Ethical dilemmas in medical humanitarian practice: cases for reflection from Médecins Sans Frontières.

Médecins Sans Frontières (MSF) is an independent medical humanitarian organisation working in over 70 countries. It has provided medical assistance for over 35 years to populations vulnerable through conflict, disease and inadequate health systems. Medical ethics define the starting point of the relationship between medical staff and patients. The ethics of humanitarian interventions and of research in conflict settings are much debated. However, less is known about the ethical dilemmas faced by medical humanitarian staff in their daily work. Ethical dilemmas can be intensified in humanitarian contexts by insecure environments, lack of optimum care, language barriers, potentially heightened power discrepancies between care providers and patients, differing cultural values and perceptions of patients, communities and medical staff. Time constraints, stressful conditions and lack of familiarity with ethical frameworks can prevent reflection on these dilemmas, as can frustration that such reflection does not necessarily provide instant solutions. Lack of reflection, however, can be distressing for medical practitioners and can reduce the quality of care. Ethical reflection has a central role in MSF, and the organisation uses ethical frameworks to help with clinical and programmatic decisions as well as in deliberations over operational research. We illustrate and discuss some real ethical dilemmas facing MSF teams. Only by sharing and seeking guidance can MSF and similar actors make more thoughtful and appropriate decisions. Our aim in sharing these cases is to invite discussion and dialogue in the wider medical community working in crisis, conflict or with severe resource limitations

Commentary: Consent and confidentiality in publishing—the view of the BMJ’s ethics committee,

Two years ago four paediatricians and an ethicist submitted to the BMJa case study as an ethical debate which the BMJ decided not to publish because the authors had not obtained the consent of the patient’s parents for publication. The authors submitted it elsewhere, and the article was published last year. Here the authors explain why they think the BMJshould have published despite the lack of consent (doi 10.1136/bmj.a1231); the editor of the journal that did publish the case study explains why he did so (doi: 10.1136/bmj.a1233); and two members of the BMJ’s ethics committee explain why they recommended not to publish it. An accompanying editorial explains why English law would now not allow the BMJto publish it without consent, even if we thought it reasonable to do so. We explain here the response of the BMJ’s ethics committee to the case study submitted by Isaacs and colleagues and make some broader points about the need for patient consent to publish case studies. We conclude that the “public interest” criterion for publication justifiably has a high threshold, which was not met by this paper. Yet we recognise that policy formation in this contested area can be difficult and that further debate is requiredThis article was written by Dr Ainsley Newson during the time of her employment with the University of Bristol, UK (2006-2012). Self-archived in the Sydney eScholarship Repository with permission of Bristol University, Sept 2014

Chemical and forensic analysis of JFK assassination bullet lots: Is a second shooter possible?

The assassination of President John Fitzgerald Kennedy (JFK) traumatized the nation. In this paper we show that evidence used to rule out a second assassin is fundamentally flawed. This paper discusses new compositional analyses of bullets reportedly to have been derived from the same batch as those used in the assassination. The new analyses show that the bullet fragments involved in the assassination are not nearly as rare as previously reported. In particular, the new test results are compared to key bullet composition testimony presented before the House Select Committee on Assassinations (HSCA). Matches of bullets within the same box of bullets are shown to be much more likely than indicated in the House Select Committee on Assassinations' testimony. Additionally, we show that one of the ten test bullets is considered a match to one or more assassination fragments. This finding means that the bullet fragments from the assassination that match could have come from three or more separate bullets. Finally, this paper presents a case for reanalyzing the assassination bullet fragments and conducting the necessary supporting scientific studies. These analyses will shed light on whether the five bullet fragments constitute three or more separate bullets. If the assassination fragments are derived from three or more separate bullets, then a second assassin is likely, as the additional bullet would not easily be attributable to the main suspect, Mr. Oswald, under widely accepted shooting scenarios [see Posner (1993), Case Closed, Bantam, New York].Comment: Published in at http://dx.doi.org/10.1214/07-AOAS119 the Annals of Applied Statistics (http://www.imstat.org/aoas/) by the Institute of Mathematical Statistics (http://www.imstat.org

Response to the Letter to the Editor

This paper has attracted interest around the world from the media (both TV and newspapers). In addition, we have received letters, emails and telephone calls. One of our favorites was a voicemail message asking us to return a call to Australia at which point we would learn who really killed JFK. We welcome the opportunity to respond to the letter to the editor from Mr. Fiorentino. Mr. Fiorentino claims that our ``statement relating to the likelihood of a second assassin based on the premise of three or more separate bullets is demonstrably false.'' In response we would like to simply quote from page 327 of Gerald Posner's book Case Closed, one of the most well known works supporting the single assassin theory: ``If Connally was hit by another bullet, it had to be fired from a second shooter, since the Warren Commission's own reconstructions showed that Oswald could not have operated the bolt and refired in 1.4 seconds.'' Mr. Fiorentino also claims that the ``second fatal flaw is the use of a rather uncomplicated formula based on Bayes Theorem.'' Let $E$ denote the evidence and $T$ denote the theory that there were just two bullets (and hence a single shooter). We used Bayes Theorem to hypothetically calculate $P(T|E)$ from $P(E|T)$ and the prior probability $P(T)$. In order to make $P(T|E)$ ten times more likely than $P(\bar{T}|E)$, the ratio of the prior probabilities [i.e., $P(T) / P(\bar{T})$] would have to be greater than 15. Thus, we again conclude that this casts serious doubt on Dr. Guinn's conclusion that the evidence supported just two bullets. Sadly, this is far from the first time that probability has been misunderstood and/or misapplied in a case of public interest. A notable British example is the Clark case. See Nobles and Schiff (2005) for details. Finally, we welcome and, in fact, encourage members of the scientific community to provide alternative analyses of the data.Comment: Published in at http://dx.doi.org/10.1214/07-AOAS154 the Annals of Applied Statistics (http://www.imstat.org/aoas/) by the Institute of Mathematical Statistics (http://www.imstat.org

Morphological Classification of Galaxies by Shapelet Decomposition in the Sloan Digital Sky Survey II: Multiwavelength Classification

We describe the application of the `shapelet' linear decomposition of galaxy images to multi-wavelength morphological classification using the $u,g,r,i,$ and $z$-band images of 1519 galaxies from the Sloan Digital Sky Survey. We utilize elliptical shapelets to remove to first-order the effect of inclination on morphology. After decomposing the galaxies we perform a principal component analysis on the shapelet coefficients to reduce the dimensionality of the spectral morphological parameter space. We give a description of each of the first ten principal component's contribution to a galaxy's spectral morphology. We find that galaxies of different broad Hubble type separate cleanly in the principal component space. We apply a mixture of Gaussians model to the 2-dimensional space spanned by the first two principal components and use the results as a basis for classification. Using the mixture model, we separate galaxies into three classes and give a description of each class's physical and morphological properties. We find that the two dominant mixture model classes correspond to early and late type galaxies, respectively. The third class has, on average, a blue, extended core surrounded by a faint red halo, and typically exhibits some asymmetry. We compare our method to a simple cut on $u-r$ color and find the shapelet method to be superior in separating galaxies. Furthermore, we find evidence that the $u-r=2.22$ decision boundary may not be optimal for separation between early and late type galaxies, and suggest that the optimal cut may be $u-r \sim 2.4$.Comment: 42 pages, 18 figs, revised version in press at AJ. Some modification to the technique, more discussion, addition/deletion/modification of several figures, color figures have been added. A high resolution version may be obtained at http://bllac.as.arizona.edu/~bkelly/shapelets/shapelets_ugriz.ps.g

A kernel extension to handle missing data

An extension for univariate kernels that deals with missing values is proposed. These extended kernels are shown to be valid Mercer kernels and can adapt to many types of variables, such as categorical or continuous. The proposed kernels are tested against standard RBF kernels in a variety of benchmark problems showing different amounts of missing values and variable types. Our experimental results are very satisfactory, because they usually yield slight to much better improvements over those achieved with standard methods.Postprint (author’s final draft

A 2dF spectroscopic study of globular clusters in NGC 5128: Probing the formation history of the nearest giant Elliptical

We have performed a spectroscopic study of globular clusters (GCs) in the giant elliptical NGC 5128 using the 2dF facility at the Anglo-Australian telescope. We obtained integrated optical spectra for a total of 254 GCs, 79 of which are newly confirmed on the basis of their radial velocities and spectra. In addition, we obtained an integrated spectrum of the galaxy starlight along the southern major axis. We derive an empirical metallicity distribution function (MDF) for 207 GCs (~14 of the estimated total GC system) based upon Milky Way GCs. This MDF is multimodal at high statistical significance with peaks at [Z/H]~-1.3 and -0.5. A comparison between the GC MDF and that of the stellar halo at 20 kpc (~4 Reff) reveals close coincidence at the metal-rich ends of the distributions. However, an inner 8 kpc stellar MDF shows a clear excess of metal-rich stars when compared to the GCs. We compare a higher S/N subsample (147 GCs) with two stellar population models which include non-solar abundance ratio corrections. The vast majority of our sample (~90%) appears old, with ages similar to the Milky Way GC system. There is evidence for a population of intermediate-age (~4-8 Gy) GCs (<15% of the sample) which are on average more metal-rich than the old GCs. We also identify at least one younger cluster (~1-2 Gy) in the central regions of the galaxy. Our observations are consistent with a picture where NGC 5128 has undergone at least two mergers and/or interactions involving star formation and limited GC formation since z=1, however the effect of non-canonical hot stellar populations on the integrated spectra of GCs remains an outstanding uncertainty in our GC age estimates.Comment: 17 figures, some long table

Sampling Plans for Control-Inspection Schemes Under Independent and Dependent Sampling Designs With Applications to Photovoltaics

The evaluation of produced items at the time of delivery is, in practice, usually amended by at least one inspection at later time points. We extend the methodology of acceptance sampling for variables for arbitrary unknown distributions when additional sampling infor- mation is available to such settings. Based on appropriate approximations of the operating characteristic, we derive new acceptance sampling plans that control the overall operating characteristic. The results cover the case of independent sampling as well as the case of dependent sampling. In particular, we study a modified panel sampling design and the case of spatial batch sampling. The latter is advisable in photovoltaic field monitoring studies, since it allows to detect and analyze local clusters of degraded or damaged modules. Some finite sample properties are examined by a simulation study, focusing on the accuracy of estimation