Assessing the effectiveness of a mammography screening service

Background: Trials have shown that mammography screening reduces mortality and probably decreases morbidity related to breast cancer. Methods: We assessed whether the major mammography service in Western Australia (BreastScreen WA) is likely to reduce mortality by comparing prognostic variables between screen-detected and other cases of breast cancer diagnosed in 1999. We assessed likely reductions in morbidity by comparing treatments received by these two groups. To confirm mortality and morbidity reduction, we also compared prognostic variables and treatments with targets. Information on demographic variables, tumour characteristics at presentation and treatments were collected from medical records for all incident cases of breast cancer in Western Australia in 1999. We matched cases with the Western Australian Cancer Registry records to determine which cases had been detected by BreastScreen WA. Results: BreastScreen WA achieved the targets for mortality reduction. Tumours detected by BreastScreen WA were smaller in size, less likely to have vascular invasion, of lower histological grade and were more likely to be ductal carcinoma in situ alone without invasive carcinoma. Oestrogen receptor status was more likely to be positive, the difference in progesterone status was not significant, and lymph node involvement tended to be lower. BreastScreen WA patients were treated more often with local therapy and less often with systemic therapy, and the proportion of patients treated with breast-conserving surgery was close to the target for minimizing morbidity in breast cancer. Conclusion: Mammographic detection of breast cancer by BreastScreen WA is associated with reduced breast cancer morbidity and a more favourable prognosis.

A distributed systems approach to secure Internet mail

One of the obstacles to improved security of the Internet is ad hoc development of technologies with different design goals and different security goals. This paper proposes reconceptualizing the Internet as a secure distributed system, focusing specifically on the application layer. The notion is to redesign specific functionality, based on principles discovered in research on distributed systems in the decades since the initial development of the Internet. Because of the problems in retrofitting new technology across millions of clients and servers, any options with prospects of success must support backward compatibility. This paper outlines a possible new architecture for internet-based mail which would replace existing protocols by a more secure framework. To maintain backward compatibility, initial implementation could offer a web browser-based front end but the longer-term approach would be to implement the system using appropriate models of replication. (C) 2005 Elsevier Ltd. All rights reserved.

Information flow analysis for fail-secure devices

Information security devices must preserve security properties even in the presence of faults. This in turn requires a rigorous evaluation of the system behaviours resulting from component failures, especially how such failures affect information flow. We introduce a compositional method of static analysis for fail-secure behaviour. Our method uses reachability matrices to identify potentially undesirable information flows based on the fault modes of the system's components.

Identifying critical components during information security evaluations

Electronic communications devices intended for government or military applications must be rigorously evaluated to ensure that they maintain data confidentiality. High-grade information security evaluations require a detailed analysis of the device's design, to determine how it achieves necessary security functions. In practice, such evaluations are labour-intensive and costly, so there is a strong incentive to find ways to make the process more efficient. In this paper we show how well-known concepts from graph theory can be applied to a device's design to optimise information security evaluations. In particular, we use end-to-end graph traversals to eliminate components that do not need to be evaluated at all, and minimal cutsets to identify the smallest group of components that needs to be evaluated in depth.

Electrodynamic heart model construction and ECG simulation

Objectives: In this paper, we present a unified electrodynamic heart model that permits simulations of the body surface potentials generated by the heart in motion. The inclusion of motion in the heart model significantly improves the accuracy of the simulated body surface potentials and therefore also the 12-lead ECG. Methods: The key step is to construct an electromechanical heart model. The cardiac excitation propagation is simulated by an electrical heart model, and the resulting cardiac active forces are used to calculate the ventricular wall motion based on a mechanical model. The source-field point relative position changes during heart systole and diastole. These can be obtained, and then used to calculate body surface ECG based on the electrical heart-torso model. Results: An electromechanical biventricular heart model is constructed and a standard 12-lead ECG is simulated. Compared with a simulated ECG based on the static electrical heart model, the simulated ECG based on the dynamic heart model is more accordant with a clinically recorded ECG, especially for the ST segment and T wave of a V1-V6 lead ECG. For slight-degree myocardial ischemia ECG simulation, the ST segment and T wave changes can be observed from the simulated ECG based on a dynamic heart model, while the ST segment and T wave of simulated ECG based on a static heart model is almost unchanged when compared with a normal ECG. Conclusions: This study confirms the importance of the mechanical factor in the ECG simulation. The dynamic heart model could provide more accurate ECG simulation, especially for myocardial ischemia or infarction simulation, since the main ECG changes occur at the ST segment and T wave, which correspond with cardiac systole and diastole phases.

On the distributed compression of quantum information

The problem of distributed compression for correlated quantum sources is considered. The classical version of this problem was solved by Slepian and Wolf, who showed that distributed compression could take full advantage of redundancy in the local sources created by the presence of correlations. Here it is shown that, in general, this is not the case for quantum sources, by proving a lower bound on the rate sum for irreducible sources of product states which is stronger than the one given by a naive application of Slepian-Wolf. Nonetheless, strategies taking advantage of correlation do exist for some special classes of quantum sources. For example, Devetak and Winter demonstrated the existence of such a strategy when one of the sources is classical. Optimal nontrivial strategies for a different extreme, sources of Bell states, are presented here. In addition, it is explained how distributed compression is connected to other problems in quantum information theory, including information-disturbance questions, entanglement distillation and quantum error correction.

Observations in a maternity ward: Usability considerations for EHRs in an interrupt driven environment

With the increasing demand on healthcare systems it is imperative that all care is provided as efficiently and effectively as possible. Technology within the medical domain offers an exciting opportunity to augment work practices in order to meet these needs. This research project explores the implications of the interrupt-driven nature of work in clinical situations on documentation within an environment that increasingly involves electronic health records (EHRs). Midwives in a busy maternity ward were observed and interviewed about the work practices they employed to document information associated with patient care. The results showed that the interrupt-driven nature of the workplace, a feature common to many healthcare settings, led to a tension between the work and the work to document the work. Further, the IT environment in which the information was collected was not designed to cater for frequent interruption of the data entry process. Several recommendations for improving the IT environment are proposed to support health professionals in documenting patient data whilst attending to the interruptions. The recommendations include timeout screens, push technology, use of handheld PDAs, and cues to augment documentation in an interrupted session. Copyright © 2008 RMIT Publishing