Shrinking the Malaria Map: A Prospectus on Malaria Elimination

\ud Thirty-nine countries across the world are making progress toward malaria elimination. Some are committed to nationwide elimination, while others are pursuing spatially progressive elimination within their borders. Influential donor and multilateral organizations are supporting their goals of achieving malaria-free status. With elimination back on the global agenda, countries face a myriad of questions. Should they change their programs to eliminate rather than control malaria? What tools are available? What policies need to be put into place? How will they benefit from elimination? Unfortunately, answers to these questions, and resources for agencies and country program managers considering or pursuing elimination, are scarce. The 39 eliminating countries are all positioned along the endemic margins of the disease, yet they naturally experience a variety of country characteristics and epidemiologies that make their malaria situations different from one another. The Malaria Elimination Group (MEG) and this Prospectus recognize\ud that there is no single solution, strategy, or time line that will be appropriate for every country, and each is encouraged to initiate a comprehensive evaluation of its readiness and strategy for elimination. The Prospectus is designed to guide countries in conducting these assessments. The Prospectus provides detailed and informed discussion on the practical means of achieving and sustaining zero transmission. It is designed as a road map, providing direction and options from which to choose an appropriate path. As on all maps, the destination is clearly marked, but the possible routes to reach it are numerous. The Prospectus is divided into two sections: Section 1 Eliminating Malaria comprises four chapters covering the strategic components important to the periods before, during, and after an elimination program. Section 2 Tools for the Job, comprises six chapters that outline basic information about how interventions in an elimination program will be different from those in a control setting. Chapter 1, Making the Decision, evaluates the issues that a country should consider when deciding whether or not to eliminate malaria. The chapter begins with a discussion about the quantitative and qualitative benefits that a country could expect from eliminating malaria and then recommends a thorough feasibility assessment. The feasibility assessment is based on three major components: operational, technical, and financial feasibility. Cross-border and regional collaboration is a key subject in this chapter. Chapter 2, Getting to Zero, describes changes that programs must consider when moving from sustained control to an elimination goal. The key strategic issues that must be addressed are considered, including supply chains, surveillance systems, intersectoral collaboration, political will, and legislative framework. Cross-border collaboration is again a key component in Getting to Zero. Chapter 3, Holding the Line, provides recommendations on how to conduct an assessment of two key factors that will affect preventing the reemergence of malaria once transmission is interrupted: outbreak risk and importation risk. The chapter emphasizes the need for a strong surveillance system in order to prevent and, if necessary, respond to imported cases. Chapter 4, Financing Elimination, reviews the cost-effectiveness of elimination as compared with sustained control and then presents the costs of selected elimination programs as examples. It evaluates four innovative financing mechanisms that must support elimination, emphasizing the need for predictable and stable financing. Case studies from Swaziland and two provinces in China are provided. Chapter 5, Understanding Malaria, considers malaria from the point of view of elimination and provides a concise overview of the current burden of the disease, malaria transmission, and the available interventions that can be used in an elimination program. Chapter 6, Learning from History, extracts important lessons from the Global Malaria Eradication Program and analyzes some elimination efforts that were successful and some that were unsuccessful. The chapter also reviews how the malaria map has been shrinking since 1900. xiv A Prosp ectus on Mala ria Elimi natio n\ud Chapter 7, Measuring Malaria for Elimination, provides a precise language for discussing malaria and gives the elimination discussion a quantitative structure. The chapter also describes the role of epidemiological theory and mathematical modeling in defining and updating an elimination agenda for malaria. Chapter 8, Killing the Parasite, outlines the importance of case detection and management in an elimination setting. Options for diagnosis, the hidden challenge of Plasmodium vivax in an elimination setting, and the impact of immunity are all discussed. Chapter 9, Suppressing the Vector, explores vector control, a necessary element of any malaria program. It considers optimal methods available to interrupt transmission and discusses potential changes, such as insecticide resistance, that may affect elimination efforts. Chapter 10, Identifying the Gaps — What We Need to Know, reviews the gaps in our understanding of what is required for elimination. The chapter outlines a short-term research agenda with a focus on the operational needs that countries are facing today. The Prospectus reviews the operational, technical, and financial feasibility for those working on the front lines and considers whether, when, and how to eliminate malaria. A companion document, A Guide on Malaria Elimination for Policy Makers, is provided for those countries or agencies whose responsibility is primarily to make the policy decisions on whether to pursue or support a malaria elimination strategy. The Guide is available at www.malaria eliminationgroup.org

The Waimakariri irrigation scheme - a vision fulfilled

The New Zealand Kellogg Rural Leaders Programme develops emerging agribusiness leaders to help shape the future of New Zealand agribusiness and rural affairs. Lincoln University has been involved with this leaders programme since 1979 when it was launched with a grant from the Kellogg Foundation, USA.The opening of the Waimakariri Irrigation Scheme on the 30th of October 1999 is a sequel or rebirth of the water race system. This water race transformed the Waimakariri-Ashley Plains when opened by the Prime Minister Richard Seddon on Monday, 16 November, 1896. The Irrigation Scheme is a tribute to all the people, their initiatives and energy who created managed and maintained the 800 kms of water races covering 40,000 hectares over the last 104 years. Continued sound management of the races should see the water flowing gently over the Plains for as long as people live here. What people in the future choose to use the water for may be quite different than what we see today

Solution Conformations and Structural Thermodynamics of Type I DNA Polymerases from Escherichia coli and Thermus aquaticus

The global conformations of DNA polymerase I from Thermus aquaticus (Taq/Klentaq) and E. coli (Pol I/Klenow) both in isolation and in complex with DNA have been examined in solution using hydrodynamic (analytical ultracentrifugation) and small/wide angle X-ray scattering techniques and then compared to their known crystal structures to assess the similarities and differences in the overall structure of these enzymes and enzyme complexes within a solution environment. These studies address the orientation of the 5’ nuclease domain with respect the polymerase domain (elongated or compact) for the full-length polymerases, and the binding mode (“polymerization” versus “editing”) of the DNA substrate when bound to Klentaq and Klenow. Comparisons of experimental and structure-based data indicate that full-length Pol I and Taq in solution adopt a conformation where the 5’ nuclease domain is extended away from the polymerase domain, similar to the elongated crystal structure. Ab initio shape models of the apo polymerases generated from the scattering data demonstrate remarkable likeness to their corresponding crystal structures and also reveal regions of flexibility. For DNA bound Klenow and Klentaq, comparative analyses indicate that 1) the global conformations of the complexes are not dependent upon the structure of the DNA substrate (primed-template versus blunt-ended) but are polymerase specific, 2) DNA binds to Klenow in the editing mode and to Klentaq in the polymerization mode, and 3) the solution structures deviate somewhat from the crystal structure-based models. Additionally, the stability landscape of Klenow, as monitored by high-throughput thermal denaturation in a variety of solution conditions, demonstrates that Klenow’s melting temperature (Tm) increases with increasing salt concentration and decreasing pH; Klenow’s Tm spans from 40 to 62 degrees C. Both cation and anion specific stabilization is observed. The cationic stabilization of Klenow can be well explained by a model postulating dampening of repulsion within surface anionic patches on the protein. Both the global conformation and the stability studies demonstrate the importance of the solution environment in the comprehensive characterization of an enzyme’s structure and function. The ability to visualize these polymerases and polymerase complexes in solution promises to open new avenues of understanding of these important enzymes

Diabetes in California: Findings From the 2001 California Health Interview Survey

Examines the prevalence of diabetes in California, with particular attention paid to disparities between different population groups. Includes access to medical care, diabetes care and management, and identifying at-risk populations

California Adolescents Increasingly Inactive

Explores the health benefits of regular exercise; the extent to which adolescents in California are getting adequate levels of physical activity; and factors that affect high rates of inactivity. Provides policy recommendations

Beyond Inspec - Building a Semantic Enrichment Service to Explore How the IET can Better Support Academic and Commercial Researchers

As the amount of content in the engineering space is constantly growing it is becoming more and more difficult to retrieve relevant information. In this context the IET has commissioned a project to evaluate the feasibility of providing a semantic enrichment service based on the terms contained in the Inspec Thesaurus. The possibility of automated tagging of a variety of content types including traditional academic publishing data (e.g. journal abstracts), commercial product information (e.g. product catalogues) and social media (e.g. twitter feeds) has been explored as well as the auto generation of new terms for the Inspec thesaurus. We have used recognized semantic data modelling techniques to create a working ontology for a subset of the Inspec thesaurus and then used this ontology to entity extract and tag the names of people, organisations and their locations, along with Inspec thesaurus terms themselves, on all items of content run through the system. In addition we have built a number of applications to test the validity and accuracy of this approach as well as to explore how such a system would cope with the volume of future indexing requirements. We are continually evaluating our approach via on-going market research and user testing