Individual Requests Research Articles

National survey on access to new oncology drugs pending health technology assessment and financial arrangements.

e13599 Background: In the Netherlands, the health insurance package usually covers cancer drugs after EMA approval and positive recommendation of the Dutch Society of Medical Oncology (NVMO). However, the government can temporarily exclude newly licensed indications with high budget impact from coverage until the national HTA-body advises on the clinical effectiveness and cost effectiveness. Based on the recommendations of the HTA-body, the government negotiates a financial arrangement with manufacturers. Because submitting value dossiers, assessments and negotiations takes time there have been concerns regarding patients’ access to these novel treatments, especially for life threatening conditions such as cancer. Due to a lack of transparency, it is not known to what extent patients are given access to ‘free of charge programmes’ (FCPs). Methods: A list of oncology drugs and indications which were temporarily excluded from reimbursement due to negotiations with the government (July 2015-Dec. 2020). We contacted all the pharmaceutical companies that were engaged in the process above, to inquire about access to their products during the HTA evaluation and negotiations. Results: In total 17 oncology drugs (46 EMA registered indications) of 11 companies were subjected to financial agreements by the government. In 41,3% (19/46) of cases, FCPs were available via individual prescriber requests in a selected number of hospitals. In all other cases such arrangements were not needed because alternative treatment options were available (15,2%; 7/46) or because treatment was not recommended by the NVMO (13,0%; 6/46). For one indication FCP was available but the treatment eventually received a negative recommendation. In 30,4% (14/46) of the cases there was immediate reimbursement in place following a positive NVMO recommendation through umbrella agreements. Such agreements cover existing indications but also all the indications that will be licensed in the future. Umbrella agreements were especially set up for immune checkpoint inhibitors that showed benefit across multiple indications. As anticipated, some patient-access programmes had already started prior to EMA approval. In 5 cases an official compassionate use programme was set up through the Dutch Medicines Evaluation Board prior to authorisation. Conclusions: Our survey indicates that all manufacturers are committed to enabling patients’ and clinicians’ early access to their products pending payers’ approval in a high income country such as the Netherlands. However, the lack of transparency regarding the hospitals offering these programmes may result in inequity in access. Besides, there is no structural data collection. Recently, the NVMO has established a platform (DRUG Access Protocol) to harmonise all compassionate use programmes and FCPs, generating real-world data and ensuring equal access for all patients.

Complex nasal reconstruction for skin cancer and posttraumatic deformity using a modified frontonasal flap - Case report.

Introduction and importanceReconstruction of the nasal tip is challenging, especially when large defects are associated with compromised nasal soft tissues and framework. The frontonasal flap is an axial-pattern myocutaneous flap from the glabella and nasal dorsum that allows for various modifications in flap design to cover medium sized defects of the nasal tip.Case presentationA 66-year-old male patient presented with a large and ulcerated squamous cell carcinoma of the nasal tip that was associated with substantial posttraumatic damage of the nasal soft tissue envelope and cartilaginous vault of the dorsum. Considering patient comorbidity, risk factors, and specific nasal condition, a single-stage tumor resection and reconstruction using a modified frontonasal flap was intended. While tumor excision resulting in a tip defect of 1.5 × 1.5 cm and flap coverage were initially achieved in a single stage, histologically incomplete tumor resection and individual patient requests mandated further surgery, including re-excision, cartilage grafting, and soft tissue contouring.Clinical discussionThe frontonasal flap allows for single-stage reconstruction of moderate size tip defects. Even in the case of prior soft tissue damage and scarring, the flap may be used safely pending individual adjustments in flap design. However, additional measures may be employed as needed to optimize the functional and aesthetic outcome in cases of complex nasal pathology.ConclusionIn a case with a combined tumor and posttraumatic nasal deformity, an individualized surgical concept incorporating a modified frontonasal flap with adjunct cartilage grafting and soft tissue contouring achieved an excellent functional and cosmetic outcome.

Genetic counseling: development of requirements, contents, and quality management in Germany.

To carry out quality management of genetic counseling, it is important to know what genetic counseling exactly means and who the players are. The term "genetic counseling" was first defined by Reed in 1947. It describes a communication process dealing with genetic facts and psychosocial aspects and is an education process, too. It has always been understood in the context of individual and family problems, and is unrelated to eugenics. In 1975 the Ad Hoc Committee of the American Society of Human Genetics published a more detailed description. With the development of new diagnostic techniques and methods in human genetics, the requirements of genetic counseling and its contents changed. Today a genetic counselor has to apply diagnostic, predictive, susceptibility, pharmacogenetic, carrier, prenatal, and preimplantation testing, as well as genetic screening. The German Human Genetic Examination Act (Genetic Diagnosis Act - GenDG) and national and international associations recommend to embed genetic testing into genetic counseling. Based on experiences of the author, some examples of pitfalls in genetic counseling are illustrated, as there are so many individual situations and requests that it seems impossible to carry out quality management. Nevertheless, the Commission for Quality in Genetic Counseling and Clinical Genetics of the Professional Association of German Human Geneticists started a pilot ring trial in 2018 with a given counseling situation. The task was to write the human genetics comment with the help of a checklist containing all issues necessary. The evaluation was conducted with the help of a catalogue of criteria which had been established beforehand and a score adjusted to the individual situation. The first genuine pilot trial was launched in 2020. It represents a possibility for quality management in genetic counseling.

P092 NICE biologics pathways for inflammatory arthritis exhibit regional variability due to modification by CCG’s: results from a national survey of pathways in England

Abstract Background/Aims NICE publishes guidance underpinned by act of Parliament and legally enforceable, on the use of biological therapies in the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) which should allow harmonisation of access independent of region. However, sufficient guidance is not provided on the use of sequential biologics nor is a numerical cap placed on the number of biologics a patient can attempt if they have had an inadequate response. We have previously reported that in a limited sample, Clinical Commissioning Groups (CCGs) interpret NICE guidance variably and restrict access to NICE approved treatments depending on geography, the so-called “postcode lottery”. We determined the variability of biologics pathways in all CCG’s in England to examine whether a potentially unfair postcode lottery exists for sequential biologics use. Methods All 135 England CCGs covering over 55 million people, were sent Freedom of Information requests, for their biologic pathways for RA, PsA and AS. Where CCGs did not have this information, the relevant acute trusts were contacted, with responses recorded under that CCG. For every CCG the local biologics pathways were examined for detail on the number and type of biologics commissioned before an Individual Funding Request was needed. “No Cap” was recorded if CCG’s responded with no restriction on the number of biologics. Results Responses were obtained from 124/135 CCG’s for RA, 122/135 for PsA and AS, all covering an estimated population in excess of 45 million people. For RA, 55% CCG’s had no cap on the number of commissioned RA biologics. 45% had a variable cap from 3 to 6 commissioned biologics. For PsA, the figures were 54% with no cap and 46% with variable capping between 2-5 biologics allowed, for AS the figures were 51% and 49% respectively. In total this represented 41 different local pathways for RA, 29 different pathways for PsA and in AS where fewer biologics choices exist, 25 different pathways depending on CCG and location. Conclusion There is wide regional variation in the interpretation of NICE guidance by CCG’s resulting in many different local pathways depending on geography. Approximately 50% of pathways restricted biologics prescribing by mandating the type and sequence of biologics used, potentially compromising patient care and delaying treatment by requiring an IFR for a NICE approved biologic. Moreover, pathways varied as to which biologics could be used at any point of management by region as well. As exemplars of good practice, approximately 50% of CCG’s had no cap, allowing clinical freedom to prescribe the most appropriate biologic. The results of this national study demonstrate the variability of biologics pathways in many areas of England ensuring a postcode lottery still exists in many regions. Disclosure J. Mistry: None. D. Hill: None. A. Bosworth: None. A. Kaul: None.

P142 Restriction of use of high cost drugs for the treatment of rheumatoid arthritis by CCGs in England

Abstract Background/Aims It became apparent at a session at the 2019 BSR Annual Conferene that some CCGs were restricting the number of high cost drugs (HCDs) that were permitted to be prescribed for an individual with rheumatoid arthritis. Further HCDs could only then be prescribed by utilising an Individual Funding Request. We were interested to explore how common this was and what the restrictions were in different areas. Methods The websites of all CCGs in England were scrutinised between March and July 2020 for local guidelines for the use of HCDs in patients with rheumatoid arthritis (RA). The results were tabulated and mapped. Results Of 134 CCGs in England, 69 (51%) had no expressed restriction on numbers of HCDs provided that NICE thresholds were observed. 10 (7%) had a pathway limiting the drugs to 6, 49 (33%) restricted to 4 and a further 9 (7%) restricted to 3. Dates of guidance implementation varied from 07/2017 to 07/2020 with the vast majority being 2018 and 2019. Geographically, the restrictions were not uniform. The CCGs restricting to 3 HCDs were all in London except for one, Oxford. Those restricting to 4 were mainly from the South East, North West and East. Those restricting to 6 HCDs were in the Liverpool area. Largely unrestricted areas were the North East, the South West, the Midlands and the majority of Yorkshire. The majority of CCGs gave no explanation for the restriction of HCDs. Where stated, the reason given was that it had not been shown to be cost effective. Conclusion Restricting the number of HCDs may deprive some patients of effective drugs that have been NICE approved contrary to NICE guidance. There are currently 5 different modes of action (MOA) of HCDs (TNFi, B cell depletion, IL6i, CTLA4 and JAKi) for the treatment of moderately or severely active RA, therefore in some areas not even all MOAs may have been tried. There is no reliable way of predicting a patient's response to an individual drug, so it is necessary to trial and observe. Non-responders will require more treatment changes. Many patients have secondary failure of drugs after initial good response, so trying other drugs with the same MOA is a logical progression. Over a long disease course, patients will need many different interventions and access to the widest possible range is important. Whilst there are lower response rates for HCDs in biologic inadequate response phase III studies, responders can be observed after only 3 months of treatment. Restricting the number of drug choices is also likely to affect clinical practice, as less effective drugs could be continued unnecessarily for fear of running out of choices. Disclosure D. Walker: Honoraria; Gilead Sciences Ltd, Ely Lilly Pharmaceuticals, Pfizer Pharmaceuticals. Grants/research support; Gilead Sciences Ltd. S. Robinson: None. J. Barry: Corporate appointments; Gilead Sciences Ltd. P. Punter: Corporate appointments; Gilead Sciences Ltd. S. Kearns: Corporate appointments; Gilead Sciences Ltd.

Communicative responsiveness in the Mexican Senate: a field experiment

ABSTRACT What motivates legislators to respond to citizen-initiated contacts about policy positions in party-centred systems with limited re-election incentives? We argue legislators are more responsive to individual citizens when they are being contacted about high-profile, salient policy issues, and when they have the relevant experience and staff resources to attend to individual requests. Using a field experiment where we email Mexican senators about their policy positions before casting eight different floor votes across nine months, we find substantial support for our argument. The article challenges the notion of re-election-based responsiveness by arguing that issue-visibility, access to individual resources, and personal political experience explain variation in communicative responsiveness in party-centred legislatures. Such findings hold critical implications for theories of democratic representation, suggesting the incentive to establish significant communicative relations with constituents does not only stem from incentives to cultivate a personal vote.

Empowered or patronized? The role of emotions in policies and professional discourses on birth care

While the focus on emotions has been associated with the rise of psychosocial welfare and has promised a gateway to accommodate individually diversified needs of citizens in policies, the article shows that the role of emotions needs to be better understood. Highlighting emotions can serve both to empower and to patronize those who experience them. Referring to emotions can thus strengthen hierarchies and downplay individual requests to initiate a change. The analysis of professional discourses on birth care in Czechia shows the value of contextualising emotions. While midwifery discourses apply the emotional context of birth to support women in their specific birth choices, medical discourses use the emotional context to patronize them and to limit their requirements. As a result, policy demands are seen as illegitimate when coming from midwives, who want to see women’s choices more respected in care. We analyse this dynamic through intimacy. As a conceptual framework used in sociology of care, ‘intimacy’ ties individual emotional experiences to collective discourses on care, the body and related feelings. Viewing professional discourses on birth care through intimacy reveals the role of emotions in the collective recognition of the personal struggle for the right to give birth in conditions that respect bodily and emotional integrity, which informs how we think of the role of emotions in policies in general.

What are the most common reasons for return of ethics submissions? An audit of an Australian health service ethics committee

One of the key criticisms of the ethical review process is the time taken to decision, and associated resource use. A key source of delay is that most submissions are required to respond to at least one request for further information or clarification from the Human Research Ethics Committee (HREC). This study audited the request letters of a single Australian public health HREC using content analysis. Twenty-four submissions were analysed, including 355 individual request elements. Most submissions received a single request letter. There was a mean number of 14.2 (SD = 5.5) elements per letter for the first request and a mean of 2.1 (SD = 1.2) for subsequent requests. Administrative errors were the most common source of request for further information, occurring in all submissions. The second most common theme was the content of the Participant Information and Consent Form, occurring in 79% of submissions. Other common themes, present in over 50% of submissions, concerned: data collection and study procedures; general ethical considerations; recruitment and consent; site, setting or patient pool; research design and methodology; and data management and security. In terms of the general purpose of the HREC comments, 44% were direct corrections or specific requests for changes, 42% were asking for more information or clarification of existing information, and 14% were the HREC expressing concerns about an element of the study, without directly suggesting a change. Overall, the study provides some evidence to show that the quality of the submission (ensuring correct attachments, up to date documents, clear information etc.) could account for a significant proportion of the burden and delay associated with ethical review.

The changing face of rhinology in the NHS: a study of septoplasty, septorhinoplasty and rhinoplasty hospital episode statistics.

In 2011, septorhinoplasty and rhinoplasty were reclassified as procedures of limited clinical value in the NHS. The criteria for funding these operations varies across England. We used hospital episode statistics and freedom of information requests to review the total number of rhinology procedures performed across the previous decade, looking at trends in practice related to time, demographics and commissioning policy. Hospital episode statistics for 2012-2019 were used to calculate the number of septoplasty, septorhinoplasty, rhinoplasty and reduction rhinoplasty procedures performed in children and adults. Freedom of information requests were also made to all clinical commissioning groups in England asking for number of procedures performed and number of individual funding requests made. A total of 158,031 procedures were performed over this period; the majority were in adult (99.0%) men (65.7%). Septoplasty was the most frequently performed operation; however, the total numbers declined by 5.4% over this period. There was a yearly reduction in the overall number of septorhinoplasty, rhinoplasty and reduction rhinoplasty operations. Four clinical commissioning groups provided a detailed breakdown of data by year and procedure. Those that required individual funding requests for all cases saw septorhinoplasty numbers fall by 81% and 75% over the period. Those that did not, saw numbers increase or remain the same. We found an overall year-on-year reduction in the number of rhinology operations being performed in the NHS, but variation in trends between different clinical commissioning groups. A reduction in operative activity likely represents the effect of underlying restrictions on commissioning rather than reduced clinical need.

Could You Ever Forget Me? Why People Want to be Forgotten Online.

The concept of people’s memory maintains the finiteness of time and capacity. However, with the advancement in technology, the amount of storage memory a person can use has increased dramatically. Given that digital traces can hardly be erased or forgotten, individuals have begun to express their desire to be forgotten in the digital world, and governments and academia are considering methods to fulfill such wishes. Capturing the difficulties in terms of a cultural lag between technological advancements and regulations on individuals’ data privacy needs, we identify six motives for individuals wishing to be forgotten online and investigate its expected effects on online content generation through a qualitative content analysis of 222 responses from open-ended surveys in Korea. Our findings provide implications for the literature on individual privacy and the right to be forgotten employing the cultural lag, as well as, elaborate further on the relationship between being forgotten online and the legitimacy of such requests of individuals. Additionally, implications for data providers, data controllers/processors, and governments to address this lag and build a balanced system of personal information are provided.

Cost containment by peer prior authorization program for second line treatment in patients with retinal disease

BackgroundHigh and increasing drug prices have prompted the establishment of a broad range of cost-containment treatment policies in health systems globally. In 2012, the supplemental insurance program of a large Israeli health maintenance organization (Clalit Health Services) introduced a prior authorization process for second-line use of ranibizumab in patients with retinal disease for whom treatment with bevacizumab proved to be ineffective. A Clalit steering committee established authorization criteria based on cost and periodically updated clinical considerations, while a team of ophthalmic specialists evaluated their colleagues’ individual patient subsidization requests, based on the funding criteria. The objectives of this study were to detail this unique authorization process and study its effectiveness in limiting unwarranted spending, while allowing for a smooth transition to a second-line more expensive drug when needed.MethodsA retrospective cohort study including all applications for a first or ongoing treatment with ranibizumab, for one or both eyes, received during March 1, 2012 - December 31, 2015. The key parameters examined were percentages of requests from patients treated by first line treatment bevacizumab, requests approved, reapplications, and results. Requests studied include reapplications and requests for treatment continuation.ResultsDuring the study period, Clalit affiliated ophthalmologists’ submitted 16,778 funding applications for intravitreal ranibizumab treatment on behalf of 5642 patients who applied for approximately three applications. An efficient sentinel effect was achieved, resulting in only 31% of patients treated with bevacizumab applying for treatment, while maintaining extremely high accessibility to second line treatment with almost 95% of requests being approved.ConclusionsThe data presented shows a low request rate for funding with a high approval rate, proving this peer reviewed report-based authorization process successfully achieved a sentinel effect while controlling cost. We suggest this innovative model be considered in similar decisions processes.

Advanced vocational training of workers as a factor in human capital development

The article examines the problem of the place and role of advanced training of workers in the system of human capital formation. The concept of "professional and personal quality of a modern worker" is revealed from the standpoint of qualitology. A comparison of this concept is made with the concept of "human capital". The pedagogical tools used to develop the vocational and personal potential of workers are presented separately. The article states that certain requirements should be imposed on the means, forms and technologies used in the process of advanced vocational training, namely: compliance with individual requests and the needs of adult learners; reliance on previous personal and professional experience, life plans and health potential of an employee undergoing training in the advanced training system. The aim of training is to update the personal potential of trainees in connection with a new type of professional activity; to promote the principle of excellence in vocational training; and to integrate in its application; use in combination with modern means of assessment (including reflective) and diagnostics. A number of models – compensatory, harmonization, supporting and complementary - have been identified and described.

Personalization as a trend in the development of corporate reporting

The article deals with the problems of the financial reporting methodology associated with the discrepancy between its new forms and the information needs of stakeholders. The purpose of the study is to examine the hypothesis about the existence of an interest of economic participants in financial reporting, focused on individual information requests of specific counterparties of the reporting companies, in the form and content that new technologies can achieve. To show the current trend of individual reporting format for a specific user, the concept of personalized reporting is used. The theoretical basis for this study was the work of Russian and foreign authors devoted to the current crisis of public corporate reporting on possible options for the development of its practice, as well as studies on the degree of compliance of traditional forms of financial reporting with the level of development of new technologies. The practical basis for this study was the materials of a survey of the top management of more than 300 Russian companies, and the requests of counterparties received by these companies for providing them with personalized reporting. The methodology for conducting this research was based on the works of a number of foreign authors who have conducted similar studies in recent years. The research has confirmed the hypothesis put forward. Conclusions are drawn that the use of new integrated communications in accounting can significantly improve the quality of information provided to stakeholders. It should be stressed that, personalized reporting can be a supplement or alternative to new financial reporting. Attention is drawn the need to rethink the accepted methods of financial reporting, as well as to study the main changes in its practice.

Approximation algorithms for profit maximisation in multicast D2D networks

As the demand for mobile data services increases, telecom companies need to develop wise strategies to retain existing customers. For instance, in a multicast scenario, satisfying individual user's quality of service (QoS), data demand at varying rates, etc. are complicated tasks. Earlier works on device-to-device (D2D) multicast have majorly discussed the cases of throughput maximisation without considering the individual user's data request rates. In this paper, we propose two algorithms to maximise the telecom operator's profit collected from the users in a two-hop D2D multicast network, when users have different channel qualities and data request rates while receiving multicast data through a single transmission session. First, we model our multicast scheme for the proposed scenario as a budgeted maximum coverage problem. Later, we propose two approximation algorithms that guarantee approximation ratios of 1−1/ √e and 1 − 1 / e, respectively, where e denotes the base of the natural logarithm. Numerical results show that the proposed algorithms perform better than the other candidate algorithms and nearly approximates the optimal solution.

ELECTIVITY AS A GUIDING PRINCIPLE OF ADULT EDUCATION

The purpose of the article is to analyse the content, features and identify the ways of effective implementation of the principle of electiveness into practice of adult education. The author analyses the main areas of implementation of such a choice by an adult: goals, content, forms and methods, information sources, resources, place, terms of study, etc. The paper examines one of the most important principles of modern adult education — electivity. As a rule, adults have educational experience, as well as working one. Their requests are more specific and pragmatic, hence, the implementation of the electivity principle in the organisation of adult education can ensure its success. The paper attempts to interpret it scientifically as an individual information request of a person, its choice of various possibilities for this principle implementation in the conditions of lifelong learning. The features of such a choice, the motives that underlie it, are characterised. It is concluded that the success of a person’s implementation of the electivity principle in learning depends, first of all, on the choice freedom of various components of the educational process. It concerns objectives, content, forms and methods, information sources and resources, place of studying, terms of studying, tools for assessing educational outcomes. The author concludes that electiveness as a guiding principle of modern education should find its understanding and study by scientists, identify ways of practical implementation, due to the need for rapid adaptation of citizens to the constant changes in society and economy. Thus, the expansion of human learning opportunities is a positive aspect not only of lifelong learning, but also of socio-economic development of society. These opportunities for human implementation of the principle of electiveness in education relate to the goals, content, forms and methods, information sources and resources, place of study, timing of educational activities, tools for evaluating results. The introduction of the principle of electiveness in adult education corresponds to modern educational trends: individualization, freedom of choice, variability, constant self-improvement of the individual.

Professional psychological selection of military personnel: structure and main characteristics

The article examines the essential characteristics of professional psychological selection of military personnel through the analysis of professional selection and its structure. The problem of effective implementation of professional psychological selection is considered by the authors as a problem of mutual correspondence of the individual and the profession. It is noted that it is solvable only if a certain set of requirements is met: both the individual's requests for a certain type of professional activity, and the requirements of the activity itself for the subjective characteristics of the «person of labor». Professional selection of military personnel structurally includes: social selection; medical selection; professional psychological selection; educational and qualification selection; assessment of the level of functional development and general physical fitness. The scientific results of the study include the fact that the general characteristics of the candidate and the military specialist performing professional psychological selection, the conditions and means of its implementation are disclosed.

Педагогический потенциал социокультурного обслуживания населения в условиях пандемии

the study of socio-cultural services of the population from a social point of view is due, on the one hand, to the increase in its social significance, on the other – to social changes, as well as events related to the pandemic. Of particular importance in the field of leisure in the process of meeting the needs of a person are not only individual requests, but also the processes of managing his social actions. Therefore, the objectives of the study are to analyze the socio-cultural services of the population, which have the characteristics of social and cultural activities, under the influence of changes in Russian society, including in the context of the pandemic, as well as to identify the possibilities of socio-cultural services in the future as a pedagogical potential for each person and society as a whole. The research methods were content analysis of domestic authors, general scientific methods, comparative (comparative) method, as well as the analysis of data from sociological studies of domestic authors and the author’s team. Results: the analysis of socio-cultural services characterizes the correlation of socio-cultural transformations in Russian society with the availability and structure of consumption of socio-cultural services. The analysis of cause-and-effect relationships allows us to identify trends, patterns and problems. The formation of a management system using the principles and methods of human service in its various aspects and taking into account the Russian specifics can change the conditions and standard of living of citizens of our country.

Increasing Use of Compassionate Use/Managed Access Channels to Obtain Medicines for Use in COVID-19.

The COVID-19 pandemic has triggered an extensive need for new therapeutics and there has been widespread use of unapproved/repurposed medicines. Several countries have regulations for access to unapproved medicines, known as compassionate use, managed/expanded access or emergency use. The Novartis Managed Access activity for COVID-19 delivered unapproved/repurposed medicines to nearly 6,000 patients over a 6-month period. With the rapid growth of such access mechanisms to address COVID-19, a better understanding of these channels is required.

Training EFL teachers online: how to improve results among adult learners (based on the experiment in Skyeng School)

The paper considers the organizational aspect of EFL teachers’ professional development with a view to improving the educational results of their students. The author suggests a way of determination of the necessity for professional development, a way to organize the process of professional development and the means of measuring the effectiveness of this process. The fundamental didactic principle of the proposed approach is the timely on-the-job professional teacher`s development. At the beginning of the paper, the author discusses the changes that came along with the development of the EdTech market, online tools in education, opening up both new requirements and new opportunities to solve the problems of all participants of the educational process. Among the burning problems of the participants of the educational process are the following ones: the individual educational request of the student, the requirements of companies for the competencies of employees and candidates in the market, the influence on the student's result by the teacher’s training, the automation of teaching aids and tools for their analysis. One of the main demands of our time is, surely, the development of separate competencies, such as: social, emotional and digital activities of a person, the ability to be flexible in relation to circumstances, the ability to learn and relearn. The ecosystem solution of the listed problems is considered by the author as the most effective way, which is designed not to separate, but to unite the efforts that coordinate the goals of each of the participants and satisfy their needs. It is proposed to influence the student's result, formulated by themselves in accordance with the market or individual educational needs, by providing teachers with timely training and support for conducting a good first and subsequent lessons. As the evidence of the effectiveness of the considered approach, the main part of the article views the experiment of the training center team responsible for the training of 10,000+ English teachers at the Skyeng online school. This part provides an exhaustive description of the project, the proposed tools, training formats and metrics to calculate the effectiveness of the experiment; for the purpose of clarity, charts and other visual decryptions are added. The paper ends with a glossary, which will be useful to all experts experimenting in education, but especially for teachers, methodologists and managers of educational programs.

SUBSIDIES TO THE INDIAN SUGAR SECTOR: IN COHERENCE WITH INDIA’S WTO OBLIGATIONS?

Recently, Brazil ,Australia and Guatemala have each filed individual requests for Consultation with India at the WTO challenging the domestic support measures and export subsidies provided by India to producers of sugarcane and sugar. The countries claim that these measures are inconsistent with India’s obligations under the WTO Agreement on Agriculture, the Agreement on Subsidies and Countervailing Measures and the General Agreement on Tariffs and Trade, 1994. Thailand, Costa Rica and European Union have also filed requests to join the Consultations5 filed by Brazil, Australia and Guatemala against India. The reason that these countries have approached the WTO against policy incentives given by the Indian government to the sugar industry is that these countries are some of the largest sugar producers of the world6and they fear that India’s sugar exports would lead to a reduction of global prices and thus leading to losses for them.