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Providing trauma care in an austere environment is very challenging, especially when the country is faced with a natural disaster. Unfortunately the combination of these elements highlights the deficiencies in managing orthopaedic trauma both in a developing country and in the face of a natural disaster, exponentially amplifying the effects of each. When considering the implementation and practice of orthopaedic trauma care in such an environment, one must consider the initial phase of program development and look further to the future in the development of a resilient program, which is sustainable. Through the use of the example of Haiti and a specific Non-Governmental Organization, we discuss the evidence for and thoughts behind developing orthopaedic trauma care program immediately after a natural disaster. This program aims to build capacity and empower a developing nation's health professionals to advance the care of orthopaedic trauma patients. We describe a model of capacity building that serves as a framework to highlight the strengths and weaknesses of low-to middle-income countries in providing orthopaedic trauma care when faced with such a challenge.

A sustainable future depends on more efficient use of the Earth's abundant energy resources in order to meet the rapidly increasing demand for energy services as well as to provide broader access to everyone. In 2005 the overall efficiency of the energy system from primary energy to useful energy was only about 34%. Owing to diverse geographic inequities in both sources and people, supply cannot always meet the demand where needed. Energy pathways from source through conversion, transmission, storage, and distribution to end-users are complicated and presently consist of numerous discrete pathways that differ widely for each energy source and carrier. These include solid fuels, liquid fuels, gaseous fuels (including hydrogen), electricity and heat. Aging equipment, congested networks, and extreme demands complicate this picture in many countries of the Organisation for Economic Co-operation and Development (OECD). Development of new infrastructure in both non-OECD and OECD countries will lock-in future dependence on conventional or non-conventional energy sources. This chapter aims to assist decision-makers by providing up-todate knowledge on the full range of energy pathways, their management, and operation. Energy systems to achieve a sustainable future should be made much more flexible in order to deal with societal needs and the probable deployment of technologies not yet commercially available (such as smart appliances, electric vehicles, fuel cells, and carbon capture and storage). Technology and policy solutions are available for supporting more energy for sustainable development, but in order to meet the transition necessary to avoid unacceptable events such as social unrest and/or climate change driven temperature rise, they should be put in place rapidly, and done in concert with each other.

In preparation for the Aquatic Environment Plan III, separate economic models were developed to assess the use of economic instruments to control for nitrogen and phosphorus pollution fromagriculture. These included taxes on various inputs; taxes on surpluses (inputs less outputs) at the national, sectoral and farm levels; and tradable quotas. The results indicated that to achieve the same reduction in nutrient surplus (a proxy for pollution) the adjustment costs for farmers were much higher when inputs were taxed than when surplus were taxed. While the government decided to not adopt a nitrogen tax (because of the success of the current regulation regime) it has introduced a tax on mineral phosphorus in feed (while having the largest adjustment cost for farmers this tax is simpler to administer). A review of the Danish pesticide tax suggested that it has been effective in moving pesticide consumption closer towards the substance quantity targets.