This article is based on an interview study which the author conducted to conceptualize Taiwanese EFL learners' L2 motivation through using the possible selves framework. Based on this interview study, the recently developed L2 Motivational Self System exerts its explanatory power in the Taiwanese EFL context; the ideal L2 self and the ought-to L2 self are helpful in informing the analysis of student motivation. The ideal L2 self illustrated with empirical evidence corresponds to its theoretical construct proposed by Dornyei (2005). Interestingly, however, the ought-to L2 self found amongst the student interviewees seems inconsistent with the original theoretical concept as it probably contains a mixture of prevention-and promotion-focused instrumentality in studying English. The shaping of the Taiwanese ought-to L2 self by the broader social context will be discussed in this article.Motivation is one of the most important variables of language learning, especially in second language (L2) acquisition. The extent of wanting to learn can make a difference in how willing and successful L2 learners can be. Discussions on L2 motivation theory were once dominated by goal-directed learning orientations in social psychological terms. Language learners would be classified as either integratively-or instrumentally-oriented (Gardner & Lambert, 1972) to achieve a needed proficiency in L2 use for identification with a specific ethnolinguistic group or for pragmatic gains. Over the past decade, this theoretical focus has shifted to a new realm of self and identity in explaining the internal identification process within learners' self-concept to stimulate motivation for L2 competence. Motivation to learn a particular language can be interpreted through inward aspirations towards certain kinds of linguistic, cultural, personal, or professional identities or possible future selves speaking the language fluently.

Background Rib fractures are the most common thoracic injury in patients who sustained blunt trauma, and potentially life-threatening associated injuries are prevalent. Multi-disciplinary work-up is crucial to achieving a comprehensive understanding of these patients. The present study demonstrated the experience of an acute care surgery (ACS) model for rib fracture management from a single level I trauma center over 13 years. Methods Data from patients diagnosed with acute rib fractures from January 2008 to December 2020 were collected from the trauma registry of Chang Gung Memorial Hospital (CGMH). Information, including patient age, sex, injury mechanism, Abbreviated Injury Scale (AIS) in different anatomic regions, injury severity score (ISS), index admission department, intensive care unit (ICU) length of stay (LOS), total admission LOS, mortality, and other characteristics of multiple rib fracture, were analyzed. Patients who received surgical stabilization of rib fractures (SSRF) were analyzed separately, and basic demographics and clinical outcomes were compared between acute care and thoracic surgeons. Results A total of 5103 patients diagnosed with acute rib fracture were admitted via the emergency department (ED) of CGMH in the 13-year study period. The Department of Trauma and Emergency Surgery (TR) received the most patients (70.8%), and the Department of Cardiovascular and Thoracic Surgery (CTS) received only 3.1% of the total patients. SSRF was initiated in 2017, and TR performed fixation for 141 patients, while CTS operated for 16 patients. The basic demographics were similar between the two groups, and no significant differences were noted in the outcomes, including LOS, LCU LOS, length of indwelling chest tube, or complications. There was only one mortality in all SSRF patients, and the patient was from the CTS group. Conclusions Acute care surgeons provided good-quality care to rib fracture patients, whether SSRF or non-SSRF. Acute care surgeons also safely performed SSRF. Therefore, we propose that the ACS model may be an option for rib fracture management, depending on the deployment of staff in each institute.

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Background: Traumatic flail chest results in respiratory distress and prolonged hospital stay. Timely surgical fixation of the flail chest reduces respiratory complications, decreases ventilator dependence, and shortens hospital stays. Concomitant head injury is not unusual in these patients and can postpone surgical timing due to the need to monitor the status of intracranial injuries. Reducing pulmonary sequelae also assists in the recovery from traumatic brain injury and improves outcomes. No previous evidence supports that early rib fixation can improve the outcome of patients with concomitant flail chest and traumatic brain injury. Research Question: Can early rib fixation improve the outcome of patients with concomitant flail chest and traumatic brain injury? Study Design and Methods: Adult patients with blunt injuries from the Trauma Quality Improvement Project between 2017 and 2019 were eligible for inclusion. Patients were divided into two treatment groups: operative and nonoperative. Inverse probability treatment weighting was used to identify the predictors of mortality and adverse hospital events. Results: Patients in the operative group had a higher intubation rate [odds ratio (OR), 2.336; 95% CI, 1.644–3.318; p<0.001), a longer length of stay (coefficient β, 4.664; SE, 0.789; p<0.001), longer ventilator days (coefficient β, 2.020; SE, 0.528; p<0.001), and lower mortality rate (OR], 0.247; 95% CI, 0.135–0.454; p<0.001). Interpretation: Timely rib fixation can improve the mortality rate of patients with flail chest and a concomitant mild-to-moderate head injury.