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.

OPRESSÃO E RESISTENCIA REVELADAS PELOS CORPOS PEREGRINOS UM ESTUDO DE GÊNERO, CLASSE E ETNIA A PARTIR DOS SALMOS DE SUBIDA (SALMOS 120-134)

A opressão e a resistência são um fio condutor dos Salmos de peregrinação, o grupo que vai do Salmo 120 até o 134. O distintivo situa-se nas formas variadas com que estas categorias são apresentadas. Este conjunto de salmos impressiona pela maneira simples e direita de dizer as coisas, sem deixar de ser profunda. A partir da análise, observamos que a opressão e a resistência surgem em variadas formas, deixando transparecer que não se trata de falar delas em sentido geral, pois envolvem diferentes formas e facetas que se entrecruzam, sendo manifestas por meio de relações de gênero, classe e raça/etnia. O objetivo desta tese é provar que a partir dos movimentos dos corpos, suas falas e suas memórias é possível apontar para práticas de relacionamentos sociais, econômicos, políticos ou religiosos, marcadas por relações de gênero, raça/etnia, classe, que não se vinculam aos interesses de sistemas institucionais. Mas surgem da interação entre experiências de opressão e resistência e se colocam como alternativas de vida. Cada salmo traz marcas de um contexto particular que se junta às particularidades do outro até revelar um único contexto e nessa dinâmica possibilitar o conjunto. Através das estruturas, formas literárias e dos conteúdos, aponta-se para a centralidade do corpo como sendo fator hermenêutico ativo que, com seu movimento, sua fala, suas memórias, mostra situações de opressão e busca por prazer. O estudo literário e os conteúdos são determinantes, tanto para a estrutura do conjunto, dividida em três grandes partes (Sl 120-122; 123-129 e 130-134), para a tematização do desenvolvimento do conjunto, quanto para a credibilidade da proposta histórica de opressão e resistência apresentada. Constata-se que a vida religiosa aparece integrada à vida social e política da qual constitui um aspecto se bem que existe mais de uma experiência religiosa, inter-relacionada. Estas experiências revelam que as visitas ao templo de Jerusalém não só eram para cumprir com os costumes religiosos, daquela época, mas principalmente, pelo interesse que peregrinos e peregrinas tinham no cotidiano de suas vidas, seus trabalhos, suas necessidades. Elas e eles souberam fazer a articulação entre a festa e a práxis. Assim, o conjunto de salmos torna-se ponte para o diálogo que revela outras vozes e outras maneiras de identificar opressão e resistência. Não para fugir ou acomodar-se, senão reconhecendo a opressão, superando-a na criatividade e na esperança. O estudo desenvolve-se em quatro capítulos. No primeiro, enfatiza-se que os textos estão entre teologia e literatura, especificamente em serem textos poéticos. A partir daí levanta-se o estado atual do estudo sobre este conjunto de salmos e aponta-se ao contexto histórico ao qual estão relacionados estes salmos. No segundo, realiza-se a análise das estruturas poéticas, até entenderque o conjunto de salmo está relacionado como um todo. No terceiro e quarto, pelos resultados do segundo, destacam-se os principais temas que de forma indiciária levam-nos à demonstração da hipótese.

Aspects of tonic accommodation and tonic vergence

Under conditions of reduced visual stimulation, the systems of accommodation and vergence tend towards physiological resting states that are intermediate within their functional range. The terms tonic accommodation (TA) and tonic vergence (TV) are used in the study to describe these stimulus-free, intermediate adjustments and to represent the systems as being in a state of innervational tonicity. The literature relating to TA and TV and the various experiments of this thesis are reviewed. Methodology has been developed enabling the determination of TA and TV under conditions of total darknessl laser optometry for TA and ~ernier-alignment for TV. The thesis describes a series of experiments designed to investigate various aspects of TA and TV, and their role in ametropia, binocular vision and their adaptation to sustained visual tasks. Measurements of TA were also utilised to investigate the effect of various autonomic effector drugs on the ciliary muscle. The effects of ethanol on binocular function are shown to be directly proportional to the .initial level of TVJ which is itself unaffected. These results support the concept of TV as the reference point for normal vergence responses. The results of the pharmacological investigations indicate the presence of a small but significant, beta-receptor mediated inhibitory sympathetic input to the ciliary muscle, and that the wide distribution in TA is a consequence of inter-observer variations in parasympathetic, rather than sympathetic tone. Following interaction with visual tasks of t5mins duration, the levels of TA and TV are found to be biased in the direction of, and proportional to, the task position: except during near-task viewing where the task-to-TA stimulus-distance exceeds 1.5D (for TA) and 3.5deg (for TV). Under these conditions the expected level of bias is attenuated, Adaptive models are discussed, proposing TA and TV as the reference points of the accommodative and vergence system.

Climate change performance measurement, control and accountability in English local areas

Purpose – This paper aims to consider how climate change performance is measured and accounted for within the performance framework for local authority areas in England adopted in 2008. It critically evaluates the design of two mitigation and one adaptation indicators that are most relevant to climate change. Further, the potential for these performance indicators to contribute to climate change mitigation and adaptation is discussed. Design/methodology/approach – The authors begin by examining the importance of the performance framework and the related Local Area Agreements (LAAs), which were negotiated for all local areas in England between central government and Local Strategic Partnerships (LSPs). This development is located within the broader literature relating to new public management. The potential for this framework to assist in delivering the UK's climate change policy objectives is researched in a two-stage process. First, government publications and all 150 LAAs were analysed to identify the level of priority given to the climate change indicators. Second, interviews were conducted in spring 2009 with civil servants and local authority officials from the English West Midlands who were engaged in negotiating the climate change content of the LAAs. Findings – Nationally, the authors find that 97 per cent of LAAs included at least one climate change indicator as a priority. The indicators themselves, however, are perceived to be problematic – in terms of appropriateness, accuracy and timeliness. In addition, concerns were identified about the level of local control over the drivers of climate change performance and, therefore, a question is raised as to how LSPs can be held accountable for this. On a more positive note, for those concerned about climate change, the authors do find evidence that the inclusion of these indicators within the performance framework has helped to move climate change up the agenda for local authorities and their partners. However, actions by the UK's new coalition government to abolish the national performance framework and substantially reduce public expenditure potentially threaten this advance. Originality/value – This paper offers an insight into a new development for measuring climate change performance at a local level, which is relatively under-researched. It also contributes to knowledge of accountability within a local government setting and provides a reference point for further research into the potential role of local actions to address the issue of climate change.

Uniform Convergence of the Newton Method for Aubin Continuous Maps

* This work was supported by National Science Foundation grant DMS 9404431.

Re-making a frontier community or defending ethnic boundaries? The Caucasus in Cossack identity

The essay focuses on the notion of the Caucasus as a reference point in the construction of Cossack identity in southern Russia. Since the late Soviet period, the Cossack revivalist/nativist movement has emerged in the territories which constituted the frontier zones of Tsarist Russia. Arguably, the historical Cossack hosts were established as a kind of frontier community which played an important role in the expansion of the Russian Empire. This essay examines how post-Soviet Cossacks reinterpret the meanings of the Caucasus as a spatial and cultural realm where, or in relation to which, they produce their identity as a distinct ethnic and cultural community.

The external dimension of EU justice and home affairs after the Lisbon Treaty::analysing the dynamics of expansion and diversification

The article introduces a research framework for analysing the external dimension of EU Justice and Home Affairs after the Lisbon Treaty. The dynamics of expansion and diversification, discernable for both the EU policy-making and the scholarly work dedicated to it, are at the centre of the article and constitute a common reference point for the present Special Issue. These dynamics have been triggered through deliberate decisions of involved policy-makers as well as through unintended spillover effects from other policy areas and/or decisions. The article also engages with the theoretically informed literature on the subject, which struggles with the definition of what this dimension actually constitutes, as well as how to best capture the practices of this field.We take stock of the scholarly debates by comparing the diverse approaches and discussing how much they complement each other and/or present different dimensions of a single ‘policy universe’.

Body representation alterations in personal but not in extrapersonal neglect patients

There is still a matter of debate around the nature of personal neglect. Is it an attention disorder or a body representation disorder? Here we investigate the presence of body representation deficits (i.e., the visuo-spatial body map) in right and left brain-damaged patients and in particular in those affected by personal neglect. 23 unilateral brain-damaged patients (5 left-brain-damaged and 18 right-brain-damaged patients) and 15 healthy controls took part in the study. The visuo-spatial body map was assessed by means of the “Frontal body-evocation subtest (FBE),” in which participants have to put tiles representing body parts on a small wooden board where only the head is depicted as a reference point. In order to compare performance on the FBE with performance on an inanimate object that had well-defined right and left sides, participants also performed the “Car test.” Group statistical analysis shows that the performance of patients with personal neglect is significantly worse than that of the controls and patients without personal neglect in the FBE but not in the Car test. Single case analyses of the five patients with pure personal neglect confirm the results of group analysis. Our data supports the hypothesis that personal neglect is a pervasive body representation disorder.

Többszempontú részvételi döntések a fenntarthatósági értékelésekben. A legnépszerűbb módszerek összehasonlítása

Egyes alternatívák, forgatókönyvek, technológiák stb. fenntarthatóságának értékelése – definíciószerűen többdimenziós probléma. A megfelelő alternatíva kiválasztásánál ugyanis a döntéshozóknak egyszerre kell figyelembe venniük környezetvédelmi, gazdasági és társadalmi szempontokat. Az ilyen döntéseket támogathatják többszempontú döntéshozatali modellek. A tanulmány hét többszempontú döntési módszertan (MAU, AHP, ELECTRE, PROMETHEE, REGIME, NAIADE és ideális-referencia pont) alkalmazhatóságát vizsgálja részvételi körülmények között. Az utóbbi évek e témában publikált esettanulmányait áttekintve megállapítható, hogy egyik módszer sem dominálja a többit, azok különböző feltételek mellett eltérő sikerrel használhatók. Ennek ellenére a különböző technikák kombinációjával előállíthatunk olyan eljárásokat, melyekkel az egyes módszerek előnyeit még jobban kiaknázhatjuk. ________ Measuring and comparing the sustainability of certain actions, scenarios, technologies, etc. – by definition – is a multidimensional problem. Decision makers must consider environmental, economic and social aspects when choosing an alternative course of action. Such decisions can be aided by multi-criteria decision analysis (MCDA). In this paper participatory seven different MCDA methodologies are investigated (MAU, the Analytic Hierarchic Process (AHP), the ELECTRE, PROMETHEE, REGIME, and NAIADE methods and the “Ideal and reference point” approaches). It is based on a series of reports, in which more than 30 real world case studies focusing on participatory MCDA were reviewed. It is emphasized that there is no “best” choice from the list of MCDA techniques, but some methods fit certain decision problems more than others. However, with the combination of these methodologies some complementary benefits of the different techniques can be exploited.

Islamist movements at crossroads: the choice between ideology and context-driven approach to politics. Case study on the Hashemite Kingdom of Jordan

The aim of the paper is to analyse the ongoing transformation process within the Islamist movements using the example of the moderate Islamic Action Front party in Jordan. The dilemma of participation in the 2010 general elections raised tensions between the Muslim Brotherhood in Jordan and its political wing, the Islamic Action Front, and between doves and hawks of the same organizations. Internal debate on the future has started recently among different groups within the Islamist movement in Jordan. The research is based on the author‘s recent field experience in Jordan (April–July 2010, Andrew W. Mellon Fellowship at the American Centre of Oriental Research, Amman, Jordan). The author also conducted research in Syria, Lebanon, Palestine and Egypt, where several interviews were carried out with leading and lower level Islamist politicians. The dynamic changes within Islamic Action Front Party in Jordan and its relation with the regime has been used as reference point. The main question of the research was aa how the changing political and regional context shapes decisions of the Islamist with special attention to the acceptance of democratic values and human rights, political participation, and the meanings of Islamic values in the 21st century, possible cooperation with secular parties/movements/the regime.

Több szempontú részvételi döntések a fenntarthatósági értékelésekben. A legnépszerűbb módszerek összehasonlítása = Participatory multi-criteria decision analysis. A comparison of methodologies

A fenntarthatóság értékelése definíciószerűen többdimenziós probléma. A megfelelő alternatíva, forgatókönyv, eljárás stb. kiválasztásakor ugyanis a döntéshozóknak egyszerre kell figyelembe venniük környezetvédelmi, gazdasági és társadalmi szempontokat. Az ilyen döntéseket alátámaszthatják a több szempontú döntéshozatali modellek. A tanulmány a több szempontú döntési eljárások közül a legfontosabb hétnek az alkalmazhatóságát vizsgálja részvételi körülmények között. Az utóbbi évek e témában publikált esettanulmányainak áttekintésével megállapítható, hogy egyik módszer sem uralja a többit, azok különböző feltételek mellett eltérő sikerrel használhatók. Ennek ellenére a különböző módszerek kombinációjával végrehajthatunk olyan eljárásokat, amelyekkel az egyes módszerek előnyeit még jobban kiaknázhatjuk. ________ Measuring and comparing the sustainability of certain actions, scenarios, technologies, etc. is by definition a multidimensional problem. Decision-makers must consider environmental, economic and social aspects when choosing an alternative course of action. Such decisions can be aided by multi-criteria decision analysis (MCDA). This paper investigates seven different MCDA methodologies: MAU, the Analytic Hierarchic Process (AHP), the ELECTRE, PROMETHEE, REGIME, and NAIADE methods, and "Ideal and reference point" approaches). It is based on a series of reports in which over 30 real-world case studies focusing on participatory MCDA were reviewed. It is stressed, however, that there is no "best" choice in the list of MCDA techniques. Some methods fit certain decision problems better than others. Nonetheless, some complementary benefits of the different techniques can be exploited by combining these methodologies.

Malachite green in food

The Panel wishes to thank the members of the Standing Working Group on non-allowed pharmacologically active substances in food and feed and their reference points for action (2015–2018): Metka Filipič, Peter Fürst, Laurentius (Ron) Hoogenboom, Anne-Katrine Lundebye, Carlo Stefano Nebbia, Michael O'Keeffe and Rolaf Van Leeuwen for the preparatory work on this scientific output, the hearing expert: Eva Persson, and EFSA staff members: Katleen Baert and Sofia Ioannidou for the support provided to this scientific opinion. The CONTAM Panel acknowledges all European competent institutions and other stakeholders that provided occurrence data on malachite green and leucomalachite green in food, and supported the data collection for the Comprehensive European Food Consumption Database.

Work-life Balance and Gender Regime After the Economic Transition

Work-life balance (WLB) is a key issue in our societies in which there is increasing pressure to be permanently available on demand and to work more intensively, and when due to technological change the borders between work and private life appear to be dissolving. However, the social, institutional and normative frames of a region have a huge impact on how people experience work and private life, where the borders between these spheres lie and how much control individuals have in managing these borders. Based on these arguments, this editorial to the special issue Work-life balance/imbalance: individual, organisational and social experiences in Intersections. EEJSP draws attention to the social institutions, frameworks and norms which have an effect on experience, practices and expectations about work-life balance. Concerning the time horizon, this editorial focuses on the change of regime as a reference point since socialist and post-socialist eras differ significantly, although there is still some continuity between them. The authors of this introduction offer an overview of the situation in CEE (Central and Eastern Europe) based mainly on examples of Visegrad countries.

Epidemiology of medication discrepancies upon hospital admission in children - a systematic review

Objectives: NICE/NPSA excluded children under 16 from their guidance concerning medicines reconciliation (MR) upon admission.1 Our aims and objectives of conducting the literature review was to identify the epidemiology of medication discrepancies upon admission, transfer and discharge in children, and if they require MR. Method: Six bibliographical databases (Medline, Embase, CINAHL, International Pharmaceutical Abstracts, Web of Science and Biosis Previews) and selected key words were used to find epidemiological studies on medication discrepancies in children upon hospital admission, transfer and discharge (key words included ‘medication discrepancy’; ‘medication reconciliation’; ‘hospital admission’; ‘hospital discharge’; ‘hospital transfer’); studies where the data for children could be extracted were included. Results: From the 1239 articles found (in May 2011), eight of the articles had extractable paediatric information, (five from Canada, two from USA, one from UK). Five of the studies involved discrepancies on admission, one involved discrepancies on admission and transfer, one involved discrepancies at transfer and one considered discharge. The reference point used to compare against the admission, transfer and the discharge order differed in each of the studies. Four studies used a rating scale to assess the clinical significance of the discrepancies to demonstrate the potential adverse clinical outcome of patients in the absence of clinical intervention. Two studies2 3 used a rating scale that was used in adults.4 A study of paediatric neurosurgical patients found that initial hospital prescriptions for children differed from the preadmission prescriptions in 39% of occasions and 50% of all prescribing variations had the potential to cause moderate or severe discomfort or clinical deterioration.2 A study by Coffey et al in general paediatric admissions in Canada showed 22% of patients experienced at least one discrepancy and 29% of the discrepancies had the potential to cause moderate or severe discomfort or clinical deterioration.3 By comparison an epidemiological study in discrepancies in adults on admission had 38.6% of the discrepancies identified with a potential to cause moderate or severe discomfort or clinical deterioration.4 All the studies involved small samples or specific patient groups such as medically complex patients. However all of the studies demonstrated that discrepancies occurred among paediatric populations during transitions in care settings and mentioned MR as an intervention. Conclusion: The results have shown that discrepancies of medication upon hospital admission, transfer and discharge occur regularly in children. With only one published study in the UK looking at hospital admission in children, and no published articles on the incidence and epidemiology of medication discrepancies upon hospital transfer or discharge further research is required in a wider paediatric population. Further work is also required to define the required interventions to improve practice.

iGPS capability study

This report presents the results of testing of the Metris iGPS system performed by the National Physical Laboratory (NPL) and the University of Bath (UoB), with the assistance of Metris, and Airbus at Airbus, Broughton in March 2008. The aim of the test was to determine the performance capability of the iGPS coordinate metrology system by comparison with a reference measurement system based on multilateration implemented using laser trackers. A network of reference points was created using SMR nests fixed to the ground and above ground level on various stands. The reference points were spread out within the measurement volume of approximately 10 m ´ 10 m ´ 2 m. The coordinates of each reference point were determined by the laser tracker survey using multilateration. The expanded uncertainty (k=2) in the relative position of these reference coordinates was estimated to be of the order of 10 µm in x, y and z. A comparison between the iGPS system and the reference system showed that for the test setup, the iGPS system was able to determine lengths up to 12 m with an uncertainty of 170 µm (k=2) and coordinates with an uncertainty of 120 µm in x and y and 190 µm in z (k=2).