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Background Although mammography screening is recommended in most European countries, the balance between the benefits and harms of different screening intervals is still a matter of debate. This review informed the European Commission Initiative on Breast Cancer (BC) recommendations. Methods We searched PubMed, EMBASE, and the Cochrane Library to identify RCTs, observational or modelling studies, comparing desirable (BC deaths averted, QALYs, BC stage, interval cancer) and undesirable (overdiagnosis, false positive related, radiation related) effects from annual, biennial, or triennial mammography screening in women of average risk for BC. We assessed the certainty of the evidence using the GRADE approach. Results We included one RCT, 13 observational, and 11 modelling studies. In women 50-69, annual compared to biennial screening may have small additional benefits but an important increase in false positive results; triennial compared to biennial screening may have smaller benefits while avoiding some harms. In younger women (aged 45-49), annual compared to biennial screening had a smaller gain in benefits and larger harms, showing a less favourable balance in this age group than in women 50-69. In women 70-74, there were fewer additional harms and similar benefits with shorter screening intervals. The overall certainty of the evidence for each of these comparisons was very low. Conclusions In women of average BC risk, screening intervals have different trade-offs for each age group. The balance probably favours biennial screening in women 50-69. In younger women, annual screening may have a less favourable balance, while in women aged 70-74 years longer screening intervals may be more favourable.

Objectives Mammography screening is generally accepted in women aged 50-69, but the balance between benefits and harms remains controversial in other age groups. This study systematically reviews these effects to inform the European Breast Cancer Guidelines. Methods We searched PubMed, EMBASE and Cochrane Library for randomised clinical trials (RCTs) or systematic reviews of observational studies in the absence of RCTs comparing invitation to mammography screening to no invitation in women at average breast cancer (BC) risk. We extracted data for mortality, BC stage, mastectomy rate, chemotherapy provision, overdiagnosis and false-positive-related adverse effects. We performed a pooled analysis of relative risks, applying an inverse-variance random-effects model for three age groups (

Background Diagnostic mammography projections (DxMM) have been traditionally used in the assessment of women recalled after a suspicious screening mammogram. Digital breast tomosynthesis (DBT) reduces the tissue overlap effect, thus improving image assessment. Some studies have suggested DBT might replace DxMM with at least equivalent performance. Objective To evaluate the replacement of DxMM with DBT in women recalled at screening. Methods We searched PubMed, EMBASE, and the Cochrane Library databases to identify diagnostic paired cohort studies or RCTs comparing DBT vs DxMM, published in English that: reported accuracy outcomes, recruited women recalled for assessment at mammography screening, and included a reference standard. Subgroup analysis was performed over lesion characteristics. We provided pooled accuracy estimates and differences between tests using a quadrivariate model. We assessed the certainty of the evidence using the GRADE approach. Results We included ten studies that reported specificity and sensitivity. One study included 7060 women while the remaining included between 52 and 738 women. DBT compared with DxMM showed a pooled difference for the sensitivity of 2% (95% CI 1%-3%) and a pooled difference for the specificity of 6% (95%CI 2%-11%). Restricting the analysis to the six studies that included women with microcalcification lesions gave similar results. In the context of a prevalence of 21% of breast cancer (BC) in recalled women, DBT probably detects 4 (95% CI 2-6) more BC cases and has 47 (95%CI 16-87) fewer false-positive results per 1000 assessments. The certainty of the evidence was moderate due to risk of bias. Conclusion The evidence in the assessment of screen-recalled findings with DBT is sparse and of moderate certainty. DBT probably has higher sensitivity and specificity than DxMM. Women, health care providers and policymakers might value as relevant the reduction of false-positive results and related fewer invasive diagnostic procedures with DBT, without missing BC cases.

Description: The European Commission Initiative for Breast Cancer Screening and Diagnosis guidelines (European Breast Guidelines) are coordinated by the European Commission's Joint Research Centre. The target audience for the guidelines includes women, health professionals, and policymakers. Methods: An international guideline panel of 28 multidisciplinary members, including patients, developed questions and corresponding recommendations that were informed by systematic reviews of the evidence conducted between March 2016 and December 2018. GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision frameworks were used to structure the process and minimize the influence of competing interests by enhancing transparency. Questions and recommendations, expressed as strong or conditional, focused on outcomes that matter to women and provided a rating of the certainty of evidence. Recommendations: This synopsis of the European Breast Guidelines provides recommendations regarding organized screening programs for women aged 40 to 75 years who are at average risk. The recommendations address digital mammography screening and the addition of hand-held ultrasonography, automated breast ultrasonography, or magnetic resonance imaging compared with mammography alone. The recommendations also discuss the frequency of screening and inform decision making for women at average risk who are recalled for suspicious lesions or who have high breast density.

Background: The Italian Group for Cervical Cancer Screening (GISCi) promoted the update of recommendations for post Cervical Intraepithelial Neoplasia grade 2 or 3 (CIN2/3) treatment follow up. Methods: A multidisciplinary panel including all the professionals involved in cervical cancer screening and CIN treatment was set up. Systematic reviews have been conducted searching in PubMed. The GRADEpro online tool was used for: defining and prioritizing clinical questions framed in PICOs (Population Intervention Comparator Outcomes); defining and scoring outcomes as critical, important or not important; synthetizing results of the systematic reviews in Evidence to Decision tables and to grade recommendations. Results: A systematic review identified the main prognostic factors, but these have almost no impact in HPV-negative women. Six questions were prioritized for the first phase: 3 about the test (Pap, HPV-DNA or Pap + HPV cotesting or co-testing + colposcopy); 1 about the number of episodes before returning to screening; 2 about the timing of episodes. For the test accuracy direct evidence was available, while for other questions mostly indirect evidence was retrieved in systematic reviews. Conclusions: The panel recommends HPV test or co-testing (conditional either the two), but not Pap test as follow up test (strong). Colposcopy can be added to assess surgical outcomes (conditional either yes or not). Two episodes instead of one, before referring women to regular screening, should be preferred (conditional). The first episode should be 6 months (vs. 12) after treatment (strong), in order to avoid progression of undiagnosed prevalent invasive cancers; the interval between first and second episode may be either 6 or 12 months (conditional).

Neither breast cancer prevention and early-detection programs, nor their outcomes, are uniform across Europe. This article describes the rationale, methods, and process for development of the European Commission ( EC) Initiative on Breast Cancer Screening and Diagnosis Guidelines. To be consistent with standards set by the Institute of Medicine and others, the EC followed 6 general principles. First, the EC selected, via an open call, a panel with broad representation of areas of expertise. Second, it ensured that all recommendations were supported by systematic reviews. Third, the EC separately considered important subgroups of women, included patient advocates in the guidelines development group, and focused on good communication to inform women's decisions. Fourth, EC rules on conflicts of interest were followed and the GRADE ( Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision frameworks were used to structure the process and minimize the influence of competing interests. Fifth, it focused its recommendations on outcomes that matter to women, and certainty of the evidence is rated for each. Sixth, the EC elicited stakeholder feedback to ensure that the recommendations remain up to date and relevant to practice. This article describes the approach and highlights ways of disseminating and adapting the recommendations both within and outside Europe, using innovative information technology tools.

To report a prospective, single-arm, multicenter clinical study evaluating the Zilver PTX drug-eluting stent for treating the above-the-knee femoropopliteal segment (NCT01094678; http://www.clinicaltrials.gov ).The Zilver PTX drug-eluting stent is a self-expanding nitinol stent with a polymer-free paclitaxel coating. Patients with symptomatic (Rutherford category 2-6) de novo or restenotic lesions (including in-stent stenosis) of the above-the-knee femoropopliteal segment were eligible for enrollment. Between April 2006 and June 2008, 787 patients (578 men; mean age 66.6±9.5 years) were enrolled at 30 international sites.Nine hundred lesions (24.3% restenotic lesions of which 59.4% were in-stent stenoses) were treated with 1722 Zilver PTX stents; the mean lesion length was 99.5±82.1 mm. The 12-month Kaplan-Meier estimates included an 89.0% event-free survival rate, an 86.2% primary patency rate, and a 90.5% rate of freedom from target lesion revascularization. There were no paclitaxel-related adverse events reported. The 12-month stent fracture rate was 1.5%. The ankle-brachial index, Rutherford score, and walking distance/speed scores significantly improved (p0.001) from baseline to 12 months.These results indicate that the Zilver PTX drug-eluting stent is safe for treatment of patients with de novo and restenotic lesions of the above-the-knee femoropopliteal segment. At 1 year, the overall anatomical and clinical effectiveness results suggest that this stent is a promising endovascular therapy.

Il capitolo indaga l'osservazione come strumento sistematico per la professionalità dell'insegnante o dell'educatore proponendo un affondo teorico accompagnato da linee guida ed esercitazioni pratiche.

Nel ccontributo si affronta il concetto di ambiente per l'apprendimento, da dove deriva la coerenza tra gli ambienti e le pratiche didattiche in essi attuate. Si approfondisce cosa è un setting e come si caratterizzano i setting sulla base delle diverse tipologie di tecnologie, in particolare i setting in presenza, online e immersivi con tecnologie innovative. Cosa si intende per sistemi adattivi e come i sistemi intelligenti possono sfruttare i dati provenienti dai diversi ambienti per migliorare la didattica.

La presente ricerca empirica si sviluppa in continuità con gli studi avviati, fin dal 2014, per elaborare setting didattici, atti a favorire il successo acca-demico di studenti che si preparano a divenire insegnanti. Nell’ambito dell’attuale studio sono stati elaborati percorsi didattici mirati centrati sullo sviluppo delle soft skills. Le soft skills come la comunicazione, la collaborazione, la creatività e l'im-prenditorialità sono sempre più richieste in campo educativo. Come possiamo misurare queste competenze relazionali e gestionali? Come gli studenti (futu-ri insegnanti) possono dimostrare di possederle? Come queste soft skills ven-gono agite negli ambienti digitali? Nel tentativo di rispondere a questi inter-rogativi ci siamo proposti di supportare 287 studenti del primo anno del corso di laurea in Scienze della Formazione Primaria dell’Università di Palermo nello sviluppo delle competenze trasversali e delle competenze trasversali di-gitali (soft skills & digital soft skills). Pensiamo che la metodologia flipped permetta la messa in pratica e l’esercizio di molte tra queste competenze. Sulla base dei risultati di precedenti ricerche, si è partiti dalla convinzione che per progettare in modo efficace la formazione professionale dei futuri maestri si dovesse rilevare, fin dall’inizio, fino a che punto fossero consape-voli di un utilizzo integrato delle T.I.C. con i contenuti disciplinari per lo svi-luppo di specifiche soft skills. Dopo l'analisi comparativa sullo stato dell'arte della ricerca scientifica sulle soft skills, la successiva fase della ricerca ha vi-sto la somministrazione di un questionario a 232 studenti del IV anno del Corso di laurea in Scienze della formazione primaria, per raccogliere infor-mazioni sul gap di competenze, sulle potenzialità dei futuri insegnanti, sulle necessità della formazione universitaria. La riflessione sui risultati del que-stionario, messi a confronto in più fasi, è diventata la base per la progettazio-ne di una check list per l'autovalutazione delle competenze sviluppate in 287 studenti di primo anno dopo un intervento formativo con attività flipped classroom. L’intervento formativo si è attuato sia durante il laboratorio sia durante le ore di lezioni, sperimentando direttamente la metodologia della flipped classroom. Nel contributo presenteremo i risultati, esplicitando in che modo abbiamo formato gli studenti a mettersi costantemente in gioco e ad essere consapevoli dell’esigenza di sviluppare le soft skills proposte attraverso l’autovalutazione di comportamenti osservabili. As part of the current study, specific didactic courses have been developed focusing on the development of soft skills. Soft skills such as communication, collaboration, creativity and entrepreneurship are increasingly required in the educational field. How can we measure these relational and managerial skills? How can students (future teachers) demonstrate that they possess them? How are these soft skills performed in digital environments? In an attempt to respond to these questions we set out to support 287 first-year students in the University of Palermo degree course in the development of transversal skills and transversal digital skills (soft skills & digital soft skills). We believe that the flipped methodology allows the implementation and exercise of many of these skills. On the basis of the results of previous research, we started from the conviction that in order to design effectively the professional training of future masters, it should be pointed out, from the beginning, to what extent they were aware of an integrated use of the ICT with the disciplinary contents for the development of specific soft skills. After the comparative analysis on the state of the art of scientific research on soft skills, the next phase of the research required the administration of a questionnaire to 232 students of the fourth year of the Degree Course in Primary Education, to gather infor -mations on the skills gap, on the potential of future teachers, on the needs of university education. The reflection on the results of the questionnaire, compared in several phases, has become the basis for the design of a check list for the self-assessment of the skills developed in 287 first-year students after a training session with flipped classroom activities . The training intervention took place both during the workshop and during the lessons, directly testing the flipped classroom methodology. In this paper we will present the results, explaining how we have trained students to constantly get involved and to be aware of the need to develop the soft skills proposed through the self-assessment of observable behaviors.

I processi di apprendimento e insegnamento hanno subito una significativa ridefinizione con la diffusione dei nuovi media digitali. Essi non sono solo supporti e ambienti per l'apprendimento, ma sempre più prodotti culturali del tessuto connettivo del nostro vivere sociale. Nel contributo si affrontano le caratteristiche dell'agire didattico e delle mediazioni culturali attraverso i processi di rappresentazione, comunicazione, collaborazione e produzione

The paper analyses the use of an automatically generated map as a mediator; that map visually represents the study domain of a university course and fosters the co-activity between teachers and stu- dents. In our approach the role of the teacher is meant as a media- tor between the student and knowledge. The mediation (and not the transmission) highlights a process in which theres no deterministic rela- tion between teaching and learning. Learning is affected by the students previous experiences, their own modalities of acquisition and by the in- puts coming from the environment. The learning path develops when the teachers and the students visions approach and, partly, overlap. In this case we have co-activity. The teacher uses artifacts-mediators in such a process (Bruner). The automatically generated map can be considered a mediator. The paper describes the experimentation of the artifact to check if its use fosters: (1) the elicitation of the different subjects per- spectives (different students and the teachers), and (2) the structural coupling that is the creation of an empathic process between the per- spectives of the teacher and the student as the way to enable co-activity processes between teaching and learning.

Il saggio si focalizza sulla necessità di aver cura dell'esperienza educativa per promuovere inclusione in ambito scolastico. In primo luogo il contributo problematizza la logica sottesa all'idea e alle pratiche di inclusione,evidenziandone le conseguenze sulle pratiche didattiche e interpretando criticamente la personalizzazione dell'insegnamento/apprendimento. l'inclusione appare così un'esperienza da progettare e da promuovere attivamente. Quindi, il contributo espone le modalità attraverso le quali poter aver cura dell'esperienza inclusiva. Innanzitutto, si focalizza sul ruolo che gli insegnanti hanno nella promozione di esperienze didattiche inclusive: il loro ruolo viene interpretato come una "parte" complessa, in cui essi agiscono sia da "attori" che da "registi" nel momento in cui istituiscono i contesti inclusivi e in essi si propongono come mediatori. Quindi, il saggio entra nel merito della disposizione dei contesti educativo-didattici, che implica attenzione e cura al tempo stesso delle dimensioni materiali e di quelle relazionali e simboliche in essi presenti. Infine, il saggio interpreta l'agire didattico-educativo in ottica inclusiva come un agire strategico e al tempo stesso problematico.

The paper focuses on the main advantages in the defnition and utilization of an open and modular e-learning software platform to support highly cognitive tasks performed by the main actors of the learning process. We present in detail the integration inside the platform of two intelligent agents devoted to talking with the student and to retrieving new information sources on the Web. The process is triggered as a reply to the system’s perception that the student feels discontented with the presented contents. The architecture is detailed, and some conclusions about the growth of the platform’s overall performance are expressed., Journal of e-Learning and Knowledge Society, Vol 6, No 2 (2010): Journal of e-Learning and Knowledge Society - Focus on: Artificial Intelligence and e-Learning