The WISDOM Study: breaking the deadlock in the breast cancer screening debate.

There are few medical issues that have generated as much controversy as screening for breast cancer. In science, controversy often stimulates innovation; however, the intensely divisive debate over mammographic screening has had the opposite effect and has stifled progress. The same two questions-whether it is better to screen annually or bi-annually, and whether women are best served by beginning screening at 40 or some later age-have been debated for 20 years, based on data generated three to four decades ago. The controversy has continued largely because our current approach to screening assumes all women have the same risk for the same type of breast cancer. In fact, we now know that cancers vary tremendously in terms of timing of onset, rate of growth, and probability of metastasis. In an era of personalized medicine, we have the opportunity to investigate tailored screening based on a woman's specific risk for a specific tumor type, generating new data that can inform best practices rather than to continue the rancorous debate. It is time to move from debate to wisdom by asking new questions and generating new knowledge. The WISDOM Study (Women Informed to Screen Depending On Measures of risk) is a pragmatic, adaptive, randomized clinical trial comparing a comprehensive risk-based, or personalized approach to traditional annual breast cancer screening. The multicenter trial will enroll 100,000 women, powered for a primary endpoint of non-inferiority with respect to the number of late stage cancers detected. The trial will determine whether screening based on personalized risk is as safe, less morbid, preferred by women, will facilitate prevention for those most likely to benefit, and adapt as we learn who is at risk for what kind of cancer. Funded by the Patient Centered Outcomes Research Institute, WISDOM is the product of a multi-year stakeholder engagement process that has brought together consumers, advocates, primary care physicians, specialists, policy makers, technology companies and payers to help break the deadlock in this debate and advance towards a new, dynamic approach to breast cancer screening

Towards self-regulation: breaking the deadlock

How do students learn - through listening and making notes or through engaging in activities and questioning their learning experiences? Teaching is gradually becoming more activity-based, reflecting recent higher education learning theory (eg Biggs 2003). But assessment is too often seen to be the point at which staff and students retreat to the traditional model of ‘tutor knows best’. Students trust their tutors judgements and tutors distrust students’ abilities to make judgements...whilst still expecting them to become ‘self regulated learners’ (Nicol, 2009). In this session tutors and students will together provide details of a case study that aimed to break this deadlock and scaffold students as learners with the confidence and ability to assess, give and receive feedback from their peers (Falchikov 2006) within the first year of an undergraduate degree in primary education. Over a period of three months tutors facilitated students’ analysis of assessment criteria, framing of success criteria and provided models of individual and generic feedback. Students completed a ‘peer assessment’ of their work and evaluated the processes involved. As prospective primary school teachers they considered the experience from the perspectives of ‘learner’ and ‘teacher’. There were three major outcomes from the peer assessment process. Firstly the assessment experience appeared to have a greater impact on students’ engagement with learning than the more passive acceptance of tutor’s written feedback on an assignment. Secondly the students’ reflections demonstrated a high degree of engagement with, and recognition of, the major issues in assessment - validity, reliability and manageability. Thirdly the students were made aware of each other as valuable resources for learning and opportunities for giving and receiving constructive feedback – a critical step towards self regulation

Ukraine, Russia and the EU : Breaking the deadlock in the Minsk process

Although the Minsk process brought about a de-escalation of the conflict in Eastern Ukraine, not all of its 13 points have been implemented, including a ceasefire and withdrawal of heavy weaponry. In the absence of a military option, economic sanctions have become the core instrument of the EU and the US, to respond to Russia’s aggression. At the end of June 2016, when EU Heads of State and Government meet to discuss the extension of sanctions against Russia, they should bear in mind that Russia did not implement the commitments it took upon itself in the framework of the Minsk agreements. Given the persistent deadlock in the Ukraine crisis, the leaders of the EU ought to agree to prolong the sanctions against Russia, push for the renegotiation of the Minsk II agreement and widen the ‘Normandy format’ to include the US and bolster reforms in Ukraine

PESCO and Third Countries: Breaking the Deadlock in European Security

FEUTURE Voice No.3 On December 11, 2017, 25 member states of the European Union (EU) formally launched the permanent structured cooperation (PESCO) in the area of defense. Although the legal provisions behind PESCO have been in place since the 2009 Lisbon Treaty, they have not translated into any concrete initiative until recently. A multitude of factors from the British decision to exit the EU and Russia’s annexation of Crimea in 2014 to the growing rift in foreign policy and security issues between the EU and the Trump administration, including doubts over the commitment of the latter towards the transatlantic alliance, have played a key role in the EU’s decision to move toward a more integrated security and defense policy

Trying to Make Peace with Bush v. Gore (Symposium: Bush v. Gore Issue 2001)

The Supreme Court\u27s decision in Bush v. Gore, shutting down the recounts of Florida\u27s vote in the 2000 presidential election and effectively awarding the election to George W. Bush, has struck many observers, including myself, as outrageous.\u27 Decisions of the Supreme Court should be more than mere reflections of ideological or partisan preference thinly camouflaged behind legalistic language. It would therefore be pleasant to be able to believe that they are more than that. Accordingly, Judge Richard Posner\u27s analysis,2 in which he defends the result reached by the Court-though not the path by which it got there-is particularly welcome. Though Judge Posner is a person of conservative political orientation, he is also fiercely independent-minded. Given that he sees merit in the Bush decision, then perhaps we can give more credence to the proposition that-whether ultimately we agree with the decision or not-it was a plausible response to a difficult situation, rather than a flagrant act of judicial usurpation

Ukraine, Russia and the EU. Breaking the deadlock in the Minsk process. CEPS Working Document No. 423 / June 2016

Although the Minsk process brought about a de-escalation of the conflict in Eastern Ukraine, not all of its 13 points have been implemented, including a ceasefire and withdrawal of heavy weaponry. In the absence of a military option, economic sanctions have become the core instrument of the EU and the US, to respond to Russia’s aggression. At the end of June 2016, when EU Heads of State and Government meet to discuss the extension of sanctions against Russia, they should bear in mind that Russia did not implement the commitments it took upon itself in the framework of the Minsk agreements. Given the persistent deadlock in the Ukraine crisis, the leaders of the EU ought to agree to prolong the sanctions against Russia, push for the renegotiation of the Minsk II agreement and widen the ‘Normandy format’ to include the US and bolster reforms in Ukraine

Trying to Make Peace with Bush v. Gore (Symposium: Bush v. Gore Issue 2001)

The Supreme Court\u27s decision in Bush v. Gore, shutting down the recounts of Florida\u27s vote in the 2000 presidential election and effectively awarding the election to George W. Bush, has struck many observers, including myself, as outrageous.\u27 Decisions of the Supreme Court should be more than mere reflections of ideological or partisan preference thinly camouflaged behind legalistic language. It would therefore be pleasant to be able to believe that they are more than that. Accordingly, Judge Richard Posner\u27s analysis,2 in which he defends the result reached by the Court-though not the path by which it got there-is particularly welcome. Though Judge Posner is a person of conservative political orientation, he is also fiercely independent-minded. Given that he sees merit in the Bush decision, then perhaps we can give more credence to the proposition that-whether ultimately we agree with the decision or not-it was a plausible response to a difficult situation, rather than a flagrant act of judicial usurpation