Privacy and trust management for electronic health records

Establishing a nationwide Electronic Health Record system has become a primary objective for many countries around the world, including Australia, in order to improve the quality of healthcare while at the same time decreasing its cost. Doing so will require federating the large number of patient data repositories currently in use throughout the country. However, implementation of EHR systems is being hindered by several obstacles, among them concerns about data privacy and trustworthiness. Current IT solutions fail to satisfy patients’ privacy desires and do not provide a trustworthiness measure for medical data. This thesis starts with the observation that existing EHR system proposals suer from six serious shortcomings that aect patients’ privacy and safety, and medical practitioners’ trust in EHR data: accuracy and privacy concerns over linking patients’ existing medical records; the inability of patients to have control over who accesses their private data; the inability to protect against inferences about patients’ sensitive data; the lack of a mechanism for evaluating the trustworthiness of medical data; and the failure of current healthcare workflow processes to capture and enforce patient’s privacy desires. Following an action research method, this thesis addresses the above shortcomings by firstly proposing an architecture for linking electronic medical records in an accurate and private way where patients are given control over what information can be revealed about them. This is accomplished by extending the structure and protocols introduced in federated identity management to link a patient’s EHR to his existing medical records by using pseudonym identifiers. Secondly, a privacy-aware access control model is developed to satisfy patients’ privacy requirements. The model is developed by integrating three standard access control models in a way that gives patients access control over their private data and ensures that legitimate uses of EHRs are not hindered. Thirdly, a probabilistic approach for detecting and restricting inference channels resulting from publicly-available medical data is developed to guard against indirect accesses to a patient’s private data. This approach is based upon a Bayesian network and the causal probabilistic relations that exist between medical data fields. The resulting definitions and algorithms show how an inference channel can be detected and restricted to satisfy patients’ expressed privacy goals. Fourthly, a medical data trustworthiness assessment model is developed to evaluate the quality of medical data by assessing the trustworthiness of its sources (e.g. a healthcare provider or medical practitioner). In this model, Beta and Dirichlet reputation systems are used to collect reputation scores about medical data sources and these are used to compute the trustworthiness of medical data via subjective logic. Finally, an extension is made to healthcare workflow management processes to capture and enforce patients’ privacy policies. This is accomplished by developing a conceptual model that introduces new workflow notions to make the workflow management system aware of a patient’s privacy requirements. These extensions are then implemented in the YAWL workflow management system.

Single nucleotide polymorphism (SNP) - genotyping of Community Acquired Methicillin-Resistant Staphylococcus aureus, including the subtyping of PVL toxin producers using Real-Time PCR

Staphylococcus aureus is a common pathogen that causes a variety of infections including soft tissue infections, impetigo, septicemia toxic shock and scalded skin syndrome. Traditionally, Methicillin-Resistant Staphylococcus aureus (MRSA) was considered a Hospital-Acquired (HA) infection. It is now recognised that the frequency of infections with MRSA is increasing in the community, and that these infections are not originating from hospital environments. A 2007 report by the Centers for Disease Control and Prevention (CDC) stated that Staphylococcus aureus is the most important cause of serious and fatal infections in the USA. Community-Acquired MRSA (CA-MRSA) are genetically diverse and distinct, meaning they are able to be identified and tracked by way of genotyping. Genotyping of MRSA using Single nucleotide polymorphisms (SNPs) is a rapid and robust method for monitoring MRSA, specifically ST93 (Queensland Clone) dissemination in the community. It has been shown that a large proportion of CA-MRSA infections in Queensland and New South Wales are caused by ST93. The rationale for this project was that SNP analysis of MLST genes is a rapid and cost-effective method for genotyping and monitoring MRSA dissemination in the community. In this study, 16 different sequence types (ST) were identified with 41% of isolates identified as ST93 making it the predominate clone. Males and Females were infected equally with an average patient age of 45yrs. Phenotypically, all of the ST93 had an identical antimicrobial resistance pattern. They were resistant to the β-lactams – Penicillin, Flu(di)cloxacillin and Cephalothin but sensitive to all other antibiotics tested. Virulence factors play an important role in allowing S. aureus to cause disease by way of colonising, replication and damage to the host. One virulence factor of particular interest is the toxin Panton-Valentine leukocidin (PVL), which is composed of two separate proteins encoded by two adjacent genes. PVL positive CA-MRSA are shown to cause recurrent, chronic or severe skin and soft tissue infections. As a result, it is important that PVL positive CA-MRSA is genotyped and tracked. Especially now that CA-MRSA infections are more prevalent than HA-MRSA infections and are now deemed endemic in Australia. 98% of all isolates in this study tested positive for the PVL toxin gene. This study showed that PVL is present in many different community based ST, not just ST93, which were all PVL positive. With this toxin becoming entrenched in CA-MRSA, genotyping would provide more accurate data and a way of tracking the dissemination. PVL gene can be sub-typed using an allele-specific Real-Time PCR (RT-PCR) followed by High resolution meltanalysis. This allows the identification of PVL subtypes within the CA-MRSA population and allow the tracking of these clones in the community.

Modeling, stability analysis and control of microgrid

With the increase in the level of global warming, renewable energy based distributed generators (DGs) will increasingly play a dominant role in electricity production. Distributed generation based on solar energy (photovoltaic and solar thermal), wind, biomass, mini-hydro along with use of fuel cells and micro turbines will gain considerable momentum in the near future. A microgrid consists of clusters of load and distributed generators that operate as a single controllable system. The interconnection of the DG to the utility/grid through power electronic converters has raised concern about safe operation and protection of the equipments. Many innovative control techniques have been used for enhancing the stability of microgrid as for proper load sharing. The most common method is the use of droop characteristics for decentralized load sharing. Parallel converters have been controlled to deliver desired real power (and reactive power) to the system. Local signals are used as feedback to control converters, since in a real system, the distance between the converters may make the inter-communication impractical. The real and reactive power sharing can be achieved by controlling two independent quantities, frequency and fundamental voltage magnitude. In this thesis, an angle droop controller is proposed to share power amongst converter interfaced DGs in a microgrid. As the angle of the output voltage can be changed instantaneously in a voltage source converter (VSC), controlling the angle to control the real power is always beneficial for quick attainment of steady state. Thus in converter based DGs, load sharing can be performed by drooping the converter output voltage magnitude and its angle instead of frequency. The angle control results in much lesser frequency variation compared to that with frequency droop. An enhanced frequency droop controller is proposed for better dynamic response and smooth transition between grid connected and islanded modes of operation. A modular controller structure with modified control loop is proposed for better load sharing between the parallel connected converters in a distributed generation system. Moreover, a method for smooth transition between grid connected and islanded modes is proposed. Power quality enhanced operation of a microgrid in presence of unbalanced and non-linear loads is also addressed in which the DGs act as compensators. The compensator can perform load balancing, harmonic compensation and reactive power control while supplying real power to the grid A frequency and voltage isolation technique between microgrid and utility is proposed by using a back-to-back converter. As utility and microgrid are totally isolated, the voltage or frequency fluctuations in the utility side do not affect the microgrid loads and vice versa. Another advantage of this scheme is that a bidirectional regulated power flow can be achieved by the back-to-back converter structure. For accurate load sharing, the droop gains have to be high, which has the potential of making the system unstable. Therefore the choice of droop gains is often a tradeoff between power sharing and stability. To improve this situation, a supplementary droop controller is proposed. A small signal model of the system is developed, based on which the parameters of the supplementary controller are designed. Two methods are proposed for load sharing in an autonomous microgrid in rural network with high R/X ratio lines. The first method proposes power sharing without any communication between the DGs. The feedback quantities and the gain matrixes are transformed with a transformation matrix based on the line R/X ratio. The second method involves minimal communication among the DGs. The converter output voltage angle reference is modified based on the active and reactive power flow in the line connected at point of common coupling (PCC). It is shown that a more economical and proper power sharing solution is possible with the web based communication of the power flow quantities. All the proposed methods are verified through PSCAD simulations. The converters are modeled with IGBT switches and anti parallel diodes with associated snubber circuits. All the rotating machines are modeled in detail including their dynamics.

Adapting a generic BEAMnrc model of the BrainLAB m3 micro-multileaf collimator to simulate a local collimation device

This work is focussed on developing a commissioning procedure so that a Monte Carlo model, which uses BEAMnrc’s standard VARMLC component module, can be adapted to match a specific BrainLAB m3 micro-multileaf collimator (μMLC). A set of measurements are recommended, for use as a reference against which the model can be tested and optimised. These include radiochromic film measurements of dose from small and offset fields, as well as measurements of μMLC transmission and interleaf leakage. Simulations and measurements to obtain μMLC scatter factors are shown to be insensitive to relevant model parameters and are therefore not recommended, unless the output of the linear accelerator model is in doubt. Ultimately, this note provides detailed instructions for those intending to optimise a VARMLC model to match the dose delivered by their local BrainLAB m3 μMLC device.

A secure framework and related protocols for ubiquitous access to electronic health records using Java SIM cards

Ubiquitous access to patient medical records is an important aspect of caring for patient safety. Unavailability of sufficient medical information at the patient point-of-care could possibly lead to a fatality. In this paper we propose employing emergent technologies such as Java SIM Cards (JSC),Smart Phones (SP), Next Generation Networks (NGN), Near Field Communications (NFC), Public Key Infrastructure (PKI), and Biometric Identification to develop a secure framework and related protocols for ubiquitous access to Electronic Health Records (EHRs). A partial EHR contained within a JSC can be used at the patient point-of-care in order to help quick diagnosis of a patient’s problems. The full EHR can be accessed from an Electronic Healthcare Records Centre (EHRC).

Contrast enhancement of EPID images via difference imaging : a feasibility study

In this study, the feasibility of difference imaging for improving the contrast of electronic portal imaging device (EPID) images is investigated. The difference imaging technique consists of the acquisition of two EPID images (with and without the placement of an additional layer of attenuating medium on the surface of the EPID)and the subtraction of one of these images from the other. The resulting difference image shows improved contrast, compared to a standard EPID image, since it is generated by lower-energy photons. Results of this study show that, ¯rstly, this method can produce images exhibiting greater contrast than is seen in standard megavoltage EPID images and that, secondly, the optimal thickness of attenuating material for producing a maximum contrast enhancement may vary with phantom thickness and composition. Further studies of the possibilities and limitations of the di®erence imaging technique, and the physics behind it, are therefore recommended.

Dynamic coast control of train movement with genetic algorithm

The railway service is now the major transportation means in most of the countries around the world. With the increasing population and expanding commercial and industrial activities, a high quality of railway service is the most desirable. Train service usually varies with the population activities throughout a day and train coordination and service regulation are then expected to meet the daily passengers' demand. Dwell time control at stations and fixed coasting point in an inter-station run are the current practices to regulate train service in most metro railway systems. However, a flexible and efficient train control and operation is not always possible. To minimize energy consumption of train operation and make certain compromises on the train schedule, coast control is an economical approach to balance run-time and energy consumption in railway operation if time is not an important issue, particularly at off-peak hours. The capability to identify the starting point for coasting according to the current traffic conditions provides the necessary flexibility for train operation. This paper presents an application of genetic algorithms (GA) to search for the appropriate coasting point(s) and investigates the possible improvement on fitness of genes. Single and multiple coasting point control with simple GA are developed to attain the solutions and their corresponding train movement is examined. Further, a hierarchical genetic algorithm (HGA) is introduced here to identify the number of coasting points required according to the traffic conditions, and Minimum-Allele-Reserve-Keeper (MARK) is adopted as a genetic operator to achieve fitter solutions.

A practical implementation of a continuous isotropic spherical omnidirectional drive

This paper presents a continuous isotropic spherical omnidirectional drive mechanism that is efficient in its mechanical simplicity and use of volume. Spherical omnidirectional mechanisms allow isotropic motion, although many are limited from achieving true isotropic motion by practical mechanical design considerations. The mechanism presented in this paper uses a single motor to drive a point on the great circle of the sphere parallel to the ground plane, and does not require a gearbox. Three mechanisms located 120 degrees apart provide a stable drive platform for a mobile robot. Results show the omnidirectional ability of the robot and demonstrate the performance of the spherical mechanism compared to a popular commercial omnidirectional wheel over edges of varying heights and gaps of varying widths.

Axial magnetic bearing development for the BiVACOR Rotary BiVAD/TAH

A suspension system for the BiVACOR biventricular assist device (BiVAD) has been developed and tested. The device features two semi-open centrifugal impellers mounted on a common rotating hub. Flow balancing is achieved through the movement of the rotor in the axial direction. The rotor is suspended in the pump casings by an active magnetic suspension system in the axial direction and a passive hydrodynamic bearing in the radial direction. This paper investigates the axial movement capacity of themagnetic bearing system and the power consumption at various operating points. The force capacity of the passive hydrodynamic bearing is investigated using a viscous glycerol solution. Axial rotor movement in the range of ±0.15 mm is confirmed and power consumption is under 15.5 W. The journal bearing is shown to stabilize the rotor in the radial direction at the required operating speed. Magnetic levitation is a viable suspension technique for the impeller of an artificial heart to improve device lifetime and reduce blood damage.

Power electronics education electronic book (PEEEB)

In this website, you can virtually attend all lectures, tutorials, computer Labs and quizzes and also access to lecture notes.

Genotyping of enterococcus faecalis and enterococcus faecium isolates using a set of eight single nucleotide polymorphisms (SNPs)

A SNP genotyping method was developed for E. faecalis and E. faecium using the 'Minimum SNPs' program. SNP sets were interrogated using allele-specific real-time PCR. SNP-typing sub-divided clonal complexes 2 and 9 of E. faecalis and 17 of E. faecium, members of which cause the majority of nosocomial infections globally.

Social clubs and social capital : the effect of electronic gaming machines in disadvantaged regions on the creation or destruction of community resilience

The role of particular third sector organisations, Social Clubs, in supporting gambling through the use of EGMs in venues presents as a difficult social issue. Social Clubs gain revenue from gambling activities; but also contribute to social well-being through the provision of services to communities. The revenues derived from gambling in specific geographic locales has been seen by government as a way to increase economic development particularly in deprived areas. However there are also concerns about accessibility of low-income citizens to Electronic Gaming Machines (EGMS) and the high level of gambling overall in these deprived areas. We argue that social capital can be viewed as a guard against deleterious effects of unconstrained use of EGM gambling in communities. However, it is contended that social capital may also be destroyed by gambling activity if commercial business actors are able to use EGMs without community obligations to service provision. This paper examines access to gambling through EGMs and its relationship to social capital and the consequent effect on community resilience, via an Australian case study. The results highlight the potential two-way relationship between gambling and volunteering, such that volunteering (and social capital more generally) may help protect against problems of gambling, but also that volunteering as an activity may be damaged by increased gambling activity. This suggests that, regardless of the direction of causation, it is necessary to build up social capital via volunteering and other social capital activities in areas where EGMS are concentrated. The study concludes that Social Clubs using EGMs to derive funds are uniquely positioned within the community to develop programs that foster social capital creation and build community resilience in deprived areas.

Export decisions within Taiwanese electrical and electronic SMEs : the role of management characteristics and attitudes

In this globalized environment, Taiwanese firms have been very successful in achieving growth via international market expansion. In particular, the Taiwanese electronics industry has shown a dynamism lacking in comparable industries around the world. However, in recent years there has been a move by many of the larger Taiwanese manufacturing firms to outsource their manufacturing to low-cost producers such as China in order to remain competitive. Conversely, most Taiwanese small- to medium-sized enterprises (SMEs) have retained their production facilities in Taiwan. These SMEs seek to expand their sales beyond the domestic market by employing an export strategy, making a significant socioeconomic contribution to the domestic and regional economies. This paper highlights the key dimensions such as enhancing factors (benefits/advantages), inhibiting factors (barriers/costs), and managerial factors (characteristics/commitment) that play an important role in the internationalization of SMEs located within the Taiwanese electronics industry. A logistic regression model is used to predict the probability of a firm being an exporter.

Electronic games: A legitimate diversional therapy intervention for health care consumers?

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