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.

Understanding the civic impact of journalism

The importance of journalism to civil society is constantly proclaimed, but empirical evidence on journalism's impact, and how this operates, is surprisingly thin. Indeed, there is confusion even about what is meant by the term “impact”. Meanwhile, the issue of the role of journalism is becoming increasingly urgent as a consequence of the rapid changes engulfing the news media, brought about by technological change and the flow-on effect to the traditional advertising-supported business model. Assessing the impact of journalism has recently been the topic of debate among practitioners and scholars particularly in the United States, where philanthropists have responded to the perceived crisis in investigative journalism by funding not-for-profit newsrooms, with resulting new pressures being placed on journalists and editors to quantify their impact on society. These recent attempts have so far failed to achieve clarity or a satisfactory conclusion, which is not surprising given the complex web of causation within which journalism operates. In this paper, the authors propose a stratified definition of journalistic impact and function. They propose a methodology for studying impact drawing on realistic evaluation—a theory-based approach developed primarily to assess large social programmes occurring in open systems. The authors argue this could allow a conceptual and methodological advance on the question of media impacts, leading to research capable of usefully informing responses at a time of worrying change.

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.

Arguing the archive: Reconceptualising the NFSA in a time of austerity

This paper examines key issues emerging from the July 2014 Where We Are Heading sessions conducted between The National Film and Sound Archive (NFSA) CEO Michael Loebenstein, industry stakeholders and members of the public seeking to engage with the future direction of the NFSA. Analysis of transcripts from these public meetings reveal significant conceptual and programmatic gaps exist between what the NFSA has done in the past, how it “self-actualises” in terms of a national collection and what it can practically and effectively achieve in the near future. These significant challenges to the historical function of the Archive occur at a time of pronounced economic austerity for public cultural institutions and expanding, digitally driven curatorial responsibilities. Tensions exist between the need for the NFSA to increase revenue while preserving the function of an open and accessible Archive. Three key areas of challenge are addressed - digitisation, funding and the need for the NFSA to connect more broadly and more deeply with Australian society. The latter area is identified as crucial as the NFSA continues to articulate and actively promote the public value of the Archive through renewed program and outreach efforts.

Claiming the Lane way

The purpose of "Claiming the Lane way" was to question the identity and potential use of Brisbane lane ways through the application of street furniture design in collaboration with industry partners and local stakeholders. The basis for student furniture design and prototype construction was provided by the site specific stakeholders brief requirements. This engagement extended to the donation of construction materials, structural engineering expertise, funding and ultimately the multi disciplinary public exhibition event - "Changing Lanes". The lane way was demonstrably activated through the language of design and creative expression to bring a community together as well as identifying the potential of the lane way as significant and valuable public space in the urban environment.

The impact of the public library as a creative place in the community: A contextual review

This review examines recent literature on the public library as a creative place and the ways in which socio-cultural impact is being measured in assessments of cultural value. Inputs such as funding and staffing are frequently measured against outputs such as visitor numbers and lending frequencies, but qualitative measures (outcomes and impacts) are minimal in the literature because of the lack of persuasive evaluative frameworks and the difficulty of designing and facilitating the evaluations at local and national levels. Nevertheless, when combined with data about outputs and outcomes, the impact on individuals and their communities can be measured effectively and reported persuasively (Poll 2012, p.124). This contextual review provides an overview of current thinking about public libraries and creative spaces with particular attention paid to the rise of so-called makerspaces and Fab Labs. This includes discussion on the types of creative activities that are occurring in the public library context, and an outline of the rhetoric and reality of the public library as a community space. These outlines are reconsidered in a discussion of the evaluative frameworks that have been employed by libraries in the past, followed by an account of some prominent creative spaces that have been formally evaluated. The existence of creative spaces in public libraries is in a state of constant flux, and the development and redevelopment of evaluative frameworks will ensure that published reports will continue to appear throughout 2015 and beyond. This review provides a brief snapshot of the state of the field as it is in the first quarter of 2015.

Theatre, networked performance, and notions of ‘democratised’ spectatorship

The potential to cultivate new relationships with spectators has long been cited as a primary motivator for those using digital technologies to construct networked or telematics performances or para-performance encounters in which performers and spectators come together in virtual – or at least virtually augmented – spaces and places. Today, with Web 2.0 technologies such as social media platforms becoming increasingly ubiquitous, and increasingly easy to use, more and more theatre makers are developing digitally mediated relationships with spectators. Sometimes for the purpose of an aesthetic encounter, sometimes for critical encounter, or sometimes as part of an audience politicisation, development or engagement agenda. Sometimes because this is genuinely an interest, and sometimes because spectators or funding bodies expect at least some engagement via Facebook, Twitter or Instagram. In this paper, I examine peculiarities and paradoxes emerging in some of these efforts to engage spectators via networked performance or para-performance encounters. I use examples ranging from theatre, to performance art, to political activism – from ‘cyberformaces’ on Helen Varley Jamieson’s Upstage Avatar Performance Platform, to Wafaa Bilal’s Domestic Tension installation where spectators around the world could use a webcam in a chat room to target him with paintballs while he was in residence in a living room set up in a gallery for a week, as a comment on use of drone technology in war, to Liz Crow’s Bedding Out where she invited people to physically and virtually join her in her bedroom to discuss the impact of an anti-disabled austerity politics emerging in her country, to Dislife’s use of holograms of disabled people popping up in disabled parking spaces when able bodied drivers attempted to pull into them, amongst others. I note the frequency with which these performance practices deploy discourses of democratisation, participation, power and agency to argue that these technologies assist in positioning spectators as co-creators actively engaged in the evolution of a performance (and, in politicised pieces that point to racism, sexism, or ableism, pushing spectators to reflect on their agency in that dramatic or daily-cum-dramatic performance of prejudice). I investigate how a range of issues – from the scenographic challenges in deploying networked technologies for both participant and bystander audiences others have already noted, to the siloisation of aesthetic, critical and audience activation activities on networked technologies, to conventionalised dramaturgies of response informed by power, politics and impression management that play out in online as much as offline performances, to the high personal, social and professional stakes involved in participating in a form where spectators responses are almost always documented, recorded and re-represented to secondary and tertiary sets of spectators via the circulation into new networks social media platforms so readily facilitate – complicate discourses of democratic co-creativity associated with networked performance and para-performance activities.

General Practitioner Antimicrobial Stewardship Programme Study (GAPS): protocol for a cluster randomised controlled trial

Background There is a strong link between antibiotic consumption and the rate of antibiotic resistance. In Australia, the vast majority of antibiotics are prescribed by general practitioners, and the most common indication is for acute respiratory infections. The aim of this study is to assess if implementing a package of integrated, multifaceted interventions reduces antibiotic prescribing for acute respiratory infections in general practice. Methods/design This is a cluster randomised trial comparing two parallel groups of general practitioners in 28 urban general practices in Queensland, Australia: 14 intervention and 14 control practices. The protocol was peer-reviewed by content experts who were nominated by the funding organization. This study evaluates an integrated, multifaceted evidence-based package of interventions implemented over a six month period. The included interventions, which have previously been demonstrated to be effective at reducing antibiotic prescribing for acute respiratory infections, are: delayed prescribing; patient decision aids; communication training; commitment to a practice prescribing policy for antibiotics; patient information leaflet; and near patient testing with C-reactive protein. In addition, two sub-studies are nested in the main study: (1) point prevalence estimation carriage of bacterial upper respiratory pathogens in practice staff and asymptomatic patients; (2) feasibility of direct measures of antibiotic resistance by nose/throat swabbing. The main outcome data are from Australia’s national health insurance scheme, Medicare, which will be accessed after the completion of the intervention phase. They include the number of antibiotic prescriptions and the number of patient visits per general practitioner for periods before and during the intervention. The incidence of antibiotic prescriptions will be modelled using the numbers of patients as the denominator and seasonal and other factors as explanatory variables. Results will compare the change in prescription rates before and during the intervention in the two groups of practices. Semi-structured interviews will be conducted with the general practitioners and practice staff (practice nurse and/or practice manager) from the intervention practices on conclusion of the intervention phase to assess the feasibility and uptake of the interventions. An economic evaluation will be conducted to estimate the costs of implementing the package, and its cost-effectiveness in terms of cost per unit reduction in prescribing. Discussion The results on the effectiveness, cost-effectiveness, acceptability and feasibility of this package of interventions will inform the policy for any national implementation.

Youth programs in remote Indigenous communities: Context matters

A diversity of programs oriented to young people seek to develop their capacities and their connection to the communities in which they live. Some focus on ameliorating a particular issue or ‘deficit’ whilst others, such as sporting, recreation and youth groups are more grounded in the community. This article reports a qualitative study undertaken in three remote Indigenous communities in Central Australia. Sixty interviews were conducted with a range of stakeholders involved in a diversity of youth programs. A range of critical challenges for and characteristics of remote Indigenous youth programs are identified if such programs are to be ‘fit for context’. ‘Youth centred-context specific’ provides a positive frame for the delivery of youth programs in remote Central Australia, encouraging an explicit focus on program logic; program content and processes; and relational, temporal, and, spatial aspects of the practice context. These provide lenses with which youth program planning and delivery may be enhanced in remote communities. Culturally safe service planning and delivery suggests locally determined processes for decision-making and community ownership. In some cases, this may mean a community preference for all ages to access the service to engage in culturally relevant activities. Where activities are targeted at young people, yet open to and inclusive of all ages, they provide a medium for cross-generational interaction that requires a high degree of flexibility on the part of staff and funding programs. Although the findings are focused in Central Australia, they may be relevant to similar contexts elsewhere.

A model of social work classification in health care

The introduction of casemix funding for Australian acute health care services has challenged Social Work to demonstrate clear reporting mechanisms, demonstrate effective practice and to justify interventions provided. The term 'casemix' is used to describe the mix and type of patients treated by a hospital or other health care services. There is wide acknowledgement that the procedure-based system of Diagnosis Related Groupings (DRGs) is grounded in a medical/illness perspective and is unsatisfactory in describing and predicting the activity of Social Work and other allied health professions in health care service delivery. The National Allied Health Casemix Committee was established in 1991 as the peak body to represent allied health professions in matters related to casemix classification. This Committee has pioneered a nationally consistent, patient-centred information system for allied health. This paper describes the classification systems and codes developed for Social Work, which includes a minimum data set, a classification hierarchy, the set of activity (input) codes and 'indicator for intervention' codes. The advantages and limitations of the system are also discussed.

Mask or mirrors? The emergence of consumer rights in nonprofit human service organisations

This paper reports on a study of 25 nonprofit human service organisations offering four types of human services. The purpose of the study was first to explore the manner in which consumer rights are both conceptualized and operationalized in the nonprofit human service context. Secondly the study explored whether differences occur between organisations whose primary funding body emphasized the importance of a rights framework in its program delivery and those where this is not the case.

Training for reduction of design waste

Construction and demolition (C&D) waste have negative impacts on the environment. As a significant proportion of C&D waste is related to the design stage of a project, there is an opportunity for architects to reduce the waste. However, research suggests that many architects often do not understand the impact of their design on waste generation. Training and education are proposed by current researchers to improve architects’ knowledge; however, this has not been adequately validated as a viable approach to solving waste issues. This research investigates architects’ perceptions towards waste management in the design phase, and determines whether they feel they are adequately skilled in reducing C&D waste. Questionnaire surveys were distributed to architects from 98 architectural firms and 25 completed surveys were returned. The results show that while architects are aware of the relationship between design and waste, ‘extra time’ and ‘lack of knowledge’ are the key barriers to implementing waste reduction strategies. In addition, the majority of respondents acknowledge their lack of skill to reduce waste through design evaluation. Therefore, training programmes can be a viable strategy to enable them to address the pressing issue of C&D waste reduction.