Political Self-characterization of U.S. Medical Students

BACKGROUND: There have been no prior studies of the political self-characterization of U.S. physicians-in-training, and little is known about physicians’ political leanings or the critical relationship between medical issues and political orientations of physicians and physicians-in-training. METHODS: All medical students in the class of 2003 at 16 nationally representative U.S. schools were eligible to complete three questionnaire administrations (at freshman orientation, entrance to wards, and senior year). RESULTS: Among these medical students, 5% self-characterized as politically very conservative, 21% conservative, 33% moderate, 31% liberal, and 9% as very liberal.” Being male, white, Protestant, intending to specialize in Surgery or anesthesiology/pathology/radiology, or currently or previously being married significantly (P ≤ .001) increased the likelihood that a student self-identified as very conservative or conservative. Disagreement or strong disagreement with the statements, “I’m glad I chose to become a physician” and “Access to care is a fundamental human right,” were also both associated with being very conservative or conservative. Being more liberal was reported by blacks and Hispanics; those intending to become ob-gyns, psychiatrists, and pediatric subspecialists; and atheists, Jews, and adherents of eastern religions. CONCLUSIONS: U.S. medical students are considerably more likely to be liberal than conservative and are more likely to be liberal than are other young U.S. adults. Future U.S. physicians may be more receptive to liberal messages than conservative ones, and their political orientation may profoundly affect their health system attitudes

On the track for an efficient detection of Escherichia coli in water : A review on PCR-based methods

Ensuring water safety is an ongoing challenge to public health providers. Assessing the presence of fecal contamination indicators in water is essential to protect public health from diseases caused by waterborne pathogens. For this purpose, the bacteria Escherichia coli has been used as the most reliable indicator of fecal contamination in water. The methods currently in use for monitoring the microbiological safety of water are based on culturing the microorganisms. However, these methods are not the desirable solution to prevent outbreaks as they provide the results with a considerable delay, lacking on specificity and sensitivity. Moreover, viable but non-culturable microorganisms, which may be present as a result of environmental stress or water treatment processes, are not detected by culture-based methods and, thus, may result in false-negative assessments of E. coli in water samples. These limitations may place public health at significant risk, leading to substantial monetary losses in health care and, additionally, in costs related with a reduced productivity in the area affected by the outbreak, and in costs supported by the water quality control departments involved. Molecular methods, particularly polymerase chain reaction-based methods, have been studied as an alternative technology to overcome the current limitations, as they offer the possibility to reduce the assay time, to improve the detection sensitivity and specificity, and to identify multiple targets and pathogens, including new or emerging strains. The variety of techniques and applications available for PCR-based methods has increased considerably and the costs involved have been substantially reduced, which together have contributed to the potential standardization of these techniques. However, they still require further refinement in order to be standardized and applied to the variety of environmental waters and their specific characteristics. The PCR-based methods under development for monitoring the presence of E. coli in water are here discussed. Special emphasis is given to methodologies that avoid pre-enrichment during the water sample preparation process so that the assay time is reduced and the required legislated sensitivity is achieved. The advantages and limitations of these methods are also reviewed, contributing to a more comprehensive overview toward a more conscious research in identifying E. coli in water.Diana Mendes (SFRH/BDE/33752/2009) was recipient of a fellowship from the Fundacao para a Ciencia e a Tecnologia (FCT, Portugal) and Frilabo, Lda. The authors thank Tatiana Aguiar (Centre of Biological Engineering) for English proofreading, the financial support from the Project "Desenvolvimento de um kit de detecao e quantificacao de E. coli e bacterias coliformes em aguas", Ref. 2009/5787, Programa Operacional Regional do Norte (ON.2 - O Novo Norte), QREN, FEDER, the FCT Strategic Project PEst-OE/EQB/LA0023/2013 and the Project "Biolnd-Biotechnology and Bioengineering for improved Industrial and processes", REF. NORTE-07-0124-FEDER-000028 Co-funded by the Programa Operacional Regional do Norte (ON.2 - O Novo Norte), QREN, FEDER

Long-term efficacy and safety of inclisiran in patients with high cardiovascular risk and elevated LDL cholesterol (ORION-3): results from the 4-year open-label extension of the ORION-1 trial

Introduction: Whether long-term treatment with the twice-yearly, siRNA therapeutic inclisiran, which reduces hepatic production of proprotein convertase subtilisin/kexin type 9 (PCSK9), results in sustained reductions in LDL cholesterol with an acceptable safety profile is not known. The aim of this study was to assess the effect of long-term dosing of inclisiran in patients with high cardiovascular risk and elevated LDL cholesterol. Methods: ORION-3 was a 4-year open-label extension study of the placebo-controlled, phase 2 ORION-1 trial, conducted at 52 sites across five countries. Patients with prevalent atherosclerotic cardiovascular disease or high-risk primary prevention and elevated LDL cholesterol despite maximally tolerated statins or other LDL-lowering treatments, or with documented statin intolerance, who had completed the ORION-1 trial were eligible. Patients receiving inclisiran in ORION-1 received twice-yearly 300 mg subcutaneous inclisiran sodium throughout ORION-3 (inclisiran-only arm), whereas patients receiving placebo in ORION-1 first received subcutaneous evolocumab 140 mg every 2 weeks until day 360 thereafter transitioning to inclisiran twice-yearly for the remainder of ORION-3 study (switching arm). The primary efficacy endpoint was the percentage change in LDL cholesterol with inclisiran from the start of ORION-1 through to day 210 of the open label extension phase in the inclisiran-only arm (approximately 570 days of total inclisiran exposure in the modified intention-to-treat population). Secondary and exploratory endpoints included changes in LDL-C cholesterol and PCSK9 concentrations levels up to day 1440 (4 years) in each arm, and safety. ORION-3 is registered with ClinicalTrials.gov, NCT03060577. Findings: Of the original ORION-1 cohort of 497 patients, 290 of 370 patients allocated to drug continued into the inclisiran-only arm and 92 of 127 patients allocated to placebo entered the switching-arm in the ORION-3 extension study conducted between March 24, 2017, and Dec 17, 2021. In the inclisiran-only arm, LDL cholesterol was reduced by 47·5% (95% CI 50·7–44·3) at day 210 and sustained over 1440 days. The 4-year averaged mean reduction of LDL-C cholesterol was 44·2% (95% CI: 47·1–41·4), with reductions in PCSK9 ranging from 62·2% to 77·8%. Adverse events at the injection site were reported in 39 (14%) of 284 patients in the inclisiran-only arm and 12 (14%) of 87 patients in the switching arm. The incidence of treatment-emergent serious adverse events possibly related to the study drug was 1% (three of 284) in the inclisiran-only arm and 1% (one of 87) in the switching arm. Interpretation: Twice-yearly inclisiran provided sustained reductions in LDL cholesterol and PCSK9 concentrations and was well tolerated over 4 years in the extension study. This is the first prospective long-term study to assess repeat hepatic exposure to inclisiran. Funding: Novartis Pharma

Etude dans le cadre de la REvision de la Stratégie de sUrveillance des Masses d'Eau côtières du Réseau Hydrologique Littoral Norman - RESUME

L’étude RESUME constituait une suite logique aux différents travaux de modélisation menés par le LER/N, que ce soit en 2005 pour la définition de la stratégie de surveillance pérenne du RHLN dans le cadre de la mise en œuvre de la Directive Cadre sur l’Eau (DCE), ou en 2015 pour la révision de cette stratégie pour le programme 2016-2021. Ce travail a permis de réaliser 27 lâchers de bouées sur 13 masses d’eau côtières ou de transition du littoral normand, qui ont totalisé 157 jours de dérive et près de 7 000 km de distance parcourue. Après une étape préliminaire de calibration du modèle NORM (MARS-3D), les trajectoires réelles des bouées ont été comparées avec des simulations de traceurs particulaires lâchés dans les mêmes conditions de forçage que les bouées. Enfin, des simulations de traceurs dissous à l’échelle des masses d’eau et à partir des points actuels de suivi du RHLN ont permis d’obtenir des cartes des temps de résidence, et l’évolution temporelle de la concentration de ces traceurs. Cette étude a permis de mieux comprendre le fonctionnement hydrodynamique du littoral normand, et pourra être complétée par une étude statistique des données in situ sur les points RHLN afin de finaliser la réflexion sur leur représentativité

Attitudes and knowledge regarding health care policy and systems: a survey of medical students in Ontario and California

BACKGROUND: Canada and the United States have similar medical education systems, but different health care systems. We surveyed medical students in Ontario and California to assess their knowledge and views about health care policy and systems, with an emphasis on attitudes toward universal care. METHODS: A web-based survey was administered during the 2010–2011 academic year to students in 5 medical schools in Ontario and 4 in California. The survey collected demographic data and evaluated attitudes and knowledge regarding broad health care policy issues and health care systems. An index of support for universal health care was created, and logistic regression models were used to examine potential determinants of such support. RESULTS: Responses were received from 2241 students: 1354 from Ontario and 887 from California, representing 42.9% of eligible respondents. Support for universal health care coverage was higher in Ontario (86.8%) than in California (51.1%), p < 0.001. In California, females, self-described nonconservatives, students with the intent to be involved in health care policy as physicians and students with a primary care orientation were associated with support for universal coverage. In Ontario, self-described liberals and accurate knowledge of the Canadian system were associated with support. A single-payer system for practice was preferred by 35.6% and 67.4% of students in California and Ontario, respectively. The quantity of instruction on health care policy in the curriculum was judged too little by 73.1% and 57.5% of students in California and Ontario, respectively. INTERPRETATION: Medical students in Ontario are substantially more supportive of universal access to health care than their California counterparts. A majority of students in both regions identified substantial curricular deficiencies in health care policy instruction

Comparing passive sampling, mussel caging and biomarkers for the evaluation of water quality for European Directives in Normandy coastal waters (France)

In the scope of the Water Framework Directive (WFD, 2000/60/EC) implementation, the aim of this work was to compare the response of different emerging tools to evaluate the chemical status of water bodies in Normandy coastal waters (France). These tools included passive samplers foreseen in future evaluation campaigns in France as a replacement for bulk seawater sampling (i.e. Diffusive Gradient in Thin films (DGT), and Polar Organic Chemical Integrative Sampler (POCIS)). They were deployed at three contrasted sites in terms of pollution level along the Normandy coast, simultaneously to mussel caging, in which three common biomarkers were analysed at the end of the experiment. This work highlighted the operational challenge of deploying passive samplers and caging in open coastal waters of the Channel. The only POCIS that could be analysed from the bay of Veys revealed the presence of metabolites of forbidden pesticides, and of several pharmaceutical substances. Results given by DGTs confirmed a gradient in metal concentrations between the three sites with a maximum at the Seine estuary, confirmed with organic and metal analyses in mussels, and with the lysosomal membrane stability biomarker which gives an indication of organisms’ health status relative to their environment

HLiN. Huı̂tres du Littoral Normand. Ponte, Dispersion, Recrutement et Colonisation des huı̂tres sauvages sur l’Ouest Cotentin : un réseau de suivi pour le littoral normand. Etude de cas 2013

Depuis 2010, le programme HLiN s’attache à suivre la colonisation et le recrutement des huîtres naturelles sur les côtes du département de la Manche. Après une période d’adaptation des protocoles à la réalité normande, il s’est posé la question de l’origine du recrutement des huîtres, notamment pour la côte ouest du Cotentin, entre les falaises de Champeaux et Saint Germain / Ay. Suite à ses travaux sur la dérive larvaire des moules de pêche en baie de Seine, le LERN de Port en Bessin avait mis au point un modèle de courantologie en 3 dimensions appelé NORM (issu du code MARS 3D). L’idée était d’appliquer la méthodologie de calage du modèle pour le golfe normand breton afin de simuler différents scénarios de ponte et de les corréler avec les observations de terrain. L’année 2013 a servi, dans le cadre de cette étude, d’année référence et de calage de la méthodologie. Les géniteurs ont été suivis par le biais du réseau RESCO d’IFREMER permettant ainsi d’obtenir des données de maturation et des dates de pontes sur les deux principales zones d’élevage du golfe. Ensuite, des bouées iridium, suivies en direct, furent nécessaires afin de caler les données du modèle avec la réalité. Avec des dates de pontes et un modèle recalé, des simulations ont été lancées à partir de 9 secteurs identifiés comme secteurs source potentiels et sur les deux dates de pontes relevées (fin juillet pour Cancale et fin août pour Blainville / Mer) lors du suivi des indices gonadiques. Les simulations, prenant Cancale comme point d’émission, montrent une dispersion relativement concentrée au nord de la pointe du Grouin et en fond de baie du Mont Saint Michel, jusqu’aux falaises de Carolles. De plus, les températures d’eau entre la fin juillet et la mi-août (période natatoire des larves) étaient supérieures à 20°C, donc favorables au bon développement des larves jusqu’à leur fixation. La simulation à partir de Blainville / Mer émise fin août quant à elle montre des concentrations relativement intéressantes sur la partie nord de la côte ouest du Cotentin (entre Saint Germain / Ay et Carteret) mais les conditions météorologiques et thermiques n’étaient pas réunies pour une ponte réussie. Les données de terrain, relevées en Mars 2014, montrent un recrutement 2013 exclusivement sur les falaises de Carolles, ce que semblaient montrer les différentes simulations du modèle NORM combiné aux données météorologiques et thermiques

Surveillance écologique et halieutique du site électronucléaire de Penly. Année 2016. Rapport scientifique annuel

Monitoring n° 29 of PENLY nuclear power - plant takes into account studies between March and September 2016. Hydrology, microbiology, phytoplankton, zooplankton and fishing are studied. This power-plant has been in operation for twenty-six years.La surveillance n° 29 sur le site de PENLY couvre la période de mars à septembre 2016. Les domaines étudiés sont l'hydrologie, la microbiologie, le plancton végétal et animal et le domaine halieutique. L’année 2016 est la vingt septième année de fonctionnement de la centrale

Surveillance écologique et halieutique du site électronucléaire de Penly. Année 2014 - Rapport scientifique annuel

Monitoring n° 28 of PENLY nuclear power - plant takes into account studies between March and September 2014. Hydrology, microbiology, phytoplankton, zooplankton and fishing are studied. This power-plant has been in operation for twenty-five years.La surveillance n° 28 sur le site de PENLY couvre la période de mars à septembre 2014. Les domaines étudiés sont l'hydrologie, la microbiologie, le plancton végétal et animal et le domaine halieutique. L’année 2014 est la vingt cinquième année de fonctionnement de la centrale

Influence of an aggregate extraction in remobilizing contaminants from sediments in surface waters of the Bay of Seine (France)

In coastal areas where monitoring data show that fine sediments contain contaminants, remobilization of these materials during aggregate extractions, which create a turbidity plume, might influence water quality. The eastern bay of Seine (France) is under the influence of the Seine plume, one of the most contaminated rivers in Europe. This study aimed at investigating remobilization of metals and organics from sediments in surface water during and after an aggregate dredging, through their behavior between total and dissolved phases. In this study area located 20 kilometers off Le Havre, sediments where sampled to identify potential contaminants. Unfiltered and filtered (< 0,2 µm) surface seawater samples were collected at different stages of the aggregate extraction : before (T0), in the turbidity plume at 20 minutes (T1), 1h (T2) and 2h (T3), and 1 h after the end (T4). Substances looked for were metals (Ag, As, Cd, Cr, Cu, Hg, Ni, Pb, V, Zn) and several organic contaminants including DEHP, PCBs, and PAHs. Results showed a significant increase in Cr, Cu, Hg, Ni, Pb, V and Zn in total samples at T1 and to a lesser extent at T3, and a tendency to return to initial concentrations at T4. DEHP showed a different behavior with decreasing concentrations from T1 to T3, before tending to initial level at T4. Dissolved concentrations remained relatively stable over the whole experiment. This work therefore shows effective remobilization of contaminants which remain mostly adsorbed on particles, and a tendency to returning to initial levels during clearing away of the turbidity plume. A schematic modeling (with a physical 3D model) of the turbidity plume confirms its limited extent and duration. Moreover, these results represent new data on substances that are of high concern in the bay of Seine, an area subject to multiple anthropogenic pressures