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

Transient response under ultrafast interband excitation of an intrinsic graphene

The transient evolution of carriers in an intrinsic graphene under ultrafast excitation, which is caused by the collisionless interband transitions, is studied theoretically. The energy relaxation due to the quasielastic acoustic phonon scattering and the interband generation-recombination transitions due to thermal radiation are analyzed. The distributions of carriers are obtained for the limiting cases when carrier-carrier scattering is negligible and when the intercarrier scattering imposes the quasiequilibrium distribution. The transient optical response (differential reflectivity and transmissivity) on a probe radiation and transient photoconductivity (response on a weak dc field) appears to be strongly dependent on the relaxation and recombination dynamics of carriers.Comment: 9 pages, 8 figure

Chylous Leak During Posterior Approach to Juvenile Scoliosis Surgery: A Case Report.

CaseWe report the first documented case of chylous leak recognized intraoperatively during posterior spinal instrumentation and fusion for juvenile scoliosis in a female patient with a history of thoracotomy and decortication for an empyema.ConclusionsThoracic duct injury can lead to severe morbidity and mortality because of chylothorax formation. Although chylous leaks are a well-documented complication of the anterior approach to spine surgery, leaks during the posterior approach are rarely reported. When these chylous leaks are recognized intraoperatively, the likelihood of serious complications may be minimized by drain placement before closure

Energy relaxation of an excited electron gas in quantum wires: many-body electron LO-phonon coupling

We theoretically study energy relaxation via LO-phonon emission in an excited one-dimensional electron gas confined in a GaAs quantum wire structure. We find that the inclusion of phonon renormalization effects in the theory extends the LO-phonon dominated loss regime down to substantially lower temperatures. We show that a simple plasmon-pole approximation works well for this problem, and discuss implications of our results for low temperature electron heating experiments in quantum wires.Comment: 10 pages, RevTex, 4 figures included. Also available at http://www-cmg.physics.umd.edu/~lzheng

Cation-ordering effects in the single layered manganite La(2/3)Sr(4/3)MnO4

We have synthesized epitaxial La(1-x)Sr(1+x)MnO4 (x=1/3) films as random alloys and cation-ordered analogues to probe how cation order affects the properties of a 2D manganite. The films show weak ferromagnetic ordering up to 130 K, although there is a dramatic difference in magnetic anisotropy depending on the cation order. While all films exhibit similar gapped insulator behavior above 130 K, there is a significant difference in the low temperature transport mechanism depending on the cation order. Differences in magnetic anisotropy and low temperature transport are consistent with differences in Mn 3d orbital occupancies. Together this work suggests that cation ordering can significantly alter the Mn 3d orbital ground state in these correlated electron systems.Comment: 4 figure

Synaptic proteins promote calcium-triggered fast transition from point contact to full fusion.

The molecular underpinnings of synaptic vesicle fusion for fast neurotransmitter release are still unclear. Here, we used a single vesicle-vesicle system with reconstituted SNARE and synaptotagmin-1 proteoliposomes to decipher the temporal sequence of membrane states upon Ca(2+)-injection at 250-500 μM on a 100-ms timescale. Furthermore, detailed membrane morphologies were imaged with cryo-electron microscopy before and after Ca(2+)-injection. We discovered a heterogeneous network of immediate and delayed fusion pathways. Remarkably, all instances of Ca(2+)-triggered immediate fusion started from a membrane-membrane point-contact and proceeded to complete fusion without discernible hemifusion intermediates. In contrast, pathways that involved a stable hemifusion diaphragm only resulted in fusion after many seconds, if at all. When complexin was included, the Ca(2+)-triggered fusion network shifted towards the immediate pathway, effectively synchronizing fusion, especially at lower Ca(2+)-concentration. Synaptic proteins may have evolved to select this immediate pathway out of a heterogeneous network of possible membrane fusion pathways.DOI:http://dx.doi.org/10.7554/eLife.00109.001

Temporal stimulated intersubband emission of photoexcited electrons

We have studied the transient evolution of electrons distributed over two levels in a wide quantum well, with the two levels below the optical phonon energy, after an ultrafast interband excitation and cascade emission of optical phonons. If electrons are distributed near the top of the passive region, a temporal negative absorption appears to be dominant in the intersubband response. This is due to the effective broadening of the upper level state under the optical phonon emission. We have then considered the amplification of the ground mode in a THz waveguide with a multiquantum well placed at the center of the cavity. A huge increase of the probe signal is obtained, which permits the temporal stimulated emission regime of the photoexcited electrons in the THz spectral region.Comment: 5 pages, 5 figures, brief repor