Objective: To explore correclational relationship between the risk factors and medical resources consumption in cardiovascular disease patients. Methods: A database containing 44940 cardiovascular disease patients in a southern Taiwan Medical center from year 2003 to 2005 was chosen as studying sample. By applying Charlson Comorbidity Index as one of the major risk factors to these cardiovascular disease patients, then using liner regression to analyze the data for their relationship with medical resources consumption. Results: Medical resources consumption increases as the cardiovascular disease patients become older. The higher the comorbidity index weight with the patient, the more the patient consumes medical resources. A patient¡¦s comorbidity index weight has great influence to the length of hospital stay of the patient and the frequency of clinic visit of the patient. The higher the comorbidity index weight a patient he or she, is likely to stay in hospital longer or to see doctors more often. The variance inflation factor (VIF) of each independent variable is ranged between 1 and 1.343, which means there are no high correlations between independent variables in the modes. In other words, there is no correlative influence effect that would invalidate the assumption. Conclusion: The findings of this study can be a good reference to hospital disease management. In addition, they can be applied to predicting the risk factor in medical resources consumption. Also they can be adapted into medical insurance payment system, thereby improving medical resource distribution.

The construction industry is a major emissions contributor and a main resource consumer. Because of this, the industry is formulating short and long-term 'sustainability targets'. The trend points towards an unsustainable future, within the next 75 years, due to actual and projected increases in resource consumption and emissions generation in response to global population growth, and improving living standards, affluence. There are no reliable studies that predict whether the required reductions in ecological impacts can actually be realized, and if so, on what time scale. In fact, currently no available system representations of the industry can serve as the basis for studying long-term sustainability through the twenty-first Century. Hard dynamic systems, based on reductionism, are no longer adequate representations to study the dynamics of complex systems. A worldview that includes complexity requires foremost a philosophical induction (a theory) of the nature of all the forces that move the industry and a mechanism for understanding how complex forces aggregate and affect growth. The dissertation examines the current understanding of the Theories of Complexity in general, and in building construction, as preparation for a deeper understanding on how sustainability and its opposite, exponential growth (or "exponentialoid") relate. Guaranteeing sustainability transcends the current arsenal of counter measures such as LEED, high-performance measures, waste containment, conservation, lessening demand, renewable resourcing, greening of the industry, creation of high-performance buildings, penalizing the polluter, carbon trading, and others… Sustainability is re-framed as the (artificial) force that tames an unsustainable exponentialoid. Sustainable forces are represented by elements of influence acting like vectorials that appear to have identifiable origin, direction and magnitude. A hypothetical example of how the heuristic/theory works is presented, pending future studies (needed to supply the necessary data required for a working model). This is pre-paradigmatic work, using both a novel worldview and method of analysis that points to increasingly detailed research work to be performed in the future.

For growing organisations that have built their data flow around a monolithic database server, anever-increasing number of applications and an ever-increasing demand for data freshness willeventually push the existing system to its limits, prompting either hardware upgrades or anupdated data architecture. Switching from an approach of full extractions of data at regularintervals to an approach where only changes are extracted, resource consumption couldpotentially be decreased, while simultaneously increasing data freshness. The objective of this thesis is to provide insights into how implementing an event streamingsetup with Apache Kafka connected to SQL Server through the Debezium source connectoraffects resource consumption on the database server. Other studies in related work have oftenbeen focused on steps further downstream in the data pipeline. This thesis can thereforecontribute to an area where more knowledge is needed. Through an empirical study done using two different setups in the same system, traditional dataextraction in batches and extraction through event streaming is measured and compared. The point of measurement is the SQL Server database from which data is extracted. Both memoryutilisation and CPU utilisation is measured, using SQL Server Profiler. Different parameters fortable sizes, volumes of data and intervals between changes are used to simulate differentscenarios. One of the takeaways of the results is that, at the same number of total changes, the size of theindividual transactions has a large impact on the resource consumption caused by eventstreaming. The study shows that an overhead cost is involved with each transaction, and also thatthe regular polling that the source connector performs causes resource consumption even inidleness. The thesis concludes that event streaming can offer reduced resource consumption on thedatabase server. However, when the source table size is small, and the number of changes large,extraction in batches is less resource-intensive.

Thesis (MPA)--Stellenbosch University, 2015. / Global urbanisation trends predict a future in which the already overburdened cities of Africa and Asia will house the bulk of the two billion new people born by 2050. This second wave of urbanisation will increase resource demands in these cities and extend the expanse of slums already surrounding them. Given the global imperative of sustainable development, and the existing imbalance of resource access, effective urban planning is necessary to meet this second urbanisation wave, and build resilient, equitable cities. However, preliminary investigation suggests a lack of data-supported decision-making in cities of the global south, due either to limited collection of, or lack of access to, city-level data. This has led to many urban development programmes being implemented with minimal scientific backing to support the success of proposed policy or infrastructure innovations. This directly impacts a city’s ability to reach service delivery, economic growth, and human development goals, let alone protect ecosystem services upon which it relies. This is particularly true in African cities, in which governments are (necessarily) more focused on delivery of basic services than on a greening or efficiency agenda. This is further compounded by the need for African cities to prepare adequate public services for the increased population expected in the second urbanisation wave. A quantitative assessment of cities’ resource profiles can support policy makers in making informed decisions about infrastructure configurations in order to improve their resource management. To this end, methods to accurately estimate and analyse these data are necessary. The primary objective of this study was to establish a resource consumption typology for African cities. Due to limitations in the availability and form of secondary data, this study shifted focus to explore how best to form a typology from limited data. It made use of data for 53 African nations and scaling theories proffered to estimate city-level economic and resource data for 120 African cities. The resultant resource profiles were then normalised and clustered in a number of ways to produce two national typologies and four city typologies. Insights from these typologies both inform the method for categorising cities by socioeconomic or resource indicators as well as provide insights into the shape and magnitude of resource profile for multiple African cities. They also highlight the key drivers of resource consumption in these spaces. Future work involves validating the scaling method with locally acquired data so as to increase confidence in the city-level data, before settling on the preferred method for clustering cities. / Wêreldwye verstedelikingstendense dui op ‘n toekoms waarin die reeds oorlaaide stede in Afrika en Asië die grootste deel van die sowat twee biljoen nuwe mense teen 2050 sal huisves. Die tweede verstedelikingsgolf sal eise wat in hierdie stede op hulpbronne gestel word verhoog, en die uitgestrektheid van krotbuurtes wat hulle reeds omsingel, nog meer laat uitkring. In die lig van die wêreldwye noodsaaklikheid van volhoubare ontwikkeling en die heersende wanbalans wat toeganklikheid tot hulpbronne betref, is doeltreffende stedelike beplanning nodig om aan hierdie verwagte tweede verstedelikingsgolf te kan voldoen en lewenskragtige, gelyke stede op te rig. Voorlopige ondersoek toon egter ‘n tekort aan data-gesteunde besluitneming in suidelike stede van die wêreld weens óf beperkte inwinning daarvan, óf gebrek aan toegang tot data op stedelike vlak. Dit het daartoe aanleiding gegee dat talle stedelike ontwikkelingsprogramme met minimale wetenskaplike steun, wat die sukses van voorgestelde beleids- of infrastruktuurinnovasies rugsteun, geïmplementeer is. ‘n Stad se vermoë om sy doelwitte ten opsigte van dienslewering, ekonomiese groei en menslike ontwikkeling te bereik, word sodoende gekortwiek om nie eens melding te maak van beskerming van die ekostelsel-dienste waarop hy staatmaak nie. Dit is veral die geval in Afrika-stede waar regeerders (uit noodsaak) meer gefokus is op die lewering van basiese dienste as op ‘n agenda vir vergroening en doelmatigheid. Dit word voorts verhewig deur die behoefte van Afrika-stede om doeltreffende openbare dienste op die been te bring vir die groter bevolking wat met die tweede verstedelikingsgolf in die vooruitsig gestel word. ‘n Kwantitatiewe vasstelling van die omvang van stede se hulpbronne, kan beleidskeppers help om ingeligte besluite te neem oor infrastruktuur-konfigurasie en sodoende die bestuur van hulle hulpbronne verbeter. Met dit as mikpunt, is metodes nodig om hierdie data korrek te bepaal en te analiseer. Die hoofdoel van hierdie verhandeling was om ‘n hulpbronkonsumpsie-tipologie op te stel. Weens beperkinge wat betref die beskikbaarheid en vorm van sekondêre data, is die verhandeling se fokus verskuif om te bepaal hoe daar ten beste ‘n tipologie uit beperkte data gevorm kan word. Daar is van data rakende 53 Afrika-nasies, en skaal-teorieë aangebied deur gebruik gemaak om data oor die ekonomieë en hulpbronne van 120 Afrika-stede te bekom. Die hulpbron-vasstelling wat hieruit voortgevloei het, is vervolgens genormaliseer en saamgevoeg op ‘n verskeidenheid van wyses om twee nasionale tipologieë en vier stadstipologieë te lewer. Insigte wat dié tipologieë voortbring, lig die metode toe waarvolgens stede deur sosio-ekonomiese of hulpbron-aanwysers gekategoriseer word en bied ook insigte rakende die voorkoms en omvang van hulpbron-bepaling vir menige Afrika-stede. Hulle benadruk ook die sleutel-aandrywers van konsumpsie in hierdie opsig. Toekomstige werk sluit die bevestiging van die skaalmetode met plaaslik aangeskafde data in ten einde die vertroue in stadsdata te vermeerder alvorens daar op die voorkeurmetode vir die bondeling van stede besluit word.

Logisektorn står för en betydande del av resurskonsumtionen och den miljömässiga påverkan från turistindustrin. Idag finns ett växande antal miljömärkningar för att hjälpa logianläggningar att bli mer hållbara - en av de ledande internationella miljömärkningarna är Green Key. Logianläggningar kan ha olika motiv till att ansluta sig till en miljömärkning förutom ett internt miljöengagemang; kostnadsbesparingar, konkurrensfördelar, fler gäster och ökad lönsamhet. Den här studien har undersökt skillnader kring Green Keys effekter på anläggningar smiljöprestanda beroende på typ av anläggning, samt om antalet uppfyllda poängkriterier påverkar miljöprestandan. Syftet var framförallt att ta reda på om Green Key minskar logianläggningars miljöpåverkan över tid, och om märkningen leder till ett ökat antal gäster beroende på vilken typ av gäster anläggningarna hade främst. En kvantitativ metod valdes och longitudinell data över Green Key-anslutna hotell och vandrarhems årliga vatten-, el- och energiförbrukning samlades in. Även data över antal gästnätter per år, typ av gäster och total inomhusyta sammanställdes. Statistiska tester genomfördes och de visade att det inte fanns ett samband mellan antal uppfyllda poängkriterier och miljöpåverkan. Logianläggningarnas resursförbrukning skiljde sig endast åt gällande elförbrukning, där hotell hade en signifikant högre elförbrukning/m2 än vandrarhem. Resultatet visade att det fanns en effekt av Green Key på anläggningarnas resursförbrukning över tid. Effekten slog något olika, men majoriteten av anläggningarna hade minskat förbrukningen över tid. Det fanns en signifikant skillnad i vattenförbrukning/gästnatt från startåret med Green Key i jämförelse med 2015. Det fanns ingen skillnad i ökning av antalet gäster beroende på typ av gäster, men antalet gästnätter totalt var dock fler efter en miljömärkning med Green Key än före. Det är emellertid svårt att påvisa om effekten beror på Green Key eller andra faktorer. / The accommodation sector accounts for a significant proportion of resource consumption and environmental impact of the tourism industry. Today, there are a growing number of ecolabels in the accommodation sector to help establishments become more sustainable. One of them is the international eco-label Green Key. Lodging establishments have different motives for joining an eco-label in addition to an internal commitment to the environment; cost savings, competitive advantages, more guests and increased profitability. This study investigated if there is any difference when it comes to the effects of Green Key depending on the type of facility, and if the number of ‘scoring criteria’ affect environmental performance. The purpose was mainly to find out whether Green Key reduces the environmental impact over time, and if the label leads to an increased number of guests, depending on the type of guests. A quantitative method was chosen and longitudinal data over Green Key hotel and hostel's annual water, electricity and energy consumption was collected. Data on the number of guest nights per year, type of guests and total indoor area was also collected. Statistical tests were conducted and they showed that there was no correlation between the number of ‘scoring criteria’ and environmental impact. Only hotel and hostel's electricity consumption differed - hotels had a significantly higher electricity consumption/m2 than hostels. The results showed that there was an effect of Green Key on the establishments' resource consumption over time, although the effect differed. However, the majority of the establishments had reduced their resource consumption over time. The results also showed that there was a significant difference in water consumption per guest night from the starting year with Green Key in comparison with 2015. There was no difference in the increase of guest nights, depending on the type of guests. Although, the number of guest nights in total had significantly increased after the establishments had been rewarded with Green Key. However, it is difficult to demonstrate that the effect depends on Green Key.

Este trabalho apresenta uma metodologia para caracterização do perfil de consumo de recursos demandados por um programa de computador a partir da análise do código binário do arquivo executável. A categorização de processos de acordo com seus perfis de consumo de recursos durante a execuçãotais como uso de CPU e memóriaé uma informação muito desejada para objetivos de projeto e gerenciamento de sistemas. Técnicas convencionais para este propósito são baseadas em testes de caixa branca (que avaliam o código fonte da aplicação), que tendem a ser de difícil aplicação dado a complexidade das arquiteturas de software além da necessidade de acesso ao código fonte; ou detecção de perfis baseada em dados de execução, que depende da disponibilidade de dados de execução confiáveis e da seleção de características que de fato vão correlacionar o perfil de consumo. A abordagem baseada em mineração de dados proposta neste trabalho evita estas dificuldades uma vez que manipula somente os arquivos binários executáveis. O método combina técnicas provindas da teoria da informação, redes complexas e filogenia para produzir um agrupamento hierárquico de um conjunto de arquivos de programas executáveis que pode ser utilizado para prever potenciais similaridades em termos de consumo de recursos em tempo de execução. As questões de pesquisa deste trabalho investigam se a transformação feita pelo compilador preserva similaridades entre código fonte e binário que podem ser detectadas através de algoritmos de compressão; em caso positivo, verificar se as similaridades encontradas no código binário estão relacionadas com o perfil de execução das aplicações, permitindo inferir o comportamento dos programas a partir da análise do código binário. Este trabalho apresenta a sistematização do método assim como os resultados da aplicação para caracterizar aplicações em termos de consumo de CPU e Entrada/Saída em uma plataforma PC padrão. Diversos experimentos foram executados em um repositório de 80 programas de várias fontes obtendo-se resultados significativos que evidenciam que a similaridade dos perfis de execução obtidas com esta abordagem é consistente com as obtidas experimentalmente por aferição. A aplicação do método também é exemplificado através de casos de estudo que caracterizam o perfil de execução de programas executáveis. / This work introduces a methodology for characterizing the runtime resource demands of a computer program from the analysis of its binary executable file. Categorization of processes according to the kind of resources required during execution such as CPU and memory usage is a sought-after piece of knowledge for the aims of computer system design and management. Conventional techniques available for this purpose include white-box static source code analysis and profile matching based on historical execution data. The former tends to be challenging in face of complex software architectures and requires access to the source code; the latter is dependent on the availability of reliable past data and on the selection of features yielding effective correlations with resource usage. The alternative data mining approach proposed in this paper avoids those difficulties by manipulating binary executable files. The method combines techniques from information theory, complex networks and phylogenetics to produce a hierarchical clustering of a set of executable files, which can be used to predict potential similarities in terms of runtime resource usage. The works research questions investigate if the transformation performed by the compiler preserves similarity information across the source and binary code representation such that it can be detected by standard compression algorithms; and if the so identified similarities in the symbolic object encoding are correlated to runtime resource usage to an extent which allows for inferring the programs behavior from the analysis of the binary file. The paper introduces the methods rationales and presents results of its application to characterize CPU and IO usages of benchmark applications executed on a standard PC platform. Essays carried out over a set of 80 executable programs from varying sources yielded numerically significant evidences that the prediction of resource usage similarity obtained by the approach is consistent with experimentally measured runtime profile. The application of the method is also exemplified in a few case studies aimed at characterizing executable programs runtime profile.

It is increasingly being recognised that global natural resource consumption levels exceed planetary limits and that the present trajectory of industrial development is not sustainable. To achieve a more viable existence necessitates a fundamental shift in priorities from the prevailing economic growth-centred, consumer driven philosophy to one that marries aspirations for economic growth with long-term environmental and social considerations. This shift in priorities requires significant contributions and action at the global, national and local levels by the primary 'wheels' of sustainability: government, corporations and civil society. Over the past 100 years, corporations have become the most powerful institution on the planet with both the financial resources and institutional capacity to take the lead role in shaping a sustainable future for humankind. Yet, within and between industry sectors and across geographic locations there has been great diversity in the extent and level of corporate commitment and engagement in societal efforts relating to planetary sustainability. Hence, greater understanding of what drives corporate interest and involvement in ecological sustainability will become increasingly critical to promoting corporate engagement in processes and practices to secure a long-term future for humanity. However, there has been limited explanatory research oriented upon developing an understanding of the processes and factors associated with corporate 'eco-change'. In recognition of this shortcoming in the literature, the present study utilised the case of the non-renewable resource extractive sector of Australia to examine corporate engagement with processes and practices for planetary sustainability. Specifically, it sought to construct and evidence an explanation of the external and internal factors that have promoted and/or retarded corporate engagement with planetary sustainability in the non-renewable resource extractive sector (NRRES) of Australia. Guided by grounded theory methodology, an instrumental case study of the NRRES in Australia was undertaken. The NRRES was chosen as this sector's profile, visibility and activities over the past twenty years have meant it has come under mounting pressure to incorporate the concept and principles of planetary sustainability into its ethos and operations. As such, the sector represents the opportunity to study this phenomenon within a dynamic context of sectoral and corporate responses to evolving societal expectations. The research was undertaken in three phases and the principal research method was in-depth key informant interviews with purposively sampled members of the sector's stakeholder groups. Each NRRES corporation is situated at the centre of a web of interconnected interests or 'stakes' necessitating efforts to balance the various stakeholder interests to maintain the institution's license-to-operate and secure a long-term existence. The thesis constructs an explanation of the societal drivers of NRRES corporate engagement with planetary sustainability, organised as the three categories of government, civil society and the corporate sector. These three groupings of stakeholders have been clustered into the broad category or theme of Activating Engagement, which recognises their collective role as the stimuli for NRRES corporation engagement in processes and practices for planetary sustainability. While the theme of Activating Engagement emphasises the importance and interrelatedness of the roles and actions within and between the three primary wheels of sustainability, of particular note is the evident rise of civil society as a more active societal stakeholder and more salient driver of corporate uptake of social and environmental issues. As the identified external drivers play a critical role in motivating NRRES corporation engagement, it is a corporation's particular characteristics that ultimately determine the extent and level of uptake of strategies to demonstrate corporate social responsibility. The thesis develops an explanation of the internal factors mediating NRRES corporate engagement comprising the factors of leadership, resources, structures, culture and understanding. These factors are conceptualised as the theme of Capacity for Engagement, which identifies their collective importance in a NRRES corporation's preparedness, impetus and capability relating to interest and participation in planetary sustainability. While all of the five factors are seen as essential to meaningful NRRES corporate engagement, the thesis identifies leadership as the most critical factor in Capacity for Engagement. Based on the findings of the research, several explanatory frameworks are developed. These frameworks aid in deepening our understanding of the NRRES corporate engagement process, in particular, the interconnections between the factors impeding and facilitating corporate interest and engagement with processes and practices for planetary sustainability. As such, these frameworks will make a substantial contribution to building our understanding of how the various factors and their components or 'pieces of the puzzle' interact and interrelate with each other to generate corporate engagement. The frameworks are the culmination of the research and, coupled with the more detailed explanations of their constituent factors, enhance our knowledge and understanding of the dynamics of NRRES corporation engagement with planetary sustainability. This enhanced understanding is significant and could be of considerable value in informing and targeting efforts to advance the depth and breadth of NRRES corporation engagement with processes and practices for planetary sustainability. To advance the standing of the study's findings, a series of case studies could be undertaken targeting the investigation of NRRES corporate engagement in other geographic locations and within different industry sectors.

Este trabalho apresenta uma metodologia para caracterização do perfil de consumo de recursos demandados por um programa de computador a partir da análise do código binário do arquivo executável. A categorização de processos de acordo com seus perfis de consumo de recursos durante a execuçãotais como uso de CPU e memóriaé uma informação muito desejada para objetivos de projeto e gerenciamento de sistemas. Técnicas convencionais para este propósito são baseadas em testes de caixa branca (que avaliam o código fonte da aplicação), que tendem a ser de difícil aplicação dado a complexidade das arquiteturas de software além da necessidade de acesso ao código fonte; ou detecção de perfis baseada em dados de execução, que depende da disponibilidade de dados de execução confiáveis e da seleção de características que de fato vão correlacionar o perfil de consumo. A abordagem baseada em mineração de dados proposta neste trabalho evita estas dificuldades uma vez que manipula somente os arquivos binários executáveis. O método combina técnicas provindas da teoria da informação, redes complexas e filogenia para produzir um agrupamento hierárquico de um conjunto de arquivos de programas executáveis que pode ser utilizado para prever potenciais similaridades em termos de consumo de recursos em tempo de execução. As questões de pesquisa deste trabalho investigam se a transformação feita pelo compilador preserva similaridades entre código fonte e binário que podem ser detectadas através de algoritmos de compressão; em caso positivo, verificar se as similaridades encontradas no código binário estão relacionadas com o perfil de execução das aplicações, permitindo inferir o comportamento dos programas a partir da análise do código binário. Este trabalho apresenta a sistematização do método assim como os resultados da aplicação para caracterizar aplicações em termos de consumo de CPU e Entrada/Saída em uma plataforma PC padrão. Diversos experimentos foram executados em um repositório de 80 programas de várias fontes obtendo-se resultados significativos que evidenciam que a similaridade dos perfis de execução obtidas com esta abordagem é consistente com as obtidas experimentalmente por aferição. A aplicação do método também é exemplificado através de casos de estudo que caracterizam o perfil de execução de programas executáveis. / This work introduces a methodology for characterizing the runtime resource demands of a computer program from the analysis of its binary executable file. Categorization of processes according to the kind of resources required during execution such as CPU and memory usage is a sought-after piece of knowledge for the aims of computer system design and management. Conventional techniques available for this purpose include white-box static source code analysis and profile matching based on historical execution data. The former tends to be challenging in face of complex software architectures and requires access to the source code; the latter is dependent on the availability of reliable past data and on the selection of features yielding effective correlations with resource usage. The alternative data mining approach proposed in this paper avoids those difficulties by manipulating binary executable files. The method combines techniques from information theory, complex networks and phylogenetics to produce a hierarchical clustering of a set of executable files, which can be used to predict potential similarities in terms of runtime resource usage. The works research questions investigate if the transformation performed by the compiler preserves similarity information across the source and binary code representation such that it can be detected by standard compression algorithms; and if the so identified similarities in the symbolic object encoding are correlated to runtime resource usage to an extent which allows for inferring the programs behavior from the analysis of the binary file. The paper introduces the methods rationales and presents results of its application to characterize CPU and IO usages of benchmark applications executed on a standard PC platform. Essays carried out over a set of 80 executable programs from varying sources yielded numerically significant evidences that the prediction of resource usage similarity obtained by the approach is consistent with experimentally measured runtime profile. The application of the method is also exemplified in a few case studies aimed at characterizing executable programs runtime profile.

Abstract The aim of this 11-year retrospective study was to evaluate the impact of two spending patterns in glaucoma care on patient outcomes. Two cities were selected to the study because the statistics of Finnish Social Insurance Institution have repeatedly shown a difference in their mean costs of glaucoma medications per patient, i.e. Oulu spending more and Turku less than the national average. Patients with newly diagnosed open angle in 1994–96 were identified from the national register for reimbursement of medication costs. Patients were 45–74 years old when treatment was initiated after which they had consistently used glaucoma medication ≥ 10 years. For availability of cost data, their place of residence was required to remain unchanged during 1994–2006. In 2006 Social Insurance Institution sent invitations to 360 patients of whom 168 patients (47%) participated and completed the protocol (85 in Oulu and 83 patients in Turku). All patients underwent an ophthalmic examination (visual acuity, intraocular pressure, visual field test, retinal nerve fiber layer and optic disc photography). In addition, patients filled out the 15D health related quality of life questionnaire. All costs of glaucoma care during 11 years were collected for each patient individually. For each follow up year, the total cost was added up including medications, physician visits, diagnostic and follow-up tests as well as laser or surgical procedures. The total 11-year costs of glaucoma care per patient were 35% higher in Oulu (6010 €) compared to Turku (4452 €). Total costs increased with worsening of the disease. After 11 years on treatment, 40% of patients did not show any structural or functional damage. Medication costs accounted up to 73% of total costs. In addition to 29% higher medication costs in Oulu, other than medication costs were also 46% higher in Oulu. In different stages of glaucoma, more treatments (medication, laser and surgery) and more tests (photographs and visual fields) were taken in Oulu. In spite of the higher resource consumption, the 15D instrument did not indicate better quality of life in patients living in Oulu. There was actually a statistically significant counterintuitive difference in the early glaucoma group, i.e. patients using more resources reported worse quality of life. This is the first study evaluating the impact of high resource utilization on quality of life and reporting 15D utility values in different stages of glaucoma. Results from this study indicate that the higher resource allocation may not always lead to measurable benefits to the patients or society in terms of less glaucoma-induced visual disability and/or better quality of life. Further data from randomized trials with both unselected populations as well pragmatic randomized trials of ‘usual patients’ with large sample sizes are required. / Tiivistelmä Tämän 11 vuoden retrospektiivisen tutkimuksen tavoite oli arvioida kahta eri kuluttamismallia glaukooman hoidossa ja niiden vaikutusta hoitotuloksiin. Tutkimusalueiksi valitut kaksi kaupunkia ovat vuosia erottuneet toisistaan Kansaneläkelaitoksen (Kelan) tilastoissa glaukoomapotilaiden keskimääräisten vuosittaisten lääkekustannusten osalta. Oulussa kustannukset potilasta kohden vuodessa ovat olleet korkeammat kuin Turussa. Turussa vuosittaiset lääkekustannukset ovat vuosia jääneet alle kansallisen keskiarvon. Kelan lääkekorvausrekisteristä poimittiin potilaita, joilla oli todettu tuore avokulmaglaukooma ja aloitettu hoito vuosien 1994–96 välillä. Potilaat olivat 45–74-vuotiaita lääkityksen alkaessa. Tämän jälkeen he olivat käyttäneet lääkitystä yhtäjaksoisesti yli 10 vuotta. Kustannustietojen saatavuuden vuoksi potilaiden tuli olla asunut samalla paikkakunnalla 1994–2006 välisen ajan. Vuonna 2006 Kela lähetti kutsun tutkimukseen 360 potilaalle, joista 168 (47 %) osallistui (85 Oulusta ja 83 Turusta). Kaikki potilaat kävivät silmätutkimuksessa (näöntarkkuus, silmänpaine, näkökentät, hermosäie- ja näköhermonpään valokuvaus). Lisäksi potilaat täyttivät 15D-kyselykaavakkeen elämänlaadusta. Kaikki glaukooman hoidosta aiheutuneet suorat kustannukset kerättiin potilaskohtaisesti 11 vuoden ajalta. Jokaisen seurantavuoden osalta määritettiin kokonaiskustannukset, sisältäen lääkityksen, lääkärikäynnit, näkökentät, valokuvat, laser- ja kirurgiset toimenpiteet. Kokonaiskustannukset 11 vuoden seurantajaksolla olivat 35 % korkeammat Oulussa (6010 €) verrattuna Turkuun (4452 €). Kokonaiskustannukset nousivat glaukooman vaikeusasteen kasvaessa. 11 vuoden lääkehoidon jälkeen 40 %:lla potilaista ei ollut glaukoomaan viittaavia vaurioita silmissään. Lääkekulujen osuus kokonaiskuluista oli jopa 73 %. Oulussa lääkekustannukset olivat 29 % ja muut hoitokustannukset 46 % korkeammat kuin Turussa. Jokaisella glaukooman vaikeusasteella hoitoresursseja käytettiin Oulussa Turkua enemmän. 15D-mittarilla tutkittuna Oulussa elämänlaatu ei ollut parempi kuin Turussa suuremmasta resurssikulutuksesta huolimatta. Tutkimuksessa todettiin yhden alaryhmän (varhainen glaukooma) kohdalla jopa viitteitä siitä, että elämänlaatu on huonompi suuremman resurssikulutuksen alueella. Tämä on ensimmäinen tutkimus, joka arvioi suuremman resurssikulutuksen vaikutusta elämänlaatuun. Tutkimus myös raportoi 15D-arvot eri glaukooman vaikeusasteilla. Tulokset viittaavat siihen, että suurempi resurssikulutus ei aina johda mitattaviin hyötyihin potilaan tai yhteiskunnan kannalta, kun päätetapahtumana on glaukooman aiheuttama näkövammaisuus tai parempi elämänlaatu. Tarvitsemme lisää suuremmalla potilasmäärällä tehtyjä satunnaistettuja tutkimuksia.

Water has a critical role in sustaining both natural ecosystems and human livelihoods. However, nowadays intensive population growth and increasing pressure on natural resources lead to substantial issues related to water services provision. At the same time, mismanagement of water resources hinders water security and leads to escalation of water-related challenges. Thus, the research of principles for good water governance has got a substantial attention and aimed at establishing new policies and institutional frameworks for addressing those challenges. Pluralistic forms of governance, with the focus on community water governance has been advocated as a way to more sensibly tackle the complexity of issues linked to water systems. The present research aims to investigate the specifics of community water governance and analyze how community governance practices can contribute to a more sustainable management of water systems on the case of Oaxen island in Stockholm archipelago.