You only need the English Proficient for international operations as it's an ICAO thing. Some countries, like France, check; others may not. Similar on the RRTO -- some countries, like Canada and the Bahamas don't require it, but others, like Turks & Caicos, do require it and do check it.
Apoptosis: A form of cell death in which a programmed sequence of events leads to the elimination of cells without releasing harmful substances into the surrounding area. Apoptosis plays a crucial role in developing and maintaining the health of the body by eliminating old cells, unnecessary cells, and unhealthy cells.
Moreover, they don't do it only when things go wrong! The apoptosis mechanism is a normal and creative aspect of multicellular life. Orchestrated apoptosis helps the growing embryo to sculpt many aspects of its final form. Every year the average human loses half of his/her body weight in cells via apoptosis!