International Specialists Research Articles

Validation of brief screening instruments for internalizing and externalizing disorders in Mozambican adolescents

BackgroundMental disorders are the leading cause of disability for youth worldwide. However, there is a dearth of validated, brief instruments to assess mental health in low- and middle-income countries (LMIC). We aimed to facilitate identification of mental disorders in LMIC contexts by adapting and validating measures of internalizing and externalizing disorders for adolescents in Mozambique, an LMIC in southeastern Africa.MethodsWe selected instruments with good support for validity in high-income and other LMIC settings: the Patient Health Questionnaire Adolescent (PHQ-A), Generalized Anxiety Disorders 7 (GAD-7), and Strengths and Difficulties Questionnaire (SDQ). Instruments were adapted by local and international mental health specialists followed by cognitive interviews (n = 48) with Mozambican adolescents. We administered the instruments along with the Miniature International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)to 485 adolescents aged 12–19 years attending two secondary schools in Maputo City, Mozambique. One week later, we re-administered instruments to a randomly selected sample of 49 adolescents.ResultsParticipants were 66.2% (n = 321) female and the average age was 15.9 (S.D = 1.7).Internal consistency (alpha = 0.80, PHQ-A; 0.84, GAD-7; 0.80, SDQ) and test–retest reliabilty (ICC = 0.74, PHQ-A; 0.70, GAD-7; 0.77, SDQ) were acceptabe for the PHQ-A, GAD-7, and the full SDQ. The SDQ internalizing subscale showed poor test–retest reliability (ICC = 0.63) and the SDQ externalizing subscale showed poor internal consistency (alpha = 0.65). All instruments demonstrated good sensitivity and specificity (> 0.70). Youden’s index identified optimal cutoff scores of 8 for the PHQ-A, 5 for the GAD-7, 10 for the SDQ internalizing and 9 for the SDQ externalizing subscales, though a range of scores provided acceptable sensitivity and specificity.ConclusionsOur data supports reliability and validity of the PHQ-A, GAD-7, and SDQ instruments for rapidly assessing mental health problems in Mozambican adolescents. Use of these tools in other contexts with limited specialists may asist with expanding mental health assessment. Specific instrument and cutoff selection should be based on screening goals, treatment resources, and program objectives.

The impact of governance quality and educational level on environmental performance

Environmental degradation and its impact on sustainable development have sparked the interest of national and international policymakers, specialists, and academia. This paper aims to demonstrate the empirical nexus between environmental performance, measured by carbon dioxide emissions, and education levels together with institutional quality in a society. To achieve this goal, the regression model includes the main variables that reflect the quality of governance (government effectiveness, regulatory quality, control of corruption, and rule of law), together with education dimension, gross domestic product, renewable energy consumption, fossil fuel energy consumption, and industry. The data were collected for the 1995–2020 period, for a set of 43 countries, consisting of all European Union (EU) members and The Group of Twenty (G20) states. The research uses three estimations methods, respectively Pooled ordinary least squares (Pooled OLS), Fixed effects model (FEM) and Random effects model (REM), together with a two-step dynamic GMM model, to address the endogeneity issue as well. The main results show that all the independent variables reflecting institutional quality from a technical point of view, included in the model when considering the PCSE estimation, have a direct and positive link to CO2 emissions’ level, with control of corruption variable being the only one to influence in a positive manner CO2 emissions at a significant level. Education level, together with economic growth, fossil fuel energy consumption and industry, had a negative significant impact as well upon environmental performance, an increase of one unit in these variables contributing to increased carbon dioxide levels in the EU and G20 sample when considering both the panel corrected model as well as the GMM scenario. Renewable energy is the only independent variable to manifest a significant positive and direct link with environmental performance, drawing attention to the need of adapting the primary sources of energy, in line with international organizations’ sustainable development policy recommendations. Also, there is a need to improve citizens’ perceptions of public services and institutions by building confidence in government’s ability to formulate and implement regulations.

Validation of a sustainable internationally monitored cervical cancer screening system using a visual smartphone inspection in Kinshasa, Democratic Republic of Congo

ObjectiveTo determine the sensitivity, specificity, and positive and negative predictive values of a cervical cancer screening program based on visual inspection with acetic acid and Lugol’s iodine using a smartphone...

Development of a new tool: progression of paediatric powered mobility- 3PM

Purpose To develop a tool to assess the progression of powered mobility skills for children and determine its psychometric properties. Method A three-phase, the mixed-method design included: I) conceptualisation based on international specialists’ input through a focus group or interview to generate initial items; II) tool development using a two-round Delphi survey and III) evaluation of psychometric properties from eight video recordings of children. The Progression of Paediatric Powered Mobility (3PM) was validated via Intraclass correlation coefficients (ICC) calculated from conventionally powered mobility assessments: the Powered Mobility Program, the Assessment of Learning Powered Mobility tool, and the Powered Mobility Proficiency test. Results Content derived from 20 clinical experts led to the development of the first version consisting of 19 demographic and 61 driving skill items. Following two Delphi rounds, the final tool included 14 demographic and 41 driving skill items. Internal consistency was excellent (Cronbach alpha = 0.96) as was the inter-rater reliability (ICC = 0.96, 95% confidence interval = 0.95–0.96). Pearson correlation coefficients between the 3PM and other PM assessments demonstrated good convergent validity. Conclusion The 3PM, created through international collaboration with experts in PM, has excellent psychometric values as a valid measure that can be used reliably to assess children’s powered mobility skills. Implications for rehabilitation The 3PM reflects the three stages of powered mobility development: exploratory, operational, and functional stages. Input from clinical experts in PM mobility contributed to the identification of the key driving skills important to include in the 3PM. A reliable and valid tool can facilitate assessment and tailored intervention in paediatric powered mobility.

Evidence-Informed Development of a Bundle for Peripheral Intravenous Catheterization in Portugal: A Delphi Consensus Study.

Contrary to many international settings, there are no clinical guidelines for peripheral intravenous catheter (PIVC) insertion and maintenance in Portugal. We sought to derive an international consensus on a PIVC bundle that could guide Portuguese nurses’ clinical decision-making in this scope. Methods: Two international vascular access specialist groups participated in an online Delphi panel. During the first round, specialists (n = 7) were sent a summary report from a previous observational study conducted in a surgical ward in Portugal. Based on the report findings, specialists were asked to provide five to eight PIVC insertion and maintenance interventions. Then, another set of specialists (n = 7) scored and revised the recommendations until a consensus was reached (≥70% agreement). The PIVC bundle was made available and discussed with the surgical ward’s nurses. Results: After three rounds, a consensus was achieved for five evidence-informed interventions: (i) involve the person and assess the peripheral venous network; (ii) maintain an aseptic no-touch technique; (iii) ensure proper catheter dressing and fixation; (iv) perform catheter flush & lock; (v) test the peripheral venous catheter’s functionality and performance at each shift. Conclusion: The final version of the PIVC bundle achieved consensus among international experts. Despite the positive feedback provided by the ward nurses, future studies are warranted to assess its effectiveness in standardizing PIVC care delivery and its potential implications for care outcomes in Portuguese clinical settings.

Unveiling the true costs and societal impacts of moderate-to-severe atopic dermatitis in Europe.

Atopic dermatitis (AD) is a chronic, auto-immune condition that imposes a high burden on individuals, society, and the healthcare system. Approximately 4.4% of adults and up to 18.6% of children/adolescents have AD in Europe, with 20% of all cases accounting for moderate-to-severe forms. This form of the condition in adults results in annual societal costs across Europe of an estimated €30 billion; €15.2 billion related to missed workdays or reduced work productivity, €10.1 billion related to direct medical costs and €4.7 billion related to personal expenditure of patients/families. AD can also substantially impact physical, emotional, and social quality-of-life. Several studies have shown the debilitating itch-scratch cycle is the main cause of the multifaceted burden, as it causes substantial sleep deprivation and stigmatisation due to the physical appearance of the skin, and confidence issues. These factors lead to psychosocial issues and can cumulate over time and prohibit patients reaching their 'full life potential'. Despite this, many patients with the condition are undertreated, resulting in uncontrolled symptoms and a further strain placed on patients, society, and the economy. The authors of this White Paper comprise the European Atopic Dermatitis Working Group, which is a network of international specialists with expertise in dermatology and healthcare policy decisions. Their programme of action is focused on harnessing their expertise to build consensus, advance research, share knowledge, and ultimately seek to improve AD care outcomes through achieving long-term symptom control. This White Paper presents a systematic evaluation of the overall financial and humanistic burden of moderate-to-severe AD and the current challenges that exist with AD care. It introduces recommendations for how, collaboratively, key stakeholders and policy makers can support improvements in AD management to achieve better disease control, thus reducing the costs and associated burden placed on individuals, society, and the economy.

First use of MRI-guided focused ultrasound to treat patients with essential tremor in Russia

Introduction. Treatment with MRI-guided focused ultrasound (MRgFUS) is a new, non-invasive surgical technique for treating extrapyramidal movement disorders. This article presents the first use of MRgFUS in Russia for treating patients with essential tremor (ET).
 Materials and methods. Patients (n = 26; 17 men and 9 women) aged 2182 years (median age 46.0 years) and with severe and refractory ET, underwent MRgFUS thalamotomy (ExAblate 4000, Insightec). One side was treated in 22 patients (left thalamus in 18 and right thalamus in 6), both sides were treated concurrently in two patients, and both sides were treated consecutively in two patients. Tremor was assessed using the Clinical Rating Scale for Tremor (CRST). Because international clinical specialists could not visit Russia due to the COVID-19 pandemic, MRgFUS was performed via telehealth on May 5, 2020, in a world first.
 Results. A satisfactory result was achieved in 25 (96%) out of 26 patients. CRST scores improved by 64.7% on the side of the operation, by 10.2% on the control side, and by 37.5% overall. Intraoperative side effects included headache during sonication (42.3%), vertigo (15.4%), nausea (11.5%), vomiting (7.7%), numbness (3.8%), ataxia (3.8%), and pathological response to cold exposure (3.8%). The symptoms resolved immediately after surgery. Unstable gait was noted in five patients, which completely resolved two weeks after surgery. Median postoperative follow-up duration was 109 days [53; 231], with a maximum of 625 days. No relapses (if the hyperkinesia had completely disappeared) or increased tremor (if reduced after surgery) were observed.
 Conclusion. The efficacy of MRgFUS for ET was 96%, with no long-term complications. Both bilateral concurrent and bilateral consecutive MRgFUS thalamotomy is possible, but its efficacy and safety should be assessed in a randomized study. In a world first, MRgFUS was successfully implemented using telehealth.

Collaborative Networking in Education: Learning Across International Contexts

There is growing consensus on the need to prepare future generations in environments of collaboration and cooperation. This way of understanding education cross borders in the quest for networking. A wide range of theoretical bases supports networking, which underlines its potential in the educational arena. There are few comparative studies that explore the forms that networking takes in education at the international level. This article discusses a series of examples from various countries in order to add to the current knowledge about networking in education in different parts of the world. The examples selected were chosen after a review of the international specialist literature (prior to Covid-19). This was followed by a screening process of the documentary sources based on temporal and thematic criteria, notably including research published in the past decade with content directly related to collaborative networking in diverse educational contexts. Many initiatives have been carried out in a wide range of school settings over the last few years through a combination of top-down interventions, accountability measures and changes in governance arrangements. This article focuses on proposals from countries whose collaboration networks can boast long experiences, together with a synthesis of the main advances reported in the area.

Ophthalmology Surgical Assessment of Tube Shunt Glaucoma Surgery

To develop an internationally standardized and validated tool to assess skill in performing tube shunt surgery. A panel of 6 glaucoma surgeons developed a tool for assessing tube shunt surgery using a modified Dreyfus scale for skill acquisition. The tool was reviewed by a panel of 10 international content experts, and their comments were incorporated into the final rubric. A different panel of 8 international glaucoma specialists independently graded videos of surgical procedures performed by 6 surgeons at various levels of ophthalmic training. Inter-rater reliability for each step in the rubric was calculated. The tube shunt rubric contained 13 steps specific to tube shunt surgery and 7 global indices. The Cronbach α statistic, a measure of internal reliability, ranged from 0.75 to 0.97, indicating strong internal reliability for all 13 steps. The tube shunt assessment tool has face validity, content validity, and interobserver reliability, and can be used to assess tube shunt surgery skills. Further studies are required to determine predictive and construct validity.

Australian Transfer-Pricing in the Aftermath of Glencore Investment Pty Ltd v Commissioner of Taxation of the Commonwealth of Australia (2019)

Glencore Investment Pty Ltd v Commissioner of Taxation of the Commonwealth of Australia (2019) 272 FCR 30 has dominated the Australian transfer pricing landscape for the past two years, with international tax specialists awaiting the outcome with great anticipation. The decision in the Federal Court of Australia and its subsequent appeal to the Full Federal Court and the High Court are of great importance to Australian transfer pricing due to its direct implications on the Australian Commissioner of Taxation’s powers of reconstruction. While dealing with older statutory legislation, the insights of the court and the methods utilised to come to a decision have the potential to provide a strong interpretative precedent in future transfer pricing disputes. It is the opinion of the author that the outcome in Glencore will affect the current transfer pricing regime despite the gradual strengthening of the Commissioner of Taxation’s powers under the new legislation. This article revisits the decision in Glencore and aims to provide a frame of reference for the use of members of the tax community and other individuals interested in understanding the context of the appeal and the implications this will have for Australian transfer pricing.

WS11.01 Divergent diagnostic assessment of cystic fibrosis and related disorders: an analysis of paediatric cases categorisation by 50 international specialists

WS11.01 Divergent diagnostic assessment of cystic fibrosis and related disorders: an analysis of paediatric cases categorisation by 50 international specialists

Degarelix administration technique optimisation: Consensus findings of an international Delphi nurse panel

AbstractWhat steps involved in degarelix (Firmagon®, Ferring Pharmaceuticals) administration and patient care do specialist nurses consider most important to reduce the risk of associated injection site reactions, and are there any variations in administration and materials used to support optimal injection technique? Degarelix is a GnRH antagonist indicated for the first‐line treatment of advanced prostate cancer that effectively suppresses testosterone production in the testes without an initial testosterone surge and possible subsequent disease flare—both typical features associated with GnRH agonists. However, injection site reactions can occur after subcutaneous injection of degarelix, which are unpleasant for patients and may represent a limiting factor for its use by healthcare professionals. The objective of this study was to reach consensus on key steps involved in degarelix administration and patient care to minimise injection site reaction risk. Injection site reactions have been associated with subcutaneous injection of degarelix in several published studies; they are usually transient, mild‐to‐moderate, and occur mainly with the initial dose. Information on prevention is limited, one research group suggesting that the injection method may contribute to injection site reaction risk, and another describing specific injection techniques and strategies developed by Canadian nurses and physicians aiming to prevent degarelix injection site reactions. An online pre‐meeting survey regarding degarelix administration and injection site reactions was conducted to gather insights from 11 international specialist nurses. Survey results supported the development of 25 best practice consensus statements for the in‐person Delphi meeting (Warsaw, Poland), attended by 15 international specialist nurses. Statements focused on degarelix reconstitution, administration and patient care. Participants voted anonymously and collated responses were discussed after each voting round to understand if consensus could be achieved. If no consensus was reached after the first voting round, up to two more voting rounds were considered. Consensus was defined as “agreement” or “disagreement” by ≥75% of nurses, with ≤15% having the opposite opinion. In the pre‐meeting survey, nurses reported that they observed injection site reactions in up to a third of treated patients after degarelix injection, and all agreed that the administration technique was, to some degree, related to the development of injection site reactions; a variety of materials were being used as guidance. In the Delphi study, consensus was reached on 5 of 9 statements related to reconstitution steps and 14 of 16 statements related to administration steps and patient care, all of which were considered to be important in the prevention of injection site reactions. This study confirmed country‐specific variations in the degarelix administration technique and highlighted pivotal steps that may potentially contribute to injection site reactions. Importantly, all nurses agreed that technique optimisation holds the potential to reduce the occurrence of such reactions (“yes,” 45%; “possibly,” 55%; “no,” 0%). The findings should be considered along with other available materials and guidance to help reduce the risk of injection site reactions in patients with advanced prostate cancer treated with degarelix.

Analysis of Approaches to Foreign Language Training of International Specialists (on the Example of MGIMO of the Ministry of Foreign Affairs of Russia)

The subject of the study is the effectiveness of approaches to the formation of foreign language linguistic competence of future international specialists. The object of the research is the professional language training of future international specialists studying at the Departments of Romano-Germanic and Oriental Languages of MGIMO of the Ministry of Foreign Affairs of Russia. The purpose of the study is to generalize the cathedral approaches, their description, analysis and justification of their effectiveness in the process of teaching the language of the profession in all areas of university training. The authors consider in detail the approaches to teaching the language of the profession at the university as a whole, focusing on the analysis of approaches, methods and strategies used to form productive and receptive skills, considering all types of speech activity. The main conclusions of the study are the theoretical justification of the effectiveness and practical assessment of the reliability of approaches and methods of teaching the language of the profession, aimed at the formation of professionally necessary skills and abilities of future specialists, taking into account each of its specifics and practiced by all departments of foreign languages of the university, providing training in all areas of professional training of future international specialists. A special contribution of the authors to the study of the topic is the theoretical consideration of the effectiveness of approaches to teaching the language of the profession, taking into account certain specifics and complexity of some types of speech activity; generalization and analysis of the cathedral approaches and methods; consideration of approaches to the peculiarities of teaching translation of texts from a foreign language into Russian and from Russian into a foreign language. The novelty of the research lies in the concretization of approaches to teaching the language of the profession as a fundamental condition for the formation of foreign language linguistic competence of future international specialists; in determining the most effective methods and strategies for teaching a foreign language in terms of specialized professional training of students at the level of joint interrelated activity "teacher-student".

Launching underwater bioacoustics in Asia by Whitlow W. L. Au

Whitlow W. L. Au combined biosonar science with engineering. His studies influenced so many students in Asia no matter what their specialities, such as physiology, morphology, and physics. The epoch-making book “The Sonar of Dolphins” is an ideal example of his interdisciplinary approach. Whit educated young researchers in various ways even he did not notice. He led discussion among scientists that motivated current and new generations to conduct underwater and terrestrial bioacoustic research in the lab, in the forest and in the ocean. Quite a few attendees were from Asia at the series of biosonar symposiums in 1991 Moscow, in 1994 Harderwijk, and in 1998 Algarve, but the symposium held in 2009 Kyoto accommodated nearly 200 international specialists and half of them were Asian. An example of his influence was the towed and fixed passive acoustic monitoring in the Yangtze River, China, which revealed a range-wide distribution of finless porpoises collaborating with an international team. These techniques were applied later in India, Thailand, Malaysia, Nepal, Taiwan, Hongkong, and many other areas including Japan for the impact assessment of offshore wind farm developments. We owe him all the outcomes of underwater biosonar studies in Asia.

Benchmarking Socio-Economic Impacts of High-Speed Rail Networks Using K-Nearest Neighbour and Pearson’s Correlation Coefficient Techniques through Computational Model-Based Analysis

Not only have high-speed rail (HSR) services stimulated the economy of many countries, but they have also significantly uplifted quality of lives (QoL) of countless people. For many decades, the aspiration for HSR network development has dramatically risen, and HSR networks have inevitably become an icon of civilisation. However, only a few successful HSR networks globally can truly generate socio-economic impacts on their societies. This research aims to understand the impact of HSR networks on social and economic impacts and to provide recommendations for success. This study is the world’s first to examine the benefits of HSR across all community demographic groups, including young and elderly people. The findings will illustrate the QoL, economic, and educational elements’ advantages in explicit terms. It has established two interconnected models via Python to codify a novel customised model for socio-economic evaluation. ‘Pearson correlation coefficient’ and ‘K-Nearest Neighbour’ techniques are applied to bolster the reliability of the research findings. The outcomes have been reviewed by 30 international HSR specialists. The benchmarking exhibits that socio-economic impacts apparently occur across vast areas. The insight stemming from this benchmarking also offers policy implications and empirical data for long-term HSR improvement, assisting the government in developing new methods for sustainable communities.

International legal regulation of government procurement for sustainable development in the framework of the WTO

The World Trade Organisation (WTO) is the main interstate controller of international trade, in which a special place is given to the regulation of government procurement. The relevance of the article is due to the necessity to study the further development of the government procurement system and improve the efficiency of the use of public funds in order to provide society with quality goods and services. In accordance with the requirements of the world economy in order to implement of the quality mechanism of rationalization of government procurement WTO member states use the rules of sustainable development. In this regard, this article is aimed at conducting a comprehensive analysis of the theoretical and practical foundations to identify the features in the international legal regulation of sustainability of government procurement within the WTO, to establish the need to reform this industry. In the study of this problem, the methods of generalisation, analysis, synthesis and modelling were used, which make it possible to form the concepts of the development of government procurement and generalized provisions of the directions of reforming international legal regulation in the studied area. The study made it possible to comprehensively analyse the international legal regulation of the foundations of relations arising in the field of government procurement, develop a conceptual framework for the systemic improvement of regulatory legal acts in this area. It has been substantiated that today there is an urgent need for such a reform, the creation of an appropriate legislative framework for this purpose and the wide involvement of international specialists in this activity.

ГЕОГРАФІЧНО-КРАЇНОЗНАВЧА ПІДГОТОВКА СУЧАСНИХ ФАХІВЦІВ З МІЖНАРОДНИХ ВІДНОСИН

The article substantiates the system of geographical knowledge, skills and abilities of modern specialists in international relations (specialties International Relations, Social Communications and Regional Studies, International Economic Relations, International Law). Possibilities of complex geographical science (including social, natural and cartographic components, branch and regional subsystems) with separate professional competences of the specialist in international relations have been compared. The peculiarities of the use of these opportunities in professional training of specialists in international relations in the higher education institutions within the different types of educational components (disciplines, term papers, practice, and state certification) have been revealed. The problem of teaching both geographical and regional studies and other disciplines in the process of studying in the field of knowledge “International Relations” has been highlighted. The expediency of implementation of geographical and ethnographic sample components for training of specialists in international relations has been determined. The “centrality” of regional studies in the training of internationals in the specialty “International Relations, Social Communications and Regional Studies” educational and professional program “Local History” has been determined, which necessitates the classical geographical and regional component during training and internships for higher education. It has been proposed to include geographical and regional components in the state certification of applicants for higher education of the first (bachelors) level in the specialty 291 “International Relations, Social Communications and Regional Studies” educational and professional program “Local History”. It has been proposed to attract international specialists into the curriculum, the subject of which may be the comprehensive analytical review of an individual country or group of countries. The mandatory analysis of territorial differentiation within the country or region has been proposed to include, as well as the balanced representative of all key blocks, as cultural, historical, economic, social, and political, without any “distortions” in favor of some components of the analysis and to the detriment of others. The importance of mastering natural and geographical processes in the country dimension has been emphasized.

INTERNATIONAL LEGAL ASPECTS OF ECONOMIC RESPONSIBILITIES OF STATES

The subject of the article is international legal aspects of economic responsibility of states. The aim of the article is to find an answer to the problematic issues of economic responsibility of states and its international legal aspects. Different concepts of economic responsibility are analyzed due to the lack of a unified approach to it both in economics and in related branches of law. It is noted that the institution of economic responsibility is designed to stabilize the relations of socio-economic development, the interests of participants in social exchange and to achieve the goals of sustainable development. From the international legal point of view of understanding economic responsibility, the state bears two types of responsibility – material (economic) and non-material (political). And international legal responsibility of the state is considered as an institution of the law of international responsibility. It is from this point of view the economic responsibility of the state is considered by international lawyers and specialists in the field of international relations. The methodology of the article is based on the fact that there are three basic mechanisms of liability – derivative of property rights, contracts, and torts. Contract law deals with breaches of duty, tort law deals with accidental or intentional injury to persons or property, and property law deals with misappropriation or interference with property rights. It is concluded that the state is the same economic entity in terms of economics as all equal economic entities. However, the applicability of the means of economic responsibility in the international legal aspect is complicated by the immunity of the state with regard to its property. Therefore, there are signs of liability not for all property, but only for that which has certain signs of applicability – use for commercial purposes, connection with the subject matter of the claim. In the aspect of economic responsibility, there is a distinction between immunity from jurisdiction and immunity from enforcement. The problem of differentiation of commercial and state property is outlined, attention is focused on the existence of certain categories of state property, the public nature of which is not in doubt and which are not considered possible for economic (property) responsibility for the conduct of diplomatic and consular activities of their missions, consulates, special missions, etc., whose immunity is enshrined in the Vienna Convention on Diplomatic Relations of 1961; military property, as well as property used for military purposes; property that is part of the cultural heritage of a foreign state or part of its archives, as well as property that is part of an exhibition of items of scientific, cultural or historical significance. It is also concluded that economic responsibility in international law is not always associated with the negative consequences of unlawful behavior, because it can also be applied as a result of lawful behavior, leading to the infliction of harm to other subjects. Thus, the economic responsibility of the state is on the verge of regulation of public and private law. This is its peculiarity and complexity of its application to the state.

Development of foreign language competence of higher education students in the context of blended learning

The circumstances of active implementation of a blended learning format at all educational levels require increased motivation and advancement of the competences learned by students of higher education institutions.Such statement equally applies to foreign language competence, which is one of most relevant skills to the future professional activity of international relations specialists. In considering this, the Ukrainian higher education institutions conducted a study on the development of foreign language competence of higher education students in the context of blended learning. The purpose of the article is to develop and empirically establish the effectiveness of the author's model of foreign language competence development of higher education students in the context of blended learning. The study involved the development, implementation and evaluation of the effectiveness of the author's model of foreign language competence development of higher education students in the context of blended learning. The participants of the study were students of higher education institutions: HEI 1, HEI 2, HEI 3, who majored in the following specialties: international activities, international relations and some technical specialities. The participants were 1st, 3rd and 5th year students.A total of 138 students were interviewed (68 from the experimental and 70 from the control group). The study confirmed that the implementation of the method of organizing the formation of foreign language competence of higher education students, which requires an optimal combination of blended learning with modern digital tools and the professional orientation of foreign language training in the system of higher education institutions, helps advance foreign language competence of higher education students.

Ductal Carcinoma In Situ - Quo Vadis?

The introduction of mammographic screening in the early 1980's was associated, in the three following decades, with a dramatic increase in the detection of ductal carcinoma in situ (DCIS), pathology rarely detected before, on surgical specimen, at the periphery of an invasive cancer (1,2,3). It is estimated that in the United States the incidence of DCIS, each year, varies between 18 to 25% of the total number of newly diagnosed breast cancers (4,5). Ductal carcinoma in situ belongs, genetically and pathomorphologically, to a heterogenous group of preinvasive neoplastic lesions characterized by clonal proliferation of malignant cells limited to the lumen of breast ducts. It has not a known natural history and its phenotypical spectrum is wide, varying from a slowly evolving disease to a fast growing one, invading the surrounding stroma and even metastasizing to distant sites (6). In the absence of reliable prognostic markers, most of patients are submitted to invasive treatments consisting mainly in surgery, alone or associated with radiation and endocrine therapy (7). Molecular subtyping has improved the understanding of breast cancer biology and its possibilities for evolution and have provided the tools to design a more personalized treatment (8). In the absence of reliable molecular markers clinical management of patients with DCIS is based on patient's option and tumor characteristics. Based on the knowledge of today, DCIS could be used to exemplify the notions of overdiagnosis and overtreatment. The final goal of the treatment of DCIS is to prevent invasive breast cancer recurrence. Mortality rate associated with DCIS is very low, being estimated at 1-2 % at 10 years, while patients with DCIS treated by wide local excision with or without radiation may have a local recurrence rate of 5 to 30% and half of these present as an invasive cancer. Today's clinicians are not able to predict the risk of progression for a DCIS diagnosed by biopsy, but neither the risk of local recurrence, as an invasive cancer, of DCIS treated by conservative surgery with or without radiation (9). Progression to invasive cancer is difficult to be predicted as the disease is highly heterogenous. Because of these uncertainties, it is highly important to carefully inform the patient and engage her in the treatment decision process (10). There is a trend for de-escalation of treatment for DCIS. A study comparing two groups of patients with pure DCIS was conducted: one with standard care and the other under active surveillance (11). The main outcome was the probability to die from breast cancer at 10 years after the diagnosis. The mortality risk from breast cancer is higher for younger women, than the older ones, under active surveillance. Women over the age of 70 years, have many comorbidities that could induce the risk of dying, regardless of DCIS treatment decision. This study suggested that active surveillance could be a reasonable option for certain category of patients. This attitude is not without risks. A patient with DCIS on core needle biopsy could hide an invasive cancer in 25% of cases (12). Today, there are four randomized control trials of active surveillance offered to patients with low-grade DCIS: LORD (LOw Risk DCIS), COMET (Comparison of Operative to Monitoring and Endocrine Therapy), LORIS (LOw RISk DCIS) and LORETTA (10,13-16). Non-surgical approaches are of two types: active surveillance alone or associated with hormone therapy. There are some differences between the trials. While in LORD and LORIS trials the study arms are represented by active surveillance only, hormone therapy is an option in COMET trial and mandatory in the single arm trial LORETTA. The aim of these studies is to examine the safety and the effectiveness of active surveillance compared with surgical management for low-risk DCIS. The results of these trials are awaited with great interest. Patients with ductal carcinoma in situ need special counseling. To talk about "a good" cancer or even no cancer and to recommend as treatment a mastectomy is highly confusing. The language used by all members of the team must be unitary, removing the anxiety and helping patients to make the best decision. This special issue is a great opportunity to have the opinions of highly respected international specialists in the field for a comprehensive review of DCIS of the breast.