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In this article we propose to use a deck of cards as cognitive artefact enabling students 1) to reconstruct a global view of an historical period, and 2) to develop the competences for the analysis of key issues related to history discipline. Cooperative learning allowed students to produce artefacts. We will provide readers with an example of possible implementation. It has been carried out for students of upper secondary education. L’utilizzo delle carte nella didattica della storia Nel presente articolo si intende proporre l’utilizzo di un mazzo di carte – prodotto in gruppo dagli studenti mediante cooperative learning – come artefatto cognitivo per consentire la ricostruzione di una visione globale di un periodo e lo sviluppo della competenza di analisi dei nodi tematici e dei nuclei fondanti della disciplina storica. Si fornirà un esempio di possibile applicazione, realizzato in alcune seconde di una scuola secondaria di secondo grado., Form@re - Open Journal per la formazione in rete, Vol. 18 No. 1 (2018): University education: quality, effectiveness, teacher training

Introduction Bipolar disorder is a chronic disease characterized by periods of mania or hypomania, depression, or a combination of both (mixed state). Because bipolar disorder is one of the leading causes of disability, it represents an important economic burden on society. Asenapine (ASE) is a new second-generation antipsychotic developed and approved for the treatment of manic or mixed episodes associated with bipolar disorder. The objective of the present study was to assess the cost-effectiveness of ASE compared to olanzapine (OLA) in the treatment of patients experiencing mixed episodes associated with bipolar I disorder in the context of the Italian National Health Service (NHS). Methods A pharmacoeconomic model was developed to simulate the management of Italian bipolar I patients with mixed episodes over a 5-year time horizon by combining clinical parameters with resource utilization. An expert panel of Italian psychiatrists and health economists was responsible for adapting a UK model to the Italian context. The primary outcome measure of the economic evaluation was the incremental cost effectiveness ratio, where effectiveness is measured in terms of quality adjusted life-years gained. Scenario analyses, sensitivity analyses, and a probabilistic sensitivity analysis were performed to test the robustness of the model. Results This pharmacoeconomic model showed that ASE resulted to be dominant over OLA; in fact, ASE was associated with lower direct costs (derived largely by the savings from hospitalizations avoided) and also generated a better quality of life. Results were robust to changes in key parameters; both scenario analyses and sensitivity analyses demonstrated model reliability. Conclusions Results from this study suggest that the management of bipolar I patients with mixed episodes using ASE as alternative to OLA can lead to cost saving for the Italian NHS and improve patients quality of life. Electronic supplementary material The online version of this article (doi:10.1007/s12325-014-0139-3) contains supplementary material, which is available to authorized users.

The morphology and histomorphology of the tongue and the histochemistry of the lingual glands of eight specimens from four species of Ligurian Sea odontocetes (Stenella coeruleoalba, Tursiops truncatur, Grampus griseus, and Ziphius cavirostris) were studied. The shape of tongues and the appearance of their dorsal surfaces differed between species. The lingual glands differed in size, distribution, and histochemistry by species. In S. coeruleoalba and G. griseus, a strong alcianophilic mucous material was detected in the lingual glands, while neutral and acidic mucous substances were observed in the most proximal secretory acini. In G. griseus, small simple alveolar apocrine glands were also found, and the duct of the serous lingual glands in Z. cavirostris is of apocrine type. Numerous mechanoreceptors were observed. Only the tongue of the young specimens showed marginal papillae: their histomorphological composition is consistent with the hypothesis that they create a tight seal between the tongue and the roof of the cavity in order to create suction. This comparative study suggests that differences in tongue morphology and in the morphology and histochemistry of lingual glands might be related to feeding habits.

Brescia-Cimino arteriovenous fistulas are the most common vascular accesses in hemodialysis patients. Arterial blood pressure inside the vein and repeated punctures cause progressive sclerosis of the vessel wall and stenosis or occlusion are the final outcome. Percutaneous dilatation is an effective method to preserve arteriovenous fistulas function. From January 1991 through December 1992, eleven dilatations were performed in 10 patients (7 women and 3 men, mean age: 55 years) using a Zijlstra dedicated catheter provided with multiple infusion holes, which allows long dilatation times and therefore progressive wall distention. A high-pressure balloon yields better results in case of stiff and diffuse stenosis. The immediate results of the maneuver were good in all patients. One acute thrombosis of the fistula was observed a few hours after the procedure, and a second dilatation was performed in a patient 8 months after the first one. Mean arteriovenous fistula patency time was 6 months. Finally, a critical review of the international literature on the subject is made and the value of dilatation in the treatment of fistula stenosis is reported; the necessity to use new dedicated catheters in also stressed.

The role of sonography is evaluated in the diagnosis of ovarian tumors. Real-time US proves more sensitive than gynecological examination in the diagnosis of ovarian diseases. As yet, however, no correlation has been found between histological findings and US appearance. An accurate review of the relative literature and of our results lead us to the conclusion that sonography does not significantly affect the early diagnosis of ovarian tumors.

Color Doppler and Duplex Doppler US were employed on 4 patients with clinically suspected pseudoaneurysms as a complication of femoral artery puncture after cardiac catheterization. Pseudoaneurysms were identified with Color Doppler US and their typical appearance was confirmed. The grey-scale findings did not allow an adequate differentiation between hematoma and pulsed hematoma without fibrous encapsulation: only Color Doppler US easily detected the track between damaged artery and blood collection and allowed a sample to be obtained for pulsed Doppler examination. Color Doppler US allowed an accurate and non-invasive diagnosis of groin masses after femoral artery catheterization.

Although embolization is widely employed in kidney cancer patients, it is not yet clearly understood whether the procedure may influence the natural history of the disease. The writers' experience consists of 99 embolized patients, performed since 1976. The effects of the procedure were reduction of tumor bulk, creation of a good edematous cleavage plane, and shrinkage of venous thrombi. In stage I and II cases embolization seems to have prolonged the survival times of patients who died of tumor, but in stage III and IV cases no difference can be detected between the embolized and nonembolized groups, whereas in stage IV cases only palliative surgery allows better survival times.

Sixteen cases are reported of dilatation of supra-aortic vessels; in 14/16 patients the vessel involved was either the subclavian artery or the brachiocephalich trunk. Special attention is paid to the choice of patients--the ideal one presenting with a single uncalcified lesion, with stenosis more than 50% of diameter; the symptoms have recently appeared, with a significant difference (more than 20 mmHg) in the pressure of the two arms. The technical aspects of the angioplastic procedure are discussed, especially in order to preserve the intracranial circulation and to limit possible complications. The presence of reversed blood flow in the vertebral artery is extremely important to preserve intracranial circulation from possible embolism; normal flow obtained at the end of the procedure is therefore an useful proof of successful dilatation. The advantages are stressed of dilatation over the surgical techniques used in the past. Finally, the importance is emphasized of a correct follow-up and doppler control of supra-aortic circulation.

The angiographic findings in 18 patients with endocrine tumors of the pancreas are analyzed. A literature review (262 cases) is performed in order to assess the accuracy of angiography in diagnosing islet cell tumors, in particular multiple and small (less than 1 cm) lesions. Problems of differential diagnosis of pancreatic and extrapancreatic structures and lesions are discussed.

It has been demonstrated, studying in retrospect a great number of urographies, that the most reliable urogram is the 5 minute urogram (5-U) after the end of the infusion of ionic contrast medium. The authors therefore, in order to save costs and dose to the population, suggest to simplify the urographical routine examination executing only 5-U. This is suggested especially in urographical evaluation of urolithiasis, urinary tract infections, prostate pathology, pelvic masses, pathologies in which 5-U is highly reliable. Very important is the immediate evaluation of 5-U, that allows to complete the urographical examination when necessary.

A case of cholangiocarcinoma observed in a woman of 38 following carotidographic examination with Thorotrast is described: the presence of radioactivity was also demonstrated by gamma spectrometry. The high mean dose absorbed by the liver (estimated at about 3,000 rad) together with the high relative biological effectiveness of the alpha contribution and the time lapse justify the hypothesis that the neoplasia was caused by irradiation.

Radiological methods useful in the examination of bladder tumours are reviewed, with particular reference to preoperative evaluation in accordance with the system. Examples are drawn from a personal series.

Lumbar epidural venography was used as the examination of choice in the investigation of suspected disc herniation in 270 patients. Compression or occlusion of an epidural and/or radicular vein at the disc level is the most significant venographic abnormality. In 110 patients operated on, the reliability of lumbar epidural venography was equal to 97.2%.

Selective arteriography of the carotid and vertebral arteries by the femoral route was carried out in 225 cases. The technique, results, indications and contraindications are reported and discussed together with complications.

This article describes the normal radiological anatomy of the epidural veins whose understanding is necessary for the correct interpretation of venographic studies. Three ways of achieving adequate visualization of the epidural venous plexus are described. Experience with 80 cases is reported; a comparison has been made among the degree of visualization of the epidural venous plexus, the length of time, the cost and the amount of radiation received by the operator and patients during the performance of each technique. Preference is expressed for simultaneous injection of contrast media via two needles introduced into right and left femoral veins.