Current landscape of ESMO/ASCO Global Curriculum adoption and medical oncology recognition: a global survey.

BACKGROUND: With the implementation of multidisciplinary treatment and development of multiple novel anticancer drugs in parallel with expanding knowledge of supportive and palliative care, a need for separate training and specialisation in medical oncology emerged. A Global Curriculum (GC) in medical oncology, developed and updated by a joint European Society for Medical Oncology/American Society of Clinical Oncology (ESMO/ASCO) GC Task Force/Working Group (GC WG), greatly contributed to the recognition of medical oncology worldwide. MATERIAL AND METHODS: ESMO/ASCO GC WG carried out a global survey on medical oncology recognition and GC adoption in 2019. RESULTS: Based on our survey, medical oncology is recognised as a separate specialty or sub-specialty in 47/62 (75%) countries participating in the survey; with a great majority of them (39/47, 83%) recognising medical oncology as a standalone specialty. Additionally, in 9 of 62 (15%) countries, medical oncology is trained together with haematology as a specialty in haemato-oncology or together with radiotherapy as a specialty in clinical oncology. As many as two-thirds of the responding countries reported that the ESMO/ASCO GC has been either fully or partially adopted or adapted in their curriculum. It has been adopted in a vast majority of countries with established training in medical oncology (28/41; 68%) and adapted in 12 countries with mixed training in haemato-oncology, clinical oncology or other specialty responsible for training on systemic anticancer treatment. CONCLUSIONS: With 75% of participating countries reporting medical oncology as a separate specialty or sub-specialty and as high as 68% of them reporting on GC adoption, the results of our survey on global landscape are reassuring. Despite a lack of data for some regions, this survey represents the most comprehensive and up-to-date information about recognition of medical oncology and GC adoption worldwide and will allow both societies to further improve the dissemination of the GC and global recognition of medical oncology, thus contributing to better cancer care worldwide.

Collaborations in gynecologic oncology education and research in low- and middle- income countries: Current status, barriers and opportunities.

Eighty-five percent of the incidents and deaths from cervical cancer occur in low and middle income countries. In many of these countries, this is the most common cancer in women. The survivals of the women with gynecologic cancers are hampered by the paucity of prevention, screening, treatment facilities and gynecologic oncology providers. Increasing efforts dedicated to improving education and research in these countries have been provided by international organizations. We describe here the existing educational and research programs that are offered by major international organizations, the barriers and opportunities provided by these collaborations and hope to improve the outcomes of cervical cancer through these efforts.

Recovery of lactoferrin and lactoperoxidase from sweet whey using colloidal gas aphrons (CGAs) generated from an anionic surfactant, AOT.

The recovery of lactoferrin and lactoperoxidase from sweet whey was studied using colloidal gas aphrons (CGAs), which are surfactant-stabilized microbubbles (10-100 microm). CGAs are generated by intense stirring (8000 rpm for 10 min) of the anionic surfactant AOT (sodium bis-2-ethylhexyl sulfosuccinate). A volume of CGAs (10-30 mL) is mixed with a given volume of whey (1-10 mL), and the mixture is allowed to separate into two phases: the aphron (top) phase and the liquid (bottom) phase. Each of the phases is analyzed by SDS-PAGE and surfactant colorimetric assay. A statistical experimental design has been developed to assess the effect of different process parameters including pH, ionic strength, the concentration of surfactant in the CGAs generating solution, the volume of CGAs and the volume of whey on separation efficiency. As expected pH, ionic strength and the volume of whey (i.e. the amount of total protein in the starting material) are the main factors influencing the partitioning of the Lf.Lp fraction into the aphron phase. Moreover, it has been demonstrated that best separation performance was achieved at pH = 4 and ionic strength = 0.1 mol/L i.e., with conditions favoring electrostatic interactions between target proteins and CGAs (recovery was 90% and the concentration of lactoferrin and lactoperoxidase in the aphron phase was 25 times higher than that in the liquid phase), whereas conditions favoring hydrophobic interactions (pH close to pI and high ionic strength) led to lower performance. However, under these conditions, as confirmed by zeta potential measurements, the adsorption of both target proteins and contaminant proteins is favored. Thus, low selectivity is achieved at all of the studied conditions. These results confirm the initial hypothesis that CGAs act as ion exchangers and that the selectivity of the process can be manipulated by changing main operating parameters such as type of surfactant, pH and ionic strength.

Time sequence of the inhibition of endothelial adhesion molecule expression by reconstituted high density lipoproteins.

We have used discoidal reconstituted high density lipoproteins (rHDL) containing apolipoprotein (apo) A-I and dimyristoyl phosphatidylcholine (DMPC) as a tool to investigate the time sequence of the HDL-mediated inhibition of vascular cell adhesion molecule (VCAM)-1 and E-selectin expression in cytokine-activated human umbilical vein endothelial cells (HUVECs). Specifically, we have asked a few questions - (i) how long do the cells need to be exposed to the rHDL before adhesion molecule expression is inhibited and (ii) how long does the inhibition persist after removing the rHDL from the cells. When the cells were not pre-incubated with the rHDL, there was no inhibition. The magnitude of the inhibition increased progressively with increasing duration of pre-incubation up to 16 h. Inhibition did not require the rHDL to be physically present during the activation of adhesion molecule expression by tumour necrosis factor(TNF)-alpha, excluding the possibility that the rHDL was merely interfering with the interaction between TNF-alpha and the cells. When HUVECs were pre-incubated for 16 h with rHDL, the inhibition remained substantial even if the rHDL were removed from the medium up to 8 h prior to addition of TNF-alpha. The HDL-mediated inhibition of VCAM-1 in HUVECs was unaffected by the presence of puromycin, an inhibitor of protein synthesis, excluding the possibility that HDL may have acted by stimulating the synthesis of a cell protein that itself inhibits adhesion molecule expression. These results have important implications in terms of understanding the mechanism(s) of the HDL-mediated inhibition of endothelial adhesion molecule expression.

Combined effect of operational variables and enzyme activity on aqueous enzymatic extraction of oil and protein from soybean.

The individual effect of two different enzymes-protease and cellulase-on oil and protein extraction yields combined with other process parameters-enzyme concentration, time of hydrolysis, particle size and solid-to-liquid ratio-was evaluated by Response Surface Methodology. The selection of the enzymes for the study was based on preliminary experiments that showed higher increments in the extraction yield with the use of the two enzymes when compared to hemicellulase and pectinase. The levels of the quantitative parameters studied were: i) enzyme concentration: 0.1, 0.45, 2 w/w %; ii) liquid-to-solid ratio: 0.05, 0.125, 0.2; iii) mean particle size: 212.5, 449.5, 855 µm; iv) time of hydrolysis: 30; 60; 120 min. Experimental data for both oil and protein extraction yields obtained with and without enzymes correlated very well with process parameters (P < 0.0001), resulting in models with high coefficient of determination for oil and protein extraction yields (r(2) = 0.9570 and r(2) = 0.9807, respectively). The use of protease resulted in significantly higher yields over the control (protein yield increased from 27.8 to 66.2%, oil yield increased from 41.8 to 58.7%) only when heat treated flour was used, or when non-heat treated flour with large particle sizes was used in the extraction. The yields of protein and oil from non-heat treated material in general decreased slightly with the use of enzymes.

Nutrition interventions: problems associated with expanding pilot/demonstration projects into national-level programs.

PIP: It is necessary to determine what makes the small-scale nutrition projects successful and what are the constraints precluding effective implementation of project-developed interventions on a large scale. Research in the Western Indian state of Maharashtra suggests that a process can be identified and isolated which helps explain how small-scale projects achieve their impact. During the 1970s, 7 community-based projects operated within Maharashtra delivering an integrated package of nutrition and health services. 6 of these were voluntary agency managed, and all but 1 was operated exclusively by the government. All 7 were similar in that they recruited, trained and utilized villagers as outreach workers. The services delivered differed from project to project but generally included nutrition, primary health care, and some fertility control services. Several projects were able to demonstrate impressive impact. The percentage of eligible couples practicing contraception was particularly impressive. After studying each project and identifying those factors responsible for impact, it is possible to construct a composite or "ideal type" project from the joint experience. The primarily management-related features provide a standard to which the implementation process of the expanded program can be compared. The underlying orientation of a project or program can help to explain how results are achieved. The 2nd factor was good staff morale. The Maharashtra projects held both staff and community accountable for their actions. The 4th and 5th factors were flexibility and community participation. In 1977 the new Janata Government launched the Community Health Worker Program (CHWP). This provided an opportunity to study what happens in the process of project expansion and why. 3 perspectives or sets of conceptual lenses were necessary to identify and analyze problems arising in the expansion of the project-developed intervention: rational actor analysis; organizational analysis; and political analysis. These are reviewed. Policy makers and program designers need to be aware of the constraints facing them when expanding a project-developed intervention. Thus far the technical, scientific, and economic aspects have taken precedence over the human elements. This time has come to focus more on the process or what makes an intervention effective.^ieng