Integration Interrupted: The Impact of September 11, 2001

( Lauren Lipovic ),( Matthew Sido ),( Animesh Ghoshal ) 세종대학교 경제통합연구소 2015 Journal of Economic Integration Vol.30 No.1

The economies of Canada and the United States, closely linked for many years, began a formal process of tighter integration with the Canada?United States Free Trade Agreement (1989) and North American Free Trade Agreement (1994). Due to the ease of border crossing, American and Canadian consumers took advantage of exchange rate variations to engage in cross-border shopping, implying a movement toward unified markets in the border regions. This process of integration was interrupted by tighter border controls after the terrorist attacks of 9/11. In this paper, we investigate the disruption of normal patterns of day tripping across the US-Canadian border. Using seasonally adjusted monthly data for the period 1994~2011, we show a robust relationship between the exchange rate and the flow of day trippers in each direction, implying cross-border shopping to be a major motive for day trippers. Using dummy variables to represent the security measures enacted in September 2001, and the stricter documentation required after January 2008, we show that both sets of measures significantly reduced cross-border trips and thickened the border.

Comparison of hepatic MDCT, MRI, and DSA to explant pathology for the detection and treatment planning of hepatocellular carcinoma

( Lauren M. Ladd ),( Temel Tirkes ),( Mark Tann ),( David M Agarwal ),( Matthew S Johnson ),( Bilal Tahir ),( Kumaresan Sandrasegaran ) 대한간학회 2016 Clinical and Molecular Hepatology(대한간학회지) Vol.22 No.4

Background/Aims: The diagnosis and treatment plan for hepatocellular carcinoma (HCC) can be made from radiologic imaging. However, lesion detection may vary depending on the imaging modality. This study aims to evaluate the sensitivities of hepatic multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) in the detection of HCC and the consequent management impact on potential liver transplant patients. Methods: One hundred and sixteen HCC lesions were analyzed in 41 patients who received an orthotopic liver transplant (OLT). All of the patients underwent pretransplantation hepatic DSA, MDCT, and/or MRI. The imaging results were independently reviewed retrospectively in a blinded fashion by two interventional and two abdominal radiologists. The liver explant pathology was used as the gold standard for assessing each imaging modality. Results: The sensitivity for overall HCC detection was higher for cross-sectional imaging using MRI (51.5%, 95% confidence interval [CI]=36.2-58.4%) and MDCT (49.8%, 95% CI=43.7-55.9%) than for DSA (41.7%, 95% CI=36.2-47.3%) (P=0.05). The difference in false-positive rate was not statistically significant between MRI (22%), MDCT (29%), and DSA (29%) (P=0.67). The sensitivity was significantly higher for detecting right lobe lesions than left lobe lesions for all modalities (MRI: 56.1% vs. 43.1%, MDCT: 55.0% vs. 42.0%, and DSA: 46.9% vs. 33.9%; all P<0.01). The sensitivities of the three imaging modalities were also higher for lesions ≥2 cm vs. <2 cm (MRI: 73.4% vs. 32.7%, MDCT: 66.9% vs. 33.8%, and DSA: 62.2% vs. 24.1%; all P<0.01). The interobserver correlation was rated as very good to excellent. Conclusions: The sensitivity for detecting HCC is higher for MRI and MDCT than for DSA, and so cross-sectional imaging modalities should be used to evaluate OLT candidacy. (Clin Mol Hepatol 2016;22:450-457)

Immediate weight-bearing is safe following lateral locked plate fixation of periprosthetic distal femoral fractures

( Oisin J. F. Keenan ),( Lauren A. Ross ),( Matthew Magill ),( Matthew Moran ),( Chloe E. H. Scott ) 대한슬관절학회 2021 대한슬관절학회지 Vol.33 No.-

Purpose: This study aimed to determine whether unrestricted weight-bearing as tolerated (WBAT) following lateral locking plate (LLP) fixation of periprosthetic distal femoral fractures (PDFFs) is associated with increased failure and reoperation, compared with restricted weight-bearing (RWB). Materials and methods: In a retrospective cohort study of consecutive patients with unilateral PDFFs undergoing LLP fixation, patients prescribed WBAT were compared with those prescribed 6 weeks of RWB. The primary outcome measure was reoperation. Kaplan-Meier and Cox multivariable analyses were performed. Results: There were 43 patients (mean age 80.9 ± 11.7 years, body mass index 26.8 ± 5.7 kg/m² and 86.0% female): 28 WBAT and 15 RWB. There were more interprosthetic fractures in the RWB group (p = 0.040). Mean follow-up was 3.8 years (range 1.0-10.4). Eight patients (18.6%) underwent reoperation. Kaplan-Meier analysis demonstrated no difference in 2-year survival between WBAT (80.6%, 95% CI 65.3-95.9) and RWB (83.3%, 95% CI 62.1-100.0; p = 0.54). Cox analysis showed increased reoperation risk with medial comminution (hazard ratio 10.7, 95% CI 1.5-80; p = 0.020) and decreased risk with anatomic reduction (hazard ratio 0.11, 95% CI 0.01-1.0; p = 0.046). Immediate weightbearing did not significantly affect the risk of reoperation compared with RWB (relative risk 1.03, 95% CI 0.61-1.74; p = 0.91). Conclusions: LLP fixation failure was associated with medial comminution and non-anatomic reductions, not with postoperative weight-bearing. Medial comminution should be managed with additional fixation. Weight-bearing restrictions additional to this appear unnecessary and should be avoided.

Ex Vivo T Cell Cytokine Expression Predicts Survival in Patients with Severe Alcoholic Hepatitis

( Ashwin D. Dhanda ),( Euan Yates ),( Lauren P. Schewitz-bowers ),( Philippa J. Lait ),( Richard W. J. Lee ),( Matthew E. Cramp ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2020 Gut and Liver Vol.14 No.2

Alcoholic hepatitis (AH) is an acute inflammatory liver condition with high early mortality rate. Steroids improve short-term survival but nonresponders have the worst outcomes. There is a clinical need to identify these high-risk individuals at the time of presentation. T cells are implicated in AH and steroid responsiveness. We measured ex vivo T cell cytokine expression as a candidate biomarker of outcomes in patients with AH. Consecutive patients (bilirubin >80 μmol/L and ratio of aspartate aminotransferase to alanine aminotransferase >1.5 who were heavy alcohol consumers with discriminant function [DF] ≥32), were recruited from University Hospitals Plymouth NHS Trust. T cells were obtained and stimulated ex vivo. Cytokine expression levels were determined by flow cytometry and protein multiplex analysis. Twenty-three patients were recruited (10 male; median age 51 years; baseline DF 67; 30% 90-day mortality). Compared to T cells from nonsurvivors at day 90, T cells from survivors had higher baseline baseline intracellular interleukin (IL)-10:IL-17A ratio (0.43 vs 1.20, p=0.02). Multiplex protein analysis identified interferon γ (IFNγ) and tumor necrosis factor-α (TNF-α) as independent predictors of 90-day mortality (p=0.04, p=0.01, respectively). The ratio of IFNγ to TNF-α was predictive of 90-day mortality (1.4 vs 0.2, p=0.03). These data demonstrate the potential utility of T cell cytokine release assays performed on pretreatment blood samples as biomarkers of survival in patients with severe AH. Our key findings were that intracellular IL-10:IL-17A and IFNγ:TNF-α in culture supernatants were predictors of 90-day mortality. This offers the promise of developing T cell-based diagnostic tools for risk stratification. (Gut Liver 2020;14:265-268)

The M5 Cell: A Color-Opponent Intrinsically Photosensitive Retinal Ganglion Cell

Stabio, Maureen E.,Sabbah, Shai,Quattrochi, Lauren E.,Ilardi, Marissa C.,Fogerson, P. Michelle,Leyrer, Megan L.,Kim, Min Tae,Kim, Inkyu,Schiel, Matthew,Renna, Jordan M.,Briggman, Kevin L.,Berson, Davi Cell Press 2018 Neuron Vol.97 No.1

Evaluating the use of the respiratory-rate oxygenation index as a predictor of high-flow nasal cannula oxygen failure in COVID-19

Scott Weerasuriya,Savvas Vlachos,Ahmed Bobo,Namitha Birur Jayaprabhu,Lauren Matthews,Adam R Blackstock,Victoria Metaxa 대한중환자의학회 2023 Acute and Critical Care Vol.38 No.1

Background It can be challenging for clinicians to predict which patients with respiratory failure secondary to coronavirus disease 2019 (COVID-19) will fail on high-flow nasal cannula (HFNC) oxygen and require escalation of therapy. This study set out to evaluate the association between the respiratory rate-oxygenation index (ROX) and HFNC failure in such patients and to assess whether ROX trajectory correlates with treatment failure. Methods This was a single-centre, retrospective, observational study of patients with COVID-19 requiring HFNC, conducted over a 3-month period. ROX was calculated as "pulse-oximetry oxygen saturation (SpO2) over the fractional inspired oxygen concentration (FiO2)/respiratory rate" for each patient at 2, 4, and 12 hours from starting HFNC. HFNC failure was defined as escalation to continuous positive airway pressure ventilation or invasive mechanical ventilation (IMV). Time-to-event analyses were performed to account for the longitudinal data set and time-dependent variables. Results We included 146 patients. Ninety-three (63.7%) experienced HFNC failure, with 53 (36.3%) requiring IMV. Higher ROX values were associated with a lower subhazard of HFNC failure on time-to-HFNC failure analysis (subhazard ratio, 0.29; 95% confidence interval [CI], 0.18–0.46; P<0.001). This remained true after controlling for informative censoring. Median ROX values changed differentially over time, increasing in the HFNC success group (0.06 per hour; 95% CI, 0.05–0.08; P<0.001) but not in the HFNC failure group (0.004 per hour; 95% CI, –0.05 to 0.08; P=0.890). Conclusions A higher ROX is associated with a lower risk of HFNC failure. Monitoring ROX trajectory over time may help identify patients at risk of treatment failure. This has potential clinical applications; however, future prospective studies are required.