In nucleotide excision repair, bulky DNA lesions such as UV-induced cyclobutane pyrimidine dimers are removed from the genome by concerted dual incisions bracketing the lesion, followed by gap filling and ligation. So far, two dual-incision patterns have been discovered: the prokaryotic type, which removes the damage in 11–13-nucleotide-long oligomers, and the eukaryotic type, which removes the damage in 24–32-nucleotide-long oligomers. However, a recent study reported that the UvrC protein of Mycobacterium tuberculosis removes damage in a manner analogous to yeast and humans in a 25-mer oligonucleotide arising from incisions at 15 nt from the 3´ end and 9 nt from the 5´ end flanking the damage. To test this model, we used the in vivo excision assay and the excision repair sequencing genome-wide repair mapping method developed in our laboratory to determine the repair pattern and genome-wide repair map of Mycobacterium smegmatis. We find that M. smegmatis, which possesses homologs of the Escherichia coli uvrA, uvrB, and uvrC genes, removes cyclobutane pyrimidine dimers from the genome in a manner identical to the prokaryotic pattern by incising 7 nt 5´ and 3 or 4 nt 3´ to the photoproduct, and performs transcription-coupled repair in a manner similar to E. coli.

The faithful segregation, or “partition,” of many low-copy number bacterial plasmids is driven by plasmid-encoded ATPases that are represented by the P1 plasmid ParA protein. ParA binds to the bacterial nucleoid via an ATP-dependent nonspecific DNA (nsDNA)-binding activity, which is essential for partition. ParA also has a site-specific DNA-binding activity to the par operator (parOP), which requires either ATP or ADP, and which is essential for it to act as a transcriptional repressor but is dispensable for partition. Here we examine how DNA binding by ParA contributes to the relative distribution of its plasmid partition and repressor activities, using a ParA with an alanine substitution at Arg351, a residue previously predicted to participate in site-specific DNA binding. In vivo, the parAR351A allele is compromised for partition, but its repressor activity is dramatically improved so that it behaves as a “super-repressor.” In vitro, ParAR351A binds and hydrolyzes ATP, and undergoes a specific conformational change required for nsDNA binding, but its nsDNA-binding activity is significantly damaged. This defect in turn significantly reduces the assembly and stability of partition complexes formed by the interaction of ParA with ParB, the centromere-binding protein, and DNA. In contrast, the R351A change shows only a mild defect in site-specific DNA binding. We conclude that the partition defect is due to altered nsDNA binding kinetics and affinity for the bacterial chromosome. Furthermore, the super-repressor phenotype is explained by an increased pool of non-nucleoid bound ParA that is competent to bind parOP and repress transcription.

Phillies pitchers and catchers have their first workout Wednesday morning at Carpenter Complex. Almost anything can happen between Wednesday and Opening Day. That said, here is a very early prediction of the Phillies' Opening Day roster, knowing the Phillies remain in the hunt to sign Bryce Harper or Manny Machado.

The 30 prospects below all are getting very long looks this spring with an eye toward breaking camp with the parent club. Even if they start the year in the Minors, they all should get the chance to contribute at some point in the very near future.

Odubel Herrera smiled and patted his stomach. The paunch that he carried into Spring Training 2018 is no longer there. Herrera has reported to camp leaner and, as he said Friday morning at Spectrum Field, motivated to bounce back from the worst season of his four-year career.

Since debuting in 2011, center fielder Mike Trout has been far and away the best player in the Majors, but the Angels have reached the postseason just once in his eight-year career.

The Angels head to Spring Training with most of their roster set, but there will be competition for a few spots. Here's a look at the projected roster for the Angels, as they begin their first campaign under manager Brad Ausmus.

The 30 prospects below all are getting very long looks this spring with an eye toward breaking camp with the parent club. Even if they start the year in the Minors, they all should get the chance to contribute at some point in the very near future.

The Angels added a veteran lefty reliever, as Dan Jennings officially signed a Minor League deal on Saturday and joined the club for workouts at the club's Spring Training complex. Jennings will earn $1 million, plus incentives, if he makes the club.

Political Opposition and Policy Alternatives in Zambia 31 October 2017 — 10:30AM TO 11:30AM Anonymous (not verified) 19 October 2017 Chatham House, London

In Zambia’s 2016 national election, the Patriotic Front (PF) was re-elected by a narrow margin. The PF’s Edgar Lungu secured 50.35 per cent of the vote according to the Electoral Commission of Zambia, narrowly avoiding a second round, while his main rival, Hakainde Hichilema, won 47.67 per cent. The UPND, led by Mr Hichilema, alleges electoral fraud and has challenged the result in the courts and through direct protests. Mr Hichilema was imprisoned for 100 days.

At this meeting, Hakainde Hichilema will discuss his UPND priorities, how to strengthen opposition parties and their role in Zambia’s democratic future.

Read transcript

Water, Energy and Development in Angola: From Ambition to Actuality 13 December 2018 — 5:00PM TO 6:00PM Anonymous (not verified) 28 November 2018 Chatham House, London

South Africa After the Elections: Balancing Domestic and International Policy Priorities 16 May 2019 — 1:30PM TO 2:30PM Anonymous (not verified) 9 May 2019 Chatham House | 10 St James's Square | London | SW1Y 4LE

The government that emerges from the 8 May election in South Africa faces immediate domestic and international foreign policy demands. Attracting Foreign Direct Investment to stimulate job growth, accelerating anti-corruption and good governance efforts are at the forefront of the new government’s agenda.

International ambitions will be upgraded such as UN security council reform, maximizing South Africa’s G20, BRICS and IBSA membership and preparing for South Africa’s chairmanship of the African Union (AU) in 2020.

At this meeting, the speakers – Moeletsi Mbeki, deputy chairman of SAIIA and author with Nobantu Mbeki of A Manifesto for Social Change: How to Save South Africa, and Elizabeth Sidiropoulos, chief executive of SAIIA and currently co-editing a volume on A South African Foreign Policy for the 2020s which will be published in 2019 – will reflect on the election and discuss the new government’s domestic and international policy agenda. The meeting will be chaired by Ann Grant, former British High Commissioner to South Africa (2000-05) with past experience working for Oxfam, Standard Chartered Bank and Tullow Oil.

Zimbabwe Futures 2030: A Vision for Inclusive Long-Term Economic Recovery 10 October 2019 — 10:00AM TO 12:15PM Anonymous (not verified) 5 September 2019 Harare, Zimbabwe

In its Vision 2030, the government of Zimbabwe committed itself to facilitating an open market and stable economy through strategies such as the Transitional Stabilization Programme (TSP) and new industrialization policy. The private sector is pivotal to these objectives and creating an environment conducive to inclusive and job-creating economic growth. Economic growth can only be achieved with a conducive policy environment and government support to underpin markets with provision of public goods, entrepreneurial incentives and protect contract enforcement and dispute resolution mechanisms.

This event will launch a new Chatham House Africa Programme publication on Zimbabwe’s Vision 2030. The paper is the culmination of an inclusive research process that has drawn on senior private sector expertise, civil society, academics, technocratic elements of government and other experts to develop policy recommendations that will support inclusive economic growth in Zimbabwe.

This event is held in partnership with the Zimbabwe Business Club and Konrad Adenauer Stiftung (KAS). It is supported by KAS and the Dulverton Trust.

Zimbabwe After Mugabe Expert comment sysadmin 12 September 2019

He was the founding father of modern Zimbabwe, but he leaves behind a contested legacy and a country at a crossroads.

Robert Mugabe’s death at age 95, after nearly 60 years at the helm of Zimbabwe’s liberation and post-independence politics, is a momentous occasion. Mugabe was the founding father of modern Zimbabwe, with all its stunning successes and grievous failures. As he moves into national legend, contestations over his legacy demonstrate that, in death as in life, the man known as Gushungo (from his family lineage) still continues to polarize opinion.

His failings are well known, including the mass murders of more than 30,000 civilians in Matabeleland during the 1980s Gukurahundi campaigns, and the killings and torture of opposition activists in the 2000s and 2010s.

The land reform process, although necessary, was handled in a haphazard way, contributing to the economic crash and 2008’s ‘year zero’, when Zimbabwe was plagued with a worthless currency, no food in the shops, unsafe drinking water and the spread of cholera and typhoid.

Nevertheless, Mugabe is genuinely mourned by millions in Zimbabwe and beyond. Partly this is for what he achieved in building Zimbabwe’s education, health and economy, and for giving land – however haphazardly – to millions of Zimbabweans.

But it was his assertion of black and African identity and pride which made Mugabe connect with millions. I grew up in Ian Smith’s Rhodesia, where being a black African was, by law, a cardinal sin and, at times, a capital offence. Mugabe helped to make being black not just acceptable but also a cause for celebration.

What now for the country?

Mugabe continues to shape Zimbabwe’s politics. Emmerson Mnangagwa’s government has tried to differentiate itself from Mugabe’s administrations, avoiding his radical and ideologically driven language and policies. But Zimbabwe’s military, which played a critical role in Mugabe’s 2017 removal, remains influential over government policy.

Mnangagwa wants to be seen as a moderate, accessible for regular meetings with private sector and international investors through the Presidential Advisory Commission, the Tripartite Negotiating Forum, investment meetings and other forums.

Politically, Zimbabwe’s bipartisan Parliamentary Portfolio Committees have emerged over the past year as key institutions able to effectively hold the government and other institutions to account. Contentious Mugabe-era legislation such as the Public Order and Security Act has been revised in line with Zimbabwe’s constitution. And the ongoing multiparty dialogue is a useful start towards a much-needed national political dialogue.

Through its Transitional Stabilization Programme, the Mnangagwa administration has outlined an ambitious economic reform agenda. There has been some progress; in January, the government reported a $113 million budget surplus, and publicly available audits of state-owned enterprises by Public Auditor Mildred Chiri have exposed the rot at the heart of institutions such as the National Social Security Authority.

The government has streamlined bureaucracy and legislation to improve Zimbabwe’s business climate; and the newly empowered Zimbabwe Anti-Corruption Commission has begun probing some high-profile fraud cases.

Zimbabwe’s global re-engagement with international financial institutions, a process which had stalled in Mugabe’s later years, is now making some progress, with Zimbabwe joining the Staff Monitored Programme with the IMF in mid-2019. The introduction of a new currency in February was designed to end the chaos of multiple US-dollar exchange rates and the dominance of the black market, but has had limited results.

Hardship

But the Mnangagwa administration’s attempts to stabilize the Zimbabwean economy have also included deep cuts in government spending, and the resulting austerity has brought severe hardship for ordinary Zimbabweans. Massive fuel, power and water shortages and the sky-rocketing cost of living are all reminiscent of the Mugabe era, damaging the credibility of the government’s promise of an economic dividend.

Shortages have also hit tourism, which had rebounded in recent years, and the new national currency initiative has pushed inflation to an official 180%. Violent urban protests took place in 2018 and 2019.

While government is right to commit to reforms, and has taken steps, such as cost-of-living allowances, to help mitigate the worst impacts, many Zimbabweans view the official ‘austerity for prosperity’ message with deep scepticism, and the current state of the economy has encouraged more young Zimbabweans to leave the country. Government and the business community need to prioritize people over statistics, and put social protection, anti-poverty programmes and economic democracy at the forefront of economic reform.

Getting public services working again will also require a broad national economic consensus and could look to capitalize on diaspora-led initiatives in education, agriculture, health and other sectors.

But this will require the opposition Movement for Democratic Change to recognize Mnangagwa’s legitimacy in return for substantive talks between government and the opposition and strengthened outreach to Zimbabwe’s nearly 5-million strong global diaspora, many in the United Kingdom, unsure of what tomorrow will bring, and an increasingly troubled South Africa.

The future

Robert Mugabe’s funeral will bring together the great and the good, not just from Zimbabwe but from all over the world. Robert Mugabe was always a voice and never an echo, and his passing, as with those of other Zimbabwean change-makers of all races and backgrounds, is an opportunity to reflect on the legacy of the liberation era.

But more importantly, it is also an opportunity to think about what lies ahead. Zimbabweans have proved to be resilient and innovative; but it will require a collective effort and a national re-engagement to ensure that Zimbabwe’s future is not its past. And with Mugabe now gone, the Zimbabwe government must prove that it can and will do better.

Black perspectives on international relations 27 October 2022 — 5:00PM TO 6:00PM Anonymous (not verified) 4 October 2022 Chatham House and Online

How can black perspectives help the world tackle global challenges and expand our understanding of international relations?

As social boundaries change, the viewpoints of black academics, thought leaders and policymakers have grown in both influence and strength worldwide, challenging western and institutional norms. 

However, many institutions and organizations, long established with the exclusion of black voices, have to adapt if there is to be greater inclusion and diversity of thought when tackling major global issues.

Growing reflection on the legacy of colonialism and the importance of the power of diversity may be needed for today’s problems.

The search for global racial equality has seen a growing commitment to ensuring the black experience is at the heart of geopolitical discussions.

This panel discussion looks at what changes are occurring now and how is the conversation shifting. It also examines the challenges posed by the increasing politicization of race and culture issues in the current political environment.

Key questions discussed by the panel include:

• What is the importance of black voices in international relations and where are the main challenges to greater incorporation?

• What are some of the leading perspectives, approaches and beliefs within Africa and across the black diaspora regarding international relations?

• To what extent are governments, businesses and leading global institutions making efforts to include more black voices in decision-making?

• How are black academics changing wider geopolitical conversations and to what extent can deeper conversations lead to change?

• Will an ‘African Century’ bring black perspectives on international relations to the fore of the geopolitical agenda?

As with all members events, questions from the audience drive the conversation.

Read the transcript. 

War on Ukraine: The energy crisis and Europe’s impending long winter 2 November 2022 — 5:00PM TO 6:00PM Anonymous (not verified) 4 October 2022 Online

Can Europe remain unified over the long winter?

Since Russia’s invasion of Ukraine, the global community has been responding to significant price shocks, especially energy. As Europe heads into a particularly difficult winter, policymakers are grappling with the costs, both political and economic, required to make sure Russian energy blackmail does not succeed.

Retaining a unified front against Russia and providing continued support to the Ukrainian government will be great challenges. As the cold begins to bite, war fatigue may accelerate among the populations of Europe. Providing their people with adequate heat will not come cheaply for governments across the continent at a time of economic uncertainty.

At this critical moment of Russia’s invasion, experts discuss:

• Have European preparations been sufficient to stave off an energy crisis this winter?
• What will be Russia’s reaction during and after the winter period, particularly if Europe avoids energy market failures?
• How will this ‘energy crisis’ ensure future dependencies on single state actors of goods and services do not occur in the future?

Read the transcript. 

American democracy in 2022: Trump, insurrection, and midterm elections 31 October 2022 — 2:00PM TO 3:00PM Anonymous (not verified) 7 October 2022 Online

How much has Donald Trump changed US politics and democracy, and will Trump and ‘Trumpism’ be more or less significant in the years ahead?

America’s democracy is divided, polarized and fragmenting. Inequality and internal division have a long history. But Trump’s lasting influence on the Republican party, and politics more broadly, continues to leave a mark. Repeated denials of President Joe Biden’s 2020 election win, wrapped in claims of electoral fraud, have eroded faith in the democratic institutions.

The memories of 6 January are still fresh, reminding all of the dangers posed by such actions. All told, America’s democracy has taken a beating in recent years.

To help make sense of the events over recent years and consequences for the coming mid-terms, Peter Baker and Susan Glasser (authors of The Divider: Trump in the White House 2017–2021) walk through in detail how the American politics of today has been arrived at.

Key questions discussed include:

• What has been learned from the January 6 Committee?

• Is there a likelihood of a similar event in the future?

• When and how will Trump lose his influence over the Republican party? 

• What are the broader ramifications of the Trump era?

• What did the events of 6 January mean for America’s relationships globally?

 As with all Chatham House member events, questions from members drive the conversation.

Read the transcript. 

Crisis in the international order 23 January 2023 — 6:00PM TO 7:00PM Anonymous (not verified) 8 December 2022 Chatham House and Online

Why societies are challenging the international order?

Major global challenges, including the climate, refugee crises and the global pandemic, are increasingly revealing shortcomings in our international system and are bringing to the forefront calls for a more just world. But what is justice? 
 
Calls for justice come in many forms and from many directions - from the fair distribution of resources to the recognition of indigenous rights. While for some there is consensus on the importance of multilateral cooperation to tackle global issues, there is a sharp North/South divide at the centre of debates on issues such as the climate crisis, racial justice, and international law. Countries from the global South are demanding more equitable and redistributive solutions, for example in the distribution of COVID-19 vaccines, while the Global North seek the status quo. 
 
North/South division slows progress on reform. Some political actors are starting to challenge the very foundations of our global order, a move that could dramatically change the global system as we know it. 

Key questions to consider include:

• Why are there tensions between the global North and South?
• How can these issues be addressed?
• Does the global North ‘owe’ the global South some form of justice? Which form of justice?
• If these issues are not addressed, what are the implications for the current international order?

This event is held in conjunction with International Affairs.

As with all members events, questions from the audience drive the conversation.

Read the transcript.

Russia’s aggression and a crisis for multilateralism 30 March 2023 — 1:00PM TO 2:00PM Anonymous (not verified) 23 March 2023 Chatham House and Online

In conversation with Dmytro Kuleba, minister of foreign affairs of Ukraine, about how multilateral organizations struggle to respond adequately to Russia’s full-scale invasion of Ukraine.

As a permanent member of the UN Security Council, Russia pursues this war in defiance of the umbrella organization’s multiple resolutions condemning the invasion, along with its war crimes, annexation of territory, deliberate targeting of civilian nuclear infrastructure, cultural extermination, and global disinformation campaign. 

This event explores the following questions: 

• How should the response of the UN to Russian aggression be assessed? 
• What can be done to uphold the guiding principles of the UN Charter? 
• Is there a ‘UN problem’ or a ‘Russia problem’? 
• How can trust and the legitimacy of multilateral cooperation be restored in times of strategic rivalry and rising global tensions?
• Who can drive such an effort? 
• Is post-Soviet transfer of the UN Security Council seat to Russia a cause of current impunity? 

This event features a live in-person audience in Kyiv as well as in London and online.

Can rhetoric match reality? Britain’s international development future 27 April 2023 — 9:00AM TO 10:00AM Anonymous (not verified) 12 April 2023 Chatham House and Online

In conversation with Andrew Mitchell, minister of state, UK Foreign, Commonwealth and Development Office. 

Last month’s updated Integrated Review positioned international development as a key pillar of British foreign policy which sets out the importance of the UK’s efforts to shape the ‘global strategic environment’.

Focusing heavily on Africa and the Indo-Pacific, international development will be central to the ambition of a ‘Global Britain’.

The Integrated Review outlines seven priority areas to revitalize the drive to meet the Global Goals, with a climate security strategy at its heart, while seeking to go beyond official development assistance (ODA).

However, there are major challenges ahead. Since 2021, the UK’s ODA has been cut from 0.7 per cent to 0.5 per cent gross national income (GNI). Some are concerned that since being subsumed by the UK Foreign Office, the UK Foreign, Commonwealth and Development Office has diluted the effectiveness of UK international development. Then there is the question of the strength of British public support for development assistance at a time of domestic economic hardship.

Can rhetoric match reality?

This event tackles questions including:

• What does the UK’s vision for international development mean in practice?
• Will aid and development help push Britain’s influence around the world?
• Can policymakers and politicians garner domestic support for international aid in times of economic uncertainty, and if so, how?
• Can the UK rebuild its reputation in the world while it doesn’t meet its 0.7 per cent GNI target?

This event will be balloted for in-person attendance. Register your interest to join and a confirmation email will be sent to you on Tuesday 25 May at 12:00 BST to confirm your place at the event.

As with all member events, questions from the audience drive the conversation.

A coffee reception will immediately follow this event.

I’m often asked if I miss working in the House of Commons. Of course I do; it’s one of the most amazing places in the world and remains the cockpit of our nation.There are obviously days I miss it more than others, usually around the big national moments. Whatever your view of Kim Leadbeater’s private member’s bill—the Terminally Ill Adults (End of Life) Bill—its second reading this month will be one of those big moments.Kim is a friend of mine, and we spoke before she decided to put her bill forward after it topped the private members’ ballot at the start of the new parliament. My advice was to proceed with great care, to remember that this will take over your career in many ways, and to read the report produced earlier this year by the Health and Social Care Committee, which I chaired, on the subject of assisted dying/assisted...

Concerns are mounting over whether the NHS can meet key performance targets this winter, NHS Providers has said, after a survey of trust leaders highlighted pressure on hospitals, ambulance services, and community and mental health teams.1Over nine in 10 of the leaders who responded (96%) said that they were extremely or moderately concerned about the effect of winter pressures on their trust and local area. The most common reasons for concerns related to financial constraints and staffing provision. The top three greatest risks to the provision of high quality patient care over winter were identified as delayed discharge (57%), social care capacity (49%), and acute care bed capacity (43%).NHS Providers surveyed 171 trust leaders from 118 trusts in September and October, accounting for 56% of the provider sector.Most trust leaders (79%) were worried or very worried about whether their trusts had capacity to meet demand for services over the next...

Memory politics: the challenge of commemoration in post-Soviet Eastern Europe and the Caucasus 5 October 2021 — 1:00PM TO 2:30PM Anonymous (not verified) 21 September 2021 Online

This event explores how to address memory and commemoration in the former Soviet states, considering their role in political processes and violent conflict. 

How the past is remembered and commemorated plays a large role – perhaps too large – in contemporary political debates and in how conflicts are negotiated.

Perceptions of history influence people’s actions and are used to judge or dismiss the actions of others. Nowhere is this more so than in the political, territorial and social debates and disputes across the former Soviet Union.
 
This event examines how to address the problems caused by entrenched memory debates – and proposes a framework for ‘ethical political commemoration’ for use across historical enquiry, political processes, and conflict transformation initiatives.

The speakers explore the topic through the context of Turkey and the Armenian genocide, as well as more broadly through their own experiences in conflict transformation and peace processes.

Interview: Sviatlana Tsikhanouskaya The World Today mhiggins.drupal 25 May 2022

Belarus’s exiled democratic opposition leader tells Roxanne Escobales about her unexpected political career and President Lukashenka’s wavering support for Putin

Sviatlana Tsikhanouskaya is the face of the Belarusian democratic movement. In 2020, she stood as a presidential candidate against Aliaksandr Lukashenka after her husband, an anti-corruption campaigner and the main opposition candidate, was arrested on the campaign trail and imprisoned. Lukashenka, autocratic ruler of Belarus for more than 30 years, was re-elected. Since then, Sviatlana has lived in exile in Lithuania meeting with western leaders and calling for regime change in her native land. Her husband Sergey remains in prison serving an 18-year sentence.

You have said in the past that there will be no free Belarus without a free Ukraine. How is the fate of the two countries connected?

The Kremlin wants to drag our countries into the past, and we are looking into a future which we want to choose for ourselves. The Kremlin doesn’t recognize Ukraine or Belarus as independent countries – it sees them as part of Russia. While the current regime is in our country, there will be a constant threat of aggression from Russia. But we are absolutely independent countries with our own languages, cultures and so on.

The fate of Belarus depends a lot on the outcome of the war in Ukraine, it is evident. When Ukraine wins – and they definitely will win – it will mean the Kremlin is weak and that Lukashenka is weak. Every day we create multiple points of pressure on the regime from within the country, from outside the country. For countries like Ukraine and Belarus the support of strong democracies is very important.

It is very important for European society to understand that it is not just a war between Russia and Ukraine. It is a war between democratic values and dictatorship on the territory of Ukraine. It is very important for democracy to have a strong voice at the moment.

Recently Lukashenka said the war was taking too long. Do you think he understood what he was getting into when he supported Vladimir Putin by allowing his illegal invasion to be launched from Belarus?

The support between the Kremlin and Lukashenka has always been situational – it is not a real friendship. Lukashenka got huge political and economic support in 2020 after the protests, and now he owes a debt to the Kremlin and had to show his loyalty.

And we see how his rhetoric is changing because the situation in Ukraine is changing. At the beginning Lukashenka always said that, ‘Me and Putin will take Ukraine in three days’, and when this blitzkrieg failed, now he wants to get out of the situation. Now he wants to say, ‘Look, we are for peace. We didn’t have any intention to invade Ukraine.’ He wants to act like he is a peacemaker.

He only cares about his own interest, not his country or its people. He just wants to keep his power.

You have been living in exile in Lithuania for two years, and a lot has happened in that time. What is the state of the Belarusian democratic movement now?

We have been a grassroots movement since the first day. There is no leader who says you have to do this or that. My role is to work on the political level. My task is to go to the European Union, to the United States, and ask for packages to assist civil society. With this technical assistance from our democratic partners, we have managed to build structures in exile, and people in Belarus have managed to build structures inside the country.

Another task of mine is to inspire people, and to explain to the international community what is going on and to show them that Belarus is not just Lukashenka’s regime – it is people who want change.

I communicate with Belarusian people almost every day, especially those who are in the country. We have to keep close ties. It is important to understand how dangerous it is in Belarus to communicate on different channels like Telegram or even to subscribe to some media sources. But people do this. They understand the threats and the consequences, but their energy is still so alive.

We have to keep this energy strong and to give this assurance to people that in case something happens to them, or their families, they will get help from outside. This is how it works.

This struggle has come at a very personal cost to you and your husband, Sergey, who is in prison for his political activities. How is he doing?

I communicate with my husband through his lawyer, who visits him once a week. It has to be short messages because there is no privacy. Our children can send him letters and they receive letters back from him.

There are thousands of people like Sergey, and we have to take care of all of them. The treatment of political prisoners is much worse than criminals because they are like Lukashenka’s personal enemies. That is why it is so important to support human rights organizations who provide lawyers to political prisoners. It is important to fund support for them and for families of political prisoners.

You were a teacher when you took over your husband’s presidential campaign. If you could go back in time, what advice would you give yourself?

I would wish I could have had more confidence. I didn’t have any political experience – I was an ordinary woman and wife, the same as millions of other Belarusians. At the beginning, I didn’t feel confident because I didn’t know about politics. I didn’t know how to communicate with the political leaders of different countries. I was scared.

What motivated you to step into your husband’s shoes?

It was an accidental choice. It was terrible for my husband. But I saw millions of people on the streets, and when you see people standing shoulder to shoulder it inspires you. Every day thousands of people call me who want to help, and I understand that we are not alone. This motivates me.

Also, the fact that thousands of children want to see their mothers and fathers who are in jail gives me strength. When sometimes you think you can’t do this any more because it is so difficult, you think about those who haven’t seen their children for two years. It is awful.

So, every day, you find something that gives you a small energy and it doesn’t let you give up.

Central and Eastern Europe become hawkish on China Expert comment LJefferson 16 September 2022

The recent withdrawal of the Baltic countries from the ‘17+1’ format displays changing perceptions of China due to its ambiguity towards the war in Ukraine.

While the Russian invasion of Ukraine only confirmed Central and Eastern Europe’s views of Russia, it is also affecting their relations with China. Although the relationship was already complicated due to unfulfilled Chinese economic promises to CEE countries and growing indications of efforts to influence their domestic politics, China’s support for Russia is pushing Central and Eastern Europeans even further away.

This shift was highlighted, and formalized, recently by several countries in the region leaving the ‘17+1’ format, through which China cooperates with a group of countries from the region. The shifting attitudes towards China will also influence the relationship between the European Union as a whole and China.

A Trojan Horse that never was

When the format was launched in 2012 between 16 CEE countries at the time and China, the countries jumping on board expected a wave of Chinese investment and an opportunity to diversify mostly west-bound trade.

These hopes never fully materialized as Chinese foreign direct investment (FDI) in CEE has been generally lower compared to the rest of Europe and China never became an important export destination for any of the countries. The growing disillusionment and concern about Chinese security threats has led to some of the countries speaking up about the perceived perils of closer cooperation.

The first to withdraw from what had become ‘17+1’ by 2021 was Lithuania, which also took an interest in strengthening ties with Taiwan and allowed it to open a Taiwanese representative office in Vilnius. This triggered a breakdown in the bilateral relations with China. As a retaliatory response, China blocked Lithuanian imports and imports from other EU states containing inputs from Lithuania, leading the EU to launch an official dispute at the WTO.

War in Ukraine

Since the invasion started, CEE countries have been dealing with large numbers of Ukrainian refugees, organizing shipments of military equipment to Ukraine, and at the same time worrying whether they could be next on Russia’s list.

However, the concerns and security environment that these countries face seems to be almost entirely disregarded by China. On the sidelines of the 2022 Winter Olympics in Beijing, Xi and Putin signed the joint communiqué in which China backed Moscow’s demands to reverse NATO borders to the pre-1997 situation, completely disregarding CEE’s security interests.

China’s implicit support for Russia after the invasion has sowed deep mistrust of its respect for the sovereignty of other nations. The Chinese diplomatic apparatus clearly noticed this changing mood among CEE governments and sent a special envoy to eight capitals in April-May tasked with ‘eliminating misunderstandings regarding Russia-Ukraine conflict’.

However, the trip was not particularly successful. The delegation failed to secure high-level meetings, with the most prominent case being the Polish minister of foreign affairs declining to meet Huo Yuzhen, the Chinese Special Councilor for CEEC cooperation. Given that Andrzej Duda, President of Poland, was the only head of an EU state who attended the Beijing Olympics opening ceremony just before the Russian invasion in February, the change in attitudes is clear.

Following the envoy’s visit to the Czech Republic, the Czech parliament’s foreign affairs committee unanimously approved a resolution calling for the country to quit the ‘16+1’ format and the government is expected to act upon it in the near future. Meanwhile, Latvia and Estonia recently jointly announced that they would no longer be participating in the cooperation framework, turning it into ‘14+1’.

In conversation with Edi Rama, prime minister of Albania 23 March 2023 — 5:30PM TO 6:30PM Anonymous (not verified) 13 March 2023 Chatham House and Online

From migration to Russia and China, how is Albania responding to the geopolitical challenges of today?

In late 2022, the UK government made a pointed remark that many of the illegal migrants attempting to get into the country were from Albania. In response, Albania prime minister Edi Rama replied that targeting Albanians as the cause of Britain’s crime and border problems ‘makes for easy rhetoric but ignores hard fact’. 

This nuanced response demonstrated the challenges and complexities that Albania faces, the same as many other countries. As well as being embroiled in the major challenge of international migration, Albania has suffered from a serious cyber-attack in July 2022 from Iran. Government networks were compromised for a month with Tirana removing the Iranian embassy in the capital.

Then there is the ongoing threat from Russia and China. Nestled in the already volatile Balkans, Albania has been at the heart of international affairs in recent months.

Prime Minister Rama speaks at Chatham House to discuss:

• How is Albania responding to Russian aggression and what is its stance on Ukraine?
• Where does Tirana believe China poses the most serious threat?
• How can countries in Europe best respond to illegal migration and better control the flow of people?
• How is the region of the Western Balkans effected by the war in Ukraine and how can it contribute to the security challenges posed by the war?

As with all member events, questions from the audience drive the conversation.

C-X-C motif chemokine receptor 4 (CXCR4)–directed imaging has gained clinical interest in aiding clinical diagnostics in primary aldosteronism (PA). We retrospectively evaluated the feasibility of CXCR4-directed scintigraphy using the novel CXCR-4 ligand [^99mTc]Tc-pentixatec in patients with PA. Methods: Six patients (mean age ± SD, 49 ± 15 y) underwent CXCR4-directed scintigraphy (including planar imaging and SPECT/CT) 30, 120, and 240 min after injection of 435 ± 50 MBq of [^99mTc]Tc-pentixatec. Adrenal CXCR4 expression was analyzed by calculating lesion-to-contralateral ratios (LCRs). Imaging results were correlated to clinical information. Histopathology and clinical follow-up served as the standard of reference. Results: Three subjects showed lateralization of adrenal tracer accumulation, with a mean maximum lesion-to-contralateral ratio of 1.65 (range, 1.52–1.70), which correlated with morphologic findings on CT. One individual underwent adrenalectomy and presented with complete biochemical and clinical remission at follow-up. Histopathologic workup confirmed unilateral aldosterone-producing adenoma. Conclusion: [^99mTc]Tc-pentixatec scintigraphy with SPECT in patients with PA is feasible and might offer a valuable alternative to CXCR4-directed imaging with [⁶⁸Ga]Ga-pentixafor PET.

The peptide hormone ghrelin is produced in cardiomyocytes and acts through the myocardial growth hormone secretagogue receptor (GHSR) to promote cardiomyocyte survival. Administration of ghrelin may have therapeutic effects on post–myocardial infarction (MI) outcomes. Therefore, there is a need to develop molecular imaging probes that can track the dynamics of GHSR in health and disease to better predict the effectiveness of ghrelin-based therapeutics. We designed a high-affinity GHSR ligand labeled with ¹⁸F for imaging by PET and characterized its in vivo properties in a canine model of MI. Methods: We rationally designed and radiolabeled with ¹⁸F a quinazolinone derivative ([¹⁸F]LCE470) with subnanomolar binding affinity to GHSR. We determined the sensitivity and in vivo and ex vivo specificity of [¹⁸F]LCE470 in a canine model of surgically induced MI using PET/MRI, which allowed for anatomic localization of tracer uptake and simultaneous determination of global cardiac function. Uptake of [¹⁸F]LCE470 was determined by time–activity curve and SUV analysis in 3 regions of the left ventricle—area of infarct, territory served by the left circumflex coronary artery, and remote myocardium—over a period of 1.5 y. Changes in cardiac perfusion were tracked by [¹³N]NH₃ PET. Results: The receptor binding affinity of LCE470 was measured at 0.33 nM, the highest known receptor binding affinity for a radiolabeled GHSR ligand. In vivo blocking studies in healthy hounds and ex vivo blocking studies in myocardial tissue showed the specificity of [¹⁸F]LCE470, and sensitivity was demonstrated by a positive correlation between tracer uptake and GHSR abundance. Post-MI changes in [¹⁸F]LCE470 uptake occurred independently of perfusion tracer distributions and changes in global cardiac function. We found that the regional distribution of [¹⁸F]LCE470 within the left ventricle diverged significantly within 1 d after MI and remained that way throughout the 1.5-y duration of the study. Conclusion: [¹⁸F]LCE470 is a high-affinity PET tracer that can detect changes in the regional distribution of myocardial GHSR after MI. In vivo PET molecular imaging of the global dynamics of GHSR may lead to improved GHSR-based therapeutics in the treatment of post-MI remodeling.

Preclinical data have shown that ¹⁶¹Tb-labeled peptides targeting the somatostatin receptor are therapeutically more effective for peptide receptor radionuclide therapy than are their ¹⁷⁷Lu-labeled counterparts. To further substantiate this enhanced therapeutic effect, we performed cellular dosimetry to quantify the absorbed dose to the cell nucleus and compared dose–response curves to evaluate differences in relative biological effectiveness in vitro. Methods: CA20948 cell survival was assessed after treatment with [¹⁶¹Tb]Tb- and [¹⁷⁷Lu]Lu-DOTATATE (agonist) and with [¹⁶¹Tb]Tb- and [¹⁷⁷Lu]Lu-DOTA-LM3 (antagonist) via a clonogenic assay. Cell binding, internalization, and dissociation assays were performed up to 7 d to acquire time-integrated activity coefficients. Separate S values for each type of particle emission (Auger/internal conversion [IC] electrons and β^– particles) were computed via Monte Carlo simulations, while considering spheric cells. Once the absorbed dose to the cell nucleus was calculated, survival curves were fitted to the appropriate linear or linear-quadratic model and corresponding relative biological effectiveness was evaluated. Results: Although the radiopeptide uptake was independent of the radionuclide, [¹⁶¹Tb]Tb-DOTATATE and [¹⁶¹Tb]Tb-DOTA-LM3 delivered a 3.6 and 3.8 times higher dose to the nucleus, respectively, than their ¹⁷⁷Lu-labeled counterparts on saturated receptor binding. This increased nucleus-absorbed dose was mainly due to the additional emission of IC and not Auger electrons by ¹⁶¹Tb. When activity concentrations were considered, both [¹⁶¹Tb]Tb-DOTATATE and [¹⁶¹Tb]Tb-DOTA-LM3 showed a lower survival fraction than did labeling with ¹⁷⁷Lu. When the absorbed dose to the nucleus was considered, no significant difference could be observed between the dose–response curves for [¹⁶¹Tb]Tb- and [¹⁷⁷Lu]Lu-DOTATATE. [¹⁶¹Tb]Tb-DOTA-LM3 showed a linear-quadratic dose response, whereas [¹⁶¹Tb]Tb-DOTATATE showed only a linear dose response within the observed dose range, suggesting additional cell membrane damage by Auger electrons. Conclusion: The IC, rather than Auger, electrons emitted by ¹⁶¹Tb resulted in a higher absorbed dose to the cell nucleus and lower clonogenic survival for [¹⁶¹Tb]Tb-DOTATATE and [¹⁶¹Tb]Tb-DOTA-LM3 than for the ¹⁷⁷Lu-labeled analogs. In contrast, [¹⁶¹Tb]Tb-DOTATATE showed no higher dose response than [¹⁷⁷Lu]Lu-DOTATATE, whereas for [¹⁶¹Tb]Tb-DOTA-LM3 an additional quadratic response was observed. Because of this quadratic response, potentially caused by cell membrane damage, [¹⁶¹Tb]Tb-DOTA-LM3 is a more effective radiopeptide than [¹⁶¹Tb]Tb-DOTATATE for labeling with ¹⁶¹Tb.

Our purpose was to prospectively assess the distribution of NETPET scores in well-differentiated (WD) grade 2 and 3 gastroenteropancreatic (GEP) neuroendocrine tumors (NETs) and to determine the impact of the NETPET score on clinical management. Methods: This single-arm, institutional ethics review board–approved prospective study included 40 patients with histologically proven WD GEP NETs. ⁶⁸Ga-DOTATATE PET and ¹⁸F-FDG PET were performed within 21 d of each other. NETPET scores were evaluated qualitatively by 2 reviewers, with up to 10 marker lesions selected for each patient. The quantitative parameters that were evaluated included marker lesion SUV_max for each tracer; ¹⁸F-FDG/⁶⁸Ga-DOTATATE SUV_max ratios; functional tumor volume (FTV) and metabolic tumor volume (MTV) on ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET, respectively; and FTV/MTV ratios. The treatment plan before and after ¹⁸F-FDG PET was recorded. Results: There were 22 men and 18 women (mean age, 60.8 y) with grade 2 (n = 24) or grade 3 (n = 16) tumors and a mean Ki-67 index of 16.1%. NETPET scores of P0, P1, P2A, P2B, P3B, P4B, and P5 were documented in 2 (5%), 5 (12.5%), 5 (12.5%) 20 (50%), 2 (5%), 4 (10%), and 2 (5%) patients, respectively. No association was found between the SUV_max of target lesions on ⁶⁸Ga-DOTATATE and the SUV_max of target lesions on ¹⁸F-FDG PET (P = 0.505). ¹⁸F-FDG/⁶⁸Ga-DOTATATE SUV_max ratios were significantly lower for patients with low (P1–P2) primary NETPET scores than for those with high (P3–P5) primary NETPET scores (mean ± SD, 0.20 ± 0.13 and 1.68 ± 1.44, respectively; P < 0.001). MTV on ¹⁸F-FDG PET was significantly lower for low primary NETPET scores than for high ones (mean ± SD, 464 ± 601 cm³ and 66 ± 114 cm³, respectively; P = 0.005). A change in the type of management was observed in 42.5% of patients after ¹⁸F-FDG PET, with the most common being a change from systemic therapy to peptide receptor radionuclide therapy and from debulking surgery to systemic therapy. Conclusion: There was a heterogeneous distribution of NETPET scores in patients with WD grade 2 and 3 GEP NETs, with more than 1 in 5 patients having a high NETPET score and a frequent change in management after ¹⁸F-FDG PET. Quantitative parameters including ¹⁸F-FDG/⁶⁸Ga-DOTATATE SUV_max ratios in target lesions and FTV/MTV ratios can discriminate between patients with high and low NETPET scores.

Our objective is to explore quantitative imaging markers for early prediction of treatment response in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) undergoing [¹⁷⁷Lu]Lu-DOTATATE therapy. By doing so, we aim to enable timely switching to more effective therapies in order to prevent time-resource waste and minimize toxicities. Methods: Patients diagnosed with unresectable or metastatic, progressive, well-differentiated, receptor-positive GEP-NETs who received 4 sessions of [¹⁷⁷Lu]Lu-DOTATATE were retrospectively selected. Using SPECT/CT images taken at the end of treatment sessions, we counted all visible tumors and measured their largest diameters to calculate the tumor burden score (TBS). Up to 4 target lesions were selected and semiautomatically segmented. Target lesion peak counts and spleen peak counts were measured, and normalized peak counts were calculated. Changes in TBS (TBS) and changes in normalized peak count (nPC) throughout treatment sessions in relation to the first treatment session were calculated. Treatment responses were evaluated using third-month CT and were binarized as progressive disease (PD) or non-PD. Results: Twenty-seven patients were included (7 PD, 20 non-PD). Significant differences were observed in TBS_second-first, TBS_third-first, and TBS_fourth-first (where second-first, third-first, and fourth-first denote scan number between the second and first, third and first, and fourth and first [¹⁷⁷Lu]Lu-DOTATATE treatment cycles), respectively) between the PD and non-PD groups (median, 0.043 vs. –0.049, 0.08 vs. –0.116, and 0.109 vs. –0.123 [P = 0.023, P = 0.002, and P < 0.001], respectively). nPC_second-first showed significant group differences (mean, –0.107 vs. –0.282; P = 0.033); nPC_third-first and nPC_fourth-first did not reach statistical significance (mean, –0.122 vs. –0.312 and –0.183 vs. –0.405 [P = 0.117 and 0.067], respectively). At the optimal threshold, TBS_fourth-first exhibited an area under the curve (AUC) of 0.957, achieving 100% sensitivity and 80% specificity. TBS_second-first and TBS_third-first reached AUCs of 0.793 and 0.893, sensitivities of 71.4%, and specificities of 85% and 95%, respectively. nPC_second-first, nPC_third-first, and nPC_fourth-first showed AUCs of 0.764, 0.693, and 0.679; sensitivities of 71.4%, 71.4%, and 100%; and specificities of 75%, 70%, and 35%, respectively. Conclusion: TBS and nPC can predict [¹⁷⁷Lu]Lu-DOTATATE response by the second treatment session.

Unspecific bone uptake (UBU) related to [¹⁸F]PSMA-1007 PET/CT imaging represents a clinical challenge. We aimed to assess whether a combination of clinical, biochemical, and imaging parameters could predict skeletal metastases in patients with [¹⁸F]PSMA-1007 bone focal uptake, aiding in result interpretation. Methods: We retrospectively analyzed [¹⁸F]PSMA-1007 PET/CT performed in hormone-sensitive prostate cancer (PCa) patients at 3 tertiary-level cancer centers. A fourth center was involved in performing an external validation. For each, a volume of interest was drawn using a threshold method to extract SUV_max, SUV_mean, PSMA tumor volume, and total lesion PSMA. The same volume of interest was applied to CT images to calculate the mean Hounsfield units (HU_mean) and maximum Hounsfield units. Clinical and laboratory data were collected from electronic medical records. A composite reference standard, including follow-up histopathology, biochemistry, and imaging data, was used to distinguish between PCa bone metastases and UBU. PET readers with less (n = 2) or more (n = 2) experience, masked to the reference standard, were asked to visually rate a subset of focal bone uptake (n = 178) as PCa metastases or not. Results: In total, 448 bone [¹⁸F]PSMA-1007 focal uptake specimens were identified in 267 PCa patients. Of the 448 uptake samples, 188 (41.9%) corresponded to PCa metastases. Ongoing androgen deprivation therapy at PET/CT (P < 0.001) with determination of SUV_max (P < 0.001) and HU_mean (P < 0.001) independently predicted bone metastases. A composite prediction score, the bone uptake metastatic probability (BUMP) score, achieving an area under the receiver-operating-characteristic curve (AUC) of 0.87, was validated through a 10-fold internal and external validation (n = 89 bone uptake, 51% metastatic; AUC, 0.92). The BUMP score’s AUC was significantly higher than that of HU_mean (AUC, 0.62) and remained high among lesions with HU_mean in the first tertile (AUC, 0.80). A decision-curve analysis showed a higher net benefit with the score. Compared with the visual assessment, the BUMP score provided added value in terms of specificity in less-experienced PET readers (88% vs. 54%, P < 0.001). Conclusion: The BUMP score accurately distinguished UBU from bone metastases in PCa patients with [¹⁸F]PSMA-1007 focal bone uptake at PET imaging, offering additional value compared with the simple assessment of the osteoblastic CT correlate. Its use could help clinicians interpret imaging results, particularly those with less experience, potentially reducing the risk of patient overstaging.

This analysis aimed to identify clinical factors associated with positivity on repeat ⁶⁸Ga-PSMA-11 PET/CT after a negative scan in patients with recurrent prostate cancer (PCa) under observation. Methods: This single-center, retrospective analysis included patients who underwent at least 2 ⁶⁸Ga-PSMA-11 PET/CT scans (PET1 and PET2) at UCLA between October 2016 and June 2021 for recurrent PCa with negative PET1 and no PCa-related treatments between the 2 scans. Using Prostate Cancer Molecular Imaging Standardized Evaluation criteria to define negative and positive scans, the final cohort was divided into PET2-negative (PET2-Neg) and PET2-positive (PET2-Pos). The same PET1 was used twice in the more than 2 PET cases with inclusion criteria fulfilled. Patient characteristics and clinical parameters were compared between the 2 cohorts using Mann–Whitney U test and Fisher exact test. Areas under the curve (AUCs) of the receiver operating characteristic and the Youden index were computed to determine the discrimination ability of statistically significant factors and specific cut points that maximized sensitivity and specificity, respectively. Results: The final analysis included 83 sets of 2 PET/CT scans from 70 patients. Thirty-nine of 83 (47%) sets were PET2-Neg, and 44 of 83 (53%) sets were PET2-Pos. Prostate-specific antigen (PSA) increased from PET1 to PET2 for all 83 (100%) sets of scans. Median PSA at PET1 was 0.4 ng/mL (interquartile range, 0.2–1.0) and at PET2 was 1.6 ng/mL (interquartile range, 0.9–3.8). We found higher serum PSA at PET2 (median, 1.8 vs. 1.1 ng/mL; P = 0.015), absolute PSA difference (median, 1.4 vs. 0.7 ng/mL; P = 0.006), percentage of PSA change (median, +270.4% vs. +150.0%: P = 0.031), and median PSA velocity (0.044 vs. 0.017 ng/mL/wk, P = 0.002) and shorter PSA doubling time (DT; median, 5.1 vs. 8.3 mo; P = 0.006) in the PET2-Pos cohort than in the PET2-Neg cohort. Receiver operating characteristic curves showed cutoffs for PSA at PET2 of 4.80 ng/mL (sensitivity, 34%; specificity, 92%; AUC, 0.66), absolute PSA difference of 0.95 ng/mL (sensitivity, 62%; specificity, 71%; AUC, 0.68), percentage of PSA change of a positive 289.50% (sensitivity, 48%; specificity, 82%; AUC, 0.64), PSA velocity of 0.033 ng/mL/wk (sensitivity, 57%; specificity, 80%; AUC, 0.70), and PSA DT of 7.91 mo (sensitivity, 71%; specificity, 62%; AUC, 0.67). Conclusion: Patients with recurrent PCa under observation after a negative ⁶⁸Ga-PSMA-11 PET/CT scan with markedly elevated serum PSA levels and shorter PSA DT are more likely to have positive findings on repeat ⁶⁸Ga-PSMA-11 PET/CT.

Understanding which patients with human epidermal growth factor receptor 2 (HER2)–negative or –low metastatic breast cancer (MBC) benefit from HER2-targeted strategies is urgently needed. We assessed the whole-body heterogeneity of HER2 expression on ⁸⁹Zr-trastuzumab PET (HER2 PET) and the diagnostic performance of HER2 PET in a large series of patients, including HER2-negative and -low MBC. Methods: In the IMPACT-MBC study, patients with newly diagnosed and nonrapidly progressive MBC of all subtypes were included. Metastasis HER2 status was determined by immunohistochemistry and in situ hybridization.⁸⁹Zr-trastuzumab uptake was quantified as SUV_max and SUV_mean. HER2 immunohistochemistry was related to the quantitative ⁸⁹Zr-trastuzumab uptake of all metastases and corresponding biopsied metastasis, uptake heterogeneity, and qualitative scan evaluation. A prediction algorithm for HER2 immunohistochemistry positivity based on uptake was developed. Results: In 200 patients, ⁸⁹Zr-trastuzumab uptake was quantified in 5,163 metastases, including 186 biopsied metastases. With increasing HER2 immunohistochemistry status, uptake was higher (geometric mean SUV_max of 7.0, 7.6, 7.3, and 17.4 for a HER2 immunohistochemistry score of 0, 1, 2, or 3+, respectively; P < 0.001). High uptake exceeding 14.6 (90th percentile) was observed in one third of patients with a HER2-negative or -low metastasis biopsy. The algorithm performed best when lesion site and size were incorporated (area under the curve, 0.86; 95% CI, 0.79–0.93). Conclusion: HER2 PET had good diagnostic performance in MBC, showing considerable whole-body HER2 heterogeneity and uptake above background in HER2-negative and -low MBC. This provides novel insights into HER2-negative and -low MBC compared with standard HER2 immunohistochemistry on a single biopsy.