Comparative cost-effectiveness of policy instruments for reducing the global burden of alcohol, tobacco and illicit drug use

Alcohol, tobacco and illicit drug use together pose a formidable challenge to international public health. Building on earlier estimates of the demonstrated burden of alcohol, tobacco and illicit drug use at the global level, this review aims to consider the comparative cost-effectiveness of evidence-based interventions for reducing the global burden of disease from these three risk factors. Although the number of published cost-effectiveness studies in the addictions field is now extensive ( reviewed briefly here) there are a series of practical problems in using them for sector-wide decision making, including methodological heterogeneity, differences in analytical reference point and the specificity of findings to a particular context. In response to these limitations, a more generalised form of cost-effectiveness analysis (CEA) is proposed, which enables like-with-like comparisons of the relative efficiency of preventive or individual-based strategies to be made, not only within but also across diseases or their risk factors. The application of generalised CEA to a range of personal and non-personal interventions for reducing the burden of addictive substances is described. While such a development avoids many of the obstacles that have plagued earlier attempts and in so doing opens up new opportunities to address important policy questions, there remain a number of caveats to population-level analysis of this kind, particularly when conducted at the global level. These issues are the subject of the final section of this review.

The role of different sources of communication and trust in reducing change-related uncertainties during organisational change

The current paper presents a qualitadve study of the role of different sources of communicadon in reducing change-related uncertaintj' experienced by employees during organisadonal change. The paper examines the role of trust in influencing how employees' appraise informadon from different sources within organisadons. Interviews with 19 employees from a range of organisadons idendfy the different types of change-related uncertaindes experienced during change. In addidon, the different sources of communicadon utilised by employees are idendfied and the role each source plays in reducing the different t}'pes of uncertaint}' invesdgated. From employee responses it is evident that t)'pically supervisors are the best source of change informadon, while communicadon from senior management usually focuses on strategic issues. Employees indicate that communicadon with coworkers operates as a support mechanism providing an avenue to share grievances arising from the change. Finally, trust is idendfied as playing an important role in influencing who employees go to for informadon when experiencing uncertainty'. ImpUcadons for change management research in addidon to pracdcal implicadons are discussed.

Aerodynamic Drag Reduction for Satellites in Low Earth Orbit

Stalker (AIAA Paper 87-0403) has suggested that, by ejecting molecules directly upstream from the entire face of a satellite, it is possible to reduce the drag on a satellite in low-Earth orbit and hence maintain orbit with a total fuel mass (for forward ejection and conventional reaction rockets) less than the typical mass requirements of conventional rockets. An analytical analysis is presented here, as well as Monte Carlo simulations. These indicate that to reduce the overall drag on the satellite significantly, collisions between the freestream and ejected molecules must occur at least two satellite diameters upstream. This can be achieved if the molecules are ejected far upstream from the satellite’s surface through a sting that projects forward from the satellite. Using some estimates of what would be feasible sting arrangements, we find that the drag on the satellite can be reduced to such an extent that the satellite’s orbit can be maintained with a total fuel mass of less than 60% of that required for reaction rockets alone. Upstream ejection is effective in reducing the drag for freestream Knudsen numbers less than approximately 250, but not otherwise.

Lingual kinematic strategies used to increase speech rate: Comparisons between younger and older adults

The primary objective of this study was to assess the lingual kinematic strategies used by younger and older adults to increase rate of speech. It was hypothesised that the strategies used by the older adults would differ from the young adults either as a direct result of, or in response to a need to compensate for, age-related changes in the tongue. Electromagnetic articulography was used to examine the tongue movements of eight young (M526.7 years) and eight older (M567.1 years) females during repetitions of /ta/ and /ka/ at a controlled moderate rate and then as fast as possible. The younger and older adults were found to significantly reduce consonant durations and increase syllable repetition rate by similar proportions. To achieve these reduced durations both groups appeared to use the same strategy, that of reducing the distances travelled by the tongue. Further comparisons at each rate, however, suggested a speed-accuracy trade-off and increased speech monitoring in the older adults. The results may assist in differentiating articulatory changes associated with normal aging from pathological changes found in disorders that affect the older population.