Malaria burden and costs of intensified control in Bhutan, 2006-2014: A situational analysis

- Introduction Malaria cases have dwindled in Bhutan with aim of malaria elimination by 2016. The aims of this study are to determine the trends and burden of malaria, the costs of intensified control activities, the main donors of the control activities and the costs of different preventive measures in the pre-elimination phase (2006-2014). - Methods A descriptive analysis of malaria surveillance data from 2006-2014 was carried out, using data from the Vector-borne Disease Control Programme (VDCP), Bhutan. Malaria morbidity and mortality among local Bhutanese and foreign nationals were analysed. The cost of different control and preventive measures, and estimation of the average numbers of long-lasting insecticidal nests (LLINs) per person were calculated. - Findings There were 5,491 confirmed malaria cases from 2006 to 2014. By 2013, there was an average of one LLIN for every 1·51 individuals. The Global Fund was the main international donor accounting for > 80% of the total funds. The cost of procuring LLINs accounted for > 90% of the total cost of prevention measures. - Interpretation The malaria burden reduced significantly over the study period with high coverage of LLINs in Bhutan. This foreseeable challenges that require national attention to maintain malaria-free status after elimination are importation of malaria, particularly from India; continued protection of the population in endemic districts through complete coverage with LLINs and IRS; and exploration of local funding modalities post elimination in the event there is a reduction in international funding.

Improved wound management at lower costs: A sensible goal for Australia

Chronic wounds cost the Australian health system at least US$2·85 billion per year. Wound care services in Australia involve a complex mix of treatment options, health care sectors and funding mechanisms. It is clear that implementation of evidence-based wound care coincides with large health improvements and cost savings, yet the majority of Australians with chronic wounds do not receive evidence-based treatment. High initial treatment costs, inadequate reimbursement, poor financial incentives to invest in optimal care and limitations in clinical skills are major barriers to the adoption of evidence-based wound care. Enhanced education and appropriate financial incentives in primary care will improve uptake of evidence-based practice. Secondary-level wound specialty clinics to fill referral gaps in the community, boosted by appropriate credentialing, will improve access to specialist care. In order to secure funding for better services in a competitive environment, evidence of cost-effectiveness is required. Future effort to generate evidence on the cost-effectiveness of wound management interventions should provide evidence that decision makers find easy to interpret. If this happens, and it will require a large effort of health services research, it could be used to inform future policy and decision-making activities, reduce health care costs and improve patient outcomes.

Biotechnology in the development of improved phytases

Phytase enzyme supplements are now ubiquitous in the commercial production of a range of livestock, particularly chickens and pigs. Significant effort has been directed over the last two decades towards producing improved enzymes with higher activity, increased stability and at economic levels in industrial fermentations. As such, there are excellent products on the market, but there is a continuing demand for further improvements to drive down costs and for enzyme manufacturers to increase market share. The rapid development of DNA sequencing and gene synthesis technologies has provided ready access to a large number of new and uncharacterised potential phytases. Challenges remain however in identifying and developing those with improved properties.

The ghost in the city industrial complex: Le Corbusier and the fascist theory of Urbanisme

Le Corbusier participated in an urban dialogue with the first group in France to call itself fascist: the journalist Georges Valois’s militant Faisceau des Combattants et Producteurs (1925-1927), the “Blue Shirts,” inspired by the Italian “Fasci” of Mussolini. Le Corbusier’s portrait photograph materialised on the front cover of the January 1927 issue of the Faisceau League’s newspaper Le Nouveau Siècle edited by the former anarcho-syndicalist journalist Georges Valois, its leader, who fashioned himself as the French Mussolini. Le Corbusier was described in the Revue as one of les animateurs (the “organisers”) of the Party1 – meaning a member of the technical elite who would drive the Faisceau’s plans. On 1 May 1927, the Nouveau Siècle printed a full-page feature “Le Plan Voisin” on Le Corbusier’s 1922 redesign of Paris : the architect’s single-point perspective sketch appeared below an extract lifted from the architect’s original polemic Le Centre de Paris on the pages of Le Corbusier’s second book Urbanisme published two years earlier, a treatise on urbanism.2 Three weeks later, Le Corbusier presented a slide show of his urban plans at a fascist rally for the inauguration of the Faisceau’s new headquarters on the rue du faubourg Poissonniere, thereby crystalising the architect’s hallowed status in the league...