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.

Collaboration in a Partnership for Primary Health Care: A Case Study From Papua New Guinea.

INTRODUCTION: In low- and middle-income countries, public-private partnerships (PPPs) are often used to support the delivery of primary health care (PHC). We explore the processes of collaboration in a corporate social responsibility investment in PHC that was delivered through a PPP model in Western Province, Papua New Guinea, in 2009-2018 to strengthen PHC services. METHODS: Qualitative interviews were conducted with stakeholders in the PPP (N=20). Key program documents were also reviewed. Data were coded using a general inductive approach, and Actor-Network Theory (ANT) was used to frame the analysis. RESULTS: Four dominant themes emerged: (1) interpersonal relationships accelerate collaboration, (2) collaboration requires time, (3) formal governance structures encourage collaboration, and (4) internal change disrupts collaboration. The research provides insight into the role of collaboration for more efficient, effective, and impactful design and implementation of PPP for PHC. It makes suggestions for how ANT may be used when designing PPPs and for the ongoing management of relationships between partners. We found ANT to be a useful framework to conceptualize the complex dynamics between the "actors" within the PPP and to identify opportunities for improvement where structural changes may be made to circumvent issues that may compromise effective collaboration. CONCLUSION: Collaboration is key to the success of PPPs for PHC. We found collaboration is not formulaic but is driven by actors, relationships, time, and governance. ANT can assist in designing, understanding, and managing the complex relationships between stakeholders of a PPP, who often come with diverse agendas, experiences, values, and perspectives.

Comparison of statistical methods for the early detection of disease outbreaks in small population settings.

Objectives: This study examines the performance of 6 aberration detection algorithms for the early detection of disease outbreaks in small population settings using syndrome-based early warning surveillance data collected by the Pacific Syndromic Surveillance System (PSSS). Although previous studies have proposed statistical methods for detecting aberrations in larger datasets, there is limited knowledge about how these perform in the presence of small numbers of background cases. Methods: To address this gap a simulation model was developed to test and compare the performance of the 6 algorithms in detecting outbreaks of different magnitudes, durations, and case distributions. Results: The study found that while the Early Aberration Reporting System-C1 algorithm developed by Hutwagner et al. outperformed others, no single approach provided reliable monitoring across all outbreak types. Furthermore, aberration detection approaches could only detect very large and acute outbreaks with any reliability. Conclusion: The findings of this study suggest that algorithm-based approaches to outbreak signal detection perform poorly when applied to settings with small numbers of background cases and should not be relied upon in these contexts. This highlights the need for alternative approaches for accurate and timely outbreak detection in small population settings, particularly those that are resource-constrained.

Pacritinib is a potent ACVR1 inhibitor with significant anemia benefit in patients with myelofibrosis.

In patients with cytopenic myelofibrosis, treatment with the JAK2/IRAK1 inhibitor pacritinib was associated with anemia benefit in the phase 3 PERSIST-2 study. The impact of pacritinib on transfusion independence (TI) has not been previously described, nor has the mechanism by which pacritinib improves anemia been elucidated. Because it has been previously postulated that inhibition of activin A receptor, type 1 (ACVR1)/activin receptor-like kinase-2 improves anemia in patients with myelofibrosis via suppression of hepcidin production, we assessed the relative inhibitory potency of pacritinib compared with other JAK2 inhibitors against ACVR1. Pacritinib inhibited ACVR1 with greater potency (half-maximal inhibitory concentration [IC50] = 16.7 nM; Cmax:IC50 = 12.7) than momelotinib (IC50 = 52.5 nM; Cmax:IC50 = 3.2), fedratinib (IC50 = 273 nM; Cmax:IC50 = 1.0), or ruxolitinib (IC50 > 1000; Cmax:IC50 < 0.01). Pacritinib's inhibitory activity against ACVR1 was corroborated via inhibition of downstream SMAD signaling in conjunction with marked suppression of hepcidin production. Among patients on PERSIST-2 who were not transfusion independent at baseline based on Gale criteria, a significantly greater proportion achieved TI on pacritinib compared with those treated on best available therapy (37% vs 7%, P = .001), and significantly more had a ≥50% reduction in transfusion burden (49% vs 9%, P < .0001). These data indicate that the anemia benefit of the JAK2/IRAK1 inhibitor pacritinib may be a function of potent ACVR1 inhibition.

Efficacy and Safety of Pacritinib vs Placebo for Patients With Severe COVID-19: A Phase 2 Randomized Clinical Trial.

Importance: The morbidity and mortality associated with COVID-19 remain high despite advances in standard of care therapy, and the role of anti-inflammatory agents that inhibit the interleukin 6/JAK2 pathway is still being elucidated. Objective: To evaluate the efficacy and safety of the oral JAK2/IRAK1 inhibitor pacritinib vs placebo in the treatment of adults with severe COVID-19. Design, Setting, and Participants: This phase 2, double-blind, placebo-controlled, randomized clinical trial enrolled hospitalized adult patients with severe COVID-19 at 21 centers across the US between June 2020 and February 2021, with approximately 1.5 months of safety follow-up per patient. Data analysis was performed from September 2021 to July 2022. Interventions: Patients were randomized 1:1 to standard of care plus pacritinib (400 mg per os on day 1 followed by 200 mg twice daily on days 2-14) vs placebo, for 14 days. Main Outcomes and Measures: The primary end point was death or need for invasive mechanical ventilation (IMV) or extracorporeal membrane oxygenation (ECMO) by day 28. All-cause mortality and safety were also assessed. Results: A total of 200 patients were randomized to pacritinib (99 patients; 56 men [56.6%]; median [range] age, 60 [19-87] years) or placebo (101 patients; 64 men [63.4%]; median [range] age 59 [28-94] years). The percentage requiring supplementary oxygen was 99.0% (98 patients) in the pacritinib group vs 98.0% (99 patients) in the placebo group. The percentage who progressed to IMV, ECMO, or death was 17.2% (17 patients) in the pacritinib group vs 22.8% (23 patients) in the placebo group (odds ratio, 0.62; 95% CI, 0.28-1.35; P = .23). Among patients with elevated interleukin 6, the rate was 17.5% (11 of 63 patients) in the pacritinib group vs 30.4% (21 of 96 patients) in the placebo group. The adverse event rate was similar for pacritinib vs placebo (78.1% [75 patients] vs 80.2% [81 patients]), with no excess in infection (14.6% [14 patients] vs 19.8% [20 patients]), bleeding (8.3% [8 patients] vs 10.9% [11 patients]), or thrombosis (8.3% [8 patients] vs 7.9% [8 patients]). Rates of grade 3 or higher adverse events were lower with pacritinib than placebo (29.2% [28 patients] vs 40.6% [41 patients]). Conclusions and Relevance: The study did not meet its primary end point in patients with severe COVID-19. Subgroup analyses may indicate specific populations with hyperinflammation that could benefit from pacritinib, although further clinical trials would be needed to confirm these effects. Trial Registration: ClinicalTrials.gov Identifier: NCT04404361.

Transmission of Antimicrobial Resistant Bacteria at the Hajj: A Scoping Review.

BACKGROUND: The Hajj is an annual religious mass gathering event held in Makkah, Saudi Arabia. With millions of participants from across the globe attending the Hajj, the risk of importation, transmission, and global spread of infectious diseases is high. The emergence of antimicrobial resistant (AMR) bacteria is of worldwide concern and the Hajj poses a serious risk to its dissemination. This review aims to synthesize published literature on AMR bacteria acquisition and transmission associated with the Hajj. METHODS: We searched electronic databases to identify literature published between January 1990 and December 2021. The search strategy included medical subject headings and keyword terms related to AMR bacteria and the Hajj. RESULTS: After screening 2214 search results, 51 studies were included in the analysis. The review found 6455 AMR bacteria transmissions related to the Hajj. Thirty predominantly enteric or respiratory disease-causing AMR bacterial species were reported with isolates identified in cases on five continents. Most were male, aged above 50 years and were diagnosed in Makkah. Most cases were identified through hospital-based research; few cases were detected in community or primary health care settings. CONCLUSIONS: This review provides a contemporary account of knowledge related to AMR transmission at the Hajj. It emphasizes the need for the enhancement of surveillance for AMR bacteria globally.

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.

Psychological and financial impacts of COVID-19-related travel measures: An international cross-sectional study.

BACKGROUND: The impact of COVID-19 international travel restrictions has to date, not been fully explored, and with the ongoing threat that new variants could potentially restrict movement further, it is important to consider the impacts that travel restrictions have on community members. This study aimed to evaluate the psychological and financial impact of COVID-19 travel restrictions on those separated from their partners or immediate families, as well as temporary visa holders who were unable to migrate. METHODS: Between 4 November 2021 to 1 December 2021, we executed a cross-sectional online survey targeting three specific groups; (1) those stranded from their partners; (2) those stranded from immediate families; and (3) temporary visa holders unable to migrate or cross international borders. We collected data on respondents' demographic profile; the nature of COVID-19-related travel impacts; depression, anxiety, and stress levels (using the validated DASS-21); and finally, data on respondents financial, employment and accommodation situation. RESULTS: 1363 respondents located globally completed the survey. 71.2% reported financial stress, 76.8% ([Formula: see text], SD = 5.94) reported moderate-to-extremely severe depression, 51.6% ([Formula: see text], SD = 5.49) moderate-to-extremely severe anxiety, and 62.6% ([Formula: see text], SD = 5.55) moderate-to-extremely severe stress levels. Statistically significant factors associated with moderate-to-extremely severe depression, anxiety, and stress included being female, chronic illness, and experiencing financial stress. Employment during COVID-19 -specifically essential services workers or unemployed-was associated with higher levels of anxiety and stress, with only essential workers being a predictor of higher stress severity. Factors that provided psychological protection included being older and having children. CONCLUSION: This study is one of the first to explore the impact COVID-19-related international travel restrictions have had on the financial status and psychological health of affected individuals. It highlights the significant human cost associated with the restrictions and identifies psychologically vulnerable populations. These results will help the design of targeted health and social policy responses.

Examining the psychological and financial impact of travel restrictions on citizens and permanent residents stranded abroad during the COVID-19 pandemic: international cross-sectional study.

OBJECTIVES: This study aimed to evaluate the psychological and financial distress reported by citizens and permanent residents stranded abroad due to international travel restrictions introduced in response to the COVID-19 pandemic. DESIGN: An international cross-sectional study. SETTING: A primary analysis of data collected between July and September 2021 through an online survey targeting individuals stranded abroad and unable to return to their country of residence due to international travel restrictions. RESPONDENTS: A total of 1054 individuals aged 18-84 years. DATA ANALYSIS: Multivariable logistic regression models were used to explore the relationship between higher levels of depression, anxiety and stress and participant variables. OUTCOME MEASURES: The survey answered questions regarding COVID-19 travel restriction-related impacts: personal stress, anxiety and depression (using the validated 21-item Depression, Anxiety and Stress Scale (DASS-21) tool), as well as impacts on housing and financial security and demographic data. RESULTS: A total of 75.4% of respondents reported wanting to return to the Oceania region (75.4%), with 45% stranded in Europe. 64.2% reported financial distress while stranded abroad. 64.4% (x̄=9.43, SD=5.81) reported moderate-to-extremely severe (based on the DASS-21 classification) levels of depression, 41.7% for anxiety (x̄=5.46, SD=4.74), and 58.1% for stress (x̄=10.64, SD=5.26). Multivariable analysis indicated that financial stress, an employment change, being <30 years, having a high perceived risk of contracting COVID-19 abroad and being stranded for >2 months were significantly related to scores of moderate-to-extremely severe depression, anxiety and stress. CONCLUSION: The study is among the first to explore the psychological and financial distress-related impacts associated with being stranded abroad due to COVID-19 travel restrictions. It highlights a range of unintended consequences that arise from pandemic-related travel restrictions, identifies the health and social needs of a particularly vulnerable population, and provides clues as to the types of support that may be adopted to best support them.

Identifying forensically relevant urban scavengers in Johannesburg, South Africa.

Unidentified human remains are frequently recovered in urban environments in South Africa, which undergo forensic (medico-legal) investigations. These remains often exhibit animal scavenging modifications and are frequently scattered by animals. This impacts the collection and forensic analysis of the remains. This study aimed to identify scavenging animals present in two urban environments in Johannesburg, South Africa, and describe their scavenging and scattering behaviours. Six pig carcasses (Sus scrofa domesticus) (30-80 kg) were placed in a veldt in Johannesburg and in an abandoned building complex. Motion-activated cameras recorded the scavenging activities. Scavenger species were identified and their behaviours, scattering pattern, and scavenging bone modifications were described. Slender mongooses (Galerella sanguinea) were the most prolific veldt scavengers. They scattered remains to a maximum distance of 10.5 m in two directions: north and southeast. These mongooses scavenged during the advanced and dry decomposition stages. Gnawing on the angle of the mandible - with multiple parallel scores on the flat surfaces and the angle margin having a stepped appearance - may be a distinguishing scavenging modification feature of the slender mongoose. Hadeda ibis (Bostrychia hagedash) were the only scavengers recorded scavenging on the intestines of a pig carcass in the abandoned building complex. They favoured colonizing insects and created multiple, large holes in the skin and removed the lips to access the insects. The described scavenging behaviours will assist in the reconstruction of postmortem events in forensic cases and the location and collection of scattered remains in Southern Africa.

Universal Health Coverage and the Pacific Islands: An Overview of Senior Leaders' Discussions, Challenges, Priorities and Solutions, 2015-2020.

In 1995, Pacific Health Ministers articulated their vision of a healthy Pacific as 'a place where children are nurtured in body and mind; environments invite learning and leisure; people work and age with dignity; where ecological balance is a source of pride; and where the ocean is protected.' Central to this vision is the achievement of universal health coverage (UHC). To provide an indication of the UHC-related priorities of Pacific health authorities and promote alignment of domestic and international investments in health sector development, we thematically analyzed the discussion, resolutions, and recommendations from 5 years (2015-2020) of senior-level Pacific health meetings. Five main themes emerged: (i) the Healthy Islands vision has (and continues to have) a unifying influence on action for UHC; (ii) adoption of appropriate service delivery models that support integrated primary health care at the community level are needed; (iii) human resources for health are critical if efforts to achieve UHC are to be successful; (iv) access to reliable health information is core to health sector improvement; and (v) while not a panacea for all challenges, digital health offers many opportunities. Small and isolated populations, chronic workforce limitations, weak governance arrangements, ageing and inadequate health facilities, and supply chain and logistics difficulties (among other issues) interact to challenge primary health care delivery across the Pacific Islands. We found evidence that the Healthy Islands vision is a tool that garners support for UHC; however, to realize the vision, a realistic understanding of needed political, human resource, and economic investments is required. The significant disruptive effect of COVID-19 and the uncertainty it brings for implementation of the medium- to long-term health development agenda raises concern that progress may stagnate or retreat.

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.

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.

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.

Arboviral Disease Outbreaks in the Pacific Islands Countries and Areas, 2014 to 2020: A Systematic Literature and Document Review.

Arthropod-borne diseases pose a significant public health threat, accounting for greater than 17% of infectious disease cases and 1 million deaths annually. Across Pacific Island countries and areas (PICs), outbreaks of dengue, chikungunya, and Zika are increasing in frequency and scale. Data about arbovirus outbreaks are incomplete, with reports sporadic, delayed, and often based solely on syndromic surveillance. We undertook a systematic review of published and grey literature and contacted relevant regional authorities to collect information about arboviral activity affecting PICs between October 2014 and June 2020. Our literature search identified 1176 unique peer-reviewed articles that were reduced to 25 relevant publications when screened. Our grey literature search identified 873 sources. Collectively, these data reported 104 unique outbreaks, including 72 dengue outbreaks affecting 19 (out of 22) PICs, 14 chikungunya outbreaks affecting 11 PICs, and 18 Zika outbreaks affecting 14 PICs. Our review is the most complete account of arboviral outbreaks to affect PICs since comparable work was published in 2014. It highlights the continued elevated level of arboviral activity across the Pacific and inconsistencies in how information about outbreaks is reported and recorded. It demonstrates the importance of a One-Health approach and the role that improved communication and reporting between different governments and sectors play in understanding the emergence, circulation, and transboundary risks posed by arboviral diseases.

The impact of digital communication and data exchange on primary health service delivery in a small island developing state setting.

Tuvalu is one of the smallest and most remote countries in the world. Due partly to its geography, the limited availability of human resources for health, infrastructure weaknesses, and the economic situation, Tuvalu faces many health systems challenges to delivering primary health care and achieving universal health coverage. Advancements in information communication technology are anticipated to change the face of health care delivery, including in developing settings. In 2020 Tuvalu commenced installation of Very Small Aperture Terminals (VSAT) at health facilities on remote outer islands to allow the digital exchange of data and information between facilities and healthcare workers. We documented the impact that the installation of VSAT has had on supporting health workers in remote locations, clinical decision-making, and delivering primary health more broadly. We found that installation of VSAT in Tuvalu has enabled regular peer-to-peer communication across facilities; supported remote clinical decision-making and reduced the number of domestic and overseas medical referrals required; and supported formal and informal staff supervision, education, and development. We also found that VSAT's stability is dependent on access to services (such as a reliable electricity supply) for which responsibility sits outside of the health sector. We stress that digital health is not a panacea for all health service delivery challenges and should be seen as a tool (not the solution) to support health service improvement. Our research provides evidence of the impact digital connectivity offers primary health care and universal health coverage efforts in developing settings. It provides insights into factors that enable and inhibit sustainable adoption of new health technologies in low- and middle-income countries.

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.

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.