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IntroductionIn most settings, the diagnosis of scabies is reliant on time-consuming and potentially intrusive clinical examination of all accesible regions of skin. With the recent recognition of scabies as a neglected tropical disease by the World Health Organization there is a need for standardised approaches to disease mapping to define populations likely to benefit from intervention, and to measure the impact of interventions. Development and validation of simplified approaches to diagnose scabies would facilitate these efforts.MethodsWe utilised data from three population-based surveys of scabies. We classified each individual as having scabies absent or present overall, based on whole body assessment, and in each of 9 regions of the body. We calculated the sensitivity of diagnosing the presence of scabies based on each individual body region compared to the reference standard based on whole body examination and identified combinations of regions which provided greater than 90% sensitivity. We assessed the sensitivity according to gender, age group, severity of scabies and the presence or absence of impetigo.ResultsWe included 1,373 individuals with scabies. The body regions with highest yield were the hands (sensitivity compared to whole body examination 51.2%), feet (49.7%), and lower legs (48.3%). Examination of the exposed components of both limbs provided a sensitivity of 93.2% (95% CI 91.2-94.4%). The sensitivity of this more limited examination was greater than 90% regardless of scabies severity or the presence or absence of secondary impetigo.DiscussionWe found that examination limited to hands, feet and lower legs was close to 90% for detecting scabies compared to a full body examination. A simplified and less intrusive diagnostic process for scabies will allow expansion of mapping and improved decision-making about public health interventions. Further studies in other settings are needed to prospectively validate this simplified approach.

Glycoside hydrolases catalyze the selective hydrolysis of glycosidic bonds in oligosaccharides, polysaccharides, and their conjugates. β-glucosidases occur in all domains of living organisms and constitute a major group among glycoside hydrolases. On the other hand, the benzoxazinoids occur in living systems and act as stable β-glucosides, such as 2-(2,4-dihydroxy-7-methoxy-2H-1,4-benzoxazin-3(4H)-one)-β-D-gluco-pyranose, which hydrolyse to an aglycone DIMBOA. Here, we synthesized the library of novel 1,3-benzoxazine scaffold based aglycones by using 2-aminobenzyl alcohols and aldehydes from one-pot reaction in a chloroacetic acid catalytic system via aerobic oxidative synthesis. Among the synthesized benzoxazines, 4-(7-chloro-2,4-dihydro-1H-benzo[d][1,3]oxazin-2-yl)phenol (compound 7) exhibit significant inhibition towards glucosidase compared to acarbose, with a IC50 value of 11.5 µM. Based upon results generated by in silico target prediction algorithms (Naïve Bayesian classifier), these aglycones potentially target the additional sodium/glucose cotransporter 1 (where a log likelihood score of 2.70 was observed). Furthermore, the in vitro glucosidase activity was correlated with the in silico docking results, with a high docking score for the aglycones towards the substrate binding site of glycosidase. Evidently, the in vitro and in vivo experiments clearly suggest an anti-hyperglycemic effect via glucose uptake inhibition by 4-(7-chloro-2,4-dihydro-1H-benzo[d][1,3]oxazin-2-yl)phenol in the starved rat model. These synthetic aglycones could constitute a novel pharmacological approach for the treatment, or re-enforcement of existing treatments, of type 2 diabetes and associated secondary complications.

This study investigates the financial cost of increasing the diversity of cereal grains in livestock feed rations. We first develop a nonlinear mathematical programming model that determines the least-cost composition of livestock feed rations of one metric ton that have at least the same energy and nutrient content as a reference feed ration. We then add into the model a diversity constraint using the Simpson Index of diversity to examine how changes in the diversity of the commodities in the ration affect the cost of the ration while maintaining the ration's energy and nutrient content at a reference ration value. We apply the model to cereal grain feed rations for livestock in 153 countries, using reference rations that depict the historical composition of cereal grain feed rations offered to livestock in each country. Results suggest that a one percent change in ration diversity changed the ration cost (i.e., the cost-diversity elasticity) from -0.67% to 1.41% (average = -0.02%) across all countries. Our results suggest that changes in ration diversity can come at a financial cost, but this financial cost appears negligible in many countries. This negligible cost could provide the feed sector more encouragement to diversify its feed supply and potentially become more resilient to price and production shocks.

BACKGROUND:The consumption of red and processed meat has been associated with increased mortality from chronic diseases, and as a result, it has been classified by the World Health Organization as carcinogenic (processed meat) and probably carcinogenic (red meat) to humans. One policy response is to regulate red and processed meat consumption similar to other carcinogens and foods of public health concerns. Here we describe a market-based approach of taxing red and processed meat according to its health impacts. METHODS:We calculated economically optimal tax levels for 149 world regions that would account for (internalize) the health costs associated with ill-health from red and processed meat consumption, and we used a coupled modelling framework to estimate the impacts of optimal taxation on consumption, health costs, and non-communicable disease mortality. Health impacts were estimated using a global comparative risk assessment framework, and economic responses were estimated using international data on health costs, prices, and price elasticities. FINDINGS:The health-related costs to society attributable to red and processed meat consumption in 2020 amounted to USD 285 billion (sensitivity intervals based on epidemiological uncertainty (SI), 93-431), three quarters of which were due to processed meat consumption. Under optimal taxation, prices for processed meat increased by 25% on average, ranging from 1% in low-income countries to over 100% in high-income countries, and prices for red meat increased by 4%, ranging from 0.2% to over 20%. Consumption of processed meat decreased by 16% on average, ranging from 1% to 25%, whilst red meat consumption remained stable as substitution for processed meat compensated price-related reductions. The number of deaths attributable to red and processed meat consumption decreased by 9% (222,000; SI, 38,000-357,000), and attributable health costs decreased by 14% (USD 41 billion; SI, 10-57) globally, in each case with greatest reductions in high and middle-income countries. INTERPRETATION:Including the social health cost of red and processed meat consumption in the price of red and processed meat could lead to significant health and environmental benefits, in particular in high and middle-income countries. The optimal tax levels estimated in this study are context-specific and can complement the simple rules of thumb currently used for setting health-motivated tax levels.