[pt] Vivemos em uma época marcada por grandes transformações tecnológicas e conseqüentemente por muitas mudanças subjetivas. Nos dias de hoje, é possível perceber o significativo aumento de usuários de celulares na nossa sociedade. O mercado multiplica-se rapidamente revelando um cenário em franca expansão. Este estudo objetiva, principalmente, investigar como os jovens da classe média do Rio de Janeiro lidam com questões como a obsolescência, o consumo e as freqüentes inovações tecnológicas no campo dos aparelhos celulares. Para alcançar esse objetivo, foi realizada uma pesquisa qualitativa com 15 jovens de ambos os sexos. Esses jovens tinham, em média, 26 anos de idade. Quase todos eram profissionais com nível superior e usuários assíduos de celulares há mais de 5 anos. As entrevistas foram realizadas on line, através do programa de conversação MSN Messenger. A análise dos depoimentos dos participantes revelou o papel central que os celulares vêm assumindo. A maioria dos entrevistados admite ter o celular por perto e ligado o tempo todo. No que se refere ao consumo de celulares, contudo, os depoimentos foram contraditórios. A maioria dos entrevistados fica com o mesmo celular um curto período de tempo, alegando os mais diferentes motivos para trocar de aparelho. Afirmam que se deve mudar de celular somente quando este pára de funcionar. Mesmo assim, trocam de aparelho muito antes do tempo previsto. As razões para esse comportamento estão, principalmente, no fato de eles se sentirem fortemente atraídos pelas freqüentes inovações tecnológicas dos aparelhos. / [en] We live in a time of ever-increasing technological changes. Nowadays, we can clearly see a significant growth in the number of cell phone users, which shows how fast the this market is expanding. The purpose of the present study was to find out how middle class young people deal with the obsolescence, consumption and constant innovations in cell phones. To reach this goal, a qualitative study was carried out with 15 young people, both male and female, whose average age was 26. Most of them were professionals and had a university degree. All had been intensively using cell phones for more than 5 years. The interviews were carried out on-line through the MSN Messenger chat program. The results showed that cell phones play a central role in their lives. Most of the interviewees admitted that they always carry their cell phones and never switch them off. However, in what concerns their consumption, the participants` statements were contradictory. Most of the interviewees keep the same model of cell phone for a short period of time, providing a host of different reasons for changing it. They all say that a new model should be bought only in case of malfunction of the previous one. However, all of them admit changing phones long before this happens. And the reasons for this behavior lie in the fact that they are attracted by the constant technological innovations.

This thesis project addresses the obsolescence of technology through the lens of accessibility to public services. It explores the processes by which electronic devices age in regards to a technological normativity that marginalizes owners of obsolete devices. My research focuses on two main questions: How might we enable owners of non-smart phones to have access to public services that have been digitalized? How might we design public services’ infrastructure in a way that challenges the obsoletion processes of technological devices?  The research is based upon a critical analysis of the term ‘obsolescence’, low-tech approaches and studies that examine the accessibility of technology. This work is based on the study of the digitalization of public services in Sweden, with specific attention to public transportation and to the electronic identification technology which enables access to various essential public services. I present the exploration of these services through the lens of obsolescence and encounter with users of obsolete devices. This leads to the design of two prototypes that propose ways of integrating obsolete devices’ users in the existing digitalized Swedish infrastructures, followed by their analysis. The designs seek to take a critical stand on technological progress as it is understood in the technology industry and propose ways of reimagining the digitalization of public services while taking into account the obsoletion processes they foster. Overall, I argue for design for obsolete devices as a way of caring for groups that are put aside during technological innovation processes. I propose ways of ‘circuit bending’ public services’ infrastructures in a way that is more hospitable to obsolete devices.

No description available.

Planned Obsolescence is a threat to sustainability and is a practice that has increased in recent years. Manufacturers and companies are often blamed, but recent research has shown that consumers play a significant role and thus hold considerable responsibility for Planned Obsolescence practices. This thesis explores the effect that Planned Obsolescence in smartphones has on sustainable consumers who reside in Sweden. Focus groups and individual interviews were carried out with sixteen participants who were identified as sustainable consumers. The results were diverse and related to different situational, social, and psychological aspects classified into four categories: social elements, implied premature upgrading, psychological elements, and misalignment in sustainable values and behaviour. The study concludes that Planned Obsolescence in smartphones creates a social barrier that does not allow sustainable consumers to maintain their sustainable consuming habits within this sector and provokes negative feelings within them, which interlink with social circumstances. Moreover, this phenomenon affects consumers by implying that they constantly should replace their devices even though they are rather satisfied with their current ones. Finally, Planned Obsolescence in smartphones broadens the gap between consumers’ sustainable values and behaviours, and this inconsistency seems to be more significant for smartphones than in other sectors.

Ce travail s’inscrit dans le cadre d’étude de la sûreté de fonctionnement.<p>La sûreté de fonctionnement est progressivement devenue partie intégrante de l’évaluation des performances des systèmes industriels. En effet, les pannes d’équipements, les pertes de production consécutives, et la maintenance des installations ont un impact économique majeur dans les entreprises. Il est donc essentiel pour un manager de pouvoir estimer de manière cohérente et réaliste les coûts de fonctionnement de l’entreprise, en tenant notamment compte des caractéristiques fiabilistes des équipements utilisés, ainsi que des coûts induits entre autres par le non-fonctionnement du système et la restauration des performances de ses composants après défaillance.<p><p>Le travail que nous avons réalisé dans le cadre de ce doctorat se concentre sur un aspect particulier de la sûreté de fonctionnement, à savoir les politiques de remplacement d’équipements basées sur la fiabilité des systèmes qu’ils constituent. La recherche menée part de l’observation suivante :si la littérature consacrée aux politiques de remplacement est abondante, elle repose généralement sur l’hypothèse implicite que les nouveaux équipements envisagés présentent les mêmes caractéristiques et performances que celles que possédaient initialement les composants objets du remplacement.<p>La réalité technologique est souvent bien différente de cette approche, quelle que soit la discipline industrielle envisagée. En effet, de nouveaux équipements sont régulièrement disponibles sur le marché ;ils assurent les mêmes fonctions que des composants plus anciens utilisés par une entreprise, mais présentent de meilleures performances, par exemple en termes de taux de défaillance, consommation d’énergie, " intelligence " (aptitude à transmettre des informations sur leur état de détérioration).<p>De plus, il peut devenir de plus en plus difficile de se procurer des composants de l’ancienne génération pour remplacer ceux qui ont été déclassés. Cette situation est généralement appelée obsolescence technologique.<p><p>Le but de ce travail est de prolonger et d’approfondir, dans le cadre de la sûreté de fonctionnement, les réflexions engagées par les différents articles présentés dans la section état de l’art afin de définir et de modéliser des stratégies de remplacements d’équipements soumis à obsolescence technologique. Il s’agira de proposer un modèle, faisant le lien entre les approches plus économiques et celles plus fiabilistes, permettant de définir et d’évaluer l’efficacité, au sens large, des différentes stratégies de remplacement des unités obsolètes. L’efficacité d’une stratégie peut se mesurer par rapport à plusieurs critères parfois contradictoires. Parmi ceux-ci citons, évidemment, le coût total moyen engendré par la stratégie de remplacement, seul critère considéré dans les articles cités au chapitre 2, mais aussi la façon dont ces coûts sont répartis au cours du temps tout au long de la stratégie, la variabilité de ces coûts autour de leur moyenne, le fait de remplir certaines conditions comme par exemple d’avoir remplacé toutes les unités d’une génération par des unités d’une autre génération avant une date donnée ou de respecter certaines contraintes sur les temps de remplacement.<p><p>Pour arriver à évaluer les différentes stratégies, la première étape sera de définir un modèle réaliste des performances des unités considérées, et en particulier de leur loi de probabilité de défaillance. Etant donné le lien direct entre la probabilité de défaillance d’un équipement et la politique de maintenance qui lui est appliquée, notamment la fréquence des maintenances préventives, leur effet, l’effet des réparations après défaillance ou les critères de remplacement de l’équipement, un modèle complet devra considérer la description mathématique des effets des interventions effectuées sur les équipements. On verra que la volonté de décrire correctement les effets des interventions nous a amené à proposer une extension des modèles d’âge effectif habituellement utilisés dans la littérature.<p>Une fois le modèle interne des unités défini, nous développerons le modèle de remplacement des équipements obsolètes proprement dit. <p><p>Nous appuyant sur la notion de stratégie K proposée dans de précédents travaux, nous verrons comment adapter cette stratégie K à un modèle pour lequel les temps d’intervention ne sont pas négligeables et le nombre d’équipes limité. Nous verrons aussi comment tenir compte dans le cadre de cette stratégie K d’une part des contraintes de gestion d’un budget demandant en général de répartir les coûts au cours du temps et d’autre part de la volonté de passer d’une génération d’unités à l’autre en un temps limité, ces deux conditions pouvant être contradictoires.<p>Un autre problème auquel on est confronté quand on parle de l’obsolescence technologique est le modèle d’obsolescence à adopter. La manière dont on va gérer le risque d’obsolescence dépendra fortement de la manière dont on pense que les technologies vont évoluer et en particulier du rythme de cette évolution. Selon que l’on considère que le temps probable d’apparition d’une nouvelle génération est inférieur au temps de vie des composants ou supérieur à son temps de vie les solutions envisagées vont être différentes. Lors de deux applications numériques spécifiques.<p><p>Nous verrons au chapitre 12 comment envisager le problème lorsque l’intervalle de temps entre les différentes générations successives est largement inférieur à la durée de vie des équipements et au chapitre 13 comment traiter le problème lorsque le délai entre deux générations est de l’ordre de grandeur de la durée de vie des équipements considérés.<p><p>Le texte est structuré de la manière suivante :Après une première partie permettant de situer le contexte dans lequel s’inscrit ce travail, la deuxième partie décrit le modèle interne des unités tel que nous l’avons utilisé dans les différentes applications. La troisième partie reprend la description des stratégies de remplacement et des différentes applications traitées. La dernière partie permet de conclure par quelques commentaires sur les résultats obtenus et de discuter des perspectives de recherche dans le domaine.<p> / Doctorat en Sciences de l'ingénieur / info:eu-repo/semantics/nonPublished

成本法為估價三大方法之一，其中折舊率之掌握至今仍無定論，Malpezzi et al.（1987）、Smith（2004）指出，由於土地無實體損壞及功能性退化，故利用特徵價格法分析折舊時，分析主體包含土地，將造成折舊的低估，而國內先前研究亦指出，分析主體包含土地，可能是使其分析結果不合常理的原因。本研究採特徵價格法，以台南市透天建物為對象，實證結果與Malpezzi等之論點一致，即不包含土地之價格函數，確有較高的折舊率，且呈現凸向原點之折舊型態。不動產價格模型亦顯示，建物壽命前期價格逐年下跌，但至後期將反轉向上，反應出土地之再開發價值。 此外，依不動產估價技術規則之規定，求取建物價格時似乎未考慮外部性退化之價值減損，或將其視為與剩餘經濟耐用年數相關。然而Colwell and Trefzger（1994）指出負面外部性將同時影響土地與建物，本文實證結果發現，外部性退化除對土地價格造成影響外，事實上對建物價格亦產生價格減損效果。此外，外部性特徵對於建物價格之影響視兩者距離相鄰程度而定，故不應將外部性退化視為與屋齡相關，而於考量後推估建物剩餘經濟耐用年數。 / In this paper, we verify that estimated depreciation rate is higher when the land price has been extracted from single-family house prices in Tainan, and the depreciation pattern of building is convex to the origin. We also find that property prices will decrease in the early years and then turn to increase; this phenomenon may testify the benefit in land redevelopment. Moreover, this study shows that external obsolescence would reduce not only the land price but also the building price when the surrounding is unattractive, and the decreasing figures caused by external obsolescence shouldn’t base on house age, but distance between house and unattractive objects.

人文與社會科學引用資料類型反映了人文社會科學研究者的資料使用行為，進而突顯其出版作品之資料類型的重要性。學術研究之發展會隨著時間的進展而發生變化，因此，本研究以2000年與2009年為主要研究範圍，以二個年代加以比較各學科引用資料類型之差異。探討各學科引用文獻之資料類型、各學科引用圖書與期刊之變化及其是否因期刊性質與年代不同而有差異。所以，本研究亦將探討各學科期刊引用文獻老化現象，並進一步以期刊性質與年代加以比較，期能幫助研究人員與專家學者對於人文社會科學領域使用資料之行為更加了解，並協助圖書館館藏發展與管理的工作。 研究結果如下：1.人文與社會科學引用參考文獻分析(1)人文學以圖書為主要引用資源，社會科學以期刊為主；(2)評述型期刊的引用文獻數量較高；(3)人文學科的研究型期刊與評述型期刊多引用圖書資源，社會科學中多引用期刊資源；(4)不同年代的人文學評述型期刊與研究型期刊主要引用資料為圖書、期刊；社會科學不同年代的研究型期刊主要引用圖書及期刊資源，評述型期刊引用較多的是圖書與電子資源。2.人文與社會科學引用文獻老化現象呈現出(1)被引用圖書的文獻老化時間較長，其中又以人文學的圖書文獻老化所需時間比較多；(2)人文學的引用圖書資源的出版年份久遠，近期與過去出版的文獻皆有引用，文獻老化程度較不顯著；(3)人文學各學科的被引用期刊半衰期可達13年至19年；另一方面，社會科學各學科被引用期刊半衰期可達7年至19年間；(4)研究型期刊之文獻老化現象中，人文學科的引用年代偏向年代較早的文獻，傾向引用6年至22年的參考文獻作研究，而社會科學者經常引用出版6至11年的文獻；(5)評述型期刊之人文學科的引用年代傾向於引用12年間的參考文獻作研究，而社會學科學者經常引用出版8至10年的文獻；(6)研究表現出研究型和評述型期刊的類型並不完全影響該學科的文獻老化程度。 本研究結果可應用於規畫重要的期刊文獻類型，有助於圖書館或相關研究單位評估人文與社會科學的相關館藏是否足以支援研究，並且藉由與其他領域的老化速度之比較，作為為採購資料之時效性以及期刊裝訂時的必要考量。同時可將研究分析應用於人文社會科學學者的學術資訊需求與特性，藉以提供研究人員完善的資訊服務，由文獻老化速度可以知道學科的發展情形，可作為人文與社會科學學者館藏研究規劃之參考。 / The Humanities and Social Sciences reference categories reflect the use of information of the researchers and highlight the importance of the publication categories. The development of academic research changes over time. Therefore, taking 2000 and 2009 as the major research areas, the study compares the difference between each discipline referring categories. The study also researches the references patterns of different disciplines, the change of referring monographs and journals in different disciplines, and whether they change the pattern due to the transformation and aging of these reference books and journals. Consequently, this study will also probe into the Literature Obsolescence in various references categories of different disciplines, and furthermore to compare the nature and years of journals, hoping to help researchers and experts in humanities and social sciences to understand the information research behavior better and to assist the Library collection development and management. The results are as follows: 1.The analysis of Citation and Reference in Humanities and Social Sciences (1)the humanities mostly refer to monograph, and the social sciences mostly journal; (2)Review journal is in a higher number of citations; (3) research and review journals of Humanities cites more monograph resources, and social science journals resources; (4)Reference materials of review and research Journals of Humanities in different generations are mainly monographs and periodicals; research journals if social sciences in different years more cites in monographs and periodicals, while review periodicals prefer to reference more monograph and electronic resources. 2. Humanities and Social Sciences Citation Literature Obsolescence reveals that (1)the cited monographs take longer for obsolescence, among which monographs in Humanities take more time; (2) the cited monographs in humanities has published from long time ago. Cited recent and past literature, citation literature of aging are less significant. (3) The half-life of the cited journal of each discipline in the humanities is up to 13-19 years. On the other hand, the half-life of Journal reference in social sciences disciplines are up to 7-19 years; (4) About the Literature Obsolescence of research journals, the humanities tend to the refer literatures in earlier years, from past 6 to 22 years, while the Social Sciences often cited published literature published from 6 to 11 years ago; (5) Review journals in the humanities tend to quote the reference materials of past 12 years for research, and social science scholars frequently cited literatures published from 8 to 10 years ago; (6) The study demonstrated the research and the review types of periodicals are not completely affect the academic literature aging. The results can be applied to planning an important type of journal, contributing to the libraries or related research units to assess if the humanities and social sciences collection sufficient to support. Furthermore, by the comparison of other areas in speed of aging, this study also can be a necessary measurement for the timeliness of procurement and for the periodicals binding. Meanwhile, the analysis can be applied to the behavior and characteristics of academic information requirement of humanities and social sciences scholars, in order to provide researchers a complete information services. From the speed of Literature Obsolescence, scholars can acknowledge the development of a subject. It can be used as the reference in humanities and social sciences collection planning.

In the early 1990s claims were made that in all areas of health care, “30-40% of patients do not receive treatments of proven effectiveness”, and, “20-25% of patients have treatments that are unnecessary or potentially harmful”. Many such practices were diffused prior to the acceptance of modern evidence-based standards of clinical- and cost-effectiveness. I define disinvestment in the context of health care as the processes of withdrawing (partially or completely) resources from any existing health care practices, procedures, technologies or pharmaceuticals that are deemed to deliver little or no health gain relative to their cost, and thus are not efficient health resource allocations. Arguably disinvestment has been central to Evidence-Based Medicine(EBM) for well over a decade yet despite general advances in EBM, this topic remains relatively unexplored. This thesis examines the ongoing challenges that exist within the Australian context relating to effective disinvestment. Upper airway surgical procedures for the treatment of adult Obstructive Sleep Apnoea Syndrome (OSA) are used as a case study to contextualise these challenges. This thesis has six sections: 1. A review of the literature outlines developments in EBM broadly and provides a detailed background to OSA, including the numerous treatment options for the condition. This review examines evidence that highlights the importance of ‘highly effective treatment’ over ‘subtherapeutic treatment’ as a necessity to confer improved health outcomes in OSA. It is argued that claims of surgical success inherent in most published results of surgery effectiveness fail to assimilate contemporary evidence for clinically significant indicators of success. 2. Section two comprises the first reported meta-analysis in this area. It presents the pooled success rates of surgery according to various definitions. Specifically, when the traditional ‘surgical’ definition of success is applied the pooled success rate for Phase I (i.e. soft palate) surgical procedures is 55% (that is 45% fail). However, using a more stringent definition (endorsed by the peak international sleep medicine body), success is reduced to 13% (that is 87% fail). Similarly for Phase II (i.e. hard palate) procedures success rates decrease from 86% to 43% respectively when moving from a surgical to a medical definition of success. That various medical specialties differentially define treatment success, I argue, creates uncertainty for observers and non-clinical participants in this debate (eg policy stakeholders and patients). This represents a barrier to disinvestment decisions. 3. Results are presented from a clinical audit of surgical cases conducted as a component of this thesis. Both clinical effectiveness and procedural variability of surgery are reported. A unique methodology was utilised to capture data from multiple centres. It is the first time such a methodology has been reported to measure procedural variability alongside clinical effectiveness (inclusive of a comparative treatment arm). The observed cohort (n=94) received 41 varying combinations of surgery in an attempt to treat OSA. Results on effectiveness demonstrate an overall physiological success rate of 13% (according to the most stringent definition; phases I and II combined). This demonstration of procedural variability combined with limited effectiveness highlights clinical uncertainty in the application of surgical procedures. 4. Section four outlines how a qualitative phase of enquiry, directed at exploring the perspectives and experiences of surgery recipients, was approved by three independent research ethics review boards but was not supported by a small group of surgeons, resulting in the project being canceled. Potential consequences of this for impeding health services research (HSR) are discussed. 5. Two sets of results are reported from a qualitative phase of enquiry (semi-structured interviews) involving senior Australian health policy stakeholders. The first results are of policy stakeholders’ perspectives on the surgical meta-analysis and clinical audit studies in 2 and 3 above. The second results are from an extended series of questions relating to challenges and direction for effecting disinvestment mechanisms in Australia. Stakeholder responses highlight that Australia currently has limited formal systems in place to support disinvestment. Themes include how defining and proving inferiority of health care practices is not only conceptually difficult but also is limited by data availability and interpretation. Also, as with any policy endeavour there is the ever-present need to balance multiple interests. Stakeholders pointed to a need, and a role, for health services and policy research to build methodological capacity and decision support tools to underpin disinvestment. 6. A final discussion piece is presented that builds on all previous sections and summarises the specific challenges that exist for disinvestment, including those methodological in nature. The thesis concludes with potential solutions to address these challenges within the Australian and international context. Systematic policy approaches to disinvestment represent one measure to further improve equity, efficiency, quality of care, as well as sustainability of resource allocation. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1297655 / Thesis (Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2007

自從智慧型手機普及以來，儼然已經成為每個人生活的必需品。根據資策會的報告，2014年臺灣智慧型手機的普及率已達65.4%，且每年都快速地攀升。正因為有如此龐大的需求和商機，智慧型手機廠商不斷地針對產品進行升級，提升產品的技術規格、增加許多令人眼睛為之一亮的創新功能、改善外型款式讓手機更加新潮時尚⋯⋯，也因為智慧型手機市場有如此多的選擇，消費者越來越容易產生產品過時恐懼，導致智慧型手機的平均換機時間越來越短，不再像以往一樣使用到損壞為止。 本研究即以智慧型手機為例，透過文獻回顧擬定假說後，再以實證資料分析新奇追求、從眾行為及獨特性需求三種消費者行為特性對產品過時恐懼的影響；產品過時恐懼對消費者智慧型手機相對持有時間比的影響；新奇追求及相對持有時間比對智慧型手機產品升級意願的影響，以及相對持有時間比對智慧型手機品牌面置換決策（再購買意願、轉換意願）的影響。 本研究所得到之研究結論如下： 1. 新奇追求、從眾行為及獨特性需求越強，皆會使消費者心理性過時恐懼越強 2. 消費者的從眾行為越強，其經濟性過時恐懼越強 3. 心理性過時恐懼及技術性過時恐懼越強會使相對持有時間比越大 4. 消費者的新奇追求程度越高，則產品升級意願越高 5. 消費者的相對持有時間比越大，則產品升級意願也越高

In the early 1990s claims were made that in all areas of health care, “30-40% of patients do not receive treatments of proven effectiveness”, and, “20-25% of patients have treatments that are unnecessary or potentially harmful”. Many such practices were diffused prior to the acceptance of modern evidence-based standards of clinical- and cost-effectiveness. I define disinvestment in the context of health care as the processes of withdrawing (partially or completely) resources from any existing health care practices, procedures, technologies or pharmaceuticals that are deemed to deliver little or no health gain relative to their cost, and thus are not efficient health resource allocations. Arguably disinvestment has been central to Evidence-Based Medicine(EBM) for well over a decade yet despite general advances in EBM, this topic remains relatively unexplored. This thesis examines the ongoing challenges that exist within the Australian context relating to effective disinvestment. Upper airway surgical procedures for the treatment of adult Obstructive Sleep Apnoea Syndrome (OSA) are used as a case study to contextualise these challenges. This thesis has six sections: 1. A review of the literature outlines developments in EBM broadly and provides a detailed background to OSA, including the numerous treatment options for the condition. This review examines evidence that highlights the importance of ‘highly effective treatment’ over ‘subtherapeutic treatment’ as a necessity to confer improved health outcomes in OSA. It is argued that claims of surgical success inherent in most published results of surgery effectiveness fail to assimilate contemporary evidence for clinically significant indicators of success. 2. Section two comprises the first reported meta-analysis in this area. It presents the pooled success rates of surgery according to various definitions. Specifically, when the traditional ‘surgical’ definition of success is applied the pooled success rate for Phase I (i.e. soft palate) surgical procedures is 55% (that is 45% fail). However, using a more stringent definition (endorsed by the peak international sleep medicine body), success is reduced to 13% (that is 87% fail). Similarly for Phase II (i.e. hard palate) procedures success rates decrease from 86% to 43% respectively when moving from a surgical to a medical definition of success. That various medical specialties differentially define treatment success, I argue, creates uncertainty for observers and non-clinical participants in this debate (eg policy stakeholders and patients). This represents a barrier to disinvestment decisions. 3. Results are presented from a clinical audit of surgical cases conducted as a component of this thesis. Both clinical effectiveness and procedural variability of surgery are reported. A unique methodology was utilised to capture data from multiple centres. It is the first time such a methodology has been reported to measure procedural variability alongside clinical effectiveness (inclusive of a comparative treatment arm). The observed cohort (n=94) received 41 varying combinations of surgery in an attempt to treat OSA. Results on effectiveness demonstrate an overall physiological success rate of 13% (according to the most stringent definition; phases I and II combined). This demonstration of procedural variability combined with limited effectiveness highlights clinical uncertainty in the application of surgical procedures. 4. Section four outlines how a qualitative phase of enquiry, directed at exploring the perspectives and experiences of surgery recipients, was approved by three independent research ethics review boards but was not supported by a small group of surgeons, resulting in the project being canceled. Potential consequences of this for impeding health services research (HSR) are discussed. 5. Two sets of results are reported from a qualitative phase of enquiry (semi-structured interviews) involving senior Australian health policy stakeholders. The first results are of policy stakeholders’ perspectives on the surgical meta-analysis and clinical audit studies in 2 and 3 above. The second results are from an extended series of questions relating to challenges and direction for effecting disinvestment mechanisms in Australia. Stakeholder responses highlight that Australia currently has limited formal systems in place to support disinvestment. Themes include how defining and proving inferiority of health care practices is not only conceptually difficult but also is limited by data availability and interpretation. Also, as with any policy endeavour there is the ever-present need to balance multiple interests. Stakeholders pointed to a need, and a role, for health services and policy research to build methodological capacity and decision support tools to underpin disinvestment. 6. A final discussion piece is presented that builds on all previous sections and summarises the specific challenges that exist for disinvestment, including those methodological in nature. The thesis concludes with potential solutions to address these challenges within the Australian and international context. Systematic policy approaches to disinvestment represent one measure to further improve equity, efficiency, quality of care, as well as sustainability of resource allocation. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1297655 / Thesis (Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2007