C/Can City Engagement Process: An Implementation Framework for Strengthening Cancer Care in Cities in Low- and Middle-Income Countries.

The effective implementation of locally adapted cancer care solutions in low- and middle-income countries continues to be a challenge in the face of fragmented and inadequately resourced health systems. Consequently, the translation of global cancer care targets to local action for patients has been severely constrained. City Cancer Challenge (C/Can) is leveraging the unique value of cities as enablers in a health systems response to cancer that prioritizes the needs of end users (patients, their caregivers and families, and health care providers). C/Can's City Engagement Process is an implementation framework whereby local stakeholders lead a staged city-wide process over a 2- to 3-year period to assess, plan, and execute locally adapted cancer care solutions. Herein, the development and implementation of the City Engagement Process Framework (CEPF) is presented, specifying the activities, outputs, processes, and indicators across the process life cycle. Lessons learned on the application of the framework in the first so-called Key Learning cities are shared, focusing on the early outputs from Cali, Colombia, the first city to join C/Can in 2017. Creating lasting change requires the creation of a high-trust environment to engage the right stakeholders as well as adapting to local context, leveraging local expertise, and fostering a sustainability mindset from the outset. In the short term, these early learnings inform the refinement of the approach in new cities. Over time, the implementation of this framework is expected to validate the proof-of-concept and contribute to a global evidence base for effective complex interventions to improve cancer care in low- and middle-income countries.

Strengthening Pathology Capacity to Deliver Quality Cancer Care in Cities in LMICs.

Diagnostic pathology services for oncology health systems are essential; yet, surveys, observations, and hard data from across low- and middle-income countries have revealed that these services are almost always lacking adequate quality and often missing completely. The City Cancer Challenge Foundation (C/Can), the American Society for Clinical Pathology, and C/Can partner cities undertook intense analysis of their existing pathology services as part of a year-long assessment process including the specific formation of a pathology-focused team. Internal and external expert assessments identified sustainable solutions adapted to the local context and level of resources and created specific local implementation projects. Through local leadership, capacity development, and collaboration, services were improved city-wide in three cities: Cali, Colombia; Asunción, Paraguay; and Yangon, Myanmar. Common problems identified across cities included deficiencies in personnel training, equipment, reagents, processes, quality, and coordination. Specific solutions included quality training, standard process development and regulation, implementation of new services, and public-private collaboration. As the first cities joining the C/Can initiative, Cali, Asunción, and Yangon demonstrate the success of the approach and the value of local expertise in identifying problems and solutions. The additional value of international partners' expertise created opportunities for growth through mentorship and technical support. Importantly, the power of healthcare programs with strong political support is emphasized.

Chia (Salvia hispanica) experiment at a 30˚ N site in Sichuan Basin, China / Performance agronômica da chia (Salvia hispanica) cultivada aos 30˚ N na Bacia de Sichuan, China

ABSTRACT: The mysterious ancient Mesoamerican Indian crop chia (Salvia hispanica) is revived and expanding worldwide due to its richness of valuable nutraceuticals such as α-linolenic acid (ALA), antioxidants, food fiber, gels, and proteins. We carried out a pilot experiment on chia planting in non-frost Sichuan Basin, at Hechuan Base (30˚0′ 43″ N, 106˚7′ 41″ E, 216 m), Southwest University, Chongqing, China. The split-plot trial contained two factors, 3 spring-summer sowing times as main plots, and 6 densities as subplots, with 3 replicates. Phenological, botanical, adversity, yield, and seed quality traits were investigated. Plants were very tall, suffered from lodging, and flowered in mid-October. Sichuan Basin can be considered as a north edge for growing chia, with low yield (680 kg/hectare) because of insufficient seed filling and maturation in autumn-winter season (1000-seed weight of 1.14 g). However, its ALA content is 5 percent points higher than the seed-donor commercial bottle (65.06%/63.96% VS 59.35%/59.74% for black/white seeds), accompanied by decrease oleic and stearic acid, while linoleic acid and palmitic acid are equivalent. Considering its short-day habit, it is recommended to try sowing in middle summer (from late June to early August) to avoid too long growing period, excessive vegetative growth, and waste of field and climate resources caused by spring-summer sowing. Furthermore, winter sowing of chia with mulch cover could also be tried, with an expectation of harvesting in summer. Most importantly, only when the photoperiod-insensitive early flowering stocks are created, chia can be recommended as a low-risk crop to the farmers of this region.

RESUMO: A chia (Salvia hispanica) é cultivada em todo o mundo por sua riqueza de nutrientes nutracêuticos valiosos, tais como a-ácido linolênico (ALA), antioxidantes, fibras alimentares, géis e proteínas. Entretanto, não há informações sobre sua performance agronômica se cultivada aos 30˚N na China. Assim, realizou-se um experimento com o cultivo de chia na base Hechuan (30°0'43"N, 106°7'41"E, 216m, que não apresenta geada) da Southwest University, Chongqing, China. O delineamento em parcela subdividida contém dois fatores,três épocas de semeadura na primavera-verão como parcelas principais e seis densidades de sementes como subparcelas, com três repetições. Foram investigados os caracteres fenológicos, botânicos, de adversidade, rendimento e qualidade da semente. As plantas se tornaram altas, acamarame floresceram em meados de outubro. A bacia de Sichuan pode ser considerada como uma fronteira limítrofe norte para o crescimento da chia, com baixo rendimento (680kg ha-1) devido ao enchimento e amadurecimento insuficientes na estação outono-inverno (peso de 1000 sementes de 1,14g). No entanto, o seu conteúdo de ALA é de 5 pontos percentuais mais elevado do que a semente comercial, 65,06%/63,96% contra 59,35%/59,74% para as sementes pretas/brancas, respectivamente, acompanhado por diminuição de ácido oleico e ácido esteárico, enquanto que o ácido linoleico e o ácido palmítico são equivalentes. Considerando o seu hábito de dia curto, recomenda-se semear no meio do verão,de junho a início de agosto, para evitar um tempo de cultivo muito longo, desenvolvimento vegetativo excessivo e desperdício de recursos de campo e clima causados pela semeadura de primavera-verão. Além disso, a semeadura de inverno da chia com cobertura morta também poderia ser realizada, com expectativa de colheita no verão. Mais importante ainda, somente quando os estoques de floração precoce insensíveis ao fotoperíodo são criados, pode-se recomendar como uma cultura de baixo risco para os agricultores desta região.

Chia (Salvia hispanica) experiment at a 30 N site in Sichuan Basin, China

ABSTRACT: The mysterious ancient Mesoamerican Indian crop chia (Salvia hispanica) is revived and expanding worldwide due to its richness of valuable nutraceuticals such as -linolenic acid (ALA), antioxidants, food fiber, gels, and proteins. We carried out a pilot experiment on chia planting in non-frost Sichuan Basin, at Hechuan Base (300 43 N, 1067 41 E, 216 m), Southwest University, Chongqing, China. The split-plot trial contained two factors, 3 spring-summer sowing times as main plots, and 6 densities as subplots, with 3 replicates. Phenological, botanical, adversity, yield, and seed quality traits were investigated. Plants were very tall, suffered from lodging, and flowered in mid-October. Sichuan Basin can be considered as a north edge for growing chia, with low yield (680 kg/hectare) because of insufficient seed filling and maturation in autumn-winter season (1000-seed weight of 1.14 g). However, its ALA content is 5 percent points higher than the seed-donor commercial bottle (65.06%/63.96% VS 59.35%/59.74% for black/white seeds), accompanied by decrease oleic and stearic acid, while linoleic acid and palmitic acid are equivalent. Considering its short-day habit, it is recommended to try sowing in middle summer (from late June to early August) to avoid too long growing period, excessive vegetative growth, and waste of field and climate resources caused by spring-summer sowing. Furthermore, winter sowing of chia with mulch cover could also be tried, with an expectation of harvesting in summer. Most importantly, only when the photoperiod-insensitive early flowering stocks are created, chia can be recommended as a low-risk crop to the farmers of this region.

RESUMO: A chia (Salvia hispanica) é cultivada em todo o mundo por sua riqueza de nutrientes nutracêuticos valiosos, tais como a-ácido linolênico (ALA), antioxidantes, fibras alimentares, géis e proteínas. Entretanto, não há informações sobre sua performance agronômica se cultivada aos 30N na China. Assim, realizou-se um experimento com o cultivo de chia na base Hechuan (30°043N, 106°741E, 216m, que não apresenta geada) da Southwest University, Chongqing, China. O delineamento em parcela subdividida contém dois fatores,três épocas de semeadura na primavera-verão como parcelas principais e seis densidades de sementes como subparcelas, com três repetições. Foram investigados os caracteres fenológicos, botânicos, de adversidade, rendimento e qualidade da semente. As plantas se tornaram altas, acamarame floresceram em meados de outubro. A bacia de Sichuan pode ser considerada como uma fronteira limítrofe norte para o crescimento da chia, com baixo rendimento (680kg ha-1) devido ao enchimento e amadurecimento insuficientes na estação outono-inverno (peso de 1000 sementes de 1,14g). No entanto, o seu conteúdo de ALA é de 5 pontos percentuais mais elevado do que a semente comercial, 65,06%/63,96% contra 59,35%/59,74% para as sementes pretas/brancas, respectivamente, acompanhado por diminuição de ácido oleico e ácido esteárico, enquanto que o ácido linoleico e o ácido palmítico são equivalentes. Considerando o seu hábito de dia curto, recomenda-se semear no meio do verão,de junho a início de agosto, para evitar um tempo de cultivo muito longo, desenvolvimento vegetativo excessivo e desperdício de recursos de campo e clima causados pela semeadura de primavera-verão. Além disso, a semeadura de inverno da chia com cobertura morta também poderia ser realizada, com expectativa de colheita no verão. Mais importante ainda, somente quando os estoques de floração precoce insensíveis ao fotoperíodo são criados, pode-se recomendar como uma cultura de baixo risco para os agricultores desta região.

Chia (Salvia hispanica) experiment at a 30 ̊ N site in Sichuan Basin, China / Performance agronômica da chia (Salvia hispanica) cultivada aos 30 ̊ N na Bacia de Sichuan, China

The mysterious ancient Mesoamerican Indian crop chia (Salvia hispanica) is revived and expanding worldwide due to its richness of valuable nutraceuticals such as α-linolenic acid (ALA), antioxidants, food fiber, gels, and proteins. We carried out a pilot experiment on chia planting in non-frost Sichuan Basin, at Hechuan Base (30 ̊0′ 43′′ N, 106 ̊7′ 41′′ E, 216 m), Southwest University, Chongqing, China. The split-plot trial contained two factors, 3 spring-summer sowing times as main plots, and 6 densities as subplots, with 3 replicates. Phenological, botanical, adversity, yield, and seed quality traits were investigated. Plants were very tall, suffered from lodging, and flowered in mid-October. Sichuan Basin can be considered as a north edge for growing chia, with low yield (680 kg/hectare) because of insufficient seed filling and maturation in autumn-winter season (1000-seed weight of 1.14 g). However, its ALA content is 5 percent points higher than the seed-donor commercial bottle (65.06%/63.96% VS 59.35%/59.74% for black/white seeds), accompanied by decrease oleic and stearic acid, while linoleic acid and palmitic acid are equivalent. Considering its short-day habit, it is recommended to try sowing in middle summer (from late June to early August) to avoid too long growing period, excessive vegetative growth, and waste of field and climate resources caused by spring-summer sowing. Furthermore, winter sowing of chia with mulch cover could also be tried, with an expectation of harvesting in summer. Most importantly, only when the photoperiod-insensitive early flowering stocks are created, chia can be recommended as a low-risk crop to the farmers of this region.(AU)

A chia (Salvia hispanica) é cultivada em todo o mundo por sua riqueza de nutrientes nutracêuticos valiosos, tais como a-ácido linolênico (ALA), antioxidantes, fibras alimentares, géis e proteínas. Entretanto, não há informações sobre sua performance agronômica se cultivada aos 30 ̊N na China. Assim, realizou-se um experimento com o cultivo de chia na base Hechuan (30°043”N, 106°741”E, 216m, que não apresenta geada) da Southwest University, Chongqing, China. O delineamento em parcela subdividida contém dois fatores,três épocas de semeadura na primavera-verão como parcelas principais e seis densidades de sementes como subparcelas, com três repetições. Foram investigados os caracteres fenológicos, botânicos, de adversidade, rendimento e qualidade da semente. As plantas se tornaram altas, acamarame floresceram em meados de outubro. A bacia de Sichuan pode ser considerada como uma fronteira limítrofe norte para o crescimento da chia, com baixo rendimento (680kg ha-1) devido ao enchimento e amadurecimento insuficientes na estação outono-inverno (peso de 1000 sementes de 1,14g). No entanto, o seu conteúdo de ALA é de 5 pontos percentuais mais elevado do que a semente comercial, 65,06%/63,96% contra 59,35%/59,74% para as sementes pretas/brancas, respectivamente, acompanhado por diminuição de ácido oleico e ácido esteárico, enquanto que o ácido linoleico e o ácido palmítico são equivalentes. Considerando o seu hábito de dia curto, recomenda-se semear no meio do verão,de junho a início de agosto, para evitar um tempo de cultivo muito longo, desenvolvimento vegetativo excessivo e desperdício de recursos de campo e clima causados pela semeadura de primavera-verão.(AU)