South Africa and Chile: Agricultural Trade Relationships

This article considers Chile and South Africa’s agricultural policy evolutions in terms of trade. It also looks at Chile and South Africa’s trade with the rest of the world, particularly with regards to agricultural trade. From an agricultural trade perspective, Chile’s position as a direct competitor of South Africa for the EU and USA markets is clearly apparent, primarily due to their joint location in the southern hemisphere. Furthermore, the movement of agricultural products between these nations from a South African export perspective is discussed. This article explores the potential for South Africa to increase its exports to Chile by deepening existing trading and investigating the expansion of trade lines. Two policy observations can be identified from this study with a view to improving South Africa’s current agricultural sector and increasing its exports trade to Chile. The first observation is the manner in which the agricultural budget is allocated (following Chile’s successful budget allocation as a guide). The second observation is, should South Africa negotiate a Free Trade Agreement (FTA) with Chile, the opportunities for agricultural export expansion from the products listed in the annexe shown on the final page.International Relations/Trade,

Comparative advantage of potato production in seven regions of South Africa

The focus of this research was to investigate the comparative advantage of the potato industry in seven potato production regions in South Africa. Potatoes are the most important vegetable crop produced in South Africa. In 2008 it contributed more than 40% to the total production of vegetables in South Africa and it accounted for more than 20% of the value of all fresh produce sold on all the major national fresh produce markets. This study uses the Resource Cost Ratio (RCR) methodology that provides an explicit indication of the efficiency with which production alternatives uses domestic resources to generate or save foreign exchange. The Nominal Protection Ratio (NPR) and Effective Protection Coefficient (EPC) were also calculated. The results show that current policies that affects the input market for potato production in South Africa is constraining the potato industry. This was confirmed by the results obtained from the NPR and EPC analysis, and the size of the policy distortions was shown through the calculation of market and economic profitability. If current policies prevail potato production in the Eastern Free State will not have a comparative advantage, but in the absence of such policies all production regions have a comparative advantage.Crop Production/Industries,

Re-imagining International Environmental Law for the Anthropocene Epoch: An Earth System Law Perspective

Concerns have been raised regarding the ability of international environmental law to respond to potentially irreversible earth system transformations in the Anthropocene. We argue that in order for international environmental law to have the capacity to respond to the socio-ecological challenges of the Anthropocene, it should embrace an earth system perspective. Earth system law, which is grounded in an earth system perspective, has been proposed as a new epistemic framework to facilitate the legal transformations necessary to respond to such socio-ecological challenges. With reference to recent developments in the international environmental law domain, we discuss the ways in which international environmental law currently fails to align with such a perspective and the types of considerations that international environmental law should reflect in order to be more responsive to a transforming earth system and, thus, better fit-for-purpose in the Anthropocene

Guiding Environmental Law’s Transformation into Earth System Law Through the Telecoupling Framework

Insights from Earth system science show us that we are crossing over into a new geological epoch, the Anthropocene. Yet, environmental law has failed to integrate these insights and adopt an Earth system perspective, with the result that environmental law has arguably become incapable of responding to the numerous complex, interconnected, and non-linear challenges of an erratic Earth system in the Anthropocene. Earth system law is proposed as a response and is intended to ‘translate’ Earth system science insights into the legal domain, thereby transforming Holocene nvironmental law and making it more fit for purpose in the Anthropocene. In order to practically explore how this transformation could take place, reliance is placed on the telecoupling framework, which analyses interconnected or coupled human and natural systems over distances. With reference to the mining activities conducted by Canadian companies in Mexico, the telecoupling framework is revealed as a valuable tool for thinking about environmental law in Earth system terms and enabling one to see a range of deeply intertwined telecoupled issues and considerations that must be taken account of by the law. In turn, this enables one to begin to imagine the types of considerations that should be incorporated into legal responses in order to adequately respond to the socio-ecological challenges of the Anthropocene

Recommendations to facilitate the ideal fit note: are they achievable in practice?

Background: Although the UK fit note has been broadly welcomed as a tool to facilitate return to work, difficulties and uncertainties have resulted in wide variation in its use. Agreement on what constitutes the ‘ideal’ fit note from the perspective of all stakeholders is needed to inform best practice. A recent Delphi study conducted by the authors reached consensus on 67 recommendations for best practice in fit note use for employed patients. However, such recommendations are not necessarily followed in practice. The purpose of this study was therefore to investigate the perceived achievability of implementing these Delphi recommendations with a further reference panel of stakeholders. Methods: Potential participants were identified by the research team and study steering group. These included representatives of employers, government departments, trades unions, patient organisations, general and medical practitioners and occupational health organisations who were believed to have the knowledge and experience to comment on the recommendations. The consensus Delphi statements were presented to the participants on-line. Participants were invited to comment on whether the recommendations were achievable, and what might hinder or facilitate their use in practice. Free text comments were combined with comments made in the Delphi study that referred to issues of feasibility or practicality. These were synthesised and analysed thematically. Results: Twelve individuals representing a range of stakeholder groups participated. Many of the recommendations were considered achievable, such as improved format and use of the electronic fit note, completion of all fields, better application and revision of guidance and education in fit note use. However a number of obstacles to implementation were identified. These included: legislation governing the fit note and GP contracts; the costs and complexity of IT systems and software; the limitations of the GP consultation; unclear roles and responsibilities for the funding and delivery of education, guidance and training for all stakeholders, and the evaluation of practice. Conclusions: This study demonstrated that although many recommendations for the ideal fit note are considered achievable, there are considerable financial, legal, organisational and professional obstacles to be overcome in order for the recommendations to be implemented successfully

Anastrozole versus tamoxifen for the prevention of locoregional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in situ (IBIS-II DCIS): a double-blind, randomised controlled trial

Background Third-generation aromatase inhibitors are more effective than tamoxifen for preventing recurrence in postmenopausal women with hormone-receptor-positive invasive breast cancer. However, it is not known whether anastrozole is more effective than tamoxifen for women with hormone-receptor-positive ductal carcinoma in situ (DCIS). Here, we compare the efficacy of anastrozole with that of tamoxifen in postmenopausal women with hormone-receptor-positive DCIS. Methods In a double-blind, multicentre, randomised placebo-controlled trial, we recruited women who had been diagnosed with locally excised, hormone-receptor-positive DCIS. Eligible women were randomly assigned in a 1:1 ratio by central computer allocation to receive 1 mg oral anastrozole or 20 mg oral tamoxifen every day for 5 years. Randomisation was stratified by major centre or hub and was done in blocks (six, eight, or ten). All trial personnel, participants, and clinicians were masked to treatment allocation and only the trial statistician had access to treatment allocation. The primary endpoint was all recurrence, including recurrent DCIS and new contralateral tumours. All analyses were done on a modified intention-to-treat basis (in all women who were randomised and did not revoke consent for their data to be included) and proportional hazard models were used to compute hazard ratios and corresponding confidence intervals. This trial is registered at the ISRCTN registry, number ISRCTN37546358. Results Between March 3, 2003, and Feb 8, 2012, we enrolled 2980 postmenopausal women from 236 centres in 14 countries and randomly assigned them to receive anastrozole (1449 analysed) or tamoxifen (1489 analysed). Median follow-up was 7·2 years (IQR 5·6–8·9), and 144 breast cancer recurrences were recorded. We noted no statistically significant difference in overall recurrence (67 recurrences for anastrozole vs 77 for tamoxifen; HR 0·89 [95% CI 0·64–1·23]). The non-inferiority of anastrozole was established (upper 95% CI <1·25), but its superiority to tamoxifen was not (p=0·49). A total of 69 deaths were recorded (33 for anastrozole vs 36 for tamoxifen; HR 0·93 [95% CI 0·58–1·50], p=0·78), and no specific cause was more common in one group than the other. The number of women reporting any adverse event was similar between anastrozole (1323 women, 91%) and tamoxifen (1379 women, 93%); the side-effect profiles of the two drugs differed, with more fractures, musculoskeletal events, hypercholesterolaemia, and strokes with anastrozole and more muscle spasm, gynaecological cancers and symptoms, vasomotor symptoms, and deep vein thromboses with tamoxifen. Conclusions No clear efficacy differences were seen between the two treatments. Anastrozole offers another treatment option for postmenopausal women with hormone-receptor-positive DCIS, which may be be more appropriate for some women with contraindications for tamoxifen. Longer follow-up will be necessary to fully evaluate treatment differences

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat