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Background Emergency surgery represents a unique context. Trauma teams are often multidisciplinary and need to operate under extreme stress and time constraints, sometimes with no awareness of the trauma’s causes or the patient’s personal and clinical information. In this perspective, the dynamics of how trauma teams function is fundamental to ensuring the best performance and outcomes. Methods An online survey was conducted among the World Society of Emergency Surgery members in early 2021. 402 fully filled questionnaires on the topics of knowledge translation dynamics and tools, non-technical skills, and difficulties in teamwork were collected. Data were analyzed using the software R, and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results Findings highlight how several surgeons are still unsure about the meaning and potential of knowledge translation and its mechanisms. Tools like training, clinical guidelines, and non-technical skills are recognized and used in clinical practice. Others, like patients’ and stakeholders’ engagement, are hardly implemented, despite their increasing importance in the modern healthcare scenario. Several difficulties in working as a team are described, including the lack of time, communication, training, trust, and ego. Discussion Scientific societies should take the lead in offering training and support about the abovementioned topics. Dedicated educational initiatives, practical cases and experiences, workshops and symposia may allow mitigating the difficulties highlighted by the survey’s participants, boosting the performance of emergency teams. Additional investigation of the survey results and its characteristics may lead to more further specific suggestions and potential solutions.

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance.

Introduction: There is a need to increase understanding of oesophagogastric cancer biology and develop methods for determining prognosis. Hypoxia is implicated in the aetiology and prognosis of a number of cancers, but has not been studied in oesophagogastric cancer. It is important to understand the patient and tumour characteristics that might influence biological data. For example, tumour length and circumferential resection margin (CRM) status have not been adequately assessed as prognostic markers in oesophageal cancer. Aims: 1) To investigate the relationship of tumour length and CRM with other histopathological variables and survival in patients with surgically treated oesophageal cancer. 2) To establish a retrospective database of patients with gastric and gastro-oesophageal junctional (GOJ) cancer; analyse relevant clinico-pathological prognostic factors prior to molecular marker analysis. 3) To investigate HIF-1α and HIF-2α expression as prognostic markers in gastric and GOJ cancer. 4) To investigate HIF- 1α and other related markers (HIF-2α, Epo, Epo-R, Glut-1, Ki67, VEGF) in oesophageal and gastric adenocarcinorna carcinogenesis. 5) To establish a prospective study to measure tumour hypoxia (by pimonidazole staining). Findings: 1) Both tumour length and CRM status were independent prognostic factors in surgically treated patients with oesophageal cancer. 2) A retrospective database of 251 patients was established. Only additional surgical resection of the spleen or pancreas and ASA grade were independent predictors of prognosis. 3) In 177 patients for whom tissue was obtained, HIF- 1α expression had no prognostic significance. However, HIF- 1α expression pattern was a significant predictor of survival on univariate analysis; patients with HIF-la expression at the invasive edge had a median survival of only 18 mths compared with 33 mths in HIF-1α negative tumours. HIF-2α expression was a prognostic factor on univariate analysis. Neither HIF-1α nor HIF-2α had independent prognostic significance. 4) The expression of the hypoxia associated markers increased significantly from normal tissue to invasive malignancy in both the oesophageal and gastric carcinogenesis models. 5) A prospective study was established after LREC and R&D approval was obtained. Data for the first 9 patients enrolled showed infra and inter-tumoral variation in hypoxia. Conclusions: 1) The development of imaging approaches for assessing tumour length pre-operatively would be of value. CRM should continue to be reported on routine histopathology. 2) There are clinico-pathological and prognostic differences between GOJ and other gastric tumours. A standard classification of GOJ tumours should be adopted internationally. 3) The dependence of HIF-1α as a prognostic factor on staining pattern may be due to its differential regulation of down-stream molecules. As neither HIF-1α or HIF-2α had independent prognostic significance, they are unlikely to play a role as single markers of prognosis. The high expression of HIF-2α suggests its further study as a therapeutic target would be of value. 4) HIF-2α should be assessed as a predictive marker of disease progression in patients with Barrett's dysplasia. 5) Some oesophagogastric cancers are strongly hypoxic.

The institute sought to recruit a \"cadre of scientists\" and would train them in public relations. As many as 20 \"respected climate scientists\" would \"inject credible science and scientific accountability into the global climate debate, thereby raising questions about and undercutting the `prevailing scientific wisdom.'\" A team of five \"independent scientists\" would be identified, recruited and trained to participate in media outreach -- that is, radio and television talk shows -- and $600,000 was earmarked for science writers, editors and journalists. All, in the words of the institute, geared to \"maximize the impact of scientific views consistent with ours on Congress, the media and other key audiences.\" Among those corporations actively involved in drafting this plan were Exxon, Chevron and the Southern Co. The GCC is known as the \"leading voice for business and industry in the climate change debate.\" In addition to individual corporate members, the GCC includes powerful industry groups such as the American Petroleum Institute, the American Iron and Steel Institute, the American Automobile Manufacturers Association, the American Forest and Paper Association, the Air Transport Association, the Association of American Railroads, the Chemical Manufacturers Association, the National Association of Manufacturers, the National Mining Association, the Society of the Plastics Industry and the U.S. Chamber of Commerce. In short, a Who's Who of American heavy industry Its philosophy has been to insist, first, that \"science -- not emotional or political reactions -- must serve as the foundation for global climate policy decisions,\" and second, that \"policy decisions must consider the economic and social impacts of alternative policy choices.\" Any solution must be equitable for all countries, and \"technology transfer\" and free trade offer the best fixes, assuming that fixes are required. Although the mission of the GCC seems reasonable on its face, it barely masks its essential agenda, which is to prevent any attempt to regulate its members or hold them responsible for global warming and its effects. Although the GCC purportedly believes that science should rule the debate on climate change, like all of the industry-sponsored media initiatives, it has vigorously attacked any science that links global warming to greenhouse gases, and promotes any view that casts doubt upon global warming. Of the three, Michaels, a climatologist from the University of Virginia, has been the most visible and his testimony and writings have been cited frequently by anti-regulatory critics of global warming accords. Michaels came to the attention of Western Fuels Association, a leading backer of ICE, in 1989, with an article he wrote in the Washington Post entitled \"The Greenhouse Climate of Fear.\" In it he expressed his opposition to what he calls \"apocalyptic environmentalism,\" which he describes as \"the most popular new religion to come along since Marxism.\" Michaels considers the issue of global warming to be driven by \"very powerful special interests\" that exploit people's fears.

Justice Antonio Lamer, in writing the unanimous decision, specifically denounced the lower court's practice of \"strait-jacketing\" First Nations by limiting their rights to simply hunting and fishing, ruling that aboriginal title gives Indian tribes the rights of occupancy: \"Aboriginal title encompasses the right to use the land held pursuant to that title for a variety of purposes, which need not be aspects of those aboriginal practices, cultures and traditions which are integral to distinctive aboriginal cultures.\" The court also eased the high standards needed by First Nations to prove their claim, ruling that the Indians had only to prove that they occupied a disputed area when Canadian title was established, rather than in 1763, when a British royal proclamation set the boundaries for colonial settlers.

The Indian youth felt that their generation was becoming less interested in changing the world and more interested in their own lives, following the trend of non-Indian youth towards a growing \"Me Generation.\" Their feelings on how their peers view social responsibility differed markedly from older respondents. For the older set, fully one-third felt their generation \"would like to change things and make the world a better place\" whereas among those under 26, only a quarter thought their generation had the same aspiration. One-third of those over 25 thought their generation \"want to make a difference\" in their home community, whereas only a little more than one in five youth felt that their generation aspired to the same goals. The younger generation, on the other hand, was much more likely to say that their generation wanted to \"enjoy themselves while they can\" or that \"the most important thing is to get a good job.\" Almost one-third of the younger generation felt that their generation was \"confused\" and could not make their minds up as to what they want, where 14 percent of the older set believed that of their generation. The most frequent reason given for Indian youth dropping out was problems at home or parents that did not encourage students to excel. An 18-year-old woman from Hoopa Valley said: \"The most important factor I see behind what a child makes of his or her life starts in the home. If the child doesn't have someone there to support, guide, encourage, and instruct them, they are left to fight in this world all alone. That is often overwhelming and leads many to take the easy route (i.e. drugs, gangs, etc.).\" An 18-year-old Pima girl shared the same thoughts: \"I personally think so many Indian youth drop out because their parents don't give them the support they need in those critical young years.\" Indeed, there may be a relationship between home life and self-esteem. According to a 24-year-old Oglala woman from Pine Ridge: \"So many Indian youth drop out because most parents don't encourage their children to achieve. Many want their kids to stay at home and take care of the younger children. Many parents are too busy looking at the negative to acknowledge the positive in their children.\" A 19-year-old Navajo woman adds, \"So many Indian youth drop out because there is no confidence coming from their parents.\" Finally, a 23-year-old man from Leech Lake summed it up: \"Many Indian youths drop out because of their home life. The schools can't make them stay in classes. It's the parent's job to let their children know that education is crucial.\" More scholarships and funding were also seen as important in keeping kids enrolled, and many suggestions were geared to changes in the schools. A 16-year-old Navajo said, \"I think they drop out because they do not feel they can incorporate their Native American values into their school lives. By incorporating more traditional values and ideas into school life, more schools may keep more Native Americans from dropping out.\" A 22-year-old Mohawk woman added: \"We need culture in our schools, we need to get credit for thinking the way we do (and more financial aid to do it).\" A 19-year-old Laguna Pueblo woman noted that \"I think we need more structure and teachers that are not so lenient. If students had more discipline here I think there would be much more success in Indian education.\" A 22-year-old Chickasaw woman felt that \"Indian federal schools are very unorganized and don't have the means to offer their students really good services\" and that they \"treat you like you are looking for a handout.\"

After scraping up the full $100,000, what the tribe got was an intimate meeting with Clinton, akin to the \"coffees\" that have been part of the administration's ever widening campaign scandals. At the luncheon, at which executives from big corporations who had also donated large sums of money to the campaign were present, Clinton, according to Charles Surveyor, a tribal leader, \"looked me straight in the eve and said, `We'll see what we can do for you.'\" When the news of the contribution and its circumstances found its way to Capitol Hill, the Republicans leading investigations into campaign finance abuses outdid each other showing their outrage. During the hearings on campaign finance, Senator Don Nickles, R-Okla., called the contribution \"an outlandish shakedown\" which \"when you are hitting up a group like this, a very low income tribe, it makes it doubly as bad.\" Senator Nickles, who happens to be from Oklahoma, failed to mention was that he has consistently blocked previous efforts by the Agriculture Department to return the land to the tribe. Indeed, there are many who believe that the Senator s ties to the wealthy oil and gas industry, who are interested in purchasing the land, are the main reason why the tribe has been unable to get their land back and why they embarked on such a desperate measure in the first place.

The brazenness of Venezuela's rush for gold in particular the mining of the sensitive Imataca forest, has led to a small backlash, and scandals have erupted over the awarding of concessions. But for a government that was named by the business research group Transparency International as \"Latin America's most corrupt country\" -- no mean feat the future appears to be in the hands of the international mining companies. Government minister Teodoro Petkoff was blunt regarding Venezuela's great forest: \"nobody, but nobody, repeat nobody is going to impede the government's plans to open up the Imataca to mining interests.\" And the minister of the environment, Luis Castro Morales, has squashed any thoughts about evicting the miners in Canaima National Park, arguing that the concessions are \"giving security to the investor, that is what they are looking for.\" Naturally, the relaxed environmental rules have attracted some of mining's most notorious polluters, including Robert Friedland, whose Summitville mine in Colorado and Omai mine in Guiana both ended up spilling cyanide into nearby rivers, effectively killing them. (see \"World Bank Quietly Insures Major Polluters,\" in the Hemispheric Digest, Native Americas, Spring 1996) According to Leda Martins and Patrick Tierney, writing in the New York Times in 1993, Friedland's Venezuelan strip-mining venture is co-owned by a prominent naturalist who happens to be a respected research associate at the University of California and the New York Botanical Gardens. Charles Brewer-Carias, known for his work protecting the Yanomami, is \"running open-pit mines on more than 12,000 acres in the environmentally protected headwaters of the Cuyuni River.\" According to an investigation being conducted by the Venezuelan government, Brewer was using his anthropological field trips \"as a cover for illegal mining\" and he had previously been charged by the police with \"using unsalaried Maquiritare Indians in illegal mining operations in the Amazon.\"

Of the approximately 270,000 indigenous peoples -- in 554 separate communities living in Brazil today, few hold legal rights to their lands. Indeed more than half of these Indian communities' lands are not even recognized by the government. Of those 210 reservations that have been created, more than 80 percent are under assault by gold miners, colonists, timber companies, or cattle barons and the Brazilian government appears incapable and unwilling to afford even the slightest protection for Indian people, who find little security in their own reservations. While the plight of Brazilian Indians, as well as the destruction of the Amazon rainforest, has attracted international attention, it has done little over the years to stop the general historical trend of the 20th century -- a trend which is characterized by the continual theft and destruction of Indian lands, the obstinate refusal of the Brazilian government to uphold Indian rights and defend the integrity of Indian territories, and a pattern of indiscriminate violence against those Indians who would defend their people and way of life. Bandeira de Mello also began to institutionalize the prevailing development policies within the new agency. The goals of these policies as summarized by Sheldon Davis in Victims of the Miracle, were: \"(1) to integrate Indians as rapidly as possible into the expanding market economy and class structure of Brazil; and (2) to insure that Indians do not serve as an obstacle to the occupation and settlement of the Amazon.\" Accordingly, the president of FUNAI drafted a new Indian statute that provided for the relocation of Indians if necessary \"to carry out public works in the interest of national development\" and \"to work valuable subsoil deposits of outstanding interest.\" While the statute, eventually passed into law in 1973, also called for the complete demarcation of Indian lands by 1978, only 16 of the more than 540 Indian communities had reserves at that time -- this was certainly not one of Bandeira de Mello's priorities, not when the government had roads to build. Not even the Xingu Park was spared, despite vigorous opposition to highway BR-080 led by the Villas Boas brothers. Rather than coming to the park's defense, FUNAI attacked the park as \"an example of isolationism\" and defended the road, claiming that it would \"encourage the Indians to play a greater role in the national economy.\" Bandeira de Mello flatly decreed that \"the development of Brazil cannot be held back because of Xingu Park.\" BR-080 bulldozed through the northern part of the park, wreaking havoc on the Txukahamae tribe and cutting off more than 3,000 square miles of Indian land, land which was then given over to cattle ranchers. As the geographer Edwin Brooks grimly wrote in his article \"The Brazilian Road to Ethnocide,\" in Brazil \"Indian reserves are hardly worth the maps they are drawn on.\"