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Search Results: 1 - 10 of 1745 matches for " Eugenio Paci "
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Mammography and beyond: developing technologies for the early detection of breast cancer
Eugenio Paci
Breast Cancer Research , 2002, DOI: 10.1186/bcr429
Abstract: Following a short presentation of the history of mammography, the theory of efficacy evaluation through randomized clinical trials (all referenced) and the more recent evaluations of screening programmes that are ongoing in several countries are critically re-examined. The second chapter discusses new developments in breast imaging and in related technologies; a table presents the current status of imaging technologies for a large number of devices, few of which are currently of interest with regard to early detection. Most of the technologies discussed pertain to clinical diagnosis, and are unlikely to surpass mammography in the field of early detection in the near future.A chapter entitled Technologies in development: genetic and tumor markers reports on the progress that has been made in this important field, but it states that "... the ability to predict who will develop breast cancer is modest at best." We are still in the realm of basic research, and application of these technologies in screening is far from reaching routine daily practice. However, the authors emphasize the opportunity to improve predictive oncology in the early stages of breast cancer. Furthermore, with private companies developing genetic tests, and the fact that "The tests are not subject to FDA [Food and Drug Administration] regulation and thus clinical validity and utility did not have to be documented before entry into the market", there is a need for a new policy and for genetic counselling for women who request testing.The following chapter on the development and regulation of new technologies (which is referred to only within the context of the USA) is original to the best of my knowledge, at least for a European audience. The narrative of the initiatives and collaborations that have been active between government agencies, private industries and associations, and the examples of funding mechanisms for medical technology development confirm the massive investment into breast cancer c
Overdiagnosis and overtreatment of breast cancer: Overdiagnosis and overtreatment in service screening
Eugenio Paci, Stephen Duffy
Breast Cancer Research , 2005, DOI: 10.1186/bcr1339
Abstract: The results of eight randomised clinical trials have shown screening mammography to be effective in reducing breast cancer mortality [1,2]. Evidence of efficacy was shown for women aged 50 years and over and service screening was implemented at national or regional levels in many countries [2,3]. The challenge today is to evaluate service screening in Europe to assess the outcome of the programmes [4] in terms of mortality and disease stage at diagnosis.The aim of breast cancer screening has been shown to be achieved by the detection of cancer (in situ or invasive) at an earlier stage of the natural history of the disease and by the subsequent use of effective treatment in the early phase of natural history. According to screening theory, the first expected consequence of mammography screening, spontaneous or organised, is the detection of the disease at earlier stages and this diagnostic anticipation changes the population incidence curve, with an increase in incidence rates at earlier ages. The shift of the curve at younger ages is expected to be more evident at the time of prevalence screening, but it will also continue over the subsequent rounds of the screening programme.This excess in incidence should not be confused with overdiagnosis. Overdiagnosis has been defined as the detection of in situ or invasive breast cancers at screening that would have never clinically surfaced in the absence of screening. It is the combination of two causes: the natural history of the disease, that is, the low potential of progression of certain lesions; and the presence of competing causes of death, such that the detected disease would not have been diagnosed in the lifespan of the subject in the absence of screening.In these terms, overdiagnosis is largely an epidemiological concept, because there is no marker today to classify a cancer as a pseudodisease. The possibility of overdiagnosis is inherent to the process of screening, however, and the quantification of such overdiag
Balancing harms and benefits of service mammography screening programs: a cohort study
Donella Puliti, Guido Miccinesi, Marco Zappa, Gianfranco Manneschi, Emanuele Crocetti, Eugenio Paci
Breast Cancer Research , 2012, DOI: 10.1186/bcr3090
Abstract: We compared breast cancer incidence and mortality in two cohorts of women, defined as 'attenders' or 'non-attenders' on the basis of the individual attitudes towards screening, who were invited to the first round of the Florentine screening program. The effects of screening exposure on breast cancer incidence and mortality were evaluated by fitting Poisson regression models adjusted for age at entry, marital status and deprivation index. We performed a sensitivity analysis excluding 34 women not responding to the invitation with a breast cancer diagnosis in the following six months.In total, we included 51,096 women aged 50 to 69 years invited at the first screening round (1991 to 1993) and followed-up for breast cancer incidence and mortality until 31 December 2007 and 31 December 2008, respectively The estimate of mortality reduction varies from 45% among 50 to 59 year-old women up to 51% among 60 to 69 year-old women. The estimate of overdiagnosis, according to the cumulative-incidence method, is an additional 10% of all breast cancer cases among 60 to 69 year-old women screened.Comparing the breast cancer mortality and breast cancer incidence between attenders and non-attenders, we have determined that the overall cost to save one life corresponds to no more than one over-diagnosed tumor (from 0.6 to 1 depending on the selection criteria of the cohort), even if a residual self-selection bias cannot be excluded.The efficacy of mammography screening programs has been assessed in large randomized trials conducted in the 1970s and 1980s both in Europe and in North America [1-3]. Moreover, the effectiveness of population-based screening in the context of routine health care has been proven in many European countries using different approaches (incidence-based mortality and case-control approaches) [4-8].Nevertheless, the use of screening mammography is still under debate and the effectiveness of mammography screening programs in reducing breast cancer mortality was r
Current problems of close-to-nature silviculture in Italy
Paci M
Forest@ , 2004,
Abstract: The main problems of Italian forests are critically reviewed, considering the ecological as well the socio-economic factors that have been responsable of the main evolutionary processes, i.e., the secondary succession under artificial conifer stands, the ageing of the coppice forest, the post-cultivation evolution on abandoned fields and the increase of wild ungulates, which currently represents one of the most dramatic problems to be faced in forest management. Concepts as biodiversity, multifunctionality and sustainable management are the foundations, nowadays, of forest management. The main elements traditionally characterizing the close-to-nature silviculture are discussed and critically examined, warning against ideology and rigidity. Two concepts are more carefully discussed: natural vegetation dynamics and mixed uneven aged forest. An analysis of the priorities of silviculture in Italy concludes the paper, namely: the importance to take advantage of the “natural opportunities” in the cheapest way (the cost of the thinnings is a first rate problem, nowadays); to consider forests ecosystems in the context of surrounding natural and cultural landscape; to define proper management strategies for secondary successions on abandoned fields and pastures; to aim at re-naturalizing artificial conifer stands and increasing/maintaining forest biodiversity; to tackle effectively the wild ungulates problem.
The importance of forest ecology in forestry faculties in Italy
Paci M
Forest@ , 2007, DOI: -
Abstract: A comment is made on recent changes in the teaching organization of Forestry faculties in Italy, which in some cases seems to constrain the role of ecological disciplines.
Perspectives for the Italian Universities
Paci M
Forest@ , 2008,
Abstract: Appropriate procedures for appointing professors, efficient evaluation and control procedures, the respect of the responsibility principle and the competitive selection of students are key points to which the Italian Universities should pay great attention and prompt action to avoid decline.
Roberto Del Favero completes the description of Italian forests
Paci M
Forest@ , 2010,
Abstract: The description of Italian woods by Roberto Del Favero is now completed: after the book dedicated to the “woods of the Alpine regions” and the one concerning the “woods of the southern Italy and Italian islands”, a third book completes the arrangement, aimed to the forest management, of the Italian woods. In the treatise, the strict connection between ecology and silviculture must be underlined: the silvicultural choices are proposed in accordance with ecological requirements of the tree species, as well as to the natural dynamic of stands.
I confini di Urania. La geografia come limes perdurante
Deborah Paci
Diacronie : Studi di Storia Contemporanea , 2009,
Abstract: The notion of “inner boundary” is the key point in understanding the internal dynamics of independence and autonomy movements that have made their appearance in Corsica and Sicily during the nineteenth and twentieth centuries. The comparative-historical dimension allows to dispel the stereotype of the insular particularism and the cultural specificity.
Criticality of Timing for Anti-HIV Therapy Initiation
Filippo Castiglione,Paola Paci
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0015294
Abstract: The time of initiation of antiretroviral therapy in HIV-1 infected patients has a determinant effect on the viral dynamics. The question is, how far can the therapy be delayed? Is sooner always better? We resort to clinical data and to microsimulations to forecast the dynamics of the viral load at therapy interruption after prolonged antiretroviral treatment. A computational model previously evaluated, produces results that are statistically adherent to clinical data. In addition, it allows a finer grain analysis of the impact of the therapy initiation point to the disease course. We find a swift increase of the viral density as a function of the time of initiation of the therapy measured when the therapy is stopped. In particular there is a critical time delay with respect to the infection instant beyond which the therapy does not affect the viral rebound. Initiation of the treatment is beneficial because it can down-regulate the immune activation, hence limiting viral replication and spread.
An assessment of volume-ratio functions for Eucalyptus globulus and E. nitens in Chile
Gilabert,Horacio; Paci,Carlos;
Ciencia e investigación agraria , 2010, DOI: 10.4067/S0718-16202010000100001
Abstract: volume-ratio and total volume models for eucalyptus nitens and e. globulus grown in southern chile were ftted independently. the validation process considered the bias and the total error in the volume estimates, as well as the age classes close to thinning and harvesting operations. volume estimates from the system of functions (volume and ratio) were compared to the volume estimates from a taper function (bruce model) to estimate the volume at different top stem diameters. the results indicated that general (as opposed to local) logarithmic functions performed better in their estimation of the total volume for both species, while a unique polynomial model was the best model for the ratio estimates for both eucalyptus species. the system of functions (total volume + ratio models) was an unbiased estimator for a top stem diameter of 5 and 10 cm for e. nitens, and was a slightly biased estimator for e. globulus. estimates of the volume of top stems with 18 cm diameters had a large bias and a large total error for both species. these total errors were generally related to errors in the total volume function rather than to errors in the ratio estimates. when the volume estimates were compared with estimates from a taper function, the volumne-ratio system performed better for e. nitens while the taper function performed better for e. globulus.
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