Are Thienopyridines like Plavix Really Beneficial for Unstable Angina or NSTEMI?


In a new meta-analysis, early management of non–ST-segment elevation myocardial infarctions with thienopyridines was not associated with significantly lower mortality and did not lower major adverse cardiovascular event rates for those eventually undergoing PCI.

Current ACC/AHA guidelines support dual antiplatelet treatment upstream with aspirin and thienopyridines (e.g., clopidogrel) for patients with unstable angina or non–ST-segment elevation myocardial infarction (NSTEMI).  Now, a new meta-analysis of more than 32,000 patients, analyzed data from available randomized trials and from registries to assess the effect of thienopyridine treatment on outcomes, both in patients who underwent subsequent percutaneous interventions (PCIs) and in those who were treated medically.

Results show that pretreatment with thienopyridines was not associated with significantly lower mortality but was associated with significantly fewer major adverse cardiovascular events (MACE; odds ratio, 0.84).However, thienopyridine therapy also was associated with significantly more major bleeding (OR, 1.32). Of note, in the subset of patients who underwent PCIs, mortality and MACE were essentially the same in those who received thienopyridine pretreatment vs those who did not.

 

 PCI for patient with NSTEMI

Summary of Updated Acute Ischemic Stroke guidelines


  • Teleradiology networks are recommended for community hospitals that lack access to neurological expertise. (Class I, Level B)

  • Intravenous (IV) thrombolysis is recommended in the setting of early ischemic changes, with the exception of frank hypodensity on computed tomography (CT). (Class I, Level A)

  • A noninvasive intracranial vascular study is strongly recommended if either intra-arterial fibrinolysis or mechanical thrombectomy is being considered, but this study should not delay initiation of tissue plasminogen activator (TPA). (Class I, Level A)

  • The target door-to-needle time for patients who receive intravenous TPA is <60 minutes. (Class I, Level A)

  • IV TPA is recommended in the 3- to 4.5-hour time window — beyond the previously recommended 3-hour window — with additional exclusion criteria (age >80, use of oral anticoagulants, baseline NIH Stroke Scale score >25, imaging evidence of ischemic injury involving more than one third of the middle cerebral artery territory, or a history of both stroke and diabetes mellitus). (Class I, Level B)

  • Use of IV TPA may be considered for patients with mild stroke or those with major surgery in the last 3 months, after weighing the risks and benefits. (Class IIb, Level C)

  • Use of IV TPA is not recommended for patients taking novel anticoagulants unless clotting tests are normal or the patient has not taken medication for >2 days (with normal renal function). (Class III, Level C)

  • When mechanical thrombectomy is considered, stent retrievers are preferred to coil retrievers. (Class I, Level A) The ability of mechanical thrombectomy devices to improve patient outcomes has not yet been established.

  • Rescue intra-arterial thrombolysis or thrombectomy may be reasonable in patients who have failed IV thrombolysis, but additional randomized trial data are needed. (Class IIb, Level B)

  • Permissive hypertension up to a BP of 220/120 mmHg is still recommended for acute ischemic strokes at least for the first 24 hours of hospitalization unless TPA is administered in which case the BP should remain below 185/110 mmHg.

acute stroke management

The one basic thing men still don’t seem to understand about women


There’s a particularly knotty theme that keeps working its way into my writing lately, a cultural force that assumes so many different forms in so many different realms that it took me until just now to connect them all. The issue is women’s right to set their own boundaries, and to live with the confidence that those boundaries are inherently powerful and credible, not questionable and permeable—because women are people, not passive extensions of men.

All sizes | Miss Cartoon Voyeurism | Flickr - Photo Sharing!

Women’s boundaries came up a month ago in the Guardian, when I wrote about a subway lothario who claimed to have gotten “over 500 dates” by pestering women who were trapped with him in an enclosed space. It came up again last week in my column about pick-up artist Julien Blanc, who was kicked out of Australia for teaching men that sexual assault is a “seduction” tactic. It’s a foundational point of my piece here at the Daily Dot about feminist social networks, in which I assert that, no, it is not women’s responsibility to weather harassment, abuse, threats, wasted time, and bad-faith devil’s advocates for the sake of civility and “discourse.” And there it is again in last week’s essay aboutArtie Lange’s racist, misogynist Twitter eruption, a breach of propriety that cost him at least one TV appearance—because female comics and comedy fans are no longer just eating shit and saying thank you. The notion even features prominently in this GQ piece about California’s “Yes Means Yes” bill, which can pretty much be summarized thusly: WOMEN ARE HUMAN BEINGS, DUMBASS.

Think about how Gamergate started—how all those months of mindless,churning misogynist idiocy grew out of one man’s presumption of ownership over a woman’s personal life. She didn’t behave the way his sex-thing was supposed to. And thousands of men (boys, really) online—angry at other disagreeable women like Anita Sarkeesian for threatening the sanctity of their virtual sex-things—concurred that this was an egregious breach of trust, of propriety, of “ethics.” They agreed that Zoe Quinn’s body belonged more to her boyfriend than to herself. And they exacted punishment not just on her, but on women at large.

Think about Jian Ghomeshi, Ray Rice, Bill Cosby, Donald Sterling,Christy Mack’s battered face, War Machine laughing in court,Steubenville, Maryville, Isla Vista, the celebrity nude photo hack, and in the midst of it all, Time “joking” that we should ban the word feminism. Think about Republicans referring to pregnant women as “hosts,” and arguing that if abortion is legal, men should be free to rape women. Think about all the things I couldn’t even list here, because this is a blog post, not a library.

Now tell me we don’t have a cultural block when it comes to women’s humanity.

But the public response to my writing lately has said just that. No, no, no, no, I’ve been told—women can’t just refuse to give their time to men who are being “nice.” It’s not fair for women to push back against objectification, or demand respect and representation, in media into which they’re pouring both money and emotional investment. A lot of men are sad, or lonely, or socially awkward, and they need women’s attention to feel better, or as a sounding board to practice their social skills.

A man named Chris emailed me to plead for “sympathy, not vitriol” when it comes to the men who rely on Julien Blanc’s “dating” classes:

In a recent article you posit that men are “lonely, desperate, socially inept” and “sad sacks,” but when we they try and correct that behaviour they become “repulsive, entitled, sexually aggressive creeps”. Such sweeping categorisation is blatant misandry.

Sam de Brito echoed those concerns in an absolutely ludicrous pro-PUA column for the Sydney Morning Herald:

No man goes out of a night worried he might be raped, sexually abused or catcalled and these are all serious instances of aberrant male behaviour that we must address, punish or discourage as a society.

The flipside of this is your average man can go out every Friday and Saturday night for five years, buy himself a drink and stand at a bar and NEVER have a woman start up a conversation with him.

… I am not equating the fear of rejection to the fear of being raped, merely pointing out that men—like most of the ones that attend Blanc’s seminars—do not do it to learn how to manipulate women, to sexually assault them or degrade them.

They do it to get a girlfriend, to have someone to hold, to find love.

Josh Barrie moaned in the Daily Telegraph that all these modern distinctions are simply too confusing for his classic Don Draper man-brain:

In a club, a man approaching a woman is a sex pest; on a train, he’s an annoying perv. On the street, he’s a weirdo. But what if he actually isn’t any of those things? What if he is just a guy who is genuinely interested, on the lookout for a possible match (not a shallow Tinder one this time)? Surely these occasions can still arise?

The brain trust over at A Voice for Men accused me of being on a “quest to kill social interaction forever,” while this Gamergate propaganda video argued that the men I was writing about “probably” had Asperger’s, and therefore I was using my platform to “vilify autism.”Cosmo ran a similar (though more measured) piece, explaining that “Men with Asperger’s are often especially honest and upfront, and want to love the whole of a person,” and complaining that “most men want to be respectful of women, but just being nice seems to get us nowhere.”

OK, guys. I hear you. Now please listen, those of you who were writing in good faith:

Treating women with respect should not be contingent on whether or not it “gets you somewhere.” Women have value even if we are too fat or too ugly or too loud or too standoffish or too homosexual to serve a “purpose” for men. Women are people.

Any person (women are people) is allowed to ignore, reject, or break up with anyone else at any time, regardless of how sad it makes them feel.

I have compassion for your social difficulties, but only to the point where they begin to impede my humanity. It isn’t women’s responsibility to bear the brunt of your loneliness, or be the means to your self-improvement. Women deal with loneliness and social anxiety and private pains too. Women deserve compassion too. If it genuinely goes without saying—as the men who write to me always claim—that you think of women as your equals, then find a solution that doesn’t hinge on exploiting women’s socialization to be passive, pliant, receptive, and kind.

“Men with Asperger’s” are not a monolith, and they certainly aren’t hardwired to harass women.

Social interaction remains fully intact, no matter how many columns I write—and, in fact, can only be improved by you treating your female conversation partners like autonomous, dynamic beings equal to yourselves.

You cannot “get” a girlfriend, because a girlfriend is not an iPad or a burrito or gonorrhea. Women are people. You aren’t entitled to “have” people, just because you think it will cure your unhappiness. Your unhappiness is your problem and no one else’s. And thinking about a girlfriend as a thing that you “get” and not an equal partner whose humanity you respect and cherish will never result in a satisfying relationship anyway.

Though Sam de Brito claimed, in the above excerpt, that he wasn’t comparing a woman being raped to a man being rejected at a bar, he literally called one the “flipside” of the other. And he’s right, in a way. When a man rapes a woman, he is violently refusing her “no.” When a man gets rejected at a bar and then seeks the advice of Julien Blanc, he is looking for a subtler, more manipulative way to get around that “no.” They are two iterations of man vs “no.”

If you’re not one of “those guys,” and you really do want to treat women like human beings, go ahead and internalize these simple truths:

1) She is more than just her physical appearance.

2) She has a complex inner life.

3) Your fulfillment is not her responsibility and your social difficulties are not her problem.

4) She is not obligated to get romantically involved with you, and she is definitely not obligated to stay with you.

5) Her time is as valuable as yours, and it’s her right to choose how she uses it.

There are no “but”s when it comes to women’s humanity. Not “but” you’re lonely, not “but” you’re horny, not “but” you’re nice, not “but” that’s how your grandparents met, not “but” she was naked in your bed. Women are people, and women just get to exist and set boundaries and say no. Always. Any time. Just like you.

Mediterranean diet ‘combats obesity’


food file picture
Mediterranean diets may help reduce the risk of heart attacks, researchers say
A Mediterranean diet may be a better way of tackling obesity than calorie counting, leading doctors have said.

Writing in the Postgraduate Medical Journal (PMJ), the doctors said a Mediterranean diet quickly reduced the risk of heart attacks and strokes.

And they said it may be better than low-fat diets for sustained weight loss.

Official NHS advice is to monitor calorie intake to maintain a healthy weight.

Last month NHS leaders stressed the need for urgent action to tackle obesity and the health problems that often go with it.

The PMJ editorial argues a focus on food intake is the best approach, but it warns crash dieting is harmful.

Signatories of the piece included the chair of the Academy of Medical Royal Colleges, Prof Terence Stephenson, and Dr Mahiben Maruthappu, who has a senior role at NHS England.

They criticise the weight-loss industry for focusing on calorie restriction rather than “good nutrition”.

Better than statinsAnd they make the case for a Mediterranean diet, including fruit and vegetables, nuts and olive oil, citing research suggesting it quickly reduces the risk of heart attacks and strokes, and may be better than low-fat diets for sustained weight loss.

The lead author, cardiologist Dr Aseem Malhotra, says the scientific evidence is overwhelming.

“What’s more responsible is that we tell people to concentrate on eating nutritious foods.

Grey line

Med dietInspired by traditional cuisine of countries such as Greece, Spain and Italy, the Mediterranean diet has long been associated with good health and fit hearts.

Typically, it consists of an abundance of vegetables, fresh fruit, wholegrain cereals, olive oil and nuts, as well as poultry and fish, rather than lots of red meat and butter or animal fats.

Grey line

“It’s going to have an impact on their health very quickly. We know the traditional Mediterranean diet, which is higher in fat, proven from randomised controlled trials, reduces the risk of heart attack and stroke even within months of implementation.”

The article also says adopting a Mediterranean diet after a heart attack is almost three times as effective at reducing deaths as taking cholesterol-lowering statin medication.

The authors argue the NHS is in a “key position” to set a national example by providing healthy food in hospitals and by ensuring doctors and nurses understand the evidence.

‘Common sense’Prof Stephenson says the service can exert a powerful influence, for good or ill.

“Our hospitals and surgeries are the frontline for delivering health, it’s nothing more than common sense then that we should be leading by example.

“We wouldn’t dream of letting people drink alcohol or smoke in any healthcare environment, so I find it incomprehensible that we facilitate and sometimes actively promote food and drink that in some ways cause as many problems. And although some positive steps have been taken on the food given to patients in hospital, their visitors and staff also deserve better.”

Public Health England is reviewing the dietary advice conveyed in the “eatwell plate” – which is used across the UK for guidance on what food to eat. Its recommendations include calorie-counted recipes to help achieve a healthy weight.

Dr Alison Tedstone, the chief nutritionist at Public Health England, said there was no single silver-bullet solution.

“Government advice is to eat plenty of bread, rice, potatoes, pasta and other starchy foods, plenty of fruit and vegetables; and some milk and dairy products, meat, fish, eggs, beans and other sources of non-dairy protein.

“Foods high in salt, fat and sugar should be eaten less often and in small amounts. If you are currently overweight you will need to eat less to achieve a healthy weight and be active as part of a healthy lifestyle.”

The chairman of the National Obesity Forum, professor David Haslam, welcomed the article.

“A calorie is not just a calorie and it is naive for anyone to think the complex hormonal and neurological appetite systems of the body respond to different substances in the diet in identical fashion.”

He said banning fast food outlets in hospitals would be a “legal minefield” given the extended contracts in existence. But he said healthy nutrition programmes could be put in place – as has happened in other big organisations – to counter what he called their “sinister effect”.

Concern over rising heart infection


 

antibiotic

Rates of a deadly heart infection have increased after guidelines advised against giving antibiotics to prevent it in patients at risk, research shows.

In 2008, the advisory body NICE said to stop giving antibiotics to prevent infective endocarditis in patients due to undergo invasive dental procedures.

A study in The Lancet shows prescriptions dropped by about 80%.

At the same time, rates of the infection rose by an extra 35 cases a month.

The UK researchers, from the University of Sheffield and other institutes, stressed that there may be other reasons for the increase. The condition is also still relatively uncommon, affecting fewer than 10 in 100,000 people a year in the UK.

“Start Quote

What is really needed is a randomised controlled trial to address the problem definitively but you would have to do a very large study which would be very expensive and very challenging”

Dr Bernard PrendergastOxford University Hospitals NHS Trust

The British Heart Foundation says the evidence for and against is not clear cut – antibiotic prescribing is not risk free.

NICE said it would immediately review its guidance on the basis of the study but until that was done the existing advice should be followed.

Heart risk

Infective endocarditis is a rare infection of the tissue that lines the chambers of the heart.

It is hard for the immune system to fight and particularly dangerous in people who already have certain heart problems such as artificial valves or congenital heart disease.

In these individuals, the risk of dying after one year can be as high as 50%.

dental check

European and US guidelines still recommend giving antibiotics as a preventive measure in high-risk patients before having dental work and other invasive procedures such as colonoscopy, but NICE had advised stopping the practice because of a lack of evidence.

The 2008 guidance, which had recommended other measures to prevent infection, was controversial and caused a lot of debate among cardiologists and dentists.

Significant rise

Analysis of the data found that between 2004 and 2008 there were, on average, 10,600 prescriptions a month of antibiotic prophylaxis for the prevention of infective endocarditis.

Between 2008 and 2013 this fell to an average of 2,236 prescriptions a month and by the end of the study (31 March 2013) had dropped to 1,307 a month.

While the rates of infection were on the rise, soon after the NICE guidance came in rates increased significantly over what would have been expected, say the researchers.

From the data, the researchers calculated that 277 antibiotic prescriptions would have to be given to prevent one case of infective endocarditis.

Study author Dr Bernard Prendergast, a cardiologist at Oxford University Hospitals NHS Trust, said it had been important to investigate the impact of the NICE guidance but they could not prove a causal relationship and other explanations such as a change in the bacteria, or patient population were possible.

“What is really needed is a randomised controlled trial to address the problem definitively but you would have to do a very large study which would be very expensive and very challenging.”

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “Where new evidence has called into question the safety of current guidance, it is right that we review that guidance as quickly as possible.”

Organic molecules detected on comet


The Philae lander has detected organic molecules on the surface of its comet, scientists have confirmed.

Carbon-containing “organics” are the basis of life on Earth and may give clues to chemical ingredients delivered to our planet early in its history.

The compounds were picked up by a German-built instrument designed to “sniff” the comet’s thin atmosphere.

Other analyses suggest the comet’s surface is largely water-ice covered with a thin dust layer.

The European Space Agency (Esa) craft touched down on the Comet 67P on 12 November after a 10-year journey.

Dr Fred Goessmann, principal investigator on the Cosac instrument, which made the organics detection, confirmed the find to BBC News. But he added that the team was still trying to interpret the results.

It has not been disclosed which molecules have been found, or how complex they are.

“Start Quote

There’s a trade off – once it gets too hot, Philae will die as well. There is a sweet spot”

Prof Mark McCaughreanSenior science adviser, Esa

But the results are likely to provide insights into the possible role of comets in contributing some of the chemical building blocks to the primordial mix from which life evolved on the early Earth.

Preliminary results from the Mupus instrument, which deployed a hammer to the comet after Philae’s landing, suggest there is a layer of dust 10-20cm thick on the surface with very hard water-ice underneath.

The ice would be frozen solid at temperatures encountered in the outer Solar System – Mupus data suggest this layer has a tensile strength similar to sandstone.

“It’s within a very broad spectrum of ice models. It was harder than expected at that location, but it’s still within bounds,” said Prof Mark McCaughrean, senior science adviser to Esa, told BBC News.

“People will be playing with [mathematical] models of pure water-ice mixed with certain amount of dust.”

Philae has gone into standby because of low power

He explained: “You can’t rule out rock, but if you look at the global story, we know the overall density of the comet is 0.4g/cubic cm. There’s no way the thing’s made of rock.

“It’s more likely there’s sintered ice at the surface with more porous material lower down that hasn’t been exposed to the Sun in the same way.”

After bouncing off the surface at least twice, Philae came to a stop in some sort of high-walled trap.

“The fact that we landed up against something may actually be in our favour. If we’d landed on the main surface, the dust layer may have been even thicker and it’s possible we might not have gone down [to the ice],” said Prof McCaughrean.

Scientists had to race to perform as many key tests as they could before Philae’s battery life ran out at the weekend.

On re-charge

A key objective was to drill a sample of “soil” and analyse it in Cosac’s oven. But, disappointingly, the latest information suggest no soil was delivered to the instrument.

Prof McCaughrean explained: “We didn’t necessarily see many organics in the signal. That could be because we didn’t manage to pick up a sample. But what we know is that the drill went down to its full extent and came back up again.”

“But there’s no independent way to say: This is what the sample looks like before you put it in there.”

Scientists are hopeful however that as Comet 67P/Churyumov-Gerasimenko approaches the Sun in coming months, Philae’s solar panels will see sunlight again. This might allow the batteries to re-charge, and enable the lander to perform science once more.

Comet

“There’s a trade off – once it gets too hot, Philae will die as well. There is a sweet spot,” said Prof McCaughrean.

He added: “Given the fact that there is a factor of six, seven, eight in solar illumination and the last action we took was to rotate the body of Philae around to get the bigger solar panel in, I think it’s perfectly reasonable to think it may well happen.

“By being in the shadow of the cliff, it might even help us, that we might not get so hot, even at full solar illumination. But if you don’t get so hot that you don’t overheat, have you got enough solar power to charge the system.”

The lander’s Alpha Particle X-ray Spectrometer (APXS), designed to provide information on the elemental composition of the surface, seems to have partially seen a signal from its own lens cover – which could have dropped off at a strange angle because Philae was not lying flat.

Geckos inspire ‘Spider-Man’ gloves


Gecko climbing

The way geckos climb has inspired a device that allowed a 70kg man to scale a glass wall like Spider-Man.

Much research has gone into trying to unlock the clever way that little geckos climb.

But trying to use gecko adhesion to work at larger scales – such as on a human hand – without any loss of performance has proven difficult.

The hand-sized silicone pads created by a team at Stanford University keep their adhesive strength at all sizes.

They employ the same attractive and repulsive forces between molecules – known as van der Waals forces – that geckos use.

Although the forces are very weak, the effect is multiplied across the many tiny hairs that cover the toes of a gecko, allowing them to stick firmly to surfaces.

Along the same lines, the Stanford team created tiny tiles called microwedges to harness van der Waals forces. They were able to produce a dry adhesive even more efficient than that of the gecko.

In tests, the 70kg (11 stone) climber successfully scaled a 3.6m-high vertical glass wall using 140 sq cm silicone pads in each hand.

The climber tested the adhesive hundreds of times on the wall without failure.

Earlier this year, America’s Defence Advanced Research Projects Agency (Darpa) demonstrated another climbing device which allowed a person to scale a sheer glass wall.

However, the exact details of their climbing method remain classified.

This latest effort was also a collaboration with Darpa. The agency’s Z-Man programme aims to develop biologically-inspired climbing aids for soldiers without the need for ropes and ladders.

The team at Stanford have published their findings in the Royal Society journal Interface.

Figuring out spillover of a bat-borne virus


Using a bat-borne virus that sporadically infects horses in Australia as an example, a team of scientists has examined conditions under which viruses that bats carry could spill over into other species.

Bats are host to a number of viruses that are lethal to humans, Ebola being one of them. Understanding what makes it possible for such viruses to make the leap out of bats is therefore of interest.

In a review paper published recently in Proceedings of the Royal Society B, scientists from Australia and the U.S. looked at factors involved in spillovers from bats, focusing on the Hendra virus.

The discovery

This virus was discovered in 1994 when 20 horses in a racing stable at Hendra, a suburb of the city of Brisbane in Australia, became infected. A trainer at the stable and his assistant also caught the virus, with the former dying of the infection.

The virus circulates in fruit bat populations in the country, and spillovers of the virus into horses have occurred sporadically. Since 2006, such spillovers have been detected with increasing frequency and over an expanding geographical range, according to the paper.

Raina K. Plowright of the Center for Infectious Disease Dynamics at Pennsylvania State University in the U.S. and colleagues examined why the spillovers occurred only in some places, and not others, where bat and horse populations overlapped. Moreover, just a small proportion of horses in an area where an outbreak occurred were affected.

In the paper, they listed a hierarchy of at least five “enabling conditions” that made it possible for the Hendra virus to cross from bat to horse.

Not only must bats be present and carrying the virus, but they must also be shedding those viruses.

New evidence

New evidence suggested that virus excretion from bats occurred in pulses that could drive spillover, they noted. Shortage of food and pregnancy might be among the factors that lead to such pulses of virus shedding.

Bats excrete urine and faeces around trees where they feed or roost, and their saliva can be present in fruit they partially consume. Horses could pick up the Hendra virus when grazing near trees with bats. In addition, the susceptibility of individual horses also determined their probability of infection.

Removal of any of the enabling conditions should prevent spillover, the scientists observed.

Conservation and restoration of critical feeding habitats for bats should reduce the risk of nutritional stress and their moving to urban and semi-urban areas in search of food. Vaccination would reduce the susceptibility of horses to the virus.

But culling or dispersing fruit bat populations — for which there has been public and political pressure in Australia — would not help.

“We found no evidence that the prevalence of Hendra virus in bat populations was associated with population density and therefore that decreases in host density would reduce virus prevalence,” they pointed out.

 

 

Flash memory breaches nanoscales


In what is considered a breakthrough in computing hardware, a team of scientists from Glasgow has proposed a way to harvest molecules and construct nano-sized non-volatile (permanent) storage devices, also known as flash memory devices. In a letter published in Naturetoday (November 20), Christoph Busche of WestCHEM School of Chemistry, University of Glasgow, and 12 others have written about their efforts to engineer molecular flash memory using nanoscale polyoxometalate clusters instead of the conventional metal-oxide semiconductor (MOS) devices.

The challenge

It is a great challenge to reduce the size of conventional MOS flash memories to sizes below ten nanometres. This poses a problem when one tries to build small flash memory devices. Hence other options have been pursued for quite some time, including those using proteins and other molecules. However, using these molecular memories involved integrating them with the MOS technologies, which was proving to be difficult and several candidates had been tried and found wanting in this attempt. The Glasgow group, headed by Leroy Cronin, has found a suitable candidate in the polyxometalate molecules.

OVEL APPROACH: A route to building molecular
flash memory devices has been suggested.

When such a molecule is doped with the selenium derivative [(Se(IV)O3)2]2- a new type of oxidisation state (5+) is observed for the selenium. This new oxidation state can be observed at the device level, and this can be used as a memory.

Device simulation

The authors demonstrate this using a device simulation. Their work suggests a route to building molecular flash memory devices.

Flash memory is in everyday usage now. It is used in digital cameras, USBs and various other places. Unlike a computer’s RAM, which is volatile — meaning that the memory stored in it will dissipate once power supply is broken — a flash memory can retain what is written on it even when power supply is discontinued. For that reason it is called a non-volatile memory. So long, flash memories have been constituted using MOS technologies. This paper now suggests a new way of going beyond its nanoscale limitations.

 

 

False promise of nuclear power


The need for costly upgrades post-Fukushima and for making the nuclear industry competitive, including by cutting back on generous government subsidies, underscore nuclear power’s dimming future.

New developments highlight the growing travails of the global nuclear-power industry. France — the “poster child” of atomic power — plans to cut its nuclear-generating capacity by a third by 2025 and focus instead on renewable sources, like its neighbours, Germany and Spain. As nuclear power becomes increasingly uneconomical at home because of skyrocketing costs, the U.S. and France are aggressively pushing exports, not just to India and China, but also to “nuclear newcomers,” such as the cash-laden oil sheikhdoms. Still, the bulk of the reactors under construction or planned worldwide are located in just four countries — China, Russia, South Korea and India.

Six decades after Lewis Strauss, chairman of the U.S. Atomic Energy Commission, claimed that nuclear energy would become “too cheap to meter,” nuclear power confronts an increasingly uncertain future, largely because of unfavourable economics. The International Energy Agency’s World Energy Outlook 2014, released last week, states: “Uncertainties continue to cloud the future for nuclear — government policy, public confidence, financing in liberalized markets, competitiveness versus other sources of generation, and the looming retirement of a large fleet of older plants.”

Heavily subsidy reliant

Nuclear power has the energy sector’s highest capital and water intensity and longest plant-construction time frame, making it hardly attractive for private investors. Plant construction time frame, with licensing approval, still averages almost a decade, as underscored by the new reactors commissioned in the past decade. The key fact about nuclear power is that it is the world’s most subsidy-fattened energy industry, even as it generates the most dangerous wastes whose safe disposal saddles future generations. Commercial reactors have been in operation for more than half-a-century, yet the industry still cannot stand on its own feet without major state support. Instead of the cost of nuclear power declining with the technology’s maturation — as is the case with other sources of energy — the costs have escalated multiple times.

In this light, nuclear power has inexorably been on a downward trajectory. The nuclear share of the world’s total electricity production reached its peak of 17 per cent in the late 1980s. Since then, it has been falling, and is currently estimated at about 13 per cent, even as new uranium discoveries have swelled global reserves. With proven reserves having grown by 12.5 per cent since just 2008, there is enough uranium to meet current demand for more than 100 years.

Yet, the worldwide aggregate installed capacity of just three renewables — wind power, solar power and biomass — has surpassed installed nuclear-generating capacity. In India and China, wind power output alone exceeds nuclear-generated electricity.

Fukushima’s impact

Before the 2011 Fukushima disaster, the global nuclear power industry — a powerful cartel of less than a dozen major state-owned or state-guided firms — had been trumpeting a global “nuclear renaissance.” This spiel was largely anchored in hope. However, the triple meltdown at Fukushima has not only reopened old safety concerns but also set in motion the renaissance of nuclear power in reverse. The dual imperative for costly upgrades post-Fukushima and for making the industry competitive, including by cutting back on the munificent government subsidies, underscores nuclear power’s dimming future. It is against this background that India’s itch to import high-priced reactors must be examined. To be sure, India should ramp up electricity production from all energy sources. There is definitely a place for safe nuclear power in India’s energy mix. Indeed, the country’s domestic nuclear-power industry has done a fairly good job both in delivering electricity at a price that is the envy of western firms and, as the newest indigenous reactors show, in beating the mean global plant construction time frame.

India should actually be encouraging its industry to export its tested and reliable midsize reactor model, which is better suited for the developing countries, considering their grid limitations. Instead, Prime Minister Manmohan Singh’s government, after making India the world’s largest importer of conventional arms since 2006, set out to make the country the world’s single largest importer of nuclear power reactors — a double whammy for Indian taxpayers, already heavily burdened by the fact that India is the only major economy in Asia that is import-dependent rather than export driven.

Critiquing India’s programme

To compound matters, the Singh government opted for major reactor imports without a competitive bidding process. It reserved a nuclear park each for four foreign firms (Areva of France, Westinghouse and GE of the U.S., and Atomstroyexport of Russia) to build multiple reactors at a single site. It then set out to acquire land from farmers and other residents, employing coercion in some cases.

Having undercut its leverage by dedicating a park to each foreign vendor, it entered into price negotiations. Because the imported reactors are to be operated by the Indian state, the foreign vendors have been freed from producing electricity at marketable rates. In other words, Indian taxpayers are to subsidise the high-priced electricity generated.

Westinghouse, GE and Areva also wish to shift the primary liability for any accident to the Indian taxpayer so that they have no downside risk but only profits to reap. If a Fukushima-type catastrophe were to strike India, it would seriously damage the Indian economy. A recent Osaka City University study has put Japan’s Fukushima-disaster bill at a whopping $105 billion.

To Dr. Singh’s discomfiture, three factors put a break on his reactor-import plans — the exorbitant price of French- and U.S.-origin reactors, the accident-liability issue, and grass-roots opposition to the planned multi-reactor complexes. After Fukushima, the grass-roots attitude in India is that nuclear power is okay as long as the plant is located in someone else’s backyard, not one’s own. This attitude took a peculiar form at Kudankulam, in Tamil Nadu, where a protest movement suddenly flared just when the Russian-origin, twin-unit nuclear power plant was virtually complete.

India’s new nuclear plants, like in most other countries, are located in coastal regions so that these water-guzzling facilities can largely draw on seawater for their operations and not bring freshwater resources under strain. But coastal areas are often not only heavily populated but also constitute prime real estate. The risks that seaside reactors face from global warming-induced natural disasters became evident more than six years before Fukushima, when the 2004 Indian Ocean tsunami inundated parts of the Madras Atomic Power Station. But the reactor core could be kept in a safe shutdown mode because the electrical systems had been installed on higher ground than the plant level.

One-sided

Dr. Singh invested so such political capital in the Indo-U.S. civil nuclear agreement that much of his first term was spent in negotiating and consummating the deal. He never explained why he overruled the nuclear establishment and shut down the CIRUS research reactor — the source of much of India’s cumulative historic production of weapons-grade plutonium since the 1960s. In fact, CIRUS had been refurbished at a cost of millions of dollars and reopened for barely two years when Dr. Singh succumbed to U.S. pressure and agreed to close it down.

Nevertheless, the nuclear accord has turned out to be a dud deal for India on energy but a roaring success for the U.S. in opening the door to major weapon sales — a development that has quietly made America the largest arms supplier to India. For the U.S., the deal from the beginning was more geostrategic in nature (designed to co-opt India as a quasi-ally) than centred on just energy.

Even if no differences had arisen over the accident-liability issue, the deal would still not have delivered a single operational nuclear power plant for a more than a decade for two reasons — the inflated price of western-origin commercial reactors and grass-roots opposition. Areva, Westinghouse and GE signed Memorandums of Understanding with the state-run Nuclear Power Corporation of India Limited (NPCIL) in 2009, but construction has yet to begin at any site.

India has offered Areva, with which negotiations are at an advanced stage, a power price of Rs.6.50 per kilowatt hour — twice the average electricity price from indigenous reactors. But the state-owned French firm is still holding out for a higher price. If Kudankulam is a clue, work at the massive nuclear complexes at Jaitapur in Maharashtra (earmarked for Areva), Mithi Virdi in Gujarat (Westinghouse) and Kovvada in Andhra Pradesh (GE) is likely to run into grass-roots resistance. Indeed, if India wishes to boost nuclear-generating capacity without paying through its nose, the better choice — given its new access to the world uranium market — would be an accelerated indigenous programme.

Globally, nuclear power is set to face increasing challenges due to its inability to compete with other energy sources in pricing. Another factor is how to manage the rising volumes of spent nuclear fuel in the absence of permanent disposal facilities. More fundamentally, without a breakthrough in fusion energy or greater commercial advances in the area that the U.S. has strived to block — breeder (and thorium) reactors — nuclear power is in no position to lead the world out of the fossil fuel age.