A voluntary accreditation scheme for Breast Cancer Services & the further development of European Breast Cancer Guidelines: project workshops report. Workshop for Experts: From 21 to 22 February 2013; Workshop for Countries Delegates: From 13 to 14 March 2013

Two Workshops were organised in order to inform and involve stakeholders about the task the JRC has been given of updating existing European Guidelines on Quality Assurance in Breast Cancer Screening and Diagnosis and, in parallel, to develop a quality assurance scheme for breast cancer services. Participants at both workshops, coming from different areas of competence and of interest (e.g. clinical experts, patients' associations, guidelines methodologists, policy makers, screening programme managers, etc), were asked to contribute with their own experience and knowledge and to provide input on project pillars and modalities to coordinated and optimise the direction of the project. This report not only includes the narration of the events, but also the main conclusions derived from a thorough discussion on the main aspects of the project and their impact on the planning of activities for meeting the requirements of the two tasks.JRC.I.2-Public Health Policy Suppor

Hypocapnia Alone Fails to Provoke Important Electrocardiogram Changes in Coronary Artery Diseased Patients

Background: There is still an urgent clinical need to develop non-invasive diagnostic tests for early ischemic heart disease because, once angina occurs, it is too late. Hypocapnia has long been known to cause coronary artery vasoconstriction. Some new cardiology tests are accompanied by the claim that they must have potential diagnostic value if hypocapnia enhances their cardiac effects in healthy subjects. But no previous study has tested whether hypocapnia produces bigger cardiac effects in patients with angina than in healthy subjects. Methods: Severe hypocapnia (a PetCO2 level of 20 mmHg) lasting >15 min was mechanically induced by facemask, while conscious and unmedicated, in 18 healthy subjects and in 10 patients with angina and angiographically confirmed coronary artery disease, awaiting by-pass surgery. Each participant was their own control in normocapnia (where CO2 was added to the inspirate) and the order of normocapnia and hypocapnia was randomized. Twelve lead electrocardiograms (ECG) were recorded and automated measurements were made on all ECG waveforms averaged over >120 beats. 2D echocardiography was also performed on healthy subjects. Results: In the 18 healthy subjects, we confirm that severe hypocapnia (a mean PetCO2 of 20 ± 0 mmHg, P 0.05) on their electro- or echocardiogram. All 10 angina patients tolerated the mechanical hyperventilation well, with minimal discomfort. Hypocpania caused a similar increase in V1 (by 39%, P 0.05 vs. healthy controls) and did not induce angina. Its effects were no greater in patients who did not take β-blockers, or did not take organic nitrates, or had the worst Canadian Cardiovascular Society scores. Conclusion: Non-invasive mechanical hyperventilation while awake and unmedicated is safe and acceptable, even to patients with angina. Using it to produce severe and prolonged hypocapnia alone does produce significant ECG changes in angina patients. But its potential diagnostic value for identifying patients with coronary stenosis requires further evaluation

Burden of Human papillomavirus (HPV)-related disease and potential impact of HPV vaccines in the Republic of Korea

Background: We aimed to review the burden and the potential impact of human papillomavirus (HPV) vaccines on HPV-related diseases in the Republic of Korea and to discuss cervical cancer prevention practices in this country. Methods: Cancer burden statistics were retrieved from GLOBOCAN-2018 and Statistics Korea. HPV disease burden was assessed via systematic review. Vaccine types relative contribution (RC) was estimated using data from an international project using formalin-fixed paraffin-embedded specimens. Results: Despite a downtrend in cervical cancer in recent years, Korean rates remain high. In contrast, oropharyngeal cancer incidence has gradually increased and other anogenital cancers remain rare. In Korea, HPV prevalence in general population is around 20%. In cervical cancer, RC of HPVs 16/18 (74.0%) increased to 92.0% when including HPVs 31/33/45/52/58. Limited information was available for other HPV-related cancer sites. Regarding prevention, since the inclusion of the HPV vaccine into the National Immunization Program, almost half (49%) of the target cohort in 2016 had received the first dose of vaccine. Further, percentage of women screened with pap has increased from 41.1%-2009 to 53.0%-2016. Conclusions: HPV-related disease burden in Korea is significant. Results suggest that the combination of effective and high coverage HPV vaccination and screening programmes could substantially impact on HPV-related disease in Korea

On the predicaments of the English L1 language learner: a conceptual article

The unparalleled rise of English has led native speakers (L1) to becoming increasingly outnumbered by L2 speakers; English as global commodity has stimulated much research into the learning and teaching of English. Meanwhile, fewer and fewer L1 English speakers are choosing to learn languages; a phenomenon which has received less attention. This article investigates both phenomena in the light of two recent theoretical developments in Applied Linguistics and second language acquisition (SLA), namely dynamic system theory and the multilingual turn in SLA, scrutinising the effects of the re-positioning of L1 English language learners. The conclusion suggests a conceptualisation of this learner group alongside, and yet very different to, other linguistically disadvantaged group. Pedagogical pathways to best support this learner group are also discussed

From Bengali to English: sequential bilingualism of a second-generation British Bangladeshi

The paper discusses sequential language acquisition of the researcher's daughter Safa who transformed from a monolingual Bengali speaker to an almost monolingual English speaker in a few months after moving to the UK. Safa was born in Bangladesh and was a monolingual Bengali speaker until she was three years and nine months when the family moved to the UK. Unlike most research on sequential bilingualism, Safa's transition from Bengali to English went through a period of an invented language, which she developed and used for a few months. Safa then underwent language shift as Bengali became her passive language. Safa's loss of fluency in Bengali was mainly due to the absence of Bengali linguistic environment, because her family lived outside the community. Safa's mother's indifference to Bangladeshi ethnicity and her parents’ positive attitude towards Britishness meant that her decline in Bengali did not cause them much concern. Despite the lack of proficiency in Bengali, Safa still retains a strong ethnic Bangladeshi identity. Tabors and Snow’s four-stage developmental process of sequential second-language acquisition has been applied to find the similarities and differences in Safa's case, while language maintenance and shift theories have contributed to the analysis of the process of her language shift

Teacher knowledge and beliefs about grammar: a case study of an English primary school

This case study of developing teacher attitudes, beliefs and content knowledge at one primary school in the North-West of England deals with the new spelling, punctuation and grammar (SPaG) elements of the National Curriculum, focusing on grammatical terms and concepts. It uses data collected over 10 months from June 2014 to March 2015, including surveys, interviews and comments made during post-observation discussions and during SPaG CPD sessions. The findings suggest that, while much work remains to be done in developing teachers’ knowledge base, attitudes are largely supportive of teaching children grammar terms and concepts

A Transgenic Drosophila Model Demonstrates That the Helicobacter pylori CagA Protein Functions as a Eukaryotic Gab Adaptor

Infection with the human gastric pathogen Helicobacter pylori is associated with a spectrum of diseases including gastritis, peptic ulcers, gastric adenocarcinoma, and gastric mucosa–associated lymphoid tissue lymphoma. The cytotoxin-associated gene A (CagA) protein of H. pylori, which is translocated into host cells via a type IV secretion system, is a major risk factor for disease development. Experiments in gastric tissue culture cells have shown that once translocated, CagA activates the phosphatase SHP-2, which is a component of receptor tyrosine kinase (RTK) pathways whose over-activation is associated with cancer formation. Based on CagA's ability to activate SHP-2, it has been proposed that CagA functions as a prokaryotic mimic of the eukaryotic Grb2-associated binder (Gab) adaptor protein, which normally activates SHP-2. We have developed a transgenic Drosophila model to test this hypothesis by investigating whether CagA can function in a well-characterized Gab-dependent process: the specification of photoreceptors cells in the Drosophila eye. We demonstrate that CagA expression is sufficient to rescue photoreceptor development in the absence of the Drosophila Gab homologue, Daughter of Sevenless (DOS). Furthermore, CagA's ability to promote photoreceptor development requires the SHP-2 phosphatase Corkscrew (CSW). These results provide the first demonstration that CagA functions as a Gab protein within the tissue of an organism and provide insight into CagA's oncogenic potential. Since many translocated bacterial proteins target highly conserved eukaryotic cellular processes, such as the RTK signaling pathway, the transgenic Drosophila model should be of general use for testing the in vivo function of bacterial effector proteins and for identifying the host genes through which they function