Diversity and ethics in trauma and acute care surgery teams: results from an international survey

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

Systems biology approach on the elucidation of the response of Medicago truncatula plants towards salinity stress

Salt stress is one of the most important factors limiting plant productivity, with salinity affecting plant physiology and metabolism at multiple levels. The aim of this study was to explore, elucidate and decipher the role of antioxidant and salt tolerance mechanisms in the model legume Medicago truncatula. For this reason, three ecotypes of M. truncatula showing differential response to salinity were used: Jemalong A17 (moderate response), TN6.18 (sensitive to salinity) and TN1.11 (tolerant to salinity). Cellular damage levels were monitored in roots and leaves after 48 h of salt stress application with 200 mM NaCl by measuring lipid peroxidation levels, as well as nitric oxide and hydrogen peroxide content, further supported by leaf stomatal conductance and chlorophyll fluorescence readings. The salt-tolerant genotype TN1.11 displayed the lowest cellular damage and ROS/RNS content, while the salt-sensitive TN6.18 was affected the greatest. Transcriptional profiling using microarray analysis of salt-stressed M. truncatula displayed differential gene expression that was both genotype and tissue-dependent. A large number of regulatory genes (associated or not previously linked with salinity stress) from a variety of biochemical pathways showed a significant induction/suppression pattern. Furthermore, metabolite profiling of M. truncatula plants was employed to analyse the effect of salt stress in the accumulation of key metabolites and their interrelationships, leading to exclusive insights into the plants' metabolic networks which however appear to be genotype- and not tissue-dependent. This global approach (with the addition of currently performed proteomics analysis) will hopefully contribute in gaining new insights into the cellular response to salt stress in M. truncatula plants

Multinational firms and the management of global networks: insights from Global Value Chain studies

This paper aims at enriching the literature on international business (IB) studies to include insights from Global Value Chain (GVC) analysis to better explain how MNCs can orchestrate a global network organization. A first important contribution of the GVC literature is that it shifts the focus from single firms to their value chains, providing instruments to study how activities are split and organized among different firms at the industry level, and how MNCs can implement different governing mechanisms within a network-based setting. The GVC literature also highlights that retailers (as global buyers) often act as \u2018lead firms\u2019 in shaping the trajectories of global industries, while IB studies have so far focused predominantly on manufacturing firms. A fine-grained analysis of alternative forms of governance characterizing value chains can offer additional elements in explaining how MNCs can manage their network relationships in a global scenario. Finally, through their focus on upgrading, GVC studies suggest that knowledge flows and innovation dynamics taking place within value chains are as important as those taking place within the MNC\u2019s organizational border. We conclude by arguing that these insights can help the IB literature to examine the challenges and opportunities MNCs face in engaging with suppliers and to explain the dynamic evolution of orchestrating global activities at the global level

Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

Background Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile. Results A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. Discussion Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions