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

This diploma thesis focuses on stock management and related issues in the automotive industry. The thesis is divided into a theoretical and a practical part. The theoretical part discusses general concepts of logistics and stock management. There are described patterns of production and its connection to the warehouse and logistics issues and more. The practical part focuses on a specific environment of companies operating in the automotive industry and describes its parts and logistics processes that are somehow related to the stock management. The practical part is also more elaborated on Aftermarket issues.

This work consists of three parts: the translation theory of drama and the specifics of school theatre, the translation of a play by David Llorente, Los árboles dormidos, and a commentary discussing the translation. The theoretical part focuses on problems and characteristics of translations of this genre. The commentary to the translation includes a translation analysis, a discussion of the translation problems and their solutions, and a typology of translation shifts. Keywords: Recipient, paradox, obsolescence of translation, scenic notes, school theatre, amateur theatre, translation analysis, translation shifts.

Nowadays vehicle design paradigm influences not only the effectiveness of the different means of transport, but also the environment and economy in a critical way. The assessment of the consequences that design choices have on society at large are necessary to understand the limits of the methods and techniques currently employed. One of the mechanisms set in motion is the planned obsolescence of products and services. This has affected vehicle design paradigm in such a way that the variety in the market has shadowed the primary function of vehicle systems: the transport of persons and goods. Amongst the consequences of the expansion of such market is the exponential rise on combustion emissions to the atmosphere, which has become a great hindrance for humans health and survival of ecosystems. The development of evaluation tools for such consequences and their piloting mechanisms is needed so as to implement an ECO2  (Ecological and Economical) vehicle design paradigm. Moreover, the multifunctional design paradigm that drives aeronautical and vehicle engineering is an ever-growing demand of smart materials and structures, able to fulfil multiple requirements in an effective way. The understanding of certain phenomena intrinsic to the introduction of novel materials has found certain limits due to the complexity of the models needed. This work presents as a first step an assessment of the causes and consequences of the vehicle exponential market growth based on the analysis of the planned obsolescence within. Furthermore, a method for the acoustic response analysis of multilayered structures including anisotropic poroelastic materials is introduced. The methodology consists in a plane wave approach as a base for introducing the complex mechanic and acoustic equations governing anisotropic homogeneous media, e.g. open-celled foams, into an alternative mathematical tool manipulating physical wave amplitudes propagation within the studied media. In addition, this method is coupled to a power partitioning and energetic assessment tool so as to understand the phenomena present in complex multilayered designs. / <p>QC 20150323</p>

In order to meet the needs of the generations to come and to achieve the global target of maximum climate change of 1.5 degrees, we need to transform the way the society consumes natural resources. The purpose of this research is to effectively align the needs of the businesses and customers alike to accelerate a market-driven resource efficiency. We also intended to investigate what the opportunities presented to businesses are, in order to achieve environmental and economic sustainability by extending the product lifetime and improving accessibility of spares/repairs/upgrades, etc. for their products. We performed an extensive review of literature in the past two decades which describe product lifetime, obsolescence of products and the various reasons of obsolescence in the larger picture. The study is a mixed approach as we gathered data from the partner businesses by way of semi-structured interviews at the management level. We carried out a survey with a potential consumer group of these products and analysed the requirements and habits of the market. Our findings suggest that the primary driving causes for optimizing the product lifetimes of the products have been ethical and social responsibilities of the businesses. Businesses acknowledge that legislative and market pressure has increased over the past half-decade but hasn’t been enough to motivate the investments required to restructure products and business models. Businesses need to improve the statistical data they acquire from products after they have been sold, in order to facilitate the streamlining of the reverse supply chains. Lastly, we have found that the top management is committed and engaged to change the way the business functions, but the ground functions are either not aware or trained to effectively implement the changes. Future research could investigate the readiness of businesses to transition to a more closed-loop business model by way of improving information flow through the lifetime of the product. / För att bemöta kraven hos de kommande generationer och för att uppnå det globala målet om en maximal klimatförändring på 1,5 grader, måste det ske en förändring på hur samhället konsumerar naturresurser. Syftet med denna forskning och studie är att effektivt anpassa behoven hos såväl kunden som företag för att påskynda en marknadsdriven resurseffektivitet. Med denna studie har vi också för avsikt att undersöka vilka möjligheter som erbjuds till företag, för att uppnå miljömässig och ekonomisk hållbarhet genom att förlänga produktens livslängd och förbättra cängligheten för reservdelar/reparationer/uppgraderingar etc. av deras produkter. Vi gjorde en omfattande litteraturgenomgång av forskning under de senaste två decennierna som beskriver produktens livslängd, produkters inkurans och de olika orsakerna till inkurans i den större bilden. Detta hjälpte oss att ta fram en konkret definition av produktens livslängd och hur den kan förbättras med bättre material, design och ökade återvinnings aktiviteter på produktnivå. Våra resultat tyder på att de främsta drivande orsakerna till att optimera produkt livslängden för produkterna i fråga har varit företagens etiska och sociala ansvar. Företagen erkänner att lagstiftnings- och marknads trycket har ökat under de senaste 5 åren, men det har inte varit tillräckligt för att motivera de investeringar som krävs för att omstrukturera produkter och affärsmodeller. Företag måste förbättra de statistiska uppgifter som de skaffar från produkter efter att de har sålts, för att underlätta effektiviseringen. Slutligen har vi funnit att den högsta ledningen är engagerad i att förändra hur verksamheten fungerar, men markfunktionerna är antingen inte medvetna eller utbildade för att effektivt implementera förändringarna. Framtida forskning skulle kunna undersöka företagens beredskap att övergå till en mer sluten affärsmodell genom att förbättra informationsflödet genom produktens livslängd.

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À cause de leur impact environnemental élevé, les déchets d’équipements électriques et électroniques (DEEE) sont un problème majeur pour les pays développés. La consommation importante de produits électroniques, dont la durée d’utilisation est de plus en plus courte, a entrainé une production croissante de DEEE. C’est dans ce contexte que l’Union européenne a instauré en 2003 la responsabilité élargie des producteurs (REP). Cet outil de politique environnementale a rendu légalement responsables les fabricants de la mise en oeuvre et du financement d’un programme d’intendance des DEEE. Alors que la REP vise principalement le traitement écologique des DEEE, cet instrument ne permet pas de réduire les quantités considérables qui sont produites par les consommateurs. Cette situation est d’autant plus inquiétante que les gains environnementaux obtenus, grâce à l’implantation de la REP, ont été annulés au regard de l’augmentation continue de la consommation de biens électroniques à l’échelle mondiale. En réponse à cette problématique, la présente thèse porte sur les pratiques de l’usager au cours de la phase de consommation des appareils électroniques (aussi appelée phase d’usage). Cette étape du cycle de vie regroupe l’achat, l’utilisation, la réparation et la mise au rebut des biens. Une approche qualitative de type exploratoire faisant appel à l’étude de cas a été utilisée. Le téléviseur, retenu comme cas d’étude, illustre des enjeux partagés par plusieurs équipements électroniques, tels que : la fréquente mise sur le marché de nouveaux modèles, le bas prix d’acquisition comparé au coût de la réparation et l’influence de la mode sur les choix effectués par le consommateur. Ces facteurs facilitent le remplacement des biens et, par conséquent, pourraient entrainer leur fin de vie prématurée qui se matérialise à travers différentes formes d’obsolescence. Dans le cadre de cette étude de cas, une trentaine d’entrevues semi-dirigées a été réalisée avec des usagers et réparateurs de produits électroniques en vue de documenter les différentes sous-étapes de la phase d’usage d’un téléviseur. Sur la base des informations recueillies, l’objectif de cette thèse est de formuler des recommandations, à destination des autorités politiques, qui pourront permettre une minimisation des impacts environnementaux liés à la phase d’usage des appareils électroniques. Les résultats ont permis de mettre en évidence, via le rôle et le statut singulier occupé par le téléviseur dans les foyers, les comportements de l’usager contribuant à augmenter l’empreinte écologique associée à la phase d’usage. L’acquisition de nombreux biens électroniques et non électroniques suite à l’achat du téléviseur, ses multiples fonctionnalités le rapprochant de celles de l’ordinateur et des tablettes, ainsi que la fin de vie prématurée de produits fonctionnels, mais obsolètes d’un point de vue technologique, font partie des résultats de cette recherche. En lien avec ces constats, cette étude propose des instruments de politique environnementale, dont l’affichage de la durée de vie des équipements électroniques, destinés à aider le consommateur à réaliser des choix plus éclairés au moment de l’achat. D’autres orientations, telles que la possibilité d’évoluer vers une réglementation horizontale, c’est-à-dire un cadre législatif qui ne se basera plus sur le produit individuel, mais sur l’ensemble des appareils ayant des fonctionnalités similaires, sont exposées. Par ailleurs, cette recherche explore certains leviers pouvant minimiser le phénomène de fin de vie prématurée des appareils électroniques, tels que l’envoi de biens obsolètes et fonctionnels des pays développés vers ceux en développement pour permettre leur réutilisation et la tendance du Do-It- Yourself dans la réparation des produits électroniques. / Given its high environmental impact, Waste Electrical and Electronic Equipment (WEEE) has become a major problem for developed countries. The growing consumption of electronic products, whose useful lifespan has decreased over the years, has led to an increasing production of WEEE. In response, the European Union has adopted in 2003 the Extended Producer Responsibility (EPR). This environmental policy tool holds legally responsible manufacturers for the implementation and financing of the e-waste stewardship program. While the ERP focuses mainly on the environmentally sound disposal of waste from electric and electronic equipment, this instrument does not prevent or even reduce the growing amounts of e-waste discarded by households. This situation is particularly worrying, since the environmental benefits achieved with the implementation of the ERP are no longer efficient considering the continuous increase of electronic goods’ consumption in the world. In light of this issue, the present thesis examines the practices of users during the consumption phase of electronic appliances (also referred to as the use phase). This stage of the products’ lifecycle includes purchase, use, repair and disposal of a good. To conduct this research, a qualitative approach by means of a case study was used. The selected case is the television, which illustrates many issues related to the use phase of electronic devices, such as frequent launch of new models in the market, low purchase price compared to the cost of repair and the influence of trends on the consumer’s choices. These factors may cause the premature replacement of electronic products and, therefore, lead to their premature end-of-life, which materialize into different types of obsolescence. In the context of this case study, around thirty semi-structured interviews were conducted with users and repairers of electronic equipment in order to document the different sub-stages of the television’s use phase. Based on collected data, the main objective of this thesis is to provide recommendations to political authorities, which could enable the minimisation of environmental impacts related to the use phase of electronic appliances. The results highlight, via the role and singular status occupied by the television, the user’s behaviour which helps increase the environmental footprint of the use phase. The multiple purchases of electronic and non-electronic goods following the television’s acquisition, its many features that are similar to those of the computers or tablets, and the premature disposal of functional but technologically obsolete devices, are among the main findings of the study. In respect of these observations, this study proposes environmental policy instruments, like an environmental labelling of the electronic products’ lifespan, which aim at supporting a more informed consumer choice. Other orientations, such as the opportunity to adopt a horizontal policy, which is a legal framework that would no longer focus on the individual product, but rather on all appliances with similar functions, are exposed. In addition, this research explores some levers that could minimize the phenomenon of premature end-of-life of electronic devices, including the exportation of obsolete and functional goods from developed to developing countries to enable their reuse and the trend of Do-It-Yourself for their repair.

Loin d’être des produits immatériels, les technologies de l’information et de la communication (TIC) ont un réel impact environnemental tout au long de leur cycle de vie. L’Éco-TIC est le point de rencontre entre le développement durable et les TIC. Le droit de l'Éco-TIC est l’ensemble des règles de droit régissant les rapports entre les technologies de l’information et le domaine environnemental. Ce mémoire a pour objectif d’examiner les normes juridiques, notamment en Europe et en Amérique du Nord, qui permettent de limiter l’impact environnemental des technologies de l’information lors des trois phases du cycle de vie des TIC. Tout d’abord, nous nous penchons sur l’étape de la conception des TIC. À cette étape, les réglementations en matière d’écoconception, l’utilisation des terres rares et l’interdiction de l’obsolescence programmée sont particulièrement pertinentes. Ensuite, nous examinons comment les entreprises tentent de réduire la consommation énergétique des TIC lors de la phase d’utilisation, notamment par le biais de la responsabilité sociétale de l’entreprise (RSE). Nous verrons également que les centres de données se multiplient afin de répondre à une demande toujours plus forte. Enfin, nous traitons de la fin de vie des TIC, phase pour laquelle l’Union européenne a créé des directives en matière de réutilisation, réduction et recyclage qui influent sur le plan international. / Information and communication technologies (ICT) are far from being intangible goods and do have an environmental impact during their entire life cycle. Green IT stands at the crossroads of sustainable development and ICT. Green IT law consists of a set of rules governing the relations between information technologies and environment. The purpose of this thesis is to investigate the European and North American legal standards regulating the environment impacts of ICT throughout the three phases of their life cycle. In the first part, the design phase of ICT is examined. At this stage, existing regulations on eco-design, the use of rare earth elements, and the interdiction of planned obsolescence are of particular relevance. The thesis then studies how companies are trying to reduce the use-phase energy consumption of ICT, notably through the Corporate Social Responsability. The issue of the multiplication of data centres, due to an ever-growing demand, is also discussed. In the end, the thesis considers the end-of-life phase of ICT and the directives created by the European Union that affect recycling and waste reduction management at an international level.

À l’heure du recyclage et du tri, les déchetteries, outils de leur mise en œuvre, sont investies par nombre d’acteurs en quête d’objets à récupérer. Cette recherche, sollicitée par une collectivité territoriale considérant qu’une gestion optimisée des déchets implique la prise en compte de facteurs humains, s’inscrit dans le champ de la demande sociale. L’exploration anthropologique de l’univers des déchets permet de compléter les analyses techniques et scientifiques plus anciennes. Ce travail rend compte de la nécessité d’appréhender par une démarche ethnopragmatique les discours sur les pratiques instituées à la déchetterie et celles qui s’y sont spontanément greffées, les pratiques informelles. Abordant les enjeux de légitimité et ontologiques qui ont prévalu à la mise en concurrence de pratiques vouées à un même objectif, celui de donner une seconde vie aux déchets, cette recherche repose sur un examen attentif de l’ordinaire d’une déchetterie et sur une étude du langage écrit ou oral des acteurs concernés. Elle se focalise aussi sur le sens donné, dans l’ordinaire des acteurs mais dans un contexte plus large de crise environnementale et de critique de la société de consommation, à l’acte de jeter et à celui de réhabiliter. Elle expérimente tant dans l’investigation que dans la manière d’en rendre compte, la mise en présence d’expériences de terrains d’enquête différenciés. Elle propose ainsi une mise en abyme des cadres de définition et de pensée circonscrits par le terrain d’enquête initial. Elle approfondit les connaissances sur les comportements individuels, les jeux d’acteurs en lien avec les déchets. Elle affine la compréhension des organisations publiques et privées, de leurs stratégies, de processus de décision, de la capacité de changement en matière de politique déchet. / At the time of recycling and sorting , waste sorting , tools implementation , are invested by many actors in search of items to collect . This research, requested by a local authority whereas optimized waste management involves consideration of human factors, is in the field of social demand. The anthropological exploration of the universe of waste can complete the technical and scientific older analyzes . This work reflects the need to understand the process by ethnopragmatique discourse practices established for disposal and those that are spontaneously grafted informal practices . Addressing issues of legitimacy and ontological that prevailed in the competition practice dedicated to the same goal , that of giving a second life to waste , this research is based on a careful examination of the ordinary and dumped on a study of written or spoken language stakeholders. It also focuses on the meaning given in the ordinary players, but in a broader context of environmental crisis and critique of consumer society, the act of throwing and than rehabilitate . She experimented both in the investigation in the way of realizing it, the bringing together experiences of differentiated land survey . It proposes a formal definition abyss frames and thought circumscribed by the initial field survey. It extends the knowledge on individual behavior , games players in connection with the waste. It refines the understanding of public and private organizations, their strategies, decision-making, the ability to change in waste policy.

本研究採用同時法與歷時法二種文獻老化研究方法，進行資訊檢索領域下系統研究及使用者研究二種主題文獻之老化研究，主要研究重點有二，一是資訊檢索領域下，系統研究及使用者研究二種不同主題文獻老化現象之差異性；二是同一主題文獻下，同時法與歷時法二種不同老化研究方法之文獻衰退情形是否一致。 同時法研究是針對現時某一特定文獻之引用參考文獻進行分析，並測得其引用年齡中數。本研究自LISA資料庫取得2006年資訊檢索領域下系統研究及使用者研究二種主題之相關文獻，作為同時法研究樣本，並利用T檢定檢測系統研究及使用者研究二種主題文獻老化現象之差異。在同時法研究結果方面，系統研究及使用者研究二種主題文獻之引用年齡中數分別為7.25歲與7.98歲，系統研究主題文獻同時法老化速度快於使用者研究主題文獻，但差異不大，T檢定結果亦顯示同時法系統研究及使用者研究二種主題文獻之老化速度無顯著差異。 歷時法研究是分析過去某特定期間所發表之文獻，其逐年被引用情形，並計算其被引用半衰期。本研究利用LISA資料庫取得1996年資訊檢索領域下系統研究及使用者研究二種主題之相關文獻，作為歷時法研究樣本，並利用WOS資料庫，取得其自1996年至2006年間逐年被引用情形。在歷時法研究結果方面，系統研究及使用者研究二種主題文獻之被引用半衰期分別為5.12歲與4.99歲，系統研究主題文獻之歷時法老化速度較使用者研究主題文獻稍慢，二者差異不大，T檢定結果亦顯示歷時法系統研究及使用者研究二種主題文獻之老化速度無顯著差異。 在同時法與歷時法二種研究方法比較部份，就文獻老化速度而言，同時法之引用參考文獻數量於高峰期後，呈現顯著文獻衰退現象；而歷時法達到被引用次數最高峰後，則未呈現明顯文獻衰退現象，可知同時法文獻老化速度較歷時法文獻老化速度快。在柯史（K-S）檢測方面，檢測結果發現，不論系統研究主題文獻或使用者研究主題文獻，同時法與歷時法之文獻老化現象皆不一致。 因此，本研究重要研究結論有二：一是資訊檢索領域下，不會因主題不同而有顯著差異；二是資訊檢索領域下，同時法所測得之文獻老化現象與歷時法所測得之文獻老化現象不一致。 / This obsolescence study uses two kinds of aging research methods - synchronous approach and diachrinous approach. Analyze two subjects of systems-centered and users-centered in the information retrieval field. The main emphasis of the research is two. First, under information retrieval field, the differences between systems-centered and user-centered in obsolescence study. Second, the difference between synchronous approach and diachrinous approach’s aging phenomenon in the same subject. Synchronous approach is targeted at the present of a particular literature references and calculated median citation age. This study acquired the information retrieval field of systems-centered and user-centered’s sample in 2006 from LISA database, and tested the difference between systems-centered and user-centered literature aging with using t-test. The result of synchronous approach, median citation age of systems-centered literature is 7.25 years and median citation age of user-centered literature is 7.98 years. So systems-centered literature aging is faster than user-centered literature. But the difference is small. T test results also revealed that difference between systems-centered and user-centered of literature aging has not significantly. Diachrinous approach was to analyze a particular during the past published literature and observed the cited times each year, and finally calculated its half-life. This study acquired the information retrieval field of systems-centered and user-centered’s sample in 1996 from LISA database, and acquired the cited times each year during 1996 to 2006 from WOS database.The result of diachrinous approach, cited half-life of system-centered literatures is 5.12 and cited half-life of user-centered literatures is 4.99 years. So user-centered literature aging was faster than system-centered literatures. But the difference was small. T test results also revealed that difference between the system-centered and user-centered of literature aging has not significantly Synchronous approach and diachrinous approach methods of comparison. By the literature on the aging speed, cited reference numbers of synchronous approach reached peak period, and the literature curve showed significant recession; cited times of diachrinous approach reached a peak, and literature curve were not significantly recession. It revealed that aging speed of synchronous approach was faster than aging speed of diachrinous approach. In the K-S test, the results showed that synchronous approach and diachrinous approach were inconsistent, whether systems-centered literatures or users-centered literatures. Therefore, the important conclusion of this study are two : First, in the information retrieval field, even different subject there will be no significant differences on literature aging phenomenon; Second, under the information retrieval field, synchronous approach and diachrinous approach which measured the aging phenomenon of literature are inconsistent.