Comparison of the effectiveness and efficiency of the grid and link search methods to recover scattered skeletal remains.

The grid and link search methods are used to recover scattered skeletal remains. Neither have not been compared robustly and clear guidelines for the link method have not been sufficiently developed. The study aimed to compare the effectiveness and efficiency of both methods and propose guidelines for the link method. The scattering patterns of two scavengers of forensic relevance-slender mongooses (Galerella sanguinea) and black-backed jackals (Canis mesomelas)-were recreated using four pig skeletons (Sus scrofa domesticus). Two groups (n = 6 each) were assigned a different method to recover the scattered remains. The length of the search and when each bone was located for each scatter pattern was recorded for each group and scatter pattern. A Likert scale questionnaire assessed participants' perceptions of their assigned method. A paired t-test (p = 0.005) compared the efficiency of each method and the questionnaire answers. Both methods were effective, recovering 100% of all remains. The link method was more efficient for both scatter patterns, despite there being no statistical significance (jackal: p = 0.089; mongoose: p = 0.464). Participants indicated favorable views for both methods; however, the link method scored significantly more favorably (p = 0.01) for efficiency. Specific guidelines were developed for the use of the link method. The link method is suggested for the recovery of scattered remains in forensic contexts, especially when the scavenger, its behavior, and scattering pattern is known or suspected.

Collaborative governance in a primary health care partnership in Papua New Guinea.

INTRODUCTION: Collaboration in primary health care is recommended to achieve global health goals. Public-private partnerships (PPP) are one means of collaboration. Our study examined collaboration in a case study PPP for primary health care in Western Province, Papua New Guinea (PNG). METHODS: Interviews with key informants involved in the PPP were conducted and key programme documents were reviewed. Data were coded and deductively analysed using the collaborative governance model developed by Emerson, Nabatchi and Balogh. RESULTS: The key features of the case study PPP that were highlighted by the collaborative governance model were: identification of partners, trust, procedural arrangements, and leadership. DISCUSSION: We identified four lessons of significance in the practical establishment and implementation of a partnership in a complex and challenging setting such as PNG: the need to (i) prioritise in-person collaboration and communication, (ii) engage dynamic individuals to lead the partnership, (iii) encourage relationships across all sectors and actors, and (iv) remain flexible and adapt to local cultural and context. CONCLUSION: Collaborative governance offers a practical framework to understand, assess and strengthen collaboration in multi-stakeholder partnerships in the health sector.

Risk factors predicting the need for intensive care unit admission within forty-eight hours of emergency department presentation: A case-control study.

BACKGROUND: Patients admitted from the emergency department to the wards, who progress to a critically unwell state, may require expeditious admission to the intensive care unit. It can be argued that earlier recognition of such patients, to facilitate prompt transfer to intensive care, could be linked to more favourable clinical outcomes. Nevertheless, this can be clinically challenging, and there are currently no established evidence-based methods for predicting the need for intensive care in the future. OBJECTIVES: We aimed to analyse the emergency department data to describe the characteristics of patients who required an intensive care admission within 48 h of presentation. Secondly, we planned to test the feasibility of using this data to identify the associated risk factors for developing a predictive model. METHODS: We designed a retrospective case-control study. Cases were patients admitted to intensive care within 48 h of their emergency department presentation. Controls were patients who did not need an intensive care admission. Groups were matched based on age, gender, admission calendar month, and diagnosis. To identify the associated variables, we used a conditional logistic regression model. RESULTS: Compared to controls, cases were more likely to be obese, and smokers and had a higher prevalence of cardiovascular (39 [35.1%] vs 20 [18%], p = 0.004) and respiratory diagnoses (45 [40.5%] vs 25 [22.5%], p = 0.004). They received more medical emergency team reviews (53 [47.8%] vs 24 [21.6%], p < 0.001), and more patients had an acute resuscitation plan (31 [27.9%] vs 15 [13.5%], p = 0.008). The predictive model showed that having acute resuscitation plans, cardiovascular and respiratory diagnoses, and receiving medical emergency team reviews were strongly associated with having an intensive care admission within 48 h of presentation. CONCLUSIONS: Our study used emergency department data to provide a detailed description of patients who had an intensive care unit admission within 48 h of their presentation. It demonstrated the feasibility of using such data to identify the associated risk factors to develop a predictive model.

Mathematical Modeling for Removing Border Entry and Quarantine Requirements for COVID-19, Vanuatu.

The Pacific Island country of Vanuatu is considering strategies to remove border restrictions implemented during 2020 to prevent imported coronavirus disease. We performed mathematical modeling to estimate the number of infectious travelers who had different entry scenarios and testing strategies. Travel bubbles and testing on entry have the greatest importation risk reduction.

Resonant cavity-enhanced photodiode array for miniaturised spectroscopic sensing.

Optical spectroscopic sensing is a technique that is commonly employed for the identification and compositional analysis of a wide variety of substances, from biological samples to greenhouse gases. High-resolution spectrometers are well established, however, attempts to miniaturise the designs can suffer from adverse effects due to the miniaturisation, for both Fourier transform based interferometric designs, as well as dispersive designs. In this work, a linear array of resonant cavity-enhanced photodiodes is realised with spatially chirped resonance wavelength, offering chip-scale free-space hyperspectral sensing. Resonant cavity-enhanced photodiodes sense over a narrow spectral band, which can be tuned by the thicknesses of the heterostructure. Through this work, multiple narrow spectral bands can be sensed by resonant cavity-enhanced photodiodes on a single chip by grading the thicknesses across the wafer. Photocurrent measurements from a fabricated array determine the wavelength of incident light with an accuracy of ± 2 nm.

Retrospective analysis of pacritinib in patients with myelofibrosis and severe thrombocytopenia.

Thrombocytopenia is common in patients with myelofibrosis (MF) and is a well-established adverse prognostic factor. Both of the approved Janus kinase (JAK) inhibitors, ruxolitinib and fedratinib, can worsen thrombocytopenia and have not been evaluated in patients with severe thrombocytopenia (platelet counts <50×109/L). Pacritinib, a novel JAK2/interleukin-1 receptor-associated kinase 1 inhibitor, has been studied in two phase III trials (PERSIST-1 and PERSIST- 2), both of which enrolled patients with MF and severe thrombocytopenia. In order to better characterize treatment outcomes for this population with advanced disease, we present a retrospective analysis of efficacy and safety data in the 189 patients with severe thrombocytopenia treated in the PERSIST studies. The proportion of patients in the pacritinib group meeting efficacy endpoints was greater than in the BAT group for ≥35% spleen volume reduction (23% vs. 2%, P=0.0007), ≥50% modified Total Symptom Score reduction (25% vs. 8%, P=0.044), and self-reported symptom benefit ("much" or "very much" improved; 25% vs. 8%, P=0.016) at the primary analysis time point (week 24). The adverse event profile of pacritinib was manageable, and dose modification was rarely required. There was no excess in bleeding or death in pacritinib-treated patients. These results indicate that pacritinib is a promising treatment for patients with MF who lack safe and effective therapeutic options due to severe thrombocytopenia.

Human Decedent Identification Unit: identifying the deceased at a South African medico-legal mortuary.

The Johannesburg Forensic Pathology Services medico-legal mortuary perform postmortem examinations on all cases of unnatural deaths in the greater Johannesburg metropolitan area, in South Africa. Unidentified decedents can comprise up to 10.0% of the total number of annual admissions at this medico-legal mortuary. To address the identification of the deceased, the Human Decedent Identification Unit (ID Unit) was created to perform secondary examinations for identification purposes. The aim of this study was to report on the identification methods and success rate of the ID Unit. Over a period of 31 months (January 2018-July 2020), unidentified decedents comprised 8.1% (n = 693) of all cases at the Johannesburg mortuary. The ID Unit processed 385 (55.6%) unidentified individuals during this period, who were mostly adult (100%), Black (94.5%), males (91.7%). DNA samples were successfully collected from most cases in the form of hair (96.4%; n = 371), blood (92.2%; n = 355), and nail samples (90.1%; n = 347). Fingerprints retrieved in 65.5% of cases (n = 252). Ultimately, 87 persons (22.6%) were positively identified. Fingerprinting was the most successful method of identification (98.9% of cases; n = 86). One positive identification was facilitated through DNA analysis. The nationalities of the positively identified decedents were from South Africa (52.9%; n = 46), Zimbabwe (5.7%), Uganda (1.1%), Mozambique (1.1%), Malawi (1.1%), South Sudan (1.1%), and undisclosed in 36.8% of cases. Through the collaborative efforts of all the agencies involved, the impact of the work of this ID Unit is vast-not only for South African authorities but most importantly for the decedents and their families.

How have governments supported citizens stranded abroad due to COVID-19 travel restrictions? A comparative analysis of the financial and health support in eleven countries.

BACKGROUND: In response to the continuing threat of importing novel coronavirus disease (COVID-19), many countries have implemented some form of border restriction. A repercussion of these restrictions has been that some travellers have found themselves stranded abroad unable to return to their country of residence, and in need for government support. Our analysis explores the COVID-19-related information and support options provided by 11 countries to their citizens stranded overseas due to travel restrictions. We also examined the quality (i.e., readability, accessibility, and useability) of the information that was available from selected governments' web-based resources. METHODS: Between June 18 to June 30, 2021, COVID-19-related webpages from 11 countries (Australia, New Zealand, Fiji, Canada, United States of America (USA), United Kingdom (UK), France, Spain, Japan, Singapore, and Thailand) were reviewed and content relating to information and support for citizens stuck overseas analysed. Government assistance-related data from each webpage was extracted and coded for the following themes: travel arrangements, health and wellbeing, finance and accommodation, information needs, and sources. Readability was examined using the Simplified Measure of Gobbledygook (SMOG) and the Flesch Kincaid readability tests; content 'accessibility' was measured using the Web Content Accessibility Guidelines (WCAG) Version 2.1; and content 'usability' assessed using the usability heuristics for website design tool. RESULTS: Ninety-eight webpages from 34 websites were evaluated. No country assessed covered all themes analysed. Most provided information and some level of support regarding repatriation options; border control and re-entry measures; medical assistance; and traveller registration. Only three countries provided information or support for emergency housing while abroad, and six provided some form of mental health support for their citizens. Our analysis of the quality of COVID-19-related information available on a subset of four countries' websites found poor readability and multiple accessibility and usability issues. CONCLUSION: This study uniquely analyses government support for citizens stuck abroad during the COVID-19 pandemic. With large variance in the information and services available across the countries analysed, our results highlight gaps, inconsistencies, and potential inequities in support available, and raise issues pertinent to the quality, accessibility, and usability of information. This study will assist policymakers plan and communicate comprehensive support packages for citizens stuck abroad due to the COVID-19 situation and design future efforts to prepare for global public health emergencies.

Citizen science as a tool for arboviral vector surveillance in a resourced-constrained setting: results of a pilot study in Honiara, Solomon Islands, 2019.

BACKGROUND: Recent arboviral disease outbreaks highlight the value a better understanding of the spread of disease-carrying mosquitoes across spatial-temporal scales can provide. Traditional surveillance tools are limited by jurisdictional boundaries, workforce constraints, logistics, and cost; factors that in low- and middle-income countries often conspire to undermine public health protection efforts. To overcome these, we undertake a pilot study designed to explore if citizen science provides a feasible strategy for arboviral vector surveillance in small developing Pacific island contexts. METHODS: We recruited, trained, and equipped community volunteers to trap and type mosquitos within their household settings, and to report count data to a central authority by short-message-service. Mosquito catches were independently assessed to measure participants' mosquito identification accuracy. Other data were collected to measure the frequency and stability of reporting, and volunteers' experiences. RESULTS: Participants collected data for 78.3% of the study period, and agreement between the volunteer citizen scientists' and the reviewing entomologist's mosquito identification was 94%. Opportunity to contribute to a project of social benefit, the chance to learn new skills, and the frequency of engagement with project staff were prime motivators for participation. Unstable electricity supply (required to run the trap's fan), insufficient personal finances (to buy electricity and phone credit), and inconvenience were identified as barriers to sustained participation. CONCLUSIONS: While there are challenges to address, our findings suggest that citizen science offers an opportunity to overcome the human resource constraints that conspire to limit health authorities' capacity to monitor arboviral vectors across populations. We note that the success of citizen science-based surveillance is dependent on the appropriate selection of equipment and participants, and the quality of engagement and support provided.

Mob justice fatalities in South Africa: a forensic mortuary study.

Mob justice fatalities are a gross violation of human rights as they represent extra-legal punishment. There is a paucity of research relating to the demographics of at-risk groups, nature of injuries and the impact to the Forensic Pathology Service at national and provincial levels. This was a retrospective study over 10 years (1 April 2006 to 31 March 2016) at Germiston Forensic Pathology Service Medico-legal Mortuary. The objectives were to describe the demographics of the victims of fatal mob justice, describe the trends of the number of fatalities and causes of death over time, assess hospitalization frequency, describe the nature and location of injuries sustained, and to report on ancillary investigations performed. A total of 354 cases were analyzed. All victims were Black (100%), with 99.4% of the sample group being male. The largest proportion was aged between 21-30 years (49.2%) with the majority having South African citizenship (68.9%). The majority of deaths were due to blunt force injuries (92.4%) with blunt force head injury being the most prevalent (79.9%). Half of the victims died on the scene (50.6%; n = 175). Hospitalization occurred in 49.4% (n = 175) of cases, of which, 56.3% died within 24 h of hospital admittance. Ancillary tests were ordered in 22.6% of cases. Adequate resources should be distributed to appropriate departments to engage with and monitor communities in high incidence areas to curb these killings.

Mid-infrared resonant cavity light emitting diodes operating at 4.5†µm.

We report on a mid-infrared resonant cavity light emitting diode (RCLED) operating at the wavelength of 4.5 µm with a narrow spectral linewidth at room temperature. Compared to a reference LED without a resonant cavity, our RCLED exhibits (85x) higher peak intensity, (13x) higher integrated output power, (16x) narrower spectral linewidth and (7x) superior temperature stability. The device consists of a one-wavelength thick micro-cavity containing an Al0.12In0.88As/InAs0.85Sb0.15 quantum well active region sandwiched between two high contrast AlAs0.08Sb0.92/GaSb distributed Bragg reflector mirrors, grown lattice-matched on GaSb by molecular beam epitaxy. The high spectral brightness, narrow linewidth and superior temperature stability are attractive features, enabling these devices to be used for detection of N2O at 4.5 µm. We show that with only minor adjustments the gases CO2 (4.2 µm) and CO (4.6 µm) are also readily accessible.

Surveillance strategies for the detection of disease outbreaks in the Pacific islands: meta-analysis of published literature, 2010-2019.

OBJECTIVE: Due to their tropical location, development status and the limited capacity of health systems, Pacific island counties and territories are particularly susceptible to infectious disease outbreaks; but evidence as to the optimal way in which outbreaks are detected is scarce. In this review, we synthesise evidence from literature about how outbreaks are detected in Pacific island countries and territories and critique factors identified as inhibiting surveillance practice. METHOD: For this systematic review, we searched electronic databases Embase, Global Health, MEDLINE and MEDLINE Epub from 1 January 2010 and 31 March 2019 for reports describing infectious disease outbreaks occurring in the Pacific islands. Reports were included if they reported the method by which an outbreak was detected or the time between an outbreak's onset and its detection. We extracted information about the report type and authors, the outbreak and its method/s of detection, and pertinent issues inhibiting surveillance practice. RESULTS: Of 860 articles identified, 37 reports describing 39 outbreaks met the inclusion criteria. Most outbreaks (n = 30) were identified through formal event-based surveillance; six through syndromic surveillance; and two by ad hoc notification from the community. Barriers to early outbreak detection included population isolation; lack of resources and infrastructure to support surveillance implementation and signal investigation; and broader health system factors such as preparedness planning and availability of laboratory services. CONCLUSION: Most surveillance-related gain in the Pacific islands may be made through building formal event-based surveillance systems and streamlining reporting processes to facilitate outbreak notification. This observation is pertinent given the focus on establishing and expanding syndromic surveillance approaches for outbreak detection in the islands over the last decade.

OBJECTIF: En raison de leur situation tropicale, de leur état de développement et de la capacité limitée des systèmes de santé, les comtés et territoires des îles du Pacifique sont particulièrement sensibles aux épidémies de maladies infectieuses, mais les données quant à la manière optimale de détecter les épidémies sont rares. Dans cette étude, nous synthétisons les données de la littérature sur la manière dont les épidémies sont détectées dans les pays et territoires des îles du Pacifique et les facteurs critiques identifiés comme entravant la pratique de la surveillance. MÉTHODE: Pour cette analyse systématique, nous avons recherché dans les bases de données électroniques Embase, Global Health, MEDLINE et MEDLINE Epub du 1er janvier 2010 et du 31 mars 2019 pour des rapports décrivant les épidémies de maladies infectieuses survenant dans les îles du Pacifique. Les rapports ont été inclus s'ils indiquaient la méthode de détection d'une épidémie ou le délai entre le début d'une épidémie et sa détection. Nous avons extrait les informations sur le type de rapport et les auteurs, l'épidémie et sa ou ses méthodes de détection, ainsi que les problèmes pertinents qui entravent la pratique de la surveillance. RÉSULTATS: Sur les 860 articles identifiés, 37 rapports décrivant 39 ménages ont satisfait aux critères d'inclusion. La plupart des épidémies (n = 30) ont été identifiés suite à une surveillance formelle basée sur les événements, six suite à une surveillance syndromique et deux suite à une notification ad-hoc de la communauté. Les obstacles à la détection précoce des épidémies comprennent l'isolement de la population, le manque de ressources et d'infrastructures pour soutenir la mise en œuvre de la surveillance et l'investigation des signaux, ainsi que des facteurs plus généraux du système de santé tels que la planification de la préparation et la disponibilité des services de laboratoire. CONCLUSION: La plupart des gains liés à la surveillance dans les îles du Pacifique peuvent être réalisés par la mise en place de systèmes de surveillance formels basés sur les événements et l'aiguillage des processus de report pour faciliter la notification des épidémies. Cette observation est pertinente étant donné l'accent mis sur l'établissement et l'expansion des approches de surveillance syndromique pour la détection des épidémies dans les îles au cours de la dernière décennie.

A packaged mindset: How elongated packages induce healthy mindsets.

Product packaging is an important instrument for marketers to draw consumer attention to specific product information and influence product perceptions. The purpose of this research is to investigate whether exposure to a product's packaging can also activate specific mindsets that, once activated, alter consumers' food perceptions. The results of three experiments demonstrate that elongated containers activate a health mindset that influences both consumers' perception of the packaged food product but also their health perceptions of subsequently encountered food. Specifically, foods in elongated containers lead consumers to think of concepts related to healthiness, which have differentiable effects on subsequent healthy and unhealthy food products.

BTB-BACK Domain Protein POB1 Suppresses Immune Cell Death by Targeting Ubiquitin E3 ligase PUB17 for Degradation.

Hypersensitive response programmed cell death (HR-PCD) is a critical feature in plant immunity required for pathogen restriction and prevention of disease development. The precise control of this process is paramount to cell survival and an effective immune response. The discovery of new components that function to suppress HR-PCD will be instrumental in understanding the regulation of this fundamental mechanism. Here we report the identification and characterisation of a BTB domain E3 ligase protein, POB1, that functions to suppress HR-PCD triggered by evolutionarily diverse pathogens. Nicotiana benthamiana and tobacco plants with reduced POB1 activity show accelerated HR-PCD whilst those with increased POB1 levels show attenuated HR-PCD. We demonstrate that POB1 dimerization and nuclear localization are vital for its function in HR-PCD suppression. Using protein-protein interaction assays, we identify the Plant U-Box E3 ligase PUB17, a well established positive regulator of plant innate immunity, as a target for POB1-mediated proteasomal degradation. Using confocal imaging and in planta immunoprecipitation assays we show that POB1 interacts with PUB17 in the nucleus and stimulates its degradation. Mutated versions of POB1 that show reduced interaction with PUB17 fail to suppress HR-PCD, indicating that POB1-mediated degradation of PUB17 U-box E3 ligase is an important step for negative regulation of specific immune pathways in plants. Our data reveals a new mechanism for BTB domain proteins in suppressing HR-PCD in plant innate immune responses.

A severe diarrhoeal outbreak in a remote Pacific island community, Anuta Island, Solomon Islands, April-June 2019.

CONTEXT: Solomon Islands is a small developing island state located in the south-western Pacific Ocean. A population of approximately 680 000 people live on more than one-third of the 992 islands that make up the country. Approximately 80% of the population reside in rural areas, many in remote, difficult to reach and poorly serviced island settings. ISSUE: In May 2019, the national surveillance system detected a rumour of a severe diarrhoea outbreak in a very remote and isolated community on Anuta Island, located halfway between the Solomon Islands archipelago and Tuvalu. This communication reports on the investigation and response to the outbreak, which affected 50 people (attack rate of 21.5%) and caused four deaths (case fatality rate of 8%). The authors highlight the system challenges faced in mounting the response and provide suggestions that may help overcome them. LESSONS LEARNED: The outbreak highlighted the challenges in detecting and responding to outbreaks in remote and rural areas of the Pacific Islands, and the limitations of rumour surveillance as a relied-upon surveillance strategy. The outbreak emphasises the need to build local capacity to detect, report and respond to outbreaks and the need for policy frameworks that ensure remote communities receive adequate health protection services.

Resonant cavity-enhanced photodetector incorporating a type-II superlattice to extend MWIR sensitivity.

Mid-infrared resonant cavity-enhanced photodetectors (RCE PD) present a promising technology for targeted gas detection. We demonstrate an RCE PD incorporating an InAs/InAsSb superlattice as the detecting element, extending the resonant wavelength beyond 4 µm. AlAsSb/GaSb mirrors and a unipolar barrier active region paralleling an nBn structure are also used, and performance is compared to a conventional broadband nBn detector incorporating the same superlattice. The RCE PD exhibited a Q-factor of ∼90 and an extremely stable resonance wavelength. Peak responsivity was 3.0 A W-1 at 240 K, equalling 84% quantum efficiency, a 5.5 times increase over the reference nBn at the same wavelength. Dark current density was 3.3×10-2 A cm-2 at 240 K, falling to 2.7×10-4 A cm-2 at 180 K. The broadband BLIP limit is approached at 180 K with specific detectivity of 2.1×1011 cm Hz1/2 W-1, which presents the potential of achieving BLIP-limited operation in the thermoelectric cooling regime.

Neural correlates of intertemporal choice in aggressive behavior.

People often have to make decisions between immediate rewards and more long-term goals. Such intertemporal judgments are often investigated in the context of monetary choice or drug use, yet not in regard to aggressive behavior. We combined a novel intertemporal aggression paradigm with functional neuroimaging to examine the role of temporal delay in aggressive behavior and the neural correlates thereof. Sixty-one participants (aged 18-22 years; 37 females) exhibited substantial variability in the extent to which they selected immediate acts of lesser aggression versus delayed acts of greater aggression against a same-sex opponent. Choosing delayed-yet-more-severe aggression was increased by provocation and associated with greater self-control. Preferences for delayed aggression were associated with greater activity in the ventromedial prefrontal cortex (VMPFC) during such choices, and reduced functional connectivity between the VMPFC and brain regions implicated in motor impulsivity. Preferences for immediate aggression were associated with reduced functional connectivity between the VMPFC and the frontoparietal control network. Dispositionally aggressive participants exhibited reduced VMPFC activity, which partially explained and suppressed their preferences for delayed aggression. Blunted VMPFC activity may thus be a neural mechanism that promotes reactive aggression towards provocateurs among dispositionally aggressive individuals. These findings demonstrate the utility of an intertemporal framework for investigating aggression and provide further evidence for the similar underlying neurobiology between aggression and other rewarding behaviors.

Epidemic surveillance in a low resource setting: lessons from an evaluation of the Solomon Islands syndromic surveillance system, 2017.

BACKGROUND: Solomon Islands is one of the least developed countries in the world. Recognising that timely detection of outbreaks is needed to enable early and effective response to disease outbreaks, the Solomon Islands government introduced a simple syndromic surveillance system in 2011. We conducted the first evaluation of the system and the first exploration of a national experience within the broader multi-country Pacific Syndromic Surveillance System to determine if it is meeting its objectives and to identify opportunities for improvement. METHODS: We used a multi-method approach involving retrospective data collection and statistical analysis, modelling, qualitative research and observational methods. RESULTS: We found that the system was well accepted, highly relied upon and designed to account for contextual limitations. We found the syndromic algorithm used to identify outbreaks was moderately sensitive, detecting 11.8% (IQR: 6.3-25.0%), 21.3% (IQR: 10.3-36.8%), 27.5% (IQR: 12.8-52.3%) and 40.5% (IQR: 13.5-65.7%) of outbreaks that caused small, moderate, large and very large increases in case presentations to health facilities, respectively. The false alert rate was 10.8% (IQR: 4.8-24.5%). Rural coverage of the system was poor. Limited workforce, surveillance resourcing and other 'upstream' health system factors constrained performance. CONCLUSIONS: The system has made a significant contribution to public health security in Solomon Islands, but remains insufficiently sensitive to detect small-moderate sized outbreaks and hence should not be relied upon as a stand-alone surveillance strategy. Rather, the system should sit within a complementary suite of early warning surveillance activities including event-based, in-patient- and laboratory-based surveillance methods. Future investments need to find a balance between actions to address the technical and systems issues that constrain performance while maintaining simplicity and hence sustainability.

Towards effective outbreak detection: a qualitative study to identify factors affecting nurses' early warning surveillance practice in Solomon Islands.

BACKGROUND: Intelligence generated by a surveillance system is dependent on the quality of data that are collected. We investigated the knowledge, attitudes and practices of nurses responsible for outbreak early warning surveillance data collection in Solomon Islands to identify factors that influence their ability to perform surveillance-related tasks with rigour. METHODS: We interviewed 12 purposively selected surveillance nurses and conducted inductive analysis on resulting data. RESULTS: Interviewees were knowledgeable and willing to contribute to the surveillance system. Constraining factors included the perception that surveillance was less important than patient care and could be 'deferred' during busy periods and wide variability in the application of case definitions. Motivating factors were frequent in-clinic training, formal recognition for good performance, incentives and designation of a focal point. Nurses held mixed views about the effect of mobile technologies on surveillance practice. CONCLUSIONS: This study identified several challenges to consistent and accurate data collection and reporting. Engagement of different parts of the health system, including human resources and health facilities' management, is needed to address these challenges.