Scaffolding children's collaborative story-telling through constructive and interactive story-making

The main aim of this research was to investigate how children's collaborative storytelling could be scaffolded through technologically mediated resources and how these resources can be made more effective by scaffolding around them. The benefits of providing children with resources, encouraging them to construct their own representations and to interact with each other while they make their story were investigated with respect to the quality of their subsequent storytelling. The first piece of work presented in this thesis is a qualitative case study aimed at exploring how the collaborative storytelling task could be resourced with and without technology, as well as the effectiveness of scaffolding around the technology through adult guidance, and whether the potential benefits could be maintained once the additional guidance was withdrawn. Although the study found that the (technology mediated and non-technological) resources provided did not support for children's engagement in discussion and storytelling, providing scaffolding around these resources was effective at promoting discussion and good collaborative storytelling. Specifically, adult guidance designed to encourage children to articulate their story ideas through questions was shown to benefit children's engagement in discussion and the quality of their collaborative storytelling. Moreover, the children continued to engage in discussion and to produce well structured, rich and coherent stories once the additional guidance was withdrawn. The second study presented in this thesis was of an experimental nature. It built on the findings from the case study by employing more structured resources as well as making the task more ecologically valid for the children through the introduction of a real audience and the matching of the participants with familiar peers (i.e., school mates). The study investigated the benefits of encouraging children to construct their own representations by comparing a task where children were presented with pictures they could manipulate and a task where children were encouraged to construct their own dynamic drawings over these pictures. The study found that children's collaborative stories were longer when the children were encouraged to construct their own dynamic drawings. The stories were also qualitatively better, as they contained more structural elements and were richer in style. However no differences were found between the stories in the two tasks with respect to extent to which children were able to build coherently on each others' contributions. This is argued to have been due to the fact that little shared understanding was established among the children about their collaborative story as a result of a lack of engagement in interactive discussion. The third study was also experimental in nature, and it investigated the benefits of complementing children's construction with scaffolding specifically aimed at encouraging them to discuss their story as this was being made. The study compared a task where children making a story together were encouraged to construct their own dynamic drawings with a task where they were also required to use a set of question prompts to discuss their ideas. It was found that when they were required to engage in reciprocal questioning, the children discussed their story more. The quality of the children's collaborative stories was also better when the children were supported through question prompting. Not only were the stories longer, but they also contained more structural elements and were richer in style. Moreover, when they were telling their stories, the children built more coherently on each other's contributions. Finally, a correlation was found between the number and type of questions asked by the children while they were making their stories together and the quality of the stories produced. These findings suggest that the engagement in discussion combined with the construction of dynamic drawings encouraged children to articulate and elaborate on their story ideas, therefore enabling the production of longer and better stories. Also, the children's engagement with each others' ideas may have facilitated the establishment of a shared understanding about the collaborative story, thus making it possible for children to build on each others' ideas during storytelling

Case Report: Metastatic breast cancer to the gallbladder

Cholecystitis is one of the leading causes of emergency surgical interventions; the occurrence of metastases to the gallbladder is rare and has only been reported in the literature exceptionally. Metastatic breast cancer to the gallbladder is even less frequent; in fact, breast cancer usually metastasizes to bone, lung, lymph nodes, liver and brain. We report the case of an 83-year-old female patient with a previous history of breast surgery with axillary dissection in 1997, followed by adjuvant chemotherapy due to invasive ductal carcinoma of the left breast. The patient was admitted at the emergency department for sepsis and an episode of acute kidney failure, anuria and fever. Right-upper quadrant abdominal pain triggered by food intake and abdominal tenderness was also present, placing the diagnostic suspicion of biliary sepsis due to acute cholecystitis. The histological examination of the surgical specimen highlighted the presence of metastasis from an infiltrating ductal breast carcinoma with positive hormone receptors. We also report here the results of a review of the literature looking at articles describing cases of gallbladder metastasis from breast cancer

Diffuse Large B-Cell Lymphoma (DLBCL) in an Aged Raccoon (Procyon lotor)

A 15-years-old, captive, female raccoon (Procyon lotor) was necropsied after a one-week history of apathy and self-isolation. Gross changes consisted of the severe enlargement of the mesenteric lymph node; hepatosplenomegaly with multifocal to coalescing, white tan nodules in the spleen and liver,; and pale kidneys. Histologically, neoplastic CD79α-positive lymphocytes effaced the mesenteric lymph node and multifocally infiltrated the spleen, liver, and kidneys, and focally infiltrated the heart. Based on pathological and immunohistochemical findings, as well as the canine-adapted World Health Organization (WHO) diagnostic criteria, a diagnosis of diffuse large B-cell lymphoma (DLBCL) was made

Vaginal Evisceration of Small Bowel With Extraperitoneal Ileal Resection of the Herniated Loops: A Case Report

Introduction: Vaginal evisceration is an extremely rare surgical emergency that can be described as the extrusion of abdominal viscera through a defect or a rupture of the vaginal wall. We reported the case of an acute abdomen due to small bowel evisceration secondary to vaginal vault dehiscence that required combined vaginal-abdominal approach Case: We discuss the case of a 72-year-old female who presented to the emergency department for a large prolapse with visible extrusion of the small bowel per vagina. The eviscerated bowel was resected by external vaginal approach due to excessive swelling of the loops which made it impossible to reduce them through the vagina defect. A midline laparotomy was undertaken for further assessment, and the vault defect was closed by transabdominal repair Conclusion: From its first description in 1864, just a few cases of vaginal evisceration had been described in the medical literature; the most common organ to eviscerate is the distal ileum, although cases of omentum, colon, fallopian tube, and appendix evisceration have also been reported. We described a rare case of transvaginal evisceration of the small bowel in our emergency department; it is a rare surgical emergency that must be managed to prevent serious consequences, such as bowel ischemia and necrosis, sepsis, and death. We suggest that a multidisciplinary approach to prompt examination and management by gynecologists and general surgeons is recommended to reduce the risk of morbidity and mortality. With this paper the authors would like to share the surgical manage of this rare emergency with other surgeons all around the world

Development and Multicenter Validation of a Novel Immune-Inflammation-Based Nomogram to Predict Survival in Western Resectable Gastric and Gastroesophageal Junction Adenocarcinoma (GEA): The NOMOGAST

Background. More than 50% of operable GEA relapse after curative-intent resection. We aimed at externally validating a nomogram to enable a more accurate estimate of individualized risk in resected GEA. Methods. Medical records of a training cohort (TC) and a validation cohort (VC) of patients undergoing radical surgery for c/uT2-T4 and/or node-positive GEA were retrieved, and potentially interesting variables were collected. Cox proportional hazards in univariate and multivariate regressions were used to assess the effects of the prognostic factors on OS. A graphical nomogram was constructed using R software’s package Regression Modeling Strategies (ver. 5.0-1). The performance of the prognostic model was evaluated and validated. Results. The TC and VC consisted of 185 and 151 patients. ECOG:PS > 0 (p < 0.001), angioinvasion (p < 0.001), log (Neutrophil/Lymphocyte ratio) (p < 0.001), and nodal status (p = 0.016) were independent prognostic values in the TC. They were used for the construction of a nomogram estimating 3- and 5-year OS. The discriminatory ability of the model was evaluated with the c-Harrell index. A 3-tier scoring system was developed through a linear predictor grouped by 25 and 75 percentiles, strengthening the model’s good discrimination (p < 0.001). A calibration plot demonstrated a concordance between the predicted and actual survival in the TC and VC. A decision curve analysis was plotted that depicted the nomogram’s clinical utility. Conclusions. We externally validated a prognostic nomogram to predict OS in a joint independent cohort of resectable GEA; the NOMOGAST could represent a valuable tool in assisting decision-making. This tool incorporates readily available and inexpensive patient and disease characteristics as well as immune-inflammatory determinants. It is accurate, generalizable, and clinically effectivex

Stimulated Expression of CXCL12 in Adrenocortical Carcinoma by the PPARgamma Ligand Rosiglitazone Impairs Cancer Progression

Adrenocortical carcinoma (ACC) is a rare malignancy with poor prognosis when metastatic and scarce treatment options in the advanced stages. In solid tumors, the chemokine CXCL12/CXCR4 axis is involved in the metastatic process. We demonstrated that the human adrenocortex expressed CXCL12 and its cognate receptors CXCR4 and CXCR7, not only in physiological conditions, but also in ACC, where the receptors' expression was higher and the CXCL12 expression was lower than in the physiological conditions. In a small pilot cohort of 22 ACC patients, CXCL12 negatively correlated with tumor size, stage, Weiss score, necrosis, and mitotic activity. In a Kaplan-Meier analysis, the CXCL12 tumor expression significantly predicted disease-free, progression-free, and overall survival. In vitro treatment of the primary ACC H295R and of the metastatic MUC-1 cell line with the PPARγ-ligand rosiglitazone (RGZ) dose-dependently reduced proliferation, resulting in a significant increase in CXCL12 and a decrease in its receptors in the H295R cells only, with no effect on the MUC-1 levels. In ACC mouse xenografts, tumor growth was inhibited by the RGZ treatment before tumor development (prevention-setting) and once the tumor had grown (therapeutic-setting), similarly to mitotane (MTT). This inhibition was associated with a significant suppression of the tumor CXCR4/CXCR7 and the stimulation of human CXCL12 expression. Tumor growth correlated inversely with CXCL12 and positively with CXCR4 expression, suggesting that local CXCL12 may impair the primary tumor cell response to the ligand gradient that may contribute to driving the tumor progression. These findings indicate that CXCL12/CXCR4 may constitute a potential target for anti-cancer agents such as rosiglitazone in the treatment of ACC

Men and wolves: Anthropogenic causes are an important driver of wolf mortality in human-dominated landscapes in Italy

Over the last 40 years the gray wolf (Canis lupus) re-colonized its historical range in Italy increasing human-predator interactions. However, temporal and spatial trends in wolf mortality, including direct and indirect persecution, were never summarized. This study aims to fill this gap by focusing on the situation of Tuscany and Emilia-Romagna regions, hosting a significant proportion of the Italian wolf population, by: (i) identifying the prevalent causes of wolf mortality, (ii) summarizing their temporal and spatial patterns and (iii) applying spatially-explicit Generalized Linear Models to predict wolf persecution. Between October 2005 and February 2021, 212 wolf carcasses were collected and subjected to necropsy, being involved in collisions with vehicles (n = 104), poisoned (n = 45), wounded with gunshot (n = 24) or blunt objects (n = 4) and being hanged (n = 2). The proportion of illegally killed wolves did not increase through time. Most persecution events occurred between October and February. None of our candidate models outperformed a null model and covariates such as the density of sheep farms, number of predations on livestock, or human density were never associated to the probability of having illegally killed wolves, at the municipal scale. Our findings show that conventional correlates of wolf persecution, combined with a supposedly high proportion of non-retrieved carcasses, fail to predict illegal wolf killings in areas where the species have become ubiquitous. The widespread spatial distribution of illegal killings indicates that persecution probably arises from multiple kinds of conflicts with humans, beyond those with husbandry. Wolf conservation in Italy should thus address cryptic wolf killings with multi-disciplinary approaches, such as shared national protocols, socioecological studies, the support of experts’ experience and effective sampling schemes for the detection of carcasses

Scaffolding children's collaborative story-telling through constructive and interactive story-making

The main aim of this research was to investigate how children's collaborative storytelling could be scaffolded through technologically mediated resources and how these resources can be made more effective by scaffolding around them. The benefits of providing children with resources, encouraging them to construct their own representations and to interact with each other while they make their story were investigated with respect to the quality of their subsequent storytelling. The first piece of work presented in this thesis is a qualitative case study aimed at exploring how the collaborative storytelling task could be resourced with and without technology, as well as the effectiveness of scaffolding around the technology through adult guidance, and whether the potential benefits could be maintained once the additional guidance was withdrawn. Although the study found that the (technology mediated and non-technological) resources provided did not support for children's engagement in discussion and storytelling, providing scaffolding around these resources was effective at promoting discussion and good collaborative storytelling. Specifically, adult guidance designed to encourage children to articulate their story ideas through questions was shown to benefit children's engagement in discussion and the quality of their collaborative storytelling. Moreover, the children continued to engage in discussion and to produce well structured, rich and coherent stories once the additional guidance was withdrawn. The second study presented in this thesis was of an experimental nature. It built on the findings from the case study by employing more structured resources as well as making the task more ecologically valid for the children through the introduction of a real audience and the matching of the participants with familiar peers (i.e., school mates). The study investigated the benefits of encouraging children to construct their own representations by comparing a task where children were presented with pictures they could manipulate and a task where children were encouraged to construct their own dynamic drawings over these pictures. The study found that children's collaborative stories were longer when the children were encouraged to construct their own dynamic drawings. The stories were also qualitatively better, as they contained more structural elements and were richer in style. However no differences were found between the stories in the two tasks with respect to extent to which children were able to build coherently on each others' contributions. This is argued to have been due to the fact that little shared understanding was established among the children about their collaborative story as a result of a lack of engagement in interactive discussion. The third study was also experimental in nature, and it investigated the benefits of complementing children's construction with scaffolding specifically aimed at encouraging them to discuss their story as this was being made. The study compared a task where children making a story together were encouraged to construct their own dynamic drawings with a task where they were also required to use a set of question prompts to discuss their ideas. It was found that when they were required to engage in reciprocal questioning, the children discussed their story more. The quality of the children's collaborative stories was also better when the children were supported through question prompting. Not only were the stories longer, but they also contained more structural elements and were richer in style. Moreover, when they were telling their stories, the children built more coherently on each other's contributions. Finally, a correlation was found between the number and type of questions asked by the children while they were making their stories together and the quality of the stories produced. These findings suggest that the engagement in discussion combined with the construction of dynamic drawings encouraged children to articulate and elaborate on their story ideas, therefore enabling the production of longer and better stories. Also, the children's engagement with each others' ideas may have facilitated the establishment of a shared understanding about the collaborative story, thus making it possible for children to build on each others' ideas during storytelling.EThOS - Electronic Theses Online ServiceGBUnited Kingdo