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Ein zentrales Thema der medizinischen Informatik ist der institutionsübergreifende Austausch von Patientendaten zwischen den Akteuren des Gesundheitswesens. Die Notwendigkeit einer einheitlichen nationalen Telematikinfrastruktur für einen institutions-übergreifenden Austausch wurde auch von der Politik anerkannt. Dementsprechend wurde 2003 mit dem Gesetz zur Modernisierung der gesetzlichen Krankenversicherung (GMG) der erste Grundstein gelegt. Eine der Anwendungen, die laut Gesetzgebung (§ 291a SGB V) über die Telematikinfrastruktur umgesetzt werden sollte, ist die sogenannte elektronische Patientenakte. Diese Anwendung sollte es dem Patienten ermöglichen, seine Versorgungsdaten in einer eigenen Dokumentation zu führen und mit den Systemen seiner Behandler elektronisch zu kommunizieren. Bei der Gesetzgebung wurde der Fokus sehr eng gefasst, um aus Datenschutzgründen eine enge Zweckbindung der elektronischen Patientenakte sicher zu stellen. Wichtige Themen wie die Partizipation der Bürger und Patienten an der medizinischen Forschung wurden ausgeklammert. Werden die Prozesse der elektronischen Datenerfassung in der Versorgung und in der medizinisch-klinischen Forschung (z. B. den Universitätskliniken) betrachtet, so fällt auf, dass relevante Daten für die Versorgung und die Forschung häufig identisch sind. Da die Systeme von Forschung und Versorgung aber getrennt voneinander betrieben werden, kommt es zu Doppelerfassungen. Diese Doppelerfassungen sind für einen Anwender, der Daten in beide Systeme eintragen muss, schwer nachvollziehbar - auch die gewünschte Partizipation der Patienten an Forschungsvorhaben ist so kaum möglich. Die grundlegende Idee dieser Arbeit ist es, eine Schnittstelle zwischen einer elektronischen Patientenakte und der medizinischen Forschung gemäß den Vorgaben der nationalen Telematikinfrastruktur zu konzipieren. Damit soll dem oben geschilderten Problem der Doppelerfassung von Patientendaten entgegengewirkt werden, indem mit Hilfe dieser Schnittstelle ein Austausch von Patientendaten über eine elektronische Patientenakte zwischen den Systemen der Versorgung und Forschung ermöglicht wird. Zu diesem Zweck wurden zunächst die Systeme der Versorgung und der Forschung analysiert und ein Kommunikationsmodell sowie Datenschutzanforderungen für die Kommunikation zwischen einer elektronischen Patientenakte und den Systemen der Forschung formuliert. Auf Grundlage des Kommunikationsmodells und der Datenschutzanforderungen wurden sowohl eine Fach- als auch eine Sicherheitsarchitektur für die Schnittstelle zwischen einer elektronischen Patientenakte und den Systemen der Forschung beschrieben. Als Ergebnis konnte herausgestellt werden, dass die Anbindung der IT-Systeme der medizinischen Forschung über eine elektronische Patientenakte sicher und datenschutzkonform umgesetzt werden kann. Abschließend wird der entstandene Ansatz mit bisherigen Lösungen zur Nutzung von Versorgungsdaten für die medizinische Forschung kritisch verglichen und die Stärken einer in der nationalen Telematikinfrastruktur integrierte Löschung gegenüber alleinstehenden Insellösungen hervorgehoben. Es wird herausgestellt, dass die grundlegenden Konzepte stehen, aber noch erheblicher Aufwand erbracht werden muss, um ein auf nationaler Ebene verfügbares System bereitzustellen. Vorschläge für die weiteren Arbeiten zu einem funktionierenden System sowie weitere Potentiale der Ergebnisse dieser Arbeit werden in einem Ausblick aufgezeigt.

Yes / The reuse of existing datasets to identify mechanisms for improving healthcare quality has been widely encouraged. There has been limited application within dementia care. Dementia Care Mapping (DCM) is an observational tool in widespread use, predominantly to assess and improve quality of care in single organisations. DCM data has the potential to be used for secondary purposes to improve quality of care. However, its suitability for such use requires careful evaluation. This study conducted in-depth interviews with 29 DCM users to identify issues, concerns and challenges regarding the secondary use of DCM data. Data was analysed using modified Grounded Theory. Major themes identified included the need to collect complimentary contextual data in addition to DCM data, to reassure users regarding ethical issues associated with storage and reuse of care related data and the need to assess and specify data quality for any data that might be available for secondary analysis. / This study was funded by the Faculty of Health Studies, University of Bradford.

No / Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. There is growing emphasis on sharing and reusing dementia care-related datasets to improve the quality of dementia care. Consequently, there is a need to develop data management solutions for collecting, integrating and storing these data in formats that enhance opportunities for reuse. Dementia Care Mapping (DCM) is an observational tool that is in widespread use internationally. It produces rich, evidence-based data on dementia care quality. Currently, that data is primarily used locally, within dementia care services, to assess and improve quality of care. Information-rich DCM data provides opportunities for secondary use including research into improving the quality of dementia care. But an effective data management solution is required to facilitate this. A rationale for the warehousing of DCM data as a technical data management solution is suggested. The authors also propose a data model for a DCM data warehouse and present user-identified challenges for reusing DCM data within a warehouse.

The secondary use of Dementia Care Mapping (DCM) data, if that data were held in a data warehouse, could contribute to global efforts in monitoring and improving dementia care quality. This qualitative study identifies requirements for the secondary use of DCM data within a data warehouse using a user-driven approach. The thesis critically analyses various technical methodologies and then argues the use and further demonstrates the applicability of a modified grounded theory as a user-driven methodology for a data warehouse. Interviews were conducted with 29 DCM researchers, trainers and practitioners in three phases. 19 interviews were face to face with the others on Skype and telephone with an average length of individual interview 45-60 minutes. The interview data was systematically analysed using open, axial and selective coding techniques and constant comparison methods. The study data highlighted benchmarking, mappers’ support and research as three perceived potential secondary uses of DCM data within a data warehouse. DCM researchers identified concerns regarding the quality and security of DCM data for secondary uses, which led to identifying the requirements for additional provenance, ethical and contextual data to be included in a warehouse alongside DCM data to meet requirements for secondary uses of this data for research. The study data was also used to extrapolate three main factors such as an individual mapper, the organization and an electronic data management that can influence the quality and availability of DCM data for secondary uses. The study makes further recommendations for designing a future DCM data warehouse.

The secondary use of Dementia Care Mapping (DCM) data, if that data were held in a data warehouse, could contribute to global efforts in monitoring and improving dementia care quality. This qualitative study identifies requirements for the secondary use of DCM data within a data warehouse using a user-driven approach. The thesis critically analyses various technical methodologies and then argues the use and further demonstrates the applicability of a modified grounded theory as a user-driven methodology for a data warehouse. Interviews were conducted with 29 DCM researchers, trainers and practitioners in three phases. 19 interviews were face to face with the others on Skype and telephone with an average length of individual interview 45-60 minutes. The interview data was systematically analysed using open, axial and selective coding techniques and constant comparison methods. The study data highlighted benchmarking, mappers’ support and research as three perceived potential secondary uses of DCM data within a data warehouse. DCM researchers identified concerns regarding the quality and security of DCM data for secondary uses, which led to identifying the requirements for additional provenance, ethical and contextual data to be included in a warehouse alongside DCM data to meet requirements for secondary uses of this data for research. The study data was also used to extrapolate three main factors such as an individual mapper, the organization and an electronic data management that can influence the quality and availability of DCM data for secondary uses. The study makes further recommendations for designing a future DCM data warehouse.

In connection to the increasing awareness of vehicles and its impact on the environment, the interest in the electric vehicle market has shown a significant growth in the recent years. According to forecasts, it is also projected to increase further in the future. These electric vehicles are driven by lithium-ion batteries with an expected service life of 5-15 years depending on different technology generations and design concepts. After the given service life, the battery has lost approximately 20 percent of its capacity and is no longer permitted to be used in its original application area again, out of safety reasons. Although the retired battery pack is not suitable for vehicles, its remaining capacity can still be utilized in other applications. Hence, the term second life has become a common subject in the automotive industry, where companies are trying to find new application areas for the retired electric vehicle battery packs. Common methods regarding second life of electric vehicle batteries are processes such as remanufacturing, repurposing and re-use. These presented second life methods are from a reverse logistics perspective. Second life alternatives enable a better sustainability and reduces the environmental impact by re-using and recycling existing materials.   In this thesis, the authors examined different second life concepts with the same prerequisite, an electric vehicle lithium-ion battery pack with an energy capacity of 20 kWh. The project has been conducted in a company that is one of the leading manufacturers in the heavy-duty industrial vehicle industry, which currently is developing their electric vehicle machines. Several different concepts have been generated and analysed to find the most applicable business model concepts from a second life perspective. The purpose has been to investigate and calculate which of these business model concepts are most feasible from an economic and a reverse logistics perspective. In order to fulfil the purpose, the following research questions have been formulated:   RQ1: Which secondary use business model concepts are feasible for battery packs of electrified machines? RQ2: Out of the above identified concepts, which business model concept is economically feasible and how can its reverse logistic be composed?   In order to answer the research questions, the authors have analysed different cost aspects and forecasts based on existing research and case company data. This is performed to develop the most profitable concepts based on the collected data, where the generated ideas concluded in three final concepts. For these concepts, individual business model canvases were created to illustrate all important parts of the concepts. The thesis resulted in an economic analysis of the three concepts, visualizing function diagrams and comparing them to each other, to identify the most applicable concept for the case company. The remanufacturing concept proved to be the most applicable one, where its associated reverse logistics and recycling process were investigated and determined. In conclusion the thesis can firstly contribute to future research by the created process map that companies can use and apply in their second life process, correlated to the managerial implications. Secondly, the remanufacturing concept can be a potential future investment for the case company, considering all valuable factors that have been analysed throughout the thesis.     Keywords: Battery pack, Battery secondary use, Business model, Reverse logistic, ESS, Remanufacturing, Battery repurposing, re-use, Battery second life economic analysis.

Background: Coronary artery disease is a common cause of morbidity and mortality in the UK. Interventional revascularisation procedures for addressing the disease include percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), which respectively seek to open up or bypass blocked arteries to restore blood flow to heart muscle. Rates at which these procedures are carried out have changed in recent years, as have clinical indications for referral. PCI is delivered by interventional cardiologists, while CABG is carried out by cardiothoracic surgeons, necessitating multi-disciplinary decision making. There is both within- and cross-speciality debate as to the optimal treatment strategy in some case types. Evaluation of the care provided is of clinical and political importance, and requires information about how post-procedure event rates per operator and hospital compare with those expected given the composition of patient populations. Methods: Two UK-wide audit databases of PCI and CABG procedures were used to explore a range of clinical outcome questions. The patient populations contained within each database were compared to see how they differed, and also how each had changed in recent years. In CABG patients, comparative effectiveness of two different surgical techniques (single vs bilateral mammary artery grafting) was assessed with respect to both short-term and long-term mortality outcomes. In PCI patients, a risk model to predict 30-day mortality was developed for use in clinical appraisal. Results: In both patient populations there had been changes to the relative frequencies of many characteristics over time. In the CABG population, multivariable analysis showed that patients undergoing single mammary artery grafting had lower odds of all-cause mortality within 30 days of procedure than those receiving bilateral mammary artery grafting, but had worse overall survival in the long term. In the PCI population, the developed risk model demonstrated good calibration and discrimination at predicting 30-day all-cause mortality. Discussion: The studies described above demonstrate that large-scale routinely collected data can be used to gain insights into clinical care quality and delivery. These resources are under-utilised at present; correcting this requires an understanding of the limitations of the data and how the information contained therein relates to actual clinical care.

Denna studies syfte är att undersöka hur biareans storlek och användningssätt påverkar prisbildningen för småhusfastigheter. Genom att studera biareans prispåverkan kan studien ge indikationer gällande hanteringen av biareans värdepåverkan inom fastighetstaxeringen och om den bör genomgå en förändring. Eftersom taxeringsvärdet används vid en mängd olika situationer i samhället är det viktigt att det baseras på aktuella och tillförlitliga uppgifter. Studien utförs på uppdrag av Lantmäteriets sektion för fastighetsekonomi i Gävle. Fastighetstaxeringen i Sverige fastställs genom en form av massvärdering vilket utmynnar i taxeringsvärden för fastigheterna. Taxeringsvärdet är uppbyggt av olika värdefaktorer där storlek är en av dessa och uttrycks som värdearea i taxeringsvärdet. Denna värdearea består av boarean tillsammans med 20 % men max 20 m² av biarean. Biarea är sådan area som inte räknas som boarea, exempelvis källarutrymme, garage som nås inifrån eller inglasad altan. För att undersöka biareans prispåverkan för småhusfastigheter har hela Gävle kommun studerats genom en ortsprisanalys innehållande 559 köp. Mindre områden i Gävle har ingått i en enkätundersökning för att ta reda på fastighetsägarnas resonemang kring biareans värde. Endast småhusfastigheter med typkod 220 har ingått i studien och biarea i form av källarutrymme är den typ av biarea som studien inriktat sig främst på. Ortsprismaterialet har analyserats utefter nyckeltalen K/T-tal och pris per kvadratmeter.  Studiens resultat visar att det finns en positiv prispåverkan för småhus med biarea efter analys av hela ortsprismaterialet. Efter indelning i hög- och lågvärdeområden observeras denna positiva prispåverkan även inom högvärdeområden men inte inom lågvärdeområden. Ortsprismaterialet delades efter den initiala analysen in i storleksgrupper avseende boarea och andelsgrupper avseende biareans omfattning. För småhusfastigheter med boarea mellan 61-90 m² kan det utefter studiens resultat konstateras att betalningsviljan ökar ju större andel biarea småhuset har och att det är vid förekomsten av källarutrymme som störst positiv prispåverkan observeras. Samma observation kan göras när det gäller högvärdeområden. Ortsprisanalysens resultat styrks av enkätundersökningen där majoriteten av fastighetsägarna svarade att källarutrymmet var en bidragande faktor vid köpet och att fastighetsägarna värderar denna biarea högre än dess andel av taxeringsvärdet.