No abstract is provided for this article.
Until World War II the only clinical phenotype of Plasmodium vivax generally recognised in medicine was one associated with either a long (8-9 months) incubation period or a similarly long interval between initial illness and the first relapse. Long-latency P. vivax 'strains' were the first in which relapse, drug resistance and pre-erythrocytic development were described. They were the infections in which primaquine radical cure dosing was developed. A long-latency 'strain' was the first to be fully sequenced. Although long-latency P. vivax is still present in some parts of Asia, North Africa and the Americas, in recent years it has been largely forgotten.
As in human societies, social learning may play an important role in shaping individual and group characteristics in other mammals. Here, we review research on non-primate mammals, concentrating on work at our long-term meerkat study site, where longitudinal data and field experiments have generated important insights into the role of social learning under natural conditions. Meerkats live under high predation pressure and occupy a difficult foraging niche. Accordingly, pups make extensive use of social information in learning to avoid predation and obtain food. Where individual learning is costly or opportunities are lacking, as in the acquisition of prey-handling skills, adults play an active role in promoting learning through teaching. Social learning can also cause information to spread through groups, but our data suggest that this does not necessarily result in homogeneous, group-wide traditions. Moreover, traditions are commonly eroded by individual learning. We suggest that traditions will only persist where there are high costs of deviating from the group norm or where skill development requires extensive time and effort. Persistent traditions could, theoretically, modify selection pressures and influence genetic evolution. Further empirical studies of social learning in natural populations are now urgently needed to substantiate theoretical claims.
In social mammals, grooming is used not only for hygienic purposes; it also serves social functions. We examined the grooming patterns of dominant males in groups of cooperatively breeding meerkats, Suricata suricatta, to test the hypothesis that the distribution of grooming reflects the value of social relationships. Grooming between dominant individuals was the most commonly observed interaction. Grooming by the dominant male was less common when the dominant female was in oestrus. Grooming between dominant males and subordinates was asymmetrical, with dominant males receiving more grooming and providing less grooming to subordinates. Because subordinate males defend the group against extragroup males, the dominant male was predicted to groom subordinate males more often than to groom subordinate females. Although the sex of a subordinate did not affect the probability of grooming occurring, dominant males groomed subordinate males for longer than they groomed subordinate females. The duration of grooming by a dominant male was longer in small groups than large groups, suggesting that grooming activity is constrained by time. In contrast, subordinates groomed dominant males for longer in larger groups, and as a result, the asymmetry of grooming exchanges was exaggerated in larger groups. This result is consistent with the biological market theory, which predicts that the value of subordinates is dependent on group size and that subordinates will alter grooming efforts accordingly. These results suggest that meerkat grooming serves several social functions, such as the maintenance of valuable and/or fitness-enhancing relationships.
CARAMAL was a large observational study which recorded mortality in children with suspected severe malaria before and after the roll-out of rectal artesunate in Nigeria, Uganda and the Democratic Republic of the Congo. The results of CARAMAL have had a huge impact on public health policy leading to a World Health Organization moratorium on the roll-out of rectal artesunate. The conclusion reported in the abstract uses strong causal language, stating that “pre-referral RAS [rectal artesunate suppositories] had no beneficial effect on child survival”. We argue that this causal interpretation of the study results is not justified. Data from the CARAMAL study inform chiefly on the strengths and weaknesses of referral systems in these three countries and do not inform reliably as to the beneficial effect of providing access to a known life-saving treatment.
Antimarial drug resistance develops when spontaneously occurring parasite mutants with reduced susceptibility are selected, and are then transmitted. Drugs for which a single point mutation confers a marked reduction in susceptibility are particularly vulnerable. Low clearance and a shallow concentration–effect relationship increase the chance of selection. Use of combinations of antimalarials that do not share the same resistance mechanisms will reduce the chance of selection because the chance of a resistant mutant surviving is the product of the per parasite mutation rates for the individual drugs, multiplied by the number of parasites in an infection that are exposed to the drugs. Artemisinin derivatives are particularly effective combination partners because (i) they are very active antimalarials, producing up to 10 000–fold reductions in parasite biomass per asexual cycle; (ii) they reduce malaria transmissibility; and (iii) no resistance to these drugs has been reported yet. There are good arguments for no longer using antimalarial drugs alone in treatment, and instead always using a combination with artemisinin or one of its derivatives.
