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

Gas-phase and heat-exchange effects on the ignition of high- and low-exothermicity porous solids subject to constant heating

This article investigates the ignition of low-exothermicity reactive porous solids exposed to a maintained source of heat (hotspot), without oxygen limitation. The gas flow within the solid, particularly in response to pressure gradients (Darcy’s law), is accounted for. Numerical experiments related to the ignition of low-exothermicity porous materials are presented. Gas and solid products of reaction are included. The first stage of the paper examines the (pseudo-homogeneous) assumption of a single temperature for both phases, amounting to an infinite rate of heat exchange between the two. Isolating the effect of gas production and flow in this manner, the effect of each on the ignition time is studied. In such cases, ignition is conveniently defined by the birth of a self-sustained combustion wave. It is found that gas production decreases the ignition time, compared to equivalent systems in which the gas-dynamic problem is effectively neglected. The reason for this is quite simple; the smaller heat capacity of the gas allows the overall temperature to attain a higher value in a similar time, and so speeds up the ignition process. Next, numerical results using a two-temperature (heterogeneous) model, allowing for local heat exchange between the phases, are presented. The pseudo-homogeneous results are recovered in the limit of infinite heat exchange. For a finite value of heat exchange, the ignition time is lower when compared to the single-temperature limit, decreasing as the rate of heat exchange decreases. However, the decrease is only mild, of the order of a few percent, indicating that the pseudo-homogeneous model is in fact a rather good approximation, at least for a constant heat-exchange rate. The relationships between the ignition time and a number of physico-chemical parameters of the system are also investigated

Comparison of Different Additive Manufacturing Methods Using Optimized Computed Tomography

Additive manufacturing (AM) allows for fast fabrication of three dimensional objects with the possibility of use of considerably less resources than would be the case in traditional manufacturing. AM is a fast and cost effective method which boasts the ability to produce components with a previously unachievable level of geometric complexity in end user industrial applications in areas such as the aerospace and automotive industries. However these processes currently lack reproducibility and repeatability with some ‘prints’ having a high rate requiring rework or even scrapping. It is therefore imperative that robust quality systems can be implemented such that the waste level of these processes can be eliminated or decreased. This study presents an artefact that has been optimised for characterisation using computed tomography (CT) with representative AM internal channels and structures. Furthermore the optimisation of the CT acquisition conditions for this artefact is presented in light of analysis of form, internal feature dimensions and position and material porosity