Selecting qualitative cases using sequence analysis: A mixed-method for in-depth understanding of life course trajectories.

In this paper, we propose a sequence analysis-based method for selecting qualitative cases depending on quantitative results. Inspired by tools developed for cross-sectional analyses, we propose indicators suitable for longitudinal study of the life course in a holistic perspective and a set of corresponding analysis guidelines. Two complementary indicators are introduced, marginality and gain, that allows labeling observations according to both their typicality within their group and their illustrativeness of a given quantitative relationship. These indicators allow selecting a diversity of cases depending on their contributions to a quantitative relationship between trajectories and a covariate or a typology. The computation of the indicators is made available in the TraMineRextras R package. The method and its advantages are illustrated through an original study of the relationships between residential trajectories in the Paris region and residential socialization during childhood. Using the Biographies et Entourage [Event history and entourage] survey and qualitative interviews conducted with a subsample of respondents, the analysis shows the contributions of the method not only to improve the understanding of statistical associations, but also to identify their limitations. Extension and generalization of the method are finally proposed to cover a wider scope of situations.

C-Nail® locking nail versus conventional plate for thalamic calcaneal fractures.

BACKGROUND: Surgery for displaced intra-articular calcaneal fractures (DIACFs) is often followed by skin complications that adversely impacts the functional outcomes. Minimally invasive techniques have been developed to decrease the risk of skin complications. The objective of this study was to compare C-Nail® locking-nail fixation to conventional plate fixation for DIACFs. HYPOTHESIS: C-Nail® fixation restores calcaneal anatomy similarly to conventional plate fixation and decreases the frequency of skin complications compared to conventional plate fixation, while providing satisfactory functional outcomes. MATERIAL AND METHODS: In this case-control study of DIACFs, fixation was with a non-locking plate in 30 patients treated between January 2016 and June 2017 and with the C-Nail® in 25 patients treated between April 2017 and April 2018. Computed tomography was performed before surgery then bilaterally after surgery for measurements of the following calcaneal parameters: height, length, width, joint-surface step-off and inter-fragmentary distance. The values of these parameters were compared between the two groups. Postoperative skin complications were recorded. The functional outcome was assessed by determining the AOFAS score 1 year after the injury. RESULTS: The two groups showed no significant differences for age, sex or fracture type. Wound healing was delayed in 3 patients in the plate group. The mean postoperative values of the calcaneal parameters were not significantly different between the two groups. The mean AOFAS score was 85.3±10.4 (range, 50-100) in the plate group and 87.0±12.0 (range, 64-100) in the C-Nail® group (p>0.05). DISCUSSION: Minimally invasive C-Nail® fixation provides similar restoration of calcaneal anatomy as does conventional plate fixation. LEVEL OF EVIDENCE: III, retrospective case-control study.

Chemotherapy for inoperable advanced or metastatic cholangiocarcinoma: retrospective analysis of 78 cases in a single center over four years.

BACKGROUND: Systemic chemotherapy is the treatment of choice for inoperable (advanced or metastatic) cholangiocarcinoma. According to phase II and III trials, regimens combining 5-fluorouracil (5FU) or gemcitabine with a platinum salt have provided an overall response rate of 12-50% with a median overall survival of 5-16 months. METHODS: This was a retrospective analysis of 78 consecutive cases of inoperable cholangiocarcinoma treated by palliative chemotherapy from July 2005 to November 2009 in one center. We firstly aimed to evaluate the impact of palliative chemotherapy in terms of survival and secondly to analyze possible related prognostic factors. RESULTS: This cohort included 25 female and 53 male patients, with a mean age of 60.8 ± 11.4 years. Intrahepatic and extrahepatic cholangiocarcinoma were observed in 57 and 21 patients, respectively. First-line chemotherapy regimens were as follows: gemcitabine (n = 7), gemcitabine plus oxaliplatin (with or without cetuximab; n = 62) and 5FU plus cisplatin (n = 9). None of the patients achieved a complete response. The partial response rate was 35.9% (27/78), and the stable disease rate was 26.9% (21/78), giving a disease control rate of 62.8%. At the time of this analysis, with a median follow-up of 18 months, 13 patients were survivors. Median overall survival was 10 months [95% confidence interval (CI) 7-12], and median progression-free survival was 7 months (95% CI 6-8). Upon univariate analysis, only the distribution of the disease was significantly linked with prognosis, with a median overall survival of 10 months (95% CI 10-24) for solitary tumors versus 7 months (95% CI 6-11) in the case of infiltrative or multifocal tumors (p = 0.039). CONCLUSION: The disease control rate, overall survival and progression free-survival in this single-center retrospective study were in agreement with earlier reports. Specific features of this cohort were a large proportion of cholangiocarcinoma with associated cirrhosis (n = 30/78, 38.5%), mostly intrahepatic (n = 25/30, 83.5%). This confirms the increasing incidence of intrahepatic localization and the epidemiological link recently reported between intrahepatic biliary tract carcinoma and cirrhosis.

Is accessibility in the eye of the beholder? Social inequalities in spatial accessibility to health-related resources in Montréal, Canada.

Neighbourhood resources are often considered to be spatially accessible to people when they are located close to their place of residence, a perspective which overlooks individuals' unique lived experience of their neighbourhood and how they define it. Drawing on the relational approach to place and on Sen's capability approach, we explore spatial accessibility to health-related resources, and the social gradient therein, in light of people's place experiences. Using data from 1101 young adults from Montreal (Canada) who participated in the Interdisciplinary Study of Inequalities in Smoking (ISIS), we compare the social gradients in the presence of health-related resources located (i) within uniform areas (defined as circular buffers and road-network buffers) around participants' place of residence; and (ii) within participants' self-defined neighbourhoods. Social inequalities in accessibility to a diversity of health-related resources (grocery stores, fruit and vegetable stores, eating and drinking places, recreational sports centres, civic, social, and fraternal organizations, bike paths, parks, social services, libraries, dental offices, physician offices) were more pronounced in self-defined neighbourhoods than in uniform buffer areas. Neglecting the variability in people's place experiences may distort the assessment of social inequalities in accessibility, and ultimately, of neighbourhood effects on health inequalities.

Establishment of critical hygiene indices for meat cooling processes evaluated by a temperature function integration method.

A temperature function integration technique that involves the calculation of the potential growth of Escherichia coli to obtain a process hygiene index (PHI) is the New Zealand industry standard method for assessing the potential for growth of enteric bacteria during meat cooling processes. The existing criteria to determine the acceptability of a cooling process with PHI values take no account of the differences between meat products and thus limit processing flexibility. A methodology was developed to set criteria for processing acceptability, based on the frequency distribution of the indicator organism E. coli number on meat carcasses immediately after slaughter (in log2 CFU per square centimeter) and a requirement that the E. coli numbers at the end of the cooling process be less than or equal to some maximum acceptable level. This methodology was used, along with accepted guidelines for maximum acceptable levels of E. coli in the meat and measured initial E. coli numbers for the whole New Zealand meat industry, to develop a set of PHI criteria that would be satisfied by a good-practice meat processing operation. A Monte Carlo modeling approach was used to illustrate the implications of these criteria if they had been applied to cooling processes for beef and lamb previously evaluated by the authors. If the proposed criteria were adopted, the maximum allowable PHI for beef cooling could be higher than that for lamb cooling because of the lower initial E. coli numbers found on beef than on lamb carcasses.

Effect of feeding pasture-finished cattle different conserved forages on Escherichia coli in the rumen and faeces.

The effects of eight different pre-slaughter diets on gut microflora, pH and dry matter were evaluated in 112 slaughter-weight, pasture-finished heifers. Hide dirtiness at slaughter, plasma cortisol, meat pH and stickiness, and liveweight loss, were also examined. The pre-slaughter diets were: 48 h of 100% meadow hay, lucerne hay, red clover hay, perennial ryegrass hay, haylage, haylage supplemented with maize silage, pasture, or 24 h fasting before transport. Fasted animals had the highest counts of rumen Escherichia coli and Enterobacteria compared to other treatments (P<0.001), while red clover hay and haylage had the lowest (P<0.05). Faecal E. coli counts were also highest for fasted animals (P<0.05). Rumen E. coli and Enterobacteria counts were positively correlated with rumen pH (P<0.001), and negatively correlated with fibre intake (P<0.001). Diet significantly affected the pH of both the rumen and faeces (P<0.001), with fasted animals having the highest rumen pH and haylage and red-clover hay-fed animals the lowest. Dry matter (%) of the rumen contents was also significantly affected by diet (P<0.001). The mean carcass weight of fed heifers was 5 kg heavier than that of the fasted heifers (P<0.05). A pH/volatile fatty acid (VFA) dependent mechanism is suggested as the major mode for E. coli suppression by feeds used in the study. Coumarins may have contributed to lower ruminal and faecal E. coli counts with E. coli counts negatively correlated with expected coumarin ingestion (P<0.01). Feeding pasture-fed cattle conserved herbaceous forages, in preference to fasting, before transport for slaughter may prove beneficial in reducing the risk of carcass contamination with E. coli and other bacteria of digesta and/or faecal origin, and in protecting carcass weight.

Breast cancer in a male with ankylosing spondylitis treated with TNFalpha antagonists.

A 72-year-old male with a 4-year history of TNFalpha antagonist therapy (infliximab and etanercept) for ankylosing spondylitis was diagnosed with breast cancer. He had a family history of breast cancer. The low incidence and considerable severity of breast cancer in males, genetic risk factors, and potential role for TNFalpha antagonist therapy are discussed.