Web based surveillance systems could improve disease detection and the response to emerging disease events

The Chinese government should be commended for its open, concerted, and rapid response to the recent H7N9 influenza outbreak. However, the first known case was not reported until 48 days after disease onset.1 Although the difficulties in detecting the virus and the lack of suitable diagnostic methods have been the focus of discussion,2 systematic limitations that may have contributed to this delay have hardly been discussed. The detection speed of surveillance systems is limited by the highly structured nature of information flow and hierarchical organisation of these systems. Flu surveillance usually relies on notification to a central authority of laboratory confirmed cases or presentations to sentinel practices for flu-like illness. Each step in this pathway presents a bottleneck at which information and time can be lost; this limitation must be dealt with...

The covenant for quiet enjoyment : a potential nuisance to lessors

Under Australian law, a tenant complaining of nuisance caused by another tenant traditionally had no recourse to the lessor unless the lessor actively participated in the nuisance. A recent Queensland Court of Appeal decision, Aussie Traveller Pty Ltd v Marklea Pty Ltd, has found that a lessor who fails to take steps to control a tenant's nuisance may be liable to other tenants for breach of the covenant of quiet enjoyment. This paper considers the recent decision in light of common law developments in Australia, England and the United States, including the American concept of constructive eviction.

Profile of women detected drink driving via Roadside Breath Testing (RBT) in Queensland, Australia, between 2000 and 2011

Background Drink driving among women is a growing problem in many motorised countries. While research has shown that male and female drink drivers differ on a number of characteristics, few studies have addressed the circumstances surrounding women’s drink driving offences specifically. Aim To add to previous research by comparing apprehension characteristics among men and women and to extend the understanding of the female drink driving problem by investigating the drink driving characteristics that are unique to women. Results The sample consisted of the 248,173 (21.5% women) drink drivers apprehended between 2000 and 2011 in Queensland, Australia. Gender comparisons showed that women were older, had lower levels of reoffending, and were more likely to be apprehended in Major Cities compared to men. Comparisons of age group and reoffending and non-reoffending among female drink drivers only revealed that higher BAC readings were more common among younger women. Moreover, a substantial minority (13.7%) of women aged 24 years or younger were apprehended with a BAC below0.05%, reflecting a breach of the zero tolerance BAC for provisional licence holders in Australia. Older women were more likely to be charged with a ‘failure to provide a test’ offence as a result of refusing to provide a breath or blood sample, indicating that drink driving is associated high levels of stigma for this group. Reoffending occurred among 16.2% of the female drink drivers and these drivers were more likely than non-reoffending drivers to record a mid to high range BAC, to be aged 30-39 or below 21years, and to be apprehended in Inner Regional or Remote locations. Conclusion Findings highlight the unique circumstances and divergent needs of female drink drivers compared to male drivers and for different groups of female drivers.

The impact of OCR accuracy on automated cancer classification of pathology reports

Objective To evaluate the effects of Optical Character Recognition (OCR) on the automatic cancer classification of pathology reports. Method Scanned images of pathology reports were converted to electronic free-text using a commercial OCR system. A state-of-the-art cancer classification system, the Medical Text Extraction (MEDTEX) system, was used to automatically classify the OCR reports. Classifications produced by MEDTEX on the OCR versions of the reports were compared with the classification from a human amended version of the OCR reports. Results The employed OCR system was found to recognise scanned pathology reports with up to 99.12% character accuracy and up to 98.95% word accuracy. Errors in the OCR processing were found to minimally impact on the automatic classification of scanned pathology reports into notifiable groups. However, the impact of OCR errors is not negligible when considering the extraction of cancer notification items, such as primary site, histological type, etc. Conclusions The automatic cancer classification system used in this work, MEDTEX, has proven to be robust to errors produced by the acquisition of freetext pathology reports from scanned images through OCR software. However, issues emerge when considering the extraction of cancer notification items.

Towards a smart cancer registry

Aims Pathology notification for a Cancer Registry is regarded as the most valid information for the confirmation of a diagnosis of cancer. In view of the importance of pathology data, an automatic medical text analysis system (Medtex) is being developed to perform electronic Cancer Registry data extraction and coding of important clinical information embedded within pathology reports. Methods The system automatically scans HL7 messages received from a Queensland pathology information system and analyses the reports for terms and concepts relevant to a cancer notification. A multitude of data items for cancer notification such as primary site, histological type, stage, and other synoptic data are classified by the system. The underlying extraction and classification technology is based on SNOMED CT1 2. The Queensland Cancer Registry business rules3 and International Classification of Diseases – Oncology – Version 34 have been incorporated. Results The cancer notification services show that the classification of notifiable reports can be achieved with sensitivities of 98% and specificities of 96%5, while the coding of cancer notification items such as basis of diagnosis, histological type and grade, primary site and laterality can be extracted with an overall accuracy of 80%6. In the case of lung cancer staging, the automated stages produced were accurate enough for the purposes of population level research and indicative staging prior to multi-disciplinary team meetings2 7. Medtex also allows for detailed tumour stream synoptic reporting8. Conclusions Medtex demonstrates how medical free-text processing could enable the automation of some Cancer Registry processes. Over 70% of Cancer Registry coding resources are devoted to information acquisition. The development of a clinical decision support system to unlock information from medical free-text could significantly reduce costs arising from duplicated processes and enable improved decision support, enhancing efficiency and timeliness of cancer information for Cancer Registries.

Classification of cancer-related death certificates using machine learning

Background Cancer monitoring and prevention relies on the critical aspect of timely notification of cancer cases. However, the abstraction and classification of cancer from the free-text of pathology reports and other relevant documents, such as death certificates, exist as complex and time-consuming activities. Aims In this paper, approaches for the automatic detection of notifiable cancer cases as the cause of death from free-text death certificates supplied to Cancer Registries are investigated. Method A number of machine learning classifiers were studied. Features were extracted using natural language techniques and the Medtex toolkit. The numerous features encompassed stemmed words, bi-grams, and concepts from the SNOMED CT medical terminology. The baseline consisted of a keyword spotter using keywords extracted from the long description of ICD-10 cancer related codes. Results Death certificates with notifiable cancer listed as the cause of death can be effectively identified with the methods studied in this paper. A Support Vector Machine (SVM) classifier achieved best performance with an overall F-measure of 0.9866 when evaluated on a set of 5,000 free-text death certificates using the token stem feature set. The SNOMED CT concept plus token stem feature set reached the lowest variance (0.0032) and false negative rate (0.0297) while achieving an F-measure of 0.9864. The SVM classifier accounts for the first 18 of the top 40 evaluated runs, and entails the most robust classifier with a variance of 0.001141, half the variance of the other classifiers. Conclusion The selection of features significantly produced the most influences on the performance of the classifiers, although the type of classifier employed also affects performance. In contrast, the feature weighting schema created a negligible effect on performance. Specifically, it is found that stemmed tokens with or without SNOMED CT concepts create the most effective feature when combined with an SVM classifier.

Insurer and insured

This chapter analyses the obligations insurers and insureds owe each other and the remedies which follow a breach of obligation.

Liability in negligence and the failure to disclose multiple risks in surgery : I would have been willing to run the risk

It has been 21 years since the decision in Rogers v Whitaker and the legal principles concerning informed consent and liability for negligence are still strongly grounded in this landmark High Court decision. This paper considers more recent developments in the law concerning the failure to disclose inherent risks in medical procedures, focusing on the decision in Wallace v Kam [2013] HCA 19. In this case, the appellant underwent a surgical procedure that carried a number of risks. The surgery itself was not performed in a sub-standard way, but the surgeon failed to disclose two risks to the patient, a failure that constituted a breach of the surgeon’s duty of care in negligence. One of the undisclosed risks was considered to be less serious than the other, and this lesser risk eventuated causing injury to the appellant. The more serious risk did not eventuate, but the appellant argued that if the more serious risk had been disclosed, he would have avoided his injuries completely because he would have refused to undergo the procedure. Liability was disputed by the surgeon, with particular reference to causation principles. The High Court of Australia held that the appellant should not be compensated for harm that resulted from a risk he would have been willing to run. We examine the policy reasons underpinning the law of negligence in this specific context and consider some of the issues raised by this unusual case. We question whether some of the judicial reasoning adopted in this case, represents a significant shift in traditional causation principles.

When leadership meets organizational change : the influence of the top management team and supervisory leaders on change appraisals, change attitudes, and adjustment to change

Despite the importance of adaption and change for firm survival, the failure rate of organizational change efforts remains alarmingly high (Beer and Nohria, 2000; Kotter, 1995). In a recent global survey of over 3,000 executives,Meaney and Pung (2008) reported that two-thirds of executives indicated that their firm had failed to successfully implement organizational changes. Similarly, academic researchers have also concluded that difficulties in implementing and managing organizational change efforts often precipitate organizational crises (Probst and Raisch, 2005). As a result, attention has been directed to identify the factors that improve the likelihood of successfully implementing organizational change efforts. While there has been practitioner-oriented discussion around the pivotal role of workplace leaders in reducing resistance to change, only a limited number of empirical studies have examined relationships between leader behavior and employee change attitudes (e.g., Bommer, Rich, and Rubin, 2005; Herold, Caldwell, and Liu, 2008; Nemanich and Keller, 2007; Oreg and Berson, 2011). However...

Remodeling of purinergic receptor-mediated Ca 2+ signaling as a consequence of EGF-induced epithelial-mesenchymal transition in breast cancer cells

Background The microenvironment plays a pivotal role in tumor cell proliferation, survival and migration. Invasive cancer cells face a new set of environmental challenges as they breach the basement membrane and colonize distant organs during the process of metastasis. Phenotypic switching, such as that which occurs during epithelial-mesenchymal transition (EMT), may be associated with a remodeling of cell surface receptors and thus altered responses to signals from the tumor microenvironment. Methodology/Principal Findings We assessed changes in intracellular Ca 2+ in cells loaded with Fluo-4 AM using a fluorometric imaging plate reader (FLIPR TETRA) and observed significant changes in the potency of ATP (EC 50 0.175 μM (-EGF) versus 1.731 μM (+EGF), P<0.05), and the nature of the ATP-induced Ca 2+ transient, corresponding with a 10-fold increase in the mesenchymal marker vimentin (P<0.05). We observed no change in the sensitivity to PAR2-mediated Ca 2+ signaling, indicating that these alterations are not simply a consequence of changes in global Ca 2+ homeostasis. To determine whether changes in ATP-mediated Ca 2+ signaling are preceded by alterations in the transcriptional profile of purinergic receptors, we analyzed the expression of a panel of P2X ionotropic and P2Y metabotropic purinergic receptors using real-time RT-PCR and found significant and specific alterations in the suite of ATP-activated purinergic receptors during EGF-induced EMT in breast cancer cells. Our studies are the first to show that P2X 5 ionotropic receptors are enriched in the mesenchymal phenotype and that silencing of P2X 5 leads to a significant reduction (25%, P<0.05) in EGF-induced vimentin protein expression. Conclusions The acquisition of a new suite of cell surface purinergic receptors is a feature of EGF-mediated EMT in MDA-MB-468 breast cancer cells. Such changes may impart advantageous phenotypic traits and represent a novel mechanism for the targeting of cancer metastasis.

Spatial-temporal epidemiological analyses of two sympatric, co-endemic alphaviral diseases in Queensland, Australia

Background: The two most reported mosquito-borne diseases in Queensland, a northern state of Australia, are Ross River virus (RRV) disease and Barmah Forest virus (BFV) disease. Both diseases are endemic in Queensland and have similar clinical symptoms and comparable transmission cycles involving a complex inter-relationship between human hosts, various mosquito vectors, and a range of nonhuman vertebrate hosts, including marsupial mammals that are unique to the Australasian region. Although these viruses are thought to share similar vectors and vertebrate hosts, RRV is four times more prevalent than BFV in Queensland. Methods: We performed a retrospective analysis of BFV and RRV human disease notification data collected from 1995 to 2007 in Queensland to ascertain whether there were differences in the incidence patterns of RRV and BFV disease. In particular, we compared the temporal incidence and spatial distribution of both diseases and considered the relationship between their disease dynamics. We also investigated whether a peak in BFV incidence during spring was indicative of the following RRV and BFV transmission season incidence levels. Results: Although there were large differences in the notification rates of the two diseases, they had similar annual temporal patterns, but there were regional variations between the length and magnitude of the transmission seasons. During periods of increased disease activity, however, there was no association between the dynamics of the two diseases. Conclusions: The results from this study suggest that while RRV and BFV share similar mosquito vectors, there are significant differences in the ecology of these viruses that result in different epidemic patterns of disease incidence. Further investigation is required into the ecology of each virus to determine which factors are important in promoting RRV and BFV disease outbreaks.

Outbreak detection algorithms for seasonal disease data : a case study using Ross River virus disease

Background Detection of outbreaks is an important part of disease surveillance. Although many algorithms have been designed for detecting outbreaks, few have been specifically assessed against diseases that have distinct seasonal incidence patterns, such as those caused by vector-borne pathogens. Methods We applied five previously reported outbreak detection algorithms to Ross River virus (RRV) disease data (1991-2007) for the four local government areas (LGAs) of Brisbane, Emerald, Redland and Townsville in Queensland, Australia. The methods used were the Early Aberration Reporting System (EARS) C1, C2 and C3 methods, negative binomial cusum (NBC), historical limits method (HLM), Poisson outbreak detection (POD) method and the purely temporal SaTScan analysis. Seasonally-adjusted variants of the NBC and SaTScan methods were developed. Some of the algorithms were applied using a range of parameter values, resulting in 17 variants of the five algorithms. Results The 9,188 RRV disease notifications that occurred in the four selected regions over the study period showed marked seasonality, which adversely affected the performance of some of the outbreak detection algorithms. Most of the methods examined were able to detect the same major events. The exception was the seasonally-adjusted NBC methods that detected an excess of short signals. The NBC, POD and temporal SaTScan algorithms were the only methods that consistently had high true positive rates and low false positive and false negative rates across the four study areas. The timeliness of outbreak signals generated by each method was also compared but there was no consistency across outbreaks and LGAs. Conclusions This study has highlighted several issues associated with applying outbreak detection algorithms to seasonal disease data. In lieu of a true gold standard, a quantitative comparison is difficult and caution should be taken when interpreting the true positives, false positives, sensitivity and specificity.

Case note : Keegan v Sussan Corporation (Aust) Pty Ltd

A recent decision of the Queensland Supreme Court highlights that merely having a policy in a workplace is not sufficient in itself – the policy must be implemented and followed if an employer wishes to establish that it is not in breach of its duty of care owed to employees. In Keegan v Sussan Corporation (Aust) Pty Ltd an employee successfully sued in negligence for her psychiatric injury caused by her employer’s failure to follow its bullying and harassment policy.

Duty to the court and the administration of justice : some examples, implications and clarifications

No liberal democracy can survive without popular trust in its judicial system. The legal profession and the judiciary enjoy a level of independence and autonomy from the executive that makes them both powerful and privileged. A UNIQUE AND ORGANIC DUTY: So long as the courts are seen to fulfil their duty to guard against encroachments by the executive on the freedoms and rights of individual citizens with integrity and credibility, they maintain enough public support to retain their normative authority. But support for those with power and privilege is easily undermined. It is contingent upon trust. Lawyers who breach that trust in ways that go to the heart of the legal system ought to expect to be made examples of and to suffer severe penalties. The good news is that the sorts of breach discussed here should be neither difficult to anticipate nor to avoid – in theory. In practice, smart and honest lawyers sometimes fall foul of these duties for all sorts of understandable (if not condonable) reasons. Law does not get practised in a social or cultural vacuum. Lawyers are people, and people have weaknesses, failings and stresses...

The Proposed Commonwealth Personal Property Securities Act 2008

Inspired by similar reforms introduced in New Zealand, Canada and the United States, the Commonwealth, with the co-operation of the States, seeks in the Personal Property Securities Bill 2008 (the Bill) to introduce a central repository of recorded information reflecting particular security interests in personal property in Australia. Specifically, the interest recorded is an interest in personal property provided for by a transaction that in substance secures the payment or the performance of an obligation. In addition to providing a notification of the use of the personal property as collateral to secure the payment of monies or the performance of an obligation, the Bill proposes to introduce a regime of prioritising interests in the same collateral. Central to this prioritisation are the concepts of a ‘perfected security interests’and ‘unperfected security interests’. Relevantly, a perfected security interest in collateral has priority over an unperfected security interest in the same collateral. The proposed mechanisms rely on the fundamental integer of personal property, which is defined as any property other than land. Recognising that property may take a tangible as well as an intangible form, the Bill reflects an appreciation of the fact that some property may have a tangible form which may act as collateral, and simultaneously the same property may involve other property, intangible property in the form of intellectual property rights, which in their own right may be the subject of a‘security agreement’. An example set out in the Commentary on the Consultation Draft of the Bill (the Commentary), indicates the practical implications involving certain property which have multiple profiles for the purposes of the Bill. This submission is concerned with the presumptions made in relation to the interphase between tangible property and intangible property arising from the same personal property, as set out in s 30 of the Bill.