Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method

Background: The extensive and rapidly expanding research literature on electronic patient records (EPRs) presents challenges to systematic reviewers. This literature is heterogeneous and at times conflicting, not least because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Aim: To map, interpret and critique the range of concepts, theories, methods and empirical findings on EPRs, with a particular emphasis on the implementation and use of EPR systems. Method: Using the meta-narrative method of systematic review, and applying search strategies that took us beyond the Medline-indexed literature, we identified over 500 full-text sources. We used ‘conflicting’ findings to address higher-order questions about how the EPR and its implementation were differently conceptualised and studied by different communities of researchers. Main findings: Our final synthesis included 24 previous systematic reviews and 94 additional primary studies, most of the latter from outside the biomedical literature. A number of tensions were evident, particularly in relation to: [1] the EPR (‘container’ or ‘itinerary’); [2] the EPR user (‘information-processer’ or ‘member of socio-technical network’); [3] organizational context (‘the setting within which the EPR is implemented’ or ‘the EPR-in-use’); [4] clinical work (‘decision-making’ or ‘situated practice’); [5] the process of change (‘the logic of determinism’ or ‘the logic of opposition’); [6] implementation success (‘objectively defined’ or ‘socially negotiated’); and [7] complexity and scale (‘the bigger the better’ or ‘small is beautiful’). Findings suggest that integration of EPRs will always require human work to re-contextualize knowledge for different uses; that whilst secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper, far from being technologically obsolete, currently offers greater ecological flexibility than most forms of electronic record; and that smaller systems may sometimes be more efficient and effective than larger ones. Conclusions: The tensions and paradoxes revealed in this study extend and challenge previous reviews and suggest that the evidence base for some EPR programs is more limited than is often assumed. We offer this paper as a preliminary contribution to a much-needed debate on this evidence and its implications, and suggest avenues for new research

A control theoretic approach for security of cyber-physical systems

In this dissertation, several novel defense methodologies for cyber-physical systems have been proposed. First, a special type of cyber-physical system, the RFID system, is considered for which a lightweight mutual authentication and ownership management protocol is proposed in order to protect the data confidentiality and integrity. Then considering the fact that the protection of the data confidentiality and integrity is insufficient to guarantee the security in cyber-physical systems, we turn to the development of a general framework for developing security schemes for cyber-physical systems wherein the cyber system states affect the physical system and vice versa. After that, we apply this general framework by selecting the traffic flow as the cyber system state and a novel attack detection scheme that is capable of capturing the abnormality in the traffic flow in those communication links due to a class of attacks has been proposed. On the other hand, an attack detection scheme that is capable of detecting both sensor and actuator attacks is proposed for the physical system in the presence of network induced delays and packet losses. Next, an attack detection scheme is proposed when the network parameters are unknown by using an optimal Q-learning approach. Finally, this attack detection and accommodation scheme has been further extended to the case where the network is modeled as a nonlinear system with unknown system dynamics --Abstract, page iv

AUTOPLUG: An Architecture for Remote Electronic Controller Unit Diagnostics in Automotive Systems

In 2010, over 20.3 million vehicles were recalled. Software issues related to automotive controls such as cruise control, anti-lock braking system, traction control and stability control, account for an increasingly large percentage of the overall vehicles recalled. There is a need for new and scalable methods to evaluate automotive controls in a realistic and open setting. We have developed AutoPlug, an automotive Electronic Controller Unit (ECU) architecture between the vehicle and a Remote Diagnostics Center to diagnose, test, update and verify controls software. Within the vehicle, we evaluate observerbased runtime diagnostic schemes and introduce a framework for remote management of vehicle recalls. The diagnostics scheme deals with both real-time and non-real time faults, and we introduce a decision function to detect and isolate faults in a system with modeling uncertainties. We also evaluate the applicability of “Opportunistic Diagnostics”, where the observerbased diagnostics are scheduled in the ECU’s RTOS only when there is slack available in the system. This aperiodic diagnostics scheme performs similar to the standard, periodic diagnostics scheme under reasonable assumptions. This approach works on existing ECUs and does not interfere with current task sets. The overall framework integrates in-vehicle and remote diagnostics and serves to make vehicle recalls management a less reactive and cost-intensive procedure

Communication Needs Assessment for Distributed Turbine Engine Control

Control system architecture is a major contributor to future propulsion engine performance enhancement and life cycle cost reduction. The control system architecture can be a means to effect net weight reduction in future engine systems, provide a streamlined approach to system design and implementation, and enable new opportunities for performance optimization and increased awareness about system health. The transition from a centralized, point-to-point analog control topology to a modular, networked, distributed system is paramount to extracting these system improvements. However, distributed engine control systems are only possible through the successful design and implementation of a suitable communication system. In a networked system, understanding the data flow between control elements is a fundamental requirement for specifying the communication architecture which, itself, is dependent on the functional capability of electronics in the engine environment. This paper presents an assessment of the communication needs for distributed control using strawman designs and relates how system design decisions relate to overall goals as we progress from the baseline centralized architecture, through partially distributed and fully distributed control systems

Design, Development and Assessment of Control Schemes for IDMS in a Standardized RTCP-based Solution

[EN] Currently, several media sharing applications that allow social interactions between distributed users are gaining momentum. In these networked scenarios, synchronized playout between the involved participants must be provided to enable truly interactive and coherent shared media experiences. This research topic is known as Inter-Destination Media Synchronization (IDMS). This paper presents the design and development of an advanced IDMS solution, which is based on extending the capabilities of RTP/RTCP standard protocols. Particularly, novel RTCP extensions, in combination with several control algorithms and adjustment techniques, have been specified to enable an adaptive, highly accurate and standard compliant IDMS solution. Moreover, as different control or architectural schemes for IDMS exist, and each one is best suited for specific use cases, the IDMS solution has been extended to be able to adopt each one of them. Simulation results prove the satisfactory responsiveness of our IDMS solution in a small scale scenario, as well as its consistent behavior, when using each one of the deployed architectural schemes.This work has been financed, partially, by Universitat Politecnica de Valencia (UPV), under its R&D Support Program in PAID-01-10. TNO's work has been partially funded by European Community's Seventh Framework Programme (FP7/2007-2013) under Grant Agreement No. ICT-2011-8-318343 (STEER Project). CWI's work has been partially funded by the European Community's Seventh Framework Programme (FP7/2007-2013) under Grant Agreement No. ICT-2011-7-287723 (REVERIE Project).Montagud Aguar, M.; Boronat Segui, F.; Stokking, H.; Cesar, P. (2014). Design, Development and Assessment of Control Schemes for IDMS in a Standardized RTCP-based Solution. Computer Networks. 70:240-259. https://doi.org/10.1016/j.comnet.2014.06.004S2402597

Distributed Fault Detection in Formation of Multi-Agent Systems with Attack Impact Analysis

Autonomous Underwater Vehicles (AUVs) are capable of performing a variety of deepwater marine applications as in multiple mobile robots and cooperative robot reconnaissance. Due to the environment that AUVs operate in, fault detection and isolation as well as the formation control of AUVs are more challenging than other Multi-Agent Systems (MASs). In this thesis, two main challenges are tackled. We first investigate the formation control and fault accommodation algorithms for AUVs in presence of abnormal events such as faults and communication attacks in any of the team members. These undesirable events can prevent the entire team to achieve a safe, reliable, and efficient performance while executing underwater mission tasks. For instance, AUVs may face unexpected actuator/sensor faults and the communication between AUVs can be compromised, and consequently make the entire multi-agent system vulnerable to cyber-attacks. Moreover, a possible deception attack on network system may have a negative impact on the environment and more importantly the national security. Furthermore, there are certain requirements for speed, position or depth of the AUV team. For this reason, we propose a distributed fault detection scheme that is able to detect and isolate faults in AUVs while maintaining their formation under security constraints. The effects of faults and communication attacks with a control theoretical perspective will be studied. Another contribution of this thesis is to study a state estimation problem for a linear dynamical system in presence of a Bias Injection Attack (BIA). For this purpose, a Kalman Filter (KF) is used, where we show that the impact of an attack can be analyzed as the solution of a quadratically constrained problem for which the exact solution can be found efficiently. We also introduce a lower bound for the attack impact in terms of the number of compromised actuators and a combination of sensors and actuators. The theoretical findings are accompanied by simulation results and numerical can study examples

The History of the Australian National University Library 1946-1996

History of the Australian National University library 1946-1996 by Peter Alexander Vido