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BACKGROUND: Rib fractures are one of the most common traumatic injuries and may result in significant morbidity and mortality. Despite growing evidence, technological advances and increasing acceptance, surgical stabilization of rib fractures (SSRF) remains not uniformly considered in trauma centers. Indications, contraindications, appropriate timing, surgical approaches and utilized implants are part of an ongoing debate. The present position paper, which is endorsed by the World Society of Emergency Surgery (WSES), and supported by the Chest Wall Injury Society, aims to provide a review of the literature investigating the use of SSRF in rib fracture management to develop graded position statements, providing an updated guide and reference for SSRF. METHODS: This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of experts then critically revised the manuscript and discussed it in detail, to develop a consensus on the position statements. RESULTS: A total of 287 studies (systematic reviews, randomized clinical trial, prospective and retrospective comparative studies, case series, original articles) have been selected from an initial pool of 9928 studies. Thirty-nine graded position statements were put forward to address eight crucial aspects of SSRF: surgical indications, contraindications, optimal timing of surgery, preoperative imaging evaluation, rib fracture sites for surgical fixation, management of concurrent thoracic injuries, surgical approach, stabilization methods and material selection. CONCLUSION: This consensus document addresses the key focus questions on surgical treatment of rib fractures. The expert recommendations clarify current evidences on SSRF indications, timing, operative planning, approaches and techniques, with the aim to guide clinicians in optimizing the management of rib fractures, to improve patient outcomes and direct future research.

Today, immersive technologies like Virtual Reality (VR) are regarded as disruptive tools in many domains, including education. While the body of literature in the field is growing, studies that present contrasting findings are not uncommon. In fact, although there is evidence of the benefits brought by VR in the educational processes, in some cases the effects of a possible trade-off between learning effectiveness and quality of the learning experience (or QoLE) may be observed. The two dimensions are difficult to disentangle, as besides learning effectiveness, other factors like motivation, technology acceptability, workload, presence, immersion, engagement, and usability come to play. This paper digs into the above scenario by focusing on the QoLE of immersive VR-based learning and comparing it with that of two conventional approaches (a physical prop-based one and a 3D desktop application). Separation of the two dimensions is pursued by imposing equality of the learning performance achieved with the three approaches, aiming at getting rid of possible confounding factors. From the results of the user study performed in the context of a STEM-related laboratory activity, the VR-based approach appeared to be generally superior to the prop-based approach and showed several advantages over the 3D desktop application.

Spin polarization in chiral molecules is a magnetic molecular response associated with electron transport and enantioselective bond polarization that occurs even in the absence of an external magnetic field. An unexpected finding by Santos and co-workers reported enantiospecific NMR responses in solid-state cross-polarization (CP) experiments, suggesting a possible additional contribution to the indirect nuclear spin-spin coupling in chiral molecules induced by bond polarization in the presence of spin-orbit coupling. Herein we provide a theoretical treatment for this phenomenon, presenting an effective spin-Hamiltonian for helical molecules like DNA and density functional theory (DFT) results on amino acids that confirm the dependence of J-couplings on the choice of enantiomer. The connection between nuclear spin dynamics and chirality could offer insights for molecular sensing and quantum information sciences. These results establish NMR as a potential tool for chiral discrimination without external agents.

BACKGROUND: The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. METHODS: Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. RESULTS: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patients directives, family feelings and representatives desires, and all decisions should be shared. CONCLUSIONS: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes.

BACKGROUND: Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. METHODS: This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. RESULTS: A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. CONCLUSIONS: The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.

Abstract Background Caregiver stress can pose serious health and psychological concerns, highlighting the importance of timely interventions for family caregivers of people with dementia. Single-session mindfulness-based interventions could be a promising yet under-researched approach to enhancing their mental well-being within their unpredictable, time-constrained contexts. This trial will evaluate the effectiveness and feasibility of a blended mindfulness-based intervention consisting of a single session and app-based follow-up in reducing caregiver stress. Methods/Design The study is a single-blinded randomized controlled trial with two arms (intervention versus an education session on dementia care) and assessments at baseline, 8 weeks, and 6 months. The eligibility criteria include: family caregivers aged 18 years or older; providing care for an individual with a confirmed medical diagnosis of dementia for at least 3 months prior to recruitment, with a minimum of 4 hours of daily contact; and exhibiting a high level of caregiver stress. The intervention comprises a 90-minute group-based session with various mindfulness practices and psychoeducation. Participants will receive a self-practice toolkit to guide their practice over a duration of 8 weeks. Sharing activities will be implemented through an online social media platform. The primary outcome is perceived caregiving stress. The secondary outcomes include depressive symptoms, positive aspects of caregiving, dyadic relationship, trait mindfulness, and neuropsychiatric symptoms of care recipients. The feasibility outcomes include eligibility and enrollment, attendance, adherence to self-practice, and retention, assessed using mixed methods. Discussion The study will contribute to the evidence base by investigating whether a single-session mindfulness intervention is effective and feasible for reducing caregiver stress among family caregivers of people with dementia. Trial registration ClinicalTrials.gov, NCT06346223. Registered on April 3, 2024.

Abstract Background Rib fractures are one of the most common traumatic injuries and may result in significant morbidity and mortality. Despite growing evidence, technological advances and increasing acceptance, surgical stabilization of rib fractures (SSRF) remains not uniformly considered in trauma centers. Indications, contraindications, appropriate timing, surgical approaches and utilized implants are part of an ongoing debate. The present position paper, which is endorsed by the World Society of Emergency Surgery (WSES), and supported by the Chest Wall Injury Society, aims to provide a review of the literature investigating the use of SSRF in rib fracture management to develop graded position statements, providing an updated guide and reference for SSRF. Methods This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of experts then critically revised the manuscript and discussed it in detail, to develop a consensus on the position statements. Results A total of 287 studies (systematic reviews, randomized clinical trial, prospective and retrospective comparative studies, case series, original articles) have been selected from an initial pool of 9928 studies. Thirty-nine graded position statements were put forward to address eight crucial aspects of SSRF: surgical indications, contraindications, optimal timing of surgery, preoperative imaging evaluation, rib fracture sites for surgical fixation, management of concurrent thoracic injuries, surgical approach, stabilization methods and material selection. Conclusion This consensus document addresses the key focus questions on surgical treatment of rib fractures. The expert recommendations clarify current evidences on SSRF indications, timing, operative planning, approaches and techniques, with the aim to guide clinicians in optimizing the management of rib fractures, to improve patient outcomes and direct future research.

Abstract The canonical G406R mutation that increases Ca2+ influx through the CACNA1C-encoded CaV1.2 Ca2+ channel underlies the multisystem disorder Timothy syndrome (TS), characterized by life-threatening arrhythmias. Severe episodic hypoglycemia is among the poorly characterized non-cardiac TS pathologies. While hypothesized from increased Ca2+ influx in pancreatic beta cells and consequent hyperinsulinism, this hypoglycemia mechanism is undemonstrated because of limited clinical data and lack of animal models. We generated a CaV1.2 G406R knockin mouse model that recapitulates key TS features, including hypoglycemia. Unexpectedly, these mice do not show hyperactive beta cells or hyperinsulinism in the setting of normal intrinsic beta cell function, suggesting dysregulated glucose homeostasis. Patient data confirm the absence of hyperinsulinism. We discover multiple alternative contributors, including perturbed counterregulatory hormone responses with defects in glucagon secretion and abnormal hypothalamic control of glucose homeostasis. These data provide new insights into contributions of CaV1.2 channels and reveal integrated consequences of the mutant channels driving life-threatening events in TS.

Abstract The recording of planetary magnetic fields is often attributed to uniformly-magnetised nanoscopic iron oxides, called single-domain. Yet, the main magnetic constituents of rocks are more complex, non-uniformly magnetised grains in single or multi-vortex states. We know little about their behaviour due to limitations in defining their precise shape and internal magnetic structure. Here we combine non-destructive Ptychographic X-ray Computed Nano-tomography with micromagnetic modelling to explore the magnetic stability of remanence-bearing minerals. Applied to a microscopic rock sample, we identified hundreds of nanoscopic grains of magnetite/maghemite with diverse morphologies. Energy barrier calculations were performed for these irregularly shaped grains. For some grains, these morphological irregularities near the transition from single-domain to the single-vortex state allow for multiple domain states, some unstable and unable to record the field for significant periods. Additionally, some other grains exhibit temperature-dependent occupancy probabilities, potentially hampering experiments to recover the intensity of past magnetic fields.

The creative and dynamic practices that multilinguals perform with linguistic and non-linguistic features such as the body, movement, senses, and space have been documented as integral to their repertoire. Drawing on interdisciplinary literature, this article advances the concept of the repertoire through "translanguaging drama" as a pedagogical practice and examines the resources that can be volitionally mobilised through language learners' "perezhivanie", or the emotional, felt and lived through experience. Translanguaging drama was implemented in two English language programmes with adult learners in Canada. While these courses focused on improving English language skills, translanguaging drama was implemented to activate learners' "perezhivanie" while using their repertoire, which not only facilitated communication in the English language but pushed for agency in using non-linguistic resources. I examine learners' "perezhivanie" with a subset of data, which included observation notes and learner diary entries. In this article, I emphasize four main interrelated areas: (1) volition and empowerment; (2) meaning-making across languages; (3) embodiment of language - through voice modulation, facial expression, and body language; and (4) language choice triggered by "perezhivanie." Implications of the study for furthering the theorisation of language, language learning and the repertoire are discussed.

As plurilingual/multilingual research advances, factors that contribute to or hinder individual's flexible language use are still underexplored. Questions such as "Why do some people identify as plurilingual and pluricultural while others do not?" and "What factors contribute to high levels of plurilingual and pluricultural competence (PPC)?" remain unknown. This article presents results of a mixed methods study with 250 plurilingual participants in the multilingual city of Montreal, Canada. Data was collected through a demographic questionnaire, the Plurilingual and Pluricultural Identity Questionnaire (PPIQ) and the Plurilingual and Pluricultural Competence (PPC) scale. Results show that a vast majority of participants identified as plurilingual and pluricultural, and seven reasons for shaping this identity were found: rich repertoire, lived experiences, awareness of differences and similarities, transculturalism, adaptation and integration, translanguaging, and openness. Moreover, there was a significant difference in PPC scores between Canadian-born participants and participants born outside of Canada, suggesting that speakers of minority languages in Canada have lower PPC scores compared to speakers of Canada's official languages. These results are significant as they enhance our understanding of language use and identity, suggesting that plurilingualism and pluriculturalism can be the new norm in multilingual contexts but minority languages need further recognition.

Plurilingualism is an inclusive language teaching approach to sustain multilingual societies, but there is little investigation on teacher candidates' (TCs) beliefs and challenges before and after its implementation. This interpretive qualitative study introduced plurilingualism in teacher education at a Canadian university. Sixteen TCs participated in the study, which 1) investigated TCs' conceptualizations of plurilingualism, and 2) examined TCs' perceptions of overall affordances of critical plurilingual pedagogies before and after their practicum. For four months, participants experimented with plurilingual pedagogies such as translanguaging and cross-linguistic analysis, designed tasks, and taught lessons. Five types of data were generated: 1) weekly annotations of readings on Perusall, 2) designed language tasks, 3) task delivery demonstrations, 4) lesson plans, and 5) final reflection after the teaching practicum. Inductive content analysis was conducted on NVivo with data triangulation. Findings suggest that TCs shifted their views of language, and aligned plurilingual pedagogies with equity, diversity, inclusion and decoloniality principles. Findings also show that TCs transgressed the monolingual discourses often present in schools, and felt empowered after the training. We call for the inclusion of critical plurilingual practices in teacher education programs for the sustainability of multi/plurilingualism.

While the use of appropriate linguistic items is essential for successful communication in any language, sociocultural factors also play an important role. Intercultural communicative competence is one dimension of sociocultural awareness that has been recognized as integral for communicative competence, but its practical application remains a challenge, possibly due to the fact that language educators tend to have more knowledge about the target language than its related cultural aspects (Celce-Murcia, 2007). While cultural references are, even if implicitly, prevalent in textbooks, teacher discourse, and the media, they are often reduced to “American” or “British” while the culture of speakers of English from many other countries, including Brazil, are often ignored. Another important dimension that positively affects language and cultural learning is the representation of one’s identity (Norton, 2013). In this sense, implementing intercultural communicative competence (ICC) in English Language Teaching (ELT) allows learners to express their identities while engaging in meaningful discussions about cultural views. This article provides a brief overview of communicative competence and draws on Byram’s (1997) model of ICC to suggest pedagogical applications aimed at validating student identity in English language classes, particularly but not exclusively, in Brazil

Organizations are keenly interested in data gathering from websites where discussions of products and brands occur. This increasingly means that programmers need an understanding of how to work with website application programming interfaces (APIs) for data acquisition. In this hands-on lab activity, students will learn how to gather data from several prominent websites using APIs and then build predictive models using that data. Unlike popular challenges on competition sites such as Kaggle where challenges often supply the data, this project emphasizes the data acquisition step of the analytics lifecycle. Working with data from Spotify, YouTube, and Twitter, students will fill out a music based March Madness bracket to predict the winner of the annual Locura De Marzo, a popular middle and high school Spanish competition. By becoming familiar with the data available from each site, through the analysis of the JSON formatted data returned by the APIs, students will be able to explore which features of a song might lend themselves to higher voting by high school students in order to build better prediction models.

Enhanced perioperative care protocols become the standard of care in elective surgery with a significant improvement in patients outcome. The key element of the enhanced perioperative care protocol is the multimodal and interdisciplinary approach targeted to the patient, focused on a holistic approach to reduce surgical stress and improve perioperative recovery. Enhanced perioperative care in emergency general surgery is still a debated topic with little evidence available. The present position paper illustrates the existing evidence about perioperative care in emergency surgery patients with a focus on each perioperative intervention in the preoperative, intraoperative and postoperative phase. For each item was proposed and approved a statement by the WSES collaborative group.

In Italy, the use of autogenous inactivated vaccines prepared with the bacterial strains isolated from affected animals is authorized by the Ministry of Health in farms where bacterial diseases occur frequently. The autogenous vaccine performed using Pasteurella multocida is frequently used in rabbit farms, but the feedback of its application is not available. Therefore, the aim of this study is to give information about the impact on the clinical signs of a bivalent autogenous vaccine in rabbits of a genetic centre. The vaccine was prepared using two P. multocida strains belonging to serogroups A and F, equipped with virulence genes and responsible for cyclical outbreak of pasteurellosis in the farm. The vaccine was administered with a first injection, followed by another one after 15 days, then another one four months after the first injection, and then continuing with a further injection every six months to all rabbits. Clinical conditions and mortality rates were monitored for two years after the first vaccination. The improvement in clinical condition and the decrease of the mortality rate were significant especially in the first year post-vaccine. In addition, the number of animals removed due to the disease decreased greatly. Based on the finding of P. multocida strains belonging to serogroup D and serogroup A equipped with different virulence-gene patterns from those previously found, we suggest that the vaccine was unable to prevent the introduction and spreading of new strains among the rabbits.