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== '''[[Evidence-based medicine]]''' ==
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'''Evidence-based medicine''' is ''"the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients."''<ref name="pmid8555924">{{cite journal |author=Sackett DL ''et al.''|title=Evidence based medicine: what it is and what it isn't |journal=BMJ |volume=312 |pages=71–2 |year=1996 |pmid=8555924 |doi=}}</ref> Alternative definitions are "''the process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions''"<ref name="pmid1404801">{{cite journal |author= |title=Evidence-based medicine. A new approach to teaching the practice of medicine. Evidence-Based Medicine Working Group|author=Evidence-Based Medicine Working Group |journal=JAMA |volume=268 |pages=2420–5 |year=1992 |pmid=1404801 |doi=}}</ref> or "''evidence-based medicine (EBM) requires the integration of the best research evidence with our clinical expertise and our patient's unique values and circumstances''."<ref name="isbn0-443-07444-5">{{cite book |author=Glasziou, Paul; Strauss, Sharon Y. |title=Evidence-based medicine: how to practice and teach EBM |publisher=Elsevier/Churchill Livingstone |location= |year=2005 |pages= |isbn=0-443-07444-5 |oclc= |doi=}}</ref>  Better known as EBM, evidence based medicine has roots in clinical [[epidemiology]] and the [[scientific method]], and emerged in the early 1990's in response to discoveries about variations and deficiencies<ref name="pmid18361259">{{cite journal |author=Thier SL, Yu-Isenberg KS, Leas BF ''et al'' |title=In chronic disease, nationwide data show poor adherence by patients to medication and by physicians to guidelines |journal=Manag Care |volume=17  |pages=48-52, 55-7 |year=2008 |pmid=18361259 |doi= |issn=}}</ref> in medical care to help healthcare providers and policy makers evaluate the efficacy of different treatments.
==Footnotes==
 
''[[Evidence-based medicine|.... (read more)]]''
 
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Latest revision as of 10:19, 11 September 2020

Nuclear weapons proliferation is one of the four big issues that have held back worldwide deployment of peaceful nuclear power. This article will address the proliferation questions raised in Nuclear power reconsidered.

As of 2022, countries with nuclear weapons have followed one or both of two paths in producing fissile materials for nuclear weapons: enrichment of uranium to very high fractions of U-235, or extraction of fissile plutonium (Pu-239) from irradiated uranium nuclear reactor fuel. The US forged the way on both paths during its World War II Manhattan Project. The fundamental aspects of both paths are well understood, but both are technically challenging. Even relatively poor countries can be successful if they have sufficient motivation, financial investment, and, in some cases, direct or illicit assistance from more technologically advanced countries.

The International Non-proliferation Regime

The International Atomic Energy Agency (IAEA) has a vigorous program to prevent additional countries from acquiring nuclear weapons. The Treaty on the Non-Proliferation of Nuclear Weapons (NPT) is the cornerstone arrangement under which strategic rivals can trust, by independent international verification, that their rivals are not developing a nuclear weapons threat. The large expense of weapons programs makes it very unlikely that a country would start its own nuclear weapons program, if it knows that its rivals are not so engaged. With some notable and worrying exceptions, this program has been largely successful.

Paths to the Bomb

It is frequently claimed that building a civil nuclear power program adds to the weapons proliferation risk. There is an overlap in the two distinct technologies, after all. To build a bomb, one needs Highly Enriched Uranium (HEU) or weapons-grade plutonium (Pu-239). Existing reactors running on Low Enriched Uranium (LEU, under 5% U-235) or advanced reactors running on High Assay LEU (HALEU,up to 20% U-235) use the same technology that can enrich uranium to very high levels, but configured differently. Enrichment levels and centrifuge configurations can be monitored using remote cameras, on-site inspections, and installed instrumentation -- hence the value of international inspections by the IAEA. Using commercial power reactors as a weapons plutonium source is an extremely ineffective, slow, expensive, and easily detectable way to produce Pu. Besides the nuclear physics issues, refueling pressurized water reactors is both time-consuming and obvious to outside observers. That is why the US and other countries developed specialized Pu production reactors and/or uranium enrichment to produce fissile cores for nuclear weapons.

Future Threats and Barriers

Minimizing the risk of future proliferation in states that want to buy nuclear reactors or fuel might require one or more barriers:
1) Insisting on full transparency for all nuclear activities in buyer states, including monitoring and inspections by the International Atomic Energy Agency (IAEA).
2) Limiting fuel processing to just a few supplier states that already have weapons or are approved by the IAEA.
3) Ensuring that fuel at any stage after initial fabrication has an isotopic composition unsuitable for weapons. "Spiking" the initial fuel with non-fissile isotopes, if necessary.
4) Limiting the types of reactors deployed to buyer states. In general, breeders are less secure than burners. Sealed reactor modules are more secure than reactors with on-site fuel processing.
5) Providing incentives and assurances for buyer states to go along with all of the above.
6) Application of diplomatic pressure, sanctions, and other economic measures to non-compliant states.
7) Agreement that any reactor declared rogue by the IAEA will be "fair game" for any state feeling threatened.

Footnotes