Humanity has entered a new geologic age wherein our actions have become the dominant influence steering both climate and environment, now having entered a new era of mass extinction. Some scientist allege that half of the extant animal species have disappeared in the last forty years, while other scientific studies project that the remaining nine million species will again halve by the end of the century. Although extinction cycles are no stranger to this planet, this sixth iteration is unique in that is being driven primarily by human consumption. It has been claimed that in order to sustain our current level of consumption, we would need a planet 1.5-2 times the size of the one we currently inhabit. It is easy to dismiss our individual responsibility as stewards of this planet. New modes of thinking about and approaching conservation at a local level must be developed in order to stave off the impending destruction of any and all species. Our own future as a species is inexorably linked to the success of the ecosystems we inhabit; their success, too, is bound to the species that sustain them. While this essay may not offer any meaningful solutions to an impending cataclysm, it is my hope that it will at the very least elicit a desire to amend the way we think about animals, nature, and the urgent responsibility we need to take for our planet in order for both our species and the Earth’s other inhabitants to endure.

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The origin of services is increasingly relevant against the backdrop of technological innovation and global value chains. Rules of origin for trade in services are especially important in Economic Integration Agreements, which are proliferating in response to the changes in global trade and production. The Southern African Development Community commenced the Protocol on Trade in Services negotiations in April 2012 with the objective of creating an integrated regional market for services. This study examines the current and dominant approaches to the formulation of rules of origin for trade in services in twenty five (25) Economic Integration Agreements with the purpose of making recommendations, to develop further, the definition of "substantial business operations" for the SADC Protocol on Trade in Services. It concludes, first, that the type best suited for SADC is a rule of origin designed to address broader socio-economic goals in the region. Second, the criteria used to define substantial business operations in the Mainland-Hong Kong, China CEPA provides a basis which SADC can consider as a key determinant of origin, in order to prevent free-riders from benefiting from the trade preferences under the SADC Protocol on Trade in Services. Lastly, the effectiveness of rules of origin will depend on domestic regulation and regional monitoring, evaluation and enforcement mechanisms to support and regulate investments in the services sectors.

A number of developing countries, particularly those in Asia, have been successful in using Special Economic Zones (SEZ) to attract Foreign Direct Investment (FDI) in export oriented manufacturing. The zones attract FDI by offering infrastructure and a hassle free business environment for investors. Most African countries that have introduced SEZs within their territories have failed to replicate the success enjoyed by a number of Asian countries. In 2000, South Africa introduced Industrial Development Zones (IDZs), another form of SEZs. The Department of Trade and Industry (DTI) defines IDZs as purpose-built industrial estates that leverage FDI in value-added and export-oriented manufacturing and services. Like other African countries, South Africa's IDZs have failed to live up to expectations. The South African zones continue to rely on Government for their current and capital expenditure. In 2006, the Government initiated a review of the IDZ Programme. The review mainly attributed the failure of the IDZ Programme to poor governance and made little reference to the infrastructure provided by the zones. In an effort to get a more comprehensive picture of the IDZs, this study investigates the quality of infrastructure within the zones. The major findings of this study have indicated that power and electricity remain a major concern in both the Coega Industrial Development Zone (CIDZ) and the East London Industrial Development Zone (ELIDZ) to zone authorities and enterprises. The two zones cannot accommodate electricity intensive operations and have resorted to focusing on enterprises that consume less electricity. It was also established that the communication infrastructure such as the cellular phone signal and internet connectivity are also a major concern within both the CIDZ and ELIDZ. This study also found that the ELIDZ does not have a deep water port to handle bulk cargo ships and that both the ELIDZ and the CIDZ do not have an efficient transportation network linking IDZ enterprises to the rest of the economy.

The researcher observed that little or no attention was being paid to the realities and experiences that the Malawian private sector faced when using various Trade Facilitation (TF) measures being implemented by Malawi within the context of Southern African Development Community (SADC) and Common Market for Eastern and Southern Africa (COMESA) and when trading within the SADC and COMESA regions. Notable gaps were identified in the overall TF management process in Malawi. This study made an assessment of each TF measure that Malawi introduced and implemented within the context of SADC and COMESA, analysing its benefits and challenges from a private-sector perspective. Questionnaires and interviews were used to get in-depth, objective and honest perspective from the private sector on these TF measures. The findings of the study revealed that the various TF measures implemented brought: universal and common tariff coding and measurement units for goods; certainty and predictability in the classification of goods; speedy release of goods; reduced delays in transit time; preferential rates of duty for the private sector. Other anticipated results include a further reduction in insurance and bond costs and faster sharing of information, once other measures are fully implemented. In brief, most TF measures reduced the cost of doing business. However, challenges were also found and they included: limited and selective awareness and involvement of the private sector during both consultation and implementation of the TF instruments; unharmonised implementation of the TF measures; notable lack of trust between customs and trade community; notable delays in implementation of some measures; no post-mortem and audit of the TF measures to check and confirm the successes and challenges that the TF measures have brought into the trade chain; poor selection and management of stakeholders to involve; secretive acts over TF information; and weaknesses in the legal frameworks of SADC and COMESA. A further analysis of these issues is presented in chapter four and chapter five.

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BACKGROUND: The American Academy of Orthopaedic Surgeons (AAOS) and the American College of Chest Physicians (ACCP) have both developed evidence- based guidelines to prevent venous thromboembolism (VTE) in high-risk orthopedic surgery patients. Recent changes to these documents have brought them into agreement as to the inclusion of aspirin as an appropriate option for VTE prophylaxis in this patient population. OBJECTIVE: To evaluate the appropriateness of aspirin to prevent VTE in high-risk orthopedic surgery patients. DATA SOURCES: Guidelines published by the AAOS in 2011 and the ACCP in 2012 were compared regarding their recommendations on the use of aspirin for the prevention of VTE. A literature search was also conducted to identify clinical trials that evaluated the use of aspirin for the prevention of VTE in this patient population. Search terms included the MeSH terms venous thromboembolism; venous thrombosis; pulmonary embolism; aspirin; arthroplasty, replacement, knee; arthroplasty, replacement, hip; and hip fractures/surgery. STUDY SELECTION AND DATA EXTRACTION: Any study that evaluated aspirin, even in combination with another method of prophylaxis (such as pneumatic compression devices), and had been published during or after 1985 was included. DATA SYNTHESIS: Randomized controlled trials, meta-analyses, and other large pooled and retrospective reviews have failed to consistently arrive at similar conclusions regarding the efficacy and safety of aspirin as an option for VTE prophylaxis in patients undergoing total knee arthroplasty (TKA), total hip arthro- plasty (THA), or hip fracture surgery (HFS). Disagreements in the appropriateness of surrogate markers for safety and efficacy have resulted in differing recommen- dations from the ACCP and AAOS. The primary argument lies in the appropriate- ness of deep vein thrombosis as a surrogate marker for more serious outcomes such as pulmonary emboli. CONCLUSIONS: Recent changes to both the ACCP and AAOS guidelines are in agreement for those who choose to use aspirin for chemoprophylaxis of VTE. Current surgical care improvement project measures do not include aspirin as an appropriate sole option for the prevention of VTE, but in patients undergoing elective TKA or who have a contraindication to pharmacologic prophylaxis and undergo a THA or HFS, aspirin in conjunction with compression devices as part of a multimodal approach would meet these measures. Data do not support the hypothesis that aspirin is less likely to cause adverse bleeding events than more potent anticoagulants.

Objective: To review the literature regarding therapeutic options for accidental epinephrine exposure via EpiPen (Mylan Specialty Inc.) autoinjector devices and to suggest a treatment algorithm based on the most common approaches found therein. Data Sources: A literature search of MEDLINE (1950-March 2012) was conducted, using the search term accidental epinephrine injection in combination with the terms adrenaline, EpiPen, anaphylaxis, autoinjector, and treatment. Case reports, case series, and systematic reviews were evaluated for efficacy and safety data. In addition, the references of the reviewed articles were examined to identify additional reports or data. Study Selection and Data Extraction: All English-language articles describing accidental exposure to epinephrine were identified. Our search included both pediatric and adult patient populations. Articles were excluded if the exposure to epinephrine was purposeful and the EpiPen described in the report was being used as intended or the outcome was not clear. Individual case reports were described in detail whereas case series and systematic reviews were included but were not described in detail. To our knowledge, there have been no clinical trials that describe or compare therapeutic options for accidental exposure to epinephrine. Data Synthesis: Accidental exposure to epinephrine is an underreported phenomenon that could warrant medical attention. The importance of this issue has recently been emphasized with the legislative requirement of many schools to store epinephrine (EpiPen) autoinjector devices. The available therapeutic options can be divided into pharmacologic and nonpharmacologic categories. The most common pharmacologic options described in the literature include phentolamine, subcutaneous terbutaline, topical nitrates, and calcium channel blockers. Nonpharmacologic options include observation and/or warm water soaks. Treatment recommendations in our proposed algorithm were based solely on the available data that we describe in our review. Conclusions: The literature did not provide clear guidance on the most appropriate management of accidental epinephrine injection. However, if pharmacologic therapy is necessary, phentolamine appears to be considered the most effective. Guidelines may be helpful in improving the management of accidental epinephrine injection, as well as in preventing unnecessary therapy.

BACKGROUND: The American Academy of Orthopaedic Surgeons (AAOS) and the American College of Chest Physicians (ACCP) have both developed evidence- based guidelines to prevent venous thromboembolism (VTE) in high-risk orthopedic surgery patients. Recent changes to these documents have brought them into agreement as to the inclusion of aspirin as an appropriate option for VTE prophylaxis in this patient population. OBJECTIVE: To evaluate the appropriateness of aspirin to prevent VTE in high-risk orthopedic surgery patients. DATA SOURCES: Guidelines published by the AAOS in 2011 and the ACCP in 2012 were compared regarding their recommendations on the use of aspirin for the prevention of VTE. A literature search was also conducted to identify clinical trials that evaluated the use of aspirin for the prevention of VTE in this patient population. Search terms included the MeSH terms venous thromboembolism; venous thrombosis; pulmonary embolism; aspirin; arthroplasty, replacement, knee; arthroplasty, replacement, hip; and hip fractures/surgery. STUDY SELECTION AND DATA EXTRACTION: Any study that evaluated aspirin, even in combination with another method of prophylaxis (such as pneumatic compression devices), and had been published during or after 1985 was included. DATA SYNTHESIS: Randomized controlled trials, meta-analyses, and other large pooled and retrospective reviews have failed to consistently arrive at similar conclusions regarding the efficacy and safety of aspirin as an option for VTE prophylaxis in patients undergoing total knee arthroplasty (TKA), total hip arthro- plasty (THA), or hip fracture surgery (HFS). Disagreements in the appropriateness of surrogate markers for safety and efficacy have resulted in differing recommen- dations from the ACCP and AAOS. The primary argument lies in the appropriate- ness of deep vein thrombosis as a surrogate marker for more serious outcomes such as pulmonary emboli. CONCLUSIONS: Recent changes to both the ACCP and AAOS guidelines are in agreement for those who choose to use aspirin for chemoprophylaxis of VTE. Current surgical care improvement project measures do not include aspirin as an appropriate sole option for the prevention of VTE, but in patients undergoing elective TKA or who have a contraindication to pharmacologic prophylaxis and undergo a THA or HFS, aspirin in conjunction with compression devices as part of a multimodal approach would meet these measures. Data do not support the hypothesis that aspirin is less likely to cause adverse bleeding events than more potent anticoagulants.

Objective: To review the literature regarding therapeutic options for accidental epinephrine exposure via EpiPen (Mylan Specialty Inc.) autoinjector devices and to suggest a treatment algorithm based on the most common approaches found therein. Data Sources: A literature search of MEDLINE (1950-March 2012) was conducted, using the search term accidental epinephrine injection in combination with the terms adrenaline, EpiPen, anaphylaxis, autoinjector, and treatment. Case reports, case series, and systematic reviews were evaluated for efficacy and safety data. In addition, the references of the reviewed articles were examined to identify additional reports or data. Study Selection and Data Extraction: All English-language articles describing accidental exposure to epinephrine were identified. Our search included both pediatric and adult patient populations. Articles were excluded if the exposure to epinephrine was purposeful and the EpiPen described in the report was being used as intended or the outcome was not clear. Individual case reports were described in detail whereas case series and systematic reviews were included but were not described in detail. To our knowledge, there have been no clinical trials that describe or compare therapeutic options for accidental exposure to epinephrine. Data Synthesis: Accidental exposure to epinephrine is an underreported phenomenon that could warrant medical attention. The importance of this issue has recently been emphasized with the legislative requirement of many schools to store epinephrine (EpiPen) autoinjector devices. The available therapeutic options can be divided into pharmacologic and nonpharmacologic categories. The most common pharmacologic options described in the literature include phentolamine, subcutaneous terbutaline, topical nitrates, and calcium channel blockers. Nonpharmacologic options include observation and/or warm water soaks. Treatment recommendations in our proposed algorithm were based solely on the available data that we describe in our review. Conclusions: The literature did not provide clear guidance on the most appropriate management of accidental epinephrine injection. However, if pharmacologic therapy is necessary, phentolamine appears to be considered the most effective. Guidelines may be helpful in improving the management of accidental epinephrine injection, as well as in preventing unnecessary therapy.