Diagnosis of two distinct malignant entities existing concurrently and at the same location (synchronous malignancy) by fine-needle aspiration (FNA) is unusual but may occur. Small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) in particular is associated with an increased incidence of secondary tumor, likely due to associated immunodeficiency. Co-occurrence of some carcinomas such as squamous cell carcinoma (SCC), may show especially aggressive behavior. A 57-year-old Caucasian male presented with recurrent upper extremity lymphedema and diffuse lymphadenopathy ofthe axillary and cervical regions. FNA ofa large cervical lymph node was diagnostic for both atypical lymphocytic proliferation and SCC. Flow cytometric analysis showed the atypical lymphocytic proliferation to be positive for CD5, CD23, CD19, CD20, HLA-DR, CD38, and the population was kappa light chain restricted. These cells were negative for CD-10 and FMC-7 antigens, suggesting a phenotype of B-cell SLL/CLL. We report a rare occurrence of metastatic SCC to a lymph node infiltrated by SLL/CLL. The diagnosis was achieved by a combination of cytomorphologic examination of FNA smears, immunohistochemical staining of cell block material, and flow cytometry on the sample obtained by FNA. To the best of our knowledge, only three cases of SCC metastasis to SLL/CLL diagnosed by FNA have been reported in the English literature. Though rare, awareness of such a possibility and careful cytological examination under the appropriate clinical conditions is warranted.

Intelligent Transport Systems (ITS) are increasingly used in public transport systems in order to provide real-time information (RTI) to passengers and operators. In particular, the RTI related to the prediction of remaining time until the arrival of the next vehicle is the most commonly provisioned information and the main focus of research. A number of predictions methods have been proposed without clear evidence of their real-world applicability, mainly because of their highly computational complexity. Moreover new sources of information, which could be used in RTI generators, become available but they have not been utilized yet. This thesis formulates a widely used real-world RTI generation meth-od, which is based on the scheduled travel time. Then, the potential contribution of real-time public transport data to RTI generation is investigated. Furthermore, a method that considers both the recent downstream running time information as well as anticipated headways and their impact on downstream dwell times is proposed. The generated predictions have to be compared against empirical bus arrival data in order to analyse the performance of the different schemes. Automatic Vehicle Location (AVL) data of the trunk bus network in Stockholm, were used for the evaluation of the proposed prediction schemes. The results illustrate the successful introduction of a robust methodology for bus arrival predictions, which outperforms the currently applied RTI generator. This methodology by integrating real-time public transport data is expected to reduce significantly passengers waiting time. In addition, the second proposed method provides a milestone for the incorporation of the dwell time component in the computation process of RTI.

Multiple myeloma is characterized by the malignant proliferation of clonal plasma cells producing monoclonal paraproteins, leading to multi-organ damage. On the other hand monoclonal B-cell lymphocytosis (MBCL) is characterized by the malignant proliferation of clonal B-lymphocytes, with potential to develop into chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). CLL/SLL can result in visceromegaly, anemia, thrombocytopenia, fevers, night sweats and unintentional weight loss. Literature review demonstrates these two malignant clonal bone marrow disorders are most frequently seen independently in patients; however, we report one rare diagnostic challenge where both clonal disorders were identified in a single patient concurrently. A 64-year-old man initially presented with worsening back pain. Thoracic spine x-ray revealed a T11 compression fracture, confirmed by magnetic resonance imaging. Complete blood count revealed a white blood cell count of 7.3 K/uL with 54% lymphocyte predominance and peripheral smear demonstrated a population of small lymphocytes with round nuclei and an atypical chromatin pattern suggestive of CLL/MBCL. Flow cytometry revealed a monoclonal B-cell CD5 positive, CD23 positive, CD10 negative population with an absolute count of 1.6 K/uL. Due to the instability and pain associated with the spinal fracture, patient had kyphoplasty performed and intraoperative bone biopsies were taken from both T11 and T12 vertebrae. Interestingly each bone biopsy revealed involvement by both a kappa-light chain restricted plasma cell neoplasm, ranging from 15% to 30% cellularity, as well as a CD5-positive B-cell lymphocyte population. It suggested two concurrent but pathologically distinct pathologies including plasma cell myeloma and a separate B-cell lymphoproliferative disorder with immunophenotypic features suggestive of CLL/MBCL. Bone marrow biopsy was performed for definitive evaluation and confirmed multiple myeloma with 15-20% kappa-restricted plasma cells identified, and also confirmed concurrent MBCL with CD5 and CD23-positive, kappa-restricted B-cells identified on bone marrow flow cytometry. Adding an additional layer of complexity, bone marrow molecular genetics revealed presence of a MYD88 mutation, raising concern for possible lymphoplasmacytic lymphoma (LPL). However, secondary pathologic review ruled out LPL, as the immunophenotypic pattern of the clonal B-cells was not consistent with that of LPL, and although the MYD88 mutation is predominantly seen in LPL, it has also been seen in a small percentage of CLL/SLL cases and exceedingly rarely described in MM as well. Serum protein electrophoresis with immunofixation, serum quantitative immunoglobulins and serum quantitative free light chain assay revealed findings consistent with IgG kappa multiple myeloma and systemic CT imaging was negative for any lymphadenopathy, confirming MBCL. Patient was started on first-line multiple myeloma systemic therapy for transplant eligible patients and has demonstrated an excellent response to treatment thus far. This patient case serves to demonstrate the importance of maintaining a broad differential when approaching hematological problems; It also underlines the necessity for a complete diagnostic evaluation to identify rare clinical conundrums such as with our patient, allowing for proper and timely treatment. While we use “Occam’s razor” to explain multiple problems with a single unifying diagnosis the rare possibility of divergent diagnosis is to be always entertained.

A previous population-based study of survival in Chronic Lymphocytic Leukemia (CLL) patients in the province of Manitoba demonstrated a lower five-year relative survival among CLL patients compared with the age- and gender-adjusted general population. This decreased relative survival was most pronounced among elderly male CLL patients. In this study, we have demonstrated that the reduced five-year relative survival observed in CLL patients compared to the general population of Manitoba may partially be attributed to increased risk of second cancers and non-referral to specialized CLL clinics. The increased risk of second cancers in CLL patients compared to Follicular Lymphoma (FL), a similar indolent B cell malignancy, was only observed after CLL diagnosis indicating that a CLL-specific factor may be responsible for the increased risk of second cancers in these patients. The risk of second cancers is independent of treatment and surveillance bias but is further increased with chemotherapy. A superior outcome in CLL patients who have been referred to the CancerCare Manitoba (CCMB) specialized CLL clinic was observed that was independent of age, gender, treatment and history of previous cancers. This superior outcome was most pronounced in the elderly CLL patients. We propose that CLL patients should be referred to CLL-specific hematologists and, where not possible, that guidelines created by such experts be followed. Appropriate screening for second cancers should be performed during routine follow up of CLL patients.

The aim of the thesis was to better understand how second language learners becomes lingual participants in a Swedish preschool. Using the following research questions: In what situations are SLLs lingual participants at the preschool? What does their emerging language look like? Are the participation any different considering children's time in the new L2 context? What kind of support does SLLs receive at the preschool? Two focal children at the same preschool was studied with ethnography of communication as method. The focal children chosen were one girl (Mandarin L1, 4.0 yrs) who arrived to Sweden and started the preschool two months ago at the time of the study, the other a boy (Serbian L1, 3.9 yrs) who started preschool and learning the L2 one year and two months before the study. Situations where the focal children interacted with other children or adults were analyzed.  Results showed that the focal children in interaction with each other understands some of the others intentions before being able to speak about them in the L2. Also episodes of shared attention showed to be the arena for intersubjective lingual negotiation and understanding. Imitation seemed to be the primary strategy for language learning at this stage. These results are in line with Tomasellos (1999, 2003) theory of early language emergence. The focal children became participants in lingual activity when they had the role as Lave and Wengers (1991) legitimate peripheral participants. In interaction with more central participants the focal children imitated their language. However, in interaction with other children the language was centered around formulaic expressions associated with play. These child-child interactions was best described through Rogoffs (2003) notion of guided participation. Whereas the focal children interaction with teachers showed imitation of a more nuanced repertoire of words and was more in line with learning as the scaffolding process put forth by Wood, Bruner & Ross (1976). This leads to a discussion of the connection between language and participation, suggesting a dual model where language development is interconnected with participation in community activities and vice versa. Also the relation between formulaic language, creativity and teacher scaffolding as resources for participation are discussed.

A monolingual target language (TL) teaching norm has been promoted in second language learning over recent decades. Despite this, international studies indicate substantial variation in how and why teachers use the TL. This study investigates the extent of TL use during English lessons in Swedish classrooms in primary school, and how the choice of language correlates with teachers’ beliefs regarding second language learning (SLL) and the inclusion of the first language (L1). This study discusses the teachers’ didactic considerations and implementations of languages during their English lessons, and the teachers’ view on how the students are affected by the use of the TL in the classroom. Semi-structured interviews are carried out with three certified primary school English teachers. The interview data from this study show that the teachers’ main perception of TL use is that it should be used as much as possible. However, they all occasionally include the use of L1 in order to aid comprehension and prevent students’ anxiety. All three teachers emphasized the importance of a safe learning environment, especially when learning a new language. Even though the teachers agreed that the knowledge criterias for the subject of English in primary school do not place high demands on the students’ abilities in English, they as teachers place higher demands. The reason being that Swedish students’ level of English is higher than ever before and in turn teachers’ expectations are higher.

Research has shown that literacy acquisition and the ultimate realisation of literacy, comprehension of the written text requires more than the ability to decode individual words. This study brings together a synthesis of current research on early language acquisition, language structure, vocabulary development and its intrinsic underpinning of comprehension in monolinguals thereby providing a theoretical framework for a comparative study of limited English proficient learners (LEP’s)/English language learners (ELLs) acquiring first time literacy with the attendant vocabulary deficits and age appropriate decoding skills. A quantitative and qualitative study examines the statistical differences between reading, vocabulary, rapid automatic naming (RAN/decoding) and comprehension when a learner born of foreign parents acquires first time literacy in a language other than the language spoken at home. The study isolates and specifies an at risk educational minority through the identification of a hidden comprehension deficit (HCD). In summarising the main findings from the literature review and the empirical investigation, an “at risk educational minority” was identified and isolated through the identification of the HCD. The envisioned outcome was achieved and the hypothesis accepted. / Educational Studies / M. Ed. (Inclusive Education)

Research has shown that literacy acquisition and the ultimate realisation of literacy, comprehension of the written text requires more than the ability to decode individual words. This study brings together a synthesis of current research on early language acquisition, language structure, vocabulary development and its intrinsic underpinning of comprehension in monolinguals thereby providing a theoretical framework for a comparative study of limited English proficient learners (LEP’s)/English language learners (ELLs) acquiring first time literacy with the attendant vocabulary deficits and age appropriate decoding skills. A quantitative and qualitative study examines the statistical differences between reading, vocabulary, rapid automatic naming (RAN/decoding) and comprehension when a learner born of foreign parents acquires first time literacy in a language other than the language spoken at home. The study isolates and specifies an at risk educational minority through the identification of a hidden comprehension deficit (HCD). In summarising the main findings from the literature review and the empirical investigation, an “at risk educational minority” was identified and isolated through the identification of the HCD. The envisioned outcome was achieved and the hypothesis accepted. / Educational Studies / M. Ed. (Inclusive Education)