Includes bibliographical references / The African Growth and Opportunity Act (AGOA) is a unilateral trade policy concession governing United States - Sub-Saharan Africa (SSA) trade and investment relations. AGOA provides United States market access for 40 SSA countries, including South Africa. This piece of legislation has the fundamental objective of facilitating the global integration of SSA countries into the world economy by extending preferential access to the United States market for exporters from eligible countries. Over the past decade, AGOA has emerged as a topical issue as scholars and policy makers sought to understand its impact on SSA, especially South Africa. This has been awarded more impetus given its pending expiration in 2015. This, naturally, raised questions about the performance of United States preference programs (such as AGOA) as part of a larger ongoing debate on the form that United States preference programs may take in the foreseeable future. With South Africa facing a serious opposition to inclusion in the next shape of AGOA given the number of trade agreements South Africa has signed with countries that are competitors to United States in certain product categories. This study will seek to highlight the importance of the AGOA dispensation to South Africa, and through that analysis make a case for the continued inclusion of South Africa in the future trade dispensations that may develop. This study focuses on two research objectives; firstly, the study seeks to assess the extent to which increased preferential access to the United States market has translated into a real and tangible increase in exports from South Africa to the United States. Secondly, the study seeks to identify the areas where South Africa and the United States have high trade potential, and help make a case for inclusion of these high potential trade products in the next iteration of the AGOA dispensation. In achieving the first research objective, the study carried out a detailed trade statistics analysis with the hope of gaining greater understanding of the extent to which AGOA has influenced trade patterns between the United States and South Africa. South Africa's trade figures show that the United States is an important trade partner. A key conclusion that can be drawn from the analysis is the observation that a fair amount of growth in South Africa's exports to the United States is fundamentally characterized by two key aspects namely; growth in specific commodities and an export base that is becoming gradually concentrated over time. This implies that trade between South Africa and the United States is shifting towards a new focus in line with AGOA incentives and by extension one may conclude that South African firms are utilizing the market opportunities and the networks that enable them to effectively exploit the United States market. In fulfilling the second research objective, the detailed trade potential analysis that is propped up by a robust analysis of trade trends was carried out. The trade potential analysis identified thirteen commodity groups as having high potential for further exports into the United States market, and Pearls, precious stones and metals were identified as having the highest indicative trade potential, although the picture changes as the data is further disaggregated. This suggests that there is enormous potential and a great scope for export of pearls, precious stones and metals to the United States.

How should the experimental use mechanism be designed in order to maintain the proper balance between the rights of patent holders and the rights retained by the public? The work explores various approaches towards the experimental use exemption in influential regions, such as US UK Germany Japan as well as in international treaties. In each of these systems some degree of vulnerability is found. Either exemption is too narrow or too broad and lacking a dynamic dimension. Therefore, the work sets out to design a dynamic and multi-step experimental use mechanism. The work proposes to view the experimental use mechanism as a right provided to the public and in turn as a duty imposed on the patent holder to suggest path/s of exploration with regard to the patented invention. This approach significantly strengthens the experimental use mechanism as it becomes part of the bundle of requirements that an inventor needs to comply with in order to obtain a patent grant. The scope of the experimental use mechanism will be determined by a three step process. In the first stage the positions and interests of the inventor, invention and researcher will be taken into account in order to determine the incentives needed to cause inventors to stay within the patent system and at the same time prevent researches from migrating to other regions. In the second stage the scope of the experimental use mechanism will be impacted by the determination whether either party adopted anticompetitive behavior. The final step will inquire whether the invention or the research is geared at improving public health. In these instances there will be a tendency to increase the scope of the experimental use mechanism due to the internationally recognized right to health and its global importance. The work incorporates concepts from different legal fields such as competition law and health policy as well as from other disciplines including economics and psychology The three step process has the potential of designing a dynamic and robust experimental use mechanism which may prove to be useful in other patent settings such as the holdup problem or blocking patents. Incorporating a flexible experimental use mechanism may diminish the attempts of patent holders to act opportunistically and curtail the rights of the public. Thus, the work contributes to the current state of the experimental use debate and towards achieving the proper balance between the rights of the patent holder and the rights of the public.

Abstract : Rare diseases are debilitating conditions often leading to severe clinical manifestations for affected patients. Orphan drugs have been developed to treat these rare diseases affecting a small number of individuals. Incentives in the legal framework aimed to recoup the research and development cost of orphan drugs for pharmaceutical companies have been implemented in the United States and the European Union. At the present time, Canada is still lacking a legal and policy framework for orphan drugs. Several problems at the federal and provincial levels remain: lack of research funds for rare diseases, discrepancies on orphan drug policies between provinces, difficulties to access and reimburse these high price drugs. Recommendations and measures are proposed, such as a pan-Canadian (national) scientific committee to establish evidence-based guidelines for patients to access orphan drugs uniformly in all provinces with a disease specific registry, a formal agreement for a centralized Canadian public funding reimbursement procedure, and increasing the role of “guardian” for prices by the Patented Medicines Review Board in Canada. These recommendations and measures will be beneficial for the implementation of a policy framework for orphan drugs in Canada. / Résumé : Les maladies rares sont des maladies sérieuses pouvant causer des manifestations cliniques sévères chez les patients atteints. Les médicaments orphelins ont été développés pour le traitement de ces maladies rares qui touchent un petit nombre d’individus. Un cadre légal permettant des incitatifs pour les compagnies pharmaceutiques aux États-Unis et au niveau de l’Union Européenne a favorisé la recherche et le développement desdits médicaments. Présentement, il n’existe pas de cadre juridique et de politiques spécifiques au Canada entourant les médicaments orphelins. Ceci a mené à plusieurs problèmes tant au niveau fédéral que provincial dont: un manque de support financier consacré à la recherche pour les maladies rares, des disparités entre les provinces concernant les politiques pour les médicaments orphelins, des difficultés d’accès et de remboursement desdits médicaments dont les coûts sont élevés. Des recommandations et mesures sont proposées, telles l’implantation d’un comité scientifique pancanadien (national) afin d’établir des lignes directrices fondées sur des données probantes pour faciliter un accès uniforme aux médicaments orphelins pour les patients, y compris un registre spécifique élaboré pour chaque maladie, établir une entente formelle centralisée pour tout le Canada pour un financement public de remboursement des médicaments orphelins, augmenter le rôle de « gardien » des prix par le Conseil d’examen du prix des médicaments brevetés au Canada. Ces recommandations et mesures serviront à l’implantation d’un cadre de politiques pour les médicaments orphelins au Canada.

Hundreds of state regulations were passed during the “managed care backlash” of the late 1990s and early 2000s. Many of these anti-managed care regulations eased or eliminated constraints on patient utilization of health care services imposed by managed care organizations. Other regulations gave managed care providers more flexibility in the way they practiced care or helped patients appeal denials of claims. Despite the effort undertaken to pass these regulations, limited research exists on whether the regulations achieved their goal. To fill this gap, this study takes advantage of the variety of regulations enacted during the managed care backlash of the late 1990s and early 2000s to investigate their impact on patient-reported quality of care and mortality for managed care enrollees. The results indicate the regulations did improve patient-reported outcomes, but to varying degrees and only in the latter period of the backlash. Specifically, managed care enrollees who lived in states that adopted moderate-intensity regulations between 2000 and 2004 reported relatively better improvements in access to care and confidence in their provider than did managed care enrollees in states with low-intensity backlash regulations. The positive effect on access to care was similar in states that adopted high-intensity regulations. However, no positive effect was found for any outcome in the first period (1996-2000). These results show that states with the most intense regulatory backlash did not realize better patient-reported outcomes. Instead, states that pursued moderate-intensity backlash regulations experienced relatively better outcomes for their managed care enrollees.

The Theory of Regulation and the Economic Theory of Regulatory Constraint have not yet been adapted by American Indian Studies scholars to explain and analyze the federal regulations connected with Federal Indian Law and Policy. It is the intention of this thesis to prove the applicability of these theories to the law and policy concentration of American Indian Studies. The adaptation of these two theories could impact how federal regulations affecting Indian Country are viewed and interpreted. An examination of Federal Indian policy, specifically the regulations (43 CFR 10) promulgated for the Native American Graves Protection and Repatriation Act (NAGPRA) and the National Historic Preservation Act (NHPA) Section 106 tribal consultation processes (36 CFR PART 800) can provide a case study for understanding the applicability of the Theory of Regulation and the Economic Theory of Regulatory Constraint to a common regulatory process in Federal Indian Law.

This thesis argues that current treatment in acute public mental health services is counterproductive for the wellbeing of those subject to such services. The consumer/survivor movement activism against the coercive nature of treatment is analysed according to new social movement theory. According to social theorists such as Alaine Touraine, new social movements are characterised by a struggle over identity. Consistent with this theme, what is identified in this thesis as central to the consumer/survivor movement objection to the nature of treatment in acute public mental health services, is the failure of services to respect patient identity as persons. What might account for this failure is analysed in this thesis through an examination of the question of the conceptualisation of the subject in the theory and concepts of psychiatry, in the practice of psychiatry, in mental health law and in government policy. / As a counterposition to the above perspectives, the work of RD Laing, Charles Taylor and Paul Ricoeur are considered in an attempt to develop a conceptualisation of the subject grounded in a historical narrative. Further, Emmanuel Levinas’ and Axel Honneth’s work is drawn on to identify the practical implications of Honneth’s claim for a politics of recognition, which also supports the consumer/survivor movement demand for recognition as subjects in mental health services.

Examining the persistence of disparities over time is an important obligation in terms of rectifying, maintaining, and improving community health and social well-being for all. This study analyzed the individual factors of (a) race/ ethnicity and (b) dual eligibility, as a proxy measure of socioeconomic status, as well as the environmental factor of (c) place of residence, and the organizational factor of (d) Rural Health Clinic (RHC) type on emergency room (ER) utilization of older adult Medicare patients treated by RHCs within the Department of Health and Human Services' (DHHS) Region 4. A prospective, multi-level, longitudinal design was employed to analyze potential health disparities or gaps that may exist among RHC Medicare beneficiary patients (+65) using longitudinal, mixed multilevel modeling in SPSS. The years of investigation were 2010 through 2012. R4 has continually lagged behind other Regions in the Nation in having higher Health Disparities and ER Utilization rates related to Race, Poverty, and Rural Isolation. A key question is: Do these disparities persist? This study's findings support that dual eligible RHC patients utilized ER services at higher rates than non-dual eligible, Medicare only RHC patients at: 77%, 80%, and 66%, in 2010, 2011, and 2012, respectively; and above the White reference group, Black RHC Medicare patients utilized ER services at higher rates of: 18%, 20%, and 34%, in 2010, 2011, and 2012, respectively. These findings support that dual Medicare and Medicaid eligibility, as a proxy measure of socioeconomic status, and race continue to influence higher rates of ER utilization in Region 4. In terms of health and utilization disparities, strikingly and persistently, as recent as 2012, Black, dual eligible RHC Medicare beneficiary patients age 65 and over are twice as likely to utilize ER services for health care than their more advantaged counterparts. Health care leaders and policymakers are seeking evidence-based performance measures as tools for detecting gaps in health care and using those subsequent findings as leverage to implement policy change for the purpose of increasing health care delivery performance system-wide while lowering health disparities across various patient populations. Toward that goal, communicating and disseminating the findings of this study contributes to the body of knowledge and enables policy leaders to better make decisions based on empirical evidence in order to strengthen the health care delivery system for older adults in diverse rural contexts. From a health and public affairs policy perspective, crafting in tandem targeted, top-down, population health and bottom-up, community interventions to curb poor health outcomes and high health care utilization would be in the public interest at-large within this region of the Southeastern United States.

This dissertation examines the tension inherent in the relationship between the Economic Community of West African States (ECOWAS) as Member States Parties of the GATT/WTO and the GATT/WTO regime. It focuses specifically on the tension triggered off by the requirements of Article I – the Most-Favoured-Nation principle (MFN) and Article III – the National Treatment principle (NT) GATT 1994. It shows that while the non-discrimination principles are meant to promote trade liberalisation and economic growth, they produce the opposite effect in developing and least developed countries like ECOWAS and aggravate the tension between those countries and the WTO. It argues that the MFN is used to deny market access to the developing countries by exposing them to stiff but unequal competitive conditions and the NT to deny national governments the policy space to protect and promote national industries, employment and economic growth. It challenges the general assumption that the MFN and the NT are good and in the interest of all the WTO Members and rather identifies them as lynch-pins of economic development in the ECOWAS region. It also shows, contrary to the assumption of non-participation, how the ECOWAS High Contracting Parties are adapting their trading systems and harmonising their laws to the key provisions of Articles I and III of the GATT. It shows that the principles of non-discrimination are the outcome of the standard-setting procedures legally formulated as the SPS and TBT Agreements which favour the developed countries and how the Dispute Settlement Body has rejected the ‘aims-and-effect’ approach, taken a literal approach, overly emphasising trade liberalisation to the neglect of market access and economic development. This dissertation concludes that it is pre-mature for ECOWAS to assume Articles I and III obligations and recommends using the provisions of Article XXIV to build up effective influence through regional organisations and incrementally uniting to transform the GATT.

The Patient Protection and Affordable Care Act (ACA) aimed to increase accessibility to medical resources for those previously uninsured. Certainly, the ACA has expanded insurance to millions of Americans, however, the evidence and discourse surrounding health accessibility calls into question why, despite the growth of insured Americans, the increase in health insurance coverage under the ACA has not lead to greater accessibility for low income minorities. I propose that disparities in preventive care, the emergency room, and primary care provider services stand as barriers for low income minorities. Insurance coverage does not necessarily equate to greater accessibility if individuals do not have the means to utilize those resources.

This thesis examines law and policy in the book publishing industry in Ghana, with an evaluation of the success of government-sponsored institutions that have been established for the purpose of publishing development in the country. Issues concerning publishing development in Ghana and other countries in Africa have attracted considerable debate and coverage in the literature. The focus of the debate has been mainly centred on challenges confronting publishing development in the continent and the promotion of sustainable schoolbooks provision. Whilst there is a body of existing literature on the historical development of book publishing and its challenges, the role of law and policy, and the contributions of government-sponsored institutions to publishing development has not been explored. This thesis therefore provides the first analysis of law and policy, and an evaluation of government-sponsored institutions. In an attempt to fill this gap, this research identifies law and policy, examines the rationale for policy formulation, the policy-making process itself, the experiences of various stakeholders in the formulation of these policies and issues relating to the implementation of policy. It also evaluates the success of government-sponsored institutions by examining how their work has influenced book development and publishing in the country. The data for this research comprise legislation, policy documents and recorded interviews. These were analysed using the framework that was developed for book policy analysis. The use of the framework has been particularly useful in the analysis because it is compatible with the critical realist approach. Over two empirical chapters, the use of content analysis provides a thorough insight of the social, economic and political context, within the context of Ghana, for which institutions dedicated to publishing development were established as well as the formulation of book policies. Although government-sponsored institutions have provided considerable support to publishing development, the findings suggest that their operations are hindered due to a lack of funds and logistics. The findings again suggest that both national and international legislation have not been adequately beneficial to publishing development. A third empirical chapter, which focuses on the interview data for policy development offers an in-depth analysis into the policy-making process and the challenges that are associated with the implementation of policy. The findings suggest existing policy is limited in terms of scope of book publishing, and even with this limitation, there is a lack of transparency in the procurement process. A major challenge of the book publishing industry in Ghana is the lack of resources to enforce legislation and implement policies. Public policy analysis is not a new concept, however this research developed a framework for book policy analysis, a framework that combines concepts from general public policy analysis and in the specific area of information science as well as guidelines from UNESCO s guide to formulating book policies in a way that allowed the content of book policies to be analysed. The research also recommends that institutions should be strengthened through review and restructuring, and to review the textbook policy towards the development of a national book policy that will recognise book publishing as a strategic national industry.