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article summary Click on the categories below to read the relevant article of the European Convention on paper Wilbraham and Monson Academy Human Rights. Article 2: Right to Life. (1) Everyone's right to life shall be protected by law. No one shall be deprived of his life intentionally save in the execution of a sentence of a court following his conviction of persuasive piece of Hotel Management, a crime for sites Wilbraham and Monson Academy, which the penalty is persuasive writing International of Hotel provided by law. (2) Deprivation of life shall not be regarded as inflicted in contravention of this Article when it results from the use of sites Wilbraham Academy, force which is no more than absolutely necessary- (a) in defence of any person from unlawful violence; (b) in order to effect a lawful arrest or to prevent the writing a conclusion essay Curtin, escape of paper Wilbraham, a person lawfully detained; (c) in action lawfully taken for the purpose of quelling a riot or insurrection. Article 3: Inhuman treatment. No one shall be subjected to articles Westminster School torture or to inhuman or degrading treatment or punishment. Article 4: Slavery. (1) No one shall be held in slavery or servitude. (2) No one shall be required to perform forced or compulsory labour. (3) For the purpose of research Academy, this Article the term forced or compulsory labour shall not include: (a) any work required to write essay be done in the ordinary course of detention imposed in accordance to the provisions of Article 5 of this Convention or during conditional release from such detention; (b) any service of a military character or, in the case of conscientious objectors in countries where they are recognised, service exacted instead of compulsory military service; (c) any service exacted in case of an emergency or calamity threatening the paper sites Wilbraham, life or well-being of the essay Stenden University, community; (d) any work or service which forms part of normal civic obligations. Article 5: Right to Liberty. Sites Wilbraham Academy! (1) Everyone has the phrases Vermont Academy, right to research sites Wilbraham and Monson Academy liberty and security of person. No one shall be deprived of his liberty save in phrases Vermont Academy the following cases and in accordance with a procedure prescribed by law: (a) the lawful detention of paper and Monson, a person after conviction by a competent court; (b) the lawful arrest or detention of a person for persuasive Les Roches Marbella International, non-compliance with the lawful order of a court or in order to secure the fulfilment of any obligation prescribed by law; (c) the lawful arrest or detention of a person effected for the purpose of bringing him before the competent legal authority on reasonable suspicion of having committed an offence or when it is reasonably considered necessary to prevent his committing an offence or fleeing after having done so; (d) the detention of a minor by lawful order for the purpose of educational supervision or his lawful detention for the purpose of bringing him before the competent legal authority; (e) the lawful detention of persons for the prevention of the spreading of sites Wilbraham, infectious diseases, of persons of unsound mind, alcoholics and drug addicts or vagrants; (f) the lawful arrest or detention of a person to prevent his effecting an unauthorised entry into the country or of a person against whom action is being taken with a view to deportation or extradition. (2) Everyone who is arrested shall be informed promptly, in piece of Hotel a language which he understands, of the reason for his arrest and of any charge against him. (3) Everyone arrested or detained in accordance with the provisions of paragraph 1(c) of paper Academy, this Article shall be brought promptly before a judge or other officer authorised by law to exercise judicial power and shall be entitled to university trial within a reasonable time or to release pending trial.

Release may be conditioned by guarantees to appear for trial. (4) Everyone who is deprived of his liberty by arrest or detention shall be entitled to take proceedings by which the lawfulness of his detention shall be decided speedily by a court and his release ordered if the detention is research sites and Monson not lawful. (5) Everyone who has been the victim of arrest or detention in contravention of the provisions of this Article shall have an enforceable right to compensation. Article 6: Right to a fair trial. (1) In the determination of his civil rights and obligations or of any criminal charge against him, everyone is entitled to a fair and public hearing within a reasonable time by write essay School, an independent and impartial tribunal established by law. Judgment shall be pronounced publicly but the press and public may be excluded from all or part of the trial in sites Wilbraham Academy the interests of morals, public order or national security in a democratic society, where the interests of juveniles or the protection of the private life of the parties so require, or to the extent strictly necessary in the opinion of the court in special circumstances where publicity would prejudice the interests of justice. (2) Everyone charged with a criminal offence shall be presumed innocent until proved guilty according to law. (3) Everyone charged with a criminal offence has the following minimum rights - (a) to be informed promptly, in a language which he understands and in article styles International detail, of the nature and cause of the accusation against him; (b) to have adequate time and facilities for the preparation of his defence; (c) to defend himself in person or through legal assistance of his own choosing or, if he has not sufficient means to pay for legal assistance, to be given it free when the interests of justice so require; (d) to examine or have examined witnesses against him and to obtain the sites and Monson, attendance and examination of witnesses on writing Curtin his behalf under the sites and Monson Academy, same conditions as witnesses against him; (e) to have the free assistance of an writing Vermont Academy, interpreter if he cannot understand or speak the language used in court. Article 7: Retrospective crimes. (1) No one shall be held guilty of any criminal offence on research Wilbraham Academy account of any act or omission which did not constitute a criminal offence under national or international law at the time when it was committed. Nor shall a heavier penalty be imposed than the one that was applicable at the time the criminal offence was committed. (2) This Article shall not prejudice the trial and punishment of any person for any act or omission which, at Sherborne the time it was committed, was criminal according to the general law recognised by civilised nations. Article 8: Right to privacy. (1) Everyone has the right for his private and family life, his home and his correspondence. (2) There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the research sites and Monson Academy, economic well-being of the country, for the prevention of writing styles, disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others. Article 9: Freedom of conscience. (1) Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief and freedom, either alone or in community with others and in public or private, to manifest his religion or belief, in research paper worship, teaching, practice and observance. (2) Freedom to manifest one's religion or beliefs shall be subject only to such limitations as are prescribed by law and writing essay (Navitas), are necessary in a democratic society in the interests of public safety, for the protection of paper Wilbraham Academy, public order, health or morals, or for the protection of the rights and freedoms of others.

Article 10: Freedom of Expression. (1) Everyone has the right of freedom of expression. This right shall include freedom to hold opinions and to receive and impart information and university help of Applied, ideas without inference by public authority and research paper Wilbraham Academy, regardless of frontiers. This Article shall not prevent States from requiring the licensing of broadcasting, television or cinema enterprises. (2) The exercise of these freedoms, since it carries with it duties and responsibilities, may be subject to essay writing such formalities, conditions, restrictions or penalties as are prescribed by law and are necessary in a democratic society, in the interests of national security, territorial integrity or public safety, for the prevention of disorder or crime, for the protection of health or morals, for the protection of the reputation or rights of paper sites Academy, others, for preventing the disclosure of information received in confidence, or for maintaining the authority and impartiality of the judiciary. Article 11: Freedom of Assembly. Essay Curtin University (Navitas)! (1) Everyone has the right to freedom of peaceful assembly and to freedom of association with others, including the right to form and to join trade unions for the protection of his interests. (2) No restrictions shall be placed on the exercise of these rights other than such as are prescribed by law and are necessary in research paper Wilbraham and Monson Academy a democratic society in the interests of write Harrow, national security or public safety, for the prevention of disorder or crime, for the protection of health or morals or for the protection of the rights and freedoms of others. Research Paper! This Article shall not prevent the imposition of lawful restrictions on an opinion Harrow the exercise of these rights by members of the armed forces, of the police or of the research paper sites Academy, administration of the state. Article 12: Marriage and the family. Men and persuasive writing piece Marbella of Hotel, women of marriageable age shall have the right to marry and to found a family, according to national laws governing the exercise of this right. Article 14: Discrimination. The enjoyment of the rights and freedoms set forth in research paper sites Wilbraham and Monson this convention shall be secured without discrimination on any ground such as sex, race, colour, language, religion, political or other opinion, national or social origin, association with a national minority, property, birth or other status. Every natural or legal person is entitled to writing the peaceful enjoyment of his possessions. No one shall be deprived of his possessions except in the public interest and research paper sites Wilbraham Academy, subject to the conditions provided for by law and by the general principles of international law.

The preceding provisions shall not, however, in any way impair the right of the Les Roches of Hotel, State to enforce such laws as it deems necessary to control the use of property in accordance with the general interest or to secure payment of taxes or other contributions or penalties. No person shall be denied a right to an education. In the exercise of any functions which it assumes in relation to education and to teaching, the State shall respect the research paper sites, right of parents to ensure such education and teaching in conformity with their own religious and philosophical convictions. The High Contracting Parties undertake to hold free elections at university essay Stenden Sciences reasonable intervals by secret ballot, under conditions which will ensure the free expression of the opinion of the people in the choice of the legislature. The BBC is not responsible for the content of external internet sites.

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Induction of labour with a Foley catheter or oral misoprostol at term: the PROBAAT-II study, a multicentre randomised controlled trial. © ten Eikelder et al.; licensee BioMed Central Ltd. 2013. The Erratum to this article has been published in BMC Pregnancy and Childbirth 2013 13 :183. Induction of labour is a common obstetric procedure. At present, different methods are used for induction of labour in women with an unfavourable cervix. Recently, we showed that in term women with an Wilbraham Academy unfavorable cervix the use of a Foley catheter in comparison with vaginal Prostaglandin E2 gel, results in a comparable vaginal delivery rate.

A meta-analysis on the subject indicated lower rates of hyperstimulation, and probably as a sequel fewer cases of postpartum haemorrhage. Misoprostol (PgE1) is another type of prostaglandin frequently used for labour induction, recommended by the international federation of gynaecology and obstetrics (FIGO). Misoprostol can be administered by article writing styles vaginal, rectal and oral route. There is sites, evidence that oral administration results in less asphyxia and hyperstimulation than vaginal administration. At present, valid comparisons between oral misoprostol and an opinion essay Harrow School Foley catheter are lacking. Therefore, we propose a randomised controlled trial comparing Foley catheter to oral misoprostol in order to assess safety and cost-effectiveness. We plan a multicentre, randomised, controlled, open-label clinical trial among term pregnant women with a vital singleton in cephalic presentation, unfavorable cervix, intact membranes and an indication for induction of labour. After informed consent, women will be randomly allocated by paper sites and Monson Academy a webbased randomisation system to transcervical Foley catheter or oral misoprostol (50 mcg every 4 hours). The primary outcome will be a composite of complications of uterine hyperstimulation, i.e. post partum haemorrhage and Curtin (Navitas) asphyxia.

Secondary outcomes are mode of delivery, maternal and neonatal morbidity, costs and women’s preference. Serious adverse events such as severe maternal or neonatal morbitity or mortality will be monitored and paper and Monson reported to an independent data safety monitory board. With a sample size of university Stenden University Sciences, 1860 women we will be able to demonstrate a 5% non-inferiority of the Foley catheter as compared to misoprostol for the composite outcome. Worldwide, various methods are being used for labour induction. Results of the proposed trial will contribute to the answer which method of induction of labour is research sites Wilbraham Academy, most safe, cost-effective, and patient friendly and to write Westminster will help to construct evidence based guidelines. The Netherlands Trial Register NTR3466. Induction of labour is a commonly practiced obstetric intervention designed to artificially initiate the research paper process of writing Marbella School of Hotel Management, effacement of the cervix, dilatation (cervical ripening), uterine contractions (often after augmentation with oxytocin) and eventually delivery of the baby. Common indications for induction of labour are post-term pregnancy, hypertensive disorders, diabetes in pregnancy, cholestasis, decreased physical activity of the sites Wilbraham and Monson Academy fetus and prelabour rupture of membranes. Induction of university University of Applied, labour with an unfavorable cervix is associated with prolonged labour compared to spontaneous onset of and Monson, labour or induction of labour with a favorable cervix. Also an an opinion Harrow School increase in instrumental deliveries and a higher rate of caesarean sections are seen [ 1 – 3 ]. To increase the and Monson Academy success of labour induction it is writing styles, essential to achieve cervical ripening in research paper Wilbraham women with an unfavorable cervix. Misoprostol has been widely studied as an agent for induction of labour.

There are currently two Cochrane reviews focusing on where to write Westminster, the use of both oral and vaginal misoprostol [ 4 , 5 ]. These systematic reviews conclude that misoprostol is an effective and safe induction agent. Oral misoprostol is preferred to sites Wilbraham vaginal administration for as it shows lower rates of uterine hyperstimulation and writing styles Sherborne International adverse neonatal outcome [ 4 , 5 ]. Although not licensed for induction of labour, misoprostol is recommended by research sites several guidelines. The British Royal College of Obstetricians and Gynaecologists (RCOG), as well as the World Health Organization (WHO), recommend the use of misoprostol tablets, based on university Stenden University, cost-effectiveness. In the paper Academy Dutch Society of Gynaecology and Obstetrics (NVOG) guideline for induction of article styles Sherborne, labor, misoprostol is research sites Wilbraham Academy, included and reported to be effective and safe [ 6 – 8 ]. Articles Westminster? Another method for paper sites induction of labour is the transcervical Foley catheter. We recently showed (PROBAAT trial) that induction of labour with a Foley catheter is as effective as induction with intravaginal prostaglandin E2 gel, with fewer maternal and to write articles School neonatal side-effects [ 9 ]. The caesarean section rate was comparable and in the meta-analysis of three trials on research paper Wilbraham Academy, the subject, the Foley catheter revealed a lower rate of article writing International, hyperstimulation, resulting in fewer cases of asphyxia and less post partum haemorrhage. Consequently, the transcervical Foley catheter was recommended for induction of labour in research and Monson Academy women with an unfavorable cervix at term [ 9 ]. The Foley catheter is essay writing phrases, reported to have similar success rates as induction of labour with misoprostol (vaginal and oral), and is associated with less uterine hyperstimulation with and without fetal heart rate (FHR) changes and a comparable caesarean section rate [ 10 – 14 ]. As prostaglandins in general have been shown to cause an increased incidence of paper Wilbraham Academy, hyperstimulation, we expect a decreased blood flow of the a conclusion essay University (Navitas) placenta and consequently an research paper Wilbraham and Monson increased the risk of asphyxia. In addition, hyperstimulation might lead to uterine muscle fatigue and thereby increase the risk for to write School post partum haemorrhage. However, randomised controlled trials currently available are underpowered to research sites and Monson Academy investigate these estimators.

In view of the scarce evidence on the subject, we propose a adequately-powered randomised controlled trial comparing induction of labour with a Foley catheter to induction of labour with oral misoprostol in women with an unfavorable cervix at term. In this trial the safety, cost-effectiveness and patient preference will be evaluated. The aim of this study is to assess the safety and cost-effectiveness of induction of labour with a transcervical Foley catheter as compared to induction with oral misoprostol in term pregnant women with an unfavourable cervix. Term pregnant women will be informed about the an opinion essay School trial at the moment the decision is paper sites, made to induce labour. Eligible are women ? 18 years with a gestational age ?37 weeks with a vital singleton in cephalic presentation, intact membranes and an unfavourable cervix (Bishop score 6).

Exclusion criteria are hypersensitivity for any of the products used, a history of caesarean section, placenta praevia, or lethal congenital anomalies. Procedures, recruitment, randomisation, collection of help University of Applied, baseline data. This trial will be a multicentre, open-label, randomised controlled trial. The study will be performed within the Dutch Consortium for Studies in Women’s Health and research sites and Monson Academy Reproductivity ( http://www.studies-obsgyn.nl ). Participating hospitals can be district, teaching or academic hospitals. Before entry into the study, women will be informed about the aims, methods, reasonably anticipated benefits and potential hazards of the study. This will generally be at writing Vermont Academy, least 1 day before actual admission for induction. They will be informed that their participation is research and Monson, voluntary and that they may withdraw consent for writing International Management participation at any time during the study. Choosing not to participate will not affect care. In each centre an independent physician will be available for paper Wilbraham and Monson Academy more detailed information for both patients and colleagues if desired. Help University Sciences? After counselling, written informed consent will be obtained.

The consent form must be signed before performing of any study-related activity. Sites Wilbraham? Randomisation will be performed web-based using ALEA. After entering patient initials, confirming inclusion criteria and absence of School, exclusion criteria, randomisation will be performed realtime based on an algorithm. Sites And Monson Academy? We will use fixed block sizes of 2 and 4 and stratify for centre and Les Roches Marbella School of Hotel Management parity. As there is no prespecified randomisation list, it will be hardly possible for anyone to paper sites Academy know the next allocation. Westminster School? Randomisation will take place after evaluation of the fetal condition by CTG, just before start of induction. Eligible women will be allocated in research and Monson Academy a 1:1 ratio to induction with a Foley catheter or oral misoprostol. There will be no blinding of patients and caregivers, as this is not feasible with these two treatment methods. Baseline demographic, obstetric and medical histories, and details of delivery and health care received till the time of discharge will be recorded for all women. Data will be entered into an electronic case-record form (Oracle Clinicle version 4.5.3) accessible through our study website with a personal login http://www.studies-obsgyn.nl/probaat2 . Article Writing? All changes made in research Wilbraham and Monson Academy this electronic case-record form will be captured in an audit trial.

In Oracle Clinicle checks will be programmed to an opinion Harrow School identify errors. All electronic case-record forms will be checked for consistency and to correct errors. At the start of the study, each centre will be instructed in sites Wilbraham Academy a brief presentation and practical training. When needed, a local research nurse is available during the inclusion period to advise the writing styles International staff on research paper sites Academy, use of the Foley catheter and/or oral misoprostol. Induction with a transcervical Foley catheter. A 16 or 18 F Foley catheter will be introduced into the cervix and styles the balloon is filled with 30 cc of 0.9% NaCl or water. The Foley catheter can be placed digitally or using a speculum according to preference of the treating physician.

No recommendations regarding disinfection will be given as there is no evidence for the best method. The external end of the Foley catheter will be tapped to the thigh without giving traction. Foley catheter location after placement can be evaluated digitally and/or by ultrasound. Women will be instructed to observe one hour of bed rest after every newly placed Foley catheter, while fetal condition and uterine activity will be monitored. Women will be examined every 12 hours if the transcervical Foley catheter does not detach spontaneously. When the Bishop score remains 6; the paper location of the Foley catheter will be evaluated and write essay a new Foley catheter will be placed after 24 of 48 our depending on the preference of the research paper sites Academy participating centre. Patients in the misoprostol group will be treated according to the protocol used in essay University of Applied Sciences the study of Gemund et al. [ 15 ]. Misoprostol will be administered every four hours with a maximum of paper Wilbraham and Monson Academy, three times a day for 4 days. For this study the protocol was adjusted to essay Vermont use of oral misoprostol. Women in the misoprostol group will receive 50 mcg misoprostol capsules. Since misoprostol 50 mcg tablets are not on the market and misoprostol as a raw material is not available, the 50 mcg tablets are made from the research paper and Monson Academy originally Cytotec 200 mcg, Searle, Maarsen, The Netherlands by the Leiden University Medical Centre pharmacy.

200 mcg Cytotec tablets are pulverized with a cube mixer. Capsules are prepared from portions of the powder mixture. Amount of powder mixture is optionally supplemented with microcrystalline cellulose to writing a conclusion essay Curtin University achieve volume for 100 capsules. Each capsule contains between 47.5 and research paper 52.5 mcg misoprostol. High-performance liquid chromatography shows the standard retention time and sample are the same (within 2.5%). Women will be instructed to observe one hour of bed rest after every dose of misoprostol, while fetal condition and essay phrases Vermont uterine activity will be monitored. When there will be 3 or more contractions in 10 minutes while the Bishop score is still 6 or when the fetal heart rate is not reassuring the next misoprostol dose will be withheld. Amniotomy and oxytocin infusion can be started at any moment of the day when the Bishop score is ? 6, and at least 4 hours after the and Monson last dose of misoprostol.

Women will be treated for essay phrases a maximum of research paper sites and Monson, 4 days with Foley catheter or oral misoprostol. If after 4 days the cervix remains unfavorable, the induction is help Stenden of Applied, considered to be failed and further management will be decided individually by the treating physician. The number of paper Wilbraham and Monson, women needing more than 48 hours of induction is expected to write an opinion Harrow School be very low. The primary endpoint will be a composite outcome of neonatal asphyxia (defined as a neonatal pH ? 7.05 and/or 5 minute Apgar score 7) and/or post partum haemorrhage (defined as an estimated blood loss of ?1000 cc ascertained over 24 h post partum). We have chosen this combined outcome as both conditions are thought to be a result of hyperstimulation.

Mode of delivery (Caesarean section, vaginal operative delivery, spontaneous delivery) and the reason for Wilbraham and Monson Academy operative delivery, i.e. Persuasive Piece Les Roches Of Hotel Management? suspected fetal distress and/or failure to sites and Monson Academy progress. Induction to delivery time, Use of writing Academy, analgetics. Number of misoprostol gifts/Foley catheters used. Number of Academy, vaginal examinations.

0 Post partum blood transfusion and School number of packed cells. 0 Tachysystole (defined as more than five contractions in ten minutes over a minimal period of two times ten minutes) 0 Hyperstimulation (defined as tachysystole with FHR changes (defined as a non reassuring CTG by treating physician)) 0 Uterine hypertonus (defined as a contraction lasting longer than two minutes with FHR changes) 0 Uterine rupture (occurrence of clinical symptoms (abdominal pain, abnormal fetal heart rate pattern, acute loss of research Wilbraham and Monson, contractions, vaginal blood loss) leading to an emergency caesarean delivery, at which the university essay Stenden University of Applied Sciences presumed diagnosis of uterine rupture was confirmed; or peripartum hysterectomy or laparotomy for paper sites Wilbraham and Monson Academy uterine rupture after vaginal birth) 0 Uterine scar dehiscence (separation of a pre-existing scar that does not disrupt the uterine serosa as seen during caesarean section, without clinical consequences) 0 Maternal infection during labour (defined as fever, i.e. temperature ? 37.8°C, or fetal tachycardia AND start of antibiotics) 0 Maternal infection within one week post partum (defined as fever, i.e. Essay Phrases Vermont Academy? temperature ? 37.8°C, AND start of antibiotics) 0 Start of intravenous antibiotics. 0 Endo(myo)metritis or urinary tract infection within one week post partum (proven positive vaginal/urine culture) 0 Other medication used during labour such as tocolytics. 0 Fetal tachycardia (sustained fetal heart rate above 160 beats per paper Academy minute) 0 Weight at write Harrow, birth. 0 Apgar scores 7 at research Wilbraham, 1 minute. 0 Admission to the neonatal ward/NICU and its reason (suspected infection, infection proven by positive culture, other reason admission to medium or intensive care). An economic analysis will be conducted alongside the PROBAAT-II trial. In order to do so, resource use in different phases of delivery will be collected in the electronic case-record form (eCRF).

To our knowledge, no validated questionnaires on women’s preference of induction of labour method are available. Therefore women’s preference for the method of induction will be evaluated by a post partum questionnaire developed for this study, based on a validated questionnaire by Wijma et al. This questionnaire was developed to assess women’s experience of labour [ 16 ]. Details of writing School of Hotel Management, admission of women and research paper sites and Monson Academy newborns will be recorded as will maternal and neonatal complications. Writing A Conclusion University (Navitas)? Long term follow-up is not part of the current study. This trial is designed as a non-inferiority trial. Primary analysis will be by intention-to-treat. In a comparative trial, where the research paper Wilbraham and Monson Academy aim is to decide if two treatments will be different, an intention-to-treat analysis is generally conservative: the writing a conclusion Curtin University inclusion of protocol violators and withdrawals will usually make the results from the two treatment groups more similar. However, for a non inferiority trial this effect is no longer conservative: any blurring of the difference between the treatment groups will increase the chance of declaring non inferiority [ 17 ]. We will therefore also perform a per paper sites Wilbraham and Monson Academy protocol analysis.

Relative risks and 95% confidence intervals will be calculated for article styles the relevant outcome measures. We will additionally adjust for the stratified randomization when calculating the relative risk. Differences between categorical variables will be tested with the Chi-square test, or if the expected cell count is research Wilbraham, below 5 with the Fisher’s exact test. Non-normally distributed continuous variables will be tested with the Mann–Whitney U test. Writing A Conclusion Essay Curtin? Time to delivery will be assessed using Kaplan-Meier analysis. Research Paper Sites? For the economic analysis we plan a cost-minimisation procedure, as we designed a non-inferior trial and expect no differences in writing Vermont Academy outcomes. Research Sites? Resource uses are multiplied by their specific costs, which are estimated according to recent guidelines on costing health care services. When a relevant differences in outcomes will be observed, we will perform a cost-effectiveness analysis, in which we calculate the to write School additional cost per prevented case of paper sites and Monson Academy, fluxus or asphyxia and the cost per prevented Caesarean section. Mean resource use and costs are compared between both arms, if any difference of interest in primary and/or secondary outcomes occurs a cost-effectiveness analysis will be performed. Using an writing Academy interaction term we will assess whether the Wilbraham and Monson Academy difference in effect between misoprostol and Foley catheter is consisted in nulliparous and multiparous women. To calculate an adequate sample size we searched the literature for comparisons between oral misoprostol and essay Foley catheter.

There is only one study which directly compared induction of paper and Monson, labour with oral misoprostol and Foley catheter. This study does not report on our primary outcome measures which makes it insufficient to use for university essay University of Applied our power calculation [ 10 ]. Wilbraham And Monson? A few studies reported on a comparison of vaginal misoprostol and prostaglandin E2, but different dosages were used and from the reported outcome parameters it was not possible to calculate the composite outcome we use [ 6 ]. Therefore we used data from the PROBAAT trial, comparing prostaglandin E2 (prostin) with Foley catheter [ 9 ]. In the Probaat trial the incidence of the University composite outcome of pH ? 7.05 and/or an Apgar 7 at 5 minutes (at least one known) and/or haemorrhage ?1000 cc post partum was 12.7% when a Foley catheter was used and 16.4% when Prostaglandin E2 gel was used. We expect the incidence of the composite outcome to be lower when using oral misoprostol than when using prostaglandin E2 but slightly higher than when a Foley catheter is used [ 5 ]. We expect that about 25% of umbilical cord pH’s will be missing, while the 5 minute Apgar will be complete in nearly all cases. So, if the research and Monson Academy umbilical artery pH data will be missing, neonatal outcome will be classified as abnormal if the 5 minute Apgar will be 7 and as normal if the Apgar was ? 7. Where To Write Articles School? With a power of 80% (1-?) and a one-sided 0.05 risk of type I error (?), we need 1860 participants (930 per group) to demonstrate non-inferiority, i.e. that the Wilbraham and Monson absolute difference in the composite outcome will be less than 5% in the misoprostol group compared to the Foley catheter group, when assuming that the composite outcome was 12.7% in the Foley catheter group and 13.7% in the misoprostol group and an 5% exclusion rate from the per university University Sciences protocol analysis. This sample size will also give us more than 80% power to demonstrate non-inferiority, i.e. less than 5% increase in the proportion of caesarean sections when using misoprostol compared to Foley catheter, assuming 23% caesarean sections in both groups [ 9 ]. We used NQuery Advisor 7.0, with the two group test of paper sites and Monson, equivalence in persuasive International School of Hotel proportion (NQueryAdvisor; Machin 1987) to calculate the research paper Wilbraham sample size. An independent data and safety monitoring board (DSMB) will be established prior to the start of the trial. All the write Harrow serious adverse events (SAE’s) (intra uterine fetal death (IUFD), uterine rupture, severe maternal and neonatal morbidity such as IC/NICU admission and related events such as placental abruption directly after insertion of research sites Academy, Foley catheter) will be reported within 48 hours to the CCMO (central commission human related research). All SAEs will be reported to the DSMB at 300 and 600 inclusions when the interim analysis will take place, or when in total 5 SAEs are reported, whichever comes first. Prior to the start of the essay (Navitas) trial the DSMB defined criteria to terminate the and Monson Academy trial prematurely. The DSMB will perform 2 interim analyses: after recruitment of 300 and writing phrases Academy 600 patients.

These interim analyses will be conducted independently of the research group, and and Monson Academy will take into writing a conclusion essay Curtin (Navitas), account safety (infection, asphyxia, haemorrhage) as well as efficacy. The study will be terminated prematurely for efficacy according to the Haybittle rule when there is a difference with P 0.001. This study has been approved by the National Central Committee on research sites Wilbraham and Monson Academy, Research involving Human Subjects (CCMO - NL 35278.018.11.), by University Sciences the ethics committee of the Academical Medical Centre (Ref. No. 2011_010#B2012219). The boards of directors of all participating hospitals approved local execution of the study. In Western countries, labour is induced in 20-30% of all pregnant women for various reasons. Paper Wilbraham Academy? Until now different methods for labour induction are used. Persuasive Writing Marbella International Of Hotel Management? In literature contradictory results are reported regarding efficacy and safety of the induction methods. The outcome of our recent study which compared prostaglandin gel to a Foley catheter was that the paper Wilbraham and Monson Foley catheter showed fewer maternal and neonatal side-effects and was as effective as prostaglandin gel [ 9 ]. Another widely used method of labour induction is the administration of misoprostol. Misoprostol is recommended by several (inter)national guidelines, based on cost-effectiveness [ 6 , 8 ]. Persuasive Writing Piece International Management? However, randomised controlled trials are underpowered to investigate the research and Monson estimators of interest.

Therefore we will compare in an adequately powered randomised open-label controlled trial induction of labour at term with a Foley catheter to oral misoprostol. Taking into account the possible risks, costs and women’s preferences; this study could assess the safest, most cost-effective and writing Curtin patient friendliest way of inducing labour with an unfavorable cervix. Eventually this study could contribute to Wilbraham and Monson Academy achieve consensus in Vermont Academy the guidelines, thereby improving the care for over 20% of all the pregnant women in western countries from who labour will be induced. Central Committee on research and Monson, Research Involving Human Subjects. Centrale Commissie Mensgebonden Onderzoek. Data safety monitoring board. Fetal heart rate. (Serious) Adverse event. This study is funded by Fonds Nuts Ohra, a Dutch organisation for Health Research and development.

The funding source had no role in article styles Sherborne International the trial design, writing of the report, or the decision to submit the research paper Wilbraham and Monson Academy paper for publication. The authors declare that they have no competing interests. ME, KB, KOD and BWM were involved in the conception and design of the study. ME, KOD and MJ drafted the manuscript. All authors mentioned in writing essay (Navitas) the manuscript are members of the PROBAAT-II-trial study group. They are local investigators at the participating centres. All authors read, edited and approved the paper Academy final manuscript. Battista L, Chung JH, Lagrew DC, Wing DA: Complications of labor induction among multiparous women in a community-based hospital system. Am J Obstet Gynecol. 2007, 197: 241-247.

View ArticlePubMedGoogle Scholar Vrouenraets FP, Roumen FJ, Dehing CJ, van den Akker ES, Aarts MJ, Scheve EJ: Bishop score and risk of cesarean delivery after induction of labor in Harrow nulliparous women. Obstet Gynecol. Paper Sites Wilbraham And Monson? 2005, 105: 690-697. 10.1097/01.AOG.0000152338.76759.38. View ArticlePubMedGoogle Scholar Goldberg AB, Greenberg MB, Darney PD: Misoprostol and pregnancy. N Engl J Med.

2001, 344: 38-47. 10.1056/NEJM200101043440107. Essay Writing Phrases? View ArticlePubMedGoogle Scholar Alfirevic Z, Weeks A: Oral misoprostol for induction of paper and Monson Academy, labour. Cochrane Database Syst Rev. University Help Stenden Of Applied? 2006, CD001338- Google Scholar Hofmeyr GJ, Gulmezoglu AM, Pileggi C: Vaginal misoprostol for research paper Wilbraham and Monson Academy cervical ripening and induction of articles School, labour. Cochrane Database Syst Rev. 2010, CD000941- Google Scholar Internet: NICE guideline Induction of labour. 2008, Accessed August 9th 2011 [ http://www.nice.org.uk/CG070 ] Internet: “Inductie van de baring” Guideline. 2006, Accessed April 12th 2012 [ http://nvog-documenten.nl/index.php?pagina=/richtlijn/pagina.phpfSelectNTG_85=86fSelectedSub=85 ] Internet: WHO recommendations for induction of labour.

2011, Accessed December 4th 2012 [ http://whqlibdoc.who.int/publications/2011/9789241501156_eng.pdf ] Jozwiak M, Oude Rengerink K, Benthem M, van Beek E, Dijksterhuis MG, de Graaf IM, van Huizen ME, Oudijk MA, Papatsonis DN, Perquin DA, Porath M, van der Post JA, Rijnders RJ, Scheepers HC, Spaanderman ME, van Pampus MG, de Leeuw JW, Mol BW, Bloemenkamp KW: Foley catheter versus vaginal prostaglandin E2 gel for induction of paper and Monson, labour at term (PROBAAT trial): an open-label, randomised controlled trial. Lancet. Essay School? 2011, 378: 2095-2103. Paper Sites Wilbraham And Monson Academy? 10.1016/S0140-6736(11)61484-0. View ArticlePubMedGoogle Scholar Abramovici D, Goldwasser S, Mabie BC, Mercer BM, Goldwasser R, Sibai BM: A randomized comparison of oral misoprostol versus Foley catheter and oxytocin for induction of write an opinion, labor at term. Am J Obstet Gynecol. 1999, 181: 1108-1112. 10.1016/S0002-9378(99)70090-6. View ArticlePubMedGoogle Scholar Culver J, Strauss RA, Brody S, Dorman K, Timlin S, McMahon MJ: A randomized trial comparing vaginal misoprostol versus Foley catheter with concurrent oxytocin for and Monson Academy labor induction in nulliparous women. Am J Perinatol.

2004, 21: 139-146. 10.1055/s-2004-823777. View ArticlePubMedGoogle Scholar Fox NS, Saltzman DH, Roman AS, Klauser CK, Moshier E, Rebarber A: Intravaginal misoprostol versus Foley catheter for write essay School labour induction: a meta-analysis. BJOG. 2011, 118: 647-654. 10.1111/j.1471-0528.2011.02905.x. View ArticlePubMedGoogle Scholar Jozwiak M, Bloemenkamp KW, Kelly AJ, Mol BW, Irion O, Boulvain M: Mechanical methods for induction of labour. Wilbraham And Monson? Cochrane Database Syst Rev. 2012, 3: CD001233 Google Scholar Oliveira MV, Oberst PV, Leite GK, Aguemi A, Kenj G, Leme VD, Sass N: Cervical Foley catheter versus vaginal misoprostol for cervical ripening and induction of labor: a randomized clinical trial. Revista brasileira de ginecologia e obstetricia: revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia. 2010, 32: 346-351.

View ArticleGoogle Scholar van Gemund N, Scherjon S, LeCessie S, van Leeuwen JH, van RJ, Kanhai HH: A randomised trial comparing low dose vaginal misoprostol and dinoprostone for labour induction. BJOG. 2004, 111: 42-49. 10.1046/j.1471-0528.2003.00010.x. View ArticlePubMedGoogle Scholar Wijma K, Wijma B: Wijma Delivery Expectancy/Experience Questionnaire. Essay Harrow? Sweden: (W-DEQ version B). © 2004 Klaas Wijma, PhD, Professor Unit of Health Psychology/Gender and Medicine Faculty of Health Sciences, Linkoping University Google Scholar Jones B, Jarvis P, Lewis JA, Ebbutt AF: Trials to assess equivalence: the importance of rigorous methods. BMJ. 1996, 313: 36-39. 10.1136/bmj.313.7048.36. View ArticlePubMedPubMed CentralGoogle Scholar.

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alchemist essays our hearts. The Alchemist IV. Paper And Monson Academy? Reading of the Novel A. Writing Essay Curtin University (Navitas)? Setting - First the story took place in an abandoned church at Andalusia, but after the boy’s dream was interpreted, the story now took place at paper, Tangier, Al-Fayoum oasis and Harrow School the Egyptian Pyramids where he had his adventures in finding his treasures. B. Characters Major Characters The Alchemist The Alchemist The Alchemist The Alchemist Minor Characters. took his hands in hers.’’ (12) A childhood fear of sites Wilbraham Academy having a gypsy woman interpret his dream, the physical fear of dying in the battle at Al-Fayoum; and the spiritual fear that he will fail to turn himself into the wind, etc. Santiago’s mentor, the alchemist expresses disapproval of fear, so he compares it to materialism, and he describes it as a product of misunderstanding of how the universe treats those pursuing their personal Legend.

In the case of those who set aside fear, they become fear dominates. the article Sherborne, alchemist summer reading Essay. Sites Wilbraham And Monson? uniquely different form of a single spirit. “He thought for a moment that it would be better to pay her fee and leave without learning a thing, that he was giving too much importance to his recurrent dream” CITATION Pau47 l 1033 (Coelho, The Alchemist).The Personal legends serve as the only means by which a person can live a satisfying life. All things on earth can only achieve perfection if all things continuously undergo a cycle of achieving their personal legend and becoming someone more pure. art of Curtin University (Navitas) alchemy as well. The desert woman, Fatima, makes Santiago experience the power of love. He also learns to sacrifice and and Monson Academy wait for the right time. And for the last character, the alchemist, he is the one who gives wisdom to the boy. Everything he says is a new lesson to him. Speaking of the plot, “The Alchemist” is a simple story of a young shepherd who dreams of a treasure in the pyramids. But long before that, he becomes a shepherd after his father’s blessing. “Take to the fields, and someday. and read the future through the omens.

The reading of omens in the natural world gives Santiago a special status reserved for men much older and learned than he is. 12) During his trek through the desert with the alchemist, Santiago is told of many basic truths. Essay Writing Vermont Academy? The alchemist says, There is only one way to learn. It’s through action. Everything you need to research paper Wilbraham and Monson Academy know you have learned through your journey. Article Writing Styles Sherborne International? What are some of the research sites Academy, things Santiago has learned through action? 13) Why did Santiago.

Paulo Coelho#x27;s Alchemist Essay examples. explains to Santiago that he is the Alchemist. The things that Santiago learns from the relationship that they eventually form, show the boy's lack of knowledge on persuasive piece Les Roches Marbella School how to attain one's personal legend while also staying true to research paper sites Wilbraham Academy his dreams. My heart is afraid that it will have to suffer, the boy confides to the alchemist one night as they look up at a moonless night. Tell your heart that the fear of suffering is worse than the suffering itself, the university University Sciences, alchemist replies, And that no heart has ever. Heart, Mind and Fear in The Alchemist by Paulo Coelho Essay. Santiago makes the decision “‘to stay at the oasis…He [has] found Fatima, and, as far as [he] [is] concerned, she [is] worth more than treasure’” (Coelho 133). The alchemist then reassures Santiago that “‘love never keeps a man from pursuing his destiny. If he abandons that pursuit, it [is] because it was [not] true love’” (Coelho 135).

The alchemist effectively changes Santiago’s mindset so he understands that true love cannot be lost, and therefore being afraid of research paper Wilbraham losing it is writing styles Sherborne, worthless and should be eliminated. Power, Wealth and Love in The Alchemist, in Hedda Gabler and in Snow Flower and the Secret Fan. power, which is trying to paper sites Wilbraham and Monson Academy have a relationship with the general daughter. Furthermore, a unique characteristic can help us create our reality. In “The Alchemist”, Santiago has shown several unique characteristics. He has the to write School, courage to go for research Wilbraham and Monson Academy an adventure, and believes in omens to help him avoid danger, and also knows the essay Academy, secret to become an alchemist. First, he shows courage when he begins to start his journey.

Coelho says that “There is only one thing that makes a dream impossible to achieve: the. telling Santiago about his own dream of treasure buried in a an abandoned church under a sycamore tree. Santiago understands that this is where he had his own dream and goes back to Wilbraham and Monson Spain where he finds his buried treasure. Although the where articles Westminster School, story of The Alchemist is sites and Monson Academy, fantastical, the write an opinion essay Harrow, themes and lessons learned by Santiago are relevant and valuable life lessons. Santiago’s courage and belief in following his heart are commendable attributes. Santiago is faced with many hard decisions, the paper Wilbraham, first of which is.

By working for the crystal shop owner, Santiago “ … received a good commission for each piece [of crystal] he sold, and had already been able to put some money aside” (51). This provided the funds that Santiago needed to trek across the desert to Egypt. The owner assists Santiago by giving him insight on his own dreams, saying “You dream about university of Applied, your sheep and the Pyramids, but you’re different from me, because you want to realize your dreams. I just want to dream …” (55). Santiago attains new knowledge. He also allowed the boy to follow his legend and realize his dream. Summary - The story begins when the shepherd boy stopped for the night in research paper and Monson Academy a church with a sycamore tree growing out of the middle. He told of the easy going life of the shepherd and how his parents had wanted to become a priest.

He had attended all of the schooling, but had decided against it at the last minute. He had wanted to see the world and he felt that the best way to do this was to go and become a shepherd. Write An Opinion Harrow? He said that the. Paper Sites And Monson Academy? Comparison of The Alchemist and The Book Thief Essay example. Crystal Merchant taught him how to make a living and paid him enough so that he could save up money to travel across the article styles Sherborne International, desert. While traveling, the Englishman first got Santiago interested in alchemy and eventually, he seeks out the alchemist. With the alchemist, he learns important skills and lessons in life and is also given instructions on how to research paper sites Wilbraham realize his personal legend of where to write articles School finding the treasure. Academy? Essay on Overview of The Alchemist by Paulo Coelho. If Santiago had not told the chieftains about the omen, then the oasis would have been affected greatly. “I’ve brought omens from the desert. the oasis is neutral ground. no one attacks here”(104-106). This explains how no one hardly ever attacks the oasis and also it explains how the oasis is a neutral ground. The omen that Santiago saw was explaining that the oasis was going to be attacked.

Santiago is a heroic figure because he is kind to persuasive Marbella School everyone he meets. Research Paper Wilbraham? Santiago is a hero because he was. Paulo Coelho’s The Alchemist and Robert Frost’s The Road Not Taken. The metaphorical journey extends to the notion vast multitude of essay phrases humans (i.e., the sheep that Santiago herded) know only the physical aspect of their existence. When an Academy individual realizes his or her oneness with the writing Les Roches Marbella School Management, universal soul, he or she sheds identification with the paper Wilbraham, material world thereby raising consciousness higher to the purer spiritual realm. Santiago’s newly found knowledge leaves him thoroughly more sagacious, ushering in spiritually illuminative understanding. Correspondingly, the.

Muslim Technology on the Iberian Peninsula and Western Europe. became the pinnacle of persuasive writing International of Hotel sword making through out the known world. The Moors also brought with them a vast knowledge of alchemy and industrial chemical engineering. Jabir ibn Hayyan, believed to be the first alchemist, wrote many treatises on alchemy that became standard texts for European alchemists. He is credited with the description of many now commonplace chemical processes; for example, crystallization, several forms of distillation, and substances such as citric acid, acetic acid, arsenic, sulfur. Disagreement with Sigmond Freud#x27;s The Future of an Illiusion. exist to him. He explains religious illusion with an research paper sites Academy analogy. “Examples of illusions which have proved true are not easy to find, but the illusion of the alchemist that all metals can be turned into gold might be one of them.” (Freud, The Future of an Illusion Pg.39).

He goes on write an opinion School to explain that religion and alchemy are both illusional, the alchemist want large sums of gold and believers want immortality and a forgiving Father figure to research sites Wilbraham protect them against the unknowns of write an opinion Harrow nature. Freud explains that. Academy? The “Other” Creation: Post-Colonialism in Mary Shelley’s Frankenstein. the Creature being labeled as a monster, never to receive compassion from a human. Young Frankenstein’s interests in the natural sciences are introduced to readers almost immediately, as he expresses a fascination with the works of the occult alchemist, Cornelius Agrippa. When he communicates this literature to his father, thinking that he might be proud of his son for embarking on such an Harrow intriguing subject, he is instead. The Life and research paper sites Wilbraham and Monson Academy Works of Paulo Coelho Essay. Persuasive Piece Les Roches Of Hotel Management? confiscation of 1000 copies, later still committed to print. (MAHATMA) His works are included in the list of best selling books, not only in Brazil, but also in the UK, USA, France, Germany, Canada, Italy, Israel, Finland and Greece. (Paulo) The book The Alchemist is still the sites Academy, best selling book in the history of Brazil, and a conclusion University (Navitas) it is mentioned in the book of Guinness World Records. Coelho is the author of paper Wilbraham and Monson Academy best selling books in writing essay Curtin (Navitas) Portuguese language. (Paulo) Essay about Historical Perspective of Alcoholism. History of Alcoholism in Arab “The oldest alcoholic drinks were fermented beverages of relatively low alcohol content, that is, the beers and wines. Sites Wilbraham And Monson Academy? When the Arabs introduced the Academy, then recent science of distilling into Europe in the Middle Ages, the alchemists believed that alcohol was the long-sought elixir of research paper sites Wilbraham and Monson life. Alcohol was therefore held to be a remedy for practically all diseases, as indicated by the term whisky (Gaelic: Hester refuse to name her lover?

She says the writing essay Curtin University, letter is already too deeply branded and research paper Wilbraham Academy cannot be taken off. She would endure his agony if she could. Her child will only know a heavenly father. Chapter 4 1.Chillingworth is an alchemist who assumes the role of writing a conclusion Curtin University physician in the story. What is. Hyperdimension Neptunia: Video Game Analysis Essay. very reminiscent of a pre-Renaissance era. When it comes to characters, though, the sites Wilbraham, game doesn’t hold back the humor as every company that had a part in the title’s development has a character inspired by their repertoire of titles: Gust has an alchemist character, NISA has a flat-chested ninja, while Idea Factory’s IF and Compile Heart’s Compa take the starring roles alongside Neptune. Each character represents their respective company with great humor and each has plenty of personality. Pending. Examining Human Alienation in Frankenstein by Mary Shelley Essay. (Shelley 29).

This eventually leads to his inevitable destruction after he has passed the where articles Westminster School, point of obsessive compulsiveness. After realizing his keenness in this condemned science, he slowly became more excited as he read works by many famous alchemists. I little expected. to find a disciple in Albertus Magnus and Paracelsus (Shelley 39). Inspired by his research and Academy studies, he decided that he would create a creature. This creature would be beautiful, pleasing to look at, and the entire. Perseverance is where articles School, a key element to achieve the goals of people as shown in Santiago’s situation where he didn’t give up at times of hardships. Paulo Coelho uses the Warrior of the Light and The Alchemist to and Monson Academy tell people that they need to Harrow interpret symbols and research paper Academy read omens to know the next step of their journey.

In The Warrior of the Light, a quote is stating that a person needs to understand everything to make a decision: “…he withdraws to write essay Harrow School the corner of his tent where he usually sits to meditate.

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