised by a succession of states
Robottiavusteinen ja laparoskooppinen ventraalinen rektopeksia lantion takaosan laskeuminen hoidossa
No full textAbstractRectal prolapse and internal rectal prolapse with symptoms of obstructed defecation and/or faecal incontinence are debilitating conditions. Often, symptoms coexist from other pelvic compartments, reducing quality of life. Robot-assisted surgery with its advanced features may offer better conditions in narrow pelvic space to correct rectal prolapses with rectopexy operation. In this thesis, we compared robot-assisted and laparoscopic techniques during the early learning curve in a ‘matched-pairs’ feasibility study (n = 30, follow-up three months) and in a prospective randomized series (n = 33, follow-up 24 months). The long-term functional results were assessed in a retrospective multicenter study with cross-sectional questionnaire assessment (n = 508, median follow-up 44 months).In the randomised series, as demonstrated with MR defecography, ventral rectopexy corrects the posterior compartment defects, external and internal rectal prolapses and recto-enteroceles. The operation restores the posterior and middle compartment anatomy and reduces pelvic organ mobility with a minor impact on the anterior compartment. Pelvic floor dysfunction and symptom-specific quality of life is improved after rectopexy; specifically, the colorectal-anal and the pelvic organ prolapse subscales in the questionnaires showed improvement. We found equality between robot-assisted rectopexy and laparoscopic rectopexy in most relevant outcome measures, which does not justify the added cost of the routine use of robots in rectopexy operations. The health-related quality of life and cost-utility analysis in our cohort indicated, however, that in long-term the technique may be cost-effective.The functional results are retained in the long term. The rate of recurrences (7.1%) and complications (10%) are acceptable and mesh-related complications (1.4%) are rare. Denovo symptoms, such as the urge to defecate or urinary incontinence, may arise, while urinary symptoms may be alleviated. In the long-run, patients with external rectal prolapse benefit more than patients with internal rectal prolapse. In part, the results of this thesis support using a multidisciplinary approach in examining patients with posterior pelvic floor dysfunction. Furthermore, the indications for robotic use in rectopexy operations need to be explored in larger patient samples.Original papersOriginal papers are not included in the electronic version of the dissertation.Mäkelä-Kaikkonen, J., Rautio, T., Klintrup, K., Takala, H., Vierimaa, M., Ohtonen, P., & Mäkelä, J. (2013). Robotic-assisted and laparoscopic ventral rectopexy in the treatment of rectal prolapse: a matched-pairs study of operative details and complications. Techniques in Coloproctology, 18(2), 151–155. https://doi.org/10.1007/s10151-013-1042-7Mäkelä-Kaikkonen, J., Rautio, T., Pääkkö, E., Biancari, F., Ohtonen, P., & Mäkelä, J. (2016). Robot-assistedvslaparoscopic ventral rectopexy for external or internal rectal prolapse and enterocele: a randomized controlled trial. Colorectal Disease, 18(10), 1010–1015. https://doi.org/10.1111/codi.13309Mäkelä-Kaikkonen, J. K., Rautio, T. T., Koivurova, S., Pääkkö, E., Ohtonen, P., Biancari, F., & Mäkelä, J. T. (2016). Anatomical and functional changes to the pelvic floor after robotic versus laparoscopic ventral rectopexy: a randomised study. International Urogynecology Journal, 27(12), 1837–1845. https://doi.org/10.1007/s00192-016-3048-yMäkelä-Kaikkonen, J., Rautio, T., Ohinmaa, A., Koivurova, S., Ohtonen, P., & Mäkelä, J. (2019). Cost-analysis and Quality of life after laparoscopic and robotic ventral mesh rectopexy for posterior compartment prolapse. Manuscript in preparation. https://doi.org/10.1007/s10151-019-01991-2Self-archived versionMäkelä-Kaikkonen, J., Rautio, T., Kairaluoma, M., Carpelan-Holmström, M., Kössi, J., Rautio, A., … Mäkelä, J. (2018). Does Ventral Rectopexy Improve Pelvic Floor Function in the Long Term? Diseases of the Colon & Rectum, 61(2), 230–238. https://doi.org/10.1097/dcr.0000000000000974Self-archived versionTiivistelmäRektumprolapsi ja peräsuolen sisäinen tuppeuma eli interni prolapsi aiheuttavat hankalia oireita, kuten ulostusvaikeuksia, ulosteinkontinenssia ja lantion kipua. Elämänlaatua heikentäviä oireita esiintyy usein samanaikaisesti myös muissa lantion osissa. Robottiavusteinen kirurgia tarjoaa paremmat leikkausolosuhteet lantion ahtaassa tilassa tehtävään rektopeksialeikkaukseen ja mahdollisesti edut voivat näkyä leikkaustuloksessa. Tässä väitöskirjassa vertailimme robottiavusteista ja laparoskooppista leikkaustekniikkaa oppimiskäyrän alkuvaiheessa käyttökelpoisuustutkimuksessa kaltaistetussa parivertailuasetelmassa (n = 40, seuranta-aika 3 kk) sekä prospektiivisessa randomoidussa tutkimussarjassa (n = 33, seuranta-aika 24 kk). Monikeskustutkimuksessa (n = 508, seuranta-ajan mediaani 44 kk) selvitimme laajassa aineistossa laparoskooppisen ventraalisen rektopeksian pitkäaikaistuloksia liittämällä aineiston analyysiin poikkileikkauskyselytutkimuksen tulokset.Randomoidussa sarjassa MR-defekografialla todennettiin, että rektopeksialeikkauksen jälkeen peräsuolen sisäinen tuppeuma, rektoseele ja enteroseele korjaantuvat. Rektopeksialeikkaus palauttaa lantion taka- ja keskiosan anatomian, vähentää elinten dynaamista liikkuvuutta ja parantaa lantionpohjan toimintaa sekä oireisiin liittyvää elämänlaatua, erityisesti suolioireiden ja gynekologisten laskeumaoireiden osalta. Robottiavusteinen ja laparoskooppinen tekniikka olivat samanvertaisia perioperatiivisten parametrien, komplikaatioiden, anatomisten ja toiminnallisten tulosten suhteen. Vaikka kustannusvertailussa kalliimpi robottikirurgia voi osoittautua kustannustehokkaaksi pitkäaikaisseurannassa, yhdenvertaiset tulokset eivät oikeuta menetelmää rutiinikäyttöön.Retrospektiivisen tutkimuksen poikkileikkauskyselyn mukaan toiminnalliset tulokset säilyvät pitkäaikaisseurannassa, residiivien (7,1 %) ja komplikaatioiden (10 %) määrä on hyväksyttävä ja verkkoon liittyviä komplikaatioita esiintyy vähän (1,4 %). Leikkauksen jälkeen ilmenee myös uusia oireita, kuten ulostuspakkoa tai virtsankarkailua. Toisaalta virtsankarkailuoire voi korjaantuakin. Pitkäaikaisseurannassa totaalin rektumprolapsin vuoksi leikatut potilaat hyötyvät leikkauksesta enemmän kuin oireisen internin prolapsin vuoksi leikatut. Osa väitöskirjatyön tuloksista tukee moniammatillisen lähestymistavan käyttöä potilaiden arvioinnissa. Jatkossa robottikirurgian käytön indikaatioita rektopeksialeikkauksissa tulisi arvioida isommissa potilasaineistoissa. OsajulkaisutOsajulkaisut eivät sisälly väitöskirjan elektroniseen versioon.Mäkelä-Kaikkonen, J., Rautio, T., Klintrup, K., Takala, H., Vierimaa, M., Ohtonen, P., & Mäkelä, J. (2013). Robotic-assisted and laparoscopic ventral rectopexy in the treatment of rectal prolapse: a matched-pairs study of operative details and complications. Techniques in Coloproctology, 18(2), 151–155. https://doi.org/10.1007/s10151-013-1042-7Mäkelä-Kaikkonen, J., Rautio, T., Pääkkö, E., Biancari, F., Ohtonen, P., & Mäkelä, J. (2016). Robot-assistedvslaparoscopic ventral rectopexy for external or internal rectal prolapse and enterocele: a randomized controlled trial. Colorectal Disease, 18(10), 1010–1015. https://doi.org/10.1111/codi.13309Mäkelä-Kaikkonen, J. K., Rautio, T. T., Koivurova, S., Pääkkö, E., Ohtonen, P., Biancari, F., & Mäkelä, J. T. (2016). Anatomical and functional changes to the pelvic floor after robotic versus laparoscopic ventral rectopexy: a randomised study. International Urogynecology Journal, 27(12), 1837–1845. https://doi.org/10.1007/s00192-016-3048-yMäkelä-Kaikkonen, J., Rautio, T., Ohinmaa, A., Koivurova, S., Ohtonen, P., & Mäkelä, J. (2019). Cost-analysis and Quality of life after laparoscopic and robotic ventral mesh rectopexy for posterior compartment prolapse. Manuscript in preparation. https://doi.org/10.1007/s10151-019-01991-2Rinnakkaistallennettu versioMäkelä-Kaikkonen, J., Rautio, T., Kairaluoma, M., Carpelan-Holmström, M., Kössi, J., Rautio, A., … Mäkelä, J. (2018). Does Ventral Rectopexy Improve Pelvic Floor Function in the Long Term? Diseases of the Colon & Rectum, 61(2), 230–238. https://doi.org/10.1097/dcr.0000000000000974Rinnakkaistallennettu versioAcademic Dissertation to be presented with the assent of the Doctoral Training Committee of Health and Biosciences of the University of Oulu for public defence in Auditorium 1 and 2 of Oulu University Hospital (Kajaanintie 50), on 29 March 2019, at 12 noonAbstract
Rectal prolapse and internal rectal prolapse with symptoms of obstructed defecation and/or faecal incontinence are debilitating conditions. Often, symptoms coexist from other pelvic compartments, reducing quality of life. Robot-assisted surgery with its advanced features may offer better conditions in narrow pelvic space to correct rectal prolapses with rectopexy operation. In this thesis, we compared robot-assisted and laparoscopic techniques during the early learning curve in a ‘matched-pairs’ feasibility study (n = 30, follow-up three months) and in a prospective randomized series (n = 33, follow-up 24 months). The long-term functional results were assessed in a retrospective multicenter study with cross-sectional questionnaire assessment (n = 508, median follow-up 44 months).
In the randomised series, as demonstrated with MR defecography, ventral rectopexy corrects the posterior compartment defects, external and internal rectal prolapses and recto-enteroceles. The operation restores the posterior and middle compartment anatomy and reduces pelvic organ mobility with a minor impact on the anterior compartment. Pelvic floor dysfunction and symptom-specific quality of life is improved after rectopexy; specifically, the colorectal-anal and the pelvic organ prolapse subscales in the questionnaires showed improvement. We found equality between robot-assisted rectopexy and laparoscopic rectopexy in most relevant outcome measures, which does not justify the added cost of the routine use of robots in rectopexy operations. The health-related quality of life and cost-utility analysis in our cohort indicated, however, that in long-term the technique may be cost-effective.
The functional results are retained in the long term. The rate of recurrences (7.1%) and complications (10%) are acceptable and mesh-related complications (1.4%) are rare. Denovo symptoms, such as the urge to defecate or urinary incontinence, may arise, while urinary symptoms may be alleviated. In the long-run, patients with external rectal prolapse benefit more than patients with internal rectal prolapse. In part, the results of this thesis support using a multidisciplinary approach in examining patients with posterior pelvic floor dysfunction. Furthermore, the indications for robotic use in rectopexy operations need to be explored in larger patient samples.Tiivistelmä
Rektumprolapsi ja peräsuolen sisäinen tuppeuma eli interni prolapsi aiheuttavat hankalia oireita, kuten ulostusvaikeuksia, ulosteinkontinenssia ja lantion kipua. Elämänlaatua heikentäviä oireita esiintyy usein samanaikaisesti myös muissa lantion osissa. Robottiavusteinen kirurgia tarjoaa paremmat leikkausolosuhteet lantion ahtaassa tilassa tehtävään rektopeksialeikkaukseen ja mahdollisesti edut voivat näkyä leikkaustuloksessa. Tässä väitöskirjassa vertailimme robottiavusteista ja laparoskooppista leikkaustekniikkaa oppimiskäyrän alkuvaiheessa käyttökelpoisuustutkimuksessa kaltaistetussa parivertailuasetelmassa (n = 40, seuranta-aika 3 kk) sekä prospektiivisessa randomoidussa tutkimussarjassa (n = 33, seuranta-aika 24 kk). Monikeskustutkimuksessa (n = 508, seuranta-ajan mediaani 44 kk) selvitimme laajassa aineistossa laparoskooppisen ventraalisen rektopeksian pitkäaikaistuloksia liittämällä aineiston analyysiin poikkileikkauskyselytutkimuksen tulokset.
Randomoidussa sarjassa MR-defekografialla todennettiin, että rektopeksialeikkauksen jälkeen peräsuolen sisäinen tuppeuma, rektoseele ja enteroseele korjaantuvat. Rektopeksialeikkaus palauttaa lantion taka- ja keskiosan anatomian, vähentää elinten dynaamista liikkuvuutta ja parantaa lantionpohjan toimintaa sekä oireisiin liittyvää elämänlaatua, erityisesti suolioireiden ja gynekologisten laskeumaoireiden osalta. Robottiavusteinen ja laparoskooppinen tekniikka olivat samanvertaisia perioperatiivisten parametrien, komplikaatioiden, anatomisten ja toiminnallisten tulosten suhteen. Vaikka kustannusvertailussa kalliimpi robottikirurgia voi osoittautua kustannustehokkaaksi pitkäaikaisseurannassa, yhdenvertaiset tulokset eivät oikeuta menetelmää rutiinikäyttöön.
Retrospektiivisen tutkimuksen poikkileikkauskyselyn mukaan toiminnalliset tulokset säilyvät pitkäaikaisseurannassa, residiivien (7,1 %) ja komplikaatioiden (10 %) määrä on hyväksyttävä ja verkkoon liittyviä komplikaatioita esiintyy vähän (1,4 %). Leikkauksen jälkeen ilmenee myös uusia oireita, kuten ulostuspakkoa tai virtsankarkailua. Toisaalta virtsankarkailuoire voi korjaantuakin. Pitkäaikaisseurannassa totaalin rektumprolapsin vuoksi leikatut potilaat hyötyvät leikkauksesta enemmän kuin oireisen internin prolapsin vuoksi leikatut. Osa väitöskirjatyön tuloksista tukee moniammatillisen lähestymistavan käyttöä potilaiden arvioinnissa. Jatkossa robottikirurgian käytön indikaatioita rektopeksialeikkauksissa tulisi arvioida isommissa potilasaineistoissa
Seawater carbonate chemistry and the growth rate of marine diatom Skeletonema marinoi
No full textBecause of their large population sizes and rapid cell division rates, marine microbes have, or can generate, ample variation to fuel evolution over a few weeks or months, and subsequently have the potential to evolve in response to global change. Here we measure evolution in the marine diatom Skeletonema marinoi evolved in a natural plankton community in CO2-enriched mesocosms deployed in situ. Mesocosm enclosures are typically used to study how the species composition and biogeochemistry of marine communities respond to environmental shifts, but have not been used for experimental evolution to date. Using this approach, we detect a large evolutionary response to CO2 enrichment in a focal marine diatom, where population growth rate increased by 1.3-fold in high CO2-evolved lineages. This study opens an exciting new possibility of carrying out in situ evolution experiments to understand how marine microbial communities evolve in response to environmental change
Human dignity, human security, terrorism and counter-terrorism
No full textAt least participants of the human rights discourse intuitively tend to think about human dignity when hearing the word ‘dignity’, but about national or public security when hearing a reference to ‘security’. Thereby dignity tends to have a positive connotation in human rights circles, while security may primarily be seen as a threat to the full enjoyment of human rights. A closer look into the two notions will, however, reveal that both dignity and security will require a nuanced treatment when addressed in a human rights perspective. In this brief chapter it is suggested that a human rights approach to combating terrorism emphasises both human dignity and human security as the proper way to frame the discourse. The chapter will address these two concepts and discuss their relevance in the fight against terrorism, ending by linking the two notions also to the definition of terrorism. Here, the author relies upon Immanuel Kant’s appeal to reason and his formulation of the categorical imperative as a maxim that any rational person must never treat another human being as mere means but always also as an end
CGHpower: exploring sample size calculations for chromosomal copy number experiments
No full textAbstract Background Determining a suitable sample size is an important step in the planning of microarray experiments. Increasing the number of arrays gives more statistical power, but adds to the total cost of the experiment. Several approaches for sample size determination have been developed for expression array studies, but so far none has been proposed for array comparative genomic hybridization (aCGH). Results Here we explore power calculations for aCGH experiments comparing two groups. In a pilot experiment CGHpower estimates the biological diversity between groups and provides a statistical framework for estimating average power as a function of sample size. As the method requires pilot data, it can be used either in the planning stage of larger studies or in estimating the power achieved in past experiments. Conclusions The proposed method relies on certain assumptions. According to our evaluation with public and simulated data sets, they do not always hold true. Violation of the assumptions typically leads to unreliable sample size estimates. Despite its limitations, this method is, at least to our knowledge, the only one currently available for performing sample size calculations in the context of aCGH. Moreover, the implementation of the method provides diagnostic plots that allow critical assessment of the assumptions on which it is based and hence on the feasibility and reliability of the sample size calculations in each case. The CGHpower web application and the program outputs from evaluation data sets can be freely accessed at http://www.cangem.org/cghpower/</p
Pemstuslakikomitea 2000: Valtiosäännön kokonaisuudistuksen haasteita ja hahmottelua
No full textThe Finnish Constitution has been a subject for frequent amendments in recent times. Before 1981, single provisions of the 1919 Constitution Act had been amended 16 times and provisions in the 1928 Parliament Act 34 times. Since 1981, 55 articles of the Constitution Act and 129 articles of the Parliament Act have been amended before the various amendments that are pending in Parliament in December 1994. The Constitutional Law Committee of Parliament has proposed »a codification» of Finnish Constitutional Law, through replacing the four separate constitutional texts with one single Constitution. The author discusses the challenges to and possibilities of such a reform. According to the author, the elaboration of »a theory of accountability» is the primary theoretical challenge to a constitutional reform. How to ensure the democratic accountability of constitutional institutions that are not within the scope of parliamentary decision-making or parliamentary accountability? The problem can be analyzed in connection with various forms of international norm-giving, the changing role of courts, »the pulverization» of public administration and the growing independence of monetary policy. According to the author, accountability can be achieved through a proper combination of open and rational reasoning, expertise, statutory objectives, publicity, »customer democracy» and respect for fundamental rights, in regard to each institution or sector. The article ends with a tentative draft for a mandate to a Government Commission entrusted with preparing a proposal on a new Constitution
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