Tungsten will be used as the plasma-facing divertor material in the International Thermonuclear Experimental Reactor (ITER) fusion reactor. Under high temperatures and high ion fluxes, a ‘fuzz’ ...nanostructure forms on the tungsten surface with dramatically different properties and could contaminate the plasma. Although simulations and experimental observations have provided understanding of the initial fuzz formation process, there is debate over whether tungsten or helium migration is rate-limiting during late-stage growth, and the mechanisms by which tungsten and helium migrations occur. Here, the proposed mechanisms are considered in turn. It is concluded that tungsten migration occurs by adatom diffusion along the fuzz surface. Continual helium migration through the porous fuzz to the tungsten bulk is also required for fuzz growth, for continued bubble growth and rupture. Helium likely migrates due to ballistic penetration, although diffusion may contribute. It is difficult to determine the limiting process, which may switch from helium penetration to tungsten adatom diffusion above a threshold flux. Areas for further research to clarify the mechanisms are then considered. A greater understanding of the fuzz formation mechanism is key to the successful design of plasma-facing tungsten components, and may have applications in forming porous tungsten catalysts.
The Hebrew Bible is permeated with depictions of military conflicts that have profoundly shaped the way many think about war. Why does war occupy so much space in the Bible? In this book, Jacob ...Wright offers a fresh and fascinating response to this question: War pervades the Bible not because ancient Israel was governed by religious factors (such as 'holy war') or because this people, along with its neighbors in the ancient Near East, was especially bellicose. The reason is rather that the Bible is fundamentally a project of constructing a new national identity for Israel, one that can both transcend deep divisions within the population and withstand military conquest by imperial armies. Drawing on the intriguing interdisciplinary research on war commemoration, Wright shows how biblical authors, like the architects of national identities from more recent times, constructed a new and influential notion of peoplehood in direct relation to memories of war, both real and imagined. This book is also available as Open Access on Cambridge Core.
Inter‐ethnic variability in pharmacokinetics (PK) has been attributed to several factors ranging from genetic to environmental. It is not clear how current teaching in higher education (HE) reflects ...what published literature suggests on this subject. This study aims to gain insights into current knowledge about inter‐ethnic differences in PK based on reports from published literature and current teaching practices in HE. A systematic literature search was conducted on PubMed and Scopus to identify suitable literature to be reviewed. Insights into inter‐ethnic differences in PK teaching among educators in HE and industry were determined using a questionnaire. Thirty‐one percent of the studies reviewed reported inter‐ethnic differences in PK, of these, 37% of authors suggested genetic polymorphism as possible explanation for the inter‐ethnic differences observed. Other factors authors proposed included diet and weight differences between ethnicities. Most respondents (80%) who taught inter‐ethnic difference in PK attributed inter‐ethnic differences to genetic polymorphism. While genetic polymorphism is one source of variability in PK, the teaching of genetic polymorphism is better associated with interindividual variabilities rather than inter‐ethnic differences in PK as there are no genes with PK implications specific to any one ethnic group. Nongenetic factors such as diet, weight, and environmental factors, should be highlighted as potential sources of interindividual variation in the PK of drugs.
Introduction
Providing care for refugees and asylum seekers requires special knowledge and training. Refugees and asylum seekers often have unique health needs that require specialized care.
Purpose
...This research focused on the need and relevance of incorporation of refugee and asylum seekers’ health in undergraduate medical curriculum teaching at King’s College London GKT Medical School.
Methods
A mixed method approach was adopted involving review of available literature on refugee health in the medical curriculum, followed by interview and e-survey on the perspectives of tutors and students, respectively.
Discussion
The research points to an overwhelming agreement on the need, learning outcomes and challenges of integrating refugee and asylum seeker health into undergraduate medical and dental education both from the perspectives of clinical teachers and medical students.
Conclusion
A collaborative approach involving students, teachers and refugee stakeholders will help in developing an effective refugee curriculum to provide equitable healthcare in the UK.
Abstract
In recent years a debate has erupted around the possibility of using quantitative tools to date biblical texts. Our article sets forth a new methodology for discerning statistically ...significant traces of diachronic layers in texts from the Hebrew Bible. This is not to suggest that an irregularity in a book is sufficient to determine that it is made of more than one source. We are only making the argument on the negative: that there is no reason to explain phenomena that ‘seem interesting’ if there is no statistical model that shows a significant difference from random distribution. More generally, this study demonstrates the need for informed and careful application of recent statistical theory to the field of biblical studies.
Iatrogenic splenic injury is a rare complication of all abdominal surgeries. Despite the procedure's overall safety, colonoscopy is now the procedure most frequently associated with iatrogenic ...splenic injury. A 58-year-old male with a past medical history of hypertension, lung cancer in remission, colon polyps, and severe scoliosis presented for grade three splenic laceration two days following a routine colonoscopy. He had no recent history of injury or other inciting events that could have led to traumatic injury. Non-operative management included splenic artery embolization and transfusion of one unit of packed red blood cells, after which he improved in the hospital and was discharged home in stable condition. This case postulates the possible influence of his severe scoliosis, and thus altered abdominal viscera anatomy, on his iatrogenic splenic injury, as well as the potential importance of investigating scoliosis as a risk factor for difficult colonoscopy or even iatrogenic splenic injury during colonoscopy.
Enzymes of natural biochemical pathways are routinely subcellularly organized in space and time in order to improve pathway efficacy and control. Designer scaffolding platforms are under development ...to confer similar benefits upon engineered pathways. Herein, we evaluate bacterial microcompartment shell (pfam0936-domain) proteins as modules for constructing well-defined nanometer scale scaffolds in vivo. We use a suite of visualization techniques to evaluate scaffold assembly and dynamics. We demonstrate recruitment of target cargo molecules onto assembled scaffolds by appending reciprocally interacting adaptor domains. These interactions can be refined by fine-tuning the scaffold expression level. Real-time observation of this system reveals a nucleation-limited step where multiple scaffolds initially form within a cell. Over time, nucleated scaffolds reorganize into a single intracellular assembly, likely due to interscaffold competition for protein subunits. Our results suggest design considerations for using self-assembling proteins as building blocks to construct nanoscaffolds, while also providing a platform to visualize scaffold-cargo dynamics in vivo.
Objectives: Standardized measurement of caregiver stress is a component of Medicare's new health care benefit supporting care planning for people with dementia. In this article we identify existing ...measures of caregiver stress, strain and burden and propose specific criteria for choosing tools that may be suitable for wide use in primary care settings. We reviewed 22 measures and identified one, the Kingston Caregiver Stress Scale (KCSS), which met all the proposed criteria but had not been studied in a U.S. sample. We conducted a psychometric evaluation of KCSS to determine its potential usefulness as a care planning tool with a U.S. sample.
Methods: We examined the internal consistency, test-retest reliability, component structure, and relationship to depression and anxiety in 227 dementia caregivers at two U.S. sites.
Results: The KCSS has high internal consistency and test-retest reliability, a strong factor structure, and moderate to high correlations with caregiver depression and anxiety.
Conclusion: KCSS is a good candidate for use as part of comprehensive care planning for people with dementia and their caregivers.
Clinical Implications: Routine assessment of caregiver stress in clinical care may facilitate timely intervention and potentially improve both patient and caregiver outcomes.
Insulin is the principal postprandial anabolic hormone and resistance to its action could contribute to sarcopenia. We developed different types of hyperinsulinemic clamp protocols to measure ...simultaneously glucose and protein metabolism in insulin resistant states (older adults, obesity, diabetes, etc.). To define effects of healthy aging in response to insulin, we employed the hyperinsulinemic, euglycemic and isoaminoacidemic (HYPER-1) clamp. The net whole-body anabolic (protein balance) response to hyperinsulinemia was lower in the elderly vs young (p = 0.007) and was highly correlated with the clamp glucose rate of disposal (r = 0.671, p < 0.001), indicating insulin resistance of protein metabolism concurrent with that of glucose. Differences in insulin resistance due to aging were observed predominantly in men, with older ones exhibiting significant lower anabolism compared with young ones. As most of the anabolism occurs during feeding, we studied the fed-state metabolic responses with aging using the hyperinsulinemic, hyperglycemic and hyperaminoacidemic clamp, including muscle biopsies. Older women showed comparable whole-body protein anabolic responses and stimulation of mixed-muscle protein synthesis by feeding to the young. The responses of skeletal muscle insulin signaling through the Akt-mTORC1 pathway were also unaltered, and therefore consistent with muscle protein synthesis results. Given that type 2 diabetes infers insulin resistance of protein metabolism with aging, we studied 10 healthy, 8 obese, and 8 obese type 2 diabetic elderly women using the HYPER-1 clamp. When compared to the group of young lean women to define the effects of obesity and diabetes with aging, whole-body change in net protein balance with hyperinsulinemia was similarly blunted in obese and diabetic older women. However, only elderly obese women with diabetes had lower net balance than lean older women. We conclude that with usual aging, the blunted whole-body anabolic response in elderly subjects is mediated by the failure of insulin to stimulate protein synthesis to the same extent as in the young, especially in men. This blunted response can be overcome at the whole-body and muscle levels during an intravenous fed state supplying a generous amount of protein, in active healthy elderly women. Obese elderly women with and without type 2 diabetes have insulin resistance of protein anabolism at the whole-body level, but this resistance is worsened with diabetes when glucose metabolism is further impaired. More investigation is needed to determine the exact role of insulin in promoting anabolism with aging. The findings from our group are relevant for the field of sarcopenia research as they provide a rationale to offer low cost nutritional interventions for overcoming this detrimental condition associated with aging and diabetes.
•The insulin resistance of glucose metabolism of aging extends to protein metabolism.•Generous protein intake with feeding overcomes the protein anabolic resistance of aging.•Healthy older women maintain stimulation of muscle protein synthesis by feeding.•Muscle insulin signaling responses to feeding are unaltered in healthy older women.•There is similar blunted protein anabolism in obese and diabetic older women.
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