Students’ Voices from the Pandemic. The Use of Modal and Semi-Modal Verbs for Expressing Subjectivity in a Local Academic Learner Corpus

This essay presents the results of a small-scale study on learner output obtained through an asynchronous writing activity completed in a Moodle forum during an English course targeting students of Primary Teacher Education at the University of Modena e Reggio Emilia (Italy) in spring 2020. The activity encouraged learners’ expression about topics relevant to their disciplinary and professional domain, thus enhancing their engagement in the learning process. The analysis focuses on the use of modal and semi-modal verbs, and it aims at contributing to research into modality in learners’ academic writing. Indeed, the insights obtained by examining material created by learners during the pandemic can help develop resources and strategies to be incorporated in a more conscious, organic, and learner-centred manner into the design of future courses. The corpus (27,430 tokens) was investigated using Sketch Engine, and the results show the students’ preference for modals and semi-modals expressing obligation. This may be determined by the topic and by the students’ background, as they integrate their personal perspective as insiders into their contributions, hence demonstrating their strong commitment towards the profession for which they are training

Primary Sclerosing Cholangitis from Childhood to Adult Age : Risk Factors, Monitoring and Outcome

BACKGROUND AND AIM This thesis includes two studies conducted in a paediatric and two studies conducted in an adult primary sclerosing cholangitis (PSC) population. The common denominator was endoscopic retrograde cholangiography (ERC) with brush cytology that was performed in all patients. The aims were to: i) identify the possible environmental risk factors (Study I) and report the long-term outcome (Study II) of paediatric-onset PSC, ii) compare ERC and magnetic resonance imaging with cholangiopancreatography (MRI-MRCP) in the evaluation of disease activity and severity of patients with PSC (Study III) and evaluate the role of ERC with brush cytology as screening for cholangiocarcinoma (CC) in patients with PSC (Study IV). MATERIAL AND METHODS PSC was diagnosed, followed-up (or both) in Helsinki University Hospital (HUH). Study I: 71 patients with a new diagnosis of paediatric-onset (age 18 years) between 1 January 2006 and 31 October 2011. All cholangiographic images were scored according to the modified Amsterdam PSC score. RESULTS Study I: In multivariate analysis, children ‘living with a cat in a block of flats’ had a higher risk (OR 3.6; 95% CI: 1.2-10.8) of having AILD than healthy controls, but not IBD controls. Study II: At the end of follow-up (9 years, range 2-20 years) all children were alive and no malignancy occurred. 29/33 (88%) were not transplanted; 26/29 (78%) were not cirrhotic and 3/29 (10%) were cirrhotic. 4/33 (12%) were transplanted after a median of 7.5 years; no PSC recurrence in the graft occurred. Study III: MRCP and ERC scores for IHBD were associated with alkaline phosphatase (p = 0.016 and p = 0.018, respectively) and CA19-9 level (p < 0.001 and p = 0.030, respectively); MRCP score for EHBD was also associated with CA19-9 level (p = 0.021). Finally, peribiliary enhancement detected on MRI correlated with cytology findings for both IHBD (Spearman’s rho = 0.322, SE: 0.095, p = 0.022) and EHBD (Spearman’s rho = 0.319, SE: 0.113, p = 0.025, respectively). Study IV: Most of the patients were asymptomatic (211/261; 80.8%) and had only mild changes on cholangiography (149/261; 57.1%) at time of first ERC. Follow-up was completed in 249/261 (95%). CC developed in 7 patients and biliary dysplasia in 8 patients; brush cytology was suspicious or malignant in 8 patients at time of PSC diagnosis. Advanced EHBD cholangiographic changes (HR: 1.7; 95% CI: 1.2-2.3) and alanine aminotransferase (HR: 14.2; 95% CI: 1.9-106.4) were associated with increased risk of biliary neoplasia. CONCLUSIONS An unidentified environmental risk factor (i.e., microbial) especially associated with cats may increase the risk of PSC in children. The clinical course and outcome of paediatric-onset PSC seems to be good until adulthood with a high survival rate, with no occurrence of malignancy and LT required in only a minority of patients. MRI-MRCP use in PSC follow-up seems to be low. In this respect, ERC with brush cytology is a good screening tool for detection of biliary dysplasia or neoplasia (or both) in patients with PSC. Advanced extrahepatic disease and alanine aminotransferase elevation may predict the occurrence of CC.TITLE IN FINNISH: Primaarinen sklerosoiva kolangiiitti lapsuudesta aikuisuuteen: riskitekijät, seuranta ja selviytyminen Common abstract in Finnish: Primaarinen sklerosoiva kolangiitti (PSC) on etiologialtaan tuntematon sappiteitä ahtauttava sairaus, joka voi johtaa maksakirroosiin tai sappitiesyöpään. Suurimmalla osalla PSC-potilaista on myös tulehduksellinen suolistosairaus (haavainen paksusuolentulehdus tai Crohnin tauti). Sappitiekarsinooman esiasteena pidetään sappitie-epiteelin dysplasiaa. Tässä väitöskirjatyössä tutkittiin sekä lapsi- että aikuispotilaita. Kaikille tutkituille potilaille oli tehty endoskooppinen retrogradinen kolangiografia (ERC) ja otettu harjairtosolunäyte sappiteistä. Väitöskirjatutkimuksen tavoitteina oli etsiä mahdollisia PSC:hen liittyviä ympäristötekijöitä, tutkia lapsipotilaiden selviytymistä pitkäaikaisseurannassa, vertailla ERC:tä ja magneettikolangiografiaa PSC:n aktiivisuuden seurannassa sekä arvioida ERC:n ja harjasolunäytteen merkitystä sappitiekarsinooman seulonnassa aikuisena PSC:hen sairastuneilla. Ensimmäisessä osatyössä selvitettiin kyselytutkimuksella PSC:n ympäristötekijöitä 71:ltä lapsena PSC:hen ja/tai autoimmuunihepatiittiin sairastuneelta. Mukana oli myös kaksi verrokkiryhmää. Tutkimuksessa todettiin, että mm. sisarusten lukumäärä, syntymäpaikka tai ruokailutottumukset eivät olleet yhteydessä sairastumisriskiin. Sen sijaan sairastumisriski oli 3.6-kertainen potilailla, jotka olivat asuneet rivitalossa ja joilla oli ollut kissa lemmikkinä. Toisessa osatyössä tutkittiin vuosina 1993-2011 PSC:hen sairastuneiden lasten selviytymistä pitkäaikaisseurannassa. Mukana oli 41 potilasta, joista 33 oli mukana lopullisessa analyysissä. Yhdeksällä prosentilla oli diagnoosivaiheessa maksakirroosi. Seurannan loppuvaiheessa kellään ei todettu sappitiekarsinoomaa, ja 36%:lla maksansisäisten sappiteiden PSC-muutokset olivat edenneet. Maksansiirto oli tehty 12%:lle. Kolmannessa osatyössä oli mukana 48 aikuispotilasta. Kaikille potilaille tehtiin sekä ERC että magneettikolangiografia ja todettiin, että näiden välinen korrelaatio sappitiemuutosten vaikeuden määrittämisessä oli vain kohtalainen. Kohonnut AFOS ja CA19-9 liittyivät maksan sisäisiin sappitiemuutoksiin sekä ERC:llä että magneettikolangiografialla tutkittuna. Harjasolunäytteen sytologinen löydös korreloi vain magneettikolangiografian löydöksiin. Neljännessä osatyössä tutkittiin 261 PSC:hen sairastunutta aikuispotilasta, joista suurin osa (81%) oli diagnoosivaiheessa oireettomia. ERC:ssä nähtävät sappitiemuutokset olivat lieviä 57%:lla. Seurannassa sappitiekarsinooma todettiin 7:llä potilaalla ja sappitiedysplasia 8:lla. Edenneet maksan ulkoisten sappiteiden muutokset, kohonnut ALAT, epäilyttävä sytologinen löydös ja kohonnut CEA assosioituivat sappitiekarsinooman ja dysplasian riskiin. Väitöskirjatyön johtopäätöksenä todettiin, että tuntematon ympäristötekijä (esim. kissoihin liittyvä mikrobi) voi lisätä PSC:n riskiä lapsilla. Lapsena alkaneella PSC:llä on kuitenkin hyvä ennuste ja maksansiirtoon päädytään harvoin. ERC:n ja magneettikolangiografian korrelaatio sappitiemuutosten arvioinnissa on vain kohtalainen. Magneettikolangiografian löydös korreloi sytologiseen löydökseen. ERC:n yhteydessä otettavaa harjasolunäytettä voidaan käyttää sappitiedysplasian tai karsinooman seulonnassa myös oireettomilla potilailla. Edenneet maksan ulkoisten sappiteiden PSC-muutokset ja kohonnut ALAT diagnoosivaiheessa liittyvät erityisen kohonneeseen sappitiekarsinooman riskiin

GORUĆA GRANICA. Komaprativna studija tršćanskog pitanja i drugih teritorijalnih problema s kojima se Italija suočila nakon poraza u Drugome svjetskom ratu (Sažetak)

The article describes why the Trieste issue is the only one of the territorial disputes Italy had with neighbouring countries at the end of the Second World War that still influences Italian public opinion and policy. The first part of the work briefly describes the problem that Italy had with its former colonies, and with France, Austria and Yugoslavia. While the topic is not discussed in detail for the sake of brevity, emphasis has been placed to the mutual impact each of these territorial issues had on the others during the period when the looming Cold War influenced all of them. The second half of the article explains what made the Trieste issue unique and why it still plays an important role in the Italian national consciousness. The article is based on Italian, Croatian and Slovenian historiography and refers, for specific aspects, to documents from the Office of the Marshal of Yugoslavia (Fond 836 - Arhiv Jugoslavije) and the Political Archives of the Ministry of Foreign Affairs of the Republic of Serbia (PA - DAMSP).U članku se objašnjava zašto je, od svih teritorijalnih pitanja koja je Italija imala sa zemljama u susjedstvu na kraju Drugog svjetskog rata, tršćansko jedino koje još uvijek utječe na talijansko javno mnijenje i politiku. U prvom se dijelu članka ukratko opisuje teritorijalni spor koji je Italija imala s Francuskom, talijanskim bivšim kolonijama, Austrijom i Jugoslavijom. Ta su pitanja promatrana u glavnim crtama radi konciznosti, s fokusom na uzajamni utjecaj koji su međusobno imali jedna na druge u fazi kad je početak hladnog rata utjecao na sve njih. U drugom se dijelu članka objašnjava zašto je tršćansko pitanje tako posebno i zašto još uvijek igra važnu ulogu u talijanskoj nacionalnoj svijesti. Članak se temelji na radovima talijanske, hrvatske i slovenske historiografije, a kako bi se bolje objasnilo određene detalje, korišteno je nekoliko dokumenata iz Kancelarije Maršala Jugoslavije (Fond 836 - Arhiv Jugoslavije) te Političkog arhiva Ministarstva vanjskih poslova Republike Srbije (PA - DAMSP)

GORUĆA GRANICA. Komaprativna studija tršćanskog pitanja i drugih teritorijalnih problema s kojima se Italija suočila nakon poraza u Drugome svjetskom ratu (Sažetak)

The article describes why the Trieste issue is the only one of the territorial disputes Italy had with neighbouring countries at the end of the Second World War that still influences Italian public opinion and policy. The first part of the work briefly describes the problem that Italy had with its former colonies, and with France, Austria and Yugoslavia. While the topic is not discussed in detail for the sake of brevity, emphasis has been placed to the mutual impact each of these territorial issues had on the others during the period when the looming Cold War influenced all of them. The second half of the article explains what made the Trieste issue unique and why it still plays an important role in the Italian national consciousness. The article is based on Italian, Croatian and Slovenian historiography and refers, for specific aspects, to documents from the Office of the Marshal of Yugoslavia (Fond 836 - Arhiv Jugoslavije) and the Political Archives of the Ministry of Foreign Affairs of the Republic of Serbia (PA - DAMSP).U članku se objašnjava zašto je, od svih teritorijalnih pitanja koja je Italija imala sa zemljama u susjedstvu na kraju Drugog svjetskog rata, tršćansko jedino koje još uvijek utječe na talijansko javno mnijenje i politiku. U prvom se dijelu članka ukratko opisuje teritorijalni spor koji je Italija imala s Francuskom, talijanskim bivšim kolonijama, Austrijom i Jugoslavijom. Ta su pitanja promatrana u glavnim crtama radi konciznosti, s fokusom na uzajamni utjecaj koji su međusobno imali jedna na druge u fazi kad je početak hladnog rata utjecao na sve njih. U drugom se dijelu članka objašnjava zašto je tršćansko pitanje tako posebno i zašto još uvijek igra važnu ulogu u talijanskoj nacionalnoj svijesti. Članak se temelji na radovima talijanske, hrvatske i slovenske historiografije, a kako bi se bolje objasnilo određene detalje, korišteno je nekoliko dokumenata iz Kancelarije Maršala Jugoslavije (Fond 836 - Arhiv Jugoslavije) te Političkog arhiva Ministarstva vanjskih poslova Republike Srbije (PA - DAMSP)

PAEDIATRIC-ONSET PRIMARY SCLEROSING CHOLANGITIS: CLINICAL COURSE AND OUTCOME

ABSTRACT BACKGROUND AND AIMS The natural history of paediatric onset PSC and PSC/AIH overlap syndrome is poorly known. Thus, this study was aimed at evaluating the clinical course and outcome of patients with a paediatric onset of disease. MATERIALS AND METHODS Between December 1993 and December 2011, thirty-five patients (median age at diagnosis 15 years), with confirmed PSC by cholangiography (ERC) and PSC/AIH by cholangiography and the modified score for AIH, were traced at Helsinki University Central Hospital. Clinical characteristics (symptoms and signs, associated diseases), diagnostic procedures (lab tests, liver biopsy, ERC) and long-term follow-up (mortality, liver transplantation, recurrence of the disease in the graft, malignancy) were reassessed until December 2013. RESULTS The original diagnosis was PSC in 22 children (63%) and PSC/AIH overlap syndrome in 13 (37%). At diagnosis most of the children had an insidious onset and most an associated IBD, being UC the most common form. Still, 4/35 (11%) had cirrhosis. Endoscopic retrograde cholangiography during follow-up was available for all of the patients and images showed a progression of intra-hepatic disease in 13/28 (46.4%) (p=0.0102). In the last follow-up (median 8 years), all patients were alive. Twenty-eight out of 35 patients (80%) and 13/35 patients (40%) were taken UDCA and immunosuppressive therapy, respectively; 3 patients were without treatment. Transaminases and GGT improved significantly. Four patients (11%) had undergone liver transplantation (after a median 7.5 years) and one was listed; and additional patient was transplanted because of Budd-Chiari syndrome. No difference in graft free survival was seen between patients with PSC and PSC/AIH. Three patients (two with PSC and one with PSC/AIH overlap syndrome) presented with cirrhosis. No malignancy occurred. CONCLUSION The clinical outcome of primary sclerosing cholangitis and overlap syndrome seems comparable including their progression to cirrhosis and requirement for liver transplantation. \u200

Covered metal stents in endoscopic therapy of biliary complications after liver transplantation

There is growing interest in using covered self-expandable metal stents for the treatment of benign biliary conditions, and the presence of anastomotic biliary strictures and leaks after liver transplantation provide a valuable opportunity for testing them. The performance of the stents is encouraging, and the technical success rate is high. They provide larger diameter dilation and are easily removed, and can potentially limit costs by reducing the number of procedures needed to treat anastomotic biliary strictures. However, drawbacks such as sub-optimal tolerability and migration may affect both patient management and costs. New stent designs are currently being evaluated. Randomized controlled trials and cost-effectiveness analyses comparing covered metal stents with multiple plastic stent endotherapy are warranted in order to define the role of the former as first-line or rescue treatment. (C) 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Endoscopic therapy of sporadic non-ampullary duodenal adenomas, single centre retrospective analysis

Introduction Although sporadic non-ampullary duodenal adenomas (SNADA) are rare, with the risk of progression to cancer, they deserve therapy. Endoscopic therapy of SNADA is effective, but with the increased risk of complications, endotherapy should be performed in high-volume units. The results of endotherapy of SNADA in our unit are presented. Patients and methods A total of 97 patients with SNADA had endoscopic resection in 2005-2021 and control endoscopies between 3 and 24 months. Snare polypectomy, endoscopic mucosal resection (EMR), endoscopic band ligation (EBL) and endoloop were used (en bloc 37% and piecemeal 63%). In cases of residual/recurrent adenomas, endotherapy was repeated. Results The median size of the adenoma was 12 (5-60) mm and most polyps were sessile (25%) or flat (65%). Primary endotherapy eradicated adenomas in 57 (59%) cases. Residual and recurrence rates were 24% (n = 23) and 17% (n = 16) with successful endotherapy in 16 (70%) and 13 (81%) patients. Endotherapy was successful in 86 (89%) patients after a median (range) follow-up of 23 (1-166) months. Four out of 11 patients with failed endotherapy had surgery; seven patients were not fit for surgery. There were no disease-specific deaths or carcinoma. Eleven patients (11%) suffered from complications: perforation requiring surgery (n = 1), sepsis (n = 1), postprocedure bleeding (n = 7), cardiac arrest (n = 1) and coronary infarct (n = 1). The thirty-day mortality was zero. Colonoscopy was performed on 67 (69%) patients with neoplastic lesions in 33% patients during follow-up. Conclusions Endotherapy of SNADA is effective and safe. Repeat endotherapy in residual and recurrent adenomas is successful. Careful patient selection is mandatory.Peer reviewe

Productor agropecuario y asesor de empresas agrícola - ganadera

El trabajo tiene la finalidad de exponer las tareas realizadas como Productor agropecuario y Asesor agrícola - ganadero. Estas tareas son llevadas adelante, en los partidos de Saladillo y General Alvear. Como productor estoy dedicado al manejo de una explotación mixta. Lo que respecta a ganadería, esta compuesta por rodeo de cría, recría y engorde. La agricultura, es efectuada en campos de terceros, bajo contratos de alquiler o en aparcería. Los cultivos implantados generalmente son trigo, soja, maíz y girasol. También realizo asesoramiento a empresas agropecuarias.Facultad de Ciencias Agrarias y Forestale

Politics of memory for post-ideological times: The Case of Italy

Gdje su izvori i koji su razlozi procesa povijesnog revizionizma koji se od devedesetih sve jače i češće pojavljuje u raznim europskih zemljama i koje bi mogle biti njegove posljedice na odnose između zemalja članica Europske unije? Kako spriječiti sukob oko interpretacije povijesti koji utječe na samu srž pojma europske konfederacije? Članak pokušava dati odgovor na ta pitanja polazeći od analize razloga krize antifašizma, kao i drugih političkih i kulturnih faktora koji su ukorijenjeni u događajima iz devedesetih te s kraja Hladnog rata i rušenja komunističkih režima u srednjoj i istočnoj Europi. Konkretno istraživanje odnosi se na slučaj Italije, gdje se “bitka sjećanja” i revizionizma vodi oko tzv. fojbi, istarskih kraških jama u kojima je stradalo nekoliko stotina Talijana za vrijeme ustanka u jesen 1943. godine. Tijekom zadnjih dvadeset godina taj povijesni događaj, o kojem skoro nitko ništa nije znao i koji je imao marginalnu ulogu u širem kontekstu talijanskog sudjelovanja u Drugom svjetskom ratu, postao je povijesni mit sa svojim službenim “danom sjećanja”, uzdignutim na razinu Dana sjećanja na Holokaust. Budući da je 2007. godine upravo oko sjećanja na fojbe došlo do diplomatskog sukoba između predsjednikâ Italije i Hrvatske, Giorgia Napolitana i Stjepana Mesića, sukoba koji je kasnije riješen potpisivanjem sporazuma o povijesnom pomirenju između Italije, Hrvatske i Slovenije u Trstu 2010. godine, fojbe su predstavljale izvrstan primjer analize “rata” na području interpretacije povijesti koji se nedavno pojavio u više krajeva Europe i koji ugrožava međunarodne odnose, ali i stanja unutar pojedinih država.Where are the sources and what are the reasons for the process of historical revisionism that emerged in many European countries in the beginning of the nineties? Is it possible to avoid conflicts around different interpretations of history that affect the core of the concept of European integration? The article is focused on the crisis of antifascist interpretation of the past in Italy, which is rooted in the events of the nineties. In particular, two events and processes have shaken the dominant discourses: the end of the Cold war and the collapse of communist regimes in Central and Eastern Europe. The focus of the research is on the Italian case, where the war of memories mainly revolved around the so-called foibe, the Istrian carsic caves in which hundreds of Italians perished in the Autumn of 1943. In the span of twenty years a historic event that only a few knew about and which played a marginal role in the bigger picture of the Italian engagement in WWII has been transformed into a historic myth with its official “Remembrance day” and put at the same level of importance as the memory of the Shoah. The new official politics of remembering the victims of the foibe has triggered a diplomatic crisis between Italy and Croatia, which has later been solved with the signing of a memorandum on historic reconciliation in Trieste in 2010 (jointly with Slovenia). The foibe case is here placed into a wider context of revisionism in interpretation of history of the Second World War and of immediate post-War events, which is currently happening in many parts of Europe – not only former Eastern Europe – and which may complicate bilateral relations between various countries, but also wider international relations

Productor agropecuario y asesor de empresas agrícola - ganadera

El trabajo tiene la finalidad de exponer las tareas realizadas como Productor agropecuario y Asesor agrícola - ganadero. Estas tareas son llevadas adelante, en los partidos de Saladillo y General Alvear. Como productor estoy dedicado al manejo de una explotación mixta. Lo que respecta a ganadería, esta compuesta por rodeo de cría, recría y engorde. La agricultura, es efectuada en campos de terceros, bajo contratos de alquiler o en aparcería. Los cultivos implantados generalmente son trigo, soja, maíz y girasol. También realizo asesoramiento a empresas agropecuarias.Facultad de Ciencias Agrarias y Forestale