The relative risk of major gastrointestinal bleeding (GIB) among different direct oral anticoagulants (DOACs) is debatable. Randomized controlled trials (RCTs) comparing DOACs with each other are lacking. We performed network meta-analysis to assess whether the risk of major GIB differs based on type and dose of DOAC. Literature search of PubMed, EMBASE and Cochrane databases from inception to August 2019, limited to English publications, was conducted to identify RCTs comparing DOACs with warfarin or enoxaparin for any indication. Primary outcome of interest was major GIB risk. We used frequentist network meta-analysis through the random-effects model to compare DOACs with each other and DOACs by dose to isolate the impact on major GIB. Twenty-eight RCTs, including 139 587 patients receiving six anticoagulants, were selected. The risk of major GIB for DOACs was equal to warfarin. Comparison of DOACs with each other did not show risk differences. After accounting for dose, rivaroxaban 20 mg, dabigatran 300 mg and edoxaban 60 mg daily had 47, 40 and 22% higher rates of major GIB versus warfarin, respectively. Apixaban 5 mg twice daily had lower major GIB compared to dabigatran 300 mg (OR, 0.63; 95% CI, 0.44-0.88) and rivaroxaban 20 mg (OR, 0.60; 95% CI, 0.43-0.83) daily. Heterogeneity was low, and the model was consistent without publication bias (Egger's test: P = 0.079). All RCTs were high-quality with low risk of bias. DOACs at standard dose, except apixaban, had a higher risk of major GIB compared to warfarin. Apixaban had a lower rate of major GIB compared to dabigatran and rivaroxaban.

No description available.

The construction and operation of hydroelectric projects consist of multiple activities in a single watershed, which can generate significant impacts on the surrounding biophysical environment and on the health and well-being of local communities. The impacts of those activities may be insignificant individually, yet together may have an important cumulative effect. The impacts of hydroelectric development on human health and well-being have been widely documented. Current practices of cumulative effects assessment (CEA), however, as conducted under project-based environmental assessment (EA), often fail to address the deeper issues of human health and social well-being. This thesis was developed to examine how health effects, including cumulative health effects, are considered within regulatory EA practices in the hydroelectric sector in Manitoba. This was achieved by reviewing the EAs of three recent hydroelectric projects –Wuskwatim Generating Station, Bipole III Transmission Project, and Keeyask Hydroelectric Generating Station – located in the Nelson River watershed in northern Manitoba. Results indicate that the consideration of human health issues in EA has gradually improved over time; however, the assessment of health impacts was invariably limited to physical health components and often lacked due consideration of broader social health issues. The inadequacy of the practice of health impact assessment (HIA) was also evident by the lack of health-related indicators and the poor consistency in the use of indicators across projects and over time for measuring and predicting changes in the health conditions of the communities due to project development. An in-depth analysis regarding the assessment of cumulative health effects was carried out in the CEA of the most recent hydroelectric development – the Keeyask project. The findings show that cumulative health effects were not adequately considered in each of the basic components of CEA – scoping, retrospective analysis, prospective analysis, and management measures. Improving the consideration of health in EA requires paying more attention to broader range of health determinants, including both biophysical and social determinants and their interconnectedness in EA. Moreover, there is a need to improve greater consistency in the use of health indicators across projects and over time. It can be assisted by developing standardized terms of reference (ToR) for project proponents to ensure the consideration and monitoring of those indicators used for development projects built within the same geographic region and affecting the same communities and environments. Approaching cumulative health effects in a more regional and strategic framework of CEA, beyond the scale of individual projects, is likely to provide the best mechanism to understand and monitor the cumulative impacts of project development on the health and well-being of the affected communities.

Master of Science / Department of Biological & Agricultural Engineering / Stacy L. Hutchinson / Gully erosion is a serious problem on military training lands resulting in not only soil erosion and environmental degradation, but also increased soldier injuries and equipment damage. Assessment of gully erosion occurring on Fort Riley was conducted in order to evaluate different gully location methods and to develop a gully prediction model based on logistic regression. Of the 360 sites visited, fifty two gullies were identified with the majority found using LiDAR based data. Logistic regression model was developed using topographic, landuse/landcover, and soil variables. Tests for multicollinearity were used to reduce the input variables such that each model input had a unique effect on the model output. The logistic regression determined that available water content was one of the most important factors affecting the formation of gullies. Additional important factors included particle size classification, runoff class, erosion class, and drainage class. Of the 1577 watersheds evaluated for the Fort Riley area, 192 watersheds were predicted to have gullies. Model accuracy was approximately 79% with an error of omission or false positive value of 10% and an error of commission or false negative value of 11%; which is a large improvement compared to previous methods used to locate gully erosion.

Doctor of Philosophy / Department of Family Studies and Human Services / Briana S. Goff / The purpose of this qualitative study was to gain an in-depth understanding of the systemic effects of trauma, particularly war-related traumatic stress as a result of military deployments to Iraq and Afghanistan, in a sample of recent war veterans and their spouses. With recent military deployments and redeployments of soldiers, empirical and clinical research is needed to eliminate further deterioration and retraumatization caused by personal and interpersonal traumatization that can lead to severe PTSD and other trauma-related symptoms. Much of the research on previous wars focused on the individual trauma survivor overlooking the impact on the couple and family system. This study focused on explaining the systemic effects of trauma as it specifically impacts couple relational systems. By employing qualitative analysis, six couples (12 participants) were selected from the original data set of 45 couples (90 participants). Participants completed questionnaires and separate individual standardized open-ended interviews about their traumatic experiences. The interviews were transcribed, coded, and analyzed producing four themes: positive impact of deployment on the couple’s relationship, the negative impact of deployment on the couple’s relationship, soldiers’ war-related trauma, and issues of secrecy. Two groups were identified (high trauma/high relational satisfaction group and high trauma/low relational satisfaction group), based on the quantitative measures that were completed by all participants. Participants reported both war deployment related and non-deployment related traumatic experiences. Many participants reported feeling as though they restarted their relationship upon returning home, while some described feeling closer to their spouse at redeployment. Participants reported having a common worry of if the soldiers would return home alive, soldiers’ missing many life events (i.e., child birth, etc.), and soldiers’ worry about the safety and health of their spouses. An interesting finding was that some couples with high levels of trauma can maintain high levels of relational satisfaction when they have knowledge and understanding of each other’s trauma history and have open, on-going communication, while some couples with high levels of trauma tend to have low relational satisfaction due to limited communication about their trauma history. Strengths and limitations of the study, research implications, and clinical implications were discussed.

"The cloud" has been a hot subject the last couple of years, and has been considered especially attractive to SMEs due to making it possible for whole information systems to be fully managed by the vendor. This can unburden the customer organization regarding for example large investment costs, hardware and software maintenance, while also adding flexibility and scalability. There are three types of service models: infrastructure, platform and software, which dictate what the customer and vendor manages. In Software-as-a-Service (SaaS), which is the focus of this study, a third part manages both the applications and hardware and the users access these resources through the Internet. However, with the usage of SaaS comes several issues for companies to handle and make use of, for example security and mobility. This master thesis' aim is to present organizational effects of SaaS usage in SME user companies, by studying customer organizations post implementation. A qualitative comparative study was conducted where we held semi-structured interviews with SME users mainly at their own offices. In total six interviews were conducted at five different companies. At least two years usage experience was a criteria we set to ensure we could retrieve enough data from the companies. To fulfill the aim of the study we set out to find common issues affecting SMEs using SaaS systems. Through a pre-study, including literature studies and customer interviews, we determined which of the common issues that could be considered most relevant. Factors taken into consideration was how SaaS specific an issue was and how relevant it is in the post implementation phase, and how much data we were able to retrieve regarding an issue through the interviews. The relevant issues were: price model, vendor relation, frequent updates, mobility and integration. Further, five hypotheses were derived, one for each relevant issue regarding the organizational effects of SaaS usage. An analytical model was constructed mainly based on DeLone and McLean's (1992; 2003) original and updated Information System Success Model. The model helped in deriving organizational effects of usage from the different relevant issues. By using the analytical model with interview and literature study material we came up with the findings of this report, as described below. The possible price models enables companies to be more flexible with their IT portfolio. Also, it was concluded that the costs of SaaS are based upon usage, which could make it harder to estimate, especially if the usage varies. But it can also be a strength enabling customers to scale their usage as needed. In general, the vendor relation between a customer and vendor was not too complex, however with one exception. Our main discovery was that certain factors of SaaS usage affect the degree of experienced vendor lock-in differently. These include the nature of the pricing model, contract binding times and data ownership rights. Further, the level of trust and lock-in level could also affect the customer intention to change system. Frequent updates, which are managed by the vendor, reduce time and effort in regards to maintenance performed by customers. However, sometimes the updates could also cause problems when the customer had own configurations. The mobility offered by SaaS systems extends organizations ability to work. This includes increased geographical freedom for mainly employees of an organization. We found that integration is much more of a general issue for information systems. But in SaaS connection of services are possible and can thus enable further value than each service can on its own. However, integration also causes increased lock-in and system management. / Molnet har var ett hett ämne de senaste åren, och har ansetts vara särskilt attraktivt för SME:s då det möjliggör att hela informationssystem sköts av systemleverantören. Detta avlastar kundorganisationer från stora investeringskostnader och underhåll av hårdvara och mjukvara, genom att samtidigt öka både skalbarheten och flexibiliteten. Det finns tre typer av tjänstetyper: infrastructure, platform och software, vilka avgör vad som leverantören och kunden hanterar. I Software-as-a-Service (SaaS), som är i fokus får denna studie, så hanteras både applikationer och hårdvara av tredje part och användare kan få åtkomst till dessa genom internet. Med SaaS tillkommer dock även vissa svårigheter som företag måste hantera, exempelvis gällande säkerhet och mobilitet. Syftet med examensarbetet var att presentera de organisatoriska effekterna av SaaS-användning för SMEs genom att studera kundorganisationer i postimplementations-fasen. En kvalitativ, jämförande studie genomfördes där vi höll semi-strukturerade intervjuer med SME:s främst på deras egna kontor. Totalt sex stycken intervjuer genomfördes på fem olika företag. Vi krävde åtminstone två års användningserfarenhet för att säkerställa åtkomst till tillräcklig data. För att uppnå syftet med arbetet så började vi med att hitta vanligt förekommande svårigheter (”common issues”) som påverkar SME-användare. Genom en förstudie som innefattade intervjuer, litterära studier och användarintervjuer så kunde vi fastställa vilka av dessa problemområden som var mest relevanta. Faktorer vi tog hänsyn till var hur SaaS-specifikt och relevanta svårigheterna var i postimplementations-fasen, samt hur mycket data vi kunde få ut av våra fallföretag genom intervjuer. De relevanta svårigheterna (”relevant issues”) var: prismodellen, relationen till systemleverantör, frekventa uppdateringar, mobilitet och integration. Dessutom tog vi fram fem hypoteser gällande de organisatoriska effekterna av SaaS-användning baserad på svårigheterna. En analytisk modell skapades huvudsakligen baserad på DeLone och McLeans (1992; 2003) ursprungliga och uppdaterade ”Information System Success Model”. Denna modell underlättade att ta fram organisatoriska effekter av användning för de olika relevanta svårigheterna. Genom användningen av den analytiska modellen tillsammans med intervjuer och litteratur så kom vi fram till resultatet av studien, beskrivet nedan. De möjliga prismodellerna möjliggör för företag att vara mer flexibla med deras IT-portföljer. Dessutom fastställdes det att när kostnaderna för SaaS baseras på användningen kan vara svårt att uppskatta totalkostnaden, särskilt när användningen varierar. Detta kan dock samtidigt vara en styrka då det möjliggör skalbarhet efter behov. Kundrelationen mellan en kund och systemleverantör var inte alltför komplicerad, dock med ett undantag. Vår huvudsakliga upptäckt var att vissa faktorer i SaaS-användning påverkar den upplevda graden av inlåsningseffekter till systemleverantören. Dessa inkluderar prismodellens utformning, bindningstider och äganderättigheter till sin data. Dessutom kunde förtroendet och inlåsningsgraden också påverka kunders avsikt att byta system. Frekventa uppdateringar som hanteras av systemleverantören, minskar både tid och ansträngning för kunden gällande underhåll. Däremot kunde uppdateringarna ibland orsaka problem när kunden hade egna konfigurationer. Mobiliteten som möjliggörs av SaaS-system utökar organisationers arbetsmöjligheter. Detta inkluderar större geografisk frihet för de anställda i en organisation. Vi kom fram till att integration är mer en generell svårighet för informationssystem. Däremot i SaaS så är det möjligt att ansluta olika SaaS-tjänster, vilket kan skapa större mervärde än vad varje tjänst var för sig kan skapa. Däremot kan integration också orsaka ökade inlåsningseffekter och ökat behov av systemunderhåll.

A hybrid method based on three-dimensional finite element idealization in the near field and a semi-analytic scheme using the principles of wave propagation in multilayered half space in the far field is proposed for dynamic soil-structure interaction analysis. It combines the advantages of both the numerical and analytical techniques. A structure resting on the surface or embedded in a multilayered soil-medium and subjected to vertically propagating plane waves is analyzed by using the method. An important aspect of the soil-structure interaction problem considered is the presence of waves scattered from the soil-structure interface and geometrical irregularities in the soil. The dynamic response of an embedded structure of rectangular cross section to a vertically propagating compressional pulse is solved as an example problem. The proposed method is verified by comparison of its predictions with those from a finite element procedure with absorbing boundaries, and from an analytical solution. The results from the hybrid method compare well with those from the other two, with closer correlation between the hybrid and analytical methods.

During past decades manufacturing companies started opening new plants and transfer their manufacturing to other countries in order to increase their competitiveness in the market. An important area in today’s complex business environment became manufacturing location decisions that have a direct impact on companies’ future success. Many scholars introduced suggestions in what factors should be considered in manufacturing location decisions when opening new plants. However, less research has been done by identifying what critical factors should be considered in manufacturing reallocation[1] decisions when a company operates within a manufacturing footprint and intends to move manufacturing activities between existing plants. In order to fulfil this gap the study was conducted by developing a conceptual framework for supporting manufacturing reallocation decisions. The main factors, evaluation and effects were explored. In order to conduct the study three cases were analysed in two Swedish manufacturing companies, where one of the companies was currently executing a manufacturing reallocation to another plant. It was found that sometimes companies are forced to reallocate manufacturing unwillingly due to currency value changes or local governmental regulations. A tendency was noticed that some of the factors are considered at the strategic level and some are left to be handled at the operational level. However, operational level factors have a great impact on the long term strategy and future costs and should be included when making manufacturing reallocation decisions. The evaluation of factors is mostly based on assumptions and intuition. Only evaluations of economic factors are based on facts. Improvements of economic factors’ evaluations could be made by closer collaboration between plants and involvement of the right people at the right time during data collection before making a decision. Manufacturing reallocations could have effects on the sending plant and long term strategy that increases the importance to include it during decision making since hidden costs and future risks could be prevented. Finally, the conceptual framework for manufacturing reallocations is presented that could be used as a support for manufacturing reallocation decisions. [1] to assign or allot to a different place from the one originally intended.

Wage structure has shown to be crucial for firms and workers. However, there existwage dispersion for identical workers in labor markets. The paper measures the effectof industry and firm size on wages in Sweden. The results show that both industry andfirm size have significant effects on wages. Regarding the explanation factors, thefinding is that human capital factors can explain a portion of the industry wagedifferentials, but have less impact on wage differentials across firm size. However,compensating differentials and union organization are not the determinants of theindustry wage differentials and firm size-wage effects. In addition, unobservedindividual characteristics can partly explain firm size effect on wages, but cannotexplain industry wage differentials based on our samples.

Master of Science / Department of Journalism and Mass Communications / Louise Benjamin / This experimental research builds upon the health communications study completed by Rustam Haydarov in 2010, with a similar approach to ascertain how an individual’s age might influence their reaction to political messages. Using a typology of frames by Levin, Schneider and Gaeth (1998), the study utilizes an older demographic (ages 55-70) and a younger comparison group (ages 18-33) to determine a) if both groups find positive advertising messages more favorable than negative advertising messages and b) if the older demographic is more wary than younger counterparts when discussing current events and the future of America. The study used a combination of qualitative and quantitative methods to determine reactions to goal-oriented and loss-oriented message framing in four mock print political campaign advertisements focusing on the topics of healthcare and college education financing. There was greater prevalence of strongly negative and strongly positive reactions among the younger demographic, except in the case of the loss-framed healthcare ad. The older group reacted more strongly to that particular ad, concerning an issue which had great relevance to them. Of the two age groups, the older demographic registered a more even-keeled reaction across the four ads. Overall, this study has focused on how message frame, topic and age of the message receiver combine to affect message resonance in the context of political communications.